|
Fentanyl 50mcg/2ml syringe [Med]
|
Facility
|
OP
|
$8.00
|
|
|
Service Code
|
HCPCS J3010
|
| Hospital Charge Code |
5286879
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.36 |
| Max. Negotiated Rate |
$7.65 |
| Rate for Payer: Aetna Commercial |
$7.49
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7.16
|
| Rate for Payer: Aetna Managed Medicare |
$2.33
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5.41
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4.41
|
| Rate for Payer: Cash Price |
$2.40
|
| Rate for Payer: Cash Price |
$2.40
|
| Rate for Payer: Cigna Commercial |
$7.65
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1.36
|
| Rate for Payer: Health EOS Commercial |
$7.40
|
| Rate for Payer: HFN Commercial |
$7.65
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6.24
|
| Rate for Payer: Multiplan Commercial |
$6.66
|
| Rate for Payer: NAPHCARE Commercial |
$4.99
|
| Rate for Payer: Preferred Network Access Commercial |
$7.65
|
| Rate for Payer: Quartz Beloit One Network |
$4.08
|
| Rate for Payer: Quartz Commercial |
$5.41
|
| Rate for Payer: Quartz Medicare Advantage |
$4.99
|
| Rate for Payer: The Alliance Commercial |
$4.95
|
| Rate for Payer: WEA Trust Commercial |
$4.58
|
| Rate for Payer: WPS Commercial |
$2.58
|
|
|
Fentanyl, Qualitative, Serum
|
Facility
|
OP
|
$171.00
|
|
|
Service Code
|
CPT 80354
|
| Hospital Charge Code |
5605738
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$49.80 |
| Max. Negotiated Rate |
$163.61 |
| Rate for Payer: Aetna Commercial |
$160.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$152.94
|
| Rate for Payer: Aetna Managed Medicare |
$49.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$115.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$88.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$85.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$94.26
|
| Rate for Payer: Cash Price |
$51.30
|
| Rate for Payer: Cigna Commercial |
$163.61
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$99.52
|
| Rate for Payer: Health EOS Commercial |
$158.28
|
| Rate for Payer: HFN Commercial |
$163.61
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$133.38
|
| Rate for Payer: Multiplan Commercial |
$142.27
|
| Rate for Payer: NAPHCARE Commercial |
$106.70
|
| Rate for Payer: Preferred Network Access Commercial |
$163.61
|
| Rate for Payer: Quartz Beloit One Network |
$87.14
|
| Rate for Payer: Quartz Commercial |
$115.60
|
| Rate for Payer: Quartz Medicare Advantage |
$106.70
|
| Rate for Payer: The Alliance Commercial |
$88.92
|
| Rate for Payer: United Healthcare PPO |
$133.38
|
| Rate for Payer: WEA Trust Commercial |
$97.81
|
| Rate for Payer: WPS Commercial |
$131.72
|
|
|
Fentanyl, Qualitative, Serum
|
Professional
|
Both
|
$171.00
|
|
|
Service Code
|
CPT 80354
|
| Hospital Charge Code |
5605738
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$78.25 |
| Max. Negotiated Rate |
$168.95 |
| Rate for Payer: Aetna Commercial |
$168.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$152.94
|
| Rate for Payer: Cash Price |
$51.30
|
| Rate for Payer: Cash Price |
$51.30
|
| Rate for Payer: Cigna Commercial |
$168.95
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$88.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$106.70
|
| Rate for Payer: Health EOS Commercial |
$161.83
|
| Rate for Payer: HFN Commercial |
$168.95
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$83.26
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$83.26
|
| Rate for Payer: Multiplan Commercial |
$142.27
|
| Rate for Payer: Preferred Network Access Commercial |
$168.95
|
| Rate for Payer: Quartz Beloit One Network |
$78.25
|
| Rate for Payer: Quartz Commercial |
$101.37
|
| Rate for Payer: The Alliance Commercial |
$88.92
|
| Rate for Payer: WEA Trust Commercial |
$97.81
|
| Rate for Payer: WPS Commercial |
$131.72
|
|
|
Fentanyl, Qualitative, Serum
|
Facility
|
IP
|
$171.00
|
|
|
Service Code
|
CPT 80354
|
| Hospital Charge Code |
5605738
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$87.14 |
| Max. Negotiated Rate |
$163.61 |
| Rate for Payer: Aetna Commercial |
$160.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$152.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$94.26
|
| Rate for Payer: Cash Price |
$51.30
|
| Rate for Payer: Cigna Commercial |
$163.61
|
| Rate for Payer: Health EOS Commercial |
$158.28
|
| Rate for Payer: HFN Commercial |
$163.61
|
| Rate for Payer: Multiplan Commercial |
$142.27
|
| Rate for Payer: Preferred Network Access Commercial |
$163.61
|
| Rate for Payer: Quartz Beloit One Network |
$87.14
|
| Rate for Payer: Quartz Commercial |
$106.70
|
| Rate for Payer: WEA Trust Commercial |
$97.81
|
| Rate for Payer: WPS Commercial |
$131.72
|
|
|
Fentanyl, Quantitative Urine
|
Facility
|
IP
|
$145.00
|
|
|
Service Code
|
CPT 80354
|
| Hospital Charge Code |
5208634
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$73.89 |
| Max. Negotiated Rate |
$138.74 |
| Rate for Payer: Aetna Commercial |
$135.72
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$129.69
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$79.92
|
| Rate for Payer: Cash Price |
$43.50
|
| Rate for Payer: Cigna Commercial |
$138.74
|
| Rate for Payer: Health EOS Commercial |
$134.21
|
| Rate for Payer: HFN Commercial |
$138.74
|
| Rate for Payer: Multiplan Commercial |
$120.64
|
| Rate for Payer: Preferred Network Access Commercial |
$138.74
|
| Rate for Payer: Quartz Beloit One Network |
$73.89
|
| Rate for Payer: Quartz Commercial |
$90.48
|
| Rate for Payer: WEA Trust Commercial |
$82.94
|
| Rate for Payer: WPS Commercial |
$111.69
|
|
|
Fentanyl, Quantitative Urine
|
Facility
|
OP
|
$145.00
|
|
|
Service Code
|
CPT 80354
|
| Hospital Charge Code |
5208634
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$42.22 |
| Max. Negotiated Rate |
$138.74 |
| Rate for Payer: Aetna Commercial |
$135.72
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$129.69
|
| Rate for Payer: Aetna Managed Medicare |
$42.22
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$98.02
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$75.40
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$72.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$79.92
|
| Rate for Payer: Cash Price |
$43.50
|
| Rate for Payer: Cigna Commercial |
$138.74
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$84.39
|
| Rate for Payer: Health EOS Commercial |
$134.21
|
| Rate for Payer: HFN Commercial |
$138.74
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$113.10
|
| Rate for Payer: Multiplan Commercial |
$120.64
|
| Rate for Payer: NAPHCARE Commercial |
$90.48
|
| Rate for Payer: Preferred Network Access Commercial |
$138.74
|
| Rate for Payer: Quartz Beloit One Network |
$73.89
|
| Rate for Payer: Quartz Commercial |
$98.02
|
| Rate for Payer: Quartz Medicare Advantage |
$90.48
|
| Rate for Payer: The Alliance Commercial |
$75.40
|
| Rate for Payer: United Healthcare PPO |
$113.10
|
| Rate for Payer: WEA Trust Commercial |
$82.94
|
| Rate for Payer: WPS Commercial |
$111.69
|
|
|
Fentanyl, Quantitative Urine
|
Professional
|
Both
|
$145.00
|
|
|
Service Code
|
CPT 80354
|
| Hospital Charge Code |
5208634
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$66.35 |
| Max. Negotiated Rate |
$143.26 |
| Rate for Payer: Aetna Commercial |
$143.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$129.69
|
| Rate for Payer: Cash Price |
$43.50
|
| Rate for Payer: Cash Price |
$43.50
|
| Rate for Payer: Cigna Commercial |
$143.26
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$75.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$90.48
|
| Rate for Payer: Health EOS Commercial |
$137.23
|
| Rate for Payer: HFN Commercial |
$143.26
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$83.26
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$83.26
|
| Rate for Payer: Multiplan Commercial |
$120.64
|
| Rate for Payer: Preferred Network Access Commercial |
$143.26
|
| Rate for Payer: Quartz Beloit One Network |
$66.35
|
| Rate for Payer: Quartz Commercial |
$85.96
|
| Rate for Payer: The Alliance Commercial |
$75.40
|
| Rate for Payer: WEA Trust Commercial |
$82.94
|
| Rate for Payer: WPS Commercial |
$111.69
|
|
|
Ferritin
|
Facility
|
OP
|
$245.00
|
|
|
Service Code
|
CPT 82728
|
| Hospital Charge Code |
633726
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.18 |
| Max. Negotiated Rate |
$234.42 |
| Rate for Payer: Aetna Commercial |
$229.32
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$219.13
|
| Rate for Payer: Aetna Managed Medicare |
$14.18
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$53.16
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$24.81
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$23.53
|
| Rate for Payer: Anthem Medicare Advantage |
$14.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$135.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$14.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$14.18
|
| Rate for Payer: Cash Price |
$73.50
|
| Rate for Payer: Cash Price |
$73.50
|
| Rate for Payer: Cigna Commercial |
$234.42
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$14.18
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$142.59
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$14.18
|
| Rate for Payer: Health EOS Commercial |
$226.77
|
| Rate for Payer: HFN Commercial |
$234.42
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$52.73
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$14.18
|
| Rate for Payer: Independent Care Health Plan Medicare |
$14.18
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$14.18
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$14.18
|
| Rate for Payer: Multiplan Commercial |
$203.84
|
| Rate for Payer: NAPHCARE Commercial |
$21.26
|
| Rate for Payer: Preferred Network Access Commercial |
$234.42
|
| Rate for Payer: Quartz Beloit One Network |
$124.85
|
| Rate for Payer: Quartz Commercial |
$165.62
|
| Rate for Payer: Quartz Medicare Advantage |
$14.18
|
| Rate for Payer: The Alliance Commercial |
$56.70
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14.18
|
| Rate for Payer: United Healthcare PPO |
$191.10
|
| Rate for Payer: WEA Trust Commercial |
$140.14
|
| Rate for Payer: Wellcare Medicare |
$14.18
|
| Rate for Payer: WPS Commercial |
$188.72
|
|
|
Ferritin
|
Facility
|
IP
|
$245.00
|
|
|
Service Code
|
CPT 82728
|
| Hospital Charge Code |
633726
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$124.85 |
| Max. Negotiated Rate |
$234.42 |
| Rate for Payer: Aetna Commercial |
$229.32
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$219.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$135.04
|
| Rate for Payer: Cash Price |
$73.50
|
| Rate for Payer: Cigna Commercial |
$234.42
|
| Rate for Payer: Health EOS Commercial |
$226.77
|
| Rate for Payer: HFN Commercial |
$234.42
|
| Rate for Payer: Multiplan Commercial |
$203.84
|
| Rate for Payer: Preferred Network Access Commercial |
$234.42
|
| Rate for Payer: Quartz Beloit One Network |
$124.85
|
| Rate for Payer: Quartz Commercial |
$152.88
|
| Rate for Payer: WEA Trust Commercial |
$140.14
|
| Rate for Payer: WPS Commercial |
$188.72
|
|
|
Ferritin
|
Professional
|
Both
|
$245.00
|
|
|
Service Code
|
CPT 82728
|
| Hospital Charge Code |
633726
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.18 |
| Max. Negotiated Rate |
$242.06 |
| Rate for Payer: Aetna Commercial |
$242.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$219.13
|
| Rate for Payer: Aetna Managed Medicare |
$14.18
|
| Rate for Payer: Anthem Medicare Advantage |
$14.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$14.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$14.18
|
| Rate for Payer: Cash Price |
$73.50
|
| Rate for Payer: Cash Price |
$73.50
|
| Rate for Payer: Cigna Commercial |
$242.06
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$127.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$14.18
|
| Rate for Payer: Health EOS Commercial |
$231.87
|
| Rate for Payer: HFN Commercial |
$242.06
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$50.03
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$50.03
|
| Rate for Payer: Independent Care Health Plan Medicare |
$14.18
|
| Rate for Payer: Multiplan Commercial |
$203.84
|
| Rate for Payer: NAPHCARE Commercial |
$21.26
|
| Rate for Payer: Preferred Network Access Commercial |
$242.06
|
| Rate for Payer: Quartz Beloit One Network |
$112.11
|
| Rate for Payer: Quartz Commercial |
$145.24
|
| Rate for Payer: Quartz Medicare Advantage |
$14.18
|
| Rate for Payer: The Alliance Commercial |
$55.99
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14.18
|
| Rate for Payer: WEA Trust Commercial |
$140.14
|
| Rate for Payer: WPS Commercial |
$62.37
|
|
|
Fetal Biophys Profile W/Inst 7681826
|
Professional
|
Both
|
$2,599.00
|
|
|
Service Code
|
CPT 76818 26
|
| Hospital Charge Code |
5144606
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$50.27 |
| Max. Negotiated Rate |
$2,567.81 |
| Rate for Payer: Aetna Commercial |
$2,567.81
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,324.55
|
| Rate for Payer: Aetna Managed Medicare |
$50.27
|
| Rate for Payer: Anthem Medicare Advantage |
$50.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$50.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$50.27
|
| Rate for Payer: Cash Price |
$779.70
|
| Rate for Payer: Cash Price |
$779.70
|
| Rate for Payer: Cash Price |
$779.70
|
| Rate for Payer: Cigna Commercial |
$2,567.81
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,351.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$50.27
|
| Rate for Payer: Health EOS Commercial |
$2,459.69
|
| Rate for Payer: HFN Commercial |
$2,567.81
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$184.30
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$184.30
|
| Rate for Payer: Independent Care Health Plan Medicare |
$50.27
|
| Rate for Payer: Multiplan Commercial |
$2,162.37
|
| Rate for Payer: NAPHCARE Commercial |
$75.41
|
| Rate for Payer: Preferred Network Access Commercial |
$2,567.81
|
| Rate for Payer: Quartz Beloit One Network |
$1,189.30
|
| Rate for Payer: Quartz Commercial |
$1,540.69
|
| Rate for Payer: Quartz Medicare Advantage |
$50.27
|
| Rate for Payer: The Alliance Commercial |
$191.04
|
| Rate for Payer: United Healthcare Medicare Advantage |
$50.27
|
| Rate for Payer: WEA Trust Commercial |
$1,486.63
|
| Rate for Payer: WPS Commercial |
$251.37
|
|
|
Fetal Fibronectin
|
Facility
|
IP
|
$1,214.00
|
|
|
Service Code
|
CPT 82731
|
| Hospital Charge Code |
977950
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$618.65 |
| Max. Negotiated Rate |
$1,161.56 |
| Rate for Payer: Aetna Commercial |
$1,136.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,085.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$669.16
|
| Rate for Payer: Cash Price |
$364.20
|
| Rate for Payer: Cigna Commercial |
$1,161.56
|
| Rate for Payer: Health EOS Commercial |
$1,123.68
|
| Rate for Payer: HFN Commercial |
$1,161.56
|
| Rate for Payer: Multiplan Commercial |
$1,010.05
|
| Rate for Payer: Preferred Network Access Commercial |
$1,161.56
|
| Rate for Payer: Quartz Beloit One Network |
$618.65
|
| Rate for Payer: Quartz Commercial |
$757.54
|
| Rate for Payer: WEA Trust Commercial |
$694.41
|
| Rate for Payer: WPS Commercial |
$935.14
|
|
|
Fetal Fibronectin
|
Professional
|
Both
|
$1,214.00
|
|
|
Service Code
|
CPT 82731
|
| Hospital Charge Code |
977950
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$66.99 |
| Max. Negotiated Rate |
$1,199.43 |
| Rate for Payer: Aetna Commercial |
$1,199.43
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,085.80
|
| Rate for Payer: Aetna Managed Medicare |
$66.99
|
| Rate for Payer: Anthem Medicare Advantage |
$66.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$66.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$66.99
|
| Rate for Payer: Cash Price |
$364.20
|
| Rate for Payer: Cash Price |
$364.20
|
| Rate for Payer: Cigna Commercial |
$1,199.43
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$631.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$66.99
|
| Rate for Payer: Health EOS Commercial |
$1,148.93
|
| Rate for Payer: HFN Commercial |
$1,199.43
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$236.46
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$236.46
|
| Rate for Payer: Independent Care Health Plan Medicare |
$66.99
|
| Rate for Payer: Multiplan Commercial |
$1,010.05
|
| Rate for Payer: NAPHCARE Commercial |
$100.48
|
| Rate for Payer: Preferred Network Access Commercial |
$1,199.43
|
| Rate for Payer: Quartz Beloit One Network |
$555.53
|
| Rate for Payer: Quartz Commercial |
$719.66
|
| Rate for Payer: Quartz Medicare Advantage |
$66.99
|
| Rate for Payer: The Alliance Commercial |
$264.60
|
| Rate for Payer: United Healthcare Medicare Advantage |
$66.99
|
| Rate for Payer: WEA Trust Commercial |
$694.41
|
| Rate for Payer: WPS Commercial |
$294.74
|
|
|
Fetal Fibronectin
|
Facility
|
OP
|
$1,214.00
|
|
|
Service Code
|
CPT 82731
|
| Hospital Charge Code |
977950
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$66.99 |
| Max. Negotiated Rate |
$1,161.56 |
| Rate for Payer: Aetna Commercial |
$1,136.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,085.80
|
| Rate for Payer: Aetna Managed Medicare |
$66.99
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$251.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$117.23
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$111.20
|
| Rate for Payer: Anthem Medicare Advantage |
$66.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$669.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$66.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$66.99
|
| Rate for Payer: Cash Price |
$364.20
|
| Rate for Payer: Cash Price |
$364.20
|
| Rate for Payer: Cigna Commercial |
$1,161.56
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$66.99
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$706.55
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$66.99
|
| Rate for Payer: Health EOS Commercial |
$1,123.68
|
| Rate for Payer: HFN Commercial |
$1,161.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$249.19
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$66.99
|
| Rate for Payer: Independent Care Health Plan Medicare |
$66.99
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$66.99
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$66.99
|
| Rate for Payer: Multiplan Commercial |
$1,010.05
|
| Rate for Payer: NAPHCARE Commercial |
$100.48
|
| Rate for Payer: Preferred Network Access Commercial |
$1,161.56
|
| Rate for Payer: Quartz Beloit One Network |
$618.65
|
| Rate for Payer: Quartz Commercial |
$820.66
|
| Rate for Payer: Quartz Medicare Advantage |
$66.99
|
| Rate for Payer: The Alliance Commercial |
$267.95
|
| Rate for Payer: United Healthcare Medicare Advantage |
$66.99
|
| Rate for Payer: United Healthcare PPO |
$946.92
|
| Rate for Payer: WEA Trust Commercial |
$694.41
|
| Rate for Payer: Wellcare Medicare |
$66.99
|
| Rate for Payer: WPS Commercial |
$935.14
|
|
|
Fetal Lung Profile
|
Facility
|
OP
|
$55.00
|
|
|
Service Code
|
CPT 84081
|
| Hospital Charge Code |
3449652
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.18 |
| Max. Negotiated Rate |
$68.72 |
| Rate for Payer: Aetna Commercial |
$51.48
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$49.19
|
| Rate for Payer: Aetna Managed Medicare |
$17.18
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$64.43
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$30.07
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$28.52
|
| Rate for Payer: Anthem Medicare Advantage |
$17.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$30.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$17.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$17.18
|
| Rate for Payer: Cash Price |
$16.50
|
| Rate for Payer: Cash Price |
$16.50
|
| Rate for Payer: Cigna Commercial |
$52.62
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$17.18
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$32.01
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$17.18
|
| Rate for Payer: Health EOS Commercial |
$50.91
|
| Rate for Payer: HFN Commercial |
$52.62
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$63.91
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$17.18
|
| Rate for Payer: Independent Care Health Plan Medicare |
$17.18
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$17.18
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$17.18
|
| Rate for Payer: Multiplan Commercial |
$45.76
|
| Rate for Payer: NAPHCARE Commercial |
$25.77
|
| Rate for Payer: Preferred Network Access Commercial |
$52.62
|
| Rate for Payer: Quartz Beloit One Network |
$28.03
|
| Rate for Payer: Quartz Commercial |
$37.18
|
| Rate for Payer: Quartz Medicare Advantage |
$17.18
|
| Rate for Payer: The Alliance Commercial |
$68.72
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17.18
|
| Rate for Payer: United Healthcare PPO |
$42.90
|
| Rate for Payer: WEA Trust Commercial |
$31.46
|
| Rate for Payer: Wellcare Medicare |
$17.18
|
| Rate for Payer: WPS Commercial |
$42.37
|
|
|
Fetal Lung Profile
|
Professional
|
Both
|
$55.00
|
|
|
Service Code
|
CPT 84081
|
| Hospital Charge Code |
3449652
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.18 |
| Max. Negotiated Rate |
$75.60 |
| Rate for Payer: Aetna Commercial |
$54.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$49.19
|
| Rate for Payer: Aetna Managed Medicare |
$17.18
|
| Rate for Payer: Anthem Medicare Advantage |
$17.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$17.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$17.18
|
| Rate for Payer: Cash Price |
$16.50
|
| Rate for Payer: Cash Price |
$16.50
|
| Rate for Payer: Cigna Commercial |
$54.34
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$28.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$17.18
|
| Rate for Payer: Health EOS Commercial |
$52.05
|
| Rate for Payer: HFN Commercial |
$54.34
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$60.65
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$60.65
|
| Rate for Payer: Independent Care Health Plan Medicare |
$17.18
|
| Rate for Payer: Multiplan Commercial |
$45.76
|
| Rate for Payer: NAPHCARE Commercial |
$25.77
|
| Rate for Payer: Preferred Network Access Commercial |
$54.34
|
| Rate for Payer: Quartz Beloit One Network |
$25.17
|
| Rate for Payer: Quartz Commercial |
$32.60
|
| Rate for Payer: Quartz Medicare Advantage |
$17.18
|
| Rate for Payer: The Alliance Commercial |
$67.86
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17.18
|
| Rate for Payer: WEA Trust Commercial |
$31.46
|
| Rate for Payer: WPS Commercial |
$75.60
|
|
|
Fetal Lung Profile
|
Facility
|
IP
|
$55.00
|
|
|
Service Code
|
CPT 84081
|
| Hospital Charge Code |
3449652
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$28.03 |
| Max. Negotiated Rate |
$52.62 |
| Rate for Payer: Aetna Commercial |
$51.48
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$49.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$30.32
|
| Rate for Payer: Cash Price |
$16.50
|
| Rate for Payer: Cigna Commercial |
$52.62
|
| Rate for Payer: Health EOS Commercial |
$50.91
|
| Rate for Payer: HFN Commercial |
$52.62
|
| Rate for Payer: Multiplan Commercial |
$45.76
|
| Rate for Payer: Preferred Network Access Commercial |
$52.62
|
| Rate for Payer: Quartz Beloit One Network |
$28.03
|
| Rate for Payer: Quartz Commercial |
$34.32
|
| Rate for Payer: WEA Trust Commercial |
$31.46
|
| Rate for Payer: WPS Commercial |
$42.37
|
|
|
Fetal Lung Profile to Mayo
|
Facility
|
IP
|
$54.00
|
|
|
Service Code
|
CPT 84081
|
| Hospital Charge Code |
3449628
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$27.52 |
| Max. Negotiated Rate |
$51.67 |
| Rate for Payer: Aetna Commercial |
$50.54
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$48.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$29.76
|
| Rate for Payer: Cash Price |
$16.20
|
| Rate for Payer: Cigna Commercial |
$51.67
|
| Rate for Payer: Health EOS Commercial |
$49.98
|
| Rate for Payer: HFN Commercial |
$51.67
|
| Rate for Payer: Multiplan Commercial |
$44.93
|
| Rate for Payer: Preferred Network Access Commercial |
$51.67
|
| Rate for Payer: Quartz Beloit One Network |
$27.52
|
| Rate for Payer: Quartz Commercial |
$33.70
|
| Rate for Payer: WEA Trust Commercial |
$30.89
|
| Rate for Payer: WPS Commercial |
$41.60
|
|
|
Fetal Lung Profile to Mayo
|
Professional
|
Both
|
$54.00
|
|
|
Service Code
|
CPT 84081
|
| Hospital Charge Code |
3449628
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.18 |
| Max. Negotiated Rate |
$75.60 |
| Rate for Payer: Aetna Commercial |
$53.35
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$48.30
|
| Rate for Payer: Aetna Managed Medicare |
$17.18
|
| Rate for Payer: Anthem Medicare Advantage |
$17.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$17.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$17.18
|
| Rate for Payer: Cash Price |
$16.20
|
| Rate for Payer: Cash Price |
$16.20
|
| Rate for Payer: Cigna Commercial |
$53.35
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$28.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$17.18
|
| Rate for Payer: Health EOS Commercial |
$51.11
|
| Rate for Payer: HFN Commercial |
$53.35
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$60.65
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$60.65
|
| Rate for Payer: Independent Care Health Plan Medicare |
$17.18
|
| Rate for Payer: Multiplan Commercial |
$44.93
|
| Rate for Payer: NAPHCARE Commercial |
$25.77
|
| Rate for Payer: Preferred Network Access Commercial |
$53.35
|
| Rate for Payer: Quartz Beloit One Network |
$24.71
|
| Rate for Payer: Quartz Commercial |
$32.01
|
| Rate for Payer: Quartz Medicare Advantage |
$17.18
|
| Rate for Payer: The Alliance Commercial |
$67.86
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17.18
|
| Rate for Payer: WEA Trust Commercial |
$30.89
|
| Rate for Payer: WPS Commercial |
$75.60
|
|
|
Fetal Lung Profile to Mayo
|
Facility
|
OP
|
$54.00
|
|
|
Service Code
|
CPT 84081
|
| Hospital Charge Code |
3449628
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.18 |
| Max. Negotiated Rate |
$68.72 |
| Rate for Payer: Aetna Commercial |
$50.54
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$48.30
|
| Rate for Payer: Aetna Managed Medicare |
$17.18
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$64.43
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$30.07
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$28.52
|
| Rate for Payer: Anthem Medicare Advantage |
$17.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$29.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$17.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$17.18
|
| Rate for Payer: Cash Price |
$16.20
|
| Rate for Payer: Cash Price |
$16.20
|
| Rate for Payer: Cigna Commercial |
$51.67
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$17.18
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$31.43
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$17.18
|
| Rate for Payer: Health EOS Commercial |
$49.98
|
| Rate for Payer: HFN Commercial |
$51.67
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$63.91
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$17.18
|
| Rate for Payer: Independent Care Health Plan Medicare |
$17.18
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$17.18
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$17.18
|
| Rate for Payer: Multiplan Commercial |
$44.93
|
| Rate for Payer: NAPHCARE Commercial |
$25.77
|
| Rate for Payer: Preferred Network Access Commercial |
$51.67
|
| Rate for Payer: Quartz Beloit One Network |
$27.52
|
| Rate for Payer: Quartz Commercial |
$36.50
|
| Rate for Payer: Quartz Medicare Advantage |
$17.18
|
| Rate for Payer: The Alliance Commercial |
$68.72
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17.18
|
| Rate for Payer: United Healthcare PPO |
$42.12
|
| Rate for Payer: WEA Trust Commercial |
$30.89
|
| Rate for Payer: Wellcare Medicare |
$17.18
|
| Rate for Payer: WPS Commercial |
$41.60
|
|
|
Fetal monitor - Devices and Equipment
|
Facility
|
OP
|
$1,537.00
|
|
|
Service Code
|
CPT 99211
|
| Hospital Charge Code |
3002386
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$30.74 |
| Max. Negotiated Rate |
$1,470.60 |
| Rate for Payer: Aetna Commercial |
$1,438.63
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,374.69
|
| Rate for Payer: Aetna Managed Medicare |
$447.57
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,039.01
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$799.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$767.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$847.19
|
| Rate for Payer: Cash Price |
$461.10
|
| Rate for Payer: Cash Price |
$461.10
|
| Rate for Payer: Cigna Commercial |
$1,470.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$894.53
|
| Rate for Payer: Health EOS Commercial |
$1,422.65
|
| Rate for Payer: HFN Commercial |
$1,470.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,198.86
|
| Rate for Payer: Multiplan Commercial |
$1,278.78
|
| Rate for Payer: NAPHCARE Commercial |
$959.09
|
| Rate for Payer: Preferred Network Access Commercial |
$1,470.60
|
| Rate for Payer: Quartz Beloit One Network |
$783.26
|
| Rate for Payer: Quartz Commercial |
$1,039.01
|
| Rate for Payer: Quartz Medicare Advantage |
$959.09
|
| Rate for Payer: The Alliance Commercial |
$30.74
|
| Rate for Payer: WEA Trust Commercial |
$879.16
|
| Rate for Payer: WPS Commercial |
$1,183.95
|
|
|
Fetal monitor - Devices and Equipment
|
Facility
|
IP
|
$1,537.00
|
|
|
Service Code
|
CPT 99211
|
| Hospital Charge Code |
3002386
|
|
Hospital Revenue Code
|
761
|
| Min. Negotiated Rate |
$783.26 |
| Max. Negotiated Rate |
$1,470.60 |
| Rate for Payer: Aetna Commercial |
$1,438.63
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,374.69
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$847.19
|
| Rate for Payer: Cash Price |
$461.10
|
| Rate for Payer: Cigna Commercial |
$1,470.60
|
| Rate for Payer: Health EOS Commercial |
$1,422.65
|
| Rate for Payer: HFN Commercial |
$1,470.60
|
| Rate for Payer: Multiplan Commercial |
$1,278.78
|
| Rate for Payer: Preferred Network Access Commercial |
$1,470.60
|
| Rate for Payer: Quartz Beloit One Network |
$783.26
|
| Rate for Payer: Quartz Commercial |
$959.09
|
| Rate for Payer: WEA Trust Commercial |
$879.16
|
| Rate for Payer: WPS Commercial |
$1,183.95
|
|
|
Fetal Non Stress Test 59025
|
Professional
|
Both
|
$119.00
|
|
|
Service Code
|
CPT 59025
|
| Hospital Charge Code |
3921389
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$41.93 |
| Max. Negotiated Rate |
$215.33 |
| Rate for Payer: Aetna Commercial |
$117.57
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$106.43
|
| Rate for Payer: Aetna Managed Medicare |
$47.85
|
| Rate for Payer: Anthem Medicare Advantage |
$47.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$47.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$47.85
|
| Rate for Payer: Cash Price |
$35.70
|
| Rate for Payer: Cash Price |
$35.70
|
| Rate for Payer: Cash Price |
$35.70
|
| Rate for Payer: Cigna Commercial |
$117.57
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$41.93
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$47.85
|
| Rate for Payer: Health EOS Commercial |
$112.62
|
| Rate for Payer: HFN Commercial |
$117.57
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$166.12
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$166.12
|
| Rate for Payer: Independent Care Health Plan Medicare |
$47.85
|
| Rate for Payer: Multiplan Commercial |
$99.01
|
| Rate for Payer: NAPHCARE Commercial |
$71.78
|
| Rate for Payer: Preferred Network Access Commercial |
$117.57
|
| Rate for Payer: Quartz Beloit One Network |
$54.45
|
| Rate for Payer: Quartz Commercial |
$70.54
|
| Rate for Payer: Quartz Medicare Advantage |
$47.85
|
| Rate for Payer: The Alliance Commercial |
$203.36
|
| Rate for Payer: United Healthcare Medicaid |
$41.93
|
| Rate for Payer: United Healthcare Medicare Advantage |
$47.85
|
| Rate for Payer: WEA Trust Commercial |
$68.07
|
| Rate for Payer: WPS Commercial |
$215.33
|
|
|
Fetal Non Stress Test 5902526
|
Professional
|
Both
|
$119.00
|
|
|
Service Code
|
CPT 59025 26
|
| Hospital Charge Code |
3121578
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$27.11 |
| Max. Negotiated Rate |
$122.01 |
| Rate for Payer: Aetna Commercial |
$117.57
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$106.43
|
| Rate for Payer: Aetna Managed Medicare |
$27.11
|
| Rate for Payer: Anthem Medicare Advantage |
$27.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$27.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$27.11
|
| Rate for Payer: Cash Price |
$35.70
|
| Rate for Payer: Cash Price |
$35.70
|
| Rate for Payer: Cash Price |
$35.70
|
| Rate for Payer: Cigna Commercial |
$117.57
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$27.75
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$27.11
|
| Rate for Payer: Health EOS Commercial |
$112.62
|
| Rate for Payer: HFN Commercial |
$117.57
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$98.17
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$98.17
|
| Rate for Payer: Independent Care Health Plan Medicare |
$27.11
|
| Rate for Payer: Multiplan Commercial |
$99.01
|
| Rate for Payer: NAPHCARE Commercial |
$40.67
|
| Rate for Payer: Preferred Network Access Commercial |
$117.57
|
| Rate for Payer: Quartz Beloit One Network |
$54.45
|
| Rate for Payer: Quartz Commercial |
$70.54
|
| Rate for Payer: Quartz Medicare Advantage |
$27.11
|
| Rate for Payer: The Alliance Commercial |
$115.23
|
| Rate for Payer: United Healthcare Medicaid |
$27.75
|
| Rate for Payer: United Healthcare Medicare Advantage |
$27.11
|
| Rate for Payer: WEA Trust Commercial |
$68.07
|
| Rate for Payer: WPS Commercial |
$122.01
|
|
|
Fetomaternal Bleed, Flow Cytometry to Mayo
|
Professional
|
Both
|
$863.00
|
|
|
Service Code
|
CPT 88184
|
| Hospital Charge Code |
3331571
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$80.41 |
| Max. Negotiated Rate |
$852.64 |
| Rate for Payer: Aetna Commercial |
$852.64
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$771.87
|
| Rate for Payer: Aetna Managed Medicare |
$80.41
|
| Rate for Payer: Anthem Medicare Advantage |
$80.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$80.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$80.41
|
| Rate for Payer: Cash Price |
$258.90
|
| Rate for Payer: Cash Price |
$258.90
|
| Rate for Payer: Cigna Commercial |
$852.64
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$448.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$80.41
|
| Rate for Payer: Health EOS Commercial |
$816.74
|
| Rate for Payer: HFN Commercial |
$852.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$239.69
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$239.69
|
| Rate for Payer: Independent Care Health Plan Medicare |
$80.41
|
| Rate for Payer: Multiplan Commercial |
$718.02
|
| Rate for Payer: NAPHCARE Commercial |
$120.62
|
| Rate for Payer: Preferred Network Access Commercial |
$852.64
|
| Rate for Payer: Quartz Beloit One Network |
$394.91
|
| Rate for Payer: Quartz Commercial |
$511.59
|
| Rate for Payer: Quartz Medicare Advantage |
$80.41
|
| Rate for Payer: The Alliance Commercial |
$317.63
|
| Rate for Payer: United Healthcare Medicare Advantage |
$80.41
|
| Rate for Payer: WEA Trust Commercial |
$493.64
|
| Rate for Payer: WPS Commercial |
$353.82
|
|
