|
LEGGINGS 89408
|
Facility
|
OP
|
$85.00
|
|
| Hospital Charge Code |
2963429
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$23.80 |
| Max. Negotiated Rate |
$340.00 |
| Rate for Payer: Aetna Commercial |
$76.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$73.10
|
| Rate for Payer: Aetna Managed Medicare |
$23.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$55.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$42.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$40.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$45.05
|
| Rate for Payer: Cash Price |
$25.50
|
| Rate for Payer: Cigna Commercial |
$78.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$47.57
|
| Rate for Payer: Health EOS Commercial |
$75.65
|
| Rate for Payer: HFN Commercial |
$78.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$63.75
|
| Rate for Payer: Multiplan Commercial |
$68.00
|
| Rate for Payer: NAPHCARE Commercial |
$51.00
|
| Rate for Payer: Preferred Network Access Commercial |
$78.20
|
| Rate for Payer: Quartz Beloit One Network |
$41.65
|
| Rate for Payer: Quartz Commercial |
$55.25
|
| Rate for Payer: Quartz Medicare Advantage |
$51.00
|
| Rate for Payer: The Alliance Commercial |
$340.00
|
| Rate for Payer: WEA Trust Commercial |
$46.75
|
| Rate for Payer: WPS Commercial |
$62.96
|
|
|
Legionella Antigen Urine
|
Professional
|
Both
|
$163.00
|
|
|
Service Code
|
CPT 87449
|
| Hospital Charge Code |
633775
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$42.29 |
| Max. Negotiated Rate |
$154.85 |
| Rate for Payer: Aetna Commercial |
$154.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$140.18
|
| Rate for Payer: Cash Price |
$48.90
|
| Rate for Payer: Cash Price |
$48.90
|
| Rate for Payer: Cigna Commercial |
$154.85
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$81.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$97.80
|
| Rate for Payer: Health EOS Commercial |
$148.33
|
| Rate for Payer: HFN Commercial |
$154.85
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$42.29
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$42.29
|
| Rate for Payer: Multiplan Commercial |
$130.40
|
| Rate for Payer: Preferred Network Access Commercial |
$154.85
|
| Rate for Payer: Quartz Beloit One Network |
$71.72
|
| Rate for Payer: Quartz Commercial |
$92.91
|
| Rate for Payer: The Alliance Commercial |
$81.50
|
| Rate for Payer: WEA Trust Commercial |
$89.65
|
| Rate for Payer: WPS Commercial |
$120.73
|
|
|
Legionella Antigen Urine
|
Facility
|
IP
|
$163.00
|
|
|
Service Code
|
CPT 87449
|
| Hospital Charge Code |
633775
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$79.87 |
| Max. Negotiated Rate |
$149.96 |
| Rate for Payer: Aetna Commercial |
$146.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$140.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$86.39
|
| Rate for Payer: Cash Price |
$48.90
|
| Rate for Payer: Cigna Commercial |
$149.96
|
| Rate for Payer: Health EOS Commercial |
$145.07
|
| Rate for Payer: HFN Commercial |
$149.96
|
| Rate for Payer: Multiplan Commercial |
$130.40
|
| Rate for Payer: NAPHCARE Commercial |
$97.80
|
| Rate for Payer: Preferred Network Access Commercial |
$149.96
|
| Rate for Payer: Quartz Beloit One Network |
$79.87
|
| Rate for Payer: Quartz Commercial |
$97.80
|
| Rate for Payer: WEA Trust Commercial |
$89.65
|
| Rate for Payer: WPS Commercial |
$120.73
|
|
|
Legionella Antigen Urine
|
Facility
|
OP
|
$163.00
|
|
|
Service Code
|
CPT 87449
|
| Hospital Charge Code |
633775
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.98 |
| Max. Negotiated Rate |
$149.96 |
| Rate for Payer: Aetna Commercial |
$146.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$140.18
|
| Rate for Payer: Aetna Managed Medicare |
$11.98
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$44.92
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$20.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$19.89
|
| Rate for Payer: Anthem Medicaid |
$12.38
|
| Rate for Payer: Anthem Medicare Advantage |
$11.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$86.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$11.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$11.98
|
| Rate for Payer: Cash Price |
$48.90
|
| Rate for Payer: Cash Price |
$48.90
|
| Rate for Payer: Cigna Commercial |
$149.96
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$11.98
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$12.38
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$91.21
|
| Rate for Payer: Dean Health Medicaid |
$12.38
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$11.98
|
| Rate for Payer: Health EOS Commercial |
$145.07
|
| Rate for Payer: HFN Commercial |
$149.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$44.57
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$11.98
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$12.38
|
| Rate for Payer: Independent Care Health Plan Medicare |
$11.98
|
| Rate for Payer: Managed Health Services Medicaid |
$12.88
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$11.98
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$11.98
|
| Rate for Payer: Multiplan Commercial |
$130.40
|
| Rate for Payer: NAPHCARE Commercial |
$17.97
|
| Rate for Payer: Preferred Network Access Commercial |
$149.96
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$12.38
|
| Rate for Payer: Quartz Beloit One Network |
$79.87
|
| Rate for Payer: Quartz Commercial |
$105.95
|
| Rate for Payer: Quartz Medicare Advantage |
$11.98
|
| Rate for Payer: The Alliance Commercial |
$47.92
|
| Rate for Payer: United Healthcare Medicaid |
$12.38
|
| Rate for Payer: United Healthcare Medicare Advantage |
$11.98
|
| Rate for Payer: United Healthcare PPO |
$122.25
|
| Rate for Payer: WEA Trust Commercial |
$89.65
|
| Rate for Payer: Wellcare Medicare |
$11.98
|
| Rate for Payer: WMAP Medicaid |
$12.38
|
| Rate for Payer: WPS Commercial |
$120.73
|
|
|
Legionella Culture / 688
|
Facility
|
OP
|
$63.00
|
|
|
Service Code
|
CPT 87081
|
| Hospital Charge Code |
5516668
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.63 |
| Max. Negotiated Rate |
$57.96 |
| Rate for Payer: Aetna Commercial |
$56.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$54.18
|
| Rate for Payer: Aetna Managed Medicare |
$6.63
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$24.86
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$11.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$11.01
|
| Rate for Payer: Anthem Medicaid |
$6.85
|
| Rate for Payer: Anthem Medicare Advantage |
$6.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$33.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$6.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$6.63
|
| Rate for Payer: Cash Price |
$18.90
|
| Rate for Payer: Cash Price |
$18.90
|
| Rate for Payer: Cigna Commercial |
$57.96
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$6.63
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$6.85
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$35.25
|
| Rate for Payer: Dean Health Medicaid |
$6.85
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$6.63
|
| Rate for Payer: Health EOS Commercial |
$56.07
|
| Rate for Payer: HFN Commercial |
$57.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$24.66
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$6.63
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$6.85
|
| Rate for Payer: Independent Care Health Plan Medicare |
$6.63
|
| Rate for Payer: Managed Health Services Medicaid |
$7.12
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$6.63
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$6.63
|
| Rate for Payer: Multiplan Commercial |
$50.40
|
| Rate for Payer: NAPHCARE Commercial |
$9.94
|
| Rate for Payer: Preferred Network Access Commercial |
$57.96
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$6.85
|
| Rate for Payer: Quartz Beloit One Network |
$30.87
|
| Rate for Payer: Quartz Commercial |
$40.95
|
| Rate for Payer: Quartz Medicare Advantage |
$6.63
|
| Rate for Payer: The Alliance Commercial |
$26.52
|
| Rate for Payer: United Healthcare Medicaid |
$6.85
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6.63
|
| Rate for Payer: United Healthcare PPO |
$47.25
|
| Rate for Payer: WEA Trust Commercial |
$34.65
|
| Rate for Payer: Wellcare Medicare |
$6.63
|
| Rate for Payer: WMAP Medicaid |
$6.85
|
| Rate for Payer: WPS Commercial |
$46.66
|
|
|
Legionella Culture / 688
|
Facility
|
IP
|
$63.00
|
|
|
Service Code
|
CPT 87081
|
| Hospital Charge Code |
5516668
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$30.87 |
| Max. Negotiated Rate |
$57.96 |
| Rate for Payer: Aetna Commercial |
$56.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$54.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$33.39
|
| Rate for Payer: Cash Price |
$18.90
|
| Rate for Payer: Cigna Commercial |
$57.96
|
| Rate for Payer: Health EOS Commercial |
$56.07
|
| Rate for Payer: HFN Commercial |
$57.96
|
| Rate for Payer: Multiplan Commercial |
$50.40
|
| Rate for Payer: NAPHCARE Commercial |
$37.80
|
| Rate for Payer: Preferred Network Access Commercial |
$57.96
|
| Rate for Payer: Quartz Beloit One Network |
$30.87
|
| Rate for Payer: Quartz Commercial |
$37.80
|
| Rate for Payer: WEA Trust Commercial |
$34.65
|
| Rate for Payer: WPS Commercial |
$46.66
|
|
|
Legionella Culture / 688
|
Professional
|
Both
|
$63.00
|
|
|
Service Code
|
CPT 87081
|
| Hospital Charge Code |
5516668
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$23.40 |
| Max. Negotiated Rate |
$59.85 |
| Rate for Payer: Aetna Commercial |
$59.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$54.18
|
| Rate for Payer: Cash Price |
$18.90
|
| Rate for Payer: Cash Price |
$18.90
|
| Rate for Payer: Cigna Commercial |
$59.85
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$31.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$37.80
|
| Rate for Payer: Health EOS Commercial |
$57.33
|
| Rate for Payer: HFN Commercial |
$59.85
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$23.40
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$23.40
|
| Rate for Payer: Multiplan Commercial |
$50.40
|
| Rate for Payer: Preferred Network Access Commercial |
$59.85
|
| Rate for Payer: Quartz Beloit One Network |
$27.72
|
| Rate for Payer: Quartz Commercial |
$35.91
|
| Rate for Payer: The Alliance Commercial |
$31.50
|
| Rate for Payer: WEA Trust Commercial |
$34.65
|
| Rate for Payer: WPS Commercial |
$46.66
|
|
|
Legionella , PCR and Culture
|
Facility
|
IP
|
$225.00
|
|
|
Service Code
|
CPT 87081
|
| Hospital Charge Code |
3710816
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$110.25 |
| Max. Negotiated Rate |
$207.00 |
| Rate for Payer: Aetna Commercial |
$202.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$193.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$119.25
|
| Rate for Payer: Cash Price |
$67.50
|
| Rate for Payer: Cigna Commercial |
$207.00
|
| Rate for Payer: Health EOS Commercial |
$200.25
|
| Rate for Payer: HFN Commercial |
$207.00
|
| Rate for Payer: Multiplan Commercial |
$180.00
|
| Rate for Payer: NAPHCARE Commercial |
$135.00
|
| Rate for Payer: Preferred Network Access Commercial |
$207.00
|
| Rate for Payer: Quartz Beloit One Network |
$110.25
|
| Rate for Payer: Quartz Commercial |
$135.00
|
| Rate for Payer: WEA Trust Commercial |
$123.75
|
| Rate for Payer: WPS Commercial |
$166.66
|
|
|
Legionella , PCR and Culture
|
Professional
|
Both
|
$225.00
|
|
|
Service Code
|
CPT 87081
|
| Hospital Charge Code |
3710816
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$23.40 |
| Max. Negotiated Rate |
$213.75 |
| Rate for Payer: Aetna Commercial |
$213.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$193.50
|
| Rate for Payer: Cash Price |
$67.50
|
| Rate for Payer: Cash Price |
$67.50
|
| Rate for Payer: Cigna Commercial |
$213.75
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$112.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$135.00
|
| Rate for Payer: Health EOS Commercial |
$204.75
|
| Rate for Payer: HFN Commercial |
$213.75
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$23.40
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$23.40
|
| Rate for Payer: Multiplan Commercial |
$180.00
|
| Rate for Payer: Preferred Network Access Commercial |
$213.75
|
| Rate for Payer: Quartz Beloit One Network |
$99.00
|
| Rate for Payer: Quartz Commercial |
$128.25
|
| Rate for Payer: The Alliance Commercial |
$112.50
|
| Rate for Payer: WEA Trust Commercial |
$123.75
|
| Rate for Payer: WPS Commercial |
$166.66
|
|
|
Legionella , PCR and Culture
|
Facility
|
OP
|
$225.00
|
|
|
Service Code
|
CPT 87081
|
| Hospital Charge Code |
3710816
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.63 |
| Max. Negotiated Rate |
$207.00 |
| Rate for Payer: Aetna Commercial |
$202.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$193.50
|
| Rate for Payer: Aetna Managed Medicare |
$6.63
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$24.86
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$11.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$11.01
|
| Rate for Payer: Anthem Medicaid |
$6.85
|
| Rate for Payer: Anthem Medicare Advantage |
$6.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$119.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$6.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$6.63
|
| Rate for Payer: Cash Price |
$67.50
|
| Rate for Payer: Cash Price |
$67.50
|
| Rate for Payer: Cigna Commercial |
$207.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$6.63
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$6.85
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$125.91
|
| Rate for Payer: Dean Health Medicaid |
$6.85
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$6.63
|
| Rate for Payer: Health EOS Commercial |
$200.25
|
| Rate for Payer: HFN Commercial |
$207.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$24.66
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$6.63
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$6.85
|
| Rate for Payer: Independent Care Health Plan Medicare |
$6.63
|
| Rate for Payer: Managed Health Services Medicaid |
$7.12
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$6.63
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$6.63
|
| Rate for Payer: Multiplan Commercial |
$180.00
|
| Rate for Payer: NAPHCARE Commercial |
$9.94
|
| Rate for Payer: Preferred Network Access Commercial |
$207.00
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$6.85
|
| Rate for Payer: Quartz Beloit One Network |
$110.25
|
| Rate for Payer: Quartz Commercial |
$146.25
|
| Rate for Payer: Quartz Medicare Advantage |
$6.63
|
| Rate for Payer: The Alliance Commercial |
$26.52
|
| Rate for Payer: United Healthcare Medicaid |
$6.85
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6.63
|
| Rate for Payer: United Healthcare PPO |
$168.75
|
| Rate for Payer: WEA Trust Commercial |
$123.75
|
| Rate for Payer: Wellcare Medicare |
$6.63
|
| Rate for Payer: WMAP Medicaid |
$6.85
|
| Rate for Payer: WPS Commercial |
$166.66
|
|
|
Legionella Pneumophila Antibody IgG, IFA
|
Professional
|
Both
|
$66.00
|
|
|
Service Code
|
CPT 86713
|
| Hospital Charge Code |
978006
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$29.04 |
| Max. Negotiated Rate |
$62.70 |
| Rate for Payer: Aetna Commercial |
$62.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$56.76
|
| Rate for Payer: Cash Price |
$19.80
|
| Rate for Payer: Cash Price |
$19.80
|
| Rate for Payer: Cigna Commercial |
$62.70
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$33.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$39.60
|
| Rate for Payer: Health EOS Commercial |
$60.06
|
| Rate for Payer: HFN Commercial |
$62.70
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$54.01
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$54.01
|
| Rate for Payer: Multiplan Commercial |
$52.80
|
| Rate for Payer: Preferred Network Access Commercial |
$62.70
|
| Rate for Payer: Quartz Beloit One Network |
$29.04
|
| Rate for Payer: Quartz Commercial |
$37.62
|
| Rate for Payer: The Alliance Commercial |
$33.00
|
| Rate for Payer: WEA Trust Commercial |
$36.30
|
| Rate for Payer: WPS Commercial |
$48.89
|
|
|
Legionella Pneumophila Antibody IgG, IFA
|
Facility
|
IP
|
$66.00
|
|
|
Service Code
|
CPT 86713
|
| Hospital Charge Code |
978006
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$32.34 |
| Max. Negotiated Rate |
$60.72 |
| Rate for Payer: Aetna Commercial |
$59.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$56.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$34.98
|
| Rate for Payer: Cash Price |
$19.80
|
| Rate for Payer: Cigna Commercial |
$60.72
|
| Rate for Payer: Health EOS Commercial |
$58.74
|
| Rate for Payer: HFN Commercial |
$60.72
|
| Rate for Payer: Multiplan Commercial |
$52.80
|
| Rate for Payer: NAPHCARE Commercial |
$39.60
|
| Rate for Payer: Preferred Network Access Commercial |
$60.72
|
| Rate for Payer: Quartz Beloit One Network |
$32.34
|
| Rate for Payer: Quartz Commercial |
$39.60
|
| Rate for Payer: WEA Trust Commercial |
$36.30
|
| Rate for Payer: WPS Commercial |
$48.89
|
|
|
Legionella Pneumophila Antibody IgG, IFA
|
Facility
|
OP
|
$66.00
|
|
|
Service Code
|
CPT 86713
|
| Hospital Charge Code |
978006
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.30 |
| Max. Negotiated Rate |
$61.20 |
| Rate for Payer: Anthem Medicare Advantage |
$15.30
|
| Rate for Payer: Aetna Commercial |
$59.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$56.76
|
| Rate for Payer: Aetna Managed Medicare |
$15.30
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$57.38
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$26.78
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$25.40
|
| Rate for Payer: Anthem Medicaid |
$15.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$34.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$15.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$15.30
|
| Rate for Payer: Cash Price |
$19.80
|
| Rate for Payer: Cash Price |
$19.80
|
| Rate for Payer: Cigna Commercial |
$60.72
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$15.30
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$15.81
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$36.93
|
| Rate for Payer: Dean Health Medicaid |
$15.81
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$15.30
|
| Rate for Payer: Health EOS Commercial |
$58.74
|
| Rate for Payer: HFN Commercial |
$60.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$56.92
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$15.30
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$15.81
|
| Rate for Payer: Independent Care Health Plan Medicare |
$15.30
|
| Rate for Payer: Managed Health Services Medicaid |
$16.44
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$15.30
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$15.30
|
| Rate for Payer: Multiplan Commercial |
$52.80
|
| Rate for Payer: NAPHCARE Commercial |
$22.95
|
| Rate for Payer: Preferred Network Access Commercial |
$60.72
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$15.81
|
| Rate for Payer: Quartz Beloit One Network |
$32.34
|
| Rate for Payer: Quartz Commercial |
$42.90
|
| Rate for Payer: Quartz Medicare Advantage |
$15.30
|
| Rate for Payer: The Alliance Commercial |
$61.20
|
| Rate for Payer: United Healthcare Medicaid |
$15.81
|
| Rate for Payer: United Healthcare Medicare Advantage |
$15.30
|
| Rate for Payer: United Healthcare PPO |
$49.50
|
| Rate for Payer: WEA Trust Commercial |
$36.30
|
| Rate for Payer: Wellcare Medicare |
$15.30
|
| Rate for Payer: WMAP Medicaid |
$15.81
|
| Rate for Payer: WPS Commercial |
$48.89
|
|
|
Legionella Pneumophila Group 2-6,8
|
Facility
|
IP
|
$69.00
|
|
|
Service Code
|
CPT 86713
|
| Hospital Charge Code |
2942936
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$33.81 |
| Max. Negotiated Rate |
$63.48 |
| Rate for Payer: Aetna Commercial |
$62.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$59.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$36.57
|
| Rate for Payer: Cash Price |
$20.70
|
| Rate for Payer: Cigna Commercial |
$63.48
|
| Rate for Payer: Health EOS Commercial |
$61.41
|
| Rate for Payer: HFN Commercial |
$63.48
|
| Rate for Payer: Multiplan Commercial |
$55.20
|
| Rate for Payer: NAPHCARE Commercial |
$41.40
|
| Rate for Payer: Preferred Network Access Commercial |
$63.48
|
| Rate for Payer: Quartz Beloit One Network |
$33.81
|
| Rate for Payer: Quartz Commercial |
$41.40
|
| Rate for Payer: WEA Trust Commercial |
$37.95
|
| Rate for Payer: WPS Commercial |
$51.11
|
|
|
Legionella Pneumophila Group 2-6,8
|
Facility
|
OP
|
$69.00
|
|
|
Service Code
|
CPT 86713
|
| Hospital Charge Code |
2942936
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.30 |
| Max. Negotiated Rate |
$63.48 |
| Rate for Payer: Aetna Commercial |
$62.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$59.34
|
| Rate for Payer: Aetna Managed Medicare |
$15.30
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$57.38
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$26.78
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$25.40
|
| Rate for Payer: Anthem Medicaid |
$15.81
|
| Rate for Payer: Anthem Medicare Advantage |
$15.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$36.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$15.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$15.30
|
| Rate for Payer: Cash Price |
$20.70
|
| Rate for Payer: Cash Price |
$20.70
|
| Rate for Payer: Cigna Commercial |
$63.48
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$15.30
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$15.81
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$38.61
|
| Rate for Payer: Dean Health Medicaid |
$15.81
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$15.30
|
| Rate for Payer: Health EOS Commercial |
$61.41
|
| Rate for Payer: HFN Commercial |
$63.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$56.92
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$15.30
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$15.81
|
| Rate for Payer: Independent Care Health Plan Medicare |
$15.30
|
| Rate for Payer: Managed Health Services Medicaid |
$16.44
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$15.30
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$15.30
|
| Rate for Payer: Multiplan Commercial |
$55.20
|
| Rate for Payer: NAPHCARE Commercial |
$22.95
|
| Rate for Payer: Preferred Network Access Commercial |
$63.48
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$15.81
|
| Rate for Payer: Quartz Beloit One Network |
$33.81
|
| Rate for Payer: Quartz Commercial |
$44.85
|
| Rate for Payer: Quartz Medicare Advantage |
$15.30
|
| Rate for Payer: The Alliance Commercial |
$61.20
|
| Rate for Payer: United Healthcare Medicaid |
$15.81
|
| Rate for Payer: United Healthcare Medicare Advantage |
$15.30
|
| Rate for Payer: United Healthcare PPO |
$51.75
|
| Rate for Payer: WEA Trust Commercial |
$37.95
|
| Rate for Payer: Wellcare Medicare |
$15.30
|
| Rate for Payer: WMAP Medicaid |
$15.81
|
| Rate for Payer: WPS Commercial |
$51.11
|
|
|
Legionella Pneumophila Group 2-6,8
|
Professional
|
Both
|
$69.00
|
|
|
Service Code
|
CPT 86713
|
| Hospital Charge Code |
2942936
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$30.36 |
| Max. Negotiated Rate |
$65.55 |
| Rate for Payer: Aetna Commercial |
$65.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$59.34
|
| Rate for Payer: Cash Price |
$20.70
|
| Rate for Payer: Cash Price |
$20.70
|
| Rate for Payer: Cigna Commercial |
$65.55
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$34.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$41.40
|
| Rate for Payer: Health EOS Commercial |
$62.79
|
| Rate for Payer: HFN Commercial |
$65.55
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$54.01
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$54.01
|
| Rate for Payer: Multiplan Commercial |
$55.20
|
| Rate for Payer: Preferred Network Access Commercial |
$65.55
|
| Rate for Payer: Quartz Beloit One Network |
$30.36
|
| Rate for Payer: Quartz Commercial |
$39.33
|
| Rate for Payer: The Alliance Commercial |
$34.50
|
| Rate for Payer: WEA Trust Commercial |
$37.95
|
| Rate for Payer: WPS Commercial |
$51.11
|
|
|
Legionella Pneumophila Serogroup 2-6,8
|
Professional
|
Both
|
$141.00
|
|
|
Service Code
|
CPT 86713
|
| Hospital Charge Code |
2942937
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$54.01 |
| Max. Negotiated Rate |
$133.95 |
| Rate for Payer: Aetna Commercial |
$133.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$121.26
|
| Rate for Payer: Cash Price |
$42.30
|
| Rate for Payer: Cash Price |
$42.30
|
| Rate for Payer: Cigna Commercial |
$133.95
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$70.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$84.60
|
| Rate for Payer: Health EOS Commercial |
$128.31
|
| Rate for Payer: HFN Commercial |
$133.95
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$54.01
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$54.01
|
| Rate for Payer: Multiplan Commercial |
$112.80
|
| Rate for Payer: Preferred Network Access Commercial |
$133.95
|
| Rate for Payer: Quartz Beloit One Network |
$62.04
|
| Rate for Payer: Quartz Commercial |
$80.37
|
| Rate for Payer: The Alliance Commercial |
$70.50
|
| Rate for Payer: WEA Trust Commercial |
$77.55
|
| Rate for Payer: WPS Commercial |
$104.44
|
|
|
Legionella Pneumophila Serogroup 2-6,8
|
Facility
|
IP
|
$141.00
|
|
|
Service Code
|
CPT 86713
|
| Hospital Charge Code |
2942937
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$69.09 |
| Max. Negotiated Rate |
$129.72 |
| Rate for Payer: Aetna Commercial |
$126.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$121.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$74.73
|
| Rate for Payer: Cash Price |
$42.30
|
| Rate for Payer: Cigna Commercial |
$129.72
|
| Rate for Payer: Health EOS Commercial |
$125.49
|
| Rate for Payer: HFN Commercial |
$129.72
|
| Rate for Payer: Multiplan Commercial |
$112.80
|
| Rate for Payer: NAPHCARE Commercial |
$84.60
|
| Rate for Payer: Preferred Network Access Commercial |
$129.72
|
| Rate for Payer: Quartz Beloit One Network |
$69.09
|
| Rate for Payer: Quartz Commercial |
$84.60
|
| Rate for Payer: WEA Trust Commercial |
$77.55
|
| Rate for Payer: WPS Commercial |
$104.44
|
|
|
Legionella Pneumophila Serogroup 2-6,8
|
Facility
|
OP
|
$141.00
|
|
|
Service Code
|
CPT 86713
|
| Hospital Charge Code |
2942937
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.30 |
| Max. Negotiated Rate |
$129.72 |
| Rate for Payer: Aetna Commercial |
$126.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$121.26
|
| Rate for Payer: Aetna Managed Medicare |
$15.30
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$57.38
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$26.78
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$25.40
|
| Rate for Payer: Anthem Medicaid |
$15.81
|
| Rate for Payer: Anthem Medicare Advantage |
$15.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$74.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$15.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$15.30
|
| Rate for Payer: Cash Price |
$42.30
|
| Rate for Payer: Cash Price |
$42.30
|
| Rate for Payer: Cigna Commercial |
$129.72
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$15.30
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$15.81
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$78.90
|
| Rate for Payer: Dean Health Medicaid |
$15.81
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$15.30
|
| Rate for Payer: Health EOS Commercial |
$125.49
|
| Rate for Payer: HFN Commercial |
$129.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$56.92
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$15.30
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$15.81
|
| Rate for Payer: Independent Care Health Plan Medicare |
$15.30
|
| Rate for Payer: Managed Health Services Medicaid |
$16.44
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$15.30
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$15.30
|
| Rate for Payer: Multiplan Commercial |
$112.80
|
| Rate for Payer: NAPHCARE Commercial |
$22.95
|
| Rate for Payer: Preferred Network Access Commercial |
$129.72
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$15.81
|
| Rate for Payer: Quartz Beloit One Network |
$69.09
|
| Rate for Payer: Quartz Commercial |
$91.65
|
| Rate for Payer: Quartz Medicare Advantage |
$15.30
|
| Rate for Payer: The Alliance Commercial |
$61.20
|
| Rate for Payer: United Healthcare Medicaid |
$15.81
|
| Rate for Payer: United Healthcare Medicare Advantage |
$15.30
|
| Rate for Payer: United Healthcare PPO |
$105.75
|
| Rate for Payer: WEA Trust Commercial |
$77.55
|
| Rate for Payer: Wellcare Medicare |
$15.30
|
| Rate for Payer: WMAP Medicaid |
$15.81
|
| Rate for Payer: WPS Commercial |
$104.44
|
|
|
LEG LOOP LEG LIFT #0815-30-898
|
Facility
|
OP
|
$394.00
|
|
| Hospital Charge Code |
2971058
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$110.32 |
| Max. Negotiated Rate |
$1,576.00 |
| Rate for Payer: Aetna Commercial |
$354.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$338.84
|
| Rate for Payer: Aetna Managed Medicare |
$110.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$256.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$197.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$189.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$208.82
|
| Rate for Payer: Cash Price |
$118.20
|
| Rate for Payer: Cigna Commercial |
$362.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$220.48
|
| Rate for Payer: Health EOS Commercial |
$350.66
|
| Rate for Payer: HFN Commercial |
$362.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$295.50
|
| Rate for Payer: Multiplan Commercial |
$315.20
|
| Rate for Payer: NAPHCARE Commercial |
$236.40
|
| Rate for Payer: Preferred Network Access Commercial |
$362.48
|
| Rate for Payer: Quartz Beloit One Network |
$193.06
|
| Rate for Payer: Quartz Commercial |
$256.10
|
| Rate for Payer: Quartz Medicare Advantage |
$236.40
|
| Rate for Payer: The Alliance Commercial |
$1,576.00
|
| Rate for Payer: WEA Trust Commercial |
$216.70
|
| Rate for Payer: WPS Commercial |
$291.84
|
|
|
LEG LOOP LEG LIFT #0815-30-898
|
Facility
|
IP
|
$394.00
|
|
| Hospital Charge Code |
2971058
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$193.06 |
| Max. Negotiated Rate |
$362.48 |
| Rate for Payer: Aetna Commercial |
$354.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$338.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$208.82
|
| Rate for Payer: Cash Price |
$118.20
|
| Rate for Payer: Cigna Commercial |
$362.48
|
| Rate for Payer: Health EOS Commercial |
$350.66
|
| Rate for Payer: HFN Commercial |
$362.48
|
| Rate for Payer: Multiplan Commercial |
$315.20
|
| Rate for Payer: NAPHCARE Commercial |
$236.40
|
| Rate for Payer: Preferred Network Access Commercial |
$362.48
|
| Rate for Payer: Quartz Beloit One Network |
$193.06
|
| Rate for Payer: Quartz Commercial |
$236.40
|
| Rate for Payer: WEA Trust Commercial |
$216.70
|
| Rate for Payer: WPS Commercial |
$291.84
|
|
|
Leneva Allograft Matrix 1.5 cc MTF - LVA01
|
Professional
|
Both
|
$563.00
|
|
| Hospital Charge Code |
5879656
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$247.72 |
| Max. Negotiated Rate |
$534.85 |
| Rate for Payer: Aetna Commercial |
$534.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$484.18
|
| Rate for Payer: Cash Price |
$168.90
|
| Rate for Payer: Cigna Commercial |
$534.85
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$281.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$337.80
|
| Rate for Payer: Health EOS Commercial |
$512.33
|
| Rate for Payer: HFN Commercial |
$534.85
|
| Rate for Payer: Multiplan Commercial |
$450.40
|
| Rate for Payer: Preferred Network Access Commercial |
$534.85
|
| Rate for Payer: Quartz Beloit One Network |
$247.72
|
| Rate for Payer: Quartz Commercial |
$320.91
|
| Rate for Payer: The Alliance Commercial |
$281.50
|
| Rate for Payer: WEA Trust Commercial |
$309.65
|
| Rate for Payer: WPS Commercial |
$417.01
|
|
|
Leneva Allograft Matrix 1.5 cc MTF - LVA01
|
Facility
|
IP
|
$563.00
|
|
| Hospital Charge Code |
5879656
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$275.87 |
| Max. Negotiated Rate |
$517.96 |
| Rate for Payer: Aetna Commercial |
$506.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$484.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$298.39
|
| Rate for Payer: Cash Price |
$168.90
|
| Rate for Payer: Cigna Commercial |
$517.96
|
| Rate for Payer: Health EOS Commercial |
$501.07
|
| Rate for Payer: HFN Commercial |
$517.96
|
| Rate for Payer: Multiplan Commercial |
$450.40
|
| Rate for Payer: NAPHCARE Commercial |
$337.80
|
| Rate for Payer: Preferred Network Access Commercial |
$517.96
|
| Rate for Payer: Quartz Beloit One Network |
$275.87
|
| Rate for Payer: Quartz Commercial |
$337.80
|
| Rate for Payer: WEA Trust Commercial |
$309.65
|
| Rate for Payer: WPS Commercial |
$417.01
|
|
|
Leneva Allograft Matrix 1.5 cc MTF - LVA01
|
Facility
|
OP
|
$563.00
|
|
| Hospital Charge Code |
5879656
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$157.64 |
| Max. Negotiated Rate |
$2,252.00 |
| Rate for Payer: Aetna Commercial |
$506.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$484.18
|
| Rate for Payer: Aetna Managed Medicare |
$157.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$365.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$281.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$270.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$298.39
|
| Rate for Payer: Cash Price |
$168.90
|
| Rate for Payer: Cigna Commercial |
$517.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$315.05
|
| Rate for Payer: Health EOS Commercial |
$501.07
|
| Rate for Payer: HFN Commercial |
$517.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$422.25
|
| Rate for Payer: Multiplan Commercial |
$450.40
|
| Rate for Payer: NAPHCARE Commercial |
$337.80
|
| Rate for Payer: Preferred Network Access Commercial |
$517.96
|
| Rate for Payer: Quartz Beloit One Network |
$275.87
|
| Rate for Payer: Quartz Commercial |
$365.95
|
| Rate for Payer: Quartz Medicare Advantage |
$337.80
|
| Rate for Payer: The Alliance Commercial |
$2,252.00
|
| Rate for Payer: WEA Trust Commercial |
$309.65
|
| Rate for Payer: WPS Commercial |
$417.01
|
|
|
LENGTHENING OR SHORTENING OF TENDON, LEG OR ANKLE; SINGLE TENDON (SEPARATE PROCEDURE)
|
Facility
|
OP
|
$12,797.24
|
|
|
Service Code
|
CPT 27685
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,199.31 |
| Max. Negotiated Rate |
$12,797.24 |
| Rate for Payer: Aetna Managed Medicare |
$3,199.31
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$9,907.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8,043.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7,639.00
|
| Rate for Payer: Anthem Medicare Advantage |
$3,199.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$3,199.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$3,199.31
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$3,199.31
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,546.14
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$3,199.31
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$11,901.43
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$3,199.31
|
| Rate for Payer: Independent Care Health Plan Medicare |
$3,199.31
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$3,199.31
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$3,199.31
|
| Rate for Payer: NAPHCARE Commercial |
$4,798.96
|
| Rate for Payer: Quartz Medicare Advantage |
$3,199.31
|
| Rate for Payer: The Alliance Commercial |
$12,797.24
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,199.31
|
| Rate for Payer: United Healthcare PPO |
$4,103.00
|
| Rate for Payer: Wellcare Medicare |
$3,199.31
|
|
