|
Immunoassay, Fibrospect II
|
Facility
|
OP
|
$332.00
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
2776820
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.27 |
| Max. Negotiated Rate |
$305.44 |
| Rate for Payer: Aetna Commercial |
$298.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$285.52
|
| Rate for Payer: Aetna Managed Medicare |
$17.27
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$64.76
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$30.22
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$28.67
|
| Rate for Payer: Anthem Medicaid |
$17.85
|
| Rate for Payer: Anthem Medicare Advantage |
$17.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$175.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$17.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$17.27
|
| Rate for Payer: Cash Price |
$99.60
|
| Rate for Payer: Cash Price |
$99.60
|
| Rate for Payer: Cigna Commercial |
$305.44
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$17.27
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$17.85
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$185.79
|
| Rate for Payer: Dean Health Medicaid |
$17.85
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$17.27
|
| Rate for Payer: Health EOS Commercial |
$295.48
|
| Rate for Payer: HFN Commercial |
$305.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$64.24
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$17.27
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$17.85
|
| Rate for Payer: Independent Care Health Plan Medicare |
$17.27
|
| Rate for Payer: Managed Health Services Medicaid |
$18.56
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$17.27
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$17.27
|
| Rate for Payer: Multiplan Commercial |
$265.60
|
| Rate for Payer: NAPHCARE Commercial |
$25.90
|
| Rate for Payer: Preferred Network Access Commercial |
$305.44
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$17.85
|
| Rate for Payer: Quartz Beloit One Network |
$162.68
|
| Rate for Payer: Quartz Commercial |
$215.80
|
| Rate for Payer: Quartz Medicare Advantage |
$17.27
|
| Rate for Payer: The Alliance Commercial |
$69.08
|
| Rate for Payer: United Healthcare Medicaid |
$17.85
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17.27
|
| Rate for Payer: United Healthcare PPO |
$249.00
|
| Rate for Payer: WEA Trust Commercial |
$182.60
|
| Rate for Payer: Wellcare Medicare |
$17.27
|
| Rate for Payer: WMAP Medicaid |
$17.85
|
| Rate for Payer: WPS Commercial |
$245.91
|
|
|
Immunoassay, Fibrospect II
|
Facility
|
IP
|
$332.00
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
2776820
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$162.68 |
| Max. Negotiated Rate |
$305.44 |
| Rate for Payer: Aetna Commercial |
$298.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$285.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$175.96
|
| Rate for Payer: Cash Price |
$99.60
|
| Rate for Payer: Cigna Commercial |
$305.44
|
| Rate for Payer: Health EOS Commercial |
$295.48
|
| Rate for Payer: HFN Commercial |
$305.44
|
| Rate for Payer: Multiplan Commercial |
$265.60
|
| Rate for Payer: NAPHCARE Commercial |
$199.20
|
| Rate for Payer: Preferred Network Access Commercial |
$305.44
|
| Rate for Payer: Quartz Beloit One Network |
$162.68
|
| Rate for Payer: Quartz Commercial |
$199.20
|
| Rate for Payer: WEA Trust Commercial |
$182.60
|
| Rate for Payer: WPS Commercial |
$245.91
|
|
|
Immunofixation
|
Facility
|
OP
|
$192.00
|
|
|
Service Code
|
CPT 86334
|
| Hospital Charge Code |
978124
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$22.34 |
| Max. Negotiated Rate |
$176.64 |
| Rate for Payer: Aetna Commercial |
$172.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$165.12
|
| Rate for Payer: Aetna Managed Medicare |
$22.34
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$83.78
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$39.10
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$37.08
|
| Rate for Payer: Anthem Medicaid |
$23.08
|
| Rate for Payer: Anthem Medicare Advantage |
$22.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$101.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$22.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$22.34
|
| Rate for Payer: Cash Price |
$57.60
|
| Rate for Payer: Cash Price |
$57.60
|
| Rate for Payer: Cigna Commercial |
$176.64
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$22.34
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$23.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$107.44
|
| Rate for Payer: Dean Health Medicaid |
$23.08
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$22.34
|
| Rate for Payer: Health EOS Commercial |
$170.88
|
| Rate for Payer: HFN Commercial |
$176.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$83.10
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$22.34
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$23.08
|
| Rate for Payer: Independent Care Health Plan Medicare |
$22.34
|
| Rate for Payer: Managed Health Services Medicaid |
$24.00
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$22.34
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$22.34
|
| Rate for Payer: Multiplan Commercial |
$153.60
|
| Rate for Payer: NAPHCARE Commercial |
$33.51
|
| Rate for Payer: Preferred Network Access Commercial |
$176.64
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$23.08
|
| Rate for Payer: Quartz Beloit One Network |
$94.08
|
| Rate for Payer: Quartz Commercial |
$124.80
|
| Rate for Payer: Quartz Medicare Advantage |
$22.34
|
| Rate for Payer: The Alliance Commercial |
$89.36
|
| Rate for Payer: United Healthcare Medicaid |
$23.08
|
| Rate for Payer: United Healthcare Medicare Advantage |
$22.34
|
| Rate for Payer: United Healthcare PPO |
$144.00
|
| Rate for Payer: WEA Trust Commercial |
$105.60
|
| Rate for Payer: Wellcare Medicare |
$22.34
|
| Rate for Payer: WMAP Medicaid |
$23.08
|
| Rate for Payer: WPS Commercial |
$142.21
|
|
|
Immunofixation
|
Professional
|
Both
|
$192.00
|
|
|
Service Code
|
CPT 86334
|
| Hospital Charge Code |
978124
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$16.61 |
| Max. Negotiated Rate |
$182.40 |
| Rate for Payer: Aetna Commercial |
$182.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$165.12
|
| Rate for Payer: Anthem Commercial |
$16.61
|
| Rate for Payer: Cash Price |
$57.60
|
| Rate for Payer: Cash Price |
$57.60
|
| Rate for Payer: Cigna Commercial |
$182.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$96.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$115.20
|
| Rate for Payer: Health EOS Commercial |
$174.72
|
| Rate for Payer: HFN Commercial |
$182.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$78.86
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$78.86
|
| Rate for Payer: Multiplan Commercial |
$153.60
|
| Rate for Payer: Preferred Network Access Commercial |
$182.40
|
| Rate for Payer: Quartz Beloit One Network |
$84.48
|
| Rate for Payer: Quartz Commercial |
$109.44
|
| Rate for Payer: The Alliance Commercial |
$96.00
|
| Rate for Payer: WEA Trust Commercial |
$105.60
|
| Rate for Payer: WPS Commercial |
$142.21
|
|
|
Immunofixation
|
Facility
|
IP
|
$409.00
|
|
|
Service Code
|
CPT 86334
|
| Hospital Charge Code |
2942981
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$200.41 |
| Max. Negotiated Rate |
$376.28 |
| Rate for Payer: Aetna Commercial |
$368.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$351.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$216.77
|
| Rate for Payer: Cash Price |
$122.70
|
| Rate for Payer: Cigna Commercial |
$376.28
|
| Rate for Payer: Health EOS Commercial |
$364.01
|
| Rate for Payer: HFN Commercial |
$376.28
|
| Rate for Payer: Multiplan Commercial |
$327.20
|
| Rate for Payer: NAPHCARE Commercial |
$245.40
|
| Rate for Payer: Preferred Network Access Commercial |
$376.28
|
| Rate for Payer: Quartz Beloit One Network |
$200.41
|
| Rate for Payer: Quartz Commercial |
$245.40
|
| Rate for Payer: WEA Trust Commercial |
$224.95
|
| Rate for Payer: WPS Commercial |
$302.95
|
|
|
Immunofixation
|
Facility
|
OP
|
$409.00
|
|
|
Service Code
|
CPT 86334
|
| Hospital Charge Code |
2942981
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$22.34 |
| Max. Negotiated Rate |
$376.28 |
| Rate for Payer: Aetna Commercial |
$368.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$351.74
|
| Rate for Payer: Aetna Managed Medicare |
$22.34
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$83.78
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$39.10
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$37.08
|
| Rate for Payer: Anthem Medicaid |
$23.08
|
| Rate for Payer: Anthem Medicare Advantage |
$22.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$216.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$22.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$22.34
|
| Rate for Payer: Cash Price |
$122.70
|
| Rate for Payer: Cash Price |
$122.70
|
| Rate for Payer: Cigna Commercial |
$376.28
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$22.34
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$23.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$228.88
|
| Rate for Payer: Dean Health Medicaid |
$23.08
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$22.34
|
| Rate for Payer: Health EOS Commercial |
$364.01
|
| Rate for Payer: HFN Commercial |
$376.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$83.10
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$22.34
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$23.08
|
| Rate for Payer: Independent Care Health Plan Medicare |
$22.34
|
| Rate for Payer: Managed Health Services Medicaid |
$24.00
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$22.34
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$22.34
|
| Rate for Payer: Multiplan Commercial |
$327.20
|
| Rate for Payer: NAPHCARE Commercial |
$33.51
|
| Rate for Payer: Preferred Network Access Commercial |
$376.28
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$23.08
|
| Rate for Payer: Quartz Beloit One Network |
$200.41
|
| Rate for Payer: Quartz Commercial |
$265.85
|
| Rate for Payer: Quartz Medicare Advantage |
$22.34
|
| Rate for Payer: The Alliance Commercial |
$89.36
|
| Rate for Payer: United Healthcare Medicaid |
$23.08
|
| Rate for Payer: United Healthcare Medicare Advantage |
$22.34
|
| Rate for Payer: United Healthcare PPO |
$306.75
|
| Rate for Payer: WEA Trust Commercial |
$224.95
|
| Rate for Payer: Wellcare Medicare |
$22.34
|
| Rate for Payer: WMAP Medicaid |
$23.08
|
| Rate for Payer: WPS Commercial |
$302.95
|
|
|
Immunofixation
|
Facility
|
IP
|
$192.00
|
|
|
Service Code
|
CPT 86334
|
| Hospital Charge Code |
978124
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$94.08 |
| Max. Negotiated Rate |
$176.64 |
| Rate for Payer: Aetna Commercial |
$172.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$165.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$101.76
|
| Rate for Payer: Cash Price |
$57.60
|
| Rate for Payer: Cigna Commercial |
$176.64
|
| Rate for Payer: Health EOS Commercial |
$170.88
|
| Rate for Payer: HFN Commercial |
$176.64
|
| Rate for Payer: Multiplan Commercial |
$153.60
|
| Rate for Payer: NAPHCARE Commercial |
$115.20
|
| Rate for Payer: Preferred Network Access Commercial |
$176.64
|
| Rate for Payer: Quartz Beloit One Network |
$94.08
|
| Rate for Payer: Quartz Commercial |
$115.20
|
| Rate for Payer: WEA Trust Commercial |
$105.60
|
| Rate for Payer: WPS Commercial |
$142.21
|
|
|
Immunofixation
|
Professional
|
Both
|
$409.00
|
|
|
Service Code
|
CPT 86334
|
| Hospital Charge Code |
2942981
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$16.61 |
| Max. Negotiated Rate |
$388.55 |
| Rate for Payer: Aetna Commercial |
$388.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$351.74
|
| Rate for Payer: Anthem Commercial |
$16.61
|
| Rate for Payer: Cash Price |
$122.70
|
| Rate for Payer: Cash Price |
$122.70
|
| Rate for Payer: Cigna Commercial |
$388.55
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$204.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$245.40
|
| Rate for Payer: Health EOS Commercial |
$372.19
|
| Rate for Payer: HFN Commercial |
$388.55
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$78.86
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$78.86
|
| Rate for Payer: Multiplan Commercial |
$327.20
|
| Rate for Payer: Preferred Network Access Commercial |
$388.55
|
| Rate for Payer: Quartz Beloit One Network |
$179.96
|
| Rate for Payer: Quartz Commercial |
$233.13
|
| Rate for Payer: The Alliance Commercial |
$204.50
|
| Rate for Payer: WEA Trust Commercial |
$224.95
|
| Rate for Payer: WPS Commercial |
$302.95
|
|
|
Immunofixation Urine
|
Facility
|
OP
|
$326.00
|
|
|
Service Code
|
CPT 86335
|
| Hospital Charge Code |
978123
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$29.35 |
| Max. Negotiated Rate |
$299.92 |
| Rate for Payer: Aetna Commercial |
$293.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$280.36
|
| Rate for Payer: Aetna Managed Medicare |
$29.35
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$110.06
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$51.36
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$48.72
|
| Rate for Payer: Anthem Medicaid |
$30.33
|
| Rate for Payer: Anthem Medicare Advantage |
$29.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$172.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$29.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$29.35
|
| Rate for Payer: Cash Price |
$97.80
|
| Rate for Payer: Cash Price |
$97.80
|
| Rate for Payer: Cigna Commercial |
$299.92
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$29.35
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$30.33
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$182.43
|
| Rate for Payer: Dean Health Medicaid |
$30.33
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$29.35
|
| Rate for Payer: Health EOS Commercial |
$290.14
|
| Rate for Payer: HFN Commercial |
$299.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$109.18
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$29.35
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$30.33
|
| Rate for Payer: Independent Care Health Plan Medicare |
$29.35
|
| Rate for Payer: Managed Health Services Medicaid |
$31.54
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$29.35
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$29.35
|
| Rate for Payer: Multiplan Commercial |
$260.80
|
| Rate for Payer: NAPHCARE Commercial |
$44.02
|
| Rate for Payer: Preferred Network Access Commercial |
$299.92
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$30.33
|
| Rate for Payer: Quartz Beloit One Network |
$159.74
|
| Rate for Payer: Quartz Commercial |
$211.90
|
| Rate for Payer: Quartz Medicare Advantage |
$29.35
|
| Rate for Payer: The Alliance Commercial |
$117.40
|
| Rate for Payer: United Healthcare Medicaid |
$30.33
|
| Rate for Payer: United Healthcare Medicare Advantage |
$29.35
|
| Rate for Payer: United Healthcare PPO |
$244.50
|
| Rate for Payer: WEA Trust Commercial |
$179.30
|
| Rate for Payer: Wellcare Medicare |
$29.35
|
| Rate for Payer: WMAP Medicaid |
$30.33
|
| Rate for Payer: WPS Commercial |
$241.47
|
|
|
Immunofixation Urine
|
Facility
|
IP
|
$326.00
|
|
|
Service Code
|
CPT 86335
|
| Hospital Charge Code |
978123
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$159.74 |
| Max. Negotiated Rate |
$299.92 |
| Rate for Payer: Aetna Commercial |
$293.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$280.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$172.78
|
| Rate for Payer: Cash Price |
$97.80
|
| Rate for Payer: Cigna Commercial |
$299.92
|
| Rate for Payer: Health EOS Commercial |
$290.14
|
| Rate for Payer: HFN Commercial |
$299.92
|
| Rate for Payer: Multiplan Commercial |
$260.80
|
| Rate for Payer: NAPHCARE Commercial |
$195.60
|
| Rate for Payer: Preferred Network Access Commercial |
$299.92
|
| Rate for Payer: Quartz Beloit One Network |
$159.74
|
| Rate for Payer: Quartz Commercial |
$195.60
|
| Rate for Payer: WEA Trust Commercial |
$179.30
|
| Rate for Payer: WPS Commercial |
$241.47
|
|
|
Immunofixation Urine
|
Professional
|
Both
|
$326.00
|
|
|
Service Code
|
CPT 86335
|
| Hospital Charge Code |
978123
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$16.61 |
| Max. Negotiated Rate |
$309.70 |
| Rate for Payer: Quartz Commercial |
$185.82
|
| Rate for Payer: The Alliance Commercial |
$163.00
|
| Rate for Payer: WEA Trust Commercial |
$179.30
|
| Rate for Payer: WPS Commercial |
$241.47
|
| Rate for Payer: Aetna Commercial |
$309.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$280.36
|
| Rate for Payer: Anthem Commercial |
$16.61
|
| Rate for Payer: Cash Price |
$97.80
|
| Rate for Payer: Cash Price |
$97.80
|
| Rate for Payer: Cigna Commercial |
$309.70
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$163.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$195.60
|
| Rate for Payer: Health EOS Commercial |
$296.66
|
| Rate for Payer: HFN Commercial |
$309.70
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$103.61
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$103.61
|
| Rate for Payer: Multiplan Commercial |
$260.80
|
| Rate for Payer: Preferred Network Access Commercial |
$309.70
|
| Rate for Payer: Quartz Beloit One Network |
$143.44
|
|
|
Immunoglobulin G Subclass 4
|
Facility
|
IP
|
$31.00
|
|
|
Service Code
|
CPT 82787
|
| Hospital Charge Code |
5455204
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.19 |
| Max. Negotiated Rate |
$28.52 |
| Rate for Payer: Aetna Commercial |
$27.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$26.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$16.43
|
| Rate for Payer: Cash Price |
$9.30
|
| Rate for Payer: Cigna Commercial |
$28.52
|
| Rate for Payer: Health EOS Commercial |
$27.59
|
| Rate for Payer: HFN Commercial |
$28.52
|
| Rate for Payer: Multiplan Commercial |
$24.80
|
| Rate for Payer: NAPHCARE Commercial |
$18.60
|
| Rate for Payer: Preferred Network Access Commercial |
$28.52
|
| Rate for Payer: Quartz Beloit One Network |
$15.19
|
| Rate for Payer: Quartz Commercial |
$18.60
|
| Rate for Payer: WEA Trust Commercial |
$17.05
|
| Rate for Payer: WPS Commercial |
$22.96
|
|
|
Immunoglobulin G Subclass 4
|
Professional
|
Both
|
$31.00
|
|
|
Service Code
|
CPT 82787
|
| Hospital Charge Code |
5455204
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.64 |
| Max. Negotiated Rate |
$29.45 |
| Rate for Payer: Aetna Commercial |
$29.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$26.66
|
| Rate for Payer: Cash Price |
$9.30
|
| Rate for Payer: Cash Price |
$9.30
|
| Rate for Payer: Cigna Commercial |
$29.45
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$15.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$18.60
|
| Rate for Payer: Health EOS Commercial |
$28.21
|
| Rate for Payer: HFN Commercial |
$29.45
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$28.31
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$28.31
|
| Rate for Payer: Multiplan Commercial |
$24.80
|
| Rate for Payer: Preferred Network Access Commercial |
$29.45
|
| Rate for Payer: Quartz Beloit One Network |
$13.64
|
| Rate for Payer: Quartz Commercial |
$17.67
|
| Rate for Payer: The Alliance Commercial |
$15.50
|
| Rate for Payer: WEA Trust Commercial |
$17.05
|
| Rate for Payer: WPS Commercial |
$22.96
|
|
|
Immunoglobulin G Subclass 4
|
Facility
|
OP
|
$31.00
|
|
|
Service Code
|
CPT 82787
|
| Hospital Charge Code |
5455204
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.90 |
| Max. Negotiated Rate |
$32.08 |
| Rate for Payer: Aetna Commercial |
$27.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$26.66
|
| Rate for Payer: Aetna Managed Medicare |
$8.02
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$30.08
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$14.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$13.31
|
| Rate for Payer: Anthem Medicaid |
$5.90
|
| Rate for Payer: Anthem Medicare Advantage |
$8.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$16.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$8.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$8.02
|
| Rate for Payer: Cash Price |
$9.30
|
| Rate for Payer: Cash Price |
$9.30
|
| Rate for Payer: Cigna Commercial |
$28.52
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$8.02
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$5.90
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$17.35
|
| Rate for Payer: Dean Health Medicaid |
$5.90
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$8.02
|
| Rate for Payer: Health EOS Commercial |
$27.59
|
| Rate for Payer: HFN Commercial |
$28.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$29.83
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$8.02
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$5.90
|
| Rate for Payer: Independent Care Health Plan Medicare |
$8.02
|
| Rate for Payer: Managed Health Services Medicaid |
$6.14
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$8.02
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$8.02
|
| Rate for Payer: Multiplan Commercial |
$24.80
|
| Rate for Payer: NAPHCARE Commercial |
$12.03
|
| Rate for Payer: Preferred Network Access Commercial |
$28.52
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$5.90
|
| Rate for Payer: Quartz Beloit One Network |
$15.19
|
| Rate for Payer: Quartz Commercial |
$20.15
|
| Rate for Payer: Quartz Medicare Advantage |
$8.02
|
| Rate for Payer: The Alliance Commercial |
$32.08
|
| Rate for Payer: United Healthcare Medicaid |
$5.90
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8.02
|
| Rate for Payer: United Healthcare PPO |
$23.25
|
| Rate for Payer: WEA Trust Commercial |
$17.05
|
| Rate for Payer: Wellcare Medicare |
$8.02
|
| Rate for Payer: WMAP Medicaid |
$5.90
|
| Rate for Payer: WPS Commercial |
$22.96
|
|
|
Immunoglobulins Quantitative
|
Facility
|
IP
|
$245.00
|
|
|
Service Code
|
CPT 82784
|
| Hospital Charge Code |
977994
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$120.05 |
| Max. Negotiated Rate |
$225.40 |
| Rate for Payer: Aetna Commercial |
$220.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$210.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$129.85
|
| Rate for Payer: Cash Price |
$73.50
|
| Rate for Payer: Cigna Commercial |
$225.40
|
| Rate for Payer: Health EOS Commercial |
$218.05
|
| Rate for Payer: HFN Commercial |
$225.40
|
| Rate for Payer: Multiplan Commercial |
$196.00
|
| Rate for Payer: NAPHCARE Commercial |
$147.00
|
| Rate for Payer: Preferred Network Access Commercial |
$225.40
|
| Rate for Payer: Quartz Beloit One Network |
$120.05
|
| Rate for Payer: Quartz Commercial |
$147.00
|
| Rate for Payer: WEA Trust Commercial |
$134.75
|
| Rate for Payer: WPS Commercial |
$181.47
|
|
|
Immunoglobulins Quantitative
|
Professional
|
Both
|
$245.00
|
|
|
Service Code
|
CPT 82784
|
| Hospital Charge Code |
977994
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$32.83 |
| Max. Negotiated Rate |
$232.75 |
| Rate for Payer: Aetna Commercial |
$232.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$210.70
|
| Rate for Payer: Cash Price |
$73.50
|
| Rate for Payer: Cash Price |
$73.50
|
| Rate for Payer: Cigna Commercial |
$232.75
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$122.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$147.00
|
| Rate for Payer: Health EOS Commercial |
$222.95
|
| Rate for Payer: HFN Commercial |
$232.75
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$32.83
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$32.83
|
| Rate for Payer: Multiplan Commercial |
$196.00
|
| Rate for Payer: Preferred Network Access Commercial |
$232.75
|
| Rate for Payer: Quartz Beloit One Network |
$107.80
|
| Rate for Payer: Quartz Commercial |
$139.65
|
| Rate for Payer: The Alliance Commercial |
$122.50
|
| Rate for Payer: WEA Trust Commercial |
$134.75
|
| Rate for Payer: WPS Commercial |
$181.47
|
|
|
Immunoglobulins Quantitative
|
Facility
|
OP
|
$245.00
|
|
|
Service Code
|
CPT 82784
|
| Hospital Charge Code |
977994
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.30 |
| Max. Negotiated Rate |
$225.40 |
| Rate for Payer: Aetna Commercial |
$220.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$210.70
|
| Rate for Payer: Aetna Managed Medicare |
$9.30
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$34.88
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$16.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$15.44
|
| Rate for Payer: Anthem Medicaid |
$9.61
|
| Rate for Payer: Anthem Medicare Advantage |
$9.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$129.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$9.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$9.30
|
| Rate for Payer: Cash Price |
$73.50
|
| Rate for Payer: Cash Price |
$73.50
|
| Rate for Payer: Cigna Commercial |
$225.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$9.30
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$9.61
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$137.10
|
| Rate for Payer: Dean Health Medicaid |
$9.61
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$9.30
|
| Rate for Payer: Health EOS Commercial |
$218.05
|
| Rate for Payer: HFN Commercial |
$225.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$34.60
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$9.30
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$9.61
|
| Rate for Payer: Independent Care Health Plan Medicare |
$9.30
|
| Rate for Payer: Managed Health Services Medicaid |
$9.99
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$9.30
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$9.30
|
| Rate for Payer: Multiplan Commercial |
$196.00
|
| Rate for Payer: NAPHCARE Commercial |
$13.95
|
| Rate for Payer: Preferred Network Access Commercial |
$225.40
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$9.61
|
| Rate for Payer: Quartz Beloit One Network |
$120.05
|
| Rate for Payer: Quartz Commercial |
$159.25
|
| Rate for Payer: Quartz Medicare Advantage |
$9.30
|
| Rate for Payer: The Alliance Commercial |
$37.20
|
| Rate for Payer: United Healthcare Medicaid |
$9.61
|
| Rate for Payer: United Healthcare Medicare Advantage |
$9.30
|
| Rate for Payer: United Healthcare PPO |
$183.75
|
| Rate for Payer: WEA Trust Commercial |
$134.75
|
| Rate for Payer: Wellcare Medicare |
$9.30
|
| Rate for Payer: WMAP Medicaid |
$9.61
|
| Rate for Payer: WPS Commercial |
$181.47
|
|
|
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 |
$23.32 |
| Max. Negotiated Rate |
$210.81 |
| Rate for Payer: Aetna Commercial |
$50.35
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$45.58
|
| 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 |
$50.35
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$39.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$31.80
|
| Rate for Payer: Health EOS Commercial |
$48.23
|
| Rate for Payer: HFN Commercial |
$50.35
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$210.81
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$210.81
|
| Rate for Payer: Multiplan Commercial |
$42.40
|
| Rate for Payer: Preferred Network Access Commercial |
$50.35
|
| Rate for Payer: Quartz Beloit One Network |
$23.32
|
| Rate for Payer: Quartz Commercial |
$30.21
|
| Rate for Payer: The Alliance Commercial |
$26.50
|
| Rate for Payer: United Healthcare Medicaid |
$39.28
|
| Rate for Payer: WEA Trust Commercial |
$29.15
|
| Rate for Payer: WPS Commercial |
$39.26
|
|
|
IMPLANT 10/125MM HUMERAL STEM
|
Facility
|
IP
|
$1,938.00
|
|
| Hospital Charge Code |
2966257
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$949.62 |
| Max. Negotiated Rate |
$1,782.96 |
| Rate for Payer: Aetna Commercial |
$1,744.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,666.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,027.14
|
| Rate for Payer: Cash Price |
$581.40
|
| Rate for Payer: Cigna Commercial |
$1,782.96
|
| Rate for Payer: Health EOS Commercial |
$1,724.82
|
| Rate for Payer: HFN Commercial |
$1,782.96
|
| Rate for Payer: Multiplan Commercial |
$1,550.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,162.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,782.96
|
| Rate for Payer: Quartz Beloit One Network |
$949.62
|
| Rate for Payer: Quartz Commercial |
$1,162.80
|
| Rate for Payer: WEA Trust Commercial |
$1,065.90
|
| Rate for Payer: WPS Commercial |
$1,435.48
|
|
|
IMPLANT 10/125MM HUMERAL STEM
|
Facility
|
OP
|
$1,938.00
|
|
| Hospital Charge Code |
2966257
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$542.64 |
| Max. Negotiated Rate |
$7,752.00 |
| Rate for Payer: Aetna Commercial |
$1,744.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,666.68
|
| Rate for Payer: Aetna Managed Medicare |
$542.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,259.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$969.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$930.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,027.14
|
| Rate for Payer: Cash Price |
$581.40
|
| Rate for Payer: Cigna Commercial |
$1,782.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,084.50
|
| Rate for Payer: Health EOS Commercial |
$1,724.82
|
| Rate for Payer: HFN Commercial |
$1,782.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,453.50
|
| Rate for Payer: Multiplan Commercial |
$1,550.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,162.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,782.96
|
| Rate for Payer: Quartz Beloit One Network |
$949.62
|
| Rate for Payer: Quartz Commercial |
$1,259.70
|
| Rate for Payer: Quartz Medicare Advantage |
$1,162.80
|
| Rate for Payer: The Alliance Commercial |
$7,752.00
|
| Rate for Payer: WEA Trust Commercial |
$1,065.90
|
| Rate for Payer: WPS Commercial |
$1,435.48
|
|
|
IMPLANT 18MM ENCOMPASS
|
Facility
|
IP
|
$1,212.00
|
|
| Hospital Charge Code |
2965449
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$593.88 |
| Max. Negotiated Rate |
$1,115.04 |
| Rate for Payer: Aetna Commercial |
$1,090.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,042.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$642.36
|
| Rate for Payer: Cash Price |
$363.60
|
| Rate for Payer: Cigna Commercial |
$1,115.04
|
| Rate for Payer: Health EOS Commercial |
$1,078.68
|
| Rate for Payer: HFN Commercial |
$1,115.04
|
| Rate for Payer: Multiplan Commercial |
$969.60
|
| Rate for Payer: NAPHCARE Commercial |
$727.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,115.04
|
| Rate for Payer: Quartz Beloit One Network |
$593.88
|
| Rate for Payer: Quartz Commercial |
$727.20
|
| Rate for Payer: WEA Trust Commercial |
$666.60
|
| Rate for Payer: WPS Commercial |
$897.73
|
|
|
IMPLANT 18MM ENCOMPASS
|
Facility
|
OP
|
$1,212.00
|
|
| Hospital Charge Code |
2965449
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$339.36 |
| Max. Negotiated Rate |
$4,848.00 |
| Rate for Payer: Aetna Commercial |
$1,090.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,042.32
|
| Rate for Payer: Aetna Managed Medicare |
$339.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$787.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$606.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$581.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$642.36
|
| Rate for Payer: Cash Price |
$363.60
|
| Rate for Payer: Cigna Commercial |
$1,115.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$678.24
|
| Rate for Payer: Health EOS Commercial |
$1,078.68
|
| Rate for Payer: HFN Commercial |
$1,115.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$909.00
|
| Rate for Payer: Multiplan Commercial |
$969.60
|
| Rate for Payer: NAPHCARE Commercial |
$727.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,115.04
|
| Rate for Payer: Quartz Beloit One Network |
$593.88
|
| Rate for Payer: Quartz Commercial |
$787.80
|
| Rate for Payer: Quartz Medicare Advantage |
$727.20
|
| Rate for Payer: The Alliance Commercial |
$4,848.00
|
| Rate for Payer: WEA Trust Commercial |
$666.60
|
| Rate for Payer: WPS Commercial |
$897.73
|
|
|
IMPLANT 42/15.75MM COCR HEAD
|
Facility
|
IP
|
$13,932.00
|
|
| Hospital Charge Code |
2966258
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,826.68 |
| Max. Negotiated Rate |
$12,817.44 |
| Rate for Payer: Aetna Commercial |
$12,538.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$11,981.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$7,383.96
|
| Rate for Payer: Cash Price |
$4,179.60
|
| Rate for Payer: Cigna Commercial |
$12,817.44
|
| Rate for Payer: Health EOS Commercial |
$12,399.48
|
| Rate for Payer: HFN Commercial |
$12,817.44
|
| Rate for Payer: Multiplan Commercial |
$11,145.60
|
| Rate for Payer: NAPHCARE Commercial |
$8,359.20
|
| Rate for Payer: Preferred Network Access Commercial |
$12,817.44
|
| Rate for Payer: Quartz Beloit One Network |
$6,826.68
|
| Rate for Payer: Quartz Commercial |
$8,359.20
|
| Rate for Payer: WEA Trust Commercial |
$7,662.60
|
| Rate for Payer: WPS Commercial |
$10,319.43
|
|
|
IMPLANT 42/15.75MM COCR HEAD
|
Facility
|
OP
|
$13,932.00
|
|
| Hospital Charge Code |
2966258
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,900.96 |
| Max. Negotiated Rate |
$55,728.00 |
| Rate for Payer: Aetna Commercial |
$12,538.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$11,981.52
|
| Rate for Payer: Aetna Managed Medicare |
$3,900.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$9,055.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$6,966.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$6,687.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$7,383.96
|
| Rate for Payer: Cash Price |
$4,179.60
|
| Rate for Payer: Cigna Commercial |
$12,817.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$7,796.35
|
| Rate for Payer: Health EOS Commercial |
$12,399.48
|
| Rate for Payer: HFN Commercial |
$12,817.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$10,449.00
|
| Rate for Payer: Multiplan Commercial |
$11,145.60
|
| Rate for Payer: NAPHCARE Commercial |
$8,359.20
|
| Rate for Payer: Preferred Network Access Commercial |
$12,817.44
|
| Rate for Payer: Quartz Beloit One Network |
$6,826.68
|
| Rate for Payer: Quartz Commercial |
$9,055.80
|
| Rate for Payer: Quartz Medicare Advantage |
$8,359.20
|
| Rate for Payer: The Alliance Commercial |
$55,728.00
|
| Rate for Payer: WEA Trust Commercial |
$7,662.60
|
| Rate for Payer: WPS Commercial |
$10,319.43
|
|
|
IMPLANT 42MM GLENOID SYNTHES
|
Facility
|
IP
|
$6,804.00
|
|
| Hospital Charge Code |
2966259
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,333.96 |
| Max. Negotiated Rate |
$6,259.68 |
| Rate for Payer: Aetna Commercial |
$6,123.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,851.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,606.12
|
| Rate for Payer: Cash Price |
$2,041.20
|
| Rate for Payer: Cigna Commercial |
$6,259.68
|
| Rate for Payer: Health EOS Commercial |
$6,055.56
|
| Rate for Payer: HFN Commercial |
$6,259.68
|
| Rate for Payer: Multiplan Commercial |
$5,443.20
|
| Rate for Payer: NAPHCARE Commercial |
$4,082.40
|
| Rate for Payer: Preferred Network Access Commercial |
$6,259.68
|
| Rate for Payer: Quartz Beloit One Network |
$3,333.96
|
| Rate for Payer: Quartz Commercial |
$4,082.40
|
| Rate for Payer: WEA Trust Commercial |
$3,742.20
|
| Rate for Payer: WPS Commercial |
$5,039.72
|
|
