|
Chromosomal Microarray, Postnatal
|
Facility
|
IP
|
$3,915.00
|
|
|
Service Code
|
CPT 81229
|
| Hospital Charge Code |
4568651
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$1,995.08 |
| Max. Negotiated Rate |
$3,745.87 |
| Rate for Payer: Aetna Commercial |
$3,664.44
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,501.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,157.95
|
| Rate for Payer: Cash Price |
$1,174.50
|
| Rate for Payer: Cigna Commercial |
$3,745.87
|
| Rate for Payer: Health EOS Commercial |
$3,623.72
|
| Rate for Payer: HFN Commercial |
$3,745.87
|
| Rate for Payer: Multiplan Commercial |
$3,257.28
|
| Rate for Payer: Preferred Network Access Commercial |
$3,745.87
|
| Rate for Payer: Quartz Beloit One Network |
$1,995.08
|
| Rate for Payer: Quartz Commercial |
$2,442.96
|
| Rate for Payer: WEA Trust Commercial |
$2,239.38
|
| Rate for Payer: WPS Commercial |
$3,015.72
|
|
|
Chromosomal Microarray, Postnatal
|
Professional
|
Both
|
$3,915.00
|
|
|
Service Code
|
CPT 81229
|
| Hospital Charge Code |
4568651
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$1,206.40 |
| Max. Negotiated Rate |
$5,308.16 |
| Rate for Payer: Aetna Commercial |
$3,868.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,501.58
|
| Rate for Payer: Aetna Managed Medicare |
$1,206.40
|
| Rate for Payer: Anthem Medicare Advantage |
$1,206.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$1,206.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$1,206.40
|
| Rate for Payer: Cash Price |
$1,174.50
|
| Rate for Payer: Cash Price |
$1,174.50
|
| Rate for Payer: Cigna Commercial |
$3,868.02
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,035.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,206.40
|
| Rate for Payer: Health EOS Commercial |
$3,705.16
|
| Rate for Payer: HFN Commercial |
$3,868.02
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,258.59
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$4,258.59
|
| Rate for Payer: Independent Care Health Plan Medicare |
$1,206.40
|
| Rate for Payer: Multiplan Commercial |
$3,257.28
|
| Rate for Payer: NAPHCARE Commercial |
$1,809.60
|
| Rate for Payer: Preferred Network Access Commercial |
$3,868.02
|
| Rate for Payer: Quartz Beloit One Network |
$1,791.50
|
| Rate for Payer: Quartz Commercial |
$2,320.81
|
| Rate for Payer: Quartz Medicare Advantage |
$1,206.40
|
| Rate for Payer: The Alliance Commercial |
$4,765.28
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,206.40
|
| Rate for Payer: WEA Trust Commercial |
$2,239.38
|
| Rate for Payer: WPS Commercial |
$5,308.16
|
|
|
Chromosomal Microarray, Postnatal
|
Facility
|
OP
|
$3,915.00
|
|
|
Service Code
|
CPT 81229
|
| Hospital Charge Code |
4568651
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$1,206.40 |
| Max. Negotiated Rate |
$4,825.60 |
| Rate for Payer: Aetna Commercial |
$3,664.44
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,501.58
|
| Rate for Payer: Aetna Managed Medicare |
$1,206.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,524.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,111.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,002.62
|
| Rate for Payer: Anthem Medicare Advantage |
$1,206.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,157.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$1,206.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$1,206.40
|
| Rate for Payer: Cash Price |
$1,174.50
|
| Rate for Payer: Cash Price |
$1,174.50
|
| Rate for Payer: Cigna Commercial |
$3,745.87
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$1,206.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,278.53
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$1,206.40
|
| Rate for Payer: Health EOS Commercial |
$3,623.72
|
| Rate for Payer: HFN Commercial |
$3,745.87
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,487.81
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,206.40
|
| Rate for Payer: Independent Care Health Plan Medicare |
$1,206.40
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$1,206.40
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$1,206.40
|
| Rate for Payer: Multiplan Commercial |
$3,257.28
|
| Rate for Payer: NAPHCARE Commercial |
$1,809.60
|
| Rate for Payer: Preferred Network Access Commercial |
$3,745.87
|
| Rate for Payer: Quartz Beloit One Network |
$1,995.08
|
| Rate for Payer: Quartz Commercial |
$2,646.54
|
| Rate for Payer: Quartz Medicare Advantage |
$1,206.40
|
| Rate for Payer: The Alliance Commercial |
$4,825.60
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,206.40
|
| Rate for Payer: United Healthcare PPO |
$3,053.70
|
| Rate for Payer: WEA Trust Commercial |
$2,239.38
|
| Rate for Payer: Wellcare Medicare |
$1,206.40
|
| Rate for Payer: WPS Commercial |
$3,015.72
|
|
|
Chromosome Analysis
|
Facility
|
IP
|
$781.00
|
|
|
Service Code
|
CPT 88182
|
| Hospital Charge Code |
2792803
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$398.00 |
| Max. Negotiated Rate |
$747.26 |
| Rate for Payer: Aetna Commercial |
$731.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$698.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$430.49
|
| Rate for Payer: Cash Price |
$234.30
|
| Rate for Payer: Cigna Commercial |
$747.26
|
| Rate for Payer: Health EOS Commercial |
$722.89
|
| Rate for Payer: HFN Commercial |
$747.26
|
| Rate for Payer: Multiplan Commercial |
$649.79
|
| Rate for Payer: Preferred Network Access Commercial |
$747.26
|
| Rate for Payer: Quartz Beloit One Network |
$398.00
|
| Rate for Payer: Quartz Commercial |
$487.34
|
| Rate for Payer: WEA Trust Commercial |
$446.73
|
| Rate for Payer: WPS Commercial |
$601.60
|
|
|
Chromosome Analysis
|
Professional
|
Both
|
$781.00
|
|
|
Service Code
|
CPT 88182
|
| Hospital Charge Code |
2792803
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$34.63 |
| Max. Negotiated Rate |
$771.63 |
| Rate for Payer: Aetna Commercial |
$771.63
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$698.53
|
| Rate for Payer: Aetna Managed Medicare |
$148.16
|
| Rate for Payer: Anthem Commercial |
$34.63
|
| Rate for Payer: Anthem Medicare Advantage |
$148.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$148.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$148.16
|
| Rate for Payer: Cash Price |
$234.30
|
| Rate for Payer: Cash Price |
$234.30
|
| Rate for Payer: Cigna Commercial |
$771.63
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$406.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$148.16
|
| Rate for Payer: Health EOS Commercial |
$739.14
|
| Rate for Payer: HFN Commercial |
$771.63
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$487.86
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$487.86
|
| Rate for Payer: Independent Care Health Plan Medicare |
$148.16
|
| Rate for Payer: Multiplan Commercial |
$649.79
|
| Rate for Payer: NAPHCARE Commercial |
$222.24
|
| Rate for Payer: Preferred Network Access Commercial |
$771.63
|
| Rate for Payer: Quartz Beloit One Network |
$357.39
|
| Rate for Payer: Quartz Commercial |
$462.98
|
| Rate for Payer: Quartz Medicare Advantage |
$148.16
|
| Rate for Payer: The Alliance Commercial |
$585.23
|
| Rate for Payer: United Healthcare Medicare Advantage |
$148.16
|
| Rate for Payer: WEA Trust Commercial |
$446.73
|
| Rate for Payer: WPS Commercial |
$651.90
|
|
|
Chromosome Analysis
|
Facility
|
OP
|
$781.00
|
|
|
Service Code
|
CPT 88182
|
| Hospital Charge Code |
2792803
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$54.84 |
| Max. Negotiated Rate |
$747.26 |
| Rate for Payer: Aetna Commercial |
$731.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$698.53
|
| Rate for Payer: Aetna Managed Medicare |
$54.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$208.88
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$97.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$92.47
|
| Rate for Payer: Anthem Medicare Advantage |
$54.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$430.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$54.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$54.84
|
| Rate for Payer: Cash Price |
$234.30
|
| Rate for Payer: Cash Price |
$234.30
|
| Rate for Payer: Cigna Commercial |
$747.26
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$54.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$454.54
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$54.84
|
| Rate for Payer: Health EOS Commercial |
$722.89
|
| Rate for Payer: HFN Commercial |
$747.26
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$204.00
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$54.84
|
| Rate for Payer: Independent Care Health Plan Medicare |
$54.84
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$54.84
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$54.84
|
| Rate for Payer: Multiplan Commercial |
$649.79
|
| Rate for Payer: NAPHCARE Commercial |
$82.26
|
| Rate for Payer: Preferred Network Access Commercial |
$747.26
|
| Rate for Payer: Quartz Beloit One Network |
$398.00
|
| Rate for Payer: Quartz Commercial |
$527.96
|
| Rate for Payer: Quartz Medicare Advantage |
$54.84
|
| Rate for Payer: The Alliance Commercial |
$219.36
|
| Rate for Payer: United Healthcare Medicare Advantage |
$54.84
|
| Rate for Payer: United Healthcare PPO |
$609.18
|
| Rate for Payer: WEA Trust Commercial |
$446.73
|
| Rate for Payer: Wellcare Medicare |
$54.84
|
| Rate for Payer: WPS Commercial |
$601.60
|
|
|
Chromosome Analysis, 20-25 Cells
|
Professional
|
Both
|
$190.00
|
|
|
Service Code
|
CPT 88264
|
| Hospital Charge Code |
3313615
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$86.94 |
| Max. Negotiated Rate |
$661.74 |
| Rate for Payer: Aetna Commercial |
$187.72
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$169.94
|
| Rate for Payer: Aetna Managed Medicare |
$150.39
|
| Rate for Payer: Anthem Medicare Advantage |
$150.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$150.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$150.39
|
| Rate for Payer: Cash Price |
$57.00
|
| Rate for Payer: Cash Price |
$57.00
|
| Rate for Payer: Cigna Commercial |
$187.72
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$98.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$150.39
|
| Rate for Payer: Health EOS Commercial |
$179.82
|
| Rate for Payer: HFN Commercial |
$187.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$530.89
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$530.89
|
| Rate for Payer: Independent Care Health Plan Medicare |
$150.39
|
| Rate for Payer: Multiplan Commercial |
$158.08
|
| Rate for Payer: NAPHCARE Commercial |
$225.59
|
| Rate for Payer: Preferred Network Access Commercial |
$187.72
|
| Rate for Payer: Quartz Beloit One Network |
$86.94
|
| Rate for Payer: Quartz Commercial |
$112.63
|
| Rate for Payer: Quartz Medicare Advantage |
$150.39
|
| Rate for Payer: The Alliance Commercial |
$594.06
|
| Rate for Payer: United Healthcare Medicare Advantage |
$150.39
|
| Rate for Payer: WEA Trust Commercial |
$108.68
|
| Rate for Payer: WPS Commercial |
$661.74
|
|
|
Chromosome Analysis, 20-25 Cells
|
Facility
|
OP
|
$190.00
|
|
|
Service Code
|
CPT 88264
|
| Hospital Charge Code |
3313615
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$96.82 |
| Max. Negotiated Rate |
$601.58 |
| Rate for Payer: Aetna Commercial |
$177.84
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$169.94
|
| Rate for Payer: Aetna Managed Medicare |
$150.39
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$563.98
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$263.19
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$249.65
|
| Rate for Payer: Anthem Medicare Advantage |
$150.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$104.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$150.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$150.39
|
| Rate for Payer: Cash Price |
$57.00
|
| Rate for Payer: Cash Price |
$57.00
|
| Rate for Payer: Cigna Commercial |
$181.79
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$150.39
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$110.58
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$150.39
|
| Rate for Payer: Health EOS Commercial |
$175.86
|
| Rate for Payer: HFN Commercial |
$181.79
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$559.47
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$150.39
|
| Rate for Payer: Independent Care Health Plan Medicare |
$150.39
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$150.39
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$150.39
|
| Rate for Payer: Multiplan Commercial |
$158.08
|
| Rate for Payer: NAPHCARE Commercial |
$225.59
|
| Rate for Payer: Preferred Network Access Commercial |
$181.79
|
| Rate for Payer: Quartz Beloit One Network |
$96.82
|
| Rate for Payer: Quartz Commercial |
$128.44
|
| Rate for Payer: Quartz Medicare Advantage |
$150.39
|
| Rate for Payer: The Alliance Commercial |
$601.58
|
| Rate for Payer: United Healthcare Medicare Advantage |
$150.39
|
| Rate for Payer: United Healthcare PPO |
$148.20
|
| Rate for Payer: WEA Trust Commercial |
$108.68
|
| Rate for Payer: Wellcare Medicare |
$150.39
|
| Rate for Payer: WPS Commercial |
$146.36
|
|
|
Chromosome Analysis, 20-25 Cells
|
Facility
|
IP
|
$190.00
|
|
|
Service Code
|
CPT 88264
|
| Hospital Charge Code |
3313615
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$96.82 |
| Max. Negotiated Rate |
$181.79 |
| Rate for Payer: Aetna Commercial |
$177.84
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$169.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$104.73
|
| Rate for Payer: Cash Price |
$57.00
|
| Rate for Payer: Cigna Commercial |
$181.79
|
| Rate for Payer: Health EOS Commercial |
$175.86
|
| Rate for Payer: HFN Commercial |
$181.79
|
| Rate for Payer: Multiplan Commercial |
$158.08
|
| Rate for Payer: Preferred Network Access Commercial |
$181.79
|
| Rate for Payer: Quartz Beloit One Network |
$96.82
|
| Rate for Payer: Quartz Commercial |
$118.56
|
| Rate for Payer: WEA Trust Commercial |
$108.68
|
| Rate for Payer: WPS Commercial |
$146.36
|
|
|
Chromosome Analysis Add Cells
|
Facility
|
IP
|
$638.00
|
|
|
Service Code
|
CPT 88280
|
| Hospital Charge Code |
2792804
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$325.12 |
| Max. Negotiated Rate |
$610.44 |
| Rate for Payer: Aetna Commercial |
$597.17
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$570.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$351.67
|
| Rate for Payer: Cash Price |
$191.40
|
| Rate for Payer: Cigna Commercial |
$610.44
|
| Rate for Payer: Health EOS Commercial |
$590.53
|
| Rate for Payer: HFN Commercial |
$610.44
|
| Rate for Payer: Multiplan Commercial |
$530.82
|
| Rate for Payer: Preferred Network Access Commercial |
$610.44
|
| Rate for Payer: Quartz Beloit One Network |
$325.12
|
| Rate for Payer: Quartz Commercial |
$398.11
|
| Rate for Payer: WEA Trust Commercial |
$364.94
|
| Rate for Payer: WPS Commercial |
$491.45
|
|
|
Chromosome Analysis Add Cells
|
Professional
|
Both
|
$638.00
|
|
|
Service Code
|
CPT 88280
|
| Hospital Charge Code |
2792804
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$34.81 |
| Max. Negotiated Rate |
$630.34 |
| Rate for Payer: Aetna Commercial |
$630.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$570.63
|
| Rate for Payer: Aetna Managed Medicare |
$34.81
|
| Rate for Payer: Anthem Medicare Advantage |
$34.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$34.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$34.81
|
| Rate for Payer: Cash Price |
$191.40
|
| Rate for Payer: Cash Price |
$191.40
|
| Rate for Payer: Cigna Commercial |
$630.34
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$331.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$34.81
|
| Rate for Payer: Health EOS Commercial |
$603.80
|
| Rate for Payer: HFN Commercial |
$630.34
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$122.88
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$122.88
|
| Rate for Payer: Independent Care Health Plan Medicare |
$34.81
|
| Rate for Payer: Multiplan Commercial |
$530.82
|
| Rate for Payer: NAPHCARE Commercial |
$52.21
|
| Rate for Payer: Preferred Network Access Commercial |
$630.34
|
| Rate for Payer: Quartz Beloit One Network |
$291.95
|
| Rate for Payer: Quartz Commercial |
$378.21
|
| Rate for Payer: Quartz Medicare Advantage |
$34.81
|
| Rate for Payer: The Alliance Commercial |
$137.49
|
| Rate for Payer: United Healthcare Medicare Advantage |
$34.81
|
| Rate for Payer: WEA Trust Commercial |
$364.94
|
| Rate for Payer: WPS Commercial |
$153.16
|
|
|
Chromosome Analysis Add Cells
|
Facility
|
OP
|
$638.00
|
|
|
Service Code
|
CPT 88280
|
| Hospital Charge Code |
2792804
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$34.81 |
| Max. Negotiated Rate |
$610.44 |
| Rate for Payer: Aetna Commercial |
$597.17
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$570.63
|
| Rate for Payer: Aetna Managed Medicare |
$34.81
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$130.53
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$60.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$57.78
|
| Rate for Payer: Anthem Medicare Advantage |
$34.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$351.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$34.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$34.81
|
| Rate for Payer: Cash Price |
$191.40
|
| Rate for Payer: Cash Price |
$191.40
|
| Rate for Payer: Cigna Commercial |
$610.44
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$34.81
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$371.32
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$34.81
|
| Rate for Payer: Health EOS Commercial |
$590.53
|
| Rate for Payer: HFN Commercial |
$610.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$129.49
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$34.81
|
| Rate for Payer: Independent Care Health Plan Medicare |
$34.81
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$34.81
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$34.81
|
| Rate for Payer: Multiplan Commercial |
$530.82
|
| Rate for Payer: NAPHCARE Commercial |
$52.21
|
| Rate for Payer: Preferred Network Access Commercial |
$610.44
|
| Rate for Payer: Quartz Beloit One Network |
$325.12
|
| Rate for Payer: Quartz Commercial |
$431.29
|
| Rate for Payer: Quartz Medicare Advantage |
$34.81
|
| Rate for Payer: The Alliance Commercial |
$139.24
|
| Rate for Payer: United Healthcare Medicare Advantage |
$34.81
|
| Rate for Payer: United Healthcare PPO |
$497.64
|
| Rate for Payer: WEA Trust Commercial |
$364.94
|
| Rate for Payer: Wellcare Medicare |
$34.81
|
| Rate for Payer: WPS Commercial |
$491.45
|
|
|
Chromosome Analysis Analyze 20
|
Facility
|
IP
|
$1,947.00
|
|
|
Service Code
|
CPT 88264
|
| Hospital Charge Code |
2792805
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$992.19 |
| Max. Negotiated Rate |
$1,862.89 |
| Rate for Payer: Aetna Commercial |
$1,822.39
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,741.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,073.19
|
| Rate for Payer: Cash Price |
$584.10
|
| Rate for Payer: Cigna Commercial |
$1,862.89
|
| Rate for Payer: Health EOS Commercial |
$1,802.14
|
| Rate for Payer: HFN Commercial |
$1,862.89
|
| Rate for Payer: Multiplan Commercial |
$1,619.90
|
| Rate for Payer: Preferred Network Access Commercial |
$1,862.89
|
| Rate for Payer: Quartz Beloit One Network |
$992.19
|
| Rate for Payer: Quartz Commercial |
$1,214.93
|
| Rate for Payer: WEA Trust Commercial |
$1,113.68
|
| Rate for Payer: WPS Commercial |
$1,499.77
|
|
|
Chromosome Analysis Analyze 20
|
Facility
|
OP
|
$1,947.00
|
|
|
Service Code
|
CPT 88264
|
| Hospital Charge Code |
2792805
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$150.39 |
| Max. Negotiated Rate |
$1,862.89 |
| Rate for Payer: Aetna Commercial |
$1,822.39
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,741.40
|
| Rate for Payer: Aetna Managed Medicare |
$150.39
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$563.98
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$263.19
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$249.65
|
| Rate for Payer: Anthem Medicare Advantage |
$150.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,073.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$150.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$150.39
|
| Rate for Payer: Cash Price |
$584.10
|
| Rate for Payer: Cash Price |
$584.10
|
| Rate for Payer: Cigna Commercial |
$1,862.89
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$150.39
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,133.15
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$150.39
|
| Rate for Payer: Health EOS Commercial |
$1,802.14
|
| Rate for Payer: HFN Commercial |
$1,862.89
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$559.47
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$150.39
|
| Rate for Payer: Independent Care Health Plan Medicare |
$150.39
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$150.39
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$150.39
|
| Rate for Payer: Multiplan Commercial |
$1,619.90
|
| Rate for Payer: NAPHCARE Commercial |
$225.59
|
| Rate for Payer: Preferred Network Access Commercial |
$1,862.89
|
| Rate for Payer: Quartz Beloit One Network |
$992.19
|
| Rate for Payer: Quartz Commercial |
$1,316.17
|
| Rate for Payer: Quartz Medicare Advantage |
$150.39
|
| Rate for Payer: The Alliance Commercial |
$601.58
|
| Rate for Payer: United Healthcare Medicare Advantage |
$150.39
|
| Rate for Payer: United Healthcare PPO |
$1,518.66
|
| Rate for Payer: WEA Trust Commercial |
$1,113.68
|
| Rate for Payer: Wellcare Medicare |
$150.39
|
| Rate for Payer: WPS Commercial |
$1,499.77
|
|
|
Chromosome Analysis Analyze 20
|
Professional
|
Both
|
$1,947.00
|
|
|
Service Code
|
CPT 88264
|
| Hospital Charge Code |
2792805
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$150.39 |
| Max. Negotiated Rate |
$1,923.64 |
| Rate for Payer: Aetna Commercial |
$1,923.64
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,741.40
|
| Rate for Payer: Aetna Managed Medicare |
$150.39
|
| Rate for Payer: Anthem Medicare Advantage |
$150.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$150.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$150.39
|
| Rate for Payer: Cash Price |
$584.10
|
| Rate for Payer: Cash Price |
$584.10
|
| Rate for Payer: Cigna Commercial |
$1,923.64
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,012.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$150.39
|
| Rate for Payer: Health EOS Commercial |
$1,842.64
|
| Rate for Payer: HFN Commercial |
$1,923.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$530.89
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$530.89
|
| Rate for Payer: Independent Care Health Plan Medicare |
$150.39
|
| Rate for Payer: Multiplan Commercial |
$1,619.90
|
| Rate for Payer: NAPHCARE Commercial |
$225.59
|
| Rate for Payer: Preferred Network Access Commercial |
$1,923.64
|
| Rate for Payer: Quartz Beloit One Network |
$890.95
|
| Rate for Payer: Quartz Commercial |
$1,154.18
|
| Rate for Payer: Quartz Medicare Advantage |
$150.39
|
| Rate for Payer: The Alliance Commercial |
$594.06
|
| Rate for Payer: United Healthcare Medicare Advantage |
$150.39
|
| Rate for Payer: WEA Trust Commercial |
$1,113.68
|
| Rate for Payer: WPS Commercial |
$661.74
|
|
|
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 |
$130.51 |
| Max. Negotiated Rate |
$3,751.61 |
| Rate for Payer: Aetna Commercial |
$3,670.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,506.94
|
| Rate for Payer: Aetna Managed Medicare |
$130.51
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$489.41
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$228.39
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$216.65
|
| Rate for Payer: Anthem Medicare Advantage |
$130.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,161.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$130.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$130.51
|
| Rate for Payer: Cash Price |
$1,176.30
|
| Rate for Payer: Cash Price |
$1,176.30
|
| Rate for Payer: Cigna Commercial |
$3,751.61
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$130.51
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,282.02
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$130.51
|
| Rate for Payer: Health EOS Commercial |
$3,629.28
|
| Rate for Payer: HFN Commercial |
$3,751.61
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$485.50
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$130.51
|
| Rate for Payer: Independent Care Health Plan Medicare |
$130.51
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$130.51
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$130.51
|
| Rate for Payer: Multiplan Commercial |
$3,262.27
|
| Rate for Payer: NAPHCARE Commercial |
$195.76
|
| Rate for Payer: Preferred Network Access Commercial |
$3,751.61
|
| Rate for Payer: Quartz Beloit One Network |
$1,998.14
|
| Rate for Payer: Quartz Commercial |
$2,650.60
|
| Rate for Payer: Quartz Medicare Advantage |
$130.51
|
| Rate for Payer: The Alliance Commercial |
$522.04
|
| Rate for Payer: United Healthcare Medicare Advantage |
$130.51
|
| Rate for Payer: United Healthcare PPO |
$3,058.38
|
| Rate for Payer: WEA Trust Commercial |
$2,242.81
|
| Rate for Payer: Wellcare Medicare |
$130.51
|
| Rate for Payer: WPS Commercial |
$3,020.35
|
|
|
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 |
$1,998.14 |
| Max. Negotiated Rate |
$3,751.61 |
| Rate for Payer: Aetna Commercial |
$3,670.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,506.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,161.26
|
| Rate for Payer: Cash Price |
$1,176.30
|
| Rate for Payer: Cigna Commercial |
$3,751.61
|
| Rate for Payer: Health EOS Commercial |
$3,629.28
|
| Rate for Payer: HFN Commercial |
$3,751.61
|
| Rate for Payer: Multiplan Commercial |
$3,262.27
|
| Rate for Payer: Preferred Network Access Commercial |
$3,751.61
|
| Rate for Payer: Quartz Beloit One Network |
$1,998.14
|
| Rate for Payer: Quartz Commercial |
$2,446.70
|
| Rate for Payer: WEA Trust Commercial |
$2,242.81
|
| Rate for Payer: WPS Commercial |
$3,020.35
|
|
|
Chromosome Analysis, CT 15-20
|
Professional
|
Both
|
$3,921.00
|
|
|
Service Code
|
CPT 88262
|
| Hospital Charge Code |
2794799
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$130.51 |
| Max. Negotiated Rate |
$3,873.95 |
| Rate for Payer: Aetna Commercial |
$3,873.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,506.94
|
| Rate for Payer: Aetna Managed Medicare |
$130.51
|
| Rate for Payer: Anthem Medicare Advantage |
$130.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$130.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$130.51
|
| Rate for Payer: Cash Price |
$1,176.30
|
| Rate for Payer: Cash Price |
$1,176.30
|
| Rate for Payer: Cigna Commercial |
$3,873.95
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,038.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$130.51
|
| Rate for Payer: Health EOS Commercial |
$3,710.83
|
| Rate for Payer: HFN Commercial |
$3,873.95
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$460.70
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$460.70
|
| Rate for Payer: Independent Care Health Plan Medicare |
$130.51
|
| Rate for Payer: Multiplan Commercial |
$3,262.27
|
| Rate for Payer: NAPHCARE Commercial |
$195.76
|
| Rate for Payer: Preferred Network Access Commercial |
$3,873.95
|
| Rate for Payer: Quartz Beloit One Network |
$1,794.25
|
| Rate for Payer: Quartz Commercial |
$2,324.37
|
| Rate for Payer: Quartz Medicare Advantage |
$130.51
|
| Rate for Payer: The Alliance Commercial |
$515.51
|
| Rate for Payer: United Healthcare Medicare Advantage |
$130.51
|
| Rate for Payer: WEA Trust Commercial |
$2,242.81
|
| Rate for Payer: WPS Commercial |
$574.24
|
|
|
Chromosome Analysis, Interp & Report
|
Facility
|
OP
|
$341.00
|
|
|
Service Code
|
CPT 88291
|
| Hospital Charge Code |
3313616
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$99.30 |
| Max. Negotiated Rate |
$326.27 |
| Rate for Payer: Aetna Commercial |
$319.18
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$304.99
|
| Rate for Payer: Aetna Managed Medicare |
$99.30
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$230.52
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$177.32
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$170.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$187.96
|
| Rate for Payer: Cash Price |
$102.30
|
| Rate for Payer: Cash Price |
$102.30
|
| Rate for Payer: Cigna Commercial |
$326.27
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$198.46
|
| Rate for Payer: Health EOS Commercial |
$315.63
|
| Rate for Payer: HFN Commercial |
$326.27
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$265.98
|
| Rate for Payer: Multiplan Commercial |
$283.71
|
| Rate for Payer: NAPHCARE Commercial |
$212.78
|
| Rate for Payer: Preferred Network Access Commercial |
$326.27
|
| Rate for Payer: Quartz Beloit One Network |
$173.77
|
| Rate for Payer: Quartz Commercial |
$230.52
|
| Rate for Payer: Quartz Medicare Advantage |
$212.78
|
| Rate for Payer: The Alliance Commercial |
$132.95
|
| Rate for Payer: United Healthcare PPO |
$265.98
|
| Rate for Payer: WEA Trust Commercial |
$195.05
|
| Rate for Payer: WPS Commercial |
$262.67
|
|
|
Chromosome Analysis, Interp & Report
|
Professional
|
Both
|
$341.00
|
|
|
Service Code
|
CPT 88291
|
| Hospital Charge Code |
3313616
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.89 |
| Max. Negotiated Rate |
$336.91 |
| Rate for Payer: Aetna Commercial |
$336.91
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$304.99
|
| Rate for Payer: Aetna Managed Medicare |
$33.24
|
| Rate for Payer: Anthem Commercial |
$5.89
|
| Rate for Payer: Anthem Medicare Advantage |
$33.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$33.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$33.24
|
| Rate for Payer: Cash Price |
$102.30
|
| Rate for Payer: Cash Price |
$102.30
|
| Rate for Payer: Cigna Commercial |
$336.91
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$177.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$33.24
|
| Rate for Payer: Health EOS Commercial |
$322.72
|
| Rate for Payer: HFN Commercial |
$336.91
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$117.59
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$117.59
|
| Rate for Payer: Independent Care Health Plan Medicare |
$33.24
|
| Rate for Payer: Multiplan Commercial |
$283.71
|
| Rate for Payer: NAPHCARE Commercial |
$49.86
|
| Rate for Payer: Preferred Network Access Commercial |
$336.91
|
| Rate for Payer: Quartz Beloit One Network |
$156.04
|
| Rate for Payer: Quartz Commercial |
$202.14
|
| Rate for Payer: Quartz Medicare Advantage |
$33.24
|
| Rate for Payer: The Alliance Commercial |
$131.29
|
| Rate for Payer: United Healthcare Medicare Advantage |
$33.24
|
| Rate for Payer: WEA Trust Commercial |
$195.05
|
| Rate for Payer: WPS Commercial |
$146.25
|
|
|
Chromosome Analysis, Interp & Report
|
Facility
|
IP
|
$341.00
|
|
|
Service Code
|
CPT 88291
|
| Hospital Charge Code |
3313616
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$173.77 |
| Max. Negotiated Rate |
$326.27 |
| Rate for Payer: Aetna Commercial |
$319.18
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$304.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$187.96
|
| Rate for Payer: Cash Price |
$102.30
|
| Rate for Payer: Cigna Commercial |
$326.27
|
| Rate for Payer: Health EOS Commercial |
$315.63
|
| Rate for Payer: HFN Commercial |
$326.27
|
| Rate for Payer: Multiplan Commercial |
$283.71
|
| Rate for Payer: Preferred Network Access Commercial |
$326.27
|
| Rate for Payer: Quartz Beloit One Network |
$173.77
|
| Rate for Payer: Quartz Commercial |
$212.78
|
| Rate for Payer: WEA Trust Commercial |
$195.05
|
| Rate for Payer: WPS Commercial |
$262.67
|
|
|
Chromosome Analysis Karyotype
|
Facility
|
IP
|
$518.00
|
|
|
Service Code
|
CPT 88262
|
| Hospital Charge Code |
4722606
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$263.97 |
| Max. Negotiated Rate |
$495.62 |
| Rate for Payer: Aetna Commercial |
$484.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$463.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$285.52
|
| Rate for Payer: Cash Price |
$155.40
|
| Rate for Payer: Cigna Commercial |
$495.62
|
| Rate for Payer: Health EOS Commercial |
$479.46
|
| Rate for Payer: HFN Commercial |
$495.62
|
| Rate for Payer: Multiplan Commercial |
$430.98
|
| Rate for Payer: Preferred Network Access Commercial |
$495.62
|
| Rate for Payer: Quartz Beloit One Network |
$263.97
|
| Rate for Payer: Quartz Commercial |
$323.23
|
| Rate for Payer: WEA Trust Commercial |
$296.30
|
| Rate for Payer: WPS Commercial |
$399.02
|
|
|
Chromosome Analysis Karyotype
|
Facility
|
OP
|
$518.00
|
|
|
Service Code
|
CPT 88262
|
| Hospital Charge Code |
4722606
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$130.51 |
| Max. Negotiated Rate |
$522.04 |
| Rate for Payer: Aetna Commercial |
$484.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$463.30
|
| Rate for Payer: Aetna Managed Medicare |
$130.51
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$489.41
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$228.39
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$216.65
|
| Rate for Payer: Anthem Medicare Advantage |
$130.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$285.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$130.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$130.51
|
| Rate for Payer: Cash Price |
$155.40
|
| Rate for Payer: Cash Price |
$155.40
|
| Rate for Payer: Cigna Commercial |
$495.62
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$130.51
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$301.48
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$130.51
|
| Rate for Payer: Health EOS Commercial |
$479.46
|
| Rate for Payer: HFN Commercial |
$495.62
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$485.50
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$130.51
|
| Rate for Payer: Independent Care Health Plan Medicare |
$130.51
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$130.51
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$130.51
|
| Rate for Payer: Multiplan Commercial |
$430.98
|
| Rate for Payer: NAPHCARE Commercial |
$195.76
|
| Rate for Payer: Preferred Network Access Commercial |
$495.62
|
| Rate for Payer: Quartz Beloit One Network |
$263.97
|
| Rate for Payer: Quartz Commercial |
$350.17
|
| Rate for Payer: Quartz Medicare Advantage |
$130.51
|
| Rate for Payer: The Alliance Commercial |
$522.04
|
| Rate for Payer: United Healthcare Medicare Advantage |
$130.51
|
| Rate for Payer: United Healthcare PPO |
$404.04
|
| Rate for Payer: WEA Trust Commercial |
$296.30
|
| Rate for Payer: Wellcare Medicare |
$130.51
|
| Rate for Payer: WPS Commercial |
$399.02
|
|
|
Chromosome Analysis Karyotype
|
Professional
|
Both
|
$518.00
|
|
|
Service Code
|
CPT 88262
|
| Hospital Charge Code |
4722606
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$130.51 |
| Max. Negotiated Rate |
$574.24 |
| Rate for Payer: Aetna Commercial |
$511.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$463.30
|
| Rate for Payer: Aetna Managed Medicare |
$130.51
|
| Rate for Payer: Anthem Medicare Advantage |
$130.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$130.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$130.51
|
| Rate for Payer: Cash Price |
$155.40
|
| Rate for Payer: Cash Price |
$155.40
|
| Rate for Payer: Cigna Commercial |
$511.78
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$269.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$130.51
|
| Rate for Payer: Health EOS Commercial |
$490.24
|
| Rate for Payer: HFN Commercial |
$511.78
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$460.70
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$460.70
|
| Rate for Payer: Independent Care Health Plan Medicare |
$130.51
|
| Rate for Payer: Multiplan Commercial |
$430.98
|
| Rate for Payer: NAPHCARE Commercial |
$195.76
|
| Rate for Payer: Preferred Network Access Commercial |
$511.78
|
| Rate for Payer: Quartz Beloit One Network |
$237.04
|
| Rate for Payer: Quartz Commercial |
$307.07
|
| Rate for Payer: Quartz Medicare Advantage |
$130.51
|
| Rate for Payer: The Alliance Commercial |
$515.51
|
| Rate for Payer: United Healthcare Medicare Advantage |
$130.51
|
| Rate for Payer: WEA Trust Commercial |
$296.30
|
| Rate for Payer: WPS Commercial |
$574.24
|
|
|
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 |
$230.34 |
| Max. Negotiated Rate |
$432.47 |
| Rate for Payer: Aetna Commercial |
$423.07
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$404.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$249.14
|
| Rate for Payer: Cash Price |
$135.60
|
| Rate for Payer: Cigna Commercial |
$432.47
|
| Rate for Payer: Health EOS Commercial |
$418.37
|
| Rate for Payer: HFN Commercial |
$432.47
|
| Rate for Payer: Multiplan Commercial |
$376.06
|
| Rate for Payer: Preferred Network Access Commercial |
$432.47
|
| Rate for Payer: Quartz Beloit One Network |
$230.34
|
| Rate for Payer: Quartz Commercial |
$282.05
|
| Rate for Payer: WEA Trust Commercial |
$258.54
|
| Rate for Payer: WPS Commercial |
$348.18
|
|
