|
Identification, Aerobic to Mayo
|
Facility
|
IP
|
$280.00
|
|
|
Service Code
|
CPT 87077
|
| Hospital Charge Code |
4630630
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$142.69 |
| Max. Negotiated Rate |
$267.90 |
| Rate for Payer: Aetna Commercial |
$262.08
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$250.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$154.34
|
| Rate for Payer: Cash Price |
$84.00
|
| Rate for Payer: Cigna Commercial |
$267.90
|
| Rate for Payer: Health EOS Commercial |
$259.17
|
| Rate for Payer: HFN Commercial |
$267.90
|
| Rate for Payer: Multiplan Commercial |
$232.96
|
| Rate for Payer: Preferred Network Access Commercial |
$267.90
|
| Rate for Payer: Quartz Beloit One Network |
$142.69
|
| Rate for Payer: Quartz Commercial |
$174.72
|
| Rate for Payer: WEA Trust Commercial |
$160.16
|
| Rate for Payer: WPS Commercial |
$215.68
|
|
|
Identification, Anaerobic to Mayo
|
Professional
|
Both
|
$367.00
|
|
|
Service Code
|
CPT 87076
|
| Hospital Charge Code |
6173408
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.40 |
| Max. Negotiated Rate |
$362.60 |
| Rate for Payer: Aetna Commercial |
$362.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$328.24
|
| Rate for Payer: Aetna Managed Medicare |
$8.40
|
| Rate for Payer: Anthem Medicare Advantage |
$8.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$8.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$8.40
|
| Rate for Payer: Cash Price |
$110.10
|
| Rate for Payer: Cash Price |
$110.10
|
| Rate for Payer: Cigna Commercial |
$362.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$190.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$8.40
|
| Rate for Payer: Health EOS Commercial |
$347.33
|
| Rate for Payer: HFN Commercial |
$362.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$29.66
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$29.66
|
| Rate for Payer: Independent Care Health Plan Medicare |
$8.40
|
| Rate for Payer: Multiplan Commercial |
$305.34
|
| Rate for Payer: NAPHCARE Commercial |
$12.60
|
| Rate for Payer: Preferred Network Access Commercial |
$362.60
|
| Rate for Payer: Quartz Beloit One Network |
$167.94
|
| Rate for Payer: Quartz Commercial |
$217.56
|
| Rate for Payer: Quartz Medicare Advantage |
$8.40
|
| Rate for Payer: The Alliance Commercial |
$33.19
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8.40
|
| Rate for Payer: WEA Trust Commercial |
$209.92
|
| Rate for Payer: WPS Commercial |
$36.97
|
|
|
Identification, Anaerobic to Mayo
|
Facility
|
IP
|
$367.00
|
|
|
Service Code
|
CPT 87076
|
| Hospital Charge Code |
6173408
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$187.02 |
| Max. Negotiated Rate |
$351.15 |
| Rate for Payer: Aetna Commercial |
$343.51
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$328.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$202.29
|
| Rate for Payer: Cash Price |
$110.10
|
| Rate for Payer: Cigna Commercial |
$351.15
|
| Rate for Payer: Health EOS Commercial |
$339.70
|
| Rate for Payer: HFN Commercial |
$351.15
|
| Rate for Payer: Multiplan Commercial |
$305.34
|
| Rate for Payer: Preferred Network Access Commercial |
$351.15
|
| Rate for Payer: Quartz Beloit One Network |
$187.02
|
| Rate for Payer: Quartz Commercial |
$229.01
|
| Rate for Payer: WEA Trust Commercial |
$209.92
|
| Rate for Payer: WPS Commercial |
$282.70
|
|
|
Identification, Anaerobic to Mayo
|
Facility
|
OP
|
$367.00
|
|
|
Service Code
|
CPT 87076
|
| Hospital Charge Code |
6173408
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.40 |
| Max. Negotiated Rate |
$351.15 |
| Rate for Payer: Aetna Commercial |
$343.51
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$328.24
|
| Rate for Payer: Aetna Managed Medicare |
$8.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$31.51
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$14.71
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$13.95
|
| Rate for Payer: Anthem Medicare Advantage |
$8.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$202.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$8.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$8.40
|
| Rate for Payer: Cash Price |
$110.10
|
| Rate for Payer: Cash Price |
$110.10
|
| Rate for Payer: Cigna Commercial |
$351.15
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$8.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$213.59
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$8.40
|
| Rate for Payer: Health EOS Commercial |
$339.70
|
| Rate for Payer: HFN Commercial |
$351.15
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$31.26
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$8.40
|
| Rate for Payer: Independent Care Health Plan Medicare |
$8.40
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$8.40
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$8.40
|
| Rate for Payer: Multiplan Commercial |
$305.34
|
| Rate for Payer: NAPHCARE Commercial |
$12.60
|
| Rate for Payer: Preferred Network Access Commercial |
$351.15
|
| Rate for Payer: Quartz Beloit One Network |
$187.02
|
| Rate for Payer: Quartz Commercial |
$248.09
|
| Rate for Payer: Quartz Medicare Advantage |
$8.40
|
| Rate for Payer: The Alliance Commercial |
$33.61
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8.40
|
| Rate for Payer: United Healthcare PPO |
$286.26
|
| Rate for Payer: WEA Trust Commercial |
$209.92
|
| Rate for Payer: Wellcare Medicare |
$8.40
|
| Rate for Payer: WPS Commercial |
$282.70
|
|
|
Identification, Fungus
|
Professional
|
Both
|
$56.00
|
|
|
Service Code
|
CPT 87107
|
| Hospital Charge Code |
4732610
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.73 |
| Max. Negotiated Rate |
$55.33 |
| Rate for Payer: Aetna Commercial |
$55.33
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$50.09
|
| Rate for Payer: Aetna Managed Medicare |
$10.73
|
| Rate for Payer: Anthem Medicare Advantage |
$10.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$10.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$10.73
|
| Rate for Payer: Cash Price |
$16.80
|
| Rate for Payer: Cash Price |
$16.80
|
| Rate for Payer: Cigna Commercial |
$55.33
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$29.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$10.73
|
| Rate for Payer: Health EOS Commercial |
$53.00
|
| Rate for Payer: HFN Commercial |
$55.33
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$37.89
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$37.89
|
| Rate for Payer: Independent Care Health Plan Medicare |
$10.73
|
| Rate for Payer: Multiplan Commercial |
$46.59
|
| Rate for Payer: NAPHCARE Commercial |
$16.10
|
| Rate for Payer: Preferred Network Access Commercial |
$55.33
|
| Rate for Payer: Quartz Beloit One Network |
$25.63
|
| Rate for Payer: Quartz Commercial |
$33.20
|
| Rate for Payer: Quartz Medicare Advantage |
$10.73
|
| Rate for Payer: The Alliance Commercial |
$42.39
|
| Rate for Payer: United Healthcare Medicare Advantage |
$10.73
|
| Rate for Payer: WEA Trust Commercial |
$32.03
|
| Rate for Payer: WPS Commercial |
$47.22
|
|
|
Identification, Fungus
|
Facility
|
IP
|
$56.00
|
|
|
Service Code
|
CPT 87107
|
| Hospital Charge Code |
4732610
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$28.54 |
| Max. Negotiated Rate |
$53.58 |
| Rate for Payer: Aetna Commercial |
$52.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$50.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$30.87
|
| Rate for Payer: Cash Price |
$16.80
|
| Rate for Payer: Cigna Commercial |
$53.58
|
| Rate for Payer: Health EOS Commercial |
$51.83
|
| Rate for Payer: HFN Commercial |
$53.58
|
| Rate for Payer: Multiplan Commercial |
$46.59
|
| Rate for Payer: Preferred Network Access Commercial |
$53.58
|
| Rate for Payer: Quartz Beloit One Network |
$28.54
|
| Rate for Payer: Quartz Commercial |
$34.94
|
| Rate for Payer: WEA Trust Commercial |
$32.03
|
| Rate for Payer: WPS Commercial |
$43.14
|
|
|
Identification, Fungus
|
Facility
|
OP
|
$56.00
|
|
|
Service Code
|
CPT 87107
|
| Hospital Charge Code |
4732610
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.73 |
| Max. Negotiated Rate |
$53.58 |
| Rate for Payer: Aetna Commercial |
$52.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$50.09
|
| Rate for Payer: Aetna Managed Medicare |
$10.73
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$40.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$18.78
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$17.82
|
| Rate for Payer: Anthem Medicare Advantage |
$10.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$30.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$10.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$10.73
|
| Rate for Payer: Cash Price |
$16.80
|
| Rate for Payer: Cash Price |
$16.80
|
| Rate for Payer: Cigna Commercial |
$53.58
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$10.73
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$32.59
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$10.73
|
| Rate for Payer: Health EOS Commercial |
$51.83
|
| Rate for Payer: HFN Commercial |
$53.58
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$39.93
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$10.73
|
| Rate for Payer: Independent Care Health Plan Medicare |
$10.73
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$10.73
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$10.73
|
| Rate for Payer: Multiplan Commercial |
$46.59
|
| Rate for Payer: NAPHCARE Commercial |
$16.10
|
| Rate for Payer: Preferred Network Access Commercial |
$53.58
|
| Rate for Payer: Quartz Beloit One Network |
$28.54
|
| Rate for Payer: Quartz Commercial |
$37.86
|
| Rate for Payer: Quartz Medicare Advantage |
$10.73
|
| Rate for Payer: The Alliance Commercial |
$42.93
|
| Rate for Payer: United Healthcare Medicare Advantage |
$10.73
|
| Rate for Payer: United Healthcare PPO |
$43.68
|
| Rate for Payer: WEA Trust Commercial |
$32.03
|
| Rate for Payer: Wellcare Medicare |
$10.73
|
| Rate for Payer: WPS Commercial |
$43.14
|
|
|
Identification Nocardia/Actinomyces
|
Facility
|
IP
|
$334.00
|
|
|
Service Code
|
CPT 87118
|
| Hospital Charge Code |
5390643
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$170.21 |
| Max. Negotiated Rate |
$319.57 |
| Rate for Payer: Aetna Commercial |
$312.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$298.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$184.10
|
| Rate for Payer: Cash Price |
$100.20
|
| Rate for Payer: Cigna Commercial |
$319.57
|
| Rate for Payer: Health EOS Commercial |
$309.15
|
| Rate for Payer: HFN Commercial |
$319.57
|
| Rate for Payer: Multiplan Commercial |
$277.89
|
| Rate for Payer: Preferred Network Access Commercial |
$319.57
|
| Rate for Payer: Quartz Beloit One Network |
$170.21
|
| Rate for Payer: Quartz Commercial |
$208.42
|
| Rate for Payer: WEA Trust Commercial |
$191.05
|
| Rate for Payer: WPS Commercial |
$257.28
|
|
|
Identification Nocardia/Actinomyces
|
Facility
|
OP
|
$334.00
|
|
|
Service Code
|
CPT 87118
|
| Hospital Charge Code |
5390643
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.19 |
| Max. Negotiated Rate |
$319.57 |
| Rate for Payer: Aetna Commercial |
$312.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$298.73
|
| Rate for Payer: Aetna Managed Medicare |
$15.19
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$56.98
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$26.59
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$25.22
|
| Rate for Payer: Anthem Medicare Advantage |
$15.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$184.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$15.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$15.19
|
| Rate for Payer: Cash Price |
$100.20
|
| Rate for Payer: Cash Price |
$100.20
|
| Rate for Payer: Cigna Commercial |
$319.57
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$15.19
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$194.39
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$15.19
|
| Rate for Payer: Health EOS Commercial |
$309.15
|
| Rate for Payer: HFN Commercial |
$319.57
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$56.52
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$15.19
|
| Rate for Payer: Independent Care Health Plan Medicare |
$15.19
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$15.19
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$15.19
|
| Rate for Payer: Multiplan Commercial |
$277.89
|
| Rate for Payer: NAPHCARE Commercial |
$22.79
|
| Rate for Payer: Preferred Network Access Commercial |
$319.57
|
| Rate for Payer: Quartz Beloit One Network |
$170.21
|
| Rate for Payer: Quartz Commercial |
$225.78
|
| Rate for Payer: Quartz Medicare Advantage |
$15.19
|
| Rate for Payer: The Alliance Commercial |
$60.78
|
| Rate for Payer: United Healthcare Medicare Advantage |
$15.19
|
| Rate for Payer: United Healthcare PPO |
$260.52
|
| Rate for Payer: WEA Trust Commercial |
$191.05
|
| Rate for Payer: Wellcare Medicare |
$15.19
|
| Rate for Payer: WPS Commercial |
$257.28
|
|
|
Identification Nocardia/Actinomyces
|
Professional
|
Both
|
$334.00
|
|
|
Service Code
|
CPT 87118
|
| Hospital Charge Code |
5390643
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.19 |
| Max. Negotiated Rate |
$329.99 |
| Rate for Payer: Aetna Commercial |
$329.99
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$298.73
|
| Rate for Payer: Aetna Managed Medicare |
$15.19
|
| Rate for Payer: Anthem Medicare Advantage |
$15.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$15.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$15.19
|
| Rate for Payer: Cash Price |
$100.20
|
| Rate for Payer: Cash Price |
$100.20
|
| Rate for Payer: Cigna Commercial |
$329.99
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$173.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$15.19
|
| Rate for Payer: Health EOS Commercial |
$316.10
|
| Rate for Payer: HFN Commercial |
$329.99
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$53.63
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$53.63
|
| Rate for Payer: Independent Care Health Plan Medicare |
$15.19
|
| Rate for Payer: Multiplan Commercial |
$277.89
|
| Rate for Payer: NAPHCARE Commercial |
$22.79
|
| Rate for Payer: Preferred Network Access Commercial |
$329.99
|
| Rate for Payer: Quartz Beloit One Network |
$152.84
|
| Rate for Payer: Quartz Commercial |
$198.00
|
| Rate for Payer: Quartz Medicare Advantage |
$15.19
|
| Rate for Payer: The Alliance Commercial |
$60.02
|
| Rate for Payer: United Healthcare Medicare Advantage |
$15.19
|
| Rate for Payer: WEA Trust Commercial |
$191.05
|
| Rate for Payer: WPS Commercial |
$66.86
|
|
|
I&D HEMATOMA SEROMA/FLUID COLLECTION - 10140
|
Facility
|
OP
|
$810.00
|
|
|
Service Code
|
CPT 10140
|
| Hospital Charge Code |
5843793
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$404.35 |
| Max. Negotiated Rate |
$6,952.48 |
| Rate for Payer: Aetna Commercial |
$758.16
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$724.46
|
| Rate for Payer: Aetna Managed Medicare |
$1,738.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$547.56
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$421.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$404.35
|
| Rate for Payer: Anthem Medicare Advantage |
$1,738.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$446.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$1,738.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$1,738.12
|
| Rate for Payer: Cash Price |
$243.00
|
| Rate for Payer: Cash Price |
$243.00
|
| Rate for Payer: Cigna Commercial |
$775.01
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$1,738.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$1,738.12
|
| Rate for Payer: Health EOS Commercial |
$749.74
|
| Rate for Payer: HFN Commercial |
$775.01
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,465.81
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,738.12
|
| Rate for Payer: Independent Care Health Plan Medicare |
$1,738.12
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$1,738.12
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$1,738.12
|
| Rate for Payer: Multiplan Commercial |
$673.92
|
| Rate for Payer: NAPHCARE Commercial |
$2,607.18
|
| Rate for Payer: Preferred Network Access Commercial |
$775.01
|
| Rate for Payer: Quartz Beloit One Network |
$412.78
|
| Rate for Payer: Quartz Commercial |
$547.56
|
| Rate for Payer: Quartz Medicare Advantage |
$1,738.12
|
| Rate for Payer: The Alliance Commercial |
$6,952.48
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,738.12
|
| Rate for Payer: WEA Trust Commercial |
$463.32
|
| Rate for Payer: Wellcare Medicare |
$1,738.12
|
| Rate for Payer: WPS Commercial |
$623.94
|
|
|
I&D HEMATOMA SEROMA/FLUID COLLECTION - 10140
|
Facility
|
IP
|
$810.00
|
|
|
Service Code
|
CPT 10140
|
| Hospital Charge Code |
5843793
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$412.78 |
| Max. Negotiated Rate |
$775.01 |
| Rate for Payer: Aetna Commercial |
$758.16
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$724.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$446.47
|
| Rate for Payer: Cash Price |
$243.00
|
| Rate for Payer: Cigna Commercial |
$775.01
|
| Rate for Payer: Health EOS Commercial |
$749.74
|
| Rate for Payer: HFN Commercial |
$775.01
|
| Rate for Payer: Multiplan Commercial |
$673.92
|
| Rate for Payer: Preferred Network Access Commercial |
$775.01
|
| Rate for Payer: Quartz Beloit One Network |
$412.78
|
| Rate for Payer: Quartz Commercial |
$505.44
|
| Rate for Payer: WEA Trust Commercial |
$463.32
|
| Rate for Payer: WPS Commercial |
$623.94
|
|
|
I&D HEMATOMA SEROMA/FLUID COLLECTION 10140
|
Professional
|
Both
|
$443.00
|
|
|
Service Code
|
CPT 10140
|
| Hospital Charge Code |
5843792
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$46.24 |
| Max. Negotiated Rate |
$506.89 |
| Rate for Payer: Aetna Commercial |
$437.68
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$396.22
|
| Rate for Payer: Aetna Managed Medicare |
$112.64
|
| Rate for Payer: Anthem Medicare Advantage |
$112.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$112.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$112.64
|
| Rate for Payer: Cash Price |
$132.90
|
| Rate for Payer: Cash Price |
$132.90
|
| Rate for Payer: Cash Price |
$132.90
|
| Rate for Payer: Cigna Commercial |
$437.68
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$46.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$112.64
|
| Rate for Payer: Health EOS Commercial |
$419.26
|
| Rate for Payer: HFN Commercial |
$437.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$411.87
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$411.87
|
| Rate for Payer: Independent Care Health Plan Medicare |
$112.64
|
| Rate for Payer: Multiplan Commercial |
$368.58
|
| Rate for Payer: NAPHCARE Commercial |
$168.96
|
| Rate for Payer: Preferred Network Access Commercial |
$437.68
|
| Rate for Payer: Quartz Beloit One Network |
$202.72
|
| Rate for Payer: Quartz Commercial |
$262.61
|
| Rate for Payer: Quartz Medicare Advantage |
$112.64
|
| Rate for Payer: The Alliance Commercial |
$478.73
|
| Rate for Payer: United Healthcare Medicaid |
$46.24
|
| Rate for Payer: United Healthcare Medicare Advantage |
$112.64
|
| Rate for Payer: WEA Trust Commercial |
$253.40
|
| Rate for Payer: WPS Commercial |
$506.89
|
|
|
ID KIT HEXAPOD STRUT 4935-1-100
|
Facility
|
IP
|
$3,934.00
|
|
| Hospital Charge Code |
6206987
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,004.77 |
| Max. Negotiated Rate |
$3,764.05 |
| Rate for Payer: Aetna Commercial |
$3,682.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,518.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,168.42
|
| Rate for Payer: Cash Price |
$1,180.20
|
| Rate for Payer: Cigna Commercial |
$3,764.05
|
| Rate for Payer: Health EOS Commercial |
$3,641.31
|
| Rate for Payer: HFN Commercial |
$3,764.05
|
| Rate for Payer: Multiplan Commercial |
$3,273.09
|
| Rate for Payer: Preferred Network Access Commercial |
$3,764.05
|
| Rate for Payer: Quartz Beloit One Network |
$2,004.77
|
| Rate for Payer: Quartz Commercial |
$2,454.82
|
| Rate for Payer: WEA Trust Commercial |
$2,250.25
|
| Rate for Payer: WPS Commercial |
$3,030.36
|
|
|
ID KIT HEXAPOD STRUT 4935-1-100
|
Facility
|
OP
|
$3,934.00
|
|
| Hospital Charge Code |
6206987
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,145.58 |
| Max. Negotiated Rate |
$3,764.05 |
| Rate for Payer: Aetna Commercial |
$3,682.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,518.57
|
| Rate for Payer: Aetna Managed Medicare |
$1,145.58
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,659.38
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,045.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,963.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,168.42
|
| Rate for Payer: Cash Price |
$1,180.20
|
| Rate for Payer: Cigna Commercial |
$3,764.05
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,289.59
|
| Rate for Payer: Health EOS Commercial |
$3,641.31
|
| Rate for Payer: HFN Commercial |
$3,764.05
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,068.52
|
| Rate for Payer: Multiplan Commercial |
$3,273.09
|
| Rate for Payer: NAPHCARE Commercial |
$2,454.82
|
| Rate for Payer: Preferred Network Access Commercial |
$3,764.05
|
| Rate for Payer: Quartz Beloit One Network |
$2,004.77
|
| Rate for Payer: Quartz Commercial |
$2,659.38
|
| Rate for Payer: Quartz Medicare Advantage |
$2,454.82
|
| Rate for Payer: The Alliance Commercial |
$2,045.68
|
| Rate for Payer: WEA Trust Commercial |
$2,250.25
|
| Rate for Payer: WPS Commercial |
$3,030.36
|
|
|
I&D of hematoma, seroma or fluid collection 10140
|
Professional
|
Both
|
$443.00
|
|
|
Service Code
|
CPT 10140
|
| Hospital Charge Code |
3013507
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$46.24 |
| Max. Negotiated Rate |
$506.89 |
| Rate for Payer: Aetna Commercial |
$437.68
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$396.22
|
| Rate for Payer: Aetna Managed Medicare |
$112.64
|
| Rate for Payer: Anthem Medicare Advantage |
$112.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$112.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$112.64
|
| Rate for Payer: Cash Price |
$132.90
|
| Rate for Payer: Cash Price |
$132.90
|
| Rate for Payer: Cash Price |
$132.90
|
| Rate for Payer: Cigna Commercial |
$437.68
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$46.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$112.64
|
| Rate for Payer: Health EOS Commercial |
$419.26
|
| Rate for Payer: HFN Commercial |
$437.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$411.87
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$411.87
|
| Rate for Payer: Independent Care Health Plan Medicare |
$112.64
|
| Rate for Payer: Multiplan Commercial |
$368.58
|
| Rate for Payer: NAPHCARE Commercial |
$168.96
|
| Rate for Payer: Preferred Network Access Commercial |
$437.68
|
| Rate for Payer: Quartz Beloit One Network |
$202.72
|
| Rate for Payer: Quartz Commercial |
$262.61
|
| Rate for Payer: Quartz Medicare Advantage |
$112.64
|
| Rate for Payer: The Alliance Commercial |
$478.73
|
| Rate for Payer: United Healthcare Medicaid |
$46.24
|
| Rate for Payer: United Healthcare Medicare Advantage |
$112.64
|
| Rate for Payer: WEA Trust Commercial |
$253.40
|
| Rate for Payer: WPS Commercial |
$506.89
|
|
|
I&D of hematoma, seroma or fluid collection 1014022
|
Professional
|
Both
|
$531.00
|
|
|
Service Code
|
CPT 10140 22
|
| Hospital Charge Code |
5250606
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$46.24 |
| Max. Negotiated Rate |
$524.63 |
| Rate for Payer: Aetna Commercial |
$524.63
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$474.93
|
| Rate for Payer: Cash Price |
$159.30
|
| Rate for Payer: Cash Price |
$159.30
|
| Rate for Payer: Cash Price |
$159.30
|
| Rate for Payer: Cigna Commercial |
$524.63
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$46.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$331.34
|
| Rate for Payer: Health EOS Commercial |
$502.54
|
| Rate for Payer: HFN Commercial |
$524.63
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$411.87
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$411.87
|
| Rate for Payer: Multiplan Commercial |
$441.79
|
| Rate for Payer: Preferred Network Access Commercial |
$524.63
|
| Rate for Payer: Quartz Beloit One Network |
$242.99
|
| Rate for Payer: Quartz Commercial |
$314.78
|
| Rate for Payer: The Alliance Commercial |
$276.12
|
| Rate for Payer: United Healthcare Medicaid |
$46.24
|
| Rate for Payer: WEA Trust Commercial |
$303.73
|
| Rate for Payer: WPS Commercial |
$409.03
|
|
|
IEF Confirms
|
Facility
|
IP
|
$105.00
|
|
|
Service Code
|
CPT 82664
|
| Hospital Charge Code |
3525525
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$53.51 |
| Max. Negotiated Rate |
$100.46 |
| Rate for Payer: Aetna Commercial |
$98.28
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$93.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$57.88
|
| Rate for Payer: Cash Price |
$31.50
|
| Rate for Payer: Cigna Commercial |
$100.46
|
| Rate for Payer: Health EOS Commercial |
$97.19
|
| Rate for Payer: HFN Commercial |
$100.46
|
| Rate for Payer: Multiplan Commercial |
$87.36
|
| Rate for Payer: Preferred Network Access Commercial |
$100.46
|
| Rate for Payer: Quartz Beloit One Network |
$53.51
|
| Rate for Payer: Quartz Commercial |
$65.52
|
| Rate for Payer: WEA Trust Commercial |
$60.06
|
| Rate for Payer: WPS Commercial |
$80.88
|
|
|
IEF Confirms
|
Professional
|
Both
|
$105.00
|
|
|
Service Code
|
CPT 82664
|
| Hospital Charge Code |
3525525
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$48.05 |
| Max. Negotiated Rate |
$281.42 |
| Rate for Payer: Aetna Commercial |
$103.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$93.91
|
| Rate for Payer: Aetna Managed Medicare |
$63.96
|
| Rate for Payer: Anthem Medicare Advantage |
$63.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$63.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$63.96
|
| Rate for Payer: Cash Price |
$31.50
|
| Rate for Payer: Cash Price |
$31.50
|
| Rate for Payer: Cigna Commercial |
$103.74
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$54.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$63.96
|
| Rate for Payer: Health EOS Commercial |
$99.37
|
| Rate for Payer: HFN Commercial |
$103.74
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$225.78
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$225.78
|
| Rate for Payer: Independent Care Health Plan Medicare |
$63.96
|
| Rate for Payer: Multiplan Commercial |
$87.36
|
| Rate for Payer: NAPHCARE Commercial |
$95.94
|
| Rate for Payer: Preferred Network Access Commercial |
$103.74
|
| Rate for Payer: Quartz Beloit One Network |
$48.05
|
| Rate for Payer: Quartz Commercial |
$62.24
|
| Rate for Payer: Quartz Medicare Advantage |
$63.96
|
| Rate for Payer: The Alliance Commercial |
$252.64
|
| Rate for Payer: United Healthcare Medicare Advantage |
$63.96
|
| Rate for Payer: WEA Trust Commercial |
$60.06
|
| Rate for Payer: WPS Commercial |
$281.42
|
|
|
IEF Confirms
|
Facility
|
OP
|
$105.00
|
|
|
Service Code
|
CPT 82664
|
| Hospital Charge Code |
3525525
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$53.51 |
| Max. Negotiated Rate |
$255.84 |
| Rate for Payer: Aetna Commercial |
$98.28
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$93.91
|
| Rate for Payer: Aetna Managed Medicare |
$63.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$239.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$111.93
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$106.17
|
| Rate for Payer: Anthem Medicare Advantage |
$63.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$57.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$63.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$63.96
|
| Rate for Payer: Cash Price |
$31.50
|
| Rate for Payer: Cash Price |
$31.50
|
| Rate for Payer: Cigna Commercial |
$100.46
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$63.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$61.11
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$63.96
|
| Rate for Payer: Health EOS Commercial |
$97.19
|
| Rate for Payer: HFN Commercial |
$100.46
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$237.93
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$63.96
|
| Rate for Payer: Independent Care Health Plan Medicare |
$63.96
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$63.96
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$63.96
|
| Rate for Payer: Multiplan Commercial |
$87.36
|
| Rate for Payer: NAPHCARE Commercial |
$95.94
|
| Rate for Payer: Preferred Network Access Commercial |
$100.46
|
| Rate for Payer: Quartz Beloit One Network |
$53.51
|
| Rate for Payer: Quartz Commercial |
$70.98
|
| Rate for Payer: Quartz Medicare Advantage |
$63.96
|
| Rate for Payer: The Alliance Commercial |
$255.84
|
| Rate for Payer: United Healthcare Medicare Advantage |
$63.96
|
| Rate for Payer: United Healthcare PPO |
$81.90
|
| Rate for Payer: WEA Trust Commercial |
$60.06
|
| Rate for Payer: Wellcare Medicare |
$63.96
|
| Rate for Payer: WPS Commercial |
$80.88
|
|
|
iFEX 3000 mg Charge
|
Facility
|
OP
|
$276.00
|
|
|
Service Code
|
HCPCS J9208
|
| Hospital Charge Code |
2958859
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$36.39 |
| Max. Negotiated Rate |
$264.08 |
| Rate for Payer: Aetna Commercial |
$258.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$246.85
|
| Rate for Payer: Aetna Managed Medicare |
$80.37
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$186.58
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$143.52
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$137.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$152.13
|
| Rate for Payer: Cash Price |
$82.80
|
| Rate for Payer: Cash Price |
$82.80
|
| Rate for Payer: Cigna Commercial |
$264.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$36.39
|
| Rate for Payer: Health EOS Commercial |
$255.47
|
| Rate for Payer: HFN Commercial |
$264.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$215.28
|
| Rate for Payer: Multiplan Commercial |
$229.63
|
| Rate for Payer: NAPHCARE Commercial |
$172.22
|
| Rate for Payer: Preferred Network Access Commercial |
$264.08
|
| Rate for Payer: Quartz Beloit One Network |
$140.65
|
| Rate for Payer: Quartz Commercial |
$186.58
|
| Rate for Payer: Quartz Medicare Advantage |
$172.22
|
| Rate for Payer: The Alliance Commercial |
$103.33
|
| Rate for Payer: WEA Trust Commercial |
$157.87
|
| Rate for Payer: WPS Commercial |
$68.76
|
|
|
iFEX 3000 mg Charge
|
Professional
|
Both
|
$276.00
|
|
|
Service Code
|
HCPCS J9208
|
| Hospital Charge Code |
2958859
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$25.83 |
| Max. Negotiated Rate |
$272.69 |
| Rate for Payer: Aetna Commercial |
$272.69
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$246.85
|
| Rate for Payer: Aetna Managed Medicare |
$25.83
|
| Rate for Payer: Anthem Medicare Advantage |
$25.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$25.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$25.83
|
| Rate for Payer: Cash Price |
$82.80
|
| Rate for Payer: Cash Price |
$82.80
|
| Rate for Payer: Cigna Commercial |
$272.69
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$25.83
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$27.50
|
| Rate for Payer: Health EOS Commercial |
$261.21
|
| Rate for Payer: HFN Commercial |
$272.69
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$39.75
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$39.75
|
| Rate for Payer: Independent Care Health Plan Medicare |
$25.83
|
| Rate for Payer: Multiplan Commercial |
$229.63
|
| Rate for Payer: NAPHCARE Commercial |
$38.75
|
| Rate for Payer: Preferred Network Access Commercial |
$272.69
|
| Rate for Payer: Quartz Beloit One Network |
$126.30
|
| Rate for Payer: Quartz Commercial |
$163.61
|
| Rate for Payer: Quartz Medicare Advantage |
$25.83
|
| Rate for Payer: The Alliance Commercial |
$71.04
|
| Rate for Payer: United Healthcare Medicaid |
$25.83
|
| Rate for Payer: United Healthcare Medicare Advantage |
$25.83
|
| Rate for Payer: WEA Trust Commercial |
$157.87
|
| Rate for Payer: WPS Commercial |
$68.76
|
|
|
iFEX 3000 mg Charge
|
Facility
|
IP
|
$276.00
|
|
|
Service Code
|
HCPCS J9208
|
| Hospital Charge Code |
2958859
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$140.65 |
| Max. Negotiated Rate |
$264.08 |
| Rate for Payer: Aetna Commercial |
$258.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$246.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$152.13
|
| Rate for Payer: Cash Price |
$82.80
|
| Rate for Payer: Cigna Commercial |
$264.08
|
| Rate for Payer: Health EOS Commercial |
$255.47
|
| Rate for Payer: HFN Commercial |
$264.08
|
| Rate for Payer: Multiplan Commercial |
$229.63
|
| Rate for Payer: Preferred Network Access Commercial |
$264.08
|
| Rate for Payer: Quartz Beloit One Network |
$140.65
|
| Rate for Payer: Quartz Commercial |
$172.22
|
| Rate for Payer: WEA Trust Commercial |
$157.87
|
| Rate for Payer: WPS Commercial |
$212.60
|
|
|
IgA
|
Facility
|
IP
|
$177.00
|
|
|
Service Code
|
CPT 82784
|
| Hospital Charge Code |
2942877
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$90.20 |
| Max. Negotiated Rate |
$169.35 |
| Rate for Payer: Aetna Commercial |
$165.67
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$158.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$97.56
|
| Rate for Payer: Cash Price |
$53.10
|
| Rate for Payer: Cigna Commercial |
$169.35
|
| Rate for Payer: Health EOS Commercial |
$163.83
|
| Rate for Payer: HFN Commercial |
$169.35
|
| Rate for Payer: Multiplan Commercial |
$147.26
|
| Rate for Payer: Preferred Network Access Commercial |
$169.35
|
| Rate for Payer: Quartz Beloit One Network |
$90.20
|
| Rate for Payer: Quartz Commercial |
$110.45
|
| Rate for Payer: WEA Trust Commercial |
$101.24
|
| Rate for Payer: WPS Commercial |
$136.34
|
|
|
IgA
|
Facility
|
OP
|
$245.00
|
|
|
Service Code
|
CPT 82784
|
| Hospital Charge Code |
977985
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.67 |
| Max. Negotiated Rate |
$234.42 |
| Rate for Payer: Aetna Commercial |
$229.32
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$219.13
|
| Rate for Payer: Aetna Managed Medicare |
$9.67
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$36.27
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$16.93
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$16.06
|
| Rate for Payer: Anthem Medicare Advantage |
$9.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$135.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$9.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$9.67
|
| Rate for Payer: Cash Price |
$73.50
|
| Rate for Payer: Cash Price |
$73.50
|
| Rate for Payer: Cigna Commercial |
$234.42
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$9.67
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$142.59
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$9.67
|
| Rate for Payer: Health EOS Commercial |
$226.77
|
| Rate for Payer: HFN Commercial |
$234.42
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$35.98
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$9.67
|
| Rate for Payer: Independent Care Health Plan Medicare |
$9.67
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$9.67
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$9.67
|
| Rate for Payer: Multiplan Commercial |
$203.84
|
| Rate for Payer: NAPHCARE Commercial |
$14.51
|
| Rate for Payer: Preferred Network Access Commercial |
$234.42
|
| Rate for Payer: Quartz Beloit One Network |
$124.85
|
| Rate for Payer: Quartz Commercial |
$165.62
|
| Rate for Payer: Quartz Medicare Advantage |
$9.67
|
| Rate for Payer: The Alliance Commercial |
$38.69
|
| Rate for Payer: United Healthcare Medicare Advantage |
$9.67
|
| Rate for Payer: United Healthcare PPO |
$191.10
|
| Rate for Payer: WEA Trust Commercial |
$140.14
|
| Rate for Payer: Wellcare Medicare |
$9.67
|
| Rate for Payer: WPS Commercial |
$188.72
|
|
