|
BOOT SLIMLINE CAST X-LARGE 2039-05
|
Facility
|
IP
|
$334.00
|
|
|
Service Code
|
HCPCS L3260
|
| Hospital Charge Code |
2974381
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$170.21 |
| Max. Negotiated Rate |
$319.57 |
| Rate for Payer: Aetna Commercial |
$312.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$298.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$184.10
|
| Rate for Payer: Cash Price |
$100.20
|
| Rate for Payer: Cigna Commercial |
$319.57
|
| Rate for Payer: Health EOS Commercial |
$309.15
|
| Rate for Payer: HFN Commercial |
$319.57
|
| Rate for Payer: Multiplan Commercial |
$277.89
|
| Rate for Payer: Preferred Network Access Commercial |
$319.57
|
| Rate for Payer: Quartz Beloit One Network |
$170.21
|
| Rate for Payer: Quartz Commercial |
$208.42
|
| Rate for Payer: WEA Trust Commercial |
$191.05
|
| Rate for Payer: WPS Commercial |
$257.28
|
|
|
BOOT SLIMLINE CAST X-LARGE 2039-05
|
Facility
|
OP
|
$334.00
|
|
|
Service Code
|
HCPCS L3260
|
| Hospital Charge Code |
2974381
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$22.43 |
| Max. Negotiated Rate |
$319.57 |
| Rate for Payer: Aetna Commercial |
$312.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$298.73
|
| Rate for Payer: Aetna Managed Medicare |
$97.26
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$22.43
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$22.43
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$22.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$184.10
|
| Rate for Payer: Cash Price |
$100.20
|
| Rate for Payer: Cash Price |
$100.20
|
| Rate for Payer: Cigna Commercial |
$319.57
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$194.39
|
| Rate for Payer: Health EOS Commercial |
$309.15
|
| Rate for Payer: HFN Commercial |
$319.57
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$260.52
|
| Rate for Payer: Multiplan Commercial |
$277.89
|
| Rate for Payer: NAPHCARE Commercial |
$208.42
|
| Rate for Payer: Preferred Network Access Commercial |
$319.57
|
| Rate for Payer: Quartz Beloit One Network |
$170.21
|
| Rate for Payer: Quartz Commercial |
$225.78
|
| Rate for Payer: Quartz Medicare Advantage |
$208.42
|
| Rate for Payer: The Alliance Commercial |
$173.68
|
| Rate for Payer: WEA Trust Commercial |
$191.05
|
| Rate for Payer: WPS Commercial |
$257.28
|
|
|
BOOT SLIMLINE CAST X-SMALL 2039-01
|
Facility
|
IP
|
$334.00
|
|
|
Service Code
|
HCPCS L3260
|
| Hospital Charge Code |
2963852
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$170.21 |
| Max. Negotiated Rate |
$319.57 |
| Rate for Payer: Aetna Commercial |
$312.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$298.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$184.10
|
| Rate for Payer: Cash Price |
$100.20
|
| Rate for Payer: Cigna Commercial |
$319.57
|
| Rate for Payer: Health EOS Commercial |
$309.15
|
| Rate for Payer: HFN Commercial |
$319.57
|
| Rate for Payer: Multiplan Commercial |
$277.89
|
| Rate for Payer: Preferred Network Access Commercial |
$319.57
|
| Rate for Payer: Quartz Beloit One Network |
$170.21
|
| Rate for Payer: Quartz Commercial |
$208.42
|
| Rate for Payer: WEA Trust Commercial |
$191.05
|
| Rate for Payer: WPS Commercial |
$257.28
|
|
|
BOOT SLIMLINE CAST X-SMALL 2039-01
|
Facility
|
OP
|
$334.00
|
|
|
Service Code
|
HCPCS L3260
|
| Hospital Charge Code |
2963852
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$22.43 |
| Max. Negotiated Rate |
$319.57 |
| Rate for Payer: Aetna Commercial |
$312.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$298.73
|
| Rate for Payer: Aetna Managed Medicare |
$97.26
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$22.43
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$22.43
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$22.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$184.10
|
| Rate for Payer: Cash Price |
$100.20
|
| Rate for Payer: Cash Price |
$100.20
|
| Rate for Payer: Cigna Commercial |
$319.57
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$194.39
|
| Rate for Payer: Health EOS Commercial |
$309.15
|
| Rate for Payer: HFN Commercial |
$319.57
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$260.52
|
| Rate for Payer: Multiplan Commercial |
$277.89
|
| Rate for Payer: NAPHCARE Commercial |
$208.42
|
| Rate for Payer: Preferred Network Access Commercial |
$319.57
|
| Rate for Payer: Quartz Beloit One Network |
$170.21
|
| Rate for Payer: Quartz Commercial |
$225.78
|
| Rate for Payer: Quartz Medicare Advantage |
$208.42
|
| Rate for Payer: The Alliance Commercial |
$173.68
|
| Rate for Payer: WEA Trust Commercial |
$191.05
|
| Rate for Payer: WPS Commercial |
$257.28
|
|
|
BOOT TRACTION UNIVERSAL ORT31100
|
Facility
|
IP
|
$349.00
|
|
| Hospital Charge Code |
2963897
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$177.85 |
| Max. Negotiated Rate |
$333.92 |
| Rate for Payer: Aetna Commercial |
$326.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$312.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$192.37
|
| Rate for Payer: Cash Price |
$104.70
|
| Rate for Payer: Cigna Commercial |
$333.92
|
| Rate for Payer: Health EOS Commercial |
$323.03
|
| Rate for Payer: HFN Commercial |
$333.92
|
| Rate for Payer: Multiplan Commercial |
$290.37
|
| Rate for Payer: Preferred Network Access Commercial |
$333.92
|
| Rate for Payer: Quartz Beloit One Network |
$177.85
|
| Rate for Payer: Quartz Commercial |
$217.78
|
| Rate for Payer: WEA Trust Commercial |
$199.63
|
| Rate for Payer: WPS Commercial |
$268.83
|
|
|
BOOT TRACTION UNIVERSAL ORT31100
|
Facility
|
OP
|
$349.00
|
|
| Hospital Charge Code |
2963897
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$101.63 |
| Max. Negotiated Rate |
$333.92 |
| Rate for Payer: Aetna Commercial |
$326.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$312.15
|
| Rate for Payer: Aetna Managed Medicare |
$101.63
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$235.92
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$181.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$174.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$192.37
|
| Rate for Payer: Cash Price |
$104.70
|
| Rate for Payer: Cigna Commercial |
$333.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$203.12
|
| Rate for Payer: Health EOS Commercial |
$323.03
|
| Rate for Payer: HFN Commercial |
$333.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$272.22
|
| Rate for Payer: Multiplan Commercial |
$290.37
|
| Rate for Payer: NAPHCARE Commercial |
$217.78
|
| Rate for Payer: Preferred Network Access Commercial |
$333.92
|
| Rate for Payer: Quartz Beloit One Network |
$177.85
|
| Rate for Payer: Quartz Commercial |
$235.92
|
| Rate for Payer: Quartz Medicare Advantage |
$217.78
|
| Rate for Payer: The Alliance Commercial |
$181.48
|
| Rate for Payer: WEA Trust Commercial |
$199.63
|
| Rate for Payer: WPS Commercial |
$268.83
|
|
|
BO Platelet Crossmatch
|
Facility
|
IP
|
$616.00
|
|
|
Service Code
|
CPT 86022
|
| Hospital Charge Code |
987763
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$313.91 |
| Max. Negotiated Rate |
$589.39 |
| Rate for Payer: Aetna Commercial |
$576.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$550.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$339.54
|
| Rate for Payer: Cash Price |
$184.80
|
| Rate for Payer: Cigna Commercial |
$589.39
|
| Rate for Payer: Health EOS Commercial |
$570.17
|
| Rate for Payer: HFN Commercial |
$589.39
|
| Rate for Payer: Multiplan Commercial |
$512.51
|
| Rate for Payer: Preferred Network Access Commercial |
$589.39
|
| Rate for Payer: Quartz Beloit One Network |
$313.91
|
| Rate for Payer: Quartz Commercial |
$384.38
|
| Rate for Payer: WEA Trust Commercial |
$352.35
|
| Rate for Payer: WPS Commercial |
$474.50
|
|
|
BO Platelet Crossmatch
|
Facility
|
OP
|
$616.00
|
|
|
Service Code
|
CPT 86022
|
| Hospital Charge Code |
987763
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$19.10 |
| Max. Negotiated Rate |
$589.39 |
| Rate for Payer: Aetna Commercial |
$576.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$550.95
|
| Rate for Payer: Aetna Managed Medicare |
$19.10
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$71.64
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$33.43
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$31.71
|
| Rate for Payer: Anthem Medicare Advantage |
$19.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$339.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$19.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$19.10
|
| Rate for Payer: Cash Price |
$184.80
|
| Rate for Payer: Cash Price |
$184.80
|
| Rate for Payer: Cigna Commercial |
$589.39
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$19.10
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$358.51
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$19.10
|
| Rate for Payer: Health EOS Commercial |
$570.17
|
| Rate for Payer: HFN Commercial |
$589.39
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$71.07
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$19.10
|
| Rate for Payer: Independent Care Health Plan Medicare |
$19.10
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$19.10
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$19.10
|
| Rate for Payer: Multiplan Commercial |
$512.51
|
| Rate for Payer: NAPHCARE Commercial |
$28.66
|
| Rate for Payer: Preferred Network Access Commercial |
$589.39
|
| Rate for Payer: Quartz Beloit One Network |
$313.91
|
| Rate for Payer: Quartz Commercial |
$416.42
|
| Rate for Payer: Quartz Medicare Advantage |
$19.10
|
| Rate for Payer: The Alliance Commercial |
$76.42
|
| Rate for Payer: United Healthcare Medicare Advantage |
$19.10
|
| Rate for Payer: United Healthcare PPO |
$480.48
|
| Rate for Payer: WEA Trust Commercial |
$352.35
|
| Rate for Payer: Wellcare Medicare |
$19.10
|
| Rate for Payer: WPS Commercial |
$474.50
|
|
|
Bordetella pertussis/parapertussis Culture
|
Facility
|
IP
|
$191.00
|
|
|
Service Code
|
CPT 87081
|
| Hospital Charge Code |
633885
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$97.33 |
| Max. Negotiated Rate |
$182.75 |
| Rate for Payer: Aetna Commercial |
$178.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$170.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$105.28
|
| Rate for Payer: Cash Price |
$57.30
|
| Rate for Payer: Cigna Commercial |
$182.75
|
| Rate for Payer: Health EOS Commercial |
$176.79
|
| Rate for Payer: HFN Commercial |
$182.75
|
| Rate for Payer: Multiplan Commercial |
$158.91
|
| Rate for Payer: Preferred Network Access Commercial |
$182.75
|
| Rate for Payer: Quartz Beloit One Network |
$97.33
|
| Rate for Payer: Quartz Commercial |
$119.18
|
| Rate for Payer: WEA Trust Commercial |
$109.25
|
| Rate for Payer: WPS Commercial |
$147.13
|
|
|
Bordetella pertussis/parapertussis Culture
|
Facility
|
OP
|
$191.00
|
|
|
Service Code
|
CPT 87081
|
| Hospital Charge Code |
633885
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.90 |
| Max. Negotiated Rate |
$182.75 |
| Rate for Payer: Aetna Commercial |
$178.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$170.83
|
| Rate for Payer: Aetna Managed Medicare |
$6.90
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$25.86
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$12.07
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$11.45
|
| Rate for Payer: Anthem Medicare Advantage |
$6.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$105.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$6.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$6.90
|
| Rate for Payer: Cash Price |
$57.30
|
| Rate for Payer: Cash Price |
$57.30
|
| Rate for Payer: Cigna Commercial |
$182.75
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$6.90
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$111.16
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$6.90
|
| Rate for Payer: Health EOS Commercial |
$176.79
|
| Rate for Payer: HFN Commercial |
$182.75
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$25.65
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$6.90
|
| Rate for Payer: Independent Care Health Plan Medicare |
$6.90
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$6.90
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$6.90
|
| Rate for Payer: Multiplan Commercial |
$158.91
|
| Rate for Payer: NAPHCARE Commercial |
$10.34
|
| Rate for Payer: Preferred Network Access Commercial |
$182.75
|
| Rate for Payer: Quartz Beloit One Network |
$97.33
|
| Rate for Payer: Quartz Commercial |
$129.12
|
| Rate for Payer: Quartz Medicare Advantage |
$6.90
|
| Rate for Payer: The Alliance Commercial |
$27.58
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6.90
|
| Rate for Payer: United Healthcare PPO |
$148.98
|
| Rate for Payer: WEA Trust Commercial |
$109.25
|
| Rate for Payer: Wellcare Medicare |
$6.90
|
| Rate for Payer: WPS Commercial |
$147.13
|
|
|
Bordetella pertussis/parapertussis Culture
|
Professional
|
Both
|
$191.00
|
|
|
Service Code
|
CPT 87081
|
| Hospital Charge Code |
633885
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.90 |
| Max. Negotiated Rate |
$188.71 |
| Rate for Payer: Aetna Commercial |
$188.71
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$170.83
|
| Rate for Payer: Aetna Managed Medicare |
$6.90
|
| Rate for Payer: Anthem Medicare Advantage |
$6.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$6.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$6.90
|
| Rate for Payer: Cash Price |
$57.30
|
| Rate for Payer: Cash Price |
$57.30
|
| Rate for Payer: Cigna Commercial |
$188.71
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$99.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6.90
|
| Rate for Payer: Health EOS Commercial |
$180.76
|
| Rate for Payer: HFN Commercial |
$188.71
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$24.34
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$24.34
|
| Rate for Payer: Independent Care Health Plan Medicare |
$6.90
|
| Rate for Payer: Multiplan Commercial |
$158.91
|
| Rate for Payer: NAPHCARE Commercial |
$10.34
|
| Rate for Payer: Preferred Network Access Commercial |
$188.71
|
| Rate for Payer: Quartz Beloit One Network |
$87.40
|
| Rate for Payer: Quartz Commercial |
$113.22
|
| Rate for Payer: Quartz Medicare Advantage |
$6.90
|
| Rate for Payer: The Alliance Commercial |
$27.24
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6.90
|
| Rate for Payer: WEA Trust Commercial |
$109.25
|
| Rate for Payer: WPS Commercial |
$30.34
|
|
|
Bordetella pertussis/parapertussis PCR
|
Facility
|
IP
|
$202.00
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
983497
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$102.94 |
| Max. Negotiated Rate |
$193.27 |
| Rate for Payer: Aetna Commercial |
$189.07
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$180.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$111.34
|
| Rate for Payer: Cash Price |
$60.60
|
| Rate for Payer: Cigna Commercial |
$193.27
|
| Rate for Payer: Health EOS Commercial |
$186.97
|
| Rate for Payer: HFN Commercial |
$193.27
|
| Rate for Payer: Multiplan Commercial |
$168.06
|
| Rate for Payer: Preferred Network Access Commercial |
$193.27
|
| Rate for Payer: Quartz Beloit One Network |
$102.94
|
| Rate for Payer: Quartz Commercial |
$126.05
|
| Rate for Payer: WEA Trust Commercial |
$115.54
|
| Rate for Payer: WPS Commercial |
$155.60
|
|
|
Bordetella pertussis/parapertussis PCR
|
Facility
|
OP
|
$202.00
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
983497
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$36.49 |
| Max. Negotiated Rate |
$193.27 |
| Rate for Payer: Aetna Commercial |
$189.07
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$180.67
|
| 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 |
$111.34
|
| 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 |
$60.60
|
| Rate for Payer: Cash Price |
$60.60
|
| Rate for Payer: Cigna Commercial |
$193.27
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$36.49
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$117.56
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$36.49
|
| Rate for Payer: Health EOS Commercial |
$186.97
|
| Rate for Payer: HFN Commercial |
$193.27
|
| 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 |
$168.06
|
| Rate for Payer: NAPHCARE Commercial |
$54.74
|
| Rate for Payer: Preferred Network Access Commercial |
$193.27
|
| Rate for Payer: Quartz Beloit One Network |
$102.94
|
| Rate for Payer: Quartz Commercial |
$136.55
|
| 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 |
$157.56
|
| Rate for Payer: WEA Trust Commercial |
$115.54
|
| Rate for Payer: Wellcare Medicare |
$36.49
|
| Rate for Payer: WPS Commercial |
$155.60
|
|
|
Bordetella pertussis/parapertussis PCR
|
Professional
|
Both
|
$202.00
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
983497
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$36.49 |
| Max. Negotiated Rate |
$199.58 |
| Rate for Payer: Aetna Commercial |
$199.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$180.67
|
| 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 |
$60.60
|
| Rate for Payer: Cash Price |
$60.60
|
| Rate for Payer: Cigna Commercial |
$199.58
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$105.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$36.49
|
| Rate for Payer: Health EOS Commercial |
$191.17
|
| Rate for Payer: HFN Commercial |
$199.58
|
| 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 |
$168.06
|
| Rate for Payer: NAPHCARE Commercial |
$54.74
|
| Rate for Payer: Preferred Network Access Commercial |
$199.58
|
| Rate for Payer: Quartz Beloit One Network |
$92.44
|
| Rate for Payer: Quartz Commercial |
$119.75
|
| 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 |
$115.54
|
| Rate for Payer: WPS Commercial |
$160.57
|
|
|
BO Ref Emergency Consultation
|
Facility
|
OP
|
$1,101.00
|
|
|
Service Code
|
CPT 86999
|
| Hospital Charge Code |
980083
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$30.44 |
| Max. Negotiated Rate |
$1,053.44 |
| Rate for Payer: Aetna Commercial |
$1,030.54
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$984.73
|
| Rate for Payer: Aetna Managed Medicare |
$30.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$744.28
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$572.52
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$549.62
|
| Rate for Payer: Anthem Medicare Advantage |
$30.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$606.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$30.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$30.44
|
| Rate for Payer: Cash Price |
$330.30
|
| Rate for Payer: Cash Price |
$330.30
|
| Rate for Payer: Cigna Commercial |
$1,053.44
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$30.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$640.78
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$30.44
|
| Rate for Payer: Health EOS Commercial |
$1,019.09
|
| Rate for Payer: HFN Commercial |
$1,053.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$113.24
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$30.44
|
| Rate for Payer: Independent Care Health Plan Medicare |
$30.44
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$30.44
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$30.44
|
| Rate for Payer: Multiplan Commercial |
$916.03
|
| Rate for Payer: NAPHCARE Commercial |
$45.66
|
| Rate for Payer: Preferred Network Access Commercial |
$1,053.44
|
| Rate for Payer: Quartz Beloit One Network |
$561.07
|
| Rate for Payer: Quartz Commercial |
$744.28
|
| Rate for Payer: Quartz Medicare Advantage |
$30.44
|
| Rate for Payer: The Alliance Commercial |
$121.76
|
| Rate for Payer: United Healthcare Medicare Advantage |
$30.44
|
| Rate for Payer: United Healthcare PPO |
$858.78
|
| Rate for Payer: WEA Trust Commercial |
$629.77
|
| Rate for Payer: Wellcare Medicare |
$30.44
|
| Rate for Payer: WPS Commercial |
$848.10
|
|
|
BO Ref Emergency Consultation
|
Facility
|
IP
|
$1,101.00
|
|
|
Service Code
|
CPT 86999
|
| Hospital Charge Code |
980083
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$561.07 |
| Max. Negotiated Rate |
$1,053.44 |
| Rate for Payer: Aetna Commercial |
$1,030.54
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$984.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$606.87
|
| Rate for Payer: Cash Price |
$330.30
|
| Rate for Payer: Cigna Commercial |
$1,053.44
|
| Rate for Payer: Health EOS Commercial |
$1,019.09
|
| Rate for Payer: HFN Commercial |
$1,053.44
|
| Rate for Payer: Multiplan Commercial |
$916.03
|
| Rate for Payer: Preferred Network Access Commercial |
$1,053.44
|
| Rate for Payer: Quartz Beloit One Network |
$561.07
|
| Rate for Payer: Quartz Commercial |
$687.02
|
| Rate for Payer: WEA Trust Commercial |
$629.77
|
| Rate for Payer: WPS Commercial |
$848.10
|
|
|
Borrelia Sp DNA PCR Blood
|
Facility
|
IP
|
$318.00
|
|
|
Service Code
|
CPT 87801
|
| Hospital Charge Code |
6180583
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$162.05 |
| Max. Negotiated Rate |
$304.26 |
| Rate for Payer: Aetna Commercial |
$297.65
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$284.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$175.28
|
| Rate for Payer: Cash Price |
$95.40
|
| Rate for Payer: Cigna Commercial |
$304.26
|
| Rate for Payer: Health EOS Commercial |
$294.34
|
| Rate for Payer: HFN Commercial |
$304.26
|
| Rate for Payer: Multiplan Commercial |
$264.58
|
| Rate for Payer: Preferred Network Access Commercial |
$304.26
|
| Rate for Payer: Quartz Beloit One Network |
$162.05
|
| Rate for Payer: Quartz Commercial |
$198.43
|
| Rate for Payer: WEA Trust Commercial |
$181.90
|
| Rate for Payer: WPS Commercial |
$244.96
|
|
|
Borrelia Sp DNA PCR Blood
|
Professional
|
Both
|
$318.00
|
|
|
Service Code
|
CPT 87801
|
| Hospital Charge Code |
6180583
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$73.01 |
| Max. Negotiated Rate |
$321.24 |
| Rate for Payer: Aetna Commercial |
$314.18
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$284.42
|
| Rate for Payer: Aetna Managed Medicare |
$73.01
|
| Rate for Payer: Anthem Medicare Advantage |
$73.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$73.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$73.01
|
| Rate for Payer: Cash Price |
$95.40
|
| Rate for Payer: Cash Price |
$95.40
|
| Rate for Payer: Cigna Commercial |
$314.18
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$165.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$73.01
|
| Rate for Payer: Health EOS Commercial |
$300.96
|
| Rate for Payer: HFN Commercial |
$314.18
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$257.72
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$257.72
|
| Rate for Payer: Independent Care Health Plan Medicare |
$73.01
|
| Rate for Payer: Multiplan Commercial |
$264.58
|
| Rate for Payer: NAPHCARE Commercial |
$109.51
|
| Rate for Payer: Preferred Network Access Commercial |
$314.18
|
| Rate for Payer: Quartz Beloit One Network |
$145.52
|
| Rate for Payer: Quartz Commercial |
$188.51
|
| Rate for Payer: Quartz Medicare Advantage |
$73.01
|
| Rate for Payer: The Alliance Commercial |
$288.38
|
| Rate for Payer: United Healthcare Medicare Advantage |
$73.01
|
| Rate for Payer: WEA Trust Commercial |
$181.90
|
| Rate for Payer: WPS Commercial |
$321.24
|
|
|
Borrelia Sp DNA PCR Blood
|
Facility
|
OP
|
$318.00
|
|
|
Service Code
|
CPT 87801
|
| Hospital Charge Code |
6180583
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$73.01 |
| Max. Negotiated Rate |
$304.26 |
| Rate for Payer: Aetna Commercial |
$297.65
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$284.42
|
| Rate for Payer: Aetna Managed Medicare |
$73.01
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$273.78
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$127.76
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$121.19
|
| Rate for Payer: Anthem Medicare Advantage |
$73.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$175.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$73.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$73.01
|
| Rate for Payer: Cash Price |
$95.40
|
| Rate for Payer: Cash Price |
$95.40
|
| Rate for Payer: Cigna Commercial |
$304.26
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$73.01
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$185.08
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$73.01
|
| Rate for Payer: Health EOS Commercial |
$294.34
|
| Rate for Payer: HFN Commercial |
$304.26
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$271.59
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$73.01
|
| Rate for Payer: Independent Care Health Plan Medicare |
$73.01
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$73.01
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$73.01
|
| Rate for Payer: Multiplan Commercial |
$264.58
|
| Rate for Payer: NAPHCARE Commercial |
$109.51
|
| Rate for Payer: Preferred Network Access Commercial |
$304.26
|
| Rate for Payer: Quartz Beloit One Network |
$162.05
|
| Rate for Payer: Quartz Commercial |
$214.97
|
| Rate for Payer: Quartz Medicare Advantage |
$73.01
|
| Rate for Payer: The Alliance Commercial |
$292.03
|
| Rate for Payer: United Healthcare Medicare Advantage |
$73.01
|
| Rate for Payer: United Healthcare PPO |
$248.04
|
| Rate for Payer: WEA Trust Commercial |
$181.90
|
| Rate for Payer: Wellcare Medicare |
$73.01
|
| Rate for Payer: WPS Commercial |
$244.96
|
|
|
Borrelia SPP PCR w/Rflx SYNF & CSF
|
Facility
|
OP
|
$235.00
|
|
|
Service Code
|
CPT 87801
|
| Hospital Charge Code |
6210448
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$73.01 |
| Max. Negotiated Rate |
$292.03 |
| Rate for Payer: Aetna Commercial |
$219.96
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$210.18
|
| Rate for Payer: Aetna Managed Medicare |
$73.01
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$273.78
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$127.76
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$121.19
|
| Rate for Payer: Anthem Medicare Advantage |
$73.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$129.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$73.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$73.01
|
| Rate for Payer: Cash Price |
$70.50
|
| Rate for Payer: Cash Price |
$70.50
|
| Rate for Payer: Cigna Commercial |
$224.85
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$73.01
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$136.77
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$73.01
|
| Rate for Payer: Health EOS Commercial |
$217.52
|
| Rate for Payer: HFN Commercial |
$224.85
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$271.59
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$73.01
|
| Rate for Payer: Independent Care Health Plan Medicare |
$73.01
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$73.01
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$73.01
|
| Rate for Payer: Multiplan Commercial |
$195.52
|
| Rate for Payer: NAPHCARE Commercial |
$109.51
|
| Rate for Payer: Preferred Network Access Commercial |
$224.85
|
| Rate for Payer: Quartz Beloit One Network |
$119.76
|
| Rate for Payer: Quartz Commercial |
$158.86
|
| Rate for Payer: Quartz Medicare Advantage |
$73.01
|
| Rate for Payer: The Alliance Commercial |
$292.03
|
| Rate for Payer: United Healthcare Medicare Advantage |
$73.01
|
| Rate for Payer: United Healthcare PPO |
$183.30
|
| Rate for Payer: WEA Trust Commercial |
$134.42
|
| Rate for Payer: Wellcare Medicare |
$73.01
|
| Rate for Payer: WPS Commercial |
$181.02
|
|
|
Borrelia SPP PCR w/Rflx SYNF & CSF
|
Facility
|
IP
|
$235.00
|
|
|
Service Code
|
CPT 87801
|
| Hospital Charge Code |
6210448
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$119.76 |
| Max. Negotiated Rate |
$224.85 |
| Rate for Payer: Aetna Commercial |
$219.96
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$210.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$129.53
|
| Rate for Payer: Cash Price |
$70.50
|
| Rate for Payer: Cigna Commercial |
$224.85
|
| Rate for Payer: Health EOS Commercial |
$217.52
|
| Rate for Payer: HFN Commercial |
$224.85
|
| Rate for Payer: Multiplan Commercial |
$195.52
|
| Rate for Payer: Preferred Network Access Commercial |
$224.85
|
| Rate for Payer: Quartz Beloit One Network |
$119.76
|
| Rate for Payer: Quartz Commercial |
$146.64
|
| Rate for Payer: WEA Trust Commercial |
$134.42
|
| Rate for Payer: WPS Commercial |
$181.02
|
|
|
Borrelia SPP PCR w/Rflx SYNF & CSF
|
Professional
|
Both
|
$235.00
|
|
|
Service Code
|
CPT 87801
|
| Hospital Charge Code |
6210448
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$73.01 |
| Max. Negotiated Rate |
$321.24 |
| Rate for Payer: Aetna Commercial |
$232.18
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$210.18
|
| Rate for Payer: Aetna Managed Medicare |
$73.01
|
| Rate for Payer: Anthem Medicare Advantage |
$73.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$73.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$73.01
|
| Rate for Payer: Cash Price |
$70.50
|
| Rate for Payer: Cash Price |
$70.50
|
| Rate for Payer: Cigna Commercial |
$232.18
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$122.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$73.01
|
| Rate for Payer: Health EOS Commercial |
$222.40
|
| Rate for Payer: HFN Commercial |
$232.18
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$257.72
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$257.72
|
| Rate for Payer: Independent Care Health Plan Medicare |
$73.01
|
| Rate for Payer: Multiplan Commercial |
$195.52
|
| Rate for Payer: NAPHCARE Commercial |
$109.51
|
| Rate for Payer: Preferred Network Access Commercial |
$232.18
|
| Rate for Payer: Quartz Beloit One Network |
$107.54
|
| Rate for Payer: Quartz Commercial |
$139.31
|
| Rate for Payer: Quartz Medicare Advantage |
$73.01
|
| Rate for Payer: The Alliance Commercial |
$288.38
|
| Rate for Payer: United Healthcare Medicare Advantage |
$73.01
|
| Rate for Payer: WEA Trust Commercial |
$134.42
|
| Rate for Payer: WPS Commercial |
$321.24
|
|
|
Botox Cosmetic 1 Unit Charge
|
Facility
|
OP
|
$17.00
|
|
|
Service Code
|
HCPCS J0585
|
| Hospital Charge Code |
2958911
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.77 |
| Max. Negotiated Rate |
$27.08 |
| Rate for Payer: Aetna Commercial |
$15.91
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$15.20
|
| Rate for Payer: Aetna Managed Medicare |
$6.77
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$11.49
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$8.49
|
| Rate for Payer: Anthem Medicare Advantage |
$6.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$6.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$6.77
|
| Rate for Payer: Cash Price |
$5.10
|
| Rate for Payer: Cash Price |
$5.10
|
| Rate for Payer: Cigna Commercial |
$16.27
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$6.77
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$8.69
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$6.77
|
| Rate for Payer: Health EOS Commercial |
$15.74
|
| Rate for Payer: HFN Commercial |
$16.27
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$25.19
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$6.77
|
| Rate for Payer: Independent Care Health Plan Medicare |
$6.77
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$6.77
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$6.77
|
| Rate for Payer: Multiplan Commercial |
$14.14
|
| Rate for Payer: NAPHCARE Commercial |
$10.16
|
| Rate for Payer: Preferred Network Access Commercial |
$16.27
|
| Rate for Payer: Quartz Beloit One Network |
$8.66
|
| Rate for Payer: Quartz Commercial |
$11.49
|
| Rate for Payer: Quartz Medicare Advantage |
$6.77
|
| Rate for Payer: The Alliance Commercial |
$27.08
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6.77
|
| Rate for Payer: WEA Trust Commercial |
$9.72
|
| Rate for Payer: Wellcare Medicare |
$6.77
|
| Rate for Payer: WPS Commercial |
$16.43
|
|
|
Botox Cosmetic 1 Unit Charge
|
Facility
|
IP
|
$17.00
|
|
|
Service Code
|
HCPCS J0585
|
| Hospital Charge Code |
2958911
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.66 |
| Max. Negotiated Rate |
$16.27 |
| Rate for Payer: Aetna Commercial |
$15.91
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$15.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9.37
|
| Rate for Payer: Cash Price |
$5.10
|
| Rate for Payer: Cigna Commercial |
$16.27
|
| Rate for Payer: Health EOS Commercial |
$15.74
|
| Rate for Payer: HFN Commercial |
$16.27
|
| Rate for Payer: Multiplan Commercial |
$14.14
|
| Rate for Payer: Preferred Network Access Commercial |
$16.27
|
| Rate for Payer: Quartz Beloit One Network |
$8.66
|
| Rate for Payer: Quartz Commercial |
$10.61
|
| Rate for Payer: WEA Trust Commercial |
$9.72
|
| Rate for Payer: WPS Commercial |
$13.10
|
|
|
Botox Cosmetic 1 Unit Charge
|
Professional
|
Both
|
$17.00
|
|
|
Service Code
|
HCPCS J0585
|
| Hospital Charge Code |
2958911
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.57 |
| Max. Negotiated Rate |
$18.62 |
| Rate for Payer: Aetna Commercial |
$16.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$15.20
|
| Rate for Payer: Aetna Managed Medicare |
$6.77
|
| Rate for Payer: Anthem Medicare Advantage |
$6.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$6.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$6.77
|
| Rate for Payer: Cash Price |
$5.10
|
| Rate for Payer: Cash Price |
$5.10
|
| Rate for Payer: Cigna Commercial |
$16.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$6.77
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6.57
|
| Rate for Payer: Health EOS Commercial |
$16.09
|
| Rate for Payer: HFN Commercial |
$16.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$9.20
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$9.20
|
| Rate for Payer: Independent Care Health Plan Medicare |
$6.77
|
| Rate for Payer: Multiplan Commercial |
$14.14
|
| Rate for Payer: NAPHCARE Commercial |
$10.16
|
| Rate for Payer: Preferred Network Access Commercial |
$16.80
|
| Rate for Payer: Quartz Beloit One Network |
$7.78
|
| Rate for Payer: Quartz Commercial |
$10.08
|
| Rate for Payer: Quartz Medicare Advantage |
$6.77
|
| Rate for Payer: The Alliance Commercial |
$18.62
|
| Rate for Payer: United Healthcare Medicaid |
$6.77
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6.77
|
| Rate for Payer: WEA Trust Commercial |
$9.72
|
| Rate for Payer: WPS Commercial |
$16.43
|
|
