|
Gentamicin Level Peak
|
Professional
|
Both
|
$272.00
|
|
|
Service Code
|
CPT 80170
|
| Hospital Charge Code |
633736
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.04 |
| Max. Negotiated Rate |
$268.74 |
| Rate for Payer: Aetna Commercial |
$268.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$243.28
|
| Rate for Payer: Aetna Managed Medicare |
$17.04
|
| Rate for Payer: Anthem Medicare Advantage |
$17.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$17.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$17.04
|
| Rate for Payer: Cash Price |
$81.60
|
| Rate for Payer: Cash Price |
$81.60
|
| Rate for Payer: Cigna Commercial |
$268.74
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$141.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$17.04
|
| Rate for Payer: Health EOS Commercial |
$257.42
|
| Rate for Payer: HFN Commercial |
$268.74
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$60.13
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$60.13
|
| Rate for Payer: Independent Care Health Plan Medicare |
$17.04
|
| Rate for Payer: Multiplan Commercial |
$226.30
|
| Rate for Payer: NAPHCARE Commercial |
$25.55
|
| Rate for Payer: Preferred Network Access Commercial |
$268.74
|
| Rate for Payer: Quartz Beloit One Network |
$124.47
|
| Rate for Payer: Quartz Commercial |
$161.24
|
| Rate for Payer: Quartz Medicare Advantage |
$17.04
|
| Rate for Payer: The Alliance Commercial |
$67.29
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17.04
|
| Rate for Payer: WEA Trust Commercial |
$155.58
|
| Rate for Payer: WPS Commercial |
$74.95
|
|
|
Gentamicin Level Peak
|
Facility
|
IP
|
$272.00
|
|
|
Service Code
|
CPT 80170
|
| Hospital Charge Code |
633736
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$138.61 |
| Max. Negotiated Rate |
$260.25 |
| Rate for Payer: Aetna Commercial |
$254.59
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$243.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$149.93
|
| Rate for Payer: Cash Price |
$81.60
|
| Rate for Payer: Cigna Commercial |
$260.25
|
| Rate for Payer: Health EOS Commercial |
$251.76
|
| Rate for Payer: HFN Commercial |
$260.25
|
| Rate for Payer: Multiplan Commercial |
$226.30
|
| Rate for Payer: Preferred Network Access Commercial |
$260.25
|
| Rate for Payer: Quartz Beloit One Network |
$138.61
|
| Rate for Payer: Quartz Commercial |
$169.73
|
| Rate for Payer: WEA Trust Commercial |
$155.58
|
| Rate for Payer: WPS Commercial |
$209.52
|
|
|
Gentamicin Level Peak
|
Facility
|
OP
|
$272.00
|
|
|
Service Code
|
CPT 80170
|
| Hospital Charge Code |
633736
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.04 |
| Max. Negotiated Rate |
$260.25 |
| Rate for Payer: Aetna Commercial |
$254.59
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$243.28
|
| Rate for Payer: Aetna Managed Medicare |
$17.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$63.88
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$29.81
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$28.28
|
| Rate for Payer: Anthem Medicare Advantage |
$17.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$149.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$17.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$17.04
|
| Rate for Payer: Cash Price |
$81.60
|
| Rate for Payer: Cash Price |
$81.60
|
| Rate for Payer: Cigna Commercial |
$260.25
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$17.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$158.30
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$17.04
|
| Rate for Payer: Health EOS Commercial |
$251.76
|
| Rate for Payer: HFN Commercial |
$260.25
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$63.37
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$17.04
|
| Rate for Payer: Independent Care Health Plan Medicare |
$17.04
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$17.04
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$17.04
|
| Rate for Payer: Multiplan Commercial |
$226.30
|
| Rate for Payer: NAPHCARE Commercial |
$25.55
|
| Rate for Payer: Preferred Network Access Commercial |
$260.25
|
| Rate for Payer: Quartz Beloit One Network |
$138.61
|
| Rate for Payer: Quartz Commercial |
$183.87
|
| Rate for Payer: Quartz Medicare Advantage |
$17.04
|
| Rate for Payer: The Alliance Commercial |
$68.14
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17.04
|
| Rate for Payer: United Healthcare PPO |
$212.16
|
| Rate for Payer: WEA Trust Commercial |
$155.58
|
| Rate for Payer: Wellcare Medicare |
$17.04
|
| Rate for Payer: WPS Commercial |
$209.52
|
|
|
Gentamicin Level Trough
|
Facility
|
OP
|
$272.00
|
|
|
Service Code
|
CPT 80170
|
| Hospital Charge Code |
633737
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.04 |
| Max. Negotiated Rate |
$260.25 |
| Rate for Payer: Aetna Commercial |
$254.59
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$243.28
|
| Rate for Payer: Aetna Managed Medicare |
$17.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$63.88
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$29.81
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$28.28
|
| Rate for Payer: Anthem Medicare Advantage |
$17.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$149.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$17.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$17.04
|
| Rate for Payer: Cash Price |
$81.60
|
| Rate for Payer: Cash Price |
$81.60
|
| Rate for Payer: Cigna Commercial |
$260.25
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$17.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$158.30
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$17.04
|
| Rate for Payer: Health EOS Commercial |
$251.76
|
| Rate for Payer: HFN Commercial |
$260.25
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$63.37
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$17.04
|
| Rate for Payer: Independent Care Health Plan Medicare |
$17.04
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$17.04
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$17.04
|
| Rate for Payer: Multiplan Commercial |
$226.30
|
| Rate for Payer: NAPHCARE Commercial |
$25.55
|
| Rate for Payer: Preferred Network Access Commercial |
$260.25
|
| Rate for Payer: Quartz Beloit One Network |
$138.61
|
| Rate for Payer: Quartz Commercial |
$183.87
|
| Rate for Payer: Quartz Medicare Advantage |
$17.04
|
| Rate for Payer: The Alliance Commercial |
$68.14
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17.04
|
| Rate for Payer: United Healthcare PPO |
$212.16
|
| Rate for Payer: WEA Trust Commercial |
$155.58
|
| Rate for Payer: Wellcare Medicare |
$17.04
|
| Rate for Payer: WPS Commercial |
$209.52
|
|
|
Gentamicin Level Trough
|
Professional
|
Both
|
$272.00
|
|
|
Service Code
|
CPT 80170
|
| Hospital Charge Code |
633737
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.04 |
| Max. Negotiated Rate |
$268.74 |
| Rate for Payer: Aetna Commercial |
$268.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$243.28
|
| Rate for Payer: Aetna Managed Medicare |
$17.04
|
| Rate for Payer: Anthem Medicare Advantage |
$17.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$17.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$17.04
|
| Rate for Payer: Cash Price |
$81.60
|
| Rate for Payer: Cash Price |
$81.60
|
| Rate for Payer: Cigna Commercial |
$268.74
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$141.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$17.04
|
| Rate for Payer: Health EOS Commercial |
$257.42
|
| Rate for Payer: HFN Commercial |
$268.74
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$60.13
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$60.13
|
| Rate for Payer: Independent Care Health Plan Medicare |
$17.04
|
| Rate for Payer: Multiplan Commercial |
$226.30
|
| Rate for Payer: NAPHCARE Commercial |
$25.55
|
| Rate for Payer: Preferred Network Access Commercial |
$268.74
|
| Rate for Payer: Quartz Beloit One Network |
$124.47
|
| Rate for Payer: Quartz Commercial |
$161.24
|
| Rate for Payer: Quartz Medicare Advantage |
$17.04
|
| Rate for Payer: The Alliance Commercial |
$67.29
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17.04
|
| Rate for Payer: WEA Trust Commercial |
$155.58
|
| Rate for Payer: WPS Commercial |
$74.95
|
|
|
Gentamicin Level Trough
|
Facility
|
IP
|
$272.00
|
|
|
Service Code
|
CPT 80170
|
| Hospital Charge Code |
633737
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$138.61 |
| Max. Negotiated Rate |
$260.25 |
| Rate for Payer: Aetna Commercial |
$254.59
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$243.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$149.93
|
| Rate for Payer: Cash Price |
$81.60
|
| Rate for Payer: Cigna Commercial |
$260.25
|
| Rate for Payer: Health EOS Commercial |
$251.76
|
| Rate for Payer: HFN Commercial |
$260.25
|
| Rate for Payer: Multiplan Commercial |
$226.30
|
| Rate for Payer: Preferred Network Access Commercial |
$260.25
|
| Rate for Payer: Quartz Beloit One Network |
$138.61
|
| Rate for Payer: Quartz Commercial |
$169.73
|
| Rate for Payer: WEA Trust Commercial |
$155.58
|
| Rate for Payer: WPS Commercial |
$209.52
|
|
|
GGT
|
Professional
|
Both
|
$76.00
|
|
|
Service Code
|
CPT 82977
|
| Hospital Charge Code |
4812608
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$7.49 |
| Max. Negotiated Rate |
$75.09 |
| Rate for Payer: Aetna Commercial |
$75.09
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$67.97
|
| Rate for Payer: Aetna Managed Medicare |
$7.49
|
| Rate for Payer: Anthem Medicare Advantage |
$7.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$7.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$7.49
|
| Rate for Payer: Cash Price |
$22.80
|
| Rate for Payer: Cash Price |
$22.80
|
| Rate for Payer: Cigna Commercial |
$75.09
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$39.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$7.49
|
| Rate for Payer: Health EOS Commercial |
$71.93
|
| Rate for Payer: HFN Commercial |
$75.09
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$26.44
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$26.44
|
| Rate for Payer: Independent Care Health Plan Medicare |
$7.49
|
| Rate for Payer: Multiplan Commercial |
$63.23
|
| Rate for Payer: NAPHCARE Commercial |
$11.23
|
| Rate for Payer: Preferred Network Access Commercial |
$75.09
|
| Rate for Payer: Quartz Beloit One Network |
$34.78
|
| Rate for Payer: Quartz Commercial |
$45.05
|
| Rate for Payer: Quartz Medicare Advantage |
$7.49
|
| Rate for Payer: The Alliance Commercial |
$29.58
|
| Rate for Payer: United Healthcare Medicare Advantage |
$7.49
|
| Rate for Payer: WEA Trust Commercial |
$43.47
|
| Rate for Payer: WPS Commercial |
$32.95
|
|
|
GGT
|
Facility
|
IP
|
$76.00
|
|
|
Service Code
|
CPT 82977
|
| Hospital Charge Code |
4812608
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$38.73 |
| Max. Negotiated Rate |
$72.72 |
| Rate for Payer: Aetna Commercial |
$71.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$67.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$41.89
|
| Rate for Payer: Cash Price |
$22.80
|
| Rate for Payer: Cigna Commercial |
$72.72
|
| Rate for Payer: Health EOS Commercial |
$70.35
|
| Rate for Payer: HFN Commercial |
$72.72
|
| Rate for Payer: Multiplan Commercial |
$63.23
|
| Rate for Payer: Preferred Network Access Commercial |
$72.72
|
| Rate for Payer: Quartz Beloit One Network |
$38.73
|
| Rate for Payer: Quartz Commercial |
$47.42
|
| Rate for Payer: WEA Trust Commercial |
$43.47
|
| Rate for Payer: WPS Commercial |
$58.54
|
|
|
GGT
|
Facility
|
OP
|
$76.00
|
|
|
Service Code
|
CPT 82977
|
| Hospital Charge Code |
4812608
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$7.49 |
| Max. Negotiated Rate |
$72.72 |
| Rate for Payer: Aetna Commercial |
$71.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$67.97
|
| Rate for Payer: Aetna Managed Medicare |
$7.49
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$28.08
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$13.10
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$12.43
|
| Rate for Payer: Anthem Medicare Advantage |
$7.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$41.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$7.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$7.49
|
| Rate for Payer: Cash Price |
$22.80
|
| Rate for Payer: Cash Price |
$22.80
|
| Rate for Payer: Cigna Commercial |
$72.72
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$7.49
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$44.23
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$7.49
|
| Rate for Payer: Health EOS Commercial |
$70.35
|
| Rate for Payer: HFN Commercial |
$72.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$27.86
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$7.49
|
| Rate for Payer: Independent Care Health Plan Medicare |
$7.49
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$7.49
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$7.49
|
| Rate for Payer: Multiplan Commercial |
$63.23
|
| Rate for Payer: NAPHCARE Commercial |
$11.23
|
| Rate for Payer: Preferred Network Access Commercial |
$72.72
|
| Rate for Payer: Quartz Beloit One Network |
$38.73
|
| Rate for Payer: Quartz Commercial |
$51.38
|
| Rate for Payer: Quartz Medicare Advantage |
$7.49
|
| Rate for Payer: The Alliance Commercial |
$29.95
|
| Rate for Payer: United Healthcare Medicare Advantage |
$7.49
|
| Rate for Payer: United Healthcare PPO |
$59.28
|
| Rate for Payer: WEA Trust Commercial |
$43.47
|
| Rate for Payer: Wellcare Medicare |
$7.49
|
| Rate for Payer: WPS Commercial |
$58.54
|
|
|
GGT (FSURE)
|
Facility
|
OP
|
$84.00
|
|
|
Service Code
|
CPT 82977
|
| Hospital Charge Code |
4538812
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$7.49 |
| Max. Negotiated Rate |
$80.37 |
| Rate for Payer: Aetna Commercial |
$78.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$75.13
|
| Rate for Payer: Aetna Managed Medicare |
$7.49
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$28.08
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$13.10
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$12.43
|
| Rate for Payer: Anthem Medicare Advantage |
$7.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$46.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$7.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$7.49
|
| Rate for Payer: Cash Price |
$25.20
|
| Rate for Payer: Cash Price |
$25.20
|
| Rate for Payer: Cigna Commercial |
$80.37
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$7.49
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$48.89
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$7.49
|
| Rate for Payer: Health EOS Commercial |
$77.75
|
| Rate for Payer: HFN Commercial |
$80.37
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$27.86
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$7.49
|
| Rate for Payer: Independent Care Health Plan Medicare |
$7.49
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$7.49
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$7.49
|
| Rate for Payer: Multiplan Commercial |
$69.89
|
| Rate for Payer: NAPHCARE Commercial |
$11.23
|
| Rate for Payer: Preferred Network Access Commercial |
$80.37
|
| Rate for Payer: Quartz Beloit One Network |
$42.81
|
| Rate for Payer: Quartz Commercial |
$56.78
|
| Rate for Payer: Quartz Medicare Advantage |
$7.49
|
| Rate for Payer: The Alliance Commercial |
$29.95
|
| Rate for Payer: United Healthcare Medicare Advantage |
$7.49
|
| Rate for Payer: United Healthcare PPO |
$65.52
|
| Rate for Payer: WEA Trust Commercial |
$48.05
|
| Rate for Payer: Wellcare Medicare |
$7.49
|
| Rate for Payer: WPS Commercial |
$64.71
|
|
|
GGT (FSURE)
|
Facility
|
IP
|
$84.00
|
|
|
Service Code
|
CPT 82977
|
| Hospital Charge Code |
4538812
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$42.81 |
| Max. Negotiated Rate |
$80.37 |
| Rate for Payer: Aetna Commercial |
$78.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$75.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$46.30
|
| Rate for Payer: Cash Price |
$25.20
|
| Rate for Payer: Cigna Commercial |
$80.37
|
| Rate for Payer: Health EOS Commercial |
$77.75
|
| Rate for Payer: HFN Commercial |
$80.37
|
| Rate for Payer: Multiplan Commercial |
$69.89
|
| Rate for Payer: Preferred Network Access Commercial |
$80.37
|
| Rate for Payer: Quartz Beloit One Network |
$42.81
|
| Rate for Payer: Quartz Commercial |
$52.42
|
| Rate for Payer: WEA Trust Commercial |
$48.05
|
| Rate for Payer: WPS Commercial |
$64.71
|
|
|
GGT (FSURE)
|
Professional
|
Both
|
$84.00
|
|
|
Service Code
|
CPT 82977
|
| Hospital Charge Code |
4538812
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$7.49 |
| Max. Negotiated Rate |
$82.99 |
| Rate for Payer: Aetna Commercial |
$82.99
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$75.13
|
| Rate for Payer: Aetna Managed Medicare |
$7.49
|
| Rate for Payer: Anthem Medicare Advantage |
$7.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$7.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$7.49
|
| Rate for Payer: Cash Price |
$25.20
|
| Rate for Payer: Cash Price |
$25.20
|
| Rate for Payer: Cigna Commercial |
$82.99
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$43.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$7.49
|
| Rate for Payer: Health EOS Commercial |
$79.50
|
| Rate for Payer: HFN Commercial |
$82.99
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$26.44
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$26.44
|
| Rate for Payer: Independent Care Health Plan Medicare |
$7.49
|
| Rate for Payer: Multiplan Commercial |
$69.89
|
| Rate for Payer: NAPHCARE Commercial |
$11.23
|
| Rate for Payer: Preferred Network Access Commercial |
$82.99
|
| Rate for Payer: Quartz Beloit One Network |
$38.44
|
| Rate for Payer: Quartz Commercial |
$49.80
|
| Rate for Payer: Quartz Medicare Advantage |
$7.49
|
| Rate for Payer: The Alliance Commercial |
$29.58
|
| Rate for Payer: United Healthcare Medicare Advantage |
$7.49
|
| Rate for Payer: WEA Trust Commercial |
$48.05
|
| Rate for Payer: WPS Commercial |
$32.95
|
|
|
Giardia Ag
|
Professional
|
Both
|
$156.00
|
|
|
Service Code
|
CPT 87329
|
| Hospital Charge Code |
979859
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.46 |
| Max. Negotiated Rate |
$154.13 |
| Rate for Payer: Aetna Commercial |
$154.13
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$139.53
|
| Rate for Payer: Aetna Managed Medicare |
$12.46
|
| Rate for Payer: Anthem Medicare Advantage |
$12.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$12.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$12.46
|
| Rate for Payer: Cash Price |
$46.80
|
| Rate for Payer: Cash Price |
$46.80
|
| Rate for Payer: Cigna Commercial |
$154.13
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$81.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12.46
|
| Rate for Payer: Health EOS Commercial |
$147.64
|
| Rate for Payer: HFN Commercial |
$154.13
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$43.98
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$43.98
|
| Rate for Payer: Independent Care Health Plan Medicare |
$12.46
|
| Rate for Payer: Multiplan Commercial |
$129.79
|
| Rate for Payer: NAPHCARE Commercial |
$18.69
|
| Rate for Payer: Preferred Network Access Commercial |
$154.13
|
| Rate for Payer: Quartz Beloit One Network |
$71.39
|
| Rate for Payer: Quartz Commercial |
$92.48
|
| Rate for Payer: Quartz Medicare Advantage |
$12.46
|
| Rate for Payer: The Alliance Commercial |
$49.21
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.46
|
| Rate for Payer: WEA Trust Commercial |
$89.23
|
| Rate for Payer: WPS Commercial |
$54.82
|
|
|
Giardia Ag
|
Facility
|
OP
|
$156.00
|
|
|
Service Code
|
CPT 87329
|
| Hospital Charge Code |
979859
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.46 |
| Max. Negotiated Rate |
$149.26 |
| Rate for Payer: Aetna Commercial |
$146.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$139.53
|
| Rate for Payer: Aetna Managed Medicare |
$12.46
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$46.72
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$21.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$20.68
|
| Rate for Payer: Anthem Medicare Advantage |
$12.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$85.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$12.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$12.46
|
| Rate for Payer: Cash Price |
$46.80
|
| Rate for Payer: Cash Price |
$46.80
|
| Rate for Payer: Cigna Commercial |
$149.26
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$12.46
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$90.79
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$12.46
|
| Rate for Payer: Health EOS Commercial |
$144.39
|
| Rate for Payer: HFN Commercial |
$149.26
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$46.35
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$12.46
|
| Rate for Payer: Independent Care Health Plan Medicare |
$12.46
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$12.46
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$12.46
|
| Rate for Payer: Multiplan Commercial |
$129.79
|
| Rate for Payer: NAPHCARE Commercial |
$18.69
|
| Rate for Payer: Preferred Network Access Commercial |
$149.26
|
| Rate for Payer: Quartz Beloit One Network |
$79.50
|
| Rate for Payer: Quartz Commercial |
$105.46
|
| Rate for Payer: Quartz Medicare Advantage |
$12.46
|
| Rate for Payer: The Alliance Commercial |
$49.84
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.46
|
| Rate for Payer: United Healthcare PPO |
$121.68
|
| Rate for Payer: WEA Trust Commercial |
$89.23
|
| Rate for Payer: Wellcare Medicare |
$12.46
|
| Rate for Payer: WPS Commercial |
$120.17
|
|
|
Giardia Ag
|
Facility
|
IP
|
$156.00
|
|
|
Service Code
|
CPT 87329
|
| Hospital Charge Code |
979859
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$79.50 |
| Max. Negotiated Rate |
$149.26 |
| Rate for Payer: Aetna Commercial |
$146.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$139.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$85.99
|
| Rate for Payer: Cash Price |
$46.80
|
| Rate for Payer: Cigna Commercial |
$149.26
|
| Rate for Payer: Health EOS Commercial |
$144.39
|
| Rate for Payer: HFN Commercial |
$149.26
|
| Rate for Payer: Multiplan Commercial |
$129.79
|
| Rate for Payer: Preferred Network Access Commercial |
$149.26
|
| Rate for Payer: Quartz Beloit One Network |
$79.50
|
| Rate for Payer: Quartz Commercial |
$97.34
|
| Rate for Payer: WEA Trust Commercial |
$89.23
|
| Rate for Payer: WPS Commercial |
$120.17
|
|
|
Giardia and Cryptosporidium Antigen Panel
|
Professional
|
Both
|
$186.00
|
|
|
Service Code
|
CPT 87015
|
| Hospital Charge Code |
5619633
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.95 |
| Max. Negotiated Rate |
$183.77 |
| Rate for Payer: Aetna Commercial |
$183.77
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$166.36
|
| Rate for Payer: Aetna Managed Medicare |
$6.95
|
| Rate for Payer: Anthem Medicare Advantage |
$6.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$6.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$6.95
|
| Rate for Payer: Cash Price |
$55.80
|
| Rate for Payer: Cash Price |
$55.80
|
| Rate for Payer: Cigna Commercial |
$183.77
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$96.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6.95
|
| Rate for Payer: Health EOS Commercial |
$176.03
|
| Rate for Payer: HFN Commercial |
$183.77
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$24.52
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$24.52
|
| Rate for Payer: Independent Care Health Plan Medicare |
$6.95
|
| Rate for Payer: Multiplan Commercial |
$154.75
|
| Rate for Payer: NAPHCARE Commercial |
$10.42
|
| Rate for Payer: Preferred Network Access Commercial |
$183.77
|
| Rate for Payer: Quartz Beloit One Network |
$85.11
|
| Rate for Payer: Quartz Commercial |
$110.26
|
| Rate for Payer: Quartz Medicare Advantage |
$6.95
|
| Rate for Payer: The Alliance Commercial |
$27.44
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6.95
|
| Rate for Payer: WEA Trust Commercial |
$106.39
|
| Rate for Payer: WPS Commercial |
$30.57
|
|
|
Giardia and Cryptosporidium Antigen Panel
|
Facility
|
IP
|
$186.00
|
|
|
Service Code
|
CPT 87015
|
| Hospital Charge Code |
5619633
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$94.79 |
| Max. Negotiated Rate |
$177.96 |
| Rate for Payer: Aetna Commercial |
$174.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$166.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$102.52
|
| Rate for Payer: Cash Price |
$55.80
|
| Rate for Payer: Cigna Commercial |
$177.96
|
| Rate for Payer: Health EOS Commercial |
$172.16
|
| Rate for Payer: HFN Commercial |
$177.96
|
| Rate for Payer: Multiplan Commercial |
$154.75
|
| Rate for Payer: Preferred Network Access Commercial |
$177.96
|
| Rate for Payer: Quartz Beloit One Network |
$94.79
|
| Rate for Payer: Quartz Commercial |
$116.06
|
| Rate for Payer: WEA Trust Commercial |
$106.39
|
| Rate for Payer: WPS Commercial |
$143.28
|
|
|
Giardia and Cryptosporidium Antigen Panel
|
Facility
|
OP
|
$186.00
|
|
|
Service Code
|
CPT 87015
|
| Hospital Charge Code |
5619633
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.95 |
| Max. Negotiated Rate |
$177.96 |
| Rate for Payer: Aetna Commercial |
$174.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$166.36
|
| Rate for Payer: Aetna Managed Medicare |
$6.95
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$26.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$12.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$11.53
|
| Rate for Payer: Anthem Medicare Advantage |
$6.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$102.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$6.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$6.95
|
| Rate for Payer: Cash Price |
$55.80
|
| Rate for Payer: Cash Price |
$55.80
|
| Rate for Payer: Cigna Commercial |
$177.96
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$6.95
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$108.25
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$6.95
|
| Rate for Payer: Health EOS Commercial |
$172.16
|
| Rate for Payer: HFN Commercial |
$177.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$25.84
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$6.95
|
| Rate for Payer: Independent Care Health Plan Medicare |
$6.95
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$6.95
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$6.95
|
| Rate for Payer: Multiplan Commercial |
$154.75
|
| Rate for Payer: NAPHCARE Commercial |
$10.42
|
| Rate for Payer: Preferred Network Access Commercial |
$177.96
|
| Rate for Payer: Quartz Beloit One Network |
$94.79
|
| Rate for Payer: Quartz Commercial |
$125.74
|
| Rate for Payer: Quartz Medicare Advantage |
$6.95
|
| Rate for Payer: The Alliance Commercial |
$27.79
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6.95
|
| Rate for Payer: United Healthcare PPO |
$145.08
|
| Rate for Payer: WEA Trust Commercial |
$106.39
|
| Rate for Payer: Wellcare Medicare |
$6.95
|
| Rate for Payer: WPS Commercial |
$143.28
|
|
|
GI Tract Capsule Endoscopy 9111026
|
Professional
|
Both
|
$1,492.00
|
|
|
Service Code
|
CPT 91110 26
|
| Hospital Charge Code |
3165592
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$118.84 |
| Max. Negotiated Rate |
$1,474.10 |
| Rate for Payer: Aetna Commercial |
$1,474.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,334.44
|
| Rate for Payer: Aetna Managed Medicare |
$118.84
|
| Rate for Payer: Anthem Medicare Advantage |
$118.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$118.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$118.84
|
| Rate for Payer: Cash Price |
$447.60
|
| Rate for Payer: Cash Price |
$447.60
|
| Rate for Payer: Cigna Commercial |
$1,474.10
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$190.81
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$118.84
|
| Rate for Payer: Health EOS Commercial |
$1,412.03
|
| Rate for Payer: HFN Commercial |
$1,474.10
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$455.11
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$455.11
|
| Rate for Payer: Independent Care Health Plan Medicare |
$118.84
|
| Rate for Payer: Multiplan Commercial |
$1,241.34
|
| Rate for Payer: NAPHCARE Commercial |
$178.26
|
| Rate for Payer: Preferred Network Access Commercial |
$1,474.10
|
| Rate for Payer: Quartz Beloit One Network |
$682.74
|
| Rate for Payer: Quartz Commercial |
$884.46
|
| Rate for Payer: Quartz Medicare Advantage |
$118.84
|
| Rate for Payer: The Alliance Commercial |
$297.10
|
| Rate for Payer: United Healthcare Medicaid |
$190.81
|
| Rate for Payer: United Healthcare Medicare Advantage |
$118.84
|
| Rate for Payer: WEA Trust Commercial |
$853.42
|
| Rate for Payer: WPS Commercial |
$475.36
|
|
|
GLAUCOMA
|
Facility
|
OP
|
$89.10
|
|
|
Service Code
|
EAPG 00552
|
| Min. Negotiated Rate |
$85.67 |
| Max. Negotiated Rate |
$89.10 |
| Rate for Payer: Anthem Medicaid |
$85.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$85.67
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$85.67
|
| Rate for Payer: Dean Health Medicaid |
$85.67
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$85.67
|
| Rate for Payer: Managed Health Services Medicaid |
$89.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$85.67
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$85.67
|
| Rate for Payer: United Healthcare Medicaid |
$85.67
|
|
|
GLAUCOMA PROSTHETIC SHUNT
|
Facility
|
OP
|
$3,935.00
|
|
|
Service Code
|
CPT 66180
|
| Hospital Charge Code |
2960372
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,005.28 |
| Max. Negotiated Rate |
$22,400.35 |
| Rate for Payer: Aetna Commercial |
$3,683.16
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,519.46
|
| Rate for Payer: Aetna Managed Medicare |
$5,600.09
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$12,727.52
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$11,350.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$10,781.68
|
| Rate for Payer: Anthem Medicare Advantage |
$5,600.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,168.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5,600.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5,600.09
|
| Rate for Payer: Cash Price |
$1,180.50
|
| Rate for Payer: Cash Price |
$1,180.50
|
| Rate for Payer: Cash Price |
$1,180.50
|
| Rate for Payer: Cigna Commercial |
$3,765.01
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$5,600.09
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$8,673.35
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$5,600.09
|
| Rate for Payer: Health EOS Commercial |
$3,642.24
|
| Rate for Payer: HFN Commercial |
$3,765.01
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$20,832.33
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$5,600.09
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5,600.09
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$5,600.09
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$5,600.09
|
| Rate for Payer: Multiplan Commercial |
$3,273.92
|
| Rate for Payer: NAPHCARE Commercial |
$8,400.13
|
| Rate for Payer: Preferred Network Access Commercial |
$3,765.01
|
| Rate for Payer: Quartz Beloit One Network |
$2,005.28
|
| Rate for Payer: Quartz Commercial |
$2,660.06
|
| Rate for Payer: Quartz Medicare Advantage |
$5,600.09
|
| Rate for Payer: The Alliance Commercial |
$22,400.35
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5,600.09
|
| Rate for Payer: United Healthcare PPO |
$4,409.60
|
| Rate for Payer: WEA Trust Commercial |
$2,250.82
|
| Rate for Payer: Wellcare Medicare |
$5,600.09
|
| Rate for Payer: WPS Commercial |
$3,031.13
|
|
|
GLAUCOMA PROSTHETIC SHUNT
|
Facility
|
IP
|
$3,935.00
|
|
|
Service Code
|
CPT 66180
|
| Hospital Charge Code |
2960372
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,005.28 |
| Max. Negotiated Rate |
$3,765.01 |
| Rate for Payer: Aetna Commercial |
$3,683.16
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,519.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,168.97
|
| Rate for Payer: Cash Price |
$1,180.50
|
| Rate for Payer: Cigna Commercial |
$3,765.01
|
| Rate for Payer: Health EOS Commercial |
$3,642.24
|
| Rate for Payer: HFN Commercial |
$3,765.01
|
| Rate for Payer: Multiplan Commercial |
$3,273.92
|
| Rate for Payer: Preferred Network Access Commercial |
$3,765.01
|
| Rate for Payer: Quartz Beloit One Network |
$2,005.28
|
| Rate for Payer: Quartz Commercial |
$2,455.44
|
| Rate for Payer: WEA Trust Commercial |
$2,250.82
|
| Rate for Payer: WPS Commercial |
$3,031.13
|
|
|
Glaucoma SCRN High Risk Direc G0118
|
Professional
|
Both
|
$136.00
|
|
|
Service Code
|
HCPCS G0118
|
| Hospital Charge Code |
4596650
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$36.38 |
| Max. Negotiated Rate |
$146.81 |
| Rate for Payer: Aetna Commercial |
$134.37
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$121.64
|
| Rate for Payer: Aetna Managed Medicare |
$40.29
|
| Rate for Payer: Anthem Medicare Advantage |
$40.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$40.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$40.29
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cigna Commercial |
$134.37
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$36.38
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$40.29
|
| Rate for Payer: Health EOS Commercial |
$128.71
|
| Rate for Payer: HFN Commercial |
$134.37
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$146.81
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$146.81
|
| Rate for Payer: Independent Care Health Plan Medicare |
$40.29
|
| Rate for Payer: Multiplan Commercial |
$113.15
|
| Rate for Payer: NAPHCARE Commercial |
$60.43
|
| Rate for Payer: Preferred Network Access Commercial |
$134.37
|
| Rate for Payer: Quartz Beloit One Network |
$62.23
|
| Rate for Payer: Quartz Commercial |
$80.62
|
| Rate for Payer: Quartz Medicare Advantage |
$40.29
|
| Rate for Payer: The Alliance Commercial |
$110.80
|
| Rate for Payer: United Healthcare Medicaid |
$36.38
|
| Rate for Payer: United Healthcare Medicare Advantage |
$40.29
|
| Rate for Payer: WEA Trust Commercial |
$77.79
|
| Rate for Payer: WPS Commercial |
$70.51
|
|
|
GLENOID 44MM
|
Facility
|
IP
|
$6,804.00
|
|
| Hospital Charge Code |
3072417
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,467.32 |
| Max. Negotiated Rate |
$6,510.07 |
| Rate for Payer: Aetna Commercial |
$6,368.54
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,085.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,750.36
|
| Rate for Payer: Cash Price |
$2,041.20
|
| Rate for Payer: Cigna Commercial |
$6,510.07
|
| Rate for Payer: Health EOS Commercial |
$6,297.78
|
| Rate for Payer: HFN Commercial |
$6,510.07
|
| Rate for Payer: Multiplan Commercial |
$5,660.93
|
| Rate for Payer: Preferred Network Access Commercial |
$6,510.07
|
| Rate for Payer: Quartz Beloit One Network |
$3,467.32
|
| Rate for Payer: Quartz Commercial |
$4,245.70
|
| Rate for Payer: WEA Trust Commercial |
$3,891.89
|
| Rate for Payer: WPS Commercial |
$5,241.12
|
|
|
GLENOID 44MM
|
Facility
|
OP
|
$6,804.00
|
|
| Hospital Charge Code |
3072417
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,981.32 |
| Max. Negotiated Rate |
$6,510.07 |
| Rate for Payer: Aetna Commercial |
$6,368.54
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,085.50
|
| Rate for Payer: Aetna Managed Medicare |
$1,981.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,599.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,538.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,396.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,750.36
|
| Rate for Payer: Cash Price |
$2,041.20
|
| Rate for Payer: Cigna Commercial |
$6,510.07
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,959.93
|
| Rate for Payer: Health EOS Commercial |
$6,297.78
|
| Rate for Payer: HFN Commercial |
$6,510.07
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,307.12
|
| Rate for Payer: Multiplan Commercial |
$5,660.93
|
| Rate for Payer: NAPHCARE Commercial |
$4,245.70
|
| Rate for Payer: Preferred Network Access Commercial |
$6,510.07
|
| Rate for Payer: Quartz Beloit One Network |
$3,467.32
|
| Rate for Payer: Quartz Commercial |
$4,599.50
|
| Rate for Payer: Quartz Medicare Advantage |
$4,245.70
|
| Rate for Payer: The Alliance Commercial |
$3,538.08
|
| Rate for Payer: WEA Trust Commercial |
$3,891.89
|
| Rate for Payer: WPS Commercial |
$5,241.12
|
|
