|
SPACER UNIVERSAL REVERSE 42 +6 AR-9550-06
|
Facility
|
IP
|
$5,012.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5349061
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,554.12 |
| Max. Negotiated Rate |
$4,795.48 |
| Rate for Payer: Aetna Commercial |
$4,691.23
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,482.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,762.61
|
| Rate for Payer: Cash Price |
$1,503.60
|
| Rate for Payer: Cigna Commercial |
$4,795.48
|
| Rate for Payer: Health EOS Commercial |
$4,639.11
|
| Rate for Payer: HFN Commercial |
$4,795.48
|
| Rate for Payer: Multiplan Commercial |
$4,169.98
|
| Rate for Payer: Preferred Network Access Commercial |
$4,795.48
|
| Rate for Payer: Quartz Beloit One Network |
$2,554.12
|
| Rate for Payer: Quartz Commercial |
$3,127.49
|
| Rate for Payer: WEA Trust Commercial |
$2,866.86
|
| Rate for Payer: WPS Commercial |
$3,860.74
|
|
|
SPACER UNIVERSAL REVERSE 42 +6 AR-9550-06
|
Facility
|
OP
|
$5,012.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5349061
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,459.49 |
| Max. Negotiated Rate |
$4,795.48 |
| Rate for Payer: Aetna Commercial |
$4,691.23
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,482.73
|
| Rate for Payer: Aetna Managed Medicare |
$1,459.49
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,388.11
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,606.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,501.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,762.61
|
| Rate for Payer: Cash Price |
$1,503.60
|
| Rate for Payer: Cigna Commercial |
$4,795.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,916.98
|
| Rate for Payer: Health EOS Commercial |
$4,639.11
|
| Rate for Payer: HFN Commercial |
$4,795.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,909.36
|
| Rate for Payer: Multiplan Commercial |
$4,169.98
|
| Rate for Payer: NAPHCARE Commercial |
$3,127.49
|
| Rate for Payer: Preferred Network Access Commercial |
$4,795.48
|
| Rate for Payer: Quartz Beloit One Network |
$2,554.12
|
| Rate for Payer: Quartz Commercial |
$3,388.11
|
| Rate for Payer: Quartz Medicare Advantage |
$3,127.49
|
| Rate for Payer: The Alliance Commercial |
$2,606.24
|
| Rate for Payer: WEA Trust Commercial |
$2,866.86
|
| Rate for Payer: WPS Commercial |
$3,860.74
|
|
|
SPATULA PROBE PLUS #EPS02
|
Facility
|
IP
|
$1,453.00
|
|
| Hospital Charge Code |
2962913
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$740.45 |
| Max. Negotiated Rate |
$1,390.23 |
| Rate for Payer: Aetna Commercial |
$1,360.01
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,299.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$800.89
|
| Rate for Payer: Cash Price |
$435.90
|
| Rate for Payer: Cigna Commercial |
$1,390.23
|
| Rate for Payer: Health EOS Commercial |
$1,344.90
|
| Rate for Payer: HFN Commercial |
$1,390.23
|
| Rate for Payer: Multiplan Commercial |
$1,208.90
|
| Rate for Payer: Preferred Network Access Commercial |
$1,390.23
|
| Rate for Payer: Quartz Beloit One Network |
$740.45
|
| Rate for Payer: Quartz Commercial |
$906.67
|
| Rate for Payer: WEA Trust Commercial |
$831.12
|
| Rate for Payer: WPS Commercial |
$1,119.25
|
|
|
SPATULA PROBE PLUS #EPS02
|
Facility
|
OP
|
$1,453.00
|
|
| Hospital Charge Code |
2962913
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$423.11 |
| Max. Negotiated Rate |
$1,390.23 |
| Rate for Payer: Aetna Commercial |
$1,360.01
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,299.56
|
| Rate for Payer: Aetna Managed Medicare |
$423.11
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$982.23
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$755.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$725.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$800.89
|
| Rate for Payer: Cash Price |
$435.90
|
| Rate for Payer: Cigna Commercial |
$1,390.23
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$845.65
|
| Rate for Payer: Health EOS Commercial |
$1,344.90
|
| Rate for Payer: HFN Commercial |
$1,390.23
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,133.34
|
| Rate for Payer: Multiplan Commercial |
$1,208.90
|
| Rate for Payer: NAPHCARE Commercial |
$906.67
|
| Rate for Payer: Preferred Network Access Commercial |
$1,390.23
|
| Rate for Payer: Quartz Beloit One Network |
$740.45
|
| Rate for Payer: Quartz Commercial |
$982.23
|
| Rate for Payer: Quartz Medicare Advantage |
$906.67
|
| Rate for Payer: The Alliance Commercial |
$755.56
|
| Rate for Payer: WEA Trust Commercial |
$831.12
|
| Rate for Payer: WPS Commercial |
$1,119.25
|
|
|
SpCO
|
Facility
|
OP
|
$67.00
|
|
|
Service Code
|
CPT 88740
|
| Hospital Charge Code |
3006906
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.74 |
| Max. Negotiated Rate |
$64.11 |
| Rate for Payer: Aetna Commercial |
$62.71
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$59.92
|
| Rate for Payer: Aetna Managed Medicare |
$9.74
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$36.54
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$17.05
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$16.18
|
| Rate for Payer: Anthem Medicare Advantage |
$9.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$36.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$9.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$9.74
|
| Rate for Payer: Cash Price |
$20.10
|
| Rate for Payer: Cash Price |
$20.10
|
| Rate for Payer: Cigna Commercial |
$64.11
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$9.74
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$38.99
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$9.74
|
| Rate for Payer: Health EOS Commercial |
$62.02
|
| Rate for Payer: HFN Commercial |
$64.11
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$36.25
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$9.74
|
| Rate for Payer: Independent Care Health Plan Medicare |
$9.74
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$9.74
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$9.74
|
| Rate for Payer: Multiplan Commercial |
$55.74
|
| Rate for Payer: NAPHCARE Commercial |
$14.62
|
| Rate for Payer: Preferred Network Access Commercial |
$64.11
|
| Rate for Payer: Quartz Beloit One Network |
$34.14
|
| Rate for Payer: Quartz Commercial |
$45.29
|
| Rate for Payer: Quartz Medicare Advantage |
$9.74
|
| Rate for Payer: The Alliance Commercial |
$38.98
|
| Rate for Payer: United Healthcare Medicare Advantage |
$9.74
|
| Rate for Payer: United Healthcare PPO |
$52.26
|
| Rate for Payer: WEA Trust Commercial |
$38.32
|
| Rate for Payer: Wellcare Medicare |
$9.74
|
| Rate for Payer: WPS Commercial |
$51.61
|
|
|
SpCO
|
Facility
|
IP
|
$67.00
|
|
|
Service Code
|
CPT 88740
|
| Hospital Charge Code |
3006906
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$34.14 |
| Max. Negotiated Rate |
$64.11 |
| Rate for Payer: Aetna Commercial |
$62.71
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$59.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$36.93
|
| Rate for Payer: Cash Price |
$20.10
|
| Rate for Payer: Cigna Commercial |
$64.11
|
| Rate for Payer: Health EOS Commercial |
$62.02
|
| Rate for Payer: HFN Commercial |
$64.11
|
| Rate for Payer: Multiplan Commercial |
$55.74
|
| Rate for Payer: Preferred Network Access Commercial |
$64.11
|
| Rate for Payer: Quartz Beloit One Network |
$34.14
|
| Rate for Payer: Quartz Commercial |
$41.81
|
| Rate for Payer: WEA Trust Commercial |
$38.32
|
| Rate for Payer: WPS Commercial |
$51.61
|
|
|
Special bed
|
Facility
|
OP
|
$139.00
|
|
|
Service Code
|
CPT 94667
|
| Hospital Charge Code |
2989710
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$69.39 |
| Max. Negotiated Rate |
$560.06 |
| Rate for Payer: Aetna Commercial |
$130.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$124.32
|
| Rate for Payer: Aetna Managed Medicare |
$140.02
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$93.96
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$72.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$69.39
|
| Rate for Payer: Anthem Medicare Advantage |
$140.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$76.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$140.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$140.02
|
| Rate for Payer: Cash Price |
$41.70
|
| Rate for Payer: Cash Price |
$41.70
|
| Rate for Payer: Cigna Commercial |
$133.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$140.02
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$80.90
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$140.02
|
| Rate for Payer: Health EOS Commercial |
$128.66
|
| Rate for Payer: HFN Commercial |
$133.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$520.86
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$140.02
|
| Rate for Payer: Independent Care Health Plan Medicare |
$140.02
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$140.02
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$140.02
|
| Rate for Payer: Multiplan Commercial |
$115.65
|
| Rate for Payer: NAPHCARE Commercial |
$210.02
|
| Rate for Payer: Preferred Network Access Commercial |
$133.00
|
| Rate for Payer: Quartz Beloit One Network |
$70.83
|
| Rate for Payer: Quartz Commercial |
$93.96
|
| Rate for Payer: Quartz Medicare Advantage |
$140.02
|
| Rate for Payer: The Alliance Commercial |
$560.06
|
| Rate for Payer: United Healthcare Medicare Advantage |
$140.02
|
| Rate for Payer: United Healthcare PPO |
$108.42
|
| Rate for Payer: WEA Trust Commercial |
$79.51
|
| Rate for Payer: Wellcare Medicare |
$140.02
|
| Rate for Payer: WPS Commercial |
$107.07
|
|
|
Special bed
|
Facility
|
IP
|
$139.00
|
|
|
Service Code
|
CPT 94667
|
| Hospital Charge Code |
2989710
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$70.83 |
| Max. Negotiated Rate |
$133.00 |
| Rate for Payer: Aetna Commercial |
$130.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$124.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$76.62
|
| Rate for Payer: Cash Price |
$41.70
|
| Rate for Payer: Cigna Commercial |
$133.00
|
| Rate for Payer: Health EOS Commercial |
$128.66
|
| Rate for Payer: HFN Commercial |
$133.00
|
| Rate for Payer: Multiplan Commercial |
$115.65
|
| Rate for Payer: Preferred Network Access Commercial |
$133.00
|
| Rate for Payer: Quartz Beloit One Network |
$70.83
|
| Rate for Payer: Quartz Commercial |
$86.74
|
| Rate for Payer: WEA Trust Commercial |
$79.51
|
| Rate for Payer: WPS Commercial |
$107.07
|
|
|
Special Care Observation Per Hour
|
Facility
|
IP
|
$110.00
|
|
|
Service Code
|
HCPCS G0378
|
| Hospital Charge Code |
3040437
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$56.06 |
| Max. Negotiated Rate |
$105.25 |
| Rate for Payer: Aetna Commercial |
$102.96
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$98.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$60.63
|
| Rate for Payer: Cash Price |
$33.00
|
| Rate for Payer: Cigna Commercial |
$105.25
|
| Rate for Payer: Health EOS Commercial |
$101.82
|
| Rate for Payer: HFN Commercial |
$105.25
|
| Rate for Payer: Multiplan Commercial |
$91.52
|
| Rate for Payer: Preferred Network Access Commercial |
$105.25
|
| Rate for Payer: Quartz Beloit One Network |
$56.06
|
| Rate for Payer: Quartz Commercial |
$68.64
|
| Rate for Payer: WEA Trust Commercial |
$62.92
|
| Rate for Payer: WPS Commercial |
$84.73
|
|
|
Special Care Observation Per Hour
|
Facility
|
OP
|
$110.00
|
|
|
Service Code
|
HCPCS G0378
|
| Hospital Charge Code |
3040437
|
|
Hospital Revenue Code
|
762
|
| Min. Negotiated Rate |
$32.03 |
| Max. Negotiated Rate |
$7,271.68 |
| Rate for Payer: Aetna Commercial |
$102.96
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$98.38
|
| Rate for Payer: Aetna Managed Medicare |
$32.03
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$7,271.68
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$6,271.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5,958.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$60.63
|
| Rate for Payer: Cash Price |
$33.00
|
| Rate for Payer: Cash Price |
$33.00
|
| Rate for Payer: Cigna Commercial |
$105.25
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$64.02
|
| Rate for Payer: Health EOS Commercial |
$101.82
|
| Rate for Payer: HFN Commercial |
$105.25
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$85.80
|
| Rate for Payer: Multiplan Commercial |
$91.52
|
| Rate for Payer: NAPHCARE Commercial |
$68.64
|
| Rate for Payer: Preferred Network Access Commercial |
$105.25
|
| Rate for Payer: Quartz Beloit One Network |
$56.06
|
| Rate for Payer: Quartz Commercial |
$74.36
|
| Rate for Payer: Quartz Medicare Advantage |
$68.64
|
| Rate for Payer: The Alliance Commercial |
$57.20
|
| Rate for Payer: United Healthcare PPO |
$2,701.92
|
| Rate for Payer: WEA Trust Commercial |
$62.92
|
| Rate for Payer: WPS Commercial |
$84.73
|
|
|
Special Dosimetry
|
Facility
|
OP
|
$745.00
|
|
|
Service Code
|
CPT 77331
|
| Hospital Charge Code |
3040385
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$141.45 |
| Max. Negotiated Rate |
$712.82 |
| Rate for Payer: Aetna Commercial |
$697.32
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$666.33
|
| Rate for Payer: Aetna Managed Medicare |
$141.45
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$523.03
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$418.42
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$397.50
|
| Rate for Payer: Anthem Medicare Advantage |
$141.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$410.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$141.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$141.45
|
| Rate for Payer: Cash Price |
$223.50
|
| Rate for Payer: Cash Price |
$223.50
|
| Rate for Payer: Cigna Commercial |
$712.82
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$141.45
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$433.59
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$141.45
|
| Rate for Payer: Health EOS Commercial |
$689.57
|
| Rate for Payer: HFN Commercial |
$712.82
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$526.20
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$141.45
|
| Rate for Payer: Independent Care Health Plan Medicare |
$141.45
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$141.45
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$141.45
|
| Rate for Payer: Multiplan Commercial |
$619.84
|
| Rate for Payer: NAPHCARE Commercial |
$212.18
|
| Rate for Payer: Preferred Network Access Commercial |
$712.82
|
| Rate for Payer: Quartz Beloit One Network |
$379.65
|
| Rate for Payer: Quartz Commercial |
$503.62
|
| Rate for Payer: Quartz Medicare Advantage |
$141.45
|
| Rate for Payer: The Alliance Commercial |
$565.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$141.45
|
| Rate for Payer: United Healthcare PPO |
$581.10
|
| Rate for Payer: WEA Trust Commercial |
$426.14
|
| Rate for Payer: Wellcare Medicare |
$141.45
|
| Rate for Payer: WPS Commercial |
$573.87
|
|
|
Special Dosimetry
|
Facility
|
IP
|
$745.00
|
|
|
Service Code
|
CPT 77331
|
| Hospital Charge Code |
3040385
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$379.65 |
| Max. Negotiated Rate |
$712.82 |
| Rate for Payer: Aetna Commercial |
$697.32
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$666.33
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$410.64
|
| Rate for Payer: Cash Price |
$223.50
|
| Rate for Payer: Cigna Commercial |
$712.82
|
| Rate for Payer: Health EOS Commercial |
$689.57
|
| Rate for Payer: HFN Commercial |
$712.82
|
| Rate for Payer: Multiplan Commercial |
$619.84
|
| Rate for Payer: Preferred Network Access Commercial |
$712.82
|
| Rate for Payer: Quartz Beloit One Network |
$379.65
|
| Rate for Payer: Quartz Commercial |
$464.88
|
| Rate for Payer: WEA Trust Commercial |
$426.14
|
| Rate for Payer: WPS Commercial |
$573.87
|
|
|
Special Dosimetry 7733126
|
Professional
|
Both
|
$291.00
|
|
|
Service Code
|
CPT 77331 26
|
| Hospital Charge Code |
5258633
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$45.93 |
| Max. Negotiated Rate |
$287.51 |
| Rate for Payer: Aetna Commercial |
$287.51
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$260.27
|
| Rate for Payer: Aetna Managed Medicare |
$45.93
|
| Rate for Payer: Anthem Medicare Advantage |
$45.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$45.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$45.93
|
| Rate for Payer: Cash Price |
$87.30
|
| Rate for Payer: Cash Price |
$87.30
|
| Rate for Payer: Cash Price |
$87.30
|
| Rate for Payer: Cigna Commercial |
$287.51
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$151.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$45.93
|
| Rate for Payer: Health EOS Commercial |
$275.40
|
| Rate for Payer: HFN Commercial |
$287.51
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$163.66
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$163.66
|
| Rate for Payer: Independent Care Health Plan Medicare |
$45.93
|
| Rate for Payer: Multiplan Commercial |
$242.11
|
| Rate for Payer: NAPHCARE Commercial |
$68.89
|
| Rate for Payer: Preferred Network Access Commercial |
$287.51
|
| Rate for Payer: Quartz Beloit One Network |
$133.16
|
| Rate for Payer: Quartz Commercial |
$172.50
|
| Rate for Payer: Quartz Medicare Advantage |
$45.93
|
| Rate for Payer: The Alliance Commercial |
$174.52
|
| Rate for Payer: United Healthcare Medicare Advantage |
$45.93
|
| Rate for Payer: WEA Trust Commercial |
$166.45
|
| Rate for Payer: WPS Commercial |
$229.63
|
|
|
Special Ophthalmolgical Services: Biometry With IOL Calculation
|
Professional
|
Both
|
$123.00
|
|
|
Service Code
|
CPT 92136
|
| Hospital Charge Code |
1188927
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$48.25 |
| Max. Negotiated Rate |
$194.21 |
| Rate for Payer: Aetna Commercial |
$121.52
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$110.01
|
| Rate for Payer: Aetna Managed Medicare |
$48.25
|
| Rate for Payer: Anthem Medicare Advantage |
$48.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$48.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$48.25
|
| Rate for Payer: Cash Price |
$36.90
|
| Rate for Payer: Cash Price |
$36.90
|
| Rate for Payer: Cash Price |
$36.90
|
| Rate for Payer: Cigna Commercial |
$121.52
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$77.17
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$48.25
|
| Rate for Payer: Health EOS Commercial |
$116.41
|
| Rate for Payer: HFN Commercial |
$121.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$194.21
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$194.21
|
| Rate for Payer: Independent Care Health Plan Medicare |
$48.25
|
| Rate for Payer: Multiplan Commercial |
$102.34
|
| Rate for Payer: NAPHCARE Commercial |
$72.37
|
| Rate for Payer: Preferred Network Access Commercial |
$121.52
|
| Rate for Payer: Quartz Beloit One Network |
$56.28
|
| Rate for Payer: Quartz Commercial |
$72.91
|
| Rate for Payer: Quartz Medicare Advantage |
$48.25
|
| Rate for Payer: The Alliance Commercial |
$120.61
|
| Rate for Payer: United Healthcare Medicaid |
$77.17
|
| Rate for Payer: United Healthcare Medicare Advantage |
$48.25
|
| Rate for Payer: WEA Trust Commercial |
$70.36
|
| Rate for Payer: WPS Commercial |
$192.98
|
|
|
Special Ophthalmolgical Services: Corneal Topography With Interpretation
|
Professional
|
Both
|
$58.00
|
|
|
Service Code
|
CPT 92025
|
| Hospital Charge Code |
1188931
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$24.88 |
| Max. Negotiated Rate |
$147.93 |
| Rate for Payer: Aetna Commercial |
$57.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$51.88
|
| Rate for Payer: Aetna Managed Medicare |
$36.98
|
| Rate for Payer: Anthem Medicare Advantage |
$36.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$36.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$36.98
|
| Rate for Payer: Cash Price |
$17.40
|
| Rate for Payer: Cash Price |
$17.40
|
| Rate for Payer: Cash Price |
$17.40
|
| Rate for Payer: Cigna Commercial |
$57.30
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$24.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$36.98
|
| Rate for Payer: Health EOS Commercial |
$54.89
|
| Rate for Payer: HFN Commercial |
$57.30
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$130.07
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$130.07
|
| Rate for Payer: Independent Care Health Plan Medicare |
$36.98
|
| Rate for Payer: Multiplan Commercial |
$48.26
|
| Rate for Payer: NAPHCARE Commercial |
$55.47
|
| Rate for Payer: Preferred Network Access Commercial |
$57.30
|
| Rate for Payer: Quartz Beloit One Network |
$26.54
|
| Rate for Payer: Quartz Commercial |
$34.38
|
| Rate for Payer: Quartz Medicare Advantage |
$36.98
|
| Rate for Payer: The Alliance Commercial |
$92.46
|
| Rate for Payer: United Healthcare Medicaid |
$24.88
|
| Rate for Payer: United Healthcare Medicare Advantage |
$36.98
|
| Rate for Payer: WEA Trust Commercial |
$33.18
|
| Rate for Payer: WPS Commercial |
$147.93
|
|
|
Special Ophthalmolgical Services: Fluorescein Angiography With Interpretation
|
Professional
|
Both
|
$401.00
|
|
|
Service Code
|
CPT 92235
|
| Hospital Charge Code |
1188929
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$112.79 |
| Max. Negotiated Rate |
$649.38 |
| Rate for Payer: Aetna Commercial |
$396.19
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$358.65
|
| Rate for Payer: Aetna Managed Medicare |
$162.34
|
| Rate for Payer: Anthem Medicare Advantage |
$162.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$162.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$162.34
|
| Rate for Payer: Cash Price |
$120.30
|
| Rate for Payer: Cash Price |
$120.30
|
| Rate for Payer: Cash Price |
$120.30
|
| Rate for Payer: Cigna Commercial |
$396.19
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$112.79
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$162.34
|
| Rate for Payer: Health EOS Commercial |
$379.51
|
| Rate for Payer: HFN Commercial |
$396.19
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$416.60
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$416.60
|
| Rate for Payer: Independent Care Health Plan Medicare |
$162.34
|
| Rate for Payer: Multiplan Commercial |
$333.63
|
| Rate for Payer: NAPHCARE Commercial |
$243.52
|
| Rate for Payer: Preferred Network Access Commercial |
$396.19
|
| Rate for Payer: Quartz Beloit One Network |
$183.50
|
| Rate for Payer: Quartz Commercial |
$237.71
|
| Rate for Payer: Quartz Medicare Advantage |
$162.34
|
| Rate for Payer: The Alliance Commercial |
$405.86
|
| Rate for Payer: United Healthcare Medicaid |
$112.79
|
| Rate for Payer: United Healthcare Medicare Advantage |
$162.34
|
| Rate for Payer: WEA Trust Commercial |
$229.37
|
| Rate for Payer: WPS Commercial |
$649.38
|
|
|
Special Ophthalmolgical Services: Fundus Photography With Interpretation
|
Professional
|
Both
|
$100.00
|
|
|
Service Code
|
CPT 92250
|
| Hospital Charge Code |
1188928
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$25.91 |
| Max. Negotiated Rate |
$148.22 |
| Rate for Payer: Aetna Commercial |
$98.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$89.44
|
| Rate for Payer: Aetna Managed Medicare |
$37.06
|
| Rate for Payer: Anthem Medicare Advantage |
$37.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$37.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$37.06
|
| Rate for Payer: Cash Price |
$30.00
|
| Rate for Payer: Cash Price |
$30.00
|
| Rate for Payer: Cash Price |
$30.00
|
| Rate for Payer: Cigna Commercial |
$98.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$25.91
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$37.06
|
| Rate for Payer: Health EOS Commercial |
$94.64
|
| Rate for Payer: HFN Commercial |
$98.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$138.88
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$138.88
|
| Rate for Payer: Independent Care Health Plan Medicare |
$37.06
|
| Rate for Payer: Multiplan Commercial |
$83.20
|
| Rate for Payer: NAPHCARE Commercial |
$55.58
|
| Rate for Payer: Preferred Network Access Commercial |
$98.80
|
| Rate for Payer: Quartz Beloit One Network |
$45.76
|
| Rate for Payer: Quartz Commercial |
$59.28
|
| Rate for Payer: Quartz Medicare Advantage |
$37.06
|
| Rate for Payer: The Alliance Commercial |
$92.64
|
| Rate for Payer: United Healthcare Medicaid |
$25.91
|
| Rate for Payer: United Healthcare Medicare Advantage |
$37.06
|
| Rate for Payer: WEA Trust Commercial |
$57.20
|
| Rate for Payer: WPS Commercial |
$148.22
|
|
|
Special Ophthalmolgic Services: Extended Exam
|
Professional
|
Both
|
$162.00
|
|
|
Service Code
|
CPT 92083
|
| Hospital Charge Code |
1188925
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$31.13 |
| Max. Negotiated Rate |
$255.30 |
| Rate for Payer: Aetna Commercial |
$160.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$144.89
|
| Rate for Payer: Aetna Managed Medicare |
$63.82
|
| Rate for Payer: Anthem Medicare Advantage |
$63.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$63.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$63.82
|
| Rate for Payer: Cash Price |
$48.60
|
| Rate for Payer: Cash Price |
$48.60
|
| Rate for Payer: Cash Price |
$48.60
|
| Rate for Payer: Cigna Commercial |
$160.06
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$31.13
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$63.82
|
| Rate for Payer: Health EOS Commercial |
$153.32
|
| Rate for Payer: HFN Commercial |
$160.06
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$224.09
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$224.09
|
| Rate for Payer: Independent Care Health Plan Medicare |
$63.82
|
| Rate for Payer: Multiplan Commercial |
$134.78
|
| Rate for Payer: NAPHCARE Commercial |
$95.74
|
| Rate for Payer: Preferred Network Access Commercial |
$160.06
|
| Rate for Payer: Quartz Beloit One Network |
$74.13
|
| Rate for Payer: Quartz Commercial |
$96.03
|
| Rate for Payer: Quartz Medicare Advantage |
$63.82
|
| Rate for Payer: The Alliance Commercial |
$159.56
|
| Rate for Payer: United Healthcare Medicaid |
$31.13
|
| Rate for Payer: United Healthcare Medicare Advantage |
$63.82
|
| Rate for Payer: WEA Trust Commercial |
$92.66
|
| Rate for Payer: WPS Commercial |
$255.30
|
|
|
Special Ophthalmological Services: Determination of Refractive State
|
Professional
|
Both
|
$52.00
|
|
|
Service Code
|
CPT 92015
|
| Hospital Charge Code |
2634799
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$10.37 |
| Max. Negotiated Rate |
$69.49 |
| Rate for Payer: Aetna Commercial |
$51.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$46.51
|
| Rate for Payer: Anthem Commercial |
$20.80
|
| Rate for Payer: Cash Price |
$15.60
|
| Rate for Payer: Cash Price |
$15.60
|
| Rate for Payer: Cigna Commercial |
$51.38
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$10.37
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$32.45
|
| Rate for Payer: Health EOS Commercial |
$49.21
|
| Rate for Payer: HFN Commercial |
$51.38
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$69.49
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$69.49
|
| Rate for Payer: Multiplan Commercial |
$43.26
|
| Rate for Payer: Preferred Network Access Commercial |
$51.38
|
| Rate for Payer: Quartz Beloit One Network |
$23.80
|
| Rate for Payer: Quartz Commercial |
$30.83
|
| Rate for Payer: The Alliance Commercial |
$27.04
|
| Rate for Payer: United Healthcare Medicaid |
$10.37
|
| Rate for Payer: WEA Trust Commercial |
$29.74
|
| Rate for Payer: WPS Commercial |
$40.06
|
|
|
Special Ophthalmological Services: Gonioscopy
|
Professional
|
Both
|
$138.00
|
|
|
Service Code
|
CPT 92020
|
| Hospital Charge Code |
1188890
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$13.99 |
| Max. Negotiated Rate |
$136.34 |
| Rate for Payer: Aetna Commercial |
$136.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$123.43
|
| Rate for Payer: Aetna Managed Medicare |
$16.61
|
| Rate for Payer: Anthem Medicare Advantage |
$16.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$16.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$16.61
|
| Rate for Payer: Cash Price |
$41.40
|
| Rate for Payer: Cash Price |
$41.40
|
| Rate for Payer: Cash Price |
$41.40
|
| Rate for Payer: Cigna Commercial |
$136.34
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$13.99
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$16.61
|
| Rate for Payer: Health EOS Commercial |
$130.60
|
| Rate for Payer: HFN Commercial |
$136.34
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$73.13
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$73.13
|
| Rate for Payer: Independent Care Health Plan Medicare |
$16.61
|
| Rate for Payer: Multiplan Commercial |
$114.82
|
| Rate for Payer: NAPHCARE Commercial |
$24.91
|
| Rate for Payer: Preferred Network Access Commercial |
$136.34
|
| Rate for Payer: Quartz Beloit One Network |
$63.15
|
| Rate for Payer: Quartz Commercial |
$81.81
|
| Rate for Payer: Quartz Medicare Advantage |
$16.61
|
| Rate for Payer: The Alliance Commercial |
$41.52
|
| Rate for Payer: United Healthcare Medicaid |
$13.99
|
| Rate for Payer: United Healthcare Medicare Advantage |
$16.61
|
| Rate for Payer: WEA Trust Commercial |
$78.94
|
| Rate for Payer: WPS Commercial |
$66.44
|
|
|
Special Ophthalmological Services: Sensorimotor Examination
|
Professional
|
Both
|
$85.00
|
|
|
Service Code
|
CPT 92060
|
| Hospital Charge Code |
1188891
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$38.90 |
| Max. Negotiated Rate |
$257.67 |
| Rate for Payer: Aetna Commercial |
$83.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$76.02
|
| Rate for Payer: Aetna Managed Medicare |
$64.42
|
| Rate for Payer: Anthem Medicare Advantage |
$64.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$64.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$64.42
|
| Rate for Payer: Cash Price |
$25.50
|
| Rate for Payer: Cash Price |
$25.50
|
| Rate for Payer: Cash Price |
$25.50
|
| Rate for Payer: Cigna Commercial |
$83.98
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$49.73
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$64.42
|
| Rate for Payer: Health EOS Commercial |
$80.44
|
| Rate for Payer: HFN Commercial |
$83.98
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$225.52
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$225.52
|
| Rate for Payer: Independent Care Health Plan Medicare |
$64.42
|
| Rate for Payer: Multiplan Commercial |
$70.72
|
| Rate for Payer: NAPHCARE Commercial |
$96.63
|
| Rate for Payer: Preferred Network Access Commercial |
$83.98
|
| Rate for Payer: Quartz Beloit One Network |
$38.90
|
| Rate for Payer: Quartz Commercial |
$50.39
|
| Rate for Payer: Quartz Medicare Advantage |
$64.42
|
| Rate for Payer: The Alliance Commercial |
$161.04
|
| Rate for Payer: United Healthcare Medicaid |
$49.73
|
| Rate for Payer: United Healthcare Medicare Advantage |
$64.42
|
| Rate for Payer: WEA Trust Commercial |
$48.62
|
| Rate for Payer: WPS Commercial |
$257.67
|
|
|
Special Ophth Services Sensorimotor Exam 9206026
|
Professional
|
Both
|
$84.00
|
|
|
Service Code
|
CPT 92060 26
|
| Hospital Charge Code |
4605871
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$24.38 |
| Max. Negotiated Rate |
$146.76 |
| Rate for Payer: Aetna Commercial |
$82.99
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$75.13
|
| Rate for Payer: Aetna Managed Medicare |
$36.69
|
| Rate for Payer: Anthem Medicare Advantage |
$36.69
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$36.69
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$36.69
|
| Rate for Payer: Cash Price |
$25.20
|
| Rate for Payer: Cash Price |
$25.20
|
| Rate for Payer: Cash Price |
$25.20
|
| Rate for Payer: Cigna Commercial |
$82.99
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$24.38
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$36.69
|
| Rate for Payer: Health EOS Commercial |
$79.50
|
| Rate for Payer: HFN Commercial |
$82.99
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$133.41
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$133.41
|
| Rate for Payer: Independent Care Health Plan Medicare |
$36.69
|
| Rate for Payer: Multiplan Commercial |
$69.89
|
| Rate for Payer: NAPHCARE Commercial |
$55.04
|
| Rate for Payer: Preferred Network Access Commercial |
$82.99
|
| Rate for Payer: Quartz Beloit One Network |
$38.44
|
| Rate for Payer: Quartz Commercial |
$49.80
|
| Rate for Payer: Quartz Medicare Advantage |
$36.69
|
| Rate for Payer: The Alliance Commercial |
$91.73
|
| Rate for Payer: United Healthcare Medicaid |
$24.38
|
| Rate for Payer: United Healthcare Medicare Advantage |
$36.69
|
| Rate for Payer: WEA Trust Commercial |
$48.05
|
| Rate for Payer: WPS Commercial |
$146.76
|
|
|
Special Physics Consultation
|
Facility
|
OP
|
$1,542.00
|
|
|
Service Code
|
CPT 77370
|
| Hospital Charge Code |
3040393
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$141.45 |
| Max. Negotiated Rate |
$1,475.39 |
| Rate for Payer: Aetna Commercial |
$1,443.31
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,379.16
|
| Rate for Payer: Aetna Managed Medicare |
$141.45
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$523.03
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$418.42
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$397.50
|
| Rate for Payer: Anthem Medicare Advantage |
$141.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$849.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$141.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$141.45
|
| Rate for Payer: Cash Price |
$462.60
|
| Rate for Payer: Cash Price |
$462.60
|
| Rate for Payer: Cigna Commercial |
$1,475.39
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$141.45
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$897.44
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$141.45
|
| Rate for Payer: Health EOS Commercial |
$1,427.28
|
| Rate for Payer: HFN Commercial |
$1,475.39
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$526.20
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$141.45
|
| Rate for Payer: Independent Care Health Plan Medicare |
$141.45
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$141.45
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$141.45
|
| Rate for Payer: Multiplan Commercial |
$1,282.94
|
| Rate for Payer: NAPHCARE Commercial |
$212.18
|
| Rate for Payer: Preferred Network Access Commercial |
$1,475.39
|
| Rate for Payer: Quartz Beloit One Network |
$785.80
|
| Rate for Payer: Quartz Commercial |
$1,042.39
|
| Rate for Payer: Quartz Medicare Advantage |
$141.45
|
| Rate for Payer: The Alliance Commercial |
$565.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$141.45
|
| Rate for Payer: United Healthcare PPO |
$1,202.76
|
| Rate for Payer: WEA Trust Commercial |
$882.02
|
| Rate for Payer: Wellcare Medicare |
$141.45
|
| Rate for Payer: WPS Commercial |
$1,187.80
|
|
|
Special Physics Consultation
|
Facility
|
IP
|
$1,542.00
|
|
|
Service Code
|
CPT 77370
|
| Hospital Charge Code |
3040393
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$785.80 |
| Max. Negotiated Rate |
$1,475.39 |
| Rate for Payer: Aetna Commercial |
$1,443.31
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,379.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$849.95
|
| Rate for Payer: Cash Price |
$462.60
|
| Rate for Payer: Cigna Commercial |
$1,475.39
|
| Rate for Payer: Health EOS Commercial |
$1,427.28
|
| Rate for Payer: HFN Commercial |
$1,475.39
|
| Rate for Payer: Multiplan Commercial |
$1,282.94
|
| Rate for Payer: Preferred Network Access Commercial |
$1,475.39
|
| Rate for Payer: Quartz Beloit One Network |
$785.80
|
| Rate for Payer: Quartz Commercial |
$962.21
|
| Rate for Payer: WEA Trust Commercial |
$882.02
|
| Rate for Payer: WPS Commercial |
$1,187.80
|
|
|
Special Stain For inclusion Bodies Or Parasites
|
Professional
|
Both
|
$138.00
|
|
|
Service Code
|
CPT 87207
|
| Hospital Charge Code |
1188853
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.23 |
| Max. Negotiated Rate |
$136.34 |
| Rate for Payer: Aetna Commercial |
$136.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$123.43
|
| Rate for Payer: Aetna Managed Medicare |
$6.23
|
| Rate for Payer: Anthem Commercial |
$17.27
|
| Rate for Payer: Anthem Medicare Advantage |
$6.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$6.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$6.23
|
| Rate for Payer: Cash Price |
$41.40
|
| Rate for Payer: Cash Price |
$41.40
|
| Rate for Payer: Cigna Commercial |
$136.34
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$71.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6.23
|
| Rate for Payer: Health EOS Commercial |
$130.60
|
| Rate for Payer: HFN Commercial |
$136.34
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$21.99
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$21.99
|
| Rate for Payer: Independent Care Health Plan Medicare |
$6.23
|
| Rate for Payer: Multiplan Commercial |
$114.82
|
| Rate for Payer: NAPHCARE Commercial |
$9.34
|
| Rate for Payer: Preferred Network Access Commercial |
$136.34
|
| Rate for Payer: Quartz Beloit One Network |
$63.15
|
| Rate for Payer: Quartz Commercial |
$81.81
|
| Rate for Payer: Quartz Medicare Advantage |
$6.23
|
| Rate for Payer: The Alliance Commercial |
$24.61
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6.23
|
| Rate for Payer: WEA Trust Commercial |
$78.94
|
| Rate for Payer: WPS Commercial |
$27.41
|
|
