|
U24 Creatinine
|
Professional
|
$116.00
|
|
|
Service Code
|
CPT 82570
|
| Hospital Charge Code |
978113
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.18 |
| Max. Negotiated Rate |
$110.20 |
| Rate for Payer: Aetna Commercial |
$110.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$99.76
|
| Rate for Payer: Aetna Managed Medicare |
$5.18
|
| Rate for Payer: Anthem Medicare Advantage |
$5.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5.18
|
| Rate for Payer: Cash Price |
$34.80
|
| Rate for Payer: Cash Price |
$34.80
|
| Rate for Payer: Cigna Commercial |
$110.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$58.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5.18
|
| Rate for Payer: Health EOS Commercial |
$105.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$18.29
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$18.29
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5.18
|
| Rate for Payer: Multiplan Commercial |
$92.80
|
| Rate for Payer: Preferred Network Access Commercial |
$110.20
|
| Rate for Payer: Quartz Beloit One Network |
$51.04
|
| Rate for Payer: Quartz Commercial |
$66.12
|
| Rate for Payer: Quartz Medicare Advantage |
$5.18
|
| Rate for Payer: The Alliance Commercial |
$20.46
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.18
|
| Rate for Payer: WEA Trust Commercial |
$63.80
|
| Rate for Payer: WPS Commercial |
$22.79
|
|
|
U24 Heavy Metal / 35386
|
Facility
IP
|
$610.00
|
|
|
Service Code
|
CPT 83015
|
| Hospital Charge Code |
977961
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$298.90 |
| Max. Negotiated Rate |
$561.20 |
| Rate for Payer: Aetna Commercial |
$549.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$323.30
|
| Rate for Payer: Cash Price |
$183.00
|
| Rate for Payer: Cigna Commercial |
$561.20
|
| Rate for Payer: Health EOS Commercial |
$542.90
|
| Rate for Payer: HFN Commercial |
$561.20
|
| Rate for Payer: Multiplan Commercial |
$488.00
|
| Rate for Payer: NAPHCARE Commercial |
$366.00
|
| Rate for Payer: Preferred Network Access Commercial |
$561.20
|
| Rate for Payer: Quartz Beloit One Network |
$298.90
|
| Rate for Payer: Quartz Commercial |
$366.00
|
| Rate for Payer: WEA Trust Commercial |
$335.50
|
| Rate for Payer: WPS Commercial |
$451.83
|
|
|
U24 Heavy Metal / 35386
|
Facility
OP
|
$610.00
|
|
|
Service Code
|
CPT 83015
|
| Hospital Charge Code |
977961
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$20.94 |
| Max. Negotiated Rate |
$2,440.00 |
| Rate for Payer: Aetna Commercial |
$549.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$524.60
|
| Rate for Payer: Aetna Managed Medicare |
$20.94
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$78.52
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$36.64
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$34.76
|
| Rate for Payer: Anthem Medicaid |
$21.64
|
| Rate for Payer: Anthem Medicare Advantage |
$20.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$323.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$20.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$20.94
|
| Rate for Payer: Cash Price |
$183.00
|
| Rate for Payer: Cash Price |
$183.00
|
| Rate for Payer: Cigna Commercial |
$561.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$20.94
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$21.64
|
| Rate for Payer: Dean Health Medicaid |
$21.64
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$20.94
|
| Rate for Payer: Health EOS Commercial |
$542.90
|
| Rate for Payer: HFN Commercial |
$561.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$77.90
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$20.94
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$21.64
|
| Rate for Payer: Independent Care Health Plan Medicare |
$20.94
|
| Rate for Payer: Managed Health Services Medicaid |
$22.51
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$20.94
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$20.94
|
| Rate for Payer: Multiplan Commercial |
$488.00
|
| Rate for Payer: NAPHCARE Commercial |
$31.41
|
| Rate for Payer: Preferred Network Access Commercial |
$561.20
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$21.64
|
| Rate for Payer: Quartz Beloit One Network |
$298.90
|
| Rate for Payer: Quartz Commercial |
$396.50
|
| Rate for Payer: Quartz Medicare Advantage |
$20.94
|
| Rate for Payer: The Alliance Commercial |
$2,440.00
|
| Rate for Payer: United Healthcare Medicaid |
$21.64
|
| Rate for Payer: United Healthcare Medicare Advantage |
$20.94
|
| Rate for Payer: United Healthcare PPO |
$457.50
|
| Rate for Payer: WEA Trust Commercial |
$335.50
|
| Rate for Payer: Wellcare Medicare |
$20.94
|
| Rate for Payer: WMAP Medicaid |
$21.64
|
| Rate for Payer: WPS Commercial |
$451.83
|
|
|
U24 Heavy Metal / 35386
|
Professional
|
$610.00
|
|
|
Service Code
|
CPT 83015
|
| Hospital Charge Code |
977961
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$20.94 |
| Max. Negotiated Rate |
$579.50 |
| Rate for Payer: Aetna Commercial |
$579.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$524.60
|
| Rate for Payer: Aetna Managed Medicare |
$20.94
|
| Rate for Payer: Anthem Medicare Advantage |
$20.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$20.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$20.94
|
| Rate for Payer: Cash Price |
$183.00
|
| Rate for Payer: Cash Price |
$183.00
|
| Rate for Payer: Cigna Commercial |
$579.50
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$305.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$20.94
|
| Rate for Payer: Health EOS Commercial |
$555.10
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$73.92
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$73.92
|
| Rate for Payer: Independent Care Health Plan Medicare |
$20.94
|
| Rate for Payer: Multiplan Commercial |
$488.00
|
| Rate for Payer: Preferred Network Access Commercial |
$579.50
|
| Rate for Payer: Quartz Beloit One Network |
$268.40
|
| Rate for Payer: Quartz Commercial |
$347.70
|
| Rate for Payer: Quartz Medicare Advantage |
$20.94
|
| Rate for Payer: The Alliance Commercial |
$82.71
|
| Rate for Payer: United Healthcare Medicare Advantage |
$20.94
|
| Rate for Payer: WEA Trust Commercial |
$335.50
|
| Rate for Payer: WPS Commercial |
$92.14
|
|
|
U24 Porphyrins, Fract, Qnt / 729
|
Facility
IP
|
$618.00
|
|
|
Service Code
|
CPT 84120
|
| Hospital Charge Code |
983365
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$302.82 |
| Max. Negotiated Rate |
$568.56 |
| Rate for Payer: Aetna Commercial |
$556.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$327.54
|
| Rate for Payer: Cash Price |
$185.40
|
| Rate for Payer: Cigna Commercial |
$568.56
|
| Rate for Payer: Health EOS Commercial |
$550.02
|
| Rate for Payer: HFN Commercial |
$568.56
|
| Rate for Payer: Multiplan Commercial |
$494.40
|
| Rate for Payer: NAPHCARE Commercial |
$370.80
|
| Rate for Payer: Preferred Network Access Commercial |
$568.56
|
| Rate for Payer: Quartz Beloit One Network |
$302.82
|
| Rate for Payer: Quartz Commercial |
$370.80
|
| Rate for Payer: WEA Trust Commercial |
$339.90
|
| Rate for Payer: WPS Commercial |
$457.75
|
|
|
U24 Porphyrins, Fract, Qnt / 729
|
Professional
|
$618.00
|
|
|
Service Code
|
CPT 84120
|
| Hospital Charge Code |
983365
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.71 |
| Max. Negotiated Rate |
$587.10 |
| Rate for Payer: Aetna Commercial |
$587.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$531.48
|
| Rate for Payer: Aetna Managed Medicare |
$14.71
|
| Rate for Payer: Anthem Medicare Advantage |
$14.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$14.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$14.71
|
| Rate for Payer: Cash Price |
$185.40
|
| Rate for Payer: Cash Price |
$185.40
|
| Rate for Payer: Cigna Commercial |
$587.10
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$309.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$14.71
|
| Rate for Payer: Health EOS Commercial |
$562.38
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$51.93
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$51.93
|
| Rate for Payer: Independent Care Health Plan Medicare |
$14.71
|
| Rate for Payer: Multiplan Commercial |
$494.40
|
| Rate for Payer: Preferred Network Access Commercial |
$587.10
|
| Rate for Payer: Quartz Beloit One Network |
$271.92
|
| Rate for Payer: Quartz Commercial |
$352.26
|
| Rate for Payer: Quartz Medicare Advantage |
$14.71
|
| Rate for Payer: The Alliance Commercial |
$58.10
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14.71
|
| Rate for Payer: WEA Trust Commercial |
$339.90
|
| Rate for Payer: WPS Commercial |
$64.72
|
|
|
U24 Porphyrins, Fract, Qnt / 729
|
Facility
OP
|
$618.00
|
|
|
Service Code
|
CPT 84120
|
| Hospital Charge Code |
983365
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.71 |
| Max. Negotiated Rate |
$2,472.00 |
| Rate for Payer: Aetna Commercial |
$556.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$531.48
|
| Rate for Payer: Aetna Managed Medicare |
$14.71
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$55.16
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$25.74
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$24.42
|
| Rate for Payer: Anthem Medicaid |
$15.20
|
| Rate for Payer: Anthem Medicare Advantage |
$14.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$327.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$14.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$14.71
|
| Rate for Payer: Cash Price |
$185.40
|
| Rate for Payer: Cash Price |
$185.40
|
| Rate for Payer: Cigna Commercial |
$568.56
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$14.71
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$15.20
|
| Rate for Payer: Dean Health Medicaid |
$15.20
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$14.71
|
| Rate for Payer: Health EOS Commercial |
$550.02
|
| Rate for Payer: HFN Commercial |
$568.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$54.72
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$14.71
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$15.20
|
| Rate for Payer: Independent Care Health Plan Medicare |
$14.71
|
| Rate for Payer: Managed Health Services Medicaid |
$15.81
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$14.71
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$14.71
|
| Rate for Payer: Multiplan Commercial |
$494.40
|
| Rate for Payer: NAPHCARE Commercial |
$22.06
|
| Rate for Payer: Preferred Network Access Commercial |
$568.56
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$15.20
|
| Rate for Payer: Quartz Beloit One Network |
$302.82
|
| Rate for Payer: Quartz Commercial |
$401.70
|
| Rate for Payer: Quartz Medicare Advantage |
$14.71
|
| Rate for Payer: The Alliance Commercial |
$2,472.00
|
| Rate for Payer: United Healthcare Medicaid |
$15.20
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14.71
|
| Rate for Payer: United Healthcare PPO |
$463.50
|
| Rate for Payer: WEA Trust Commercial |
$339.90
|
| Rate for Payer: Wellcare Medicare |
$14.71
|
| Rate for Payer: WMAP Medicaid |
$15.20
|
| Rate for Payer: WPS Commercial |
$457.75
|
|
|
U Arsenic / 270
|
Professional
|
$173.00
|
|
|
Service Code
|
CPT 82175
|
| Hospital Charge Code |
977872
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.97 |
| Max. Negotiated Rate |
$164.35 |
| Rate for Payer: Aetna Commercial |
$164.35
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$148.78
|
| Rate for Payer: Aetna Managed Medicare |
$18.97
|
| Rate for Payer: Anthem Medicare Advantage |
$18.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$18.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$18.97
|
| Rate for Payer: Cash Price |
$51.90
|
| Rate for Payer: Cash Price |
$51.90
|
| Rate for Payer: Cigna Commercial |
$164.35
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$86.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$18.97
|
| Rate for Payer: Health EOS Commercial |
$157.43
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$66.96
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$66.96
|
| Rate for Payer: Independent Care Health Plan Medicare |
$18.97
|
| Rate for Payer: Multiplan Commercial |
$138.40
|
| Rate for Payer: Preferred Network Access Commercial |
$164.35
|
| Rate for Payer: Quartz Beloit One Network |
$76.12
|
| Rate for Payer: Quartz Commercial |
$98.61
|
| Rate for Payer: Quartz Medicare Advantage |
$18.97
|
| Rate for Payer: The Alliance Commercial |
$74.93
|
| Rate for Payer: United Healthcare Medicare Advantage |
$18.97
|
| Rate for Payer: WEA Trust Commercial |
$95.15
|
| Rate for Payer: WPS Commercial |
$83.47
|
|
|
U Arsenic / 270
|
Facility
IP
|
$173.00
|
|
|
Service Code
|
CPT 82175
|
| Hospital Charge Code |
977872
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$84.77 |
| Max. Negotiated Rate |
$159.16 |
| Rate for Payer: Aetna Commercial |
$155.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$91.69
|
| Rate for Payer: Cash Price |
$51.90
|
| Rate for Payer: Cigna Commercial |
$159.16
|
| Rate for Payer: Health EOS Commercial |
$153.97
|
| Rate for Payer: HFN Commercial |
$159.16
|
| Rate for Payer: Multiplan Commercial |
$138.40
|
| Rate for Payer: NAPHCARE Commercial |
$103.80
|
| Rate for Payer: Preferred Network Access Commercial |
$159.16
|
| Rate for Payer: Quartz Beloit One Network |
$84.77
|
| Rate for Payer: Quartz Commercial |
$103.80
|
| Rate for Payer: WEA Trust Commercial |
$95.15
|
| Rate for Payer: WPS Commercial |
$128.14
|
|
|
U Arsenic / 270
|
Facility
OP
|
$173.00
|
|
|
Service Code
|
CPT 82175
|
| Hospital Charge Code |
977872
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.97 |
| Max. Negotiated Rate |
$692.00 |
| Rate for Payer: Aetna Commercial |
$155.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$148.78
|
| Rate for Payer: Aetna Managed Medicare |
$18.97
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$71.14
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$33.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$31.49
|
| Rate for Payer: Anthem Medicaid |
$19.60
|
| Rate for Payer: Anthem Medicare Advantage |
$18.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$91.69
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$18.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$18.97
|
| Rate for Payer: Cash Price |
$51.90
|
| Rate for Payer: Cash Price |
$51.90
|
| Rate for Payer: Cigna Commercial |
$159.16
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$18.97
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$19.60
|
| Rate for Payer: Dean Health Medicaid |
$19.60
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$18.97
|
| Rate for Payer: Health EOS Commercial |
$153.97
|
| Rate for Payer: HFN Commercial |
$159.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$70.57
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$18.97
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$19.60
|
| Rate for Payer: Independent Care Health Plan Medicare |
$18.97
|
| Rate for Payer: Managed Health Services Medicaid |
$20.38
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$18.97
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$18.97
|
| Rate for Payer: Multiplan Commercial |
$138.40
|
| Rate for Payer: NAPHCARE Commercial |
$28.46
|
| Rate for Payer: Preferred Network Access Commercial |
$159.16
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$19.60
|
| Rate for Payer: Quartz Beloit One Network |
$84.77
|
| Rate for Payer: Quartz Commercial |
$112.45
|
| Rate for Payer: Quartz Medicare Advantage |
$18.97
|
| Rate for Payer: The Alliance Commercial |
$692.00
|
| Rate for Payer: United Healthcare Medicaid |
$19.60
|
| Rate for Payer: United Healthcare Medicare Advantage |
$18.97
|
| Rate for Payer: United Healthcare PPO |
$129.75
|
| Rate for Payer: WEA Trust Commercial |
$95.15
|
| Rate for Payer: Wellcare Medicare |
$18.97
|
| Rate for Payer: WMAP Medicaid |
$19.60
|
| Rate for Payer: WPS Commercial |
$128.14
|
|
|
U Creatinine
|
Facility
IP
|
$19.00
|
|
|
Service Code
|
CPT 82570
|
| Hospital Charge Code |
4506665
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.31 |
| Max. Negotiated Rate |
$17.48 |
| Rate for Payer: Aetna Commercial |
$17.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$10.07
|
| Rate for Payer: Cash Price |
$5.70
|
| Rate for Payer: Cigna Commercial |
$17.48
|
| Rate for Payer: Health EOS Commercial |
$16.91
|
| Rate for Payer: HFN Commercial |
$17.48
|
| Rate for Payer: Multiplan Commercial |
$15.20
|
| Rate for Payer: NAPHCARE Commercial |
$11.40
|
| Rate for Payer: Preferred Network Access Commercial |
$17.48
|
| Rate for Payer: Quartz Beloit One Network |
$9.31
|
| Rate for Payer: Quartz Commercial |
$11.40
|
| Rate for Payer: WEA Trust Commercial |
$10.45
|
| Rate for Payer: WPS Commercial |
$14.07
|
|
|
U Creatinine
|
Professional
|
$19.00
|
|
|
Service Code
|
CPT 82570
|
| Hospital Charge Code |
4506665
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.18 |
| Max. Negotiated Rate |
$22.79 |
| Rate for Payer: Aetna Commercial |
$18.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$16.34
|
| Rate for Payer: Aetna Managed Medicare |
$5.18
|
| Rate for Payer: Anthem Medicare Advantage |
$5.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5.18
|
| Rate for Payer: Cash Price |
$5.70
|
| Rate for Payer: Cash Price |
$5.70
|
| Rate for Payer: Cigna Commercial |
$18.05
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$9.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5.18
|
| Rate for Payer: Health EOS Commercial |
$17.29
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$18.29
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$18.29
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5.18
|
| Rate for Payer: Multiplan Commercial |
$15.20
|
| Rate for Payer: Preferred Network Access Commercial |
$18.05
|
| Rate for Payer: Quartz Beloit One Network |
$8.36
|
| Rate for Payer: Quartz Commercial |
$10.83
|
| Rate for Payer: Quartz Medicare Advantage |
$5.18
|
| Rate for Payer: The Alliance Commercial |
$20.46
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.18
|
| Rate for Payer: WEA Trust Commercial |
$10.45
|
| Rate for Payer: WPS Commercial |
$22.79
|
|
|
U Creatinine
|
Facility
OP
|
$19.00
|
|
|
Service Code
|
CPT 82570
|
| Hospital Charge Code |
4506665
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.18 |
| Max. Negotiated Rate |
$76.00 |
| Rate for Payer: Aetna Commercial |
$17.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$16.34
|
| Rate for Payer: Aetna Managed Medicare |
$5.18
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$19.42
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$9.06
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$8.60
|
| Rate for Payer: Anthem Medicaid |
$5.35
|
| Rate for Payer: Anthem Medicare Advantage |
$5.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$10.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5.18
|
| Rate for Payer: Cash Price |
$5.70
|
| Rate for Payer: Cash Price |
$5.70
|
| Rate for Payer: Cigna Commercial |
$17.48
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$5.18
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$5.35
|
| Rate for Payer: Dean Health Medicaid |
$5.35
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$5.18
|
| Rate for Payer: Health EOS Commercial |
$16.91
|
| Rate for Payer: HFN Commercial |
$17.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$19.27
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$5.18
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$5.35
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5.18
|
| Rate for Payer: Managed Health Services Medicaid |
$5.56
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$5.18
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$5.18
|
| Rate for Payer: Multiplan Commercial |
$15.20
|
| Rate for Payer: NAPHCARE Commercial |
$7.77
|
| Rate for Payer: Preferred Network Access Commercial |
$17.48
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$5.35
|
| Rate for Payer: Quartz Beloit One Network |
$9.31
|
| Rate for Payer: Quartz Commercial |
$12.35
|
| Rate for Payer: Quartz Medicare Advantage |
$5.18
|
| Rate for Payer: The Alliance Commercial |
$76.00
|
| Rate for Payer: United Healthcare Medicaid |
$5.35
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.18
|
| Rate for Payer: United Healthcare PPO |
$14.25
|
| Rate for Payer: WEA Trust Commercial |
$10.45
|
| Rate for Payer: Wellcare Medicare |
$5.18
|
| Rate for Payer: WMAP Medicaid |
$5.35
|
| Rate for Payer: WPS Commercial |
$14.07
|
|
|
UE Fx Orth Shoul Cap Forearm L3981
|
Professional
|
$1,326.00
|
|
|
Service Code
|
HCPCS L3981
|
| Hospital Charge Code |
4924611
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$583.44 |
| Max. Negotiated Rate |
$3,246.08 |
| Rate for Payer: Aetna Commercial |
$1,259.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,140.36
|
| Rate for Payer: Cash Price |
$397.80
|
| Rate for Payer: Cash Price |
$397.80
|
| Rate for Payer: Cigna Commercial |
$1,259.70
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$663.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$795.60
|
| Rate for Payer: Health EOS Commercial |
$1,206.66
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,246.08
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$3,246.08
|
| Rate for Payer: Multiplan Commercial |
$1,060.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,259.70
|
| Rate for Payer: Quartz Beloit One Network |
$583.44
|
| Rate for Payer: Quartz Commercial |
$755.82
|
| Rate for Payer: The Alliance Commercial |
$663.00
|
| Rate for Payer: WEA Trust Commercial |
$729.30
|
| Rate for Payer: WPS Commercial |
$982.17
|
|
|
UE Fx Orth Shoul Cap Forearm L3981
|
Facility
OP
|
$1,326.00
|
|
|
Service Code
|
HCPCS L3981
|
| Hospital Charge Code |
4924611
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$371.28 |
| Max. Negotiated Rate |
$5,304.00 |
| Rate for Payer: Aetna Commercial |
$1,193.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,140.36
|
| Rate for Payer: Aetna Managed Medicare |
$371.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$861.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$663.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$636.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$702.78
|
| Rate for Payer: Cash Price |
$397.80
|
| Rate for Payer: Cigna Commercial |
$1,219.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$742.03
|
| Rate for Payer: Health EOS Commercial |
$1,180.14
|
| Rate for Payer: HFN Commercial |
$1,219.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$994.50
|
| Rate for Payer: Multiplan Commercial |
$1,060.80
|
| Rate for Payer: NAPHCARE Commercial |
$795.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,219.92
|
| Rate for Payer: Quartz Beloit One Network |
$649.74
|
| Rate for Payer: Quartz Commercial |
$861.90
|
| Rate for Payer: Quartz Medicare Advantage |
$795.60
|
| Rate for Payer: The Alliance Commercial |
$5,304.00
|
| Rate for Payer: WEA Trust Commercial |
$729.30
|
| Rate for Payer: WPS Commercial |
$982.17
|
|
|
UE Fx Orth Shoul Cap Forearm L3981
|
Facility
IP
|
$1,326.00
|
|
|
Service Code
|
HCPCS L3981
|
| Hospital Charge Code |
4924611
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$649.74 |
| Max. Negotiated Rate |
$1,219.92 |
| Rate for Payer: Aetna Commercial |
$1,193.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$702.78
|
| Rate for Payer: Cash Price |
$397.80
|
| Rate for Payer: Cigna Commercial |
$1,219.92
|
| Rate for Payer: Health EOS Commercial |
$1,180.14
|
| Rate for Payer: HFN Commercial |
$1,219.92
|
| Rate for Payer: Multiplan Commercial |
$1,060.80
|
| Rate for Payer: NAPHCARE Commercial |
$795.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,219.92
|
| Rate for Payer: Quartz Beloit One Network |
$649.74
|
| Rate for Payer: Quartz Commercial |
$795.60
|
| Rate for Payer: WEA Trust Commercial |
$729.30
|
| Rate for Payer: WPS Commercial |
$982.17
|
|
|
U Ethyl Glucuronide / 90418
|
Facility
OP
|
$129.00
|
|
|
Service Code
|
CPT 80321
|
| Hospital Charge Code |
3530179
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$36.12 |
| Max. Negotiated Rate |
$118.68 |
| Rate for Payer: Aetna Commercial |
$116.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$110.94
|
| Rate for Payer: Aetna Managed Medicare |
$36.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$83.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$64.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$61.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$68.37
|
| Rate for Payer: Cash Price |
$38.70
|
| Rate for Payer: Cash Price |
$38.70
|
| Rate for Payer: Cigna Commercial |
$118.68
|
| Rate for Payer: Health EOS Commercial |
$114.81
|
| Rate for Payer: HFN Commercial |
$118.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$96.75
|
| Rate for Payer: Multiplan Commercial |
$103.20
|
| Rate for Payer: NAPHCARE Commercial |
$77.40
|
| Rate for Payer: Preferred Network Access Commercial |
$118.68
|
| Rate for Payer: Quartz Beloit One Network |
$63.21
|
| Rate for Payer: Quartz Commercial |
$83.85
|
| Rate for Payer: Quartz Medicare Advantage |
$77.40
|
| Rate for Payer: United Healthcare PPO |
$96.75
|
| Rate for Payer: WEA Trust Commercial |
$70.95
|
| Rate for Payer: WPS Commercial |
$95.55
|
|
|
U Ethyl Glucuronide / 90418
|
Facility
IP
|
$129.00
|
|
|
Service Code
|
CPT 80321
|
| Hospital Charge Code |
3530179
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$63.21 |
| Max. Negotiated Rate |
$118.68 |
| Rate for Payer: Aetna Commercial |
$116.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$68.37
|
| Rate for Payer: Cash Price |
$38.70
|
| Rate for Payer: Cigna Commercial |
$118.68
|
| Rate for Payer: Health EOS Commercial |
$114.81
|
| Rate for Payer: HFN Commercial |
$118.68
|
| Rate for Payer: Multiplan Commercial |
$103.20
|
| Rate for Payer: NAPHCARE Commercial |
$77.40
|
| Rate for Payer: Preferred Network Access Commercial |
$118.68
|
| Rate for Payer: Quartz Beloit One Network |
$63.21
|
| Rate for Payer: Quartz Commercial |
$77.40
|
| Rate for Payer: WEA Trust Commercial |
$70.95
|
| Rate for Payer: WPS Commercial |
$95.55
|
|
|
U Ethyl Glucuronide / 90418
|
Professional
|
$129.00
|
|
|
Service Code
|
CPT 80321
|
| Hospital Charge Code |
3530179
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$47.55 |
| Max. Negotiated Rate |
$122.55 |
| Rate for Payer: Aetna Commercial |
$122.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$110.94
|
| Rate for Payer: Cash Price |
$38.70
|
| Rate for Payer: Cash Price |
$38.70
|
| Rate for Payer: Cigna Commercial |
$122.55
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$64.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$77.40
|
| Rate for Payer: Health EOS Commercial |
$117.39
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$47.55
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$47.55
|
| Rate for Payer: Multiplan Commercial |
$103.20
|
| Rate for Payer: Preferred Network Access Commercial |
$122.55
|
| Rate for Payer: Quartz Beloit One Network |
$56.76
|
| Rate for Payer: Quartz Commercial |
$73.53
|
| Rate for Payer: The Alliance Commercial |
$64.50
|
| Rate for Payer: WEA Trust Commercial |
$70.95
|
| Rate for Payer: WPS Commercial |
$95.55
|
|
|
UGT1A1 Gene Polymorphism (TA Repeat)
|
Facility
OP
|
$716.00
|
|
|
Service Code
|
CPT 81350
|
| Hospital Charge Code |
4392920
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$234.00 |
| Max. Negotiated Rate |
$2,864.00 |
| Rate for Payer: Aetna Commercial |
$644.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$615.76
|
| Rate for Payer: Aetna Managed Medicare |
$234.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$877.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$409.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$388.44
|
| Rate for Payer: Anthem Medicare Advantage |
$234.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$379.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$234.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$234.00
|
| Rate for Payer: Cash Price |
$214.80
|
| Rate for Payer: Cash Price |
$214.80
|
| Rate for Payer: Cigna Commercial |
$658.72
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$234.00
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$234.00
|
| Rate for Payer: Health EOS Commercial |
$637.24
|
| Rate for Payer: HFN Commercial |
$658.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$870.48
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$234.00
|
| Rate for Payer: Independent Care Health Plan Medicare |
$234.00
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$234.00
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$234.00
|
| Rate for Payer: Multiplan Commercial |
$572.80
|
| Rate for Payer: NAPHCARE Commercial |
$351.00
|
| Rate for Payer: Preferred Network Access Commercial |
$658.72
|
| Rate for Payer: Quartz Beloit One Network |
$350.84
|
| Rate for Payer: Quartz Commercial |
$465.40
|
| Rate for Payer: Quartz Medicare Advantage |
$234.00
|
| Rate for Payer: The Alliance Commercial |
$2,864.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$234.00
|
| Rate for Payer: United Healthcare PPO |
$537.00
|
| Rate for Payer: WEA Trust Commercial |
$393.80
|
| Rate for Payer: Wellcare Medicare |
$234.00
|
| Rate for Payer: WPS Commercial |
$530.34
|
|
|
UGT1A1 Gene Polymorphism (TA Repeat)
|
Facility
IP
|
$716.00
|
|
|
Service Code
|
CPT 81350
|
| Hospital Charge Code |
4392920
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$350.84 |
| Max. Negotiated Rate |
$658.72 |
| Rate for Payer: Aetna Commercial |
$644.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$379.48
|
| Rate for Payer: Cash Price |
$214.80
|
| Rate for Payer: Cigna Commercial |
$658.72
|
| Rate for Payer: Health EOS Commercial |
$637.24
|
| Rate for Payer: HFN Commercial |
$658.72
|
| Rate for Payer: Multiplan Commercial |
$572.80
|
| Rate for Payer: NAPHCARE Commercial |
$429.60
|
| Rate for Payer: Preferred Network Access Commercial |
$658.72
|
| Rate for Payer: Quartz Beloit One Network |
$350.84
|
| Rate for Payer: Quartz Commercial |
$429.60
|
| Rate for Payer: WEA Trust Commercial |
$393.80
|
| Rate for Payer: WPS Commercial |
$530.34
|
|
|
UGT1A1 Gene Polymorphism (TA Repeat)
|
Professional
|
$716.00
|
|
|
Service Code
|
CPT 81350
|
| Hospital Charge Code |
4392920
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$234.00 |
| Max. Negotiated Rate |
$1,029.60 |
| Rate for Payer: Aetna Commercial |
$680.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$615.76
|
| Rate for Payer: Aetna Managed Medicare |
$234.00
|
| Rate for Payer: Anthem Medicare Advantage |
$234.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$234.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$234.00
|
| Rate for Payer: Cash Price |
$214.80
|
| Rate for Payer: Cash Price |
$214.80
|
| Rate for Payer: Cigna Commercial |
$680.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$358.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$234.00
|
| Rate for Payer: Health EOS Commercial |
$651.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$826.02
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$826.02
|
| Rate for Payer: Independent Care Health Plan Medicare |
$234.00
|
| Rate for Payer: Multiplan Commercial |
$572.80
|
| Rate for Payer: Preferred Network Access Commercial |
$680.20
|
| Rate for Payer: Quartz Beloit One Network |
$315.04
|
| Rate for Payer: Quartz Commercial |
$408.12
|
| Rate for Payer: Quartz Medicare Advantage |
$234.00
|
| Rate for Payer: The Alliance Commercial |
$924.30
|
| Rate for Payer: United Healthcare Medicare Advantage |
$234.00
|
| Rate for Payer: WEA Trust Commercial |
$393.80
|
| Rate for Payer: WPS Commercial |
$1,029.60
|
|
|
ULNA INTRAMEDULLARY RODDING
|
Facility
IP
|
$4,560.00
|
|
| Hospital Charge Code |
2960153
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,234.40 |
| Max. Negotiated Rate |
$4,195.20 |
| Rate for Payer: Aetna Commercial |
$4,104.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,416.80
|
| Rate for Payer: Cash Price |
$1,368.00
|
| Rate for Payer: Cigna Commercial |
$4,195.20
|
| Rate for Payer: Health EOS Commercial |
$4,058.40
|
| Rate for Payer: HFN Commercial |
$4,195.20
|
| Rate for Payer: Multiplan Commercial |
$3,648.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,736.00
|
| Rate for Payer: Preferred Network Access Commercial |
$4,195.20
|
| Rate for Payer: Quartz Beloit One Network |
$2,234.40
|
| Rate for Payer: Quartz Commercial |
$2,736.00
|
| Rate for Payer: WEA Trust Commercial |
$2,508.00
|
| Rate for Payer: WPS Commercial |
$3,377.59
|
|
|
ULNA INTRAMEDULLARY RODDING
|
Facility
OP
|
$4,560.00
|
|
| Hospital Charge Code |
2960153
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,276.80 |
| Max. Negotiated Rate |
$18,240.00 |
| Rate for Payer: Aetna Commercial |
$4,104.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,921.60
|
| Rate for Payer: Aetna Managed Medicare |
$1,276.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,964.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,280.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,188.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,416.80
|
| Rate for Payer: Cash Price |
$1,368.00
|
| Rate for Payer: Cigna Commercial |
$4,195.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,551.78
|
| Rate for Payer: Health EOS Commercial |
$4,058.40
|
| Rate for Payer: HFN Commercial |
$4,195.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,420.00
|
| Rate for Payer: Multiplan Commercial |
$3,648.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,736.00
|
| Rate for Payer: Preferred Network Access Commercial |
$4,195.20
|
| Rate for Payer: Quartz Beloit One Network |
$2,234.40
|
| Rate for Payer: Quartz Commercial |
$2,964.00
|
| Rate for Payer: Quartz Medicare Advantage |
$2,736.00
|
| Rate for Payer: The Alliance Commercial |
$18,240.00
|
| Rate for Payer: WEA Trust Commercial |
$2,508.00
|
| Rate for Payer: WPS Commercial |
$3,377.59
|
|
|
ULNAR COLATERAL LIGAMENT RECONSTRUCTION
|
Facility
OP
|
$4,170.00
|
|
| Hospital Charge Code |
2960202
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,167.60 |
| Max. Negotiated Rate |
$16,680.00 |
| Rate for Payer: Aetna Commercial |
$3,753.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,586.20
|
| Rate for Payer: Aetna Managed Medicare |
$1,167.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,710.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,085.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,001.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,210.10
|
| Rate for Payer: Cash Price |
$1,251.00
|
| Rate for Payer: Cigna Commercial |
$3,836.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,333.53
|
| Rate for Payer: Health EOS Commercial |
$3,711.30
|
| Rate for Payer: HFN Commercial |
$3,836.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,127.50
|
| Rate for Payer: Multiplan Commercial |
$3,336.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,502.00
|
| Rate for Payer: Preferred Network Access Commercial |
$3,836.40
|
| Rate for Payer: Quartz Beloit One Network |
$2,043.30
|
| Rate for Payer: Quartz Commercial |
$2,710.50
|
| Rate for Payer: Quartz Medicare Advantage |
$2,502.00
|
| Rate for Payer: The Alliance Commercial |
$16,680.00
|
| Rate for Payer: WEA Trust Commercial |
$2,293.50
|
| Rate for Payer: WPS Commercial |
$3,088.72
|
|
