|
COVER TRANSDUCER STERILE 610575
|
Facility
|
OP
|
$264.00
|
|
| Hospital Charge Code |
2970214
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$76.88 |
| Max. Negotiated Rate |
$252.60 |
| Rate for Payer: Aetna Commercial |
$247.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$236.12
|
| Rate for Payer: Aetna Managed Medicare |
$76.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$178.46
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$137.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$131.79
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$145.52
|
| Rate for Payer: Cash Price |
$79.20
|
| Rate for Payer: Cigna Commercial |
$252.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$153.65
|
| Rate for Payer: Health EOS Commercial |
$244.36
|
| Rate for Payer: HFN Commercial |
$252.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$205.92
|
| Rate for Payer: Multiplan Commercial |
$219.65
|
| Rate for Payer: NAPHCARE Commercial |
$164.74
|
| Rate for Payer: Preferred Network Access Commercial |
$252.60
|
| Rate for Payer: Quartz Beloit One Network |
$134.53
|
| Rate for Payer: Quartz Commercial |
$178.46
|
| Rate for Payer: Quartz Medicare Advantage |
$164.74
|
| Rate for Payer: The Alliance Commercial |
$137.28
|
| Rate for Payer: WEA Trust Commercial |
$151.01
|
| Rate for Payer: WPS Commercial |
$203.36
|
|
|
COVID-19, Antibody IgG Quantitative
|
Professional
|
Both
|
$292.00
|
|
|
Service Code
|
CPT 86769
|
| Hospital Charge Code |
5711633
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$43.82 |
| Max. Negotiated Rate |
$288.50 |
| Rate for Payer: Aetna Commercial |
$288.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$261.16
|
| Rate for Payer: Aetna Managed Medicare |
$43.82
|
| Rate for Payer: Anthem Medicare Advantage |
$43.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$43.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$43.82
|
| Rate for Payer: Cash Price |
$87.60
|
| Rate for Payer: Cash Price |
$87.60
|
| Rate for Payer: Cigna Commercial |
$288.50
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$151.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$43.82
|
| Rate for Payer: Health EOS Commercial |
$276.35
|
| Rate for Payer: HFN Commercial |
$288.50
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$154.67
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$154.67
|
| Rate for Payer: Independent Care Health Plan Medicare |
$43.82
|
| Rate for Payer: Multiplan Commercial |
$242.94
|
| Rate for Payer: NAPHCARE Commercial |
$65.72
|
| Rate for Payer: Preferred Network Access Commercial |
$288.50
|
| Rate for Payer: Quartz Beloit One Network |
$133.62
|
| Rate for Payer: Quartz Commercial |
$173.10
|
| Rate for Payer: Quartz Medicare Advantage |
$43.82
|
| Rate for Payer: The Alliance Commercial |
$173.07
|
| Rate for Payer: United Healthcare Medicare Advantage |
$43.82
|
| Rate for Payer: WEA Trust Commercial |
$167.02
|
| Rate for Payer: WPS Commercial |
$192.79
|
|
|
COVID-19, Antibody IgG Quantitative
|
Facility
|
OP
|
$292.00
|
|
|
Service Code
|
CPT 86769
|
| Hospital Charge Code |
5711633
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$43.82 |
| Max. Negotiated Rate |
$279.39 |
| Rate for Payer: Aetna Commercial |
$273.31
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$261.16
|
| Rate for Payer: Aetna Managed Medicare |
$43.82
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$164.31
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$76.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$72.73
|
| Rate for Payer: Anthem Medicare Advantage |
$43.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$160.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$43.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$43.82
|
| Rate for Payer: Cash Price |
$87.60
|
| Rate for Payer: Cash Price |
$87.60
|
| Rate for Payer: Cigna Commercial |
$279.39
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$43.82
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$169.94
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$43.82
|
| Rate for Payer: Health EOS Commercial |
$270.28
|
| Rate for Payer: HFN Commercial |
$279.39
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$162.99
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$43.82
|
| Rate for Payer: Independent Care Health Plan Medicare |
$43.82
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$43.82
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$43.82
|
| Rate for Payer: Multiplan Commercial |
$242.94
|
| Rate for Payer: NAPHCARE Commercial |
$65.72
|
| Rate for Payer: Preferred Network Access Commercial |
$279.39
|
| Rate for Payer: Quartz Beloit One Network |
$148.80
|
| Rate for Payer: Quartz Commercial |
$197.39
|
| Rate for Payer: Quartz Medicare Advantage |
$43.82
|
| Rate for Payer: The Alliance Commercial |
$175.26
|
| Rate for Payer: United Healthcare Medicare Advantage |
$43.82
|
| Rate for Payer: United Healthcare PPO |
$227.76
|
| Rate for Payer: WEA Trust Commercial |
$167.02
|
| Rate for Payer: Wellcare Medicare |
$43.82
|
| Rate for Payer: WPS Commercial |
$224.93
|
|
|
COVID-19, Antibody IgG Quantitative
|
Facility
|
IP
|
$292.00
|
|
|
Service Code
|
CPT 86769
|
| Hospital Charge Code |
5711633
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$148.80 |
| Max. Negotiated Rate |
$279.39 |
| Rate for Payer: Aetna Commercial |
$273.31
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$261.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$160.95
|
| Rate for Payer: Cash Price |
$87.60
|
| Rate for Payer: Cigna Commercial |
$279.39
|
| Rate for Payer: Health EOS Commercial |
$270.28
|
| Rate for Payer: HFN Commercial |
$279.39
|
| Rate for Payer: Multiplan Commercial |
$242.94
|
| Rate for Payer: Preferred Network Access Commercial |
$279.39
|
| Rate for Payer: Quartz Beloit One Network |
$148.80
|
| Rate for Payer: Quartz Commercial |
$182.21
|
| Rate for Payer: WEA Trust Commercial |
$167.02
|
| Rate for Payer: WPS Commercial |
$224.93
|
|
|
COVID-19, Antigen at BMH
|
Facility
|
OP
|
$186.00
|
|
|
Service Code
|
CPT 87426
|
| Hospital Charge Code |
5637624
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$36.74 |
| Max. Negotiated Rate |
$177.96 |
| Rate for Payer: Aetna Commercial |
$174.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$166.36
|
| Rate for Payer: Aetna Managed Medicare |
$36.74
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$137.79
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$64.30
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$60.99
|
| Rate for Payer: Anthem Medicare Advantage |
$36.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$102.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$36.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$36.74
|
| Rate for Payer: Cash Price |
$55.80
|
| Rate for Payer: Cash Price |
$55.80
|
| Rate for Payer: Cigna Commercial |
$177.96
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$36.74
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$108.25
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$36.74
|
| Rate for Payer: Health EOS Commercial |
$172.16
|
| Rate for Payer: HFN Commercial |
$177.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$136.68
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$36.74
|
| Rate for Payer: Independent Care Health Plan Medicare |
$36.74
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$36.74
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$36.74
|
| Rate for Payer: Multiplan Commercial |
$154.75
|
| Rate for Payer: NAPHCARE Commercial |
$55.11
|
| Rate for Payer: Preferred Network Access Commercial |
$177.96
|
| Rate for Payer: Quartz Beloit One Network |
$94.79
|
| Rate for Payer: Quartz Commercial |
$125.74
|
| Rate for Payer: Quartz Medicare Advantage |
$36.74
|
| Rate for Payer: The Alliance Commercial |
$146.97
|
| Rate for Payer: United Healthcare Medicare Advantage |
$36.74
|
| Rate for Payer: United Healthcare PPO |
$145.08
|
| Rate for Payer: WEA Trust Commercial |
$106.39
|
| Rate for Payer: Wellcare Medicare |
$36.74
|
| Rate for Payer: WPS Commercial |
$143.28
|
|
|
COVID-19, Antigen at BMH
|
Professional
|
Both
|
$186.00
|
|
|
Service Code
|
CPT 87426
|
| Hospital Charge Code |
5637624
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$36.74 |
| Max. Negotiated Rate |
$183.77 |
| Rate for Payer: Aetna Commercial |
$183.77
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$166.36
|
| Rate for Payer: Aetna Managed Medicare |
$36.74
|
| Rate for Payer: Anthem Medicare Advantage |
$36.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$36.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$36.74
|
| Rate for Payer: Cash Price |
$55.80
|
| Rate for Payer: Cash Price |
$55.80
|
| Rate for Payer: Cigna Commercial |
$183.77
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$96.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$36.74
|
| Rate for Payer: Health EOS Commercial |
$176.03
|
| Rate for Payer: HFN Commercial |
$183.77
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$166.05
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$166.05
|
| Rate for Payer: Independent Care Health Plan Medicare |
$36.74
|
| Rate for Payer: Multiplan Commercial |
$154.75
|
| Rate for Payer: NAPHCARE Commercial |
$55.11
|
| Rate for Payer: Preferred Network Access Commercial |
$183.77
|
| Rate for Payer: Quartz Beloit One Network |
$85.11
|
| Rate for Payer: Quartz Commercial |
$110.26
|
| Rate for Payer: Quartz Medicare Advantage |
$36.74
|
| Rate for Payer: The Alliance Commercial |
$145.14
|
| Rate for Payer: United Healthcare Medicare Advantage |
$36.74
|
| Rate for Payer: WEA Trust Commercial |
$106.39
|
| Rate for Payer: WPS Commercial |
$161.67
|
|
|
COVID-19, Antigen at BMH
|
Facility
|
IP
|
$186.00
|
|
|
Service Code
|
CPT 87426
|
| Hospital Charge Code |
5637624
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$94.79 |
| Max. Negotiated Rate |
$177.96 |
| Rate for Payer: Aetna Commercial |
$174.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$166.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$102.52
|
| Rate for Payer: Cash Price |
$55.80
|
| Rate for Payer: Cigna Commercial |
$177.96
|
| Rate for Payer: Health EOS Commercial |
$172.16
|
| Rate for Payer: HFN Commercial |
$177.96
|
| Rate for Payer: Multiplan Commercial |
$154.75
|
| Rate for Payer: Preferred Network Access Commercial |
$177.96
|
| Rate for Payer: Quartz Beloit One Network |
$94.79
|
| Rate for Payer: Quartz Commercial |
$116.06
|
| Rate for Payer: WEA Trust Commercial |
$106.39
|
| Rate for Payer: WPS Commercial |
$143.28
|
|
|
COVID-19, BinaxNOW Card
|
Facility
|
IP
|
$47.00
|
|
|
Service Code
|
CPT 87811
|
| Hospital Charge Code |
5637625
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$23.95 |
| Max. Negotiated Rate |
$44.97 |
| Rate for Payer: Aetna Commercial |
$43.99
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$42.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$25.91
|
| Rate for Payer: Cash Price |
$14.10
|
| Rate for Payer: Cigna Commercial |
$44.97
|
| Rate for Payer: Health EOS Commercial |
$43.50
|
| Rate for Payer: HFN Commercial |
$44.97
|
| Rate for Payer: Multiplan Commercial |
$39.10
|
| Rate for Payer: Preferred Network Access Commercial |
$44.97
|
| Rate for Payer: Quartz Beloit One Network |
$23.95
|
| Rate for Payer: Quartz Commercial |
$29.33
|
| Rate for Payer: WEA Trust Commercial |
$26.88
|
| Rate for Payer: WPS Commercial |
$36.20
|
|
|
COVID-19, BinaxNOW Card
|
Professional
|
Both
|
$47.00
|
|
|
Service Code
|
CPT 87811
|
| Hospital Charge Code |
5637625
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$21.51 |
| Max. Negotiated Rate |
$189.35 |
| Rate for Payer: Aetna Commercial |
$46.44
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$42.04
|
| Rate for Payer: Aetna Managed Medicare |
$43.04
|
| Rate for Payer: Anthem Medicare Advantage |
$43.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$43.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$43.04
|
| Rate for Payer: Cash Price |
$14.10
|
| Rate for Payer: Cash Price |
$14.10
|
| Rate for Payer: Cigna Commercial |
$46.44
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$24.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$43.04
|
| Rate for Payer: Health EOS Commercial |
$44.48
|
| Rate for Payer: HFN Commercial |
$46.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$151.91
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$151.91
|
| Rate for Payer: Independent Care Health Plan Medicare |
$43.04
|
| Rate for Payer: Multiplan Commercial |
$39.10
|
| Rate for Payer: NAPHCARE Commercial |
$64.55
|
| Rate for Payer: Preferred Network Access Commercial |
$46.44
|
| Rate for Payer: Quartz Beloit One Network |
$21.51
|
| Rate for Payer: Quartz Commercial |
$27.86
|
| Rate for Payer: Quartz Medicare Advantage |
$43.04
|
| Rate for Payer: The Alliance Commercial |
$169.99
|
| Rate for Payer: United Healthcare Medicare Advantage |
$43.04
|
| Rate for Payer: WEA Trust Commercial |
$26.88
|
| Rate for Payer: WPS Commercial |
$189.35
|
|
|
COVID-19, BinaxNOW Card
|
Facility
|
OP
|
$47.00
|
|
|
Service Code
|
CPT 87811
|
| Hospital Charge Code |
5637625
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$23.95 |
| Max. Negotiated Rate |
$172.14 |
| Rate for Payer: Aetna Commercial |
$43.99
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$42.04
|
| Rate for Payer: Aetna Managed Medicare |
$43.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$161.38
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$75.31
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$71.44
|
| Rate for Payer: Anthem Medicare Advantage |
$43.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$25.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$43.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$43.04
|
| Rate for Payer: Cash Price |
$14.10
|
| Rate for Payer: Cash Price |
$14.10
|
| Rate for Payer: Cigna Commercial |
$44.97
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$43.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$27.35
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$43.04
|
| Rate for Payer: Health EOS Commercial |
$43.50
|
| Rate for Payer: HFN Commercial |
$44.97
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$160.09
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$43.04
|
| Rate for Payer: Independent Care Health Plan Medicare |
$43.04
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$43.04
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$43.04
|
| Rate for Payer: Multiplan Commercial |
$39.10
|
| Rate for Payer: NAPHCARE Commercial |
$64.55
|
| Rate for Payer: Preferred Network Access Commercial |
$44.97
|
| Rate for Payer: Quartz Beloit One Network |
$23.95
|
| Rate for Payer: Quartz Commercial |
$31.77
|
| Rate for Payer: Quartz Medicare Advantage |
$43.04
|
| Rate for Payer: The Alliance Commercial |
$172.14
|
| Rate for Payer: United Healthcare Medicare Advantage |
$43.04
|
| Rate for Payer: United Healthcare PPO |
$36.66
|
| Rate for Payer: WEA Trust Commercial |
$26.88
|
| Rate for Payer: Wellcare Medicare |
$43.04
|
| Rate for Payer: WPS Commercial |
$36.20
|
|
|
COVID-19 Collection/Transport Fee
|
Facility
|
IP
|
$29.00
|
|
|
Service Code
|
CPT 99001
|
| Hospital Charge Code |
5589238
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.78 |
| Max. Negotiated Rate |
$27.75 |
| Rate for Payer: Aetna Commercial |
$27.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$25.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$15.98
|
| Rate for Payer: Cash Price |
$8.70
|
| Rate for Payer: Cigna Commercial |
$27.75
|
| Rate for Payer: Health EOS Commercial |
$26.84
|
| Rate for Payer: HFN Commercial |
$27.75
|
| Rate for Payer: Multiplan Commercial |
$24.13
|
| Rate for Payer: Preferred Network Access Commercial |
$27.75
|
| Rate for Payer: Quartz Beloit One Network |
$14.78
|
| Rate for Payer: Quartz Commercial |
$18.10
|
| Rate for Payer: WEA Trust Commercial |
$16.59
|
| Rate for Payer: WPS Commercial |
$22.34
|
|
|
COVID-19 Collection/Transport Fee
|
Professional
|
Both
|
$29.00
|
|
|
Service Code
|
CPT 99001
|
| Hospital Charge Code |
5589238
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.27 |
| Max. Negotiated Rate |
$28.65 |
| Rate for Payer: Aetna Commercial |
$28.65
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$25.94
|
| Rate for Payer: Cash Price |
$8.70
|
| Rate for Payer: Cash Price |
$8.70
|
| Rate for Payer: Cigna Commercial |
$28.65
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$15.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$18.10
|
| Rate for Payer: Health EOS Commercial |
$27.45
|
| Rate for Payer: HFN Commercial |
$28.65
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$22.54
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$22.54
|
| Rate for Payer: Multiplan Commercial |
$24.13
|
| Rate for Payer: Preferred Network Access Commercial |
$28.65
|
| Rate for Payer: Quartz Beloit One Network |
$13.27
|
| Rate for Payer: Quartz Commercial |
$17.19
|
| Rate for Payer: The Alliance Commercial |
$15.08
|
| Rate for Payer: WEA Trust Commercial |
$16.59
|
| Rate for Payer: WPS Commercial |
$22.34
|
|
|
COVID-19 Collection/Transport Fee
|
Facility
|
OP
|
$29.00
|
|
|
Service Code
|
CPT 99001
|
| Hospital Charge Code |
5589238
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.44 |
| Max. Negotiated Rate |
$27.75 |
| Rate for Payer: Aetna Commercial |
$27.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$25.94
|
| Rate for Payer: Aetna Managed Medicare |
$8.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$19.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$15.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$14.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$15.98
|
| Rate for Payer: Cash Price |
$8.70
|
| Rate for Payer: Cigna Commercial |
$27.75
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$16.88
|
| Rate for Payer: Health EOS Commercial |
$26.84
|
| Rate for Payer: HFN Commercial |
$27.75
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$22.62
|
| Rate for Payer: Multiplan Commercial |
$24.13
|
| Rate for Payer: NAPHCARE Commercial |
$18.10
|
| Rate for Payer: Preferred Network Access Commercial |
$27.75
|
| Rate for Payer: Quartz Beloit One Network |
$14.78
|
| Rate for Payer: Quartz Commercial |
$19.60
|
| Rate for Payer: Quartz Medicare Advantage |
$18.10
|
| Rate for Payer: The Alliance Commercial |
$15.08
|
| Rate for Payer: United Healthcare PPO |
$22.62
|
| Rate for Payer: WEA Trust Commercial |
$16.59
|
| Rate for Payer: WPS Commercial |
$22.34
|
|
|
COVID-19, PCR at BMH
|
Facility
|
OP
|
$193.00
|
|
|
Service Code
|
CPT 87635
|
| Hospital Charge Code |
5585257
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$53.36 |
| Max. Negotiated Rate |
$213.45 |
| Rate for Payer: Aetna Commercial |
$180.65
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$172.62
|
| Rate for Payer: Aetna Managed Medicare |
$53.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$200.11
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$93.38
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$88.58
|
| Rate for Payer: Anthem Medicare Advantage |
$53.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$106.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$53.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$53.36
|
| Rate for Payer: Cash Price |
$57.90
|
| Rate for Payer: Cash Price |
$57.90
|
| Rate for Payer: Cigna Commercial |
$184.66
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$53.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$112.33
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$53.36
|
| Rate for Payer: Health EOS Commercial |
$178.64
|
| Rate for Payer: HFN Commercial |
$184.66
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$198.51
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$53.36
|
| Rate for Payer: Independent Care Health Plan Medicare |
$53.36
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$53.36
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$53.36
|
| Rate for Payer: Multiplan Commercial |
$160.58
|
| Rate for Payer: NAPHCARE Commercial |
$80.04
|
| Rate for Payer: Preferred Network Access Commercial |
$184.66
|
| Rate for Payer: Quartz Beloit One Network |
$98.35
|
| Rate for Payer: Quartz Commercial |
$130.47
|
| Rate for Payer: Quartz Medicare Advantage |
$53.36
|
| Rate for Payer: The Alliance Commercial |
$213.45
|
| Rate for Payer: United Healthcare Medicare Advantage |
$53.36
|
| Rate for Payer: United Healthcare PPO |
$150.54
|
| Rate for Payer: WEA Trust Commercial |
$110.40
|
| Rate for Payer: Wellcare Medicare |
$53.36
|
| Rate for Payer: WPS Commercial |
$148.67
|
|
|
COVID-19, PCR at BMH
|
Professional
|
Both
|
$193.00
|
|
|
Service Code
|
CPT 87635
|
| Hospital Charge Code |
5585257
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$53.36 |
| Max. Negotiated Rate |
$234.79 |
| Rate for Payer: Aetna Commercial |
$190.68
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$172.62
|
| Rate for Payer: Aetna Managed Medicare |
$53.36
|
| Rate for Payer: Anthem Medicare Advantage |
$53.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$53.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$53.36
|
| Rate for Payer: Cash Price |
$57.90
|
| Rate for Payer: Cash Price |
$57.90
|
| Rate for Payer: Cigna Commercial |
$190.68
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$100.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$53.36
|
| Rate for Payer: Health EOS Commercial |
$182.66
|
| Rate for Payer: HFN Commercial |
$190.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$188.36
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$188.36
|
| Rate for Payer: Independent Care Health Plan Medicare |
$53.36
|
| Rate for Payer: Multiplan Commercial |
$160.58
|
| Rate for Payer: NAPHCARE Commercial |
$80.04
|
| Rate for Payer: Preferred Network Access Commercial |
$190.68
|
| Rate for Payer: Quartz Beloit One Network |
$88.32
|
| Rate for Payer: Quartz Commercial |
$114.41
|
| Rate for Payer: Quartz Medicare Advantage |
$53.36
|
| Rate for Payer: The Alliance Commercial |
$210.78
|
| Rate for Payer: United Healthcare Medicare Advantage |
$53.36
|
| Rate for Payer: WEA Trust Commercial |
$110.40
|
| Rate for Payer: WPS Commercial |
$234.79
|
|
|
COVID-19, PCR at BMH
|
Facility
|
IP
|
$193.00
|
|
|
Service Code
|
CPT 87635
|
| Hospital Charge Code |
5585257
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$98.35 |
| Max. Negotiated Rate |
$184.66 |
| Rate for Payer: Aetna Commercial |
$180.65
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$172.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$106.38
|
| Rate for Payer: Cash Price |
$57.90
|
| Rate for Payer: Cigna Commercial |
$184.66
|
| Rate for Payer: Health EOS Commercial |
$178.64
|
| Rate for Payer: HFN Commercial |
$184.66
|
| Rate for Payer: Multiplan Commercial |
$160.58
|
| Rate for Payer: Preferred Network Access Commercial |
$184.66
|
| Rate for Payer: Quartz Beloit One Network |
$98.35
|
| Rate for Payer: Quartz Commercial |
$120.43
|
| Rate for Payer: WEA Trust Commercial |
$110.40
|
| Rate for Payer: WPS Commercial |
$148.67
|
|
|
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 |
$315.44 |
| Max. Negotiated Rate |
$592.26 |
| Rate for Payer: Aetna Commercial |
$579.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$553.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$341.19
|
| Rate for Payer: Cash Price |
$185.70
|
| Rate for Payer: Cigna Commercial |
$592.26
|
| Rate for Payer: Health EOS Commercial |
$572.95
|
| Rate for Payer: HFN Commercial |
$592.26
|
| Rate for Payer: Multiplan Commercial |
$515.01
|
| Rate for Payer: Preferred Network Access Commercial |
$592.26
|
| Rate for Payer: Quartz Beloit One Network |
$315.44
|
| Rate for Payer: Quartz Commercial |
$386.26
|
| Rate for Payer: WEA Trust Commercial |
$354.07
|
| Rate for Payer: WPS Commercial |
$476.82
|
|
|
COVID-19, PCR with FLU A/B & RSV at BMH
|
Professional
|
Both
|
$619.00
|
|
|
Service Code
|
CPT 0241U
|
| Hospital Charge Code |
5619938
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$283.25 |
| Max. Negotiated Rate |
$611.57 |
| Rate for Payer: Aetna Commercial |
$611.57
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$553.63
|
| Rate for Payer: Cash Price |
$185.70
|
| Rate for Payer: Cash Price |
$185.70
|
| Rate for Payer: Cigna Commercial |
$611.57
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$321.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$386.26
|
| Rate for Payer: Health EOS Commercial |
$585.82
|
| Rate for Payer: HFN Commercial |
$611.57
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$523.62
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$523.62
|
| Rate for Payer: Multiplan Commercial |
$515.01
|
| Rate for Payer: Preferred Network Access Commercial |
$611.57
|
| Rate for Payer: Quartz Beloit One Network |
$283.25
|
| Rate for Payer: Quartz Commercial |
$366.94
|
| Rate for Payer: The Alliance Commercial |
$321.88
|
| Rate for Payer: WEA Trust Commercial |
$354.07
|
| Rate for Payer: WPS Commercial |
$476.82
|
|
|
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 |
$180.25 |
| Max. Negotiated Rate |
$592.26 |
| Rate for Payer: Aetna Commercial |
$579.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$553.63
|
| Rate for Payer: Aetna Managed Medicare |
$180.25
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$418.44
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$321.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$309.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$341.19
|
| Rate for Payer: Cash Price |
$185.70
|
| Rate for Payer: Cigna Commercial |
$592.26
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$360.26
|
| Rate for Payer: Health EOS Commercial |
$572.95
|
| Rate for Payer: HFN Commercial |
$592.26
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$482.82
|
| Rate for Payer: Multiplan Commercial |
$515.01
|
| Rate for Payer: NAPHCARE Commercial |
$386.26
|
| Rate for Payer: Preferred Network Access Commercial |
$592.26
|
| Rate for Payer: Quartz Beloit One Network |
$315.44
|
| Rate for Payer: Quartz Commercial |
$418.44
|
| Rate for Payer: Quartz Medicare Advantage |
$386.26
|
| Rate for Payer: The Alliance Commercial |
$321.88
|
| Rate for Payer: United Healthcare PPO |
$482.82
|
| Rate for Payer: WEA Trust Commercial |
$354.07
|
| Rate for Payer: WPS Commercial |
$476.82
|
|
|
Covid Admin Charge 90480 - Covid Admin Charge
|
Professional
|
Both
|
$48.00
|
|
|
Service Code
|
CPT 90480
|
| Hospital Charge Code |
6219810
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$15.60 |
| Max. Negotiated Rate |
$47.42 |
| Rate for Payer: Aetna Commercial |
$47.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$42.93
|
| Rate for Payer: Cash Price |
$14.40
|
| Rate for Payer: Cash Price |
$14.40
|
| Rate for Payer: Cigna Commercial |
$47.42
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$15.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$29.95
|
| Rate for Payer: Health EOS Commercial |
$45.43
|
| Rate for Payer: HFN Commercial |
$47.42
|
| Rate for Payer: Multiplan Commercial |
$39.94
|
| Rate for Payer: Preferred Network Access Commercial |
$47.42
|
| Rate for Payer: Quartz Beloit One Network |
$21.96
|
| Rate for Payer: Quartz Commercial |
$28.45
|
| Rate for Payer: The Alliance Commercial |
$24.96
|
| Rate for Payer: United Healthcare Medicaid |
$15.60
|
| Rate for Payer: WEA Trust Commercial |
$27.46
|
| Rate for Payer: WPS Commercial |
$36.97
|
|
|
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 |
$23.96 |
| Max. Negotiated Rate |
$171.06 |
| Rate for Payer: Aetna Commercial |
$44.93
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$42.93
|
| Rate for Payer: Aetna Managed Medicare |
$42.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$32.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$24.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$23.96
|
| Rate for Payer: Anthem Medicare Advantage |
$42.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$26.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$42.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$42.76
|
| Rate for Payer: Cash Price |
$14.40
|
| Rate for Payer: Cash Price |
$14.40
|
| Rate for Payer: Cigna Commercial |
$45.93
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$42.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$27.94
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$42.76
|
| Rate for Payer: Health EOS Commercial |
$44.43
|
| Rate for Payer: HFN Commercial |
$45.93
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$159.09
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$42.76
|
| Rate for Payer: Independent Care Health Plan Medicare |
$42.76
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$42.76
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$42.76
|
| Rate for Payer: Multiplan Commercial |
$39.94
|
| Rate for Payer: NAPHCARE Commercial |
$64.15
|
| Rate for Payer: Preferred Network Access Commercial |
$45.93
|
| Rate for Payer: Quartz Beloit One Network |
$24.46
|
| Rate for Payer: Quartz Commercial |
$32.45
|
| Rate for Payer: Quartz Medicare Advantage |
$42.76
|
| Rate for Payer: The Alliance Commercial |
$171.06
|
| Rate for Payer: United Healthcare Medicare Advantage |
$42.76
|
| Rate for Payer: United Healthcare PPO |
$37.44
|
| Rate for Payer: WEA Trust Commercial |
$27.46
|
| Rate for Payer: Wellcare Medicare |
$42.76
|
| Rate for Payer: WPS Commercial |
$36.97
|
|
|
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 |
$24.46 |
| Max. Negotiated Rate |
$45.93 |
| Rate for Payer: Aetna Commercial |
$44.93
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$42.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$26.46
|
| Rate for Payer: Cash Price |
$14.40
|
| Rate for Payer: Cigna Commercial |
$45.93
|
| Rate for Payer: Health EOS Commercial |
$44.43
|
| Rate for Payer: HFN Commercial |
$45.93
|
| Rate for Payer: Multiplan Commercial |
$39.94
|
| Rate for Payer: Preferred Network Access Commercial |
$45.93
|
| Rate for Payer: Quartz Beloit One Network |
$24.46
|
| Rate for Payer: Quartz Commercial |
$29.95
|
| Rate for Payer: WEA Trust Commercial |
$27.46
|
| Rate for Payer: WPS Commercial |
$36.97
|
|
|
Coxsackie B (1-6) Antibodies
|
Facility
|
IP
|
$29.00
|
|
|
Service Code
|
CPT 86658
|
| Hospital Charge Code |
3315483
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.78 |
| Max. Negotiated Rate |
$27.75 |
| Rate for Payer: Aetna Commercial |
$27.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$25.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$15.98
|
| Rate for Payer: Cash Price |
$8.70
|
| Rate for Payer: Cigna Commercial |
$27.75
|
| Rate for Payer: Health EOS Commercial |
$26.84
|
| Rate for Payer: HFN Commercial |
$27.75
|
| Rate for Payer: Multiplan Commercial |
$24.13
|
| Rate for Payer: Preferred Network Access Commercial |
$27.75
|
| Rate for Payer: Quartz Beloit One Network |
$14.78
|
| Rate for Payer: Quartz Commercial |
$18.10
|
| Rate for Payer: WEA Trust Commercial |
$16.59
|
| Rate for Payer: WPS Commercial |
$22.34
|
|
|
Coxsackie B (1-6) Antibodies
|
Facility
|
OP
|
$29.00
|
|
|
Service Code
|
CPT 86658
|
| Hospital Charge Code |
3315483
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.55 |
| Max. Negotiated Rate |
$54.20 |
| Rate for Payer: Aetna Commercial |
$27.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$25.94
|
| Rate for Payer: Aetna Managed Medicare |
$13.55
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$50.82
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$23.71
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$22.49
|
| Rate for Payer: Anthem Medicare Advantage |
$13.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$15.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$13.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$13.55
|
| Rate for Payer: Cash Price |
$8.70
|
| Rate for Payer: Cash Price |
$8.70
|
| Rate for Payer: Cigna Commercial |
$27.75
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$13.55
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$16.88
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$13.55
|
| Rate for Payer: Health EOS Commercial |
$26.84
|
| Rate for Payer: HFN Commercial |
$27.75
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$50.41
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$13.55
|
| Rate for Payer: Independent Care Health Plan Medicare |
$13.55
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$13.55
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$13.55
|
| Rate for Payer: Multiplan Commercial |
$24.13
|
| Rate for Payer: NAPHCARE Commercial |
$20.33
|
| Rate for Payer: Preferred Network Access Commercial |
$27.75
|
| Rate for Payer: Quartz Beloit One Network |
$14.78
|
| Rate for Payer: Quartz Commercial |
$19.60
|
| Rate for Payer: Quartz Medicare Advantage |
$13.55
|
| Rate for Payer: The Alliance Commercial |
$54.20
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.55
|
| Rate for Payer: United Healthcare PPO |
$22.62
|
| Rate for Payer: WEA Trust Commercial |
$16.59
|
| Rate for Payer: Wellcare Medicare |
$13.55
|
| Rate for Payer: WPS Commercial |
$22.34
|
|
|
Coxsackie B (1-6) Antibodies
|
Professional
|
Both
|
$29.00
|
|
|
Service Code
|
CPT 86658
|
| Hospital Charge Code |
3315483
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.27 |
| Max. Negotiated Rate |
$59.63 |
| Rate for Payer: Aetna Commercial |
$28.65
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$25.94
|
| Rate for Payer: Aetna Managed Medicare |
$13.55
|
| Rate for Payer: Anthem Medicare Advantage |
$13.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$13.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$13.55
|
| Rate for Payer: Cash Price |
$8.70
|
| Rate for Payer: Cash Price |
$8.70
|
| Rate for Payer: Cigna Commercial |
$28.65
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$15.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$13.55
|
| Rate for Payer: Health EOS Commercial |
$27.45
|
| Rate for Payer: HFN Commercial |
$28.65
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$47.84
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$47.84
|
| Rate for Payer: Independent Care Health Plan Medicare |
$13.55
|
| Rate for Payer: Multiplan Commercial |
$24.13
|
| Rate for Payer: NAPHCARE Commercial |
$20.33
|
| Rate for Payer: Preferred Network Access Commercial |
$28.65
|
| Rate for Payer: Quartz Beloit One Network |
$13.27
|
| Rate for Payer: Quartz Commercial |
$17.19
|
| Rate for Payer: Quartz Medicare Advantage |
$13.55
|
| Rate for Payer: The Alliance Commercial |
$53.53
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.55
|
| Rate for Payer: WEA Trust Commercial |
$16.59
|
| Rate for Payer: WPS Commercial |
$59.63
|
|
