|
STABLESOFT 2S ATTACHMENT T401212S
|
Facility
OP
|
$3,056.00
|
|
| Hospital Charge Code |
2967353
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$855.68 |
| Max. Negotiated Rate |
$12,224.00 |
| Rate for Payer: Aetna Commercial |
$2,750.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,628.16
|
| Rate for Payer: Aetna Managed Medicare |
$855.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,986.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,528.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,466.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,619.68
|
| Rate for Payer: Cash Price |
$916.80
|
| Rate for Payer: Cigna Commercial |
$2,811.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,710.14
|
| Rate for Payer: Health EOS Commercial |
$2,719.84
|
| Rate for Payer: HFN Commercial |
$2,811.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,292.00
|
| Rate for Payer: Multiplan Commercial |
$2,444.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,833.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,811.52
|
| Rate for Payer: Quartz Beloit One Network |
$1,497.44
|
| Rate for Payer: Quartz Commercial |
$1,986.40
|
| Rate for Payer: Quartz Medicare Advantage |
$1,833.60
|
| Rate for Payer: The Alliance Commercial |
$12,224.00
|
| Rate for Payer: WEA Trust Commercial |
$1,680.80
|
| Rate for Payer: WPS Commercial |
$2,263.58
|
|
|
STAB PHLEBECTOMY OF VARICOSE VEINS, 1 EXTREMITY; 10-20 STAB INCISIONS
|
Facility
OP
|
$66,829.24
|
|
|
Service Code
|
CPT 37765
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,150.53 |
| Max. Negotiated Rate |
$66,829.24 |
| Rate for Payer: Aetna Managed Medicare |
$3,150.53
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$9,907.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8,043.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7,639.00
|
| Rate for Payer: Anthem Medicare Advantage |
$3,150.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$3,150.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$3,150.53
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$3,150.53
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,546.14
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$3,150.53
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$11,719.97
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$3,150.53
|
| Rate for Payer: Independent Care Health Plan Medicare |
$3,150.53
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$3,150.53
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$3,150.53
|
| Rate for Payer: NAPHCARE Commercial |
$4,725.80
|
| Rate for Payer: Quartz Medicare Advantage |
$3,150.53
|
| Rate for Payer: The Alliance Commercial |
$66,829.24
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,150.53
|
| Rate for Payer: United Healthcare PPO |
$4,103.00
|
| Rate for Payer: Wellcare Medicare |
$3,150.53
|
|
|
STAB PHLEBECTOMY OF VARICOSE VEINS, 1 EXTREMITY; MORE THAN 20 INCISIONS
|
Facility
OP
|
$41,927.24
|
|
|
Service Code
|
CPT 37766
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,150.53 |
| Max. Negotiated Rate |
$41,927.24 |
| Rate for Payer: Aetna Managed Medicare |
$3,150.53
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$9,907.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8,043.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7,639.00
|
| Rate for Payer: Anthem Medicare Advantage |
$3,150.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$3,150.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$3,150.53
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$3,150.53
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,546.14
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$3,150.53
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$11,719.97
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$3,150.53
|
| Rate for Payer: Independent Care Health Plan Medicare |
$3,150.53
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$3,150.53
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$3,150.53
|
| Rate for Payer: NAPHCARE Commercial |
$4,725.80
|
| Rate for Payer: Quartz Medicare Advantage |
$3,150.53
|
| Rate for Payer: The Alliance Commercial |
$41,927.24
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,150.53
|
| Rate for Payer: United Healthcare PPO |
$4,103.00
|
| Rate for Payer: Wellcare Medicare |
$3,150.53
|
|
|
Stachybotrys chartarum/atra IgE
|
Professional
|
$103.00
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
6149788
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.22 |
| Max. Negotiated Rate |
$97.85 |
| Rate for Payer: Aetna Commercial |
$97.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$88.58
|
| Rate for Payer: Aetna Managed Medicare |
$5.22
|
| Rate for Payer: Anthem Medicare Advantage |
$5.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5.22
|
| Rate for Payer: Cash Price |
$30.90
|
| Rate for Payer: Cash Price |
$30.90
|
| Rate for Payer: Cigna Commercial |
$97.85
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$51.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5.22
|
| Rate for Payer: Health EOS Commercial |
$93.73
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$18.43
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$18.43
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5.22
|
| Rate for Payer: Multiplan Commercial |
$82.40
|
| Rate for Payer: Preferred Network Access Commercial |
$97.85
|
| Rate for Payer: Quartz Beloit One Network |
$45.32
|
| Rate for Payer: Quartz Commercial |
$58.71
|
| Rate for Payer: Quartz Medicare Advantage |
$5.22
|
| Rate for Payer: The Alliance Commercial |
$20.62
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.22
|
| Rate for Payer: WEA Trust Commercial |
$56.65
|
| Rate for Payer: WPS Commercial |
$22.97
|
|
|
Stachybotrys chartarum/atra IgE
|
Facility
IP
|
$103.00
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
6149788
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$50.47 |
| Max. Negotiated Rate |
$94.76 |
| Rate for Payer: Aetna Commercial |
$92.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$54.59
|
| Rate for Payer: Cash Price |
$30.90
|
| Rate for Payer: Cigna Commercial |
$94.76
|
| Rate for Payer: Health EOS Commercial |
$91.67
|
| Rate for Payer: HFN Commercial |
$94.76
|
| Rate for Payer: Multiplan Commercial |
$82.40
|
| Rate for Payer: NAPHCARE Commercial |
$61.80
|
| Rate for Payer: Preferred Network Access Commercial |
$94.76
|
| Rate for Payer: Quartz Beloit One Network |
$50.47
|
| Rate for Payer: Quartz Commercial |
$61.80
|
| Rate for Payer: WEA Trust Commercial |
$56.65
|
| Rate for Payer: WPS Commercial |
$76.29
|
|
|
Stachybotrys chartarum/atra IgE
|
Facility
OP
|
$103.00
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
6149788
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.57 |
| Max. Negotiated Rate |
$412.00 |
| Rate for Payer: Aetna Commercial |
$92.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$88.58
|
| Rate for Payer: Aetna Managed Medicare |
$5.22
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$19.58
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$9.14
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$8.67
|
| Rate for Payer: Anthem Medicaid |
$4.57
|
| Rate for Payer: Anthem Medicare Advantage |
$5.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$54.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5.22
|
| Rate for Payer: Cash Price |
$30.90
|
| Rate for Payer: Cash Price |
$30.90
|
| Rate for Payer: Cigna Commercial |
$94.76
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$5.22
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$4.57
|
| Rate for Payer: Dean Health Medicaid |
$4.57
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$5.22
|
| Rate for Payer: Health EOS Commercial |
$91.67
|
| Rate for Payer: HFN Commercial |
$94.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$19.42
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$5.22
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$4.57
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5.22
|
| Rate for Payer: Managed Health Services Medicaid |
$4.75
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$5.22
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$5.22
|
| Rate for Payer: Multiplan Commercial |
$82.40
|
| Rate for Payer: NAPHCARE Commercial |
$7.83
|
| Rate for Payer: Preferred Network Access Commercial |
$94.76
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$4.57
|
| Rate for Payer: Quartz Beloit One Network |
$50.47
|
| Rate for Payer: Quartz Commercial |
$66.95
|
| Rate for Payer: Quartz Medicare Advantage |
$5.22
|
| Rate for Payer: The Alliance Commercial |
$412.00
|
| Rate for Payer: United Healthcare Medicaid |
$4.57
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.22
|
| Rate for Payer: United Healthcare PPO |
$77.25
|
| Rate for Payer: WEA Trust Commercial |
$56.65
|
| Rate for Payer: Wellcare Medicare |
$5.22
|
| Rate for Payer: WMAP Medicaid |
$4.57
|
| Rate for Payer: WPS Commercial |
$76.29
|
|
|
Stachybotrys chartarum/atra IgG
|
Facility
OP
|
$103.00
|
|
|
Service Code
|
CPT 86001
|
| Hospital Charge Code |
6149789
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.57 |
| Max. Negotiated Rate |
$412.00 |
| Rate for Payer: Aetna Commercial |
$92.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$88.58
|
| Rate for Payer: Aetna Managed Medicare |
$7.82
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$29.32
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$13.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$12.98
|
| Rate for Payer: Anthem Medicaid |
$4.57
|
| Rate for Payer: Anthem Medicare Advantage |
$7.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$54.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$7.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$7.82
|
| Rate for Payer: Cash Price |
$30.90
|
| Rate for Payer: Cash Price |
$30.90
|
| Rate for Payer: Cigna Commercial |
$94.76
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$7.82
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$4.57
|
| Rate for Payer: Dean Health Medicaid |
$4.57
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$7.82
|
| Rate for Payer: Health EOS Commercial |
$91.67
|
| Rate for Payer: HFN Commercial |
$94.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$29.09
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$7.82
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$4.57
|
| Rate for Payer: Independent Care Health Plan Medicare |
$7.82
|
| Rate for Payer: Managed Health Services Medicaid |
$4.75
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$7.82
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$7.82
|
| Rate for Payer: Multiplan Commercial |
$82.40
|
| Rate for Payer: NAPHCARE Commercial |
$11.73
|
| Rate for Payer: Preferred Network Access Commercial |
$94.76
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$4.57
|
| Rate for Payer: Quartz Beloit One Network |
$50.47
|
| Rate for Payer: Quartz Commercial |
$66.95
|
| Rate for Payer: Quartz Medicare Advantage |
$7.82
|
| Rate for Payer: The Alliance Commercial |
$412.00
|
| Rate for Payer: United Healthcare Medicaid |
$4.57
|
| Rate for Payer: United Healthcare Medicare Advantage |
$7.82
|
| Rate for Payer: United Healthcare PPO |
$77.25
|
| Rate for Payer: WEA Trust Commercial |
$56.65
|
| Rate for Payer: Wellcare Medicare |
$7.82
|
| Rate for Payer: WMAP Medicaid |
$4.57
|
| Rate for Payer: WPS Commercial |
$76.29
|
|
|
Stachybotrys chartarum/atra IgG
|
Professional
|
$103.00
|
|
|
Service Code
|
CPT 86001
|
| Hospital Charge Code |
6149789
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$7.82 |
| Max. Negotiated Rate |
$97.85 |
| Rate for Payer: Aetna Commercial |
$97.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$88.58
|
| Rate for Payer: Aetna Managed Medicare |
$7.82
|
| Rate for Payer: Anthem Medicare Advantage |
$7.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$7.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$7.82
|
| Rate for Payer: Cash Price |
$30.90
|
| Rate for Payer: Cash Price |
$30.90
|
| Rate for Payer: Cigna Commercial |
$97.85
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$51.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$7.82
|
| Rate for Payer: Health EOS Commercial |
$93.73
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$27.60
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$27.60
|
| Rate for Payer: Independent Care Health Plan Medicare |
$7.82
|
| Rate for Payer: Multiplan Commercial |
$82.40
|
| Rate for Payer: Preferred Network Access Commercial |
$97.85
|
| Rate for Payer: Quartz Beloit One Network |
$45.32
|
| Rate for Payer: Quartz Commercial |
$58.71
|
| Rate for Payer: Quartz Medicare Advantage |
$7.82
|
| Rate for Payer: The Alliance Commercial |
$30.89
|
| Rate for Payer: United Healthcare Medicare Advantage |
$7.82
|
| Rate for Payer: WEA Trust Commercial |
$56.65
|
| Rate for Payer: WPS Commercial |
$34.41
|
|
|
Stachybotrys chartarum/atra IgG
|
Facility
IP
|
$103.00
|
|
|
Service Code
|
CPT 86001
|
| Hospital Charge Code |
6149789
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$50.47 |
| Max. Negotiated Rate |
$94.76 |
| Rate for Payer: Aetna Commercial |
$92.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$54.59
|
| Rate for Payer: Cash Price |
$30.90
|
| Rate for Payer: Cigna Commercial |
$94.76
|
| Rate for Payer: Health EOS Commercial |
$91.67
|
| Rate for Payer: HFN Commercial |
$94.76
|
| Rate for Payer: Multiplan Commercial |
$82.40
|
| Rate for Payer: NAPHCARE Commercial |
$61.80
|
| Rate for Payer: Preferred Network Access Commercial |
$94.76
|
| Rate for Payer: Quartz Beloit One Network |
$50.47
|
| Rate for Payer: Quartz Commercial |
$61.80
|
| Rate for Payer: WEA Trust Commercial |
$56.65
|
| Rate for Payer: WPS Commercial |
$76.29
|
|
|
Stachybotrys IgA
|
Professional
|
$67.00
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
5546930
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.27 |
| Max. Negotiated Rate |
$75.99 |
| Rate for Payer: Aetna Commercial |
$63.65
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$57.62
|
| Rate for Payer: Aetna Managed Medicare |
$17.27
|
| Rate for Payer: Anthem Medicare Advantage |
$17.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$17.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$17.27
|
| Rate for Payer: Cash Price |
$20.10
|
| Rate for Payer: Cash Price |
$20.10
|
| Rate for Payer: Cigna Commercial |
$63.65
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$33.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$17.27
|
| Rate for Payer: Health EOS Commercial |
$60.97
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$60.96
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$60.96
|
| Rate for Payer: Independent Care Health Plan Medicare |
$17.27
|
| Rate for Payer: Multiplan Commercial |
$53.60
|
| Rate for Payer: Preferred Network Access Commercial |
$63.65
|
| Rate for Payer: Quartz Beloit One Network |
$29.48
|
| Rate for Payer: Quartz Commercial |
$38.19
|
| Rate for Payer: Quartz Medicare Advantage |
$17.27
|
| Rate for Payer: The Alliance Commercial |
$68.22
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17.27
|
| Rate for Payer: WEA Trust Commercial |
$36.85
|
| Rate for Payer: WPS Commercial |
$75.99
|
|
|
Stachybotrys IgA
|
Facility
IP
|
$67.00
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
5546930
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$32.83 |
| Max. Negotiated Rate |
$61.64 |
| Rate for Payer: Aetna Commercial |
$60.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$35.51
|
| Rate for Payer: Cash Price |
$20.10
|
| Rate for Payer: Cigna Commercial |
$61.64
|
| Rate for Payer: Health EOS Commercial |
$59.63
|
| Rate for Payer: HFN Commercial |
$61.64
|
| Rate for Payer: Multiplan Commercial |
$53.60
|
| Rate for Payer: NAPHCARE Commercial |
$40.20
|
| Rate for Payer: Preferred Network Access Commercial |
$61.64
|
| Rate for Payer: Quartz Beloit One Network |
$32.83
|
| Rate for Payer: Quartz Commercial |
$40.20
|
| Rate for Payer: WEA Trust Commercial |
$36.85
|
| Rate for Payer: WPS Commercial |
$49.63
|
|
|
Stachybotrys IgA
|
Facility
OP
|
$67.00
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
5546930
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.27 |
| Max. Negotiated Rate |
$268.00 |
| Rate for Payer: Aetna Commercial |
$60.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$57.62
|
| Rate for Payer: Aetna Managed Medicare |
$17.27
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$64.76
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$30.22
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$28.67
|
| Rate for Payer: Anthem Medicaid |
$17.85
|
| Rate for Payer: Anthem Medicare Advantage |
$17.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$35.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$17.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$17.27
|
| Rate for Payer: Cash Price |
$20.10
|
| Rate for Payer: Cash Price |
$20.10
|
| Rate for Payer: Cigna Commercial |
$61.64
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$17.27
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$17.85
|
| Rate for Payer: Dean Health Medicaid |
$17.85
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$17.27
|
| Rate for Payer: Health EOS Commercial |
$59.63
|
| Rate for Payer: HFN Commercial |
$61.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$64.24
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$17.27
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$17.85
|
| Rate for Payer: Independent Care Health Plan Medicare |
$17.27
|
| Rate for Payer: Managed Health Services Medicaid |
$18.56
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$17.27
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$17.27
|
| Rate for Payer: Multiplan Commercial |
$53.60
|
| Rate for Payer: NAPHCARE Commercial |
$25.90
|
| Rate for Payer: Preferred Network Access Commercial |
$61.64
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$17.85
|
| Rate for Payer: Quartz Beloit One Network |
$32.83
|
| Rate for Payer: Quartz Commercial |
$43.55
|
| Rate for Payer: Quartz Medicare Advantage |
$17.27
|
| Rate for Payer: The Alliance Commercial |
$268.00
|
| Rate for Payer: United Healthcare Medicaid |
$17.85
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17.27
|
| Rate for Payer: United Healthcare PPO |
$50.25
|
| Rate for Payer: WEA Trust Commercial |
$36.85
|
| Rate for Payer: Wellcare Medicare |
$17.27
|
| Rate for Payer: WMAP Medicaid |
$17.85
|
| Rate for Payer: WPS Commercial |
$49.63
|
|
|
Stachybotrys IgE
|
Facility
IP
|
$67.00
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
5546929
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$32.83 |
| Max. Negotiated Rate |
$61.64 |
| Rate for Payer: Aetna Commercial |
$60.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$35.51
|
| Rate for Payer: Cash Price |
$20.10
|
| Rate for Payer: Cigna Commercial |
$61.64
|
| Rate for Payer: Health EOS Commercial |
$59.63
|
| Rate for Payer: HFN Commercial |
$61.64
|
| Rate for Payer: Multiplan Commercial |
$53.60
|
| Rate for Payer: NAPHCARE Commercial |
$40.20
|
| Rate for Payer: Preferred Network Access Commercial |
$61.64
|
| Rate for Payer: Quartz Beloit One Network |
$32.83
|
| Rate for Payer: Quartz Commercial |
$40.20
|
| Rate for Payer: WEA Trust Commercial |
$36.85
|
| Rate for Payer: WPS Commercial |
$49.63
|
|
|
Stachybotrys IgE
|
Facility
OP
|
$67.00
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
5546929
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.57 |
| Max. Negotiated Rate |
$268.00 |
| Rate for Payer: Aetna Commercial |
$60.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$57.62
|
| Rate for Payer: Aetna Managed Medicare |
$5.22
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$19.58
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$9.14
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$8.67
|
| Rate for Payer: Anthem Medicaid |
$4.57
|
| Rate for Payer: Anthem Medicare Advantage |
$5.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$35.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5.22
|
| Rate for Payer: Cash Price |
$20.10
|
| Rate for Payer: Cash Price |
$20.10
|
| Rate for Payer: Cigna Commercial |
$61.64
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$5.22
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$4.57
|
| Rate for Payer: Dean Health Medicaid |
$4.57
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$5.22
|
| Rate for Payer: Health EOS Commercial |
$59.63
|
| Rate for Payer: HFN Commercial |
$61.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$19.42
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$5.22
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$4.57
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5.22
|
| Rate for Payer: Managed Health Services Medicaid |
$4.75
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$5.22
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$5.22
|
| Rate for Payer: Multiplan Commercial |
$53.60
|
| Rate for Payer: NAPHCARE Commercial |
$7.83
|
| Rate for Payer: Preferred Network Access Commercial |
$61.64
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$4.57
|
| Rate for Payer: Quartz Beloit One Network |
$32.83
|
| Rate for Payer: Quartz Commercial |
$43.55
|
| Rate for Payer: Quartz Medicare Advantage |
$5.22
|
| Rate for Payer: The Alliance Commercial |
$268.00
|
| Rate for Payer: United Healthcare Medicaid |
$4.57
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.22
|
| Rate for Payer: United Healthcare PPO |
$50.25
|
| Rate for Payer: WEA Trust Commercial |
$36.85
|
| Rate for Payer: Wellcare Medicare |
$5.22
|
| Rate for Payer: WMAP Medicaid |
$4.57
|
| Rate for Payer: WPS Commercial |
$49.63
|
|
|
Stachybotrys IgE
|
Professional
|
$67.00
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
5546929
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.22 |
| Max. Negotiated Rate |
$63.65 |
| Rate for Payer: Aetna Commercial |
$63.65
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$57.62
|
| Rate for Payer: Aetna Managed Medicare |
$5.22
|
| Rate for Payer: Anthem Medicare Advantage |
$5.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5.22
|
| Rate for Payer: Cash Price |
$20.10
|
| Rate for Payer: Cash Price |
$20.10
|
| Rate for Payer: Cigna Commercial |
$63.65
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$33.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5.22
|
| Rate for Payer: Health EOS Commercial |
$60.97
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$18.43
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$18.43
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5.22
|
| Rate for Payer: Multiplan Commercial |
$53.60
|
| Rate for Payer: Preferred Network Access Commercial |
$63.65
|
| Rate for Payer: Quartz Beloit One Network |
$29.48
|
| Rate for Payer: Quartz Commercial |
$38.19
|
| Rate for Payer: Quartz Medicare Advantage |
$5.22
|
| Rate for Payer: The Alliance Commercial |
$20.62
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.22
|
| Rate for Payer: WEA Trust Commercial |
$36.85
|
| Rate for Payer: WPS Commercial |
$22.97
|
|
|
STAPEDECTOMY
|
Facility
IP
|
$7,602.00
|
|
| Hospital Charge Code |
2960387
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,724.98 |
| Max. Negotiated Rate |
$6,993.84 |
| Rate for Payer: Aetna Commercial |
$6,841.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,029.06
|
| Rate for Payer: Cash Price |
$2,280.60
|
| Rate for Payer: Cigna Commercial |
$6,993.84
|
| Rate for Payer: Health EOS Commercial |
$6,765.78
|
| Rate for Payer: HFN Commercial |
$6,993.84
|
| Rate for Payer: Multiplan Commercial |
$6,081.60
|
| Rate for Payer: NAPHCARE Commercial |
$4,561.20
|
| Rate for Payer: Preferred Network Access Commercial |
$6,993.84
|
| Rate for Payer: Quartz Beloit One Network |
$3,724.98
|
| Rate for Payer: Quartz Commercial |
$4,561.20
|
| Rate for Payer: WEA Trust Commercial |
$4,181.10
|
| Rate for Payer: WPS Commercial |
$5,630.80
|
|
|
STAPEDECTOMY
|
Facility
OP
|
$7,602.00
|
|
| Hospital Charge Code |
2960387
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,128.56 |
| Max. Negotiated Rate |
$30,408.00 |
| Rate for Payer: Aetna Commercial |
$6,841.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,537.72
|
| Rate for Payer: Aetna Managed Medicare |
$2,128.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,941.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,801.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,648.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,029.06
|
| Rate for Payer: Cash Price |
$2,280.60
|
| Rate for Payer: Cigna Commercial |
$6,993.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,254.08
|
| Rate for Payer: Health EOS Commercial |
$6,765.78
|
| Rate for Payer: HFN Commercial |
$6,993.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,701.50
|
| Rate for Payer: Multiplan Commercial |
$6,081.60
|
| Rate for Payer: NAPHCARE Commercial |
$4,561.20
|
| Rate for Payer: Preferred Network Access Commercial |
$6,993.84
|
| Rate for Payer: Quartz Beloit One Network |
$3,724.98
|
| Rate for Payer: Quartz Commercial |
$4,941.30
|
| Rate for Payer: Quartz Medicare Advantage |
$4,561.20
|
| Rate for Payer: The Alliance Commercial |
$30,408.00
|
| Rate for Payer: WEA Trust Commercial |
$4,181.10
|
| Rate for Payer: WPS Commercial |
$5,630.80
|
|
|
STAPER RELOAD 80-3.8 GIA8038L
|
Facility
OP
|
$1,882.00
|
|
| Hospital Charge Code |
2962915
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$526.96 |
| Max. Negotiated Rate |
$7,528.00 |
| Rate for Payer: Quartz Medicare Advantage |
$1,129.20
|
| Rate for Payer: Aetna Commercial |
$1,693.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,618.52
|
| Rate for Payer: Aetna Managed Medicare |
$526.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,223.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$941.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$903.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$997.46
|
| Rate for Payer: Cash Price |
$564.60
|
| Rate for Payer: Cigna Commercial |
$1,731.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,053.17
|
| Rate for Payer: Health EOS Commercial |
$1,674.98
|
| Rate for Payer: HFN Commercial |
$1,731.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,411.50
|
| Rate for Payer: Multiplan Commercial |
$1,505.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,129.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,731.44
|
| Rate for Payer: Quartz Beloit One Network |
$922.18
|
| Rate for Payer: Quartz Commercial |
$1,223.30
|
| Rate for Payer: The Alliance Commercial |
$7,528.00
|
| Rate for Payer: WEA Trust Commercial |
$1,035.10
|
| Rate for Payer: WPS Commercial |
$1,394.00
|
|
|
STAPER RELOAD 80-3.8 GIA8038L
|
Facility
IP
|
$1,882.00
|
|
| Hospital Charge Code |
2962915
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$922.18 |
| Max. Negotiated Rate |
$1,731.44 |
| Rate for Payer: Aetna Commercial |
$1,693.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$997.46
|
| Rate for Payer: Cash Price |
$564.60
|
| Rate for Payer: Cigna Commercial |
$1,731.44
|
| Rate for Payer: Health EOS Commercial |
$1,674.98
|
| Rate for Payer: HFN Commercial |
$1,731.44
|
| Rate for Payer: Multiplan Commercial |
$1,505.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,129.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,731.44
|
| Rate for Payer: Quartz Beloit One Network |
$922.18
|
| Rate for Payer: Quartz Commercial |
$1,129.20
|
| Rate for Payer: WEA Trust Commercial |
$1,035.10
|
| Rate for Payer: WPS Commercial |
$1,394.00
|
|
|
STAPLE DYNANITE NITI 15WX15L AR-8719DS-1515
|
Facility
IP
|
$13,271.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5547383
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,502.79 |
| Max. Negotiated Rate |
$12,209.32 |
| Rate for Payer: Aetna Commercial |
$11,943.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$7,033.63
|
| Rate for Payer: Cash Price |
$3,981.30
|
| Rate for Payer: Cigna Commercial |
$12,209.32
|
| Rate for Payer: Health EOS Commercial |
$11,811.19
|
| Rate for Payer: HFN Commercial |
$12,209.32
|
| Rate for Payer: Multiplan Commercial |
$10,616.80
|
| Rate for Payer: NAPHCARE Commercial |
$7,962.60
|
| Rate for Payer: Preferred Network Access Commercial |
$12,209.32
|
| Rate for Payer: Quartz Beloit One Network |
$6,502.79
|
| Rate for Payer: Quartz Commercial |
$7,962.60
|
| Rate for Payer: WEA Trust Commercial |
$7,299.05
|
| Rate for Payer: WPS Commercial |
$9,829.83
|
|
|
STAPLE DYNANITE NITI 15WX15L AR-8719DS-1515
|
Facility
OP
|
$13,271.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5547383
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,715.88 |
| Max. Negotiated Rate |
$12,209.32 |
| Rate for Payer: Aetna Commercial |
$11,943.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$11,413.06
|
| Rate for Payer: Aetna Managed Medicare |
$3,715.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$8,626.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$6,635.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$6,370.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$7,033.63
|
| Rate for Payer: Cash Price |
$3,981.30
|
| Rate for Payer: Cigna Commercial |
$12,209.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$7,426.45
|
| Rate for Payer: Health EOS Commercial |
$11,811.19
|
| Rate for Payer: HFN Commercial |
$12,209.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$9,953.25
|
| Rate for Payer: Multiplan Commercial |
$10,616.80
|
| Rate for Payer: NAPHCARE Commercial |
$7,962.60
|
| Rate for Payer: Preferred Network Access Commercial |
$12,209.32
|
| Rate for Payer: Quartz Beloit One Network |
$6,502.79
|
| Rate for Payer: Quartz Commercial |
$8,626.15
|
| Rate for Payer: Quartz Medicare Advantage |
$7,962.60
|
| Rate for Payer: WEA Trust Commercial |
$7,299.05
|
| Rate for Payer: WPS Commercial |
$9,829.83
|
|
|
STAPLE DYNANITE SUPERMX 18WX15L AR-8719MXDS-1815
|
Facility
IP
|
$13,271.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5591396
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,502.79 |
| Max. Negotiated Rate |
$12,209.32 |
| Rate for Payer: Aetna Commercial |
$11,943.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$7,033.63
|
| Rate for Payer: Cash Price |
$3,981.30
|
| Rate for Payer: Cigna Commercial |
$12,209.32
|
| Rate for Payer: Health EOS Commercial |
$11,811.19
|
| Rate for Payer: HFN Commercial |
$12,209.32
|
| Rate for Payer: Multiplan Commercial |
$10,616.80
|
| Rate for Payer: NAPHCARE Commercial |
$7,962.60
|
| Rate for Payer: Preferred Network Access Commercial |
$12,209.32
|
| Rate for Payer: Quartz Beloit One Network |
$6,502.79
|
| Rate for Payer: Quartz Commercial |
$7,962.60
|
| Rate for Payer: WEA Trust Commercial |
$7,299.05
|
| Rate for Payer: WPS Commercial |
$9,829.83
|
|
|
STAPLE DYNANITE SUPERMX 18WX15L AR-8719MXDS-1815
|
Facility
OP
|
$13,271.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5591396
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,715.88 |
| Max. Negotiated Rate |
$12,209.32 |
| Rate for Payer: Aetna Commercial |
$11,943.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$11,413.06
|
| Rate for Payer: Aetna Managed Medicare |
$3,715.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$8,626.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$6,635.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$6,370.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$7,033.63
|
| Rate for Payer: Cash Price |
$3,981.30
|
| Rate for Payer: Cigna Commercial |
$12,209.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$7,426.45
|
| Rate for Payer: Health EOS Commercial |
$11,811.19
|
| Rate for Payer: HFN Commercial |
$12,209.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$9,953.25
|
| Rate for Payer: Multiplan Commercial |
$10,616.80
|
| Rate for Payer: NAPHCARE Commercial |
$7,962.60
|
| Rate for Payer: Preferred Network Access Commercial |
$12,209.32
|
| Rate for Payer: Quartz Beloit One Network |
$6,502.79
|
| Rate for Payer: Quartz Commercial |
$8,626.15
|
| Rate for Payer: Quartz Medicare Advantage |
$7,962.60
|
| Rate for Payer: WEA Trust Commercial |
$7,299.05
|
| Rate for Payer: WPS Commercial |
$9,829.83
|
|
|
STAPLE DYNANITE SUPERMX 20WX20L AR-8719MXDS-2020
|
Facility
IP
|
$13,271.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5603780
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,502.79 |
| Max. Negotiated Rate |
$12,209.32 |
| Rate for Payer: Aetna Commercial |
$11,943.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$7,033.63
|
| Rate for Payer: Cash Price |
$3,981.30
|
| Rate for Payer: Cigna Commercial |
$12,209.32
|
| Rate for Payer: Health EOS Commercial |
$11,811.19
|
| Rate for Payer: HFN Commercial |
$12,209.32
|
| Rate for Payer: Multiplan Commercial |
$10,616.80
|
| Rate for Payer: NAPHCARE Commercial |
$7,962.60
|
| Rate for Payer: Preferred Network Access Commercial |
$12,209.32
|
| Rate for Payer: Quartz Beloit One Network |
$6,502.79
|
| Rate for Payer: Quartz Commercial |
$7,962.60
|
| Rate for Payer: WEA Trust Commercial |
$7,299.05
|
| Rate for Payer: WPS Commercial |
$9,829.83
|
|
|
STAPLE DYNANITE SUPERMX 20WX20L AR-8719MXDS-2020
|
Facility
OP
|
$13,271.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5603780
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,715.88 |
| Max. Negotiated Rate |
$12,209.32 |
| Rate for Payer: Aetna Commercial |
$11,943.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$11,413.06
|
| Rate for Payer: Aetna Managed Medicare |
$3,715.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$8,626.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$6,635.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$6,370.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$7,033.63
|
| Rate for Payer: Cash Price |
$3,981.30
|
| Rate for Payer: Cigna Commercial |
$12,209.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$7,426.45
|
| Rate for Payer: Health EOS Commercial |
$11,811.19
|
| Rate for Payer: HFN Commercial |
$12,209.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$9,953.25
|
| Rate for Payer: Multiplan Commercial |
$10,616.80
|
| Rate for Payer: NAPHCARE Commercial |
$7,962.60
|
| Rate for Payer: Preferred Network Access Commercial |
$12,209.32
|
| Rate for Payer: Quartz Beloit One Network |
$6,502.79
|
| Rate for Payer: Quartz Commercial |
$8,626.15
|
| Rate for Payer: Quartz Medicare Advantage |
$7,962.60
|
| Rate for Payer: WEA Trust Commercial |
$7,299.05
|
| Rate for Payer: WPS Commercial |
$9,829.83
|
|
