|
EXTRACTOR CAPTURA 2.8 3-WIRE G32757
|
Facility
|
OP
|
$2,412.00
|
|
| Hospital Charge Code |
2965858
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$702.37 |
| Max. Negotiated Rate |
$2,307.80 |
| Rate for Payer: Aetna Commercial |
$2,257.63
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,157.29
|
| Rate for Payer: Aetna Managed Medicare |
$702.37
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,630.51
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,254.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,204.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,329.49
|
| Rate for Payer: Cash Price |
$723.60
|
| Rate for Payer: Cigna Commercial |
$2,307.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,403.78
|
| Rate for Payer: Health EOS Commercial |
$2,232.55
|
| Rate for Payer: HFN Commercial |
$2,307.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,881.36
|
| Rate for Payer: Multiplan Commercial |
$2,006.78
|
| Rate for Payer: NAPHCARE Commercial |
$1,505.09
|
| Rate for Payer: Preferred Network Access Commercial |
$2,307.80
|
| Rate for Payer: Quartz Beloit One Network |
$1,229.16
|
| Rate for Payer: Quartz Commercial |
$1,630.51
|
| Rate for Payer: Quartz Medicare Advantage |
$1,505.09
|
| Rate for Payer: The Alliance Commercial |
$1,254.24
|
| Rate for Payer: WEA Trust Commercial |
$1,379.66
|
| Rate for Payer: WPS Commercial |
$1,857.96
|
|
|
EXTRACTOR CAPTURA 2.8 4-WIRE G32756
|
Facility
|
IP
|
$1,212.00
|
|
| Hospital Charge Code |
2965859
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$617.64 |
| Max. Negotiated Rate |
$1,159.64 |
| Rate for Payer: Aetna Commercial |
$1,134.43
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,084.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$668.05
|
| Rate for Payer: Cash Price |
$363.60
|
| Rate for Payer: Cigna Commercial |
$1,159.64
|
| Rate for Payer: Health EOS Commercial |
$1,121.83
|
| Rate for Payer: HFN Commercial |
$1,159.64
|
| Rate for Payer: Multiplan Commercial |
$1,008.38
|
| Rate for Payer: Preferred Network Access Commercial |
$1,159.64
|
| Rate for Payer: Quartz Beloit One Network |
$617.64
|
| Rate for Payer: Quartz Commercial |
$756.29
|
| Rate for Payer: WEA Trust Commercial |
$693.26
|
| Rate for Payer: WPS Commercial |
$933.60
|
|
|
EXTRACTOR CAPTURA 2.8 4-WIRE G32756
|
Facility
|
OP
|
$1,212.00
|
|
| Hospital Charge Code |
2965859
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$352.93 |
| Max. Negotiated Rate |
$1,159.64 |
| Rate for Payer: Aetna Commercial |
$1,134.43
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,084.01
|
| Rate for Payer: Aetna Managed Medicare |
$352.93
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$819.31
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$630.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$605.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$668.05
|
| Rate for Payer: Cash Price |
$363.60
|
| Rate for Payer: Cigna Commercial |
$1,159.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$705.38
|
| Rate for Payer: Health EOS Commercial |
$1,121.83
|
| Rate for Payer: HFN Commercial |
$1,159.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$945.36
|
| Rate for Payer: Multiplan Commercial |
$1,008.38
|
| Rate for Payer: NAPHCARE Commercial |
$756.29
|
| Rate for Payer: Preferred Network Access Commercial |
$1,159.64
|
| Rate for Payer: Quartz Beloit One Network |
$617.64
|
| Rate for Payer: Quartz Commercial |
$819.31
|
| Rate for Payer: Quartz Medicare Advantage |
$756.29
|
| Rate for Payer: The Alliance Commercial |
$630.24
|
| Rate for Payer: WEA Trust Commercial |
$693.26
|
| Rate for Payer: WPS Commercial |
$933.60
|
|
|
EXTRACTOR NCIRCLE 1.5FR 115CM G46206
|
Facility
|
IP
|
$1,726.00
|
|
| Hospital Charge Code |
2965860
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$879.57 |
| Max. Negotiated Rate |
$1,651.44 |
| Rate for Payer: Aetna Commercial |
$1,615.54
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,543.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$951.37
|
| Rate for Payer: Cash Price |
$517.80
|
| Rate for Payer: Cigna Commercial |
$1,651.44
|
| Rate for Payer: Health EOS Commercial |
$1,597.59
|
| Rate for Payer: HFN Commercial |
$1,651.44
|
| Rate for Payer: Multiplan Commercial |
$1,436.03
|
| Rate for Payer: Preferred Network Access Commercial |
$1,651.44
|
| Rate for Payer: Quartz Beloit One Network |
$879.57
|
| Rate for Payer: Quartz Commercial |
$1,077.02
|
| Rate for Payer: WEA Trust Commercial |
$987.27
|
| Rate for Payer: WPS Commercial |
$1,329.54
|
|
|
EXTRACTOR NCIRCLE 1.5FR 115CM G46206
|
Facility
|
OP
|
$1,726.00
|
|
| Hospital Charge Code |
2965860
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$502.61 |
| Max. Negotiated Rate |
$1,651.44 |
| Rate for Payer: Aetna Commercial |
$1,615.54
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,543.73
|
| Rate for Payer: Aetna Managed Medicare |
$502.61
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,166.78
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$897.52
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$861.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$951.37
|
| Rate for Payer: Cash Price |
$517.80
|
| Rate for Payer: Cigna Commercial |
$1,651.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,004.53
|
| Rate for Payer: Health EOS Commercial |
$1,597.59
|
| Rate for Payer: HFN Commercial |
$1,651.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,346.28
|
| Rate for Payer: Multiplan Commercial |
$1,436.03
|
| Rate for Payer: NAPHCARE Commercial |
$1,077.02
|
| Rate for Payer: Preferred Network Access Commercial |
$1,651.44
|
| Rate for Payer: Quartz Beloit One Network |
$879.57
|
| Rate for Payer: Quartz Commercial |
$1,166.78
|
| Rate for Payer: Quartz Medicare Advantage |
$1,077.02
|
| Rate for Payer: The Alliance Commercial |
$897.52
|
| Rate for Payer: WEA Trust Commercial |
$987.27
|
| Rate for Payer: WPS Commercial |
$1,329.54
|
|
|
EXTRACTOR NCIRCLE 2.2FR 115CM G18778
|
Facility
|
OP
|
$2,833.00
|
|
| Hospital Charge Code |
2965861
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$824.97 |
| Max. Negotiated Rate |
$2,710.61 |
| Rate for Payer: Aetna Commercial |
$2,651.69
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,533.84
|
| Rate for Payer: Aetna Managed Medicare |
$824.97
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,915.11
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,473.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,414.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,561.55
|
| Rate for Payer: Cash Price |
$849.90
|
| Rate for Payer: Cigna Commercial |
$2,710.61
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,648.81
|
| Rate for Payer: Health EOS Commercial |
$2,622.22
|
| Rate for Payer: HFN Commercial |
$2,710.61
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,209.74
|
| Rate for Payer: Multiplan Commercial |
$2,357.06
|
| Rate for Payer: NAPHCARE Commercial |
$1,767.79
|
| Rate for Payer: Preferred Network Access Commercial |
$2,710.61
|
| Rate for Payer: Quartz Beloit One Network |
$1,443.70
|
| Rate for Payer: Quartz Commercial |
$1,915.11
|
| Rate for Payer: Quartz Medicare Advantage |
$1,767.79
|
| Rate for Payer: The Alliance Commercial |
$1,473.16
|
| Rate for Payer: WEA Trust Commercial |
$1,620.48
|
| Rate for Payer: WPS Commercial |
$2,182.26
|
|
|
EXTRACTOR NCIRCLE 2.2FR 115CM G18778
|
Facility
|
IP
|
$2,833.00
|
|
| Hospital Charge Code |
2965861
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,443.70 |
| Max. Negotiated Rate |
$2,710.61 |
| Rate for Payer: Aetna Commercial |
$2,651.69
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,533.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,561.55
|
| Rate for Payer: Cash Price |
$849.90
|
| Rate for Payer: Cigna Commercial |
$2,710.61
|
| Rate for Payer: Health EOS Commercial |
$2,622.22
|
| Rate for Payer: HFN Commercial |
$2,710.61
|
| Rate for Payer: Multiplan Commercial |
$2,357.06
|
| Rate for Payer: Preferred Network Access Commercial |
$2,710.61
|
| Rate for Payer: Quartz Beloit One Network |
$1,443.70
|
| Rate for Payer: Quartz Commercial |
$1,767.79
|
| Rate for Payer: WEA Trust Commercial |
$1,620.48
|
| Rate for Payer: WPS Commercial |
$2,182.26
|
|
|
EXTRACTOR NGAGE NITINOL STONE 2.2FR/115CM G48297
|
Facility
|
OP
|
$2,870.00
|
|
| Hospital Charge Code |
2965862
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$835.74 |
| Max. Negotiated Rate |
$2,746.02 |
| Rate for Payer: Aetna Commercial |
$2,686.32
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,566.93
|
| Rate for Payer: Aetna Managed Medicare |
$835.74
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,940.12
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,492.40
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,432.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,581.94
|
| Rate for Payer: Cash Price |
$861.00
|
| Rate for Payer: Cigna Commercial |
$2,746.02
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,670.34
|
| Rate for Payer: Health EOS Commercial |
$2,656.47
|
| Rate for Payer: HFN Commercial |
$2,746.02
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,238.60
|
| Rate for Payer: Multiplan Commercial |
$2,387.84
|
| Rate for Payer: NAPHCARE Commercial |
$1,790.88
|
| Rate for Payer: Preferred Network Access Commercial |
$2,746.02
|
| Rate for Payer: Quartz Beloit One Network |
$1,462.55
|
| Rate for Payer: Quartz Commercial |
$1,940.12
|
| Rate for Payer: Quartz Medicare Advantage |
$1,790.88
|
| Rate for Payer: The Alliance Commercial |
$1,492.40
|
| Rate for Payer: WEA Trust Commercial |
$1,641.64
|
| Rate for Payer: WPS Commercial |
$2,210.76
|
|
|
EXTRACTOR NGAGE NITINOL STONE 2.2FR/115CM G48297
|
Facility
|
IP
|
$2,870.00
|
|
| Hospital Charge Code |
2965862
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,462.55 |
| Max. Negotiated Rate |
$2,746.02 |
| Rate for Payer: Aetna Commercial |
$2,686.32
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,566.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,581.94
|
| Rate for Payer: Cash Price |
$861.00
|
| Rate for Payer: Cigna Commercial |
$2,746.02
|
| Rate for Payer: Health EOS Commercial |
$2,656.47
|
| Rate for Payer: HFN Commercial |
$2,746.02
|
| Rate for Payer: Multiplan Commercial |
$2,387.84
|
| Rate for Payer: Preferred Network Access Commercial |
$2,746.02
|
| Rate for Payer: Quartz Beloit One Network |
$1,462.55
|
| Rate for Payer: Quartz Commercial |
$1,790.88
|
| Rate for Payer: WEA Trust Commercial |
$1,641.64
|
| Rate for Payer: WPS Commercial |
$2,210.76
|
|
|
EXTRACTOR NTRAP 2.8FR 145CM G32724
|
Facility
|
IP
|
$2,952.00
|
|
| Hospital Charge Code |
2965863
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,504.34 |
| Max. Negotiated Rate |
$2,824.47 |
| Rate for Payer: Aetna Commercial |
$2,763.07
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,640.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,627.14
|
| Rate for Payer: Cash Price |
$885.60
|
| Rate for Payer: Cigna Commercial |
$2,824.47
|
| Rate for Payer: Health EOS Commercial |
$2,732.37
|
| Rate for Payer: HFN Commercial |
$2,824.47
|
| Rate for Payer: Multiplan Commercial |
$2,456.06
|
| Rate for Payer: Preferred Network Access Commercial |
$2,824.47
|
| Rate for Payer: Quartz Beloit One Network |
$1,504.34
|
| Rate for Payer: Quartz Commercial |
$1,842.05
|
| Rate for Payer: WEA Trust Commercial |
$1,688.54
|
| Rate for Payer: WPS Commercial |
$2,273.93
|
|
|
EXTRACTOR NTRAP 2.8FR 145CM G32724
|
Facility
|
OP
|
$2,952.00
|
|
| Hospital Charge Code |
2965863
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$859.62 |
| Max. Negotiated Rate |
$2,824.47 |
| Rate for Payer: Aetna Commercial |
$2,763.07
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,640.27
|
| Rate for Payer: Aetna Managed Medicare |
$859.62
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,995.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,535.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,473.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,627.14
|
| Rate for Payer: Cash Price |
$885.60
|
| Rate for Payer: Cigna Commercial |
$2,824.47
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,718.06
|
| Rate for Payer: Health EOS Commercial |
$2,732.37
|
| Rate for Payer: HFN Commercial |
$2,824.47
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,302.56
|
| Rate for Payer: Multiplan Commercial |
$2,456.06
|
| Rate for Payer: NAPHCARE Commercial |
$1,842.05
|
| Rate for Payer: Preferred Network Access Commercial |
$2,824.47
|
| Rate for Payer: Quartz Beloit One Network |
$1,504.34
|
| Rate for Payer: Quartz Commercial |
$1,995.55
|
| Rate for Payer: Quartz Medicare Advantage |
$1,842.05
|
| Rate for Payer: The Alliance Commercial |
$1,535.04
|
| Rate for Payer: WEA Trust Commercial |
$1,688.54
|
| Rate for Payer: WPS Commercial |
$2,273.93
|
|
|
EXTRAOCULAR PROCEDURES EXCEPT ORBIT
|
Facility
|
IP
|
$43,587.44
|
|
|
Service Code
|
MSDRG 115
|
| Min. Negotiated Rate |
$12,261.34 |
| Max. Negotiated Rate |
$43,587.44 |
| Rate for Payer: Aetna Managed Medicare |
$12,261.34
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$33,490.29
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$25,670.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$24,388.21
|
| Rate for Payer: Anthem Medicare Advantage |
$12,261.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$12,261.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$12,261.34
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$12,261.34
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$27,073.15
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$12,261.34
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$31,726.03
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$12,261.34
|
| Rate for Payer: Independent Care Health Plan Medicare |
$12,261.34
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$12,261.34
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$12,261.34
|
| Rate for Payer: NAPHCARE Commercial |
$18,392.01
|
| Rate for Payer: Quartz Medicare Advantage |
$12,261.34
|
| Rate for Payer: The Alliance Commercial |
$43,587.44
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12,261.34
|
| Rate for Payer: United Healthcare PPO |
$24,699.13
|
| Rate for Payer: Wellcare Medicare |
$12,261.34
|
|
|
EXTREME IMMATURITY OR RESPIRATORY DISTRESS SYNDROME, NEONATE
|
Facility
|
IP
|
$166,232.56
|
|
|
Service Code
|
MSDRG 790
|
| Min. Negotiated Rate |
$3,321.76 |
| Max. Negotiated Rate |
$166,232.56 |
| Rate for Payer: Aetna Managed Medicare |
$46,023.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,242.16
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,583.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,403.92
|
| Rate for Payer: Anthem Medicare Advantage |
$46,023.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$46,023.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$46,023.28
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$46,023.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$104,833.71
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$46,023.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,108.00
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$46,023.28
|
| Rate for Payer: Independent Care Health Plan Medicare |
$46,023.28
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$46,023.28
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$46,023.28
|
| Rate for Payer: NAPHCARE Commercial |
$69,034.91
|
| Rate for Payer: Quartz Medicare Advantage |
$46,023.28
|
| Rate for Payer: The Alliance Commercial |
$166,232.56
|
| Rate for Payer: United Healthcare Medicare Advantage |
$46,023.28
|
| Rate for Payer: United Healthcare PPO |
$3,321.76
|
| Rate for Payer: Wellcare Medicare |
$46,023.28
|
|
|
EXTREMITY STUDY 9392426
|
Professional
|
Both
|
$166.00
|
|
|
Service Code
|
CPT 93924 26
|
| Hospital Charge Code |
3015432
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$22.98 |
| Max. Negotiated Rate |
$164.01 |
| Rate for Payer: Aetna Commercial |
$164.01
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$148.47
|
| Rate for Payer: Aetna Managed Medicare |
$22.98
|
| Rate for Payer: Anthem Medicare Advantage |
$22.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$22.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$22.98
|
| Rate for Payer: Cash Price |
$49.80
|
| Rate for Payer: Cash Price |
$49.80
|
| Rate for Payer: Cash Price |
$49.80
|
| Rate for Payer: Cigna Commercial |
$164.01
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$27.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$22.98
|
| Rate for Payer: Health EOS Commercial |
$157.10
|
| Rate for Payer: HFN Commercial |
$164.01
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$84.03
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$84.03
|
| Rate for Payer: Independent Care Health Plan Medicare |
$22.98
|
| Rate for Payer: Multiplan Commercial |
$138.11
|
| Rate for Payer: NAPHCARE Commercial |
$34.48
|
| Rate for Payer: Preferred Network Access Commercial |
$164.01
|
| Rate for Payer: Quartz Beloit One Network |
$75.96
|
| Rate for Payer: Quartz Commercial |
$98.40
|
| Rate for Payer: Quartz Medicare Advantage |
$22.98
|
| Rate for Payer: The Alliance Commercial |
$57.46
|
| Rate for Payer: United Healthcare Medicaid |
$27.84
|
| Rate for Payer: United Healthcare Medicare Advantage |
$22.98
|
| Rate for Payer: WEA Trust Commercial |
$94.95
|
| Rate for Payer: WPS Commercial |
$91.94
|
|
|
EXTREMITY STUDY 9397026
|
Professional
|
Both
|
$1,073.00
|
|
|
Service Code
|
CPT 93970 26
|
| Hospital Charge Code |
3015442
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$31.58 |
| Max. Negotiated Rate |
$1,060.12 |
| Rate for Payer: Aetna Commercial |
$1,060.12
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$959.69
|
| Rate for Payer: Aetna Managed Medicare |
$31.58
|
| Rate for Payer: Anthem Medicare Advantage |
$31.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$31.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$31.58
|
| Rate for Payer: Cash Price |
$321.90
|
| Rate for Payer: Cash Price |
$321.90
|
| Rate for Payer: Cash Price |
$321.90
|
| Rate for Payer: Cigna Commercial |
$1,060.12
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$34.37
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$31.58
|
| Rate for Payer: Health EOS Commercial |
$1,015.49
|
| Rate for Payer: HFN Commercial |
$1,060.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$118.10
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$118.10
|
| Rate for Payer: Independent Care Health Plan Medicare |
$31.58
|
| Rate for Payer: Multiplan Commercial |
$892.74
|
| Rate for Payer: NAPHCARE Commercial |
$47.38
|
| Rate for Payer: Preferred Network Access Commercial |
$1,060.12
|
| Rate for Payer: Quartz Beloit One Network |
$491.00
|
| Rate for Payer: Quartz Commercial |
$636.07
|
| Rate for Payer: Quartz Medicare Advantage |
$31.58
|
| Rate for Payer: The Alliance Commercial |
$78.96
|
| Rate for Payer: United Healthcare Medicaid |
$34.37
|
| Rate for Payer: United Healthcare Medicare Advantage |
$31.58
|
| Rate for Payer: WEA Trust Commercial |
$613.76
|
| Rate for Payer: WPS Commercial |
$126.34
|
|
|
EXTREMITY STUDY COMP BILAT 3 OR MORE LEVELS 9392326
|
Professional
|
Both
|
$113.00
|
|
|
Service Code
|
CPT 93923 26
|
| Hospital Charge Code |
3015431
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$20.58 |
| Max. Negotiated Rate |
$111.64 |
| Rate for Payer: Aetna Commercial |
$111.64
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$101.07
|
| Rate for Payer: Aetna Managed Medicare |
$20.58
|
| Rate for Payer: Anthem Medicare Advantage |
$20.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$20.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$20.58
|
| Rate for Payer: Cash Price |
$33.90
|
| Rate for Payer: Cash Price |
$33.90
|
| Rate for Payer: Cash Price |
$33.90
|
| Rate for Payer: Cigna Commercial |
$111.64
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$24.81
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$20.58
|
| Rate for Payer: Health EOS Commercial |
$106.94
|
| Rate for Payer: HFN Commercial |
$111.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$75.22
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$75.22
|
| Rate for Payer: Independent Care Health Plan Medicare |
$20.58
|
| Rate for Payer: Multiplan Commercial |
$94.02
|
| Rate for Payer: NAPHCARE Commercial |
$30.87
|
| Rate for Payer: Preferred Network Access Commercial |
$111.64
|
| Rate for Payer: Quartz Beloit One Network |
$51.71
|
| Rate for Payer: Quartz Commercial |
$66.99
|
| Rate for Payer: Quartz Medicare Advantage |
$20.58
|
| Rate for Payer: The Alliance Commercial |
$51.45
|
| Rate for Payer: United Healthcare Medicaid |
$24.81
|
| Rate for Payer: United Healthcare Medicare Advantage |
$20.58
|
| Rate for Payer: WEA Trust Commercial |
$64.64
|
| Rate for Payer: WPS Commercial |
$82.33
|
|
|
EXTREMITY STUDY LIMITED 1-2 LEVELS 9392226
|
Professional
|
Both
|
$150.00
|
|
|
Service Code
|
CPT 93922 26
|
| Hospital Charge Code |
3015430
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$11.32 |
| Max. Negotiated Rate |
$148.20 |
| Rate for Payer: Aetna Commercial |
$148.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$134.16
|
| Rate for Payer: Aetna Managed Medicare |
$11.32
|
| Rate for Payer: Anthem Medicare Advantage |
$11.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$11.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$11.32
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Cigna Commercial |
$148.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$13.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$11.32
|
| Rate for Payer: Health EOS Commercial |
$141.96
|
| Rate for Payer: HFN Commercial |
$148.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$43.21
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$43.21
|
| Rate for Payer: Independent Care Health Plan Medicare |
$11.32
|
| Rate for Payer: Multiplan Commercial |
$124.80
|
| Rate for Payer: NAPHCARE Commercial |
$16.97
|
| Rate for Payer: Preferred Network Access Commercial |
$148.20
|
| Rate for Payer: Quartz Beloit One Network |
$68.64
|
| Rate for Payer: Quartz Commercial |
$88.92
|
| Rate for Payer: Quartz Medicare Advantage |
$11.32
|
| Rate for Payer: The Alliance Commercial |
$28.29
|
| Rate for Payer: United Healthcare Medicaid |
$13.76
|
| Rate for Payer: United Healthcare Medicare Advantage |
$11.32
|
| Rate for Payer: WEA Trust Commercial |
$85.80
|
| Rate for Payer: WPS Commercial |
$45.26
|
|
|
Ext Telemetry 72 hrs up to 7 days recording
|
Facility
|
IP
|
$100.00
|
|
|
Service Code
|
CPT 93242
|
| Hospital Charge Code |
5753623
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$50.96 |
| Max. Negotiated Rate |
$95.68 |
| Rate for Payer: Aetna Commercial |
$93.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$89.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$55.12
|
| Rate for Payer: Cash Price |
$30.00
|
| Rate for Payer: Cigna Commercial |
$95.68
|
| Rate for Payer: Health EOS Commercial |
$92.56
|
| Rate for Payer: HFN Commercial |
$95.68
|
| Rate for Payer: Multiplan Commercial |
$83.20
|
| Rate for Payer: Preferred Network Access Commercial |
$95.68
|
| Rate for Payer: Quartz Beloit One Network |
$50.96
|
| Rate for Payer: Quartz Commercial |
$62.40
|
| Rate for Payer: WEA Trust Commercial |
$57.20
|
| Rate for Payer: WPS Commercial |
$77.03
|
|
|
Ext Telemetry 72 hrs up to 7 days recording
|
Professional
|
Both
|
$100.00
|
|
|
Service Code
|
CPT 93242
|
| Hospital Charge Code |
5753623
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$11.42 |
| Max. Negotiated Rate |
$98.80 |
| Rate for Payer: Aetna Commercial |
$98.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$89.44
|
| Rate for Payer: Aetna Managed Medicare |
$11.42
|
| Rate for Payer: Anthem Medicare Advantage |
$11.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$11.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$11.42
|
| Rate for Payer: Cash Price |
$30.00
|
| Rate for Payer: Cash Price |
$30.00
|
| Rate for Payer: Cash Price |
$30.00
|
| Rate for Payer: Cigna Commercial |
$98.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$11.85
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$11.42
|
| Rate for Payer: Health EOS Commercial |
$94.64
|
| Rate for Payer: HFN Commercial |
$98.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$52.28
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$52.28
|
| Rate for Payer: Independent Care Health Plan Medicare |
$11.42
|
| Rate for Payer: Multiplan Commercial |
$83.20
|
| Rate for Payer: NAPHCARE Commercial |
$17.13
|
| Rate for Payer: Preferred Network Access Commercial |
$98.80
|
| Rate for Payer: Quartz Beloit One Network |
$45.76
|
| Rate for Payer: Quartz Commercial |
$59.28
|
| Rate for Payer: Quartz Medicare Advantage |
$11.42
|
| Rate for Payer: The Alliance Commercial |
$43.39
|
| Rate for Payer: United Healthcare Medicaid |
$11.85
|
| Rate for Payer: United Healthcare Medicare Advantage |
$11.42
|
| Rate for Payer: WEA Trust Commercial |
$57.20
|
| Rate for Payer: WPS Commercial |
$45.68
|
|
|
Ext Telemetry 72 hrs up to 7 days recording
|
Facility
|
OP
|
$100.00
|
|
|
Service Code
|
CPT 93242
|
| Hospital Charge Code |
5753623
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$39.31 |
| Max. Negotiated Rate |
$157.25 |
| Rate for Payer: Aetna Commercial |
$93.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$89.44
|
| Rate for Payer: Aetna Managed Medicare |
$39.31
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$67.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$52.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$49.92
|
| Rate for Payer: Anthem Medicare Advantage |
$39.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$55.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$39.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$39.31
|
| Rate for Payer: Cash Price |
$30.00
|
| Rate for Payer: Cash Price |
$30.00
|
| Rate for Payer: Cigna Commercial |
$95.68
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$39.31
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$58.20
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$39.31
|
| Rate for Payer: Health EOS Commercial |
$92.56
|
| Rate for Payer: HFN Commercial |
$95.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$146.24
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$39.31
|
| Rate for Payer: Independent Care Health Plan Medicare |
$39.31
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$39.31
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$39.31
|
| Rate for Payer: Multiplan Commercial |
$83.20
|
| Rate for Payer: NAPHCARE Commercial |
$58.97
|
| Rate for Payer: Preferred Network Access Commercial |
$95.68
|
| Rate for Payer: Quartz Beloit One Network |
$50.96
|
| Rate for Payer: Quartz Commercial |
$67.60
|
| Rate for Payer: Quartz Medicare Advantage |
$39.31
|
| Rate for Payer: The Alliance Commercial |
$157.25
|
| Rate for Payer: United Healthcare Medicare Advantage |
$39.31
|
| Rate for Payer: United Healthcare PPO |
$78.00
|
| Rate for Payer: WEA Trust Commercial |
$57.20
|
| Rate for Payer: Wellcare Medicare |
$39.31
|
| Rate for Payer: WPS Commercial |
$77.03
|
|
|
Ext Telemetry 7 days up to 15 days recording
|
Facility
|
OP
|
$100.00
|
|
|
Service Code
|
CPT 93246
|
| Hospital Charge Code |
5753624
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$39.31 |
| Max. Negotiated Rate |
$157.25 |
| Rate for Payer: Aetna Commercial |
$93.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$89.44
|
| Rate for Payer: Aetna Managed Medicare |
$39.31
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$67.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$52.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$49.92
|
| Rate for Payer: Anthem Medicare Advantage |
$39.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$55.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$39.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$39.31
|
| Rate for Payer: Cash Price |
$30.00
|
| Rate for Payer: Cash Price |
$30.00
|
| Rate for Payer: Cigna Commercial |
$95.68
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$39.31
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$58.20
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$39.31
|
| Rate for Payer: Health EOS Commercial |
$92.56
|
| Rate for Payer: HFN Commercial |
$95.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$146.24
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$39.31
|
| Rate for Payer: Independent Care Health Plan Medicare |
$39.31
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$39.31
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$39.31
|
| Rate for Payer: Multiplan Commercial |
$83.20
|
| Rate for Payer: NAPHCARE Commercial |
$58.97
|
| Rate for Payer: Preferred Network Access Commercial |
$95.68
|
| Rate for Payer: Quartz Beloit One Network |
$50.96
|
| Rate for Payer: Quartz Commercial |
$67.60
|
| Rate for Payer: Quartz Medicare Advantage |
$39.31
|
| Rate for Payer: The Alliance Commercial |
$157.25
|
| Rate for Payer: United Healthcare Medicare Advantage |
$39.31
|
| Rate for Payer: United Healthcare PPO |
$78.00
|
| Rate for Payer: WEA Trust Commercial |
$57.20
|
| Rate for Payer: Wellcare Medicare |
$39.31
|
| Rate for Payer: WPS Commercial |
$77.03
|
|
|
Ext Telemetry 7 days up to 15 days recording
|
Facility
|
IP
|
$100.00
|
|
|
Service Code
|
CPT 93246
|
| Hospital Charge Code |
5753624
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$50.96 |
| Max. Negotiated Rate |
$95.68 |
| Rate for Payer: Aetna Commercial |
$93.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$89.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$55.12
|
| Rate for Payer: Cash Price |
$30.00
|
| Rate for Payer: Cigna Commercial |
$95.68
|
| Rate for Payer: Health EOS Commercial |
$92.56
|
| Rate for Payer: HFN Commercial |
$95.68
|
| Rate for Payer: Multiplan Commercial |
$83.20
|
| Rate for Payer: Preferred Network Access Commercial |
$95.68
|
| Rate for Payer: Quartz Beloit One Network |
$50.96
|
| Rate for Payer: Quartz Commercial |
$62.40
|
| Rate for Payer: WEA Trust Commercial |
$57.20
|
| Rate for Payer: WPS Commercial |
$77.03
|
|
|
Ext Telemetry 7 days up to 15 days recording
|
Professional
|
Both
|
$100.00
|
|
|
Service Code
|
CPT 93246
|
| Hospital Charge Code |
5753624
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$11.42 |
| Max. Negotiated Rate |
$98.80 |
| Rate for Payer: Aetna Commercial |
$98.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$89.44
|
| Rate for Payer: Aetna Managed Medicare |
$11.42
|
| Rate for Payer: Anthem Medicare Advantage |
$11.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$11.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$11.42
|
| Rate for Payer: Cash Price |
$30.00
|
| Rate for Payer: Cash Price |
$30.00
|
| Rate for Payer: Cash Price |
$30.00
|
| Rate for Payer: Cigna Commercial |
$98.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$11.85
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$11.42
|
| Rate for Payer: Health EOS Commercial |
$94.64
|
| Rate for Payer: HFN Commercial |
$98.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$52.28
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$52.28
|
| Rate for Payer: Independent Care Health Plan Medicare |
$11.42
|
| Rate for Payer: Multiplan Commercial |
$83.20
|
| Rate for Payer: NAPHCARE Commercial |
$17.13
|
| Rate for Payer: Preferred Network Access Commercial |
$98.80
|
| Rate for Payer: Quartz Beloit One Network |
$45.76
|
| Rate for Payer: Quartz Commercial |
$59.28
|
| Rate for Payer: Quartz Medicare Advantage |
$11.42
|
| Rate for Payer: The Alliance Commercial |
$43.39
|
| Rate for Payer: United Healthcare Medicaid |
$11.85
|
| Rate for Payer: United Healthcare Medicare Advantage |
$11.42
|
| Rate for Payer: WEA Trust Commercial |
$57.20
|
| Rate for Payer: WPS Commercial |
$45.68
|
|
|
Eye Culture
|
Facility
|
OP
|
$225.00
|
|
|
Service Code
|
CPT 87070
|
| Hospital Charge Code |
633892
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.96 |
| Max. Negotiated Rate |
$215.28 |
| Rate for Payer: Aetna Commercial |
$210.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$201.24
|
| Rate for Payer: Aetna Managed Medicare |
$8.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$33.62
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$15.69
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$14.88
|
| Rate for Payer: Anthem Medicare Advantage |
$8.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$124.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$8.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$8.96
|
| Rate for Payer: Cash Price |
$67.50
|
| Rate for Payer: Cash Price |
$67.50
|
| Rate for Payer: Cigna Commercial |
$215.28
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$8.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$130.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$8.96
|
| Rate for Payer: Health EOS Commercial |
$208.26
|
| Rate for Payer: HFN Commercial |
$215.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$33.35
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$8.96
|
| Rate for Payer: Independent Care Health Plan Medicare |
$8.96
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$8.96
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$8.96
|
| Rate for Payer: Multiplan Commercial |
$187.20
|
| Rate for Payer: NAPHCARE Commercial |
$13.45
|
| Rate for Payer: Preferred Network Access Commercial |
$215.28
|
| Rate for Payer: Quartz Beloit One Network |
$114.66
|
| Rate for Payer: Quartz Commercial |
$152.10
|
| Rate for Payer: Quartz Medicare Advantage |
$8.96
|
| Rate for Payer: The Alliance Commercial |
$35.86
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8.96
|
| Rate for Payer: United Healthcare PPO |
$175.50
|
| Rate for Payer: WEA Trust Commercial |
$128.70
|
| Rate for Payer: Wellcare Medicare |
$8.96
|
| Rate for Payer: WPS Commercial |
$173.32
|
|
|
Eye Culture
|
Professional
|
Both
|
$225.00
|
|
|
Service Code
|
CPT 87070
|
| Hospital Charge Code |
633892
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.96 |
| Max. Negotiated Rate |
$222.30 |
| Rate for Payer: Aetna Commercial |
$222.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$201.24
|
| Rate for Payer: Aetna Managed Medicare |
$8.96
|
| Rate for Payer: Anthem Medicare Advantage |
$8.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$8.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$8.96
|
| Rate for Payer: Cash Price |
$67.50
|
| Rate for Payer: Cash Price |
$67.50
|
| Rate for Payer: Cigna Commercial |
$222.30
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$117.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$8.96
|
| Rate for Payer: Health EOS Commercial |
$212.94
|
| Rate for Payer: HFN Commercial |
$222.30
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$31.65
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$31.65
|
| Rate for Payer: Independent Care Health Plan Medicare |
$8.96
|
| Rate for Payer: Multiplan Commercial |
$187.20
|
| Rate for Payer: NAPHCARE Commercial |
$13.45
|
| Rate for Payer: Preferred Network Access Commercial |
$222.30
|
| Rate for Payer: Quartz Beloit One Network |
$102.96
|
| Rate for Payer: Quartz Commercial |
$133.38
|
| Rate for Payer: Quartz Medicare Advantage |
$8.96
|
| Rate for Payer: The Alliance Commercial |
$35.41
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8.96
|
| Rate for Payer: WEA Trust Commercial |
$128.70
|
| Rate for Payer: WPS Commercial |
$39.45
|
|
