|
FULL RING 180MM 4933-2-180
|
Facility
|
OP
|
$6,010.00
|
|
| Hospital Charge Code |
6165643
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,750.11 |
| Max. Negotiated Rate |
$5,750.37 |
| Rate for Payer: Aetna Commercial |
$5,625.36
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,375.34
|
| Rate for Payer: Aetna Managed Medicare |
$1,750.11
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,062.76
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,125.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,000.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,312.71
|
| Rate for Payer: Cash Price |
$1,803.00
|
| Rate for Payer: Cigna Commercial |
$5,750.37
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,497.82
|
| Rate for Payer: Health EOS Commercial |
$5,562.86
|
| Rate for Payer: HFN Commercial |
$5,750.37
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,687.80
|
| Rate for Payer: Multiplan Commercial |
$5,000.32
|
| Rate for Payer: NAPHCARE Commercial |
$3,750.24
|
| Rate for Payer: Preferred Network Access Commercial |
$5,750.37
|
| Rate for Payer: Quartz Beloit One Network |
$3,062.70
|
| Rate for Payer: Quartz Commercial |
$4,062.76
|
| Rate for Payer: Quartz Medicare Advantage |
$3,750.24
|
| Rate for Payer: The Alliance Commercial |
$3,125.20
|
| Rate for Payer: WEA Trust Commercial |
$3,437.72
|
| Rate for Payer: WPS Commercial |
$4,629.50
|
|
|
FULL RING 180MM 4933-2-180
|
Facility
|
IP
|
$6,010.00
|
|
| Hospital Charge Code |
6165643
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3,062.70 |
| Max. Negotiated Rate |
$5,750.37 |
| Rate for Payer: Aetna Commercial |
$5,625.36
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,375.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,312.71
|
| Rate for Payer: Cash Price |
$1,803.00
|
| Rate for Payer: Cigna Commercial |
$5,750.37
|
| Rate for Payer: Health EOS Commercial |
$5,562.86
|
| Rate for Payer: HFN Commercial |
$5,750.37
|
| Rate for Payer: Multiplan Commercial |
$5,000.32
|
| Rate for Payer: Preferred Network Access Commercial |
$5,750.37
|
| Rate for Payer: Quartz Beloit One Network |
$3,062.70
|
| Rate for Payer: Quartz Commercial |
$3,750.24
|
| Rate for Payer: WEA Trust Commercial |
$3,437.72
|
| Rate for Payer: WPS Commercial |
$4,629.50
|
|
|
FULL RING 210MM 4933-2-210
|
Facility
|
OP
|
$6,501.00
|
|
| Hospital Charge Code |
5603592
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,893.09 |
| Max. Negotiated Rate |
$6,220.16 |
| Rate for Payer: Aetna Commercial |
$6,084.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,814.49
|
| Rate for Payer: Aetna Managed Medicare |
$1,893.09
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,394.68
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,380.52
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,245.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,583.35
|
| Rate for Payer: Cash Price |
$1,950.30
|
| Rate for Payer: Cigna Commercial |
$6,220.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,783.58
|
| Rate for Payer: Health EOS Commercial |
$6,017.33
|
| Rate for Payer: HFN Commercial |
$6,220.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,070.78
|
| Rate for Payer: Multiplan Commercial |
$5,408.83
|
| Rate for Payer: NAPHCARE Commercial |
$4,056.62
|
| Rate for Payer: Preferred Network Access Commercial |
$6,220.16
|
| Rate for Payer: Quartz Beloit One Network |
$3,312.91
|
| Rate for Payer: Quartz Commercial |
$4,394.68
|
| Rate for Payer: Quartz Medicare Advantage |
$4,056.62
|
| Rate for Payer: The Alliance Commercial |
$3,380.52
|
| Rate for Payer: WEA Trust Commercial |
$3,718.57
|
| Rate for Payer: WPS Commercial |
$5,007.72
|
|
|
FULL RING 210MM 4933-2-210
|
Facility
|
IP
|
$6,501.00
|
|
| Hospital Charge Code |
5603592
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3,312.91 |
| Max. Negotiated Rate |
$6,220.16 |
| Rate for Payer: Aetna Commercial |
$6,084.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,814.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,583.35
|
| Rate for Payer: Cash Price |
$1,950.30
|
| Rate for Payer: Cigna Commercial |
$6,220.16
|
| Rate for Payer: Health EOS Commercial |
$6,017.33
|
| Rate for Payer: HFN Commercial |
$6,220.16
|
| Rate for Payer: Multiplan Commercial |
$5,408.83
|
| Rate for Payer: Preferred Network Access Commercial |
$6,220.16
|
| Rate for Payer: Quartz Beloit One Network |
$3,312.91
|
| Rate for Payer: Quartz Commercial |
$4,056.62
|
| Rate for Payer: WEA Trust Commercial |
$3,718.57
|
| Rate for Payer: WPS Commercial |
$5,007.72
|
|
|
FULL TERM NEONATE WITH MAJOR PROBLEMS
|
Facility
|
IP
|
$116,718.16
|
|
|
Service Code
|
MSDRG 793
|
| Min. Negotiated Rate |
$2,496.00 |
| Max. Negotiated Rate |
$116,718.16 |
| Rate for Payer: Aetna Managed Medicare |
$32,438.40
|
| 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 |
$32,438.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$32,438.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$32,438.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$32,438.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$73,544.99
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$32,438.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,108.00
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$32,438.40
|
| Rate for Payer: Independent Care Health Plan Medicare |
$32,438.40
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$32,438.40
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$32,438.40
|
| Rate for Payer: NAPHCARE Commercial |
$48,657.60
|
| Rate for Payer: Quartz Medicare Advantage |
$32,438.40
|
| Rate for Payer: The Alliance Commercial |
$116,718.16
|
| Rate for Payer: United Healthcare Medicare Advantage |
$32,438.40
|
| Rate for Payer: United Healthcare PPO |
$2,496.00
|
| Rate for Payer: Wellcare Medicare |
$32,438.40
|
|
|
FULL THICKNESS BURN WITHOUT SKIN GRAFT OR INHALATION INJURY
|
Facility
|
IP
|
$58,190.08
|
|
|
Service Code
|
MSDRG 934
|
| Min. Negotiated Rate |
$17,435.98 |
| Max. Negotiated Rate |
$58,190.08 |
| Rate for Payer: Aetna Managed Medicare |
$17,435.98
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$48,233.52
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$36,970.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$35,124.49
|
| Rate for Payer: Anthem Medicare Advantage |
$17,435.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$17,435.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$17,435.98
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$17,435.98
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$38,991.40
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$17,435.98
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$42,435.90
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$17,435.98
|
| Rate for Payer: Independent Care Health Plan Medicare |
$17,435.98
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$17,435.98
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$17,435.98
|
| Rate for Payer: NAPHCARE Commercial |
$26,153.98
|
| Rate for Payer: Quartz Medicare Advantage |
$17,435.98
|
| Rate for Payer: The Alliance Commercial |
$58,190.08
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17,435.98
|
| Rate for Payer: United Healthcare PPO |
$33,036.89
|
| Rate for Payer: Wellcare Medicare |
$17,435.98
|
|
|
FULL THICKNESS BURN WITH SKIN GRAFT OR INHALATION INJURY WITH CC/MCC
|
Facility
|
IP
|
$191,658.48
|
|
|
Service Code
|
MSDRG 928
|
| Min. Negotiated Rate |
$55,436.73 |
| Max. Negotiated Rate |
$191,658.48 |
| Rate for Payer: Aetna Managed Medicare |
$55,436.73
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$156,502.58
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$119,957.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$113,967.89
|
| Rate for Payer: Anthem Medicare Advantage |
$55,436.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$55,436.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$55,436.73
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$55,436.73
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$126,514.81
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$55,436.73
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$140,331.57
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$55,436.73
|
| Rate for Payer: Independent Care Health Plan Medicare |
$55,436.73
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$55,436.73
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$55,436.73
|
| Rate for Payer: NAPHCARE Commercial |
$83,155.10
|
| Rate for Payer: Quartz Medicare Advantage |
$55,436.73
|
| Rate for Payer: The Alliance Commercial |
$191,658.48
|
| Rate for Payer: United Healthcare Medicare Advantage |
$55,436.73
|
| Rate for Payer: United Healthcare PPO |
$109,249.89
|
| Rate for Payer: Wellcare Medicare |
$55,436.73
|
|
|
FULL THICKNESS BURN WITH SKIN GRAFT OR INHALATION INJURY WITHOUT CC/MCC
|
Facility
|
IP
|
$89,240.32
|
|
|
Service Code
|
MSDRG 929
|
| Min. Negotiated Rate |
$25,172.31 |
| Max. Negotiated Rate |
$89,240.32 |
| Rate for Payer: Aetna Managed Medicare |
$25,172.31
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$70,275.28
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$53,865.43
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$51,175.68
|
| Rate for Payer: Anthem Medicare Advantage |
$25,172.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$25,172.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$25,172.31
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$25,172.31
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$56,809.69
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$25,172.31
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$65,210.34
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$25,172.31
|
| Rate for Payer: Independent Care Health Plan Medicare |
$25,172.31
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$25,172.31
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$25,172.31
|
| Rate for Payer: NAPHCARE Commercial |
$37,758.46
|
| Rate for Payer: Quartz Medicare Advantage |
$25,172.31
|
| Rate for Payer: The Alliance Commercial |
$89,240.32
|
| Rate for Payer: United Healthcare Medicare Advantage |
$25,172.31
|
| Rate for Payer: United Healthcare PPO |
$50,767.09
|
| Rate for Payer: Wellcare Medicare |
$25,172.31
|
|
|
FULL THICKNESS GRAFT, FREE, INCLUDING DIRECT CLOSURE OF DONOR SITE, NOSE, EARS, EYELIDS, AND/OR LIPS; 20 SQ CM OR LESS
|
Facility
|
OP
|
$8,685.50
|
|
|
Service Code
|
CPT 15260
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,171.37 |
| Max. Negotiated Rate |
$8,685.50 |
| Rate for Payer: Aetna Managed Medicare |
$2,171.37
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,635.84
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,985.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,835.04
|
| Rate for Payer: Anthem Medicare Advantage |
$2,171.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$2,171.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$2,171.37
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$2,171.37
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,947.89
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$2,171.37
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$8,077.51
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$2,171.37
|
| Rate for Payer: Independent Care Health Plan Medicare |
$2,171.37
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$2,171.37
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$2,171.37
|
| Rate for Payer: NAPHCARE Commercial |
$3,257.06
|
| Rate for Payer: Quartz Medicare Advantage |
$2,171.37
|
| Rate for Payer: The Alliance Commercial |
$8,685.50
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,171.37
|
| Rate for Payer: United Healthcare PPO |
$3,726.32
|
| Rate for Payer: Wellcare Medicare |
$2,171.37
|
|
|
FUNCTIONAL ENDOSCOPIC SINUS SURGERY (FESS)
|
Facility
|
IP
|
$5,511.00
|
|
| Hospital Charge Code |
2950499
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,808.41 |
| Max. Negotiated Rate |
$5,272.92 |
| Rate for Payer: Aetna Commercial |
$5,158.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,929.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,037.66
|
| Rate for Payer: Cash Price |
$1,653.30
|
| Rate for Payer: Cigna Commercial |
$5,272.92
|
| Rate for Payer: Health EOS Commercial |
$5,100.98
|
| Rate for Payer: HFN Commercial |
$5,272.92
|
| Rate for Payer: Multiplan Commercial |
$4,585.15
|
| Rate for Payer: Preferred Network Access Commercial |
$5,272.92
|
| Rate for Payer: Quartz Beloit One Network |
$2,808.41
|
| Rate for Payer: Quartz Commercial |
$3,438.86
|
| Rate for Payer: WEA Trust Commercial |
$3,152.29
|
| Rate for Payer: WPS Commercial |
$4,245.12
|
|
|
FUNCTIONAL ENDOSCOPIC SINUS SURGERY (FESS)
|
Facility
|
OP
|
$5,511.00
|
|
| Hospital Charge Code |
2950499
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,604.80 |
| Max. Negotiated Rate |
$5,272.92 |
| Rate for Payer: Aetna Commercial |
$5,158.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,929.04
|
| Rate for Payer: Aetna Managed Medicare |
$1,604.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,725.44
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,865.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,751.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,037.66
|
| Rate for Payer: Cash Price |
$1,653.30
|
| Rate for Payer: Cigna Commercial |
$5,272.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,207.40
|
| Rate for Payer: Health EOS Commercial |
$5,100.98
|
| Rate for Payer: HFN Commercial |
$5,272.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,298.58
|
| Rate for Payer: Multiplan Commercial |
$4,585.15
|
| Rate for Payer: NAPHCARE Commercial |
$3,438.86
|
| Rate for Payer: Preferred Network Access Commercial |
$5,272.92
|
| Rate for Payer: Quartz Beloit One Network |
$2,808.41
|
| Rate for Payer: Quartz Commercial |
$3,725.44
|
| Rate for Payer: Quartz Medicare Advantage |
$3,438.86
|
| Rate for Payer: The Alliance Commercial |
$2,865.72
|
| Rate for Payer: WEA Trust Commercial |
$3,152.29
|
| Rate for Payer: WPS Commercial |
$4,245.12
|
|
|
FUNCTIONAL ENDO SINUS SURGERY W/LANDMARK
|
Facility
|
OP
|
$7,351.00
|
|
| Hospital Charge Code |
2960069
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,140.61 |
| Max. Negotiated Rate |
$7,033.44 |
| Rate for Payer: Aetna Commercial |
$6,880.54
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,574.73
|
| Rate for Payer: Aetna Managed Medicare |
$2,140.61
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,969.28
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,822.52
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,669.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,051.87
|
| Rate for Payer: Cash Price |
$2,205.30
|
| Rate for Payer: Cigna Commercial |
$7,033.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,278.28
|
| Rate for Payer: Health EOS Commercial |
$6,804.09
|
| Rate for Payer: HFN Commercial |
$7,033.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,733.78
|
| Rate for Payer: Multiplan Commercial |
$6,116.03
|
| Rate for Payer: NAPHCARE Commercial |
$4,587.02
|
| Rate for Payer: Preferred Network Access Commercial |
$7,033.44
|
| Rate for Payer: Quartz Beloit One Network |
$3,746.07
|
| Rate for Payer: Quartz Commercial |
$4,969.28
|
| Rate for Payer: Quartz Medicare Advantage |
$4,587.02
|
| Rate for Payer: The Alliance Commercial |
$3,822.52
|
| Rate for Payer: WEA Trust Commercial |
$4,204.77
|
| Rate for Payer: WPS Commercial |
$5,662.48
|
|
|
FUNCTIONAL ENDO SINUS SURGERY W/LANDMARK
|
Facility
|
IP
|
$7,351.00
|
|
| Hospital Charge Code |
2960069
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,746.07 |
| Max. Negotiated Rate |
$7,033.44 |
| Rate for Payer: Aetna Commercial |
$6,880.54
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,574.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,051.87
|
| Rate for Payer: Cash Price |
$2,205.30
|
| Rate for Payer: Cigna Commercial |
$7,033.44
|
| Rate for Payer: Health EOS Commercial |
$6,804.09
|
| Rate for Payer: HFN Commercial |
$7,033.44
|
| Rate for Payer: Multiplan Commercial |
$6,116.03
|
| Rate for Payer: Preferred Network Access Commercial |
$7,033.44
|
| Rate for Payer: Quartz Beloit One Network |
$3,746.07
|
| Rate for Payer: Quartz Commercial |
$4,587.02
|
| Rate for Payer: WEA Trust Commercial |
$4,204.77
|
| Rate for Payer: WPS Commercial |
$5,662.48
|
|
|
Functional Residual Capacity - Pulmonary Function Test Charge
|
Facility
|
OP
|
$706.00
|
|
|
Service Code
|
CPT 94013
|
| Hospital Charge Code |
3006995
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$352.44 |
| Max. Negotiated Rate |
$1,570.82 |
| Rate for Payer: Aetna Commercial |
$660.82
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$631.45
|
| Rate for Payer: Aetna Managed Medicare |
$392.70
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$477.26
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$367.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$352.44
|
| Rate for Payer: Anthem Medicare Advantage |
$392.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$389.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$392.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$392.70
|
| Rate for Payer: Cash Price |
$211.80
|
| Rate for Payer: Cash Price |
$211.80
|
| Rate for Payer: Cigna Commercial |
$675.50
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$392.70
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$410.89
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$392.70
|
| Rate for Payer: Health EOS Commercial |
$653.47
|
| Rate for Payer: HFN Commercial |
$675.50
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,460.86
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$392.70
|
| Rate for Payer: Independent Care Health Plan Medicare |
$392.70
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$392.70
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$392.70
|
| Rate for Payer: Multiplan Commercial |
$587.39
|
| Rate for Payer: NAPHCARE Commercial |
$589.06
|
| Rate for Payer: Preferred Network Access Commercial |
$675.50
|
| Rate for Payer: Quartz Beloit One Network |
$359.78
|
| Rate for Payer: Quartz Commercial |
$477.26
|
| Rate for Payer: Quartz Medicare Advantage |
$392.70
|
| Rate for Payer: The Alliance Commercial |
$1,570.82
|
| Rate for Payer: United Healthcare Medicare Advantage |
$392.70
|
| Rate for Payer: United Healthcare PPO |
$550.68
|
| Rate for Payer: WEA Trust Commercial |
$403.83
|
| Rate for Payer: Wellcare Medicare |
$392.70
|
| Rate for Payer: WPS Commercial |
$543.83
|
|
|
Functional Residual Capacity - Pulmonary Function Test Charge
|
Facility
|
IP
|
$706.00
|
|
|
Service Code
|
CPT 94013
|
| Hospital Charge Code |
3006995
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$359.78 |
| Max. Negotiated Rate |
$675.50 |
| Rate for Payer: Aetna Commercial |
$660.82
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$631.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$389.15
|
| Rate for Payer: Cash Price |
$211.80
|
| Rate for Payer: Cigna Commercial |
$675.50
|
| Rate for Payer: Health EOS Commercial |
$653.47
|
| Rate for Payer: HFN Commercial |
$675.50
|
| Rate for Payer: Multiplan Commercial |
$587.39
|
| Rate for Payer: Preferred Network Access Commercial |
$675.50
|
| Rate for Payer: Quartz Beloit One Network |
$359.78
|
| Rate for Payer: Quartz Commercial |
$440.54
|
| Rate for Payer: WEA Trust Commercial |
$403.83
|
| Rate for Payer: WPS Commercial |
$543.83
|
|
|
Fungal Panel 3 / 37699
|
Facility
|
IP
|
$57.00
|
|
|
Service Code
|
CPT 86628
|
| Hospital Charge Code |
5598602
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$29.05 |
| Max. Negotiated Rate |
$54.54 |
| Rate for Payer: Aetna Commercial |
$53.35
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$50.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$31.42
|
| Rate for Payer: Cash Price |
$17.10
|
| Rate for Payer: Cigna Commercial |
$54.54
|
| Rate for Payer: Health EOS Commercial |
$52.76
|
| Rate for Payer: HFN Commercial |
$54.54
|
| Rate for Payer: Multiplan Commercial |
$47.42
|
| Rate for Payer: Preferred Network Access Commercial |
$54.54
|
| Rate for Payer: Quartz Beloit One Network |
$29.05
|
| Rate for Payer: Quartz Commercial |
$35.57
|
| Rate for Payer: WEA Trust Commercial |
$32.60
|
| Rate for Payer: WPS Commercial |
$43.91
|
|
|
Fungal Panel 3 / 37699
|
Facility
|
OP
|
$57.00
|
|
|
Service Code
|
CPT 86628
|
| Hospital Charge Code |
5598602
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.49 |
| Max. Negotiated Rate |
$54.54 |
| Rate for Payer: Aetna Commercial |
$53.35
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$50.98
|
| Rate for Payer: Aetna Managed Medicare |
$12.49
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$46.84
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$21.86
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$20.73
|
| Rate for Payer: Anthem Medicare Advantage |
$12.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$31.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$12.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$12.49
|
| Rate for Payer: Cash Price |
$17.10
|
| Rate for Payer: Cash Price |
$17.10
|
| Rate for Payer: Cigna Commercial |
$54.54
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$12.49
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$33.17
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$12.49
|
| Rate for Payer: Health EOS Commercial |
$52.76
|
| Rate for Payer: HFN Commercial |
$54.54
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$46.46
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$12.49
|
| Rate for Payer: Independent Care Health Plan Medicare |
$12.49
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$12.49
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$12.49
|
| Rate for Payer: Multiplan Commercial |
$47.42
|
| Rate for Payer: NAPHCARE Commercial |
$18.74
|
| Rate for Payer: Preferred Network Access Commercial |
$54.54
|
| Rate for Payer: Quartz Beloit One Network |
$29.05
|
| Rate for Payer: Quartz Commercial |
$38.53
|
| Rate for Payer: Quartz Medicare Advantage |
$12.49
|
| Rate for Payer: The Alliance Commercial |
$49.96
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.49
|
| Rate for Payer: United Healthcare PPO |
$44.46
|
| Rate for Payer: WEA Trust Commercial |
$32.60
|
| Rate for Payer: Wellcare Medicare |
$12.49
|
| Rate for Payer: WPS Commercial |
$43.91
|
|
|
Fungal Panel 3 / 37699
|
Professional
|
Both
|
$57.00
|
|
|
Service Code
|
CPT 86628
|
| Hospital Charge Code |
5598602
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.49 |
| Max. Negotiated Rate |
$56.32 |
| Rate for Payer: Aetna Commercial |
$56.32
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$50.98
|
| Rate for Payer: Aetna Managed Medicare |
$12.49
|
| Rate for Payer: Anthem Medicare Advantage |
$12.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$12.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$12.49
|
| Rate for Payer: Cash Price |
$17.10
|
| Rate for Payer: Cash Price |
$17.10
|
| Rate for Payer: Cigna Commercial |
$56.32
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$29.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12.49
|
| Rate for Payer: Health EOS Commercial |
$53.94
|
| Rate for Payer: HFN Commercial |
$56.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$44.10
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$44.10
|
| Rate for Payer: Independent Care Health Plan Medicare |
$12.49
|
| Rate for Payer: Multiplan Commercial |
$47.42
|
| Rate for Payer: NAPHCARE Commercial |
$18.74
|
| Rate for Payer: Preferred Network Access Commercial |
$56.32
|
| Rate for Payer: Quartz Beloit One Network |
$26.08
|
| Rate for Payer: Quartz Commercial |
$33.79
|
| Rate for Payer: Quartz Medicare Advantage |
$12.49
|
| Rate for Payer: The Alliance Commercial |
$49.34
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.49
|
| Rate for Payer: WEA Trust Commercial |
$32.60
|
| Rate for Payer: WPS Commercial |
$54.96
|
|
|
Fungitell (1-3) Beta-D-Glucan Assay
|
Facility
|
IP
|
$312.00
|
|
|
Service Code
|
CPT 84311
|
| Hospital Charge Code |
4500573
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$159.00 |
| Max. Negotiated Rate |
$298.52 |
| Rate for Payer: Aetna Commercial |
$292.03
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$279.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$171.97
|
| Rate for Payer: Cash Price |
$93.60
|
| Rate for Payer: Cigna Commercial |
$298.52
|
| Rate for Payer: Health EOS Commercial |
$288.79
|
| Rate for Payer: HFN Commercial |
$298.52
|
| Rate for Payer: Multiplan Commercial |
$259.58
|
| Rate for Payer: Preferred Network Access Commercial |
$298.52
|
| Rate for Payer: Quartz Beloit One Network |
$159.00
|
| Rate for Payer: Quartz Commercial |
$194.69
|
| Rate for Payer: WEA Trust Commercial |
$178.46
|
| Rate for Payer: WPS Commercial |
$240.33
|
|
|
Fungitell (1-3) Beta-D-Glucan Assay
|
Professional
|
Both
|
$312.00
|
|
|
Service Code
|
CPT 84311
|
| Hospital Charge Code |
4500573
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.42 |
| Max. Negotiated Rate |
$308.26 |
| Rate for Payer: Aetna Commercial |
$308.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$279.05
|
| Rate for Payer: Aetna Managed Medicare |
$8.42
|
| Rate for Payer: Anthem Medicare Advantage |
$8.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$8.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$8.42
|
| Rate for Payer: Cash Price |
$93.60
|
| Rate for Payer: Cash Price |
$93.60
|
| Rate for Payer: Cigna Commercial |
$308.26
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$162.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$8.42
|
| Rate for Payer: Health EOS Commercial |
$295.28
|
| Rate for Payer: HFN Commercial |
$308.26
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$29.73
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$29.73
|
| Rate for Payer: Independent Care Health Plan Medicare |
$8.42
|
| Rate for Payer: Multiplan Commercial |
$259.58
|
| Rate for Payer: NAPHCARE Commercial |
$12.64
|
| Rate for Payer: Preferred Network Access Commercial |
$308.26
|
| Rate for Payer: Quartz Beloit One Network |
$142.77
|
| Rate for Payer: Quartz Commercial |
$184.95
|
| Rate for Payer: Quartz Medicare Advantage |
$8.42
|
| Rate for Payer: The Alliance Commercial |
$33.27
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8.42
|
| Rate for Payer: WEA Trust Commercial |
$178.46
|
| Rate for Payer: WPS Commercial |
$37.07
|
|
|
Fungitell (1-3) Beta-D-Glucan Assay
|
Facility
|
OP
|
$312.00
|
|
|
Service Code
|
CPT 84311
|
| Hospital Charge Code |
4500573
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.42 |
| Max. Negotiated Rate |
$298.52 |
| Rate for Payer: Aetna Commercial |
$292.03
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$279.05
|
| Rate for Payer: Aetna Managed Medicare |
$8.42
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$31.59
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$14.74
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$13.98
|
| Rate for Payer: Anthem Medicare Advantage |
$8.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$171.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$8.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$8.42
|
| Rate for Payer: Cash Price |
$93.60
|
| Rate for Payer: Cash Price |
$93.60
|
| Rate for Payer: Cigna Commercial |
$298.52
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$8.42
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$181.58
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$8.42
|
| Rate for Payer: Health EOS Commercial |
$288.79
|
| Rate for Payer: HFN Commercial |
$298.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$31.34
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$8.42
|
| Rate for Payer: Independent Care Health Plan Medicare |
$8.42
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$8.42
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$8.42
|
| Rate for Payer: Multiplan Commercial |
$259.58
|
| Rate for Payer: NAPHCARE Commercial |
$12.64
|
| Rate for Payer: Preferred Network Access Commercial |
$298.52
|
| Rate for Payer: Quartz Beloit One Network |
$159.00
|
| Rate for Payer: Quartz Commercial |
$210.91
|
| Rate for Payer: Quartz Medicare Advantage |
$8.42
|
| Rate for Payer: The Alliance Commercial |
$33.70
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8.42
|
| Rate for Payer: United Healthcare PPO |
$243.36
|
| Rate for Payer: WEA Trust Commercial |
$178.46
|
| Rate for Payer: Wellcare Medicare |
$8.42
|
| Rate for Payer: WPS Commercial |
$240.33
|
|
|
Fungus Culture
|
Facility
|
OP
|
$218.00
|
|
|
Service Code
|
CPT 87102
|
| Hospital Charge Code |
633893
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.75 |
| Max. Negotiated Rate |
$208.58 |
| Rate for Payer: Aetna Commercial |
$204.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$194.98
|
| Rate for Payer: Aetna Managed Medicare |
$8.75
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$32.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$15.31
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$14.52
|
| Rate for Payer: Anthem Medicare Advantage |
$8.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$120.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$8.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$8.75
|
| Rate for Payer: Cash Price |
$65.40
|
| Rate for Payer: Cash Price |
$65.40
|
| Rate for Payer: Cigna Commercial |
$208.58
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$8.75
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$126.88
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$8.75
|
| Rate for Payer: Health EOS Commercial |
$201.78
|
| Rate for Payer: HFN Commercial |
$208.58
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$32.54
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$8.75
|
| Rate for Payer: Independent Care Health Plan Medicare |
$8.75
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$8.75
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$8.75
|
| Rate for Payer: Multiplan Commercial |
$181.38
|
| Rate for Payer: NAPHCARE Commercial |
$13.12
|
| Rate for Payer: Preferred Network Access Commercial |
$208.58
|
| Rate for Payer: Quartz Beloit One Network |
$111.09
|
| Rate for Payer: Quartz Commercial |
$147.37
|
| Rate for Payer: Quartz Medicare Advantage |
$8.75
|
| Rate for Payer: The Alliance Commercial |
$34.99
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8.75
|
| Rate for Payer: United Healthcare PPO |
$170.04
|
| Rate for Payer: WEA Trust Commercial |
$124.70
|
| Rate for Payer: Wellcare Medicare |
$8.75
|
| Rate for Payer: WPS Commercial |
$167.93
|
|
|
Fungus Culture
|
Professional
|
Both
|
$218.00
|
|
|
Service Code
|
CPT 87102
|
| Hospital Charge Code |
633893
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.75 |
| Max. Negotiated Rate |
$215.38 |
| Rate for Payer: Aetna Commercial |
$215.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$194.98
|
| Rate for Payer: Aetna Managed Medicare |
$8.75
|
| Rate for Payer: Anthem Medicare Advantage |
$8.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$8.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$8.75
|
| Rate for Payer: Cash Price |
$65.40
|
| Rate for Payer: Cash Price |
$65.40
|
| Rate for Payer: Cigna Commercial |
$215.38
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$113.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$8.75
|
| Rate for Payer: Health EOS Commercial |
$206.32
|
| Rate for Payer: HFN Commercial |
$215.38
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$30.88
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$30.88
|
| Rate for Payer: Independent Care Health Plan Medicare |
$8.75
|
| Rate for Payer: Multiplan Commercial |
$181.38
|
| Rate for Payer: NAPHCARE Commercial |
$13.12
|
| Rate for Payer: Preferred Network Access Commercial |
$215.38
|
| Rate for Payer: Quartz Beloit One Network |
$99.76
|
| Rate for Payer: Quartz Commercial |
$129.23
|
| Rate for Payer: Quartz Medicare Advantage |
$8.75
|
| Rate for Payer: The Alliance Commercial |
$34.55
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8.75
|
| Rate for Payer: WEA Trust Commercial |
$124.70
|
| Rate for Payer: WPS Commercial |
$38.48
|
|
|
Fungus Culture
|
Facility
|
IP
|
$218.00
|
|
|
Service Code
|
CPT 87102
|
| Hospital Charge Code |
633893
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$111.09 |
| Max. Negotiated Rate |
$208.58 |
| Rate for Payer: Aetna Commercial |
$204.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$194.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$120.16
|
| Rate for Payer: Cash Price |
$65.40
|
| Rate for Payer: Cigna Commercial |
$208.58
|
| Rate for Payer: Health EOS Commercial |
$201.78
|
| Rate for Payer: HFN Commercial |
$208.58
|
| Rate for Payer: Multiplan Commercial |
$181.38
|
| Rate for Payer: Preferred Network Access Commercial |
$208.58
|
| Rate for Payer: Quartz Beloit One Network |
$111.09
|
| Rate for Payer: Quartz Commercial |
$136.03
|
| Rate for Payer: WEA Trust Commercial |
$124.70
|
| Rate for Payer: WPS Commercial |
$167.93
|
|
|
Fungus Culture Blood
|
Professional
|
Both
|
$144.00
|
|
|
Service Code
|
CPT 87103
|
| Hospital Charge Code |
979911
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$21.28 |
| Max. Negotiated Rate |
$142.27 |
| Rate for Payer: Aetna Commercial |
$142.27
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$128.79
|
| Rate for Payer: Aetna Managed Medicare |
$21.28
|
| Rate for Payer: Anthem Medicare Advantage |
$21.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$21.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$21.28
|
| Rate for Payer: Cash Price |
$43.20
|
| Rate for Payer: Cash Price |
$43.20
|
| Rate for Payer: Cigna Commercial |
$142.27
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$74.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$21.28
|
| Rate for Payer: Health EOS Commercial |
$136.28
|
| Rate for Payer: HFN Commercial |
$142.27
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$75.11
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$75.11
|
| Rate for Payer: Independent Care Health Plan Medicare |
$21.28
|
| Rate for Payer: Multiplan Commercial |
$119.81
|
| Rate for Payer: NAPHCARE Commercial |
$31.92
|
| Rate for Payer: Preferred Network Access Commercial |
$142.27
|
| Rate for Payer: Quartz Beloit One Network |
$65.89
|
| Rate for Payer: Quartz Commercial |
$85.36
|
| Rate for Payer: Quartz Medicare Advantage |
$21.28
|
| Rate for Payer: The Alliance Commercial |
$84.05
|
| Rate for Payer: United Healthcare Medicare Advantage |
$21.28
|
| Rate for Payer: WEA Trust Commercial |
$82.37
|
| Rate for Payer: WPS Commercial |
$93.62
|
|
