|
Rh Typing
|
Facility
|
OP
|
$115.00
|
|
|
Service Code
|
CPT 86901
|
| Hospital Charge Code |
2952721
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.11 |
| Max. Negotiated Rate |
$154.60 |
| Rate for Payer: Aetna Commercial |
$107.64
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$102.86
|
| Rate for Payer: Aetna Managed Medicare |
$3.11
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$154.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$72.14
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$68.43
|
| Rate for Payer: Anthem Medicare Advantage |
$3.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$63.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$3.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$3.11
|
| Rate for Payer: Cash Price |
$34.50
|
| Rate for Payer: Cash Price |
$34.50
|
| Rate for Payer: Cigna Commercial |
$110.03
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$3.11
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$66.93
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$3.11
|
| Rate for Payer: Health EOS Commercial |
$106.44
|
| Rate for Payer: HFN Commercial |
$110.03
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$11.57
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$3.11
|
| Rate for Payer: Independent Care Health Plan Medicare |
$3.11
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$3.11
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$3.11
|
| Rate for Payer: Multiplan Commercial |
$95.68
|
| Rate for Payer: NAPHCARE Commercial |
$4.66
|
| Rate for Payer: Preferred Network Access Commercial |
$110.03
|
| Rate for Payer: Quartz Beloit One Network |
$58.60
|
| Rate for Payer: Quartz Commercial |
$77.74
|
| Rate for Payer: Quartz Medicare Advantage |
$3.11
|
| Rate for Payer: The Alliance Commercial |
$12.44
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3.11
|
| Rate for Payer: United Healthcare PPO |
$89.70
|
| Rate for Payer: WEA Trust Commercial |
$65.78
|
| Rate for Payer: Wellcare Medicare |
$3.11
|
| Rate for Payer: WPS Commercial |
$88.58
|
|
|
RHYTHM ECG WITH REPORT 93040
|
Professional
|
Both
|
$78.00
|
|
|
Service Code
|
CPT 93040
|
| Hospital Charge Code |
3015357
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$14.25 |
| Max. Negotiated Rate |
$77.06 |
| Rate for Payer: Aetna Commercial |
$77.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$69.76
|
| Rate for Payer: Aetna Managed Medicare |
$14.75
|
| Rate for Payer: Anthem Medicare Advantage |
$14.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$14.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$14.75
|
| Rate for Payer: Cash Price |
$23.40
|
| Rate for Payer: Cash Price |
$23.40
|
| Rate for Payer: Cash Price |
$23.40
|
| Rate for Payer: Cigna Commercial |
$77.06
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$14.25
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$14.75
|
| Rate for Payer: Health EOS Commercial |
$73.82
|
| Rate for Payer: HFN Commercial |
$77.06
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$44.10
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$44.10
|
| Rate for Payer: Independent Care Health Plan Medicare |
$14.75
|
| Rate for Payer: Multiplan Commercial |
$64.90
|
| Rate for Payer: NAPHCARE Commercial |
$22.12
|
| Rate for Payer: Preferred Network Access Commercial |
$77.06
|
| Rate for Payer: Quartz Beloit One Network |
$35.69
|
| Rate for Payer: Quartz Commercial |
$46.24
|
| Rate for Payer: Quartz Medicare Advantage |
$14.75
|
| Rate for Payer: The Alliance Commercial |
$56.04
|
| Rate for Payer: United Healthcare Medicaid |
$14.25
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14.75
|
| Rate for Payer: WEA Trust Commercial |
$44.62
|
| Rate for Payer: WPS Commercial |
$58.99
|
|
|
RHYTHM EEG - 1-3 LEADS
|
Facility
|
OP
|
$5,791.00
|
|
|
Service Code
|
CPT 95819
|
| Hospital Charge Code |
3058220
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$227.24 |
| Max. Negotiated Rate |
$5,540.83 |
| Rate for Payer: Aetna Commercial |
$5,420.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,179.47
|
| Rate for Payer: Aetna Managed Medicare |
$227.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,914.72
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,011.32
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,890.87
|
| Rate for Payer: Anthem Medicare Advantage |
$227.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,192.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$227.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$227.24
|
| Rate for Payer: Cash Price |
$1,737.30
|
| Rate for Payer: Cash Price |
$1,737.30
|
| Rate for Payer: Cigna Commercial |
$5,540.83
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$227.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,370.36
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$227.24
|
| Rate for Payer: Health EOS Commercial |
$5,360.15
|
| Rate for Payer: HFN Commercial |
$5,540.83
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$845.33
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$227.24
|
| Rate for Payer: Independent Care Health Plan Medicare |
$227.24
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$227.24
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$227.24
|
| Rate for Payer: Multiplan Commercial |
$4,818.11
|
| Rate for Payer: NAPHCARE Commercial |
$340.86
|
| Rate for Payer: Preferred Network Access Commercial |
$5,540.83
|
| Rate for Payer: Quartz Beloit One Network |
$2,951.09
|
| Rate for Payer: Quartz Commercial |
$3,914.72
|
| Rate for Payer: Quartz Medicare Advantage |
$227.24
|
| Rate for Payer: The Alliance Commercial |
$908.96
|
| Rate for Payer: United Healthcare Medicare Advantage |
$227.24
|
| Rate for Payer: United Healthcare PPO |
$4,516.98
|
| Rate for Payer: WEA Trust Commercial |
$3,312.45
|
| Rate for Payer: Wellcare Medicare |
$227.24
|
| Rate for Payer: WPS Commercial |
$4,460.81
|
|
|
RHYTHM EEG - 1-3 LEADS
|
Facility
|
IP
|
$5,791.00
|
|
|
Service Code
|
CPT 95819
|
| Hospital Charge Code |
3058220
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$2,951.09 |
| Max. Negotiated Rate |
$5,540.83 |
| Rate for Payer: Aetna Commercial |
$5,420.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,179.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,192.00
|
| Rate for Payer: Cash Price |
$1,737.30
|
| Rate for Payer: Cigna Commercial |
$5,540.83
|
| Rate for Payer: Health EOS Commercial |
$5,360.15
|
| Rate for Payer: HFN Commercial |
$5,540.83
|
| Rate for Payer: Multiplan Commercial |
$4,818.11
|
| Rate for Payer: Preferred Network Access Commercial |
$5,540.83
|
| Rate for Payer: Quartz Beloit One Network |
$2,951.09
|
| Rate for Payer: Quartz Commercial |
$3,613.58
|
| Rate for Payer: WEA Trust Commercial |
$3,312.45
|
| Rate for Payer: WPS Commercial |
$4,460.81
|
|
|
Ribonucleoprotein Antibody
|
Facility
|
OP
|
$194.00
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
978057
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.65 |
| Max. Negotiated Rate |
$185.62 |
| Rate for Payer: Aetna Commercial |
$181.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$173.51
|
| Rate for Payer: Aetna Managed Medicare |
$18.65
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$69.93
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$32.63
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$30.95
|
| Rate for Payer: Anthem Medicare Advantage |
$18.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$106.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$18.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$18.65
|
| Rate for Payer: Cash Price |
$58.20
|
| Rate for Payer: Cash Price |
$58.20
|
| Rate for Payer: Cigna Commercial |
$185.62
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$18.65
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$112.91
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$18.65
|
| Rate for Payer: Health EOS Commercial |
$179.57
|
| Rate for Payer: HFN Commercial |
$185.62
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$69.37
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$18.65
|
| Rate for Payer: Independent Care Health Plan Medicare |
$18.65
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$18.65
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$18.65
|
| Rate for Payer: Multiplan Commercial |
$161.41
|
| Rate for Payer: NAPHCARE Commercial |
$27.97
|
| Rate for Payer: Preferred Network Access Commercial |
$185.62
|
| Rate for Payer: Quartz Beloit One Network |
$98.86
|
| Rate for Payer: Quartz Commercial |
$131.14
|
| Rate for Payer: Quartz Medicare Advantage |
$18.65
|
| Rate for Payer: The Alliance Commercial |
$74.59
|
| Rate for Payer: United Healthcare Medicare Advantage |
$18.65
|
| Rate for Payer: United Healthcare PPO |
$151.32
|
| Rate for Payer: WEA Trust Commercial |
$110.97
|
| Rate for Payer: Wellcare Medicare |
$18.65
|
| Rate for Payer: WPS Commercial |
$149.44
|
|
|
Ribonucleoprotein Antibody
|
Professional
|
Both
|
$194.00
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
978057
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.65 |
| Max. Negotiated Rate |
$191.67 |
| Rate for Payer: Aetna Commercial |
$191.67
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$173.51
|
| Rate for Payer: Aetna Managed Medicare |
$18.65
|
| Rate for Payer: Anthem Medicare Advantage |
$18.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$18.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$18.65
|
| Rate for Payer: Cash Price |
$58.20
|
| Rate for Payer: Cash Price |
$58.20
|
| Rate for Payer: Cigna Commercial |
$191.67
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$100.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$18.65
|
| Rate for Payer: Health EOS Commercial |
$183.60
|
| Rate for Payer: HFN Commercial |
$191.67
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$65.82
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$65.82
|
| Rate for Payer: Independent Care Health Plan Medicare |
$18.65
|
| Rate for Payer: Multiplan Commercial |
$161.41
|
| Rate for Payer: NAPHCARE Commercial |
$27.97
|
| Rate for Payer: Preferred Network Access Commercial |
$191.67
|
| Rate for Payer: Quartz Beloit One Network |
$88.77
|
| Rate for Payer: Quartz Commercial |
$115.00
|
| Rate for Payer: Quartz Medicare Advantage |
$18.65
|
| Rate for Payer: The Alliance Commercial |
$73.66
|
| Rate for Payer: United Healthcare Medicare Advantage |
$18.65
|
| Rate for Payer: WEA Trust Commercial |
$110.97
|
| Rate for Payer: WPS Commercial |
$82.05
|
|
|
Ribonucleoprotein Antibody
|
Facility
|
IP
|
$194.00
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
978057
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$98.86 |
| Max. Negotiated Rate |
$185.62 |
| Rate for Payer: Aetna Commercial |
$181.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$173.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$106.93
|
| Rate for Payer: Cash Price |
$58.20
|
| Rate for Payer: Cigna Commercial |
$185.62
|
| Rate for Payer: Health EOS Commercial |
$179.57
|
| Rate for Payer: HFN Commercial |
$185.62
|
| Rate for Payer: Multiplan Commercial |
$161.41
|
| Rate for Payer: Preferred Network Access Commercial |
$185.62
|
| Rate for Payer: Quartz Beloit One Network |
$98.86
|
| Rate for Payer: Quartz Commercial |
$121.06
|
| Rate for Payer: WEA Trust Commercial |
$110.97
|
| Rate for Payer: WPS Commercial |
$149.44
|
|
|
Ribosomal Antibody
|
Facility
|
IP
|
$62.00
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
5360653
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$31.60 |
| Max. Negotiated Rate |
$59.32 |
| Rate for Payer: Aetna Commercial |
$58.03
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$55.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$34.17
|
| Rate for Payer: Cash Price |
$18.60
|
| Rate for Payer: Cigna Commercial |
$59.32
|
| Rate for Payer: Health EOS Commercial |
$57.39
|
| Rate for Payer: HFN Commercial |
$59.32
|
| Rate for Payer: Multiplan Commercial |
$51.58
|
| Rate for Payer: Preferred Network Access Commercial |
$59.32
|
| Rate for Payer: Quartz Beloit One Network |
$31.60
|
| Rate for Payer: Quartz Commercial |
$38.69
|
| Rate for Payer: WEA Trust Commercial |
$35.46
|
| Rate for Payer: WPS Commercial |
$47.76
|
|
|
Ribosomal Antibody
|
Professional
|
Both
|
$62.00
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
5360653
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.99 |
| Max. Negotiated Rate |
$61.26 |
| Rate for Payer: Aetna Commercial |
$61.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$55.45
|
| Rate for Payer: Aetna Managed Medicare |
$11.99
|
| Rate for Payer: Anthem Medicare Advantage |
$11.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$11.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$11.99
|
| Rate for Payer: Cash Price |
$18.60
|
| Rate for Payer: Cash Price |
$18.60
|
| Rate for Payer: Cigna Commercial |
$61.26
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$32.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$11.99
|
| Rate for Payer: Health EOS Commercial |
$58.68
|
| Rate for Payer: HFN Commercial |
$61.26
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$42.33
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$42.33
|
| Rate for Payer: Independent Care Health Plan Medicare |
$11.99
|
| Rate for Payer: Multiplan Commercial |
$51.58
|
| Rate for Payer: NAPHCARE Commercial |
$17.99
|
| Rate for Payer: Preferred Network Access Commercial |
$61.26
|
| Rate for Payer: Quartz Beloit One Network |
$28.37
|
| Rate for Payer: Quartz Commercial |
$36.75
|
| Rate for Payer: Quartz Medicare Advantage |
$11.99
|
| Rate for Payer: The Alliance Commercial |
$47.37
|
| Rate for Payer: United Healthcare Medicare Advantage |
$11.99
|
| Rate for Payer: WEA Trust Commercial |
$35.46
|
| Rate for Payer: WPS Commercial |
$52.76
|
|
|
Ribosomal Antibody
|
Facility
|
OP
|
$62.00
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
5360653
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.99 |
| Max. Negotiated Rate |
$59.32 |
| Rate for Payer: Aetna Commercial |
$58.03
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$55.45
|
| Rate for Payer: Aetna Managed Medicare |
$11.99
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$44.97
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$20.98
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$19.91
|
| Rate for Payer: Anthem Medicare Advantage |
$11.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$34.17
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$11.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$11.99
|
| Rate for Payer: Cash Price |
$18.60
|
| Rate for Payer: Cash Price |
$18.60
|
| Rate for Payer: Cigna Commercial |
$59.32
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$11.99
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$36.08
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$11.99
|
| Rate for Payer: Health EOS Commercial |
$57.39
|
| Rate for Payer: HFN Commercial |
$59.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$44.61
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$11.99
|
| Rate for Payer: Independent Care Health Plan Medicare |
$11.99
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$11.99
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$11.99
|
| Rate for Payer: Multiplan Commercial |
$51.58
|
| Rate for Payer: NAPHCARE Commercial |
$17.99
|
| Rate for Payer: Preferred Network Access Commercial |
$59.32
|
| Rate for Payer: Quartz Beloit One Network |
$31.60
|
| Rate for Payer: Quartz Commercial |
$41.91
|
| Rate for Payer: Quartz Medicare Advantage |
$11.99
|
| Rate for Payer: The Alliance Commercial |
$47.96
|
| Rate for Payer: United Healthcare Medicare Advantage |
$11.99
|
| Rate for Payer: United Healthcare PPO |
$48.36
|
| Rate for Payer: WEA Trust Commercial |
$35.46
|
| Rate for Payer: Wellcare Medicare |
$11.99
|
| Rate for Payer: WPS Commercial |
$47.76
|
|
|
Ribosomal P Antibody
|
Facility
|
OP
|
$335.00
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
983391
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.99 |
| Max. Negotiated Rate |
$320.53 |
| Rate for Payer: Aetna Commercial |
$313.56
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$299.62
|
| Rate for Payer: Aetna Managed Medicare |
$11.99
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$44.97
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$20.98
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$19.91
|
| Rate for Payer: Anthem Medicare Advantage |
$11.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$184.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$11.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$11.99
|
| Rate for Payer: Cash Price |
$100.50
|
| Rate for Payer: Cash Price |
$100.50
|
| Rate for Payer: Cigna Commercial |
$320.53
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$11.99
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$194.97
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$11.99
|
| Rate for Payer: Health EOS Commercial |
$310.08
|
| Rate for Payer: HFN Commercial |
$320.53
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$44.61
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$11.99
|
| Rate for Payer: Independent Care Health Plan Medicare |
$11.99
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$11.99
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$11.99
|
| Rate for Payer: Multiplan Commercial |
$278.72
|
| Rate for Payer: NAPHCARE Commercial |
$17.99
|
| Rate for Payer: Preferred Network Access Commercial |
$320.53
|
| Rate for Payer: Quartz Beloit One Network |
$170.72
|
| Rate for Payer: Quartz Commercial |
$226.46
|
| Rate for Payer: Quartz Medicare Advantage |
$11.99
|
| Rate for Payer: The Alliance Commercial |
$47.96
|
| Rate for Payer: United Healthcare Medicare Advantage |
$11.99
|
| Rate for Payer: United Healthcare PPO |
$261.30
|
| Rate for Payer: WEA Trust Commercial |
$191.62
|
| Rate for Payer: Wellcare Medicare |
$11.99
|
| Rate for Payer: WPS Commercial |
$258.05
|
|
|
Ribosomal P Antibody
|
Facility
|
IP
|
$335.00
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
983391
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$170.72 |
| Max. Negotiated Rate |
$320.53 |
| Rate for Payer: Aetna Commercial |
$313.56
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$299.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$184.65
|
| Rate for Payer: Cash Price |
$100.50
|
| Rate for Payer: Cigna Commercial |
$320.53
|
| Rate for Payer: Health EOS Commercial |
$310.08
|
| Rate for Payer: HFN Commercial |
$320.53
|
| Rate for Payer: Multiplan Commercial |
$278.72
|
| Rate for Payer: Preferred Network Access Commercial |
$320.53
|
| Rate for Payer: Quartz Beloit One Network |
$170.72
|
| Rate for Payer: Quartz Commercial |
$209.04
|
| Rate for Payer: WEA Trust Commercial |
$191.62
|
| Rate for Payer: WPS Commercial |
$258.05
|
|
|
Ribosomal P Antibody
|
Professional
|
Both
|
$335.00
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
983391
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.99 |
| Max. Negotiated Rate |
$330.98 |
| Rate for Payer: Aetna Commercial |
$330.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$299.62
|
| Rate for Payer: Aetna Managed Medicare |
$11.99
|
| Rate for Payer: Anthem Medicare Advantage |
$11.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$11.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$11.99
|
| Rate for Payer: Cash Price |
$100.50
|
| Rate for Payer: Cash Price |
$100.50
|
| Rate for Payer: Cigna Commercial |
$330.98
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$174.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$11.99
|
| Rate for Payer: Health EOS Commercial |
$317.04
|
| Rate for Payer: HFN Commercial |
$330.98
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$42.33
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$42.33
|
| Rate for Payer: Independent Care Health Plan Medicare |
$11.99
|
| Rate for Payer: Multiplan Commercial |
$278.72
|
| Rate for Payer: NAPHCARE Commercial |
$17.99
|
| Rate for Payer: Preferred Network Access Commercial |
$330.98
|
| Rate for Payer: Quartz Beloit One Network |
$153.30
|
| Rate for Payer: Quartz Commercial |
$198.59
|
| Rate for Payer: Quartz Medicare Advantage |
$11.99
|
| Rate for Payer: The Alliance Commercial |
$47.37
|
| Rate for Payer: United Healthcare Medicare Advantage |
$11.99
|
| Rate for Payer: WEA Trust Commercial |
$191.62
|
| Rate for Payer: WPS Commercial |
$52.76
|
|
|
RIB RESECTION
|
Facility
|
OP
|
$3,935.00
|
|
| Hospital Charge Code |
2960357
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,145.87 |
| Max. Negotiated Rate |
$3,765.01 |
| Rate for Payer: Aetna Commercial |
$3,683.16
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,519.46
|
| Rate for Payer: Aetna Managed Medicare |
$1,145.87
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,660.06
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,046.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,964.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,168.97
|
| Rate for Payer: Cash Price |
$1,180.50
|
| Rate for Payer: Cigna Commercial |
$3,765.01
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,290.17
|
| Rate for Payer: Health EOS Commercial |
$3,642.24
|
| Rate for Payer: HFN Commercial |
$3,765.01
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,069.30
|
| Rate for Payer: Multiplan Commercial |
$3,273.92
|
| Rate for Payer: NAPHCARE Commercial |
$2,455.44
|
| Rate for Payer: Preferred Network Access Commercial |
$3,765.01
|
| Rate for Payer: Quartz Beloit One Network |
$2,005.28
|
| Rate for Payer: Quartz Commercial |
$2,660.06
|
| Rate for Payer: Quartz Medicare Advantage |
$2,455.44
|
| Rate for Payer: The Alliance Commercial |
$2,046.20
|
| Rate for Payer: WEA Trust Commercial |
$2,250.82
|
| Rate for Payer: WPS Commercial |
$3,031.13
|
|
|
RIB RESECTION
|
Facility
|
IP
|
$3,935.00
|
|
| Hospital Charge Code |
2960357
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,005.28 |
| Max. Negotiated Rate |
$3,765.01 |
| Rate for Payer: Aetna Commercial |
$3,683.16
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,519.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,168.97
|
| Rate for Payer: Cash Price |
$1,180.50
|
| Rate for Payer: Cigna Commercial |
$3,765.01
|
| Rate for Payer: Health EOS Commercial |
$3,642.24
|
| Rate for Payer: HFN Commercial |
$3,765.01
|
| Rate for Payer: Multiplan Commercial |
$3,273.92
|
| Rate for Payer: Preferred Network Access Commercial |
$3,765.01
|
| Rate for Payer: Quartz Beloit One Network |
$2,005.28
|
| Rate for Payer: Quartz Commercial |
$2,455.44
|
| Rate for Payer: WEA Trust Commercial |
$2,250.82
|
| Rate for Payer: WPS Commercial |
$3,031.13
|
|
|
Right - Ear, impacted cerumen removal
|
Facility
|
IP
|
$223.00
|
|
|
Service Code
|
CPT 69209
|
| Hospital Charge Code |
4612684
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$113.64 |
| Max. Negotiated Rate |
$213.37 |
| Rate for Payer: Aetna Commercial |
$208.73
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$199.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$122.92
|
| Rate for Payer: Cash Price |
$66.90
|
| Rate for Payer: Cigna Commercial |
$213.37
|
| Rate for Payer: Health EOS Commercial |
$206.41
|
| Rate for Payer: HFN Commercial |
$213.37
|
| Rate for Payer: Multiplan Commercial |
$185.54
|
| Rate for Payer: Preferred Network Access Commercial |
$213.37
|
| Rate for Payer: Quartz Beloit One Network |
$113.64
|
| Rate for Payer: Quartz Commercial |
$139.15
|
| Rate for Payer: WEA Trust Commercial |
$127.56
|
| Rate for Payer: WPS Commercial |
$171.78
|
|
|
Right - Ear, impacted cerumen removal
|
Facility
|
OP
|
$223.00
|
|
|
Service Code
|
CPT 69209
|
| Hospital Charge Code |
4612684
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$62.09 |
| Max. Negotiated Rate |
$4,386.95 |
| Rate for Payer: Aetna Commercial |
$208.73
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$199.45
|
| Rate for Payer: Aetna Managed Medicare |
$62.09
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$150.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$115.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$111.32
|
| Rate for Payer: Anthem Medicare Advantage |
$62.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$122.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$62.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$62.09
|
| Rate for Payer: Cash Price |
$66.90
|
| Rate for Payer: Cash Price |
$66.90
|
| Rate for Payer: Cash Price |
$66.90
|
| Rate for Payer: Cigna Commercial |
$213.37
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$62.09
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$62.09
|
| Rate for Payer: Health EOS Commercial |
$206.41
|
| Rate for Payer: HFN Commercial |
$213.37
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$230.97
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$62.09
|
| Rate for Payer: Independent Care Health Plan Medicare |
$62.09
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$62.09
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$62.09
|
| Rate for Payer: Multiplan Commercial |
$185.54
|
| Rate for Payer: NAPHCARE Commercial |
$93.13
|
| Rate for Payer: Preferred Network Access Commercial |
$213.37
|
| Rate for Payer: Quartz Beloit One Network |
$113.64
|
| Rate for Payer: Quartz Commercial |
$150.75
|
| Rate for Payer: Quartz Medicare Advantage |
$62.09
|
| Rate for Payer: The Alliance Commercial |
$248.35
|
| Rate for Payer: United Healthcare Medicare Advantage |
$62.09
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$127.56
|
| Rate for Payer: Wellcare Medicare |
$62.09
|
| Rate for Payer: WPS Commercial |
$171.78
|
|
|
Rigid EO wo joints L3762
|
Facility
|
IP
|
$308.00
|
|
|
Service Code
|
HCPCS L3762
|
| Hospital Charge Code |
4590638
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$156.96 |
| Max. Negotiated Rate |
$294.69 |
| Rate for Payer: Aetna Commercial |
$288.29
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$275.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$169.77
|
| Rate for Payer: Cash Price |
$92.40
|
| Rate for Payer: Cigna Commercial |
$294.69
|
| Rate for Payer: Health EOS Commercial |
$285.08
|
| Rate for Payer: HFN Commercial |
$294.69
|
| Rate for Payer: Multiplan Commercial |
$256.26
|
| Rate for Payer: Preferred Network Access Commercial |
$294.69
|
| Rate for Payer: Quartz Beloit One Network |
$156.96
|
| Rate for Payer: Quartz Commercial |
$192.19
|
| Rate for Payer: WEA Trust Commercial |
$176.18
|
| Rate for Payer: WPS Commercial |
$237.25
|
|
|
Rigid EO wo joints L3762
|
Facility
|
OP
|
$308.00
|
|
|
Service Code
|
HCPCS L3762
|
| Hospital Charge Code |
4590638
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$45.60 |
| Max. Negotiated Rate |
$500.24 |
| Rate for Payer: Aetna Commercial |
$288.29
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$275.48
|
| Rate for Payer: Aetna Managed Medicare |
$89.69
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$45.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$45.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$45.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$169.77
|
| Rate for Payer: Cash Price |
$92.40
|
| Rate for Payer: Cash Price |
$92.40
|
| Rate for Payer: Cigna Commercial |
$294.69
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$179.26
|
| Rate for Payer: Health EOS Commercial |
$285.08
|
| Rate for Payer: HFN Commercial |
$294.69
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$240.24
|
| Rate for Payer: Multiplan Commercial |
$256.26
|
| Rate for Payer: NAPHCARE Commercial |
$192.19
|
| Rate for Payer: Preferred Network Access Commercial |
$294.69
|
| Rate for Payer: Quartz Beloit One Network |
$156.96
|
| Rate for Payer: Quartz Commercial |
$208.21
|
| Rate for Payer: Quartz Medicare Advantage |
$192.19
|
| Rate for Payer: The Alliance Commercial |
$500.24
|
| Rate for Payer: WEA Trust Commercial |
$176.18
|
| Rate for Payer: WPS Commercial |
$237.25
|
|
|
Rigid EO wo joints L3762
|
Professional
|
Both
|
$308.00
|
|
|
Service Code
|
HCPCS L3762
|
| Hospital Charge Code |
4590638
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$125.06 |
| Max. Negotiated Rate |
$360.59 |
| Rate for Payer: Aetna Commercial |
$304.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$275.48
|
| Rate for Payer: Aetna Managed Medicare |
$125.06
|
| Rate for Payer: Anthem Medicare Advantage |
$125.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$125.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$125.06
|
| Rate for Payer: Cash Price |
$92.40
|
| Rate for Payer: Cash Price |
$92.40
|
| Rate for Payer: Cigna Commercial |
$304.30
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$160.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$125.06
|
| Rate for Payer: Health EOS Commercial |
$291.49
|
| Rate for Payer: HFN Commercial |
$304.30
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$360.59
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$360.59
|
| Rate for Payer: Independent Care Health Plan Medicare |
$125.06
|
| Rate for Payer: Multiplan Commercial |
$256.26
|
| Rate for Payer: NAPHCARE Commercial |
$187.59
|
| Rate for Payer: Preferred Network Access Commercial |
$304.30
|
| Rate for Payer: Quartz Beloit One Network |
$140.94
|
| Rate for Payer: Quartz Commercial |
$182.58
|
| Rate for Payer: Quartz Medicare Advantage |
$125.06
|
| Rate for Payer: The Alliance Commercial |
$343.92
|
| Rate for Payer: United Healthcare Medicare Advantage |
$125.06
|
| Rate for Payer: WEA Trust Commercial |
$176.18
|
| Rate for Payer: WPS Commercial |
$218.85
|
|
|
RIMPLATE MATRIX MIDFACE ORBITAL 12HL 0.5MM THICK TI 04.503.343
|
Facility
|
OP
|
$2,502.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5264665
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$728.58 |
| Max. Negotiated Rate |
$2,393.91 |
| Rate for Payer: Aetna Commercial |
$2,341.87
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,237.79
|
| Rate for Payer: Aetna Managed Medicare |
$728.58
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,691.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,301.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,249.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,379.10
|
| Rate for Payer: Cash Price |
$750.60
|
| Rate for Payer: Cigna Commercial |
$2,393.91
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,456.16
|
| Rate for Payer: Health EOS Commercial |
$2,315.85
|
| Rate for Payer: HFN Commercial |
$2,393.91
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,951.56
|
| Rate for Payer: Multiplan Commercial |
$2,081.66
|
| Rate for Payer: NAPHCARE Commercial |
$1,561.25
|
| Rate for Payer: Preferred Network Access Commercial |
$2,393.91
|
| Rate for Payer: Quartz Beloit One Network |
$1,275.02
|
| Rate for Payer: Quartz Commercial |
$1,691.35
|
| Rate for Payer: Quartz Medicare Advantage |
$1,561.25
|
| Rate for Payer: The Alliance Commercial |
$1,301.04
|
| Rate for Payer: WEA Trust Commercial |
$1,431.14
|
| Rate for Payer: WPS Commercial |
$1,927.29
|
|
|
RIMPLATE MATRIX MIDFACE ORBITAL 12HL 0.5MM THICK TI 04.503.343
|
Facility
|
IP
|
$2,502.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5264665
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,275.02 |
| Max. Negotiated Rate |
$2,393.91 |
| Rate for Payer: Aetna Commercial |
$2,341.87
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,237.79
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,379.10
|
| Rate for Payer: Cash Price |
$750.60
|
| Rate for Payer: Cigna Commercial |
$2,393.91
|
| Rate for Payer: Health EOS Commercial |
$2,315.85
|
| Rate for Payer: HFN Commercial |
$2,393.91
|
| Rate for Payer: Multiplan Commercial |
$2,081.66
|
| Rate for Payer: Preferred Network Access Commercial |
$2,393.91
|
| Rate for Payer: Quartz Beloit One Network |
$1,275.02
|
| Rate for Payer: Quartz Commercial |
$1,561.25
|
| Rate for Payer: WEA Trust Commercial |
$1,431.14
|
| Rate for Payer: WPS Commercial |
$1,927.29
|
|
|
RIMPLATE MATRIX MIDFACE ORBITAL 12HL 0.7MM THICK TI 04.503.373
|
Facility
|
OP
|
$2,465.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5384732
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$717.81 |
| Max. Negotiated Rate |
$2,358.51 |
| Rate for Payer: Aetna Commercial |
$2,307.24
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,204.70
|
| Rate for Payer: Aetna Managed Medicare |
$717.81
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,666.34
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,281.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,230.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,358.71
|
| Rate for Payer: Cash Price |
$739.50
|
| Rate for Payer: Cigna Commercial |
$2,358.51
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,434.63
|
| Rate for Payer: Health EOS Commercial |
$2,281.60
|
| Rate for Payer: HFN Commercial |
$2,358.51
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,922.70
|
| Rate for Payer: Multiplan Commercial |
$2,050.88
|
| Rate for Payer: NAPHCARE Commercial |
$1,538.16
|
| Rate for Payer: Preferred Network Access Commercial |
$2,358.51
|
| Rate for Payer: Quartz Beloit One Network |
$1,256.16
|
| Rate for Payer: Quartz Commercial |
$1,666.34
|
| Rate for Payer: Quartz Medicare Advantage |
$1,538.16
|
| Rate for Payer: The Alliance Commercial |
$1,281.80
|
| Rate for Payer: WEA Trust Commercial |
$1,409.98
|
| Rate for Payer: WPS Commercial |
$1,898.79
|
|
|
RIMPLATE MATRIX MIDFACE ORBITAL 12HL 0.7MM THICK TI 04.503.373
|
Facility
|
IP
|
$2,465.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5384732
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,256.16 |
| Max. Negotiated Rate |
$2,358.51 |
| Rate for Payer: Aetna Commercial |
$2,307.24
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,204.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,358.71
|
| Rate for Payer: Cash Price |
$739.50
|
| Rate for Payer: Cigna Commercial |
$2,358.51
|
| Rate for Payer: Health EOS Commercial |
$2,281.60
|
| Rate for Payer: HFN Commercial |
$2,358.51
|
| Rate for Payer: Multiplan Commercial |
$2,050.88
|
| Rate for Payer: Preferred Network Access Commercial |
$2,358.51
|
| Rate for Payer: Quartz Beloit One Network |
$1,256.16
|
| Rate for Payer: Quartz Commercial |
$1,538.16
|
| Rate for Payer: WEA Trust Commercial |
$1,409.98
|
| Rate for Payer: WPS Commercial |
$1,898.79
|
|
|
RIMPLATE MATRIX ORBITAL 12HL 0.8MM THICK TI 04.503.397
|
Facility
|
IP
|
$5,270.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6226130
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,685.59 |
| Max. Negotiated Rate |
$5,042.34 |
| Rate for Payer: Aetna Commercial |
$4,932.72
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,713.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,904.82
|
| Rate for Payer: Cash Price |
$1,581.00
|
| Rate for Payer: Cigna Commercial |
$5,042.34
|
| Rate for Payer: Health EOS Commercial |
$4,877.91
|
| Rate for Payer: HFN Commercial |
$5,042.34
|
| Rate for Payer: Multiplan Commercial |
$4,384.64
|
| Rate for Payer: Preferred Network Access Commercial |
$5,042.34
|
| Rate for Payer: Quartz Beloit One Network |
$2,685.59
|
| Rate for Payer: Quartz Commercial |
$3,288.48
|
| Rate for Payer: WEA Trust Commercial |
$3,014.44
|
| Rate for Payer: WPS Commercial |
$4,059.48
|
|
