|
Thiamine hcl 100 MG J3411
|
Facility
|
OP
|
$7.00
|
|
|
Service Code
|
HCPCS J3411
|
| Hospital Charge Code |
3407537
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.04 |
| Max. Negotiated Rate |
$7.53 |
| Rate for Payer: Aetna Commercial |
$6.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6.26
|
| Rate for Payer: Aetna Managed Medicare |
$2.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4.73
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3.64
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3.86
|
| Rate for Payer: Cash Price |
$2.10
|
| Rate for Payer: Cash Price |
$2.10
|
| Rate for Payer: Cigna Commercial |
$6.70
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3.11
|
| Rate for Payer: Health EOS Commercial |
$6.48
|
| Rate for Payer: HFN Commercial |
$6.70
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5.46
|
| Rate for Payer: Multiplan Commercial |
$5.82
|
| Rate for Payer: NAPHCARE Commercial |
$4.37
|
| Rate for Payer: Preferred Network Access Commercial |
$6.70
|
| Rate for Payer: Quartz Beloit One Network |
$3.57
|
| Rate for Payer: Quartz Commercial |
$4.73
|
| Rate for Payer: Quartz Medicare Advantage |
$4.37
|
| Rate for Payer: The Alliance Commercial |
$7.53
|
| Rate for Payer: WEA Trust Commercial |
$4.00
|
| Rate for Payer: WPS Commercial |
$5.88
|
|
|
Thiamine hcl 100 MG J3411
|
Facility
|
IP
|
$7.00
|
|
|
Service Code
|
HCPCS J3411
|
| Hospital Charge Code |
3407537
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.57 |
| Max. Negotiated Rate |
$6.70 |
| Rate for Payer: Aetna Commercial |
$6.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3.86
|
| Rate for Payer: Cash Price |
$2.10
|
| Rate for Payer: Cigna Commercial |
$6.70
|
| Rate for Payer: Health EOS Commercial |
$6.48
|
| Rate for Payer: HFN Commercial |
$6.70
|
| Rate for Payer: Multiplan Commercial |
$5.82
|
| Rate for Payer: Preferred Network Access Commercial |
$6.70
|
| Rate for Payer: Quartz Beloit One Network |
$3.57
|
| Rate for Payer: Quartz Commercial |
$4.37
|
| Rate for Payer: WEA Trust Commercial |
$4.00
|
| Rate for Payer: WPS Commercial |
$5.39
|
|
|
ThinPrep Pap #58315
|
Professional
|
Both
|
$147.00
|
|
|
Service Code
|
CPT 88175
|
| Hospital Charge Code |
5460754
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$27.67 |
| Max. Negotiated Rate |
$145.24 |
| Rate for Payer: Aetna Commercial |
$145.24
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$131.48
|
| Rate for Payer: Aetna Managed Medicare |
$27.67
|
| Rate for Payer: Anthem Medicare Advantage |
$27.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$27.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$27.67
|
| Rate for Payer: Cash Price |
$44.10
|
| Rate for Payer: Cash Price |
$44.10
|
| Rate for Payer: Cigna Commercial |
$145.24
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$76.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$27.67
|
| Rate for Payer: Health EOS Commercial |
$139.12
|
| Rate for Payer: HFN Commercial |
$145.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$97.69
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$97.69
|
| Rate for Payer: Independent Care Health Plan Medicare |
$27.67
|
| Rate for Payer: Multiplan Commercial |
$122.30
|
| Rate for Payer: NAPHCARE Commercial |
$41.51
|
| Rate for Payer: Preferred Network Access Commercial |
$145.24
|
| Rate for Payer: Quartz Beloit One Network |
$67.27
|
| Rate for Payer: Quartz Commercial |
$87.14
|
| Rate for Payer: Quartz Medicare Advantage |
$27.67
|
| Rate for Payer: The Alliance Commercial |
$109.31
|
| Rate for Payer: United Healthcare Medicare Advantage |
$27.67
|
| Rate for Payer: WEA Trust Commercial |
$84.08
|
| Rate for Payer: WPS Commercial |
$121.77
|
|
|
ThinPrep Pap #58315
|
Facility
|
IP
|
$147.00
|
|
|
Service Code
|
CPT 88175
|
| Hospital Charge Code |
5460754
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$74.91 |
| Max. Negotiated Rate |
$140.65 |
| Rate for Payer: Aetna Commercial |
$137.59
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$131.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$81.03
|
| Rate for Payer: Cash Price |
$44.10
|
| Rate for Payer: Cigna Commercial |
$140.65
|
| Rate for Payer: Health EOS Commercial |
$136.06
|
| Rate for Payer: HFN Commercial |
$140.65
|
| Rate for Payer: Multiplan Commercial |
$122.30
|
| Rate for Payer: Preferred Network Access Commercial |
$140.65
|
| Rate for Payer: Quartz Beloit One Network |
$74.91
|
| Rate for Payer: Quartz Commercial |
$91.73
|
| Rate for Payer: WEA Trust Commercial |
$84.08
|
| Rate for Payer: WPS Commercial |
$113.23
|
|
|
ThinPrep Pap #58315
|
Facility
|
OP
|
$147.00
|
|
|
Service Code
|
CPT 88175
|
| Hospital Charge Code |
5460754
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$27.67 |
| Max. Negotiated Rate |
$140.65 |
| Rate for Payer: Aetna Commercial |
$137.59
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$131.48
|
| Rate for Payer: Aetna Managed Medicare |
$27.67
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$103.78
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$48.43
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$45.94
|
| Rate for Payer: Anthem Medicare Advantage |
$27.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$81.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$27.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$27.67
|
| Rate for Payer: Cash Price |
$44.10
|
| Rate for Payer: Cash Price |
$44.10
|
| Rate for Payer: Cigna Commercial |
$140.65
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$27.67
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$85.55
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$27.67
|
| Rate for Payer: Health EOS Commercial |
$136.06
|
| Rate for Payer: HFN Commercial |
$140.65
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$102.95
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$27.67
|
| Rate for Payer: Independent Care Health Plan Medicare |
$27.67
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$27.67
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$27.67
|
| Rate for Payer: Multiplan Commercial |
$122.30
|
| Rate for Payer: NAPHCARE Commercial |
$41.51
|
| Rate for Payer: Preferred Network Access Commercial |
$140.65
|
| Rate for Payer: Quartz Beloit One Network |
$74.91
|
| Rate for Payer: Quartz Commercial |
$99.37
|
| Rate for Payer: Quartz Medicare Advantage |
$27.67
|
| Rate for Payer: The Alliance Commercial |
$110.70
|
| Rate for Payer: United Healthcare Medicare Advantage |
$27.67
|
| Rate for Payer: United Healthcare PPO |
$114.66
|
| Rate for Payer: WEA Trust Commercial |
$84.08
|
| Rate for Payer: Wellcare Medicare |
$27.67
|
| Rate for Payer: WPS Commercial |
$113.23
|
|
|
ThinPrep Pap & HPV mRNA E6/E7 #90933
|
Facility
|
IP
|
$147.00
|
|
|
Service Code
|
CPT 88175
|
| Hospital Charge Code |
5460756
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$74.91 |
| Max. Negotiated Rate |
$140.65 |
| Rate for Payer: Aetna Commercial |
$137.59
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$131.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$81.03
|
| Rate for Payer: Cash Price |
$44.10
|
| Rate for Payer: Cigna Commercial |
$140.65
|
| Rate for Payer: Health EOS Commercial |
$136.06
|
| Rate for Payer: HFN Commercial |
$140.65
|
| Rate for Payer: Multiplan Commercial |
$122.30
|
| Rate for Payer: Preferred Network Access Commercial |
$140.65
|
| Rate for Payer: Quartz Beloit One Network |
$74.91
|
| Rate for Payer: Quartz Commercial |
$91.73
|
| Rate for Payer: WEA Trust Commercial |
$84.08
|
| Rate for Payer: WPS Commercial |
$113.23
|
|
|
ThinPrep Pap & HPV mRNA E6/E7 #90933
|
Facility
|
OP
|
$147.00
|
|
|
Service Code
|
CPT 88175
|
| Hospital Charge Code |
5460756
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$27.67 |
| Max. Negotiated Rate |
$140.65 |
| Rate for Payer: Aetna Commercial |
$137.59
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$131.48
|
| Rate for Payer: Aetna Managed Medicare |
$27.67
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$103.78
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$48.43
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$45.94
|
| Rate for Payer: Anthem Medicare Advantage |
$27.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$81.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$27.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$27.67
|
| Rate for Payer: Cash Price |
$44.10
|
| Rate for Payer: Cash Price |
$44.10
|
| Rate for Payer: Cigna Commercial |
$140.65
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$27.67
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$85.55
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$27.67
|
| Rate for Payer: Health EOS Commercial |
$136.06
|
| Rate for Payer: HFN Commercial |
$140.65
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$102.95
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$27.67
|
| Rate for Payer: Independent Care Health Plan Medicare |
$27.67
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$27.67
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$27.67
|
| Rate for Payer: Multiplan Commercial |
$122.30
|
| Rate for Payer: NAPHCARE Commercial |
$41.51
|
| Rate for Payer: Preferred Network Access Commercial |
$140.65
|
| Rate for Payer: Quartz Beloit One Network |
$74.91
|
| Rate for Payer: Quartz Commercial |
$99.37
|
| Rate for Payer: Quartz Medicare Advantage |
$27.67
|
| Rate for Payer: The Alliance Commercial |
$110.70
|
| Rate for Payer: United Healthcare Medicare Advantage |
$27.67
|
| Rate for Payer: United Healthcare PPO |
$114.66
|
| Rate for Payer: WEA Trust Commercial |
$84.08
|
| Rate for Payer: Wellcare Medicare |
$27.67
|
| Rate for Payer: WPS Commercial |
$113.23
|
|
|
ThinPrep Pap & HPV mRNA E6/E7 #90933
|
Professional
|
Both
|
$147.00
|
|
|
Service Code
|
CPT 88175
|
| Hospital Charge Code |
5460756
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$27.67 |
| Max. Negotiated Rate |
$145.24 |
| Rate for Payer: Aetna Commercial |
$145.24
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$131.48
|
| Rate for Payer: Aetna Managed Medicare |
$27.67
|
| Rate for Payer: Anthem Medicare Advantage |
$27.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$27.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$27.67
|
| Rate for Payer: Cash Price |
$44.10
|
| Rate for Payer: Cash Price |
$44.10
|
| Rate for Payer: Cigna Commercial |
$145.24
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$76.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$27.67
|
| Rate for Payer: Health EOS Commercial |
$139.12
|
| Rate for Payer: HFN Commercial |
$145.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$97.69
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$97.69
|
| Rate for Payer: Independent Care Health Plan Medicare |
$27.67
|
| Rate for Payer: Multiplan Commercial |
$122.30
|
| Rate for Payer: NAPHCARE Commercial |
$41.51
|
| Rate for Payer: Preferred Network Access Commercial |
$145.24
|
| Rate for Payer: Quartz Beloit One Network |
$67.27
|
| Rate for Payer: Quartz Commercial |
$87.14
|
| Rate for Payer: Quartz Medicare Advantage |
$27.67
|
| Rate for Payer: The Alliance Commercial |
$109.31
|
| Rate for Payer: United Healthcare Medicare Advantage |
$27.67
|
| Rate for Payer: WEA Trust Commercial |
$84.08
|
| Rate for Payer: WPS Commercial |
$121.77
|
|
|
ThinPrep Pap & HPV mRNA w/Rfx HPV 16,18/45 #91414
|
Facility
|
OP
|
$147.00
|
|
|
Service Code
|
CPT 88175
|
| Hospital Charge Code |
5460757
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$27.67 |
| Max. Negotiated Rate |
$140.65 |
| Rate for Payer: Aetna Commercial |
$137.59
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$131.48
|
| Rate for Payer: Aetna Managed Medicare |
$27.67
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$103.78
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$48.43
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$45.94
|
| Rate for Payer: Anthem Medicare Advantage |
$27.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$81.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$27.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$27.67
|
| Rate for Payer: Cash Price |
$44.10
|
| Rate for Payer: Cash Price |
$44.10
|
| Rate for Payer: Cigna Commercial |
$140.65
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$27.67
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$85.55
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$27.67
|
| Rate for Payer: Health EOS Commercial |
$136.06
|
| Rate for Payer: HFN Commercial |
$140.65
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$102.95
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$27.67
|
| Rate for Payer: Independent Care Health Plan Medicare |
$27.67
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$27.67
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$27.67
|
| Rate for Payer: Multiplan Commercial |
$122.30
|
| Rate for Payer: NAPHCARE Commercial |
$41.51
|
| Rate for Payer: Preferred Network Access Commercial |
$140.65
|
| Rate for Payer: Quartz Beloit One Network |
$74.91
|
| Rate for Payer: Quartz Commercial |
$99.37
|
| Rate for Payer: Quartz Medicare Advantage |
$27.67
|
| Rate for Payer: The Alliance Commercial |
$110.70
|
| Rate for Payer: United Healthcare Medicare Advantage |
$27.67
|
| Rate for Payer: United Healthcare PPO |
$114.66
|
| Rate for Payer: WEA Trust Commercial |
$84.08
|
| Rate for Payer: Wellcare Medicare |
$27.67
|
| Rate for Payer: WPS Commercial |
$113.23
|
|
|
ThinPrep Pap & HPV mRNA w/Rfx HPV 16,18/45 #91414
|
Facility
|
IP
|
$147.00
|
|
|
Service Code
|
CPT 88175
|
| Hospital Charge Code |
5460757
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$74.91 |
| Max. Negotiated Rate |
$140.65 |
| Rate for Payer: Aetna Commercial |
$137.59
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$131.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$81.03
|
| Rate for Payer: Cash Price |
$44.10
|
| Rate for Payer: Cigna Commercial |
$140.65
|
| Rate for Payer: Health EOS Commercial |
$136.06
|
| Rate for Payer: HFN Commercial |
$140.65
|
| Rate for Payer: Multiplan Commercial |
$122.30
|
| Rate for Payer: Preferred Network Access Commercial |
$140.65
|
| Rate for Payer: Quartz Beloit One Network |
$74.91
|
| Rate for Payer: Quartz Commercial |
$91.73
|
| Rate for Payer: WEA Trust Commercial |
$84.08
|
| Rate for Payer: WPS Commercial |
$113.23
|
|
|
ThinPrep Pap & HPV mRNA w/Rfx HPV 16,18/45 #91414
|
Professional
|
Both
|
$147.00
|
|
|
Service Code
|
CPT 88175
|
| Hospital Charge Code |
5460757
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$27.67 |
| Max. Negotiated Rate |
$145.24 |
| Rate for Payer: Aetna Commercial |
$145.24
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$131.48
|
| Rate for Payer: Aetna Managed Medicare |
$27.67
|
| Rate for Payer: Anthem Medicare Advantage |
$27.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$27.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$27.67
|
| Rate for Payer: Cash Price |
$44.10
|
| Rate for Payer: Cash Price |
$44.10
|
| Rate for Payer: Cigna Commercial |
$145.24
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$76.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$27.67
|
| Rate for Payer: Health EOS Commercial |
$139.12
|
| Rate for Payer: HFN Commercial |
$145.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$97.69
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$97.69
|
| Rate for Payer: Independent Care Health Plan Medicare |
$27.67
|
| Rate for Payer: Multiplan Commercial |
$122.30
|
| Rate for Payer: NAPHCARE Commercial |
$41.51
|
| Rate for Payer: Preferred Network Access Commercial |
$145.24
|
| Rate for Payer: Quartz Beloit One Network |
$67.27
|
| Rate for Payer: Quartz Commercial |
$87.14
|
| Rate for Payer: Quartz Medicare Advantage |
$27.67
|
| Rate for Payer: The Alliance Commercial |
$109.31
|
| Rate for Payer: United Healthcare Medicare Advantage |
$27.67
|
| Rate for Payer: WEA Trust Commercial |
$84.08
|
| Rate for Payer: WPS Commercial |
$121.77
|
|
|
ThinPrep Pap w/Rfx HPV mRNA E6/E7 #90934
|
Facility
|
IP
|
$147.00
|
|
|
Service Code
|
CPT 88175
|
| Hospital Charge Code |
5460755
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$74.91 |
| Max. Negotiated Rate |
$140.65 |
| Rate for Payer: Aetna Commercial |
$137.59
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$131.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$81.03
|
| Rate for Payer: Cash Price |
$44.10
|
| Rate for Payer: Cigna Commercial |
$140.65
|
| Rate for Payer: Health EOS Commercial |
$136.06
|
| Rate for Payer: HFN Commercial |
$140.65
|
| Rate for Payer: Multiplan Commercial |
$122.30
|
| Rate for Payer: Preferred Network Access Commercial |
$140.65
|
| Rate for Payer: Quartz Beloit One Network |
$74.91
|
| Rate for Payer: Quartz Commercial |
$91.73
|
| Rate for Payer: WEA Trust Commercial |
$84.08
|
| Rate for Payer: WPS Commercial |
$113.23
|
|
|
ThinPrep Pap w/Rfx HPV mRNA E6/E7 #90934
|
Professional
|
Both
|
$147.00
|
|
|
Service Code
|
CPT 88175
|
| Hospital Charge Code |
5460755
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$27.67 |
| Max. Negotiated Rate |
$145.24 |
| Rate for Payer: Aetna Commercial |
$145.24
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$131.48
|
| Rate for Payer: Aetna Managed Medicare |
$27.67
|
| Rate for Payer: Anthem Medicare Advantage |
$27.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$27.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$27.67
|
| Rate for Payer: Cash Price |
$44.10
|
| Rate for Payer: Cash Price |
$44.10
|
| Rate for Payer: Cigna Commercial |
$145.24
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$76.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$27.67
|
| Rate for Payer: Health EOS Commercial |
$139.12
|
| Rate for Payer: HFN Commercial |
$145.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$97.69
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$97.69
|
| Rate for Payer: Independent Care Health Plan Medicare |
$27.67
|
| Rate for Payer: Multiplan Commercial |
$122.30
|
| Rate for Payer: NAPHCARE Commercial |
$41.51
|
| Rate for Payer: Preferred Network Access Commercial |
$145.24
|
| Rate for Payer: Quartz Beloit One Network |
$67.27
|
| Rate for Payer: Quartz Commercial |
$87.14
|
| Rate for Payer: Quartz Medicare Advantage |
$27.67
|
| Rate for Payer: The Alliance Commercial |
$109.31
|
| Rate for Payer: United Healthcare Medicare Advantage |
$27.67
|
| Rate for Payer: WEA Trust Commercial |
$84.08
|
| Rate for Payer: WPS Commercial |
$121.77
|
|
|
ThinPrep Pap w/Rfx HPV mRNA E6/E7 #90934
|
Facility
|
OP
|
$147.00
|
|
|
Service Code
|
CPT 88175
|
| Hospital Charge Code |
5460755
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$27.67 |
| Max. Negotiated Rate |
$140.65 |
| Rate for Payer: Aetna Commercial |
$137.59
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$131.48
|
| Rate for Payer: Aetna Managed Medicare |
$27.67
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$103.78
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$48.43
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$45.94
|
| Rate for Payer: Anthem Medicare Advantage |
$27.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$81.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$27.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$27.67
|
| Rate for Payer: Cash Price |
$44.10
|
| Rate for Payer: Cash Price |
$44.10
|
| Rate for Payer: Cigna Commercial |
$140.65
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$27.67
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$85.55
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$27.67
|
| Rate for Payer: Health EOS Commercial |
$136.06
|
| Rate for Payer: HFN Commercial |
$140.65
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$102.95
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$27.67
|
| Rate for Payer: Independent Care Health Plan Medicare |
$27.67
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$27.67
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$27.67
|
| Rate for Payer: Multiplan Commercial |
$122.30
|
| Rate for Payer: NAPHCARE Commercial |
$41.51
|
| Rate for Payer: Preferred Network Access Commercial |
$140.65
|
| Rate for Payer: Quartz Beloit One Network |
$74.91
|
| Rate for Payer: Quartz Commercial |
$99.37
|
| Rate for Payer: Quartz Medicare Advantage |
$27.67
|
| Rate for Payer: The Alliance Commercial |
$110.70
|
| Rate for Payer: United Healthcare Medicare Advantage |
$27.67
|
| Rate for Payer: United Healthcare PPO |
$114.66
|
| Rate for Payer: WEA Trust Commercial |
$84.08
|
| Rate for Payer: Wellcare Medicare |
$27.67
|
| Rate for Payer: WPS Commercial |
$113.23
|
|
|
Thiopurine Metabolites
|
Facility
|
OP
|
$130.00
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
5438798
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$19.39 |
| Max. Negotiated Rate |
$124.38 |
| Rate for Payer: Aetna Commercial |
$121.68
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$116.27
|
| Rate for Payer: Aetna Managed Medicare |
$19.39
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$72.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$33.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$32.18
|
| Rate for Payer: Anthem Medicare Advantage |
$19.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$71.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$19.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$19.39
|
| Rate for Payer: Cash Price |
$39.00
|
| Rate for Payer: Cash Price |
$39.00
|
| Rate for Payer: Cigna Commercial |
$124.38
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$19.39
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$75.66
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$19.39
|
| Rate for Payer: Health EOS Commercial |
$120.33
|
| Rate for Payer: HFN Commercial |
$124.38
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$72.11
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$19.39
|
| Rate for Payer: Independent Care Health Plan Medicare |
$19.39
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$19.39
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$19.39
|
| Rate for Payer: Multiplan Commercial |
$108.16
|
| Rate for Payer: NAPHCARE Commercial |
$29.08
|
| Rate for Payer: Preferred Network Access Commercial |
$124.38
|
| Rate for Payer: Quartz Beloit One Network |
$66.25
|
| Rate for Payer: Quartz Commercial |
$87.88
|
| Rate for Payer: Quartz Medicare Advantage |
$19.39
|
| Rate for Payer: The Alliance Commercial |
$77.54
|
| Rate for Payer: United Healthcare Medicare Advantage |
$19.39
|
| Rate for Payer: United Healthcare PPO |
$101.40
|
| Rate for Payer: WEA Trust Commercial |
$74.36
|
| Rate for Payer: Wellcare Medicare |
$19.39
|
| Rate for Payer: WPS Commercial |
$100.14
|
|
|
Thiopurine Metabolites
|
Professional
|
Both
|
$130.00
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
5438798
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$19.39 |
| Max. Negotiated Rate |
$128.44 |
| Rate for Payer: Aetna Commercial |
$128.44
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$116.27
|
| Rate for Payer: Aetna Managed Medicare |
$19.39
|
| Rate for Payer: Anthem Medicare Advantage |
$19.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$19.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$19.39
|
| Rate for Payer: Cash Price |
$39.00
|
| Rate for Payer: Cash Price |
$39.00
|
| Rate for Payer: Cigna Commercial |
$128.44
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$67.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$19.39
|
| Rate for Payer: Health EOS Commercial |
$123.03
|
| Rate for Payer: HFN Commercial |
$128.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$68.43
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$68.43
|
| Rate for Payer: Independent Care Health Plan Medicare |
$19.39
|
| Rate for Payer: Multiplan Commercial |
$108.16
|
| Rate for Payer: NAPHCARE Commercial |
$29.08
|
| Rate for Payer: Preferred Network Access Commercial |
$128.44
|
| Rate for Payer: Quartz Beloit One Network |
$59.49
|
| Rate for Payer: Quartz Commercial |
$77.06
|
| Rate for Payer: Quartz Medicare Advantage |
$19.39
|
| Rate for Payer: The Alliance Commercial |
$76.57
|
| Rate for Payer: United Healthcare Medicare Advantage |
$19.39
|
| Rate for Payer: WEA Trust Commercial |
$74.36
|
| Rate for Payer: WPS Commercial |
$85.30
|
|
|
Thiopurine Metabolites
|
Facility
|
IP
|
$130.00
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
5438798
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$66.25 |
| Max. Negotiated Rate |
$124.38 |
| Rate for Payer: Aetna Commercial |
$121.68
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$116.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$71.66
|
| Rate for Payer: Cash Price |
$39.00
|
| Rate for Payer: Cigna Commercial |
$124.38
|
| Rate for Payer: Health EOS Commercial |
$120.33
|
| Rate for Payer: HFN Commercial |
$124.38
|
| Rate for Payer: Multiplan Commercial |
$108.16
|
| Rate for Payer: Preferred Network Access Commercial |
$124.38
|
| Rate for Payer: Quartz Beloit One Network |
$66.25
|
| Rate for Payer: Quartz Commercial |
$81.12
|
| Rate for Payer: WEA Trust Commercial |
$74.36
|
| Rate for Payer: WPS Commercial |
$100.14
|
|
|
Thiopurine Metabolites to Prometheus
|
Professional
|
Both
|
$301.00
|
|
| Hospital Charge Code |
2778835
|
| Min. Negotiated Rate |
$137.74 |
| Max. Negotiated Rate |
$297.39 |
| Rate for Payer: Aetna Commercial |
$297.39
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$269.21
|
| Rate for Payer: Cash Price |
$90.30
|
| Rate for Payer: Cigna Commercial |
$297.39
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$156.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$187.82
|
| Rate for Payer: Health EOS Commercial |
$284.87
|
| Rate for Payer: HFN Commercial |
$297.39
|
| Rate for Payer: Multiplan Commercial |
$250.43
|
| Rate for Payer: Preferred Network Access Commercial |
$297.39
|
| Rate for Payer: Quartz Beloit One Network |
$137.74
|
| Rate for Payer: Quartz Commercial |
$178.43
|
| Rate for Payer: The Alliance Commercial |
$156.52
|
| Rate for Payer: WEA Trust Commercial |
$172.17
|
| Rate for Payer: WPS Commercial |
$231.86
|
|
|
Thiopurine Metabolites to Prometheus
|
Facility
|
IP
|
$301.00
|
|
| Hospital Charge Code |
2778835
|
| Min. Negotiated Rate |
$153.39 |
| Max. Negotiated Rate |
$288.00 |
| Rate for Payer: Aetna Commercial |
$281.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$269.21
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$165.91
|
| Rate for Payer: Cash Price |
$90.30
|
| Rate for Payer: Cigna Commercial |
$288.00
|
| Rate for Payer: Health EOS Commercial |
$278.61
|
| Rate for Payer: HFN Commercial |
$288.00
|
| Rate for Payer: Multiplan Commercial |
$250.43
|
| Rate for Payer: Preferred Network Access Commercial |
$288.00
|
| Rate for Payer: Quartz Beloit One Network |
$153.39
|
| Rate for Payer: Quartz Commercial |
$187.82
|
| Rate for Payer: WEA Trust Commercial |
$172.17
|
| Rate for Payer: WPS Commercial |
$231.86
|
|
|
Thiopurine Metabolites to Prometheus
|
Facility
|
OP
|
$301.00
|
|
| Hospital Charge Code |
2778835
|
| Min. Negotiated Rate |
$87.65 |
| Max. Negotiated Rate |
$288.00 |
| Rate for Payer: Aetna Commercial |
$281.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$269.21
|
| Rate for Payer: Aetna Managed Medicare |
$87.65
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$203.48
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$156.52
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$150.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$165.91
|
| Rate for Payer: Cash Price |
$90.30
|
| Rate for Payer: Cigna Commercial |
$288.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$175.18
|
| Rate for Payer: Health EOS Commercial |
$278.61
|
| Rate for Payer: HFN Commercial |
$288.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$234.78
|
| Rate for Payer: Multiplan Commercial |
$250.43
|
| Rate for Payer: NAPHCARE Commercial |
$187.82
|
| Rate for Payer: Preferred Network Access Commercial |
$288.00
|
| Rate for Payer: Quartz Beloit One Network |
$153.39
|
| Rate for Payer: Quartz Commercial |
$203.48
|
| Rate for Payer: Quartz Medicare Advantage |
$187.82
|
| Rate for Payer: The Alliance Commercial |
$156.52
|
| Rate for Payer: WEA Trust Commercial |
$172.17
|
| Rate for Payer: WPS Commercial |
$231.86
|
|
|
Thiopurine S-Methyltransferase (TPMT) Genotype
|
Professional
|
Both
|
$719.00
|
|
|
Service Code
|
CPT 81335
|
| Hospital Charge Code |
5412828
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$181.80 |
| Max. Negotiated Rate |
$799.93 |
| Rate for Payer: Aetna Commercial |
$710.37
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$643.07
|
| Rate for Payer: Aetna Managed Medicare |
$181.80
|
| Rate for Payer: Anthem Medicare Advantage |
$181.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$181.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$181.80
|
| Rate for Payer: Cash Price |
$215.70
|
| Rate for Payer: Cash Price |
$215.70
|
| Rate for Payer: Cigna Commercial |
$710.37
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$373.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$181.80
|
| Rate for Payer: Health EOS Commercial |
$680.46
|
| Rate for Payer: HFN Commercial |
$710.37
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$641.76
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$641.76
|
| Rate for Payer: Independent Care Health Plan Medicare |
$181.80
|
| Rate for Payer: Multiplan Commercial |
$598.21
|
| Rate for Payer: NAPHCARE Commercial |
$272.70
|
| Rate for Payer: Preferred Network Access Commercial |
$710.37
|
| Rate for Payer: Quartz Beloit One Network |
$329.01
|
| Rate for Payer: Quartz Commercial |
$426.22
|
| Rate for Payer: Quartz Medicare Advantage |
$181.80
|
| Rate for Payer: The Alliance Commercial |
$718.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$181.80
|
| Rate for Payer: WEA Trust Commercial |
$411.27
|
| Rate for Payer: WPS Commercial |
$799.93
|
|
|
Thiopurine S-Methyltransferase (TPMT) Genotype
|
Facility
|
OP
|
$719.00
|
|
|
Service Code
|
CPT 81335
|
| Hospital Charge Code |
5412828
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$181.80 |
| Max. Negotiated Rate |
$727.21 |
| Rate for Payer: Aetna Commercial |
$672.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$643.07
|
| Rate for Payer: Aetna Managed Medicare |
$181.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$681.76
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$318.15
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$301.79
|
| Rate for Payer: Anthem Medicare Advantage |
$181.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$396.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$181.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$181.80
|
| Rate for Payer: Cash Price |
$215.70
|
| Rate for Payer: Cash Price |
$215.70
|
| Rate for Payer: Cigna Commercial |
$687.94
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$181.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$418.46
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$181.80
|
| Rate for Payer: Health EOS Commercial |
$665.51
|
| Rate for Payer: HFN Commercial |
$687.94
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$676.30
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$181.80
|
| Rate for Payer: Independent Care Health Plan Medicare |
$181.80
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$181.80
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$181.80
|
| Rate for Payer: Multiplan Commercial |
$598.21
|
| Rate for Payer: NAPHCARE Commercial |
$272.70
|
| Rate for Payer: Preferred Network Access Commercial |
$687.94
|
| Rate for Payer: Quartz Beloit One Network |
$366.40
|
| Rate for Payer: Quartz Commercial |
$486.04
|
| Rate for Payer: Quartz Medicare Advantage |
$181.80
|
| Rate for Payer: The Alliance Commercial |
$727.21
|
| Rate for Payer: United Healthcare Medicare Advantage |
$181.80
|
| Rate for Payer: United Healthcare PPO |
$560.82
|
| Rate for Payer: WEA Trust Commercial |
$411.27
|
| Rate for Payer: Wellcare Medicare |
$181.80
|
| Rate for Payer: WPS Commercial |
$553.85
|
|
|
Thiopurine S-Methyltransferase (TPMT) Genotype
|
Facility
|
IP
|
$719.00
|
|
|
Service Code
|
CPT 81335
|
| Hospital Charge Code |
5412828
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$366.40 |
| Max. Negotiated Rate |
$687.94 |
| Rate for Payer: Aetna Commercial |
$672.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$643.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$396.31
|
| Rate for Payer: Cash Price |
$215.70
|
| Rate for Payer: Cigna Commercial |
$687.94
|
| Rate for Payer: Health EOS Commercial |
$665.51
|
| Rate for Payer: HFN Commercial |
$687.94
|
| Rate for Payer: Multiplan Commercial |
$598.21
|
| Rate for Payer: Preferred Network Access Commercial |
$687.94
|
| Rate for Payer: Quartz Beloit One Network |
$366.40
|
| Rate for Payer: Quartz Commercial |
$448.66
|
| Rate for Payer: WEA Trust Commercial |
$411.27
|
| Rate for Payer: WPS Commercial |
$553.85
|
|
|
THORACENTESIS, CHEST
|
Facility
|
IP
|
$270.00
|
|
| Hospital Charge Code |
2960431
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$137.59 |
| Max. Negotiated Rate |
$258.34 |
| Rate for Payer: Aetna Commercial |
$252.72
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$241.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$148.82
|
| Rate for Payer: Cash Price |
$81.00
|
| Rate for Payer: Cigna Commercial |
$258.34
|
| Rate for Payer: Health EOS Commercial |
$249.91
|
| Rate for Payer: HFN Commercial |
$258.34
|
| Rate for Payer: Multiplan Commercial |
$224.64
|
| Rate for Payer: Preferred Network Access Commercial |
$258.34
|
| Rate for Payer: Quartz Beloit One Network |
$137.59
|
| Rate for Payer: Quartz Commercial |
$168.48
|
| Rate for Payer: WEA Trust Commercial |
$154.44
|
| Rate for Payer: WPS Commercial |
$207.98
|
|
|
THORACENTESIS, CHEST
|
Facility
|
OP
|
$270.00
|
|
| Hospital Charge Code |
2960431
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$78.62 |
| Max. Negotiated Rate |
$258.34 |
| Rate for Payer: Aetna Commercial |
$252.72
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$241.49
|
| Rate for Payer: Aetna Managed Medicare |
$78.62
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$182.52
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$140.40
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$134.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$148.82
|
| Rate for Payer: Cash Price |
$81.00
|
| Rate for Payer: Cigna Commercial |
$258.34
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$157.14
|
| Rate for Payer: Health EOS Commercial |
$249.91
|
| Rate for Payer: HFN Commercial |
$258.34
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$210.60
|
| Rate for Payer: Multiplan Commercial |
$224.64
|
| Rate for Payer: NAPHCARE Commercial |
$168.48
|
| Rate for Payer: Preferred Network Access Commercial |
$258.34
|
| Rate for Payer: Quartz Beloit One Network |
$137.59
|
| Rate for Payer: Quartz Commercial |
$182.52
|
| Rate for Payer: Quartz Medicare Advantage |
$168.48
|
| Rate for Payer: The Alliance Commercial |
$140.40
|
| Rate for Payer: WEA Trust Commercial |
$154.44
|
| Rate for Payer: WPS Commercial |
$207.98
|
|
