|
IRRIGATOR HYDRO-SURG PLUS NEZHAT-DORSEY 0026870
|
Facility
|
OP
|
$839.00
|
|
| Hospital Charge Code |
5178939
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$244.32 |
| Max. Negotiated Rate |
$802.76 |
| Rate for Payer: Aetna Commercial |
$785.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$750.40
|
| Rate for Payer: Aetna Managed Medicare |
$244.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$567.16
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$436.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$418.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$462.46
|
| Rate for Payer: Cash Price |
$251.70
|
| Rate for Payer: Cigna Commercial |
$802.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$488.30
|
| Rate for Payer: Health EOS Commercial |
$776.58
|
| Rate for Payer: HFN Commercial |
$802.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$654.42
|
| Rate for Payer: Multiplan Commercial |
$698.05
|
| Rate for Payer: NAPHCARE Commercial |
$523.54
|
| Rate for Payer: Preferred Network Access Commercial |
$802.76
|
| Rate for Payer: Quartz Beloit One Network |
$427.55
|
| Rate for Payer: Quartz Commercial |
$567.16
|
| Rate for Payer: Quartz Medicare Advantage |
$523.54
|
| Rate for Payer: The Alliance Commercial |
$436.28
|
| Rate for Payer: WEA Trust Commercial |
$479.91
|
| Rate for Payer: WPS Commercial |
$646.28
|
|
|
IRRITABLE BOWEL SYNDROME
|
Facility
|
OP
|
$74.69
|
|
|
Service Code
|
EAPG 00632
|
| Min. Negotiated Rate |
$71.81 |
| Max. Negotiated Rate |
$74.69 |
| Rate for Payer: Anthem Medicaid |
$71.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$71.81
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$71.81
|
| Rate for Payer: Dean Health Medicaid |
$71.81
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$71.81
|
| Rate for Payer: Managed Health Services Medicaid |
$74.69
|
| Rate for Payer: Molina Healthcare Medicaid |
$71.81
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$71.81
|
| Rate for Payer: United Healthcare Medicaid |
$71.81
|
|
|
Isavuconazole Level
|
Facility
|
OP
|
$634.00
|
|
|
Service Code
|
CPT 80375
|
| Hospital Charge Code |
5412826
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$184.62 |
| Max. Negotiated Rate |
$606.61 |
| Rate for Payer: Aetna Commercial |
$593.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$567.05
|
| Rate for Payer: Aetna Managed Medicare |
$184.62
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$428.58
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$329.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$316.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$349.46
|
| Rate for Payer: Cash Price |
$190.20
|
| Rate for Payer: Cigna Commercial |
$606.61
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$368.99
|
| Rate for Payer: Health EOS Commercial |
$586.83
|
| Rate for Payer: HFN Commercial |
$606.61
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$494.52
|
| Rate for Payer: Multiplan Commercial |
$527.49
|
| Rate for Payer: NAPHCARE Commercial |
$395.62
|
| Rate for Payer: Preferred Network Access Commercial |
$606.61
|
| Rate for Payer: Quartz Beloit One Network |
$323.09
|
| Rate for Payer: Quartz Commercial |
$428.58
|
| Rate for Payer: Quartz Medicare Advantage |
$395.62
|
| Rate for Payer: The Alliance Commercial |
$329.68
|
| Rate for Payer: United Healthcare PPO |
$494.52
|
| Rate for Payer: WEA Trust Commercial |
$362.65
|
| Rate for Payer: WPS Commercial |
$488.37
|
|
|
Isavuconazole Level
|
Facility
|
IP
|
$634.00
|
|
|
Service Code
|
CPT 80375
|
| Hospital Charge Code |
5412826
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$323.09 |
| Max. Negotiated Rate |
$606.61 |
| Rate for Payer: Aetna Commercial |
$593.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$567.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$349.46
|
| Rate for Payer: Cash Price |
$190.20
|
| Rate for Payer: Cigna Commercial |
$606.61
|
| Rate for Payer: Health EOS Commercial |
$586.83
|
| Rate for Payer: HFN Commercial |
$606.61
|
| Rate for Payer: Multiplan Commercial |
$527.49
|
| Rate for Payer: Preferred Network Access Commercial |
$606.61
|
| Rate for Payer: Quartz Beloit One Network |
$323.09
|
| Rate for Payer: Quartz Commercial |
$395.62
|
| Rate for Payer: WEA Trust Commercial |
$362.65
|
| Rate for Payer: WPS Commercial |
$488.37
|
|
|
Isavuconazole Level
|
Professional
|
Both
|
$634.00
|
|
|
Service Code
|
CPT 80375
|
| Hospital Charge Code |
5412826
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$83.26 |
| Max. Negotiated Rate |
$626.39 |
| Rate for Payer: Aetna Commercial |
$626.39
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$567.05
|
| Rate for Payer: Cash Price |
$190.20
|
| Rate for Payer: Cash Price |
$190.20
|
| Rate for Payer: Cigna Commercial |
$626.39
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$329.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$395.62
|
| Rate for Payer: Health EOS Commercial |
$600.02
|
| Rate for Payer: HFN Commercial |
$626.39
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$83.26
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$83.26
|
| Rate for Payer: Multiplan Commercial |
$527.49
|
| Rate for Payer: Preferred Network Access Commercial |
$626.39
|
| Rate for Payer: Quartz Beloit One Network |
$290.12
|
| Rate for Payer: Quartz Commercial |
$375.84
|
| Rate for Payer: The Alliance Commercial |
$329.68
|
| Rate for Payer: WEA Trust Commercial |
$362.65
|
| Rate for Payer: WPS Commercial |
$488.37
|
|
|
ISCHEMIC STROKE, PRECEREBRAL OCCLUSION OR TRANSIENT ISCHEMIA WITH THROMBOLYTIC AGENT WITH CC
|
Facility
|
IP
|
$52,084.24
|
|
|
Service Code
|
MSDRG 062
|
| Min. Negotiated Rate |
$13,963.76 |
| Max. Negotiated Rate |
$52,084.24 |
| Rate for Payer: Aetna Managed Medicare |
$13,963.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$38,340.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$29,387.83
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$27,920.36
|
| Rate for Payer: Anthem Medicare Advantage |
$13,963.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$13,963.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$13,963.76
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$13,963.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$30,994.16
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$13,963.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$37,958.08
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$13,963.76
|
| Rate for Payer: Independent Care Health Plan Medicare |
$13,963.76
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$13,963.76
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$13,963.76
|
| Rate for Payer: NAPHCARE Commercial |
$20,945.64
|
| Rate for Payer: Quartz Medicare Advantage |
$13,963.76
|
| Rate for Payer: The Alliance Commercial |
$52,084.24
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13,963.76
|
| Rate for Payer: United Healthcare PPO |
$29,550.85
|
| Rate for Payer: Wellcare Medicare |
$13,963.76
|
|
|
ISCHEMIC STROKE, PRECEREBRAL OCCLUSION OR TRANSIENT ISCHEMIA WITH THROMBOLYTIC AGENT WITH MCC
|
Facility
|
IP
|
$77,829.44
|
|
|
Service Code
|
MSDRG 061
|
| Min. Negotiated Rate |
$21,621.20 |
| Max. Negotiated Rate |
$77,829.44 |
| Rate for Payer: Aetna Managed Medicare |
$21,621.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$60,157.72
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$46,110.40
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$43,807.89
|
| Rate for Payer: Anthem Medicare Advantage |
$21,621.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$21,621.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$21,621.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$21,621.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$48,630.78
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$21,621.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$56,840.78
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$21,621.20
|
| Rate for Payer: Independent Care Health Plan Medicare |
$21,621.20
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$21,621.20
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$21,621.20
|
| Rate for Payer: NAPHCARE Commercial |
$32,431.81
|
| Rate for Payer: Quartz Medicare Advantage |
$21,621.20
|
| Rate for Payer: The Alliance Commercial |
$77,829.44
|
| Rate for Payer: United Healthcare Medicare Advantage |
$21,621.20
|
| Rate for Payer: United Healthcare PPO |
$44,251.28
|
| Rate for Payer: Wellcare Medicare |
$21,621.20
|
|
|
ISCHEMIC STROKE, PRECEREBRAL OCCLUSION OR TRANSIENT ISCHEMIA WITH THROMBOLYTIC AGENT WITHOUT CC/MCC
|
Facility
|
IP
|
$41,441.92
|
|
|
Service Code
|
MSDRG 063
|
| Min. Negotiated Rate |
$11,257.38 |
| Max. Negotiated Rate |
$41,441.92 |
| Rate for Payer: Aetna Managed Medicare |
$11,257.38
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$30,629.79
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$23,477.49
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$22,305.15
|
| Rate for Payer: Anthem Medicare Advantage |
$11,257.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$11,257.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$11,257.38
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$11,257.38
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$24,760.76
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$11,257.38
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$30,152.30
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$11,257.38
|
| Rate for Payer: Independent Care Health Plan Medicare |
$11,257.38
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$11,257.38
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$11,257.38
|
| Rate for Payer: NAPHCARE Commercial |
$16,886.06
|
| Rate for Payer: Quartz Medicare Advantage |
$11,257.38
|
| Rate for Payer: The Alliance Commercial |
$41,441.92
|
| Rate for Payer: United Healthcare Medicare Advantage |
$11,257.38
|
| Rate for Payer: United Healthcare PPO |
$23,473.95
|
| Rate for Payer: Wellcare Medicare |
$11,257.38
|
|
|
ISLAND PEDICLE FLAP GRAFT 15740
|
Professional
|
Both
|
$5,349.00
|
|
|
Service Code
|
CPT 15740
|
| Hospital Charge Code |
3013648
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$705.09 |
| Max. Negotiated Rate |
$5,284.81 |
| Rate for Payer: Aetna Commercial |
$5,284.81
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,784.15
|
| Rate for Payer: Aetna Managed Medicare |
$723.67
|
| Rate for Payer: Anthem Medicare Advantage |
$723.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$723.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$723.67
|
| Rate for Payer: Cash Price |
$1,604.70
|
| Rate for Payer: Cash Price |
$1,604.70
|
| Rate for Payer: Cash Price |
$1,604.70
|
| Rate for Payer: Cigna Commercial |
$5,284.81
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$705.09
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$723.67
|
| Rate for Payer: Health EOS Commercial |
$5,062.29
|
| Rate for Payer: HFN Commercial |
$5,284.81
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,886.59
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$2,886.59
|
| Rate for Payer: Independent Care Health Plan Medicare |
$723.67
|
| Rate for Payer: Multiplan Commercial |
$4,450.37
|
| Rate for Payer: NAPHCARE Commercial |
$1,085.51
|
| Rate for Payer: Preferred Network Access Commercial |
$5,284.81
|
| Rate for Payer: Quartz Beloit One Network |
$2,447.70
|
| Rate for Payer: Quartz Commercial |
$3,170.89
|
| Rate for Payer: Quartz Medicare Advantage |
$723.67
|
| Rate for Payer: The Alliance Commercial |
$3,075.61
|
| Rate for Payer: United Healthcare Medicaid |
$705.09
|
| Rate for Payer: United Healthcare Medicare Advantage |
$723.67
|
| Rate for Payer: WEA Trust Commercial |
$3,059.63
|
| Rate for Payer: WPS Commercial |
$3,256.53
|
|
|
Islet Cell Antibody
|
Facility
|
OP
|
$244.00
|
|
|
Service Code
|
CPT 86341
|
| Hospital Charge Code |
978000
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$24.51 |
| Max. Negotiated Rate |
$233.46 |
| Rate for Payer: Aetna Commercial |
$228.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$218.23
|
| Rate for Payer: Aetna Managed Medicare |
$24.51
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$91.92
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$42.90
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$40.69
|
| Rate for Payer: Anthem Medicare Advantage |
$24.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$134.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$24.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$24.51
|
| Rate for Payer: Cash Price |
$73.20
|
| Rate for Payer: Cash Price |
$73.20
|
| Rate for Payer: Cigna Commercial |
$233.46
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$24.51
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$142.01
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$24.51
|
| Rate for Payer: Health EOS Commercial |
$225.85
|
| Rate for Payer: HFN Commercial |
$233.46
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$91.19
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$24.51
|
| Rate for Payer: Independent Care Health Plan Medicare |
$24.51
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$24.51
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$24.51
|
| Rate for Payer: Multiplan Commercial |
$203.01
|
| Rate for Payer: NAPHCARE Commercial |
$36.77
|
| Rate for Payer: Preferred Network Access Commercial |
$233.46
|
| Rate for Payer: Quartz Beloit One Network |
$124.34
|
| Rate for Payer: Quartz Commercial |
$164.94
|
| Rate for Payer: Quartz Medicare Advantage |
$24.51
|
| Rate for Payer: The Alliance Commercial |
$98.05
|
| Rate for Payer: United Healthcare Medicare Advantage |
$24.51
|
| Rate for Payer: United Healthcare PPO |
$190.32
|
| Rate for Payer: WEA Trust Commercial |
$139.57
|
| Rate for Payer: Wellcare Medicare |
$24.51
|
| Rate for Payer: WPS Commercial |
$187.95
|
|
|
Islet Cell Antibody
|
Professional
|
Both
|
$244.00
|
|
|
Service Code
|
CPT 86341
|
| Hospital Charge Code |
978000
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$24.51 |
| Max. Negotiated Rate |
$241.07 |
| Rate for Payer: Aetna Commercial |
$241.07
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$218.23
|
| Rate for Payer: Aetna Managed Medicare |
$24.51
|
| Rate for Payer: Anthem Medicare Advantage |
$24.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$24.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$24.51
|
| Rate for Payer: Cash Price |
$73.20
|
| Rate for Payer: Cash Price |
$73.20
|
| Rate for Payer: Cigna Commercial |
$241.07
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$126.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$24.51
|
| Rate for Payer: Health EOS Commercial |
$230.92
|
| Rate for Payer: HFN Commercial |
$241.07
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$86.53
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$86.53
|
| Rate for Payer: Independent Care Health Plan Medicare |
$24.51
|
| Rate for Payer: Multiplan Commercial |
$203.01
|
| Rate for Payer: NAPHCARE Commercial |
$36.77
|
| Rate for Payer: Preferred Network Access Commercial |
$241.07
|
| Rate for Payer: Quartz Beloit One Network |
$111.65
|
| Rate for Payer: Quartz Commercial |
$144.64
|
| Rate for Payer: Quartz Medicare Advantage |
$24.51
|
| Rate for Payer: The Alliance Commercial |
$96.83
|
| Rate for Payer: United Healthcare Medicare Advantage |
$24.51
|
| Rate for Payer: WEA Trust Commercial |
$139.57
|
| Rate for Payer: WPS Commercial |
$107.86
|
|
|
Islet Cell Antibody
|
Facility
|
IP
|
$244.00
|
|
|
Service Code
|
CPT 86341
|
| Hospital Charge Code |
978000
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$124.34 |
| Max. Negotiated Rate |
$233.46 |
| Rate for Payer: Aetna Commercial |
$228.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$218.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$134.49
|
| Rate for Payer: Cash Price |
$73.20
|
| Rate for Payer: Cigna Commercial |
$233.46
|
| Rate for Payer: Health EOS Commercial |
$225.85
|
| Rate for Payer: HFN Commercial |
$233.46
|
| Rate for Payer: Multiplan Commercial |
$203.01
|
| Rate for Payer: Preferred Network Access Commercial |
$233.46
|
| Rate for Payer: Quartz Beloit One Network |
$124.34
|
| Rate for Payer: Quartz Commercial |
$152.26
|
| Rate for Payer: WEA Trust Commercial |
$139.57
|
| Rate for Payer: WPS Commercial |
$187.95
|
|
|
Islet Cell Antibody Titer
|
Facility
|
IP
|
$86.00
|
|
|
Service Code
|
CPT 86341
|
| Hospital Charge Code |
3856694
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$43.83 |
| Max. Negotiated Rate |
$82.28 |
| Rate for Payer: Aetna Commercial |
$80.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$76.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$47.40
|
| Rate for Payer: Cash Price |
$25.80
|
| Rate for Payer: Cigna Commercial |
$82.28
|
| Rate for Payer: Health EOS Commercial |
$79.60
|
| Rate for Payer: HFN Commercial |
$82.28
|
| Rate for Payer: Multiplan Commercial |
$71.55
|
| Rate for Payer: Preferred Network Access Commercial |
$82.28
|
| Rate for Payer: Quartz Beloit One Network |
$43.83
|
| Rate for Payer: Quartz Commercial |
$53.66
|
| Rate for Payer: WEA Trust Commercial |
$49.19
|
| Rate for Payer: WPS Commercial |
$66.25
|
|
|
Islet Cell Antibody Titer
|
Professional
|
Both
|
$86.00
|
|
|
Service Code
|
CPT 86341
|
| Hospital Charge Code |
3856694
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$24.51 |
| Max. Negotiated Rate |
$107.86 |
| Rate for Payer: Aetna Commercial |
$84.97
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$76.92
|
| Rate for Payer: Aetna Managed Medicare |
$24.51
|
| Rate for Payer: Anthem Medicare Advantage |
$24.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$24.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$24.51
|
| Rate for Payer: Cash Price |
$25.80
|
| Rate for Payer: Cash Price |
$25.80
|
| Rate for Payer: Cigna Commercial |
$84.97
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$44.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$24.51
|
| Rate for Payer: Health EOS Commercial |
$81.39
|
| Rate for Payer: HFN Commercial |
$84.97
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$86.53
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$86.53
|
| Rate for Payer: Independent Care Health Plan Medicare |
$24.51
|
| Rate for Payer: Multiplan Commercial |
$71.55
|
| Rate for Payer: NAPHCARE Commercial |
$36.77
|
| Rate for Payer: Preferred Network Access Commercial |
$84.97
|
| Rate for Payer: Quartz Beloit One Network |
$39.35
|
| Rate for Payer: Quartz Commercial |
$50.98
|
| Rate for Payer: Quartz Medicare Advantage |
$24.51
|
| Rate for Payer: The Alliance Commercial |
$96.83
|
| Rate for Payer: United Healthcare Medicare Advantage |
$24.51
|
| Rate for Payer: WEA Trust Commercial |
$49.19
|
| Rate for Payer: WPS Commercial |
$107.86
|
|
|
Islet Cell Antibody Titer
|
Facility
|
OP
|
$86.00
|
|
|
Service Code
|
CPT 86341
|
| Hospital Charge Code |
3856694
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$24.51 |
| Max. Negotiated Rate |
$98.05 |
| Rate for Payer: Aetna Commercial |
$80.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$76.92
|
| Rate for Payer: Aetna Managed Medicare |
$24.51
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$91.92
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$42.90
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$40.69
|
| Rate for Payer: Anthem Medicare Advantage |
$24.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$47.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$24.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$24.51
|
| Rate for Payer: Cash Price |
$25.80
|
| Rate for Payer: Cash Price |
$25.80
|
| Rate for Payer: Cigna Commercial |
$82.28
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$24.51
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$50.05
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$24.51
|
| Rate for Payer: Health EOS Commercial |
$79.60
|
| Rate for Payer: HFN Commercial |
$82.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$91.19
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$24.51
|
| Rate for Payer: Independent Care Health Plan Medicare |
$24.51
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$24.51
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$24.51
|
| Rate for Payer: Multiplan Commercial |
$71.55
|
| Rate for Payer: NAPHCARE Commercial |
$36.77
|
| Rate for Payer: Preferred Network Access Commercial |
$82.28
|
| Rate for Payer: Quartz Beloit One Network |
$43.83
|
| Rate for Payer: Quartz Commercial |
$58.14
|
| Rate for Payer: Quartz Medicare Advantage |
$24.51
|
| Rate for Payer: The Alliance Commercial |
$98.05
|
| Rate for Payer: United Healthcare Medicare Advantage |
$24.51
|
| Rate for Payer: United Healthcare PPO |
$67.08
|
| Rate for Payer: WEA Trust Commercial |
$49.19
|
| Rate for Payer: Wellcare Medicare |
$24.51
|
| Rate for Payer: WPS Commercial |
$66.25
|
|
|
ISNARE LARIAT SNARE BX00711084
|
Facility
|
IP
|
$4,309.00
|
|
| Hospital Charge Code |
5415807
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,195.87 |
| Max. Negotiated Rate |
$4,122.85 |
| Rate for Payer: Aetna Commercial |
$4,033.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,853.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,375.12
|
| Rate for Payer: Cash Price |
$1,292.70
|
| Rate for Payer: Cigna Commercial |
$4,122.85
|
| Rate for Payer: Health EOS Commercial |
$3,988.41
|
| Rate for Payer: HFN Commercial |
$4,122.85
|
| Rate for Payer: Multiplan Commercial |
$3,585.09
|
| Rate for Payer: Preferred Network Access Commercial |
$4,122.85
|
| Rate for Payer: Quartz Beloit One Network |
$2,195.87
|
| Rate for Payer: Quartz Commercial |
$2,688.82
|
| Rate for Payer: WEA Trust Commercial |
$2,464.75
|
| Rate for Payer: WPS Commercial |
$3,319.22
|
|
|
ISNARE LARIAT SNARE BX00711084
|
Facility
|
OP
|
$4,309.00
|
|
| Hospital Charge Code |
5415807
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,254.78 |
| Max. Negotiated Rate |
$4,122.85 |
| Rate for Payer: Aetna Commercial |
$4,033.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,853.97
|
| Rate for Payer: Aetna Managed Medicare |
$1,254.78
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,912.88
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,240.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,151.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,375.12
|
| Rate for Payer: Cash Price |
$1,292.70
|
| Rate for Payer: Cigna Commercial |
$4,122.85
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,507.84
|
| Rate for Payer: Health EOS Commercial |
$3,988.41
|
| Rate for Payer: HFN Commercial |
$4,122.85
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,361.02
|
| Rate for Payer: Multiplan Commercial |
$3,585.09
|
| Rate for Payer: NAPHCARE Commercial |
$2,688.82
|
| Rate for Payer: Preferred Network Access Commercial |
$4,122.85
|
| Rate for Payer: Quartz Beloit One Network |
$2,195.87
|
| Rate for Payer: Quartz Commercial |
$2,912.88
|
| Rate for Payer: Quartz Medicare Advantage |
$2,688.82
|
| Rate for Payer: The Alliance Commercial |
$2,240.68
|
| Rate for Payer: WEA Trust Commercial |
$2,464.75
|
| Rate for Payer: WPS Commercial |
$3,319.22
|
|
|
Isoagglutinin Titer, Anti-B
|
Facility
|
IP
|
$747.00
|
|
|
Service Code
|
CPT 86886
|
| Hospital Charge Code |
5867634
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$380.67 |
| Max. Negotiated Rate |
$714.73 |
| Rate for Payer: Aetna Commercial |
$699.19
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$668.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$411.75
|
| Rate for Payer: Cash Price |
$224.10
|
| Rate for Payer: Cigna Commercial |
$714.73
|
| Rate for Payer: Health EOS Commercial |
$691.42
|
| Rate for Payer: HFN Commercial |
$714.73
|
| Rate for Payer: Multiplan Commercial |
$621.50
|
| Rate for Payer: Preferred Network Access Commercial |
$714.73
|
| Rate for Payer: Quartz Beloit One Network |
$380.67
|
| Rate for Payer: Quartz Commercial |
$466.13
|
| Rate for Payer: WEA Trust Commercial |
$427.28
|
| Rate for Payer: WPS Commercial |
$575.41
|
|
|
Isoagglutinin Titer, Anti-B
|
Facility
|
OP
|
$747.00
|
|
|
Service Code
|
CPT 86886
|
| Hospital Charge Code |
5867634
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.39 |
| Max. Negotiated Rate |
$714.73 |
| Rate for Payer: Aetna Commercial |
$699.19
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$668.12
|
| Rate for Payer: Aetna Managed Medicare |
$5.39
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$658.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$307.25
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$291.45
|
| Rate for Payer: Anthem Medicare Advantage |
$5.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$411.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5.39
|
| Rate for Payer: Cash Price |
$224.10
|
| Rate for Payer: Cash Price |
$224.10
|
| Rate for Payer: Cigna Commercial |
$714.73
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$5.39
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$434.75
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$5.39
|
| Rate for Payer: Health EOS Commercial |
$691.42
|
| Rate for Payer: HFN Commercial |
$714.73
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$20.04
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$5.39
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5.39
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$5.39
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$5.39
|
| Rate for Payer: Multiplan Commercial |
$621.50
|
| Rate for Payer: NAPHCARE Commercial |
$8.08
|
| Rate for Payer: Preferred Network Access Commercial |
$714.73
|
| Rate for Payer: Quartz Beloit One Network |
$380.67
|
| Rate for Payer: Quartz Commercial |
$504.97
|
| Rate for Payer: Quartz Medicare Advantage |
$5.39
|
| Rate for Payer: The Alliance Commercial |
$21.55
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.39
|
| Rate for Payer: United Healthcare PPO |
$582.66
|
| Rate for Payer: WEA Trust Commercial |
$427.28
|
| Rate for Payer: Wellcare Medicare |
$5.39
|
| Rate for Payer: WPS Commercial |
$575.41
|
|
|
Isoagglutinin Titer, Anti-B
|
Professional
|
Both
|
$747.00
|
|
|
Service Code
|
CPT 86886
|
| Hospital Charge Code |
5867634
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.39 |
| Max. Negotiated Rate |
$738.04 |
| Rate for Payer: Aetna Commercial |
$738.04
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$668.12
|
| Rate for Payer: Aetna Managed Medicare |
$5.39
|
| Rate for Payer: Anthem Medicare Advantage |
$5.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5.39
|
| Rate for Payer: Cash Price |
$224.10
|
| Rate for Payer: Cash Price |
$224.10
|
| Rate for Payer: Cigna Commercial |
$738.04
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$388.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5.39
|
| Rate for Payer: Health EOS Commercial |
$706.96
|
| Rate for Payer: HFN Commercial |
$738.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$19.02
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$19.02
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5.39
|
| Rate for Payer: Multiplan Commercial |
$621.50
|
| Rate for Payer: NAPHCARE Commercial |
$8.08
|
| Rate for Payer: Preferred Network Access Commercial |
$738.04
|
| Rate for Payer: Quartz Beloit One Network |
$341.83
|
| Rate for Payer: Quartz Commercial |
$442.82
|
| Rate for Payer: Quartz Medicare Advantage |
$5.39
|
| Rate for Payer: The Alliance Commercial |
$21.28
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.39
|
| Rate for Payer: WEA Trust Commercial |
$427.28
|
| Rate for Payer: WPS Commercial |
$23.70
|
|
|
Isodose Plan Complex
|
Facility
|
OP
|
$3,323.00
|
|
|
Service Code
|
CPT 77307
|
| Hospital Charge Code |
3040383
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$394.05 |
| Max. Negotiated Rate |
$3,179.45 |
| Rate for Payer: Aetna Commercial |
$3,110.33
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,972.09
|
| Rate for Payer: Aetna Managed Medicare |
$394.05
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,424.32
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,139.46
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,082.48
|
| Rate for Payer: Anthem Medicare Advantage |
$394.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,831.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$394.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$394.05
|
| Rate for Payer: Cash Price |
$996.90
|
| Rate for Payer: Cash Price |
$996.90
|
| Rate for Payer: Cigna Commercial |
$3,179.45
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$394.05
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,933.99
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$394.05
|
| Rate for Payer: Health EOS Commercial |
$3,075.77
|
| Rate for Payer: HFN Commercial |
$3,179.45
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,465.85
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$394.05
|
| Rate for Payer: Independent Care Health Plan Medicare |
$394.05
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$394.05
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$394.05
|
| Rate for Payer: Multiplan Commercial |
$2,764.74
|
| Rate for Payer: NAPHCARE Commercial |
$591.07
|
| Rate for Payer: Preferred Network Access Commercial |
$3,179.45
|
| Rate for Payer: Quartz Beloit One Network |
$1,693.40
|
| Rate for Payer: Quartz Commercial |
$2,246.35
|
| Rate for Payer: Quartz Medicare Advantage |
$394.05
|
| Rate for Payer: The Alliance Commercial |
$1,576.18
|
| Rate for Payer: United Healthcare Medicare Advantage |
$394.05
|
| Rate for Payer: United Healthcare PPO |
$2,591.94
|
| Rate for Payer: WEA Trust Commercial |
$1,900.76
|
| Rate for Payer: Wellcare Medicare |
$394.05
|
| Rate for Payer: WPS Commercial |
$2,559.71
|
|
|
Isodose Plan Complex
|
Facility
|
IP
|
$3,323.00
|
|
|
Service Code
|
CPT 77307
|
| Hospital Charge Code |
3040383
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$1,693.40 |
| Max. Negotiated Rate |
$3,179.45 |
| Rate for Payer: Aetna Commercial |
$3,110.33
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,972.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,831.64
|
| Rate for Payer: Cash Price |
$996.90
|
| Rate for Payer: Cigna Commercial |
$3,179.45
|
| Rate for Payer: Health EOS Commercial |
$3,075.77
|
| Rate for Payer: HFN Commercial |
$3,179.45
|
| Rate for Payer: Multiplan Commercial |
$2,764.74
|
| Rate for Payer: Preferred Network Access Commercial |
$3,179.45
|
| Rate for Payer: Quartz Beloit One Network |
$1,693.40
|
| Rate for Payer: Quartz Commercial |
$2,073.55
|
| Rate for Payer: WEA Trust Commercial |
$1,900.76
|
| Rate for Payer: WPS Commercial |
$2,559.71
|
|
|
Isodose Plan Simple
|
Facility
|
OP
|
$530.00
|
|
|
Service Code
|
CPT 77306
|
| Hospital Charge Code |
3040381
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$270.09 |
| Max. Negotiated Rate |
$1,576.18 |
| Rate for Payer: Aetna Commercial |
$496.08
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$474.03
|
| Rate for Payer: Aetna Managed Medicare |
$394.05
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,424.32
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,139.46
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,082.48
|
| Rate for Payer: Anthem Medicare Advantage |
$394.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$292.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$394.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$394.05
|
| Rate for Payer: Cash Price |
$159.00
|
| Rate for Payer: Cash Price |
$159.00
|
| Rate for Payer: Cigna Commercial |
$507.10
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$394.05
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$308.46
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$394.05
|
| Rate for Payer: Health EOS Commercial |
$490.57
|
| Rate for Payer: HFN Commercial |
$507.10
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,465.85
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$394.05
|
| Rate for Payer: Independent Care Health Plan Medicare |
$394.05
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$394.05
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$394.05
|
| Rate for Payer: Multiplan Commercial |
$440.96
|
| Rate for Payer: NAPHCARE Commercial |
$591.07
|
| Rate for Payer: Preferred Network Access Commercial |
$507.10
|
| Rate for Payer: Quartz Beloit One Network |
$270.09
|
| Rate for Payer: Quartz Commercial |
$358.28
|
| Rate for Payer: Quartz Medicare Advantage |
$394.05
|
| Rate for Payer: The Alliance Commercial |
$1,576.18
|
| Rate for Payer: United Healthcare Medicare Advantage |
$394.05
|
| Rate for Payer: United Healthcare PPO |
$413.40
|
| Rate for Payer: WEA Trust Commercial |
$303.16
|
| Rate for Payer: Wellcare Medicare |
$394.05
|
| Rate for Payer: WPS Commercial |
$408.26
|
|
|
Isodose Plan Simple
|
Facility
|
IP
|
$530.00
|
|
|
Service Code
|
CPT 77306
|
| Hospital Charge Code |
3040381
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$270.09 |
| Max. Negotiated Rate |
$507.10 |
| Rate for Payer: Aetna Commercial |
$496.08
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$474.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$292.14
|
| Rate for Payer: Cash Price |
$159.00
|
| Rate for Payer: Cigna Commercial |
$507.10
|
| Rate for Payer: Health EOS Commercial |
$490.57
|
| Rate for Payer: HFN Commercial |
$507.10
|
| Rate for Payer: Multiplan Commercial |
$440.96
|
| Rate for Payer: Preferred Network Access Commercial |
$507.10
|
| Rate for Payer: Quartz Beloit One Network |
$270.09
|
| Rate for Payer: Quartz Commercial |
$330.72
|
| Rate for Payer: WEA Trust Commercial |
$303.16
|
| Rate for Payer: WPS Commercial |
$408.26
|
|
|
Isolation/Extraction Hi Pur Na
|
Professional
|
Both
|
$79.00
|
|
| Hospital Charge Code |
2776825
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$36.15 |
| Max. Negotiated Rate |
$78.05 |
| Rate for Payer: Aetna Commercial |
$78.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$70.66
|
| Rate for Payer: Cash Price |
$23.70
|
| Rate for Payer: Cigna Commercial |
$78.05
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$41.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$49.30
|
| Rate for Payer: Health EOS Commercial |
$74.77
|
| Rate for Payer: HFN Commercial |
$78.05
|
| Rate for Payer: Multiplan Commercial |
$65.73
|
| Rate for Payer: Preferred Network Access Commercial |
$78.05
|
| Rate for Payer: Quartz Beloit One Network |
$36.15
|
| Rate for Payer: Quartz Commercial |
$46.83
|
| Rate for Payer: The Alliance Commercial |
$41.08
|
| Rate for Payer: WEA Trust Commercial |
$45.19
|
| Rate for Payer: WPS Commercial |
$60.85
|
|
