|
AMPUTATION OF LOWER LIMB FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITH MCC
|
Facility
|
IP
|
$109,761.60
|
|
|
Service Code
|
MSDRG 616
|
| Min. Negotiated Rate |
$27,213.98 |
| Max. Negotiated Rate |
$109,761.60 |
| Rate for Payer: Aetna Managed Medicare |
$27,213.98
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$76,092.28
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$58,324.11
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$55,411.72
|
| Rate for Payer: Anthem Medicare Advantage |
$27,213.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$27,213.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$27,213.98
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$27,213.98
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$61,512.09
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$27,213.98
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$80,262.16
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$27,213.98
|
| Rate for Payer: Independent Care Health Plan Medicare |
$27,213.98
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$27,213.98
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$27,213.98
|
| Rate for Payer: NAPHCARE Commercial |
$40,820.97
|
| Rate for Payer: Quartz Medicare Advantage |
$27,213.98
|
| Rate for Payer: The Alliance Commercial |
$109,761.60
|
| Rate for Payer: United Healthcare Medicare Advantage |
$27,213.98
|
| Rate for Payer: United Healthcare PPO |
$62,485.11
|
| Rate for Payer: Wellcare Medicare |
$27,213.98
|
|
|
AMPUTATION OF LOWER LIMB FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITHOUT CC/MCC
|
Facility
|
IP
|
$32,448.00
|
|
|
Service Code
|
MSDRG 618
|
| Min. Negotiated Rate |
$11,368.40 |
| Max. Negotiated Rate |
$32,448.00 |
| Rate for Payer: Aetna Managed Medicare |
$11,368.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$30,946.17
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$23,719.99
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$22,535.54
|
| Rate for Payer: Anthem Medicare Advantage |
$11,368.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$11,368.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$11,368.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$11,368.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$25,016.51
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$11,368.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$23,555.22
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$11,368.40
|
| Rate for Payer: Independent Care Health Plan Medicare |
$11,368.40
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$11,368.40
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$11,368.40
|
| Rate for Payer: NAPHCARE Commercial |
$17,052.59
|
| Rate for Payer: Quartz Medicare Advantage |
$11,368.40
|
| Rate for Payer: The Alliance Commercial |
$32,448.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$11,368.40
|
| Rate for Payer: United Healthcare PPO |
$18,338.04
|
| Rate for Payer: Wellcare Medicare |
$11,368.40
|
|
|
AMPUTATION OF TOE 28820
|
Professional
|
Both
|
$1,290.00
|
|
|
Service Code
|
CPT 28820
|
| Hospital Charge Code |
3014285
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$156.57 |
| Max. Negotiated Rate |
$1,274.52 |
| Rate for Payer: Aetna Commercial |
$1,274.52
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,153.78
|
| Rate for Payer: Aetna Managed Medicare |
$156.57
|
| Rate for Payer: Anthem Medicare Advantage |
$156.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$156.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$156.57
|
| Rate for Payer: Cash Price |
$387.00
|
| Rate for Payer: Cash Price |
$387.00
|
| Rate for Payer: Cash Price |
$387.00
|
| Rate for Payer: Cigna Commercial |
$1,274.52
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$188.03
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$156.57
|
| Rate for Payer: Health EOS Commercial |
$1,220.86
|
| Rate for Payer: HFN Commercial |
$1,274.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$627.99
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$627.99
|
| Rate for Payer: Independent Care Health Plan Medicare |
$156.57
|
| Rate for Payer: Multiplan Commercial |
$1,073.28
|
| Rate for Payer: NAPHCARE Commercial |
$234.86
|
| Rate for Payer: Preferred Network Access Commercial |
$1,274.52
|
| Rate for Payer: Quartz Beloit One Network |
$590.30
|
| Rate for Payer: Quartz Commercial |
$764.71
|
| Rate for Payer: Quartz Medicare Advantage |
$156.57
|
| Rate for Payer: The Alliance Commercial |
$665.43
|
| Rate for Payer: United Healthcare Medicaid |
$188.03
|
| Rate for Payer: United Healthcare Medicare Advantage |
$156.57
|
| Rate for Payer: WEA Trust Commercial |
$737.88
|
| Rate for Payer: WPS Commercial |
$704.57
|
|
|
AMPUTATION, PENILE
|
Facility
|
IP
|
$3,935.00
|
|
| Hospital Charge Code |
2959795
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,005.28 |
| Max. Negotiated Rate |
$3,765.01 |
| Rate for Payer: Aetna Commercial |
$3,683.16
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,519.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,168.97
|
| Rate for Payer: Cash Price |
$1,180.50
|
| Rate for Payer: Cigna Commercial |
$3,765.01
|
| Rate for Payer: Health EOS Commercial |
$3,642.24
|
| Rate for Payer: HFN Commercial |
$3,765.01
|
| Rate for Payer: Multiplan Commercial |
$3,273.92
|
| Rate for Payer: Preferred Network Access Commercial |
$3,765.01
|
| Rate for Payer: Quartz Beloit One Network |
$2,005.28
|
| Rate for Payer: Quartz Commercial |
$2,455.44
|
| Rate for Payer: WEA Trust Commercial |
$2,250.82
|
| Rate for Payer: WPS Commercial |
$3,031.13
|
|
|
AMPUTATION, PENILE
|
Facility
|
OP
|
$3,935.00
|
|
| Hospital Charge Code |
2959795
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,145.87 |
| Max. Negotiated Rate |
$3,765.01 |
| Rate for Payer: Aetna Commercial |
$3,683.16
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,519.46
|
| Rate for Payer: Aetna Managed Medicare |
$1,145.87
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,660.06
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,046.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,964.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,168.97
|
| Rate for Payer: Cash Price |
$1,180.50
|
| Rate for Payer: Cigna Commercial |
$3,765.01
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,290.17
|
| Rate for Payer: Health EOS Commercial |
$3,642.24
|
| Rate for Payer: HFN Commercial |
$3,765.01
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,069.30
|
| Rate for Payer: Multiplan Commercial |
$3,273.92
|
| Rate for Payer: NAPHCARE Commercial |
$2,455.44
|
| Rate for Payer: Preferred Network Access Commercial |
$3,765.01
|
| Rate for Payer: Quartz Beloit One Network |
$2,005.28
|
| Rate for Payer: Quartz Commercial |
$2,660.06
|
| Rate for Payer: Quartz Medicare Advantage |
$2,455.44
|
| Rate for Payer: The Alliance Commercial |
$2,046.20
|
| Rate for Payer: WEA Trust Commercial |
$2,250.82
|
| Rate for Payer: WPS Commercial |
$3,031.13
|
|
|
AMPUTATION, SHOULDER/HUMERUS
|
Facility
|
OP
|
$4,324.00
|
|
| Hospital Charge Code |
2959796
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,259.15 |
| Max. Negotiated Rate |
$4,137.20 |
| Rate for Payer: Aetna Commercial |
$4,047.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,867.39
|
| Rate for Payer: Aetna Managed Medicare |
$1,259.15
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,923.02
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,248.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,158.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,383.39
|
| Rate for Payer: Cash Price |
$1,297.20
|
| Rate for Payer: Cigna Commercial |
$4,137.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,516.57
|
| Rate for Payer: Health EOS Commercial |
$4,002.29
|
| Rate for Payer: HFN Commercial |
$4,137.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,372.72
|
| Rate for Payer: Multiplan Commercial |
$3,597.57
|
| Rate for Payer: NAPHCARE Commercial |
$2,698.18
|
| Rate for Payer: Preferred Network Access Commercial |
$4,137.20
|
| Rate for Payer: Quartz Beloit One Network |
$2,203.51
|
| Rate for Payer: Quartz Commercial |
$2,923.02
|
| Rate for Payer: Quartz Medicare Advantage |
$2,698.18
|
| Rate for Payer: The Alliance Commercial |
$2,248.48
|
| Rate for Payer: WEA Trust Commercial |
$2,473.33
|
| Rate for Payer: WPS Commercial |
$3,330.78
|
|
|
AMPUTATION, SHOULDER/HUMERUS
|
Facility
|
IP
|
$4,324.00
|
|
| Hospital Charge Code |
2959796
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,203.51 |
| Max. Negotiated Rate |
$4,137.20 |
| Rate for Payer: Aetna Commercial |
$4,047.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,867.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,383.39
|
| Rate for Payer: Cash Price |
$1,297.20
|
| Rate for Payer: Cigna Commercial |
$4,137.20
|
| Rate for Payer: Health EOS Commercial |
$4,002.29
|
| Rate for Payer: HFN Commercial |
$4,137.20
|
| Rate for Payer: Multiplan Commercial |
$3,597.57
|
| Rate for Payer: Preferred Network Access Commercial |
$4,137.20
|
| Rate for Payer: Quartz Beloit One Network |
$2,203.51
|
| Rate for Payer: Quartz Commercial |
$2,698.18
|
| Rate for Payer: WEA Trust Commercial |
$2,473.33
|
| Rate for Payer: WPS Commercial |
$3,330.78
|
|
|
AMPUTATION, THIGH, THROUGH FEMUR, ANY LEVEL; RE-AMPUTATION
|
Facility
|
OP
|
$13,773.68
|
|
|
Service Code
|
CPT 27596
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,443.42 |
| Max. Negotiated Rate |
$13,773.68 |
| Rate for Payer: Aetna Managed Medicare |
$3,443.42
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$10,303.28
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8,364.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7,944.56
|
| Rate for Payer: Anthem Medicare Advantage |
$3,443.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$3,443.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$3,443.42
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$3,443.42
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12,349.86
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$3,443.42
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$12,809.52
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$3,443.42
|
| Rate for Payer: Independent Care Health Plan Medicare |
$3,443.42
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$3,443.42
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$3,443.42
|
| Rate for Payer: NAPHCARE Commercial |
$5,165.13
|
| Rate for Payer: Quartz Medicare Advantage |
$3,443.42
|
| Rate for Payer: The Alliance Commercial |
$13,773.68
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,443.42
|
| Rate for Payer: United Healthcare PPO |
$4,267.12
|
| Rate for Payer: Wellcare Medicare |
$3,443.42
|
|
|
AMPUTATION, TOE; METATARSOPHALANGEAL JOINT
|
Facility
|
OP
|
$13,773.68
|
|
|
Service Code
|
CPT 28820
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,443.42 |
| Max. Negotiated Rate |
$13,773.68 |
| Rate for Payer: Aetna Managed Medicare |
$3,443.42
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$10,303.28
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8,364.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7,944.56
|
| Rate for Payer: Anthem Medicare Advantage |
$3,443.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$3,443.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$3,443.42
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$3,443.42
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,947.89
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$3,443.42
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$12,809.52
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$3,443.42
|
| Rate for Payer: Independent Care Health Plan Medicare |
$3,443.42
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$3,443.42
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$3,443.42
|
| Rate for Payer: NAPHCARE Commercial |
$5,165.13
|
| Rate for Payer: Quartz Medicare Advantage |
$3,443.42
|
| Rate for Payer: The Alliance Commercial |
$13,773.68
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,443.42
|
| Rate for Payer: United Healthcare PPO |
$4,267.12
|
| Rate for Payer: Wellcare Medicare |
$3,443.42
|
|
|
AMVISC PLUS 60081L
|
Facility
|
IP
|
$570.00
|
|
| Hospital Charge Code |
5415289
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$290.47 |
| Max. Negotiated Rate |
$545.38 |
| Rate for Payer: Aetna Commercial |
$533.52
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$509.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$314.18
|
| Rate for Payer: Cash Price |
$171.00
|
| Rate for Payer: Cigna Commercial |
$545.38
|
| Rate for Payer: Health EOS Commercial |
$527.59
|
| Rate for Payer: HFN Commercial |
$545.38
|
| Rate for Payer: Multiplan Commercial |
$474.24
|
| Rate for Payer: Preferred Network Access Commercial |
$545.38
|
| Rate for Payer: Quartz Beloit One Network |
$290.47
|
| Rate for Payer: Quartz Commercial |
$355.68
|
| Rate for Payer: WEA Trust Commercial |
$326.04
|
| Rate for Payer: WPS Commercial |
$439.07
|
|
|
AMVISC PLUS 60081L
|
Facility
|
OP
|
$570.00
|
|
| Hospital Charge Code |
5415289
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$165.98 |
| Max. Negotiated Rate |
$545.38 |
| Rate for Payer: Aetna Commercial |
$533.52
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$509.81
|
| Rate for Payer: Aetna Managed Medicare |
$165.98
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$385.32
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$296.40
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$284.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$314.18
|
| Rate for Payer: Cash Price |
$171.00
|
| Rate for Payer: Cigna Commercial |
$545.38
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$331.74
|
| Rate for Payer: Health EOS Commercial |
$527.59
|
| Rate for Payer: HFN Commercial |
$545.38
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$444.60
|
| Rate for Payer: Multiplan Commercial |
$474.24
|
| Rate for Payer: NAPHCARE Commercial |
$355.68
|
| Rate for Payer: Preferred Network Access Commercial |
$545.38
|
| Rate for Payer: Quartz Beloit One Network |
$290.47
|
| Rate for Payer: Quartz Commercial |
$385.32
|
| Rate for Payer: Quartz Medicare Advantage |
$355.68
|
| Rate for Payer: The Alliance Commercial |
$296.40
|
| Rate for Payer: WEA Trust Commercial |
$326.04
|
| Rate for Payer: WPS Commercial |
$439.07
|
|
|
Amylase 24 Hour Urine
|
Facility
|
IP
|
$67.00
|
|
|
Service Code
|
CPT 82150
|
| Hospital Charge Code |
3315632
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$34.14 |
| Max. Negotiated Rate |
$64.11 |
| Rate for Payer: Aetna Commercial |
$62.71
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$59.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$36.93
|
| Rate for Payer: Cash Price |
$20.10
|
| Rate for Payer: Cigna Commercial |
$64.11
|
| Rate for Payer: Health EOS Commercial |
$62.02
|
| Rate for Payer: HFN Commercial |
$64.11
|
| Rate for Payer: Multiplan Commercial |
$55.74
|
| Rate for Payer: Preferred Network Access Commercial |
$64.11
|
| Rate for Payer: Quartz Beloit One Network |
$34.14
|
| Rate for Payer: Quartz Commercial |
$41.81
|
| Rate for Payer: WEA Trust Commercial |
$38.32
|
| Rate for Payer: WPS Commercial |
$51.61
|
|
|
Amylase 24 Hour Urine
|
Professional
|
Both
|
$67.00
|
|
|
Service Code
|
CPT 82150
|
| Hospital Charge Code |
3315632
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.74 |
| Max. Negotiated Rate |
$66.20 |
| Rate for Payer: Aetna Commercial |
$66.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$59.92
|
| Rate for Payer: Aetna Managed Medicare |
$6.74
|
| Rate for Payer: Anthem Medicare Advantage |
$6.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$6.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$6.74
|
| Rate for Payer: Cash Price |
$20.10
|
| Rate for Payer: Cash Price |
$20.10
|
| Rate for Payer: Cigna Commercial |
$66.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$34.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6.74
|
| Rate for Payer: Health EOS Commercial |
$63.41
|
| Rate for Payer: HFN Commercial |
$66.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$23.78
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$23.78
|
| Rate for Payer: Independent Care Health Plan Medicare |
$6.74
|
| Rate for Payer: Multiplan Commercial |
$55.74
|
| Rate for Payer: NAPHCARE Commercial |
$10.11
|
| Rate for Payer: Preferred Network Access Commercial |
$66.20
|
| Rate for Payer: Quartz Beloit One Network |
$30.66
|
| Rate for Payer: Quartz Commercial |
$39.72
|
| Rate for Payer: Quartz Medicare Advantage |
$6.74
|
| Rate for Payer: The Alliance Commercial |
$26.62
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6.74
|
| Rate for Payer: WEA Trust Commercial |
$38.32
|
| Rate for Payer: WPS Commercial |
$29.65
|
|
|
Amylase 24 Hour Urine
|
Facility
|
OP
|
$67.00
|
|
|
Service Code
|
CPT 82150
|
| Hospital Charge Code |
3315632
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.74 |
| Max. Negotiated Rate |
$64.11 |
| Rate for Payer: Aetna Commercial |
$62.71
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$59.92
|
| Rate for Payer: Aetna Managed Medicare |
$6.74
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$25.27
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$11.79
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$11.19
|
| Rate for Payer: Anthem Medicare Advantage |
$6.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$36.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$6.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$6.74
|
| Rate for Payer: Cash Price |
$20.10
|
| Rate for Payer: Cash Price |
$20.10
|
| Rate for Payer: Cigna Commercial |
$64.11
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$6.74
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$38.99
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$6.74
|
| Rate for Payer: Health EOS Commercial |
$62.02
|
| Rate for Payer: HFN Commercial |
$64.11
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$25.07
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$6.74
|
| Rate for Payer: Independent Care Health Plan Medicare |
$6.74
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$6.74
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$6.74
|
| Rate for Payer: Multiplan Commercial |
$55.74
|
| Rate for Payer: NAPHCARE Commercial |
$10.11
|
| Rate for Payer: Preferred Network Access Commercial |
$64.11
|
| Rate for Payer: Quartz Beloit One Network |
$34.14
|
| Rate for Payer: Quartz Commercial |
$45.29
|
| Rate for Payer: Quartz Medicare Advantage |
$6.74
|
| Rate for Payer: The Alliance Commercial |
$26.96
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6.74
|
| Rate for Payer: United Healthcare PPO |
$52.26
|
| Rate for Payer: WEA Trust Commercial |
$38.32
|
| Rate for Payer: Wellcare Medicare |
$6.74
|
| Rate for Payer: WPS Commercial |
$51.61
|
|
|
Amylase Level
|
Professional
|
Both
|
$162.00
|
|
|
Service Code
|
CPT 82150
|
| Hospital Charge Code |
631567
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.74 |
| Max. Negotiated Rate |
$160.06 |
| Rate for Payer: Aetna Commercial |
$160.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$144.89
|
| Rate for Payer: Aetna Managed Medicare |
$6.74
|
| Rate for Payer: Anthem Medicare Advantage |
$6.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$6.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$6.74
|
| Rate for Payer: Cash Price |
$48.60
|
| Rate for Payer: Cash Price |
$48.60
|
| Rate for Payer: Cigna Commercial |
$160.06
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$84.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6.74
|
| Rate for Payer: Health EOS Commercial |
$153.32
|
| Rate for Payer: HFN Commercial |
$160.06
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$23.78
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$23.78
|
| Rate for Payer: Independent Care Health Plan Medicare |
$6.74
|
| Rate for Payer: Multiplan Commercial |
$134.78
|
| Rate for Payer: NAPHCARE Commercial |
$10.11
|
| Rate for Payer: Preferred Network Access Commercial |
$160.06
|
| Rate for Payer: Quartz Beloit One Network |
$74.13
|
| Rate for Payer: Quartz Commercial |
$96.03
|
| Rate for Payer: Quartz Medicare Advantage |
$6.74
|
| Rate for Payer: The Alliance Commercial |
$26.62
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6.74
|
| Rate for Payer: WEA Trust Commercial |
$92.66
|
| Rate for Payer: WPS Commercial |
$29.65
|
|
|
Amylase Level
|
Facility
|
OP
|
$162.00
|
|
|
Service Code
|
CPT 82150
|
| Hospital Charge Code |
631567
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.74 |
| Max. Negotiated Rate |
$155.00 |
| Rate for Payer: Aetna Commercial |
$151.63
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$144.89
|
| Rate for Payer: Aetna Managed Medicare |
$6.74
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$25.27
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$11.79
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$11.19
|
| Rate for Payer: Anthem Medicare Advantage |
$6.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$89.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$6.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$6.74
|
| Rate for Payer: Cash Price |
$48.60
|
| Rate for Payer: Cash Price |
$48.60
|
| Rate for Payer: Cigna Commercial |
$155.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$6.74
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$94.28
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$6.74
|
| Rate for Payer: Health EOS Commercial |
$149.95
|
| Rate for Payer: HFN Commercial |
$155.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$25.07
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$6.74
|
| Rate for Payer: Independent Care Health Plan Medicare |
$6.74
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$6.74
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$6.74
|
| Rate for Payer: Multiplan Commercial |
$134.78
|
| Rate for Payer: NAPHCARE Commercial |
$10.11
|
| Rate for Payer: Preferred Network Access Commercial |
$155.00
|
| Rate for Payer: Quartz Beloit One Network |
$82.56
|
| Rate for Payer: Quartz Commercial |
$109.51
|
| Rate for Payer: Quartz Medicare Advantage |
$6.74
|
| Rate for Payer: The Alliance Commercial |
$26.96
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6.74
|
| Rate for Payer: United Healthcare PPO |
$126.36
|
| Rate for Payer: WEA Trust Commercial |
$92.66
|
| Rate for Payer: Wellcare Medicare |
$6.74
|
| Rate for Payer: WPS Commercial |
$124.79
|
|
|
Amylase Level
|
Facility
|
IP
|
$162.00
|
|
|
Service Code
|
CPT 82150
|
| Hospital Charge Code |
631567
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$82.56 |
| Max. Negotiated Rate |
$155.00 |
| Rate for Payer: Aetna Commercial |
$151.63
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$144.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$89.29
|
| Rate for Payer: Cash Price |
$48.60
|
| Rate for Payer: Cigna Commercial |
$155.00
|
| Rate for Payer: Health EOS Commercial |
$149.95
|
| Rate for Payer: HFN Commercial |
$155.00
|
| Rate for Payer: Multiplan Commercial |
$134.78
|
| Rate for Payer: Preferred Network Access Commercial |
$155.00
|
| Rate for Payer: Quartz Beloit One Network |
$82.56
|
| Rate for Payer: Quartz Commercial |
$101.09
|
| Rate for Payer: WEA Trust Commercial |
$92.66
|
| Rate for Payer: WPS Commercial |
$124.79
|
|
|
Amylase, Peritoneal Fluid
|
Facility
|
IP
|
$54.00
|
|
|
Service Code
|
CPT 82150
|
| Hospital Charge Code |
3154867
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$27.52 |
| Max. Negotiated Rate |
$51.67 |
| Rate for Payer: Aetna Commercial |
$50.54
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$48.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$29.76
|
| Rate for Payer: Cash Price |
$16.20
|
| Rate for Payer: Cigna Commercial |
$51.67
|
| Rate for Payer: Health EOS Commercial |
$49.98
|
| Rate for Payer: HFN Commercial |
$51.67
|
| Rate for Payer: Multiplan Commercial |
$44.93
|
| Rate for Payer: Preferred Network Access Commercial |
$51.67
|
| Rate for Payer: Quartz Beloit One Network |
$27.52
|
| Rate for Payer: Quartz Commercial |
$33.70
|
| Rate for Payer: WEA Trust Commercial |
$30.89
|
| Rate for Payer: WPS Commercial |
$41.60
|
|
|
Amylase, Peritoneal Fluid
|
Facility
|
OP
|
$54.00
|
|
|
Service Code
|
CPT 82150
|
| Hospital Charge Code |
3154867
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.74 |
| Max. Negotiated Rate |
$51.67 |
| Rate for Payer: Aetna Commercial |
$50.54
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$48.30
|
| Rate for Payer: Aetna Managed Medicare |
$6.74
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$25.27
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$11.79
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$11.19
|
| Rate for Payer: Anthem Medicare Advantage |
$6.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$29.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$6.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$6.74
|
| Rate for Payer: Cash Price |
$16.20
|
| Rate for Payer: Cash Price |
$16.20
|
| Rate for Payer: Cigna Commercial |
$51.67
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$6.74
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$31.43
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$6.74
|
| Rate for Payer: Health EOS Commercial |
$49.98
|
| Rate for Payer: HFN Commercial |
$51.67
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$25.07
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$6.74
|
| Rate for Payer: Independent Care Health Plan Medicare |
$6.74
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$6.74
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$6.74
|
| Rate for Payer: Multiplan Commercial |
$44.93
|
| Rate for Payer: NAPHCARE Commercial |
$10.11
|
| Rate for Payer: Preferred Network Access Commercial |
$51.67
|
| Rate for Payer: Quartz Beloit One Network |
$27.52
|
| Rate for Payer: Quartz Commercial |
$36.50
|
| Rate for Payer: Quartz Medicare Advantage |
$6.74
|
| Rate for Payer: The Alliance Commercial |
$26.96
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6.74
|
| Rate for Payer: United Healthcare PPO |
$42.12
|
| Rate for Payer: WEA Trust Commercial |
$30.89
|
| Rate for Payer: Wellcare Medicare |
$6.74
|
| Rate for Payer: WPS Commercial |
$41.60
|
|
|
Amylase, Peritoneal Fluid
|
Professional
|
Both
|
$54.00
|
|
|
Service Code
|
CPT 82150
|
| Hospital Charge Code |
3154867
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.74 |
| Max. Negotiated Rate |
$53.35 |
| Rate for Payer: Aetna Commercial |
$53.35
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$48.30
|
| Rate for Payer: Aetna Managed Medicare |
$6.74
|
| Rate for Payer: Anthem Medicare Advantage |
$6.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$6.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$6.74
|
| Rate for Payer: Cash Price |
$16.20
|
| Rate for Payer: Cash Price |
$16.20
|
| Rate for Payer: Cigna Commercial |
$53.35
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$28.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6.74
|
| Rate for Payer: Health EOS Commercial |
$51.11
|
| Rate for Payer: HFN Commercial |
$53.35
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$23.78
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$23.78
|
| Rate for Payer: Independent Care Health Plan Medicare |
$6.74
|
| Rate for Payer: Multiplan Commercial |
$44.93
|
| Rate for Payer: NAPHCARE Commercial |
$10.11
|
| Rate for Payer: Preferred Network Access Commercial |
$53.35
|
| Rate for Payer: Quartz Beloit One Network |
$24.71
|
| Rate for Payer: Quartz Commercial |
$32.01
|
| Rate for Payer: Quartz Medicare Advantage |
$6.74
|
| Rate for Payer: The Alliance Commercial |
$26.62
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6.74
|
| Rate for Payer: WEA Trust Commercial |
$30.89
|
| Rate for Payer: WPS Commercial |
$29.65
|
|
|
Amylase, Pleural Fluid
|
Facility
|
OP
|
$54.00
|
|
|
Service Code
|
CPT 82150
|
| Hospital Charge Code |
3154866
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.74 |
| Max. Negotiated Rate |
$51.67 |
| Rate for Payer: Aetna Commercial |
$50.54
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$48.30
|
| Rate for Payer: Aetna Managed Medicare |
$6.74
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$25.27
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$11.79
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$11.19
|
| Rate for Payer: Anthem Medicare Advantage |
$6.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$29.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$6.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$6.74
|
| Rate for Payer: Cash Price |
$16.20
|
| Rate for Payer: Cash Price |
$16.20
|
| Rate for Payer: Cigna Commercial |
$51.67
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$6.74
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$31.43
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$6.74
|
| Rate for Payer: Health EOS Commercial |
$49.98
|
| Rate for Payer: HFN Commercial |
$51.67
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$25.07
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$6.74
|
| Rate for Payer: Independent Care Health Plan Medicare |
$6.74
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$6.74
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$6.74
|
| Rate for Payer: Multiplan Commercial |
$44.93
|
| Rate for Payer: NAPHCARE Commercial |
$10.11
|
| Rate for Payer: Preferred Network Access Commercial |
$51.67
|
| Rate for Payer: Quartz Beloit One Network |
$27.52
|
| Rate for Payer: Quartz Commercial |
$36.50
|
| Rate for Payer: Quartz Medicare Advantage |
$6.74
|
| Rate for Payer: The Alliance Commercial |
$26.96
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6.74
|
| Rate for Payer: United Healthcare PPO |
$42.12
|
| Rate for Payer: WEA Trust Commercial |
$30.89
|
| Rate for Payer: Wellcare Medicare |
$6.74
|
| Rate for Payer: WPS Commercial |
$41.60
|
|
|
Amylase, Pleural Fluid
|
Professional
|
Both
|
$54.00
|
|
|
Service Code
|
CPT 82150
|
| Hospital Charge Code |
3154866
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.74 |
| Max. Negotiated Rate |
$53.35 |
| Rate for Payer: Aetna Commercial |
$53.35
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$48.30
|
| Rate for Payer: Aetna Managed Medicare |
$6.74
|
| Rate for Payer: Anthem Medicare Advantage |
$6.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$6.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$6.74
|
| Rate for Payer: Cash Price |
$16.20
|
| Rate for Payer: Cash Price |
$16.20
|
| Rate for Payer: Cigna Commercial |
$53.35
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$28.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6.74
|
| Rate for Payer: Health EOS Commercial |
$51.11
|
| Rate for Payer: HFN Commercial |
$53.35
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$23.78
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$23.78
|
| Rate for Payer: Independent Care Health Plan Medicare |
$6.74
|
| Rate for Payer: Multiplan Commercial |
$44.93
|
| Rate for Payer: NAPHCARE Commercial |
$10.11
|
| Rate for Payer: Preferred Network Access Commercial |
$53.35
|
| Rate for Payer: Quartz Beloit One Network |
$24.71
|
| Rate for Payer: Quartz Commercial |
$32.01
|
| Rate for Payer: Quartz Medicare Advantage |
$6.74
|
| Rate for Payer: The Alliance Commercial |
$26.62
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6.74
|
| Rate for Payer: WEA Trust Commercial |
$30.89
|
| Rate for Payer: WPS Commercial |
$29.65
|
|
|
Amylase, Pleural Fluid
|
Facility
|
IP
|
$54.00
|
|
|
Service Code
|
CPT 82150
|
| Hospital Charge Code |
3154866
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$27.52 |
| Max. Negotiated Rate |
$51.67 |
| Rate for Payer: Aetna Commercial |
$50.54
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$48.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$29.76
|
| Rate for Payer: Cash Price |
$16.20
|
| Rate for Payer: Cigna Commercial |
$51.67
|
| Rate for Payer: Health EOS Commercial |
$49.98
|
| Rate for Payer: HFN Commercial |
$51.67
|
| Rate for Payer: Multiplan Commercial |
$44.93
|
| Rate for Payer: Preferred Network Access Commercial |
$51.67
|
| Rate for Payer: Quartz Beloit One Network |
$27.52
|
| Rate for Payer: Quartz Commercial |
$33.70
|
| Rate for Payer: WEA Trust Commercial |
$30.89
|
| Rate for Payer: WPS Commercial |
$41.60
|
|
|
Amyloid B Protein
|
Facility
|
IP
|
$493.00
|
|
|
Service Code
|
CPT 83519
|
| Hospital Charge Code |
5502670
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$251.23 |
| Max. Negotiated Rate |
$471.70 |
| Rate for Payer: Aetna Commercial |
$461.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$440.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$271.74
|
| Rate for Payer: Cash Price |
$147.90
|
| Rate for Payer: Cigna Commercial |
$471.70
|
| Rate for Payer: Health EOS Commercial |
$456.32
|
| Rate for Payer: HFN Commercial |
$471.70
|
| Rate for Payer: Multiplan Commercial |
$410.18
|
| Rate for Payer: Preferred Network Access Commercial |
$471.70
|
| Rate for Payer: Quartz Beloit One Network |
$251.23
|
| Rate for Payer: Quartz Commercial |
$307.63
|
| Rate for Payer: WEA Trust Commercial |
$282.00
|
| Rate for Payer: WPS Commercial |
$379.76
|
|
|
Amyloid B Protein
|
Facility
|
OP
|
$493.00
|
|
|
Service Code
|
CPT 83519
|
| Hospital Charge Code |
5502670
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$19.14 |
| Max. Negotiated Rate |
$471.70 |
| Rate for Payer: Aetna Commercial |
$461.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$440.94
|
| Rate for Payer: Aetna Managed Medicare |
$19.14
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$71.76
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$33.49
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$31.77
|
| Rate for Payer: Anthem Medicare Advantage |
$19.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$271.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$19.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$19.14
|
| Rate for Payer: Cash Price |
$147.90
|
| Rate for Payer: Cash Price |
$147.90
|
| Rate for Payer: Cigna Commercial |
$471.70
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$19.14
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$286.93
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$19.14
|
| Rate for Payer: Health EOS Commercial |
$456.32
|
| Rate for Payer: HFN Commercial |
$471.70
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$71.19
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$19.14
|
| Rate for Payer: Independent Care Health Plan Medicare |
$19.14
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$19.14
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$19.14
|
| Rate for Payer: Multiplan Commercial |
$410.18
|
| Rate for Payer: NAPHCARE Commercial |
$28.70
|
| Rate for Payer: Preferred Network Access Commercial |
$471.70
|
| Rate for Payer: Quartz Beloit One Network |
$251.23
|
| Rate for Payer: Quartz Commercial |
$333.27
|
| Rate for Payer: Quartz Medicare Advantage |
$19.14
|
| Rate for Payer: The Alliance Commercial |
$76.54
|
| Rate for Payer: United Healthcare Medicare Advantage |
$19.14
|
| Rate for Payer: United Healthcare PPO |
$384.54
|
| Rate for Payer: WEA Trust Commercial |
$282.00
|
| Rate for Payer: Wellcare Medicare |
$19.14
|
| Rate for Payer: WPS Commercial |
$379.76
|
|
