|
Streptococcus Group B Antigen
|
Professional
|
Both
|
$88.00
|
|
|
Service Code
|
CPT 86403
|
| Hospital Charge Code |
5096642
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$38.72 |
| Max. Negotiated Rate |
$83.60 |
| Rate for Payer: Aetna Commercial |
$83.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$75.68
|
| Rate for Payer: Cash Price |
$26.40
|
| Rate for Payer: Cash Price |
$26.40
|
| Rate for Payer: Cigna Commercial |
$83.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$44.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$52.80
|
| Rate for Payer: Health EOS Commercial |
$80.08
|
| Rate for Payer: HFN Commercial |
$83.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$40.74
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$40.74
|
| Rate for Payer: Multiplan Commercial |
$70.40
|
| Rate for Payer: Preferred Network Access Commercial |
$83.60
|
| Rate for Payer: Quartz Beloit One Network |
$38.72
|
| Rate for Payer: Quartz Commercial |
$50.16
|
| Rate for Payer: The Alliance Commercial |
$44.00
|
| Rate for Payer: WEA Trust Commercial |
$48.40
|
| Rate for Payer: WPS Commercial |
$65.18
|
|
|
Streptococcus pneumoniae IgG Antibody Panel
|
Professional
|
Both
|
$31.00
|
|
|
Service Code
|
CPT 86317
|
| Hospital Charge Code |
983411
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.64 |
| Max. Negotiated Rate |
$52.91 |
| Rate for Payer: Aetna Commercial |
$29.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$26.66
|
| Rate for Payer: Cash Price |
$9.30
|
| Rate for Payer: Cash Price |
$9.30
|
| Rate for Payer: Cigna Commercial |
$29.45
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$15.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$18.60
|
| Rate for Payer: Health EOS Commercial |
$28.21
|
| Rate for Payer: HFN Commercial |
$29.45
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$52.91
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$52.91
|
| Rate for Payer: Multiplan Commercial |
$24.80
|
| Rate for Payer: Preferred Network Access Commercial |
$29.45
|
| Rate for Payer: Quartz Beloit One Network |
$13.64
|
| Rate for Payer: Quartz Commercial |
$17.67
|
| Rate for Payer: The Alliance Commercial |
$15.50
|
| Rate for Payer: WEA Trust Commercial |
$17.05
|
| Rate for Payer: WPS Commercial |
$22.96
|
|
|
Streptococcus pneumoniae IgG Antibody Panel
|
Facility
|
OP
|
$31.00
|
|
|
Service Code
|
CPT 86317
|
| Hospital Charge Code |
983411
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.99 |
| Max. Negotiated Rate |
$59.96 |
| Rate for Payer: Cigna Commercial |
$28.52
|
| Rate for Payer: Aetna Commercial |
$27.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$26.66
|
| Rate for Payer: Aetna Managed Medicare |
$14.99
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$56.21
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$26.23
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$24.88
|
| Rate for Payer: Anthem Medicaid |
$15.49
|
| Rate for Payer: Anthem Medicare Advantage |
$14.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$16.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$14.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$14.99
|
| Rate for Payer: Cash Price |
$9.30
|
| Rate for Payer: Cash Price |
$9.30
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$14.99
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$15.49
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$17.35
|
| Rate for Payer: Dean Health Medicaid |
$15.49
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$14.99
|
| Rate for Payer: Health EOS Commercial |
$27.59
|
| Rate for Payer: HFN Commercial |
$28.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$55.76
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$14.99
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$15.49
|
| Rate for Payer: Independent Care Health Plan Medicare |
$14.99
|
| Rate for Payer: Managed Health Services Medicaid |
$16.11
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$14.99
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$14.99
|
| Rate for Payer: Multiplan Commercial |
$24.80
|
| Rate for Payer: NAPHCARE Commercial |
$22.48
|
| Rate for Payer: Preferred Network Access Commercial |
$28.52
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$15.49
|
| Rate for Payer: Quartz Beloit One Network |
$15.19
|
| Rate for Payer: Quartz Commercial |
$20.15
|
| Rate for Payer: Quartz Medicare Advantage |
$14.99
|
| Rate for Payer: The Alliance Commercial |
$59.96
|
| Rate for Payer: United Healthcare Medicaid |
$15.49
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14.99
|
| Rate for Payer: United Healthcare PPO |
$23.25
|
| Rate for Payer: WEA Trust Commercial |
$17.05
|
| Rate for Payer: Wellcare Medicare |
$14.99
|
| Rate for Payer: WMAP Medicaid |
$15.49
|
| Rate for Payer: WPS Commercial |
$22.96
|
|
|
Streptococcus pneumoniae IgG Antibody Panel
|
Facility
|
IP
|
$31.00
|
|
|
Service Code
|
CPT 86317
|
| Hospital Charge Code |
983411
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.19 |
| Max. Negotiated Rate |
$28.52 |
| Rate for Payer: Aetna Commercial |
$27.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$26.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$16.43
|
| Rate for Payer: Cash Price |
$9.30
|
| Rate for Payer: Cigna Commercial |
$28.52
|
| Rate for Payer: Health EOS Commercial |
$27.59
|
| Rate for Payer: HFN Commercial |
$28.52
|
| Rate for Payer: Multiplan Commercial |
$24.80
|
| Rate for Payer: NAPHCARE Commercial |
$18.60
|
| Rate for Payer: Preferred Network Access Commercial |
$28.52
|
| Rate for Payer: Quartz Beloit One Network |
$15.19
|
| Rate for Payer: Quartz Commercial |
$18.60
|
| Rate for Payer: WEA Trust Commercial |
$17.05
|
| Rate for Payer: WPS Commercial |
$22.96
|
|
|
Streptomycin Level
|
Facility
|
IP
|
$146.00
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
4926606
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$71.54 |
| Max. Negotiated Rate |
$134.32 |
| Rate for Payer: Aetna Commercial |
$131.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$125.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$77.38
|
| Rate for Payer: Cash Price |
$43.80
|
| Rate for Payer: Cigna Commercial |
$134.32
|
| Rate for Payer: Health EOS Commercial |
$129.94
|
| Rate for Payer: HFN Commercial |
$134.32
|
| Rate for Payer: Multiplan Commercial |
$116.80
|
| Rate for Payer: NAPHCARE Commercial |
$87.60
|
| Rate for Payer: Preferred Network Access Commercial |
$134.32
|
| Rate for Payer: Quartz Beloit One Network |
$71.54
|
| Rate for Payer: Quartz Commercial |
$87.60
|
| Rate for Payer: WEA Trust Commercial |
$80.30
|
| Rate for Payer: WPS Commercial |
$108.14
|
|
|
Streptomycin Level
|
Professional
|
Both
|
$146.00
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
4926606
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$64.24 |
| Max. Negotiated Rate |
$138.70 |
| Rate for Payer: Aetna Commercial |
$138.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$125.56
|
| Rate for Payer: Cash Price |
$43.80
|
| Rate for Payer: Cash Price |
$43.80
|
| Rate for Payer: Cigna Commercial |
$138.70
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$73.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$87.60
|
| Rate for Payer: Health EOS Commercial |
$132.86
|
| Rate for Payer: HFN Commercial |
$138.70
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$65.80
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$65.80
|
| Rate for Payer: Multiplan Commercial |
$116.80
|
| Rate for Payer: Preferred Network Access Commercial |
$138.70
|
| Rate for Payer: Quartz Beloit One Network |
$64.24
|
| Rate for Payer: Quartz Commercial |
$83.22
|
| Rate for Payer: The Alliance Commercial |
$73.00
|
| Rate for Payer: WEA Trust Commercial |
$80.30
|
| Rate for Payer: WPS Commercial |
$108.14
|
|
|
Streptomycin Level
|
Facility
|
OP
|
$146.00
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
4926606
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.64 |
| Max. Negotiated Rate |
$134.32 |
| Rate for Payer: Aetna Commercial |
$131.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$125.56
|
| Rate for Payer: Aetna Managed Medicare |
$18.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$69.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$32.62
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$30.94
|
| Rate for Payer: Anthem Medicaid |
$19.26
|
| Rate for Payer: Anthem Medicare Advantage |
$18.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$77.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$18.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$18.64
|
| Rate for Payer: Cash Price |
$43.80
|
| Rate for Payer: Cash Price |
$43.80
|
| Rate for Payer: Cigna Commercial |
$134.32
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$18.64
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$19.26
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$81.70
|
| Rate for Payer: Dean Health Medicaid |
$19.26
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$18.64
|
| Rate for Payer: Health EOS Commercial |
$129.94
|
| Rate for Payer: HFN Commercial |
$134.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$69.34
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$18.64
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$19.26
|
| Rate for Payer: Independent Care Health Plan Medicare |
$18.64
|
| Rate for Payer: Managed Health Services Medicaid |
$20.03
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$18.64
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$18.64
|
| Rate for Payer: Multiplan Commercial |
$116.80
|
| Rate for Payer: NAPHCARE Commercial |
$27.96
|
| Rate for Payer: Preferred Network Access Commercial |
$134.32
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$19.26
|
| Rate for Payer: Quartz Beloit One Network |
$71.54
|
| Rate for Payer: Quartz Commercial |
$94.90
|
| Rate for Payer: Quartz Medicare Advantage |
$18.64
|
| Rate for Payer: The Alliance Commercial |
$74.56
|
| Rate for Payer: United Healthcare Medicaid |
$19.26
|
| Rate for Payer: United Healthcare Medicare Advantage |
$18.64
|
| Rate for Payer: United Healthcare PPO |
$109.50
|
| Rate for Payer: WEA Trust Commercial |
$80.30
|
| Rate for Payer: Wellcare Medicare |
$18.64
|
| Rate for Payer: WMAP Medicaid |
$19.26
|
| Rate for Payer: WPS Commercial |
$108.14
|
|
|
Streptozyme Screen w/ Reflex Titer
|
Facility
|
OP
|
$70.00
|
|
|
Service Code
|
CPT 86403
|
| Hospital Charge Code |
3788257
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.54 |
| Max. Negotiated Rate |
$64.40 |
| Rate for Payer: Aetna Commercial |
$63.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$60.20
|
| Rate for Payer: Aetna Managed Medicare |
$11.54
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$43.28
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$20.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$19.16
|
| Rate for Payer: Anthem Medicaid |
$11.92
|
| Rate for Payer: Anthem Medicare Advantage |
$11.54
|
| 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 |
$11.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$11.54
|
| 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 |
$11.54
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$11.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$39.17
|
| Rate for Payer: Dean Health Medicaid |
$11.92
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$11.54
|
| Rate for Payer: Health EOS Commercial |
$62.30
|
| Rate for Payer: HFN Commercial |
$64.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$42.93
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$11.54
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$11.92
|
| Rate for Payer: Independent Care Health Plan Medicare |
$11.54
|
| Rate for Payer: Managed Health Services Medicaid |
$12.40
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$11.54
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$11.54
|
| Rate for Payer: Multiplan Commercial |
$56.00
|
| Rate for Payer: NAPHCARE Commercial |
$17.31
|
| Rate for Payer: Preferred Network Access Commercial |
$64.40
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$11.92
|
| Rate for Payer: Quartz Beloit One Network |
$34.30
|
| Rate for Payer: Quartz Commercial |
$45.50
|
| Rate for Payer: Quartz Medicare Advantage |
$11.54
|
| Rate for Payer: The Alliance Commercial |
$46.16
|
| Rate for Payer: United Healthcare Medicaid |
$11.92
|
| Rate for Payer: United Healthcare Medicare Advantage |
$11.54
|
| Rate for Payer: United Healthcare PPO |
$52.50
|
| Rate for Payer: WEA Trust Commercial |
$38.50
|
| Rate for Payer: Wellcare Medicare |
$11.54
|
| Rate for Payer: WMAP Medicaid |
$11.92
|
| Rate for Payer: WPS Commercial |
$51.85
|
|
|
Streptozyme Screen w/ Reflex Titer
|
Facility
|
IP
|
$70.00
|
|
|
Service Code
|
CPT 86403
|
| Hospital Charge Code |
3788257
|
|
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
|
|
|
Streptozyme Screen w/ Reflex Titer
|
Professional
|
Both
|
$70.00
|
|
|
Service Code
|
CPT 86403
|
| Hospital Charge Code |
3788257
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$30.80 |
| Max. Negotiated Rate |
$66.50 |
| Rate for Payer: Aetna Commercial |
$66.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$60.20
|
| Rate for Payer: Cash Price |
$21.00
|
| Rate for Payer: Cash Price |
$21.00
|
| Rate for Payer: Cigna Commercial |
$66.50
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$35.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$42.00
|
| Rate for Payer: Health EOS Commercial |
$63.70
|
| Rate for Payer: HFN Commercial |
$66.50
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$40.74
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$40.74
|
| Rate for Payer: Multiplan Commercial |
$56.00
|
| Rate for Payer: Preferred Network Access Commercial |
$66.50
|
| Rate for Payer: Quartz Beloit One Network |
$30.80
|
| Rate for Payer: Quartz Commercial |
$39.90
|
| Rate for Payer: The Alliance Commercial |
$35.00
|
| Rate for Payer: WEA Trust Commercial |
$38.50
|
| Rate for Payer: WPS Commercial |
$51.85
|
|
|
Streptozyme Titer
|
Facility
|
OP
|
$136.00
|
|
|
Service Code
|
CPT 86406
|
| Hospital Charge Code |
3856689
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.85 |
| Max. Negotiated Rate |
$125.12 |
| Rate for Payer: Aetna Commercial |
$122.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$116.96
|
| Rate for Payer: Aetna Managed Medicare |
$10.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$39.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$18.62
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$17.66
|
| Rate for Payer: Anthem Medicaid |
$9.85
|
| Rate for Payer: Anthem Medicare Advantage |
$10.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$72.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$10.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$10.64
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cigna Commercial |
$125.12
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$10.64
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$9.85
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$76.11
|
| Rate for Payer: Dean Health Medicaid |
$9.85
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$10.64
|
| Rate for Payer: Health EOS Commercial |
$121.04
|
| Rate for Payer: HFN Commercial |
$125.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$39.58
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$10.64
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$9.85
|
| Rate for Payer: Independent Care Health Plan Medicare |
$10.64
|
| Rate for Payer: Managed Health Services Medicaid |
$10.24
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$10.64
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$10.64
|
| Rate for Payer: Multiplan Commercial |
$108.80
|
| Rate for Payer: NAPHCARE Commercial |
$15.96
|
| Rate for Payer: Preferred Network Access Commercial |
$125.12
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$9.85
|
| Rate for Payer: Quartz Beloit One Network |
$66.64
|
| Rate for Payer: Quartz Commercial |
$88.40
|
| Rate for Payer: Quartz Medicare Advantage |
$10.64
|
| Rate for Payer: The Alliance Commercial |
$42.56
|
| Rate for Payer: United Healthcare Medicaid |
$9.85
|
| Rate for Payer: United Healthcare Medicare Advantage |
$10.64
|
| Rate for Payer: United Healthcare PPO |
$102.00
|
| Rate for Payer: WEA Trust Commercial |
$74.80
|
| Rate for Payer: Wellcare Medicare |
$10.64
|
| Rate for Payer: WMAP Medicaid |
$9.85
|
| Rate for Payer: WPS Commercial |
$100.74
|
|
|
Streptozyme Titer
|
Facility
|
IP
|
$136.00
|
|
|
Service Code
|
CPT 86406
|
| Hospital Charge Code |
3856689
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$66.64 |
| Max. Negotiated Rate |
$125.12 |
| Rate for Payer: Aetna Commercial |
$122.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$116.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$72.08
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cigna Commercial |
$125.12
|
| Rate for Payer: Health EOS Commercial |
$121.04
|
| Rate for Payer: HFN Commercial |
$125.12
|
| Rate for Payer: Multiplan Commercial |
$108.80
|
| Rate for Payer: NAPHCARE Commercial |
$81.60
|
| Rate for Payer: Preferred Network Access Commercial |
$125.12
|
| Rate for Payer: Quartz Beloit One Network |
$66.64
|
| Rate for Payer: Quartz Commercial |
$81.60
|
| Rate for Payer: WEA Trust Commercial |
$74.80
|
| Rate for Payer: WPS Commercial |
$100.74
|
|
|
Streptozyme Titer
|
Professional
|
Both
|
$136.00
|
|
|
Service Code
|
CPT 86406
|
| Hospital Charge Code |
3856689
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$37.56 |
| Max. Negotiated Rate |
$129.20 |
| Rate for Payer: Aetna Commercial |
$129.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$116.96
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cigna Commercial |
$129.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$68.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$81.60
|
| Rate for Payer: Health EOS Commercial |
$123.76
|
| Rate for Payer: HFN Commercial |
$129.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$37.56
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$37.56
|
| Rate for Payer: Multiplan Commercial |
$108.80
|
| Rate for Payer: Preferred Network Access Commercial |
$129.20
|
| Rate for Payer: Quartz Beloit One Network |
$59.84
|
| Rate for Payer: Quartz Commercial |
$77.52
|
| Rate for Payer: The Alliance Commercial |
$68.00
|
| Rate for Payer: WEA Trust Commercial |
$74.80
|
| Rate for Payer: WPS Commercial |
$100.74
|
|
|
Stress Test Tracing 93017
|
Facility
|
OP
|
$1,575.00
|
|
|
Service Code
|
CPT 93017
|
| Hospital Charge Code |
5381788
|
|
Hospital Revenue Code
|
482
|
| Min. Negotiated Rate |
$310.24 |
| Max. Negotiated Rate |
$1,449.00 |
| Rate for Payer: Aetna Commercial |
$1,417.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,354.50
|
| Rate for Payer: Aetna Managed Medicare |
$310.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,023.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$787.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$756.00
|
| Rate for Payer: Anthem Medicare Advantage |
$310.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$834.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$310.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$310.24
|
| Rate for Payer: Cash Price |
$472.50
|
| Rate for Payer: Cash Price |
$472.50
|
| Rate for Payer: Cigna Commercial |
$1,449.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$310.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$881.37
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$310.24
|
| Rate for Payer: Health EOS Commercial |
$1,401.75
|
| Rate for Payer: HFN Commercial |
$1,449.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,154.09
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$310.24
|
| Rate for Payer: Independent Care Health Plan Medicare |
$310.24
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$310.24
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$310.24
|
| Rate for Payer: Multiplan Commercial |
$1,260.00
|
| Rate for Payer: NAPHCARE Commercial |
$465.36
|
| Rate for Payer: Preferred Network Access Commercial |
$1,449.00
|
| Rate for Payer: Quartz Beloit One Network |
$771.75
|
| Rate for Payer: Quartz Commercial |
$1,023.75
|
| Rate for Payer: Quartz Medicare Advantage |
$310.24
|
| Rate for Payer: The Alliance Commercial |
$1,240.96
|
| Rate for Payer: United Healthcare Medicare Advantage |
$310.24
|
| Rate for Payer: United Healthcare PPO |
$1,181.25
|
| Rate for Payer: WEA Trust Commercial |
$866.25
|
| Rate for Payer: Wellcare Medicare |
$310.24
|
| Rate for Payer: WPS Commercial |
$1,166.60
|
|
|
Stress Test Tracing 93017
|
Facility
|
IP
|
$1,575.00
|
|
|
Service Code
|
CPT 93017
|
| Hospital Charge Code |
5381788
|
|
Hospital Revenue Code
|
482
|
| Min. Negotiated Rate |
$771.75 |
| Max. Negotiated Rate |
$1,449.00 |
| Rate for Payer: Aetna Commercial |
$1,417.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,354.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$834.75
|
| Rate for Payer: Cash Price |
$472.50
|
| Rate for Payer: Cigna Commercial |
$1,449.00
|
| Rate for Payer: Health EOS Commercial |
$1,401.75
|
| Rate for Payer: HFN Commercial |
$1,449.00
|
| Rate for Payer: Multiplan Commercial |
$1,260.00
|
| Rate for Payer: NAPHCARE Commercial |
$945.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,449.00
|
| Rate for Payer: Quartz Beloit One Network |
$771.75
|
| Rate for Payer: Quartz Commercial |
$945.00
|
| Rate for Payer: WEA Trust Commercial |
$866.25
|
| Rate for Payer: WPS Commercial |
$1,166.60
|
|
|
Stress Test Tracing ONLY
|
Facility
|
IP
|
$1,516.00
|
|
|
Service Code
|
CPT 93017
|
| Hospital Charge Code |
3114226
|
|
Hospital Revenue Code
|
482
|
| Min. Negotiated Rate |
$742.84 |
| Max. Negotiated Rate |
$1,394.72 |
| Rate for Payer: Aetna Commercial |
$1,364.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,303.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$803.48
|
| Rate for Payer: Cash Price |
$454.80
|
| Rate for Payer: Cigna Commercial |
$1,394.72
|
| Rate for Payer: Health EOS Commercial |
$1,349.24
|
| Rate for Payer: HFN Commercial |
$1,394.72
|
| Rate for Payer: Multiplan Commercial |
$1,212.80
|
| Rate for Payer: NAPHCARE Commercial |
$909.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,394.72
|
| Rate for Payer: Quartz Beloit One Network |
$742.84
|
| Rate for Payer: Quartz Commercial |
$909.60
|
| Rate for Payer: WEA Trust Commercial |
$833.80
|
| Rate for Payer: WPS Commercial |
$1,122.90
|
|
|
Stress Test Tracing ONLY
|
Facility
|
OP
|
$1,516.00
|
|
|
Service Code
|
CPT 93017
|
| Hospital Charge Code |
3114226
|
|
Hospital Revenue Code
|
482
|
| Min. Negotiated Rate |
$310.24 |
| Max. Negotiated Rate |
$1,394.72 |
| Rate for Payer: Aetna Commercial |
$1,364.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,303.76
|
| Rate for Payer: Aetna Managed Medicare |
$310.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$985.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$758.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$727.68
|
| Rate for Payer: Anthem Medicare Advantage |
$310.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$803.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$310.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$310.24
|
| Rate for Payer: Cash Price |
$454.80
|
| Rate for Payer: Cash Price |
$454.80
|
| Rate for Payer: Cigna Commercial |
$1,394.72
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$310.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$848.35
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$310.24
|
| Rate for Payer: Health EOS Commercial |
$1,349.24
|
| Rate for Payer: HFN Commercial |
$1,394.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,154.09
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$310.24
|
| Rate for Payer: Independent Care Health Plan Medicare |
$310.24
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$310.24
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$310.24
|
| Rate for Payer: Multiplan Commercial |
$1,212.80
|
| Rate for Payer: NAPHCARE Commercial |
$465.36
|
| Rate for Payer: Preferred Network Access Commercial |
$1,394.72
|
| Rate for Payer: Quartz Beloit One Network |
$742.84
|
| Rate for Payer: Quartz Commercial |
$985.40
|
| Rate for Payer: Quartz Medicare Advantage |
$310.24
|
| Rate for Payer: The Alliance Commercial |
$1,240.96
|
| Rate for Payer: United Healthcare Medicare Advantage |
$310.24
|
| Rate for Payer: United Healthcare PPO |
$1,137.00
|
| Rate for Payer: WEA Trust Commercial |
$833.80
|
| Rate for Payer: Wellcare Medicare |
$310.24
|
| Rate for Payer: WPS Commercial |
$1,122.90
|
|
|
Stress Test Tracing ONLY
|
Professional
|
Both
|
$1,516.00
|
|
|
Service Code
|
CPT 93017
|
| Hospital Charge Code |
3114226
|
|
Hospital Revenue Code
|
482
|
| Min. Negotiated Rate |
$115.61 |
| Max. Negotiated Rate |
$1,440.20 |
| Rate for Payer: Aetna Commercial |
$1,440.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,303.76
|
| Rate for Payer: Cash Price |
$454.80
|
| Rate for Payer: Cash Price |
$454.80
|
| Rate for Payer: Cash Price |
$454.80
|
| Rate for Payer: Cigna Commercial |
$1,440.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$758.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$909.60
|
| Rate for Payer: Health EOS Commercial |
$1,379.56
|
| Rate for Payer: HFN Commercial |
$1,440.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$115.61
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$115.61
|
| Rate for Payer: Multiplan Commercial |
$1,212.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,440.20
|
| Rate for Payer: Quartz Beloit One Network |
$667.04
|
| Rate for Payer: Quartz Commercial |
$864.12
|
| Rate for Payer: The Alliance Commercial |
$758.00
|
| Rate for Payer: WEA Trust Commercial |
$833.80
|
| Rate for Payer: WPS Commercial |
$1,122.90
|
|
|
Stress Test Tracing Treadmill
|
Facility
|
OP
|
$1,575.00
|
|
|
Service Code
|
CPT 93017
|
| Hospital Charge Code |
5388799
|
|
Hospital Revenue Code
|
482
|
| Min. Negotiated Rate |
$310.24 |
| Max. Negotiated Rate |
$1,449.00 |
| Rate for Payer: Aetna Commercial |
$1,417.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,354.50
|
| Rate for Payer: Aetna Managed Medicare |
$310.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,023.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$787.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$756.00
|
| Rate for Payer: Anthem Medicare Advantage |
$310.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$834.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$310.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$310.24
|
| Rate for Payer: Cash Price |
$472.50
|
| Rate for Payer: Cash Price |
$472.50
|
| Rate for Payer: Cigna Commercial |
$1,449.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$310.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$881.37
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$310.24
|
| Rate for Payer: Health EOS Commercial |
$1,401.75
|
| Rate for Payer: HFN Commercial |
$1,449.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,154.09
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$310.24
|
| Rate for Payer: Independent Care Health Plan Medicare |
$310.24
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$310.24
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$310.24
|
| Rate for Payer: Multiplan Commercial |
$1,260.00
|
| Rate for Payer: NAPHCARE Commercial |
$465.36
|
| Rate for Payer: Preferred Network Access Commercial |
$1,449.00
|
| Rate for Payer: Quartz Beloit One Network |
$771.75
|
| Rate for Payer: Quartz Commercial |
$1,023.75
|
| Rate for Payer: Quartz Medicare Advantage |
$310.24
|
| Rate for Payer: The Alliance Commercial |
$1,240.96
|
| Rate for Payer: United Healthcare Medicare Advantage |
$310.24
|
| Rate for Payer: United Healthcare PPO |
$1,181.25
|
| Rate for Payer: WEA Trust Commercial |
$866.25
|
| Rate for Payer: Wellcare Medicare |
$310.24
|
| Rate for Payer: WPS Commercial |
$1,166.60
|
|
|
Stress Test Tracing Treadmill
|
Facility
|
IP
|
$1,575.00
|
|
|
Service Code
|
CPT 93017
|
| Hospital Charge Code |
5388799
|
|
Hospital Revenue Code
|
482
|
| Min. Negotiated Rate |
$771.75 |
| Max. Negotiated Rate |
$1,449.00 |
| Rate for Payer: Aetna Commercial |
$1,417.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,354.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$834.75
|
| Rate for Payer: Cash Price |
$472.50
|
| Rate for Payer: Cigna Commercial |
$1,449.00
|
| Rate for Payer: Health EOS Commercial |
$1,401.75
|
| Rate for Payer: HFN Commercial |
$1,449.00
|
| Rate for Payer: Multiplan Commercial |
$1,260.00
|
| Rate for Payer: NAPHCARE Commercial |
$945.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,449.00
|
| Rate for Payer: Quartz Beloit One Network |
$771.75
|
| Rate for Payer: Quartz Commercial |
$945.00
|
| Rate for Payer: WEA Trust Commercial |
$866.25
|
| Rate for Payer: WPS Commercial |
$1,166.60
|
|
|
Stress Test Tracing Treadmill
|
Professional
|
Both
|
$1,575.00
|
|
|
Service Code
|
CPT 93017
|
| Hospital Charge Code |
5388799
|
|
Hospital Revenue Code
|
482
|
| Min. Negotiated Rate |
$115.61 |
| Max. Negotiated Rate |
$1,496.25 |
| Rate for Payer: Aetna Commercial |
$1,496.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,354.50
|
| Rate for Payer: Cash Price |
$472.50
|
| Rate for Payer: Cash Price |
$472.50
|
| Rate for Payer: Cash Price |
$472.50
|
| Rate for Payer: Cigna Commercial |
$1,496.25
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$787.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$945.00
|
| Rate for Payer: Health EOS Commercial |
$1,433.25
|
| Rate for Payer: HFN Commercial |
$1,496.25
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$115.61
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$115.61
|
| Rate for Payer: Multiplan Commercial |
$1,260.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,496.25
|
| Rate for Payer: Quartz Beloit One Network |
$693.00
|
| Rate for Payer: Quartz Commercial |
$897.75
|
| Rate for Payer: The Alliance Commercial |
$787.50
|
| Rate for Payer: WEA Trust Commercial |
$866.25
|
| Rate for Payer: WPS Commercial |
$1,166.60
|
|
|
Striated Muscle Antibody w/ Reflex
|
Professional
|
Both
|
$171.00
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
983412
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$16.61 |
| Max. Negotiated Rate |
$162.45 |
| Rate for Payer: Aetna Commercial |
$162.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$147.06
|
| Rate for Payer: Anthem Commercial |
$16.61
|
| Rate for Payer: Cash Price |
$51.30
|
| Rate for Payer: Cash Price |
$51.30
|
| Rate for Payer: Cigna Commercial |
$162.45
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$85.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$102.60
|
| Rate for Payer: Health EOS Commercial |
$155.61
|
| Rate for Payer: HFN Commercial |
$162.45
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$42.54
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$42.54
|
| Rate for Payer: Multiplan Commercial |
$136.80
|
| Rate for Payer: Preferred Network Access Commercial |
$162.45
|
| Rate for Payer: Quartz Beloit One Network |
$75.24
|
| Rate for Payer: Quartz Commercial |
$97.47
|
| Rate for Payer: The Alliance Commercial |
$85.50
|
| Rate for Payer: WEA Trust Commercial |
$94.05
|
| Rate for Payer: WPS Commercial |
$126.66
|
|
|
Striated Muscle Antibody w/ Reflex
|
Facility
|
OP
|
$171.00
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
983412
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.05 |
| Max. Negotiated Rate |
$157.32 |
| Rate for Payer: HFN Commercial |
$157.32
|
| Rate for Payer: Aetna Commercial |
$153.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$147.06
|
| Rate for Payer: Aetna Managed Medicare |
$12.05
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$45.19
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$21.09
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$20.00
|
| Rate for Payer: Anthem Medicaid |
$12.45
|
| Rate for Payer: Anthem Medicare Advantage |
$12.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$90.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$12.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$12.05
|
| Rate for Payer: Cash Price |
$51.30
|
| Rate for Payer: Cash Price |
$51.30
|
| Rate for Payer: Cigna Commercial |
$157.32
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$12.05
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$12.45
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$95.69
|
| Rate for Payer: Dean Health Medicaid |
$12.45
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$12.05
|
| Rate for Payer: Health EOS Commercial |
$152.19
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$44.83
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$12.05
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$12.45
|
| Rate for Payer: Independent Care Health Plan Medicare |
$12.05
|
| Rate for Payer: Managed Health Services Medicaid |
$12.95
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$12.05
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$12.05
|
| Rate for Payer: Multiplan Commercial |
$136.80
|
| Rate for Payer: NAPHCARE Commercial |
$18.08
|
| Rate for Payer: Preferred Network Access Commercial |
$157.32
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$12.45
|
| Rate for Payer: Quartz Beloit One Network |
$83.79
|
| Rate for Payer: Quartz Commercial |
$111.15
|
| Rate for Payer: Quartz Medicare Advantage |
$12.05
|
| Rate for Payer: The Alliance Commercial |
$48.20
|
| Rate for Payer: United Healthcare Medicaid |
$12.45
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.05
|
| Rate for Payer: United Healthcare PPO |
$128.25
|
| Rate for Payer: WEA Trust Commercial |
$94.05
|
| Rate for Payer: Wellcare Medicare |
$12.05
|
| Rate for Payer: WMAP Medicaid |
$12.45
|
| Rate for Payer: WPS Commercial |
$126.66
|
|
|
Striated Muscle Antibody w/ Reflex
|
Facility
|
IP
|
$171.00
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
983412
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$83.79 |
| Max. Negotiated Rate |
$157.32 |
| Rate for Payer: Aetna Commercial |
$153.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$147.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$90.63
|
| Rate for Payer: Cash Price |
$51.30
|
| Rate for Payer: Cigna Commercial |
$157.32
|
| Rate for Payer: Health EOS Commercial |
$152.19
|
| Rate for Payer: HFN Commercial |
$157.32
|
| Rate for Payer: Multiplan Commercial |
$136.80
|
| Rate for Payer: NAPHCARE Commercial |
$102.60
|
| Rate for Payer: Preferred Network Access Commercial |
$157.32
|
| Rate for Payer: Quartz Beloit One Network |
$83.79
|
| Rate for Payer: Quartz Commercial |
$102.60
|
| Rate for Payer: WEA Trust Commercial |
$94.05
|
| Rate for Payer: WPS Commercial |
$126.66
|
|
|
STRIP BLOOD LEAK TEST #5119
|
Facility
|
IP
|
$988.00
|
|
| Hospital Charge Code |
2971904
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$484.12 |
| Max. Negotiated Rate |
$908.96 |
| Rate for Payer: Aetna Commercial |
$889.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$849.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$523.64
|
| Rate for Payer: Cash Price |
$296.40
|
| Rate for Payer: Cigna Commercial |
$908.96
|
| Rate for Payer: Health EOS Commercial |
$879.32
|
| Rate for Payer: HFN Commercial |
$908.96
|
| Rate for Payer: Multiplan Commercial |
$790.40
|
| Rate for Payer: NAPHCARE Commercial |
$592.80
|
| Rate for Payer: Preferred Network Access Commercial |
$908.96
|
| Rate for Payer: Quartz Beloit One Network |
$484.12
|
| Rate for Payer: Quartz Commercial |
$592.80
|
| Rate for Payer: WEA Trust Commercial |
$543.40
|
| Rate for Payer: WPS Commercial |
$731.81
|
|
