|
CLOUD WALKR ORTH XLG M 12-13 W 14-15 L3040
|
Professional
|
Both
|
$28.00
|
|
|
Service Code
|
HCPCS L3040
|
| Hospital Charge Code |
5607689
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$12.81 |
| Max. Negotiated Rate |
$173.46 |
| Rate for Payer: Aetna Commercial |
$27.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$25.04
|
| Rate for Payer: Aetna Managed Medicare |
$60.15
|
| Rate for Payer: Anthem Medicare Advantage |
$60.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$60.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$60.15
|
| Rate for Payer: Cash Price |
$8.40
|
| Rate for Payer: Cash Price |
$8.40
|
| Rate for Payer: Cigna Commercial |
$27.66
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$14.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$60.15
|
| Rate for Payer: Health EOS Commercial |
$26.50
|
| Rate for Payer: HFN Commercial |
$27.66
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$173.46
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$173.46
|
| Rate for Payer: Independent Care Health Plan Medicare |
$60.15
|
| Rate for Payer: Multiplan Commercial |
$23.30
|
| Rate for Payer: NAPHCARE Commercial |
$90.23
|
| Rate for Payer: Preferred Network Access Commercial |
$27.66
|
| Rate for Payer: Quartz Beloit One Network |
$12.81
|
| Rate for Payer: Quartz Commercial |
$16.60
|
| Rate for Payer: Quartz Medicare Advantage |
$60.15
|
| Rate for Payer: The Alliance Commercial |
$165.42
|
| Rate for Payer: United Healthcare Medicare Advantage |
$60.15
|
| Rate for Payer: WEA Trust Commercial |
$16.02
|
| Rate for Payer: WPS Commercial |
$105.27
|
|
|
CLOUD WALKR ORTH XS M 4-5 W 5-7 L3040
|
Facility
|
OP
|
$28.00
|
|
|
Service Code
|
HCPCS L3040
|
| Hospital Charge Code |
5607690
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$8.15 |
| Max. Negotiated Rate |
$240.61 |
| Rate for Payer: Aetna Commercial |
$26.21
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$25.04
|
| Rate for Payer: Aetna Managed Medicare |
$8.15
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$18.93
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$14.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$13.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$15.43
|
| Rate for Payer: Cash Price |
$8.40
|
| Rate for Payer: Cash Price |
$8.40
|
| Rate for Payer: Cigna Commercial |
$26.79
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$16.30
|
| Rate for Payer: Health EOS Commercial |
$25.92
|
| Rate for Payer: HFN Commercial |
$26.79
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$21.84
|
| Rate for Payer: Multiplan Commercial |
$23.30
|
| Rate for Payer: NAPHCARE Commercial |
$17.47
|
| Rate for Payer: Preferred Network Access Commercial |
$26.79
|
| Rate for Payer: Quartz Beloit One Network |
$14.27
|
| Rate for Payer: Quartz Commercial |
$18.93
|
| Rate for Payer: Quartz Medicare Advantage |
$17.47
|
| Rate for Payer: The Alliance Commercial |
$240.61
|
| Rate for Payer: WEA Trust Commercial |
$16.02
|
| Rate for Payer: WPS Commercial |
$21.57
|
|
|
CLOUD WALKR ORTH XS M 4-5 W 5-7 L3040
|
Facility
|
IP
|
$28.00
|
|
|
Service Code
|
HCPCS L3040
|
| Hospital Charge Code |
5607690
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$14.27 |
| Max. Negotiated Rate |
$26.79 |
| Rate for Payer: Aetna Commercial |
$26.21
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$25.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$15.43
|
| Rate for Payer: Cash Price |
$8.40
|
| Rate for Payer: Cigna Commercial |
$26.79
|
| Rate for Payer: Health EOS Commercial |
$25.92
|
| Rate for Payer: HFN Commercial |
$26.79
|
| Rate for Payer: Multiplan Commercial |
$23.30
|
| Rate for Payer: Preferred Network Access Commercial |
$26.79
|
| Rate for Payer: Quartz Beloit One Network |
$14.27
|
| Rate for Payer: Quartz Commercial |
$17.47
|
| Rate for Payer: WEA Trust Commercial |
$16.02
|
| Rate for Payer: WPS Commercial |
$21.57
|
|
|
CLOUD WALKR ORTH XS M 4-5 W 5-7 L3040
|
Professional
|
Both
|
$28.00
|
|
|
Service Code
|
HCPCS L3040
|
| Hospital Charge Code |
5607690
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$12.81 |
| Max. Negotiated Rate |
$173.46 |
| Rate for Payer: Aetna Commercial |
$27.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$25.04
|
| Rate for Payer: Aetna Managed Medicare |
$60.15
|
| Rate for Payer: Anthem Medicare Advantage |
$60.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$60.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$60.15
|
| Rate for Payer: Cash Price |
$8.40
|
| Rate for Payer: Cash Price |
$8.40
|
| Rate for Payer: Cigna Commercial |
$27.66
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$14.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$60.15
|
| Rate for Payer: Health EOS Commercial |
$26.50
|
| Rate for Payer: HFN Commercial |
$27.66
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$173.46
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$173.46
|
| Rate for Payer: Independent Care Health Plan Medicare |
$60.15
|
| Rate for Payer: Multiplan Commercial |
$23.30
|
| Rate for Payer: NAPHCARE Commercial |
$90.23
|
| Rate for Payer: Preferred Network Access Commercial |
$27.66
|
| Rate for Payer: Quartz Beloit One Network |
$12.81
|
| Rate for Payer: Quartz Commercial |
$16.60
|
| Rate for Payer: Quartz Medicare Advantage |
$60.15
|
| Rate for Payer: The Alliance Commercial |
$165.42
|
| Rate for Payer: United Healthcare Medicare Advantage |
$60.15
|
| Rate for Payer: WEA Trust Commercial |
$16.02
|
| Rate for Payer: WPS Commercial |
$105.27
|
|
|
CLOUD WALKR ORTH XXLG M 14-15 L3040
|
Facility
|
OP
|
$28.00
|
|
|
Service Code
|
HCPCS L3040
|
| Hospital Charge Code |
5607691
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$8.15 |
| Max. Negotiated Rate |
$240.61 |
| Rate for Payer: Aetna Commercial |
$26.21
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$25.04
|
| Rate for Payer: Aetna Managed Medicare |
$8.15
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$18.93
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$14.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$13.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$15.43
|
| Rate for Payer: Cash Price |
$8.40
|
| Rate for Payer: Cash Price |
$8.40
|
| Rate for Payer: Cigna Commercial |
$26.79
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$16.30
|
| Rate for Payer: Health EOS Commercial |
$25.92
|
| Rate for Payer: HFN Commercial |
$26.79
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$21.84
|
| Rate for Payer: Multiplan Commercial |
$23.30
|
| Rate for Payer: NAPHCARE Commercial |
$17.47
|
| Rate for Payer: Preferred Network Access Commercial |
$26.79
|
| Rate for Payer: Quartz Beloit One Network |
$14.27
|
| Rate for Payer: Quartz Commercial |
$18.93
|
| Rate for Payer: Quartz Medicare Advantage |
$17.47
|
| Rate for Payer: The Alliance Commercial |
$240.61
|
| Rate for Payer: WEA Trust Commercial |
$16.02
|
| Rate for Payer: WPS Commercial |
$21.57
|
|
|
CLOUD WALKR ORTH XXLG M 14-15 L3040
|
Facility
|
IP
|
$28.00
|
|
|
Service Code
|
HCPCS L3040
|
| Hospital Charge Code |
5607691
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$14.27 |
| Max. Negotiated Rate |
$26.79 |
| Rate for Payer: Aetna Commercial |
$26.21
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$25.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$15.43
|
| Rate for Payer: Cash Price |
$8.40
|
| Rate for Payer: Cigna Commercial |
$26.79
|
| Rate for Payer: Health EOS Commercial |
$25.92
|
| Rate for Payer: HFN Commercial |
$26.79
|
| Rate for Payer: Multiplan Commercial |
$23.30
|
| Rate for Payer: Preferred Network Access Commercial |
$26.79
|
| Rate for Payer: Quartz Beloit One Network |
$14.27
|
| Rate for Payer: Quartz Commercial |
$17.47
|
| Rate for Payer: WEA Trust Commercial |
$16.02
|
| Rate for Payer: WPS Commercial |
$21.57
|
|
|
CLOUD WALKR ORTH XXLG M 14-15 L3040
|
Professional
|
Both
|
$28.00
|
|
|
Service Code
|
HCPCS L3040
|
| Hospital Charge Code |
5607691
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$12.81 |
| Max. Negotiated Rate |
$173.46 |
| Rate for Payer: Aetna Commercial |
$27.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$25.04
|
| Rate for Payer: Aetna Managed Medicare |
$60.15
|
| Rate for Payer: Anthem Medicare Advantage |
$60.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$60.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$60.15
|
| Rate for Payer: Cash Price |
$8.40
|
| Rate for Payer: Cash Price |
$8.40
|
| Rate for Payer: Cigna Commercial |
$27.66
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$14.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$60.15
|
| Rate for Payer: Health EOS Commercial |
$26.50
|
| Rate for Payer: HFN Commercial |
$27.66
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$173.46
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$173.46
|
| Rate for Payer: Independent Care Health Plan Medicare |
$60.15
|
| Rate for Payer: Multiplan Commercial |
$23.30
|
| Rate for Payer: NAPHCARE Commercial |
$90.23
|
| Rate for Payer: Preferred Network Access Commercial |
$27.66
|
| Rate for Payer: Quartz Beloit One Network |
$12.81
|
| Rate for Payer: Quartz Commercial |
$16.60
|
| Rate for Payer: Quartz Medicare Advantage |
$60.15
|
| Rate for Payer: The Alliance Commercial |
$165.42
|
| Rate for Payer: United Healthcare Medicare Advantage |
$60.15
|
| Rate for Payer: WEA Trust Commercial |
$16.02
|
| Rate for Payer: WPS Commercial |
$105.27
|
|
|
Clozapine Level
|
Facility
|
OP
|
$287.00
|
|
|
Service Code
|
CPT 80159
|
| Hospital Charge Code |
977905
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$20.96 |
| Max. Negotiated Rate |
$274.60 |
| Rate for Payer: Aetna Commercial |
$268.63
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$256.69
|
| Rate for Payer: Aetna Managed Medicare |
$20.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$78.58
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$36.67
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$34.79
|
| Rate for Payer: Anthem Medicare Advantage |
$20.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$158.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$20.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$20.96
|
| Rate for Payer: Cash Price |
$86.10
|
| Rate for Payer: Cash Price |
$86.10
|
| Rate for Payer: Cigna Commercial |
$274.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$20.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$167.03
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$20.96
|
| Rate for Payer: Health EOS Commercial |
$265.65
|
| Rate for Payer: HFN Commercial |
$274.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$77.96
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$20.96
|
| Rate for Payer: Independent Care Health Plan Medicare |
$20.96
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$20.96
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$20.96
|
| Rate for Payer: Multiplan Commercial |
$238.78
|
| Rate for Payer: NAPHCARE Commercial |
$31.43
|
| Rate for Payer: Preferred Network Access Commercial |
$274.60
|
| Rate for Payer: Quartz Beloit One Network |
$146.26
|
| Rate for Payer: Quartz Commercial |
$194.01
|
| Rate for Payer: Quartz Medicare Advantage |
$20.96
|
| Rate for Payer: The Alliance Commercial |
$83.82
|
| Rate for Payer: United Healthcare Medicare Advantage |
$20.96
|
| Rate for Payer: United Healthcare PPO |
$223.86
|
| Rate for Payer: WEA Trust Commercial |
$164.16
|
| Rate for Payer: Wellcare Medicare |
$20.96
|
| Rate for Payer: WPS Commercial |
$221.08
|
|
|
Clozapine Level
|
Professional
|
Both
|
$287.00
|
|
|
Service Code
|
CPT 80159
|
| Hospital Charge Code |
977905
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$20.96 |
| Max. Negotiated Rate |
$283.56 |
| Rate for Payer: Aetna Commercial |
$283.56
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$256.69
|
| Rate for Payer: Aetna Managed Medicare |
$20.96
|
| Rate for Payer: Anthem Medicare Advantage |
$20.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$20.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$20.96
|
| Rate for Payer: Cash Price |
$86.10
|
| Rate for Payer: Cash Price |
$86.10
|
| Rate for Payer: Cigna Commercial |
$283.56
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$149.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$20.96
|
| Rate for Payer: Health EOS Commercial |
$271.62
|
| Rate for Payer: HFN Commercial |
$283.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$73.98
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$73.98
|
| Rate for Payer: Independent Care Health Plan Medicare |
$20.96
|
| Rate for Payer: Multiplan Commercial |
$238.78
|
| Rate for Payer: NAPHCARE Commercial |
$31.43
|
| Rate for Payer: Preferred Network Access Commercial |
$283.56
|
| Rate for Payer: Quartz Beloit One Network |
$131.33
|
| Rate for Payer: Quartz Commercial |
$170.13
|
| Rate for Payer: Quartz Medicare Advantage |
$20.96
|
| Rate for Payer: The Alliance Commercial |
$82.78
|
| Rate for Payer: United Healthcare Medicare Advantage |
$20.96
|
| Rate for Payer: WEA Trust Commercial |
$164.16
|
| Rate for Payer: WPS Commercial |
$92.21
|
|
|
Clozapine Level
|
Facility
|
IP
|
$287.00
|
|
|
Service Code
|
CPT 80159
|
| Hospital Charge Code |
977905
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$146.26 |
| Max. Negotiated Rate |
$274.60 |
| Rate for Payer: Aetna Commercial |
$268.63
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$256.69
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$158.19
|
| Rate for Payer: Cash Price |
$86.10
|
| Rate for Payer: Cigna Commercial |
$274.60
|
| Rate for Payer: Health EOS Commercial |
$265.65
|
| Rate for Payer: HFN Commercial |
$274.60
|
| Rate for Payer: Multiplan Commercial |
$238.78
|
| Rate for Payer: Preferred Network Access Commercial |
$274.60
|
| Rate for Payer: Quartz Beloit One Network |
$146.26
|
| Rate for Payer: Quartz Commercial |
$179.09
|
| Rate for Payer: WEA Trust Commercial |
$164.16
|
| Rate for Payer: WPS Commercial |
$221.08
|
|
|
CLTX MED ANKLE FX W/MNPJ 27762
|
Professional
|
Both
|
$1,216.00
|
|
|
Service Code
|
CPT 27762
|
| Hospital Charge Code |
3014145
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$432.00 |
| Max. Negotiated Rate |
$2,111.90 |
| Rate for Payer: Aetna Commercial |
$1,201.41
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,087.59
|
| Rate for Payer: Aetna Managed Medicare |
$469.31
|
| Rate for Payer: Anthem Medicare Advantage |
$469.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$469.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$469.31
|
| Rate for Payer: Cash Price |
$364.80
|
| Rate for Payer: Cash Price |
$364.80
|
| Rate for Payer: Cash Price |
$364.80
|
| Rate for Payer: Cigna Commercial |
$1,201.41
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$432.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$469.31
|
| Rate for Payer: Health EOS Commercial |
$1,150.82
|
| Rate for Payer: HFN Commercial |
$1,201.41
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,503.61
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,503.61
|
| Rate for Payer: Independent Care Health Plan Medicare |
$469.31
|
| Rate for Payer: Multiplan Commercial |
$1,011.71
|
| Rate for Payer: NAPHCARE Commercial |
$703.97
|
| Rate for Payer: Preferred Network Access Commercial |
$1,201.41
|
| Rate for Payer: Quartz Beloit One Network |
$556.44
|
| Rate for Payer: Quartz Commercial |
$720.84
|
| Rate for Payer: Quartz Medicare Advantage |
$469.31
|
| Rate for Payer: The Alliance Commercial |
$1,994.57
|
| Rate for Payer: United Healthcare Medicaid |
$432.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$469.31
|
| Rate for Payer: WEA Trust Commercial |
$695.55
|
| Rate for Payer: WPS Commercial |
$2,111.90
|
|
|
CLTX POST ANKLE FX 27767
|
Professional
|
Both
|
$781.00
|
|
|
Service Code
|
CPT 27767
|
| Hospital Charge Code |
3014147
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$184.63 |
| Max. Negotiated Rate |
$1,315.88 |
| Rate for Payer: Aetna Commercial |
$771.63
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$698.53
|
| Rate for Payer: Aetna Managed Medicare |
$292.42
|
| Rate for Payer: Anthem Medicare Advantage |
$292.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$292.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$292.42
|
| Rate for Payer: Cash Price |
$234.30
|
| Rate for Payer: Cash Price |
$234.30
|
| Rate for Payer: Cash Price |
$234.30
|
| Rate for Payer: Cigna Commercial |
$771.63
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$184.63
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$292.42
|
| Rate for Payer: Health EOS Commercial |
$739.14
|
| Rate for Payer: HFN Commercial |
$771.63
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,015.24
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,015.24
|
| Rate for Payer: Independent Care Health Plan Medicare |
$292.42
|
| Rate for Payer: Multiplan Commercial |
$649.79
|
| Rate for Payer: NAPHCARE Commercial |
$438.63
|
| Rate for Payer: Preferred Network Access Commercial |
$771.63
|
| Rate for Payer: Quartz Beloit One Network |
$357.39
|
| Rate for Payer: Quartz Commercial |
$462.98
|
| Rate for Payer: Quartz Medicare Advantage |
$292.42
|
| Rate for Payer: The Alliance Commercial |
$1,242.77
|
| Rate for Payer: United Healthcare Medicaid |
$184.63
|
| Rate for Payer: United Healthcare Medicare Advantage |
$292.42
|
| Rate for Payer: WEA Trust Commercial |
$446.73
|
| Rate for Payer: WPS Commercial |
$1,315.88
|
|
|
CLUB FOOT DEFORMITY REPAIR
|
Facility
|
IP
|
$4,560.00
|
|
| Hospital Charge Code |
2959935
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,323.78 |
| Max. Negotiated Rate |
$4,363.01 |
| Rate for Payer: Aetna Commercial |
$4,268.16
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,078.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,513.47
|
| Rate for Payer: Cash Price |
$1,368.00
|
| Rate for Payer: Cigna Commercial |
$4,363.01
|
| Rate for Payer: Health EOS Commercial |
$4,220.74
|
| Rate for Payer: HFN Commercial |
$4,363.01
|
| Rate for Payer: Multiplan Commercial |
$3,793.92
|
| Rate for Payer: Preferred Network Access Commercial |
$4,363.01
|
| Rate for Payer: Quartz Beloit One Network |
$2,323.78
|
| Rate for Payer: Quartz Commercial |
$2,845.44
|
| Rate for Payer: WEA Trust Commercial |
$2,608.32
|
| Rate for Payer: WPS Commercial |
$3,512.57
|
|
|
CLUB FOOT DEFORMITY REPAIR
|
Facility
|
OP
|
$4,560.00
|
|
| Hospital Charge Code |
2959935
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,327.87 |
| Max. Negotiated Rate |
$4,363.01 |
| Rate for Payer: Aetna Commercial |
$4,268.16
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,078.46
|
| Rate for Payer: Aetna Managed Medicare |
$1,327.87
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,082.56
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,371.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,276.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,513.47
|
| Rate for Payer: Cash Price |
$1,368.00
|
| Rate for Payer: Cigna Commercial |
$4,363.01
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,653.92
|
| Rate for Payer: Health EOS Commercial |
$4,220.74
|
| Rate for Payer: HFN Commercial |
$4,363.01
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,556.80
|
| Rate for Payer: Multiplan Commercial |
$3,793.92
|
| Rate for Payer: NAPHCARE Commercial |
$2,845.44
|
| Rate for Payer: Preferred Network Access Commercial |
$4,363.01
|
| Rate for Payer: Quartz Beloit One Network |
$2,323.78
|
| Rate for Payer: Quartz Commercial |
$3,082.56
|
| Rate for Payer: Quartz Medicare Advantage |
$2,845.44
|
| Rate for Payer: The Alliance Commercial |
$2,371.20
|
| Rate for Payer: WEA Trust Commercial |
$2,608.32
|
| Rate for Payer: WPS Commercial |
$3,512.57
|
|
|
Cmptr ophth dx img ant segmt 92132
|
Professional
|
Both
|
$98.00
|
|
|
Service Code
|
CPT 92132
|
| Hospital Charge Code |
3015326
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$27.12 |
| Max. Negotiated Rate |
$118.31 |
| Rate for Payer: Aetna Commercial |
$96.82
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$87.65
|
| Rate for Payer: Aetna Managed Medicare |
$29.58
|
| Rate for Payer: Anthem Medicare Advantage |
$29.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$29.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$29.58
|
| Rate for Payer: Cash Price |
$29.40
|
| Rate for Payer: Cash Price |
$29.40
|
| Rate for Payer: Cash Price |
$29.40
|
| Rate for Payer: Cigna Commercial |
$96.82
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$27.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$29.58
|
| Rate for Payer: Health EOS Commercial |
$92.75
|
| Rate for Payer: HFN Commercial |
$96.82
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$111.60
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$111.60
|
| Rate for Payer: Independent Care Health Plan Medicare |
$29.58
|
| Rate for Payer: Multiplan Commercial |
$81.54
|
| Rate for Payer: NAPHCARE Commercial |
$44.37
|
| Rate for Payer: Preferred Network Access Commercial |
$96.82
|
| Rate for Payer: Quartz Beloit One Network |
$44.84
|
| Rate for Payer: Quartz Commercial |
$58.09
|
| Rate for Payer: Quartz Medicare Advantage |
$29.58
|
| Rate for Payer: The Alliance Commercial |
$73.94
|
| Rate for Payer: United Healthcare Medicaid |
$27.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$29.58
|
| Rate for Payer: WEA Trust Commercial |
$56.06
|
| Rate for Payer: WPS Commercial |
$118.31
|
|
|
Cmptr ophth dx img ant segmt 9213226
|
Professional
|
Both
|
$98.00
|
|
|
Service Code
|
CPT 92132 26
|
| Hospital Charge Code |
3015327
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$15.49 |
| Max. Negotiated Rate |
$96.82 |
| Rate for Payer: Aetna Commercial |
$96.82
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$87.65
|
| Rate for Payer: Aetna Managed Medicare |
$15.49
|
| Rate for Payer: Anthem Medicare Advantage |
$15.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$15.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$15.49
|
| Rate for Payer: Cash Price |
$29.40
|
| Rate for Payer: Cash Price |
$29.40
|
| Rate for Payer: Cash Price |
$29.40
|
| Rate for Payer: Cigna Commercial |
$96.82
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$15.71
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$15.49
|
| Rate for Payer: Health EOS Commercial |
$92.75
|
| Rate for Payer: HFN Commercial |
$96.82
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$58.12
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$58.12
|
| Rate for Payer: Independent Care Health Plan Medicare |
$15.49
|
| Rate for Payer: Multiplan Commercial |
$81.54
|
| Rate for Payer: NAPHCARE Commercial |
$23.23
|
| Rate for Payer: Preferred Network Access Commercial |
$96.82
|
| Rate for Payer: Quartz Beloit One Network |
$44.84
|
| Rate for Payer: Quartz Commercial |
$58.09
|
| Rate for Payer: Quartz Medicare Advantage |
$15.49
|
| Rate for Payer: The Alliance Commercial |
$38.71
|
| Rate for Payer: United Healthcare Medicaid |
$15.71
|
| Rate for Payer: United Healthcare Medicare Advantage |
$15.49
|
| Rate for Payer: WEA Trust Commercial |
$56.06
|
| Rate for Payer: WPS Commercial |
$61.94
|
|
|
CMS SCORING ASSISTANT
|
Facility
|
IP
|
$6,397.00
|
|
| Hospital Charge Code |
2973707
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$3,259.91 |
| Max. Negotiated Rate |
$6,120.65 |
| Rate for Payer: Aetna Commercial |
$5,987.59
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,721.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,526.03
|
| Rate for Payer: Cash Price |
$1,919.10
|
| Rate for Payer: Cigna Commercial |
$6,120.65
|
| Rate for Payer: Health EOS Commercial |
$5,921.06
|
| Rate for Payer: HFN Commercial |
$6,120.65
|
| Rate for Payer: Multiplan Commercial |
$5,322.30
|
| Rate for Payer: Preferred Network Access Commercial |
$6,120.65
|
| Rate for Payer: Quartz Beloit One Network |
$3,259.91
|
| Rate for Payer: Quartz Commercial |
$3,991.73
|
| Rate for Payer: WEA Trust Commercial |
$3,659.08
|
| Rate for Payer: WPS Commercial |
$4,927.61
|
|
|
CMS SCORING ASSISTANT
|
Facility
|
OP
|
$6,397.00
|
|
| Hospital Charge Code |
2973707
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$1,862.81 |
| Max. Negotiated Rate |
$6,120.65 |
| Rate for Payer: Aetna Commercial |
$5,987.59
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,721.48
|
| Rate for Payer: Aetna Managed Medicare |
$1,862.81
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,324.37
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,326.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,193.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,526.03
|
| Rate for Payer: Cash Price |
$1,919.10
|
| Rate for Payer: Cigna Commercial |
$6,120.65
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,723.05
|
| Rate for Payer: Health EOS Commercial |
$5,921.06
|
| Rate for Payer: HFN Commercial |
$6,120.65
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,989.66
|
| Rate for Payer: Multiplan Commercial |
$5,322.30
|
| Rate for Payer: NAPHCARE Commercial |
$3,991.73
|
| Rate for Payer: Preferred Network Access Commercial |
$6,120.65
|
| Rate for Payer: Quartz Beloit One Network |
$3,259.91
|
| Rate for Payer: Quartz Commercial |
$4,324.37
|
| Rate for Payer: Quartz Medicare Advantage |
$3,991.73
|
| Rate for Payer: The Alliance Commercial |
$3,326.44
|
| Rate for Payer: WEA Trust Commercial |
$3,659.08
|
| Rate for Payer: WPS Commercial |
$4,927.61
|
|
|
CMV Ab IgM, CSF
|
Facility
|
IP
|
$69.00
|
|
|
Service Code
|
CPT 86645
|
| Hospital Charge Code |
4597184
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$35.16 |
| Max. Negotiated Rate |
$66.02 |
| Rate for Payer: Aetna Commercial |
$64.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$61.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$38.03
|
| Rate for Payer: Cash Price |
$20.70
|
| Rate for Payer: Cigna Commercial |
$66.02
|
| Rate for Payer: Health EOS Commercial |
$63.87
|
| Rate for Payer: HFN Commercial |
$66.02
|
| Rate for Payer: Multiplan Commercial |
$57.41
|
| Rate for Payer: Preferred Network Access Commercial |
$66.02
|
| Rate for Payer: Quartz Beloit One Network |
$35.16
|
| Rate for Payer: Quartz Commercial |
$43.06
|
| Rate for Payer: WEA Trust Commercial |
$39.47
|
| Rate for Payer: WPS Commercial |
$53.15
|
|
|
CMV Ab IgM, CSF
|
Facility
|
OP
|
$69.00
|
|
|
Service Code
|
CPT 86645
|
| Hospital Charge Code |
4597184
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.52 |
| Max. Negotiated Rate |
$70.10 |
| Rate for Payer: Aetna Commercial |
$64.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$61.71
|
| Rate for Payer: Aetna Managed Medicare |
$17.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$65.72
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$30.67
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$29.09
|
| Rate for Payer: Anthem Medicare Advantage |
$17.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$38.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$17.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$17.52
|
| Rate for Payer: Cash Price |
$20.70
|
| Rate for Payer: Cash Price |
$20.70
|
| Rate for Payer: Cigna Commercial |
$66.02
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$17.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$40.16
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$17.52
|
| Rate for Payer: Health EOS Commercial |
$63.87
|
| Rate for Payer: HFN Commercial |
$66.02
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$65.19
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$17.52
|
| Rate for Payer: Independent Care Health Plan Medicare |
$17.52
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$17.52
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$17.52
|
| Rate for Payer: Multiplan Commercial |
$57.41
|
| Rate for Payer: NAPHCARE Commercial |
$26.29
|
| Rate for Payer: Preferred Network Access Commercial |
$66.02
|
| Rate for Payer: Quartz Beloit One Network |
$35.16
|
| Rate for Payer: Quartz Commercial |
$46.64
|
| Rate for Payer: Quartz Medicare Advantage |
$17.52
|
| Rate for Payer: The Alliance Commercial |
$70.10
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17.52
|
| Rate for Payer: United Healthcare PPO |
$53.82
|
| Rate for Payer: WEA Trust Commercial |
$39.47
|
| Rate for Payer: Wellcare Medicare |
$17.52
|
| Rate for Payer: WPS Commercial |
$53.15
|
|
|
CMV Ab IgM, CSF
|
Professional
|
Both
|
$69.00
|
|
|
Service Code
|
CPT 86645
|
| Hospital Charge Code |
4597184
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.52 |
| Max. Negotiated Rate |
$77.11 |
| Rate for Payer: Aetna Commercial |
$68.17
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$61.71
|
| Rate for Payer: Aetna Managed Medicare |
$17.52
|
| Rate for Payer: Anthem Medicare Advantage |
$17.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$17.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$17.52
|
| Rate for Payer: Cash Price |
$20.70
|
| Rate for Payer: Cash Price |
$20.70
|
| Rate for Payer: Cigna Commercial |
$68.17
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$35.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$17.52
|
| Rate for Payer: Health EOS Commercial |
$65.30
|
| Rate for Payer: HFN Commercial |
$68.17
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$61.86
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$61.86
|
| Rate for Payer: Independent Care Health Plan Medicare |
$17.52
|
| Rate for Payer: Multiplan Commercial |
$57.41
|
| Rate for Payer: NAPHCARE Commercial |
$26.29
|
| Rate for Payer: Preferred Network Access Commercial |
$68.17
|
| Rate for Payer: Quartz Beloit One Network |
$31.57
|
| Rate for Payer: Quartz Commercial |
$40.90
|
| Rate for Payer: Quartz Medicare Advantage |
$17.52
|
| Rate for Payer: The Alliance Commercial |
$69.22
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17.52
|
| Rate for Payer: WEA Trust Commercial |
$39.47
|
| Rate for Payer: WPS Commercial |
$77.11
|
|
|
CMV Antibody IgM
|
Facility
|
OP
|
$102.00
|
|
|
Service Code
|
CPT 86645
|
| Hospital Charge Code |
2943018
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.52 |
| Max. Negotiated Rate |
$97.59 |
| Rate for Payer: Aetna Commercial |
$95.47
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$91.23
|
| Rate for Payer: Aetna Managed Medicare |
$17.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$65.72
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$30.67
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$29.09
|
| Rate for Payer: Anthem Medicare Advantage |
$17.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$56.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$17.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$17.52
|
| Rate for Payer: Cash Price |
$30.60
|
| Rate for Payer: Cash Price |
$30.60
|
| Rate for Payer: Cigna Commercial |
$97.59
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$17.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$59.36
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$17.52
|
| Rate for Payer: Health EOS Commercial |
$94.41
|
| Rate for Payer: HFN Commercial |
$97.59
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$65.19
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$17.52
|
| Rate for Payer: Independent Care Health Plan Medicare |
$17.52
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$17.52
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$17.52
|
| Rate for Payer: Multiplan Commercial |
$84.86
|
| Rate for Payer: NAPHCARE Commercial |
$26.29
|
| Rate for Payer: Preferred Network Access Commercial |
$97.59
|
| Rate for Payer: Quartz Beloit One Network |
$51.98
|
| Rate for Payer: Quartz Commercial |
$68.95
|
| Rate for Payer: Quartz Medicare Advantage |
$17.52
|
| Rate for Payer: The Alliance Commercial |
$70.10
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17.52
|
| Rate for Payer: United Healthcare PPO |
$79.56
|
| Rate for Payer: WEA Trust Commercial |
$58.34
|
| Rate for Payer: Wellcare Medicare |
$17.52
|
| Rate for Payer: WPS Commercial |
$78.57
|
|
|
CMV Antibody IgM
|
Professional
|
Both
|
$102.00
|
|
|
Service Code
|
CPT 86645
|
| Hospital Charge Code |
2943018
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.52 |
| Max. Negotiated Rate |
$100.78 |
| Rate for Payer: Aetna Commercial |
$100.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$91.23
|
| Rate for Payer: Aetna Managed Medicare |
$17.52
|
| Rate for Payer: Anthem Medicare Advantage |
$17.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$17.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$17.52
|
| Rate for Payer: Cash Price |
$30.60
|
| Rate for Payer: Cash Price |
$30.60
|
| Rate for Payer: Cigna Commercial |
$100.78
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$53.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$17.52
|
| Rate for Payer: Health EOS Commercial |
$96.53
|
| Rate for Payer: HFN Commercial |
$100.78
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$61.86
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$61.86
|
| Rate for Payer: Independent Care Health Plan Medicare |
$17.52
|
| Rate for Payer: Multiplan Commercial |
$84.86
|
| Rate for Payer: NAPHCARE Commercial |
$26.29
|
| Rate for Payer: Preferred Network Access Commercial |
$100.78
|
| Rate for Payer: Quartz Beloit One Network |
$46.68
|
| Rate for Payer: Quartz Commercial |
$60.47
|
| Rate for Payer: Quartz Medicare Advantage |
$17.52
|
| Rate for Payer: The Alliance Commercial |
$69.22
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17.52
|
| Rate for Payer: WEA Trust Commercial |
$58.34
|
| Rate for Payer: WPS Commercial |
$77.11
|
|
|
CMV Antibody IgM
|
Facility
|
IP
|
$102.00
|
|
|
Service Code
|
CPT 86645
|
| Hospital Charge Code |
2943018
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$51.98 |
| Max. Negotiated Rate |
$97.59 |
| Rate for Payer: Aetna Commercial |
$95.47
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$91.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$56.22
|
| Rate for Payer: Cash Price |
$30.60
|
| Rate for Payer: Cigna Commercial |
$97.59
|
| Rate for Payer: Health EOS Commercial |
$94.41
|
| Rate for Payer: HFN Commercial |
$97.59
|
| Rate for Payer: Multiplan Commercial |
$84.86
|
| Rate for Payer: Preferred Network Access Commercial |
$97.59
|
| Rate for Payer: Quartz Beloit One Network |
$51.98
|
| Rate for Payer: Quartz Commercial |
$63.65
|
| Rate for Payer: WEA Trust Commercial |
$58.34
|
| Rate for Payer: WPS Commercial |
$78.57
|
|
|
CMV Genotype
|
Professional
|
Both
|
$704.00
|
|
|
Service Code
|
CPT 87910
|
| Hospital Charge Code |
4732608
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$267.75 |
| Max. Negotiated Rate |
$1,178.09 |
| Rate for Payer: Aetna Commercial |
$695.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$629.66
|
| Rate for Payer: Aetna Managed Medicare |
$267.75
|
| Rate for Payer: Anthem Medicare Advantage |
$267.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$267.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$267.75
|
| Rate for Payer: Cash Price |
$211.20
|
| Rate for Payer: Cash Price |
$211.20
|
| Rate for Payer: Cigna Commercial |
$695.55
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$366.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$267.75
|
| Rate for Payer: Health EOS Commercial |
$666.27
|
| Rate for Payer: HFN Commercial |
$695.55
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$945.15
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$945.15
|
| Rate for Payer: Independent Care Health Plan Medicare |
$267.75
|
| Rate for Payer: Multiplan Commercial |
$585.73
|
| Rate for Payer: NAPHCARE Commercial |
$401.62
|
| Rate for Payer: Preferred Network Access Commercial |
$695.55
|
| Rate for Payer: Quartz Beloit One Network |
$322.15
|
| Rate for Payer: Quartz Commercial |
$417.33
|
| Rate for Payer: Quartz Medicare Advantage |
$267.75
|
| Rate for Payer: The Alliance Commercial |
$1,057.60
|
| Rate for Payer: United Healthcare Medicare Advantage |
$267.75
|
| Rate for Payer: WEA Trust Commercial |
$402.69
|
| Rate for Payer: WPS Commercial |
$1,178.09
|
|
