|
Platelet Circulating IgM Antibody
|
Professional
|
Both
|
$696.00
|
|
|
Service Code
|
CPT 86022
|
| Hospital Charge Code |
2942968
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$64.85 |
| Max. Negotiated Rate |
$661.20 |
| Rate for Payer: Aetna Commercial |
$661.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$598.56
|
| Rate for Payer: Cash Price |
$208.80
|
| Rate for Payer: Cash Price |
$208.80
|
| Rate for Payer: Cigna Commercial |
$661.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$348.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$417.60
|
| Rate for Payer: Health EOS Commercial |
$633.36
|
| Rate for Payer: HFN Commercial |
$661.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$64.85
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$64.85
|
| Rate for Payer: Multiplan Commercial |
$556.80
|
| Rate for Payer: Preferred Network Access Commercial |
$661.20
|
| Rate for Payer: Quartz Beloit One Network |
$306.24
|
| Rate for Payer: Quartz Commercial |
$396.72
|
| Rate for Payer: The Alliance Commercial |
$348.00
|
| Rate for Payer: WEA Trust Commercial |
$382.80
|
| Rate for Payer: WPS Commercial |
$515.53
|
|
|
Platelet Circulating IgM Antibody
|
Facility
|
IP
|
$696.00
|
|
|
Service Code
|
CPT 86022
|
| Hospital Charge Code |
2942968
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$341.04 |
| Max. Negotiated Rate |
$640.32 |
| Rate for Payer: Aetna Commercial |
$626.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$598.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$368.88
|
| Rate for Payer: Cash Price |
$208.80
|
| Rate for Payer: Cigna Commercial |
$640.32
|
| Rate for Payer: Health EOS Commercial |
$619.44
|
| Rate for Payer: HFN Commercial |
$640.32
|
| Rate for Payer: Multiplan Commercial |
$556.80
|
| Rate for Payer: NAPHCARE Commercial |
$417.60
|
| Rate for Payer: Preferred Network Access Commercial |
$640.32
|
| Rate for Payer: Quartz Beloit One Network |
$341.04
|
| Rate for Payer: Quartz Commercial |
$417.60
|
| Rate for Payer: WEA Trust Commercial |
$382.80
|
| Rate for Payer: WPS Commercial |
$515.53
|
|
|
Platelet Circulating IgM Antibody
|
Facility
|
OP
|
$696.00
|
|
|
Service Code
|
CPT 86022
|
| Hospital Charge Code |
2942968
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.37 |
| Max. Negotiated Rate |
$640.32 |
| Rate for Payer: Aetna Commercial |
$626.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$598.56
|
| Rate for Payer: Aetna Managed Medicare |
$18.37
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$68.89
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$32.15
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$30.49
|
| Rate for Payer: Anthem Medicaid |
$18.98
|
| Rate for Payer: Anthem Medicare Advantage |
$18.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$368.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$18.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$18.37
|
| Rate for Payer: Cash Price |
$208.80
|
| Rate for Payer: Cash Price |
$208.80
|
| Rate for Payer: Cigna Commercial |
$640.32
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$18.37
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$18.98
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$389.48
|
| Rate for Payer: Dean Health Medicaid |
$18.98
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$18.37
|
| Rate for Payer: Health EOS Commercial |
$619.44
|
| Rate for Payer: HFN Commercial |
$640.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$68.34
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$18.37
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$18.98
|
| Rate for Payer: Independent Care Health Plan Medicare |
$18.37
|
| Rate for Payer: Managed Health Services Medicaid |
$19.74
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$18.37
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$18.37
|
| Rate for Payer: Multiplan Commercial |
$556.80
|
| Rate for Payer: NAPHCARE Commercial |
$27.56
|
| Rate for Payer: Preferred Network Access Commercial |
$640.32
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$18.98
|
| Rate for Payer: Quartz Beloit One Network |
$341.04
|
| Rate for Payer: Quartz Commercial |
$452.40
|
| Rate for Payer: Quartz Medicare Advantage |
$18.37
|
| Rate for Payer: The Alliance Commercial |
$73.48
|
| Rate for Payer: United Healthcare Medicaid |
$18.98
|
| Rate for Payer: United Healthcare Medicare Advantage |
$18.37
|
| Rate for Payer: United Healthcare PPO |
$522.00
|
| Rate for Payer: WEA Trust Commercial |
$382.80
|
| Rate for Payer: Wellcare Medicare |
$18.37
|
| Rate for Payer: WMAP Medicaid |
$18.98
|
| Rate for Payer: WPS Commercial |
$515.53
|
|
|
Platelet Count
|
Professional
|
Both
|
$86.00
|
|
|
Service Code
|
CPT 85049
|
| Hospital Charge Code |
633807
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.81 |
| Max. Negotiated Rate |
$81.70 |
| Rate for Payer: Aetna Commercial |
$81.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$73.96
|
| Rate for Payer: Cash Price |
$25.80
|
| Rate for Payer: Cash Price |
$25.80
|
| Rate for Payer: Cigna Commercial |
$81.70
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$43.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$51.60
|
| Rate for Payer: Health EOS Commercial |
$78.26
|
| Rate for Payer: HFN Commercial |
$81.70
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$15.81
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$15.81
|
| Rate for Payer: Multiplan Commercial |
$68.80
|
| Rate for Payer: Preferred Network Access Commercial |
$81.70
|
| Rate for Payer: Quartz Beloit One Network |
$37.84
|
| Rate for Payer: Quartz Commercial |
$49.02
|
| Rate for Payer: The Alliance Commercial |
$43.00
|
| Rate for Payer: WEA Trust Commercial |
$47.30
|
| Rate for Payer: WPS Commercial |
$63.70
|
|
|
Platelet Count
|
Facility
|
IP
|
$86.00
|
|
|
Service Code
|
CPT 85049
|
| Hospital Charge Code |
633807
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$42.14 |
| Max. Negotiated Rate |
$79.12 |
| Rate for Payer: Aetna Commercial |
$77.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$73.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$45.58
|
| Rate for Payer: Cash Price |
$25.80
|
| Rate for Payer: Cigna Commercial |
$79.12
|
| Rate for Payer: Health EOS Commercial |
$76.54
|
| Rate for Payer: HFN Commercial |
$79.12
|
| Rate for Payer: Multiplan Commercial |
$68.80
|
| Rate for Payer: NAPHCARE Commercial |
$51.60
|
| Rate for Payer: Preferred Network Access Commercial |
$79.12
|
| Rate for Payer: Quartz Beloit One Network |
$42.14
|
| Rate for Payer: Quartz Commercial |
$51.60
|
| Rate for Payer: WEA Trust Commercial |
$47.30
|
| Rate for Payer: WPS Commercial |
$63.70
|
|
|
Platelet Count
|
Facility
|
OP
|
$86.00
|
|
|
Service Code
|
CPT 85049
|
| Hospital Charge Code |
633807
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.48 |
| Max. Negotiated Rate |
$79.12 |
| Rate for Payer: Aetna Commercial |
$77.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$73.96
|
| Rate for Payer: Aetna Managed Medicare |
$4.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$16.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$7.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7.44
|
| Rate for Payer: Anthem Medicaid |
$4.63
|
| Rate for Payer: Anthem Medicare Advantage |
$4.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$45.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$4.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$4.48
|
| Rate for Payer: Cash Price |
$25.80
|
| Rate for Payer: Cash Price |
$25.80
|
| Rate for Payer: Cigna Commercial |
$79.12
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$4.48
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$4.63
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$48.13
|
| Rate for Payer: Dean Health Medicaid |
$4.63
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$4.48
|
| Rate for Payer: Health EOS Commercial |
$76.54
|
| Rate for Payer: HFN Commercial |
$79.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$16.67
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$4.48
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$4.63
|
| Rate for Payer: Independent Care Health Plan Medicare |
$4.48
|
| Rate for Payer: Managed Health Services Medicaid |
$4.82
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$4.48
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$4.48
|
| Rate for Payer: Multiplan Commercial |
$68.80
|
| Rate for Payer: NAPHCARE Commercial |
$6.72
|
| Rate for Payer: Preferred Network Access Commercial |
$79.12
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$4.63
|
| Rate for Payer: Quartz Beloit One Network |
$42.14
|
| Rate for Payer: Quartz Commercial |
$55.90
|
| Rate for Payer: Quartz Medicare Advantage |
$4.48
|
| Rate for Payer: The Alliance Commercial |
$17.92
|
| Rate for Payer: United Healthcare Medicaid |
$4.63
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4.48
|
| Rate for Payer: United Healthcare PPO |
$64.50
|
| Rate for Payer: WEA Trust Commercial |
$47.30
|
| Rate for Payer: Wellcare Medicare |
$4.48
|
| Rate for Payer: WMAP Medicaid |
$4.63
|
| Rate for Payer: WPS Commercial |
$63.70
|
|
|
Platelet (FS)
|
Facility
|
OP
|
$5.00
|
|
|
Service Code
|
CPT 85049
|
| Hospital Charge Code |
4538808
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$2.45 |
| Max. Negotiated Rate |
$17.92 |
| Rate for Payer: Aetna Commercial |
$4.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4.30
|
| Rate for Payer: Aetna Managed Medicare |
$4.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$16.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$7.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7.44
|
| Rate for Payer: Anthem Medicaid |
$4.63
|
| Rate for Payer: Anthem Medicare Advantage |
$4.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$4.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$4.48
|
| Rate for Payer: Cash Price |
$1.50
|
| Rate for Payer: Cash Price |
$1.50
|
| Rate for Payer: Cigna Commercial |
$4.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$4.48
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$4.63
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2.80
|
| Rate for Payer: Dean Health Medicaid |
$4.63
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$4.48
|
| Rate for Payer: Health EOS Commercial |
$4.45
|
| Rate for Payer: HFN Commercial |
$4.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$16.67
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$4.48
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$4.63
|
| Rate for Payer: Independent Care Health Plan Medicare |
$4.48
|
| Rate for Payer: Managed Health Services Medicaid |
$4.82
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$4.48
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$4.48
|
| Rate for Payer: Multiplan Commercial |
$4.00
|
| Rate for Payer: NAPHCARE Commercial |
$6.72
|
| Rate for Payer: Preferred Network Access Commercial |
$4.60
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$4.63
|
| Rate for Payer: Quartz Beloit One Network |
$2.45
|
| Rate for Payer: Quartz Commercial |
$3.25
|
| Rate for Payer: Quartz Medicare Advantage |
$4.48
|
| Rate for Payer: The Alliance Commercial |
$17.92
|
| Rate for Payer: United Healthcare Medicaid |
$4.63
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4.48
|
| Rate for Payer: United Healthcare PPO |
$3.75
|
| Rate for Payer: WEA Trust Commercial |
$2.75
|
| Rate for Payer: Wellcare Medicare |
$4.48
|
| Rate for Payer: WMAP Medicaid |
$4.63
|
| Rate for Payer: WPS Commercial |
$3.70
|
|
|
Platelet (FS)
|
Facility
|
IP
|
$5.00
|
|
|
Service Code
|
CPT 85049
|
| Hospital Charge Code |
4538808
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$2.45 |
| Max. Negotiated Rate |
$4.60 |
| Rate for Payer: Aetna Commercial |
$4.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2.65
|
| Rate for Payer: Cash Price |
$1.50
|
| Rate for Payer: Cigna Commercial |
$4.60
|
| Rate for Payer: Health EOS Commercial |
$4.45
|
| Rate for Payer: HFN Commercial |
$4.60
|
| Rate for Payer: Multiplan Commercial |
$4.00
|
| Rate for Payer: NAPHCARE Commercial |
$3.00
|
| Rate for Payer: Preferred Network Access Commercial |
$4.60
|
| Rate for Payer: Quartz Beloit One Network |
$2.45
|
| Rate for Payer: Quartz Commercial |
$3.00
|
| Rate for Payer: WEA Trust Commercial |
$2.75
|
| Rate for Payer: WPS Commercial |
$3.70
|
|
|
Platelet (FS)
|
Professional
|
Both
|
$5.00
|
|
|
Service Code
|
CPT 85049
|
| Hospital Charge Code |
4538808
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$2.20 |
| Max. Negotiated Rate |
$15.81 |
| Rate for Payer: Aetna Commercial |
$4.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4.30
|
| Rate for Payer: Cash Price |
$1.50
|
| Rate for Payer: Cash Price |
$1.50
|
| Rate for Payer: Cigna Commercial |
$4.75
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3.00
|
| Rate for Payer: Health EOS Commercial |
$4.55
|
| Rate for Payer: HFN Commercial |
$4.75
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$15.81
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$15.81
|
| Rate for Payer: Multiplan Commercial |
$4.00
|
| Rate for Payer: Preferred Network Access Commercial |
$4.75
|
| Rate for Payer: Quartz Beloit One Network |
$2.20
|
| Rate for Payer: Quartz Commercial |
$2.85
|
| Rate for Payer: The Alliance Commercial |
$2.50
|
| Rate for Payer: WEA Trust Commercial |
$2.75
|
| Rate for Payer: WPS Commercial |
$3.70
|
|
|
Platelet Function Assay
|
Professional
|
Both
|
$272.00
|
|
|
Service Code
|
CPT 85576
|
| Hospital Charge Code |
4464657
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$16.61 |
| Max. Negotiated Rate |
$258.40 |
| Rate for Payer: Aetna Commercial |
$258.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$233.92
|
| Rate for Payer: Anthem Commercial |
$16.61
|
| Rate for Payer: Cash Price |
$81.60
|
| Rate for Payer: Cash Price |
$81.60
|
| Rate for Payer: Cigna Commercial |
$258.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$136.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$163.20
|
| Rate for Payer: Health EOS Commercial |
$247.52
|
| Rate for Payer: HFN Commercial |
$258.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$87.93
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$87.93
|
| Rate for Payer: Multiplan Commercial |
$217.60
|
| Rate for Payer: Preferred Network Access Commercial |
$258.40
|
| Rate for Payer: Quartz Beloit One Network |
$119.68
|
| Rate for Payer: Quartz Commercial |
$155.04
|
| Rate for Payer: The Alliance Commercial |
$136.00
|
| Rate for Payer: WEA Trust Commercial |
$149.60
|
| Rate for Payer: WPS Commercial |
$201.47
|
|
|
Platelet Function Assay
|
Facility
|
OP
|
$272.00
|
|
|
Service Code
|
CPT 85576
|
| Hospital Charge Code |
4464657
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$24.91 |
| Max. Negotiated Rate |
$250.24 |
| Rate for Payer: Aetna Commercial |
$244.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$233.92
|
| Rate for Payer: Aetna Managed Medicare |
$24.91
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$93.41
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$43.59
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$41.35
|
| Rate for Payer: Anthem Medicaid |
$25.74
|
| Rate for Payer: Anthem Medicare Advantage |
$24.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$144.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$24.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$24.91
|
| Rate for Payer: Cash Price |
$81.60
|
| Rate for Payer: Cash Price |
$81.60
|
| Rate for Payer: Cigna Commercial |
$250.24
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$24.91
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$25.74
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$152.21
|
| Rate for Payer: Dean Health Medicaid |
$25.74
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$24.91
|
| Rate for Payer: Health EOS Commercial |
$242.08
|
| Rate for Payer: HFN Commercial |
$250.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$92.67
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$24.91
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$25.74
|
| Rate for Payer: Independent Care Health Plan Medicare |
$24.91
|
| Rate for Payer: Managed Health Services Medicaid |
$26.77
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$24.91
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$24.91
|
| Rate for Payer: Multiplan Commercial |
$217.60
|
| Rate for Payer: NAPHCARE Commercial |
$37.36
|
| Rate for Payer: Preferred Network Access Commercial |
$250.24
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$25.74
|
| Rate for Payer: Quartz Beloit One Network |
$133.28
|
| Rate for Payer: Quartz Commercial |
$176.80
|
| Rate for Payer: Quartz Medicare Advantage |
$24.91
|
| Rate for Payer: The Alliance Commercial |
$99.64
|
| Rate for Payer: United Healthcare Medicaid |
$25.74
|
| Rate for Payer: United Healthcare Medicare Advantage |
$24.91
|
| Rate for Payer: United Healthcare PPO |
$204.00
|
| Rate for Payer: WEA Trust Commercial |
$149.60
|
| Rate for Payer: Wellcare Medicare |
$24.91
|
| Rate for Payer: WMAP Medicaid |
$25.74
|
| Rate for Payer: WPS Commercial |
$201.47
|
|
|
Platelet Function Assay
|
Facility
|
IP
|
$272.00
|
|
|
Service Code
|
CPT 85576
|
| Hospital Charge Code |
4464657
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$133.28 |
| Max. Negotiated Rate |
$250.24 |
| Rate for Payer: Aetna Commercial |
$244.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$233.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$144.16
|
| Rate for Payer: Cash Price |
$81.60
|
| Rate for Payer: Cigna Commercial |
$250.24
|
| Rate for Payer: Health EOS Commercial |
$242.08
|
| Rate for Payer: HFN Commercial |
$250.24
|
| Rate for Payer: Multiplan Commercial |
$217.60
|
| Rate for Payer: NAPHCARE Commercial |
$163.20
|
| Rate for Payer: Preferred Network Access Commercial |
$250.24
|
| Rate for Payer: Quartz Beloit One Network |
$133.28
|
| Rate for Payer: Quartz Commercial |
$163.20
|
| Rate for Payer: WEA Trust Commercial |
$149.60
|
| Rate for Payer: WPS Commercial |
$201.47
|
|
|
Platelet IgA Indirect
|
Facility
|
OP
|
$137.00
|
|
|
Service Code
|
CPT 86022
|
| Hospital Charge Code |
4500768
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.37 |
| Max. Negotiated Rate |
$126.04 |
| Rate for Payer: Aetna Commercial |
$123.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$117.82
|
| Rate for Payer: Aetna Managed Medicare |
$18.37
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$68.89
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$32.15
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$30.49
|
| Rate for Payer: Anthem Medicaid |
$18.98
|
| Rate for Payer: Anthem Medicare Advantage |
$18.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$72.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$18.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$18.37
|
| Rate for Payer: Cash Price |
$41.10
|
| Rate for Payer: Cash Price |
$41.10
|
| Rate for Payer: Cigna Commercial |
$126.04
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$18.37
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$18.98
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$76.67
|
| Rate for Payer: Dean Health Medicaid |
$18.98
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$18.37
|
| Rate for Payer: Health EOS Commercial |
$121.93
|
| Rate for Payer: HFN Commercial |
$126.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$68.34
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$18.37
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$18.98
|
| Rate for Payer: Independent Care Health Plan Medicare |
$18.37
|
| Rate for Payer: Managed Health Services Medicaid |
$19.74
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$18.37
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$18.37
|
| Rate for Payer: Multiplan Commercial |
$109.60
|
| Rate for Payer: NAPHCARE Commercial |
$27.56
|
| Rate for Payer: Preferred Network Access Commercial |
$126.04
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$18.98
|
| Rate for Payer: Quartz Beloit One Network |
$67.13
|
| Rate for Payer: Quartz Commercial |
$89.05
|
| Rate for Payer: Quartz Medicare Advantage |
$18.37
|
| Rate for Payer: The Alliance Commercial |
$73.48
|
| Rate for Payer: United Healthcare Medicaid |
$18.98
|
| Rate for Payer: United Healthcare Medicare Advantage |
$18.37
|
| Rate for Payer: United Healthcare PPO |
$102.75
|
| Rate for Payer: WEA Trust Commercial |
$75.35
|
| Rate for Payer: Wellcare Medicare |
$18.37
|
| Rate for Payer: WMAP Medicaid |
$18.98
|
| Rate for Payer: WPS Commercial |
$101.48
|
|
|
Platelet IgA Indirect
|
Facility
|
IP
|
$137.00
|
|
|
Service Code
|
CPT 86022
|
| Hospital Charge Code |
4500768
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$67.13 |
| Max. Negotiated Rate |
$126.04 |
| Rate for Payer: Aetna Commercial |
$123.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$117.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$72.61
|
| Rate for Payer: Cash Price |
$41.10
|
| Rate for Payer: Cigna Commercial |
$126.04
|
| Rate for Payer: Health EOS Commercial |
$121.93
|
| Rate for Payer: HFN Commercial |
$126.04
|
| Rate for Payer: Multiplan Commercial |
$109.60
|
| Rate for Payer: NAPHCARE Commercial |
$82.20
|
| Rate for Payer: Preferred Network Access Commercial |
$126.04
|
| Rate for Payer: Quartz Beloit One Network |
$67.13
|
| Rate for Payer: Quartz Commercial |
$82.20
|
| Rate for Payer: WEA Trust Commercial |
$75.35
|
| Rate for Payer: WPS Commercial |
$101.48
|
|
|
Platelet IgA Indirect
|
Professional
|
Both
|
$137.00
|
|
|
Service Code
|
CPT 86022
|
| Hospital Charge Code |
4500768
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$60.28 |
| Max. Negotiated Rate |
$130.15 |
| Rate for Payer: Aetna Commercial |
$130.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$117.82
|
| Rate for Payer: Cash Price |
$41.10
|
| Rate for Payer: Cash Price |
$41.10
|
| Rate for Payer: Cigna Commercial |
$130.15
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$68.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$82.20
|
| Rate for Payer: Health EOS Commercial |
$124.67
|
| Rate for Payer: HFN Commercial |
$130.15
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$64.85
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$64.85
|
| Rate for Payer: Multiplan Commercial |
$109.60
|
| Rate for Payer: Preferred Network Access Commercial |
$130.15
|
| Rate for Payer: Quartz Beloit One Network |
$60.28
|
| Rate for Payer: Quartz Commercial |
$78.09
|
| Rate for Payer: The Alliance Commercial |
$68.50
|
| Rate for Payer: WEA Trust Commercial |
$75.35
|
| Rate for Payer: WPS Commercial |
$101.48
|
|
|
Platelet IgG Indirect
|
Professional
|
Both
|
$137.00
|
|
|
Service Code
|
CPT 86022
|
| Hospital Charge Code |
4500766
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$60.28 |
| Max. Negotiated Rate |
$130.15 |
| Rate for Payer: Aetna Commercial |
$130.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$117.82
|
| Rate for Payer: Cash Price |
$41.10
|
| Rate for Payer: Cash Price |
$41.10
|
| Rate for Payer: Cigna Commercial |
$130.15
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$68.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$82.20
|
| Rate for Payer: Health EOS Commercial |
$124.67
|
| Rate for Payer: HFN Commercial |
$130.15
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$64.85
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$64.85
|
| Rate for Payer: Multiplan Commercial |
$109.60
|
| Rate for Payer: Preferred Network Access Commercial |
$130.15
|
| Rate for Payer: Quartz Beloit One Network |
$60.28
|
| Rate for Payer: Quartz Commercial |
$78.09
|
| Rate for Payer: The Alliance Commercial |
$68.50
|
| Rate for Payer: WEA Trust Commercial |
$75.35
|
| Rate for Payer: WPS Commercial |
$101.48
|
|
|
Platelet IgG Indirect
|
Facility
|
IP
|
$137.00
|
|
|
Service Code
|
CPT 86022
|
| Hospital Charge Code |
4500766
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$67.13 |
| Max. Negotiated Rate |
$126.04 |
| Rate for Payer: Aetna Commercial |
$123.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$117.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$72.61
|
| Rate for Payer: Cash Price |
$41.10
|
| Rate for Payer: Cigna Commercial |
$126.04
|
| Rate for Payer: Health EOS Commercial |
$121.93
|
| Rate for Payer: HFN Commercial |
$126.04
|
| Rate for Payer: Multiplan Commercial |
$109.60
|
| Rate for Payer: NAPHCARE Commercial |
$82.20
|
| Rate for Payer: Preferred Network Access Commercial |
$126.04
|
| Rate for Payer: Quartz Beloit One Network |
$67.13
|
| Rate for Payer: Quartz Commercial |
$82.20
|
| Rate for Payer: WEA Trust Commercial |
$75.35
|
| Rate for Payer: WPS Commercial |
$101.48
|
|
|
Platelet IgG Indirect
|
Facility
|
OP
|
$137.00
|
|
|
Service Code
|
CPT 86022
|
| Hospital Charge Code |
4500766
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.37 |
| Max. Negotiated Rate |
$126.04 |
| Rate for Payer: Aetna Commercial |
$123.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$117.82
|
| Rate for Payer: Aetna Managed Medicare |
$18.37
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$68.89
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$32.15
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$30.49
|
| Rate for Payer: Anthem Medicaid |
$18.98
|
| Rate for Payer: Anthem Medicare Advantage |
$18.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$72.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$18.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$18.37
|
| Rate for Payer: Cash Price |
$41.10
|
| Rate for Payer: Cash Price |
$41.10
|
| Rate for Payer: Cigna Commercial |
$126.04
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$18.37
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$18.98
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$76.67
|
| Rate for Payer: Dean Health Medicaid |
$18.98
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$18.37
|
| Rate for Payer: Health EOS Commercial |
$121.93
|
| Rate for Payer: HFN Commercial |
$126.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$68.34
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$18.37
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$18.98
|
| Rate for Payer: Independent Care Health Plan Medicare |
$18.37
|
| Rate for Payer: Managed Health Services Medicaid |
$19.74
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$18.37
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$18.37
|
| Rate for Payer: Multiplan Commercial |
$109.60
|
| Rate for Payer: NAPHCARE Commercial |
$27.56
|
| Rate for Payer: Preferred Network Access Commercial |
$126.04
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$18.98
|
| Rate for Payer: Quartz Beloit One Network |
$67.13
|
| Rate for Payer: Quartz Commercial |
$89.05
|
| Rate for Payer: Quartz Medicare Advantage |
$18.37
|
| Rate for Payer: The Alliance Commercial |
$73.48
|
| Rate for Payer: United Healthcare Medicaid |
$18.98
|
| Rate for Payer: United Healthcare Medicare Advantage |
$18.37
|
| Rate for Payer: United Healthcare PPO |
$102.75
|
| Rate for Payer: WEA Trust Commercial |
$75.35
|
| Rate for Payer: Wellcare Medicare |
$18.37
|
| Rate for Payer: WMAP Medicaid |
$18.98
|
| Rate for Payer: WPS Commercial |
$101.48
|
|
|
Platelet IgM Indirect
|
Facility
|
IP
|
$137.00
|
|
|
Service Code
|
CPT 86022
|
| Hospital Charge Code |
4500767
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$67.13 |
| Max. Negotiated Rate |
$126.04 |
| Rate for Payer: Aetna Commercial |
$123.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$117.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$72.61
|
| Rate for Payer: Cash Price |
$41.10
|
| Rate for Payer: Cigna Commercial |
$126.04
|
| Rate for Payer: Health EOS Commercial |
$121.93
|
| Rate for Payer: HFN Commercial |
$126.04
|
| Rate for Payer: Multiplan Commercial |
$109.60
|
| Rate for Payer: NAPHCARE Commercial |
$82.20
|
| Rate for Payer: Preferred Network Access Commercial |
$126.04
|
| Rate for Payer: Quartz Beloit One Network |
$67.13
|
| Rate for Payer: Quartz Commercial |
$82.20
|
| Rate for Payer: WEA Trust Commercial |
$75.35
|
| Rate for Payer: WPS Commercial |
$101.48
|
|
|
Platelet IgM Indirect
|
Facility
|
OP
|
$137.00
|
|
|
Service Code
|
CPT 86022
|
| Hospital Charge Code |
4500767
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.37 |
| Max. Negotiated Rate |
$126.04 |
| Rate for Payer: Aetna Commercial |
$123.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$117.82
|
| Rate for Payer: Aetna Managed Medicare |
$18.37
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$68.89
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$32.15
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$30.49
|
| Rate for Payer: Anthem Medicaid |
$18.98
|
| Rate for Payer: Anthem Medicare Advantage |
$18.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$72.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$18.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$18.37
|
| Rate for Payer: Cash Price |
$41.10
|
| Rate for Payer: Cash Price |
$41.10
|
| Rate for Payer: Cigna Commercial |
$126.04
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$18.37
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$18.98
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$76.67
|
| Rate for Payer: Dean Health Medicaid |
$18.98
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$18.37
|
| Rate for Payer: Health EOS Commercial |
$121.93
|
| Rate for Payer: HFN Commercial |
$126.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$68.34
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$18.37
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$18.98
|
| Rate for Payer: Independent Care Health Plan Medicare |
$18.37
|
| Rate for Payer: Managed Health Services Medicaid |
$19.74
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$18.37
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$18.37
|
| Rate for Payer: Multiplan Commercial |
$109.60
|
| Rate for Payer: NAPHCARE Commercial |
$27.56
|
| Rate for Payer: Preferred Network Access Commercial |
$126.04
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$18.98
|
| Rate for Payer: Quartz Beloit One Network |
$67.13
|
| Rate for Payer: Quartz Commercial |
$89.05
|
| Rate for Payer: Quartz Medicare Advantage |
$18.37
|
| Rate for Payer: The Alliance Commercial |
$73.48
|
| Rate for Payer: United Healthcare Medicaid |
$18.98
|
| Rate for Payer: United Healthcare Medicare Advantage |
$18.37
|
| Rate for Payer: United Healthcare PPO |
$102.75
|
| Rate for Payer: WEA Trust Commercial |
$75.35
|
| Rate for Payer: Wellcare Medicare |
$18.37
|
| Rate for Payer: WMAP Medicaid |
$18.98
|
| Rate for Payer: WPS Commercial |
$101.48
|
|
|
Platelet IgM Indirect
|
Professional
|
Both
|
$137.00
|
|
|
Service Code
|
CPT 86022
|
| Hospital Charge Code |
4500767
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$60.28 |
| Max. Negotiated Rate |
$130.15 |
| Rate for Payer: Aetna Commercial |
$130.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$117.82
|
| Rate for Payer: Cash Price |
$41.10
|
| Rate for Payer: Cash Price |
$41.10
|
| Rate for Payer: Cigna Commercial |
$130.15
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$68.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$82.20
|
| Rate for Payer: Health EOS Commercial |
$124.67
|
| Rate for Payer: HFN Commercial |
$130.15
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$64.85
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$64.85
|
| Rate for Payer: Multiplan Commercial |
$109.60
|
| Rate for Payer: Preferred Network Access Commercial |
$130.15
|
| Rate for Payer: Quartz Beloit One Network |
$60.28
|
| Rate for Payer: Quartz Commercial |
$78.09
|
| Rate for Payer: The Alliance Commercial |
$68.50
|
| Rate for Payer: WEA Trust Commercial |
$75.35
|
| Rate for Payer: WPS Commercial |
$101.48
|
|
|
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 |
$1,795.36 |
| Max. Negotiated Rate |
$25,648.00 |
| Rate for Payer: Aetna Commercial |
$5,770.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,514.32
|
| Rate for Payer: Aetna Managed Medicare |
$1,795.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,167.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,206.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,077.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,398.36
|
| Rate for Payer: Cash Price |
$1,923.60
|
| Rate for Payer: Cigna Commercial |
$5,899.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,588.16
|
| Rate for Payer: Health EOS Commercial |
$5,706.68
|
| Rate for Payer: HFN Commercial |
$5,899.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,809.00
|
| Rate for Payer: Multiplan Commercial |
$5,129.60
|
| Rate for Payer: NAPHCARE Commercial |
$3,847.20
|
| Rate for Payer: Preferred Network Access Commercial |
$5,899.04
|
| Rate for Payer: Quartz Beloit One Network |
$3,141.88
|
| Rate for Payer: Quartz Commercial |
$4,167.80
|
| Rate for Payer: Quartz Medicare Advantage |
$3,847.20
|
| Rate for Payer: The Alliance Commercial |
$25,648.00
|
| Rate for Payer: WEA Trust Commercial |
$3,526.60
|
| Rate for Payer: WPS Commercial |
$4,749.37
|
|
|
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 |
$3,141.88 |
| Max. Negotiated Rate |
$5,899.04 |
| Rate for Payer: Aetna Commercial |
$5,770.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,514.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,398.36
|
| Rate for Payer: Cash Price |
$1,923.60
|
| Rate for Payer: Cigna Commercial |
$5,899.04
|
| Rate for Payer: Health EOS Commercial |
$5,706.68
|
| Rate for Payer: HFN Commercial |
$5,899.04
|
| Rate for Payer: Multiplan Commercial |
$5,129.60
|
| Rate for Payer: NAPHCARE Commercial |
$3,847.20
|
| Rate for Payer: Preferred Network Access Commercial |
$5,899.04
|
| Rate for Payer: Quartz Beloit One Network |
$3,141.88
|
| Rate for Payer: Quartz Commercial |
$3,847.20
|
| Rate for Payer: WEA Trust Commercial |
$3,526.60
|
| Rate for Payer: WPS Commercial |
$4,749.37
|
|
|
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 |
$2,163.84 |
| Max. Negotiated Rate |
$30,912.00 |
| Rate for Payer: Aetna Commercial |
$6,955.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,646.08
|
| Rate for Payer: Aetna Managed Medicare |
$2,163.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,023.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,864.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,709.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,095.84
|
| Rate for Payer: Cash Price |
$2,318.40
|
| Rate for Payer: Cigna Commercial |
$7,109.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,324.59
|
| Rate for Payer: Health EOS Commercial |
$6,877.92
|
| Rate for Payer: HFN Commercial |
$7,109.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,796.00
|
| Rate for Payer: Multiplan Commercial |
$6,182.40
|
| Rate for Payer: NAPHCARE Commercial |
$4,636.80
|
| Rate for Payer: Preferred Network Access Commercial |
$7,109.76
|
| Rate for Payer: Quartz Beloit One Network |
$3,786.72
|
| Rate for Payer: Quartz Commercial |
$5,023.20
|
| Rate for Payer: Quartz Medicare Advantage |
$4,636.80
|
| Rate for Payer: The Alliance Commercial |
$30,912.00
|
| Rate for Payer: WEA Trust Commercial |
$4,250.40
|
| Rate for Payer: WPS Commercial |
$5,724.13
|
|
|
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 |
$3,786.72 |
| Max. Negotiated Rate |
$7,109.76 |
| Rate for Payer: Aetna Commercial |
$6,955.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,646.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,095.84
|
| Rate for Payer: Cash Price |
$2,318.40
|
| Rate for Payer: Cigna Commercial |
$7,109.76
|
| Rate for Payer: Health EOS Commercial |
$6,877.92
|
| Rate for Payer: HFN Commercial |
$7,109.76
|
| Rate for Payer: Multiplan Commercial |
$6,182.40
|
| Rate for Payer: NAPHCARE Commercial |
$4,636.80
|
| Rate for Payer: Preferred Network Access Commercial |
$7,109.76
|
| Rate for Payer: Quartz Beloit One Network |
$3,786.72
|
| Rate for Payer: Quartz Commercial |
$4,636.80
|
| Rate for Payer: WEA Trust Commercial |
$4,250.40
|
| Rate for Payer: WPS Commercial |
$5,724.13
|
|
