|
PLATE LCP 2.0 6HL 247.346
|
Facility
|
OP
|
$2,227.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5767794
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$623.56 |
| Max. Negotiated Rate |
$8,908.00 |
| Rate for Payer: Aetna Commercial |
$2,004.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,915.22
|
| Rate for Payer: Aetna Managed Medicare |
$623.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,447.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,113.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,068.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,180.31
|
| Rate for Payer: Cash Price |
$668.10
|
| Rate for Payer: Cigna Commercial |
$2,048.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,246.23
|
| Rate for Payer: Health EOS Commercial |
$1,982.03
|
| Rate for Payer: HFN Commercial |
$2,048.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,670.25
|
| Rate for Payer: Multiplan Commercial |
$1,781.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,336.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,048.84
|
| Rate for Payer: Quartz Beloit One Network |
$1,091.23
|
| Rate for Payer: Quartz Commercial |
$1,447.55
|
| Rate for Payer: Quartz Medicare Advantage |
$1,336.20
|
| Rate for Payer: The Alliance Commercial |
$8,908.00
|
| Rate for Payer: WEA Trust Commercial |
$1,224.85
|
| Rate for Payer: WPS Commercial |
$1,649.54
|
|
|
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 |
$599.48 |
| Max. Negotiated Rate |
$8,564.00 |
| Rate for Payer: Aetna Commercial |
$1,926.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,841.26
|
| Rate for Payer: Aetna Managed Medicare |
$599.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,391.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,070.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,027.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,134.73
|
| Rate for Payer: Cash Price |
$642.30
|
| Rate for Payer: Cigna Commercial |
$1,969.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,198.10
|
| Rate for Payer: Health EOS Commercial |
$1,905.49
|
| Rate for Payer: HFN Commercial |
$1,969.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,605.75
|
| Rate for Payer: Multiplan Commercial |
$1,712.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,284.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,969.72
|
| Rate for Payer: Quartz Beloit One Network |
$1,049.09
|
| Rate for Payer: Quartz Commercial |
$1,391.65
|
| Rate for Payer: Quartz Medicare Advantage |
$1,284.60
|
| Rate for Payer: The Alliance Commercial |
$8,564.00
|
| Rate for Payer: WEA Trust Commercial |
$1,177.55
|
| Rate for Payer: WPS Commercial |
$1,585.84
|
|
|
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 |
$1,049.09 |
| Max. Negotiated Rate |
$1,969.72 |
| Rate for Payer: Aetna Commercial |
$1,926.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,841.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,134.73
|
| Rate for Payer: Cash Price |
$642.30
|
| Rate for Payer: Cigna Commercial |
$1,969.72
|
| Rate for Payer: Health EOS Commercial |
$1,905.49
|
| Rate for Payer: HFN Commercial |
$1,969.72
|
| Rate for Payer: Multiplan Commercial |
$1,712.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,284.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,969.72
|
| Rate for Payer: Quartz Beloit One Network |
$1,049.09
|
| Rate for Payer: Quartz Commercial |
$1,284.60
|
| Rate for Payer: WEA Trust Commercial |
$1,177.55
|
| Rate for Payer: WPS Commercial |
$1,585.84
|
|
|
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 |
$623.56 |
| Max. Negotiated Rate |
$8,908.00 |
| Rate for Payer: Aetna Commercial |
$2,004.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,915.22
|
| Rate for Payer: Aetna Managed Medicare |
$623.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,447.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,113.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,068.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,180.31
|
| Rate for Payer: Cash Price |
$668.10
|
| Rate for Payer: Cigna Commercial |
$2,048.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,246.23
|
| Rate for Payer: Health EOS Commercial |
$1,982.03
|
| Rate for Payer: HFN Commercial |
$2,048.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,670.25
|
| Rate for Payer: Multiplan Commercial |
$1,781.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,336.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,048.84
|
| Rate for Payer: Quartz Beloit One Network |
$1,091.23
|
| Rate for Payer: Quartz Commercial |
$1,447.55
|
| Rate for Payer: Quartz Medicare Advantage |
$1,336.20
|
| Rate for Payer: The Alliance Commercial |
$8,908.00
|
| Rate for Payer: WEA Trust Commercial |
$1,224.85
|
| Rate for Payer: WPS Commercial |
$1,649.54
|
|
|
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 |
$1,091.23 |
| Max. Negotiated Rate |
$2,048.84 |
| Rate for Payer: Aetna Commercial |
$2,004.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,915.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,180.31
|
| Rate for Payer: Cash Price |
$668.10
|
| Rate for Payer: Cigna Commercial |
$2,048.84
|
| Rate for Payer: Health EOS Commercial |
$1,982.03
|
| Rate for Payer: HFN Commercial |
$2,048.84
|
| Rate for Payer: Multiplan Commercial |
$1,781.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,336.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,048.84
|
| Rate for Payer: Quartz Beloit One Network |
$1,091.23
|
| Rate for Payer: Quartz Commercial |
$1,336.20
|
| Rate for Payer: WEA Trust Commercial |
$1,224.85
|
| Rate for Payer: WPS Commercial |
$1,649.54
|
|
|
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 |
$1,378.44 |
| Max. Negotiated Rate |
$19,692.00 |
| Rate for Payer: Aetna Commercial |
$4,430.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,233.78
|
| Rate for Payer: Aetna Managed Medicare |
$1,378.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,199.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,461.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,363.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,609.19
|
| Rate for Payer: Cash Price |
$1,476.90
|
| Rate for Payer: Cigna Commercial |
$4,529.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,754.91
|
| Rate for Payer: Health EOS Commercial |
$4,381.47
|
| Rate for Payer: HFN Commercial |
$4,529.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,692.25
|
| Rate for Payer: Multiplan Commercial |
$3,938.40
|
| Rate for Payer: NAPHCARE Commercial |
$2,953.80
|
| Rate for Payer: Preferred Network Access Commercial |
$4,529.16
|
| Rate for Payer: Quartz Beloit One Network |
$2,412.27
|
| Rate for Payer: Quartz Commercial |
$3,199.95
|
| Rate for Payer: Quartz Medicare Advantage |
$2,953.80
|
| Rate for Payer: The Alliance Commercial |
$19,692.00
|
| Rate for Payer: WEA Trust Commercial |
$2,707.65
|
| Rate for Payer: WPS Commercial |
$3,646.47
|
|
|
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 |
$2,412.27 |
| Max. Negotiated Rate |
$4,529.16 |
| Rate for Payer: Aetna Commercial |
$4,430.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,233.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,609.19
|
| Rate for Payer: Cash Price |
$1,476.90
|
| Rate for Payer: Cigna Commercial |
$4,529.16
|
| Rate for Payer: Health EOS Commercial |
$4,381.47
|
| Rate for Payer: HFN Commercial |
$4,529.16
|
| Rate for Payer: Multiplan Commercial |
$3,938.40
|
| Rate for Payer: NAPHCARE Commercial |
$2,953.80
|
| Rate for Payer: Preferred Network Access Commercial |
$4,529.16
|
| Rate for Payer: Quartz Beloit One Network |
$2,412.27
|
| Rate for Payer: Quartz Commercial |
$2,953.80
|
| Rate for Payer: WEA Trust Commercial |
$2,707.65
|
| Rate for Payer: WPS Commercial |
$3,646.47
|
|
|
Platelet Antibody, Direct IgG
|
Facility
|
IP
|
$125.00
|
|
|
Service Code
|
CPT 86023
|
| Hospital Charge Code |
4500769
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$61.25 |
| Max. Negotiated Rate |
$115.00 |
| Rate for Payer: Aetna Commercial |
$112.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$107.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$66.25
|
| Rate for Payer: Cash Price |
$37.50
|
| Rate for Payer: Cigna Commercial |
$115.00
|
| Rate for Payer: Health EOS Commercial |
$111.25
|
| Rate for Payer: HFN Commercial |
$115.00
|
| Rate for Payer: Multiplan Commercial |
$100.00
|
| Rate for Payer: NAPHCARE Commercial |
$75.00
|
| Rate for Payer: Preferred Network Access Commercial |
$115.00
|
| Rate for Payer: Quartz Beloit One Network |
$61.25
|
| Rate for Payer: Quartz Commercial |
$75.00
|
| Rate for Payer: WEA Trust Commercial |
$68.75
|
| Rate for Payer: WPS Commercial |
$92.59
|
|
|
Platelet Antibody, Direct IgG
|
Professional
|
Both
|
$125.00
|
|
|
Service Code
|
CPT 86023
|
| Hospital Charge Code |
4500769
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$43.98 |
| Max. Negotiated Rate |
$118.75 |
| Rate for Payer: Aetna Commercial |
$118.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$107.50
|
| Rate for Payer: Cash Price |
$37.50
|
| Rate for Payer: Cash Price |
$37.50
|
| Rate for Payer: Cigna Commercial |
$118.75
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$62.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$75.00
|
| Rate for Payer: Health EOS Commercial |
$113.75
|
| Rate for Payer: HFN Commercial |
$118.75
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$43.98
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$43.98
|
| Rate for Payer: Multiplan Commercial |
$100.00
|
| Rate for Payer: Preferred Network Access Commercial |
$118.75
|
| Rate for Payer: Quartz Beloit One Network |
$55.00
|
| Rate for Payer: Quartz Commercial |
$71.25
|
| Rate for Payer: The Alliance Commercial |
$62.50
|
| Rate for Payer: WEA Trust Commercial |
$68.75
|
| Rate for Payer: WPS Commercial |
$92.59
|
|
|
Platelet Antibody, Direct IgG
|
Facility
|
OP
|
$125.00
|
|
|
Service Code
|
CPT 86023
|
| Hospital Charge Code |
4500769
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.46 |
| Max. Negotiated Rate |
$115.00 |
| Rate for Payer: Aetna Commercial |
$112.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$107.50
|
| Rate for Payer: Aetna Managed Medicare |
$12.46
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$46.72
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$21.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$20.68
|
| Rate for Payer: Anthem Medicaid |
$12.87
|
| Rate for Payer: Anthem Medicare Advantage |
$12.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$66.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$12.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$12.46
|
| Rate for Payer: Cash Price |
$37.50
|
| Rate for Payer: Cash Price |
$37.50
|
| Rate for Payer: Cigna Commercial |
$115.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$12.46
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$12.87
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$69.95
|
| Rate for Payer: Dean Health Medicaid |
$12.87
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$12.46
|
| Rate for Payer: Health EOS Commercial |
$111.25
|
| Rate for Payer: HFN Commercial |
$115.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$46.35
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$12.46
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$12.87
|
| Rate for Payer: Independent Care Health Plan Medicare |
$12.46
|
| Rate for Payer: Managed Health Services Medicaid |
$13.38
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$12.46
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$12.46
|
| Rate for Payer: Multiplan Commercial |
$100.00
|
| Rate for Payer: NAPHCARE Commercial |
$18.69
|
| Rate for Payer: Preferred Network Access Commercial |
$115.00
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$12.87
|
| Rate for Payer: Quartz Beloit One Network |
$61.25
|
| Rate for Payer: Quartz Commercial |
$81.25
|
| Rate for Payer: Quartz Medicare Advantage |
$12.46
|
| Rate for Payer: The Alliance Commercial |
$49.84
|
| Rate for Payer: United Healthcare Medicaid |
$12.87
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.46
|
| Rate for Payer: United Healthcare PPO |
$93.75
|
| Rate for Payer: WEA Trust Commercial |
$68.75
|
| Rate for Payer: Wellcare Medicare |
$12.46
|
| Rate for Payer: WMAP Medicaid |
$12.87
|
| Rate for Payer: WPS Commercial |
$92.59
|
|
|
Platelet Associated IgA Antibody
|
Facility
|
OP
|
$580.00
|
|
|
Service Code
|
CPT 86023
|
| Hospital Charge Code |
2942972
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.46 |
| Max. Negotiated Rate |
$533.60 |
| Rate for Payer: Aetna Commercial |
$522.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$498.80
|
| Rate for Payer: Aetna Managed Medicare |
$12.46
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$46.72
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$21.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$20.68
|
| Rate for Payer: Anthem Medicaid |
$12.87
|
| Rate for Payer: Anthem Medicare Advantage |
$12.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$307.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$12.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$12.46
|
| Rate for Payer: Cash Price |
$174.00
|
| Rate for Payer: Cash Price |
$174.00
|
| Rate for Payer: Cigna Commercial |
$533.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$12.46
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$12.87
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$324.57
|
| Rate for Payer: Dean Health Medicaid |
$12.87
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$12.46
|
| Rate for Payer: Health EOS Commercial |
$516.20
|
| Rate for Payer: HFN Commercial |
$533.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$46.35
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$12.46
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$12.87
|
| Rate for Payer: Independent Care Health Plan Medicare |
$12.46
|
| Rate for Payer: Managed Health Services Medicaid |
$13.38
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$12.46
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$12.46
|
| Rate for Payer: Multiplan Commercial |
$464.00
|
| Rate for Payer: NAPHCARE Commercial |
$18.69
|
| Rate for Payer: Preferred Network Access Commercial |
$533.60
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$12.87
|
| Rate for Payer: Quartz Beloit One Network |
$284.20
|
| Rate for Payer: Quartz Commercial |
$377.00
|
| Rate for Payer: Quartz Medicare Advantage |
$12.46
|
| Rate for Payer: The Alliance Commercial |
$49.84
|
| Rate for Payer: United Healthcare Medicaid |
$12.87
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.46
|
| Rate for Payer: United Healthcare PPO |
$435.00
|
| Rate for Payer: WEA Trust Commercial |
$319.00
|
| Rate for Payer: Wellcare Medicare |
$12.46
|
| Rate for Payer: WMAP Medicaid |
$12.87
|
| Rate for Payer: WPS Commercial |
$429.61
|
|
|
Platelet Associated IgA Antibody
|
Professional
|
Both
|
$580.00
|
|
|
Service Code
|
CPT 86023
|
| Hospital Charge Code |
2942972
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$43.98 |
| Max. Negotiated Rate |
$551.00 |
| Rate for Payer: Aetna Commercial |
$551.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$498.80
|
| Rate for Payer: Cash Price |
$174.00
|
| Rate for Payer: Cash Price |
$174.00
|
| Rate for Payer: Cigna Commercial |
$551.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$290.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$348.00
|
| Rate for Payer: Health EOS Commercial |
$527.80
|
| Rate for Payer: HFN Commercial |
$551.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$43.98
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$43.98
|
| Rate for Payer: Multiplan Commercial |
$464.00
|
| Rate for Payer: Preferred Network Access Commercial |
$551.00
|
| Rate for Payer: Quartz Beloit One Network |
$255.20
|
| Rate for Payer: Quartz Commercial |
$330.60
|
| Rate for Payer: The Alliance Commercial |
$290.00
|
| Rate for Payer: WEA Trust Commercial |
$319.00
|
| Rate for Payer: WPS Commercial |
$429.61
|
|
|
Platelet Associated IgA Antibody
|
Facility
|
IP
|
$580.00
|
|
|
Service Code
|
CPT 86023
|
| Hospital Charge Code |
2942972
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$284.20 |
| Max. Negotiated Rate |
$533.60 |
| Rate for Payer: Aetna Commercial |
$522.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$498.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$307.40
|
| Rate for Payer: Cash Price |
$174.00
|
| Rate for Payer: Cigna Commercial |
$533.60
|
| Rate for Payer: Health EOS Commercial |
$516.20
|
| Rate for Payer: HFN Commercial |
$533.60
|
| Rate for Payer: Multiplan Commercial |
$464.00
|
| Rate for Payer: NAPHCARE Commercial |
$348.00
|
| Rate for Payer: Preferred Network Access Commercial |
$533.60
|
| Rate for Payer: Quartz Beloit One Network |
$284.20
|
| Rate for Payer: Quartz Commercial |
$348.00
|
| Rate for Payer: WEA Trust Commercial |
$319.00
|
| Rate for Payer: WPS Commercial |
$429.61
|
|
|
Platelet Associated IgG Antibody
|
Facility
|
OP
|
$580.00
|
|
|
Service Code
|
CPT 86023
|
| Hospital Charge Code |
2942970
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.46 |
| Max. Negotiated Rate |
$533.60 |
| Rate for Payer: Aetna Commercial |
$522.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$498.80
|
| Rate for Payer: Aetna Managed Medicare |
$12.46
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$46.72
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$21.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$20.68
|
| Rate for Payer: Anthem Medicaid |
$12.87
|
| Rate for Payer: Anthem Medicare Advantage |
$12.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$307.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$12.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$12.46
|
| Rate for Payer: Cash Price |
$174.00
|
| Rate for Payer: Cash Price |
$174.00
|
| Rate for Payer: Cigna Commercial |
$533.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$12.46
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$12.87
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$324.57
|
| Rate for Payer: Dean Health Medicaid |
$12.87
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$12.46
|
| Rate for Payer: Health EOS Commercial |
$516.20
|
| Rate for Payer: HFN Commercial |
$533.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$46.35
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$12.46
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$12.87
|
| Rate for Payer: Independent Care Health Plan Medicare |
$12.46
|
| Rate for Payer: Managed Health Services Medicaid |
$13.38
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$12.46
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$12.46
|
| Rate for Payer: Multiplan Commercial |
$464.00
|
| Rate for Payer: NAPHCARE Commercial |
$18.69
|
| Rate for Payer: Preferred Network Access Commercial |
$533.60
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$12.87
|
| Rate for Payer: Quartz Beloit One Network |
$284.20
|
| Rate for Payer: Quartz Commercial |
$377.00
|
| Rate for Payer: Quartz Medicare Advantage |
$12.46
|
| Rate for Payer: The Alliance Commercial |
$49.84
|
| Rate for Payer: United Healthcare Medicaid |
$12.87
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.46
|
| Rate for Payer: United Healthcare PPO |
$435.00
|
| Rate for Payer: WEA Trust Commercial |
$319.00
|
| Rate for Payer: Wellcare Medicare |
$12.46
|
| Rate for Payer: WMAP Medicaid |
$12.87
|
| Rate for Payer: WPS Commercial |
$429.61
|
|
|
Platelet Associated IgG Antibody
|
Facility
|
IP
|
$580.00
|
|
|
Service Code
|
CPT 86023
|
| Hospital Charge Code |
2942970
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$284.20 |
| Max. Negotiated Rate |
$533.60 |
| Rate for Payer: Aetna Commercial |
$522.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$498.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$307.40
|
| Rate for Payer: Cash Price |
$174.00
|
| Rate for Payer: Cigna Commercial |
$533.60
|
| Rate for Payer: Health EOS Commercial |
$516.20
|
| Rate for Payer: HFN Commercial |
$533.60
|
| Rate for Payer: Multiplan Commercial |
$464.00
|
| Rate for Payer: NAPHCARE Commercial |
$348.00
|
| Rate for Payer: Preferred Network Access Commercial |
$533.60
|
| Rate for Payer: Quartz Beloit One Network |
$284.20
|
| Rate for Payer: Quartz Commercial |
$348.00
|
| Rate for Payer: WEA Trust Commercial |
$319.00
|
| Rate for Payer: WPS Commercial |
$429.61
|
|
|
Platelet Associated IgG Antibody
|
Professional
|
Both
|
$580.00
|
|
|
Service Code
|
CPT 86023
|
| Hospital Charge Code |
2942970
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$43.98 |
| Max. Negotiated Rate |
$551.00 |
| Rate for Payer: Aetna Commercial |
$551.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$498.80
|
| Rate for Payer: Cash Price |
$174.00
|
| Rate for Payer: Cash Price |
$174.00
|
| Rate for Payer: Cigna Commercial |
$551.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$290.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$348.00
|
| Rate for Payer: Health EOS Commercial |
$527.80
|
| Rate for Payer: HFN Commercial |
$551.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$43.98
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$43.98
|
| Rate for Payer: Multiplan Commercial |
$464.00
|
| Rate for Payer: Preferred Network Access Commercial |
$551.00
|
| Rate for Payer: Quartz Beloit One Network |
$255.20
|
| Rate for Payer: Quartz Commercial |
$330.60
|
| Rate for Payer: The Alliance Commercial |
$290.00
|
| Rate for Payer: WEA Trust Commercial |
$319.00
|
| Rate for Payer: WPS Commercial |
$429.61
|
|
|
Platelet Associated IgM Antibody
|
Facility
|
IP
|
$580.00
|
|
|
Service Code
|
CPT 86023
|
| Hospital Charge Code |
2942971
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$284.20 |
| Max. Negotiated Rate |
$533.60 |
| Rate for Payer: Aetna Commercial |
$522.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$498.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$307.40
|
| Rate for Payer: Cash Price |
$174.00
|
| Rate for Payer: Cigna Commercial |
$533.60
|
| Rate for Payer: Health EOS Commercial |
$516.20
|
| Rate for Payer: HFN Commercial |
$533.60
|
| Rate for Payer: Multiplan Commercial |
$464.00
|
| Rate for Payer: NAPHCARE Commercial |
$348.00
|
| Rate for Payer: Preferred Network Access Commercial |
$533.60
|
| Rate for Payer: Quartz Beloit One Network |
$284.20
|
| Rate for Payer: Quartz Commercial |
$348.00
|
| Rate for Payer: WEA Trust Commercial |
$319.00
|
| Rate for Payer: WPS Commercial |
$429.61
|
|
|
Platelet Associated IgM Antibody
|
Professional
|
Both
|
$580.00
|
|
|
Service Code
|
CPT 86023
|
| Hospital Charge Code |
2942971
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$43.98 |
| Max. Negotiated Rate |
$551.00 |
| Rate for Payer: Aetna Commercial |
$551.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$498.80
|
| Rate for Payer: Cash Price |
$174.00
|
| Rate for Payer: Cash Price |
$174.00
|
| Rate for Payer: Cigna Commercial |
$551.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$290.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$348.00
|
| Rate for Payer: Health EOS Commercial |
$527.80
|
| Rate for Payer: HFN Commercial |
$551.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$43.98
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$43.98
|
| Rate for Payer: Multiplan Commercial |
$464.00
|
| Rate for Payer: Preferred Network Access Commercial |
$551.00
|
| Rate for Payer: Quartz Beloit One Network |
$255.20
|
| Rate for Payer: Quartz Commercial |
$330.60
|
| Rate for Payer: The Alliance Commercial |
$290.00
|
| Rate for Payer: WEA Trust Commercial |
$319.00
|
| Rate for Payer: WPS Commercial |
$429.61
|
|
|
Platelet Associated IgM Antibody
|
Facility
|
OP
|
$580.00
|
|
|
Service Code
|
CPT 86023
|
| Hospital Charge Code |
2942971
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.46 |
| Max. Negotiated Rate |
$533.60 |
| Rate for Payer: Aetna Commercial |
$522.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$498.80
|
| Rate for Payer: Aetna Managed Medicare |
$12.46
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$46.72
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$21.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$20.68
|
| Rate for Payer: Anthem Medicaid |
$12.87
|
| Rate for Payer: Anthem Medicare Advantage |
$12.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$307.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$12.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$12.46
|
| Rate for Payer: Cash Price |
$174.00
|
| Rate for Payer: Cash Price |
$174.00
|
| Rate for Payer: Cigna Commercial |
$533.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$12.46
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$12.87
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$324.57
|
| Rate for Payer: Dean Health Medicaid |
$12.87
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$12.46
|
| Rate for Payer: Health EOS Commercial |
$516.20
|
| Rate for Payer: HFN Commercial |
$533.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$46.35
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$12.46
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$12.87
|
| Rate for Payer: Independent Care Health Plan Medicare |
$12.46
|
| Rate for Payer: Managed Health Services Medicaid |
$13.38
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$12.46
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$12.46
|
| Rate for Payer: Multiplan Commercial |
$464.00
|
| Rate for Payer: NAPHCARE Commercial |
$18.69
|
| Rate for Payer: Preferred Network Access Commercial |
$533.60
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$12.87
|
| Rate for Payer: Quartz Beloit One Network |
$284.20
|
| Rate for Payer: Quartz Commercial |
$377.00
|
| Rate for Payer: Quartz Medicare Advantage |
$12.46
|
| Rate for Payer: The Alliance Commercial |
$49.84
|
| Rate for Payer: United Healthcare Medicaid |
$12.87
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.46
|
| Rate for Payer: United Healthcare PPO |
$435.00
|
| Rate for Payer: WEA Trust Commercial |
$319.00
|
| Rate for Payer: Wellcare Medicare |
$12.46
|
| Rate for Payer: WMAP Medicaid |
$12.87
|
| Rate for Payer: WPS Commercial |
$429.61
|
|
|
Platelet Autoantibodies
|
Facility
|
OP
|
$100.00
|
|
|
Service Code
|
CPT 86023
|
| Hospital Charge Code |
2956833
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.46 |
| Max. Negotiated Rate |
$92.00 |
| Rate for Payer: Aetna Commercial |
$90.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$86.00
|
| Rate for Payer: Aetna Managed Medicare |
$12.46
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$46.72
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$21.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$20.68
|
| Rate for Payer: Anthem Medicaid |
$12.87
|
| Rate for Payer: Anthem Medicare Advantage |
$12.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$53.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$12.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$12.46
|
| Rate for Payer: Cash Price |
$30.00
|
| Rate for Payer: Cash Price |
$30.00
|
| Rate for Payer: Cigna Commercial |
$92.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$12.46
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$12.87
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$55.96
|
| Rate for Payer: Dean Health Medicaid |
$12.87
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$12.46
|
| Rate for Payer: Health EOS Commercial |
$89.00
|
| Rate for Payer: HFN Commercial |
$92.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$46.35
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$12.46
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$12.87
|
| Rate for Payer: Independent Care Health Plan Medicare |
$12.46
|
| Rate for Payer: Managed Health Services Medicaid |
$13.38
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$12.46
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$12.46
|
| Rate for Payer: Multiplan Commercial |
$80.00
|
| Rate for Payer: NAPHCARE Commercial |
$18.69
|
| Rate for Payer: Preferred Network Access Commercial |
$92.00
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$12.87
|
| Rate for Payer: Quartz Beloit One Network |
$49.00
|
| Rate for Payer: Quartz Commercial |
$65.00
|
| Rate for Payer: Quartz Medicare Advantage |
$12.46
|
| Rate for Payer: The Alliance Commercial |
$49.84
|
| Rate for Payer: United Healthcare Medicaid |
$12.87
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.46
|
| Rate for Payer: United Healthcare PPO |
$75.00
|
| Rate for Payer: WEA Trust Commercial |
$55.00
|
| Rate for Payer: Wellcare Medicare |
$12.46
|
| Rate for Payer: WMAP Medicaid |
$12.87
|
| Rate for Payer: WPS Commercial |
$74.07
|
|
|
Platelet Autoantibodies
|
Facility
|
IP
|
$100.00
|
|
|
Service Code
|
CPT 86023
|
| Hospital Charge Code |
2956833
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$49.00 |
| Max. Negotiated Rate |
$92.00 |
| Rate for Payer: Aetna Commercial |
$90.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$86.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$53.00
|
| Rate for Payer: Cash Price |
$30.00
|
| Rate for Payer: Cigna Commercial |
$92.00
|
| Rate for Payer: Health EOS Commercial |
$89.00
|
| Rate for Payer: HFN Commercial |
$92.00
|
| Rate for Payer: Multiplan Commercial |
$80.00
|
| Rate for Payer: NAPHCARE Commercial |
$60.00
|
| Rate for Payer: Preferred Network Access Commercial |
$92.00
|
| Rate for Payer: Quartz Beloit One Network |
$49.00
|
| Rate for Payer: Quartz Commercial |
$60.00
|
| Rate for Payer: WEA Trust Commercial |
$55.00
|
| Rate for Payer: WPS Commercial |
$74.07
|
|
|
Platelet Autoantibodies
|
Professional
|
Both
|
$100.00
|
|
|
Service Code
|
CPT 86023
|
| Hospital Charge Code |
2956833
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$43.98 |
| Max. Negotiated Rate |
$95.00 |
| Rate for Payer: Aetna Commercial |
$95.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$86.00
|
| Rate for Payer: Cash Price |
$30.00
|
| Rate for Payer: Cash Price |
$30.00
|
| Rate for Payer: Cigna Commercial |
$95.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$50.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$60.00
|
| Rate for Payer: Health EOS Commercial |
$91.00
|
| Rate for Payer: HFN Commercial |
$95.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$43.98
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$43.98
|
| Rate for Payer: Multiplan Commercial |
$80.00
|
| Rate for Payer: Preferred Network Access Commercial |
$95.00
|
| Rate for Payer: Quartz Beloit One Network |
$44.00
|
| Rate for Payer: Quartz Commercial |
$57.00
|
| Rate for Payer: The Alliance Commercial |
$50.00
|
| Rate for Payer: WEA Trust Commercial |
$55.00
|
| Rate for Payer: WPS Commercial |
$74.07
|
|
|
Platelet Circulating IgA Antibody
|
Facility
|
OP
|
$696.00
|
|
|
Service Code
|
CPT 86022
|
| Hospital Charge Code |
2942969
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.37 |
| Max. Negotiated Rate |
$640.32 |
| Rate for Payer: Aetna Commercial |
$626.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$598.56
|
| Rate for Payer: Aetna Managed Medicare |
$18.37
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$68.89
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$32.15
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$30.49
|
| Rate for Payer: Anthem Medicaid |
$18.98
|
| Rate for Payer: Anthem Medicare Advantage |
$18.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$368.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$18.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$18.37
|
| Rate for Payer: Cash Price |
$208.80
|
| Rate for Payer: Cash Price |
$208.80
|
| Rate for Payer: Cigna Commercial |
$640.32
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$18.37
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$18.98
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$389.48
|
| Rate for Payer: Dean Health Medicaid |
$18.98
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$18.37
|
| Rate for Payer: Health EOS Commercial |
$619.44
|
| Rate for Payer: HFN Commercial |
$640.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$68.34
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$18.37
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$18.98
|
| Rate for Payer: Independent Care Health Plan Medicare |
$18.37
|
| Rate for Payer: Managed Health Services Medicaid |
$19.74
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$18.37
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$18.37
|
| Rate for Payer: Multiplan Commercial |
$556.80
|
| Rate for Payer: NAPHCARE Commercial |
$27.56
|
| Rate for Payer: Preferred Network Access Commercial |
$640.32
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$18.98
|
| Rate for Payer: Quartz Beloit One Network |
$341.04
|
| Rate for Payer: Quartz Commercial |
$452.40
|
| Rate for Payer: Quartz Medicare Advantage |
$18.37
|
| Rate for Payer: The Alliance Commercial |
$73.48
|
| Rate for Payer: United Healthcare Medicaid |
$18.98
|
| Rate for Payer: United Healthcare Medicare Advantage |
$18.37
|
| Rate for Payer: United Healthcare PPO |
$522.00
|
| Rate for Payer: WEA Trust Commercial |
$382.80
|
| Rate for Payer: Wellcare Medicare |
$18.37
|
| Rate for Payer: WMAP Medicaid |
$18.98
|
| Rate for Payer: WPS Commercial |
$515.53
|
|
|
Platelet Circulating IgA Antibody
|
Professional
|
Both
|
$696.00
|
|
|
Service Code
|
CPT 86022
|
| Hospital Charge Code |
2942969
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$64.85 |
| Max. Negotiated Rate |
$661.20 |
| Rate for Payer: Aetna Commercial |
$661.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$598.56
|
| Rate for Payer: Cash Price |
$208.80
|
| Rate for Payer: Cash Price |
$208.80
|
| Rate for Payer: Cigna Commercial |
$661.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$348.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$417.60
|
| Rate for Payer: Health EOS Commercial |
$633.36
|
| Rate for Payer: HFN Commercial |
$661.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$64.85
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$64.85
|
| Rate for Payer: Multiplan Commercial |
$556.80
|
| Rate for Payer: Preferred Network Access Commercial |
$661.20
|
| Rate for Payer: Quartz Beloit One Network |
$306.24
|
| Rate for Payer: Quartz Commercial |
$396.72
|
| Rate for Payer: The Alliance Commercial |
$348.00
|
| Rate for Payer: WEA Trust Commercial |
$382.80
|
| Rate for Payer: WPS Commercial |
$515.53
|
|
|
Platelet Circulating IgA Antibody
|
Facility
|
IP
|
$696.00
|
|
|
Service Code
|
CPT 86022
|
| Hospital Charge Code |
2942969
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$341.04 |
| Max. Negotiated Rate |
$640.32 |
| Rate for Payer: Aetna Commercial |
$626.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$598.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$368.88
|
| Rate for Payer: Cash Price |
$208.80
|
| Rate for Payer: Cigna Commercial |
$640.32
|
| Rate for Payer: Health EOS Commercial |
$619.44
|
| Rate for Payer: HFN Commercial |
$640.32
|
| Rate for Payer: Multiplan Commercial |
$556.80
|
| Rate for Payer: NAPHCARE Commercial |
$417.60
|
| Rate for Payer: Preferred Network Access Commercial |
$640.32
|
| Rate for Payer: Quartz Beloit One Network |
$341.04
|
| Rate for Payer: Quartz Commercial |
$417.60
|
| Rate for Payer: WEA Trust Commercial |
$382.80
|
| Rate for Payer: WPS Commercial |
$515.53
|
|
