|
RED BLOOD CELL DISORDERS WITH MCC
|
Facility
|
IP
|
$39,142.48
|
|
|
Service Code
|
MSDRG 811
|
| Min. Negotiated Rate |
$11,261.19 |
| Max. Negotiated Rate |
$39,142.48 |
| Rate for Payer: Aetna Managed Medicare |
$11,261.19
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$30,640.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$23,485.85
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$22,313.09
|
| Rate for Payer: Anthem Medicare Advantage |
$11,261.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$11,261.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$11,261.19
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$11,261.19
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$24,769.58
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$11,261.19
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$28,465.01
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$11,261.19
|
| Rate for Payer: Independent Care Health Plan Medicare |
$11,261.19
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$11,261.19
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$11,261.19
|
| Rate for Payer: NAPHCARE Commercial |
$16,891.79
|
| Rate for Payer: Quartz Medicare Advantage |
$11,261.19
|
| Rate for Payer: The Alliance Commercial |
$39,142.48
|
| Rate for Payer: United Healthcare Medicare Advantage |
$11,261.19
|
| Rate for Payer: United Healthcare PPO |
$22,160.37
|
| Rate for Payer: Wellcare Medicare |
$11,261.19
|
|
|
RED BLOOD CELL DISORDERS WITHOUT MCC
|
Facility
|
IP
|
$25,236.64
|
|
|
Service Code
|
MSDRG 812
|
| Min. Negotiated Rate |
$7,538.53 |
| Max. Negotiated Rate |
$25,236.64 |
| Rate for Payer: Aetna Managed Medicare |
$7,538.53
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$20,034.39
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$15,356.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$14,589.39
|
| Rate for Payer: Anthem Medicare Advantage |
$7,538.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$7,538.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$7,538.53
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$7,538.53
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$16,195.56
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$7,538.53
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$18,266.20
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$7,538.53
|
| Rate for Payer: Independent Care Health Plan Medicare |
$7,538.53
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$7,538.53
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$7,538.53
|
| Rate for Payer: NAPHCARE Commercial |
$11,307.80
|
| Rate for Payer: Quartz Medicare Advantage |
$7,538.53
|
| Rate for Payer: The Alliance Commercial |
$25,236.64
|
| Rate for Payer: United Healthcare Medicare Advantage |
$7,538.53
|
| Rate for Payer: United Healthcare PPO |
$14,220.47
|
| Rate for Payer: Wellcare Medicare |
$7,538.53
|
|
|
Red Blood Cell Membrane Evaluation
|
Professional
|
Both
|
$1,671.00
|
|
|
Service Code
|
CPT 88184
|
| Hospital Charge Code |
4606700
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$80.41 |
| Max. Negotiated Rate |
$1,650.95 |
| Rate for Payer: Aetna Commercial |
$1,650.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,494.54
|
| Rate for Payer: Aetna Managed Medicare |
$80.41
|
| Rate for Payer: Anthem Medicare Advantage |
$80.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$80.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$80.41
|
| Rate for Payer: Cash Price |
$501.30
|
| Rate for Payer: Cash Price |
$501.30
|
| Rate for Payer: Cigna Commercial |
$1,650.95
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$868.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$80.41
|
| Rate for Payer: Health EOS Commercial |
$1,581.43
|
| Rate for Payer: HFN Commercial |
$1,650.95
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$239.69
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$239.69
|
| Rate for Payer: Independent Care Health Plan Medicare |
$80.41
|
| Rate for Payer: Multiplan Commercial |
$1,390.27
|
| Rate for Payer: NAPHCARE Commercial |
$120.62
|
| Rate for Payer: Preferred Network Access Commercial |
$1,650.95
|
| Rate for Payer: Quartz Beloit One Network |
$764.65
|
| Rate for Payer: Quartz Commercial |
$990.57
|
| Rate for Payer: Quartz Medicare Advantage |
$80.41
|
| Rate for Payer: The Alliance Commercial |
$317.63
|
| Rate for Payer: United Healthcare Medicare Advantage |
$80.41
|
| Rate for Payer: WEA Trust Commercial |
$955.81
|
| Rate for Payer: WPS Commercial |
$353.82
|
|
|
Red Blood Cell Membrane Evaluation
|
Facility
|
OP
|
$1,671.00
|
|
|
Service Code
|
CPT 88184
|
| Hospital Charge Code |
4606700
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$377.23 |
| Max. Negotiated Rate |
$1,598.81 |
| Rate for Payer: Aetna Commercial |
$1,564.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,494.54
|
| Rate for Payer: Aetna Managed Medicare |
$377.23
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,385.59
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$646.61
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$613.36
|
| Rate for Payer: Anthem Medicare Advantage |
$377.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$921.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$377.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$377.23
|
| Rate for Payer: Cash Price |
$501.30
|
| Rate for Payer: Cash Price |
$501.30
|
| Rate for Payer: Cigna Commercial |
$1,598.81
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$377.23
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$972.52
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$377.23
|
| Rate for Payer: Health EOS Commercial |
$1,546.68
|
| Rate for Payer: HFN Commercial |
$1,598.81
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,403.29
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$377.23
|
| Rate for Payer: Independent Care Health Plan Medicare |
$377.23
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$377.23
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$377.23
|
| Rate for Payer: Multiplan Commercial |
$1,390.27
|
| Rate for Payer: NAPHCARE Commercial |
$565.84
|
| Rate for Payer: Preferred Network Access Commercial |
$1,598.81
|
| Rate for Payer: Quartz Beloit One Network |
$851.54
|
| Rate for Payer: Quartz Commercial |
$1,129.60
|
| Rate for Payer: Quartz Medicare Advantage |
$377.23
|
| Rate for Payer: The Alliance Commercial |
$1,508.92
|
| Rate for Payer: United Healthcare Medicare Advantage |
$377.23
|
| Rate for Payer: United Healthcare PPO |
$1,303.38
|
| Rate for Payer: WEA Trust Commercial |
$955.81
|
| Rate for Payer: Wellcare Medicare |
$377.23
|
| Rate for Payer: WPS Commercial |
$1,287.17
|
|
|
Red Blood Cell Membrane Evaluation
|
Facility
|
IP
|
$1,671.00
|
|
|
Service Code
|
CPT 88184
|
| Hospital Charge Code |
4606700
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$851.54 |
| Max. Negotiated Rate |
$1,598.81 |
| Rate for Payer: Aetna Commercial |
$1,564.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,494.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$921.06
|
| Rate for Payer: Cash Price |
$501.30
|
| Rate for Payer: Cigna Commercial |
$1,598.81
|
| Rate for Payer: Health EOS Commercial |
$1,546.68
|
| Rate for Payer: HFN Commercial |
$1,598.81
|
| Rate for Payer: Multiplan Commercial |
$1,390.27
|
| Rate for Payer: Preferred Network Access Commercial |
$1,598.81
|
| Rate for Payer: Quartz Beloit One Network |
$851.54
|
| Rate for Payer: Quartz Commercial |
$1,042.70
|
| Rate for Payer: WEA Trust Commercial |
$955.81
|
| Rate for Payer: WPS Commercial |
$1,287.17
|
|
|
Red Cell Count, Fluid
|
Facility
|
OP
|
$90.00
|
|
|
Service Code
|
CPT 89050
|
| Hospital Charge Code |
979868
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.91 |
| Max. Negotiated Rate |
$86.11 |
| Rate for Payer: Aetna Commercial |
$84.24
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$80.50
|
| Rate for Payer: Aetna Managed Medicare |
$4.91
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$18.41
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8.59
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$8.15
|
| Rate for Payer: Anthem Medicare Advantage |
$4.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$49.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$4.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$4.91
|
| Rate for Payer: Cash Price |
$27.00
|
| Rate for Payer: Cash Price |
$27.00
|
| Rate for Payer: Cigna Commercial |
$86.11
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$4.91
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$52.38
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$4.91
|
| Rate for Payer: Health EOS Commercial |
$83.30
|
| Rate for Payer: HFN Commercial |
$86.11
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$18.26
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$4.91
|
| Rate for Payer: Independent Care Health Plan Medicare |
$4.91
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$4.91
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$4.91
|
| Rate for Payer: Multiplan Commercial |
$74.88
|
| Rate for Payer: NAPHCARE Commercial |
$7.36
|
| Rate for Payer: Preferred Network Access Commercial |
$86.11
|
| Rate for Payer: Quartz Beloit One Network |
$45.86
|
| Rate for Payer: Quartz Commercial |
$60.84
|
| Rate for Payer: Quartz Medicare Advantage |
$4.91
|
| Rate for Payer: The Alliance Commercial |
$19.64
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4.91
|
| Rate for Payer: United Healthcare PPO |
$70.20
|
| Rate for Payer: WEA Trust Commercial |
$51.48
|
| Rate for Payer: Wellcare Medicare |
$4.91
|
| Rate for Payer: WPS Commercial |
$69.33
|
|
|
Red Cell Count, Fluid
|
Facility
|
IP
|
$90.00
|
|
|
Service Code
|
CPT 89050
|
| Hospital Charge Code |
979868
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$45.86 |
| Max. Negotiated Rate |
$86.11 |
| Rate for Payer: Aetna Commercial |
$84.24
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$80.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$49.61
|
| Rate for Payer: Cash Price |
$27.00
|
| Rate for Payer: Cigna Commercial |
$86.11
|
| Rate for Payer: Health EOS Commercial |
$83.30
|
| Rate for Payer: HFN Commercial |
$86.11
|
| Rate for Payer: Multiplan Commercial |
$74.88
|
| Rate for Payer: Preferred Network Access Commercial |
$86.11
|
| Rate for Payer: Quartz Beloit One Network |
$45.86
|
| Rate for Payer: Quartz Commercial |
$56.16
|
| Rate for Payer: WEA Trust Commercial |
$51.48
|
| Rate for Payer: WPS Commercial |
$69.33
|
|
|
Red Cell Count, Fluid
|
Professional
|
Both
|
$90.00
|
|
|
Service Code
|
CPT 89050
|
| Hospital Charge Code |
979868
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.91 |
| Max. Negotiated Rate |
$88.92 |
| Rate for Payer: Aetna Commercial |
$88.92
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$80.50
|
| Rate for Payer: Aetna Managed Medicare |
$4.91
|
| Rate for Payer: Anthem Medicare Advantage |
$4.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$4.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$4.91
|
| Rate for Payer: Cash Price |
$27.00
|
| Rate for Payer: Cash Price |
$27.00
|
| Rate for Payer: Cigna Commercial |
$88.92
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$46.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4.91
|
| Rate for Payer: Health EOS Commercial |
$85.18
|
| Rate for Payer: HFN Commercial |
$88.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$17.33
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$17.33
|
| Rate for Payer: Independent Care Health Plan Medicare |
$4.91
|
| Rate for Payer: Multiplan Commercial |
$74.88
|
| Rate for Payer: NAPHCARE Commercial |
$7.36
|
| Rate for Payer: Preferred Network Access Commercial |
$88.92
|
| Rate for Payer: Quartz Beloit One Network |
$41.18
|
| Rate for Payer: Quartz Commercial |
$53.35
|
| Rate for Payer: Quartz Medicare Advantage |
$4.91
|
| Rate for Payer: The Alliance Commercial |
$19.39
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4.91
|
| Rate for Payer: WEA Trust Commercial |
$51.48
|
| Rate for Payer: WPS Commercial |
$21.60
|
|
|
Red Cell Folate
|
Professional
|
Both
|
$232.00
|
|
|
Service Code
|
CPT 82747
|
| Hospital Charge Code |
978131
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.36 |
| Max. Negotiated Rate |
$229.22 |
| Rate for Payer: Aetna Commercial |
$229.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$207.50
|
| Rate for Payer: Aetna Managed Medicare |
$18.36
|
| Rate for Payer: Anthem Medicare Advantage |
$18.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$18.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$18.36
|
| Rate for Payer: Cash Price |
$69.60
|
| Rate for Payer: Cash Price |
$69.60
|
| Rate for Payer: Cigna Commercial |
$229.22
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$120.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$18.36
|
| Rate for Payer: Health EOS Commercial |
$219.56
|
| Rate for Payer: HFN Commercial |
$229.22
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$64.79
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$64.79
|
| Rate for Payer: Independent Care Health Plan Medicare |
$18.36
|
| Rate for Payer: Multiplan Commercial |
$193.02
|
| Rate for Payer: NAPHCARE Commercial |
$27.53
|
| Rate for Payer: Preferred Network Access Commercial |
$229.22
|
| Rate for Payer: Quartz Beloit One Network |
$106.16
|
| Rate for Payer: Quartz Commercial |
$137.53
|
| Rate for Payer: Quartz Medicare Advantage |
$18.36
|
| Rate for Payer: The Alliance Commercial |
$72.51
|
| Rate for Payer: United Healthcare Medicare Advantage |
$18.36
|
| Rate for Payer: WEA Trust Commercial |
$132.70
|
| Rate for Payer: WPS Commercial |
$80.77
|
|
|
Red Cell Folate
|
Facility
|
OP
|
$232.00
|
|
|
Service Code
|
CPT 82747
|
| Hospital Charge Code |
978131
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.36 |
| Max. Negotiated Rate |
$221.98 |
| Rate for Payer: Aetna Commercial |
$217.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$207.50
|
| Rate for Payer: Aetna Managed Medicare |
$18.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$68.83
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$32.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$30.47
|
| Rate for Payer: Anthem Medicare Advantage |
$18.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$127.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$18.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$18.36
|
| Rate for Payer: Cash Price |
$69.60
|
| Rate for Payer: Cash Price |
$69.60
|
| Rate for Payer: Cigna Commercial |
$221.98
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$18.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$135.02
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$18.36
|
| Rate for Payer: Health EOS Commercial |
$214.74
|
| Rate for Payer: HFN Commercial |
$221.98
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$68.28
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$18.36
|
| Rate for Payer: Independent Care Health Plan Medicare |
$18.36
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$18.36
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$18.36
|
| Rate for Payer: Multiplan Commercial |
$193.02
|
| Rate for Payer: NAPHCARE Commercial |
$27.53
|
| Rate for Payer: Preferred Network Access Commercial |
$221.98
|
| Rate for Payer: Quartz Beloit One Network |
$118.23
|
| Rate for Payer: Quartz Commercial |
$156.83
|
| Rate for Payer: Quartz Medicare Advantage |
$18.36
|
| Rate for Payer: The Alliance Commercial |
$73.42
|
| Rate for Payer: United Healthcare Medicare Advantage |
$18.36
|
| Rate for Payer: United Healthcare PPO |
$180.96
|
| Rate for Payer: WEA Trust Commercial |
$132.70
|
| Rate for Payer: Wellcare Medicare |
$18.36
|
| Rate for Payer: WPS Commercial |
$178.71
|
|
|
Red Cell Folate
|
Facility
|
IP
|
$232.00
|
|
|
Service Code
|
CPT 82747
|
| Hospital Charge Code |
978131
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$118.23 |
| Max. Negotiated Rate |
$221.98 |
| Rate for Payer: Aetna Commercial |
$217.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$207.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$127.88
|
| Rate for Payer: Cash Price |
$69.60
|
| Rate for Payer: Cigna Commercial |
$221.98
|
| Rate for Payer: Health EOS Commercial |
$214.74
|
| Rate for Payer: HFN Commercial |
$221.98
|
| Rate for Payer: Multiplan Commercial |
$193.02
|
| Rate for Payer: Preferred Network Access Commercial |
$221.98
|
| Rate for Payer: Quartz Beloit One Network |
$118.23
|
| Rate for Payer: Quartz Commercial |
$144.77
|
| Rate for Payer: WEA Trust Commercial |
$132.70
|
| Rate for Payer: WPS Commercial |
$178.71
|
|
|
Red Cell Genotyping - Common Panel
|
Facility
|
IP
|
$567.00
|
|
|
Service Code
|
CPT 81403
|
| Hospital Charge Code |
5134613
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$288.94 |
| Max. Negotiated Rate |
$542.51 |
| Rate for Payer: Aetna Commercial |
$530.71
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$507.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$312.53
|
| Rate for Payer: Cash Price |
$170.10
|
| Rate for Payer: Cigna Commercial |
$542.51
|
| Rate for Payer: Health EOS Commercial |
$524.82
|
| Rate for Payer: HFN Commercial |
$542.51
|
| Rate for Payer: Multiplan Commercial |
$471.74
|
| Rate for Payer: Preferred Network Access Commercial |
$542.51
|
| Rate for Payer: Quartz Beloit One Network |
$288.94
|
| Rate for Payer: Quartz Commercial |
$353.81
|
| Rate for Payer: WEA Trust Commercial |
$324.32
|
| Rate for Payer: WPS Commercial |
$436.76
|
|
|
Red Cell Genotyping - Common Panel
|
Facility
|
OP
|
$567.00
|
|
|
Service Code
|
CPT 81403
|
| Hospital Charge Code |
5134613
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$192.61 |
| Max. Negotiated Rate |
$770.43 |
| Rate for Payer: Aetna Commercial |
$530.71
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$507.12
|
| Rate for Payer: Aetna Managed Medicare |
$192.61
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$722.28
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$337.06
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$319.73
|
| Rate for Payer: Anthem Medicare Advantage |
$192.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$312.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$192.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$192.61
|
| Rate for Payer: Cash Price |
$170.10
|
| Rate for Payer: Cash Price |
$170.10
|
| Rate for Payer: Cigna Commercial |
$542.51
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$192.61
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$329.99
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$192.61
|
| Rate for Payer: Health EOS Commercial |
$524.82
|
| Rate for Payer: HFN Commercial |
$542.51
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$716.50
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$192.61
|
| Rate for Payer: Independent Care Health Plan Medicare |
$192.61
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$192.61
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$192.61
|
| Rate for Payer: Multiplan Commercial |
$471.74
|
| Rate for Payer: NAPHCARE Commercial |
$288.91
|
| Rate for Payer: Preferred Network Access Commercial |
$542.51
|
| Rate for Payer: Quartz Beloit One Network |
$288.94
|
| Rate for Payer: Quartz Commercial |
$383.29
|
| Rate for Payer: Quartz Medicare Advantage |
$192.61
|
| Rate for Payer: The Alliance Commercial |
$770.43
|
| Rate for Payer: United Healthcare Medicare Advantage |
$192.61
|
| Rate for Payer: United Healthcare PPO |
$442.26
|
| Rate for Payer: WEA Trust Commercial |
$324.32
|
| Rate for Payer: Wellcare Medicare |
$192.61
|
| Rate for Payer: WPS Commercial |
$436.76
|
|
|
Red Cell Genotyping - Common Panel
|
Professional
|
Both
|
$567.00
|
|
|
Service Code
|
CPT 81403
|
| Hospital Charge Code |
5134613
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$192.61 |
| Max. Negotiated Rate |
$847.48 |
| Rate for Payer: Aetna Commercial |
$560.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$507.12
|
| Rate for Payer: Aetna Managed Medicare |
$192.61
|
| Rate for Payer: Anthem Medicare Advantage |
$192.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$192.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$192.61
|
| Rate for Payer: Cash Price |
$170.10
|
| Rate for Payer: Cash Price |
$170.10
|
| Rate for Payer: Cigna Commercial |
$560.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$294.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$192.61
|
| Rate for Payer: Health EOS Commercial |
$536.61
|
| Rate for Payer: HFN Commercial |
$560.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$679.91
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$679.91
|
| Rate for Payer: Independent Care Health Plan Medicare |
$192.61
|
| Rate for Payer: Multiplan Commercial |
$471.74
|
| Rate for Payer: NAPHCARE Commercial |
$288.91
|
| Rate for Payer: Preferred Network Access Commercial |
$560.20
|
| Rate for Payer: Quartz Beloit One Network |
$259.46
|
| Rate for Payer: Quartz Commercial |
$336.12
|
| Rate for Payer: Quartz Medicare Advantage |
$192.61
|
| Rate for Payer: The Alliance Commercial |
$760.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$192.61
|
| Rate for Payer: WEA Trust Commercial |
$324.32
|
| Rate for Payer: WPS Commercial |
$847.48
|
|
|
Reducing Substance Stool
|
Facility
|
OP
|
$250.00
|
|
|
Service Code
|
CPT 84376
|
| Hospital Charge Code |
978053
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.72 |
| Max. Negotiated Rate |
$239.20 |
| Rate for Payer: Aetna Commercial |
$234.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$223.60
|
| Rate for Payer: Aetna Managed Medicare |
$5.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$21.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$10.01
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$9.50
|
| Rate for Payer: Anthem Medicare Advantage |
$5.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$137.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5.72
|
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: Cigna Commercial |
$239.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$5.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$145.50
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$5.72
|
| Rate for Payer: Health EOS Commercial |
$231.40
|
| Rate for Payer: HFN Commercial |
$239.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$21.28
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$5.72
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5.72
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$5.72
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$5.72
|
| Rate for Payer: Multiplan Commercial |
$208.00
|
| Rate for Payer: NAPHCARE Commercial |
$8.58
|
| Rate for Payer: Preferred Network Access Commercial |
$239.20
|
| Rate for Payer: Quartz Beloit One Network |
$127.40
|
| Rate for Payer: Quartz Commercial |
$169.00
|
| Rate for Payer: Quartz Medicare Advantage |
$5.72
|
| Rate for Payer: The Alliance Commercial |
$22.88
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.72
|
| Rate for Payer: United Healthcare PPO |
$195.00
|
| Rate for Payer: WEA Trust Commercial |
$143.00
|
| Rate for Payer: Wellcare Medicare |
$5.72
|
| Rate for Payer: WPS Commercial |
$192.57
|
|
|
Reducing Substance Stool
|
Professional
|
Both
|
$250.00
|
|
|
Service Code
|
CPT 84376
|
| Hospital Charge Code |
978053
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.72 |
| Max. Negotiated Rate |
$247.00 |
| Rate for Payer: Aetna Commercial |
$247.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$223.60
|
| Rate for Payer: Aetna Managed Medicare |
$5.72
|
| Rate for Payer: Anthem Medicare Advantage |
$5.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5.72
|
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: Cigna Commercial |
$247.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$130.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5.72
|
| Rate for Payer: Health EOS Commercial |
$236.60
|
| Rate for Payer: HFN Commercial |
$247.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$20.20
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$20.20
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5.72
|
| Rate for Payer: Multiplan Commercial |
$208.00
|
| Rate for Payer: NAPHCARE Commercial |
$8.58
|
| Rate for Payer: Preferred Network Access Commercial |
$247.00
|
| Rate for Payer: Quartz Beloit One Network |
$114.40
|
| Rate for Payer: Quartz Commercial |
$148.20
|
| Rate for Payer: Quartz Medicare Advantage |
$5.72
|
| Rate for Payer: The Alliance Commercial |
$22.59
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.72
|
| Rate for Payer: WEA Trust Commercial |
$143.00
|
| Rate for Payer: WPS Commercial |
$25.17
|
|
|
Reducing Substance Stool
|
Facility
|
IP
|
$250.00
|
|
|
Service Code
|
CPT 84376
|
| Hospital Charge Code |
978053
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$127.40 |
| Max. Negotiated Rate |
$239.20 |
| Rate for Payer: Aetna Commercial |
$234.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$223.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$137.80
|
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: Cigna Commercial |
$239.20
|
| Rate for Payer: Health EOS Commercial |
$231.40
|
| Rate for Payer: HFN Commercial |
$239.20
|
| Rate for Payer: Multiplan Commercial |
$208.00
|
| Rate for Payer: Preferred Network Access Commercial |
$239.20
|
| Rate for Payer: Quartz Beloit One Network |
$127.40
|
| Rate for Payer: Quartz Commercial |
$156.00
|
| Rate for Payer: WEA Trust Commercial |
$143.00
|
| Rate for Payer: WPS Commercial |
$192.57
|
|
|
Ref HLA-AB Low Resolution
|
Facility
|
OP
|
$60.00
|
|
| Hospital Charge Code |
980075
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.47 |
| Max. Negotiated Rate |
$57.41 |
| Rate for Payer: Aetna Commercial |
$56.16
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$53.66
|
| Rate for Payer: Aetna Managed Medicare |
$17.47
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$40.56
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$31.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$29.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$33.07
|
| Rate for Payer: Cash Price |
$18.00
|
| Rate for Payer: Cigna Commercial |
$57.41
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$34.92
|
| Rate for Payer: Health EOS Commercial |
$55.54
|
| Rate for Payer: HFN Commercial |
$57.41
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$46.80
|
| Rate for Payer: Multiplan Commercial |
$49.92
|
| Rate for Payer: NAPHCARE Commercial |
$37.44
|
| Rate for Payer: Preferred Network Access Commercial |
$57.41
|
| Rate for Payer: Quartz Beloit One Network |
$30.58
|
| Rate for Payer: Quartz Commercial |
$40.56
|
| Rate for Payer: Quartz Medicare Advantage |
$37.44
|
| Rate for Payer: The Alliance Commercial |
$31.20
|
| Rate for Payer: United Healthcare PPO |
$46.80
|
| Rate for Payer: WEA Trust Commercial |
$34.32
|
| Rate for Payer: WPS Commercial |
$46.22
|
|
|
Ref HLA-AB Low Resolution
|
Facility
|
IP
|
$60.00
|
|
| Hospital Charge Code |
980075
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$30.58 |
| Max. Negotiated Rate |
$57.41 |
| Rate for Payer: Aetna Commercial |
$56.16
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$53.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$33.07
|
| Rate for Payer: Cash Price |
$18.00
|
| Rate for Payer: Cigna Commercial |
$57.41
|
| Rate for Payer: Health EOS Commercial |
$55.54
|
| Rate for Payer: HFN Commercial |
$57.41
|
| Rate for Payer: Multiplan Commercial |
$49.92
|
| Rate for Payer: Preferred Network Access Commercial |
$57.41
|
| Rate for Payer: Quartz Beloit One Network |
$30.58
|
| Rate for Payer: Quartz Commercial |
$37.44
|
| Rate for Payer: WEA Trust Commercial |
$34.32
|
| Rate for Payer: WPS Commercial |
$46.22
|
|
|
Ref HLA Antibody Class II
|
Facility
|
IP
|
$620.00
|
|
|
Service Code
|
CPT 86021
|
| Hospital Charge Code |
980078
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$315.95 |
| Max. Negotiated Rate |
$593.22 |
| Rate for Payer: Aetna Commercial |
$580.32
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$554.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$341.74
|
| Rate for Payer: Cash Price |
$186.00
|
| Rate for Payer: Cigna Commercial |
$593.22
|
| Rate for Payer: Health EOS Commercial |
$573.87
|
| Rate for Payer: HFN Commercial |
$593.22
|
| Rate for Payer: Multiplan Commercial |
$515.84
|
| Rate for Payer: Preferred Network Access Commercial |
$593.22
|
| Rate for Payer: Quartz Beloit One Network |
$315.95
|
| Rate for Payer: Quartz Commercial |
$386.88
|
| Rate for Payer: WEA Trust Commercial |
$354.64
|
| Rate for Payer: WPS Commercial |
$477.59
|
|
|
Ref HLA Antibody Class II
|
Facility
|
OP
|
$620.00
|
|
|
Service Code
|
CPT 86021
|
| Hospital Charge Code |
980078
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.65 |
| Max. Negotiated Rate |
$593.22 |
| Rate for Payer: Aetna Commercial |
$580.32
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$554.53
|
| Rate for Payer: Aetna Managed Medicare |
$15.65
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$58.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$27.39
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$25.98
|
| Rate for Payer: Anthem Medicare Advantage |
$15.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$341.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$15.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$15.65
|
| Rate for Payer: Cash Price |
$186.00
|
| Rate for Payer: Cash Price |
$186.00
|
| Rate for Payer: Cigna Commercial |
$593.22
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$15.65
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$360.84
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$15.65
|
| Rate for Payer: Health EOS Commercial |
$573.87
|
| Rate for Payer: HFN Commercial |
$593.22
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$58.23
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$15.65
|
| Rate for Payer: Independent Care Health Plan Medicare |
$15.65
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$15.65
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$15.65
|
| Rate for Payer: Multiplan Commercial |
$515.84
|
| Rate for Payer: NAPHCARE Commercial |
$23.48
|
| Rate for Payer: Preferred Network Access Commercial |
$593.22
|
| Rate for Payer: Quartz Beloit One Network |
$315.95
|
| Rate for Payer: Quartz Commercial |
$419.12
|
| Rate for Payer: Quartz Medicare Advantage |
$15.65
|
| Rate for Payer: The Alliance Commercial |
$62.61
|
| Rate for Payer: United Healthcare Medicare Advantage |
$15.65
|
| Rate for Payer: United Healthcare PPO |
$483.60
|
| Rate for Payer: WEA Trust Commercial |
$354.64
|
| Rate for Payer: Wellcare Medicare |
$15.65
|
| Rate for Payer: WPS Commercial |
$477.59
|
|
|
Ref HLA Antibody Detect and ID
|
Facility
|
IP
|
$70.00
|
|
|
Service Code
|
CPT 88184
|
| Hospital Charge Code |
980076
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$35.67 |
| Max. Negotiated Rate |
$66.98 |
| Rate for Payer: Aetna Commercial |
$65.52
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$62.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$38.58
|
| Rate for Payer: Cash Price |
$21.00
|
| Rate for Payer: Cigna Commercial |
$66.98
|
| Rate for Payer: Health EOS Commercial |
$64.79
|
| Rate for Payer: HFN Commercial |
$66.98
|
| Rate for Payer: Multiplan Commercial |
$58.24
|
| Rate for Payer: Preferred Network Access Commercial |
$66.98
|
| Rate for Payer: Quartz Beloit One Network |
$35.67
|
| Rate for Payer: Quartz Commercial |
$43.68
|
| Rate for Payer: WEA Trust Commercial |
$40.04
|
| Rate for Payer: WPS Commercial |
$53.92
|
|
|
Ref HLA Antibody Detect and ID
|
Facility
|
OP
|
$70.00
|
|
|
Service Code
|
CPT 88184
|
| Hospital Charge Code |
980076
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$35.67 |
| Max. Negotiated Rate |
$1,508.92 |
| Rate for Payer: Aetna Commercial |
$65.52
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$62.61
|
| Rate for Payer: Aetna Managed Medicare |
$377.23
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,385.59
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$646.61
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$613.36
|
| Rate for Payer: Anthem Medicare Advantage |
$377.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$38.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$377.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$377.23
|
| Rate for Payer: Cash Price |
$21.00
|
| Rate for Payer: Cash Price |
$21.00
|
| Rate for Payer: Cigna Commercial |
$66.98
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$377.23
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$40.74
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$377.23
|
| Rate for Payer: Health EOS Commercial |
$64.79
|
| Rate for Payer: HFN Commercial |
$66.98
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,403.29
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$377.23
|
| Rate for Payer: Independent Care Health Plan Medicare |
$377.23
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$377.23
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$377.23
|
| Rate for Payer: Multiplan Commercial |
$58.24
|
| Rate for Payer: NAPHCARE Commercial |
$565.84
|
| Rate for Payer: Preferred Network Access Commercial |
$66.98
|
| Rate for Payer: Quartz Beloit One Network |
$35.67
|
| Rate for Payer: Quartz Commercial |
$47.32
|
| Rate for Payer: Quartz Medicare Advantage |
$377.23
|
| Rate for Payer: The Alliance Commercial |
$1,508.92
|
| Rate for Payer: United Healthcare Medicare Advantage |
$377.23
|
| Rate for Payer: United Healthcare PPO |
$54.60
|
| Rate for Payer: WEA Trust Commercial |
$40.04
|
| Rate for Payer: Wellcare Medicare |
$377.23
|
| Rate for Payer: WPS Commercial |
$53.92
|
|
|
Ref HLA Antibody ID Class I
|
Facility
|
OP
|
$620.00
|
|
|
Service Code
|
CPT 86021
|
| Hospital Charge Code |
980077
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.65 |
| Max. Negotiated Rate |
$593.22 |
| Rate for Payer: Aetna Commercial |
$580.32
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$554.53
|
| Rate for Payer: Aetna Managed Medicare |
$15.65
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$58.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$27.39
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$25.98
|
| Rate for Payer: Anthem Medicare Advantage |
$15.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$341.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$15.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$15.65
|
| Rate for Payer: Cash Price |
$186.00
|
| Rate for Payer: Cash Price |
$186.00
|
| Rate for Payer: Cigna Commercial |
$593.22
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$15.65
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$360.84
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$15.65
|
| Rate for Payer: Health EOS Commercial |
$573.87
|
| Rate for Payer: HFN Commercial |
$593.22
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$58.23
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$15.65
|
| Rate for Payer: Independent Care Health Plan Medicare |
$15.65
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$15.65
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$15.65
|
| Rate for Payer: Multiplan Commercial |
$515.84
|
| Rate for Payer: NAPHCARE Commercial |
$23.48
|
| Rate for Payer: Preferred Network Access Commercial |
$593.22
|
| Rate for Payer: Quartz Beloit One Network |
$315.95
|
| Rate for Payer: Quartz Commercial |
$419.12
|
| Rate for Payer: Quartz Medicare Advantage |
$15.65
|
| Rate for Payer: The Alliance Commercial |
$62.61
|
| Rate for Payer: United Healthcare Medicare Advantage |
$15.65
|
| Rate for Payer: United Healthcare PPO |
$483.60
|
| Rate for Payer: WEA Trust Commercial |
$354.64
|
| Rate for Payer: Wellcare Medicare |
$15.65
|
| Rate for Payer: WPS Commercial |
$477.59
|
|
|
Ref HLA Antibody ID Class I
|
Facility
|
IP
|
$620.00
|
|
|
Service Code
|
CPT 86021
|
| Hospital Charge Code |
980077
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$315.95 |
| Max. Negotiated Rate |
$593.22 |
| Rate for Payer: Aetna Commercial |
$580.32
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$554.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$341.74
|
| Rate for Payer: Cash Price |
$186.00
|
| Rate for Payer: Cigna Commercial |
$593.22
|
| Rate for Payer: Health EOS Commercial |
$573.87
|
| Rate for Payer: HFN Commercial |
$593.22
|
| Rate for Payer: Multiplan Commercial |
$515.84
|
| Rate for Payer: Preferred Network Access Commercial |
$593.22
|
| Rate for Payer: Quartz Beloit One Network |
$315.95
|
| Rate for Payer: Quartz Commercial |
$386.88
|
| Rate for Payer: WEA Trust Commercial |
$354.64
|
| Rate for Payer: WPS Commercial |
$477.59
|
|
