|
Rapid Strep POC (Clinics.)
|
Facility
|
OP
|
$191.00
|
|
|
Service Code
|
CPT 87880
|
| Hospital Charge Code |
3991999
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.19 |
| Max. Negotiated Rate |
$182.75 |
| Rate for Payer: Aetna Commercial |
$178.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$170.83
|
| Rate for Payer: Aetna Managed Medicare |
$17.19
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$64.47
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$30.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$28.54
|
| Rate for Payer: Anthem Medicare Advantage |
$17.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$105.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$17.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$17.19
|
| Rate for Payer: Cash Price |
$57.30
|
| Rate for Payer: Cash Price |
$57.30
|
| Rate for Payer: Cigna Commercial |
$182.75
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$17.19
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$111.16
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$17.19
|
| Rate for Payer: Health EOS Commercial |
$176.79
|
| Rate for Payer: HFN Commercial |
$182.75
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$63.95
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$17.19
|
| Rate for Payer: Independent Care Health Plan Medicare |
$17.19
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$17.19
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$17.19
|
| Rate for Payer: Multiplan Commercial |
$158.91
|
| Rate for Payer: NAPHCARE Commercial |
$25.79
|
| Rate for Payer: Preferred Network Access Commercial |
$182.75
|
| Rate for Payer: Quartz Beloit One Network |
$97.33
|
| Rate for Payer: Quartz Commercial |
$129.12
|
| Rate for Payer: Quartz Medicare Advantage |
$17.19
|
| Rate for Payer: The Alliance Commercial |
$68.76
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17.19
|
| Rate for Payer: United Healthcare PPO |
$148.98
|
| Rate for Payer: WEA Trust Commercial |
$109.25
|
| Rate for Payer: Wellcare Medicare |
$17.19
|
| Rate for Payer: WPS Commercial |
$147.13
|
|
|
Rapid Strep POC (Clinics.)
|
Professional
|
Both
|
$191.00
|
|
|
Service Code
|
CPT 87880
|
| Hospital Charge Code |
3991999
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.19 |
| Max. Negotiated Rate |
$188.71 |
| Rate for Payer: Aetna Commercial |
$188.71
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$170.83
|
| Rate for Payer: Aetna Managed Medicare |
$17.19
|
| Rate for Payer: Anthem Medicare Advantage |
$17.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$17.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$17.19
|
| Rate for Payer: Cash Price |
$57.30
|
| Rate for Payer: Cash Price |
$57.30
|
| Rate for Payer: Cigna Commercial |
$188.71
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$99.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$17.19
|
| Rate for Payer: Health EOS Commercial |
$180.76
|
| Rate for Payer: HFN Commercial |
$188.71
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$60.68
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$60.68
|
| Rate for Payer: Independent Care Health Plan Medicare |
$17.19
|
| Rate for Payer: Multiplan Commercial |
$158.91
|
| Rate for Payer: NAPHCARE Commercial |
$25.79
|
| Rate for Payer: Preferred Network Access Commercial |
$188.71
|
| Rate for Payer: Quartz Beloit One Network |
$87.40
|
| Rate for Payer: Quartz Commercial |
$113.22
|
| Rate for Payer: Quartz Medicare Advantage |
$17.19
|
| Rate for Payer: The Alliance Commercial |
$67.91
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17.19
|
| Rate for Payer: WEA Trust Commercial |
$109.25
|
| Rate for Payer: WPS Commercial |
$75.64
|
|
|
Rapid Strep POC (Clinics.)
|
Facility
|
IP
|
$191.00
|
|
|
Service Code
|
CPT 87880
|
| Hospital Charge Code |
3991999
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$97.33 |
| Max. Negotiated Rate |
$182.75 |
| Rate for Payer: Aetna Commercial |
$178.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$170.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$105.28
|
| Rate for Payer: Cash Price |
$57.30
|
| Rate for Payer: Cigna Commercial |
$182.75
|
| Rate for Payer: Health EOS Commercial |
$176.79
|
| Rate for Payer: HFN Commercial |
$182.75
|
| Rate for Payer: Multiplan Commercial |
$158.91
|
| Rate for Payer: Preferred Network Access Commercial |
$182.75
|
| Rate for Payer: Quartz Beloit One Network |
$97.33
|
| Rate for Payer: Quartz Commercial |
$119.18
|
| Rate for Payer: WEA Trust Commercial |
$109.25
|
| Rate for Payer: WPS Commercial |
$147.13
|
|
|
Rapid Yeast ID
|
Facility
|
IP
|
$151.00
|
|
|
Service Code
|
CPT 87106
|
| Hospital Charge Code |
1942804
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$76.95 |
| Max. Negotiated Rate |
$144.48 |
| Rate for Payer: Aetna Commercial |
$141.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$135.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$83.23
|
| Rate for Payer: Cash Price |
$45.30
|
| Rate for Payer: Cigna Commercial |
$144.48
|
| Rate for Payer: Health EOS Commercial |
$139.77
|
| Rate for Payer: HFN Commercial |
$144.48
|
| Rate for Payer: Multiplan Commercial |
$125.63
|
| Rate for Payer: Preferred Network Access Commercial |
$144.48
|
| Rate for Payer: Quartz Beloit One Network |
$76.95
|
| Rate for Payer: Quartz Commercial |
$94.22
|
| Rate for Payer: WEA Trust Commercial |
$86.37
|
| Rate for Payer: WPS Commercial |
$116.32
|
|
|
Rapid Yeast ID
|
Professional
|
Both
|
$151.00
|
|
|
Service Code
|
CPT 87106
|
| Hospital Charge Code |
1942804
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.73 |
| Max. Negotiated Rate |
$149.19 |
| Rate for Payer: Aetna Commercial |
$149.19
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$135.05
|
| Rate for Payer: Aetna Managed Medicare |
$10.73
|
| Rate for Payer: Anthem Medicare Advantage |
$10.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$10.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$10.73
|
| Rate for Payer: Cash Price |
$45.30
|
| Rate for Payer: Cash Price |
$45.30
|
| Rate for Payer: Cigna Commercial |
$149.19
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$78.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$10.73
|
| Rate for Payer: Health EOS Commercial |
$142.91
|
| Rate for Payer: HFN Commercial |
$149.19
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$37.89
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$37.89
|
| Rate for Payer: Independent Care Health Plan Medicare |
$10.73
|
| Rate for Payer: Multiplan Commercial |
$125.63
|
| Rate for Payer: NAPHCARE Commercial |
$16.10
|
| Rate for Payer: Preferred Network Access Commercial |
$149.19
|
| Rate for Payer: Quartz Beloit One Network |
$69.10
|
| Rate for Payer: Quartz Commercial |
$89.51
|
| Rate for Payer: Quartz Medicare Advantage |
$10.73
|
| Rate for Payer: The Alliance Commercial |
$42.39
|
| Rate for Payer: United Healthcare Medicare Advantage |
$10.73
|
| Rate for Payer: WEA Trust Commercial |
$86.37
|
| Rate for Payer: WPS Commercial |
$47.22
|
|
|
Rapid Yeast ID
|
Facility
|
OP
|
$151.00
|
|
|
Service Code
|
CPT 87106
|
| Hospital Charge Code |
1942804
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.73 |
| Max. Negotiated Rate |
$144.48 |
| Rate for Payer: Aetna Commercial |
$141.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$135.05
|
| Rate for Payer: Aetna Managed Medicare |
$10.73
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$40.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$18.78
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$17.82
|
| Rate for Payer: Anthem Medicare Advantage |
$10.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$83.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$10.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$10.73
|
| Rate for Payer: Cash Price |
$45.30
|
| Rate for Payer: Cash Price |
$45.30
|
| Rate for Payer: Cigna Commercial |
$144.48
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$10.73
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$87.88
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$10.73
|
| Rate for Payer: Health EOS Commercial |
$139.77
|
| Rate for Payer: HFN Commercial |
$144.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$39.93
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$10.73
|
| Rate for Payer: Independent Care Health Plan Medicare |
$10.73
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$10.73
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$10.73
|
| Rate for Payer: Multiplan Commercial |
$125.63
|
| Rate for Payer: NAPHCARE Commercial |
$16.10
|
| Rate for Payer: Preferred Network Access Commercial |
$144.48
|
| Rate for Payer: Quartz Beloit One Network |
$76.95
|
| Rate for Payer: Quartz Commercial |
$102.08
|
| Rate for Payer: Quartz Medicare Advantage |
$10.73
|
| Rate for Payer: The Alliance Commercial |
$42.93
|
| Rate for Payer: United Healthcare Medicare Advantage |
$10.73
|
| Rate for Payer: United Healthcare PPO |
$117.78
|
| Rate for Payer: WEA Trust Commercial |
$86.37
|
| Rate for Payer: Wellcare Medicare |
$10.73
|
| Rate for Payer: WPS Commercial |
$116.32
|
|
|
RAPTOR GRASPING DEVICE BX00711177
|
Facility
|
IP
|
$2,078.00
|
|
| Hospital Charge Code |
3065506
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,058.95 |
| Max. Negotiated Rate |
$1,988.23 |
| Rate for Payer: Aetna Commercial |
$1,945.01
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,858.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,145.39
|
| Rate for Payer: Cash Price |
$623.40
|
| Rate for Payer: Cigna Commercial |
$1,988.23
|
| Rate for Payer: Health EOS Commercial |
$1,923.40
|
| Rate for Payer: HFN Commercial |
$1,988.23
|
| Rate for Payer: Multiplan Commercial |
$1,728.90
|
| Rate for Payer: Preferred Network Access Commercial |
$1,988.23
|
| Rate for Payer: Quartz Beloit One Network |
$1,058.95
|
| Rate for Payer: Quartz Commercial |
$1,296.67
|
| Rate for Payer: WEA Trust Commercial |
$1,188.62
|
| Rate for Payer: WPS Commercial |
$1,600.68
|
|
|
RAPTOR GRASPING DEVICE BX00711177
|
Facility
|
OP
|
$2,078.00
|
|
| Hospital Charge Code |
3065506
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$605.11 |
| Max. Negotiated Rate |
$1,988.23 |
| Rate for Payer: Aetna Commercial |
$1,945.01
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,858.56
|
| Rate for Payer: Aetna Managed Medicare |
$605.11
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,404.73
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,080.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,037.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,145.39
|
| Rate for Payer: Cash Price |
$623.40
|
| Rate for Payer: Cigna Commercial |
$1,988.23
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,209.40
|
| Rate for Payer: Health EOS Commercial |
$1,923.40
|
| Rate for Payer: HFN Commercial |
$1,988.23
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,620.84
|
| Rate for Payer: Multiplan Commercial |
$1,728.90
|
| Rate for Payer: NAPHCARE Commercial |
$1,296.67
|
| Rate for Payer: Preferred Network Access Commercial |
$1,988.23
|
| Rate for Payer: Quartz Beloit One Network |
$1,058.95
|
| Rate for Payer: Quartz Commercial |
$1,404.73
|
| Rate for Payer: Quartz Medicare Advantage |
$1,296.67
|
| Rate for Payer: The Alliance Commercial |
$1,080.56
|
| Rate for Payer: WEA Trust Commercial |
$1,188.62
|
| Rate for Payer: WPS Commercial |
$1,600.68
|
|
|
RAZOR PERSONNA ASR TWIN BLADE
|
Facility
|
IP
|
$87.00
|
|
| Hospital Charge Code |
2963919
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$44.34 |
| Max. Negotiated Rate |
$83.24 |
| Rate for Payer: Aetna Commercial |
$81.43
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$77.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$47.95
|
| Rate for Payer: Cash Price |
$26.10
|
| Rate for Payer: Cigna Commercial |
$83.24
|
| Rate for Payer: Health EOS Commercial |
$80.53
|
| Rate for Payer: HFN Commercial |
$83.24
|
| Rate for Payer: Multiplan Commercial |
$72.38
|
| Rate for Payer: Preferred Network Access Commercial |
$83.24
|
| Rate for Payer: Quartz Beloit One Network |
$44.34
|
| Rate for Payer: Quartz Commercial |
$54.29
|
| Rate for Payer: WEA Trust Commercial |
$49.76
|
| Rate for Payer: WPS Commercial |
$67.02
|
|
|
RAZOR PERSONNA ASR TWIN BLADE
|
Facility
|
OP
|
$87.00
|
|
| Hospital Charge Code |
2963919
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$25.33 |
| Max. Negotiated Rate |
$83.24 |
| Rate for Payer: Aetna Commercial |
$81.43
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$77.81
|
| Rate for Payer: Aetna Managed Medicare |
$25.33
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$58.81
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$45.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$43.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$47.95
|
| Rate for Payer: Cash Price |
$26.10
|
| Rate for Payer: Cigna Commercial |
$83.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$50.63
|
| Rate for Payer: Health EOS Commercial |
$80.53
|
| Rate for Payer: HFN Commercial |
$83.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$67.86
|
| Rate for Payer: Multiplan Commercial |
$72.38
|
| Rate for Payer: NAPHCARE Commercial |
$54.29
|
| Rate for Payer: Preferred Network Access Commercial |
$83.24
|
| Rate for Payer: Quartz Beloit One Network |
$44.34
|
| Rate for Payer: Quartz Commercial |
$58.81
|
| Rate for Payer: Quartz Medicare Advantage |
$54.29
|
| Rate for Payer: The Alliance Commercial |
$45.24
|
| Rate for Payer: WEA Trust Commercial |
$49.76
|
| Rate for Payer: WPS Commercial |
$67.02
|
|
|
RBC 500 Irr
|
Facility
|
IP
|
$615.00
|
|
|
Service Code
|
HCPCS P9021
|
| Hospital Charge Code |
1052809
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$313.40 |
| Max. Negotiated Rate |
$588.43 |
| Rate for Payer: Aetna Commercial |
$575.64
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$550.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$338.99
|
| Rate for Payer: Cash Price |
$184.50
|
| Rate for Payer: Cigna Commercial |
$588.43
|
| Rate for Payer: Health EOS Commercial |
$569.24
|
| Rate for Payer: HFN Commercial |
$588.43
|
| Rate for Payer: Multiplan Commercial |
$511.68
|
| Rate for Payer: Preferred Network Access Commercial |
$588.43
|
| Rate for Payer: Quartz Beloit One Network |
$313.40
|
| Rate for Payer: Quartz Commercial |
$383.76
|
| Rate for Payer: WEA Trust Commercial |
$351.78
|
| Rate for Payer: WPS Commercial |
$473.73
|
|
|
RBC 500 Irr
|
Facility
|
OP
|
$615.00
|
|
|
Service Code
|
HCPCS P9021
|
| Hospital Charge Code |
1052809
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$155.10 |
| Max. Negotiated Rate |
$620.38 |
| Rate for Payer: Aetna Commercial |
$575.64
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$550.06
|
| Rate for Payer: Aetna Managed Medicare |
$155.10
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$415.74
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$319.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$307.01
|
| Rate for Payer: Anthem Medicare Advantage |
$155.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$338.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$155.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$155.10
|
| Rate for Payer: Cash Price |
$184.50
|
| Rate for Payer: Cash Price |
$184.50
|
| Rate for Payer: Cigna Commercial |
$588.43
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$155.10
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$357.93
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$155.10
|
| Rate for Payer: Health EOS Commercial |
$569.24
|
| Rate for Payer: HFN Commercial |
$588.43
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$576.95
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$155.10
|
| Rate for Payer: Independent Care Health Plan Medicare |
$155.10
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$155.10
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$155.10
|
| Rate for Payer: Multiplan Commercial |
$511.68
|
| Rate for Payer: NAPHCARE Commercial |
$232.64
|
| Rate for Payer: Preferred Network Access Commercial |
$588.43
|
| Rate for Payer: Quartz Beloit One Network |
$313.40
|
| Rate for Payer: Quartz Commercial |
$415.74
|
| Rate for Payer: Quartz Medicare Advantage |
$155.10
|
| Rate for Payer: The Alliance Commercial |
$620.38
|
| Rate for Payer: United Healthcare Medicare Advantage |
$155.10
|
| Rate for Payer: United Healthcare PPO |
$479.70
|
| Rate for Payer: WEA Trust Commercial |
$351.78
|
| Rate for Payer: Wellcare Medicare |
$155.10
|
| Rate for Payer: WPS Commercial |
$473.73
|
|
|
RBC 500 Irr 1
|
Facility
|
IP
|
$615.00
|
|
|
Service Code
|
HCPCS P9021
|
| Hospital Charge Code |
1052868
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$313.40 |
| Max. Negotiated Rate |
$588.43 |
| Rate for Payer: Aetna Commercial |
$575.64
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$550.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$338.99
|
| Rate for Payer: Cash Price |
$184.50
|
| Rate for Payer: Cigna Commercial |
$588.43
|
| Rate for Payer: Health EOS Commercial |
$569.24
|
| Rate for Payer: HFN Commercial |
$588.43
|
| Rate for Payer: Multiplan Commercial |
$511.68
|
| Rate for Payer: Preferred Network Access Commercial |
$588.43
|
| Rate for Payer: Quartz Beloit One Network |
$313.40
|
| Rate for Payer: Quartz Commercial |
$383.76
|
| Rate for Payer: WEA Trust Commercial |
$351.78
|
| Rate for Payer: WPS Commercial |
$473.73
|
|
|
RBC 500 Irr 1
|
Facility
|
OP
|
$615.00
|
|
|
Service Code
|
HCPCS P9021
|
| Hospital Charge Code |
1052868
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$155.10 |
| Max. Negotiated Rate |
$620.38 |
| Rate for Payer: Aetna Commercial |
$575.64
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$550.06
|
| Rate for Payer: Aetna Managed Medicare |
$155.10
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$415.74
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$319.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$307.01
|
| Rate for Payer: Anthem Medicare Advantage |
$155.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$338.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$155.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$155.10
|
| Rate for Payer: Cash Price |
$184.50
|
| Rate for Payer: Cash Price |
$184.50
|
| Rate for Payer: Cigna Commercial |
$588.43
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$155.10
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$357.93
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$155.10
|
| Rate for Payer: Health EOS Commercial |
$569.24
|
| Rate for Payer: HFN Commercial |
$588.43
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$576.95
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$155.10
|
| Rate for Payer: Independent Care Health Plan Medicare |
$155.10
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$155.10
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$155.10
|
| Rate for Payer: Multiplan Commercial |
$511.68
|
| Rate for Payer: NAPHCARE Commercial |
$232.64
|
| Rate for Payer: Preferred Network Access Commercial |
$588.43
|
| Rate for Payer: Quartz Beloit One Network |
$313.40
|
| Rate for Payer: Quartz Commercial |
$415.74
|
| Rate for Payer: Quartz Medicare Advantage |
$155.10
|
| Rate for Payer: The Alliance Commercial |
$620.38
|
| Rate for Payer: United Healthcare Medicare Advantage |
$155.10
|
| Rate for Payer: United Healthcare PPO |
$479.70
|
| Rate for Payer: WEA Trust Commercial |
$351.78
|
| Rate for Payer: Wellcare Medicare |
$155.10
|
| Rate for Payer: WPS Commercial |
$473.73
|
|
|
RBC 500 Irr 2
|
Facility
|
IP
|
$615.00
|
|
|
Service Code
|
HCPCS P9021
|
| Hospital Charge Code |
1052870
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$313.40 |
| Max. Negotiated Rate |
$588.43 |
| Rate for Payer: Aetna Commercial |
$575.64
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$550.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$338.99
|
| Rate for Payer: Cash Price |
$184.50
|
| Rate for Payer: Cigna Commercial |
$588.43
|
| Rate for Payer: Health EOS Commercial |
$569.24
|
| Rate for Payer: HFN Commercial |
$588.43
|
| Rate for Payer: Multiplan Commercial |
$511.68
|
| Rate for Payer: Preferred Network Access Commercial |
$588.43
|
| Rate for Payer: Quartz Beloit One Network |
$313.40
|
| Rate for Payer: Quartz Commercial |
$383.76
|
| Rate for Payer: WEA Trust Commercial |
$351.78
|
| Rate for Payer: WPS Commercial |
$473.73
|
|
|
RBC 500 Irr 2
|
Facility
|
OP
|
$615.00
|
|
|
Service Code
|
HCPCS P9021
|
| Hospital Charge Code |
1052870
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$155.10 |
| Max. Negotiated Rate |
$620.38 |
| Rate for Payer: Aetna Commercial |
$575.64
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$550.06
|
| Rate for Payer: Aetna Managed Medicare |
$155.10
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$415.74
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$319.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$307.01
|
| Rate for Payer: Anthem Medicare Advantage |
$155.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$338.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$155.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$155.10
|
| Rate for Payer: Cash Price |
$184.50
|
| Rate for Payer: Cash Price |
$184.50
|
| Rate for Payer: Cigna Commercial |
$588.43
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$155.10
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$357.93
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$155.10
|
| Rate for Payer: Health EOS Commercial |
$569.24
|
| Rate for Payer: HFN Commercial |
$588.43
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$576.95
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$155.10
|
| Rate for Payer: Independent Care Health Plan Medicare |
$155.10
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$155.10
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$155.10
|
| Rate for Payer: Multiplan Commercial |
$511.68
|
| Rate for Payer: NAPHCARE Commercial |
$232.64
|
| Rate for Payer: Preferred Network Access Commercial |
$588.43
|
| Rate for Payer: Quartz Beloit One Network |
$313.40
|
| Rate for Payer: Quartz Commercial |
$415.74
|
| Rate for Payer: Quartz Medicare Advantage |
$155.10
|
| Rate for Payer: The Alliance Commercial |
$620.38
|
| Rate for Payer: United Healthcare Medicare Advantage |
$155.10
|
| Rate for Payer: United Healthcare PPO |
$479.70
|
| Rate for Payer: WEA Trust Commercial |
$351.78
|
| Rate for Payer: Wellcare Medicare |
$155.10
|
| Rate for Payer: WPS Commercial |
$473.73
|
|
|
RBC Count CSF
|
Professional
|
Both
|
$90.00
|
|
|
Service Code
|
CPT 89050
|
| Hospital Charge Code |
1050840
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.91 |
| Max. Negotiated Rate |
$88.92 |
| Rate for Payer: Aetna Commercial |
$88.92
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$80.50
|
| Rate for Payer: Aetna Managed Medicare |
$4.91
|
| Rate for Payer: Anthem Medicare Advantage |
$4.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$4.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$4.91
|
| Rate for Payer: Cash Price |
$27.00
|
| Rate for Payer: Cash Price |
$27.00
|
| Rate for Payer: Cigna Commercial |
$88.92
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$46.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4.91
|
| Rate for Payer: Health EOS Commercial |
$85.18
|
| Rate for Payer: HFN Commercial |
$88.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$17.33
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$17.33
|
| Rate for Payer: Independent Care Health Plan Medicare |
$4.91
|
| Rate for Payer: Multiplan Commercial |
$74.88
|
| Rate for Payer: NAPHCARE Commercial |
$7.36
|
| Rate for Payer: Preferred Network Access Commercial |
$88.92
|
| Rate for Payer: Quartz Beloit One Network |
$41.18
|
| Rate for Payer: Quartz Commercial |
$53.35
|
| Rate for Payer: Quartz Medicare Advantage |
$4.91
|
| Rate for Payer: The Alliance Commercial |
$19.39
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4.91
|
| Rate for Payer: WEA Trust Commercial |
$51.48
|
| Rate for Payer: WPS Commercial |
$21.60
|
|
|
RBC Count CSF
|
Facility
|
IP
|
$90.00
|
|
|
Service Code
|
CPT 89050
|
| Hospital Charge Code |
1050840
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$45.86 |
| Max. Negotiated Rate |
$86.11 |
| Rate for Payer: Aetna Commercial |
$84.24
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$80.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$49.61
|
| Rate for Payer: Cash Price |
$27.00
|
| Rate for Payer: Cigna Commercial |
$86.11
|
| Rate for Payer: Health EOS Commercial |
$83.30
|
| Rate for Payer: HFN Commercial |
$86.11
|
| Rate for Payer: Multiplan Commercial |
$74.88
|
| Rate for Payer: Preferred Network Access Commercial |
$86.11
|
| Rate for Payer: Quartz Beloit One Network |
$45.86
|
| Rate for Payer: Quartz Commercial |
$56.16
|
| Rate for Payer: WEA Trust Commercial |
$51.48
|
| Rate for Payer: WPS Commercial |
$69.33
|
|
|
RBC Count CSF
|
Facility
|
OP
|
$90.00
|
|
|
Service Code
|
CPT 89050
|
| Hospital Charge Code |
1050840
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.91 |
| Max. Negotiated Rate |
$86.11 |
| Rate for Payer: Aetna Commercial |
$84.24
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$80.50
|
| Rate for Payer: Aetna Managed Medicare |
$4.91
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$18.41
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8.59
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$8.15
|
| Rate for Payer: Anthem Medicare Advantage |
$4.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$49.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$4.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$4.91
|
| Rate for Payer: Cash Price |
$27.00
|
| Rate for Payer: Cash Price |
$27.00
|
| Rate for Payer: Cigna Commercial |
$86.11
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$4.91
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$52.38
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$4.91
|
| Rate for Payer: Health EOS Commercial |
$83.30
|
| Rate for Payer: HFN Commercial |
$86.11
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$18.26
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$4.91
|
| Rate for Payer: Independent Care Health Plan Medicare |
$4.91
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$4.91
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$4.91
|
| Rate for Payer: Multiplan Commercial |
$74.88
|
| Rate for Payer: NAPHCARE Commercial |
$7.36
|
| Rate for Payer: Preferred Network Access Commercial |
$86.11
|
| Rate for Payer: Quartz Beloit One Network |
$45.86
|
| Rate for Payer: Quartz Commercial |
$60.84
|
| Rate for Payer: Quartz Medicare Advantage |
$4.91
|
| Rate for Payer: The Alliance Commercial |
$19.64
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4.91
|
| Rate for Payer: United Healthcare PPO |
$70.20
|
| Rate for Payer: WEA Trust Commercial |
$51.48
|
| Rate for Payer: Wellcare Medicare |
$4.91
|
| Rate for Payer: WPS Commercial |
$69.33
|
|
|
RBC CP2D AS3 450 LR Irr
|
Facility
|
IP
|
$615.00
|
|
|
Service Code
|
HCPCS P9021
|
| Hospital Charge Code |
1052817
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$313.40 |
| Max. Negotiated Rate |
$588.43 |
| Rate for Payer: Aetna Commercial |
$575.64
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$550.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$338.99
|
| Rate for Payer: Cash Price |
$184.50
|
| Rate for Payer: Cigna Commercial |
$588.43
|
| Rate for Payer: Health EOS Commercial |
$569.24
|
| Rate for Payer: HFN Commercial |
$588.43
|
| Rate for Payer: Multiplan Commercial |
$511.68
|
| Rate for Payer: Preferred Network Access Commercial |
$588.43
|
| Rate for Payer: Quartz Beloit One Network |
$313.40
|
| Rate for Payer: Quartz Commercial |
$383.76
|
| Rate for Payer: WEA Trust Commercial |
$351.78
|
| Rate for Payer: WPS Commercial |
$473.73
|
|
|
RBC CP2D AS3 450 LR Irr
|
Facility
|
OP
|
$615.00
|
|
|
Service Code
|
HCPCS P9021
|
| Hospital Charge Code |
1052817
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$155.10 |
| Max. Negotiated Rate |
$620.38 |
| Rate for Payer: Aetna Commercial |
$575.64
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$550.06
|
| Rate for Payer: Aetna Managed Medicare |
$155.10
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$415.74
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$319.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$307.01
|
| Rate for Payer: Anthem Medicare Advantage |
$155.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$338.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$155.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$155.10
|
| Rate for Payer: Cash Price |
$184.50
|
| Rate for Payer: Cash Price |
$184.50
|
| Rate for Payer: Cigna Commercial |
$588.43
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$155.10
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$357.93
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$155.10
|
| Rate for Payer: Health EOS Commercial |
$569.24
|
| Rate for Payer: HFN Commercial |
$588.43
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$576.95
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$155.10
|
| Rate for Payer: Independent Care Health Plan Medicare |
$155.10
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$155.10
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$155.10
|
| Rate for Payer: Multiplan Commercial |
$511.68
|
| Rate for Payer: NAPHCARE Commercial |
$232.64
|
| Rate for Payer: Preferred Network Access Commercial |
$588.43
|
| Rate for Payer: Quartz Beloit One Network |
$313.40
|
| Rate for Payer: Quartz Commercial |
$415.74
|
| Rate for Payer: Quartz Medicare Advantage |
$155.10
|
| Rate for Payer: The Alliance Commercial |
$620.38
|
| Rate for Payer: United Healthcare Medicare Advantage |
$155.10
|
| Rate for Payer: United Healthcare PPO |
$479.70
|
| Rate for Payer: WEA Trust Commercial |
$351.78
|
| Rate for Payer: Wellcare Medicare |
$155.10
|
| Rate for Payer: WPS Commercial |
$473.73
|
|
|
RBC CP2D AS3 500LR
|
Facility
|
IP
|
$591.00
|
|
|
Service Code
|
HCPCS P9021
|
| Hospital Charge Code |
5433148
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$301.17 |
| Max. Negotiated Rate |
$565.47 |
| Rate for Payer: Aetna Commercial |
$553.18
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$528.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$325.76
|
| Rate for Payer: Cash Price |
$177.30
|
| Rate for Payer: Cigna Commercial |
$565.47
|
| Rate for Payer: Health EOS Commercial |
$547.03
|
| Rate for Payer: HFN Commercial |
$565.47
|
| Rate for Payer: Multiplan Commercial |
$491.71
|
| Rate for Payer: Preferred Network Access Commercial |
$565.47
|
| Rate for Payer: Quartz Beloit One Network |
$301.17
|
| Rate for Payer: Quartz Commercial |
$368.78
|
| Rate for Payer: WEA Trust Commercial |
$338.05
|
| Rate for Payer: WPS Commercial |
$455.25
|
|
|
RBC CP2D AS3 500LR
|
Facility
|
OP
|
$591.00
|
|
|
Service Code
|
HCPCS P9021
|
| Hospital Charge Code |
5433148
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$155.10 |
| Max. Negotiated Rate |
$620.38 |
| Rate for Payer: Aetna Commercial |
$553.18
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$528.59
|
| Rate for Payer: Aetna Managed Medicare |
$155.10
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$399.52
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$307.32
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$295.03
|
| Rate for Payer: Anthem Medicare Advantage |
$155.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$325.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$155.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$155.10
|
| Rate for Payer: Cash Price |
$177.30
|
| Rate for Payer: Cash Price |
$177.30
|
| Rate for Payer: Cigna Commercial |
$565.47
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$155.10
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$343.96
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$155.10
|
| Rate for Payer: Health EOS Commercial |
$547.03
|
| Rate for Payer: HFN Commercial |
$565.47
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$576.95
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$155.10
|
| Rate for Payer: Independent Care Health Plan Medicare |
$155.10
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$155.10
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$155.10
|
| Rate for Payer: Multiplan Commercial |
$491.71
|
| Rate for Payer: NAPHCARE Commercial |
$232.64
|
| Rate for Payer: Preferred Network Access Commercial |
$565.47
|
| Rate for Payer: Quartz Beloit One Network |
$301.17
|
| Rate for Payer: Quartz Commercial |
$399.52
|
| Rate for Payer: Quartz Medicare Advantage |
$155.10
|
| Rate for Payer: The Alliance Commercial |
$620.38
|
| Rate for Payer: United Healthcare Medicare Advantage |
$155.10
|
| Rate for Payer: United Healthcare PPO |
$460.98
|
| Rate for Payer: WEA Trust Commercial |
$338.05
|
| Rate for Payer: Wellcare Medicare |
$155.10
|
| Rate for Payer: WPS Commercial |
$455.25
|
|
|
RBC CPD 450
|
Facility
|
IP
|
$615.00
|
|
|
Service Code
|
HCPCS P9021
|
| Hospital Charge Code |
1052858
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$313.40 |
| Max. Negotiated Rate |
$588.43 |
| Rate for Payer: Aetna Commercial |
$575.64
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$550.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$338.99
|
| Rate for Payer: Cash Price |
$184.50
|
| Rate for Payer: Cigna Commercial |
$588.43
|
| Rate for Payer: Health EOS Commercial |
$569.24
|
| Rate for Payer: HFN Commercial |
$588.43
|
| Rate for Payer: Multiplan Commercial |
$511.68
|
| Rate for Payer: Preferred Network Access Commercial |
$588.43
|
| Rate for Payer: Quartz Beloit One Network |
$313.40
|
| Rate for Payer: Quartz Commercial |
$383.76
|
| Rate for Payer: WEA Trust Commercial |
$351.78
|
| Rate for Payer: WPS Commercial |
$473.73
|
|
|
RBC CPD 450
|
Facility
|
OP
|
$615.00
|
|
|
Service Code
|
HCPCS P9021
|
| Hospital Charge Code |
1052858
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$155.10 |
| Max. Negotiated Rate |
$620.38 |
| Rate for Payer: Aetna Commercial |
$575.64
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$550.06
|
| Rate for Payer: Aetna Managed Medicare |
$155.10
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$415.74
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$319.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$307.01
|
| Rate for Payer: Anthem Medicare Advantage |
$155.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$338.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$155.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$155.10
|
| Rate for Payer: Cash Price |
$184.50
|
| Rate for Payer: Cash Price |
$184.50
|
| Rate for Payer: Cigna Commercial |
$588.43
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$155.10
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$357.93
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$155.10
|
| Rate for Payer: Health EOS Commercial |
$569.24
|
| Rate for Payer: HFN Commercial |
$588.43
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$576.95
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$155.10
|
| Rate for Payer: Independent Care Health Plan Medicare |
$155.10
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$155.10
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$155.10
|
| Rate for Payer: Multiplan Commercial |
$511.68
|
| Rate for Payer: NAPHCARE Commercial |
$232.64
|
| Rate for Payer: Preferred Network Access Commercial |
$588.43
|
| Rate for Payer: Quartz Beloit One Network |
$313.40
|
| Rate for Payer: Quartz Commercial |
$415.74
|
| Rate for Payer: Quartz Medicare Advantage |
$155.10
|
| Rate for Payer: The Alliance Commercial |
$620.38
|
| Rate for Payer: United Healthcare Medicare Advantage |
$155.10
|
| Rate for Payer: United Healthcare PPO |
$479.70
|
| Rate for Payer: WEA Trust Commercial |
$351.78
|
| Rate for Payer: Wellcare Medicare |
$155.10
|
| Rate for Payer: WPS Commercial |
$473.73
|
|
