|
Holter Monitor Interpretation 93227
|
Professional
|
Both
|
$846.00
|
|
|
Service Code
|
CPT 93227
|
| Hospital Charge Code |
3595541
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$17.96 |
| Max. Negotiated Rate |
$835.85 |
| Rate for Payer: Aetna Commercial |
$835.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$756.66
|
| Rate for Payer: Aetna Managed Medicare |
$17.96
|
| Rate for Payer: Anthem Medicare Advantage |
$17.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$17.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$17.96
|
| Rate for Payer: Cash Price |
$253.80
|
| Rate for Payer: Cash Price |
$253.80
|
| Rate for Payer: Cash Price |
$253.80
|
| Rate for Payer: Cigna Commercial |
$835.85
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$28.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$17.96
|
| Rate for Payer: Health EOS Commercial |
$800.65
|
| Rate for Payer: HFN Commercial |
$835.85
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$67.22
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$67.22
|
| Rate for Payer: Independent Care Health Plan Medicare |
$17.96
|
| Rate for Payer: Multiplan Commercial |
$703.87
|
| Rate for Payer: NAPHCARE Commercial |
$26.94
|
| Rate for Payer: Preferred Network Access Commercial |
$835.85
|
| Rate for Payer: Quartz Beloit One Network |
$387.13
|
| Rate for Payer: Quartz Commercial |
$501.51
|
| Rate for Payer: Quartz Medicare Advantage |
$17.96
|
| Rate for Payer: The Alliance Commercial |
$68.25
|
| Rate for Payer: United Healthcare Medicaid |
$28.36
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17.96
|
| Rate for Payer: WEA Trust Commercial |
$483.91
|
| Rate for Payer: WPS Commercial |
$71.84
|
|
|
Holter Monitor Recording Sheet #1
|
Facility
|
OP
|
$704.00
|
|
|
Service Code
|
CPT 93225
|
| Hospital Charge Code |
2982414
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$140.02 |
| Max. Negotiated Rate |
$673.59 |
| Rate for Payer: Aetna Commercial |
$658.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$629.66
|
| Rate for Payer: Aetna Managed Medicare |
$140.02
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$475.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$366.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$351.44
|
| Rate for Payer: Anthem Medicare Advantage |
$140.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$388.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$140.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$140.02
|
| Rate for Payer: Cash Price |
$211.20
|
| Rate for Payer: Cash Price |
$211.20
|
| Rate for Payer: Cigna Commercial |
$673.59
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$140.02
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$409.73
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$140.02
|
| Rate for Payer: Health EOS Commercial |
$651.62
|
| Rate for Payer: HFN Commercial |
$673.59
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$520.86
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$140.02
|
| Rate for Payer: Independent Care Health Plan Medicare |
$140.02
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$140.02
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$140.02
|
| Rate for Payer: Multiplan Commercial |
$585.73
|
| Rate for Payer: NAPHCARE Commercial |
$210.02
|
| Rate for Payer: Preferred Network Access Commercial |
$673.59
|
| Rate for Payer: Quartz Beloit One Network |
$358.76
|
| Rate for Payer: Quartz Commercial |
$475.90
|
| Rate for Payer: Quartz Medicare Advantage |
$140.02
|
| Rate for Payer: The Alliance Commercial |
$560.06
|
| Rate for Payer: United Healthcare Medicare Advantage |
$140.02
|
| Rate for Payer: WEA Trust Commercial |
$402.69
|
| Rate for Payer: Wellcare Medicare |
$140.02
|
| Rate for Payer: WPS Commercial |
$542.29
|
|
|
Holter Monitor Recording Sheet #1
|
Facility
|
IP
|
$704.00
|
|
|
Service Code
|
CPT 93225
|
| Hospital Charge Code |
2982414
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$358.76 |
| Max. Negotiated Rate |
$673.59 |
| Rate for Payer: Aetna Commercial |
$658.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$629.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$388.04
|
| Rate for Payer: Cash Price |
$211.20
|
| Rate for Payer: Cigna Commercial |
$673.59
|
| Rate for Payer: Health EOS Commercial |
$651.62
|
| Rate for Payer: HFN Commercial |
$673.59
|
| Rate for Payer: Multiplan Commercial |
$585.73
|
| Rate for Payer: Preferred Network Access Commercial |
$673.59
|
| Rate for Payer: Quartz Beloit One Network |
$358.76
|
| Rate for Payer: Quartz Commercial |
$439.30
|
| Rate for Payer: WEA Trust Commercial |
$402.69
|
| Rate for Payer: WPS Commercial |
$542.29
|
|
|
Holter Monitor Scan
|
Facility
|
OP
|
$1,401.00
|
|
|
Service Code
|
CPT 93226
|
| Hospital Charge Code |
2982415
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$62.09 |
| Max. Negotiated Rate |
$1,340.48 |
| Rate for Payer: Aetna Commercial |
$1,311.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,253.05
|
| Rate for Payer: Aetna Managed Medicare |
$62.09
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$947.08
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$728.52
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$699.38
|
| Rate for Payer: Anthem Medicare Advantage |
$62.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$772.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$62.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$62.09
|
| Rate for Payer: Cash Price |
$420.30
|
| Rate for Payer: Cash Price |
$420.30
|
| Rate for Payer: Cigna Commercial |
$1,340.48
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$62.09
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$815.38
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$62.09
|
| Rate for Payer: Health EOS Commercial |
$1,296.77
|
| Rate for Payer: HFN Commercial |
$1,340.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$230.97
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$62.09
|
| Rate for Payer: Independent Care Health Plan Medicare |
$62.09
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$62.09
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$62.09
|
| Rate for Payer: Multiplan Commercial |
$1,165.63
|
| Rate for Payer: NAPHCARE Commercial |
$93.13
|
| Rate for Payer: Preferred Network Access Commercial |
$1,340.48
|
| Rate for Payer: Quartz Beloit One Network |
$713.95
|
| Rate for Payer: Quartz Commercial |
$947.08
|
| Rate for Payer: Quartz Medicare Advantage |
$62.09
|
| Rate for Payer: The Alliance Commercial |
$248.35
|
| Rate for Payer: United Healthcare Medicare Advantage |
$62.09
|
| Rate for Payer: United Healthcare PPO |
$1,092.78
|
| Rate for Payer: WEA Trust Commercial |
$801.37
|
| Rate for Payer: Wellcare Medicare |
$62.09
|
| Rate for Payer: WPS Commercial |
$1,079.19
|
|
|
Holter Monitor Scan
|
Facility
|
IP
|
$1,401.00
|
|
|
Service Code
|
CPT 93226
|
| Hospital Charge Code |
2982415
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$713.95 |
| Max. Negotiated Rate |
$1,340.48 |
| Rate for Payer: Aetna Commercial |
$1,311.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,253.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$772.23
|
| Rate for Payer: Cash Price |
$420.30
|
| Rate for Payer: Cigna Commercial |
$1,340.48
|
| Rate for Payer: Health EOS Commercial |
$1,296.77
|
| Rate for Payer: HFN Commercial |
$1,340.48
|
| Rate for Payer: Multiplan Commercial |
$1,165.63
|
| Rate for Payer: Preferred Network Access Commercial |
$1,340.48
|
| Rate for Payer: Quartz Beloit One Network |
$713.95
|
| Rate for Payer: Quartz Commercial |
$874.22
|
| Rate for Payer: WEA Trust Commercial |
$801.37
|
| Rate for Payer: WPS Commercial |
$1,079.19
|
|
|
Holter Monitor Scan w/ Report
|
Facility
|
OP
|
$1,485.00
|
|
|
Service Code
|
CPT 93226
|
| Hospital Charge Code |
4596643
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$62.09 |
| Max. Negotiated Rate |
$1,420.85 |
| Rate for Payer: Aetna Commercial |
$1,389.96
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,328.18
|
| Rate for Payer: Aetna Managed Medicare |
$62.09
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,003.86
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$772.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$741.31
|
| Rate for Payer: Anthem Medicare Advantage |
$62.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$818.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$62.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$62.09
|
| Rate for Payer: Cash Price |
$445.50
|
| Rate for Payer: Cash Price |
$445.50
|
| Rate for Payer: Cigna Commercial |
$1,420.85
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$62.09
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$864.27
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$62.09
|
| Rate for Payer: Health EOS Commercial |
$1,374.52
|
| Rate for Payer: HFN Commercial |
$1,420.85
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$230.97
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$62.09
|
| Rate for Payer: Independent Care Health Plan Medicare |
$62.09
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$62.09
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$62.09
|
| Rate for Payer: Multiplan Commercial |
$1,235.52
|
| Rate for Payer: NAPHCARE Commercial |
$93.13
|
| Rate for Payer: Preferred Network Access Commercial |
$1,420.85
|
| Rate for Payer: Quartz Beloit One Network |
$756.76
|
| Rate for Payer: Quartz Commercial |
$1,003.86
|
| Rate for Payer: Quartz Medicare Advantage |
$62.09
|
| Rate for Payer: The Alliance Commercial |
$248.35
|
| Rate for Payer: United Healthcare Medicare Advantage |
$62.09
|
| Rate for Payer: United Healthcare PPO |
$1,158.30
|
| Rate for Payer: WEA Trust Commercial |
$849.42
|
| Rate for Payer: Wellcare Medicare |
$62.09
|
| Rate for Payer: WPS Commercial |
$1,143.90
|
|
|
Holter Monitor Scan w/ Report
|
Professional
|
Both
|
$1,485.00
|
|
|
Service Code
|
CPT 93226
|
| Hospital Charge Code |
4596643
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$34.38 |
| Max. Negotiated Rate |
$1,467.18 |
| Rate for Payer: Aetna Commercial |
$1,467.18
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,328.18
|
| Rate for Payer: Aetna Managed Medicare |
$34.38
|
| Rate for Payer: Anthem Medicare Advantage |
$34.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$34.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$34.38
|
| Rate for Payer: Cash Price |
$445.50
|
| Rate for Payer: Cash Price |
$445.50
|
| Rate for Payer: Cash Price |
$445.50
|
| Rate for Payer: Cigna Commercial |
$1,467.18
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$84.53
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$34.38
|
| Rate for Payer: Health EOS Commercial |
$1,405.40
|
| Rate for Payer: HFN Commercial |
$1,467.18
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$142.77
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$142.77
|
| Rate for Payer: Independent Care Health Plan Medicare |
$34.38
|
| Rate for Payer: Multiplan Commercial |
$1,235.52
|
| Rate for Payer: NAPHCARE Commercial |
$51.57
|
| Rate for Payer: Preferred Network Access Commercial |
$1,467.18
|
| Rate for Payer: Quartz Beloit One Network |
$679.54
|
| Rate for Payer: Quartz Commercial |
$880.31
|
| Rate for Payer: Quartz Medicare Advantage |
$34.38
|
| Rate for Payer: The Alliance Commercial |
$130.65
|
| Rate for Payer: United Healthcare Medicaid |
$84.53
|
| Rate for Payer: United Healthcare Medicare Advantage |
$34.38
|
| Rate for Payer: WEA Trust Commercial |
$849.42
|
| Rate for Payer: WPS Commercial |
$137.53
|
|
|
Holter Monitor Scan w/ Report
|
Facility
|
IP
|
$1,485.00
|
|
|
Service Code
|
CPT 93226
|
| Hospital Charge Code |
4596643
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$756.76 |
| Max. Negotiated Rate |
$1,420.85 |
| Rate for Payer: Aetna Commercial |
$1,389.96
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,328.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$818.53
|
| Rate for Payer: Cash Price |
$445.50
|
| Rate for Payer: Cigna Commercial |
$1,420.85
|
| Rate for Payer: Health EOS Commercial |
$1,374.52
|
| Rate for Payer: HFN Commercial |
$1,420.85
|
| Rate for Payer: Multiplan Commercial |
$1,235.52
|
| Rate for Payer: Preferred Network Access Commercial |
$1,420.85
|
| Rate for Payer: Quartz Beloit One Network |
$756.76
|
| Rate for Payer: Quartz Commercial |
$926.64
|
| Rate for Payer: WEA Trust Commercial |
$849.42
|
| Rate for Payer: WPS Commercial |
$1,143.90
|
|
|
Home Sleep Test
|
Facility
|
IP
|
$927.00
|
|
|
Service Code
|
CPT 95806
|
| Hospital Charge Code |
3801364
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$472.40 |
| Max. Negotiated Rate |
$886.95 |
| Rate for Payer: Aetna Commercial |
$867.67
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$829.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$510.96
|
| Rate for Payer: Cash Price |
$278.10
|
| Rate for Payer: Cigna Commercial |
$886.95
|
| Rate for Payer: Health EOS Commercial |
$858.03
|
| Rate for Payer: HFN Commercial |
$886.95
|
| Rate for Payer: Multiplan Commercial |
$771.26
|
| Rate for Payer: Preferred Network Access Commercial |
$886.95
|
| Rate for Payer: Quartz Beloit One Network |
$472.40
|
| Rate for Payer: Quartz Commercial |
$578.45
|
| Rate for Payer: WEA Trust Commercial |
$530.24
|
| Rate for Payer: WPS Commercial |
$714.07
|
|
|
Home Sleep Test
|
Facility
|
OP
|
$927.00
|
|
|
Service Code
|
CPT 95806
|
| Hospital Charge Code |
3801364
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$227.24 |
| Max. Negotiated Rate |
$1,452.88 |
| Rate for Payer: Aetna Commercial |
$867.67
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$829.11
|
| Rate for Payer: Aetna Managed Medicare |
$227.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,452.88
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,194.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,134.64
|
| Rate for Payer: Anthem Medicare Advantage |
$227.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$510.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$227.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$227.24
|
| Rate for Payer: Cash Price |
$278.10
|
| Rate for Payer: Cash Price |
$278.10
|
| Rate for Payer: Cash Price |
$278.10
|
| Rate for Payer: Cigna Commercial |
$886.95
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$227.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$539.51
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$227.24
|
| Rate for Payer: Health EOS Commercial |
$858.03
|
| Rate for Payer: HFN Commercial |
$886.95
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$845.33
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$227.24
|
| Rate for Payer: Independent Care Health Plan Medicare |
$227.24
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$227.24
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$227.24
|
| Rate for Payer: Multiplan Commercial |
$771.26
|
| Rate for Payer: NAPHCARE Commercial |
$340.86
|
| Rate for Payer: Preferred Network Access Commercial |
$886.95
|
| Rate for Payer: Quartz Beloit One Network |
$472.40
|
| Rate for Payer: Quartz Commercial |
$626.65
|
| Rate for Payer: Quartz Medicare Advantage |
$227.24
|
| Rate for Payer: The Alliance Commercial |
$908.96
|
| Rate for Payer: United Healthcare Medicare Advantage |
$227.24
|
| Rate for Payer: United Healthcare PPO |
$723.06
|
| Rate for Payer: WEA Trust Commercial |
$530.24
|
| Rate for Payer: Wellcare Medicare |
$227.24
|
| Rate for Payer: WPS Commercial |
$714.07
|
|
|
Homocysteine, Cardio
|
Facility
|
OP
|
$323.00
|
|
|
Service Code
|
CPT 83090
|
| Hospital Charge Code |
5749631
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.64 |
| Max. Negotiated Rate |
$309.05 |
| Rate for Payer: Aetna Commercial |
$302.33
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$288.89
|
| Rate for Payer: Aetna Managed Medicare |
$18.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$69.89
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$32.61
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$30.94
|
| Rate for Payer: Anthem Medicare Advantage |
$18.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$178.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$18.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$18.64
|
| Rate for Payer: Cash Price |
$96.90
|
| Rate for Payer: Cash Price |
$96.90
|
| Rate for Payer: Cigna Commercial |
$309.05
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$18.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$187.99
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$18.64
|
| Rate for Payer: Health EOS Commercial |
$298.97
|
| Rate for Payer: HFN Commercial |
$309.05
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$69.33
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$18.64
|
| Rate for Payer: Independent Care Health Plan Medicare |
$18.64
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$18.64
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$18.64
|
| Rate for Payer: Multiplan Commercial |
$268.74
|
| Rate for Payer: NAPHCARE Commercial |
$27.96
|
| Rate for Payer: Preferred Network Access Commercial |
$309.05
|
| Rate for Payer: Quartz Beloit One Network |
$164.60
|
| Rate for Payer: Quartz Commercial |
$218.35
|
| Rate for Payer: Quartz Medicare Advantage |
$18.64
|
| Rate for Payer: The Alliance Commercial |
$74.55
|
| Rate for Payer: United Healthcare Medicare Advantage |
$18.64
|
| Rate for Payer: United Healthcare PPO |
$251.94
|
| Rate for Payer: WEA Trust Commercial |
$184.76
|
| Rate for Payer: Wellcare Medicare |
$18.64
|
| Rate for Payer: WPS Commercial |
$248.81
|
|
|
Homocysteine, Cardio
|
Facility
|
IP
|
$323.00
|
|
|
Service Code
|
CPT 83090
|
| Hospital Charge Code |
5749631
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$164.60 |
| Max. Negotiated Rate |
$309.05 |
| Rate for Payer: Aetna Commercial |
$302.33
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$288.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$178.04
|
| Rate for Payer: Cash Price |
$96.90
|
| Rate for Payer: Cigna Commercial |
$309.05
|
| Rate for Payer: Health EOS Commercial |
$298.97
|
| Rate for Payer: HFN Commercial |
$309.05
|
| Rate for Payer: Multiplan Commercial |
$268.74
|
| Rate for Payer: Preferred Network Access Commercial |
$309.05
|
| Rate for Payer: Quartz Beloit One Network |
$164.60
|
| Rate for Payer: Quartz Commercial |
$201.55
|
| Rate for Payer: WEA Trust Commercial |
$184.76
|
| Rate for Payer: WPS Commercial |
$248.81
|
|
|
Homocysteine, Cardio
|
Professional
|
Both
|
$323.00
|
|
|
Service Code
|
CPT 83090
|
| Hospital Charge Code |
5749631
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.64 |
| Max. Negotiated Rate |
$319.12 |
| Rate for Payer: Aetna Commercial |
$319.12
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$288.89
|
| Rate for Payer: Aetna Managed Medicare |
$18.64
|
| Rate for Payer: Anthem Medicare Advantage |
$18.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$18.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$18.64
|
| Rate for Payer: Cash Price |
$96.90
|
| Rate for Payer: Cash Price |
$96.90
|
| Rate for Payer: Cigna Commercial |
$319.12
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$167.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$18.64
|
| Rate for Payer: Health EOS Commercial |
$305.69
|
| Rate for Payer: HFN Commercial |
$319.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$65.79
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$65.79
|
| Rate for Payer: Independent Care Health Plan Medicare |
$18.64
|
| Rate for Payer: Multiplan Commercial |
$268.74
|
| Rate for Payer: NAPHCARE Commercial |
$27.96
|
| Rate for Payer: Preferred Network Access Commercial |
$319.12
|
| Rate for Payer: Quartz Beloit One Network |
$147.80
|
| Rate for Payer: Quartz Commercial |
$191.47
|
| Rate for Payer: Quartz Medicare Advantage |
$18.64
|
| Rate for Payer: The Alliance Commercial |
$73.62
|
| Rate for Payer: United Healthcare Medicare Advantage |
$18.64
|
| Rate for Payer: WEA Trust Commercial |
$184.76
|
| Rate for Payer: WPS Commercial |
$82.00
|
|
|
Homocysteine, Cardiovascular
|
Facility
|
OP
|
$630.00
|
|
|
Service Code
|
CPT 83090
|
| Hospital Charge Code |
1039201
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.64 |
| Max. Negotiated Rate |
$602.78 |
| Rate for Payer: Aetna Commercial |
$589.68
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$563.47
|
| Rate for Payer: Aetna Managed Medicare |
$18.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$69.89
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$32.61
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$30.94
|
| Rate for Payer: Anthem Medicare Advantage |
$18.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$347.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$18.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$18.64
|
| Rate for Payer: Cash Price |
$189.00
|
| Rate for Payer: Cash Price |
$189.00
|
| Rate for Payer: Cigna Commercial |
$602.78
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$18.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$366.66
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$18.64
|
| Rate for Payer: Health EOS Commercial |
$583.13
|
| Rate for Payer: HFN Commercial |
$602.78
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$69.33
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$18.64
|
| Rate for Payer: Independent Care Health Plan Medicare |
$18.64
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$18.64
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$18.64
|
| Rate for Payer: Multiplan Commercial |
$524.16
|
| Rate for Payer: NAPHCARE Commercial |
$27.96
|
| Rate for Payer: Preferred Network Access Commercial |
$602.78
|
| Rate for Payer: Quartz Beloit One Network |
$321.05
|
| Rate for Payer: Quartz Commercial |
$425.88
|
| Rate for Payer: Quartz Medicare Advantage |
$18.64
|
| Rate for Payer: The Alliance Commercial |
$74.55
|
| Rate for Payer: United Healthcare Medicare Advantage |
$18.64
|
| Rate for Payer: United Healthcare PPO |
$491.40
|
| Rate for Payer: WEA Trust Commercial |
$360.36
|
| Rate for Payer: Wellcare Medicare |
$18.64
|
| Rate for Payer: WPS Commercial |
$485.29
|
|
|
Homocysteine, Cardiovascular
|
Facility
|
IP
|
$630.00
|
|
|
Service Code
|
CPT 83090
|
| Hospital Charge Code |
1039201
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$321.05 |
| Max. Negotiated Rate |
$602.78 |
| Rate for Payer: Aetna Commercial |
$589.68
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$563.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$347.26
|
| Rate for Payer: Cash Price |
$189.00
|
| Rate for Payer: Cigna Commercial |
$602.78
|
| Rate for Payer: Health EOS Commercial |
$583.13
|
| Rate for Payer: HFN Commercial |
$602.78
|
| Rate for Payer: Multiplan Commercial |
$524.16
|
| Rate for Payer: Preferred Network Access Commercial |
$602.78
|
| Rate for Payer: Quartz Beloit One Network |
$321.05
|
| Rate for Payer: Quartz Commercial |
$393.12
|
| Rate for Payer: WEA Trust Commercial |
$360.36
|
| Rate for Payer: WPS Commercial |
$485.29
|
|
|
Homocysteine, Cardiovascular
|
Professional
|
Both
|
$630.00
|
|
|
Service Code
|
CPT 83090
|
| Hospital Charge Code |
1039201
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.64 |
| Max. Negotiated Rate |
$622.44 |
| Rate for Payer: Aetna Commercial |
$622.44
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$563.47
|
| Rate for Payer: Aetna Managed Medicare |
$18.64
|
| Rate for Payer: Anthem Medicare Advantage |
$18.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$18.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$18.64
|
| Rate for Payer: Cash Price |
$189.00
|
| Rate for Payer: Cash Price |
$189.00
|
| Rate for Payer: Cigna Commercial |
$622.44
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$327.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$18.64
|
| Rate for Payer: Health EOS Commercial |
$596.23
|
| Rate for Payer: HFN Commercial |
$622.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$65.79
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$65.79
|
| Rate for Payer: Independent Care Health Plan Medicare |
$18.64
|
| Rate for Payer: Multiplan Commercial |
$524.16
|
| Rate for Payer: NAPHCARE Commercial |
$27.96
|
| Rate for Payer: Preferred Network Access Commercial |
$622.44
|
| Rate for Payer: Quartz Beloit One Network |
$288.29
|
| Rate for Payer: Quartz Commercial |
$373.46
|
| Rate for Payer: Quartz Medicare Advantage |
$18.64
|
| Rate for Payer: The Alliance Commercial |
$73.62
|
| Rate for Payer: United Healthcare Medicare Advantage |
$18.64
|
| Rate for Payer: WEA Trust Commercial |
$360.36
|
| Rate for Payer: WPS Commercial |
$82.00
|
|
|
Homovanillic Acid 24 Hour Urine
|
Professional
|
Both
|
$46.92
|
|
|
Service Code
|
CPT 83150
|
| Hospital Charge Code |
977983
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$21.47 |
| Max. Negotiated Rate |
$102.55 |
| Rate for Payer: Aetna Commercial |
$46.36
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$41.97
|
| Rate for Payer: Aetna Managed Medicare |
$23.31
|
| Rate for Payer: Anthem Medicare Advantage |
$23.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$23.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$23.31
|
| Rate for Payer: Cash Price |
$14.08
|
| Rate for Payer: Cash Price |
$14.08
|
| Rate for Payer: Cigna Commercial |
$46.36
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$24.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$23.31
|
| Rate for Payer: Health EOS Commercial |
$44.41
|
| Rate for Payer: HFN Commercial |
$46.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$82.27
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$82.27
|
| Rate for Payer: Independent Care Health Plan Medicare |
$23.31
|
| Rate for Payer: Multiplan Commercial |
$39.04
|
| Rate for Payer: NAPHCARE Commercial |
$34.96
|
| Rate for Payer: Preferred Network Access Commercial |
$46.36
|
| Rate for Payer: Quartz Beloit One Network |
$21.47
|
| Rate for Payer: Quartz Commercial |
$27.81
|
| Rate for Payer: Quartz Medicare Advantage |
$23.31
|
| Rate for Payer: The Alliance Commercial |
$92.06
|
| Rate for Payer: United Healthcare Medicare Advantage |
$23.31
|
| Rate for Payer: WEA Trust Commercial |
$26.84
|
| Rate for Payer: WPS Commercial |
$102.55
|
|
|
Homovanillic Acid 24 Hour Urine
|
Facility
|
OP
|
$46.92
|
|
|
Service Code
|
CPT 83150
|
| Hospital Charge Code |
977983
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$23.31 |
| Max. Negotiated Rate |
$93.23 |
| Rate for Payer: Aetna Commercial |
$43.92
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$41.97
|
| Rate for Payer: Aetna Managed Medicare |
$23.31
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$87.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$40.79
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$38.69
|
| Rate for Payer: Anthem Medicare Advantage |
$23.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$25.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$23.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$23.31
|
| Rate for Payer: Cash Price |
$14.08
|
| Rate for Payer: Cash Price |
$14.08
|
| Rate for Payer: Cigna Commercial |
$44.89
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$23.31
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$27.31
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$23.31
|
| Rate for Payer: Health EOS Commercial |
$43.43
|
| Rate for Payer: HFN Commercial |
$44.89
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$86.70
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$23.31
|
| Rate for Payer: Independent Care Health Plan Medicare |
$23.31
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$23.31
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$23.31
|
| Rate for Payer: Multiplan Commercial |
$39.04
|
| Rate for Payer: NAPHCARE Commercial |
$34.96
|
| Rate for Payer: Preferred Network Access Commercial |
$44.89
|
| Rate for Payer: Quartz Beloit One Network |
$23.91
|
| Rate for Payer: Quartz Commercial |
$31.72
|
| Rate for Payer: Quartz Medicare Advantage |
$23.31
|
| Rate for Payer: The Alliance Commercial |
$93.23
|
| Rate for Payer: United Healthcare Medicare Advantage |
$23.31
|
| Rate for Payer: United Healthcare PPO |
$36.60
|
| Rate for Payer: WEA Trust Commercial |
$26.84
|
| Rate for Payer: Wellcare Medicare |
$23.31
|
| Rate for Payer: WPS Commercial |
$36.14
|
|
|
Homovanillic Acid 24 Hour Urine
|
Facility
|
IP
|
$46.92
|
|
|
Service Code
|
CPT 83150
|
| Hospital Charge Code |
977983
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$23.91 |
| Max. Negotiated Rate |
$44.89 |
| Rate for Payer: Aetna Commercial |
$43.92
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$41.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$25.86
|
| Rate for Payer: Cash Price |
$14.08
|
| Rate for Payer: Cigna Commercial |
$44.89
|
| Rate for Payer: Health EOS Commercial |
$43.43
|
| Rate for Payer: HFN Commercial |
$44.89
|
| Rate for Payer: Multiplan Commercial |
$39.04
|
| Rate for Payer: Preferred Network Access Commercial |
$44.89
|
| Rate for Payer: Quartz Beloit One Network |
$23.91
|
| Rate for Payer: Quartz Commercial |
$29.28
|
| Rate for Payer: WEA Trust Commercial |
$26.84
|
| Rate for Payer: WPS Commercial |
$36.14
|
|
|
Homovanillic Acid, Random Urine
|
Facility
|
OP
|
$46.59
|
|
|
Service Code
|
CPT 82570
|
| Hospital Charge Code |
4076076
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.39 |
| Max. Negotiated Rate |
$44.58 |
| Rate for Payer: Aetna Commercial |
$43.61
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$41.67
|
| Rate for Payer: Aetna Managed Medicare |
$5.39
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$20.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$9.43
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$8.94
|
| Rate for Payer: Anthem Medicare Advantage |
$5.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$25.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5.39
|
| Rate for Payer: Cash Price |
$13.98
|
| Rate for Payer: Cash Price |
$13.98
|
| Rate for Payer: Cigna Commercial |
$44.58
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$5.39
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$27.12
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$5.39
|
| Rate for Payer: Health EOS Commercial |
$43.12
|
| Rate for Payer: HFN Commercial |
$44.58
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$20.04
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$5.39
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5.39
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$5.39
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$5.39
|
| Rate for Payer: Multiplan Commercial |
$38.76
|
| Rate for Payer: NAPHCARE Commercial |
$8.08
|
| Rate for Payer: Preferred Network Access Commercial |
$44.58
|
| Rate for Payer: Quartz Beloit One Network |
$23.74
|
| Rate for Payer: Quartz Commercial |
$31.49
|
| Rate for Payer: Quartz Medicare Advantage |
$5.39
|
| Rate for Payer: The Alliance Commercial |
$21.55
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.39
|
| Rate for Payer: United Healthcare PPO |
$36.34
|
| Rate for Payer: WEA Trust Commercial |
$26.65
|
| Rate for Payer: Wellcare Medicare |
$5.39
|
| Rate for Payer: WPS Commercial |
$35.89
|
|
|
Homovanillic Acid, Random Urine
|
Facility
|
IP
|
$46.59
|
|
|
Service Code
|
CPT 82570
|
| Hospital Charge Code |
4076076
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$23.74 |
| Max. Negotiated Rate |
$44.58 |
| Rate for Payer: Aetna Commercial |
$43.61
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$41.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$25.68
|
| Rate for Payer: Cash Price |
$13.98
|
| Rate for Payer: Cigna Commercial |
$44.58
|
| Rate for Payer: Health EOS Commercial |
$43.12
|
| Rate for Payer: HFN Commercial |
$44.58
|
| Rate for Payer: Multiplan Commercial |
$38.76
|
| Rate for Payer: Preferred Network Access Commercial |
$44.58
|
| Rate for Payer: Quartz Beloit One Network |
$23.74
|
| Rate for Payer: Quartz Commercial |
$29.07
|
| Rate for Payer: WEA Trust Commercial |
$26.65
|
| Rate for Payer: WPS Commercial |
$35.89
|
|
|
Homovanillic Acid, Random Urine
|
Professional
|
Both
|
$46.59
|
|
|
Service Code
|
CPT 82570
|
| Hospital Charge Code |
4076076
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.39 |
| Max. Negotiated Rate |
$46.03 |
| Rate for Payer: Aetna Commercial |
$46.03
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$41.67
|
| Rate for Payer: Aetna Managed Medicare |
$5.39
|
| Rate for Payer: Anthem Medicare Advantage |
$5.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5.39
|
| Rate for Payer: Cash Price |
$13.98
|
| Rate for Payer: Cash Price |
$13.98
|
| Rate for Payer: Cigna Commercial |
$46.03
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$24.23
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5.39
|
| Rate for Payer: Health EOS Commercial |
$44.09
|
| Rate for Payer: HFN Commercial |
$46.03
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$19.02
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$19.02
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5.39
|
| Rate for Payer: Multiplan Commercial |
$38.76
|
| Rate for Payer: NAPHCARE Commercial |
$8.08
|
| Rate for Payer: Preferred Network Access Commercial |
$46.03
|
| Rate for Payer: Quartz Beloit One Network |
$21.32
|
| Rate for Payer: Quartz Commercial |
$27.62
|
| Rate for Payer: Quartz Medicare Advantage |
$5.39
|
| Rate for Payer: The Alliance Commercial |
$21.28
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.39
|
| Rate for Payer: WEA Trust Commercial |
$26.65
|
| Rate for Payer: WPS Commercial |
$23.70
|
|
|
HOOK BLUNT 5MM 3316-8G
|
Facility
|
OP
|
$171.00
|
|
| Hospital Charge Code |
2964998
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$49.80 |
| Max. Negotiated Rate |
$163.61 |
| Rate for Payer: Aetna Commercial |
$160.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$152.94
|
| Rate for Payer: Aetna Managed Medicare |
$49.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$115.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$88.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$85.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$94.26
|
| Rate for Payer: Cash Price |
$51.30
|
| Rate for Payer: Cigna Commercial |
$163.61
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$99.52
|
| Rate for Payer: Health EOS Commercial |
$158.28
|
| Rate for Payer: HFN Commercial |
$163.61
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$133.38
|
| Rate for Payer: Multiplan Commercial |
$142.27
|
| Rate for Payer: NAPHCARE Commercial |
$106.70
|
| Rate for Payer: Preferred Network Access Commercial |
$163.61
|
| Rate for Payer: Quartz Beloit One Network |
$87.14
|
| Rate for Payer: Quartz Commercial |
$115.60
|
| Rate for Payer: Quartz Medicare Advantage |
$106.70
|
| Rate for Payer: The Alliance Commercial |
$88.92
|
| Rate for Payer: WEA Trust Commercial |
$97.81
|
| Rate for Payer: WPS Commercial |
$131.72
|
|
|
HOOK BLUNT 5MM 3316-8G
|
Facility
|
IP
|
$171.00
|
|
| Hospital Charge Code |
2964998
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$87.14 |
| Max. Negotiated Rate |
$163.61 |
| Rate for Payer: Aetna Commercial |
$160.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$152.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$94.26
|
| Rate for Payer: Cash Price |
$51.30
|
| Rate for Payer: Cigna Commercial |
$163.61
|
| Rate for Payer: Health EOS Commercial |
$158.28
|
| Rate for Payer: HFN Commercial |
$163.61
|
| Rate for Payer: Multiplan Commercial |
$142.27
|
| Rate for Payer: Preferred Network Access Commercial |
$163.61
|
| Rate for Payer: Quartz Beloit One Network |
$87.14
|
| Rate for Payer: Quartz Commercial |
$106.70
|
| Rate for Payer: WEA Trust Commercial |
$97.81
|
| Rate for Payer: WPS Commercial |
$131.72
|
|
|
HOOK SELF ADHESIVE VELCRO 1 25yd #7011-02-25"
|
Facility
|
IP
|
$50.00
|
|
| Hospital Charge Code |
2971376
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$25.48 |
| Max. Negotiated Rate |
$47.84 |
| Rate for Payer: Aetna Commercial |
$46.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$44.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$27.56
|
| Rate for Payer: Cash Price |
$15.00
|
| Rate for Payer: Cigna Commercial |
$47.84
|
| Rate for Payer: Health EOS Commercial |
$46.28
|
| Rate for Payer: HFN Commercial |
$47.84
|
| Rate for Payer: Multiplan Commercial |
$41.60
|
| Rate for Payer: Preferred Network Access Commercial |
$47.84
|
| Rate for Payer: Quartz Beloit One Network |
$25.48
|
| Rate for Payer: Quartz Commercial |
$31.20
|
| Rate for Payer: WEA Trust Commercial |
$28.60
|
| Rate for Payer: WPS Commercial |
$38.52
|
|
