|
Rheumatoid Factor IgM Antibody
|
Professional
|
Both
|
$252.00
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
2942988
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.96 |
| Max. Negotiated Rate |
$248.98 |
| Rate for Payer: Aetna Commercial |
$248.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$225.39
|
| Rate for Payer: Aetna Managed Medicare |
$17.96
|
| Rate for Payer: Anthem Medicare Advantage |
$17.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$17.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$17.96
|
| Rate for Payer: Cash Price |
$75.60
|
| Rate for Payer: Cash Price |
$75.60
|
| Rate for Payer: Cigna Commercial |
$248.98
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$131.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$17.96
|
| Rate for Payer: Health EOS Commercial |
$238.49
|
| Rate for Payer: HFN Commercial |
$248.98
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$63.40
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$63.40
|
| Rate for Payer: Independent Care Health Plan Medicare |
$17.96
|
| Rate for Payer: Multiplan Commercial |
$209.66
|
| Rate for Payer: NAPHCARE Commercial |
$26.94
|
| Rate for Payer: Preferred Network Access Commercial |
$248.98
|
| Rate for Payer: Quartz Beloit One Network |
$115.32
|
| Rate for Payer: Quartz Commercial |
$149.39
|
| Rate for Payer: Quartz Medicare Advantage |
$17.96
|
| Rate for Payer: The Alliance Commercial |
$70.95
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17.96
|
| Rate for Payer: WEA Trust Commercial |
$144.14
|
| Rate for Payer: WPS Commercial |
$79.03
|
|
|
Rheumatoid Factor Qnt
|
Facility
|
IP
|
$105.00
|
|
|
Service Code
|
CPT 86431
|
| Hospital Charge Code |
5605698
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$53.51 |
| Max. Negotiated Rate |
$100.46 |
| Rate for Payer: Aetna Commercial |
$98.28
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$93.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$57.88
|
| Rate for Payer: Cash Price |
$31.50
|
| Rate for Payer: Cigna Commercial |
$100.46
|
| Rate for Payer: Health EOS Commercial |
$97.19
|
| Rate for Payer: HFN Commercial |
$100.46
|
| Rate for Payer: Multiplan Commercial |
$87.36
|
| Rate for Payer: Preferred Network Access Commercial |
$100.46
|
| Rate for Payer: Quartz Beloit One Network |
$53.51
|
| Rate for Payer: Quartz Commercial |
$65.52
|
| Rate for Payer: WEA Trust Commercial |
$60.06
|
| Rate for Payer: WPS Commercial |
$80.88
|
|
|
Rheumatoid Factor Qnt
|
Facility
|
OP
|
$105.00
|
|
|
Service Code
|
CPT 86431
|
| Hospital Charge Code |
5605698
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.90 |
| Max. Negotiated Rate |
$100.46 |
| Rate for Payer: Aetna Commercial |
$98.28
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$93.91
|
| Rate for Payer: Aetna Managed Medicare |
$5.90
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$22.11
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$10.32
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$9.79
|
| Rate for Payer: Anthem Medicare Advantage |
$5.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$57.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5.90
|
| Rate for Payer: Cash Price |
$31.50
|
| Rate for Payer: Cash Price |
$31.50
|
| Rate for Payer: Cigna Commercial |
$100.46
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$5.90
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$61.11
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$5.90
|
| Rate for Payer: Health EOS Commercial |
$97.19
|
| Rate for Payer: HFN Commercial |
$100.46
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$21.94
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$5.90
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5.90
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$5.90
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$5.90
|
| Rate for Payer: Multiplan Commercial |
$87.36
|
| Rate for Payer: NAPHCARE Commercial |
$8.85
|
| Rate for Payer: Preferred Network Access Commercial |
$100.46
|
| Rate for Payer: Quartz Beloit One Network |
$53.51
|
| Rate for Payer: Quartz Commercial |
$70.98
|
| Rate for Payer: Quartz Medicare Advantage |
$5.90
|
| Rate for Payer: The Alliance Commercial |
$23.59
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.90
|
| Rate for Payer: United Healthcare PPO |
$81.90
|
| Rate for Payer: WEA Trust Commercial |
$60.06
|
| Rate for Payer: Wellcare Medicare |
$5.90
|
| Rate for Payer: WPS Commercial |
$80.88
|
|
|
Rheumatoid Factor Qnt
|
Professional
|
Both
|
$105.00
|
|
|
Service Code
|
CPT 86431
|
| Hospital Charge Code |
5605698
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.90 |
| Max. Negotiated Rate |
$103.74 |
| Rate for Payer: Aetna Commercial |
$103.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$93.91
|
| Rate for Payer: Aetna Managed Medicare |
$5.90
|
| Rate for Payer: Anthem Medicare Advantage |
$5.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5.90
|
| Rate for Payer: Cash Price |
$31.50
|
| Rate for Payer: Cash Price |
$31.50
|
| Rate for Payer: Cigna Commercial |
$103.74
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$54.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5.90
|
| Rate for Payer: Health EOS Commercial |
$99.37
|
| Rate for Payer: HFN Commercial |
$103.74
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$20.82
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$20.82
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5.90
|
| Rate for Payer: Multiplan Commercial |
$87.36
|
| Rate for Payer: NAPHCARE Commercial |
$8.85
|
| Rate for Payer: Preferred Network Access Commercial |
$103.74
|
| Rate for Payer: Quartz Beloit One Network |
$48.05
|
| Rate for Payer: Quartz Commercial |
$62.24
|
| Rate for Payer: Quartz Medicare Advantage |
$5.90
|
| Rate for Payer: The Alliance Commercial |
$23.29
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.90
|
| Rate for Payer: WEA Trust Commercial |
$60.06
|
| Rate for Payer: WPS Commercial |
$25.95
|
|
|
Rheumatoid Factor Quantitative
|
Facility
|
OP
|
$109.00
|
|
|
Service Code
|
CPT 86431
|
| Hospital Charge Code |
978055
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.90 |
| Max. Negotiated Rate |
$104.29 |
| Rate for Payer: Aetna Commercial |
$102.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$97.49
|
| Rate for Payer: Aetna Managed Medicare |
$5.90
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$22.11
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$10.32
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$9.79
|
| Rate for Payer: Anthem Medicare Advantage |
$5.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$60.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5.90
|
| Rate for Payer: Cash Price |
$32.70
|
| Rate for Payer: Cash Price |
$32.70
|
| Rate for Payer: Cigna Commercial |
$104.29
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$5.90
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$63.44
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$5.90
|
| Rate for Payer: Health EOS Commercial |
$100.89
|
| Rate for Payer: HFN Commercial |
$104.29
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$21.94
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$5.90
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5.90
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$5.90
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$5.90
|
| Rate for Payer: Multiplan Commercial |
$90.69
|
| Rate for Payer: NAPHCARE Commercial |
$8.85
|
| Rate for Payer: Preferred Network Access Commercial |
$104.29
|
| Rate for Payer: Quartz Beloit One Network |
$55.55
|
| Rate for Payer: Quartz Commercial |
$73.68
|
| Rate for Payer: Quartz Medicare Advantage |
$5.90
|
| Rate for Payer: The Alliance Commercial |
$23.59
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.90
|
| Rate for Payer: United Healthcare PPO |
$85.02
|
| Rate for Payer: WEA Trust Commercial |
$62.35
|
| Rate for Payer: Wellcare Medicare |
$5.90
|
| Rate for Payer: WPS Commercial |
$83.96
|
|
|
Rheumatoid Factor Quantitative
|
Facility
|
IP
|
$109.00
|
|
|
Service Code
|
CPT 86431
|
| Hospital Charge Code |
978055
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$55.55 |
| Max. Negotiated Rate |
$104.29 |
| Rate for Payer: Aetna Commercial |
$102.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$97.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$60.08
|
| Rate for Payer: Cash Price |
$32.70
|
| Rate for Payer: Cigna Commercial |
$104.29
|
| Rate for Payer: Health EOS Commercial |
$100.89
|
| Rate for Payer: HFN Commercial |
$104.29
|
| Rate for Payer: Multiplan Commercial |
$90.69
|
| Rate for Payer: Preferred Network Access Commercial |
$104.29
|
| Rate for Payer: Quartz Beloit One Network |
$55.55
|
| Rate for Payer: Quartz Commercial |
$68.02
|
| Rate for Payer: WEA Trust Commercial |
$62.35
|
| Rate for Payer: WPS Commercial |
$83.96
|
|
|
Rheumatoid Factor Quantitative
|
Professional
|
Both
|
$109.00
|
|
|
Service Code
|
CPT 86431
|
| Hospital Charge Code |
978055
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.90 |
| Max. Negotiated Rate |
$107.69 |
| Rate for Payer: Aetna Commercial |
$107.69
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$97.49
|
| Rate for Payer: Aetna Managed Medicare |
$5.90
|
| Rate for Payer: Anthem Medicare Advantage |
$5.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5.90
|
| Rate for Payer: Cash Price |
$32.70
|
| Rate for Payer: Cash Price |
$32.70
|
| Rate for Payer: Cigna Commercial |
$107.69
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$56.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5.90
|
| Rate for Payer: Health EOS Commercial |
$103.16
|
| Rate for Payer: HFN Commercial |
$107.69
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$20.82
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$20.82
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5.90
|
| Rate for Payer: Multiplan Commercial |
$90.69
|
| Rate for Payer: NAPHCARE Commercial |
$8.85
|
| Rate for Payer: Preferred Network Access Commercial |
$107.69
|
| Rate for Payer: Quartz Beloit One Network |
$49.88
|
| Rate for Payer: Quartz Commercial |
$64.62
|
| Rate for Payer: Quartz Medicare Advantage |
$5.90
|
| Rate for Payer: The Alliance Commercial |
$23.29
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.90
|
| Rate for Payer: WEA Trust Commercial |
$62.35
|
| Rate for Payer: WPS Commercial |
$25.95
|
|
|
Rheumatoid Factor, Syn Fluid, Screen w/ Rfx Titer
|
Facility
|
OP
|
$134.00
|
|
|
Service Code
|
CPT 86431
|
| Hospital Charge Code |
983389
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.90 |
| Max. Negotiated Rate |
$128.21 |
| Rate for Payer: Aetna Commercial |
$125.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$119.85
|
| Rate for Payer: Aetna Managed Medicare |
$5.90
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$22.11
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$10.32
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$9.79
|
| Rate for Payer: Anthem Medicare Advantage |
$5.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$73.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5.90
|
| Rate for Payer: Cash Price |
$40.20
|
| Rate for Payer: Cash Price |
$40.20
|
| Rate for Payer: Cigna Commercial |
$128.21
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$5.90
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$77.99
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$5.90
|
| Rate for Payer: Health EOS Commercial |
$124.03
|
| Rate for Payer: HFN Commercial |
$128.21
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$21.94
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$5.90
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5.90
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$5.90
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$5.90
|
| Rate for Payer: Multiplan Commercial |
$111.49
|
| Rate for Payer: NAPHCARE Commercial |
$8.85
|
| Rate for Payer: Preferred Network Access Commercial |
$128.21
|
| Rate for Payer: Quartz Beloit One Network |
$68.29
|
| Rate for Payer: Quartz Commercial |
$90.58
|
| Rate for Payer: Quartz Medicare Advantage |
$5.90
|
| Rate for Payer: The Alliance Commercial |
$23.59
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.90
|
| Rate for Payer: United Healthcare PPO |
$104.52
|
| Rate for Payer: WEA Trust Commercial |
$76.65
|
| Rate for Payer: Wellcare Medicare |
$5.90
|
| Rate for Payer: WPS Commercial |
$103.22
|
|
|
Rheumatoid Factor, Syn Fluid, Screen w/ Rfx Titer
|
Professional
|
Both
|
$134.00
|
|
|
Service Code
|
CPT 86431
|
| Hospital Charge Code |
983389
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.90 |
| Max. Negotiated Rate |
$132.39 |
| Rate for Payer: Aetna Commercial |
$132.39
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$119.85
|
| Rate for Payer: Aetna Managed Medicare |
$5.90
|
| Rate for Payer: Anthem Medicare Advantage |
$5.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5.90
|
| Rate for Payer: Cash Price |
$40.20
|
| Rate for Payer: Cash Price |
$40.20
|
| Rate for Payer: Cigna Commercial |
$132.39
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$69.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5.90
|
| Rate for Payer: Health EOS Commercial |
$126.82
|
| Rate for Payer: HFN Commercial |
$132.39
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$20.82
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$20.82
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5.90
|
| Rate for Payer: Multiplan Commercial |
$111.49
|
| Rate for Payer: NAPHCARE Commercial |
$8.85
|
| Rate for Payer: Preferred Network Access Commercial |
$132.39
|
| Rate for Payer: Quartz Beloit One Network |
$61.32
|
| Rate for Payer: Quartz Commercial |
$79.44
|
| Rate for Payer: Quartz Medicare Advantage |
$5.90
|
| Rate for Payer: The Alliance Commercial |
$23.29
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.90
|
| Rate for Payer: WEA Trust Commercial |
$76.65
|
| Rate for Payer: WPS Commercial |
$25.95
|
|
|
Rheumatoid Factor, Syn Fluid, Screen w/ Rfx Titer
|
Facility
|
IP
|
$134.00
|
|
|
Service Code
|
CPT 86431
|
| Hospital Charge Code |
983389
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$68.29 |
| Max. Negotiated Rate |
$128.21 |
| Rate for Payer: Aetna Commercial |
$125.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$119.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$73.86
|
| Rate for Payer: Cash Price |
$40.20
|
| Rate for Payer: Cigna Commercial |
$128.21
|
| Rate for Payer: Health EOS Commercial |
$124.03
|
| Rate for Payer: HFN Commercial |
$128.21
|
| Rate for Payer: Multiplan Commercial |
$111.49
|
| Rate for Payer: Preferred Network Access Commercial |
$128.21
|
| Rate for Payer: Quartz Beloit One Network |
$68.29
|
| Rate for Payer: Quartz Commercial |
$83.62
|
| Rate for Payer: WEA Trust Commercial |
$76.65
|
| Rate for Payer: WPS Commercial |
$103.22
|
|
|
Rheumatoid Factor, Syn Fluid, Titer
|
Facility
|
IP
|
$93.00
|
|
|
Service Code
|
CPT 86430
|
| Hospital Charge Code |
1039098
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$47.39 |
| Max. Negotiated Rate |
$88.98 |
| Rate for Payer: Aetna Commercial |
$87.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$83.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$51.26
|
| Rate for Payer: Cash Price |
$27.90
|
| Rate for Payer: Cigna Commercial |
$88.98
|
| Rate for Payer: Health EOS Commercial |
$86.08
|
| Rate for Payer: HFN Commercial |
$88.98
|
| Rate for Payer: Multiplan Commercial |
$77.38
|
| Rate for Payer: Preferred Network Access Commercial |
$88.98
|
| Rate for Payer: Quartz Beloit One Network |
$47.39
|
| Rate for Payer: Quartz Commercial |
$58.03
|
| Rate for Payer: WEA Trust Commercial |
$53.20
|
| Rate for Payer: WPS Commercial |
$71.64
|
|
|
Rheumatoid Factor, Syn Fluid, Titer
|
Professional
|
Both
|
$93.00
|
|
|
Service Code
|
CPT 86430
|
| Hospital Charge Code |
1039098
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.39 |
| Max. Negotiated Rate |
$91.88 |
| Rate for Payer: Aetna Commercial |
$91.88
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$83.18
|
| Rate for Payer: Aetna Managed Medicare |
$6.39
|
| Rate for Payer: Anthem Medicare Advantage |
$6.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$6.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$6.39
|
| Rate for Payer: Cash Price |
$27.90
|
| Rate for Payer: Cash Price |
$27.90
|
| Rate for Payer: Cigna Commercial |
$91.88
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$48.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6.39
|
| Rate for Payer: Health EOS Commercial |
$88.02
|
| Rate for Payer: HFN Commercial |
$91.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$22.54
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$22.54
|
| Rate for Payer: Independent Care Health Plan Medicare |
$6.39
|
| Rate for Payer: Multiplan Commercial |
$77.38
|
| Rate for Payer: NAPHCARE Commercial |
$9.58
|
| Rate for Payer: Preferred Network Access Commercial |
$91.88
|
| Rate for Payer: Quartz Beloit One Network |
$42.56
|
| Rate for Payer: Quartz Commercial |
$55.13
|
| Rate for Payer: Quartz Medicare Advantage |
$6.39
|
| Rate for Payer: The Alliance Commercial |
$25.22
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6.39
|
| Rate for Payer: WEA Trust Commercial |
$53.20
|
| Rate for Payer: WPS Commercial |
$28.10
|
|
|
Rheumatoid Factor, Syn Fluid, Titer
|
Facility
|
OP
|
$93.00
|
|
|
Service Code
|
CPT 86430
|
| Hospital Charge Code |
1039098
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.39 |
| Max. Negotiated Rate |
$88.98 |
| Rate for Payer: Aetna Commercial |
$87.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$83.18
|
| Rate for Payer: Aetna Managed Medicare |
$6.39
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$23.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$11.17
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$10.60
|
| Rate for Payer: Anthem Medicare Advantage |
$6.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$51.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$6.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$6.39
|
| Rate for Payer: Cash Price |
$27.90
|
| Rate for Payer: Cash Price |
$27.90
|
| Rate for Payer: Cigna Commercial |
$88.98
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$6.39
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$54.13
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$6.39
|
| Rate for Payer: Health EOS Commercial |
$86.08
|
| Rate for Payer: HFN Commercial |
$88.98
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$23.75
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$6.39
|
| Rate for Payer: Independent Care Health Plan Medicare |
$6.39
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$6.39
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$6.39
|
| Rate for Payer: Multiplan Commercial |
$77.38
|
| Rate for Payer: NAPHCARE Commercial |
$9.58
|
| Rate for Payer: Preferred Network Access Commercial |
$88.98
|
| Rate for Payer: Quartz Beloit One Network |
$47.39
|
| Rate for Payer: Quartz Commercial |
$62.87
|
| Rate for Payer: Quartz Medicare Advantage |
$6.39
|
| Rate for Payer: The Alliance Commercial |
$25.54
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6.39
|
| Rate for Payer: United Healthcare PPO |
$72.54
|
| Rate for Payer: WEA Trust Commercial |
$53.20
|
| Rate for Payer: Wellcare Medicare |
$6.39
|
| Rate for Payer: WPS Commercial |
$71.64
|
|
|
RHIG
|
Facility
|
OP
|
$509.00
|
|
|
Service Code
|
HCPCS J2790
|
| Hospital Charge Code |
2952700
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$110.04 |
| Max. Negotiated Rate |
$487.01 |
| Rate for Payer: Aetna Commercial |
$476.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$455.25
|
| Rate for Payer: Aetna Managed Medicare |
$148.22
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$344.08
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$264.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$254.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$280.56
|
| Rate for Payer: Cash Price |
$152.70
|
| Rate for Payer: Cash Price |
$152.70
|
| Rate for Payer: Cigna Commercial |
$487.01
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$110.04
|
| Rate for Payer: Health EOS Commercial |
$471.13
|
| Rate for Payer: HFN Commercial |
$487.01
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$397.02
|
| Rate for Payer: Multiplan Commercial |
$423.49
|
| Rate for Payer: NAPHCARE Commercial |
$317.62
|
| Rate for Payer: Preferred Network Access Commercial |
$487.01
|
| Rate for Payer: Quartz Beloit One Network |
$259.39
|
| Rate for Payer: Quartz Commercial |
$344.08
|
| Rate for Payer: Quartz Medicare Advantage |
$317.62
|
| Rate for Payer: The Alliance Commercial |
$335.00
|
| Rate for Payer: WEA Trust Commercial |
$291.15
|
| Rate for Payer: WPS Commercial |
$207.94
|
|
|
RHIG
|
Facility
|
IP
|
$509.00
|
|
|
Service Code
|
HCPCS J2790
|
| Hospital Charge Code |
2952700
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$259.39 |
| Max. Negotiated Rate |
$487.01 |
| Rate for Payer: Aetna Commercial |
$476.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$455.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$280.56
|
| Rate for Payer: Cash Price |
$152.70
|
| Rate for Payer: Cigna Commercial |
$487.01
|
| Rate for Payer: Health EOS Commercial |
$471.13
|
| Rate for Payer: HFN Commercial |
$487.01
|
| Rate for Payer: Multiplan Commercial |
$423.49
|
| Rate for Payer: Preferred Network Access Commercial |
$487.01
|
| Rate for Payer: Quartz Beloit One Network |
$259.39
|
| Rate for Payer: Quartz Commercial |
$317.62
|
| Rate for Payer: WEA Trust Commercial |
$291.15
|
| Rate for Payer: WPS Commercial |
$392.08
|
|
|
RH IG, Full-Dose, IM 90384
|
Facility
|
OP
|
$375.00
|
|
|
Service Code
|
CPT 90384
|
| Hospital Charge Code |
3549521
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$109.20 |
| Max. Negotiated Rate |
$358.80 |
| Rate for Payer: Aetna Commercial |
$351.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$335.40
|
| Rate for Payer: Aetna Managed Medicare |
$109.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$253.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$195.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$187.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$206.70
|
| Rate for Payer: Cash Price |
$112.50
|
| Rate for Payer: Cigna Commercial |
$358.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$218.25
|
| Rate for Payer: Health EOS Commercial |
$347.10
|
| Rate for Payer: HFN Commercial |
$358.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$292.50
|
| Rate for Payer: Multiplan Commercial |
$312.00
|
| Rate for Payer: NAPHCARE Commercial |
$234.00
|
| Rate for Payer: Preferred Network Access Commercial |
$358.80
|
| Rate for Payer: Quartz Beloit One Network |
$191.10
|
| Rate for Payer: Quartz Commercial |
$253.50
|
| Rate for Payer: Quartz Medicare Advantage |
$234.00
|
| Rate for Payer: The Alliance Commercial |
$195.00
|
| Rate for Payer: WEA Trust Commercial |
$214.50
|
| Rate for Payer: WPS Commercial |
$288.86
|
|
|
RH IG, Full-Dose, IM 90384
|
Professional
|
Both
|
$375.00
|
|
|
Service Code
|
CPT 90384
|
| Hospital Charge Code |
3549521
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$99.84 |
| Max. Negotiated Rate |
$370.50 |
| Rate for Payer: Aetna Commercial |
$370.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$335.40
|
| Rate for Payer: Cash Price |
$112.50
|
| Rate for Payer: Cash Price |
$112.50
|
| Rate for Payer: Cigna Commercial |
$370.50
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$99.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$234.00
|
| Rate for Payer: Health EOS Commercial |
$354.90
|
| Rate for Payer: HFN Commercial |
$370.50
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$210.43
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$210.43
|
| Rate for Payer: Multiplan Commercial |
$312.00
|
| Rate for Payer: Preferred Network Access Commercial |
$370.50
|
| Rate for Payer: Quartz Beloit One Network |
$171.60
|
| Rate for Payer: Quartz Commercial |
$222.30
|
| Rate for Payer: The Alliance Commercial |
$195.00
|
| Rate for Payer: United Healthcare Medicaid |
$99.84
|
| Rate for Payer: WEA Trust Commercial |
$214.50
|
| Rate for Payer: WPS Commercial |
$288.86
|
|
|
RH IG, Full-Dose, IM 90384
|
Facility
|
IP
|
$375.00
|
|
|
Service Code
|
CPT 90384
|
| Hospital Charge Code |
3549521
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$191.10 |
| Max. Negotiated Rate |
$358.80 |
| Rate for Payer: Aetna Commercial |
$351.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$335.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$206.70
|
| Rate for Payer: Cash Price |
$112.50
|
| Rate for Payer: Cigna Commercial |
$358.80
|
| Rate for Payer: Health EOS Commercial |
$347.10
|
| Rate for Payer: HFN Commercial |
$358.80
|
| Rate for Payer: Multiplan Commercial |
$312.00
|
| Rate for Payer: Preferred Network Access Commercial |
$358.80
|
| Rate for Payer: Quartz Beloit One Network |
$191.10
|
| Rate for Payer: Quartz Commercial |
$234.00
|
| Rate for Payer: WEA Trust Commercial |
$214.50
|
| Rate for Payer: WPS Commercial |
$288.86
|
|
|
RHINOPLASTY/SEPTORHINOPLASTY
|
Facility
|
OP
|
$3,935.00
|
|
| Hospital Charge Code |
2960354
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,145.87 |
| Max. Negotiated Rate |
$3,765.01 |
| Rate for Payer: Aetna Commercial |
$3,683.16
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,519.46
|
| Rate for Payer: Aetna Managed Medicare |
$1,145.87
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,660.06
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,046.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,964.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,168.97
|
| Rate for Payer: Cash Price |
$1,180.50
|
| Rate for Payer: Cigna Commercial |
$3,765.01
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,290.17
|
| Rate for Payer: Health EOS Commercial |
$3,642.24
|
| Rate for Payer: HFN Commercial |
$3,765.01
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,069.30
|
| Rate for Payer: Multiplan Commercial |
$3,273.92
|
| Rate for Payer: NAPHCARE Commercial |
$2,455.44
|
| Rate for Payer: Preferred Network Access Commercial |
$3,765.01
|
| Rate for Payer: Quartz Beloit One Network |
$2,005.28
|
| Rate for Payer: Quartz Commercial |
$2,660.06
|
| Rate for Payer: Quartz Medicare Advantage |
$2,455.44
|
| Rate for Payer: The Alliance Commercial |
$2,046.20
|
| Rate for Payer: WEA Trust Commercial |
$2,250.82
|
| Rate for Payer: WPS Commercial |
$3,031.13
|
|
|
RHINOPLASTY/SEPTORHINOPLASTY
|
Facility
|
IP
|
$3,935.00
|
|
| Hospital Charge Code |
2960354
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,005.28 |
| Max. Negotiated Rate |
$3,765.01 |
| Rate for Payer: Aetna Commercial |
$3,683.16
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,519.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,168.97
|
| Rate for Payer: Cash Price |
$1,180.50
|
| Rate for Payer: Cigna Commercial |
$3,765.01
|
| Rate for Payer: Health EOS Commercial |
$3,642.24
|
| Rate for Payer: HFN Commercial |
$3,765.01
|
| Rate for Payer: Multiplan Commercial |
$3,273.92
|
| Rate for Payer: Preferred Network Access Commercial |
$3,765.01
|
| Rate for Payer: Quartz Beloit One Network |
$2,005.28
|
| Rate for Payer: Quartz Commercial |
$2,455.44
|
| Rate for Payer: WEA Trust Commercial |
$2,250.82
|
| Rate for Payer: WPS Commercial |
$3,031.13
|
|
|
Rhogam 300 mcg Charge
|
Facility
|
OP
|
$406.00
|
|
|
Service Code
|
CPT 90384
|
| Hospital Charge Code |
2958965
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$118.23 |
| Max. Negotiated Rate |
$388.46 |
| Rate for Payer: Aetna Commercial |
$380.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$363.13
|
| Rate for Payer: Aetna Managed Medicare |
$118.23
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$274.46
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$211.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$202.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$223.79
|
| Rate for Payer: Cash Price |
$121.80
|
| Rate for Payer: Cigna Commercial |
$388.46
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$236.29
|
| Rate for Payer: Health EOS Commercial |
$375.79
|
| Rate for Payer: HFN Commercial |
$388.46
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$316.68
|
| Rate for Payer: Multiplan Commercial |
$337.79
|
| Rate for Payer: NAPHCARE Commercial |
$253.34
|
| Rate for Payer: Preferred Network Access Commercial |
$388.46
|
| Rate for Payer: Quartz Beloit One Network |
$206.90
|
| Rate for Payer: Quartz Commercial |
$274.46
|
| Rate for Payer: Quartz Medicare Advantage |
$253.34
|
| Rate for Payer: The Alliance Commercial |
$211.12
|
| Rate for Payer: WEA Trust Commercial |
$232.23
|
| Rate for Payer: WPS Commercial |
$312.74
|
|
|
Rhogam 300 mcg Charge
|
Facility
|
IP
|
$406.00
|
|
|
Service Code
|
CPT 90384
|
| Hospital Charge Code |
2958965
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$206.90 |
| Max. Negotiated Rate |
$388.46 |
| Rate for Payer: Aetna Commercial |
$380.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$363.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$223.79
|
| Rate for Payer: Cash Price |
$121.80
|
| Rate for Payer: Cigna Commercial |
$388.46
|
| Rate for Payer: Health EOS Commercial |
$375.79
|
| Rate for Payer: HFN Commercial |
$388.46
|
| Rate for Payer: Multiplan Commercial |
$337.79
|
| Rate for Payer: Preferred Network Access Commercial |
$388.46
|
| Rate for Payer: Quartz Beloit One Network |
$206.90
|
| Rate for Payer: Quartz Commercial |
$253.34
|
| Rate for Payer: WEA Trust Commercial |
$232.23
|
| Rate for Payer: WPS Commercial |
$312.74
|
|
|
Rhogam 300 mcg Charge
|
Professional
|
Both
|
$406.00
|
|
|
Service Code
|
CPT 90384
|
| Hospital Charge Code |
2958965
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$99.84 |
| Max. Negotiated Rate |
$401.13 |
| Rate for Payer: Aetna Commercial |
$401.13
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$363.13
|
| Rate for Payer: Cash Price |
$121.80
|
| Rate for Payer: Cash Price |
$121.80
|
| Rate for Payer: Cigna Commercial |
$401.13
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$99.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$253.34
|
| Rate for Payer: Health EOS Commercial |
$384.24
|
| Rate for Payer: HFN Commercial |
$401.13
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$210.43
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$210.43
|
| Rate for Payer: Multiplan Commercial |
$337.79
|
| Rate for Payer: Preferred Network Access Commercial |
$401.13
|
| Rate for Payer: Quartz Beloit One Network |
$185.79
|
| Rate for Payer: Quartz Commercial |
$240.68
|
| Rate for Payer: The Alliance Commercial |
$211.12
|
| Rate for Payer: United Healthcare Medicaid |
$99.84
|
| Rate for Payer: WEA Trust Commercial |
$232.23
|
| Rate for Payer: WPS Commercial |
$312.74
|
|
|
Rh Typing
|
Facility
|
IP
|
$115.00
|
|
|
Service Code
|
CPT 86901
|
| Hospital Charge Code |
2952721
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$58.60 |
| Max. Negotiated Rate |
$110.03 |
| Rate for Payer: Aetna Commercial |
$107.64
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$102.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$63.39
|
| Rate for Payer: Cash Price |
$34.50
|
| Rate for Payer: Cigna Commercial |
$110.03
|
| Rate for Payer: Health EOS Commercial |
$106.44
|
| Rate for Payer: HFN Commercial |
$110.03
|
| Rate for Payer: Multiplan Commercial |
$95.68
|
| Rate for Payer: Preferred Network Access Commercial |
$110.03
|
| Rate for Payer: Quartz Beloit One Network |
$58.60
|
| Rate for Payer: Quartz Commercial |
$71.76
|
| Rate for Payer: WEA Trust Commercial |
$65.78
|
| Rate for Payer: WPS Commercial |
$88.58
|
|
|
Rh Typing
|
Professional
|
Both
|
$115.00
|
|
|
Service Code
|
CPT 86901
|
| Hospital Charge Code |
2952721
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.11 |
| Max. Negotiated Rate |
$113.62 |
| Rate for Payer: Aetna Commercial |
$113.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$102.86
|
| Rate for Payer: Aetna Managed Medicare |
$3.11
|
| Rate for Payer: Anthem Medicare Advantage |
$3.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$3.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$3.11
|
| Rate for Payer: Cash Price |
$34.50
|
| Rate for Payer: Cash Price |
$34.50
|
| Rate for Payer: Cigna Commercial |
$113.62
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$59.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3.11
|
| Rate for Payer: Health EOS Commercial |
$108.84
|
| Rate for Payer: HFN Commercial |
$113.62
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$10.97
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$10.97
|
| Rate for Payer: Independent Care Health Plan Medicare |
$3.11
|
| Rate for Payer: Multiplan Commercial |
$95.68
|
| Rate for Payer: NAPHCARE Commercial |
$4.66
|
| Rate for Payer: Preferred Network Access Commercial |
$113.62
|
| Rate for Payer: Quartz Beloit One Network |
$52.62
|
| Rate for Payer: Quartz Commercial |
$68.17
|
| Rate for Payer: Quartz Medicare Advantage |
$3.11
|
| Rate for Payer: The Alliance Commercial |
$12.28
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3.11
|
| Rate for Payer: WEA Trust Commercial |
$65.78
|
| Rate for Payer: WPS Commercial |
$13.68
|
|
