|
EAR, NOSE, MOUTH AND THROAT MALIGNANCY WITH CC
|
Facility
IP
|
$33,175.00
|
|
|
Service Code
|
MS-DRG 147
|
| Min. Negotiated Rate |
$11,933.58 |
| Max. Negotiated Rate |
$33,175.00 |
| Rate for Payer: Aetna Managed Medicare |
$11,933.58
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$26,015.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$19,940.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$18,944.72
|
| Rate for Payer: Anthem Medicare Advantage |
$11,933.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$11,933.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$11,933.58
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$11,933.58
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$21,030.38
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$11,933.58
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$24,098.10
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$11,933.58
|
| Rate for Payer: Independent Care Health Plan Medicare |
$11,933.58
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$11,933.58
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$11,933.58
|
| Rate for Payer: NAPHCARE Commercial |
$17,900.37
|
| Rate for Payer: Quartz Medicare Advantage |
$11,933.58
|
| Rate for Payer: The Alliance Commercial |
$33,175.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$11,933.58
|
| Rate for Payer: United Healthcare PPO |
$18,760.68
|
| Rate for Payer: Wellcare Medicare |
$11,933.58
|
|
|
EAR, NOSE, MOUTH AND THROAT MALIGNANCY WITH MCC
|
Facility
IP
|
$56,443.00
|
|
|
Service Code
|
MS-DRG 146
|
| Min. Negotiated Rate |
$20,303.39 |
| Max. Negotiated Rate |
$56,443.00 |
| Rate for Payer: Aetna Managed Medicare |
$20,303.39
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$44,267.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$33,930.91
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$32,236.58
|
| Rate for Payer: Anthem Medicare Advantage |
$20,303.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$20,303.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$20,303.39
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$20,303.39
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$35,785.56
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$20,303.39
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$41,164.50
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$20,303.39
|
| Rate for Payer: Independent Care Health Plan Medicare |
$20,303.39
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$20,303.39
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$20,303.39
|
| Rate for Payer: NAPHCARE Commercial |
$30,455.08
|
| Rate for Payer: Quartz Medicare Advantage |
$20,303.39
|
| Rate for Payer: The Alliance Commercial |
$56,443.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$20,303.39
|
| Rate for Payer: United Healthcare PPO |
$32,047.09
|
| Rate for Payer: Wellcare Medicare |
$20,303.39
|
|
|
EAR, NOSE, MOUTH AND THROAT MALIGNANCY WITHOUT CC/MCC
|
Facility
IP
|
$23,974.00
|
|
|
Service Code
|
MS-DRG 148
|
| Min. Negotiated Rate |
$8,623.73 |
| Max. Negotiated Rate |
$23,974.00 |
| Rate for Payer: Aetna Managed Medicare |
$8,623.73
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$18,672.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$14,312.09
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$13,597.42
|
| Rate for Payer: Anthem Medicare Advantage |
$8,623.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$8,623.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$8,623.73
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$8,623.73
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$15,094.38
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$8,623.73
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$17,349.15
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$8,623.73
|
| Rate for Payer: Independent Care Health Plan Medicare |
$8,623.73
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$8,623.73
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$8,623.73
|
| Rate for Payer: NAPHCARE Commercial |
$12,935.60
|
| Rate for Payer: Quartz Medicare Advantage |
$8,623.73
|
| Rate for Payer: The Alliance Commercial |
$23,974.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8,623.73
|
| Rate for Payer: United Healthcare PPO |
$13,506.54
|
| Rate for Payer: Wellcare Medicare |
$8,623.73
|
|
|
East Equine IgG
|
Professional
|
$87.00
|
|
|
Service Code
|
CPT 86652
|
| Hospital Charge Code |
4916650
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.19 |
| Max. Negotiated Rate |
$82.65 |
| Rate for Payer: Aetna Commercial |
$82.65
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$74.82
|
| Rate for Payer: Aetna Managed Medicare |
$13.19
|
| Rate for Payer: Anthem Medicare Advantage |
$13.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$13.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$13.19
|
| Rate for Payer: Cash Price |
$26.10
|
| Rate for Payer: Cash Price |
$26.10
|
| Rate for Payer: Cigna Commercial |
$82.65
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$43.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$13.19
|
| Rate for Payer: Health EOS Commercial |
$79.17
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$46.56
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$46.56
|
| Rate for Payer: Independent Care Health Plan Medicare |
$13.19
|
| Rate for Payer: Multiplan Commercial |
$69.60
|
| Rate for Payer: Preferred Network Access Commercial |
$82.65
|
| Rate for Payer: Quartz Beloit One Network |
$38.28
|
| Rate for Payer: Quartz Commercial |
$49.59
|
| Rate for Payer: Quartz Medicare Advantage |
$13.19
|
| Rate for Payer: The Alliance Commercial |
$52.10
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.19
|
| Rate for Payer: WEA Trust Commercial |
$47.85
|
| Rate for Payer: WPS Commercial |
$58.04
|
|
|
East Equine IgG
|
Facility
OP
|
$87.00
|
|
|
Service Code
|
CPT 86652
|
| Hospital Charge Code |
4916650
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.17 |
| Max. Negotiated Rate |
$348.00 |
| Rate for Payer: Aetna Commercial |
$78.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$74.82
|
| Rate for Payer: Aetna Managed Medicare |
$13.19
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$49.46
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$23.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$21.90
|
| Rate for Payer: Anthem Medicaid |
$8.17
|
| Rate for Payer: Anthem Medicare Advantage |
$13.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$46.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$13.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$13.19
|
| Rate for Payer: Cash Price |
$26.10
|
| Rate for Payer: Cash Price |
$26.10
|
| Rate for Payer: Cigna Commercial |
$80.04
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$13.19
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$8.17
|
| Rate for Payer: Dean Health Medicaid |
$8.17
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$13.19
|
| Rate for Payer: Health EOS Commercial |
$77.43
|
| Rate for Payer: HFN Commercial |
$80.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$49.07
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$13.19
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$8.17
|
| Rate for Payer: Independent Care Health Plan Medicare |
$13.19
|
| Rate for Payer: Managed Health Services Medicaid |
$8.50
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$13.19
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$13.19
|
| Rate for Payer: Multiplan Commercial |
$69.60
|
| Rate for Payer: NAPHCARE Commercial |
$19.78
|
| Rate for Payer: Preferred Network Access Commercial |
$80.04
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$8.17
|
| Rate for Payer: Quartz Beloit One Network |
$42.63
|
| Rate for Payer: Quartz Commercial |
$56.55
|
| Rate for Payer: Quartz Medicare Advantage |
$13.19
|
| Rate for Payer: The Alliance Commercial |
$348.00
|
| Rate for Payer: United Healthcare Medicaid |
$8.17
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.19
|
| Rate for Payer: United Healthcare PPO |
$65.25
|
| Rate for Payer: WEA Trust Commercial |
$47.85
|
| Rate for Payer: Wellcare Medicare |
$13.19
|
| Rate for Payer: WMAP Medicaid |
$8.17
|
| Rate for Payer: WPS Commercial |
$64.44
|
|
|
East Equine IgG
|
Facility
IP
|
$87.00
|
|
|
Service Code
|
CPT 86652
|
| Hospital Charge Code |
4916650
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$42.63 |
| Max. Negotiated Rate |
$80.04 |
| Rate for Payer: Aetna Commercial |
$78.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$46.11
|
| Rate for Payer: Cash Price |
$26.10
|
| Rate for Payer: Cigna Commercial |
$80.04
|
| Rate for Payer: Health EOS Commercial |
$77.43
|
| Rate for Payer: HFN Commercial |
$80.04
|
| Rate for Payer: Multiplan Commercial |
$69.60
|
| Rate for Payer: NAPHCARE Commercial |
$52.20
|
| Rate for Payer: Preferred Network Access Commercial |
$80.04
|
| Rate for Payer: Quartz Beloit One Network |
$42.63
|
| Rate for Payer: Quartz Commercial |
$52.20
|
| Rate for Payer: WEA Trust Commercial |
$47.85
|
| Rate for Payer: WPS Commercial |
$64.44
|
|
|
East Equine IgM
|
Facility
IP
|
$87.00
|
|
|
Service Code
|
CPT 86652
|
| Hospital Charge Code |
4916651
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$42.63 |
| Max. Negotiated Rate |
$80.04 |
| Rate for Payer: Aetna Commercial |
$78.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$46.11
|
| Rate for Payer: Cash Price |
$26.10
|
| Rate for Payer: Cigna Commercial |
$80.04
|
| Rate for Payer: Health EOS Commercial |
$77.43
|
| Rate for Payer: HFN Commercial |
$80.04
|
| Rate for Payer: Multiplan Commercial |
$69.60
|
| Rate for Payer: NAPHCARE Commercial |
$52.20
|
| Rate for Payer: Preferred Network Access Commercial |
$80.04
|
| Rate for Payer: Quartz Beloit One Network |
$42.63
|
| Rate for Payer: Quartz Commercial |
$52.20
|
| Rate for Payer: WEA Trust Commercial |
$47.85
|
| Rate for Payer: WPS Commercial |
$64.44
|
|
|
East Equine IgM
|
Professional
|
$87.00
|
|
|
Service Code
|
CPT 86652
|
| Hospital Charge Code |
4916651
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.19 |
| Max. Negotiated Rate |
$82.65 |
| Rate for Payer: Aetna Commercial |
$82.65
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$74.82
|
| Rate for Payer: Aetna Managed Medicare |
$13.19
|
| Rate for Payer: Anthem Medicare Advantage |
$13.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$13.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$13.19
|
| Rate for Payer: Cash Price |
$26.10
|
| Rate for Payer: Cash Price |
$26.10
|
| Rate for Payer: Cigna Commercial |
$82.65
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$43.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$13.19
|
| Rate for Payer: Health EOS Commercial |
$79.17
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$46.56
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$46.56
|
| Rate for Payer: Independent Care Health Plan Medicare |
$13.19
|
| Rate for Payer: Multiplan Commercial |
$69.60
|
| Rate for Payer: Preferred Network Access Commercial |
$82.65
|
| Rate for Payer: Quartz Beloit One Network |
$38.28
|
| Rate for Payer: Quartz Commercial |
$49.59
|
| Rate for Payer: Quartz Medicare Advantage |
$13.19
|
| Rate for Payer: The Alliance Commercial |
$52.10
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.19
|
| Rate for Payer: WEA Trust Commercial |
$47.85
|
| Rate for Payer: WPS Commercial |
$58.04
|
|
|
East Equine IgM
|
Facility
OP
|
$87.00
|
|
|
Service Code
|
CPT 86652
|
| Hospital Charge Code |
4916651
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.17 |
| Max. Negotiated Rate |
$348.00 |
| Rate for Payer: Aetna Commercial |
$78.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$74.82
|
| Rate for Payer: Aetna Managed Medicare |
$13.19
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$49.46
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$23.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$21.90
|
| Rate for Payer: Anthem Medicaid |
$8.17
|
| Rate for Payer: Anthem Medicare Advantage |
$13.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$46.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$13.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$13.19
|
| Rate for Payer: Cash Price |
$26.10
|
| Rate for Payer: Cash Price |
$26.10
|
| Rate for Payer: Cigna Commercial |
$80.04
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$13.19
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$8.17
|
| Rate for Payer: Dean Health Medicaid |
$8.17
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$13.19
|
| Rate for Payer: Health EOS Commercial |
$77.43
|
| Rate for Payer: HFN Commercial |
$80.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$49.07
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$13.19
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$8.17
|
| Rate for Payer: Independent Care Health Plan Medicare |
$13.19
|
| Rate for Payer: Managed Health Services Medicaid |
$8.50
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$13.19
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$13.19
|
| Rate for Payer: Multiplan Commercial |
$69.60
|
| Rate for Payer: NAPHCARE Commercial |
$19.78
|
| Rate for Payer: Preferred Network Access Commercial |
$80.04
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$8.17
|
| Rate for Payer: Quartz Beloit One Network |
$42.63
|
| Rate for Payer: Quartz Commercial |
$56.55
|
| Rate for Payer: Quartz Medicare Advantage |
$13.19
|
| Rate for Payer: The Alliance Commercial |
$348.00
|
| Rate for Payer: United Healthcare Medicaid |
$8.17
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.19
|
| Rate for Payer: United Healthcare PPO |
$65.25
|
| Rate for Payer: WEA Trust Commercial |
$47.85
|
| Rate for Payer: Wellcare Medicare |
$13.19
|
| Rate for Payer: WMAP Medicaid |
$8.17
|
| Rate for Payer: WPS Commercial |
$64.44
|
|
|
Eastern Equine IgG
|
Facility
IP
|
$85.00
|
|
|
Service Code
|
CPT 86652
|
| Hospital Charge Code |
4924645
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$41.65 |
| Max. Negotiated Rate |
$78.20 |
| Rate for Payer: Aetna Commercial |
$76.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$45.05
|
| Rate for Payer: Cash Price |
$25.50
|
| Rate for Payer: Cigna Commercial |
$78.20
|
| Rate for Payer: Health EOS Commercial |
$75.65
|
| Rate for Payer: HFN Commercial |
$78.20
|
| Rate for Payer: Multiplan Commercial |
$68.00
|
| Rate for Payer: NAPHCARE Commercial |
$51.00
|
| Rate for Payer: Preferred Network Access Commercial |
$78.20
|
| Rate for Payer: Quartz Beloit One Network |
$41.65
|
| Rate for Payer: Quartz Commercial |
$51.00
|
| Rate for Payer: WEA Trust Commercial |
$46.75
|
| Rate for Payer: WPS Commercial |
$62.96
|
|
|
Eastern Equine IgG
|
Professional
|
$85.00
|
|
|
Service Code
|
CPT 86652
|
| Hospital Charge Code |
4924645
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.19 |
| Max. Negotiated Rate |
$80.75 |
| Rate for Payer: Aetna Commercial |
$80.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$73.10
|
| Rate for Payer: Aetna Managed Medicare |
$13.19
|
| Rate for Payer: Anthem Medicare Advantage |
$13.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$13.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$13.19
|
| Rate for Payer: Cash Price |
$25.50
|
| Rate for Payer: Cash Price |
$25.50
|
| Rate for Payer: Cigna Commercial |
$80.75
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$42.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$13.19
|
| Rate for Payer: Health EOS Commercial |
$77.35
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$46.56
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$46.56
|
| Rate for Payer: Independent Care Health Plan Medicare |
$13.19
|
| Rate for Payer: Multiplan Commercial |
$68.00
|
| Rate for Payer: Preferred Network Access Commercial |
$80.75
|
| Rate for Payer: Quartz Beloit One Network |
$37.40
|
| Rate for Payer: Quartz Commercial |
$48.45
|
| Rate for Payer: Quartz Medicare Advantage |
$13.19
|
| Rate for Payer: The Alliance Commercial |
$52.10
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.19
|
| Rate for Payer: WEA Trust Commercial |
$46.75
|
| Rate for Payer: WPS Commercial |
$58.04
|
|
|
Eastern Equine IgG
|
Facility
OP
|
$85.00
|
|
|
Service Code
|
CPT 86652
|
| Hospital Charge Code |
4924645
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.17 |
| Max. Negotiated Rate |
$340.00 |
| Rate for Payer: Aetna Commercial |
$76.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$73.10
|
| Rate for Payer: Aetna Managed Medicare |
$13.19
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$49.46
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$23.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$21.90
|
| Rate for Payer: Anthem Medicaid |
$8.17
|
| Rate for Payer: Anthem Medicare Advantage |
$13.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$45.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$13.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$13.19
|
| Rate for Payer: Cash Price |
$25.50
|
| Rate for Payer: Cash Price |
$25.50
|
| Rate for Payer: Cigna Commercial |
$78.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$13.19
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$8.17
|
| Rate for Payer: Dean Health Medicaid |
$8.17
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$13.19
|
| Rate for Payer: Health EOS Commercial |
$75.65
|
| Rate for Payer: HFN Commercial |
$78.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$49.07
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$13.19
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$8.17
|
| Rate for Payer: Independent Care Health Plan Medicare |
$13.19
|
| Rate for Payer: Managed Health Services Medicaid |
$8.50
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$13.19
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$13.19
|
| Rate for Payer: Multiplan Commercial |
$68.00
|
| Rate for Payer: NAPHCARE Commercial |
$19.78
|
| Rate for Payer: Preferred Network Access Commercial |
$78.20
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$8.17
|
| Rate for Payer: Quartz Beloit One Network |
$41.65
|
| Rate for Payer: Quartz Commercial |
$55.25
|
| Rate for Payer: Quartz Medicare Advantage |
$13.19
|
| Rate for Payer: The Alliance Commercial |
$340.00
|
| Rate for Payer: United Healthcare Medicaid |
$8.17
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.19
|
| Rate for Payer: United Healthcare PPO |
$63.75
|
| Rate for Payer: WEA Trust Commercial |
$46.75
|
| Rate for Payer: Wellcare Medicare |
$13.19
|
| Rate for Payer: WMAP Medicaid |
$8.17
|
| Rate for Payer: WPS Commercial |
$62.96
|
|
|
Eastern Equine IgM
|
Facility
IP
|
$85.00
|
|
|
Service Code
|
CPT 86652
|
| Hospital Charge Code |
4924646
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$41.65 |
| Max. Negotiated Rate |
$78.20 |
| Rate for Payer: Aetna Commercial |
$76.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$45.05
|
| Rate for Payer: Cash Price |
$25.50
|
| Rate for Payer: Cigna Commercial |
$78.20
|
| Rate for Payer: Health EOS Commercial |
$75.65
|
| Rate for Payer: HFN Commercial |
$78.20
|
| Rate for Payer: Multiplan Commercial |
$68.00
|
| Rate for Payer: NAPHCARE Commercial |
$51.00
|
| Rate for Payer: Preferred Network Access Commercial |
$78.20
|
| Rate for Payer: Quartz Beloit One Network |
$41.65
|
| Rate for Payer: Quartz Commercial |
$51.00
|
| Rate for Payer: WEA Trust Commercial |
$46.75
|
| Rate for Payer: WPS Commercial |
$62.96
|
|
|
Eastern Equine IgM
|
Professional
|
$85.00
|
|
|
Service Code
|
CPT 86652
|
| Hospital Charge Code |
4924646
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.19 |
| Max. Negotiated Rate |
$80.75 |
| Rate for Payer: Aetna Commercial |
$80.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$73.10
|
| Rate for Payer: Aetna Managed Medicare |
$13.19
|
| Rate for Payer: Anthem Medicare Advantage |
$13.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$13.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$13.19
|
| Rate for Payer: Cash Price |
$25.50
|
| Rate for Payer: Cash Price |
$25.50
|
| Rate for Payer: Cigna Commercial |
$80.75
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$42.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$13.19
|
| Rate for Payer: Health EOS Commercial |
$77.35
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$46.56
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$46.56
|
| Rate for Payer: Independent Care Health Plan Medicare |
$13.19
|
| Rate for Payer: Multiplan Commercial |
$68.00
|
| Rate for Payer: Preferred Network Access Commercial |
$80.75
|
| Rate for Payer: Quartz Beloit One Network |
$37.40
|
| Rate for Payer: Quartz Commercial |
$48.45
|
| Rate for Payer: Quartz Medicare Advantage |
$13.19
|
| Rate for Payer: The Alliance Commercial |
$52.10
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.19
|
| Rate for Payer: WEA Trust Commercial |
$46.75
|
| Rate for Payer: WPS Commercial |
$58.04
|
|
|
Eastern Equine IgM
|
Facility
OP
|
$85.00
|
|
|
Service Code
|
CPT 86652
|
| Hospital Charge Code |
4924646
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.17 |
| Max. Negotiated Rate |
$340.00 |
| Rate for Payer: Aetna Commercial |
$76.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$73.10
|
| Rate for Payer: Aetna Managed Medicare |
$13.19
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$49.46
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$23.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$21.90
|
| Rate for Payer: Anthem Medicaid |
$8.17
|
| Rate for Payer: Anthem Medicare Advantage |
$13.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$45.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$13.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$13.19
|
| Rate for Payer: Cash Price |
$25.50
|
| Rate for Payer: Cash Price |
$25.50
|
| Rate for Payer: Cigna Commercial |
$78.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$13.19
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$8.17
|
| Rate for Payer: Dean Health Medicaid |
$8.17
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$13.19
|
| Rate for Payer: Health EOS Commercial |
$75.65
|
| Rate for Payer: HFN Commercial |
$78.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$49.07
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$13.19
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$8.17
|
| Rate for Payer: Independent Care Health Plan Medicare |
$13.19
|
| Rate for Payer: Managed Health Services Medicaid |
$8.50
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$13.19
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$13.19
|
| Rate for Payer: Multiplan Commercial |
$68.00
|
| Rate for Payer: NAPHCARE Commercial |
$19.78
|
| Rate for Payer: Preferred Network Access Commercial |
$78.20
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$8.17
|
| Rate for Payer: Quartz Beloit One Network |
$41.65
|
| Rate for Payer: Quartz Commercial |
$55.25
|
| Rate for Payer: Quartz Medicare Advantage |
$13.19
|
| Rate for Payer: The Alliance Commercial |
$340.00
|
| Rate for Payer: United Healthcare Medicaid |
$8.17
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.19
|
| Rate for Payer: United Healthcare PPO |
$63.75
|
| Rate for Payer: WEA Trust Commercial |
$46.75
|
| Rate for Payer: Wellcare Medicare |
$13.19
|
| Rate for Payer: WMAP Medicaid |
$8.17
|
| Rate for Payer: WPS Commercial |
$62.96
|
|
|
EASY CLIP 10x10x10 EZM10-10-10
|
Facility
OP
|
$6,178.00
|
|
| Hospital Charge Code |
2965383
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,729.84 |
| Max. Negotiated Rate |
$24,712.00 |
| Rate for Payer: Aetna Commercial |
$5,560.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,313.08
|
| Rate for Payer: Aetna Managed Medicare |
$1,729.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,015.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,089.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,965.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,274.34
|
| Rate for Payer: Cash Price |
$1,853.40
|
| Rate for Payer: Cigna Commercial |
$5,683.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,457.21
|
| Rate for Payer: Health EOS Commercial |
$5,498.42
|
| Rate for Payer: HFN Commercial |
$5,683.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,633.50
|
| Rate for Payer: Multiplan Commercial |
$4,942.40
|
| Rate for Payer: NAPHCARE Commercial |
$3,706.80
|
| Rate for Payer: Preferred Network Access Commercial |
$5,683.76
|
| Rate for Payer: Quartz Beloit One Network |
$3,027.22
|
| Rate for Payer: Quartz Commercial |
$4,015.70
|
| Rate for Payer: Quartz Medicare Advantage |
$3,706.80
|
| Rate for Payer: The Alliance Commercial |
$24,712.00
|
| Rate for Payer: WEA Trust Commercial |
$3,397.90
|
| Rate for Payer: WPS Commercial |
$4,576.04
|
|
|
EASY CLIP 10x10x10 EZM10-10-10
|
Facility
IP
|
$6,178.00
|
|
| Hospital Charge Code |
2965383
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,027.22 |
| Max. Negotiated Rate |
$5,683.76 |
| Rate for Payer: Aetna Commercial |
$5,560.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,274.34
|
| Rate for Payer: Cash Price |
$1,853.40
|
| Rate for Payer: Cigna Commercial |
$5,683.76
|
| Rate for Payer: Health EOS Commercial |
$5,498.42
|
| Rate for Payer: HFN Commercial |
$5,683.76
|
| Rate for Payer: Multiplan Commercial |
$4,942.40
|
| Rate for Payer: NAPHCARE Commercial |
$3,706.80
|
| Rate for Payer: Preferred Network Access Commercial |
$5,683.76
|
| Rate for Payer: Quartz Beloit One Network |
$3,027.22
|
| Rate for Payer: Quartz Commercial |
$3,706.80
|
| Rate for Payer: WEA Trust Commercial |
$3,397.90
|
| Rate for Payer: WPS Commercial |
$4,576.04
|
|
|
ebus intervent periph lesion - Bronchoscopy Charge
|
Facility
OP
|
$4,900.00
|
|
|
Service Code
|
CPT 31654
|
| Hospital Charge Code |
5412630
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,372.00 |
| Max. Negotiated Rate |
$5,242.85 |
| Rate for Payer: Aetna Commercial |
$4,410.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,214.00
|
| Rate for Payer: Aetna Managed Medicare |
$1,372.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,185.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,450.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,352.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,597.00
|
| Rate for Payer: Cash Price |
$1,470.00
|
| Rate for Payer: Cash Price |
$1,470.00
|
| Rate for Payer: Cigna Commercial |
$4,508.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,218.22
|
| Rate for Payer: Health EOS Commercial |
$4,361.00
|
| Rate for Payer: HFN Commercial |
$4,508.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,675.00
|
| Rate for Payer: Multiplan Commercial |
$3,920.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,940.00
|
| Rate for Payer: Preferred Network Access Commercial |
$4,508.00
|
| Rate for Payer: Quartz Beloit One Network |
$2,401.00
|
| Rate for Payer: Quartz Commercial |
$3,185.00
|
| Rate for Payer: Quartz Medicare Advantage |
$2,940.00
|
| Rate for Payer: The Alliance Commercial |
$5,242.85
|
| Rate for Payer: WEA Trust Commercial |
$2,695.00
|
| Rate for Payer: WPS Commercial |
$3,629.43
|
|
|
ebus intervent periph lesion - Bronchoscopy Charge
|
Facility
IP
|
$4,900.00
|
|
|
Service Code
|
CPT 31654
|
| Hospital Charge Code |
5412630
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,401.00 |
| Max. Negotiated Rate |
$4,508.00 |
| Rate for Payer: Aetna Commercial |
$4,410.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,597.00
|
| Rate for Payer: Cash Price |
$1,470.00
|
| Rate for Payer: Cigna Commercial |
$4,508.00
|
| Rate for Payer: Health EOS Commercial |
$4,361.00
|
| Rate for Payer: HFN Commercial |
$4,508.00
|
| Rate for Payer: Multiplan Commercial |
$3,920.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,940.00
|
| Rate for Payer: Preferred Network Access Commercial |
$4,508.00
|
| Rate for Payer: Quartz Beloit One Network |
$2,401.00
|
| Rate for Payer: Quartz Commercial |
$2,940.00
|
| Rate for Payer: WEA Trust Commercial |
$2,695.00
|
| Rate for Payer: WPS Commercial |
$3,629.43
|
|
|
ebus sampling 1-2 nodes - Bronchoscopy Charge
|
Facility
IP
|
$7,707.00
|
|
|
Service Code
|
CPT 31652
|
| Hospital Charge Code |
5412628
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,776.43 |
| Max. Negotiated Rate |
$7,090.44 |
| Rate for Payer: Aetna Commercial |
$6,936.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,084.71
|
| Rate for Payer: Cash Price |
$2,312.10
|
| Rate for Payer: Cigna Commercial |
$7,090.44
|
| Rate for Payer: Health EOS Commercial |
$6,859.23
|
| Rate for Payer: HFN Commercial |
$7,090.44
|
| Rate for Payer: Multiplan Commercial |
$6,165.60
|
| Rate for Payer: NAPHCARE Commercial |
$4,624.20
|
| Rate for Payer: Preferred Network Access Commercial |
$7,090.44
|
| Rate for Payer: Quartz Beloit One Network |
$3,776.43
|
| Rate for Payer: Quartz Commercial |
$4,624.20
|
| Rate for Payer: WEA Trust Commercial |
$4,238.85
|
| Rate for Payer: WPS Commercial |
$5,708.57
|
|
|
ebus sampling 1-2 nodes - Bronchoscopy Charge
|
Facility
OP
|
$7,707.00
|
|
|
Service Code
|
CPT 31652
|
| Hospital Charge Code |
5412628
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,701.42 |
| Max. Negotiated Rate |
$13,769.28 |
| Rate for Payer: Aetna Commercial |
$6,936.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,628.02
|
| Rate for Payer: Aetna Managed Medicare |
$3,701.42
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$9,907.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8,043.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7,639.00
|
| Rate for Payer: Anthem Medicare Advantage |
$3,701.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,084.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$3,701.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$3,701.42
|
| Rate for Payer: Cash Price |
$2,312.10
|
| Rate for Payer: Cash Price |
$2,312.10
|
| Rate for Payer: Cash Price |
$2,312.10
|
| Rate for Payer: Cigna Commercial |
$7,090.44
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$3,701.42
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$11,874.87
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$3,701.42
|
| Rate for Payer: Health EOS Commercial |
$6,859.23
|
| Rate for Payer: HFN Commercial |
$7,090.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$13,769.28
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$3,701.42
|
| Rate for Payer: Independent Care Health Plan Medicare |
$3,701.42
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$3,701.42
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$3,701.42
|
| Rate for Payer: Multiplan Commercial |
$6,165.60
|
| Rate for Payer: NAPHCARE Commercial |
$5,552.13
|
| Rate for Payer: Preferred Network Access Commercial |
$7,090.44
|
| Rate for Payer: Quartz Beloit One Network |
$3,776.43
|
| Rate for Payer: Quartz Commercial |
$5,009.55
|
| Rate for Payer: Quartz Medicare Advantage |
$3,701.42
|
| Rate for Payer: The Alliance Commercial |
$5,242.85
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,701.42
|
| Rate for Payer: United Healthcare PPO |
$4,103.00
|
| Rate for Payer: WEA Trust Commercial |
$4,238.85
|
| Rate for Payer: Wellcare Medicare |
$3,701.42
|
| Rate for Payer: WPS Commercial |
$5,708.57
|
|
|
ebus sampling 3 > nodes - Bronchoscopy Charge
|
Facility
OP
|
$10,386.00
|
|
|
Service Code
|
CPT 31653
|
| Hospital Charge Code |
5412629
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,701.42 |
| Max. Negotiated Rate |
$13,769.28 |
| Rate for Payer: Aetna Commercial |
$9,347.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,931.96
|
| Rate for Payer: Aetna Managed Medicare |
$3,701.42
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$9,907.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8,043.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7,639.00
|
| Rate for Payer: Anthem Medicare Advantage |
$3,701.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,504.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$3,701.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$3,701.42
|
| Rate for Payer: Cash Price |
$3,115.80
|
| Rate for Payer: Cash Price |
$3,115.80
|
| Rate for Payer: Cash Price |
$3,115.80
|
| Rate for Payer: Cigna Commercial |
$9,555.12
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$3,701.42
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,546.14
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$3,701.42
|
| Rate for Payer: Health EOS Commercial |
$9,243.54
|
| Rate for Payer: HFN Commercial |
$9,555.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$13,769.28
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$3,701.42
|
| Rate for Payer: Independent Care Health Plan Medicare |
$3,701.42
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$3,701.42
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$3,701.42
|
| Rate for Payer: Multiplan Commercial |
$8,308.80
|
| Rate for Payer: NAPHCARE Commercial |
$5,552.13
|
| Rate for Payer: Preferred Network Access Commercial |
$9,555.12
|
| Rate for Payer: Quartz Beloit One Network |
$5,089.14
|
| Rate for Payer: Quartz Commercial |
$6,750.90
|
| Rate for Payer: Quartz Medicare Advantage |
$3,701.42
|
| Rate for Payer: The Alliance Commercial |
$5,242.85
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,701.42
|
| Rate for Payer: United Healthcare PPO |
$4,103.00
|
| Rate for Payer: WEA Trust Commercial |
$5,712.30
|
| Rate for Payer: Wellcare Medicare |
$3,701.42
|
| Rate for Payer: WPS Commercial |
$7,692.91
|
|
|
ebus sampling 3 > nodes - Bronchoscopy Charge
|
Facility
IP
|
$10,386.00
|
|
|
Service Code
|
CPT 31653
|
| Hospital Charge Code |
5412629
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$5,089.14 |
| Max. Negotiated Rate |
$9,555.12 |
| Rate for Payer: Aetna Commercial |
$9,347.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,504.58
|
| Rate for Payer: Cash Price |
$3,115.80
|
| Rate for Payer: Cigna Commercial |
$9,555.12
|
| Rate for Payer: Health EOS Commercial |
$9,243.54
|
| Rate for Payer: HFN Commercial |
$9,555.12
|
| Rate for Payer: Multiplan Commercial |
$8,308.80
|
| Rate for Payer: NAPHCARE Commercial |
$6,231.60
|
| Rate for Payer: Preferred Network Access Commercial |
$9,555.12
|
| Rate for Payer: Quartz Beloit One Network |
$5,089.14
|
| Rate for Payer: Quartz Commercial |
$6,231.60
|
| Rate for Payer: WEA Trust Commercial |
$5,712.30
|
| Rate for Payer: WPS Commercial |
$7,692.91
|
|
|
ECCENTER TI SYNTHES
|
Facility
IP
|
$4,889.00
|
|
| Hospital Charge Code |
2966227
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,395.61 |
| Max. Negotiated Rate |
$4,497.88 |
| Rate for Payer: Aetna Commercial |
$4,400.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,591.17
|
| Rate for Payer: Cash Price |
$1,466.70
|
| Rate for Payer: Cigna Commercial |
$4,497.88
|
| Rate for Payer: Health EOS Commercial |
$4,351.21
|
| Rate for Payer: HFN Commercial |
$4,497.88
|
| Rate for Payer: Multiplan Commercial |
$3,911.20
|
| Rate for Payer: NAPHCARE Commercial |
$2,933.40
|
| Rate for Payer: Preferred Network Access Commercial |
$4,497.88
|
| Rate for Payer: Quartz Beloit One Network |
$2,395.61
|
| Rate for Payer: Quartz Commercial |
$2,933.40
|
| Rate for Payer: WEA Trust Commercial |
$2,688.95
|
| Rate for Payer: WPS Commercial |
$3,621.28
|
|
|
ECCENTER TI SYNTHES
|
Facility
OP
|
$4,889.00
|
|
| Hospital Charge Code |
2966227
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,368.92 |
| Max. Negotiated Rate |
$19,556.00 |
| Rate for Payer: Aetna Commercial |
$4,400.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,204.54
|
| Rate for Payer: Aetna Managed Medicare |
$1,368.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,177.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,444.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,346.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,591.17
|
| Rate for Payer: Cash Price |
$1,466.70
|
| Rate for Payer: Cigna Commercial |
$4,497.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,735.88
|
| Rate for Payer: Health EOS Commercial |
$4,351.21
|
| Rate for Payer: HFN Commercial |
$4,497.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,666.75
|
| Rate for Payer: Multiplan Commercial |
$3,911.20
|
| Rate for Payer: NAPHCARE Commercial |
$2,933.40
|
| Rate for Payer: Preferred Network Access Commercial |
$4,497.88
|
| Rate for Payer: Quartz Beloit One Network |
$2,395.61
|
| Rate for Payer: Quartz Commercial |
$3,177.85
|
| Rate for Payer: Quartz Medicare Advantage |
$2,933.40
|
| Rate for Payer: The Alliance Commercial |
$19,556.00
|
| Rate for Payer: WEA Trust Commercial |
$2,688.95
|
| Rate for Payer: WPS Commercial |
$3,621.28
|
|
