|
Celiac Serology EMA
|
Professional
|
Both
|
$427.00
|
|
|
Service Code
|
CPT 88346
|
| Hospital Charge Code |
3331526
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$33.43 |
| Max. Negotiated Rate |
$488.69 |
| Rate for Payer: Aetna Commercial |
$405.65
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$367.22
|
| Rate for Payer: Anthem Commercial |
$33.43
|
| Rate for Payer: Cash Price |
$128.10
|
| Rate for Payer: Cash Price |
$128.10
|
| Rate for Payer: Cigna Commercial |
$405.65
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$213.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$256.20
|
| Rate for Payer: Health EOS Commercial |
$388.57
|
| Rate for Payer: HFN Commercial |
$405.65
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$488.69
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$488.69
|
| Rate for Payer: Multiplan Commercial |
$341.60
|
| Rate for Payer: Preferred Network Access Commercial |
$405.65
|
| Rate for Payer: Quartz Beloit One Network |
$187.88
|
| Rate for Payer: Quartz Commercial |
$243.39
|
| Rate for Payer: The Alliance Commercial |
$213.50
|
| Rate for Payer: WEA Trust Commercial |
$234.85
|
| Rate for Payer: WPS Commercial |
$316.28
|
|
|
Celiac Serology EMA
|
Facility
|
OP
|
$427.00
|
|
|
Service Code
|
CPT 88346
|
| Hospital Charge Code |
3331526
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$168.82 |
| Max. Negotiated Rate |
$675.28 |
| Rate for Payer: Aetna Commercial |
$384.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$367.22
|
| Rate for Payer: Aetna Managed Medicare |
$168.82
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$633.08
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$295.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$280.24
|
| Rate for Payer: Anthem Medicare Advantage |
$168.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$226.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$168.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$168.82
|
| Rate for Payer: Cash Price |
$128.10
|
| Rate for Payer: Cash Price |
$128.10
|
| Rate for Payer: Cigna Commercial |
$392.84
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$168.82
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$238.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$168.82
|
| Rate for Payer: Health EOS Commercial |
$380.03
|
| Rate for Payer: HFN Commercial |
$392.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$628.01
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$168.82
|
| Rate for Payer: Independent Care Health Plan Medicare |
$168.82
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$168.82
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$168.82
|
| Rate for Payer: Multiplan Commercial |
$341.60
|
| Rate for Payer: NAPHCARE Commercial |
$253.23
|
| Rate for Payer: Preferred Network Access Commercial |
$392.84
|
| Rate for Payer: Quartz Beloit One Network |
$209.23
|
| Rate for Payer: Quartz Commercial |
$277.55
|
| Rate for Payer: Quartz Medicare Advantage |
$168.82
|
| Rate for Payer: The Alliance Commercial |
$675.28
|
| Rate for Payer: United Healthcare Medicare Advantage |
$168.82
|
| Rate for Payer: United Healthcare PPO |
$320.25
|
| Rate for Payer: WEA Trust Commercial |
$234.85
|
| Rate for Payer: Wellcare Medicare |
$168.82
|
| Rate for Payer: WPS Commercial |
$316.28
|
|
|
Celiac Serology IgA
|
Facility
|
OP
|
$40.00
|
|
|
Service Code
|
CPT 82784
|
| Hospital Charge Code |
2790812
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.30 |
| Max. Negotiated Rate |
$37.20 |
| Rate for Payer: Aetna Commercial |
$36.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$34.40
|
| Rate for Payer: Aetna Managed Medicare |
$9.30
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$34.88
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$16.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$15.44
|
| Rate for Payer: Anthem Medicaid |
$9.61
|
| Rate for Payer: Anthem Medicare Advantage |
$9.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$21.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$9.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$9.30
|
| Rate for Payer: Cash Price |
$12.00
|
| Rate for Payer: Cash Price |
$12.00
|
| Rate for Payer: Cigna Commercial |
$36.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$9.30
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$9.61
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$22.38
|
| Rate for Payer: Dean Health Medicaid |
$9.61
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$9.30
|
| Rate for Payer: Health EOS Commercial |
$35.60
|
| Rate for Payer: HFN Commercial |
$36.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$34.60
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$9.30
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$9.61
|
| Rate for Payer: Independent Care Health Plan Medicare |
$9.30
|
| Rate for Payer: Managed Health Services Medicaid |
$9.99
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$9.30
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$9.30
|
| Rate for Payer: Multiplan Commercial |
$32.00
|
| Rate for Payer: NAPHCARE Commercial |
$13.95
|
| Rate for Payer: Preferred Network Access Commercial |
$36.80
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$9.61
|
| Rate for Payer: Quartz Beloit One Network |
$19.60
|
| Rate for Payer: Quartz Commercial |
$26.00
|
| Rate for Payer: Quartz Medicare Advantage |
$9.30
|
| Rate for Payer: The Alliance Commercial |
$37.20
|
| Rate for Payer: United Healthcare Medicaid |
$9.61
|
| Rate for Payer: United Healthcare Medicare Advantage |
$9.30
|
| Rate for Payer: United Healthcare PPO |
$30.00
|
| Rate for Payer: WEA Trust Commercial |
$22.00
|
| Rate for Payer: Wellcare Medicare |
$9.30
|
| Rate for Payer: WMAP Medicaid |
$9.61
|
| Rate for Payer: WPS Commercial |
$29.63
|
|
|
Celiac Serology IgA
|
Professional
|
Both
|
$40.00
|
|
|
Service Code
|
CPT 82784
|
| Hospital Charge Code |
2790812
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.60 |
| Max. Negotiated Rate |
$38.00 |
| Rate for Payer: Aetna Commercial |
$38.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$34.40
|
| Rate for Payer: Cash Price |
$12.00
|
| Rate for Payer: Cash Price |
$12.00
|
| Rate for Payer: Cigna Commercial |
$38.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$20.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$24.00
|
| Rate for Payer: Health EOS Commercial |
$36.40
|
| Rate for Payer: HFN Commercial |
$38.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$32.83
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$32.83
|
| Rate for Payer: Multiplan Commercial |
$32.00
|
| Rate for Payer: Preferred Network Access Commercial |
$38.00
|
| Rate for Payer: Quartz Beloit One Network |
$17.60
|
| Rate for Payer: Quartz Commercial |
$22.80
|
| Rate for Payer: The Alliance Commercial |
$20.00
|
| Rate for Payer: WEA Trust Commercial |
$22.00
|
| Rate for Payer: WPS Commercial |
$29.63
|
|
|
Celiac Serology IgA
|
Facility
|
IP
|
$40.00
|
|
|
Service Code
|
CPT 82784
|
| Hospital Charge Code |
2790812
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$19.60 |
| Max. Negotiated Rate |
$36.80 |
| Rate for Payer: Aetna Commercial |
$36.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$34.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$21.20
|
| Rate for Payer: Cash Price |
$12.00
|
| Rate for Payer: Cigna Commercial |
$36.80
|
| Rate for Payer: Health EOS Commercial |
$35.60
|
| Rate for Payer: HFN Commercial |
$36.80
|
| Rate for Payer: Multiplan Commercial |
$32.00
|
| Rate for Payer: NAPHCARE Commercial |
$24.00
|
| Rate for Payer: Preferred Network Access Commercial |
$36.80
|
| Rate for Payer: Quartz Beloit One Network |
$19.60
|
| Rate for Payer: Quartz Commercial |
$24.00
|
| Rate for Payer: WEA Trust Commercial |
$22.00
|
| Rate for Payer: WPS Commercial |
$29.63
|
|
|
Celiac Serology to Prometheus
|
Facility
|
OP
|
$702.00
|
|
|
Service Code
|
CPT 81382
|
| Hospital Charge Code |
3062694
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$123.68 |
| Max. Negotiated Rate |
$645.84 |
| Rate for Payer: Aetna Commercial |
$631.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$603.72
|
| Rate for Payer: Aetna Managed Medicare |
$123.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$463.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$216.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$205.31
|
| Rate for Payer: Anthem Medicaid |
$127.80
|
| Rate for Payer: Anthem Medicare Advantage |
$123.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$372.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$123.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$123.68
|
| Rate for Payer: Cash Price |
$210.60
|
| Rate for Payer: Cash Price |
$210.60
|
| Rate for Payer: Cigna Commercial |
$645.84
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$123.68
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$127.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$392.84
|
| Rate for Payer: Dean Health Medicaid |
$127.80
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$123.68
|
| Rate for Payer: Health EOS Commercial |
$624.78
|
| Rate for Payer: HFN Commercial |
$645.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$460.09
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$123.68
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$127.80
|
| Rate for Payer: Independent Care Health Plan Medicare |
$123.68
|
| Rate for Payer: Managed Health Services Medicaid |
$132.91
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$123.68
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$123.68
|
| Rate for Payer: Multiplan Commercial |
$561.60
|
| Rate for Payer: NAPHCARE Commercial |
$185.52
|
| Rate for Payer: Preferred Network Access Commercial |
$645.84
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$127.80
|
| Rate for Payer: Quartz Beloit One Network |
$343.98
|
| Rate for Payer: Quartz Commercial |
$456.30
|
| Rate for Payer: Quartz Medicare Advantage |
$123.68
|
| Rate for Payer: The Alliance Commercial |
$494.72
|
| Rate for Payer: United Healthcare Medicaid |
$127.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$123.68
|
| Rate for Payer: United Healthcare PPO |
$526.50
|
| Rate for Payer: WEA Trust Commercial |
$386.10
|
| Rate for Payer: Wellcare Medicare |
$123.68
|
| Rate for Payer: WMAP Medicaid |
$127.80
|
| Rate for Payer: WPS Commercial |
$519.97
|
|
|
Celiac Serology to Prometheus
|
Facility
|
IP
|
$702.00
|
|
|
Service Code
|
CPT 81382
|
| Hospital Charge Code |
3062694
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$343.98 |
| Max. Negotiated Rate |
$645.84 |
| Rate for Payer: Aetna Commercial |
$631.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$603.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$372.06
|
| Rate for Payer: Cash Price |
$210.60
|
| Rate for Payer: Cigna Commercial |
$645.84
|
| Rate for Payer: Health EOS Commercial |
$624.78
|
| Rate for Payer: HFN Commercial |
$645.84
|
| Rate for Payer: Multiplan Commercial |
$561.60
|
| Rate for Payer: NAPHCARE Commercial |
$421.20
|
| Rate for Payer: Preferred Network Access Commercial |
$645.84
|
| Rate for Payer: Quartz Beloit One Network |
$343.98
|
| Rate for Payer: Quartz Commercial |
$421.20
|
| Rate for Payer: WEA Trust Commercial |
$386.10
|
| Rate for Payer: WPS Commercial |
$519.97
|
|
|
Celiac Serology to Prometheus
|
Professional
|
Both
|
$702.00
|
|
|
Service Code
|
CPT 81382
|
| Hospital Charge Code |
3062694
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$308.88 |
| Max. Negotiated Rate |
$666.90 |
| Rate for Payer: Aetna Commercial |
$666.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$603.72
|
| Rate for Payer: Cash Price |
$210.60
|
| Rate for Payer: Cash Price |
$210.60
|
| Rate for Payer: Cigna Commercial |
$666.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$351.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$421.20
|
| Rate for Payer: Health EOS Commercial |
$638.82
|
| Rate for Payer: HFN Commercial |
$666.90
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$436.59
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$436.59
|
| Rate for Payer: Multiplan Commercial |
$561.60
|
| Rate for Payer: Preferred Network Access Commercial |
$666.90
|
| Rate for Payer: Quartz Beloit One Network |
$308.88
|
| Rate for Payer: Quartz Commercial |
$400.14
|
| Rate for Payer: The Alliance Commercial |
$351.00
|
| Rate for Payer: WEA Trust Commercial |
$386.10
|
| Rate for Payer: WPS Commercial |
$519.97
|
|
|
Celiac Serology TTG
|
Professional
|
Both
|
$110.00
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
2790816
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$48.40 |
| Max. Negotiated Rate |
$104.50 |
| Rate for Payer: Aetna Commercial |
$104.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$94.60
|
| Rate for Payer: Cash Price |
$33.00
|
| Rate for Payer: Cash Price |
$33.00
|
| Rate for Payer: Cigna Commercial |
$104.50
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$55.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$66.00
|
| Rate for Payer: Health EOS Commercial |
$100.10
|
| Rate for Payer: HFN Commercial |
$104.50
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$60.96
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$60.96
|
| Rate for Payer: Multiplan Commercial |
$88.00
|
| Rate for Payer: Preferred Network Access Commercial |
$104.50
|
| Rate for Payer: Quartz Beloit One Network |
$48.40
|
| Rate for Payer: Quartz Commercial |
$62.70
|
| Rate for Payer: The Alliance Commercial |
$55.00
|
| Rate for Payer: WEA Trust Commercial |
$60.50
|
| Rate for Payer: WPS Commercial |
$81.48
|
|
|
Celiac Serology TTG
|
Facility
|
OP
|
$110.00
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
2790816
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.27 |
| Max. Negotiated Rate |
$101.20 |
| Rate for Payer: Aetna Commercial |
$99.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$94.60
|
| Rate for Payer: Aetna Managed Medicare |
$17.27
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$64.76
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$30.22
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$28.67
|
| Rate for Payer: Anthem Medicaid |
$17.85
|
| Rate for Payer: Anthem Medicare Advantage |
$17.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$58.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$17.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$17.27
|
| Rate for Payer: Cash Price |
$33.00
|
| Rate for Payer: Cash Price |
$33.00
|
| Rate for Payer: Cigna Commercial |
$101.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$17.27
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$17.85
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$61.56
|
| Rate for Payer: Dean Health Medicaid |
$17.85
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$17.27
|
| Rate for Payer: Health EOS Commercial |
$97.90
|
| Rate for Payer: HFN Commercial |
$101.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$64.24
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$17.27
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$17.85
|
| Rate for Payer: Independent Care Health Plan Medicare |
$17.27
|
| Rate for Payer: Managed Health Services Medicaid |
$18.56
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$17.27
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$17.27
|
| Rate for Payer: Multiplan Commercial |
$88.00
|
| Rate for Payer: NAPHCARE Commercial |
$25.90
|
| Rate for Payer: Preferred Network Access Commercial |
$101.20
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$17.85
|
| Rate for Payer: Quartz Beloit One Network |
$53.90
|
| Rate for Payer: Quartz Commercial |
$71.50
|
| Rate for Payer: Quartz Medicare Advantage |
$17.27
|
| Rate for Payer: The Alliance Commercial |
$69.08
|
| Rate for Payer: United Healthcare Medicaid |
$17.85
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17.27
|
| Rate for Payer: United Healthcare PPO |
$82.50
|
| Rate for Payer: WEA Trust Commercial |
$60.50
|
| Rate for Payer: Wellcare Medicare |
$17.27
|
| Rate for Payer: WMAP Medicaid |
$17.85
|
| Rate for Payer: WPS Commercial |
$81.48
|
|
|
Celiac Serology TTG
|
Facility
|
IP
|
$110.00
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
2790816
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$53.90 |
| Max. Negotiated Rate |
$101.20 |
| Rate for Payer: Aetna Commercial |
$99.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$94.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$58.30
|
| Rate for Payer: Cash Price |
$33.00
|
| Rate for Payer: Cigna Commercial |
$101.20
|
| Rate for Payer: Health EOS Commercial |
$97.90
|
| Rate for Payer: HFN Commercial |
$101.20
|
| Rate for Payer: Multiplan Commercial |
$88.00
|
| Rate for Payer: NAPHCARE Commercial |
$66.00
|
| Rate for Payer: Preferred Network Access Commercial |
$101.20
|
| Rate for Payer: Quartz Beloit One Network |
$53.90
|
| Rate for Payer: Quartz Commercial |
$66.00
|
| Rate for Payer: WEA Trust Commercial |
$60.50
|
| Rate for Payer: WPS Commercial |
$81.48
|
|
|
Cell Count & Differential, BAL
|
Facility
|
OP
|
$109.00
|
|
|
Service Code
|
CPT 89051
|
| Hospital Charge Code |
5296695
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.60 |
| Max. Negotiated Rate |
$100.28 |
| Rate for Payer: Aetna Commercial |
$98.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$93.74
|
| Rate for Payer: Aetna Managed Medicare |
$5.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$21.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$9.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$9.30
|
| Rate for Payer: Anthem Medicaid |
$5.79
|
| Rate for Payer: Anthem Medicare Advantage |
$5.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$57.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5.60
|
| Rate for Payer: Cash Price |
$32.70
|
| Rate for Payer: Cash Price |
$32.70
|
| Rate for Payer: Cigna Commercial |
$100.28
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$5.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$5.79
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$61.00
|
| Rate for Payer: Dean Health Medicaid |
$5.79
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$5.60
|
| Rate for Payer: Health EOS Commercial |
$97.01
|
| Rate for Payer: HFN Commercial |
$100.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$20.83
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$5.60
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$5.79
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5.60
|
| Rate for Payer: Managed Health Services Medicaid |
$6.02
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$5.60
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$5.60
|
| Rate for Payer: Multiplan Commercial |
$87.20
|
| Rate for Payer: NAPHCARE Commercial |
$8.40
|
| Rate for Payer: Preferred Network Access Commercial |
$100.28
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$5.79
|
| Rate for Payer: Quartz Beloit One Network |
$53.41
|
| Rate for Payer: Quartz Commercial |
$70.85
|
| Rate for Payer: Quartz Medicare Advantage |
$5.60
|
| Rate for Payer: The Alliance Commercial |
$22.40
|
| Rate for Payer: United Healthcare Medicaid |
$5.79
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.60
|
| Rate for Payer: United Healthcare PPO |
$81.75
|
| Rate for Payer: WEA Trust Commercial |
$59.95
|
| Rate for Payer: Wellcare Medicare |
$5.60
|
| Rate for Payer: WMAP Medicaid |
$5.79
|
| Rate for Payer: WPS Commercial |
$80.74
|
|
|
Cell Count & Differential, BAL
|
Facility
|
IP
|
$109.00
|
|
|
Service Code
|
CPT 89051
|
| Hospital Charge Code |
5296695
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$53.41 |
| Max. Negotiated Rate |
$100.28 |
| Rate for Payer: Aetna Commercial |
$98.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$93.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$57.77
|
| Rate for Payer: Cash Price |
$32.70
|
| Rate for Payer: Cigna Commercial |
$100.28
|
| Rate for Payer: Health EOS Commercial |
$97.01
|
| Rate for Payer: HFN Commercial |
$100.28
|
| Rate for Payer: Multiplan Commercial |
$87.20
|
| Rate for Payer: NAPHCARE Commercial |
$65.40
|
| Rate for Payer: Preferred Network Access Commercial |
$100.28
|
| Rate for Payer: Quartz Beloit One Network |
$53.41
|
| Rate for Payer: Quartz Commercial |
$65.40
|
| Rate for Payer: WEA Trust Commercial |
$59.95
|
| Rate for Payer: WPS Commercial |
$80.74
|
|
|
Cell Count & Differential, BAL
|
Professional
|
Both
|
$109.00
|
|
|
Service Code
|
CPT 89051
|
| Hospital Charge Code |
5296695
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$19.77 |
| Max. Negotiated Rate |
$103.55 |
| Rate for Payer: Aetna Commercial |
$103.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$93.74
|
| Rate for Payer: Cash Price |
$32.70
|
| Rate for Payer: Cash Price |
$32.70
|
| Rate for Payer: Cigna Commercial |
$103.55
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$54.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$65.40
|
| Rate for Payer: Health EOS Commercial |
$99.19
|
| Rate for Payer: HFN Commercial |
$103.55
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$19.77
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$19.77
|
| Rate for Payer: Multiplan Commercial |
$87.20
|
| Rate for Payer: Preferred Network Access Commercial |
$103.55
|
| Rate for Payer: Quartz Beloit One Network |
$47.96
|
| Rate for Payer: Quartz Commercial |
$62.13
|
| Rate for Payer: The Alliance Commercial |
$54.50
|
| Rate for Payer: WEA Trust Commercial |
$59.95
|
| Rate for Payer: WPS Commercial |
$80.74
|
|
|
Cell Count w/ Diff Body Fluid
|
Facility
|
OP
|
$189.00
|
|
|
Service Code
|
CPT 89051
|
| Hospital Charge Code |
633699
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.60 |
| Max. Negotiated Rate |
$173.88 |
| Rate for Payer: Aetna Commercial |
$170.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$162.54
|
| Rate for Payer: Aetna Managed Medicare |
$5.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$21.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$9.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$9.30
|
| Rate for Payer: Anthem Medicaid |
$5.79
|
| Rate for Payer: Anthem Medicare Advantage |
$5.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$100.17
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5.60
|
| Rate for Payer: Cash Price |
$56.70
|
| Rate for Payer: Cash Price |
$56.70
|
| Rate for Payer: Cigna Commercial |
$173.88
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$5.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$5.79
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$105.76
|
| Rate for Payer: Dean Health Medicaid |
$5.79
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$5.60
|
| Rate for Payer: Health EOS Commercial |
$168.21
|
| Rate for Payer: HFN Commercial |
$173.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$20.83
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$5.60
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$5.79
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5.60
|
| Rate for Payer: Managed Health Services Medicaid |
$6.02
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$5.60
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$5.60
|
| Rate for Payer: Multiplan Commercial |
$151.20
|
| Rate for Payer: NAPHCARE Commercial |
$8.40
|
| Rate for Payer: Preferred Network Access Commercial |
$173.88
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$5.79
|
| Rate for Payer: Quartz Beloit One Network |
$92.61
|
| Rate for Payer: Quartz Commercial |
$122.85
|
| Rate for Payer: Quartz Medicare Advantage |
$5.60
|
| Rate for Payer: The Alliance Commercial |
$22.40
|
| Rate for Payer: United Healthcare Medicaid |
$5.79
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.60
|
| Rate for Payer: United Healthcare PPO |
$141.75
|
| Rate for Payer: WEA Trust Commercial |
$103.95
|
| Rate for Payer: Wellcare Medicare |
$5.60
|
| Rate for Payer: WMAP Medicaid |
$5.79
|
| Rate for Payer: WPS Commercial |
$139.99
|
|
|
Cell Count w/ Diff Body Fluid
|
Professional
|
Both
|
$189.00
|
|
|
Service Code
|
CPT 89051
|
| Hospital Charge Code |
633699
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$19.77 |
| Max. Negotiated Rate |
$179.55 |
| Rate for Payer: Aetna Commercial |
$179.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$162.54
|
| Rate for Payer: Cash Price |
$56.70
|
| Rate for Payer: Cash Price |
$56.70
|
| Rate for Payer: Cigna Commercial |
$179.55
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$94.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$113.40
|
| Rate for Payer: Health EOS Commercial |
$171.99
|
| Rate for Payer: HFN Commercial |
$179.55
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$19.77
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$19.77
|
| Rate for Payer: Multiplan Commercial |
$151.20
|
| Rate for Payer: Preferred Network Access Commercial |
$179.55
|
| Rate for Payer: Quartz Beloit One Network |
$83.16
|
| Rate for Payer: Quartz Commercial |
$107.73
|
| Rate for Payer: The Alliance Commercial |
$94.50
|
| Rate for Payer: WEA Trust Commercial |
$103.95
|
| Rate for Payer: WPS Commercial |
$139.99
|
|
|
Cell Count w/ Diff Body Fluid
|
Facility
|
IP
|
$189.00
|
|
|
Service Code
|
CPT 89051
|
| Hospital Charge Code |
633699
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$92.61 |
| Max. Negotiated Rate |
$173.88 |
| Rate for Payer: Aetna Commercial |
$170.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$162.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$100.17
|
| Rate for Payer: Cash Price |
$56.70
|
| Rate for Payer: Cigna Commercial |
$173.88
|
| Rate for Payer: Health EOS Commercial |
$168.21
|
| Rate for Payer: HFN Commercial |
$173.88
|
| Rate for Payer: Multiplan Commercial |
$151.20
|
| Rate for Payer: NAPHCARE Commercial |
$113.40
|
| Rate for Payer: Preferred Network Access Commercial |
$173.88
|
| Rate for Payer: Quartz Beloit One Network |
$92.61
|
| Rate for Payer: Quartz Commercial |
$113.40
|
| Rate for Payer: WEA Trust Commercial |
$103.95
|
| Rate for Payer: WPS Commercial |
$139.99
|
|
|
CELLULITIS WITH MCC
|
Facility
|
IP
|
$39,867.00
|
|
|
Service Code
|
MSDRG 602
|
| Min. Negotiated Rate |
$14,340.67 |
| Max. Negotiated Rate |
$39,867.00 |
| Rate for Payer: Aetna Managed Medicare |
$14,340.67
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$31,260.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$23,960.69
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$22,764.22
|
| Rate for Payer: Anthem Medicare Advantage |
$14,340.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$14,340.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$14,340.67
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$14,340.67
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$25,270.37
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$14,340.67
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$29,006.25
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$14,340.67
|
| Rate for Payer: Independent Care Health Plan Medicare |
$14,340.67
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$14,340.67
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$14,340.67
|
| Rate for Payer: NAPHCARE Commercial |
$21,511.00
|
| Rate for Payer: Quartz Medicare Advantage |
$14,340.67
|
| Rate for Payer: The Alliance Commercial |
$39,867.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14,340.67
|
| Rate for Payer: United Healthcare PPO |
$22,581.74
|
| Rate for Payer: Wellcare Medicare |
$14,340.67
|
|
|
CELLULITIS WITHOUT MCC
|
Facility
|
IP
|
$23,841.00
|
|
|
Service Code
|
MSDRG 603
|
| Min. Negotiated Rate |
$8,575.91 |
| Max. Negotiated Rate |
$23,841.00 |
| Rate for Payer: Aetna Managed Medicare |
$8,575.91
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$18,462.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$14,151.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$13,444.64
|
| Rate for Payer: Anthem Medicare Advantage |
$8,575.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$8,575.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$8,575.91
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$8,575.91
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$14,924.78
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$8,575.91
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$17,251.65
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$8,575.91
|
| Rate for Payer: Independent Care Health Plan Medicare |
$8,575.91
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$8,575.91
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$8,575.91
|
| Rate for Payer: NAPHCARE Commercial |
$12,863.86
|
| Rate for Payer: Quartz Medicare Advantage |
$8,575.91
|
| Rate for Payer: The Alliance Commercial |
$23,841.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8,575.91
|
| Rate for Payer: United Healthcare PPO |
$13,430.63
|
| Rate for Payer: Wellcare Medicare |
$8,575.91
|
|
|
CEMENT BONESYNC CALCIUM PHOSPHATE DRILLABLE FAST SET 3CC ABS-3103
|
Facility
|
IP
|
$6,649.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5603744
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,258.01 |
| Max. Negotiated Rate |
$6,117.08 |
| Rate for Payer: Aetna Commercial |
$5,984.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,718.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,523.97
|
| Rate for Payer: Cash Price |
$1,994.70
|
| Rate for Payer: Cigna Commercial |
$6,117.08
|
| Rate for Payer: Health EOS Commercial |
$5,917.61
|
| Rate for Payer: HFN Commercial |
$6,117.08
|
| Rate for Payer: Multiplan Commercial |
$5,319.20
|
| Rate for Payer: NAPHCARE Commercial |
$3,989.40
|
| Rate for Payer: Preferred Network Access Commercial |
$6,117.08
|
| Rate for Payer: Quartz Beloit One Network |
$3,258.01
|
| Rate for Payer: Quartz Commercial |
$3,989.40
|
| Rate for Payer: WEA Trust Commercial |
$3,656.95
|
| Rate for Payer: WPS Commercial |
$4,924.91
|
|
|
CEMENT BONESYNC CALCIUM PHOSPHATE DRILLABLE FAST SET 3CC ABS-3103
|
Facility
|
OP
|
$6,649.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5603744
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,861.72 |
| Max. Negotiated Rate |
$26,596.00 |
| Rate for Payer: Aetna Commercial |
$5,984.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,718.14
|
| Rate for Payer: Aetna Managed Medicare |
$1,861.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,321.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,324.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,191.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,523.97
|
| Rate for Payer: Cash Price |
$1,994.70
|
| Rate for Payer: Cigna Commercial |
$6,117.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,720.78
|
| Rate for Payer: Health EOS Commercial |
$5,917.61
|
| Rate for Payer: HFN Commercial |
$6,117.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,986.75
|
| Rate for Payer: Multiplan Commercial |
$5,319.20
|
| Rate for Payer: NAPHCARE Commercial |
$3,989.40
|
| Rate for Payer: Preferred Network Access Commercial |
$6,117.08
|
| Rate for Payer: Quartz Beloit One Network |
$3,258.01
|
| Rate for Payer: Quartz Commercial |
$4,321.85
|
| Rate for Payer: Quartz Medicare Advantage |
$3,989.40
|
| Rate for Payer: The Alliance Commercial |
$26,596.00
|
| Rate for Payer: WEA Trust Commercial |
$3,656.95
|
| Rate for Payer: WPS Commercial |
$4,924.91
|
|
|
CEMENT BONESYNC CALCIUM PHOSPHATE DRILLABLE FAST SET 5CC ABS-3105
|
Facility
|
IP
|
$8,439.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5490734
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4,135.11 |
| Max. Negotiated Rate |
$7,763.88 |
| Rate for Payer: Aetna Commercial |
$7,595.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,257.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,472.67
|
| Rate for Payer: Cash Price |
$2,531.70
|
| Rate for Payer: Cigna Commercial |
$7,763.88
|
| Rate for Payer: Health EOS Commercial |
$7,510.71
|
| Rate for Payer: HFN Commercial |
$7,763.88
|
| Rate for Payer: Multiplan Commercial |
$6,751.20
|
| Rate for Payer: NAPHCARE Commercial |
$5,063.40
|
| Rate for Payer: Preferred Network Access Commercial |
$7,763.88
|
| Rate for Payer: Quartz Beloit One Network |
$4,135.11
|
| Rate for Payer: Quartz Commercial |
$5,063.40
|
| Rate for Payer: WEA Trust Commercial |
$4,641.45
|
| Rate for Payer: WPS Commercial |
$6,250.77
|
|
|
CEMENT BONESYNC CALCIUM PHOSPHATE DRILLABLE FAST SET 5CC ABS-3105
|
Facility
|
OP
|
$8,439.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5490734
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,362.92 |
| Max. Negotiated Rate |
$33,756.00 |
| Rate for Payer: Aetna Commercial |
$7,595.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,257.54
|
| Rate for Payer: Aetna Managed Medicare |
$2,362.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,485.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,219.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,050.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,472.67
|
| Rate for Payer: Cash Price |
$2,531.70
|
| Rate for Payer: Cigna Commercial |
$7,763.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,722.46
|
| Rate for Payer: Health EOS Commercial |
$7,510.71
|
| Rate for Payer: HFN Commercial |
$7,763.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,329.25
|
| Rate for Payer: Multiplan Commercial |
$6,751.20
|
| Rate for Payer: NAPHCARE Commercial |
$5,063.40
|
| Rate for Payer: Preferred Network Access Commercial |
$7,763.88
|
| Rate for Payer: Quartz Beloit One Network |
$4,135.11
|
| Rate for Payer: Quartz Commercial |
$5,485.35
|
| Rate for Payer: Quartz Medicare Advantage |
$5,063.40
|
| Rate for Payer: The Alliance Commercial |
$33,756.00
|
| Rate for Payer: WEA Trust Commercial |
$4,641.45
|
| Rate for Payer: WPS Commercial |
$6,250.77
|
|
|
CEMENT MIXING SYSTEM SMARTMIX TOWER 5401-98-000
|
Facility
|
OP
|
$2,116.00
|
|
| Hospital Charge Code |
6172835
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$592.48 |
| Max. Negotiated Rate |
$8,464.00 |
| Rate for Payer: Aetna Commercial |
$1,904.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,819.76
|
| Rate for Payer: Aetna Managed Medicare |
$592.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,375.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,058.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,015.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,121.48
|
| Rate for Payer: Cash Price |
$634.80
|
| Rate for Payer: Cigna Commercial |
$1,946.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,184.11
|
| Rate for Payer: Health EOS Commercial |
$1,883.24
|
| Rate for Payer: HFN Commercial |
$1,946.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,587.00
|
| Rate for Payer: Multiplan Commercial |
$1,692.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,269.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,946.72
|
| Rate for Payer: Quartz Beloit One Network |
$1,036.84
|
| Rate for Payer: Quartz Commercial |
$1,375.40
|
| Rate for Payer: Quartz Medicare Advantage |
$1,269.60
|
| Rate for Payer: The Alliance Commercial |
$8,464.00
|
| Rate for Payer: WEA Trust Commercial |
$1,163.80
|
| Rate for Payer: WPS Commercial |
$1,567.32
|
|
|
CEMENT MIXING SYSTEM SMARTMIX TOWER 5401-98-000
|
Facility
|
IP
|
$2,116.00
|
|
| Hospital Charge Code |
6172835
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,036.84 |
| Max. Negotiated Rate |
$1,946.72 |
| Rate for Payer: Aetna Commercial |
$1,904.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,819.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,121.48
|
| Rate for Payer: Cash Price |
$634.80
|
| Rate for Payer: Cigna Commercial |
$1,946.72
|
| Rate for Payer: Health EOS Commercial |
$1,883.24
|
| Rate for Payer: HFN Commercial |
$1,946.72
|
| Rate for Payer: Multiplan Commercial |
$1,692.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,269.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,946.72
|
| Rate for Payer: Quartz Beloit One Network |
$1,036.84
|
| Rate for Payer: Quartz Commercial |
$1,269.60
|
| Rate for Payer: WEA Trust Commercial |
$1,163.80
|
| Rate for Payer: WPS Commercial |
$1,567.32
|
|
