|
West Nile IgM, CSF
|
Facility
|
OP
|
$72.00
|
|
|
Service Code
|
CPT 86788
|
| Hospital Charge Code |
3328221
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.52 |
| Max. Negotiated Rate |
$70.10 |
| Rate for Payer: Aetna Commercial |
$67.39
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$64.40
|
| Rate for Payer: Aetna Managed Medicare |
$17.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$65.72
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$30.67
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$29.09
|
| Rate for Payer: Anthem Medicare Advantage |
$17.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$39.69
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$17.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$17.52
|
| Rate for Payer: Cash Price |
$21.60
|
| Rate for Payer: Cash Price |
$21.60
|
| Rate for Payer: Cigna Commercial |
$68.89
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$17.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$41.90
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$17.52
|
| Rate for Payer: Health EOS Commercial |
$66.64
|
| Rate for Payer: HFN Commercial |
$68.89
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$65.19
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$17.52
|
| Rate for Payer: Independent Care Health Plan Medicare |
$17.52
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$17.52
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$17.52
|
| Rate for Payer: Multiplan Commercial |
$59.90
|
| Rate for Payer: NAPHCARE Commercial |
$26.29
|
| Rate for Payer: Preferred Network Access Commercial |
$68.89
|
| Rate for Payer: Quartz Beloit One Network |
$36.69
|
| Rate for Payer: Quartz Commercial |
$48.67
|
| Rate for Payer: Quartz Medicare Advantage |
$17.52
|
| Rate for Payer: The Alliance Commercial |
$70.10
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17.52
|
| Rate for Payer: United Healthcare PPO |
$56.16
|
| Rate for Payer: WEA Trust Commercial |
$41.18
|
| Rate for Payer: Wellcare Medicare |
$17.52
|
| Rate for Payer: WPS Commercial |
$55.46
|
|
|
West Nile IgM, CSF
|
Professional
|
Both
|
$72.00
|
|
|
Service Code
|
CPT 86788
|
| Hospital Charge Code |
3328221
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.52 |
| Max. Negotiated Rate |
$77.11 |
| Rate for Payer: Aetna Commercial |
$71.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$64.40
|
| Rate for Payer: Aetna Managed Medicare |
$17.52
|
| Rate for Payer: Anthem Medicare Advantage |
$17.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$17.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$17.52
|
| Rate for Payer: Cash Price |
$21.60
|
| Rate for Payer: Cash Price |
$21.60
|
| Rate for Payer: Cigna Commercial |
$71.14
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$37.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$17.52
|
| Rate for Payer: Health EOS Commercial |
$68.14
|
| Rate for Payer: HFN Commercial |
$71.14
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$61.86
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$61.86
|
| Rate for Payer: Independent Care Health Plan Medicare |
$17.52
|
| Rate for Payer: Multiplan Commercial |
$59.90
|
| Rate for Payer: NAPHCARE Commercial |
$26.29
|
| Rate for Payer: Preferred Network Access Commercial |
$71.14
|
| Rate for Payer: Quartz Beloit One Network |
$32.95
|
| Rate for Payer: Quartz Commercial |
$42.68
|
| Rate for Payer: Quartz Medicare Advantage |
$17.52
|
| Rate for Payer: The Alliance Commercial |
$69.22
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17.52
|
| Rate for Payer: WEA Trust Commercial |
$41.18
|
| Rate for Payer: WPS Commercial |
$77.11
|
|
|
West Nile RNA, Ql PCR / 17563
|
Professional
|
Both
|
$716.00
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
3318194
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$36.49 |
| Max. Negotiated Rate |
$707.41 |
| Rate for Payer: Aetna Commercial |
$707.41
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$640.39
|
| Rate for Payer: Aetna Managed Medicare |
$36.49
|
| Rate for Payer: Anthem Medicare Advantage |
$36.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$36.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$36.49
|
| Rate for Payer: Cash Price |
$214.80
|
| Rate for Payer: Cash Price |
$214.80
|
| Rate for Payer: Cigna Commercial |
$707.41
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$372.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$36.49
|
| Rate for Payer: Health EOS Commercial |
$677.62
|
| Rate for Payer: HFN Commercial |
$707.41
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$128.82
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$128.82
|
| Rate for Payer: Independent Care Health Plan Medicare |
$36.49
|
| Rate for Payer: Multiplan Commercial |
$595.71
|
| Rate for Payer: NAPHCARE Commercial |
$54.74
|
| Rate for Payer: Preferred Network Access Commercial |
$707.41
|
| Rate for Payer: Quartz Beloit One Network |
$327.64
|
| Rate for Payer: Quartz Commercial |
$424.44
|
| Rate for Payer: Quartz Medicare Advantage |
$36.49
|
| Rate for Payer: The Alliance Commercial |
$144.15
|
| Rate for Payer: United Healthcare Medicare Advantage |
$36.49
|
| Rate for Payer: WEA Trust Commercial |
$409.55
|
| Rate for Payer: WPS Commercial |
$160.57
|
|
|
West Nile RNA, Ql PCR / 17563
|
Facility
|
IP
|
$716.00
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
3318194
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$364.87 |
| Max. Negotiated Rate |
$685.07 |
| Rate for Payer: Aetna Commercial |
$670.18
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$640.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$394.66
|
| Rate for Payer: Cash Price |
$214.80
|
| Rate for Payer: Cigna Commercial |
$685.07
|
| Rate for Payer: Health EOS Commercial |
$662.73
|
| Rate for Payer: HFN Commercial |
$685.07
|
| Rate for Payer: Multiplan Commercial |
$595.71
|
| Rate for Payer: Preferred Network Access Commercial |
$685.07
|
| Rate for Payer: Quartz Beloit One Network |
$364.87
|
| Rate for Payer: Quartz Commercial |
$446.78
|
| Rate for Payer: WEA Trust Commercial |
$409.55
|
| Rate for Payer: WPS Commercial |
$551.53
|
|
|
West Nile RNA, Ql PCR / 17563
|
Facility
|
OP
|
$716.00
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
3318194
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$36.49 |
| Max. Negotiated Rate |
$685.07 |
| Rate for Payer: Aetna Commercial |
$670.18
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$640.39
|
| Rate for Payer: Aetna Managed Medicare |
$36.49
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$136.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$63.86
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$60.58
|
| Rate for Payer: Anthem Medicare Advantage |
$36.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$394.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$36.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$36.49
|
| Rate for Payer: Cash Price |
$214.80
|
| Rate for Payer: Cash Price |
$214.80
|
| Rate for Payer: Cigna Commercial |
$685.07
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$36.49
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$416.71
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$36.49
|
| Rate for Payer: Health EOS Commercial |
$662.73
|
| Rate for Payer: HFN Commercial |
$685.07
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$135.76
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$36.49
|
| Rate for Payer: Independent Care Health Plan Medicare |
$36.49
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$36.49
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$36.49
|
| Rate for Payer: Multiplan Commercial |
$595.71
|
| Rate for Payer: NAPHCARE Commercial |
$54.74
|
| Rate for Payer: Preferred Network Access Commercial |
$685.07
|
| Rate for Payer: Quartz Beloit One Network |
$364.87
|
| Rate for Payer: Quartz Commercial |
$484.02
|
| Rate for Payer: Quartz Medicare Advantage |
$36.49
|
| Rate for Payer: The Alliance Commercial |
$145.97
|
| Rate for Payer: United Healthcare Medicare Advantage |
$36.49
|
| Rate for Payer: United Healthcare PPO |
$558.48
|
| Rate for Payer: WEA Trust Commercial |
$409.55
|
| Rate for Payer: Wellcare Medicare |
$36.49
|
| Rate for Payer: WPS Commercial |
$551.53
|
|
|
West Nile Virus Antibodies IgG and IgM, Serum
|
Facility
|
OP
|
$250.00
|
|
|
Service Code
|
CPT 86788
|
| Hospital Charge Code |
978098
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.52 |
| Max. Negotiated Rate |
$239.20 |
| Rate for Payer: Aetna Commercial |
$234.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$223.60
|
| Rate for Payer: Aetna Managed Medicare |
$17.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$65.72
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$30.67
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$29.09
|
| Rate for Payer: Anthem Medicare Advantage |
$17.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$137.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$17.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$17.52
|
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: Cigna Commercial |
$239.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$17.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$145.50
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$17.52
|
| Rate for Payer: Health EOS Commercial |
$231.40
|
| Rate for Payer: HFN Commercial |
$239.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$65.19
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$17.52
|
| Rate for Payer: Independent Care Health Plan Medicare |
$17.52
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$17.52
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$17.52
|
| Rate for Payer: Multiplan Commercial |
$208.00
|
| Rate for Payer: NAPHCARE Commercial |
$26.29
|
| Rate for Payer: Preferred Network Access Commercial |
$239.20
|
| Rate for Payer: Quartz Beloit One Network |
$127.40
|
| Rate for Payer: Quartz Commercial |
$169.00
|
| Rate for Payer: Quartz Medicare Advantage |
$17.52
|
| Rate for Payer: The Alliance Commercial |
$70.10
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17.52
|
| Rate for Payer: United Healthcare PPO |
$195.00
|
| Rate for Payer: WEA Trust Commercial |
$143.00
|
| Rate for Payer: Wellcare Medicare |
$17.52
|
| Rate for Payer: WPS Commercial |
$192.57
|
|
|
West Nile Virus Antibodies IgG and IgM, Serum
|
Facility
|
IP
|
$250.00
|
|
|
Service Code
|
CPT 86788
|
| Hospital Charge Code |
978098
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$127.40 |
| Max. Negotiated Rate |
$239.20 |
| Rate for Payer: Aetna Commercial |
$234.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$223.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$137.80
|
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: Cigna Commercial |
$239.20
|
| Rate for Payer: Health EOS Commercial |
$231.40
|
| Rate for Payer: HFN Commercial |
$239.20
|
| Rate for Payer: Multiplan Commercial |
$208.00
|
| Rate for Payer: Preferred Network Access Commercial |
$239.20
|
| Rate for Payer: Quartz Beloit One Network |
$127.40
|
| Rate for Payer: Quartz Commercial |
$156.00
|
| Rate for Payer: WEA Trust Commercial |
$143.00
|
| Rate for Payer: WPS Commercial |
$192.57
|
|
|
West Nile Virus Antibodies IgG and IgM, Serum
|
Professional
|
Both
|
$250.00
|
|
|
Service Code
|
CPT 86788
|
| Hospital Charge Code |
978098
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.52 |
| Max. Negotiated Rate |
$247.00 |
| Rate for Payer: Aetna Commercial |
$247.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$223.60
|
| Rate for Payer: Aetna Managed Medicare |
$17.52
|
| Rate for Payer: Anthem Medicare Advantage |
$17.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$17.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$17.52
|
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: Cigna Commercial |
$247.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$130.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$17.52
|
| Rate for Payer: Health EOS Commercial |
$236.60
|
| Rate for Payer: HFN Commercial |
$247.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$61.86
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$61.86
|
| Rate for Payer: Independent Care Health Plan Medicare |
$17.52
|
| Rate for Payer: Multiplan Commercial |
$208.00
|
| Rate for Payer: NAPHCARE Commercial |
$26.29
|
| Rate for Payer: Preferred Network Access Commercial |
$247.00
|
| Rate for Payer: Quartz Beloit One Network |
$114.40
|
| Rate for Payer: Quartz Commercial |
$148.20
|
| Rate for Payer: Quartz Medicare Advantage |
$17.52
|
| Rate for Payer: The Alliance Commercial |
$69.22
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17.52
|
| Rate for Payer: WEA Trust Commercial |
$143.00
|
| Rate for Payer: WPS Commercial |
$77.11
|
|
|
West Nile Virus Antibody IgM
|
Facility
|
OP
|
$268.00
|
|
|
Service Code
|
CPT 86788
|
| Hospital Charge Code |
2943025
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.52 |
| Max. Negotiated Rate |
$256.42 |
| Rate for Payer: Aetna Commercial |
$250.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$239.70
|
| Rate for Payer: Aetna Managed Medicare |
$17.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$65.72
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$30.67
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$29.09
|
| Rate for Payer: Anthem Medicare Advantage |
$17.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$147.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$17.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$17.52
|
| Rate for Payer: Cash Price |
$80.40
|
| Rate for Payer: Cash Price |
$80.40
|
| Rate for Payer: Cigna Commercial |
$256.42
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$17.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$155.98
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$17.52
|
| Rate for Payer: Health EOS Commercial |
$248.06
|
| Rate for Payer: HFN Commercial |
$256.42
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$65.19
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$17.52
|
| Rate for Payer: Independent Care Health Plan Medicare |
$17.52
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$17.52
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$17.52
|
| Rate for Payer: Multiplan Commercial |
$222.98
|
| Rate for Payer: NAPHCARE Commercial |
$26.29
|
| Rate for Payer: Preferred Network Access Commercial |
$256.42
|
| Rate for Payer: Quartz Beloit One Network |
$136.57
|
| Rate for Payer: Quartz Commercial |
$181.17
|
| Rate for Payer: Quartz Medicare Advantage |
$17.52
|
| Rate for Payer: The Alliance Commercial |
$70.10
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17.52
|
| Rate for Payer: United Healthcare PPO |
$209.04
|
| Rate for Payer: WEA Trust Commercial |
$153.30
|
| Rate for Payer: Wellcare Medicare |
$17.52
|
| Rate for Payer: WPS Commercial |
$206.44
|
|
|
West Nile Virus Antibody IgM
|
Professional
|
Both
|
$268.00
|
|
|
Service Code
|
CPT 86788
|
| Hospital Charge Code |
2943025
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.52 |
| Max. Negotiated Rate |
$264.78 |
| Rate for Payer: Aetna Commercial |
$264.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$239.70
|
| Rate for Payer: Aetna Managed Medicare |
$17.52
|
| Rate for Payer: Anthem Medicare Advantage |
$17.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$17.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$17.52
|
| Rate for Payer: Cash Price |
$80.40
|
| Rate for Payer: Cash Price |
$80.40
|
| Rate for Payer: Cigna Commercial |
$264.78
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$139.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$17.52
|
| Rate for Payer: Health EOS Commercial |
$253.64
|
| Rate for Payer: HFN Commercial |
$264.78
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$61.86
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$61.86
|
| Rate for Payer: Independent Care Health Plan Medicare |
$17.52
|
| Rate for Payer: Multiplan Commercial |
$222.98
|
| Rate for Payer: NAPHCARE Commercial |
$26.29
|
| Rate for Payer: Preferred Network Access Commercial |
$264.78
|
| Rate for Payer: Quartz Beloit One Network |
$122.64
|
| Rate for Payer: Quartz Commercial |
$158.87
|
| Rate for Payer: Quartz Medicare Advantage |
$17.52
|
| Rate for Payer: The Alliance Commercial |
$69.22
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17.52
|
| Rate for Payer: WEA Trust Commercial |
$153.30
|
| Rate for Payer: WPS Commercial |
$77.11
|
|
|
West Nile Virus Antibody IgM
|
Facility
|
IP
|
$268.00
|
|
|
Service Code
|
CPT 86788
|
| Hospital Charge Code |
2943025
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$136.57 |
| Max. Negotiated Rate |
$256.42 |
| Rate for Payer: Aetna Commercial |
$250.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$239.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$147.72
|
| Rate for Payer: Cash Price |
$80.40
|
| Rate for Payer: Cigna Commercial |
$256.42
|
| Rate for Payer: Health EOS Commercial |
$248.06
|
| Rate for Payer: HFN Commercial |
$256.42
|
| Rate for Payer: Multiplan Commercial |
$222.98
|
| Rate for Payer: Preferred Network Access Commercial |
$256.42
|
| Rate for Payer: Quartz Beloit One Network |
$136.57
|
| Rate for Payer: Quartz Commercial |
$167.23
|
| Rate for Payer: WEA Trust Commercial |
$153.30
|
| Rate for Payer: WPS Commercial |
$206.44
|
|
|
Wet Prep
|
Professional
|
Both
|
$69.00
|
|
|
Service Code
|
CPT 87210
|
| Hospital Charge Code |
1098799
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.05 |
| Max. Negotiated Rate |
$68.17 |
| Rate for Payer: Aetna Commercial |
$68.17
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$61.71
|
| Rate for Payer: Aetna Managed Medicare |
$6.05
|
| Rate for Payer: Anthem Medicare Advantage |
$6.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$6.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$6.05
|
| Rate for Payer: Cash Price |
$20.70
|
| Rate for Payer: Cash Price |
$20.70
|
| Rate for Payer: Cigna Commercial |
$68.17
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$35.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6.05
|
| Rate for Payer: Health EOS Commercial |
$65.30
|
| Rate for Payer: HFN Commercial |
$68.17
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$21.36
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$21.36
|
| Rate for Payer: Independent Care Health Plan Medicare |
$6.05
|
| Rate for Payer: Multiplan Commercial |
$57.41
|
| Rate for Payer: NAPHCARE Commercial |
$9.08
|
| Rate for Payer: Preferred Network Access Commercial |
$68.17
|
| Rate for Payer: Quartz Beloit One Network |
$31.57
|
| Rate for Payer: Quartz Commercial |
$40.90
|
| Rate for Payer: Quartz Medicare Advantage |
$6.05
|
| Rate for Payer: The Alliance Commercial |
$23.91
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6.05
|
| Rate for Payer: WEA Trust Commercial |
$39.47
|
| Rate for Payer: WPS Commercial |
$26.63
|
|
|
Wet Prep
|
Facility
|
IP
|
$69.00
|
|
|
Service Code
|
CPT 87210
|
| Hospital Charge Code |
1098799
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$35.16 |
| Max. Negotiated Rate |
$66.02 |
| Rate for Payer: Aetna Commercial |
$64.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$61.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$38.03
|
| Rate for Payer: Cash Price |
$20.70
|
| Rate for Payer: Cigna Commercial |
$66.02
|
| Rate for Payer: Health EOS Commercial |
$63.87
|
| Rate for Payer: HFN Commercial |
$66.02
|
| Rate for Payer: Multiplan Commercial |
$57.41
|
| Rate for Payer: Preferred Network Access Commercial |
$66.02
|
| Rate for Payer: Quartz Beloit One Network |
$35.16
|
| Rate for Payer: Quartz Commercial |
$43.06
|
| Rate for Payer: WEA Trust Commercial |
$39.47
|
| Rate for Payer: WPS Commercial |
$53.15
|
|
|
Wet Prep
|
Facility
|
OP
|
$69.00
|
|
|
Service Code
|
CPT 87210
|
| Hospital Charge Code |
1098799
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.05 |
| Max. Negotiated Rate |
$66.02 |
| Rate for Payer: Aetna Commercial |
$64.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$61.71
|
| Rate for Payer: Aetna Managed Medicare |
$6.05
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$22.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$10.59
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$10.05
|
| Rate for Payer: Anthem Medicare Advantage |
$6.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$38.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$6.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$6.05
|
| Rate for Payer: Cash Price |
$20.70
|
| Rate for Payer: Cash Price |
$20.70
|
| Rate for Payer: Cigna Commercial |
$66.02
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$6.05
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$40.16
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$6.05
|
| Rate for Payer: Health EOS Commercial |
$63.87
|
| Rate for Payer: HFN Commercial |
$66.02
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$22.52
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$6.05
|
| Rate for Payer: Independent Care Health Plan Medicare |
$6.05
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$6.05
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$6.05
|
| Rate for Payer: Multiplan Commercial |
$57.41
|
| Rate for Payer: NAPHCARE Commercial |
$9.08
|
| Rate for Payer: Preferred Network Access Commercial |
$66.02
|
| Rate for Payer: Quartz Beloit One Network |
$35.16
|
| Rate for Payer: Quartz Commercial |
$46.64
|
| Rate for Payer: Quartz Medicare Advantage |
$6.05
|
| Rate for Payer: The Alliance Commercial |
$24.21
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6.05
|
| Rate for Payer: United Healthcare PPO |
$53.82
|
| Rate for Payer: WEA Trust Commercial |
$39.47
|
| Rate for Payer: Wellcare Medicare |
$6.05
|
| Rate for Payer: WPS Commercial |
$53.15
|
|
|
Wet Prep POC
|
Facility
|
IP
|
$64.00
|
|
|
Service Code
|
CPT 87210
|
| Hospital Charge Code |
3080730
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$32.61 |
| Max. Negotiated Rate |
$61.24 |
| Rate for Payer: Aetna Commercial |
$59.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$57.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$35.28
|
| Rate for Payer: Cash Price |
$19.20
|
| Rate for Payer: Cigna Commercial |
$61.24
|
| Rate for Payer: Health EOS Commercial |
$59.24
|
| Rate for Payer: HFN Commercial |
$61.24
|
| Rate for Payer: Multiplan Commercial |
$53.25
|
| Rate for Payer: Preferred Network Access Commercial |
$61.24
|
| Rate for Payer: Quartz Beloit One Network |
$32.61
|
| Rate for Payer: Quartz Commercial |
$39.94
|
| Rate for Payer: WEA Trust Commercial |
$36.61
|
| Rate for Payer: WPS Commercial |
$49.30
|
|
|
Wet Prep POC
|
Professional
|
Both
|
$64.00
|
|
|
Service Code
|
CPT 87210
|
| Hospital Charge Code |
3080730
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$6.05 |
| Max. Negotiated Rate |
$63.23 |
| Rate for Payer: Aetna Commercial |
$63.23
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$57.24
|
| Rate for Payer: Aetna Managed Medicare |
$6.05
|
| Rate for Payer: Anthem Medicare Advantage |
$6.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$6.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$6.05
|
| Rate for Payer: Cash Price |
$19.20
|
| Rate for Payer: Cash Price |
$19.20
|
| Rate for Payer: Cigna Commercial |
$63.23
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$33.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6.05
|
| Rate for Payer: Health EOS Commercial |
$60.57
|
| Rate for Payer: HFN Commercial |
$63.23
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$21.36
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$21.36
|
| Rate for Payer: Independent Care Health Plan Medicare |
$6.05
|
| Rate for Payer: Multiplan Commercial |
$53.25
|
| Rate for Payer: NAPHCARE Commercial |
$9.08
|
| Rate for Payer: Preferred Network Access Commercial |
$63.23
|
| Rate for Payer: Quartz Beloit One Network |
$29.29
|
| Rate for Payer: Quartz Commercial |
$37.94
|
| Rate for Payer: Quartz Medicare Advantage |
$6.05
|
| Rate for Payer: The Alliance Commercial |
$23.91
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6.05
|
| Rate for Payer: WEA Trust Commercial |
$36.61
|
| Rate for Payer: WPS Commercial |
$26.63
|
|
|
Wet Prep POC
|
Facility
|
OP
|
$64.00
|
|
|
Service Code
|
CPT 87210
|
| Hospital Charge Code |
3080730
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$6.05 |
| Max. Negotiated Rate |
$61.24 |
| Rate for Payer: Aetna Commercial |
$59.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$57.24
|
| Rate for Payer: Aetna Managed Medicare |
$6.05
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$43.26
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$33.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$31.95
|
| Rate for Payer: Anthem Medicare Advantage |
$6.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$35.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$6.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$6.05
|
| Rate for Payer: Cash Price |
$19.20
|
| Rate for Payer: Cash Price |
$19.20
|
| Rate for Payer: Cigna Commercial |
$61.24
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$6.05
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$37.25
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$6.05
|
| Rate for Payer: Health EOS Commercial |
$59.24
|
| Rate for Payer: HFN Commercial |
$61.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$22.52
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$6.05
|
| Rate for Payer: Independent Care Health Plan Medicare |
$6.05
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$6.05
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$6.05
|
| Rate for Payer: Multiplan Commercial |
$53.25
|
| Rate for Payer: NAPHCARE Commercial |
$9.08
|
| Rate for Payer: Preferred Network Access Commercial |
$61.24
|
| Rate for Payer: Quartz Beloit One Network |
$32.61
|
| Rate for Payer: Quartz Commercial |
$43.26
|
| Rate for Payer: Quartz Medicare Advantage |
$6.05
|
| Rate for Payer: The Alliance Commercial |
$24.21
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6.05
|
| Rate for Payer: WEA Trust Commercial |
$36.61
|
| Rate for Payer: Wellcare Medicare |
$6.05
|
| Rate for Payer: WPS Commercial |
$49.30
|
|
|
WHFO,no joint,prefabricated L3807
|
Professional
|
Both
|
$52.00
|
|
|
Service Code
|
HCPCS L3807
|
| Hospital Charge Code |
3983438
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$23.80 |
| Max. Negotiated Rate |
$838.61 |
| Rate for Payer: Aetna Commercial |
$51.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$46.51
|
| Rate for Payer: Aetna Managed Medicare |
$290.86
|
| Rate for Payer: Anthem Medicare Advantage |
$290.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$290.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$290.86
|
| Rate for Payer: Cash Price |
$15.60
|
| Rate for Payer: Cash Price |
$15.60
|
| Rate for Payer: Cigna Commercial |
$51.38
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$27.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$290.86
|
| Rate for Payer: Health EOS Commercial |
$49.21
|
| Rate for Payer: HFN Commercial |
$51.38
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$838.61
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$838.61
|
| Rate for Payer: Independent Care Health Plan Medicare |
$290.86
|
| Rate for Payer: Multiplan Commercial |
$43.26
|
| Rate for Payer: NAPHCARE Commercial |
$436.29
|
| Rate for Payer: Preferred Network Access Commercial |
$51.38
|
| Rate for Payer: Quartz Beloit One Network |
$23.80
|
| Rate for Payer: Quartz Commercial |
$30.83
|
| Rate for Payer: Quartz Medicare Advantage |
$290.86
|
| Rate for Payer: The Alliance Commercial |
$799.86
|
| Rate for Payer: United Healthcare Medicare Advantage |
$290.86
|
| Rate for Payer: WEA Trust Commercial |
$29.74
|
| Rate for Payer: WPS Commercial |
$509.00
|
|
|
WHFO,no joint,prefabricated L3807
|
Facility
|
IP
|
$52.00
|
|
|
Service Code
|
HCPCS L3807
|
| Hospital Charge Code |
3983438
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$26.50 |
| Max. Negotiated Rate |
$49.75 |
| Rate for Payer: Aetna Commercial |
$48.67
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$46.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$28.66
|
| Rate for Payer: Cash Price |
$15.60
|
| Rate for Payer: Cigna Commercial |
$49.75
|
| Rate for Payer: Health EOS Commercial |
$48.13
|
| Rate for Payer: HFN Commercial |
$49.75
|
| Rate for Payer: Multiplan Commercial |
$43.26
|
| Rate for Payer: Preferred Network Access Commercial |
$49.75
|
| Rate for Payer: Quartz Beloit One Network |
$26.50
|
| Rate for Payer: Quartz Commercial |
$32.45
|
| Rate for Payer: WEA Trust Commercial |
$29.74
|
| Rate for Payer: WPS Commercial |
$40.06
|
|
|
WHFO,no joint,prefabricated L3807
|
Facility
|
OP
|
$52.00
|
|
|
Service Code
|
HCPCS L3807
|
| Hospital Charge Code |
3983438
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$15.14 |
| Max. Negotiated Rate |
$1,163.43 |
| Rate for Payer: Aetna Commercial |
$48.67
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$46.51
|
| Rate for Payer: Aetna Managed Medicare |
$15.14
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$148.54
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$148.54
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$148.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$28.66
|
| Rate for Payer: Cash Price |
$15.60
|
| Rate for Payer: Cash Price |
$15.60
|
| Rate for Payer: Cigna Commercial |
$49.75
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$30.26
|
| Rate for Payer: Health EOS Commercial |
$48.13
|
| Rate for Payer: HFN Commercial |
$49.75
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$40.56
|
| Rate for Payer: Multiplan Commercial |
$43.26
|
| Rate for Payer: NAPHCARE Commercial |
$32.45
|
| Rate for Payer: Preferred Network Access Commercial |
$49.75
|
| Rate for Payer: Quartz Beloit One Network |
$26.50
|
| Rate for Payer: Quartz Commercial |
$35.15
|
| Rate for Payer: Quartz Medicare Advantage |
$32.45
|
| Rate for Payer: The Alliance Commercial |
$1,163.43
|
| Rate for Payer: WEA Trust Commercial |
$29.74
|
| Rate for Payer: WPS Commercial |
$40.06
|
|
|
WHFO W/O Joints Pre OTS L3809
|
Facility
|
OP
|
$778.00
|
|
|
Service Code
|
HCPCS L3809
|
| Hospital Charge Code |
4392949
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$56.71 |
| Max. Negotiated Rate |
$1,163.43 |
| Rate for Payer: Aetna Commercial |
$728.21
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$695.84
|
| Rate for Payer: Aetna Managed Medicare |
$226.55
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$56.71
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$56.71
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$56.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$428.83
|
| Rate for Payer: Cash Price |
$233.40
|
| Rate for Payer: Cash Price |
$233.40
|
| Rate for Payer: Cigna Commercial |
$744.39
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$452.80
|
| Rate for Payer: Health EOS Commercial |
$720.12
|
| Rate for Payer: HFN Commercial |
$744.39
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$606.84
|
| Rate for Payer: Multiplan Commercial |
$647.30
|
| Rate for Payer: NAPHCARE Commercial |
$485.47
|
| Rate for Payer: Preferred Network Access Commercial |
$744.39
|
| Rate for Payer: Quartz Beloit One Network |
$396.47
|
| Rate for Payer: Quartz Commercial |
$525.93
|
| Rate for Payer: Quartz Medicare Advantage |
$485.47
|
| Rate for Payer: The Alliance Commercial |
$1,163.43
|
| Rate for Payer: WEA Trust Commercial |
$445.02
|
| Rate for Payer: WPS Commercial |
$599.29
|
|
|
WHFO W/O Joints Pre OTS L3809
|
Professional
|
Both
|
$778.00
|
|
|
Service Code
|
HCPCS L3809
|
| Hospital Charge Code |
4392949
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$290.86 |
| Max. Negotiated Rate |
$838.61 |
| Rate for Payer: Aetna Commercial |
$768.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$695.84
|
| Rate for Payer: Aetna Managed Medicare |
$290.86
|
| Rate for Payer: Anthem Medicare Advantage |
$290.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$290.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$290.86
|
| Rate for Payer: Cash Price |
$233.40
|
| Rate for Payer: Cash Price |
$233.40
|
| Rate for Payer: Cigna Commercial |
$768.66
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$404.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$290.86
|
| Rate for Payer: Health EOS Commercial |
$736.30
|
| Rate for Payer: HFN Commercial |
$768.66
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$838.61
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$838.61
|
| Rate for Payer: Independent Care Health Plan Medicare |
$290.86
|
| Rate for Payer: Multiplan Commercial |
$647.30
|
| Rate for Payer: NAPHCARE Commercial |
$436.29
|
| Rate for Payer: Preferred Network Access Commercial |
$768.66
|
| Rate for Payer: Quartz Beloit One Network |
$356.01
|
| Rate for Payer: Quartz Commercial |
$461.20
|
| Rate for Payer: Quartz Medicare Advantage |
$290.86
|
| Rate for Payer: The Alliance Commercial |
$799.86
|
| Rate for Payer: United Healthcare Medicare Advantage |
$290.86
|
| Rate for Payer: WEA Trust Commercial |
$445.02
|
| Rate for Payer: WPS Commercial |
$509.00
|
|
|
WHFO W/O Joints Pre OTS L3809
|
Facility
|
IP
|
$778.00
|
|
|
Service Code
|
HCPCS L3809
|
| Hospital Charge Code |
4392949
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$396.47 |
| Max. Negotiated Rate |
$744.39 |
| Rate for Payer: Aetna Commercial |
$728.21
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$695.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$428.83
|
| Rate for Payer: Cash Price |
$233.40
|
| Rate for Payer: Cigna Commercial |
$744.39
|
| Rate for Payer: Health EOS Commercial |
$720.12
|
| Rate for Payer: HFN Commercial |
$744.39
|
| Rate for Payer: Multiplan Commercial |
$647.30
|
| Rate for Payer: Preferred Network Access Commercial |
$744.39
|
| Rate for Payer: Quartz Beloit One Network |
$396.47
|
| Rate for Payer: Quartz Commercial |
$485.47
|
| Rate for Payer: WEA Trust Commercial |
$445.02
|
| Rate for Payer: WPS Commercial |
$599.29
|
|
|
WHISHERS MINI #MW100
|
Facility
|
OP
|
$261.00
|
|
| Hospital Charge Code |
2972425
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$76.00 |
| Max. Negotiated Rate |
$249.72 |
| Rate for Payer: Aetna Commercial |
$244.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$233.44
|
| Rate for Payer: Aetna Managed Medicare |
$76.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$176.44
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$135.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$130.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$143.86
|
| Rate for Payer: Cash Price |
$78.30
|
| Rate for Payer: Cigna Commercial |
$249.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$151.90
|
| Rate for Payer: Health EOS Commercial |
$241.58
|
| Rate for Payer: HFN Commercial |
$249.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$203.58
|
| Rate for Payer: Multiplan Commercial |
$217.15
|
| Rate for Payer: NAPHCARE Commercial |
$162.86
|
| Rate for Payer: Preferred Network Access Commercial |
$249.72
|
| Rate for Payer: Quartz Beloit One Network |
$133.01
|
| Rate for Payer: Quartz Commercial |
$176.44
|
| Rate for Payer: Quartz Medicare Advantage |
$162.86
|
| Rate for Payer: The Alliance Commercial |
$135.72
|
| Rate for Payer: WEA Trust Commercial |
$149.29
|
| Rate for Payer: WPS Commercial |
$201.05
|
|
|
WHISHERS MINI #MW100
|
Facility
|
IP
|
$261.00
|
|
| Hospital Charge Code |
2972425
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$133.01 |
| Max. Negotiated Rate |
$249.72 |
| Rate for Payer: Aetna Commercial |
$244.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$233.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$143.86
|
| Rate for Payer: Cash Price |
$78.30
|
| Rate for Payer: Cigna Commercial |
$249.72
|
| Rate for Payer: Health EOS Commercial |
$241.58
|
| Rate for Payer: HFN Commercial |
$249.72
|
| Rate for Payer: Multiplan Commercial |
$217.15
|
| Rate for Payer: Preferred Network Access Commercial |
$249.72
|
| Rate for Payer: Quartz Beloit One Network |
$133.01
|
| Rate for Payer: Quartz Commercial |
$162.86
|
| Rate for Payer: WEA Trust Commercial |
$149.29
|
| Rate for Payer: WPS Commercial |
$201.05
|
|
