|
TIPS EAR CANAL WAX IRRIGATION #A1003
|
Facility
OP
|
$63.00
|
|
| Hospital Charge Code |
2970140
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$17.64 |
| Max. Negotiated Rate |
$252.00 |
| Rate for Payer: Aetna Commercial |
$56.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$54.18
|
| Rate for Payer: Aetna Managed Medicare |
$17.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$40.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$31.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$30.24
|
| 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: Dean Health DHI/DHP/ASO |
$35.25
|
| Rate for Payer: Health EOS Commercial |
$56.07
|
| Rate for Payer: HFN Commercial |
$57.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$47.25
|
| 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 |
$40.95
|
| Rate for Payer: Quartz Medicare Advantage |
$37.80
|
| Rate for Payer: The Alliance Commercial |
$252.00
|
| Rate for Payer: WEA Trust Commercial |
$34.65
|
| Rate for Payer: WPS Commercial |
$46.66
|
|
|
TIPS EAR CANAL WAX IRRIGATION #A1003
|
Facility
IP
|
$63.00
|
|
| Hospital Charge Code |
2970140
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$30.87 |
| Max. Negotiated Rate |
$57.96 |
| Rate for Payer: Aetna Commercial |
$56.70
|
| 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
|
|
|
TIP VITAL VUE 8886828306
|
Facility
IP
|
$2,182.00
|
|
| Hospital Charge Code |
2965537
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,069.18 |
| Max. Negotiated Rate |
$2,007.44 |
| Rate for Payer: Aetna Commercial |
$1,963.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,156.46
|
| Rate for Payer: Cash Price |
$654.60
|
| Rate for Payer: Cigna Commercial |
$2,007.44
|
| Rate for Payer: Health EOS Commercial |
$1,941.98
|
| Rate for Payer: HFN Commercial |
$2,007.44
|
| Rate for Payer: Multiplan Commercial |
$1,745.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,309.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,007.44
|
| Rate for Payer: Quartz Beloit One Network |
$1,069.18
|
| Rate for Payer: Quartz Commercial |
$1,309.20
|
| Rate for Payer: WEA Trust Commercial |
$1,200.10
|
| Rate for Payer: WPS Commercial |
$1,616.21
|
|
|
TIP VITAL VUE 8886828306
|
Facility
OP
|
$2,182.00
|
|
| Hospital Charge Code |
2965537
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$610.96 |
| Max. Negotiated Rate |
$8,728.00 |
| Rate for Payer: Aetna Commercial |
$1,963.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,876.52
|
| Rate for Payer: Aetna Managed Medicare |
$610.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,418.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,091.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,047.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,156.46
|
| Rate for Payer: Cash Price |
$654.60
|
| Rate for Payer: Cigna Commercial |
$2,007.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,221.05
|
| Rate for Payer: Health EOS Commercial |
$1,941.98
|
| Rate for Payer: HFN Commercial |
$2,007.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,636.50
|
| Rate for Payer: Multiplan Commercial |
$1,745.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,309.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,007.44
|
| Rate for Payer: Quartz Beloit One Network |
$1,069.18
|
| Rate for Payer: Quartz Commercial |
$1,418.30
|
| Rate for Payer: Quartz Medicare Advantage |
$1,309.20
|
| Rate for Payer: The Alliance Commercial |
$8,728.00
|
| Rate for Payer: WEA Trust Commercial |
$1,200.10
|
| Rate for Payer: WPS Commercial |
$1,616.21
|
|
|
TISSEEL FIBRIN SEALANT 10ML 1501263 (MED)
|
Facility
OP
|
$4,984.00
|
|
| Hospital Charge Code |
4294559
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,395.52 |
| Max. Negotiated Rate |
$19,936.00 |
| Rate for Payer: Aetna Commercial |
$4,485.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,286.24
|
| Rate for Payer: Aetna Managed Medicare |
$1,395.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,239.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,492.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,392.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,641.52
|
| Rate for Payer: Cash Price |
$1,495.20
|
| Rate for Payer: Cigna Commercial |
$4,585.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,789.05
|
| Rate for Payer: Health EOS Commercial |
$4,435.76
|
| Rate for Payer: HFN Commercial |
$4,585.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,738.00
|
| Rate for Payer: Multiplan Commercial |
$3,987.20
|
| Rate for Payer: NAPHCARE Commercial |
$2,990.40
|
| Rate for Payer: Preferred Network Access Commercial |
$4,585.28
|
| Rate for Payer: Quartz Beloit One Network |
$2,442.16
|
| Rate for Payer: Quartz Commercial |
$3,239.60
|
| Rate for Payer: Quartz Medicare Advantage |
$2,990.40
|
| Rate for Payer: The Alliance Commercial |
$19,936.00
|
| Rate for Payer: WEA Trust Commercial |
$2,741.20
|
| Rate for Payer: WPS Commercial |
$3,691.65
|
|
|
TISSEEL FIBRIN SEALANT 10ML 1501263 (MED)
|
Facility
IP
|
$4,984.00
|
|
| Hospital Charge Code |
4294559
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,442.16 |
| Max. Negotiated Rate |
$4,585.28 |
| Rate for Payer: Aetna Commercial |
$4,485.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,641.52
|
| Rate for Payer: Cash Price |
$1,495.20
|
| Rate for Payer: Cigna Commercial |
$4,585.28
|
| Rate for Payer: Health EOS Commercial |
$4,435.76
|
| Rate for Payer: HFN Commercial |
$4,585.28
|
| Rate for Payer: Multiplan Commercial |
$3,987.20
|
| Rate for Payer: NAPHCARE Commercial |
$2,990.40
|
| Rate for Payer: Preferred Network Access Commercial |
$4,585.28
|
| Rate for Payer: Quartz Beloit One Network |
$2,442.16
|
| Rate for Payer: Quartz Commercial |
$2,990.40
|
| Rate for Payer: WEA Trust Commercial |
$2,741.20
|
| Rate for Payer: WPS Commercial |
$3,691.65
|
|
|
TISSEEL FIBRIN SEALANT 4ML 1501262 (MED)
|
Facility
OP
|
$2,707.00
|
|
| Hospital Charge Code |
4294557
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$757.96 |
| Max. Negotiated Rate |
$10,828.00 |
| Rate for Payer: Aetna Commercial |
$2,436.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,328.02
|
| Rate for Payer: Aetna Managed Medicare |
$757.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,759.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,353.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,299.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,434.71
|
| Rate for Payer: Cash Price |
$812.10
|
| Rate for Payer: Cigna Commercial |
$2,490.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,514.84
|
| Rate for Payer: Health EOS Commercial |
$2,409.23
|
| Rate for Payer: HFN Commercial |
$2,490.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,030.25
|
| Rate for Payer: Multiplan Commercial |
$2,165.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,624.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,490.44
|
| Rate for Payer: Quartz Beloit One Network |
$1,326.43
|
| Rate for Payer: Quartz Commercial |
$1,759.55
|
| Rate for Payer: Quartz Medicare Advantage |
$1,624.20
|
| Rate for Payer: The Alliance Commercial |
$10,828.00
|
| Rate for Payer: WEA Trust Commercial |
$1,488.85
|
| Rate for Payer: WPS Commercial |
$2,005.07
|
|
|
TISSEEL FIBRIN SEALANT 4ML 1501262 (MED)
|
Facility
IP
|
$2,707.00
|
|
| Hospital Charge Code |
4294557
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,326.43 |
| Max. Negotiated Rate |
$2,490.44 |
| Rate for Payer: Aetna Commercial |
$2,436.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,434.71
|
| Rate for Payer: Cash Price |
$812.10
|
| Rate for Payer: Cigna Commercial |
$2,490.44
|
| Rate for Payer: Health EOS Commercial |
$2,409.23
|
| Rate for Payer: HFN Commercial |
$2,490.44
|
| Rate for Payer: Multiplan Commercial |
$2,165.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,624.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,490.44
|
| Rate for Payer: Quartz Beloit One Network |
$1,326.43
|
| Rate for Payer: Quartz Commercial |
$1,624.20
|
| Rate for Payer: WEA Trust Commercial |
$1,488.85
|
| Rate for Payer: WPS Commercial |
$2,005.07
|
|
|
Tissue Culture
|
Facility
OP
|
$225.00
|
|
|
Service Code
|
CPT 87070
|
| Hospital Charge Code |
633906
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.62 |
| Max. Negotiated Rate |
$900.00 |
| Rate for Payer: Aetna Commercial |
$202.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$193.50
|
| Rate for Payer: Aetna Managed Medicare |
$8.62
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$32.32
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$15.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$14.31
|
| Rate for Payer: Anthem Medicaid |
$8.91
|
| Rate for Payer: Anthem Medicare Advantage |
$8.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$119.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$8.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$8.62
|
| Rate for Payer: Cash Price |
$67.50
|
| Rate for Payer: Cash Price |
$67.50
|
| Rate for Payer: Cigna Commercial |
$207.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$8.62
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$8.91
|
| Rate for Payer: Dean Health Medicaid |
$8.91
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$8.62
|
| Rate for Payer: Health EOS Commercial |
$200.25
|
| Rate for Payer: HFN Commercial |
$207.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$32.07
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$8.62
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$8.91
|
| Rate for Payer: Independent Care Health Plan Medicare |
$8.62
|
| Rate for Payer: Managed Health Services Medicaid |
$9.27
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$8.62
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$8.62
|
| Rate for Payer: Multiplan Commercial |
$180.00
|
| Rate for Payer: NAPHCARE Commercial |
$12.93
|
| Rate for Payer: Preferred Network Access Commercial |
$207.00
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$8.91
|
| Rate for Payer: Quartz Beloit One Network |
$110.25
|
| Rate for Payer: Quartz Commercial |
$146.25
|
| Rate for Payer: Quartz Medicare Advantage |
$8.62
|
| Rate for Payer: The Alliance Commercial |
$900.00
|
| Rate for Payer: United Healthcare Medicaid |
$8.91
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8.62
|
| Rate for Payer: United Healthcare PPO |
$168.75
|
| Rate for Payer: WEA Trust Commercial |
$123.75
|
| Rate for Payer: Wellcare Medicare |
$8.62
|
| Rate for Payer: WMAP Medicaid |
$8.91
|
| Rate for Payer: WPS Commercial |
$166.66
|
|
|
Tissue Culture
|
Facility
IP
|
$225.00
|
|
|
Service Code
|
CPT 87070
|
| Hospital Charge Code |
633906
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$110.25 |
| Max. Negotiated Rate |
$207.00 |
| Rate for Payer: Aetna Commercial |
$202.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$119.25
|
| Rate for Payer: Cash Price |
$67.50
|
| Rate for Payer: Cigna Commercial |
$207.00
|
| Rate for Payer: Health EOS Commercial |
$200.25
|
| Rate for Payer: HFN Commercial |
$207.00
|
| Rate for Payer: Multiplan Commercial |
$180.00
|
| Rate for Payer: NAPHCARE Commercial |
$135.00
|
| Rate for Payer: Preferred Network Access Commercial |
$207.00
|
| Rate for Payer: Quartz Beloit One Network |
$110.25
|
| Rate for Payer: Quartz Commercial |
$135.00
|
| Rate for Payer: WEA Trust Commercial |
$123.75
|
| Rate for Payer: WPS Commercial |
$166.66
|
|
|
Tissue Culture
|
Professional
|
$225.00
|
|
|
Service Code
|
CPT 87070
|
| Hospital Charge Code |
633906
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.62 |
| Max. Negotiated Rate |
$213.75 |
| Rate for Payer: Aetna Commercial |
$213.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$193.50
|
| Rate for Payer: Aetna Managed Medicare |
$8.62
|
| Rate for Payer: Anthem Medicare Advantage |
$8.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$8.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$8.62
|
| Rate for Payer: Cash Price |
$67.50
|
| Rate for Payer: Cash Price |
$67.50
|
| Rate for Payer: Cigna Commercial |
$213.75
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$112.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$8.62
|
| Rate for Payer: Health EOS Commercial |
$204.75
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$30.43
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$30.43
|
| Rate for Payer: Independent Care Health Plan Medicare |
$8.62
|
| Rate for Payer: Multiplan Commercial |
$180.00
|
| Rate for Payer: Preferred Network Access Commercial |
$213.75
|
| Rate for Payer: Quartz Beloit One Network |
$99.00
|
| Rate for Payer: Quartz Commercial |
$128.25
|
| Rate for Payer: Quartz Medicare Advantage |
$8.62
|
| Rate for Payer: The Alliance Commercial |
$34.05
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8.62
|
| Rate for Payer: WEA Trust Commercial |
$123.75
|
| Rate for Payer: WPS Commercial |
$37.93
|
|
|
Tissue Culture, Bone Marrow
|
Facility
OP
|
$219.00
|
|
|
Service Code
|
CPT 88237
|
| Hospital Charge Code |
3313614
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$70.04 |
| Max. Negotiated Rate |
$876.00 |
| Rate for Payer: Aetna Commercial |
$197.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$188.34
|
| Rate for Payer: Aetna Managed Medicare |
$143.75
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$539.06
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$251.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$238.62
|
| Rate for Payer: Anthem Medicaid |
$70.04
|
| Rate for Payer: Anthem Medicare Advantage |
$143.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$116.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$143.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$143.75
|
| Rate for Payer: Cash Price |
$65.70
|
| Rate for Payer: Cash Price |
$65.70
|
| Rate for Payer: Cigna Commercial |
$201.48
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$143.75
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$70.04
|
| Rate for Payer: Dean Health Medicaid |
$70.04
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$143.75
|
| Rate for Payer: Health EOS Commercial |
$194.91
|
| Rate for Payer: HFN Commercial |
$201.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$534.75
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$143.75
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$70.04
|
| Rate for Payer: Independent Care Health Plan Medicare |
$143.75
|
| Rate for Payer: Managed Health Services Medicaid |
$72.84
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$143.75
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$143.75
|
| Rate for Payer: Multiplan Commercial |
$175.20
|
| Rate for Payer: NAPHCARE Commercial |
$215.62
|
| Rate for Payer: Preferred Network Access Commercial |
$201.48
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$70.04
|
| Rate for Payer: Quartz Beloit One Network |
$107.31
|
| Rate for Payer: Quartz Commercial |
$142.35
|
| Rate for Payer: Quartz Medicare Advantage |
$143.75
|
| Rate for Payer: The Alliance Commercial |
$876.00
|
| Rate for Payer: United Healthcare Medicaid |
$70.04
|
| Rate for Payer: United Healthcare Medicare Advantage |
$143.75
|
| Rate for Payer: United Healthcare PPO |
$164.25
|
| Rate for Payer: WEA Trust Commercial |
$120.45
|
| Rate for Payer: Wellcare Medicare |
$143.75
|
| Rate for Payer: WMAP Medicaid |
$70.04
|
| Rate for Payer: WPS Commercial |
$162.21
|
|
|
Tissue Culture, Bone Marrow
|
Professional
|
$219.00
|
|
|
Service Code
|
CPT 88237
|
| Hospital Charge Code |
3313614
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$96.36 |
| Max. Negotiated Rate |
$632.50 |
| Rate for Payer: Aetna Commercial |
$208.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$188.34
|
| Rate for Payer: Aetna Managed Medicare |
$143.75
|
| Rate for Payer: Anthem Medicare Advantage |
$143.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$143.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$143.75
|
| Rate for Payer: Cash Price |
$65.70
|
| Rate for Payer: Cash Price |
$65.70
|
| Rate for Payer: Cigna Commercial |
$208.05
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$109.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$143.75
|
| Rate for Payer: Health EOS Commercial |
$199.29
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$507.44
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$507.44
|
| Rate for Payer: Independent Care Health Plan Medicare |
$143.75
|
| Rate for Payer: Multiplan Commercial |
$175.20
|
| Rate for Payer: Preferred Network Access Commercial |
$208.05
|
| Rate for Payer: Quartz Beloit One Network |
$96.36
|
| Rate for Payer: Quartz Commercial |
$124.83
|
| Rate for Payer: Quartz Medicare Advantage |
$143.75
|
| Rate for Payer: The Alliance Commercial |
$567.81
|
| Rate for Payer: United Healthcare Medicare Advantage |
$143.75
|
| Rate for Payer: WEA Trust Commercial |
$120.45
|
| Rate for Payer: WPS Commercial |
$632.50
|
|
|
Tissue Culture, Bone Marrow
|
Facility
IP
|
$219.00
|
|
|
Service Code
|
CPT 88237
|
| Hospital Charge Code |
3313614
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$107.31 |
| Max. Negotiated Rate |
$201.48 |
| Rate for Payer: Aetna Commercial |
$197.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$116.07
|
| Rate for Payer: Cash Price |
$65.70
|
| Rate for Payer: Cigna Commercial |
$201.48
|
| Rate for Payer: Health EOS Commercial |
$194.91
|
| Rate for Payer: HFN Commercial |
$201.48
|
| Rate for Payer: Multiplan Commercial |
$175.20
|
| Rate for Payer: NAPHCARE Commercial |
$131.40
|
| Rate for Payer: Preferred Network Access Commercial |
$201.48
|
| Rate for Payer: Quartz Beloit One Network |
$107.31
|
| Rate for Payer: Quartz Commercial |
$131.40
|
| Rate for Payer: WEA Trust Commercial |
$120.45
|
| Rate for Payer: WPS Commercial |
$162.21
|
|
|
Tissue Culture for Neo
|
Facility
OP
|
$1,355.00
|
|
|
Service Code
|
CPT 88237
|
| Hospital Charge Code |
2778836
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$70.04 |
| Max. Negotiated Rate |
$5,420.00 |
| Rate for Payer: Aetna Commercial |
$1,219.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,165.30
|
| Rate for Payer: Aetna Managed Medicare |
$143.75
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$539.06
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$251.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$238.62
|
| Rate for Payer: Anthem Medicaid |
$70.04
|
| Rate for Payer: Anthem Medicare Advantage |
$143.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$718.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$143.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$143.75
|
| Rate for Payer: Cash Price |
$406.50
|
| Rate for Payer: Cash Price |
$406.50
|
| Rate for Payer: Cigna Commercial |
$1,246.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$143.75
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$70.04
|
| Rate for Payer: Dean Health Medicaid |
$70.04
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$143.75
|
| Rate for Payer: Health EOS Commercial |
$1,205.95
|
| Rate for Payer: HFN Commercial |
$1,246.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$534.75
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$143.75
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$70.04
|
| Rate for Payer: Independent Care Health Plan Medicare |
$143.75
|
| Rate for Payer: Managed Health Services Medicaid |
$72.84
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$143.75
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$143.75
|
| Rate for Payer: Multiplan Commercial |
$1,084.00
|
| Rate for Payer: NAPHCARE Commercial |
$215.62
|
| Rate for Payer: Preferred Network Access Commercial |
$1,246.60
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$70.04
|
| Rate for Payer: Quartz Beloit One Network |
$663.95
|
| Rate for Payer: Quartz Commercial |
$880.75
|
| Rate for Payer: Quartz Medicare Advantage |
$143.75
|
| Rate for Payer: The Alliance Commercial |
$5,420.00
|
| Rate for Payer: United Healthcare Medicaid |
$70.04
|
| Rate for Payer: United Healthcare Medicare Advantage |
$143.75
|
| Rate for Payer: United Healthcare PPO |
$1,016.25
|
| Rate for Payer: WEA Trust Commercial |
$745.25
|
| Rate for Payer: Wellcare Medicare |
$143.75
|
| Rate for Payer: WMAP Medicaid |
$70.04
|
| Rate for Payer: WPS Commercial |
$1,003.65
|
|
|
Tissue Culture for Neo
|
Facility
IP
|
$1,355.00
|
|
|
Service Code
|
CPT 88237
|
| Hospital Charge Code |
2778836
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$663.95 |
| Max. Negotiated Rate |
$1,246.60 |
| Rate for Payer: Aetna Commercial |
$1,219.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$718.15
|
| Rate for Payer: Cash Price |
$406.50
|
| Rate for Payer: Cigna Commercial |
$1,246.60
|
| Rate for Payer: Health EOS Commercial |
$1,205.95
|
| Rate for Payer: HFN Commercial |
$1,246.60
|
| Rate for Payer: Multiplan Commercial |
$1,084.00
|
| Rate for Payer: NAPHCARE Commercial |
$813.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,246.60
|
| Rate for Payer: Quartz Beloit One Network |
$663.95
|
| Rate for Payer: Quartz Commercial |
$813.00
|
| Rate for Payer: WEA Trust Commercial |
$745.25
|
| Rate for Payer: WPS Commercial |
$1,003.65
|
|
|
Tissue Culture for Neo
|
Professional
|
$1,355.00
|
|
|
Service Code
|
CPT 88237
|
| Hospital Charge Code |
2778836
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$143.75 |
| Max. Negotiated Rate |
$1,287.25 |
| Rate for Payer: Aetna Commercial |
$1,287.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,165.30
|
| Rate for Payer: Aetna Managed Medicare |
$143.75
|
| Rate for Payer: Anthem Medicare Advantage |
$143.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$143.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$143.75
|
| Rate for Payer: Cash Price |
$406.50
|
| Rate for Payer: Cash Price |
$406.50
|
| Rate for Payer: Cigna Commercial |
$1,287.25
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$677.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$143.75
|
| Rate for Payer: Health EOS Commercial |
$1,233.05
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$507.44
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$507.44
|
| Rate for Payer: Independent Care Health Plan Medicare |
$143.75
|
| Rate for Payer: Multiplan Commercial |
$1,084.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,287.25
|
| Rate for Payer: Quartz Beloit One Network |
$596.20
|
| Rate for Payer: Quartz Commercial |
$772.35
|
| Rate for Payer: Quartz Medicare Advantage |
$143.75
|
| Rate for Payer: The Alliance Commercial |
$567.81
|
| Rate for Payer: United Healthcare Medicare Advantage |
$143.75
|
| Rate for Payer: WEA Trust Commercial |
$745.25
|
| Rate for Payer: WPS Commercial |
$632.50
|
|
|
Tissue Culture, Non-Neo, Lympho
|
Professional
|
$1,426.00
|
|
|
Service Code
|
CPT 88230
|
| Hospital Charge Code |
2778837
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$116.49 |
| Max. Negotiated Rate |
$1,354.70 |
| Rate for Payer: Aetna Commercial |
$1,354.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,226.36
|
| Rate for Payer: Aetna Managed Medicare |
$116.49
|
| Rate for Payer: Anthem Medicare Advantage |
$116.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$116.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$116.49
|
| Rate for Payer: Cash Price |
$427.80
|
| Rate for Payer: Cash Price |
$427.80
|
| Rate for Payer: Cigna Commercial |
$1,354.70
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$713.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$116.49
|
| Rate for Payer: Health EOS Commercial |
$1,297.66
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$411.21
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$411.21
|
| Rate for Payer: Independent Care Health Plan Medicare |
$116.49
|
| Rate for Payer: Multiplan Commercial |
$1,140.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,354.70
|
| Rate for Payer: Quartz Beloit One Network |
$627.44
|
| Rate for Payer: Quartz Commercial |
$812.82
|
| Rate for Payer: Quartz Medicare Advantage |
$116.49
|
| Rate for Payer: The Alliance Commercial |
$460.14
|
| Rate for Payer: United Healthcare Medicare Advantage |
$116.49
|
| Rate for Payer: WEA Trust Commercial |
$784.30
|
| Rate for Payer: WPS Commercial |
$512.56
|
|
|
Tissue Culture, Non-Neo, Lympho
|
Facility
IP
|
$1,426.00
|
|
|
Service Code
|
CPT 88230
|
| Hospital Charge Code |
2778837
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$698.74 |
| Max. Negotiated Rate |
$1,311.92 |
| Rate for Payer: Aetna Commercial |
$1,283.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$755.78
|
| Rate for Payer: Cash Price |
$427.80
|
| Rate for Payer: Cigna Commercial |
$1,311.92
|
| Rate for Payer: Health EOS Commercial |
$1,269.14
|
| Rate for Payer: HFN Commercial |
$1,311.92
|
| Rate for Payer: Multiplan Commercial |
$1,140.80
|
| Rate for Payer: NAPHCARE Commercial |
$855.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,311.92
|
| Rate for Payer: Quartz Beloit One Network |
$698.74
|
| Rate for Payer: Quartz Commercial |
$855.60
|
| Rate for Payer: WEA Trust Commercial |
$784.30
|
| Rate for Payer: WPS Commercial |
$1,056.24
|
|
|
Tissue Culture, Non-Neo, Lympho
|
Facility
OP
|
$1,426.00
|
|
|
Service Code
|
CPT 88230
|
| Hospital Charge Code |
2778837
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$70.04 |
| Max. Negotiated Rate |
$5,704.00 |
| Rate for Payer: Aetna Commercial |
$1,283.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,226.36
|
| Rate for Payer: Aetna Managed Medicare |
$116.49
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$436.84
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$203.86
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$193.37
|
| Rate for Payer: Anthem Medicaid |
$70.04
|
| Rate for Payer: Anthem Medicare Advantage |
$116.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$755.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$116.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$116.49
|
| Rate for Payer: Cash Price |
$427.80
|
| Rate for Payer: Cash Price |
$427.80
|
| Rate for Payer: Cigna Commercial |
$1,311.92
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$116.49
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$70.04
|
| Rate for Payer: Dean Health Medicaid |
$70.04
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$116.49
|
| Rate for Payer: Health EOS Commercial |
$1,269.14
|
| Rate for Payer: HFN Commercial |
$1,311.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$433.34
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$116.49
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$70.04
|
| Rate for Payer: Independent Care Health Plan Medicare |
$116.49
|
| Rate for Payer: Managed Health Services Medicaid |
$72.84
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$116.49
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$116.49
|
| Rate for Payer: Multiplan Commercial |
$1,140.80
|
| Rate for Payer: NAPHCARE Commercial |
$174.74
|
| Rate for Payer: Preferred Network Access Commercial |
$1,311.92
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$70.04
|
| Rate for Payer: Quartz Beloit One Network |
$698.74
|
| Rate for Payer: Quartz Commercial |
$926.90
|
| Rate for Payer: Quartz Medicare Advantage |
$116.49
|
| Rate for Payer: The Alliance Commercial |
$5,704.00
|
| Rate for Payer: United Healthcare Medicaid |
$70.04
|
| Rate for Payer: United Healthcare Medicare Advantage |
$116.49
|
| Rate for Payer: United Healthcare PPO |
$1,069.50
|
| Rate for Payer: WEA Trust Commercial |
$784.30
|
| Rate for Payer: Wellcare Medicare |
$116.49
|
| Rate for Payer: WMAP Medicaid |
$70.04
|
| Rate for Payer: WPS Commercial |
$1,056.24
|
|
|
Tissue Examination By KOH Slide Of Samples
|
Professional
|
$94.00
|
|
|
Service Code
|
CPT 87220
|
| Hospital Charge Code |
1188852
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.27 |
| Max. Negotiated Rate |
$89.30 |
| Rate for Payer: Aetna Commercial |
$89.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$80.84
|
| Rate for Payer: Aetna Managed Medicare |
$4.27
|
| Rate for Payer: Anthem Medicare Advantage |
$4.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$4.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$4.27
|
| Rate for Payer: Cash Price |
$28.20
|
| Rate for Payer: Cash Price |
$28.20
|
| Rate for Payer: Cigna Commercial |
$89.30
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$47.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4.27
|
| Rate for Payer: Health EOS Commercial |
$85.54
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$15.07
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$15.07
|
| Rate for Payer: Independent Care Health Plan Medicare |
$4.27
|
| Rate for Payer: Multiplan Commercial |
$75.20
|
| Rate for Payer: Preferred Network Access Commercial |
$89.30
|
| Rate for Payer: Quartz Beloit One Network |
$41.36
|
| Rate for Payer: Quartz Commercial |
$53.58
|
| Rate for Payer: Quartz Medicare Advantage |
$4.27
|
| Rate for Payer: The Alliance Commercial |
$16.87
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4.27
|
| Rate for Payer: WEA Trust Commercial |
$51.70
|
| Rate for Payer: WPS Commercial |
$18.79
|
|
|
TISSUE EXPANDER 275CC 354211
|
Facility
IP
|
$9,151.00
|
|
|
Service Code
|
HCPCS L8600
|
| Hospital Charge Code |
2965394
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,483.99 |
| Max. Negotiated Rate |
$8,418.92 |
| Rate for Payer: Aetna Commercial |
$8,235.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,850.03
|
| Rate for Payer: Cash Price |
$2,745.30
|
| Rate for Payer: Cigna Commercial |
$8,418.92
|
| Rate for Payer: Health EOS Commercial |
$8,144.39
|
| Rate for Payer: HFN Commercial |
$8,418.92
|
| Rate for Payer: Multiplan Commercial |
$7,320.80
|
| Rate for Payer: NAPHCARE Commercial |
$5,490.60
|
| Rate for Payer: Preferred Network Access Commercial |
$8,418.92
|
| Rate for Payer: Quartz Beloit One Network |
$4,483.99
|
| Rate for Payer: Quartz Commercial |
$5,490.60
|
| Rate for Payer: WEA Trust Commercial |
$5,033.05
|
| Rate for Payer: WPS Commercial |
$6,778.15
|
|
|
TISSUE EXPANDER 275CC 354211
|
Facility
OP
|
$9,151.00
|
|
|
Service Code
|
HCPCS L8600
|
| Hospital Charge Code |
2965394
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$595.32 |
| Max. Negotiated Rate |
$8,418.92 |
| Rate for Payer: Aetna Commercial |
$8,235.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,869.86
|
| Rate for Payer: Aetna Managed Medicare |
$2,562.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,948.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,575.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,392.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,850.03
|
| Rate for Payer: Cash Price |
$2,745.30
|
| Rate for Payer: Cash Price |
$2,745.30
|
| Rate for Payer: Cigna Commercial |
$8,418.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,120.90
|
| Rate for Payer: Health EOS Commercial |
$8,144.39
|
| Rate for Payer: HFN Commercial |
$8,418.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,863.25
|
| Rate for Payer: Multiplan Commercial |
$7,320.80
|
| Rate for Payer: NAPHCARE Commercial |
$5,490.60
|
| Rate for Payer: Preferred Network Access Commercial |
$8,418.92
|
| Rate for Payer: Quartz Beloit One Network |
$4,483.99
|
| Rate for Payer: Quartz Commercial |
$5,948.15
|
| Rate for Payer: Quartz Medicare Advantage |
$5,490.60
|
| Rate for Payer: The Alliance Commercial |
$595.32
|
| Rate for Payer: WEA Trust Commercial |
$5,033.05
|
| Rate for Payer: WPS Commercial |
$6,778.15
|
|
|
TISSUE EXPANDER 400CC 133MV13
|
Facility
OP
|
$8,512.00
|
|
| Hospital Charge Code |
2964627
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,383.36 |
| Max. Negotiated Rate |
$34,048.00 |
| Rate for Payer: Aetna Commercial |
$7,660.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,320.32
|
| Rate for Payer: Aetna Managed Medicare |
$2,383.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,532.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,256.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,085.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,511.36
|
| Rate for Payer: Cash Price |
$2,553.60
|
| Rate for Payer: Cigna Commercial |
$7,831.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,763.32
|
| Rate for Payer: Health EOS Commercial |
$7,575.68
|
| Rate for Payer: HFN Commercial |
$7,831.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,384.00
|
| Rate for Payer: Multiplan Commercial |
$6,809.60
|
| Rate for Payer: NAPHCARE Commercial |
$5,107.20
|
| Rate for Payer: Preferred Network Access Commercial |
$7,831.04
|
| Rate for Payer: Quartz Beloit One Network |
$4,170.88
|
| Rate for Payer: Quartz Commercial |
$5,532.80
|
| Rate for Payer: Quartz Medicare Advantage |
$5,107.20
|
| Rate for Payer: The Alliance Commercial |
$34,048.00
|
| Rate for Payer: WEA Trust Commercial |
$4,681.60
|
| Rate for Payer: WPS Commercial |
$6,304.84
|
|
|
TISSUE EXPANDER 400CC 133MV13
|
Facility
IP
|
$8,512.00
|
|
| Hospital Charge Code |
2964627
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,170.88 |
| Max. Negotiated Rate |
$7,831.04 |
| Rate for Payer: Aetna Commercial |
$7,660.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,511.36
|
| Rate for Payer: Cash Price |
$2,553.60
|
| Rate for Payer: Cigna Commercial |
$7,831.04
|
| Rate for Payer: Health EOS Commercial |
$7,575.68
|
| Rate for Payer: HFN Commercial |
$7,831.04
|
| Rate for Payer: Multiplan Commercial |
$6,809.60
|
| Rate for Payer: NAPHCARE Commercial |
$5,107.20
|
| Rate for Payer: Preferred Network Access Commercial |
$7,831.04
|
| Rate for Payer: Quartz Beloit One Network |
$4,170.88
|
| Rate for Payer: Quartz Commercial |
$5,107.20
|
| Rate for Payer: WEA Trust Commercial |
$4,681.60
|
| Rate for Payer: WPS Commercial |
$6,304.84
|
|
