|
Antiglomerular Basement Membrane Antibody
|
Facility
|
IP
|
$463.00
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
633654
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$226.87 |
| Max. Negotiated Rate |
$425.96 |
| Rate for Payer: Aetna Commercial |
$416.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$398.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$245.39
|
| Rate for Payer: Cash Price |
$138.90
|
| Rate for Payer: Cigna Commercial |
$425.96
|
| Rate for Payer: Health EOS Commercial |
$412.07
|
| Rate for Payer: HFN Commercial |
$425.96
|
| Rate for Payer: Multiplan Commercial |
$370.40
|
| Rate for Payer: NAPHCARE Commercial |
$277.80
|
| Rate for Payer: Preferred Network Access Commercial |
$425.96
|
| Rate for Payer: Quartz Beloit One Network |
$226.87
|
| Rate for Payer: Quartz Commercial |
$277.80
|
| Rate for Payer: WEA Trust Commercial |
$254.65
|
| Rate for Payer: WPS Commercial |
$342.94
|
|
|
Antiglomerular Basement Membrane Antibody
|
Facility
|
OP
|
$463.00
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
633654
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.27 |
| Max. Negotiated Rate |
$425.96 |
| Rate for Payer: Aetna Commercial |
$416.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$398.18
|
| Rate for Payer: Aetna Managed Medicare |
$17.27
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$64.76
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$30.22
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$28.67
|
| Rate for Payer: Anthem Medicaid |
$17.85
|
| Rate for Payer: Anthem Medicare Advantage |
$17.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$245.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$17.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$17.27
|
| Rate for Payer: Cash Price |
$138.90
|
| Rate for Payer: Cash Price |
$138.90
|
| Rate for Payer: Cigna Commercial |
$425.96
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$17.27
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$17.85
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$259.09
|
| Rate for Payer: Dean Health Medicaid |
$17.85
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$17.27
|
| Rate for Payer: Health EOS Commercial |
$412.07
|
| Rate for Payer: HFN Commercial |
$425.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$64.24
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$17.27
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$17.85
|
| Rate for Payer: Independent Care Health Plan Medicare |
$17.27
|
| Rate for Payer: Managed Health Services Medicaid |
$18.56
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$17.27
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$17.27
|
| Rate for Payer: Multiplan Commercial |
$370.40
|
| Rate for Payer: NAPHCARE Commercial |
$25.90
|
| Rate for Payer: Preferred Network Access Commercial |
$425.96
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$17.85
|
| Rate for Payer: Quartz Beloit One Network |
$226.87
|
| Rate for Payer: Quartz Commercial |
$300.95
|
| Rate for Payer: Quartz Medicare Advantage |
$17.27
|
| Rate for Payer: The Alliance Commercial |
$69.08
|
| Rate for Payer: United Healthcare Medicaid |
$17.85
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17.27
|
| Rate for Payer: United Healthcare PPO |
$347.25
|
| Rate for Payer: WEA Trust Commercial |
$254.65
|
| Rate for Payer: Wellcare Medicare |
$17.27
|
| Rate for Payer: WMAP Medicaid |
$17.85
|
| Rate for Payer: WPS Commercial |
$342.94
|
|
|
Antiglomerular Basement Membrane Antibody
|
Professional
|
Both
|
$463.00
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
633654
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$60.96 |
| Max. Negotiated Rate |
$439.85 |
| Rate for Payer: Aetna Commercial |
$439.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$398.18
|
| Rate for Payer: Cash Price |
$138.90
|
| Rate for Payer: Cash Price |
$138.90
|
| Rate for Payer: Cigna Commercial |
$439.85
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$231.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$277.80
|
| Rate for Payer: Health EOS Commercial |
$421.33
|
| Rate for Payer: HFN Commercial |
$439.85
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$60.96
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$60.96
|
| Rate for Payer: Multiplan Commercial |
$370.40
|
| Rate for Payer: Preferred Network Access Commercial |
$439.85
|
| Rate for Payer: Quartz Beloit One Network |
$203.72
|
| Rate for Payer: Quartz Commercial |
$263.91
|
| Rate for Payer: The Alliance Commercial |
$231.50
|
| Rate for Payer: WEA Trust Commercial |
$254.65
|
| Rate for Payer: WPS Commercial |
$342.94
|
|
|
Anti-HMGCR Antibody
|
Facility
|
OP
|
$345.00
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
5128608
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.27 |
| Max. Negotiated Rate |
$317.40 |
| Rate for Payer: Aetna Commercial |
$310.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$296.70
|
| Rate for Payer: Aetna Managed Medicare |
$17.27
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$64.76
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$30.22
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$28.67
|
| Rate for Payer: Anthem Medicaid |
$17.85
|
| Rate for Payer: Anthem Medicare Advantage |
$17.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$182.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$17.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$17.27
|
| Rate for Payer: Cash Price |
$103.50
|
| Rate for Payer: Cash Price |
$103.50
|
| Rate for Payer: Cigna Commercial |
$317.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$17.27
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$17.85
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$193.06
|
| Rate for Payer: Dean Health Medicaid |
$17.85
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$17.27
|
| Rate for Payer: Health EOS Commercial |
$307.05
|
| Rate for Payer: HFN Commercial |
$317.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$64.24
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$17.27
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$17.85
|
| Rate for Payer: Independent Care Health Plan Medicare |
$17.27
|
| Rate for Payer: Managed Health Services Medicaid |
$18.56
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$17.27
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$17.27
|
| Rate for Payer: Multiplan Commercial |
$276.00
|
| Rate for Payer: NAPHCARE Commercial |
$25.90
|
| Rate for Payer: Preferred Network Access Commercial |
$317.40
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$17.85
|
| Rate for Payer: Quartz Beloit One Network |
$169.05
|
| Rate for Payer: Quartz Commercial |
$224.25
|
| Rate for Payer: Quartz Medicare Advantage |
$17.27
|
| Rate for Payer: The Alliance Commercial |
$69.08
|
| Rate for Payer: United Healthcare Medicaid |
$17.85
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17.27
|
| Rate for Payer: United Healthcare PPO |
$258.75
|
| Rate for Payer: WEA Trust Commercial |
$189.75
|
| Rate for Payer: Wellcare Medicare |
$17.27
|
| Rate for Payer: WMAP Medicaid |
$17.85
|
| Rate for Payer: WPS Commercial |
$255.54
|
|
|
Anti-HMGCR Antibody
|
Facility
|
IP
|
$345.00
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
5128608
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$169.05 |
| Max. Negotiated Rate |
$317.40 |
| Rate for Payer: Aetna Commercial |
$310.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$296.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$182.85
|
| Rate for Payer: Cash Price |
$103.50
|
| Rate for Payer: Cigna Commercial |
$317.40
|
| Rate for Payer: Health EOS Commercial |
$307.05
|
| Rate for Payer: HFN Commercial |
$317.40
|
| Rate for Payer: Multiplan Commercial |
$276.00
|
| Rate for Payer: NAPHCARE Commercial |
$207.00
|
| Rate for Payer: Preferred Network Access Commercial |
$317.40
|
| Rate for Payer: Quartz Beloit One Network |
$169.05
|
| Rate for Payer: Quartz Commercial |
$207.00
|
| Rate for Payer: WEA Trust Commercial |
$189.75
|
| Rate for Payer: WPS Commercial |
$255.54
|
|
|
Anti-HMGCR Antibody
|
Professional
|
Both
|
$345.00
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
5128608
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$60.96 |
| Max. Negotiated Rate |
$327.75 |
| Rate for Payer: Aetna Commercial |
$327.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$296.70
|
| Rate for Payer: Cash Price |
$103.50
|
| Rate for Payer: Cash Price |
$103.50
|
| Rate for Payer: Cigna Commercial |
$327.75
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$172.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$207.00
|
| Rate for Payer: Health EOS Commercial |
$313.95
|
| Rate for Payer: HFN Commercial |
$327.75
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$60.96
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$60.96
|
| Rate for Payer: Multiplan Commercial |
$276.00
|
| Rate for Payer: Preferred Network Access Commercial |
$327.75
|
| Rate for Payer: Quartz Beloit One Network |
$151.80
|
| Rate for Payer: Quartz Commercial |
$196.65
|
| Rate for Payer: The Alliance Commercial |
$172.50
|
| Rate for Payer: WEA Trust Commercial |
$189.75
|
| Rate for Payer: WPS Commercial |
$255.54
|
|
|
Anti-I2
|
Facility
|
OP
|
$72.00
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
2770812
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.27 |
| Max. Negotiated Rate |
$69.08 |
| Rate for Payer: Aetna Commercial |
$64.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$61.92
|
| Rate for Payer: Aetna Managed Medicare |
$17.27
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$64.76
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$30.22
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$28.67
|
| Rate for Payer: Anthem Medicaid |
$17.85
|
| Rate for Payer: Anthem Medicare Advantage |
$17.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$38.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$17.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$17.27
|
| Rate for Payer: Cash Price |
$21.60
|
| Rate for Payer: Cash Price |
$21.60
|
| Rate for Payer: Cigna Commercial |
$66.24
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$17.27
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$17.85
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$40.29
|
| Rate for Payer: Dean Health Medicaid |
$17.85
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$17.27
|
| Rate for Payer: Health EOS Commercial |
$64.08
|
| Rate for Payer: HFN Commercial |
$66.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$64.24
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$17.27
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$17.85
|
| Rate for Payer: Independent Care Health Plan Medicare |
$17.27
|
| Rate for Payer: Managed Health Services Medicaid |
$18.56
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$17.27
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$17.27
|
| Rate for Payer: Multiplan Commercial |
$57.60
|
| Rate for Payer: NAPHCARE Commercial |
$25.90
|
| Rate for Payer: Preferred Network Access Commercial |
$66.24
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$17.85
|
| Rate for Payer: Quartz Beloit One Network |
$35.28
|
| Rate for Payer: Quartz Commercial |
$46.80
|
| Rate for Payer: Quartz Medicare Advantage |
$17.27
|
| Rate for Payer: The Alliance Commercial |
$69.08
|
| Rate for Payer: United Healthcare Medicaid |
$17.85
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17.27
|
| Rate for Payer: United Healthcare PPO |
$54.00
|
| Rate for Payer: WEA Trust Commercial |
$39.60
|
| Rate for Payer: Wellcare Medicare |
$17.27
|
| Rate for Payer: WMAP Medicaid |
$17.85
|
| Rate for Payer: WPS Commercial |
$53.33
|
|
|
Anti-I2
|
Facility
|
IP
|
$72.00
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
2770812
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$35.28 |
| Max. Negotiated Rate |
$66.24 |
| Rate for Payer: Aetna Commercial |
$64.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$61.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$38.16
|
| Rate for Payer: Cash Price |
$21.60
|
| Rate for Payer: Cigna Commercial |
$66.24
|
| Rate for Payer: Health EOS Commercial |
$64.08
|
| Rate for Payer: HFN Commercial |
$66.24
|
| Rate for Payer: Multiplan Commercial |
$57.60
|
| Rate for Payer: NAPHCARE Commercial |
$43.20
|
| Rate for Payer: Preferred Network Access Commercial |
$66.24
|
| Rate for Payer: Quartz Beloit One Network |
$35.28
|
| Rate for Payer: Quartz Commercial |
$43.20
|
| Rate for Payer: WEA Trust Commercial |
$39.60
|
| Rate for Payer: WPS Commercial |
$53.33
|
|
|
Anti-I2
|
Professional
|
Both
|
$72.00
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
2770812
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$31.68 |
| Max. Negotiated Rate |
$68.40 |
| Rate for Payer: Aetna Commercial |
$68.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$61.92
|
| Rate for Payer: Cash Price |
$21.60
|
| Rate for Payer: Cash Price |
$21.60
|
| Rate for Payer: Cigna Commercial |
$68.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$36.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$43.20
|
| Rate for Payer: Health EOS Commercial |
$65.52
|
| Rate for Payer: HFN Commercial |
$68.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$60.96
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$60.96
|
| Rate for Payer: Multiplan Commercial |
$57.60
|
| Rate for Payer: Preferred Network Access Commercial |
$68.40
|
| Rate for Payer: Quartz Beloit One Network |
$31.68
|
| Rate for Payer: Quartz Commercial |
$41.04
|
| Rate for Payer: The Alliance Commercial |
$36.00
|
| Rate for Payer: WEA Trust Commercial |
$39.60
|
| Rate for Payer: WPS Commercial |
$53.33
|
|
|
Anti-Mullerian Hormone Female
|
Facility
|
OP
|
$356.00
|
|
|
Service Code
|
CPT 82166
|
| Hospital Charge Code |
980024
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$99.68 |
| Max. Negotiated Rate |
$1,424.00 |
| Rate for Payer: Aetna Commercial |
$320.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$306.16
|
| Rate for Payer: Aetna Managed Medicare |
$99.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$231.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$178.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$170.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$188.68
|
| Rate for Payer: Cash Price |
$106.80
|
| Rate for Payer: Cigna Commercial |
$327.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$199.22
|
| Rate for Payer: Health EOS Commercial |
$316.84
|
| Rate for Payer: HFN Commercial |
$327.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$267.00
|
| Rate for Payer: Multiplan Commercial |
$284.80
|
| Rate for Payer: NAPHCARE Commercial |
$213.60
|
| Rate for Payer: Preferred Network Access Commercial |
$327.52
|
| Rate for Payer: Quartz Beloit One Network |
$174.44
|
| Rate for Payer: Quartz Commercial |
$231.40
|
| Rate for Payer: Quartz Medicare Advantage |
$213.60
|
| Rate for Payer: The Alliance Commercial |
$1,424.00
|
| Rate for Payer: United Healthcare PPO |
$267.00
|
| Rate for Payer: WEA Trust Commercial |
$195.80
|
| Rate for Payer: WPS Commercial |
$263.69
|
|
|
Anti-Mullerian Hormone Female
|
Professional
|
Both
|
$356.00
|
|
|
Service Code
|
CPT 82166
|
| Hospital Charge Code |
980024
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$156.64 |
| Max. Negotiated Rate |
$338.20 |
| Rate for Payer: Aetna Commercial |
$338.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$306.16
|
| Rate for Payer: Cash Price |
$106.80
|
| Rate for Payer: Cigna Commercial |
$338.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$178.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$213.60
|
| Rate for Payer: Health EOS Commercial |
$323.96
|
| Rate for Payer: HFN Commercial |
$338.20
|
| Rate for Payer: Multiplan Commercial |
$284.80
|
| Rate for Payer: Preferred Network Access Commercial |
$338.20
|
| Rate for Payer: Quartz Beloit One Network |
$156.64
|
| Rate for Payer: Quartz Commercial |
$202.92
|
| Rate for Payer: The Alliance Commercial |
$178.00
|
| Rate for Payer: WEA Trust Commercial |
$195.80
|
| Rate for Payer: WPS Commercial |
$263.69
|
|
|
Anti-Mullerian Hormone Female
|
Facility
|
IP
|
$356.00
|
|
|
Service Code
|
CPT 82166
|
| Hospital Charge Code |
980024
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$174.44 |
| Max. Negotiated Rate |
$327.52 |
| Rate for Payer: Aetna Commercial |
$320.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$306.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$188.68
|
| Rate for Payer: Cash Price |
$106.80
|
| Rate for Payer: Cigna Commercial |
$327.52
|
| Rate for Payer: Health EOS Commercial |
$316.84
|
| Rate for Payer: HFN Commercial |
$327.52
|
| Rate for Payer: Multiplan Commercial |
$284.80
|
| Rate for Payer: NAPHCARE Commercial |
$213.60
|
| Rate for Payer: Preferred Network Access Commercial |
$327.52
|
| Rate for Payer: Quartz Beloit One Network |
$174.44
|
| Rate for Payer: Quartz Commercial |
$213.60
|
| Rate for Payer: WEA Trust Commercial |
$195.80
|
| Rate for Payer: WPS Commercial |
$263.69
|
|
|
Antineutrophil Cytoplasmic Antibody Screen w/ Reflex Titer
|
Facility
|
OP
|
$223.00
|
|
|
Service Code
|
CPT 86021
|
| Hospital Charge Code |
633656
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.05 |
| Max. Negotiated Rate |
$205.16 |
| Rate for Payer: Aetna Commercial |
$200.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$191.78
|
| Rate for Payer: Aetna Managed Medicare |
$15.05
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$56.44
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$26.34
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$24.98
|
| Rate for Payer: Anthem Medicaid |
$15.55
|
| Rate for Payer: Anthem Medicare Advantage |
$15.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$118.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$15.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$15.05
|
| Rate for Payer: Cash Price |
$66.90
|
| Rate for Payer: Cash Price |
$66.90
|
| Rate for Payer: Cigna Commercial |
$205.16
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$15.05
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$15.55
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$124.79
|
| Rate for Payer: Dean Health Medicaid |
$15.55
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$15.05
|
| Rate for Payer: Health EOS Commercial |
$198.47
|
| Rate for Payer: HFN Commercial |
$205.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$55.99
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$15.05
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$15.55
|
| Rate for Payer: Independent Care Health Plan Medicare |
$15.05
|
| Rate for Payer: Managed Health Services Medicaid |
$16.17
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$15.05
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$15.05
|
| Rate for Payer: Multiplan Commercial |
$178.40
|
| Rate for Payer: NAPHCARE Commercial |
$22.58
|
| Rate for Payer: Preferred Network Access Commercial |
$205.16
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$15.55
|
| Rate for Payer: Quartz Beloit One Network |
$109.27
|
| Rate for Payer: Quartz Commercial |
$144.95
|
| Rate for Payer: Quartz Medicare Advantage |
$15.05
|
| Rate for Payer: The Alliance Commercial |
$60.20
|
| Rate for Payer: United Healthcare Medicaid |
$15.55
|
| Rate for Payer: United Healthcare Medicare Advantage |
$15.05
|
| Rate for Payer: United Healthcare PPO |
$167.25
|
| Rate for Payer: WEA Trust Commercial |
$122.65
|
| Rate for Payer: Wellcare Medicare |
$15.05
|
| Rate for Payer: WMAP Medicaid |
$15.55
|
| Rate for Payer: WPS Commercial |
$165.18
|
|
|
Antineutrophil Cytoplasmic Antibody Screen w/ Reflex Titer
|
Professional
|
Both
|
$223.00
|
|
|
Service Code
|
CPT 86021
|
| Hospital Charge Code |
633656
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$53.13 |
| Max. Negotiated Rate |
$211.85 |
| Rate for Payer: Aetna Commercial |
$211.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$191.78
|
| Rate for Payer: Cash Price |
$66.90
|
| Rate for Payer: Cash Price |
$66.90
|
| Rate for Payer: Cigna Commercial |
$211.85
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$111.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$133.80
|
| Rate for Payer: Health EOS Commercial |
$202.93
|
| Rate for Payer: HFN Commercial |
$211.85
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$53.13
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$53.13
|
| Rate for Payer: Multiplan Commercial |
$178.40
|
| Rate for Payer: Preferred Network Access Commercial |
$211.85
|
| Rate for Payer: Quartz Beloit One Network |
$98.12
|
| Rate for Payer: Quartz Commercial |
$127.11
|
| Rate for Payer: The Alliance Commercial |
$111.50
|
| Rate for Payer: WEA Trust Commercial |
$122.65
|
| Rate for Payer: WPS Commercial |
$165.18
|
|
|
Antineutrophil Cytoplasmic Antibody Screen w/ Reflex Titer
|
Facility
|
IP
|
$223.00
|
|
|
Service Code
|
CPT 86021
|
| Hospital Charge Code |
633656
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$109.27 |
| Max. Negotiated Rate |
$205.16 |
| Rate for Payer: Aetna Commercial |
$200.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$191.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$118.19
|
| Rate for Payer: Cash Price |
$66.90
|
| Rate for Payer: Cigna Commercial |
$205.16
|
| Rate for Payer: Health EOS Commercial |
$198.47
|
| Rate for Payer: HFN Commercial |
$205.16
|
| Rate for Payer: Multiplan Commercial |
$178.40
|
| Rate for Payer: NAPHCARE Commercial |
$133.80
|
| Rate for Payer: Preferred Network Access Commercial |
$205.16
|
| Rate for Payer: Quartz Beloit One Network |
$109.27
|
| Rate for Payer: Quartz Commercial |
$133.80
|
| Rate for Payer: WEA Trust Commercial |
$122.65
|
| Rate for Payer: WPS Commercial |
$165.18
|
|
|
Anti-OmpC IgA
|
Facility
|
OP
|
$72.00
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
2770813
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.27 |
| Max. Negotiated Rate |
$69.08 |
| Rate for Payer: Aetna Commercial |
$64.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$61.92
|
| Rate for Payer: Aetna Managed Medicare |
$17.27
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$64.76
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$30.22
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$28.67
|
| Rate for Payer: Anthem Medicaid |
$17.85
|
| Rate for Payer: Anthem Medicare Advantage |
$17.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$38.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$17.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$17.27
|
| Rate for Payer: Cash Price |
$21.60
|
| Rate for Payer: Cash Price |
$21.60
|
| Rate for Payer: Cigna Commercial |
$66.24
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$17.27
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$17.85
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$40.29
|
| Rate for Payer: Dean Health Medicaid |
$17.85
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$17.27
|
| Rate for Payer: Health EOS Commercial |
$64.08
|
| Rate for Payer: HFN Commercial |
$66.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$64.24
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$17.27
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$17.85
|
| Rate for Payer: Independent Care Health Plan Medicare |
$17.27
|
| Rate for Payer: Managed Health Services Medicaid |
$18.56
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$17.27
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$17.27
|
| Rate for Payer: Multiplan Commercial |
$57.60
|
| Rate for Payer: NAPHCARE Commercial |
$25.90
|
| Rate for Payer: Preferred Network Access Commercial |
$66.24
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$17.85
|
| Rate for Payer: Quartz Beloit One Network |
$35.28
|
| Rate for Payer: Quartz Commercial |
$46.80
|
| Rate for Payer: Quartz Medicare Advantage |
$17.27
|
| Rate for Payer: The Alliance Commercial |
$69.08
|
| Rate for Payer: United Healthcare Medicaid |
$17.85
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17.27
|
| Rate for Payer: United Healthcare PPO |
$54.00
|
| Rate for Payer: WEA Trust Commercial |
$39.60
|
| Rate for Payer: Wellcare Medicare |
$17.27
|
| Rate for Payer: WMAP Medicaid |
$17.85
|
| Rate for Payer: WPS Commercial |
$53.33
|
|
|
Anti-OmpC IgA
|
Facility
|
IP
|
$72.00
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
2770813
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$35.28 |
| Max. Negotiated Rate |
$66.24 |
| Rate for Payer: Aetna Commercial |
$64.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$61.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$38.16
|
| Rate for Payer: Cash Price |
$21.60
|
| Rate for Payer: Cigna Commercial |
$66.24
|
| Rate for Payer: Health EOS Commercial |
$64.08
|
| Rate for Payer: HFN Commercial |
$66.24
|
| Rate for Payer: Multiplan Commercial |
$57.60
|
| Rate for Payer: NAPHCARE Commercial |
$43.20
|
| Rate for Payer: Preferred Network Access Commercial |
$66.24
|
| Rate for Payer: Quartz Beloit One Network |
$35.28
|
| Rate for Payer: Quartz Commercial |
$43.20
|
| Rate for Payer: WEA Trust Commercial |
$39.60
|
| Rate for Payer: WPS Commercial |
$53.33
|
|
|
Anti-OmpC IgA
|
Professional
|
Both
|
$72.00
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
2770813
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$31.68 |
| Max. Negotiated Rate |
$68.40 |
| Rate for Payer: Aetna Commercial |
$68.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$61.92
|
| Rate for Payer: Cash Price |
$21.60
|
| Rate for Payer: Cash Price |
$21.60
|
| Rate for Payer: Cigna Commercial |
$68.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$36.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$43.20
|
| Rate for Payer: Health EOS Commercial |
$65.52
|
| Rate for Payer: HFN Commercial |
$68.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$60.96
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$60.96
|
| Rate for Payer: Multiplan Commercial |
$57.60
|
| Rate for Payer: Preferred Network Access Commercial |
$68.40
|
| Rate for Payer: Quartz Beloit One Network |
$31.68
|
| Rate for Payer: Quartz Commercial |
$41.04
|
| Rate for Payer: The Alliance Commercial |
$36.00
|
| Rate for Payer: WEA Trust Commercial |
$39.60
|
| Rate for Payer: WPS Commercial |
$53.33
|
|
|
Antiphospholipid Antibody Panel
|
Professional
|
Both
|
$344.00
|
|
|
Service Code
|
CPT 86148
|
| Hospital Charge Code |
980025
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$56.73 |
| Max. Negotiated Rate |
$326.80 |
| Rate for Payer: Aetna Commercial |
$326.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$295.84
|
| Rate for Payer: Cash Price |
$103.20
|
| Rate for Payer: Cash Price |
$103.20
|
| Rate for Payer: Cigna Commercial |
$326.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$172.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$206.40
|
| Rate for Payer: Health EOS Commercial |
$313.04
|
| Rate for Payer: HFN Commercial |
$326.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$56.73
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$56.73
|
| Rate for Payer: Multiplan Commercial |
$275.20
|
| Rate for Payer: Preferred Network Access Commercial |
$326.80
|
| Rate for Payer: Quartz Beloit One Network |
$151.36
|
| Rate for Payer: Quartz Commercial |
$196.08
|
| Rate for Payer: The Alliance Commercial |
$172.00
|
| Rate for Payer: WEA Trust Commercial |
$189.20
|
| Rate for Payer: WPS Commercial |
$254.80
|
|
|
Antiphospholipid Antibody Panel
|
Facility
|
OP
|
$344.00
|
|
|
Service Code
|
CPT 86148
|
| Hospital Charge Code |
980025
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.17 |
| Max. Negotiated Rate |
$316.48 |
| Rate for Payer: Aetna Commercial |
$309.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$295.84
|
| Rate for Payer: Aetna Managed Medicare |
$16.07
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$60.26
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$28.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$26.68
|
| Rate for Payer: Anthem Medicaid |
$8.17
|
| Rate for Payer: Anthem Medicare Advantage |
$16.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$182.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$16.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$16.07
|
| Rate for Payer: Cash Price |
$103.20
|
| Rate for Payer: Cash Price |
$103.20
|
| Rate for Payer: Cigna Commercial |
$316.48
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$16.07
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$8.17
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$192.50
|
| Rate for Payer: Dean Health Medicaid |
$8.17
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$16.07
|
| Rate for Payer: Health EOS Commercial |
$306.16
|
| Rate for Payer: HFN Commercial |
$316.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$59.78
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$16.07
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$8.17
|
| Rate for Payer: Independent Care Health Plan Medicare |
$16.07
|
| Rate for Payer: Managed Health Services Medicaid |
$8.50
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$16.07
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$16.07
|
| Rate for Payer: Multiplan Commercial |
$275.20
|
| Rate for Payer: NAPHCARE Commercial |
$24.10
|
| Rate for Payer: Preferred Network Access Commercial |
$316.48
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$8.17
|
| Rate for Payer: Quartz Beloit One Network |
$168.56
|
| Rate for Payer: Quartz Commercial |
$223.60
|
| Rate for Payer: Quartz Medicare Advantage |
$16.07
|
| Rate for Payer: The Alliance Commercial |
$64.28
|
| Rate for Payer: United Healthcare Medicaid |
$8.17
|
| Rate for Payer: United Healthcare Medicare Advantage |
$16.07
|
| Rate for Payer: United Healthcare PPO |
$258.00
|
| Rate for Payer: WEA Trust Commercial |
$189.20
|
| Rate for Payer: Wellcare Medicare |
$16.07
|
| Rate for Payer: WMAP Medicaid |
$8.17
|
| Rate for Payer: WPS Commercial |
$254.80
|
|
|
Antiphospholipid Antibody Panel
|
Facility
|
IP
|
$344.00
|
|
|
Service Code
|
CPT 86148
|
| Hospital Charge Code |
980025
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$168.56 |
| Max. Negotiated Rate |
$316.48 |
| Rate for Payer: Aetna Commercial |
$309.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$295.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$182.32
|
| Rate for Payer: Cash Price |
$103.20
|
| Rate for Payer: Cigna Commercial |
$316.48
|
| Rate for Payer: Health EOS Commercial |
$306.16
|
| Rate for Payer: HFN Commercial |
$316.48
|
| Rate for Payer: Multiplan Commercial |
$275.20
|
| Rate for Payer: NAPHCARE Commercial |
$206.40
|
| Rate for Payer: Preferred Network Access Commercial |
$316.48
|
| Rate for Payer: Quartz Beloit One Network |
$168.56
|
| Rate for Payer: Quartz Commercial |
$206.40
|
| Rate for Payer: WEA Trust Commercial |
$189.20
|
| Rate for Payer: WPS Commercial |
$254.80
|
|
|
ANTIROTATION SCREW FEMORAL NECK 75MM 04.168.475S
|
Facility
|
OP
|
$2,407.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
6178975
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$673.96 |
| Max. Negotiated Rate |
$9,628.00 |
| Rate for Payer: Aetna Commercial |
$2,166.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,070.02
|
| Rate for Payer: Aetna Managed Medicare |
$673.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,564.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,203.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,155.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,275.71
|
| Rate for Payer: Cash Price |
$722.10
|
| Rate for Payer: Cigna Commercial |
$2,214.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,346.96
|
| Rate for Payer: Health EOS Commercial |
$2,142.23
|
| Rate for Payer: HFN Commercial |
$2,214.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,805.25
|
| Rate for Payer: Multiplan Commercial |
$1,925.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,444.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,214.44
|
| Rate for Payer: Quartz Beloit One Network |
$1,179.43
|
| Rate for Payer: Quartz Commercial |
$1,564.55
|
| Rate for Payer: Quartz Medicare Advantage |
$1,444.20
|
| Rate for Payer: The Alliance Commercial |
$9,628.00
|
| Rate for Payer: WEA Trust Commercial |
$1,323.85
|
| Rate for Payer: WPS Commercial |
$1,782.86
|
|
|
ANTIROTATION SCREW FEMORAL NECK 75MM 04.168.475S
|
Facility
|
IP
|
$2,407.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
6178975
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,179.43 |
| Max. Negotiated Rate |
$2,214.44 |
| Rate for Payer: Aetna Commercial |
$2,166.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,070.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,275.71
|
| Rate for Payer: Cash Price |
$722.10
|
| Rate for Payer: Cigna Commercial |
$2,214.44
|
| Rate for Payer: Health EOS Commercial |
$2,142.23
|
| Rate for Payer: HFN Commercial |
$2,214.44
|
| Rate for Payer: Multiplan Commercial |
$1,925.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,444.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,214.44
|
| Rate for Payer: Quartz Beloit One Network |
$1,179.43
|
| Rate for Payer: Quartz Commercial |
$1,444.20
|
| Rate for Payer: WEA Trust Commercial |
$1,323.85
|
| Rate for Payer: WPS Commercial |
$1,782.86
|
|
|
ANTIROTATION SCREW FEMORAL NECK 90MM 04.168.490S
|
Facility
|
OP
|
$2,407.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
6178976
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$673.96 |
| Max. Negotiated Rate |
$9,628.00 |
| Rate for Payer: Aetna Commercial |
$2,166.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,070.02
|
| Rate for Payer: Aetna Managed Medicare |
$673.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,564.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,203.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,155.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,275.71
|
| Rate for Payer: Cash Price |
$722.10
|
| Rate for Payer: Cigna Commercial |
$2,214.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,346.96
|
| Rate for Payer: Health EOS Commercial |
$2,142.23
|
| Rate for Payer: HFN Commercial |
$2,214.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,805.25
|
| Rate for Payer: Multiplan Commercial |
$1,925.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,444.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,214.44
|
| Rate for Payer: Quartz Beloit One Network |
$1,179.43
|
| Rate for Payer: Quartz Commercial |
$1,564.55
|
| Rate for Payer: Quartz Medicare Advantage |
$1,444.20
|
| Rate for Payer: The Alliance Commercial |
$9,628.00
|
| Rate for Payer: WEA Trust Commercial |
$1,323.85
|
| Rate for Payer: WPS Commercial |
$1,782.86
|
|
|
ANTIROTATION SCREW FEMORAL NECK 90MM 04.168.490S
|
Facility
|
IP
|
$2,407.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
6178976
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,179.43 |
| Max. Negotiated Rate |
$2,214.44 |
| Rate for Payer: Aetna Commercial |
$2,166.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,070.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,275.71
|
| Rate for Payer: Cash Price |
$722.10
|
| Rate for Payer: Cigna Commercial |
$2,214.44
|
| Rate for Payer: Health EOS Commercial |
$2,142.23
|
| Rate for Payer: HFN Commercial |
$2,214.44
|
| Rate for Payer: Multiplan Commercial |
$1,925.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,444.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,214.44
|
| Rate for Payer: Quartz Beloit One Network |
$1,179.43
|
| Rate for Payer: Quartz Commercial |
$1,444.20
|
| Rate for Payer: WEA Trust Commercial |
$1,323.85
|
| Rate for Payer: WPS Commercial |
$1,782.86
|
|
