|
Chromosome Analysis, 20-25 Cells
|
Facility
OP
|
$190.00
|
|
|
Service Code
|
CPT 88264
|
| Hospital Charge Code |
3313615
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$93.10 |
| Max. Negotiated Rate |
$760.00 |
| Rate for Payer: Aetna Commercial |
$171.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$163.40
|
| Rate for Payer: Aetna Managed Medicare |
$144.61
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$542.29
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$253.07
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$240.05
|
| Rate for Payer: Anthem Medicaid |
$149.43
|
| Rate for Payer: Anthem Medicare Advantage |
$144.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$100.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$144.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$144.61
|
| Rate for Payer: Cash Price |
$57.00
|
| Rate for Payer: Cash Price |
$57.00
|
| Rate for Payer: Cigna Commercial |
$174.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$144.61
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$149.43
|
| Rate for Payer: Dean Health Medicaid |
$149.43
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$144.61
|
| Rate for Payer: Health EOS Commercial |
$169.10
|
| Rate for Payer: HFN Commercial |
$174.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$537.95
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$144.61
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$149.43
|
| Rate for Payer: Independent Care Health Plan Medicare |
$144.61
|
| Rate for Payer: Managed Health Services Medicaid |
$155.41
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$144.61
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$144.61
|
| Rate for Payer: Multiplan Commercial |
$152.00
|
| Rate for Payer: NAPHCARE Commercial |
$216.92
|
| Rate for Payer: Preferred Network Access Commercial |
$174.80
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$149.43
|
| Rate for Payer: Quartz Beloit One Network |
$93.10
|
| Rate for Payer: Quartz Commercial |
$123.50
|
| Rate for Payer: Quartz Medicare Advantage |
$144.61
|
| Rate for Payer: The Alliance Commercial |
$760.00
|
| Rate for Payer: United Healthcare Medicaid |
$149.43
|
| Rate for Payer: United Healthcare Medicare Advantage |
$144.61
|
| Rate for Payer: United Healthcare PPO |
$142.50
|
| Rate for Payer: WEA Trust Commercial |
$104.50
|
| Rate for Payer: Wellcare Medicare |
$144.61
|
| Rate for Payer: WMAP Medicaid |
$149.43
|
| Rate for Payer: WPS Commercial |
$140.73
|
|
|
Chromosome Analysis, 20-25 Cells
|
Facility
IP
|
$190.00
|
|
|
Service Code
|
CPT 88264
|
| Hospital Charge Code |
3313615
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$93.10 |
| Max. Negotiated Rate |
$174.80 |
| Rate for Payer: Aetna Commercial |
$171.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$100.70
|
| Rate for Payer: Cash Price |
$57.00
|
| Rate for Payer: Cigna Commercial |
$174.80
|
| Rate for Payer: Health EOS Commercial |
$169.10
|
| Rate for Payer: HFN Commercial |
$174.80
|
| Rate for Payer: Multiplan Commercial |
$152.00
|
| Rate for Payer: NAPHCARE Commercial |
$114.00
|
| Rate for Payer: Preferred Network Access Commercial |
$174.80
|
| Rate for Payer: Quartz Beloit One Network |
$93.10
|
| Rate for Payer: Quartz Commercial |
$114.00
|
| Rate for Payer: WEA Trust Commercial |
$104.50
|
| Rate for Payer: WPS Commercial |
$140.73
|
|
|
Chromosome Analysis Add Cells
|
Facility
OP
|
$638.00
|
|
|
Service Code
|
CPT 88280
|
| Hospital Charge Code |
2792804
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$33.47 |
| Max. Negotiated Rate |
$2,552.00 |
| Rate for Payer: Aetna Commercial |
$574.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$548.68
|
| Rate for Payer: Aetna Managed Medicare |
$33.47
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$125.51
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$58.57
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$55.56
|
| Rate for Payer: Anthem Medicaid |
$34.58
|
| Rate for Payer: Anthem Medicare Advantage |
$33.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$338.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$33.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$33.47
|
| Rate for Payer: Cash Price |
$191.40
|
| Rate for Payer: Cash Price |
$191.40
|
| Rate for Payer: Cigna Commercial |
$586.96
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$33.47
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$34.58
|
| Rate for Payer: Dean Health Medicaid |
$34.58
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$33.47
|
| Rate for Payer: Health EOS Commercial |
$567.82
|
| Rate for Payer: HFN Commercial |
$586.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$124.51
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$33.47
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$34.58
|
| Rate for Payer: Independent Care Health Plan Medicare |
$33.47
|
| Rate for Payer: Managed Health Services Medicaid |
$35.96
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$33.47
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$33.47
|
| Rate for Payer: Multiplan Commercial |
$510.40
|
| Rate for Payer: NAPHCARE Commercial |
$50.20
|
| Rate for Payer: Preferred Network Access Commercial |
$586.96
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$34.58
|
| Rate for Payer: Quartz Beloit One Network |
$312.62
|
| Rate for Payer: Quartz Commercial |
$414.70
|
| Rate for Payer: Quartz Medicare Advantage |
$33.47
|
| Rate for Payer: The Alliance Commercial |
$2,552.00
|
| Rate for Payer: United Healthcare Medicaid |
$34.58
|
| Rate for Payer: United Healthcare Medicare Advantage |
$33.47
|
| Rate for Payer: United Healthcare PPO |
$478.50
|
| Rate for Payer: WEA Trust Commercial |
$350.90
|
| Rate for Payer: Wellcare Medicare |
$33.47
|
| Rate for Payer: WMAP Medicaid |
$34.58
|
| Rate for Payer: WPS Commercial |
$472.57
|
|
|
Chromosome Analysis Add Cells
|
Facility
IP
|
$638.00
|
|
|
Service Code
|
CPT 88280
|
| Hospital Charge Code |
2792804
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$312.62 |
| Max. Negotiated Rate |
$586.96 |
| Rate for Payer: Aetna Commercial |
$574.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$338.14
|
| Rate for Payer: Cash Price |
$191.40
|
| Rate for Payer: Cigna Commercial |
$586.96
|
| Rate for Payer: Health EOS Commercial |
$567.82
|
| Rate for Payer: HFN Commercial |
$586.96
|
| Rate for Payer: Multiplan Commercial |
$510.40
|
| Rate for Payer: NAPHCARE Commercial |
$382.80
|
| Rate for Payer: Preferred Network Access Commercial |
$586.96
|
| Rate for Payer: Quartz Beloit One Network |
$312.62
|
| Rate for Payer: Quartz Commercial |
$382.80
|
| Rate for Payer: WEA Trust Commercial |
$350.90
|
| Rate for Payer: WPS Commercial |
$472.57
|
|
|
Chromosome Analysis Add Cells
|
Professional
|
$638.00
|
|
|
Service Code
|
CPT 88280
|
| Hospital Charge Code |
2792804
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$33.47 |
| Max. Negotiated Rate |
$606.10 |
| Rate for Payer: Aetna Commercial |
$606.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$548.68
|
| Rate for Payer: Aetna Managed Medicare |
$33.47
|
| Rate for Payer: Anthem Medicare Advantage |
$33.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$33.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$33.47
|
| Rate for Payer: Cash Price |
$191.40
|
| Rate for Payer: Cash Price |
$191.40
|
| Rate for Payer: Cigna Commercial |
$606.10
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$319.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$33.47
|
| Rate for Payer: Health EOS Commercial |
$580.58
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$118.15
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$118.15
|
| Rate for Payer: Independent Care Health Plan Medicare |
$33.47
|
| Rate for Payer: Multiplan Commercial |
$510.40
|
| Rate for Payer: Preferred Network Access Commercial |
$606.10
|
| Rate for Payer: Quartz Beloit One Network |
$280.72
|
| Rate for Payer: Quartz Commercial |
$363.66
|
| Rate for Payer: Quartz Medicare Advantage |
$33.47
|
| Rate for Payer: The Alliance Commercial |
$132.21
|
| Rate for Payer: United Healthcare Medicare Advantage |
$33.47
|
| Rate for Payer: WEA Trust Commercial |
$350.90
|
| Rate for Payer: WPS Commercial |
$147.27
|
|
|
Chromosome Analysis Analyze 20
|
Facility
IP
|
$1,947.00
|
|
|
Service Code
|
CPT 88264
|
| Hospital Charge Code |
2792805
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$954.03 |
| Max. Negotiated Rate |
$1,791.24 |
| Rate for Payer: Aetna Commercial |
$1,752.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,031.91
|
| Rate for Payer: Cash Price |
$584.10
|
| Rate for Payer: Cigna Commercial |
$1,791.24
|
| Rate for Payer: Health EOS Commercial |
$1,732.83
|
| Rate for Payer: HFN Commercial |
$1,791.24
|
| Rate for Payer: Multiplan Commercial |
$1,557.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,168.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,791.24
|
| Rate for Payer: Quartz Beloit One Network |
$954.03
|
| Rate for Payer: Quartz Commercial |
$1,168.20
|
| Rate for Payer: WEA Trust Commercial |
$1,070.85
|
| Rate for Payer: WPS Commercial |
$1,442.14
|
|
|
Chromosome Analysis Analyze 20
|
Professional
|
$1,947.00
|
|
|
Service Code
|
CPT 88264
|
| Hospital Charge Code |
2792805
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$144.61 |
| Max. Negotiated Rate |
$1,849.65 |
| Rate for Payer: Aetna Commercial |
$1,849.65
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,674.42
|
| Rate for Payer: Aetna Managed Medicare |
$144.61
|
| Rate for Payer: Anthem Medicare Advantage |
$144.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$144.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$144.61
|
| Rate for Payer: Cash Price |
$584.10
|
| Rate for Payer: Cash Price |
$584.10
|
| Rate for Payer: Cigna Commercial |
$1,849.65
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$973.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$144.61
|
| Rate for Payer: Health EOS Commercial |
$1,771.77
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$510.47
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$510.47
|
| Rate for Payer: Independent Care Health Plan Medicare |
$144.61
|
| Rate for Payer: Multiplan Commercial |
$1,557.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,849.65
|
| Rate for Payer: Quartz Beloit One Network |
$856.68
|
| Rate for Payer: Quartz Commercial |
$1,109.79
|
| Rate for Payer: Quartz Medicare Advantage |
$144.61
|
| Rate for Payer: The Alliance Commercial |
$571.21
|
| Rate for Payer: United Healthcare Medicare Advantage |
$144.61
|
| Rate for Payer: WEA Trust Commercial |
$1,070.85
|
| Rate for Payer: WPS Commercial |
$636.28
|
|
|
Chromosome Analysis Analyze 20
|
Facility
OP
|
$1,947.00
|
|
|
Service Code
|
CPT 88264
|
| Hospital Charge Code |
2792805
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$144.61 |
| Max. Negotiated Rate |
$7,788.00 |
| Rate for Payer: Aetna Commercial |
$1,752.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,674.42
|
| Rate for Payer: Aetna Managed Medicare |
$144.61
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$542.29
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$253.07
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$240.05
|
| Rate for Payer: Anthem Medicaid |
$149.43
|
| Rate for Payer: Anthem Medicare Advantage |
$144.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,031.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$144.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$144.61
|
| Rate for Payer: Cash Price |
$584.10
|
| Rate for Payer: Cash Price |
$584.10
|
| Rate for Payer: Cigna Commercial |
$1,791.24
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$144.61
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$149.43
|
| Rate for Payer: Dean Health Medicaid |
$149.43
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$144.61
|
| Rate for Payer: Health EOS Commercial |
$1,732.83
|
| Rate for Payer: HFN Commercial |
$1,791.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$537.95
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$144.61
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$149.43
|
| Rate for Payer: Independent Care Health Plan Medicare |
$144.61
|
| Rate for Payer: Managed Health Services Medicaid |
$155.41
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$144.61
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$144.61
|
| Rate for Payer: Multiplan Commercial |
$1,557.60
|
| Rate for Payer: NAPHCARE Commercial |
$216.92
|
| Rate for Payer: Preferred Network Access Commercial |
$1,791.24
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$149.43
|
| Rate for Payer: Quartz Beloit One Network |
$954.03
|
| Rate for Payer: Quartz Commercial |
$1,265.55
|
| Rate for Payer: Quartz Medicare Advantage |
$144.61
|
| Rate for Payer: The Alliance Commercial |
$7,788.00
|
| Rate for Payer: United Healthcare Medicaid |
$149.43
|
| Rate for Payer: United Healthcare Medicare Advantage |
$144.61
|
| Rate for Payer: United Healthcare PPO |
$1,460.25
|
| Rate for Payer: WEA Trust Commercial |
$1,070.85
|
| Rate for Payer: Wellcare Medicare |
$144.61
|
| Rate for Payer: WMAP Medicaid |
$149.43
|
| Rate for Payer: WPS Commercial |
$1,442.14
|
|
|
Chromosome Analysis, CT 15-20
|
Professional
|
$3,921.00
|
|
|
Service Code
|
CPT 88262
|
| Hospital Charge Code |
2794799
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$125.49 |
| Max. Negotiated Rate |
$3,724.95 |
| Rate for Payer: Aetna Commercial |
$3,724.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,372.06
|
| Rate for Payer: Aetna Managed Medicare |
$125.49
|
| Rate for Payer: Anthem Medicare Advantage |
$125.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$125.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$125.49
|
| Rate for Payer: Cash Price |
$1,176.30
|
| Rate for Payer: Cash Price |
$1,176.30
|
| Rate for Payer: Cigna Commercial |
$3,724.95
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,960.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$125.49
|
| Rate for Payer: Health EOS Commercial |
$3,568.11
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$442.98
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$442.98
|
| Rate for Payer: Independent Care Health Plan Medicare |
$125.49
|
| Rate for Payer: Multiplan Commercial |
$3,136.80
|
| Rate for Payer: Preferred Network Access Commercial |
$3,724.95
|
| Rate for Payer: Quartz Beloit One Network |
$1,725.24
|
| Rate for Payer: Quartz Commercial |
$2,234.97
|
| Rate for Payer: Quartz Medicare Advantage |
$125.49
|
| Rate for Payer: The Alliance Commercial |
$495.69
|
| Rate for Payer: United Healthcare Medicare Advantage |
$125.49
|
| Rate for Payer: WEA Trust Commercial |
$2,156.55
|
| Rate for Payer: WPS Commercial |
$552.16
|
|
|
Chromosome Analysis, CT 15-20
|
Facility
OP
|
$3,921.00
|
|
|
Service Code
|
CPT 88262
|
| Hospital Charge Code |
2794799
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$125.49 |
| Max. Negotiated Rate |
$15,684.00 |
| Rate for Payer: Aetna Commercial |
$3,528.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,372.06
|
| Rate for Payer: Aetna Managed Medicare |
$125.49
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$470.59
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$219.61
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$208.31
|
| Rate for Payer: Anthem Medicaid |
$129.67
|
| Rate for Payer: Anthem Medicare Advantage |
$125.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,078.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$125.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$125.49
|
| Rate for Payer: Cash Price |
$1,176.30
|
| Rate for Payer: Cash Price |
$1,176.30
|
| Rate for Payer: Cigna Commercial |
$3,607.32
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$125.49
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$129.67
|
| Rate for Payer: Dean Health Medicaid |
$129.67
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$125.49
|
| Rate for Payer: Health EOS Commercial |
$3,489.69
|
| Rate for Payer: HFN Commercial |
$3,607.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$466.82
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$125.49
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$129.67
|
| Rate for Payer: Independent Care Health Plan Medicare |
$125.49
|
| Rate for Payer: Managed Health Services Medicaid |
$134.86
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$125.49
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$125.49
|
| Rate for Payer: Multiplan Commercial |
$3,136.80
|
| Rate for Payer: NAPHCARE Commercial |
$188.24
|
| Rate for Payer: Preferred Network Access Commercial |
$3,607.32
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$129.67
|
| Rate for Payer: Quartz Beloit One Network |
$1,921.29
|
| Rate for Payer: Quartz Commercial |
$2,548.65
|
| Rate for Payer: Quartz Medicare Advantage |
$125.49
|
| Rate for Payer: The Alliance Commercial |
$15,684.00
|
| Rate for Payer: United Healthcare Medicaid |
$129.67
|
| Rate for Payer: United Healthcare Medicare Advantage |
$125.49
|
| Rate for Payer: United Healthcare PPO |
$2,940.75
|
| Rate for Payer: WEA Trust Commercial |
$2,156.55
|
| Rate for Payer: Wellcare Medicare |
$125.49
|
| Rate for Payer: WMAP Medicaid |
$129.67
|
| Rate for Payer: WPS Commercial |
$2,904.28
|
|
|
Chromosome Analysis, CT 15-20
|
Facility
IP
|
$3,921.00
|
|
|
Service Code
|
CPT 88262
|
| Hospital Charge Code |
2794799
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$1,921.29 |
| Max. Negotiated Rate |
$3,607.32 |
| Rate for Payer: Aetna Commercial |
$3,528.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,078.13
|
| Rate for Payer: Cash Price |
$1,176.30
|
| Rate for Payer: Cigna Commercial |
$3,607.32
|
| Rate for Payer: Health EOS Commercial |
$3,489.69
|
| Rate for Payer: HFN Commercial |
$3,607.32
|
| Rate for Payer: Multiplan Commercial |
$3,136.80
|
| Rate for Payer: NAPHCARE Commercial |
$2,352.60
|
| Rate for Payer: Preferred Network Access Commercial |
$3,607.32
|
| Rate for Payer: Quartz Beloit One Network |
$1,921.29
|
| Rate for Payer: Quartz Commercial |
$2,352.60
|
| Rate for Payer: WEA Trust Commercial |
$2,156.55
|
| Rate for Payer: WPS Commercial |
$2,904.28
|
|
|
Chromosome Analysis, Interp & Report
|
Professional
|
$341.00
|
|
|
Service Code
|
CPT 88291
|
| Hospital Charge Code |
3313616
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.66 |
| Max. Negotiated Rate |
$323.95 |
| Rate for Payer: Aetna Commercial |
$323.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$293.26
|
| Rate for Payer: Aetna Managed Medicare |
$31.36
|
| Rate for Payer: Anthem Commercial |
$5.66
|
| Rate for Payer: Anthem Medicare Advantage |
$31.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$31.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$31.36
|
| Rate for Payer: Cash Price |
$102.30
|
| Rate for Payer: Cash Price |
$102.30
|
| Rate for Payer: Cigna Commercial |
$323.95
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$170.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$31.36
|
| Rate for Payer: Health EOS Commercial |
$310.31
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$113.07
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$113.07
|
| Rate for Payer: Independent Care Health Plan Medicare |
$31.36
|
| Rate for Payer: Multiplan Commercial |
$272.80
|
| Rate for Payer: Preferred Network Access Commercial |
$323.95
|
| Rate for Payer: Quartz Beloit One Network |
$150.04
|
| Rate for Payer: Quartz Commercial |
$194.37
|
| Rate for Payer: Quartz Medicare Advantage |
$31.36
|
| Rate for Payer: The Alliance Commercial |
$123.87
|
| Rate for Payer: United Healthcare Medicare Advantage |
$31.36
|
| Rate for Payer: WEA Trust Commercial |
$187.55
|
| Rate for Payer: WPS Commercial |
$137.98
|
|
|
Chromosome Analysis, Interp & Report
|
Facility
OP
|
$341.00
|
|
|
Service Code
|
CPT 88291
|
| Hospital Charge Code |
3313616
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$95.48 |
| Max. Negotiated Rate |
$1,364.00 |
| Rate for Payer: Aetna Commercial |
$306.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$293.26
|
| Rate for Payer: Aetna Managed Medicare |
$95.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$221.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$170.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$163.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$180.73
|
| Rate for Payer: Cash Price |
$102.30
|
| Rate for Payer: Cash Price |
$102.30
|
| Rate for Payer: Cigna Commercial |
$313.72
|
| Rate for Payer: Health EOS Commercial |
$303.49
|
| Rate for Payer: HFN Commercial |
$313.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$255.75
|
| Rate for Payer: Multiplan Commercial |
$272.80
|
| Rate for Payer: NAPHCARE Commercial |
$204.60
|
| Rate for Payer: Preferred Network Access Commercial |
$313.72
|
| Rate for Payer: Quartz Beloit One Network |
$167.09
|
| Rate for Payer: Quartz Commercial |
$221.65
|
| Rate for Payer: Quartz Medicare Advantage |
$204.60
|
| Rate for Payer: The Alliance Commercial |
$1,364.00
|
| Rate for Payer: United Healthcare PPO |
$255.75
|
| Rate for Payer: WEA Trust Commercial |
$187.55
|
| Rate for Payer: WPS Commercial |
$252.58
|
|
|
Chromosome Analysis, Interp & Report
|
Facility
IP
|
$341.00
|
|
|
Service Code
|
CPT 88291
|
| Hospital Charge Code |
3313616
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$167.09 |
| Max. Negotiated Rate |
$313.72 |
| Rate for Payer: Aetna Commercial |
$306.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$180.73
|
| Rate for Payer: Cash Price |
$102.30
|
| Rate for Payer: Cigna Commercial |
$313.72
|
| Rate for Payer: Health EOS Commercial |
$303.49
|
| Rate for Payer: HFN Commercial |
$313.72
|
| Rate for Payer: Multiplan Commercial |
$272.80
|
| Rate for Payer: NAPHCARE Commercial |
$204.60
|
| Rate for Payer: Preferred Network Access Commercial |
$313.72
|
| Rate for Payer: Quartz Beloit One Network |
$167.09
|
| Rate for Payer: Quartz Commercial |
$204.60
|
| Rate for Payer: WEA Trust Commercial |
$187.55
|
| Rate for Payer: WPS Commercial |
$252.58
|
|
|
Chromosome Analysis Karyotype
|
Professional
|
$518.00
|
|
|
Service Code
|
CPT 88262
|
| Hospital Charge Code |
4722606
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$125.49 |
| Max. Negotiated Rate |
$552.16 |
| Rate for Payer: Aetna Commercial |
$492.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$445.48
|
| Rate for Payer: Aetna Managed Medicare |
$125.49
|
| Rate for Payer: Anthem Medicare Advantage |
$125.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$125.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$125.49
|
| Rate for Payer: Cash Price |
$155.40
|
| Rate for Payer: Cash Price |
$155.40
|
| Rate for Payer: Cigna Commercial |
$492.10
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$259.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$125.49
|
| Rate for Payer: Health EOS Commercial |
$471.38
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$442.98
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$442.98
|
| Rate for Payer: Independent Care Health Plan Medicare |
$125.49
|
| Rate for Payer: Multiplan Commercial |
$414.40
|
| Rate for Payer: Preferred Network Access Commercial |
$492.10
|
| Rate for Payer: Quartz Beloit One Network |
$227.92
|
| Rate for Payer: Quartz Commercial |
$295.26
|
| Rate for Payer: Quartz Medicare Advantage |
$125.49
|
| Rate for Payer: The Alliance Commercial |
$495.69
|
| Rate for Payer: United Healthcare Medicare Advantage |
$125.49
|
| Rate for Payer: WEA Trust Commercial |
$284.90
|
| Rate for Payer: WPS Commercial |
$552.16
|
|
|
Chromosome Analysis Karyotype
|
Facility
OP
|
$518.00
|
|
|
Service Code
|
CPT 88262
|
| Hospital Charge Code |
4722606
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$125.49 |
| Max. Negotiated Rate |
$2,072.00 |
| Rate for Payer: Aetna Commercial |
$466.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$445.48
|
| Rate for Payer: Aetna Managed Medicare |
$125.49
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$470.59
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$219.61
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$208.31
|
| Rate for Payer: Anthem Medicaid |
$129.67
|
| Rate for Payer: Anthem Medicare Advantage |
$125.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$274.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$125.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$125.49
|
| Rate for Payer: Cash Price |
$155.40
|
| Rate for Payer: Cash Price |
$155.40
|
| Rate for Payer: Cigna Commercial |
$476.56
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$125.49
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$129.67
|
| Rate for Payer: Dean Health Medicaid |
$129.67
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$125.49
|
| Rate for Payer: Health EOS Commercial |
$461.02
|
| Rate for Payer: HFN Commercial |
$476.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$466.82
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$125.49
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$129.67
|
| Rate for Payer: Independent Care Health Plan Medicare |
$125.49
|
| Rate for Payer: Managed Health Services Medicaid |
$134.86
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$125.49
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$125.49
|
| Rate for Payer: Multiplan Commercial |
$414.40
|
| Rate for Payer: NAPHCARE Commercial |
$188.24
|
| Rate for Payer: Preferred Network Access Commercial |
$476.56
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$129.67
|
| Rate for Payer: Quartz Beloit One Network |
$253.82
|
| Rate for Payer: Quartz Commercial |
$336.70
|
| Rate for Payer: Quartz Medicare Advantage |
$125.49
|
| Rate for Payer: The Alliance Commercial |
$2,072.00
|
| Rate for Payer: United Healthcare Medicaid |
$129.67
|
| Rate for Payer: United Healthcare Medicare Advantage |
$125.49
|
| Rate for Payer: United Healthcare PPO |
$388.50
|
| Rate for Payer: WEA Trust Commercial |
$284.90
|
| Rate for Payer: Wellcare Medicare |
$125.49
|
| Rate for Payer: WMAP Medicaid |
$129.67
|
| Rate for Payer: WPS Commercial |
$383.68
|
|
|
Chromosome Analysis Karyotype
|
Facility
IP
|
$518.00
|
|
|
Service Code
|
CPT 88262
|
| Hospital Charge Code |
4722606
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$253.82 |
| Max. Negotiated Rate |
$476.56 |
| Rate for Payer: Aetna Commercial |
$466.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$274.54
|
| Rate for Payer: Cash Price |
$155.40
|
| Rate for Payer: Cigna Commercial |
$476.56
|
| Rate for Payer: Health EOS Commercial |
$461.02
|
| Rate for Payer: HFN Commercial |
$476.56
|
| Rate for Payer: Multiplan Commercial |
$414.40
|
| Rate for Payer: NAPHCARE Commercial |
$310.80
|
| Rate for Payer: Preferred Network Access Commercial |
$476.56
|
| Rate for Payer: Quartz Beloit One Network |
$253.82
|
| Rate for Payer: Quartz Commercial |
$310.80
|
| Rate for Payer: WEA Trust Commercial |
$284.90
|
| Rate for Payer: WPS Commercial |
$383.68
|
|
|
Chromosomes, DEB Assay for Fanconi Anemia
|
Facility
IP
|
$452.00
|
|
|
Service Code
|
CPT 88230
|
| Hospital Charge Code |
4125582
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$221.48 |
| Max. Negotiated Rate |
$415.84 |
| Rate for Payer: Aetna Commercial |
$406.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$239.56
|
| Rate for Payer: Cash Price |
$135.60
|
| Rate for Payer: Cigna Commercial |
$415.84
|
| Rate for Payer: Health EOS Commercial |
$402.28
|
| Rate for Payer: HFN Commercial |
$415.84
|
| Rate for Payer: Multiplan Commercial |
$361.60
|
| Rate for Payer: NAPHCARE Commercial |
$271.20
|
| Rate for Payer: Preferred Network Access Commercial |
$415.84
|
| Rate for Payer: Quartz Beloit One Network |
$221.48
|
| Rate for Payer: Quartz Commercial |
$271.20
|
| Rate for Payer: WEA Trust Commercial |
$248.60
|
| Rate for Payer: WPS Commercial |
$334.80
|
|
|
Chromosomes, DEB Assay for Fanconi Anemia
|
Professional
|
$452.00
|
|
|
Service Code
|
CPT 88230
|
| Hospital Charge Code |
4125582
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$116.49 |
| Max. Negotiated Rate |
$512.56 |
| Rate for Payer: Aetna Commercial |
$429.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$388.72
|
| Rate for Payer: Aetna Managed Medicare |
$116.49
|
| Rate for Payer: Anthem Medicare Advantage |
$116.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$116.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$116.49
|
| Rate for Payer: Cash Price |
$135.60
|
| Rate for Payer: Cash Price |
$135.60
|
| Rate for Payer: Cigna Commercial |
$429.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$226.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$116.49
|
| Rate for Payer: Health EOS Commercial |
$411.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$411.21
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$411.21
|
| Rate for Payer: Independent Care Health Plan Medicare |
$116.49
|
| Rate for Payer: Multiplan Commercial |
$361.60
|
| Rate for Payer: Preferred Network Access Commercial |
$429.40
|
| Rate for Payer: Quartz Beloit One Network |
$198.88
|
| Rate for Payer: Quartz Commercial |
$257.64
|
| Rate for Payer: Quartz Medicare Advantage |
$116.49
|
| Rate for Payer: The Alliance Commercial |
$460.14
|
| Rate for Payer: United Healthcare Medicare Advantage |
$116.49
|
| Rate for Payer: WEA Trust Commercial |
$248.60
|
| Rate for Payer: WPS Commercial |
$512.56
|
|
|
Chromosomes, DEB Assay for Fanconi Anemia
|
Facility
OP
|
$452.00
|
|
|
Service Code
|
CPT 88230
|
| Hospital Charge Code |
4125582
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$70.04 |
| Max. Negotiated Rate |
$1,808.00 |
| Rate for Payer: The Alliance Commercial |
$1,808.00
|
| Rate for Payer: Aetna Commercial |
$406.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$388.72
|
| Rate for Payer: Aetna Managed Medicare |
$116.49
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$436.84
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$203.86
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$193.37
|
| Rate for Payer: Anthem Medicaid |
$70.04
|
| Rate for Payer: Anthem Medicare Advantage |
$116.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$239.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$116.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$116.49
|
| Rate for Payer: Cash Price |
$135.60
|
| Rate for Payer: Cash Price |
$135.60
|
| Rate for Payer: Cigna Commercial |
$415.84
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$116.49
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$70.04
|
| Rate for Payer: Dean Health Medicaid |
$70.04
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$116.49
|
| Rate for Payer: Health EOS Commercial |
$402.28
|
| Rate for Payer: HFN Commercial |
$415.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$433.34
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$116.49
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$70.04
|
| Rate for Payer: Independent Care Health Plan Medicare |
$116.49
|
| Rate for Payer: Managed Health Services Medicaid |
$72.84
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$116.49
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$116.49
|
| Rate for Payer: Multiplan Commercial |
$361.60
|
| Rate for Payer: NAPHCARE Commercial |
$174.74
|
| Rate for Payer: Preferred Network Access Commercial |
$415.84
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$70.04
|
| Rate for Payer: Quartz Beloit One Network |
$221.48
|
| Rate for Payer: Quartz Commercial |
$293.80
|
| Rate for Payer: Quartz Medicare Advantage |
$116.49
|
| Rate for Payer: United Healthcare Medicaid |
$70.04
|
| Rate for Payer: United Healthcare Medicare Advantage |
$116.49
|
| Rate for Payer: United Healthcare PPO |
$339.00
|
| Rate for Payer: WEA Trust Commercial |
$248.60
|
| Rate for Payer: Wellcare Medicare |
$116.49
|
| Rate for Payer: WMAP Medicaid |
$70.04
|
| Rate for Payer: WPS Commercial |
$334.80
|
|
|
CHROMOTUBATION OF OVIDUCT, INCLUDING MATERIALS
|
Facility
OP
|
$18,288.45
|
|
|
Service Code
|
CPT 58350
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4,218.22 |
| Max. Negotiated Rate |
$18,288.45 |
| Rate for Payer: Aetna Managed Medicare |
$4,916.25
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$12,238.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$10,914.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$10,367.00
|
| Rate for Payer: Anthem Medicare Advantage |
$4,916.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$4,916.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$4,916.25
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$4,916.25
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,218.22
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$4,916.25
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$18,288.45
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$4,916.25
|
| Rate for Payer: Independent Care Health Plan Medicare |
$4,916.25
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$4,916.25
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$4,916.25
|
| Rate for Payer: NAPHCARE Commercial |
$7,374.38
|
| Rate for Payer: Quartz Medicare Advantage |
$4,916.25
|
| Rate for Payer: The Alliance Commercial |
$8,881.40
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4,916.25
|
| Rate for Payer: United Healthcare PPO |
$4,240.00
|
| Rate for Payer: Wellcare Medicare |
$4,916.25
|
|
|
Chronic Care Management 20 min 99490
|
Professional
|
$135.00
|
|
|
Service Code
|
CPT 99490
|
| Hospital Charge Code |
4596801
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$48.15 |
| Max. Negotiated Rate |
$132.41 |
| Rate for Payer: Aetna Commercial |
$128.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$116.10
|
| Rate for Payer: Aetna Managed Medicare |
$48.15
|
| Rate for Payer: Anthem Medicare Advantage |
$48.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$48.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$48.15
|
| Rate for Payer: Cash Price |
$40.50
|
| Rate for Payer: Cash Price |
$40.50
|
| Rate for Payer: Cigna Commercial |
$128.25
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$67.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$48.15
|
| Rate for Payer: Health EOS Commercial |
$122.85
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$106.75
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$106.75
|
| Rate for Payer: Independent Care Health Plan Medicare |
$48.15
|
| Rate for Payer: Multiplan Commercial |
$108.00
|
| Rate for Payer: Preferred Network Access Commercial |
$128.25
|
| Rate for Payer: Quartz Beloit One Network |
$59.40
|
| Rate for Payer: Quartz Commercial |
$76.95
|
| Rate for Payer: Quartz Medicare Advantage |
$48.15
|
| Rate for Payer: The Alliance Commercial |
$115.56
|
| Rate for Payer: United Healthcare Medicare Advantage |
$48.15
|
| Rate for Payer: WEA Trust Commercial |
$74.25
|
| Rate for Payer: WPS Commercial |
$132.41
|
|
|
Chronic Lymphocytic Leukemia Panel, FISH
|
Facility
IP
|
$476.00
|
|
|
Service Code
|
CPT 88271
|
| Hospital Charge Code |
5432849
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$233.24 |
| Max. Negotiated Rate |
$437.92 |
| Rate for Payer: Aetna Commercial |
$428.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$252.28
|
| Rate for Payer: Cash Price |
$142.80
|
| Rate for Payer: Cigna Commercial |
$437.92
|
| Rate for Payer: Health EOS Commercial |
$423.64
|
| Rate for Payer: HFN Commercial |
$437.92
|
| Rate for Payer: Multiplan Commercial |
$380.80
|
| Rate for Payer: NAPHCARE Commercial |
$285.60
|
| Rate for Payer: Preferred Network Access Commercial |
$437.92
|
| Rate for Payer: Quartz Beloit One Network |
$233.24
|
| Rate for Payer: Quartz Commercial |
$285.60
|
| Rate for Payer: WEA Trust Commercial |
$261.80
|
| Rate for Payer: WPS Commercial |
$352.57
|
|
|
Chronic Lymphocytic Leukemia Panel, FISH
|
Professional
|
$476.00
|
|
|
Service Code
|
CPT 88271
|
| Hospital Charge Code |
5432849
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$21.42 |
| Max. Negotiated Rate |
$452.20 |
| Rate for Payer: Aetna Commercial |
$452.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$409.36
|
| Rate for Payer: Aetna Managed Medicare |
$21.42
|
| Rate for Payer: Anthem Medicare Advantage |
$21.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$21.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$21.42
|
| Rate for Payer: Cash Price |
$142.80
|
| Rate for Payer: Cash Price |
$142.80
|
| Rate for Payer: Cigna Commercial |
$452.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$238.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$21.42
|
| Rate for Payer: Health EOS Commercial |
$433.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$75.61
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$75.61
|
| Rate for Payer: Independent Care Health Plan Medicare |
$21.42
|
| Rate for Payer: Multiplan Commercial |
$380.80
|
| Rate for Payer: Preferred Network Access Commercial |
$452.20
|
| Rate for Payer: Quartz Beloit One Network |
$209.44
|
| Rate for Payer: Quartz Commercial |
$271.32
|
| Rate for Payer: Quartz Medicare Advantage |
$21.42
|
| Rate for Payer: The Alliance Commercial |
$84.61
|
| Rate for Payer: United Healthcare Medicare Advantage |
$21.42
|
| Rate for Payer: WEA Trust Commercial |
$261.80
|
| Rate for Payer: WPS Commercial |
$94.25
|
|
|
Chronic Lymphocytic Leukemia Panel, FISH
|
Facility
OP
|
$476.00
|
|
|
Service Code
|
CPT 88271
|
| Hospital Charge Code |
5432849
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$20.36 |
| Max. Negotiated Rate |
$1,904.00 |
| Rate for Payer: Aetna Commercial |
$428.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$409.36
|
| Rate for Payer: Aetna Managed Medicare |
$21.42
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$80.32
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$37.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$35.56
|
| Rate for Payer: Anthem Medicaid |
$20.36
|
| Rate for Payer: Anthem Medicare Advantage |
$21.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$252.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$21.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$21.42
|
| Rate for Payer: Cash Price |
$142.80
|
| Rate for Payer: Cash Price |
$142.80
|
| Rate for Payer: Cigna Commercial |
$437.92
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$21.42
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$20.36
|
| Rate for Payer: Dean Health Medicaid |
$20.36
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$21.42
|
| Rate for Payer: Health EOS Commercial |
$423.64
|
| Rate for Payer: HFN Commercial |
$437.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$79.68
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$21.42
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$20.36
|
| Rate for Payer: Independent Care Health Plan Medicare |
$21.42
|
| Rate for Payer: Managed Health Services Medicaid |
$21.17
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$21.42
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$21.42
|
| Rate for Payer: Multiplan Commercial |
$380.80
|
| Rate for Payer: NAPHCARE Commercial |
$32.13
|
| Rate for Payer: Preferred Network Access Commercial |
$437.92
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$20.36
|
| Rate for Payer: Quartz Beloit One Network |
$233.24
|
| Rate for Payer: Quartz Commercial |
$309.40
|
| Rate for Payer: Quartz Medicare Advantage |
$21.42
|
| Rate for Payer: The Alliance Commercial |
$1,904.00
|
| Rate for Payer: United Healthcare Medicaid |
$20.36
|
| Rate for Payer: United Healthcare Medicare Advantage |
$21.42
|
| Rate for Payer: United Healthcare PPO |
$357.00
|
| Rate for Payer: WEA Trust Commercial |
$261.80
|
| Rate for Payer: Wellcare Medicare |
$21.42
|
| Rate for Payer: WMAP Medicaid |
$20.36
|
| Rate for Payer: WPS Commercial |
$352.57
|
|
