|
U24 Creatinine
|
Professional
|
Both
|
$116.00
|
|
|
Service Code
|
CPT 82570
|
| Hospital Charge Code |
978113
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.39 |
| Max. Negotiated Rate |
$114.61 |
| Rate for Payer: Aetna Commercial |
$114.61
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$103.75
|
| Rate for Payer: Aetna Managed Medicare |
$5.39
|
| Rate for Payer: Anthem Medicare Advantage |
$5.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5.39
|
| Rate for Payer: Cash Price |
$34.80
|
| Rate for Payer: Cash Price |
$34.80
|
| Rate for Payer: Cigna Commercial |
$114.61
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$60.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5.39
|
| Rate for Payer: Health EOS Commercial |
$109.78
|
| Rate for Payer: HFN Commercial |
$114.61
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$19.02
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$19.02
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5.39
|
| Rate for Payer: Multiplan Commercial |
$96.51
|
| Rate for Payer: NAPHCARE Commercial |
$8.08
|
| Rate for Payer: Preferred Network Access Commercial |
$114.61
|
| Rate for Payer: Quartz Beloit One Network |
$53.08
|
| Rate for Payer: Quartz Commercial |
$68.76
|
| Rate for Payer: Quartz Medicare Advantage |
$5.39
|
| Rate for Payer: The Alliance Commercial |
$21.28
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.39
|
| Rate for Payer: WEA Trust Commercial |
$66.35
|
| Rate for Payer: WPS Commercial |
$23.70
|
|
|
U24 Heavy Metal / 35386
|
Facility
|
IP
|
$610.00
|
|
|
Service Code
|
CPT 83015
|
| Hospital Charge Code |
977961
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$310.86 |
| Max. Negotiated Rate |
$583.65 |
| Rate for Payer: Aetna Commercial |
$570.96
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$545.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$336.23
|
| Rate for Payer: Cash Price |
$183.00
|
| Rate for Payer: Cigna Commercial |
$583.65
|
| Rate for Payer: Health EOS Commercial |
$564.62
|
| Rate for Payer: HFN Commercial |
$583.65
|
| Rate for Payer: Multiplan Commercial |
$507.52
|
| Rate for Payer: Preferred Network Access Commercial |
$583.65
|
| Rate for Payer: Quartz Beloit One Network |
$310.86
|
| Rate for Payer: Quartz Commercial |
$380.64
|
| Rate for Payer: WEA Trust Commercial |
$348.92
|
| Rate for Payer: WPS Commercial |
$469.88
|
|
|
U24 Heavy Metal / 35386
|
Facility
|
OP
|
$610.00
|
|
|
Service Code
|
CPT 83015
|
| Hospital Charge Code |
977961
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$21.78 |
| Max. Negotiated Rate |
$583.65 |
| Rate for Payer: Aetna Commercial |
$570.96
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$545.58
|
| Rate for Payer: Aetna Managed Medicare |
$21.78
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$81.67
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$38.11
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$36.15
|
| Rate for Payer: Anthem Medicare Advantage |
$21.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$336.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$21.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$21.78
|
| Rate for Payer: Cash Price |
$183.00
|
| Rate for Payer: Cash Price |
$183.00
|
| Rate for Payer: Cigna Commercial |
$583.65
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$21.78
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$355.02
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$21.78
|
| Rate for Payer: Health EOS Commercial |
$564.62
|
| Rate for Payer: HFN Commercial |
$583.65
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$81.01
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$21.78
|
| Rate for Payer: Independent Care Health Plan Medicare |
$21.78
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$21.78
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$21.78
|
| Rate for Payer: Multiplan Commercial |
$507.52
|
| Rate for Payer: NAPHCARE Commercial |
$32.67
|
| Rate for Payer: Preferred Network Access Commercial |
$583.65
|
| Rate for Payer: Quartz Beloit One Network |
$310.86
|
| Rate for Payer: Quartz Commercial |
$412.36
|
| Rate for Payer: Quartz Medicare Advantage |
$21.78
|
| Rate for Payer: The Alliance Commercial |
$87.11
|
| Rate for Payer: United Healthcare Medicare Advantage |
$21.78
|
| Rate for Payer: United Healthcare PPO |
$475.80
|
| Rate for Payer: WEA Trust Commercial |
$348.92
|
| Rate for Payer: Wellcare Medicare |
$21.78
|
| Rate for Payer: WPS Commercial |
$469.88
|
|
|
U24 Heavy Metal / 35386
|
Professional
|
Both
|
$610.00
|
|
|
Service Code
|
CPT 83015
|
| Hospital Charge Code |
977961
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$21.78 |
| Max. Negotiated Rate |
$602.68 |
| Rate for Payer: Aetna Commercial |
$602.68
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$545.58
|
| Rate for Payer: Aetna Managed Medicare |
$21.78
|
| Rate for Payer: Anthem Medicare Advantage |
$21.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$21.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$21.78
|
| Rate for Payer: Cash Price |
$183.00
|
| Rate for Payer: Cash Price |
$183.00
|
| Rate for Payer: Cigna Commercial |
$602.68
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$317.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$21.78
|
| Rate for Payer: Health EOS Commercial |
$577.30
|
| Rate for Payer: HFN Commercial |
$602.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$76.88
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$76.88
|
| Rate for Payer: Independent Care Health Plan Medicare |
$21.78
|
| Rate for Payer: Multiplan Commercial |
$507.52
|
| Rate for Payer: NAPHCARE Commercial |
$32.67
|
| Rate for Payer: Preferred Network Access Commercial |
$602.68
|
| Rate for Payer: Quartz Beloit One Network |
$279.14
|
| Rate for Payer: Quartz Commercial |
$361.61
|
| Rate for Payer: Quartz Medicare Advantage |
$21.78
|
| Rate for Payer: The Alliance Commercial |
$86.02
|
| Rate for Payer: United Healthcare Medicare Advantage |
$21.78
|
| Rate for Payer: WEA Trust Commercial |
$348.92
|
| Rate for Payer: WPS Commercial |
$95.82
|
|
|
U24 Porphyrins, Fract, Qnt / 729
|
Facility
|
IP
|
$618.00
|
|
|
Service Code
|
CPT 84120
|
| Hospital Charge Code |
983365
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$314.93 |
| Max. Negotiated Rate |
$591.30 |
| Rate for Payer: Aetna Commercial |
$578.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$552.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$340.64
|
| Rate for Payer: Cash Price |
$185.40
|
| Rate for Payer: Cigna Commercial |
$591.30
|
| Rate for Payer: Health EOS Commercial |
$572.02
|
| Rate for Payer: HFN Commercial |
$591.30
|
| Rate for Payer: Multiplan Commercial |
$514.18
|
| Rate for Payer: Preferred Network Access Commercial |
$591.30
|
| Rate for Payer: Quartz Beloit One Network |
$314.93
|
| Rate for Payer: Quartz Commercial |
$385.63
|
| Rate for Payer: WEA Trust Commercial |
$353.50
|
| Rate for Payer: WPS Commercial |
$476.05
|
|
|
U24 Porphyrins, Fract, Qnt / 729
|
Facility
|
OP
|
$618.00
|
|
|
Service Code
|
CPT 84120
|
| Hospital Charge Code |
983365
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.30 |
| Max. Negotiated Rate |
$591.30 |
| Rate for Payer: Aetna Commercial |
$578.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$552.74
|
| Rate for Payer: Aetna Managed Medicare |
$15.30
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$57.37
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$26.77
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$25.40
|
| Rate for Payer: Anthem Medicare Advantage |
$15.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$340.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$15.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$15.30
|
| Rate for Payer: Cash Price |
$185.40
|
| Rate for Payer: Cash Price |
$185.40
|
| Rate for Payer: Cigna Commercial |
$591.30
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$15.30
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$359.68
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$15.30
|
| Rate for Payer: Health EOS Commercial |
$572.02
|
| Rate for Payer: HFN Commercial |
$591.30
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$56.91
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$15.30
|
| Rate for Payer: Independent Care Health Plan Medicare |
$15.30
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$15.30
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$15.30
|
| Rate for Payer: Multiplan Commercial |
$514.18
|
| Rate for Payer: NAPHCARE Commercial |
$22.95
|
| Rate for Payer: Preferred Network Access Commercial |
$591.30
|
| Rate for Payer: Quartz Beloit One Network |
$314.93
|
| Rate for Payer: Quartz Commercial |
$417.77
|
| Rate for Payer: Quartz Medicare Advantage |
$15.30
|
| Rate for Payer: The Alliance Commercial |
$61.19
|
| Rate for Payer: United Healthcare Medicare Advantage |
$15.30
|
| Rate for Payer: United Healthcare PPO |
$482.04
|
| Rate for Payer: WEA Trust Commercial |
$353.50
|
| Rate for Payer: Wellcare Medicare |
$15.30
|
| Rate for Payer: WPS Commercial |
$476.05
|
|
|
U24 Porphyrins, Fract, Qnt / 729
|
Professional
|
Both
|
$618.00
|
|
|
Service Code
|
CPT 84120
|
| Hospital Charge Code |
983365
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.30 |
| Max. Negotiated Rate |
$610.58 |
| Rate for Payer: Aetna Commercial |
$610.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$552.74
|
| Rate for Payer: Aetna Managed Medicare |
$15.30
|
| Rate for Payer: Anthem Medicare Advantage |
$15.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$15.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$15.30
|
| Rate for Payer: Cash Price |
$185.40
|
| Rate for Payer: Cash Price |
$185.40
|
| Rate for Payer: Cigna Commercial |
$610.58
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$321.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$15.30
|
| Rate for Payer: Health EOS Commercial |
$584.88
|
| Rate for Payer: HFN Commercial |
$610.58
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$54.01
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$54.01
|
| Rate for Payer: Independent Care Health Plan Medicare |
$15.30
|
| Rate for Payer: Multiplan Commercial |
$514.18
|
| Rate for Payer: NAPHCARE Commercial |
$22.95
|
| Rate for Payer: Preferred Network Access Commercial |
$610.58
|
| Rate for Payer: Quartz Beloit One Network |
$282.80
|
| Rate for Payer: Quartz Commercial |
$366.35
|
| Rate for Payer: Quartz Medicare Advantage |
$15.30
|
| Rate for Payer: The Alliance Commercial |
$60.43
|
| Rate for Payer: United Healthcare Medicare Advantage |
$15.30
|
| Rate for Payer: WEA Trust Commercial |
$353.50
|
| Rate for Payer: WPS Commercial |
$67.31
|
|
|
U Arsenic / 270
|
Professional
|
Both
|
$173.00
|
|
|
Service Code
|
CPT 82175
|
| Hospital Charge Code |
977872
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$19.73 |
| Max. Negotiated Rate |
$170.92 |
| Rate for Payer: Aetna Commercial |
$170.92
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$154.73
|
| Rate for Payer: Aetna Managed Medicare |
$19.73
|
| Rate for Payer: Anthem Medicare Advantage |
$19.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$19.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$19.73
|
| Rate for Payer: Cash Price |
$51.90
|
| Rate for Payer: Cash Price |
$51.90
|
| Rate for Payer: Cigna Commercial |
$170.92
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$89.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$19.73
|
| Rate for Payer: Health EOS Commercial |
$163.73
|
| Rate for Payer: HFN Commercial |
$170.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$69.64
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$69.64
|
| Rate for Payer: Independent Care Health Plan Medicare |
$19.73
|
| Rate for Payer: Multiplan Commercial |
$143.94
|
| Rate for Payer: NAPHCARE Commercial |
$29.59
|
| Rate for Payer: Preferred Network Access Commercial |
$170.92
|
| Rate for Payer: Quartz Beloit One Network |
$79.16
|
| Rate for Payer: Quartz Commercial |
$102.55
|
| Rate for Payer: Quartz Medicare Advantage |
$19.73
|
| Rate for Payer: The Alliance Commercial |
$77.93
|
| Rate for Payer: United Healthcare Medicare Advantage |
$19.73
|
| Rate for Payer: WEA Trust Commercial |
$98.96
|
| Rate for Payer: WPS Commercial |
$86.81
|
|
|
U Arsenic / 270
|
Facility
|
IP
|
$173.00
|
|
|
Service Code
|
CPT 82175
|
| Hospital Charge Code |
977872
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$88.16 |
| Max. Negotiated Rate |
$165.53 |
| Rate for Payer: Aetna Commercial |
$161.93
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$154.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$95.36
|
| Rate for Payer: Cash Price |
$51.90
|
| Rate for Payer: Cigna Commercial |
$165.53
|
| Rate for Payer: Health EOS Commercial |
$160.13
|
| Rate for Payer: HFN Commercial |
$165.53
|
| Rate for Payer: Multiplan Commercial |
$143.94
|
| Rate for Payer: Preferred Network Access Commercial |
$165.53
|
| Rate for Payer: Quartz Beloit One Network |
$88.16
|
| Rate for Payer: Quartz Commercial |
$107.95
|
| Rate for Payer: WEA Trust Commercial |
$98.96
|
| Rate for Payer: WPS Commercial |
$133.26
|
|
|
U Arsenic / 270
|
Facility
|
OP
|
$173.00
|
|
|
Service Code
|
CPT 82175
|
| Hospital Charge Code |
977872
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$19.73 |
| Max. Negotiated Rate |
$165.53 |
| Rate for Payer: Aetna Commercial |
$161.93
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$154.73
|
| Rate for Payer: Aetna Managed Medicare |
$19.73
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$73.98
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$34.53
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$32.75
|
| Rate for Payer: Anthem Medicare Advantage |
$19.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$95.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$19.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$19.73
|
| Rate for Payer: Cash Price |
$51.90
|
| Rate for Payer: Cash Price |
$51.90
|
| Rate for Payer: Cigna Commercial |
$165.53
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$19.73
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$100.69
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$19.73
|
| Rate for Payer: Health EOS Commercial |
$160.13
|
| Rate for Payer: HFN Commercial |
$165.53
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$73.39
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$19.73
|
| Rate for Payer: Independent Care Health Plan Medicare |
$19.73
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$19.73
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$19.73
|
| Rate for Payer: Multiplan Commercial |
$143.94
|
| Rate for Payer: NAPHCARE Commercial |
$29.59
|
| Rate for Payer: Preferred Network Access Commercial |
$165.53
|
| Rate for Payer: Quartz Beloit One Network |
$88.16
|
| Rate for Payer: Quartz Commercial |
$116.95
|
| Rate for Payer: Quartz Medicare Advantage |
$19.73
|
| Rate for Payer: The Alliance Commercial |
$78.92
|
| Rate for Payer: United Healthcare Medicare Advantage |
$19.73
|
| Rate for Payer: United Healthcare PPO |
$134.94
|
| Rate for Payer: WEA Trust Commercial |
$98.96
|
| Rate for Payer: Wellcare Medicare |
$19.73
|
| Rate for Payer: WPS Commercial |
$133.26
|
|
|
U Creatinine
|
Facility
|
IP
|
$19.00
|
|
|
Service Code
|
CPT 82570
|
| Hospital Charge Code |
4506665
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.68 |
| Max. Negotiated Rate |
$18.18 |
| Rate for Payer: Aetna Commercial |
$17.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$16.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$10.47
|
| Rate for Payer: Cash Price |
$5.70
|
| Rate for Payer: Cigna Commercial |
$18.18
|
| Rate for Payer: Health EOS Commercial |
$17.59
|
| Rate for Payer: HFN Commercial |
$18.18
|
| Rate for Payer: Multiplan Commercial |
$15.81
|
| Rate for Payer: Preferred Network Access Commercial |
$18.18
|
| Rate for Payer: Quartz Beloit One Network |
$9.68
|
| Rate for Payer: Quartz Commercial |
$11.86
|
| Rate for Payer: WEA Trust Commercial |
$10.87
|
| Rate for Payer: WPS Commercial |
$14.64
|
|
|
U Creatinine
|
Professional
|
Both
|
$19.00
|
|
|
Service Code
|
CPT 82570
|
| Hospital Charge Code |
4506665
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.39 |
| Max. Negotiated Rate |
$23.70 |
| Rate for Payer: Aetna Commercial |
$18.77
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$16.99
|
| Rate for Payer: Aetna Managed Medicare |
$5.39
|
| Rate for Payer: Anthem Medicare Advantage |
$5.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5.39
|
| Rate for Payer: Cash Price |
$5.70
|
| Rate for Payer: Cash Price |
$5.70
|
| Rate for Payer: Cigna Commercial |
$18.77
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$9.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5.39
|
| Rate for Payer: Health EOS Commercial |
$17.98
|
| Rate for Payer: HFN Commercial |
$18.77
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$19.02
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$19.02
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5.39
|
| Rate for Payer: Multiplan Commercial |
$15.81
|
| Rate for Payer: NAPHCARE Commercial |
$8.08
|
| Rate for Payer: Preferred Network Access Commercial |
$18.77
|
| Rate for Payer: Quartz Beloit One Network |
$8.69
|
| Rate for Payer: Quartz Commercial |
$11.26
|
| Rate for Payer: Quartz Medicare Advantage |
$5.39
|
| Rate for Payer: The Alliance Commercial |
$21.28
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.39
|
| Rate for Payer: WEA Trust Commercial |
$10.87
|
| Rate for Payer: WPS Commercial |
$23.70
|
|
|
U Creatinine
|
Facility
|
OP
|
$19.00
|
|
|
Service Code
|
CPT 82570
|
| Hospital Charge Code |
4506665
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.39 |
| Max. Negotiated Rate |
$21.55 |
| Rate for Payer: Aetna Commercial |
$17.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$16.99
|
| Rate for Payer: Aetna Managed Medicare |
$5.39
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$20.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$9.43
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$8.94
|
| Rate for Payer: Anthem Medicare Advantage |
$5.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$10.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5.39
|
| Rate for Payer: Cash Price |
$5.70
|
| Rate for Payer: Cash Price |
$5.70
|
| Rate for Payer: Cigna Commercial |
$18.18
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$5.39
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$11.06
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$5.39
|
| Rate for Payer: Health EOS Commercial |
$17.59
|
| Rate for Payer: HFN Commercial |
$18.18
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$20.04
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$5.39
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5.39
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$5.39
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$5.39
|
| Rate for Payer: Multiplan Commercial |
$15.81
|
| Rate for Payer: NAPHCARE Commercial |
$8.08
|
| Rate for Payer: Preferred Network Access Commercial |
$18.18
|
| Rate for Payer: Quartz Beloit One Network |
$9.68
|
| Rate for Payer: Quartz Commercial |
$12.84
|
| Rate for Payer: Quartz Medicare Advantage |
$5.39
|
| Rate for Payer: The Alliance Commercial |
$21.55
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.39
|
| Rate for Payer: United Healthcare PPO |
$14.82
|
| Rate for Payer: WEA Trust Commercial |
$10.87
|
| Rate for Payer: Wellcare Medicare |
$5.39
|
| Rate for Payer: WPS Commercial |
$14.64
|
|
|
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 |
$386.13 |
| Max. Negotiated Rate |
$4,683.33 |
| Rate for Payer: Aetna Commercial |
$1,241.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,185.97
|
| Rate for Payer: Aetna Managed Medicare |
$386.13
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$896.38
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$689.52
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$661.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$730.89
|
| Rate for Payer: Cash Price |
$397.80
|
| Rate for Payer: Cash Price |
$397.80
|
| Rate for Payer: Cigna Commercial |
$1,268.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$771.73
|
| Rate for Payer: Health EOS Commercial |
$1,227.35
|
| Rate for Payer: HFN Commercial |
$1,268.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,034.28
|
| Rate for Payer: Multiplan Commercial |
$1,103.23
|
| Rate for Payer: NAPHCARE Commercial |
$827.42
|
| Rate for Payer: Preferred Network Access Commercial |
$1,268.72
|
| Rate for Payer: Quartz Beloit One Network |
$675.73
|
| Rate for Payer: Quartz Commercial |
$896.38
|
| Rate for Payer: Quartz Medicare Advantage |
$827.42
|
| Rate for Payer: The Alliance Commercial |
$4,683.33
|
| Rate for Payer: WEA Trust Commercial |
$758.47
|
| Rate for Payer: WPS Commercial |
$1,021.42
|
|
|
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 |
$675.73 |
| Max. Negotiated Rate |
$1,268.72 |
| Rate for Payer: Aetna Commercial |
$1,241.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,185.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$730.89
|
| Rate for Payer: Cash Price |
$397.80
|
| Rate for Payer: Cigna Commercial |
$1,268.72
|
| Rate for Payer: Health EOS Commercial |
$1,227.35
|
| Rate for Payer: HFN Commercial |
$1,268.72
|
| Rate for Payer: Multiplan Commercial |
$1,103.23
|
| Rate for Payer: Preferred Network Access Commercial |
$1,268.72
|
| Rate for Payer: Quartz Beloit One Network |
$675.73
|
| Rate for Payer: Quartz Commercial |
$827.42
|
| Rate for Payer: WEA Trust Commercial |
$758.47
|
| Rate for Payer: WPS Commercial |
$1,021.42
|
|
|
UE Fx Orth Shoul Cap Forearm L3981
|
Professional
|
Both
|
$1,326.00
|
|
|
Service Code
|
HCPCS L3981
|
| Hospital Charge Code |
4924611
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$606.78 |
| Max. Negotiated Rate |
$3,375.92 |
| Rate for Payer: Aetna Commercial |
$1,310.09
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,185.97
|
| Rate for Payer: Aetna Managed Medicare |
$1,170.83
|
| Rate for Payer: Anthem Medicare Advantage |
$1,170.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$1,170.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$1,170.83
|
| Rate for Payer: Cash Price |
$397.80
|
| Rate for Payer: Cash Price |
$397.80
|
| Rate for Payer: Cigna Commercial |
$1,310.09
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$689.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,170.83
|
| Rate for Payer: Health EOS Commercial |
$1,254.93
|
| Rate for Payer: HFN Commercial |
$1,310.09
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,375.92
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$3,375.92
|
| Rate for Payer: Independent Care Health Plan Medicare |
$1,170.83
|
| Rate for Payer: Multiplan Commercial |
$1,103.23
|
| Rate for Payer: NAPHCARE Commercial |
$1,756.25
|
| Rate for Payer: Preferred Network Access Commercial |
$1,310.09
|
| Rate for Payer: Quartz Beloit One Network |
$606.78
|
| Rate for Payer: Quartz Commercial |
$786.05
|
| Rate for Payer: Quartz Medicare Advantage |
$1,170.83
|
| Rate for Payer: The Alliance Commercial |
$3,219.79
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,170.83
|
| Rate for Payer: WEA Trust Commercial |
$758.47
|
| Rate for Payer: WPS Commercial |
$2,048.96
|
|
|
U Ethyl Glucuronide / 90418
|
Facility
|
OP
|
$129.00
|
|
|
Service Code
|
CPT 80321
|
| Hospital Charge Code |
3530179
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$37.56 |
| Max. Negotiated Rate |
$123.43 |
| Rate for Payer: Aetna Commercial |
$120.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$115.38
|
| Rate for Payer: Aetna Managed Medicare |
$37.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$87.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$67.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$64.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$71.10
|
| Rate for Payer: Cash Price |
$38.70
|
| Rate for Payer: Cigna Commercial |
$123.43
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$75.08
|
| Rate for Payer: Health EOS Commercial |
$119.40
|
| Rate for Payer: HFN Commercial |
$123.43
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$100.62
|
| Rate for Payer: Multiplan Commercial |
$107.33
|
| Rate for Payer: NAPHCARE Commercial |
$80.50
|
| Rate for Payer: Preferred Network Access Commercial |
$123.43
|
| Rate for Payer: Quartz Beloit One Network |
$65.74
|
| Rate for Payer: Quartz Commercial |
$87.20
|
| Rate for Payer: Quartz Medicare Advantage |
$80.50
|
| Rate for Payer: The Alliance Commercial |
$67.08
|
| Rate for Payer: United Healthcare PPO |
$100.62
|
| Rate for Payer: WEA Trust Commercial |
$73.79
|
| Rate for Payer: WPS Commercial |
$99.37
|
|
|
U Ethyl Glucuronide / 90418
|
Professional
|
Both
|
$129.00
|
|
|
Service Code
|
CPT 80321
|
| Hospital Charge Code |
3530179
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$49.45 |
| Max. Negotiated Rate |
$127.45 |
| Rate for Payer: Aetna Commercial |
$127.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$115.38
|
| Rate for Payer: Cash Price |
$38.70
|
| Rate for Payer: Cash Price |
$38.70
|
| Rate for Payer: Cigna Commercial |
$127.45
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$67.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$80.50
|
| Rate for Payer: Health EOS Commercial |
$122.09
|
| Rate for Payer: HFN Commercial |
$127.45
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$49.45
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$49.45
|
| Rate for Payer: Multiplan Commercial |
$107.33
|
| Rate for Payer: Preferred Network Access Commercial |
$127.45
|
| Rate for Payer: Quartz Beloit One Network |
$59.03
|
| Rate for Payer: Quartz Commercial |
$76.47
|
| Rate for Payer: The Alliance Commercial |
$67.08
|
| Rate for Payer: WEA Trust Commercial |
$73.79
|
| Rate for Payer: WPS Commercial |
$99.37
|
|
|
U Ethyl Glucuronide / 90418
|
Facility
|
IP
|
$129.00
|
|
|
Service Code
|
CPT 80321
|
| Hospital Charge Code |
3530179
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$65.74 |
| Max. Negotiated Rate |
$123.43 |
| Rate for Payer: Aetna Commercial |
$120.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$115.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$71.10
|
| Rate for Payer: Cash Price |
$38.70
|
| Rate for Payer: Cigna Commercial |
$123.43
|
| Rate for Payer: Health EOS Commercial |
$119.40
|
| Rate for Payer: HFN Commercial |
$123.43
|
| Rate for Payer: Multiplan Commercial |
$107.33
|
| Rate for Payer: Preferred Network Access Commercial |
$123.43
|
| Rate for Payer: Quartz Beloit One Network |
$65.74
|
| Rate for Payer: Quartz Commercial |
$80.50
|
| Rate for Payer: WEA Trust Commercial |
$73.79
|
| Rate for Payer: WPS Commercial |
$99.37
|
|
|
UGT1A1 Gene Polymorphism (TA Repeat)
|
Professional
|
Both
|
$716.00
|
|
|
Service Code
|
CPT 81350
|
| Hospital Charge Code |
4392920
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$243.36 |
| Max. Negotiated Rate |
$1,070.78 |
| Rate for Payer: Aetna Commercial |
$707.41
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$640.39
|
| Rate for Payer: Aetna Managed Medicare |
$243.36
|
| Rate for Payer: Anthem Medicare Advantage |
$243.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$243.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$243.36
|
| Rate for Payer: Cash Price |
$214.80
|
| Rate for Payer: Cash Price |
$214.80
|
| Rate for Payer: Cigna Commercial |
$707.41
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$372.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$243.36
|
| Rate for Payer: Health EOS Commercial |
$677.62
|
| Rate for Payer: HFN Commercial |
$707.41
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$859.06
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$859.06
|
| Rate for Payer: Independent Care Health Plan Medicare |
$243.36
|
| Rate for Payer: Multiplan Commercial |
$595.71
|
| Rate for Payer: NAPHCARE Commercial |
$365.04
|
| Rate for Payer: Preferred Network Access Commercial |
$707.41
|
| Rate for Payer: Quartz Beloit One Network |
$327.64
|
| Rate for Payer: Quartz Commercial |
$424.44
|
| Rate for Payer: Quartz Medicare Advantage |
$243.36
|
| Rate for Payer: The Alliance Commercial |
$961.27
|
| Rate for Payer: United Healthcare Medicare Advantage |
$243.36
|
| Rate for Payer: WEA Trust Commercial |
$409.55
|
| Rate for Payer: WPS Commercial |
$1,070.78
|
|
|
UGT1A1 Gene Polymorphism (TA Repeat)
|
Facility
|
OP
|
$716.00
|
|
|
Service Code
|
CPT 81350
|
| Hospital Charge Code |
4392920
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$243.36 |
| Max. Negotiated Rate |
$973.44 |
| Rate for Payer: Aetna Commercial |
$670.18
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$640.39
|
| Rate for Payer: Aetna Managed Medicare |
$243.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$912.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$425.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$403.98
|
| Rate for Payer: Anthem Medicare Advantage |
$243.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$394.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$243.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$243.36
|
| Rate for Payer: Cash Price |
$214.80
|
| Rate for Payer: Cash Price |
$214.80
|
| Rate for Payer: Cigna Commercial |
$685.07
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$243.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$416.71
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$243.36
|
| Rate for Payer: Health EOS Commercial |
$662.73
|
| Rate for Payer: HFN Commercial |
$685.07
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$905.30
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$243.36
|
| Rate for Payer: Independent Care Health Plan Medicare |
$243.36
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$243.36
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$243.36
|
| Rate for Payer: Multiplan Commercial |
$595.71
|
| Rate for Payer: NAPHCARE Commercial |
$365.04
|
| Rate for Payer: Preferred Network Access Commercial |
$685.07
|
| Rate for Payer: Quartz Beloit One Network |
$364.87
|
| Rate for Payer: Quartz Commercial |
$484.02
|
| Rate for Payer: Quartz Medicare Advantage |
$243.36
|
| Rate for Payer: The Alliance Commercial |
$973.44
|
| Rate for Payer: United Healthcare Medicare Advantage |
$243.36
|
| Rate for Payer: United Healthcare PPO |
$558.48
|
| Rate for Payer: WEA Trust Commercial |
$409.55
|
| Rate for Payer: Wellcare Medicare |
$243.36
|
| Rate for Payer: WPS Commercial |
$551.53
|
|
|
UGT1A1 Gene Polymorphism (TA Repeat)
|
Facility
|
IP
|
$716.00
|
|
|
Service Code
|
CPT 81350
|
| Hospital Charge Code |
4392920
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$364.87 |
| Max. Negotiated Rate |
$685.07 |
| Rate for Payer: Aetna Commercial |
$670.18
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$640.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$394.66
|
| Rate for Payer: Cash Price |
$214.80
|
| Rate for Payer: Cigna Commercial |
$685.07
|
| Rate for Payer: Health EOS Commercial |
$662.73
|
| Rate for Payer: HFN Commercial |
$685.07
|
| Rate for Payer: Multiplan Commercial |
$595.71
|
| Rate for Payer: Preferred Network Access Commercial |
$685.07
|
| Rate for Payer: Quartz Beloit One Network |
$364.87
|
| Rate for Payer: Quartz Commercial |
$446.78
|
| Rate for Payer: WEA Trust Commercial |
$409.55
|
| Rate for Payer: WPS Commercial |
$551.53
|
|
|
ULNA INTRAMEDULLARY RODDING
|
Facility
|
OP
|
$4,560.00
|
|
| Hospital Charge Code |
2960153
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,327.87 |
| Max. Negotiated Rate |
$4,363.01 |
| Rate for Payer: Aetna Commercial |
$4,268.16
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,078.46
|
| Rate for Payer: Aetna Managed Medicare |
$1,327.87
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,082.56
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,371.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,276.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,513.47
|
| Rate for Payer: Cash Price |
$1,368.00
|
| Rate for Payer: Cigna Commercial |
$4,363.01
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,653.92
|
| Rate for Payer: Health EOS Commercial |
$4,220.74
|
| Rate for Payer: HFN Commercial |
$4,363.01
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,556.80
|
| Rate for Payer: Multiplan Commercial |
$3,793.92
|
| Rate for Payer: NAPHCARE Commercial |
$2,845.44
|
| Rate for Payer: Preferred Network Access Commercial |
$4,363.01
|
| Rate for Payer: Quartz Beloit One Network |
$2,323.78
|
| Rate for Payer: Quartz Commercial |
$3,082.56
|
| Rate for Payer: Quartz Medicare Advantage |
$2,845.44
|
| Rate for Payer: The Alliance Commercial |
$2,371.20
|
| Rate for Payer: WEA Trust Commercial |
$2,608.32
|
| Rate for Payer: WPS Commercial |
$3,512.57
|
|
|
ULNA INTRAMEDULLARY RODDING
|
Facility
|
IP
|
$4,560.00
|
|
| Hospital Charge Code |
2960153
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,323.78 |
| Max. Negotiated Rate |
$4,363.01 |
| Rate for Payer: Aetna Commercial |
$4,268.16
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,078.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,513.47
|
| Rate for Payer: Cash Price |
$1,368.00
|
| Rate for Payer: Cigna Commercial |
$4,363.01
|
| Rate for Payer: Health EOS Commercial |
$4,220.74
|
| Rate for Payer: HFN Commercial |
$4,363.01
|
| Rate for Payer: Multiplan Commercial |
$3,793.92
|
| Rate for Payer: Preferred Network Access Commercial |
$4,363.01
|
| Rate for Payer: Quartz Beloit One Network |
$2,323.78
|
| Rate for Payer: Quartz Commercial |
$2,845.44
|
| Rate for Payer: WEA Trust Commercial |
$2,608.32
|
| Rate for Payer: WPS Commercial |
$3,512.57
|
|
|
ULNAR COLATERAL LIGAMENT RECONSTRUCTION
|
Facility
|
OP
|
$4,170.00
|
|
| Hospital Charge Code |
2960202
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,214.30 |
| Max. Negotiated Rate |
$3,989.86 |
| Rate for Payer: Aetna Commercial |
$3,903.12
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,729.65
|
| Rate for Payer: Aetna Managed Medicare |
$1,214.30
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,818.92
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,168.40
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,081.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,298.50
|
| Rate for Payer: Cash Price |
$1,251.00
|
| Rate for Payer: Cigna Commercial |
$3,989.86
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,426.94
|
| Rate for Payer: Health EOS Commercial |
$3,859.75
|
| Rate for Payer: HFN Commercial |
$3,989.86
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,252.60
|
| Rate for Payer: Multiplan Commercial |
$3,469.44
|
| Rate for Payer: NAPHCARE Commercial |
$2,602.08
|
| Rate for Payer: Preferred Network Access Commercial |
$3,989.86
|
| Rate for Payer: Quartz Beloit One Network |
$2,125.03
|
| Rate for Payer: Quartz Commercial |
$2,818.92
|
| Rate for Payer: Quartz Medicare Advantage |
$2,602.08
|
| Rate for Payer: The Alliance Commercial |
$2,168.40
|
| Rate for Payer: WEA Trust Commercial |
$2,385.24
|
| Rate for Payer: WPS Commercial |
$3,212.15
|
|
