|
Cortisol Level
|
Facility
IP
|
$182.00
|
|
|
Service Code
|
CPT 82533
|
| Hospital Charge Code |
633710
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$89.18 |
| Max. Negotiated Rate |
$167.44 |
| Rate for Payer: Aetna Commercial |
$163.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$96.46
|
| Rate for Payer: Cash Price |
$54.60
|
| Rate for Payer: Cigna Commercial |
$167.44
|
| Rate for Payer: Health EOS Commercial |
$161.98
|
| Rate for Payer: HFN Commercial |
$167.44
|
| Rate for Payer: Multiplan Commercial |
$145.60
|
| Rate for Payer: NAPHCARE Commercial |
$109.20
|
| Rate for Payer: Preferred Network Access Commercial |
$167.44
|
| Rate for Payer: Quartz Beloit One Network |
$89.18
|
| Rate for Payer: Quartz Commercial |
$109.20
|
| Rate for Payer: WEA Trust Commercial |
$100.10
|
| Rate for Payer: WPS Commercial |
$134.81
|
|
|
Cortisol Morning
|
Facility
IP
|
$339.00
|
|
|
Service Code
|
CPT 82533
|
| Hospital Charge Code |
977911
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$166.11 |
| Max. Negotiated Rate |
$311.88 |
| Rate for Payer: Aetna Commercial |
$305.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$179.67
|
| Rate for Payer: Cash Price |
$101.70
|
| Rate for Payer: Cigna Commercial |
$311.88
|
| Rate for Payer: Health EOS Commercial |
$301.71
|
| Rate for Payer: HFN Commercial |
$311.88
|
| Rate for Payer: Multiplan Commercial |
$271.20
|
| Rate for Payer: NAPHCARE Commercial |
$203.40
|
| Rate for Payer: Preferred Network Access Commercial |
$311.88
|
| Rate for Payer: Quartz Beloit One Network |
$166.11
|
| Rate for Payer: Quartz Commercial |
$203.40
|
| Rate for Payer: WEA Trust Commercial |
$186.45
|
| Rate for Payer: WPS Commercial |
$251.10
|
|
|
Cortisol Morning
|
Facility
OP
|
$339.00
|
|
|
Service Code
|
CPT 82533
|
| Hospital Charge Code |
977911
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$16.30 |
| Max. Negotiated Rate |
$1,356.00 |
| Rate for Payer: Aetna Commercial |
$305.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$291.54
|
| Rate for Payer: Aetna Managed Medicare |
$16.30
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$61.12
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$28.52
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$27.06
|
| Rate for Payer: Anthem Medicaid |
$16.84
|
| Rate for Payer: Anthem Medicare Advantage |
$16.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$179.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$16.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$16.30
|
| Rate for Payer: Cash Price |
$101.70
|
| Rate for Payer: Cash Price |
$101.70
|
| Rate for Payer: Cigna Commercial |
$311.88
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$16.30
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$16.84
|
| Rate for Payer: Dean Health Medicaid |
$16.84
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$16.30
|
| Rate for Payer: Health EOS Commercial |
$301.71
|
| Rate for Payer: HFN Commercial |
$311.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$60.64
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$16.30
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$16.84
|
| Rate for Payer: Independent Care Health Plan Medicare |
$16.30
|
| Rate for Payer: Managed Health Services Medicaid |
$17.51
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$16.30
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$16.30
|
| Rate for Payer: Multiplan Commercial |
$271.20
|
| Rate for Payer: NAPHCARE Commercial |
$24.45
|
| Rate for Payer: Preferred Network Access Commercial |
$311.88
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$16.84
|
| Rate for Payer: Quartz Beloit One Network |
$166.11
|
| Rate for Payer: Quartz Commercial |
$220.35
|
| Rate for Payer: Quartz Medicare Advantage |
$16.30
|
| Rate for Payer: The Alliance Commercial |
$1,356.00
|
| Rate for Payer: United Healthcare Medicaid |
$16.84
|
| Rate for Payer: United Healthcare Medicare Advantage |
$16.30
|
| Rate for Payer: United Healthcare PPO |
$254.25
|
| Rate for Payer: WEA Trust Commercial |
$186.45
|
| Rate for Payer: Wellcare Medicare |
$16.30
|
| Rate for Payer: WMAP Medicaid |
$16.84
|
| Rate for Payer: WPS Commercial |
$251.10
|
|
|
Cortisol Morning
|
Professional
|
$339.00
|
|
|
Service Code
|
CPT 82533
|
| Hospital Charge Code |
977911
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$16.30 |
| Max. Negotiated Rate |
$322.05 |
| Rate for Payer: Aetna Commercial |
$322.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$291.54
|
| Rate for Payer: Aetna Managed Medicare |
$16.30
|
| Rate for Payer: Anthem Medicare Advantage |
$16.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$16.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$16.30
|
| Rate for Payer: Cash Price |
$101.70
|
| Rate for Payer: Cash Price |
$101.70
|
| Rate for Payer: Cigna Commercial |
$322.05
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$169.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$16.30
|
| Rate for Payer: Health EOS Commercial |
$308.49
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$57.54
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$57.54
|
| Rate for Payer: Independent Care Health Plan Medicare |
$16.30
|
| Rate for Payer: Multiplan Commercial |
$271.20
|
| Rate for Payer: Preferred Network Access Commercial |
$322.05
|
| Rate for Payer: Quartz Beloit One Network |
$149.16
|
| Rate for Payer: Quartz Commercial |
$193.23
|
| Rate for Payer: Quartz Medicare Advantage |
$16.30
|
| Rate for Payer: The Alliance Commercial |
$64.38
|
| Rate for Payer: United Healthcare Medicare Advantage |
$16.30
|
| Rate for Payer: WEA Trust Commercial |
$186.45
|
| Rate for Payer: WPS Commercial |
$71.72
|
|
|
Cortisol Saliva
|
Facility
IP
|
$391.00
|
|
|
Service Code
|
CPT 82530
|
| Hospital Charge Code |
1038907
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$191.59 |
| Max. Negotiated Rate |
$359.72 |
| Rate for Payer: Aetna Commercial |
$351.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$207.23
|
| Rate for Payer: Cash Price |
$117.30
|
| Rate for Payer: Cigna Commercial |
$359.72
|
| Rate for Payer: Health EOS Commercial |
$347.99
|
| Rate for Payer: HFN Commercial |
$359.72
|
| Rate for Payer: Multiplan Commercial |
$312.80
|
| Rate for Payer: NAPHCARE Commercial |
$234.60
|
| Rate for Payer: Preferred Network Access Commercial |
$359.72
|
| Rate for Payer: Quartz Beloit One Network |
$191.59
|
| Rate for Payer: Quartz Commercial |
$234.60
|
| Rate for Payer: WEA Trust Commercial |
$215.05
|
| Rate for Payer: WPS Commercial |
$289.61
|
|
|
Cortisol Saliva
|
Professional
|
$391.00
|
|
|
Service Code
|
CPT 82530
|
| Hospital Charge Code |
1038907
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$16.71 |
| Max. Negotiated Rate |
$371.45 |
| Rate for Payer: Aetna Commercial |
$371.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$336.26
|
| Rate for Payer: Aetna Managed Medicare |
$16.71
|
| Rate for Payer: Anthem Medicare Advantage |
$16.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$16.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$16.71
|
| Rate for Payer: Cash Price |
$117.30
|
| Rate for Payer: Cash Price |
$117.30
|
| Rate for Payer: Cigna Commercial |
$371.45
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$195.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$16.71
|
| Rate for Payer: Health EOS Commercial |
$355.81
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$58.99
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$58.99
|
| Rate for Payer: Independent Care Health Plan Medicare |
$16.71
|
| Rate for Payer: Multiplan Commercial |
$312.80
|
| Rate for Payer: Preferred Network Access Commercial |
$371.45
|
| Rate for Payer: Quartz Beloit One Network |
$172.04
|
| Rate for Payer: Quartz Commercial |
$222.87
|
| Rate for Payer: Quartz Medicare Advantage |
$16.71
|
| Rate for Payer: The Alliance Commercial |
$66.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$16.71
|
| Rate for Payer: WEA Trust Commercial |
$215.05
|
| Rate for Payer: WPS Commercial |
$73.52
|
|
|
Cortisol Saliva
|
Facility
OP
|
$391.00
|
|
|
Service Code
|
CPT 82530
|
| Hospital Charge Code |
1038907
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$16.71 |
| Max. Negotiated Rate |
$1,564.00 |
| Rate for Payer: Aetna Commercial |
$351.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$336.26
|
| Rate for Payer: Aetna Managed Medicare |
$16.71
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$62.66
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$29.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$27.74
|
| Rate for Payer: Anthem Medicaid |
$17.27
|
| Rate for Payer: Anthem Medicare Advantage |
$16.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$207.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$16.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$16.71
|
| Rate for Payer: Cash Price |
$117.30
|
| Rate for Payer: Cash Price |
$117.30
|
| Rate for Payer: Cigna Commercial |
$359.72
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$16.71
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$17.27
|
| Rate for Payer: Dean Health Medicaid |
$17.27
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$16.71
|
| Rate for Payer: Health EOS Commercial |
$347.99
|
| Rate for Payer: HFN Commercial |
$359.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$62.16
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$16.71
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$17.27
|
| Rate for Payer: Independent Care Health Plan Medicare |
$16.71
|
| Rate for Payer: Managed Health Services Medicaid |
$17.96
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$16.71
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$16.71
|
| Rate for Payer: Multiplan Commercial |
$312.80
|
| Rate for Payer: NAPHCARE Commercial |
$25.06
|
| Rate for Payer: Preferred Network Access Commercial |
$359.72
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$17.27
|
| Rate for Payer: Quartz Beloit One Network |
$191.59
|
| Rate for Payer: Quartz Commercial |
$254.15
|
| Rate for Payer: Quartz Medicare Advantage |
$16.71
|
| Rate for Payer: The Alliance Commercial |
$1,564.00
|
| Rate for Payer: United Healthcare Medicaid |
$17.27
|
| Rate for Payer: United Healthcare Medicare Advantage |
$16.71
|
| Rate for Payer: United Healthcare PPO |
$293.25
|
| Rate for Payer: WEA Trust Commercial |
$215.05
|
| Rate for Payer: Wellcare Medicare |
$16.71
|
| Rate for Payer: WMAP Medicaid |
$17.27
|
| Rate for Payer: WPS Commercial |
$289.61
|
|
|
Cortisol Saliva 3sp
|
Professional
|
$148.20
|
|
|
Service Code
|
CPT 82530
|
| Hospital Charge Code |
6180723
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$16.71 |
| Max. Negotiated Rate |
$140.79 |
| Rate for Payer: Aetna Commercial |
$140.79
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$127.45
|
| Rate for Payer: Aetna Managed Medicare |
$16.71
|
| Rate for Payer: Anthem Medicare Advantage |
$16.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$16.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$16.71
|
| Rate for Payer: Cash Price |
$44.46
|
| Rate for Payer: Cash Price |
$44.46
|
| Rate for Payer: Cigna Commercial |
$140.79
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$74.10
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$16.71
|
| Rate for Payer: Health EOS Commercial |
$134.86
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$58.99
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$58.99
|
| Rate for Payer: Independent Care Health Plan Medicare |
$16.71
|
| Rate for Payer: Multiplan Commercial |
$118.56
|
| Rate for Payer: Preferred Network Access Commercial |
$140.79
|
| Rate for Payer: Quartz Beloit One Network |
$65.21
|
| Rate for Payer: Quartz Commercial |
$84.47
|
| Rate for Payer: Quartz Medicare Advantage |
$16.71
|
| Rate for Payer: The Alliance Commercial |
$66.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$16.71
|
| Rate for Payer: WEA Trust Commercial |
$81.51
|
| Rate for Payer: WPS Commercial |
$73.52
|
|
|
Cortisol Saliva 3sp
|
Facility
OP
|
$148.20
|
|
|
Service Code
|
CPT 82530
|
| Hospital Charge Code |
6180723
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$16.71 |
| Max. Negotiated Rate |
$592.80 |
| Rate for Payer: Aetna Commercial |
$133.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$127.45
|
| Rate for Payer: Aetna Managed Medicare |
$16.71
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$62.66
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$29.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$27.74
|
| Rate for Payer: Anthem Medicaid |
$17.27
|
| Rate for Payer: Anthem Medicare Advantage |
$16.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$78.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$16.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$16.71
|
| Rate for Payer: Cash Price |
$44.46
|
| Rate for Payer: Cash Price |
$44.46
|
| Rate for Payer: Cigna Commercial |
$136.34
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$16.71
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$17.27
|
| Rate for Payer: Dean Health Medicaid |
$17.27
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$16.71
|
| Rate for Payer: Health EOS Commercial |
$131.90
|
| Rate for Payer: HFN Commercial |
$136.34
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$62.16
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$16.71
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$17.27
|
| Rate for Payer: Independent Care Health Plan Medicare |
$16.71
|
| Rate for Payer: Managed Health Services Medicaid |
$17.96
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$16.71
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$16.71
|
| Rate for Payer: Multiplan Commercial |
$118.56
|
| Rate for Payer: NAPHCARE Commercial |
$25.06
|
| Rate for Payer: Preferred Network Access Commercial |
$136.34
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$17.27
|
| Rate for Payer: Quartz Beloit One Network |
$72.62
|
| Rate for Payer: Quartz Commercial |
$96.33
|
| Rate for Payer: Quartz Medicare Advantage |
$16.71
|
| Rate for Payer: The Alliance Commercial |
$592.80
|
| Rate for Payer: United Healthcare Medicaid |
$17.27
|
| Rate for Payer: United Healthcare Medicare Advantage |
$16.71
|
| Rate for Payer: United Healthcare PPO |
$111.15
|
| Rate for Payer: WEA Trust Commercial |
$81.51
|
| Rate for Payer: Wellcare Medicare |
$16.71
|
| Rate for Payer: WMAP Medicaid |
$17.27
|
| Rate for Payer: WPS Commercial |
$109.77
|
|
|
Cortisol Saliva 3sp
|
Facility
IP
|
$148.20
|
|
|
Service Code
|
CPT 82530
|
| Hospital Charge Code |
6180723
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$72.62 |
| Max. Negotiated Rate |
$136.34 |
| Rate for Payer: Aetna Commercial |
$133.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$78.55
|
| Rate for Payer: Cash Price |
$44.46
|
| Rate for Payer: Cigna Commercial |
$136.34
|
| Rate for Payer: Health EOS Commercial |
$131.90
|
| Rate for Payer: HFN Commercial |
$136.34
|
| Rate for Payer: Multiplan Commercial |
$118.56
|
| Rate for Payer: NAPHCARE Commercial |
$88.92
|
| Rate for Payer: Preferred Network Access Commercial |
$136.34
|
| Rate for Payer: Quartz Beloit One Network |
$72.62
|
| Rate for Payer: Quartz Commercial |
$88.92
|
| Rate for Payer: WEA Trust Commercial |
$81.51
|
| Rate for Payer: WPS Commercial |
$109.77
|
|
|
Cortisol Total
|
Professional
|
$115.00
|
|
|
Service Code
|
CPT 82533
|
| Hospital Charge Code |
2942880
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$16.30 |
| Max. Negotiated Rate |
$109.25 |
| Rate for Payer: Aetna Commercial |
$109.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$98.90
|
| Rate for Payer: Aetna Managed Medicare |
$16.30
|
| Rate for Payer: Anthem Medicare Advantage |
$16.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$16.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$16.30
|
| Rate for Payer: Cash Price |
$34.50
|
| Rate for Payer: Cash Price |
$34.50
|
| Rate for Payer: Cigna Commercial |
$109.25
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$57.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$16.30
|
| Rate for Payer: Health EOS Commercial |
$104.65
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$57.54
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$57.54
|
| Rate for Payer: Independent Care Health Plan Medicare |
$16.30
|
| Rate for Payer: Multiplan Commercial |
$92.00
|
| Rate for Payer: Preferred Network Access Commercial |
$109.25
|
| Rate for Payer: Quartz Beloit One Network |
$50.60
|
| Rate for Payer: Quartz Commercial |
$65.55
|
| Rate for Payer: Quartz Medicare Advantage |
$16.30
|
| Rate for Payer: The Alliance Commercial |
$64.38
|
| Rate for Payer: United Healthcare Medicare Advantage |
$16.30
|
| Rate for Payer: WEA Trust Commercial |
$63.25
|
| Rate for Payer: WPS Commercial |
$71.72
|
|
|
Cortisol Total
|
Facility
OP
|
$115.00
|
|
|
Service Code
|
CPT 82533
|
| Hospital Charge Code |
2942880
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$16.30 |
| Max. Negotiated Rate |
$460.00 |
| Rate for Payer: Aetna Commercial |
$103.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$98.90
|
| Rate for Payer: Aetna Managed Medicare |
$16.30
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$61.12
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$28.52
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$27.06
|
| Rate for Payer: Anthem Medicaid |
$16.84
|
| Rate for Payer: Anthem Medicare Advantage |
$16.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$60.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$16.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$16.30
|
| Rate for Payer: Cash Price |
$34.50
|
| Rate for Payer: Cash Price |
$34.50
|
| Rate for Payer: Cigna Commercial |
$105.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$16.30
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$16.84
|
| Rate for Payer: Dean Health Medicaid |
$16.84
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$16.30
|
| Rate for Payer: Health EOS Commercial |
$102.35
|
| Rate for Payer: HFN Commercial |
$105.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$60.64
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$16.30
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$16.84
|
| Rate for Payer: Independent Care Health Plan Medicare |
$16.30
|
| Rate for Payer: Managed Health Services Medicaid |
$17.51
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$16.30
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$16.30
|
| Rate for Payer: Multiplan Commercial |
$92.00
|
| Rate for Payer: NAPHCARE Commercial |
$24.45
|
| Rate for Payer: Preferred Network Access Commercial |
$105.80
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$16.84
|
| Rate for Payer: Quartz Beloit One Network |
$56.35
|
| Rate for Payer: Quartz Commercial |
$74.75
|
| Rate for Payer: Quartz Medicare Advantage |
$16.30
|
| Rate for Payer: The Alliance Commercial |
$460.00
|
| Rate for Payer: United Healthcare Medicaid |
$16.84
|
| Rate for Payer: United Healthcare Medicare Advantage |
$16.30
|
| Rate for Payer: United Healthcare PPO |
$86.25
|
| Rate for Payer: WEA Trust Commercial |
$63.25
|
| Rate for Payer: Wellcare Medicare |
$16.30
|
| Rate for Payer: WMAP Medicaid |
$16.84
|
| Rate for Payer: WPS Commercial |
$85.18
|
|
|
Cortisol Total
|
Facility
IP
|
$115.00
|
|
|
Service Code
|
CPT 82533
|
| Hospital Charge Code |
2942880
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$56.35 |
| Max. Negotiated Rate |
$105.80 |
| Rate for Payer: Aetna Commercial |
$103.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$60.95
|
| Rate for Payer: Cash Price |
$34.50
|
| Rate for Payer: Cigna Commercial |
$105.80
|
| Rate for Payer: Health EOS Commercial |
$102.35
|
| Rate for Payer: HFN Commercial |
$105.80
|
| Rate for Payer: Multiplan Commercial |
$92.00
|
| Rate for Payer: NAPHCARE Commercial |
$69.00
|
| Rate for Payer: Preferred Network Access Commercial |
$105.80
|
| Rate for Payer: Quartz Beloit One Network |
$56.35
|
| Rate for Payer: Quartz Commercial |
$69.00
|
| Rate for Payer: WEA Trust Commercial |
$63.25
|
| Rate for Payer: WPS Commercial |
$85.18
|
|
|
Cortisone 24 Hour Urine
|
Facility
OP
|
$276.00
|
|
|
Service Code
|
CPT 83789
|
| Hospital Charge Code |
1038926
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$24.11 |
| Max. Negotiated Rate |
$1,104.00 |
| Rate for Payer: Aetna Commercial |
$248.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$237.36
|
| Rate for Payer: Aetna Managed Medicare |
$24.11
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$90.41
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$42.19
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$40.02
|
| Rate for Payer: Anthem Medicaid |
$24.91
|
| Rate for Payer: Anthem Medicare Advantage |
$24.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$146.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$24.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$24.11
|
| Rate for Payer: Cash Price |
$82.80
|
| Rate for Payer: Cash Price |
$82.80
|
| Rate for Payer: Cigna Commercial |
$253.92
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$24.11
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$24.91
|
| Rate for Payer: Dean Health Medicaid |
$24.91
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$24.11
|
| Rate for Payer: Health EOS Commercial |
$245.64
|
| Rate for Payer: HFN Commercial |
$253.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$89.69
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$24.11
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$24.91
|
| Rate for Payer: Independent Care Health Plan Medicare |
$24.11
|
| Rate for Payer: Managed Health Services Medicaid |
$25.91
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$24.11
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$24.11
|
| Rate for Payer: Multiplan Commercial |
$220.80
|
| Rate for Payer: NAPHCARE Commercial |
$36.16
|
| Rate for Payer: Preferred Network Access Commercial |
$253.92
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$24.91
|
| Rate for Payer: Quartz Beloit One Network |
$135.24
|
| Rate for Payer: Quartz Commercial |
$179.40
|
| Rate for Payer: Quartz Medicare Advantage |
$24.11
|
| Rate for Payer: The Alliance Commercial |
$1,104.00
|
| Rate for Payer: United Healthcare Medicaid |
$24.91
|
| Rate for Payer: United Healthcare Medicare Advantage |
$24.11
|
| Rate for Payer: United Healthcare PPO |
$207.00
|
| Rate for Payer: WEA Trust Commercial |
$151.80
|
| Rate for Payer: Wellcare Medicare |
$24.11
|
| Rate for Payer: WMAP Medicaid |
$24.91
|
| Rate for Payer: WPS Commercial |
$204.43
|
|
|
Cortisone 24 Hour Urine
|
Facility
IP
|
$276.00
|
|
|
Service Code
|
CPT 83789
|
| Hospital Charge Code |
1038926
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$135.24 |
| Max. Negotiated Rate |
$253.92 |
| Rate for Payer: Aetna Commercial |
$248.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$146.28
|
| Rate for Payer: Cash Price |
$82.80
|
| Rate for Payer: Cigna Commercial |
$253.92
|
| Rate for Payer: Health EOS Commercial |
$245.64
|
| Rate for Payer: HFN Commercial |
$253.92
|
| Rate for Payer: Multiplan Commercial |
$220.80
|
| Rate for Payer: NAPHCARE Commercial |
$165.60
|
| Rate for Payer: Preferred Network Access Commercial |
$253.92
|
| Rate for Payer: Quartz Beloit One Network |
$135.24
|
| Rate for Payer: Quartz Commercial |
$165.60
|
| Rate for Payer: WEA Trust Commercial |
$151.80
|
| Rate for Payer: WPS Commercial |
$204.43
|
|
|
Cortisone 24 Hour Urine
|
Professional
|
$276.00
|
|
|
Service Code
|
CPT 83789
|
| Hospital Charge Code |
1038926
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$24.11 |
| Max. Negotiated Rate |
$262.20 |
| Rate for Payer: Aetna Commercial |
$262.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$237.36
|
| Rate for Payer: Aetna Managed Medicare |
$24.11
|
| Rate for Payer: Anthem Medicare Advantage |
$24.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$24.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$24.11
|
| Rate for Payer: Cash Price |
$82.80
|
| Rate for Payer: Cash Price |
$82.80
|
| Rate for Payer: Cigna Commercial |
$262.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$138.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$24.11
|
| Rate for Payer: Health EOS Commercial |
$251.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$85.11
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$85.11
|
| Rate for Payer: Independent Care Health Plan Medicare |
$24.11
|
| Rate for Payer: Multiplan Commercial |
$220.80
|
| Rate for Payer: Preferred Network Access Commercial |
$262.20
|
| Rate for Payer: Quartz Beloit One Network |
$121.44
|
| Rate for Payer: Quartz Commercial |
$157.32
|
| Rate for Payer: Quartz Medicare Advantage |
$24.11
|
| Rate for Payer: The Alliance Commercial |
$95.23
|
| Rate for Payer: United Healthcare Medicare Advantage |
$24.11
|
| Rate for Payer: WEA Trust Commercial |
$151.80
|
| Rate for Payer: WPS Commercial |
$106.08
|
|
|
Cortisporin Otic Suspension 10ml [Med]
|
Facility
OP
|
$340.00
|
|
| Hospital Charge Code |
2974926
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$95.20 |
| Max. Negotiated Rate |
$1,360.00 |
| Rate for Payer: Aetna Commercial |
$306.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$292.40
|
| Rate for Payer: Aetna Managed Medicare |
$95.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$221.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$170.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$163.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$180.20
|
| Rate for Payer: Cash Price |
$102.00
|
| Rate for Payer: Cigna Commercial |
$312.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$190.26
|
| Rate for Payer: Health EOS Commercial |
$302.60
|
| Rate for Payer: HFN Commercial |
$312.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$255.00
|
| Rate for Payer: Multiplan Commercial |
$272.00
|
| Rate for Payer: NAPHCARE Commercial |
$204.00
|
| Rate for Payer: Preferred Network Access Commercial |
$312.80
|
| Rate for Payer: Quartz Beloit One Network |
$166.60
|
| Rate for Payer: Quartz Commercial |
$221.00
|
| Rate for Payer: Quartz Medicare Advantage |
$204.00
|
| Rate for Payer: The Alliance Commercial |
$1,360.00
|
| Rate for Payer: WEA Trust Commercial |
$187.00
|
| Rate for Payer: WPS Commercial |
$251.84
|
|
|
Cortisporin Otic Suspension 10ml [Med]
|
Facility
IP
|
$340.00
|
|
| Hospital Charge Code |
2974926
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$166.60 |
| Max. Negotiated Rate |
$312.80 |
| Rate for Payer: Aetna Commercial |
$306.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$180.20
|
| Rate for Payer: Cash Price |
$102.00
|
| Rate for Payer: Cigna Commercial |
$312.80
|
| Rate for Payer: Health EOS Commercial |
$302.60
|
| Rate for Payer: HFN Commercial |
$312.80
|
| Rate for Payer: Multiplan Commercial |
$272.00
|
| Rate for Payer: NAPHCARE Commercial |
$204.00
|
| Rate for Payer: Preferred Network Access Commercial |
$312.80
|
| Rate for Payer: Quartz Beloit One Network |
$166.60
|
| Rate for Payer: Quartz Commercial |
$204.00
|
| Rate for Payer: WEA Trust Commercial |
$187.00
|
| Rate for Payer: WPS Commercial |
$251.84
|
|
|
Cortrosyn 0.25 mg Charge
|
Facility
IP
|
$848.00
|
|
|
Service Code
|
HCPCS J0834
|
| Hospital Charge Code |
2958863
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$415.52 |
| Max. Negotiated Rate |
$780.16 |
| Rate for Payer: Aetna Commercial |
$763.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$449.44
|
| Rate for Payer: Cash Price |
$254.40
|
| Rate for Payer: Cigna Commercial |
$780.16
|
| Rate for Payer: Health EOS Commercial |
$754.72
|
| Rate for Payer: HFN Commercial |
$780.16
|
| Rate for Payer: Multiplan Commercial |
$678.40
|
| Rate for Payer: NAPHCARE Commercial |
$508.80
|
| Rate for Payer: Preferred Network Access Commercial |
$780.16
|
| Rate for Payer: Quartz Beloit One Network |
$415.52
|
| Rate for Payer: Quartz Commercial |
$508.80
|
| Rate for Payer: WEA Trust Commercial |
$466.40
|
| Rate for Payer: WPS Commercial |
$628.11
|
|
|
Cortrosyn 0.25 mg Charge
|
Facility
OP
|
$848.00
|
|
|
Service Code
|
HCPCS J0834
|
| Hospital Charge Code |
2958863
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$37.83 |
| Max. Negotiated Rate |
$780.16 |
| Rate for Payer: Aetna Commercial |
$763.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$729.28
|
| Rate for Payer: Aetna Managed Medicare |
$237.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$551.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$424.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$407.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$449.44
|
| Rate for Payer: Cash Price |
$254.40
|
| Rate for Payer: Cash Price |
$254.40
|
| Rate for Payer: Cigna Commercial |
$780.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$37.83
|
| Rate for Payer: Health EOS Commercial |
$754.72
|
| Rate for Payer: HFN Commercial |
$780.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$636.00
|
| Rate for Payer: Multiplan Commercial |
$678.40
|
| Rate for Payer: NAPHCARE Commercial |
$508.80
|
| Rate for Payer: Preferred Network Access Commercial |
$780.16
|
| Rate for Payer: Quartz Beloit One Network |
$415.52
|
| Rate for Payer: Quartz Commercial |
$551.20
|
| Rate for Payer: Quartz Medicare Advantage |
$508.80
|
| Rate for Payer: The Alliance Commercial |
$607.64
|
| Rate for Payer: WEA Trust Commercial |
$466.40
|
| Rate for Payer: WPS Commercial |
$71.48
|
|
|
Cortrosyn 0.25 mg Charge
|
Professional
|
$848.00
|
|
|
Service Code
|
HCPCS J0834
|
| Hospital Charge Code |
2958863
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$27.11 |
| Max. Negotiated Rate |
$805.60 |
| Rate for Payer: Aetna Commercial |
$805.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$729.28
|
| Rate for Payer: Aetna Managed Medicare |
$27.88
|
| Rate for Payer: Anthem Medicare Advantage |
$27.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$27.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$27.88
|
| Rate for Payer: Cash Price |
$254.40
|
| Rate for Payer: Cash Price |
$254.40
|
| Rate for Payer: Cigna Commercial |
$805.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$424.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$28.59
|
| Rate for Payer: Health EOS Commercial |
$771.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$50.15
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$50.15
|
| Rate for Payer: Independent Care Health Plan Medicare |
$27.88
|
| Rate for Payer: Multiplan Commercial |
$678.40
|
| Rate for Payer: Preferred Network Access Commercial |
$805.60
|
| Rate for Payer: Quartz Beloit One Network |
$373.12
|
| Rate for Payer: Quartz Commercial |
$483.36
|
| Rate for Payer: Quartz Medicare Advantage |
$27.88
|
| Rate for Payer: The Alliance Commercial |
$76.67
|
| Rate for Payer: United Healthcare Medicaid |
$27.11
|
| Rate for Payer: United Healthcare Medicare Advantage |
$27.88
|
| Rate for Payer: WEA Trust Commercial |
$466.40
|
| Rate for Payer: WPS Commercial |
$71.48
|
|
|
COTTON TIP APPLICATOR PLASTIC 6 IN STERILE 10PK 30-351
|
Facility
OP
|
$36.00
|
|
| Hospital Charge Code |
2969967
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$10.08 |
| Max. Negotiated Rate |
$144.00 |
| Rate for Payer: Aetna Commercial |
$32.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$30.96
|
| Rate for Payer: Aetna Managed Medicare |
$10.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$23.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$18.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$17.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$19.08
|
| Rate for Payer: Cash Price |
$10.80
|
| Rate for Payer: Cigna Commercial |
$33.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$20.15
|
| Rate for Payer: Health EOS Commercial |
$32.04
|
| Rate for Payer: HFN Commercial |
$33.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$27.00
|
| Rate for Payer: Multiplan Commercial |
$28.80
|
| Rate for Payer: NAPHCARE Commercial |
$21.60
|
| Rate for Payer: Preferred Network Access Commercial |
$33.12
|
| Rate for Payer: Quartz Beloit One Network |
$17.64
|
| Rate for Payer: Quartz Commercial |
$23.40
|
| Rate for Payer: Quartz Medicare Advantage |
$21.60
|
| Rate for Payer: The Alliance Commercial |
$144.00
|
| Rate for Payer: WEA Trust Commercial |
$19.80
|
| Rate for Payer: WPS Commercial |
$26.67
|
|
|
COTTON TIP APPLICATOR PLASTIC 6 IN STERILE 10PK 30-351
|
Facility
IP
|
$36.00
|
|
| Hospital Charge Code |
2969967
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$17.64 |
| Max. Negotiated Rate |
$33.12 |
| Rate for Payer: Aetna Commercial |
$32.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$19.08
|
| Rate for Payer: Cash Price |
$10.80
|
| Rate for Payer: Cigna Commercial |
$33.12
|
| Rate for Payer: Health EOS Commercial |
$32.04
|
| Rate for Payer: HFN Commercial |
$33.12
|
| Rate for Payer: Multiplan Commercial |
$28.80
|
| Rate for Payer: NAPHCARE Commercial |
$21.60
|
| Rate for Payer: Preferred Network Access Commercial |
$33.12
|
| Rate for Payer: Quartz Beloit One Network |
$17.64
|
| Rate for Payer: Quartz Commercial |
$21.60
|
| Rate for Payer: WEA Trust Commercial |
$19.80
|
| Rate for Payer: WPS Commercial |
$26.67
|
|
|
Coude* - Urinary catheter type:
|
Facility
OP
|
$509.00
|
|
|
Service Code
|
CPT 51702
|
| Hospital Charge Code |
5877762
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$126.26 |
| Max. Negotiated Rate |
$6,179.00 |
| Rate for Payer: Aetna Commercial |
$458.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$437.74
|
| Rate for Payer: Aetna Managed Medicare |
$126.26
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$330.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$254.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$244.32
|
| Rate for Payer: Anthem Medicare Advantage |
$126.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$269.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$126.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$126.26
|
| Rate for Payer: Cash Price |
$152.70
|
| Rate for Payer: Cash Price |
$152.70
|
| Rate for Payer: Cigna Commercial |
$468.28
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$126.26
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,218.22
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$126.26
|
| Rate for Payer: Health EOS Commercial |
$453.01
|
| Rate for Payer: HFN Commercial |
$468.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$469.69
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$126.26
|
| Rate for Payer: Independent Care Health Plan Medicare |
$126.26
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$126.26
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$126.26
|
| Rate for Payer: Multiplan Commercial |
$407.20
|
| Rate for Payer: NAPHCARE Commercial |
$189.39
|
| Rate for Payer: Preferred Network Access Commercial |
$468.28
|
| Rate for Payer: Quartz Beloit One Network |
$249.41
|
| Rate for Payer: Quartz Commercial |
$330.85
|
| Rate for Payer: Quartz Medicare Advantage |
$126.26
|
| Rate for Payer: The Alliance Commercial |
$6,179.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$126.26
|
| Rate for Payer: WEA Trust Commercial |
$279.95
|
| Rate for Payer: Wellcare Medicare |
$126.26
|
| Rate for Payer: WPS Commercial |
$377.02
|
|
|
Coude* - Urinary catheter type:
|
Facility
IP
|
$509.00
|
|
|
Service Code
|
CPT 51702
|
| Hospital Charge Code |
5877762
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$249.41 |
| Max. Negotiated Rate |
$468.28 |
| Rate for Payer: Aetna Commercial |
$458.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$269.77
|
| Rate for Payer: Cash Price |
$152.70
|
| Rate for Payer: Cigna Commercial |
$468.28
|
| Rate for Payer: Health EOS Commercial |
$453.01
|
| Rate for Payer: HFN Commercial |
$468.28
|
| Rate for Payer: Multiplan Commercial |
$407.20
|
| Rate for Payer: NAPHCARE Commercial |
$305.40
|
| Rate for Payer: Preferred Network Access Commercial |
$468.28
|
| Rate for Payer: Quartz Beloit One Network |
$249.41
|
| Rate for Payer: Quartz Commercial |
$305.40
|
| Rate for Payer: WEA Trust Commercial |
$279.95
|
| Rate for Payer: WPS Commercial |
$377.02
|
|
