|
PYLOROPLASTY
|
Facility
|
OP
|
$3,935.00
|
|
| Hospital Charge Code |
2960332
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,101.80 |
| Max. Negotiated Rate |
$15,740.00 |
| Rate for Payer: Aetna Commercial |
$3,541.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,384.10
|
| Rate for Payer: Aetna Managed Medicare |
$1,101.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,557.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,967.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,888.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,085.55
|
| Rate for Payer: Cash Price |
$1,180.50
|
| Rate for Payer: Cigna Commercial |
$3,620.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,202.03
|
| Rate for Payer: Health EOS Commercial |
$3,502.15
|
| Rate for Payer: HFN Commercial |
$3,620.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,951.25
|
| Rate for Payer: Multiplan Commercial |
$3,148.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,361.00
|
| Rate for Payer: Preferred Network Access Commercial |
$3,620.20
|
| Rate for Payer: Quartz Beloit One Network |
$1,928.15
|
| Rate for Payer: Quartz Commercial |
$2,557.75
|
| Rate for Payer: Quartz Medicare Advantage |
$2,361.00
|
| Rate for Payer: The Alliance Commercial |
$15,740.00
|
| Rate for Payer: WEA Trust Commercial |
$2,164.25
|
| Rate for Payer: WPS Commercial |
$2,914.65
|
|
|
PYLOROPLASTY
|
Facility
|
IP
|
$3,935.00
|
|
| Hospital Charge Code |
2960332
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,928.15 |
| Max. Negotiated Rate |
$3,620.20 |
| Rate for Payer: Aetna Commercial |
$3,541.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,384.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,085.55
|
| Rate for Payer: Cash Price |
$1,180.50
|
| Rate for Payer: Cigna Commercial |
$3,620.20
|
| Rate for Payer: Health EOS Commercial |
$3,502.15
|
| Rate for Payer: HFN Commercial |
$3,620.20
|
| Rate for Payer: Multiplan Commercial |
$3,148.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,361.00
|
| Rate for Payer: Preferred Network Access Commercial |
$3,620.20
|
| Rate for Payer: Quartz Beloit One Network |
$1,928.15
|
| Rate for Payer: Quartz Commercial |
$2,361.00
|
| Rate for Payer: WEA Trust Commercial |
$2,164.25
|
| Rate for Payer: WPS Commercial |
$2,914.65
|
|
|
Pyruvate
|
Facility
|
OP
|
$109.00
|
|
|
Service Code
|
CPT 84210
|
| Hospital Charge Code |
4578739
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.48 |
| Max. Negotiated Rate |
$100.28 |
| Rate for Payer: Aetna Commercial |
$98.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$93.74
|
| Rate for Payer: Aetna Managed Medicare |
$14.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$54.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$25.34
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$24.04
|
| Rate for Payer: Anthem Medicaid |
$14.96
|
| Rate for Payer: Anthem Medicare Advantage |
$14.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$57.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$14.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$14.48
|
| Rate for Payer: Cash Price |
$32.70
|
| Rate for Payer: Cash Price |
$32.70
|
| Rate for Payer: Cigna Commercial |
$100.28
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$14.48
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$14.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$61.00
|
| Rate for Payer: Dean Health Medicaid |
$14.96
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$14.48
|
| Rate for Payer: Health EOS Commercial |
$97.01
|
| Rate for Payer: HFN Commercial |
$100.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$53.87
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$14.48
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$14.96
|
| Rate for Payer: Independent Care Health Plan Medicare |
$14.48
|
| Rate for Payer: Managed Health Services Medicaid |
$15.56
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$14.48
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$14.48
|
| Rate for Payer: Multiplan Commercial |
$87.20
|
| Rate for Payer: NAPHCARE Commercial |
$21.72
|
| Rate for Payer: Preferred Network Access Commercial |
$100.28
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$14.96
|
| Rate for Payer: Quartz Beloit One Network |
$53.41
|
| Rate for Payer: Quartz Commercial |
$70.85
|
| Rate for Payer: Quartz Medicare Advantage |
$14.48
|
| Rate for Payer: The Alliance Commercial |
$57.92
|
| Rate for Payer: United Healthcare Medicaid |
$14.96
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14.48
|
| Rate for Payer: United Healthcare PPO |
$81.75
|
| Rate for Payer: WEA Trust Commercial |
$59.95
|
| Rate for Payer: Wellcare Medicare |
$14.48
|
| Rate for Payer: WMAP Medicaid |
$14.96
|
| Rate for Payer: WPS Commercial |
$80.74
|
|
|
Pyruvate
|
Professional
|
Both
|
$109.00
|
|
|
Service Code
|
CPT 84210
|
| Hospital Charge Code |
4578739
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$47.96 |
| Max. Negotiated Rate |
$103.55 |
| Rate for Payer: Aetna Commercial |
$103.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$93.74
|
| Rate for Payer: Cash Price |
$32.70
|
| Rate for Payer: Cash Price |
$32.70
|
| Rate for Payer: Cigna Commercial |
$103.55
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$54.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$65.40
|
| Rate for Payer: Health EOS Commercial |
$99.19
|
| Rate for Payer: HFN Commercial |
$103.55
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$51.11
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$51.11
|
| Rate for Payer: Multiplan Commercial |
$87.20
|
| Rate for Payer: Preferred Network Access Commercial |
$103.55
|
| Rate for Payer: Quartz Beloit One Network |
$47.96
|
| Rate for Payer: Quartz Commercial |
$62.13
|
| Rate for Payer: The Alliance Commercial |
$54.50
|
| Rate for Payer: WEA Trust Commercial |
$59.95
|
| Rate for Payer: WPS Commercial |
$80.74
|
|
|
Pyruvate
|
Facility
|
IP
|
$109.00
|
|
|
Service Code
|
CPT 84210
|
| Hospital Charge Code |
4578739
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$53.41 |
| Max. Negotiated Rate |
$100.28 |
| Rate for Payer: Aetna Commercial |
$98.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$93.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$57.77
|
| Rate for Payer: Cash Price |
$32.70
|
| Rate for Payer: Cigna Commercial |
$100.28
|
| Rate for Payer: Health EOS Commercial |
$97.01
|
| Rate for Payer: HFN Commercial |
$100.28
|
| Rate for Payer: Multiplan Commercial |
$87.20
|
| Rate for Payer: NAPHCARE Commercial |
$65.40
|
| Rate for Payer: Preferred Network Access Commercial |
$100.28
|
| Rate for Payer: Quartz Beloit One Network |
$53.41
|
| Rate for Payer: Quartz Commercial |
$65.40
|
| Rate for Payer: WEA Trust Commercial |
$59.95
|
| Rate for Payer: WPS Commercial |
$80.74
|
|
|
Pyruvic Acid
|
Professional
|
Both
|
$63.00
|
|
|
Service Code
|
CPT 84210
|
| Hospital Charge Code |
978052
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$27.72 |
| Max. Negotiated Rate |
$59.85 |
| Rate for Payer: Aetna Commercial |
$59.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$54.18
|
| Rate for Payer: Cash Price |
$18.90
|
| Rate for Payer: Cash Price |
$18.90
|
| Rate for Payer: Cigna Commercial |
$59.85
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$31.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$37.80
|
| Rate for Payer: Health EOS Commercial |
$57.33
|
| Rate for Payer: HFN Commercial |
$59.85
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$51.11
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$51.11
|
| Rate for Payer: Multiplan Commercial |
$50.40
|
| Rate for Payer: Preferred Network Access Commercial |
$59.85
|
| Rate for Payer: Quartz Beloit One Network |
$27.72
|
| Rate for Payer: Quartz Commercial |
$35.91
|
| Rate for Payer: The Alliance Commercial |
$31.50
|
| Rate for Payer: WEA Trust Commercial |
$34.65
|
| Rate for Payer: WPS Commercial |
$46.66
|
|
|
Pyruvic Acid
|
Facility
|
OP
|
$63.00
|
|
|
Service Code
|
CPT 84210
|
| Hospital Charge Code |
978052
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.48 |
| Max. Negotiated Rate |
$57.96 |
| Rate for Payer: Aetna Commercial |
$56.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$54.18
|
| Rate for Payer: Aetna Managed Medicare |
$14.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$54.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$25.34
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$24.04
|
| Rate for Payer: Anthem Medicaid |
$14.96
|
| Rate for Payer: Anthem Medicare Advantage |
$14.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$33.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$14.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$14.48
|
| Rate for Payer: Cash Price |
$18.90
|
| Rate for Payer: Cash Price |
$18.90
|
| Rate for Payer: Cigna Commercial |
$57.96
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$14.48
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$14.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$35.25
|
| Rate for Payer: Dean Health Medicaid |
$14.96
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$14.48
|
| Rate for Payer: Health EOS Commercial |
$56.07
|
| Rate for Payer: HFN Commercial |
$57.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$53.87
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$14.48
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$14.96
|
| Rate for Payer: Independent Care Health Plan Medicare |
$14.48
|
| Rate for Payer: Managed Health Services Medicaid |
$15.56
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$14.48
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$14.48
|
| Rate for Payer: Multiplan Commercial |
$50.40
|
| Rate for Payer: NAPHCARE Commercial |
$21.72
|
| Rate for Payer: Preferred Network Access Commercial |
$57.96
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$14.96
|
| Rate for Payer: Quartz Beloit One Network |
$30.87
|
| Rate for Payer: Quartz Commercial |
$40.95
|
| Rate for Payer: Quartz Medicare Advantage |
$14.48
|
| Rate for Payer: The Alliance Commercial |
$57.92
|
| Rate for Payer: United Healthcare Medicaid |
$14.96
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14.48
|
| Rate for Payer: United Healthcare PPO |
$47.25
|
| Rate for Payer: WEA Trust Commercial |
$34.65
|
| Rate for Payer: Wellcare Medicare |
$14.48
|
| Rate for Payer: WMAP Medicaid |
$14.96
|
| Rate for Payer: WPS Commercial |
$46.66
|
|
|
Pyruvic Acid
|
Facility
|
IP
|
$63.00
|
|
|
Service Code
|
CPT 84210
|
| Hospital Charge Code |
978052
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$30.87 |
| Max. Negotiated Rate |
$57.96 |
| Rate for Payer: Aetna Commercial |
$56.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$54.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$33.39
|
| Rate for Payer: Cash Price |
$18.90
|
| Rate for Payer: Cigna Commercial |
$57.96
|
| Rate for Payer: Health EOS Commercial |
$56.07
|
| Rate for Payer: HFN Commercial |
$57.96
|
| Rate for Payer: Multiplan Commercial |
$50.40
|
| Rate for Payer: NAPHCARE Commercial |
$37.80
|
| Rate for Payer: Preferred Network Access Commercial |
$57.96
|
| Rate for Payer: Quartz Beloit One Network |
$30.87
|
| Rate for Payer: Quartz Commercial |
$37.80
|
| Rate for Payer: WEA Trust Commercial |
$34.65
|
| Rate for Payer: WPS Commercial |
$46.66
|
|
|
Q Fever Ab (IgG, IgM)
|
Facility
|
IP
|
$63.75
|
|
|
Service Code
|
CPT 86638
|
| Hospital Charge Code |
4521289
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$31.24 |
| Max. Negotiated Rate |
$58.65 |
| Rate for Payer: Aetna Commercial |
$57.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$54.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$33.79
|
| Rate for Payer: Cash Price |
$19.12
|
| Rate for Payer: Cigna Commercial |
$58.65
|
| Rate for Payer: Health EOS Commercial |
$56.74
|
| Rate for Payer: HFN Commercial |
$58.65
|
| Rate for Payer: Multiplan Commercial |
$51.00
|
| Rate for Payer: NAPHCARE Commercial |
$38.25
|
| Rate for Payer: Preferred Network Access Commercial |
$58.65
|
| Rate for Payer: Quartz Beloit One Network |
$31.24
|
| Rate for Payer: Quartz Commercial |
$38.25
|
| Rate for Payer: WEA Trust Commercial |
$35.06
|
| Rate for Payer: WPS Commercial |
$47.22
|
|
|
Q Fever Ab (IgG, IgM)
|
Professional
|
Both
|
$63.75
|
|
|
Service Code
|
CPT 86638
|
| Hospital Charge Code |
4521289
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$28.05 |
| Max. Negotiated Rate |
$60.56 |
| Rate for Payer: Aetna Commercial |
$60.56
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$54.82
|
| Rate for Payer: Cash Price |
$19.12
|
| Rate for Payer: Cash Price |
$19.12
|
| Rate for Payer: Cigna Commercial |
$60.56
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$31.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$38.25
|
| Rate for Payer: Health EOS Commercial |
$58.01
|
| Rate for Payer: HFN Commercial |
$60.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$42.78
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$42.78
|
| Rate for Payer: Multiplan Commercial |
$51.00
|
| Rate for Payer: Preferred Network Access Commercial |
$60.56
|
| Rate for Payer: Quartz Beloit One Network |
$28.05
|
| Rate for Payer: Quartz Commercial |
$36.34
|
| Rate for Payer: The Alliance Commercial |
$31.88
|
| Rate for Payer: WEA Trust Commercial |
$35.06
|
| Rate for Payer: WPS Commercial |
$47.22
|
|
|
Q Fever Ab (IgG, IgM)
|
Facility
|
OP
|
$63.75
|
|
|
Service Code
|
CPT 86638
|
| Hospital Charge Code |
4521289
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.17 |
| Max. Negotiated Rate |
$58.65 |
| Rate for Payer: Aetna Commercial |
$57.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$54.82
|
| Rate for Payer: Aetna Managed Medicare |
$12.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$45.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$21.21
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$20.12
|
| Rate for Payer: Anthem Medicaid |
$8.17
|
| Rate for Payer: Anthem Medicare Advantage |
$12.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$33.79
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$12.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$12.12
|
| Rate for Payer: Cash Price |
$19.12
|
| Rate for Payer: Cash Price |
$19.12
|
| Rate for Payer: Cigna Commercial |
$58.65
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$12.12
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$8.17
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$35.67
|
| Rate for Payer: Dean Health Medicaid |
$8.17
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$12.12
|
| Rate for Payer: Health EOS Commercial |
$56.74
|
| Rate for Payer: HFN Commercial |
$58.65
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$45.09
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$12.12
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$8.17
|
| Rate for Payer: Independent Care Health Plan Medicare |
$12.12
|
| Rate for Payer: Managed Health Services Medicaid |
$8.50
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$12.12
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$12.12
|
| Rate for Payer: Multiplan Commercial |
$51.00
|
| Rate for Payer: NAPHCARE Commercial |
$18.18
|
| Rate for Payer: Preferred Network Access Commercial |
$58.65
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$8.17
|
| Rate for Payer: Quartz Beloit One Network |
$31.24
|
| Rate for Payer: Quartz Commercial |
$41.44
|
| Rate for Payer: Quartz Medicare Advantage |
$12.12
|
| Rate for Payer: The Alliance Commercial |
$48.48
|
| Rate for Payer: United Healthcare Medicaid |
$8.17
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.12
|
| Rate for Payer: United Healthcare PPO |
$47.81
|
| Rate for Payer: WEA Trust Commercial |
$35.06
|
| Rate for Payer: Wellcare Medicare |
$12.12
|
| Rate for Payer: WMAP Medicaid |
$8.17
|
| Rate for Payer: WPS Commercial |
$47.22
|
|
|
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 |
$12.32 |
| Max. Negotiated Rate |
$42.78 |
| Rate for Payer: Aetna Commercial |
$26.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$24.08
|
| Rate for Payer: Cash Price |
$8.40
|
| Rate for Payer: Cash Price |
$8.40
|
| Rate for Payer: Cigna Commercial |
$26.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$14.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$16.80
|
| Rate for Payer: Health EOS Commercial |
$25.48
|
| Rate for Payer: HFN Commercial |
$26.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$42.78
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$42.78
|
| Rate for Payer: Multiplan Commercial |
$22.40
|
| Rate for Payer: Preferred Network Access Commercial |
$26.60
|
| Rate for Payer: Quartz Beloit One Network |
$12.32
|
| Rate for Payer: Quartz Commercial |
$15.96
|
| Rate for Payer: The Alliance Commercial |
$14.00
|
| Rate for Payer: WEA Trust Commercial |
$15.40
|
| Rate for Payer: WPS Commercial |
$20.74
|
|
|
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 |
$13.72 |
| Max. Negotiated Rate |
$25.76 |
| Rate for Payer: Aetna Commercial |
$25.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$24.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$14.84
|
| Rate for Payer: Cash Price |
$8.40
|
| Rate for Payer: Cigna Commercial |
$25.76
|
| Rate for Payer: Health EOS Commercial |
$24.92
|
| Rate for Payer: HFN Commercial |
$25.76
|
| Rate for Payer: Multiplan Commercial |
$22.40
|
| Rate for Payer: NAPHCARE Commercial |
$16.80
|
| Rate for Payer: Preferred Network Access Commercial |
$25.76
|
| Rate for Payer: Quartz Beloit One Network |
$13.72
|
| Rate for Payer: Quartz Commercial |
$16.80
|
| Rate for Payer: WEA Trust Commercial |
$15.40
|
| Rate for Payer: WPS Commercial |
$20.74
|
|
|
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 |
$8.17 |
| Max. Negotiated Rate |
$48.48 |
| Rate for Payer: Aetna Commercial |
$25.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$24.08
|
| Rate for Payer: Aetna Managed Medicare |
$12.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$45.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$21.21
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$20.12
|
| Rate for Payer: Anthem Medicaid |
$8.17
|
| Rate for Payer: Anthem Medicare Advantage |
$12.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$14.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$12.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$12.12
|
| Rate for Payer: Cash Price |
$8.40
|
| Rate for Payer: Cash Price |
$8.40
|
| Rate for Payer: Cigna Commercial |
$25.76
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$12.12
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$8.17
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$15.67
|
| Rate for Payer: Dean Health Medicaid |
$8.17
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$12.12
|
| Rate for Payer: Health EOS Commercial |
$24.92
|
| Rate for Payer: HFN Commercial |
$25.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$45.09
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$12.12
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$8.17
|
| Rate for Payer: Independent Care Health Plan Medicare |
$12.12
|
| Rate for Payer: Managed Health Services Medicaid |
$8.50
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$12.12
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$12.12
|
| Rate for Payer: Multiplan Commercial |
$22.40
|
| Rate for Payer: NAPHCARE Commercial |
$18.18
|
| Rate for Payer: Preferred Network Access Commercial |
$25.76
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$8.17
|
| Rate for Payer: Quartz Beloit One Network |
$13.72
|
| Rate for Payer: Quartz Commercial |
$18.20
|
| Rate for Payer: Quartz Medicare Advantage |
$12.12
|
| Rate for Payer: The Alliance Commercial |
$48.48
|
| Rate for Payer: United Healthcare Medicaid |
$8.17
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.12
|
| Rate for Payer: United Healthcare PPO |
$21.00
|
| Rate for Payer: WEA Trust Commercial |
$15.40
|
| Rate for Payer: Wellcare Medicare |
$12.12
|
| Rate for Payer: WMAP Medicaid |
$8.17
|
| Rate for Payer: WPS Commercial |
$20.74
|
|
|
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 |
$12.32 |
| Max. Negotiated Rate |
$42.78 |
| Rate for Payer: Aetna Commercial |
$26.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$24.08
|
| Rate for Payer: Cash Price |
$8.40
|
| Rate for Payer: Cash Price |
$8.40
|
| Rate for Payer: Cigna Commercial |
$26.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$14.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$16.80
|
| Rate for Payer: Health EOS Commercial |
$25.48
|
| Rate for Payer: HFN Commercial |
$26.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$42.78
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$42.78
|
| Rate for Payer: Multiplan Commercial |
$22.40
|
| Rate for Payer: Preferred Network Access Commercial |
$26.60
|
| Rate for Payer: Quartz Beloit One Network |
$12.32
|
| Rate for Payer: Quartz Commercial |
$15.96
|
| Rate for Payer: The Alliance Commercial |
$14.00
|
| Rate for Payer: WEA Trust Commercial |
$15.40
|
| Rate for Payer: WPS Commercial |
$20.74
|
|
|
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 |
$8.17 |
| Max. Negotiated Rate |
$48.48 |
| Rate for Payer: Aetna Commercial |
$25.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$24.08
|
| Rate for Payer: Aetna Managed Medicare |
$12.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$45.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$21.21
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$20.12
|
| Rate for Payer: Anthem Medicaid |
$8.17
|
| Rate for Payer: Anthem Medicare Advantage |
$12.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$14.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$12.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$12.12
|
| Rate for Payer: Cash Price |
$8.40
|
| Rate for Payer: Cash Price |
$8.40
|
| Rate for Payer: Cigna Commercial |
$25.76
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$12.12
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$8.17
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$15.67
|
| Rate for Payer: Dean Health Medicaid |
$8.17
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$12.12
|
| Rate for Payer: Health EOS Commercial |
$24.92
|
| Rate for Payer: HFN Commercial |
$25.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$45.09
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$12.12
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$8.17
|
| Rate for Payer: Independent Care Health Plan Medicare |
$12.12
|
| Rate for Payer: Managed Health Services Medicaid |
$8.50
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$12.12
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$12.12
|
| Rate for Payer: Multiplan Commercial |
$22.40
|
| Rate for Payer: NAPHCARE Commercial |
$18.18
|
| Rate for Payer: Preferred Network Access Commercial |
$25.76
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$8.17
|
| Rate for Payer: Quartz Beloit One Network |
$13.72
|
| Rate for Payer: Quartz Commercial |
$18.20
|
| Rate for Payer: Quartz Medicare Advantage |
$12.12
|
| Rate for Payer: The Alliance Commercial |
$48.48
|
| Rate for Payer: United Healthcare Medicaid |
$8.17
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.12
|
| Rate for Payer: United Healthcare PPO |
$21.00
|
| Rate for Payer: WEA Trust Commercial |
$15.40
|
| Rate for Payer: Wellcare Medicare |
$12.12
|
| Rate for Payer: WMAP Medicaid |
$8.17
|
| Rate for Payer: WPS Commercial |
$20.74
|
|
|
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 |
$13.72 |
| Max. Negotiated Rate |
$25.76 |
| Rate for Payer: Aetna Commercial |
$25.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$24.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$14.84
|
| Rate for Payer: Cash Price |
$8.40
|
| Rate for Payer: Cigna Commercial |
$25.76
|
| Rate for Payer: Health EOS Commercial |
$24.92
|
| Rate for Payer: HFN Commercial |
$25.76
|
| Rate for Payer: Multiplan Commercial |
$22.40
|
| Rate for Payer: NAPHCARE Commercial |
$16.80
|
| Rate for Payer: Preferred Network Access Commercial |
$25.76
|
| Rate for Payer: Quartz Beloit One Network |
$13.72
|
| Rate for Payer: Quartz Commercial |
$16.80
|
| Rate for Payer: WEA Trust Commercial |
$15.40
|
| Rate for Payer: WPS Commercial |
$20.74
|
|
|
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 |
$8.17 |
| Max. Negotiated Rate |
$48.48 |
| Rate for Payer: Aetna Commercial |
$25.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$24.08
|
| Rate for Payer: Aetna Managed Medicare |
$12.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$45.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$21.21
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$20.12
|
| Rate for Payer: Anthem Medicaid |
$8.17
|
| Rate for Payer: Anthem Medicare Advantage |
$12.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$14.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$12.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$12.12
|
| Rate for Payer: Cash Price |
$8.40
|
| Rate for Payer: Cash Price |
$8.40
|
| Rate for Payer: Cigna Commercial |
$25.76
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$12.12
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$8.17
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$15.67
|
| Rate for Payer: Dean Health Medicaid |
$8.17
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$12.12
|
| Rate for Payer: Health EOS Commercial |
$24.92
|
| Rate for Payer: HFN Commercial |
$25.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$45.09
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$12.12
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$8.17
|
| Rate for Payer: Independent Care Health Plan Medicare |
$12.12
|
| Rate for Payer: Managed Health Services Medicaid |
$8.50
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$12.12
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$12.12
|
| Rate for Payer: Multiplan Commercial |
$22.40
|
| Rate for Payer: NAPHCARE Commercial |
$18.18
|
| Rate for Payer: Preferred Network Access Commercial |
$25.76
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$8.17
|
| Rate for Payer: Quartz Beloit One Network |
$13.72
|
| Rate for Payer: Quartz Commercial |
$18.20
|
| Rate for Payer: Quartz Medicare Advantage |
$12.12
|
| Rate for Payer: The Alliance Commercial |
$48.48
|
| Rate for Payer: United Healthcare Medicaid |
$8.17
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.12
|
| Rate for Payer: United Healthcare PPO |
$21.00
|
| Rate for Payer: WEA Trust Commercial |
$15.40
|
| Rate for Payer: Wellcare Medicare |
$12.12
|
| Rate for Payer: WMAP Medicaid |
$8.17
|
| Rate for Payer: WPS Commercial |
$20.74
|
|
|
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 |
$12.32 |
| Max. Negotiated Rate |
$42.78 |
| Rate for Payer: Aetna Commercial |
$26.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$24.08
|
| Rate for Payer: Cash Price |
$8.40
|
| Rate for Payer: Cash Price |
$8.40
|
| Rate for Payer: Cigna Commercial |
$26.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$14.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$16.80
|
| Rate for Payer: Health EOS Commercial |
$25.48
|
| Rate for Payer: HFN Commercial |
$26.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$42.78
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$42.78
|
| Rate for Payer: Multiplan Commercial |
$22.40
|
| Rate for Payer: Preferred Network Access Commercial |
$26.60
|
| Rate for Payer: Quartz Beloit One Network |
$12.32
|
| Rate for Payer: Quartz Commercial |
$15.96
|
| Rate for Payer: The Alliance Commercial |
$14.00
|
| Rate for Payer: WEA Trust Commercial |
$15.40
|
| Rate for Payer: WPS Commercial |
$20.74
|
|
|
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 |
$13.72 |
| Max. Negotiated Rate |
$25.76 |
| Rate for Payer: Aetna Commercial |
$25.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$24.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$14.84
|
| Rate for Payer: Cash Price |
$8.40
|
| Rate for Payer: Cigna Commercial |
$25.76
|
| Rate for Payer: Health EOS Commercial |
$24.92
|
| Rate for Payer: HFN Commercial |
$25.76
|
| Rate for Payer: Multiplan Commercial |
$22.40
|
| Rate for Payer: NAPHCARE Commercial |
$16.80
|
| Rate for Payer: Preferred Network Access Commercial |
$25.76
|
| Rate for Payer: Quartz Beloit One Network |
$13.72
|
| Rate for Payer: Quartz Commercial |
$16.80
|
| Rate for Payer: WEA Trust Commercial |
$15.40
|
| Rate for Payer: WPS Commercial |
$20.74
|
|
|
QUADRICEPS TENDON REPAIR, RUPTURED
|
Facility
|
OP
|
$4,912.00
|
|
| Hospital Charge Code |
2960537
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,375.36 |
| Max. Negotiated Rate |
$19,648.00 |
| Rate for Payer: Aetna Commercial |
$4,420.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,224.32
|
| Rate for Payer: Aetna Managed Medicare |
$1,375.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,192.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,456.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,357.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,603.36
|
| Rate for Payer: Cash Price |
$1,473.60
|
| Rate for Payer: Cigna Commercial |
$4,519.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,748.76
|
| Rate for Payer: Health EOS Commercial |
$4,371.68
|
| Rate for Payer: HFN Commercial |
$4,519.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,684.00
|
| Rate for Payer: Multiplan Commercial |
$3,929.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,947.20
|
| Rate for Payer: Preferred Network Access Commercial |
$4,519.04
|
| Rate for Payer: Quartz Beloit One Network |
$2,406.88
|
| Rate for Payer: Quartz Commercial |
$3,192.80
|
| Rate for Payer: Quartz Medicare Advantage |
$2,947.20
|
| Rate for Payer: The Alliance Commercial |
$19,648.00
|
| Rate for Payer: WEA Trust Commercial |
$2,701.60
|
| Rate for Payer: WPS Commercial |
$3,638.32
|
|
|
QUADRICEPS TENDON REPAIR, RUPTURED
|
Facility
|
IP
|
$4,912.00
|
|
| Hospital Charge Code |
2960537
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,406.88 |
| Max. Negotiated Rate |
$4,519.04 |
| Rate for Payer: Aetna Commercial |
$4,420.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,224.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,603.36
|
| Rate for Payer: Cash Price |
$1,473.60
|
| Rate for Payer: Cigna Commercial |
$4,519.04
|
| Rate for Payer: Health EOS Commercial |
$4,371.68
|
| Rate for Payer: HFN Commercial |
$4,519.04
|
| Rate for Payer: Multiplan Commercial |
$3,929.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,947.20
|
| Rate for Payer: Preferred Network Access Commercial |
$4,519.04
|
| Rate for Payer: Quartz Beloit One Network |
$2,406.88
|
| Rate for Payer: Quartz Commercial |
$2,947.20
|
| Rate for Payer: WEA Trust Commercial |
$2,701.60
|
| Rate for Payer: WPS Commercial |
$3,638.32
|
|
|
Quad Screen
|
Facility
|
OP
|
$245.00
|
|
|
Service Code
|
CPT 82105
|
| Hospital Charge Code |
983383
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$16.77 |
| Max. Negotiated Rate |
$225.40 |
| Rate for Payer: Aetna Commercial |
$220.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$210.70
|
| Rate for Payer: Aetna Managed Medicare |
$16.77
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$62.89
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$29.35
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$27.84
|
| Rate for Payer: Anthem Medicaid |
$17.33
|
| Rate for Payer: Anthem Medicare Advantage |
$16.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$129.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$16.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$16.77
|
| Rate for Payer: Cash Price |
$73.50
|
| Rate for Payer: Cash Price |
$73.50
|
| Rate for Payer: Cigna Commercial |
$225.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$16.77
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$17.33
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$137.10
|
| Rate for Payer: Dean Health Medicaid |
$17.33
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$16.77
|
| Rate for Payer: Health EOS Commercial |
$218.05
|
| Rate for Payer: HFN Commercial |
$225.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$62.38
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$16.77
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$17.33
|
| Rate for Payer: Independent Care Health Plan Medicare |
$16.77
|
| Rate for Payer: Managed Health Services Medicaid |
$18.02
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$16.77
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$16.77
|
| Rate for Payer: Multiplan Commercial |
$196.00
|
| Rate for Payer: NAPHCARE Commercial |
$25.16
|
| Rate for Payer: Preferred Network Access Commercial |
$225.40
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$17.33
|
| Rate for Payer: Quartz Beloit One Network |
$120.05
|
| Rate for Payer: Quartz Commercial |
$159.25
|
| Rate for Payer: Quartz Medicare Advantage |
$16.77
|
| Rate for Payer: The Alliance Commercial |
$67.08
|
| Rate for Payer: United Healthcare Medicaid |
$17.33
|
| Rate for Payer: United Healthcare Medicare Advantage |
$16.77
|
| Rate for Payer: United Healthcare PPO |
$183.75
|
| Rate for Payer: WEA Trust Commercial |
$134.75
|
| Rate for Payer: Wellcare Medicare |
$16.77
|
| Rate for Payer: WMAP Medicaid |
$17.33
|
| Rate for Payer: WPS Commercial |
$181.47
|
|
|
Quad Screen
|
Facility
|
IP
|
$245.00
|
|
|
Service Code
|
CPT 82105
|
| Hospital Charge Code |
983383
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$120.05 |
| Max. Negotiated Rate |
$225.40 |
| Rate for Payer: Aetna Commercial |
$220.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$210.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$129.85
|
| Rate for Payer: Cash Price |
$73.50
|
| Rate for Payer: Cigna Commercial |
$225.40
|
| Rate for Payer: Health EOS Commercial |
$218.05
|
| Rate for Payer: HFN Commercial |
$225.40
|
| Rate for Payer: Multiplan Commercial |
$196.00
|
| Rate for Payer: NAPHCARE Commercial |
$147.00
|
| Rate for Payer: Preferred Network Access Commercial |
$225.40
|
| Rate for Payer: Quartz Beloit One Network |
$120.05
|
| Rate for Payer: Quartz Commercial |
$147.00
|
| Rate for Payer: WEA Trust Commercial |
$134.75
|
| Rate for Payer: WPS Commercial |
$181.47
|
|
|
Quad Screen
|
Professional
|
Both
|
$245.00
|
|
|
Service Code
|
CPT 82105
|
| Hospital Charge Code |
983383
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$59.20 |
| Max. Negotiated Rate |
$232.75 |
| Rate for Payer: Aetna Commercial |
$232.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$210.70
|
| Rate for Payer: Cash Price |
$73.50
|
| Rate for Payer: Cash Price |
$73.50
|
| Rate for Payer: Cigna Commercial |
$232.75
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$122.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$147.00
|
| Rate for Payer: Health EOS Commercial |
$222.95
|
| Rate for Payer: HFN Commercial |
$232.75
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$59.20
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$59.20
|
| Rate for Payer: Multiplan Commercial |
$196.00
|
| Rate for Payer: Preferred Network Access Commercial |
$232.75
|
| Rate for Payer: Quartz Beloit One Network |
$107.80
|
| Rate for Payer: Quartz Commercial |
$139.65
|
| Rate for Payer: The Alliance Commercial |
$122.50
|
| Rate for Payer: WEA Trust Commercial |
$134.75
|
| Rate for Payer: WPS Commercial |
$181.47
|
|
