|
Ultrasound Guide For Radth
|
Facility
|
OP
|
$704.00
|
|
| Hospital Charge Code |
3040411
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$205.00 |
| Max. Negotiated Rate |
$848.64 |
| Rate for Payer: Aetna Commercial |
$658.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$629.66
|
| Rate for Payer: Aetna Managed Medicare |
$205.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$848.64
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$716.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$681.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$388.04
|
| Rate for Payer: Cash Price |
$211.20
|
| Rate for Payer: Cash Price |
$211.20
|
| Rate for Payer: Cash Price |
$211.20
|
| Rate for Payer: Cigna Commercial |
$673.59
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$409.73
|
| Rate for Payer: Health EOS Commercial |
$651.62
|
| Rate for Payer: HFN Commercial |
$673.59
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$549.12
|
| Rate for Payer: Multiplan Commercial |
$585.73
|
| Rate for Payer: NAPHCARE Commercial |
$439.30
|
| Rate for Payer: Preferred Network Access Commercial |
$673.59
|
| Rate for Payer: Quartz Beloit One Network |
$358.76
|
| Rate for Payer: Quartz Commercial |
$475.90
|
| Rate for Payer: Quartz Medicare Advantage |
$439.30
|
| Rate for Payer: The Alliance Commercial |
$366.08
|
| Rate for Payer: United Healthcare PPO |
$596.96
|
| Rate for Payer: WEA Trust Commercial |
$402.69
|
| Rate for Payer: WPS Commercial |
$542.29
|
|
|
Ultrasound Pregnant Uterus; Limited
|
Professional
|
Both
|
$210.00
|
|
|
Service Code
|
CPT 76815
|
| Hospital Charge Code |
1188876
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$80.98 |
| Max. Negotiated Rate |
$404.92 |
| Rate for Payer: Aetna Commercial |
$207.48
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$187.82
|
| Rate for Payer: Aetna Managed Medicare |
$80.98
|
| Rate for Payer: Anthem Medicare Advantage |
$80.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$80.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$80.98
|
| Rate for Payer: Cash Price |
$63.00
|
| Rate for Payer: Cash Price |
$63.00
|
| Rate for Payer: Cash Price |
$63.00
|
| Rate for Payer: Cigna Commercial |
$207.48
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$109.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$80.98
|
| Rate for Payer: Health EOS Commercial |
$198.74
|
| Rate for Payer: HFN Commercial |
$207.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$298.76
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$298.76
|
| Rate for Payer: Independent Care Health Plan Medicare |
$80.98
|
| Rate for Payer: Multiplan Commercial |
$174.72
|
| Rate for Payer: NAPHCARE Commercial |
$121.48
|
| Rate for Payer: Preferred Network Access Commercial |
$207.48
|
| Rate for Payer: Quartz Beloit One Network |
$96.10
|
| Rate for Payer: Quartz Commercial |
$124.49
|
| Rate for Payer: Quartz Medicare Advantage |
$80.98
|
| Rate for Payer: The Alliance Commercial |
$307.74
|
| Rate for Payer: United Healthcare Medicare Advantage |
$80.98
|
| Rate for Payer: WEA Trust Commercial |
$120.12
|
| Rate for Payer: WPS Commercial |
$404.92
|
|
|
Umbilical Artery Catheter Insertion
|
Facility
|
OP
|
$2,192.00
|
|
| Hospital Charge Code |
3718168
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$638.31 |
| Max. Negotiated Rate |
$2,097.31 |
| Rate for Payer: Aetna Commercial |
$2,051.71
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,960.52
|
| Rate for Payer: Aetna Managed Medicare |
$638.31
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,481.79
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,139.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,094.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,208.23
|
| Rate for Payer: Cash Price |
$657.60
|
| Rate for Payer: Cigna Commercial |
$2,097.31
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,275.74
|
| Rate for Payer: Health EOS Commercial |
$2,028.92
|
| Rate for Payer: HFN Commercial |
$2,097.31
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,709.76
|
| Rate for Payer: Multiplan Commercial |
$1,823.74
|
| Rate for Payer: NAPHCARE Commercial |
$1,367.81
|
| Rate for Payer: Preferred Network Access Commercial |
$2,097.31
|
| Rate for Payer: Quartz Beloit One Network |
$1,117.04
|
| Rate for Payer: Quartz Commercial |
$1,481.79
|
| Rate for Payer: Quartz Medicare Advantage |
$1,367.81
|
| Rate for Payer: The Alliance Commercial |
$1,139.84
|
| Rate for Payer: WEA Trust Commercial |
$1,253.82
|
| Rate for Payer: WPS Commercial |
$1,688.50
|
|
|
Umbilical Artery Catheter Insertion
|
Facility
|
IP
|
$2,192.00
|
|
| Hospital Charge Code |
3718168
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$1,117.04 |
| Max. Negotiated Rate |
$2,097.31 |
| Rate for Payer: Aetna Commercial |
$2,051.71
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,960.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,208.23
|
| Rate for Payer: Cash Price |
$657.60
|
| Rate for Payer: Cigna Commercial |
$2,097.31
|
| Rate for Payer: Health EOS Commercial |
$2,028.92
|
| Rate for Payer: HFN Commercial |
$2,097.31
|
| Rate for Payer: Multiplan Commercial |
$1,823.74
|
| Rate for Payer: Preferred Network Access Commercial |
$2,097.31
|
| Rate for Payer: Quartz Beloit One Network |
$1,117.04
|
| Rate for Payer: Quartz Commercial |
$1,367.81
|
| Rate for Payer: WEA Trust Commercial |
$1,253.82
|
| Rate for Payer: WPS Commercial |
$1,688.50
|
|
|
UNCOMPLICATED PEPTIC ULCER WITH MCC
|
Facility
|
IP
|
$38,992.72
|
|
|
Service Code
|
MSDRG 383
|
| Min. Negotiated Rate |
$11,080.46 |
| Max. Negotiated Rate |
$38,992.72 |
| Rate for Payer: Aetna Managed Medicare |
$11,080.46
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$30,125.77
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$23,091.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$21,938.11
|
| Rate for Payer: Anthem Medicare Advantage |
$11,080.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$11,080.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$11,080.46
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$11,080.46
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$24,353.31
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$11,080.46
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$28,355.50
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$11,080.46
|
| Rate for Payer: Independent Care Health Plan Medicare |
$11,080.46
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$11,080.46
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$11,080.46
|
| Rate for Payer: NAPHCARE Commercial |
$16,620.69
|
| Rate for Payer: Quartz Medicare Advantage |
$11,080.46
|
| Rate for Payer: The Alliance Commercial |
$38,992.72
|
| Rate for Payer: United Healthcare Medicare Advantage |
$11,080.46
|
| Rate for Payer: United Healthcare PPO |
$22,075.11
|
| Rate for Payer: Wellcare Medicare |
$11,080.46
|
|
|
UNCOMPLICATED PEPTIC ULCER WITHOUT MCC
|
Facility
|
IP
|
$24,546.08
|
|
|
Service Code
|
MSDRG 384
|
| Min. Negotiated Rate |
$7,053.01 |
| Max. Negotiated Rate |
$24,546.08 |
| Rate for Payer: Aetna Managed Medicare |
$7,053.01
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$18,651.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$14,295.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$13,582.02
|
| Rate for Payer: Anthem Medicare Advantage |
$7,053.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$7,053.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$7,053.01
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$7,053.01
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$15,077.29
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$7,053.01
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$17,759.20
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$7,053.01
|
| Rate for Payer: Independent Care Health Plan Medicare |
$7,053.01
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$7,053.01
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$7,053.01
|
| Rate for Payer: NAPHCARE Commercial |
$10,579.51
|
| Rate for Payer: Quartz Medicare Advantage |
$7,053.01
|
| Rate for Payer: The Alliance Commercial |
$24,546.08
|
| Rate for Payer: United Healthcare Medicare Advantage |
$7,053.01
|
| Rate for Payer: United Healthcare PPO |
$13,825.76
|
| Rate for Payer: Wellcare Medicare |
$7,053.01
|
|
|
UNDERWEAR DISP PULL UP XL #1625
|
Facility
|
IP
|
$27.00
|
|
| Hospital Charge Code |
2974518
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$13.76 |
| Max. Negotiated Rate |
$25.83 |
| Rate for Payer: Aetna Commercial |
$25.27
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$24.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$14.88
|
| Rate for Payer: Cash Price |
$8.10
|
| Rate for Payer: Cigna Commercial |
$25.83
|
| Rate for Payer: Health EOS Commercial |
$24.99
|
| Rate for Payer: HFN Commercial |
$25.83
|
| Rate for Payer: Multiplan Commercial |
$22.46
|
| Rate for Payer: Preferred Network Access Commercial |
$25.83
|
| Rate for Payer: Quartz Beloit One Network |
$13.76
|
| Rate for Payer: Quartz Commercial |
$16.85
|
| Rate for Payer: WEA Trust Commercial |
$15.44
|
| Rate for Payer: WPS Commercial |
$20.80
|
|
|
UNDERWEAR DISP PULL UP XL #1625
|
Facility
|
OP
|
$27.00
|
|
| Hospital Charge Code |
2974518
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$7.86 |
| Max. Negotiated Rate |
$25.83 |
| Rate for Payer: Aetna Commercial |
$25.27
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$24.15
|
| Rate for Payer: Aetna Managed Medicare |
$7.86
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$18.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$14.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$13.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$14.88
|
| Rate for Payer: Cash Price |
$8.10
|
| Rate for Payer: Cigna Commercial |
$25.83
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$15.71
|
| Rate for Payer: Health EOS Commercial |
$24.99
|
| Rate for Payer: HFN Commercial |
$25.83
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$21.06
|
| Rate for Payer: Multiplan Commercial |
$22.46
|
| Rate for Payer: NAPHCARE Commercial |
$16.85
|
| Rate for Payer: Preferred Network Access Commercial |
$25.83
|
| Rate for Payer: Quartz Beloit One Network |
$13.76
|
| Rate for Payer: Quartz Commercial |
$18.25
|
| Rate for Payer: Quartz Medicare Advantage |
$16.85
|
| Rate for Payer: The Alliance Commercial |
$14.04
|
| Rate for Payer: WEA Trust Commercial |
$15.44
|
| Rate for Payer: WPS Commercial |
$20.80
|
|
|
UNI COMPARTMENTAL KNEE ARTHROPLASTY
|
Facility
|
OP
|
$13,291.00
|
|
| Hospital Charge Code |
4524686
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,870.34 |
| Max. Negotiated Rate |
$12,716.83 |
| Rate for Payer: Aetna Commercial |
$12,440.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$11,887.47
|
| Rate for Payer: Aetna Managed Medicare |
$3,870.34
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$8,984.72
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$6,911.32
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$6,634.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$7,326.00
|
| Rate for Payer: Cash Price |
$3,987.30
|
| Rate for Payer: Cigna Commercial |
$12,716.83
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$7,735.36
|
| Rate for Payer: Health EOS Commercial |
$12,302.15
|
| Rate for Payer: HFN Commercial |
$12,716.83
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$10,366.98
|
| Rate for Payer: Multiplan Commercial |
$11,058.11
|
| Rate for Payer: NAPHCARE Commercial |
$8,293.58
|
| Rate for Payer: Preferred Network Access Commercial |
$12,716.83
|
| Rate for Payer: Quartz Beloit One Network |
$6,773.09
|
| Rate for Payer: Quartz Commercial |
$8,984.72
|
| Rate for Payer: Quartz Medicare Advantage |
$8,293.58
|
| Rate for Payer: The Alliance Commercial |
$6,911.32
|
| Rate for Payer: WEA Trust Commercial |
$7,602.45
|
| Rate for Payer: WPS Commercial |
$10,238.06
|
|
|
UNI COMPARTMENTAL KNEE ARTHROPLASTY
|
Facility
|
IP
|
$13,291.00
|
|
| Hospital Charge Code |
4524686
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$6,773.09 |
| Max. Negotiated Rate |
$12,716.83 |
| Rate for Payer: Aetna Commercial |
$12,440.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$11,887.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$7,326.00
|
| Rate for Payer: Cash Price |
$3,987.30
|
| Rate for Payer: Cigna Commercial |
$12,716.83
|
| Rate for Payer: Health EOS Commercial |
$12,302.15
|
| Rate for Payer: HFN Commercial |
$12,716.83
|
| Rate for Payer: Multiplan Commercial |
$11,058.11
|
| Rate for Payer: Preferred Network Access Commercial |
$12,716.83
|
| Rate for Payer: Quartz Beloit One Network |
$6,773.09
|
| Rate for Payer: Quartz Commercial |
$8,293.58
|
| Rate for Payer: WEA Trust Commercial |
$7,602.45
|
| Rate for Payer: WPS Commercial |
$10,238.06
|
|
|
UNIVERSAL JOINT FOR TWO TUBES 393.71
|
Facility
|
IP
|
$4,057.00
|
|
| Hospital Charge Code |
5811628
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,067.45 |
| Max. Negotiated Rate |
$3,881.74 |
| Rate for Payer: Aetna Commercial |
$3,797.35
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,628.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,236.22
|
| Rate for Payer: Cash Price |
$1,217.10
|
| Rate for Payer: Cigna Commercial |
$3,881.74
|
| Rate for Payer: Health EOS Commercial |
$3,755.16
|
| Rate for Payer: HFN Commercial |
$3,881.74
|
| Rate for Payer: Multiplan Commercial |
$3,375.42
|
| Rate for Payer: Preferred Network Access Commercial |
$3,881.74
|
| Rate for Payer: Quartz Beloit One Network |
$2,067.45
|
| Rate for Payer: Quartz Commercial |
$2,531.57
|
| Rate for Payer: WEA Trust Commercial |
$2,320.60
|
| Rate for Payer: WPS Commercial |
$3,125.11
|
|
|
UNIVERSAL JOINT FOR TWO TUBES 393.71
|
Facility
|
OP
|
$4,057.00
|
|
| Hospital Charge Code |
5811628
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,181.40 |
| Max. Negotiated Rate |
$3,881.74 |
| Rate for Payer: Aetna Commercial |
$3,797.35
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,628.58
|
| Rate for Payer: Aetna Managed Medicare |
$1,181.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,742.53
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,109.64
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,025.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,236.22
|
| Rate for Payer: Cash Price |
$1,217.10
|
| Rate for Payer: Cigna Commercial |
$3,881.74
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,361.17
|
| Rate for Payer: Health EOS Commercial |
$3,755.16
|
| Rate for Payer: HFN Commercial |
$3,881.74
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,164.46
|
| Rate for Payer: Multiplan Commercial |
$3,375.42
|
| Rate for Payer: NAPHCARE Commercial |
$2,531.57
|
| Rate for Payer: Preferred Network Access Commercial |
$3,881.74
|
| Rate for Payer: Quartz Beloit One Network |
$2,067.45
|
| Rate for Payer: Quartz Commercial |
$2,742.53
|
| Rate for Payer: Quartz Medicare Advantage |
$2,531.57
|
| Rate for Payer: The Alliance Commercial |
$2,109.64
|
| Rate for Payer: WEA Trust Commercial |
$2,320.60
|
| Rate for Payer: WPS Commercial |
$3,125.11
|
|
|
UNLISTED LAPAROSCOPIC PROCEDURE, LIVER
|
Facility
|
OP
|
$25,449.01
|
|
|
Service Code
|
CPT 47379
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$5,476.64 |
| Max. Negotiated Rate |
$25,449.01 |
| Rate for Payer: Aetna Managed Medicare |
$6,362.25
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$15,758.08
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$13,140.40
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$12,483.12
|
| Rate for Payer: Anthem Medicare Advantage |
$6,362.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$6,362.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$6,362.25
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$6,362.25
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12,490.12
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$6,362.25
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$23,667.58
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$6,362.25
|
| Rate for Payer: Independent Care Health Plan Medicare |
$6,362.25
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$6,362.25
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$6,362.25
|
| Rate for Payer: NAPHCARE Commercial |
$9,543.38
|
| Rate for Payer: Quartz Medicare Advantage |
$6,362.25
|
| Rate for Payer: The Alliance Commercial |
$25,449.01
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,362.25
|
| Rate for Payer: United Healthcare PPO |
$5,476.64
|
| Rate for Payer: Wellcare Medicare |
$6,362.25
|
|
|
UNLISTED LAPAROSCOPY PROCEDURE, ABDOMEN, PERITONEUM AND OMENTUM
|
Facility
|
OP
|
$25,449.01
|
|
|
Service Code
|
CPT 49329
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$5,476.64 |
| Max. Negotiated Rate |
$25,449.01 |
| Rate for Payer: Aetna Managed Medicare |
$6,362.25
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$15,758.08
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$13,140.40
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$12,483.12
|
| Rate for Payer: Anthem Medicare Advantage |
$6,362.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$6,362.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$6,362.25
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$6,362.25
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12,490.12
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$6,362.25
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$23,667.58
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$6,362.25
|
| Rate for Payer: Independent Care Health Plan Medicare |
$6,362.25
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$6,362.25
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$6,362.25
|
| Rate for Payer: NAPHCARE Commercial |
$9,543.38
|
| Rate for Payer: Quartz Medicare Advantage |
$6,362.25
|
| Rate for Payer: The Alliance Commercial |
$25,449.01
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,362.25
|
| Rate for Payer: United Healthcare PPO |
$5,476.64
|
| Rate for Payer: Wellcare Medicare |
$6,362.25
|
|
|
UNLISTED LAPAROSCOPY PROCEDURE, HERNIOPLASTY, HERNIORRHAPHY, HERNIOTOMY
|
Facility
|
OP
|
$25,449.01
|
|
|
Service Code
|
CPT 49659
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$5,476.64 |
| Max. Negotiated Rate |
$25,449.01 |
| Rate for Payer: Aetna Managed Medicare |
$6,362.25
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$15,758.08
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$13,140.40
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$12,483.12
|
| Rate for Payer: Anthem Medicare Advantage |
$6,362.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$6,362.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$6,362.25
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$6,362.25
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12,490.12
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$6,362.25
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$23,667.58
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$6,362.25
|
| Rate for Payer: Independent Care Health Plan Medicare |
$6,362.25
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$6,362.25
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$6,362.25
|
| Rate for Payer: NAPHCARE Commercial |
$9,543.38
|
| Rate for Payer: Quartz Medicare Advantage |
$6,362.25
|
| Rate for Payer: The Alliance Commercial |
$25,449.01
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,362.25
|
| Rate for Payer: United Healthcare PPO |
$5,476.64
|
| Rate for Payer: Wellcare Medicare |
$6,362.25
|
|
|
UNLISTED LAPAROSCOPY PROCEDURE, INTESTINE (EXCEPT RECTUM)
|
Facility
|
OP
|
$25,449.01
|
|
|
Service Code
|
CPT 44238
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$5,476.64 |
| Max. Negotiated Rate |
$25,449.01 |
| Rate for Payer: Aetna Managed Medicare |
$6,362.25
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$15,758.08
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$13,140.40
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$12,483.12
|
| Rate for Payer: Anthem Medicare Advantage |
$6,362.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$6,362.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$6,362.25
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$6,362.25
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12,490.12
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$6,362.25
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$23,667.58
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$6,362.25
|
| Rate for Payer: Independent Care Health Plan Medicare |
$6,362.25
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$6,362.25
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$6,362.25
|
| Rate for Payer: NAPHCARE Commercial |
$9,543.38
|
| Rate for Payer: Quartz Medicare Advantage |
$6,362.25
|
| Rate for Payer: The Alliance Commercial |
$25,449.01
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,362.25
|
| Rate for Payer: United Healthcare PPO |
$5,476.64
|
| Rate for Payer: Wellcare Medicare |
$6,362.25
|
|
|
UNLISTED LAPAROSCOPY PROCEDURE, SPERMATIC CORD
|
Facility
|
OP
|
$25,449.01
|
|
|
Service Code
|
CPT 55559
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$5,476.64 |
| Max. Negotiated Rate |
$25,449.01 |
| Rate for Payer: Aetna Managed Medicare |
$6,362.25
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$15,758.08
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$13,140.40
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$12,483.12
|
| Rate for Payer: Anthem Medicare Advantage |
$6,362.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$6,362.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$6,362.25
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$6,362.25
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12,490.12
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$6,362.25
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$23,667.58
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$6,362.25
|
| Rate for Payer: Independent Care Health Plan Medicare |
$6,362.25
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$6,362.25
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$6,362.25
|
| Rate for Payer: NAPHCARE Commercial |
$9,543.38
|
| Rate for Payer: Quartz Medicare Advantage |
$6,362.25
|
| Rate for Payer: The Alliance Commercial |
$25,449.01
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,362.25
|
| Rate for Payer: United Healthcare PPO |
$5,476.64
|
| Rate for Payer: Wellcare Medicare |
$6,362.25
|
|
|
Unlisted Magnetic Resonance 7649872195
|
Facility
|
IP
|
$5,056.00
|
|
|
Service Code
|
CPT 76498
|
| Hospital Charge Code |
5518689
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$2,576.54 |
| Max. Negotiated Rate |
$4,837.58 |
| Rate for Payer: Aetna Commercial |
$4,732.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,522.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,786.87
|
| Rate for Payer: Cash Price |
$1,516.80
|
| Rate for Payer: Cigna Commercial |
$4,837.58
|
| Rate for Payer: Health EOS Commercial |
$4,679.83
|
| Rate for Payer: HFN Commercial |
$4,837.58
|
| Rate for Payer: Multiplan Commercial |
$4,206.59
|
| Rate for Payer: Preferred Network Access Commercial |
$4,837.58
|
| Rate for Payer: Quartz Beloit One Network |
$2,576.54
|
| Rate for Payer: Quartz Commercial |
$3,154.94
|
| Rate for Payer: WEA Trust Commercial |
$2,892.03
|
| Rate for Payer: WPS Commercial |
$3,894.64
|
|
|
Unlisted Magnetic Resonance 7649872195
|
Facility
|
OP
|
$5,056.00
|
|
|
Service Code
|
CPT 76498
|
| Hospital Charge Code |
5518689
|
|
Hospital Revenue Code
|
610
|
| Min. Negotiated Rate |
$91.58 |
| Max. Negotiated Rate |
$4,837.58 |
| Rate for Payer: Aetna Commercial |
$4,732.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,522.09
|
| Rate for Payer: Aetna Managed Medicare |
$91.58
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,635.84
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,985.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,835.04
|
| Rate for Payer: Anthem Medicare Advantage |
$91.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,786.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$91.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$91.58
|
| Rate for Payer: Cash Price |
$1,516.80
|
| Rate for Payer: Cash Price |
$1,516.80
|
| Rate for Payer: Cash Price |
$1,516.80
|
| Rate for Payer: Cash Price |
$1,516.80
|
| Rate for Payer: Cigna Commercial |
$4,837.58
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$91.58
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,942.59
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$91.58
|
| Rate for Payer: Health EOS Commercial |
$4,679.83
|
| Rate for Payer: HFN Commercial |
$4,837.58
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$340.69
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$91.58
|
| Rate for Payer: Independent Care Health Plan Medicare |
$91.58
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$91.58
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$91.58
|
| Rate for Payer: Multiplan Commercial |
$4,206.59
|
| Rate for Payer: NAPHCARE Commercial |
$137.37
|
| Rate for Payer: Preferred Network Access Commercial |
$4,837.58
|
| Rate for Payer: Quartz Beloit One Network |
$2,576.54
|
| Rate for Payer: Quartz Commercial |
$3,417.86
|
| Rate for Payer: Quartz Medicare Advantage |
$91.58
|
| Rate for Payer: The Alliance Commercial |
$366.33
|
| Rate for Payer: United Healthcare Medicare Advantage |
$91.58
|
| Rate for Payer: United Healthcare PPO |
$3,142.88
|
| Rate for Payer: WEA Trust Commercial |
$2,892.03
|
| Rate for Payer: Wellcare Medicare |
$91.58
|
| Rate for Payer: WPS Commercial |
$3,894.64
|
|
|
UNLISTED PROCEDURE, ABDOMEN, MUSCULOSKELETAL SYSTEM
|
Facility
|
OP
|
$29,092.96
|
|
|
Service Code
|
CPT 22999
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$259.59 |
| Max. Negotiated Rate |
$29,092.96 |
| Rate for Payer: Aetna Managed Medicare |
$259.59
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$29,092.96
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$26,282.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$24,968.32
|
| Rate for Payer: Anthem Medicare Advantage |
$259.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$259.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$259.59
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$259.59
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$259.59
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$965.69
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$259.59
|
| Rate for Payer: Independent Care Health Plan Medicare |
$259.59
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$259.59
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$259.59
|
| Rate for Payer: NAPHCARE Commercial |
$389.39
|
| Rate for Payer: Quartz Medicare Advantage |
$259.59
|
| Rate for Payer: The Alliance Commercial |
$1,038.38
|
| Rate for Payer: United Healthcare Medicare Advantage |
$259.59
|
| Rate for Payer: United Healthcare PPO |
$14,223.04
|
| Rate for Payer: Wellcare Medicare |
$259.59
|
|
|
UNLISTED PROCEDURE, ABDOMEN, PERITONEUM AND OMENTUM
|
Facility
|
OP
|
$29,092.96
|
|
|
Service Code
|
CPT 49999
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$954.50 |
| Max. Negotiated Rate |
$29,092.96 |
| Rate for Payer: Aetna Managed Medicare |
$954.50
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$29,092.96
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$26,282.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$24,968.32
|
| Rate for Payer: Anthem Medicare Advantage |
$954.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$954.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$954.50
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$954.50
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$954.50
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,550.75
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$954.50
|
| Rate for Payer: Independent Care Health Plan Medicare |
$954.50
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$954.50
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$954.50
|
| Rate for Payer: NAPHCARE Commercial |
$1,431.75
|
| Rate for Payer: Quartz Medicare Advantage |
$954.50
|
| Rate for Payer: The Alliance Commercial |
$3,818.01
|
| Rate for Payer: United Healthcare Medicare Advantage |
$954.50
|
| Rate for Payer: United Healthcare PPO |
$14,223.04
|
| Rate for Payer: Wellcare Medicare |
$954.50
|
|
|
UNLISTED PROCEDURE, ANUS
|
Facility
|
OP
|
$29,092.96
|
|
|
Service Code
|
CPT 46999
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$978.68 |
| Max. Negotiated Rate |
$29,092.96 |
| Rate for Payer: Aetna Managed Medicare |
$978.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$29,092.96
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$26,282.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$24,968.32
|
| Rate for Payer: Anthem Medicare Advantage |
$978.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$978.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$978.68
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$978.68
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$978.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,640.70
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$978.68
|
| Rate for Payer: Independent Care Health Plan Medicare |
$978.68
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$978.68
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$978.68
|
| Rate for Payer: NAPHCARE Commercial |
$1,468.02
|
| Rate for Payer: Quartz Medicare Advantage |
$978.68
|
| Rate for Payer: The Alliance Commercial |
$3,914.73
|
| Rate for Payer: United Healthcare Medicare Advantage |
$978.68
|
| Rate for Payer: United Healthcare PPO |
$14,223.04
|
| Rate for Payer: Wellcare Medicare |
$978.68
|
|
|
UNLISTED PROCEDURE, ARTHROSCOPY
|
Facility
|
OP
|
$29,092.96
|
|
|
Service Code
|
CPT 29999
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$259.59 |
| Max. Negotiated Rate |
$29,092.96 |
| Rate for Payer: Aetna Managed Medicare |
$259.59
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$29,092.96
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$26,282.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$24,968.32
|
| Rate for Payer: Anthem Medicare Advantage |
$259.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$259.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$259.59
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$259.59
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$259.59
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$965.69
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$259.59
|
| Rate for Payer: Independent Care Health Plan Medicare |
$259.59
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$259.59
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$259.59
|
| Rate for Payer: NAPHCARE Commercial |
$389.39
|
| Rate for Payer: Quartz Medicare Advantage |
$259.59
|
| Rate for Payer: The Alliance Commercial |
$1,038.38
|
| Rate for Payer: United Healthcare Medicare Advantage |
$259.59
|
| Rate for Payer: United Healthcare PPO |
$14,223.04
|
| Rate for Payer: Wellcare Medicare |
$259.59
|
|
|
UNLISTED PROCEDURE, LEG OR ANKLE
|
Facility
|
OP
|
$29,092.96
|
|
|
Service Code
|
CPT 27899
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$259.59 |
| Max. Negotiated Rate |
$29,092.96 |
| Rate for Payer: Aetna Managed Medicare |
$259.59
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$29,092.96
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$26,282.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$24,968.32
|
| Rate for Payer: Anthem Medicare Advantage |
$259.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$259.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$259.59
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$259.59
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$259.59
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$965.69
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$259.59
|
| Rate for Payer: Independent Care Health Plan Medicare |
$259.59
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$259.59
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$259.59
|
| Rate for Payer: NAPHCARE Commercial |
$389.39
|
| Rate for Payer: Quartz Medicare Advantage |
$259.59
|
| Rate for Payer: The Alliance Commercial |
$1,038.38
|
| Rate for Payer: United Healthcare Medicare Advantage |
$259.59
|
| Rate for Payer: United Healthcare PPO |
$14,223.04
|
| Rate for Payer: Wellcare Medicare |
$259.59
|
|
|
UNLISTED PROCEDURE, MALE GENITAL SYSTEM
|
Facility
|
OP
|
$29,092.96
|
|
|
Service Code
|
CPT 55899
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$262.93 |
| Max. Negotiated Rate |
$29,092.96 |
| Rate for Payer: Aetna Managed Medicare |
$262.93
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$29,092.96
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$26,282.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$24,968.32
|
| Rate for Payer: Anthem Medicare Advantage |
$262.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$262.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$262.93
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$262.93
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$262.93
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$978.11
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$262.93
|
| Rate for Payer: Independent Care Health Plan Medicare |
$262.93
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$262.93
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$262.93
|
| Rate for Payer: NAPHCARE Commercial |
$394.40
|
| Rate for Payer: Quartz Medicare Advantage |
$262.93
|
| Rate for Payer: The Alliance Commercial |
$1,051.73
|
| Rate for Payer: United Healthcare Medicare Advantage |
$262.93
|
| Rate for Payer: United Healthcare PPO |
$14,223.04
|
| Rate for Payer: Wellcare Medicare |
$262.93
|
|
