|
LYMPHOMA AND NON-ACUTE LEUKEMIA WITH CC
|
Facility
|
IP
|
$42,153.00
|
|
|
Service Code
|
MSDRG 841
|
| Min. Negotiated Rate |
$15,163.11 |
| Max. Negotiated Rate |
$42,153.00 |
| Rate for Payer: Aetna Managed Medicare |
$15,163.11
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$32,938.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$25,247.17
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$23,986.46
|
| Rate for Payer: Anthem Medicare Advantage |
$15,163.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$15,163.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$15,163.11
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$15,163.11
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$26,627.17
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$15,163.11
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$30,683.25
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$15,163.11
|
| Rate for Payer: Independent Care Health Plan Medicare |
$15,163.11
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$15,163.11
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$15,163.11
|
| Rate for Payer: NAPHCARE Commercial |
$22,744.66
|
| Rate for Payer: Quartz Medicare Advantage |
$15,163.11
|
| Rate for Payer: The Alliance Commercial |
$42,153.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$15,163.11
|
| Rate for Payer: United Healthcare PPO |
$23,887.30
|
| Rate for Payer: Wellcare Medicare |
$15,163.11
|
|
|
LYMPHOMA AND NON-ACUTE LEUKEMIA WITH MCC
|
Facility
|
IP
|
$83,407.00
|
|
|
Service Code
|
MSDRG 840
|
| Min. Negotiated Rate |
$30,002.47 |
| Max. Negotiated Rate |
$83,407.00 |
| Rate for Payer: Aetna Managed Medicare |
$30,002.47
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$65,667.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$50,333.53
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$47,820.14
|
| Rate for Payer: Anthem Medicare Advantage |
$30,002.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$30,002.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$30,002.47
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$30,002.47
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$53,084.74
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$30,002.47
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$60,941.40
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$30,002.47
|
| Rate for Payer: Independent Care Health Plan Medicare |
$30,002.47
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$30,002.47
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$30,002.47
|
| Rate for Payer: NAPHCARE Commercial |
$45,003.70
|
| Rate for Payer: Quartz Medicare Advantage |
$30,002.47
|
| Rate for Payer: The Alliance Commercial |
$83,407.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$30,002.47
|
| Rate for Payer: United Healthcare PPO |
$47,443.66
|
| Rate for Payer: Wellcare Medicare |
$30,002.47
|
|
|
LYMPHOMA AND NON-ACUTE LEUKEMIA WITH OTHER PROCEDURES WITH CC
|
Facility
|
IP
|
$59,684.00
|
|
|
Service Code
|
MSDRG 824
|
| Min. Negotiated Rate |
$21,469.14 |
| Max. Negotiated Rate |
$59,684.00 |
| Rate for Payer: Quartz Medicare Advantage |
$21,469.14
|
| Rate for Payer: The Alliance Commercial |
$59,684.00
|
| Rate for Payer: Aetna Managed Medicare |
$21,469.14
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$46,785.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$35,860.63
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$34,069.94
|
| Rate for Payer: Anthem Medicare Advantage |
$21,469.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$21,469.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$21,469.14
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$21,469.14
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$37,820.76
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$21,469.14
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$43,541.55
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$21,469.14
|
| Rate for Payer: Independent Care Health Plan Medicare |
$21,469.14
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$21,469.14
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$21,469.14
|
| Rate for Payer: NAPHCARE Commercial |
$32,203.71
|
| Rate for Payer: United Healthcare Medicare Advantage |
$21,469.14
|
| Rate for Payer: United Healthcare PPO |
$33,897.65
|
| Rate for Payer: Wellcare Medicare |
$21,469.14
|
|
|
LYMPHOMA AND NON-ACUTE LEUKEMIA WITH OTHER PROCEDURES WITH MCC
|
Facility
|
IP
|
$120,008.00
|
|
|
Service Code
|
MSDRG 823
|
| Min. Negotiated Rate |
$43,168.26 |
| Max. Negotiated Rate |
$120,008.00 |
| Rate for Payer: Aetna Managed Medicare |
$43,168.26
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$94,410.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$72,364.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$68,751.00
|
| Rate for Payer: Anthem Medicare Advantage |
$43,168.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$43,168.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$43,168.26
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$43,168.26
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$76,319.91
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$43,168.26
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$87,787.05
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$43,168.26
|
| Rate for Payer: Independent Care Health Plan Medicare |
$43,168.26
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$43,168.26
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$43,168.26
|
| Rate for Payer: NAPHCARE Commercial |
$64,752.39
|
| Rate for Payer: Quartz Medicare Advantage |
$43,168.26
|
| Rate for Payer: The Alliance Commercial |
$120,008.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$43,168.26
|
| Rate for Payer: United Healthcare PPO |
$68,343.34
|
| Rate for Payer: Wellcare Medicare |
$43,168.26
|
|
|
LYMPHOMA AND NON-ACUTE LEUKEMIA WITH OTHER PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$34,654.00
|
|
|
Service Code
|
MSDRG 825
|
| Min. Negotiated Rate |
$12,465.31 |
| Max. Negotiated Rate |
$34,654.00 |
| Rate for Payer: Aetna Managed Medicare |
$12,465.31
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$27,064.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$20,744.49
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$19,708.62
|
| Rate for Payer: Anthem Medicare Advantage |
$12,465.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$12,465.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$12,465.31
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$12,465.31
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$21,878.37
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$12,465.31
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$25,182.30
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$12,465.31
|
| Rate for Payer: Independent Care Health Plan Medicare |
$12,465.31
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$12,465.31
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$12,465.31
|
| Rate for Payer: NAPHCARE Commercial |
$18,697.96
|
| Rate for Payer: Quartz Medicare Advantage |
$12,465.31
|
| Rate for Payer: The Alliance Commercial |
$34,654.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12,465.31
|
| Rate for Payer: United Healthcare PPO |
$19,604.74
|
| Rate for Payer: Wellcare Medicare |
$12,465.31
|
|
|
LYMPHOMA AND NON-ACUTE LEUKEMIA WITHOUT CC/MCC
|
Facility
|
IP
|
$28,672.00
|
|
|
Service Code
|
MSDRG 842
|
| Min. Negotiated Rate |
$10,313.55 |
| Max. Negotiated Rate |
$28,672.00 |
| Rate for Payer: Aetna Managed Medicare |
$10,313.55
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$22,448.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$17,206.67
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$16,347.46
|
| Rate for Payer: Anthem Medicare Advantage |
$10,313.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$10,313.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$10,313.55
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$10,313.55
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$18,147.18
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$10,313.55
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$20,794.80
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$10,313.55
|
| Rate for Payer: Independent Care Health Plan Medicare |
$10,313.55
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$10,313.55
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$10,313.55
|
| Rate for Payer: NAPHCARE Commercial |
$15,470.32
|
| Rate for Payer: Quartz Medicare Advantage |
$10,313.55
|
| Rate for Payer: The Alliance Commercial |
$28,672.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$10,313.55
|
| Rate for Payer: United Healthcare PPO |
$16,189.02
|
| Rate for Payer: Wellcare Medicare |
$10,313.55
|
|
|
Lynch Syndrome Dup/Del
|
Professional
|
Both
|
$668.00
|
|
|
Service Code
|
CPT 81297
|
| Hospital Charge Code |
5542922
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$293.92 |
| Max. Negotiated Rate |
$752.95 |
| Rate for Payer: Aetna Commercial |
$634.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$574.48
|
| Rate for Payer: Cash Price |
$200.40
|
| Rate for Payer: Cash Price |
$200.40
|
| Rate for Payer: Cigna Commercial |
$634.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$334.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$400.80
|
| Rate for Payer: Health EOS Commercial |
$607.88
|
| Rate for Payer: HFN Commercial |
$634.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$752.95
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$752.95
|
| Rate for Payer: Multiplan Commercial |
$534.40
|
| Rate for Payer: Preferred Network Access Commercial |
$634.60
|
| Rate for Payer: Quartz Beloit One Network |
$293.92
|
| Rate for Payer: Quartz Commercial |
$380.76
|
| Rate for Payer: The Alliance Commercial |
$334.00
|
| Rate for Payer: WEA Trust Commercial |
$367.40
|
| Rate for Payer: WPS Commercial |
$494.79
|
|
|
Lynch Syndrome Dup/Del
|
Facility
|
OP
|
$668.00
|
|
|
Service Code
|
CPT 81297
|
| Hospital Charge Code |
5542922
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$156.37 |
| Max. Negotiated Rate |
$853.20 |
| Rate for Payer: Aetna Commercial |
$601.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$574.48
|
| Rate for Payer: Aetna Managed Medicare |
$213.30
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$799.88
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$373.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$354.08
|
| Rate for Payer: Anthem Medicaid |
$156.37
|
| Rate for Payer: Anthem Medicare Advantage |
$213.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$354.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$213.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$213.30
|
| Rate for Payer: Cash Price |
$200.40
|
| Rate for Payer: Cash Price |
$200.40
|
| Rate for Payer: Cigna Commercial |
$614.56
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$213.30
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$156.37
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$373.81
|
| Rate for Payer: Dean Health Medicaid |
$156.37
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$213.30
|
| Rate for Payer: Health EOS Commercial |
$594.52
|
| Rate for Payer: HFN Commercial |
$614.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$793.48
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$213.30
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$156.37
|
| Rate for Payer: Independent Care Health Plan Medicare |
$213.30
|
| Rate for Payer: Managed Health Services Medicaid |
$162.62
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$213.30
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$213.30
|
| Rate for Payer: Multiplan Commercial |
$534.40
|
| Rate for Payer: NAPHCARE Commercial |
$319.95
|
| Rate for Payer: Preferred Network Access Commercial |
$614.56
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$156.37
|
| Rate for Payer: Quartz Beloit One Network |
$327.32
|
| Rate for Payer: Quartz Commercial |
$434.20
|
| Rate for Payer: Quartz Medicare Advantage |
$213.30
|
| Rate for Payer: The Alliance Commercial |
$853.20
|
| Rate for Payer: United Healthcare Medicaid |
$156.37
|
| Rate for Payer: United Healthcare Medicare Advantage |
$213.30
|
| Rate for Payer: United Healthcare PPO |
$501.00
|
| Rate for Payer: WEA Trust Commercial |
$367.40
|
| Rate for Payer: Wellcare Medicare |
$213.30
|
| Rate for Payer: WMAP Medicaid |
$156.37
|
| Rate for Payer: WPS Commercial |
$494.79
|
|
|
Lynch Syndrome Dup/Del
|
Facility
|
IP
|
$668.00
|
|
|
Service Code
|
CPT 81297
|
| Hospital Charge Code |
5542922
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$327.32 |
| Max. Negotiated Rate |
$614.56 |
| Rate for Payer: Aetna Commercial |
$601.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$574.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$354.04
|
| Rate for Payer: Cash Price |
$200.40
|
| Rate for Payer: Cigna Commercial |
$614.56
|
| Rate for Payer: Health EOS Commercial |
$594.52
|
| Rate for Payer: HFN Commercial |
$614.56
|
| Rate for Payer: Multiplan Commercial |
$534.40
|
| Rate for Payer: NAPHCARE Commercial |
$400.80
|
| Rate for Payer: Preferred Network Access Commercial |
$614.56
|
| Rate for Payer: Quartz Beloit One Network |
$327.32
|
| Rate for Payer: Quartz Commercial |
$400.80
|
| Rate for Payer: WEA Trust Commercial |
$367.40
|
| Rate for Payer: WPS Commercial |
$494.79
|
|
|
Lynch Syndrome Panel
|
Facility
|
IP
|
$668.00
|
|
|
Service Code
|
CPT 81295
|
| Hospital Charge Code |
5542683
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$327.32 |
| Max. Negotiated Rate |
$614.56 |
| Rate for Payer: Aetna Commercial |
$601.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$574.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$354.04
|
| Rate for Payer: Cash Price |
$200.40
|
| Rate for Payer: Cigna Commercial |
$614.56
|
| Rate for Payer: Health EOS Commercial |
$594.52
|
| Rate for Payer: HFN Commercial |
$614.56
|
| Rate for Payer: Multiplan Commercial |
$534.40
|
| Rate for Payer: NAPHCARE Commercial |
$400.80
|
| Rate for Payer: Preferred Network Access Commercial |
$614.56
|
| Rate for Payer: Quartz Beloit One Network |
$327.32
|
| Rate for Payer: Quartz Commercial |
$400.80
|
| Rate for Payer: WEA Trust Commercial |
$367.40
|
| Rate for Payer: WPS Commercial |
$494.79
|
|
|
Lynch Syndrome Panel
|
Professional
|
Both
|
$668.00
|
|
|
Service Code
|
CPT 81295
|
| Hospital Charge Code |
5542683
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$293.92 |
| Max. Negotiated Rate |
$1,347.40 |
| Rate for Payer: Aetna Commercial |
$634.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$574.48
|
| Rate for Payer: Cash Price |
$200.40
|
| Rate for Payer: Cash Price |
$200.40
|
| Rate for Payer: Cigna Commercial |
$634.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$334.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$400.80
|
| Rate for Payer: Health EOS Commercial |
$607.88
|
| Rate for Payer: HFN Commercial |
$634.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,347.40
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,347.40
|
| Rate for Payer: Multiplan Commercial |
$534.40
|
| Rate for Payer: Preferred Network Access Commercial |
$634.60
|
| Rate for Payer: Quartz Beloit One Network |
$293.92
|
| Rate for Payer: Quartz Commercial |
$380.76
|
| Rate for Payer: The Alliance Commercial |
$334.00
|
| Rate for Payer: WEA Trust Commercial |
$367.40
|
| Rate for Payer: WPS Commercial |
$494.79
|
|
|
Lynch Syndrome Panel
|
Facility
|
OP
|
$668.00
|
|
|
Service Code
|
CPT 81295
|
| Hospital Charge Code |
5542683
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$103.62 |
| Max. Negotiated Rate |
$1,526.80 |
| Rate for Payer: Aetna Commercial |
$601.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$574.48
|
| Rate for Payer: Aetna Managed Medicare |
$381.70
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,431.38
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$667.98
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$633.62
|
| Rate for Payer: Anthem Medicaid |
$103.62
|
| Rate for Payer: Anthem Medicare Advantage |
$381.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$354.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$381.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$381.70
|
| Rate for Payer: Cash Price |
$200.40
|
| Rate for Payer: Cash Price |
$200.40
|
| Rate for Payer: Cigna Commercial |
$614.56
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$381.70
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$103.62
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$373.81
|
| Rate for Payer: Dean Health Medicaid |
$103.62
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$381.70
|
| Rate for Payer: Health EOS Commercial |
$594.52
|
| Rate for Payer: HFN Commercial |
$614.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,419.92
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$381.70
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$103.62
|
| Rate for Payer: Independent Care Health Plan Medicare |
$381.70
|
| Rate for Payer: Managed Health Services Medicaid |
$107.76
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$381.70
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$381.70
|
| Rate for Payer: Multiplan Commercial |
$534.40
|
| Rate for Payer: NAPHCARE Commercial |
$572.55
|
| Rate for Payer: Preferred Network Access Commercial |
$614.56
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$103.62
|
| Rate for Payer: Quartz Beloit One Network |
$327.32
|
| Rate for Payer: Quartz Commercial |
$434.20
|
| Rate for Payer: Quartz Medicare Advantage |
$381.70
|
| Rate for Payer: The Alliance Commercial |
$1,526.80
|
| Rate for Payer: United Healthcare Medicaid |
$103.62
|
| Rate for Payer: United Healthcare Medicare Advantage |
$381.70
|
| Rate for Payer: United Healthcare PPO |
$501.00
|
| Rate for Payer: WEA Trust Commercial |
$367.40
|
| Rate for Payer: Wellcare Medicare |
$381.70
|
| Rate for Payer: WMAP Medicaid |
$103.62
|
| Rate for Payer: WPS Commercial |
$494.79
|
|
|
LYNX WHFO (RIGHT/LARGE)
|
Facility
|
OP
|
$924.00
|
|
| Hospital Charge Code |
2971862
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$258.72 |
| Max. Negotiated Rate |
$3,696.00 |
| Rate for Payer: Aetna Commercial |
$831.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$794.64
|
| Rate for Payer: Aetna Managed Medicare |
$258.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$600.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$462.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$443.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$489.72
|
| Rate for Payer: Cash Price |
$277.20
|
| Rate for Payer: Cigna Commercial |
$850.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$517.07
|
| Rate for Payer: Health EOS Commercial |
$822.36
|
| Rate for Payer: HFN Commercial |
$850.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$693.00
|
| Rate for Payer: Multiplan Commercial |
$739.20
|
| Rate for Payer: NAPHCARE Commercial |
$554.40
|
| Rate for Payer: Preferred Network Access Commercial |
$850.08
|
| Rate for Payer: Quartz Beloit One Network |
$452.76
|
| Rate for Payer: Quartz Commercial |
$600.60
|
| Rate for Payer: Quartz Medicare Advantage |
$554.40
|
| Rate for Payer: The Alliance Commercial |
$3,696.00
|
| Rate for Payer: WEA Trust Commercial |
$508.20
|
| Rate for Payer: WPS Commercial |
$684.41
|
|
|
LYNX WHFO (RIGHT/LARGE)
|
Facility
|
IP
|
$924.00
|
|
| Hospital Charge Code |
2971862
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$452.76 |
| Max. Negotiated Rate |
$850.08 |
| Rate for Payer: Aetna Commercial |
$831.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$794.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$489.72
|
| Rate for Payer: Cash Price |
$277.20
|
| Rate for Payer: Cigna Commercial |
$850.08
|
| Rate for Payer: Health EOS Commercial |
$822.36
|
| Rate for Payer: HFN Commercial |
$850.08
|
| Rate for Payer: Multiplan Commercial |
$739.20
|
| Rate for Payer: NAPHCARE Commercial |
$554.40
|
| Rate for Payer: Preferred Network Access Commercial |
$850.08
|
| Rate for Payer: Quartz Beloit One Network |
$452.76
|
| Rate for Payer: Quartz Commercial |
$554.40
|
| Rate for Payer: WEA Trust Commercial |
$508.20
|
| Rate for Payer: WPS Commercial |
$684.41
|
|
|
LYSIS INTRANASAL SYNECHIA
|
Facility
|
OP
|
$4,757.59
|
|
|
Service Code
|
CPT 30560
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$543.83 |
| Max. Negotiated Rate |
$4,757.59 |
| Rate for Payer: Aetna Managed Medicare |
$543.83
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,914.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,297.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,183.00
|
| Rate for Payer: Anthem Medicare Advantage |
$543.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$543.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$543.83
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$543.83
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,757.59
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$543.83
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,023.05
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$543.83
|
| Rate for Payer: Independent Care Health Plan Medicare |
$543.83
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$543.83
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$543.83
|
| Rate for Payer: NAPHCARE Commercial |
$815.74
|
| Rate for Payer: Quartz Medicare Advantage |
$543.83
|
| Rate for Payer: The Alliance Commercial |
$2,175.32
|
| Rate for Payer: United Healthcare Medicare Advantage |
$543.83
|
| Rate for Payer: United Healthcare PPO |
$2,257.00
|
| Rate for Payer: Wellcare Medicare |
$543.83
|
|
|
LYSIS INTRANASAL SYNECHIA 30560
|
Professional
|
Both
|
$1,773.00
|
|
|
Service Code
|
CPT 30560
|
| Hospital Charge Code |
5581934
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$17.68 |
| Max. Negotiated Rate |
$1,684.35 |
| Rate for Payer: Aetna Commercial |
$1,684.35
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,524.78
|
| Rate for Payer: Cash Price |
$531.90
|
| Rate for Payer: Cash Price |
$531.90
|
| Rate for Payer: Cash Price |
$531.90
|
| Rate for Payer: Cigna Commercial |
$1,684.35
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$17.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,063.80
|
| Rate for Payer: Health EOS Commercial |
$1,613.43
|
| Rate for Payer: HFN Commercial |
$1,684.35
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$496.64
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$496.64
|
| Rate for Payer: Multiplan Commercial |
$1,418.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,684.35
|
| Rate for Payer: Quartz Beloit One Network |
$780.12
|
| Rate for Payer: Quartz Commercial |
$1,010.61
|
| Rate for Payer: The Alliance Commercial |
$886.50
|
| Rate for Payer: United Healthcare Medicaid |
$17.68
|
| Rate for Payer: WEA Trust Commercial |
$975.15
|
| Rate for Payer: WPS Commercial |
$1,313.26
|
|
|
Lysis of cells
|
Professional
|
Both
|
$61.00
|
|
| Hospital Charge Code |
2776832
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$26.84 |
| Max. Negotiated Rate |
$57.95 |
| Rate for Payer: Aetna Commercial |
$57.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$52.46
|
| Rate for Payer: Cash Price |
$18.30
|
| Rate for Payer: Cigna Commercial |
$57.95
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$30.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$36.60
|
| Rate for Payer: Health EOS Commercial |
$55.51
|
| Rate for Payer: HFN Commercial |
$57.95
|
| Rate for Payer: Multiplan Commercial |
$48.80
|
| Rate for Payer: Preferred Network Access Commercial |
$57.95
|
| Rate for Payer: Quartz Beloit One Network |
$26.84
|
| Rate for Payer: Quartz Commercial |
$34.77
|
| Rate for Payer: The Alliance Commercial |
$30.50
|
| Rate for Payer: WEA Trust Commercial |
$33.55
|
| Rate for Payer: WPS Commercial |
$45.18
|
|
|
Lysis of cells
|
Facility
|
IP
|
$61.00
|
|
| Hospital Charge Code |
2776832
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$29.89 |
| Max. Negotiated Rate |
$56.12 |
| Rate for Payer: Aetna Commercial |
$54.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$52.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$32.33
|
| Rate for Payer: Cash Price |
$18.30
|
| Rate for Payer: Cigna Commercial |
$56.12
|
| Rate for Payer: Health EOS Commercial |
$54.29
|
| Rate for Payer: HFN Commercial |
$56.12
|
| Rate for Payer: Multiplan Commercial |
$48.80
|
| Rate for Payer: NAPHCARE Commercial |
$36.60
|
| Rate for Payer: Preferred Network Access Commercial |
$56.12
|
| Rate for Payer: Quartz Beloit One Network |
$29.89
|
| Rate for Payer: Quartz Commercial |
$36.60
|
| Rate for Payer: WEA Trust Commercial |
$33.55
|
| Rate for Payer: WPS Commercial |
$45.18
|
|
|
Lysis of cells
|
Facility
|
OP
|
$61.00
|
|
| Hospital Charge Code |
2776832
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.08 |
| Max. Negotiated Rate |
$244.00 |
| Rate for Payer: Aetna Commercial |
$54.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$52.46
|
| Rate for Payer: Aetna Managed Medicare |
$17.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$39.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$30.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$29.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$32.33
|
| Rate for Payer: Cash Price |
$18.30
|
| Rate for Payer: Cigna Commercial |
$56.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$34.14
|
| Rate for Payer: Health EOS Commercial |
$54.29
|
| Rate for Payer: HFN Commercial |
$56.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$45.75
|
| Rate for Payer: Multiplan Commercial |
$48.80
|
| Rate for Payer: NAPHCARE Commercial |
$36.60
|
| Rate for Payer: Preferred Network Access Commercial |
$56.12
|
| Rate for Payer: Quartz Beloit One Network |
$29.89
|
| Rate for Payer: Quartz Commercial |
$39.65
|
| Rate for Payer: Quartz Medicare Advantage |
$36.60
|
| Rate for Payer: The Alliance Commercial |
$244.00
|
| Rate for Payer: United Healthcare PPO |
$45.75
|
| Rate for Payer: WEA Trust Commercial |
$33.55
|
| Rate for Payer: WPS Commercial |
$45.18
|
|
|
LYSIS OR EXCISION OF PENILE POST-CIRCUMCISION ADHESIONS
|
Facility
|
OP
|
$8,052.80
|
|
|
Service Code
|
CPT 54162
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,013.20 |
| Max. Negotiated Rate |
$8,052.80 |
| Rate for Payer: Aetna Managed Medicare |
$2,013.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,496.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,871.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,726.00
|
| Rate for Payer: Anthem Medicare Advantage |
$2,013.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$2,013.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$2,013.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$2,013.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,757.59
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$2,013.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7,489.10
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$2,013.20
|
| Rate for Payer: Independent Care Health Plan Medicare |
$2,013.20
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$2,013.20
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$2,013.20
|
| Rate for Payer: NAPHCARE Commercial |
$3,019.80
|
| Rate for Payer: Quartz Medicare Advantage |
$2,013.20
|
| Rate for Payer: The Alliance Commercial |
$8,052.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,013.20
|
| Rate for Payer: United Healthcare PPO |
$3,583.00
|
| Rate for Payer: Wellcare Medicare |
$2,013.20
|
|
|
LYSIS PENIL CIRCUMIC LESION 54162
|
Professional
|
Both
|
$1,389.00
|
|
|
Service Code
|
CPT 54162
|
| Hospital Charge Code |
3015025
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$86.82 |
| Max. Negotiated Rate |
$1,319.55 |
| Rate for Payer: Aetna Commercial |
$1,319.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,194.54
|
| Rate for Payer: Cash Price |
$416.70
|
| Rate for Payer: Cash Price |
$416.70
|
| Rate for Payer: Cash Price |
$416.70
|
| Rate for Payer: Cigna Commercial |
$1,319.55
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$86.82
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$833.40
|
| Rate for Payer: Health EOS Commercial |
$1,263.99
|
| Rate for Payer: HFN Commercial |
$1,319.55
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$669.15
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$669.15
|
| Rate for Payer: Multiplan Commercial |
$1,111.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,319.55
|
| Rate for Payer: Quartz Beloit One Network |
$611.16
|
| Rate for Payer: Quartz Commercial |
$791.73
|
| Rate for Payer: The Alliance Commercial |
$694.50
|
| Rate for Payer: United Healthcare Medicaid |
$86.82
|
| Rate for Payer: WEA Trust Commercial |
$763.95
|
| Rate for Payer: WPS Commercial |
$1,028.83
|
|
|
MA Breast Ndl Loc Placement Left
|
Professional
|
Both
|
$2,504.00
|
|
|
Service Code
|
CPT 19281
|
| Hospital Charge Code |
1268801
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$75.88 |
| Max. Negotiated Rate |
$2,378.80 |
| Rate for Payer: Aetna Commercial |
$2,378.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,153.44
|
| Rate for Payer: Cash Price |
$751.20
|
| Rate for Payer: Cash Price |
$751.20
|
| Rate for Payer: Cash Price |
$751.20
|
| Rate for Payer: Cigna Commercial |
$2,378.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$75.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,502.40
|
| Rate for Payer: Health EOS Commercial |
$2,278.64
|
| Rate for Payer: HFN Commercial |
$2,378.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$335.70
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$335.70
|
| Rate for Payer: Multiplan Commercial |
$2,003.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,378.80
|
| Rate for Payer: Quartz Beloit One Network |
$1,101.76
|
| Rate for Payer: Quartz Commercial |
$1,427.28
|
| Rate for Payer: The Alliance Commercial |
$1,252.00
|
| Rate for Payer: United Healthcare Medicaid |
$75.88
|
| Rate for Payer: WEA Trust Commercial |
$1,377.20
|
| Rate for Payer: WPS Commercial |
$1,854.71
|
|
|
MA Breast Ndl Loc Placement Left
|
Facility
|
OP
|
$2,504.00
|
|
|
Service Code
|
CPT 19281
|
| Hospital Charge Code |
1268801
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$301.00 |
| Max. Negotiated Rate |
$6,409.96 |
| Rate for Payer: Aetna Commercial |
$2,253.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,153.44
|
| Rate for Payer: Aetna Managed Medicare |
$1,602.49
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,627.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,252.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,201.92
|
| Rate for Payer: Anthem Medicare Advantage |
$1,602.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,327.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$1,602.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$1,602.49
|
| Rate for Payer: Cash Price |
$751.20
|
| Rate for Payer: Cash Price |
$751.20
|
| Rate for Payer: Cash Price |
$751.20
|
| Rate for Payer: Cigna Commercial |
$2,303.68
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$1,602.49
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,757.59
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$1,602.49
|
| Rate for Payer: Health EOS Commercial |
$2,228.56
|
| Rate for Payer: HFN Commercial |
$2,303.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,961.26
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,602.49
|
| Rate for Payer: Independent Care Health Plan Medicare |
$1,602.49
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$1,602.49
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$1,602.49
|
| Rate for Payer: Multiplan Commercial |
$2,003.20
|
| Rate for Payer: NAPHCARE Commercial |
$2,403.74
|
| Rate for Payer: Preferred Network Access Commercial |
$2,303.68
|
| Rate for Payer: Quartz Beloit One Network |
$1,226.96
|
| Rate for Payer: Quartz Commercial |
$1,627.60
|
| Rate for Payer: Quartz Medicare Advantage |
$1,602.49
|
| Rate for Payer: The Alliance Commercial |
$6,409.96
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,602.49
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$1,377.20
|
| Rate for Payer: Wellcare Medicare |
$1,602.49
|
| Rate for Payer: WPS Commercial |
$1,854.71
|
|
|
MA Breast Ndl Loc Placement Left
|
Facility
|
IP
|
$2,504.00
|
|
|
Service Code
|
CPT 19281
|
| Hospital Charge Code |
1268801
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,226.96 |
| Max. Negotiated Rate |
$2,303.68 |
| Rate for Payer: Aetna Commercial |
$2,253.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,153.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,327.12
|
| Rate for Payer: Cash Price |
$751.20
|
| Rate for Payer: Cigna Commercial |
$2,303.68
|
| Rate for Payer: Health EOS Commercial |
$2,228.56
|
| Rate for Payer: HFN Commercial |
$2,303.68
|
| Rate for Payer: Multiplan Commercial |
$2,003.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,502.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,303.68
|
| Rate for Payer: Quartz Beloit One Network |
$1,226.96
|
| Rate for Payer: Quartz Commercial |
$1,502.40
|
| Rate for Payer: WEA Trust Commercial |
$1,377.20
|
| Rate for Payer: WPS Commercial |
$1,854.71
|
|
|
MA Breast Ndl Loc Placement Right
|
Facility
|
IP
|
$2,504.00
|
|
|
Service Code
|
CPT 19281
|
| Hospital Charge Code |
1268803
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,226.96 |
| Max. Negotiated Rate |
$2,303.68 |
| Rate for Payer: Aetna Commercial |
$2,253.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,153.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,327.12
|
| Rate for Payer: Cash Price |
$751.20
|
| Rate for Payer: Cigna Commercial |
$2,303.68
|
| Rate for Payer: Health EOS Commercial |
$2,228.56
|
| Rate for Payer: HFN Commercial |
$2,303.68
|
| Rate for Payer: Multiplan Commercial |
$2,003.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,502.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,303.68
|
| Rate for Payer: Quartz Beloit One Network |
$1,226.96
|
| Rate for Payer: Quartz Commercial |
$1,502.40
|
| Rate for Payer: WEA Trust Commercial |
$1,377.20
|
| Rate for Payer: WPS Commercial |
$1,854.71
|
|
