|
CIRRHOSIS AND ALCOHOLIC HEPATITIS WITHOUT CC/MCC
|
Facility
IP
|
$18,120.00
|
|
|
Service Code
|
MS-DRG 434
|
| Min. Negotiated Rate |
$6,517.90 |
| Max. Negotiated Rate |
$18,120.00 |
| Rate for Payer: Aetna Managed Medicare |
$6,517.90
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$14,056.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$10,774.27
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$10,236.26
|
| Rate for Payer: Anthem Medicare Advantage |
$6,517.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$6,517.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$6,517.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$6,517.90
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$11,363.19
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$6,517.90
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$13,055.25
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$6,517.90
|
| Rate for Payer: Independent Care Health Plan Medicare |
$6,517.90
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$6,517.90
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$6,517.90
|
| Rate for Payer: NAPHCARE Commercial |
$9,776.85
|
| Rate for Payer: Quartz Medicare Advantage |
$6,517.90
|
| Rate for Payer: The Alliance Commercial |
$18,120.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,517.90
|
| Rate for Payer: United Healthcare PPO |
$10,163.68
|
| Rate for Payer: Wellcare Medicare |
$6,517.90
|
|
|
Citalopram Level
|
Facility
IP
|
$256.00
|
|
|
Service Code
|
CPT 80332
|
| Hospital Charge Code |
1038869
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$125.44 |
| Max. Negotiated Rate |
$235.52 |
| Rate for Payer: Aetna Commercial |
$230.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$135.68
|
| Rate for Payer: Cash Price |
$76.80
|
| Rate for Payer: Cigna Commercial |
$235.52
|
| Rate for Payer: Health EOS Commercial |
$227.84
|
| Rate for Payer: HFN Commercial |
$235.52
|
| Rate for Payer: Multiplan Commercial |
$204.80
|
| Rate for Payer: NAPHCARE Commercial |
$153.60
|
| Rate for Payer: Preferred Network Access Commercial |
$235.52
|
| Rate for Payer: Quartz Beloit One Network |
$125.44
|
| Rate for Payer: Quartz Commercial |
$153.60
|
| Rate for Payer: WEA Trust Commercial |
$140.80
|
| Rate for Payer: WPS Commercial |
$189.62
|
|
|
Citalopram Level
|
Professional
|
$256.00
|
|
|
Service Code
|
CPT 80332
|
| Hospital Charge Code |
1038869
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$80.06 |
| Max. Negotiated Rate |
$243.20 |
| Rate for Payer: Aetna Commercial |
$243.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$220.16
|
| Rate for Payer: Cash Price |
$76.80
|
| Rate for Payer: Cash Price |
$76.80
|
| Rate for Payer: Cigna Commercial |
$243.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$128.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$153.60
|
| Rate for Payer: Health EOS Commercial |
$232.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$80.06
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$80.06
|
| Rate for Payer: Multiplan Commercial |
$204.80
|
| Rate for Payer: Preferred Network Access Commercial |
$243.20
|
| Rate for Payer: Quartz Beloit One Network |
$112.64
|
| Rate for Payer: Quartz Commercial |
$145.92
|
| Rate for Payer: The Alliance Commercial |
$128.00
|
| Rate for Payer: WEA Trust Commercial |
$140.80
|
| Rate for Payer: WPS Commercial |
$189.62
|
|
|
Citalopram Level
|
Facility
OP
|
$256.00
|
|
|
Service Code
|
CPT 80332
|
| Hospital Charge Code |
1038869
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$71.68 |
| Max. Negotiated Rate |
$235.52 |
| Rate for Payer: Aetna Commercial |
$230.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$220.16
|
| Rate for Payer: Aetna Managed Medicare |
$71.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$166.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$128.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$122.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$135.68
|
| Rate for Payer: Cash Price |
$76.80
|
| Rate for Payer: Cash Price |
$76.80
|
| Rate for Payer: Cigna Commercial |
$235.52
|
| Rate for Payer: Health EOS Commercial |
$227.84
|
| Rate for Payer: HFN Commercial |
$235.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$192.00
|
| Rate for Payer: Multiplan Commercial |
$204.80
|
| Rate for Payer: NAPHCARE Commercial |
$153.60
|
| Rate for Payer: Preferred Network Access Commercial |
$235.52
|
| Rate for Payer: Quartz Beloit One Network |
$125.44
|
| Rate for Payer: Quartz Commercial |
$166.40
|
| Rate for Payer: Quartz Medicare Advantage |
$153.60
|
| Rate for Payer: United Healthcare PPO |
$192.00
|
| Rate for Payer: WEA Trust Commercial |
$140.80
|
| Rate for Payer: WPS Commercial |
$189.62
|
|
|
Citrate Excretion, Urine
|
Facility
OP
|
$166.00
|
|
|
Service Code
|
CPT 82507
|
| Hospital Charge Code |
5474692
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$27.80 |
| Max. Negotiated Rate |
$664.00 |
| Rate for Payer: Aetna Commercial |
$149.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$142.76
|
| Rate for Payer: Aetna Managed Medicare |
$27.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$104.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$48.65
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$46.15
|
| Rate for Payer: Anthem Medicaid |
$28.73
|
| Rate for Payer: Anthem Medicare Advantage |
$27.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$87.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$27.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$27.80
|
| Rate for Payer: Cash Price |
$49.80
|
| Rate for Payer: Cash Price |
$49.80
|
| Rate for Payer: Cigna Commercial |
$152.72
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$27.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$28.73
|
| Rate for Payer: Dean Health Medicaid |
$28.73
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$27.80
|
| Rate for Payer: Health EOS Commercial |
$147.74
|
| Rate for Payer: HFN Commercial |
$152.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$103.42
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$27.80
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$28.73
|
| Rate for Payer: Independent Care Health Plan Medicare |
$27.80
|
| Rate for Payer: Managed Health Services Medicaid |
$29.88
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$27.80
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$27.80
|
| Rate for Payer: Multiplan Commercial |
$132.80
|
| Rate for Payer: NAPHCARE Commercial |
$41.70
|
| Rate for Payer: Preferred Network Access Commercial |
$152.72
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$28.73
|
| Rate for Payer: Quartz Beloit One Network |
$81.34
|
| Rate for Payer: Quartz Commercial |
$107.90
|
| Rate for Payer: Quartz Medicare Advantage |
$27.80
|
| Rate for Payer: The Alliance Commercial |
$664.00
|
| Rate for Payer: United Healthcare Medicaid |
$28.73
|
| Rate for Payer: United Healthcare Medicare Advantage |
$27.80
|
| Rate for Payer: United Healthcare PPO |
$124.50
|
| Rate for Payer: WEA Trust Commercial |
$91.30
|
| Rate for Payer: Wellcare Medicare |
$27.80
|
| Rate for Payer: WMAP Medicaid |
$28.73
|
| Rate for Payer: WPS Commercial |
$122.96
|
|
|
Citrate Excretion, Urine
|
Professional
|
$166.00
|
|
|
Service Code
|
CPT 82507
|
| Hospital Charge Code |
5474692
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$27.80 |
| Max. Negotiated Rate |
$157.70 |
| Rate for Payer: Aetna Commercial |
$157.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$142.76
|
| Rate for Payer: Aetna Managed Medicare |
$27.80
|
| Rate for Payer: Anthem Medicare Advantage |
$27.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$27.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$27.80
|
| Rate for Payer: Cash Price |
$49.80
|
| Rate for Payer: Cash Price |
$49.80
|
| Rate for Payer: Cigna Commercial |
$157.70
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$83.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$27.80
|
| Rate for Payer: Health EOS Commercial |
$151.06
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$98.13
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$98.13
|
| Rate for Payer: Independent Care Health Plan Medicare |
$27.80
|
| Rate for Payer: Multiplan Commercial |
$132.80
|
| Rate for Payer: Preferred Network Access Commercial |
$157.70
|
| Rate for Payer: Quartz Beloit One Network |
$73.04
|
| Rate for Payer: Quartz Commercial |
$94.62
|
| Rate for Payer: Quartz Medicare Advantage |
$27.80
|
| Rate for Payer: The Alliance Commercial |
$109.81
|
| Rate for Payer: United Healthcare Medicare Advantage |
$27.80
|
| Rate for Payer: WEA Trust Commercial |
$91.30
|
| Rate for Payer: WPS Commercial |
$122.32
|
|
|
Citrate Excretion, Urine
|
Facility
IP
|
$166.00
|
|
|
Service Code
|
CPT 82507
|
| Hospital Charge Code |
5474692
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$81.34 |
| Max. Negotiated Rate |
$152.72 |
| Rate for Payer: Aetna Commercial |
$149.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$87.98
|
| Rate for Payer: Cash Price |
$49.80
|
| Rate for Payer: Cigna Commercial |
$152.72
|
| Rate for Payer: Health EOS Commercial |
$147.74
|
| Rate for Payer: HFN Commercial |
$152.72
|
| Rate for Payer: Multiplan Commercial |
$132.80
|
| Rate for Payer: NAPHCARE Commercial |
$99.60
|
| Rate for Payer: Preferred Network Access Commercial |
$152.72
|
| Rate for Payer: Quartz Beloit One Network |
$81.34
|
| Rate for Payer: Quartz Commercial |
$99.60
|
| Rate for Payer: WEA Trust Commercial |
$91.30
|
| Rate for Payer: WPS Commercial |
$122.96
|
|
|
Citrate Level 24 Hour Urine
|
Facility
OP
|
$354.00
|
|
|
Service Code
|
CPT 82507
|
| Hospital Charge Code |
978110
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$27.80 |
| Max. Negotiated Rate |
$1,416.00 |
| Rate for Payer: Aetna Commercial |
$318.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$304.44
|
| Rate for Payer: Aetna Managed Medicare |
$27.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$104.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$48.65
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$46.15
|
| Rate for Payer: Anthem Medicaid |
$28.73
|
| Rate for Payer: Anthem Medicare Advantage |
$27.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$187.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$27.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$27.80
|
| Rate for Payer: Cash Price |
$106.20
|
| Rate for Payer: Cash Price |
$106.20
|
| Rate for Payer: Cigna Commercial |
$325.68
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$27.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$28.73
|
| Rate for Payer: Dean Health Medicaid |
$28.73
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$27.80
|
| Rate for Payer: Health EOS Commercial |
$315.06
|
| Rate for Payer: HFN Commercial |
$325.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$103.42
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$27.80
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$28.73
|
| Rate for Payer: Independent Care Health Plan Medicare |
$27.80
|
| Rate for Payer: Managed Health Services Medicaid |
$29.88
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$27.80
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$27.80
|
| Rate for Payer: Multiplan Commercial |
$283.20
|
| Rate for Payer: NAPHCARE Commercial |
$41.70
|
| Rate for Payer: Preferred Network Access Commercial |
$325.68
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$28.73
|
| Rate for Payer: Quartz Beloit One Network |
$173.46
|
| Rate for Payer: Quartz Commercial |
$230.10
|
| Rate for Payer: Quartz Medicare Advantage |
$27.80
|
| Rate for Payer: The Alliance Commercial |
$1,416.00
|
| Rate for Payer: United Healthcare Medicaid |
$28.73
|
| Rate for Payer: United Healthcare Medicare Advantage |
$27.80
|
| Rate for Payer: United Healthcare PPO |
$265.50
|
| Rate for Payer: WEA Trust Commercial |
$194.70
|
| Rate for Payer: Wellcare Medicare |
$27.80
|
| Rate for Payer: WMAP Medicaid |
$28.73
|
| Rate for Payer: WPS Commercial |
$262.21
|
|
|
Citrate Level 24 Hour Urine
|
Facility
IP
|
$354.00
|
|
|
Service Code
|
CPT 82507
|
| Hospital Charge Code |
978110
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$173.46 |
| Max. Negotiated Rate |
$325.68 |
| Rate for Payer: Aetna Commercial |
$318.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$187.62
|
| Rate for Payer: Cash Price |
$106.20
|
| Rate for Payer: Cigna Commercial |
$325.68
|
| Rate for Payer: Health EOS Commercial |
$315.06
|
| Rate for Payer: HFN Commercial |
$325.68
|
| Rate for Payer: Multiplan Commercial |
$283.20
|
| Rate for Payer: NAPHCARE Commercial |
$212.40
|
| Rate for Payer: Preferred Network Access Commercial |
$325.68
|
| Rate for Payer: Quartz Beloit One Network |
$173.46
|
| Rate for Payer: Quartz Commercial |
$212.40
|
| Rate for Payer: WEA Trust Commercial |
$194.70
|
| Rate for Payer: WPS Commercial |
$262.21
|
|
|
Citrate Level 24 Hour Urine
|
Professional
|
$354.00
|
|
|
Service Code
|
CPT 82507
|
| Hospital Charge Code |
978110
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$27.80 |
| Max. Negotiated Rate |
$336.30 |
| Rate for Payer: Aetna Commercial |
$336.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$304.44
|
| Rate for Payer: Aetna Managed Medicare |
$27.80
|
| Rate for Payer: Anthem Medicare Advantage |
$27.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$27.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$27.80
|
| Rate for Payer: Cash Price |
$106.20
|
| Rate for Payer: Cash Price |
$106.20
|
| Rate for Payer: Cigna Commercial |
$336.30
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$177.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$27.80
|
| Rate for Payer: Health EOS Commercial |
$322.14
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$98.13
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$98.13
|
| Rate for Payer: Independent Care Health Plan Medicare |
$27.80
|
| Rate for Payer: Multiplan Commercial |
$283.20
|
| Rate for Payer: Preferred Network Access Commercial |
$336.30
|
| Rate for Payer: Quartz Beloit One Network |
$155.76
|
| Rate for Payer: Quartz Commercial |
$201.78
|
| Rate for Payer: Quartz Medicare Advantage |
$27.80
|
| Rate for Payer: The Alliance Commercial |
$109.81
|
| Rate for Payer: United Healthcare Medicare Advantage |
$27.80
|
| Rate for Payer: WEA Trust Commercial |
$194.70
|
| Rate for Payer: WPS Commercial |
$122.32
|
|
|
Citrate Level Urine
|
Facility
IP
|
$528.00
|
|
|
Service Code
|
CPT 82507
|
| Hospital Charge Code |
978111
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$258.72 |
| Max. Negotiated Rate |
$485.76 |
| Rate for Payer: Aetna Commercial |
$475.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$279.84
|
| Rate for Payer: Cash Price |
$158.40
|
| Rate for Payer: Cigna Commercial |
$485.76
|
| Rate for Payer: Health EOS Commercial |
$469.92
|
| Rate for Payer: HFN Commercial |
$485.76
|
| Rate for Payer: Multiplan Commercial |
$422.40
|
| Rate for Payer: NAPHCARE Commercial |
$316.80
|
| Rate for Payer: Preferred Network Access Commercial |
$485.76
|
| Rate for Payer: Quartz Beloit One Network |
$258.72
|
| Rate for Payer: Quartz Commercial |
$316.80
|
| Rate for Payer: WEA Trust Commercial |
$290.40
|
| Rate for Payer: WPS Commercial |
$391.09
|
|
|
Citrate Level Urine
|
Facility
OP
|
$528.00
|
|
|
Service Code
|
CPT 82507
|
| Hospital Charge Code |
978111
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$27.80 |
| Max. Negotiated Rate |
$2,112.00 |
| Rate for Payer: Aetna Commercial |
$475.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$454.08
|
| Rate for Payer: Aetna Managed Medicare |
$27.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$104.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$48.65
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$46.15
|
| Rate for Payer: Anthem Medicaid |
$28.73
|
| Rate for Payer: Anthem Medicare Advantage |
$27.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$279.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$27.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$27.80
|
| Rate for Payer: Cash Price |
$158.40
|
| Rate for Payer: Cash Price |
$158.40
|
| Rate for Payer: Cigna Commercial |
$485.76
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$27.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$28.73
|
| Rate for Payer: Dean Health Medicaid |
$28.73
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$27.80
|
| Rate for Payer: Health EOS Commercial |
$469.92
|
| Rate for Payer: HFN Commercial |
$485.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$103.42
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$27.80
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$28.73
|
| Rate for Payer: Independent Care Health Plan Medicare |
$27.80
|
| Rate for Payer: Managed Health Services Medicaid |
$29.88
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$27.80
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$27.80
|
| Rate for Payer: Multiplan Commercial |
$422.40
|
| Rate for Payer: NAPHCARE Commercial |
$41.70
|
| Rate for Payer: Preferred Network Access Commercial |
$485.76
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$28.73
|
| Rate for Payer: Quartz Beloit One Network |
$258.72
|
| Rate for Payer: Quartz Commercial |
$343.20
|
| Rate for Payer: Quartz Medicare Advantage |
$27.80
|
| Rate for Payer: The Alliance Commercial |
$2,112.00
|
| Rate for Payer: United Healthcare Medicaid |
$28.73
|
| Rate for Payer: United Healthcare Medicare Advantage |
$27.80
|
| Rate for Payer: United Healthcare PPO |
$396.00
|
| Rate for Payer: WEA Trust Commercial |
$290.40
|
| Rate for Payer: Wellcare Medicare |
$27.80
|
| Rate for Payer: WMAP Medicaid |
$28.73
|
| Rate for Payer: WPS Commercial |
$391.09
|
|
|
Citrate Level Urine
|
Professional
|
$528.00
|
|
|
Service Code
|
CPT 82507
|
| Hospital Charge Code |
978111
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$27.80 |
| Max. Negotiated Rate |
$501.60 |
| Rate for Payer: Aetna Commercial |
$501.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$454.08
|
| Rate for Payer: Aetna Managed Medicare |
$27.80
|
| Rate for Payer: Anthem Medicare Advantage |
$27.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$27.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$27.80
|
| Rate for Payer: Cash Price |
$158.40
|
| Rate for Payer: Cash Price |
$158.40
|
| Rate for Payer: Cigna Commercial |
$501.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$264.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$27.80
|
| Rate for Payer: Health EOS Commercial |
$480.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$98.13
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$98.13
|
| Rate for Payer: Independent Care Health Plan Medicare |
$27.80
|
| Rate for Payer: Multiplan Commercial |
$422.40
|
| Rate for Payer: Preferred Network Access Commercial |
$501.60
|
| Rate for Payer: Quartz Beloit One Network |
$232.32
|
| Rate for Payer: Quartz Commercial |
$300.96
|
| Rate for Payer: Quartz Medicare Advantage |
$27.80
|
| Rate for Payer: The Alliance Commercial |
$109.81
|
| Rate for Payer: United Healthcare Medicare Advantage |
$27.80
|
| Rate for Payer: WEA Trust Commercial |
$290.40
|
| Rate for Payer: WPS Commercial |
$122.32
|
|
|
CK-MB Isoenzyme
|
Facility
IP
|
$237.00
|
|
|
Service Code
|
CPT 82553
|
| Hospital Charge Code |
633713
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$116.13 |
| Max. Negotiated Rate |
$218.04 |
| Rate for Payer: Aetna Commercial |
$213.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$125.61
|
| Rate for Payer: Cash Price |
$71.10
|
| Rate for Payer: Cigna Commercial |
$218.04
|
| Rate for Payer: Health EOS Commercial |
$210.93
|
| Rate for Payer: HFN Commercial |
$218.04
|
| Rate for Payer: Multiplan Commercial |
$189.60
|
| Rate for Payer: NAPHCARE Commercial |
$142.20
|
| Rate for Payer: Preferred Network Access Commercial |
$218.04
|
| Rate for Payer: Quartz Beloit One Network |
$116.13
|
| Rate for Payer: Quartz Commercial |
$142.20
|
| Rate for Payer: WEA Trust Commercial |
$130.35
|
| Rate for Payer: WPS Commercial |
$175.55
|
|
|
CK-MB Isoenzyme
|
Facility
OP
|
$237.00
|
|
|
Service Code
|
CPT 82553
|
| Hospital Charge Code |
633713
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.66 |
| Max. Negotiated Rate |
$948.00 |
| Rate for Payer: Aetna Commercial |
$213.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$203.82
|
| Rate for Payer: Aetna Managed Medicare |
$11.55
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$43.31
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$20.21
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$19.17
|
| Rate for Payer: Anthem Medicaid |
$8.66
|
| Rate for Payer: Anthem Medicare Advantage |
$11.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$125.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$11.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$11.55
|
| Rate for Payer: Cash Price |
$71.10
|
| Rate for Payer: Cash Price |
$71.10
|
| Rate for Payer: Cigna Commercial |
$218.04
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$11.55
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$8.66
|
| Rate for Payer: Dean Health Medicaid |
$8.66
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$11.55
|
| Rate for Payer: Health EOS Commercial |
$210.93
|
| Rate for Payer: HFN Commercial |
$218.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$42.97
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$11.55
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$8.66
|
| Rate for Payer: Independent Care Health Plan Medicare |
$11.55
|
| Rate for Payer: Managed Health Services Medicaid |
$9.01
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$11.55
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$11.55
|
| Rate for Payer: Multiplan Commercial |
$189.60
|
| Rate for Payer: NAPHCARE Commercial |
$17.32
|
| Rate for Payer: Preferred Network Access Commercial |
$218.04
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$8.66
|
| Rate for Payer: Quartz Beloit One Network |
$116.13
|
| Rate for Payer: Quartz Commercial |
$154.05
|
| Rate for Payer: Quartz Medicare Advantage |
$11.55
|
| Rate for Payer: The Alliance Commercial |
$948.00
|
| Rate for Payer: United Healthcare Medicaid |
$8.66
|
| Rate for Payer: United Healthcare Medicare Advantage |
$11.55
|
| Rate for Payer: United Healthcare PPO |
$177.75
|
| Rate for Payer: WEA Trust Commercial |
$130.35
|
| Rate for Payer: Wellcare Medicare |
$11.55
|
| Rate for Payer: WMAP Medicaid |
$8.66
|
| Rate for Payer: WPS Commercial |
$175.55
|
|
|
CK-MB Isoenzyme
|
Professional
|
$237.00
|
|
|
Service Code
|
CPT 82553
|
| Hospital Charge Code |
633713
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.55 |
| Max. Negotiated Rate |
$225.15 |
| Rate for Payer: Aetna Commercial |
$225.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$203.82
|
| Rate for Payer: Aetna Managed Medicare |
$11.55
|
| Rate for Payer: Anthem Medicare Advantage |
$11.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$11.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$11.55
|
| Rate for Payer: Cash Price |
$71.10
|
| Rate for Payer: Cash Price |
$71.10
|
| Rate for Payer: Cigna Commercial |
$225.15
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$118.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$11.55
|
| Rate for Payer: Health EOS Commercial |
$215.67
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$40.77
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$40.77
|
| Rate for Payer: Independent Care Health Plan Medicare |
$11.55
|
| Rate for Payer: Multiplan Commercial |
$189.60
|
| Rate for Payer: Preferred Network Access Commercial |
$225.15
|
| Rate for Payer: Quartz Beloit One Network |
$104.28
|
| Rate for Payer: Quartz Commercial |
$135.09
|
| Rate for Payer: Quartz Medicare Advantage |
$11.55
|
| Rate for Payer: The Alliance Commercial |
$45.62
|
| Rate for Payer: United Healthcare Medicare Advantage |
$11.55
|
| Rate for Payer: WEA Trust Commercial |
$130.35
|
| Rate for Payer: WPS Commercial |
$50.82
|
|
|
Cladosporium hormodendrum IgG4
|
Facility
IP
|
$122.00
|
|
|
Service Code
|
CPT 86001
|
| Hospital Charge Code |
6196560
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$59.78 |
| Max. Negotiated Rate |
$112.24 |
| Rate for Payer: Aetna Commercial |
$109.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$64.66
|
| Rate for Payer: Cash Price |
$36.60
|
| Rate for Payer: Cigna Commercial |
$112.24
|
| Rate for Payer: Health EOS Commercial |
$108.58
|
| Rate for Payer: HFN Commercial |
$112.24
|
| Rate for Payer: Multiplan Commercial |
$97.60
|
| Rate for Payer: NAPHCARE Commercial |
$73.20
|
| Rate for Payer: Preferred Network Access Commercial |
$112.24
|
| Rate for Payer: Quartz Beloit One Network |
$59.78
|
| Rate for Payer: Quartz Commercial |
$73.20
|
| Rate for Payer: WEA Trust Commercial |
$67.10
|
| Rate for Payer: WPS Commercial |
$90.37
|
|
|
Cladosporium hormodendrum IgG4
|
Professional
|
$122.00
|
|
|
Service Code
|
CPT 86001
|
| Hospital Charge Code |
6196560
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$7.82 |
| Max. Negotiated Rate |
$115.90 |
| Rate for Payer: Aetna Commercial |
$115.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$104.92
|
| Rate for Payer: Aetna Managed Medicare |
$7.82
|
| Rate for Payer: Anthem Medicare Advantage |
$7.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$7.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$7.82
|
| Rate for Payer: Cash Price |
$36.60
|
| Rate for Payer: Cash Price |
$36.60
|
| Rate for Payer: Cigna Commercial |
$115.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$61.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$7.82
|
| Rate for Payer: Health EOS Commercial |
$111.02
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$27.60
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$27.60
|
| Rate for Payer: Independent Care Health Plan Medicare |
$7.82
|
| Rate for Payer: Multiplan Commercial |
$97.60
|
| Rate for Payer: Preferred Network Access Commercial |
$115.90
|
| Rate for Payer: Quartz Beloit One Network |
$53.68
|
| Rate for Payer: Quartz Commercial |
$69.54
|
| Rate for Payer: Quartz Medicare Advantage |
$7.82
|
| Rate for Payer: The Alliance Commercial |
$30.89
|
| Rate for Payer: United Healthcare Medicare Advantage |
$7.82
|
| Rate for Payer: WEA Trust Commercial |
$67.10
|
| Rate for Payer: WPS Commercial |
$34.41
|
|
|
Cladosporium hormodendrum IgG4
|
Facility
OP
|
$122.00
|
|
|
Service Code
|
CPT 86001
|
| Hospital Charge Code |
6196560
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.57 |
| Max. Negotiated Rate |
$488.00 |
| Rate for Payer: Aetna Commercial |
$109.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$104.92
|
| Rate for Payer: Aetna Managed Medicare |
$7.82
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$29.32
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$13.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$12.98
|
| Rate for Payer: Anthem Medicaid |
$4.57
|
| Rate for Payer: Anthem Medicare Advantage |
$7.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$64.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$7.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$7.82
|
| Rate for Payer: Cash Price |
$36.60
|
| Rate for Payer: Cash Price |
$36.60
|
| Rate for Payer: Cigna Commercial |
$112.24
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$7.82
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$4.57
|
| Rate for Payer: Dean Health Medicaid |
$4.57
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$7.82
|
| Rate for Payer: Health EOS Commercial |
$108.58
|
| Rate for Payer: HFN Commercial |
$112.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$29.09
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$7.82
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$4.57
|
| Rate for Payer: Independent Care Health Plan Medicare |
$7.82
|
| Rate for Payer: Managed Health Services Medicaid |
$4.75
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$7.82
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$7.82
|
| Rate for Payer: Multiplan Commercial |
$97.60
|
| Rate for Payer: NAPHCARE Commercial |
$11.73
|
| Rate for Payer: Preferred Network Access Commercial |
$112.24
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$4.57
|
| Rate for Payer: Quartz Beloit One Network |
$59.78
|
| Rate for Payer: Quartz Commercial |
$79.30
|
| Rate for Payer: Quartz Medicare Advantage |
$7.82
|
| Rate for Payer: The Alliance Commercial |
$488.00
|
| Rate for Payer: United Healthcare Medicaid |
$4.57
|
| Rate for Payer: United Healthcare Medicare Advantage |
$7.82
|
| Rate for Payer: United Healthcare PPO |
$91.50
|
| Rate for Payer: WEA Trust Commercial |
$67.10
|
| Rate for Payer: Wellcare Medicare |
$7.82
|
| Rate for Payer: WMAP Medicaid |
$4.57
|
| Rate for Payer: WPS Commercial |
$90.37
|
|
|
CLAMP 4.O ADJUSTABLE 390.051
|
Facility
OP
|
$7,837.00
|
|
| Hospital Charge Code |
2966162
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,194.36 |
| Max. Negotiated Rate |
$31,348.00 |
| Rate for Payer: Aetna Commercial |
$7,053.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,739.82
|
| Rate for Payer: Aetna Managed Medicare |
$2,194.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,094.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,918.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,761.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,153.61
|
| Rate for Payer: Cash Price |
$2,351.10
|
| Rate for Payer: Cigna Commercial |
$7,210.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,385.59
|
| Rate for Payer: Health EOS Commercial |
$6,974.93
|
| Rate for Payer: HFN Commercial |
$7,210.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,877.75
|
| Rate for Payer: Multiplan Commercial |
$6,269.60
|
| Rate for Payer: NAPHCARE Commercial |
$4,702.20
|
| Rate for Payer: Preferred Network Access Commercial |
$7,210.04
|
| Rate for Payer: Quartz Beloit One Network |
$3,840.13
|
| Rate for Payer: Quartz Commercial |
$5,094.05
|
| Rate for Payer: Quartz Medicare Advantage |
$4,702.20
|
| Rate for Payer: The Alliance Commercial |
$31,348.00
|
| Rate for Payer: WEA Trust Commercial |
$4,310.35
|
| Rate for Payer: WPS Commercial |
$5,804.87
|
|
|
CLAMP 4.O ADJUSTABLE 390.051
|
Facility
IP
|
$7,837.00
|
|
| Hospital Charge Code |
2966162
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3,840.13 |
| Max. Negotiated Rate |
$7,210.04 |
| Rate for Payer: Aetna Commercial |
$7,053.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,153.61
|
| Rate for Payer: Cash Price |
$2,351.10
|
| Rate for Payer: Cigna Commercial |
$7,210.04
|
| Rate for Payer: Health EOS Commercial |
$6,974.93
|
| Rate for Payer: HFN Commercial |
$7,210.04
|
| Rate for Payer: Multiplan Commercial |
$6,269.60
|
| Rate for Payer: NAPHCARE Commercial |
$4,702.20
|
| Rate for Payer: Preferred Network Access Commercial |
$7,210.04
|
| Rate for Payer: Quartz Beloit One Network |
$3,840.13
|
| Rate for Payer: Quartz Commercial |
$4,702.20
|
| Rate for Payer: WEA Trust Commercial |
$4,310.35
|
| Rate for Payer: WPS Commercial |
$5,804.87
|
|
|
CLAMP ADJUSTABLE 393.64
|
Facility
IP
|
$2,968.00
|
|
| Hospital Charge Code |
5811625
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,454.32 |
| Max. Negotiated Rate |
$2,730.56 |
| Rate for Payer: Aetna Commercial |
$2,671.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,573.04
|
| Rate for Payer: Cash Price |
$890.40
|
| Rate for Payer: Cigna Commercial |
$2,730.56
|
| Rate for Payer: Health EOS Commercial |
$2,641.52
|
| Rate for Payer: HFN Commercial |
$2,730.56
|
| Rate for Payer: Multiplan Commercial |
$2,374.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,780.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,730.56
|
| Rate for Payer: Quartz Beloit One Network |
$1,454.32
|
| Rate for Payer: Quartz Commercial |
$1,780.80
|
| Rate for Payer: WEA Trust Commercial |
$1,632.40
|
| Rate for Payer: WPS Commercial |
$2,198.40
|
|
|
CLAMP ADJUSTABLE 393.64
|
Facility
OP
|
$2,968.00
|
|
| Hospital Charge Code |
5811625
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$831.04 |
| Max. Negotiated Rate |
$11,872.00 |
| Rate for Payer: Aetna Commercial |
$2,671.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,552.48
|
| Rate for Payer: Aetna Managed Medicare |
$831.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,929.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,484.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,424.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,573.04
|
| Rate for Payer: Cash Price |
$890.40
|
| Rate for Payer: Cigna Commercial |
$2,730.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,660.89
|
| Rate for Payer: Health EOS Commercial |
$2,641.52
|
| Rate for Payer: HFN Commercial |
$2,730.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,226.00
|
| Rate for Payer: Multiplan Commercial |
$2,374.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,780.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,730.56
|
| Rate for Payer: Quartz Beloit One Network |
$1,454.32
|
| Rate for Payer: Quartz Commercial |
$1,929.20
|
| Rate for Payer: Quartz Medicare Advantage |
$1,780.80
|
| Rate for Payer: The Alliance Commercial |
$11,872.00
|
| Rate for Payer: WEA Trust Commercial |
$1,632.40
|
| Rate for Payer: WPS Commercial |
$2,198.40
|
|
|
CLAMP ADJUSTABLE WIRE PIN
|
Facility
IP
|
$8,681.00
|
|
| Hospital Charge Code |
2966163
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4,253.69 |
| Max. Negotiated Rate |
$7,986.52 |
| Rate for Payer: Aetna Commercial |
$7,812.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,600.93
|
| Rate for Payer: Cash Price |
$2,604.30
|
| Rate for Payer: Cigna Commercial |
$7,986.52
|
| Rate for Payer: Health EOS Commercial |
$7,726.09
|
| Rate for Payer: HFN Commercial |
$7,986.52
|
| Rate for Payer: Multiplan Commercial |
$6,944.80
|
| Rate for Payer: NAPHCARE Commercial |
$5,208.60
|
| Rate for Payer: Preferred Network Access Commercial |
$7,986.52
|
| Rate for Payer: Quartz Beloit One Network |
$4,253.69
|
| Rate for Payer: Quartz Commercial |
$5,208.60
|
| Rate for Payer: WEA Trust Commercial |
$4,774.55
|
| Rate for Payer: WPS Commercial |
$6,430.02
|
|
|
CLAMP ADJUSTABLE WIRE PIN
|
Facility
OP
|
$8,681.00
|
|
| Hospital Charge Code |
2966163
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,430.68 |
| Max. Negotiated Rate |
$34,724.00 |
| Rate for Payer: Aetna Commercial |
$7,812.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,465.66
|
| Rate for Payer: Aetna Managed Medicare |
$2,430.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,642.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,340.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,166.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,600.93
|
| Rate for Payer: Cash Price |
$2,604.30
|
| Rate for Payer: Cigna Commercial |
$7,986.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,857.89
|
| Rate for Payer: Health EOS Commercial |
$7,726.09
|
| Rate for Payer: HFN Commercial |
$7,986.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,510.75
|
| Rate for Payer: Multiplan Commercial |
$6,944.80
|
| Rate for Payer: NAPHCARE Commercial |
$5,208.60
|
| Rate for Payer: Preferred Network Access Commercial |
$7,986.52
|
| Rate for Payer: Quartz Beloit One Network |
$4,253.69
|
| Rate for Payer: Quartz Commercial |
$5,642.65
|
| Rate for Payer: Quartz Medicare Advantage |
$5,208.60
|
| Rate for Payer: The Alliance Commercial |
$34,724.00
|
| Rate for Payer: WEA Trust Commercial |
$4,774.55
|
| Rate for Payer: WPS Commercial |
$6,430.02
|
|
