|
Daily use - Vapotherm Charge
|
Facility
OP
|
$561.00
|
|
|
Service Code
|
CPT 94660
|
| Hospital Charge Code |
3006979
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$210.82 |
| Max. Negotiated Rate |
$784.25 |
| Rate for Payer: Aetna Commercial |
$504.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$482.46
|
| Rate for Payer: Aetna Managed Medicare |
$210.82
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$364.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$280.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$269.28
|
| Rate for Payer: Anthem Medicare Advantage |
$210.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$297.33
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$210.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$210.82
|
| Rate for Payer: Cash Price |
$168.30
|
| Rate for Payer: Cash Price |
$168.30
|
| Rate for Payer: Cigna Commercial |
$516.12
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$210.82
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$313.94
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$210.82
|
| Rate for Payer: Health EOS Commercial |
$499.29
|
| Rate for Payer: HFN Commercial |
$516.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$784.25
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$210.82
|
| Rate for Payer: Independent Care Health Plan Medicare |
$210.82
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$210.82
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$210.82
|
| Rate for Payer: Multiplan Commercial |
$448.80
|
| Rate for Payer: NAPHCARE Commercial |
$316.23
|
| Rate for Payer: Preferred Network Access Commercial |
$516.12
|
| Rate for Payer: Quartz Beloit One Network |
$274.89
|
| Rate for Payer: Quartz Commercial |
$364.65
|
| Rate for Payer: Quartz Medicare Advantage |
$210.82
|
| Rate for Payer: United Healthcare Medicare Advantage |
$210.82
|
| Rate for Payer: United Healthcare PPO |
$420.75
|
| Rate for Payer: WEA Trust Commercial |
$308.55
|
| Rate for Payer: Wellcare Medicare |
$210.82
|
| Rate for Payer: WPS Commercial |
$415.53
|
|
|
Daily use - Vapotherm Charge
|
Facility
IP
|
$561.00
|
|
|
Service Code
|
CPT 94660
|
| Hospital Charge Code |
3006979
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$274.89 |
| Max. Negotiated Rate |
$516.12 |
| Rate for Payer: Aetna Commercial |
$504.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$297.33
|
| Rate for Payer: Cash Price |
$168.30
|
| Rate for Payer: Cigna Commercial |
$516.12
|
| Rate for Payer: Health EOS Commercial |
$499.29
|
| Rate for Payer: HFN Commercial |
$516.12
|
| Rate for Payer: Multiplan Commercial |
$448.80
|
| Rate for Payer: NAPHCARE Commercial |
$336.60
|
| Rate for Payer: Preferred Network Access Commercial |
$516.12
|
| Rate for Payer: Quartz Beloit One Network |
$274.89
|
| Rate for Payer: Quartz Commercial |
$336.60
|
| Rate for Payer: WEA Trust Commercial |
$308.55
|
| Rate for Payer: WPS Commercial |
$415.53
|
|
|
Daily use - Ventilator Charge
|
Facility
IP
|
$1,526.00
|
|
|
Service Code
|
CPT 94003
|
| Hospital Charge Code |
2990155
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$747.74 |
| Max. Negotiated Rate |
$1,403.92 |
| Rate for Payer: Aetna Commercial |
$1,373.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$808.78
|
| Rate for Payer: Cash Price |
$457.80
|
| Rate for Payer: Cigna Commercial |
$1,403.92
|
| Rate for Payer: Health EOS Commercial |
$1,358.14
|
| Rate for Payer: HFN Commercial |
$1,403.92
|
| Rate for Payer: Multiplan Commercial |
$1,220.80
|
| Rate for Payer: NAPHCARE Commercial |
$915.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,403.92
|
| Rate for Payer: Quartz Beloit One Network |
$747.74
|
| Rate for Payer: Quartz Commercial |
$915.60
|
| Rate for Payer: WEA Trust Commercial |
$839.30
|
| Rate for Payer: WPS Commercial |
$1,130.31
|
|
|
Daily use - Ventilator Charge
|
Facility
OP
|
$1,526.00
|
|
|
Service Code
|
CPT 94003
|
| Hospital Charge Code |
2990155
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$619.40 |
| Max. Negotiated Rate |
$2,304.17 |
| Rate for Payer: Aetna Commercial |
$1,373.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,312.36
|
| Rate for Payer: Aetna Managed Medicare |
$619.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$991.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$763.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$732.48
|
| Rate for Payer: Anthem Medicare Advantage |
$619.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$808.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$619.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$619.40
|
| Rate for Payer: Cash Price |
$457.80
|
| Rate for Payer: Cash Price |
$457.80
|
| Rate for Payer: Cigna Commercial |
$1,403.92
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$619.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$853.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$619.40
|
| Rate for Payer: Health EOS Commercial |
$1,358.14
|
| Rate for Payer: HFN Commercial |
$1,403.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,304.17
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$619.40
|
| Rate for Payer: Independent Care Health Plan Medicare |
$619.40
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$619.40
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$619.40
|
| Rate for Payer: Multiplan Commercial |
$1,220.80
|
| Rate for Payer: NAPHCARE Commercial |
$929.10
|
| Rate for Payer: Preferred Network Access Commercial |
$1,403.92
|
| Rate for Payer: Quartz Beloit One Network |
$747.74
|
| Rate for Payer: Quartz Commercial |
$991.90
|
| Rate for Payer: Quartz Medicare Advantage |
$619.40
|
| Rate for Payer: United Healthcare Medicare Advantage |
$619.40
|
| Rate for Payer: United Healthcare PPO |
$1,144.50
|
| Rate for Payer: WEA Trust Commercial |
$839.30
|
| Rate for Payer: Wellcare Medicare |
$619.40
|
| Rate for Payer: WPS Commercial |
$1,130.31
|
|
|
Daily VAC Rental - PT Equipment Issued Rehab
|
Professional
|
$292.00
|
|
| Hospital Charge Code |
2989876
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$128.48 |
| Max. Negotiated Rate |
$277.40 |
| Rate for Payer: Aetna Commercial |
$277.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$251.12
|
| Rate for Payer: Cash Price |
$87.60
|
| Rate for Payer: Cigna Commercial |
$277.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$146.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$175.20
|
| Rate for Payer: Health EOS Commercial |
$265.72
|
| Rate for Payer: Multiplan Commercial |
$233.60
|
| Rate for Payer: Preferred Network Access Commercial |
$277.40
|
| Rate for Payer: Quartz Beloit One Network |
$128.48
|
| Rate for Payer: Quartz Commercial |
$166.44
|
| Rate for Payer: The Alliance Commercial |
$146.00
|
| Rate for Payer: WEA Trust Commercial |
$160.60
|
| Rate for Payer: WPS Commercial |
$216.28
|
|
|
Daily VAC Rental - PT Equipment Issued Rehab
|
Facility
OP
|
$292.00
|
|
| Hospital Charge Code |
2989876
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$81.76 |
| Max. Negotiated Rate |
$1,168.00 |
| Rate for Payer: Aetna Commercial |
$262.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$251.12
|
| Rate for Payer: Aetna Managed Medicare |
$81.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$189.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$146.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$140.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$154.76
|
| Rate for Payer: Cash Price |
$87.60
|
| Rate for Payer: Cigna Commercial |
$268.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$163.40
|
| Rate for Payer: Health EOS Commercial |
$259.88
|
| Rate for Payer: HFN Commercial |
$268.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$219.00
|
| Rate for Payer: Multiplan Commercial |
$233.60
|
| Rate for Payer: NAPHCARE Commercial |
$175.20
|
| Rate for Payer: Preferred Network Access Commercial |
$268.64
|
| Rate for Payer: Quartz Beloit One Network |
$143.08
|
| Rate for Payer: Quartz Commercial |
$189.80
|
| Rate for Payer: Quartz Medicare Advantage |
$175.20
|
| Rate for Payer: The Alliance Commercial |
$1,168.00
|
| Rate for Payer: WEA Trust Commercial |
$160.60
|
| Rate for Payer: WPS Commercial |
$216.28
|
|
|
Daily VAC Rental - PT Equipment Issued Rehab
|
Facility
IP
|
$292.00
|
|
| Hospital Charge Code |
2989876
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$143.08 |
| Max. Negotiated Rate |
$268.64 |
| Rate for Payer: Aetna Commercial |
$262.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$154.76
|
| Rate for Payer: Cash Price |
$87.60
|
| Rate for Payer: Cigna Commercial |
$268.64
|
| Rate for Payer: Health EOS Commercial |
$259.88
|
| Rate for Payer: HFN Commercial |
$268.64
|
| Rate for Payer: Multiplan Commercial |
$233.60
|
| Rate for Payer: NAPHCARE Commercial |
$175.20
|
| Rate for Payer: Preferred Network Access Commercial |
$268.64
|
| Rate for Payer: Quartz Beloit One Network |
$143.08
|
| Rate for Payer: Quartz Commercial |
$175.20
|
| Rate for Payer: WEA Trust Commercial |
$160.60
|
| Rate for Payer: WPS Commercial |
$216.28
|
|
|
D Antigen Typing
|
Professional
|
$102.00
|
|
|
Service Code
|
CPT 86901
|
| Hospital Charge Code |
5374643
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$2.99 |
| Max. Negotiated Rate |
$96.90 |
| Rate for Payer: Aetna Commercial |
$96.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$87.72
|
| Rate for Payer: Aetna Managed Medicare |
$2.99
|
| Rate for Payer: Anthem Medicare Advantage |
$2.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$2.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$2.99
|
| Rate for Payer: Cash Price |
$30.60
|
| Rate for Payer: Cash Price |
$30.60
|
| Rate for Payer: Cigna Commercial |
$96.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$51.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2.99
|
| Rate for Payer: Health EOS Commercial |
$92.82
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$10.55
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$10.55
|
| Rate for Payer: Independent Care Health Plan Medicare |
$2.99
|
| Rate for Payer: Multiplan Commercial |
$81.60
|
| Rate for Payer: Preferred Network Access Commercial |
$96.90
|
| Rate for Payer: Quartz Beloit One Network |
$44.88
|
| Rate for Payer: Quartz Commercial |
$58.14
|
| Rate for Payer: Quartz Medicare Advantage |
$2.99
|
| Rate for Payer: The Alliance Commercial |
$11.81
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2.99
|
| Rate for Payer: WEA Trust Commercial |
$56.10
|
| Rate for Payer: WPS Commercial |
$13.16
|
|
|
D Antigen Typing
|
Facility
OP
|
$102.00
|
|
|
Service Code
|
CPT 86901
|
| Hospital Charge Code |
5374643
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.09 |
| Max. Negotiated Rate |
$148.65 |
| Rate for Payer: Aetna Commercial |
$91.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$87.72
|
| Rate for Payer: Aetna Managed Medicare |
$39.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$148.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$69.37
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$65.80
|
| Rate for Payer: Anthem Medicaid |
$3.09
|
| Rate for Payer: Anthem Medicare Advantage |
$39.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$54.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$39.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$39.64
|
| Rate for Payer: Cash Price |
$30.60
|
| Rate for Payer: Cash Price |
$30.60
|
| Rate for Payer: Cigna Commercial |
$93.84
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$39.64
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$3.09
|
| Rate for Payer: Dean Health Medicaid |
$3.09
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$39.64
|
| Rate for Payer: Health EOS Commercial |
$90.78
|
| Rate for Payer: HFN Commercial |
$93.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$147.46
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$39.64
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$3.09
|
| Rate for Payer: Independent Care Health Plan Medicare |
$39.64
|
| Rate for Payer: Managed Health Services Medicaid |
$3.21
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$39.64
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$39.64
|
| Rate for Payer: Multiplan Commercial |
$81.60
|
| Rate for Payer: NAPHCARE Commercial |
$59.46
|
| Rate for Payer: Preferred Network Access Commercial |
$93.84
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$3.09
|
| Rate for Payer: Quartz Beloit One Network |
$49.98
|
| Rate for Payer: Quartz Commercial |
$66.30
|
| Rate for Payer: Quartz Medicare Advantage |
$39.64
|
| Rate for Payer: United Healthcare Medicaid |
$3.09
|
| Rate for Payer: United Healthcare Medicare Advantage |
$39.64
|
| Rate for Payer: United Healthcare PPO |
$76.50
|
| Rate for Payer: WEA Trust Commercial |
$56.10
|
| Rate for Payer: Wellcare Medicare |
$39.64
|
| Rate for Payer: WMAP Medicaid |
$3.09
|
| Rate for Payer: WPS Commercial |
$75.55
|
|
|
D Antigen Typing
|
Facility
IP
|
$102.00
|
|
|
Service Code
|
CPT 86901
|
| Hospital Charge Code |
5374643
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$49.98 |
| Max. Negotiated Rate |
$93.84 |
| Rate for Payer: Aetna Commercial |
$91.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$54.06
|
| Rate for Payer: Cash Price |
$30.60
|
| Rate for Payer: Cigna Commercial |
$93.84
|
| Rate for Payer: Health EOS Commercial |
$90.78
|
| Rate for Payer: HFN Commercial |
$93.84
|
| Rate for Payer: Multiplan Commercial |
$81.60
|
| Rate for Payer: NAPHCARE Commercial |
$61.20
|
| Rate for Payer: Preferred Network Access Commercial |
$93.84
|
| Rate for Payer: Quartz Beloit One Network |
$49.98
|
| Rate for Payer: Quartz Commercial |
$61.20
|
| Rate for Payer: WEA Trust Commercial |
$56.10
|
| Rate for Payer: WPS Commercial |
$75.55
|
|
|
DAPS INTRODUCTORY KIT
|
Facility
IP
|
$2,782.00
|
|
| Hospital Charge Code |
2973257
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$1,363.18 |
| Max. Negotiated Rate |
$2,559.44 |
| Rate for Payer: Aetna Commercial |
$2,503.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,474.46
|
| Rate for Payer: Cash Price |
$834.60
|
| Rate for Payer: Cigna Commercial |
$2,559.44
|
| Rate for Payer: Health EOS Commercial |
$2,475.98
|
| Rate for Payer: HFN Commercial |
$2,559.44
|
| Rate for Payer: Multiplan Commercial |
$2,225.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,669.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,559.44
|
| Rate for Payer: Quartz Beloit One Network |
$1,363.18
|
| Rate for Payer: Quartz Commercial |
$1,669.20
|
| Rate for Payer: WEA Trust Commercial |
$1,530.10
|
| Rate for Payer: WPS Commercial |
$2,060.63
|
|
|
DAPS INTRODUCTORY KIT
|
Facility
OP
|
$2,782.00
|
|
| Hospital Charge Code |
2973257
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$778.96 |
| Max. Negotiated Rate |
$11,128.00 |
| Rate for Payer: Aetna Commercial |
$2,503.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,392.52
|
| Rate for Payer: Aetna Managed Medicare |
$778.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,808.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,391.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,335.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,474.46
|
| Rate for Payer: Cash Price |
$834.60
|
| Rate for Payer: Cigna Commercial |
$2,559.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,556.81
|
| Rate for Payer: Health EOS Commercial |
$2,475.98
|
| Rate for Payer: HFN Commercial |
$2,559.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,086.50
|
| Rate for Payer: Multiplan Commercial |
$2,225.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,669.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,559.44
|
| Rate for Payer: Quartz Beloit One Network |
$1,363.18
|
| Rate for Payer: Quartz Commercial |
$1,808.30
|
| Rate for Payer: Quartz Medicare Advantage |
$1,669.20
|
| Rate for Payer: The Alliance Commercial |
$11,128.00
|
| Rate for Payer: WEA Trust Commercial |
$1,530.10
|
| Rate for Payer: WPS Commercial |
$2,060.63
|
|
|
DARTOS POUCH PROCEDURE
|
Facility
IP
|
$1,084.00
|
|
| Hospital Charge Code |
2959987
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$531.16 |
| Max. Negotiated Rate |
$997.28 |
| Rate for Payer: Aetna Commercial |
$975.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$574.52
|
| Rate for Payer: Cash Price |
$325.20
|
| Rate for Payer: Cigna Commercial |
$997.28
|
| Rate for Payer: Health EOS Commercial |
$964.76
|
| Rate for Payer: HFN Commercial |
$997.28
|
| Rate for Payer: Multiplan Commercial |
$867.20
|
| Rate for Payer: NAPHCARE Commercial |
$650.40
|
| Rate for Payer: Preferred Network Access Commercial |
$997.28
|
| Rate for Payer: Quartz Beloit One Network |
$531.16
|
| Rate for Payer: Quartz Commercial |
$650.40
|
| Rate for Payer: WEA Trust Commercial |
$596.20
|
| Rate for Payer: WPS Commercial |
$802.92
|
|
|
DARTOS POUCH PROCEDURE
|
Facility
OP
|
$1,084.00
|
|
| Hospital Charge Code |
2959987
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$303.52 |
| Max. Negotiated Rate |
$4,336.00 |
| Rate for Payer: Aetna Commercial |
$975.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$932.24
|
| Rate for Payer: Aetna Managed Medicare |
$303.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$704.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$542.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$520.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$574.52
|
| Rate for Payer: Cash Price |
$325.20
|
| Rate for Payer: Cigna Commercial |
$997.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$606.61
|
| Rate for Payer: Health EOS Commercial |
$964.76
|
| Rate for Payer: HFN Commercial |
$997.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$813.00
|
| Rate for Payer: Multiplan Commercial |
$867.20
|
| Rate for Payer: NAPHCARE Commercial |
$650.40
|
| Rate for Payer: Preferred Network Access Commercial |
$997.28
|
| Rate for Payer: Quartz Beloit One Network |
$531.16
|
| Rate for Payer: Quartz Commercial |
$704.60
|
| Rate for Payer: Quartz Medicare Advantage |
$650.40
|
| Rate for Payer: The Alliance Commercial |
$4,336.00
|
| Rate for Payer: WEA Trust Commercial |
$596.20
|
| Rate for Payer: WPS Commercial |
$802.92
|
|
|
D & C AFTER DELIVERY 59160
|
Professional
|
$1,471.00
|
|
|
Service Code
|
CPT 59160
|
| Hospital Charge Code |
3015152
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$170.50 |
| Max. Negotiated Rate |
$1,397.45 |
| Rate for Payer: Aetna Commercial |
$1,397.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,265.06
|
| Rate for Payer: Aetna Managed Medicare |
$170.50
|
| Rate for Payer: Anthem Medicare Advantage |
$170.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$170.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$170.50
|
| Rate for Payer: Cash Price |
$441.30
|
| Rate for Payer: Cash Price |
$441.30
|
| Rate for Payer: Cigna Commercial |
$1,397.45
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$735.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$170.50
|
| Rate for Payer: Health EOS Commercial |
$1,338.61
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$599.01
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$599.01
|
| Rate for Payer: Independent Care Health Plan Medicare |
$170.50
|
| Rate for Payer: Multiplan Commercial |
$1,176.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,397.45
|
| Rate for Payer: Quartz Beloit One Network |
$647.24
|
| Rate for Payer: Quartz Commercial |
$838.47
|
| Rate for Payer: Quartz Medicare Advantage |
$170.50
|
| Rate for Payer: The Alliance Commercial |
$724.62
|
| Rate for Payer: United Healthcare Medicaid |
$185.63
|
| Rate for Payer: United Healthcare Medicare Advantage |
$170.50
|
| Rate for Payer: WEA Trust Commercial |
$809.05
|
| Rate for Payer: WPS Commercial |
$767.25
|
|
|
D&C, CONIZATION, LAPAROSCOPY AND TUBAL INTERRUPTION WITH CC/MCC
|
Facility
IP
|
$50,366.00
|
|
|
Service Code
|
MS-DRG 744
|
| Min. Negotiated Rate |
$18,117.22 |
| Max. Negotiated Rate |
$50,366.00 |
| Rate for Payer: Aetna Managed Medicare |
$18,117.22
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$39,442.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$30,232.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$28,722.64
|
| Rate for Payer: Anthem Medicare Advantage |
$18,117.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$18,117.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$18,117.22
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$18,117.22
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$31,884.76
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$18,117.22
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$36,706.80
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$18,117.22
|
| Rate for Payer: Independent Care Health Plan Medicare |
$18,117.22
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$18,117.22
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$18,117.22
|
| Rate for Payer: NAPHCARE Commercial |
$27,175.83
|
| Rate for Payer: Quartz Medicare Advantage |
$18,117.22
|
| Rate for Payer: The Alliance Commercial |
$50,366.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$18,117.22
|
| Rate for Payer: United Healthcare PPO |
$28,576.71
|
| Rate for Payer: Wellcare Medicare |
$18,117.22
|
|
|
D&C, CONIZATION, LAPAROSCOPY AND TUBAL INTERRUPTION WITHOUT CC/MCC
|
Facility
IP
|
$27,861.00
|
|
|
Service Code
|
MS-DRG 745
|
| Min. Negotiated Rate |
$10,021.88 |
| Max. Negotiated Rate |
$27,861.00 |
| Rate for Payer: Aetna Managed Medicare |
$10,021.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$21,819.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$16,724.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$15,889.12
|
| Rate for Payer: Anthem Medicare Advantage |
$10,021.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$10,021.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$10,021.88
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$10,021.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$17,638.38
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$10,021.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$20,200.05
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$10,021.88
|
| Rate for Payer: Independent Care Health Plan Medicare |
$10,021.88
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$10,021.88
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$10,021.88
|
| Rate for Payer: NAPHCARE Commercial |
$15,032.82
|
| Rate for Payer: Quartz Medicare Advantage |
$10,021.88
|
| Rate for Payer: The Alliance Commercial |
$27,861.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$10,021.88
|
| Rate for Payer: United Healthcare PPO |
$15,726.00
|
| Rate for Payer: Wellcare Medicare |
$10,021.88
|
|
|
D-Dimer
|
Professional
|
$313.00
|
|
|
Service Code
|
CPT 85379
|
| Hospital Charge Code |
633718
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.18 |
| Max. Negotiated Rate |
$297.35 |
| Rate for Payer: Aetna Commercial |
$297.35
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$269.18
|
| Rate for Payer: Aetna Managed Medicare |
$10.18
|
| Rate for Payer: Anthem Medicare Advantage |
$10.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$10.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$10.18
|
| Rate for Payer: Cash Price |
$93.90
|
| Rate for Payer: Cash Price |
$93.90
|
| Rate for Payer: Cigna Commercial |
$297.35
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$156.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$10.18
|
| Rate for Payer: Health EOS Commercial |
$284.83
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$35.94
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$35.94
|
| Rate for Payer: Independent Care Health Plan Medicare |
$10.18
|
| Rate for Payer: Multiplan Commercial |
$250.40
|
| Rate for Payer: Preferred Network Access Commercial |
$297.35
|
| Rate for Payer: Quartz Beloit One Network |
$137.72
|
| Rate for Payer: Quartz Commercial |
$178.41
|
| Rate for Payer: Quartz Medicare Advantage |
$10.18
|
| Rate for Payer: The Alliance Commercial |
$40.21
|
| Rate for Payer: United Healthcare Medicare Advantage |
$10.18
|
| Rate for Payer: WEA Trust Commercial |
$172.15
|
| Rate for Payer: WPS Commercial |
$44.79
|
|
|
D-Dimer
|
Facility
OP
|
$313.00
|
|
|
Service Code
|
CPT 85379
|
| Hospital Charge Code |
633718
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.18 |
| Max. Negotiated Rate |
$1,252.00 |
| Rate for Payer: Aetna Commercial |
$281.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$269.18
|
| Rate for Payer: Aetna Managed Medicare |
$10.18
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$38.18
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$17.82
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$16.90
|
| Rate for Payer: Anthem Medicaid |
$10.52
|
| Rate for Payer: Anthem Medicare Advantage |
$10.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$165.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$10.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$10.18
|
| Rate for Payer: Cash Price |
$93.90
|
| Rate for Payer: Cash Price |
$93.90
|
| Rate for Payer: Cigna Commercial |
$287.96
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$10.18
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$10.52
|
| Rate for Payer: Dean Health Medicaid |
$10.52
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$10.18
|
| Rate for Payer: Health EOS Commercial |
$278.57
|
| Rate for Payer: HFN Commercial |
$287.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$37.87
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$10.18
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$10.52
|
| Rate for Payer: Independent Care Health Plan Medicare |
$10.18
|
| Rate for Payer: Managed Health Services Medicaid |
$10.94
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$10.18
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$10.18
|
| Rate for Payer: Multiplan Commercial |
$250.40
|
| Rate for Payer: NAPHCARE Commercial |
$15.27
|
| Rate for Payer: Preferred Network Access Commercial |
$287.96
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$10.52
|
| Rate for Payer: Quartz Beloit One Network |
$153.37
|
| Rate for Payer: Quartz Commercial |
$203.45
|
| Rate for Payer: Quartz Medicare Advantage |
$10.18
|
| Rate for Payer: The Alliance Commercial |
$1,252.00
|
| Rate for Payer: United Healthcare Medicaid |
$10.52
|
| Rate for Payer: United Healthcare Medicare Advantage |
$10.18
|
| Rate for Payer: United Healthcare PPO |
$234.75
|
| Rate for Payer: WEA Trust Commercial |
$172.15
|
| Rate for Payer: Wellcare Medicare |
$10.18
|
| Rate for Payer: WMAP Medicaid |
$10.52
|
| Rate for Payer: WPS Commercial |
$231.84
|
|
|
D-Dimer
|
Facility
IP
|
$313.00
|
|
|
Service Code
|
CPT 85379
|
| Hospital Charge Code |
633718
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$153.37 |
| Max. Negotiated Rate |
$287.96 |
| Rate for Payer: Aetna Commercial |
$281.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$165.89
|
| Rate for Payer: Cash Price |
$93.90
|
| Rate for Payer: Cigna Commercial |
$287.96
|
| Rate for Payer: Health EOS Commercial |
$278.57
|
| Rate for Payer: HFN Commercial |
$287.96
|
| Rate for Payer: Multiplan Commercial |
$250.40
|
| Rate for Payer: NAPHCARE Commercial |
$187.80
|
| Rate for Payer: Preferred Network Access Commercial |
$287.96
|
| Rate for Payer: Quartz Beloit One Network |
$153.37
|
| Rate for Payer: Quartz Commercial |
$187.80
|
| Rate for Payer: WEA Trust Commercial |
$172.15
|
| Rate for Payer: WPS Commercial |
$231.84
|
|
|
DEB Assay for Fanconi Anemia
|
Facility
OP
|
$461.00
|
|
|
Service Code
|
CPT 88249
|
| Hospital Charge Code |
4125590
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$173.17 |
| Max. Negotiated Rate |
$1,844.00 |
| Rate for Payer: Aetna Commercial |
$414.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$396.46
|
| Rate for Payer: Aetna Managed Medicare |
$173.17
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$649.39
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$303.05
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$287.46
|
| Rate for Payer: Anthem Medicaid |
$178.94
|
| Rate for Payer: Anthem Medicare Advantage |
$173.17
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$244.33
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$173.17
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$173.17
|
| Rate for Payer: Cash Price |
$138.30
|
| Rate for Payer: Cash Price |
$138.30
|
| Rate for Payer: Cigna Commercial |
$424.12
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$173.17
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$178.94
|
| Rate for Payer: Dean Health Medicaid |
$178.94
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$173.17
|
| Rate for Payer: Health EOS Commercial |
$410.29
|
| Rate for Payer: HFN Commercial |
$424.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$644.19
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$173.17
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$178.94
|
| Rate for Payer: Independent Care Health Plan Medicare |
$173.17
|
| Rate for Payer: Managed Health Services Medicaid |
$186.10
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$173.17
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$173.17
|
| Rate for Payer: Multiplan Commercial |
$368.80
|
| Rate for Payer: NAPHCARE Commercial |
$259.76
|
| Rate for Payer: Preferred Network Access Commercial |
$424.12
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$178.94
|
| Rate for Payer: Quartz Beloit One Network |
$225.89
|
| Rate for Payer: Quartz Commercial |
$299.65
|
| Rate for Payer: Quartz Medicare Advantage |
$173.17
|
| Rate for Payer: The Alliance Commercial |
$1,844.00
|
| Rate for Payer: United Healthcare Medicaid |
$178.94
|
| Rate for Payer: United Healthcare Medicare Advantage |
$173.17
|
| Rate for Payer: United Healthcare PPO |
$345.75
|
| Rate for Payer: WEA Trust Commercial |
$253.55
|
| Rate for Payer: Wellcare Medicare |
$173.17
|
| Rate for Payer: WMAP Medicaid |
$178.94
|
| Rate for Payer: WPS Commercial |
$341.46
|
|
|
DEB Assay for Fanconi Anemia
|
Professional
|
$461.00
|
|
|
Service Code
|
CPT 88249
|
| Hospital Charge Code |
4125590
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$173.17 |
| Max. Negotiated Rate |
$761.95 |
| Rate for Payer: Aetna Commercial |
$437.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$396.46
|
| Rate for Payer: Aetna Managed Medicare |
$173.17
|
| Rate for Payer: Anthem Medicare Advantage |
$173.17
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$173.17
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$173.17
|
| Rate for Payer: Cash Price |
$138.30
|
| Rate for Payer: Cash Price |
$138.30
|
| Rate for Payer: Cigna Commercial |
$437.95
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$230.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$173.17
|
| Rate for Payer: Health EOS Commercial |
$419.51
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$611.29
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$611.29
|
| Rate for Payer: Independent Care Health Plan Medicare |
$173.17
|
| Rate for Payer: Multiplan Commercial |
$368.80
|
| Rate for Payer: Preferred Network Access Commercial |
$437.95
|
| Rate for Payer: Quartz Beloit One Network |
$202.84
|
| Rate for Payer: Quartz Commercial |
$262.77
|
| Rate for Payer: Quartz Medicare Advantage |
$173.17
|
| Rate for Payer: The Alliance Commercial |
$684.02
|
| Rate for Payer: United Healthcare Medicare Advantage |
$173.17
|
| Rate for Payer: WEA Trust Commercial |
$253.55
|
| Rate for Payer: WPS Commercial |
$761.95
|
|
|
DEB Assay for Fanconi Anemia
|
Facility
OP
|
$461.00
|
|
|
Service Code
|
CPT 88291
|
| Hospital Charge Code |
4125589
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$129.08 |
| Max. Negotiated Rate |
$1,844.00 |
| Rate for Payer: Aetna Commercial |
$414.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$396.46
|
| Rate for Payer: Aetna Managed Medicare |
$129.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$299.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$230.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$221.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$244.33
|
| Rate for Payer: Cash Price |
$138.30
|
| Rate for Payer: Cash Price |
$138.30
|
| Rate for Payer: Cigna Commercial |
$424.12
|
| Rate for Payer: Health EOS Commercial |
$410.29
|
| Rate for Payer: HFN Commercial |
$424.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$345.75
|
| Rate for Payer: Multiplan Commercial |
$368.80
|
| Rate for Payer: NAPHCARE Commercial |
$276.60
|
| Rate for Payer: Preferred Network Access Commercial |
$424.12
|
| Rate for Payer: Quartz Beloit One Network |
$225.89
|
| Rate for Payer: Quartz Commercial |
$299.65
|
| Rate for Payer: Quartz Medicare Advantage |
$276.60
|
| Rate for Payer: The Alliance Commercial |
$1,844.00
|
| Rate for Payer: United Healthcare PPO |
$345.75
|
| Rate for Payer: WEA Trust Commercial |
$253.55
|
| Rate for Payer: WPS Commercial |
$341.46
|
|
|
DEB Assay for Fanconi Anemia
|
Facility
IP
|
$461.00
|
|
|
Service Code
|
CPT 88291
|
| Hospital Charge Code |
4125589
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$225.89 |
| Max. Negotiated Rate |
$424.12 |
| Rate for Payer: Aetna Commercial |
$414.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$244.33
|
| Rate for Payer: Cash Price |
$138.30
|
| Rate for Payer: Cigna Commercial |
$424.12
|
| Rate for Payer: Health EOS Commercial |
$410.29
|
| Rate for Payer: HFN Commercial |
$424.12
|
| Rate for Payer: Multiplan Commercial |
$368.80
|
| Rate for Payer: NAPHCARE Commercial |
$276.60
|
| Rate for Payer: Preferred Network Access Commercial |
$424.12
|
| Rate for Payer: Quartz Beloit One Network |
$225.89
|
| Rate for Payer: Quartz Commercial |
$276.60
|
| Rate for Payer: WEA Trust Commercial |
$253.55
|
| Rate for Payer: WPS Commercial |
$341.46
|
|
|
DEB Assay for Fanconi Anemia
|
Facility
IP
|
$461.00
|
|
|
Service Code
|
CPT 88249
|
| Hospital Charge Code |
4125590
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$225.89 |
| Max. Negotiated Rate |
$424.12 |
| Rate for Payer: Aetna Commercial |
$414.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$244.33
|
| Rate for Payer: Cash Price |
$138.30
|
| Rate for Payer: Cigna Commercial |
$424.12
|
| Rate for Payer: Health EOS Commercial |
$410.29
|
| Rate for Payer: HFN Commercial |
$424.12
|
| Rate for Payer: Multiplan Commercial |
$368.80
|
| Rate for Payer: NAPHCARE Commercial |
$276.60
|
| Rate for Payer: Preferred Network Access Commercial |
$424.12
|
| Rate for Payer: Quartz Beloit One Network |
$225.89
|
| Rate for Payer: Quartz Commercial |
$276.60
|
| Rate for Payer: WEA Trust Commercial |
$253.55
|
| Rate for Payer: WPS Commercial |
$341.46
|
|
