|
XR Nephrostogram
|
Facility
|
IP
|
$796.00
|
|
|
Service Code
|
CPT 74425
|
| Hospital Charge Code |
2587235
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$390.04 |
| Max. Negotiated Rate |
$732.32 |
| Rate for Payer: Aetna Commercial |
$716.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$684.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$421.88
|
| Rate for Payer: Cash Price |
$238.80
|
| Rate for Payer: Cigna Commercial |
$732.32
|
| Rate for Payer: Health EOS Commercial |
$708.44
|
| Rate for Payer: HFN Commercial |
$732.32
|
| Rate for Payer: Multiplan Commercial |
$636.80
|
| Rate for Payer: NAPHCARE Commercial |
$477.60
|
| Rate for Payer: Preferred Network Access Commercial |
$732.32
|
| Rate for Payer: Quartz Beloit One Network |
$390.04
|
| Rate for Payer: Quartz Commercial |
$477.60
|
| Rate for Payer: WEA Trust Commercial |
$437.80
|
| Rate for Payer: WPS Commercial |
$589.60
|
|
|
XR Nephrostogram
|
Facility
|
OP
|
$796.00
|
|
|
Service Code
|
CPT 74425
|
| Hospital Charge Code |
2587235
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$301.00 |
| Max. Negotiated Rate |
$1,520.48 |
| Rate for Payer: Aetna Commercial |
$716.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$684.56
|
| Rate for Payer: Aetna Managed Medicare |
$380.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,425.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,140.36
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,083.34
|
| Rate for Payer: Anthem Medicare Advantage |
$380.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$421.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$380.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$380.12
|
| Rate for Payer: Cash Price |
$238.80
|
| Rate for Payer: Cash Price |
$238.80
|
| Rate for Payer: Cash Price |
$238.80
|
| Rate for Payer: Cigna Commercial |
$732.32
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$380.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$445.44
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$380.12
|
| Rate for Payer: Health EOS Commercial |
$708.44
|
| Rate for Payer: HFN Commercial |
$732.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,414.05
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$380.12
|
| Rate for Payer: Independent Care Health Plan Medicare |
$380.12
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$380.12
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$380.12
|
| Rate for Payer: Multiplan Commercial |
$636.80
|
| Rate for Payer: NAPHCARE Commercial |
$570.18
|
| Rate for Payer: Preferred Network Access Commercial |
$732.32
|
| Rate for Payer: Quartz Beloit One Network |
$390.04
|
| Rate for Payer: Quartz Commercial |
$517.40
|
| Rate for Payer: Quartz Medicare Advantage |
$380.12
|
| Rate for Payer: The Alliance Commercial |
$1,520.48
|
| Rate for Payer: United Healthcare Medicare Advantage |
$380.12
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$437.80
|
| Rate for Payer: Wellcare Medicare |
$380.12
|
| Rate for Payer: WPS Commercial |
$589.60
|
|
|
XR Nephrostogram
|
Professional
|
Both
|
$796.00
|
|
|
Service Code
|
CPT 74425
|
| Hospital Charge Code |
2587235
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$350.24 |
| Max. Negotiated Rate |
$756.20 |
| Rate for Payer: Aetna Commercial |
$756.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$684.56
|
| Rate for Payer: Cash Price |
$238.80
|
| Rate for Payer: Cash Price |
$238.80
|
| Rate for Payer: Cash Price |
$238.80
|
| Rate for Payer: Cigna Commercial |
$756.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$398.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$477.60
|
| Rate for Payer: Health EOS Commercial |
$724.36
|
| Rate for Payer: HFN Commercial |
$756.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$473.48
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$473.48
|
| Rate for Payer: Multiplan Commercial |
$636.80
|
| Rate for Payer: Preferred Network Access Commercial |
$756.20
|
| Rate for Payer: Quartz Beloit One Network |
$350.24
|
| Rate for Payer: Quartz Commercial |
$453.72
|
| Rate for Payer: The Alliance Commercial |
$398.00
|
| Rate for Payer: WEA Trust Commercial |
$437.80
|
| Rate for Payer: WPS Commercial |
$589.60
|
|
|
XR Nephrostomy Dilation Bilateral
|
Facility
|
OP
|
$2,162.00
|
|
|
Service Code
|
CPT 50432 LT,TC
|
| Hospital Charge Code |
2587238
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$301.00 |
| Max. Negotiated Rate |
$8,052.80 |
| Rate for Payer: Aetna Commercial |
$1,945.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,859.32
|
| Rate for Payer: Aetna Managed Medicare |
$2,013.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,405.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,081.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,037.76
|
| Rate for Payer: Anthem Medicare Advantage |
$2,013.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,145.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$2,013.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$2,013.20
|
| Rate for Payer: Cash Price |
$648.60
|
| Rate for Payer: Cash Price |
$648.60
|
| Rate for Payer: Cash Price |
$648.60
|
| Rate for Payer: Cigna Commercial |
$1,989.04
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$2,013.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,757.59
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$2,013.20
|
| Rate for Payer: Health EOS Commercial |
$1,924.18
|
| Rate for Payer: HFN Commercial |
$1,989.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7,489.10
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$2,013.20
|
| Rate for Payer: Independent Care Health Plan Medicare |
$2,013.20
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$2,013.20
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$2,013.20
|
| Rate for Payer: Multiplan Commercial |
$1,729.60
|
| Rate for Payer: NAPHCARE Commercial |
$3,019.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,989.04
|
| Rate for Payer: Quartz Beloit One Network |
$1,059.38
|
| Rate for Payer: Quartz Commercial |
$1,405.30
|
| Rate for Payer: Quartz Medicare Advantage |
$2,013.20
|
| Rate for Payer: The Alliance Commercial |
$8,052.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,013.20
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$1,189.10
|
| Rate for Payer: Wellcare Medicare |
$2,013.20
|
| Rate for Payer: WPS Commercial |
$1,601.39
|
|
|
XR Nephrostomy Dilation Bilateral
|
Professional
|
Both
|
$2,162.00
|
|
|
Service Code
|
CPT 50432 LT,TC
|
| Hospital Charge Code |
2587238
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$656.93 |
| Max. Negotiated Rate |
$2,053.90 |
| Rate for Payer: Aetna Commercial |
$2,053.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,859.32
|
| Rate for Payer: Cash Price |
$648.60
|
| Rate for Payer: Cash Price |
$648.60
|
| Rate for Payer: Cash Price |
$648.60
|
| Rate for Payer: Cigna Commercial |
$2,053.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$656.93
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,297.20
|
| Rate for Payer: Health EOS Commercial |
$1,967.42
|
| Rate for Payer: HFN Commercial |
$2,053.90
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$687.26
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$687.26
|
| Rate for Payer: Multiplan Commercial |
$1,729.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,053.90
|
| Rate for Payer: Quartz Beloit One Network |
$951.28
|
| Rate for Payer: Quartz Commercial |
$1,232.34
|
| Rate for Payer: The Alliance Commercial |
$1,081.00
|
| Rate for Payer: United Healthcare Medicaid |
$656.93
|
| Rate for Payer: WEA Trust Commercial |
$1,189.10
|
| Rate for Payer: WPS Commercial |
$1,601.39
|
|
|
XR Nephrostomy Dilation Bilateral
|
Facility
|
IP
|
$2,162.00
|
|
|
Service Code
|
CPT 50432 LT,TC
|
| Hospital Charge Code |
2587238
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,059.38 |
| Max. Negotiated Rate |
$1,989.04 |
| Rate for Payer: Aetna Commercial |
$1,945.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,859.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,145.86
|
| Rate for Payer: Cash Price |
$648.60
|
| Rate for Payer: Cigna Commercial |
$1,989.04
|
| Rate for Payer: Health EOS Commercial |
$1,924.18
|
| Rate for Payer: HFN Commercial |
$1,989.04
|
| Rate for Payer: Multiplan Commercial |
$1,729.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,297.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,989.04
|
| Rate for Payer: Quartz Beloit One Network |
$1,059.38
|
| Rate for Payer: Quartz Commercial |
$1,297.20
|
| Rate for Payer: WEA Trust Commercial |
$1,189.10
|
| Rate for Payer: WPS Commercial |
$1,601.39
|
|
|
XR Nephrostomy Dilation Left
|
Facility
|
OP
|
$2,162.00
|
|
|
Service Code
|
CPT 50432 TC,LT
|
| Hospital Charge Code |
2587241
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$301.00 |
| Max. Negotiated Rate |
$8,052.80 |
| Rate for Payer: Aetna Commercial |
$1,945.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,859.32
|
| Rate for Payer: Aetna Managed Medicare |
$2,013.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,405.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,081.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,037.76
|
| Rate for Payer: Anthem Medicare Advantage |
$2,013.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,145.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$2,013.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$2,013.20
|
| Rate for Payer: Cash Price |
$648.60
|
| Rate for Payer: Cash Price |
$648.60
|
| Rate for Payer: Cash Price |
$648.60
|
| Rate for Payer: Cigna Commercial |
$1,989.04
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$2,013.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,757.59
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$2,013.20
|
| Rate for Payer: Health EOS Commercial |
$1,924.18
|
| Rate for Payer: HFN Commercial |
$1,989.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7,489.10
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$2,013.20
|
| Rate for Payer: Independent Care Health Plan Medicare |
$2,013.20
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$2,013.20
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$2,013.20
|
| Rate for Payer: Multiplan Commercial |
$1,729.60
|
| Rate for Payer: NAPHCARE Commercial |
$3,019.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,989.04
|
| Rate for Payer: Quartz Beloit One Network |
$1,059.38
|
| Rate for Payer: Quartz Commercial |
$1,405.30
|
| Rate for Payer: Quartz Medicare Advantage |
$2,013.20
|
| Rate for Payer: The Alliance Commercial |
$8,052.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,013.20
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$1,189.10
|
| Rate for Payer: Wellcare Medicare |
$2,013.20
|
| Rate for Payer: WPS Commercial |
$1,601.39
|
|
|
XR Nephrostomy Dilation Left
|
Professional
|
Both
|
$2,162.00
|
|
|
Service Code
|
CPT 50432 TC,LT
|
| Hospital Charge Code |
2587241
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$656.93 |
| Max. Negotiated Rate |
$2,053.90 |
| Rate for Payer: Aetna Commercial |
$2,053.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,859.32
|
| Rate for Payer: Cash Price |
$648.60
|
| Rate for Payer: Cash Price |
$648.60
|
| Rate for Payer: Cash Price |
$648.60
|
| Rate for Payer: Cigna Commercial |
$2,053.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$656.93
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,297.20
|
| Rate for Payer: Health EOS Commercial |
$1,967.42
|
| Rate for Payer: HFN Commercial |
$2,053.90
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$687.26
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$687.26
|
| Rate for Payer: Multiplan Commercial |
$1,729.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,053.90
|
| Rate for Payer: Quartz Beloit One Network |
$951.28
|
| Rate for Payer: Quartz Commercial |
$1,232.34
|
| Rate for Payer: The Alliance Commercial |
$1,081.00
|
| Rate for Payer: United Healthcare Medicaid |
$656.93
|
| Rate for Payer: WEA Trust Commercial |
$1,189.10
|
| Rate for Payer: WPS Commercial |
$1,601.39
|
|
|
XR Nephrostomy Dilation Left
|
Facility
|
IP
|
$2,162.00
|
|
|
Service Code
|
CPT 50432 TC,LT
|
| Hospital Charge Code |
2587241
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,059.38 |
| Max. Negotiated Rate |
$1,989.04 |
| Rate for Payer: Aetna Commercial |
$1,945.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,859.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,145.86
|
| Rate for Payer: Cash Price |
$648.60
|
| Rate for Payer: Cigna Commercial |
$1,989.04
|
| Rate for Payer: Health EOS Commercial |
$1,924.18
|
| Rate for Payer: HFN Commercial |
$1,989.04
|
| Rate for Payer: Multiplan Commercial |
$1,729.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,297.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,989.04
|
| Rate for Payer: Quartz Beloit One Network |
$1,059.38
|
| Rate for Payer: Quartz Commercial |
$1,297.20
|
| Rate for Payer: WEA Trust Commercial |
$1,189.10
|
| Rate for Payer: WPS Commercial |
$1,601.39
|
|
|
XR Nephrostomy Dilation Right
|
Facility
|
IP
|
$2,702.00
|
|
|
Service Code
|
CPT 50432 RT,TC
|
| Hospital Charge Code |
2587244
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,323.98 |
| Max. Negotiated Rate |
$2,485.84 |
| Rate for Payer: Aetna Commercial |
$2,431.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,323.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,432.06
|
| Rate for Payer: Cash Price |
$810.60
|
| Rate for Payer: Cigna Commercial |
$2,485.84
|
| Rate for Payer: Health EOS Commercial |
$2,404.78
|
| Rate for Payer: HFN Commercial |
$2,485.84
|
| Rate for Payer: Multiplan Commercial |
$2,161.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,621.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,485.84
|
| Rate for Payer: Quartz Beloit One Network |
$1,323.98
|
| Rate for Payer: Quartz Commercial |
$1,621.20
|
| Rate for Payer: WEA Trust Commercial |
$1,486.10
|
| Rate for Payer: WPS Commercial |
$2,001.37
|
|
|
XR Nephrostomy Dilation Right
|
Professional
|
Both
|
$2,702.00
|
|
|
Service Code
|
CPT 50432 RT,TC
|
| Hospital Charge Code |
2587244
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$656.93 |
| Max. Negotiated Rate |
$2,566.90 |
| Rate for Payer: Aetna Commercial |
$2,566.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,323.72
|
| Rate for Payer: Cash Price |
$810.60
|
| Rate for Payer: Cash Price |
$810.60
|
| Rate for Payer: Cash Price |
$810.60
|
| Rate for Payer: Cigna Commercial |
$2,566.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$656.93
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,621.20
|
| Rate for Payer: Health EOS Commercial |
$2,458.82
|
| Rate for Payer: HFN Commercial |
$2,566.90
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$687.26
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$687.26
|
| Rate for Payer: Multiplan Commercial |
$2,161.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,566.90
|
| Rate for Payer: Quartz Beloit One Network |
$1,188.88
|
| Rate for Payer: Quartz Commercial |
$1,540.14
|
| Rate for Payer: The Alliance Commercial |
$1,351.00
|
| Rate for Payer: United Healthcare Medicaid |
$656.93
|
| Rate for Payer: WEA Trust Commercial |
$1,486.10
|
| Rate for Payer: WPS Commercial |
$2,001.37
|
|
|
XR Nephrostomy Dilation Right
|
Professional
|
Both
|
$2,162.00
|
|
|
Service Code
|
CPT 50432 TC,RT
|
| Hospital Charge Code |
5430655
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$656.93 |
| Max. Negotiated Rate |
$2,053.90 |
| Rate for Payer: Aetna Commercial |
$2,053.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,859.32
|
| Rate for Payer: Cash Price |
$648.60
|
| Rate for Payer: Cash Price |
$648.60
|
| Rate for Payer: Cash Price |
$648.60
|
| Rate for Payer: Cigna Commercial |
$2,053.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$656.93
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,297.20
|
| Rate for Payer: Health EOS Commercial |
$1,967.42
|
| Rate for Payer: HFN Commercial |
$2,053.90
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$687.26
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$687.26
|
| Rate for Payer: Multiplan Commercial |
$1,729.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,053.90
|
| Rate for Payer: Quartz Beloit One Network |
$951.28
|
| Rate for Payer: Quartz Commercial |
$1,232.34
|
| Rate for Payer: The Alliance Commercial |
$1,081.00
|
| Rate for Payer: United Healthcare Medicaid |
$656.93
|
| Rate for Payer: WEA Trust Commercial |
$1,189.10
|
| Rate for Payer: WPS Commercial |
$1,601.39
|
|
|
XR Nephrostomy Dilation Right
|
Facility
|
IP
|
$2,162.00
|
|
|
Service Code
|
CPT 50432 TC,RT
|
| Hospital Charge Code |
5430655
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,059.38 |
| Max. Negotiated Rate |
$1,989.04 |
| Rate for Payer: Aetna Commercial |
$1,945.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,859.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,145.86
|
| Rate for Payer: Cash Price |
$648.60
|
| Rate for Payer: Cigna Commercial |
$1,989.04
|
| Rate for Payer: Health EOS Commercial |
$1,924.18
|
| Rate for Payer: HFN Commercial |
$1,989.04
|
| Rate for Payer: Multiplan Commercial |
$1,729.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,297.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,989.04
|
| Rate for Payer: Quartz Beloit One Network |
$1,059.38
|
| Rate for Payer: Quartz Commercial |
$1,297.20
|
| Rate for Payer: WEA Trust Commercial |
$1,189.10
|
| Rate for Payer: WPS Commercial |
$1,601.39
|
|
|
XR Nephrostomy Dilation Right
|
Facility
|
OP
|
$2,702.00
|
|
|
Service Code
|
CPT 50432 RT,TC
|
| Hospital Charge Code |
2587244
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$301.00 |
| Max. Negotiated Rate |
$8,052.80 |
| Rate for Payer: Aetna Commercial |
$2,431.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,323.72
|
| Rate for Payer: Aetna Managed Medicare |
$2,013.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,756.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,351.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,296.96
|
| Rate for Payer: Anthem Medicare Advantage |
$2,013.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,432.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$2,013.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$2,013.20
|
| Rate for Payer: Cash Price |
$810.60
|
| Rate for Payer: Cash Price |
$810.60
|
| Rate for Payer: Cash Price |
$810.60
|
| Rate for Payer: Cigna Commercial |
$2,485.84
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$2,013.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,757.59
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$2,013.20
|
| Rate for Payer: Health EOS Commercial |
$2,404.78
|
| Rate for Payer: HFN Commercial |
$2,485.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7,489.10
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$2,013.20
|
| Rate for Payer: Independent Care Health Plan Medicare |
$2,013.20
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$2,013.20
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$2,013.20
|
| Rate for Payer: Multiplan Commercial |
$2,161.60
|
| Rate for Payer: NAPHCARE Commercial |
$3,019.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,485.84
|
| Rate for Payer: Quartz Beloit One Network |
$1,323.98
|
| Rate for Payer: Quartz Commercial |
$1,756.30
|
| Rate for Payer: Quartz Medicare Advantage |
$2,013.20
|
| Rate for Payer: The Alliance Commercial |
$8,052.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,013.20
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$1,486.10
|
| Rate for Payer: Wellcare Medicare |
$2,013.20
|
| Rate for Payer: WPS Commercial |
$2,001.37
|
|
|
XR Nephrostomy Dilation Right
|
Facility
|
OP
|
$2,162.00
|
|
|
Service Code
|
CPT 50432 TC,RT
|
| Hospital Charge Code |
5430655
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$301.00 |
| Max. Negotiated Rate |
$8,052.80 |
| Rate for Payer: Aetna Commercial |
$1,945.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,859.32
|
| Rate for Payer: Aetna Managed Medicare |
$2,013.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,405.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,081.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,037.76
|
| Rate for Payer: Anthem Medicare Advantage |
$2,013.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,145.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$2,013.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$2,013.20
|
| Rate for Payer: Cash Price |
$648.60
|
| Rate for Payer: Cash Price |
$648.60
|
| Rate for Payer: Cash Price |
$648.60
|
| Rate for Payer: Cigna Commercial |
$1,989.04
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$2,013.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,757.59
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$2,013.20
|
| Rate for Payer: Health EOS Commercial |
$1,924.18
|
| Rate for Payer: HFN Commercial |
$1,989.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7,489.10
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$2,013.20
|
| Rate for Payer: Independent Care Health Plan Medicare |
$2,013.20
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$2,013.20
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$2,013.20
|
| Rate for Payer: Multiplan Commercial |
$1,729.60
|
| Rate for Payer: NAPHCARE Commercial |
$3,019.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,989.04
|
| Rate for Payer: Quartz Beloit One Network |
$1,059.38
|
| Rate for Payer: Quartz Commercial |
$1,405.30
|
| Rate for Payer: Quartz Medicare Advantage |
$2,013.20
|
| Rate for Payer: The Alliance Commercial |
$8,052.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,013.20
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$1,189.10
|
| Rate for Payer: Wellcare Medicare |
$2,013.20
|
| Rate for Payer: WPS Commercial |
$1,601.39
|
|
|
XR Optic Foramina Left
|
Facility
|
OP
|
$509.00
|
|
|
Service Code
|
CPT 70190 LT,TC
|
| Hospital Charge Code |
1537210
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$89.82 |
| Max. Negotiated Rate |
$468.28 |
| Rate for Payer: Aetna Commercial |
$458.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$437.74
|
| Rate for Payer: Aetna Managed Medicare |
$89.82
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$336.82
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$269.46
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$255.99
|
| Rate for Payer: Anthem Medicare Advantage |
$89.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$269.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$89.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$89.82
|
| Rate for Payer: Cash Price |
$152.70
|
| Rate for Payer: Cash Price |
$152.70
|
| Rate for Payer: Cash Price |
$152.70
|
| Rate for Payer: Cigna Commercial |
$468.28
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$89.82
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$284.84
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$89.82
|
| Rate for Payer: Health EOS Commercial |
$453.01
|
| Rate for Payer: HFN Commercial |
$468.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$334.13
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$89.82
|
| Rate for Payer: Independent Care Health Plan Medicare |
$89.82
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$89.82
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$89.82
|
| Rate for Payer: Multiplan Commercial |
$407.20
|
| Rate for Payer: NAPHCARE Commercial |
$134.73
|
| Rate for Payer: Preferred Network Access Commercial |
$468.28
|
| Rate for Payer: Quartz Beloit One Network |
$249.41
|
| Rate for Payer: Quartz Commercial |
$330.85
|
| Rate for Payer: Quartz Medicare Advantage |
$89.82
|
| Rate for Payer: The Alliance Commercial |
$359.28
|
| Rate for Payer: United Healthcare Medicare Advantage |
$89.82
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$279.95
|
| Rate for Payer: Wellcare Medicare |
$89.82
|
| Rate for Payer: WPS Commercial |
$377.02
|
|
|
XR Optic Foramina Left
|
Professional
|
Both
|
$509.00
|
|
|
Service Code
|
CPT 70190 LT,TC
|
| Hospital Charge Code |
1537210
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$131.03 |
| Max. Negotiated Rate |
$483.55 |
| Rate for Payer: Aetna Commercial |
$483.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$437.74
|
| Rate for Payer: Cash Price |
$152.70
|
| Rate for Payer: Cash Price |
$152.70
|
| Rate for Payer: Cash Price |
$152.70
|
| Rate for Payer: Cigna Commercial |
$483.55
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$254.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$305.40
|
| Rate for Payer: Health EOS Commercial |
$463.19
|
| Rate for Payer: HFN Commercial |
$483.55
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$131.03
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$131.03
|
| Rate for Payer: Multiplan Commercial |
$407.20
|
| Rate for Payer: Preferred Network Access Commercial |
$483.55
|
| Rate for Payer: Quartz Beloit One Network |
$223.96
|
| Rate for Payer: Quartz Commercial |
$290.13
|
| Rate for Payer: The Alliance Commercial |
$254.50
|
| Rate for Payer: WEA Trust Commercial |
$279.95
|
| Rate for Payer: WPS Commercial |
$377.02
|
|
|
XR Optic Foramina Left
|
Professional
|
Both
|
$489.00
|
|
|
Service Code
|
CPT 70190
|
| Hospital Charge Code |
630305
|
| Min. Negotiated Rate |
$131.03 |
| Max. Negotiated Rate |
$464.55 |
| Rate for Payer: Aetna Commercial |
$464.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$420.54
|
| Rate for Payer: Cash Price |
$146.70
|
| Rate for Payer: Cash Price |
$146.70
|
| Rate for Payer: Cash Price |
$146.70
|
| Rate for Payer: Cigna Commercial |
$464.55
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$244.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$293.40
|
| Rate for Payer: Health EOS Commercial |
$444.99
|
| Rate for Payer: HFN Commercial |
$464.55
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$131.03
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$131.03
|
| Rate for Payer: Multiplan Commercial |
$391.20
|
| Rate for Payer: Preferred Network Access Commercial |
$464.55
|
| Rate for Payer: Quartz Beloit One Network |
$215.16
|
| Rate for Payer: Quartz Commercial |
$278.73
|
| Rate for Payer: The Alliance Commercial |
$244.50
|
| Rate for Payer: WEA Trust Commercial |
$268.95
|
| Rate for Payer: WPS Commercial |
$362.20
|
|
|
XR Optic Foramina Left
|
Facility
|
IP
|
$489.00
|
|
|
Service Code
|
CPT 70190
|
| Hospital Charge Code |
630305
|
| Min. Negotiated Rate |
$239.61 |
| Max. Negotiated Rate |
$449.88 |
| Rate for Payer: Aetna Commercial |
$440.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$420.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$259.17
|
| Rate for Payer: Cash Price |
$146.70
|
| Rate for Payer: Cigna Commercial |
$449.88
|
| Rate for Payer: Health EOS Commercial |
$435.21
|
| Rate for Payer: HFN Commercial |
$449.88
|
| Rate for Payer: Multiplan Commercial |
$391.20
|
| Rate for Payer: NAPHCARE Commercial |
$293.40
|
| Rate for Payer: Preferred Network Access Commercial |
$449.88
|
| Rate for Payer: Quartz Beloit One Network |
$239.61
|
| Rate for Payer: Quartz Commercial |
$293.40
|
| Rate for Payer: WEA Trust Commercial |
$268.95
|
| Rate for Payer: WPS Commercial |
$362.20
|
|
|
XR Optic Foramina Left
|
Facility
|
IP
|
$509.00
|
|
|
Service Code
|
CPT 70190 LT,TC
|
| Hospital Charge Code |
1537210
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$249.41 |
| Max. Negotiated Rate |
$468.28 |
| Rate for Payer: Aetna Commercial |
$458.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$437.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$269.77
|
| Rate for Payer: Cash Price |
$152.70
|
| Rate for Payer: Cigna Commercial |
$468.28
|
| Rate for Payer: Health EOS Commercial |
$453.01
|
| Rate for Payer: HFN Commercial |
$468.28
|
| Rate for Payer: Multiplan Commercial |
$407.20
|
| Rate for Payer: NAPHCARE Commercial |
$305.40
|
| Rate for Payer: Preferred Network Access Commercial |
$468.28
|
| Rate for Payer: Quartz Beloit One Network |
$249.41
|
| Rate for Payer: Quartz Commercial |
$305.40
|
| Rate for Payer: WEA Trust Commercial |
$279.95
|
| Rate for Payer: WPS Commercial |
$377.02
|
|
|
XR Optic Foramina Left
|
Facility
|
OP
|
$489.00
|
|
|
Service Code
|
CPT 70190
|
| Hospital Charge Code |
630305
|
| Min. Negotiated Rate |
$89.82 |
| Max. Negotiated Rate |
$449.88 |
| Rate for Payer: Aetna Commercial |
$440.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$420.54
|
| Rate for Payer: Aetna Managed Medicare |
$89.82
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$317.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$244.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$234.72
|
| Rate for Payer: Anthem Medicare Advantage |
$89.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$259.17
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$89.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$89.82
|
| Rate for Payer: Cash Price |
$146.70
|
| Rate for Payer: Cash Price |
$146.70
|
| Rate for Payer: Cigna Commercial |
$449.88
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$89.82
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$273.64
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$89.82
|
| Rate for Payer: Health EOS Commercial |
$435.21
|
| Rate for Payer: HFN Commercial |
$449.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$334.13
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$89.82
|
| Rate for Payer: Independent Care Health Plan Medicare |
$89.82
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$89.82
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$89.82
|
| Rate for Payer: Multiplan Commercial |
$391.20
|
| Rate for Payer: NAPHCARE Commercial |
$134.73
|
| Rate for Payer: Preferred Network Access Commercial |
$449.88
|
| Rate for Payer: Quartz Beloit One Network |
$239.61
|
| Rate for Payer: Quartz Commercial |
$317.85
|
| Rate for Payer: Quartz Medicare Advantage |
$89.82
|
| Rate for Payer: The Alliance Commercial |
$359.28
|
| Rate for Payer: United Healthcare Medicare Advantage |
$89.82
|
| Rate for Payer: WEA Trust Commercial |
$268.95
|
| Rate for Payer: Wellcare Medicare |
$89.82
|
| Rate for Payer: WPS Commercial |
$362.20
|
|
|
XR Optic Foramina Right
|
Facility
|
IP
|
$489.00
|
|
|
Service Code
|
CPT 70190
|
| Hospital Charge Code |
630303
|
| Min. Negotiated Rate |
$239.61 |
| Max. Negotiated Rate |
$449.88 |
| Rate for Payer: Aetna Commercial |
$440.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$420.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$259.17
|
| Rate for Payer: Cash Price |
$146.70
|
| Rate for Payer: Cigna Commercial |
$449.88
|
| Rate for Payer: Health EOS Commercial |
$435.21
|
| Rate for Payer: HFN Commercial |
$449.88
|
| Rate for Payer: Multiplan Commercial |
$391.20
|
| Rate for Payer: NAPHCARE Commercial |
$293.40
|
| Rate for Payer: Preferred Network Access Commercial |
$449.88
|
| Rate for Payer: Quartz Beloit One Network |
$239.61
|
| Rate for Payer: Quartz Commercial |
$293.40
|
| Rate for Payer: WEA Trust Commercial |
$268.95
|
| Rate for Payer: WPS Commercial |
$362.20
|
|
|
XR Optic Foramina Right
|
Professional
|
Both
|
$509.00
|
|
|
Service Code
|
CPT 70190 RT,TC
|
| Hospital Charge Code |
1537212
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$131.03 |
| Max. Negotiated Rate |
$483.55 |
| Rate for Payer: Aetna Commercial |
$483.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$437.74
|
| Rate for Payer: Cash Price |
$152.70
|
| Rate for Payer: Cash Price |
$152.70
|
| Rate for Payer: Cash Price |
$152.70
|
| Rate for Payer: Cigna Commercial |
$483.55
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$254.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$305.40
|
| Rate for Payer: Health EOS Commercial |
$463.19
|
| Rate for Payer: HFN Commercial |
$483.55
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$131.03
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$131.03
|
| Rate for Payer: Multiplan Commercial |
$407.20
|
| Rate for Payer: Preferred Network Access Commercial |
$483.55
|
| Rate for Payer: Quartz Beloit One Network |
$223.96
|
| Rate for Payer: Quartz Commercial |
$290.13
|
| Rate for Payer: The Alliance Commercial |
$254.50
|
| Rate for Payer: WEA Trust Commercial |
$279.95
|
| Rate for Payer: WPS Commercial |
$377.02
|
|
|
XR Optic Foramina Right
|
Facility
|
IP
|
$509.00
|
|
|
Service Code
|
CPT 70190 RT,TC
|
| Hospital Charge Code |
1537212
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$249.41 |
| Max. Negotiated Rate |
$468.28 |
| Rate for Payer: Aetna Commercial |
$458.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$437.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$269.77
|
| Rate for Payer: Cash Price |
$152.70
|
| Rate for Payer: Cigna Commercial |
$468.28
|
| Rate for Payer: Health EOS Commercial |
$453.01
|
| Rate for Payer: HFN Commercial |
$468.28
|
| Rate for Payer: Multiplan Commercial |
$407.20
|
| Rate for Payer: NAPHCARE Commercial |
$305.40
|
| Rate for Payer: Preferred Network Access Commercial |
$468.28
|
| Rate for Payer: Quartz Beloit One Network |
$249.41
|
| Rate for Payer: Quartz Commercial |
$305.40
|
| Rate for Payer: WEA Trust Commercial |
$279.95
|
| Rate for Payer: WPS Commercial |
$377.02
|
|
|
XR Optic Foramina Right
|
Facility
|
OP
|
$489.00
|
|
|
Service Code
|
CPT 70190
|
| Hospital Charge Code |
630303
|
| Min. Negotiated Rate |
$89.82 |
| Max. Negotiated Rate |
$449.88 |
| Rate for Payer: Aetna Commercial |
$440.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$420.54
|
| Rate for Payer: Aetna Managed Medicare |
$89.82
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$317.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$244.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$234.72
|
| Rate for Payer: Anthem Medicare Advantage |
$89.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$259.17
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$89.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$89.82
|
| Rate for Payer: Cash Price |
$146.70
|
| Rate for Payer: Cash Price |
$146.70
|
| Rate for Payer: Cigna Commercial |
$449.88
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$89.82
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$273.64
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$89.82
|
| Rate for Payer: Health EOS Commercial |
$435.21
|
| Rate for Payer: HFN Commercial |
$449.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$334.13
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$89.82
|
| Rate for Payer: Independent Care Health Plan Medicare |
$89.82
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$89.82
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$89.82
|
| Rate for Payer: Multiplan Commercial |
$391.20
|
| Rate for Payer: NAPHCARE Commercial |
$134.73
|
| Rate for Payer: Preferred Network Access Commercial |
$449.88
|
| Rate for Payer: Quartz Beloit One Network |
$239.61
|
| Rate for Payer: Quartz Commercial |
$317.85
|
| Rate for Payer: Quartz Medicare Advantage |
$89.82
|
| Rate for Payer: The Alliance Commercial |
$359.28
|
| Rate for Payer: United Healthcare Medicare Advantage |
$89.82
|
| Rate for Payer: WEA Trust Commercial |
$268.95
|
| Rate for Payer: Wellcare Medicare |
$89.82
|
| Rate for Payer: WPS Commercial |
$362.20
|
|
