|
Blastomyces Antibody
|
Facility
IP
|
$57.00
|
|
|
Service Code
|
CPT 86612
|
| Hospital Charge Code |
5598645
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$27.93 |
| Max. Negotiated Rate |
$52.44 |
| Rate for Payer: Aetna Commercial |
$51.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$30.21
|
| Rate for Payer: Cash Price |
$17.10
|
| Rate for Payer: Cigna Commercial |
$52.44
|
| Rate for Payer: Health EOS Commercial |
$50.73
|
| Rate for Payer: HFN Commercial |
$52.44
|
| Rate for Payer: Multiplan Commercial |
$45.60
|
| Rate for Payer: NAPHCARE Commercial |
$34.20
|
| Rate for Payer: Preferred Network Access Commercial |
$52.44
|
| Rate for Payer: Quartz Beloit One Network |
$27.93
|
| Rate for Payer: Quartz Commercial |
$34.20
|
| Rate for Payer: WEA Trust Commercial |
$31.35
|
| Rate for Payer: WPS Commercial |
$42.22
|
|
|
Blastomyces Antibody
|
Facility
OP
|
$57.00
|
|
|
Service Code
|
CPT 86612
|
| Hospital Charge Code |
5598645
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.17 |
| Max. Negotiated Rate |
$228.00 |
| Rate for Payer: Aetna Commercial |
$51.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$49.02
|
| Rate for Payer: Aetna Managed Medicare |
$12.90
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$48.38
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$22.58
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$21.41
|
| Rate for Payer: Anthem Medicaid |
$8.17
|
| Rate for Payer: Anthem Medicare Advantage |
$12.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$30.21
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$12.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$12.90
|
| Rate for Payer: Cash Price |
$17.10
|
| Rate for Payer: Cash Price |
$17.10
|
| Rate for Payer: Cigna Commercial |
$52.44
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$12.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$8.17
|
| Rate for Payer: Dean Health Medicaid |
$8.17
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$12.90
|
| Rate for Payer: Health EOS Commercial |
$50.73
|
| Rate for Payer: HFN Commercial |
$52.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$47.99
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$12.90
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$8.17
|
| Rate for Payer: Independent Care Health Plan Medicare |
$12.90
|
| Rate for Payer: Managed Health Services Medicaid |
$8.50
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$12.90
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$12.90
|
| Rate for Payer: Multiplan Commercial |
$45.60
|
| Rate for Payer: NAPHCARE Commercial |
$19.35
|
| Rate for Payer: Preferred Network Access Commercial |
$52.44
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$8.17
|
| Rate for Payer: Quartz Beloit One Network |
$27.93
|
| Rate for Payer: Quartz Commercial |
$37.05
|
| Rate for Payer: Quartz Medicare Advantage |
$12.90
|
| Rate for Payer: The Alliance Commercial |
$228.00
|
| Rate for Payer: United Healthcare Medicaid |
$8.17
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.90
|
| Rate for Payer: United Healthcare PPO |
$42.75
|
| Rate for Payer: WEA Trust Commercial |
$31.35
|
| Rate for Payer: Wellcare Medicare |
$12.90
|
| Rate for Payer: WMAP Medicaid |
$8.17
|
| Rate for Payer: WPS Commercial |
$42.22
|
|
|
Blastomyces Antibody
|
Professional
|
$57.00
|
|
|
Service Code
|
CPT 86612
|
| Hospital Charge Code |
5598645
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.90 |
| Max. Negotiated Rate |
$56.76 |
| Rate for Payer: Aetna Commercial |
$54.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$49.02
|
| Rate for Payer: Aetna Managed Medicare |
$12.90
|
| Rate for Payer: Anthem Medicare Advantage |
$12.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$12.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$12.90
|
| Rate for Payer: Cash Price |
$17.10
|
| Rate for Payer: Cash Price |
$17.10
|
| Rate for Payer: Cigna Commercial |
$54.15
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$28.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12.90
|
| Rate for Payer: Health EOS Commercial |
$51.87
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$45.54
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$45.54
|
| Rate for Payer: Independent Care Health Plan Medicare |
$12.90
|
| Rate for Payer: Multiplan Commercial |
$45.60
|
| Rate for Payer: Preferred Network Access Commercial |
$54.15
|
| Rate for Payer: Quartz Beloit One Network |
$25.08
|
| Rate for Payer: Quartz Commercial |
$32.49
|
| Rate for Payer: Quartz Medicare Advantage |
$12.90
|
| Rate for Payer: The Alliance Commercial |
$50.96
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.90
|
| Rate for Payer: WEA Trust Commercial |
$31.35
|
| Rate for Payer: WPS Commercial |
$56.76
|
|
|
Blastomyces AntibodyCF
|
Facility
IP
|
$75.00
|
|
|
Service Code
|
CPT 86612
|
| Hospital Charge Code |
4392619
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$36.75 |
| Max. Negotiated Rate |
$69.00 |
| Rate for Payer: Aetna Commercial |
$67.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$39.75
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Cigna Commercial |
$69.00
|
| Rate for Payer: Health EOS Commercial |
$66.75
|
| Rate for Payer: HFN Commercial |
$69.00
|
| Rate for Payer: Multiplan Commercial |
$60.00
|
| Rate for Payer: NAPHCARE Commercial |
$45.00
|
| Rate for Payer: Preferred Network Access Commercial |
$69.00
|
| Rate for Payer: Quartz Beloit One Network |
$36.75
|
| Rate for Payer: Quartz Commercial |
$45.00
|
| Rate for Payer: WEA Trust Commercial |
$41.25
|
| Rate for Payer: WPS Commercial |
$55.55
|
|
|
Blastomyces AntibodyCF
|
Professional
|
$75.00
|
|
|
Service Code
|
CPT 86612
|
| Hospital Charge Code |
4392619
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.90 |
| Max. Negotiated Rate |
$71.25 |
| Rate for Payer: Aetna Commercial |
$71.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$64.50
|
| Rate for Payer: Aetna Managed Medicare |
$12.90
|
| Rate for Payer: Anthem Medicare Advantage |
$12.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$12.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$12.90
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Cigna Commercial |
$71.25
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$37.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12.90
|
| Rate for Payer: Health EOS Commercial |
$68.25
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$45.54
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$45.54
|
| Rate for Payer: Independent Care Health Plan Medicare |
$12.90
|
| Rate for Payer: Multiplan Commercial |
$60.00
|
| Rate for Payer: Preferred Network Access Commercial |
$71.25
|
| Rate for Payer: Quartz Beloit One Network |
$33.00
|
| Rate for Payer: Quartz Commercial |
$42.75
|
| Rate for Payer: Quartz Medicare Advantage |
$12.90
|
| Rate for Payer: The Alliance Commercial |
$50.96
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.90
|
| Rate for Payer: WEA Trust Commercial |
$41.25
|
| Rate for Payer: WPS Commercial |
$56.76
|
|
|
Blastomyces AntibodyCF
|
Facility
OP
|
$75.00
|
|
|
Service Code
|
CPT 86612
|
| Hospital Charge Code |
4392619
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.17 |
| Max. Negotiated Rate |
$300.00 |
| Rate for Payer: Aetna Commercial |
$67.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$64.50
|
| Rate for Payer: Aetna Managed Medicare |
$12.90
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$48.38
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$22.58
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$21.41
|
| Rate for Payer: Anthem Medicaid |
$8.17
|
| Rate for Payer: Anthem Medicare Advantage |
$12.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$39.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$12.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$12.90
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Cigna Commercial |
$69.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$12.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$8.17
|
| Rate for Payer: Dean Health Medicaid |
$8.17
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$12.90
|
| Rate for Payer: Health EOS Commercial |
$66.75
|
| Rate for Payer: HFN Commercial |
$69.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$47.99
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$12.90
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$8.17
|
| Rate for Payer: Independent Care Health Plan Medicare |
$12.90
|
| Rate for Payer: Managed Health Services Medicaid |
$8.50
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$12.90
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$12.90
|
| Rate for Payer: Multiplan Commercial |
$60.00
|
| Rate for Payer: NAPHCARE Commercial |
$19.35
|
| Rate for Payer: Preferred Network Access Commercial |
$69.00
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$8.17
|
| Rate for Payer: Quartz Beloit One Network |
$36.75
|
| Rate for Payer: Quartz Commercial |
$48.75
|
| Rate for Payer: Quartz Medicare Advantage |
$12.90
|
| Rate for Payer: The Alliance Commercial |
$300.00
|
| Rate for Payer: United Healthcare Medicaid |
$8.17
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.90
|
| Rate for Payer: United Healthcare PPO |
$56.25
|
| Rate for Payer: WEA Trust Commercial |
$41.25
|
| Rate for Payer: Wellcare Medicare |
$12.90
|
| Rate for Payer: WMAP Medicaid |
$8.17
|
| Rate for Payer: WPS Commercial |
$55.55
|
|
|
Blastomyces Antibody, CF and ID
|
Facility
IP
|
$92.00
|
|
|
Service Code
|
CPT 86612
|
| Hospital Charge Code |
5280687
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$45.08 |
| Max. Negotiated Rate |
$84.64 |
| Rate for Payer: Aetna Commercial |
$82.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$48.76
|
| Rate for Payer: Cash Price |
$27.60
|
| Rate for Payer: Cigna Commercial |
$84.64
|
| Rate for Payer: Health EOS Commercial |
$81.88
|
| Rate for Payer: HFN Commercial |
$84.64
|
| Rate for Payer: Multiplan Commercial |
$73.60
|
| Rate for Payer: NAPHCARE Commercial |
$55.20
|
| Rate for Payer: Preferred Network Access Commercial |
$84.64
|
| Rate for Payer: Quartz Beloit One Network |
$45.08
|
| Rate for Payer: Quartz Commercial |
$55.20
|
| Rate for Payer: WEA Trust Commercial |
$50.60
|
| Rate for Payer: WPS Commercial |
$68.14
|
|
|
Blastomyces Antibody, CF and ID
|
Facility
OP
|
$92.00
|
|
|
Service Code
|
CPT 86612
|
| Hospital Charge Code |
5280687
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.17 |
| Max. Negotiated Rate |
$368.00 |
| Rate for Payer: Aetna Commercial |
$82.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$79.12
|
| Rate for Payer: Aetna Managed Medicare |
$12.90
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$48.38
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$22.58
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$21.41
|
| Rate for Payer: Anthem Medicaid |
$8.17
|
| Rate for Payer: Anthem Medicare Advantage |
$12.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$48.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$12.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$12.90
|
| Rate for Payer: Cash Price |
$27.60
|
| Rate for Payer: Cash Price |
$27.60
|
| Rate for Payer: Cigna Commercial |
$84.64
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$12.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$8.17
|
| Rate for Payer: Dean Health Medicaid |
$8.17
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$12.90
|
| Rate for Payer: Health EOS Commercial |
$81.88
|
| Rate for Payer: HFN Commercial |
$84.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$47.99
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$12.90
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$8.17
|
| Rate for Payer: Independent Care Health Plan Medicare |
$12.90
|
| Rate for Payer: Managed Health Services Medicaid |
$8.50
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$12.90
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$12.90
|
| Rate for Payer: Multiplan Commercial |
$73.60
|
| Rate for Payer: NAPHCARE Commercial |
$19.35
|
| Rate for Payer: Preferred Network Access Commercial |
$84.64
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$8.17
|
| Rate for Payer: Quartz Beloit One Network |
$45.08
|
| Rate for Payer: Quartz Commercial |
$59.80
|
| Rate for Payer: Quartz Medicare Advantage |
$12.90
|
| Rate for Payer: The Alliance Commercial |
$368.00
|
| Rate for Payer: United Healthcare Medicaid |
$8.17
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.90
|
| Rate for Payer: United Healthcare PPO |
$69.00
|
| Rate for Payer: WEA Trust Commercial |
$50.60
|
| Rate for Payer: Wellcare Medicare |
$12.90
|
| Rate for Payer: WMAP Medicaid |
$8.17
|
| Rate for Payer: WPS Commercial |
$68.14
|
|
|
Blastomyces Antibody, CF and ID
|
Professional
|
$92.00
|
|
|
Service Code
|
CPT 86612
|
| Hospital Charge Code |
5280687
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.90 |
| Max. Negotiated Rate |
$87.40 |
| Rate for Payer: Aetna Commercial |
$87.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$79.12
|
| Rate for Payer: Aetna Managed Medicare |
$12.90
|
| Rate for Payer: Anthem Medicare Advantage |
$12.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$12.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$12.90
|
| Rate for Payer: Cash Price |
$27.60
|
| Rate for Payer: Cash Price |
$27.60
|
| Rate for Payer: Cigna Commercial |
$87.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$46.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12.90
|
| Rate for Payer: Health EOS Commercial |
$83.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$45.54
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$45.54
|
| Rate for Payer: Independent Care Health Plan Medicare |
$12.90
|
| Rate for Payer: Multiplan Commercial |
$73.60
|
| Rate for Payer: Preferred Network Access Commercial |
$87.40
|
| Rate for Payer: Quartz Beloit One Network |
$40.48
|
| Rate for Payer: Quartz Commercial |
$52.44
|
| Rate for Payer: Quartz Medicare Advantage |
$12.90
|
| Rate for Payer: The Alliance Commercial |
$50.96
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.90
|
| Rate for Payer: WEA Trust Commercial |
$50.60
|
| Rate for Payer: WPS Commercial |
$56.76
|
|
|
Blastomyces Antibody ID
|
Professional
|
$75.00
|
|
|
Service Code
|
CPT 86612
|
| Hospital Charge Code |
4392618
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.90 |
| Max. Negotiated Rate |
$71.25 |
| Rate for Payer: Aetna Commercial |
$71.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$64.50
|
| Rate for Payer: Aetna Managed Medicare |
$12.90
|
| Rate for Payer: Anthem Medicare Advantage |
$12.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$12.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$12.90
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Cigna Commercial |
$71.25
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$37.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12.90
|
| Rate for Payer: Health EOS Commercial |
$68.25
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$45.54
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$45.54
|
| Rate for Payer: Independent Care Health Plan Medicare |
$12.90
|
| Rate for Payer: Multiplan Commercial |
$60.00
|
| Rate for Payer: Preferred Network Access Commercial |
$71.25
|
| Rate for Payer: Quartz Beloit One Network |
$33.00
|
| Rate for Payer: Quartz Commercial |
$42.75
|
| Rate for Payer: Quartz Medicare Advantage |
$12.90
|
| Rate for Payer: The Alliance Commercial |
$50.96
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.90
|
| Rate for Payer: WEA Trust Commercial |
$41.25
|
| Rate for Payer: WPS Commercial |
$56.76
|
|
|
Blastomyces Antibody ID
|
Facility
IP
|
$82.00
|
|
|
Service Code
|
CPT 86612
|
| Hospital Charge Code |
5280690
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$40.18 |
| Max. Negotiated Rate |
$75.44 |
| Rate for Payer: Aetna Commercial |
$73.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$43.46
|
| Rate for Payer: Cash Price |
$24.60
|
| Rate for Payer: Cigna Commercial |
$75.44
|
| Rate for Payer: Health EOS Commercial |
$72.98
|
| Rate for Payer: HFN Commercial |
$75.44
|
| Rate for Payer: Multiplan Commercial |
$65.60
|
| Rate for Payer: NAPHCARE Commercial |
$49.20
|
| Rate for Payer: Preferred Network Access Commercial |
$75.44
|
| Rate for Payer: Quartz Beloit One Network |
$40.18
|
| Rate for Payer: Quartz Commercial |
$49.20
|
| Rate for Payer: WEA Trust Commercial |
$45.10
|
| Rate for Payer: WPS Commercial |
$60.74
|
|
|
Blastomyces Antibody ID
|
Facility
IP
|
$75.00
|
|
|
Service Code
|
CPT 86612
|
| Hospital Charge Code |
4392618
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$36.75 |
| Max. Negotiated Rate |
$69.00 |
| Rate for Payer: Aetna Commercial |
$67.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$39.75
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Cigna Commercial |
$69.00
|
| Rate for Payer: Health EOS Commercial |
$66.75
|
| Rate for Payer: HFN Commercial |
$69.00
|
| Rate for Payer: Multiplan Commercial |
$60.00
|
| Rate for Payer: NAPHCARE Commercial |
$45.00
|
| Rate for Payer: Preferred Network Access Commercial |
$69.00
|
| Rate for Payer: Quartz Beloit One Network |
$36.75
|
| Rate for Payer: Quartz Commercial |
$45.00
|
| Rate for Payer: WEA Trust Commercial |
$41.25
|
| Rate for Payer: WPS Commercial |
$55.55
|
|
|
Blastomyces Antibody ID
|
Facility
OP
|
$82.00
|
|
|
Service Code
|
CPT 86612
|
| Hospital Charge Code |
5280690
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.17 |
| Max. Negotiated Rate |
$328.00 |
| Rate for Payer: Aetna Commercial |
$73.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$70.52
|
| Rate for Payer: Aetna Managed Medicare |
$12.90
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$48.38
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$22.58
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$21.41
|
| Rate for Payer: Anthem Medicaid |
$8.17
|
| Rate for Payer: Anthem Medicare Advantage |
$12.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$43.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$12.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$12.90
|
| Rate for Payer: Cash Price |
$24.60
|
| Rate for Payer: Cash Price |
$24.60
|
| Rate for Payer: Cigna Commercial |
$75.44
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$12.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$8.17
|
| Rate for Payer: Dean Health Medicaid |
$8.17
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$12.90
|
| Rate for Payer: Health EOS Commercial |
$72.98
|
| Rate for Payer: HFN Commercial |
$75.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$47.99
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$12.90
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$8.17
|
| Rate for Payer: Independent Care Health Plan Medicare |
$12.90
|
| Rate for Payer: Managed Health Services Medicaid |
$8.50
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$12.90
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$12.90
|
| Rate for Payer: Multiplan Commercial |
$65.60
|
| Rate for Payer: NAPHCARE Commercial |
$19.35
|
| Rate for Payer: Preferred Network Access Commercial |
$75.44
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$8.17
|
| Rate for Payer: Quartz Beloit One Network |
$40.18
|
| Rate for Payer: Quartz Commercial |
$53.30
|
| Rate for Payer: Quartz Medicare Advantage |
$12.90
|
| Rate for Payer: The Alliance Commercial |
$328.00
|
| Rate for Payer: United Healthcare Medicaid |
$8.17
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.90
|
| Rate for Payer: United Healthcare PPO |
$61.50
|
| Rate for Payer: WEA Trust Commercial |
$45.10
|
| Rate for Payer: Wellcare Medicare |
$12.90
|
| Rate for Payer: WMAP Medicaid |
$8.17
|
| Rate for Payer: WPS Commercial |
$60.74
|
|
|
Blastomyces Antibody ID
|
Facility
OP
|
$75.00
|
|
|
Service Code
|
CPT 86612
|
| Hospital Charge Code |
4392618
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.17 |
| Max. Negotiated Rate |
$300.00 |
| Rate for Payer: Aetna Commercial |
$67.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$64.50
|
| Rate for Payer: Aetna Managed Medicare |
$12.90
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$48.38
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$22.58
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$21.41
|
| Rate for Payer: Anthem Medicaid |
$8.17
|
| Rate for Payer: Anthem Medicare Advantage |
$12.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$39.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$12.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$12.90
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Cigna Commercial |
$69.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$12.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$8.17
|
| Rate for Payer: Dean Health Medicaid |
$8.17
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$12.90
|
| Rate for Payer: Health EOS Commercial |
$66.75
|
| Rate for Payer: HFN Commercial |
$69.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$47.99
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$12.90
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$8.17
|
| Rate for Payer: Independent Care Health Plan Medicare |
$12.90
|
| Rate for Payer: Managed Health Services Medicaid |
$8.50
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$12.90
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$12.90
|
| Rate for Payer: Multiplan Commercial |
$60.00
|
| Rate for Payer: NAPHCARE Commercial |
$19.35
|
| Rate for Payer: Preferred Network Access Commercial |
$69.00
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$8.17
|
| Rate for Payer: Quartz Beloit One Network |
$36.75
|
| Rate for Payer: Quartz Commercial |
$48.75
|
| Rate for Payer: Quartz Medicare Advantage |
$12.90
|
| Rate for Payer: The Alliance Commercial |
$300.00
|
| Rate for Payer: United Healthcare Medicaid |
$8.17
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.90
|
| Rate for Payer: United Healthcare PPO |
$56.25
|
| Rate for Payer: WEA Trust Commercial |
$41.25
|
| Rate for Payer: Wellcare Medicare |
$12.90
|
| Rate for Payer: WMAP Medicaid |
$8.17
|
| Rate for Payer: WPS Commercial |
$55.55
|
|
|
Blastomyces Antibody ID
|
Professional
|
$82.00
|
|
|
Service Code
|
CPT 86612
|
| Hospital Charge Code |
5280690
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.90 |
| Max. Negotiated Rate |
$77.90 |
| Rate for Payer: Aetna Commercial |
$77.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$70.52
|
| Rate for Payer: Aetna Managed Medicare |
$12.90
|
| Rate for Payer: Anthem Medicare Advantage |
$12.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$12.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$12.90
|
| Rate for Payer: Cash Price |
$24.60
|
| Rate for Payer: Cash Price |
$24.60
|
| Rate for Payer: Cigna Commercial |
$77.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$41.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12.90
|
| Rate for Payer: Health EOS Commercial |
$74.62
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$45.54
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$45.54
|
| Rate for Payer: Independent Care Health Plan Medicare |
$12.90
|
| Rate for Payer: Multiplan Commercial |
$65.60
|
| Rate for Payer: Preferred Network Access Commercial |
$77.90
|
| Rate for Payer: Quartz Beloit One Network |
$36.08
|
| Rate for Payer: Quartz Commercial |
$46.74
|
| Rate for Payer: Quartz Medicare Advantage |
$12.90
|
| Rate for Payer: The Alliance Commercial |
$50.96
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.90
|
| Rate for Payer: WEA Trust Commercial |
$45.10
|
| Rate for Payer: WPS Commercial |
$56.76
|
|
|
Blastomyces Antibody, Immunodiffusion
|
Professional
|
$38.00
|
|
|
Service Code
|
CPT 86612
|
| Hospital Charge Code |
4554639
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.90 |
| Max. Negotiated Rate |
$56.76 |
| Rate for Payer: Aetna Commercial |
$36.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$32.68
|
| Rate for Payer: Aetna Managed Medicare |
$12.90
|
| Rate for Payer: Anthem Medicare Advantage |
$12.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$12.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$12.90
|
| Rate for Payer: Cash Price |
$11.40
|
| Rate for Payer: Cash Price |
$11.40
|
| Rate for Payer: Cigna Commercial |
$36.10
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$19.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12.90
|
| Rate for Payer: Health EOS Commercial |
$34.58
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$45.54
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$45.54
|
| Rate for Payer: Independent Care Health Plan Medicare |
$12.90
|
| Rate for Payer: Multiplan Commercial |
$30.40
|
| Rate for Payer: Preferred Network Access Commercial |
$36.10
|
| Rate for Payer: Quartz Beloit One Network |
$16.72
|
| Rate for Payer: Quartz Commercial |
$21.66
|
| Rate for Payer: Quartz Medicare Advantage |
$12.90
|
| Rate for Payer: The Alliance Commercial |
$50.96
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.90
|
| Rate for Payer: WEA Trust Commercial |
$20.90
|
| Rate for Payer: WPS Commercial |
$56.76
|
|
|
Blastomyces Antibody, Immunodiffusion
|
Facility
IP
|
$38.00
|
|
|
Service Code
|
CPT 86612
|
| Hospital Charge Code |
4554639
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.62 |
| Max. Negotiated Rate |
$34.96 |
| Rate for Payer: Aetna Commercial |
$34.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$20.14
|
| Rate for Payer: Cash Price |
$11.40
|
| Rate for Payer: Cigna Commercial |
$34.96
|
| Rate for Payer: Health EOS Commercial |
$33.82
|
| Rate for Payer: HFN Commercial |
$34.96
|
| Rate for Payer: Multiplan Commercial |
$30.40
|
| Rate for Payer: NAPHCARE Commercial |
$22.80
|
| Rate for Payer: Preferred Network Access Commercial |
$34.96
|
| Rate for Payer: Quartz Beloit One Network |
$18.62
|
| Rate for Payer: Quartz Commercial |
$22.80
|
| Rate for Payer: WEA Trust Commercial |
$20.90
|
| Rate for Payer: WPS Commercial |
$28.15
|
|
|
Blastomyces Antibody, Immunodiffusion
|
Facility
OP
|
$38.00
|
|
|
Service Code
|
CPT 86612
|
| Hospital Charge Code |
4554639
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.17 |
| Max. Negotiated Rate |
$152.00 |
| Rate for Payer: Aetna Commercial |
$34.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$32.68
|
| Rate for Payer: Aetna Managed Medicare |
$12.90
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$48.38
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$22.58
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$21.41
|
| Rate for Payer: Anthem Medicaid |
$8.17
|
| Rate for Payer: Anthem Medicare Advantage |
$12.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$20.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$12.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$12.90
|
| Rate for Payer: Cash Price |
$11.40
|
| Rate for Payer: Cash Price |
$11.40
|
| Rate for Payer: Cigna Commercial |
$34.96
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$12.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$8.17
|
| Rate for Payer: Dean Health Medicaid |
$8.17
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$12.90
|
| Rate for Payer: Health EOS Commercial |
$33.82
|
| Rate for Payer: HFN Commercial |
$34.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$47.99
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$12.90
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$8.17
|
| Rate for Payer: Independent Care Health Plan Medicare |
$12.90
|
| Rate for Payer: Managed Health Services Medicaid |
$8.50
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$12.90
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$12.90
|
| Rate for Payer: Multiplan Commercial |
$30.40
|
| Rate for Payer: NAPHCARE Commercial |
$19.35
|
| Rate for Payer: Preferred Network Access Commercial |
$34.96
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$8.17
|
| Rate for Payer: Quartz Beloit One Network |
$18.62
|
| Rate for Payer: Quartz Commercial |
$24.70
|
| Rate for Payer: Quartz Medicare Advantage |
$12.90
|
| Rate for Payer: The Alliance Commercial |
$152.00
|
| Rate for Payer: United Healthcare Medicaid |
$8.17
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.90
|
| Rate for Payer: United Healthcare PPO |
$28.50
|
| Rate for Payer: WEA Trust Commercial |
$20.90
|
| Rate for Payer: Wellcare Medicare |
$12.90
|
| Rate for Payer: WMAP Medicaid |
$8.17
|
| Rate for Payer: WPS Commercial |
$28.15
|
|
|
Blastomyces Quant Antigen EIA (MVista)
|
Facility
OP
|
$243.00
|
|
|
Service Code
|
CPT 87449
|
| Hospital Charge Code |
3256222
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.98 |
| Max. Negotiated Rate |
$972.00 |
| Rate for Payer: Aetna Commercial |
$218.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$208.98
|
| Rate for Payer: Aetna Managed Medicare |
$11.98
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$44.92
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$20.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$19.89
|
| Rate for Payer: Anthem Medicaid |
$12.38
|
| Rate for Payer: Anthem Medicare Advantage |
$11.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$128.79
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$11.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$11.98
|
| Rate for Payer: Cash Price |
$72.90
|
| Rate for Payer: Cash Price |
$72.90
|
| Rate for Payer: Cigna Commercial |
$223.56
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$11.98
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$12.38
|
| Rate for Payer: Dean Health Medicaid |
$12.38
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$11.98
|
| Rate for Payer: Health EOS Commercial |
$216.27
|
| Rate for Payer: HFN Commercial |
$223.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$44.57
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$11.98
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$12.38
|
| Rate for Payer: Independent Care Health Plan Medicare |
$11.98
|
| Rate for Payer: Managed Health Services Medicaid |
$12.88
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$11.98
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$11.98
|
| Rate for Payer: Multiplan Commercial |
$194.40
|
| Rate for Payer: NAPHCARE Commercial |
$17.97
|
| Rate for Payer: Preferred Network Access Commercial |
$223.56
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$12.38
|
| Rate for Payer: Quartz Beloit One Network |
$119.07
|
| Rate for Payer: Quartz Commercial |
$157.95
|
| Rate for Payer: Quartz Medicare Advantage |
$11.98
|
| Rate for Payer: The Alliance Commercial |
$972.00
|
| Rate for Payer: United Healthcare Medicaid |
$12.38
|
| Rate for Payer: United Healthcare Medicare Advantage |
$11.98
|
| Rate for Payer: United Healthcare PPO |
$182.25
|
| Rate for Payer: WEA Trust Commercial |
$133.65
|
| Rate for Payer: Wellcare Medicare |
$11.98
|
| Rate for Payer: WMAP Medicaid |
$12.38
|
| Rate for Payer: WPS Commercial |
$179.99
|
|
|
Blastomyces Quant Antigen EIA (MVista)
|
Facility
IP
|
$243.00
|
|
|
Service Code
|
CPT 87449
|
| Hospital Charge Code |
3256222
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$119.07 |
| Max. Negotiated Rate |
$223.56 |
| Rate for Payer: Aetna Commercial |
$218.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$128.79
|
| Rate for Payer: Cash Price |
$72.90
|
| Rate for Payer: Cigna Commercial |
$223.56
|
| Rate for Payer: Health EOS Commercial |
$216.27
|
| Rate for Payer: HFN Commercial |
$223.56
|
| Rate for Payer: Multiplan Commercial |
$194.40
|
| Rate for Payer: NAPHCARE Commercial |
$145.80
|
| Rate for Payer: Preferred Network Access Commercial |
$223.56
|
| Rate for Payer: Quartz Beloit One Network |
$119.07
|
| Rate for Payer: Quartz Commercial |
$145.80
|
| Rate for Payer: WEA Trust Commercial |
$133.65
|
| Rate for Payer: WPS Commercial |
$179.99
|
|
|
Blastomyces Quant Antigen EIA (MVista)
|
Professional
|
$243.00
|
|
|
Service Code
|
CPT 87449
|
| Hospital Charge Code |
3256222
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.98 |
| Max. Negotiated Rate |
$230.85 |
| Rate for Payer: Aetna Commercial |
$230.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$208.98
|
| Rate for Payer: Aetna Managed Medicare |
$11.98
|
| Rate for Payer: Anthem Medicare Advantage |
$11.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$11.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$11.98
|
| Rate for Payer: Cash Price |
$72.90
|
| Rate for Payer: Cash Price |
$72.90
|
| Rate for Payer: Cigna Commercial |
$230.85
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$121.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$11.98
|
| Rate for Payer: Health EOS Commercial |
$221.13
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$42.29
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$42.29
|
| Rate for Payer: Independent Care Health Plan Medicare |
$11.98
|
| Rate for Payer: Multiplan Commercial |
$194.40
|
| Rate for Payer: Preferred Network Access Commercial |
$230.85
|
| Rate for Payer: Quartz Beloit One Network |
$106.92
|
| Rate for Payer: Quartz Commercial |
$138.51
|
| Rate for Payer: Quartz Medicare Advantage |
$11.98
|
| Rate for Payer: The Alliance Commercial |
$47.32
|
| Rate for Payer: United Healthcare Medicare Advantage |
$11.98
|
| Rate for Payer: WEA Trust Commercial |
$133.65
|
| Rate for Payer: WPS Commercial |
$52.71
|
|
|
BL DRAW UNDER 3 YRS FEM/JUGULAR 36400
|
Professional
|
$208.00
|
|
|
Service Code
|
CPT 36400
|
| Hospital Charge Code |
3014520
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$17.81 |
| Max. Negotiated Rate |
$197.60 |
| Rate for Payer: Aetna Commercial |
$197.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$178.88
|
| Rate for Payer: Aetna Managed Medicare |
$17.81
|
| Rate for Payer: Anthem Medicare Advantage |
$17.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$17.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$17.81
|
| Rate for Payer: Cash Price |
$62.40
|
| Rate for Payer: Cash Price |
$62.40
|
| Rate for Payer: Cigna Commercial |
$197.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$104.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$17.81
|
| Rate for Payer: Health EOS Commercial |
$189.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$64.49
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$64.49
|
| Rate for Payer: Independent Care Health Plan Medicare |
$17.81
|
| Rate for Payer: Multiplan Commercial |
$166.40
|
| Rate for Payer: Preferred Network Access Commercial |
$197.60
|
| Rate for Payer: Quartz Beloit One Network |
$91.52
|
| Rate for Payer: Quartz Commercial |
$118.56
|
| Rate for Payer: Quartz Medicare Advantage |
$17.81
|
| Rate for Payer: The Alliance Commercial |
$75.69
|
| Rate for Payer: United Healthcare Medicaid |
$34.21
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17.81
|
| Rate for Payer: WEA Trust Commercial |
$114.40
|
| Rate for Payer: WPS Commercial |
$80.14
|
|
|
BL DRAW UNDER 3 YRS OTHER VEIN 36406
|
Professional
|
$168.00
|
|
|
Service Code
|
CPT 36406
|
| Hospital Charge Code |
3014522
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$8.46 |
| Max. Negotiated Rate |
$159.60 |
| Rate for Payer: Aetna Commercial |
$159.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$144.48
|
| Rate for Payer: Aetna Managed Medicare |
$8.46
|
| Rate for Payer: Anthem Medicare Advantage |
$8.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$8.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$8.46
|
| Rate for Payer: Cash Price |
$50.40
|
| Rate for Payer: Cash Price |
$50.40
|
| Rate for Payer: Cigna Commercial |
$159.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$84.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$8.46
|
| Rate for Payer: Health EOS Commercial |
$152.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$29.51
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$29.51
|
| Rate for Payer: Independent Care Health Plan Medicare |
$8.46
|
| Rate for Payer: Multiplan Commercial |
$134.40
|
| Rate for Payer: Preferred Network Access Commercial |
$159.60
|
| Rate for Payer: Quartz Beloit One Network |
$73.92
|
| Rate for Payer: Quartz Commercial |
$95.76
|
| Rate for Payer: Quartz Medicare Advantage |
$8.46
|
| Rate for Payer: The Alliance Commercial |
$35.96
|
| Rate for Payer: United Healthcare Medicaid |
$17.52
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8.46
|
| Rate for Payer: WEA Trust Commercial |
$92.40
|
| Rate for Payer: WPS Commercial |
$38.07
|
|
|
BLENDING CONNECTOR WITH MIXER SA-3678
|
Facility
IP
|
$522.00
|
|
| Hospital Charge Code |
6234193
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$255.78 |
| Max. Negotiated Rate |
$480.24 |
| Rate for Payer: Aetna Commercial |
$469.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$276.66
|
| Rate for Payer: Cash Price |
$156.60
|
| Rate for Payer: Cigna Commercial |
$480.24
|
| Rate for Payer: Health EOS Commercial |
$464.58
|
| Rate for Payer: HFN Commercial |
$480.24
|
| Rate for Payer: Multiplan Commercial |
$417.60
|
| Rate for Payer: NAPHCARE Commercial |
$313.20
|
| Rate for Payer: Preferred Network Access Commercial |
$480.24
|
| Rate for Payer: Quartz Beloit One Network |
$255.78
|
| Rate for Payer: Quartz Commercial |
$313.20
|
| Rate for Payer: WEA Trust Commercial |
$287.10
|
| Rate for Payer: WPS Commercial |
$386.65
|
|
|
BLENDING CONNECTOR WITH MIXER SA-3678
|
Facility
OP
|
$522.00
|
|
| Hospital Charge Code |
6234193
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$146.16 |
| Max. Negotiated Rate |
$2,088.00 |
| Rate for Payer: Aetna Commercial |
$469.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$448.92
|
| Rate for Payer: Aetna Managed Medicare |
$146.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$339.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$261.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$250.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$276.66
|
| Rate for Payer: Cash Price |
$156.60
|
| Rate for Payer: Cigna Commercial |
$480.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$292.11
|
| Rate for Payer: Health EOS Commercial |
$464.58
|
| Rate for Payer: HFN Commercial |
$480.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$391.50
|
| Rate for Payer: Multiplan Commercial |
$417.60
|
| Rate for Payer: NAPHCARE Commercial |
$313.20
|
| Rate for Payer: Preferred Network Access Commercial |
$480.24
|
| Rate for Payer: Quartz Beloit One Network |
$255.78
|
| Rate for Payer: Quartz Commercial |
$339.30
|
| Rate for Payer: Quartz Medicare Advantage |
$313.20
|
| Rate for Payer: The Alliance Commercial |
$2,088.00
|
| Rate for Payer: WEA Trust Commercial |
$287.10
|
| Rate for Payer: WPS Commercial |
$386.65
|
|
