|
US Abdomen Limited
|
Professional
|
Both
|
$1,763.00
|
|
|
Service Code
|
CPT 76705 TC
|
| Hospital Charge Code |
2430803
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$58.34 |
| Max. Negotiated Rate |
$1,741.84 |
| Rate for Payer: Aetna Commercial |
$1,741.84
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,576.83
|
| Rate for Payer: Aetna Managed Medicare |
$58.34
|
| Rate for Payer: Anthem Medicare Advantage |
$58.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$58.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$58.34
|
| 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 |
$1,741.84
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$916.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$58.34
|
| Rate for Payer: Health EOS Commercial |
$1,668.50
|
| Rate for Payer: HFN Commercial |
$1,741.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$220.01
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$220.01
|
| Rate for Payer: Independent Care Health Plan Medicare |
$58.34
|
| Rate for Payer: Multiplan Commercial |
$1,466.82
|
| Rate for Payer: NAPHCARE Commercial |
$87.52
|
| Rate for Payer: Preferred Network Access Commercial |
$1,741.84
|
| Rate for Payer: Quartz Beloit One Network |
$806.75
|
| Rate for Payer: Quartz Commercial |
$1,045.11
|
| Rate for Payer: Quartz Medicare Advantage |
$58.34
|
| Rate for Payer: The Alliance Commercial |
$221.71
|
| Rate for Payer: United Healthcare Medicare Advantage |
$58.34
|
| Rate for Payer: WEA Trust Commercial |
$1,008.44
|
| Rate for Payer: WPS Commercial |
$291.72
|
|
|
US Abdomen Limited
|
Facility
|
IP
|
$1,499.00
|
|
|
Service Code
|
CPT 76705
|
| Hospital Charge Code |
625610
|
| Min. Negotiated Rate |
$763.89 |
| Max. Negotiated Rate |
$1,434.24 |
| Rate for Payer: Aetna Commercial |
$1,403.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,340.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$826.25
|
| Rate for Payer: Cash Price |
$449.70
|
| Rate for Payer: Cigna Commercial |
$1,434.24
|
| Rate for Payer: Health EOS Commercial |
$1,387.47
|
| Rate for Payer: HFN Commercial |
$1,434.24
|
| Rate for Payer: Multiplan Commercial |
$1,247.17
|
| Rate for Payer: Preferred Network Access Commercial |
$1,434.24
|
| Rate for Payer: Quartz Beloit One Network |
$763.89
|
| Rate for Payer: Quartz Commercial |
$935.38
|
| Rate for Payer: WEA Trust Commercial |
$857.43
|
| Rate for Payer: WPS Commercial |
$1,154.68
|
|
|
US Abdomen Limited
|
Facility
|
OP
|
$1,499.00
|
|
|
Service Code
|
CPT 76705
|
| Hospital Charge Code |
625610
|
| Min. Negotiated Rate |
$110.02 |
| Max. Negotiated Rate |
$1,434.24 |
| Rate for Payer: Aetna Commercial |
$1,403.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,340.71
|
| Rate for Payer: Aetna Managed Medicare |
$110.02
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,013.32
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$779.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$748.30
|
| Rate for Payer: Anthem Medicare Advantage |
$110.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$826.25
|
| 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 |
$449.70
|
| Rate for Payer: Cash Price |
$449.70
|
| Rate for Payer: Cigna Commercial |
$1,434.24
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$110.02
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$872.42
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$110.02
|
| Rate for Payer: Health EOS Commercial |
$1,387.47
|
| Rate for Payer: HFN Commercial |
$1,434.24
|
| 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 |
$1,247.17
|
| Rate for Payer: NAPHCARE Commercial |
$165.03
|
| Rate for Payer: Preferred Network Access Commercial |
$1,434.24
|
| Rate for Payer: Quartz Beloit One Network |
$763.89
|
| Rate for Payer: Quartz Commercial |
$1,013.32
|
| 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 |
$857.43
|
| Rate for Payer: Wellcare Medicare |
$110.02
|
| Rate for Payer: WPS Commercial |
$1,154.68
|
|
|
US Abdominal Aorta
|
Professional
|
Both
|
$322.00
|
|
|
Service Code
|
CPT 76775
|
| Hospital Charge Code |
2552801
|
| Min. Negotiated Rate |
$60.50 |
| Max. Negotiated Rate |
$318.14 |
| Rate for Payer: Aetna Commercial |
$318.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$288.00
|
| Rate for Payer: Aetna Managed Medicare |
$60.50
|
| Rate for Payer: Anthem Medicare Advantage |
$60.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$60.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$60.50
|
| Rate for Payer: Cash Price |
$96.60
|
| Rate for Payer: Cash Price |
$96.60
|
| Rate for Payer: Cash Price |
$96.60
|
| Rate for Payer: Cigna Commercial |
$318.14
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$167.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$60.50
|
| Rate for Payer: Health EOS Commercial |
$304.74
|
| Rate for Payer: HFN Commercial |
$318.14
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$207.72
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$207.72
|
| Rate for Payer: Independent Care Health Plan Medicare |
$60.50
|
| Rate for Payer: Multiplan Commercial |
$267.90
|
| Rate for Payer: NAPHCARE Commercial |
$90.75
|
| Rate for Payer: Preferred Network Access Commercial |
$318.14
|
| Rate for Payer: Quartz Beloit One Network |
$147.35
|
| Rate for Payer: Quartz Commercial |
$190.88
|
| Rate for Payer: Quartz Medicare Advantage |
$60.50
|
| Rate for Payer: The Alliance Commercial |
$229.89
|
| Rate for Payer: United Healthcare Medicare Advantage |
$60.50
|
| Rate for Payer: WEA Trust Commercial |
$184.18
|
| Rate for Payer: WPS Commercial |
$302.48
|
|
|
US Abdominal Aorta
|
Professional
|
Both
|
$735.00
|
|
|
Service Code
|
CPT 76775 TC
|
| Hospital Charge Code |
2587076
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$33.38 |
| Max. Negotiated Rate |
$726.18 |
| Rate for Payer: Aetna Commercial |
$726.18
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$657.38
|
| Rate for Payer: Aetna Managed Medicare |
$33.38
|
| Rate for Payer: Anthem Medicare Advantage |
$33.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$33.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$33.38
|
| Rate for Payer: Cash Price |
$220.50
|
| Rate for Payer: Cash Price |
$220.50
|
| Rate for Payer: Cash Price |
$220.50
|
| Rate for Payer: Cigna Commercial |
$726.18
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$382.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$33.38
|
| Rate for Payer: Health EOS Commercial |
$695.60
|
| Rate for Payer: HFN Commercial |
$726.18
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$106.58
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$106.58
|
| Rate for Payer: Independent Care Health Plan Medicare |
$33.38
|
| Rate for Payer: Multiplan Commercial |
$611.52
|
| Rate for Payer: NAPHCARE Commercial |
$50.08
|
| Rate for Payer: Preferred Network Access Commercial |
$726.18
|
| Rate for Payer: Quartz Beloit One Network |
$336.34
|
| Rate for Payer: Quartz Commercial |
$435.71
|
| Rate for Payer: Quartz Medicare Advantage |
$33.38
|
| Rate for Payer: The Alliance Commercial |
$126.86
|
| Rate for Payer: United Healthcare Medicare Advantage |
$33.38
|
| Rate for Payer: WEA Trust Commercial |
$420.42
|
| Rate for Payer: WPS Commercial |
$166.92
|
|
|
US Abdominal Aorta
|
Facility
|
OP
|
$735.00
|
|
|
Service Code
|
CPT 76775 TC
|
| Hospital Charge Code |
2587076
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$133.54 |
| Max. Negotiated Rate |
$848.64 |
| Rate for Payer: Aetna Commercial |
$687.96
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$657.38
|
| Rate for Payer: Aetna Managed Medicare |
$214.03
|
| 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 |
$405.13
|
| Rate for Payer: Cash Price |
$220.50
|
| Rate for Payer: Cash Price |
$220.50
|
| Rate for Payer: Cash Price |
$220.50
|
| Rate for Payer: Cigna Commercial |
$703.25
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$427.77
|
| Rate for Payer: Health EOS Commercial |
$680.32
|
| Rate for Payer: HFN Commercial |
$703.25
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$573.30
|
| Rate for Payer: Multiplan Commercial |
$611.52
|
| Rate for Payer: NAPHCARE Commercial |
$458.64
|
| Rate for Payer: Preferred Network Access Commercial |
$703.25
|
| Rate for Payer: Quartz Beloit One Network |
$374.56
|
| Rate for Payer: Quartz Commercial |
$496.86
|
| Rate for Payer: Quartz Medicare Advantage |
$458.64
|
| Rate for Payer: The Alliance Commercial |
$133.54
|
| Rate for Payer: United Healthcare PPO |
$596.96
|
| Rate for Payer: WEA Trust Commercial |
$420.42
|
| Rate for Payer: WPS Commercial |
$566.17
|
|
|
US Abdominal Aorta
|
Facility
|
OP
|
$322.00
|
|
|
Service Code
|
CPT 76775
|
| Hospital Charge Code |
2552801
|
| Min. Negotiated Rate |
$110.02 |
| Max. Negotiated Rate |
$440.09 |
| Rate for Payer: Aetna Commercial |
$301.39
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$288.00
|
| Rate for Payer: Aetna Managed Medicare |
$110.02
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$217.67
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$167.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$160.74
|
| Rate for Payer: Anthem Medicare Advantage |
$110.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$177.49
|
| 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 |
$96.60
|
| Rate for Payer: Cash Price |
$96.60
|
| Rate for Payer: Cigna Commercial |
$308.09
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$110.02
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$187.40
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$110.02
|
| Rate for Payer: Health EOS Commercial |
$298.04
|
| Rate for Payer: HFN Commercial |
$308.09
|
| 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 |
$267.90
|
| Rate for Payer: NAPHCARE Commercial |
$165.03
|
| Rate for Payer: Preferred Network Access Commercial |
$308.09
|
| Rate for Payer: Quartz Beloit One Network |
$164.09
|
| Rate for Payer: Quartz Commercial |
$217.67
|
| 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 |
$184.18
|
| Rate for Payer: Wellcare Medicare |
$110.02
|
| Rate for Payer: WPS Commercial |
$248.04
|
|
|
US Abdominal Aorta
|
Facility
|
IP
|
$322.00
|
|
|
Service Code
|
CPT 76775
|
| Hospital Charge Code |
2552801
|
| Min. Negotiated Rate |
$164.09 |
| Max. Negotiated Rate |
$308.09 |
| Rate for Payer: Aetna Commercial |
$301.39
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$288.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$177.49
|
| Rate for Payer: Cash Price |
$96.60
|
| Rate for Payer: Cigna Commercial |
$308.09
|
| Rate for Payer: Health EOS Commercial |
$298.04
|
| Rate for Payer: HFN Commercial |
$308.09
|
| Rate for Payer: Multiplan Commercial |
$267.90
|
| Rate for Payer: Preferred Network Access Commercial |
$308.09
|
| Rate for Payer: Quartz Beloit One Network |
$164.09
|
| Rate for Payer: Quartz Commercial |
$200.93
|
| Rate for Payer: WEA Trust Commercial |
$184.18
|
| Rate for Payer: WPS Commercial |
$248.04
|
|
|
US Abdominal Aorta
|
Facility
|
IP
|
$735.00
|
|
|
Service Code
|
CPT 76775 TC
|
| Hospital Charge Code |
2587076
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$374.56 |
| Max. Negotiated Rate |
$703.25 |
| Rate for Payer: Aetna Commercial |
$687.96
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$657.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$405.13
|
| Rate for Payer: Cash Price |
$220.50
|
| Rate for Payer: Cigna Commercial |
$703.25
|
| Rate for Payer: Health EOS Commercial |
$680.32
|
| Rate for Payer: HFN Commercial |
$703.25
|
| Rate for Payer: Multiplan Commercial |
$611.52
|
| Rate for Payer: Preferred Network Access Commercial |
$703.25
|
| Rate for Payer: Quartz Beloit One Network |
$374.56
|
| Rate for Payer: Quartz Commercial |
$458.64
|
| Rate for Payer: WEA Trust Commercial |
$420.42
|
| Rate for Payer: WPS Commercial |
$566.17
|
|
|
US Aorta Complete
|
Facility
|
IP
|
$1,152.00
|
|
|
Service Code
|
CPT 76770
|
| Hospital Charge Code |
631475
|
| Min. Negotiated Rate |
$587.06 |
| Max. Negotiated Rate |
$1,102.23 |
| Rate for Payer: Aetna Commercial |
$1,078.27
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,030.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$634.98
|
| Rate for Payer: Cash Price |
$345.60
|
| Rate for Payer: Cigna Commercial |
$1,102.23
|
| Rate for Payer: Health EOS Commercial |
$1,066.29
|
| Rate for Payer: HFN Commercial |
$1,102.23
|
| Rate for Payer: Multiplan Commercial |
$958.46
|
| Rate for Payer: Preferred Network Access Commercial |
$1,102.23
|
| Rate for Payer: Quartz Beloit One Network |
$587.06
|
| Rate for Payer: Quartz Commercial |
$718.85
|
| Rate for Payer: WEA Trust Commercial |
$658.94
|
| Rate for Payer: WPS Commercial |
$887.39
|
|
|
US Aorta Complete
|
Professional
|
Both
|
$1,179.00
|
|
|
Service Code
|
CPT 76770 TC
|
| Hospital Charge Code |
2430805
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$71.66 |
| Max. Negotiated Rate |
$1,164.85 |
| Rate for Payer: The Alliance Commercial |
$272.29
|
| Rate for Payer: Aetna Commercial |
$1,164.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,054.50
|
| Rate for Payer: Aetna Managed Medicare |
$71.66
|
| Rate for Payer: Anthem Medicare Advantage |
$71.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$71.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$71.66
|
| Rate for Payer: Cash Price |
$353.70
|
| Rate for Payer: Cash Price |
$353.70
|
| Rate for Payer: Cash Price |
$353.70
|
| Rate for Payer: Cigna Commercial |
$1,164.85
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$613.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$71.66
|
| Rate for Payer: Health EOS Commercial |
$1,115.81
|
| Rate for Payer: HFN Commercial |
$1,164.85
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$271.89
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$271.89
|
| Rate for Payer: Independent Care Health Plan Medicare |
$71.66
|
| Rate for Payer: Multiplan Commercial |
$980.93
|
| Rate for Payer: NAPHCARE Commercial |
$107.48
|
| Rate for Payer: Preferred Network Access Commercial |
$1,164.85
|
| Rate for Payer: Quartz Beloit One Network |
$539.51
|
| Rate for Payer: Quartz Commercial |
$698.91
|
| Rate for Payer: Quartz Medicare Advantage |
$71.66
|
| Rate for Payer: United Healthcare Medicare Advantage |
$71.66
|
| Rate for Payer: WEA Trust Commercial |
$674.39
|
| Rate for Payer: WPS Commercial |
$358.28
|
|
|
US Aorta Complete
|
Facility
|
IP
|
$1,179.00
|
|
|
Service Code
|
CPT 76770 TC
|
| Hospital Charge Code |
2430805
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$600.82 |
| Max. Negotiated Rate |
$1,128.07 |
| Rate for Payer: Aetna Commercial |
$1,103.54
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,054.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$649.86
|
| Rate for Payer: Cash Price |
$353.70
|
| Rate for Payer: Cigna Commercial |
$1,128.07
|
| Rate for Payer: Health EOS Commercial |
$1,091.28
|
| Rate for Payer: HFN Commercial |
$1,128.07
|
| Rate for Payer: Multiplan Commercial |
$980.93
|
| Rate for Payer: Preferred Network Access Commercial |
$1,128.07
|
| Rate for Payer: Quartz Beloit One Network |
$600.82
|
| Rate for Payer: Quartz Commercial |
$735.70
|
| Rate for Payer: WEA Trust Commercial |
$674.39
|
| Rate for Payer: WPS Commercial |
$908.18
|
|
|
US Aorta Complete
|
Professional
|
Both
|
$1,152.00
|
|
|
Service Code
|
CPT 76770
|
| Hospital Charge Code |
631475
|
| Min. Negotiated Rate |
$105.75 |
| Max. Negotiated Rate |
$1,138.18 |
| Rate for Payer: Aetna Commercial |
$1,138.18
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,030.35
|
| Rate for Payer: Aetna Managed Medicare |
$105.75
|
| Rate for Payer: Anthem Medicare Advantage |
$105.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$105.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$105.75
|
| Rate for Payer: Cash Price |
$345.60
|
| Rate for Payer: Cash Price |
$345.60
|
| Rate for Payer: Cash Price |
$345.60
|
| Rate for Payer: Cigna Commercial |
$1,138.18
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$599.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$105.75
|
| Rate for Payer: Health EOS Commercial |
$1,090.25
|
| Rate for Payer: HFN Commercial |
$1,138.18
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$399.58
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$399.58
|
| Rate for Payer: Independent Care Health Plan Medicare |
$105.75
|
| Rate for Payer: Multiplan Commercial |
$958.46
|
| Rate for Payer: NAPHCARE Commercial |
$158.62
|
| Rate for Payer: Preferred Network Access Commercial |
$1,138.18
|
| Rate for Payer: Quartz Beloit One Network |
$527.16
|
| Rate for Payer: Quartz Commercial |
$682.91
|
| Rate for Payer: Quartz Medicare Advantage |
$105.75
|
| Rate for Payer: The Alliance Commercial |
$401.84
|
| Rate for Payer: United Healthcare Medicare Advantage |
$105.75
|
| Rate for Payer: WEA Trust Commercial |
$658.94
|
| Rate for Payer: WPS Commercial |
$528.74
|
|
|
US Aorta Complete
|
Facility
|
OP
|
$1,179.00
|
|
|
Service Code
|
CPT 76770 TC
|
| Hospital Charge Code |
2430805
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$286.62 |
| Max. Negotiated Rate |
$1,128.07 |
| Rate for Payer: Aetna Commercial |
$1,103.54
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,054.50
|
| Rate for Payer: Aetna Managed Medicare |
$343.32
|
| 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 |
$649.86
|
| Rate for Payer: Cash Price |
$353.70
|
| Rate for Payer: Cash Price |
$353.70
|
| Rate for Payer: Cash Price |
$353.70
|
| Rate for Payer: Cigna Commercial |
$1,128.07
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$686.18
|
| Rate for Payer: Health EOS Commercial |
$1,091.28
|
| Rate for Payer: HFN Commercial |
$1,128.07
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$919.62
|
| Rate for Payer: Multiplan Commercial |
$980.93
|
| Rate for Payer: NAPHCARE Commercial |
$735.70
|
| Rate for Payer: Preferred Network Access Commercial |
$1,128.07
|
| Rate for Payer: Quartz Beloit One Network |
$600.82
|
| Rate for Payer: Quartz Commercial |
$797.00
|
| Rate for Payer: Quartz Medicare Advantage |
$735.70
|
| Rate for Payer: The Alliance Commercial |
$286.62
|
| Rate for Payer: United Healthcare PPO |
$596.96
|
| Rate for Payer: WEA Trust Commercial |
$674.39
|
| Rate for Payer: WPS Commercial |
$908.18
|
|
|
US Aorta Complete
|
Facility
|
OP
|
$1,152.00
|
|
|
Service Code
|
CPT 76770
|
| Hospital Charge Code |
631475
|
| Min. Negotiated Rate |
$110.02 |
| Max. Negotiated Rate |
$1,102.23 |
| Rate for Payer: Aetna Commercial |
$1,078.27
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,030.35
|
| Rate for Payer: Aetna Managed Medicare |
$110.02
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$778.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$599.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$575.08
|
| Rate for Payer: Anthem Medicare Advantage |
$110.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$634.98
|
| 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 |
$345.60
|
| Rate for Payer: Cash Price |
$345.60
|
| Rate for Payer: Cigna Commercial |
$1,102.23
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$110.02
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$670.46
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$110.02
|
| Rate for Payer: Health EOS Commercial |
$1,066.29
|
| Rate for Payer: HFN Commercial |
$1,102.23
|
| 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 |
$958.46
|
| Rate for Payer: NAPHCARE Commercial |
$165.03
|
| Rate for Payer: Preferred Network Access Commercial |
$1,102.23
|
| Rate for Payer: Quartz Beloit One Network |
$587.06
|
| Rate for Payer: Quartz Commercial |
$778.75
|
| 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 |
$658.94
|
| Rate for Payer: Wellcare Medicare |
$110.02
|
| Rate for Payer: WPS Commercial |
$887.39
|
|
|
US Aorta Duplex Complete
|
Facility
|
OP
|
$1,032.00
|
|
|
Service Code
|
CPT 76770 TC
|
| Hospital Charge Code |
2430807
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$286.62 |
| Max. Negotiated Rate |
$987.42 |
| Rate for Payer: Aetna Commercial |
$965.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$923.02
|
| Rate for Payer: Aetna Managed Medicare |
$300.52
|
| 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 |
$568.84
|
| Rate for Payer: Cash Price |
$309.60
|
| Rate for Payer: Cash Price |
$309.60
|
| Rate for Payer: Cash Price |
$309.60
|
| Rate for Payer: Cigna Commercial |
$987.42
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$600.62
|
| Rate for Payer: Health EOS Commercial |
$955.22
|
| Rate for Payer: HFN Commercial |
$987.42
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$804.96
|
| Rate for Payer: Multiplan Commercial |
$858.62
|
| Rate for Payer: NAPHCARE Commercial |
$643.97
|
| Rate for Payer: Preferred Network Access Commercial |
$987.42
|
| Rate for Payer: Quartz Beloit One Network |
$525.91
|
| Rate for Payer: Quartz Commercial |
$697.63
|
| Rate for Payer: Quartz Medicare Advantage |
$643.97
|
| Rate for Payer: The Alliance Commercial |
$286.62
|
| Rate for Payer: United Healthcare PPO |
$596.96
|
| Rate for Payer: WEA Trust Commercial |
$590.30
|
| Rate for Payer: WPS Commercial |
$794.95
|
|
|
US Aorta Duplex Complete
|
Facility
|
IP
|
$1,032.00
|
|
|
Service Code
|
CPT 76770 TC
|
| Hospital Charge Code |
2430807
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$525.91 |
| Max. Negotiated Rate |
$987.42 |
| Rate for Payer: Aetna Commercial |
$965.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$923.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$568.84
|
| Rate for Payer: Cash Price |
$309.60
|
| Rate for Payer: Cigna Commercial |
$987.42
|
| Rate for Payer: Health EOS Commercial |
$955.22
|
| Rate for Payer: HFN Commercial |
$987.42
|
| Rate for Payer: Multiplan Commercial |
$858.62
|
| Rate for Payer: Preferred Network Access Commercial |
$987.42
|
| Rate for Payer: Quartz Beloit One Network |
$525.91
|
| Rate for Payer: Quartz Commercial |
$643.97
|
| Rate for Payer: WEA Trust Commercial |
$590.30
|
| Rate for Payer: WPS Commercial |
$794.95
|
|
|
US Aorta Duplex Complete
|
Professional
|
Both
|
$1,032.00
|
|
|
Service Code
|
CPT 76770 TC
|
| Hospital Charge Code |
2430807
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$71.66 |
| Max. Negotiated Rate |
$1,019.62 |
| Rate for Payer: Aetna Commercial |
$1,019.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$923.02
|
| Rate for Payer: Aetna Managed Medicare |
$71.66
|
| Rate for Payer: Anthem Medicare Advantage |
$71.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$71.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$71.66
|
| Rate for Payer: Cash Price |
$309.60
|
| Rate for Payer: Cash Price |
$309.60
|
| Rate for Payer: Cash Price |
$309.60
|
| Rate for Payer: Cigna Commercial |
$1,019.62
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$536.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$71.66
|
| Rate for Payer: Health EOS Commercial |
$976.68
|
| Rate for Payer: HFN Commercial |
$1,019.62
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$271.89
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$271.89
|
| Rate for Payer: Independent Care Health Plan Medicare |
$71.66
|
| Rate for Payer: Multiplan Commercial |
$858.62
|
| Rate for Payer: NAPHCARE Commercial |
$107.48
|
| Rate for Payer: Preferred Network Access Commercial |
$1,019.62
|
| Rate for Payer: Quartz Beloit One Network |
$472.24
|
| Rate for Payer: Quartz Commercial |
$611.77
|
| Rate for Payer: Quartz Medicare Advantage |
$71.66
|
| Rate for Payer: The Alliance Commercial |
$272.29
|
| Rate for Payer: United Healthcare Medicare Advantage |
$71.66
|
| Rate for Payer: WEA Trust Commercial |
$590.30
|
| Rate for Payer: WPS Commercial |
$358.28
|
|
|
US Aorta Duplex Limited
|
Facility
|
IP
|
$677.00
|
|
|
Service Code
|
CPT 76775 TC
|
| Hospital Charge Code |
2430809
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$345.00 |
| Max. Negotiated Rate |
$647.75 |
| Rate for Payer: Aetna Commercial |
$633.67
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$605.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$373.16
|
| Rate for Payer: Cash Price |
$203.10
|
| Rate for Payer: Cigna Commercial |
$647.75
|
| Rate for Payer: Health EOS Commercial |
$626.63
|
| Rate for Payer: HFN Commercial |
$647.75
|
| Rate for Payer: Multiplan Commercial |
$563.26
|
| Rate for Payer: Preferred Network Access Commercial |
$647.75
|
| Rate for Payer: Quartz Beloit One Network |
$345.00
|
| Rate for Payer: Quartz Commercial |
$422.45
|
| Rate for Payer: WEA Trust Commercial |
$387.24
|
| Rate for Payer: WPS Commercial |
$521.49
|
|
|
US Aorta Duplex Limited
|
Facility
|
OP
|
$677.00
|
|
|
Service Code
|
CPT 76775 TC
|
| Hospital Charge Code |
2430809
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$133.54 |
| Max. Negotiated Rate |
$848.64 |
| Rate for Payer: Aetna Commercial |
$633.67
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$605.51
|
| Rate for Payer: Aetna Managed Medicare |
$197.14
|
| 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 |
$373.16
|
| Rate for Payer: Cash Price |
$203.10
|
| Rate for Payer: Cash Price |
$203.10
|
| Rate for Payer: Cash Price |
$203.10
|
| Rate for Payer: Cigna Commercial |
$647.75
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$394.01
|
| Rate for Payer: Health EOS Commercial |
$626.63
|
| Rate for Payer: HFN Commercial |
$647.75
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$528.06
|
| Rate for Payer: Multiplan Commercial |
$563.26
|
| Rate for Payer: NAPHCARE Commercial |
$422.45
|
| Rate for Payer: Preferred Network Access Commercial |
$647.75
|
| Rate for Payer: Quartz Beloit One Network |
$345.00
|
| Rate for Payer: Quartz Commercial |
$457.65
|
| Rate for Payer: Quartz Medicare Advantage |
$422.45
|
| Rate for Payer: The Alliance Commercial |
$133.54
|
| Rate for Payer: United Healthcare PPO |
$596.96
|
| Rate for Payer: WEA Trust Commercial |
$387.24
|
| Rate for Payer: WPS Commercial |
$521.49
|
|
|
US Aorta Duplex Limited
|
Professional
|
Both
|
$677.00
|
|
|
Service Code
|
CPT 76775 TC
|
| Hospital Charge Code |
2430809
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$33.38 |
| Max. Negotiated Rate |
$668.88 |
| Rate for Payer: Aetna Commercial |
$668.88
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$605.51
|
| Rate for Payer: Aetna Managed Medicare |
$33.38
|
| Rate for Payer: Anthem Medicare Advantage |
$33.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$33.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$33.38
|
| Rate for Payer: Cash Price |
$203.10
|
| Rate for Payer: Cash Price |
$203.10
|
| Rate for Payer: Cash Price |
$203.10
|
| Rate for Payer: Cigna Commercial |
$668.88
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$352.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$33.38
|
| Rate for Payer: Health EOS Commercial |
$640.71
|
| Rate for Payer: HFN Commercial |
$668.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$106.58
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$106.58
|
| Rate for Payer: Independent Care Health Plan Medicare |
$33.38
|
| Rate for Payer: Multiplan Commercial |
$563.26
|
| Rate for Payer: NAPHCARE Commercial |
$50.08
|
| Rate for Payer: Preferred Network Access Commercial |
$668.88
|
| Rate for Payer: Quartz Beloit One Network |
$309.80
|
| Rate for Payer: Quartz Commercial |
$401.33
|
| Rate for Payer: Quartz Medicare Advantage |
$33.38
|
| Rate for Payer: The Alliance Commercial |
$126.86
|
| Rate for Payer: United Healthcare Medicare Advantage |
$33.38
|
| Rate for Payer: WEA Trust Commercial |
$387.24
|
| Rate for Payer: WPS Commercial |
$166.92
|
|
|
US Aspiration/Inj/Biopsy Left ea add
|
Facility
|
OP
|
$1,400.00
|
|
|
Service Code
|
CPT 76942 TC
|
| Hospital Charge Code |
6187003
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$129.54 |
| Max. Negotiated Rate |
$1,339.52 |
| Rate for Payer: Aetna Commercial |
$1,310.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,252.16
|
| Rate for Payer: Aetna Managed Medicare |
$407.68
|
| 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 |
$771.68
|
| Rate for Payer: Cash Price |
$420.00
|
| Rate for Payer: Cash Price |
$420.00
|
| Rate for Payer: Cash Price |
$420.00
|
| Rate for Payer: Cigna Commercial |
$1,339.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$814.80
|
| Rate for Payer: Health EOS Commercial |
$1,295.84
|
| Rate for Payer: HFN Commercial |
$1,339.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,092.00
|
| Rate for Payer: Multiplan Commercial |
$1,164.80
|
| Rate for Payer: NAPHCARE Commercial |
$873.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,339.52
|
| Rate for Payer: Quartz Beloit One Network |
$713.44
|
| Rate for Payer: Quartz Commercial |
$946.40
|
| Rate for Payer: Quartz Medicare Advantage |
$873.60
|
| Rate for Payer: The Alliance Commercial |
$129.54
|
| Rate for Payer: United Healthcare PPO |
$596.96
|
| Rate for Payer: WEA Trust Commercial |
$800.80
|
| Rate for Payer: WPS Commercial |
$1,078.42
|
|
|
US Aspiration/Inj/Biopsy Left ea add
|
Facility
|
IP
|
$1,400.00
|
|
|
Service Code
|
CPT 76942 TC
|
| Hospital Charge Code |
6187003
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$713.44 |
| Max. Negotiated Rate |
$1,339.52 |
| Rate for Payer: Aetna Commercial |
$1,310.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,252.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$771.68
|
| Rate for Payer: Cash Price |
$420.00
|
| Rate for Payer: Cigna Commercial |
$1,339.52
|
| Rate for Payer: Health EOS Commercial |
$1,295.84
|
| Rate for Payer: HFN Commercial |
$1,339.52
|
| Rate for Payer: Multiplan Commercial |
$1,164.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,339.52
|
| Rate for Payer: Quartz Beloit One Network |
$713.44
|
| Rate for Payer: Quartz Commercial |
$873.60
|
| Rate for Payer: WEA Trust Commercial |
$800.80
|
| Rate for Payer: WPS Commercial |
$1,078.42
|
|
|
US Aspiration/Inj/Biopsy Left ea add
|
Professional
|
Both
|
$1,400.00
|
|
|
Service Code
|
CPT 76942 TC
|
| Hospital Charge Code |
6187003
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$32.39 |
| Max. Negotiated Rate |
$1,383.20 |
| Rate for Payer: Aetna Commercial |
$1,383.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,252.16
|
| Rate for Payer: Aetna Managed Medicare |
$32.39
|
| Rate for Payer: Anthem Medicare Advantage |
$32.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$32.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$32.39
|
| Rate for Payer: Cash Price |
$420.00
|
| Rate for Payer: Cash Price |
$420.00
|
| Rate for Payer: Cash Price |
$420.00
|
| Rate for Payer: Cigna Commercial |
$1,383.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$728.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$32.39
|
| Rate for Payer: Health EOS Commercial |
$1,324.96
|
| Rate for Payer: HFN Commercial |
$1,383.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$94.49
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$94.49
|
| Rate for Payer: Independent Care Health Plan Medicare |
$32.39
|
| Rate for Payer: Multiplan Commercial |
$1,164.80
|
| Rate for Payer: NAPHCARE Commercial |
$48.58
|
| Rate for Payer: Preferred Network Access Commercial |
$1,383.20
|
| Rate for Payer: Quartz Beloit One Network |
$640.64
|
| Rate for Payer: Quartz Commercial |
$829.92
|
| Rate for Payer: Quartz Medicare Advantage |
$32.39
|
| Rate for Payer: The Alliance Commercial |
$123.07
|
| Rate for Payer: United Healthcare Medicare Advantage |
$32.39
|
| Rate for Payer: WEA Trust Commercial |
$800.80
|
| Rate for Payer: WPS Commercial |
$161.93
|
|
|
US Aspiration/Inj/Biopsy Right ea add
|
Professional
|
Both
|
$1,400.00
|
|
|
Service Code
|
CPT 76942 TC
|
| Hospital Charge Code |
6187005
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$32.39 |
| Max. Negotiated Rate |
$1,383.20 |
| Rate for Payer: Aetna Commercial |
$1,383.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,252.16
|
| Rate for Payer: Aetna Managed Medicare |
$32.39
|
| Rate for Payer: Anthem Medicare Advantage |
$32.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$32.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$32.39
|
| Rate for Payer: Cash Price |
$420.00
|
| Rate for Payer: Cash Price |
$420.00
|
| Rate for Payer: Cash Price |
$420.00
|
| Rate for Payer: Cigna Commercial |
$1,383.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$728.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$32.39
|
| Rate for Payer: Health EOS Commercial |
$1,324.96
|
| Rate for Payer: HFN Commercial |
$1,383.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$94.49
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$94.49
|
| Rate for Payer: Independent Care Health Plan Medicare |
$32.39
|
| Rate for Payer: Multiplan Commercial |
$1,164.80
|
| Rate for Payer: NAPHCARE Commercial |
$48.58
|
| Rate for Payer: Preferred Network Access Commercial |
$1,383.20
|
| Rate for Payer: Quartz Beloit One Network |
$640.64
|
| Rate for Payer: Quartz Commercial |
$829.92
|
| Rate for Payer: Quartz Medicare Advantage |
$32.39
|
| Rate for Payer: The Alliance Commercial |
$123.07
|
| Rate for Payer: United Healthcare Medicare Advantage |
$32.39
|
| Rate for Payer: WEA Trust Commercial |
$800.80
|
| Rate for Payer: WPS Commercial |
$161.93
|
|
