|
Partial Thromboplastin Time
|
Professional
|
Both
|
$152.00
|
|
|
Service Code
|
CPT 85730
|
| Hospital Charge Code |
633794
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.25 |
| Max. Negotiated Rate |
$150.18 |
| Rate for Payer: Aetna Commercial |
$150.18
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$135.95
|
| Rate for Payer: Aetna Managed Medicare |
$6.25
|
| Rate for Payer: Anthem Medicare Advantage |
$6.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$6.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$6.25
|
| Rate for Payer: Cash Price |
$45.60
|
| Rate for Payer: Cash Price |
$45.60
|
| Rate for Payer: Cigna Commercial |
$150.18
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$79.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6.25
|
| Rate for Payer: Health EOS Commercial |
$143.85
|
| Rate for Payer: HFN Commercial |
$150.18
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$22.07
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$22.07
|
| Rate for Payer: Independent Care Health Plan Medicare |
$6.25
|
| Rate for Payer: Multiplan Commercial |
$126.46
|
| Rate for Payer: NAPHCARE Commercial |
$9.38
|
| Rate for Payer: Preferred Network Access Commercial |
$150.18
|
| Rate for Payer: Quartz Beloit One Network |
$69.56
|
| Rate for Payer: Quartz Commercial |
$90.11
|
| Rate for Payer: Quartz Medicare Advantage |
$6.25
|
| Rate for Payer: The Alliance Commercial |
$24.69
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6.25
|
| Rate for Payer: WEA Trust Commercial |
$86.94
|
| Rate for Payer: WPS Commercial |
$27.50
|
|
|
Partial Thromboplastin Time
|
Facility
|
IP
|
$152.00
|
|
|
Service Code
|
CPT 85730
|
| Hospital Charge Code |
633794
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$77.46 |
| Max. Negotiated Rate |
$145.43 |
| Rate for Payer: Aetna Commercial |
$142.27
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$135.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$83.78
|
| Rate for Payer: Cash Price |
$45.60
|
| Rate for Payer: Cigna Commercial |
$145.43
|
| Rate for Payer: Health EOS Commercial |
$140.69
|
| Rate for Payer: HFN Commercial |
$145.43
|
| Rate for Payer: Multiplan Commercial |
$126.46
|
| Rate for Payer: Preferred Network Access Commercial |
$145.43
|
| Rate for Payer: Quartz Beloit One Network |
$77.46
|
| Rate for Payer: Quartz Commercial |
$94.85
|
| Rate for Payer: WEA Trust Commercial |
$86.94
|
| Rate for Payer: WPS Commercial |
$117.09
|
|
|
Partial Thromboplastin Time
|
Facility
|
OP
|
$152.00
|
|
|
Service Code
|
CPT 85730
|
| Hospital Charge Code |
633794
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.25 |
| Max. Negotiated Rate |
$145.43 |
| Rate for Payer: Aetna Commercial |
$142.27
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$135.95
|
| Rate for Payer: Aetna Managed Medicare |
$6.25
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$23.44
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$10.94
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$10.38
|
| Rate for Payer: Anthem Medicare Advantage |
$6.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$83.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$6.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$6.25
|
| Rate for Payer: Cash Price |
$45.60
|
| Rate for Payer: Cash Price |
$45.60
|
| Rate for Payer: Cigna Commercial |
$145.43
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$6.25
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$88.46
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$6.25
|
| Rate for Payer: Health EOS Commercial |
$140.69
|
| Rate for Payer: HFN Commercial |
$145.43
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$23.25
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$6.25
|
| Rate for Payer: Independent Care Health Plan Medicare |
$6.25
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$6.25
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$6.25
|
| Rate for Payer: Multiplan Commercial |
$126.46
|
| Rate for Payer: NAPHCARE Commercial |
$9.38
|
| Rate for Payer: Preferred Network Access Commercial |
$145.43
|
| Rate for Payer: Quartz Beloit One Network |
$77.46
|
| Rate for Payer: Quartz Commercial |
$102.75
|
| Rate for Payer: Quartz Medicare Advantage |
$6.25
|
| Rate for Payer: The Alliance Commercial |
$25.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6.25
|
| Rate for Payer: United Healthcare PPO |
$118.56
|
| Rate for Payer: WEA Trust Commercial |
$86.94
|
| Rate for Payer: Wellcare Medicare |
$6.25
|
| Rate for Payer: WPS Commercial |
$117.09
|
|
|
PART REMOVAL OF ANKLE/HEEL 28120
|
Professional
|
Both
|
$2,714.00
|
|
|
Service Code
|
CPT 28120
|
| Hospital Charge Code |
3014206
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$391.73 |
| Max. Negotiated Rate |
$2,681.43 |
| Rate for Payer: Aetna Commercial |
$2,681.43
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,427.40
|
| Rate for Payer: Aetna Managed Medicare |
$455.61
|
| Rate for Payer: Anthem Medicare Advantage |
$455.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$455.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$455.61
|
| Rate for Payer: Cash Price |
$814.20
|
| Rate for Payer: Cash Price |
$814.20
|
| Rate for Payer: Cash Price |
$814.20
|
| Rate for Payer: Cigna Commercial |
$2,681.43
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$391.73
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$455.61
|
| Rate for Payer: Health EOS Commercial |
$2,568.53
|
| Rate for Payer: HFN Commercial |
$2,681.43
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,733.02
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,733.02
|
| Rate for Payer: Independent Care Health Plan Medicare |
$455.61
|
| Rate for Payer: Multiplan Commercial |
$2,258.05
|
| Rate for Payer: NAPHCARE Commercial |
$683.42
|
| Rate for Payer: Preferred Network Access Commercial |
$2,681.43
|
| Rate for Payer: Quartz Beloit One Network |
$1,241.93
|
| Rate for Payer: Quartz Commercial |
$1,608.86
|
| Rate for Payer: Quartz Medicare Advantage |
$455.61
|
| Rate for Payer: The Alliance Commercial |
$1,936.36
|
| Rate for Payer: United Healthcare Medicaid |
$391.73
|
| Rate for Payer: United Healthcare Medicare Advantage |
$455.61
|
| Rate for Payer: WEA Trust Commercial |
$1,552.41
|
| Rate for Payer: WPS Commercial |
$2,050.26
|
|
|
Part Removal of Ankle/Heel 2812050
|
Professional
|
Both
|
$5,428.00
|
|
|
Service Code
|
CPT 28120 50
|
| Hospital Charge Code |
5222855
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$391.73 |
| Max. Negotiated Rate |
$5,362.86 |
| Rate for Payer: Aetna Commercial |
$5,362.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,854.80
|
| Rate for Payer: Cash Price |
$1,628.40
|
| Rate for Payer: Cash Price |
$1,628.40
|
| Rate for Payer: Cash Price |
$1,628.40
|
| Rate for Payer: Cigna Commercial |
$5,362.86
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$391.73
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,387.07
|
| Rate for Payer: Health EOS Commercial |
$5,137.06
|
| Rate for Payer: HFN Commercial |
$5,362.86
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,733.02
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,733.02
|
| Rate for Payer: Multiplan Commercial |
$4,516.10
|
| Rate for Payer: Preferred Network Access Commercial |
$5,362.86
|
| Rate for Payer: Quartz Beloit One Network |
$2,483.85
|
| Rate for Payer: Quartz Commercial |
$3,217.72
|
| Rate for Payer: The Alliance Commercial |
$2,822.56
|
| Rate for Payer: United Healthcare Medicaid |
$391.73
|
| Rate for Payer: WEA Trust Commercial |
$3,104.82
|
| Rate for Payer: WPS Commercial |
$4,181.19
|
|
|
PART REMOVAL OF METATARSAL 28110
|
Professional
|
Both
|
$2,052.00
|
|
|
Service Code
|
CPT 28110
|
| Hospital Charge Code |
3014200
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$276.81 |
| Max. Negotiated Rate |
$2,027.38 |
| Rate for Payer: Aetna Commercial |
$2,027.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,835.31
|
| Rate for Payer: Aetna Managed Medicare |
$276.81
|
| Rate for Payer: Anthem Medicare Advantage |
$276.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$276.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$276.81
|
| Rate for Payer: Cash Price |
$615.60
|
| Rate for Payer: Cash Price |
$615.60
|
| Rate for Payer: Cash Price |
$615.60
|
| Rate for Payer: Cigna Commercial |
$2,027.38
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$285.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$276.81
|
| Rate for Payer: Health EOS Commercial |
$1,942.01
|
| Rate for Payer: HFN Commercial |
$2,027.38
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,016.63
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,016.63
|
| Rate for Payer: Independent Care Health Plan Medicare |
$276.81
|
| Rate for Payer: Multiplan Commercial |
$1,707.26
|
| Rate for Payer: NAPHCARE Commercial |
$415.21
|
| Rate for Payer: Preferred Network Access Commercial |
$2,027.38
|
| Rate for Payer: Quartz Beloit One Network |
$939.00
|
| Rate for Payer: Quartz Commercial |
$1,216.43
|
| Rate for Payer: Quartz Medicare Advantage |
$276.81
|
| Rate for Payer: The Alliance Commercial |
$1,176.43
|
| Rate for Payer: United Healthcare Medicaid |
$285.92
|
| Rate for Payer: United Healthcare Medicare Advantage |
$276.81
|
| Rate for Payer: WEA Trust Commercial |
$1,173.74
|
| Rate for Payer: WPS Commercial |
$1,245.63
|
|
|
PART REMOVAL OF METATARSAL 28112
|
Professional
|
Both
|
$2,316.00
|
|
|
Service Code
|
CPT 28112
|
| Hospital Charge Code |
3014202
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$282.02 |
| Max. Negotiated Rate |
$2,288.21 |
| Rate for Payer: Aetna Commercial |
$2,288.21
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,071.43
|
| Rate for Payer: Aetna Managed Medicare |
$291.36
|
| Rate for Payer: Anthem Medicare Advantage |
$291.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$291.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$291.36
|
| Rate for Payer: Cash Price |
$694.80
|
| Rate for Payer: Cash Price |
$694.80
|
| Rate for Payer: Cash Price |
$694.80
|
| Rate for Payer: Cigna Commercial |
$2,288.21
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$282.02
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$291.36
|
| Rate for Payer: Health EOS Commercial |
$2,191.86
|
| Rate for Payer: HFN Commercial |
$2,288.21
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,091.55
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,091.55
|
| Rate for Payer: Independent Care Health Plan Medicare |
$291.36
|
| Rate for Payer: Multiplan Commercial |
$1,926.91
|
| Rate for Payer: NAPHCARE Commercial |
$437.03
|
| Rate for Payer: Preferred Network Access Commercial |
$2,288.21
|
| Rate for Payer: Quartz Beloit One Network |
$1,059.80
|
| Rate for Payer: Quartz Commercial |
$1,372.92
|
| Rate for Payer: Quartz Medicare Advantage |
$291.36
|
| Rate for Payer: The Alliance Commercial |
$1,238.26
|
| Rate for Payer: United Healthcare Medicaid |
$282.02
|
| Rate for Payer: United Healthcare Medicare Advantage |
$291.36
|
| Rate for Payer: WEA Trust Commercial |
$1,324.75
|
| Rate for Payer: WPS Commercial |
$1,311.10
|
|
|
PART REMOVAL OF METATARSAL 28113
|
Professional
|
Both
|
$2,459.00
|
|
|
Service Code
|
CPT 28113
|
| Hospital Charge Code |
3014203
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$94.00 |
| Max. Negotiated Rate |
$2,429.49 |
| Rate for Payer: Aetna Commercial |
$2,429.49
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,199.33
|
| Rate for Payer: Aetna Managed Medicare |
$400.14
|
| Rate for Payer: Anthem Medicare Advantage |
$400.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$400.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$400.14
|
| Rate for Payer: Cash Price |
$737.70
|
| Rate for Payer: Cash Price |
$737.70
|
| Rate for Payer: Cash Price |
$737.70
|
| Rate for Payer: Cigna Commercial |
$2,429.49
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$94.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$400.14
|
| Rate for Payer: Health EOS Commercial |
$2,327.20
|
| Rate for Payer: HFN Commercial |
$2,429.49
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,490.03
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,490.03
|
| Rate for Payer: Independent Care Health Plan Medicare |
$400.14
|
| Rate for Payer: Multiplan Commercial |
$2,045.89
|
| Rate for Payer: NAPHCARE Commercial |
$600.21
|
| Rate for Payer: Preferred Network Access Commercial |
$2,429.49
|
| Rate for Payer: Quartz Beloit One Network |
$1,125.24
|
| Rate for Payer: Quartz Commercial |
$1,457.70
|
| Rate for Payer: Quartz Medicare Advantage |
$400.14
|
| Rate for Payer: The Alliance Commercial |
$1,700.60
|
| Rate for Payer: United Healthcare Medicaid |
$94.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$400.14
|
| Rate for Payer: WEA Trust Commercial |
$1,406.55
|
| Rate for Payer: WPS Commercial |
$1,800.63
|
|
|
Parvovirus B19 Ab IgG and IgM
|
Facility
|
IP
|
$274.00
|
|
|
Service Code
|
CPT 86747
|
| Hospital Charge Code |
978034
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$139.63 |
| Max. Negotiated Rate |
$262.16 |
| Rate for Payer: Aetna Commercial |
$256.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$245.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$151.03
|
| Rate for Payer: Cash Price |
$82.20
|
| Rate for Payer: Cigna Commercial |
$262.16
|
| Rate for Payer: Health EOS Commercial |
$253.61
|
| Rate for Payer: HFN Commercial |
$262.16
|
| Rate for Payer: Multiplan Commercial |
$227.97
|
| Rate for Payer: Preferred Network Access Commercial |
$262.16
|
| Rate for Payer: Quartz Beloit One Network |
$139.63
|
| Rate for Payer: Quartz Commercial |
$170.98
|
| Rate for Payer: WEA Trust Commercial |
$156.73
|
| Rate for Payer: WPS Commercial |
$211.06
|
|
|
Parvovirus B19 Ab IgG and IgM
|
Professional
|
Both
|
$274.00
|
|
|
Service Code
|
CPT 86747
|
| Hospital Charge Code |
978034
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.63 |
| Max. Negotiated Rate |
$270.71 |
| Rate for Payer: Aetna Commercial |
$270.71
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$245.07
|
| Rate for Payer: Aetna Managed Medicare |
$15.63
|
| Rate for Payer: Anthem Medicare Advantage |
$15.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$15.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$15.63
|
| Rate for Payer: Cash Price |
$82.20
|
| Rate for Payer: Cash Price |
$82.20
|
| Rate for Payer: Cigna Commercial |
$270.71
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$142.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$15.63
|
| Rate for Payer: Health EOS Commercial |
$259.31
|
| Rate for Payer: HFN Commercial |
$270.71
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$55.18
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$55.18
|
| Rate for Payer: Independent Care Health Plan Medicare |
$15.63
|
| Rate for Payer: Multiplan Commercial |
$227.97
|
| Rate for Payer: NAPHCARE Commercial |
$23.45
|
| Rate for Payer: Preferred Network Access Commercial |
$270.71
|
| Rate for Payer: Quartz Beloit One Network |
$125.38
|
| Rate for Payer: Quartz Commercial |
$162.43
|
| Rate for Payer: Quartz Medicare Advantage |
$15.63
|
| Rate for Payer: The Alliance Commercial |
$61.74
|
| Rate for Payer: United Healthcare Medicare Advantage |
$15.63
|
| Rate for Payer: WEA Trust Commercial |
$156.73
|
| Rate for Payer: WPS Commercial |
$68.78
|
|
|
Parvovirus B19 Ab IgG and IgM
|
Facility
|
OP
|
$274.00
|
|
|
Service Code
|
CPT 86747
|
| Hospital Charge Code |
978034
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.63 |
| Max. Negotiated Rate |
$262.16 |
| Rate for Payer: Aetna Commercial |
$256.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$245.07
|
| Rate for Payer: Aetna Managed Medicare |
$15.63
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$58.62
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$27.35
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$25.95
|
| Rate for Payer: Anthem Medicare Advantage |
$15.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$151.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$15.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$15.63
|
| Rate for Payer: Cash Price |
$82.20
|
| Rate for Payer: Cash Price |
$82.20
|
| Rate for Payer: Cigna Commercial |
$262.16
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$15.63
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$159.47
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$15.63
|
| Rate for Payer: Health EOS Commercial |
$253.61
|
| Rate for Payer: HFN Commercial |
$262.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$58.15
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$15.63
|
| Rate for Payer: Independent Care Health Plan Medicare |
$15.63
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$15.63
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$15.63
|
| Rate for Payer: Multiplan Commercial |
$227.97
|
| Rate for Payer: NAPHCARE Commercial |
$23.45
|
| Rate for Payer: Preferred Network Access Commercial |
$262.16
|
| Rate for Payer: Quartz Beloit One Network |
$139.63
|
| Rate for Payer: Quartz Commercial |
$185.22
|
| Rate for Payer: Quartz Medicare Advantage |
$15.63
|
| Rate for Payer: The Alliance Commercial |
$62.52
|
| Rate for Payer: United Healthcare Medicare Advantage |
$15.63
|
| Rate for Payer: United Healthcare PPO |
$213.72
|
| Rate for Payer: WEA Trust Commercial |
$156.73
|
| Rate for Payer: Wellcare Medicare |
$15.63
|
| Rate for Payer: WPS Commercial |
$211.06
|
|
|
Parvovirus B19 Antibody IgG
|
Professional
|
Both
|
$263.00
|
|
|
Service Code
|
CPT 86747
|
| Hospital Charge Code |
978035
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.63 |
| Max. Negotiated Rate |
$259.84 |
| Rate for Payer: Aetna Commercial |
$259.84
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$235.23
|
| Rate for Payer: Aetna Managed Medicare |
$15.63
|
| Rate for Payer: Anthem Medicare Advantage |
$15.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$15.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$15.63
|
| Rate for Payer: Cash Price |
$78.90
|
| Rate for Payer: Cash Price |
$78.90
|
| Rate for Payer: Cigna Commercial |
$259.84
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$136.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$15.63
|
| Rate for Payer: Health EOS Commercial |
$248.90
|
| Rate for Payer: HFN Commercial |
$259.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$55.18
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$55.18
|
| Rate for Payer: Independent Care Health Plan Medicare |
$15.63
|
| Rate for Payer: Multiplan Commercial |
$218.82
|
| Rate for Payer: NAPHCARE Commercial |
$23.45
|
| Rate for Payer: Preferred Network Access Commercial |
$259.84
|
| Rate for Payer: Quartz Beloit One Network |
$120.35
|
| Rate for Payer: Quartz Commercial |
$155.91
|
| Rate for Payer: Quartz Medicare Advantage |
$15.63
|
| Rate for Payer: The Alliance Commercial |
$61.74
|
| Rate for Payer: United Healthcare Medicare Advantage |
$15.63
|
| Rate for Payer: WEA Trust Commercial |
$150.44
|
| Rate for Payer: WPS Commercial |
$68.78
|
|
|
Parvovirus B19 Antibody IgG
|
Facility
|
IP
|
$263.00
|
|
|
Service Code
|
CPT 86747
|
| Hospital Charge Code |
978035
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$134.02 |
| Max. Negotiated Rate |
$251.64 |
| Rate for Payer: Aetna Commercial |
$246.17
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$235.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$144.97
|
| Rate for Payer: Cash Price |
$78.90
|
| Rate for Payer: Cigna Commercial |
$251.64
|
| Rate for Payer: Health EOS Commercial |
$243.43
|
| Rate for Payer: HFN Commercial |
$251.64
|
| Rate for Payer: Multiplan Commercial |
$218.82
|
| Rate for Payer: Preferred Network Access Commercial |
$251.64
|
| Rate for Payer: Quartz Beloit One Network |
$134.02
|
| Rate for Payer: Quartz Commercial |
$164.11
|
| Rate for Payer: WEA Trust Commercial |
$150.44
|
| Rate for Payer: WPS Commercial |
$202.59
|
|
|
Parvovirus B19 Antibody IgG
|
Facility
|
OP
|
$263.00
|
|
|
Service Code
|
CPT 86747
|
| Hospital Charge Code |
978035
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.63 |
| Max. Negotiated Rate |
$251.64 |
| Rate for Payer: Aetna Commercial |
$246.17
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$235.23
|
| Rate for Payer: Aetna Managed Medicare |
$15.63
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$58.62
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$27.35
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$25.95
|
| Rate for Payer: Anthem Medicare Advantage |
$15.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$144.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$15.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$15.63
|
| Rate for Payer: Cash Price |
$78.90
|
| Rate for Payer: Cash Price |
$78.90
|
| Rate for Payer: Cigna Commercial |
$251.64
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$15.63
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$153.07
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$15.63
|
| Rate for Payer: Health EOS Commercial |
$243.43
|
| Rate for Payer: HFN Commercial |
$251.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$58.15
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$15.63
|
| Rate for Payer: Independent Care Health Plan Medicare |
$15.63
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$15.63
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$15.63
|
| Rate for Payer: Multiplan Commercial |
$218.82
|
| Rate for Payer: NAPHCARE Commercial |
$23.45
|
| Rate for Payer: Preferred Network Access Commercial |
$251.64
|
| Rate for Payer: Quartz Beloit One Network |
$134.02
|
| Rate for Payer: Quartz Commercial |
$177.79
|
| Rate for Payer: Quartz Medicare Advantage |
$15.63
|
| Rate for Payer: The Alliance Commercial |
$62.52
|
| Rate for Payer: United Healthcare Medicare Advantage |
$15.63
|
| Rate for Payer: United Healthcare PPO |
$205.14
|
| Rate for Payer: WEA Trust Commercial |
$150.44
|
| Rate for Payer: Wellcare Medicare |
$15.63
|
| Rate for Payer: WPS Commercial |
$202.59
|
|
|
Parvovirus B19 Antibody IgM
|
Facility
|
IP
|
$263.00
|
|
|
Service Code
|
CPT 86747
|
| Hospital Charge Code |
978036
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$134.02 |
| Max. Negotiated Rate |
$251.64 |
| Rate for Payer: Aetna Commercial |
$246.17
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$235.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$144.97
|
| Rate for Payer: Cash Price |
$78.90
|
| Rate for Payer: Cigna Commercial |
$251.64
|
| Rate for Payer: Health EOS Commercial |
$243.43
|
| Rate for Payer: HFN Commercial |
$251.64
|
| Rate for Payer: Multiplan Commercial |
$218.82
|
| Rate for Payer: Preferred Network Access Commercial |
$251.64
|
| Rate for Payer: Quartz Beloit One Network |
$134.02
|
| Rate for Payer: Quartz Commercial |
$164.11
|
| Rate for Payer: WEA Trust Commercial |
$150.44
|
| Rate for Payer: WPS Commercial |
$202.59
|
|
|
Parvovirus B19 Antibody IgM
|
Professional
|
Both
|
$263.00
|
|
|
Service Code
|
CPT 86747
|
| Hospital Charge Code |
978036
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.63 |
| Max. Negotiated Rate |
$259.84 |
| Rate for Payer: Aetna Commercial |
$259.84
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$235.23
|
| Rate for Payer: Aetna Managed Medicare |
$15.63
|
| Rate for Payer: Anthem Medicare Advantage |
$15.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$15.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$15.63
|
| Rate for Payer: Cash Price |
$78.90
|
| Rate for Payer: Cash Price |
$78.90
|
| Rate for Payer: Cigna Commercial |
$259.84
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$136.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$15.63
|
| Rate for Payer: Health EOS Commercial |
$248.90
|
| Rate for Payer: HFN Commercial |
$259.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$55.18
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$55.18
|
| Rate for Payer: Independent Care Health Plan Medicare |
$15.63
|
| Rate for Payer: Multiplan Commercial |
$218.82
|
| Rate for Payer: NAPHCARE Commercial |
$23.45
|
| Rate for Payer: Preferred Network Access Commercial |
$259.84
|
| Rate for Payer: Quartz Beloit One Network |
$120.35
|
| Rate for Payer: Quartz Commercial |
$155.91
|
| Rate for Payer: Quartz Medicare Advantage |
$15.63
|
| Rate for Payer: The Alliance Commercial |
$61.74
|
| Rate for Payer: United Healthcare Medicare Advantage |
$15.63
|
| Rate for Payer: WEA Trust Commercial |
$150.44
|
| Rate for Payer: WPS Commercial |
$68.78
|
|
|
Parvovirus B19 Antibody IgM
|
Facility
|
OP
|
$263.00
|
|
|
Service Code
|
CPT 86747
|
| Hospital Charge Code |
978036
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.63 |
| Max. Negotiated Rate |
$251.64 |
| Rate for Payer: Aetna Commercial |
$246.17
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$235.23
|
| Rate for Payer: Aetna Managed Medicare |
$15.63
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$58.62
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$27.35
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$25.95
|
| Rate for Payer: Anthem Medicare Advantage |
$15.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$144.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$15.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$15.63
|
| Rate for Payer: Cash Price |
$78.90
|
| Rate for Payer: Cash Price |
$78.90
|
| Rate for Payer: Cigna Commercial |
$251.64
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$15.63
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$153.07
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$15.63
|
| Rate for Payer: Health EOS Commercial |
$243.43
|
| Rate for Payer: HFN Commercial |
$251.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$58.15
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$15.63
|
| Rate for Payer: Independent Care Health Plan Medicare |
$15.63
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$15.63
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$15.63
|
| Rate for Payer: Multiplan Commercial |
$218.82
|
| Rate for Payer: NAPHCARE Commercial |
$23.45
|
| Rate for Payer: Preferred Network Access Commercial |
$251.64
|
| Rate for Payer: Quartz Beloit One Network |
$134.02
|
| Rate for Payer: Quartz Commercial |
$177.79
|
| Rate for Payer: Quartz Medicare Advantage |
$15.63
|
| Rate for Payer: The Alliance Commercial |
$62.52
|
| Rate for Payer: United Healthcare Medicare Advantage |
$15.63
|
| Rate for Payer: United Healthcare PPO |
$205.14
|
| Rate for Payer: WEA Trust Commercial |
$150.44
|
| Rate for Payer: Wellcare Medicare |
$15.63
|
| Rate for Payer: WPS Commercial |
$202.59
|
|
|
Parvovirus B19, DNA, Qual, PCR
|
Professional
|
Both
|
$405.00
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
983357
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$36.49 |
| Max. Negotiated Rate |
$400.14 |
| Rate for Payer: Aetna Commercial |
$400.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$362.23
|
| 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 |
$121.50
|
| Rate for Payer: Cash Price |
$121.50
|
| Rate for Payer: Cigna Commercial |
$400.14
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$210.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$36.49
|
| Rate for Payer: Health EOS Commercial |
$383.29
|
| Rate for Payer: HFN Commercial |
$400.14
|
| 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 |
$336.96
|
| Rate for Payer: NAPHCARE Commercial |
$54.74
|
| Rate for Payer: Preferred Network Access Commercial |
$400.14
|
| Rate for Payer: Quartz Beloit One Network |
$185.33
|
| Rate for Payer: Quartz Commercial |
$240.08
|
| 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 |
$231.66
|
| Rate for Payer: WPS Commercial |
$160.57
|
|
|
Parvovirus B19, DNA, Qual, PCR
|
Facility
|
IP
|
$405.00
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
983357
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$206.39 |
| Max. Negotiated Rate |
$387.50 |
| Rate for Payer: Aetna Commercial |
$379.08
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$362.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$223.24
|
| Rate for Payer: Cash Price |
$121.50
|
| Rate for Payer: Cigna Commercial |
$387.50
|
| Rate for Payer: Health EOS Commercial |
$374.87
|
| Rate for Payer: HFN Commercial |
$387.50
|
| Rate for Payer: Multiplan Commercial |
$336.96
|
| Rate for Payer: Preferred Network Access Commercial |
$387.50
|
| Rate for Payer: Quartz Beloit One Network |
$206.39
|
| Rate for Payer: Quartz Commercial |
$252.72
|
| Rate for Payer: WEA Trust Commercial |
$231.66
|
| Rate for Payer: WPS Commercial |
$311.97
|
|
|
Parvovirus B19, DNA, Qual, PCR
|
Facility
|
OP
|
$405.00
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
983357
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$36.49 |
| Max. Negotiated Rate |
$387.50 |
| Rate for Payer: Aetna Commercial |
$379.08
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$362.23
|
| 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 |
$223.24
|
| 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 |
$121.50
|
| Rate for Payer: Cash Price |
$121.50
|
| Rate for Payer: Cigna Commercial |
$387.50
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$36.49
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$235.71
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$36.49
|
| Rate for Payer: Health EOS Commercial |
$374.87
|
| Rate for Payer: HFN Commercial |
$387.50
|
| 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 |
$336.96
|
| Rate for Payer: NAPHCARE Commercial |
$54.74
|
| Rate for Payer: Preferred Network Access Commercial |
$387.50
|
| Rate for Payer: Quartz Beloit One Network |
$206.39
|
| Rate for Payer: Quartz Commercial |
$273.78
|
| 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 |
$315.90
|
| Rate for Payer: WEA Trust Commercial |
$231.66
|
| Rate for Payer: Wellcare Medicare |
$36.49
|
| Rate for Payer: WPS Commercial |
$311.97
|
|
|
Parvovirus B19 IgM Antibody
|
Facility
|
OP
|
$185.00
|
|
|
Service Code
|
CPT 86747
|
| Hospital Charge Code |
2942967
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.63 |
| Max. Negotiated Rate |
$177.01 |
| Rate for Payer: Aetna Commercial |
$173.16
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$165.46
|
| Rate for Payer: Aetna Managed Medicare |
$15.63
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$58.62
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$27.35
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$25.95
|
| Rate for Payer: Anthem Medicare Advantage |
$15.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$101.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$15.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$15.63
|
| Rate for Payer: Cash Price |
$55.50
|
| Rate for Payer: Cash Price |
$55.50
|
| Rate for Payer: Cigna Commercial |
$177.01
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$15.63
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$107.67
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$15.63
|
| Rate for Payer: Health EOS Commercial |
$171.24
|
| Rate for Payer: HFN Commercial |
$177.01
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$58.15
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$15.63
|
| Rate for Payer: Independent Care Health Plan Medicare |
$15.63
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$15.63
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$15.63
|
| Rate for Payer: Multiplan Commercial |
$153.92
|
| Rate for Payer: NAPHCARE Commercial |
$23.45
|
| Rate for Payer: Preferred Network Access Commercial |
$177.01
|
| Rate for Payer: Quartz Beloit One Network |
$94.28
|
| Rate for Payer: Quartz Commercial |
$125.06
|
| Rate for Payer: Quartz Medicare Advantage |
$15.63
|
| Rate for Payer: The Alliance Commercial |
$62.52
|
| Rate for Payer: United Healthcare Medicare Advantage |
$15.63
|
| Rate for Payer: United Healthcare PPO |
$144.30
|
| Rate for Payer: WEA Trust Commercial |
$105.82
|
| Rate for Payer: Wellcare Medicare |
$15.63
|
| Rate for Payer: WPS Commercial |
$142.51
|
|
|
Parvovirus B19 IgM Antibody
|
Facility
|
IP
|
$185.00
|
|
|
Service Code
|
CPT 86747
|
| Hospital Charge Code |
2942967
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$94.28 |
| Max. Negotiated Rate |
$177.01 |
| Rate for Payer: Aetna Commercial |
$173.16
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$165.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$101.97
|
| Rate for Payer: Cash Price |
$55.50
|
| Rate for Payer: Cigna Commercial |
$177.01
|
| Rate for Payer: Health EOS Commercial |
$171.24
|
| Rate for Payer: HFN Commercial |
$177.01
|
| Rate for Payer: Multiplan Commercial |
$153.92
|
| Rate for Payer: Preferred Network Access Commercial |
$177.01
|
| Rate for Payer: Quartz Beloit One Network |
$94.28
|
| Rate for Payer: Quartz Commercial |
$115.44
|
| Rate for Payer: WEA Trust Commercial |
$105.82
|
| Rate for Payer: WPS Commercial |
$142.51
|
|
|
Parvovirus B19 IgM Antibody
|
Professional
|
Both
|
$185.00
|
|
|
Service Code
|
CPT 86747
|
| Hospital Charge Code |
2942967
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.63 |
| Max. Negotiated Rate |
$182.78 |
| Rate for Payer: Aetna Commercial |
$182.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$165.46
|
| Rate for Payer: Aetna Managed Medicare |
$15.63
|
| Rate for Payer: Anthem Medicare Advantage |
$15.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$15.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$15.63
|
| Rate for Payer: Cash Price |
$55.50
|
| Rate for Payer: Cash Price |
$55.50
|
| Rate for Payer: Cigna Commercial |
$182.78
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$96.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$15.63
|
| Rate for Payer: Health EOS Commercial |
$175.08
|
| Rate for Payer: HFN Commercial |
$182.78
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$55.18
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$55.18
|
| Rate for Payer: Independent Care Health Plan Medicare |
$15.63
|
| Rate for Payer: Multiplan Commercial |
$153.92
|
| Rate for Payer: NAPHCARE Commercial |
$23.45
|
| Rate for Payer: Preferred Network Access Commercial |
$182.78
|
| Rate for Payer: Quartz Beloit One Network |
$84.66
|
| Rate for Payer: Quartz Commercial |
$109.67
|
| Rate for Payer: Quartz Medicare Advantage |
$15.63
|
| Rate for Payer: The Alliance Commercial |
$61.74
|
| Rate for Payer: United Healthcare Medicare Advantage |
$15.63
|
| Rate for Payer: WEA Trust Commercial |
$105.82
|
| Rate for Payer: WPS Commercial |
$68.78
|
|
|
PASSING NEEDLE CERCLAGE MD SINGLE USE AR-7816
|
Facility
|
IP
|
$1,459.00
|
|
| Hospital Charge Code |
5803671
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$743.51 |
| Max. Negotiated Rate |
$1,395.97 |
| Rate for Payer: Aetna Commercial |
$1,365.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,304.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$804.20
|
| Rate for Payer: Cash Price |
$437.70
|
| Rate for Payer: Cigna Commercial |
$1,395.97
|
| Rate for Payer: Health EOS Commercial |
$1,350.45
|
| Rate for Payer: HFN Commercial |
$1,395.97
|
| Rate for Payer: Multiplan Commercial |
$1,213.89
|
| Rate for Payer: Preferred Network Access Commercial |
$1,395.97
|
| Rate for Payer: Quartz Beloit One Network |
$743.51
|
| Rate for Payer: Quartz Commercial |
$910.42
|
| Rate for Payer: WEA Trust Commercial |
$834.55
|
| Rate for Payer: WPS Commercial |
$1,123.87
|
|
|
PASSING NEEDLE CERCLAGE MD SINGLE USE AR-7816
|
Facility
|
OP
|
$1,459.00
|
|
| Hospital Charge Code |
5803671
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$424.86 |
| Max. Negotiated Rate |
$1,395.97 |
| Rate for Payer: Aetna Commercial |
$1,365.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,304.93
|
| Rate for Payer: Aetna Managed Medicare |
$424.86
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$986.28
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$758.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$728.33
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$804.20
|
| Rate for Payer: Cash Price |
$437.70
|
| Rate for Payer: Cigna Commercial |
$1,395.97
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$849.14
|
| Rate for Payer: Health EOS Commercial |
$1,350.45
|
| Rate for Payer: HFN Commercial |
$1,395.97
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,138.02
|
| Rate for Payer: Multiplan Commercial |
$1,213.89
|
| Rate for Payer: NAPHCARE Commercial |
$910.42
|
| Rate for Payer: Preferred Network Access Commercial |
$1,395.97
|
| Rate for Payer: Quartz Beloit One Network |
$743.51
|
| Rate for Payer: Quartz Commercial |
$986.28
|
| Rate for Payer: Quartz Medicare Advantage |
$910.42
|
| Rate for Payer: The Alliance Commercial |
$758.68
|
| Rate for Payer: WEA Trust Commercial |
$834.55
|
| Rate for Payer: WPS Commercial |
$1,123.87
|
|
