|
Intravenous Infusion for therapy, prophylaxis or diagnosis; initial up to 1 Hr 96366
|
Facility
|
OP
|
$264.00
|
|
|
Service Code
|
CPT 96366
|
| Hospital Charge Code |
5516706
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$46.95 |
| Max. Negotiated Rate |
$242.88 |
| Rate for Payer: Aetna Commercial |
$237.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$227.04
|
| Rate for Payer: Aetna Managed Medicare |
$46.95
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$171.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$132.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$126.72
|
| Rate for Payer: Anthem Medicare Advantage |
$46.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$139.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$46.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$46.95
|
| Rate for Payer: Cash Price |
$79.20
|
| Rate for Payer: Cash Price |
$79.20
|
| Rate for Payer: Cigna Commercial |
$242.88
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$46.95
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$147.73
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$46.95
|
| Rate for Payer: Health EOS Commercial |
$234.96
|
| Rate for Payer: HFN Commercial |
$242.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$174.65
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$46.95
|
| Rate for Payer: Independent Care Health Plan Medicare |
$46.95
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$46.95
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$46.95
|
| Rate for Payer: Multiplan Commercial |
$211.20
|
| Rate for Payer: NAPHCARE Commercial |
$70.42
|
| Rate for Payer: Preferred Network Access Commercial |
$242.88
|
| Rate for Payer: Quartz Beloit One Network |
$129.36
|
| Rate for Payer: Quartz Commercial |
$171.60
|
| Rate for Payer: Quartz Medicare Advantage |
$46.95
|
| Rate for Payer: The Alliance Commercial |
$187.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$46.95
|
| Rate for Payer: United Healthcare PPO |
$198.00
|
| Rate for Payer: WEA Trust Commercial |
$145.20
|
| Rate for Payer: Wellcare Medicare |
$46.95
|
| Rate for Payer: WPS Commercial |
$195.54
|
|
|
Intravenous Injection
|
Facility
|
IP
|
$349.00
|
|
|
Service Code
|
CPT 96374
|
| Hospital Charge Code |
3040224
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$171.01 |
| Max. Negotiated Rate |
$321.08 |
| Rate for Payer: Aetna Commercial |
$314.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$300.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$184.97
|
| Rate for Payer: Cash Price |
$104.70
|
| Rate for Payer: Cigna Commercial |
$321.08
|
| Rate for Payer: Health EOS Commercial |
$310.61
|
| Rate for Payer: HFN Commercial |
$321.08
|
| Rate for Payer: Multiplan Commercial |
$279.20
|
| Rate for Payer: NAPHCARE Commercial |
$209.40
|
| Rate for Payer: Preferred Network Access Commercial |
$321.08
|
| Rate for Payer: Quartz Beloit One Network |
$171.01
|
| Rate for Payer: Quartz Commercial |
$209.40
|
| Rate for Payer: WEA Trust Commercial |
$191.95
|
| Rate for Payer: WPS Commercial |
$258.50
|
|
|
Intravenous Injection
|
Facility
|
OP
|
$349.00
|
|
|
Service Code
|
CPT 96374
|
| Hospital Charge Code |
3040224
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$167.52 |
| Max. Negotiated Rate |
$847.40 |
| Rate for Payer: Aetna Commercial |
$314.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$300.14
|
| Rate for Payer: Aetna Managed Medicare |
$211.85
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$226.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$174.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$167.52
|
| Rate for Payer: Anthem Medicare Advantage |
$211.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$184.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$211.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$211.85
|
| Rate for Payer: Cash Price |
$104.70
|
| Rate for Payer: Cash Price |
$104.70
|
| Rate for Payer: Cigna Commercial |
$321.08
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$211.85
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$195.30
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$211.85
|
| Rate for Payer: Health EOS Commercial |
$310.61
|
| Rate for Payer: HFN Commercial |
$321.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$788.08
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$211.85
|
| Rate for Payer: Independent Care Health Plan Medicare |
$211.85
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$211.85
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$211.85
|
| Rate for Payer: Multiplan Commercial |
$279.20
|
| Rate for Payer: NAPHCARE Commercial |
$317.78
|
| Rate for Payer: Preferred Network Access Commercial |
$321.08
|
| Rate for Payer: Quartz Beloit One Network |
$171.01
|
| Rate for Payer: Quartz Commercial |
$226.85
|
| Rate for Payer: Quartz Medicare Advantage |
$211.85
|
| Rate for Payer: The Alliance Commercial |
$847.40
|
| Rate for Payer: United Healthcare Medicare Advantage |
$211.85
|
| Rate for Payer: United Healthcare PPO |
$261.75
|
| Rate for Payer: WEA Trust Commercial |
$191.95
|
| Rate for Payer: Wellcare Medicare |
$211.85
|
| Rate for Payer: WPS Commercial |
$258.50
|
|
|
Intravenous Injection - 96374
|
Facility
|
OP
|
$349.00
|
|
|
Service Code
|
CPT 96374
|
| Hospital Charge Code |
5516710
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$167.52 |
| Max. Negotiated Rate |
$847.40 |
| Rate for Payer: Aetna Commercial |
$314.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$300.14
|
| Rate for Payer: Aetna Managed Medicare |
$211.85
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$226.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$174.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$167.52
|
| Rate for Payer: Anthem Medicare Advantage |
$211.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$184.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$211.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$211.85
|
| Rate for Payer: Cash Price |
$104.70
|
| Rate for Payer: Cash Price |
$104.70
|
| Rate for Payer: Cigna Commercial |
$321.08
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$211.85
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$195.30
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$211.85
|
| Rate for Payer: Health EOS Commercial |
$310.61
|
| Rate for Payer: HFN Commercial |
$321.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$788.08
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$211.85
|
| Rate for Payer: Independent Care Health Plan Medicare |
$211.85
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$211.85
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$211.85
|
| Rate for Payer: Multiplan Commercial |
$279.20
|
| Rate for Payer: NAPHCARE Commercial |
$317.78
|
| Rate for Payer: Preferred Network Access Commercial |
$321.08
|
| Rate for Payer: Quartz Beloit One Network |
$171.01
|
| Rate for Payer: Quartz Commercial |
$226.85
|
| Rate for Payer: Quartz Medicare Advantage |
$211.85
|
| Rate for Payer: The Alliance Commercial |
$847.40
|
| Rate for Payer: United Healthcare Medicare Advantage |
$211.85
|
| Rate for Payer: United Healthcare PPO |
$261.75
|
| Rate for Payer: WEA Trust Commercial |
$191.95
|
| Rate for Payer: Wellcare Medicare |
$211.85
|
| Rate for Payer: WPS Commercial |
$258.50
|
|
|
Intravenous Injection - 96374
|
Facility
|
IP
|
$349.00
|
|
|
Service Code
|
CPT 96374
|
| Hospital Charge Code |
5516710
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$171.01 |
| Max. Negotiated Rate |
$321.08 |
| Rate for Payer: Aetna Commercial |
$314.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$300.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$184.97
|
| Rate for Payer: Cash Price |
$104.70
|
| Rate for Payer: Cigna Commercial |
$321.08
|
| Rate for Payer: Health EOS Commercial |
$310.61
|
| Rate for Payer: HFN Commercial |
$321.08
|
| Rate for Payer: Multiplan Commercial |
$279.20
|
| Rate for Payer: NAPHCARE Commercial |
$209.40
|
| Rate for Payer: Preferred Network Access Commercial |
$321.08
|
| Rate for Payer: Quartz Beloit One Network |
$171.01
|
| Rate for Payer: Quartz Commercial |
$209.40
|
| Rate for Payer: WEA Trust Commercial |
$191.95
|
| Rate for Payer: WPS Commercial |
$258.50
|
|
|
Intravenous Therapy Additional Sequential of a New Drug/Substance up to an hour - 96367
|
Facility
|
IP
|
$388.00
|
|
|
Service Code
|
CPT 96367
|
| Hospital Charge Code |
5516707
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$190.12 |
| Max. Negotiated Rate |
$356.96 |
| Rate for Payer: Aetna Commercial |
$349.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$333.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$205.64
|
| Rate for Payer: Cash Price |
$116.40
|
| Rate for Payer: Cigna Commercial |
$356.96
|
| Rate for Payer: Health EOS Commercial |
$345.32
|
| Rate for Payer: HFN Commercial |
$356.96
|
| Rate for Payer: Multiplan Commercial |
$310.40
|
| Rate for Payer: NAPHCARE Commercial |
$232.80
|
| Rate for Payer: Preferred Network Access Commercial |
$356.96
|
| Rate for Payer: Quartz Beloit One Network |
$190.12
|
| Rate for Payer: Quartz Commercial |
$232.80
|
| Rate for Payer: WEA Trust Commercial |
$213.40
|
| Rate for Payer: WPS Commercial |
$287.39
|
|
|
Intravenous Therapy Additional Sequential of a New Drug/Substance up to an hour - 96367
|
Facility
|
OP
|
$388.00
|
|
|
Service Code
|
CPT 96367
|
| Hospital Charge Code |
5516707
|
|
Hospital Revenue Code
|
260
|
| Min. Negotiated Rate |
$69.63 |
| Max. Negotiated Rate |
$356.96 |
| Rate for Payer: Aetna Commercial |
$349.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$333.68
|
| Rate for Payer: Aetna Managed Medicare |
$69.63
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$252.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$194.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$186.24
|
| Rate for Payer: Anthem Medicare Advantage |
$69.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$205.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$69.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$69.63
|
| Rate for Payer: Cash Price |
$116.40
|
| Rate for Payer: Cash Price |
$116.40
|
| Rate for Payer: Cigna Commercial |
$356.96
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$69.63
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$217.12
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$69.63
|
| Rate for Payer: Health EOS Commercial |
$345.32
|
| Rate for Payer: HFN Commercial |
$356.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$259.02
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$69.63
|
| Rate for Payer: Independent Care Health Plan Medicare |
$69.63
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$69.63
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$69.63
|
| Rate for Payer: Multiplan Commercial |
$310.40
|
| Rate for Payer: NAPHCARE Commercial |
$104.44
|
| Rate for Payer: Preferred Network Access Commercial |
$356.96
|
| Rate for Payer: Quartz Beloit One Network |
$190.12
|
| Rate for Payer: Quartz Commercial |
$252.20
|
| Rate for Payer: Quartz Medicare Advantage |
$69.63
|
| Rate for Payer: The Alliance Commercial |
$278.52
|
| Rate for Payer: United Healthcare Medicare Advantage |
$69.63
|
| Rate for Payer: United Healthcare PPO |
$291.00
|
| Rate for Payer: WEA Trust Commercial |
$213.40
|
| Rate for Payer: Wellcare Medicare |
$69.63
|
| Rate for Payer: WPS Commercial |
$287.39
|
|
|
Intravitreal Injection Of Pharmacologic Agent
|
Professional
|
Both
|
$698.00
|
|
|
Service Code
|
CPT 67028
|
| Hospital Charge Code |
1188935
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$170.72 |
| Max. Negotiated Rate |
$663.10 |
| Rate for Payer: Aetna Commercial |
$663.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$600.28
|
| Rate for Payer: Cash Price |
$209.40
|
| Rate for Payer: Cash Price |
$209.40
|
| Rate for Payer: Cash Price |
$209.40
|
| Rate for Payer: Cigna Commercial |
$663.10
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$170.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$418.80
|
| Rate for Payer: Health EOS Commercial |
$635.18
|
| Rate for Payer: HFN Commercial |
$663.10
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$310.18
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$310.18
|
| Rate for Payer: Multiplan Commercial |
$558.40
|
| Rate for Payer: Preferred Network Access Commercial |
$663.10
|
| Rate for Payer: Quartz Beloit One Network |
$307.12
|
| Rate for Payer: Quartz Commercial |
$397.86
|
| Rate for Payer: The Alliance Commercial |
$349.00
|
| Rate for Payer: United Healthcare Medicaid |
$170.72
|
| Rate for Payer: WEA Trust Commercial |
$383.90
|
| Rate for Payer: WPS Commercial |
$517.01
|
|
|
Intrinsic Factor Antibody
|
Professional
|
Both
|
$272.00
|
|
|
Service Code
|
CPT 86340
|
| Hospital Charge Code |
977999
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$53.23 |
| Max. Negotiated Rate |
$258.40 |
| Rate for Payer: The Alliance Commercial |
$136.00
|
| Rate for Payer: WEA Trust Commercial |
$149.60
|
| Rate for Payer: WPS Commercial |
$201.47
|
| Rate for Payer: Aetna Commercial |
$258.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$233.92
|
| Rate for Payer: Cash Price |
$81.60
|
| Rate for Payer: Cash Price |
$81.60
|
| Rate for Payer: Cigna Commercial |
$258.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$136.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$163.20
|
| Rate for Payer: Health EOS Commercial |
$247.52
|
| Rate for Payer: HFN Commercial |
$258.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$53.23
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$53.23
|
| Rate for Payer: Multiplan Commercial |
$217.60
|
| Rate for Payer: Preferred Network Access Commercial |
$258.40
|
| Rate for Payer: Quartz Beloit One Network |
$119.68
|
| Rate for Payer: Quartz Commercial |
$155.04
|
|
|
Intrinsic Factor Antibody
|
Facility
|
IP
|
$272.00
|
|
|
Service Code
|
CPT 86340
|
| Hospital Charge Code |
977999
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$133.28 |
| Max. Negotiated Rate |
$250.24 |
| Rate for Payer: Aetna Commercial |
$244.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$233.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$144.16
|
| Rate for Payer: Cash Price |
$81.60
|
| Rate for Payer: Cigna Commercial |
$250.24
|
| Rate for Payer: Health EOS Commercial |
$242.08
|
| Rate for Payer: HFN Commercial |
$250.24
|
| Rate for Payer: Multiplan Commercial |
$217.60
|
| Rate for Payer: NAPHCARE Commercial |
$163.20
|
| Rate for Payer: Preferred Network Access Commercial |
$250.24
|
| Rate for Payer: Quartz Beloit One Network |
$133.28
|
| Rate for Payer: Quartz Commercial |
$163.20
|
| Rate for Payer: WEA Trust Commercial |
$149.60
|
| Rate for Payer: WPS Commercial |
$201.47
|
|
|
Intrinsic Factor Antibody
|
Facility
|
OP
|
$272.00
|
|
|
Service Code
|
CPT 86340
|
| Hospital Charge Code |
977999
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.28 |
| Max. Negotiated Rate |
$250.24 |
| Rate for Payer: Aetna Commercial |
$244.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$233.92
|
| Rate for Payer: Aetna Managed Medicare |
$15.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$56.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$26.39
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$25.03
|
| Rate for Payer: Anthem Medicaid |
$14.28
|
| Rate for Payer: Anthem Medicare Advantage |
$15.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$144.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$15.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$15.08
|
| Rate for Payer: Cash Price |
$81.60
|
| Rate for Payer: Cash Price |
$81.60
|
| Rate for Payer: Cigna Commercial |
$250.24
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$15.08
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$14.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$152.21
|
| Rate for Payer: Dean Health Medicaid |
$14.28
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$15.08
|
| Rate for Payer: Health EOS Commercial |
$242.08
|
| Rate for Payer: HFN Commercial |
$250.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$56.10
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$15.08
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$14.28
|
| Rate for Payer: Independent Care Health Plan Medicare |
$15.08
|
| Rate for Payer: Managed Health Services Medicaid |
$14.85
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$15.08
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$15.08
|
| Rate for Payer: Multiplan Commercial |
$217.60
|
| Rate for Payer: NAPHCARE Commercial |
$22.62
|
| Rate for Payer: Preferred Network Access Commercial |
$250.24
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$14.28
|
| Rate for Payer: Quartz Beloit One Network |
$133.28
|
| Rate for Payer: Quartz Commercial |
$176.80
|
| Rate for Payer: Quartz Medicare Advantage |
$15.08
|
| Rate for Payer: The Alliance Commercial |
$60.32
|
| Rate for Payer: United Healthcare Medicaid |
$14.28
|
| Rate for Payer: United Healthcare Medicare Advantage |
$15.08
|
| Rate for Payer: United Healthcare PPO |
$204.00
|
| Rate for Payer: WEA Trust Commercial |
$149.60
|
| Rate for Payer: Wellcare Medicare |
$15.08
|
| Rate for Payer: WMAP Medicaid |
$14.28
|
| Rate for Payer: WPS Commercial |
$201.47
|
|
|
Intro Catheter Aorta
|
Facility
|
IP
|
$1,496.00
|
|
|
Service Code
|
CPT 36200
|
| Hospital Charge Code |
4066550
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$733.04 |
| Max. Negotiated Rate |
$1,376.32 |
| Rate for Payer: Aetna Commercial |
$1,346.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,286.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$792.88
|
| Rate for Payer: Cash Price |
$448.80
|
| Rate for Payer: Cigna Commercial |
$1,376.32
|
| Rate for Payer: Health EOS Commercial |
$1,331.44
|
| Rate for Payer: HFN Commercial |
$1,376.32
|
| Rate for Payer: Multiplan Commercial |
$1,196.80
|
| Rate for Payer: NAPHCARE Commercial |
$897.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,376.32
|
| Rate for Payer: Quartz Beloit One Network |
$733.04
|
| Rate for Payer: Quartz Commercial |
$897.60
|
| Rate for Payer: WEA Trust Commercial |
$822.80
|
| Rate for Payer: WPS Commercial |
$1,108.09
|
|
|
Intro Catheter Aorta
|
Facility
|
IP
|
$1,398.00
|
|
|
Service Code
|
CPT 36200
|
| Hospital Charge Code |
3913416
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$685.02 |
| Max. Negotiated Rate |
$1,286.16 |
| Rate for Payer: Aetna Commercial |
$1,258.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,202.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$740.94
|
| Rate for Payer: Cash Price |
$419.40
|
| Rate for Payer: Cigna Commercial |
$1,286.16
|
| Rate for Payer: Health EOS Commercial |
$1,244.22
|
| Rate for Payer: HFN Commercial |
$1,286.16
|
| Rate for Payer: Multiplan Commercial |
$1,118.40
|
| Rate for Payer: NAPHCARE Commercial |
$838.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,286.16
|
| Rate for Payer: Quartz Beloit One Network |
$685.02
|
| Rate for Payer: Quartz Commercial |
$838.80
|
| Rate for Payer: WEA Trust Commercial |
$768.90
|
| Rate for Payer: WPS Commercial |
$1,035.50
|
|
|
Intro Catheter Aorta
|
Facility
|
OP
|
$1,398.00
|
|
|
Service Code
|
CPT 36200
|
| Hospital Charge Code |
3913416
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$391.44 |
| Max. Negotiated Rate |
$5,592.00 |
| Rate for Payer: Aetna Commercial |
$1,258.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,202.28
|
| Rate for Payer: Aetna Managed Medicare |
$391.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$908.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$699.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$671.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$740.94
|
| Rate for Payer: Cash Price |
$419.40
|
| Rate for Payer: Cash Price |
$419.40
|
| Rate for Payer: Cigna Commercial |
$1,286.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,218.22
|
| Rate for Payer: Health EOS Commercial |
$1,244.22
|
| Rate for Payer: HFN Commercial |
$1,286.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,048.50
|
| Rate for Payer: Multiplan Commercial |
$1,118.40
|
| Rate for Payer: NAPHCARE Commercial |
$838.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,286.16
|
| Rate for Payer: Quartz Beloit One Network |
$685.02
|
| Rate for Payer: Quartz Commercial |
$908.70
|
| Rate for Payer: Quartz Medicare Advantage |
$838.80
|
| Rate for Payer: The Alliance Commercial |
$5,592.00
|
| Rate for Payer: United Healthcare PPO |
$1,048.50
|
| Rate for Payer: WEA Trust Commercial |
$768.90
|
| Rate for Payer: WPS Commercial |
$1,035.50
|
|
|
Intro Catheter Aorta
|
Facility
|
OP
|
$1,496.00
|
|
|
Service Code
|
CPT 36200
|
| Hospital Charge Code |
4066550
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$418.88 |
| Max. Negotiated Rate |
$5,984.00 |
| Rate for Payer: Aetna Commercial |
$1,346.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,286.56
|
| Rate for Payer: Aetna Managed Medicare |
$418.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$972.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$748.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$718.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$792.88
|
| Rate for Payer: Cash Price |
$448.80
|
| Rate for Payer: Cash Price |
$448.80
|
| Rate for Payer: Cigna Commercial |
$1,376.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,218.22
|
| Rate for Payer: Health EOS Commercial |
$1,331.44
|
| Rate for Payer: HFN Commercial |
$1,376.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,122.00
|
| Rate for Payer: Multiplan Commercial |
$1,196.80
|
| Rate for Payer: NAPHCARE Commercial |
$897.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,376.32
|
| Rate for Payer: Quartz Beloit One Network |
$733.04
|
| Rate for Payer: Quartz Commercial |
$972.40
|
| Rate for Payer: Quartz Medicare Advantage |
$897.60
|
| Rate for Payer: The Alliance Commercial |
$5,984.00
|
| Rate for Payer: WEA Trust Commercial |
$822.80
|
| Rate for Payer: WPS Commercial |
$1,108.09
|
|
|
Intro Catheter Aorta
|
Professional
|
Both
|
$1,496.00
|
|
|
Service Code
|
CPT 36200
|
| Hospital Charge Code |
4066550
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$241.35 |
| Max. Negotiated Rate |
$1,421.20 |
| Rate for Payer: Aetna Commercial |
$1,421.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,286.56
|
| Rate for Payer: Cash Price |
$448.80
|
| Rate for Payer: Cash Price |
$448.80
|
| Rate for Payer: Cash Price |
$448.80
|
| Rate for Payer: Cigna Commercial |
$1,421.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$241.35
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$897.60
|
| Rate for Payer: Health EOS Commercial |
$1,361.36
|
| Rate for Payer: HFN Commercial |
$1,421.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$442.77
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$442.77
|
| Rate for Payer: Multiplan Commercial |
$1,196.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,421.20
|
| Rate for Payer: Quartz Beloit One Network |
$658.24
|
| Rate for Payer: Quartz Commercial |
$852.72
|
| Rate for Payer: The Alliance Commercial |
$748.00
|
| Rate for Payer: United Healthcare Medicaid |
$241.35
|
| Rate for Payer: WEA Trust Commercial |
$822.80
|
| Rate for Payer: WPS Commercial |
$1,108.09
|
|
|
Intro Cath Extremity Artery
|
Facility
|
OP
|
$2,694.00
|
|
|
Service Code
|
CPT 36140
|
| Hospital Charge Code |
3913413
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$754.32 |
| Max. Negotiated Rate |
$10,776.00 |
| Rate for Payer: Aetna Commercial |
$2,424.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,316.84
|
| Rate for Payer: Aetna Managed Medicare |
$754.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,751.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,347.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,293.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,427.82
|
| Rate for Payer: Cash Price |
$808.20
|
| Rate for Payer: Cash Price |
$808.20
|
| Rate for Payer: Cigna Commercial |
$2,478.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,218.22
|
| Rate for Payer: Health EOS Commercial |
$2,397.66
|
| Rate for Payer: HFN Commercial |
$2,478.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,020.50
|
| Rate for Payer: Multiplan Commercial |
$2,155.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,616.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,478.48
|
| Rate for Payer: Quartz Beloit One Network |
$1,320.06
|
| Rate for Payer: Quartz Commercial |
$1,751.10
|
| Rate for Payer: Quartz Medicare Advantage |
$1,616.40
|
| Rate for Payer: The Alliance Commercial |
$10,776.00
|
| Rate for Payer: WEA Trust Commercial |
$1,481.70
|
| Rate for Payer: WPS Commercial |
$1,995.45
|
|
|
Intro Cath Extremity Artery
|
Facility
|
IP
|
$2,694.00
|
|
|
Service Code
|
CPT 36140
|
| Hospital Charge Code |
3913413
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,320.06 |
| Max. Negotiated Rate |
$2,478.48 |
| Rate for Payer: Aetna Commercial |
$2,424.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,316.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,427.82
|
| Rate for Payer: Cash Price |
$808.20
|
| Rate for Payer: Cigna Commercial |
$2,478.48
|
| Rate for Payer: Health EOS Commercial |
$2,397.66
|
| Rate for Payer: HFN Commercial |
$2,478.48
|
| Rate for Payer: Multiplan Commercial |
$2,155.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,616.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,478.48
|
| Rate for Payer: Quartz Beloit One Network |
$1,320.06
|
| Rate for Payer: Quartz Commercial |
$1,616.40
|
| Rate for Payer: WEA Trust Commercial |
$1,481.70
|
| Rate for Payer: WPS Commercial |
$1,995.45
|
|
|
Intro Cath IVC/SVC
|
Facility
|
IP
|
$10,327.00
|
|
|
Service Code
|
CPT 36010
|
| Hospital Charge Code |
3052416
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$5,060.23 |
| Max. Negotiated Rate |
$9,500.84 |
| Rate for Payer: Aetna Commercial |
$9,294.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,881.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,473.31
|
| Rate for Payer: Cash Price |
$3,098.10
|
| Rate for Payer: Cigna Commercial |
$9,500.84
|
| Rate for Payer: Health EOS Commercial |
$9,191.03
|
| Rate for Payer: HFN Commercial |
$9,500.84
|
| Rate for Payer: Multiplan Commercial |
$8,261.60
|
| Rate for Payer: NAPHCARE Commercial |
$6,196.20
|
| Rate for Payer: Preferred Network Access Commercial |
$9,500.84
|
| Rate for Payer: Quartz Beloit One Network |
$5,060.23
|
| Rate for Payer: Quartz Commercial |
$6,196.20
|
| Rate for Payer: WEA Trust Commercial |
$5,679.85
|
| Rate for Payer: WPS Commercial |
$7,649.21
|
|
|
Intro Cath IVC/SVC
|
Facility
|
OP
|
$10,327.00
|
|
|
Service Code
|
CPT 36010
|
| Hospital Charge Code |
3052416
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,891.56 |
| Max. Negotiated Rate |
$41,308.00 |
| Rate for Payer: Aetna Commercial |
$9,294.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,881.22
|
| Rate for Payer: Aetna Managed Medicare |
$2,891.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6,712.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5,163.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,956.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,473.31
|
| Rate for Payer: Cash Price |
$3,098.10
|
| Rate for Payer: Cash Price |
$3,098.10
|
| Rate for Payer: Cigna Commercial |
$9,500.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,218.22
|
| Rate for Payer: Health EOS Commercial |
$9,191.03
|
| Rate for Payer: HFN Commercial |
$9,500.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7,745.25
|
| Rate for Payer: Multiplan Commercial |
$8,261.60
|
| Rate for Payer: NAPHCARE Commercial |
$6,196.20
|
| Rate for Payer: Preferred Network Access Commercial |
$9,500.84
|
| Rate for Payer: Quartz Beloit One Network |
$5,060.23
|
| Rate for Payer: Quartz Commercial |
$6,712.55
|
| Rate for Payer: Quartz Medicare Advantage |
$6,196.20
|
| Rate for Payer: The Alliance Commercial |
$41,308.00
|
| Rate for Payer: WEA Trust Commercial |
$5,679.85
|
| Rate for Payer: WPS Commercial |
$7,649.21
|
|
|
Intro Cath Renal Pelvis Perc
|
Facility
|
IP
|
$542.00
|
|
| Hospital Charge Code |
3052579
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$265.58 |
| Max. Negotiated Rate |
$498.64 |
| Rate for Payer: Aetna Commercial |
$487.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$466.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$287.26
|
| Rate for Payer: Cash Price |
$162.60
|
| Rate for Payer: Cigna Commercial |
$498.64
|
| Rate for Payer: Health EOS Commercial |
$482.38
|
| Rate for Payer: HFN Commercial |
$498.64
|
| Rate for Payer: Multiplan Commercial |
$433.60
|
| Rate for Payer: NAPHCARE Commercial |
$325.20
|
| Rate for Payer: Preferred Network Access Commercial |
$498.64
|
| Rate for Payer: Quartz Beloit One Network |
$265.58
|
| Rate for Payer: Quartz Commercial |
$325.20
|
| Rate for Payer: WEA Trust Commercial |
$298.10
|
| Rate for Payer: WPS Commercial |
$401.46
|
|
|
Intro Cath Renal Pelvis Perc
|
Facility
|
OP
|
$542.00
|
|
| Hospital Charge Code |
3052579
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$151.76 |
| Max. Negotiated Rate |
$2,168.00 |
| Rate for Payer: Aetna Commercial |
$487.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$466.12
|
| Rate for Payer: Aetna Managed Medicare |
$151.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$352.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$271.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$260.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$287.26
|
| Rate for Payer: Cash Price |
$162.60
|
| Rate for Payer: Cigna Commercial |
$498.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$303.30
|
| Rate for Payer: Health EOS Commercial |
$482.38
|
| Rate for Payer: HFN Commercial |
$498.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$406.50
|
| Rate for Payer: Multiplan Commercial |
$433.60
|
| Rate for Payer: NAPHCARE Commercial |
$325.20
|
| Rate for Payer: Preferred Network Access Commercial |
$498.64
|
| Rate for Payer: Quartz Beloit One Network |
$265.58
|
| Rate for Payer: Quartz Commercial |
$352.30
|
| Rate for Payer: Quartz Medicare Advantage |
$325.20
|
| Rate for Payer: The Alliance Commercial |
$2,168.00
|
| Rate for Payer: WEA Trust Commercial |
$298.10
|
| Rate for Payer: WPS Commercial |
$401.46
|
|
|
Intro Cath/Stent Renal Pelvis
|
Professional
|
Both
|
$5,040.00
|
|
|
Service Code
|
CPT 50693
|
| Hospital Charge Code |
3072748
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$683.48 |
| Max. Negotiated Rate |
$4,788.00 |
| Rate for Payer: Aetna Commercial |
$4,788.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,334.40
|
| Rate for Payer: Cash Price |
$1,512.00
|
| Rate for Payer: Cash Price |
$1,512.00
|
| Rate for Payer: Cash Price |
$1,512.00
|
| Rate for Payer: Cigna Commercial |
$4,788.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$822.75
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,024.00
|
| Rate for Payer: Health EOS Commercial |
$4,586.40
|
| Rate for Payer: HFN Commercial |
$4,788.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$683.48
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$683.48
|
| Rate for Payer: Multiplan Commercial |
$4,032.00
|
| Rate for Payer: Preferred Network Access Commercial |
$4,788.00
|
| Rate for Payer: Quartz Beloit One Network |
$2,217.60
|
| Rate for Payer: Quartz Commercial |
$2,872.80
|
| Rate for Payer: The Alliance Commercial |
$2,520.00
|
| Rate for Payer: United Healthcare Medicaid |
$822.75
|
| Rate for Payer: WEA Trust Commercial |
$2,772.00
|
| Rate for Payer: WPS Commercial |
$3,733.13
|
|
|
Intro Cath/Stent Renal Pelvis
|
Facility
|
OP
|
$5,040.00
|
|
|
Service Code
|
CPT 50693
|
| Hospital Charge Code |
3072748
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$301.00 |
| Max. Negotiated Rate |
$13,782.96 |
| Rate for Payer: Aetna Commercial |
$4,536.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,334.40
|
| Rate for Payer: Aetna Managed Medicare |
$3,445.74
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,276.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,520.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,419.20
|
| Rate for Payer: Anthem Medicare Advantage |
$3,445.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,671.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$3,445.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$3,445.74
|
| Rate for Payer: Cash Price |
$1,512.00
|
| Rate for Payer: Cash Price |
$1,512.00
|
| Rate for Payer: Cash Price |
$1,512.00
|
| Rate for Payer: Cigna Commercial |
$4,636.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$3,445.74
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,218.22
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$3,445.74
|
| Rate for Payer: Health EOS Commercial |
$4,485.60
|
| Rate for Payer: HFN Commercial |
$4,636.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$12,818.15
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$3,445.74
|
| Rate for Payer: Independent Care Health Plan Medicare |
$3,445.74
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$3,445.74
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$3,445.74
|
| Rate for Payer: Multiplan Commercial |
$4,032.00
|
| Rate for Payer: NAPHCARE Commercial |
$5,168.61
|
| Rate for Payer: Preferred Network Access Commercial |
$4,636.80
|
| Rate for Payer: Quartz Beloit One Network |
$2,469.60
|
| Rate for Payer: Quartz Commercial |
$3,276.00
|
| Rate for Payer: Quartz Medicare Advantage |
$3,445.74
|
| Rate for Payer: The Alliance Commercial |
$13,782.96
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,445.74
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$2,772.00
|
| Rate for Payer: Wellcare Medicare |
$3,445.74
|
| Rate for Payer: WPS Commercial |
$3,733.13
|
|
|
Intro Cath/Stent Renal Pelvis
|
Facility
|
IP
|
$5,040.00
|
|
|
Service Code
|
CPT 50693
|
| Hospital Charge Code |
3072748
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$2,469.60 |
| Max. Negotiated Rate |
$4,636.80 |
| Rate for Payer: Aetna Commercial |
$4,536.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,334.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,671.20
|
| Rate for Payer: Cash Price |
$1,512.00
|
| Rate for Payer: Cigna Commercial |
$4,636.80
|
| Rate for Payer: Health EOS Commercial |
$4,485.60
|
| Rate for Payer: HFN Commercial |
$4,636.80
|
| Rate for Payer: Multiplan Commercial |
$4,032.00
|
| Rate for Payer: NAPHCARE Commercial |
$3,024.00
|
| Rate for Payer: Preferred Network Access Commercial |
$4,636.80
|
| Rate for Payer: Quartz Beloit One Network |
$2,469.60
|
| Rate for Payer: Quartz Commercial |
$3,024.00
|
| Rate for Payer: WEA Trust Commercial |
$2,772.00
|
| Rate for Payer: WPS Commercial |
$3,733.13
|
|
