|
Cytology, Non-Gynecological
|
Facility
|
IP
|
$191.00
|
|
|
Service Code
|
CPT 88161
|
| Hospital Charge Code |
4522715
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$93.59 |
| Max. Negotiated Rate |
$175.72 |
| Rate for Payer: Aetna Commercial |
$171.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$164.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$101.23
|
| Rate for Payer: Cash Price |
$57.30
|
| Rate for Payer: Cigna Commercial |
$175.72
|
| Rate for Payer: Health EOS Commercial |
$169.99
|
| Rate for Payer: HFN Commercial |
$175.72
|
| Rate for Payer: Multiplan Commercial |
$152.80
|
| Rate for Payer: NAPHCARE Commercial |
$114.60
|
| Rate for Payer: Preferred Network Access Commercial |
$175.72
|
| Rate for Payer: Quartz Beloit One Network |
$93.59
|
| Rate for Payer: Quartz Commercial |
$114.60
|
| Rate for Payer: WEA Trust Commercial |
$105.05
|
| Rate for Payer: WPS Commercial |
$141.47
|
|
|
Cytomegalovirus Antibody IgG
|
Facility
|
OP
|
$353.00
|
|
|
Service Code
|
CPT 86644
|
| Hospital Charge Code |
977906
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.39 |
| Max. Negotiated Rate |
$324.76 |
| Rate for Payer: Aetna Commercial |
$317.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$303.58
|
| Rate for Payer: Aetna Managed Medicare |
$14.39
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$53.96
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$25.18
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$23.89
|
| Rate for Payer: Anthem Medicaid |
$14.87
|
| Rate for Payer: Anthem Medicare Advantage |
$14.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$187.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$14.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$14.39
|
| Rate for Payer: Cash Price |
$105.90
|
| Rate for Payer: Cash Price |
$105.90
|
| Rate for Payer: Cigna Commercial |
$324.76
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$14.39
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$14.87
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$197.54
|
| Rate for Payer: Dean Health Medicaid |
$14.87
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$14.39
|
| Rate for Payer: Health EOS Commercial |
$314.17
|
| Rate for Payer: HFN Commercial |
$324.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$53.53
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$14.39
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$14.87
|
| Rate for Payer: Independent Care Health Plan Medicare |
$14.39
|
| Rate for Payer: Managed Health Services Medicaid |
$15.46
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$14.39
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$14.39
|
| Rate for Payer: Multiplan Commercial |
$282.40
|
| Rate for Payer: NAPHCARE Commercial |
$21.58
|
| Rate for Payer: Preferred Network Access Commercial |
$324.76
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$14.87
|
| Rate for Payer: Quartz Beloit One Network |
$172.97
|
| Rate for Payer: Quartz Commercial |
$229.45
|
| Rate for Payer: Quartz Medicare Advantage |
$14.39
|
| Rate for Payer: The Alliance Commercial |
$57.56
|
| Rate for Payer: United Healthcare Medicaid |
$14.87
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14.39
|
| Rate for Payer: United Healthcare PPO |
$264.75
|
| Rate for Payer: WEA Trust Commercial |
$194.15
|
| Rate for Payer: Wellcare Medicare |
$14.39
|
| Rate for Payer: WMAP Medicaid |
$14.87
|
| Rate for Payer: WPS Commercial |
$261.47
|
|
|
Cytomegalovirus Antibody IgG
|
Professional
|
Both
|
$353.00
|
|
|
Service Code
|
CPT 86644
|
| Hospital Charge Code |
977906
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$50.80 |
| Max. Negotiated Rate |
$335.35 |
| Rate for Payer: Aetna Commercial |
$335.35
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$303.58
|
| Rate for Payer: Cash Price |
$105.90
|
| Rate for Payer: Cash Price |
$105.90
|
| Rate for Payer: Cigna Commercial |
$335.35
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$176.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$211.80
|
| Rate for Payer: Health EOS Commercial |
$321.23
|
| Rate for Payer: HFN Commercial |
$335.35
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$50.80
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$50.80
|
| Rate for Payer: Multiplan Commercial |
$282.40
|
| Rate for Payer: Preferred Network Access Commercial |
$335.35
|
| Rate for Payer: Quartz Beloit One Network |
$155.32
|
| Rate for Payer: Quartz Commercial |
$201.21
|
| Rate for Payer: The Alliance Commercial |
$176.50
|
| Rate for Payer: WEA Trust Commercial |
$194.15
|
| Rate for Payer: WPS Commercial |
$261.47
|
|
|
Cytomegalovirus Antibody IgG
|
Facility
|
IP
|
$353.00
|
|
|
Service Code
|
CPT 86644
|
| Hospital Charge Code |
977906
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$172.97 |
| Max. Negotiated Rate |
$324.76 |
| Rate for Payer: Aetna Commercial |
$317.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$303.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$187.09
|
| Rate for Payer: Cash Price |
$105.90
|
| Rate for Payer: Cigna Commercial |
$324.76
|
| Rate for Payer: Health EOS Commercial |
$314.17
|
| Rate for Payer: HFN Commercial |
$324.76
|
| Rate for Payer: Multiplan Commercial |
$282.40
|
| Rate for Payer: NAPHCARE Commercial |
$211.80
|
| Rate for Payer: Preferred Network Access Commercial |
$324.76
|
| Rate for Payer: Quartz Beloit One Network |
$172.97
|
| Rate for Payer: Quartz Commercial |
$211.80
|
| Rate for Payer: WEA Trust Commercial |
$194.15
|
| Rate for Payer: WPS Commercial |
$261.47
|
|
|
Cytomegalovirus Antibody IgM
|
Facility
|
OP
|
$148.00
|
|
|
Service Code
|
CPT 86645
|
| Hospital Charge Code |
978112
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.17 |
| Max. Negotiated Rate |
$136.16 |
| Rate for Payer: Aetna Commercial |
$133.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$127.28
|
| Rate for Payer: Aetna Managed Medicare |
$16.85
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$63.19
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$29.49
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$27.97
|
| Rate for Payer: Anthem Medicaid |
$8.17
|
| Rate for Payer: Anthem Medicare Advantage |
$16.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$78.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$16.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$16.85
|
| Rate for Payer: Cash Price |
$44.40
|
| Rate for Payer: Cash Price |
$44.40
|
| Rate for Payer: Cigna Commercial |
$136.16
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$16.85
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$8.17
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$82.82
|
| Rate for Payer: Dean Health Medicaid |
$8.17
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$16.85
|
| Rate for Payer: Health EOS Commercial |
$131.72
|
| Rate for Payer: HFN Commercial |
$136.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$62.68
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$16.85
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$8.17
|
| Rate for Payer: Independent Care Health Plan Medicare |
$16.85
|
| Rate for Payer: Managed Health Services Medicaid |
$8.50
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$16.85
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$16.85
|
| Rate for Payer: Multiplan Commercial |
$118.40
|
| Rate for Payer: NAPHCARE Commercial |
$25.28
|
| Rate for Payer: Preferred Network Access Commercial |
$136.16
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$8.17
|
| Rate for Payer: Quartz Beloit One Network |
$72.52
|
| Rate for Payer: Quartz Commercial |
$96.20
|
| Rate for Payer: Quartz Medicare Advantage |
$16.85
|
| Rate for Payer: The Alliance Commercial |
$67.40
|
| Rate for Payer: United Healthcare Medicaid |
$8.17
|
| Rate for Payer: United Healthcare Medicare Advantage |
$16.85
|
| Rate for Payer: United Healthcare PPO |
$111.00
|
| Rate for Payer: WEA Trust Commercial |
$81.40
|
| Rate for Payer: Wellcare Medicare |
$16.85
|
| Rate for Payer: WMAP Medicaid |
$8.17
|
| Rate for Payer: WPS Commercial |
$109.62
|
|
|
Cytomegalovirus Antibody IgM
|
Professional
|
Both
|
$148.00
|
|
|
Service Code
|
CPT 86645
|
| Hospital Charge Code |
978112
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$59.48 |
| Max. Negotiated Rate |
$140.60 |
| Rate for Payer: Aetna Commercial |
$140.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$127.28
|
| Rate for Payer: Cash Price |
$44.40
|
| Rate for Payer: Cash Price |
$44.40
|
| Rate for Payer: Cigna Commercial |
$140.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$74.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$88.80
|
| Rate for Payer: Health EOS Commercial |
$134.68
|
| Rate for Payer: HFN Commercial |
$140.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$59.48
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$59.48
|
| Rate for Payer: Multiplan Commercial |
$118.40
|
| Rate for Payer: Preferred Network Access Commercial |
$140.60
|
| Rate for Payer: Quartz Beloit One Network |
$65.12
|
| Rate for Payer: Quartz Commercial |
$84.36
|
| Rate for Payer: The Alliance Commercial |
$74.00
|
| Rate for Payer: WEA Trust Commercial |
$81.40
|
| Rate for Payer: WPS Commercial |
$109.62
|
|
|
Cytomegalovirus Antibody IgM
|
Facility
|
IP
|
$148.00
|
|
|
Service Code
|
CPT 86645
|
| Hospital Charge Code |
978112
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$72.52 |
| Max. Negotiated Rate |
$136.16 |
| Rate for Payer: Aetna Commercial |
$133.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$127.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$78.44
|
| Rate for Payer: Cash Price |
$44.40
|
| Rate for Payer: Cigna Commercial |
$136.16
|
| Rate for Payer: Health EOS Commercial |
$131.72
|
| Rate for Payer: HFN Commercial |
$136.16
|
| Rate for Payer: Multiplan Commercial |
$118.40
|
| Rate for Payer: NAPHCARE Commercial |
$88.80
|
| Rate for Payer: Preferred Network Access Commercial |
$136.16
|
| Rate for Payer: Quartz Beloit One Network |
$72.52
|
| Rate for Payer: Quartz Commercial |
$88.80
|
| Rate for Payer: WEA Trust Commercial |
$81.40
|
| Rate for Payer: WPS Commercial |
$109.62
|
|
|
Cytomegalovirus DNA by PCR, Qualitative
|
Facility
|
IP
|
$601.00
|
|
|
Service Code
|
CPT 87496
|
| Hospital Charge Code |
1038881
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$294.49 |
| Max. Negotiated Rate |
$552.92 |
| Rate for Payer: Aetna Commercial |
$540.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$516.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$318.53
|
| Rate for Payer: Cash Price |
$180.30
|
| Rate for Payer: Cigna Commercial |
$552.92
|
| Rate for Payer: Health EOS Commercial |
$534.89
|
| Rate for Payer: HFN Commercial |
$552.92
|
| Rate for Payer: Multiplan Commercial |
$480.80
|
| Rate for Payer: NAPHCARE Commercial |
$360.60
|
| Rate for Payer: Preferred Network Access Commercial |
$552.92
|
| Rate for Payer: Quartz Beloit One Network |
$294.49
|
| Rate for Payer: Quartz Commercial |
$360.60
|
| Rate for Payer: WEA Trust Commercial |
$330.55
|
| Rate for Payer: WPS Commercial |
$445.16
|
|
|
Cytomegalovirus DNA by PCR, Qualitative
|
Professional
|
Both
|
$601.00
|
|
|
Service Code
|
CPT 87496
|
| Hospital Charge Code |
1038881
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$123.87 |
| Max. Negotiated Rate |
$570.95 |
| Rate for Payer: Aetna Commercial |
$570.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$516.86
|
| Rate for Payer: Cash Price |
$180.30
|
| Rate for Payer: Cash Price |
$180.30
|
| Rate for Payer: Cigna Commercial |
$570.95
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$300.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$360.60
|
| Rate for Payer: Health EOS Commercial |
$546.91
|
| Rate for Payer: HFN Commercial |
$570.95
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$123.87
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$123.87
|
| Rate for Payer: Multiplan Commercial |
$480.80
|
| Rate for Payer: Preferred Network Access Commercial |
$570.95
|
| Rate for Payer: Quartz Beloit One Network |
$264.44
|
| Rate for Payer: Quartz Commercial |
$342.57
|
| Rate for Payer: The Alliance Commercial |
$300.50
|
| Rate for Payer: WEA Trust Commercial |
$330.55
|
| Rate for Payer: WPS Commercial |
$445.16
|
|
|
Cytomegalovirus DNA by PCR, Qualitative
|
Facility
|
OP
|
$601.00
|
|
|
Service Code
|
CPT 87496
|
| Hospital Charge Code |
1038881
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$35.09 |
| Max. Negotiated Rate |
$552.92 |
| Rate for Payer: Aetna Commercial |
$540.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$516.86
|
| Rate for Payer: Aetna Managed Medicare |
$35.09
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$131.59
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$61.41
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$58.25
|
| Rate for Payer: Anthem Medicaid |
$36.26
|
| Rate for Payer: Anthem Medicare Advantage |
$35.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$318.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$35.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$35.09
|
| Rate for Payer: Cash Price |
$180.30
|
| Rate for Payer: Cash Price |
$180.30
|
| Rate for Payer: Cigna Commercial |
$552.92
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$35.09
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$36.26
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$336.32
|
| Rate for Payer: Dean Health Medicaid |
$36.26
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$35.09
|
| Rate for Payer: Health EOS Commercial |
$534.89
|
| Rate for Payer: HFN Commercial |
$552.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$130.53
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$35.09
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$36.26
|
| Rate for Payer: Independent Care Health Plan Medicare |
$35.09
|
| Rate for Payer: Managed Health Services Medicaid |
$37.71
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$35.09
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$35.09
|
| Rate for Payer: Multiplan Commercial |
$480.80
|
| Rate for Payer: NAPHCARE Commercial |
$52.64
|
| Rate for Payer: Preferred Network Access Commercial |
$552.92
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$36.26
|
| Rate for Payer: Quartz Beloit One Network |
$294.49
|
| Rate for Payer: Quartz Commercial |
$390.65
|
| Rate for Payer: Quartz Medicare Advantage |
$35.09
|
| Rate for Payer: The Alliance Commercial |
$140.36
|
| Rate for Payer: United Healthcare Medicaid |
$36.26
|
| Rate for Payer: United Healthcare Medicare Advantage |
$35.09
|
| Rate for Payer: United Healthcare PPO |
$450.75
|
| Rate for Payer: WEA Trust Commercial |
$330.55
|
| Rate for Payer: Wellcare Medicare |
$35.09
|
| Rate for Payer: WMAP Medicaid |
$36.26
|
| Rate for Payer: WPS Commercial |
$445.16
|
|
|
Cytomegalovirus DNA by PCR, Quantitative
|
Facility
|
IP
|
$755.00
|
|
|
Service Code
|
CPT 87497
|
| Hospital Charge Code |
1038882
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$369.95 |
| Max. Negotiated Rate |
$694.60 |
| Rate for Payer: Aetna Commercial |
$679.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$649.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$400.15
|
| Rate for Payer: Cash Price |
$226.50
|
| Rate for Payer: Cigna Commercial |
$694.60
|
| Rate for Payer: Health EOS Commercial |
$671.95
|
| Rate for Payer: HFN Commercial |
$694.60
|
| Rate for Payer: Multiplan Commercial |
$604.00
|
| Rate for Payer: NAPHCARE Commercial |
$453.00
|
| Rate for Payer: Preferred Network Access Commercial |
$694.60
|
| Rate for Payer: Quartz Beloit One Network |
$369.95
|
| Rate for Payer: Quartz Commercial |
$453.00
|
| Rate for Payer: WEA Trust Commercial |
$415.25
|
| Rate for Payer: WPS Commercial |
$559.23
|
|
|
Cytomegalovirus DNA by PCR, Quantitative
|
Professional
|
Both
|
$755.00
|
|
|
Service Code
|
CPT 87497
|
| Hospital Charge Code |
1038882
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$151.23 |
| Max. Negotiated Rate |
$717.25 |
| Rate for Payer: Aetna Commercial |
$717.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$649.30
|
| Rate for Payer: Cash Price |
$226.50
|
| Rate for Payer: Cash Price |
$226.50
|
| Rate for Payer: Cigna Commercial |
$717.25
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$377.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$453.00
|
| Rate for Payer: Health EOS Commercial |
$687.05
|
| Rate for Payer: HFN Commercial |
$717.25
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$151.23
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$151.23
|
| Rate for Payer: Multiplan Commercial |
$604.00
|
| Rate for Payer: Preferred Network Access Commercial |
$717.25
|
| Rate for Payer: Quartz Beloit One Network |
$332.20
|
| Rate for Payer: Quartz Commercial |
$430.35
|
| Rate for Payer: The Alliance Commercial |
$377.50
|
| Rate for Payer: WEA Trust Commercial |
$415.25
|
| Rate for Payer: WPS Commercial |
$559.23
|
|
|
Cytomegalovirus DNA by PCR, Quantitative
|
Facility
|
OP
|
$755.00
|
|
|
Service Code
|
CPT 87497
|
| Hospital Charge Code |
1038882
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$42.84 |
| Max. Negotiated Rate |
$694.60 |
| Rate for Payer: Aetna Commercial |
$679.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$649.30
|
| Rate for Payer: Aetna Managed Medicare |
$42.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$160.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$74.97
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$71.11
|
| Rate for Payer: Anthem Medicaid |
$44.27
|
| Rate for Payer: Anthem Medicare Advantage |
$42.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$400.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$42.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$42.84
|
| Rate for Payer: Cash Price |
$226.50
|
| Rate for Payer: Cash Price |
$226.50
|
| Rate for Payer: Cigna Commercial |
$694.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$42.84
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$44.27
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$422.50
|
| Rate for Payer: Dean Health Medicaid |
$44.27
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$42.84
|
| Rate for Payer: Health EOS Commercial |
$671.95
|
| Rate for Payer: HFN Commercial |
$694.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$159.36
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$42.84
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$44.27
|
| Rate for Payer: Independent Care Health Plan Medicare |
$42.84
|
| Rate for Payer: Managed Health Services Medicaid |
$46.04
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$42.84
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$42.84
|
| Rate for Payer: Multiplan Commercial |
$604.00
|
| Rate for Payer: NAPHCARE Commercial |
$64.26
|
| Rate for Payer: Preferred Network Access Commercial |
$694.60
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$44.27
|
| Rate for Payer: Quartz Beloit One Network |
$369.95
|
| Rate for Payer: Quartz Commercial |
$490.75
|
| Rate for Payer: Quartz Medicare Advantage |
$42.84
|
| Rate for Payer: The Alliance Commercial |
$171.36
|
| Rate for Payer: United Healthcare Medicaid |
$44.27
|
| Rate for Payer: United Healthcare Medicare Advantage |
$42.84
|
| Rate for Payer: United Healthcare PPO |
$566.25
|
| Rate for Payer: WEA Trust Commercial |
$415.25
|
| Rate for Payer: Wellcare Medicare |
$42.84
|
| Rate for Payer: WMAP Medicaid |
$44.27
|
| Rate for Payer: WPS Commercial |
$559.23
|
|
|
Cytomegalovirus PCR Occular
|
Professional
|
Both
|
$299.00
|
|
|
Service Code
|
CPT 87496
|
| Hospital Charge Code |
6196141
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$123.87 |
| Max. Negotiated Rate |
$284.05 |
| Rate for Payer: Aetna Commercial |
$284.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$257.14
|
| Rate for Payer: Cash Price |
$89.70
|
| Rate for Payer: Cash Price |
$89.70
|
| Rate for Payer: Cigna Commercial |
$284.05
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$149.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$179.40
|
| Rate for Payer: Health EOS Commercial |
$272.09
|
| Rate for Payer: HFN Commercial |
$284.05
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$123.87
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$123.87
|
| Rate for Payer: Multiplan Commercial |
$239.20
|
| Rate for Payer: Preferred Network Access Commercial |
$284.05
|
| Rate for Payer: Quartz Beloit One Network |
$131.56
|
| Rate for Payer: Quartz Commercial |
$170.43
|
| Rate for Payer: The Alliance Commercial |
$149.50
|
| Rate for Payer: WEA Trust Commercial |
$164.45
|
| Rate for Payer: WPS Commercial |
$221.47
|
|
|
Cytomegalovirus PCR Occular
|
Facility
|
IP
|
$299.00
|
|
|
Service Code
|
CPT 87496
|
| Hospital Charge Code |
6196141
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$146.51 |
| Max. Negotiated Rate |
$275.08 |
| Rate for Payer: Aetna Commercial |
$269.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$257.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$158.47
|
| Rate for Payer: Cash Price |
$89.70
|
| Rate for Payer: Cigna Commercial |
$275.08
|
| Rate for Payer: Health EOS Commercial |
$266.11
|
| Rate for Payer: HFN Commercial |
$275.08
|
| Rate for Payer: Multiplan Commercial |
$239.20
|
| Rate for Payer: NAPHCARE Commercial |
$179.40
|
| Rate for Payer: Preferred Network Access Commercial |
$275.08
|
| Rate for Payer: Quartz Beloit One Network |
$146.51
|
| Rate for Payer: Quartz Commercial |
$179.40
|
| Rate for Payer: WEA Trust Commercial |
$164.45
|
| Rate for Payer: WPS Commercial |
$221.47
|
|
|
Cytomegalovirus PCR Occular
|
Facility
|
OP
|
$299.00
|
|
|
Service Code
|
CPT 87496
|
| Hospital Charge Code |
6196141
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$35.09 |
| Max. Negotiated Rate |
$275.08 |
| Rate for Payer: Aetna Commercial |
$269.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$257.14
|
| Rate for Payer: Aetna Managed Medicare |
$35.09
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$131.59
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$61.41
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$58.25
|
| Rate for Payer: Anthem Medicaid |
$36.26
|
| Rate for Payer: Anthem Medicare Advantage |
$35.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$158.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$35.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$35.09
|
| Rate for Payer: Cash Price |
$89.70
|
| Rate for Payer: Cash Price |
$89.70
|
| Rate for Payer: Cigna Commercial |
$275.08
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$35.09
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$36.26
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$167.32
|
| Rate for Payer: Dean Health Medicaid |
$36.26
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$35.09
|
| Rate for Payer: Health EOS Commercial |
$266.11
|
| Rate for Payer: HFN Commercial |
$275.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$130.53
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$35.09
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$36.26
|
| Rate for Payer: Independent Care Health Plan Medicare |
$35.09
|
| Rate for Payer: Managed Health Services Medicaid |
$37.71
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$35.09
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$35.09
|
| Rate for Payer: Multiplan Commercial |
$239.20
|
| Rate for Payer: NAPHCARE Commercial |
$52.64
|
| Rate for Payer: Preferred Network Access Commercial |
$275.08
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$36.26
|
| Rate for Payer: Quartz Beloit One Network |
$146.51
|
| Rate for Payer: Quartz Commercial |
$194.35
|
| Rate for Payer: Quartz Medicare Advantage |
$35.09
|
| Rate for Payer: The Alliance Commercial |
$140.36
|
| Rate for Payer: United Healthcare Medicaid |
$36.26
|
| Rate for Payer: United Healthcare Medicare Advantage |
$35.09
|
| Rate for Payer: United Healthcare PPO |
$224.25
|
| Rate for Payer: WEA Trust Commercial |
$164.45
|
| Rate for Payer: Wellcare Medicare |
$35.09
|
| Rate for Payer: WMAP Medicaid |
$36.26
|
| Rate for Payer: WPS Commercial |
$221.47
|
|
|
Cytomegalovirus, Rapid Cx
|
Facility
|
IP
|
$92.00
|
|
|
Service Code
|
CPT 87254
|
| Hospital Charge Code |
6180573
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$45.08 |
| Max. Negotiated Rate |
$84.64 |
| Rate for Payer: Aetna Commercial |
$82.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$79.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$48.76
|
| Rate for Payer: Cash Price |
$27.60
|
| Rate for Payer: Cigna Commercial |
$84.64
|
| Rate for Payer: Health EOS Commercial |
$81.88
|
| Rate for Payer: HFN Commercial |
$84.64
|
| Rate for Payer: Multiplan Commercial |
$73.60
|
| Rate for Payer: NAPHCARE Commercial |
$55.20
|
| Rate for Payer: Preferred Network Access Commercial |
$84.64
|
| Rate for Payer: Quartz Beloit One Network |
$45.08
|
| Rate for Payer: Quartz Commercial |
$55.20
|
| Rate for Payer: WEA Trust Commercial |
$50.60
|
| Rate for Payer: WPS Commercial |
$68.14
|
|
|
Cytomegalovirus, Rapid Cx
|
Facility
|
OP
|
$92.00
|
|
|
Service Code
|
CPT 87254
|
| Hospital Charge Code |
6180573
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$7.06 |
| Max. Negotiated Rate |
$84.64 |
| Rate for Payer: Aetna Commercial |
$82.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$79.12
|
| Rate for Payer: Aetna Managed Medicare |
$19.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$73.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$34.23
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$32.47
|
| Rate for Payer: Anthem Medicaid |
$7.06
|
| Rate for Payer: Anthem Medicare Advantage |
$19.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$48.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$19.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$19.56
|
| Rate for Payer: Cash Price |
$27.60
|
| Rate for Payer: Cash Price |
$27.60
|
| Rate for Payer: Cigna Commercial |
$84.64
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$19.56
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$7.06
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$51.48
|
| Rate for Payer: Dean Health Medicaid |
$7.06
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$19.56
|
| Rate for Payer: Health EOS Commercial |
$81.88
|
| Rate for Payer: HFN Commercial |
$84.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$72.76
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$19.56
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$7.06
|
| Rate for Payer: Independent Care Health Plan Medicare |
$19.56
|
| Rate for Payer: Managed Health Services Medicaid |
$7.34
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$19.56
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$19.56
|
| Rate for Payer: Multiplan Commercial |
$73.60
|
| Rate for Payer: NAPHCARE Commercial |
$29.34
|
| Rate for Payer: Preferred Network Access Commercial |
$84.64
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$7.06
|
| Rate for Payer: Quartz Beloit One Network |
$45.08
|
| Rate for Payer: Quartz Commercial |
$59.80
|
| Rate for Payer: Quartz Medicare Advantage |
$19.56
|
| Rate for Payer: The Alliance Commercial |
$78.24
|
| Rate for Payer: United Healthcare Medicaid |
$7.06
|
| Rate for Payer: United Healthcare Medicare Advantage |
$19.56
|
| Rate for Payer: United Healthcare PPO |
$69.00
|
| Rate for Payer: WEA Trust Commercial |
$50.60
|
| Rate for Payer: Wellcare Medicare |
$19.56
|
| Rate for Payer: WMAP Medicaid |
$7.06
|
| Rate for Payer: WPS Commercial |
$68.14
|
|
|
Cytomegalovirus, Rapid Cx
|
Professional
|
Both
|
$92.00
|
|
|
Service Code
|
CPT 87254
|
| Hospital Charge Code |
6180573
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$40.48 |
| Max. Negotiated Rate |
$87.40 |
| Rate for Payer: Aetna Commercial |
$87.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$79.12
|
| Rate for Payer: Cash Price |
$27.60
|
| Rate for Payer: Cash Price |
$27.60
|
| Rate for Payer: Cigna Commercial |
$87.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$46.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$55.20
|
| Rate for Payer: Health EOS Commercial |
$83.72
|
| Rate for Payer: HFN Commercial |
$87.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$69.05
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$69.05
|
| Rate for Payer: Multiplan Commercial |
$73.60
|
| Rate for Payer: Preferred Network Access Commercial |
$87.40
|
| Rate for Payer: Quartz Beloit One Network |
$40.48
|
| Rate for Payer: Quartz Commercial |
$52.44
|
| Rate for Payer: The Alliance Commercial |
$46.00
|
| Rate for Payer: WEA Trust Commercial |
$50.60
|
| Rate for Payer: WPS Commercial |
$68.14
|
|
|
Dacogen 1 mg Charge
|
Facility
|
IP
|
$146.00
|
|
|
Service Code
|
HCPCS J0894
|
| Hospital Charge Code |
2958910
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$71.54 |
| Max. Negotiated Rate |
$134.32 |
| Rate for Payer: Aetna Commercial |
$131.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$125.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$77.38
|
| Rate for Payer: Cash Price |
$43.80
|
| Rate for Payer: Cigna Commercial |
$134.32
|
| Rate for Payer: Health EOS Commercial |
$129.94
|
| Rate for Payer: HFN Commercial |
$134.32
|
| Rate for Payer: Multiplan Commercial |
$116.80
|
| Rate for Payer: NAPHCARE Commercial |
$87.60
|
| Rate for Payer: Preferred Network Access Commercial |
$134.32
|
| Rate for Payer: Quartz Beloit One Network |
$71.54
|
| Rate for Payer: Quartz Commercial |
$87.60
|
| Rate for Payer: WEA Trust Commercial |
$80.30
|
| Rate for Payer: WPS Commercial |
$108.14
|
|
|
Dacogen 1 mg Charge
|
Facility
|
OP
|
$146.00
|
|
|
Service Code
|
HCPCS J0894
|
| Hospital Charge Code |
2958910
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.17 |
| Max. Negotiated Rate |
$584.00 |
| Rate for Payer: Aetna Commercial |
$131.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$125.56
|
| Rate for Payer: Aetna Managed Medicare |
$40.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$94.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$73.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$70.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$77.38
|
| Rate for Payer: Cash Price |
$43.80
|
| Rate for Payer: Cash Price |
$43.80
|
| Rate for Payer: Cigna Commercial |
$134.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2.17
|
| Rate for Payer: Health EOS Commercial |
$129.94
|
| Rate for Payer: HFN Commercial |
$134.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$109.50
|
| Rate for Payer: Multiplan Commercial |
$116.80
|
| Rate for Payer: NAPHCARE Commercial |
$87.60
|
| Rate for Payer: Preferred Network Access Commercial |
$134.32
|
| Rate for Payer: Quartz Beloit One Network |
$71.54
|
| Rate for Payer: Quartz Commercial |
$94.90
|
| Rate for Payer: Quartz Medicare Advantage |
$87.60
|
| Rate for Payer: The Alliance Commercial |
$584.00
|
| Rate for Payer: WEA Trust Commercial |
$80.30
|
| Rate for Payer: WPS Commercial |
$4.10
|
|
|
Dacogen 1 mg Charge
|
Professional
|
Both
|
$146.00
|
|
|
Service Code
|
HCPCS J0894
|
| Hospital Charge Code |
2958910
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.64 |
| Max. Negotiated Rate |
$138.70 |
| Rate for Payer: Aetna Commercial |
$138.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$125.56
|
| Rate for Payer: Cash Price |
$43.80
|
| Rate for Payer: Cash Price |
$43.80
|
| Rate for Payer: Cigna Commercial |
$138.70
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1.64
|
| Rate for Payer: Health EOS Commercial |
$132.86
|
| Rate for Payer: HFN Commercial |
$138.70
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5.05
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$5.05
|
| Rate for Payer: Multiplan Commercial |
$116.80
|
| Rate for Payer: Preferred Network Access Commercial |
$138.70
|
| Rate for Payer: Quartz Beloit One Network |
$64.24
|
| Rate for Payer: Quartz Commercial |
$83.22
|
| Rate for Payer: The Alliance Commercial |
$73.00
|
| Rate for Payer: United Healthcare Medicaid |
$1.64
|
| Rate for Payer: WEA Trust Commercial |
$80.30
|
| Rate for Payer: WPS Commercial |
$4.10
|
|
|
DACROCYSTORHINOSTOMY (DCR)
|
Facility
|
IP
|
$6,808.00
|
|
| Hospital Charge Code |
2959989
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,335.92 |
| Max. Negotiated Rate |
$6,263.36 |
| Rate for Payer: Aetna Commercial |
$6,127.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,854.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,608.24
|
| Rate for Payer: Cash Price |
$2,042.40
|
| Rate for Payer: Cigna Commercial |
$6,263.36
|
| Rate for Payer: Health EOS Commercial |
$6,059.12
|
| Rate for Payer: HFN Commercial |
$6,263.36
|
| Rate for Payer: Multiplan Commercial |
$5,446.40
|
| Rate for Payer: NAPHCARE Commercial |
$4,084.80
|
| Rate for Payer: Preferred Network Access Commercial |
$6,263.36
|
| Rate for Payer: Quartz Beloit One Network |
$3,335.92
|
| Rate for Payer: Quartz Commercial |
$4,084.80
|
| Rate for Payer: WEA Trust Commercial |
$3,744.40
|
| Rate for Payer: WPS Commercial |
$5,042.69
|
|
|
DACROCYSTORHINOSTOMY (DCR)
|
Facility
|
OP
|
$6,808.00
|
|
| Hospital Charge Code |
2959989
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,906.24 |
| Max. Negotiated Rate |
$27,232.00 |
| Rate for Payer: Aetna Commercial |
$6,127.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,854.88
|
| Rate for Payer: Aetna Managed Medicare |
$1,906.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,425.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,404.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,267.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,608.24
|
| Rate for Payer: Cash Price |
$2,042.40
|
| Rate for Payer: Cigna Commercial |
$6,263.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,809.76
|
| Rate for Payer: Health EOS Commercial |
$6,059.12
|
| Rate for Payer: HFN Commercial |
$6,263.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,106.00
|
| Rate for Payer: Multiplan Commercial |
$5,446.40
|
| Rate for Payer: NAPHCARE Commercial |
$4,084.80
|
| Rate for Payer: Preferred Network Access Commercial |
$6,263.36
|
| Rate for Payer: Quartz Beloit One Network |
$3,335.92
|
| Rate for Payer: Quartz Commercial |
$4,425.20
|
| Rate for Payer: Quartz Medicare Advantage |
$4,084.80
|
| Rate for Payer: The Alliance Commercial |
$27,232.00
|
| Rate for Payer: WEA Trust Commercial |
$3,744.40
|
| Rate for Payer: WPS Commercial |
$5,042.69
|
|
|
Daily - Therapeutic Gases Charge
|
Facility
|
IP
|
$612.00
|
|
| Hospital Charge Code |
3004207
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$299.88 |
| Max. Negotiated Rate |
$563.04 |
| Rate for Payer: Aetna Commercial |
$550.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$526.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$324.36
|
| Rate for Payer: Cash Price |
$183.60
|
| Rate for Payer: Cigna Commercial |
$563.04
|
| Rate for Payer: Health EOS Commercial |
$544.68
|
| Rate for Payer: HFN Commercial |
$563.04
|
| Rate for Payer: Multiplan Commercial |
$489.60
|
| Rate for Payer: NAPHCARE Commercial |
$367.20
|
| Rate for Payer: Preferred Network Access Commercial |
$563.04
|
| Rate for Payer: Quartz Beloit One Network |
$299.88
|
| Rate for Payer: Quartz Commercial |
$367.20
|
| Rate for Payer: WEA Trust Commercial |
$336.60
|
| Rate for Payer: WPS Commercial |
$453.31
|
|
