|
Fungal Panel 3 / 37699
|
Professional
|
Both
|
$57.00
|
|
|
Service Code
|
CPT 86628
|
| Hospital Charge Code |
5598602
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$25.08 |
| Max. Negotiated Rate |
$54.15 |
| Rate for Payer: Aetna Commercial |
$54.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$49.02
|
| Rate for Payer: Cash Price |
$17.10
|
| Rate for Payer: Cash Price |
$17.10
|
| Rate for Payer: Cigna Commercial |
$54.15
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$28.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$34.20
|
| Rate for Payer: Health EOS Commercial |
$51.87
|
| Rate for Payer: HFN Commercial |
$54.15
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$42.40
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$42.40
|
| Rate for Payer: Multiplan Commercial |
$45.60
|
| Rate for Payer: Preferred Network Access Commercial |
$54.15
|
| Rate for Payer: Quartz Beloit One Network |
$25.08
|
| Rate for Payer: Quartz Commercial |
$32.49
|
| Rate for Payer: The Alliance Commercial |
$28.50
|
| Rate for Payer: WEA Trust Commercial |
$31.35
|
| Rate for Payer: WPS Commercial |
$42.22
|
|
|
Fungal Panel 3 / 37699
|
Facility
|
OP
|
$57.00
|
|
|
Service Code
|
CPT 86628
|
| Hospital Charge Code |
5598602
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.17 |
| Max. Negotiated Rate |
$52.44 |
| Rate for Payer: Aetna Commercial |
$51.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$49.02
|
| Rate for Payer: Aetna Managed Medicare |
$12.01
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$45.04
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$21.02
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$19.94
|
| Rate for Payer: Anthem Medicaid |
$8.17
|
| Rate for Payer: Anthem Medicare Advantage |
$12.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$30.21
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$12.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$12.01
|
| Rate for Payer: Cash Price |
$17.10
|
| Rate for Payer: Cash Price |
$17.10
|
| Rate for Payer: Cigna Commercial |
$52.44
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$12.01
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$8.17
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$31.90
|
| Rate for Payer: Dean Health Medicaid |
$8.17
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$12.01
|
| Rate for Payer: Health EOS Commercial |
$50.73
|
| Rate for Payer: HFN Commercial |
$52.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$44.68
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$12.01
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$8.17
|
| Rate for Payer: Independent Care Health Plan Medicare |
$12.01
|
| Rate for Payer: Managed Health Services Medicaid |
$8.50
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$12.01
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$12.01
|
| Rate for Payer: Multiplan Commercial |
$45.60
|
| Rate for Payer: NAPHCARE Commercial |
$18.02
|
| Rate for Payer: Preferred Network Access Commercial |
$52.44
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$8.17
|
| Rate for Payer: Quartz Beloit One Network |
$27.93
|
| Rate for Payer: Quartz Commercial |
$37.05
|
| Rate for Payer: Quartz Medicare Advantage |
$12.01
|
| Rate for Payer: The Alliance Commercial |
$48.04
|
| Rate for Payer: United Healthcare Medicaid |
$8.17
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.01
|
| Rate for Payer: United Healthcare PPO |
$42.75
|
| Rate for Payer: WEA Trust Commercial |
$31.35
|
| Rate for Payer: Wellcare Medicare |
$12.01
|
| Rate for Payer: WMAP Medicaid |
$8.17
|
| Rate for Payer: WPS Commercial |
$42.22
|
|
|
Fungal Panel 3 / 37699
|
Facility
|
IP
|
$57.00
|
|
|
Service Code
|
CPT 86628
|
| Hospital Charge Code |
5598602
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$27.93 |
| Max. Negotiated Rate |
$52.44 |
| Rate for Payer: Aetna Commercial |
$51.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$49.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$30.21
|
| Rate for Payer: Cash Price |
$17.10
|
| Rate for Payer: Cigna Commercial |
$52.44
|
| Rate for Payer: Health EOS Commercial |
$50.73
|
| Rate for Payer: HFN Commercial |
$52.44
|
| Rate for Payer: Multiplan Commercial |
$45.60
|
| Rate for Payer: NAPHCARE Commercial |
$34.20
|
| Rate for Payer: Preferred Network Access Commercial |
$52.44
|
| Rate for Payer: Quartz Beloit One Network |
$27.93
|
| Rate for Payer: Quartz Commercial |
$34.20
|
| Rate for Payer: WEA Trust Commercial |
$31.35
|
| Rate for Payer: WPS Commercial |
$42.22
|
|
|
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 |
$8.10 |
| Max. Negotiated Rate |
$287.04 |
| Rate for Payer: Aetna Commercial |
$280.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$268.32
|
| Rate for Payer: Aetna Managed Medicare |
$8.10
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$30.38
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$14.18
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$13.45
|
| Rate for Payer: Anthem Medicaid |
$8.37
|
| Rate for Payer: Anthem Medicare Advantage |
$8.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$165.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$8.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$8.10
|
| Rate for Payer: Cash Price |
$93.60
|
| Rate for Payer: Cash Price |
$93.60
|
| Rate for Payer: Cigna Commercial |
$287.04
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$8.10
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$8.37
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$174.60
|
| Rate for Payer: Dean Health Medicaid |
$8.37
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$8.10
|
| Rate for Payer: Health EOS Commercial |
$277.68
|
| Rate for Payer: HFN Commercial |
$287.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$30.13
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$8.10
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$8.37
|
| Rate for Payer: Independent Care Health Plan Medicare |
$8.10
|
| Rate for Payer: Managed Health Services Medicaid |
$8.70
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$8.10
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$8.10
|
| Rate for Payer: Multiplan Commercial |
$249.60
|
| Rate for Payer: NAPHCARE Commercial |
$12.15
|
| Rate for Payer: Preferred Network Access Commercial |
$287.04
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$8.37
|
| Rate for Payer: Quartz Beloit One Network |
$152.88
|
| Rate for Payer: Quartz Commercial |
$202.80
|
| Rate for Payer: Quartz Medicare Advantage |
$8.10
|
| Rate for Payer: The Alliance Commercial |
$32.40
|
| Rate for Payer: United Healthcare Medicaid |
$8.37
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8.10
|
| Rate for Payer: United Healthcare PPO |
$234.00
|
| Rate for Payer: WEA Trust Commercial |
$171.60
|
| Rate for Payer: Wellcare Medicare |
$8.10
|
| Rate for Payer: WMAP Medicaid |
$8.37
|
| Rate for Payer: WPS Commercial |
$231.10
|
|
|
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 |
$152.88 |
| Max. Negotiated Rate |
$287.04 |
| Rate for Payer: Aetna Commercial |
$280.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$268.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$165.36
|
| Rate for Payer: Cash Price |
$93.60
|
| Rate for Payer: Cigna Commercial |
$287.04
|
| Rate for Payer: Health EOS Commercial |
$277.68
|
| Rate for Payer: HFN Commercial |
$287.04
|
| Rate for Payer: Multiplan Commercial |
$249.60
|
| Rate for Payer: NAPHCARE Commercial |
$187.20
|
| Rate for Payer: Preferred Network Access Commercial |
$287.04
|
| Rate for Payer: Quartz Beloit One Network |
$152.88
|
| Rate for Payer: Quartz Commercial |
$187.20
|
| Rate for Payer: WEA Trust Commercial |
$171.60
|
| Rate for Payer: WPS Commercial |
$231.10
|
|
|
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 |
$28.59 |
| Max. Negotiated Rate |
$296.40 |
| Rate for Payer: Aetna Commercial |
$296.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$268.32
|
| Rate for Payer: Cash Price |
$93.60
|
| Rate for Payer: Cash Price |
$93.60
|
| Rate for Payer: Cigna Commercial |
$296.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$156.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$187.20
|
| Rate for Payer: Health EOS Commercial |
$283.92
|
| Rate for Payer: HFN Commercial |
$296.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$28.59
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$28.59
|
| Rate for Payer: Multiplan Commercial |
$249.60
|
| Rate for Payer: Preferred Network Access Commercial |
$296.40
|
| Rate for Payer: Quartz Beloit One Network |
$137.28
|
| Rate for Payer: Quartz Commercial |
$177.84
|
| Rate for Payer: The Alliance Commercial |
$156.00
|
| Rate for Payer: WEA Trust Commercial |
$171.60
|
| Rate for Payer: WPS Commercial |
$231.10
|
|
|
Fungus Culture
|
Facility
|
IP
|
$218.00
|
|
|
Service Code
|
CPT 87102
|
| Hospital Charge Code |
633893
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$106.82 |
| Max. Negotiated Rate |
$200.56 |
| Rate for Payer: Aetna Commercial |
$196.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$187.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$115.54
|
| Rate for Payer: Cash Price |
$65.40
|
| Rate for Payer: Cigna Commercial |
$200.56
|
| Rate for Payer: Health EOS Commercial |
$194.02
|
| Rate for Payer: HFN Commercial |
$200.56
|
| Rate for Payer: Multiplan Commercial |
$174.40
|
| Rate for Payer: NAPHCARE Commercial |
$130.80
|
| Rate for Payer: Preferred Network Access Commercial |
$200.56
|
| Rate for Payer: Quartz Beloit One Network |
$106.82
|
| Rate for Payer: Quartz Commercial |
$130.80
|
| Rate for Payer: WEA Trust Commercial |
$119.90
|
| Rate for Payer: WPS Commercial |
$161.47
|
|
|
Fungus Culture
|
Professional
|
Both
|
$218.00
|
|
|
Service Code
|
CPT 87102
|
| Hospital Charge Code |
633893
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$29.69 |
| Max. Negotiated Rate |
$207.10 |
| Rate for Payer: Aetna Commercial |
$207.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$187.48
|
| Rate for Payer: Cash Price |
$65.40
|
| Rate for Payer: Cash Price |
$65.40
|
| Rate for Payer: Cigna Commercial |
$207.10
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$109.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$130.80
|
| Rate for Payer: Health EOS Commercial |
$198.38
|
| Rate for Payer: HFN Commercial |
$207.10
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$29.69
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$29.69
|
| Rate for Payer: Multiplan Commercial |
$174.40
|
| Rate for Payer: Preferred Network Access Commercial |
$207.10
|
| Rate for Payer: Quartz Beloit One Network |
$95.92
|
| Rate for Payer: Quartz Commercial |
$124.26
|
| Rate for Payer: The Alliance Commercial |
$109.00
|
| Rate for Payer: WEA Trust Commercial |
$119.90
|
| Rate for Payer: WPS Commercial |
$161.47
|
|
|
Fungus Culture
|
Facility
|
OP
|
$218.00
|
|
|
Service Code
|
CPT 87102
|
| Hospital Charge Code |
633893
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.41 |
| Max. Negotiated Rate |
$200.56 |
| Rate for Payer: Aetna Commercial |
$196.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$187.48
|
| Rate for Payer: Aetna Managed Medicare |
$8.41
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$31.54
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$14.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$13.96
|
| Rate for Payer: Anthem Medicaid |
$8.69
|
| Rate for Payer: Anthem Medicare Advantage |
$8.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$115.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$8.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$8.41
|
| Rate for Payer: Cash Price |
$65.40
|
| Rate for Payer: Cash Price |
$65.40
|
| Rate for Payer: Cigna Commercial |
$200.56
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$8.41
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$8.69
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$121.99
|
| Rate for Payer: Dean Health Medicaid |
$8.69
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$8.41
|
| Rate for Payer: Health EOS Commercial |
$194.02
|
| Rate for Payer: HFN Commercial |
$200.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$31.29
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$8.41
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$8.69
|
| Rate for Payer: Independent Care Health Plan Medicare |
$8.41
|
| Rate for Payer: Managed Health Services Medicaid |
$9.04
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$8.41
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$8.41
|
| Rate for Payer: Multiplan Commercial |
$174.40
|
| Rate for Payer: NAPHCARE Commercial |
$12.62
|
| Rate for Payer: Preferred Network Access Commercial |
$200.56
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$8.69
|
| Rate for Payer: Quartz Beloit One Network |
$106.82
|
| Rate for Payer: Quartz Commercial |
$141.70
|
| Rate for Payer: Quartz Medicare Advantage |
$8.41
|
| Rate for Payer: The Alliance Commercial |
$33.64
|
| Rate for Payer: United Healthcare Medicaid |
$8.69
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8.41
|
| Rate for Payer: United Healthcare PPO |
$163.50
|
| Rate for Payer: WEA Trust Commercial |
$119.90
|
| Rate for Payer: Wellcare Medicare |
$8.41
|
| Rate for Payer: WMAP Medicaid |
$8.69
|
| Rate for Payer: WPS Commercial |
$161.47
|
|
|
Fungus Culture Blood
|
Professional
|
Both
|
$144.00
|
|
|
Service Code
|
CPT 87103
|
| Hospital Charge Code |
979911
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$63.36 |
| Max. Negotiated Rate |
$136.80 |
| Rate for Payer: Aetna Commercial |
$136.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$123.84
|
| Rate for Payer: Cash Price |
$43.20
|
| Rate for Payer: Cash Price |
$43.20
|
| Rate for Payer: Cigna Commercial |
$136.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$72.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$86.40
|
| Rate for Payer: Health EOS Commercial |
$131.04
|
| Rate for Payer: HFN Commercial |
$136.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$72.22
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$72.22
|
| Rate for Payer: Multiplan Commercial |
$115.20
|
| Rate for Payer: Preferred Network Access Commercial |
$136.80
|
| Rate for Payer: Quartz Beloit One Network |
$63.36
|
| Rate for Payer: Quartz Commercial |
$82.08
|
| Rate for Payer: The Alliance Commercial |
$72.00
|
| Rate for Payer: WEA Trust Commercial |
$79.20
|
| Rate for Payer: WPS Commercial |
$106.66
|
|
|
Fungus Culture Blood
|
Facility
|
IP
|
$144.00
|
|
|
Service Code
|
CPT 87103
|
| Hospital Charge Code |
979911
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$70.56 |
| Max. Negotiated Rate |
$132.48 |
| Rate for Payer: Aetna Commercial |
$129.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$123.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$76.32
|
| Rate for Payer: Cash Price |
$43.20
|
| Rate for Payer: Cigna Commercial |
$132.48
|
| Rate for Payer: Health EOS Commercial |
$128.16
|
| Rate for Payer: HFN Commercial |
$132.48
|
| Rate for Payer: Multiplan Commercial |
$115.20
|
| Rate for Payer: NAPHCARE Commercial |
$86.40
|
| Rate for Payer: Preferred Network Access Commercial |
$132.48
|
| Rate for Payer: Quartz Beloit One Network |
$70.56
|
| Rate for Payer: Quartz Commercial |
$86.40
|
| Rate for Payer: WEA Trust Commercial |
$79.20
|
| Rate for Payer: WPS Commercial |
$106.66
|
|
|
Fungus Culture Blood
|
Facility
|
OP
|
$144.00
|
|
|
Service Code
|
CPT 87103
|
| Hospital Charge Code |
979911
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.68 |
| Max. Negotiated Rate |
$132.48 |
| Rate for Payer: Aetna Commercial |
$129.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$123.84
|
| Rate for Payer: Aetna Managed Medicare |
$20.46
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$76.72
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$35.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$33.96
|
| Rate for Payer: Anthem Medicaid |
$12.68
|
| Rate for Payer: Anthem Medicare Advantage |
$20.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$76.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$20.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$20.46
|
| Rate for Payer: Cash Price |
$43.20
|
| Rate for Payer: Cash Price |
$43.20
|
| Rate for Payer: Cigna Commercial |
$132.48
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$20.46
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$12.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$80.58
|
| Rate for Payer: Dean Health Medicaid |
$12.68
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$20.46
|
| Rate for Payer: Health EOS Commercial |
$128.16
|
| Rate for Payer: HFN Commercial |
$132.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$76.11
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$20.46
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$12.68
|
| Rate for Payer: Independent Care Health Plan Medicare |
$20.46
|
| Rate for Payer: Managed Health Services Medicaid |
$13.19
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$20.46
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$20.46
|
| Rate for Payer: Multiplan Commercial |
$115.20
|
| Rate for Payer: NAPHCARE Commercial |
$30.69
|
| Rate for Payer: Preferred Network Access Commercial |
$132.48
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$12.68
|
| Rate for Payer: Quartz Beloit One Network |
$70.56
|
| Rate for Payer: Quartz Commercial |
$93.60
|
| Rate for Payer: Quartz Medicare Advantage |
$20.46
|
| Rate for Payer: The Alliance Commercial |
$81.84
|
| Rate for Payer: United Healthcare Medicaid |
$12.68
|
| Rate for Payer: United Healthcare Medicare Advantage |
$20.46
|
| Rate for Payer: United Healthcare PPO |
$108.00
|
| Rate for Payer: WEA Trust Commercial |
$79.20
|
| Rate for Payer: Wellcare Medicare |
$20.46
|
| Rate for Payer: WMAP Medicaid |
$12.68
|
| Rate for Payer: WPS Commercial |
$106.66
|
|
|
Furosemide JW Waste Charge per 20 mg
|
Professional
|
Both
|
$9.00
|
|
|
Service Code
|
HCPCS J1940 JW
|
| Hospital Charge Code |
5266672
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.61 |
| Max. Negotiated Rate |
$8.55 |
| Rate for Payer: Aetna Commercial |
$8.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7.74
|
| Rate for Payer: Cash Price |
$2.70
|
| Rate for Payer: Cash Price |
$2.70
|
| Rate for Payer: Cigna Commercial |
$8.55
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$0.61
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$0.61
|
| Rate for Payer: Health EOS Commercial |
$8.19
|
| Rate for Payer: HFN Commercial |
$8.55
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1.12
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1.12
|
| Rate for Payer: Multiplan Commercial |
$7.20
|
| Rate for Payer: Preferred Network Access Commercial |
$8.55
|
| Rate for Payer: Quartz Beloit One Network |
$3.96
|
| Rate for Payer: Quartz Commercial |
$5.13
|
| Rate for Payer: The Alliance Commercial |
$4.50
|
| Rate for Payer: United Healthcare Medicaid |
$0.61
|
| Rate for Payer: WEA Trust Commercial |
$4.95
|
| Rate for Payer: WPS Commercial |
$1.52
|
|
|
Furosemide JW Waste Charge per 20 mg
|
Facility
|
OP
|
$9.00
|
|
|
Service Code
|
HCPCS J1940 JW
|
| Hospital Charge Code |
5266672
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.80 |
| Max. Negotiated Rate |
$36.00 |
| Rate for Payer: Aetna Commercial |
$8.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7.74
|
| Rate for Payer: Aetna Managed Medicare |
$2.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4.77
|
| Rate for Payer: Cash Price |
$2.70
|
| Rate for Payer: Cash Price |
$2.70
|
| Rate for Payer: Cigna Commercial |
$8.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$0.80
|
| Rate for Payer: Health EOS Commercial |
$8.01
|
| Rate for Payer: HFN Commercial |
$8.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6.75
|
| Rate for Payer: Multiplan Commercial |
$7.20
|
| Rate for Payer: NAPHCARE Commercial |
$5.40
|
| Rate for Payer: Preferred Network Access Commercial |
$8.28
|
| Rate for Payer: Quartz Beloit One Network |
$4.41
|
| Rate for Payer: Quartz Commercial |
$5.85
|
| Rate for Payer: Quartz Medicare Advantage |
$5.40
|
| Rate for Payer: The Alliance Commercial |
$36.00
|
| Rate for Payer: WEA Trust Commercial |
$4.95
|
| Rate for Payer: WPS Commercial |
$1.52
|
|
|
Furosemide JW Waste Charge per 20 mg
|
Facility
|
IP
|
$9.00
|
|
|
Service Code
|
HCPCS J1940 JW
|
| Hospital Charge Code |
5266672
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.41 |
| Max. Negotiated Rate |
$8.28 |
| Rate for Payer: Aetna Commercial |
$8.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4.77
|
| Rate for Payer: Cash Price |
$2.70
|
| Rate for Payer: Cigna Commercial |
$8.28
|
| Rate for Payer: Health EOS Commercial |
$8.01
|
| Rate for Payer: HFN Commercial |
$8.28
|
| Rate for Payer: Multiplan Commercial |
$7.20
|
| Rate for Payer: NAPHCARE Commercial |
$5.40
|
| Rate for Payer: Preferred Network Access Commercial |
$8.28
|
| Rate for Payer: Quartz Beloit One Network |
$4.41
|
| Rate for Payer: Quartz Commercial |
$5.40
|
| Rate for Payer: WEA Trust Commercial |
$4.95
|
| Rate for Payer: WPS Commercial |
$6.67
|
|
|
FUSION OF BIG TOE JOINT 28750
|
Professional
|
Both
|
$2,522.00
|
|
|
Service Code
|
CPT 28750
|
| Hospital Charge Code |
3014279
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$267.97 |
| Max. Negotiated Rate |
$2,395.90 |
| Rate for Payer: Aetna Commercial |
$2,395.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,168.92
|
| Rate for Payer: Cash Price |
$756.60
|
| Rate for Payer: Cash Price |
$756.60
|
| Rate for Payer: Cash Price |
$756.60
|
| Rate for Payer: Cigna Commercial |
$2,395.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$267.97
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,513.20
|
| Rate for Payer: Health EOS Commercial |
$2,295.02
|
| Rate for Payer: HFN Commercial |
$2,395.90
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,947.22
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,947.22
|
| Rate for Payer: Multiplan Commercial |
$2,017.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,395.90
|
| Rate for Payer: Quartz Beloit One Network |
$1,109.68
|
| Rate for Payer: Quartz Commercial |
$1,437.54
|
| Rate for Payer: The Alliance Commercial |
$1,261.00
|
| Rate for Payer: United Healthcare Medicaid |
$267.97
|
| Rate for Payer: WEA Trust Commercial |
$1,387.10
|
| Rate for Payer: WPS Commercial |
$1,868.05
|
|
|
FUSION OF BIG TOE JOINT 28755
|
Professional
|
Both
|
$1,805.00
|
|
|
Service Code
|
CPT 28755
|
| Hospital Charge Code |
3014280
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$226.00 |
| Max. Negotiated Rate |
$1,714.75 |
| Rate for Payer: Aetna Commercial |
$1,714.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,552.30
|
| Rate for Payer: Cash Price |
$541.50
|
| Rate for Payer: Cash Price |
$541.50
|
| Rate for Payer: Cash Price |
$541.50
|
| Rate for Payer: Cigna Commercial |
$1,714.75
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$226.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,083.00
|
| Rate for Payer: Health EOS Commercial |
$1,642.55
|
| Rate for Payer: HFN Commercial |
$1,714.75
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,124.34
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,124.34
|
| Rate for Payer: Multiplan Commercial |
$1,444.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,714.75
|
| Rate for Payer: Quartz Beloit One Network |
$794.20
|
| Rate for Payer: Quartz Commercial |
$1,028.85
|
| Rate for Payer: The Alliance Commercial |
$902.50
|
| Rate for Payer: United Healthcare Medicaid |
$226.00
|
| Rate for Payer: WEA Trust Commercial |
$992.75
|
| Rate for Payer: WPS Commercial |
$1,336.96
|
|
|
FUSION OF BIG TOE JOINT 28760
|
Professional
|
Both
|
$3,085.00
|
|
|
Service Code
|
CPT 28760
|
| Hospital Charge Code |
3014281
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$376.66 |
| Max. Negotiated Rate |
$2,930.75 |
| Rate for Payer: Aetna Commercial |
$2,930.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,653.10
|
| Rate for Payer: Cash Price |
$925.50
|
| Rate for Payer: Cash Price |
$925.50
|
| Rate for Payer: Cash Price |
$925.50
|
| Rate for Payer: Cigna Commercial |
$2,930.75
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$376.66
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,851.00
|
| Rate for Payer: Health EOS Commercial |
$2,807.35
|
| Rate for Payer: HFN Commercial |
$2,930.75
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,915.34
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,915.34
|
| Rate for Payer: Multiplan Commercial |
$2,468.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,930.75
|
| Rate for Payer: Quartz Beloit One Network |
$1,357.40
|
| Rate for Payer: Quartz Commercial |
$1,758.45
|
| Rate for Payer: The Alliance Commercial |
$1,542.50
|
| Rate for Payer: United Healthcare Medicaid |
$376.66
|
| Rate for Payer: WEA Trust Commercial |
$1,696.75
|
| Rate for Payer: WPS Commercial |
$2,285.06
|
|
|
FUSION OF TOES 28280
|
Professional
|
Both
|
$1,484.00
|
|
|
Service Code
|
CPT 28280
|
| Hospital Charge Code |
3014228
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$226.00 |
| Max. Negotiated Rate |
$1,409.80 |
| Rate for Payer: Aetna Commercial |
$1,409.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,276.24
|
| Rate for Payer: Cash Price |
$445.20
|
| Rate for Payer: Cash Price |
$445.20
|
| Rate for Payer: Cash Price |
$445.20
|
| Rate for Payer: Cigna Commercial |
$1,409.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$226.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$890.40
|
| Rate for Payer: Health EOS Commercial |
$1,350.44
|
| Rate for Payer: HFN Commercial |
$1,409.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,166.98
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,166.98
|
| Rate for Payer: Multiplan Commercial |
$1,187.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,409.80
|
| Rate for Payer: Quartz Beloit One Network |
$652.96
|
| Rate for Payer: Quartz Commercial |
$845.88
|
| Rate for Payer: The Alliance Commercial |
$742.00
|
| Rate for Payer: United Healthcare Medicaid |
$226.00
|
| Rate for Payer: WEA Trust Commercial |
$816.20
|
| Rate for Payer: WPS Commercial |
$1,099.20
|
|
|
FUSION PLATE MPJ MED. LT
|
Facility
|
OP
|
$8,940.00
|
|
| Hospital Charge Code |
2964737
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,503.20 |
| Max. Negotiated Rate |
$35,760.00 |
| Rate for Payer: Aetna Commercial |
$8,046.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,688.40
|
| Rate for Payer: Aetna Managed Medicare |
$2,503.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,811.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,470.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,291.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,738.20
|
| Rate for Payer: Cash Price |
$2,682.00
|
| Rate for Payer: Cigna Commercial |
$8,224.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,002.82
|
| Rate for Payer: Health EOS Commercial |
$7,956.60
|
| Rate for Payer: HFN Commercial |
$8,224.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,705.00
|
| Rate for Payer: Multiplan Commercial |
$7,152.00
|
| Rate for Payer: NAPHCARE Commercial |
$5,364.00
|
| Rate for Payer: Preferred Network Access Commercial |
$8,224.80
|
| Rate for Payer: Quartz Beloit One Network |
$4,380.60
|
| Rate for Payer: Quartz Commercial |
$5,811.00
|
| Rate for Payer: Quartz Medicare Advantage |
$5,364.00
|
| Rate for Payer: The Alliance Commercial |
$35,760.00
|
| Rate for Payer: WEA Trust Commercial |
$4,917.00
|
| Rate for Payer: WPS Commercial |
$6,621.86
|
|
|
FUSION PLATE MPJ MED. LT
|
Facility
|
IP
|
$8,940.00
|
|
| Hospital Charge Code |
2964737
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,380.60 |
| Max. Negotiated Rate |
$8,224.80 |
| Rate for Payer: Aetna Commercial |
$8,046.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,688.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,738.20
|
| Rate for Payer: Cash Price |
$2,682.00
|
| Rate for Payer: Cigna Commercial |
$8,224.80
|
| Rate for Payer: Health EOS Commercial |
$7,956.60
|
| Rate for Payer: HFN Commercial |
$8,224.80
|
| Rate for Payer: Multiplan Commercial |
$7,152.00
|
| Rate for Payer: NAPHCARE Commercial |
$5,364.00
|
| Rate for Payer: Preferred Network Access Commercial |
$8,224.80
|
| Rate for Payer: Quartz Beloit One Network |
$4,380.60
|
| Rate for Payer: Quartz Commercial |
$5,364.00
|
| Rate for Payer: WEA Trust Commercial |
$4,917.00
|
| Rate for Payer: WPS Commercial |
$6,621.86
|
|
|
G0416 Prostate Histology
|
Facility
|
OP
|
$591.00
|
|
|
Service Code
|
HCPCS G0416
|
| Hospital Charge Code |
4510700
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$283.68 |
| Max. Negotiated Rate |
$1,421.12 |
| Rate for Payer: Aetna Commercial |
$531.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$508.26
|
| Rate for Payer: Aetna Managed Medicare |
$355.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$384.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$295.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$283.68
|
| Rate for Payer: Anthem Medicare Advantage |
$355.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$313.23
|
| 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 |
$177.30
|
| Rate for Payer: Cash Price |
$177.30
|
| Rate for Payer: Cigna Commercial |
$543.72
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$355.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$330.72
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$355.28
|
| Rate for Payer: Health EOS Commercial |
$525.99
|
| Rate for Payer: HFN Commercial |
$543.72
|
| 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 |
$472.80
|
| Rate for Payer: NAPHCARE Commercial |
$532.92
|
| Rate for Payer: Preferred Network Access Commercial |
$543.72
|
| Rate for Payer: Quartz Beloit One Network |
$289.59
|
| Rate for Payer: Quartz Commercial |
$384.15
|
| 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 |
$443.25
|
| Rate for Payer: WEA Trust Commercial |
$325.05
|
| Rate for Payer: Wellcare Medicare |
$355.28
|
| Rate for Payer: WPS Commercial |
$437.75
|
|
|
G0416 Prostate Histology
|
Facility
|
IP
|
$591.00
|
|
|
Service Code
|
HCPCS G0416
|
| Hospital Charge Code |
4510700
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$289.59 |
| Max. Negotiated Rate |
$543.72 |
| Rate for Payer: Aetna Commercial |
$531.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$508.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$313.23
|
| Rate for Payer: Cash Price |
$177.30
|
| Rate for Payer: Cigna Commercial |
$543.72
|
| Rate for Payer: Health EOS Commercial |
$525.99
|
| Rate for Payer: HFN Commercial |
$543.72
|
| Rate for Payer: Multiplan Commercial |
$472.80
|
| Rate for Payer: NAPHCARE Commercial |
$354.60
|
| Rate for Payer: Preferred Network Access Commercial |
$543.72
|
| Rate for Payer: Quartz Beloit One Network |
$289.59
|
| Rate for Payer: Quartz Commercial |
$354.60
|
| Rate for Payer: WEA Trust Commercial |
$325.05
|
| Rate for Payer: WPS Commercial |
$437.75
|
|
|
Gabapentin Level
|
Facility
|
IP
|
$326.00
|
|
|
Service Code
|
CPT 80171
|
| Hospital Charge Code |
977954
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$159.74 |
| Max. Negotiated Rate |
$299.92 |
| Rate for Payer: Aetna Commercial |
$293.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$280.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$172.78
|
| Rate for Payer: Cash Price |
$97.80
|
| Rate for Payer: Cigna Commercial |
$299.92
|
| Rate for Payer: Health EOS Commercial |
$290.14
|
| Rate for Payer: HFN Commercial |
$299.92
|
| Rate for Payer: Multiplan Commercial |
$260.80
|
| Rate for Payer: NAPHCARE Commercial |
$195.60
|
| Rate for Payer: Preferred Network Access Commercial |
$299.92
|
| Rate for Payer: Quartz Beloit One Network |
$159.74
|
| Rate for Payer: Quartz Commercial |
$195.60
|
| Rate for Payer: WEA Trust Commercial |
$179.30
|
| Rate for Payer: WPS Commercial |
$241.47
|
|
|
Gabapentin Level
|
Facility
|
OP
|
$326.00
|
|
|
Service Code
|
CPT 80171
|
| Hospital Charge Code |
977954
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.48 |
| Max. Negotiated Rate |
$299.92 |
| Rate for Payer: Aetna Commercial |
$293.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$280.36
|
| Rate for Payer: Aetna Managed Medicare |
$21.67
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$81.26
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$37.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$35.97
|
| Rate for Payer: Anthem Medicaid |
$14.48
|
| Rate for Payer: Anthem Medicare Advantage |
$21.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$172.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$21.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$21.67
|
| Rate for Payer: Cash Price |
$97.80
|
| Rate for Payer: Cash Price |
$97.80
|
| Rate for Payer: Cigna Commercial |
$299.92
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$21.67
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$14.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$182.43
|
| Rate for Payer: Dean Health Medicaid |
$14.48
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$21.67
|
| Rate for Payer: Health EOS Commercial |
$290.14
|
| Rate for Payer: HFN Commercial |
$299.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$80.61
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$21.67
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$14.48
|
| Rate for Payer: Independent Care Health Plan Medicare |
$21.67
|
| Rate for Payer: Managed Health Services Medicaid |
$15.06
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$21.67
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$21.67
|
| Rate for Payer: Multiplan Commercial |
$260.80
|
| Rate for Payer: NAPHCARE Commercial |
$32.50
|
| Rate for Payer: Preferred Network Access Commercial |
$299.92
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$14.48
|
| Rate for Payer: Quartz Beloit One Network |
$159.74
|
| Rate for Payer: Quartz Commercial |
$211.90
|
| Rate for Payer: Quartz Medicare Advantage |
$21.67
|
| Rate for Payer: The Alliance Commercial |
$86.68
|
| Rate for Payer: United Healthcare Medicaid |
$14.48
|
| Rate for Payer: United Healthcare Medicare Advantage |
$21.67
|
| Rate for Payer: United Healthcare PPO |
$244.50
|
| Rate for Payer: WEA Trust Commercial |
$179.30
|
| Rate for Payer: Wellcare Medicare |
$21.67
|
| Rate for Payer: WMAP Medicaid |
$14.48
|
| Rate for Payer: WPS Commercial |
$241.47
|
|
