|
TIBIA PERSONA 5 DEG STEMMED RT SZ G 42-5320-079-02
|
Facility
|
IP
|
$7,632.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
3116527
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,889.27 |
| Max. Negotiated Rate |
$7,302.30 |
| Rate for Payer: Aetna Commercial |
$7,143.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,826.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,206.76
|
| Rate for Payer: Cash Price |
$2,289.60
|
| Rate for Payer: Cigna Commercial |
$7,302.30
|
| Rate for Payer: Health EOS Commercial |
$7,064.18
|
| Rate for Payer: HFN Commercial |
$7,302.30
|
| Rate for Payer: Multiplan Commercial |
$6,349.82
|
| Rate for Payer: Preferred Network Access Commercial |
$7,302.30
|
| Rate for Payer: Quartz Beloit One Network |
$3,889.27
|
| Rate for Payer: Quartz Commercial |
$4,762.37
|
| Rate for Payer: WEA Trust Commercial |
$4,365.50
|
| Rate for Payer: WPS Commercial |
$5,878.93
|
|
|
TIBIA PERSONA 5 DEG STEMMED RT SZ H 42-5320-083-02
|
Facility
|
OP
|
$7,632.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
3739521
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,222.44 |
| Max. Negotiated Rate |
$7,302.30 |
| Rate for Payer: Aetna Commercial |
$7,143.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,826.06
|
| Rate for Payer: Aetna Managed Medicare |
$2,222.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,159.23
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,968.64
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,809.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,206.76
|
| Rate for Payer: Cash Price |
$2,289.60
|
| Rate for Payer: Cigna Commercial |
$7,302.30
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,441.82
|
| Rate for Payer: Health EOS Commercial |
$7,064.18
|
| Rate for Payer: HFN Commercial |
$7,302.30
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,952.96
|
| Rate for Payer: Multiplan Commercial |
$6,349.82
|
| Rate for Payer: NAPHCARE Commercial |
$4,762.37
|
| Rate for Payer: Preferred Network Access Commercial |
$7,302.30
|
| Rate for Payer: Quartz Beloit One Network |
$3,889.27
|
| Rate for Payer: Quartz Commercial |
$5,159.23
|
| Rate for Payer: Quartz Medicare Advantage |
$4,762.37
|
| Rate for Payer: The Alliance Commercial |
$3,968.64
|
| Rate for Payer: WEA Trust Commercial |
$4,365.50
|
| Rate for Payer: WPS Commercial |
$5,878.93
|
|
|
TIBIA PERSONA 5 DEG STEMMED RT SZ H 42-5320-083-02
|
Facility
|
IP
|
$7,632.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
3739521
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,889.27 |
| Max. Negotiated Rate |
$7,302.30 |
| Rate for Payer: Aetna Commercial |
$7,143.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,826.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,206.76
|
| Rate for Payer: Cash Price |
$2,289.60
|
| Rate for Payer: Cigna Commercial |
$7,302.30
|
| Rate for Payer: Health EOS Commercial |
$7,064.18
|
| Rate for Payer: HFN Commercial |
$7,302.30
|
| Rate for Payer: Multiplan Commercial |
$6,349.82
|
| Rate for Payer: Preferred Network Access Commercial |
$7,302.30
|
| Rate for Payer: Quartz Beloit One Network |
$3,889.27
|
| Rate for Payer: Quartz Commercial |
$4,762.37
|
| Rate for Payer: WEA Trust Commercial |
$4,365.50
|
| Rate for Payer: WPS Commercial |
$5,878.93
|
|
|
TIBIA TRAY ZUK HIGH FLEX SZ 2 RT MED/LT LAT 5842-02-02
|
Facility
|
IP
|
$6,892.00
|
|
| Hospital Charge Code |
3241465
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,512.16 |
| Max. Negotiated Rate |
$6,594.27 |
| Rate for Payer: Aetna Commercial |
$6,450.91
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,164.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,798.87
|
| Rate for Payer: Cash Price |
$2,067.60
|
| Rate for Payer: Cigna Commercial |
$6,594.27
|
| Rate for Payer: Health EOS Commercial |
$6,379.24
|
| Rate for Payer: HFN Commercial |
$6,594.27
|
| Rate for Payer: Multiplan Commercial |
$5,734.14
|
| Rate for Payer: Preferred Network Access Commercial |
$6,594.27
|
| Rate for Payer: Quartz Beloit One Network |
$3,512.16
|
| Rate for Payer: Quartz Commercial |
$4,300.61
|
| Rate for Payer: WEA Trust Commercial |
$3,942.22
|
| Rate for Payer: WPS Commercial |
$5,308.91
|
|
|
TIBIA TRAY ZUK HIGH FLEX SZ 2 RT MED/LT LAT 5842-02-02
|
Facility
|
OP
|
$6,892.00
|
|
| Hospital Charge Code |
3241465
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,006.95 |
| Max. Negotiated Rate |
$6,594.27 |
| Rate for Payer: Aetna Commercial |
$6,450.91
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,164.20
|
| Rate for Payer: Aetna Managed Medicare |
$2,006.95
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,658.99
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,583.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,440.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,798.87
|
| Rate for Payer: Cash Price |
$2,067.60
|
| Rate for Payer: Cigna Commercial |
$6,594.27
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,011.14
|
| Rate for Payer: Health EOS Commercial |
$6,379.24
|
| Rate for Payer: HFN Commercial |
$6,594.27
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,375.76
|
| Rate for Payer: Multiplan Commercial |
$5,734.14
|
| Rate for Payer: NAPHCARE Commercial |
$4,300.61
|
| Rate for Payer: Preferred Network Access Commercial |
$6,594.27
|
| Rate for Payer: Quartz Beloit One Network |
$3,512.16
|
| Rate for Payer: Quartz Commercial |
$4,658.99
|
| Rate for Payer: Quartz Medicare Advantage |
$4,300.61
|
| Rate for Payer: The Alliance Commercial |
$3,583.84
|
| Rate for Payer: WEA Trust Commercial |
$3,942.22
|
| Rate for Payer: WPS Commercial |
$5,308.91
|
|
|
Tick and Arthropods ID
|
Facility
|
OP
|
$81.00
|
|
|
Service Code
|
CPT 87168
|
| Hospital Charge Code |
4716606
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.44 |
| Max. Negotiated Rate |
$77.50 |
| Rate for Payer: Aetna Commercial |
$75.82
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$72.45
|
| Rate for Payer: Aetna Managed Medicare |
$4.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$16.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$7.77
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7.37
|
| Rate for Payer: Anthem Medicare Advantage |
$4.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$44.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$4.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$4.44
|
| Rate for Payer: Cash Price |
$24.30
|
| Rate for Payer: Cash Price |
$24.30
|
| Rate for Payer: Cigna Commercial |
$77.50
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$4.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$47.14
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$4.44
|
| Rate for Payer: Health EOS Commercial |
$74.97
|
| Rate for Payer: HFN Commercial |
$77.50
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$16.52
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$4.44
|
| Rate for Payer: Independent Care Health Plan Medicare |
$4.44
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$4.44
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$4.44
|
| Rate for Payer: Multiplan Commercial |
$67.39
|
| Rate for Payer: NAPHCARE Commercial |
$6.66
|
| Rate for Payer: Preferred Network Access Commercial |
$77.50
|
| Rate for Payer: Quartz Beloit One Network |
$41.28
|
| Rate for Payer: Quartz Commercial |
$54.76
|
| Rate for Payer: Quartz Medicare Advantage |
$4.44
|
| Rate for Payer: The Alliance Commercial |
$17.76
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4.44
|
| Rate for Payer: United Healthcare PPO |
$63.18
|
| Rate for Payer: WEA Trust Commercial |
$46.33
|
| Rate for Payer: Wellcare Medicare |
$4.44
|
| Rate for Payer: WPS Commercial |
$62.39
|
|
|
Tick and Arthropods ID
|
Professional
|
Both
|
$81.00
|
|
|
Service Code
|
CPT 87168
|
| Hospital Charge Code |
4716606
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.44 |
| Max. Negotiated Rate |
$80.03 |
| Rate for Payer: Aetna Commercial |
$80.03
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$72.45
|
| Rate for Payer: Aetna Managed Medicare |
$4.44
|
| Rate for Payer: Anthem Medicare Advantage |
$4.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$4.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$4.44
|
| Rate for Payer: Cash Price |
$24.30
|
| Rate for Payer: Cash Price |
$24.30
|
| Rate for Payer: Cigna Commercial |
$80.03
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$42.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4.44
|
| Rate for Payer: Health EOS Commercial |
$76.66
|
| Rate for Payer: HFN Commercial |
$80.03
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$15.67
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$15.67
|
| Rate for Payer: Independent Care Health Plan Medicare |
$4.44
|
| Rate for Payer: Multiplan Commercial |
$67.39
|
| Rate for Payer: NAPHCARE Commercial |
$6.66
|
| Rate for Payer: Preferred Network Access Commercial |
$80.03
|
| Rate for Payer: Quartz Beloit One Network |
$37.07
|
| Rate for Payer: Quartz Commercial |
$48.02
|
| Rate for Payer: Quartz Medicare Advantage |
$4.44
|
| Rate for Payer: The Alliance Commercial |
$17.54
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4.44
|
| Rate for Payer: WEA Trust Commercial |
$46.33
|
| Rate for Payer: WPS Commercial |
$19.54
|
|
|
Tick and Arthropods ID
|
Facility
|
IP
|
$81.00
|
|
|
Service Code
|
CPT 87168
|
| Hospital Charge Code |
4716606
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$41.28 |
| Max. Negotiated Rate |
$77.50 |
| Rate for Payer: Aetna Commercial |
$75.82
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$72.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$44.65
|
| Rate for Payer: Cash Price |
$24.30
|
| Rate for Payer: Cigna Commercial |
$77.50
|
| Rate for Payer: Health EOS Commercial |
$74.97
|
| Rate for Payer: HFN Commercial |
$77.50
|
| Rate for Payer: Multiplan Commercial |
$67.39
|
| Rate for Payer: Preferred Network Access Commercial |
$77.50
|
| Rate for Payer: Quartz Beloit One Network |
$41.28
|
| Rate for Payer: Quartz Commercial |
$50.54
|
| Rate for Payer: WEA Trust Commercial |
$46.33
|
| Rate for Payer: WPS Commercial |
$62.39
|
|
|
Tick-Borne Disease, Antibody Panel
|
Facility
|
OP
|
$414.00
|
|
|
Service Code
|
CPT 86618
|
| Hospital Charge Code |
5675623
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.71 |
| Max. Negotiated Rate |
$396.12 |
| Rate for Payer: Aetna Commercial |
$387.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$370.28
|
| Rate for Payer: Aetna Managed Medicare |
$17.71
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$66.42
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$30.99
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$29.40
|
| Rate for Payer: Anthem Medicare Advantage |
$17.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$228.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$17.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$17.71
|
| Rate for Payer: Cash Price |
$124.20
|
| Rate for Payer: Cash Price |
$124.20
|
| Rate for Payer: Cigna Commercial |
$396.12
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$17.71
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$240.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$17.71
|
| Rate for Payer: Health EOS Commercial |
$383.20
|
| Rate for Payer: HFN Commercial |
$396.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$65.89
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$17.71
|
| Rate for Payer: Independent Care Health Plan Medicare |
$17.71
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$17.71
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$17.71
|
| Rate for Payer: Multiplan Commercial |
$344.45
|
| Rate for Payer: NAPHCARE Commercial |
$26.57
|
| Rate for Payer: Preferred Network Access Commercial |
$396.12
|
| Rate for Payer: Quartz Beloit One Network |
$210.97
|
| Rate for Payer: Quartz Commercial |
$279.86
|
| Rate for Payer: Quartz Medicare Advantage |
$17.71
|
| Rate for Payer: The Alliance Commercial |
$70.84
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17.71
|
| Rate for Payer: United Healthcare PPO |
$322.92
|
| Rate for Payer: WEA Trust Commercial |
$236.81
|
| Rate for Payer: Wellcare Medicare |
$17.71
|
| Rate for Payer: WPS Commercial |
$318.90
|
|
|
Tick-Borne Disease, Antibody Panel
|
Facility
|
IP
|
$414.00
|
|
|
Service Code
|
CPT 86618
|
| Hospital Charge Code |
5675623
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$210.97 |
| Max. Negotiated Rate |
$396.12 |
| Rate for Payer: Aetna Commercial |
$387.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$370.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$228.20
|
| Rate for Payer: Cash Price |
$124.20
|
| Rate for Payer: Cigna Commercial |
$396.12
|
| Rate for Payer: Health EOS Commercial |
$383.20
|
| Rate for Payer: HFN Commercial |
$396.12
|
| Rate for Payer: Multiplan Commercial |
$344.45
|
| Rate for Payer: Preferred Network Access Commercial |
$396.12
|
| Rate for Payer: Quartz Beloit One Network |
$210.97
|
| Rate for Payer: Quartz Commercial |
$258.34
|
| Rate for Payer: WEA Trust Commercial |
$236.81
|
| Rate for Payer: WPS Commercial |
$318.90
|
|
|
Tick-Borne Disease, Antibody Panel
|
Professional
|
Both
|
$414.00
|
|
|
Service Code
|
CPT 86618
|
| Hospital Charge Code |
5675623
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.71 |
| Max. Negotiated Rate |
$409.03 |
| Rate for Payer: Aetna Commercial |
$409.03
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$370.28
|
| Rate for Payer: Aetna Managed Medicare |
$17.71
|
| Rate for Payer: Anthem Medicare Advantage |
$17.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$17.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$17.71
|
| Rate for Payer: Cash Price |
$124.20
|
| Rate for Payer: Cash Price |
$124.20
|
| Rate for Payer: Cigna Commercial |
$409.03
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$215.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$17.71
|
| Rate for Payer: Health EOS Commercial |
$391.81
|
| Rate for Payer: HFN Commercial |
$409.03
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$62.52
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$62.52
|
| Rate for Payer: Independent Care Health Plan Medicare |
$17.71
|
| Rate for Payer: Multiplan Commercial |
$344.45
|
| Rate for Payer: NAPHCARE Commercial |
$26.57
|
| Rate for Payer: Preferred Network Access Commercial |
$409.03
|
| Rate for Payer: Quartz Beloit One Network |
$189.45
|
| Rate for Payer: Quartz Commercial |
$245.42
|
| Rate for Payer: Quartz Medicare Advantage |
$17.71
|
| Rate for Payer: The Alliance Commercial |
$69.96
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17.71
|
| Rate for Payer: WEA Trust Commercial |
$236.81
|
| Rate for Payer: WPS Commercial |
$77.93
|
|
|
Tick-Borne DNA Panel, PCR, Blood to Mayo
|
Facility
|
OP
|
$405.00
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
3591523
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$36.49 |
| Max. Negotiated Rate |
$387.50 |
| Rate for Payer: Aetna Commercial |
$379.08
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$362.23
|
| Rate for Payer: Aetna Managed Medicare |
$36.49
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$136.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$63.86
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$60.58
|
| Rate for Payer: Anthem Medicare Advantage |
$36.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$223.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$36.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$36.49
|
| Rate for Payer: Cash Price |
$121.50
|
| Rate for Payer: Cash Price |
$121.50
|
| Rate for Payer: Cigna Commercial |
$387.50
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$36.49
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$235.71
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$36.49
|
| Rate for Payer: Health EOS Commercial |
$374.87
|
| Rate for Payer: HFN Commercial |
$387.50
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$135.76
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$36.49
|
| Rate for Payer: Independent Care Health Plan Medicare |
$36.49
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$36.49
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$36.49
|
| Rate for Payer: Multiplan Commercial |
$336.96
|
| Rate for Payer: NAPHCARE Commercial |
$54.74
|
| Rate for Payer: Preferred Network Access Commercial |
$387.50
|
| Rate for Payer: Quartz Beloit One Network |
$206.39
|
| Rate for Payer: Quartz Commercial |
$273.78
|
| Rate for Payer: Quartz Medicare Advantage |
$36.49
|
| Rate for Payer: The Alliance Commercial |
$145.97
|
| Rate for Payer: United Healthcare Medicare Advantage |
$36.49
|
| Rate for Payer: United Healthcare PPO |
$315.90
|
| Rate for Payer: WEA Trust Commercial |
$231.66
|
| Rate for Payer: Wellcare Medicare |
$36.49
|
| Rate for Payer: WPS Commercial |
$311.97
|
|
|
Tick-Borne DNA Panel, PCR, Blood to Mayo
|
Facility
|
IP
|
$405.00
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
3591523
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$206.39 |
| Max. Negotiated Rate |
$387.50 |
| Rate for Payer: Aetna Commercial |
$379.08
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$362.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$223.24
|
| Rate for Payer: Cash Price |
$121.50
|
| Rate for Payer: Cigna Commercial |
$387.50
|
| Rate for Payer: Health EOS Commercial |
$374.87
|
| Rate for Payer: HFN Commercial |
$387.50
|
| Rate for Payer: Multiplan Commercial |
$336.96
|
| Rate for Payer: Preferred Network Access Commercial |
$387.50
|
| Rate for Payer: Quartz Beloit One Network |
$206.39
|
| Rate for Payer: Quartz Commercial |
$252.72
|
| Rate for Payer: WEA Trust Commercial |
$231.66
|
| Rate for Payer: WPS Commercial |
$311.97
|
|
|
Tick-Borne DNA Panel, PCR, Blood to Mayo
|
Professional
|
Both
|
$405.00
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
3591523
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$36.49 |
| Max. Negotiated Rate |
$400.14 |
| Rate for Payer: Aetna Commercial |
$400.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$362.23
|
| Rate for Payer: Aetna Managed Medicare |
$36.49
|
| Rate for Payer: Anthem Medicare Advantage |
$36.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$36.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$36.49
|
| Rate for Payer: Cash Price |
$121.50
|
| Rate for Payer: Cash Price |
$121.50
|
| Rate for Payer: Cigna Commercial |
$400.14
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$210.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$36.49
|
| Rate for Payer: Health EOS Commercial |
$383.29
|
| Rate for Payer: HFN Commercial |
$400.14
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$128.82
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$128.82
|
| Rate for Payer: Independent Care Health Plan Medicare |
$36.49
|
| Rate for Payer: Multiplan Commercial |
$336.96
|
| Rate for Payer: NAPHCARE Commercial |
$54.74
|
| Rate for Payer: Preferred Network Access Commercial |
$400.14
|
| Rate for Payer: Quartz Beloit One Network |
$185.33
|
| Rate for Payer: Quartz Commercial |
$240.08
|
| Rate for Payer: Quartz Medicare Advantage |
$36.49
|
| Rate for Payer: The Alliance Commercial |
$144.15
|
| Rate for Payer: United Healthcare Medicare Advantage |
$36.49
|
| Rate for Payer: WEA Trust Commercial |
$231.66
|
| Rate for Payer: WPS Commercial |
$160.57
|
|
|
Tick ID w/ Reflex Lyme Disease DNA, Real Time PCR, Tick
|
Facility
|
OP
|
$90.00
|
|
|
Service Code
|
CPT 87168
|
| Hospital Charge Code |
3398170
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.44 |
| Max. Negotiated Rate |
$86.11 |
| Rate for Payer: Aetna Commercial |
$84.24
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$80.50
|
| Rate for Payer: Aetna Managed Medicare |
$4.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$16.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$7.77
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7.37
|
| Rate for Payer: Anthem Medicare Advantage |
$4.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$49.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$4.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$4.44
|
| Rate for Payer: Cash Price |
$27.00
|
| Rate for Payer: Cash Price |
$27.00
|
| Rate for Payer: Cigna Commercial |
$86.11
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$4.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$52.38
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$4.44
|
| Rate for Payer: Health EOS Commercial |
$83.30
|
| Rate for Payer: HFN Commercial |
$86.11
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$16.52
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$4.44
|
| Rate for Payer: Independent Care Health Plan Medicare |
$4.44
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$4.44
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$4.44
|
| Rate for Payer: Multiplan Commercial |
$74.88
|
| Rate for Payer: NAPHCARE Commercial |
$6.66
|
| Rate for Payer: Preferred Network Access Commercial |
$86.11
|
| Rate for Payer: Quartz Beloit One Network |
$45.86
|
| Rate for Payer: Quartz Commercial |
$60.84
|
| Rate for Payer: Quartz Medicare Advantage |
$4.44
|
| Rate for Payer: The Alliance Commercial |
$17.76
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4.44
|
| Rate for Payer: United Healthcare PPO |
$70.20
|
| Rate for Payer: WEA Trust Commercial |
$51.48
|
| Rate for Payer: Wellcare Medicare |
$4.44
|
| Rate for Payer: WPS Commercial |
$69.33
|
|
|
Tick ID w/ Reflex Lyme Disease DNA, Real Time PCR, Tick
|
Professional
|
Both
|
$90.00
|
|
|
Service Code
|
CPT 87168
|
| Hospital Charge Code |
3398170
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.44 |
| Max. Negotiated Rate |
$88.92 |
| Rate for Payer: Aetna Commercial |
$88.92
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$80.50
|
| Rate for Payer: Aetna Managed Medicare |
$4.44
|
| Rate for Payer: Anthem Medicare Advantage |
$4.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$4.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$4.44
|
| Rate for Payer: Cash Price |
$27.00
|
| Rate for Payer: Cash Price |
$27.00
|
| Rate for Payer: Cigna Commercial |
$88.92
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$46.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4.44
|
| Rate for Payer: Health EOS Commercial |
$85.18
|
| Rate for Payer: HFN Commercial |
$88.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$15.67
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$15.67
|
| Rate for Payer: Independent Care Health Plan Medicare |
$4.44
|
| Rate for Payer: Multiplan Commercial |
$74.88
|
| Rate for Payer: NAPHCARE Commercial |
$6.66
|
| Rate for Payer: Preferred Network Access Commercial |
$88.92
|
| Rate for Payer: Quartz Beloit One Network |
$41.18
|
| Rate for Payer: Quartz Commercial |
$53.35
|
| Rate for Payer: Quartz Medicare Advantage |
$4.44
|
| Rate for Payer: The Alliance Commercial |
$17.54
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4.44
|
| Rate for Payer: WEA Trust Commercial |
$51.48
|
| Rate for Payer: WPS Commercial |
$19.54
|
|
|
Tick ID w/ Reflex Lyme Disease DNA, Real Time PCR, Tick
|
Facility
|
IP
|
$90.00
|
|
|
Service Code
|
CPT 87168
|
| Hospital Charge Code |
3398170
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$45.86 |
| Max. Negotiated Rate |
$86.11 |
| Rate for Payer: Aetna Commercial |
$84.24
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$80.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$49.61
|
| Rate for Payer: Cash Price |
$27.00
|
| Rate for Payer: Cigna Commercial |
$86.11
|
| Rate for Payer: Health EOS Commercial |
$83.30
|
| Rate for Payer: HFN Commercial |
$86.11
|
| Rate for Payer: Multiplan Commercial |
$74.88
|
| Rate for Payer: Preferred Network Access Commercial |
$86.11
|
| Rate for Payer: Quartz Beloit One Network |
$45.86
|
| Rate for Payer: Quartz Commercial |
$56.16
|
| Rate for Payer: WEA Trust Commercial |
$51.48
|
| Rate for Payer: WPS Commercial |
$69.33
|
|
|
TIGERTAPE #2 BLUE
|
Facility
|
OP
|
$1,180.00
|
|
| Hospital Charge Code |
2967903
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$343.62 |
| Max. Negotiated Rate |
$1,129.02 |
| Rate for Payer: Aetna Commercial |
$1,104.48
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,055.39
|
| Rate for Payer: Aetna Managed Medicare |
$343.62
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$797.68
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$613.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$589.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$650.42
|
| Rate for Payer: Cash Price |
$354.00
|
| Rate for Payer: Cigna Commercial |
$1,129.02
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$686.76
|
| Rate for Payer: Health EOS Commercial |
$1,092.21
|
| Rate for Payer: HFN Commercial |
$1,129.02
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$920.40
|
| Rate for Payer: Multiplan Commercial |
$981.76
|
| Rate for Payer: NAPHCARE Commercial |
$736.32
|
| Rate for Payer: Preferred Network Access Commercial |
$1,129.02
|
| Rate for Payer: Quartz Beloit One Network |
$601.33
|
| Rate for Payer: Quartz Commercial |
$797.68
|
| Rate for Payer: Quartz Medicare Advantage |
$736.32
|
| Rate for Payer: The Alliance Commercial |
$613.60
|
| Rate for Payer: WEA Trust Commercial |
$674.96
|
| Rate for Payer: WPS Commercial |
$908.95
|
|
|
TIGERTAPE #2 BLUE
|
Facility
|
IP
|
$1,180.00
|
|
| Hospital Charge Code |
2967903
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$601.33 |
| Max. Negotiated Rate |
$1,129.02 |
| Rate for Payer: Aetna Commercial |
$1,104.48
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,055.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$650.42
|
| Rate for Payer: Cash Price |
$354.00
|
| Rate for Payer: Cigna Commercial |
$1,129.02
|
| Rate for Payer: Health EOS Commercial |
$1,092.21
|
| Rate for Payer: HFN Commercial |
$1,129.02
|
| Rate for Payer: Multiplan Commercial |
$981.76
|
| Rate for Payer: Preferred Network Access Commercial |
$1,129.02
|
| Rate for Payer: Quartz Beloit One Network |
$601.33
|
| Rate for Payer: Quartz Commercial |
$736.32
|
| Rate for Payer: WEA Trust Commercial |
$674.96
|
| Rate for Payer: WPS Commercial |
$908.95
|
|
|
TIGERTAPE CERCLAGE SUTURE (BLUE) AR-7267
|
Facility
|
OP
|
$4,603.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5804368
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,340.39 |
| Max. Negotiated Rate |
$4,404.15 |
| Rate for Payer: Aetna Commercial |
$4,308.41
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,116.92
|
| Rate for Payer: Aetna Managed Medicare |
$1,340.39
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,111.63
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,393.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,297.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,537.17
|
| Rate for Payer: Cash Price |
$1,380.90
|
| Rate for Payer: Cigna Commercial |
$4,404.15
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,678.95
|
| Rate for Payer: Health EOS Commercial |
$4,260.54
|
| Rate for Payer: HFN Commercial |
$4,404.15
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,590.34
|
| Rate for Payer: Multiplan Commercial |
$3,829.70
|
| Rate for Payer: NAPHCARE Commercial |
$2,872.27
|
| Rate for Payer: Preferred Network Access Commercial |
$4,404.15
|
| Rate for Payer: Quartz Beloit One Network |
$2,345.69
|
| Rate for Payer: Quartz Commercial |
$3,111.63
|
| Rate for Payer: Quartz Medicare Advantage |
$2,872.27
|
| Rate for Payer: The Alliance Commercial |
$2,393.56
|
| Rate for Payer: WEA Trust Commercial |
$2,632.92
|
| Rate for Payer: WPS Commercial |
$3,545.69
|
|
|
TIGERTAPE CERCLAGE SUTURE (BLUE) AR-7267
|
Facility
|
IP
|
$4,603.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5804368
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,345.69 |
| Max. Negotiated Rate |
$4,404.15 |
| Rate for Payer: Aetna Commercial |
$4,308.41
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,116.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,537.17
|
| Rate for Payer: Cash Price |
$1,380.90
|
| Rate for Payer: Cigna Commercial |
$4,404.15
|
| Rate for Payer: Health EOS Commercial |
$4,260.54
|
| Rate for Payer: HFN Commercial |
$4,404.15
|
| Rate for Payer: Multiplan Commercial |
$3,829.70
|
| Rate for Payer: Preferred Network Access Commercial |
$4,404.15
|
| Rate for Payer: Quartz Beloit One Network |
$2,345.69
|
| Rate for Payer: Quartz Commercial |
$2,872.27
|
| Rate for Payer: WEA Trust Commercial |
$2,632.92
|
| Rate for Payer: WPS Commercial |
$3,545.69
|
|
|
TIGERTAPE CERCLAGE SUTURE (WHITE/BLACK) AR-7267T
|
Facility
|
OP
|
$4,603.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5803670
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,340.39 |
| Max. Negotiated Rate |
$4,404.15 |
| Rate for Payer: Aetna Commercial |
$4,308.41
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,116.92
|
| Rate for Payer: Aetna Managed Medicare |
$1,340.39
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,111.63
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,393.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,297.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,537.17
|
| Rate for Payer: Cash Price |
$1,380.90
|
| Rate for Payer: Cigna Commercial |
$4,404.15
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,678.95
|
| Rate for Payer: Health EOS Commercial |
$4,260.54
|
| Rate for Payer: HFN Commercial |
$4,404.15
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,590.34
|
| Rate for Payer: Multiplan Commercial |
$3,829.70
|
| Rate for Payer: NAPHCARE Commercial |
$2,872.27
|
| Rate for Payer: Preferred Network Access Commercial |
$4,404.15
|
| Rate for Payer: Quartz Beloit One Network |
$2,345.69
|
| Rate for Payer: Quartz Commercial |
$3,111.63
|
| Rate for Payer: Quartz Medicare Advantage |
$2,872.27
|
| Rate for Payer: The Alliance Commercial |
$2,393.56
|
| Rate for Payer: WEA Trust Commercial |
$2,632.92
|
| Rate for Payer: WPS Commercial |
$3,545.69
|
|
|
TIGERTAPE CERCLAGE SUTURE (WHITE/BLACK) AR-7267T
|
Facility
|
IP
|
$4,603.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5803670
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,345.69 |
| Max. Negotiated Rate |
$4,404.15 |
| Rate for Payer: Aetna Commercial |
$4,308.41
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,116.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,537.17
|
| Rate for Payer: Cash Price |
$1,380.90
|
| Rate for Payer: Cigna Commercial |
$4,404.15
|
| Rate for Payer: Health EOS Commercial |
$4,260.54
|
| Rate for Payer: HFN Commercial |
$4,404.15
|
| Rate for Payer: Multiplan Commercial |
$3,829.70
|
| Rate for Payer: Preferred Network Access Commercial |
$4,404.15
|
| Rate for Payer: Quartz Beloit One Network |
$2,345.69
|
| Rate for Payer: Quartz Commercial |
$2,872.27
|
| Rate for Payer: WEA Trust Commercial |
$2,632.92
|
| Rate for Payer: WPS Commercial |
$3,545.69
|
|
|
TIGERTAPE CERCLAGE SUTURE W/O NEEDLE AR-7268
|
Facility
|
IP
|
$4,672.00
|
|
| Hospital Charge Code |
6166114
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,380.85 |
| Max. Negotiated Rate |
$4,470.17 |
| Rate for Payer: Aetna Commercial |
$4,372.99
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,178.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,575.21
|
| Rate for Payer: Cash Price |
$1,401.60
|
| Rate for Payer: Cigna Commercial |
$4,470.17
|
| Rate for Payer: Health EOS Commercial |
$4,324.40
|
| Rate for Payer: HFN Commercial |
$4,470.17
|
| Rate for Payer: Multiplan Commercial |
$3,887.10
|
| Rate for Payer: Preferred Network Access Commercial |
$4,470.17
|
| Rate for Payer: Quartz Beloit One Network |
$2,380.85
|
| Rate for Payer: Quartz Commercial |
$2,915.33
|
| Rate for Payer: WEA Trust Commercial |
$2,672.38
|
| Rate for Payer: WPS Commercial |
$3,598.84
|
|
|
TIGERTAPE CERCLAGE SUTURE W/O NEEDLE AR-7268
|
Facility
|
OP
|
$4,672.00
|
|
| Hospital Charge Code |
6166114
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,360.49 |
| Max. Negotiated Rate |
$4,470.17 |
| Rate for Payer: Aetna Commercial |
$4,372.99
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,178.64
|
| Rate for Payer: Aetna Managed Medicare |
$1,360.49
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,158.27
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,429.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,332.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,575.21
|
| Rate for Payer: Cash Price |
$1,401.60
|
| Rate for Payer: Cigna Commercial |
$4,470.17
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,719.10
|
| Rate for Payer: Health EOS Commercial |
$4,324.40
|
| Rate for Payer: HFN Commercial |
$4,470.17
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,644.16
|
| Rate for Payer: Multiplan Commercial |
$3,887.10
|
| Rate for Payer: NAPHCARE Commercial |
$2,915.33
|
| Rate for Payer: Preferred Network Access Commercial |
$4,470.17
|
| Rate for Payer: Quartz Beloit One Network |
$2,380.85
|
| Rate for Payer: Quartz Commercial |
$3,158.27
|
| Rate for Payer: Quartz Medicare Advantage |
$2,915.33
|
| Rate for Payer: The Alliance Commercial |
$2,429.44
|
| Rate for Payer: WEA Trust Commercial |
$2,672.38
|
| Rate for Payer: WPS Commercial |
$3,598.84
|
|
