|
Bacitracin/Polymyxin B Ophth Oiintment 3.5gm [Med]
|
Facility
OP
|
$35.00
|
|
| Hospital Charge Code |
2974972
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.80 |
| Max. Negotiated Rate |
$140.00 |
| Rate for Payer: Aetna Commercial |
$31.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$30.10
|
| Rate for Payer: Aetna Managed Medicare |
$9.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$22.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$17.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$16.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$18.55
|
| Rate for Payer: Cash Price |
$10.50
|
| Rate for Payer: Cigna Commercial |
$32.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$19.59
|
| Rate for Payer: Health EOS Commercial |
$31.15
|
| Rate for Payer: HFN Commercial |
$32.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$26.25
|
| Rate for Payer: Multiplan Commercial |
$28.00
|
| Rate for Payer: NAPHCARE Commercial |
$21.00
|
| Rate for Payer: Preferred Network Access Commercial |
$32.20
|
| Rate for Payer: Quartz Beloit One Network |
$17.15
|
| Rate for Payer: Quartz Commercial |
$22.75
|
| Rate for Payer: Quartz Medicare Advantage |
$21.00
|
| Rate for Payer: The Alliance Commercial |
$140.00
|
| Rate for Payer: WEA Trust Commercial |
$19.25
|
| Rate for Payer: WPS Commercial |
$25.92
|
|
|
Bacitracin Solution 500ml [Med]
|
Facility
IP
|
$191.00
|
|
| Hospital Charge Code |
2974913
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$93.59 |
| Max. Negotiated Rate |
$175.72 |
| Rate for Payer: Aetna Commercial |
$171.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$101.23
|
| Rate for Payer: Cash Price |
$57.30
|
| Rate for Payer: Cigna Commercial |
$175.72
|
| Rate for Payer: Health EOS Commercial |
$169.99
|
| Rate for Payer: HFN Commercial |
$175.72
|
| Rate for Payer: Multiplan Commercial |
$152.80
|
| Rate for Payer: NAPHCARE Commercial |
$114.60
|
| Rate for Payer: Preferred Network Access Commercial |
$175.72
|
| Rate for Payer: Quartz Beloit One Network |
$93.59
|
| Rate for Payer: Quartz Commercial |
$114.60
|
| Rate for Payer: WEA Trust Commercial |
$105.05
|
| Rate for Payer: WPS Commercial |
$141.47
|
|
|
Bacitracin Solution 500ml [Med]
|
Facility
OP
|
$191.00
|
|
| Hospital Charge Code |
2974913
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$53.48 |
| Max. Negotiated Rate |
$764.00 |
| Rate for Payer: Aetna Commercial |
$171.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$164.26
|
| Rate for Payer: Aetna Managed Medicare |
$53.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$124.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$95.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$91.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$101.23
|
| Rate for Payer: Cash Price |
$57.30
|
| Rate for Payer: Cigna Commercial |
$175.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$106.88
|
| Rate for Payer: Health EOS Commercial |
$169.99
|
| Rate for Payer: HFN Commercial |
$175.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$143.25
|
| Rate for Payer: Multiplan Commercial |
$152.80
|
| Rate for Payer: NAPHCARE Commercial |
$114.60
|
| Rate for Payer: Preferred Network Access Commercial |
$175.72
|
| Rate for Payer: Quartz Beloit One Network |
$93.59
|
| Rate for Payer: Quartz Commercial |
$124.15
|
| Rate for Payer: Quartz Medicare Advantage |
$114.60
|
| Rate for Payer: The Alliance Commercial |
$764.00
|
| Rate for Payer: WEA Trust Commercial |
$105.05
|
| Rate for Payer: WPS Commercial |
$141.47
|
|
|
BACK AND NECK PROCEDURES EXCEPT SPINAL FUSION WITH CC
|
Facility
IP
|
$52,658.00
|
|
|
Service Code
|
MS-DRG 519
|
| Min. Negotiated Rate |
$18,941.55 |
| Max. Negotiated Rate |
$52,658.00 |
| Rate for Payer: Aetna Managed Medicare |
$18,941.55
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$41,330.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$31,679.57
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$30,097.66
|
| Rate for Payer: Anthem Medicare Advantage |
$18,941.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$18,941.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$18,941.55
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$18,941.55
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$33,411.16
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$18,941.55
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$38,387.70
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$18,941.55
|
| Rate for Payer: Independent Care Health Plan Medicare |
$18,941.55
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$18,941.55
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$18,941.55
|
| Rate for Payer: NAPHCARE Commercial |
$28,412.32
|
| Rate for Payer: Quartz Medicare Advantage |
$18,941.55
|
| Rate for Payer: The Alliance Commercial |
$52,658.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$18,941.55
|
| Rate for Payer: United Healthcare PPO |
$29,885.32
|
| Rate for Payer: Wellcare Medicare |
$18,941.55
|
|
|
BACK AND NECK PROCEDURES EXCEPT SPINAL FUSION WITH MCC OR DISC DEVICE OR NEUROSTIMULATOR
|
Facility
IP
|
$97,407.00
|
|
|
Service Code
|
MS-DRG 518
|
| Min. Negotiated Rate |
$35,038.51 |
| Max. Negotiated Rate |
$97,407.00 |
| Rate for Payer: Aetna Managed Medicare |
$35,038.51
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$76,577.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$58,695.65
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$55,764.70
|
| Rate for Payer: Anthem Medicare Advantage |
$35,038.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$35,038.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$35,038.51
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$35,038.51
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$61,903.93
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$35,038.51
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$71,210.10
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$35,038.51
|
| Rate for Payer: Independent Care Health Plan Medicare |
$35,038.51
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$35,038.51
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$35,038.51
|
| Rate for Payer: NAPHCARE Commercial |
$52,557.76
|
| Rate for Payer: Quartz Medicare Advantage |
$35,038.51
|
| Rate for Payer: The Alliance Commercial |
$97,407.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$35,038.51
|
| Rate for Payer: United Healthcare PPO |
$55,437.98
|
| Rate for Payer: Wellcare Medicare |
$35,038.51
|
|
|
BACK AND NECK PROCEDURES EXCEPT SPINAL FUSION WITHOUT CC/MCC
|
Facility
IP
|
$38,378.00
|
|
|
Service Code
|
MS-DRG 520
|
| Min. Negotiated Rate |
$13,805.11 |
| Max. Negotiated Rate |
$38,378.00 |
| Rate for Payer: Aetna Managed Medicare |
$13,805.11
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$30,001.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$22,995.83
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$21,847.54
|
| Rate for Payer: Anthem Medicare Advantage |
$13,805.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$13,805.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$13,805.11
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$13,805.11
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$24,252.77
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$13,805.11
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$27,914.25
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$13,805.11
|
| Rate for Payer: Independent Care Health Plan Medicare |
$13,805.11
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$13,805.11
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$13,805.11
|
| Rate for Payer: NAPHCARE Commercial |
$20,707.66
|
| Rate for Payer: Quartz Medicare Advantage |
$13,805.11
|
| Rate for Payer: The Alliance Commercial |
$38,378.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13,805.11
|
| Rate for Payer: United Healthcare PPO |
$21,731.60
|
| Rate for Payer: Wellcare Medicare |
$13,805.11
|
|
|
Bacteria ID, Aerobic / 34118
|
Professional
|
$23.00
|
|
|
Service Code
|
CPT 87077
|
| Hospital Charge Code |
4624617
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.08 |
| Max. Negotiated Rate |
$35.55 |
| Rate for Payer: Aetna Commercial |
$21.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$19.78
|
| Rate for Payer: Aetna Managed Medicare |
$8.08
|
| Rate for Payer: Anthem Medicare Advantage |
$8.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$8.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$8.08
|
| Rate for Payer: Cash Price |
$6.90
|
| Rate for Payer: Cash Price |
$6.90
|
| Rate for Payer: Cigna Commercial |
$21.85
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$11.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$8.08
|
| Rate for Payer: Health EOS Commercial |
$20.93
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$28.52
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$28.52
|
| Rate for Payer: Independent Care Health Plan Medicare |
$8.08
|
| Rate for Payer: Multiplan Commercial |
$18.40
|
| Rate for Payer: Preferred Network Access Commercial |
$21.85
|
| Rate for Payer: Quartz Beloit One Network |
$10.12
|
| Rate for Payer: Quartz Commercial |
$13.11
|
| Rate for Payer: Quartz Medicare Advantage |
$8.08
|
| Rate for Payer: The Alliance Commercial |
$31.92
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8.08
|
| Rate for Payer: WEA Trust Commercial |
$12.65
|
| Rate for Payer: WPS Commercial |
$35.55
|
|
|
Bacteria ID, Aerobic / 34118
|
Facility
OP
|
$23.00
|
|
|
Service Code
|
CPT 87077
|
| Hospital Charge Code |
4624617
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.08 |
| Max. Negotiated Rate |
$92.00 |
| Rate for Payer: Aetna Commercial |
$20.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$19.78
|
| Rate for Payer: Aetna Managed Medicare |
$8.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$30.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$14.14
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$13.41
|
| Rate for Payer: Anthem Medicaid |
$8.35
|
| Rate for Payer: Anthem Medicare Advantage |
$8.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$12.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$8.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$8.08
|
| Rate for Payer: Cash Price |
$6.90
|
| Rate for Payer: Cash Price |
$6.90
|
| Rate for Payer: Cigna Commercial |
$21.16
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$8.08
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$8.35
|
| Rate for Payer: Dean Health Medicaid |
$8.35
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$8.08
|
| Rate for Payer: Health EOS Commercial |
$20.47
|
| Rate for Payer: HFN Commercial |
$21.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$30.06
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$8.08
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$8.35
|
| Rate for Payer: Independent Care Health Plan Medicare |
$8.08
|
| Rate for Payer: Managed Health Services Medicaid |
$8.68
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$8.08
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$8.08
|
| Rate for Payer: Multiplan Commercial |
$18.40
|
| Rate for Payer: NAPHCARE Commercial |
$12.12
|
| Rate for Payer: Preferred Network Access Commercial |
$21.16
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$8.35
|
| Rate for Payer: Quartz Beloit One Network |
$11.27
|
| Rate for Payer: Quartz Commercial |
$14.95
|
| Rate for Payer: Quartz Medicare Advantage |
$8.08
|
| Rate for Payer: The Alliance Commercial |
$92.00
|
| Rate for Payer: United Healthcare Medicaid |
$8.35
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8.08
|
| Rate for Payer: United Healthcare PPO |
$17.25
|
| Rate for Payer: WEA Trust Commercial |
$12.65
|
| Rate for Payer: Wellcare Medicare |
$8.08
|
| Rate for Payer: WMAP Medicaid |
$8.35
|
| Rate for Payer: WPS Commercial |
$17.04
|
|
|
Bacteria ID, Aerobic / 34118
|
Facility
IP
|
$23.00
|
|
|
Service Code
|
CPT 87077
|
| Hospital Charge Code |
4624617
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.27 |
| Max. Negotiated Rate |
$21.16 |
| Rate for Payer: Aetna Commercial |
$20.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$12.19
|
| Rate for Payer: Cash Price |
$6.90
|
| Rate for Payer: Cigna Commercial |
$21.16
|
| Rate for Payer: Health EOS Commercial |
$20.47
|
| Rate for Payer: HFN Commercial |
$21.16
|
| Rate for Payer: Multiplan Commercial |
$18.40
|
| Rate for Payer: NAPHCARE Commercial |
$13.80
|
| Rate for Payer: Preferred Network Access Commercial |
$21.16
|
| Rate for Payer: Quartz Beloit One Network |
$11.27
|
| Rate for Payer: Quartz Commercial |
$13.80
|
| Rate for Payer: WEA Trust Commercial |
$12.65
|
| Rate for Payer: WPS Commercial |
$17.04
|
|
|
BACTERIAL AND TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM WITH CC
|
Facility
IP
|
$63,707.00
|
|
|
Service Code
|
MS-DRG 095
|
| Min. Negotiated Rate |
$22,916.07 |
| Max. Negotiated Rate |
$63,707.00 |
| Rate for Payer: Aetna Managed Medicare |
$22,916.07
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$49,932.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$38,272.78
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$36,361.64
|
| Rate for Payer: Anthem Medicare Advantage |
$22,916.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$22,916.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$22,916.07
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$22,916.07
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$40,364.75
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$22,916.07
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$46,491.90
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$22,916.07
|
| Rate for Payer: Independent Care Health Plan Medicare |
$22,916.07
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$22,916.07
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$22,916.07
|
| Rate for Payer: NAPHCARE Commercial |
$34,374.10
|
| Rate for Payer: Quartz Medicare Advantage |
$22,916.07
|
| Rate for Payer: The Alliance Commercial |
$63,707.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$22,916.07
|
| Rate for Payer: United Healthcare PPO |
$36,194.54
|
| Rate for Payer: Wellcare Medicare |
$22,916.07
|
|
|
BACTERIAL AND TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM WITH MCC
|
Facility
IP
|
$96,633.00
|
|
|
Service Code
|
MS-DRG 094
|
| Min. Negotiated Rate |
$34,760.21 |
| Max. Negotiated Rate |
$96,633.00 |
| Rate for Payer: Quartz Medicare Advantage |
$34,760.21
|
| Rate for Payer: Aetna Managed Medicare |
$34,760.21
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$75,947.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$58,213.22
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$55,306.36
|
| Rate for Payer: Anthem Medicare Advantage |
$34,760.21
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$34,760.21
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$34,760.21
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$34,760.21
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$61,395.13
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$34,760.21
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$70,642.65
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$34,760.21
|
| Rate for Payer: Independent Care Health Plan Medicare |
$34,760.21
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$34,760.21
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$34,760.21
|
| Rate for Payer: NAPHCARE Commercial |
$52,140.32
|
| Rate for Payer: The Alliance Commercial |
$96,633.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$34,760.21
|
| Rate for Payer: United Healthcare PPO |
$54,996.21
|
| Rate for Payer: Wellcare Medicare |
$34,760.21
|
|
|
BACTERIAL AND TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM WITHOUT CC/MCC
|
Facility
IP
|
$58,270.00
|
|
|
Service Code
|
MS-DRG 096
|
| Min. Negotiated Rate |
$20,960.38 |
| Max. Negotiated Rate |
$58,270.00 |
| Rate for Payer: Aetna Managed Medicare |
$20,960.38
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$45,736.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$35,056.58
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$33,306.04
|
| Rate for Payer: Anthem Medicare Advantage |
$20,960.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$20,960.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$20,960.38
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$20,960.38
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$36,972.76
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$20,960.38
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$42,504.15
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$20,960.38
|
| Rate for Payer: Independent Care Health Plan Medicare |
$20,960.38
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$20,960.38
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$20,960.38
|
| Rate for Payer: NAPHCARE Commercial |
$31,440.57
|
| Rate for Payer: Quartz Medicare Advantage |
$20,960.38
|
| Rate for Payer: The Alliance Commercial |
$58,270.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$20,960.38
|
| Rate for Payer: United Healthcare PPO |
$33,090.03
|
| Rate for Payer: Wellcare Medicare |
$20,960.38
|
|
|
Bacterial Antigen
|
Facility
IP
|
$31.00
|
|
|
Service Code
|
CPT 86403
|
| Hospital Charge Code |
2770816
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.19 |
| Max. Negotiated Rate |
$28.52 |
| Rate for Payer: Aetna Commercial |
$27.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$16.43
|
| Rate for Payer: Cash Price |
$9.30
|
| Rate for Payer: Cigna Commercial |
$28.52
|
| Rate for Payer: Health EOS Commercial |
$27.59
|
| Rate for Payer: HFN Commercial |
$28.52
|
| Rate for Payer: Multiplan Commercial |
$24.80
|
| Rate for Payer: NAPHCARE Commercial |
$18.60
|
| Rate for Payer: Preferred Network Access Commercial |
$28.52
|
| Rate for Payer: Quartz Beloit One Network |
$15.19
|
| Rate for Payer: Quartz Commercial |
$18.60
|
| Rate for Payer: WEA Trust Commercial |
$17.05
|
| Rate for Payer: WPS Commercial |
$22.96
|
|
|
Bacterial Antigen
|
Professional
|
$31.00
|
|
|
Service Code
|
CPT 86403
|
| Hospital Charge Code |
2770816
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.54 |
| Max. Negotiated Rate |
$50.78 |
| Rate for Payer: Aetna Commercial |
$29.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$26.66
|
| Rate for Payer: Aetna Managed Medicare |
$11.54
|
| Rate for Payer: Anthem Medicare Advantage |
$11.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$11.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$11.54
|
| Rate for Payer: Cash Price |
$9.30
|
| Rate for Payer: Cash Price |
$9.30
|
| Rate for Payer: Cigna Commercial |
$29.45
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$15.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$11.54
|
| Rate for Payer: Health EOS Commercial |
$28.21
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$40.74
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$40.74
|
| Rate for Payer: Independent Care Health Plan Medicare |
$11.54
|
| Rate for Payer: Multiplan Commercial |
$24.80
|
| Rate for Payer: Preferred Network Access Commercial |
$29.45
|
| Rate for Payer: Quartz Beloit One Network |
$13.64
|
| Rate for Payer: Quartz Commercial |
$17.67
|
| Rate for Payer: Quartz Medicare Advantage |
$11.54
|
| Rate for Payer: The Alliance Commercial |
$45.58
|
| Rate for Payer: United Healthcare Medicare Advantage |
$11.54
|
| Rate for Payer: WEA Trust Commercial |
$17.05
|
| Rate for Payer: WPS Commercial |
$50.78
|
|
|
Bacterial Antigen
|
Facility
OP
|
$31.00
|
|
|
Service Code
|
CPT 86403
|
| Hospital Charge Code |
2770816
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.54 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: Aetna Commercial |
$27.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$26.66
|
| Rate for Payer: Aetna Managed Medicare |
$11.54
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$43.28
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$20.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$19.16
|
| Rate for Payer: Anthem Medicaid |
$11.92
|
| Rate for Payer: Anthem Medicare Advantage |
$11.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$16.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$11.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$11.54
|
| Rate for Payer: Cash Price |
$9.30
|
| Rate for Payer: Cash Price |
$9.30
|
| Rate for Payer: Cigna Commercial |
$28.52
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$11.54
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$11.92
|
| Rate for Payer: Dean Health Medicaid |
$11.92
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$11.54
|
| Rate for Payer: Health EOS Commercial |
$27.59
|
| Rate for Payer: HFN Commercial |
$28.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$42.93
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$11.54
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$11.92
|
| Rate for Payer: Independent Care Health Plan Medicare |
$11.54
|
| Rate for Payer: Managed Health Services Medicaid |
$12.40
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$11.54
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$11.54
|
| Rate for Payer: Multiplan Commercial |
$24.80
|
| Rate for Payer: NAPHCARE Commercial |
$17.31
|
| Rate for Payer: Preferred Network Access Commercial |
$28.52
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$11.92
|
| Rate for Payer: Quartz Beloit One Network |
$15.19
|
| Rate for Payer: Quartz Commercial |
$20.15
|
| Rate for Payer: Quartz Medicare Advantage |
$11.54
|
| Rate for Payer: The Alliance Commercial |
$124.00
|
| Rate for Payer: United Healthcare Medicaid |
$11.92
|
| Rate for Payer: United Healthcare Medicare Advantage |
$11.54
|
| Rate for Payer: United Healthcare PPO |
$23.25
|
| Rate for Payer: WEA Trust Commercial |
$17.05
|
| Rate for Payer: Wellcare Medicare |
$11.54
|
| Rate for Payer: WMAP Medicaid |
$11.92
|
| Rate for Payer: WPS Commercial |
$22.96
|
|
|
Bacterial DNA detection by 16S to UW
|
Professional
|
$1,000.00
|
|
|
Service Code
|
CPT 87153
|
| Hospital Charge Code |
4732612
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$115.36 |
| Max. Negotiated Rate |
$950.00 |
| Rate for Payer: Aetna Commercial |
$950.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$860.00
|
| Rate for Payer: Aetna Managed Medicare |
$115.36
|
| Rate for Payer: Anthem Medicare Advantage |
$115.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$115.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$115.36
|
| Rate for Payer: Cash Price |
$300.00
|
| Rate for Payer: Cash Price |
$300.00
|
| Rate for Payer: Cigna Commercial |
$950.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$500.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$115.36
|
| Rate for Payer: Health EOS Commercial |
$910.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$407.22
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$407.22
|
| Rate for Payer: Independent Care Health Plan Medicare |
$115.36
|
| Rate for Payer: Multiplan Commercial |
$800.00
|
| Rate for Payer: Preferred Network Access Commercial |
$950.00
|
| Rate for Payer: Quartz Beloit One Network |
$440.00
|
| Rate for Payer: Quartz Commercial |
$570.00
|
| Rate for Payer: Quartz Medicare Advantage |
$115.36
|
| Rate for Payer: The Alliance Commercial |
$455.67
|
| Rate for Payer: United Healthcare Medicare Advantage |
$115.36
|
| Rate for Payer: WEA Trust Commercial |
$550.00
|
| Rate for Payer: WPS Commercial |
$507.58
|
|
|
Bacterial DNA detection by 16S to UW
|
Facility
IP
|
$1,000.00
|
|
|
Service Code
|
CPT 87153
|
| Hospital Charge Code |
4732612
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$490.00 |
| Max. Negotiated Rate |
$920.00 |
| Rate for Payer: Aetna Commercial |
$900.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$530.00
|
| Rate for Payer: Cash Price |
$300.00
|
| Rate for Payer: Cigna Commercial |
$920.00
|
| Rate for Payer: Health EOS Commercial |
$890.00
|
| Rate for Payer: HFN Commercial |
$920.00
|
| Rate for Payer: Multiplan Commercial |
$800.00
|
| Rate for Payer: NAPHCARE Commercial |
$600.00
|
| Rate for Payer: Preferred Network Access Commercial |
$920.00
|
| Rate for Payer: Quartz Beloit One Network |
$490.00
|
| Rate for Payer: Quartz Commercial |
$600.00
|
| Rate for Payer: WEA Trust Commercial |
$550.00
|
| Rate for Payer: WPS Commercial |
$740.70
|
|
|
Bacterial DNA detection by 16S to UW
|
Facility
OP
|
$1,000.00
|
|
|
Service Code
|
CPT 87153
|
| Hospital Charge Code |
4732612
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$115.36 |
| Max. Negotiated Rate |
$4,000.00 |
| Rate for Payer: Aetna Commercial |
$900.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$860.00
|
| Rate for Payer: Aetna Managed Medicare |
$115.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$432.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$201.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$191.50
|
| Rate for Payer: Anthem Medicaid |
$119.20
|
| Rate for Payer: Anthem Medicare Advantage |
$115.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$530.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$115.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$115.36
|
| Rate for Payer: Cash Price |
$300.00
|
| Rate for Payer: Cash Price |
$300.00
|
| Rate for Payer: Cigna Commercial |
$920.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$115.36
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$119.20
|
| Rate for Payer: Dean Health Medicaid |
$119.20
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$115.36
|
| Rate for Payer: Health EOS Commercial |
$890.00
|
| Rate for Payer: HFN Commercial |
$920.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$429.14
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$115.36
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$119.20
|
| Rate for Payer: Independent Care Health Plan Medicare |
$115.36
|
| Rate for Payer: Managed Health Services Medicaid |
$123.97
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$115.36
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$115.36
|
| Rate for Payer: Multiplan Commercial |
$800.00
|
| Rate for Payer: NAPHCARE Commercial |
$173.04
|
| Rate for Payer: Preferred Network Access Commercial |
$920.00
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$119.20
|
| Rate for Payer: Quartz Beloit One Network |
$490.00
|
| Rate for Payer: Quartz Commercial |
$650.00
|
| Rate for Payer: Quartz Medicare Advantage |
$115.36
|
| Rate for Payer: The Alliance Commercial |
$4,000.00
|
| Rate for Payer: United Healthcare Medicaid |
$119.20
|
| Rate for Payer: United Healthcare Medicare Advantage |
$115.36
|
| Rate for Payer: United Healthcare PPO |
$750.00
|
| Rate for Payer: WEA Trust Commercial |
$550.00
|
| Rate for Payer: Wellcare Medicare |
$115.36
|
| Rate for Payer: WMAP Medicaid |
$119.20
|
| Rate for Payer: WPS Commercial |
$740.70
|
|
|
Bacteriostatic Sodium Chloride 30ml MDV [Med]
|
Facility
OP
|
$11.00
|
|
| Hospital Charge Code |
2974981
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.08 |
| Max. Negotiated Rate |
$44.00 |
| Rate for Payer: Aetna Commercial |
$9.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9.46
|
| Rate for Payer: Aetna Managed Medicare |
$3.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$7.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5.83
|
| Rate for Payer: Cash Price |
$3.30
|
| Rate for Payer: Cigna Commercial |
$10.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6.16
|
| Rate for Payer: Health EOS Commercial |
$9.79
|
| Rate for Payer: HFN Commercial |
$10.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$8.25
|
| Rate for Payer: Multiplan Commercial |
$8.80
|
| Rate for Payer: NAPHCARE Commercial |
$6.60
|
| Rate for Payer: Preferred Network Access Commercial |
$10.12
|
| Rate for Payer: Quartz Beloit One Network |
$5.39
|
| Rate for Payer: Quartz Commercial |
$7.15
|
| Rate for Payer: Quartz Medicare Advantage |
$6.60
|
| Rate for Payer: The Alliance Commercial |
$44.00
|
| Rate for Payer: WEA Trust Commercial |
$6.05
|
| Rate for Payer: WPS Commercial |
$8.15
|
|
|
Bacteriostatic Sodium Chloride 30ml MDV [Med]
|
Facility
IP
|
$11.00
|
|
| Hospital Charge Code |
2974981
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$5.39 |
| Max. Negotiated Rate |
$10.12 |
| Rate for Payer: Aetna Commercial |
$9.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5.83
|
| Rate for Payer: Cash Price |
$3.30
|
| Rate for Payer: Cigna Commercial |
$10.12
|
| Rate for Payer: Health EOS Commercial |
$9.79
|
| Rate for Payer: HFN Commercial |
$10.12
|
| Rate for Payer: Multiplan Commercial |
$8.80
|
| Rate for Payer: NAPHCARE Commercial |
$6.60
|
| Rate for Payer: Preferred Network Access Commercial |
$10.12
|
| Rate for Payer: Quartz Beloit One Network |
$5.39
|
| Rate for Payer: Quartz Commercial |
$6.60
|
| Rate for Payer: WEA Trust Commercial |
$6.05
|
| Rate for Payer: WPS Commercial |
$8.15
|
|
|
BAG 150ML RESERVOIR #1PR-150
|
Facility
OP
|
$260.00
|
|
|
Service Code
|
HCPCS A4627
|
| Hospital Charge Code |
2970379
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$72.80 |
| Max. Negotiated Rate |
$1,040.00 |
| Rate for Payer: WEA Trust Commercial |
$143.00
|
| Rate for Payer: Aetna Commercial |
$234.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$223.60
|
| Rate for Payer: Aetna Managed Medicare |
$72.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$169.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$130.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$124.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$137.80
|
| Rate for Payer: Cash Price |
$78.00
|
| Rate for Payer: Cigna Commercial |
$239.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$145.50
|
| Rate for Payer: Health EOS Commercial |
$231.40
|
| Rate for Payer: HFN Commercial |
$239.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$195.00
|
| Rate for Payer: Multiplan Commercial |
$208.00
|
| Rate for Payer: NAPHCARE Commercial |
$156.00
|
| Rate for Payer: Preferred Network Access Commercial |
$239.20
|
| Rate for Payer: Quartz Beloit One Network |
$127.40
|
| Rate for Payer: Quartz Commercial |
$169.00
|
| Rate for Payer: Quartz Medicare Advantage |
$156.00
|
| Rate for Payer: The Alliance Commercial |
$1,040.00
|
| Rate for Payer: WPS Commercial |
$192.58
|
|
|
BAG 150ML RESERVOIR #1PR-150
|
Facility
IP
|
$260.00
|
|
|
Service Code
|
HCPCS A4627
|
| Hospital Charge Code |
2970379
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$127.40 |
| Max. Negotiated Rate |
$239.20 |
| Rate for Payer: Aetna Commercial |
$234.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$137.80
|
| Rate for Payer: Cash Price |
$78.00
|
| Rate for Payer: Cigna Commercial |
$239.20
|
| Rate for Payer: Health EOS Commercial |
$231.40
|
| Rate for Payer: HFN Commercial |
$239.20
|
| Rate for Payer: Multiplan Commercial |
$208.00
|
| Rate for Payer: NAPHCARE Commercial |
$156.00
|
| Rate for Payer: Preferred Network Access Commercial |
$239.20
|
| Rate for Payer: Quartz Beloit One Network |
$127.40
|
| Rate for Payer: Quartz Commercial |
$156.00
|
| Rate for Payer: WEA Trust Commercial |
$143.00
|
| Rate for Payer: WPS Commercial |
$192.58
|
|
|
BAG BELLY COLLECTION 1000ML
|
Facility
IP
|
$458.00
|
|
|
Service Code
|
HCPCS A4335
|
| Hospital Charge Code |
2974440
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$224.42 |
| Max. Negotiated Rate |
$421.36 |
| Rate for Payer: Aetna Commercial |
$412.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$242.74
|
| Rate for Payer: Cash Price |
$137.40
|
| Rate for Payer: Cigna Commercial |
$421.36
|
| Rate for Payer: Health EOS Commercial |
$407.62
|
| Rate for Payer: HFN Commercial |
$421.36
|
| Rate for Payer: Multiplan Commercial |
$366.40
|
| Rate for Payer: NAPHCARE Commercial |
$274.80
|
| Rate for Payer: Preferred Network Access Commercial |
$421.36
|
| Rate for Payer: Quartz Beloit One Network |
$224.42
|
| Rate for Payer: Quartz Commercial |
$274.80
|
| Rate for Payer: WEA Trust Commercial |
$251.90
|
| Rate for Payer: WPS Commercial |
$339.24
|
|
|
BAG BELLY COLLECTION 1000ML
|
Facility
OP
|
$458.00
|
|
|
Service Code
|
HCPCS A4335
|
| Hospital Charge Code |
2974440
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$128.24 |
| Max. Negotiated Rate |
$421.36 |
| Rate for Payer: Aetna Commercial |
$412.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$393.88
|
| Rate for Payer: Aetna Managed Medicare |
$128.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$297.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$229.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$219.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$242.74
|
| Rate for Payer: Cash Price |
$137.40
|
| Rate for Payer: Cigna Commercial |
$421.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$256.30
|
| Rate for Payer: Health EOS Commercial |
$407.62
|
| Rate for Payer: HFN Commercial |
$421.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$343.50
|
| Rate for Payer: Multiplan Commercial |
$366.40
|
| Rate for Payer: NAPHCARE Commercial |
$274.80
|
| Rate for Payer: Preferred Network Access Commercial |
$421.36
|
| Rate for Payer: Quartz Beloit One Network |
$224.42
|
| Rate for Payer: Quartz Commercial |
$297.70
|
| Rate for Payer: Quartz Medicare Advantage |
$274.80
|
| Rate for Payer: WEA Trust Commercial |
$251.90
|
| Rate for Payer: WPS Commercial |
$339.24
|
|
|
BAG BREATHING 2L SYNTHETIC #20902
|
Facility
IP
|
$83.00
|
|
| Hospital Charge Code |
2962840
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$40.67 |
| Max. Negotiated Rate |
$76.36 |
| Rate for Payer: Aetna Commercial |
$74.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$43.99
|
| Rate for Payer: Cash Price |
$24.90
|
| Rate for Payer: Cigna Commercial |
$76.36
|
| Rate for Payer: Health EOS Commercial |
$73.87
|
| Rate for Payer: HFN Commercial |
$76.36
|
| Rate for Payer: Multiplan Commercial |
$66.40
|
| Rate for Payer: NAPHCARE Commercial |
$49.80
|
| Rate for Payer: Preferred Network Access Commercial |
$76.36
|
| Rate for Payer: Quartz Beloit One Network |
$40.67
|
| Rate for Payer: Quartz Commercial |
$49.80
|
| Rate for Payer: WEA Trust Commercial |
$45.65
|
| Rate for Payer: WPS Commercial |
$61.48
|
|
