|
Yes - Video Swallow Eval (Flexible Fiberoptic)
|
Facility
|
OP
|
$646.00
|
|
|
Service Code
|
CPT 92611 GN
|
| Hospital Charge Code |
2989780
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$180.88 |
| Max. Negotiated Rate |
$2,584.00 |
| Rate for Payer: Aetna Commercial |
$581.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$555.56
|
| Rate for Payer: Aetna Managed Medicare |
$180.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$349.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$287.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$272.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$342.38
|
| Rate for Payer: Cash Price |
$193.80
|
| Rate for Payer: Cash Price |
$193.80
|
| Rate for Payer: Cigna Commercial |
$594.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$361.50
|
| Rate for Payer: Health EOS Commercial |
$574.94
|
| Rate for Payer: HFN Commercial |
$594.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$202.00
|
| Rate for Payer: Multiplan Commercial |
$516.80
|
| Rate for Payer: NAPHCARE Commercial |
$387.60
|
| Rate for Payer: Preferred Network Access Commercial |
$594.32
|
| Rate for Payer: Quartz Beloit One Network |
$316.54
|
| Rate for Payer: Quartz Commercial |
$419.90
|
| Rate for Payer: Quartz Medicare Advantage |
$387.60
|
| Rate for Payer: The Alliance Commercial |
$2,584.00
|
| Rate for Payer: United Healthcare PPO |
$484.50
|
| Rate for Payer: WEA Trust Commercial |
$355.30
|
| Rate for Payer: WPS Commercial |
$478.49
|
|
|
Yes - Wound Care Non-Selective Debride Charge
|
Professional
|
Both
|
$107.00
|
|
|
Service Code
|
CPT 97602
|
| Hospital Charge Code |
3554169
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$47.08 |
| Max. Negotiated Rate |
$281.38 |
| Rate for Payer: Aetna Commercial |
$101.65
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$92.02
|
| Rate for Payer: Cash Price |
$32.10
|
| Rate for Payer: Cash Price |
$32.10
|
| Rate for Payer: Cash Price |
$32.10
|
| Rate for Payer: Cigna Commercial |
$101.65
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$53.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$64.20
|
| Rate for Payer: Health EOS Commercial |
$97.37
|
| Rate for Payer: HFN Commercial |
$101.65
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$281.38
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$281.38
|
| Rate for Payer: Multiplan Commercial |
$85.60
|
| Rate for Payer: Preferred Network Access Commercial |
$101.65
|
| Rate for Payer: Quartz Beloit One Network |
$47.08
|
| Rate for Payer: Quartz Commercial |
$60.99
|
| Rate for Payer: The Alliance Commercial |
$53.50
|
| Rate for Payer: WEA Trust Commercial |
$58.85
|
| Rate for Payer: WPS Commercial |
$79.25
|
|
|
Yes - Wound Care Non-Selective Debride Charge
|
Facility
|
IP
|
$107.00
|
|
|
Service Code
|
CPT 97602
|
| Hospital Charge Code |
3554169
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$52.43 |
| Max. Negotiated Rate |
$98.44 |
| Rate for Payer: Aetna Commercial |
$96.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$92.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$56.71
|
| Rate for Payer: Cash Price |
$32.10
|
| Rate for Payer: Cigna Commercial |
$98.44
|
| Rate for Payer: Health EOS Commercial |
$95.23
|
| Rate for Payer: HFN Commercial |
$98.44
|
| Rate for Payer: Multiplan Commercial |
$85.60
|
| Rate for Payer: NAPHCARE Commercial |
$64.20
|
| Rate for Payer: Preferred Network Access Commercial |
$98.44
|
| Rate for Payer: Quartz Beloit One Network |
$52.43
|
| Rate for Payer: Quartz Commercial |
$64.20
|
| Rate for Payer: WEA Trust Commercial |
$58.85
|
| Rate for Payer: WPS Commercial |
$79.25
|
|
|
Yes - Wound Care Non-Selective Debride Charge
|
Facility
|
OP
|
$107.00
|
|
|
Service Code
|
CPT 97602
|
| Hospital Charge Code |
3554169
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$52.43 |
| Max. Negotiated Rate |
$791.52 |
| Rate for Payer: Aetna Commercial |
$96.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$92.02
|
| Rate for Payer: Aetna Managed Medicare |
$197.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$349.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$287.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$272.00
|
| Rate for Payer: Anthem Medicare Advantage |
$197.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$56.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$197.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$197.88
|
| Rate for Payer: Cash Price |
$32.10
|
| Rate for Payer: Cash Price |
$32.10
|
| Rate for Payer: Cash Price |
$32.10
|
| Rate for Payer: Cigna Commercial |
$98.44
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$197.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$59.88
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$197.88
|
| Rate for Payer: Health EOS Commercial |
$95.23
|
| Rate for Payer: HFN Commercial |
$98.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$202.00
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$197.88
|
| Rate for Payer: Independent Care Health Plan Medicare |
$197.88
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$197.88
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$197.88
|
| Rate for Payer: Multiplan Commercial |
$85.60
|
| Rate for Payer: NAPHCARE Commercial |
$296.82
|
| Rate for Payer: Preferred Network Access Commercial |
$98.44
|
| Rate for Payer: Quartz Beloit One Network |
$52.43
|
| Rate for Payer: Quartz Commercial |
$69.55
|
| Rate for Payer: Quartz Medicare Advantage |
$197.88
|
| Rate for Payer: The Alliance Commercial |
$791.52
|
| Rate for Payer: United Healthcare Medicare Advantage |
$197.88
|
| Rate for Payer: United Healthcare PPO |
$80.25
|
| Rate for Payer: WEA Trust Commercial |
$58.85
|
| Rate for Payer: Wellcare Medicare |
$197.88
|
| Rate for Payer: WPS Commercial |
$79.25
|
|
|
Yes - Wound Vac 50 sq cm Charges
|
Facility
|
OP
|
$317.00
|
|
|
Service Code
|
CPT 97605 GP
|
| Hospital Charge Code |
2989816
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$155.33 |
| Max. Negotiated Rate |
$791.52 |
| Rate for Payer: Aetna Commercial |
$285.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$272.62
|
| Rate for Payer: Aetna Managed Medicare |
$197.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$349.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$287.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$272.00
|
| Rate for Payer: Anthem Medicare Advantage |
$197.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$168.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$197.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$197.88
|
| Rate for Payer: Cash Price |
$95.10
|
| Rate for Payer: Cash Price |
$95.10
|
| Rate for Payer: Cash Price |
$95.10
|
| Rate for Payer: Cigna Commercial |
$291.64
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$197.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$177.39
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$197.88
|
| Rate for Payer: Health EOS Commercial |
$282.13
|
| Rate for Payer: HFN Commercial |
$291.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$202.00
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$197.88
|
| Rate for Payer: Independent Care Health Plan Medicare |
$197.88
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$197.88
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$197.88
|
| Rate for Payer: Multiplan Commercial |
$253.60
|
| Rate for Payer: NAPHCARE Commercial |
$296.82
|
| Rate for Payer: Preferred Network Access Commercial |
$291.64
|
| Rate for Payer: Quartz Beloit One Network |
$155.33
|
| Rate for Payer: Quartz Commercial |
$206.05
|
| Rate for Payer: Quartz Medicare Advantage |
$197.88
|
| Rate for Payer: The Alliance Commercial |
$791.52
|
| Rate for Payer: United Healthcare Medicare Advantage |
$197.88
|
| Rate for Payer: United Healthcare PPO |
$237.75
|
| Rate for Payer: WEA Trust Commercial |
$174.35
|
| Rate for Payer: Wellcare Medicare |
$197.88
|
| Rate for Payer: WPS Commercial |
$234.80
|
|
|
Yes - Wound Vac 50 sq cm Charges
|
Professional
|
Both
|
$317.00
|
|
|
Service Code
|
CPT 97605 GP
|
| Hospital Charge Code |
2989816
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$28.83 |
| Max. Negotiated Rate |
$301.15 |
| Rate for Payer: Aetna Commercial |
$301.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$272.62
|
| Rate for Payer: Cash Price |
$95.10
|
| Rate for Payer: Cash Price |
$95.10
|
| Rate for Payer: Cash Price |
$95.10
|
| Rate for Payer: Cigna Commercial |
$301.15
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$28.83
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$190.20
|
| Rate for Payer: Health EOS Commercial |
$288.47
|
| Rate for Payer: HFN Commercial |
$301.15
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$87.05
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$87.05
|
| Rate for Payer: Multiplan Commercial |
$253.60
|
| Rate for Payer: Preferred Network Access Commercial |
$301.15
|
| Rate for Payer: Quartz Beloit One Network |
$139.48
|
| Rate for Payer: Quartz Commercial |
$180.69
|
| Rate for Payer: The Alliance Commercial |
$158.50
|
| Rate for Payer: United Healthcare Medicaid |
$28.83
|
| Rate for Payer: WEA Trust Commercial |
$174.35
|
| Rate for Payer: WPS Commercial |
$234.80
|
|
|
Yes - Wound Vac 50 sq cm Charges
|
Facility
|
IP
|
$317.00
|
|
|
Service Code
|
CPT 97605 GP
|
| Hospital Charge Code |
2989816
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$155.33 |
| Max. Negotiated Rate |
$291.64 |
| Rate for Payer: Aetna Commercial |
$285.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$272.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$168.01
|
| Rate for Payer: Cash Price |
$95.10
|
| Rate for Payer: Cigna Commercial |
$291.64
|
| Rate for Payer: Health EOS Commercial |
$282.13
|
| Rate for Payer: HFN Commercial |
$291.64
|
| Rate for Payer: Multiplan Commercial |
$253.60
|
| Rate for Payer: NAPHCARE Commercial |
$190.20
|
| Rate for Payer: Preferred Network Access Commercial |
$291.64
|
| Rate for Payer: Quartz Beloit One Network |
$155.33
|
| Rate for Payer: Quartz Commercial |
$190.20
|
| Rate for Payer: WEA Trust Commercial |
$174.35
|
| Rate for Payer: WPS Commercial |
$234.80
|
|
|
Yes - Wound Vac Addit. 50 sq cm Charges
|
Facility
|
OP
|
$330.00
|
|
|
Service Code
|
CPT 97606 GP
|
| Hospital Charge Code |
2989817
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$161.70 |
| Max. Negotiated Rate |
$1,576.48 |
| Rate for Payer: Aetna Commercial |
$297.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$283.80
|
| Rate for Payer: Aetna Managed Medicare |
$394.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$349.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$287.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$272.00
|
| Rate for Payer: Anthem Medicare Advantage |
$394.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$174.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$394.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$394.12
|
| Rate for Payer: Cash Price |
$99.00
|
| Rate for Payer: Cash Price |
$99.00
|
| Rate for Payer: Cash Price |
$99.00
|
| Rate for Payer: Cigna Commercial |
$303.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$394.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$184.67
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$394.12
|
| Rate for Payer: Health EOS Commercial |
$293.70
|
| Rate for Payer: HFN Commercial |
$303.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$202.00
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$394.12
|
| Rate for Payer: Independent Care Health Plan Medicare |
$394.12
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$394.12
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$394.12
|
| Rate for Payer: Multiplan Commercial |
$264.00
|
| Rate for Payer: NAPHCARE Commercial |
$591.18
|
| Rate for Payer: Preferred Network Access Commercial |
$303.60
|
| Rate for Payer: Quartz Beloit One Network |
$161.70
|
| Rate for Payer: Quartz Commercial |
$214.50
|
| Rate for Payer: Quartz Medicare Advantage |
$394.12
|
| Rate for Payer: The Alliance Commercial |
$1,576.48
|
| Rate for Payer: United Healthcare Medicare Advantage |
$394.12
|
| Rate for Payer: United Healthcare PPO |
$247.50
|
| Rate for Payer: WEA Trust Commercial |
$181.50
|
| Rate for Payer: Wellcare Medicare |
$394.12
|
| Rate for Payer: WPS Commercial |
$244.43
|
|
|
Yes - Wound Vac Addit. 50 sq cm Charges
|
Facility
|
IP
|
$330.00
|
|
|
Service Code
|
CPT 97606 GP
|
| Hospital Charge Code |
2989817
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$161.70 |
| Max. Negotiated Rate |
$303.60 |
| Rate for Payer: Aetna Commercial |
$297.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$283.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$174.90
|
| Rate for Payer: Cash Price |
$99.00
|
| Rate for Payer: Cigna Commercial |
$303.60
|
| Rate for Payer: Health EOS Commercial |
$293.70
|
| Rate for Payer: HFN Commercial |
$303.60
|
| Rate for Payer: Multiplan Commercial |
$264.00
|
| Rate for Payer: NAPHCARE Commercial |
$198.00
|
| Rate for Payer: Preferred Network Access Commercial |
$303.60
|
| Rate for Payer: Quartz Beloit One Network |
$161.70
|
| Rate for Payer: Quartz Commercial |
$198.00
|
| Rate for Payer: WEA Trust Commercial |
$181.50
|
| Rate for Payer: WPS Commercial |
$244.43
|
|
|
Yes - Wound Vac Addit. 50 sq cm Charges
|
Professional
|
Both
|
$330.00
|
|
|
Service Code
|
CPT 97606 GP
|
| Hospital Charge Code |
2989817
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$31.14 |
| Max. Negotiated Rate |
$313.50 |
| Rate for Payer: Aetna Commercial |
$313.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$283.80
|
| Rate for Payer: Cash Price |
$99.00
|
| Rate for Payer: Cash Price |
$99.00
|
| Rate for Payer: Cash Price |
$99.00
|
| Rate for Payer: Cigna Commercial |
$313.50
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$31.14
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$198.00
|
| Rate for Payer: Health EOS Commercial |
$300.30
|
| Rate for Payer: HFN Commercial |
$313.50
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$95.52
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$95.52
|
| Rate for Payer: Multiplan Commercial |
$264.00
|
| Rate for Payer: Preferred Network Access Commercial |
$313.50
|
| Rate for Payer: Quartz Beloit One Network |
$145.20
|
| Rate for Payer: Quartz Commercial |
$188.10
|
| Rate for Payer: The Alliance Commercial |
$165.00
|
| Rate for Payer: United Healthcare Medicaid |
$31.14
|
| Rate for Payer: WEA Trust Commercial |
$181.50
|
| Rate for Payer: WPS Commercial |
$244.43
|
|
|
Yes - Wound Vac Disposable Charges >50 sq cm
|
Facility
|
OP
|
$457.00
|
|
|
Service Code
|
CPT 97608 GP
|
| Hospital Charge Code |
5364681
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$202.00 |
| Max. Negotiated Rate |
$1,576.48 |
| Rate for Payer: Aetna Commercial |
$411.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$393.02
|
| Rate for Payer: Aetna Managed Medicare |
$394.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$349.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$287.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$272.00
|
| Rate for Payer: Anthem Medicare Advantage |
$394.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$242.21
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$394.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$394.12
|
| Rate for Payer: Cash Price |
$137.10
|
| Rate for Payer: Cash Price |
$137.10
|
| Rate for Payer: Cash Price |
$137.10
|
| Rate for Payer: Cigna Commercial |
$420.44
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$394.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$255.74
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$394.12
|
| Rate for Payer: Health EOS Commercial |
$406.73
|
| Rate for Payer: HFN Commercial |
$420.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$202.00
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$394.12
|
| Rate for Payer: Independent Care Health Plan Medicare |
$394.12
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$394.12
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$394.12
|
| Rate for Payer: Multiplan Commercial |
$365.60
|
| Rate for Payer: NAPHCARE Commercial |
$591.18
|
| Rate for Payer: Preferred Network Access Commercial |
$420.44
|
| Rate for Payer: Quartz Beloit One Network |
$223.93
|
| Rate for Payer: Quartz Commercial |
$297.05
|
| Rate for Payer: Quartz Medicare Advantage |
$394.12
|
| Rate for Payer: The Alliance Commercial |
$1,576.48
|
| Rate for Payer: United Healthcare Medicare Advantage |
$394.12
|
| Rate for Payer: United Healthcare PPO |
$342.75
|
| Rate for Payer: WEA Trust Commercial |
$251.35
|
| Rate for Payer: Wellcare Medicare |
$394.12
|
| Rate for Payer: WPS Commercial |
$338.50
|
|
|
Yes - Wound Vac Disposable Charges >50 sq cm
|
Facility
|
IP
|
$457.00
|
|
|
Service Code
|
CPT 97608 GP
|
| Hospital Charge Code |
5364681
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$223.93 |
| Max. Negotiated Rate |
$420.44 |
| Rate for Payer: Aetna Commercial |
$411.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$393.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$242.21
|
| Rate for Payer: Cash Price |
$137.10
|
| Rate for Payer: Cigna Commercial |
$420.44
|
| Rate for Payer: Health EOS Commercial |
$406.73
|
| Rate for Payer: HFN Commercial |
$420.44
|
| Rate for Payer: Multiplan Commercial |
$365.60
|
| Rate for Payer: NAPHCARE Commercial |
$274.20
|
| Rate for Payer: Preferred Network Access Commercial |
$420.44
|
| Rate for Payer: Quartz Beloit One Network |
$223.93
|
| Rate for Payer: Quartz Commercial |
$274.20
|
| Rate for Payer: WEA Trust Commercial |
$251.35
|
| Rate for Payer: WPS Commercial |
$338.50
|
|
|
Yes - Wound Vac Disposable Charges 50 sq cm
|
Facility
|
IP
|
$457.00
|
|
|
Service Code
|
CPT 97607 GP
|
| Hospital Charge Code |
5364671
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$223.93 |
| Max. Negotiated Rate |
$420.44 |
| Rate for Payer: Aetna Commercial |
$411.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$393.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$242.21
|
| Rate for Payer: Cash Price |
$137.10
|
| Rate for Payer: Cigna Commercial |
$420.44
|
| Rate for Payer: Health EOS Commercial |
$406.73
|
| Rate for Payer: HFN Commercial |
$420.44
|
| Rate for Payer: Multiplan Commercial |
$365.60
|
| Rate for Payer: NAPHCARE Commercial |
$274.20
|
| Rate for Payer: Preferred Network Access Commercial |
$420.44
|
| Rate for Payer: Quartz Beloit One Network |
$223.93
|
| Rate for Payer: Quartz Commercial |
$274.20
|
| Rate for Payer: WEA Trust Commercial |
$251.35
|
| Rate for Payer: WPS Commercial |
$338.50
|
|
|
Yes - Wound Vac Disposable Charges 50 sq cm
|
Facility
|
OP
|
$457.00
|
|
|
Service Code
|
CPT 97607 GP
|
| Hospital Charge Code |
5364671
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$202.00 |
| Max. Negotiated Rate |
$1,576.48 |
| Rate for Payer: Aetna Commercial |
$411.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$393.02
|
| Rate for Payer: Aetna Managed Medicare |
$394.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$349.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$287.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$272.00
|
| Rate for Payer: Anthem Medicare Advantage |
$394.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$242.21
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$394.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$394.12
|
| Rate for Payer: Cash Price |
$137.10
|
| Rate for Payer: Cash Price |
$137.10
|
| Rate for Payer: Cash Price |
$137.10
|
| Rate for Payer: Cigna Commercial |
$420.44
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$394.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$255.74
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$394.12
|
| Rate for Payer: Health EOS Commercial |
$406.73
|
| Rate for Payer: HFN Commercial |
$420.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$202.00
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$394.12
|
| Rate for Payer: Independent Care Health Plan Medicare |
$394.12
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$394.12
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$394.12
|
| Rate for Payer: Multiplan Commercial |
$365.60
|
| Rate for Payer: NAPHCARE Commercial |
$591.18
|
| Rate for Payer: Preferred Network Access Commercial |
$420.44
|
| Rate for Payer: Quartz Beloit One Network |
$223.93
|
| Rate for Payer: Quartz Commercial |
$297.05
|
| Rate for Payer: Quartz Medicare Advantage |
$394.12
|
| Rate for Payer: The Alliance Commercial |
$1,576.48
|
| Rate for Payer: United Healthcare Medicare Advantage |
$394.12
|
| Rate for Payer: United Healthcare PPO |
$342.75
|
| Rate for Payer: WEA Trust Commercial |
$251.35
|
| Rate for Payer: Wellcare Medicare |
$394.12
|
| Rate for Payer: WPS Commercial |
$338.50
|
|
|
Yes - Wound Vac Disposable Charges 50 sq cm
|
Professional
|
Both
|
$457.00
|
|
|
Service Code
|
CPT 97607 GP
|
| Hospital Charge Code |
5364671
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$31.14 |
| Max. Negotiated Rate |
$1,165.32 |
| Rate for Payer: Aetna Commercial |
$434.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$393.02
|
| Rate for Payer: Cash Price |
$137.10
|
| Rate for Payer: Cash Price |
$137.10
|
| Rate for Payer: Cash Price |
$137.10
|
| Rate for Payer: Cigna Commercial |
$434.15
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$31.14
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$274.20
|
| Rate for Payer: Health EOS Commercial |
$415.87
|
| Rate for Payer: HFN Commercial |
$434.15
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,165.32
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,165.32
|
| Rate for Payer: Multiplan Commercial |
$365.60
|
| Rate for Payer: Preferred Network Access Commercial |
$434.15
|
| Rate for Payer: Quartz Beloit One Network |
$201.08
|
| Rate for Payer: Quartz Commercial |
$260.49
|
| Rate for Payer: The Alliance Commercial |
$228.50
|
| Rate for Payer: United Healthcare Medicaid |
$31.14
|
| Rate for Payer: WEA Trust Commercial |
$251.35
|
| Rate for Payer: WPS Commercial |
$338.50
|
|
|
YID
|
Professional
|
Both
|
$83.00
|
|
|
Service Code
|
CPT 87106
|
| Hospital Charge Code |
5313599
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$36.43 |
| Max. Negotiated Rate |
$78.85 |
| Rate for Payer: Aetna Commercial |
$78.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$71.38
|
| Rate for Payer: Cash Price |
$24.90
|
| Rate for Payer: Cash Price |
$24.90
|
| Rate for Payer: Cigna Commercial |
$78.85
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$41.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$49.80
|
| Rate for Payer: Health EOS Commercial |
$75.53
|
| Rate for Payer: HFN Commercial |
$78.85
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$36.43
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$36.43
|
| Rate for Payer: Multiplan Commercial |
$66.40
|
| Rate for Payer: Preferred Network Access Commercial |
$78.85
|
| Rate for Payer: Quartz Beloit One Network |
$36.52
|
| Rate for Payer: Quartz Commercial |
$47.31
|
| Rate for Payer: The Alliance Commercial |
$41.50
|
| Rate for Payer: WEA Trust Commercial |
$45.65
|
| Rate for Payer: WPS Commercial |
$61.48
|
|
|
YID
|
Facility
|
IP
|
$83.00
|
|
|
Service Code
|
CPT 87106
|
| Hospital Charge Code |
5313599
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$40.67 |
| Max. Negotiated Rate |
$76.36 |
| Rate for Payer: Aetna Commercial |
$74.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$71.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$43.99
|
| Rate for Payer: Cash Price |
$24.90
|
| Rate for Payer: Cigna Commercial |
$76.36
|
| Rate for Payer: Health EOS Commercial |
$73.87
|
| Rate for Payer: HFN Commercial |
$76.36
|
| Rate for Payer: Multiplan Commercial |
$66.40
|
| Rate for Payer: NAPHCARE Commercial |
$49.80
|
| Rate for Payer: Preferred Network Access Commercial |
$76.36
|
| Rate for Payer: Quartz Beloit One Network |
$40.67
|
| Rate for Payer: Quartz Commercial |
$49.80
|
| Rate for Payer: WEA Trust Commercial |
$45.65
|
| Rate for Payer: WPS Commercial |
$61.48
|
|
|
YID
|
Facility
|
OP
|
$83.00
|
|
|
Service Code
|
CPT 87106
|
| Hospital Charge Code |
5313599
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.32 |
| Max. Negotiated Rate |
$76.36 |
| Rate for Payer: Aetna Commercial |
$74.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$71.38
|
| Rate for Payer: Aetna Managed Medicare |
$10.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$38.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$18.06
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$17.13
|
| Rate for Payer: Anthem Medicaid |
$10.66
|
| Rate for Payer: Anthem Medicare Advantage |
$10.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$43.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$10.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$10.32
|
| Rate for Payer: Cash Price |
$24.90
|
| Rate for Payer: Cash Price |
$24.90
|
| Rate for Payer: Cigna Commercial |
$76.36
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$10.32
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$10.66
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$46.45
|
| Rate for Payer: Dean Health Medicaid |
$10.66
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$10.32
|
| Rate for Payer: Health EOS Commercial |
$73.87
|
| Rate for Payer: HFN Commercial |
$76.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$38.39
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$10.32
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$10.66
|
| Rate for Payer: Independent Care Health Plan Medicare |
$10.32
|
| Rate for Payer: Managed Health Services Medicaid |
$11.09
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$10.32
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$10.32
|
| Rate for Payer: Multiplan Commercial |
$66.40
|
| Rate for Payer: NAPHCARE Commercial |
$15.48
|
| Rate for Payer: Preferred Network Access Commercial |
$76.36
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$10.66
|
| Rate for Payer: Quartz Beloit One Network |
$40.67
|
| Rate for Payer: Quartz Commercial |
$53.95
|
| Rate for Payer: Quartz Medicare Advantage |
$10.32
|
| Rate for Payer: The Alliance Commercial |
$41.28
|
| Rate for Payer: United Healthcare Medicaid |
$10.66
|
| Rate for Payer: United Healthcare Medicare Advantage |
$10.32
|
| Rate for Payer: United Healthcare PPO |
$62.25
|
| Rate for Payer: WEA Trust Commercial |
$45.65
|
| Rate for Payer: Wellcare Medicare |
$10.32
|
| Rate for Payer: WMAP Medicaid |
$10.66
|
| Rate for Payer: WPS Commercial |
$61.48
|
|
|
Y-PLATE 1.3MM 3H HEAD/8H SHAFT 221.335
|
Facility
|
IP
|
$3,201.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4508598
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,568.49 |
| Max. Negotiated Rate |
$2,944.92 |
| Rate for Payer: Aetna Commercial |
$2,880.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,752.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,696.53
|
| Rate for Payer: Cash Price |
$960.30
|
| Rate for Payer: Cigna Commercial |
$2,944.92
|
| Rate for Payer: Health EOS Commercial |
$2,848.89
|
| Rate for Payer: HFN Commercial |
$2,944.92
|
| Rate for Payer: Multiplan Commercial |
$2,560.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,920.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,944.92
|
| Rate for Payer: Quartz Beloit One Network |
$1,568.49
|
| Rate for Payer: Quartz Commercial |
$1,920.60
|
| Rate for Payer: WEA Trust Commercial |
$1,760.55
|
| Rate for Payer: WPS Commercial |
$2,370.98
|
|
|
Y-PLATE 1.3MM 3H HEAD/8H SHAFT 221.335
|
Facility
|
OP
|
$3,201.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4508598
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$896.28 |
| Max. Negotiated Rate |
$12,804.00 |
| Rate for Payer: Aetna Commercial |
$2,880.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,752.86
|
| Rate for Payer: Aetna Managed Medicare |
$896.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,080.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,600.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,536.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,696.53
|
| Rate for Payer: Cash Price |
$960.30
|
| Rate for Payer: Cigna Commercial |
$2,944.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,791.28
|
| Rate for Payer: Health EOS Commercial |
$2,848.89
|
| Rate for Payer: HFN Commercial |
$2,944.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,400.75
|
| Rate for Payer: Multiplan Commercial |
$2,560.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,920.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,944.92
|
| Rate for Payer: Quartz Beloit One Network |
$1,568.49
|
| Rate for Payer: Quartz Commercial |
$2,080.65
|
| Rate for Payer: Quartz Medicare Advantage |
$1,920.60
|
| Rate for Payer: The Alliance Commercial |
$12,804.00
|
| Rate for Payer: WEA Trust Commercial |
$1,760.55
|
| Rate for Payer: WPS Commercial |
$2,370.98
|
|
|
Y-PLATE 1.5MM 3H HEAD 8H SHAFT 246.612
|
Facility
|
OP
|
$3,819.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4508669
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,069.32 |
| Max. Negotiated Rate |
$15,276.00 |
| Rate for Payer: Aetna Commercial |
$3,437.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,284.34
|
| Rate for Payer: Aetna Managed Medicare |
$1,069.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,482.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,909.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,833.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,024.07
|
| Rate for Payer: Cash Price |
$1,145.70
|
| Rate for Payer: Cigna Commercial |
$3,513.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,137.11
|
| Rate for Payer: Health EOS Commercial |
$3,398.91
|
| Rate for Payer: HFN Commercial |
$3,513.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,864.25
|
| Rate for Payer: Multiplan Commercial |
$3,055.20
|
| Rate for Payer: NAPHCARE Commercial |
$2,291.40
|
| Rate for Payer: Preferred Network Access Commercial |
$3,513.48
|
| Rate for Payer: Quartz Beloit One Network |
$1,871.31
|
| Rate for Payer: Quartz Commercial |
$2,482.35
|
| Rate for Payer: Quartz Medicare Advantage |
$2,291.40
|
| Rate for Payer: The Alliance Commercial |
$15,276.00
|
| Rate for Payer: WEA Trust Commercial |
$2,100.45
|
| Rate for Payer: WPS Commercial |
$2,828.73
|
|
|
Y-PLATE 1.5MM 3H HEAD 8H SHAFT 246.612
|
Facility
|
IP
|
$3,819.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4508669
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,871.31 |
| Max. Negotiated Rate |
$3,513.48 |
| Rate for Payer: Aetna Commercial |
$3,437.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,284.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,024.07
|
| Rate for Payer: Cash Price |
$1,145.70
|
| Rate for Payer: Cigna Commercial |
$3,513.48
|
| Rate for Payer: Health EOS Commercial |
$3,398.91
|
| Rate for Payer: HFN Commercial |
$3,513.48
|
| Rate for Payer: Multiplan Commercial |
$3,055.20
|
| Rate for Payer: NAPHCARE Commercial |
$2,291.40
|
| Rate for Payer: Preferred Network Access Commercial |
$3,513.48
|
| Rate for Payer: Quartz Beloit One Network |
$1,871.31
|
| Rate for Payer: Quartz Commercial |
$2,291.40
|
| Rate for Payer: WEA Trust Commercial |
$2,100.45
|
| Rate for Payer: WPS Commercial |
$2,828.73
|
|
|
Y-PLATE 1.5MM LCP 3H HEAD/8H SHAFT 02.114.513
|
Facility
|
IP
|
$5,680.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4508926
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,783.20 |
| Max. Negotiated Rate |
$5,225.60 |
| Rate for Payer: Aetna Commercial |
$5,112.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,884.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,010.40
|
| Rate for Payer: Cash Price |
$1,704.00
|
| Rate for Payer: Cigna Commercial |
$5,225.60
|
| Rate for Payer: Health EOS Commercial |
$5,055.20
|
| Rate for Payer: HFN Commercial |
$5,225.60
|
| Rate for Payer: Multiplan Commercial |
$4,544.00
|
| Rate for Payer: NAPHCARE Commercial |
$3,408.00
|
| Rate for Payer: Preferred Network Access Commercial |
$5,225.60
|
| Rate for Payer: Quartz Beloit One Network |
$2,783.20
|
| Rate for Payer: Quartz Commercial |
$3,408.00
|
| Rate for Payer: WEA Trust Commercial |
$3,124.00
|
| Rate for Payer: WPS Commercial |
$4,207.18
|
|
|
Y-PLATE 1.5MM LCP 3H HEAD/8H SHAFT 02.114.513
|
Facility
|
OP
|
$5,680.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4508926
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,590.40 |
| Max. Negotiated Rate |
$22,720.00 |
| Rate for Payer: Aetna Commercial |
$5,112.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,884.80
|
| Rate for Payer: Aetna Managed Medicare |
$1,590.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,692.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,840.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,726.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,010.40
|
| Rate for Payer: Cash Price |
$1,704.00
|
| Rate for Payer: Cigna Commercial |
$5,225.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,178.53
|
| Rate for Payer: Health EOS Commercial |
$5,055.20
|
| Rate for Payer: HFN Commercial |
$5,225.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,260.00
|
| Rate for Payer: Multiplan Commercial |
$4,544.00
|
| Rate for Payer: NAPHCARE Commercial |
$3,408.00
|
| Rate for Payer: Preferred Network Access Commercial |
$5,225.60
|
| Rate for Payer: Quartz Beloit One Network |
$2,783.20
|
| Rate for Payer: Quartz Commercial |
$3,692.00
|
| Rate for Payer: Quartz Medicare Advantage |
$3,408.00
|
| Rate for Payer: The Alliance Commercial |
$22,720.00
|
| Rate for Payer: WEA Trust Commercial |
$3,124.00
|
| Rate for Payer: WPS Commercial |
$4,207.18
|
|
|
Y-PLATE 2.0 3HEAD 7HL 247.350
|
Facility
|
IP
|
$3,944.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5767802
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,932.56 |
| Max. Negotiated Rate |
$3,628.48 |
| Rate for Payer: Aetna Commercial |
$3,549.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,391.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,090.32
|
| Rate for Payer: Cash Price |
$1,183.20
|
| Rate for Payer: Cigna Commercial |
$3,628.48
|
| Rate for Payer: Health EOS Commercial |
$3,510.16
|
| Rate for Payer: HFN Commercial |
$3,628.48
|
| Rate for Payer: Multiplan Commercial |
$3,155.20
|
| Rate for Payer: NAPHCARE Commercial |
$2,366.40
|
| Rate for Payer: Preferred Network Access Commercial |
$3,628.48
|
| Rate for Payer: Quartz Beloit One Network |
$1,932.56
|
| Rate for Payer: Quartz Commercial |
$2,366.40
|
| Rate for Payer: WEA Trust Commercial |
$2,169.20
|
| Rate for Payer: WPS Commercial |
$2,921.32
|
|
