|
CIRRHOSIS AND ALCOHOLIC HEPATITIS WITH MCC
|
Facility
|
IP
|
$53,309.36
|
|
|
Service Code
|
MSDRG 432
|
| Min. Negotiated Rate |
$15,579.65 |
| Max. Negotiated Rate |
$53,309.36 |
| Rate for Payer: Aetna Managed Medicare |
$15,579.65
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$42,944.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$32,916.65
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$31,272.97
|
| Rate for Payer: Anthem Medicare Advantage |
$15,579.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$15,579.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$15,579.65
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$15,579.65
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$34,715.86
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$15,579.65
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$38,856.48
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$15,579.65
|
| Rate for Payer: Independent Care Health Plan Medicare |
$15,579.65
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$15,579.65
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$15,579.65
|
| Rate for Payer: NAPHCARE Commercial |
$23,369.47
|
| Rate for Payer: Quartz Medicare Advantage |
$15,579.65
|
| Rate for Payer: The Alliance Commercial |
$53,309.36
|
| Rate for Payer: United Healthcare Medicare Advantage |
$15,579.65
|
| Rate for Payer: United Healthcare PPO |
$30,250.27
|
| Rate for Payer: Wellcare Medicare |
$15,579.65
|
|
|
CIRRHOSIS AND ALCOHOLIC HEPATITIS WITHOUT CC/MCC
|
Facility
|
IP
|
$18,844.80
|
|
|
Service Code
|
MSDRG 434
|
| Min. Negotiated Rate |
$5,963.26 |
| Max. Negotiated Rate |
$18,844.80 |
| Rate for Payer: Aetna Managed Medicare |
$5,963.26
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$15,546.18
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$11,916.02
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$11,321.00
|
| Rate for Payer: Anthem Medicare Advantage |
$5,963.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5,963.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5,963.26
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$5,963.26
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12,567.35
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$5,963.26
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$13,577.46
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$5,963.26
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5,963.26
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$5,963.26
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$5,963.26
|
| Rate for Payer: NAPHCARE Commercial |
$8,944.88
|
| Rate for Payer: Quartz Medicare Advantage |
$5,963.26
|
| Rate for Payer: The Alliance Commercial |
$18,844.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5,963.26
|
| Rate for Payer: United Healthcare PPO |
$10,570.23
|
| Rate for Payer: Wellcare Medicare |
$5,963.26
|
|
|
Citalopram Level
|
Professional
|
Both
|
$256.00
|
|
|
Service Code
|
CPT 80332
|
| Hospital Charge Code |
1038869
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$83.26 |
| Max. Negotiated Rate |
$252.93 |
| Rate for Payer: Aetna Commercial |
$252.93
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$228.97
|
| Rate for Payer: Cash Price |
$76.80
|
| Rate for Payer: Cash Price |
$76.80
|
| Rate for Payer: Cigna Commercial |
$252.93
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$133.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$159.74
|
| Rate for Payer: Health EOS Commercial |
$242.28
|
| Rate for Payer: HFN Commercial |
$252.93
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$83.26
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$83.26
|
| Rate for Payer: Multiplan Commercial |
$212.99
|
| Rate for Payer: Preferred Network Access Commercial |
$252.93
|
| Rate for Payer: Quartz Beloit One Network |
$117.15
|
| Rate for Payer: Quartz Commercial |
$151.76
|
| Rate for Payer: The Alliance Commercial |
$133.12
|
| Rate for Payer: WEA Trust Commercial |
$146.43
|
| Rate for Payer: WPS Commercial |
$197.20
|
|
|
Citalopram Level
|
Facility
|
IP
|
$256.00
|
|
|
Service Code
|
CPT 80332
|
| Hospital Charge Code |
1038869
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$130.46 |
| Max. Negotiated Rate |
$244.94 |
| Rate for Payer: Aetna Commercial |
$239.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$228.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$141.11
|
| Rate for Payer: Cash Price |
$76.80
|
| Rate for Payer: Cigna Commercial |
$244.94
|
| Rate for Payer: Health EOS Commercial |
$236.95
|
| Rate for Payer: HFN Commercial |
$244.94
|
| Rate for Payer: Multiplan Commercial |
$212.99
|
| Rate for Payer: Preferred Network Access Commercial |
$244.94
|
| Rate for Payer: Quartz Beloit One Network |
$130.46
|
| Rate for Payer: Quartz Commercial |
$159.74
|
| Rate for Payer: WEA Trust Commercial |
$146.43
|
| Rate for Payer: WPS Commercial |
$197.20
|
|
|
Citalopram Level
|
Facility
|
OP
|
$256.00
|
|
|
Service Code
|
CPT 80332
|
| Hospital Charge Code |
1038869
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$74.55 |
| Max. Negotiated Rate |
$244.94 |
| Rate for Payer: Aetna Commercial |
$239.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$228.97
|
| Rate for Payer: Aetna Managed Medicare |
$74.55
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$173.06
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$133.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$127.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$141.11
|
| Rate for Payer: Cash Price |
$76.80
|
| Rate for Payer: Cigna Commercial |
$244.94
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$148.99
|
| Rate for Payer: Health EOS Commercial |
$236.95
|
| Rate for Payer: HFN Commercial |
$244.94
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$199.68
|
| Rate for Payer: Multiplan Commercial |
$212.99
|
| Rate for Payer: NAPHCARE Commercial |
$159.74
|
| Rate for Payer: Preferred Network Access Commercial |
$244.94
|
| Rate for Payer: Quartz Beloit One Network |
$130.46
|
| Rate for Payer: Quartz Commercial |
$173.06
|
| Rate for Payer: Quartz Medicare Advantage |
$159.74
|
| Rate for Payer: The Alliance Commercial |
$133.12
|
| Rate for Payer: United Healthcare PPO |
$199.68
|
| Rate for Payer: WEA Trust Commercial |
$146.43
|
| Rate for Payer: WPS Commercial |
$197.20
|
|
|
Citrate Excretion, Urine
|
Professional
|
Both
|
$166.00
|
|
|
Service Code
|
CPT 82507
|
| Hospital Charge Code |
5474692
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$28.91 |
| Max. Negotiated Rate |
$164.01 |
| Rate for Payer: Aetna Commercial |
$164.01
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$148.47
|
| Rate for Payer: Aetna Managed Medicare |
$28.91
|
| Rate for Payer: Anthem Medicare Advantage |
$28.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$28.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$28.91
|
| Rate for Payer: Cash Price |
$49.80
|
| Rate for Payer: Cash Price |
$49.80
|
| Rate for Payer: Cigna Commercial |
$164.01
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$86.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$28.91
|
| Rate for Payer: Health EOS Commercial |
$157.10
|
| Rate for Payer: HFN Commercial |
$164.01
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$102.06
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$102.06
|
| Rate for Payer: Independent Care Health Plan Medicare |
$28.91
|
| Rate for Payer: Multiplan Commercial |
$138.11
|
| Rate for Payer: NAPHCARE Commercial |
$43.37
|
| Rate for Payer: Preferred Network Access Commercial |
$164.01
|
| Rate for Payer: Quartz Beloit One Network |
$75.96
|
| Rate for Payer: Quartz Commercial |
$98.40
|
| Rate for Payer: Quartz Medicare Advantage |
$28.91
|
| Rate for Payer: The Alliance Commercial |
$114.20
|
| Rate for Payer: United Healthcare Medicare Advantage |
$28.91
|
| Rate for Payer: WEA Trust Commercial |
$94.95
|
| Rate for Payer: WPS Commercial |
$127.21
|
|
|
Citrate Excretion, Urine
|
Facility
|
IP
|
$166.00
|
|
|
Service Code
|
CPT 82507
|
| Hospital Charge Code |
5474692
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$84.59 |
| Max. Negotiated Rate |
$158.83 |
| Rate for Payer: Aetna Commercial |
$155.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$148.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$91.50
|
| Rate for Payer: Cash Price |
$49.80
|
| Rate for Payer: Cigna Commercial |
$158.83
|
| Rate for Payer: Health EOS Commercial |
$153.65
|
| Rate for Payer: HFN Commercial |
$158.83
|
| Rate for Payer: Multiplan Commercial |
$138.11
|
| Rate for Payer: Preferred Network Access Commercial |
$158.83
|
| Rate for Payer: Quartz Beloit One Network |
$84.59
|
| Rate for Payer: Quartz Commercial |
$103.58
|
| Rate for Payer: WEA Trust Commercial |
$94.95
|
| Rate for Payer: WPS Commercial |
$127.87
|
|
|
Citrate Excretion, Urine
|
Facility
|
OP
|
$166.00
|
|
|
Service Code
|
CPT 82507
|
| Hospital Charge Code |
5474692
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$28.91 |
| Max. Negotiated Rate |
$158.83 |
| Rate for Payer: Aetna Commercial |
$155.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$148.47
|
| Rate for Payer: Aetna Managed Medicare |
$28.91
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$108.42
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$50.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$47.99
|
| Rate for Payer: Anthem Medicare Advantage |
$28.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$91.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$28.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$28.91
|
| Rate for Payer: Cash Price |
$49.80
|
| Rate for Payer: Cash Price |
$49.80
|
| Rate for Payer: Cigna Commercial |
$158.83
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$28.91
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$96.61
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$28.91
|
| Rate for Payer: Health EOS Commercial |
$153.65
|
| Rate for Payer: HFN Commercial |
$158.83
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$107.55
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$28.91
|
| Rate for Payer: Independent Care Health Plan Medicare |
$28.91
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$28.91
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$28.91
|
| Rate for Payer: Multiplan Commercial |
$138.11
|
| Rate for Payer: NAPHCARE Commercial |
$43.37
|
| Rate for Payer: Preferred Network Access Commercial |
$158.83
|
| Rate for Payer: Quartz Beloit One Network |
$84.59
|
| Rate for Payer: Quartz Commercial |
$112.22
|
| Rate for Payer: Quartz Medicare Advantage |
$28.91
|
| Rate for Payer: The Alliance Commercial |
$115.65
|
| Rate for Payer: United Healthcare Medicare Advantage |
$28.91
|
| Rate for Payer: United Healthcare PPO |
$129.48
|
| Rate for Payer: WEA Trust Commercial |
$94.95
|
| Rate for Payer: Wellcare Medicare |
$28.91
|
| Rate for Payer: WPS Commercial |
$127.87
|
|
|
Citrate Level 24 Hour Urine
|
Professional
|
Both
|
$354.00
|
|
|
Service Code
|
CPT 82507
|
| Hospital Charge Code |
978110
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$28.91 |
| Max. Negotiated Rate |
$349.75 |
| Rate for Payer: Aetna Commercial |
$349.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$316.62
|
| Rate for Payer: Aetna Managed Medicare |
$28.91
|
| Rate for Payer: Anthem Medicare Advantage |
$28.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$28.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$28.91
|
| Rate for Payer: Cash Price |
$106.20
|
| Rate for Payer: Cash Price |
$106.20
|
| Rate for Payer: Cigna Commercial |
$349.75
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$184.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$28.91
|
| Rate for Payer: Health EOS Commercial |
$335.03
|
| Rate for Payer: HFN Commercial |
$349.75
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$102.06
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$102.06
|
| Rate for Payer: Independent Care Health Plan Medicare |
$28.91
|
| Rate for Payer: Multiplan Commercial |
$294.53
|
| Rate for Payer: NAPHCARE Commercial |
$43.37
|
| Rate for Payer: Preferred Network Access Commercial |
$349.75
|
| Rate for Payer: Quartz Beloit One Network |
$161.99
|
| Rate for Payer: Quartz Commercial |
$209.85
|
| Rate for Payer: Quartz Medicare Advantage |
$28.91
|
| Rate for Payer: The Alliance Commercial |
$114.20
|
| Rate for Payer: United Healthcare Medicare Advantage |
$28.91
|
| Rate for Payer: WEA Trust Commercial |
$202.49
|
| Rate for Payer: WPS Commercial |
$127.21
|
|
|
Citrate Level 24 Hour Urine
|
Facility
|
OP
|
$354.00
|
|
|
Service Code
|
CPT 82507
|
| Hospital Charge Code |
978110
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$28.91 |
| Max. Negotiated Rate |
$338.71 |
| Rate for Payer: Aetna Commercial |
$331.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$316.62
|
| Rate for Payer: Aetna Managed Medicare |
$28.91
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$108.42
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$50.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$47.99
|
| Rate for Payer: Anthem Medicare Advantage |
$28.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$195.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$28.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$28.91
|
| Rate for Payer: Cash Price |
$106.20
|
| Rate for Payer: Cash Price |
$106.20
|
| Rate for Payer: Cigna Commercial |
$338.71
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$28.91
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$206.03
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$28.91
|
| Rate for Payer: Health EOS Commercial |
$327.66
|
| Rate for Payer: HFN Commercial |
$338.71
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$107.55
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$28.91
|
| Rate for Payer: Independent Care Health Plan Medicare |
$28.91
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$28.91
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$28.91
|
| Rate for Payer: Multiplan Commercial |
$294.53
|
| Rate for Payer: NAPHCARE Commercial |
$43.37
|
| Rate for Payer: Preferred Network Access Commercial |
$338.71
|
| Rate for Payer: Quartz Beloit One Network |
$180.40
|
| Rate for Payer: Quartz Commercial |
$239.30
|
| Rate for Payer: Quartz Medicare Advantage |
$28.91
|
| Rate for Payer: The Alliance Commercial |
$115.65
|
| Rate for Payer: United Healthcare Medicare Advantage |
$28.91
|
| Rate for Payer: United Healthcare PPO |
$276.12
|
| Rate for Payer: WEA Trust Commercial |
$202.49
|
| Rate for Payer: Wellcare Medicare |
$28.91
|
| Rate for Payer: WPS Commercial |
$272.69
|
|
|
Citrate Level 24 Hour Urine
|
Facility
|
IP
|
$354.00
|
|
|
Service Code
|
CPT 82507
|
| Hospital Charge Code |
978110
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$180.40 |
| Max. Negotiated Rate |
$338.71 |
| Rate for Payer: Aetna Commercial |
$331.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$316.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$195.12
|
| Rate for Payer: Cash Price |
$106.20
|
| Rate for Payer: Cigna Commercial |
$338.71
|
| Rate for Payer: Health EOS Commercial |
$327.66
|
| Rate for Payer: HFN Commercial |
$338.71
|
| Rate for Payer: Multiplan Commercial |
$294.53
|
| Rate for Payer: Preferred Network Access Commercial |
$338.71
|
| Rate for Payer: Quartz Beloit One Network |
$180.40
|
| Rate for Payer: Quartz Commercial |
$220.90
|
| Rate for Payer: WEA Trust Commercial |
$202.49
|
| Rate for Payer: WPS Commercial |
$272.69
|
|
|
Citrate Level Urine
|
Professional
|
Both
|
$528.00
|
|
|
Service Code
|
CPT 82507
|
| Hospital Charge Code |
978111
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$28.91 |
| Max. Negotiated Rate |
$521.66 |
| Rate for Payer: Aetna Commercial |
$521.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$472.24
|
| Rate for Payer: Aetna Managed Medicare |
$28.91
|
| Rate for Payer: Anthem Medicare Advantage |
$28.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$28.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$28.91
|
| Rate for Payer: Cash Price |
$158.40
|
| Rate for Payer: Cash Price |
$158.40
|
| Rate for Payer: Cigna Commercial |
$521.66
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$274.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$28.91
|
| Rate for Payer: Health EOS Commercial |
$499.70
|
| Rate for Payer: HFN Commercial |
$521.66
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$102.06
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$102.06
|
| Rate for Payer: Independent Care Health Plan Medicare |
$28.91
|
| Rate for Payer: Multiplan Commercial |
$439.30
|
| Rate for Payer: NAPHCARE Commercial |
$43.37
|
| Rate for Payer: Preferred Network Access Commercial |
$521.66
|
| Rate for Payer: Quartz Beloit One Network |
$241.61
|
| Rate for Payer: Quartz Commercial |
$313.00
|
| Rate for Payer: Quartz Medicare Advantage |
$28.91
|
| Rate for Payer: The Alliance Commercial |
$114.20
|
| Rate for Payer: United Healthcare Medicare Advantage |
$28.91
|
| Rate for Payer: WEA Trust Commercial |
$302.02
|
| Rate for Payer: WPS Commercial |
$127.21
|
|
|
Citrate Level Urine
|
Facility
|
OP
|
$528.00
|
|
|
Service Code
|
CPT 82507
|
| Hospital Charge Code |
978111
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$28.91 |
| Max. Negotiated Rate |
$505.19 |
| Rate for Payer: Aetna Commercial |
$494.21
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$472.24
|
| Rate for Payer: Aetna Managed Medicare |
$28.91
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$108.42
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$50.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$47.99
|
| Rate for Payer: Anthem Medicare Advantage |
$28.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$291.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$28.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$28.91
|
| Rate for Payer: Cash Price |
$158.40
|
| Rate for Payer: Cash Price |
$158.40
|
| Rate for Payer: Cigna Commercial |
$505.19
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$28.91
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$307.30
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$28.91
|
| Rate for Payer: Health EOS Commercial |
$488.72
|
| Rate for Payer: HFN Commercial |
$505.19
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$107.55
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$28.91
|
| Rate for Payer: Independent Care Health Plan Medicare |
$28.91
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$28.91
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$28.91
|
| Rate for Payer: Multiplan Commercial |
$439.30
|
| Rate for Payer: NAPHCARE Commercial |
$43.37
|
| Rate for Payer: Preferred Network Access Commercial |
$505.19
|
| Rate for Payer: Quartz Beloit One Network |
$269.07
|
| Rate for Payer: Quartz Commercial |
$356.93
|
| Rate for Payer: Quartz Medicare Advantage |
$28.91
|
| Rate for Payer: The Alliance Commercial |
$115.65
|
| Rate for Payer: United Healthcare Medicare Advantage |
$28.91
|
| Rate for Payer: United Healthcare PPO |
$411.84
|
| Rate for Payer: WEA Trust Commercial |
$302.02
|
| Rate for Payer: Wellcare Medicare |
$28.91
|
| Rate for Payer: WPS Commercial |
$406.72
|
|
|
Citrate Level Urine
|
Facility
|
IP
|
$528.00
|
|
|
Service Code
|
CPT 82507
|
| Hospital Charge Code |
978111
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$269.07 |
| Max. Negotiated Rate |
$505.19 |
| Rate for Payer: Aetna Commercial |
$494.21
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$472.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$291.03
|
| Rate for Payer: Cash Price |
$158.40
|
| Rate for Payer: Cigna Commercial |
$505.19
|
| Rate for Payer: Health EOS Commercial |
$488.72
|
| Rate for Payer: HFN Commercial |
$505.19
|
| Rate for Payer: Multiplan Commercial |
$439.30
|
| Rate for Payer: Preferred Network Access Commercial |
$505.19
|
| Rate for Payer: Quartz Beloit One Network |
$269.07
|
| Rate for Payer: Quartz Commercial |
$329.47
|
| Rate for Payer: WEA Trust Commercial |
$302.02
|
| Rate for Payer: WPS Commercial |
$406.72
|
|
|
CK-MB Isoenzyme
|
Facility
|
IP
|
$237.00
|
|
|
Service Code
|
CPT 82553
|
| Hospital Charge Code |
633713
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$120.78 |
| Max. Negotiated Rate |
$226.76 |
| Rate for Payer: Aetna Commercial |
$221.83
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$211.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$130.63
|
| Rate for Payer: Cash Price |
$71.10
|
| Rate for Payer: Cigna Commercial |
$226.76
|
| Rate for Payer: Health EOS Commercial |
$219.37
|
| Rate for Payer: HFN Commercial |
$226.76
|
| Rate for Payer: Multiplan Commercial |
$197.18
|
| Rate for Payer: Preferred Network Access Commercial |
$226.76
|
| Rate for Payer: Quartz Beloit One Network |
$120.78
|
| Rate for Payer: Quartz Commercial |
$147.89
|
| Rate for Payer: WEA Trust Commercial |
$135.56
|
| Rate for Payer: WPS Commercial |
$182.56
|
|
|
CK-MB Isoenzyme
|
Professional
|
Both
|
$237.00
|
|
|
Service Code
|
CPT 82553
|
| Hospital Charge Code |
633713
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.01 |
| Max. Negotiated Rate |
$234.16 |
| Rate for Payer: Aetna Commercial |
$234.16
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$211.97
|
| Rate for Payer: Aetna Managed Medicare |
$12.01
|
| Rate for Payer: Anthem Medicare Advantage |
$12.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$12.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$12.01
|
| Rate for Payer: Cash Price |
$71.10
|
| Rate for Payer: Cash Price |
$71.10
|
| Rate for Payer: Cigna Commercial |
$234.16
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$123.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12.01
|
| Rate for Payer: Health EOS Commercial |
$224.30
|
| Rate for Payer: HFN Commercial |
$234.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$42.40
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$42.40
|
| Rate for Payer: Independent Care Health Plan Medicare |
$12.01
|
| Rate for Payer: Multiplan Commercial |
$197.18
|
| Rate for Payer: NAPHCARE Commercial |
$18.02
|
| Rate for Payer: Preferred Network Access Commercial |
$234.16
|
| Rate for Payer: Quartz Beloit One Network |
$108.45
|
| Rate for Payer: Quartz Commercial |
$140.49
|
| Rate for Payer: Quartz Medicare Advantage |
$12.01
|
| Rate for Payer: The Alliance Commercial |
$47.45
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.01
|
| Rate for Payer: WEA Trust Commercial |
$135.56
|
| Rate for Payer: WPS Commercial |
$52.85
|
|
|
CK-MB Isoenzyme
|
Facility
|
OP
|
$237.00
|
|
|
Service Code
|
CPT 82553
|
| Hospital Charge Code |
633713
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.01 |
| Max. Negotiated Rate |
$226.76 |
| Rate for Payer: Aetna Commercial |
$221.83
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$211.97
|
| Rate for Payer: Aetna Managed Medicare |
$12.01
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$45.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$21.02
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$19.94
|
| Rate for Payer: Anthem Medicare Advantage |
$12.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$130.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$12.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$12.01
|
| Rate for Payer: Cash Price |
$71.10
|
| Rate for Payer: Cash Price |
$71.10
|
| Rate for Payer: Cigna Commercial |
$226.76
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$12.01
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$137.93
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$12.01
|
| Rate for Payer: Health EOS Commercial |
$219.37
|
| Rate for Payer: HFN Commercial |
$226.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$44.68
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$12.01
|
| Rate for Payer: Independent Care Health Plan Medicare |
$12.01
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$12.01
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$12.01
|
| Rate for Payer: Multiplan Commercial |
$197.18
|
| Rate for Payer: NAPHCARE Commercial |
$18.02
|
| Rate for Payer: Preferred Network Access Commercial |
$226.76
|
| Rate for Payer: Quartz Beloit One Network |
$120.78
|
| Rate for Payer: Quartz Commercial |
$160.21
|
| Rate for Payer: Quartz Medicare Advantage |
$12.01
|
| Rate for Payer: The Alliance Commercial |
$48.05
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.01
|
| Rate for Payer: United Healthcare PPO |
$184.86
|
| Rate for Payer: WEA Trust Commercial |
$135.56
|
| Rate for Payer: Wellcare Medicare |
$12.01
|
| Rate for Payer: WPS Commercial |
$182.56
|
|
|
Cladosporium hormodendrum IgG4
|
Facility
|
IP
|
$122.00
|
|
|
Service Code
|
CPT 86001
|
| Hospital Charge Code |
6196560
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$62.17 |
| Max. Negotiated Rate |
$116.73 |
| Rate for Payer: Aetna Commercial |
$114.19
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$109.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$67.25
|
| Rate for Payer: Cash Price |
$36.60
|
| Rate for Payer: Cigna Commercial |
$116.73
|
| Rate for Payer: Health EOS Commercial |
$112.92
|
| Rate for Payer: HFN Commercial |
$116.73
|
| Rate for Payer: Multiplan Commercial |
$101.50
|
| Rate for Payer: Preferred Network Access Commercial |
$116.73
|
| Rate for Payer: Quartz Beloit One Network |
$62.17
|
| Rate for Payer: Quartz Commercial |
$76.13
|
| Rate for Payer: WEA Trust Commercial |
$69.78
|
| Rate for Payer: WPS Commercial |
$93.98
|
|
|
Cladosporium hormodendrum IgG4
|
Facility
|
OP
|
$122.00
|
|
|
Service Code
|
CPT 86001
|
| Hospital Charge Code |
6196560
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.13 |
| Max. Negotiated Rate |
$116.73 |
| Rate for Payer: Aetna Commercial |
$114.19
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$109.12
|
| Rate for Payer: Aetna Managed Medicare |
$8.13
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$30.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$14.23
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$13.50
|
| Rate for Payer: Anthem Medicare Advantage |
$8.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$67.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$8.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$8.13
|
| Rate for Payer: Cash Price |
$36.60
|
| Rate for Payer: Cash Price |
$36.60
|
| Rate for Payer: Cigna Commercial |
$116.73
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$8.13
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$71.00
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$8.13
|
| Rate for Payer: Health EOS Commercial |
$112.92
|
| Rate for Payer: HFN Commercial |
$116.73
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$30.25
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$8.13
|
| Rate for Payer: Independent Care Health Plan Medicare |
$8.13
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$8.13
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$8.13
|
| Rate for Payer: Multiplan Commercial |
$101.50
|
| Rate for Payer: NAPHCARE Commercial |
$12.20
|
| Rate for Payer: Preferred Network Access Commercial |
$116.73
|
| Rate for Payer: Quartz Beloit One Network |
$62.17
|
| Rate for Payer: Quartz Commercial |
$82.47
|
| Rate for Payer: Quartz Medicare Advantage |
$8.13
|
| Rate for Payer: The Alliance Commercial |
$32.53
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8.13
|
| Rate for Payer: United Healthcare PPO |
$95.16
|
| Rate for Payer: WEA Trust Commercial |
$69.78
|
| Rate for Payer: Wellcare Medicare |
$8.13
|
| Rate for Payer: WPS Commercial |
$93.98
|
|
|
Cladosporium hormodendrum IgG4
|
Professional
|
Both
|
$122.00
|
|
|
Service Code
|
CPT 86001
|
| Hospital Charge Code |
6196560
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.13 |
| Max. Negotiated Rate |
$120.54 |
| Rate for Payer: Aetna Commercial |
$120.54
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$109.12
|
| Rate for Payer: Aetna Managed Medicare |
$8.13
|
| Rate for Payer: Anthem Medicare Advantage |
$8.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$8.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$8.13
|
| Rate for Payer: Cash Price |
$36.60
|
| Rate for Payer: Cash Price |
$36.60
|
| Rate for Payer: Cigna Commercial |
$120.54
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$63.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$8.13
|
| Rate for Payer: Health EOS Commercial |
$115.46
|
| Rate for Payer: HFN Commercial |
$120.54
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$28.70
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$28.70
|
| Rate for Payer: Independent Care Health Plan Medicare |
$8.13
|
| Rate for Payer: Multiplan Commercial |
$101.50
|
| Rate for Payer: NAPHCARE Commercial |
$12.20
|
| Rate for Payer: Preferred Network Access Commercial |
$120.54
|
| Rate for Payer: Quartz Beloit One Network |
$55.83
|
| Rate for Payer: Quartz Commercial |
$72.32
|
| Rate for Payer: Quartz Medicare Advantage |
$8.13
|
| Rate for Payer: The Alliance Commercial |
$32.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8.13
|
| Rate for Payer: WEA Trust Commercial |
$69.78
|
| Rate for Payer: WPS Commercial |
$35.78
|
|
|
CLAMP 4.O ADJUSTABLE 390.051
|
Facility
|
IP
|
$7,837.00
|
|
| Hospital Charge Code |
2966162
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3,993.74 |
| Max. Negotiated Rate |
$7,498.44 |
| Rate for Payer: Aetna Commercial |
$7,335.43
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,009.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,319.75
|
| Rate for Payer: Cash Price |
$2,351.10
|
| Rate for Payer: Cigna Commercial |
$7,498.44
|
| Rate for Payer: Health EOS Commercial |
$7,253.93
|
| Rate for Payer: HFN Commercial |
$7,498.44
|
| Rate for Payer: Multiplan Commercial |
$6,520.38
|
| Rate for Payer: Preferred Network Access Commercial |
$7,498.44
|
| Rate for Payer: Quartz Beloit One Network |
$3,993.74
|
| Rate for Payer: Quartz Commercial |
$4,890.29
|
| Rate for Payer: WEA Trust Commercial |
$4,482.76
|
| Rate for Payer: WPS Commercial |
$6,036.84
|
|
|
CLAMP 4.O ADJUSTABLE 390.051
|
Facility
|
OP
|
$7,837.00
|
|
| Hospital Charge Code |
2966162
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,282.13 |
| Max. Negotiated Rate |
$7,498.44 |
| Rate for Payer: Aetna Commercial |
$7,335.43
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,009.41
|
| Rate for Payer: Aetna Managed Medicare |
$2,282.13
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,297.81
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,075.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,912.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,319.75
|
| Rate for Payer: Cash Price |
$2,351.10
|
| Rate for Payer: Cigna Commercial |
$7,498.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,561.13
|
| Rate for Payer: Health EOS Commercial |
$7,253.93
|
| Rate for Payer: HFN Commercial |
$7,498.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,112.86
|
| Rate for Payer: Multiplan Commercial |
$6,520.38
|
| Rate for Payer: NAPHCARE Commercial |
$4,890.29
|
| Rate for Payer: Preferred Network Access Commercial |
$7,498.44
|
| Rate for Payer: Quartz Beloit One Network |
$3,993.74
|
| Rate for Payer: Quartz Commercial |
$5,297.81
|
| Rate for Payer: Quartz Medicare Advantage |
$4,890.29
|
| Rate for Payer: The Alliance Commercial |
$4,075.24
|
| Rate for Payer: WEA Trust Commercial |
$4,482.76
|
| Rate for Payer: WPS Commercial |
$6,036.84
|
|
|
CLAMP ADJUSTABLE 393.64
|
Facility
|
OP
|
$2,968.00
|
|
| Hospital Charge Code |
5811625
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$864.28 |
| Max. Negotiated Rate |
$2,839.78 |
| Rate for Payer: Aetna Commercial |
$2,778.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,654.58
|
| Rate for Payer: Aetna Managed Medicare |
$864.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,006.37
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,543.36
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,481.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,635.96
|
| Rate for Payer: Cash Price |
$890.40
|
| Rate for Payer: Cigna Commercial |
$2,839.78
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,727.38
|
| Rate for Payer: Health EOS Commercial |
$2,747.18
|
| Rate for Payer: HFN Commercial |
$2,839.78
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,315.04
|
| Rate for Payer: Multiplan Commercial |
$2,469.38
|
| Rate for Payer: NAPHCARE Commercial |
$1,852.03
|
| Rate for Payer: Preferred Network Access Commercial |
$2,839.78
|
| Rate for Payer: Quartz Beloit One Network |
$1,512.49
|
| Rate for Payer: Quartz Commercial |
$2,006.37
|
| Rate for Payer: Quartz Medicare Advantage |
$1,852.03
|
| Rate for Payer: The Alliance Commercial |
$1,543.36
|
| Rate for Payer: WEA Trust Commercial |
$1,697.70
|
| Rate for Payer: WPS Commercial |
$2,286.25
|
|
|
CLAMP ADJUSTABLE 393.64
|
Facility
|
IP
|
$2,968.00
|
|
| Hospital Charge Code |
5811625
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,512.49 |
| Max. Negotiated Rate |
$2,839.78 |
| Rate for Payer: Aetna Commercial |
$2,778.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,654.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,635.96
|
| Rate for Payer: Cash Price |
$890.40
|
| Rate for Payer: Cigna Commercial |
$2,839.78
|
| Rate for Payer: Health EOS Commercial |
$2,747.18
|
| Rate for Payer: HFN Commercial |
$2,839.78
|
| Rate for Payer: Multiplan Commercial |
$2,469.38
|
| Rate for Payer: Preferred Network Access Commercial |
$2,839.78
|
| Rate for Payer: Quartz Beloit One Network |
$1,512.49
|
| Rate for Payer: Quartz Commercial |
$1,852.03
|
| Rate for Payer: WEA Trust Commercial |
$1,697.70
|
| Rate for Payer: WPS Commercial |
$2,286.25
|
|
|
CLAMP ADJUSTABLE WIRE PIN
|
Facility
|
IP
|
$8,681.00
|
|
| Hospital Charge Code |
2966163
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4,423.84 |
| Max. Negotiated Rate |
$8,305.98 |
| Rate for Payer: Aetna Commercial |
$8,125.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,764.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,784.97
|
| Rate for Payer: Cash Price |
$2,604.30
|
| Rate for Payer: Cigna Commercial |
$8,305.98
|
| Rate for Payer: Health EOS Commercial |
$8,035.13
|
| Rate for Payer: HFN Commercial |
$8,305.98
|
| Rate for Payer: Multiplan Commercial |
$7,222.59
|
| Rate for Payer: Preferred Network Access Commercial |
$8,305.98
|
| Rate for Payer: Quartz Beloit One Network |
$4,423.84
|
| Rate for Payer: Quartz Commercial |
$5,416.94
|
| Rate for Payer: WEA Trust Commercial |
$4,965.53
|
| Rate for Payer: WPS Commercial |
$6,686.97
|
|
