|
AMPUTATION, PENILE
|
Facility
IP
|
$3,935.00
|
|
| Hospital Charge Code |
2959795
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,928.15 |
| Max. Negotiated Rate |
$3,620.20 |
| Rate for Payer: Aetna Commercial |
$3,541.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,085.55
|
| Rate for Payer: Cash Price |
$1,180.50
|
| Rate for Payer: Cigna Commercial |
$3,620.20
|
| Rate for Payer: Health EOS Commercial |
$3,502.15
|
| Rate for Payer: HFN Commercial |
$3,620.20
|
| Rate for Payer: Multiplan Commercial |
$3,148.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,361.00
|
| Rate for Payer: Preferred Network Access Commercial |
$3,620.20
|
| Rate for Payer: Quartz Beloit One Network |
$1,928.15
|
| Rate for Payer: Quartz Commercial |
$2,361.00
|
| Rate for Payer: WEA Trust Commercial |
$2,164.25
|
| Rate for Payer: WPS Commercial |
$2,914.65
|
|
|
AMPUTATION, SHOULDER/HUMERUS
|
Facility
IP
|
$4,324.00
|
|
| Hospital Charge Code |
2959796
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,118.76 |
| Max. Negotiated Rate |
$3,978.08 |
| Rate for Payer: Aetna Commercial |
$3,891.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,291.72
|
| Rate for Payer: Cash Price |
$1,297.20
|
| Rate for Payer: Cigna Commercial |
$3,978.08
|
| Rate for Payer: Health EOS Commercial |
$3,848.36
|
| Rate for Payer: HFN Commercial |
$3,978.08
|
| Rate for Payer: Multiplan Commercial |
$3,459.20
|
| Rate for Payer: NAPHCARE Commercial |
$2,594.40
|
| Rate for Payer: Preferred Network Access Commercial |
$3,978.08
|
| Rate for Payer: Quartz Beloit One Network |
$2,118.76
|
| Rate for Payer: Quartz Commercial |
$2,594.40
|
| Rate for Payer: WEA Trust Commercial |
$2,378.20
|
| Rate for Payer: WPS Commercial |
$3,202.79
|
|
|
AMPUTATION, SHOULDER/HUMERUS
|
Facility
OP
|
$4,324.00
|
|
| Hospital Charge Code |
2959796
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,210.72 |
| Max. Negotiated Rate |
$17,296.00 |
| Rate for Payer: Aetna Commercial |
$3,891.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,718.64
|
| Rate for Payer: Aetna Managed Medicare |
$1,210.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,810.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,162.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,075.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,291.72
|
| Rate for Payer: Cash Price |
$1,297.20
|
| Rate for Payer: Cigna Commercial |
$3,978.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,419.71
|
| Rate for Payer: Health EOS Commercial |
$3,848.36
|
| Rate for Payer: HFN Commercial |
$3,978.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,243.00
|
| Rate for Payer: Multiplan Commercial |
$3,459.20
|
| Rate for Payer: NAPHCARE Commercial |
$2,594.40
|
| Rate for Payer: Preferred Network Access Commercial |
$3,978.08
|
| Rate for Payer: Quartz Beloit One Network |
$2,118.76
|
| Rate for Payer: Quartz Commercial |
$2,810.60
|
| Rate for Payer: Quartz Medicare Advantage |
$2,594.40
|
| Rate for Payer: The Alliance Commercial |
$17,296.00
|
| Rate for Payer: WEA Trust Commercial |
$2,378.20
|
| Rate for Payer: WPS Commercial |
$3,202.79
|
|
|
AMPUTATION, THIGH, THROUGH FEMUR, ANY LEVEL; RE-AMPUTATION
|
Facility
OP
|
$11,874.87
|
|
|
Service Code
|
CPT 27596
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4,103.00 |
| Max. Negotiated Rate |
$11,874.87 |
| 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: Dean Health DHI/DHP/ASO |
$11,874.87
|
| Rate for Payer: United Healthcare PPO |
$4,103.00
|
|
|
AMPUTATION, TOE; METATARSOPHALANGEAL JOINT
|
Facility
OP
|
$12,336.12
|
|
|
Service Code
|
CPT 28820
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,199.31 |
| Max. Negotiated Rate |
$12,336.12 |
| Rate for Payer: Aetna Managed Medicare |
$3,199.31
|
| 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 |
$3,199.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$3,199.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$3,199.31
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$3,199.31
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,757.59
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$3,199.31
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$11,901.43
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$3,199.31
|
| Rate for Payer: Independent Care Health Plan Medicare |
$3,199.31
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$3,199.31
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$3,199.31
|
| Rate for Payer: NAPHCARE Commercial |
$4,798.96
|
| Rate for Payer: Quartz Medicare Advantage |
$3,199.31
|
| Rate for Payer: The Alliance Commercial |
$12,336.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,199.31
|
| Rate for Payer: United Healthcare PPO |
$4,103.00
|
| Rate for Payer: Wellcare Medicare |
$3,199.31
|
|
|
AMVISC PLUS 60081L
|
Facility
IP
|
$570.00
|
|
| Hospital Charge Code |
5415289
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$279.30 |
| Max. Negotiated Rate |
$524.40 |
| Rate for Payer: Aetna Commercial |
$513.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$302.10
|
| Rate for Payer: Cash Price |
$171.00
|
| Rate for Payer: Cigna Commercial |
$524.40
|
| Rate for Payer: Health EOS Commercial |
$507.30
|
| Rate for Payer: HFN Commercial |
$524.40
|
| Rate for Payer: Multiplan Commercial |
$456.00
|
| Rate for Payer: NAPHCARE Commercial |
$342.00
|
| Rate for Payer: Preferred Network Access Commercial |
$524.40
|
| Rate for Payer: Quartz Beloit One Network |
$279.30
|
| Rate for Payer: Quartz Commercial |
$342.00
|
| Rate for Payer: WEA Trust Commercial |
$313.50
|
| Rate for Payer: WPS Commercial |
$422.20
|
|
|
AMVISC PLUS 60081L
|
Facility
OP
|
$570.00
|
|
| Hospital Charge Code |
5415289
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$159.60 |
| Max. Negotiated Rate |
$2,280.00 |
| Rate for Payer: Aetna Commercial |
$513.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$490.20
|
| Rate for Payer: Aetna Managed Medicare |
$159.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$370.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$285.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$273.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$302.10
|
| Rate for Payer: Cash Price |
$171.00
|
| Rate for Payer: Cigna Commercial |
$524.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$318.97
|
| Rate for Payer: Health EOS Commercial |
$507.30
|
| Rate for Payer: HFN Commercial |
$524.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$427.50
|
| Rate for Payer: Multiplan Commercial |
$456.00
|
| Rate for Payer: NAPHCARE Commercial |
$342.00
|
| Rate for Payer: Preferred Network Access Commercial |
$524.40
|
| Rate for Payer: Quartz Beloit One Network |
$279.30
|
| Rate for Payer: Quartz Commercial |
$370.50
|
| Rate for Payer: Quartz Medicare Advantage |
$342.00
|
| Rate for Payer: The Alliance Commercial |
$2,280.00
|
| Rate for Payer: WEA Trust Commercial |
$313.50
|
| Rate for Payer: WPS Commercial |
$422.20
|
|
|
Amylase 24 Hour Urine
|
Facility
IP
|
$67.00
|
|
|
Service Code
|
CPT 82150
|
| Hospital Charge Code |
3315632
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$32.83 |
| Max. Negotiated Rate |
$61.64 |
| Rate for Payer: Aetna Commercial |
$60.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$35.51
|
| Rate for Payer: Cash Price |
$20.10
|
| Rate for Payer: Cigna Commercial |
$61.64
|
| Rate for Payer: Health EOS Commercial |
$59.63
|
| Rate for Payer: HFN Commercial |
$61.64
|
| Rate for Payer: Multiplan Commercial |
$53.60
|
| Rate for Payer: NAPHCARE Commercial |
$40.20
|
| Rate for Payer: Preferred Network Access Commercial |
$61.64
|
| Rate for Payer: Quartz Beloit One Network |
$32.83
|
| Rate for Payer: Quartz Commercial |
$40.20
|
| Rate for Payer: WEA Trust Commercial |
$36.85
|
| Rate for Payer: WPS Commercial |
$49.63
|
|
|
Amylase 24 Hour Urine
|
Facility
OP
|
$67.00
|
|
|
Service Code
|
CPT 82150
|
| Hospital Charge Code |
3315632
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.48 |
| Max. Negotiated Rate |
$268.00 |
| Rate for Payer: Aetna Commercial |
$60.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$57.62
|
| Rate for Payer: Aetna Managed Medicare |
$6.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$24.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$11.34
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$10.76
|
| Rate for Payer: Anthem Medicaid |
$6.70
|
| Rate for Payer: Anthem Medicare Advantage |
$6.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$35.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$6.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$6.48
|
| Rate for Payer: Cash Price |
$20.10
|
| Rate for Payer: Cash Price |
$20.10
|
| Rate for Payer: Cigna Commercial |
$61.64
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$6.48
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$6.70
|
| Rate for Payer: Dean Health Medicaid |
$6.70
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$6.48
|
| Rate for Payer: Health EOS Commercial |
$59.63
|
| Rate for Payer: HFN Commercial |
$61.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$24.11
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$6.48
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$6.70
|
| Rate for Payer: Independent Care Health Plan Medicare |
$6.48
|
| Rate for Payer: Managed Health Services Medicaid |
$6.97
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$6.48
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$6.48
|
| Rate for Payer: Multiplan Commercial |
$53.60
|
| Rate for Payer: NAPHCARE Commercial |
$9.72
|
| Rate for Payer: Preferred Network Access Commercial |
$61.64
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$6.70
|
| Rate for Payer: Quartz Beloit One Network |
$32.83
|
| Rate for Payer: Quartz Commercial |
$43.55
|
| Rate for Payer: Quartz Medicare Advantage |
$6.48
|
| Rate for Payer: The Alliance Commercial |
$268.00
|
| Rate for Payer: United Healthcare Medicaid |
$6.70
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6.48
|
| Rate for Payer: United Healthcare PPO |
$50.25
|
| Rate for Payer: WEA Trust Commercial |
$36.85
|
| Rate for Payer: Wellcare Medicare |
$6.48
|
| Rate for Payer: WMAP Medicaid |
$6.70
|
| Rate for Payer: WPS Commercial |
$49.63
|
|
|
Amylase 24 Hour Urine
|
Professional
|
$67.00
|
|
|
Service Code
|
CPT 82150
|
| Hospital Charge Code |
3315632
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.48 |
| Max. Negotiated Rate |
$63.65 |
| Rate for Payer: Aetna Commercial |
$63.65
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$57.62
|
| Rate for Payer: Aetna Managed Medicare |
$6.48
|
| Rate for Payer: Anthem Medicare Advantage |
$6.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$6.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$6.48
|
| Rate for Payer: Cash Price |
$20.10
|
| Rate for Payer: Cash Price |
$20.10
|
| Rate for Payer: Cigna Commercial |
$63.65
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$33.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6.48
|
| Rate for Payer: Health EOS Commercial |
$60.97
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$22.87
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$22.87
|
| Rate for Payer: Independent Care Health Plan Medicare |
$6.48
|
| Rate for Payer: Multiplan Commercial |
$53.60
|
| Rate for Payer: Preferred Network Access Commercial |
$63.65
|
| Rate for Payer: Quartz Beloit One Network |
$29.48
|
| Rate for Payer: Quartz Commercial |
$38.19
|
| Rate for Payer: Quartz Medicare Advantage |
$6.48
|
| Rate for Payer: The Alliance Commercial |
$25.60
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6.48
|
| Rate for Payer: WEA Trust Commercial |
$36.85
|
| Rate for Payer: WPS Commercial |
$28.51
|
|
|
Amylase Level
|
Professional
|
$162.00
|
|
|
Service Code
|
CPT 82150
|
| Hospital Charge Code |
631567
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.48 |
| Max. Negotiated Rate |
$153.90 |
| Rate for Payer: Aetna Commercial |
$153.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$139.32
|
| Rate for Payer: Aetna Managed Medicare |
$6.48
|
| Rate for Payer: Anthem Medicare Advantage |
$6.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$6.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$6.48
|
| Rate for Payer: Cash Price |
$48.60
|
| Rate for Payer: Cash Price |
$48.60
|
| Rate for Payer: Cigna Commercial |
$153.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$81.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6.48
|
| Rate for Payer: Health EOS Commercial |
$147.42
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$22.87
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$22.87
|
| Rate for Payer: Independent Care Health Plan Medicare |
$6.48
|
| Rate for Payer: Multiplan Commercial |
$129.60
|
| Rate for Payer: Preferred Network Access Commercial |
$153.90
|
| Rate for Payer: Quartz Beloit One Network |
$71.28
|
| Rate for Payer: Quartz Commercial |
$92.34
|
| Rate for Payer: Quartz Medicare Advantage |
$6.48
|
| Rate for Payer: The Alliance Commercial |
$25.60
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6.48
|
| Rate for Payer: WEA Trust Commercial |
$89.10
|
| Rate for Payer: WPS Commercial |
$28.51
|
|
|
Amylase Level
|
Facility
OP
|
$162.00
|
|
|
Service Code
|
CPT 82150
|
| Hospital Charge Code |
631567
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.48 |
| Max. Negotiated Rate |
$648.00 |
| Rate for Payer: Aetna Commercial |
$145.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$139.32
|
| Rate for Payer: Aetna Managed Medicare |
$6.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$24.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$11.34
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$10.76
|
| Rate for Payer: Anthem Medicaid |
$6.70
|
| Rate for Payer: Anthem Medicare Advantage |
$6.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$85.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$6.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$6.48
|
| Rate for Payer: Cash Price |
$48.60
|
| Rate for Payer: Cash Price |
$48.60
|
| Rate for Payer: Cigna Commercial |
$149.04
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$6.48
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$6.70
|
| Rate for Payer: Dean Health Medicaid |
$6.70
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$6.48
|
| Rate for Payer: Health EOS Commercial |
$144.18
|
| Rate for Payer: HFN Commercial |
$149.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$24.11
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$6.48
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$6.70
|
| Rate for Payer: Independent Care Health Plan Medicare |
$6.48
|
| Rate for Payer: Managed Health Services Medicaid |
$6.97
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$6.48
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$6.48
|
| Rate for Payer: Multiplan Commercial |
$129.60
|
| Rate for Payer: NAPHCARE Commercial |
$9.72
|
| Rate for Payer: Preferred Network Access Commercial |
$149.04
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$6.70
|
| Rate for Payer: Quartz Beloit One Network |
$79.38
|
| Rate for Payer: Quartz Commercial |
$105.30
|
| Rate for Payer: Quartz Medicare Advantage |
$6.48
|
| Rate for Payer: The Alliance Commercial |
$648.00
|
| Rate for Payer: United Healthcare Medicaid |
$6.70
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6.48
|
| Rate for Payer: United Healthcare PPO |
$121.50
|
| Rate for Payer: WEA Trust Commercial |
$89.10
|
| Rate for Payer: Wellcare Medicare |
$6.48
|
| Rate for Payer: WMAP Medicaid |
$6.70
|
| Rate for Payer: WPS Commercial |
$119.99
|
|
|
Amylase Level
|
Facility
IP
|
$162.00
|
|
|
Service Code
|
CPT 82150
|
| Hospital Charge Code |
631567
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$79.38 |
| Max. Negotiated Rate |
$149.04 |
| Rate for Payer: Aetna Commercial |
$145.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$85.86
|
| Rate for Payer: Cash Price |
$48.60
|
| Rate for Payer: Cigna Commercial |
$149.04
|
| Rate for Payer: Health EOS Commercial |
$144.18
|
| Rate for Payer: HFN Commercial |
$149.04
|
| Rate for Payer: Multiplan Commercial |
$129.60
|
| Rate for Payer: NAPHCARE Commercial |
$97.20
|
| Rate for Payer: Preferred Network Access Commercial |
$149.04
|
| Rate for Payer: Quartz Beloit One Network |
$79.38
|
| Rate for Payer: Quartz Commercial |
$97.20
|
| Rate for Payer: WEA Trust Commercial |
$89.10
|
| Rate for Payer: WPS Commercial |
$119.99
|
|
|
Amylase, Peritoneal Fluid
|
Facility
IP
|
$54.00
|
|
|
Service Code
|
CPT 82150
|
| Hospital Charge Code |
3154867
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$26.46 |
| Max. Negotiated Rate |
$49.68 |
| Rate for Payer: Aetna Commercial |
$48.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$28.62
|
| Rate for Payer: Cash Price |
$16.20
|
| Rate for Payer: Cigna Commercial |
$49.68
|
| Rate for Payer: Health EOS Commercial |
$48.06
|
| Rate for Payer: HFN Commercial |
$49.68
|
| Rate for Payer: Multiplan Commercial |
$43.20
|
| Rate for Payer: NAPHCARE Commercial |
$32.40
|
| Rate for Payer: Preferred Network Access Commercial |
$49.68
|
| Rate for Payer: Quartz Beloit One Network |
$26.46
|
| Rate for Payer: Quartz Commercial |
$32.40
|
| Rate for Payer: WEA Trust Commercial |
$29.70
|
| Rate for Payer: WPS Commercial |
$40.00
|
|
|
Amylase, Peritoneal Fluid
|
Facility
OP
|
$54.00
|
|
|
Service Code
|
CPT 82150
|
| Hospital Charge Code |
3154867
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.48 |
| Max. Negotiated Rate |
$216.00 |
| Rate for Payer: Aetna Commercial |
$48.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$46.44
|
| Rate for Payer: Aetna Managed Medicare |
$6.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$24.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$11.34
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$10.76
|
| Rate for Payer: Anthem Medicaid |
$6.70
|
| Rate for Payer: Anthem Medicare Advantage |
$6.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$28.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$6.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$6.48
|
| Rate for Payer: Cash Price |
$16.20
|
| Rate for Payer: Cash Price |
$16.20
|
| Rate for Payer: Cigna Commercial |
$49.68
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$6.48
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$6.70
|
| Rate for Payer: Dean Health Medicaid |
$6.70
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$6.48
|
| Rate for Payer: Health EOS Commercial |
$48.06
|
| Rate for Payer: HFN Commercial |
$49.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$24.11
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$6.48
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$6.70
|
| Rate for Payer: Independent Care Health Plan Medicare |
$6.48
|
| Rate for Payer: Managed Health Services Medicaid |
$6.97
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$6.48
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$6.48
|
| Rate for Payer: Multiplan Commercial |
$43.20
|
| Rate for Payer: NAPHCARE Commercial |
$9.72
|
| Rate for Payer: Preferred Network Access Commercial |
$49.68
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$6.70
|
| Rate for Payer: Quartz Beloit One Network |
$26.46
|
| Rate for Payer: Quartz Commercial |
$35.10
|
| Rate for Payer: Quartz Medicare Advantage |
$6.48
|
| Rate for Payer: The Alliance Commercial |
$216.00
|
| Rate for Payer: United Healthcare Medicaid |
$6.70
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6.48
|
| Rate for Payer: United Healthcare PPO |
$40.50
|
| Rate for Payer: WEA Trust Commercial |
$29.70
|
| Rate for Payer: Wellcare Medicare |
$6.48
|
| Rate for Payer: WMAP Medicaid |
$6.70
|
| Rate for Payer: WPS Commercial |
$40.00
|
|
|
Amylase, Peritoneal Fluid
|
Professional
|
$54.00
|
|
|
Service Code
|
CPT 82150
|
| Hospital Charge Code |
3154867
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.48 |
| Max. Negotiated Rate |
$51.30 |
| Rate for Payer: Aetna Commercial |
$51.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$46.44
|
| Rate for Payer: Aetna Managed Medicare |
$6.48
|
| Rate for Payer: Anthem Medicare Advantage |
$6.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$6.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$6.48
|
| Rate for Payer: Cash Price |
$16.20
|
| Rate for Payer: Cash Price |
$16.20
|
| Rate for Payer: Cigna Commercial |
$51.30
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$27.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6.48
|
| Rate for Payer: Health EOS Commercial |
$49.14
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$22.87
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$22.87
|
| Rate for Payer: Independent Care Health Plan Medicare |
$6.48
|
| Rate for Payer: Multiplan Commercial |
$43.20
|
| Rate for Payer: Preferred Network Access Commercial |
$51.30
|
| Rate for Payer: Quartz Beloit One Network |
$23.76
|
| Rate for Payer: Quartz Commercial |
$30.78
|
| Rate for Payer: Quartz Medicare Advantage |
$6.48
|
| Rate for Payer: The Alliance Commercial |
$25.60
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6.48
|
| Rate for Payer: WEA Trust Commercial |
$29.70
|
| Rate for Payer: WPS Commercial |
$28.51
|
|
|
Amylase, Pleural Fluid
|
Facility
IP
|
$54.00
|
|
|
Service Code
|
CPT 82150
|
| Hospital Charge Code |
3154866
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$26.46 |
| Max. Negotiated Rate |
$49.68 |
| Rate for Payer: Aetna Commercial |
$48.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$28.62
|
| Rate for Payer: Cash Price |
$16.20
|
| Rate for Payer: Cigna Commercial |
$49.68
|
| Rate for Payer: Health EOS Commercial |
$48.06
|
| Rate for Payer: HFN Commercial |
$49.68
|
| Rate for Payer: Multiplan Commercial |
$43.20
|
| Rate for Payer: NAPHCARE Commercial |
$32.40
|
| Rate for Payer: Preferred Network Access Commercial |
$49.68
|
| Rate for Payer: Quartz Beloit One Network |
$26.46
|
| Rate for Payer: Quartz Commercial |
$32.40
|
| Rate for Payer: WEA Trust Commercial |
$29.70
|
| Rate for Payer: WPS Commercial |
$40.00
|
|
|
Amylase, Pleural Fluid
|
Professional
|
$54.00
|
|
|
Service Code
|
CPT 82150
|
| Hospital Charge Code |
3154866
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.48 |
| Max. Negotiated Rate |
$51.30 |
| Rate for Payer: Aetna Commercial |
$51.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$46.44
|
| Rate for Payer: Aetna Managed Medicare |
$6.48
|
| Rate for Payer: Anthem Medicare Advantage |
$6.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$6.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$6.48
|
| Rate for Payer: Cash Price |
$16.20
|
| Rate for Payer: Cash Price |
$16.20
|
| Rate for Payer: Cigna Commercial |
$51.30
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$27.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6.48
|
| Rate for Payer: Health EOS Commercial |
$49.14
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$22.87
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$22.87
|
| Rate for Payer: Independent Care Health Plan Medicare |
$6.48
|
| Rate for Payer: Multiplan Commercial |
$43.20
|
| Rate for Payer: Preferred Network Access Commercial |
$51.30
|
| Rate for Payer: Quartz Beloit One Network |
$23.76
|
| Rate for Payer: Quartz Commercial |
$30.78
|
| Rate for Payer: Quartz Medicare Advantage |
$6.48
|
| Rate for Payer: The Alliance Commercial |
$25.60
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6.48
|
| Rate for Payer: WEA Trust Commercial |
$29.70
|
| Rate for Payer: WPS Commercial |
$28.51
|
|
|
Amylase, Pleural Fluid
|
Facility
OP
|
$54.00
|
|
|
Service Code
|
CPT 82150
|
| Hospital Charge Code |
3154866
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.48 |
| Max. Negotiated Rate |
$216.00 |
| Rate for Payer: Aetna Commercial |
$48.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$46.44
|
| Rate for Payer: Aetna Managed Medicare |
$6.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$24.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$11.34
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$10.76
|
| Rate for Payer: Anthem Medicaid |
$6.70
|
| Rate for Payer: Anthem Medicare Advantage |
$6.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$28.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$6.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$6.48
|
| Rate for Payer: Cash Price |
$16.20
|
| Rate for Payer: Cash Price |
$16.20
|
| Rate for Payer: Cigna Commercial |
$49.68
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$6.48
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$6.70
|
| Rate for Payer: Dean Health Medicaid |
$6.70
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$6.48
|
| Rate for Payer: Health EOS Commercial |
$48.06
|
| Rate for Payer: HFN Commercial |
$49.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$24.11
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$6.48
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$6.70
|
| Rate for Payer: Independent Care Health Plan Medicare |
$6.48
|
| Rate for Payer: Managed Health Services Medicaid |
$6.97
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$6.48
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$6.48
|
| Rate for Payer: Multiplan Commercial |
$43.20
|
| Rate for Payer: NAPHCARE Commercial |
$9.72
|
| Rate for Payer: Preferred Network Access Commercial |
$49.68
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$6.70
|
| Rate for Payer: Quartz Beloit One Network |
$26.46
|
| Rate for Payer: Quartz Commercial |
$35.10
|
| Rate for Payer: Quartz Medicare Advantage |
$6.48
|
| Rate for Payer: The Alliance Commercial |
$216.00
|
| Rate for Payer: United Healthcare Medicaid |
$6.70
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6.48
|
| Rate for Payer: United Healthcare PPO |
$40.50
|
| Rate for Payer: WEA Trust Commercial |
$29.70
|
| Rate for Payer: Wellcare Medicare |
$6.48
|
| Rate for Payer: WMAP Medicaid |
$6.70
|
| Rate for Payer: WPS Commercial |
$40.00
|
|
|
Amyloid B Protein
|
Facility
OP
|
$493.00
|
|
|
Service Code
|
CPT 83519
|
| Hospital Charge Code |
5502670
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.40 |
| Max. Negotiated Rate |
$1,972.00 |
| Rate for Payer: Aetna Commercial |
$443.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$423.98
|
| Rate for Payer: Aetna Managed Medicare |
$18.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$69.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$32.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$30.54
|
| Rate for Payer: Anthem Medicaid |
$19.00
|
| Rate for Payer: Anthem Medicare Advantage |
$18.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$261.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$18.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$18.40
|
| Rate for Payer: Cash Price |
$147.90
|
| Rate for Payer: Cash Price |
$147.90
|
| Rate for Payer: Cigna Commercial |
$453.56
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$18.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$19.00
|
| Rate for Payer: Dean Health Medicaid |
$19.00
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$18.40
|
| Rate for Payer: Health EOS Commercial |
$438.77
|
| Rate for Payer: HFN Commercial |
$453.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$68.45
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$18.40
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$19.00
|
| Rate for Payer: Independent Care Health Plan Medicare |
$18.40
|
| Rate for Payer: Managed Health Services Medicaid |
$19.76
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$18.40
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$18.40
|
| Rate for Payer: Multiplan Commercial |
$394.40
|
| Rate for Payer: NAPHCARE Commercial |
$27.60
|
| Rate for Payer: Preferred Network Access Commercial |
$453.56
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$19.00
|
| Rate for Payer: Quartz Beloit One Network |
$241.57
|
| Rate for Payer: Quartz Commercial |
$320.45
|
| Rate for Payer: Quartz Medicare Advantage |
$18.40
|
| Rate for Payer: The Alliance Commercial |
$1,972.00
|
| Rate for Payer: United Healthcare Medicaid |
$19.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$18.40
|
| Rate for Payer: United Healthcare PPO |
$369.75
|
| Rate for Payer: WEA Trust Commercial |
$271.15
|
| Rate for Payer: Wellcare Medicare |
$18.40
|
| Rate for Payer: WMAP Medicaid |
$19.00
|
| Rate for Payer: WPS Commercial |
$365.17
|
|
|
Amyloid B Protein
|
Facility
IP
|
$493.00
|
|
|
Service Code
|
CPT 83519
|
| Hospital Charge Code |
5502670
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$241.57 |
| Max. Negotiated Rate |
$453.56 |
| Rate for Payer: Aetna Commercial |
$443.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$261.29
|
| Rate for Payer: Cash Price |
$147.90
|
| Rate for Payer: Cigna Commercial |
$453.56
|
| Rate for Payer: Health EOS Commercial |
$438.77
|
| Rate for Payer: HFN Commercial |
$453.56
|
| Rate for Payer: Multiplan Commercial |
$394.40
|
| Rate for Payer: NAPHCARE Commercial |
$295.80
|
| Rate for Payer: Preferred Network Access Commercial |
$453.56
|
| Rate for Payer: Quartz Beloit One Network |
$241.57
|
| Rate for Payer: Quartz Commercial |
$295.80
|
| Rate for Payer: WEA Trust Commercial |
$271.15
|
| Rate for Payer: WPS Commercial |
$365.17
|
|
|
Amyloid B Protein
|
Professional
|
$493.00
|
|
|
Service Code
|
CPT 83519
|
| Hospital Charge Code |
5502670
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.40 |
| Max. Negotiated Rate |
$468.35 |
| Rate for Payer: Quartz Medicare Advantage |
$18.40
|
| Rate for Payer: Aetna Commercial |
$468.35
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$423.98
|
| Rate for Payer: Aetna Managed Medicare |
$18.40
|
| Rate for Payer: Anthem Medicare Advantage |
$18.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$18.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$18.40
|
| Rate for Payer: Cash Price |
$147.90
|
| Rate for Payer: Cash Price |
$147.90
|
| Rate for Payer: Cigna Commercial |
$468.35
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$246.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$18.40
|
| Rate for Payer: Health EOS Commercial |
$448.63
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$64.95
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$64.95
|
| Rate for Payer: Independent Care Health Plan Medicare |
$18.40
|
| Rate for Payer: Multiplan Commercial |
$394.40
|
| Rate for Payer: Preferred Network Access Commercial |
$468.35
|
| Rate for Payer: Quartz Beloit One Network |
$216.92
|
| Rate for Payer: Quartz Commercial |
$281.01
|
| Rate for Payer: The Alliance Commercial |
$72.68
|
| Rate for Payer: United Healthcare Medicare Advantage |
$18.40
|
| Rate for Payer: WEA Trust Commercial |
$271.15
|
| Rate for Payer: WPS Commercial |
$80.96
|
|
|
Amyloidosis Transthyretin-Assoc Familial Rflx
|
Facility
IP
|
$217.39
|
|
|
Service Code
|
CPT 82542
|
| Hospital Charge Code |
6242817
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$106.52 |
| Max. Negotiated Rate |
$200.00 |
| Rate for Payer: Aetna Commercial |
$195.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$115.22
|
| Rate for Payer: Cash Price |
$65.22
|
| Rate for Payer: Cigna Commercial |
$200.00
|
| Rate for Payer: Health EOS Commercial |
$193.48
|
| Rate for Payer: HFN Commercial |
$200.00
|
| Rate for Payer: Multiplan Commercial |
$173.91
|
| Rate for Payer: NAPHCARE Commercial |
$130.43
|
| Rate for Payer: Preferred Network Access Commercial |
$200.00
|
| Rate for Payer: Quartz Beloit One Network |
$106.52
|
| Rate for Payer: Quartz Commercial |
$130.43
|
| Rate for Payer: WEA Trust Commercial |
$119.56
|
| Rate for Payer: WPS Commercial |
$161.02
|
|
|
Amyloidosis Transthyretin-Assoc Familial Rflx
|
Professional
|
$217.39
|
|
|
Service Code
|
CPT 82542
|
| Hospital Charge Code |
6242817
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$24.09 |
| Max. Negotiated Rate |
$206.52 |
| Rate for Payer: Aetna Commercial |
$206.52
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$186.96
|
| Rate for Payer: Aetna Managed Medicare |
$24.09
|
| Rate for Payer: Anthem Medicare Advantage |
$24.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$24.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$24.09
|
| Rate for Payer: Cash Price |
$65.22
|
| Rate for Payer: Cash Price |
$65.22
|
| Rate for Payer: Cigna Commercial |
$206.52
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$108.70
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$24.09
|
| Rate for Payer: Health EOS Commercial |
$197.82
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$85.04
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$85.04
|
| Rate for Payer: Independent Care Health Plan Medicare |
$24.09
|
| Rate for Payer: Multiplan Commercial |
$173.91
|
| Rate for Payer: Preferred Network Access Commercial |
$206.52
|
| Rate for Payer: Quartz Beloit One Network |
$95.65
|
| Rate for Payer: Quartz Commercial |
$123.91
|
| Rate for Payer: Quartz Medicare Advantage |
$24.09
|
| Rate for Payer: The Alliance Commercial |
$95.16
|
| Rate for Payer: United Healthcare Medicare Advantage |
$24.09
|
| Rate for Payer: WEA Trust Commercial |
$119.56
|
| Rate for Payer: WPS Commercial |
$106.00
|
|
|
Amyloidosis Transthyretin-Assoc Familial Rflx
|
Facility
OP
|
$217.39
|
|
|
Service Code
|
CPT 82542
|
| Hospital Charge Code |
6242817
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$24.09 |
| Max. Negotiated Rate |
$869.56 |
| Rate for Payer: Aetna Commercial |
$195.65
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$186.96
|
| Rate for Payer: Aetna Managed Medicare |
$24.09
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$90.34
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$42.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$39.99
|
| Rate for Payer: Anthem Medicaid |
$24.89
|
| Rate for Payer: Anthem Medicare Advantage |
$24.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$115.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$24.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$24.09
|
| Rate for Payer: Cash Price |
$65.22
|
| Rate for Payer: Cash Price |
$65.22
|
| Rate for Payer: Cigna Commercial |
$200.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$24.09
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$24.89
|
| Rate for Payer: Dean Health Medicaid |
$24.89
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$24.09
|
| Rate for Payer: Health EOS Commercial |
$193.48
|
| Rate for Payer: HFN Commercial |
$200.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$89.61
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$24.09
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$24.89
|
| Rate for Payer: Independent Care Health Plan Medicare |
$24.09
|
| Rate for Payer: Managed Health Services Medicaid |
$25.89
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$24.09
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$24.09
|
| Rate for Payer: Multiplan Commercial |
$173.91
|
| Rate for Payer: NAPHCARE Commercial |
$36.14
|
| Rate for Payer: Preferred Network Access Commercial |
$200.00
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$24.89
|
| Rate for Payer: Quartz Beloit One Network |
$106.52
|
| Rate for Payer: Quartz Commercial |
$141.30
|
| Rate for Payer: Quartz Medicare Advantage |
$24.09
|
| Rate for Payer: The Alliance Commercial |
$869.56
|
| Rate for Payer: United Healthcare Medicaid |
$24.89
|
| Rate for Payer: United Healthcare Medicare Advantage |
$24.09
|
| Rate for Payer: United Healthcare PPO |
$163.04
|
| Rate for Payer: WEA Trust Commercial |
$119.56
|
| Rate for Payer: Wellcare Medicare |
$24.09
|
| Rate for Payer: WMAP Medicaid |
$24.89
|
| Rate for Payer: WPS Commercial |
$161.02
|
|
