|
Mutamycin 5 mg Charge
|
Facility
|
IP
|
$407.00
|
|
|
Service Code
|
HCPCS J9280
|
| Hospital Charge Code |
2958982
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$207.41 |
| Max. Negotiated Rate |
$389.42 |
| Rate for Payer: Aetna Commercial |
$380.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$364.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$224.34
|
| Rate for Payer: Cash Price |
$122.10
|
| Rate for Payer: Cigna Commercial |
$389.42
|
| Rate for Payer: Health EOS Commercial |
$376.72
|
| Rate for Payer: HFN Commercial |
$389.42
|
| Rate for Payer: Multiplan Commercial |
$338.62
|
| Rate for Payer: Preferred Network Access Commercial |
$389.42
|
| Rate for Payer: Quartz Beloit One Network |
$207.41
|
| Rate for Payer: Quartz Commercial |
$253.97
|
| Rate for Payer: WEA Trust Commercial |
$232.80
|
| Rate for Payer: WPS Commercial |
$313.51
|
|
|
Mutamycin 5 mg Charge
|
Professional
|
Both
|
$407.00
|
|
|
Service Code
|
HCPCS J9280
|
| Hospital Charge Code |
2958982
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$27.14 |
| Max. Negotiated Rate |
$402.12 |
| Rate for Payer: Aetna Commercial |
$402.12
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$364.02
|
| Rate for Payer: Aetna Managed Medicare |
$27.14
|
| Rate for Payer: Anthem Medicare Advantage |
$27.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$27.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$27.14
|
| Rate for Payer: Cash Price |
$122.10
|
| Rate for Payer: Cash Price |
$122.10
|
| Rate for Payer: Cigna Commercial |
$402.12
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$27.14
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$69.71
|
| Rate for Payer: Health EOS Commercial |
$385.18
|
| Rate for Payer: HFN Commercial |
$402.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$64.93
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$64.93
|
| Rate for Payer: Independent Care Health Plan Medicare |
$27.14
|
| Rate for Payer: Multiplan Commercial |
$338.62
|
| Rate for Payer: NAPHCARE Commercial |
$40.72
|
| Rate for Payer: Preferred Network Access Commercial |
$402.12
|
| Rate for Payer: Quartz Beloit One Network |
$186.24
|
| Rate for Payer: Quartz Commercial |
$241.27
|
| Rate for Payer: Quartz Medicare Advantage |
$27.14
|
| Rate for Payer: The Alliance Commercial |
$74.65
|
| Rate for Payer: United Healthcare Medicaid |
$27.14
|
| Rate for Payer: United Healthcare Medicare Advantage |
$27.14
|
| Rate for Payer: WEA Trust Commercial |
$232.80
|
| Rate for Payer: WPS Commercial |
$174.28
|
|
|
Mutamycin 5 mg Charge
|
Facility
|
OP
|
$407.00
|
|
|
Service Code
|
HCPCS J9280
|
| Hospital Charge Code |
2958982
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$27.14 |
| Max. Negotiated Rate |
$389.42 |
| Rate for Payer: Aetna Commercial |
$380.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$364.02
|
| Rate for Payer: Aetna Managed Medicare |
$27.14
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$275.13
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$211.64
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$203.17
|
| Rate for Payer: Anthem Medicare Advantage |
$27.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$224.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$27.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$27.14
|
| Rate for Payer: Cash Price |
$122.10
|
| Rate for Payer: Cash Price |
$122.10
|
| Rate for Payer: Cigna Commercial |
$389.42
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$27.14
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$92.23
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$27.14
|
| Rate for Payer: Health EOS Commercial |
$376.72
|
| Rate for Payer: HFN Commercial |
$389.42
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$100.98
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$27.14
|
| Rate for Payer: Independent Care Health Plan Medicare |
$27.14
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$27.14
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$27.14
|
| Rate for Payer: Multiplan Commercial |
$338.62
|
| Rate for Payer: NAPHCARE Commercial |
$40.72
|
| Rate for Payer: Preferred Network Access Commercial |
$389.42
|
| Rate for Payer: Quartz Beloit One Network |
$207.41
|
| Rate for Payer: Quartz Commercial |
$275.13
|
| Rate for Payer: Quartz Medicare Advantage |
$27.14
|
| Rate for Payer: The Alliance Commercial |
$108.58
|
| Rate for Payer: United Healthcare Medicare Advantage |
$27.14
|
| Rate for Payer: WEA Trust Commercial |
$232.80
|
| Rate for Payer: Wellcare Medicare |
$27.14
|
| Rate for Payer: WPS Commercial |
$174.28
|
|
|
Mutation ID by Enzymatic Ligat
|
Facility
|
IP
|
$285.00
|
|
| Hospital Charge Code |
2776842
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$145.24 |
| Max. Negotiated Rate |
$272.69 |
| Rate for Payer: Aetna Commercial |
$266.76
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$254.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$157.09
|
| Rate for Payer: Cash Price |
$85.50
|
| Rate for Payer: Cigna Commercial |
$272.69
|
| Rate for Payer: Health EOS Commercial |
$263.80
|
| Rate for Payer: HFN Commercial |
$272.69
|
| Rate for Payer: Multiplan Commercial |
$237.12
|
| Rate for Payer: Preferred Network Access Commercial |
$272.69
|
| Rate for Payer: Quartz Beloit One Network |
$145.24
|
| Rate for Payer: Quartz Commercial |
$177.84
|
| Rate for Payer: WEA Trust Commercial |
$163.02
|
| Rate for Payer: WPS Commercial |
$219.54
|
|
|
Mutation ID by Enzymatic Ligat
|
Facility
|
OP
|
$285.00
|
|
| Hospital Charge Code |
2776842
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$82.99 |
| Max. Negotiated Rate |
$272.69 |
| Rate for Payer: Aetna Commercial |
$266.76
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$254.90
|
| Rate for Payer: Aetna Managed Medicare |
$82.99
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$192.66
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$148.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$142.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$157.09
|
| Rate for Payer: Cash Price |
$85.50
|
| Rate for Payer: Cigna Commercial |
$272.69
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$165.87
|
| Rate for Payer: Health EOS Commercial |
$263.80
|
| Rate for Payer: HFN Commercial |
$272.69
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$222.30
|
| Rate for Payer: Multiplan Commercial |
$237.12
|
| Rate for Payer: NAPHCARE Commercial |
$177.84
|
| Rate for Payer: Preferred Network Access Commercial |
$272.69
|
| Rate for Payer: Quartz Beloit One Network |
$145.24
|
| Rate for Payer: Quartz Commercial |
$192.66
|
| Rate for Payer: Quartz Medicare Advantage |
$177.84
|
| Rate for Payer: The Alliance Commercial |
$148.20
|
| Rate for Payer: United Healthcare PPO |
$222.30
|
| Rate for Payer: WEA Trust Commercial |
$163.02
|
| Rate for Payer: WPS Commercial |
$219.54
|
|
|
Mutation ID by Enzymatic Ligat
|
Professional
|
Both
|
$285.00
|
|
| Hospital Charge Code |
2776842
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$130.42 |
| Max. Negotiated Rate |
$281.58 |
| Rate for Payer: Aetna Commercial |
$281.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$254.90
|
| Rate for Payer: Cash Price |
$85.50
|
| Rate for Payer: Cigna Commercial |
$281.58
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$148.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$177.84
|
| Rate for Payer: Health EOS Commercial |
$269.72
|
| Rate for Payer: HFN Commercial |
$281.58
|
| Rate for Payer: Multiplan Commercial |
$237.12
|
| Rate for Payer: Preferred Network Access Commercial |
$281.58
|
| Rate for Payer: Quartz Beloit One Network |
$130.42
|
| Rate for Payer: Quartz Commercial |
$168.95
|
| Rate for Payer: The Alliance Commercial |
$148.20
|
| Rate for Payer: WEA Trust Commercial |
$163.02
|
| Rate for Payer: WPS Commercial |
$219.54
|
|
|
Myasthenia Gravis Panel 2
|
Facility
|
IP
|
$160.00
|
|
|
Service Code
|
CPT 86041
|
| Hospital Charge Code |
5544898
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$81.54 |
| Max. Negotiated Rate |
$153.09 |
| Rate for Payer: Aetna Commercial |
$149.76
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$143.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$88.19
|
| Rate for Payer: Cash Price |
$48.00
|
| Rate for Payer: Cigna Commercial |
$153.09
|
| Rate for Payer: Health EOS Commercial |
$148.10
|
| Rate for Payer: HFN Commercial |
$153.09
|
| Rate for Payer: Multiplan Commercial |
$133.12
|
| Rate for Payer: Preferred Network Access Commercial |
$153.09
|
| Rate for Payer: Quartz Beloit One Network |
$81.54
|
| Rate for Payer: Quartz Commercial |
$99.84
|
| Rate for Payer: WEA Trust Commercial |
$91.52
|
| Rate for Payer: WPS Commercial |
$123.25
|
|
|
Myasthenia Gravis Panel 2
|
Facility
|
OP
|
$160.00
|
|
|
Service Code
|
CPT 86041
|
| Hospital Charge Code |
5544898
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$19.14 |
| Max. Negotiated Rate |
$153.09 |
| Rate for Payer: Aetna Commercial |
$149.76
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$143.10
|
| Rate for Payer: Aetna Managed Medicare |
$19.14
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$108.16
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$83.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$79.87
|
| Rate for Payer: Anthem Medicare Advantage |
$19.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$88.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$19.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$19.14
|
| Rate for Payer: Cash Price |
$48.00
|
| Rate for Payer: Cash Price |
$48.00
|
| Rate for Payer: Cigna Commercial |
$153.09
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$19.14
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$93.12
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$19.14
|
| Rate for Payer: Health EOS Commercial |
$148.10
|
| Rate for Payer: HFN Commercial |
$153.09
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$71.19
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$19.14
|
| Rate for Payer: Independent Care Health Plan Medicare |
$19.14
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$19.14
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$19.14
|
| Rate for Payer: Multiplan Commercial |
$133.12
|
| Rate for Payer: NAPHCARE Commercial |
$28.70
|
| Rate for Payer: Preferred Network Access Commercial |
$153.09
|
| Rate for Payer: Quartz Beloit One Network |
$81.54
|
| Rate for Payer: Quartz Commercial |
$108.16
|
| Rate for Payer: Quartz Medicare Advantage |
$19.14
|
| Rate for Payer: The Alliance Commercial |
$76.54
|
| Rate for Payer: United Healthcare Medicare Advantage |
$19.14
|
| Rate for Payer: United Healthcare PPO |
$124.80
|
| Rate for Payer: WEA Trust Commercial |
$91.52
|
| Rate for Payer: Wellcare Medicare |
$19.14
|
| Rate for Payer: WPS Commercial |
$123.25
|
|
|
Myasthenia Gravis Panel 2
|
Professional
|
Both
|
$160.00
|
|
|
Service Code
|
CPT 86041
|
| Hospital Charge Code |
5544898
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$19.14 |
| Max. Negotiated Rate |
$158.08 |
| Rate for Payer: Aetna Commercial |
$158.08
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$143.10
|
| Rate for Payer: Aetna Managed Medicare |
$19.14
|
| Rate for Payer: Anthem Medicare Advantage |
$19.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$19.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$19.14
|
| Rate for Payer: Cash Price |
$48.00
|
| Rate for Payer: Cash Price |
$48.00
|
| Rate for Payer: Cigna Commercial |
$158.08
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$83.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$19.14
|
| Rate for Payer: Health EOS Commercial |
$151.42
|
| Rate for Payer: HFN Commercial |
$158.08
|
| Rate for Payer: Independent Care Health Plan Medicare |
$19.14
|
| Rate for Payer: Multiplan Commercial |
$133.12
|
| Rate for Payer: NAPHCARE Commercial |
$28.70
|
| Rate for Payer: Preferred Network Access Commercial |
$158.08
|
| Rate for Payer: Quartz Beloit One Network |
$73.22
|
| Rate for Payer: Quartz Commercial |
$94.85
|
| Rate for Payer: Quartz Medicare Advantage |
$19.14
|
| Rate for Payer: The Alliance Commercial |
$75.59
|
| Rate for Payer: United Healthcare Medicare Advantage |
$19.14
|
| Rate for Payer: WEA Trust Commercial |
$91.52
|
| Rate for Payer: WPS Commercial |
$84.20
|
|
|
Mycelial Phase Anitbody
|
Professional
|
Both
|
$49.00
|
|
|
Service Code
|
CPT 86698
|
| Hospital Charge Code |
4392626
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.34 |
| Max. Negotiated Rate |
$63.10 |
| Rate for Payer: Aetna Commercial |
$48.41
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$43.83
|
| Rate for Payer: Aetna Managed Medicare |
$14.34
|
| Rate for Payer: Anthem Medicare Advantage |
$14.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$14.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$14.34
|
| Rate for Payer: Cash Price |
$14.70
|
| Rate for Payer: Cash Price |
$14.70
|
| Rate for Payer: Cigna Commercial |
$48.41
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$25.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$14.34
|
| Rate for Payer: Health EOS Commercial |
$46.37
|
| Rate for Payer: HFN Commercial |
$48.41
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$50.63
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$50.63
|
| Rate for Payer: Independent Care Health Plan Medicare |
$14.34
|
| Rate for Payer: Multiplan Commercial |
$40.77
|
| Rate for Payer: NAPHCARE Commercial |
$21.51
|
| Rate for Payer: Preferred Network Access Commercial |
$48.41
|
| Rate for Payer: Quartz Beloit One Network |
$22.42
|
| Rate for Payer: Quartz Commercial |
$29.05
|
| Rate for Payer: Quartz Medicare Advantage |
$14.34
|
| Rate for Payer: The Alliance Commercial |
$56.65
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14.34
|
| Rate for Payer: WEA Trust Commercial |
$28.03
|
| Rate for Payer: WPS Commercial |
$63.10
|
|
|
Mycelial Phase Anitbody
|
Facility
|
IP
|
$49.00
|
|
|
Service Code
|
CPT 86698
|
| Hospital Charge Code |
4392626
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$24.97 |
| Max. Negotiated Rate |
$46.88 |
| Rate for Payer: Aetna Commercial |
$45.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$43.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$27.01
|
| Rate for Payer: Cash Price |
$14.70
|
| Rate for Payer: Cigna Commercial |
$46.88
|
| Rate for Payer: Health EOS Commercial |
$45.35
|
| Rate for Payer: HFN Commercial |
$46.88
|
| Rate for Payer: Multiplan Commercial |
$40.77
|
| Rate for Payer: Preferred Network Access Commercial |
$46.88
|
| Rate for Payer: Quartz Beloit One Network |
$24.97
|
| Rate for Payer: Quartz Commercial |
$30.58
|
| Rate for Payer: WEA Trust Commercial |
$28.03
|
| Rate for Payer: WPS Commercial |
$37.74
|
|
|
Mycelial Phase Anitbody
|
Facility
|
OP
|
$116.00
|
|
|
Service Code
|
CPT 86698
|
| Hospital Charge Code |
2942917
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.34 |
| Max. Negotiated Rate |
$110.99 |
| Rate for Payer: Aetna Commercial |
$108.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$103.75
|
| Rate for Payer: Aetna Managed Medicare |
$14.34
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$53.78
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$25.10
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$23.81
|
| Rate for Payer: Anthem Medicare Advantage |
$14.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$63.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$14.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$14.34
|
| Rate for Payer: Cash Price |
$34.80
|
| Rate for Payer: Cash Price |
$34.80
|
| Rate for Payer: Cigna Commercial |
$110.99
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$14.34
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$67.51
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$14.34
|
| Rate for Payer: Health EOS Commercial |
$107.37
|
| Rate for Payer: HFN Commercial |
$110.99
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$53.35
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$14.34
|
| Rate for Payer: Independent Care Health Plan Medicare |
$14.34
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$14.34
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$14.34
|
| Rate for Payer: Multiplan Commercial |
$96.51
|
| Rate for Payer: NAPHCARE Commercial |
$21.51
|
| Rate for Payer: Preferred Network Access Commercial |
$110.99
|
| Rate for Payer: Quartz Beloit One Network |
$59.11
|
| Rate for Payer: Quartz Commercial |
$78.42
|
| Rate for Payer: Quartz Medicare Advantage |
$14.34
|
| Rate for Payer: The Alliance Commercial |
$57.37
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14.34
|
| Rate for Payer: United Healthcare PPO |
$90.48
|
| Rate for Payer: WEA Trust Commercial |
$66.35
|
| Rate for Payer: Wellcare Medicare |
$14.34
|
| Rate for Payer: WPS Commercial |
$89.35
|
|
|
Mycelial Phase Anitbody
|
Facility
|
IP
|
$116.00
|
|
|
Service Code
|
CPT 86698
|
| Hospital Charge Code |
2942917
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$59.11 |
| Max. Negotiated Rate |
$110.99 |
| Rate for Payer: Aetna Commercial |
$108.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$103.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$63.94
|
| Rate for Payer: Cash Price |
$34.80
|
| Rate for Payer: Cigna Commercial |
$110.99
|
| Rate for Payer: Health EOS Commercial |
$107.37
|
| Rate for Payer: HFN Commercial |
$110.99
|
| Rate for Payer: Multiplan Commercial |
$96.51
|
| Rate for Payer: Preferred Network Access Commercial |
$110.99
|
| Rate for Payer: Quartz Beloit One Network |
$59.11
|
| Rate for Payer: Quartz Commercial |
$72.38
|
| Rate for Payer: WEA Trust Commercial |
$66.35
|
| Rate for Payer: WPS Commercial |
$89.35
|
|
|
Mycelial Phase Anitbody
|
Professional
|
Both
|
$116.00
|
|
|
Service Code
|
CPT 86698
|
| Hospital Charge Code |
2942917
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.34 |
| Max. Negotiated Rate |
$114.61 |
| Rate for Payer: Aetna Commercial |
$114.61
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$103.75
|
| Rate for Payer: Aetna Managed Medicare |
$14.34
|
| Rate for Payer: Anthem Medicare Advantage |
$14.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$14.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$14.34
|
| Rate for Payer: Cash Price |
$34.80
|
| Rate for Payer: Cash Price |
$34.80
|
| Rate for Payer: Cigna Commercial |
$114.61
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$60.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$14.34
|
| Rate for Payer: Health EOS Commercial |
$109.78
|
| Rate for Payer: HFN Commercial |
$114.61
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$50.63
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$50.63
|
| Rate for Payer: Independent Care Health Plan Medicare |
$14.34
|
| Rate for Payer: Multiplan Commercial |
$96.51
|
| Rate for Payer: NAPHCARE Commercial |
$21.51
|
| Rate for Payer: Preferred Network Access Commercial |
$114.61
|
| Rate for Payer: Quartz Beloit One Network |
$53.08
|
| Rate for Payer: Quartz Commercial |
$68.76
|
| Rate for Payer: Quartz Medicare Advantage |
$14.34
|
| Rate for Payer: The Alliance Commercial |
$56.65
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14.34
|
| Rate for Payer: WEA Trust Commercial |
$66.35
|
| Rate for Payer: WPS Commercial |
$63.10
|
|
|
Mycelial Phase Anitbody
|
Facility
|
OP
|
$49.00
|
|
|
Service Code
|
CPT 86698
|
| Hospital Charge Code |
4392626
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.34 |
| Max. Negotiated Rate |
$57.37 |
| Rate for Payer: Aetna Commercial |
$45.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$43.83
|
| Rate for Payer: Aetna Managed Medicare |
$14.34
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$53.78
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$25.10
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$23.81
|
| Rate for Payer: Anthem Medicare Advantage |
$14.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$27.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$14.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$14.34
|
| Rate for Payer: Cash Price |
$14.70
|
| Rate for Payer: Cash Price |
$14.70
|
| Rate for Payer: Cigna Commercial |
$46.88
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$14.34
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$28.52
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$14.34
|
| Rate for Payer: Health EOS Commercial |
$45.35
|
| Rate for Payer: HFN Commercial |
$46.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$53.35
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$14.34
|
| Rate for Payer: Independent Care Health Plan Medicare |
$14.34
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$14.34
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$14.34
|
| Rate for Payer: Multiplan Commercial |
$40.77
|
| Rate for Payer: NAPHCARE Commercial |
$21.51
|
| Rate for Payer: Preferred Network Access Commercial |
$46.88
|
| Rate for Payer: Quartz Beloit One Network |
$24.97
|
| Rate for Payer: Quartz Commercial |
$33.12
|
| Rate for Payer: Quartz Medicare Advantage |
$14.34
|
| Rate for Payer: The Alliance Commercial |
$57.37
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14.34
|
| Rate for Payer: United Healthcare PPO |
$38.22
|
| Rate for Payer: WEA Trust Commercial |
$28.03
|
| Rate for Payer: Wellcare Medicare |
$14.34
|
| Rate for Payer: WPS Commercial |
$37.74
|
|
|
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 |
$43.35 |
| Max. Negotiated Rate |
$487.08 |
| Rate for Payer: Aetna Commercial |
$487.08
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$440.94
|
| Rate for Payer: Aetna Managed Medicare |
$43.35
|
| Rate for Payer: Anthem Medicare Advantage |
$43.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$43.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$43.35
|
| Rate for Payer: Cash Price |
$147.90
|
| Rate for Payer: Cash Price |
$147.90
|
| Rate for Payer: Cigna Commercial |
$487.08
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$256.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$43.35
|
| Rate for Payer: Health EOS Commercial |
$466.58
|
| Rate for Payer: HFN Commercial |
$487.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$153.02
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$153.02
|
| Rate for Payer: Independent Care Health Plan Medicare |
$43.35
|
| Rate for Payer: Multiplan Commercial |
$410.18
|
| Rate for Payer: NAPHCARE Commercial |
$65.02
|
| Rate for Payer: Preferred Network Access Commercial |
$487.08
|
| Rate for Payer: Quartz Beloit One Network |
$225.60
|
| Rate for Payer: Quartz Commercial |
$292.25
|
| Rate for Payer: Quartz Medicare Advantage |
$43.35
|
| Rate for Payer: The Alliance Commercial |
$171.22
|
| Rate for Payer: United Healthcare Medicare Advantage |
$43.35
|
| Rate for Payer: WEA Trust Commercial |
$282.00
|
| Rate for Payer: WPS Commercial |
$190.73
|
|
|
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 |
$43.35 |
| Max. Negotiated Rate |
$471.70 |
| Rate for Payer: Aetna Commercial |
$461.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$440.94
|
| Rate for Payer: Aetna Managed Medicare |
$43.35
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$162.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$75.86
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$71.96
|
| Rate for Payer: Anthem Medicare Advantage |
$43.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$271.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$43.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$43.35
|
| Rate for Payer: Cash Price |
$147.90
|
| Rate for Payer: Cash Price |
$147.90
|
| Rate for Payer: Cigna Commercial |
$471.70
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$43.35
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$286.93
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$43.35
|
| Rate for Payer: Health EOS Commercial |
$456.32
|
| Rate for Payer: HFN Commercial |
$471.70
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$161.25
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$43.35
|
| Rate for Payer: Independent Care Health Plan Medicare |
$43.35
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$43.35
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$43.35
|
| Rate for Payer: Multiplan Commercial |
$410.18
|
| Rate for Payer: NAPHCARE Commercial |
$65.02
|
| Rate for Payer: Preferred Network Access Commercial |
$471.70
|
| Rate for Payer: Quartz Beloit One Network |
$251.23
|
| Rate for Payer: Quartz Commercial |
$333.27
|
| Rate for Payer: Quartz Medicare Advantage |
$43.35
|
| Rate for Payer: The Alliance Commercial |
$173.39
|
| Rate for Payer: United Healthcare Medicare Advantage |
$43.35
|
| Rate for Payer: United Healthcare PPO |
$384.54
|
| Rate for Payer: WEA Trust Commercial |
$282.00
|
| Rate for Payer: Wellcare Medicare |
$43.35
|
| Rate for Payer: WPS Commercial |
$379.76
|
|
|
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 |
$251.23 |
| Max. Negotiated Rate |
$471.70 |
| Rate for Payer: Aetna Commercial |
$461.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$440.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$271.74
|
| Rate for Payer: Cash Price |
$147.90
|
| Rate for Payer: Cigna Commercial |
$471.70
|
| Rate for Payer: Health EOS Commercial |
$456.32
|
| Rate for Payer: HFN Commercial |
$471.70
|
| Rate for Payer: Multiplan Commercial |
$410.18
|
| Rate for Payer: Preferred Network Access Commercial |
$471.70
|
| Rate for Payer: Quartz Beloit One Network |
$251.23
|
| Rate for Payer: Quartz Commercial |
$307.63
|
| Rate for Payer: WEA Trust Commercial |
$282.00
|
| Rate for Payer: WPS Commercial |
$379.76
|
|
|
Mycophenolic Acid
|
Professional
|
Both
|
$297.00
|
|
|
Service Code
|
CPT 80180
|
| Hospital Charge Code |
983335
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.77 |
| Max. Negotiated Rate |
$293.44 |
| Rate for Payer: Aetna Commercial |
$293.44
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$265.64
|
| Rate for Payer: Aetna Managed Medicare |
$18.77
|
| Rate for Payer: Anthem Medicare Advantage |
$18.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$18.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$18.77
|
| Rate for Payer: Cash Price |
$89.10
|
| Rate for Payer: Cash Price |
$89.10
|
| Rate for Payer: Cigna Commercial |
$293.44
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$154.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$18.77
|
| Rate for Payer: Health EOS Commercial |
$281.08
|
| Rate for Payer: HFN Commercial |
$293.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$66.27
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$66.27
|
| Rate for Payer: Independent Care Health Plan Medicare |
$18.77
|
| Rate for Payer: Multiplan Commercial |
$247.10
|
| Rate for Payer: NAPHCARE Commercial |
$28.16
|
| Rate for Payer: Preferred Network Access Commercial |
$293.44
|
| Rate for Payer: Quartz Beloit One Network |
$135.91
|
| Rate for Payer: Quartz Commercial |
$176.06
|
| Rate for Payer: Quartz Medicare Advantage |
$18.77
|
| Rate for Payer: The Alliance Commercial |
$74.15
|
| Rate for Payer: United Healthcare Medicare Advantage |
$18.77
|
| Rate for Payer: WEA Trust Commercial |
$169.88
|
| Rate for Payer: WPS Commercial |
$82.60
|
|
|
Mycophenolic Acid
|
Facility
|
IP
|
$297.00
|
|
|
Service Code
|
CPT 80180
|
| Hospital Charge Code |
983335
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$151.35 |
| Max. Negotiated Rate |
$284.17 |
| Rate for Payer: Aetna Commercial |
$277.99
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$265.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$163.71
|
| Rate for Payer: Cash Price |
$89.10
|
| Rate for Payer: Cigna Commercial |
$284.17
|
| Rate for Payer: Health EOS Commercial |
$274.90
|
| Rate for Payer: HFN Commercial |
$284.17
|
| Rate for Payer: Multiplan Commercial |
$247.10
|
| Rate for Payer: Preferred Network Access Commercial |
$284.17
|
| Rate for Payer: Quartz Beloit One Network |
$151.35
|
| Rate for Payer: Quartz Commercial |
$185.33
|
| Rate for Payer: WEA Trust Commercial |
$169.88
|
| Rate for Payer: WPS Commercial |
$228.78
|
|
|
Mycophenolic Acid
|
Facility
|
OP
|
$297.00
|
|
|
Service Code
|
CPT 80180
|
| Hospital Charge Code |
983335
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.77 |
| Max. Negotiated Rate |
$284.17 |
| Rate for Payer: Aetna Commercial |
$277.99
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$265.64
|
| Rate for Payer: Aetna Managed Medicare |
$18.77
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$70.39
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$32.85
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$31.16
|
| Rate for Payer: Anthem Medicare Advantage |
$18.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$163.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$18.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$18.77
|
| Rate for Payer: Cash Price |
$89.10
|
| Rate for Payer: Cash Price |
$89.10
|
| Rate for Payer: Cigna Commercial |
$284.17
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$18.77
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$172.85
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$18.77
|
| Rate for Payer: Health EOS Commercial |
$274.90
|
| Rate for Payer: HFN Commercial |
$284.17
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$69.83
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$18.77
|
| Rate for Payer: Independent Care Health Plan Medicare |
$18.77
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$18.77
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$18.77
|
| Rate for Payer: Multiplan Commercial |
$247.10
|
| Rate for Payer: NAPHCARE Commercial |
$28.16
|
| Rate for Payer: Preferred Network Access Commercial |
$284.17
|
| Rate for Payer: Quartz Beloit One Network |
$151.35
|
| Rate for Payer: Quartz Commercial |
$200.77
|
| Rate for Payer: Quartz Medicare Advantage |
$18.77
|
| Rate for Payer: The Alliance Commercial |
$75.09
|
| Rate for Payer: United Healthcare Medicare Advantage |
$18.77
|
| Rate for Payer: United Healthcare PPO |
$231.66
|
| Rate for Payer: WEA Trust Commercial |
$169.88
|
| Rate for Payer: Wellcare Medicare |
$18.77
|
| Rate for Payer: WPS Commercial |
$228.78
|
|
|
Mycoplasma Antibody IgM
|
Facility
|
IP
|
$57.00
|
|
|
Service Code
|
CPT 86738
|
| Hospital Charge Code |
2942950
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$29.05 |
| Max. Negotiated Rate |
$54.54 |
| Rate for Payer: Aetna Commercial |
$53.35
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$50.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$31.42
|
| Rate for Payer: Cash Price |
$17.10
|
| Rate for Payer: Cigna Commercial |
$54.54
|
| Rate for Payer: Health EOS Commercial |
$52.76
|
| Rate for Payer: HFN Commercial |
$54.54
|
| Rate for Payer: Multiplan Commercial |
$47.42
|
| Rate for Payer: Preferred Network Access Commercial |
$54.54
|
| Rate for Payer: Quartz Beloit One Network |
$29.05
|
| Rate for Payer: Quartz Commercial |
$35.57
|
| Rate for Payer: WEA Trust Commercial |
$32.60
|
| Rate for Payer: WPS Commercial |
$43.91
|
|
|
Mycoplasma Antibody IgM
|
Professional
|
Both
|
$57.00
|
|
|
Service Code
|
CPT 86738
|
| Hospital Charge Code |
2942950
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.77 |
| Max. Negotiated Rate |
$60.59 |
| Rate for Payer: Aetna Commercial |
$56.32
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$50.98
|
| Rate for Payer: Aetna Managed Medicare |
$13.77
|
| Rate for Payer: Anthem Medicare Advantage |
$13.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$13.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$13.77
|
| Rate for Payer: Cash Price |
$17.10
|
| Rate for Payer: Cash Price |
$17.10
|
| Rate for Payer: Cigna Commercial |
$56.32
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$29.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$13.77
|
| Rate for Payer: Health EOS Commercial |
$53.94
|
| Rate for Payer: HFN Commercial |
$56.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$48.61
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$48.61
|
| Rate for Payer: Independent Care Health Plan Medicare |
$13.77
|
| Rate for Payer: Multiplan Commercial |
$47.42
|
| Rate for Payer: NAPHCARE Commercial |
$20.65
|
| Rate for Payer: Preferred Network Access Commercial |
$56.32
|
| Rate for Payer: Quartz Beloit One Network |
$26.08
|
| Rate for Payer: Quartz Commercial |
$33.79
|
| Rate for Payer: Quartz Medicare Advantage |
$13.77
|
| Rate for Payer: The Alliance Commercial |
$54.39
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.77
|
| Rate for Payer: WEA Trust Commercial |
$32.60
|
| Rate for Payer: WPS Commercial |
$60.59
|
|
|
Mycoplasma Antibody IgM
|
Facility
|
OP
|
$57.00
|
|
|
Service Code
|
CPT 86738
|
| Hospital Charge Code |
2942950
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.77 |
| Max. Negotiated Rate |
$55.08 |
| Rate for Payer: Aetna Commercial |
$53.35
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$50.98
|
| Rate for Payer: Aetna Managed Medicare |
$13.77
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$51.64
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$24.10
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$22.86
|
| Rate for Payer: Anthem Medicare Advantage |
$13.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$31.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$13.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$13.77
|
| Rate for Payer: Cash Price |
$17.10
|
| Rate for Payer: Cash Price |
$17.10
|
| Rate for Payer: Cigna Commercial |
$54.54
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$13.77
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$33.17
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$13.77
|
| Rate for Payer: Health EOS Commercial |
$52.76
|
| Rate for Payer: HFN Commercial |
$54.54
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$51.22
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$13.77
|
| Rate for Payer: Independent Care Health Plan Medicare |
$13.77
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$13.77
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$13.77
|
| Rate for Payer: Multiplan Commercial |
$47.42
|
| Rate for Payer: NAPHCARE Commercial |
$20.65
|
| Rate for Payer: Preferred Network Access Commercial |
$54.54
|
| Rate for Payer: Quartz Beloit One Network |
$29.05
|
| Rate for Payer: Quartz Commercial |
$38.53
|
| Rate for Payer: Quartz Medicare Advantage |
$13.77
|
| Rate for Payer: The Alliance Commercial |
$55.08
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.77
|
| Rate for Payer: United Healthcare PPO |
$44.46
|
| Rate for Payer: WEA Trust Commercial |
$32.60
|
| Rate for Payer: Wellcare Medicare |
$13.77
|
| Rate for Payer: WPS Commercial |
$43.91
|
|
|
Mycoplasma pneumoniae Antibodies, IgG & IgM
|
Facility
|
IP
|
$51.00
|
|
|
Service Code
|
CPT 86738
|
| Hospital Charge Code |
983337
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$25.99 |
| Max. Negotiated Rate |
$48.80 |
| Rate for Payer: Aetna Commercial |
$47.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$45.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$28.11
|
| Rate for Payer: Cash Price |
$15.30
|
| Rate for Payer: Cigna Commercial |
$48.80
|
| Rate for Payer: Health EOS Commercial |
$47.21
|
| Rate for Payer: HFN Commercial |
$48.80
|
| Rate for Payer: Multiplan Commercial |
$42.43
|
| Rate for Payer: Preferred Network Access Commercial |
$48.80
|
| Rate for Payer: Quartz Beloit One Network |
$25.99
|
| Rate for Payer: Quartz Commercial |
$31.82
|
| Rate for Payer: WEA Trust Commercial |
$29.17
|
| Rate for Payer: WPS Commercial |
$39.29
|
|
