|
Mycelial Phase Anitbody
|
Professional
|
Both
|
$49.00
|
|
|
Service Code
|
CPT 86698
|
| Hospital Charge Code |
4392626
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$21.56 |
| Max. Negotiated Rate |
$48.68 |
| Rate for Payer: Aetna Commercial |
$46.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$42.14
|
| Rate for Payer: Cash Price |
$14.70
|
| Rate for Payer: Cash Price |
$14.70
|
| Rate for Payer: Cigna Commercial |
$46.55
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$24.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$29.40
|
| Rate for Payer: Health EOS Commercial |
$44.59
|
| Rate for Payer: HFN Commercial |
$46.55
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$48.68
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$48.68
|
| Rate for Payer: Multiplan Commercial |
$39.20
|
| Rate for Payer: Preferred Network Access Commercial |
$46.55
|
| Rate for Payer: Quartz Beloit One Network |
$21.56
|
| Rate for Payer: Quartz Commercial |
$27.93
|
| Rate for Payer: The Alliance Commercial |
$24.50
|
| Rate for Payer: WEA Trust Commercial |
$26.95
|
| Rate for Payer: WPS Commercial |
$36.29
|
|
|
Mycobacterium tuberculosis Complex, PCR to Mayo
|
Facility
|
IP
|
$493.00
|
|
|
Service Code
|
CPT 87556
|
| Hospital Charge Code |
5343774
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$241.57 |
| Max. Negotiated Rate |
$453.56 |
| Rate for Payer: Aetna Commercial |
$443.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$423.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$261.29
|
| Rate for Payer: Cash Price |
$147.90
|
| Rate for Payer: Cigna Commercial |
$453.56
|
| Rate for Payer: Health EOS Commercial |
$438.77
|
| Rate for Payer: HFN Commercial |
$453.56
|
| Rate for Payer: Multiplan Commercial |
$394.40
|
| Rate for Payer: NAPHCARE Commercial |
$295.80
|
| Rate for Payer: Preferred Network Access Commercial |
$453.56
|
| Rate for Payer: Quartz Beloit One Network |
$241.57
|
| Rate for Payer: Quartz Commercial |
$295.80
|
| Rate for Payer: WEA Trust Commercial |
$271.15
|
| Rate for Payer: WPS Commercial |
$365.17
|
|
|
Mycobacterium tuberculosis Complex, PCR to Mayo
|
Facility
|
OP
|
$493.00
|
|
|
Service Code
|
CPT 87556
|
| Hospital Charge Code |
5343774
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$41.68 |
| Max. Negotiated Rate |
$453.56 |
| Rate for Payer: Aetna Commercial |
$443.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$423.98
|
| Rate for Payer: Aetna Managed Medicare |
$41.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$156.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$72.94
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$69.19
|
| Rate for Payer: Anthem Medicaid |
$43.07
|
| Rate for Payer: Anthem Medicare Advantage |
$41.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$261.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$41.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$41.68
|
| Rate for Payer: Cash Price |
$147.90
|
| Rate for Payer: Cash Price |
$147.90
|
| Rate for Payer: Cigna Commercial |
$453.56
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$41.68
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$43.07
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$275.88
|
| Rate for Payer: Dean Health Medicaid |
$43.07
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$41.68
|
| Rate for Payer: Health EOS Commercial |
$438.77
|
| Rate for Payer: HFN Commercial |
$453.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$155.05
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$41.68
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$43.07
|
| Rate for Payer: Independent Care Health Plan Medicare |
$41.68
|
| Rate for Payer: Managed Health Services Medicaid |
$44.79
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$41.68
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$41.68
|
| Rate for Payer: Multiplan Commercial |
$394.40
|
| Rate for Payer: NAPHCARE Commercial |
$62.52
|
| Rate for Payer: Preferred Network Access Commercial |
$453.56
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$43.07
|
| Rate for Payer: Quartz Beloit One Network |
$241.57
|
| Rate for Payer: Quartz Commercial |
$320.45
|
| Rate for Payer: Quartz Medicare Advantage |
$41.68
|
| Rate for Payer: The Alliance Commercial |
$166.72
|
| Rate for Payer: United Healthcare Medicaid |
$43.07
|
| Rate for Payer: United Healthcare Medicare Advantage |
$41.68
|
| Rate for Payer: United Healthcare PPO |
$369.75
|
| Rate for Payer: WEA Trust Commercial |
$271.15
|
| Rate for Payer: Wellcare Medicare |
$41.68
|
| Rate for Payer: WMAP Medicaid |
$43.07
|
| Rate for Payer: WPS Commercial |
$365.17
|
|
|
Mycobacterium tuberculosis Complex, PCR to Mayo
|
Professional
|
Both
|
$493.00
|
|
|
Service Code
|
CPT 87556
|
| Hospital Charge Code |
5343774
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$147.13 |
| Max. Negotiated Rate |
$468.35 |
| Rate for Payer: Aetna Commercial |
$468.35
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$423.98
|
| Rate for Payer: Cash Price |
$147.90
|
| Rate for Payer: Cash Price |
$147.90
|
| Rate for Payer: Cigna Commercial |
$468.35
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$246.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$295.80
|
| Rate for Payer: Health EOS Commercial |
$448.63
|
| Rate for Payer: HFN Commercial |
$468.35
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$147.13
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$147.13
|
| Rate for Payer: Multiplan Commercial |
$394.40
|
| Rate for Payer: Preferred Network Access Commercial |
$468.35
|
| Rate for Payer: Quartz Beloit One Network |
$216.92
|
| Rate for Payer: Quartz Commercial |
$281.01
|
| Rate for Payer: The Alliance Commercial |
$246.50
|
| Rate for Payer: WEA Trust Commercial |
$271.15
|
| Rate for Payer: WPS Commercial |
$365.17
|
|
|
Mycophenolic Acid
|
Professional
|
Both
|
$297.00
|
|
|
Service Code
|
CPT 80180
|
| Hospital Charge Code |
983335
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$63.72 |
| Max. Negotiated Rate |
$282.15 |
| Rate for Payer: Aetna Commercial |
$282.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$255.42
|
| Rate for Payer: Cash Price |
$89.10
|
| Rate for Payer: Cash Price |
$89.10
|
| Rate for Payer: Cigna Commercial |
$282.15
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$148.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$178.20
|
| Rate for Payer: Health EOS Commercial |
$270.27
|
| Rate for Payer: HFN Commercial |
$282.15
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$63.72
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$63.72
|
| Rate for Payer: Multiplan Commercial |
$237.60
|
| Rate for Payer: Preferred Network Access Commercial |
$282.15
|
| Rate for Payer: Quartz Beloit One Network |
$130.68
|
| Rate for Payer: Quartz Commercial |
$169.29
|
| Rate for Payer: The Alliance Commercial |
$148.50
|
| Rate for Payer: WEA Trust Commercial |
$163.35
|
| Rate for Payer: WPS Commercial |
$219.99
|
|
|
Mycophenolic Acid
|
Facility
|
IP
|
$297.00
|
|
|
Service Code
|
CPT 80180
|
| Hospital Charge Code |
983335
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$145.53 |
| Max. Negotiated Rate |
$273.24 |
| Rate for Payer: Aetna Commercial |
$267.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$255.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$157.41
|
| Rate for Payer: Cash Price |
$89.10
|
| Rate for Payer: Cigna Commercial |
$273.24
|
| Rate for Payer: Health EOS Commercial |
$264.33
|
| Rate for Payer: HFN Commercial |
$273.24
|
| Rate for Payer: Multiplan Commercial |
$237.60
|
| Rate for Payer: NAPHCARE Commercial |
$178.20
|
| Rate for Payer: Preferred Network Access Commercial |
$273.24
|
| Rate for Payer: Quartz Beloit One Network |
$145.53
|
| Rate for Payer: Quartz Commercial |
$178.20
|
| Rate for Payer: WEA Trust Commercial |
$163.35
|
| Rate for Payer: WPS Commercial |
$219.99
|
|
|
Mycophenolic Acid
|
Facility
|
OP
|
$297.00
|
|
|
Service Code
|
CPT 80180
|
| Hospital Charge Code |
983335
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.05 |
| Max. Negotiated Rate |
$273.24 |
| Rate for Payer: Aetna Commercial |
$267.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$255.42
|
| Rate for Payer: Aetna Managed Medicare |
$18.05
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$67.69
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$31.59
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$29.96
|
| Rate for Payer: Anthem Medicaid |
$18.65
|
| Rate for Payer: Anthem Medicare Advantage |
$18.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$157.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$18.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$18.05
|
| Rate for Payer: Cash Price |
$89.10
|
| Rate for Payer: Cash Price |
$89.10
|
| Rate for Payer: Cigna Commercial |
$273.24
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$18.05
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$18.65
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$166.20
|
| Rate for Payer: Dean Health Medicaid |
$18.65
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$18.05
|
| Rate for Payer: Health EOS Commercial |
$264.33
|
| Rate for Payer: HFN Commercial |
$273.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$67.15
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$18.05
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$18.65
|
| Rate for Payer: Independent Care Health Plan Medicare |
$18.05
|
| Rate for Payer: Managed Health Services Medicaid |
$19.40
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$18.05
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$18.05
|
| Rate for Payer: Multiplan Commercial |
$237.60
|
| Rate for Payer: NAPHCARE Commercial |
$27.08
|
| Rate for Payer: Preferred Network Access Commercial |
$273.24
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$18.65
|
| Rate for Payer: Quartz Beloit One Network |
$145.53
|
| Rate for Payer: Quartz Commercial |
$193.05
|
| Rate for Payer: Quartz Medicare Advantage |
$18.05
|
| Rate for Payer: The Alliance Commercial |
$72.20
|
| Rate for Payer: United Healthcare Medicaid |
$18.65
|
| Rate for Payer: United Healthcare Medicare Advantage |
$18.05
|
| Rate for Payer: United Healthcare PPO |
$222.75
|
| Rate for Payer: WEA Trust Commercial |
$163.35
|
| Rate for Payer: Wellcare Medicare |
$18.05
|
| Rate for Payer: WMAP Medicaid |
$18.65
|
| Rate for Payer: WPS Commercial |
$219.99
|
|
|
Mycoplasma Antibody IgM
|
Professional
|
Both
|
$57.00
|
|
|
Service Code
|
CPT 86738
|
| Hospital Charge Code |
2942950
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$25.08 |
| Max. Negotiated Rate |
$54.15 |
| Rate for Payer: Aetna Commercial |
$54.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$49.02
|
| Rate for Payer: Cash Price |
$17.10
|
| Rate for Payer: Cash Price |
$17.10
|
| Rate for Payer: Cigna Commercial |
$54.15
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$28.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$34.20
|
| Rate for Payer: Health EOS Commercial |
$51.87
|
| Rate for Payer: HFN Commercial |
$54.15
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$46.74
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$46.74
|
| Rate for Payer: Multiplan Commercial |
$45.60
|
| Rate for Payer: Preferred Network Access Commercial |
$54.15
|
| Rate for Payer: Quartz Beloit One Network |
$25.08
|
| Rate for Payer: Quartz Commercial |
$32.49
|
| Rate for Payer: The Alliance Commercial |
$28.50
|
| Rate for Payer: WEA Trust Commercial |
$31.35
|
| Rate for Payer: WPS Commercial |
$42.22
|
|
|
Mycoplasma Antibody IgM
|
Facility
|
IP
|
$57.00
|
|
|
Service Code
|
CPT 86738
|
| Hospital Charge Code |
2942950
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$27.93 |
| Max. Negotiated Rate |
$52.44 |
| Rate for Payer: Aetna Commercial |
$51.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$49.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$30.21
|
| Rate for Payer: Cash Price |
$17.10
|
| Rate for Payer: Cigna Commercial |
$52.44
|
| Rate for Payer: Health EOS Commercial |
$50.73
|
| Rate for Payer: HFN Commercial |
$52.44
|
| Rate for Payer: Multiplan Commercial |
$45.60
|
| Rate for Payer: NAPHCARE Commercial |
$34.20
|
| Rate for Payer: Preferred Network Access Commercial |
$52.44
|
| Rate for Payer: Quartz Beloit One Network |
$27.93
|
| Rate for Payer: Quartz Commercial |
$34.20
|
| Rate for Payer: WEA Trust Commercial |
$31.35
|
| Rate for Payer: WPS Commercial |
$42.22
|
|
|
Mycoplasma Antibody IgM
|
Facility
|
OP
|
$57.00
|
|
|
Service Code
|
CPT 86738
|
| Hospital Charge Code |
2942950
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.24 |
| Max. Negotiated Rate |
$52.96 |
| Rate for Payer: Aetna Commercial |
$51.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$49.02
|
| Rate for Payer: Aetna Managed Medicare |
$13.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$49.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$23.17
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$21.98
|
| Rate for Payer: Anthem Medicaid |
$13.68
|
| Rate for Payer: Anthem Medicare Advantage |
$13.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$30.21
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$13.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$13.24
|
| Rate for Payer: Cash Price |
$17.10
|
| Rate for Payer: Cash Price |
$17.10
|
| Rate for Payer: Cigna Commercial |
$52.44
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$13.24
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$13.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$31.90
|
| Rate for Payer: Dean Health Medicaid |
$13.68
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$13.24
|
| Rate for Payer: Health EOS Commercial |
$50.73
|
| Rate for Payer: HFN Commercial |
$52.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$49.25
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$13.24
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$13.68
|
| Rate for Payer: Independent Care Health Plan Medicare |
$13.24
|
| Rate for Payer: Managed Health Services Medicaid |
$14.23
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$13.24
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$13.24
|
| Rate for Payer: Multiplan Commercial |
$45.60
|
| Rate for Payer: NAPHCARE Commercial |
$19.86
|
| Rate for Payer: Preferred Network Access Commercial |
$52.44
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$13.68
|
| Rate for Payer: Quartz Beloit One Network |
$27.93
|
| Rate for Payer: Quartz Commercial |
$37.05
|
| Rate for Payer: Quartz Medicare Advantage |
$13.24
|
| Rate for Payer: The Alliance Commercial |
$52.96
|
| Rate for Payer: United Healthcare Medicaid |
$13.68
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.24
|
| Rate for Payer: United Healthcare PPO |
$42.75
|
| Rate for Payer: WEA Trust Commercial |
$31.35
|
| Rate for Payer: Wellcare Medicare |
$13.24
|
| Rate for Payer: WMAP Medicaid |
$13.68
|
| Rate for Payer: WPS Commercial |
$42.22
|
|
|
Mycoplasma pneumoniae Antibodies, IgG & IgM
|
Facility
|
IP
|
$51.00
|
|
|
Service Code
|
CPT 86738
|
| Hospital Charge Code |
983337
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$24.99 |
| Max. Negotiated Rate |
$46.92 |
| Rate for Payer: Aetna Commercial |
$45.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$43.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$27.03
|
| Rate for Payer: Cash Price |
$15.30
|
| Rate for Payer: Cigna Commercial |
$46.92
|
| Rate for Payer: Health EOS Commercial |
$45.39
|
| Rate for Payer: HFN Commercial |
$46.92
|
| Rate for Payer: Multiplan Commercial |
$40.80
|
| Rate for Payer: NAPHCARE Commercial |
$30.60
|
| Rate for Payer: Preferred Network Access Commercial |
$46.92
|
| Rate for Payer: Quartz Beloit One Network |
$24.99
|
| Rate for Payer: Quartz Commercial |
$30.60
|
| Rate for Payer: WEA Trust Commercial |
$28.05
|
| Rate for Payer: WPS Commercial |
$37.78
|
|
|
Mycoplasma pneumoniae Antibodies, IgG & IgM
|
Facility
|
OP
|
$51.00
|
|
|
Service Code
|
CPT 86738
|
| Hospital Charge Code |
983337
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.24 |
| Max. Negotiated Rate |
$52.96 |
| Rate for Payer: Aetna Commercial |
$45.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$43.86
|
| Rate for Payer: Aetna Managed Medicare |
$13.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$49.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$23.17
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$21.98
|
| Rate for Payer: Anthem Medicaid |
$13.68
|
| Rate for Payer: Anthem Medicare Advantage |
$13.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$27.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$13.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$13.24
|
| Rate for Payer: Cash Price |
$15.30
|
| Rate for Payer: Cash Price |
$15.30
|
| Rate for Payer: Cigna Commercial |
$46.92
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$13.24
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$13.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$28.54
|
| Rate for Payer: Dean Health Medicaid |
$13.68
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$13.24
|
| Rate for Payer: Health EOS Commercial |
$45.39
|
| Rate for Payer: HFN Commercial |
$46.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$49.25
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$13.24
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$13.68
|
| Rate for Payer: Independent Care Health Plan Medicare |
$13.24
|
| Rate for Payer: Managed Health Services Medicaid |
$14.23
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$13.24
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$13.24
|
| Rate for Payer: Multiplan Commercial |
$40.80
|
| Rate for Payer: NAPHCARE Commercial |
$19.86
|
| Rate for Payer: Preferred Network Access Commercial |
$46.92
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$13.68
|
| Rate for Payer: Quartz Beloit One Network |
$24.99
|
| Rate for Payer: Quartz Commercial |
$33.15
|
| Rate for Payer: Quartz Medicare Advantage |
$13.24
|
| Rate for Payer: The Alliance Commercial |
$52.96
|
| Rate for Payer: United Healthcare Medicaid |
$13.68
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.24
|
| Rate for Payer: United Healthcare PPO |
$38.25
|
| Rate for Payer: WEA Trust Commercial |
$28.05
|
| Rate for Payer: Wellcare Medicare |
$13.24
|
| Rate for Payer: WMAP Medicaid |
$13.68
|
| Rate for Payer: WPS Commercial |
$37.78
|
|
|
Mycoplasma pneumoniae Antibodies, IgG & IgM
|
Professional
|
Both
|
$51.00
|
|
|
Service Code
|
CPT 86738
|
| Hospital Charge Code |
983337
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$22.44 |
| Max. Negotiated Rate |
$48.45 |
| Rate for Payer: Aetna Commercial |
$48.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$43.86
|
| Rate for Payer: Cash Price |
$15.30
|
| Rate for Payer: Cash Price |
$15.30
|
| Rate for Payer: Cigna Commercial |
$48.45
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$25.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$30.60
|
| Rate for Payer: Health EOS Commercial |
$46.41
|
| Rate for Payer: HFN Commercial |
$48.45
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$46.74
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$46.74
|
| Rate for Payer: Multiplan Commercial |
$40.80
|
| Rate for Payer: Preferred Network Access Commercial |
$48.45
|
| Rate for Payer: Quartz Beloit One Network |
$22.44
|
| Rate for Payer: Quartz Commercial |
$29.07
|
| Rate for Payer: The Alliance Commercial |
$25.50
|
| Rate for Payer: WEA Trust Commercial |
$28.05
|
| Rate for Payer: WPS Commercial |
$37.78
|
|
|
Mycoplasma pneumoniae Antibody, IgM
|
Facility
|
IP
|
$266.00
|
|
|
Service Code
|
CPT 86738
|
| Hospital Charge Code |
983338
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$130.34 |
| Max. Negotiated Rate |
$244.72 |
| Rate for Payer: Aetna Commercial |
$239.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$228.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$140.98
|
| Rate for Payer: Cash Price |
$79.80
|
| Rate for Payer: Cigna Commercial |
$244.72
|
| Rate for Payer: Health EOS Commercial |
$236.74
|
| Rate for Payer: HFN Commercial |
$244.72
|
| Rate for Payer: Multiplan Commercial |
$212.80
|
| Rate for Payer: NAPHCARE Commercial |
$159.60
|
| Rate for Payer: Preferred Network Access Commercial |
$244.72
|
| Rate for Payer: Quartz Beloit One Network |
$130.34
|
| Rate for Payer: Quartz Commercial |
$159.60
|
| Rate for Payer: WEA Trust Commercial |
$146.30
|
| Rate for Payer: WPS Commercial |
$197.03
|
|
|
Mycoplasma pneumoniae Antibody, IgM
|
Facility
|
OP
|
$266.00
|
|
|
Service Code
|
CPT 86738
|
| Hospital Charge Code |
983338
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.24 |
| Max. Negotiated Rate |
$244.72 |
| Rate for Payer: Aetna Commercial |
$239.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$228.76
|
| Rate for Payer: Aetna Managed Medicare |
$13.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$49.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$23.17
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$21.98
|
| Rate for Payer: Anthem Medicaid |
$13.68
|
| Rate for Payer: Anthem Medicare Advantage |
$13.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$140.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$13.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$13.24
|
| Rate for Payer: Cash Price |
$79.80
|
| Rate for Payer: Cash Price |
$79.80
|
| Rate for Payer: Cigna Commercial |
$244.72
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$13.24
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$13.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$148.85
|
| Rate for Payer: Dean Health Medicaid |
$13.68
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$13.24
|
| Rate for Payer: Health EOS Commercial |
$236.74
|
| Rate for Payer: HFN Commercial |
$244.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$49.25
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$13.24
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$13.68
|
| Rate for Payer: Independent Care Health Plan Medicare |
$13.24
|
| Rate for Payer: Managed Health Services Medicaid |
$14.23
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$13.24
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$13.24
|
| Rate for Payer: Multiplan Commercial |
$212.80
|
| Rate for Payer: NAPHCARE Commercial |
$19.86
|
| Rate for Payer: Preferred Network Access Commercial |
$244.72
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$13.68
|
| Rate for Payer: Quartz Beloit One Network |
$130.34
|
| Rate for Payer: Quartz Commercial |
$172.90
|
| Rate for Payer: Quartz Medicare Advantage |
$13.24
|
| Rate for Payer: The Alliance Commercial |
$52.96
|
| Rate for Payer: United Healthcare Medicaid |
$13.68
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.24
|
| Rate for Payer: United Healthcare PPO |
$199.50
|
| Rate for Payer: WEA Trust Commercial |
$146.30
|
| Rate for Payer: Wellcare Medicare |
$13.24
|
| Rate for Payer: WMAP Medicaid |
$13.68
|
| Rate for Payer: WPS Commercial |
$197.03
|
|
|
Mycoplasma pneumoniae Antibody, IgM
|
Professional
|
Both
|
$266.00
|
|
|
Service Code
|
CPT 86738
|
| Hospital Charge Code |
983338
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$46.74 |
| Max. Negotiated Rate |
$252.70 |
| Rate for Payer: Aetna Commercial |
$252.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$228.76
|
| Rate for Payer: Cash Price |
$79.80
|
| Rate for Payer: Cash Price |
$79.80
|
| Rate for Payer: Cigna Commercial |
$252.70
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$133.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$159.60
|
| Rate for Payer: Health EOS Commercial |
$242.06
|
| Rate for Payer: HFN Commercial |
$252.70
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$46.74
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$46.74
|
| Rate for Payer: Multiplan Commercial |
$212.80
|
| Rate for Payer: Preferred Network Access Commercial |
$252.70
|
| Rate for Payer: Quartz Beloit One Network |
$117.04
|
| Rate for Payer: Quartz Commercial |
$151.62
|
| Rate for Payer: The Alliance Commercial |
$133.00
|
| Rate for Payer: WEA Trust Commercial |
$146.30
|
| Rate for Payer: WPS Commercial |
$197.03
|
|
|
Mycoplasma Pneumoniae DNA, Qual, PCR
|
Facility
|
IP
|
$371.00
|
|
|
Service Code
|
CPT 87581
|
| Hospital Charge Code |
5273724
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$181.79 |
| Max. Negotiated Rate |
$341.32 |
| Rate for Payer: Aetna Commercial |
$333.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$319.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$196.63
|
| Rate for Payer: Cash Price |
$111.30
|
| Rate for Payer: Cigna Commercial |
$341.32
|
| Rate for Payer: Health EOS Commercial |
$330.19
|
| Rate for Payer: HFN Commercial |
$341.32
|
| Rate for Payer: Multiplan Commercial |
$296.80
|
| Rate for Payer: NAPHCARE Commercial |
$222.60
|
| Rate for Payer: Preferred Network Access Commercial |
$341.32
|
| Rate for Payer: Quartz Beloit One Network |
$181.79
|
| Rate for Payer: Quartz Commercial |
$222.60
|
| Rate for Payer: WEA Trust Commercial |
$204.05
|
| Rate for Payer: WPS Commercial |
$274.80
|
|
|
Mycoplasma Pneumoniae DNA, Qual, PCR
|
Facility
|
OP
|
$371.00
|
|
|
Service Code
|
CPT 87581
|
| Hospital Charge Code |
5273724
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$35.09 |
| Max. Negotiated Rate |
$341.32 |
| Rate for Payer: Aetna Commercial |
$333.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$319.06
|
| Rate for Payer: Aetna Managed Medicare |
$35.09
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$131.59
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$61.41
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$58.25
|
| Rate for Payer: Anthem Medicaid |
$36.26
|
| Rate for Payer: Anthem Medicare Advantage |
$35.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$196.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$35.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$35.09
|
| Rate for Payer: Cash Price |
$111.30
|
| Rate for Payer: Cash Price |
$111.30
|
| Rate for Payer: Cigna Commercial |
$341.32
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$35.09
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$36.26
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$207.61
|
| Rate for Payer: Dean Health Medicaid |
$36.26
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$35.09
|
| Rate for Payer: Health EOS Commercial |
$330.19
|
| Rate for Payer: HFN Commercial |
$341.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$130.53
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$35.09
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$36.26
|
| Rate for Payer: Independent Care Health Plan Medicare |
$35.09
|
| Rate for Payer: Managed Health Services Medicaid |
$37.71
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$35.09
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$35.09
|
| Rate for Payer: Multiplan Commercial |
$296.80
|
| Rate for Payer: NAPHCARE Commercial |
$52.64
|
| Rate for Payer: Preferred Network Access Commercial |
$341.32
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$36.26
|
| Rate for Payer: Quartz Beloit One Network |
$181.79
|
| Rate for Payer: Quartz Commercial |
$241.15
|
| Rate for Payer: Quartz Medicare Advantage |
$35.09
|
| Rate for Payer: The Alliance Commercial |
$140.36
|
| Rate for Payer: United Healthcare Medicaid |
$36.26
|
| Rate for Payer: United Healthcare Medicare Advantage |
$35.09
|
| Rate for Payer: United Healthcare PPO |
$278.25
|
| Rate for Payer: WEA Trust Commercial |
$204.05
|
| Rate for Payer: Wellcare Medicare |
$35.09
|
| Rate for Payer: WMAP Medicaid |
$36.26
|
| Rate for Payer: WPS Commercial |
$274.80
|
|
|
Mycoplasma Pneumoniae DNA, Qual, PCR
|
Professional
|
Both
|
$371.00
|
|
|
Service Code
|
CPT 87581
|
| Hospital Charge Code |
5273724
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$123.87 |
| Max. Negotiated Rate |
$352.45 |
| Rate for Payer: Aetna Commercial |
$352.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$319.06
|
| Rate for Payer: Cash Price |
$111.30
|
| Rate for Payer: Cash Price |
$111.30
|
| Rate for Payer: Cigna Commercial |
$352.45
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$185.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$222.60
|
| Rate for Payer: Health EOS Commercial |
$337.61
|
| Rate for Payer: HFN Commercial |
$352.45
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$123.87
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$123.87
|
| Rate for Payer: Multiplan Commercial |
$296.80
|
| Rate for Payer: Preferred Network Access Commercial |
$352.45
|
| Rate for Payer: Quartz Beloit One Network |
$163.24
|
| Rate for Payer: Quartz Commercial |
$211.47
|
| Rate for Payer: The Alliance Commercial |
$185.50
|
| Rate for Payer: WEA Trust Commercial |
$204.05
|
| Rate for Payer: WPS Commercial |
$274.80
|
|
|
Mycoplasma/Ureaplasma Panel PCR
|
Professional
|
Both
|
$643.00
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
5455252
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$123.87 |
| Max. Negotiated Rate |
$610.85 |
| Rate for Payer: Aetna Commercial |
$610.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$552.98
|
| Rate for Payer: Cash Price |
$192.90
|
| Rate for Payer: Cash Price |
$192.90
|
| Rate for Payer: Cigna Commercial |
$610.85
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$321.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$385.80
|
| Rate for Payer: Health EOS Commercial |
$585.13
|
| Rate for Payer: HFN Commercial |
$610.85
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$123.87
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$123.87
|
| Rate for Payer: Multiplan Commercial |
$514.40
|
| Rate for Payer: Preferred Network Access Commercial |
$610.85
|
| Rate for Payer: Quartz Beloit One Network |
$282.92
|
| Rate for Payer: Quartz Commercial |
$366.51
|
| Rate for Payer: The Alliance Commercial |
$321.50
|
| Rate for Payer: WEA Trust Commercial |
$353.65
|
| Rate for Payer: WPS Commercial |
$476.27
|
|
|
Mycoplasma/Ureaplasma Panel PCR
|
Facility
|
IP
|
$643.00
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
5455252
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$315.07 |
| Max. Negotiated Rate |
$591.56 |
| Rate for Payer: Aetna Commercial |
$578.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$552.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$340.79
|
| Rate for Payer: Cash Price |
$192.90
|
| Rate for Payer: Cigna Commercial |
$591.56
|
| Rate for Payer: Health EOS Commercial |
$572.27
|
| Rate for Payer: HFN Commercial |
$591.56
|
| Rate for Payer: Multiplan Commercial |
$514.40
|
| Rate for Payer: NAPHCARE Commercial |
$385.80
|
| Rate for Payer: Preferred Network Access Commercial |
$591.56
|
| Rate for Payer: Quartz Beloit One Network |
$315.07
|
| Rate for Payer: Quartz Commercial |
$385.80
|
| Rate for Payer: WEA Trust Commercial |
$353.65
|
| Rate for Payer: WPS Commercial |
$476.27
|
|
|
Mycoplasma/Ureaplasma Panel PCR
|
Facility
|
OP
|
$643.00
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
5455252
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$35.09 |
| Max. Negotiated Rate |
$591.56 |
| Rate for Payer: Aetna Commercial |
$578.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$552.98
|
| Rate for Payer: Aetna Managed Medicare |
$35.09
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$131.59
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$61.41
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$58.25
|
| Rate for Payer: Anthem Medicaid |
$36.26
|
| Rate for Payer: Anthem Medicare Advantage |
$35.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$340.79
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$35.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$35.09
|
| Rate for Payer: Cash Price |
$192.90
|
| Rate for Payer: Cash Price |
$192.90
|
| Rate for Payer: Cigna Commercial |
$591.56
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$35.09
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$36.26
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$359.82
|
| Rate for Payer: Dean Health Medicaid |
$36.26
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$35.09
|
| Rate for Payer: Health EOS Commercial |
$572.27
|
| Rate for Payer: HFN Commercial |
$591.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$130.53
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$35.09
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$36.26
|
| Rate for Payer: Independent Care Health Plan Medicare |
$35.09
|
| Rate for Payer: Managed Health Services Medicaid |
$37.71
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$35.09
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$35.09
|
| Rate for Payer: Multiplan Commercial |
$514.40
|
| Rate for Payer: NAPHCARE Commercial |
$52.64
|
| Rate for Payer: Preferred Network Access Commercial |
$591.56
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$36.26
|
| Rate for Payer: Quartz Beloit One Network |
$315.07
|
| Rate for Payer: Quartz Commercial |
$417.95
|
| Rate for Payer: Quartz Medicare Advantage |
$35.09
|
| Rate for Payer: The Alliance Commercial |
$140.36
|
| Rate for Payer: United Healthcare Medicaid |
$36.26
|
| Rate for Payer: United Healthcare Medicare Advantage |
$35.09
|
| Rate for Payer: United Healthcare PPO |
$482.25
|
| Rate for Payer: WEA Trust Commercial |
$353.65
|
| Rate for Payer: Wellcare Medicare |
$35.09
|
| Rate for Payer: WMAP Medicaid |
$36.26
|
| Rate for Payer: WPS Commercial |
$476.27
|
|
|
Myelin Associated Glycoprotein Antibody w/ Rfx
|
Facility
|
IP
|
$148.00
|
|
|
Service Code
|
CPT 84181
|
| Hospital Charge Code |
6165650
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$72.52 |
| Max. Negotiated Rate |
$136.16 |
| Rate for Payer: Aetna Commercial |
$133.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$127.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$78.44
|
| Rate for Payer: Cash Price |
$44.40
|
| Rate for Payer: Cigna Commercial |
$136.16
|
| Rate for Payer: Health EOS Commercial |
$131.72
|
| Rate for Payer: HFN Commercial |
$136.16
|
| Rate for Payer: Multiplan Commercial |
$118.40
|
| Rate for Payer: NAPHCARE Commercial |
$88.80
|
| Rate for Payer: Preferred Network Access Commercial |
$136.16
|
| Rate for Payer: Quartz Beloit One Network |
$72.52
|
| Rate for Payer: Quartz Commercial |
$88.80
|
| Rate for Payer: WEA Trust Commercial |
$81.40
|
| Rate for Payer: WPS Commercial |
$109.62
|
|
|
Myelin Associated Glycoprotein Antibody w/ Rfx
|
Facility
|
OP
|
$148.00
|
|
|
Service Code
|
CPT 84181
|
| Hospital Charge Code |
6165650
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.03 |
| Max. Negotiated Rate |
$136.16 |
| Rate for Payer: Aetna Commercial |
$133.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$127.28
|
| Rate for Payer: Aetna Managed Medicare |
$17.03
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$63.86
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$29.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$28.27
|
| Rate for Payer: Anthem Medicaid |
$17.60
|
| Rate for Payer: Anthem Medicare Advantage |
$17.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$78.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$17.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$17.03
|
| Rate for Payer: Cash Price |
$44.40
|
| Rate for Payer: Cash Price |
$44.40
|
| Rate for Payer: Cigna Commercial |
$136.16
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$17.03
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$17.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$82.82
|
| Rate for Payer: Dean Health Medicaid |
$17.60
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$17.03
|
| Rate for Payer: Health EOS Commercial |
$131.72
|
| Rate for Payer: HFN Commercial |
$136.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$63.35
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$17.03
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$17.60
|
| Rate for Payer: Independent Care Health Plan Medicare |
$17.03
|
| Rate for Payer: Managed Health Services Medicaid |
$18.30
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$17.03
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$17.03
|
| Rate for Payer: Multiplan Commercial |
$118.40
|
| Rate for Payer: NAPHCARE Commercial |
$25.54
|
| Rate for Payer: Preferred Network Access Commercial |
$136.16
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$17.60
|
| Rate for Payer: Quartz Beloit One Network |
$72.52
|
| Rate for Payer: Quartz Commercial |
$96.20
|
| Rate for Payer: Quartz Medicare Advantage |
$17.03
|
| Rate for Payer: The Alliance Commercial |
$68.12
|
| Rate for Payer: United Healthcare Medicaid |
$17.60
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17.03
|
| Rate for Payer: United Healthcare PPO |
$111.00
|
| Rate for Payer: WEA Trust Commercial |
$81.40
|
| Rate for Payer: Wellcare Medicare |
$17.03
|
| Rate for Payer: WMAP Medicaid |
$17.60
|
| Rate for Payer: WPS Commercial |
$109.62
|
|
|
Myelin Associated Glycoprotein Antibody w/ Rfx
|
Professional
|
Both
|
$148.00
|
|
|
Service Code
|
CPT 84181
|
| Hospital Charge Code |
6165650
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$16.61 |
| Max. Negotiated Rate |
$140.60 |
| Rate for Payer: Aetna Commercial |
$140.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$127.28
|
| Rate for Payer: Anthem Commercial |
$16.61
|
| Rate for Payer: Cash Price |
$44.40
|
| Rate for Payer: Cash Price |
$44.40
|
| Rate for Payer: Cigna Commercial |
$140.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$74.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$88.80
|
| Rate for Payer: Health EOS Commercial |
$134.68
|
| Rate for Payer: HFN Commercial |
$140.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$60.12
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$60.12
|
| Rate for Payer: Multiplan Commercial |
$118.40
|
| Rate for Payer: Preferred Network Access Commercial |
$140.60
|
| Rate for Payer: Quartz Beloit One Network |
$65.12
|
| Rate for Payer: Quartz Commercial |
$84.36
|
| Rate for Payer: The Alliance Commercial |
$74.00
|
| Rate for Payer: WEA Trust Commercial |
$81.40
|
| Rate for Payer: WPS Commercial |
$109.62
|
|
