|
ICD REM&REP Gen + Single/Dual Leads
|
Facility
|
OP
|
$1,199.00
|
|
|
Service Code
|
CPT 33241
|
| Hospital Charge Code |
4318609
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$587.51 |
| Max. Negotiated Rate |
$15,525.92 |
| Rate for Payer: Aetna Commercial |
$1,079.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,031.14
|
| Rate for Payer: Aetna Managed Medicare |
$3,881.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$9,907.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8,043.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7,639.00
|
| Rate for Payer: Anthem Medicare Advantage |
$3,881.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$635.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$3,881.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$3,881.48
|
| Rate for Payer: Cash Price |
$359.70
|
| Rate for Payer: Cash Price |
$359.70
|
| Rate for Payer: Cash Price |
$359.70
|
| Rate for Payer: Cigna Commercial |
$1,103.08
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$3,881.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$11,874.87
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$3,881.48
|
| Rate for Payer: Health EOS Commercial |
$1,067.11
|
| Rate for Payer: HFN Commercial |
$1,103.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$14,439.11
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$3,881.48
|
| Rate for Payer: Independent Care Health Plan Medicare |
$3,881.48
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$3,881.48
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$3,881.48
|
| Rate for Payer: Multiplan Commercial |
$959.20
|
| Rate for Payer: NAPHCARE Commercial |
$5,822.22
|
| Rate for Payer: Preferred Network Access Commercial |
$1,103.08
|
| Rate for Payer: Quartz Beloit One Network |
$587.51
|
| Rate for Payer: Quartz Commercial |
$779.35
|
| Rate for Payer: Quartz Medicare Advantage |
$3,881.48
|
| Rate for Payer: The Alliance Commercial |
$15,525.92
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,881.48
|
| Rate for Payer: United Healthcare PPO |
$4,103.00
|
| Rate for Payer: WEA Trust Commercial |
$659.45
|
| Rate for Payer: Wellcare Medicare |
$3,881.48
|
| Rate for Payer: WPS Commercial |
$888.10
|
|
|
ICD REM&REP Gen + Single/Dual Leads
|
Facility
|
IP
|
$1,199.00
|
|
|
Service Code
|
CPT 33241
|
| Hospital Charge Code |
4318609
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$587.51 |
| Max. Negotiated Rate |
$1,103.08 |
| Rate for Payer: Aetna Commercial |
$1,079.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,031.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$635.47
|
| Rate for Payer: Cash Price |
$359.70
|
| Rate for Payer: Cigna Commercial |
$1,103.08
|
| Rate for Payer: Health EOS Commercial |
$1,067.11
|
| Rate for Payer: HFN Commercial |
$1,103.08
|
| Rate for Payer: Multiplan Commercial |
$959.20
|
| Rate for Payer: NAPHCARE Commercial |
$719.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,103.08
|
| Rate for Payer: Quartz Beloit One Network |
$587.51
|
| Rate for Payer: Quartz Commercial |
$719.40
|
| Rate for Payer: WEA Trust Commercial |
$659.45
|
| Rate for Payer: WPS Commercial |
$888.10
|
|
|
ICD Repos Subq Lead Only
|
Facility
|
OP
|
$4,276.00
|
|
|
Service Code
|
CPT 33273
|
| Hospital Charge Code |
4584631
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,095.24 |
| Max. Negotiated Rate |
$15,525.92 |
| Rate for Payer: Aetna Commercial |
$3,848.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,677.36
|
| Rate for Payer: Aetna Managed Medicare |
$3,881.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$9,907.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8,043.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7,639.00
|
| Rate for Payer: Anthem Medicare Advantage |
$3,881.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,266.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$3,881.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$3,881.48
|
| Rate for Payer: Cash Price |
$1,282.80
|
| Rate for Payer: Cash Price |
$1,282.80
|
| Rate for Payer: Cash Price |
$1,282.80
|
| Rate for Payer: Cigna Commercial |
$3,933.92
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$3,881.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$11,874.87
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$3,881.48
|
| Rate for Payer: Health EOS Commercial |
$3,805.64
|
| Rate for Payer: HFN Commercial |
$3,933.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$14,439.11
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$3,881.48
|
| Rate for Payer: Independent Care Health Plan Medicare |
$3,881.48
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$3,881.48
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$3,881.48
|
| Rate for Payer: Multiplan Commercial |
$3,420.80
|
| Rate for Payer: NAPHCARE Commercial |
$5,822.22
|
| Rate for Payer: Preferred Network Access Commercial |
$3,933.92
|
| Rate for Payer: Quartz Beloit One Network |
$2,095.24
|
| Rate for Payer: Quartz Commercial |
$2,779.40
|
| Rate for Payer: Quartz Medicare Advantage |
$3,881.48
|
| Rate for Payer: The Alliance Commercial |
$15,525.92
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,881.48
|
| Rate for Payer: United Healthcare PPO |
$4,103.00
|
| Rate for Payer: WEA Trust Commercial |
$2,351.80
|
| Rate for Payer: Wellcare Medicare |
$3,881.48
|
| Rate for Payer: WPS Commercial |
$3,167.23
|
|
|
ICD Repos Subq Lead Only
|
Facility
|
IP
|
$4,276.00
|
|
|
Service Code
|
CPT 33273
|
| Hospital Charge Code |
4584631
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,095.24 |
| Max. Negotiated Rate |
$3,933.92 |
| Rate for Payer: Aetna Commercial |
$3,848.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,677.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,266.28
|
| Rate for Payer: Cash Price |
$1,282.80
|
| Rate for Payer: Cigna Commercial |
$3,933.92
|
| Rate for Payer: Health EOS Commercial |
$3,805.64
|
| Rate for Payer: HFN Commercial |
$3,933.92
|
| Rate for Payer: Multiplan Commercial |
$3,420.80
|
| Rate for Payer: NAPHCARE Commercial |
$2,565.60
|
| Rate for Payer: Preferred Network Access Commercial |
$3,933.92
|
| Rate for Payer: Quartz Beloit One Network |
$2,095.24
|
| Rate for Payer: Quartz Commercial |
$2,565.60
|
| Rate for Payer: WEA Trust Commercial |
$2,351.80
|
| Rate for Payer: WPS Commercial |
$3,167.23
|
|
|
ICD Subq Check w/o Repgrogram
|
Facility
|
OP
|
$1,320.00
|
|
|
Service Code
|
CPT 93261
|
| Hospital Charge Code |
4584636
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$37.27 |
| Max. Negotiated Rate |
$1,214.40 |
| Rate for Payer: Aetna Commercial |
$1,188.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,135.20
|
| Rate for Payer: Aetna Managed Medicare |
$37.27
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$858.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$660.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$633.60
|
| Rate for Payer: Anthem Medicare Advantage |
$37.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$699.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$37.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$37.27
|
| Rate for Payer: Cash Price |
$396.00
|
| Rate for Payer: Cash Price |
$396.00
|
| Rate for Payer: Cigna Commercial |
$1,214.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$37.27
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$738.67
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$37.27
|
| Rate for Payer: Health EOS Commercial |
$1,174.80
|
| Rate for Payer: HFN Commercial |
$1,214.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$138.64
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$37.27
|
| Rate for Payer: Independent Care Health Plan Medicare |
$37.27
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$37.27
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$37.27
|
| Rate for Payer: Multiplan Commercial |
$1,056.00
|
| Rate for Payer: NAPHCARE Commercial |
$55.90
|
| Rate for Payer: Preferred Network Access Commercial |
$1,214.40
|
| Rate for Payer: Quartz Beloit One Network |
$646.80
|
| Rate for Payer: Quartz Commercial |
$858.00
|
| Rate for Payer: Quartz Medicare Advantage |
$37.27
|
| Rate for Payer: The Alliance Commercial |
$149.08
|
| Rate for Payer: United Healthcare Medicare Advantage |
$37.27
|
| Rate for Payer: United Healthcare PPO |
$990.00
|
| Rate for Payer: WEA Trust Commercial |
$726.00
|
| Rate for Payer: Wellcare Medicare |
$37.27
|
| Rate for Payer: WPS Commercial |
$977.72
|
|
|
ICD Subq Check w/o Repgrogram
|
Facility
|
IP
|
$1,320.00
|
|
|
Service Code
|
CPT 93261
|
| Hospital Charge Code |
4584636
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$646.80 |
| Max. Negotiated Rate |
$1,214.40 |
| Rate for Payer: Aetna Commercial |
$1,188.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,135.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$699.60
|
| Rate for Payer: Cash Price |
$396.00
|
| Rate for Payer: Cigna Commercial |
$1,214.40
|
| Rate for Payer: Health EOS Commercial |
$1,174.80
|
| Rate for Payer: HFN Commercial |
$1,214.40
|
| Rate for Payer: Multiplan Commercial |
$1,056.00
|
| Rate for Payer: NAPHCARE Commercial |
$792.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,214.40
|
| Rate for Payer: Quartz Beloit One Network |
$646.80
|
| Rate for Payer: Quartz Commercial |
$792.00
|
| Rate for Payer: WEA Trust Commercial |
$726.00
|
| Rate for Payer: WPS Commercial |
$977.72
|
|
|
ICD Subq Check w/ Reprogram
|
Facility
|
IP
|
$1,456.00
|
|
|
Service Code
|
CPT 93260
|
| Hospital Charge Code |
4584635
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$713.44 |
| Max. Negotiated Rate |
$1,339.52 |
| Rate for Payer: Aetna Commercial |
$1,310.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,252.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$771.68
|
| Rate for Payer: Cash Price |
$436.80
|
| Rate for Payer: Cigna Commercial |
$1,339.52
|
| Rate for Payer: Health EOS Commercial |
$1,295.84
|
| Rate for Payer: HFN Commercial |
$1,339.52
|
| Rate for Payer: Multiplan Commercial |
$1,164.80
|
| Rate for Payer: NAPHCARE Commercial |
$873.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,339.52
|
| Rate for Payer: Quartz Beloit One Network |
$713.44
|
| Rate for Payer: Quartz Commercial |
$873.60
|
| Rate for Payer: WEA Trust Commercial |
$800.80
|
| Rate for Payer: WPS Commercial |
$1,078.46
|
|
|
ICD Subq Check w/ Reprogram
|
Facility
|
OP
|
$1,456.00
|
|
|
Service Code
|
CPT 93260
|
| Hospital Charge Code |
4584635
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$37.27 |
| Max. Negotiated Rate |
$1,339.52 |
| Rate for Payer: Aetna Commercial |
$1,310.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,252.16
|
| Rate for Payer: Aetna Managed Medicare |
$37.27
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$946.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$728.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$698.88
|
| Rate for Payer: Anthem Medicare Advantage |
$37.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$771.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$37.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$37.27
|
| Rate for Payer: Cash Price |
$436.80
|
| Rate for Payer: Cash Price |
$436.80
|
| Rate for Payer: Cigna Commercial |
$1,339.52
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$37.27
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$814.78
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$37.27
|
| Rate for Payer: Health EOS Commercial |
$1,295.84
|
| Rate for Payer: HFN Commercial |
$1,339.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$138.64
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$37.27
|
| Rate for Payer: Independent Care Health Plan Medicare |
$37.27
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$37.27
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$37.27
|
| Rate for Payer: Multiplan Commercial |
$1,164.80
|
| Rate for Payer: NAPHCARE Commercial |
$55.90
|
| Rate for Payer: Preferred Network Access Commercial |
$1,339.52
|
| Rate for Payer: Quartz Beloit One Network |
$713.44
|
| Rate for Payer: Quartz Commercial |
$946.40
|
| Rate for Payer: Quartz Medicare Advantage |
$37.27
|
| Rate for Payer: The Alliance Commercial |
$149.08
|
| Rate for Payer: United Healthcare Medicare Advantage |
$37.27
|
| Rate for Payer: United Healthcare PPO |
$1,092.00
|
| Rate for Payer: WEA Trust Commercial |
$800.80
|
| Rate for Payer: Wellcare Medicare |
$37.27
|
| Rate for Payer: WPS Commercial |
$1,078.46
|
|
|
ICD Upgrade Dual Lead to BI-V
|
Facility
|
OP
|
$3,978.00
|
|
|
Service Code
|
CPT 33225
|
| Hospital Charge Code |
4308789
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,113.84 |
| Max. Negotiated Rate |
$15,912.00 |
| Rate for Payer: Aetna Commercial |
$3,580.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,421.08
|
| Rate for Payer: Aetna Managed Medicare |
$1,113.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,585.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,989.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,909.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,108.34
|
| Rate for Payer: Cash Price |
$1,193.40
|
| Rate for Payer: Cash Price |
$1,193.40
|
| Rate for Payer: Cigna Commercial |
$3,659.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$11,874.87
|
| Rate for Payer: Health EOS Commercial |
$3,540.42
|
| Rate for Payer: HFN Commercial |
$3,659.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,983.50
|
| Rate for Payer: Multiplan Commercial |
$3,182.40
|
| Rate for Payer: NAPHCARE Commercial |
$2,386.80
|
| Rate for Payer: Preferred Network Access Commercial |
$3,659.76
|
| Rate for Payer: Quartz Beloit One Network |
$1,949.22
|
| Rate for Payer: Quartz Commercial |
$2,585.70
|
| Rate for Payer: Quartz Medicare Advantage |
$2,386.80
|
| Rate for Payer: The Alliance Commercial |
$15,912.00
|
| Rate for Payer: WEA Trust Commercial |
$2,187.90
|
| Rate for Payer: WPS Commercial |
$2,946.50
|
|
|
ICD Upgrade Dual Lead to BI-V
|
Facility
|
IP
|
$3,978.00
|
|
|
Service Code
|
CPT 33225
|
| Hospital Charge Code |
4308789
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,949.22 |
| Max. Negotiated Rate |
$3,659.76 |
| Rate for Payer: Aetna Commercial |
$3,580.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,421.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,108.34
|
| Rate for Payer: Cash Price |
$1,193.40
|
| Rate for Payer: Cigna Commercial |
$3,659.76
|
| Rate for Payer: Health EOS Commercial |
$3,540.42
|
| Rate for Payer: HFN Commercial |
$3,659.76
|
| Rate for Payer: Multiplan Commercial |
$3,182.40
|
| Rate for Payer: NAPHCARE Commercial |
$2,386.80
|
| Rate for Payer: Preferred Network Access Commercial |
$3,659.76
|
| Rate for Payer: Quartz Beloit One Network |
$1,949.22
|
| Rate for Payer: Quartz Commercial |
$2,386.80
|
| Rate for Payer: WEA Trust Commercial |
$2,187.90
|
| Rate for Payer: WPS Commercial |
$2,946.50
|
|
|
ICD Upgrade Single to Dual
|
Facility
|
OP
|
$1,199.00
|
|
|
Service Code
|
CPT 33241
|
| Hospital Charge Code |
4318590
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$587.51 |
| Max. Negotiated Rate |
$15,525.92 |
| Rate for Payer: Aetna Commercial |
$1,079.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,031.14
|
| Rate for Payer: Aetna Managed Medicare |
$3,881.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$9,907.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8,043.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7,639.00
|
| Rate for Payer: Anthem Medicare Advantage |
$3,881.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$635.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$3,881.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$3,881.48
|
| Rate for Payer: Cash Price |
$359.70
|
| Rate for Payer: Cash Price |
$359.70
|
| Rate for Payer: Cash Price |
$359.70
|
| Rate for Payer: Cigna Commercial |
$1,103.08
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$3,881.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$11,874.87
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$3,881.48
|
| Rate for Payer: Health EOS Commercial |
$1,067.11
|
| Rate for Payer: HFN Commercial |
$1,103.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$14,439.11
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$3,881.48
|
| Rate for Payer: Independent Care Health Plan Medicare |
$3,881.48
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$3,881.48
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$3,881.48
|
| Rate for Payer: Multiplan Commercial |
$959.20
|
| Rate for Payer: NAPHCARE Commercial |
$5,822.22
|
| Rate for Payer: Preferred Network Access Commercial |
$1,103.08
|
| Rate for Payer: Quartz Beloit One Network |
$587.51
|
| Rate for Payer: Quartz Commercial |
$779.35
|
| Rate for Payer: Quartz Medicare Advantage |
$3,881.48
|
| Rate for Payer: The Alliance Commercial |
$15,525.92
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,881.48
|
| Rate for Payer: United Healthcare PPO |
$4,103.00
|
| Rate for Payer: WEA Trust Commercial |
$659.45
|
| Rate for Payer: Wellcare Medicare |
$3,881.48
|
| Rate for Payer: WPS Commercial |
$888.10
|
|
|
ICD Upgrade Single to Dual
|
Facility
|
IP
|
$1,199.00
|
|
|
Service Code
|
CPT 33241
|
| Hospital Charge Code |
4318590
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$587.51 |
| Max. Negotiated Rate |
$1,103.08 |
| Rate for Payer: Aetna Commercial |
$1,079.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,031.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$635.47
|
| Rate for Payer: Cash Price |
$359.70
|
| Rate for Payer: Cigna Commercial |
$1,103.08
|
| Rate for Payer: Health EOS Commercial |
$1,067.11
|
| Rate for Payer: HFN Commercial |
$1,103.08
|
| Rate for Payer: Multiplan Commercial |
$959.20
|
| Rate for Payer: NAPHCARE Commercial |
$719.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,103.08
|
| Rate for Payer: Quartz Beloit One Network |
$587.51
|
| Rate for Payer: Quartz Commercial |
$719.40
|
| Rate for Payer: WEA Trust Commercial |
$659.45
|
| Rate for Payer: WPS Commercial |
$888.10
|
|
|
Ice Pack
|
Facility
|
IP
|
$8.00
|
|
| Hospital Charge Code |
3040326
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$3.92 |
| Max. Negotiated Rate |
$7.36 |
| Rate for Payer: Aetna Commercial |
$7.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4.24
|
| Rate for Payer: Cash Price |
$2.40
|
| Rate for Payer: Cigna Commercial |
$7.36
|
| Rate for Payer: Health EOS Commercial |
$7.12
|
| Rate for Payer: HFN Commercial |
$7.36
|
| Rate for Payer: Multiplan Commercial |
$6.40
|
| Rate for Payer: NAPHCARE Commercial |
$4.80
|
| Rate for Payer: Preferred Network Access Commercial |
$7.36
|
| Rate for Payer: Quartz Beloit One Network |
$3.92
|
| Rate for Payer: Quartz Commercial |
$4.80
|
| Rate for Payer: WEA Trust Commercial |
$4.40
|
| Rate for Payer: WPS Commercial |
$5.93
|
|
|
Ice Pack
|
Facility
|
OP
|
$8.00
|
|
| Hospital Charge Code |
3040326
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$2.24 |
| Max. Negotiated Rate |
$32.00 |
| Rate for Payer: Aetna Commercial |
$7.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6.88
|
| Rate for Payer: Aetna Managed Medicare |
$2.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4.24
|
| Rate for Payer: Cash Price |
$2.40
|
| Rate for Payer: Cigna Commercial |
$7.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4.48
|
| Rate for Payer: Health EOS Commercial |
$7.12
|
| Rate for Payer: HFN Commercial |
$7.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6.00
|
| Rate for Payer: Multiplan Commercial |
$6.40
|
| Rate for Payer: NAPHCARE Commercial |
$4.80
|
| Rate for Payer: Preferred Network Access Commercial |
$7.36
|
| Rate for Payer: Quartz Beloit One Network |
$3.92
|
| Rate for Payer: Quartz Commercial |
$5.20
|
| Rate for Payer: Quartz Medicare Advantage |
$4.80
|
| Rate for Payer: The Alliance Commercial |
$32.00
|
| Rate for Payer: WEA Trust Commercial |
$4.40
|
| Rate for Payer: WPS Commercial |
$5.93
|
|
|
Ic/Id Skin Test W/Allergenic Extracts, Immediate Reaction 95024
|
Professional
|
Both
|
$3.00
|
|
|
Service Code
|
CPT 95024
|
| Hospital Charge Code |
1188809
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$1.32 |
| Max. Negotiated Rate |
$28.28 |
| Rate for Payer: Aetna Commercial |
$2.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2.58
|
| Rate for Payer: Cash Price |
$0.90
|
| Rate for Payer: Cash Price |
$0.90
|
| Rate for Payer: Cash Price |
$0.90
|
| Rate for Payer: Cigna Commercial |
$2.85
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$4.65
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1.80
|
| Rate for Payer: Health EOS Commercial |
$2.73
|
| Rate for Payer: HFN Commercial |
$2.85
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$28.28
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$28.28
|
| Rate for Payer: Multiplan Commercial |
$2.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2.85
|
| Rate for Payer: Quartz Beloit One Network |
$1.32
|
| Rate for Payer: Quartz Commercial |
$1.71
|
| Rate for Payer: The Alliance Commercial |
$1.50
|
| Rate for Payer: United Healthcare Medicaid |
$4.65
|
| Rate for Payer: WEA Trust Commercial |
$1.65
|
| Rate for Payer: WPS Commercial |
$2.22
|
|
|
I&D abscess complicated or multiple 10061
|
Professional
|
Both
|
$567.00
|
|
|
Service Code
|
CPT 10061
|
| Hospital Charge Code |
3013503
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$91.47 |
| Max. Negotiated Rate |
$611.25 |
| Rate for Payer: Aetna Commercial |
$538.65
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$487.62
|
| Rate for Payer: Cash Price |
$170.10
|
| Rate for Payer: Cash Price |
$170.10
|
| Rate for Payer: Cash Price |
$170.10
|
| Rate for Payer: Cigna Commercial |
$538.65
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$91.47
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$340.20
|
| Rate for Payer: Health EOS Commercial |
$515.97
|
| Rate for Payer: HFN Commercial |
$538.65
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$611.25
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$611.25
|
| Rate for Payer: Multiplan Commercial |
$453.60
|
| Rate for Payer: Preferred Network Access Commercial |
$538.65
|
| Rate for Payer: Quartz Beloit One Network |
$249.48
|
| Rate for Payer: Quartz Commercial |
$323.19
|
| Rate for Payer: The Alliance Commercial |
$283.50
|
| Rate for Payer: United Healthcare Medicaid |
$91.47
|
| Rate for Payer: WEA Trust Commercial |
$311.85
|
| Rate for Payer: WPS Commercial |
$419.98
|
|
|
I&D abscess simple or single 10060
|
Professional
|
Both
|
$310.00
|
|
|
Service Code
|
CPT 10060
|
| Hospital Charge Code |
1188870
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$40.42 |
| Max. Negotiated Rate |
$347.63 |
| Rate for Payer: Aetna Commercial |
$294.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$266.60
|
| Rate for Payer: Cash Price |
$93.00
|
| Rate for Payer: Cash Price |
$93.00
|
| Rate for Payer: Cash Price |
$93.00
|
| Rate for Payer: Cigna Commercial |
$294.50
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$40.42
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$186.00
|
| Rate for Payer: Health EOS Commercial |
$282.10
|
| Rate for Payer: HFN Commercial |
$294.50
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$347.63
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$347.63
|
| Rate for Payer: Multiplan Commercial |
$248.00
|
| Rate for Payer: Preferred Network Access Commercial |
$294.50
|
| Rate for Payer: Quartz Beloit One Network |
$136.40
|
| Rate for Payer: Quartz Commercial |
$176.70
|
| Rate for Payer: The Alliance Commercial |
$155.00
|
| Rate for Payer: United Healthcare Medicaid |
$40.42
|
| Rate for Payer: WEA Trust Commercial |
$170.50
|
| Rate for Payer: WPS Commercial |
$229.62
|
|
|
I&D abscess simple or single 22999-10060
|
Professional
|
Both
|
$512.00
|
|
|
Service Code
|
CPT 22999
|
| Hospital Charge Code |
6180262
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$225.28 |
| Max. Negotiated Rate |
$486.40 |
| Rate for Payer: Aetna Commercial |
$486.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$440.32
|
| Rate for Payer: Cash Price |
$153.60
|
| Rate for Payer: Cash Price |
$153.60
|
| Rate for Payer: Cigna Commercial |
$486.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$256.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$307.20
|
| Rate for Payer: Health EOS Commercial |
$465.92
|
| Rate for Payer: HFN Commercial |
$486.40
|
| Rate for Payer: Multiplan Commercial |
$409.60
|
| Rate for Payer: Preferred Network Access Commercial |
$486.40
|
| Rate for Payer: Quartz Beloit One Network |
$225.28
|
| Rate for Payer: Quartz Commercial |
$291.84
|
| Rate for Payer: The Alliance Commercial |
$256.00
|
| Rate for Payer: WEA Trust Commercial |
$281.60
|
| Rate for Payer: WPS Commercial |
$379.24
|
|
|
I&D below fascia, w or w/o tendon sheath involvement, foot, multiple areas 28002
|
Professional
|
Both
|
$1,305.00
|
|
|
Service Code
|
CPT 28002
|
| Hospital Charge Code |
3014175
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$141.34 |
| Max. Negotiated Rate |
$1,239.75 |
| Rate for Payer: Aetna Commercial |
$1,239.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,122.30
|
| Rate for Payer: Cash Price |
$391.50
|
| Rate for Payer: Cash Price |
$391.50
|
| Rate for Payer: Cash Price |
$391.50
|
| Rate for Payer: Cigna Commercial |
$1,239.75
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$141.34
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$783.00
|
| Rate for Payer: Health EOS Commercial |
$1,187.55
|
| Rate for Payer: HFN Commercial |
$1,239.75
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,064.97
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,064.97
|
| Rate for Payer: Multiplan Commercial |
$1,044.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,239.75
|
| Rate for Payer: Quartz Beloit One Network |
$574.20
|
| Rate for Payer: Quartz Commercial |
$743.85
|
| Rate for Payer: The Alliance Commercial |
$652.50
|
| Rate for Payer: United Healthcare Medicaid |
$141.34
|
| Rate for Payer: WEA Trust Commercial |
$717.75
|
| Rate for Payer: WPS Commercial |
$966.61
|
|
|
I&D bursa, foot 28001
|
Professional
|
Both
|
$480.00
|
|
|
Service Code
|
CPT 28001
|
| Hospital Charge Code |
4546785
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$45.18 |
| Max. Negotiated Rate |
$568.51 |
| Rate for Payer: Aetna Commercial |
$456.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$412.80
|
| Rate for Payer: Cash Price |
$144.00
|
| Rate for Payer: Cash Price |
$144.00
|
| Rate for Payer: Cash Price |
$144.00
|
| Rate for Payer: Cigna Commercial |
$456.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$45.18
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$288.00
|
| Rate for Payer: Health EOS Commercial |
$436.80
|
| Rate for Payer: HFN Commercial |
$456.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$568.51
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$568.51
|
| Rate for Payer: Multiplan Commercial |
$384.00
|
| Rate for Payer: Preferred Network Access Commercial |
$456.00
|
| Rate for Payer: Quartz Beloit One Network |
$211.20
|
| Rate for Payer: Quartz Commercial |
$273.60
|
| Rate for Payer: The Alliance Commercial |
$240.00
|
| Rate for Payer: United Healthcare Medicaid |
$45.18
|
| Rate for Payer: WEA Trust Commercial |
$264.00
|
| Rate for Payer: WPS Commercial |
$355.54
|
|
|
Identification, Aerobic to Mayo
|
Facility
|
OP
|
$280.00
|
|
|
Service Code
|
CPT 87077
|
| Hospital Charge Code |
4630630
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.08 |
| Max. Negotiated Rate |
$257.60 |
| Rate for Payer: Aetna Commercial |
$252.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$240.80
|
| Rate for Payer: Aetna Managed Medicare |
$8.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$30.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$14.14
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$13.41
|
| Rate for Payer: Anthem Medicaid |
$8.35
|
| Rate for Payer: Anthem Medicare Advantage |
$8.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$148.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$8.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$8.08
|
| Rate for Payer: Cash Price |
$84.00
|
| Rate for Payer: Cash Price |
$84.00
|
| Rate for Payer: Cigna Commercial |
$257.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$8.08
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$8.35
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$156.69
|
| Rate for Payer: Dean Health Medicaid |
$8.35
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$8.08
|
| Rate for Payer: Health EOS Commercial |
$249.20
|
| Rate for Payer: HFN Commercial |
$257.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$30.06
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$8.08
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$8.35
|
| Rate for Payer: Independent Care Health Plan Medicare |
$8.08
|
| Rate for Payer: Managed Health Services Medicaid |
$8.68
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$8.08
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$8.08
|
| Rate for Payer: Multiplan Commercial |
$224.00
|
| Rate for Payer: NAPHCARE Commercial |
$12.12
|
| Rate for Payer: Preferred Network Access Commercial |
$257.60
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$8.35
|
| Rate for Payer: Quartz Beloit One Network |
$137.20
|
| Rate for Payer: Quartz Commercial |
$182.00
|
| Rate for Payer: Quartz Medicare Advantage |
$8.08
|
| Rate for Payer: The Alliance Commercial |
$32.32
|
| Rate for Payer: United Healthcare Medicaid |
$8.35
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8.08
|
| Rate for Payer: United Healthcare PPO |
$210.00
|
| Rate for Payer: WEA Trust Commercial |
$154.00
|
| Rate for Payer: Wellcare Medicare |
$8.08
|
| Rate for Payer: WMAP Medicaid |
$8.35
|
| Rate for Payer: WPS Commercial |
$207.40
|
|
|
Identification, Aerobic to Mayo
|
Facility
|
IP
|
$280.00
|
|
|
Service Code
|
CPT 87077
|
| Hospital Charge Code |
4630630
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$137.20 |
| Max. Negotiated Rate |
$257.60 |
| Rate for Payer: Aetna Commercial |
$252.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$240.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$148.40
|
| Rate for Payer: Cash Price |
$84.00
|
| Rate for Payer: Cigna Commercial |
$257.60
|
| Rate for Payer: Health EOS Commercial |
$249.20
|
| Rate for Payer: HFN Commercial |
$257.60
|
| Rate for Payer: Multiplan Commercial |
$224.00
|
| Rate for Payer: NAPHCARE Commercial |
$168.00
|
| Rate for Payer: Preferred Network Access Commercial |
$257.60
|
| Rate for Payer: Quartz Beloit One Network |
$137.20
|
| Rate for Payer: Quartz Commercial |
$168.00
|
| Rate for Payer: WEA Trust Commercial |
$154.00
|
| Rate for Payer: WPS Commercial |
$207.40
|
|
|
Identification, Aerobic to Mayo
|
Professional
|
Both
|
$280.00
|
|
|
Service Code
|
CPT 87077
|
| Hospital Charge Code |
4630630
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$28.52 |
| Max. Negotiated Rate |
$266.00 |
| Rate for Payer: Aetna Commercial |
$266.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$240.80
|
| Rate for Payer: Cash Price |
$84.00
|
| Rate for Payer: Cash Price |
$84.00
|
| Rate for Payer: Cigna Commercial |
$266.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$140.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$168.00
|
| Rate for Payer: Health EOS Commercial |
$254.80
|
| Rate for Payer: HFN Commercial |
$266.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$28.52
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$28.52
|
| Rate for Payer: Multiplan Commercial |
$224.00
|
| Rate for Payer: Preferred Network Access Commercial |
$266.00
|
| Rate for Payer: Quartz Beloit One Network |
$123.20
|
| Rate for Payer: Quartz Commercial |
$159.60
|
| Rate for Payer: The Alliance Commercial |
$140.00
|
| Rate for Payer: WEA Trust Commercial |
$154.00
|
| Rate for Payer: WPS Commercial |
$207.40
|
|
|
Identification, Anaerobic to Mayo
|
Professional
|
Both
|
$367.00
|
|
|
Service Code
|
CPT 87076
|
| Hospital Charge Code |
6173408
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$28.52 |
| Max. Negotiated Rate |
$348.65 |
| Rate for Payer: Aetna Commercial |
$348.65
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$315.62
|
| Rate for Payer: Cash Price |
$110.10
|
| Rate for Payer: Cash Price |
$110.10
|
| Rate for Payer: Cigna Commercial |
$348.65
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$183.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$220.20
|
| Rate for Payer: Health EOS Commercial |
$333.97
|
| Rate for Payer: HFN Commercial |
$348.65
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$28.52
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$28.52
|
| Rate for Payer: Multiplan Commercial |
$293.60
|
| Rate for Payer: Preferred Network Access Commercial |
$348.65
|
| Rate for Payer: Quartz Beloit One Network |
$161.48
|
| Rate for Payer: Quartz Commercial |
$209.19
|
| Rate for Payer: The Alliance Commercial |
$183.50
|
| Rate for Payer: WEA Trust Commercial |
$201.85
|
| Rate for Payer: WPS Commercial |
$271.84
|
|
|
Identification, Anaerobic to Mayo
|
Facility
|
OP
|
$367.00
|
|
|
Service Code
|
CPT 87076
|
| Hospital Charge Code |
6173408
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.08 |
| Max. Negotiated Rate |
$337.64 |
| Rate for Payer: Aetna Commercial |
$330.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$315.62
|
| Rate for Payer: Aetna Managed Medicare |
$8.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$30.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$14.14
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$13.41
|
| Rate for Payer: Anthem Medicaid |
$8.35
|
| Rate for Payer: Anthem Medicare Advantage |
$8.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$194.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$8.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$8.08
|
| Rate for Payer: Cash Price |
$110.10
|
| Rate for Payer: Cash Price |
$110.10
|
| Rate for Payer: Cigna Commercial |
$337.64
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$8.08
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$8.35
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$205.37
|
| Rate for Payer: Dean Health Medicaid |
$8.35
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$8.08
|
| Rate for Payer: Health EOS Commercial |
$326.63
|
| Rate for Payer: HFN Commercial |
$337.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$30.06
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$8.08
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$8.35
|
| Rate for Payer: Independent Care Health Plan Medicare |
$8.08
|
| Rate for Payer: Managed Health Services Medicaid |
$8.68
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$8.08
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$8.08
|
| Rate for Payer: Multiplan Commercial |
$293.60
|
| Rate for Payer: NAPHCARE Commercial |
$12.12
|
| Rate for Payer: Preferred Network Access Commercial |
$337.64
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$8.35
|
| Rate for Payer: Quartz Beloit One Network |
$179.83
|
| Rate for Payer: Quartz Commercial |
$238.55
|
| Rate for Payer: Quartz Medicare Advantage |
$8.08
|
| Rate for Payer: The Alliance Commercial |
$32.32
|
| Rate for Payer: United Healthcare Medicaid |
$8.35
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8.08
|
| Rate for Payer: United Healthcare PPO |
$275.25
|
| Rate for Payer: WEA Trust Commercial |
$201.85
|
| Rate for Payer: Wellcare Medicare |
$8.08
|
| Rate for Payer: WMAP Medicaid |
$8.35
|
| Rate for Payer: WPS Commercial |
$271.84
|
|
