|
XR Zygomatic Arches
|
Facility
OP
|
$497.00
|
|
|
Service Code
|
CPT 70140
|
| Hospital Charge Code |
711799
|
| Min. Negotiated Rate |
$3.80 |
| Max. Negotiated Rate |
$457.24 |
| Rate for Payer: Aetna Commercial |
$447.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$427.42
|
| Rate for Payer: Aetna Managed Medicare |
$89.82
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$323.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$248.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$238.56
|
| Rate for Payer: Anthem Medicare Advantage |
$89.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$263.41
|
| 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 |
$149.10
|
| Rate for Payer: Cash Price |
$149.10
|
| Rate for Payer: Cigna Commercial |
$457.24
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$89.82
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$89.82
|
| Rate for Payer: Health EOS Commercial |
$442.33
|
| Rate for Payer: HFN Commercial |
$457.24
|
| 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 |
$397.60
|
| Rate for Payer: NAPHCARE Commercial |
$134.73
|
| Rate for Payer: Preferred Network Access Commercial |
$457.24
|
| Rate for Payer: Quartz Beloit One Network |
$243.53
|
| Rate for Payer: Quartz Commercial |
$323.05
|
| Rate for Payer: Quartz Medicare Advantage |
$89.82
|
| Rate for Payer: The Alliance Commercial |
$3.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$89.82
|
| Rate for Payer: WEA Trust Commercial |
$273.35
|
| Rate for Payer: Wellcare Medicare |
$89.82
|
| Rate for Payer: WPS Commercial |
$368.13
|
|
|
Xtrnl Ocular Photog W/I&R Docmt Medical 92285
|
Professional
|
$96.00
|
|
|
Service Code
|
CPT 92285
|
| Hospital Charge Code |
4596849
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$16.20 |
| Max. Negotiated Rate |
$91.20 |
| Rate for Payer: Aetna Commercial |
$91.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$82.56
|
| Rate for Payer: Aetna Managed Medicare |
$21.87
|
| Rate for Payer: Anthem Medicare Advantage |
$21.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$21.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$21.87
|
| Rate for Payer: Cash Price |
$28.80
|
| Rate for Payer: Cash Price |
$28.80
|
| Rate for Payer: Cigna Commercial |
$91.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$48.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$21.87
|
| Rate for Payer: Health EOS Commercial |
$87.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$76.50
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$76.50
|
| Rate for Payer: Independent Care Health Plan Medicare |
$21.87
|
| Rate for Payer: Multiplan Commercial |
$76.80
|
| Rate for Payer: Preferred Network Access Commercial |
$91.20
|
| Rate for Payer: Quartz Beloit One Network |
$42.24
|
| Rate for Payer: Quartz Commercial |
$54.72
|
| Rate for Payer: Quartz Medicare Advantage |
$21.87
|
| Rate for Payer: The Alliance Commercial |
$54.68
|
| Rate for Payer: United Healthcare Medicaid |
$16.20
|
| Rate for Payer: United Healthcare Medicare Advantage |
$21.87
|
| Rate for Payer: WEA Trust Commercial |
$52.80
|
| Rate for Payer: WPS Commercial |
$87.48
|
|
|
Xtrnl Ocular Photog W/I&R Docmt Medical 9228526
|
Professional
|
$96.00
|
|
|
Service Code
|
CPT 92285 26
|
| Hospital Charge Code |
4596850
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$2.77 |
| Max. Negotiated Rate |
$91.20 |
| Rate for Payer: Aetna Commercial |
$91.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$82.56
|
| Rate for Payer: Aetna Managed Medicare |
$2.77
|
| Rate for Payer: Anthem Medicare Advantage |
$2.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$2.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$2.77
|
| Rate for Payer: Cash Price |
$28.80
|
| Rate for Payer: Cash Price |
$28.80
|
| Rate for Payer: Cigna Commercial |
$91.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$48.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2.77
|
| Rate for Payer: Health EOS Commercial |
$87.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$9.99
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$9.99
|
| Rate for Payer: Independent Care Health Plan Medicare |
$2.77
|
| Rate for Payer: Multiplan Commercial |
$76.80
|
| Rate for Payer: Preferred Network Access Commercial |
$91.20
|
| Rate for Payer: Quartz Beloit One Network |
$42.24
|
| Rate for Payer: Quartz Commercial |
$54.72
|
| Rate for Payer: Quartz Medicare Advantage |
$2.77
|
| Rate for Payer: The Alliance Commercial |
$6.92
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2.77
|
| Rate for Payer: WEA Trust Commercial |
$52.80
|
| Rate for Payer: WPS Commercial |
$11.08
|
|
|
Y-ADAPTER GATEWAY ADVANTAGE M0067301501
|
Facility
OP
|
$385.00
|
|
| Hospital Charge Code |
4640855
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$107.80 |
| Max. Negotiated Rate |
$1,540.00 |
| Rate for Payer: Aetna Commercial |
$346.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$331.10
|
| Rate for Payer: Aetna Managed Medicare |
$107.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$250.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$192.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$184.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$204.05
|
| Rate for Payer: Cash Price |
$115.50
|
| Rate for Payer: Cigna Commercial |
$354.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$215.45
|
| Rate for Payer: Health EOS Commercial |
$342.65
|
| Rate for Payer: HFN Commercial |
$354.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$288.75
|
| Rate for Payer: Multiplan Commercial |
$308.00
|
| Rate for Payer: NAPHCARE Commercial |
$231.00
|
| Rate for Payer: Preferred Network Access Commercial |
$354.20
|
| Rate for Payer: Quartz Beloit One Network |
$188.65
|
| Rate for Payer: Quartz Commercial |
$250.25
|
| Rate for Payer: Quartz Medicare Advantage |
$231.00
|
| Rate for Payer: The Alliance Commercial |
$1,540.00
|
| Rate for Payer: WEA Trust Commercial |
$211.75
|
| Rate for Payer: WPS Commercial |
$285.17
|
|
|
Y-ADAPTER GATEWAY ADVANTAGE M0067301501
|
Facility
IP
|
$385.00
|
|
| Hospital Charge Code |
4640855
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$188.65 |
| Max. Negotiated Rate |
$354.20 |
| Rate for Payer: Aetna Commercial |
$346.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$204.05
|
| Rate for Payer: Cash Price |
$115.50
|
| Rate for Payer: Cigna Commercial |
$354.20
|
| Rate for Payer: Health EOS Commercial |
$342.65
|
| Rate for Payer: HFN Commercial |
$354.20
|
| Rate for Payer: Multiplan Commercial |
$308.00
|
| Rate for Payer: NAPHCARE Commercial |
$231.00
|
| Rate for Payer: Preferred Network Access Commercial |
$354.20
|
| Rate for Payer: Quartz Beloit One Network |
$188.65
|
| Rate for Payer: Quartz Commercial |
$231.00
|
| Rate for Payer: WEA Trust Commercial |
$211.75
|
| Rate for Payer: WPS Commercial |
$285.17
|
|
|
Yankauer Suction Tip-Pediatric
|
Facility
IP
|
$1.00
|
|
| Hospital Charge Code |
3040347
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$0.49 |
| Max. Negotiated Rate |
$0.92 |
| Rate for Payer: Aetna Commercial |
$0.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$0.53
|
| Rate for Payer: Cash Price |
$0.30
|
| Rate for Payer: Cigna Commercial |
$0.92
|
| Rate for Payer: Health EOS Commercial |
$0.89
|
| Rate for Payer: HFN Commercial |
$0.92
|
| Rate for Payer: Multiplan Commercial |
$0.80
|
| Rate for Payer: NAPHCARE Commercial |
$0.60
|
| Rate for Payer: Preferred Network Access Commercial |
$0.92
|
| Rate for Payer: Quartz Beloit One Network |
$0.49
|
| Rate for Payer: Quartz Commercial |
$0.60
|
| Rate for Payer: WEA Trust Commercial |
$0.55
|
| Rate for Payer: WPS Commercial |
$0.74
|
|
|
Yankauer Suction Tip-Pediatric
|
Facility
OP
|
$1.00
|
|
| Hospital Charge Code |
3040347
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$0.28 |
| Max. Negotiated Rate |
$4.00 |
| Rate for Payer: Aetna Commercial |
$0.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$0.86
|
| Rate for Payer: Aetna Managed Medicare |
$0.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$0.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$0.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$0.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$0.53
|
| Rate for Payer: Cash Price |
$0.30
|
| Rate for Payer: Cigna Commercial |
$0.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$0.56
|
| Rate for Payer: Health EOS Commercial |
$0.89
|
| Rate for Payer: HFN Commercial |
$0.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$0.75
|
| Rate for Payer: Multiplan Commercial |
$0.80
|
| Rate for Payer: NAPHCARE Commercial |
$0.60
|
| Rate for Payer: Preferred Network Access Commercial |
$0.92
|
| Rate for Payer: Quartz Beloit One Network |
$0.49
|
| Rate for Payer: Quartz Commercial |
$0.65
|
| Rate for Payer: Quartz Medicare Advantage |
$0.60
|
| Rate for Payer: The Alliance Commercial |
$4.00
|
| Rate for Payer: WEA Trust Commercial |
$0.55
|
| Rate for Payer: WPS Commercial |
$0.74
|
|
|
YANKAUER WITH BULB TIP DYND50130
|
Facility
IP
|
$45.00
|
|
| Hospital Charge Code |
2965838
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$22.05 |
| Max. Negotiated Rate |
$41.40 |
| Rate for Payer: Aetna Commercial |
$40.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$23.85
|
| Rate for Payer: Cash Price |
$13.50
|
| Rate for Payer: Cigna Commercial |
$41.40
|
| Rate for Payer: Health EOS Commercial |
$40.05
|
| Rate for Payer: HFN Commercial |
$41.40
|
| Rate for Payer: Multiplan Commercial |
$36.00
|
| Rate for Payer: NAPHCARE Commercial |
$27.00
|
| Rate for Payer: Preferred Network Access Commercial |
$41.40
|
| Rate for Payer: Quartz Beloit One Network |
$22.05
|
| Rate for Payer: Quartz Commercial |
$27.00
|
| Rate for Payer: WEA Trust Commercial |
$24.75
|
| Rate for Payer: WPS Commercial |
$33.33
|
|
|
YANKAUER WITH BULB TIP DYND50130
|
Facility
OP
|
$45.00
|
|
| Hospital Charge Code |
2965838
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$12.60 |
| Max. Negotiated Rate |
$180.00 |
| Rate for Payer: Aetna Commercial |
$40.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$38.70
|
| Rate for Payer: Aetna Managed Medicare |
$12.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$29.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$22.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$21.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$23.85
|
| Rate for Payer: Cash Price |
$13.50
|
| Rate for Payer: Cigna Commercial |
$41.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$25.18
|
| Rate for Payer: Health EOS Commercial |
$40.05
|
| Rate for Payer: HFN Commercial |
$41.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$33.75
|
| Rate for Payer: Multiplan Commercial |
$36.00
|
| Rate for Payer: NAPHCARE Commercial |
$27.00
|
| Rate for Payer: Preferred Network Access Commercial |
$41.40
|
| Rate for Payer: Quartz Beloit One Network |
$22.05
|
| Rate for Payer: Quartz Commercial |
$29.25
|
| Rate for Payer: Quartz Medicare Advantage |
$27.00
|
| Rate for Payer: The Alliance Commercial |
$180.00
|
| Rate for Payer: WEA Trust Commercial |
$24.75
|
| Rate for Payer: WPS Commercial |
$33.33
|
|
|
Yeast Culture
|
Facility
IP
|
$84.00
|
|
|
Service Code
|
CPT 87102
|
| Hospital Charge Code |
979917
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$41.16 |
| Max. Negotiated Rate |
$77.28 |
| Rate for Payer: Aetna Commercial |
$75.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$44.52
|
| Rate for Payer: Cash Price |
$25.20
|
| Rate for Payer: Cigna Commercial |
$77.28
|
| Rate for Payer: Health EOS Commercial |
$74.76
|
| Rate for Payer: HFN Commercial |
$77.28
|
| Rate for Payer: Multiplan Commercial |
$67.20
|
| Rate for Payer: NAPHCARE Commercial |
$50.40
|
| Rate for Payer: Preferred Network Access Commercial |
$77.28
|
| Rate for Payer: Quartz Beloit One Network |
$41.16
|
| Rate for Payer: Quartz Commercial |
$50.40
|
| Rate for Payer: WEA Trust Commercial |
$46.20
|
| Rate for Payer: WPS Commercial |
$62.22
|
|
|
Yeast Culture
|
Professional
|
$84.00
|
|
|
Service Code
|
CPT 87102
|
| Hospital Charge Code |
979917
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.41 |
| Max. Negotiated Rate |
$79.80 |
| Rate for Payer: Aetna Commercial |
$79.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$72.24
|
| Rate for Payer: Aetna Managed Medicare |
$8.41
|
| Rate for Payer: Anthem Medicare Advantage |
$8.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$8.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$8.41
|
| Rate for Payer: Cash Price |
$25.20
|
| Rate for Payer: Cash Price |
$25.20
|
| Rate for Payer: Cigna Commercial |
$79.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$42.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$8.41
|
| Rate for Payer: Health EOS Commercial |
$76.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$29.69
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$29.69
|
| Rate for Payer: Independent Care Health Plan Medicare |
$8.41
|
| Rate for Payer: Multiplan Commercial |
$67.20
|
| Rate for Payer: Preferred Network Access Commercial |
$79.80
|
| Rate for Payer: Quartz Beloit One Network |
$36.96
|
| Rate for Payer: Quartz Commercial |
$47.88
|
| Rate for Payer: Quartz Medicare Advantage |
$8.41
|
| Rate for Payer: The Alliance Commercial |
$33.22
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8.41
|
| Rate for Payer: WEA Trust Commercial |
$46.20
|
| Rate for Payer: WPS Commercial |
$37.00
|
|
|
Yeast Culture
|
Facility
OP
|
$84.00
|
|
|
Service Code
|
CPT 87102
|
| Hospital Charge Code |
979917
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.41 |
| Max. Negotiated Rate |
$336.00 |
| Rate for Payer: Aetna Commercial |
$75.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$72.24
|
| Rate for Payer: Aetna Managed Medicare |
$8.41
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$31.54
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$14.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$13.96
|
| Rate for Payer: Anthem Medicaid |
$8.69
|
| Rate for Payer: Anthem Medicare Advantage |
$8.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$44.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$8.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$8.41
|
| Rate for Payer: Cash Price |
$25.20
|
| Rate for Payer: Cash Price |
$25.20
|
| Rate for Payer: Cigna Commercial |
$77.28
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$8.41
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$8.69
|
| Rate for Payer: Dean Health Medicaid |
$8.69
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$8.41
|
| Rate for Payer: Health EOS Commercial |
$74.76
|
| Rate for Payer: HFN Commercial |
$77.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$31.29
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$8.41
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$8.69
|
| Rate for Payer: Independent Care Health Plan Medicare |
$8.41
|
| Rate for Payer: Managed Health Services Medicaid |
$9.04
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$8.41
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$8.41
|
| Rate for Payer: Multiplan Commercial |
$67.20
|
| Rate for Payer: NAPHCARE Commercial |
$12.62
|
| Rate for Payer: Preferred Network Access Commercial |
$77.28
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$8.69
|
| Rate for Payer: Quartz Beloit One Network |
$41.16
|
| Rate for Payer: Quartz Commercial |
$54.60
|
| Rate for Payer: Quartz Medicare Advantage |
$8.41
|
| Rate for Payer: The Alliance Commercial |
$336.00
|
| Rate for Payer: United Healthcare Medicaid |
$8.69
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8.41
|
| Rate for Payer: United Healthcare PPO |
$63.00
|
| Rate for Payer: WEA Trust Commercial |
$46.20
|
| Rate for Payer: Wellcare Medicare |
$8.41
|
| Rate for Payer: WMAP Medicaid |
$8.69
|
| Rate for Payer: WPS Commercial |
$62.22
|
|
|
Yeast Phase Antibody
|
Facility
IP
|
$49.00
|
|
|
Service Code
|
CPT 86698
|
| Hospital Charge Code |
4392625
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$24.01 |
| Max. Negotiated Rate |
$45.08 |
| Rate for Payer: Aetna Commercial |
$44.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$25.97
|
| Rate for Payer: Cash Price |
$14.70
|
| Rate for Payer: Cigna Commercial |
$45.08
|
| Rate for Payer: Health EOS Commercial |
$43.61
|
| Rate for Payer: HFN Commercial |
$45.08
|
| Rate for Payer: Multiplan Commercial |
$39.20
|
| Rate for Payer: NAPHCARE Commercial |
$29.40
|
| Rate for Payer: Preferred Network Access Commercial |
$45.08
|
| Rate for Payer: Quartz Beloit One Network |
$24.01
|
| Rate for Payer: Quartz Commercial |
$29.40
|
| Rate for Payer: WEA Trust Commercial |
$26.95
|
| Rate for Payer: WPS Commercial |
$36.29
|
|
|
Yeast Phase Antibody
|
Facility
OP
|
$49.00
|
|
|
Service Code
|
CPT 86698
|
| Hospital Charge Code |
4392625
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.79 |
| Max. Negotiated Rate |
$196.00 |
| Rate for Payer: Aetna Commercial |
$44.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$42.14
|
| Rate for Payer: Aetna Managed Medicare |
$13.79
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$51.71
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$24.13
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$22.89
|
| Rate for Payer: Anthem Medicaid |
$14.25
|
| Rate for Payer: Anthem Medicare Advantage |
$13.79
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$25.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$13.79
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$13.79
|
| Rate for Payer: Cash Price |
$14.70
|
| Rate for Payer: Cash Price |
$14.70
|
| Rate for Payer: Cigna Commercial |
$45.08
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$13.79
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$14.25
|
| Rate for Payer: Dean Health Medicaid |
$14.25
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$13.79
|
| Rate for Payer: Health EOS Commercial |
$43.61
|
| Rate for Payer: HFN Commercial |
$45.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$51.30
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$13.79
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$14.25
|
| Rate for Payer: Independent Care Health Plan Medicare |
$13.79
|
| Rate for Payer: Managed Health Services Medicaid |
$14.82
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$13.79
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$13.79
|
| Rate for Payer: Multiplan Commercial |
$39.20
|
| Rate for Payer: NAPHCARE Commercial |
$20.68
|
| Rate for Payer: Preferred Network Access Commercial |
$45.08
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$14.25
|
| Rate for Payer: Quartz Beloit One Network |
$24.01
|
| Rate for Payer: Quartz Commercial |
$31.85
|
| Rate for Payer: Quartz Medicare Advantage |
$13.79
|
| Rate for Payer: The Alliance Commercial |
$196.00
|
| Rate for Payer: United Healthcare Medicaid |
$14.25
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.79
|
| Rate for Payer: United Healthcare PPO |
$36.75
|
| Rate for Payer: WEA Trust Commercial |
$26.95
|
| Rate for Payer: Wellcare Medicare |
$13.79
|
| Rate for Payer: WMAP Medicaid |
$14.25
|
| Rate for Payer: WPS Commercial |
$36.29
|
|
|
Yeast Phase Antibody
|
Facility
OP
|
$24.00
|
|
|
Service Code
|
CPT 86698
|
| Hospital Charge Code |
5582899
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.76 |
| Max. Negotiated Rate |
$96.00 |
| Rate for Payer: Aetna Commercial |
$21.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$20.64
|
| Rate for Payer: Aetna Managed Medicare |
$13.79
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$51.71
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$24.13
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$22.89
|
| Rate for Payer: Anthem Medicaid |
$14.25
|
| Rate for Payer: Anthem Medicare Advantage |
$13.79
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$12.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$13.79
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$13.79
|
| Rate for Payer: Cash Price |
$7.20
|
| Rate for Payer: Cash Price |
$7.20
|
| Rate for Payer: Cigna Commercial |
$22.08
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$13.79
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$14.25
|
| Rate for Payer: Dean Health Medicaid |
$14.25
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$13.79
|
| Rate for Payer: Health EOS Commercial |
$21.36
|
| Rate for Payer: HFN Commercial |
$22.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$51.30
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$13.79
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$14.25
|
| Rate for Payer: Independent Care Health Plan Medicare |
$13.79
|
| Rate for Payer: Managed Health Services Medicaid |
$14.82
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$13.79
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$13.79
|
| Rate for Payer: Multiplan Commercial |
$19.20
|
| Rate for Payer: NAPHCARE Commercial |
$20.68
|
| Rate for Payer: Preferred Network Access Commercial |
$22.08
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$14.25
|
| Rate for Payer: Quartz Beloit One Network |
$11.76
|
| Rate for Payer: Quartz Commercial |
$15.60
|
| Rate for Payer: Quartz Medicare Advantage |
$13.79
|
| Rate for Payer: The Alliance Commercial |
$96.00
|
| Rate for Payer: United Healthcare Medicaid |
$14.25
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.79
|
| Rate for Payer: United Healthcare PPO |
$18.00
|
| Rate for Payer: WEA Trust Commercial |
$13.20
|
| Rate for Payer: Wellcare Medicare |
$13.79
|
| Rate for Payer: WMAP Medicaid |
$14.25
|
| Rate for Payer: WPS Commercial |
$17.78
|
|
|
Yeast Phase Antibody
|
Facility
IP
|
$24.00
|
|
|
Service Code
|
CPT 86698
|
| Hospital Charge Code |
5582899
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.76 |
| Max. Negotiated Rate |
$22.08 |
| Rate for Payer: Aetna Commercial |
$21.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$12.72
|
| Rate for Payer: Cash Price |
$7.20
|
| Rate for Payer: Cigna Commercial |
$22.08
|
| Rate for Payer: Health EOS Commercial |
$21.36
|
| Rate for Payer: HFN Commercial |
$22.08
|
| Rate for Payer: Multiplan Commercial |
$19.20
|
| Rate for Payer: NAPHCARE Commercial |
$14.40
|
| Rate for Payer: Preferred Network Access Commercial |
$22.08
|
| Rate for Payer: Quartz Beloit One Network |
$11.76
|
| Rate for Payer: Quartz Commercial |
$14.40
|
| Rate for Payer: WEA Trust Commercial |
$13.20
|
| Rate for Payer: WPS Commercial |
$17.78
|
|
|
Yeast Phase Antibody
|
Professional
|
$49.00
|
|
|
Service Code
|
CPT 86698
|
| Hospital Charge Code |
4392625
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.79 |
| Max. Negotiated Rate |
$60.68 |
| Rate for Payer: Aetna Commercial |
$46.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$42.14
|
| Rate for Payer: Aetna Managed Medicare |
$13.79
|
| Rate for Payer: Anthem Medicare Advantage |
$13.79
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$13.79
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$13.79
|
| Rate for Payer: Cash Price |
$14.70
|
| Rate for Payer: Cash Price |
$14.70
|
| Rate for Payer: Cigna Commercial |
$46.55
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$24.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$13.79
|
| Rate for Payer: Health EOS Commercial |
$44.59
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$48.68
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$48.68
|
| Rate for Payer: Independent Care Health Plan Medicare |
$13.79
|
| Rate for Payer: Multiplan Commercial |
$39.20
|
| Rate for Payer: Preferred Network Access Commercial |
$46.55
|
| Rate for Payer: Quartz Beloit One Network |
$21.56
|
| Rate for Payer: Quartz Commercial |
$27.93
|
| Rate for Payer: Quartz Medicare Advantage |
$13.79
|
| Rate for Payer: The Alliance Commercial |
$54.47
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.79
|
| Rate for Payer: WEA Trust Commercial |
$26.95
|
| Rate for Payer: WPS Commercial |
$60.68
|
|
|
Yeast Phase Antibody
|
Professional
|
$24.00
|
|
|
Service Code
|
CPT 86698
|
| Hospital Charge Code |
5582899
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.56 |
| Max. Negotiated Rate |
$60.68 |
| Rate for Payer: Aetna Commercial |
$22.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$20.64
|
| Rate for Payer: Aetna Managed Medicare |
$13.79
|
| Rate for Payer: Anthem Medicare Advantage |
$13.79
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$13.79
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$13.79
|
| Rate for Payer: Cash Price |
$7.20
|
| Rate for Payer: Cash Price |
$7.20
|
| Rate for Payer: Cigna Commercial |
$22.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$12.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$13.79
|
| Rate for Payer: Health EOS Commercial |
$21.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$48.68
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$48.68
|
| Rate for Payer: Independent Care Health Plan Medicare |
$13.79
|
| Rate for Payer: Multiplan Commercial |
$19.20
|
| Rate for Payer: Preferred Network Access Commercial |
$22.80
|
| Rate for Payer: Quartz Beloit One Network |
$10.56
|
| Rate for Payer: Quartz Commercial |
$13.68
|
| Rate for Payer: Quartz Medicare Advantage |
$13.79
|
| Rate for Payer: The Alliance Commercial |
$54.47
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.79
|
| Rate for Payer: WEA Trust Commercial |
$13.20
|
| Rate for Payer: WPS Commercial |
$60.68
|
|
|
Yersinia Culture
|
Facility
OP
|
$51.00
|
|
|
Service Code
|
CPT 87046
|
| Hospital Charge Code |
4506971
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.40 |
| Max. Negotiated Rate |
$204.00 |
| Rate for Payer: Aetna Commercial |
$45.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$43.86
|
| Rate for Payer: Aetna Managed Medicare |
$9.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$35.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$16.52
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$15.67
|
| Rate for Payer: Anthem Medicaid |
$3.40
|
| Rate for Payer: Anthem Medicare Advantage |
$9.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$27.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$9.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$9.44
|
| Rate for Payer: Cash Price |
$15.30
|
| Rate for Payer: Cash Price |
$15.30
|
| Rate for Payer: Cigna Commercial |
$46.92
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$9.44
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$3.40
|
| Rate for Payer: Dean Health Medicaid |
$3.40
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$9.44
|
| Rate for Payer: Health EOS Commercial |
$45.39
|
| Rate for Payer: HFN Commercial |
$46.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$35.12
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$9.44
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$3.40
|
| Rate for Payer: Independent Care Health Plan Medicare |
$9.44
|
| Rate for Payer: Managed Health Services Medicaid |
$3.54
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$9.44
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$9.44
|
| Rate for Payer: Multiplan Commercial |
$40.80
|
| Rate for Payer: NAPHCARE Commercial |
$14.16
|
| Rate for Payer: Preferred Network Access Commercial |
$46.92
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$3.40
|
| Rate for Payer: Quartz Beloit One Network |
$24.99
|
| Rate for Payer: Quartz Commercial |
$33.15
|
| Rate for Payer: Quartz Medicare Advantage |
$9.44
|
| Rate for Payer: The Alliance Commercial |
$204.00
|
| Rate for Payer: United Healthcare Medicaid |
$3.40
|
| Rate for Payer: United Healthcare Medicare Advantage |
$9.44
|
| Rate for Payer: United Healthcare PPO |
$38.25
|
| Rate for Payer: WEA Trust Commercial |
$28.05
|
| Rate for Payer: Wellcare Medicare |
$9.44
|
| Rate for Payer: WMAP Medicaid |
$3.40
|
| Rate for Payer: WPS Commercial |
$37.78
|
|
|
Yersinia Culture
|
Professional
|
$51.00
|
|
|
Service Code
|
CPT 87046
|
| Hospital Charge Code |
4506971
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.44 |
| Max. Negotiated Rate |
$48.45 |
| Rate for Payer: Aetna Commercial |
$48.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$43.86
|
| Rate for Payer: Aetna Managed Medicare |
$9.44
|
| Rate for Payer: Anthem Medicare Advantage |
$9.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$9.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$9.44
|
| Rate for Payer: Cash Price |
$15.30
|
| Rate for Payer: Cash Price |
$15.30
|
| Rate for Payer: Cigna Commercial |
$48.45
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$25.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$9.44
|
| Rate for Payer: Health EOS Commercial |
$46.41
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$33.32
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$33.32
|
| Rate for Payer: Independent Care Health Plan Medicare |
$9.44
|
| Rate for Payer: Multiplan Commercial |
$40.80
|
| Rate for Payer: Preferred Network Access Commercial |
$48.45
|
| Rate for Payer: Quartz Beloit One Network |
$22.44
|
| Rate for Payer: Quartz Commercial |
$29.07
|
| Rate for Payer: Quartz Medicare Advantage |
$9.44
|
| Rate for Payer: The Alliance Commercial |
$37.29
|
| Rate for Payer: United Healthcare Medicare Advantage |
$9.44
|
| Rate for Payer: WEA Trust Commercial |
$28.05
|
| Rate for Payer: WPS Commercial |
$41.54
|
|
|
Yersinia Culture
|
Facility
IP
|
$51.00
|
|
|
Service Code
|
CPT 87046
|
| Hospital Charge Code |
4506971
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$24.99 |
| Max. Negotiated Rate |
$46.92 |
| Rate for Payer: Aetna Commercial |
$45.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$27.03
|
| Rate for Payer: Cash Price |
$15.30
|
| Rate for Payer: Cigna Commercial |
$46.92
|
| Rate for Payer: Health EOS Commercial |
$45.39
|
| Rate for Payer: HFN Commercial |
$46.92
|
| Rate for Payer: Multiplan Commercial |
$40.80
|
| Rate for Payer: NAPHCARE Commercial |
$30.60
|
| Rate for Payer: Preferred Network Access Commercial |
$46.92
|
| Rate for Payer: Quartz Beloit One Network |
$24.99
|
| Rate for Payer: Quartz Commercial |
$30.60
|
| Rate for Payer: WEA Trust Commercial |
$28.05
|
| Rate for Payer: WPS Commercial |
$37.78
|
|
|
Yes
|
Facility
OP
|
$538.00
|
|
| Hospital Charge Code |
2990178
|
| Min. Negotiated Rate |
$150.64 |
| Max. Negotiated Rate |
$2,152.00 |
| Rate for Payer: Aetna Commercial |
$484.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$462.68
|
| Rate for Payer: Aetna Managed Medicare |
$150.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$349.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$269.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$258.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$285.14
|
| Rate for Payer: Cash Price |
$161.40
|
| Rate for Payer: Cigna Commercial |
$494.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$301.06
|
| Rate for Payer: Health EOS Commercial |
$478.82
|
| Rate for Payer: HFN Commercial |
$494.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$403.50
|
| Rate for Payer: Multiplan Commercial |
$430.40
|
| Rate for Payer: NAPHCARE Commercial |
$322.80
|
| Rate for Payer: Preferred Network Access Commercial |
$494.96
|
| Rate for Payer: Quartz Beloit One Network |
$263.62
|
| Rate for Payer: Quartz Commercial |
$349.70
|
| Rate for Payer: Quartz Medicare Advantage |
$322.80
|
| Rate for Payer: The Alliance Commercial |
$2,152.00
|
| Rate for Payer: WEA Trust Commercial |
$295.90
|
| Rate for Payer: WPS Commercial |
$398.50
|
|
|
Yes
|
Facility
IP
|
$538.00
|
|
| Hospital Charge Code |
2990178
|
| Min. Negotiated Rate |
$263.62 |
| Max. Negotiated Rate |
$494.96 |
| Rate for Payer: Aetna Commercial |
$484.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$285.14
|
| Rate for Payer: Cash Price |
$161.40
|
| Rate for Payer: Cigna Commercial |
$494.96
|
| Rate for Payer: Health EOS Commercial |
$478.82
|
| Rate for Payer: HFN Commercial |
$494.96
|
| Rate for Payer: Multiplan Commercial |
$430.40
|
| Rate for Payer: NAPHCARE Commercial |
$322.80
|
| Rate for Payer: Preferred Network Access Commercial |
$494.96
|
| Rate for Payer: Quartz Beloit One Network |
$263.62
|
| Rate for Payer: Quartz Commercial |
$322.80
|
| Rate for Payer: WEA Trust Commercial |
$295.90
|
| Rate for Payer: WPS Commercial |
$398.50
|
|
|
Yes - 02 Humidifier Charge
|
Facility
OP
|
$63.00
|
|
| Hospital Charge Code |
3006980
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$17.64 |
| Max. Negotiated Rate |
$252.00 |
| Rate for Payer: Aetna Commercial |
$56.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$54.18
|
| Rate for Payer: Aetna Managed Medicare |
$17.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$40.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$31.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$30.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$33.39
|
| Rate for Payer: Cash Price |
$18.90
|
| Rate for Payer: Cigna Commercial |
$57.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$35.25
|
| Rate for Payer: Health EOS Commercial |
$56.07
|
| Rate for Payer: HFN Commercial |
$57.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$47.25
|
| Rate for Payer: Multiplan Commercial |
$50.40
|
| Rate for Payer: NAPHCARE Commercial |
$37.80
|
| Rate for Payer: Preferred Network Access Commercial |
$57.96
|
| Rate for Payer: Quartz Beloit One Network |
$30.87
|
| Rate for Payer: Quartz Commercial |
$40.95
|
| Rate for Payer: Quartz Medicare Advantage |
$37.80
|
| Rate for Payer: The Alliance Commercial |
$252.00
|
| Rate for Payer: WEA Trust Commercial |
$34.65
|
| Rate for Payer: WPS Commercial |
$46.66
|
|
|
Yes - 02 Humidifier Charge
|
Facility
IP
|
$63.00
|
|
| Hospital Charge Code |
3006980
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$30.87 |
| Max. Negotiated Rate |
$57.96 |
| Rate for Payer: Aetna Commercial |
$56.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$33.39
|
| Rate for Payer: Cash Price |
$18.90
|
| Rate for Payer: Cigna Commercial |
$57.96
|
| Rate for Payer: Health EOS Commercial |
$56.07
|
| Rate for Payer: HFN Commercial |
$57.96
|
| Rate for Payer: Multiplan Commercial |
$50.40
|
| Rate for Payer: NAPHCARE Commercial |
$37.80
|
| Rate for Payer: Preferred Network Access Commercial |
$57.96
|
| Rate for Payer: Quartz Beloit One Network |
$30.87
|
| Rate for Payer: Quartz Commercial |
$37.80
|
| Rate for Payer: WEA Trust Commercial |
$34.65
|
| Rate for Payer: WPS Commercial |
$46.66
|
|
