|
PLATE LCP 2.0 6HL 247.346
|
Facility
|
IP
|
$2,227.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5767794
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,134.88 |
| Max. Negotiated Rate |
$2,130.79 |
| Rate for Payer: Aetna Commercial |
$2,084.47
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,991.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,227.52
|
| Rate for Payer: Cash Price |
$668.10
|
| Rate for Payer: Cigna Commercial |
$2,130.79
|
| Rate for Payer: Health EOS Commercial |
$2,061.31
|
| Rate for Payer: HFN Commercial |
$2,130.79
|
| Rate for Payer: Multiplan Commercial |
$1,852.86
|
| Rate for Payer: Preferred Network Access Commercial |
$2,130.79
|
| Rate for Payer: Quartz Beloit One Network |
$1,134.88
|
| Rate for Payer: Quartz Commercial |
$1,389.65
|
| Rate for Payer: WEA Trust Commercial |
$1,273.84
|
| Rate for Payer: WPS Commercial |
$1,715.46
|
|
|
PLATE LCP 2.0 7HL 247.347
|
Facility
|
IP
|
$2,141.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5767795
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,091.05 |
| Max. Negotiated Rate |
$2,048.51 |
| Rate for Payer: Aetna Commercial |
$2,003.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,914.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,180.12
|
| Rate for Payer: Cash Price |
$642.30
|
| Rate for Payer: Cigna Commercial |
$2,048.51
|
| Rate for Payer: Health EOS Commercial |
$1,981.71
|
| Rate for Payer: HFN Commercial |
$2,048.51
|
| Rate for Payer: Multiplan Commercial |
$1,781.31
|
| Rate for Payer: Preferred Network Access Commercial |
$2,048.51
|
| Rate for Payer: Quartz Beloit One Network |
$1,091.05
|
| Rate for Payer: Quartz Commercial |
$1,335.98
|
| Rate for Payer: WEA Trust Commercial |
$1,224.65
|
| Rate for Payer: WPS Commercial |
$1,649.21
|
|
|
PLATE LCP 2.0 7HL 247.347
|
Facility
|
OP
|
$2,141.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5767795
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$623.46 |
| Max. Negotiated Rate |
$2,048.51 |
| Rate for Payer: Aetna Commercial |
$2,003.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,914.91
|
| Rate for Payer: Aetna Managed Medicare |
$623.46
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,447.32
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,113.32
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,068.79
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,180.12
|
| Rate for Payer: Cash Price |
$642.30
|
| Rate for Payer: Cigna Commercial |
$2,048.51
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,246.06
|
| Rate for Payer: Health EOS Commercial |
$1,981.71
|
| Rate for Payer: HFN Commercial |
$2,048.51
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,669.98
|
| Rate for Payer: Multiplan Commercial |
$1,781.31
|
| Rate for Payer: NAPHCARE Commercial |
$1,335.98
|
| Rate for Payer: Preferred Network Access Commercial |
$2,048.51
|
| Rate for Payer: Quartz Beloit One Network |
$1,091.05
|
| Rate for Payer: Quartz Commercial |
$1,447.32
|
| Rate for Payer: Quartz Medicare Advantage |
$1,335.98
|
| Rate for Payer: The Alliance Commercial |
$1,113.32
|
| Rate for Payer: WEA Trust Commercial |
$1,224.65
|
| Rate for Payer: WPS Commercial |
$1,649.21
|
|
|
PLATE LCP 2.0 8HL 247.348
|
Facility
|
IP
|
$2,227.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5767796
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,134.88 |
| Max. Negotiated Rate |
$2,130.79 |
| Rate for Payer: Aetna Commercial |
$2,084.47
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,991.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,227.52
|
| Rate for Payer: Cash Price |
$668.10
|
| Rate for Payer: Cigna Commercial |
$2,130.79
|
| Rate for Payer: Health EOS Commercial |
$2,061.31
|
| Rate for Payer: HFN Commercial |
$2,130.79
|
| Rate for Payer: Multiplan Commercial |
$1,852.86
|
| Rate for Payer: Preferred Network Access Commercial |
$2,130.79
|
| Rate for Payer: Quartz Beloit One Network |
$1,134.88
|
| Rate for Payer: Quartz Commercial |
$1,389.65
|
| Rate for Payer: WEA Trust Commercial |
$1,273.84
|
| Rate for Payer: WPS Commercial |
$1,715.46
|
|
|
PLATE LCP 2.0 8HL 247.348
|
Facility
|
OP
|
$2,227.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5767796
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$648.50 |
| Max. Negotiated Rate |
$2,130.79 |
| Rate for Payer: Aetna Commercial |
$2,084.47
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,991.83
|
| Rate for Payer: Aetna Managed Medicare |
$648.50
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,505.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,158.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,111.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,227.52
|
| Rate for Payer: Cash Price |
$668.10
|
| Rate for Payer: Cigna Commercial |
$2,130.79
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,296.11
|
| Rate for Payer: Health EOS Commercial |
$2,061.31
|
| Rate for Payer: HFN Commercial |
$2,130.79
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,737.06
|
| Rate for Payer: Multiplan Commercial |
$1,852.86
|
| Rate for Payer: NAPHCARE Commercial |
$1,389.65
|
| Rate for Payer: Preferred Network Access Commercial |
$2,130.79
|
| Rate for Payer: Quartz Beloit One Network |
$1,134.88
|
| Rate for Payer: Quartz Commercial |
$1,505.45
|
| Rate for Payer: Quartz Medicare Advantage |
$1,389.65
|
| Rate for Payer: The Alliance Commercial |
$1,158.04
|
| Rate for Payer: WEA Trust Commercial |
$1,273.84
|
| Rate for Payer: WPS Commercial |
$1,715.46
|
|
|
PLATE LCP ADAPTION 2.0 12HL 247.362
|
Facility
|
OP
|
$4,923.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5767799
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,433.58 |
| Max. Negotiated Rate |
$4,710.33 |
| Rate for Payer: Aetna Commercial |
$4,607.93
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,403.13
|
| Rate for Payer: Aetna Managed Medicare |
$1,433.58
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,327.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,559.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,457.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,713.56
|
| Rate for Payer: Cash Price |
$1,476.90
|
| Rate for Payer: Cigna Commercial |
$4,710.33
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,865.19
|
| Rate for Payer: Health EOS Commercial |
$4,556.73
|
| Rate for Payer: HFN Commercial |
$4,710.33
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,839.94
|
| Rate for Payer: Multiplan Commercial |
$4,095.94
|
| Rate for Payer: NAPHCARE Commercial |
$3,071.95
|
| Rate for Payer: Preferred Network Access Commercial |
$4,710.33
|
| Rate for Payer: Quartz Beloit One Network |
$2,508.76
|
| Rate for Payer: Quartz Commercial |
$3,327.95
|
| Rate for Payer: Quartz Medicare Advantage |
$3,071.95
|
| Rate for Payer: The Alliance Commercial |
$2,559.96
|
| Rate for Payer: WEA Trust Commercial |
$2,815.96
|
| Rate for Payer: WPS Commercial |
$3,792.19
|
|
|
PLATE LCP ADAPTION 2.0 12HL 247.362
|
Facility
|
IP
|
$4,923.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5767799
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,508.76 |
| Max. Negotiated Rate |
$4,710.33 |
| Rate for Payer: Aetna Commercial |
$4,607.93
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,403.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,713.56
|
| Rate for Payer: Cash Price |
$1,476.90
|
| Rate for Payer: Cigna Commercial |
$4,710.33
|
| Rate for Payer: Health EOS Commercial |
$4,556.73
|
| Rate for Payer: HFN Commercial |
$4,710.33
|
| Rate for Payer: Multiplan Commercial |
$4,095.94
|
| Rate for Payer: Preferred Network Access Commercial |
$4,710.33
|
| Rate for Payer: Quartz Beloit One Network |
$2,508.76
|
| Rate for Payer: Quartz Commercial |
$3,071.95
|
| Rate for Payer: WEA Trust Commercial |
$2,815.96
|
| Rate for Payer: WPS Commercial |
$3,792.19
|
|
|
Platelet Antibody, Direct IgG
|
Facility
|
OP
|
$125.00
|
|
|
Service Code
|
CPT 86023
|
| Hospital Charge Code |
4500769
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.96 |
| Max. Negotiated Rate |
$119.60 |
| Rate for Payer: Aetna Commercial |
$117.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$111.80
|
| Rate for Payer: Aetna Managed Medicare |
$12.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$48.59
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$22.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$21.51
|
| Rate for Payer: Anthem Medicare Advantage |
$12.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$68.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$12.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$12.96
|
| Rate for Payer: Cash Price |
$37.50
|
| Rate for Payer: Cash Price |
$37.50
|
| Rate for Payer: Cigna Commercial |
$119.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$12.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$72.75
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$12.96
|
| Rate for Payer: Health EOS Commercial |
$115.70
|
| Rate for Payer: HFN Commercial |
$119.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$48.21
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$12.96
|
| Rate for Payer: Independent Care Health Plan Medicare |
$12.96
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$12.96
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$12.96
|
| Rate for Payer: Multiplan Commercial |
$104.00
|
| Rate for Payer: NAPHCARE Commercial |
$19.44
|
| Rate for Payer: Preferred Network Access Commercial |
$119.60
|
| Rate for Payer: Quartz Beloit One Network |
$63.70
|
| Rate for Payer: Quartz Commercial |
$84.50
|
| Rate for Payer: Quartz Medicare Advantage |
$12.96
|
| Rate for Payer: The Alliance Commercial |
$51.83
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.96
|
| Rate for Payer: United Healthcare PPO |
$97.50
|
| Rate for Payer: WEA Trust Commercial |
$71.50
|
| Rate for Payer: Wellcare Medicare |
$12.96
|
| Rate for Payer: WPS Commercial |
$96.29
|
|
|
Platelet Antibody, Direct IgG
|
Professional
|
Both
|
$125.00
|
|
|
Service Code
|
CPT 86023
|
| Hospital Charge Code |
4500769
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.96 |
| Max. Negotiated Rate |
$123.50 |
| Rate for Payer: Aetna Commercial |
$123.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$111.80
|
| Rate for Payer: Aetna Managed Medicare |
$12.96
|
| Rate for Payer: Anthem Medicare Advantage |
$12.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$12.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$12.96
|
| Rate for Payer: Cash Price |
$37.50
|
| Rate for Payer: Cash Price |
$37.50
|
| Rate for Payer: Cigna Commercial |
$123.50
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$65.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12.96
|
| Rate for Payer: Health EOS Commercial |
$118.30
|
| Rate for Payer: HFN Commercial |
$123.50
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$45.74
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$45.74
|
| Rate for Payer: Independent Care Health Plan Medicare |
$12.96
|
| Rate for Payer: Multiplan Commercial |
$104.00
|
| Rate for Payer: NAPHCARE Commercial |
$19.44
|
| Rate for Payer: Preferred Network Access Commercial |
$123.50
|
| Rate for Payer: Quartz Beloit One Network |
$57.20
|
| Rate for Payer: Quartz Commercial |
$74.10
|
| Rate for Payer: Quartz Medicare Advantage |
$12.96
|
| Rate for Payer: The Alliance Commercial |
$51.19
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.96
|
| Rate for Payer: WEA Trust Commercial |
$71.50
|
| Rate for Payer: WPS Commercial |
$57.02
|
|
|
Platelet Antibody, Direct IgG
|
Facility
|
IP
|
$125.00
|
|
|
Service Code
|
CPT 86023
|
| Hospital Charge Code |
4500769
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$63.70 |
| Max. Negotiated Rate |
$119.60 |
| Rate for Payer: Aetna Commercial |
$117.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$111.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$68.90
|
| Rate for Payer: Cash Price |
$37.50
|
| Rate for Payer: Cigna Commercial |
$119.60
|
| Rate for Payer: Health EOS Commercial |
$115.70
|
| Rate for Payer: HFN Commercial |
$119.60
|
| Rate for Payer: Multiplan Commercial |
$104.00
|
| Rate for Payer: Preferred Network Access Commercial |
$119.60
|
| Rate for Payer: Quartz Beloit One Network |
$63.70
|
| Rate for Payer: Quartz Commercial |
$78.00
|
| Rate for Payer: WEA Trust Commercial |
$71.50
|
| Rate for Payer: WPS Commercial |
$96.29
|
|
|
Platelet Associated IgA Antibody
|
Facility
|
OP
|
$580.00
|
|
|
Service Code
|
CPT 86023
|
| Hospital Charge Code |
2942972
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.96 |
| Max. Negotiated Rate |
$554.94 |
| Rate for Payer: Aetna Commercial |
$542.88
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$518.75
|
| Rate for Payer: Aetna Managed Medicare |
$12.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$48.59
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$22.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$21.51
|
| Rate for Payer: Anthem Medicare Advantage |
$12.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$319.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$12.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$12.96
|
| Rate for Payer: Cash Price |
$174.00
|
| Rate for Payer: Cash Price |
$174.00
|
| Rate for Payer: Cigna Commercial |
$554.94
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$12.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$337.56
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$12.96
|
| Rate for Payer: Health EOS Commercial |
$536.85
|
| Rate for Payer: HFN Commercial |
$554.94
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$48.21
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$12.96
|
| Rate for Payer: Independent Care Health Plan Medicare |
$12.96
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$12.96
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$12.96
|
| Rate for Payer: Multiplan Commercial |
$482.56
|
| Rate for Payer: NAPHCARE Commercial |
$19.44
|
| Rate for Payer: Preferred Network Access Commercial |
$554.94
|
| Rate for Payer: Quartz Beloit One Network |
$295.57
|
| Rate for Payer: Quartz Commercial |
$392.08
|
| Rate for Payer: Quartz Medicare Advantage |
$12.96
|
| Rate for Payer: The Alliance Commercial |
$51.83
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.96
|
| Rate for Payer: United Healthcare PPO |
$452.40
|
| Rate for Payer: WEA Trust Commercial |
$331.76
|
| Rate for Payer: Wellcare Medicare |
$12.96
|
| Rate for Payer: WPS Commercial |
$446.77
|
|
|
Platelet Associated IgA Antibody
|
Professional
|
Both
|
$580.00
|
|
|
Service Code
|
CPT 86023
|
| Hospital Charge Code |
2942972
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.96 |
| Max. Negotiated Rate |
$573.04 |
| Rate for Payer: Aetna Commercial |
$573.04
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$518.75
|
| Rate for Payer: Aetna Managed Medicare |
$12.96
|
| Rate for Payer: Anthem Medicare Advantage |
$12.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$12.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$12.96
|
| Rate for Payer: Cash Price |
$174.00
|
| Rate for Payer: Cash Price |
$174.00
|
| Rate for Payer: Cigna Commercial |
$573.04
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$301.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12.96
|
| Rate for Payer: Health EOS Commercial |
$548.91
|
| Rate for Payer: HFN Commercial |
$573.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$45.74
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$45.74
|
| Rate for Payer: Independent Care Health Plan Medicare |
$12.96
|
| Rate for Payer: Multiplan Commercial |
$482.56
|
| Rate for Payer: NAPHCARE Commercial |
$19.44
|
| Rate for Payer: Preferred Network Access Commercial |
$573.04
|
| Rate for Payer: Quartz Beloit One Network |
$265.41
|
| Rate for Payer: Quartz Commercial |
$343.82
|
| Rate for Payer: Quartz Medicare Advantage |
$12.96
|
| Rate for Payer: The Alliance Commercial |
$51.19
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.96
|
| Rate for Payer: WEA Trust Commercial |
$331.76
|
| Rate for Payer: WPS Commercial |
$57.02
|
|
|
Platelet Associated IgA Antibody
|
Facility
|
IP
|
$580.00
|
|
|
Service Code
|
CPT 86023
|
| Hospital Charge Code |
2942972
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$295.57 |
| Max. Negotiated Rate |
$554.94 |
| Rate for Payer: Aetna Commercial |
$542.88
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$518.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$319.70
|
| Rate for Payer: Cash Price |
$174.00
|
| Rate for Payer: Cigna Commercial |
$554.94
|
| Rate for Payer: Health EOS Commercial |
$536.85
|
| Rate for Payer: HFN Commercial |
$554.94
|
| Rate for Payer: Multiplan Commercial |
$482.56
|
| Rate for Payer: Preferred Network Access Commercial |
$554.94
|
| Rate for Payer: Quartz Beloit One Network |
$295.57
|
| Rate for Payer: Quartz Commercial |
$361.92
|
| Rate for Payer: WEA Trust Commercial |
$331.76
|
| Rate for Payer: WPS Commercial |
$446.77
|
|
|
Platelet Associated IgG Antibody
|
Facility
|
IP
|
$580.00
|
|
|
Service Code
|
CPT 86023
|
| Hospital Charge Code |
2942970
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$295.57 |
| Max. Negotiated Rate |
$554.94 |
| Rate for Payer: Aetna Commercial |
$542.88
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$518.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$319.70
|
| Rate for Payer: Cash Price |
$174.00
|
| Rate for Payer: Cigna Commercial |
$554.94
|
| Rate for Payer: Health EOS Commercial |
$536.85
|
| Rate for Payer: HFN Commercial |
$554.94
|
| Rate for Payer: Multiplan Commercial |
$482.56
|
| Rate for Payer: Preferred Network Access Commercial |
$554.94
|
| Rate for Payer: Quartz Beloit One Network |
$295.57
|
| Rate for Payer: Quartz Commercial |
$361.92
|
| Rate for Payer: WEA Trust Commercial |
$331.76
|
| Rate for Payer: WPS Commercial |
$446.77
|
|
|
Platelet Associated IgG Antibody
|
Facility
|
OP
|
$580.00
|
|
|
Service Code
|
CPT 86023
|
| Hospital Charge Code |
2942970
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.96 |
| Max. Negotiated Rate |
$554.94 |
| Rate for Payer: Aetna Commercial |
$542.88
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$518.75
|
| Rate for Payer: Aetna Managed Medicare |
$12.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$48.59
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$22.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$21.51
|
| Rate for Payer: Anthem Medicare Advantage |
$12.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$319.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$12.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$12.96
|
| Rate for Payer: Cash Price |
$174.00
|
| Rate for Payer: Cash Price |
$174.00
|
| Rate for Payer: Cigna Commercial |
$554.94
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$12.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$337.56
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$12.96
|
| Rate for Payer: Health EOS Commercial |
$536.85
|
| Rate for Payer: HFN Commercial |
$554.94
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$48.21
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$12.96
|
| Rate for Payer: Independent Care Health Plan Medicare |
$12.96
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$12.96
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$12.96
|
| Rate for Payer: Multiplan Commercial |
$482.56
|
| Rate for Payer: NAPHCARE Commercial |
$19.44
|
| Rate for Payer: Preferred Network Access Commercial |
$554.94
|
| Rate for Payer: Quartz Beloit One Network |
$295.57
|
| Rate for Payer: Quartz Commercial |
$392.08
|
| Rate for Payer: Quartz Medicare Advantage |
$12.96
|
| Rate for Payer: The Alliance Commercial |
$51.83
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.96
|
| Rate for Payer: United Healthcare PPO |
$452.40
|
| Rate for Payer: WEA Trust Commercial |
$331.76
|
| Rate for Payer: Wellcare Medicare |
$12.96
|
| Rate for Payer: WPS Commercial |
$446.77
|
|
|
Platelet Associated IgG Antibody
|
Professional
|
Both
|
$580.00
|
|
|
Service Code
|
CPT 86023
|
| Hospital Charge Code |
2942970
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.96 |
| Max. Negotiated Rate |
$573.04 |
| Rate for Payer: Aetna Commercial |
$573.04
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$518.75
|
| Rate for Payer: Aetna Managed Medicare |
$12.96
|
| Rate for Payer: Anthem Medicare Advantage |
$12.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$12.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$12.96
|
| Rate for Payer: Cash Price |
$174.00
|
| Rate for Payer: Cash Price |
$174.00
|
| Rate for Payer: Cigna Commercial |
$573.04
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$301.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12.96
|
| Rate for Payer: Health EOS Commercial |
$548.91
|
| Rate for Payer: HFN Commercial |
$573.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$45.74
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$45.74
|
| Rate for Payer: Independent Care Health Plan Medicare |
$12.96
|
| Rate for Payer: Multiplan Commercial |
$482.56
|
| Rate for Payer: NAPHCARE Commercial |
$19.44
|
| Rate for Payer: Preferred Network Access Commercial |
$573.04
|
| Rate for Payer: Quartz Beloit One Network |
$265.41
|
| Rate for Payer: Quartz Commercial |
$343.82
|
| Rate for Payer: Quartz Medicare Advantage |
$12.96
|
| Rate for Payer: The Alliance Commercial |
$51.19
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.96
|
| Rate for Payer: WEA Trust Commercial |
$331.76
|
| Rate for Payer: WPS Commercial |
$57.02
|
|
|
Platelet Associated IgM Antibody
|
Professional
|
Both
|
$580.00
|
|
|
Service Code
|
CPT 86023
|
| Hospital Charge Code |
2942971
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.96 |
| Max. Negotiated Rate |
$573.04 |
| Rate for Payer: Aetna Commercial |
$573.04
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$518.75
|
| Rate for Payer: Aetna Managed Medicare |
$12.96
|
| Rate for Payer: Anthem Medicare Advantage |
$12.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$12.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$12.96
|
| Rate for Payer: Cash Price |
$174.00
|
| Rate for Payer: Cash Price |
$174.00
|
| Rate for Payer: Cigna Commercial |
$573.04
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$301.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12.96
|
| Rate for Payer: Health EOS Commercial |
$548.91
|
| Rate for Payer: HFN Commercial |
$573.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$45.74
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$45.74
|
| Rate for Payer: Independent Care Health Plan Medicare |
$12.96
|
| Rate for Payer: Multiplan Commercial |
$482.56
|
| Rate for Payer: NAPHCARE Commercial |
$19.44
|
| Rate for Payer: Preferred Network Access Commercial |
$573.04
|
| Rate for Payer: Quartz Beloit One Network |
$265.41
|
| Rate for Payer: Quartz Commercial |
$343.82
|
| Rate for Payer: Quartz Medicare Advantage |
$12.96
|
| Rate for Payer: The Alliance Commercial |
$51.19
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.96
|
| Rate for Payer: WEA Trust Commercial |
$331.76
|
| Rate for Payer: WPS Commercial |
$57.02
|
|
|
Platelet Associated IgM Antibody
|
Facility
|
OP
|
$580.00
|
|
|
Service Code
|
CPT 86023
|
| Hospital Charge Code |
2942971
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.96 |
| Max. Negotiated Rate |
$554.94 |
| Rate for Payer: Aetna Commercial |
$542.88
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$518.75
|
| Rate for Payer: Aetna Managed Medicare |
$12.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$48.59
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$22.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$21.51
|
| Rate for Payer: Anthem Medicare Advantage |
$12.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$319.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$12.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$12.96
|
| Rate for Payer: Cash Price |
$174.00
|
| Rate for Payer: Cash Price |
$174.00
|
| Rate for Payer: Cigna Commercial |
$554.94
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$12.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$337.56
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$12.96
|
| Rate for Payer: Health EOS Commercial |
$536.85
|
| Rate for Payer: HFN Commercial |
$554.94
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$48.21
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$12.96
|
| Rate for Payer: Independent Care Health Plan Medicare |
$12.96
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$12.96
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$12.96
|
| Rate for Payer: Multiplan Commercial |
$482.56
|
| Rate for Payer: NAPHCARE Commercial |
$19.44
|
| Rate for Payer: Preferred Network Access Commercial |
$554.94
|
| Rate for Payer: Quartz Beloit One Network |
$295.57
|
| Rate for Payer: Quartz Commercial |
$392.08
|
| Rate for Payer: Quartz Medicare Advantage |
$12.96
|
| Rate for Payer: The Alliance Commercial |
$51.83
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.96
|
| Rate for Payer: United Healthcare PPO |
$452.40
|
| Rate for Payer: WEA Trust Commercial |
$331.76
|
| Rate for Payer: Wellcare Medicare |
$12.96
|
| Rate for Payer: WPS Commercial |
$446.77
|
|
|
Platelet Associated IgM Antibody
|
Facility
|
IP
|
$580.00
|
|
|
Service Code
|
CPT 86023
|
| Hospital Charge Code |
2942971
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$295.57 |
| Max. Negotiated Rate |
$554.94 |
| Rate for Payer: Aetna Commercial |
$542.88
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$518.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$319.70
|
| Rate for Payer: Cash Price |
$174.00
|
| Rate for Payer: Cigna Commercial |
$554.94
|
| Rate for Payer: Health EOS Commercial |
$536.85
|
| Rate for Payer: HFN Commercial |
$554.94
|
| Rate for Payer: Multiplan Commercial |
$482.56
|
| Rate for Payer: Preferred Network Access Commercial |
$554.94
|
| Rate for Payer: Quartz Beloit One Network |
$295.57
|
| Rate for Payer: Quartz Commercial |
$361.92
|
| Rate for Payer: WEA Trust Commercial |
$331.76
|
| Rate for Payer: WPS Commercial |
$446.77
|
|
|
Platelet Autoantibodies
|
Facility
|
OP
|
$100.00
|
|
|
Service Code
|
CPT 86023
|
| Hospital Charge Code |
2956833
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.96 |
| Max. Negotiated Rate |
$95.68 |
| Rate for Payer: Aetna Commercial |
$93.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$89.44
|
| Rate for Payer: Aetna Managed Medicare |
$12.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$48.59
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$22.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$21.51
|
| Rate for Payer: Anthem Medicare Advantage |
$12.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$55.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$12.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$12.96
|
| Rate for Payer: Cash Price |
$30.00
|
| Rate for Payer: Cash Price |
$30.00
|
| Rate for Payer: Cigna Commercial |
$95.68
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$12.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$58.20
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$12.96
|
| Rate for Payer: Health EOS Commercial |
$92.56
|
| Rate for Payer: HFN Commercial |
$95.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$48.21
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$12.96
|
| Rate for Payer: Independent Care Health Plan Medicare |
$12.96
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$12.96
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$12.96
|
| Rate for Payer: Multiplan Commercial |
$83.20
|
| Rate for Payer: NAPHCARE Commercial |
$19.44
|
| Rate for Payer: Preferred Network Access Commercial |
$95.68
|
| Rate for Payer: Quartz Beloit One Network |
$50.96
|
| Rate for Payer: Quartz Commercial |
$67.60
|
| Rate for Payer: Quartz Medicare Advantage |
$12.96
|
| Rate for Payer: The Alliance Commercial |
$51.83
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.96
|
| Rate for Payer: United Healthcare PPO |
$78.00
|
| Rate for Payer: WEA Trust Commercial |
$57.20
|
| Rate for Payer: Wellcare Medicare |
$12.96
|
| Rate for Payer: WPS Commercial |
$77.03
|
|
|
Platelet Autoantibodies
|
Professional
|
Both
|
$100.00
|
|
|
Service Code
|
CPT 86023
|
| Hospital Charge Code |
2956833
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.96 |
| Max. Negotiated Rate |
$98.80 |
| Rate for Payer: Aetna Commercial |
$98.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$89.44
|
| Rate for Payer: Aetna Managed Medicare |
$12.96
|
| Rate for Payer: Anthem Medicare Advantage |
$12.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$12.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$12.96
|
| Rate for Payer: Cash Price |
$30.00
|
| Rate for Payer: Cash Price |
$30.00
|
| Rate for Payer: Cigna Commercial |
$98.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$52.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12.96
|
| Rate for Payer: Health EOS Commercial |
$94.64
|
| Rate for Payer: HFN Commercial |
$98.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$45.74
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$45.74
|
| Rate for Payer: Independent Care Health Plan Medicare |
$12.96
|
| Rate for Payer: Multiplan Commercial |
$83.20
|
| Rate for Payer: NAPHCARE Commercial |
$19.44
|
| Rate for Payer: Preferred Network Access Commercial |
$98.80
|
| Rate for Payer: Quartz Beloit One Network |
$45.76
|
| Rate for Payer: Quartz Commercial |
$59.28
|
| Rate for Payer: Quartz Medicare Advantage |
$12.96
|
| Rate for Payer: The Alliance Commercial |
$51.19
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.96
|
| Rate for Payer: WEA Trust Commercial |
$57.20
|
| Rate for Payer: WPS Commercial |
$57.02
|
|
|
Platelet Autoantibodies
|
Facility
|
IP
|
$100.00
|
|
|
Service Code
|
CPT 86023
|
| Hospital Charge Code |
2956833
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$50.96 |
| Max. Negotiated Rate |
$95.68 |
| Rate for Payer: Aetna Commercial |
$93.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$89.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$55.12
|
| Rate for Payer: Cash Price |
$30.00
|
| Rate for Payer: Cigna Commercial |
$95.68
|
| Rate for Payer: Health EOS Commercial |
$92.56
|
| Rate for Payer: HFN Commercial |
$95.68
|
| Rate for Payer: Multiplan Commercial |
$83.20
|
| Rate for Payer: Preferred Network Access Commercial |
$95.68
|
| Rate for Payer: Quartz Beloit One Network |
$50.96
|
| Rate for Payer: Quartz Commercial |
$62.40
|
| Rate for Payer: WEA Trust Commercial |
$57.20
|
| Rate for Payer: WPS Commercial |
$77.03
|
|
|
Platelet Circulating IgA Antibody
|
Facility
|
IP
|
$696.00
|
|
|
Service Code
|
CPT 86022
|
| Hospital Charge Code |
2942969
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$354.68 |
| Max. Negotiated Rate |
$665.93 |
| Rate for Payer: Aetna Commercial |
$651.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$622.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$383.64
|
| Rate for Payer: Cash Price |
$208.80
|
| Rate for Payer: Cigna Commercial |
$665.93
|
| Rate for Payer: Health EOS Commercial |
$644.22
|
| Rate for Payer: HFN Commercial |
$665.93
|
| Rate for Payer: Multiplan Commercial |
$579.07
|
| Rate for Payer: Preferred Network Access Commercial |
$665.93
|
| Rate for Payer: Quartz Beloit One Network |
$354.68
|
| Rate for Payer: Quartz Commercial |
$434.30
|
| Rate for Payer: WEA Trust Commercial |
$398.11
|
| Rate for Payer: WPS Commercial |
$536.13
|
|
|
Platelet Circulating IgA Antibody
|
Professional
|
Both
|
$696.00
|
|
|
Service Code
|
CPT 86022
|
| Hospital Charge Code |
2942969
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$19.10 |
| Max. Negotiated Rate |
$687.65 |
| Rate for Payer: Aetna Commercial |
$687.65
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$622.50
|
| Rate for Payer: Aetna Managed Medicare |
$19.10
|
| Rate for Payer: Anthem Medicare Advantage |
$19.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$19.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$19.10
|
| Rate for Payer: Cash Price |
$208.80
|
| Rate for Payer: Cash Price |
$208.80
|
| Rate for Payer: Cigna Commercial |
$687.65
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$361.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$19.10
|
| Rate for Payer: Health EOS Commercial |
$658.69
|
| Rate for Payer: HFN Commercial |
$687.65
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$67.44
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$67.44
|
| Rate for Payer: Independent Care Health Plan Medicare |
$19.10
|
| Rate for Payer: Multiplan Commercial |
$579.07
|
| Rate for Payer: NAPHCARE Commercial |
$28.66
|
| Rate for Payer: Preferred Network Access Commercial |
$687.65
|
| Rate for Payer: Quartz Beloit One Network |
$318.49
|
| Rate for Payer: Quartz Commercial |
$412.59
|
| Rate for Payer: Quartz Medicare Advantage |
$19.10
|
| Rate for Payer: The Alliance Commercial |
$75.46
|
| Rate for Payer: United Healthcare Medicare Advantage |
$19.10
|
| Rate for Payer: WEA Trust Commercial |
$398.11
|
| Rate for Payer: WPS Commercial |
$84.06
|
|
|
Platelet Circulating IgA Antibody
|
Facility
|
OP
|
$696.00
|
|
|
Service Code
|
CPT 86022
|
| Hospital Charge Code |
2942969
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$19.10 |
| Max. Negotiated Rate |
$665.93 |
| Rate for Payer: Aetna Commercial |
$651.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$622.50
|
| Rate for Payer: Aetna Managed Medicare |
$19.10
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$71.64
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$33.43
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$31.71
|
| Rate for Payer: Anthem Medicare Advantage |
$19.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$383.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$19.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$19.10
|
| Rate for Payer: Cash Price |
$208.80
|
| Rate for Payer: Cash Price |
$208.80
|
| Rate for Payer: Cigna Commercial |
$665.93
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$19.10
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$405.07
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$19.10
|
| Rate for Payer: Health EOS Commercial |
$644.22
|
| Rate for Payer: HFN Commercial |
$665.93
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$71.07
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$19.10
|
| Rate for Payer: Independent Care Health Plan Medicare |
$19.10
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$19.10
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$19.10
|
| Rate for Payer: Multiplan Commercial |
$579.07
|
| Rate for Payer: NAPHCARE Commercial |
$28.66
|
| Rate for Payer: Preferred Network Access Commercial |
$665.93
|
| Rate for Payer: Quartz Beloit One Network |
$354.68
|
| Rate for Payer: Quartz Commercial |
$470.50
|
| Rate for Payer: Quartz Medicare Advantage |
$19.10
|
| Rate for Payer: The Alliance Commercial |
$76.42
|
| Rate for Payer: United Healthcare Medicare Advantage |
$19.10
|
| Rate for Payer: United Healthcare PPO |
$542.88
|
| Rate for Payer: WEA Trust Commercial |
$398.11
|
| Rate for Payer: Wellcare Medicare |
$19.10
|
| Rate for Payer: WPS Commercial |
$536.13
|
|
