|
DNase-B Antibody
|
Facility
IP
|
$848.00
|
|
|
Service Code
|
CPT 86215
|
| Hospital Charge Code |
1038969
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$415.52 |
| Max. Negotiated Rate |
$780.16 |
| Rate for Payer: Aetna Commercial |
$763.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$449.44
|
| Rate for Payer: Cash Price |
$254.40
|
| Rate for Payer: Cigna Commercial |
$780.16
|
| Rate for Payer: Health EOS Commercial |
$754.72
|
| Rate for Payer: HFN Commercial |
$780.16
|
| Rate for Payer: Multiplan Commercial |
$678.40
|
| Rate for Payer: NAPHCARE Commercial |
$508.80
|
| Rate for Payer: Preferred Network Access Commercial |
$780.16
|
| Rate for Payer: Quartz Beloit One Network |
$415.52
|
| Rate for Payer: Quartz Commercial |
$508.80
|
| Rate for Payer: WEA Trust Commercial |
$466.40
|
| Rate for Payer: WPS Commercial |
$628.11
|
|
|
DNase-B Antibody
|
Facility
OP
|
$848.00
|
|
|
Service Code
|
CPT 86215
|
| Hospital Charge Code |
1038969
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.25 |
| Max. Negotiated Rate |
$3,392.00 |
| Rate for Payer: Aetna Commercial |
$763.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$729.28
|
| Rate for Payer: Aetna Managed Medicare |
$13.25
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$49.69
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$23.19
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$22.00
|
| Rate for Payer: Anthem Medicaid |
$13.69
|
| Rate for Payer: Anthem Medicare Advantage |
$13.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$449.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$13.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$13.25
|
| Rate for Payer: Cash Price |
$254.40
|
| Rate for Payer: Cash Price |
$254.40
|
| Rate for Payer: Cigna Commercial |
$780.16
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$13.25
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$13.69
|
| Rate for Payer: Dean Health Medicaid |
$13.69
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$13.25
|
| Rate for Payer: Health EOS Commercial |
$754.72
|
| Rate for Payer: HFN Commercial |
$780.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$49.29
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$13.25
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$13.69
|
| Rate for Payer: Independent Care Health Plan Medicare |
$13.25
|
| Rate for Payer: Managed Health Services Medicaid |
$14.24
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$13.25
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$13.25
|
| Rate for Payer: Multiplan Commercial |
$678.40
|
| Rate for Payer: NAPHCARE Commercial |
$19.88
|
| Rate for Payer: Preferred Network Access Commercial |
$780.16
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$13.69
|
| Rate for Payer: Quartz Beloit One Network |
$415.52
|
| Rate for Payer: Quartz Commercial |
$551.20
|
| Rate for Payer: Quartz Medicare Advantage |
$13.25
|
| Rate for Payer: The Alliance Commercial |
$3,392.00
|
| Rate for Payer: United Healthcare Medicaid |
$13.69
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.25
|
| Rate for Payer: United Healthcare PPO |
$636.00
|
| Rate for Payer: WEA Trust Commercial |
$466.40
|
| Rate for Payer: Wellcare Medicare |
$13.25
|
| Rate for Payer: WMAP Medicaid |
$13.69
|
| Rate for Payer: WPS Commercial |
$628.11
|
|
|
DNase-B Antibody
|
Professional
|
$848.00
|
|
|
Service Code
|
CPT 86215
|
| Hospital Charge Code |
1038969
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.25 |
| Max. Negotiated Rate |
$805.60 |
| Rate for Payer: Aetna Commercial |
$805.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$729.28
|
| Rate for Payer: Aetna Managed Medicare |
$13.25
|
| Rate for Payer: Anthem Medicare Advantage |
$13.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$13.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$13.25
|
| Rate for Payer: Cash Price |
$254.40
|
| Rate for Payer: Cash Price |
$254.40
|
| Rate for Payer: Cigna Commercial |
$805.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$424.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$13.25
|
| Rate for Payer: Health EOS Commercial |
$771.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$46.77
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$46.77
|
| Rate for Payer: Independent Care Health Plan Medicare |
$13.25
|
| Rate for Payer: Multiplan Commercial |
$678.40
|
| Rate for Payer: Preferred Network Access Commercial |
$805.60
|
| Rate for Payer: Quartz Beloit One Network |
$373.12
|
| Rate for Payer: Quartz Commercial |
$483.36
|
| Rate for Payer: Quartz Medicare Advantage |
$13.25
|
| Rate for Payer: The Alliance Commercial |
$52.34
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.25
|
| Rate for Payer: WEA Trust Commercial |
$466.40
|
| Rate for Payer: WPS Commercial |
$58.30
|
|
|
DNAse sensitivity
|
Professional
|
$255.00
|
|
|
Service Code
|
CPT 88350
|
| Hospital Charge Code |
2798804
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$22.51 |
| Max. Negotiated Rate |
$494.03 |
| Rate for Payer: Aetna Commercial |
$242.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$219.30
|
| Rate for Payer: Aetna Managed Medicare |
$112.28
|
| Rate for Payer: Anthem Commercial |
$22.51
|
| Rate for Payer: Anthem Medicare Advantage |
$112.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$112.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$112.28
|
| Rate for Payer: Cash Price |
$76.50
|
| Rate for Payer: Cash Price |
$76.50
|
| Rate for Payer: Cigna Commercial |
$242.25
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$127.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$112.28
|
| Rate for Payer: Health EOS Commercial |
$232.05
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$370.44
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$370.44
|
| Rate for Payer: Independent Care Health Plan Medicare |
$112.28
|
| Rate for Payer: Multiplan Commercial |
$204.00
|
| Rate for Payer: Preferred Network Access Commercial |
$242.25
|
| Rate for Payer: Quartz Beloit One Network |
$112.20
|
| Rate for Payer: Quartz Commercial |
$145.35
|
| Rate for Payer: Quartz Medicare Advantage |
$112.28
|
| Rate for Payer: The Alliance Commercial |
$443.51
|
| Rate for Payer: United Healthcare Medicare Advantage |
$112.28
|
| Rate for Payer: WEA Trust Commercial |
$140.25
|
| Rate for Payer: WPS Commercial |
$494.03
|
|
|
DNAse sensitivity
|
Facility
IP
|
$255.00
|
|
|
Service Code
|
CPT 88350
|
| Hospital Charge Code |
2798804
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$124.95 |
| Max. Negotiated Rate |
$234.60 |
| Rate for Payer: Aetna Commercial |
$229.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$135.15
|
| Rate for Payer: Cash Price |
$76.50
|
| Rate for Payer: Cigna Commercial |
$234.60
|
| Rate for Payer: Health EOS Commercial |
$226.95
|
| Rate for Payer: HFN Commercial |
$234.60
|
| Rate for Payer: Multiplan Commercial |
$204.00
|
| Rate for Payer: NAPHCARE Commercial |
$153.00
|
| Rate for Payer: Preferred Network Access Commercial |
$234.60
|
| Rate for Payer: Quartz Beloit One Network |
$124.95
|
| Rate for Payer: Quartz Commercial |
$153.00
|
| Rate for Payer: WEA Trust Commercial |
$140.25
|
| Rate for Payer: WPS Commercial |
$188.88
|
|
|
DNAse sensitivity
|
Facility
OP
|
$255.00
|
|
|
Service Code
|
CPT 88350
|
| Hospital Charge Code |
2798804
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$71.40 |
| Max. Negotiated Rate |
$234.60 |
| Rate for Payer: Aetna Commercial |
$229.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$219.30
|
| Rate for Payer: Aetna Managed Medicare |
$71.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$165.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$127.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$122.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$135.15
|
| Rate for Payer: Cash Price |
$76.50
|
| Rate for Payer: Cash Price |
$76.50
|
| Rate for Payer: Cigna Commercial |
$234.60
|
| Rate for Payer: Health EOS Commercial |
$226.95
|
| Rate for Payer: HFN Commercial |
$234.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$191.25
|
| Rate for Payer: Multiplan Commercial |
$204.00
|
| Rate for Payer: NAPHCARE Commercial |
$153.00
|
| Rate for Payer: Preferred Network Access Commercial |
$234.60
|
| Rate for Payer: Quartz Beloit One Network |
$124.95
|
| Rate for Payer: Quartz Commercial |
$165.75
|
| Rate for Payer: Quartz Medicare Advantage |
$153.00
|
| Rate for Payer: United Healthcare PPO |
$191.25
|
| Rate for Payer: WEA Trust Commercial |
$140.25
|
| Rate for Payer: WPS Commercial |
$188.88
|
|
|
DOME HOLE PLUG CONTINUUM 00-8757-000-01
|
Facility
OP
|
$1,472.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
2967682
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$412.16 |
| Max. Negotiated Rate |
$1,354.24 |
| Rate for Payer: Aetna Commercial |
$1,324.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,265.92
|
| Rate for Payer: Aetna Managed Medicare |
$412.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$956.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$736.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$706.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$780.16
|
| Rate for Payer: Cash Price |
$441.60
|
| Rate for Payer: Cigna Commercial |
$1,354.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$823.73
|
| Rate for Payer: Health EOS Commercial |
$1,310.08
|
| Rate for Payer: HFN Commercial |
$1,354.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,104.00
|
| Rate for Payer: Multiplan Commercial |
$1,177.60
|
| Rate for Payer: NAPHCARE Commercial |
$883.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,354.24
|
| Rate for Payer: Quartz Beloit One Network |
$721.28
|
| Rate for Payer: Quartz Commercial |
$956.80
|
| Rate for Payer: Quartz Medicare Advantage |
$883.20
|
| Rate for Payer: WEA Trust Commercial |
$809.60
|
| Rate for Payer: WPS Commercial |
$1,090.31
|
|
|
DOME HOLE PLUG CONTINUUM 00-8757-000-01
|
Facility
IP
|
$1,472.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
2967682
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$721.28 |
| Max. Negotiated Rate |
$1,354.24 |
| Rate for Payer: Aetna Commercial |
$1,324.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$780.16
|
| Rate for Payer: Cash Price |
$441.60
|
| Rate for Payer: Cigna Commercial |
$1,354.24
|
| Rate for Payer: Health EOS Commercial |
$1,310.08
|
| Rate for Payer: HFN Commercial |
$1,354.24
|
| Rate for Payer: Multiplan Commercial |
$1,177.60
|
| Rate for Payer: NAPHCARE Commercial |
$883.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,354.24
|
| Rate for Payer: Quartz Beloit One Network |
$721.28
|
| Rate for Payer: Quartz Commercial |
$883.20
|
| Rate for Payer: WEA Trust Commercial |
$809.60
|
| Rate for Payer: WPS Commercial |
$1,090.31
|
|
|
Domicil/R-Home Visit Est Pat 99335
|
Professional
|
$344.00
|
|
|
Service Code
|
CPT 99335
|
| Hospital Charge Code |
3375521
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$151.36 |
| Max. Negotiated Rate |
$326.80 |
| Rate for Payer: Aetna Commercial |
$326.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$295.84
|
| Rate for Payer: Cash Price |
$103.20
|
| Rate for Payer: Cash Price |
$103.20
|
| Rate for Payer: Cigna Commercial |
$326.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$172.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$206.40
|
| Rate for Payer: Health EOS Commercial |
$313.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$322.25
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$322.25
|
| Rate for Payer: Multiplan Commercial |
$275.20
|
| Rate for Payer: Preferred Network Access Commercial |
$326.80
|
| Rate for Payer: Quartz Beloit One Network |
$151.36
|
| Rate for Payer: Quartz Commercial |
$196.08
|
| Rate for Payer: The Alliance Commercial |
$172.00
|
| Rate for Payer: WEA Trust Commercial |
$189.20
|
| Rate for Payer: WPS Commercial |
$254.80
|
|
|
***DO NOT USE***GRAFT INTERGARD 14X7MM BIF IGK1407***DO NOT USE ON PREF CARD***
|
Facility
IP
|
$6,505.00
|
|
| Hospital Charge Code |
2965277
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,187.45 |
| Max. Negotiated Rate |
$5,984.60 |
| Rate for Payer: Aetna Commercial |
$5,854.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,447.65
|
| Rate for Payer: Cash Price |
$1,951.50
|
| Rate for Payer: Cigna Commercial |
$5,984.60
|
| Rate for Payer: Health EOS Commercial |
$5,789.45
|
| Rate for Payer: HFN Commercial |
$5,984.60
|
| Rate for Payer: Multiplan Commercial |
$5,204.00
|
| Rate for Payer: NAPHCARE Commercial |
$3,903.00
|
| Rate for Payer: Preferred Network Access Commercial |
$5,984.60
|
| Rate for Payer: Quartz Beloit One Network |
$3,187.45
|
| Rate for Payer: Quartz Commercial |
$3,903.00
|
| Rate for Payer: WEA Trust Commercial |
$3,577.75
|
| Rate for Payer: WPS Commercial |
$4,818.25
|
|
|
***DO NOT USE***GRAFT INTERGARD 14X7MM BIF IGK1407***DO NOT USE ON PREF CARD***
|
Facility
OP
|
$6,505.00
|
|
| Hospital Charge Code |
2965277
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,821.40 |
| Max. Negotiated Rate |
$26,020.00 |
| Rate for Payer: Aetna Commercial |
$5,854.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,594.30
|
| Rate for Payer: Aetna Managed Medicare |
$1,821.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,228.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,252.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,122.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,447.65
|
| Rate for Payer: Cash Price |
$1,951.50
|
| Rate for Payer: Cigna Commercial |
$5,984.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,640.20
|
| Rate for Payer: Health EOS Commercial |
$5,789.45
|
| Rate for Payer: HFN Commercial |
$5,984.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,878.75
|
| Rate for Payer: Multiplan Commercial |
$5,204.00
|
| Rate for Payer: NAPHCARE Commercial |
$3,903.00
|
| Rate for Payer: Preferred Network Access Commercial |
$5,984.60
|
| Rate for Payer: Quartz Beloit One Network |
$3,187.45
|
| Rate for Payer: Quartz Commercial |
$4,228.25
|
| Rate for Payer: Quartz Medicare Advantage |
$3,903.00
|
| Rate for Payer: The Alliance Commercial |
$26,020.00
|
| Rate for Payer: WEA Trust Commercial |
$3,577.75
|
| Rate for Payer: WPS Commercial |
$4,818.25
|
|
|
Dopamine, Plasma
|
Facility
IP
|
$30.00
|
|
|
Service Code
|
CPT 82542
|
| Hospital Charge Code |
4522642
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.70 |
| Max. Negotiated Rate |
$27.60 |
| Rate for Payer: Aetna Commercial |
$27.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$15.90
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Cigna Commercial |
$27.60
|
| Rate for Payer: Health EOS Commercial |
$26.70
|
| Rate for Payer: HFN Commercial |
$27.60
|
| Rate for Payer: Multiplan Commercial |
$24.00
|
| Rate for Payer: NAPHCARE Commercial |
$18.00
|
| Rate for Payer: Preferred Network Access Commercial |
$27.60
|
| Rate for Payer: Quartz Beloit One Network |
$14.70
|
| Rate for Payer: Quartz Commercial |
$18.00
|
| Rate for Payer: WEA Trust Commercial |
$16.50
|
| Rate for Payer: WPS Commercial |
$22.22
|
|
|
Dopamine, Plasma
|
Facility
OP
|
$30.00
|
|
|
Service Code
|
CPT 82542
|
| Hospital Charge Code |
4522642
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.70 |
| Max. Negotiated Rate |
$120.00 |
| Rate for Payer: Aetna Commercial |
$27.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$25.80
|
| Rate for Payer: Aetna Managed Medicare |
$24.09
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$90.34
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$42.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$39.99
|
| Rate for Payer: Anthem Medicaid |
$24.89
|
| Rate for Payer: Anthem Medicare Advantage |
$24.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$15.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$24.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$24.09
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Cigna Commercial |
$27.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$24.09
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$24.89
|
| Rate for Payer: Dean Health Medicaid |
$24.89
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$24.09
|
| Rate for Payer: Health EOS Commercial |
$26.70
|
| Rate for Payer: HFN Commercial |
$27.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$89.61
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$24.09
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$24.89
|
| Rate for Payer: Independent Care Health Plan Medicare |
$24.09
|
| Rate for Payer: Managed Health Services Medicaid |
$25.89
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$24.09
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$24.09
|
| Rate for Payer: Multiplan Commercial |
$24.00
|
| Rate for Payer: NAPHCARE Commercial |
$36.14
|
| Rate for Payer: Preferred Network Access Commercial |
$27.60
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$24.89
|
| Rate for Payer: Quartz Beloit One Network |
$14.70
|
| Rate for Payer: Quartz Commercial |
$19.50
|
| Rate for Payer: Quartz Medicare Advantage |
$24.09
|
| Rate for Payer: The Alliance Commercial |
$120.00
|
| Rate for Payer: United Healthcare Medicaid |
$24.89
|
| Rate for Payer: United Healthcare Medicare Advantage |
$24.09
|
| Rate for Payer: United Healthcare PPO |
$22.50
|
| Rate for Payer: WEA Trust Commercial |
$16.50
|
| Rate for Payer: Wellcare Medicare |
$24.09
|
| Rate for Payer: WMAP Medicaid |
$24.89
|
| Rate for Payer: WPS Commercial |
$22.22
|
|
|
Dopamine, Plasma
|
Professional
|
$30.00
|
|
|
Service Code
|
CPT 82542
|
| Hospital Charge Code |
4522642
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.20 |
| Max. Negotiated Rate |
$106.00 |
| Rate for Payer: Aetna Commercial |
$28.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$25.80
|
| Rate for Payer: Aetna Managed Medicare |
$24.09
|
| Rate for Payer: Anthem Medicare Advantage |
$24.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$24.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$24.09
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Cigna Commercial |
$28.50
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$15.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$24.09
|
| Rate for Payer: Health EOS Commercial |
$27.30
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$85.04
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$85.04
|
| Rate for Payer: Independent Care Health Plan Medicare |
$24.09
|
| Rate for Payer: Multiplan Commercial |
$24.00
|
| Rate for Payer: Preferred Network Access Commercial |
$28.50
|
| Rate for Payer: Quartz Beloit One Network |
$13.20
|
| Rate for Payer: Quartz Commercial |
$17.10
|
| Rate for Payer: Quartz Medicare Advantage |
$24.09
|
| Rate for Payer: The Alliance Commercial |
$95.16
|
| Rate for Payer: United Healthcare Medicare Advantage |
$24.09
|
| Rate for Payer: WEA Trust Commercial |
$16.50
|
| Rate for Payer: WPS Commercial |
$106.00
|
|
|
Dopamine, Urine
|
Facility
OP
|
$332.00
|
|
|
Service Code
|
CPT 82542
|
| Hospital Charge Code |
4522641
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$24.09 |
| Max. Negotiated Rate |
$1,328.00 |
| Rate for Payer: Aetna Commercial |
$298.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$285.52
|
| Rate for Payer: Aetna Managed Medicare |
$24.09
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$90.34
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$42.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$39.99
|
| Rate for Payer: Anthem Medicaid |
$24.89
|
| Rate for Payer: Anthem Medicare Advantage |
$24.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$175.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$24.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$24.09
|
| Rate for Payer: Cash Price |
$99.60
|
| Rate for Payer: Cash Price |
$99.60
|
| Rate for Payer: Cigna Commercial |
$305.44
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$24.09
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$24.89
|
| Rate for Payer: Dean Health Medicaid |
$24.89
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$24.09
|
| Rate for Payer: Health EOS Commercial |
$295.48
|
| Rate for Payer: HFN Commercial |
$305.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$89.61
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$24.09
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$24.89
|
| Rate for Payer: Independent Care Health Plan Medicare |
$24.09
|
| Rate for Payer: Managed Health Services Medicaid |
$25.89
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$24.09
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$24.09
|
| Rate for Payer: Multiplan Commercial |
$265.60
|
| Rate for Payer: NAPHCARE Commercial |
$36.14
|
| Rate for Payer: Preferred Network Access Commercial |
$305.44
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$24.89
|
| Rate for Payer: Quartz Beloit One Network |
$162.68
|
| Rate for Payer: Quartz Commercial |
$215.80
|
| Rate for Payer: Quartz Medicare Advantage |
$24.09
|
| Rate for Payer: The Alliance Commercial |
$1,328.00
|
| Rate for Payer: United Healthcare Medicaid |
$24.89
|
| Rate for Payer: United Healthcare Medicare Advantage |
$24.09
|
| Rate for Payer: United Healthcare PPO |
$249.00
|
| Rate for Payer: WEA Trust Commercial |
$182.60
|
| Rate for Payer: Wellcare Medicare |
$24.09
|
| Rate for Payer: WMAP Medicaid |
$24.89
|
| Rate for Payer: WPS Commercial |
$245.91
|
|
|
Dopamine, Urine
|
Professional
|
$332.00
|
|
|
Service Code
|
CPT 82542
|
| Hospital Charge Code |
4522641
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$24.09 |
| Max. Negotiated Rate |
$315.40 |
| Rate for Payer: Aetna Commercial |
$315.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$285.52
|
| Rate for Payer: Aetna Managed Medicare |
$24.09
|
| Rate for Payer: Anthem Medicare Advantage |
$24.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$24.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$24.09
|
| Rate for Payer: Cash Price |
$99.60
|
| Rate for Payer: Cash Price |
$99.60
|
| Rate for Payer: Cigna Commercial |
$315.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$166.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$24.09
|
| Rate for Payer: Health EOS Commercial |
$302.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$85.04
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$85.04
|
| Rate for Payer: Independent Care Health Plan Medicare |
$24.09
|
| Rate for Payer: Multiplan Commercial |
$265.60
|
| Rate for Payer: Preferred Network Access Commercial |
$315.40
|
| Rate for Payer: Quartz Beloit One Network |
$146.08
|
| Rate for Payer: Quartz Commercial |
$189.24
|
| Rate for Payer: Quartz Medicare Advantage |
$24.09
|
| Rate for Payer: The Alliance Commercial |
$95.16
|
| Rate for Payer: United Healthcare Medicare Advantage |
$24.09
|
| Rate for Payer: WEA Trust Commercial |
$182.60
|
| Rate for Payer: WPS Commercial |
$106.00
|
|
|
Dopamine, Urine
|
Facility
IP
|
$332.00
|
|
|
Service Code
|
CPT 82542
|
| Hospital Charge Code |
4522641
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$162.68 |
| Max. Negotiated Rate |
$305.44 |
| Rate for Payer: Aetna Commercial |
$298.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$175.96
|
| Rate for Payer: Cash Price |
$99.60
|
| Rate for Payer: Cigna Commercial |
$305.44
|
| Rate for Payer: Health EOS Commercial |
$295.48
|
| Rate for Payer: HFN Commercial |
$305.44
|
| Rate for Payer: Multiplan Commercial |
$265.60
|
| Rate for Payer: NAPHCARE Commercial |
$199.20
|
| Rate for Payer: Preferred Network Access Commercial |
$305.44
|
| Rate for Payer: Quartz Beloit One Network |
$162.68
|
| Rate for Payer: Quartz Commercial |
$199.20
|
| Rate for Payer: WEA Trust Commercial |
$182.60
|
| Rate for Payer: WPS Commercial |
$245.91
|
|
|
DOP Echocard Pulse Wave W/Spectral 93321
|
Professional
|
$235.00
|
|
|
Service Code
|
CPT 93321
|
| Hospital Charge Code |
5104618
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$24.18 |
| Max. Negotiated Rate |
$223.25 |
| Rate for Payer: Aetna Commercial |
$223.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$202.10
|
| Rate for Payer: Aetna Managed Medicare |
$24.18
|
| Rate for Payer: Anthem Medicare Advantage |
$24.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$24.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$24.18
|
| Rate for Payer: Cash Price |
$70.50
|
| Rate for Payer: Cash Price |
$70.50
|
| Rate for Payer: Cigna Commercial |
$223.25
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$117.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$24.18
|
| Rate for Payer: Health EOS Commercial |
$213.85
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$90.79
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$90.79
|
| Rate for Payer: Independent Care Health Plan Medicare |
$24.18
|
| Rate for Payer: Multiplan Commercial |
$188.00
|
| Rate for Payer: Preferred Network Access Commercial |
$223.25
|
| Rate for Payer: Quartz Beloit One Network |
$103.40
|
| Rate for Payer: Quartz Commercial |
$133.95
|
| Rate for Payer: Quartz Medicare Advantage |
$24.18
|
| Rate for Payer: The Alliance Commercial |
$91.88
|
| Rate for Payer: United Healthcare Medicaid |
$30.99
|
| Rate for Payer: United Healthcare Medicare Advantage |
$24.18
|
| Rate for Payer: WEA Trust Commercial |
$129.25
|
| Rate for Payer: WPS Commercial |
$96.72
|
|
|
DOP Echocard Pulse Wave W/Spectral 9332126
|
Professional
|
$235.00
|
|
|
Service Code
|
CPT 93321 26
|
| Hospital Charge Code |
5104619
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$6.80 |
| Max. Negotiated Rate |
$223.25 |
| Rate for Payer: Aetna Commercial |
$223.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$202.10
|
| Rate for Payer: Aetna Managed Medicare |
$6.80
|
| Rate for Payer: Anthem Medicare Advantage |
$6.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$6.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$6.80
|
| Rate for Payer: Cash Price |
$70.50
|
| Rate for Payer: Cash Price |
$70.50
|
| Rate for Payer: Cigna Commercial |
$223.25
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$117.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6.80
|
| Rate for Payer: Health EOS Commercial |
$213.85
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$24.64
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$24.64
|
| Rate for Payer: Independent Care Health Plan Medicare |
$6.80
|
| Rate for Payer: Multiplan Commercial |
$188.00
|
| Rate for Payer: Preferred Network Access Commercial |
$223.25
|
| Rate for Payer: Quartz Beloit One Network |
$103.40
|
| Rate for Payer: Quartz Commercial |
$133.95
|
| Rate for Payer: Quartz Medicare Advantage |
$6.80
|
| Rate for Payer: The Alliance Commercial |
$25.84
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6.80
|
| Rate for Payer: WEA Trust Commercial |
$129.25
|
| Rate for Payer: WPS Commercial |
$27.20
|
|
|
DOPPLER COLOR FLOW ADD-ON 9332526
|
Professional
|
$126.00
|
|
|
Service Code
|
CPT 93325 26
|
| Hospital Charge Code |
3015379
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$3.02 |
| Max. Negotiated Rate |
$119.70 |
| Rate for Payer: Aetna Commercial |
$119.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$108.36
|
| Rate for Payer: Aetna Managed Medicare |
$3.02
|
| Rate for Payer: Anthem Medicare Advantage |
$3.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$3.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$3.02
|
| Rate for Payer: Cash Price |
$37.80
|
| Rate for Payer: Cash Price |
$37.80
|
| Rate for Payer: Cigna Commercial |
$119.70
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$63.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3.02
|
| Rate for Payer: Health EOS Commercial |
$114.66
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$10.94
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$10.94
|
| Rate for Payer: Independent Care Health Plan Medicare |
$3.02
|
| Rate for Payer: Multiplan Commercial |
$100.80
|
| Rate for Payer: Preferred Network Access Commercial |
$119.70
|
| Rate for Payer: Quartz Beloit One Network |
$55.44
|
| Rate for Payer: Quartz Commercial |
$71.82
|
| Rate for Payer: Quartz Medicare Advantage |
$3.02
|
| Rate for Payer: The Alliance Commercial |
$11.48
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3.02
|
| Rate for Payer: WEA Trust Commercial |
$69.30
|
| Rate for Payer: WPS Commercial |
$12.08
|
|
|
DOPPLER ECHO EXAM, HEART 9332026
|
Professional
|
$415.00
|
|
|
Service Code
|
CPT 93320 26
|
| Hospital Charge Code |
3015377
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$17.17 |
| Max. Negotiated Rate |
$394.25 |
| Rate for Payer: Aetna Commercial |
$394.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$356.90
|
| Rate for Payer: Aetna Managed Medicare |
$17.17
|
| Rate for Payer: Anthem Medicare Advantage |
$17.17
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$17.17
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$17.17
|
| Rate for Payer: Cash Price |
$124.50
|
| Rate for Payer: Cash Price |
$124.50
|
| Rate for Payer: Cigna Commercial |
$394.25
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$207.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$17.17
|
| Rate for Payer: Health EOS Commercial |
$377.65
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$62.27
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$62.27
|
| Rate for Payer: Independent Care Health Plan Medicare |
$17.17
|
| Rate for Payer: Multiplan Commercial |
$332.00
|
| Rate for Payer: Preferred Network Access Commercial |
$394.25
|
| Rate for Payer: Quartz Beloit One Network |
$182.60
|
| Rate for Payer: Quartz Commercial |
$236.55
|
| Rate for Payer: Quartz Medicare Advantage |
$17.17
|
| Rate for Payer: The Alliance Commercial |
$65.25
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17.17
|
| Rate for Payer: WEA Trust Commercial |
$228.25
|
| Rate for Payer: WPS Commercial |
$68.68
|
|
|
DOPPLER FLOW TESTING 9399026
|
Professional
|
$75.00
|
|
|
Service Code
|
CPT 93990 26
|
| Hospital Charge Code |
3015450
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$21.34 |
| Max. Negotiated Rate |
$85.36 |
| Rate for Payer: Aetna Commercial |
$71.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$64.50
|
| Rate for Payer: Aetna Managed Medicare |
$21.34
|
| Rate for Payer: Anthem Medicare Advantage |
$21.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$21.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$21.34
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Cigna Commercial |
$71.25
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$37.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$21.34
|
| Rate for Payer: Health EOS Commercial |
$68.25
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$77.62
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$77.62
|
| Rate for Payer: Independent Care Health Plan Medicare |
$21.34
|
| Rate for Payer: Multiplan Commercial |
$60.00
|
| Rate for Payer: Preferred Network Access Commercial |
$71.25
|
| Rate for Payer: Quartz Beloit One Network |
$33.00
|
| Rate for Payer: Quartz Commercial |
$42.75
|
| Rate for Payer: Quartz Medicare Advantage |
$21.34
|
| Rate for Payer: The Alliance Commercial |
$53.35
|
| Rate for Payer: United Healthcare Medicare Advantage |
$21.34
|
| Rate for Payer: WEA Trust Commercial |
$41.25
|
| Rate for Payer: WPS Commercial |
$85.36
|
|
|
DORSAL BLOCKING SPLINT SMALL
|
Facility
IP
|
$769.00
|
|
| Hospital Charge Code |
2971619
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$376.81 |
| Max. Negotiated Rate |
$707.48 |
| Rate for Payer: Aetna Commercial |
$692.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$407.57
|
| Rate for Payer: Cash Price |
$230.70
|
| Rate for Payer: Cigna Commercial |
$707.48
|
| Rate for Payer: Health EOS Commercial |
$684.41
|
| Rate for Payer: HFN Commercial |
$707.48
|
| Rate for Payer: Multiplan Commercial |
$615.20
|
| Rate for Payer: NAPHCARE Commercial |
$461.40
|
| Rate for Payer: Preferred Network Access Commercial |
$707.48
|
| Rate for Payer: Quartz Beloit One Network |
$376.81
|
| Rate for Payer: Quartz Commercial |
$461.40
|
| Rate for Payer: WEA Trust Commercial |
$422.95
|
| Rate for Payer: WPS Commercial |
$569.60
|
|
|
DORSAL BLOCKING SPLINT SMALL
|
Facility
OP
|
$769.00
|
|
| Hospital Charge Code |
2971619
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$215.32 |
| Max. Negotiated Rate |
$3,076.00 |
| Rate for Payer: Aetna Commercial |
$692.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$661.34
|
| Rate for Payer: Aetna Managed Medicare |
$215.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$499.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$384.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$369.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$407.57
|
| Rate for Payer: Cash Price |
$230.70
|
| Rate for Payer: Cigna Commercial |
$707.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$430.33
|
| Rate for Payer: Health EOS Commercial |
$684.41
|
| Rate for Payer: HFN Commercial |
$707.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$576.75
|
| Rate for Payer: Multiplan Commercial |
$615.20
|
| Rate for Payer: NAPHCARE Commercial |
$461.40
|
| Rate for Payer: Preferred Network Access Commercial |
$707.48
|
| Rate for Payer: Quartz Beloit One Network |
$376.81
|
| Rate for Payer: Quartz Commercial |
$499.85
|
| Rate for Payer: Quartz Medicare Advantage |
$461.40
|
| Rate for Payer: The Alliance Commercial |
$3,076.00
|
| Rate for Payer: WEA Trust Commercial |
$422.95
|
| Rate for Payer: WPS Commercial |
$569.60
|
|
|
DORSAL SLIT
|
Facility
OP
|
$1,006.00
|
|
| Hospital Charge Code |
2959997
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$281.68 |
| Max. Negotiated Rate |
$4,024.00 |
| Rate for Payer: Aetna Commercial |
$905.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$865.16
|
| Rate for Payer: Aetna Managed Medicare |
$281.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$653.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$503.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$482.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$533.18
|
| Rate for Payer: Cash Price |
$301.80
|
| Rate for Payer: Cigna Commercial |
$925.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$562.96
|
| Rate for Payer: Health EOS Commercial |
$895.34
|
| Rate for Payer: HFN Commercial |
$925.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$754.50
|
| Rate for Payer: Multiplan Commercial |
$804.80
|
| Rate for Payer: NAPHCARE Commercial |
$603.60
|
| Rate for Payer: Preferred Network Access Commercial |
$925.52
|
| Rate for Payer: Quartz Beloit One Network |
$492.94
|
| Rate for Payer: Quartz Commercial |
$653.90
|
| Rate for Payer: Quartz Medicare Advantage |
$603.60
|
| Rate for Payer: The Alliance Commercial |
$4,024.00
|
| Rate for Payer: WEA Trust Commercial |
$553.30
|
| Rate for Payer: WPS Commercial |
$745.14
|
|
