|
Mycoplasma pneumoniae Antibodies, IgG & IgM
|
Facility
|
OP
|
$51.00
|
|
|
Service Code
|
CPT 86738
|
| Hospital Charge Code |
983337
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.77 |
| Max. Negotiated Rate |
$55.08 |
| Rate for Payer: Aetna Commercial |
$47.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$45.61
|
| 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 |
$28.11
|
| 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 |
$15.30
|
| Rate for Payer: Cash Price |
$15.30
|
| Rate for Payer: Cigna Commercial |
$48.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$13.77
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$29.68
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$13.77
|
| Rate for Payer: Health EOS Commercial |
$47.21
|
| Rate for Payer: HFN Commercial |
$48.80
|
| 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 |
$42.43
|
| Rate for Payer: NAPHCARE Commercial |
$20.65
|
| Rate for Payer: Preferred Network Access Commercial |
$48.80
|
| Rate for Payer: Quartz Beloit One Network |
$25.99
|
| Rate for Payer: Quartz Commercial |
$34.48
|
| 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 |
$39.78
|
| Rate for Payer: WEA Trust Commercial |
$29.17
|
| Rate for Payer: Wellcare Medicare |
$13.77
|
| Rate for Payer: WPS Commercial |
$39.29
|
|
|
Mycoplasma pneumoniae Antibodies, IgG & IgM
|
Professional
|
Both
|
$51.00
|
|
|
Service Code
|
CPT 86738
|
| Hospital Charge Code |
983337
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.77 |
| Max. Negotiated Rate |
$60.59 |
| Rate for Payer: Aetna Commercial |
$50.39
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$45.61
|
| 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 |
$15.30
|
| Rate for Payer: Cash Price |
$15.30
|
| Rate for Payer: Cigna Commercial |
$50.39
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$26.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$13.77
|
| Rate for Payer: Health EOS Commercial |
$48.27
|
| Rate for Payer: HFN Commercial |
$50.39
|
| 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 |
$42.43
|
| Rate for Payer: NAPHCARE Commercial |
$20.65
|
| Rate for Payer: Preferred Network Access Commercial |
$50.39
|
| Rate for Payer: Quartz Beloit One Network |
$23.34
|
| Rate for Payer: Quartz Commercial |
$30.23
|
| 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 |
$29.17
|
| Rate for Payer: WPS Commercial |
$60.59
|
|
|
Mycoplasma pneumoniae Antibody, IgM
|
Professional
|
Both
|
$266.00
|
|
|
Service Code
|
CPT 86738
|
| Hospital Charge Code |
983338
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.77 |
| Max. Negotiated Rate |
$262.81 |
| Rate for Payer: Aetna Commercial |
$262.81
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$237.91
|
| 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 |
$79.80
|
| Rate for Payer: Cash Price |
$79.80
|
| Rate for Payer: Cigna Commercial |
$262.81
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$138.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$13.77
|
| Rate for Payer: Health EOS Commercial |
$251.74
|
| Rate for Payer: HFN Commercial |
$262.81
|
| 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 |
$221.31
|
| Rate for Payer: NAPHCARE Commercial |
$20.65
|
| Rate for Payer: Preferred Network Access Commercial |
$262.81
|
| Rate for Payer: Quartz Beloit One Network |
$121.72
|
| Rate for Payer: Quartz Commercial |
$157.68
|
| 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 |
$152.15
|
| Rate for Payer: WPS Commercial |
$60.59
|
|
|
Mycoplasma pneumoniae Antibody, IgM
|
Facility
|
IP
|
$266.00
|
|
|
Service Code
|
CPT 86738
|
| Hospital Charge Code |
983338
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$135.55 |
| Max. Negotiated Rate |
$254.51 |
| Rate for Payer: Aetna Commercial |
$248.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$237.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$146.62
|
| Rate for Payer: Cash Price |
$79.80
|
| Rate for Payer: Cigna Commercial |
$254.51
|
| Rate for Payer: Health EOS Commercial |
$246.21
|
| Rate for Payer: HFN Commercial |
$254.51
|
| Rate for Payer: Multiplan Commercial |
$221.31
|
| Rate for Payer: Preferred Network Access Commercial |
$254.51
|
| Rate for Payer: Quartz Beloit One Network |
$135.55
|
| Rate for Payer: Quartz Commercial |
$165.98
|
| Rate for Payer: WEA Trust Commercial |
$152.15
|
| Rate for Payer: WPS Commercial |
$204.90
|
|
|
Mycoplasma pneumoniae Antibody, IgM
|
Facility
|
OP
|
$266.00
|
|
|
Service Code
|
CPT 86738
|
| Hospital Charge Code |
983338
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.77 |
| Max. Negotiated Rate |
$254.51 |
| Rate for Payer: Aetna Commercial |
$248.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$237.91
|
| 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 |
$146.62
|
| 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 |
$79.80
|
| Rate for Payer: Cash Price |
$79.80
|
| Rate for Payer: Cigna Commercial |
$254.51
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$13.77
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$154.81
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$13.77
|
| Rate for Payer: Health EOS Commercial |
$246.21
|
| Rate for Payer: HFN Commercial |
$254.51
|
| 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 |
$221.31
|
| Rate for Payer: NAPHCARE Commercial |
$20.65
|
| Rate for Payer: Preferred Network Access Commercial |
$254.51
|
| Rate for Payer: Quartz Beloit One Network |
$135.55
|
| Rate for Payer: Quartz Commercial |
$179.82
|
| 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 |
$207.48
|
| Rate for Payer: WEA Trust Commercial |
$152.15
|
| Rate for Payer: Wellcare Medicare |
$13.77
|
| Rate for Payer: WPS Commercial |
$204.90
|
|
|
Mycoplasma Pneumoniae DNA, Qual, PCR
|
Facility
|
IP
|
$371.00
|
|
|
Service Code
|
CPT 87581
|
| Hospital Charge Code |
5273724
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$189.06 |
| Max. Negotiated Rate |
$354.97 |
| Rate for Payer: Aetna Commercial |
$347.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$331.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$204.50
|
| Rate for Payer: Cash Price |
$111.30
|
| Rate for Payer: Cigna Commercial |
$354.97
|
| Rate for Payer: Health EOS Commercial |
$343.40
|
| Rate for Payer: HFN Commercial |
$354.97
|
| Rate for Payer: Multiplan Commercial |
$308.67
|
| Rate for Payer: Preferred Network Access Commercial |
$354.97
|
| Rate for Payer: Quartz Beloit One Network |
$189.06
|
| Rate for Payer: Quartz Commercial |
$231.50
|
| Rate for Payer: WEA Trust Commercial |
$212.21
|
| Rate for Payer: WPS Commercial |
$285.78
|
|
|
Mycoplasma Pneumoniae DNA, Qual, PCR
|
Facility
|
OP
|
$371.00
|
|
|
Service Code
|
CPT 87581
|
| Hospital Charge Code |
5273724
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$36.49 |
| Max. Negotiated Rate |
$354.97 |
| Rate for Payer: Aetna Commercial |
$347.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$331.82
|
| Rate for Payer: Aetna Managed Medicare |
$36.49
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$136.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$63.86
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$60.58
|
| Rate for Payer: Anthem Medicare Advantage |
$36.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$204.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$36.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$36.49
|
| Rate for Payer: Cash Price |
$111.30
|
| Rate for Payer: Cash Price |
$111.30
|
| Rate for Payer: Cigna Commercial |
$354.97
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$36.49
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$215.92
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$36.49
|
| Rate for Payer: Health EOS Commercial |
$343.40
|
| Rate for Payer: HFN Commercial |
$354.97
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$135.76
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$36.49
|
| Rate for Payer: Independent Care Health Plan Medicare |
$36.49
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$36.49
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$36.49
|
| Rate for Payer: Multiplan Commercial |
$308.67
|
| Rate for Payer: NAPHCARE Commercial |
$54.74
|
| Rate for Payer: Preferred Network Access Commercial |
$354.97
|
| Rate for Payer: Quartz Beloit One Network |
$189.06
|
| Rate for Payer: Quartz Commercial |
$250.80
|
| Rate for Payer: Quartz Medicare Advantage |
$36.49
|
| Rate for Payer: The Alliance Commercial |
$145.97
|
| Rate for Payer: United Healthcare Medicare Advantage |
$36.49
|
| Rate for Payer: United Healthcare PPO |
$289.38
|
| Rate for Payer: WEA Trust Commercial |
$212.21
|
| Rate for Payer: Wellcare Medicare |
$36.49
|
| Rate for Payer: WPS Commercial |
$285.78
|
|
|
Mycoplasma Pneumoniae DNA, Qual, PCR
|
Professional
|
Both
|
$371.00
|
|
|
Service Code
|
CPT 87581
|
| Hospital Charge Code |
5273724
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$36.49 |
| Max. Negotiated Rate |
$366.55 |
| Rate for Payer: Aetna Commercial |
$366.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$331.82
|
| Rate for Payer: Aetna Managed Medicare |
$36.49
|
| Rate for Payer: Anthem Medicare Advantage |
$36.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$36.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$36.49
|
| Rate for Payer: Cash Price |
$111.30
|
| Rate for Payer: Cash Price |
$111.30
|
| Rate for Payer: Cigna Commercial |
$366.55
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$192.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$36.49
|
| Rate for Payer: Health EOS Commercial |
$351.11
|
| Rate for Payer: HFN Commercial |
$366.55
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$128.82
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$128.82
|
| Rate for Payer: Independent Care Health Plan Medicare |
$36.49
|
| Rate for Payer: Multiplan Commercial |
$308.67
|
| Rate for Payer: NAPHCARE Commercial |
$54.74
|
| Rate for Payer: Preferred Network Access Commercial |
$366.55
|
| Rate for Payer: Quartz Beloit One Network |
$169.77
|
| Rate for Payer: Quartz Commercial |
$219.93
|
| Rate for Payer: Quartz Medicare Advantage |
$36.49
|
| Rate for Payer: The Alliance Commercial |
$144.15
|
| Rate for Payer: United Healthcare Medicare Advantage |
$36.49
|
| Rate for Payer: WEA Trust Commercial |
$212.21
|
| Rate for Payer: WPS Commercial |
$160.57
|
|
|
Mycoplasma/Ureaplasma Panel PCR
|
Facility
|
IP
|
$643.00
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
5455252
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$327.67 |
| Max. Negotiated Rate |
$615.22 |
| Rate for Payer: Aetna Commercial |
$601.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$575.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$354.42
|
| Rate for Payer: Cash Price |
$192.90
|
| Rate for Payer: Cigna Commercial |
$615.22
|
| Rate for Payer: Health EOS Commercial |
$595.16
|
| Rate for Payer: HFN Commercial |
$615.22
|
| Rate for Payer: Multiplan Commercial |
$534.98
|
| Rate for Payer: Preferred Network Access Commercial |
$615.22
|
| Rate for Payer: Quartz Beloit One Network |
$327.67
|
| Rate for Payer: Quartz Commercial |
$401.23
|
| Rate for Payer: WEA Trust Commercial |
$367.80
|
| Rate for Payer: WPS Commercial |
$495.30
|
|
|
Mycoplasma/Ureaplasma Panel PCR
|
Professional
|
Both
|
$643.00
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
5455252
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$36.49 |
| Max. Negotiated Rate |
$635.28 |
| Rate for Payer: Aetna Commercial |
$635.28
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$575.10
|
| Rate for Payer: Aetna Managed Medicare |
$36.49
|
| Rate for Payer: Anthem Medicare Advantage |
$36.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$36.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$36.49
|
| Rate for Payer: Cash Price |
$192.90
|
| Rate for Payer: Cash Price |
$192.90
|
| Rate for Payer: Cigna Commercial |
$635.28
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$334.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$36.49
|
| Rate for Payer: Health EOS Commercial |
$608.54
|
| Rate for Payer: HFN Commercial |
$635.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$128.82
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$128.82
|
| Rate for Payer: Independent Care Health Plan Medicare |
$36.49
|
| Rate for Payer: Multiplan Commercial |
$534.98
|
| Rate for Payer: NAPHCARE Commercial |
$54.74
|
| Rate for Payer: Preferred Network Access Commercial |
$635.28
|
| Rate for Payer: Quartz Beloit One Network |
$294.24
|
| Rate for Payer: Quartz Commercial |
$381.17
|
| Rate for Payer: Quartz Medicare Advantage |
$36.49
|
| Rate for Payer: The Alliance Commercial |
$144.15
|
| Rate for Payer: United Healthcare Medicare Advantage |
$36.49
|
| Rate for Payer: WEA Trust Commercial |
$367.80
|
| Rate for Payer: WPS Commercial |
$160.57
|
|
|
Mycoplasma/Ureaplasma Panel PCR
|
Facility
|
OP
|
$643.00
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
5455252
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$36.49 |
| Max. Negotiated Rate |
$615.22 |
| Rate for Payer: Aetna Commercial |
$601.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$575.10
|
| Rate for Payer: Aetna Managed Medicare |
$36.49
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$136.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$63.86
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$60.58
|
| Rate for Payer: Anthem Medicare Advantage |
$36.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$354.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$36.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$36.49
|
| Rate for Payer: Cash Price |
$192.90
|
| Rate for Payer: Cash Price |
$192.90
|
| Rate for Payer: Cigna Commercial |
$615.22
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$36.49
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$374.23
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$36.49
|
| Rate for Payer: Health EOS Commercial |
$595.16
|
| Rate for Payer: HFN Commercial |
$615.22
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$135.76
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$36.49
|
| Rate for Payer: Independent Care Health Plan Medicare |
$36.49
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$36.49
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$36.49
|
| Rate for Payer: Multiplan Commercial |
$534.98
|
| Rate for Payer: NAPHCARE Commercial |
$54.74
|
| Rate for Payer: Preferred Network Access Commercial |
$615.22
|
| Rate for Payer: Quartz Beloit One Network |
$327.67
|
| Rate for Payer: Quartz Commercial |
$434.67
|
| Rate for Payer: Quartz Medicare Advantage |
$36.49
|
| Rate for Payer: The Alliance Commercial |
$145.97
|
| Rate for Payer: United Healthcare Medicare Advantage |
$36.49
|
| Rate for Payer: United Healthcare PPO |
$501.54
|
| Rate for Payer: WEA Trust Commercial |
$367.80
|
| Rate for Payer: Wellcare Medicare |
$36.49
|
| Rate for Payer: WPS Commercial |
$495.30
|
|
|
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 |
$75.42 |
| Max. Negotiated Rate |
$141.61 |
| Rate for Payer: Aetna Commercial |
$138.53
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$132.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$81.58
|
| Rate for Payer: Cash Price |
$44.40
|
| Rate for Payer: Cigna Commercial |
$141.61
|
| Rate for Payer: Health EOS Commercial |
$136.99
|
| Rate for Payer: HFN Commercial |
$141.61
|
| Rate for Payer: Multiplan Commercial |
$123.14
|
| Rate for Payer: Preferred Network Access Commercial |
$141.61
|
| Rate for Payer: Quartz Beloit One Network |
$75.42
|
| Rate for Payer: Quartz Commercial |
$92.35
|
| Rate for Payer: WEA Trust Commercial |
$84.66
|
| Rate for Payer: WPS Commercial |
$114.00
|
|
|
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 |
$17.71 |
| Max. Negotiated Rate |
$141.61 |
| Rate for Payer: Aetna Commercial |
$138.53
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$132.37
|
| Rate for Payer: Aetna Managed Medicare |
$17.71
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$66.42
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$30.99
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$29.40
|
| Rate for Payer: Anthem Medicare Advantage |
$17.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$81.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$17.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$17.71
|
| Rate for Payer: Cash Price |
$44.40
|
| Rate for Payer: Cash Price |
$44.40
|
| Rate for Payer: Cigna Commercial |
$141.61
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$17.71
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$86.14
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$17.71
|
| Rate for Payer: Health EOS Commercial |
$136.99
|
| Rate for Payer: HFN Commercial |
$141.61
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$65.89
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$17.71
|
| Rate for Payer: Independent Care Health Plan Medicare |
$17.71
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$17.71
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$17.71
|
| Rate for Payer: Multiplan Commercial |
$123.14
|
| Rate for Payer: NAPHCARE Commercial |
$26.57
|
| Rate for Payer: Preferred Network Access Commercial |
$141.61
|
| Rate for Payer: Quartz Beloit One Network |
$75.42
|
| Rate for Payer: Quartz Commercial |
$100.05
|
| Rate for Payer: Quartz Medicare Advantage |
$17.71
|
| Rate for Payer: The Alliance Commercial |
$70.84
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17.71
|
| Rate for Payer: United Healthcare PPO |
$115.44
|
| Rate for Payer: WEA Trust Commercial |
$84.66
|
| Rate for Payer: Wellcare Medicare |
$17.71
|
| Rate for Payer: WPS Commercial |
$114.00
|
|
|
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 |
$17.27 |
| Max. Negotiated Rate |
$146.22 |
| Rate for Payer: Aetna Commercial |
$146.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$132.37
|
| Rate for Payer: Aetna Managed Medicare |
$17.71
|
| Rate for Payer: Anthem Commercial |
$17.27
|
| Rate for Payer: Anthem Medicare Advantage |
$17.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$17.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$17.71
|
| Rate for Payer: Cash Price |
$44.40
|
| Rate for Payer: Cash Price |
$44.40
|
| Rate for Payer: Cigna Commercial |
$146.22
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$76.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$17.71
|
| Rate for Payer: Health EOS Commercial |
$140.07
|
| Rate for Payer: HFN Commercial |
$146.22
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$62.52
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$62.52
|
| Rate for Payer: Independent Care Health Plan Medicare |
$17.71
|
| Rate for Payer: Multiplan Commercial |
$123.14
|
| Rate for Payer: NAPHCARE Commercial |
$26.57
|
| Rate for Payer: Preferred Network Access Commercial |
$146.22
|
| Rate for Payer: Quartz Beloit One Network |
$67.72
|
| Rate for Payer: Quartz Commercial |
$87.73
|
| Rate for Payer: Quartz Medicare Advantage |
$17.71
|
| Rate for Payer: The Alliance Commercial |
$69.96
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17.71
|
| Rate for Payer: WEA Trust Commercial |
$84.66
|
| Rate for Payer: WPS Commercial |
$77.93
|
|
|
Myelin Basic Protein Cerebrospinal Fluid
|
Facility
|
OP
|
$491.00
|
|
|
Service Code
|
CPT 83873
|
| Hospital Charge Code |
978023
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.89 |
| Max. Negotiated Rate |
$469.79 |
| Rate for Payer: Aetna Commercial |
$459.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$439.15
|
| Rate for Payer: Aetna Managed Medicare |
$17.89
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$67.08
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$31.30
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$29.69
|
| Rate for Payer: Anthem Medicare Advantage |
$17.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$270.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$17.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$17.89
|
| Rate for Payer: Cash Price |
$147.30
|
| Rate for Payer: Cash Price |
$147.30
|
| Rate for Payer: Cigna Commercial |
$469.79
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$17.89
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$285.76
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$17.89
|
| Rate for Payer: Health EOS Commercial |
$454.47
|
| Rate for Payer: HFN Commercial |
$469.79
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$66.54
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$17.89
|
| Rate for Payer: Independent Care Health Plan Medicare |
$17.89
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$17.89
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$17.89
|
| Rate for Payer: Multiplan Commercial |
$408.51
|
| Rate for Payer: NAPHCARE Commercial |
$26.83
|
| Rate for Payer: Preferred Network Access Commercial |
$469.79
|
| Rate for Payer: Quartz Beloit One Network |
$250.21
|
| Rate for Payer: Quartz Commercial |
$331.92
|
| Rate for Payer: Quartz Medicare Advantage |
$17.89
|
| Rate for Payer: The Alliance Commercial |
$71.55
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17.89
|
| Rate for Payer: United Healthcare PPO |
$382.98
|
| Rate for Payer: WEA Trust Commercial |
$280.85
|
| Rate for Payer: Wellcare Medicare |
$17.89
|
| Rate for Payer: WPS Commercial |
$378.22
|
|
|
Myelin Basic Protein Cerebrospinal Fluid
|
Professional
|
Both
|
$491.00
|
|
|
Service Code
|
CPT 83873
|
| Hospital Charge Code |
978023
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.89 |
| Max. Negotiated Rate |
$485.11 |
| Rate for Payer: Aetna Commercial |
$485.11
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$439.15
|
| Rate for Payer: Aetna Managed Medicare |
$17.89
|
| Rate for Payer: Anthem Medicare Advantage |
$17.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$17.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$17.89
|
| Rate for Payer: Cash Price |
$147.30
|
| Rate for Payer: Cash Price |
$147.30
|
| Rate for Payer: Cigna Commercial |
$485.11
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$255.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$17.89
|
| Rate for Payer: Health EOS Commercial |
$464.68
|
| Rate for Payer: HFN Commercial |
$485.11
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$63.15
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$63.15
|
| Rate for Payer: Independent Care Health Plan Medicare |
$17.89
|
| Rate for Payer: Multiplan Commercial |
$408.51
|
| Rate for Payer: NAPHCARE Commercial |
$26.83
|
| Rate for Payer: Preferred Network Access Commercial |
$485.11
|
| Rate for Payer: Quartz Beloit One Network |
$224.68
|
| Rate for Payer: Quartz Commercial |
$291.06
|
| Rate for Payer: Quartz Medicare Advantage |
$17.89
|
| Rate for Payer: The Alliance Commercial |
$70.66
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17.89
|
| Rate for Payer: WEA Trust Commercial |
$280.85
|
| Rate for Payer: WPS Commercial |
$78.71
|
|
|
Myelin Basic Protein Cerebrospinal Fluid
|
Facility
|
IP
|
$491.00
|
|
|
Service Code
|
CPT 83873
|
| Hospital Charge Code |
978023
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$250.21 |
| Max. Negotiated Rate |
$469.79 |
| Rate for Payer: Aetna Commercial |
$459.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$439.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$270.64
|
| Rate for Payer: Cash Price |
$147.30
|
| Rate for Payer: Cigna Commercial |
$469.79
|
| Rate for Payer: Health EOS Commercial |
$454.47
|
| Rate for Payer: HFN Commercial |
$469.79
|
| Rate for Payer: Multiplan Commercial |
$408.51
|
| Rate for Payer: Preferred Network Access Commercial |
$469.79
|
| Rate for Payer: Quartz Beloit One Network |
$250.21
|
| Rate for Payer: Quartz Commercial |
$306.38
|
| Rate for Payer: WEA Trust Commercial |
$280.85
|
| Rate for Payer: WPS Commercial |
$378.22
|
|
|
Myelin Basic Protein CSF
|
Facility
|
OP
|
$321.00
|
|
|
Service Code
|
CPT 83873
|
| Hospital Charge Code |
1114848
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.89 |
| Max. Negotiated Rate |
$307.13 |
| Rate for Payer: Aetna Commercial |
$300.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$287.10
|
| Rate for Payer: Aetna Managed Medicare |
$17.89
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$67.08
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$31.30
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$29.69
|
| Rate for Payer: Anthem Medicare Advantage |
$17.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$176.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$17.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$17.89
|
| Rate for Payer: Cash Price |
$96.30
|
| Rate for Payer: Cash Price |
$96.30
|
| Rate for Payer: Cigna Commercial |
$307.13
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$17.89
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$186.82
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$17.89
|
| Rate for Payer: Health EOS Commercial |
$297.12
|
| Rate for Payer: HFN Commercial |
$307.13
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$66.54
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$17.89
|
| Rate for Payer: Independent Care Health Plan Medicare |
$17.89
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$17.89
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$17.89
|
| Rate for Payer: Multiplan Commercial |
$267.07
|
| Rate for Payer: NAPHCARE Commercial |
$26.83
|
| Rate for Payer: Preferred Network Access Commercial |
$307.13
|
| Rate for Payer: Quartz Beloit One Network |
$163.58
|
| Rate for Payer: Quartz Commercial |
$217.00
|
| Rate for Payer: Quartz Medicare Advantage |
$17.89
|
| Rate for Payer: The Alliance Commercial |
$71.55
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17.89
|
| Rate for Payer: United Healthcare PPO |
$250.38
|
| Rate for Payer: WEA Trust Commercial |
$183.61
|
| Rate for Payer: Wellcare Medicare |
$17.89
|
| Rate for Payer: WPS Commercial |
$247.27
|
|
|
Myelin Basic Protein CSF
|
Facility
|
IP
|
$321.00
|
|
|
Service Code
|
CPT 83873
|
| Hospital Charge Code |
1114848
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$163.58 |
| Max. Negotiated Rate |
$307.13 |
| Rate for Payer: Aetna Commercial |
$300.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$287.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$176.94
|
| Rate for Payer: Cash Price |
$96.30
|
| Rate for Payer: Cigna Commercial |
$307.13
|
| Rate for Payer: Health EOS Commercial |
$297.12
|
| Rate for Payer: HFN Commercial |
$307.13
|
| Rate for Payer: Multiplan Commercial |
$267.07
|
| Rate for Payer: Preferred Network Access Commercial |
$307.13
|
| Rate for Payer: Quartz Beloit One Network |
$163.58
|
| Rate for Payer: Quartz Commercial |
$200.30
|
| Rate for Payer: WEA Trust Commercial |
$183.61
|
| Rate for Payer: WPS Commercial |
$247.27
|
|
|
Myelin Oligodendrocyte Glycoprotein Antibody
|
Facility
|
IP
|
$686.40
|
|
|
Service Code
|
CPT 86362
|
| Hospital Charge Code |
5595323
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$349.79 |
| Max. Negotiated Rate |
$656.75 |
| Rate for Payer: Aetna Commercial |
$642.47
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$613.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$378.34
|
| Rate for Payer: Cash Price |
$205.92
|
| Rate for Payer: Cigna Commercial |
$656.75
|
| Rate for Payer: Health EOS Commercial |
$635.33
|
| Rate for Payer: HFN Commercial |
$656.75
|
| Rate for Payer: Multiplan Commercial |
$571.08
|
| Rate for Payer: Preferred Network Access Commercial |
$656.75
|
| Rate for Payer: Quartz Beloit One Network |
$349.79
|
| Rate for Payer: Quartz Commercial |
$428.31
|
| Rate for Payer: WEA Trust Commercial |
$392.62
|
| Rate for Payer: WPS Commercial |
$528.73
|
|
|
Myelin Oligodendrocyte Glycoprotein Antibody
|
Professional
|
Both
|
$686.40
|
|
|
Service Code
|
CPT 86362
|
| Hospital Charge Code |
5595323
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.53 |
| Max. Negotiated Rate |
$678.16 |
| Rate for Payer: Aetna Commercial |
$678.16
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$613.92
|
| Rate for Payer: Aetna Managed Medicare |
$12.53
|
| Rate for Payer: Anthem Medicare Advantage |
$12.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$12.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$12.53
|
| Rate for Payer: Cash Price |
$205.92
|
| Rate for Payer: Cash Price |
$205.92
|
| Rate for Payer: Cigna Commercial |
$678.16
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$356.93
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12.53
|
| Rate for Payer: Health EOS Commercial |
$649.61
|
| Rate for Payer: HFN Commercial |
$678.16
|
| Rate for Payer: Independent Care Health Plan Medicare |
$12.53
|
| Rate for Payer: Multiplan Commercial |
$571.08
|
| Rate for Payer: NAPHCARE Commercial |
$18.80
|
| Rate for Payer: Preferred Network Access Commercial |
$678.16
|
| Rate for Payer: Quartz Beloit One Network |
$314.10
|
| Rate for Payer: Quartz Commercial |
$406.90
|
| Rate for Payer: Quartz Medicare Advantage |
$12.53
|
| Rate for Payer: The Alliance Commercial |
$49.50
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.53
|
| Rate for Payer: WEA Trust Commercial |
$392.62
|
| Rate for Payer: WPS Commercial |
$55.14
|
|
|
Myelin Oligodendrocyte Glycoprotein Antibody
|
Facility
|
OP
|
$686.40
|
|
|
Service Code
|
CPT 86362
|
| Hospital Charge Code |
5595323
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.53 |
| Max. Negotiated Rate |
$656.75 |
| Rate for Payer: Aetna Commercial |
$642.47
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$613.92
|
| Rate for Payer: Aetna Managed Medicare |
$12.53
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$46.99
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$21.93
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$20.80
|
| Rate for Payer: Anthem Medicare Advantage |
$12.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$378.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$12.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$12.53
|
| Rate for Payer: Cash Price |
$205.92
|
| Rate for Payer: Cash Price |
$205.92
|
| Rate for Payer: Cigna Commercial |
$656.75
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$12.53
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$399.48
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$12.53
|
| Rate for Payer: Health EOS Commercial |
$635.33
|
| Rate for Payer: HFN Commercial |
$656.75
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$46.62
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$12.53
|
| Rate for Payer: Independent Care Health Plan Medicare |
$12.53
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$12.53
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$12.53
|
| Rate for Payer: Multiplan Commercial |
$571.08
|
| Rate for Payer: NAPHCARE Commercial |
$18.80
|
| Rate for Payer: Preferred Network Access Commercial |
$656.75
|
| Rate for Payer: Quartz Beloit One Network |
$349.79
|
| Rate for Payer: Quartz Commercial |
$464.01
|
| Rate for Payer: Quartz Medicare Advantage |
$12.53
|
| Rate for Payer: The Alliance Commercial |
$50.13
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.53
|
| Rate for Payer: United Healthcare PPO |
$535.39
|
| Rate for Payer: WEA Trust Commercial |
$392.62
|
| Rate for Payer: Wellcare Medicare |
$12.53
|
| Rate for Payer: WPS Commercial |
$528.73
|
|
|
MYELOGRAPHY AND DISCOGRAPHY IMAGING PROCEDURES
|
Facility
|
OP
|
$425.85
|
|
|
Service Code
|
EAPG 00284
|
| Min. Negotiated Rate |
$409.47 |
| Max. Negotiated Rate |
$425.85 |
| Rate for Payer: Anthem Medicaid |
$409.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$409.47
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$409.47
|
| Rate for Payer: Dean Health Medicaid |
$409.47
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$409.47
|
| Rate for Payer: Managed Health Services Medicaid |
$425.85
|
| Rate for Payer: Molina Healthcare Medicaid |
$409.47
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$409.47
|
| Rate for Payer: United Healthcare Medicaid |
$409.47
|
|
|
Myeloperoxidase Antibody
|
Facility
|
IP
|
$236.00
|
|
|
Service Code
|
CPT 86021
|
| Hospital Charge Code |
2942859
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$120.27 |
| Max. Negotiated Rate |
$225.80 |
| Rate for Payer: Aetna Commercial |
$220.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$211.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$130.08
|
| Rate for Payer: Cash Price |
$70.80
|
| Rate for Payer: Cigna Commercial |
$225.80
|
| Rate for Payer: Health EOS Commercial |
$218.44
|
| Rate for Payer: HFN Commercial |
$225.80
|
| Rate for Payer: Multiplan Commercial |
$196.35
|
| Rate for Payer: Preferred Network Access Commercial |
$225.80
|
| Rate for Payer: Quartz Beloit One Network |
$120.27
|
| Rate for Payer: Quartz Commercial |
$147.26
|
| Rate for Payer: WEA Trust Commercial |
$134.99
|
| Rate for Payer: WPS Commercial |
$181.79
|
|
|
Myeloperoxidase Antibody
|
Professional
|
Both
|
$236.00
|
|
|
Service Code
|
CPT 86021
|
| Hospital Charge Code |
2942859
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.65 |
| Max. Negotiated Rate |
$233.17 |
| Rate for Payer: Aetna Commercial |
$233.17
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$211.08
|
| 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 |
$70.80
|
| Rate for Payer: Cash Price |
$70.80
|
| Rate for Payer: Cigna Commercial |
$233.17
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$122.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$15.65
|
| Rate for Payer: Health EOS Commercial |
$223.35
|
| Rate for Payer: HFN Commercial |
$233.17
|
| 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 |
$196.35
|
| Rate for Payer: NAPHCARE Commercial |
$23.48
|
| Rate for Payer: Preferred Network Access Commercial |
$233.17
|
| Rate for Payer: Quartz Beloit One Network |
$107.99
|
| Rate for Payer: Quartz Commercial |
$139.90
|
| 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 |
$134.99
|
| Rate for Payer: WPS Commercial |
$68.87
|
|
