|
Stress Test Tracing 93017
|
Facility
|
IP
|
$1,575.00
|
|
|
Service Code
|
CPT 93017
|
| Hospital Charge Code |
5381788
|
|
Hospital Revenue Code
|
482
|
| Min. Negotiated Rate |
$802.62 |
| Max. Negotiated Rate |
$1,506.96 |
| Rate for Payer: Aetna Commercial |
$1,474.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,408.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$868.14
|
| Rate for Payer: Cash Price |
$472.50
|
| Rate for Payer: Cigna Commercial |
$1,506.96
|
| Rate for Payer: Health EOS Commercial |
$1,457.82
|
| Rate for Payer: HFN Commercial |
$1,506.96
|
| Rate for Payer: Multiplan Commercial |
$1,310.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,506.96
|
| Rate for Payer: Quartz Beloit One Network |
$802.62
|
| Rate for Payer: Quartz Commercial |
$982.80
|
| Rate for Payer: WEA Trust Commercial |
$900.90
|
| Rate for Payer: WPS Commercial |
$1,213.22
|
|
|
Stress Test Tracing ONLY
|
Facility
|
IP
|
$1,516.00
|
|
|
Service Code
|
CPT 93017
|
| Hospital Charge Code |
3114226
|
|
Hospital Revenue Code
|
482
|
| Min. Negotiated Rate |
$772.55 |
| Max. Negotiated Rate |
$1,450.51 |
| Rate for Payer: Aetna Commercial |
$1,418.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,355.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$835.62
|
| Rate for Payer: Cash Price |
$454.80
|
| Rate for Payer: Cigna Commercial |
$1,450.51
|
| Rate for Payer: Health EOS Commercial |
$1,403.21
|
| Rate for Payer: HFN Commercial |
$1,450.51
|
| Rate for Payer: Multiplan Commercial |
$1,261.31
|
| Rate for Payer: Preferred Network Access Commercial |
$1,450.51
|
| Rate for Payer: Quartz Beloit One Network |
$772.55
|
| Rate for Payer: Quartz Commercial |
$945.98
|
| Rate for Payer: WEA Trust Commercial |
$867.15
|
| Rate for Payer: WPS Commercial |
$1,167.77
|
|
|
Stress Test Tracing ONLY
|
Facility
|
OP
|
$1,516.00
|
|
|
Service Code
|
CPT 93017
|
| Hospital Charge Code |
3114226
|
|
Hospital Revenue Code
|
482
|
| Min. Negotiated Rate |
$227.24 |
| Max. Negotiated Rate |
$1,450.51 |
| Rate for Payer: Aetna Commercial |
$1,418.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,355.91
|
| Rate for Payer: Aetna Managed Medicare |
$227.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,024.82
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$788.32
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$756.79
|
| Rate for Payer: Anthem Medicare Advantage |
$227.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$835.62
|
| 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 |
$454.80
|
| Rate for Payer: Cash Price |
$454.80
|
| Rate for Payer: Cigna Commercial |
$1,450.51
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$227.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$882.31
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$227.24
|
| Rate for Payer: Health EOS Commercial |
$1,403.21
|
| Rate for Payer: HFN Commercial |
$1,450.51
|
| 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 |
$1,261.31
|
| Rate for Payer: NAPHCARE Commercial |
$340.86
|
| Rate for Payer: Preferred Network Access Commercial |
$1,450.51
|
| Rate for Payer: Quartz Beloit One Network |
$772.55
|
| Rate for Payer: Quartz Commercial |
$1,024.82
|
| 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 |
$1,182.48
|
| Rate for Payer: WEA Trust Commercial |
$867.15
|
| Rate for Payer: Wellcare Medicare |
$227.24
|
| Rate for Payer: WPS Commercial |
$1,167.77
|
|
|
Stress Test Tracing ONLY
|
Professional
|
Both
|
$1,516.00
|
|
|
Service Code
|
CPT 93017
|
| Hospital Charge Code |
3114226
|
|
Hospital Revenue Code
|
482
|
| Min. Negotiated Rate |
$38.48 |
| Max. Negotiated Rate |
$1,497.81 |
| Rate for Payer: Aetna Commercial |
$1,497.81
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,355.91
|
| Rate for Payer: Aetna Managed Medicare |
$38.48
|
| Rate for Payer: Anthem Medicare Advantage |
$38.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$38.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$38.48
|
| Rate for Payer: Cash Price |
$454.80
|
| Rate for Payer: Cash Price |
$454.80
|
| Rate for Payer: Cash Price |
$454.80
|
| Rate for Payer: Cigna Commercial |
$1,497.81
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$65.30
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$38.48
|
| Rate for Payer: Health EOS Commercial |
$1,434.74
|
| Rate for Payer: HFN Commercial |
$1,497.81
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$120.23
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$120.23
|
| Rate for Payer: Independent Care Health Plan Medicare |
$38.48
|
| Rate for Payer: Multiplan Commercial |
$1,261.31
|
| Rate for Payer: NAPHCARE Commercial |
$57.72
|
| Rate for Payer: Preferred Network Access Commercial |
$1,497.81
|
| Rate for Payer: Quartz Beloit One Network |
$693.72
|
| Rate for Payer: Quartz Commercial |
$898.68
|
| Rate for Payer: Quartz Medicare Advantage |
$38.48
|
| Rate for Payer: The Alliance Commercial |
$146.22
|
| Rate for Payer: United Healthcare Medicaid |
$65.30
|
| Rate for Payer: United Healthcare Medicare Advantage |
$38.48
|
| Rate for Payer: WEA Trust Commercial |
$867.15
|
| Rate for Payer: WPS Commercial |
$153.92
|
|
|
Stress Test Tracing Treadmill
|
Professional
|
Both
|
$1,575.00
|
|
|
Service Code
|
CPT 93017
|
| Hospital Charge Code |
5388799
|
|
Hospital Revenue Code
|
482
|
| Min. Negotiated Rate |
$38.48 |
| Max. Negotiated Rate |
$1,556.10 |
| Rate for Payer: Aetna Commercial |
$1,556.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,408.68
|
| Rate for Payer: Aetna Managed Medicare |
$38.48
|
| Rate for Payer: Anthem Medicare Advantage |
$38.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$38.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$38.48
|
| Rate for Payer: Cash Price |
$472.50
|
| Rate for Payer: Cash Price |
$472.50
|
| Rate for Payer: Cash Price |
$472.50
|
| Rate for Payer: Cigna Commercial |
$1,556.10
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$65.30
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$38.48
|
| Rate for Payer: Health EOS Commercial |
$1,490.58
|
| Rate for Payer: HFN Commercial |
$1,556.10
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$120.23
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$120.23
|
| Rate for Payer: Independent Care Health Plan Medicare |
$38.48
|
| Rate for Payer: Multiplan Commercial |
$1,310.40
|
| Rate for Payer: NAPHCARE Commercial |
$57.72
|
| Rate for Payer: Preferred Network Access Commercial |
$1,556.10
|
| Rate for Payer: Quartz Beloit One Network |
$720.72
|
| Rate for Payer: Quartz Commercial |
$933.66
|
| Rate for Payer: Quartz Medicare Advantage |
$38.48
|
| Rate for Payer: The Alliance Commercial |
$146.22
|
| Rate for Payer: United Healthcare Medicaid |
$65.30
|
| Rate for Payer: United Healthcare Medicare Advantage |
$38.48
|
| Rate for Payer: WEA Trust Commercial |
$900.90
|
| Rate for Payer: WPS Commercial |
$153.92
|
|
|
Stress Test Tracing Treadmill
|
Facility
|
OP
|
$1,575.00
|
|
|
Service Code
|
CPT 93017
|
| Hospital Charge Code |
5388799
|
|
Hospital Revenue Code
|
482
|
| Min. Negotiated Rate |
$227.24 |
| Max. Negotiated Rate |
$1,506.96 |
| Rate for Payer: Aetna Commercial |
$1,474.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,408.68
|
| Rate for Payer: Aetna Managed Medicare |
$227.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,064.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$819.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$786.24
|
| Rate for Payer: Anthem Medicare Advantage |
$227.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$868.14
|
| 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 |
$472.50
|
| Rate for Payer: Cash Price |
$472.50
|
| Rate for Payer: Cigna Commercial |
$1,506.96
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$227.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$916.65
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$227.24
|
| Rate for Payer: Health EOS Commercial |
$1,457.82
|
| Rate for Payer: HFN Commercial |
$1,506.96
|
| 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 |
$1,310.40
|
| Rate for Payer: NAPHCARE Commercial |
$340.86
|
| Rate for Payer: Preferred Network Access Commercial |
$1,506.96
|
| Rate for Payer: Quartz Beloit One Network |
$802.62
|
| Rate for Payer: Quartz Commercial |
$1,064.70
|
| 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 |
$1,228.50
|
| Rate for Payer: WEA Trust Commercial |
$900.90
|
| Rate for Payer: Wellcare Medicare |
$227.24
|
| Rate for Payer: WPS Commercial |
$1,213.22
|
|
|
Stress Test Tracing Treadmill
|
Facility
|
IP
|
$1,575.00
|
|
|
Service Code
|
CPT 93017
|
| Hospital Charge Code |
5388799
|
|
Hospital Revenue Code
|
482
|
| Min. Negotiated Rate |
$802.62 |
| Max. Negotiated Rate |
$1,506.96 |
| Rate for Payer: Aetna Commercial |
$1,474.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,408.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$868.14
|
| Rate for Payer: Cash Price |
$472.50
|
| Rate for Payer: Cigna Commercial |
$1,506.96
|
| Rate for Payer: Health EOS Commercial |
$1,457.82
|
| Rate for Payer: HFN Commercial |
$1,506.96
|
| Rate for Payer: Multiplan Commercial |
$1,310.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,506.96
|
| Rate for Payer: Quartz Beloit One Network |
$802.62
|
| Rate for Payer: Quartz Commercial |
$982.80
|
| Rate for Payer: WEA Trust Commercial |
$900.90
|
| Rate for Payer: WPS Commercial |
$1,213.22
|
|
|
Striated Muscle Antibody w/ Reflex
|
Facility
|
IP
|
$171.00
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
983412
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$87.14 |
| Max. Negotiated Rate |
$163.61 |
| Rate for Payer: Aetna Commercial |
$160.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$152.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$94.26
|
| Rate for Payer: Cash Price |
$51.30
|
| Rate for Payer: Cigna Commercial |
$163.61
|
| Rate for Payer: Health EOS Commercial |
$158.28
|
| Rate for Payer: HFN Commercial |
$163.61
|
| Rate for Payer: Multiplan Commercial |
$142.27
|
| Rate for Payer: Preferred Network Access Commercial |
$163.61
|
| Rate for Payer: Quartz Beloit One Network |
$87.14
|
| Rate for Payer: Quartz Commercial |
$106.70
|
| Rate for Payer: WEA Trust Commercial |
$97.81
|
| Rate for Payer: WPS Commercial |
$131.72
|
|
|
Striated Muscle Antibody w/ Reflex
|
Facility
|
OP
|
$171.00
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
983412
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.53 |
| Max. Negotiated Rate |
$163.61 |
| Rate for Payer: Aetna Commercial |
$160.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$152.94
|
| Rate for Payer: Aetna Managed Medicare |
$12.53
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$46.99
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$21.93
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$20.80
|
| Rate for Payer: Anthem Medicare Advantage |
$12.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$94.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$12.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$12.53
|
| Rate for Payer: Cash Price |
$51.30
|
| Rate for Payer: Cash Price |
$51.30
|
| Rate for Payer: Cigna Commercial |
$163.61
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$12.53
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$99.52
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$12.53
|
| Rate for Payer: Health EOS Commercial |
$158.28
|
| Rate for Payer: HFN Commercial |
$163.61
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$46.62
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$12.53
|
| Rate for Payer: Independent Care Health Plan Medicare |
$12.53
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$12.53
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$12.53
|
| Rate for Payer: Multiplan Commercial |
$142.27
|
| Rate for Payer: NAPHCARE Commercial |
$18.80
|
| Rate for Payer: Preferred Network Access Commercial |
$163.61
|
| Rate for Payer: Quartz Beloit One Network |
$87.14
|
| Rate for Payer: Quartz Commercial |
$115.60
|
| Rate for Payer: Quartz Medicare Advantage |
$12.53
|
| Rate for Payer: The Alliance Commercial |
$50.13
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.53
|
| Rate for Payer: United Healthcare PPO |
$133.38
|
| Rate for Payer: WEA Trust Commercial |
$97.81
|
| Rate for Payer: Wellcare Medicare |
$12.53
|
| Rate for Payer: WPS Commercial |
$131.72
|
|
|
Striated Muscle Antibody w/ Reflex
|
Professional
|
Both
|
$171.00
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
983412
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.53 |
| Max. Negotiated Rate |
$168.95 |
| Rate for Payer: Aetna Commercial |
$168.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$152.94
|
| Rate for Payer: Aetna Managed Medicare |
$12.53
|
| Rate for Payer: Anthem Commercial |
$17.27
|
| Rate for Payer: Anthem Medicare Advantage |
$12.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$12.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$12.53
|
| Rate for Payer: Cash Price |
$51.30
|
| Rate for Payer: Cash Price |
$51.30
|
| Rate for Payer: Cigna Commercial |
$168.95
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$88.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12.53
|
| Rate for Payer: Health EOS Commercial |
$161.83
|
| Rate for Payer: HFN Commercial |
$168.95
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$44.24
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$44.24
|
| Rate for Payer: Independent Care Health Plan Medicare |
$12.53
|
| Rate for Payer: Multiplan Commercial |
$142.27
|
| Rate for Payer: NAPHCARE Commercial |
$18.80
|
| Rate for Payer: Preferred Network Access Commercial |
$168.95
|
| Rate for Payer: Quartz Beloit One Network |
$78.25
|
| Rate for Payer: Quartz Commercial |
$101.37
|
| Rate for Payer: Quartz Medicare Advantage |
$12.53
|
| Rate for Payer: The Alliance Commercial |
$49.50
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.53
|
| Rate for Payer: WEA Trust Commercial |
$97.81
|
| Rate for Payer: WPS Commercial |
$55.14
|
|
|
STRIP BLOOD LEAK TEST #5119
|
Facility
|
OP
|
$988.00
|
|
| Hospital Charge Code |
2971904
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$287.71 |
| Max. Negotiated Rate |
$945.32 |
| Rate for Payer: Aetna Commercial |
$924.77
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$883.67
|
| Rate for Payer: Aetna Managed Medicare |
$287.71
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$667.89
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$513.76
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$493.21
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$544.59
|
| Rate for Payer: Cash Price |
$296.40
|
| Rate for Payer: Cigna Commercial |
$945.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$575.02
|
| Rate for Payer: Health EOS Commercial |
$914.49
|
| Rate for Payer: HFN Commercial |
$945.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$770.64
|
| Rate for Payer: Multiplan Commercial |
$822.02
|
| Rate for Payer: NAPHCARE Commercial |
$616.51
|
| Rate for Payer: Preferred Network Access Commercial |
$945.32
|
| Rate for Payer: Quartz Beloit One Network |
$503.48
|
| Rate for Payer: Quartz Commercial |
$667.89
|
| Rate for Payer: Quartz Medicare Advantage |
$616.51
|
| Rate for Payer: The Alliance Commercial |
$513.76
|
| Rate for Payer: WEA Trust Commercial |
$565.14
|
| Rate for Payer: WPS Commercial |
$761.06
|
|
|
STRIP BLOOD LEAK TEST #5119
|
Facility
|
IP
|
$988.00
|
|
| Hospital Charge Code |
2971904
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$503.48 |
| Max. Negotiated Rate |
$945.32 |
| Rate for Payer: Aetna Commercial |
$924.77
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$883.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$544.59
|
| Rate for Payer: Cash Price |
$296.40
|
| Rate for Payer: Cigna Commercial |
$945.32
|
| Rate for Payer: Health EOS Commercial |
$914.49
|
| Rate for Payer: HFN Commercial |
$945.32
|
| Rate for Payer: Multiplan Commercial |
$822.02
|
| Rate for Payer: Preferred Network Access Commercial |
$945.32
|
| Rate for Payer: Quartz Beloit One Network |
$503.48
|
| Rate for Payer: Quartz Commercial |
$616.51
|
| Rate for Payer: WEA Trust Commercial |
$565.14
|
| Rate for Payer: WPS Commercial |
$761.06
|
|
|
Strongyloides Antibody IgG
|
Professional
|
Both
|
$126.00
|
|
|
Service Code
|
CPT 86682
|
| Hospital Charge Code |
5100606
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.53 |
| Max. Negotiated Rate |
$124.49 |
| Rate for Payer: Aetna Commercial |
$124.49
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$112.69
|
| Rate for Payer: Aetna Managed Medicare |
$13.53
|
| Rate for Payer: Anthem Medicare Advantage |
$13.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$13.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$13.53
|
| Rate for Payer: Cash Price |
$37.80
|
| Rate for Payer: Cash Price |
$37.80
|
| Rate for Payer: Cigna Commercial |
$124.49
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$65.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$13.53
|
| Rate for Payer: Health EOS Commercial |
$119.25
|
| Rate for Payer: HFN Commercial |
$124.49
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$47.77
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$47.77
|
| Rate for Payer: Independent Care Health Plan Medicare |
$13.53
|
| Rate for Payer: Multiplan Commercial |
$104.83
|
| Rate for Payer: NAPHCARE Commercial |
$20.30
|
| Rate for Payer: Preferred Network Access Commercial |
$124.49
|
| Rate for Payer: Quartz Beloit One Network |
$57.66
|
| Rate for Payer: Quartz Commercial |
$74.69
|
| Rate for Payer: Quartz Medicare Advantage |
$13.53
|
| Rate for Payer: The Alliance Commercial |
$53.45
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.53
|
| Rate for Payer: WEA Trust Commercial |
$72.07
|
| Rate for Payer: WPS Commercial |
$59.53
|
|
|
Strongyloides Antibody IgG
|
Facility
|
OP
|
$126.00
|
|
|
Service Code
|
CPT 86682
|
| Hospital Charge Code |
5100606
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.53 |
| Max. Negotiated Rate |
$120.56 |
| Rate for Payer: Aetna Commercial |
$117.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$112.69
|
| Rate for Payer: Aetna Managed Medicare |
$13.53
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$50.74
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$23.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$22.46
|
| Rate for Payer: Anthem Medicare Advantage |
$13.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$69.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$13.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$13.53
|
| Rate for Payer: Cash Price |
$37.80
|
| Rate for Payer: Cash Price |
$37.80
|
| Rate for Payer: Cigna Commercial |
$120.56
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$13.53
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$73.33
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$13.53
|
| Rate for Payer: Health EOS Commercial |
$116.63
|
| Rate for Payer: HFN Commercial |
$120.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$50.33
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$13.53
|
| Rate for Payer: Independent Care Health Plan Medicare |
$13.53
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$13.53
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$13.53
|
| Rate for Payer: Multiplan Commercial |
$104.83
|
| Rate for Payer: NAPHCARE Commercial |
$20.30
|
| Rate for Payer: Preferred Network Access Commercial |
$120.56
|
| Rate for Payer: Quartz Beloit One Network |
$64.21
|
| Rate for Payer: Quartz Commercial |
$85.18
|
| Rate for Payer: Quartz Medicare Advantage |
$13.53
|
| Rate for Payer: The Alliance Commercial |
$54.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.53
|
| Rate for Payer: United Healthcare PPO |
$98.28
|
| Rate for Payer: WEA Trust Commercial |
$72.07
|
| Rate for Payer: Wellcare Medicare |
$13.53
|
| Rate for Payer: WPS Commercial |
$97.06
|
|
|
Strongyloides Antibody IgG
|
Facility
|
IP
|
$126.00
|
|
|
Service Code
|
CPT 86682
|
| Hospital Charge Code |
5100606
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$64.21 |
| Max. Negotiated Rate |
$120.56 |
| Rate for Payer: Aetna Commercial |
$117.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$112.69
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$69.45
|
| Rate for Payer: Cash Price |
$37.80
|
| Rate for Payer: Cigna Commercial |
$120.56
|
| Rate for Payer: Health EOS Commercial |
$116.63
|
| Rate for Payer: HFN Commercial |
$120.56
|
| Rate for Payer: Multiplan Commercial |
$104.83
|
| Rate for Payer: Preferred Network Access Commercial |
$120.56
|
| Rate for Payer: Quartz Beloit One Network |
$64.21
|
| Rate for Payer: Quartz Commercial |
$78.62
|
| Rate for Payer: WEA Trust Commercial |
$72.07
|
| Rate for Payer: WPS Commercial |
$97.06
|
|
|
Strontium-89
|
Facility
|
OP
|
$13,042.00
|
|
|
Service Code
|
HCPCS A9600
|
| Hospital Charge Code |
1486856
|
|
Hospital Revenue Code
|
344
|
| Min. Negotiated Rate |
$4,312.19 |
| Max. Negotiated Rate |
$17,248.77 |
| Rate for Payer: Aetna Commercial |
$12,207.31
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$11,664.76
|
| Rate for Payer: Aetna Managed Medicare |
$4,312.19
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$8,816.39
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$6,781.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$6,510.57
|
| Rate for Payer: Anthem Medicare Advantage |
$4,312.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$7,188.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$4,312.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$4,312.19
|
| Rate for Payer: Cash Price |
$3,912.60
|
| Rate for Payer: Cash Price |
$3,912.60
|
| Rate for Payer: Cigna Commercial |
$12,478.59
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$4,312.19
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$7,590.44
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$4,312.19
|
| Rate for Payer: Health EOS Commercial |
$12,071.68
|
| Rate for Payer: HFN Commercial |
$12,478.59
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$16,041.36
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$4,312.19
|
| Rate for Payer: Independent Care Health Plan Medicare |
$4,312.19
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$4,312.19
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$4,312.19
|
| Rate for Payer: Multiplan Commercial |
$10,850.94
|
| Rate for Payer: NAPHCARE Commercial |
$6,468.29
|
| Rate for Payer: Preferred Network Access Commercial |
$12,478.59
|
| Rate for Payer: Quartz Beloit One Network |
$6,646.20
|
| Rate for Payer: Quartz Commercial |
$8,816.39
|
| Rate for Payer: Quartz Medicare Advantage |
$4,312.19
|
| Rate for Payer: The Alliance Commercial |
$17,248.77
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4,312.19
|
| Rate for Payer: WEA Trust Commercial |
$7,460.02
|
| Rate for Payer: Wellcare Medicare |
$4,312.19
|
| Rate for Payer: WPS Commercial |
$10,046.25
|
|
|
Strontium-89
|
Facility
|
IP
|
$13,042.00
|
|
|
Service Code
|
HCPCS A9600
|
| Hospital Charge Code |
1486856
|
|
Hospital Revenue Code
|
344
|
| Min. Negotiated Rate |
$6,646.20 |
| Max. Negotiated Rate |
$12,478.59 |
| Rate for Payer: Aetna Commercial |
$12,207.31
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$11,664.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$7,188.75
|
| Rate for Payer: Cash Price |
$3,912.60
|
| Rate for Payer: Cigna Commercial |
$12,478.59
|
| Rate for Payer: Health EOS Commercial |
$12,071.68
|
| Rate for Payer: HFN Commercial |
$12,478.59
|
| Rate for Payer: Multiplan Commercial |
$10,850.94
|
| Rate for Payer: Preferred Network Access Commercial |
$12,478.59
|
| Rate for Payer: Quartz Beloit One Network |
$6,646.20
|
| Rate for Payer: Quartz Commercial |
$8,138.21
|
| Rate for Payer: WEA Trust Commercial |
$7,460.02
|
| Rate for Payer: WPS Commercial |
$10,046.25
|
|
|
Strontium-89
|
Professional
|
Both
|
$13,042.00
|
|
|
Service Code
|
HCPCS A9600
|
| Hospital Charge Code |
1486856
|
|
Hospital Revenue Code
|
344
|
| Min. Negotiated Rate |
$1,001.95 |
| Max. Negotiated Rate |
$12,885.50 |
| Rate for Payer: Aetna Commercial |
$12,885.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$11,664.76
|
| Rate for Payer: Cash Price |
$3,912.60
|
| Rate for Payer: Cash Price |
$3,912.60
|
| Rate for Payer: Cigna Commercial |
$12,885.50
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,001.95
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$8,138.21
|
| Rate for Payer: Health EOS Commercial |
$12,342.95
|
| Rate for Payer: HFN Commercial |
$12,885.50
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,382.66
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$2,382.66
|
| Rate for Payer: Multiplan Commercial |
$10,850.94
|
| Rate for Payer: Preferred Network Access Commercial |
$12,885.50
|
| Rate for Payer: Quartz Beloit One Network |
$5,968.02
|
| Rate for Payer: Quartz Commercial |
$7,731.30
|
| Rate for Payer: The Alliance Commercial |
$6,781.84
|
| Rate for Payer: United Healthcare Medicaid |
$1,001.95
|
| Rate for Payer: WEA Trust Commercial |
$7,460.02
|
| Rate for Payer: WPS Commercial |
$10,046.25
|
|
|
STRUT CONNECTING BOLT M6 NUT HOFFMANN LIMB 4933-1-702
|
Facility
|
OP
|
$368.00
|
|
| Hospital Charge Code |
5599714
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$107.16 |
| Max. Negotiated Rate |
$352.10 |
| Rate for Payer: Aetna Commercial |
$344.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$329.14
|
| Rate for Payer: Aetna Managed Medicare |
$107.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$248.77
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$191.36
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$183.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$202.84
|
| Rate for Payer: Cash Price |
$110.40
|
| Rate for Payer: Cigna Commercial |
$352.10
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$214.18
|
| Rate for Payer: Health EOS Commercial |
$340.62
|
| Rate for Payer: HFN Commercial |
$352.10
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$287.04
|
| Rate for Payer: Multiplan Commercial |
$306.18
|
| Rate for Payer: NAPHCARE Commercial |
$229.63
|
| Rate for Payer: Preferred Network Access Commercial |
$352.10
|
| Rate for Payer: Quartz Beloit One Network |
$187.53
|
| Rate for Payer: Quartz Commercial |
$248.77
|
| Rate for Payer: Quartz Medicare Advantage |
$229.63
|
| Rate for Payer: The Alliance Commercial |
$191.36
|
| Rate for Payer: WEA Trust Commercial |
$210.50
|
| Rate for Payer: WPS Commercial |
$283.47
|
|
|
STRUT CONNECTING BOLT M6 NUT HOFFMANN LIMB 4933-1-702
|
Facility
|
IP
|
$368.00
|
|
| Hospital Charge Code |
5599714
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$187.53 |
| Max. Negotiated Rate |
$352.10 |
| Rate for Payer: Aetna Commercial |
$344.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$329.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$202.84
|
| Rate for Payer: Cash Price |
$110.40
|
| Rate for Payer: Cigna Commercial |
$352.10
|
| Rate for Payer: Health EOS Commercial |
$340.62
|
| Rate for Payer: HFN Commercial |
$352.10
|
| Rate for Payer: Multiplan Commercial |
$306.18
|
| Rate for Payer: Preferred Network Access Commercial |
$352.10
|
| Rate for Payer: Quartz Beloit One Network |
$187.53
|
| Rate for Payer: Quartz Commercial |
$229.63
|
| Rate for Payer: WEA Trust Commercial |
$210.50
|
| Rate for Payer: WPS Commercial |
$283.47
|
|
|
STRUT HEXAPOD LONG 183MM - 295MM HOFFMANN LIMB 4935-0-040
|
Facility
|
OP
|
$10,592.00
|
|
| Hospital Charge Code |
6206986
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3,084.39 |
| Max. Negotiated Rate |
$10,134.43 |
| Rate for Payer: Aetna Commercial |
$9,914.11
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,473.48
|
| Rate for Payer: Aetna Managed Medicare |
$3,084.39
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$7,160.19
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5,507.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5,287.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,838.31
|
| Rate for Payer: Cash Price |
$3,177.60
|
| Rate for Payer: Cigna Commercial |
$10,134.43
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,164.54
|
| Rate for Payer: Health EOS Commercial |
$9,803.96
|
| Rate for Payer: HFN Commercial |
$10,134.43
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$8,261.76
|
| Rate for Payer: Multiplan Commercial |
$8,812.54
|
| Rate for Payer: NAPHCARE Commercial |
$6,609.41
|
| Rate for Payer: Preferred Network Access Commercial |
$10,134.43
|
| Rate for Payer: Quartz Beloit One Network |
$5,397.68
|
| Rate for Payer: Quartz Commercial |
$7,160.19
|
| Rate for Payer: Quartz Medicare Advantage |
$6,609.41
|
| Rate for Payer: The Alliance Commercial |
$5,507.84
|
| Rate for Payer: WEA Trust Commercial |
$6,058.62
|
| Rate for Payer: WPS Commercial |
$8,159.02
|
|
|
STRUT HEXAPOD LONG 183MM - 295MM HOFFMANN LIMB 4935-0-040
|
Facility
|
IP
|
$10,592.00
|
|
| Hospital Charge Code |
6206986
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5,397.68 |
| Max. Negotiated Rate |
$10,134.43 |
| Rate for Payer: Aetna Commercial |
$9,914.11
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,473.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,838.31
|
| Rate for Payer: Cash Price |
$3,177.60
|
| Rate for Payer: Cigna Commercial |
$10,134.43
|
| Rate for Payer: Health EOS Commercial |
$9,803.96
|
| Rate for Payer: HFN Commercial |
$10,134.43
|
| Rate for Payer: Multiplan Commercial |
$8,812.54
|
| Rate for Payer: Preferred Network Access Commercial |
$10,134.43
|
| Rate for Payer: Quartz Beloit One Network |
$5,397.68
|
| Rate for Payer: Quartz Commercial |
$6,609.41
|
| Rate for Payer: WEA Trust Commercial |
$6,058.62
|
| Rate for Payer: WPS Commercial |
$8,159.02
|
|
|
STRUT HEXAPOD MEDIUM 131MM - 191MM HOFFMANN LIMB 4935-0-030
|
Facility
|
IP
|
$10,592.00
|
|
| Hospital Charge Code |
6206985
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5,397.68 |
| Max. Negotiated Rate |
$10,134.43 |
| Rate for Payer: Aetna Commercial |
$9,914.11
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,473.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,838.31
|
| Rate for Payer: Cash Price |
$3,177.60
|
| Rate for Payer: Cigna Commercial |
$10,134.43
|
| Rate for Payer: Health EOS Commercial |
$9,803.96
|
| Rate for Payer: HFN Commercial |
$10,134.43
|
| Rate for Payer: Multiplan Commercial |
$8,812.54
|
| Rate for Payer: Preferred Network Access Commercial |
$10,134.43
|
| Rate for Payer: Quartz Beloit One Network |
$5,397.68
|
| Rate for Payer: Quartz Commercial |
$6,609.41
|
| Rate for Payer: WEA Trust Commercial |
$6,058.62
|
| Rate for Payer: WPS Commercial |
$8,159.02
|
|
|
STRUT HEXAPOD MEDIUM 131MM - 191MM HOFFMANN LIMB 4935-0-030
|
Facility
|
OP
|
$10,592.00
|
|
| Hospital Charge Code |
6206985
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3,084.39 |
| Max. Negotiated Rate |
$10,134.43 |
| Rate for Payer: Aetna Commercial |
$9,914.11
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,473.48
|
| Rate for Payer: Aetna Managed Medicare |
$3,084.39
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$7,160.19
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5,507.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5,287.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,838.31
|
| Rate for Payer: Cash Price |
$3,177.60
|
| Rate for Payer: Cigna Commercial |
$10,134.43
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,164.54
|
| Rate for Payer: Health EOS Commercial |
$9,803.96
|
| Rate for Payer: HFN Commercial |
$10,134.43
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$8,261.76
|
| Rate for Payer: Multiplan Commercial |
$8,812.54
|
| Rate for Payer: NAPHCARE Commercial |
$6,609.41
|
| Rate for Payer: Preferred Network Access Commercial |
$10,134.43
|
| Rate for Payer: Quartz Beloit One Network |
$5,397.68
|
| Rate for Payer: Quartz Commercial |
$7,160.19
|
| Rate for Payer: Quartz Medicare Advantage |
$6,609.41
|
| Rate for Payer: The Alliance Commercial |
$5,507.84
|
| Rate for Payer: WEA Trust Commercial |
$6,058.62
|
| Rate for Payer: WPS Commercial |
$8,159.02
|
|
|
STRUT STATIC LONG 60MM HOFFMANN LIMB 4933-1-560
|
Facility
|
IP
|
$1,196.00
|
|
| Hospital Charge Code |
5599707
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$609.48 |
| Max. Negotiated Rate |
$1,144.33 |
| Rate for Payer: Aetna Commercial |
$1,119.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,069.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$659.24
|
| Rate for Payer: Cash Price |
$358.80
|
| Rate for Payer: Cigna Commercial |
$1,144.33
|
| Rate for Payer: Health EOS Commercial |
$1,107.02
|
| Rate for Payer: HFN Commercial |
$1,144.33
|
| Rate for Payer: Multiplan Commercial |
$995.07
|
| Rate for Payer: Preferred Network Access Commercial |
$1,144.33
|
| Rate for Payer: Quartz Beloit One Network |
$609.48
|
| Rate for Payer: Quartz Commercial |
$746.30
|
| Rate for Payer: WEA Trust Commercial |
$684.11
|
| Rate for Payer: WPS Commercial |
$921.28
|
|
