|
STRAPS LEG SML FRABRIC #9342
|
Facility
|
IP
|
$88.00
|
|
| Hospital Charge Code |
2974513
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$43.12 |
| Max. Negotiated Rate |
$80.96 |
| Rate for Payer: Aetna Commercial |
$79.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$75.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$46.64
|
| Rate for Payer: Cash Price |
$26.40
|
| Rate for Payer: Cigna Commercial |
$80.96
|
| Rate for Payer: Health EOS Commercial |
$78.32
|
| Rate for Payer: HFN Commercial |
$80.96
|
| Rate for Payer: Multiplan Commercial |
$70.40
|
| Rate for Payer: NAPHCARE Commercial |
$52.80
|
| Rate for Payer: Preferred Network Access Commercial |
$80.96
|
| Rate for Payer: Quartz Beloit One Network |
$43.12
|
| Rate for Payer: Quartz Commercial |
$52.80
|
| Rate for Payer: WEA Trust Commercial |
$48.40
|
| Rate for Payer: WPS Commercial |
$65.18
|
|
|
STRAPS LEG SML FRABRIC #9342
|
Facility
|
OP
|
$88.00
|
|
| Hospital Charge Code |
2974513
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$24.64 |
| Max. Negotiated Rate |
$352.00 |
| Rate for Payer: Aetna Commercial |
$79.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$75.68
|
| Rate for Payer: Aetna Managed Medicare |
$24.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$57.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$44.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$42.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$46.64
|
| Rate for Payer: Cash Price |
$26.40
|
| Rate for Payer: Cigna Commercial |
$80.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$49.24
|
| Rate for Payer: Health EOS Commercial |
$78.32
|
| Rate for Payer: HFN Commercial |
$80.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$66.00
|
| Rate for Payer: Multiplan Commercial |
$70.40
|
| Rate for Payer: NAPHCARE Commercial |
$52.80
|
| Rate for Payer: Preferred Network Access Commercial |
$80.96
|
| Rate for Payer: Quartz Beloit One Network |
$43.12
|
| Rate for Payer: Quartz Commercial |
$57.20
|
| Rate for Payer: Quartz Medicare Advantage |
$52.80
|
| Rate for Payer: The Alliance Commercial |
$352.00
|
| Rate for Payer: WEA Trust Commercial |
$48.40
|
| Rate for Payer: WPS Commercial |
$65.18
|
|
|
STRAP ULNAR DEVIATION #A309-9
|
Facility
|
OP
|
$371.00
|
|
| Hospital Charge Code |
2971022
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$103.88 |
| Max. Negotiated Rate |
$1,484.00 |
| Rate for Payer: Aetna Commercial |
$333.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$319.06
|
| Rate for Payer: Aetna Managed Medicare |
$103.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$241.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$185.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$178.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$196.63
|
| Rate for Payer: Cash Price |
$111.30
|
| Rate for Payer: Cigna Commercial |
$341.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$207.61
|
| Rate for Payer: Health EOS Commercial |
$330.19
|
| Rate for Payer: HFN Commercial |
$341.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$278.25
|
| Rate for Payer: Multiplan Commercial |
$296.80
|
| Rate for Payer: NAPHCARE Commercial |
$222.60
|
| Rate for Payer: Preferred Network Access Commercial |
$341.32
|
| Rate for Payer: Quartz Beloit One Network |
$181.79
|
| Rate for Payer: Quartz Commercial |
$241.15
|
| Rate for Payer: Quartz Medicare Advantage |
$222.60
|
| Rate for Payer: The Alliance Commercial |
$1,484.00
|
| Rate for Payer: WEA Trust Commercial |
$204.05
|
| Rate for Payer: WPS Commercial |
$274.80
|
|
|
STRAP ULNAR DEVIATION #A309-9
|
Facility
|
IP
|
$371.00
|
|
| Hospital Charge Code |
2971022
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$181.79 |
| Max. Negotiated Rate |
$341.32 |
| Rate for Payer: Aetna Commercial |
$333.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$319.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$196.63
|
| Rate for Payer: Cash Price |
$111.30
|
| Rate for Payer: Cigna Commercial |
$341.32
|
| Rate for Payer: Health EOS Commercial |
$330.19
|
| Rate for Payer: HFN Commercial |
$341.32
|
| Rate for Payer: Multiplan Commercial |
$296.80
|
| Rate for Payer: NAPHCARE Commercial |
$222.60
|
| Rate for Payer: Preferred Network Access Commercial |
$341.32
|
| Rate for Payer: Quartz Beloit One Network |
$181.79
|
| Rate for Payer: Quartz Commercial |
$222.60
|
| Rate for Payer: WEA Trust Commercial |
$204.05
|
| Rate for Payer: WPS Commercial |
$274.80
|
|
|
STRASSBURG SOCK LARGE
|
Facility
|
OP
|
$513.00
|
|
| Hospital Charge Code |
2971342
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$143.64 |
| Max. Negotiated Rate |
$2,052.00 |
| Rate for Payer: Aetna Commercial |
$461.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$441.18
|
| Rate for Payer: Aetna Managed Medicare |
$143.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$333.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$256.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$246.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$271.89
|
| Rate for Payer: Cash Price |
$153.90
|
| Rate for Payer: Cigna Commercial |
$471.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$287.07
|
| Rate for Payer: Health EOS Commercial |
$456.57
|
| Rate for Payer: HFN Commercial |
$471.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$384.75
|
| Rate for Payer: Multiplan Commercial |
$410.40
|
| Rate for Payer: NAPHCARE Commercial |
$307.80
|
| Rate for Payer: Preferred Network Access Commercial |
$471.96
|
| Rate for Payer: Quartz Beloit One Network |
$251.37
|
| Rate for Payer: Quartz Commercial |
$333.45
|
| Rate for Payer: Quartz Medicare Advantage |
$307.80
|
| Rate for Payer: The Alliance Commercial |
$2,052.00
|
| Rate for Payer: WEA Trust Commercial |
$282.15
|
| Rate for Payer: WPS Commercial |
$379.98
|
|
|
STRASSBURG SOCK LARGE
|
Facility
|
IP
|
$513.00
|
|
| Hospital Charge Code |
2971342
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$251.37 |
| Max. Negotiated Rate |
$471.96 |
| Rate for Payer: Aetna Commercial |
$461.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$441.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$271.89
|
| Rate for Payer: Cash Price |
$153.90
|
| Rate for Payer: Cigna Commercial |
$471.96
|
| Rate for Payer: Health EOS Commercial |
$456.57
|
| Rate for Payer: HFN Commercial |
$471.96
|
| Rate for Payer: Multiplan Commercial |
$410.40
|
| Rate for Payer: NAPHCARE Commercial |
$307.80
|
| Rate for Payer: Preferred Network Access Commercial |
$471.96
|
| Rate for Payer: Quartz Beloit One Network |
$251.37
|
| Rate for Payer: Quartz Commercial |
$307.80
|
| Rate for Payer: WEA Trust Commercial |
$282.15
|
| Rate for Payer: WPS Commercial |
$379.98
|
|
|
STRASSBURG SOCK ( MIN 5) REGULAR
|
Facility
|
IP
|
$487.00
|
|
| Hospital Charge Code |
2971206
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$238.63 |
| Max. Negotiated Rate |
$448.04 |
| Rate for Payer: Aetna Commercial |
$438.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$418.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$258.11
|
| Rate for Payer: Cash Price |
$146.10
|
| Rate for Payer: Cigna Commercial |
$448.04
|
| Rate for Payer: Health EOS Commercial |
$433.43
|
| Rate for Payer: HFN Commercial |
$448.04
|
| Rate for Payer: Multiplan Commercial |
$389.60
|
| Rate for Payer: NAPHCARE Commercial |
$292.20
|
| Rate for Payer: Preferred Network Access Commercial |
$448.04
|
| Rate for Payer: Quartz Beloit One Network |
$238.63
|
| Rate for Payer: Quartz Commercial |
$292.20
|
| Rate for Payer: WEA Trust Commercial |
$267.85
|
| Rate for Payer: WPS Commercial |
$360.72
|
|
|
STRASSBURG SOCK ( MIN 5) REGULAR
|
Facility
|
OP
|
$487.00
|
|
| Hospital Charge Code |
2971206
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$136.36 |
| Max. Negotiated Rate |
$1,948.00 |
| Rate for Payer: Aetna Commercial |
$438.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$418.82
|
| Rate for Payer: Aetna Managed Medicare |
$136.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$316.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$243.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$233.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$258.11
|
| Rate for Payer: Cash Price |
$146.10
|
| Rate for Payer: Cigna Commercial |
$448.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$272.53
|
| Rate for Payer: Health EOS Commercial |
$433.43
|
| Rate for Payer: HFN Commercial |
$448.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$365.25
|
| Rate for Payer: Multiplan Commercial |
$389.60
|
| Rate for Payer: NAPHCARE Commercial |
$292.20
|
| Rate for Payer: Preferred Network Access Commercial |
$448.04
|
| Rate for Payer: Quartz Beloit One Network |
$238.63
|
| Rate for Payer: Quartz Commercial |
$316.55
|
| Rate for Payer: Quartz Medicare Advantage |
$292.20
|
| Rate for Payer: The Alliance Commercial |
$1,948.00
|
| Rate for Payer: WEA Trust Commercial |
$267.85
|
| Rate for Payer: WPS Commercial |
$360.72
|
|
|
.Stratify JCV Ab Inhibition Assay
|
Professional
|
Both
|
$790.00
|
|
|
Service Code
|
CPT 86711
|
| Hospital Charge Code |
6187226
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$59.62 |
| Max. Negotiated Rate |
$750.50 |
| Rate for Payer: Aetna Commercial |
$750.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$679.40
|
| Rate for Payer: Cash Price |
$237.00
|
| Rate for Payer: Cash Price |
$237.00
|
| Rate for Payer: Cigna Commercial |
$750.50
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$395.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$474.00
|
| Rate for Payer: Health EOS Commercial |
$718.90
|
| Rate for Payer: HFN Commercial |
$750.50
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$59.62
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$59.62
|
| Rate for Payer: Multiplan Commercial |
$632.00
|
| Rate for Payer: Preferred Network Access Commercial |
$750.50
|
| Rate for Payer: Quartz Beloit One Network |
$347.60
|
| Rate for Payer: Quartz Commercial |
$450.30
|
| Rate for Payer: The Alliance Commercial |
$395.00
|
| Rate for Payer: WEA Trust Commercial |
$434.50
|
| Rate for Payer: WPS Commercial |
$585.15
|
|
|
.Stratify JCV Ab Inhibition Assay
|
Facility
|
OP
|
$790.00
|
|
|
Service Code
|
CPT 86711
|
| Hospital Charge Code |
6187226
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.79 |
| Max. Negotiated Rate |
$726.80 |
| Rate for Payer: Aetna Commercial |
$711.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$679.40
|
| Rate for Payer: Aetna Managed Medicare |
$16.89
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$63.34
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$29.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$28.04
|
| Rate for Payer: Anthem Medicaid |
$15.79
|
| Rate for Payer: Anthem Medicare Advantage |
$16.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$418.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$16.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$16.89
|
| Rate for Payer: Cash Price |
$237.00
|
| Rate for Payer: Cash Price |
$237.00
|
| Rate for Payer: Cigna Commercial |
$726.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$16.89
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$15.79
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$442.08
|
| Rate for Payer: Dean Health Medicaid |
$15.79
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$16.89
|
| Rate for Payer: Health EOS Commercial |
$703.10
|
| Rate for Payer: HFN Commercial |
$726.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$62.83
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$16.89
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$15.79
|
| Rate for Payer: Independent Care Health Plan Medicare |
$16.89
|
| Rate for Payer: Managed Health Services Medicaid |
$16.42
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$16.89
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$16.89
|
| Rate for Payer: Multiplan Commercial |
$632.00
|
| Rate for Payer: NAPHCARE Commercial |
$25.34
|
| Rate for Payer: Preferred Network Access Commercial |
$726.80
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$15.79
|
| Rate for Payer: Quartz Beloit One Network |
$387.10
|
| Rate for Payer: Quartz Commercial |
$513.50
|
| Rate for Payer: Quartz Medicare Advantage |
$16.89
|
| Rate for Payer: The Alliance Commercial |
$67.56
|
| Rate for Payer: United Healthcare Medicaid |
$15.79
|
| Rate for Payer: United Healthcare Medicare Advantage |
$16.89
|
| Rate for Payer: United Healthcare PPO |
$592.50
|
| Rate for Payer: WEA Trust Commercial |
$434.50
|
| Rate for Payer: Wellcare Medicare |
$16.89
|
| Rate for Payer: WMAP Medicaid |
$15.79
|
| Rate for Payer: WPS Commercial |
$585.15
|
|
|
.Stratify JCV Ab Inhibition Assay
|
Facility
|
IP
|
$790.00
|
|
|
Service Code
|
CPT 86711
|
| Hospital Charge Code |
6187226
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$387.10 |
| Max. Negotiated Rate |
$726.80 |
| Rate for Payer: Aetna Commercial |
$711.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$679.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$418.70
|
| Rate for Payer: Cash Price |
$237.00
|
| Rate for Payer: Cigna Commercial |
$726.80
|
| Rate for Payer: Health EOS Commercial |
$703.10
|
| Rate for Payer: HFN Commercial |
$726.80
|
| Rate for Payer: Multiplan Commercial |
$632.00
|
| Rate for Payer: NAPHCARE Commercial |
$474.00
|
| Rate for Payer: Preferred Network Access Commercial |
$726.80
|
| Rate for Payer: Quartz Beloit One Network |
$387.10
|
| Rate for Payer: Quartz Commercial |
$474.00
|
| Rate for Payer: WEA Trust Commercial |
$434.50
|
| Rate for Payer: WPS Commercial |
$585.15
|
|
|
Stratify JCV Antibody w/Rfx Inhibition Assay
|
Professional
|
Both
|
$2,425.00
|
|
|
Service Code
|
CPT 86711
|
| Hospital Charge Code |
4622700
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$59.62 |
| Max. Negotiated Rate |
$2,303.75 |
| Rate for Payer: Aetna Commercial |
$2,303.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,085.50
|
| Rate for Payer: Cash Price |
$727.50
|
| Rate for Payer: Cash Price |
$727.50
|
| Rate for Payer: Cigna Commercial |
$2,303.75
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,212.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,455.00
|
| Rate for Payer: Health EOS Commercial |
$2,206.75
|
| Rate for Payer: HFN Commercial |
$2,303.75
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$59.62
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$59.62
|
| Rate for Payer: Multiplan Commercial |
$1,940.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,303.75
|
| Rate for Payer: Quartz Beloit One Network |
$1,067.00
|
| Rate for Payer: Quartz Commercial |
$1,382.25
|
| Rate for Payer: The Alliance Commercial |
$1,212.50
|
| Rate for Payer: WEA Trust Commercial |
$1,333.75
|
| Rate for Payer: WPS Commercial |
$1,796.20
|
|
|
Stratify JCV Antibody w/Rfx Inhibition Assay
|
Facility
|
OP
|
$2,425.00
|
|
|
Service Code
|
CPT 86711
|
| Hospital Charge Code |
4622700
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.79 |
| Max. Negotiated Rate |
$2,231.00 |
| Rate for Payer: Aetna Commercial |
$2,182.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,085.50
|
| Rate for Payer: Aetna Managed Medicare |
$16.89
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$63.34
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$29.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$28.04
|
| Rate for Payer: Anthem Medicaid |
$15.79
|
| Rate for Payer: Anthem Medicare Advantage |
$16.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,285.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$16.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$16.89
|
| Rate for Payer: Cash Price |
$727.50
|
| Rate for Payer: Cash Price |
$727.50
|
| Rate for Payer: Cigna Commercial |
$2,231.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$16.89
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$15.79
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,357.03
|
| Rate for Payer: Dean Health Medicaid |
$15.79
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$16.89
|
| Rate for Payer: Health EOS Commercial |
$2,158.25
|
| Rate for Payer: HFN Commercial |
$2,231.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$62.83
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$16.89
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$15.79
|
| Rate for Payer: Independent Care Health Plan Medicare |
$16.89
|
| Rate for Payer: Managed Health Services Medicaid |
$16.42
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$16.89
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$16.89
|
| Rate for Payer: Multiplan Commercial |
$1,940.00
|
| Rate for Payer: NAPHCARE Commercial |
$25.34
|
| Rate for Payer: Preferred Network Access Commercial |
$2,231.00
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$15.79
|
| Rate for Payer: Quartz Beloit One Network |
$1,188.25
|
| Rate for Payer: Quartz Commercial |
$1,576.25
|
| Rate for Payer: Quartz Medicare Advantage |
$16.89
|
| Rate for Payer: The Alliance Commercial |
$67.56
|
| Rate for Payer: United Healthcare Medicaid |
$15.79
|
| Rate for Payer: United Healthcare Medicare Advantage |
$16.89
|
| Rate for Payer: United Healthcare PPO |
$1,818.75
|
| Rate for Payer: WEA Trust Commercial |
$1,333.75
|
| Rate for Payer: Wellcare Medicare |
$16.89
|
| Rate for Payer: WMAP Medicaid |
$15.79
|
| Rate for Payer: WPS Commercial |
$1,796.20
|
|
|
Stratify JCV Antibody w/Rfx Inhibition Assay
|
Facility
|
IP
|
$2,425.00
|
|
|
Service Code
|
CPT 86711
|
| Hospital Charge Code |
4622700
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$1,188.25 |
| Max. Negotiated Rate |
$2,231.00 |
| Rate for Payer: Aetna Commercial |
$2,182.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,085.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,285.25
|
| Rate for Payer: Cash Price |
$727.50
|
| Rate for Payer: Cigna Commercial |
$2,231.00
|
| Rate for Payer: Health EOS Commercial |
$2,158.25
|
| Rate for Payer: HFN Commercial |
$2,231.00
|
| Rate for Payer: Multiplan Commercial |
$1,940.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,455.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,231.00
|
| Rate for Payer: Quartz Beloit One Network |
$1,188.25
|
| Rate for Payer: Quartz Commercial |
$1,455.00
|
| Rate for Payer: WEA Trust Commercial |
$1,333.75
|
| Rate for Payer: WPS Commercial |
$1,796.20
|
|
|
Strep A PCR
|
Professional
|
Both
|
$194.00
|
|
|
Service Code
|
CPT 87651
|
| Hospital Charge Code |
5484959
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$85.36 |
| Max. Negotiated Rate |
$184.30 |
| Rate for Payer: Aetna Commercial |
$184.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$166.84
|
| Rate for Payer: Cash Price |
$58.20
|
| Rate for Payer: Cash Price |
$58.20
|
| Rate for Payer: Cigna Commercial |
$184.30
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$97.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$116.40
|
| Rate for Payer: Health EOS Commercial |
$176.54
|
| Rate for Payer: HFN Commercial |
$184.30
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$123.87
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$123.87
|
| Rate for Payer: Multiplan Commercial |
$155.20
|
| Rate for Payer: Preferred Network Access Commercial |
$184.30
|
| Rate for Payer: Quartz Beloit One Network |
$85.36
|
| Rate for Payer: Quartz Commercial |
$110.58
|
| Rate for Payer: The Alliance Commercial |
$97.00
|
| Rate for Payer: WEA Trust Commercial |
$106.70
|
| Rate for Payer: WPS Commercial |
$143.70
|
|
|
Strep A PCR
|
Facility
|
OP
|
$194.00
|
|
|
Service Code
|
CPT 87651
|
| Hospital Charge Code |
5484959
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$35.09 |
| Max. Negotiated Rate |
$178.48 |
| Rate for Payer: Aetna Commercial |
$174.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$166.84
|
| Rate for Payer: Aetna Managed Medicare |
$35.09
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$131.59
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$61.41
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$58.25
|
| Rate for Payer: Anthem Medicaid |
$36.26
|
| Rate for Payer: Anthem Medicare Advantage |
$35.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$102.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$35.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$35.09
|
| Rate for Payer: Cash Price |
$58.20
|
| Rate for Payer: Cash Price |
$58.20
|
| Rate for Payer: Cigna Commercial |
$178.48
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$35.09
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$36.26
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$108.56
|
| Rate for Payer: Dean Health Medicaid |
$36.26
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$35.09
|
| Rate for Payer: Health EOS Commercial |
$172.66
|
| Rate for Payer: HFN Commercial |
$178.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$130.53
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$35.09
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$36.26
|
| Rate for Payer: Independent Care Health Plan Medicare |
$35.09
|
| Rate for Payer: Managed Health Services Medicaid |
$37.71
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$35.09
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$35.09
|
| Rate for Payer: Multiplan Commercial |
$155.20
|
| Rate for Payer: NAPHCARE Commercial |
$52.64
|
| Rate for Payer: Preferred Network Access Commercial |
$178.48
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$36.26
|
| Rate for Payer: Quartz Beloit One Network |
$95.06
|
| Rate for Payer: Quartz Commercial |
$126.10
|
| Rate for Payer: Quartz Medicare Advantage |
$35.09
|
| Rate for Payer: The Alliance Commercial |
$140.36
|
| Rate for Payer: United Healthcare Medicaid |
$36.26
|
| Rate for Payer: United Healthcare Medicare Advantage |
$35.09
|
| Rate for Payer: United Healthcare PPO |
$145.50
|
| Rate for Payer: WEA Trust Commercial |
$106.70
|
| Rate for Payer: Wellcare Medicare |
$35.09
|
| Rate for Payer: WMAP Medicaid |
$36.26
|
| Rate for Payer: WPS Commercial |
$143.70
|
|
|
Strep A PCR
|
Facility
|
IP
|
$194.00
|
|
|
Service Code
|
CPT 87651
|
| Hospital Charge Code |
5484959
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$95.06 |
| Max. Negotiated Rate |
$178.48 |
| Rate for Payer: Aetna Commercial |
$174.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$166.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$102.82
|
| Rate for Payer: Cash Price |
$58.20
|
| Rate for Payer: Cigna Commercial |
$178.48
|
| Rate for Payer: Health EOS Commercial |
$172.66
|
| Rate for Payer: HFN Commercial |
$178.48
|
| Rate for Payer: Multiplan Commercial |
$155.20
|
| Rate for Payer: NAPHCARE Commercial |
$116.40
|
| Rate for Payer: Preferred Network Access Commercial |
$178.48
|
| Rate for Payer: Quartz Beloit One Network |
$95.06
|
| Rate for Payer: Quartz Commercial |
$116.40
|
| Rate for Payer: WEA Trust Commercial |
$106.70
|
| Rate for Payer: WPS Commercial |
$143.70
|
|
|
Strep B PCR
|
Professional
|
Both
|
$242.00
|
|
|
Service Code
|
CPT 87150
|
| Hospital Charge Code |
5418731
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$106.48 |
| Max. Negotiated Rate |
$229.90 |
| Rate for Payer: Aetna Commercial |
$229.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$208.12
|
| Rate for Payer: Cash Price |
$72.60
|
| Rate for Payer: Cash Price |
$72.60
|
| Rate for Payer: Cigna Commercial |
$229.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$121.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$145.20
|
| Rate for Payer: Health EOS Commercial |
$220.22
|
| Rate for Payer: HFN Commercial |
$229.90
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$123.87
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$123.87
|
| Rate for Payer: Multiplan Commercial |
$193.60
|
| Rate for Payer: Preferred Network Access Commercial |
$229.90
|
| Rate for Payer: Quartz Beloit One Network |
$106.48
|
| Rate for Payer: Quartz Commercial |
$137.94
|
| Rate for Payer: The Alliance Commercial |
$121.00
|
| Rate for Payer: WEA Trust Commercial |
$133.10
|
| Rate for Payer: WPS Commercial |
$179.25
|
|
|
Strep B PCR
|
Facility
|
IP
|
$242.00
|
|
|
Service Code
|
CPT 87150
|
| Hospital Charge Code |
5418731
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$118.58 |
| Max. Negotiated Rate |
$222.64 |
| Rate for Payer: Aetna Commercial |
$217.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$208.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$128.26
|
| Rate for Payer: Cash Price |
$72.60
|
| Rate for Payer: Cigna Commercial |
$222.64
|
| Rate for Payer: Health EOS Commercial |
$215.38
|
| Rate for Payer: HFN Commercial |
$222.64
|
| Rate for Payer: Multiplan Commercial |
$193.60
|
| Rate for Payer: NAPHCARE Commercial |
$145.20
|
| Rate for Payer: Preferred Network Access Commercial |
$222.64
|
| Rate for Payer: Quartz Beloit One Network |
$118.58
|
| Rate for Payer: Quartz Commercial |
$145.20
|
| Rate for Payer: WEA Trust Commercial |
$133.10
|
| Rate for Payer: WPS Commercial |
$179.25
|
|
|
Strep B PCR
|
Facility
|
OP
|
$242.00
|
|
|
Service Code
|
CPT 87150
|
| Hospital Charge Code |
5418731
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$35.09 |
| Max. Negotiated Rate |
$222.64 |
| Rate for Payer: Aetna Commercial |
$217.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$208.12
|
| Rate for Payer: Aetna Managed Medicare |
$35.09
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$131.59
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$61.41
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$58.25
|
| Rate for Payer: Anthem Medicaid |
$36.26
|
| Rate for Payer: Anthem Medicare Advantage |
$35.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$128.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$35.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$35.09
|
| Rate for Payer: Cash Price |
$72.60
|
| Rate for Payer: Cash Price |
$72.60
|
| Rate for Payer: Cigna Commercial |
$222.64
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$35.09
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$36.26
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$135.42
|
| Rate for Payer: Dean Health Medicaid |
$36.26
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$35.09
|
| Rate for Payer: Health EOS Commercial |
$215.38
|
| Rate for Payer: HFN Commercial |
$222.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$130.53
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$35.09
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$36.26
|
| Rate for Payer: Independent Care Health Plan Medicare |
$35.09
|
| Rate for Payer: Managed Health Services Medicaid |
$37.71
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$35.09
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$35.09
|
| Rate for Payer: Multiplan Commercial |
$193.60
|
| Rate for Payer: NAPHCARE Commercial |
$52.64
|
| Rate for Payer: Preferred Network Access Commercial |
$222.64
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$36.26
|
| Rate for Payer: Quartz Beloit One Network |
$118.58
|
| Rate for Payer: Quartz Commercial |
$157.30
|
| Rate for Payer: Quartz Medicare Advantage |
$35.09
|
| Rate for Payer: The Alliance Commercial |
$140.36
|
| Rate for Payer: United Healthcare Medicaid |
$36.26
|
| Rate for Payer: United Healthcare Medicare Advantage |
$35.09
|
| Rate for Payer: United Healthcare PPO |
$181.50
|
| Rate for Payer: WEA Trust Commercial |
$133.10
|
| Rate for Payer: Wellcare Medicare |
$35.09
|
| Rate for Payer: WMAP Medicaid |
$36.26
|
| Rate for Payer: WPS Commercial |
$179.25
|
|
|
Strep F latex
|
Facility
|
IP
|
$10.00
|
|
| Hospital Charge Code |
634181
|
| Min. Negotiated Rate |
$4.90 |
| Max. Negotiated Rate |
$9.20 |
| Rate for Payer: Aetna Commercial |
$9.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5.30
|
| Rate for Payer: Cash Price |
$3.00
|
| Rate for Payer: Cigna Commercial |
$9.20
|
| Rate for Payer: Health EOS Commercial |
$8.90
|
| Rate for Payer: HFN Commercial |
$9.20
|
| Rate for Payer: Multiplan Commercial |
$8.00
|
| Rate for Payer: NAPHCARE Commercial |
$6.00
|
| Rate for Payer: Preferred Network Access Commercial |
$9.20
|
| Rate for Payer: Quartz Beloit One Network |
$4.90
|
| Rate for Payer: Quartz Commercial |
$6.00
|
| Rate for Payer: WEA Trust Commercial |
$5.50
|
| Rate for Payer: WPS Commercial |
$7.41
|
|
|
Strep F latex
|
Facility
|
OP
|
$10.00
|
|
| Hospital Charge Code |
634181
|
| Min. Negotiated Rate |
$2.80 |
| Max. Negotiated Rate |
$40.00 |
| Rate for Payer: Aetna Commercial |
$9.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8.60
|
| Rate for Payer: Aetna Managed Medicare |
$2.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5.30
|
| Rate for Payer: Cash Price |
$3.00
|
| Rate for Payer: Cigna Commercial |
$9.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5.60
|
| Rate for Payer: Health EOS Commercial |
$8.90
|
| Rate for Payer: HFN Commercial |
$9.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7.50
|
| Rate for Payer: Multiplan Commercial |
$8.00
|
| Rate for Payer: NAPHCARE Commercial |
$6.00
|
| Rate for Payer: Preferred Network Access Commercial |
$9.20
|
| Rate for Payer: Quartz Beloit One Network |
$4.90
|
| Rate for Payer: Quartz Commercial |
$6.50
|
| Rate for Payer: Quartz Medicare Advantage |
$6.00
|
| Rate for Payer: The Alliance Commercial |
$40.00
|
| Rate for Payer: WEA Trust Commercial |
$5.50
|
| Rate for Payer: WPS Commercial |
$7.41
|
|
|
Strep F latex
|
Professional
|
Both
|
$10.00
|
|
| Hospital Charge Code |
634181
|
| Min. Negotiated Rate |
$4.40 |
| Max. Negotiated Rate |
$9.50 |
| Rate for Payer: Aetna Commercial |
$9.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8.60
|
| Rate for Payer: Cash Price |
$3.00
|
| Rate for Payer: Cigna Commercial |
$9.50
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$5.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6.00
|
| Rate for Payer: Health EOS Commercial |
$9.10
|
| Rate for Payer: HFN Commercial |
$9.50
|
| Rate for Payer: Multiplan Commercial |
$8.00
|
| Rate for Payer: Preferred Network Access Commercial |
$9.50
|
| Rate for Payer: Quartz Beloit One Network |
$4.40
|
| Rate for Payer: Quartz Commercial |
$5.70
|
| Rate for Payer: The Alliance Commercial |
$5.00
|
| Rate for Payer: WEA Trust Commercial |
$5.50
|
| Rate for Payer: WPS Commercial |
$7.41
|
|
|
Streptococcus Group B Antigen
|
Facility
|
IP
|
$88.00
|
|
|
Service Code
|
CPT 86403
|
| Hospital Charge Code |
5096642
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$43.12 |
| Max. Negotiated Rate |
$80.96 |
| Rate for Payer: Aetna Commercial |
$79.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$75.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$46.64
|
| Rate for Payer: Cash Price |
$26.40
|
| Rate for Payer: Cigna Commercial |
$80.96
|
| Rate for Payer: Health EOS Commercial |
$78.32
|
| Rate for Payer: HFN Commercial |
$80.96
|
| Rate for Payer: Multiplan Commercial |
$70.40
|
| Rate for Payer: NAPHCARE Commercial |
$52.80
|
| Rate for Payer: Preferred Network Access Commercial |
$80.96
|
| Rate for Payer: Quartz Beloit One Network |
$43.12
|
| Rate for Payer: Quartz Commercial |
$52.80
|
| Rate for Payer: WEA Trust Commercial |
$48.40
|
| Rate for Payer: WPS Commercial |
$65.18
|
|
|
Streptococcus Group B Antigen
|
Facility
|
OP
|
$88.00
|
|
|
Service Code
|
CPT 86403
|
| Hospital Charge Code |
5096642
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.54 |
| Max. Negotiated Rate |
$80.96 |
| Rate for Payer: Aetna Commercial |
$79.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$75.68
|
| Rate for Payer: Aetna Managed Medicare |
$11.54
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$43.28
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$20.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$19.16
|
| Rate for Payer: Anthem Medicaid |
$11.92
|
| Rate for Payer: Anthem Medicare Advantage |
$11.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$46.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$11.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$11.54
|
| Rate for Payer: Cash Price |
$26.40
|
| Rate for Payer: Cash Price |
$26.40
|
| Rate for Payer: Cigna Commercial |
$80.96
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$11.54
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$11.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$49.24
|
| Rate for Payer: Dean Health Medicaid |
$11.92
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$11.54
|
| Rate for Payer: Health EOS Commercial |
$78.32
|
| Rate for Payer: HFN Commercial |
$80.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$42.93
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$11.54
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$11.92
|
| Rate for Payer: Independent Care Health Plan Medicare |
$11.54
|
| Rate for Payer: Managed Health Services Medicaid |
$12.40
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$11.54
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$11.54
|
| Rate for Payer: Multiplan Commercial |
$70.40
|
| Rate for Payer: NAPHCARE Commercial |
$17.31
|
| Rate for Payer: Preferred Network Access Commercial |
$80.96
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$11.92
|
| Rate for Payer: Quartz Beloit One Network |
$43.12
|
| Rate for Payer: Quartz Commercial |
$57.20
|
| Rate for Payer: Quartz Medicare Advantage |
$11.54
|
| Rate for Payer: The Alliance Commercial |
$46.16
|
| Rate for Payer: United Healthcare Medicaid |
$11.92
|
| Rate for Payer: United Healthcare Medicare Advantage |
$11.54
|
| Rate for Payer: United Healthcare PPO |
$66.00
|
| Rate for Payer: WEA Trust Commercial |
$48.40
|
| Rate for Payer: Wellcare Medicare |
$11.54
|
| Rate for Payer: WMAP Medicaid |
$11.92
|
| Rate for Payer: WPS Commercial |
$65.18
|
|
