|
TOWEL POLY LINED #696
|
Facility
|
OP
|
$53.00
|
|
| Hospital Charge Code |
2972747
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$15.43 |
| Max. Negotiated Rate |
$50.71 |
| Rate for Payer: Aetna Commercial |
$49.61
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$47.40
|
| Rate for Payer: Aetna Managed Medicare |
$15.43
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$35.83
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$27.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$26.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$29.21
|
| Rate for Payer: Cash Price |
$15.90
|
| Rate for Payer: Cigna Commercial |
$50.71
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$30.85
|
| Rate for Payer: Health EOS Commercial |
$49.06
|
| Rate for Payer: HFN Commercial |
$50.71
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$41.34
|
| Rate for Payer: Multiplan Commercial |
$44.10
|
| Rate for Payer: NAPHCARE Commercial |
$33.07
|
| Rate for Payer: Preferred Network Access Commercial |
$50.71
|
| Rate for Payer: Quartz Beloit One Network |
$27.01
|
| Rate for Payer: Quartz Commercial |
$35.83
|
| Rate for Payer: Quartz Medicare Advantage |
$33.07
|
| Rate for Payer: The Alliance Commercial |
$27.56
|
| Rate for Payer: WEA Trust Commercial |
$30.32
|
| Rate for Payer: WPS Commercial |
$40.83
|
|
|
TOWEL POLY LINED #696
|
Facility
|
IP
|
$53.00
|
|
| Hospital Charge Code |
2972747
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$27.01 |
| Max. Negotiated Rate |
$50.71 |
| Rate for Payer: Aetna Commercial |
$49.61
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$47.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$29.21
|
| Rate for Payer: Cash Price |
$15.90
|
| Rate for Payer: Cigna Commercial |
$50.71
|
| Rate for Payer: Health EOS Commercial |
$49.06
|
| Rate for Payer: HFN Commercial |
$50.71
|
| Rate for Payer: Multiplan Commercial |
$44.10
|
| Rate for Payer: Preferred Network Access Commercial |
$50.71
|
| Rate for Payer: Quartz Beloit One Network |
$27.01
|
| Rate for Payer: Quartz Commercial |
$33.07
|
| Rate for Payer: WEA Trust Commercial |
$30.32
|
| Rate for Payer: WPS Commercial |
$40.83
|
|
|
TOXIC EFFECTS OF NON-MEDICINAL SUBSTANCES
|
Facility
|
OP
|
$102.20
|
|
|
Service Code
|
EAPG 00854
|
| Min. Negotiated Rate |
$98.27 |
| Max. Negotiated Rate |
$102.20 |
| Rate for Payer: Anthem Medicaid |
$98.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$98.27
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$98.27
|
| Rate for Payer: Dean Health Medicaid |
$98.27
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$98.27
|
| Rate for Payer: Managed Health Services Medicaid |
$102.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$98.27
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$98.27
|
| Rate for Payer: United Healthcare Medicaid |
$98.27
|
|
|
TOXIC EFFECTS OF NON-MEDICINAL SUBSTANCES
|
Facility
|
IP
|
$4,296.47
|
|
|
Service Code
|
APR-DRG 8161
|
| Min. Negotiated Rate |
$3,816.39 |
| Max. Negotiated Rate |
$4,296.47 |
| Rate for Payer: Anthem Medicaid |
$4,114.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$4,114.11
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$4,114.11
|
| Rate for Payer: Dean Health Medicaid |
$4,114.11
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$3,816.39
|
| Rate for Payer: Managed Health Services Medicaid |
$4,296.47
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,114.11
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$4,114.11
|
| Rate for Payer: United Healthcare Medicaid |
$4,114.11
|
|
|
TOXIC EFFECTS OF NON-MEDICINAL SUBSTANCES
|
Facility
|
IP
|
$5,874.77
|
|
|
Service Code
|
APR-DRG 8162
|
| Min. Negotiated Rate |
$5,218.34 |
| Max. Negotiated Rate |
$5,874.77 |
| Rate for Payer: Anthem Medicaid |
$5,625.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$5,625.41
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$5,625.41
|
| Rate for Payer: Dean Health Medicaid |
$5,625.41
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$5,218.34
|
| Rate for Payer: Managed Health Services Medicaid |
$5,874.77
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,625.41
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$5,625.41
|
| Rate for Payer: United Healthcare Medicaid |
$5,625.41
|
|
|
TOXIC EFFECTS OF NON-MEDICINAL SUBSTANCES
|
Facility
|
IP
|
$21,306.99
|
|
|
Service Code
|
APR-DRG 8164
|
| Min. Negotiated Rate |
$18,926.20 |
| Max. Negotiated Rate |
$21,306.99 |
| Rate for Payer: Anthem Medicaid |
$20,402.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$20,402.62
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$20,402.62
|
| Rate for Payer: Dean Health Medicaid |
$20,402.62
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$18,926.20
|
| Rate for Payer: Managed Health Services Medicaid |
$21,306.99
|
| Rate for Payer: Molina Healthcare Medicaid |
$20,402.62
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$20,402.62
|
| Rate for Payer: United Healthcare Medicaid |
$20,402.62
|
|
|
TOXIC EFFECTS OF NON-MEDICINAL SUBSTANCES
|
Facility
|
IP
|
$11,135.75
|
|
|
Service Code
|
APR-DRG 8163
|
| Min. Negotiated Rate |
$9,891.47 |
| Max. Negotiated Rate |
$11,135.75 |
| Rate for Payer: Anthem Medicaid |
$10,663.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$10,663.10
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$10,663.10
|
| Rate for Payer: Dean Health Medicaid |
$10,663.10
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$9,891.47
|
| Rate for Payer: Managed Health Services Medicaid |
$11,135.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$10,663.10
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$10,663.10
|
| Rate for Payer: United Healthcare Medicaid |
$10,663.10
|
|
|
Toxicology Screen Urine
|
Professional
|
Both
|
$722.00
|
|
|
Service Code
|
CPT 80306
|
| Hospital Charge Code |
993777
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.83 |
| Max. Negotiated Rate |
$713.34 |
| Rate for Payer: Aetna Commercial |
$713.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$645.76
|
| Rate for Payer: Aetna Managed Medicare |
$17.83
|
| Rate for Payer: Anthem Medicare Advantage |
$17.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$17.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$17.83
|
| Rate for Payer: Cash Price |
$216.60
|
| Rate for Payer: Cash Price |
$216.60
|
| Rate for Payer: Cigna Commercial |
$713.34
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$375.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$17.83
|
| Rate for Payer: Health EOS Commercial |
$683.30
|
| Rate for Payer: HFN Commercial |
$713.34
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$62.92
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$62.92
|
| Rate for Payer: Independent Care Health Plan Medicare |
$17.83
|
| Rate for Payer: Multiplan Commercial |
$600.70
|
| Rate for Payer: NAPHCARE Commercial |
$26.74
|
| Rate for Payer: Preferred Network Access Commercial |
$713.34
|
| Rate for Payer: Quartz Beloit One Network |
$330.39
|
| Rate for Payer: Quartz Commercial |
$428.00
|
| Rate for Payer: Quartz Medicare Advantage |
$17.83
|
| Rate for Payer: The Alliance Commercial |
$70.41
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17.83
|
| Rate for Payer: WEA Trust Commercial |
$412.98
|
| Rate for Payer: WPS Commercial |
$78.43
|
|
|
Toxicology Screen Urine
|
Facility
|
OP
|
$722.00
|
|
|
Service Code
|
CPT 80306
|
| Hospital Charge Code |
993777
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.83 |
| Max. Negotiated Rate |
$690.81 |
| Rate for Payer: Aetna Commercial |
$675.79
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$645.76
|
| Rate for Payer: Aetna Managed Medicare |
$17.83
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$66.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$31.19
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$29.59
|
| Rate for Payer: Anthem Medicare Advantage |
$17.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$397.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$17.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$17.83
|
| Rate for Payer: Cash Price |
$216.60
|
| Rate for Payer: Cash Price |
$216.60
|
| Rate for Payer: Cigna Commercial |
$690.81
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$17.83
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$420.20
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$17.83
|
| Rate for Payer: Health EOS Commercial |
$668.28
|
| Rate for Payer: HFN Commercial |
$690.81
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$66.31
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$17.83
|
| Rate for Payer: Independent Care Health Plan Medicare |
$17.83
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$17.83
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$17.83
|
| Rate for Payer: Multiplan Commercial |
$600.70
|
| Rate for Payer: NAPHCARE Commercial |
$26.74
|
| Rate for Payer: Preferred Network Access Commercial |
$690.81
|
| Rate for Payer: Quartz Beloit One Network |
$367.93
|
| Rate for Payer: Quartz Commercial |
$488.07
|
| Rate for Payer: Quartz Medicare Advantage |
$17.83
|
| Rate for Payer: The Alliance Commercial |
$71.30
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17.83
|
| Rate for Payer: United Healthcare PPO |
$563.16
|
| Rate for Payer: WEA Trust Commercial |
$412.98
|
| Rate for Payer: Wellcare Medicare |
$17.83
|
| Rate for Payer: WPS Commercial |
$556.16
|
|
|
Toxicology Screen Urine
|
Facility
|
IP
|
$722.00
|
|
|
Service Code
|
CPT 80306
|
| Hospital Charge Code |
993777
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$367.93 |
| Max. Negotiated Rate |
$690.81 |
| Rate for Payer: Aetna Commercial |
$675.79
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$645.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$397.97
|
| Rate for Payer: Cash Price |
$216.60
|
| Rate for Payer: Cigna Commercial |
$690.81
|
| Rate for Payer: Health EOS Commercial |
$668.28
|
| Rate for Payer: HFN Commercial |
$690.81
|
| Rate for Payer: Multiplan Commercial |
$600.70
|
| Rate for Payer: Preferred Network Access Commercial |
$690.81
|
| Rate for Payer: Quartz Beloit One Network |
$367.93
|
| Rate for Payer: Quartz Commercial |
$450.53
|
| Rate for Payer: WEA Trust Commercial |
$412.98
|
| Rate for Payer: WPS Commercial |
$556.16
|
|
|
TOXICOLOGY TESTS
|
Facility
|
OP
|
$15.72
|
|
|
Service Code
|
EAPG 00404
|
| Min. Negotiated Rate |
$15.12 |
| Max. Negotiated Rate |
$15.72 |
| Rate for Payer: Anthem Medicaid |
$15.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$15.12
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$15.12
|
| Rate for Payer: Dean Health Medicaid |
$15.12
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$15.12
|
| Rate for Payer: Managed Health Services Medicaid |
$15.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$15.12
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$15.12
|
| Rate for Payer: United Healthcare Medicaid |
$15.12
|
|
|
Toxocara Antibody IgG
|
Facility
|
OP
|
$106.00
|
|
|
Service Code
|
CPT 86682
|
| Hospital Charge Code |
978081
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.53 |
| Max. Negotiated Rate |
$101.42 |
| Rate for Payer: Aetna Commercial |
$99.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$94.81
|
| Rate for Payer: Aetna Managed Medicare |
$13.53
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$50.74
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$23.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$22.46
|
| Rate for Payer: Anthem Medicare Advantage |
$13.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$58.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$13.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$13.53
|
| Rate for Payer: Cash Price |
$31.80
|
| Rate for Payer: Cash Price |
$31.80
|
| Rate for Payer: Cigna Commercial |
$101.42
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$13.53
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$61.69
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$13.53
|
| Rate for Payer: Health EOS Commercial |
$98.11
|
| Rate for Payer: HFN Commercial |
$101.42
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$50.33
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$13.53
|
| Rate for Payer: Independent Care Health Plan Medicare |
$13.53
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$13.53
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$13.53
|
| Rate for Payer: Multiplan Commercial |
$88.19
|
| Rate for Payer: NAPHCARE Commercial |
$20.30
|
| Rate for Payer: Preferred Network Access Commercial |
$101.42
|
| Rate for Payer: Quartz Beloit One Network |
$54.02
|
| Rate for Payer: Quartz Commercial |
$71.66
|
| Rate for Payer: Quartz Medicare Advantage |
$13.53
|
| Rate for Payer: The Alliance Commercial |
$54.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.53
|
| Rate for Payer: United Healthcare PPO |
$82.68
|
| Rate for Payer: WEA Trust Commercial |
$60.63
|
| Rate for Payer: Wellcare Medicare |
$13.53
|
| Rate for Payer: WPS Commercial |
$81.65
|
|
|
Toxocara Antibody IgG
|
Professional
|
Both
|
$106.00
|
|
|
Service Code
|
CPT 86682
|
| Hospital Charge Code |
978081
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.53 |
| Max. Negotiated Rate |
$104.73 |
| Rate for Payer: Aetna Commercial |
$104.73
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$94.81
|
| Rate for Payer: Aetna Managed Medicare |
$13.53
|
| Rate for Payer: Anthem Medicare Advantage |
$13.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$13.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$13.53
|
| Rate for Payer: Cash Price |
$31.80
|
| Rate for Payer: Cash Price |
$31.80
|
| Rate for Payer: Cigna Commercial |
$104.73
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$55.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$13.53
|
| Rate for Payer: Health EOS Commercial |
$100.32
|
| Rate for Payer: HFN Commercial |
$104.73
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$47.77
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$47.77
|
| Rate for Payer: Independent Care Health Plan Medicare |
$13.53
|
| Rate for Payer: Multiplan Commercial |
$88.19
|
| Rate for Payer: NAPHCARE Commercial |
$20.30
|
| Rate for Payer: Preferred Network Access Commercial |
$104.73
|
| Rate for Payer: Quartz Beloit One Network |
$48.51
|
| Rate for Payer: Quartz Commercial |
$62.84
|
| Rate for Payer: Quartz Medicare Advantage |
$13.53
|
| Rate for Payer: The Alliance Commercial |
$53.45
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.53
|
| Rate for Payer: WEA Trust Commercial |
$60.63
|
| Rate for Payer: WPS Commercial |
$59.53
|
|
|
Toxocara Antibody IgG
|
Facility
|
IP
|
$106.00
|
|
|
Service Code
|
CPT 86682
|
| Hospital Charge Code |
978081
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$54.02 |
| Max. Negotiated Rate |
$101.42 |
| Rate for Payer: Aetna Commercial |
$99.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$94.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$58.43
|
| Rate for Payer: Cash Price |
$31.80
|
| Rate for Payer: Cigna Commercial |
$101.42
|
| Rate for Payer: Health EOS Commercial |
$98.11
|
| Rate for Payer: HFN Commercial |
$101.42
|
| Rate for Payer: Multiplan Commercial |
$88.19
|
| Rate for Payer: Preferred Network Access Commercial |
$101.42
|
| Rate for Payer: Quartz Beloit One Network |
$54.02
|
| Rate for Payer: Quartz Commercial |
$66.14
|
| Rate for Payer: WEA Trust Commercial |
$60.63
|
| Rate for Payer: WPS Commercial |
$81.65
|
|
|
Toxoplasma Antibody IgG
|
Facility
|
OP
|
$83.00
|
|
|
Service Code
|
CPT 86777
|
| Hospital Charge Code |
2943020
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.97 |
| Max. Negotiated Rate |
$79.41 |
| Rate for Payer: Aetna Commercial |
$77.69
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$74.24
|
| Rate for Payer: Aetna Managed Medicare |
$14.97
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$56.12
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$26.19
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$24.84
|
| Rate for Payer: Anthem Medicare Advantage |
$14.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$45.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$14.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$14.97
|
| Rate for Payer: Cash Price |
$24.90
|
| Rate for Payer: Cash Price |
$24.90
|
| Rate for Payer: Cigna Commercial |
$79.41
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$14.97
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$48.31
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$14.97
|
| Rate for Payer: Health EOS Commercial |
$76.82
|
| Rate for Payer: HFN Commercial |
$79.41
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$55.67
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$14.97
|
| Rate for Payer: Independent Care Health Plan Medicare |
$14.97
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$14.97
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$14.97
|
| Rate for Payer: Multiplan Commercial |
$69.06
|
| Rate for Payer: NAPHCARE Commercial |
$22.45
|
| Rate for Payer: Preferred Network Access Commercial |
$79.41
|
| Rate for Payer: Quartz Beloit One Network |
$42.30
|
| Rate for Payer: Quartz Commercial |
$56.11
|
| Rate for Payer: Quartz Medicare Advantage |
$14.97
|
| Rate for Payer: The Alliance Commercial |
$59.86
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14.97
|
| Rate for Payer: United Healthcare PPO |
$64.74
|
| Rate for Payer: WEA Trust Commercial |
$47.48
|
| Rate for Payer: Wellcare Medicare |
$14.97
|
| Rate for Payer: WPS Commercial |
$63.93
|
|
|
Toxoplasma Antibody IgG
|
Professional
|
Both
|
$83.00
|
|
|
Service Code
|
CPT 86777
|
| Hospital Charge Code |
2943020
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.97 |
| Max. Negotiated Rate |
$82.00 |
| Rate for Payer: Aetna Commercial |
$82.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$74.24
|
| Rate for Payer: Aetna Managed Medicare |
$14.97
|
| Rate for Payer: Anthem Medicare Advantage |
$14.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$14.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$14.97
|
| Rate for Payer: Cash Price |
$24.90
|
| Rate for Payer: Cash Price |
$24.90
|
| Rate for Payer: Cigna Commercial |
$82.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$43.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$14.97
|
| Rate for Payer: Health EOS Commercial |
$78.55
|
| Rate for Payer: HFN Commercial |
$82.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$52.83
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$52.83
|
| Rate for Payer: Independent Care Health Plan Medicare |
$14.97
|
| Rate for Payer: Multiplan Commercial |
$69.06
|
| Rate for Payer: NAPHCARE Commercial |
$22.45
|
| Rate for Payer: Preferred Network Access Commercial |
$82.00
|
| Rate for Payer: Quartz Beloit One Network |
$37.98
|
| Rate for Payer: Quartz Commercial |
$49.20
|
| Rate for Payer: Quartz Medicare Advantage |
$14.97
|
| Rate for Payer: The Alliance Commercial |
$59.11
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14.97
|
| Rate for Payer: WEA Trust Commercial |
$47.48
|
| Rate for Payer: WPS Commercial |
$65.85
|
|
|
Toxoplasma Antibody IgG
|
Facility
|
IP
|
$83.00
|
|
|
Service Code
|
CPT 86777
|
| Hospital Charge Code |
2943020
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$42.30 |
| Max. Negotiated Rate |
$79.41 |
| Rate for Payer: Aetna Commercial |
$77.69
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$74.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$45.75
|
| Rate for Payer: Cash Price |
$24.90
|
| Rate for Payer: Cigna Commercial |
$79.41
|
| Rate for Payer: Health EOS Commercial |
$76.82
|
| Rate for Payer: HFN Commercial |
$79.41
|
| Rate for Payer: Multiplan Commercial |
$69.06
|
| Rate for Payer: Preferred Network Access Commercial |
$79.41
|
| Rate for Payer: Quartz Beloit One Network |
$42.30
|
| Rate for Payer: Quartz Commercial |
$51.79
|
| Rate for Payer: WEA Trust Commercial |
$47.48
|
| Rate for Payer: WPS Commercial |
$63.93
|
|
|
Toxoplasma Antibody IgG
|
Professional
|
Both
|
$185.00
|
|
|
Service Code
|
CPT 86777
|
| Hospital Charge Code |
978082
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.97 |
| Max. Negotiated Rate |
$182.78 |
| Rate for Payer: Aetna Commercial |
$182.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$165.46
|
| Rate for Payer: Aetna Managed Medicare |
$14.97
|
| Rate for Payer: Anthem Medicare Advantage |
$14.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$14.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$14.97
|
| Rate for Payer: Cash Price |
$55.50
|
| Rate for Payer: Cash Price |
$55.50
|
| Rate for Payer: Cigna Commercial |
$182.78
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$96.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$14.97
|
| Rate for Payer: Health EOS Commercial |
$175.08
|
| Rate for Payer: HFN Commercial |
$182.78
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$52.83
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$52.83
|
| Rate for Payer: Independent Care Health Plan Medicare |
$14.97
|
| Rate for Payer: Multiplan Commercial |
$153.92
|
| Rate for Payer: NAPHCARE Commercial |
$22.45
|
| Rate for Payer: Preferred Network Access Commercial |
$182.78
|
| Rate for Payer: Quartz Beloit One Network |
$84.66
|
| Rate for Payer: Quartz Commercial |
$109.67
|
| Rate for Payer: Quartz Medicare Advantage |
$14.97
|
| Rate for Payer: The Alliance Commercial |
$59.11
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14.97
|
| Rate for Payer: WEA Trust Commercial |
$105.82
|
| Rate for Payer: WPS Commercial |
$65.85
|
|
|
Toxoplasma Antibody IgG
|
Facility
|
IP
|
$185.00
|
|
|
Service Code
|
CPT 86777
|
| Hospital Charge Code |
978082
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$94.28 |
| Max. Negotiated Rate |
$177.01 |
| Rate for Payer: Aetna Commercial |
$173.16
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$165.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$101.97
|
| Rate for Payer: Cash Price |
$55.50
|
| Rate for Payer: Cigna Commercial |
$177.01
|
| Rate for Payer: Health EOS Commercial |
$171.24
|
| Rate for Payer: HFN Commercial |
$177.01
|
| Rate for Payer: Multiplan Commercial |
$153.92
|
| Rate for Payer: Preferred Network Access Commercial |
$177.01
|
| Rate for Payer: Quartz Beloit One Network |
$94.28
|
| Rate for Payer: Quartz Commercial |
$115.44
|
| Rate for Payer: WEA Trust Commercial |
$105.82
|
| Rate for Payer: WPS Commercial |
$142.51
|
|
|
Toxoplasma Antibody IgG
|
Facility
|
OP
|
$185.00
|
|
|
Service Code
|
CPT 86777
|
| Hospital Charge Code |
978082
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.97 |
| Max. Negotiated Rate |
$177.01 |
| Rate for Payer: Aetna Commercial |
$173.16
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$165.46
|
| Rate for Payer: Aetna Managed Medicare |
$14.97
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$56.12
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$26.19
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$24.84
|
| Rate for Payer: Anthem Medicare Advantage |
$14.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$101.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$14.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$14.97
|
| Rate for Payer: Cash Price |
$55.50
|
| Rate for Payer: Cash Price |
$55.50
|
| Rate for Payer: Cigna Commercial |
$177.01
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$14.97
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$107.67
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$14.97
|
| Rate for Payer: Health EOS Commercial |
$171.24
|
| Rate for Payer: HFN Commercial |
$177.01
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$55.67
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$14.97
|
| Rate for Payer: Independent Care Health Plan Medicare |
$14.97
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$14.97
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$14.97
|
| Rate for Payer: Multiplan Commercial |
$153.92
|
| Rate for Payer: NAPHCARE Commercial |
$22.45
|
| Rate for Payer: Preferred Network Access Commercial |
$177.01
|
| Rate for Payer: Quartz Beloit One Network |
$94.28
|
| Rate for Payer: Quartz Commercial |
$125.06
|
| Rate for Payer: Quartz Medicare Advantage |
$14.97
|
| Rate for Payer: The Alliance Commercial |
$59.86
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14.97
|
| Rate for Payer: United Healthcare PPO |
$144.30
|
| Rate for Payer: WEA Trust Commercial |
$105.82
|
| Rate for Payer: Wellcare Medicare |
$14.97
|
| Rate for Payer: WPS Commercial |
$142.51
|
|
|
Toxoplasma Antibody IgG and IgM
|
Facility
|
IP
|
$125.00
|
|
|
Service Code
|
CPT 86777
|
| Hospital Charge Code |
978083
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$63.70 |
| Max. Negotiated Rate |
$119.60 |
| Rate for Payer: Aetna Commercial |
$117.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$111.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$68.90
|
| Rate for Payer: Cash Price |
$37.50
|
| Rate for Payer: Cigna Commercial |
$119.60
|
| Rate for Payer: Health EOS Commercial |
$115.70
|
| Rate for Payer: HFN Commercial |
$119.60
|
| Rate for Payer: Multiplan Commercial |
$104.00
|
| Rate for Payer: Preferred Network Access Commercial |
$119.60
|
| Rate for Payer: Quartz Beloit One Network |
$63.70
|
| Rate for Payer: Quartz Commercial |
$78.00
|
| Rate for Payer: WEA Trust Commercial |
$71.50
|
| Rate for Payer: WPS Commercial |
$96.29
|
|
|
Toxoplasma Antibody IgG and IgM
|
Facility
|
OP
|
$125.00
|
|
|
Service Code
|
CPT 86777
|
| Hospital Charge Code |
978083
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.97 |
| Max. Negotiated Rate |
$119.60 |
| Rate for Payer: Aetna Commercial |
$117.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$111.80
|
| Rate for Payer: Aetna Managed Medicare |
$14.97
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$56.12
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$26.19
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$24.84
|
| Rate for Payer: Anthem Medicare Advantage |
$14.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$68.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$14.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$14.97
|
| Rate for Payer: Cash Price |
$37.50
|
| Rate for Payer: Cash Price |
$37.50
|
| Rate for Payer: Cigna Commercial |
$119.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$14.97
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$72.75
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$14.97
|
| Rate for Payer: Health EOS Commercial |
$115.70
|
| Rate for Payer: HFN Commercial |
$119.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$55.67
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$14.97
|
| Rate for Payer: Independent Care Health Plan Medicare |
$14.97
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$14.97
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$14.97
|
| Rate for Payer: Multiplan Commercial |
$104.00
|
| Rate for Payer: NAPHCARE Commercial |
$22.45
|
| Rate for Payer: Preferred Network Access Commercial |
$119.60
|
| Rate for Payer: Quartz Beloit One Network |
$63.70
|
| Rate for Payer: Quartz Commercial |
$84.50
|
| Rate for Payer: Quartz Medicare Advantage |
$14.97
|
| Rate for Payer: The Alliance Commercial |
$59.86
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14.97
|
| Rate for Payer: United Healthcare PPO |
$97.50
|
| Rate for Payer: WEA Trust Commercial |
$71.50
|
| Rate for Payer: Wellcare Medicare |
$14.97
|
| Rate for Payer: WPS Commercial |
$96.29
|
|
|
Toxoplasma Antibody IgG and IgM
|
Professional
|
Both
|
$125.00
|
|
|
Service Code
|
CPT 86777
|
| Hospital Charge Code |
978083
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.97 |
| Max. Negotiated Rate |
$123.50 |
| Rate for Payer: Aetna Commercial |
$123.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$111.80
|
| Rate for Payer: Aetna Managed Medicare |
$14.97
|
| Rate for Payer: Anthem Medicare Advantage |
$14.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$14.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$14.97
|
| Rate for Payer: Cash Price |
$37.50
|
| Rate for Payer: Cash Price |
$37.50
|
| Rate for Payer: Cigna Commercial |
$123.50
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$65.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$14.97
|
| Rate for Payer: Health EOS Commercial |
$118.30
|
| Rate for Payer: HFN Commercial |
$123.50
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$52.83
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$52.83
|
| Rate for Payer: Independent Care Health Plan Medicare |
$14.97
|
| Rate for Payer: Multiplan Commercial |
$104.00
|
| Rate for Payer: NAPHCARE Commercial |
$22.45
|
| Rate for Payer: Preferred Network Access Commercial |
$123.50
|
| Rate for Payer: Quartz Beloit One Network |
$57.20
|
| Rate for Payer: Quartz Commercial |
$74.10
|
| Rate for Payer: Quartz Medicare Advantage |
$14.97
|
| Rate for Payer: The Alliance Commercial |
$59.11
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14.97
|
| Rate for Payer: WEA Trust Commercial |
$71.50
|
| Rate for Payer: WPS Commercial |
$65.85
|
|
|
Toxoplasma Antibody IgM
|
Facility
|
OP
|
$119.00
|
|
|
Service Code
|
CPT 86778
|
| Hospital Charge Code |
2943021
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.99 |
| Max. Negotiated Rate |
$113.86 |
| Rate for Payer: Aetna Commercial |
$111.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$106.43
|
| Rate for Payer: Aetna Managed Medicare |
$14.99
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$56.20
|
| 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 Medicare Advantage |
$14.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$65.59
|
| 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 |
$35.70
|
| Rate for Payer: Cash Price |
$35.70
|
| Rate for Payer: Cigna Commercial |
$113.86
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$14.99
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$69.26
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$14.99
|
| Rate for Payer: Health EOS Commercial |
$110.15
|
| Rate for Payer: HFN Commercial |
$113.86
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$55.75
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$14.99
|
| Rate for Payer: Independent Care Health Plan Medicare |
$14.99
|
| 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 |
$99.01
|
| Rate for Payer: NAPHCARE Commercial |
$22.48
|
| Rate for Payer: Preferred Network Access Commercial |
$113.86
|
| Rate for Payer: Quartz Beloit One Network |
$60.64
|
| Rate for Payer: Quartz Commercial |
$80.44
|
| Rate for Payer: Quartz Medicare Advantage |
$14.99
|
| Rate for Payer: The Alliance Commercial |
$59.95
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14.99
|
| Rate for Payer: United Healthcare PPO |
$92.82
|
| Rate for Payer: WEA Trust Commercial |
$68.07
|
| Rate for Payer: Wellcare Medicare |
$14.99
|
| Rate for Payer: WPS Commercial |
$91.67
|
|
|
Toxoplasma Antibody IgM
|
Facility
|
IP
|
$119.00
|
|
|
Service Code
|
CPT 86778
|
| Hospital Charge Code |
2943021
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$60.64 |
| Max. Negotiated Rate |
$113.86 |
| Rate for Payer: Aetna Commercial |
$111.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$106.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$65.59
|
| Rate for Payer: Cash Price |
$35.70
|
| Rate for Payer: Cigna Commercial |
$113.86
|
| Rate for Payer: Health EOS Commercial |
$110.15
|
| Rate for Payer: HFN Commercial |
$113.86
|
| Rate for Payer: Multiplan Commercial |
$99.01
|
| Rate for Payer: Preferred Network Access Commercial |
$113.86
|
| Rate for Payer: Quartz Beloit One Network |
$60.64
|
| Rate for Payer: Quartz Commercial |
$74.26
|
| Rate for Payer: WEA Trust Commercial |
$68.07
|
| Rate for Payer: WPS Commercial |
$91.67
|
|
