|
Blastomyces Antibody
|
Facility
|
OP
|
$57.00
|
|
|
Service Code
|
CPT 86612
|
| Hospital Charge Code |
5598645
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.42 |
| Max. Negotiated Rate |
$54.54 |
| Rate for Payer: Aetna Commercial |
$53.35
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$50.98
|
| Rate for Payer: Aetna Managed Medicare |
$13.42
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$50.31
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$23.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$22.27
|
| Rate for Payer: Anthem Medicare Advantage |
$13.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$31.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$13.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$13.42
|
| Rate for Payer: Cash Price |
$17.10
|
| Rate for Payer: Cash Price |
$17.10
|
| Rate for Payer: Cigna Commercial |
$54.54
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$13.42
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$33.17
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$13.42
|
| Rate for Payer: Health EOS Commercial |
$52.76
|
| Rate for Payer: HFN Commercial |
$54.54
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$49.91
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$13.42
|
| Rate for Payer: Independent Care Health Plan Medicare |
$13.42
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$13.42
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$13.42
|
| Rate for Payer: Multiplan Commercial |
$47.42
|
| Rate for Payer: NAPHCARE Commercial |
$20.12
|
| Rate for Payer: Preferred Network Access Commercial |
$54.54
|
| Rate for Payer: Quartz Beloit One Network |
$29.05
|
| Rate for Payer: Quartz Commercial |
$38.53
|
| Rate for Payer: Quartz Medicare Advantage |
$13.42
|
| Rate for Payer: The Alliance Commercial |
$53.66
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.42
|
| Rate for Payer: United Healthcare PPO |
$44.46
|
| Rate for Payer: WEA Trust Commercial |
$32.60
|
| Rate for Payer: Wellcare Medicare |
$13.42
|
| Rate for Payer: WPS Commercial |
$43.91
|
|
|
Blastomyces AntibodyCF
|
Professional
|
Both
|
$75.00
|
|
|
Service Code
|
CPT 86612
|
| Hospital Charge Code |
4392619
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.42 |
| Max. Negotiated Rate |
$74.10 |
| Rate for Payer: Aetna Commercial |
$74.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$67.08
|
| Rate for Payer: Aetna Managed Medicare |
$13.42
|
| Rate for Payer: Anthem Medicare Advantage |
$13.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$13.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$13.42
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Cigna Commercial |
$74.10
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$39.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$13.42
|
| Rate for Payer: Health EOS Commercial |
$70.98
|
| Rate for Payer: HFN Commercial |
$74.10
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$47.36
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$47.36
|
| Rate for Payer: Independent Care Health Plan Medicare |
$13.42
|
| Rate for Payer: Multiplan Commercial |
$62.40
|
| Rate for Payer: NAPHCARE Commercial |
$20.12
|
| Rate for Payer: Preferred Network Access Commercial |
$74.10
|
| Rate for Payer: Quartz Beloit One Network |
$34.32
|
| Rate for Payer: Quartz Commercial |
$44.46
|
| Rate for Payer: Quartz Medicare Advantage |
$13.42
|
| Rate for Payer: The Alliance Commercial |
$52.99
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.42
|
| Rate for Payer: WEA Trust Commercial |
$42.90
|
| Rate for Payer: WPS Commercial |
$59.03
|
|
|
Blastomyces AntibodyCF
|
Facility
|
OP
|
$75.00
|
|
|
Service Code
|
CPT 86612
|
| Hospital Charge Code |
4392619
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.42 |
| Max. Negotiated Rate |
$71.76 |
| Rate for Payer: Aetna Commercial |
$70.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$67.08
|
| Rate for Payer: Aetna Managed Medicare |
$13.42
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$50.31
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$23.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$22.27
|
| Rate for Payer: Anthem Medicare Advantage |
$13.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$41.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$13.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$13.42
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Cigna Commercial |
$71.76
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$13.42
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$43.65
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$13.42
|
| Rate for Payer: Health EOS Commercial |
$69.42
|
| Rate for Payer: HFN Commercial |
$71.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$49.91
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$13.42
|
| Rate for Payer: Independent Care Health Plan Medicare |
$13.42
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$13.42
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$13.42
|
| Rate for Payer: Multiplan Commercial |
$62.40
|
| Rate for Payer: NAPHCARE Commercial |
$20.12
|
| Rate for Payer: Preferred Network Access Commercial |
$71.76
|
| Rate for Payer: Quartz Beloit One Network |
$38.22
|
| Rate for Payer: Quartz Commercial |
$50.70
|
| Rate for Payer: Quartz Medicare Advantage |
$13.42
|
| Rate for Payer: The Alliance Commercial |
$53.66
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.42
|
| Rate for Payer: United Healthcare PPO |
$58.50
|
| Rate for Payer: WEA Trust Commercial |
$42.90
|
| Rate for Payer: Wellcare Medicare |
$13.42
|
| Rate for Payer: WPS Commercial |
$57.77
|
|
|
Blastomyces AntibodyCF
|
Facility
|
IP
|
$75.00
|
|
|
Service Code
|
CPT 86612
|
| Hospital Charge Code |
4392619
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$38.22 |
| Max. Negotiated Rate |
$71.76 |
| Rate for Payer: Aetna Commercial |
$70.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$67.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$41.34
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Cigna Commercial |
$71.76
|
| Rate for Payer: Health EOS Commercial |
$69.42
|
| Rate for Payer: HFN Commercial |
$71.76
|
| Rate for Payer: Multiplan Commercial |
$62.40
|
| Rate for Payer: Preferred Network Access Commercial |
$71.76
|
| Rate for Payer: Quartz Beloit One Network |
$38.22
|
| Rate for Payer: Quartz Commercial |
$46.80
|
| Rate for Payer: WEA Trust Commercial |
$42.90
|
| Rate for Payer: WPS Commercial |
$57.77
|
|
|
Blastomyces Antibody, CF and ID
|
Professional
|
Both
|
$92.00
|
|
|
Service Code
|
CPT 86612
|
| Hospital Charge Code |
5280687
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.42 |
| Max. Negotiated Rate |
$90.90 |
| Rate for Payer: Aetna Commercial |
$90.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$82.28
|
| Rate for Payer: Aetna Managed Medicare |
$13.42
|
| Rate for Payer: Anthem Medicare Advantage |
$13.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$13.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$13.42
|
| Rate for Payer: Cash Price |
$27.60
|
| Rate for Payer: Cash Price |
$27.60
|
| Rate for Payer: Cigna Commercial |
$90.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$47.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$13.42
|
| Rate for Payer: Health EOS Commercial |
$87.07
|
| Rate for Payer: HFN Commercial |
$90.90
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$47.36
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$47.36
|
| Rate for Payer: Independent Care Health Plan Medicare |
$13.42
|
| Rate for Payer: Multiplan Commercial |
$76.54
|
| Rate for Payer: NAPHCARE Commercial |
$20.12
|
| Rate for Payer: Preferred Network Access Commercial |
$90.90
|
| Rate for Payer: Quartz Beloit One Network |
$42.10
|
| Rate for Payer: Quartz Commercial |
$54.54
|
| Rate for Payer: Quartz Medicare Advantage |
$13.42
|
| Rate for Payer: The Alliance Commercial |
$52.99
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.42
|
| Rate for Payer: WEA Trust Commercial |
$52.62
|
| Rate for Payer: WPS Commercial |
$59.03
|
|
|
Blastomyces Antibody, CF and ID
|
Facility
|
IP
|
$92.00
|
|
|
Service Code
|
CPT 86612
|
| Hospital Charge Code |
5280687
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$46.88 |
| Max. Negotiated Rate |
$88.03 |
| Rate for Payer: Aetna Commercial |
$86.11
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$82.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$50.71
|
| Rate for Payer: Cash Price |
$27.60
|
| Rate for Payer: Cigna Commercial |
$88.03
|
| Rate for Payer: Health EOS Commercial |
$85.16
|
| Rate for Payer: HFN Commercial |
$88.03
|
| Rate for Payer: Multiplan Commercial |
$76.54
|
| Rate for Payer: Preferred Network Access Commercial |
$88.03
|
| Rate for Payer: Quartz Beloit One Network |
$46.88
|
| Rate for Payer: Quartz Commercial |
$57.41
|
| Rate for Payer: WEA Trust Commercial |
$52.62
|
| Rate for Payer: WPS Commercial |
$70.87
|
|
|
Blastomyces Antibody, CF and ID
|
Facility
|
OP
|
$92.00
|
|
|
Service Code
|
CPT 86612
|
| Hospital Charge Code |
5280687
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.42 |
| Max. Negotiated Rate |
$88.03 |
| Rate for Payer: Aetna Commercial |
$86.11
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$82.28
|
| Rate for Payer: Aetna Managed Medicare |
$13.42
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$50.31
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$23.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$22.27
|
| Rate for Payer: Anthem Medicare Advantage |
$13.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$50.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$13.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$13.42
|
| Rate for Payer: Cash Price |
$27.60
|
| Rate for Payer: Cash Price |
$27.60
|
| Rate for Payer: Cigna Commercial |
$88.03
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$13.42
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$53.54
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$13.42
|
| Rate for Payer: Health EOS Commercial |
$85.16
|
| Rate for Payer: HFN Commercial |
$88.03
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$49.91
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$13.42
|
| Rate for Payer: Independent Care Health Plan Medicare |
$13.42
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$13.42
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$13.42
|
| Rate for Payer: Multiplan Commercial |
$76.54
|
| Rate for Payer: NAPHCARE Commercial |
$20.12
|
| Rate for Payer: Preferred Network Access Commercial |
$88.03
|
| Rate for Payer: Quartz Beloit One Network |
$46.88
|
| Rate for Payer: Quartz Commercial |
$62.19
|
| Rate for Payer: Quartz Medicare Advantage |
$13.42
|
| Rate for Payer: The Alliance Commercial |
$53.66
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.42
|
| Rate for Payer: United Healthcare PPO |
$71.76
|
| Rate for Payer: WEA Trust Commercial |
$52.62
|
| Rate for Payer: Wellcare Medicare |
$13.42
|
| Rate for Payer: WPS Commercial |
$70.87
|
|
|
Blastomyces Antibody ID
|
Facility
|
IP
|
$82.00
|
|
|
Service Code
|
CPT 86612
|
| Hospital Charge Code |
5280690
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$41.79 |
| Max. Negotiated Rate |
$78.46 |
| Rate for Payer: Aetna Commercial |
$76.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$73.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$45.20
|
| Rate for Payer: Cash Price |
$24.60
|
| Rate for Payer: Cigna Commercial |
$78.46
|
| Rate for Payer: Health EOS Commercial |
$75.90
|
| Rate for Payer: HFN Commercial |
$78.46
|
| Rate for Payer: Multiplan Commercial |
$68.22
|
| Rate for Payer: Preferred Network Access Commercial |
$78.46
|
| Rate for Payer: Quartz Beloit One Network |
$41.79
|
| Rate for Payer: Quartz Commercial |
$51.17
|
| Rate for Payer: WEA Trust Commercial |
$46.90
|
| Rate for Payer: WPS Commercial |
$63.16
|
|
|
Blastomyces Antibody ID
|
Facility
|
OP
|
$82.00
|
|
|
Service Code
|
CPT 86612
|
| Hospital Charge Code |
5280690
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.42 |
| Max. Negotiated Rate |
$78.46 |
| Rate for Payer: Aetna Commercial |
$76.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$73.34
|
| Rate for Payer: Aetna Managed Medicare |
$13.42
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$50.31
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$23.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$22.27
|
| Rate for Payer: Anthem Medicare Advantage |
$13.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$45.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$13.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$13.42
|
| Rate for Payer: Cash Price |
$24.60
|
| Rate for Payer: Cash Price |
$24.60
|
| Rate for Payer: Cigna Commercial |
$78.46
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$13.42
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$47.72
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$13.42
|
| Rate for Payer: Health EOS Commercial |
$75.90
|
| Rate for Payer: HFN Commercial |
$78.46
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$49.91
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$13.42
|
| Rate for Payer: Independent Care Health Plan Medicare |
$13.42
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$13.42
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$13.42
|
| Rate for Payer: Multiplan Commercial |
$68.22
|
| Rate for Payer: NAPHCARE Commercial |
$20.12
|
| Rate for Payer: Preferred Network Access Commercial |
$78.46
|
| Rate for Payer: Quartz Beloit One Network |
$41.79
|
| Rate for Payer: Quartz Commercial |
$55.43
|
| Rate for Payer: Quartz Medicare Advantage |
$13.42
|
| Rate for Payer: The Alliance Commercial |
$53.66
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.42
|
| Rate for Payer: United Healthcare PPO |
$63.96
|
| Rate for Payer: WEA Trust Commercial |
$46.90
|
| Rate for Payer: Wellcare Medicare |
$13.42
|
| Rate for Payer: WPS Commercial |
$63.16
|
|
|
Blastomyces Antibody ID
|
Professional
|
Both
|
$82.00
|
|
|
Service Code
|
CPT 86612
|
| Hospital Charge Code |
5280690
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.42 |
| Max. Negotiated Rate |
$81.02 |
| Rate for Payer: Aetna Commercial |
$81.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$73.34
|
| Rate for Payer: Aetna Managed Medicare |
$13.42
|
| Rate for Payer: Anthem Medicare Advantage |
$13.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$13.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$13.42
|
| Rate for Payer: Cash Price |
$24.60
|
| Rate for Payer: Cash Price |
$24.60
|
| Rate for Payer: Cigna Commercial |
$81.02
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$42.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$13.42
|
| Rate for Payer: Health EOS Commercial |
$77.60
|
| Rate for Payer: HFN Commercial |
$81.02
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$47.36
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$47.36
|
| Rate for Payer: Independent Care Health Plan Medicare |
$13.42
|
| Rate for Payer: Multiplan Commercial |
$68.22
|
| Rate for Payer: NAPHCARE Commercial |
$20.12
|
| Rate for Payer: Preferred Network Access Commercial |
$81.02
|
| Rate for Payer: Quartz Beloit One Network |
$37.52
|
| Rate for Payer: Quartz Commercial |
$48.61
|
| Rate for Payer: Quartz Medicare Advantage |
$13.42
|
| Rate for Payer: The Alliance Commercial |
$52.99
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.42
|
| Rate for Payer: WEA Trust Commercial |
$46.90
|
| Rate for Payer: WPS Commercial |
$59.03
|
|
|
Blastomyces Antibody ID
|
Facility
|
IP
|
$75.00
|
|
|
Service Code
|
CPT 86612
|
| Hospital Charge Code |
4392618
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$38.22 |
| Max. Negotiated Rate |
$71.76 |
| Rate for Payer: Aetna Commercial |
$70.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$67.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$41.34
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Cigna Commercial |
$71.76
|
| Rate for Payer: Health EOS Commercial |
$69.42
|
| Rate for Payer: HFN Commercial |
$71.76
|
| Rate for Payer: Multiplan Commercial |
$62.40
|
| Rate for Payer: Preferred Network Access Commercial |
$71.76
|
| Rate for Payer: Quartz Beloit One Network |
$38.22
|
| Rate for Payer: Quartz Commercial |
$46.80
|
| Rate for Payer: WEA Trust Commercial |
$42.90
|
| Rate for Payer: WPS Commercial |
$57.77
|
|
|
Blastomyces Antibody ID
|
Facility
|
OP
|
$75.00
|
|
|
Service Code
|
CPT 86612
|
| Hospital Charge Code |
4392618
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.42 |
| Max. Negotiated Rate |
$71.76 |
| Rate for Payer: Aetna Commercial |
$70.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$67.08
|
| Rate for Payer: Aetna Managed Medicare |
$13.42
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$50.31
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$23.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$22.27
|
| Rate for Payer: Anthem Medicare Advantage |
$13.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$41.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$13.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$13.42
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Cigna Commercial |
$71.76
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$13.42
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$43.65
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$13.42
|
| Rate for Payer: Health EOS Commercial |
$69.42
|
| Rate for Payer: HFN Commercial |
$71.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$49.91
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$13.42
|
| Rate for Payer: Independent Care Health Plan Medicare |
$13.42
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$13.42
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$13.42
|
| Rate for Payer: Multiplan Commercial |
$62.40
|
| Rate for Payer: NAPHCARE Commercial |
$20.12
|
| Rate for Payer: Preferred Network Access Commercial |
$71.76
|
| Rate for Payer: Quartz Beloit One Network |
$38.22
|
| Rate for Payer: Quartz Commercial |
$50.70
|
| Rate for Payer: Quartz Medicare Advantage |
$13.42
|
| Rate for Payer: The Alliance Commercial |
$53.66
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.42
|
| Rate for Payer: United Healthcare PPO |
$58.50
|
| Rate for Payer: WEA Trust Commercial |
$42.90
|
| Rate for Payer: Wellcare Medicare |
$13.42
|
| Rate for Payer: WPS Commercial |
$57.77
|
|
|
Blastomyces Antibody ID
|
Professional
|
Both
|
$75.00
|
|
|
Service Code
|
CPT 86612
|
| Hospital Charge Code |
4392618
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.42 |
| Max. Negotiated Rate |
$74.10 |
| Rate for Payer: Aetna Commercial |
$74.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$67.08
|
| Rate for Payer: Aetna Managed Medicare |
$13.42
|
| Rate for Payer: Anthem Medicare Advantage |
$13.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$13.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$13.42
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Cigna Commercial |
$74.10
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$39.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$13.42
|
| Rate for Payer: Health EOS Commercial |
$70.98
|
| Rate for Payer: HFN Commercial |
$74.10
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$47.36
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$47.36
|
| Rate for Payer: Independent Care Health Plan Medicare |
$13.42
|
| Rate for Payer: Multiplan Commercial |
$62.40
|
| Rate for Payer: NAPHCARE Commercial |
$20.12
|
| Rate for Payer: Preferred Network Access Commercial |
$74.10
|
| Rate for Payer: Quartz Beloit One Network |
$34.32
|
| Rate for Payer: Quartz Commercial |
$44.46
|
| Rate for Payer: Quartz Medicare Advantage |
$13.42
|
| Rate for Payer: The Alliance Commercial |
$52.99
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.42
|
| Rate for Payer: WEA Trust Commercial |
$42.90
|
| Rate for Payer: WPS Commercial |
$59.03
|
|
|
Blastomyces Antibody, Immunodiffusion
|
Facility
|
OP
|
$38.00
|
|
|
Service Code
|
CPT 86612
|
| Hospital Charge Code |
4554639
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.42 |
| Max. Negotiated Rate |
$53.66 |
| Rate for Payer: Aetna Commercial |
$35.57
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$33.99
|
| Rate for Payer: Aetna Managed Medicare |
$13.42
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$50.31
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$23.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$22.27
|
| Rate for Payer: Anthem Medicare Advantage |
$13.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$20.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$13.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$13.42
|
| Rate for Payer: Cash Price |
$11.40
|
| Rate for Payer: Cash Price |
$11.40
|
| Rate for Payer: Cigna Commercial |
$36.36
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$13.42
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$22.12
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$13.42
|
| Rate for Payer: Health EOS Commercial |
$35.17
|
| Rate for Payer: HFN Commercial |
$36.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$49.91
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$13.42
|
| Rate for Payer: Independent Care Health Plan Medicare |
$13.42
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$13.42
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$13.42
|
| Rate for Payer: Multiplan Commercial |
$31.62
|
| Rate for Payer: NAPHCARE Commercial |
$20.12
|
| Rate for Payer: Preferred Network Access Commercial |
$36.36
|
| Rate for Payer: Quartz Beloit One Network |
$19.36
|
| Rate for Payer: Quartz Commercial |
$25.69
|
| Rate for Payer: Quartz Medicare Advantage |
$13.42
|
| Rate for Payer: The Alliance Commercial |
$53.66
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.42
|
| Rate for Payer: United Healthcare PPO |
$29.64
|
| Rate for Payer: WEA Trust Commercial |
$21.74
|
| Rate for Payer: Wellcare Medicare |
$13.42
|
| Rate for Payer: WPS Commercial |
$29.27
|
|
|
Blastomyces Antibody, Immunodiffusion
|
Facility
|
IP
|
$38.00
|
|
|
Service Code
|
CPT 86612
|
| Hospital Charge Code |
4554639
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$19.36 |
| Max. Negotiated Rate |
$36.36 |
| Rate for Payer: Aetna Commercial |
$35.57
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$33.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$20.95
|
| Rate for Payer: Cash Price |
$11.40
|
| Rate for Payer: Cigna Commercial |
$36.36
|
| Rate for Payer: Health EOS Commercial |
$35.17
|
| Rate for Payer: HFN Commercial |
$36.36
|
| Rate for Payer: Multiplan Commercial |
$31.62
|
| Rate for Payer: Preferred Network Access Commercial |
$36.36
|
| Rate for Payer: Quartz Beloit One Network |
$19.36
|
| Rate for Payer: Quartz Commercial |
$23.71
|
| Rate for Payer: WEA Trust Commercial |
$21.74
|
| Rate for Payer: WPS Commercial |
$29.27
|
|
|
Blastomyces Antibody, Immunodiffusion
|
Professional
|
Both
|
$38.00
|
|
|
Service Code
|
CPT 86612
|
| Hospital Charge Code |
4554639
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.42 |
| Max. Negotiated Rate |
$59.03 |
| Rate for Payer: Aetna Commercial |
$37.54
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$33.99
|
| Rate for Payer: Aetna Managed Medicare |
$13.42
|
| Rate for Payer: Anthem Medicare Advantage |
$13.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$13.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$13.42
|
| Rate for Payer: Cash Price |
$11.40
|
| Rate for Payer: Cash Price |
$11.40
|
| Rate for Payer: Cigna Commercial |
$37.54
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$19.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$13.42
|
| Rate for Payer: Health EOS Commercial |
$35.96
|
| Rate for Payer: HFN Commercial |
$37.54
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$47.36
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$47.36
|
| Rate for Payer: Independent Care Health Plan Medicare |
$13.42
|
| Rate for Payer: Multiplan Commercial |
$31.62
|
| Rate for Payer: NAPHCARE Commercial |
$20.12
|
| Rate for Payer: Preferred Network Access Commercial |
$37.54
|
| Rate for Payer: Quartz Beloit One Network |
$17.39
|
| Rate for Payer: Quartz Commercial |
$22.53
|
| Rate for Payer: Quartz Medicare Advantage |
$13.42
|
| Rate for Payer: The Alliance Commercial |
$52.99
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.42
|
| Rate for Payer: WEA Trust Commercial |
$21.74
|
| Rate for Payer: WPS Commercial |
$59.03
|
|
|
Blastomyces Quant Antigen EIA (MVista)
|
Facility
|
IP
|
$243.00
|
|
|
Service Code
|
CPT 87449
|
| Hospital Charge Code |
3256222
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$123.83 |
| Max. Negotiated Rate |
$232.50 |
| Rate for Payer: Aetna Commercial |
$227.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$217.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$133.94
|
| Rate for Payer: Cash Price |
$72.90
|
| Rate for Payer: Cigna Commercial |
$232.50
|
| Rate for Payer: Health EOS Commercial |
$224.92
|
| Rate for Payer: HFN Commercial |
$232.50
|
| Rate for Payer: Multiplan Commercial |
$202.18
|
| Rate for Payer: Preferred Network Access Commercial |
$232.50
|
| Rate for Payer: Quartz Beloit One Network |
$123.83
|
| Rate for Payer: Quartz Commercial |
$151.63
|
| Rate for Payer: WEA Trust Commercial |
$139.00
|
| Rate for Payer: WPS Commercial |
$187.18
|
|
|
Blastomyces Quant Antigen EIA (MVista)
|
Professional
|
Both
|
$243.00
|
|
|
Service Code
|
CPT 87449
|
| Hospital Charge Code |
3256222
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.46 |
| Max. Negotiated Rate |
$240.08 |
| Rate for Payer: Aetna Commercial |
$240.08
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$217.34
|
| Rate for Payer: Aetna Managed Medicare |
$12.46
|
| Rate for Payer: Anthem Medicare Advantage |
$12.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$12.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$12.46
|
| Rate for Payer: Cash Price |
$72.90
|
| Rate for Payer: Cash Price |
$72.90
|
| Rate for Payer: Cigna Commercial |
$240.08
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$126.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12.46
|
| Rate for Payer: Health EOS Commercial |
$229.98
|
| Rate for Payer: HFN Commercial |
$240.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$43.98
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$43.98
|
| Rate for Payer: Independent Care Health Plan Medicare |
$12.46
|
| Rate for Payer: Multiplan Commercial |
$202.18
|
| Rate for Payer: NAPHCARE Commercial |
$18.69
|
| Rate for Payer: Preferred Network Access Commercial |
$240.08
|
| Rate for Payer: Quartz Beloit One Network |
$111.20
|
| Rate for Payer: Quartz Commercial |
$144.05
|
| Rate for Payer: Quartz Medicare Advantage |
$12.46
|
| Rate for Payer: The Alliance Commercial |
$49.21
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.46
|
| Rate for Payer: WEA Trust Commercial |
$139.00
|
| Rate for Payer: WPS Commercial |
$54.82
|
|
|
Blastomyces Quant Antigen EIA (MVista)
|
Facility
|
OP
|
$243.00
|
|
|
Service Code
|
CPT 87449
|
| Hospital Charge Code |
3256222
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.46 |
| Max. Negotiated Rate |
$232.50 |
| Rate for Payer: Aetna Commercial |
$227.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$217.34
|
| Rate for Payer: Aetna Managed Medicare |
$12.46
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$46.72
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$21.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$20.68
|
| Rate for Payer: Anthem Medicare Advantage |
$12.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$133.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$12.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$12.46
|
| Rate for Payer: Cash Price |
$72.90
|
| Rate for Payer: Cash Price |
$72.90
|
| Rate for Payer: Cigna Commercial |
$232.50
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$12.46
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$141.43
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$12.46
|
| Rate for Payer: Health EOS Commercial |
$224.92
|
| Rate for Payer: HFN Commercial |
$232.50
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$46.35
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$12.46
|
| Rate for Payer: Independent Care Health Plan Medicare |
$12.46
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$12.46
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$12.46
|
| Rate for Payer: Multiplan Commercial |
$202.18
|
| Rate for Payer: NAPHCARE Commercial |
$18.69
|
| Rate for Payer: Preferred Network Access Commercial |
$232.50
|
| Rate for Payer: Quartz Beloit One Network |
$123.83
|
| Rate for Payer: Quartz Commercial |
$164.27
|
| Rate for Payer: Quartz Medicare Advantage |
$12.46
|
| Rate for Payer: The Alliance Commercial |
$49.84
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.46
|
| Rate for Payer: United Healthcare PPO |
$189.54
|
| Rate for Payer: WEA Trust Commercial |
$139.00
|
| Rate for Payer: Wellcare Medicare |
$12.46
|
| Rate for Payer: WPS Commercial |
$187.18
|
|
|
BL DRAW UNDER 3 YRS FEM/JUGULAR 36400
|
Professional
|
Both
|
$208.00
|
|
|
Service Code
|
CPT 36400
|
| Hospital Charge Code |
3014520
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$15.72 |
| Max. Negotiated Rate |
$205.50 |
| Rate for Payer: Aetna Commercial |
$205.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$186.04
|
| Rate for Payer: Aetna Managed Medicare |
$15.72
|
| Rate for Payer: Anthem Medicare Advantage |
$15.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$15.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$15.72
|
| Rate for Payer: Cash Price |
$62.40
|
| Rate for Payer: Cash Price |
$62.40
|
| Rate for Payer: Cash Price |
$62.40
|
| Rate for Payer: Cigna Commercial |
$205.50
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$35.58
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$15.72
|
| Rate for Payer: Health EOS Commercial |
$196.85
|
| Rate for Payer: HFN Commercial |
$205.50
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$67.07
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$67.07
|
| Rate for Payer: Independent Care Health Plan Medicare |
$15.72
|
| Rate for Payer: Multiplan Commercial |
$173.06
|
| Rate for Payer: NAPHCARE Commercial |
$23.59
|
| Rate for Payer: Preferred Network Access Commercial |
$205.50
|
| Rate for Payer: Quartz Beloit One Network |
$95.18
|
| Rate for Payer: Quartz Commercial |
$123.30
|
| Rate for Payer: Quartz Medicare Advantage |
$15.72
|
| Rate for Payer: The Alliance Commercial |
$66.83
|
| Rate for Payer: United Healthcare Medicaid |
$35.58
|
| Rate for Payer: United Healthcare Medicare Advantage |
$15.72
|
| Rate for Payer: WEA Trust Commercial |
$118.98
|
| Rate for Payer: WPS Commercial |
$70.76
|
|
|
BL DRAW UNDER 3 YRS OTHER VEIN 36406
|
Professional
|
Both
|
$168.00
|
|
|
Service Code
|
CPT 36406
|
| Hospital Charge Code |
3014522
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$7.69 |
| Max. Negotiated Rate |
$165.98 |
| Rate for Payer: Aetna Commercial |
$165.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$150.26
|
| Rate for Payer: Aetna Managed Medicare |
$7.69
|
| Rate for Payer: Anthem Medicare Advantage |
$7.69
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$7.69
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$7.69
|
| Rate for Payer: Cash Price |
$50.40
|
| Rate for Payer: Cash Price |
$50.40
|
| Rate for Payer: Cash Price |
$50.40
|
| Rate for Payer: Cigna Commercial |
$165.98
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$18.22
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$7.69
|
| Rate for Payer: Health EOS Commercial |
$159.00
|
| Rate for Payer: HFN Commercial |
$165.98
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$30.69
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$30.69
|
| Rate for Payer: Independent Care Health Plan Medicare |
$7.69
|
| Rate for Payer: Multiplan Commercial |
$139.78
|
| Rate for Payer: NAPHCARE Commercial |
$11.53
|
| Rate for Payer: Preferred Network Access Commercial |
$165.98
|
| Rate for Payer: Quartz Beloit One Network |
$76.88
|
| Rate for Payer: Quartz Commercial |
$99.59
|
| Rate for Payer: Quartz Medicare Advantage |
$7.69
|
| Rate for Payer: The Alliance Commercial |
$32.66
|
| Rate for Payer: United Healthcare Medicaid |
$18.22
|
| Rate for Payer: United Healthcare Medicare Advantage |
$7.69
|
| Rate for Payer: WEA Trust Commercial |
$96.10
|
| Rate for Payer: WPS Commercial |
$34.59
|
|
|
BLENDING CONNECTOR WITH MIXER SA-3678
|
Facility
|
IP
|
$522.00
|
|
| Hospital Charge Code |
6234193
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$266.01 |
| Max. Negotiated Rate |
$499.45 |
| Rate for Payer: Aetna Commercial |
$488.59
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$466.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$287.73
|
| Rate for Payer: Cash Price |
$156.60
|
| Rate for Payer: Cigna Commercial |
$499.45
|
| Rate for Payer: Health EOS Commercial |
$483.16
|
| Rate for Payer: HFN Commercial |
$499.45
|
| Rate for Payer: Multiplan Commercial |
$434.30
|
| Rate for Payer: Preferred Network Access Commercial |
$499.45
|
| Rate for Payer: Quartz Beloit One Network |
$266.01
|
| Rate for Payer: Quartz Commercial |
$325.73
|
| Rate for Payer: WEA Trust Commercial |
$298.58
|
| Rate for Payer: WPS Commercial |
$402.10
|
|
|
BLENDING CONNECTOR WITH MIXER SA-3678
|
Facility
|
OP
|
$522.00
|
|
| Hospital Charge Code |
6234193
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$152.01 |
| Max. Negotiated Rate |
$499.45 |
| Rate for Payer: Aetna Commercial |
$488.59
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$466.88
|
| Rate for Payer: Aetna Managed Medicare |
$152.01
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$352.87
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$271.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$260.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$287.73
|
| Rate for Payer: Cash Price |
$156.60
|
| Rate for Payer: Cigna Commercial |
$499.45
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$303.80
|
| Rate for Payer: Health EOS Commercial |
$483.16
|
| Rate for Payer: HFN Commercial |
$499.45
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$407.16
|
| Rate for Payer: Multiplan Commercial |
$434.30
|
| Rate for Payer: NAPHCARE Commercial |
$325.73
|
| Rate for Payer: Preferred Network Access Commercial |
$499.45
|
| Rate for Payer: Quartz Beloit One Network |
$266.01
|
| Rate for Payer: Quartz Commercial |
$352.87
|
| Rate for Payer: Quartz Medicare Advantage |
$325.73
|
| Rate for Payer: The Alliance Commercial |
$271.44
|
| Rate for Payer: WEA Trust Commercial |
$298.58
|
| Rate for Payer: WPS Commercial |
$402.10
|
|
|
Blenoxane 15 units Charge
|
Facility
|
OP
|
$270.00
|
|
|
Service Code
|
HCPCS J9040
|
| Hospital Charge Code |
2958921
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$31.81 |
| Max. Negotiated Rate |
$258.34 |
| Rate for Payer: Aetna Commercial |
$252.72
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$241.49
|
| Rate for Payer: Aetna Managed Medicare |
$78.62
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$182.52
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$140.40
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$134.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$148.82
|
| Rate for Payer: Cash Price |
$81.00
|
| Rate for Payer: Cash Price |
$81.00
|
| Rate for Payer: Cigna Commercial |
$258.34
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$31.81
|
| Rate for Payer: Health EOS Commercial |
$249.91
|
| Rate for Payer: HFN Commercial |
$258.34
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$210.60
|
| Rate for Payer: Multiplan Commercial |
$224.64
|
| Rate for Payer: NAPHCARE Commercial |
$168.48
|
| Rate for Payer: Preferred Network Access Commercial |
$258.34
|
| Rate for Payer: Quartz Beloit One Network |
$137.59
|
| Rate for Payer: Quartz Commercial |
$182.52
|
| Rate for Payer: Quartz Medicare Advantage |
$168.48
|
| Rate for Payer: The Alliance Commercial |
$95.76
|
| Rate for Payer: WEA Trust Commercial |
$154.44
|
| Rate for Payer: WPS Commercial |
$60.11
|
|
|
Blenoxane 15 units Charge
|
Facility
|
IP
|
$270.00
|
|
|
Service Code
|
HCPCS J9040
|
| Hospital Charge Code |
2958921
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$137.59 |
| Max. Negotiated Rate |
$258.34 |
| Rate for Payer: Aetna Commercial |
$252.72
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$241.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$148.82
|
| Rate for Payer: Cash Price |
$81.00
|
| Rate for Payer: Cigna Commercial |
$258.34
|
| Rate for Payer: Health EOS Commercial |
$249.91
|
| Rate for Payer: HFN Commercial |
$258.34
|
| Rate for Payer: Multiplan Commercial |
$224.64
|
| Rate for Payer: Preferred Network Access Commercial |
$258.34
|
| Rate for Payer: Quartz Beloit One Network |
$137.59
|
| Rate for Payer: Quartz Commercial |
$168.48
|
| Rate for Payer: WEA Trust Commercial |
$154.44
|
| Rate for Payer: WPS Commercial |
$207.98
|
|
