|
Coccidioides Antibody
|
Facility
IP
|
$42.00
|
|
|
Service Code
|
CPT 86635
|
| Hospital Charge Code |
3304829
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$20.58 |
| Max. Negotiated Rate |
$38.64 |
| Rate for Payer: Aetna Commercial |
$37.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$22.26
|
| Rate for Payer: Cash Price |
$12.60
|
| Rate for Payer: Cigna Commercial |
$38.64
|
| Rate for Payer: Health EOS Commercial |
$37.38
|
| Rate for Payer: HFN Commercial |
$38.64
|
| Rate for Payer: Multiplan Commercial |
$33.60
|
| Rate for Payer: NAPHCARE Commercial |
$25.20
|
| Rate for Payer: Preferred Network Access Commercial |
$38.64
|
| Rate for Payer: Quartz Beloit One Network |
$20.58
|
| Rate for Payer: Quartz Commercial |
$25.20
|
| Rate for Payer: WEA Trust Commercial |
$23.10
|
| Rate for Payer: WPS Commercial |
$31.11
|
|
|
Coccidioides Antibody
|
Professional
|
$57.00
|
|
|
Service Code
|
CPT 86635
|
| Hospital Charge Code |
5598646
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.47 |
| Max. Negotiated Rate |
$54.15 |
| Rate for Payer: Aetna Commercial |
$54.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$49.02
|
| Rate for Payer: Aetna Managed Medicare |
$11.47
|
| Rate for Payer: Anthem Medicare Advantage |
$11.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$11.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$11.47
|
| 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 |
$11.47
|
| Rate for Payer: Health EOS Commercial |
$51.87
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$40.49
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$40.49
|
| Rate for Payer: Independent Care Health Plan Medicare |
$11.47
|
| 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 |
$11.47
|
| Rate for Payer: The Alliance Commercial |
$45.31
|
| Rate for Payer: United Healthcare Medicare Advantage |
$11.47
|
| Rate for Payer: WEA Trust Commercial |
$31.35
|
| Rate for Payer: WPS Commercial |
$50.47
|
|
|
Coccidioides Antibody
|
Facility
IP
|
$57.00
|
|
|
Service Code
|
CPT 86635
|
| Hospital Charge Code |
5598646
|
|
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
|
|
|
Coccidioides Antibody
|
Facility
OP
|
$57.00
|
|
|
Service Code
|
CPT 86635
|
| Hospital Charge Code |
5598646
|
|
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 |
$11.47
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$43.01
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$20.07
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$19.04
|
| Rate for Payer: Anthem Medicaid |
$8.17
|
| Rate for Payer: Anthem Medicare Advantage |
$11.47
|
| 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 |
$11.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$11.47
|
| 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 |
$11.47
|
| 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 |
$11.47
|
| Rate for Payer: Health EOS Commercial |
$50.73
|
| Rate for Payer: HFN Commercial |
$52.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$42.67
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$11.47
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$8.17
|
| Rate for Payer: Independent Care Health Plan Medicare |
$11.47
|
| Rate for Payer: Managed Health Services Medicaid |
$8.50
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$11.47
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$11.47
|
| Rate for Payer: Multiplan Commercial |
$45.60
|
| Rate for Payer: NAPHCARE Commercial |
$17.20
|
| 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 |
$11.47
|
| Rate for Payer: The Alliance Commercial |
$228.00
|
| Rate for Payer: United Healthcare Medicaid |
$8.17
|
| Rate for Payer: United Healthcare Medicare Advantage |
$11.47
|
| Rate for Payer: United Healthcare PPO |
$42.75
|
| Rate for Payer: WEA Trust Commercial |
$31.35
|
| Rate for Payer: Wellcare Medicare |
$11.47
|
| Rate for Payer: WMAP Medicaid |
$8.17
|
| Rate for Payer: WPS Commercial |
$42.22
|
|
|
Coccidioides Antibody
|
Professional
|
$42.00
|
|
|
Service Code
|
CPT 86635
|
| Hospital Charge Code |
3304829
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.47 |
| Max. Negotiated Rate |
$50.47 |
| Rate for Payer: Aetna Commercial |
$39.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$36.12
|
| Rate for Payer: Aetna Managed Medicare |
$11.47
|
| Rate for Payer: Anthem Medicare Advantage |
$11.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$11.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$11.47
|
| Rate for Payer: Cash Price |
$12.60
|
| Rate for Payer: Cash Price |
$12.60
|
| Rate for Payer: Cigna Commercial |
$39.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$21.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$11.47
|
| Rate for Payer: Health EOS Commercial |
$38.22
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$40.49
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$40.49
|
| Rate for Payer: Independent Care Health Plan Medicare |
$11.47
|
| Rate for Payer: Multiplan Commercial |
$33.60
|
| Rate for Payer: Preferred Network Access Commercial |
$39.90
|
| Rate for Payer: Quartz Beloit One Network |
$18.48
|
| Rate for Payer: Quartz Commercial |
$23.94
|
| Rate for Payer: Quartz Medicare Advantage |
$11.47
|
| Rate for Payer: The Alliance Commercial |
$45.31
|
| Rate for Payer: United Healthcare Medicare Advantage |
$11.47
|
| Rate for Payer: WEA Trust Commercial |
$23.10
|
| Rate for Payer: WPS Commercial |
$50.47
|
|
|
Coccidioides Antibody CF
|
Facility
IP
|
$75.00
|
|
|
Service Code
|
CPT 86635
|
| Hospital Charge Code |
4392616
|
|
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
|
|
|
Coccidioides Antibody CF
|
Professional
|
$75.00
|
|
|
Service Code
|
CPT 86635
|
| Hospital Charge Code |
4392616
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.47 |
| 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 |
$11.47
|
| Rate for Payer: Anthem Medicare Advantage |
$11.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$11.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$11.47
|
| 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 |
$11.47
|
| Rate for Payer: Health EOS Commercial |
$68.25
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$40.49
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$40.49
|
| Rate for Payer: Independent Care Health Plan Medicare |
$11.47
|
| 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 |
$11.47
|
| Rate for Payer: The Alliance Commercial |
$45.31
|
| Rate for Payer: United Healthcare Medicare Advantage |
$11.47
|
| Rate for Payer: WEA Trust Commercial |
$41.25
|
| Rate for Payer: WPS Commercial |
$50.47
|
|
|
Coccidioides Antibody CF
|
Facility
OP
|
$75.00
|
|
|
Service Code
|
CPT 86635
|
| Hospital Charge Code |
4392616
|
|
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 |
$11.47
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$43.01
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$20.07
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$19.04
|
| Rate for Payer: Anthem Medicaid |
$8.17
|
| Rate for Payer: Anthem Medicare Advantage |
$11.47
|
| 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 |
$11.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$11.47
|
| 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 |
$11.47
|
| 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 |
$11.47
|
| Rate for Payer: Health EOS Commercial |
$66.75
|
| Rate for Payer: HFN Commercial |
$69.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$42.67
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$11.47
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$8.17
|
| Rate for Payer: Independent Care Health Plan Medicare |
$11.47
|
| Rate for Payer: Managed Health Services Medicaid |
$8.50
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$11.47
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$11.47
|
| Rate for Payer: Multiplan Commercial |
$60.00
|
| Rate for Payer: NAPHCARE Commercial |
$17.20
|
| 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 |
$11.47
|
| Rate for Payer: The Alliance Commercial |
$300.00
|
| Rate for Payer: United Healthcare Medicaid |
$8.17
|
| Rate for Payer: United Healthcare Medicare Advantage |
$11.47
|
| Rate for Payer: United Healthcare PPO |
$56.25
|
| Rate for Payer: WEA Trust Commercial |
$41.25
|
| Rate for Payer: Wellcare Medicare |
$11.47
|
| Rate for Payer: WMAP Medicaid |
$8.17
|
| Rate for Payer: WPS Commercial |
$55.55
|
|
|
Coccidioides Antibody, Complement Fixation
|
Facility
IP
|
$80.00
|
|
|
Service Code
|
CPT 86635
|
| Hospital Charge Code |
5433345
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$39.20 |
| Max. Negotiated Rate |
$73.60 |
| Rate for Payer: Aetna Commercial |
$72.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$42.40
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Cigna Commercial |
$73.60
|
| Rate for Payer: Health EOS Commercial |
$71.20
|
| Rate for Payer: HFN Commercial |
$73.60
|
| Rate for Payer: Multiplan Commercial |
$64.00
|
| Rate for Payer: NAPHCARE Commercial |
$48.00
|
| Rate for Payer: Preferred Network Access Commercial |
$73.60
|
| Rate for Payer: Quartz Beloit One Network |
$39.20
|
| Rate for Payer: Quartz Commercial |
$48.00
|
| Rate for Payer: WEA Trust Commercial |
$44.00
|
| Rate for Payer: WPS Commercial |
$59.26
|
|
|
Coccidioides Antibody, Complement Fixation
|
Professional
|
$80.00
|
|
|
Service Code
|
CPT 86635
|
| Hospital Charge Code |
5433345
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.47 |
| Max. Negotiated Rate |
$76.00 |
| Rate for Payer: Aetna Commercial |
$76.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$68.80
|
| Rate for Payer: Aetna Managed Medicare |
$11.47
|
| Rate for Payer: Anthem Medicare Advantage |
$11.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$11.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$11.47
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Cigna Commercial |
$76.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$40.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$11.47
|
| Rate for Payer: Health EOS Commercial |
$72.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$40.49
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$40.49
|
| Rate for Payer: Independent Care Health Plan Medicare |
$11.47
|
| Rate for Payer: Multiplan Commercial |
$64.00
|
| Rate for Payer: Preferred Network Access Commercial |
$76.00
|
| Rate for Payer: Quartz Beloit One Network |
$35.20
|
| Rate for Payer: Quartz Commercial |
$45.60
|
| Rate for Payer: Quartz Medicare Advantage |
$11.47
|
| Rate for Payer: The Alliance Commercial |
$45.31
|
| Rate for Payer: United Healthcare Medicare Advantage |
$11.47
|
| Rate for Payer: WEA Trust Commercial |
$44.00
|
| Rate for Payer: WPS Commercial |
$50.47
|
|
|
Coccidioides Antibody, Complement Fixation
|
Facility
OP
|
$80.00
|
|
|
Service Code
|
CPT 86635
|
| Hospital Charge Code |
5433345
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.17 |
| Max. Negotiated Rate |
$320.00 |
| Rate for Payer: Aetna Commercial |
$72.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$68.80
|
| Rate for Payer: Aetna Managed Medicare |
$11.47
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$43.01
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$20.07
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$19.04
|
| Rate for Payer: Anthem Medicaid |
$8.17
|
| Rate for Payer: Anthem Medicare Advantage |
$11.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$42.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$11.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$11.47
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Cigna Commercial |
$73.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$11.47
|
| 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 |
$11.47
|
| Rate for Payer: Health EOS Commercial |
$71.20
|
| Rate for Payer: HFN Commercial |
$73.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$42.67
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$11.47
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$8.17
|
| Rate for Payer: Independent Care Health Plan Medicare |
$11.47
|
| Rate for Payer: Managed Health Services Medicaid |
$8.50
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$11.47
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$11.47
|
| Rate for Payer: Multiplan Commercial |
$64.00
|
| Rate for Payer: NAPHCARE Commercial |
$17.20
|
| Rate for Payer: Preferred Network Access Commercial |
$73.60
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$8.17
|
| Rate for Payer: Quartz Beloit One Network |
$39.20
|
| Rate for Payer: Quartz Commercial |
$52.00
|
| Rate for Payer: Quartz Medicare Advantage |
$11.47
|
| Rate for Payer: The Alliance Commercial |
$320.00
|
| Rate for Payer: United Healthcare Medicaid |
$8.17
|
| Rate for Payer: United Healthcare Medicare Advantage |
$11.47
|
| Rate for Payer: United Healthcare PPO |
$60.00
|
| Rate for Payer: WEA Trust Commercial |
$44.00
|
| Rate for Payer: Wellcare Medicare |
$11.47
|
| Rate for Payer: WMAP Medicaid |
$8.17
|
| Rate for Payer: WPS Commercial |
$59.26
|
|
|
Coccidioides Antibody, CSF
|
Facility
IP
|
$109.00
|
|
|
Service Code
|
CPT 86635
|
| Hospital Charge Code |
5274882
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$53.41 |
| Max. Negotiated Rate |
$100.28 |
| Rate for Payer: Aetna Commercial |
$98.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$57.77
|
| Rate for Payer: Cash Price |
$32.70
|
| Rate for Payer: Cigna Commercial |
$100.28
|
| Rate for Payer: Health EOS Commercial |
$97.01
|
| Rate for Payer: HFN Commercial |
$100.28
|
| Rate for Payer: Multiplan Commercial |
$87.20
|
| Rate for Payer: NAPHCARE Commercial |
$65.40
|
| Rate for Payer: Preferred Network Access Commercial |
$100.28
|
| Rate for Payer: Quartz Beloit One Network |
$53.41
|
| Rate for Payer: Quartz Commercial |
$65.40
|
| Rate for Payer: WEA Trust Commercial |
$59.95
|
| Rate for Payer: WPS Commercial |
$80.74
|
|
|
Coccidioides Antibody, CSF
|
Facility
OP
|
$109.00
|
|
|
Service Code
|
CPT 86635
|
| Hospital Charge Code |
5274882
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.17 |
| Max. Negotiated Rate |
$436.00 |
| Rate for Payer: Aetna Commercial |
$98.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$93.74
|
| Rate for Payer: Aetna Managed Medicare |
$11.47
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$43.01
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$20.07
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$19.04
|
| Rate for Payer: Anthem Medicaid |
$8.17
|
| Rate for Payer: Anthem Medicare Advantage |
$11.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$57.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$11.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$11.47
|
| Rate for Payer: Cash Price |
$32.70
|
| Rate for Payer: Cash Price |
$32.70
|
| Rate for Payer: Cigna Commercial |
$100.28
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$11.47
|
| 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 |
$11.47
|
| Rate for Payer: Health EOS Commercial |
$97.01
|
| Rate for Payer: HFN Commercial |
$100.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$42.67
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$11.47
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$8.17
|
| Rate for Payer: Independent Care Health Plan Medicare |
$11.47
|
| Rate for Payer: Managed Health Services Medicaid |
$8.50
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$11.47
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$11.47
|
| Rate for Payer: Multiplan Commercial |
$87.20
|
| Rate for Payer: NAPHCARE Commercial |
$17.20
|
| Rate for Payer: Preferred Network Access Commercial |
$100.28
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$8.17
|
| Rate for Payer: Quartz Beloit One Network |
$53.41
|
| Rate for Payer: Quartz Commercial |
$70.85
|
| Rate for Payer: Quartz Medicare Advantage |
$11.47
|
| Rate for Payer: The Alliance Commercial |
$436.00
|
| Rate for Payer: United Healthcare Medicaid |
$8.17
|
| Rate for Payer: United Healthcare Medicare Advantage |
$11.47
|
| Rate for Payer: United Healthcare PPO |
$81.75
|
| Rate for Payer: WEA Trust Commercial |
$59.95
|
| Rate for Payer: Wellcare Medicare |
$11.47
|
| Rate for Payer: WMAP Medicaid |
$8.17
|
| Rate for Payer: WPS Commercial |
$80.74
|
|
|
Coccidioides Antibody, CSF
|
Professional
|
$109.00
|
|
|
Service Code
|
CPT 86635
|
| Hospital Charge Code |
5274882
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.47 |
| Max. Negotiated Rate |
$103.55 |
| Rate for Payer: Aetna Commercial |
$103.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$93.74
|
| Rate for Payer: Aetna Managed Medicare |
$11.47
|
| Rate for Payer: Anthem Medicare Advantage |
$11.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$11.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$11.47
|
| Rate for Payer: Cash Price |
$32.70
|
| Rate for Payer: Cash Price |
$32.70
|
| Rate for Payer: Cigna Commercial |
$103.55
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$54.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$11.47
|
| Rate for Payer: Health EOS Commercial |
$99.19
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$40.49
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$40.49
|
| Rate for Payer: Independent Care Health Plan Medicare |
$11.47
|
| Rate for Payer: Multiplan Commercial |
$87.20
|
| Rate for Payer: Preferred Network Access Commercial |
$103.55
|
| Rate for Payer: Quartz Beloit One Network |
$47.96
|
| Rate for Payer: Quartz Commercial |
$62.13
|
| Rate for Payer: Quartz Medicare Advantage |
$11.47
|
| Rate for Payer: The Alliance Commercial |
$45.31
|
| Rate for Payer: United Healthcare Medicare Advantage |
$11.47
|
| Rate for Payer: WEA Trust Commercial |
$59.95
|
| Rate for Payer: WPS Commercial |
$50.47
|
|
|
Coccidioides Antibody ID
|
Professional
|
$75.00
|
|
|
Service Code
|
CPT 86635
|
| Hospital Charge Code |
4392617
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.47 |
| 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 |
$11.47
|
| Rate for Payer: Anthem Medicare Advantage |
$11.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$11.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$11.47
|
| 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 |
$11.47
|
| Rate for Payer: Health EOS Commercial |
$68.25
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$40.49
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$40.49
|
| Rate for Payer: Independent Care Health Plan Medicare |
$11.47
|
| 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 |
$11.47
|
| Rate for Payer: The Alliance Commercial |
$45.31
|
| Rate for Payer: United Healthcare Medicare Advantage |
$11.47
|
| Rate for Payer: WEA Trust Commercial |
$41.25
|
| Rate for Payer: WPS Commercial |
$50.47
|
|
|
Coccidioides Antibody ID
|
Facility
OP
|
$75.00
|
|
|
Service Code
|
CPT 86635
|
| Hospital Charge Code |
4392617
|
|
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 |
$11.47
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$43.01
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$20.07
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$19.04
|
| Rate for Payer: Anthem Medicaid |
$8.17
|
| Rate for Payer: Anthem Medicare Advantage |
$11.47
|
| 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 |
$11.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$11.47
|
| 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 |
$11.47
|
| 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 |
$11.47
|
| Rate for Payer: Health EOS Commercial |
$66.75
|
| Rate for Payer: HFN Commercial |
$69.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$42.67
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$11.47
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$8.17
|
| Rate for Payer: Independent Care Health Plan Medicare |
$11.47
|
| Rate for Payer: Managed Health Services Medicaid |
$8.50
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$11.47
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$11.47
|
| Rate for Payer: Multiplan Commercial |
$60.00
|
| Rate for Payer: NAPHCARE Commercial |
$17.20
|
| 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 |
$11.47
|
| Rate for Payer: The Alliance Commercial |
$300.00
|
| Rate for Payer: United Healthcare Medicaid |
$8.17
|
| Rate for Payer: United Healthcare Medicare Advantage |
$11.47
|
| Rate for Payer: United Healthcare PPO |
$56.25
|
| Rate for Payer: WEA Trust Commercial |
$41.25
|
| Rate for Payer: Wellcare Medicare |
$11.47
|
| Rate for Payer: WMAP Medicaid |
$8.17
|
| Rate for Payer: WPS Commercial |
$55.55
|
|
|
Coccidioides Antibody ID
|
Facility
IP
|
$75.00
|
|
|
Service Code
|
CPT 86635
|
| Hospital Charge Code |
4392617
|
|
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
|
|
|
Coenzyme Q10 Level
|
Facility
IP
|
$172.00
|
|
|
Service Code
|
CPT 82542
|
| Hospital Charge Code |
1038902
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$84.28 |
| Max. Negotiated Rate |
$158.24 |
| Rate for Payer: Aetna Commercial |
$154.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$91.16
|
| Rate for Payer: Cash Price |
$51.60
|
| Rate for Payer: Cigna Commercial |
$158.24
|
| Rate for Payer: Health EOS Commercial |
$153.08
|
| Rate for Payer: HFN Commercial |
$158.24
|
| Rate for Payer: Multiplan Commercial |
$137.60
|
| Rate for Payer: NAPHCARE Commercial |
$103.20
|
| Rate for Payer: Preferred Network Access Commercial |
$158.24
|
| Rate for Payer: Quartz Beloit One Network |
$84.28
|
| Rate for Payer: Quartz Commercial |
$103.20
|
| Rate for Payer: WEA Trust Commercial |
$94.60
|
| Rate for Payer: WPS Commercial |
$127.40
|
|
|
Coenzyme Q10 Level
|
Facility
OP
|
$172.00
|
|
|
Service Code
|
CPT 82542
|
| Hospital Charge Code |
1038902
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$24.09 |
| Max. Negotiated Rate |
$688.00 |
| Rate for Payer: Aetna Commercial |
$154.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$147.92
|
| Rate for Payer: Aetna Managed Medicare |
$24.09
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$90.34
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$42.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$39.99
|
| Rate for Payer: Anthem Medicaid |
$24.89
|
| Rate for Payer: Anthem Medicare Advantage |
$24.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$91.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$24.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$24.09
|
| Rate for Payer: Cash Price |
$51.60
|
| Rate for Payer: Cash Price |
$51.60
|
| Rate for Payer: Cigna Commercial |
$158.24
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$24.09
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$24.89
|
| Rate for Payer: Dean Health Medicaid |
$24.89
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$24.09
|
| Rate for Payer: Health EOS Commercial |
$153.08
|
| Rate for Payer: HFN Commercial |
$158.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$89.61
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$24.09
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$24.89
|
| Rate for Payer: Independent Care Health Plan Medicare |
$24.09
|
| Rate for Payer: Managed Health Services Medicaid |
$25.89
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$24.09
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$24.09
|
| Rate for Payer: Multiplan Commercial |
$137.60
|
| Rate for Payer: NAPHCARE Commercial |
$36.14
|
| Rate for Payer: Preferred Network Access Commercial |
$158.24
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$24.89
|
| Rate for Payer: Quartz Beloit One Network |
$84.28
|
| Rate for Payer: Quartz Commercial |
$111.80
|
| Rate for Payer: Quartz Medicare Advantage |
$24.09
|
| Rate for Payer: The Alliance Commercial |
$688.00
|
| Rate for Payer: United Healthcare Medicaid |
$24.89
|
| Rate for Payer: United Healthcare Medicare Advantage |
$24.09
|
| Rate for Payer: United Healthcare PPO |
$129.00
|
| Rate for Payer: WEA Trust Commercial |
$94.60
|
| Rate for Payer: Wellcare Medicare |
$24.09
|
| Rate for Payer: WMAP Medicaid |
$24.89
|
| Rate for Payer: WPS Commercial |
$127.40
|
|
|
Coenzyme Q10 Level
|
Professional
|
$172.00
|
|
|
Service Code
|
CPT 82542
|
| Hospital Charge Code |
1038902
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$24.09 |
| Max. Negotiated Rate |
$163.40 |
| Rate for Payer: Aetna Commercial |
$163.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$147.92
|
| Rate for Payer: Aetna Managed Medicare |
$24.09
|
| Rate for Payer: Anthem Medicare Advantage |
$24.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$24.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$24.09
|
| Rate for Payer: Cash Price |
$51.60
|
| Rate for Payer: Cash Price |
$51.60
|
| Rate for Payer: Cigna Commercial |
$163.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$86.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$24.09
|
| Rate for Payer: Health EOS Commercial |
$156.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$85.04
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$85.04
|
| Rate for Payer: Independent Care Health Plan Medicare |
$24.09
|
| Rate for Payer: Multiplan Commercial |
$137.60
|
| Rate for Payer: Preferred Network Access Commercial |
$163.40
|
| Rate for Payer: Quartz Beloit One Network |
$75.68
|
| Rate for Payer: Quartz Commercial |
$98.04
|
| Rate for Payer: Quartz Medicare Advantage |
$24.09
|
| Rate for Payer: The Alliance Commercial |
$95.16
|
| Rate for Payer: United Healthcare Medicare Advantage |
$24.09
|
| Rate for Payer: WEA Trust Commercial |
$94.60
|
| Rate for Payer: WPS Commercial |
$106.00
|
|
|
COIL MREYE CHROMIUM/IRON 5CM X 4MM X .035 3.9 LOOP G20322
|
Facility
OP
|
$2,201.00
|
|
|
Service Code
|
HCPCS C1889
|
| Hospital Charge Code |
6201004
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$616.28 |
| Max. Negotiated Rate |
$2,024.92 |
| Rate for Payer: Aetna Commercial |
$1,980.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,892.86
|
| Rate for Payer: Aetna Managed Medicare |
$616.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,430.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,100.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,056.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,166.53
|
| Rate for Payer: Cash Price |
$660.30
|
| Rate for Payer: Cigna Commercial |
$2,024.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,231.68
|
| Rate for Payer: Health EOS Commercial |
$1,958.89
|
| Rate for Payer: HFN Commercial |
$2,024.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,650.75
|
| Rate for Payer: Multiplan Commercial |
$1,760.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,320.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,024.92
|
| Rate for Payer: Quartz Beloit One Network |
$1,078.49
|
| Rate for Payer: Quartz Commercial |
$1,430.65
|
| Rate for Payer: Quartz Medicare Advantage |
$1,320.60
|
| Rate for Payer: WEA Trust Commercial |
$1,210.55
|
| Rate for Payer: WPS Commercial |
$1,630.28
|
|
|
COIL MREYE CHROMIUM/IRON 5CM X 4MM X .035 3.9 LOOP G20322
|
Facility
IP
|
$2,201.00
|
|
|
Service Code
|
HCPCS C1889
|
| Hospital Charge Code |
6201004
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,078.49 |
| Max. Negotiated Rate |
$2,024.92 |
| Rate for Payer: Aetna Commercial |
$1,980.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,166.53
|
| Rate for Payer: Cash Price |
$660.30
|
| Rate for Payer: Cigna Commercial |
$2,024.92
|
| Rate for Payer: Health EOS Commercial |
$1,958.89
|
| Rate for Payer: HFN Commercial |
$2,024.92
|
| Rate for Payer: Multiplan Commercial |
$1,760.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,320.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,024.92
|
| Rate for Payer: Quartz Beloit One Network |
$1,078.49
|
| Rate for Payer: Quartz Commercial |
$1,320.60
|
| Rate for Payer: WEA Trust Commercial |
$1,210.55
|
| Rate for Payer: WPS Commercial |
$1,630.28
|
|
|
COIL MREYE EMBOLIZATION 5CM X 5MM .035 3.1 LOOP G36405
|
Facility
OP
|
$1,250.00
|
|
|
Service Code
|
HCPCS C1889
|
| Hospital Charge Code |
6200994
|
|
Hospital Revenue Code
|
273
|
| Min. Negotiated Rate |
$350.00 |
| Max. Negotiated Rate |
$1,150.00 |
| Rate for Payer: Aetna Commercial |
$1,125.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,075.00
|
| Rate for Payer: Aetna Managed Medicare |
$350.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$812.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$625.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$600.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$662.50
|
| Rate for Payer: Cash Price |
$375.00
|
| Rate for Payer: Cigna Commercial |
$1,150.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$699.50
|
| Rate for Payer: Health EOS Commercial |
$1,112.50
|
| Rate for Payer: HFN Commercial |
$1,150.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$937.50
|
| Rate for Payer: Multiplan Commercial |
$1,000.00
|
| Rate for Payer: NAPHCARE Commercial |
$750.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,150.00
|
| Rate for Payer: Quartz Beloit One Network |
$612.50
|
| Rate for Payer: Quartz Commercial |
$812.50
|
| Rate for Payer: Quartz Medicare Advantage |
$750.00
|
| Rate for Payer: WEA Trust Commercial |
$687.50
|
| Rate for Payer: WPS Commercial |
$925.88
|
|
|
COIL MREYE EMBOLIZATION 5CM X 5MM .035 3.1 LOOP G36405
|
Facility
IP
|
$1,250.00
|
|
|
Service Code
|
HCPCS C1889
|
| Hospital Charge Code |
6200994
|
|
Hospital Revenue Code
|
273
|
| Min. Negotiated Rate |
$612.50 |
| Max. Negotiated Rate |
$1,150.00 |
| Rate for Payer: Aetna Commercial |
$1,125.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$662.50
|
| Rate for Payer: Cash Price |
$375.00
|
| Rate for Payer: Cigna Commercial |
$1,150.00
|
| Rate for Payer: Health EOS Commercial |
$1,112.50
|
| Rate for Payer: HFN Commercial |
$1,150.00
|
| Rate for Payer: Multiplan Commercial |
$1,000.00
|
| Rate for Payer: NAPHCARE Commercial |
$750.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,150.00
|
| Rate for Payer: Quartz Beloit One Network |
$612.50
|
| Rate for Payer: Quartz Commercial |
$750.00
|
| Rate for Payer: WEA Trust Commercial |
$687.50
|
| Rate for Payer: WPS Commercial |
$925.88
|
|
|
COIL MREYE EMBOLIZATION 5CM X 6MM .035 2.6 LOOP G20291
|
Facility
OP
|
$1,250.00
|
|
|
Service Code
|
HCPCS C1889
|
| Hospital Charge Code |
6200995
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$350.00 |
| Max. Negotiated Rate |
$1,150.00 |
| Rate for Payer: Aetna Commercial |
$1,125.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,075.00
|
| Rate for Payer: Aetna Managed Medicare |
$350.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$812.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$625.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$600.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$662.50
|
| Rate for Payer: Cash Price |
$375.00
|
| Rate for Payer: Cigna Commercial |
$1,150.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$699.50
|
| Rate for Payer: Health EOS Commercial |
$1,112.50
|
| Rate for Payer: HFN Commercial |
$1,150.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$937.50
|
| Rate for Payer: Multiplan Commercial |
$1,000.00
|
| Rate for Payer: NAPHCARE Commercial |
$750.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,150.00
|
| Rate for Payer: Quartz Beloit One Network |
$612.50
|
| Rate for Payer: Quartz Commercial |
$812.50
|
| Rate for Payer: Quartz Medicare Advantage |
$750.00
|
| Rate for Payer: WEA Trust Commercial |
$687.50
|
| Rate for Payer: WPS Commercial |
$925.88
|
|
