|
Immunization Admin, Each Addl
|
Facility
|
OP
|
$56.00
|
|
|
Service Code
|
CPT 90472
|
| Hospital Charge Code |
3575512
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$16.31 |
| Max. Negotiated Rate |
$63.86 |
| Rate for Payer: Aetna Commercial |
$52.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$50.09
|
| Rate for Payer: Aetna Managed Medicare |
$16.31
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$37.86
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$29.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$27.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$30.87
|
| Rate for Payer: Cash Price |
$16.80
|
| Rate for Payer: Cash Price |
$16.80
|
| Rate for Payer: Cigna Commercial |
$53.58
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$32.59
|
| Rate for Payer: Health EOS Commercial |
$51.83
|
| Rate for Payer: HFN Commercial |
$53.58
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$43.68
|
| Rate for Payer: Multiplan Commercial |
$46.59
|
| Rate for Payer: NAPHCARE Commercial |
$34.94
|
| 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 |
$34.94
|
| Rate for Payer: The Alliance Commercial |
$63.86
|
| Rate for Payer: United Healthcare PPO |
$43.68
|
| Rate for Payer: WEA Trust Commercial |
$32.03
|
| Rate for Payer: WPS Commercial |
$43.14
|
|
|
Immunization Admin, Each Addl
|
Facility
|
IP
|
$56.00
|
|
|
Service Code
|
CPT 90472
|
| Hospital Charge Code |
3575512
|
|
Hospital Revenue Code
|
771
|
| 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
|
|
|
Immunoassay, Fibrospect II
|
Facility
|
OP
|
$332.00
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
2776820
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.96 |
| Max. Negotiated Rate |
$317.66 |
| Rate for Payer: Aetna Commercial |
$310.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$296.94
|
| Rate for Payer: Aetna Managed Medicare |
$17.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$67.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$31.43
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$29.81
|
| Rate for Payer: Anthem Medicare Advantage |
$17.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$183.00
|
| 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 |
$99.60
|
| Rate for Payer: Cash Price |
$99.60
|
| Rate for Payer: Cigna Commercial |
$317.66
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$17.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$193.22
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$17.96
|
| Rate for Payer: Health EOS Commercial |
$307.30
|
| Rate for Payer: HFN Commercial |
$317.66
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$66.81
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$17.96
|
| Rate for Payer: Independent Care Health Plan Medicare |
$17.96
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$17.96
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$17.96
|
| Rate for Payer: Multiplan Commercial |
$276.22
|
| Rate for Payer: NAPHCARE Commercial |
$26.94
|
| Rate for Payer: Preferred Network Access Commercial |
$317.66
|
| Rate for Payer: Quartz Beloit One Network |
$169.19
|
| Rate for Payer: Quartz Commercial |
$224.43
|
| Rate for Payer: Quartz Medicare Advantage |
$17.96
|
| Rate for Payer: The Alliance Commercial |
$71.84
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17.96
|
| Rate for Payer: United Healthcare PPO |
$258.96
|
| Rate for Payer: WEA Trust Commercial |
$189.90
|
| Rate for Payer: Wellcare Medicare |
$17.96
|
| Rate for Payer: WPS Commercial |
$255.74
|
|
|
Immunoassay, Fibrospect II
|
Facility
|
IP
|
$332.00
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
2776820
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$169.19 |
| Max. Negotiated Rate |
$317.66 |
| Rate for Payer: Aetna Commercial |
$310.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$296.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$183.00
|
| Rate for Payer: Cash Price |
$99.60
|
| Rate for Payer: Cigna Commercial |
$317.66
|
| Rate for Payer: Health EOS Commercial |
$307.30
|
| Rate for Payer: HFN Commercial |
$317.66
|
| Rate for Payer: Multiplan Commercial |
$276.22
|
| Rate for Payer: Preferred Network Access Commercial |
$317.66
|
| Rate for Payer: Quartz Beloit One Network |
$169.19
|
| Rate for Payer: Quartz Commercial |
$207.17
|
| Rate for Payer: WEA Trust Commercial |
$189.90
|
| Rate for Payer: WPS Commercial |
$255.74
|
|
|
Immunoassay, Fibrospect II
|
Professional
|
Both
|
$332.00
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
2776820
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.96 |
| Max. Negotiated Rate |
$328.02 |
| Rate for Payer: Aetna Commercial |
$328.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$296.94
|
| 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 |
$99.60
|
| Rate for Payer: Cash Price |
$99.60
|
| Rate for Payer: Cigna Commercial |
$328.02
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$172.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$17.96
|
| Rate for Payer: Health EOS Commercial |
$314.20
|
| Rate for Payer: HFN Commercial |
$328.02
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$63.40
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$63.40
|
| Rate for Payer: Independent Care Health Plan Medicare |
$17.96
|
| Rate for Payer: Multiplan Commercial |
$276.22
|
| Rate for Payer: NAPHCARE Commercial |
$26.94
|
| Rate for Payer: Preferred Network Access Commercial |
$328.02
|
| Rate for Payer: Quartz Beloit One Network |
$151.92
|
| Rate for Payer: Quartz Commercial |
$196.81
|
| Rate for Payer: Quartz Medicare Advantage |
$17.96
|
| Rate for Payer: The Alliance Commercial |
$70.95
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17.96
|
| Rate for Payer: WEA Trust Commercial |
$189.90
|
| Rate for Payer: WPS Commercial |
$79.03
|
|
|
Immunofixation
|
Facility
|
IP
|
$409.00
|
|
|
Service Code
|
CPT 86334
|
| Hospital Charge Code |
2942981
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$208.43 |
| Max. Negotiated Rate |
$391.33 |
| Rate for Payer: Aetna Commercial |
$382.82
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$365.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$225.44
|
| Rate for Payer: Cash Price |
$122.70
|
| Rate for Payer: Cigna Commercial |
$391.33
|
| Rate for Payer: Health EOS Commercial |
$378.57
|
| Rate for Payer: HFN Commercial |
$391.33
|
| Rate for Payer: Multiplan Commercial |
$340.29
|
| Rate for Payer: Preferred Network Access Commercial |
$391.33
|
| Rate for Payer: Quartz Beloit One Network |
$208.43
|
| Rate for Payer: Quartz Commercial |
$255.22
|
| Rate for Payer: WEA Trust Commercial |
$233.95
|
| Rate for Payer: WPS Commercial |
$315.05
|
|
|
Immunofixation
|
Facility
|
IP
|
$192.00
|
|
|
Service Code
|
CPT 86334
|
| Hospital Charge Code |
978124
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$97.84 |
| Max. Negotiated Rate |
$183.71 |
| Rate for Payer: Aetna Commercial |
$179.71
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$171.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$105.83
|
| Rate for Payer: Cash Price |
$57.60
|
| Rate for Payer: Cigna Commercial |
$183.71
|
| Rate for Payer: Health EOS Commercial |
$177.72
|
| Rate for Payer: HFN Commercial |
$183.71
|
| Rate for Payer: Multiplan Commercial |
$159.74
|
| Rate for Payer: Preferred Network Access Commercial |
$183.71
|
| Rate for Payer: Quartz Beloit One Network |
$97.84
|
| Rate for Payer: Quartz Commercial |
$119.81
|
| Rate for Payer: WEA Trust Commercial |
$109.82
|
| Rate for Payer: WPS Commercial |
$147.90
|
|
|
Immunofixation
|
Facility
|
OP
|
$409.00
|
|
|
Service Code
|
CPT 86334
|
| Hospital Charge Code |
2942981
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$23.23 |
| Max. Negotiated Rate |
$391.33 |
| Rate for Payer: Aetna Commercial |
$382.82
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$365.81
|
| Rate for Payer: Aetna Managed Medicare |
$23.23
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$87.13
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$40.66
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$38.57
|
| Rate for Payer: Anthem Medicare Advantage |
$23.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$225.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$23.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$23.23
|
| Rate for Payer: Cash Price |
$122.70
|
| Rate for Payer: Cash Price |
$122.70
|
| Rate for Payer: Cigna Commercial |
$391.33
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$23.23
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$238.04
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$23.23
|
| Rate for Payer: Health EOS Commercial |
$378.57
|
| Rate for Payer: HFN Commercial |
$391.33
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$86.43
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$23.23
|
| Rate for Payer: Independent Care Health Plan Medicare |
$23.23
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$23.23
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$23.23
|
| Rate for Payer: Multiplan Commercial |
$340.29
|
| Rate for Payer: NAPHCARE Commercial |
$34.85
|
| Rate for Payer: Preferred Network Access Commercial |
$391.33
|
| Rate for Payer: Quartz Beloit One Network |
$208.43
|
| Rate for Payer: Quartz Commercial |
$276.48
|
| Rate for Payer: Quartz Medicare Advantage |
$23.23
|
| Rate for Payer: The Alliance Commercial |
$92.93
|
| Rate for Payer: United Healthcare Medicare Advantage |
$23.23
|
| Rate for Payer: United Healthcare PPO |
$319.02
|
| Rate for Payer: WEA Trust Commercial |
$233.95
|
| Rate for Payer: Wellcare Medicare |
$23.23
|
| Rate for Payer: WPS Commercial |
$315.05
|
|
|
Immunofixation
|
Facility
|
OP
|
$192.00
|
|
|
Service Code
|
CPT 86334
|
| Hospital Charge Code |
978124
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$23.23 |
| Max. Negotiated Rate |
$183.71 |
| Rate for Payer: Aetna Commercial |
$179.71
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$171.72
|
| Rate for Payer: Aetna Managed Medicare |
$23.23
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$87.13
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$40.66
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$38.57
|
| Rate for Payer: Anthem Medicare Advantage |
$23.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$105.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$23.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$23.23
|
| Rate for Payer: Cash Price |
$57.60
|
| Rate for Payer: Cash Price |
$57.60
|
| Rate for Payer: Cigna Commercial |
$183.71
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$23.23
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$111.74
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$23.23
|
| Rate for Payer: Health EOS Commercial |
$177.72
|
| Rate for Payer: HFN Commercial |
$183.71
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$86.43
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$23.23
|
| Rate for Payer: Independent Care Health Plan Medicare |
$23.23
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$23.23
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$23.23
|
| Rate for Payer: Multiplan Commercial |
$159.74
|
| Rate for Payer: NAPHCARE Commercial |
$34.85
|
| Rate for Payer: Preferred Network Access Commercial |
$183.71
|
| Rate for Payer: Quartz Beloit One Network |
$97.84
|
| Rate for Payer: Quartz Commercial |
$129.79
|
| Rate for Payer: Quartz Medicare Advantage |
$23.23
|
| Rate for Payer: The Alliance Commercial |
$92.93
|
| Rate for Payer: United Healthcare Medicare Advantage |
$23.23
|
| Rate for Payer: United Healthcare PPO |
$149.76
|
| Rate for Payer: WEA Trust Commercial |
$109.82
|
| Rate for Payer: Wellcare Medicare |
$23.23
|
| Rate for Payer: WPS Commercial |
$147.90
|
|
|
Immunofixation
|
Professional
|
Both
|
$409.00
|
|
|
Service Code
|
CPT 86334
|
| Hospital Charge Code |
2942981
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.27 |
| Max. Negotiated Rate |
$404.09 |
| Rate for Payer: Aetna Commercial |
$404.09
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$365.81
|
| Rate for Payer: Aetna Managed Medicare |
$23.23
|
| Rate for Payer: Anthem Commercial |
$17.27
|
| Rate for Payer: Anthem Medicare Advantage |
$23.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$23.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$23.23
|
| Rate for Payer: Cash Price |
$122.70
|
| Rate for Payer: Cash Price |
$122.70
|
| Rate for Payer: Cigna Commercial |
$404.09
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$212.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$23.23
|
| Rate for Payer: Health EOS Commercial |
$387.08
|
| Rate for Payer: HFN Commercial |
$404.09
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$82.01
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$82.01
|
| Rate for Payer: Independent Care Health Plan Medicare |
$23.23
|
| Rate for Payer: Multiplan Commercial |
$340.29
|
| Rate for Payer: NAPHCARE Commercial |
$34.85
|
| Rate for Payer: Preferred Network Access Commercial |
$404.09
|
| Rate for Payer: Quartz Beloit One Network |
$187.16
|
| Rate for Payer: Quartz Commercial |
$242.46
|
| Rate for Payer: Quartz Medicare Advantage |
$23.23
|
| Rate for Payer: The Alliance Commercial |
$91.77
|
| Rate for Payer: United Healthcare Medicare Advantage |
$23.23
|
| Rate for Payer: WEA Trust Commercial |
$233.95
|
| Rate for Payer: WPS Commercial |
$102.23
|
|
|
Immunofixation
|
Professional
|
Both
|
$192.00
|
|
|
Service Code
|
CPT 86334
|
| Hospital Charge Code |
978124
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.27 |
| Max. Negotiated Rate |
$189.70 |
| Rate for Payer: Aetna Commercial |
$189.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$171.72
|
| Rate for Payer: Aetna Managed Medicare |
$23.23
|
| Rate for Payer: Anthem Commercial |
$17.27
|
| Rate for Payer: Anthem Medicare Advantage |
$23.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$23.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$23.23
|
| Rate for Payer: Cash Price |
$57.60
|
| Rate for Payer: Cash Price |
$57.60
|
| Rate for Payer: Cigna Commercial |
$189.70
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$99.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$23.23
|
| Rate for Payer: Health EOS Commercial |
$181.71
|
| Rate for Payer: HFN Commercial |
$189.70
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$82.01
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$82.01
|
| Rate for Payer: Independent Care Health Plan Medicare |
$23.23
|
| Rate for Payer: Multiplan Commercial |
$159.74
|
| Rate for Payer: NAPHCARE Commercial |
$34.85
|
| Rate for Payer: Preferred Network Access Commercial |
$189.70
|
| Rate for Payer: Quartz Beloit One Network |
$87.86
|
| Rate for Payer: Quartz Commercial |
$113.82
|
| Rate for Payer: Quartz Medicare Advantage |
$23.23
|
| Rate for Payer: The Alliance Commercial |
$91.77
|
| Rate for Payer: United Healthcare Medicare Advantage |
$23.23
|
| Rate for Payer: WEA Trust Commercial |
$109.82
|
| Rate for Payer: WPS Commercial |
$102.23
|
|
|
Immunofixation Urine
|
Facility
|
IP
|
$326.00
|
|
|
Service Code
|
CPT 86335
|
| Hospital Charge Code |
978123
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$166.13 |
| Max. Negotiated Rate |
$311.92 |
| Rate for Payer: Aetna Commercial |
$305.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$291.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$179.69
|
| Rate for Payer: Cash Price |
$97.80
|
| Rate for Payer: Cigna Commercial |
$311.92
|
| Rate for Payer: Health EOS Commercial |
$301.75
|
| Rate for Payer: HFN Commercial |
$311.92
|
| Rate for Payer: Multiplan Commercial |
$271.23
|
| Rate for Payer: Preferred Network Access Commercial |
$311.92
|
| Rate for Payer: Quartz Beloit One Network |
$166.13
|
| Rate for Payer: Quartz Commercial |
$203.42
|
| Rate for Payer: WEA Trust Commercial |
$186.47
|
| Rate for Payer: WPS Commercial |
$251.12
|
|
|
Immunofixation Urine
|
Facility
|
OP
|
$326.00
|
|
|
Service Code
|
CPT 86335
|
| Hospital Charge Code |
978123
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$30.52 |
| Max. Negotiated Rate |
$311.92 |
| Rate for Payer: Aetna Commercial |
$305.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$291.57
|
| Rate for Payer: Aetna Managed Medicare |
$30.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$114.47
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$53.42
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$50.67
|
| Rate for Payer: Anthem Medicare Advantage |
$30.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$179.69
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$30.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$30.52
|
| Rate for Payer: Cash Price |
$97.80
|
| Rate for Payer: Cash Price |
$97.80
|
| Rate for Payer: Cigna Commercial |
$311.92
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$30.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$189.73
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$30.52
|
| Rate for Payer: Health EOS Commercial |
$301.75
|
| Rate for Payer: HFN Commercial |
$311.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$113.55
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$30.52
|
| Rate for Payer: Independent Care Health Plan Medicare |
$30.52
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$30.52
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$30.52
|
| Rate for Payer: Multiplan Commercial |
$271.23
|
| Rate for Payer: NAPHCARE Commercial |
$45.79
|
| Rate for Payer: Preferred Network Access Commercial |
$311.92
|
| Rate for Payer: Quartz Beloit One Network |
$166.13
|
| Rate for Payer: Quartz Commercial |
$220.38
|
| Rate for Payer: Quartz Medicare Advantage |
$30.52
|
| Rate for Payer: The Alliance Commercial |
$122.10
|
| Rate for Payer: United Healthcare Medicare Advantage |
$30.52
|
| Rate for Payer: United Healthcare PPO |
$254.28
|
| Rate for Payer: WEA Trust Commercial |
$186.47
|
| Rate for Payer: Wellcare Medicare |
$30.52
|
| Rate for Payer: WPS Commercial |
$251.12
|
|
|
Immunofixation Urine
|
Professional
|
Both
|
$326.00
|
|
|
Service Code
|
CPT 86335
|
| Hospital Charge Code |
978123
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.27 |
| Max. Negotiated Rate |
$322.09 |
| Rate for Payer: Aetna Commercial |
$322.09
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$291.57
|
| Rate for Payer: Aetna Managed Medicare |
$30.52
|
| Rate for Payer: Anthem Commercial |
$17.27
|
| Rate for Payer: Anthem Medicare Advantage |
$30.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$30.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$30.52
|
| Rate for Payer: Cash Price |
$97.80
|
| Rate for Payer: Cash Price |
$97.80
|
| Rate for Payer: Cigna Commercial |
$322.09
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$169.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$30.52
|
| Rate for Payer: Health EOS Commercial |
$308.53
|
| Rate for Payer: HFN Commercial |
$322.09
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$107.75
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$107.75
|
| Rate for Payer: Independent Care Health Plan Medicare |
$30.52
|
| Rate for Payer: Multiplan Commercial |
$271.23
|
| Rate for Payer: NAPHCARE Commercial |
$45.79
|
| Rate for Payer: Preferred Network Access Commercial |
$322.09
|
| Rate for Payer: Quartz Beloit One Network |
$149.18
|
| Rate for Payer: Quartz Commercial |
$193.25
|
| Rate for Payer: Quartz Medicare Advantage |
$30.52
|
| Rate for Payer: The Alliance Commercial |
$120.57
|
| Rate for Payer: United Healthcare Medicare Advantage |
$30.52
|
| Rate for Payer: WEA Trust Commercial |
$186.47
|
| Rate for Payer: WPS Commercial |
$134.31
|
|
|
Immunoglobulin G Subclass 4
|
Facility
|
OP
|
$31.00
|
|
|
Service Code
|
CPT 82787
|
| Hospital Charge Code |
5455204
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.34 |
| Max. Negotiated Rate |
$33.36 |
| Rate for Payer: Aetna Commercial |
$29.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$27.73
|
| Rate for Payer: Aetna Managed Medicare |
$8.34
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$31.28
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$14.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$13.85
|
| Rate for Payer: Anthem Medicare Advantage |
$8.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$17.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$8.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$8.34
|
| Rate for Payer: Cash Price |
$9.30
|
| Rate for Payer: Cash Price |
$9.30
|
| Rate for Payer: Cigna Commercial |
$29.66
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$8.34
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$18.04
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$8.34
|
| Rate for Payer: Health EOS Commercial |
$28.69
|
| Rate for Payer: HFN Commercial |
$29.66
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$31.03
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$8.34
|
| Rate for Payer: Independent Care Health Plan Medicare |
$8.34
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$8.34
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$8.34
|
| Rate for Payer: Multiplan Commercial |
$25.79
|
| Rate for Payer: NAPHCARE Commercial |
$12.51
|
| Rate for Payer: Preferred Network Access Commercial |
$29.66
|
| Rate for Payer: Quartz Beloit One Network |
$15.80
|
| Rate for Payer: Quartz Commercial |
$20.96
|
| Rate for Payer: Quartz Medicare Advantage |
$8.34
|
| Rate for Payer: The Alliance Commercial |
$33.36
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8.34
|
| Rate for Payer: United Healthcare PPO |
$24.18
|
| Rate for Payer: WEA Trust Commercial |
$17.73
|
| Rate for Payer: Wellcare Medicare |
$8.34
|
| Rate for Payer: WPS Commercial |
$23.88
|
|
|
Immunoglobulin G Subclass 4
|
Facility
|
IP
|
$31.00
|
|
|
Service Code
|
CPT 82787
|
| Hospital Charge Code |
5455204
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.80 |
| Max. Negotiated Rate |
$29.66 |
| Rate for Payer: Aetna Commercial |
$29.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$27.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$17.09
|
| Rate for Payer: Cash Price |
$9.30
|
| Rate for Payer: Cigna Commercial |
$29.66
|
| Rate for Payer: Health EOS Commercial |
$28.69
|
| Rate for Payer: HFN Commercial |
$29.66
|
| Rate for Payer: Multiplan Commercial |
$25.79
|
| Rate for Payer: Preferred Network Access Commercial |
$29.66
|
| Rate for Payer: Quartz Beloit One Network |
$15.80
|
| Rate for Payer: Quartz Commercial |
$19.34
|
| Rate for Payer: WEA Trust Commercial |
$17.73
|
| Rate for Payer: WPS Commercial |
$23.88
|
|
|
Immunoglobulin G Subclass 4
|
Professional
|
Both
|
$31.00
|
|
|
Service Code
|
CPT 82787
|
| Hospital Charge Code |
5455204
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.34 |
| Max. Negotiated Rate |
$36.70 |
| Rate for Payer: Aetna Commercial |
$30.63
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$27.73
|
| Rate for Payer: Aetna Managed Medicare |
$8.34
|
| Rate for Payer: Anthem Medicare Advantage |
$8.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$8.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$8.34
|
| Rate for Payer: Cash Price |
$9.30
|
| Rate for Payer: Cash Price |
$9.30
|
| Rate for Payer: Cigna Commercial |
$30.63
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$16.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$8.34
|
| Rate for Payer: Health EOS Commercial |
$29.34
|
| Rate for Payer: HFN Commercial |
$30.63
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$29.44
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$29.44
|
| Rate for Payer: Independent Care Health Plan Medicare |
$8.34
|
| Rate for Payer: Multiplan Commercial |
$25.79
|
| Rate for Payer: NAPHCARE Commercial |
$12.51
|
| Rate for Payer: Preferred Network Access Commercial |
$30.63
|
| Rate for Payer: Quartz Beloit One Network |
$14.19
|
| Rate for Payer: Quartz Commercial |
$18.38
|
| Rate for Payer: Quartz Medicare Advantage |
$8.34
|
| Rate for Payer: The Alliance Commercial |
$32.95
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8.34
|
| Rate for Payer: WEA Trust Commercial |
$17.73
|
| Rate for Payer: WPS Commercial |
$36.70
|
|
|
Immunoglobulins Quantitative
|
Facility
|
OP
|
$245.00
|
|
|
Service Code
|
CPT 82784
|
| Hospital Charge Code |
977994
|
|
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
|
|
|
Immunoglobulins Quantitative
|
Facility
|
IP
|
$245.00
|
|
|
Service Code
|
CPT 82784
|
| Hospital Charge Code |
977994
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$124.85 |
| Max. Negotiated Rate |
$234.42 |
| Rate for Payer: Aetna Commercial |
$229.32
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$219.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$135.04
|
| Rate for Payer: Cash Price |
$73.50
|
| Rate for Payer: Cigna Commercial |
$234.42
|
| Rate for Payer: Health EOS Commercial |
$226.77
|
| Rate for Payer: HFN Commercial |
$234.42
|
| Rate for Payer: Multiplan Commercial |
$203.84
|
| Rate for Payer: Preferred Network Access Commercial |
$234.42
|
| Rate for Payer: Quartz Beloit One Network |
$124.85
|
| Rate for Payer: Quartz Commercial |
$152.88
|
| Rate for Payer: WEA Trust Commercial |
$140.14
|
| Rate for Payer: WPS Commercial |
$188.72
|
|
|
Immunoglobulins Quantitative
|
Professional
|
Both
|
$245.00
|
|
|
Service Code
|
CPT 82784
|
| Hospital Charge Code |
977994
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.67 |
| Max. Negotiated Rate |
$242.06 |
| Rate for Payer: Aetna Commercial |
$242.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$219.13
|
| Rate for Payer: Aetna Managed Medicare |
$9.67
|
| Rate for Payer: Anthem Medicare Advantage |
$9.67
|
| 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 |
$242.06
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$127.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$9.67
|
| Rate for Payer: Health EOS Commercial |
$231.87
|
| Rate for Payer: HFN Commercial |
$242.06
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$34.14
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$34.14
|
| Rate for Payer: Independent Care Health Plan Medicare |
$9.67
|
| Rate for Payer: Multiplan Commercial |
$203.84
|
| Rate for Payer: NAPHCARE Commercial |
$14.51
|
| Rate for Payer: Preferred Network Access Commercial |
$242.06
|
| Rate for Payer: Quartz Beloit One Network |
$112.11
|
| Rate for Payer: Quartz Commercial |
$145.24
|
| Rate for Payer: Quartz Medicare Advantage |
$9.67
|
| Rate for Payer: The Alliance Commercial |
$38.20
|
| Rate for Payer: United Healthcare Medicare Advantage |
$9.67
|
| Rate for Payer: WEA Trust Commercial |
$140.14
|
| Rate for Payer: WPS Commercial |
$42.56
|
|
|
Immunotherapy, Three Single Stinging Insect Venoms
|
Professional
|
Both
|
$53.00
|
|
|
Service Code
|
CPT 95147
|
| Hospital Charge Code |
1190807
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$2.53 |
| Max. Negotiated Rate |
$219.24 |
| Rate for Payer: Aetna Commercial |
$52.36
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$47.40
|
| Rate for Payer: Aetna Managed Medicare |
$2.53
|
| Rate for Payer: Anthem Medicare Advantage |
$2.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$2.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$2.53
|
| Rate for Payer: Cash Price |
$15.90
|
| Rate for Payer: Cash Price |
$15.90
|
| Rate for Payer: Cash Price |
$15.90
|
| Rate for Payer: Cigna Commercial |
$52.36
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$40.85
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2.53
|
| Rate for Payer: Health EOS Commercial |
$50.16
|
| Rate for Payer: HFN Commercial |
$52.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$219.24
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$219.24
|
| Rate for Payer: Independent Care Health Plan Medicare |
$2.53
|
| Rate for Payer: Multiplan Commercial |
$44.10
|
| Rate for Payer: NAPHCARE Commercial |
$3.79
|
| Rate for Payer: Preferred Network Access Commercial |
$52.36
|
| Rate for Payer: Quartz Beloit One Network |
$24.25
|
| Rate for Payer: Quartz Commercial |
$31.42
|
| Rate for Payer: Quartz Medicare Advantage |
$2.53
|
| Rate for Payer: The Alliance Commercial |
$6.32
|
| Rate for Payer: United Healthcare Medicaid |
$40.85
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2.53
|
| Rate for Payer: WEA Trust Commercial |
$30.32
|
| Rate for Payer: WPS Commercial |
$10.11
|
|
|
IMPLANT 10/125MM HUMERAL STEM
|
Facility
|
OP
|
$1,938.00
|
|
| Hospital Charge Code |
2966257
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$564.35 |
| Max. Negotiated Rate |
$1,854.28 |
| Rate for Payer: Aetna Commercial |
$1,813.97
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,733.35
|
| Rate for Payer: Aetna Managed Medicare |
$564.35
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,310.09
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,007.76
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$967.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,068.23
|
| Rate for Payer: Cash Price |
$581.40
|
| Rate for Payer: Cigna Commercial |
$1,854.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,127.92
|
| Rate for Payer: Health EOS Commercial |
$1,793.81
|
| Rate for Payer: HFN Commercial |
$1,854.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,511.64
|
| Rate for Payer: Multiplan Commercial |
$1,612.42
|
| Rate for Payer: NAPHCARE Commercial |
$1,209.31
|
| Rate for Payer: Preferred Network Access Commercial |
$1,854.28
|
| Rate for Payer: Quartz Beloit One Network |
$987.60
|
| Rate for Payer: Quartz Commercial |
$1,310.09
|
| Rate for Payer: Quartz Medicare Advantage |
$1,209.31
|
| Rate for Payer: The Alliance Commercial |
$1,007.76
|
| Rate for Payer: WEA Trust Commercial |
$1,108.54
|
| Rate for Payer: WPS Commercial |
$1,492.84
|
|
|
IMPLANT 10/125MM HUMERAL STEM
|
Facility
|
IP
|
$1,938.00
|
|
| Hospital Charge Code |
2966257
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$987.60 |
| Max. Negotiated Rate |
$1,854.28 |
| Rate for Payer: Aetna Commercial |
$1,813.97
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,733.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,068.23
|
| Rate for Payer: Cash Price |
$581.40
|
| Rate for Payer: Cigna Commercial |
$1,854.28
|
| Rate for Payer: Health EOS Commercial |
$1,793.81
|
| Rate for Payer: HFN Commercial |
$1,854.28
|
| Rate for Payer: Multiplan Commercial |
$1,612.42
|
| Rate for Payer: Preferred Network Access Commercial |
$1,854.28
|
| Rate for Payer: Quartz Beloit One Network |
$987.60
|
| Rate for Payer: Quartz Commercial |
$1,209.31
|
| Rate for Payer: WEA Trust Commercial |
$1,108.54
|
| Rate for Payer: WPS Commercial |
$1,492.84
|
|
|
IMPLANT 18MM ENCOMPASS
|
Facility
|
OP
|
$1,212.00
|
|
| Hospital Charge Code |
2965449
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$352.93 |
| Max. Negotiated Rate |
$1,159.64 |
| Rate for Payer: Aetna Commercial |
$1,134.43
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,084.01
|
| Rate for Payer: Aetna Managed Medicare |
$352.93
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$819.31
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$630.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$605.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$668.05
|
| Rate for Payer: Cash Price |
$363.60
|
| Rate for Payer: Cigna Commercial |
$1,159.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$705.38
|
| Rate for Payer: Health EOS Commercial |
$1,121.83
|
| Rate for Payer: HFN Commercial |
$1,159.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$945.36
|
| Rate for Payer: Multiplan Commercial |
$1,008.38
|
| Rate for Payer: NAPHCARE Commercial |
$756.29
|
| Rate for Payer: Preferred Network Access Commercial |
$1,159.64
|
| Rate for Payer: Quartz Beloit One Network |
$617.64
|
| Rate for Payer: Quartz Commercial |
$819.31
|
| Rate for Payer: Quartz Medicare Advantage |
$756.29
|
| Rate for Payer: The Alliance Commercial |
$630.24
|
| Rate for Payer: WEA Trust Commercial |
$693.26
|
| Rate for Payer: WPS Commercial |
$933.60
|
|
|
IMPLANT 18MM ENCOMPASS
|
Facility
|
IP
|
$1,212.00
|
|
| Hospital Charge Code |
2965449
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$617.64 |
| Max. Negotiated Rate |
$1,159.64 |
| Rate for Payer: Aetna Commercial |
$1,134.43
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,084.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$668.05
|
| Rate for Payer: Cash Price |
$363.60
|
| Rate for Payer: Cigna Commercial |
$1,159.64
|
| Rate for Payer: Health EOS Commercial |
$1,121.83
|
| Rate for Payer: HFN Commercial |
$1,159.64
|
| Rate for Payer: Multiplan Commercial |
$1,008.38
|
| Rate for Payer: Preferred Network Access Commercial |
$1,159.64
|
| Rate for Payer: Quartz Beloit One Network |
$617.64
|
| Rate for Payer: Quartz Commercial |
$756.29
|
| Rate for Payer: WEA Trust Commercial |
$693.26
|
| Rate for Payer: WPS Commercial |
$933.60
|
|
