|
Urine Uric Acid
|
Professional
|
Both
|
$21.00
|
|
|
Service Code
|
CPT 84560
|
| Hospital Charge Code |
3813071
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.28 |
| Max. Negotiated Rate |
$23.25 |
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5.28
|
| Rate for Payer: Aetna Commercial |
$20.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$18.78
|
| Rate for Payer: Aetna Managed Medicare |
$5.28
|
| Rate for Payer: Anthem Medicare Advantage |
$5.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5.28
|
| Rate for Payer: Cash Price |
$6.30
|
| Rate for Payer: Cash Price |
$6.30
|
| Rate for Payer: Cigna Commercial |
$20.75
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$10.92
|
| Rate for Payer: Health EOS Commercial |
$19.87
|
| Rate for Payer: HFN Commercial |
$20.75
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$18.65
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$18.65
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5.28
|
| Rate for Payer: Multiplan Commercial |
$17.47
|
| Rate for Payer: NAPHCARE Commercial |
$7.92
|
| Rate for Payer: Preferred Network Access Commercial |
$20.75
|
| Rate for Payer: Quartz Beloit One Network |
$9.61
|
| Rate for Payer: Quartz Commercial |
$12.45
|
| Rate for Payer: Quartz Medicare Advantage |
$5.28
|
| Rate for Payer: The Alliance Commercial |
$20.87
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.28
|
| Rate for Payer: WEA Trust Commercial |
$12.01
|
| Rate for Payer: WPS Commercial |
$23.25
|
|
|
Urine Uric Acid
|
Professional
|
Both
|
$62.00
|
|
|
Service Code
|
CPT 84560
|
| Hospital Charge Code |
2942991
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.28 |
| Max. Negotiated Rate |
$61.26 |
| Rate for Payer: Aetna Commercial |
$61.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$55.45
|
| Rate for Payer: Aetna Managed Medicare |
$5.28
|
| Rate for Payer: Anthem Medicare Advantage |
$5.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5.28
|
| Rate for Payer: Cash Price |
$18.60
|
| Rate for Payer: Cash Price |
$18.60
|
| Rate for Payer: Cigna Commercial |
$61.26
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$32.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5.28
|
| Rate for Payer: Health EOS Commercial |
$58.68
|
| Rate for Payer: HFN Commercial |
$61.26
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$18.65
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$18.65
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5.28
|
| Rate for Payer: Multiplan Commercial |
$51.58
|
| Rate for Payer: NAPHCARE Commercial |
$7.92
|
| Rate for Payer: Preferred Network Access Commercial |
$61.26
|
| Rate for Payer: Quartz Beloit One Network |
$28.37
|
| Rate for Payer: Quartz Commercial |
$36.75
|
| Rate for Payer: Quartz Medicare Advantage |
$5.28
|
| Rate for Payer: The Alliance Commercial |
$20.87
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.28
|
| Rate for Payer: WEA Trust Commercial |
$35.46
|
| Rate for Payer: WPS Commercial |
$23.25
|
|
|
Urine Uric Acid
|
Facility
|
IP
|
$62.00
|
|
|
Service Code
|
CPT 84560
|
| Hospital Charge Code |
2942991
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$31.60 |
| Max. Negotiated Rate |
$59.32 |
| Rate for Payer: Aetna Commercial |
$58.03
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$55.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$34.17
|
| Rate for Payer: Cash Price |
$18.60
|
| Rate for Payer: Cigna Commercial |
$59.32
|
| Rate for Payer: Health EOS Commercial |
$57.39
|
| Rate for Payer: HFN Commercial |
$59.32
|
| Rate for Payer: Multiplan Commercial |
$51.58
|
| Rate for Payer: Preferred Network Access Commercial |
$59.32
|
| Rate for Payer: Quartz Beloit One Network |
$31.60
|
| Rate for Payer: Quartz Commercial |
$38.69
|
| Rate for Payer: WEA Trust Commercial |
$35.46
|
| Rate for Payer: WPS Commercial |
$47.76
|
|
|
Urine Vanillylmandelic Acid
|
Professional
|
Both
|
$36.00
|
|
|
Service Code
|
CPT 84585
|
| Hospital Charge Code |
4076085
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$16.12 |
| Max. Negotiated Rate |
$70.93 |
| Rate for Payer: Aetna Commercial |
$35.57
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$32.20
|
| Rate for Payer: Aetna Managed Medicare |
$16.12
|
| Rate for Payer: Anthem Medicare Advantage |
$16.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$16.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$16.12
|
| Rate for Payer: Cash Price |
$10.80
|
| Rate for Payer: Cash Price |
$10.80
|
| Rate for Payer: Cigna Commercial |
$35.57
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$18.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$16.12
|
| Rate for Payer: Health EOS Commercial |
$34.07
|
| Rate for Payer: HFN Commercial |
$35.57
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$56.91
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$56.91
|
| Rate for Payer: Independent Care Health Plan Medicare |
$16.12
|
| Rate for Payer: Multiplan Commercial |
$29.95
|
| Rate for Payer: NAPHCARE Commercial |
$24.18
|
| Rate for Payer: Preferred Network Access Commercial |
$35.57
|
| Rate for Payer: Quartz Beloit One Network |
$16.47
|
| Rate for Payer: Quartz Commercial |
$21.34
|
| Rate for Payer: Quartz Medicare Advantage |
$16.12
|
| Rate for Payer: The Alliance Commercial |
$63.67
|
| Rate for Payer: United Healthcare Medicare Advantage |
$16.12
|
| Rate for Payer: WEA Trust Commercial |
$20.59
|
| Rate for Payer: WPS Commercial |
$70.93
|
|
|
Urine Vanillylmandelic Acid
|
Facility
|
OP
|
$36.00
|
|
|
Service Code
|
CPT 84585
|
| Hospital Charge Code |
4076085
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$16.12 |
| Max. Negotiated Rate |
$64.48 |
| Rate for Payer: Aetna Commercial |
$33.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$32.20
|
| Rate for Payer: Aetna Managed Medicare |
$16.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$60.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$28.21
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$26.76
|
| Rate for Payer: Anthem Medicare Advantage |
$16.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$19.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$16.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$16.12
|
| Rate for Payer: Cash Price |
$10.80
|
| Rate for Payer: Cash Price |
$10.80
|
| Rate for Payer: Cigna Commercial |
$34.44
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$16.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$20.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$16.12
|
| Rate for Payer: Health EOS Commercial |
$33.32
|
| Rate for Payer: HFN Commercial |
$34.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$59.97
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$16.12
|
| Rate for Payer: Independent Care Health Plan Medicare |
$16.12
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$16.12
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$16.12
|
| Rate for Payer: Multiplan Commercial |
$29.95
|
| Rate for Payer: NAPHCARE Commercial |
$24.18
|
| Rate for Payer: Preferred Network Access Commercial |
$34.44
|
| Rate for Payer: Quartz Beloit One Network |
$18.35
|
| Rate for Payer: Quartz Commercial |
$24.34
|
| Rate for Payer: Quartz Medicare Advantage |
$16.12
|
| Rate for Payer: The Alliance Commercial |
$64.48
|
| Rate for Payer: United Healthcare Medicare Advantage |
$16.12
|
| Rate for Payer: United Healthcare PPO |
$28.08
|
| Rate for Payer: WEA Trust Commercial |
$20.59
|
| Rate for Payer: Wellcare Medicare |
$16.12
|
| Rate for Payer: WPS Commercial |
$27.73
|
|
|
Urine Vanillylmandelic Acid
|
Facility
|
IP
|
$36.00
|
|
|
Service Code
|
CPT 84585
|
| Hospital Charge Code |
4076085
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.35 |
| Max. Negotiated Rate |
$34.44 |
| Rate for Payer: Aetna Commercial |
$33.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$32.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$19.84
|
| Rate for Payer: Cash Price |
$10.80
|
| Rate for Payer: Cigna Commercial |
$34.44
|
| Rate for Payer: Health EOS Commercial |
$33.32
|
| Rate for Payer: HFN Commercial |
$34.44
|
| Rate for Payer: Multiplan Commercial |
$29.95
|
| Rate for Payer: Preferred Network Access Commercial |
$34.44
|
| Rate for Payer: Quartz Beloit One Network |
$18.35
|
| Rate for Payer: Quartz Commercial |
$22.46
|
| Rate for Payer: WEA Trust Commercial |
$20.59
|
| Rate for Payer: WPS Commercial |
$27.73
|
|
|
URO Flow Testing
|
Facility
|
IP
|
$227.00
|
|
|
Service Code
|
CPT 51741
|
| Hospital Charge Code |
3005560
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$115.68 |
| Max. Negotiated Rate |
$217.19 |
| Rate for Payer: Aetna Commercial |
$212.47
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$203.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$125.12
|
| Rate for Payer: Cash Price |
$68.10
|
| Rate for Payer: Cigna Commercial |
$217.19
|
| Rate for Payer: Health EOS Commercial |
$210.11
|
| Rate for Payer: HFN Commercial |
$217.19
|
| Rate for Payer: Multiplan Commercial |
$188.86
|
| Rate for Payer: Preferred Network Access Commercial |
$217.19
|
| Rate for Payer: Quartz Beloit One Network |
$115.68
|
| Rate for Payer: Quartz Commercial |
$141.65
|
| Rate for Payer: WEA Trust Commercial |
$129.84
|
| Rate for Payer: WPS Commercial |
$174.86
|
|
|
URO Flow Testing
|
Facility
|
OP
|
$227.00
|
|
|
Service Code
|
CPT 51741
|
| Hospital Charge Code |
3005560
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$113.32 |
| Max. Negotiated Rate |
$4,386.95 |
| Rate for Payer: Aetna Commercial |
$212.47
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$203.03
|
| Rate for Payer: Aetna Managed Medicare |
$227.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$153.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$118.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$113.32
|
| Rate for Payer: Anthem Medicare Advantage |
$227.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$125.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$227.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$227.24
|
| Rate for Payer: Cash Price |
$68.10
|
| Rate for Payer: Cash Price |
$68.10
|
| Rate for Payer: Cigna Commercial |
$217.19
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$227.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$227.24
|
| Rate for Payer: Health EOS Commercial |
$210.11
|
| Rate for Payer: HFN Commercial |
$217.19
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$845.33
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$227.24
|
| Rate for Payer: Independent Care Health Plan Medicare |
$227.24
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$227.24
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$227.24
|
| Rate for Payer: Multiplan Commercial |
$188.86
|
| Rate for Payer: NAPHCARE Commercial |
$340.86
|
| Rate for Payer: Preferred Network Access Commercial |
$217.19
|
| Rate for Payer: Quartz Beloit One Network |
$115.68
|
| Rate for Payer: Quartz Commercial |
$153.45
|
| Rate for Payer: Quartz Medicare Advantage |
$227.24
|
| Rate for Payer: The Alliance Commercial |
$908.96
|
| Rate for Payer: United Healthcare Medicare Advantage |
$227.24
|
| Rate for Payer: United Healthcare PPO |
$177.06
|
| Rate for Payer: WEA Trust Commercial |
$129.84
|
| Rate for Payer: Wellcare Medicare |
$227.24
|
| Rate for Payer: WPS Commercial |
$174.86
|
|
|
UROSTOMY STERILE KIT 19252
|
Facility
|
IP
|
$217.00
|
|
| Hospital Charge Code |
2963705
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$110.58 |
| Max. Negotiated Rate |
$207.63 |
| Rate for Payer: Aetna Commercial |
$203.11
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$194.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$119.61
|
| Rate for Payer: Cash Price |
$65.10
|
| Rate for Payer: Cigna Commercial |
$207.63
|
| Rate for Payer: Health EOS Commercial |
$200.86
|
| Rate for Payer: HFN Commercial |
$207.63
|
| Rate for Payer: Multiplan Commercial |
$180.54
|
| Rate for Payer: Preferred Network Access Commercial |
$207.63
|
| Rate for Payer: Quartz Beloit One Network |
$110.58
|
| Rate for Payer: Quartz Commercial |
$135.41
|
| Rate for Payer: WEA Trust Commercial |
$124.12
|
| Rate for Payer: WPS Commercial |
$167.16
|
|
|
UROSTOMY STERILE KIT 19252
|
Facility
|
OP
|
$217.00
|
|
| Hospital Charge Code |
2963705
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$63.19 |
| Max. Negotiated Rate |
$207.63 |
| Rate for Payer: Aetna Commercial |
$203.11
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$194.08
|
| Rate for Payer: Aetna Managed Medicare |
$63.19
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$146.69
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$112.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$108.33
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$119.61
|
| Rate for Payer: Cash Price |
$65.10
|
| Rate for Payer: Cigna Commercial |
$207.63
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$126.29
|
| Rate for Payer: Health EOS Commercial |
$200.86
|
| Rate for Payer: HFN Commercial |
$207.63
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$169.26
|
| Rate for Payer: Multiplan Commercial |
$180.54
|
| Rate for Payer: NAPHCARE Commercial |
$135.41
|
| Rate for Payer: Preferred Network Access Commercial |
$207.63
|
| Rate for Payer: Quartz Beloit One Network |
$110.58
|
| Rate for Payer: Quartz Commercial |
$146.69
|
| Rate for Payer: Quartz Medicare Advantage |
$135.41
|
| Rate for Payer: The Alliance Commercial |
$112.84
|
| Rate for Payer: WEA Trust Commercial |
$124.12
|
| Rate for Payer: WPS Commercial |
$167.16
|
|
|
UroVysion, Detection of Bladder Cancer
|
Facility
|
IP
|
$1,997.00
|
|
|
Service Code
|
CPT 88120
|
| Hospital Charge Code |
5543245
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$1,017.67 |
| Max. Negotiated Rate |
$1,910.73 |
| Rate for Payer: Aetna Commercial |
$1,869.19
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,786.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,100.75
|
| Rate for Payer: Cash Price |
$599.10
|
| Rate for Payer: Cigna Commercial |
$1,910.73
|
| Rate for Payer: Health EOS Commercial |
$1,848.42
|
| Rate for Payer: HFN Commercial |
$1,910.73
|
| Rate for Payer: Multiplan Commercial |
$1,661.50
|
| Rate for Payer: Preferred Network Access Commercial |
$1,910.73
|
| Rate for Payer: Quartz Beloit One Network |
$1,017.67
|
| Rate for Payer: Quartz Commercial |
$1,246.13
|
| Rate for Payer: WEA Trust Commercial |
$1,142.28
|
| Rate for Payer: WPS Commercial |
$1,538.29
|
|
|
UroVysion, Detection of Bladder Cancer
|
Professional
|
Both
|
$1,997.00
|
|
|
Service Code
|
CPT 88120
|
| Hospital Charge Code |
5543245
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$39.80 |
| Max. Negotiated Rate |
$2,378.97 |
| Rate for Payer: Aetna Commercial |
$1,973.04
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,786.12
|
| Rate for Payer: Aetna Managed Medicare |
$540.68
|
| Rate for Payer: Anthem Commercial |
$39.80
|
| Rate for Payer: Anthem Medicare Advantage |
$540.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$540.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$540.68
|
| Rate for Payer: Cash Price |
$599.10
|
| Rate for Payer: Cash Price |
$599.10
|
| Rate for Payer: Cigna Commercial |
$1,973.04
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,038.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$540.68
|
| Rate for Payer: Health EOS Commercial |
$1,889.96
|
| Rate for Payer: HFN Commercial |
$1,973.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,194.57
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$2,194.57
|
| Rate for Payer: Independent Care Health Plan Medicare |
$540.68
|
| Rate for Payer: Multiplan Commercial |
$1,661.50
|
| Rate for Payer: NAPHCARE Commercial |
$811.01
|
| Rate for Payer: Preferred Network Access Commercial |
$1,973.04
|
| Rate for Payer: Quartz Beloit One Network |
$913.83
|
| Rate for Payer: Quartz Commercial |
$1,183.82
|
| Rate for Payer: Quartz Medicare Advantage |
$540.68
|
| Rate for Payer: The Alliance Commercial |
$2,135.67
|
| Rate for Payer: United Healthcare Medicare Advantage |
$540.68
|
| Rate for Payer: WEA Trust Commercial |
$1,142.28
|
| Rate for Payer: WPS Commercial |
$2,378.97
|
|
|
UroVysion, Detection of Bladder Cancer
|
Facility
|
OP
|
$1,997.00
|
|
|
Service Code
|
CPT 88120
|
| Hospital Charge Code |
5543245
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$179.30 |
| Max. Negotiated Rate |
$1,910.73 |
| Rate for Payer: Aetna Commercial |
$1,869.19
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,786.12
|
| Rate for Payer: Aetna Managed Medicare |
$179.30
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$658.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$307.25
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$291.45
|
| Rate for Payer: Anthem Medicare Advantage |
$179.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,100.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$179.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$179.30
|
| Rate for Payer: Cash Price |
$599.10
|
| Rate for Payer: Cash Price |
$599.10
|
| Rate for Payer: Cigna Commercial |
$1,910.73
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$179.30
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,162.25
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$179.30
|
| Rate for Payer: Health EOS Commercial |
$1,848.42
|
| Rate for Payer: HFN Commercial |
$1,910.73
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$666.98
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$179.30
|
| Rate for Payer: Independent Care Health Plan Medicare |
$179.30
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$179.30
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$179.30
|
| Rate for Payer: Multiplan Commercial |
$1,661.50
|
| Rate for Payer: NAPHCARE Commercial |
$268.94
|
| Rate for Payer: Preferred Network Access Commercial |
$1,910.73
|
| Rate for Payer: Quartz Beloit One Network |
$1,017.67
|
| Rate for Payer: Quartz Commercial |
$1,349.97
|
| Rate for Payer: Quartz Medicare Advantage |
$179.30
|
| Rate for Payer: The Alliance Commercial |
$717.18
|
| Rate for Payer: United Healthcare Medicare Advantage |
$179.30
|
| Rate for Payer: United Healthcare PPO |
$1,557.66
|
| Rate for Payer: WEA Trust Commercial |
$1,142.28
|
| Rate for Payer: Wellcare Medicare |
$179.30
|
| Rate for Payer: WPS Commercial |
$1,538.29
|
|
|
US Abdomen Complete
|
Facility
|
OP
|
$1,739.00
|
|
|
Service Code
|
CPT 76700 TC
|
| Hospital Charge Code |
2430801
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$304.35 |
| Max. Negotiated Rate |
$1,663.88 |
| Rate for Payer: Aetna Commercial |
$1,627.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,555.36
|
| Rate for Payer: Aetna Managed Medicare |
$506.40
|
| 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 |
$958.54
|
| Rate for Payer: Cash Price |
$521.70
|
| Rate for Payer: Cash Price |
$521.70
|
| Rate for Payer: Cash Price |
$521.70
|
| Rate for Payer: Cigna Commercial |
$1,663.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,012.10
|
| Rate for Payer: Health EOS Commercial |
$1,609.62
|
| Rate for Payer: HFN Commercial |
$1,663.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,356.42
|
| Rate for Payer: Multiplan Commercial |
$1,446.85
|
| Rate for Payer: NAPHCARE Commercial |
$1,085.14
|
| Rate for Payer: Preferred Network Access Commercial |
$1,663.88
|
| Rate for Payer: Quartz Beloit One Network |
$886.19
|
| Rate for Payer: Quartz Commercial |
$1,175.56
|
| Rate for Payer: Quartz Medicare Advantage |
$1,085.14
|
| Rate for Payer: The Alliance Commercial |
$304.35
|
| Rate for Payer: United Healthcare PPO |
$596.96
|
| Rate for Payer: WEA Trust Commercial |
$994.71
|
| Rate for Payer: WPS Commercial |
$1,339.55
|
|
|
US Abdomen Complete
|
Facility
|
IP
|
$1,739.00
|
|
|
Service Code
|
CPT 76700 TC
|
| Hospital Charge Code |
2430801
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$886.19 |
| Max. Negotiated Rate |
$1,663.88 |
| Rate for Payer: Aetna Commercial |
$1,627.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,555.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$958.54
|
| Rate for Payer: Cash Price |
$521.70
|
| Rate for Payer: Cigna Commercial |
$1,663.88
|
| Rate for Payer: Health EOS Commercial |
$1,609.62
|
| Rate for Payer: HFN Commercial |
$1,663.88
|
| Rate for Payer: Multiplan Commercial |
$1,446.85
|
| Rate for Payer: Preferred Network Access Commercial |
$1,663.88
|
| Rate for Payer: Quartz Beloit One Network |
$886.19
|
| Rate for Payer: Quartz Commercial |
$1,085.14
|
| Rate for Payer: WEA Trust Commercial |
$994.71
|
| Rate for Payer: WPS Commercial |
$1,339.55
|
|
|
US Abdomen Complete
|
Professional
|
Both
|
$1,739.00
|
|
|
Service Code
|
CPT 76700 TC
|
| Hospital Charge Code |
3072696
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$76.09 |
| Max. Negotiated Rate |
$1,718.13 |
| Rate for Payer: Aetna Commercial |
$1,718.13
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,555.36
|
| Rate for Payer: Aetna Managed Medicare |
$76.09
|
| Rate for Payer: Anthem Medicare Advantage |
$76.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$76.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$76.09
|
| Rate for Payer: Cash Price |
$521.70
|
| Rate for Payer: Cash Price |
$521.70
|
| Rate for Payer: Cash Price |
$521.70
|
| Rate for Payer: Cigna Commercial |
$1,718.13
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$904.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$76.09
|
| Rate for Payer: Health EOS Commercial |
$1,645.79
|
| Rate for Payer: HFN Commercial |
$1,718.13
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$292.41
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$292.41
|
| Rate for Payer: Independent Care Health Plan Medicare |
$76.09
|
| Rate for Payer: Multiplan Commercial |
$1,446.85
|
| Rate for Payer: NAPHCARE Commercial |
$114.13
|
| Rate for Payer: Preferred Network Access Commercial |
$1,718.13
|
| Rate for Payer: Quartz Beloit One Network |
$795.77
|
| Rate for Payer: Quartz Commercial |
$1,030.88
|
| Rate for Payer: Quartz Medicare Advantage |
$76.09
|
| Rate for Payer: The Alliance Commercial |
$289.13
|
| Rate for Payer: United Healthcare Medicare Advantage |
$76.09
|
| Rate for Payer: WEA Trust Commercial |
$994.71
|
| Rate for Payer: WPS Commercial |
$380.43
|
|
|
US Abdomen Complete
|
Facility
|
OP
|
$1,739.00
|
|
|
Service Code
|
CPT 76700 TC
|
| Hospital Charge Code |
3072696
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$304.35 |
| Max. Negotiated Rate |
$1,663.88 |
| Rate for Payer: Aetna Commercial |
$1,627.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,555.36
|
| Rate for Payer: Aetna Managed Medicare |
$506.40
|
| 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 |
$958.54
|
| Rate for Payer: Cash Price |
$521.70
|
| Rate for Payer: Cash Price |
$521.70
|
| Rate for Payer: Cash Price |
$521.70
|
| Rate for Payer: Cigna Commercial |
$1,663.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,012.10
|
| Rate for Payer: Health EOS Commercial |
$1,609.62
|
| Rate for Payer: HFN Commercial |
$1,663.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,356.42
|
| Rate for Payer: Multiplan Commercial |
$1,446.85
|
| Rate for Payer: NAPHCARE Commercial |
$1,085.14
|
| Rate for Payer: Preferred Network Access Commercial |
$1,663.88
|
| Rate for Payer: Quartz Beloit One Network |
$886.19
|
| Rate for Payer: Quartz Commercial |
$1,175.56
|
| Rate for Payer: Quartz Medicare Advantage |
$1,085.14
|
| Rate for Payer: The Alliance Commercial |
$304.35
|
| Rate for Payer: United Healthcare PPO |
$596.96
|
| Rate for Payer: WEA Trust Commercial |
$994.71
|
| Rate for Payer: WPS Commercial |
$1,339.55
|
|
|
US Abdomen Complete
|
Facility
|
IP
|
$1,739.00
|
|
|
Service Code
|
CPT 76700 TC
|
| Hospital Charge Code |
3072696
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$886.19 |
| Max. Negotiated Rate |
$1,663.88 |
| Rate for Payer: Aetna Commercial |
$1,627.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,555.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$958.54
|
| Rate for Payer: Cash Price |
$521.70
|
| Rate for Payer: Cigna Commercial |
$1,663.88
|
| Rate for Payer: Health EOS Commercial |
$1,609.62
|
| Rate for Payer: HFN Commercial |
$1,663.88
|
| Rate for Payer: Multiplan Commercial |
$1,446.85
|
| Rate for Payer: Preferred Network Access Commercial |
$1,663.88
|
| Rate for Payer: Quartz Beloit One Network |
$886.19
|
| Rate for Payer: Quartz Commercial |
$1,085.14
|
| Rate for Payer: WEA Trust Commercial |
$994.71
|
| Rate for Payer: WPS Commercial |
$1,339.55
|
|
|
US Abdomen Complete
|
Facility
|
IP
|
$1,427.00
|
|
|
Service Code
|
CPT 76700
|
| Hospital Charge Code |
625608
|
| Min. Negotiated Rate |
$727.20 |
| Max. Negotiated Rate |
$1,365.35 |
| Rate for Payer: Aetna Commercial |
$1,335.67
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,276.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$786.56
|
| Rate for Payer: Cash Price |
$428.10
|
| Rate for Payer: Cigna Commercial |
$1,365.35
|
| Rate for Payer: Health EOS Commercial |
$1,320.83
|
| Rate for Payer: HFN Commercial |
$1,365.35
|
| Rate for Payer: Multiplan Commercial |
$1,187.26
|
| Rate for Payer: Preferred Network Access Commercial |
$1,365.35
|
| Rate for Payer: Quartz Beloit One Network |
$727.20
|
| Rate for Payer: Quartz Commercial |
$890.45
|
| Rate for Payer: WEA Trust Commercial |
$816.24
|
| Rate for Payer: WPS Commercial |
$1,099.22
|
|
|
US Abdomen Complete
|
Professional
|
Both
|
$1,427.00
|
|
|
Service Code
|
CPT 76700
|
| Hospital Charge Code |
625608
|
| Min. Negotiated Rate |
$113.61 |
| Max. Negotiated Rate |
$1,409.88 |
| Rate for Payer: Aetna Commercial |
$1,409.88
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,276.31
|
| Rate for Payer: Aetna Managed Medicare |
$113.61
|
| Rate for Payer: Anthem Medicare Advantage |
$113.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$113.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$113.61
|
| Rate for Payer: Cash Price |
$428.10
|
| Rate for Payer: Cash Price |
$428.10
|
| Rate for Payer: Cash Price |
$428.10
|
| Rate for Payer: Cigna Commercial |
$1,409.88
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$742.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$113.61
|
| Rate for Payer: Health EOS Commercial |
$1,350.51
|
| Rate for Payer: HFN Commercial |
$1,409.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$432.69
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$432.69
|
| Rate for Payer: Independent Care Health Plan Medicare |
$113.61
|
| Rate for Payer: Multiplan Commercial |
$1,187.26
|
| Rate for Payer: NAPHCARE Commercial |
$170.41
|
| Rate for Payer: Preferred Network Access Commercial |
$1,409.88
|
| Rate for Payer: Quartz Beloit One Network |
$653.00
|
| Rate for Payer: Quartz Commercial |
$845.93
|
| Rate for Payer: Quartz Medicare Advantage |
$113.61
|
| Rate for Payer: The Alliance Commercial |
$431.72
|
| Rate for Payer: United Healthcare Medicare Advantage |
$113.61
|
| Rate for Payer: WEA Trust Commercial |
$816.24
|
| Rate for Payer: WPS Commercial |
$568.05
|
|
|
US Abdomen Complete
|
Facility
|
OP
|
$1,427.00
|
|
|
Service Code
|
CPT 76700
|
| Hospital Charge Code |
625608
|
| Min. Negotiated Rate |
$110.02 |
| Max. Negotiated Rate |
$1,365.35 |
| Rate for Payer: Aetna Commercial |
$1,335.67
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,276.31
|
| Rate for Payer: Aetna Managed Medicare |
$110.02
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$964.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$742.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$712.36
|
| Rate for Payer: Anthem Medicare Advantage |
$110.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$786.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$110.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$110.02
|
| Rate for Payer: Cash Price |
$428.10
|
| Rate for Payer: Cash Price |
$428.10
|
| Rate for Payer: Cigna Commercial |
$1,365.35
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$110.02
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$830.51
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$110.02
|
| Rate for Payer: Health EOS Commercial |
$1,320.83
|
| Rate for Payer: HFN Commercial |
$1,365.35
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$409.28
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$110.02
|
| Rate for Payer: Independent Care Health Plan Medicare |
$110.02
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$110.02
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$110.02
|
| Rate for Payer: Multiplan Commercial |
$1,187.26
|
| Rate for Payer: NAPHCARE Commercial |
$165.03
|
| Rate for Payer: Preferred Network Access Commercial |
$1,365.35
|
| Rate for Payer: Quartz Beloit One Network |
$727.20
|
| Rate for Payer: Quartz Commercial |
$964.65
|
| Rate for Payer: Quartz Medicare Advantage |
$110.02
|
| Rate for Payer: The Alliance Commercial |
$440.09
|
| Rate for Payer: United Healthcare Medicare Advantage |
$110.02
|
| Rate for Payer: WEA Trust Commercial |
$816.24
|
| Rate for Payer: Wellcare Medicare |
$110.02
|
| Rate for Payer: WPS Commercial |
$1,099.22
|
|
|
US Abdomen Complete
|
Professional
|
Both
|
$1,739.00
|
|
|
Service Code
|
CPT 76700 TC
|
| Hospital Charge Code |
2430801
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$76.09 |
| Max. Negotiated Rate |
$1,718.13 |
| Rate for Payer: Aetna Commercial |
$1,718.13
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,555.36
|
| Rate for Payer: Aetna Managed Medicare |
$76.09
|
| Rate for Payer: Anthem Medicare Advantage |
$76.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$76.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$76.09
|
| Rate for Payer: Cash Price |
$521.70
|
| Rate for Payer: Cash Price |
$521.70
|
| Rate for Payer: Cash Price |
$521.70
|
| Rate for Payer: Cigna Commercial |
$1,718.13
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$904.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$76.09
|
| Rate for Payer: Health EOS Commercial |
$1,645.79
|
| Rate for Payer: HFN Commercial |
$1,718.13
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$292.41
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$292.41
|
| Rate for Payer: Independent Care Health Plan Medicare |
$76.09
|
| Rate for Payer: Multiplan Commercial |
$1,446.85
|
| Rate for Payer: NAPHCARE Commercial |
$114.13
|
| Rate for Payer: Preferred Network Access Commercial |
$1,718.13
|
| Rate for Payer: Quartz Beloit One Network |
$795.77
|
| Rate for Payer: Quartz Commercial |
$1,030.88
|
| Rate for Payer: Quartz Medicare Advantage |
$76.09
|
| Rate for Payer: The Alliance Commercial |
$289.13
|
| Rate for Payer: United Healthcare Medicare Advantage |
$76.09
|
| Rate for Payer: WEA Trust Commercial |
$994.71
|
| Rate for Payer: WPS Commercial |
$380.43
|
|
|
US Abdomen Limited
|
Facility
|
IP
|
$1,763.00
|
|
|
Service Code
|
CPT 76705 TC
|
| Hospital Charge Code |
2430803
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$898.42 |
| Max. Negotiated Rate |
$1,686.84 |
| Rate for Payer: Aetna Commercial |
$1,650.17
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,576.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$971.77
|
| Rate for Payer: Cash Price |
$528.90
|
| Rate for Payer: Cigna Commercial |
$1,686.84
|
| Rate for Payer: Health EOS Commercial |
$1,631.83
|
| Rate for Payer: HFN Commercial |
$1,686.84
|
| Rate for Payer: Multiplan Commercial |
$1,466.82
|
| Rate for Payer: Preferred Network Access Commercial |
$1,686.84
|
| Rate for Payer: Quartz Beloit One Network |
$898.42
|
| Rate for Payer: Quartz Commercial |
$1,100.11
|
| Rate for Payer: WEA Trust Commercial |
$1,008.44
|
| Rate for Payer: WPS Commercial |
$1,358.04
|
|
|
US Abdomen Limited
|
Facility
|
OP
|
$1,763.00
|
|
|
Service Code
|
CPT 76705 TC
|
| Hospital Charge Code |
2430803
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$233.38 |
| Max. Negotiated Rate |
$1,686.84 |
| Rate for Payer: Aetna Commercial |
$1,650.17
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,576.83
|
| Rate for Payer: Aetna Managed Medicare |
$513.39
|
| 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 |
$971.77
|
| Rate for Payer: Cash Price |
$528.90
|
| Rate for Payer: Cash Price |
$528.90
|
| Rate for Payer: Cash Price |
$528.90
|
| Rate for Payer: Cigna Commercial |
$1,686.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,026.07
|
| Rate for Payer: Health EOS Commercial |
$1,631.83
|
| Rate for Payer: HFN Commercial |
$1,686.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,375.14
|
| Rate for Payer: Multiplan Commercial |
$1,466.82
|
| Rate for Payer: NAPHCARE Commercial |
$1,100.11
|
| Rate for Payer: Preferred Network Access Commercial |
$1,686.84
|
| Rate for Payer: Quartz Beloit One Network |
$898.42
|
| Rate for Payer: Quartz Commercial |
$1,191.79
|
| Rate for Payer: Quartz Medicare Advantage |
$1,100.11
|
| Rate for Payer: The Alliance Commercial |
$233.38
|
| Rate for Payer: United Healthcare PPO |
$596.96
|
| Rate for Payer: WEA Trust Commercial |
$1,008.44
|
| Rate for Payer: WPS Commercial |
$1,358.04
|
|
|
US Abdomen Limited
|
Professional
|
Both
|
$1,499.00
|
|
|
Service Code
|
CPT 76705
|
| Hospital Charge Code |
625610
|
| Min. Negotiated Rate |
$85.80 |
| Max. Negotiated Rate |
$1,481.01 |
| Rate for Payer: Aetna Commercial |
$1,481.01
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,340.71
|
| Rate for Payer: Aetna Managed Medicare |
$85.80
|
| Rate for Payer: Anthem Medicare Advantage |
$85.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$85.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$85.80
|
| Rate for Payer: Cash Price |
$449.70
|
| Rate for Payer: Cash Price |
$449.70
|
| Rate for Payer: Cash Price |
$449.70
|
| Rate for Payer: Cigna Commercial |
$1,481.01
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$779.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$85.80
|
| Rate for Payer: Health EOS Commercial |
$1,418.65
|
| Rate for Payer: HFN Commercial |
$1,481.01
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$322.44
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$322.44
|
| Rate for Payer: Independent Care Health Plan Medicare |
$85.80
|
| Rate for Payer: Multiplan Commercial |
$1,247.17
|
| Rate for Payer: NAPHCARE Commercial |
$128.70
|
| Rate for Payer: Preferred Network Access Commercial |
$1,481.01
|
| Rate for Payer: Quartz Beloit One Network |
$685.94
|
| Rate for Payer: Quartz Commercial |
$888.61
|
| Rate for Payer: Quartz Medicare Advantage |
$85.80
|
| Rate for Payer: The Alliance Commercial |
$326.04
|
| Rate for Payer: United Healthcare Medicare Advantage |
$85.80
|
| Rate for Payer: WEA Trust Commercial |
$857.43
|
| Rate for Payer: WPS Commercial |
$429.00
|
|
