|
LDL Direct
|
Facility
|
OP
|
$261.00
|
|
|
Service Code
|
CPT 83721
|
| Hospital Charge Code |
633704
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.92 |
| Max. Negotiated Rate |
$249.72 |
| Rate for Payer: Aetna Commercial |
$244.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$233.44
|
| Rate for Payer: Aetna Managed Medicare |
$10.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$40.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$19.11
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$18.13
|
| Rate for Payer: Anthem Medicare Advantage |
$10.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$143.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$10.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$10.92
|
| Rate for Payer: Cash Price |
$78.30
|
| Rate for Payer: Cash Price |
$78.30
|
| Rate for Payer: Cigna Commercial |
$249.72
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$10.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$151.90
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$10.92
|
| Rate for Payer: Health EOS Commercial |
$241.58
|
| Rate for Payer: HFN Commercial |
$249.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$40.62
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$10.92
|
| Rate for Payer: Independent Care Health Plan Medicare |
$10.92
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$10.92
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$10.92
|
| Rate for Payer: Multiplan Commercial |
$217.15
|
| Rate for Payer: NAPHCARE Commercial |
$16.38
|
| Rate for Payer: Preferred Network Access Commercial |
$249.72
|
| Rate for Payer: Quartz Beloit One Network |
$133.01
|
| Rate for Payer: Quartz Commercial |
$176.44
|
| Rate for Payer: Quartz Medicare Advantage |
$10.92
|
| Rate for Payer: The Alliance Commercial |
$43.68
|
| Rate for Payer: United Healthcare Medicare Advantage |
$10.92
|
| Rate for Payer: United Healthcare PPO |
$203.58
|
| Rate for Payer: WEA Trust Commercial |
$149.29
|
| Rate for Payer: Wellcare Medicare |
$10.92
|
| Rate for Payer: WPS Commercial |
$201.05
|
|
|
LDL Direct
|
Facility
|
IP
|
$261.00
|
|
|
Service Code
|
CPT 83721
|
| Hospital Charge Code |
633704
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$133.01 |
| Max. Negotiated Rate |
$249.72 |
| Rate for Payer: Aetna Commercial |
$244.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$233.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$143.86
|
| Rate for Payer: Cash Price |
$78.30
|
| Rate for Payer: Cigna Commercial |
$249.72
|
| Rate for Payer: Health EOS Commercial |
$241.58
|
| Rate for Payer: HFN Commercial |
$249.72
|
| Rate for Payer: Multiplan Commercial |
$217.15
|
| Rate for Payer: Preferred Network Access Commercial |
$249.72
|
| Rate for Payer: Quartz Beloit One Network |
$133.01
|
| Rate for Payer: Quartz Commercial |
$162.86
|
| Rate for Payer: WEA Trust Commercial |
$149.29
|
| Rate for Payer: WPS Commercial |
$201.05
|
|
|
LDL Direct
|
Professional
|
Both
|
$261.00
|
|
|
Service Code
|
CPT 83721
|
| Hospital Charge Code |
633704
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.92 |
| Max. Negotiated Rate |
$257.87 |
| Rate for Payer: Aetna Commercial |
$257.87
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$233.44
|
| Rate for Payer: Aetna Managed Medicare |
$10.92
|
| Rate for Payer: Anthem Medicare Advantage |
$10.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$10.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$10.92
|
| Rate for Payer: Cash Price |
$78.30
|
| Rate for Payer: Cash Price |
$78.30
|
| Rate for Payer: Cigna Commercial |
$257.87
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$135.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$10.92
|
| Rate for Payer: Health EOS Commercial |
$247.01
|
| Rate for Payer: HFN Commercial |
$257.87
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$38.55
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$38.55
|
| Rate for Payer: Independent Care Health Plan Medicare |
$10.92
|
| Rate for Payer: Multiplan Commercial |
$217.15
|
| Rate for Payer: NAPHCARE Commercial |
$16.38
|
| Rate for Payer: Preferred Network Access Commercial |
$257.87
|
| Rate for Payer: Quartz Beloit One Network |
$119.43
|
| Rate for Payer: Quartz Commercial |
$154.72
|
| Rate for Payer: Quartz Medicare Advantage |
$10.92
|
| Rate for Payer: The Alliance Commercial |
$43.13
|
| Rate for Payer: United Healthcare Medicare Advantage |
$10.92
|
| Rate for Payer: WEA Trust Commercial |
$149.29
|
| Rate for Payer: WPS Commercial |
$48.05
|
|
|
LDL Particle Number
|
Facility
|
OP
|
$110.00
|
|
|
Service Code
|
CPT 83704
|
| Hospital Charge Code |
4566648
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$35.56 |
| Max. Negotiated Rate |
$142.23 |
| Rate for Payer: Aetna Commercial |
$102.96
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$98.38
|
| Rate for Payer: Aetna Managed Medicare |
$35.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$133.34
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$62.23
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$59.03
|
| Rate for Payer: Anthem Medicare Advantage |
$35.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$60.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$35.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$35.56
|
| Rate for Payer: Cash Price |
$33.00
|
| Rate for Payer: Cash Price |
$33.00
|
| Rate for Payer: Cigna Commercial |
$105.25
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$35.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$64.02
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$35.56
|
| Rate for Payer: Health EOS Commercial |
$101.82
|
| Rate for Payer: HFN Commercial |
$105.25
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$132.27
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$35.56
|
| Rate for Payer: Independent Care Health Plan Medicare |
$35.56
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$35.56
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$35.56
|
| Rate for Payer: Multiplan Commercial |
$91.52
|
| Rate for Payer: NAPHCARE Commercial |
$53.34
|
| Rate for Payer: Preferred Network Access Commercial |
$105.25
|
| Rate for Payer: Quartz Beloit One Network |
$56.06
|
| Rate for Payer: Quartz Commercial |
$74.36
|
| Rate for Payer: Quartz Medicare Advantage |
$35.56
|
| Rate for Payer: The Alliance Commercial |
$142.23
|
| Rate for Payer: United Healthcare Medicare Advantage |
$35.56
|
| Rate for Payer: United Healthcare PPO |
$85.80
|
| Rate for Payer: WEA Trust Commercial |
$62.92
|
| Rate for Payer: Wellcare Medicare |
$35.56
|
| Rate for Payer: WPS Commercial |
$84.73
|
|
|
LDL Particle Number
|
Professional
|
Both
|
$110.00
|
|
|
Service Code
|
CPT 83704
|
| Hospital Charge Code |
4566648
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$35.56 |
| Max. Negotiated Rate |
$156.45 |
| Rate for Payer: Aetna Commercial |
$108.68
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$98.38
|
| Rate for Payer: Aetna Managed Medicare |
$35.56
|
| Rate for Payer: Anthem Medicare Advantage |
$35.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$35.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$35.56
|
| Rate for Payer: Cash Price |
$33.00
|
| Rate for Payer: Cash Price |
$33.00
|
| Rate for Payer: Cigna Commercial |
$108.68
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$57.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$35.56
|
| Rate for Payer: Health EOS Commercial |
$104.10
|
| Rate for Payer: HFN Commercial |
$108.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$125.52
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$125.52
|
| Rate for Payer: Independent Care Health Plan Medicare |
$35.56
|
| Rate for Payer: Multiplan Commercial |
$91.52
|
| Rate for Payer: NAPHCARE Commercial |
$53.34
|
| Rate for Payer: Preferred Network Access Commercial |
$108.68
|
| Rate for Payer: Quartz Beloit One Network |
$50.34
|
| Rate for Payer: Quartz Commercial |
$65.21
|
| Rate for Payer: Quartz Medicare Advantage |
$35.56
|
| Rate for Payer: The Alliance Commercial |
$140.45
|
| Rate for Payer: United Healthcare Medicare Advantage |
$35.56
|
| Rate for Payer: WEA Trust Commercial |
$62.92
|
| Rate for Payer: WPS Commercial |
$156.45
|
|
|
LDL Particle Number
|
Facility
|
IP
|
$110.00
|
|
|
Service Code
|
CPT 83704
|
| Hospital Charge Code |
4566648
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$56.06 |
| Max. Negotiated Rate |
$105.25 |
| Rate for Payer: Aetna Commercial |
$102.96
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$98.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$60.63
|
| Rate for Payer: Cash Price |
$33.00
|
| Rate for Payer: Cigna Commercial |
$105.25
|
| Rate for Payer: Health EOS Commercial |
$101.82
|
| Rate for Payer: HFN Commercial |
$105.25
|
| Rate for Payer: Multiplan Commercial |
$91.52
|
| Rate for Payer: Preferred Network Access Commercial |
$105.25
|
| Rate for Payer: Quartz Beloit One Network |
$56.06
|
| Rate for Payer: Quartz Commercial |
$68.64
|
| Rate for Payer: WEA Trust Commercial |
$62.92
|
| Rate for Payer: WPS Commercial |
$84.73
|
|
|
LD, Pericardial Fluid
|
Facility
|
OP
|
$103.00
|
|
|
Service Code
|
CPT 83615
|
| Hospital Charge Code |
3154872
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.28 |
| Max. Negotiated Rate |
$98.55 |
| Rate for Payer: Aetna Commercial |
$96.41
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$92.12
|
| Rate for Payer: Aetna Managed Medicare |
$6.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$23.56
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$10.99
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$10.43
|
| Rate for Payer: Anthem Medicare Advantage |
$6.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$56.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$6.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$6.28
|
| Rate for Payer: Cash Price |
$30.90
|
| Rate for Payer: Cash Price |
$30.90
|
| Rate for Payer: Cigna Commercial |
$98.55
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$6.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$59.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$6.28
|
| Rate for Payer: Health EOS Commercial |
$95.34
|
| Rate for Payer: HFN Commercial |
$98.55
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$23.37
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$6.28
|
| Rate for Payer: Independent Care Health Plan Medicare |
$6.28
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$6.28
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$6.28
|
| Rate for Payer: Multiplan Commercial |
$85.70
|
| Rate for Payer: NAPHCARE Commercial |
$9.42
|
| Rate for Payer: Preferred Network Access Commercial |
$98.55
|
| Rate for Payer: Quartz Beloit One Network |
$52.49
|
| Rate for Payer: Quartz Commercial |
$69.63
|
| Rate for Payer: Quartz Medicare Advantage |
$6.28
|
| Rate for Payer: The Alliance Commercial |
$25.13
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6.28
|
| Rate for Payer: United Healthcare PPO |
$80.34
|
| Rate for Payer: WEA Trust Commercial |
$58.92
|
| Rate for Payer: Wellcare Medicare |
$6.28
|
| Rate for Payer: WPS Commercial |
$79.34
|
|
|
LD, Pericardial Fluid
|
Professional
|
Both
|
$103.00
|
|
|
Service Code
|
CPT 83615
|
| Hospital Charge Code |
3154872
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.28 |
| Max. Negotiated Rate |
$101.76 |
| Rate for Payer: Aetna Commercial |
$101.76
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$92.12
|
| Rate for Payer: Aetna Managed Medicare |
$6.28
|
| Rate for Payer: Anthem Medicare Advantage |
$6.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$6.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$6.28
|
| Rate for Payer: Cash Price |
$30.90
|
| Rate for Payer: Cash Price |
$30.90
|
| Rate for Payer: Cigna Commercial |
$101.76
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$53.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6.28
|
| Rate for Payer: Health EOS Commercial |
$97.48
|
| Rate for Payer: HFN Commercial |
$101.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$22.17
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$22.17
|
| Rate for Payer: Independent Care Health Plan Medicare |
$6.28
|
| Rate for Payer: Multiplan Commercial |
$85.70
|
| Rate for Payer: NAPHCARE Commercial |
$9.42
|
| Rate for Payer: Preferred Network Access Commercial |
$101.76
|
| Rate for Payer: Quartz Beloit One Network |
$47.13
|
| Rate for Payer: Quartz Commercial |
$61.06
|
| Rate for Payer: Quartz Medicare Advantage |
$6.28
|
| Rate for Payer: The Alliance Commercial |
$24.81
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6.28
|
| Rate for Payer: WEA Trust Commercial |
$58.92
|
| Rate for Payer: WPS Commercial |
$27.64
|
|
|
LD, Pericardial Fluid
|
Facility
|
IP
|
$103.00
|
|
|
Service Code
|
CPT 83615
|
| Hospital Charge Code |
3154872
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$52.49 |
| Max. Negotiated Rate |
$98.55 |
| Rate for Payer: Aetna Commercial |
$96.41
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$92.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$56.77
|
| Rate for Payer: Cash Price |
$30.90
|
| Rate for Payer: Cigna Commercial |
$98.55
|
| Rate for Payer: Health EOS Commercial |
$95.34
|
| Rate for Payer: HFN Commercial |
$98.55
|
| Rate for Payer: Multiplan Commercial |
$85.70
|
| Rate for Payer: Preferred Network Access Commercial |
$98.55
|
| Rate for Payer: Quartz Beloit One Network |
$52.49
|
| Rate for Payer: Quartz Commercial |
$64.27
|
| Rate for Payer: WEA Trust Commercial |
$58.92
|
| Rate for Payer: WPS Commercial |
$79.34
|
|
|
LD, Peritoneal Fluid
|
Facility
|
IP
|
$103.00
|
|
|
Service Code
|
CPT 83615
|
| Hospital Charge Code |
3154874
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$52.49 |
| Max. Negotiated Rate |
$98.55 |
| Rate for Payer: Aetna Commercial |
$96.41
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$92.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$56.77
|
| Rate for Payer: Cash Price |
$30.90
|
| Rate for Payer: Cigna Commercial |
$98.55
|
| Rate for Payer: Health EOS Commercial |
$95.34
|
| Rate for Payer: HFN Commercial |
$98.55
|
| Rate for Payer: Multiplan Commercial |
$85.70
|
| Rate for Payer: Preferred Network Access Commercial |
$98.55
|
| Rate for Payer: Quartz Beloit One Network |
$52.49
|
| Rate for Payer: Quartz Commercial |
$64.27
|
| Rate for Payer: WEA Trust Commercial |
$58.92
|
| Rate for Payer: WPS Commercial |
$79.34
|
|
|
LD, Peritoneal Fluid
|
Professional
|
Both
|
$103.00
|
|
|
Service Code
|
CPT 83615
|
| Hospital Charge Code |
3154874
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.28 |
| Max. Negotiated Rate |
$101.76 |
| Rate for Payer: Aetna Commercial |
$101.76
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$92.12
|
| Rate for Payer: Aetna Managed Medicare |
$6.28
|
| Rate for Payer: Anthem Medicare Advantage |
$6.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$6.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$6.28
|
| Rate for Payer: Cash Price |
$30.90
|
| Rate for Payer: Cash Price |
$30.90
|
| Rate for Payer: Cigna Commercial |
$101.76
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$53.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6.28
|
| Rate for Payer: Health EOS Commercial |
$97.48
|
| Rate for Payer: HFN Commercial |
$101.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$22.17
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$22.17
|
| Rate for Payer: Independent Care Health Plan Medicare |
$6.28
|
| Rate for Payer: Multiplan Commercial |
$85.70
|
| Rate for Payer: NAPHCARE Commercial |
$9.42
|
| Rate for Payer: Preferred Network Access Commercial |
$101.76
|
| Rate for Payer: Quartz Beloit One Network |
$47.13
|
| Rate for Payer: Quartz Commercial |
$61.06
|
| Rate for Payer: Quartz Medicare Advantage |
$6.28
|
| Rate for Payer: The Alliance Commercial |
$24.81
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6.28
|
| Rate for Payer: WEA Trust Commercial |
$58.92
|
| Rate for Payer: WPS Commercial |
$27.64
|
|
|
LD, Peritoneal Fluid
|
Facility
|
OP
|
$103.00
|
|
|
Service Code
|
CPT 83615
|
| Hospital Charge Code |
3154874
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.28 |
| Max. Negotiated Rate |
$98.55 |
| Rate for Payer: Aetna Commercial |
$96.41
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$92.12
|
| Rate for Payer: Aetna Managed Medicare |
$6.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$23.56
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$10.99
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$10.43
|
| Rate for Payer: Anthem Medicare Advantage |
$6.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$56.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$6.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$6.28
|
| Rate for Payer: Cash Price |
$30.90
|
| Rate for Payer: Cash Price |
$30.90
|
| Rate for Payer: Cigna Commercial |
$98.55
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$6.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$59.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$6.28
|
| Rate for Payer: Health EOS Commercial |
$95.34
|
| Rate for Payer: HFN Commercial |
$98.55
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$23.37
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$6.28
|
| Rate for Payer: Independent Care Health Plan Medicare |
$6.28
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$6.28
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$6.28
|
| Rate for Payer: Multiplan Commercial |
$85.70
|
| Rate for Payer: NAPHCARE Commercial |
$9.42
|
| Rate for Payer: Preferred Network Access Commercial |
$98.55
|
| Rate for Payer: Quartz Beloit One Network |
$52.49
|
| Rate for Payer: Quartz Commercial |
$69.63
|
| Rate for Payer: Quartz Medicare Advantage |
$6.28
|
| Rate for Payer: The Alliance Commercial |
$25.13
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6.28
|
| Rate for Payer: United Healthcare PPO |
$80.34
|
| Rate for Payer: WEA Trust Commercial |
$58.92
|
| Rate for Payer: Wellcare Medicare |
$6.28
|
| Rate for Payer: WPS Commercial |
$79.34
|
|
|
LD, Pleural Fluid
|
Professional
|
Both
|
$103.00
|
|
|
Service Code
|
CPT 83615
|
| Hospital Charge Code |
3154873
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.28 |
| Max. Negotiated Rate |
$101.76 |
| Rate for Payer: Aetna Commercial |
$101.76
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$92.12
|
| Rate for Payer: Aetna Managed Medicare |
$6.28
|
| Rate for Payer: Anthem Medicare Advantage |
$6.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$6.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$6.28
|
| Rate for Payer: Cash Price |
$30.90
|
| Rate for Payer: Cash Price |
$30.90
|
| Rate for Payer: Cigna Commercial |
$101.76
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$53.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6.28
|
| Rate for Payer: Health EOS Commercial |
$97.48
|
| Rate for Payer: HFN Commercial |
$101.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$22.17
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$22.17
|
| Rate for Payer: Independent Care Health Plan Medicare |
$6.28
|
| Rate for Payer: Multiplan Commercial |
$85.70
|
| Rate for Payer: NAPHCARE Commercial |
$9.42
|
| Rate for Payer: Preferred Network Access Commercial |
$101.76
|
| Rate for Payer: Quartz Beloit One Network |
$47.13
|
| Rate for Payer: Quartz Commercial |
$61.06
|
| Rate for Payer: Quartz Medicare Advantage |
$6.28
|
| Rate for Payer: The Alliance Commercial |
$24.81
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6.28
|
| Rate for Payer: WEA Trust Commercial |
$58.92
|
| Rate for Payer: WPS Commercial |
$27.64
|
|
|
LD, Pleural Fluid
|
Facility
|
OP
|
$103.00
|
|
|
Service Code
|
CPT 83615
|
| Hospital Charge Code |
3154873
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.28 |
| Max. Negotiated Rate |
$98.55 |
| Rate for Payer: Aetna Commercial |
$96.41
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$92.12
|
| Rate for Payer: Aetna Managed Medicare |
$6.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$23.56
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$10.99
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$10.43
|
| Rate for Payer: Anthem Medicare Advantage |
$6.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$56.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$6.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$6.28
|
| Rate for Payer: Cash Price |
$30.90
|
| Rate for Payer: Cash Price |
$30.90
|
| Rate for Payer: Cigna Commercial |
$98.55
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$6.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$59.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$6.28
|
| Rate for Payer: Health EOS Commercial |
$95.34
|
| Rate for Payer: HFN Commercial |
$98.55
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$23.37
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$6.28
|
| Rate for Payer: Independent Care Health Plan Medicare |
$6.28
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$6.28
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$6.28
|
| Rate for Payer: Multiplan Commercial |
$85.70
|
| Rate for Payer: NAPHCARE Commercial |
$9.42
|
| Rate for Payer: Preferred Network Access Commercial |
$98.55
|
| Rate for Payer: Quartz Beloit One Network |
$52.49
|
| Rate for Payer: Quartz Commercial |
$69.63
|
| Rate for Payer: Quartz Medicare Advantage |
$6.28
|
| Rate for Payer: The Alliance Commercial |
$25.13
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6.28
|
| Rate for Payer: United Healthcare PPO |
$80.34
|
| Rate for Payer: WEA Trust Commercial |
$58.92
|
| Rate for Payer: Wellcare Medicare |
$6.28
|
| Rate for Payer: WPS Commercial |
$79.34
|
|
|
LD, Pleural Fluid
|
Facility
|
IP
|
$103.00
|
|
|
Service Code
|
CPT 83615
|
| Hospital Charge Code |
3154873
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$52.49 |
| Max. Negotiated Rate |
$98.55 |
| Rate for Payer: Aetna Commercial |
$96.41
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$92.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$56.77
|
| Rate for Payer: Cash Price |
$30.90
|
| Rate for Payer: Cigna Commercial |
$98.55
|
| Rate for Payer: Health EOS Commercial |
$95.34
|
| Rate for Payer: HFN Commercial |
$98.55
|
| Rate for Payer: Multiplan Commercial |
$85.70
|
| Rate for Payer: Preferred Network Access Commercial |
$98.55
|
| Rate for Payer: Quartz Beloit One Network |
$52.49
|
| Rate for Payer: Quartz Commercial |
$64.27
|
| Rate for Payer: WEA Trust Commercial |
$58.92
|
| Rate for Payer: WPS Commercial |
$79.34
|
|
|
LD, Synovial Fluid
|
Professional
|
Both
|
$103.00
|
|
|
Service Code
|
CPT 83615
|
| Hospital Charge Code |
3154875
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.28 |
| Max. Negotiated Rate |
$101.76 |
| Rate for Payer: Aetna Commercial |
$101.76
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$92.12
|
| Rate for Payer: Aetna Managed Medicare |
$6.28
|
| Rate for Payer: Anthem Medicare Advantage |
$6.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$6.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$6.28
|
| Rate for Payer: Cash Price |
$30.90
|
| Rate for Payer: Cash Price |
$30.90
|
| Rate for Payer: Cigna Commercial |
$101.76
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$53.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6.28
|
| Rate for Payer: Health EOS Commercial |
$97.48
|
| Rate for Payer: HFN Commercial |
$101.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$22.17
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$22.17
|
| Rate for Payer: Independent Care Health Plan Medicare |
$6.28
|
| Rate for Payer: Multiplan Commercial |
$85.70
|
| Rate for Payer: NAPHCARE Commercial |
$9.42
|
| Rate for Payer: Preferred Network Access Commercial |
$101.76
|
| Rate for Payer: Quartz Beloit One Network |
$47.13
|
| Rate for Payer: Quartz Commercial |
$61.06
|
| Rate for Payer: Quartz Medicare Advantage |
$6.28
|
| Rate for Payer: The Alliance Commercial |
$24.81
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6.28
|
| Rate for Payer: WEA Trust Commercial |
$58.92
|
| Rate for Payer: WPS Commercial |
$27.64
|
|
|
LD, Synovial Fluid
|
Facility
|
OP
|
$103.00
|
|
|
Service Code
|
CPT 83615
|
| Hospital Charge Code |
3154875
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.28 |
| Max. Negotiated Rate |
$98.55 |
| Rate for Payer: Aetna Commercial |
$96.41
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$92.12
|
| Rate for Payer: Aetna Managed Medicare |
$6.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$23.56
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$10.99
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$10.43
|
| Rate for Payer: Anthem Medicare Advantage |
$6.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$56.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$6.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$6.28
|
| Rate for Payer: Cash Price |
$30.90
|
| Rate for Payer: Cash Price |
$30.90
|
| Rate for Payer: Cigna Commercial |
$98.55
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$6.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$59.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$6.28
|
| Rate for Payer: Health EOS Commercial |
$95.34
|
| Rate for Payer: HFN Commercial |
$98.55
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$23.37
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$6.28
|
| Rate for Payer: Independent Care Health Plan Medicare |
$6.28
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$6.28
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$6.28
|
| Rate for Payer: Multiplan Commercial |
$85.70
|
| Rate for Payer: NAPHCARE Commercial |
$9.42
|
| Rate for Payer: Preferred Network Access Commercial |
$98.55
|
| Rate for Payer: Quartz Beloit One Network |
$52.49
|
| Rate for Payer: Quartz Commercial |
$69.63
|
| Rate for Payer: Quartz Medicare Advantage |
$6.28
|
| Rate for Payer: The Alliance Commercial |
$25.13
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6.28
|
| Rate for Payer: United Healthcare PPO |
$80.34
|
| Rate for Payer: WEA Trust Commercial |
$58.92
|
| Rate for Payer: Wellcare Medicare |
$6.28
|
| Rate for Payer: WPS Commercial |
$79.34
|
|
|
LD, Synovial Fluid
|
Facility
|
IP
|
$103.00
|
|
|
Service Code
|
CPT 83615
|
| Hospital Charge Code |
3154875
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$52.49 |
| Max. Negotiated Rate |
$98.55 |
| Rate for Payer: Aetna Commercial |
$96.41
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$92.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$56.77
|
| Rate for Payer: Cash Price |
$30.90
|
| Rate for Payer: Cigna Commercial |
$98.55
|
| Rate for Payer: Health EOS Commercial |
$95.34
|
| Rate for Payer: HFN Commercial |
$98.55
|
| Rate for Payer: Multiplan Commercial |
$85.70
|
| Rate for Payer: Preferred Network Access Commercial |
$98.55
|
| Rate for Payer: Quartz Beloit One Network |
$52.49
|
| Rate for Payer: Quartz Commercial |
$64.27
|
| Rate for Payer: WEA Trust Commercial |
$58.92
|
| Rate for Payer: WPS Commercial |
$79.34
|
|
|
LE/ABD/Pelvic 1st Order
|
Facility
|
OP
|
$2,462.00
|
|
|
Service Code
|
CPT 36245
|
| Hospital Charge Code |
3052562
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$716.93 |
| Max. Negotiated Rate |
$4,386.95 |
| Rate for Payer: Aetna Commercial |
$2,304.43
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,202.01
|
| Rate for Payer: Aetna Managed Medicare |
$716.93
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,664.31
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,280.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,229.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,357.05
|
| Rate for Payer: Cash Price |
$738.60
|
| Rate for Payer: Cash Price |
$738.60
|
| Rate for Payer: Cigna Commercial |
$2,355.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Health EOS Commercial |
$2,278.83
|
| Rate for Payer: HFN Commercial |
$2,355.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,920.36
|
| Rate for Payer: Multiplan Commercial |
$2,048.38
|
| Rate for Payer: NAPHCARE Commercial |
$1,536.29
|
| Rate for Payer: Preferred Network Access Commercial |
$2,355.64
|
| Rate for Payer: Quartz Beloit One Network |
$1,254.64
|
| Rate for Payer: Quartz Commercial |
$1,664.31
|
| Rate for Payer: Quartz Medicare Advantage |
$1,536.29
|
| Rate for Payer: The Alliance Commercial |
$774.05
|
| Rate for Payer: WEA Trust Commercial |
$1,408.26
|
| Rate for Payer: WPS Commercial |
$1,896.48
|
|
|
LE/ABD/Pelvic 1st Order
|
Facility
|
IP
|
$2,462.00
|
|
|
Service Code
|
CPT 36245
|
| Hospital Charge Code |
3052562
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,254.64 |
| Max. Negotiated Rate |
$2,355.64 |
| Rate for Payer: Aetna Commercial |
$2,304.43
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,202.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,357.05
|
| Rate for Payer: Cash Price |
$738.60
|
| Rate for Payer: Cigna Commercial |
$2,355.64
|
| Rate for Payer: Health EOS Commercial |
$2,278.83
|
| Rate for Payer: HFN Commercial |
$2,355.64
|
| Rate for Payer: Multiplan Commercial |
$2,048.38
|
| Rate for Payer: Preferred Network Access Commercial |
$2,355.64
|
| Rate for Payer: Quartz Beloit One Network |
$1,254.64
|
| Rate for Payer: Quartz Commercial |
$1,536.29
|
| Rate for Payer: WEA Trust Commercial |
$1,408.26
|
| Rate for Payer: WPS Commercial |
$1,896.48
|
|
|
LE/ABD/Pelvic 2nd Order
|
Facility
|
OP
|
$1,619.00
|
|
|
Service Code
|
CPT 36246
|
| Hospital Charge Code |
3052563
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$471.45 |
| Max. Negotiated Rate |
$4,386.95 |
| Rate for Payer: Aetna Commercial |
$1,515.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,448.03
|
| Rate for Payer: Aetna Managed Medicare |
$471.45
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,094.44
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$841.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$808.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$892.39
|
| Rate for Payer: Cash Price |
$485.70
|
| Rate for Payer: Cash Price |
$485.70
|
| Rate for Payer: Cigna Commercial |
$1,549.06
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Health EOS Commercial |
$1,498.55
|
| Rate for Payer: HFN Commercial |
$1,549.06
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,262.82
|
| Rate for Payer: Multiplan Commercial |
$1,347.01
|
| Rate for Payer: NAPHCARE Commercial |
$1,010.26
|
| Rate for Payer: Preferred Network Access Commercial |
$1,549.06
|
| Rate for Payer: Quartz Beloit One Network |
$825.04
|
| Rate for Payer: Quartz Commercial |
$1,094.44
|
| Rate for Payer: Quartz Medicare Advantage |
$1,010.26
|
| Rate for Payer: The Alliance Commercial |
$816.23
|
| Rate for Payer: WEA Trust Commercial |
$926.07
|
| Rate for Payer: WPS Commercial |
$1,247.12
|
|
|
LE/ABD/Pelvic 2nd Order
|
Facility
|
IP
|
$1,619.00
|
|
|
Service Code
|
CPT 36246
|
| Hospital Charge Code |
3052563
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$825.04 |
| Max. Negotiated Rate |
$1,549.06 |
| Rate for Payer: Aetna Commercial |
$1,515.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,448.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$892.39
|
| Rate for Payer: Cash Price |
$485.70
|
| Rate for Payer: Cigna Commercial |
$1,549.06
|
| Rate for Payer: Health EOS Commercial |
$1,498.55
|
| Rate for Payer: HFN Commercial |
$1,549.06
|
| Rate for Payer: Multiplan Commercial |
$1,347.01
|
| Rate for Payer: Preferred Network Access Commercial |
$1,549.06
|
| Rate for Payer: Quartz Beloit One Network |
$825.04
|
| Rate for Payer: Quartz Commercial |
$1,010.26
|
| Rate for Payer: WEA Trust Commercial |
$926.07
|
| Rate for Payer: WPS Commercial |
$1,247.12
|
|
|
LE/ABD Pelvic 3rd Order
|
Facility
|
IP
|
$3,427.00
|
|
|
Service Code
|
CPT 36247
|
| Hospital Charge Code |
3052564
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,746.40 |
| Max. Negotiated Rate |
$3,278.95 |
| Rate for Payer: Aetna Commercial |
$3,207.67
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,065.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,888.96
|
| Rate for Payer: Cash Price |
$1,028.10
|
| Rate for Payer: Cigna Commercial |
$3,278.95
|
| Rate for Payer: Health EOS Commercial |
$3,172.03
|
| Rate for Payer: HFN Commercial |
$3,278.95
|
| Rate for Payer: Multiplan Commercial |
$2,851.26
|
| Rate for Payer: Preferred Network Access Commercial |
$3,278.95
|
| Rate for Payer: Quartz Beloit One Network |
$1,746.40
|
| Rate for Payer: Quartz Commercial |
$2,138.45
|
| Rate for Payer: WEA Trust Commercial |
$1,960.24
|
| Rate for Payer: WPS Commercial |
$2,639.82
|
|
|
LE/ABD Pelvic 3rd Order
|
Facility
|
OP
|
$3,427.00
|
|
|
Service Code
|
CPT 36247
|
| Hospital Charge Code |
3052564
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$976.56 |
| Max. Negotiated Rate |
$4,386.95 |
| Rate for Payer: Aetna Commercial |
$3,207.67
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,065.11
|
| Rate for Payer: Aetna Managed Medicare |
$997.94
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,316.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,782.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,710.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,888.96
|
| Rate for Payer: Cash Price |
$1,028.10
|
| Rate for Payer: Cash Price |
$1,028.10
|
| Rate for Payer: Cigna Commercial |
$3,278.95
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Health EOS Commercial |
$3,172.03
|
| Rate for Payer: HFN Commercial |
$3,278.95
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,673.06
|
| Rate for Payer: Multiplan Commercial |
$2,851.26
|
| Rate for Payer: NAPHCARE Commercial |
$2,138.45
|
| Rate for Payer: Preferred Network Access Commercial |
$3,278.95
|
| Rate for Payer: Quartz Beloit One Network |
$1,746.40
|
| Rate for Payer: Quartz Commercial |
$2,316.65
|
| Rate for Payer: Quartz Medicare Advantage |
$2,138.45
|
| Rate for Payer: The Alliance Commercial |
$976.56
|
| Rate for Payer: WEA Trust Commercial |
$1,960.24
|
| Rate for Payer: WPS Commercial |
$2,639.82
|
|
|
LE/ABD Pelvic Ea Add Vessel +
|
Facility
|
OP
|
$503.00
|
|
|
Service Code
|
CPT 36248
|
| Hospital Charge Code |
4125627
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$146.47 |
| Max. Negotiated Rate |
$4,386.95 |
| Rate for Payer: Aetna Commercial |
$470.81
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$449.88
|
| Rate for Payer: Aetna Managed Medicare |
$146.47
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$340.03
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$261.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$251.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$277.25
|
| Rate for Payer: Cash Price |
$150.90
|
| Rate for Payer: Cash Price |
$150.90
|
| Rate for Payer: Cigna Commercial |
$481.27
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Health EOS Commercial |
$465.58
|
| Rate for Payer: HFN Commercial |
$481.27
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$392.34
|
| Rate for Payer: Multiplan Commercial |
$418.50
|
| Rate for Payer: NAPHCARE Commercial |
$313.87
|
| Rate for Payer: Preferred Network Access Commercial |
$481.27
|
| Rate for Payer: Quartz Beloit One Network |
$256.33
|
| Rate for Payer: Quartz Commercial |
$340.03
|
| Rate for Payer: Quartz Medicare Advantage |
$313.87
|
| Rate for Payer: The Alliance Commercial |
$159.95
|
| Rate for Payer: WEA Trust Commercial |
$287.72
|
| Rate for Payer: WPS Commercial |
$387.46
|
|
