|
Platelet Circulating IgM Antibody
|
Facility
|
IP
|
$696.00
|
|
|
Service Code
|
CPT 86022
|
| Hospital Charge Code |
2942968
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$354.68 |
| Max. Negotiated Rate |
$665.93 |
| Rate for Payer: Aetna Commercial |
$651.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$622.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$383.64
|
| Rate for Payer: Cash Price |
$208.80
|
| Rate for Payer: Cigna Commercial |
$665.93
|
| Rate for Payer: Health EOS Commercial |
$644.22
|
| Rate for Payer: HFN Commercial |
$665.93
|
| Rate for Payer: Multiplan Commercial |
$579.07
|
| Rate for Payer: Preferred Network Access Commercial |
$665.93
|
| Rate for Payer: Quartz Beloit One Network |
$354.68
|
| Rate for Payer: Quartz Commercial |
$434.30
|
| Rate for Payer: WEA Trust Commercial |
$398.11
|
| Rate for Payer: WPS Commercial |
$536.13
|
|
|
Platelet Circulating IgM Antibody
|
Professional
|
Both
|
$696.00
|
|
|
Service Code
|
CPT 86022
|
| Hospital Charge Code |
2942968
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$19.10 |
| Max. Negotiated Rate |
$687.65 |
| Rate for Payer: Aetna Commercial |
$687.65
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$622.50
|
| Rate for Payer: Aetna Managed Medicare |
$19.10
|
| Rate for Payer: Anthem Medicare Advantage |
$19.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$19.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$19.10
|
| Rate for Payer: Cash Price |
$208.80
|
| Rate for Payer: Cash Price |
$208.80
|
| Rate for Payer: Cigna Commercial |
$687.65
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$361.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$19.10
|
| Rate for Payer: Health EOS Commercial |
$658.69
|
| Rate for Payer: HFN Commercial |
$687.65
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$67.44
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$67.44
|
| Rate for Payer: Independent Care Health Plan Medicare |
$19.10
|
| Rate for Payer: Multiplan Commercial |
$579.07
|
| Rate for Payer: NAPHCARE Commercial |
$28.66
|
| Rate for Payer: Preferred Network Access Commercial |
$687.65
|
| Rate for Payer: Quartz Beloit One Network |
$318.49
|
| Rate for Payer: Quartz Commercial |
$412.59
|
| Rate for Payer: Quartz Medicare Advantage |
$19.10
|
| Rate for Payer: The Alliance Commercial |
$75.46
|
| Rate for Payer: United Healthcare Medicare Advantage |
$19.10
|
| Rate for Payer: WEA Trust Commercial |
$398.11
|
| Rate for Payer: WPS Commercial |
$84.06
|
|
|
Platelet Circulating IgM Antibody
|
Facility
|
OP
|
$696.00
|
|
|
Service Code
|
CPT 86022
|
| Hospital Charge Code |
2942968
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$19.10 |
| Max. Negotiated Rate |
$665.93 |
| Rate for Payer: Aetna Commercial |
$651.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$622.50
|
| Rate for Payer: Aetna Managed Medicare |
$19.10
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$71.64
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$33.43
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$31.71
|
| Rate for Payer: Anthem Medicare Advantage |
$19.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$383.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$19.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$19.10
|
| Rate for Payer: Cash Price |
$208.80
|
| Rate for Payer: Cash Price |
$208.80
|
| Rate for Payer: Cigna Commercial |
$665.93
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$19.10
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$405.07
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$19.10
|
| Rate for Payer: Health EOS Commercial |
$644.22
|
| Rate for Payer: HFN Commercial |
$665.93
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$71.07
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$19.10
|
| Rate for Payer: Independent Care Health Plan Medicare |
$19.10
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$19.10
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$19.10
|
| Rate for Payer: Multiplan Commercial |
$579.07
|
| Rate for Payer: NAPHCARE Commercial |
$28.66
|
| Rate for Payer: Preferred Network Access Commercial |
$665.93
|
| Rate for Payer: Quartz Beloit One Network |
$354.68
|
| Rate for Payer: Quartz Commercial |
$470.50
|
| Rate for Payer: Quartz Medicare Advantage |
$19.10
|
| Rate for Payer: The Alliance Commercial |
$76.42
|
| Rate for Payer: United Healthcare Medicare Advantage |
$19.10
|
| Rate for Payer: United Healthcare PPO |
$542.88
|
| Rate for Payer: WEA Trust Commercial |
$398.11
|
| Rate for Payer: Wellcare Medicare |
$19.10
|
| Rate for Payer: WPS Commercial |
$536.13
|
|
|
Platelet Count
|
Professional
|
Both
|
$86.00
|
|
|
Service Code
|
CPT 85049
|
| Hospital Charge Code |
633807
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.66 |
| Max. Negotiated Rate |
$84.97 |
| Rate for Payer: Aetna Commercial |
$84.97
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$76.92
|
| Rate for Payer: Aetna Managed Medicare |
$4.66
|
| Rate for Payer: Anthem Medicare Advantage |
$4.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$4.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$4.66
|
| Rate for Payer: Cash Price |
$25.80
|
| Rate for Payer: Cash Price |
$25.80
|
| Rate for Payer: Cigna Commercial |
$84.97
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$44.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4.66
|
| Rate for Payer: Health EOS Commercial |
$81.39
|
| Rate for Payer: HFN Commercial |
$84.97
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$16.44
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$16.44
|
| Rate for Payer: Independent Care Health Plan Medicare |
$4.66
|
| Rate for Payer: Multiplan Commercial |
$71.55
|
| Rate for Payer: NAPHCARE Commercial |
$6.99
|
| Rate for Payer: Preferred Network Access Commercial |
$84.97
|
| Rate for Payer: Quartz Beloit One Network |
$39.35
|
| Rate for Payer: Quartz Commercial |
$50.98
|
| Rate for Payer: Quartz Medicare Advantage |
$4.66
|
| Rate for Payer: The Alliance Commercial |
$18.40
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4.66
|
| Rate for Payer: WEA Trust Commercial |
$49.19
|
| Rate for Payer: WPS Commercial |
$20.50
|
|
|
Platelet Count
|
Facility
|
OP
|
$86.00
|
|
|
Service Code
|
CPT 85049
|
| Hospital Charge Code |
633807
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.66 |
| Max. Negotiated Rate |
$82.28 |
| Rate for Payer: Aetna Commercial |
$80.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$76.92
|
| Rate for Payer: Aetna Managed Medicare |
$4.66
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$17.47
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8.15
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7.73
|
| Rate for Payer: Anthem Medicare Advantage |
$4.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$47.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$4.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$4.66
|
| Rate for Payer: Cash Price |
$25.80
|
| Rate for Payer: Cash Price |
$25.80
|
| Rate for Payer: Cigna Commercial |
$82.28
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$4.66
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$50.05
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$4.66
|
| Rate for Payer: Health EOS Commercial |
$79.60
|
| Rate for Payer: HFN Commercial |
$82.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$17.33
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$4.66
|
| Rate for Payer: Independent Care Health Plan Medicare |
$4.66
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$4.66
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$4.66
|
| Rate for Payer: Multiplan Commercial |
$71.55
|
| Rate for Payer: NAPHCARE Commercial |
$6.99
|
| Rate for Payer: Preferred Network Access Commercial |
$82.28
|
| Rate for Payer: Quartz Beloit One Network |
$43.83
|
| Rate for Payer: Quartz Commercial |
$58.14
|
| Rate for Payer: Quartz Medicare Advantage |
$4.66
|
| Rate for Payer: The Alliance Commercial |
$18.64
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4.66
|
| Rate for Payer: United Healthcare PPO |
$67.08
|
| Rate for Payer: WEA Trust Commercial |
$49.19
|
| Rate for Payer: Wellcare Medicare |
$4.66
|
| Rate for Payer: WPS Commercial |
$66.25
|
|
|
Platelet Count
|
Facility
|
IP
|
$86.00
|
|
|
Service Code
|
CPT 85049
|
| Hospital Charge Code |
633807
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$43.83 |
| Max. Negotiated Rate |
$82.28 |
| Rate for Payer: Aetna Commercial |
$80.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$76.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$47.40
|
| Rate for Payer: Cash Price |
$25.80
|
| Rate for Payer: Cigna Commercial |
$82.28
|
| Rate for Payer: Health EOS Commercial |
$79.60
|
| Rate for Payer: HFN Commercial |
$82.28
|
| Rate for Payer: Multiplan Commercial |
$71.55
|
| Rate for Payer: Preferred Network Access Commercial |
$82.28
|
| Rate for Payer: Quartz Beloit One Network |
$43.83
|
| Rate for Payer: Quartz Commercial |
$53.66
|
| Rate for Payer: WEA Trust Commercial |
$49.19
|
| Rate for Payer: WPS Commercial |
$66.25
|
|
|
Platelet (FS)
|
Professional
|
Both
|
$5.00
|
|
|
Service Code
|
CPT 85049
|
| Hospital Charge Code |
4538808
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$2.29 |
| Max. Negotiated Rate |
$20.50 |
| Rate for Payer: Aetna Commercial |
$4.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4.47
|
| Rate for Payer: Aetna Managed Medicare |
$4.66
|
| Rate for Payer: Anthem Medicare Advantage |
$4.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$4.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$4.66
|
| Rate for Payer: Cash Price |
$1.50
|
| Rate for Payer: Cash Price |
$1.50
|
| Rate for Payer: Cigna Commercial |
$4.94
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4.66
|
| Rate for Payer: Health EOS Commercial |
$4.73
|
| Rate for Payer: HFN Commercial |
$4.94
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$16.44
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$16.44
|
| Rate for Payer: Independent Care Health Plan Medicare |
$4.66
|
| Rate for Payer: Multiplan Commercial |
$4.16
|
| Rate for Payer: NAPHCARE Commercial |
$6.99
|
| Rate for Payer: Preferred Network Access Commercial |
$4.94
|
| Rate for Payer: Quartz Beloit One Network |
$2.29
|
| Rate for Payer: Quartz Commercial |
$2.96
|
| Rate for Payer: Quartz Medicare Advantage |
$4.66
|
| Rate for Payer: The Alliance Commercial |
$18.40
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4.66
|
| Rate for Payer: WEA Trust Commercial |
$2.86
|
| Rate for Payer: WPS Commercial |
$20.50
|
|
|
Platelet (FS)
|
Facility
|
OP
|
$5.00
|
|
|
Service Code
|
CPT 85049
|
| Hospital Charge Code |
4538808
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$2.55 |
| Max. Negotiated Rate |
$18.64 |
| Rate for Payer: Aetna Commercial |
$4.68
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4.47
|
| Rate for Payer: Aetna Managed Medicare |
$4.66
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$17.47
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8.15
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7.73
|
| Rate for Payer: Anthem Medicare Advantage |
$4.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$4.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$4.66
|
| Rate for Payer: Cash Price |
$1.50
|
| Rate for Payer: Cash Price |
$1.50
|
| Rate for Payer: Cigna Commercial |
$4.78
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$4.66
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2.91
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$4.66
|
| Rate for Payer: Health EOS Commercial |
$4.63
|
| Rate for Payer: HFN Commercial |
$4.78
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$17.33
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$4.66
|
| Rate for Payer: Independent Care Health Plan Medicare |
$4.66
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$4.66
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$4.66
|
| Rate for Payer: Multiplan Commercial |
$4.16
|
| Rate for Payer: NAPHCARE Commercial |
$6.99
|
| Rate for Payer: Preferred Network Access Commercial |
$4.78
|
| Rate for Payer: Quartz Beloit One Network |
$2.55
|
| Rate for Payer: Quartz Commercial |
$3.38
|
| Rate for Payer: Quartz Medicare Advantage |
$4.66
|
| Rate for Payer: The Alliance Commercial |
$18.64
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4.66
|
| Rate for Payer: United Healthcare PPO |
$3.90
|
| Rate for Payer: WEA Trust Commercial |
$2.86
|
| Rate for Payer: Wellcare Medicare |
$4.66
|
| Rate for Payer: WPS Commercial |
$3.85
|
|
|
Platelet (FS)
|
Facility
|
IP
|
$5.00
|
|
|
Service Code
|
CPT 85049
|
| Hospital Charge Code |
4538808
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$2.55 |
| Max. Negotiated Rate |
$4.78 |
| Rate for Payer: Aetna Commercial |
$4.68
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2.76
|
| Rate for Payer: Cash Price |
$1.50
|
| Rate for Payer: Cigna Commercial |
$4.78
|
| Rate for Payer: Health EOS Commercial |
$4.63
|
| Rate for Payer: HFN Commercial |
$4.78
|
| Rate for Payer: Multiplan Commercial |
$4.16
|
| Rate for Payer: Preferred Network Access Commercial |
$4.78
|
| Rate for Payer: Quartz Beloit One Network |
$2.55
|
| Rate for Payer: Quartz Commercial |
$3.12
|
| Rate for Payer: WEA Trust Commercial |
$2.86
|
| Rate for Payer: WPS Commercial |
$3.85
|
|
|
Platelet Function Assay
|
Facility
|
OP
|
$272.00
|
|
|
Service Code
|
CPT 85576
|
| Hospital Charge Code |
4464657
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$25.91 |
| Max. Negotiated Rate |
$260.25 |
| Rate for Payer: Aetna Commercial |
$254.59
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$243.28
|
| Rate for Payer: Aetna Managed Medicare |
$25.91
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$97.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$45.34
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$43.00
|
| Rate for Payer: Anthem Medicare Advantage |
$25.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$149.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$25.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$25.91
|
| Rate for Payer: Cash Price |
$81.60
|
| Rate for Payer: Cash Price |
$81.60
|
| Rate for Payer: Cigna Commercial |
$260.25
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$25.91
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$158.30
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$25.91
|
| Rate for Payer: Health EOS Commercial |
$251.76
|
| Rate for Payer: HFN Commercial |
$260.25
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$96.37
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$25.91
|
| Rate for Payer: Independent Care Health Plan Medicare |
$25.91
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$25.91
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$25.91
|
| Rate for Payer: Multiplan Commercial |
$226.30
|
| Rate for Payer: NAPHCARE Commercial |
$38.86
|
| Rate for Payer: Preferred Network Access Commercial |
$260.25
|
| Rate for Payer: Quartz Beloit One Network |
$138.61
|
| Rate for Payer: Quartz Commercial |
$183.87
|
| Rate for Payer: Quartz Medicare Advantage |
$25.91
|
| Rate for Payer: The Alliance Commercial |
$103.63
|
| Rate for Payer: United Healthcare Medicare Advantage |
$25.91
|
| Rate for Payer: United Healthcare PPO |
$212.16
|
| Rate for Payer: WEA Trust Commercial |
$155.58
|
| Rate for Payer: Wellcare Medicare |
$25.91
|
| Rate for Payer: WPS Commercial |
$209.52
|
|
|
Platelet Function Assay
|
Professional
|
Both
|
$272.00
|
|
|
Service Code
|
CPT 85576
|
| Hospital Charge Code |
4464657
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.27 |
| Max. Negotiated Rate |
$268.74 |
| Rate for Payer: Aetna Commercial |
$268.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$243.28
|
| Rate for Payer: Aetna Managed Medicare |
$25.91
|
| Rate for Payer: Anthem Commercial |
$17.27
|
| Rate for Payer: Anthem Medicare Advantage |
$25.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$25.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$25.91
|
| Rate for Payer: Cash Price |
$81.60
|
| Rate for Payer: Cash Price |
$81.60
|
| Rate for Payer: Cigna Commercial |
$268.74
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$141.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$25.91
|
| Rate for Payer: Health EOS Commercial |
$257.42
|
| Rate for Payer: HFN Commercial |
$268.74
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$91.45
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$91.45
|
| Rate for Payer: Independent Care Health Plan Medicare |
$25.91
|
| Rate for Payer: Multiplan Commercial |
$226.30
|
| Rate for Payer: NAPHCARE Commercial |
$38.86
|
| Rate for Payer: Preferred Network Access Commercial |
$268.74
|
| Rate for Payer: Quartz Beloit One Network |
$124.47
|
| Rate for Payer: Quartz Commercial |
$161.24
|
| Rate for Payer: Quartz Medicare Advantage |
$25.91
|
| Rate for Payer: The Alliance Commercial |
$102.33
|
| Rate for Payer: United Healthcare Medicare Advantage |
$25.91
|
| Rate for Payer: WEA Trust Commercial |
$155.58
|
| Rate for Payer: WPS Commercial |
$113.99
|
|
|
Platelet Function Assay
|
Facility
|
IP
|
$272.00
|
|
|
Service Code
|
CPT 85576
|
| Hospital Charge Code |
4464657
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$138.61 |
| Max. Negotiated Rate |
$260.25 |
| Rate for Payer: Aetna Commercial |
$254.59
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$243.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$149.93
|
| Rate for Payer: Cash Price |
$81.60
|
| Rate for Payer: Cigna Commercial |
$260.25
|
| Rate for Payer: Health EOS Commercial |
$251.76
|
| Rate for Payer: HFN Commercial |
$260.25
|
| Rate for Payer: Multiplan Commercial |
$226.30
|
| Rate for Payer: Preferred Network Access Commercial |
$260.25
|
| Rate for Payer: Quartz Beloit One Network |
$138.61
|
| Rate for Payer: Quartz Commercial |
$169.73
|
| Rate for Payer: WEA Trust Commercial |
$155.58
|
| Rate for Payer: WPS Commercial |
$209.52
|
|
|
Platelet IgA Indirect
|
Facility
|
IP
|
$137.00
|
|
|
Service Code
|
CPT 86022
|
| Hospital Charge Code |
4500768
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$69.82 |
| Max. Negotiated Rate |
$131.08 |
| Rate for Payer: Aetna Commercial |
$128.23
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$122.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$75.51
|
| Rate for Payer: Cash Price |
$41.10
|
| Rate for Payer: Cigna Commercial |
$131.08
|
| Rate for Payer: Health EOS Commercial |
$126.81
|
| Rate for Payer: HFN Commercial |
$131.08
|
| Rate for Payer: Multiplan Commercial |
$113.98
|
| Rate for Payer: Preferred Network Access Commercial |
$131.08
|
| Rate for Payer: Quartz Beloit One Network |
$69.82
|
| Rate for Payer: Quartz Commercial |
$85.49
|
| Rate for Payer: WEA Trust Commercial |
$78.36
|
| Rate for Payer: WPS Commercial |
$105.53
|
|
|
Platelet IgA Indirect
|
Facility
|
OP
|
$137.00
|
|
|
Service Code
|
CPT 86022
|
| Hospital Charge Code |
4500768
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$19.10 |
| Max. Negotiated Rate |
$131.08 |
| Rate for Payer: Aetna Commercial |
$128.23
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$122.53
|
| Rate for Payer: Aetna Managed Medicare |
$19.10
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$71.64
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$33.43
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$31.71
|
| Rate for Payer: Anthem Medicare Advantage |
$19.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$75.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$19.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$19.10
|
| Rate for Payer: Cash Price |
$41.10
|
| Rate for Payer: Cash Price |
$41.10
|
| Rate for Payer: Cigna Commercial |
$131.08
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$19.10
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$79.73
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$19.10
|
| Rate for Payer: Health EOS Commercial |
$126.81
|
| Rate for Payer: HFN Commercial |
$131.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$71.07
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$19.10
|
| Rate for Payer: Independent Care Health Plan Medicare |
$19.10
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$19.10
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$19.10
|
| Rate for Payer: Multiplan Commercial |
$113.98
|
| Rate for Payer: NAPHCARE Commercial |
$28.66
|
| Rate for Payer: Preferred Network Access Commercial |
$131.08
|
| Rate for Payer: Quartz Beloit One Network |
$69.82
|
| Rate for Payer: Quartz Commercial |
$92.61
|
| Rate for Payer: Quartz Medicare Advantage |
$19.10
|
| Rate for Payer: The Alliance Commercial |
$76.42
|
| Rate for Payer: United Healthcare Medicare Advantage |
$19.10
|
| Rate for Payer: United Healthcare PPO |
$106.86
|
| Rate for Payer: WEA Trust Commercial |
$78.36
|
| Rate for Payer: Wellcare Medicare |
$19.10
|
| Rate for Payer: WPS Commercial |
$105.53
|
|
|
Platelet IgA Indirect
|
Professional
|
Both
|
$137.00
|
|
|
Service Code
|
CPT 86022
|
| Hospital Charge Code |
4500768
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$19.10 |
| Max. Negotiated Rate |
$135.36 |
| Rate for Payer: Aetna Commercial |
$135.36
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$122.53
|
| Rate for Payer: Aetna Managed Medicare |
$19.10
|
| Rate for Payer: Anthem Medicare Advantage |
$19.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$19.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$19.10
|
| Rate for Payer: Cash Price |
$41.10
|
| Rate for Payer: Cash Price |
$41.10
|
| Rate for Payer: Cigna Commercial |
$135.36
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$71.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$19.10
|
| Rate for Payer: Health EOS Commercial |
$129.66
|
| Rate for Payer: HFN Commercial |
$135.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$67.44
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$67.44
|
| Rate for Payer: Independent Care Health Plan Medicare |
$19.10
|
| Rate for Payer: Multiplan Commercial |
$113.98
|
| Rate for Payer: NAPHCARE Commercial |
$28.66
|
| Rate for Payer: Preferred Network Access Commercial |
$135.36
|
| Rate for Payer: Quartz Beloit One Network |
$62.69
|
| Rate for Payer: Quartz Commercial |
$81.21
|
| Rate for Payer: Quartz Medicare Advantage |
$19.10
|
| Rate for Payer: The Alliance Commercial |
$75.46
|
| Rate for Payer: United Healthcare Medicare Advantage |
$19.10
|
| Rate for Payer: WEA Trust Commercial |
$78.36
|
| Rate for Payer: WPS Commercial |
$84.06
|
|
|
Platelet IgG Indirect
|
Professional
|
Both
|
$137.00
|
|
|
Service Code
|
CPT 86022
|
| Hospital Charge Code |
4500766
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$19.10 |
| Max. Negotiated Rate |
$135.36 |
| Rate for Payer: Aetna Commercial |
$135.36
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$122.53
|
| Rate for Payer: Aetna Managed Medicare |
$19.10
|
| Rate for Payer: Anthem Medicare Advantage |
$19.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$19.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$19.10
|
| Rate for Payer: Cash Price |
$41.10
|
| Rate for Payer: Cash Price |
$41.10
|
| Rate for Payer: Cigna Commercial |
$135.36
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$71.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$19.10
|
| Rate for Payer: Health EOS Commercial |
$129.66
|
| Rate for Payer: HFN Commercial |
$135.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$67.44
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$67.44
|
| Rate for Payer: Independent Care Health Plan Medicare |
$19.10
|
| Rate for Payer: Multiplan Commercial |
$113.98
|
| Rate for Payer: NAPHCARE Commercial |
$28.66
|
| Rate for Payer: Preferred Network Access Commercial |
$135.36
|
| Rate for Payer: Quartz Beloit One Network |
$62.69
|
| Rate for Payer: Quartz Commercial |
$81.21
|
| Rate for Payer: Quartz Medicare Advantage |
$19.10
|
| Rate for Payer: The Alliance Commercial |
$75.46
|
| Rate for Payer: United Healthcare Medicare Advantage |
$19.10
|
| Rate for Payer: WEA Trust Commercial |
$78.36
|
| Rate for Payer: WPS Commercial |
$84.06
|
|
|
Platelet IgG Indirect
|
Facility
|
IP
|
$137.00
|
|
|
Service Code
|
CPT 86022
|
| Hospital Charge Code |
4500766
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$69.82 |
| Max. Negotiated Rate |
$131.08 |
| Rate for Payer: Aetna Commercial |
$128.23
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$122.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$75.51
|
| Rate for Payer: Cash Price |
$41.10
|
| Rate for Payer: Cigna Commercial |
$131.08
|
| Rate for Payer: Health EOS Commercial |
$126.81
|
| Rate for Payer: HFN Commercial |
$131.08
|
| Rate for Payer: Multiplan Commercial |
$113.98
|
| Rate for Payer: Preferred Network Access Commercial |
$131.08
|
| Rate for Payer: Quartz Beloit One Network |
$69.82
|
| Rate for Payer: Quartz Commercial |
$85.49
|
| Rate for Payer: WEA Trust Commercial |
$78.36
|
| Rate for Payer: WPS Commercial |
$105.53
|
|
|
Platelet IgG Indirect
|
Facility
|
OP
|
$137.00
|
|
|
Service Code
|
CPT 86022
|
| Hospital Charge Code |
4500766
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$19.10 |
| Max. Negotiated Rate |
$131.08 |
| Rate for Payer: Aetna Commercial |
$128.23
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$122.53
|
| Rate for Payer: Aetna Managed Medicare |
$19.10
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$71.64
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$33.43
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$31.71
|
| Rate for Payer: Anthem Medicare Advantage |
$19.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$75.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$19.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$19.10
|
| Rate for Payer: Cash Price |
$41.10
|
| Rate for Payer: Cash Price |
$41.10
|
| Rate for Payer: Cigna Commercial |
$131.08
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$19.10
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$79.73
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$19.10
|
| Rate for Payer: Health EOS Commercial |
$126.81
|
| Rate for Payer: HFN Commercial |
$131.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$71.07
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$19.10
|
| Rate for Payer: Independent Care Health Plan Medicare |
$19.10
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$19.10
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$19.10
|
| Rate for Payer: Multiplan Commercial |
$113.98
|
| Rate for Payer: NAPHCARE Commercial |
$28.66
|
| Rate for Payer: Preferred Network Access Commercial |
$131.08
|
| Rate for Payer: Quartz Beloit One Network |
$69.82
|
| Rate for Payer: Quartz Commercial |
$92.61
|
| Rate for Payer: Quartz Medicare Advantage |
$19.10
|
| Rate for Payer: The Alliance Commercial |
$76.42
|
| Rate for Payer: United Healthcare Medicare Advantage |
$19.10
|
| Rate for Payer: United Healthcare PPO |
$106.86
|
| Rate for Payer: WEA Trust Commercial |
$78.36
|
| Rate for Payer: Wellcare Medicare |
$19.10
|
| Rate for Payer: WPS Commercial |
$105.53
|
|
|
Platelet IgM Indirect
|
Facility
|
IP
|
$137.00
|
|
|
Service Code
|
CPT 86022
|
| Hospital Charge Code |
4500767
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$69.82 |
| Max. Negotiated Rate |
$131.08 |
| Rate for Payer: Aetna Commercial |
$128.23
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$122.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$75.51
|
| Rate for Payer: Cash Price |
$41.10
|
| Rate for Payer: Cigna Commercial |
$131.08
|
| Rate for Payer: Health EOS Commercial |
$126.81
|
| Rate for Payer: HFN Commercial |
$131.08
|
| Rate for Payer: Multiplan Commercial |
$113.98
|
| Rate for Payer: Preferred Network Access Commercial |
$131.08
|
| Rate for Payer: Quartz Beloit One Network |
$69.82
|
| Rate for Payer: Quartz Commercial |
$85.49
|
| Rate for Payer: WEA Trust Commercial |
$78.36
|
| Rate for Payer: WPS Commercial |
$105.53
|
|
|
Platelet IgM Indirect
|
Facility
|
OP
|
$137.00
|
|
|
Service Code
|
CPT 86022
|
| Hospital Charge Code |
4500767
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$19.10 |
| Max. Negotiated Rate |
$131.08 |
| Rate for Payer: Aetna Commercial |
$128.23
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$122.53
|
| Rate for Payer: Aetna Managed Medicare |
$19.10
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$71.64
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$33.43
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$31.71
|
| Rate for Payer: Anthem Medicare Advantage |
$19.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$75.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$19.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$19.10
|
| Rate for Payer: Cash Price |
$41.10
|
| Rate for Payer: Cash Price |
$41.10
|
| Rate for Payer: Cigna Commercial |
$131.08
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$19.10
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$79.73
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$19.10
|
| Rate for Payer: Health EOS Commercial |
$126.81
|
| Rate for Payer: HFN Commercial |
$131.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$71.07
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$19.10
|
| Rate for Payer: Independent Care Health Plan Medicare |
$19.10
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$19.10
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$19.10
|
| Rate for Payer: Multiplan Commercial |
$113.98
|
| Rate for Payer: NAPHCARE Commercial |
$28.66
|
| Rate for Payer: Preferred Network Access Commercial |
$131.08
|
| Rate for Payer: Quartz Beloit One Network |
$69.82
|
| Rate for Payer: Quartz Commercial |
$92.61
|
| Rate for Payer: Quartz Medicare Advantage |
$19.10
|
| Rate for Payer: The Alliance Commercial |
$76.42
|
| Rate for Payer: United Healthcare Medicare Advantage |
$19.10
|
| Rate for Payer: United Healthcare PPO |
$106.86
|
| Rate for Payer: WEA Trust Commercial |
$78.36
|
| Rate for Payer: Wellcare Medicare |
$19.10
|
| Rate for Payer: WPS Commercial |
$105.53
|
|
|
Platelet IgM Indirect
|
Professional
|
Both
|
$137.00
|
|
|
Service Code
|
CPT 86022
|
| Hospital Charge Code |
4500767
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$19.10 |
| Max. Negotiated Rate |
$135.36 |
| Rate for Payer: Aetna Commercial |
$135.36
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$122.53
|
| Rate for Payer: Aetna Managed Medicare |
$19.10
|
| Rate for Payer: Anthem Medicare Advantage |
$19.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$19.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$19.10
|
| Rate for Payer: Cash Price |
$41.10
|
| Rate for Payer: Cash Price |
$41.10
|
| Rate for Payer: Cigna Commercial |
$135.36
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$71.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$19.10
|
| Rate for Payer: Health EOS Commercial |
$129.66
|
| Rate for Payer: HFN Commercial |
$135.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$67.44
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$67.44
|
| Rate for Payer: Independent Care Health Plan Medicare |
$19.10
|
| Rate for Payer: Multiplan Commercial |
$113.98
|
| Rate for Payer: NAPHCARE Commercial |
$28.66
|
| Rate for Payer: Preferred Network Access Commercial |
$135.36
|
| Rate for Payer: Quartz Beloit One Network |
$62.69
|
| Rate for Payer: Quartz Commercial |
$81.21
|
| Rate for Payer: Quartz Medicare Advantage |
$19.10
|
| Rate for Payer: The Alliance Commercial |
$75.46
|
| Rate for Payer: United Healthcare Medicare Advantage |
$19.10
|
| Rate for Payer: WEA Trust Commercial |
$78.36
|
| Rate for Payer: WPS Commercial |
$84.06
|
|
|
PLATE LOCKING CALCANEAL 241.623
|
Facility
|
OP
|
$6,412.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966371
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,867.17 |
| Max. Negotiated Rate |
$6,135.00 |
| Rate for Payer: Aetna Commercial |
$6,001.63
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,734.89
|
| Rate for Payer: Aetna Managed Medicare |
$1,867.17
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,334.51
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,334.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,200.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,534.29
|
| Rate for Payer: Cash Price |
$1,923.60
|
| Rate for Payer: Cigna Commercial |
$6,135.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,731.78
|
| Rate for Payer: Health EOS Commercial |
$5,934.95
|
| Rate for Payer: HFN Commercial |
$6,135.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,001.36
|
| Rate for Payer: Multiplan Commercial |
$5,334.78
|
| Rate for Payer: NAPHCARE Commercial |
$4,001.09
|
| Rate for Payer: Preferred Network Access Commercial |
$6,135.00
|
| Rate for Payer: Quartz Beloit One Network |
$3,267.56
|
| Rate for Payer: Quartz Commercial |
$4,334.51
|
| Rate for Payer: Quartz Medicare Advantage |
$4,001.09
|
| Rate for Payer: The Alliance Commercial |
$3,334.24
|
| Rate for Payer: WEA Trust Commercial |
$3,667.66
|
| Rate for Payer: WPS Commercial |
$4,939.16
|
|
|
PLATE LOCKING CALCANEAL 241.623
|
Facility
|
IP
|
$6,412.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966371
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,267.56 |
| Max. Negotiated Rate |
$6,135.00 |
| Rate for Payer: Aetna Commercial |
$6,001.63
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,734.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,534.29
|
| Rate for Payer: Cash Price |
$1,923.60
|
| Rate for Payer: Cigna Commercial |
$6,135.00
|
| Rate for Payer: Health EOS Commercial |
$5,934.95
|
| Rate for Payer: HFN Commercial |
$6,135.00
|
| Rate for Payer: Multiplan Commercial |
$5,334.78
|
| Rate for Payer: Preferred Network Access Commercial |
$6,135.00
|
| Rate for Payer: Quartz Beloit One Network |
$3,267.56
|
| Rate for Payer: Quartz Commercial |
$4,001.09
|
| Rate for Payer: WEA Trust Commercial |
$3,667.66
|
| Rate for Payer: WPS Commercial |
$4,939.16
|
|
|
PLATE MATRIX MANDIBLE 2.0MM 12HL 04.503.729
|
Facility
|
IP
|
$7,728.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5831672
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,938.19 |
| Max. Negotiated Rate |
$7,394.15 |
| Rate for Payer: Aetna Commercial |
$7,233.41
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,911.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,259.67
|
| Rate for Payer: Cash Price |
$2,318.40
|
| Rate for Payer: Cigna Commercial |
$7,394.15
|
| Rate for Payer: Health EOS Commercial |
$7,153.04
|
| Rate for Payer: HFN Commercial |
$7,394.15
|
| Rate for Payer: Multiplan Commercial |
$6,429.70
|
| Rate for Payer: Preferred Network Access Commercial |
$7,394.15
|
| Rate for Payer: Quartz Beloit One Network |
$3,938.19
|
| Rate for Payer: Quartz Commercial |
$4,822.27
|
| Rate for Payer: WEA Trust Commercial |
$4,420.42
|
| Rate for Payer: WPS Commercial |
$5,952.88
|
|
|
PLATE MATRIX MANDIBLE 2.0MM 12HL 04.503.729
|
Facility
|
OP
|
$7,728.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5831672
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,250.39 |
| Max. Negotiated Rate |
$7,394.15 |
| Rate for Payer: Aetna Commercial |
$7,233.41
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,911.92
|
| Rate for Payer: Aetna Managed Medicare |
$2,250.39
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,224.13
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,018.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,857.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,259.67
|
| Rate for Payer: Cash Price |
$2,318.40
|
| Rate for Payer: Cigna Commercial |
$7,394.15
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,497.70
|
| Rate for Payer: Health EOS Commercial |
$7,153.04
|
| Rate for Payer: HFN Commercial |
$7,394.15
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,027.84
|
| Rate for Payer: Multiplan Commercial |
$6,429.70
|
| Rate for Payer: NAPHCARE Commercial |
$4,822.27
|
| Rate for Payer: Preferred Network Access Commercial |
$7,394.15
|
| Rate for Payer: Quartz Beloit One Network |
$3,938.19
|
| Rate for Payer: Quartz Commercial |
$5,224.13
|
| Rate for Payer: Quartz Medicare Advantage |
$4,822.27
|
| Rate for Payer: The Alliance Commercial |
$4,018.56
|
| Rate for Payer: WEA Trust Commercial |
$4,420.42
|
| Rate for Payer: WPS Commercial |
$5,952.88
|
|
