|
Fetal Fibronectin
|
Facility
|
IP
|
$1,214.00
|
|
|
Service Code
|
CPT 82731
|
| Hospital Charge Code |
977950
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$594.86 |
| Max. Negotiated Rate |
$1,116.88 |
| Rate for Payer: Aetna Commercial |
$1,092.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,044.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$643.42
|
| Rate for Payer: Cash Price |
$364.20
|
| Rate for Payer: Cigna Commercial |
$1,116.88
|
| Rate for Payer: Health EOS Commercial |
$1,080.46
|
| Rate for Payer: HFN Commercial |
$1,116.88
|
| Rate for Payer: Multiplan Commercial |
$971.20
|
| Rate for Payer: NAPHCARE Commercial |
$728.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,116.88
|
| Rate for Payer: Quartz Beloit One Network |
$594.86
|
| Rate for Payer: Quartz Commercial |
$728.40
|
| Rate for Payer: WEA Trust Commercial |
$667.70
|
| Rate for Payer: WPS Commercial |
$899.21
|
|
|
Fetal Fibronectin
|
Facility
|
OP
|
$1,214.00
|
|
|
Service Code
|
CPT 82731
|
| Hospital Charge Code |
977950
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$64.41 |
| Max. Negotiated Rate |
$1,116.88 |
| Rate for Payer: Aetna Commercial |
$1,092.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,044.04
|
| Rate for Payer: Aetna Managed Medicare |
$64.41
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$241.54
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$112.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$106.92
|
| Rate for Payer: Anthem Medicaid |
$66.55
|
| Rate for Payer: Anthem Medicare Advantage |
$64.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$643.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$64.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$64.41
|
| Rate for Payer: Cash Price |
$364.20
|
| Rate for Payer: Cash Price |
$364.20
|
| Rate for Payer: Cigna Commercial |
$1,116.88
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$64.41
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$66.55
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$679.35
|
| Rate for Payer: Dean Health Medicaid |
$66.55
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$64.41
|
| Rate for Payer: Health EOS Commercial |
$1,080.46
|
| Rate for Payer: HFN Commercial |
$1,116.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$239.61
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$64.41
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$66.55
|
| Rate for Payer: Independent Care Health Plan Medicare |
$64.41
|
| Rate for Payer: Managed Health Services Medicaid |
$69.21
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$64.41
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$64.41
|
| Rate for Payer: Multiplan Commercial |
$971.20
|
| Rate for Payer: NAPHCARE Commercial |
$96.62
|
| Rate for Payer: Preferred Network Access Commercial |
$1,116.88
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$66.55
|
| Rate for Payer: Quartz Beloit One Network |
$594.86
|
| Rate for Payer: Quartz Commercial |
$789.10
|
| Rate for Payer: Quartz Medicare Advantage |
$64.41
|
| Rate for Payer: The Alliance Commercial |
$257.64
|
| Rate for Payer: United Healthcare Medicaid |
$66.55
|
| Rate for Payer: United Healthcare Medicare Advantage |
$64.41
|
| Rate for Payer: United Healthcare PPO |
$910.50
|
| Rate for Payer: WEA Trust Commercial |
$667.70
|
| Rate for Payer: Wellcare Medicare |
$64.41
|
| Rate for Payer: WMAP Medicaid |
$66.55
|
| Rate for Payer: WPS Commercial |
$899.21
|
|
|
Fetal Lung Profile
|
Facility
|
OP
|
$55.00
|
|
|
Service Code
|
CPT 84081
|
| Hospital Charge Code |
3449652
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$16.52 |
| Max. Negotiated Rate |
$66.08 |
| Rate for Payer: Aetna Commercial |
$49.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$47.30
|
| Rate for Payer: Aetna Managed Medicare |
$16.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$61.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$28.91
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$27.42
|
| Rate for Payer: Anthem Medicaid |
$17.07
|
| Rate for Payer: Anthem Medicare Advantage |
$16.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$29.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$16.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$16.52
|
| Rate for Payer: Cash Price |
$16.50
|
| Rate for Payer: Cash Price |
$16.50
|
| Rate for Payer: Cigna Commercial |
$50.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$16.52
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$17.07
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$30.78
|
| Rate for Payer: Dean Health Medicaid |
$17.07
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$16.52
|
| Rate for Payer: Health EOS Commercial |
$48.95
|
| Rate for Payer: HFN Commercial |
$50.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$61.45
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$16.52
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$17.07
|
| Rate for Payer: Independent Care Health Plan Medicare |
$16.52
|
| Rate for Payer: Managed Health Services Medicaid |
$17.75
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$16.52
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$16.52
|
| Rate for Payer: Multiplan Commercial |
$44.00
|
| Rate for Payer: NAPHCARE Commercial |
$24.78
|
| Rate for Payer: Preferred Network Access Commercial |
$50.60
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$17.07
|
| Rate for Payer: Quartz Beloit One Network |
$26.95
|
| Rate for Payer: Quartz Commercial |
$35.75
|
| Rate for Payer: Quartz Medicare Advantage |
$16.52
|
| Rate for Payer: The Alliance Commercial |
$66.08
|
| Rate for Payer: United Healthcare Medicaid |
$17.07
|
| Rate for Payer: United Healthcare Medicare Advantage |
$16.52
|
| Rate for Payer: United Healthcare PPO |
$41.25
|
| Rate for Payer: WEA Trust Commercial |
$30.25
|
| Rate for Payer: Wellcare Medicare |
$16.52
|
| Rate for Payer: WMAP Medicaid |
$17.07
|
| Rate for Payer: WPS Commercial |
$40.74
|
|
|
Fetal Lung Profile
|
Facility
|
IP
|
$55.00
|
|
|
Service Code
|
CPT 84081
|
| Hospital Charge Code |
3449652
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$26.95 |
| Max. Negotiated Rate |
$50.60 |
| Rate for Payer: Aetna Commercial |
$49.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$47.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$29.15
|
| Rate for Payer: Cash Price |
$16.50
|
| Rate for Payer: Cigna Commercial |
$50.60
|
| Rate for Payer: Health EOS Commercial |
$48.95
|
| Rate for Payer: HFN Commercial |
$50.60
|
| Rate for Payer: Multiplan Commercial |
$44.00
|
| Rate for Payer: NAPHCARE Commercial |
$33.00
|
| Rate for Payer: Preferred Network Access Commercial |
$50.60
|
| Rate for Payer: Quartz Beloit One Network |
$26.95
|
| Rate for Payer: Quartz Commercial |
$33.00
|
| Rate for Payer: WEA Trust Commercial |
$30.25
|
| Rate for Payer: WPS Commercial |
$40.74
|
|
|
Fetal Lung Profile
|
Professional
|
Both
|
$55.00
|
|
|
Service Code
|
CPT 84081
|
| Hospital Charge Code |
3449652
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$24.20 |
| Max. Negotiated Rate |
$58.32 |
| Rate for Payer: Aetna Commercial |
$52.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$47.30
|
| Rate for Payer: Cash Price |
$16.50
|
| Rate for Payer: Cash Price |
$16.50
|
| Rate for Payer: Cigna Commercial |
$52.25
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$27.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$33.00
|
| Rate for Payer: Health EOS Commercial |
$50.05
|
| Rate for Payer: HFN Commercial |
$52.25
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$58.32
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$58.32
|
| Rate for Payer: Multiplan Commercial |
$44.00
|
| Rate for Payer: Preferred Network Access Commercial |
$52.25
|
| Rate for Payer: Quartz Beloit One Network |
$24.20
|
| Rate for Payer: Quartz Commercial |
$31.35
|
| Rate for Payer: The Alliance Commercial |
$27.50
|
| Rate for Payer: WEA Trust Commercial |
$30.25
|
| Rate for Payer: WPS Commercial |
$40.74
|
|
|
Fetal Lung Profile to Mayo
|
Professional
|
Both
|
$54.00
|
|
|
Service Code
|
CPT 84081
|
| Hospital Charge Code |
3449628
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$23.76 |
| Max. Negotiated Rate |
$58.32 |
| Rate for Payer: Aetna Commercial |
$51.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$46.44
|
| Rate for Payer: Cash Price |
$16.20
|
| Rate for Payer: Cash Price |
$16.20
|
| Rate for Payer: Cigna Commercial |
$51.30
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$27.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$32.40
|
| Rate for Payer: Health EOS Commercial |
$49.14
|
| Rate for Payer: HFN Commercial |
$51.30
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$58.32
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$58.32
|
| Rate for Payer: Multiplan Commercial |
$43.20
|
| Rate for Payer: Preferred Network Access Commercial |
$51.30
|
| Rate for Payer: Quartz Beloit One Network |
$23.76
|
| Rate for Payer: Quartz Commercial |
$30.78
|
| Rate for Payer: The Alliance Commercial |
$27.00
|
| Rate for Payer: WEA Trust Commercial |
$29.70
|
| Rate for Payer: WPS Commercial |
$40.00
|
|
|
Fetal Lung Profile to Mayo
|
Facility
|
IP
|
$54.00
|
|
|
Service Code
|
CPT 84081
|
| Hospital Charge Code |
3449628
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$26.46 |
| Max. Negotiated Rate |
$49.68 |
| Rate for Payer: Aetna Commercial |
$48.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$46.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$28.62
|
| Rate for Payer: Cash Price |
$16.20
|
| Rate for Payer: Cigna Commercial |
$49.68
|
| Rate for Payer: Health EOS Commercial |
$48.06
|
| Rate for Payer: HFN Commercial |
$49.68
|
| Rate for Payer: Multiplan Commercial |
$43.20
|
| Rate for Payer: NAPHCARE Commercial |
$32.40
|
| Rate for Payer: Preferred Network Access Commercial |
$49.68
|
| Rate for Payer: Quartz Beloit One Network |
$26.46
|
| Rate for Payer: Quartz Commercial |
$32.40
|
| Rate for Payer: WEA Trust Commercial |
$29.70
|
| Rate for Payer: WPS Commercial |
$40.00
|
|
|
Fetal Lung Profile to Mayo
|
Facility
|
OP
|
$54.00
|
|
|
Service Code
|
CPT 84081
|
| Hospital Charge Code |
3449628
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$16.52 |
| Max. Negotiated Rate |
$66.08 |
| Rate for Payer: Aetna Commercial |
$48.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$46.44
|
| Rate for Payer: Aetna Managed Medicare |
$16.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$61.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$28.91
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$27.42
|
| Rate for Payer: Anthem Medicaid |
$17.07
|
| Rate for Payer: Anthem Medicare Advantage |
$16.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$28.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$16.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$16.52
|
| Rate for Payer: Cash Price |
$16.20
|
| Rate for Payer: Cash Price |
$16.20
|
| Rate for Payer: Cigna Commercial |
$49.68
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$16.52
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$17.07
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$30.22
|
| Rate for Payer: Dean Health Medicaid |
$17.07
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$16.52
|
| Rate for Payer: Health EOS Commercial |
$48.06
|
| Rate for Payer: HFN Commercial |
$49.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$61.45
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$16.52
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$17.07
|
| Rate for Payer: Independent Care Health Plan Medicare |
$16.52
|
| Rate for Payer: Managed Health Services Medicaid |
$17.75
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$16.52
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$16.52
|
| Rate for Payer: Multiplan Commercial |
$43.20
|
| Rate for Payer: NAPHCARE Commercial |
$24.78
|
| Rate for Payer: Preferred Network Access Commercial |
$49.68
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$17.07
|
| Rate for Payer: Quartz Beloit One Network |
$26.46
|
| Rate for Payer: Quartz Commercial |
$35.10
|
| Rate for Payer: Quartz Medicare Advantage |
$16.52
|
| Rate for Payer: The Alliance Commercial |
$66.08
|
| Rate for Payer: United Healthcare Medicaid |
$17.07
|
| Rate for Payer: United Healthcare Medicare Advantage |
$16.52
|
| Rate for Payer: United Healthcare PPO |
$40.50
|
| Rate for Payer: WEA Trust Commercial |
$29.70
|
| Rate for Payer: Wellcare Medicare |
$16.52
|
| Rate for Payer: WMAP Medicaid |
$17.07
|
| Rate for Payer: WPS Commercial |
$40.00
|
|
|
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 |
$430.36 |
| Max. Negotiated Rate |
$6,148.00 |
| Rate for Payer: Aetna Commercial |
$1,383.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,321.82
|
| Rate for Payer: Aetna Managed Medicare |
$430.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$999.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$768.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$737.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$814.61
|
| Rate for Payer: Cash Price |
$461.10
|
| Rate for Payer: Cigna Commercial |
$1,414.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$860.11
|
| Rate for Payer: Health EOS Commercial |
$1,367.93
|
| Rate for Payer: HFN Commercial |
$1,414.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,152.75
|
| Rate for Payer: Multiplan Commercial |
$1,229.60
|
| Rate for Payer: NAPHCARE Commercial |
$922.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,414.04
|
| Rate for Payer: Quartz Beloit One Network |
$753.13
|
| Rate for Payer: Quartz Commercial |
$999.05
|
| Rate for Payer: Quartz Medicare Advantage |
$922.20
|
| Rate for Payer: The Alliance Commercial |
$6,148.00
|
| Rate for Payer: WEA Trust Commercial |
$845.35
|
| Rate for Payer: WPS Commercial |
$1,138.46
|
|
|
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 |
$753.13 |
| Max. Negotiated Rate |
$1,414.04 |
| Rate for Payer: Aetna Commercial |
$1,383.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,321.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$814.61
|
| Rate for Payer: Cash Price |
$461.10
|
| Rate for Payer: Cigna Commercial |
$1,414.04
|
| Rate for Payer: Health EOS Commercial |
$1,367.93
|
| Rate for Payer: HFN Commercial |
$1,414.04
|
| Rate for Payer: Multiplan Commercial |
$1,229.60
|
| Rate for Payer: NAPHCARE Commercial |
$922.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,414.04
|
| Rate for Payer: Quartz Beloit One Network |
$753.13
|
| Rate for Payer: Quartz Commercial |
$922.20
|
| Rate for Payer: WEA Trust Commercial |
$845.35
|
| Rate for Payer: WPS Commercial |
$1,138.46
|
|
|
Fetal Non Stress Test 59025
|
Professional
|
Both
|
$119.00
|
|
|
Service Code
|
CPT 59025
|
| Hospital Charge Code |
3921389
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$40.32 |
| Max. Negotiated Rate |
$159.73 |
| Rate for Payer: Aetna Commercial |
$113.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$102.34
|
| 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 |
$113.05
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$40.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$71.40
|
| Rate for Payer: Health EOS Commercial |
$108.29
|
| Rate for Payer: HFN Commercial |
$113.05
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$159.73
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$159.73
|
| Rate for Payer: Multiplan Commercial |
$95.20
|
| Rate for Payer: Preferred Network Access Commercial |
$113.05
|
| Rate for Payer: Quartz Beloit One Network |
$52.36
|
| Rate for Payer: Quartz Commercial |
$67.83
|
| Rate for Payer: The Alliance Commercial |
$59.50
|
| Rate for Payer: United Healthcare Medicaid |
$40.32
|
| Rate for Payer: WEA Trust Commercial |
$65.45
|
| Rate for Payer: WPS Commercial |
$88.14
|
|
|
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 |
$26.68 |
| Max. Negotiated Rate |
$113.05 |
| Rate for Payer: Aetna Commercial |
$113.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$102.34
|
| 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 |
$113.05
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$26.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$71.40
|
| Rate for Payer: Health EOS Commercial |
$108.29
|
| Rate for Payer: HFN Commercial |
$113.05
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$94.39
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$94.39
|
| Rate for Payer: Multiplan Commercial |
$95.20
|
| Rate for Payer: Preferred Network Access Commercial |
$113.05
|
| Rate for Payer: Quartz Beloit One Network |
$52.36
|
| Rate for Payer: Quartz Commercial |
$67.83
|
| Rate for Payer: The Alliance Commercial |
$59.50
|
| Rate for Payer: United Healthcare Medicaid |
$26.68
|
| Rate for Payer: WEA Trust Commercial |
$65.45
|
| Rate for Payer: WPS Commercial |
$88.14
|
|
|
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 |
$230.47 |
| Max. Negotiated Rate |
$819.85 |
| Rate for Payer: Aetna Commercial |
$819.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$742.18
|
| Rate for Payer: Cash Price |
$258.90
|
| Rate for Payer: Cash Price |
$258.90
|
| Rate for Payer: Cigna Commercial |
$819.85
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$431.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$517.80
|
| Rate for Payer: Health EOS Commercial |
$785.33
|
| Rate for Payer: HFN Commercial |
$819.85
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$230.47
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$230.47
|
| Rate for Payer: Multiplan Commercial |
$690.40
|
| Rate for Payer: Preferred Network Access Commercial |
$819.85
|
| Rate for Payer: Quartz Beloit One Network |
$379.72
|
| Rate for Payer: Quartz Commercial |
$491.91
|
| Rate for Payer: The Alliance Commercial |
$431.50
|
| Rate for Payer: WEA Trust Commercial |
$474.65
|
| Rate for Payer: WPS Commercial |
$639.22
|
|
|
Fetomaternal Bleed, Flow Cytometry to Mayo
|
Facility
|
IP
|
$863.00
|
|
|
Service Code
|
CPT 88184
|
| Hospital Charge Code |
3331571
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$422.87 |
| Max. Negotiated Rate |
$793.96 |
| Rate for Payer: Aetna Commercial |
$776.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$742.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$457.39
|
| Rate for Payer: Cash Price |
$258.90
|
| Rate for Payer: Cigna Commercial |
$793.96
|
| Rate for Payer: Health EOS Commercial |
$768.07
|
| Rate for Payer: HFN Commercial |
$793.96
|
| Rate for Payer: Multiplan Commercial |
$690.40
|
| Rate for Payer: NAPHCARE Commercial |
$517.80
|
| Rate for Payer: Preferred Network Access Commercial |
$793.96
|
| Rate for Payer: Quartz Beloit One Network |
$422.87
|
| Rate for Payer: Quartz Commercial |
$517.80
|
| Rate for Payer: WEA Trust Commercial |
$474.65
|
| Rate for Payer: WPS Commercial |
$639.22
|
|
|
Fetomaternal Bleed, Flow Cytometry to Mayo
|
Facility
|
OP
|
$863.00
|
|
|
Service Code
|
CPT 88184
|
| Hospital Charge Code |
3331571
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$355.28 |
| Max. Negotiated Rate |
$1,421.12 |
| Rate for Payer: Aetna Commercial |
$776.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$742.18
|
| Rate for Payer: Aetna Managed Medicare |
$355.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,332.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$621.74
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$589.76
|
| Rate for Payer: Anthem Medicare Advantage |
$355.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$457.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$355.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$355.28
|
| Rate for Payer: Cash Price |
$258.90
|
| Rate for Payer: Cash Price |
$258.90
|
| Rate for Payer: Cigna Commercial |
$793.96
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$355.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$482.93
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$355.28
|
| Rate for Payer: Health EOS Commercial |
$768.07
|
| Rate for Payer: HFN Commercial |
$793.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,321.64
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$355.28
|
| Rate for Payer: Independent Care Health Plan Medicare |
$355.28
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$355.28
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$355.28
|
| Rate for Payer: Multiplan Commercial |
$690.40
|
| Rate for Payer: NAPHCARE Commercial |
$532.92
|
| Rate for Payer: Preferred Network Access Commercial |
$793.96
|
| Rate for Payer: Quartz Beloit One Network |
$422.87
|
| Rate for Payer: Quartz Commercial |
$560.95
|
| Rate for Payer: Quartz Medicare Advantage |
$355.28
|
| Rate for Payer: The Alliance Commercial |
$1,421.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$355.28
|
| Rate for Payer: United Healthcare PPO |
$647.25
|
| Rate for Payer: WEA Trust Commercial |
$474.65
|
| Rate for Payer: Wellcare Medicare |
$355.28
|
| Rate for Payer: WPS Commercial |
$639.22
|
|
|
FEVER AND INFLAMMATORY CONDITIONS
|
Facility
|
IP
|
$23,791.00
|
|
|
Service Code
|
MSDRG 864
|
| Min. Negotiated Rate |
$8,557.75 |
| Max. Negotiated Rate |
$23,791.00 |
| Rate for Payer: Wellcare Medicare |
$8,557.75
|
| Rate for Payer: Aetna Managed Medicare |
$8,557.75
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$18,462.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$14,151.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$13,444.64
|
| Rate for Payer: Anthem Medicare Advantage |
$8,557.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$8,557.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$8,557.75
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$8,557.75
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$14,924.78
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$8,557.75
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$17,214.60
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$8,557.75
|
| Rate for Payer: Independent Care Health Plan Medicare |
$8,557.75
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$8,557.75
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$8,557.75
|
| Rate for Payer: NAPHCARE Commercial |
$12,836.62
|
| Rate for Payer: Quartz Medicare Advantage |
$8,557.75
|
| Rate for Payer: The Alliance Commercial |
$23,791.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8,557.75
|
| Rate for Payer: United Healthcare PPO |
$13,401.79
|
|
|
Fever Detector Stat Temp
|
Facility
|
OP
|
$53.00
|
|
| Hospital Charge Code |
3101745
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$14.84 |
| Max. Negotiated Rate |
$212.00 |
| Rate for Payer: Aetna Commercial |
$47.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$45.58
|
| Rate for Payer: Aetna Managed Medicare |
$14.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$34.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$26.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$25.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$28.09
|
| Rate for Payer: Cash Price |
$15.90
|
| Rate for Payer: Cigna Commercial |
$48.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$29.66
|
| Rate for Payer: Health EOS Commercial |
$47.17
|
| Rate for Payer: HFN Commercial |
$48.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$39.75
|
| Rate for Payer: Multiplan Commercial |
$42.40
|
| Rate for Payer: NAPHCARE Commercial |
$31.80
|
| Rate for Payer: Preferred Network Access Commercial |
$48.76
|
| Rate for Payer: Quartz Beloit One Network |
$25.97
|
| Rate for Payer: Quartz Commercial |
$34.45
|
| Rate for Payer: Quartz Medicare Advantage |
$31.80
|
| Rate for Payer: The Alliance Commercial |
$212.00
|
| Rate for Payer: WEA Trust Commercial |
$29.15
|
| Rate for Payer: WPS Commercial |
$39.26
|
|
|
Fever Detector Stat Temp
|
Facility
|
IP
|
$53.00
|
|
| Hospital Charge Code |
3101745
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$25.97 |
| Max. Negotiated Rate |
$48.76 |
| Rate for Payer: Aetna Commercial |
$47.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$45.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$28.09
|
| Rate for Payer: Cash Price |
$15.90
|
| Rate for Payer: Cigna Commercial |
$48.76
|
| Rate for Payer: Health EOS Commercial |
$47.17
|
| Rate for Payer: HFN Commercial |
$48.76
|
| Rate for Payer: Multiplan Commercial |
$42.40
|
| Rate for Payer: NAPHCARE Commercial |
$31.80
|
| Rate for Payer: Preferred Network Access Commercial |
$48.76
|
| Rate for Payer: Quartz Beloit One Network |
$25.97
|
| Rate for Payer: Quartz Commercial |
$31.80
|
| Rate for Payer: WEA Trust Commercial |
$29.15
|
| Rate for Payer: WPS Commercial |
$39.26
|
|
|
FFP 1
|
Facility
|
IP
|
$385.00
|
|
|
Service Code
|
HCPCS P9017
|
| Hospital Charge Code |
1052846
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$188.65 |
| Max. Negotiated Rate |
$354.20 |
| Rate for Payer: Aetna Commercial |
$346.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$331.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$204.05
|
| Rate for Payer: Cash Price |
$115.50
|
| Rate for Payer: Cigna Commercial |
$354.20
|
| Rate for Payer: Health EOS Commercial |
$342.65
|
| Rate for Payer: HFN Commercial |
$354.20
|
| Rate for Payer: Multiplan Commercial |
$308.00
|
| Rate for Payer: NAPHCARE Commercial |
$231.00
|
| Rate for Payer: Preferred Network Access Commercial |
$354.20
|
| Rate for Payer: Quartz Beloit One Network |
$188.65
|
| Rate for Payer: Quartz Commercial |
$231.00
|
| Rate for Payer: WEA Trust Commercial |
$211.75
|
| Rate for Payer: WPS Commercial |
$285.17
|
|
|
FFP 1
|
Facility
|
OP
|
$385.00
|
|
|
Service Code
|
HCPCS P9017
|
| Hospital Charge Code |
1052846
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$38.65 |
| Max. Negotiated Rate |
$354.20 |
| Rate for Payer: Aetna Commercial |
$346.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$331.10
|
| Rate for Payer: Aetna Managed Medicare |
$82.95
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$250.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$192.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$184.80
|
| Rate for Payer: Anthem Medicaid |
$38.65
|
| Rate for Payer: Anthem Medicare Advantage |
$82.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$204.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$82.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$82.95
|
| Rate for Payer: Cash Price |
$115.50
|
| Rate for Payer: Cash Price |
$115.50
|
| Rate for Payer: Cigna Commercial |
$354.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$82.95
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$38.65
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$215.45
|
| Rate for Payer: Dean Health Medicaid |
$38.65
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$82.95
|
| Rate for Payer: Health EOS Commercial |
$342.65
|
| Rate for Payer: HFN Commercial |
$354.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$308.57
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$82.95
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$38.65
|
| Rate for Payer: Independent Care Health Plan Medicare |
$82.95
|
| Rate for Payer: Managed Health Services Medicaid |
$40.20
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$82.95
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$82.95
|
| Rate for Payer: Multiplan Commercial |
$308.00
|
| Rate for Payer: NAPHCARE Commercial |
$124.42
|
| Rate for Payer: Preferred Network Access Commercial |
$354.20
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$38.65
|
| Rate for Payer: Quartz Beloit One Network |
$188.65
|
| Rate for Payer: Quartz Commercial |
$250.25
|
| Rate for Payer: Quartz Medicare Advantage |
$82.95
|
| Rate for Payer: The Alliance Commercial |
$331.80
|
| Rate for Payer: United Healthcare Medicaid |
$38.65
|
| Rate for Payer: United Healthcare Medicare Advantage |
$82.95
|
| Rate for Payer: United Healthcare PPO |
$288.75
|
| Rate for Payer: WEA Trust Commercial |
$211.75
|
| Rate for Payer: Wellcare Medicare |
$82.95
|
| Rate for Payer: WMAP Medicaid |
$38.65
|
| Rate for Payer: WPS Commercial |
$285.17
|
|
|
FFP 2
|
Facility
|
OP
|
$385.00
|
|
|
Service Code
|
HCPCS P9017
|
| Hospital Charge Code |
1052848
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$38.65 |
| Max. Negotiated Rate |
$354.20 |
| Rate for Payer: Aetna Commercial |
$346.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$331.10
|
| Rate for Payer: Aetna Managed Medicare |
$82.95
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$250.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$192.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$184.80
|
| Rate for Payer: Anthem Medicaid |
$38.65
|
| Rate for Payer: Anthem Medicare Advantage |
$82.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$204.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$82.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$82.95
|
| Rate for Payer: Cash Price |
$115.50
|
| Rate for Payer: Cash Price |
$115.50
|
| Rate for Payer: Cigna Commercial |
$354.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$82.95
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$38.65
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$215.45
|
| Rate for Payer: Dean Health Medicaid |
$38.65
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$82.95
|
| Rate for Payer: Health EOS Commercial |
$342.65
|
| Rate for Payer: HFN Commercial |
$354.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$308.57
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$82.95
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$38.65
|
| Rate for Payer: Independent Care Health Plan Medicare |
$82.95
|
| Rate for Payer: Managed Health Services Medicaid |
$40.20
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$82.95
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$82.95
|
| Rate for Payer: Multiplan Commercial |
$308.00
|
| Rate for Payer: NAPHCARE Commercial |
$124.42
|
| Rate for Payer: Preferred Network Access Commercial |
$354.20
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$38.65
|
| Rate for Payer: Quartz Beloit One Network |
$188.65
|
| Rate for Payer: Quartz Commercial |
$250.25
|
| Rate for Payer: Quartz Medicare Advantage |
$82.95
|
| Rate for Payer: The Alliance Commercial |
$331.80
|
| Rate for Payer: United Healthcare Medicaid |
$38.65
|
| Rate for Payer: United Healthcare Medicare Advantage |
$82.95
|
| Rate for Payer: United Healthcare PPO |
$288.75
|
| Rate for Payer: WEA Trust Commercial |
$211.75
|
| Rate for Payer: Wellcare Medicare |
$82.95
|
| Rate for Payer: WMAP Medicaid |
$38.65
|
| Rate for Payer: WPS Commercial |
$285.17
|
|
|
FFP 2
|
Facility
|
IP
|
$385.00
|
|
|
Service Code
|
HCPCS P9017
|
| Hospital Charge Code |
1052848
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$188.65 |
| Max. Negotiated Rate |
$354.20 |
| Rate for Payer: Aetna Commercial |
$346.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$331.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$204.05
|
| Rate for Payer: Cash Price |
$115.50
|
| Rate for Payer: Cigna Commercial |
$354.20
|
| Rate for Payer: Health EOS Commercial |
$342.65
|
| Rate for Payer: HFN Commercial |
$354.20
|
| Rate for Payer: Multiplan Commercial |
$308.00
|
| Rate for Payer: NAPHCARE Commercial |
$231.00
|
| Rate for Payer: Preferred Network Access Commercial |
$354.20
|
| Rate for Payer: Quartz Beloit One Network |
$188.65
|
| Rate for Payer: Quartz Commercial |
$231.00
|
| Rate for Payer: WEA Trust Commercial |
$211.75
|
| Rate for Payer: WPS Commercial |
$285.17
|
|
|
FFP CP2D
|
Facility
|
OP
|
$385.00
|
|
|
Service Code
|
HCPCS P9017
|
| Hospital Charge Code |
1052855
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$38.65 |
| Max. Negotiated Rate |
$354.20 |
| Rate for Payer: Aetna Commercial |
$346.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$331.10
|
| Rate for Payer: Aetna Managed Medicare |
$82.95
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$250.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$192.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$184.80
|
| Rate for Payer: Anthem Medicaid |
$38.65
|
| Rate for Payer: Anthem Medicare Advantage |
$82.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$204.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$82.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$82.95
|
| Rate for Payer: Cash Price |
$115.50
|
| Rate for Payer: Cash Price |
$115.50
|
| Rate for Payer: Cigna Commercial |
$354.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$82.95
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$38.65
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$215.45
|
| Rate for Payer: Dean Health Medicaid |
$38.65
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$82.95
|
| Rate for Payer: Health EOS Commercial |
$342.65
|
| Rate for Payer: HFN Commercial |
$354.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$308.57
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$82.95
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$38.65
|
| Rate for Payer: Independent Care Health Plan Medicare |
$82.95
|
| Rate for Payer: Managed Health Services Medicaid |
$40.20
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$82.95
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$82.95
|
| Rate for Payer: Multiplan Commercial |
$308.00
|
| Rate for Payer: NAPHCARE Commercial |
$124.42
|
| Rate for Payer: Preferred Network Access Commercial |
$354.20
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$38.65
|
| Rate for Payer: Quartz Beloit One Network |
$188.65
|
| Rate for Payer: Quartz Commercial |
$250.25
|
| Rate for Payer: Quartz Medicare Advantage |
$82.95
|
| Rate for Payer: The Alliance Commercial |
$331.80
|
| Rate for Payer: United Healthcare Medicaid |
$38.65
|
| Rate for Payer: United Healthcare Medicare Advantage |
$82.95
|
| Rate for Payer: United Healthcare PPO |
$288.75
|
| Rate for Payer: WEA Trust Commercial |
$211.75
|
| Rate for Payer: Wellcare Medicare |
$82.95
|
| Rate for Payer: WMAP Medicaid |
$38.65
|
| Rate for Payer: WPS Commercial |
$285.17
|
|
|
FFP CP2D
|
Facility
|
IP
|
$385.00
|
|
|
Service Code
|
HCPCS P9017
|
| Hospital Charge Code |
1052855
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$188.65 |
| Max. Negotiated Rate |
$354.20 |
| Rate for Payer: Aetna Commercial |
$346.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$331.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$204.05
|
| Rate for Payer: Cash Price |
$115.50
|
| Rate for Payer: Cigna Commercial |
$354.20
|
| Rate for Payer: Health EOS Commercial |
$342.65
|
| Rate for Payer: HFN Commercial |
$354.20
|
| Rate for Payer: Multiplan Commercial |
$308.00
|
| Rate for Payer: NAPHCARE Commercial |
$231.00
|
| Rate for Payer: Preferred Network Access Commercial |
$354.20
|
| Rate for Payer: Quartz Beloit One Network |
$188.65
|
| Rate for Payer: Quartz Commercial |
$231.00
|
| Rate for Payer: WEA Trust Commercial |
$211.75
|
| Rate for Payer: WPS Commercial |
$285.17
|
|
|
FFP CPD
|
Facility
|
IP
|
$385.00
|
|
|
Service Code
|
HCPCS P9017
|
| Hospital Charge Code |
1052866
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$188.65 |
| Max. Negotiated Rate |
$354.20 |
| Rate for Payer: Aetna Commercial |
$346.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$331.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$204.05
|
| Rate for Payer: Cash Price |
$115.50
|
| Rate for Payer: Cigna Commercial |
$354.20
|
| Rate for Payer: Health EOS Commercial |
$342.65
|
| Rate for Payer: HFN Commercial |
$354.20
|
| Rate for Payer: Multiplan Commercial |
$308.00
|
| Rate for Payer: NAPHCARE Commercial |
$231.00
|
| Rate for Payer: Preferred Network Access Commercial |
$354.20
|
| Rate for Payer: Quartz Beloit One Network |
$188.65
|
| Rate for Payer: Quartz Commercial |
$231.00
|
| Rate for Payer: WEA Trust Commercial |
$211.75
|
| Rate for Payer: WPS Commercial |
$285.17
|
|
