|
BARTHOLIN CYST MARSUPIALIZATION
|
Facility
|
OP
|
$1,084.00
|
|
| Hospital Charge Code |
2959841
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$315.66 |
| Max. Negotiated Rate |
$1,037.17 |
| Rate for Payer: Aetna Commercial |
$1,014.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$969.53
|
| Rate for Payer: Aetna Managed Medicare |
$315.66
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$732.78
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$563.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$541.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$597.50
|
| Rate for Payer: Cash Price |
$325.20
|
| Rate for Payer: Cigna Commercial |
$1,037.17
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$630.89
|
| Rate for Payer: Health EOS Commercial |
$1,003.35
|
| Rate for Payer: HFN Commercial |
$1,037.17
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$845.52
|
| Rate for Payer: Multiplan Commercial |
$901.89
|
| Rate for Payer: NAPHCARE Commercial |
$676.42
|
| Rate for Payer: Preferred Network Access Commercial |
$1,037.17
|
| Rate for Payer: Quartz Beloit One Network |
$552.41
|
| Rate for Payer: Quartz Commercial |
$732.78
|
| Rate for Payer: Quartz Medicare Advantage |
$676.42
|
| Rate for Payer: The Alliance Commercial |
$563.68
|
| Rate for Payer: WEA Trust Commercial |
$620.05
|
| Rate for Payer: WPS Commercial |
$835.01
|
|
|
Bartonella DNA, Qualitative PCR
|
Facility
|
OP
|
$389.00
|
|
|
Service Code
|
CPT 87471
|
| Hospital Charge Code |
5162611
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$36.49 |
| Max. Negotiated Rate |
$372.20 |
| Rate for Payer: Aetna Commercial |
$364.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$347.92
|
| 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 |
$214.42
|
| 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 |
$116.70
|
| Rate for Payer: Cash Price |
$116.70
|
| Rate for Payer: Cigna Commercial |
$372.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$36.49
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$226.40
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$36.49
|
| Rate for Payer: Health EOS Commercial |
$360.06
|
| Rate for Payer: HFN Commercial |
$372.20
|
| 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 |
$323.65
|
| Rate for Payer: NAPHCARE Commercial |
$54.74
|
| Rate for Payer: Preferred Network Access Commercial |
$372.20
|
| Rate for Payer: Quartz Beloit One Network |
$198.23
|
| Rate for Payer: Quartz Commercial |
$262.96
|
| 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 |
$303.42
|
| Rate for Payer: WEA Trust Commercial |
$222.51
|
| Rate for Payer: Wellcare Medicare |
$36.49
|
| Rate for Payer: WPS Commercial |
$299.65
|
|
|
Bartonella DNA, Qualitative PCR
|
Professional
|
Both
|
$389.00
|
|
|
Service Code
|
CPT 87471
|
| Hospital Charge Code |
5162611
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$36.49 |
| Max. Negotiated Rate |
$384.33 |
| Rate for Payer: Aetna Commercial |
$384.33
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$347.92
|
| 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 |
$116.70
|
| Rate for Payer: Cash Price |
$116.70
|
| Rate for Payer: Cigna Commercial |
$384.33
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$202.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$36.49
|
| Rate for Payer: Health EOS Commercial |
$368.15
|
| Rate for Payer: HFN Commercial |
$384.33
|
| 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 |
$323.65
|
| Rate for Payer: NAPHCARE Commercial |
$54.74
|
| Rate for Payer: Preferred Network Access Commercial |
$384.33
|
| Rate for Payer: Quartz Beloit One Network |
$178.01
|
| Rate for Payer: Quartz Commercial |
$230.60
|
| 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 |
$222.51
|
| Rate for Payer: WPS Commercial |
$160.57
|
|
|
Bartonella DNA, Qualitative PCR
|
Facility
|
IP
|
$389.00
|
|
|
Service Code
|
CPT 87471
|
| Hospital Charge Code |
5162611
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$198.23 |
| Max. Negotiated Rate |
$372.20 |
| Rate for Payer: Aetna Commercial |
$364.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$347.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$214.42
|
| Rate for Payer: Cash Price |
$116.70
|
| Rate for Payer: Cigna Commercial |
$372.20
|
| Rate for Payer: Health EOS Commercial |
$360.06
|
| Rate for Payer: HFN Commercial |
$372.20
|
| Rate for Payer: Multiplan Commercial |
$323.65
|
| Rate for Payer: Preferred Network Access Commercial |
$372.20
|
| Rate for Payer: Quartz Beloit One Network |
$198.23
|
| Rate for Payer: Quartz Commercial |
$242.74
|
| Rate for Payer: WEA Trust Commercial |
$222.51
|
| Rate for Payer: WPS Commercial |
$299.65
|
|
|
Bartonella henselae Antibodies w/Rfx Titer
|
Facility
|
IP
|
$45.00
|
|
|
Service Code
|
CPT 86611
|
| Hospital Charge Code |
4634646
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$22.93 |
| Max. Negotiated Rate |
$43.06 |
| Rate for Payer: Aetna Commercial |
$42.12
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$40.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$24.80
|
| Rate for Payer: Cash Price |
$13.50
|
| Rate for Payer: Cigna Commercial |
$43.06
|
| Rate for Payer: Health EOS Commercial |
$41.65
|
| Rate for Payer: HFN Commercial |
$43.06
|
| Rate for Payer: Multiplan Commercial |
$37.44
|
| Rate for Payer: Preferred Network Access Commercial |
$43.06
|
| Rate for Payer: Quartz Beloit One Network |
$22.93
|
| Rate for Payer: Quartz Commercial |
$28.08
|
| Rate for Payer: WEA Trust Commercial |
$25.74
|
| Rate for Payer: WPS Commercial |
$34.66
|
|
|
Bartonella henselae Antibodies w/Rfx Titer
|
Facility
|
OP
|
$45.00
|
|
|
Service Code
|
CPT 86611
|
| Hospital Charge Code |
4634646
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.59 |
| Max. Negotiated Rate |
$43.06 |
| Rate for Payer: Aetna Commercial |
$42.12
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$40.25
|
| Rate for Payer: Aetna Managed Medicare |
$10.59
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$39.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$18.53
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$17.57
|
| Rate for Payer: Anthem Medicare Advantage |
$10.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$24.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$10.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$10.59
|
| Rate for Payer: Cash Price |
$13.50
|
| Rate for Payer: Cash Price |
$13.50
|
| Rate for Payer: Cigna Commercial |
$43.06
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$10.59
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$26.19
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$10.59
|
| Rate for Payer: Health EOS Commercial |
$41.65
|
| Rate for Payer: HFN Commercial |
$43.06
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$39.38
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$10.59
|
| Rate for Payer: Independent Care Health Plan Medicare |
$10.59
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$10.59
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$10.59
|
| Rate for Payer: Multiplan Commercial |
$37.44
|
| Rate for Payer: NAPHCARE Commercial |
$15.88
|
| Rate for Payer: Preferred Network Access Commercial |
$43.06
|
| Rate for Payer: Quartz Beloit One Network |
$22.93
|
| Rate for Payer: Quartz Commercial |
$30.42
|
| Rate for Payer: Quartz Medicare Advantage |
$10.59
|
| Rate for Payer: The Alliance Commercial |
$42.35
|
| Rate for Payer: United Healthcare Medicare Advantage |
$10.59
|
| Rate for Payer: United Healthcare PPO |
$35.10
|
| Rate for Payer: WEA Trust Commercial |
$25.74
|
| Rate for Payer: Wellcare Medicare |
$10.59
|
| Rate for Payer: WPS Commercial |
$34.66
|
|
|
Bartonella henselae Antibodies w/Rfx Titer
|
Professional
|
Both
|
$45.00
|
|
|
Service Code
|
CPT 86611
|
| Hospital Charge Code |
4634646
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.59 |
| Max. Negotiated Rate |
$46.58 |
| Rate for Payer: Aetna Commercial |
$44.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$40.25
|
| Rate for Payer: Aetna Managed Medicare |
$10.59
|
| Rate for Payer: Anthem Medicare Advantage |
$10.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$10.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$10.59
|
| Rate for Payer: Cash Price |
$13.50
|
| Rate for Payer: Cash Price |
$13.50
|
| Rate for Payer: Cigna Commercial |
$44.46
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$23.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$10.59
|
| Rate for Payer: Health EOS Commercial |
$42.59
|
| Rate for Payer: HFN Commercial |
$44.46
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$37.38
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$37.38
|
| Rate for Payer: Independent Care Health Plan Medicare |
$10.59
|
| Rate for Payer: Multiplan Commercial |
$37.44
|
| Rate for Payer: NAPHCARE Commercial |
$15.88
|
| Rate for Payer: Preferred Network Access Commercial |
$44.46
|
| Rate for Payer: Quartz Beloit One Network |
$20.59
|
| Rate for Payer: Quartz Commercial |
$26.68
|
| Rate for Payer: Quartz Medicare Advantage |
$10.59
|
| Rate for Payer: The Alliance Commercial |
$41.82
|
| Rate for Payer: United Healthcare Medicare Advantage |
$10.59
|
| Rate for Payer: WEA Trust Commercial |
$25.74
|
| Rate for Payer: WPS Commercial |
$46.58
|
|
|
Bartonella henselae Antibody IgM
|
Facility
|
IP
|
$30.00
|
|
|
Service Code
|
CPT 86611
|
| Hospital Charge Code |
4634684
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.29 |
| Max. Negotiated Rate |
$28.70 |
| Rate for Payer: Aetna Commercial |
$28.08
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$26.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$16.54
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Cigna Commercial |
$28.70
|
| Rate for Payer: Health EOS Commercial |
$27.77
|
| Rate for Payer: HFN Commercial |
$28.70
|
| Rate for Payer: Multiplan Commercial |
$24.96
|
| Rate for Payer: Preferred Network Access Commercial |
$28.70
|
| Rate for Payer: Quartz Beloit One Network |
$15.29
|
| Rate for Payer: Quartz Commercial |
$18.72
|
| Rate for Payer: WEA Trust Commercial |
$17.16
|
| Rate for Payer: WPS Commercial |
$23.11
|
|
|
Bartonella henselae Antibody IgM
|
Facility
|
OP
|
$30.00
|
|
|
Service Code
|
CPT 86611
|
| Hospital Charge Code |
4634684
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.59 |
| Max. Negotiated Rate |
$42.35 |
| Rate for Payer: Aetna Commercial |
$28.08
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$26.83
|
| Rate for Payer: Aetna Managed Medicare |
$10.59
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$39.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$18.53
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$17.57
|
| Rate for Payer: Anthem Medicare Advantage |
$10.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$16.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$10.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$10.59
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Cigna Commercial |
$28.70
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$10.59
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$17.46
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$10.59
|
| Rate for Payer: Health EOS Commercial |
$27.77
|
| Rate for Payer: HFN Commercial |
$28.70
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$39.38
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$10.59
|
| Rate for Payer: Independent Care Health Plan Medicare |
$10.59
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$10.59
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$10.59
|
| Rate for Payer: Multiplan Commercial |
$24.96
|
| Rate for Payer: NAPHCARE Commercial |
$15.88
|
| Rate for Payer: Preferred Network Access Commercial |
$28.70
|
| Rate for Payer: Quartz Beloit One Network |
$15.29
|
| Rate for Payer: Quartz Commercial |
$20.28
|
| Rate for Payer: Quartz Medicare Advantage |
$10.59
|
| Rate for Payer: The Alliance Commercial |
$42.35
|
| Rate for Payer: United Healthcare Medicare Advantage |
$10.59
|
| Rate for Payer: United Healthcare PPO |
$23.40
|
| Rate for Payer: WEA Trust Commercial |
$17.16
|
| Rate for Payer: Wellcare Medicare |
$10.59
|
| Rate for Payer: WPS Commercial |
$23.11
|
|
|
Bartonella henselae Antibody IgM
|
Professional
|
Both
|
$30.00
|
|
|
Service Code
|
CPT 86611
|
| Hospital Charge Code |
4634684
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.59 |
| Max. Negotiated Rate |
$46.58 |
| Rate for Payer: Aetna Commercial |
$29.64
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$26.83
|
| Rate for Payer: Aetna Managed Medicare |
$10.59
|
| Rate for Payer: Anthem Medicare Advantage |
$10.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$10.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$10.59
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Cigna Commercial |
$29.64
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$15.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$10.59
|
| Rate for Payer: Health EOS Commercial |
$28.39
|
| Rate for Payer: HFN Commercial |
$29.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$37.38
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$37.38
|
| Rate for Payer: Independent Care Health Plan Medicare |
$10.59
|
| Rate for Payer: Multiplan Commercial |
$24.96
|
| Rate for Payer: NAPHCARE Commercial |
$15.88
|
| Rate for Payer: Preferred Network Access Commercial |
$29.64
|
| Rate for Payer: Quartz Beloit One Network |
$13.73
|
| Rate for Payer: Quartz Commercial |
$17.78
|
| Rate for Payer: Quartz Medicare Advantage |
$10.59
|
| Rate for Payer: The Alliance Commercial |
$41.82
|
| Rate for Payer: United Healthcare Medicare Advantage |
$10.59
|
| Rate for Payer: WEA Trust Commercial |
$17.16
|
| Rate for Payer: WPS Commercial |
$46.58
|
|
|
Bartonella henselae IgM Screen
|
Facility
|
IP
|
$114.00
|
|
|
Service Code
|
CPT 86611
|
| Hospital Charge Code |
2942873
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$58.09 |
| Max. Negotiated Rate |
$109.08 |
| Rate for Payer: Aetna Commercial |
$106.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$101.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$62.84
|
| Rate for Payer: Cash Price |
$34.20
|
| Rate for Payer: Cigna Commercial |
$109.08
|
| Rate for Payer: Health EOS Commercial |
$105.52
|
| Rate for Payer: HFN Commercial |
$109.08
|
| Rate for Payer: Multiplan Commercial |
$94.85
|
| Rate for Payer: Preferred Network Access Commercial |
$109.08
|
| Rate for Payer: Quartz Beloit One Network |
$58.09
|
| Rate for Payer: Quartz Commercial |
$71.14
|
| Rate for Payer: WEA Trust Commercial |
$65.21
|
| Rate for Payer: WPS Commercial |
$87.81
|
|
|
Bartonella henselae IgM Screen
|
Professional
|
Both
|
$114.00
|
|
|
Service Code
|
CPT 86611
|
| Hospital Charge Code |
2942873
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.59 |
| Max. Negotiated Rate |
$112.63 |
| Rate for Payer: Aetna Commercial |
$112.63
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$101.96
|
| Rate for Payer: Aetna Managed Medicare |
$10.59
|
| Rate for Payer: Anthem Medicare Advantage |
$10.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$10.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$10.59
|
| Rate for Payer: Cash Price |
$34.20
|
| Rate for Payer: Cash Price |
$34.20
|
| Rate for Payer: Cigna Commercial |
$112.63
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$59.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$10.59
|
| Rate for Payer: Health EOS Commercial |
$107.89
|
| Rate for Payer: HFN Commercial |
$112.63
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$37.38
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$37.38
|
| Rate for Payer: Independent Care Health Plan Medicare |
$10.59
|
| Rate for Payer: Multiplan Commercial |
$94.85
|
| Rate for Payer: NAPHCARE Commercial |
$15.88
|
| Rate for Payer: Preferred Network Access Commercial |
$112.63
|
| Rate for Payer: Quartz Beloit One Network |
$52.17
|
| Rate for Payer: Quartz Commercial |
$67.58
|
| Rate for Payer: Quartz Medicare Advantage |
$10.59
|
| Rate for Payer: The Alliance Commercial |
$41.82
|
| Rate for Payer: United Healthcare Medicare Advantage |
$10.59
|
| Rate for Payer: WEA Trust Commercial |
$65.21
|
| Rate for Payer: WPS Commercial |
$46.58
|
|
|
Bartonella henselae IgM Screen
|
Facility
|
OP
|
$114.00
|
|
|
Service Code
|
CPT 86611
|
| Hospital Charge Code |
2942873
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.59 |
| Max. Negotiated Rate |
$109.08 |
| Rate for Payer: Aetna Commercial |
$106.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$101.96
|
| Rate for Payer: Aetna Managed Medicare |
$10.59
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$39.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$18.53
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$17.57
|
| Rate for Payer: Anthem Medicare Advantage |
$10.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$62.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$10.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$10.59
|
| Rate for Payer: Cash Price |
$34.20
|
| Rate for Payer: Cash Price |
$34.20
|
| Rate for Payer: Cigna Commercial |
$109.08
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$10.59
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$66.35
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$10.59
|
| Rate for Payer: Health EOS Commercial |
$105.52
|
| Rate for Payer: HFN Commercial |
$109.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$39.38
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$10.59
|
| Rate for Payer: Independent Care Health Plan Medicare |
$10.59
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$10.59
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$10.59
|
| Rate for Payer: Multiplan Commercial |
$94.85
|
| Rate for Payer: NAPHCARE Commercial |
$15.88
|
| Rate for Payer: Preferred Network Access Commercial |
$109.08
|
| Rate for Payer: Quartz Beloit One Network |
$58.09
|
| Rate for Payer: Quartz Commercial |
$77.06
|
| Rate for Payer: Quartz Medicare Advantage |
$10.59
|
| Rate for Payer: The Alliance Commercial |
$42.35
|
| Rate for Payer: United Healthcare Medicare Advantage |
$10.59
|
| Rate for Payer: United Healthcare PPO |
$88.92
|
| Rate for Payer: WEA Trust Commercial |
$65.21
|
| Rate for Payer: Wellcare Medicare |
$10.59
|
| Rate for Payer: WPS Commercial |
$87.81
|
|
|
Bartonella quintana IgG Screen
|
Professional
|
Both
|
$114.00
|
|
|
Service Code
|
CPT 86611
|
| Hospital Charge Code |
2942872
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.59 |
| Max. Negotiated Rate |
$112.63 |
| Rate for Payer: Aetna Commercial |
$112.63
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$101.96
|
| Rate for Payer: Aetna Managed Medicare |
$10.59
|
| Rate for Payer: Anthem Medicare Advantage |
$10.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$10.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$10.59
|
| Rate for Payer: Cash Price |
$34.20
|
| Rate for Payer: Cash Price |
$34.20
|
| Rate for Payer: Cigna Commercial |
$112.63
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$59.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$10.59
|
| Rate for Payer: Health EOS Commercial |
$107.89
|
| Rate for Payer: HFN Commercial |
$112.63
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$37.38
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$37.38
|
| Rate for Payer: Independent Care Health Plan Medicare |
$10.59
|
| Rate for Payer: Multiplan Commercial |
$94.85
|
| Rate for Payer: NAPHCARE Commercial |
$15.88
|
| Rate for Payer: Preferred Network Access Commercial |
$112.63
|
| Rate for Payer: Quartz Beloit One Network |
$52.17
|
| Rate for Payer: Quartz Commercial |
$67.58
|
| Rate for Payer: Quartz Medicare Advantage |
$10.59
|
| Rate for Payer: The Alliance Commercial |
$41.82
|
| Rate for Payer: United Healthcare Medicare Advantage |
$10.59
|
| Rate for Payer: WEA Trust Commercial |
$65.21
|
| Rate for Payer: WPS Commercial |
$46.58
|
|
|
Bartonella quintana IgG Screen
|
Facility
|
IP
|
$114.00
|
|
|
Service Code
|
CPT 86611
|
| Hospital Charge Code |
2942872
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$58.09 |
| Max. Negotiated Rate |
$109.08 |
| Rate for Payer: Aetna Commercial |
$106.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$101.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$62.84
|
| Rate for Payer: Cash Price |
$34.20
|
| Rate for Payer: Cigna Commercial |
$109.08
|
| Rate for Payer: Health EOS Commercial |
$105.52
|
| Rate for Payer: HFN Commercial |
$109.08
|
| Rate for Payer: Multiplan Commercial |
$94.85
|
| Rate for Payer: Preferred Network Access Commercial |
$109.08
|
| Rate for Payer: Quartz Beloit One Network |
$58.09
|
| Rate for Payer: Quartz Commercial |
$71.14
|
| Rate for Payer: WEA Trust Commercial |
$65.21
|
| Rate for Payer: WPS Commercial |
$87.81
|
|
|
Bartonella quintana IgG Screen
|
Facility
|
OP
|
$114.00
|
|
|
Service Code
|
CPT 86611
|
| Hospital Charge Code |
2942872
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.59 |
| Max. Negotiated Rate |
$109.08 |
| Rate for Payer: Aetna Commercial |
$106.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$101.96
|
| Rate for Payer: Aetna Managed Medicare |
$10.59
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$39.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$18.53
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$17.57
|
| Rate for Payer: Anthem Medicare Advantage |
$10.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$62.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$10.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$10.59
|
| Rate for Payer: Cash Price |
$34.20
|
| Rate for Payer: Cash Price |
$34.20
|
| Rate for Payer: Cigna Commercial |
$109.08
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$10.59
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$66.35
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$10.59
|
| Rate for Payer: Health EOS Commercial |
$105.52
|
| Rate for Payer: HFN Commercial |
$109.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$39.38
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$10.59
|
| Rate for Payer: Independent Care Health Plan Medicare |
$10.59
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$10.59
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$10.59
|
| Rate for Payer: Multiplan Commercial |
$94.85
|
| Rate for Payer: NAPHCARE Commercial |
$15.88
|
| Rate for Payer: Preferred Network Access Commercial |
$109.08
|
| Rate for Payer: Quartz Beloit One Network |
$58.09
|
| Rate for Payer: Quartz Commercial |
$77.06
|
| Rate for Payer: Quartz Medicare Advantage |
$10.59
|
| Rate for Payer: The Alliance Commercial |
$42.35
|
| Rate for Payer: United Healthcare Medicare Advantage |
$10.59
|
| Rate for Payer: United Healthcare PPO |
$88.92
|
| Rate for Payer: WEA Trust Commercial |
$65.21
|
| Rate for Payer: Wellcare Medicare |
$10.59
|
| Rate for Payer: WPS Commercial |
$87.81
|
|
|
Bartonella quintana IgM Screen
|
Facility
|
IP
|
$114.00
|
|
|
Service Code
|
CPT 86611
|
| Hospital Charge Code |
2942874
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$58.09 |
| Max. Negotiated Rate |
$109.08 |
| Rate for Payer: Aetna Commercial |
$106.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$101.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$62.84
|
| Rate for Payer: Cash Price |
$34.20
|
| Rate for Payer: Cigna Commercial |
$109.08
|
| Rate for Payer: Health EOS Commercial |
$105.52
|
| Rate for Payer: HFN Commercial |
$109.08
|
| Rate for Payer: Multiplan Commercial |
$94.85
|
| Rate for Payer: Preferred Network Access Commercial |
$109.08
|
| Rate for Payer: Quartz Beloit One Network |
$58.09
|
| Rate for Payer: Quartz Commercial |
$71.14
|
| Rate for Payer: WEA Trust Commercial |
$65.21
|
| Rate for Payer: WPS Commercial |
$87.81
|
|
|
Bartonella quintana IgM Screen
|
Professional
|
Both
|
$114.00
|
|
|
Service Code
|
CPT 86611
|
| Hospital Charge Code |
2942874
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.59 |
| Max. Negotiated Rate |
$112.63 |
| Rate for Payer: Aetna Commercial |
$112.63
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$101.96
|
| Rate for Payer: Aetna Managed Medicare |
$10.59
|
| Rate for Payer: Anthem Medicare Advantage |
$10.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$10.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$10.59
|
| Rate for Payer: Cash Price |
$34.20
|
| Rate for Payer: Cash Price |
$34.20
|
| Rate for Payer: Cigna Commercial |
$112.63
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$59.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$10.59
|
| Rate for Payer: Health EOS Commercial |
$107.89
|
| Rate for Payer: HFN Commercial |
$112.63
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$37.38
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$37.38
|
| Rate for Payer: Independent Care Health Plan Medicare |
$10.59
|
| Rate for Payer: Multiplan Commercial |
$94.85
|
| Rate for Payer: NAPHCARE Commercial |
$15.88
|
| Rate for Payer: Preferred Network Access Commercial |
$112.63
|
| Rate for Payer: Quartz Beloit One Network |
$52.17
|
| Rate for Payer: Quartz Commercial |
$67.58
|
| Rate for Payer: Quartz Medicare Advantage |
$10.59
|
| Rate for Payer: The Alliance Commercial |
$41.82
|
| Rate for Payer: United Healthcare Medicare Advantage |
$10.59
|
| Rate for Payer: WEA Trust Commercial |
$65.21
|
| Rate for Payer: WPS Commercial |
$46.58
|
|
|
Bartonella quintana IgM Screen
|
Facility
|
OP
|
$114.00
|
|
|
Service Code
|
CPT 86611
|
| Hospital Charge Code |
2942874
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.59 |
| Max. Negotiated Rate |
$109.08 |
| Rate for Payer: Aetna Commercial |
$106.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$101.96
|
| Rate for Payer: Aetna Managed Medicare |
$10.59
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$39.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$18.53
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$17.57
|
| Rate for Payer: Anthem Medicare Advantage |
$10.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$62.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$10.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$10.59
|
| Rate for Payer: Cash Price |
$34.20
|
| Rate for Payer: Cash Price |
$34.20
|
| Rate for Payer: Cigna Commercial |
$109.08
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$10.59
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$66.35
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$10.59
|
| Rate for Payer: Health EOS Commercial |
$105.52
|
| Rate for Payer: HFN Commercial |
$109.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$39.38
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$10.59
|
| Rate for Payer: Independent Care Health Plan Medicare |
$10.59
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$10.59
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$10.59
|
| Rate for Payer: Multiplan Commercial |
$94.85
|
| Rate for Payer: NAPHCARE Commercial |
$15.88
|
| Rate for Payer: Preferred Network Access Commercial |
$109.08
|
| Rate for Payer: Quartz Beloit One Network |
$58.09
|
| Rate for Payer: Quartz Commercial |
$77.06
|
| Rate for Payer: Quartz Medicare Advantage |
$10.59
|
| Rate for Payer: The Alliance Commercial |
$42.35
|
| Rate for Payer: United Healthcare Medicare Advantage |
$10.59
|
| Rate for Payer: United Healthcare PPO |
$88.92
|
| Rate for Payer: WEA Trust Commercial |
$65.21
|
| Rate for Payer: Wellcare Medicare |
$10.59
|
| Rate for Payer: WPS Commercial |
$87.81
|
|
|
Bartonella Species Antibodies IgG & IgM
|
Facility
|
IP
|
$170.00
|
|
|
Service Code
|
CPT 86611
|
| Hospital Charge Code |
977877
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$86.63 |
| Max. Negotiated Rate |
$162.66 |
| Rate for Payer: Aetna Commercial |
$159.12
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$152.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$93.70
|
| Rate for Payer: Cash Price |
$51.00
|
| Rate for Payer: Cigna Commercial |
$162.66
|
| Rate for Payer: Health EOS Commercial |
$157.35
|
| Rate for Payer: HFN Commercial |
$162.66
|
| Rate for Payer: Multiplan Commercial |
$141.44
|
| Rate for Payer: Preferred Network Access Commercial |
$162.66
|
| Rate for Payer: Quartz Beloit One Network |
$86.63
|
| Rate for Payer: Quartz Commercial |
$106.08
|
| Rate for Payer: WEA Trust Commercial |
$97.24
|
| Rate for Payer: WPS Commercial |
$130.95
|
|
|
Bartonella Species Antibodies IgG & IgM
|
Facility
|
OP
|
$170.00
|
|
|
Service Code
|
CPT 86611
|
| Hospital Charge Code |
977877
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.59 |
| Max. Negotiated Rate |
$162.66 |
| Rate for Payer: Aetna Commercial |
$159.12
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$152.05
|
| Rate for Payer: Aetna Managed Medicare |
$10.59
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$39.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$18.53
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$17.57
|
| Rate for Payer: Anthem Medicare Advantage |
$10.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$93.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$10.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$10.59
|
| Rate for Payer: Cash Price |
$51.00
|
| Rate for Payer: Cash Price |
$51.00
|
| Rate for Payer: Cigna Commercial |
$162.66
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$10.59
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$98.94
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$10.59
|
| Rate for Payer: Health EOS Commercial |
$157.35
|
| Rate for Payer: HFN Commercial |
$162.66
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$39.38
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$10.59
|
| Rate for Payer: Independent Care Health Plan Medicare |
$10.59
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$10.59
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$10.59
|
| Rate for Payer: Multiplan Commercial |
$141.44
|
| Rate for Payer: NAPHCARE Commercial |
$15.88
|
| Rate for Payer: Preferred Network Access Commercial |
$162.66
|
| Rate for Payer: Quartz Beloit One Network |
$86.63
|
| Rate for Payer: Quartz Commercial |
$114.92
|
| Rate for Payer: Quartz Medicare Advantage |
$10.59
|
| Rate for Payer: The Alliance Commercial |
$42.35
|
| Rate for Payer: United Healthcare Medicare Advantage |
$10.59
|
| Rate for Payer: United Healthcare PPO |
$132.60
|
| Rate for Payer: WEA Trust Commercial |
$97.24
|
| Rate for Payer: Wellcare Medicare |
$10.59
|
| Rate for Payer: WPS Commercial |
$130.95
|
|
|
Bartonella Species Antibodies IgG & IgM
|
Professional
|
Both
|
$170.00
|
|
|
Service Code
|
CPT 86611
|
| Hospital Charge Code |
977877
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.59 |
| Max. Negotiated Rate |
$167.96 |
| Rate for Payer: Aetna Commercial |
$167.96
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$152.05
|
| Rate for Payer: Aetna Managed Medicare |
$10.59
|
| Rate for Payer: Anthem Medicare Advantage |
$10.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$10.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$10.59
|
| Rate for Payer: Cash Price |
$51.00
|
| Rate for Payer: Cash Price |
$51.00
|
| Rate for Payer: Cigna Commercial |
$167.96
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$88.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$10.59
|
| Rate for Payer: Health EOS Commercial |
$160.89
|
| Rate for Payer: HFN Commercial |
$167.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$37.38
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$37.38
|
| Rate for Payer: Independent Care Health Plan Medicare |
$10.59
|
| Rate for Payer: Multiplan Commercial |
$141.44
|
| Rate for Payer: NAPHCARE Commercial |
$15.88
|
| Rate for Payer: Preferred Network Access Commercial |
$167.96
|
| Rate for Payer: Quartz Beloit One Network |
$77.79
|
| Rate for Payer: Quartz Commercial |
$100.78
|
| Rate for Payer: Quartz Medicare Advantage |
$10.59
|
| Rate for Payer: The Alliance Commercial |
$41.82
|
| Rate for Payer: United Healthcare Medicare Advantage |
$10.59
|
| Rate for Payer: WEA Trust Commercial |
$97.24
|
| Rate for Payer: WPS Commercial |
$46.58
|
|
|
BASEPLATE 24MM 20 DEG FULL AUGMENT +2 LATERAL AR-9580-2420-2
|
Facility
|
IP
|
$16,365.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5685843
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,339.60 |
| Max. Negotiated Rate |
$15,658.03 |
| Rate for Payer: Aetna Commercial |
$15,317.64
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$14,636.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,020.39
|
| Rate for Payer: Cash Price |
$4,909.50
|
| Rate for Payer: Cigna Commercial |
$15,658.03
|
| Rate for Payer: Health EOS Commercial |
$15,147.44
|
| Rate for Payer: HFN Commercial |
$15,658.03
|
| Rate for Payer: Multiplan Commercial |
$13,615.68
|
| Rate for Payer: Preferred Network Access Commercial |
$15,658.03
|
| Rate for Payer: Quartz Beloit One Network |
$8,339.60
|
| Rate for Payer: Quartz Commercial |
$10,211.76
|
| Rate for Payer: WEA Trust Commercial |
$9,360.78
|
| Rate for Payer: WPS Commercial |
$12,605.96
|
|
|
BASEPLATE 24MM 20 DEG FULL AUGMENT +2 LATERAL AR-9580-2420-2
|
Facility
|
OP
|
$16,365.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5685843
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,765.49 |
| Max. Negotiated Rate |
$15,658.03 |
| Rate for Payer: Aetna Commercial |
$15,317.64
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$14,636.86
|
| Rate for Payer: Aetna Managed Medicare |
$4,765.49
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$11,062.74
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8,509.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$8,169.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,020.39
|
| Rate for Payer: Cash Price |
$4,909.50
|
| Rate for Payer: Cigna Commercial |
$15,658.03
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$9,524.43
|
| Rate for Payer: Health EOS Commercial |
$15,147.44
|
| Rate for Payer: HFN Commercial |
$15,658.03
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$12,764.70
|
| Rate for Payer: Multiplan Commercial |
$13,615.68
|
| Rate for Payer: NAPHCARE Commercial |
$10,211.76
|
| Rate for Payer: Preferred Network Access Commercial |
$15,658.03
|
| Rate for Payer: Quartz Beloit One Network |
$8,339.60
|
| Rate for Payer: Quartz Commercial |
$11,062.74
|
| Rate for Payer: Quartz Medicare Advantage |
$10,211.76
|
| Rate for Payer: The Alliance Commercial |
$8,509.80
|
| Rate for Payer: WEA Trust Commercial |
$9,360.78
|
| Rate for Payer: WPS Commercial |
$12,605.96
|
|
|
BASEPLATE 24MM 20 DEG FULL AUGMENT AR-9580-2420
|
Facility
|
OP
|
$15,736.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
6065654
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,582.32 |
| Max. Negotiated Rate |
$15,056.20 |
| Rate for Payer: Aetna Commercial |
$14,728.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$14,074.28
|
| Rate for Payer: Aetna Managed Medicare |
$4,582.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$10,637.54
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8,182.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7,855.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$8,673.68
|
| Rate for Payer: Cash Price |
$4,720.80
|
| Rate for Payer: Cigna Commercial |
$15,056.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$9,158.35
|
| Rate for Payer: Health EOS Commercial |
$14,565.24
|
| Rate for Payer: HFN Commercial |
$15,056.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$12,274.08
|
| Rate for Payer: Multiplan Commercial |
$13,092.35
|
| Rate for Payer: NAPHCARE Commercial |
$9,819.26
|
| Rate for Payer: Preferred Network Access Commercial |
$15,056.20
|
| Rate for Payer: Quartz Beloit One Network |
$8,019.07
|
| Rate for Payer: Quartz Commercial |
$10,637.54
|
| Rate for Payer: Quartz Medicare Advantage |
$9,819.26
|
| Rate for Payer: The Alliance Commercial |
$8,182.72
|
| Rate for Payer: WEA Trust Commercial |
$9,000.99
|
| Rate for Payer: WPS Commercial |
$12,121.44
|
|
