|
CRYOVEIN SAPHENOUS VEIN V010
|
Facility
|
OP
|
$41,836.00
|
|
| Hospital Charge Code |
3669501
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$12,182.64 |
| Max. Negotiated Rate |
$40,028.68 |
| Rate for Payer: Aetna Commercial |
$39,158.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$37,418.12
|
| Rate for Payer: Aetna Managed Medicare |
$12,182.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$28,281.14
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$21,754.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$20,884.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$23,060.00
|
| Rate for Payer: Cash Price |
$12,550.80
|
| Rate for Payer: Cigna Commercial |
$40,028.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$24,348.55
|
| Rate for Payer: Health EOS Commercial |
$38,723.40
|
| Rate for Payer: HFN Commercial |
$40,028.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$32,632.08
|
| Rate for Payer: Multiplan Commercial |
$34,807.55
|
| Rate for Payer: NAPHCARE Commercial |
$26,105.66
|
| Rate for Payer: Preferred Network Access Commercial |
$40,028.68
|
| Rate for Payer: Quartz Beloit One Network |
$21,319.63
|
| Rate for Payer: Quartz Commercial |
$28,281.14
|
| Rate for Payer: Quartz Medicare Advantage |
$26,105.66
|
| Rate for Payer: The Alliance Commercial |
$21,754.72
|
| Rate for Payer: WEA Trust Commercial |
$23,930.19
|
| Rate for Payer: WPS Commercial |
$32,226.27
|
|
|
.Cryptococcal Ag Latex Titer
|
Facility
|
OP
|
$132.00
|
|
|
Service Code
|
CPT 86406
|
| Hospital Charge Code |
4614609
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.07 |
| Max. Negotiated Rate |
$126.30 |
| Rate for Payer: Aetna Commercial |
$123.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$118.06
|
| Rate for Payer: Aetna Managed Medicare |
$11.07
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$41.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$19.36
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$18.37
|
| Rate for Payer: Anthem Medicare Advantage |
$11.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$72.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$11.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$11.07
|
| Rate for Payer: Cash Price |
$39.60
|
| Rate for Payer: Cash Price |
$39.60
|
| Rate for Payer: Cigna Commercial |
$126.30
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$11.07
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$76.82
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$11.07
|
| Rate for Payer: Health EOS Commercial |
$122.18
|
| Rate for Payer: HFN Commercial |
$126.30
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$41.16
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$11.07
|
| Rate for Payer: Independent Care Health Plan Medicare |
$11.07
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$11.07
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$11.07
|
| Rate for Payer: Multiplan Commercial |
$109.82
|
| Rate for Payer: NAPHCARE Commercial |
$16.60
|
| Rate for Payer: Preferred Network Access Commercial |
$126.30
|
| Rate for Payer: Quartz Beloit One Network |
$67.27
|
| Rate for Payer: Quartz Commercial |
$89.23
|
| Rate for Payer: Quartz Medicare Advantage |
$11.07
|
| Rate for Payer: The Alliance Commercial |
$44.26
|
| Rate for Payer: United Healthcare Medicare Advantage |
$11.07
|
| Rate for Payer: United Healthcare PPO |
$102.96
|
| Rate for Payer: WEA Trust Commercial |
$75.50
|
| Rate for Payer: Wellcare Medicare |
$11.07
|
| Rate for Payer: WPS Commercial |
$101.68
|
|
|
.Cryptococcal Ag Latex Titer
|
Professional
|
Both
|
$132.00
|
|
|
Service Code
|
CPT 86406
|
| Hospital Charge Code |
4614609
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.07 |
| Max. Negotiated Rate |
$130.42 |
| Rate for Payer: Aetna Commercial |
$130.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$118.06
|
| Rate for Payer: Aetna Managed Medicare |
$11.07
|
| Rate for Payer: Anthem Medicare Advantage |
$11.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$11.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$11.07
|
| Rate for Payer: Cash Price |
$39.60
|
| Rate for Payer: Cash Price |
$39.60
|
| Rate for Payer: Cigna Commercial |
$130.42
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$68.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$11.07
|
| Rate for Payer: Health EOS Commercial |
$124.92
|
| Rate for Payer: HFN Commercial |
$130.42
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$39.06
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$39.06
|
| Rate for Payer: Independent Care Health Plan Medicare |
$11.07
|
| Rate for Payer: Multiplan Commercial |
$109.82
|
| Rate for Payer: NAPHCARE Commercial |
$16.60
|
| Rate for Payer: Preferred Network Access Commercial |
$130.42
|
| Rate for Payer: Quartz Beloit One Network |
$60.40
|
| Rate for Payer: Quartz Commercial |
$78.25
|
| Rate for Payer: Quartz Medicare Advantage |
$11.07
|
| Rate for Payer: The Alliance Commercial |
$43.71
|
| Rate for Payer: United Healthcare Medicare Advantage |
$11.07
|
| Rate for Payer: WEA Trust Commercial |
$75.50
|
| Rate for Payer: WPS Commercial |
$48.69
|
|
|
.Cryptococcal Ag Latex Titer
|
Facility
|
IP
|
$132.00
|
|
|
Service Code
|
CPT 86406
|
| Hospital Charge Code |
4614609
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$67.27 |
| Max. Negotiated Rate |
$126.30 |
| Rate for Payer: Aetna Commercial |
$123.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$118.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$72.76
|
| Rate for Payer: Cash Price |
$39.60
|
| Rate for Payer: Cigna Commercial |
$126.30
|
| Rate for Payer: Health EOS Commercial |
$122.18
|
| Rate for Payer: HFN Commercial |
$126.30
|
| Rate for Payer: Multiplan Commercial |
$109.82
|
| Rate for Payer: Preferred Network Access Commercial |
$126.30
|
| Rate for Payer: Quartz Beloit One Network |
$67.27
|
| Rate for Payer: Quartz Commercial |
$82.37
|
| Rate for Payer: WEA Trust Commercial |
$75.50
|
| Rate for Payer: WPS Commercial |
$101.68
|
|
|
Cryptococcal Antigen, Screen w/ Rfx Titer
|
Facility
|
IP
|
$285.00
|
|
|
Service Code
|
CPT 87327
|
| Hospital Charge Code |
977916
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$145.24 |
| Max. Negotiated Rate |
$272.69 |
| Rate for Payer: Aetna Commercial |
$266.76
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$254.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$157.09
|
| Rate for Payer: Cash Price |
$85.50
|
| Rate for Payer: Cigna Commercial |
$272.69
|
| Rate for Payer: Health EOS Commercial |
$263.80
|
| Rate for Payer: HFN Commercial |
$272.69
|
| Rate for Payer: Multiplan Commercial |
$237.12
|
| Rate for Payer: Preferred Network Access Commercial |
$272.69
|
| Rate for Payer: Quartz Beloit One Network |
$145.24
|
| Rate for Payer: Quartz Commercial |
$177.84
|
| Rate for Payer: WEA Trust Commercial |
$163.02
|
| Rate for Payer: WPS Commercial |
$219.54
|
|
|
Cryptococcal Antigen, Screen w/ Rfx Titer
|
Professional
|
Both
|
$285.00
|
|
|
Service Code
|
CPT 87327
|
| Hospital Charge Code |
977916
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.96 |
| Max. Negotiated Rate |
$281.58 |
| Rate for Payer: Dean Health DHI/DHP/ASO |
$13.96
|
| Rate for Payer: Aetna Commercial |
$281.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$254.90
|
| Rate for Payer: Aetna Managed Medicare |
$13.96
|
| Rate for Payer: Anthem Medicare Advantage |
$13.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$13.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$13.96
|
| Rate for Payer: Cash Price |
$85.50
|
| Rate for Payer: Cash Price |
$85.50
|
| Rate for Payer: Cigna Commercial |
$281.58
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$148.20
|
| Rate for Payer: Health EOS Commercial |
$269.72
|
| Rate for Payer: HFN Commercial |
$281.58
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$49.26
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$49.26
|
| Rate for Payer: Independent Care Health Plan Medicare |
$13.96
|
| Rate for Payer: Multiplan Commercial |
$237.12
|
| Rate for Payer: NAPHCARE Commercial |
$20.94
|
| Rate for Payer: Preferred Network Access Commercial |
$281.58
|
| Rate for Payer: Quartz Beloit One Network |
$130.42
|
| Rate for Payer: Quartz Commercial |
$168.95
|
| Rate for Payer: Quartz Medicare Advantage |
$13.96
|
| Rate for Payer: The Alliance Commercial |
$55.13
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.96
|
| Rate for Payer: WEA Trust Commercial |
$163.02
|
| Rate for Payer: WPS Commercial |
$61.41
|
|
|
Cryptococcal Antigen, Screen w/ Rfx Titer
|
Facility
|
OP
|
$285.00
|
|
|
Service Code
|
CPT 87327
|
| Hospital Charge Code |
977916
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.96 |
| Max. Negotiated Rate |
$272.69 |
| Rate for Payer: Aetna Commercial |
$266.76
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$254.90
|
| Rate for Payer: Aetna Managed Medicare |
$13.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$52.34
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$24.42
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$23.17
|
| Rate for Payer: Anthem Medicare Advantage |
$13.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$157.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$13.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$13.96
|
| Rate for Payer: Cash Price |
$85.50
|
| Rate for Payer: Cash Price |
$85.50
|
| Rate for Payer: Cigna Commercial |
$272.69
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$13.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$165.87
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$13.96
|
| Rate for Payer: Health EOS Commercial |
$263.80
|
| Rate for Payer: HFN Commercial |
$272.69
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$51.92
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$13.96
|
| Rate for Payer: Independent Care Health Plan Medicare |
$13.96
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$13.96
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$13.96
|
| Rate for Payer: Multiplan Commercial |
$237.12
|
| Rate for Payer: NAPHCARE Commercial |
$20.94
|
| Rate for Payer: Preferred Network Access Commercial |
$272.69
|
| Rate for Payer: Quartz Beloit One Network |
$145.24
|
| Rate for Payer: Quartz Commercial |
$192.66
|
| Rate for Payer: Quartz Medicare Advantage |
$13.96
|
| Rate for Payer: The Alliance Commercial |
$55.83
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.96
|
| Rate for Payer: United Healthcare PPO |
$222.30
|
| Rate for Payer: WEA Trust Commercial |
$163.02
|
| Rate for Payer: Wellcare Medicare |
$13.96
|
| Rate for Payer: WPS Commercial |
$219.54
|
|
|
Cryptosp Ag
|
Professional
|
Both
|
$159.00
|
|
|
Service Code
|
CPT 87328
|
| Hospital Charge Code |
979860
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.37 |
| Max. Negotiated Rate |
$157.09 |
| Rate for Payer: Aetna Commercial |
$157.09
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$142.21
|
| Rate for Payer: Aetna Managed Medicare |
$14.37
|
| Rate for Payer: Anthem Medicare Advantage |
$14.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$14.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$14.37
|
| Rate for Payer: Cash Price |
$47.70
|
| Rate for Payer: Cash Price |
$47.70
|
| Rate for Payer: Cigna Commercial |
$157.09
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$82.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$14.37
|
| Rate for Payer: Health EOS Commercial |
$150.48
|
| Rate for Payer: HFN Commercial |
$157.09
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$50.73
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$50.73
|
| Rate for Payer: Independent Care Health Plan Medicare |
$14.37
|
| Rate for Payer: Multiplan Commercial |
$132.29
|
| Rate for Payer: NAPHCARE Commercial |
$21.56
|
| Rate for Payer: Preferred Network Access Commercial |
$157.09
|
| Rate for Payer: Quartz Beloit One Network |
$72.76
|
| Rate for Payer: Quartz Commercial |
$94.26
|
| Rate for Payer: Quartz Medicare Advantage |
$14.37
|
| Rate for Payer: The Alliance Commercial |
$56.77
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14.37
|
| Rate for Payer: WEA Trust Commercial |
$90.95
|
| Rate for Payer: WPS Commercial |
$63.24
|
|
|
Cryptosp Ag
|
Facility
|
IP
|
$159.00
|
|
|
Service Code
|
CPT 87328
|
| Hospital Charge Code |
979860
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$81.03 |
| Max. Negotiated Rate |
$152.13 |
| Rate for Payer: Aetna Commercial |
$148.82
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$142.21
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$87.64
|
| Rate for Payer: Cash Price |
$47.70
|
| Rate for Payer: Cigna Commercial |
$152.13
|
| Rate for Payer: Health EOS Commercial |
$147.17
|
| Rate for Payer: HFN Commercial |
$152.13
|
| Rate for Payer: Multiplan Commercial |
$132.29
|
| Rate for Payer: Preferred Network Access Commercial |
$152.13
|
| Rate for Payer: Quartz Beloit One Network |
$81.03
|
| Rate for Payer: Quartz Commercial |
$99.22
|
| Rate for Payer: WEA Trust Commercial |
$90.95
|
| Rate for Payer: WPS Commercial |
$122.48
|
|
|
Cryptosp Ag
|
Facility
|
OP
|
$159.00
|
|
|
Service Code
|
CPT 87328
|
| Hospital Charge Code |
979860
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.37 |
| Max. Negotiated Rate |
$152.13 |
| Rate for Payer: Aetna Commercial |
$148.82
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$142.21
|
| Rate for Payer: Aetna Managed Medicare |
$14.37
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$53.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$25.15
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$23.86
|
| Rate for Payer: Anthem Medicare Advantage |
$14.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$87.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$14.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$14.37
|
| Rate for Payer: Cash Price |
$47.70
|
| Rate for Payer: Cash Price |
$47.70
|
| Rate for Payer: Cigna Commercial |
$152.13
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$14.37
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$92.54
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$14.37
|
| Rate for Payer: Health EOS Commercial |
$147.17
|
| Rate for Payer: HFN Commercial |
$152.13
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$53.47
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$14.37
|
| Rate for Payer: Independent Care Health Plan Medicare |
$14.37
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$14.37
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$14.37
|
| Rate for Payer: Multiplan Commercial |
$132.29
|
| Rate for Payer: NAPHCARE Commercial |
$21.56
|
| Rate for Payer: Preferred Network Access Commercial |
$152.13
|
| Rate for Payer: Quartz Beloit One Network |
$81.03
|
| Rate for Payer: Quartz Commercial |
$107.48
|
| Rate for Payer: Quartz Medicare Advantage |
$14.37
|
| Rate for Payer: The Alliance Commercial |
$57.49
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14.37
|
| Rate for Payer: United Healthcare PPO |
$124.02
|
| Rate for Payer: WEA Trust Commercial |
$90.95
|
| Rate for Payer: Wellcare Medicare |
$14.37
|
| Rate for Payer: WPS Commercial |
$122.48
|
|
|
Cryptosporidium Antigen
|
Facility
|
IP
|
$186.00
|
|
|
Service Code
|
CPT 87272
|
| Hospital Charge Code |
5619697
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$94.79 |
| Max. Negotiated Rate |
$177.96 |
| Rate for Payer: Aetna Commercial |
$174.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$166.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$102.52
|
| Rate for Payer: Cash Price |
$55.80
|
| Rate for Payer: Cigna Commercial |
$177.96
|
| Rate for Payer: Health EOS Commercial |
$172.16
|
| Rate for Payer: HFN Commercial |
$177.96
|
| Rate for Payer: Multiplan Commercial |
$154.75
|
| Rate for Payer: Preferred Network Access Commercial |
$177.96
|
| Rate for Payer: Quartz Beloit One Network |
$94.79
|
| Rate for Payer: Quartz Commercial |
$116.06
|
| Rate for Payer: WEA Trust Commercial |
$106.39
|
| Rate for Payer: WPS Commercial |
$143.28
|
|
|
Cryptosporidium Antigen
|
Facility
|
OP
|
$186.00
|
|
|
Service Code
|
CPT 87272
|
| Hospital Charge Code |
5619697
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.46 |
| Max. Negotiated Rate |
$177.96 |
| Rate for Payer: Aetna Commercial |
$174.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$166.36
|
| Rate for Payer: Aetna Managed Medicare |
$12.46
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$46.72
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$21.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$20.68
|
| Rate for Payer: Anthem Medicare Advantage |
$12.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$102.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$12.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$12.46
|
| Rate for Payer: Cash Price |
$55.80
|
| Rate for Payer: Cash Price |
$55.80
|
| Rate for Payer: Cigna Commercial |
$177.96
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$12.46
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$108.25
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$12.46
|
| Rate for Payer: Health EOS Commercial |
$172.16
|
| Rate for Payer: HFN Commercial |
$177.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$46.35
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$12.46
|
| Rate for Payer: Independent Care Health Plan Medicare |
$12.46
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$12.46
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$12.46
|
| Rate for Payer: Multiplan Commercial |
$154.75
|
| Rate for Payer: NAPHCARE Commercial |
$18.69
|
| Rate for Payer: Preferred Network Access Commercial |
$177.96
|
| Rate for Payer: Quartz Beloit One Network |
$94.79
|
| Rate for Payer: Quartz Commercial |
$125.74
|
| Rate for Payer: Quartz Medicare Advantage |
$12.46
|
| Rate for Payer: The Alliance Commercial |
$49.84
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.46
|
| Rate for Payer: United Healthcare PPO |
$145.08
|
| Rate for Payer: WEA Trust Commercial |
$106.39
|
| Rate for Payer: Wellcare Medicare |
$12.46
|
| Rate for Payer: WPS Commercial |
$143.28
|
|
|
Cryptosporidium Antigen
|
Professional
|
Both
|
$186.00
|
|
|
Service Code
|
CPT 87272
|
| Hospital Charge Code |
5619697
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.46 |
| Max. Negotiated Rate |
$183.77 |
| Rate for Payer: Aetna Commercial |
$183.77
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$166.36
|
| Rate for Payer: Aetna Managed Medicare |
$12.46
|
| Rate for Payer: Anthem Medicare Advantage |
$12.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$12.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$12.46
|
| Rate for Payer: Cash Price |
$55.80
|
| Rate for Payer: Cash Price |
$55.80
|
| Rate for Payer: Cigna Commercial |
$183.77
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$96.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12.46
|
| Rate for Payer: Health EOS Commercial |
$176.03
|
| Rate for Payer: HFN Commercial |
$183.77
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$43.98
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$43.98
|
| Rate for Payer: Independent Care Health Plan Medicare |
$12.46
|
| Rate for Payer: Multiplan Commercial |
$154.75
|
| Rate for Payer: NAPHCARE Commercial |
$18.69
|
| Rate for Payer: Preferred Network Access Commercial |
$183.77
|
| Rate for Payer: Quartz Beloit One Network |
$85.11
|
| Rate for Payer: Quartz Commercial |
$110.26
|
| Rate for Payer: Quartz Medicare Advantage |
$12.46
|
| Rate for Payer: The Alliance Commercial |
$49.21
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.46
|
| Rate for Payer: WEA Trust Commercial |
$106.39
|
| Rate for Payer: WPS Commercial |
$54.82
|
|
|
Crystal Identification By Microscope 89060PP
|
Professional
|
Both
|
$185.00
|
|
|
Service Code
|
CPT 89060
|
| Hospital Charge Code |
3127495
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$7.62 |
| Max. Negotiated Rate |
$182.78 |
| Rate for Payer: Aetna Commercial |
$182.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$165.46
|
| Rate for Payer: Aetna Managed Medicare |
$7.62
|
| Rate for Payer: Anthem Commercial |
$17.27
|
| Rate for Payer: Anthem Medicare Advantage |
$7.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$7.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$7.62
|
| Rate for Payer: Cash Price |
$55.50
|
| Rate for Payer: Cash Price |
$55.50
|
| Rate for Payer: Cigna Commercial |
$182.78
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$96.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$7.62
|
| Rate for Payer: Health EOS Commercial |
$175.08
|
| Rate for Payer: HFN Commercial |
$182.78
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$26.90
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$26.90
|
| Rate for Payer: Independent Care Health Plan Medicare |
$7.62
|
| Rate for Payer: Multiplan Commercial |
$153.92
|
| Rate for Payer: NAPHCARE Commercial |
$11.43
|
| Rate for Payer: Preferred Network Access Commercial |
$182.78
|
| Rate for Payer: Quartz Beloit One Network |
$84.66
|
| Rate for Payer: Quartz Commercial |
$109.67
|
| Rate for Payer: Quartz Medicare Advantage |
$7.62
|
| Rate for Payer: The Alliance Commercial |
$30.11
|
| Rate for Payer: United Healthcare Medicare Advantage |
$7.62
|
| Rate for Payer: WEA Trust Commercial |
$105.82
|
| Rate for Payer: WPS Commercial |
$33.54
|
|
|
Crystal Identification By Microscope POC
|
Professional
|
Both
|
$163.00
|
|
|
Service Code
|
CPT 89060
|
| Hospital Charge Code |
2580819
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$7.62 |
| Max. Negotiated Rate |
$161.04 |
| Rate for Payer: Aetna Commercial |
$161.04
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$145.79
|
| Rate for Payer: Aetna Managed Medicare |
$7.62
|
| Rate for Payer: Anthem Commercial |
$17.27
|
| Rate for Payer: Anthem Medicare Advantage |
$7.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$7.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$7.62
|
| Rate for Payer: Cash Price |
$48.90
|
| Rate for Payer: Cash Price |
$48.90
|
| Rate for Payer: Cigna Commercial |
$161.04
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$84.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$7.62
|
| Rate for Payer: Health EOS Commercial |
$154.26
|
| Rate for Payer: HFN Commercial |
$161.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$26.90
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$26.90
|
| Rate for Payer: Independent Care Health Plan Medicare |
$7.62
|
| Rate for Payer: Multiplan Commercial |
$135.62
|
| Rate for Payer: NAPHCARE Commercial |
$11.43
|
| Rate for Payer: Preferred Network Access Commercial |
$161.04
|
| Rate for Payer: Quartz Beloit One Network |
$74.59
|
| Rate for Payer: Quartz Commercial |
$96.63
|
| Rate for Payer: Quartz Medicare Advantage |
$7.62
|
| Rate for Payer: The Alliance Commercial |
$30.11
|
| Rate for Payer: United Healthcare Medicare Advantage |
$7.62
|
| Rate for Payer: WEA Trust Commercial |
$93.24
|
| Rate for Payer: WPS Commercial |
$33.54
|
|
|
Crystal Identification By Microscope POC
|
Facility
|
OP
|
$163.00
|
|
|
Service Code
|
CPT 89060
|
| Hospital Charge Code |
2580819
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$7.62 |
| Max. Negotiated Rate |
$155.96 |
| Rate for Payer: Aetna Commercial |
$152.57
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$145.79
|
| Rate for Payer: Aetna Managed Medicare |
$7.62
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$28.59
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$13.34
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$12.65
|
| Rate for Payer: Anthem Medicare Advantage |
$7.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$89.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$7.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$7.62
|
| Rate for Payer: Cash Price |
$48.90
|
| Rate for Payer: Cash Price |
$48.90
|
| Rate for Payer: Cigna Commercial |
$155.96
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$7.62
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$94.87
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$7.62
|
| Rate for Payer: Health EOS Commercial |
$150.87
|
| Rate for Payer: HFN Commercial |
$155.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$28.36
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$7.62
|
| Rate for Payer: Independent Care Health Plan Medicare |
$7.62
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$7.62
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$7.62
|
| Rate for Payer: Multiplan Commercial |
$135.62
|
| Rate for Payer: NAPHCARE Commercial |
$11.43
|
| Rate for Payer: Preferred Network Access Commercial |
$155.96
|
| Rate for Payer: Quartz Beloit One Network |
$83.06
|
| Rate for Payer: Quartz Commercial |
$110.19
|
| Rate for Payer: Quartz Medicare Advantage |
$7.62
|
| Rate for Payer: The Alliance Commercial |
$30.49
|
| Rate for Payer: United Healthcare Medicare Advantage |
$7.62
|
| Rate for Payer: United Healthcare PPO |
$127.14
|
| Rate for Payer: WEA Trust Commercial |
$93.24
|
| Rate for Payer: Wellcare Medicare |
$7.62
|
| Rate for Payer: WPS Commercial |
$125.56
|
|
|
Crystal Identification By Microscope POC
|
Facility
|
IP
|
$163.00
|
|
|
Service Code
|
CPT 89060
|
| Hospital Charge Code |
2580819
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$83.06 |
| Max. Negotiated Rate |
$155.96 |
| Rate for Payer: Aetna Commercial |
$152.57
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$145.79
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$89.85
|
| Rate for Payer: Cash Price |
$48.90
|
| Rate for Payer: Cigna Commercial |
$155.96
|
| Rate for Payer: Health EOS Commercial |
$150.87
|
| Rate for Payer: HFN Commercial |
$155.96
|
| Rate for Payer: Multiplan Commercial |
$135.62
|
| Rate for Payer: Preferred Network Access Commercial |
$155.96
|
| Rate for Payer: Quartz Beloit One Network |
$83.06
|
| Rate for Payer: Quartz Commercial |
$101.71
|
| Rate for Payer: WEA Trust Commercial |
$93.24
|
| Rate for Payer: WPS Commercial |
$125.56
|
|
|
Crystals, Fluid
|
Facility
|
IP
|
$163.00
|
|
|
Service Code
|
CPT 89060
|
| Hospital Charge Code |
979851
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$83.06 |
| Max. Negotiated Rate |
$155.96 |
| Rate for Payer: Aetna Commercial |
$152.57
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$145.79
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$89.85
|
| Rate for Payer: Cash Price |
$48.90
|
| Rate for Payer: Cigna Commercial |
$155.96
|
| Rate for Payer: Health EOS Commercial |
$150.87
|
| Rate for Payer: HFN Commercial |
$155.96
|
| Rate for Payer: Multiplan Commercial |
$135.62
|
| Rate for Payer: Preferred Network Access Commercial |
$155.96
|
| Rate for Payer: Quartz Beloit One Network |
$83.06
|
| Rate for Payer: Quartz Commercial |
$101.71
|
| Rate for Payer: WEA Trust Commercial |
$93.24
|
| Rate for Payer: WPS Commercial |
$125.56
|
|
|
Crystals, Fluid
|
Facility
|
OP
|
$163.00
|
|
|
Service Code
|
CPT 89060
|
| Hospital Charge Code |
979851
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$7.62 |
| Max. Negotiated Rate |
$155.96 |
| Rate for Payer: Aetna Commercial |
$152.57
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$145.79
|
| Rate for Payer: Aetna Managed Medicare |
$7.62
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$28.59
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$13.34
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$12.65
|
| Rate for Payer: Anthem Medicare Advantage |
$7.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$89.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$7.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$7.62
|
| Rate for Payer: Cash Price |
$48.90
|
| Rate for Payer: Cash Price |
$48.90
|
| Rate for Payer: Cigna Commercial |
$155.96
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$7.62
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$94.87
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$7.62
|
| Rate for Payer: Health EOS Commercial |
$150.87
|
| Rate for Payer: HFN Commercial |
$155.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$28.36
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$7.62
|
| Rate for Payer: Independent Care Health Plan Medicare |
$7.62
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$7.62
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$7.62
|
| Rate for Payer: Multiplan Commercial |
$135.62
|
| Rate for Payer: NAPHCARE Commercial |
$11.43
|
| Rate for Payer: Preferred Network Access Commercial |
$155.96
|
| Rate for Payer: Quartz Beloit One Network |
$83.06
|
| Rate for Payer: Quartz Commercial |
$110.19
|
| Rate for Payer: Quartz Medicare Advantage |
$7.62
|
| Rate for Payer: The Alliance Commercial |
$30.49
|
| Rate for Payer: United Healthcare Medicare Advantage |
$7.62
|
| Rate for Payer: United Healthcare PPO |
$127.14
|
| Rate for Payer: WEA Trust Commercial |
$93.24
|
| Rate for Payer: Wellcare Medicare |
$7.62
|
| Rate for Payer: WPS Commercial |
$125.56
|
|
|
Crystals, Fluid
|
Professional
|
Both
|
$163.00
|
|
|
Service Code
|
CPT 89060
|
| Hospital Charge Code |
979851
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$7.62 |
| Max. Negotiated Rate |
$161.04 |
| Rate for Payer: Aetna Commercial |
$161.04
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$145.79
|
| Rate for Payer: Aetna Managed Medicare |
$7.62
|
| Rate for Payer: Anthem Commercial |
$17.27
|
| Rate for Payer: Anthem Medicare Advantage |
$7.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$7.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$7.62
|
| Rate for Payer: Cash Price |
$48.90
|
| Rate for Payer: Cash Price |
$48.90
|
| Rate for Payer: Cigna Commercial |
$161.04
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$84.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$7.62
|
| Rate for Payer: Health EOS Commercial |
$154.26
|
| Rate for Payer: HFN Commercial |
$161.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$26.90
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$26.90
|
| Rate for Payer: Independent Care Health Plan Medicare |
$7.62
|
| Rate for Payer: Multiplan Commercial |
$135.62
|
| Rate for Payer: NAPHCARE Commercial |
$11.43
|
| Rate for Payer: Preferred Network Access Commercial |
$161.04
|
| Rate for Payer: Quartz Beloit One Network |
$74.59
|
| Rate for Payer: Quartz Commercial |
$96.63
|
| Rate for Payer: Quartz Medicare Advantage |
$7.62
|
| Rate for Payer: The Alliance Commercial |
$30.11
|
| Rate for Payer: United Healthcare Medicare Advantage |
$7.62
|
| Rate for Payer: WEA Trust Commercial |
$93.24
|
| Rate for Payer: WPS Commercial |
$33.54
|
|
|
CSF LEAK REPAIR
|
Facility
|
IP
|
$7,388.00
|
|
| Hospital Charge Code |
2959972
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,764.92 |
| Max. Negotiated Rate |
$7,068.84 |
| Rate for Payer: Aetna Commercial |
$6,915.17
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,607.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,072.27
|
| Rate for Payer: Cash Price |
$2,216.40
|
| Rate for Payer: Cigna Commercial |
$7,068.84
|
| Rate for Payer: Health EOS Commercial |
$6,838.33
|
| Rate for Payer: HFN Commercial |
$7,068.84
|
| Rate for Payer: Multiplan Commercial |
$6,146.82
|
| Rate for Payer: Preferred Network Access Commercial |
$7,068.84
|
| Rate for Payer: Quartz Beloit One Network |
$3,764.92
|
| Rate for Payer: Quartz Commercial |
$4,610.11
|
| Rate for Payer: WEA Trust Commercial |
$4,225.94
|
| Rate for Payer: WPS Commercial |
$5,690.98
|
|
|
CSF LEAK REPAIR
|
Facility
|
OP
|
$7,388.00
|
|
| Hospital Charge Code |
2959972
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,151.39 |
| Max. Negotiated Rate |
$7,068.84 |
| Rate for Payer: Aetna Commercial |
$6,915.17
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,607.83
|
| Rate for Payer: Aetna Managed Medicare |
$2,151.39
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,994.29
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,841.76
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,688.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,072.27
|
| Rate for Payer: Cash Price |
$2,216.40
|
| Rate for Payer: Cigna Commercial |
$7,068.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,299.82
|
| Rate for Payer: Health EOS Commercial |
$6,838.33
|
| Rate for Payer: HFN Commercial |
$7,068.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,762.64
|
| Rate for Payer: Multiplan Commercial |
$6,146.82
|
| Rate for Payer: NAPHCARE Commercial |
$4,610.11
|
| Rate for Payer: Preferred Network Access Commercial |
$7,068.84
|
| Rate for Payer: Quartz Beloit One Network |
$3,764.92
|
| Rate for Payer: Quartz Commercial |
$4,994.29
|
| Rate for Payer: Quartz Medicare Advantage |
$4,610.11
|
| Rate for Payer: The Alliance Commercial |
$3,841.76
|
| Rate for Payer: WEA Trust Commercial |
$4,225.94
|
| Rate for Payer: WPS Commercial |
$5,690.98
|
|
|
CT 3D Reconstruction
|
Facility
|
OP
|
$551.00
|
|
|
Service Code
|
CPT 76376
|
| Hospital Charge Code |
615588
|
| Min. Negotiated Rate |
$100.51 |
| Max. Negotiated Rate |
$527.20 |
| Rate for Payer: Aetna Commercial |
$515.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$492.81
|
| Rate for Payer: Aetna Managed Medicare |
$160.45
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$372.48
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$286.52
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$275.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$303.71
|
| Rate for Payer: Cash Price |
$165.30
|
| Rate for Payer: Cash Price |
$165.30
|
| Rate for Payer: Cigna Commercial |
$527.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$320.68
|
| Rate for Payer: Health EOS Commercial |
$510.01
|
| Rate for Payer: HFN Commercial |
$527.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$429.78
|
| Rate for Payer: Multiplan Commercial |
$458.43
|
| Rate for Payer: NAPHCARE Commercial |
$343.82
|
| Rate for Payer: Preferred Network Access Commercial |
$527.20
|
| Rate for Payer: Quartz Beloit One Network |
$280.79
|
| Rate for Payer: Quartz Commercial |
$372.48
|
| Rate for Payer: Quartz Medicare Advantage |
$343.82
|
| Rate for Payer: The Alliance Commercial |
$100.51
|
| Rate for Payer: WEA Trust Commercial |
$315.17
|
| Rate for Payer: WPS Commercial |
$424.44
|
|
|
CT 3D Reconstruction
|
Professional
|
Both
|
$551.00
|
|
|
Service Code
|
CPT 76376
|
| Hospital Charge Code |
615588
|
| Min. Negotiated Rate |
$25.13 |
| Max. Negotiated Rate |
$544.39 |
| Rate for Payer: Aetna Commercial |
$544.39
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$492.81
|
| Rate for Payer: Aetna Managed Medicare |
$25.13
|
| Rate for Payer: Anthem Medicare Advantage |
$25.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$25.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$25.13
|
| Rate for Payer: Cash Price |
$165.30
|
| Rate for Payer: Cash Price |
$165.30
|
| Rate for Payer: Cash Price |
$165.30
|
| Rate for Payer: Cigna Commercial |
$544.39
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$286.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$25.13
|
| Rate for Payer: Health EOS Commercial |
$521.47
|
| Rate for Payer: HFN Commercial |
$544.39
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$79.48
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$79.48
|
| Rate for Payer: Independent Care Health Plan Medicare |
$25.13
|
| Rate for Payer: Multiplan Commercial |
$458.43
|
| Rate for Payer: NAPHCARE Commercial |
$37.69
|
| Rate for Payer: Preferred Network Access Commercial |
$544.39
|
| Rate for Payer: Quartz Beloit One Network |
$252.14
|
| Rate for Payer: Quartz Commercial |
$326.63
|
| Rate for Payer: Quartz Medicare Advantage |
$25.13
|
| Rate for Payer: The Alliance Commercial |
$95.48
|
| Rate for Payer: United Healthcare Medicare Advantage |
$25.13
|
| Rate for Payer: WEA Trust Commercial |
$315.17
|
| Rate for Payer: WPS Commercial |
$125.63
|
|
|
CT 3D Reconstruction
|
Facility
|
OP
|
$540.00
|
|
|
Service Code
|
CPT 76376 TC
|
| Hospital Charge Code |
1240799
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$62.98 |
| Max. Negotiated Rate |
$3,333.20 |
| Rate for Payer: Aetna Commercial |
$505.44
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$482.98
|
| Rate for Payer: Aetna Managed Medicare |
$157.25
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,333.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,689.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,552.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$297.65
|
| Rate for Payer: Cash Price |
$162.00
|
| Rate for Payer: Cash Price |
$162.00
|
| Rate for Payer: Cash Price |
$162.00
|
| Rate for Payer: Cash Price |
$162.00
|
| Rate for Payer: Cigna Commercial |
$516.67
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$314.28
|
| Rate for Payer: Health EOS Commercial |
$499.82
|
| Rate for Payer: HFN Commercial |
$516.67
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$421.20
|
| Rate for Payer: Multiplan Commercial |
$449.28
|
| Rate for Payer: NAPHCARE Commercial |
$336.96
|
| Rate for Payer: Preferred Network Access Commercial |
$516.67
|
| Rate for Payer: Quartz Beloit One Network |
$275.18
|
| Rate for Payer: Quartz Commercial |
$365.04
|
| Rate for Payer: Quartz Medicare Advantage |
$336.96
|
| Rate for Payer: The Alliance Commercial |
$62.98
|
| Rate for Payer: United Healthcare PPO |
$2,147.60
|
| Rate for Payer: WEA Trust Commercial |
$308.88
|
| Rate for Payer: WPS Commercial |
$110.22
|
|
