|
CD4/CD8 Ratio
|
Professional
|
$97.00
|
|
|
Service Code
|
CPT 86360
|
| Hospital Charge Code |
4746614
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$42.68 |
| Max. Negotiated Rate |
$206.71 |
| Rate for Payer: Aetna Commercial |
$92.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$83.42
|
| Rate for Payer: Aetna Managed Medicare |
$46.98
|
| Rate for Payer: Anthem Medicare Advantage |
$46.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$46.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$46.98
|
| Rate for Payer: Cash Price |
$29.10
|
| Rate for Payer: Cash Price |
$29.10
|
| Rate for Payer: Cigna Commercial |
$92.15
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$48.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$46.98
|
| Rate for Payer: Health EOS Commercial |
$88.27
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$165.84
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$165.84
|
| Rate for Payer: Independent Care Health Plan Medicare |
$46.98
|
| Rate for Payer: Multiplan Commercial |
$77.60
|
| Rate for Payer: Preferred Network Access Commercial |
$92.15
|
| Rate for Payer: Quartz Beloit One Network |
$42.68
|
| Rate for Payer: Quartz Commercial |
$55.29
|
| Rate for Payer: Quartz Medicare Advantage |
$46.98
|
| Rate for Payer: The Alliance Commercial |
$185.57
|
| Rate for Payer: United Healthcare Medicare Advantage |
$46.98
|
| Rate for Payer: WEA Trust Commercial |
$53.35
|
| Rate for Payer: WPS Commercial |
$206.71
|
|
|
CD57, CD3, CD8 Flow Cytometry
|
Professional
|
$98.00
|
|
|
Service Code
|
CPT 88185
|
| Hospital Charge Code |
3451558
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$22.86 |
| Max. Negotiated Rate |
$100.58 |
| Rate for Payer: Aetna Commercial |
$93.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$84.28
|
| Rate for Payer: Aetna Managed Medicare |
$22.86
|
| Rate for Payer: Anthem Medicare Advantage |
$22.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$22.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$22.86
|
| Rate for Payer: Cash Price |
$29.40
|
| Rate for Payer: Cash Price |
$29.40
|
| Rate for Payer: Cigna Commercial |
$93.10
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$49.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$22.86
|
| Rate for Payer: Health EOS Commercial |
$89.18
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$76.57
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$76.57
|
| Rate for Payer: Independent Care Health Plan Medicare |
$22.86
|
| Rate for Payer: Multiplan Commercial |
$78.40
|
| Rate for Payer: Preferred Network Access Commercial |
$93.10
|
| Rate for Payer: Quartz Beloit One Network |
$43.12
|
| Rate for Payer: Quartz Commercial |
$55.86
|
| Rate for Payer: Quartz Medicare Advantage |
$22.86
|
| Rate for Payer: The Alliance Commercial |
$90.30
|
| Rate for Payer: United Healthcare Medicare Advantage |
$22.86
|
| Rate for Payer: WEA Trust Commercial |
$53.90
|
| Rate for Payer: WPS Commercial |
$100.58
|
|
|
CD57, CD3, CD8 Flow Cytometry
|
Facility
IP
|
$98.00
|
|
|
Service Code
|
CPT 88185
|
| Hospital Charge Code |
3451558
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$48.02 |
| Max. Negotiated Rate |
$90.16 |
| Rate for Payer: Aetna Commercial |
$88.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$51.94
|
| Rate for Payer: Cash Price |
$29.40
|
| Rate for Payer: Cigna Commercial |
$90.16
|
| Rate for Payer: Health EOS Commercial |
$87.22
|
| Rate for Payer: HFN Commercial |
$90.16
|
| Rate for Payer: Multiplan Commercial |
$78.40
|
| Rate for Payer: NAPHCARE Commercial |
$58.80
|
| Rate for Payer: Preferred Network Access Commercial |
$90.16
|
| Rate for Payer: Quartz Beloit One Network |
$48.02
|
| Rate for Payer: Quartz Commercial |
$58.80
|
| Rate for Payer: WEA Trust Commercial |
$53.90
|
| Rate for Payer: WPS Commercial |
$72.59
|
|
|
CD57, CD3, CD8 Flow Cytometry
|
Facility
OP
|
$98.00
|
|
|
Service Code
|
CPT 88185
|
| Hospital Charge Code |
3451558
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$27.44 |
| Max. Negotiated Rate |
$90.16 |
| Rate for Payer: Aetna Commercial |
$88.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$84.28
|
| Rate for Payer: Aetna Managed Medicare |
$27.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$63.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$49.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$47.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$51.94
|
| Rate for Payer: Cash Price |
$29.40
|
| Rate for Payer: Cash Price |
$29.40
|
| Rate for Payer: Cigna Commercial |
$90.16
|
| Rate for Payer: Health EOS Commercial |
$87.22
|
| Rate for Payer: HFN Commercial |
$90.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$73.50
|
| Rate for Payer: Multiplan Commercial |
$78.40
|
| Rate for Payer: NAPHCARE Commercial |
$58.80
|
| Rate for Payer: Preferred Network Access Commercial |
$90.16
|
| Rate for Payer: Quartz Beloit One Network |
$48.02
|
| Rate for Payer: Quartz Commercial |
$63.70
|
| Rate for Payer: Quartz Medicare Advantage |
$58.80
|
| Rate for Payer: United Healthcare PPO |
$73.50
|
| Rate for Payer: WEA Trust Commercial |
$53.90
|
| Rate for Payer: WPS Commercial |
$72.59
|
|
|
C diff 027-NAP1-BI
|
Facility
OP
|
$168.00
|
|
|
Service Code
|
CPT 87493
|
| Hospital Charge Code |
4125436
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$37.27 |
| Max. Negotiated Rate |
$672.00 |
| Rate for Payer: Aetna Commercial |
$151.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$144.48
|
| Rate for Payer: Aetna Managed Medicare |
$37.27
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$139.76
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$65.22
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$61.87
|
| Rate for Payer: Anthem Medicaid |
$38.51
|
| Rate for Payer: Anthem Medicare Advantage |
$37.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$89.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$37.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$37.27
|
| Rate for Payer: Cash Price |
$50.40
|
| Rate for Payer: Cash Price |
$50.40
|
| Rate for Payer: Cigna Commercial |
$154.56
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$37.27
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$38.51
|
| Rate for Payer: Dean Health Medicaid |
$38.51
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$37.27
|
| Rate for Payer: Health EOS Commercial |
$149.52
|
| Rate for Payer: HFN Commercial |
$154.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$138.64
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$37.27
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$38.51
|
| Rate for Payer: Independent Care Health Plan Medicare |
$37.27
|
| Rate for Payer: Managed Health Services Medicaid |
$40.05
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$37.27
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$37.27
|
| Rate for Payer: Multiplan Commercial |
$134.40
|
| Rate for Payer: NAPHCARE Commercial |
$55.90
|
| Rate for Payer: Preferred Network Access Commercial |
$154.56
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$38.51
|
| Rate for Payer: Quartz Beloit One Network |
$82.32
|
| Rate for Payer: Quartz Commercial |
$109.20
|
| Rate for Payer: Quartz Medicare Advantage |
$37.27
|
| Rate for Payer: The Alliance Commercial |
$672.00
|
| Rate for Payer: United Healthcare Medicaid |
$38.51
|
| Rate for Payer: United Healthcare Medicare Advantage |
$37.27
|
| Rate for Payer: United Healthcare PPO |
$126.00
|
| Rate for Payer: WEA Trust Commercial |
$92.40
|
| Rate for Payer: Wellcare Medicare |
$37.27
|
| Rate for Payer: WMAP Medicaid |
$38.51
|
| Rate for Payer: WPS Commercial |
$124.44
|
|
|
C diff 027-NAP1-BI
|
Professional
|
$168.00
|
|
|
Service Code
|
CPT 87493
|
| Hospital Charge Code |
4125436
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$37.27 |
| Max. Negotiated Rate |
$163.99 |
| Rate for Payer: Aetna Commercial |
$159.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$144.48
|
| Rate for Payer: Aetna Managed Medicare |
$37.27
|
| Rate for Payer: Anthem Medicare Advantage |
$37.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$37.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$37.27
|
| Rate for Payer: Cash Price |
$50.40
|
| Rate for Payer: Cash Price |
$50.40
|
| Rate for Payer: Cigna Commercial |
$159.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$84.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$37.27
|
| Rate for Payer: Health EOS Commercial |
$152.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$131.56
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$131.56
|
| Rate for Payer: Independent Care Health Plan Medicare |
$37.27
|
| Rate for Payer: Multiplan Commercial |
$134.40
|
| Rate for Payer: Preferred Network Access Commercial |
$159.60
|
| Rate for Payer: Quartz Beloit One Network |
$73.92
|
| Rate for Payer: Quartz Commercial |
$95.76
|
| Rate for Payer: Quartz Medicare Advantage |
$37.27
|
| Rate for Payer: The Alliance Commercial |
$147.22
|
| Rate for Payer: United Healthcare Medicare Advantage |
$37.27
|
| Rate for Payer: WEA Trust Commercial |
$92.40
|
| Rate for Payer: WPS Commercial |
$163.99
|
|
|
C diff 027-NAP1-BI
|
Facility
IP
|
$168.00
|
|
|
Service Code
|
CPT 87493
|
| Hospital Charge Code |
4125436
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$82.32 |
| Max. Negotiated Rate |
$154.56 |
| Rate for Payer: Aetna Commercial |
$151.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$89.04
|
| Rate for Payer: Cash Price |
$50.40
|
| Rate for Payer: Cigna Commercial |
$154.56
|
| Rate for Payer: Health EOS Commercial |
$149.52
|
| Rate for Payer: HFN Commercial |
$154.56
|
| Rate for Payer: Multiplan Commercial |
$134.40
|
| Rate for Payer: NAPHCARE Commercial |
$100.80
|
| Rate for Payer: Preferred Network Access Commercial |
$154.56
|
| Rate for Payer: Quartz Beloit One Network |
$82.32
|
| Rate for Payer: Quartz Commercial |
$100.80
|
| Rate for Payer: WEA Trust Commercial |
$92.40
|
| Rate for Payer: WPS Commercial |
$124.44
|
|
|
C diff B
|
Facility
IP
|
$665.00
|
|
|
Service Code
|
CPT 87324
|
| Hospital Charge Code |
2790811
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$325.85 |
| Max. Negotiated Rate |
$611.80 |
| Rate for Payer: Aetna Commercial |
$598.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$352.45
|
| Rate for Payer: Cash Price |
$199.50
|
| Rate for Payer: Cigna Commercial |
$611.80
|
| Rate for Payer: Health EOS Commercial |
$591.85
|
| Rate for Payer: HFN Commercial |
$611.80
|
| Rate for Payer: Multiplan Commercial |
$532.00
|
| Rate for Payer: NAPHCARE Commercial |
$399.00
|
| Rate for Payer: Preferred Network Access Commercial |
$611.80
|
| Rate for Payer: Quartz Beloit One Network |
$325.85
|
| Rate for Payer: Quartz Commercial |
$399.00
|
| Rate for Payer: WEA Trust Commercial |
$365.75
|
| Rate for Payer: WPS Commercial |
$492.57
|
|
|
C diff B
|
Professional
|
$665.00
|
|
|
Service Code
|
CPT 87324
|
| Hospital Charge Code |
2790811
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.98 |
| Max. Negotiated Rate |
$631.75 |
| Rate for Payer: Aetna Commercial |
$631.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$571.90
|
| Rate for Payer: Aetna Managed Medicare |
$11.98
|
| Rate for Payer: Anthem Medicare Advantage |
$11.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$11.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$11.98
|
| Rate for Payer: Cash Price |
$199.50
|
| Rate for Payer: Cash Price |
$199.50
|
| Rate for Payer: Cigna Commercial |
$631.75
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$332.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$11.98
|
| Rate for Payer: Health EOS Commercial |
$605.15
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$42.29
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$42.29
|
| Rate for Payer: Independent Care Health Plan Medicare |
$11.98
|
| Rate for Payer: Multiplan Commercial |
$532.00
|
| Rate for Payer: Preferred Network Access Commercial |
$631.75
|
| Rate for Payer: Quartz Beloit One Network |
$292.60
|
| Rate for Payer: Quartz Commercial |
$379.05
|
| Rate for Payer: Quartz Medicare Advantage |
$11.98
|
| Rate for Payer: The Alliance Commercial |
$47.32
|
| Rate for Payer: United Healthcare Medicare Advantage |
$11.98
|
| Rate for Payer: WEA Trust Commercial |
$365.75
|
| Rate for Payer: WPS Commercial |
$52.71
|
|
|
C diff B
|
Facility
OP
|
$665.00
|
|
|
Service Code
|
CPT 87324
|
| Hospital Charge Code |
2790811
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.98 |
| Max. Negotiated Rate |
$2,660.00 |
| Rate for Payer: Aetna Commercial |
$598.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$571.90
|
| Rate for Payer: Aetna Managed Medicare |
$11.98
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$44.92
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$20.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$19.89
|
| Rate for Payer: Anthem Medicaid |
$12.38
|
| Rate for Payer: Anthem Medicare Advantage |
$11.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$352.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$11.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$11.98
|
| Rate for Payer: Cash Price |
$199.50
|
| Rate for Payer: Cash Price |
$199.50
|
| Rate for Payer: Cigna Commercial |
$611.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$11.98
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$12.38
|
| Rate for Payer: Dean Health Medicaid |
$12.38
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$11.98
|
| Rate for Payer: Health EOS Commercial |
$591.85
|
| Rate for Payer: HFN Commercial |
$611.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$44.57
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$11.98
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$12.38
|
| Rate for Payer: Independent Care Health Plan Medicare |
$11.98
|
| Rate for Payer: Managed Health Services Medicaid |
$12.88
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$11.98
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$11.98
|
| Rate for Payer: Multiplan Commercial |
$532.00
|
| Rate for Payer: NAPHCARE Commercial |
$17.97
|
| Rate for Payer: Preferred Network Access Commercial |
$611.80
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$12.38
|
| Rate for Payer: Quartz Beloit One Network |
$325.85
|
| Rate for Payer: Quartz Commercial |
$432.25
|
| Rate for Payer: Quartz Medicare Advantage |
$11.98
|
| Rate for Payer: The Alliance Commercial |
$2,660.00
|
| Rate for Payer: United Healthcare Medicaid |
$12.38
|
| Rate for Payer: United Healthcare Medicare Advantage |
$11.98
|
| Rate for Payer: United Healthcare PPO |
$498.75
|
| Rate for Payer: WEA Trust Commercial |
$365.75
|
| Rate for Payer: Wellcare Medicare |
$11.98
|
| Rate for Payer: WMAP Medicaid |
$12.38
|
| Rate for Payer: WPS Commercial |
$492.57
|
|
|
C diff, PCR w/Rfx Cdiff Toxin A/B
|
Facility
OP
|
$136.00
|
|
|
Service Code
|
CPT 87493
|
| Hospital Charge Code |
4109350
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$37.27 |
| Max. Negotiated Rate |
$544.00 |
| Rate for Payer: Aetna Commercial |
$122.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$116.96
|
| Rate for Payer: Aetna Managed Medicare |
$37.27
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$139.76
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$65.22
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$61.87
|
| Rate for Payer: Anthem Medicaid |
$38.51
|
| Rate for Payer: Anthem Medicare Advantage |
$37.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$72.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$37.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$37.27
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cigna Commercial |
$125.12
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$37.27
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$38.51
|
| Rate for Payer: Dean Health Medicaid |
$38.51
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$37.27
|
| Rate for Payer: Health EOS Commercial |
$121.04
|
| Rate for Payer: HFN Commercial |
$125.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$138.64
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$37.27
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$38.51
|
| Rate for Payer: Independent Care Health Plan Medicare |
$37.27
|
| Rate for Payer: Managed Health Services Medicaid |
$40.05
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$37.27
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$37.27
|
| Rate for Payer: Multiplan Commercial |
$108.80
|
| Rate for Payer: NAPHCARE Commercial |
$55.90
|
| Rate for Payer: Preferred Network Access Commercial |
$125.12
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$38.51
|
| Rate for Payer: Quartz Beloit One Network |
$66.64
|
| Rate for Payer: Quartz Commercial |
$88.40
|
| Rate for Payer: Quartz Medicare Advantage |
$37.27
|
| Rate for Payer: The Alliance Commercial |
$544.00
|
| Rate for Payer: United Healthcare Medicaid |
$38.51
|
| Rate for Payer: United Healthcare Medicare Advantage |
$37.27
|
| Rate for Payer: United Healthcare PPO |
$102.00
|
| Rate for Payer: WEA Trust Commercial |
$74.80
|
| Rate for Payer: Wellcare Medicare |
$37.27
|
| Rate for Payer: WMAP Medicaid |
$38.51
|
| Rate for Payer: WPS Commercial |
$100.74
|
|
|
C diff, PCR w/Rfx Cdiff Toxin A/B
|
Facility
IP
|
$136.00
|
|
|
Service Code
|
CPT 87493
|
| Hospital Charge Code |
4109350
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$66.64 |
| Max. Negotiated Rate |
$125.12 |
| Rate for Payer: Aetna Commercial |
$122.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$72.08
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cigna Commercial |
$125.12
|
| Rate for Payer: Health EOS Commercial |
$121.04
|
| Rate for Payer: HFN Commercial |
$125.12
|
| Rate for Payer: Multiplan Commercial |
$108.80
|
| Rate for Payer: NAPHCARE Commercial |
$81.60
|
| Rate for Payer: Preferred Network Access Commercial |
$125.12
|
| Rate for Payer: Quartz Beloit One Network |
$66.64
|
| Rate for Payer: Quartz Commercial |
$81.60
|
| Rate for Payer: WEA Trust Commercial |
$74.80
|
| Rate for Payer: WPS Commercial |
$100.74
|
|
|
C diff, PCR w/Rfx Cdiff Toxin A/B
|
Professional
|
$136.00
|
|
|
Service Code
|
CPT 87493
|
| Hospital Charge Code |
4109350
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$37.27 |
| Max. Negotiated Rate |
$163.99 |
| Rate for Payer: Aetna Commercial |
$129.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$116.96
|
| Rate for Payer: Aetna Managed Medicare |
$37.27
|
| Rate for Payer: Anthem Medicare Advantage |
$37.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$37.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$37.27
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cigna Commercial |
$129.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$68.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$37.27
|
| Rate for Payer: Health EOS Commercial |
$123.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$131.56
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$131.56
|
| Rate for Payer: Independent Care Health Plan Medicare |
$37.27
|
| Rate for Payer: Multiplan Commercial |
$108.80
|
| Rate for Payer: Preferred Network Access Commercial |
$129.20
|
| Rate for Payer: Quartz Beloit One Network |
$59.84
|
| Rate for Payer: Quartz Commercial |
$77.52
|
| Rate for Payer: Quartz Medicare Advantage |
$37.27
|
| Rate for Payer: The Alliance Commercial |
$147.22
|
| Rate for Payer: United Healthcare Medicare Advantage |
$37.27
|
| Rate for Payer: WEA Trust Commercial |
$74.80
|
| Rate for Payer: WPS Commercial |
$163.99
|
|
|
C diff Toxin A/B, EIA
|
Facility
IP
|
$79.00
|
|
|
Service Code
|
CPT 87324
|
| Hospital Charge Code |
5432762
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$38.71 |
| Max. Negotiated Rate |
$72.68 |
| Rate for Payer: Aetna Commercial |
$71.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$41.87
|
| Rate for Payer: Cash Price |
$23.70
|
| Rate for Payer: Cigna Commercial |
$72.68
|
| Rate for Payer: Health EOS Commercial |
$70.31
|
| Rate for Payer: HFN Commercial |
$72.68
|
| Rate for Payer: Multiplan Commercial |
$63.20
|
| Rate for Payer: NAPHCARE Commercial |
$47.40
|
| Rate for Payer: Preferred Network Access Commercial |
$72.68
|
| Rate for Payer: Quartz Beloit One Network |
$38.71
|
| Rate for Payer: Quartz Commercial |
$47.40
|
| Rate for Payer: WEA Trust Commercial |
$43.45
|
| Rate for Payer: WPS Commercial |
$58.52
|
|
|
C diff Toxin A/B, EIA
|
Facility
OP
|
$79.00
|
|
|
Service Code
|
CPT 87324
|
| Hospital Charge Code |
5432762
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.98 |
| Max. Negotiated Rate |
$316.00 |
| Rate for Payer: Aetna Commercial |
$71.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$67.94
|
| Rate for Payer: Aetna Managed Medicare |
$11.98
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$44.92
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$20.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$19.89
|
| Rate for Payer: Anthem Medicaid |
$12.38
|
| Rate for Payer: Anthem Medicare Advantage |
$11.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$41.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$11.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$11.98
|
| Rate for Payer: Cash Price |
$23.70
|
| Rate for Payer: Cash Price |
$23.70
|
| Rate for Payer: Cigna Commercial |
$72.68
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$11.98
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$12.38
|
| Rate for Payer: Dean Health Medicaid |
$12.38
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$11.98
|
| Rate for Payer: Health EOS Commercial |
$70.31
|
| Rate for Payer: HFN Commercial |
$72.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$44.57
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$11.98
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$12.38
|
| Rate for Payer: Independent Care Health Plan Medicare |
$11.98
|
| Rate for Payer: Managed Health Services Medicaid |
$12.88
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$11.98
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$11.98
|
| Rate for Payer: Multiplan Commercial |
$63.20
|
| Rate for Payer: NAPHCARE Commercial |
$17.97
|
| Rate for Payer: Preferred Network Access Commercial |
$72.68
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$12.38
|
| Rate for Payer: Quartz Beloit One Network |
$38.71
|
| Rate for Payer: Quartz Commercial |
$51.35
|
| Rate for Payer: Quartz Medicare Advantage |
$11.98
|
| Rate for Payer: The Alliance Commercial |
$316.00
|
| Rate for Payer: United Healthcare Medicaid |
$12.38
|
| Rate for Payer: United Healthcare Medicare Advantage |
$11.98
|
| Rate for Payer: United Healthcare PPO |
$59.25
|
| Rate for Payer: WEA Trust Commercial |
$43.45
|
| Rate for Payer: Wellcare Medicare |
$11.98
|
| Rate for Payer: WMAP Medicaid |
$12.38
|
| Rate for Payer: WPS Commercial |
$58.52
|
|
|
C diff Toxin A/B, EIA
|
Professional
|
$79.00
|
|
|
Service Code
|
CPT 87324
|
| Hospital Charge Code |
5432762
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.98 |
| Max. Negotiated Rate |
$75.05 |
| Rate for Payer: Aetna Commercial |
$75.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$67.94
|
| Rate for Payer: Aetna Managed Medicare |
$11.98
|
| Rate for Payer: Anthem Medicare Advantage |
$11.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$11.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$11.98
|
| Rate for Payer: Cash Price |
$23.70
|
| Rate for Payer: Cash Price |
$23.70
|
| Rate for Payer: Cigna Commercial |
$75.05
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$39.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$11.98
|
| Rate for Payer: Health EOS Commercial |
$71.89
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$42.29
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$42.29
|
| Rate for Payer: Independent Care Health Plan Medicare |
$11.98
|
| Rate for Payer: Multiplan Commercial |
$63.20
|
| Rate for Payer: Preferred Network Access Commercial |
$75.05
|
| Rate for Payer: Quartz Beloit One Network |
$34.76
|
| Rate for Payer: Quartz Commercial |
$45.03
|
| Rate for Payer: Quartz Medicare Advantage |
$11.98
|
| Rate for Payer: The Alliance Commercial |
$47.32
|
| Rate for Payer: United Healthcare Medicare Advantage |
$11.98
|
| Rate for Payer: WEA Trust Commercial |
$43.45
|
| Rate for Payer: WPS Commercial |
$52.71
|
|
|
C. diff Toxin/GDH
|
Facility
IP
|
$101.00
|
|
|
Service Code
|
CPT 87324
|
| Hospital Charge Code |
5230628
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$49.49 |
| Max. Negotiated Rate |
$92.92 |
| Rate for Payer: Aetna Commercial |
$90.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$53.53
|
| Rate for Payer: Cash Price |
$30.30
|
| Rate for Payer: Cigna Commercial |
$92.92
|
| Rate for Payer: Health EOS Commercial |
$89.89
|
| Rate for Payer: HFN Commercial |
$92.92
|
| Rate for Payer: Multiplan Commercial |
$80.80
|
| Rate for Payer: NAPHCARE Commercial |
$60.60
|
| Rate for Payer: Preferred Network Access Commercial |
$92.92
|
| Rate for Payer: Quartz Beloit One Network |
$49.49
|
| Rate for Payer: Quartz Commercial |
$60.60
|
| Rate for Payer: WEA Trust Commercial |
$55.55
|
| Rate for Payer: WPS Commercial |
$74.81
|
|
|
C. diff Toxin/GDH
|
Professional
|
$101.00
|
|
|
Service Code
|
CPT 87324
|
| Hospital Charge Code |
5230628
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.98 |
| Max. Negotiated Rate |
$95.95 |
| Rate for Payer: Aetna Commercial |
$95.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$86.86
|
| Rate for Payer: Aetna Managed Medicare |
$11.98
|
| Rate for Payer: Anthem Medicare Advantage |
$11.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$11.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$11.98
|
| Rate for Payer: Cash Price |
$30.30
|
| Rate for Payer: Cash Price |
$30.30
|
| Rate for Payer: Cigna Commercial |
$95.95
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$50.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$11.98
|
| Rate for Payer: Health EOS Commercial |
$91.91
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$42.29
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$42.29
|
| Rate for Payer: Independent Care Health Plan Medicare |
$11.98
|
| Rate for Payer: Multiplan Commercial |
$80.80
|
| Rate for Payer: Preferred Network Access Commercial |
$95.95
|
| Rate for Payer: Quartz Beloit One Network |
$44.44
|
| Rate for Payer: Quartz Commercial |
$57.57
|
| Rate for Payer: Quartz Medicare Advantage |
$11.98
|
| Rate for Payer: The Alliance Commercial |
$47.32
|
| Rate for Payer: United Healthcare Medicare Advantage |
$11.98
|
| Rate for Payer: WEA Trust Commercial |
$55.55
|
| Rate for Payer: WPS Commercial |
$52.71
|
|
|
C. diff Toxin/GDH
|
Facility
OP
|
$101.00
|
|
|
Service Code
|
CPT 87324
|
| Hospital Charge Code |
5230628
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.98 |
| Max. Negotiated Rate |
$404.00 |
| Rate for Payer: Aetna Commercial |
$90.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$86.86
|
| Rate for Payer: Aetna Managed Medicare |
$11.98
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$44.92
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$20.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$19.89
|
| Rate for Payer: Anthem Medicaid |
$12.38
|
| Rate for Payer: Anthem Medicare Advantage |
$11.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$53.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$11.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$11.98
|
| Rate for Payer: Cash Price |
$30.30
|
| Rate for Payer: Cash Price |
$30.30
|
| Rate for Payer: Cigna Commercial |
$92.92
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$11.98
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$12.38
|
| Rate for Payer: Dean Health Medicaid |
$12.38
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$11.98
|
| Rate for Payer: Health EOS Commercial |
$89.89
|
| Rate for Payer: HFN Commercial |
$92.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$44.57
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$11.98
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$12.38
|
| Rate for Payer: Independent Care Health Plan Medicare |
$11.98
|
| Rate for Payer: Managed Health Services Medicaid |
$12.88
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$11.98
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$11.98
|
| Rate for Payer: Multiplan Commercial |
$80.80
|
| Rate for Payer: NAPHCARE Commercial |
$17.97
|
| Rate for Payer: Preferred Network Access Commercial |
$92.92
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$12.38
|
| Rate for Payer: Quartz Beloit One Network |
$49.49
|
| Rate for Payer: Quartz Commercial |
$65.65
|
| Rate for Payer: Quartz Medicare Advantage |
$11.98
|
| Rate for Payer: The Alliance Commercial |
$404.00
|
| Rate for Payer: United Healthcare Medicaid |
$12.38
|
| Rate for Payer: United Healthcare Medicare Advantage |
$11.98
|
| Rate for Payer: United Healthcare PPO |
$75.75
|
| Rate for Payer: WEA Trust Commercial |
$55.55
|
| Rate for Payer: Wellcare Medicare |
$11.98
|
| Rate for Payer: WMAP Medicaid |
$12.38
|
| Rate for Payer: WPS Commercial |
$74.81
|
|
|
CDS C-SECTION BOX DYNJ900878J
|
Facility
IP
|
$1,400.00
|
|
| Hospital Charge Code |
4115516
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$686.00 |
| Max. Negotiated Rate |
$1,288.00 |
| Rate for Payer: Aetna Commercial |
$1,260.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$742.00
|
| Rate for Payer: Cash Price |
$420.00
|
| Rate for Payer: Cigna Commercial |
$1,288.00
|
| Rate for Payer: Health EOS Commercial |
$1,246.00
|
| Rate for Payer: HFN Commercial |
$1,288.00
|
| Rate for Payer: Multiplan Commercial |
$1,120.00
|
| Rate for Payer: NAPHCARE Commercial |
$840.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,288.00
|
| Rate for Payer: Quartz Beloit One Network |
$686.00
|
| Rate for Payer: Quartz Commercial |
$840.00
|
| Rate for Payer: WEA Trust Commercial |
$770.00
|
| Rate for Payer: WPS Commercial |
$1,036.98
|
|
|
CDS C-SECTION BOX DYNJ900878J
|
Facility
OP
|
$1,400.00
|
|
| Hospital Charge Code |
4115516
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$392.00 |
| Max. Negotiated Rate |
$5,600.00 |
| Rate for Payer: Aetna Commercial |
$1,260.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,204.00
|
| Rate for Payer: Aetna Managed Medicare |
$392.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$910.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$700.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$672.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$742.00
|
| Rate for Payer: Cash Price |
$420.00
|
| Rate for Payer: Cigna Commercial |
$1,288.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$783.44
|
| Rate for Payer: Health EOS Commercial |
$1,246.00
|
| Rate for Payer: HFN Commercial |
$1,288.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,050.00
|
| Rate for Payer: Multiplan Commercial |
$1,120.00
|
| Rate for Payer: NAPHCARE Commercial |
$840.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,288.00
|
| Rate for Payer: Quartz Beloit One Network |
$686.00
|
| Rate for Payer: Quartz Commercial |
$910.00
|
| Rate for Payer: Quartz Medicare Advantage |
$840.00
|
| Rate for Payer: The Alliance Commercial |
$5,600.00
|
| Rate for Payer: WEA Trust Commercial |
$770.00
|
| Rate for Payer: WPS Commercial |
$1,036.98
|
|
|
CDS CYSTO/TUR BOX DYNJ900875K
|
Facility
IP
|
$1,556.00
|
|
| Hospital Charge Code |
4124774
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$762.44 |
| Max. Negotiated Rate |
$1,431.52 |
| Rate for Payer: Aetna Commercial |
$1,400.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$824.68
|
| Rate for Payer: Cash Price |
$466.80
|
| Rate for Payer: Cigna Commercial |
$1,431.52
|
| Rate for Payer: Health EOS Commercial |
$1,384.84
|
| Rate for Payer: HFN Commercial |
$1,431.52
|
| Rate for Payer: Multiplan Commercial |
$1,244.80
|
| Rate for Payer: NAPHCARE Commercial |
$933.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,431.52
|
| Rate for Payer: Quartz Beloit One Network |
$762.44
|
| Rate for Payer: Quartz Commercial |
$933.60
|
| Rate for Payer: WEA Trust Commercial |
$855.80
|
| Rate for Payer: WPS Commercial |
$1,152.53
|
|
|
CDS CYSTO/TUR BOX DYNJ900875K
|
Facility
OP
|
$1,556.00
|
|
| Hospital Charge Code |
4124774
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$435.68 |
| Max. Negotiated Rate |
$6,224.00 |
| Rate for Payer: Aetna Commercial |
$1,400.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,338.16
|
| Rate for Payer: Aetna Managed Medicare |
$435.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,011.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$778.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$746.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$824.68
|
| Rate for Payer: Cash Price |
$466.80
|
| Rate for Payer: Cigna Commercial |
$1,431.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$870.74
|
| Rate for Payer: Health EOS Commercial |
$1,384.84
|
| Rate for Payer: HFN Commercial |
$1,431.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,167.00
|
| Rate for Payer: Multiplan Commercial |
$1,244.80
|
| Rate for Payer: NAPHCARE Commercial |
$933.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,431.52
|
| Rate for Payer: Quartz Beloit One Network |
$762.44
|
| Rate for Payer: Quartz Commercial |
$1,011.40
|
| Rate for Payer: Quartz Medicare Advantage |
$933.60
|
| Rate for Payer: The Alliance Commercial |
$6,224.00
|
| Rate for Payer: WEA Trust Commercial |
$855.80
|
| Rate for Payer: WPS Commercial |
$1,152.53
|
|
|
CDS ENT/HEAD & NECK BOX DYNJ900886
|
Facility
IP
|
$1,805.00
|
|
| Hospital Charge Code |
4124771
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$884.45 |
| Max. Negotiated Rate |
$1,660.60 |
| Rate for Payer: Aetna Commercial |
$1,624.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$956.65
|
| Rate for Payer: Cash Price |
$541.50
|
| Rate for Payer: Cigna Commercial |
$1,660.60
|
| Rate for Payer: Health EOS Commercial |
$1,606.45
|
| Rate for Payer: HFN Commercial |
$1,660.60
|
| Rate for Payer: Multiplan Commercial |
$1,444.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,083.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,660.60
|
| Rate for Payer: Quartz Beloit One Network |
$884.45
|
| Rate for Payer: Quartz Commercial |
$1,083.00
|
| Rate for Payer: WEA Trust Commercial |
$992.75
|
| Rate for Payer: WPS Commercial |
$1,336.96
|
|
|
CDS ENT/HEAD & NECK BOX DYNJ900886
|
Facility
OP
|
$1,805.00
|
|
| Hospital Charge Code |
4124771
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$505.40 |
| Max. Negotiated Rate |
$7,220.00 |
| Rate for Payer: Aetna Commercial |
$1,624.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,552.30
|
| Rate for Payer: Aetna Managed Medicare |
$505.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,173.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$902.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$866.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$956.65
|
| Rate for Payer: Cash Price |
$541.50
|
| Rate for Payer: Cigna Commercial |
$1,660.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,010.08
|
| Rate for Payer: Health EOS Commercial |
$1,606.45
|
| Rate for Payer: HFN Commercial |
$1,660.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,353.75
|
| Rate for Payer: Multiplan Commercial |
$1,444.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,083.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,660.60
|
| Rate for Payer: Quartz Beloit One Network |
$884.45
|
| Rate for Payer: Quartz Commercial |
$1,173.25
|
| Rate for Payer: Quartz Medicare Advantage |
$1,083.00
|
| Rate for Payer: The Alliance Commercial |
$7,220.00
|
| Rate for Payer: WEA Trust Commercial |
$992.75
|
| Rate for Payer: WPS Commercial |
$1,336.96
|
|
