|
Anti-Factor Xa
|
Professional
|
Both
|
$188.00
|
|
|
Service Code
|
CPT 85520
|
| Hospital Charge Code |
977870
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.61 |
| Max. Negotiated Rate |
$185.74 |
| Rate for Payer: Aetna Commercial |
$185.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$168.15
|
| Rate for Payer: Aetna Managed Medicare |
$13.61
|
| Rate for Payer: Anthem Medicare Advantage |
$13.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$13.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$13.61
|
| Rate for Payer: Cash Price |
$56.40
|
| Rate for Payer: Cash Price |
$56.40
|
| Rate for Payer: Cigna Commercial |
$185.74
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$97.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$13.61
|
| Rate for Payer: Health EOS Commercial |
$177.92
|
| Rate for Payer: HFN Commercial |
$185.74
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$48.06
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$48.06
|
| Rate for Payer: Independent Care Health Plan Medicare |
$13.61
|
| Rate for Payer: Multiplan Commercial |
$156.42
|
| Rate for Payer: NAPHCARE Commercial |
$20.42
|
| Rate for Payer: Preferred Network Access Commercial |
$185.74
|
| Rate for Payer: Quartz Beloit One Network |
$86.03
|
| Rate for Payer: Quartz Commercial |
$111.45
|
| Rate for Payer: Quartz Medicare Advantage |
$13.61
|
| Rate for Payer: The Alliance Commercial |
$53.77
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.61
|
| Rate for Payer: WEA Trust Commercial |
$107.54
|
| Rate for Payer: WPS Commercial |
$59.90
|
|
|
Anti-Factor Xa
|
Facility
|
OP
|
$188.00
|
|
|
Service Code
|
CPT 85520
|
| Hospital Charge Code |
977870
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.61 |
| Max. Negotiated Rate |
$179.88 |
| Rate for Payer: Aetna Commercial |
$175.97
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$168.15
|
| Rate for Payer: Aetna Managed Medicare |
$13.61
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$51.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$23.82
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$22.60
|
| Rate for Payer: Anthem Medicare Advantage |
$13.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$103.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$13.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$13.61
|
| Rate for Payer: Cash Price |
$56.40
|
| Rate for Payer: Cash Price |
$56.40
|
| Rate for Payer: Cigna Commercial |
$179.88
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$13.61
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$109.42
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$13.61
|
| Rate for Payer: Health EOS Commercial |
$174.01
|
| Rate for Payer: HFN Commercial |
$179.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$50.64
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$13.61
|
| Rate for Payer: Independent Care Health Plan Medicare |
$13.61
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$13.61
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$13.61
|
| Rate for Payer: Multiplan Commercial |
$156.42
|
| Rate for Payer: NAPHCARE Commercial |
$20.42
|
| Rate for Payer: Preferred Network Access Commercial |
$179.88
|
| Rate for Payer: Quartz Beloit One Network |
$95.80
|
| Rate for Payer: Quartz Commercial |
$127.09
|
| Rate for Payer: Quartz Medicare Advantage |
$13.61
|
| Rate for Payer: The Alliance Commercial |
$54.45
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.61
|
| Rate for Payer: United Healthcare PPO |
$146.64
|
| Rate for Payer: WEA Trust Commercial |
$107.54
|
| Rate for Payer: Wellcare Medicare |
$13.61
|
| Rate for Payer: WPS Commercial |
$144.82
|
|
|
Anti-Factor Xa
|
Facility
|
IP
|
$188.00
|
|
|
Service Code
|
CPT 85520
|
| Hospital Charge Code |
977870
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$95.80 |
| Max. Negotiated Rate |
$179.88 |
| Rate for Payer: Aetna Commercial |
$175.97
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$168.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$103.63
|
| Rate for Payer: Cash Price |
$56.40
|
| Rate for Payer: Cigna Commercial |
$179.88
|
| Rate for Payer: Health EOS Commercial |
$174.01
|
| Rate for Payer: HFN Commercial |
$179.88
|
| Rate for Payer: Multiplan Commercial |
$156.42
|
| Rate for Payer: Preferred Network Access Commercial |
$179.88
|
| Rate for Payer: Quartz Beloit One Network |
$95.80
|
| Rate for Payer: Quartz Commercial |
$117.31
|
| Rate for Payer: WEA Trust Commercial |
$107.54
|
| Rate for Payer: WPS Commercial |
$144.82
|
|
|
Antiglomerular Basement Membrane Antibody
|
Facility
|
OP
|
$463.00
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
633654
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.96 |
| Max. Negotiated Rate |
$443.00 |
| Rate for Payer: Aetna Commercial |
$433.37
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$414.11
|
| Rate for Payer: Aetna Managed Medicare |
$17.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$67.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$31.43
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$29.81
|
| Rate for Payer: Anthem Medicare Advantage |
$17.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$255.21
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$17.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$17.96
|
| Rate for Payer: Cash Price |
$138.90
|
| Rate for Payer: Cash Price |
$138.90
|
| Rate for Payer: Cigna Commercial |
$443.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$17.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$269.47
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$17.96
|
| Rate for Payer: Health EOS Commercial |
$428.55
|
| Rate for Payer: HFN Commercial |
$443.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$66.81
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$17.96
|
| Rate for Payer: Independent Care Health Plan Medicare |
$17.96
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$17.96
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$17.96
|
| Rate for Payer: Multiplan Commercial |
$385.22
|
| Rate for Payer: NAPHCARE Commercial |
$26.94
|
| Rate for Payer: Preferred Network Access Commercial |
$443.00
|
| Rate for Payer: Quartz Beloit One Network |
$235.94
|
| Rate for Payer: Quartz Commercial |
$312.99
|
| Rate for Payer: Quartz Medicare Advantage |
$17.96
|
| Rate for Payer: The Alliance Commercial |
$71.84
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17.96
|
| Rate for Payer: United Healthcare PPO |
$361.14
|
| Rate for Payer: WEA Trust Commercial |
$264.84
|
| Rate for Payer: Wellcare Medicare |
$17.96
|
| Rate for Payer: WPS Commercial |
$356.65
|
|
|
Antiglomerular Basement Membrane Antibody
|
Facility
|
IP
|
$463.00
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
633654
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$235.94 |
| Max. Negotiated Rate |
$443.00 |
| Rate for Payer: Aetna Commercial |
$433.37
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$414.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$255.21
|
| Rate for Payer: Cash Price |
$138.90
|
| Rate for Payer: Cigna Commercial |
$443.00
|
| Rate for Payer: Health EOS Commercial |
$428.55
|
| Rate for Payer: HFN Commercial |
$443.00
|
| Rate for Payer: Multiplan Commercial |
$385.22
|
| Rate for Payer: Preferred Network Access Commercial |
$443.00
|
| Rate for Payer: Quartz Beloit One Network |
$235.94
|
| Rate for Payer: Quartz Commercial |
$288.91
|
| Rate for Payer: WEA Trust Commercial |
$264.84
|
| Rate for Payer: WPS Commercial |
$356.65
|
|
|
Antiglomerular Basement Membrane Antibody
|
Professional
|
Both
|
$463.00
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
633654
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.96 |
| Max. Negotiated Rate |
$457.44 |
| Rate for Payer: Aetna Commercial |
$457.44
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$414.11
|
| Rate for Payer: Aetna Managed Medicare |
$17.96
|
| Rate for Payer: Anthem Medicare Advantage |
$17.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$17.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$17.96
|
| Rate for Payer: Cash Price |
$138.90
|
| Rate for Payer: Cash Price |
$138.90
|
| Rate for Payer: Cigna Commercial |
$457.44
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$240.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$17.96
|
| Rate for Payer: Health EOS Commercial |
$438.18
|
| Rate for Payer: HFN Commercial |
$457.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$63.40
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$63.40
|
| Rate for Payer: Independent Care Health Plan Medicare |
$17.96
|
| Rate for Payer: Multiplan Commercial |
$385.22
|
| Rate for Payer: NAPHCARE Commercial |
$26.94
|
| Rate for Payer: Preferred Network Access Commercial |
$457.44
|
| Rate for Payer: Quartz Beloit One Network |
$211.87
|
| Rate for Payer: Quartz Commercial |
$274.47
|
| Rate for Payer: Quartz Medicare Advantage |
$17.96
|
| Rate for Payer: The Alliance Commercial |
$70.95
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17.96
|
| Rate for Payer: WEA Trust Commercial |
$264.84
|
| Rate for Payer: WPS Commercial |
$79.03
|
|
|
Anti-HMGCR Antibody
|
Professional
|
Both
|
$345.00
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
5128608
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.96 |
| Max. Negotiated Rate |
$340.86 |
| Rate for Payer: Aetna Commercial |
$340.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$308.57
|
| Rate for Payer: Aetna Managed Medicare |
$17.96
|
| Rate for Payer: Anthem Medicare Advantage |
$17.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$17.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$17.96
|
| Rate for Payer: Cash Price |
$103.50
|
| Rate for Payer: Cash Price |
$103.50
|
| Rate for Payer: Cigna Commercial |
$340.86
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$179.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$17.96
|
| Rate for Payer: Health EOS Commercial |
$326.51
|
| Rate for Payer: HFN Commercial |
$340.86
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$63.40
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$63.40
|
| Rate for Payer: Independent Care Health Plan Medicare |
$17.96
|
| Rate for Payer: Multiplan Commercial |
$287.04
|
| Rate for Payer: NAPHCARE Commercial |
$26.94
|
| Rate for Payer: Preferred Network Access Commercial |
$340.86
|
| Rate for Payer: Quartz Beloit One Network |
$157.87
|
| Rate for Payer: Quartz Commercial |
$204.52
|
| Rate for Payer: Quartz Medicare Advantage |
$17.96
|
| Rate for Payer: The Alliance Commercial |
$70.95
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17.96
|
| Rate for Payer: WEA Trust Commercial |
$197.34
|
| Rate for Payer: WPS Commercial |
$79.03
|
|
|
Anti-HMGCR Antibody
|
Facility
|
IP
|
$345.00
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
5128608
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$175.81 |
| Max. Negotiated Rate |
$330.10 |
| Rate for Payer: Aetna Commercial |
$322.92
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$308.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$190.16
|
| Rate for Payer: Cash Price |
$103.50
|
| Rate for Payer: Cigna Commercial |
$330.10
|
| Rate for Payer: Health EOS Commercial |
$319.33
|
| Rate for Payer: HFN Commercial |
$330.10
|
| Rate for Payer: Multiplan Commercial |
$287.04
|
| Rate for Payer: Preferred Network Access Commercial |
$330.10
|
| Rate for Payer: Quartz Beloit One Network |
$175.81
|
| Rate for Payer: Quartz Commercial |
$215.28
|
| Rate for Payer: WEA Trust Commercial |
$197.34
|
| Rate for Payer: WPS Commercial |
$265.75
|
|
|
Anti-HMGCR Antibody
|
Facility
|
OP
|
$345.00
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
5128608
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.96 |
| Max. Negotiated Rate |
$330.10 |
| Rate for Payer: Aetna Commercial |
$322.92
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$308.57
|
| Rate for Payer: Aetna Managed Medicare |
$17.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$67.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$31.43
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$29.81
|
| Rate for Payer: Anthem Medicare Advantage |
$17.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$190.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$17.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$17.96
|
| Rate for Payer: Cash Price |
$103.50
|
| Rate for Payer: Cash Price |
$103.50
|
| Rate for Payer: Cigna Commercial |
$330.10
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$17.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$200.79
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$17.96
|
| Rate for Payer: Health EOS Commercial |
$319.33
|
| Rate for Payer: HFN Commercial |
$330.10
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$66.81
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$17.96
|
| Rate for Payer: Independent Care Health Plan Medicare |
$17.96
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$17.96
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$17.96
|
| Rate for Payer: Multiplan Commercial |
$287.04
|
| Rate for Payer: NAPHCARE Commercial |
$26.94
|
| Rate for Payer: Preferred Network Access Commercial |
$330.10
|
| Rate for Payer: Quartz Beloit One Network |
$175.81
|
| Rate for Payer: Quartz Commercial |
$233.22
|
| Rate for Payer: Quartz Medicare Advantage |
$17.96
|
| Rate for Payer: The Alliance Commercial |
$71.84
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17.96
|
| Rate for Payer: United Healthcare PPO |
$269.10
|
| Rate for Payer: WEA Trust Commercial |
$197.34
|
| Rate for Payer: Wellcare Medicare |
$17.96
|
| Rate for Payer: WPS Commercial |
$265.75
|
|
|
Anti-I2
|
Professional
|
Both
|
$72.00
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
2770812
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.96 |
| Max. Negotiated Rate |
$79.03 |
| Rate for Payer: Aetna Commercial |
$71.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$64.40
|
| Rate for Payer: Aetna Managed Medicare |
$17.96
|
| Rate for Payer: Anthem Medicare Advantage |
$17.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$17.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$17.96
|
| Rate for Payer: Cash Price |
$21.60
|
| Rate for Payer: Cash Price |
$21.60
|
| Rate for Payer: Cigna Commercial |
$71.14
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$37.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$17.96
|
| Rate for Payer: Health EOS Commercial |
$68.14
|
| Rate for Payer: HFN Commercial |
$71.14
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$63.40
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$63.40
|
| Rate for Payer: Independent Care Health Plan Medicare |
$17.96
|
| Rate for Payer: Multiplan Commercial |
$59.90
|
| Rate for Payer: NAPHCARE Commercial |
$26.94
|
| Rate for Payer: Preferred Network Access Commercial |
$71.14
|
| Rate for Payer: Quartz Beloit One Network |
$32.95
|
| Rate for Payer: Quartz Commercial |
$42.68
|
| Rate for Payer: Quartz Medicare Advantage |
$17.96
|
| Rate for Payer: The Alliance Commercial |
$70.95
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17.96
|
| Rate for Payer: WEA Trust Commercial |
$41.18
|
| Rate for Payer: WPS Commercial |
$79.03
|
|
|
Anti-I2
|
Facility
|
OP
|
$72.00
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
2770812
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.96 |
| Max. Negotiated Rate |
$71.84 |
| Rate for Payer: Aetna Commercial |
$67.39
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$64.40
|
| Rate for Payer: Aetna Managed Medicare |
$17.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$67.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$31.43
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$29.81
|
| Rate for Payer: Anthem Medicare Advantage |
$17.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$39.69
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$17.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$17.96
|
| Rate for Payer: Cash Price |
$21.60
|
| Rate for Payer: Cash Price |
$21.60
|
| Rate for Payer: Cigna Commercial |
$68.89
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$17.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$41.90
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$17.96
|
| Rate for Payer: Health EOS Commercial |
$66.64
|
| Rate for Payer: HFN Commercial |
$68.89
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$66.81
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$17.96
|
| Rate for Payer: Independent Care Health Plan Medicare |
$17.96
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$17.96
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$17.96
|
| Rate for Payer: Multiplan Commercial |
$59.90
|
| Rate for Payer: NAPHCARE Commercial |
$26.94
|
| Rate for Payer: Preferred Network Access Commercial |
$68.89
|
| Rate for Payer: Quartz Beloit One Network |
$36.69
|
| Rate for Payer: Quartz Commercial |
$48.67
|
| Rate for Payer: Quartz Medicare Advantage |
$17.96
|
| Rate for Payer: The Alliance Commercial |
$71.84
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17.96
|
| Rate for Payer: United Healthcare PPO |
$56.16
|
| Rate for Payer: WEA Trust Commercial |
$41.18
|
| Rate for Payer: Wellcare Medicare |
$17.96
|
| Rate for Payer: WPS Commercial |
$55.46
|
|
|
Anti-I2
|
Facility
|
IP
|
$72.00
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
2770812
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$36.69 |
| Max. Negotiated Rate |
$68.89 |
| Rate for Payer: Aetna Commercial |
$67.39
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$64.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$39.69
|
| Rate for Payer: Cash Price |
$21.60
|
| Rate for Payer: Cigna Commercial |
$68.89
|
| Rate for Payer: Health EOS Commercial |
$66.64
|
| Rate for Payer: HFN Commercial |
$68.89
|
| Rate for Payer: Multiplan Commercial |
$59.90
|
| Rate for Payer: Preferred Network Access Commercial |
$68.89
|
| Rate for Payer: Quartz Beloit One Network |
$36.69
|
| Rate for Payer: Quartz Commercial |
$44.93
|
| Rate for Payer: WEA Trust Commercial |
$41.18
|
| Rate for Payer: WPS Commercial |
$55.46
|
|
|
Anti-Mullerian Hormone Female
|
Professional
|
Both
|
$356.00
|
|
|
Service Code
|
CPT 82166
|
| Hospital Charge Code |
980024
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$40.16 |
| Max. Negotiated Rate |
$351.73 |
| Rate for Payer: Aetna Commercial |
$351.73
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$318.41
|
| Rate for Payer: Aetna Managed Medicare |
$40.16
|
| Rate for Payer: Anthem Medicare Advantage |
$40.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$40.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$40.16
|
| Rate for Payer: Cash Price |
$106.80
|
| Rate for Payer: Cash Price |
$106.80
|
| Rate for Payer: Cigna Commercial |
$351.73
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$185.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$40.16
|
| Rate for Payer: Health EOS Commercial |
$336.92
|
| Rate for Payer: HFN Commercial |
$351.73
|
| Rate for Payer: Independent Care Health Plan Medicare |
$40.16
|
| Rate for Payer: Multiplan Commercial |
$296.19
|
| Rate for Payer: NAPHCARE Commercial |
$60.25
|
| Rate for Payer: Preferred Network Access Commercial |
$351.73
|
| Rate for Payer: Quartz Beloit One Network |
$162.91
|
| Rate for Payer: Quartz Commercial |
$211.04
|
| Rate for Payer: Quartz Medicare Advantage |
$40.16
|
| Rate for Payer: The Alliance Commercial |
$158.65
|
| Rate for Payer: United Healthcare Medicare Advantage |
$40.16
|
| Rate for Payer: WEA Trust Commercial |
$203.63
|
| Rate for Payer: WPS Commercial |
$176.73
|
|
|
Anti-Mullerian Hormone Female
|
Facility
|
OP
|
$356.00
|
|
|
Service Code
|
CPT 82166
|
| Hospital Charge Code |
980024
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$40.16 |
| Max. Negotiated Rate |
$340.62 |
| Rate for Payer: Aetna Commercial |
$333.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$318.41
|
| Rate for Payer: Aetna Managed Medicare |
$40.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$240.66
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$185.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$177.72
|
| Rate for Payer: Anthem Medicare Advantage |
$40.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$196.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$40.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$40.16
|
| Rate for Payer: Cash Price |
$106.80
|
| Rate for Payer: Cash Price |
$106.80
|
| Rate for Payer: Cigna Commercial |
$340.62
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$40.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$207.19
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$40.16
|
| Rate for Payer: Health EOS Commercial |
$329.51
|
| Rate for Payer: HFN Commercial |
$340.62
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$149.41
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$40.16
|
| Rate for Payer: Independent Care Health Plan Medicare |
$40.16
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$40.16
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$40.16
|
| Rate for Payer: Multiplan Commercial |
$296.19
|
| Rate for Payer: NAPHCARE Commercial |
$60.25
|
| Rate for Payer: Preferred Network Access Commercial |
$340.62
|
| Rate for Payer: Quartz Beloit One Network |
$181.42
|
| Rate for Payer: Quartz Commercial |
$240.66
|
| Rate for Payer: Quartz Medicare Advantage |
$40.16
|
| Rate for Payer: The Alliance Commercial |
$160.66
|
| Rate for Payer: United Healthcare Medicare Advantage |
$40.16
|
| Rate for Payer: United Healthcare PPO |
$277.68
|
| Rate for Payer: WEA Trust Commercial |
$203.63
|
| Rate for Payer: Wellcare Medicare |
$40.16
|
| Rate for Payer: WPS Commercial |
$274.23
|
|
|
Anti-Mullerian Hormone Female
|
Facility
|
IP
|
$356.00
|
|
|
Service Code
|
CPT 82166
|
| Hospital Charge Code |
980024
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$181.42 |
| Max. Negotiated Rate |
$340.62 |
| Rate for Payer: Aetna Commercial |
$333.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$318.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$196.23
|
| Rate for Payer: Cash Price |
$106.80
|
| Rate for Payer: Cigna Commercial |
$340.62
|
| Rate for Payer: Health EOS Commercial |
$329.51
|
| Rate for Payer: HFN Commercial |
$340.62
|
| Rate for Payer: Multiplan Commercial |
$296.19
|
| Rate for Payer: Preferred Network Access Commercial |
$340.62
|
| Rate for Payer: Quartz Beloit One Network |
$181.42
|
| Rate for Payer: Quartz Commercial |
$222.14
|
| Rate for Payer: WEA Trust Commercial |
$203.63
|
| Rate for Payer: WPS Commercial |
$274.23
|
|
|
Antineutrophil Cytoplasmic Antibody Screen w/ Reflex Titer
|
Professional
|
Both
|
$223.00
|
|
|
Service Code
|
CPT 86021
|
| Hospital Charge Code |
633656
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.65 |
| Max. Negotiated Rate |
$220.32 |
| Rate for Payer: Aetna Commercial |
$220.32
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$199.45
|
| Rate for Payer: Aetna Managed Medicare |
$15.65
|
| Rate for Payer: Anthem Medicare Advantage |
$15.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$15.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$15.65
|
| Rate for Payer: Cash Price |
$66.90
|
| Rate for Payer: Cash Price |
$66.90
|
| Rate for Payer: Cigna Commercial |
$220.32
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$115.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$15.65
|
| Rate for Payer: Health EOS Commercial |
$211.05
|
| Rate for Payer: HFN Commercial |
$220.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$55.26
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$55.26
|
| Rate for Payer: Independent Care Health Plan Medicare |
$15.65
|
| Rate for Payer: Multiplan Commercial |
$185.54
|
| Rate for Payer: NAPHCARE Commercial |
$23.48
|
| Rate for Payer: Preferred Network Access Commercial |
$220.32
|
| Rate for Payer: Quartz Beloit One Network |
$102.04
|
| Rate for Payer: Quartz Commercial |
$132.19
|
| Rate for Payer: Quartz Medicare Advantage |
$15.65
|
| Rate for Payer: The Alliance Commercial |
$61.83
|
| Rate for Payer: United Healthcare Medicare Advantage |
$15.65
|
| Rate for Payer: WEA Trust Commercial |
$127.56
|
| Rate for Payer: WPS Commercial |
$68.87
|
|
|
Antineutrophil Cytoplasmic Antibody Screen w/ Reflex Titer
|
Facility
|
IP
|
$223.00
|
|
|
Service Code
|
CPT 86021
|
| Hospital Charge Code |
633656
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$113.64 |
| Max. Negotiated Rate |
$213.37 |
| Rate for Payer: Aetna Commercial |
$208.73
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$199.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$122.92
|
| Rate for Payer: Cash Price |
$66.90
|
| Rate for Payer: Cigna Commercial |
$213.37
|
| Rate for Payer: Health EOS Commercial |
$206.41
|
| Rate for Payer: HFN Commercial |
$213.37
|
| Rate for Payer: Multiplan Commercial |
$185.54
|
| Rate for Payer: Preferred Network Access Commercial |
$213.37
|
| Rate for Payer: Quartz Beloit One Network |
$113.64
|
| Rate for Payer: Quartz Commercial |
$139.15
|
| Rate for Payer: WEA Trust Commercial |
$127.56
|
| Rate for Payer: WPS Commercial |
$171.78
|
|
|
Antineutrophil Cytoplasmic Antibody Screen w/ Reflex Titer
|
Facility
|
OP
|
$223.00
|
|
|
Service Code
|
CPT 86021
|
| Hospital Charge Code |
633656
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.65 |
| Max. Negotiated Rate |
$213.37 |
| Rate for Payer: Aetna Commercial |
$208.73
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$199.45
|
| Rate for Payer: Aetna Managed Medicare |
$15.65
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$58.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$27.39
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$25.98
|
| Rate for Payer: Anthem Medicare Advantage |
$15.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$122.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$15.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$15.65
|
| Rate for Payer: Cash Price |
$66.90
|
| Rate for Payer: Cash Price |
$66.90
|
| Rate for Payer: Cigna Commercial |
$213.37
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$15.65
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$129.79
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$15.65
|
| Rate for Payer: Health EOS Commercial |
$206.41
|
| Rate for Payer: HFN Commercial |
$213.37
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$58.23
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$15.65
|
| Rate for Payer: Independent Care Health Plan Medicare |
$15.65
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$15.65
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$15.65
|
| Rate for Payer: Multiplan Commercial |
$185.54
|
| Rate for Payer: NAPHCARE Commercial |
$23.48
|
| Rate for Payer: Preferred Network Access Commercial |
$213.37
|
| Rate for Payer: Quartz Beloit One Network |
$113.64
|
| Rate for Payer: Quartz Commercial |
$150.75
|
| Rate for Payer: Quartz Medicare Advantage |
$15.65
|
| Rate for Payer: The Alliance Commercial |
$62.61
|
| Rate for Payer: United Healthcare Medicare Advantage |
$15.65
|
| Rate for Payer: United Healthcare PPO |
$173.94
|
| Rate for Payer: WEA Trust Commercial |
$127.56
|
| Rate for Payer: Wellcare Medicare |
$15.65
|
| Rate for Payer: WPS Commercial |
$171.78
|
|
|
Anti-OmpC IgA
|
Facility
|
OP
|
$72.00
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
2770813
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.96 |
| Max. Negotiated Rate |
$71.84 |
| Rate for Payer: Aetna Commercial |
$67.39
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$64.40
|
| Rate for Payer: Aetna Managed Medicare |
$17.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$67.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$31.43
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$29.81
|
| Rate for Payer: Anthem Medicare Advantage |
$17.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$39.69
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$17.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$17.96
|
| Rate for Payer: Cash Price |
$21.60
|
| Rate for Payer: Cash Price |
$21.60
|
| Rate for Payer: Cigna Commercial |
$68.89
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$17.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$41.90
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$17.96
|
| Rate for Payer: Health EOS Commercial |
$66.64
|
| Rate for Payer: HFN Commercial |
$68.89
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$66.81
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$17.96
|
| Rate for Payer: Independent Care Health Plan Medicare |
$17.96
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$17.96
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$17.96
|
| Rate for Payer: Multiplan Commercial |
$59.90
|
| Rate for Payer: NAPHCARE Commercial |
$26.94
|
| Rate for Payer: Preferred Network Access Commercial |
$68.89
|
| Rate for Payer: Quartz Beloit One Network |
$36.69
|
| Rate for Payer: Quartz Commercial |
$48.67
|
| Rate for Payer: Quartz Medicare Advantage |
$17.96
|
| Rate for Payer: The Alliance Commercial |
$71.84
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17.96
|
| Rate for Payer: United Healthcare PPO |
$56.16
|
| Rate for Payer: WEA Trust Commercial |
$41.18
|
| Rate for Payer: Wellcare Medicare |
$17.96
|
| Rate for Payer: WPS Commercial |
$55.46
|
|
|
Anti-OmpC IgA
|
Professional
|
Both
|
$72.00
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
2770813
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.96 |
| Max. Negotiated Rate |
$79.03 |
| Rate for Payer: Aetna Commercial |
$71.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$64.40
|
| Rate for Payer: Aetna Managed Medicare |
$17.96
|
| Rate for Payer: Anthem Medicare Advantage |
$17.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$17.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$17.96
|
| Rate for Payer: Cash Price |
$21.60
|
| Rate for Payer: Cash Price |
$21.60
|
| Rate for Payer: Cigna Commercial |
$71.14
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$37.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$17.96
|
| Rate for Payer: Health EOS Commercial |
$68.14
|
| Rate for Payer: HFN Commercial |
$71.14
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$63.40
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$63.40
|
| Rate for Payer: Independent Care Health Plan Medicare |
$17.96
|
| Rate for Payer: Multiplan Commercial |
$59.90
|
| Rate for Payer: NAPHCARE Commercial |
$26.94
|
| Rate for Payer: Preferred Network Access Commercial |
$71.14
|
| Rate for Payer: Quartz Beloit One Network |
$32.95
|
| Rate for Payer: Quartz Commercial |
$42.68
|
| Rate for Payer: Quartz Medicare Advantage |
$17.96
|
| Rate for Payer: The Alliance Commercial |
$70.95
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17.96
|
| Rate for Payer: WEA Trust Commercial |
$41.18
|
| Rate for Payer: WPS Commercial |
$79.03
|
|
|
Anti-OmpC IgA
|
Facility
|
IP
|
$72.00
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
2770813
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$36.69 |
| Max. Negotiated Rate |
$68.89 |
| Rate for Payer: Aetna Commercial |
$67.39
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$64.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$39.69
|
| Rate for Payer: Cash Price |
$21.60
|
| Rate for Payer: Cigna Commercial |
$68.89
|
| Rate for Payer: Health EOS Commercial |
$66.64
|
| Rate for Payer: HFN Commercial |
$68.89
|
| Rate for Payer: Multiplan Commercial |
$59.90
|
| Rate for Payer: Preferred Network Access Commercial |
$68.89
|
| Rate for Payer: Quartz Beloit One Network |
$36.69
|
| Rate for Payer: Quartz Commercial |
$44.93
|
| Rate for Payer: WEA Trust Commercial |
$41.18
|
| Rate for Payer: WPS Commercial |
$55.46
|
|
|
Antiphospholipid Antibody Panel
|
Facility
|
OP
|
$344.00
|
|
|
Service Code
|
CPT 86148
|
| Hospital Charge Code |
980025
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$16.71 |
| Max. Negotiated Rate |
$329.14 |
| Rate for Payer: Aetna Commercial |
$321.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$307.67
|
| Rate for Payer: Aetna Managed Medicare |
$16.71
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$62.67
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$29.25
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$27.74
|
| Rate for Payer: Anthem Medicare Advantage |
$16.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$189.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$16.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$16.71
|
| Rate for Payer: Cash Price |
$103.20
|
| Rate for Payer: Cash Price |
$103.20
|
| Rate for Payer: Cigna Commercial |
$329.14
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$16.71
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$200.21
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$16.71
|
| Rate for Payer: Health EOS Commercial |
$318.41
|
| Rate for Payer: HFN Commercial |
$329.14
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$62.17
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$16.71
|
| Rate for Payer: Independent Care Health Plan Medicare |
$16.71
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$16.71
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$16.71
|
| Rate for Payer: Multiplan Commercial |
$286.21
|
| Rate for Payer: NAPHCARE Commercial |
$25.07
|
| Rate for Payer: Preferred Network Access Commercial |
$329.14
|
| Rate for Payer: Quartz Beloit One Network |
$175.30
|
| Rate for Payer: Quartz Commercial |
$232.54
|
| Rate for Payer: Quartz Medicare Advantage |
$16.71
|
| Rate for Payer: The Alliance Commercial |
$66.85
|
| Rate for Payer: United Healthcare Medicare Advantage |
$16.71
|
| Rate for Payer: United Healthcare PPO |
$268.32
|
| Rate for Payer: WEA Trust Commercial |
$196.77
|
| Rate for Payer: Wellcare Medicare |
$16.71
|
| Rate for Payer: WPS Commercial |
$264.98
|
|
|
Antiphospholipid Antibody Panel
|
Professional
|
Both
|
$344.00
|
|
|
Service Code
|
CPT 86148
|
| Hospital Charge Code |
980025
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$16.71 |
| Max. Negotiated Rate |
$339.87 |
| Rate for Payer: Aetna Commercial |
$339.87
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$307.67
|
| Rate for Payer: Aetna Managed Medicare |
$16.71
|
| Rate for Payer: Anthem Medicare Advantage |
$16.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$16.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$16.71
|
| Rate for Payer: Cash Price |
$103.20
|
| Rate for Payer: Cash Price |
$103.20
|
| Rate for Payer: Cigna Commercial |
$339.87
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$178.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$16.71
|
| Rate for Payer: Health EOS Commercial |
$325.56
|
| Rate for Payer: HFN Commercial |
$339.87
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$59.00
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$59.00
|
| Rate for Payer: Independent Care Health Plan Medicare |
$16.71
|
| Rate for Payer: Multiplan Commercial |
$286.21
|
| Rate for Payer: NAPHCARE Commercial |
$25.07
|
| Rate for Payer: Preferred Network Access Commercial |
$339.87
|
| Rate for Payer: Quartz Beloit One Network |
$157.41
|
| Rate for Payer: Quartz Commercial |
$203.92
|
| Rate for Payer: Quartz Medicare Advantage |
$16.71
|
| Rate for Payer: The Alliance Commercial |
$66.02
|
| Rate for Payer: United Healthcare Medicare Advantage |
$16.71
|
| Rate for Payer: WEA Trust Commercial |
$196.77
|
| Rate for Payer: WPS Commercial |
$73.54
|
|
|
Antiphospholipid Antibody Panel
|
Facility
|
IP
|
$344.00
|
|
|
Service Code
|
CPT 86148
|
| Hospital Charge Code |
980025
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$175.30 |
| Max. Negotiated Rate |
$329.14 |
| Rate for Payer: Aetna Commercial |
$321.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$307.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$189.61
|
| Rate for Payer: Cash Price |
$103.20
|
| Rate for Payer: Cigna Commercial |
$329.14
|
| Rate for Payer: Health EOS Commercial |
$318.41
|
| Rate for Payer: HFN Commercial |
$329.14
|
| Rate for Payer: Multiplan Commercial |
$286.21
|
| Rate for Payer: Preferred Network Access Commercial |
$329.14
|
| Rate for Payer: Quartz Beloit One Network |
$175.30
|
| Rate for Payer: Quartz Commercial |
$214.66
|
| Rate for Payer: WEA Trust Commercial |
$196.77
|
| Rate for Payer: WPS Commercial |
$264.98
|
|
|
ANTIROTATION SCREW FEMORAL NECK 75MM 04.168.475S
|
Facility
|
IP
|
$2,407.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
6178975
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,226.61 |
| Max. Negotiated Rate |
$2,303.02 |
| Rate for Payer: Aetna Commercial |
$2,252.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,152.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,326.74
|
| Rate for Payer: Cash Price |
$722.10
|
| Rate for Payer: Cigna Commercial |
$2,303.02
|
| Rate for Payer: Health EOS Commercial |
$2,227.92
|
| Rate for Payer: HFN Commercial |
$2,303.02
|
| Rate for Payer: Multiplan Commercial |
$2,002.62
|
| Rate for Payer: Preferred Network Access Commercial |
$2,303.02
|
| Rate for Payer: Quartz Beloit One Network |
$1,226.61
|
| Rate for Payer: Quartz Commercial |
$1,501.97
|
| Rate for Payer: WEA Trust Commercial |
$1,376.80
|
| Rate for Payer: WPS Commercial |
$1,854.11
|
|
