|
RNP/SM to TheraTest
|
Facility
|
IP
|
$54.00
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
2778817
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$26.46 |
| Max. Negotiated Rate |
$49.68 |
| Rate for Payer: Aetna Commercial |
$48.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$46.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$28.62
|
| Rate for Payer: Cash Price |
$16.20
|
| Rate for Payer: Cigna Commercial |
$49.68
|
| Rate for Payer: Health EOS Commercial |
$48.06
|
| Rate for Payer: HFN Commercial |
$49.68
|
| Rate for Payer: Multiplan Commercial |
$43.20
|
| Rate for Payer: NAPHCARE Commercial |
$32.40
|
| Rate for Payer: Preferred Network Access Commercial |
$49.68
|
| Rate for Payer: Quartz Beloit One Network |
$26.46
|
| Rate for Payer: Quartz Commercial |
$32.40
|
| Rate for Payer: WEA Trust Commercial |
$29.70
|
| Rate for Payer: WPS Commercial |
$40.00
|
|
|
Rocephin 250 mg Charge
|
Facility
|
OP
|
$7.00
|
|
|
Service Code
|
HCPCS J0696
|
| Hospital Charge Code |
2472895
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$28.00 |
| Rate for Payer: Aetna Commercial |
$6.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6.02
|
| Rate for Payer: Aetna Managed Medicare |
$1.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3.71
|
| Rate for Payer: Cash Price |
$2.10
|
| Rate for Payer: Cash Price |
$2.10
|
| Rate for Payer: Cigna Commercial |
$6.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$0.60
|
| Rate for Payer: Health EOS Commercial |
$6.23
|
| Rate for Payer: HFN Commercial |
$6.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5.25
|
| Rate for Payer: Multiplan Commercial |
$5.60
|
| Rate for Payer: NAPHCARE Commercial |
$4.20
|
| Rate for Payer: Preferred Network Access Commercial |
$6.44
|
| Rate for Payer: Quartz Beloit One Network |
$3.43
|
| Rate for Payer: Quartz Commercial |
$4.55
|
| Rate for Payer: Quartz Medicare Advantage |
$4.20
|
| Rate for Payer: The Alliance Commercial |
$28.00
|
| Rate for Payer: WEA Trust Commercial |
$3.85
|
| Rate for Payer: WPS Commercial |
$1.14
|
|
|
Rocephin 250 mg Charge
|
Facility
|
IP
|
$7.00
|
|
|
Service Code
|
HCPCS J0696
|
| Hospital Charge Code |
2472895
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.43 |
| Max. Negotiated Rate |
$6.44 |
| Rate for Payer: Aetna Commercial |
$6.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3.71
|
| Rate for Payer: Cash Price |
$2.10
|
| Rate for Payer: Cigna Commercial |
$6.44
|
| Rate for Payer: Health EOS Commercial |
$6.23
|
| Rate for Payer: HFN Commercial |
$6.44
|
| Rate for Payer: Multiplan Commercial |
$5.60
|
| Rate for Payer: NAPHCARE Commercial |
$4.20
|
| Rate for Payer: Preferred Network Access Commercial |
$6.44
|
| Rate for Payer: Quartz Beloit One Network |
$3.43
|
| Rate for Payer: Quartz Commercial |
$4.20
|
| Rate for Payer: WEA Trust Commercial |
$3.85
|
| Rate for Payer: WPS Commercial |
$5.18
|
|
|
Rocephin 250 mg Charge
|
Professional
|
Both
|
$7.00
|
|
|
Service Code
|
HCPCS J0696
|
| Hospital Charge Code |
2472895
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.45 |
| Max. Negotiated Rate |
$6.65 |
| Rate for Payer: Aetna Commercial |
$6.65
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6.02
|
| Rate for Payer: Cash Price |
$2.10
|
| Rate for Payer: Cash Price |
$2.10
|
| Rate for Payer: Cigna Commercial |
$6.65
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$0.45
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$0.45
|
| Rate for Payer: Health EOS Commercial |
$6.37
|
| Rate for Payer: HFN Commercial |
$6.65
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$0.79
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$0.79
|
| Rate for Payer: Multiplan Commercial |
$5.60
|
| Rate for Payer: Preferred Network Access Commercial |
$6.65
|
| Rate for Payer: Quartz Beloit One Network |
$3.08
|
| Rate for Payer: Quartz Commercial |
$3.99
|
| Rate for Payer: The Alliance Commercial |
$3.50
|
| Rate for Payer: United Healthcare Medicaid |
$0.45
|
| Rate for Payer: WEA Trust Commercial |
$3.85
|
| Rate for Payer: WPS Commercial |
$1.14
|
|
|
Rocephin JW Waste Charge
|
Professional
|
Both
|
$7.00
|
|
|
Service Code
|
HCPCS J0696 JW
|
| Hospital Charge Code |
5246657
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.45 |
| Max. Negotiated Rate |
$6.65 |
| Rate for Payer: Aetna Commercial |
$6.65
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6.02
|
| Rate for Payer: Cash Price |
$2.10
|
| Rate for Payer: Cash Price |
$2.10
|
| Rate for Payer: Cigna Commercial |
$6.65
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$0.49
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$0.45
|
| Rate for Payer: Health EOS Commercial |
$6.37
|
| Rate for Payer: HFN Commercial |
$6.65
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$0.79
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$0.79
|
| Rate for Payer: Multiplan Commercial |
$5.60
|
| Rate for Payer: Preferred Network Access Commercial |
$6.65
|
| Rate for Payer: Quartz Beloit One Network |
$3.08
|
| Rate for Payer: Quartz Commercial |
$3.99
|
| Rate for Payer: The Alliance Commercial |
$3.50
|
| Rate for Payer: United Healthcare Medicaid |
$0.49
|
| Rate for Payer: WEA Trust Commercial |
$3.85
|
| Rate for Payer: WPS Commercial |
$1.14
|
|
|
Rocephin JW Waste Charge
|
Facility
|
IP
|
$7.00
|
|
|
Service Code
|
HCPCS J0696 JW
|
| Hospital Charge Code |
5246657
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.43 |
| Max. Negotiated Rate |
$6.44 |
| Rate for Payer: Aetna Commercial |
$6.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3.71
|
| Rate for Payer: Cash Price |
$2.10
|
| Rate for Payer: Cigna Commercial |
$6.44
|
| Rate for Payer: Health EOS Commercial |
$6.23
|
| Rate for Payer: HFN Commercial |
$6.44
|
| Rate for Payer: Multiplan Commercial |
$5.60
|
| Rate for Payer: NAPHCARE Commercial |
$4.20
|
| Rate for Payer: Preferred Network Access Commercial |
$6.44
|
| Rate for Payer: Quartz Beloit One Network |
$3.43
|
| Rate for Payer: Quartz Commercial |
$4.20
|
| Rate for Payer: WEA Trust Commercial |
$3.85
|
| Rate for Payer: WPS Commercial |
$5.18
|
|
|
Rocephin JW Waste Charge
|
Facility
|
OP
|
$7.00
|
|
|
Service Code
|
HCPCS J0696 JW
|
| Hospital Charge Code |
5246657
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.60 |
| Max. Negotiated Rate |
$28.00 |
| Rate for Payer: Aetna Commercial |
$6.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6.02
|
| Rate for Payer: Aetna Managed Medicare |
$1.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3.71
|
| Rate for Payer: Cash Price |
$2.10
|
| Rate for Payer: Cash Price |
$2.10
|
| Rate for Payer: Cigna Commercial |
$6.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$0.60
|
| Rate for Payer: Health EOS Commercial |
$6.23
|
| Rate for Payer: HFN Commercial |
$6.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5.25
|
| Rate for Payer: Multiplan Commercial |
$5.60
|
| Rate for Payer: NAPHCARE Commercial |
$4.20
|
| Rate for Payer: Preferred Network Access Commercial |
$6.44
|
| Rate for Payer: Quartz Beloit One Network |
$3.43
|
| Rate for Payer: Quartz Commercial |
$4.55
|
| Rate for Payer: Quartz Medicare Advantage |
$4.20
|
| Rate for Payer: The Alliance Commercial |
$28.00
|
| Rate for Payer: WEA Trust Commercial |
$3.85
|
| Rate for Payer: WPS Commercial |
$1.14
|
|
|
ROCKER SHOES FOR FOOT RING LONG 140/155MM HOFFMANN LIMB 4934-8-140
|
Facility
|
IP
|
$7,722.00
|
|
| Hospital Charge Code |
5685635
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3,783.78 |
| Max. Negotiated Rate |
$7,104.24 |
| Rate for Payer: Aetna Commercial |
$6,949.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,640.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,092.66
|
| Rate for Payer: Cash Price |
$2,316.60
|
| Rate for Payer: Cigna Commercial |
$7,104.24
|
| Rate for Payer: Health EOS Commercial |
$6,872.58
|
| Rate for Payer: HFN Commercial |
$7,104.24
|
| Rate for Payer: Multiplan Commercial |
$6,177.60
|
| Rate for Payer: NAPHCARE Commercial |
$4,633.20
|
| Rate for Payer: Preferred Network Access Commercial |
$7,104.24
|
| Rate for Payer: Quartz Beloit One Network |
$3,783.78
|
| Rate for Payer: Quartz Commercial |
$4,633.20
|
| Rate for Payer: WEA Trust Commercial |
$4,247.10
|
| Rate for Payer: WPS Commercial |
$5,719.69
|
|
|
ROCKER SHOES FOR FOOT RING LONG 140/155MM HOFFMANN LIMB 4934-8-140
|
Facility
|
OP
|
$7,722.00
|
|
| Hospital Charge Code |
5685635
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,162.16 |
| Max. Negotiated Rate |
$30,888.00 |
| Rate for Payer: Aetna Commercial |
$6,949.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,640.92
|
| Rate for Payer: Aetna Managed Medicare |
$2,162.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,019.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,861.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,706.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,092.66
|
| Rate for Payer: Cash Price |
$2,316.60
|
| Rate for Payer: Cigna Commercial |
$7,104.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,321.23
|
| Rate for Payer: Health EOS Commercial |
$6,872.58
|
| Rate for Payer: HFN Commercial |
$7,104.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,791.50
|
| Rate for Payer: Multiplan Commercial |
$6,177.60
|
| Rate for Payer: NAPHCARE Commercial |
$4,633.20
|
| Rate for Payer: Preferred Network Access Commercial |
$7,104.24
|
| Rate for Payer: Quartz Beloit One Network |
$3,783.78
|
| Rate for Payer: Quartz Commercial |
$5,019.30
|
| Rate for Payer: Quartz Medicare Advantage |
$4,633.20
|
| Rate for Payer: The Alliance Commercial |
$30,888.00
|
| Rate for Payer: WEA Trust Commercial |
$4,247.10
|
| Rate for Payer: WPS Commercial |
$5,719.69
|
|
|
ROCKER SHOES FOR FOOT RING LONG 180/120MM HOFFMANN LIMB 4934-8-180
|
Facility
|
IP
|
$8,031.00
|
|
| Hospital Charge Code |
5599712
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3,935.19 |
| Max. Negotiated Rate |
$7,388.52 |
| Rate for Payer: Aetna Commercial |
$7,227.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,906.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,256.43
|
| Rate for Payer: Cash Price |
$2,409.30
|
| Rate for Payer: Cigna Commercial |
$7,388.52
|
| Rate for Payer: Health EOS Commercial |
$7,147.59
|
| Rate for Payer: HFN Commercial |
$7,388.52
|
| Rate for Payer: Multiplan Commercial |
$6,424.80
|
| Rate for Payer: NAPHCARE Commercial |
$4,818.60
|
| Rate for Payer: Preferred Network Access Commercial |
$7,388.52
|
| Rate for Payer: Quartz Beloit One Network |
$3,935.19
|
| Rate for Payer: Quartz Commercial |
$4,818.60
|
| Rate for Payer: WEA Trust Commercial |
$4,417.05
|
| Rate for Payer: WPS Commercial |
$5,948.56
|
|
|
ROCKER SHOES FOR FOOT RING LONG 180/120MM HOFFMANN LIMB 4934-8-180
|
Facility
|
OP
|
$8,031.00
|
|
| Hospital Charge Code |
5599712
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,248.68 |
| Max. Negotiated Rate |
$32,124.00 |
| Rate for Payer: Aetna Commercial |
$7,227.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,906.66
|
| Rate for Payer: Aetna Managed Medicare |
$2,248.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,220.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,015.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,854.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,256.43
|
| Rate for Payer: Cash Price |
$2,409.30
|
| Rate for Payer: Cigna Commercial |
$7,388.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,494.15
|
| Rate for Payer: Health EOS Commercial |
$7,147.59
|
| Rate for Payer: HFN Commercial |
$7,388.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,023.25
|
| Rate for Payer: Multiplan Commercial |
$6,424.80
|
| Rate for Payer: NAPHCARE Commercial |
$4,818.60
|
| Rate for Payer: Preferred Network Access Commercial |
$7,388.52
|
| Rate for Payer: Quartz Beloit One Network |
$3,935.19
|
| Rate for Payer: Quartz Commercial |
$5,220.15
|
| Rate for Payer: Quartz Medicare Advantage |
$4,818.60
|
| Rate for Payer: The Alliance Commercial |
$32,124.00
|
| Rate for Payer: WEA Trust Commercial |
$4,417.05
|
| Rate for Payer: WPS Commercial |
$5,948.56
|
|
|
Rocky Mountain Spotted Fever Ab IgM
|
Facility
|
IP
|
$236.00
|
|
|
Service Code
|
CPT 86757
|
| Hospital Charge Code |
2942989
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$115.64 |
| Max. Negotiated Rate |
$217.12 |
| Rate for Payer: Aetna Commercial |
$212.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$202.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$125.08
|
| Rate for Payer: Cash Price |
$70.80
|
| Rate for Payer: Cigna Commercial |
$217.12
|
| Rate for Payer: Health EOS Commercial |
$210.04
|
| Rate for Payer: HFN Commercial |
$217.12
|
| Rate for Payer: Multiplan Commercial |
$188.80
|
| Rate for Payer: NAPHCARE Commercial |
$141.60
|
| Rate for Payer: Preferred Network Access Commercial |
$217.12
|
| Rate for Payer: Quartz Beloit One Network |
$115.64
|
| Rate for Payer: Quartz Commercial |
$141.60
|
| Rate for Payer: WEA Trust Commercial |
$129.80
|
| Rate for Payer: WPS Commercial |
$174.81
|
|
|
Rocky Mountain Spotted Fever Ab IgM
|
Professional
|
Both
|
$236.00
|
|
|
Service Code
|
CPT 86757
|
| Hospital Charge Code |
2942989
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$68.31 |
| Max. Negotiated Rate |
$224.20 |
| Rate for Payer: Aetna Commercial |
$224.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$202.96
|
| Rate for Payer: Cash Price |
$70.80
|
| Rate for Payer: Cash Price |
$70.80
|
| Rate for Payer: Cigna Commercial |
$224.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$118.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$141.60
|
| Rate for Payer: Health EOS Commercial |
$214.76
|
| Rate for Payer: HFN Commercial |
$224.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$68.31
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$68.31
|
| Rate for Payer: Multiplan Commercial |
$188.80
|
| Rate for Payer: Preferred Network Access Commercial |
$224.20
|
| Rate for Payer: Quartz Beloit One Network |
$103.84
|
| Rate for Payer: Quartz Commercial |
$134.52
|
| Rate for Payer: The Alliance Commercial |
$118.00
|
| Rate for Payer: WEA Trust Commercial |
$129.80
|
| Rate for Payer: WPS Commercial |
$174.81
|
|
|
Rocky Mountain Spotted Fever Ab IgM
|
Facility
|
OP
|
$236.00
|
|
|
Service Code
|
CPT 86757
|
| Hospital Charge Code |
2942989
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$19.35 |
| Max. Negotiated Rate |
$217.12 |
| Rate for Payer: Aetna Commercial |
$212.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$202.96
|
| Rate for Payer: Aetna Managed Medicare |
$19.35
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$72.56
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$33.86
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$32.12
|
| Rate for Payer: Anthem Medicaid |
$19.99
|
| Rate for Payer: Anthem Medicare Advantage |
$19.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$125.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$19.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$19.35
|
| Rate for Payer: Cash Price |
$70.80
|
| Rate for Payer: Cash Price |
$70.80
|
| Rate for Payer: Cigna Commercial |
$217.12
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$19.35
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$19.99
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$132.07
|
| Rate for Payer: Dean Health Medicaid |
$19.99
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$19.35
|
| Rate for Payer: Health EOS Commercial |
$210.04
|
| Rate for Payer: HFN Commercial |
$217.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$71.98
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$19.35
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$19.99
|
| Rate for Payer: Independent Care Health Plan Medicare |
$19.35
|
| Rate for Payer: Managed Health Services Medicaid |
$20.79
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$19.35
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$19.35
|
| Rate for Payer: Multiplan Commercial |
$188.80
|
| Rate for Payer: NAPHCARE Commercial |
$29.02
|
| Rate for Payer: Preferred Network Access Commercial |
$217.12
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$19.99
|
| Rate for Payer: Quartz Beloit One Network |
$115.64
|
| Rate for Payer: Quartz Commercial |
$153.40
|
| Rate for Payer: Quartz Medicare Advantage |
$19.35
|
| Rate for Payer: The Alliance Commercial |
$77.40
|
| Rate for Payer: United Healthcare Medicaid |
$19.99
|
| Rate for Payer: United Healthcare Medicare Advantage |
$19.35
|
| Rate for Payer: United Healthcare PPO |
$177.00
|
| Rate for Payer: WEA Trust Commercial |
$129.80
|
| Rate for Payer: Wellcare Medicare |
$19.35
|
| Rate for Payer: WMAP Medicaid |
$19.99
|
| Rate for Payer: WPS Commercial |
$174.81
|
|
|
Rocky Mountain Spotted Fever IgG & IgM
|
Professional
|
Both
|
$231.00
|
|
|
Service Code
|
CPT 86757
|
| Hospital Charge Code |
978058
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$68.31 |
| Max. Negotiated Rate |
$219.45 |
| Rate for Payer: Aetna Commercial |
$219.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$198.66
|
| Rate for Payer: Cash Price |
$69.30
|
| Rate for Payer: Cash Price |
$69.30
|
| Rate for Payer: Cigna Commercial |
$219.45
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$115.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$138.60
|
| Rate for Payer: Health EOS Commercial |
$210.21
|
| Rate for Payer: HFN Commercial |
$219.45
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$68.31
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$68.31
|
| Rate for Payer: Multiplan Commercial |
$184.80
|
| Rate for Payer: Preferred Network Access Commercial |
$219.45
|
| Rate for Payer: Quartz Beloit One Network |
$101.64
|
| Rate for Payer: Quartz Commercial |
$131.67
|
| Rate for Payer: The Alliance Commercial |
$115.50
|
| Rate for Payer: WEA Trust Commercial |
$127.05
|
| Rate for Payer: WPS Commercial |
$171.10
|
|
|
Rocky Mountain Spotted Fever IgG & IgM
|
Facility
|
IP
|
$231.00
|
|
|
Service Code
|
CPT 86757
|
| Hospital Charge Code |
978058
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$113.19 |
| Max. Negotiated Rate |
$212.52 |
| Rate for Payer: Aetna Commercial |
$207.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$198.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$122.43
|
| Rate for Payer: Cash Price |
$69.30
|
| Rate for Payer: Cigna Commercial |
$212.52
|
| Rate for Payer: Health EOS Commercial |
$205.59
|
| Rate for Payer: HFN Commercial |
$212.52
|
| Rate for Payer: Multiplan Commercial |
$184.80
|
| Rate for Payer: NAPHCARE Commercial |
$138.60
|
| Rate for Payer: Preferred Network Access Commercial |
$212.52
|
| Rate for Payer: Quartz Beloit One Network |
$113.19
|
| Rate for Payer: Quartz Commercial |
$138.60
|
| Rate for Payer: WEA Trust Commercial |
$127.05
|
| Rate for Payer: WPS Commercial |
$171.10
|
|
|
Rocky Mountain Spotted Fever IgG & IgM
|
Facility
|
OP
|
$231.00
|
|
|
Service Code
|
CPT 86757
|
| Hospital Charge Code |
978058
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$19.35 |
| Max. Negotiated Rate |
$212.52 |
| Rate for Payer: Aetna Commercial |
$207.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$198.66
|
| Rate for Payer: Aetna Managed Medicare |
$19.35
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$72.56
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$33.86
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$32.12
|
| Rate for Payer: Anthem Medicaid |
$19.99
|
| Rate for Payer: Anthem Medicare Advantage |
$19.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$122.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$19.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$19.35
|
| Rate for Payer: Cash Price |
$69.30
|
| Rate for Payer: Cash Price |
$69.30
|
| Rate for Payer: Cigna Commercial |
$212.52
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$19.35
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$19.99
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$129.27
|
| Rate for Payer: Dean Health Medicaid |
$19.99
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$19.35
|
| Rate for Payer: Health EOS Commercial |
$205.59
|
| Rate for Payer: HFN Commercial |
$212.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$71.98
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$19.35
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$19.99
|
| Rate for Payer: Independent Care Health Plan Medicare |
$19.35
|
| Rate for Payer: Managed Health Services Medicaid |
$20.79
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$19.35
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$19.35
|
| Rate for Payer: Multiplan Commercial |
$184.80
|
| Rate for Payer: NAPHCARE Commercial |
$29.02
|
| Rate for Payer: Preferred Network Access Commercial |
$212.52
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$19.99
|
| Rate for Payer: Quartz Beloit One Network |
$113.19
|
| Rate for Payer: Quartz Commercial |
$150.15
|
| Rate for Payer: Quartz Medicare Advantage |
$19.35
|
| Rate for Payer: The Alliance Commercial |
$77.40
|
| Rate for Payer: United Healthcare Medicaid |
$19.99
|
| Rate for Payer: United Healthcare Medicare Advantage |
$19.35
|
| Rate for Payer: United Healthcare PPO |
$173.25
|
| Rate for Payer: WEA Trust Commercial |
$127.05
|
| Rate for Payer: Wellcare Medicare |
$19.35
|
| Rate for Payer: WMAP Medicaid |
$19.99
|
| Rate for Payer: WPS Commercial |
$171.10
|
|
|
Rocky Mountain Spotted Fever IgG Titer
|
Facility
|
OP
|
$223.00
|
|
|
Service Code
|
CPT 86757
|
| Hospital Charge Code |
1043037
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$19.35 |
| 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 |
$19.35
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$72.56
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$33.86
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$32.12
|
| Rate for Payer: Anthem Medicaid |
$19.99
|
| Rate for Payer: Anthem Medicare Advantage |
$19.35
|
| 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 |
$19.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$19.35
|
| 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 |
$19.35
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$19.99
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$124.79
|
| Rate for Payer: Dean Health Medicaid |
$19.99
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$19.35
|
| Rate for Payer: Health EOS Commercial |
$198.47
|
| Rate for Payer: HFN Commercial |
$205.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$71.98
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$19.35
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$19.99
|
| Rate for Payer: Independent Care Health Plan Medicare |
$19.35
|
| Rate for Payer: Managed Health Services Medicaid |
$20.79
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$19.35
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$19.35
|
| Rate for Payer: Multiplan Commercial |
$178.40
|
| Rate for Payer: NAPHCARE Commercial |
$29.02
|
| Rate for Payer: Preferred Network Access Commercial |
$205.16
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$19.99
|
| Rate for Payer: Quartz Beloit One Network |
$109.27
|
| Rate for Payer: Quartz Commercial |
$144.95
|
| Rate for Payer: Quartz Medicare Advantage |
$19.35
|
| Rate for Payer: The Alliance Commercial |
$77.40
|
| Rate for Payer: United Healthcare Medicaid |
$19.99
|
| Rate for Payer: United Healthcare Medicare Advantage |
$19.35
|
| Rate for Payer: United Healthcare PPO |
$167.25
|
| Rate for Payer: WEA Trust Commercial |
$122.65
|
| Rate for Payer: Wellcare Medicare |
$19.35
|
| Rate for Payer: WMAP Medicaid |
$19.99
|
| Rate for Payer: WPS Commercial |
$165.18
|
|
|
Rocky Mountain Spotted Fever IgG Titer
|
Facility
|
IP
|
$223.00
|
|
|
Service Code
|
CPT 86757
|
| Hospital Charge Code |
1043037
|
|
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
|
|
|
Rocky Mountain Spotted Fever IgG Titer
|
Professional
|
Both
|
$223.00
|
|
|
Service Code
|
CPT 86757
|
| Hospital Charge Code |
1043037
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$68.31 |
| 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 |
$68.31
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$68.31
|
| 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
|
|
|
Rocky Mountain Spotted Fever IgM Titer
|
Facility
|
OP
|
$97.58
|
|
|
Service Code
|
CPT 86757
|
| Hospital Charge Code |
2956797
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$19.35 |
| Max. Negotiated Rate |
$89.77 |
| Rate for Payer: Aetna Commercial |
$87.82
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$83.92
|
| Rate for Payer: Aetna Managed Medicare |
$19.35
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$72.56
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$33.86
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$32.12
|
| Rate for Payer: Anthem Medicaid |
$19.99
|
| Rate for Payer: Anthem Medicare Advantage |
$19.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$51.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$19.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$19.35
|
| Rate for Payer: Cash Price |
$29.27
|
| Rate for Payer: Cash Price |
$29.27
|
| Rate for Payer: Cigna Commercial |
$89.77
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$19.35
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$19.99
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$54.61
|
| Rate for Payer: Dean Health Medicaid |
$19.99
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$19.35
|
| Rate for Payer: Health EOS Commercial |
$86.85
|
| Rate for Payer: HFN Commercial |
$89.77
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$71.98
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$19.35
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$19.99
|
| Rate for Payer: Independent Care Health Plan Medicare |
$19.35
|
| Rate for Payer: Managed Health Services Medicaid |
$20.79
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$19.35
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$19.35
|
| Rate for Payer: Multiplan Commercial |
$78.06
|
| Rate for Payer: NAPHCARE Commercial |
$29.02
|
| Rate for Payer: Preferred Network Access Commercial |
$89.77
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$19.99
|
| Rate for Payer: Quartz Beloit One Network |
$47.81
|
| Rate for Payer: Quartz Commercial |
$63.43
|
| Rate for Payer: Quartz Medicare Advantage |
$19.35
|
| Rate for Payer: The Alliance Commercial |
$77.40
|
| Rate for Payer: United Healthcare Medicaid |
$19.99
|
| Rate for Payer: United Healthcare Medicare Advantage |
$19.35
|
| Rate for Payer: United Healthcare PPO |
$73.18
|
| Rate for Payer: WEA Trust Commercial |
$53.67
|
| Rate for Payer: Wellcare Medicare |
$19.35
|
| Rate for Payer: WMAP Medicaid |
$19.99
|
| Rate for Payer: WPS Commercial |
$72.28
|
|
|
Rocky Mountain Spotted Fever IgM Titer
|
Facility
|
IP
|
$97.58
|
|
|
Service Code
|
CPT 86757
|
| Hospital Charge Code |
2956797
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$47.81 |
| Max. Negotiated Rate |
$89.77 |
| Rate for Payer: Aetna Commercial |
$87.82
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$83.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$51.72
|
| Rate for Payer: Cash Price |
$29.27
|
| Rate for Payer: Cigna Commercial |
$89.77
|
| Rate for Payer: Health EOS Commercial |
$86.85
|
| Rate for Payer: HFN Commercial |
$89.77
|
| Rate for Payer: Multiplan Commercial |
$78.06
|
| Rate for Payer: NAPHCARE Commercial |
$58.55
|
| Rate for Payer: Preferred Network Access Commercial |
$89.77
|
| Rate for Payer: Quartz Beloit One Network |
$47.81
|
| Rate for Payer: Quartz Commercial |
$58.55
|
| Rate for Payer: WEA Trust Commercial |
$53.67
|
| Rate for Payer: WPS Commercial |
$72.28
|
|
|
Rocky Mountain Spotted Fever IgM Titer
|
Professional
|
Both
|
$97.58
|
|
|
Service Code
|
CPT 86757
|
| Hospital Charge Code |
2956797
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$42.94 |
| Max. Negotiated Rate |
$92.70 |
| Rate for Payer: Aetna Commercial |
$92.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$83.92
|
| Rate for Payer: Cash Price |
$29.27
|
| Rate for Payer: Cash Price |
$29.27
|
| Rate for Payer: Cigna Commercial |
$92.70
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$48.79
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$58.55
|
| Rate for Payer: Health EOS Commercial |
$88.80
|
| Rate for Payer: HFN Commercial |
$92.70
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$68.31
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$68.31
|
| Rate for Payer: Multiplan Commercial |
$78.06
|
| Rate for Payer: Preferred Network Access Commercial |
$92.70
|
| Rate for Payer: Quartz Beloit One Network |
$42.94
|
| Rate for Payer: Quartz Commercial |
$55.62
|
| Rate for Payer: The Alliance Commercial |
$48.79
|
| Rate for Payer: WEA Trust Commercial |
$53.67
|
| Rate for Payer: WPS Commercial |
$72.28
|
|
|
ROD ATTACHMENT FOR LARGE MULTI-PIN CLAMP 390.003
|
Facility
|
IP
|
$5,867.00
|
|
| Hospital Charge Code |
2969386
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,874.83 |
| Max. Negotiated Rate |
$5,397.64 |
| Rate for Payer: Aetna Commercial |
$5,280.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,045.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,109.51
|
| Rate for Payer: Cash Price |
$1,760.10
|
| Rate for Payer: Cigna Commercial |
$5,397.64
|
| Rate for Payer: Health EOS Commercial |
$5,221.63
|
| Rate for Payer: HFN Commercial |
$5,397.64
|
| Rate for Payer: Multiplan Commercial |
$4,693.60
|
| Rate for Payer: NAPHCARE Commercial |
$3,520.20
|
| Rate for Payer: Preferred Network Access Commercial |
$5,397.64
|
| Rate for Payer: Quartz Beloit One Network |
$2,874.83
|
| Rate for Payer: Quartz Commercial |
$3,520.20
|
| Rate for Payer: WEA Trust Commercial |
$3,226.85
|
| Rate for Payer: WPS Commercial |
$4,345.69
|
|
|
ROD ATTACHMENT FOR LARGE MULTI-PIN CLAMP 390.003
|
Facility
|
OP
|
$5,867.00
|
|
| Hospital Charge Code |
2969386
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,642.76 |
| Max. Negotiated Rate |
$23,468.00 |
| Rate for Payer: Aetna Commercial |
$5,280.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,045.62
|
| Rate for Payer: Aetna Managed Medicare |
$1,642.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,813.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,933.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,816.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,109.51
|
| Rate for Payer: Cash Price |
$1,760.10
|
| Rate for Payer: Cigna Commercial |
$5,397.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,283.17
|
| Rate for Payer: Health EOS Commercial |
$5,221.63
|
| Rate for Payer: HFN Commercial |
$5,397.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,400.25
|
| Rate for Payer: Multiplan Commercial |
$4,693.60
|
| Rate for Payer: NAPHCARE Commercial |
$3,520.20
|
| Rate for Payer: Preferred Network Access Commercial |
$5,397.64
|
| Rate for Payer: Quartz Beloit One Network |
$2,874.83
|
| Rate for Payer: Quartz Commercial |
$3,813.55
|
| Rate for Payer: Quartz Medicare Advantage |
$3,520.20
|
| Rate for Payer: The Alliance Commercial |
$23,468.00
|
| Rate for Payer: WEA Trust Commercial |
$3,226.85
|
| Rate for Payer: WPS Commercial |
$4,345.69
|
|
