|
Cocaine Meconium
|
Facility
|
OP
|
$38.00
|
|
| Hospital Charge Code |
2942887
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.64 |
| Max. Negotiated Rate |
$152.00 |
| Rate for Payer: Aetna Commercial |
$34.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$32.68
|
| Rate for Payer: Aetna Managed Medicare |
$10.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$24.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$19.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$18.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$20.14
|
| Rate for Payer: Cash Price |
$11.40
|
| Rate for Payer: Cigna Commercial |
$34.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$21.26
|
| Rate for Payer: Health EOS Commercial |
$33.82
|
| Rate for Payer: HFN Commercial |
$34.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$28.50
|
| Rate for Payer: Multiplan Commercial |
$30.40
|
| Rate for Payer: NAPHCARE Commercial |
$22.80
|
| Rate for Payer: Preferred Network Access Commercial |
$34.96
|
| Rate for Payer: Quartz Beloit One Network |
$18.62
|
| Rate for Payer: Quartz Commercial |
$24.70
|
| Rate for Payer: Quartz Medicare Advantage |
$22.80
|
| Rate for Payer: The Alliance Commercial |
$152.00
|
| Rate for Payer: United Healthcare PPO |
$28.50
|
| Rate for Payer: WEA Trust Commercial |
$20.90
|
| Rate for Payer: WPS Commercial |
$28.15
|
|
|
Cocaine Metabolite Quantitative, Urine
|
Facility
|
OP
|
$152.00
|
|
|
Service Code
|
CPT 80353
|
| Hospital Charge Code |
5322767
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$42.56 |
| Max. Negotiated Rate |
$608.00 |
| Rate for Payer: Aetna Commercial |
$136.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$130.72
|
| Rate for Payer: Aetna Managed Medicare |
$42.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$98.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$76.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$72.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$80.56
|
| Rate for Payer: Cash Price |
$45.60
|
| Rate for Payer: Cigna Commercial |
$139.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$85.06
|
| Rate for Payer: Health EOS Commercial |
$135.28
|
| Rate for Payer: HFN Commercial |
$139.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$114.00
|
| Rate for Payer: Multiplan Commercial |
$121.60
|
| Rate for Payer: NAPHCARE Commercial |
$91.20
|
| Rate for Payer: Preferred Network Access Commercial |
$139.84
|
| Rate for Payer: Quartz Beloit One Network |
$74.48
|
| Rate for Payer: Quartz Commercial |
$98.80
|
| Rate for Payer: Quartz Medicare Advantage |
$91.20
|
| Rate for Payer: The Alliance Commercial |
$608.00
|
| Rate for Payer: United Healthcare PPO |
$114.00
|
| Rate for Payer: WEA Trust Commercial |
$83.60
|
| Rate for Payer: WPS Commercial |
$112.59
|
|
|
Cocaine Metabolite Quantitative, Urine
|
Facility
|
IP
|
$152.00
|
|
|
Service Code
|
CPT 80353
|
| Hospital Charge Code |
5322767
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$74.48 |
| Max. Negotiated Rate |
$139.84 |
| Rate for Payer: Aetna Commercial |
$136.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$130.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$80.56
|
| Rate for Payer: Cash Price |
$45.60
|
| Rate for Payer: Cigna Commercial |
$139.84
|
| Rate for Payer: Health EOS Commercial |
$135.28
|
| Rate for Payer: HFN Commercial |
$139.84
|
| Rate for Payer: Multiplan Commercial |
$121.60
|
| Rate for Payer: NAPHCARE Commercial |
$91.20
|
| Rate for Payer: Preferred Network Access Commercial |
$139.84
|
| Rate for Payer: Quartz Beloit One Network |
$74.48
|
| Rate for Payer: Quartz Commercial |
$91.20
|
| Rate for Payer: WEA Trust Commercial |
$83.60
|
| Rate for Payer: WPS Commercial |
$112.59
|
|
|
Cocaine Metabolite Quantitative, Urine
|
Professional
|
Both
|
$152.00
|
|
|
Service Code
|
CPT 80353
|
| Hospital Charge Code |
5322767
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$66.88 |
| Max. Negotiated Rate |
$144.40 |
| Rate for Payer: Aetna Commercial |
$144.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$130.72
|
| Rate for Payer: Cash Price |
$45.60
|
| Rate for Payer: Cash Price |
$45.60
|
| Rate for Payer: Cigna Commercial |
$144.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$76.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$91.20
|
| Rate for Payer: Health EOS Commercial |
$138.32
|
| Rate for Payer: HFN Commercial |
$144.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$80.06
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$80.06
|
| Rate for Payer: Multiplan Commercial |
$121.60
|
| Rate for Payer: Preferred Network Access Commercial |
$144.40
|
| Rate for Payer: Quartz Beloit One Network |
$66.88
|
| Rate for Payer: Quartz Commercial |
$86.64
|
| Rate for Payer: The Alliance Commercial |
$76.00
|
| Rate for Payer: WEA Trust Commercial |
$83.60
|
| Rate for Payer: WPS Commercial |
$112.59
|
|
|
Cocaine Metabolites Screen
|
Professional
|
Both
|
$48.00
|
|
| Hospital Charge Code |
2942892
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$21.12 |
| Max. Negotiated Rate |
$45.60 |
| Rate for Payer: Aetna Commercial |
$45.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$41.28
|
| Rate for Payer: Cash Price |
$14.40
|
| Rate for Payer: Cigna Commercial |
$45.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$24.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$28.80
|
| Rate for Payer: Health EOS Commercial |
$43.68
|
| Rate for Payer: HFN Commercial |
$45.60
|
| Rate for Payer: Multiplan Commercial |
$38.40
|
| Rate for Payer: Preferred Network Access Commercial |
$45.60
|
| Rate for Payer: Quartz Beloit One Network |
$21.12
|
| Rate for Payer: Quartz Commercial |
$27.36
|
| Rate for Payer: The Alliance Commercial |
$24.00
|
| Rate for Payer: WEA Trust Commercial |
$26.40
|
| Rate for Payer: WPS Commercial |
$35.55
|
|
|
Cocaine Metabolites Screen
|
Facility
|
IP
|
$48.00
|
|
| Hospital Charge Code |
2942892
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$23.52 |
| Max. Negotiated Rate |
$44.16 |
| Rate for Payer: Aetna Commercial |
$43.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$41.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$25.44
|
| Rate for Payer: Cash Price |
$14.40
|
| Rate for Payer: Cigna Commercial |
$44.16
|
| Rate for Payer: Health EOS Commercial |
$42.72
|
| Rate for Payer: HFN Commercial |
$44.16
|
| Rate for Payer: Multiplan Commercial |
$38.40
|
| Rate for Payer: NAPHCARE Commercial |
$28.80
|
| Rate for Payer: Preferred Network Access Commercial |
$44.16
|
| Rate for Payer: Quartz Beloit One Network |
$23.52
|
| Rate for Payer: Quartz Commercial |
$28.80
|
| Rate for Payer: WEA Trust Commercial |
$26.40
|
| Rate for Payer: WPS Commercial |
$35.55
|
|
|
Cocaine Metabolites Screen
|
Facility
|
OP
|
$48.00
|
|
| Hospital Charge Code |
2942892
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.44 |
| Max. Negotiated Rate |
$192.00 |
| Rate for Payer: Aetna Commercial |
$43.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$41.28
|
| Rate for Payer: Aetna Managed Medicare |
$13.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$31.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$24.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$23.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$25.44
|
| Rate for Payer: Cash Price |
$14.40
|
| Rate for Payer: Cigna Commercial |
$44.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$26.86
|
| Rate for Payer: Health EOS Commercial |
$42.72
|
| Rate for Payer: HFN Commercial |
$44.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$36.00
|
| Rate for Payer: Multiplan Commercial |
$38.40
|
| Rate for Payer: NAPHCARE Commercial |
$28.80
|
| Rate for Payer: Preferred Network Access Commercial |
$44.16
|
| Rate for Payer: Quartz Beloit One Network |
$23.52
|
| Rate for Payer: Quartz Commercial |
$31.20
|
| Rate for Payer: Quartz Medicare Advantage |
$28.80
|
| Rate for Payer: The Alliance Commercial |
$192.00
|
| Rate for Payer: United Healthcare PPO |
$36.00
|
| Rate for Payer: WEA Trust Commercial |
$26.40
|
| Rate for Payer: WPS Commercial |
$35.55
|
|
|
Coccidioides Antibodies (IgG, IgM)
|
Facility
|
IP
|
$104.00
|
|
|
Service Code
|
CPT 86635
|
| Hospital Charge Code |
5366668
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$50.96 |
| Max. Negotiated Rate |
$95.68 |
| Rate for Payer: Aetna Commercial |
$93.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$89.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$55.12
|
| Rate for Payer: Cash Price |
$31.20
|
| Rate for Payer: Cigna Commercial |
$95.68
|
| Rate for Payer: Health EOS Commercial |
$92.56
|
| Rate for Payer: HFN Commercial |
$95.68
|
| Rate for Payer: Multiplan Commercial |
$83.20
|
| Rate for Payer: NAPHCARE Commercial |
$62.40
|
| Rate for Payer: Preferred Network Access Commercial |
$95.68
|
| Rate for Payer: Quartz Beloit One Network |
$50.96
|
| Rate for Payer: Quartz Commercial |
$62.40
|
| Rate for Payer: WEA Trust Commercial |
$57.20
|
| Rate for Payer: WPS Commercial |
$77.03
|
|
|
Coccidioides Antibodies (IgG, IgM)
|
Professional
|
Both
|
$104.00
|
|
|
Service Code
|
CPT 86635
|
| Hospital Charge Code |
5366668
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$40.49 |
| Max. Negotiated Rate |
$98.80 |
| Rate for Payer: Aetna Commercial |
$98.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$89.44
|
| Rate for Payer: Cash Price |
$31.20
|
| Rate for Payer: Cash Price |
$31.20
|
| Rate for Payer: Cigna Commercial |
$98.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$52.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$62.40
|
| Rate for Payer: Health EOS Commercial |
$94.64
|
| Rate for Payer: HFN Commercial |
$98.80
|
| 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: Multiplan Commercial |
$83.20
|
| Rate for Payer: Preferred Network Access Commercial |
$98.80
|
| Rate for Payer: Quartz Beloit One Network |
$45.76
|
| Rate for Payer: Quartz Commercial |
$59.28
|
| Rate for Payer: The Alliance Commercial |
$52.00
|
| Rate for Payer: WEA Trust Commercial |
$57.20
|
| Rate for Payer: WPS Commercial |
$77.03
|
|
|
Coccidioides Antibodies (IgG, IgM)
|
Facility
|
OP
|
$104.00
|
|
|
Service Code
|
CPT 86635
|
| Hospital Charge Code |
5366668
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.17 |
| Max. Negotiated Rate |
$95.68 |
| Rate for Payer: Aetna Commercial |
$93.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$89.44
|
| 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 |
$55.12
|
| 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 |
$31.20
|
| Rate for Payer: Cash Price |
$31.20
|
| Rate for Payer: Cigna Commercial |
$95.68
|
| 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 DHI/DHP/ASO |
$58.20
|
| 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 |
$92.56
|
| Rate for Payer: HFN Commercial |
$95.68
|
| 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 |
$83.20
|
| Rate for Payer: NAPHCARE Commercial |
$17.20
|
| Rate for Payer: Preferred Network Access Commercial |
$95.68
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$8.17
|
| Rate for Payer: Quartz Beloit One Network |
$50.96
|
| Rate for Payer: Quartz Commercial |
$67.60
|
| Rate for Payer: Quartz Medicare Advantage |
$11.47
|
| Rate for Payer: The Alliance Commercial |
$45.88
|
| Rate for Payer: United Healthcare Medicaid |
$8.17
|
| Rate for Payer: United Healthcare Medicare Advantage |
$11.47
|
| Rate for Payer: United Healthcare PPO |
$78.00
|
| Rate for Payer: WEA Trust Commercial |
$57.20
|
| Rate for Payer: Wellcare Medicare |
$11.47
|
| Rate for Payer: WMAP Medicaid |
$8.17
|
| Rate for Payer: WPS Commercial |
$77.03
|
|
|
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: Aetna Gatekeeper/Not Gatekeeper |
$49.02
|
| 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 |
$52.44 |
| 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 DHI/DHP/ASO |
$31.90
|
| 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 |
$45.88
|
| 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
|
Both
|
$57.00
|
|
|
Service Code
|
CPT 86635
|
| Hospital Charge Code |
5598646
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$25.08 |
| Max. Negotiated Rate |
$54.15 |
| Rate for Payer: Aetna Commercial |
$54.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$49.02
|
| 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 |
$34.20
|
| Rate for Payer: Health EOS Commercial |
$51.87
|
| Rate for Payer: HFN Commercial |
$54.15
|
| 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: 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: The Alliance Commercial |
$28.50
|
| Rate for Payer: WEA Trust Commercial |
$31.35
|
| Rate for Payer: WPS Commercial |
$42.22
|
|
|
Coccidioides Antibody
|
Professional
|
Both
|
$42.00
|
|
|
Service Code
|
CPT 86635
|
| Hospital Charge Code |
3304829
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.48 |
| Max. Negotiated Rate |
$40.49 |
| Rate for Payer: Aetna Commercial |
$39.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$36.12
|
| 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 |
$25.20
|
| Rate for Payer: Health EOS Commercial |
$38.22
|
| Rate for Payer: HFN Commercial |
$39.90
|
| 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: 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: The Alliance Commercial |
$21.00
|
| Rate for Payer: WEA Trust Commercial |
$23.10
|
| Rate for Payer: WPS Commercial |
$31.11
|
|
|
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: Aetna Gatekeeper/Not Gatekeeper |
$36.12
|
| 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
|
Facility
|
OP
|
$42.00
|
|
|
Service Code
|
CPT 86635
|
| Hospital Charge Code |
3304829
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.17 |
| Max. Negotiated Rate |
$45.88 |
| Rate for Payer: Aetna Commercial |
$37.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$36.12
|
| 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 |
$22.26
|
| 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 |
$38.64
|
| 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 DHI/DHP/ASO |
$23.50
|
| 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 |
$37.38
|
| Rate for Payer: HFN Commercial |
$38.64
|
| 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 |
$33.60
|
| Rate for Payer: NAPHCARE Commercial |
$17.20
|
| Rate for Payer: Preferred Network Access Commercial |
$38.64
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$8.17
|
| Rate for Payer: Quartz Beloit One Network |
$20.58
|
| Rate for Payer: Quartz Commercial |
$27.30
|
| Rate for Payer: Quartz Medicare Advantage |
$11.47
|
| Rate for Payer: The Alliance Commercial |
$45.88
|
| Rate for Payer: United Healthcare Medicaid |
$8.17
|
| Rate for Payer: United Healthcare Medicare Advantage |
$11.47
|
| Rate for Payer: United Healthcare PPO |
$31.50
|
| Rate for Payer: WEA Trust Commercial |
$23.10
|
| Rate for Payer: Wellcare Medicare |
$11.47
|
| Rate for Payer: WMAP Medicaid |
$8.17
|
| Rate for Payer: WPS Commercial |
$31.11
|
|
|
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: Aetna Gatekeeper/Not Gatekeeper |
$64.50
|
| 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
|
Both
|
$75.00
|
|
|
Service Code
|
CPT 86635
|
| Hospital Charge Code |
4392616
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$33.00 |
| Max. Negotiated Rate |
$71.25 |
| Rate for Payer: Aetna Commercial |
$71.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$64.50
|
| 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 |
$45.00
|
| Rate for Payer: Health EOS Commercial |
$68.25
|
| Rate for Payer: HFN Commercial |
$71.25
|
| 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: 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: The Alliance Commercial |
$37.50
|
| Rate for Payer: WEA Trust Commercial |
$41.25
|
| Rate for Payer: WPS Commercial |
$55.55
|
|
|
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 |
$69.00 |
| 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 DHI/DHP/ASO |
$41.97
|
| 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 |
$45.88
|
| 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
|
OP
|
$80.00
|
|
|
Service Code
|
CPT 86635
|
| Hospital Charge Code |
5433345
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.17 |
| Max. Negotiated Rate |
$73.60 |
| 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 DHI/DHP/ASO |
$44.77
|
| 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 |
$45.88
|
| 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, 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: Aetna Gatekeeper/Not Gatekeeper |
$68.80
|
| 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
|
Both
|
$80.00
|
|
|
Service Code
|
CPT 86635
|
| Hospital Charge Code |
5433345
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$35.20 |
| Max. Negotiated Rate |
$76.00 |
| Rate for Payer: Aetna Commercial |
$76.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$68.80
|
| 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 |
$48.00
|
| Rate for Payer: Health EOS Commercial |
$72.80
|
| Rate for Payer: HFN Commercial |
$76.00
|
| 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: 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: The Alliance Commercial |
$40.00
|
| Rate for Payer: WEA Trust Commercial |
$44.00
|
| Rate for Payer: WPS Commercial |
$59.26
|
|
|
Coccidioides Antibody, CSF
|
Professional
|
Both
|
$109.00
|
|
|
Service Code
|
CPT 86635
|
| Hospital Charge Code |
5274882
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$40.49 |
| Max. Negotiated Rate |
$103.55 |
| Rate for Payer: Aetna Commercial |
$103.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$93.74
|
| 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 |
$65.40
|
| Rate for Payer: Health EOS Commercial |
$99.19
|
| Rate for Payer: HFN Commercial |
$103.55
|
| 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: 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: The Alliance Commercial |
$54.50
|
| 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 |
$100.28 |
| 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 DHI/DHP/ASO |
$61.00
|
| 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 |
$45.88
|
| 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
|
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: Aetna Gatekeeper/Not Gatekeeper |
$93.74
|
| 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
|
|
