|
Red Cell Folate
|
Professional
|
Both
|
$232.00
|
|
|
Service Code
|
CPT 82747
|
| Hospital Charge Code |
978131
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$62.30 |
| Max. Negotiated Rate |
$220.40 |
| Rate for Payer: Aetna Commercial |
$220.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$199.52
|
| Rate for Payer: Cash Price |
$69.60
|
| Rate for Payer: Cash Price |
$69.60
|
| Rate for Payer: Cigna Commercial |
$220.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$116.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$139.20
|
| Rate for Payer: Health EOS Commercial |
$211.12
|
| Rate for Payer: HFN Commercial |
$220.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$62.30
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$62.30
|
| Rate for Payer: Multiplan Commercial |
$185.60
|
| Rate for Payer: Preferred Network Access Commercial |
$220.40
|
| Rate for Payer: Quartz Beloit One Network |
$102.08
|
| Rate for Payer: Quartz Commercial |
$132.24
|
| Rate for Payer: The Alliance Commercial |
$116.00
|
| Rate for Payer: WEA Trust Commercial |
$127.60
|
| Rate for Payer: WPS Commercial |
$171.84
|
|
|
Red Cell Folate
|
Facility
|
IP
|
$232.00
|
|
|
Service Code
|
CPT 82747
|
| Hospital Charge Code |
978131
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$113.68 |
| Max. Negotiated Rate |
$213.44 |
| Rate for Payer: Aetna Commercial |
$208.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$199.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$122.96
|
| Rate for Payer: Cash Price |
$69.60
|
| Rate for Payer: Cigna Commercial |
$213.44
|
| Rate for Payer: Health EOS Commercial |
$206.48
|
| Rate for Payer: HFN Commercial |
$213.44
|
| Rate for Payer: Multiplan Commercial |
$185.60
|
| Rate for Payer: NAPHCARE Commercial |
$139.20
|
| Rate for Payer: Preferred Network Access Commercial |
$213.44
|
| Rate for Payer: Quartz Beloit One Network |
$113.68
|
| Rate for Payer: Quartz Commercial |
$139.20
|
| Rate for Payer: WEA Trust Commercial |
$127.60
|
| Rate for Payer: WPS Commercial |
$171.84
|
|
|
Red Cell Folate
|
Facility
|
OP
|
$232.00
|
|
|
Service Code
|
CPT 82747
|
| Hospital Charge Code |
978131
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$16.37 |
| Max. Negotiated Rate |
$213.44 |
| Rate for Payer: Aetna Commercial |
$208.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$199.52
|
| Rate for Payer: Aetna Managed Medicare |
$17.65
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$66.19
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$30.89
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$29.30
|
| Rate for Payer: Anthem Medicaid |
$16.37
|
| Rate for Payer: Anthem Medicare Advantage |
$17.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$122.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$17.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$17.65
|
| Rate for Payer: Cash Price |
$69.60
|
| Rate for Payer: Cash Price |
$69.60
|
| Rate for Payer: Cigna Commercial |
$213.44
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$17.65
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$16.37
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$129.83
|
| Rate for Payer: Dean Health Medicaid |
$16.37
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$17.65
|
| Rate for Payer: Health EOS Commercial |
$206.48
|
| Rate for Payer: HFN Commercial |
$213.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$65.66
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$17.65
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$16.37
|
| Rate for Payer: Independent Care Health Plan Medicare |
$17.65
|
| Rate for Payer: Managed Health Services Medicaid |
$17.02
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$17.65
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$17.65
|
| Rate for Payer: Multiplan Commercial |
$185.60
|
| Rate for Payer: NAPHCARE Commercial |
$26.48
|
| Rate for Payer: Preferred Network Access Commercial |
$213.44
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$16.37
|
| Rate for Payer: Quartz Beloit One Network |
$113.68
|
| Rate for Payer: Quartz Commercial |
$150.80
|
| Rate for Payer: Quartz Medicare Advantage |
$17.65
|
| Rate for Payer: The Alliance Commercial |
$70.60
|
| Rate for Payer: United Healthcare Medicaid |
$16.37
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17.65
|
| Rate for Payer: United Healthcare PPO |
$174.00
|
| Rate for Payer: WEA Trust Commercial |
$127.60
|
| Rate for Payer: Wellcare Medicare |
$17.65
|
| Rate for Payer: WMAP Medicaid |
$16.37
|
| Rate for Payer: WPS Commercial |
$171.84
|
|
|
Red Cell Genotyping - Common Panel
|
Professional
|
Both
|
$567.00
|
|
|
Service Code
|
CPT 81403
|
| Hospital Charge Code |
5134613
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$249.48 |
| Max. Negotiated Rate |
$653.76 |
| Rate for Payer: Aetna Commercial |
$538.65
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$487.62
|
| Rate for Payer: Cash Price |
$170.10
|
| Rate for Payer: Cash Price |
$170.10
|
| Rate for Payer: Cigna Commercial |
$538.65
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$283.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$340.20
|
| Rate for Payer: Health EOS Commercial |
$515.97
|
| Rate for Payer: HFN Commercial |
$538.65
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$653.76
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$653.76
|
| Rate for Payer: Multiplan Commercial |
$453.60
|
| Rate for Payer: Preferred Network Access Commercial |
$538.65
|
| Rate for Payer: Quartz Beloit One Network |
$249.48
|
| Rate for Payer: Quartz Commercial |
$323.19
|
| Rate for Payer: The Alliance Commercial |
$283.50
|
| Rate for Payer: WEA Trust Commercial |
$311.85
|
| Rate for Payer: WPS Commercial |
$419.98
|
|
|
Red Cell Genotyping - Common Panel
|
Facility
|
IP
|
$567.00
|
|
|
Service Code
|
CPT 81403
|
| Hospital Charge Code |
5134613
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$277.83 |
| Max. Negotiated Rate |
$521.64 |
| Rate for Payer: Aetna Commercial |
$510.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$487.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$300.51
|
| Rate for Payer: Cash Price |
$170.10
|
| Rate for Payer: Cigna Commercial |
$521.64
|
| Rate for Payer: Health EOS Commercial |
$504.63
|
| Rate for Payer: HFN Commercial |
$521.64
|
| Rate for Payer: Multiplan Commercial |
$453.60
|
| Rate for Payer: NAPHCARE Commercial |
$340.20
|
| Rate for Payer: Preferred Network Access Commercial |
$521.64
|
| Rate for Payer: Quartz Beloit One Network |
$277.83
|
| Rate for Payer: Quartz Commercial |
$340.20
|
| Rate for Payer: WEA Trust Commercial |
$311.85
|
| Rate for Payer: WPS Commercial |
$419.98
|
|
|
Red Cell Genotyping - Common Panel
|
Facility
|
OP
|
$567.00
|
|
|
Service Code
|
CPT 81403
|
| Hospital Charge Code |
5134613
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$185.20 |
| Max. Negotiated Rate |
$740.80 |
| Rate for Payer: Aetna Commercial |
$510.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$487.62
|
| Rate for Payer: Aetna Managed Medicare |
$185.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$694.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$324.10
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$307.43
|
| Rate for Payer: Anthem Medicaid |
$185.20
|
| Rate for Payer: Anthem Medicare Advantage |
$185.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$300.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$185.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$185.20
|
| Rate for Payer: Cash Price |
$170.10
|
| Rate for Payer: Cash Price |
$170.10
|
| Rate for Payer: Cigna Commercial |
$521.64
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$185.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$185.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$317.29
|
| Rate for Payer: Dean Health Medicaid |
$185.20
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$185.20
|
| Rate for Payer: Health EOS Commercial |
$504.63
|
| Rate for Payer: HFN Commercial |
$521.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$688.94
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$185.20
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$185.20
|
| Rate for Payer: Independent Care Health Plan Medicare |
$185.20
|
| Rate for Payer: Managed Health Services Medicaid |
$192.61
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$185.20
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$185.20
|
| Rate for Payer: Multiplan Commercial |
$453.60
|
| Rate for Payer: NAPHCARE Commercial |
$277.80
|
| Rate for Payer: Preferred Network Access Commercial |
$521.64
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$185.20
|
| Rate for Payer: Quartz Beloit One Network |
$277.83
|
| Rate for Payer: Quartz Commercial |
$368.55
|
| Rate for Payer: Quartz Medicare Advantage |
$185.20
|
| Rate for Payer: The Alliance Commercial |
$740.80
|
| Rate for Payer: United Healthcare Medicaid |
$185.20
|
| Rate for Payer: United Healthcare Medicare Advantage |
$185.20
|
| Rate for Payer: United Healthcare PPO |
$425.25
|
| Rate for Payer: WEA Trust Commercial |
$311.85
|
| Rate for Payer: Wellcare Medicare |
$185.20
|
| Rate for Payer: WMAP Medicaid |
$185.20
|
| Rate for Payer: WPS Commercial |
$419.98
|
|
|
Reducing Substance Stool
|
Facility
|
OP
|
$250.00
|
|
|
Service Code
|
CPT 84376
|
| Hospital Charge Code |
978053
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.50 |
| Max. Negotiated Rate |
$230.00 |
| Rate for Payer: Aetna Commercial |
$225.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$215.00
|
| Rate for Payer: Aetna Managed Medicare |
$5.50
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$20.62
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$9.62
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$9.13
|
| Rate for Payer: Anthem Medicaid |
$5.68
|
| Rate for Payer: Anthem Medicare Advantage |
$5.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$132.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5.50
|
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: Cigna Commercial |
$230.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$5.50
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$5.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$139.90
|
| Rate for Payer: Dean Health Medicaid |
$5.68
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$5.50
|
| Rate for Payer: Health EOS Commercial |
$222.50
|
| Rate for Payer: HFN Commercial |
$230.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$20.46
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$5.50
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$5.68
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5.50
|
| Rate for Payer: Managed Health Services Medicaid |
$5.91
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$5.50
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$5.50
|
| Rate for Payer: Multiplan Commercial |
$200.00
|
| Rate for Payer: NAPHCARE Commercial |
$8.25
|
| Rate for Payer: Preferred Network Access Commercial |
$230.00
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$5.68
|
| Rate for Payer: Quartz Beloit One Network |
$122.50
|
| Rate for Payer: Quartz Commercial |
$162.50
|
| Rate for Payer: Quartz Medicare Advantage |
$5.50
|
| Rate for Payer: The Alliance Commercial |
$22.00
|
| Rate for Payer: United Healthcare Medicaid |
$5.68
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.50
|
| Rate for Payer: United Healthcare PPO |
$187.50
|
| Rate for Payer: WEA Trust Commercial |
$137.50
|
| Rate for Payer: Wellcare Medicare |
$5.50
|
| Rate for Payer: WMAP Medicaid |
$5.68
|
| Rate for Payer: WPS Commercial |
$185.18
|
|
|
Reducing Substance Stool
|
Facility
|
IP
|
$250.00
|
|
|
Service Code
|
CPT 84376
|
| Hospital Charge Code |
978053
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$122.50 |
| Max. Negotiated Rate |
$230.00 |
| Rate for Payer: Aetna Commercial |
$225.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$215.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$132.50
|
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: Cigna Commercial |
$230.00
|
| Rate for Payer: Health EOS Commercial |
$222.50
|
| Rate for Payer: HFN Commercial |
$230.00
|
| Rate for Payer: Multiplan Commercial |
$200.00
|
| Rate for Payer: NAPHCARE Commercial |
$150.00
|
| Rate for Payer: Preferred Network Access Commercial |
$230.00
|
| Rate for Payer: Quartz Beloit One Network |
$122.50
|
| Rate for Payer: Quartz Commercial |
$150.00
|
| Rate for Payer: WEA Trust Commercial |
$137.50
|
| Rate for Payer: WPS Commercial |
$185.18
|
|
|
Reducing Substance Stool
|
Professional
|
Both
|
$250.00
|
|
|
Service Code
|
CPT 84376
|
| Hospital Charge Code |
978053
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$19.42 |
| Max. Negotiated Rate |
$237.50 |
| Rate for Payer: Aetna Commercial |
$237.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$215.00
|
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: Cash Price |
$75.00
|
| Rate for Payer: Cigna Commercial |
$237.50
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$125.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$150.00
|
| Rate for Payer: Health EOS Commercial |
$227.50
|
| Rate for Payer: HFN Commercial |
$237.50
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$19.42
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$19.42
|
| Rate for Payer: Multiplan Commercial |
$200.00
|
| Rate for Payer: Preferred Network Access Commercial |
$237.50
|
| Rate for Payer: Quartz Beloit One Network |
$110.00
|
| Rate for Payer: Quartz Commercial |
$142.50
|
| Rate for Payer: The Alliance Commercial |
$125.00
|
| Rate for Payer: WEA Trust Commercial |
$137.50
|
| Rate for Payer: WPS Commercial |
$185.18
|
|
|
Ref HLA-AB Low Resolution
|
Facility
|
IP
|
$60.00
|
|
| Hospital Charge Code |
980075
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$29.40 |
| Max. Negotiated Rate |
$55.20 |
| Rate for Payer: Aetna Commercial |
$54.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$51.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$31.80
|
| Rate for Payer: Cash Price |
$18.00
|
| Rate for Payer: Cigna Commercial |
$55.20
|
| Rate for Payer: Health EOS Commercial |
$53.40
|
| Rate for Payer: HFN Commercial |
$55.20
|
| Rate for Payer: Multiplan Commercial |
$48.00
|
| Rate for Payer: NAPHCARE Commercial |
$36.00
|
| Rate for Payer: Preferred Network Access Commercial |
$55.20
|
| Rate for Payer: Quartz Beloit One Network |
$29.40
|
| Rate for Payer: Quartz Commercial |
$36.00
|
| Rate for Payer: WEA Trust Commercial |
$33.00
|
| Rate for Payer: WPS Commercial |
$44.44
|
|
|
Ref HLA-AB Low Resolution
|
Facility
|
OP
|
$60.00
|
|
| Hospital Charge Code |
980075
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$16.80 |
| Max. Negotiated Rate |
$240.00 |
| Rate for Payer: Aetna Commercial |
$54.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$51.60
|
| Rate for Payer: Aetna Managed Medicare |
$16.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$39.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$30.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$28.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$31.80
|
| Rate for Payer: Cash Price |
$18.00
|
| Rate for Payer: Cigna Commercial |
$55.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$33.58
|
| Rate for Payer: Health EOS Commercial |
$53.40
|
| Rate for Payer: HFN Commercial |
$55.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$45.00
|
| Rate for Payer: Multiplan Commercial |
$48.00
|
| Rate for Payer: NAPHCARE Commercial |
$36.00
|
| Rate for Payer: Preferred Network Access Commercial |
$55.20
|
| Rate for Payer: Quartz Beloit One Network |
$29.40
|
| Rate for Payer: Quartz Commercial |
$39.00
|
| Rate for Payer: Quartz Medicare Advantage |
$36.00
|
| Rate for Payer: The Alliance Commercial |
$240.00
|
| Rate for Payer: United Healthcare PPO |
$45.00
|
| Rate for Payer: WEA Trust Commercial |
$33.00
|
| Rate for Payer: WPS Commercial |
$44.44
|
|
|
Ref HLA Antibody Class II
|
Facility
|
IP
|
$620.00
|
|
|
Service Code
|
CPT 86021
|
| Hospital Charge Code |
980078
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$303.80 |
| Max. Negotiated Rate |
$570.40 |
| Rate for Payer: Aetna Commercial |
$558.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$533.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$328.60
|
| Rate for Payer: Cash Price |
$186.00
|
| Rate for Payer: Cigna Commercial |
$570.40
|
| Rate for Payer: Health EOS Commercial |
$551.80
|
| Rate for Payer: HFN Commercial |
$570.40
|
| Rate for Payer: Multiplan Commercial |
$496.00
|
| Rate for Payer: NAPHCARE Commercial |
$372.00
|
| Rate for Payer: Preferred Network Access Commercial |
$570.40
|
| Rate for Payer: Quartz Beloit One Network |
$303.80
|
| Rate for Payer: Quartz Commercial |
$372.00
|
| Rate for Payer: WEA Trust Commercial |
$341.00
|
| Rate for Payer: WPS Commercial |
$459.23
|
|
|
Ref HLA Antibody Class II
|
Facility
|
OP
|
$620.00
|
|
|
Service Code
|
CPT 86021
|
| Hospital Charge Code |
980078
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.05 |
| Max. Negotiated Rate |
$570.40 |
| Rate for Payer: Aetna Commercial |
$558.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$533.20
|
| Rate for Payer: Aetna Managed Medicare |
$15.05
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$56.44
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$26.34
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$24.98
|
| Rate for Payer: Anthem Medicaid |
$15.55
|
| Rate for Payer: Anthem Medicare Advantage |
$15.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$328.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$15.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$15.05
|
| Rate for Payer: Cash Price |
$186.00
|
| Rate for Payer: Cash Price |
$186.00
|
| Rate for Payer: Cigna Commercial |
$570.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$15.05
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$15.55
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$346.95
|
| Rate for Payer: Dean Health Medicaid |
$15.55
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$15.05
|
| Rate for Payer: Health EOS Commercial |
$551.80
|
| Rate for Payer: HFN Commercial |
$570.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$55.99
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$15.05
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$15.55
|
| Rate for Payer: Independent Care Health Plan Medicare |
$15.05
|
| Rate for Payer: Managed Health Services Medicaid |
$16.17
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$15.05
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$15.05
|
| Rate for Payer: Multiplan Commercial |
$496.00
|
| Rate for Payer: NAPHCARE Commercial |
$22.58
|
| Rate for Payer: Preferred Network Access Commercial |
$570.40
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$15.55
|
| Rate for Payer: Quartz Beloit One Network |
$303.80
|
| Rate for Payer: Quartz Commercial |
$403.00
|
| Rate for Payer: Quartz Medicare Advantage |
$15.05
|
| Rate for Payer: The Alliance Commercial |
$60.20
|
| Rate for Payer: United Healthcare Medicaid |
$15.55
|
| Rate for Payer: United Healthcare Medicare Advantage |
$15.05
|
| Rate for Payer: United Healthcare PPO |
$465.00
|
| Rate for Payer: WEA Trust Commercial |
$341.00
|
| Rate for Payer: Wellcare Medicare |
$15.05
|
| Rate for Payer: WMAP Medicaid |
$15.55
|
| Rate for Payer: WPS Commercial |
$459.23
|
|
|
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 |
$34.30 |
| Max. Negotiated Rate |
$64.40 |
| Rate for Payer: Aetna Commercial |
$63.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$60.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$37.10
|
| Rate for Payer: Cash Price |
$21.00
|
| Rate for Payer: Cigna Commercial |
$64.40
|
| Rate for Payer: Health EOS Commercial |
$62.30
|
| Rate for Payer: HFN Commercial |
$64.40
|
| Rate for Payer: Multiplan Commercial |
$56.00
|
| Rate for Payer: NAPHCARE Commercial |
$42.00
|
| Rate for Payer: Preferred Network Access Commercial |
$64.40
|
| Rate for Payer: Quartz Beloit One Network |
$34.30
|
| Rate for Payer: Quartz Commercial |
$42.00
|
| Rate for Payer: WEA Trust Commercial |
$38.50
|
| Rate for Payer: WPS Commercial |
$51.85
|
|
|
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 |
$34.30 |
| Max. Negotiated Rate |
$1,421.12 |
| Rate for Payer: Aetna Commercial |
$63.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$60.20
|
| Rate for Payer: Aetna Managed Medicare |
$355.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,332.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$621.74
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$589.76
|
| Rate for Payer: Anthem Medicare Advantage |
$355.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$37.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$355.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$355.28
|
| Rate for Payer: Cash Price |
$21.00
|
| Rate for Payer: Cash Price |
$21.00
|
| Rate for Payer: Cigna Commercial |
$64.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$355.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$39.17
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$355.28
|
| Rate for Payer: Health EOS Commercial |
$62.30
|
| Rate for Payer: HFN Commercial |
$64.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,321.64
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$355.28
|
| Rate for Payer: Independent Care Health Plan Medicare |
$355.28
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$355.28
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$355.28
|
| Rate for Payer: Multiplan Commercial |
$56.00
|
| Rate for Payer: NAPHCARE Commercial |
$532.92
|
| Rate for Payer: Preferred Network Access Commercial |
$64.40
|
| Rate for Payer: Quartz Beloit One Network |
$34.30
|
| Rate for Payer: Quartz Commercial |
$45.50
|
| Rate for Payer: Quartz Medicare Advantage |
$355.28
|
| Rate for Payer: The Alliance Commercial |
$1,421.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$355.28
|
| Rate for Payer: United Healthcare PPO |
$52.50
|
| Rate for Payer: WEA Trust Commercial |
$38.50
|
| Rate for Payer: Wellcare Medicare |
$355.28
|
| Rate for Payer: WPS Commercial |
$51.85
|
|
|
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 |
$303.80 |
| Max. Negotiated Rate |
$570.40 |
| Rate for Payer: Aetna Commercial |
$558.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$533.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$328.60
|
| Rate for Payer: Cash Price |
$186.00
|
| Rate for Payer: Cigna Commercial |
$570.40
|
| Rate for Payer: Health EOS Commercial |
$551.80
|
| Rate for Payer: HFN Commercial |
$570.40
|
| Rate for Payer: Multiplan Commercial |
$496.00
|
| Rate for Payer: NAPHCARE Commercial |
$372.00
|
| Rate for Payer: Preferred Network Access Commercial |
$570.40
|
| Rate for Payer: Quartz Beloit One Network |
$303.80
|
| Rate for Payer: Quartz Commercial |
$372.00
|
| Rate for Payer: WEA Trust Commercial |
$341.00
|
| Rate for Payer: WPS Commercial |
$459.23
|
|
|
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 |
$15.05 |
| Max. Negotiated Rate |
$570.40 |
| Rate for Payer: Aetna Commercial |
$558.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$533.20
|
| Rate for Payer: Aetna Managed Medicare |
$15.05
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$56.44
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$26.34
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$24.98
|
| Rate for Payer: Anthem Medicaid |
$15.55
|
| Rate for Payer: Anthem Medicare Advantage |
$15.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$328.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$15.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$15.05
|
| Rate for Payer: Cash Price |
$186.00
|
| Rate for Payer: Cash Price |
$186.00
|
| Rate for Payer: Cigna Commercial |
$570.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$15.05
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$15.55
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$346.95
|
| Rate for Payer: Dean Health Medicaid |
$15.55
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$15.05
|
| Rate for Payer: Health EOS Commercial |
$551.80
|
| Rate for Payer: HFN Commercial |
$570.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$55.99
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$15.05
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$15.55
|
| Rate for Payer: Independent Care Health Plan Medicare |
$15.05
|
| Rate for Payer: Managed Health Services Medicaid |
$16.17
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$15.05
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$15.05
|
| Rate for Payer: Multiplan Commercial |
$496.00
|
| Rate for Payer: NAPHCARE Commercial |
$22.58
|
| Rate for Payer: Preferred Network Access Commercial |
$570.40
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$15.55
|
| Rate for Payer: Quartz Beloit One Network |
$303.80
|
| Rate for Payer: Quartz Commercial |
$403.00
|
| Rate for Payer: Quartz Medicare Advantage |
$15.05
|
| Rate for Payer: The Alliance Commercial |
$60.20
|
| Rate for Payer: United Healthcare Medicaid |
$15.55
|
| Rate for Payer: United Healthcare Medicare Advantage |
$15.05
|
| Rate for Payer: United Healthcare PPO |
$465.00
|
| Rate for Payer: WEA Trust Commercial |
$341.00
|
| Rate for Payer: Wellcare Medicare |
$15.05
|
| Rate for Payer: WMAP Medicaid |
$15.55
|
| Rate for Payer: WPS Commercial |
$459.23
|
|
|
Ref Platelet Antibody Screen
|
Facility
|
OP
|
$235.00
|
|
|
Service Code
|
CPT 86022
|
| Hospital Charge Code |
980079
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.37 |
| Max. Negotiated Rate |
$216.20 |
| Rate for Payer: Aetna Commercial |
$211.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$202.10
|
| 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 |
$124.55
|
| 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 |
$70.50
|
| Rate for Payer: Cash Price |
$70.50
|
| Rate for Payer: Cigna Commercial |
$216.20
|
| 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 |
$131.51
|
| 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 |
$209.15
|
| Rate for Payer: HFN Commercial |
$216.20
|
| 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 |
$188.00
|
| Rate for Payer: NAPHCARE Commercial |
$27.56
|
| Rate for Payer: Preferred Network Access Commercial |
$216.20
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$18.98
|
| Rate for Payer: Quartz Beloit One Network |
$115.15
|
| Rate for Payer: Quartz Commercial |
$152.75
|
| 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 |
$176.25
|
| Rate for Payer: WEA Trust Commercial |
$129.25
|
| Rate for Payer: Wellcare Medicare |
$18.37
|
| Rate for Payer: WMAP Medicaid |
$18.98
|
| Rate for Payer: WPS Commercial |
$174.06
|
|
|
Ref Platelet Antibody Screen
|
Facility
|
IP
|
$235.00
|
|
|
Service Code
|
CPT 86022
|
| Hospital Charge Code |
980079
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$115.15 |
| Max. Negotiated Rate |
$216.20 |
| Rate for Payer: Aetna Commercial |
$211.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$202.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$124.55
|
| Rate for Payer: Cash Price |
$70.50
|
| Rate for Payer: Cigna Commercial |
$216.20
|
| Rate for Payer: Health EOS Commercial |
$209.15
|
| Rate for Payer: HFN Commercial |
$216.20
|
| Rate for Payer: Multiplan Commercial |
$188.00
|
| Rate for Payer: NAPHCARE Commercial |
$141.00
|
| Rate for Payer: Preferred Network Access Commercial |
$216.20
|
| Rate for Payer: Quartz Beloit One Network |
$115.15
|
| Rate for Payer: Quartz Commercial |
$141.00
|
| Rate for Payer: WEA Trust Commercial |
$129.25
|
| Rate for Payer: WPS Commercial |
$174.06
|
|
|
Ref Platelet Autoantibodies
|
Facility
|
OP
|
$235.00
|
|
|
Service Code
|
CPT 86022
|
| Hospital Charge Code |
980080
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.37 |
| Max. Negotiated Rate |
$216.20 |
| Rate for Payer: Aetna Commercial |
$211.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$202.10
|
| 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 |
$124.55
|
| 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 |
$70.50
|
| Rate for Payer: Cash Price |
$70.50
|
| Rate for Payer: Cigna Commercial |
$216.20
|
| 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 |
$131.51
|
| 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 |
$209.15
|
| Rate for Payer: HFN Commercial |
$216.20
|
| 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 |
$188.00
|
| Rate for Payer: NAPHCARE Commercial |
$27.56
|
| Rate for Payer: Preferred Network Access Commercial |
$216.20
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$18.98
|
| Rate for Payer: Quartz Beloit One Network |
$115.15
|
| Rate for Payer: Quartz Commercial |
$152.75
|
| 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 |
$176.25
|
| Rate for Payer: WEA Trust Commercial |
$129.25
|
| Rate for Payer: Wellcare Medicare |
$18.37
|
| Rate for Payer: WMAP Medicaid |
$18.98
|
| Rate for Payer: WPS Commercial |
$174.06
|
|
|
Ref Platelet Autoantibodies
|
Facility
|
IP
|
$235.00
|
|
|
Service Code
|
CPT 86022
|
| Hospital Charge Code |
980080
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$115.15 |
| Max. Negotiated Rate |
$216.20 |
| Rate for Payer: Aetna Commercial |
$211.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$202.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$124.55
|
| Rate for Payer: Cash Price |
$70.50
|
| Rate for Payer: Cigna Commercial |
$216.20
|
| Rate for Payer: Health EOS Commercial |
$209.15
|
| Rate for Payer: HFN Commercial |
$216.20
|
| Rate for Payer: Multiplan Commercial |
$188.00
|
| Rate for Payer: NAPHCARE Commercial |
$141.00
|
| Rate for Payer: Preferred Network Access Commercial |
$216.20
|
| Rate for Payer: Quartz Beloit One Network |
$115.15
|
| Rate for Payer: Quartz Commercial |
$141.00
|
| Rate for Payer: WEA Trust Commercial |
$129.25
|
| Rate for Payer: WPS Commercial |
$174.06
|
|
|
REG TULIS CL.HEEL CUP 7873-01
|
Facility
|
OP
|
$233.00
|
|
| Hospital Charge Code |
2970723
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$65.24 |
| Max. Negotiated Rate |
$932.00 |
| Rate for Payer: Aetna Commercial |
$209.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$200.38
|
| Rate for Payer: Aetna Managed Medicare |
$65.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$151.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$116.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$111.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$123.49
|
| Rate for Payer: Cash Price |
$69.90
|
| Rate for Payer: Cigna Commercial |
$214.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$130.39
|
| Rate for Payer: Health EOS Commercial |
$207.37
|
| Rate for Payer: HFN Commercial |
$214.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$174.75
|
| Rate for Payer: Multiplan Commercial |
$186.40
|
| Rate for Payer: NAPHCARE Commercial |
$139.80
|
| Rate for Payer: Preferred Network Access Commercial |
$214.36
|
| Rate for Payer: Quartz Beloit One Network |
$114.17
|
| Rate for Payer: Quartz Commercial |
$151.45
|
| Rate for Payer: Quartz Medicare Advantage |
$139.80
|
| Rate for Payer: The Alliance Commercial |
$932.00
|
| Rate for Payer: WEA Trust Commercial |
$128.15
|
| Rate for Payer: WPS Commercial |
$172.58
|
|
|
REG TULIS CL.HEEL CUP 7873-01
|
Facility
|
IP
|
$233.00
|
|
| Hospital Charge Code |
2970723
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$114.17 |
| Max. Negotiated Rate |
$214.36 |
| Rate for Payer: Aetna Commercial |
$209.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$200.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$123.49
|
| Rate for Payer: Cash Price |
$69.90
|
| Rate for Payer: Cigna Commercial |
$214.36
|
| Rate for Payer: Health EOS Commercial |
$207.37
|
| Rate for Payer: HFN Commercial |
$214.36
|
| Rate for Payer: Multiplan Commercial |
$186.40
|
| Rate for Payer: NAPHCARE Commercial |
$139.80
|
| Rate for Payer: Preferred Network Access Commercial |
$214.36
|
| Rate for Payer: Quartz Beloit One Network |
$114.17
|
| Rate for Payer: Quartz Commercial |
$139.80
|
| Rate for Payer: WEA Trust Commercial |
$128.15
|
| Rate for Payer: WPS Commercial |
$172.58
|
|
|
REHABILITATION WITH CC/MCC
|
Facility
|
IP
|
$40,452.00
|
|
|
Service Code
|
MSDRG 945
|
| Min. Negotiated Rate |
$14,551.05 |
| Max. Negotiated Rate |
$40,452.00 |
| Rate for Payer: Aetna Managed Medicare |
$14,551.05
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$31,679.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$24,282.31
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$23,069.78
|
| Rate for Payer: Anthem Medicare Advantage |
$14,551.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$14,551.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$14,551.05
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$14,551.05
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$25,609.57
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$14,551.05
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$29,435.25
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$14,551.05
|
| Rate for Payer: Independent Care Health Plan Medicare |
$14,551.05
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$14,551.05
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$14,551.05
|
| Rate for Payer: NAPHCARE Commercial |
$21,826.58
|
| Rate for Payer: Quartz Medicare Advantage |
$14,551.05
|
| Rate for Payer: The Alliance Commercial |
$40,452.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14,551.05
|
| Rate for Payer: United Healthcare PPO |
$22,915.72
|
| Rate for Payer: Wellcare Medicare |
$14,551.05
|
|
|
REHABILITATION WITHOUT CC/MCC
|
Facility
|
IP
|
$27,244.00
|
|
|
Service Code
|
MSDRG 946
|
| Min. Negotiated Rate |
$9,800.01 |
| Max. Negotiated Rate |
$27,244.00 |
| Rate for Payer: Aetna Managed Medicare |
$9,800.01
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$21,189.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$16,241.81
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$15,430.78
|
| Rate for Payer: Anthem Medicare Advantage |
$9,800.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$9,800.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$9,800.01
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$9,800.01
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$17,129.58
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$9,800.01
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$19,747.65
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$9,800.01
|
| Rate for Payer: Independent Care Health Plan Medicare |
$9,800.01
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$9,800.01
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$9,800.01
|
| Rate for Payer: NAPHCARE Commercial |
$14,700.02
|
| Rate for Payer: Quartz Medicare Advantage |
$9,800.01
|
| Rate for Payer: The Alliance Commercial |
$27,244.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$9,800.01
|
| Rate for Payer: United Healthcare PPO |
$15,373.80
|
| Rate for Payer: Wellcare Medicare |
$9,800.01
|
|
