|
COVID-19, Antigen at BMH
|
Professional
|
$186.00
|
|
|
Service Code
|
CPT 87426
|
| Hospital Charge Code |
5637624
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$35.33 |
| Max. Negotiated Rate |
$176.70 |
| Rate for Payer: Aetna Commercial |
$176.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$159.96
|
| Rate for Payer: Aetna Managed Medicare |
$35.33
|
| Rate for Payer: Anthem Medicare Advantage |
$35.33
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$35.33
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$35.33
|
| Rate for Payer: Cash Price |
$55.80
|
| Rate for Payer: Cash Price |
$55.80
|
| Rate for Payer: Cigna Commercial |
$176.70
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$93.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$35.33
|
| Rate for Payer: Health EOS Commercial |
$169.26
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$159.66
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$159.66
|
| Rate for Payer: Independent Care Health Plan Medicare |
$35.33
|
| Rate for Payer: Multiplan Commercial |
$148.80
|
| Rate for Payer: Preferred Network Access Commercial |
$176.70
|
| Rate for Payer: Quartz Beloit One Network |
$81.84
|
| Rate for Payer: Quartz Commercial |
$106.02
|
| Rate for Payer: Quartz Medicare Advantage |
$35.33
|
| Rate for Payer: The Alliance Commercial |
$139.55
|
| Rate for Payer: United Healthcare Medicare Advantage |
$35.33
|
| Rate for Payer: WEA Trust Commercial |
$102.30
|
| Rate for Payer: WPS Commercial |
$155.45
|
|
|
COVID-19, Antigen at BMH
|
Facility
IP
|
$186.00
|
|
|
Service Code
|
CPT 87426
|
| Hospital Charge Code |
5637624
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$91.14 |
| Max. Negotiated Rate |
$171.12 |
| Rate for Payer: Aetna Commercial |
$167.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$98.58
|
| Rate for Payer: Cash Price |
$55.80
|
| Rate for Payer: Cigna Commercial |
$171.12
|
| Rate for Payer: Health EOS Commercial |
$165.54
|
| Rate for Payer: HFN Commercial |
$171.12
|
| Rate for Payer: Multiplan Commercial |
$148.80
|
| Rate for Payer: NAPHCARE Commercial |
$111.60
|
| Rate for Payer: Preferred Network Access Commercial |
$171.12
|
| Rate for Payer: Quartz Beloit One Network |
$91.14
|
| Rate for Payer: Quartz Commercial |
$111.60
|
| Rate for Payer: WEA Trust Commercial |
$102.30
|
| Rate for Payer: WPS Commercial |
$137.77
|
|
|
COVID-19, BinaxNOW Card
|
Facility
IP
|
$47.00
|
|
|
Service Code
|
CPT 87811
|
| Hospital Charge Code |
5637625
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$23.03 |
| Max. Negotiated Rate |
$43.24 |
| Rate for Payer: Aetna Commercial |
$42.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$24.91
|
| Rate for Payer: Cash Price |
$14.10
|
| Rate for Payer: Cigna Commercial |
$43.24
|
| Rate for Payer: Health EOS Commercial |
$41.83
|
| Rate for Payer: HFN Commercial |
$43.24
|
| Rate for Payer: Multiplan Commercial |
$37.60
|
| Rate for Payer: NAPHCARE Commercial |
$28.20
|
| Rate for Payer: Preferred Network Access Commercial |
$43.24
|
| Rate for Payer: Quartz Beloit One Network |
$23.03
|
| Rate for Payer: Quartz Commercial |
$28.20
|
| Rate for Payer: WEA Trust Commercial |
$25.85
|
| Rate for Payer: WPS Commercial |
$34.81
|
|
|
COVID-19, BinaxNOW Card
|
Facility
OP
|
$47.00
|
|
|
Service Code
|
CPT 87811
|
| Hospital Charge Code |
5637625
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$23.03 |
| Max. Negotiated Rate |
$188.00 |
| Rate for Payer: Aetna Commercial |
$42.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$40.42
|
| Rate for Payer: Aetna Managed Medicare |
$41.38
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$155.18
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$72.42
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$68.69
|
| Rate for Payer: Anthem Medicaid |
$41.38
|
| Rate for Payer: Anthem Medicare Advantage |
$41.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$24.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$41.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$41.38
|
| Rate for Payer: Cash Price |
$14.10
|
| Rate for Payer: Cash Price |
$14.10
|
| Rate for Payer: Cigna Commercial |
$43.24
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$41.38
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$41.38
|
| Rate for Payer: Dean Health Medicaid |
$41.38
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$41.38
|
| Rate for Payer: Health EOS Commercial |
$41.83
|
| Rate for Payer: HFN Commercial |
$43.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$153.93
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$41.38
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$41.38
|
| Rate for Payer: Independent Care Health Plan Medicare |
$41.38
|
| Rate for Payer: Managed Health Services Medicaid |
$43.04
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$41.38
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$41.38
|
| Rate for Payer: Multiplan Commercial |
$37.60
|
| Rate for Payer: NAPHCARE Commercial |
$62.07
|
| Rate for Payer: Preferred Network Access Commercial |
$43.24
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$41.38
|
| Rate for Payer: Quartz Beloit One Network |
$23.03
|
| Rate for Payer: Quartz Commercial |
$30.55
|
| Rate for Payer: Quartz Medicare Advantage |
$41.38
|
| Rate for Payer: The Alliance Commercial |
$188.00
|
| Rate for Payer: United Healthcare Medicaid |
$41.38
|
| Rate for Payer: United Healthcare Medicare Advantage |
$41.38
|
| Rate for Payer: United Healthcare PPO |
$35.25
|
| Rate for Payer: WEA Trust Commercial |
$25.85
|
| Rate for Payer: Wellcare Medicare |
$41.38
|
| Rate for Payer: WMAP Medicaid |
$41.38
|
| Rate for Payer: WPS Commercial |
$34.81
|
|
|
COVID-19, BinaxNOW Card
|
Professional
|
$47.00
|
|
|
Service Code
|
CPT 87811
|
| Hospital Charge Code |
5637625
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$20.68 |
| Max. Negotiated Rate |
$182.07 |
| Rate for Payer: Aetna Commercial |
$44.65
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$40.42
|
| Rate for Payer: Aetna Managed Medicare |
$41.38
|
| Rate for Payer: Anthem Medicare Advantage |
$41.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$41.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$41.38
|
| Rate for Payer: Cash Price |
$14.10
|
| Rate for Payer: Cash Price |
$14.10
|
| Rate for Payer: Cigna Commercial |
$44.65
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$23.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$41.38
|
| Rate for Payer: Health EOS Commercial |
$42.77
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$146.07
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$146.07
|
| Rate for Payer: Independent Care Health Plan Medicare |
$41.38
|
| Rate for Payer: Multiplan Commercial |
$37.60
|
| Rate for Payer: Preferred Network Access Commercial |
$44.65
|
| Rate for Payer: Quartz Beloit One Network |
$20.68
|
| Rate for Payer: Quartz Commercial |
$26.79
|
| Rate for Payer: Quartz Medicare Advantage |
$41.38
|
| Rate for Payer: The Alliance Commercial |
$163.45
|
| Rate for Payer: United Healthcare Medicare Advantage |
$41.38
|
| Rate for Payer: WEA Trust Commercial |
$25.85
|
| Rate for Payer: WPS Commercial |
$182.07
|
|
|
COVID-19 Collection/Transport Fee
|
Facility
IP
|
$29.00
|
|
|
Service Code
|
CPT 99001
|
| Hospital Charge Code |
5589238
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.21 |
| Max. Negotiated Rate |
$26.68 |
| Rate for Payer: Aetna Commercial |
$26.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$15.37
|
| Rate for Payer: Cash Price |
$8.70
|
| Rate for Payer: Cigna Commercial |
$26.68
|
| Rate for Payer: Health EOS Commercial |
$25.81
|
| Rate for Payer: HFN Commercial |
$26.68
|
| Rate for Payer: Multiplan Commercial |
$23.20
|
| Rate for Payer: NAPHCARE Commercial |
$17.40
|
| Rate for Payer: Preferred Network Access Commercial |
$26.68
|
| Rate for Payer: Quartz Beloit One Network |
$14.21
|
| Rate for Payer: Quartz Commercial |
$17.40
|
| Rate for Payer: WEA Trust Commercial |
$15.95
|
| Rate for Payer: WPS Commercial |
$21.48
|
|
|
COVID-19 Collection/Transport Fee
|
Facility
OP
|
$29.00
|
|
|
Service Code
|
CPT 99001
|
| Hospital Charge Code |
5589238
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.92 |
| Max. Negotiated Rate |
$116.00 |
| Rate for Payer: Aetna Commercial |
$26.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$24.94
|
| Rate for Payer: Aetna Managed Medicare |
$8.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$18.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$14.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$13.92
|
| Rate for Payer: Anthem Medicaid |
$3.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$15.37
|
| Rate for Payer: Cash Price |
$8.70
|
| Rate for Payer: Cash Price |
$8.70
|
| Rate for Payer: Cigna Commercial |
$26.68
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$3.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$16.23
|
| Rate for Payer: Dean Health Medicaid |
$3.92
|
| Rate for Payer: Health EOS Commercial |
$25.81
|
| Rate for Payer: HFN Commercial |
$26.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$21.75
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$3.92
|
| Rate for Payer: Managed Health Services Medicaid |
$4.08
|
| Rate for Payer: Multiplan Commercial |
$23.20
|
| Rate for Payer: NAPHCARE Commercial |
$17.40
|
| Rate for Payer: Preferred Network Access Commercial |
$26.68
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$3.92
|
| Rate for Payer: Quartz Beloit One Network |
$14.21
|
| Rate for Payer: Quartz Commercial |
$18.85
|
| Rate for Payer: Quartz Medicare Advantage |
$17.40
|
| Rate for Payer: The Alliance Commercial |
$116.00
|
| Rate for Payer: United Healthcare Medicaid |
$3.92
|
| Rate for Payer: United Healthcare PPO |
$21.75
|
| Rate for Payer: WEA Trust Commercial |
$15.95
|
| Rate for Payer: WMAP Medicaid |
$3.92
|
| Rate for Payer: WPS Commercial |
$21.48
|
|
|
COVID-19 Collection/Transport Fee
|
Professional
|
$29.00
|
|
|
Service Code
|
CPT 99001
|
| Hospital Charge Code |
5589238
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.76 |
| Max. Negotiated Rate |
$27.55 |
| Rate for Payer: Aetna Commercial |
$27.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$24.94
|
| Rate for Payer: Cash Price |
$8.70
|
| Rate for Payer: Cash Price |
$8.70
|
| Rate for Payer: Cigna Commercial |
$27.55
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$14.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$17.40
|
| Rate for Payer: Health EOS Commercial |
$26.39
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$21.67
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$21.67
|
| Rate for Payer: Multiplan Commercial |
$23.20
|
| Rate for Payer: Preferred Network Access Commercial |
$27.55
|
| Rate for Payer: Quartz Beloit One Network |
$12.76
|
| Rate for Payer: Quartz Commercial |
$16.53
|
| Rate for Payer: The Alliance Commercial |
$14.50
|
| Rate for Payer: WEA Trust Commercial |
$15.95
|
| Rate for Payer: WPS Commercial |
$21.48
|
|
|
COVID-19, PCR at BMH
|
Professional
|
$193.00
|
|
|
Service Code
|
CPT 87635
|
| Hospital Charge Code |
5585257
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$51.31 |
| Max. Negotiated Rate |
$225.76 |
| Rate for Payer: Aetna Commercial |
$183.35
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$165.98
|
| Rate for Payer: Aetna Managed Medicare |
$51.31
|
| Rate for Payer: Anthem Medicare Advantage |
$51.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$51.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$51.31
|
| Rate for Payer: Cash Price |
$57.90
|
| Rate for Payer: Cash Price |
$57.90
|
| Rate for Payer: Cigna Commercial |
$183.35
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$96.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$51.31
|
| Rate for Payer: Health EOS Commercial |
$175.63
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$181.12
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$181.12
|
| Rate for Payer: Independent Care Health Plan Medicare |
$51.31
|
| Rate for Payer: Multiplan Commercial |
$154.40
|
| Rate for Payer: Preferred Network Access Commercial |
$183.35
|
| Rate for Payer: Quartz Beloit One Network |
$84.92
|
| Rate for Payer: Quartz Commercial |
$110.01
|
| Rate for Payer: Quartz Medicare Advantage |
$51.31
|
| Rate for Payer: The Alliance Commercial |
$202.67
|
| Rate for Payer: United Healthcare Medicare Advantage |
$51.31
|
| Rate for Payer: WEA Trust Commercial |
$106.15
|
| Rate for Payer: WPS Commercial |
$225.76
|
|
|
COVID-19, PCR at BMH
|
Facility
OP
|
$193.00
|
|
|
Service Code
|
CPT 87635
|
| Hospital Charge Code |
5585257
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$51.31 |
| Max. Negotiated Rate |
$772.00 |
| Rate for Payer: Aetna Commercial |
$173.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$165.98
|
| Rate for Payer: Aetna Managed Medicare |
$51.31
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$192.41
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$89.79
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$85.17
|
| Rate for Payer: Anthem Medicaid |
$51.31
|
| Rate for Payer: Anthem Medicare Advantage |
$51.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$102.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$51.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$51.31
|
| Rate for Payer: Cash Price |
$57.90
|
| Rate for Payer: Cash Price |
$57.90
|
| Rate for Payer: Cigna Commercial |
$177.56
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$51.31
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$51.31
|
| Rate for Payer: Dean Health Medicaid |
$51.31
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$51.31
|
| Rate for Payer: Health EOS Commercial |
$171.77
|
| Rate for Payer: HFN Commercial |
$177.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$190.87
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$51.31
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$51.31
|
| Rate for Payer: Independent Care Health Plan Medicare |
$51.31
|
| Rate for Payer: Managed Health Services Medicaid |
$53.36
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$51.31
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$51.31
|
| Rate for Payer: Multiplan Commercial |
$154.40
|
| Rate for Payer: NAPHCARE Commercial |
$76.96
|
| Rate for Payer: Preferred Network Access Commercial |
$177.56
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$51.31
|
| Rate for Payer: Quartz Beloit One Network |
$94.57
|
| Rate for Payer: Quartz Commercial |
$125.45
|
| Rate for Payer: Quartz Medicare Advantage |
$51.31
|
| Rate for Payer: The Alliance Commercial |
$772.00
|
| Rate for Payer: United Healthcare Medicaid |
$51.31
|
| Rate for Payer: United Healthcare Medicare Advantage |
$51.31
|
| Rate for Payer: United Healthcare PPO |
$144.75
|
| Rate for Payer: WEA Trust Commercial |
$106.15
|
| Rate for Payer: Wellcare Medicare |
$51.31
|
| Rate for Payer: WMAP Medicaid |
$51.31
|
| Rate for Payer: WPS Commercial |
$142.96
|
|
|
COVID-19, PCR at BMH
|
Facility
IP
|
$193.00
|
|
|
Service Code
|
CPT 87635
|
| Hospital Charge Code |
5585257
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$94.57 |
| Max. Negotiated Rate |
$177.56 |
| Rate for Payer: Aetna Commercial |
$173.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$102.29
|
| Rate for Payer: Cash Price |
$57.90
|
| Rate for Payer: Cigna Commercial |
$177.56
|
| Rate for Payer: Health EOS Commercial |
$171.77
|
| Rate for Payer: HFN Commercial |
$177.56
|
| Rate for Payer: Multiplan Commercial |
$154.40
|
| Rate for Payer: NAPHCARE Commercial |
$115.80
|
| Rate for Payer: Preferred Network Access Commercial |
$177.56
|
| Rate for Payer: Quartz Beloit One Network |
$94.57
|
| Rate for Payer: Quartz Commercial |
$115.80
|
| Rate for Payer: WEA Trust Commercial |
$106.15
|
| Rate for Payer: WPS Commercial |
$142.96
|
|
|
COVID-19, PCR with FLU A/B & RSV at BMH
|
Facility
IP
|
$619.00
|
|
|
Service Code
|
CPT 0241U
|
| Hospital Charge Code |
5619938
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$303.31 |
| Max. Negotiated Rate |
$569.48 |
| Rate for Payer: Aetna Commercial |
$557.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$328.07
|
| Rate for Payer: Cash Price |
$185.70
|
| Rate for Payer: Cigna Commercial |
$569.48
|
| Rate for Payer: Health EOS Commercial |
$550.91
|
| Rate for Payer: HFN Commercial |
$569.48
|
| Rate for Payer: Multiplan Commercial |
$495.20
|
| Rate for Payer: NAPHCARE Commercial |
$371.40
|
| Rate for Payer: Preferred Network Access Commercial |
$569.48
|
| Rate for Payer: Quartz Beloit One Network |
$303.31
|
| Rate for Payer: Quartz Commercial |
$371.40
|
| Rate for Payer: WEA Trust Commercial |
$340.45
|
| Rate for Payer: WPS Commercial |
$458.49
|
|
|
COVID-19, PCR with FLU A/B & RSV at BMH
|
Facility
OP
|
$619.00
|
|
|
Service Code
|
CPT 0241U
|
| Hospital Charge Code |
5619938
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$35.91 |
| Max. Negotiated Rate |
$2,476.00 |
| Rate for Payer: Aetna Commercial |
$557.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$532.34
|
| Rate for Payer: Aetna Managed Medicare |
$142.63
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$402.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$309.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$297.12
|
| Rate for Payer: Anthem Medicaid |
$35.91
|
| Rate for Payer: Anthem Medicare Advantage |
$142.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$328.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$142.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$142.63
|
| Rate for Payer: Cash Price |
$185.70
|
| Rate for Payer: Cash Price |
$185.70
|
| Rate for Payer: Cigna Commercial |
$569.48
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$142.63
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$35.91
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$346.39
|
| Rate for Payer: Dean Health Medicaid |
$35.91
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$142.63
|
| Rate for Payer: Health EOS Commercial |
$550.91
|
| Rate for Payer: HFN Commercial |
$569.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$530.58
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$142.63
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$35.91
|
| Rate for Payer: Independent Care Health Plan Medicare |
$142.63
|
| Rate for Payer: Managed Health Services Medicaid |
$37.35
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$142.63
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$142.63
|
| Rate for Payer: Multiplan Commercial |
$495.20
|
| Rate for Payer: NAPHCARE Commercial |
$213.94
|
| Rate for Payer: Preferred Network Access Commercial |
$569.48
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$35.91
|
| Rate for Payer: Quartz Beloit One Network |
$303.31
|
| Rate for Payer: Quartz Commercial |
$402.35
|
| Rate for Payer: Quartz Medicare Advantage |
$142.63
|
| Rate for Payer: The Alliance Commercial |
$2,476.00
|
| Rate for Payer: United Healthcare Medicaid |
$35.91
|
| Rate for Payer: United Healthcare Medicare Advantage |
$142.63
|
| Rate for Payer: United Healthcare PPO |
$464.25
|
| Rate for Payer: WEA Trust Commercial |
$340.45
|
| Rate for Payer: Wellcare Medicare |
$142.63
|
| Rate for Payer: WMAP Medicaid |
$35.91
|
| Rate for Payer: WPS Commercial |
$458.49
|
|
|
COVID-19, PCR with FLU A/B & RSV at BMH
|
Professional
|
$619.00
|
|
|
Service Code
|
CPT 0241U
|
| Hospital Charge Code |
5619938
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$142.63 |
| Max. Negotiated Rate |
$588.05 |
| Rate for Payer: Aetna Commercial |
$588.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$532.34
|
| Rate for Payer: Aetna Managed Medicare |
$142.63
|
| Rate for Payer: Anthem Medicare Advantage |
$142.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$142.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$142.63
|
| Rate for Payer: Cash Price |
$185.70
|
| Rate for Payer: Cash Price |
$185.70
|
| Rate for Payer: Cigna Commercial |
$588.05
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$309.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$142.63
|
| Rate for Payer: Health EOS Commercial |
$563.29
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$503.48
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$503.48
|
| Rate for Payer: Independent Care Health Plan Medicare |
$142.63
|
| Rate for Payer: Multiplan Commercial |
$495.20
|
| Rate for Payer: Preferred Network Access Commercial |
$588.05
|
| Rate for Payer: Quartz Beloit One Network |
$272.36
|
| Rate for Payer: Quartz Commercial |
$352.83
|
| Rate for Payer: Quartz Medicare Advantage |
$142.63
|
| Rate for Payer: The Alliance Commercial |
$392.23
|
| Rate for Payer: United Healthcare Medicare Advantage |
$142.63
|
| Rate for Payer: WEA Trust Commercial |
$340.45
|
| Rate for Payer: WPS Commercial |
$249.60
|
|
|
Covid Admin Charge 90480 - Covid Admin Charge
|
Professional
|
$48.00
|
|
|
Service Code
|
CPT 90480
|
| Hospital Charge Code |
6219810
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$21.12 |
| Max. Negotiated Rate |
$45.60 |
| Rate for Payer: Aetna Commercial |
$45.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$41.28
|
| Rate for Payer: Cash Price |
$14.40
|
| Rate for Payer: Cash Price |
$14.40
|
| Rate for Payer: Cigna Commercial |
$45.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$24.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$28.80
|
| Rate for Payer: Health EOS Commercial |
$43.68
|
| Rate for Payer: Multiplan Commercial |
$38.40
|
| Rate for Payer: Preferred Network Access Commercial |
$45.60
|
| Rate for Payer: Quartz Beloit One Network |
$21.12
|
| Rate for Payer: Quartz Commercial |
$27.36
|
| Rate for Payer: The Alliance Commercial |
$24.00
|
| Rate for Payer: United Healthcare Medicaid |
$38.16
|
| Rate for Payer: WEA Trust Commercial |
$26.40
|
| Rate for Payer: WPS Commercial |
$35.55
|
|
|
Covid Admin Charge 90480 - Covid Admin Charge
|
Facility
IP
|
$48.00
|
|
|
Service Code
|
CPT 90480
|
| Hospital Charge Code |
6219810
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$23.52 |
| Max. Negotiated Rate |
$44.16 |
| Rate for Payer: Aetna Commercial |
$43.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$25.44
|
| Rate for Payer: Cash Price |
$14.40
|
| Rate for Payer: Cigna Commercial |
$44.16
|
| Rate for Payer: Health EOS Commercial |
$42.72
|
| Rate for Payer: HFN Commercial |
$44.16
|
| Rate for Payer: Multiplan Commercial |
$38.40
|
| Rate for Payer: NAPHCARE Commercial |
$28.80
|
| Rate for Payer: Preferred Network Access Commercial |
$44.16
|
| Rate for Payer: Quartz Beloit One Network |
$23.52
|
| Rate for Payer: Quartz Commercial |
$28.80
|
| Rate for Payer: WEA Trust Commercial |
$26.40
|
| Rate for Payer: WPS Commercial |
$35.55
|
|
|
Covid Admin Charge 90480 - Covid Admin Charge
|
Facility
OP
|
$48.00
|
|
|
Service Code
|
CPT 90480
|
| Hospital Charge Code |
6219810
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$16.80 |
| Max. Negotiated Rate |
$160.22 |
| Rate for Payer: Aetna Commercial |
$43.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$41.28
|
| Rate for Payer: Aetna Managed Medicare |
$43.07
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$31.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$24.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$23.04
|
| Rate for Payer: Anthem Medicaid |
$38.16
|
| Rate for Payer: Anthem Medicare Advantage |
$43.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$25.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$43.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$43.07
|
| Rate for Payer: Cash Price |
$14.40
|
| Rate for Payer: Cash Price |
$14.40
|
| Rate for Payer: Cigna Commercial |
$44.16
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$43.07
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$38.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$26.86
|
| Rate for Payer: Dean Health Medicaid |
$38.16
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$43.07
|
| Rate for Payer: Health EOS Commercial |
$42.72
|
| Rate for Payer: HFN Commercial |
$44.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$160.22
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$43.07
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$38.16
|
| Rate for Payer: Independent Care Health Plan Medicare |
$43.07
|
| Rate for Payer: Managed Health Services Medicaid |
$39.69
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$43.07
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$43.07
|
| Rate for Payer: Multiplan Commercial |
$38.40
|
| Rate for Payer: NAPHCARE Commercial |
$64.60
|
| Rate for Payer: Preferred Network Access Commercial |
$44.16
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$38.16
|
| Rate for Payer: Quartz Beloit One Network |
$23.52
|
| Rate for Payer: Quartz Commercial |
$31.20
|
| Rate for Payer: Quartz Medicare Advantage |
$43.07
|
| Rate for Payer: The Alliance Commercial |
$16.80
|
| Rate for Payer: United Healthcare Medicaid |
$38.16
|
| Rate for Payer: United Healthcare Medicare Advantage |
$43.07
|
| Rate for Payer: United Healthcare PPO |
$36.00
|
| Rate for Payer: WEA Trust Commercial |
$26.40
|
| Rate for Payer: Wellcare Medicare |
$43.07
|
| Rate for Payer: WMAP Medicaid |
$38.16
|
| Rate for Payer: WPS Commercial |
$35.55
|
|
|
Coxsackie B (1-6) Antibodies
|
Facility
IP
|
$29.00
|
|
|
Service Code
|
CPT 86658
|
| Hospital Charge Code |
3315483
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.21 |
| Max. Negotiated Rate |
$26.68 |
| Rate for Payer: Aetna Commercial |
$26.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$15.37
|
| Rate for Payer: Cash Price |
$8.70
|
| Rate for Payer: Cigna Commercial |
$26.68
|
| Rate for Payer: Health EOS Commercial |
$25.81
|
| Rate for Payer: HFN Commercial |
$26.68
|
| Rate for Payer: Multiplan Commercial |
$23.20
|
| Rate for Payer: NAPHCARE Commercial |
$17.40
|
| Rate for Payer: Preferred Network Access Commercial |
$26.68
|
| Rate for Payer: Quartz Beloit One Network |
$14.21
|
| Rate for Payer: Quartz Commercial |
$17.40
|
| Rate for Payer: WEA Trust Commercial |
$15.95
|
| Rate for Payer: WPS Commercial |
$21.48
|
|
|
Coxsackie B (1-6) Antibodies
|
Facility
OP
|
$29.00
|
|
|
Service Code
|
CPT 86658
|
| Hospital Charge Code |
3315483
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.17 |
| Max. Negotiated Rate |
$116.00 |
| Rate for Payer: Aetna Commercial |
$26.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$24.94
|
| Rate for Payer: Aetna Managed Medicare |
$13.03
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$48.86
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$22.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$21.63
|
| Rate for Payer: Anthem Medicaid |
$8.17
|
| Rate for Payer: Anthem Medicare Advantage |
$13.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$15.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$13.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$13.03
|
| Rate for Payer: Cash Price |
$8.70
|
| Rate for Payer: Cash Price |
$8.70
|
| Rate for Payer: Cigna Commercial |
$26.68
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$13.03
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$8.17
|
| Rate for Payer: Dean Health Medicaid |
$8.17
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$13.03
|
| Rate for Payer: Health EOS Commercial |
$25.81
|
| Rate for Payer: HFN Commercial |
$26.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$48.47
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$13.03
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$8.17
|
| Rate for Payer: Independent Care Health Plan Medicare |
$13.03
|
| Rate for Payer: Managed Health Services Medicaid |
$8.50
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$13.03
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$13.03
|
| Rate for Payer: Multiplan Commercial |
$23.20
|
| Rate for Payer: NAPHCARE Commercial |
$19.54
|
| Rate for Payer: Preferred Network Access Commercial |
$26.68
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$8.17
|
| Rate for Payer: Quartz Beloit One Network |
$14.21
|
| Rate for Payer: Quartz Commercial |
$18.85
|
| Rate for Payer: Quartz Medicare Advantage |
$13.03
|
| Rate for Payer: The Alliance Commercial |
$116.00
|
| Rate for Payer: United Healthcare Medicaid |
$8.17
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.03
|
| Rate for Payer: United Healthcare PPO |
$21.75
|
| Rate for Payer: WEA Trust Commercial |
$15.95
|
| Rate for Payer: Wellcare Medicare |
$13.03
|
| Rate for Payer: WMAP Medicaid |
$8.17
|
| Rate for Payer: WPS Commercial |
$21.48
|
|
|
Coxsackie B (1-6) Antibodies
|
Professional
|
$29.00
|
|
|
Service Code
|
CPT 86658
|
| Hospital Charge Code |
3315483
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.76 |
| Max. Negotiated Rate |
$57.33 |
| Rate for Payer: Aetna Commercial |
$27.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$24.94
|
| Rate for Payer: Aetna Managed Medicare |
$13.03
|
| Rate for Payer: Anthem Medicare Advantage |
$13.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$13.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$13.03
|
| Rate for Payer: Cash Price |
$8.70
|
| Rate for Payer: Cash Price |
$8.70
|
| Rate for Payer: Cigna Commercial |
$27.55
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$14.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$13.03
|
| Rate for Payer: Health EOS Commercial |
$26.39
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$46.00
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$46.00
|
| Rate for Payer: Independent Care Health Plan Medicare |
$13.03
|
| Rate for Payer: Multiplan Commercial |
$23.20
|
| Rate for Payer: Preferred Network Access Commercial |
$27.55
|
| Rate for Payer: Quartz Beloit One Network |
$12.76
|
| Rate for Payer: Quartz Commercial |
$16.53
|
| Rate for Payer: Quartz Medicare Advantage |
$13.03
|
| Rate for Payer: The Alliance Commercial |
$51.47
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.03
|
| Rate for Payer: WEA Trust Commercial |
$15.95
|
| Rate for Payer: WPS Commercial |
$57.33
|
|
|
Coxsackie B (1-6) Antibodies, Serum
|
Facility
IP
|
$29.00
|
|
|
Service Code
|
CPT 86658
|
| Hospital Charge Code |
3256225
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.21 |
| Max. Negotiated Rate |
$26.68 |
| Rate for Payer: Aetna Commercial |
$26.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$15.37
|
| Rate for Payer: Cash Price |
$8.70
|
| Rate for Payer: Cigna Commercial |
$26.68
|
| Rate for Payer: Health EOS Commercial |
$25.81
|
| Rate for Payer: HFN Commercial |
$26.68
|
| Rate for Payer: Multiplan Commercial |
$23.20
|
| Rate for Payer: NAPHCARE Commercial |
$17.40
|
| Rate for Payer: Preferred Network Access Commercial |
$26.68
|
| Rate for Payer: Quartz Beloit One Network |
$14.21
|
| Rate for Payer: Quartz Commercial |
$17.40
|
| Rate for Payer: WEA Trust Commercial |
$15.95
|
| Rate for Payer: WPS Commercial |
$21.48
|
|
|
Coxsackie B (1-6) Antibodies, Serum
|
Facility
OP
|
$29.00
|
|
|
Service Code
|
CPT 86658
|
| Hospital Charge Code |
3256225
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.17 |
| Max. Negotiated Rate |
$116.00 |
| Rate for Payer: Aetna Commercial |
$26.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$24.94
|
| Rate for Payer: Aetna Managed Medicare |
$13.03
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$48.86
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$22.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$21.63
|
| Rate for Payer: Anthem Medicaid |
$8.17
|
| Rate for Payer: Anthem Medicare Advantage |
$13.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$15.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$13.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$13.03
|
| Rate for Payer: Cash Price |
$8.70
|
| Rate for Payer: Cash Price |
$8.70
|
| Rate for Payer: Cigna Commercial |
$26.68
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$13.03
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$8.17
|
| Rate for Payer: Dean Health Medicaid |
$8.17
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$13.03
|
| Rate for Payer: Health EOS Commercial |
$25.81
|
| Rate for Payer: HFN Commercial |
$26.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$48.47
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$13.03
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$8.17
|
| Rate for Payer: Independent Care Health Plan Medicare |
$13.03
|
| Rate for Payer: Managed Health Services Medicaid |
$8.50
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$13.03
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$13.03
|
| Rate for Payer: Multiplan Commercial |
$23.20
|
| Rate for Payer: NAPHCARE Commercial |
$19.54
|
| Rate for Payer: Preferred Network Access Commercial |
$26.68
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$8.17
|
| Rate for Payer: Quartz Beloit One Network |
$14.21
|
| Rate for Payer: Quartz Commercial |
$18.85
|
| Rate for Payer: Quartz Medicare Advantage |
$13.03
|
| Rate for Payer: The Alliance Commercial |
$116.00
|
| Rate for Payer: United Healthcare Medicaid |
$8.17
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.03
|
| Rate for Payer: United Healthcare PPO |
$21.75
|
| Rate for Payer: WEA Trust Commercial |
$15.95
|
| Rate for Payer: Wellcare Medicare |
$13.03
|
| Rate for Payer: WMAP Medicaid |
$8.17
|
| Rate for Payer: WPS Commercial |
$21.48
|
|
|
Coxsackie B (1-6) Antibodies, Serum
|
Professional
|
$29.00
|
|
|
Service Code
|
CPT 86658
|
| Hospital Charge Code |
3256225
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.76 |
| Max. Negotiated Rate |
$57.33 |
| Rate for Payer: Aetna Commercial |
$27.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$24.94
|
| Rate for Payer: Aetna Managed Medicare |
$13.03
|
| Rate for Payer: Anthem Medicare Advantage |
$13.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$13.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$13.03
|
| Rate for Payer: Cash Price |
$8.70
|
| Rate for Payer: Cash Price |
$8.70
|
| Rate for Payer: Cigna Commercial |
$27.55
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$14.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$13.03
|
| Rate for Payer: Health EOS Commercial |
$26.39
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$46.00
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$46.00
|
| Rate for Payer: Independent Care Health Plan Medicare |
$13.03
|
| Rate for Payer: Multiplan Commercial |
$23.20
|
| Rate for Payer: Preferred Network Access Commercial |
$27.55
|
| Rate for Payer: Quartz Beloit One Network |
$12.76
|
| Rate for Payer: Quartz Commercial |
$16.53
|
| Rate for Payer: Quartz Medicare Advantage |
$13.03
|
| Rate for Payer: The Alliance Commercial |
$51.47
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.03
|
| Rate for Payer: WEA Trust Commercial |
$15.95
|
| Rate for Payer: WPS Commercial |
$57.33
|
|
|
Cpap Inline Nebkit
|
Facility
OP
|
$18.00
|
|
| Hospital Charge Code |
3040340
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$5.04 |
| Max. Negotiated Rate |
$72.00 |
| Rate for Payer: Aetna Commercial |
$16.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$15.48
|
| Rate for Payer: Aetna Managed Medicare |
$5.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$11.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$9.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$8.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9.54
|
| Rate for Payer: Cash Price |
$5.40
|
| Rate for Payer: Cigna Commercial |
$16.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$10.07
|
| Rate for Payer: Health EOS Commercial |
$16.02
|
| Rate for Payer: HFN Commercial |
$16.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$13.50
|
| Rate for Payer: Multiplan Commercial |
$14.40
|
| Rate for Payer: NAPHCARE Commercial |
$10.80
|
| Rate for Payer: Preferred Network Access Commercial |
$16.56
|
| Rate for Payer: Quartz Beloit One Network |
$8.82
|
| Rate for Payer: Quartz Commercial |
$11.70
|
| Rate for Payer: Quartz Medicare Advantage |
$10.80
|
| Rate for Payer: The Alliance Commercial |
$72.00
|
| Rate for Payer: WEA Trust Commercial |
$9.90
|
| Rate for Payer: WPS Commercial |
$13.33
|
|
|
Cpap Inline Nebkit
|
Facility
IP
|
$18.00
|
|
| Hospital Charge Code |
3040340
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$8.82 |
| Max. Negotiated Rate |
$16.56 |
| Rate for Payer: Aetna Commercial |
$16.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9.54
|
| Rate for Payer: Cash Price |
$5.40
|
| Rate for Payer: Cigna Commercial |
$16.56
|
| Rate for Payer: Health EOS Commercial |
$16.02
|
| Rate for Payer: HFN Commercial |
$16.56
|
| Rate for Payer: Multiplan Commercial |
$14.40
|
| Rate for Payer: NAPHCARE Commercial |
$10.80
|
| Rate for Payer: Preferred Network Access Commercial |
$16.56
|
| Rate for Payer: Quartz Beloit One Network |
$8.82
|
| Rate for Payer: Quartz Commercial |
$10.80
|
| Rate for Payer: WEA Trust Commercial |
$9.90
|
| Rate for Payer: WPS Commercial |
$13.33
|
|
