|
CARBON ROD 3MM X 90MM 5079-6-090
|
Facility
|
IP
|
$885.00
|
|
| Hospital Charge Code |
5459555
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$433.65 |
| Max. Negotiated Rate |
$814.20 |
| Rate for Payer: Aetna Commercial |
$796.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$761.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$469.05
|
| Rate for Payer: Cash Price |
$265.50
|
| Rate for Payer: Cigna Commercial |
$814.20
|
| Rate for Payer: Health EOS Commercial |
$787.65
|
| Rate for Payer: HFN Commercial |
$814.20
|
| Rate for Payer: Multiplan Commercial |
$708.00
|
| Rate for Payer: NAPHCARE Commercial |
$531.00
|
| Rate for Payer: Preferred Network Access Commercial |
$814.20
|
| Rate for Payer: Quartz Beloit One Network |
$433.65
|
| Rate for Payer: Quartz Commercial |
$531.00
|
| Rate for Payer: WEA Trust Commercial |
$486.75
|
| Rate for Payer: WPS Commercial |
$655.52
|
|
|
Carboprost 250mcg ampule [Med]
|
Facility
|
OP
|
$1,918.00
|
|
| Hospital Charge Code |
2974944
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$537.04 |
| Max. Negotiated Rate |
$7,672.00 |
| Rate for Payer: Aetna Commercial |
$1,726.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,649.48
|
| Rate for Payer: Aetna Managed Medicare |
$537.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,246.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$959.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$920.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,016.54
|
| Rate for Payer: Cash Price |
$575.40
|
| Rate for Payer: Cigna Commercial |
$1,764.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,073.31
|
| Rate for Payer: Health EOS Commercial |
$1,707.02
|
| Rate for Payer: HFN Commercial |
$1,764.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,438.50
|
| Rate for Payer: Multiplan Commercial |
$1,534.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,150.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,764.56
|
| Rate for Payer: Quartz Beloit One Network |
$939.82
|
| Rate for Payer: Quartz Commercial |
$1,246.70
|
| Rate for Payer: Quartz Medicare Advantage |
$1,150.80
|
| Rate for Payer: The Alliance Commercial |
$7,672.00
|
| Rate for Payer: WEA Trust Commercial |
$1,054.90
|
| Rate for Payer: WPS Commercial |
$1,420.66
|
|
|
Carboprost 250mcg ampule [Med]
|
Facility
|
IP
|
$1,918.00
|
|
| Hospital Charge Code |
2974944
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$939.82 |
| Max. Negotiated Rate |
$1,764.56 |
| Rate for Payer: Aetna Commercial |
$1,726.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,649.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,016.54
|
| Rate for Payer: Cash Price |
$575.40
|
| Rate for Payer: Cigna Commercial |
$1,764.56
|
| Rate for Payer: Health EOS Commercial |
$1,707.02
|
| Rate for Payer: HFN Commercial |
$1,764.56
|
| Rate for Payer: Multiplan Commercial |
$1,534.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,150.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,764.56
|
| Rate for Payer: Quartz Beloit One Network |
$939.82
|
| Rate for Payer: Quartz Commercial |
$1,150.80
|
| Rate for Payer: WEA Trust Commercial |
$1,054.90
|
| Rate for Payer: WPS Commercial |
$1,420.66
|
|
|
Carboxyhemoglobin Level
|
Facility
|
OP
|
$477.00
|
|
|
Service Code
|
CPT 82375
|
| Hospital Charge Code |
633627
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.32 |
| Max. Negotiated Rate |
$438.84 |
| Rate for Payer: Aetna Commercial |
$429.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$410.22
|
| Rate for Payer: Aetna Managed Medicare |
$12.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$46.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$21.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$20.45
|
| Rate for Payer: Anthem Medicaid |
$12.73
|
| Rate for Payer: Anthem Medicare Advantage |
$12.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$252.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$12.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$12.32
|
| Rate for Payer: Cash Price |
$143.10
|
| Rate for Payer: Cash Price |
$143.10
|
| Rate for Payer: Cigna Commercial |
$438.84
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$12.32
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$12.73
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$266.93
|
| Rate for Payer: Dean Health Medicaid |
$12.73
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$12.32
|
| Rate for Payer: Health EOS Commercial |
$424.53
|
| Rate for Payer: HFN Commercial |
$438.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$45.83
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$12.32
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$12.73
|
| Rate for Payer: Independent Care Health Plan Medicare |
$12.32
|
| Rate for Payer: Managed Health Services Medicaid |
$13.24
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$12.32
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$12.32
|
| Rate for Payer: Multiplan Commercial |
$381.60
|
| Rate for Payer: NAPHCARE Commercial |
$18.48
|
| Rate for Payer: Preferred Network Access Commercial |
$438.84
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$12.73
|
| Rate for Payer: Quartz Beloit One Network |
$233.73
|
| Rate for Payer: Quartz Commercial |
$310.05
|
| Rate for Payer: Quartz Medicare Advantage |
$12.32
|
| Rate for Payer: The Alliance Commercial |
$49.28
|
| Rate for Payer: United Healthcare Medicaid |
$12.73
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.32
|
| Rate for Payer: United Healthcare PPO |
$357.75
|
| Rate for Payer: WEA Trust Commercial |
$262.35
|
| Rate for Payer: Wellcare Medicare |
$12.32
|
| Rate for Payer: WMAP Medicaid |
$12.73
|
| Rate for Payer: WPS Commercial |
$353.31
|
|
|
Carboxyhemoglobin Level
|
Professional
|
Both
|
$477.00
|
|
|
Service Code
|
CPT 82375
|
| Hospital Charge Code |
633627
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$43.49 |
| Max. Negotiated Rate |
$453.15 |
| Rate for Payer: Aetna Commercial |
$453.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$410.22
|
| Rate for Payer: Cash Price |
$143.10
|
| Rate for Payer: Cash Price |
$143.10
|
| Rate for Payer: Cigna Commercial |
$453.15
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$238.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$286.20
|
| Rate for Payer: Health EOS Commercial |
$434.07
|
| Rate for Payer: HFN Commercial |
$453.15
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$43.49
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$43.49
|
| Rate for Payer: Multiplan Commercial |
$381.60
|
| Rate for Payer: Preferred Network Access Commercial |
$453.15
|
| Rate for Payer: Quartz Beloit One Network |
$209.88
|
| Rate for Payer: Quartz Commercial |
$271.89
|
| Rate for Payer: The Alliance Commercial |
$238.50
|
| Rate for Payer: WEA Trust Commercial |
$262.35
|
| Rate for Payer: WPS Commercial |
$353.31
|
|
|
Carboxyhemoglobin Level
|
Facility
|
IP
|
$477.00
|
|
|
Service Code
|
CPT 82375
|
| Hospital Charge Code |
633627
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$233.73 |
| Max. Negotiated Rate |
$438.84 |
| Rate for Payer: Aetna Commercial |
$429.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$410.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$252.81
|
| Rate for Payer: Cash Price |
$143.10
|
| Rate for Payer: Cigna Commercial |
$438.84
|
| Rate for Payer: Health EOS Commercial |
$424.53
|
| Rate for Payer: HFN Commercial |
$438.84
|
| Rate for Payer: Multiplan Commercial |
$381.60
|
| Rate for Payer: NAPHCARE Commercial |
$286.20
|
| Rate for Payer: Preferred Network Access Commercial |
$438.84
|
| Rate for Payer: Quartz Beloit One Network |
$233.73
|
| Rate for Payer: Quartz Commercial |
$286.20
|
| Rate for Payer: WEA Trust Commercial |
$262.35
|
| Rate for Payer: WPS Commercial |
$353.31
|
|
|
Carcinoembryonic Antigen
|
Facility
|
OP
|
$368.00
|
|
|
Service Code
|
CPT 82378
|
| Hospital Charge Code |
633697
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.96 |
| Max. Negotiated Rate |
$338.56 |
| Rate for Payer: Aetna Commercial |
$331.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$316.48
|
| Rate for Payer: Aetna Managed Medicare |
$18.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$71.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$33.18
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$31.47
|
| Rate for Payer: Anthem Medicaid |
$19.59
|
| Rate for Payer: Anthem Medicare Advantage |
$18.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$195.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$18.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$18.96
|
| Rate for Payer: Cash Price |
$110.40
|
| Rate for Payer: Cash Price |
$110.40
|
| Rate for Payer: Cigna Commercial |
$338.56
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$18.96
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$19.59
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$205.93
|
| Rate for Payer: Dean Health Medicaid |
$19.59
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$18.96
|
| Rate for Payer: Health EOS Commercial |
$327.52
|
| Rate for Payer: HFN Commercial |
$338.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$70.53
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$18.96
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$19.59
|
| Rate for Payer: Independent Care Health Plan Medicare |
$18.96
|
| Rate for Payer: Managed Health Services Medicaid |
$20.37
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$18.96
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$18.96
|
| Rate for Payer: Multiplan Commercial |
$294.40
|
| Rate for Payer: NAPHCARE Commercial |
$28.44
|
| Rate for Payer: Preferred Network Access Commercial |
$338.56
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$19.59
|
| Rate for Payer: Quartz Beloit One Network |
$180.32
|
| Rate for Payer: Quartz Commercial |
$239.20
|
| Rate for Payer: Quartz Medicare Advantage |
$18.96
|
| Rate for Payer: The Alliance Commercial |
$75.84
|
| Rate for Payer: United Healthcare Medicaid |
$19.59
|
| Rate for Payer: United Healthcare Medicare Advantage |
$18.96
|
| Rate for Payer: United Healthcare PPO |
$276.00
|
| Rate for Payer: WEA Trust Commercial |
$202.40
|
| Rate for Payer: Wellcare Medicare |
$18.96
|
| Rate for Payer: WMAP Medicaid |
$19.59
|
| Rate for Payer: WPS Commercial |
$272.58
|
|
|
Carcinoembryonic Antigen
|
Facility
|
IP
|
$368.00
|
|
|
Service Code
|
CPT 82378
|
| Hospital Charge Code |
633697
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$180.32 |
| Max. Negotiated Rate |
$338.56 |
| Rate for Payer: Aetna Commercial |
$331.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$316.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$195.04
|
| Rate for Payer: Cash Price |
$110.40
|
| Rate for Payer: Cigna Commercial |
$338.56
|
| Rate for Payer: Health EOS Commercial |
$327.52
|
| Rate for Payer: HFN Commercial |
$338.56
|
| Rate for Payer: Multiplan Commercial |
$294.40
|
| Rate for Payer: NAPHCARE Commercial |
$220.80
|
| Rate for Payer: Preferred Network Access Commercial |
$338.56
|
| Rate for Payer: Quartz Beloit One Network |
$180.32
|
| Rate for Payer: Quartz Commercial |
$220.80
|
| Rate for Payer: WEA Trust Commercial |
$202.40
|
| Rate for Payer: WPS Commercial |
$272.58
|
|
|
Carcinoembryonic Antigen
|
Professional
|
Both
|
$368.00
|
|
|
Service Code
|
CPT 82378
|
| Hospital Charge Code |
633697
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$66.93 |
| Max. Negotiated Rate |
$349.60 |
| Rate for Payer: Aetna Commercial |
$349.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$316.48
|
| Rate for Payer: Cash Price |
$110.40
|
| Rate for Payer: Cash Price |
$110.40
|
| Rate for Payer: Cigna Commercial |
$349.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$184.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$220.80
|
| Rate for Payer: Health EOS Commercial |
$334.88
|
| Rate for Payer: HFN Commercial |
$349.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$66.93
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$66.93
|
| Rate for Payer: Multiplan Commercial |
$294.40
|
| Rate for Payer: Preferred Network Access Commercial |
$349.60
|
| Rate for Payer: Quartz Beloit One Network |
$161.92
|
| Rate for Payer: Quartz Commercial |
$209.76
|
| Rate for Payer: The Alliance Commercial |
$184.00
|
| Rate for Payer: WEA Trust Commercial |
$202.40
|
| Rate for Payer: WPS Commercial |
$272.58
|
|
|
Cardiac/Apnea Monitor - Daily Charges
|
Facility
|
IP
|
$851.00
|
|
| Hospital Charge Code |
3003967
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$416.99 |
| Max. Negotiated Rate |
$782.92 |
| Rate for Payer: Aetna Commercial |
$765.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$731.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$451.03
|
| Rate for Payer: Cash Price |
$255.30
|
| Rate for Payer: Cigna Commercial |
$782.92
|
| Rate for Payer: Health EOS Commercial |
$757.39
|
| Rate for Payer: HFN Commercial |
$782.92
|
| Rate for Payer: Multiplan Commercial |
$680.80
|
| Rate for Payer: NAPHCARE Commercial |
$510.60
|
| Rate for Payer: Preferred Network Access Commercial |
$782.92
|
| Rate for Payer: Quartz Beloit One Network |
$416.99
|
| Rate for Payer: Quartz Commercial |
$510.60
|
| Rate for Payer: WEA Trust Commercial |
$468.05
|
| Rate for Payer: WPS Commercial |
$630.34
|
|
|
Cardiac/Apnea Monitor - Daily Charges
|
Facility
|
OP
|
$851.00
|
|
| Hospital Charge Code |
3003967
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$238.28 |
| Max. Negotiated Rate |
$3,404.00 |
| Rate for Payer: Aetna Commercial |
$765.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$731.86
|
| Rate for Payer: Aetna Managed Medicare |
$238.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$553.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$425.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$408.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$451.03
|
| Rate for Payer: Cash Price |
$255.30
|
| Rate for Payer: Cigna Commercial |
$782.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$476.22
|
| Rate for Payer: Health EOS Commercial |
$757.39
|
| Rate for Payer: HFN Commercial |
$782.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$638.25
|
| Rate for Payer: Multiplan Commercial |
$680.80
|
| Rate for Payer: NAPHCARE Commercial |
$510.60
|
| Rate for Payer: Preferred Network Access Commercial |
$782.92
|
| Rate for Payer: Quartz Beloit One Network |
$416.99
|
| Rate for Payer: Quartz Commercial |
$553.15
|
| Rate for Payer: Quartz Medicare Advantage |
$510.60
|
| Rate for Payer: The Alliance Commercial |
$3,404.00
|
| Rate for Payer: United Healthcare PPO |
$638.25
|
| Rate for Payer: WEA Trust Commercial |
$468.05
|
| Rate for Payer: WPS Commercial |
$630.34
|
|
|
Cardiac/Apnea Monitor - Nursery Daily Charges
|
Facility
|
IP
|
$851.00
|
|
| Hospital Charge Code |
3003953
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$416.99 |
| Max. Negotiated Rate |
$782.92 |
| Rate for Payer: Aetna Commercial |
$765.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$731.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$451.03
|
| Rate for Payer: Cash Price |
$255.30
|
| Rate for Payer: Cigna Commercial |
$782.92
|
| Rate for Payer: Health EOS Commercial |
$757.39
|
| Rate for Payer: HFN Commercial |
$782.92
|
| Rate for Payer: Multiplan Commercial |
$680.80
|
| Rate for Payer: NAPHCARE Commercial |
$510.60
|
| Rate for Payer: Preferred Network Access Commercial |
$782.92
|
| Rate for Payer: Quartz Beloit One Network |
$416.99
|
| Rate for Payer: Quartz Commercial |
$510.60
|
| Rate for Payer: WEA Trust Commercial |
$468.05
|
| Rate for Payer: WPS Commercial |
$630.34
|
|
|
Cardiac/Apnea Monitor - Nursery Daily Charges
|
Facility
|
OP
|
$851.00
|
|
| Hospital Charge Code |
3003953
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$238.28 |
| Max. Negotiated Rate |
$3,404.00 |
| Rate for Payer: Aetna Commercial |
$765.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$731.86
|
| Rate for Payer: Aetna Managed Medicare |
$238.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$553.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$425.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$408.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$451.03
|
| Rate for Payer: Cash Price |
$255.30
|
| Rate for Payer: Cigna Commercial |
$782.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$476.22
|
| Rate for Payer: Health EOS Commercial |
$757.39
|
| Rate for Payer: HFN Commercial |
$782.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$638.25
|
| Rate for Payer: Multiplan Commercial |
$680.80
|
| Rate for Payer: NAPHCARE Commercial |
$510.60
|
| Rate for Payer: Preferred Network Access Commercial |
$782.92
|
| Rate for Payer: Quartz Beloit One Network |
$416.99
|
| Rate for Payer: Quartz Commercial |
$553.15
|
| Rate for Payer: Quartz Medicare Advantage |
$510.60
|
| Rate for Payer: The Alliance Commercial |
$3,404.00
|
| Rate for Payer: United Healthcare PPO |
$638.25
|
| Rate for Payer: WEA Trust Commercial |
$468.05
|
| Rate for Payer: WPS Commercial |
$630.34
|
|
|
CARDIAC ARREST, UNEXPLAINED WITH CC
|
Facility
|
IP
|
$19,691.00
|
|
|
Service Code
|
MSDRG 297
|
| Min. Negotiated Rate |
$7,083.09 |
| Max. Negotiated Rate |
$19,691.00 |
| Rate for Payer: Aetna Managed Medicare |
$7,083.09
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$15,315.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$11,739.13
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$11,152.94
|
| Rate for Payer: Anthem Medicare Advantage |
$7,083.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$7,083.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$7,083.09
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$7,083.09
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12,380.79
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$7,083.09
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$14,207.70
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$7,083.09
|
| Rate for Payer: Independent Care Health Plan Medicare |
$7,083.09
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$7,083.09
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$7,083.09
|
| Rate for Payer: NAPHCARE Commercial |
$10,624.64
|
| Rate for Payer: Quartz Medicare Advantage |
$7,083.09
|
| Rate for Payer: The Alliance Commercial |
$19,691.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$7,083.09
|
| Rate for Payer: United Healthcare PPO |
$11,060.88
|
| Rate for Payer: Wellcare Medicare |
$7,083.09
|
|
|
CARDIAC ARREST, UNEXPLAINED WITH MCC
|
Facility
|
IP
|
$42,943.00
|
|
|
Service Code
|
MSDRG 296
|
| Min. Negotiated Rate |
$15,447.14 |
| Max. Negotiated Rate |
$42,943.00 |
| Rate for Payer: Aetna Managed Medicare |
$15,447.14
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$33,568.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$25,729.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$24,444.80
|
| Rate for Payer: Anthem Medicare Advantage |
$15,447.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$15,447.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$15,447.14
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$15,447.14
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$27,135.97
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$15,447.14
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$31,262.40
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$15,447.14
|
| Rate for Payer: Independent Care Health Plan Medicare |
$15,447.14
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$15,447.14
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$15,447.14
|
| Rate for Payer: NAPHCARE Commercial |
$23,170.71
|
| Rate for Payer: Quartz Medicare Advantage |
$15,447.14
|
| Rate for Payer: The Alliance Commercial |
$42,943.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$15,447.14
|
| Rate for Payer: United Healthcare PPO |
$24,338.18
|
| Rate for Payer: Wellcare Medicare |
$15,447.14
|
|
|
CARDIAC ARREST, UNEXPLAINED WITHOUT CC/MCC
|
Facility
|
IP
|
$12,010.00
|
|
|
Service Code
|
MSDRG 298
|
| Min. Negotiated Rate |
$4,320.25 |
| Max. Negotiated Rate |
$12,010.00 |
| Rate for Payer: Aetna Managed Medicare |
$4,320.25
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$9,231.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$7,075.64
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$6,722.32
|
| Rate for Payer: Anthem Medicare Advantage |
$4,320.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$4,320.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$4,320.25
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$4,320.25
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$7,462.39
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$4,320.25
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$8,558.55
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$4,320.25
|
| Rate for Payer: Independent Care Health Plan Medicare |
$4,320.25
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$4,320.25
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$4,320.25
|
| Rate for Payer: NAPHCARE Commercial |
$6,480.38
|
| Rate for Payer: Quartz Medicare Advantage |
$4,320.25
|
| Rate for Payer: The Alliance Commercial |
$12,010.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4,320.25
|
| Rate for Payer: United Healthcare PPO |
$6,662.94
|
| Rate for Payer: Wellcare Medicare |
$4,320.25
|
|
|
CARDIAC ARRHYTHMIA AND CONDUCTION DISORDERS WITH CC
|
Facility
|
IP
|
$20,119.00
|
|
|
Service Code
|
MSDRG 309
|
| Min. Negotiated Rate |
$7,237.06 |
| Max. Negotiated Rate |
$20,119.00 |
| Rate for Payer: Aetna Managed Medicare |
$7,237.06
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$15,525.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$11,899.94
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$11,305.72
|
| Rate for Payer: Anthem Medicare Advantage |
$7,237.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$7,237.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$7,237.06
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$7,237.06
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12,550.39
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$7,237.06
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$14,521.65
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$7,237.06
|
| Rate for Payer: Independent Care Health Plan Medicare |
$7,237.06
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$7,237.06
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$7,237.06
|
| Rate for Payer: NAPHCARE Commercial |
$10,855.59
|
| Rate for Payer: Quartz Medicare Advantage |
$7,237.06
|
| Rate for Payer: The Alliance Commercial |
$20,119.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$7,237.06
|
| Rate for Payer: United Healthcare PPO |
$11,305.29
|
| Rate for Payer: Wellcare Medicare |
$7,237.06
|
|
|
CARDIAC ARRHYTHMIA AND CONDUCTION DISORDERS WITH MCC
|
Facility
|
IP
|
$32,282.00
|
|
|
Service Code
|
MSDRG 308
|
| Min. Negotiated Rate |
$11,612.26 |
| Max. Negotiated Rate |
$32,282.00 |
| Rate for Payer: Aetna Managed Medicare |
$11,612.26
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$25,176.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$19,297.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$18,333.60
|
| Rate for Payer: Anthem Medicare Advantage |
$11,612.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$11,612.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$11,612.26
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$11,612.26
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$20,351.98
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$11,612.26
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$23,442.90
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$11,612.26
|
| Rate for Payer: Independent Care Health Plan Medicare |
$11,612.26
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$11,612.26
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$11,612.26
|
| Rate for Payer: NAPHCARE Commercial |
$17,418.39
|
| Rate for Payer: Quartz Medicare Advantage |
$11,612.26
|
| Rate for Payer: The Alliance Commercial |
$32,282.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$11,612.26
|
| Rate for Payer: United Healthcare PPO |
$18,250.60
|
| Rate for Payer: Wellcare Medicare |
$11,612.26
|
|
|
CARDIAC ARRHYTHMIA AND CONDUCTION DISORDERS WITHOUT CC/MCC
|
Facility
|
IP
|
$15,022.00
|
|
|
Service Code
|
MSDRG 310
|
| Min. Negotiated Rate |
$5,403.77 |
| Max. Negotiated Rate |
$15,022.00 |
| Rate for Payer: Aetna Managed Medicare |
$5,403.77
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$11,539.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8,844.55
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$8,402.90
|
| Rate for Payer: Anthem Medicare Advantage |
$5,403.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5,403.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5,403.77
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$5,403.77
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$9,327.99
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$5,403.77
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$10,783.50
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$5,403.77
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5,403.77
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$5,403.77
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$5,403.77
|
| Rate for Payer: NAPHCARE Commercial |
$8,105.66
|
| Rate for Payer: Quartz Medicare Advantage |
$5,403.77
|
| Rate for Payer: The Alliance Commercial |
$15,022.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5,403.77
|
| Rate for Payer: United Healthcare PPO |
$8,395.09
|
| Rate for Payer: Wellcare Medicare |
$5,403.77
|
|
|
CARDIAC CONGENITAL AND VALVULAR DISORDERS WITH MCC
|
Facility
|
IP
|
$41,178.00
|
|
|
Service Code
|
MSDRG 306
|
| Min. Negotiated Rate |
$14,812.14 |
| Max. Negotiated Rate |
$41,178.00 |
| Rate for Payer: Aetna Managed Medicare |
$14,812.14
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$32,309.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$24,764.74
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$23,528.12
|
| Rate for Payer: Anthem Medicare Advantage |
$14,812.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$14,812.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$14,812.14
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$14,812.14
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$26,118.37
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$14,812.14
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$29,967.60
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$14,812.14
|
| Rate for Payer: Independent Care Health Plan Medicare |
$14,812.14
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$14,812.14
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$14,812.14
|
| Rate for Payer: NAPHCARE Commercial |
$22,218.21
|
| Rate for Payer: Quartz Medicare Advantage |
$14,812.14
|
| Rate for Payer: The Alliance Commercial |
$41,178.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14,812.14
|
| Rate for Payer: United Healthcare PPO |
$23,330.16
|
| Rate for Payer: Wellcare Medicare |
$14,812.14
|
|
|
CARDIAC CONGENITAL AND VALVULAR DISORDERS WITHOUT MCC
|
Facility
|
IP
|
$25,380.00
|
|
|
Service Code
|
MSDRG 307
|
| Min. Negotiated Rate |
$9,129.63 |
| Max. Negotiated Rate |
$25,380.00 |
| Rate for Payer: Aetna Managed Medicare |
$9,129.63
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$19,721.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$15,116.14
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$14,361.32
|
| Rate for Payer: Anthem Medicare Advantage |
$9,129.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$9,129.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$9,129.63
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$9,129.63
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$15,942.38
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$9,129.63
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$18,380.70
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$9,129.63
|
| Rate for Payer: Independent Care Health Plan Medicare |
$9,129.63
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$9,129.63
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$9,129.63
|
| Rate for Payer: NAPHCARE Commercial |
$13,694.44
|
| Rate for Payer: Quartz Medicare Advantage |
$9,129.63
|
| Rate for Payer: The Alliance Commercial |
$25,380.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$9,129.63
|
| Rate for Payer: United Healthcare PPO |
$14,309.61
|
| Rate for Payer: Wellcare Medicare |
$9,129.63
|
|
|
CARDIAC DEFIBRILLATOR IMPLANT WITH CARDIAC CATHETERIZATION AND MCC
|
Facility
|
IP
|
$187,374.00
|
|
|
Service Code
|
MSDRG 275
|
| Min. Negotiated Rate |
$67,400.68 |
| Max. Negotiated Rate |
$187,374.00 |
| Rate for Payer: Aetna Managed Medicare |
$67,400.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$147,699.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$113,210.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$107,557.12
|
| Rate for Payer: Anthem Medicare Advantage |
$67,400.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$67,400.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$67,400.68
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$67,400.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$119,398.26
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$67,400.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$137,198.10
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$67,400.68
|
| Rate for Payer: Independent Care Health Plan Medicare |
$67,400.68
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$67,400.68
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$67,400.68
|
| Rate for Payer: NAPHCARE Commercial |
$101,101.02
|
| Rate for Payer: Quartz Medicare Advantage |
$67,400.68
|
| Rate for Payer: The Alliance Commercial |
$187,374.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$67,400.68
|
| Rate for Payer: United Healthcare PPO |
$106,810.48
|
| Rate for Payer: Wellcare Medicare |
$67,400.68
|
|
|
CARDIAC DEFIBRILLATOR IMPLANT WITH MCC
|
Facility
|
IP
|
$165,425.00
|
|
|
Service Code
|
MSDRG 276
|
| Min. Negotiated Rate |
$59,505.24 |
| Max. Negotiated Rate |
$165,425.00 |
| Rate for Payer: Aetna Managed Medicare |
$59,505.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$130,285.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$99,863.01
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$94,876.38
|
| Rate for Payer: Anthem Medicare Advantage |
$59,505.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$59,505.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$59,505.24
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$59,505.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$105,321.48
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$59,505.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$121,098.90
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$59,505.24
|
| Rate for Payer: Independent Care Health Plan Medicare |
$59,505.24
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$59,505.24
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$59,505.24
|
| Rate for Payer: NAPHCARE Commercial |
$89,257.86
|
| Rate for Payer: Quartz Medicare Advantage |
$59,505.24
|
| Rate for Payer: The Alliance Commercial |
$165,425.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$59,505.24
|
| Rate for Payer: United Healthcare PPO |
$94,277.05
|
| Rate for Payer: Wellcare Medicare |
$59,505.24
|
|
|
CARDIAC DEFIBRILLATOR IMPLANT WITHOUT MCC
|
Facility
|
IP
|
$127,465.00
|
|
|
Service Code
|
MSDRG 277
|
| Min. Negotiated Rate |
$45,850.76 |
| Max. Negotiated Rate |
$127,465.00 |
| Rate for Payer: Aetna Managed Medicare |
$45,850.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$100,284.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$76,867.18
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$73,028.84
|
| Rate for Payer: Anthem Medicare Advantage |
$45,850.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$45,850.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$45,850.76
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$45,850.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$81,068.70
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$45,850.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$93,256.80
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$45,850.76
|
| Rate for Payer: Independent Care Health Plan Medicare |
$45,850.76
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$45,850.76
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$45,850.76
|
| Rate for Payer: NAPHCARE Commercial |
$68,776.14
|
| Rate for Payer: Quartz Medicare Advantage |
$45,850.76
|
| Rate for Payer: The Alliance Commercial |
$127,465.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$45,850.76
|
| Rate for Payer: United Healthcare PPO |
$72,601.61
|
| Rate for Payer: Wellcare Medicare |
$45,850.76
|
|
|
CARDIAC DRUG STRESS TEST 93024
|
Professional
|
Both
|
$437.00
|
|
|
Service Code
|
CPT 93024
|
| Hospital Charge Code |
3015356
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$103.36 |
| Max. Negotiated Rate |
$415.15 |
| Rate for Payer: Aetna Commercial |
$415.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$375.82
|
| Rate for Payer: Cash Price |
$131.10
|
| Rate for Payer: Cash Price |
$131.10
|
| Rate for Payer: Cigna Commercial |
$415.15
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$103.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$262.20
|
| Rate for Payer: Health EOS Commercial |
$397.67
|
| Rate for Payer: HFN Commercial |
$415.15
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$370.23
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$370.23
|
| Rate for Payer: Multiplan Commercial |
$349.60
|
| Rate for Payer: Preferred Network Access Commercial |
$415.15
|
| Rate for Payer: Quartz Beloit One Network |
$192.28
|
| Rate for Payer: Quartz Commercial |
$249.09
|
| Rate for Payer: The Alliance Commercial |
$218.50
|
| Rate for Payer: United Healthcare Medicaid |
$103.36
|
| Rate for Payer: WEA Trust Commercial |
$240.35
|
| Rate for Payer: WPS Commercial |
$323.69
|
|
