|
Coccidioides Antibody
|
Professional
|
Both
|
$57.00
|
|
|
Service Code
|
CPT 86635
|
| Hospital Charge Code |
5598646
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.93 |
| Max. Negotiated Rate |
$56.32 |
| Rate for Payer: Aetna Commercial |
$56.32
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$50.98
|
| Rate for Payer: Aetna Managed Medicare |
$11.93
|
| Rate for Payer: Anthem Medicare Advantage |
$11.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$11.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$11.93
|
| Rate for Payer: Cash Price |
$17.10
|
| Rate for Payer: Cash Price |
$17.10
|
| Rate for Payer: Cigna Commercial |
$56.32
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$29.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$11.93
|
| Rate for Payer: Health EOS Commercial |
$53.94
|
| Rate for Payer: HFN Commercial |
$56.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$42.11
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$42.11
|
| Rate for Payer: Independent Care Health Plan Medicare |
$11.93
|
| Rate for Payer: Multiplan Commercial |
$47.42
|
| Rate for Payer: NAPHCARE Commercial |
$17.89
|
| Rate for Payer: Preferred Network Access Commercial |
$56.32
|
| Rate for Payer: Quartz Beloit One Network |
$26.08
|
| Rate for Payer: Quartz Commercial |
$33.79
|
| Rate for Payer: Quartz Medicare Advantage |
$11.93
|
| Rate for Payer: The Alliance Commercial |
$47.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$11.93
|
| Rate for Payer: WEA Trust Commercial |
$32.60
|
| Rate for Payer: WPS Commercial |
$52.49
|
|
|
Coccidioides Antibody
|
Facility
|
IP
|
$42.00
|
|
|
Service Code
|
CPT 86635
|
| Hospital Charge Code |
3304829
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$21.40 |
| Max. Negotiated Rate |
$40.19 |
| Rate for Payer: Aetna Commercial |
$39.31
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$37.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$23.15
|
| Rate for Payer: Cash Price |
$12.60
|
| Rate for Payer: Cigna Commercial |
$40.19
|
| Rate for Payer: Health EOS Commercial |
$38.88
|
| Rate for Payer: HFN Commercial |
$40.19
|
| Rate for Payer: Multiplan Commercial |
$34.94
|
| Rate for Payer: Preferred Network Access Commercial |
$40.19
|
| Rate for Payer: Quartz Beloit One Network |
$21.40
|
| Rate for Payer: Quartz Commercial |
$26.21
|
| Rate for Payer: WEA Trust Commercial |
$24.02
|
| Rate for Payer: WPS Commercial |
$32.35
|
|
|
Coccidioides Antibody CF
|
Facility
|
OP
|
$75.00
|
|
|
Service Code
|
CPT 86635
|
| Hospital Charge Code |
4392616
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.93 |
| Max. Negotiated Rate |
$71.76 |
| Rate for Payer: Aetna Commercial |
$70.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$67.08
|
| Rate for Payer: Aetna Managed Medicare |
$11.93
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$44.73
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$20.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$19.80
|
| Rate for Payer: Anthem Medicare Advantage |
$11.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$41.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$11.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$11.93
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Cigna Commercial |
$71.76
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$11.93
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$43.65
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$11.93
|
| Rate for Payer: Health EOS Commercial |
$69.42
|
| Rate for Payer: HFN Commercial |
$71.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$44.38
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$11.93
|
| Rate for Payer: Independent Care Health Plan Medicare |
$11.93
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$11.93
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$11.93
|
| Rate for Payer: Multiplan Commercial |
$62.40
|
| Rate for Payer: NAPHCARE Commercial |
$17.89
|
| Rate for Payer: Preferred Network Access Commercial |
$71.76
|
| Rate for Payer: Quartz Beloit One Network |
$38.22
|
| Rate for Payer: Quartz Commercial |
$50.70
|
| Rate for Payer: Quartz Medicare Advantage |
$11.93
|
| Rate for Payer: The Alliance Commercial |
$47.72
|
| Rate for Payer: United Healthcare Medicare Advantage |
$11.93
|
| Rate for Payer: United Healthcare PPO |
$58.50
|
| Rate for Payer: WEA Trust Commercial |
$42.90
|
| Rate for Payer: Wellcare Medicare |
$11.93
|
| Rate for Payer: WPS Commercial |
$57.77
|
|
|
Coccidioides Antibody CF
|
Professional
|
Both
|
$75.00
|
|
|
Service Code
|
CPT 86635
|
| Hospital Charge Code |
4392616
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.93 |
| Max. Negotiated Rate |
$74.10 |
| Rate for Payer: Aetna Commercial |
$74.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$67.08
|
| Rate for Payer: Aetna Managed Medicare |
$11.93
|
| Rate for Payer: Anthem Medicare Advantage |
$11.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$11.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$11.93
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Cigna Commercial |
$74.10
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$39.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$11.93
|
| Rate for Payer: Health EOS Commercial |
$70.98
|
| Rate for Payer: HFN Commercial |
$74.10
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$42.11
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$42.11
|
| Rate for Payer: Independent Care Health Plan Medicare |
$11.93
|
| Rate for Payer: Multiplan Commercial |
$62.40
|
| Rate for Payer: NAPHCARE Commercial |
$17.89
|
| Rate for Payer: Preferred Network Access Commercial |
$74.10
|
| Rate for Payer: Quartz Beloit One Network |
$34.32
|
| Rate for Payer: Quartz Commercial |
$44.46
|
| Rate for Payer: Quartz Medicare Advantage |
$11.93
|
| Rate for Payer: The Alliance Commercial |
$47.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$11.93
|
| Rate for Payer: WEA Trust Commercial |
$42.90
|
| Rate for Payer: WPS Commercial |
$52.49
|
|
|
Coccidioides Antibody CF
|
Facility
|
IP
|
$75.00
|
|
|
Service Code
|
CPT 86635
|
| Hospital Charge Code |
4392616
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$38.22 |
| Max. Negotiated Rate |
$71.76 |
| Rate for Payer: Aetna Commercial |
$70.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$67.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$41.34
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Cigna Commercial |
$71.76
|
| Rate for Payer: Health EOS Commercial |
$69.42
|
| Rate for Payer: HFN Commercial |
$71.76
|
| Rate for Payer: Multiplan Commercial |
$62.40
|
| Rate for Payer: Preferred Network Access Commercial |
$71.76
|
| Rate for Payer: Quartz Beloit One Network |
$38.22
|
| Rate for Payer: Quartz Commercial |
$46.80
|
| Rate for Payer: WEA Trust Commercial |
$42.90
|
| Rate for Payer: WPS Commercial |
$57.77
|
|
|
Coccidioides Antibody, Complement Fixation
|
Facility
|
IP
|
$80.00
|
|
|
Service Code
|
CPT 86635
|
| Hospital Charge Code |
5433345
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$40.77 |
| Max. Negotiated Rate |
$76.54 |
| Rate for Payer: Aetna Commercial |
$74.88
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$71.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$44.10
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Cigna Commercial |
$76.54
|
| Rate for Payer: Health EOS Commercial |
$74.05
|
| Rate for Payer: HFN Commercial |
$76.54
|
| Rate for Payer: Multiplan Commercial |
$66.56
|
| Rate for Payer: Preferred Network Access Commercial |
$76.54
|
| Rate for Payer: Quartz Beloit One Network |
$40.77
|
| Rate for Payer: Quartz Commercial |
$49.92
|
| Rate for Payer: WEA Trust Commercial |
$45.76
|
| Rate for Payer: WPS Commercial |
$61.62
|
|
|
Coccidioides Antibody, Complement Fixation
|
Facility
|
OP
|
$80.00
|
|
|
Service Code
|
CPT 86635
|
| Hospital Charge Code |
5433345
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.93 |
| Max. Negotiated Rate |
$76.54 |
| Rate for Payer: Aetna Commercial |
$74.88
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$71.55
|
| Rate for Payer: Aetna Managed Medicare |
$11.93
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$44.73
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$20.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$19.80
|
| Rate for Payer: Anthem Medicare Advantage |
$11.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$44.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$11.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$11.93
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Cigna Commercial |
$76.54
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$11.93
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$46.56
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$11.93
|
| Rate for Payer: Health EOS Commercial |
$74.05
|
| Rate for Payer: HFN Commercial |
$76.54
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$44.38
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$11.93
|
| Rate for Payer: Independent Care Health Plan Medicare |
$11.93
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$11.93
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$11.93
|
| Rate for Payer: Multiplan Commercial |
$66.56
|
| Rate for Payer: NAPHCARE Commercial |
$17.89
|
| Rate for Payer: Preferred Network Access Commercial |
$76.54
|
| Rate for Payer: Quartz Beloit One Network |
$40.77
|
| Rate for Payer: Quartz Commercial |
$54.08
|
| Rate for Payer: Quartz Medicare Advantage |
$11.93
|
| Rate for Payer: The Alliance Commercial |
$47.72
|
| Rate for Payer: United Healthcare Medicare Advantage |
$11.93
|
| Rate for Payer: United Healthcare PPO |
$62.40
|
| Rate for Payer: WEA Trust Commercial |
$45.76
|
| Rate for Payer: Wellcare Medicare |
$11.93
|
| Rate for Payer: WPS Commercial |
$61.62
|
|
|
Coccidioides Antibody, Complement Fixation
|
Professional
|
Both
|
$80.00
|
|
|
Service Code
|
CPT 86635
|
| Hospital Charge Code |
5433345
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.93 |
| Max. Negotiated Rate |
$79.04 |
| Rate for Payer: Aetna Commercial |
$79.04
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$71.55
|
| Rate for Payer: Aetna Managed Medicare |
$11.93
|
| Rate for Payer: Anthem Medicare Advantage |
$11.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$11.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$11.93
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Cigna Commercial |
$79.04
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$41.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$11.93
|
| Rate for Payer: Health EOS Commercial |
$75.71
|
| Rate for Payer: HFN Commercial |
$79.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$42.11
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$42.11
|
| Rate for Payer: Independent Care Health Plan Medicare |
$11.93
|
| Rate for Payer: Multiplan Commercial |
$66.56
|
| Rate for Payer: NAPHCARE Commercial |
$17.89
|
| Rate for Payer: Preferred Network Access Commercial |
$79.04
|
| Rate for Payer: Quartz Beloit One Network |
$36.61
|
| Rate for Payer: Quartz Commercial |
$47.42
|
| Rate for Payer: Quartz Medicare Advantage |
$11.93
|
| Rate for Payer: The Alliance Commercial |
$47.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$11.93
|
| Rate for Payer: WEA Trust Commercial |
$45.76
|
| Rate for Payer: WPS Commercial |
$52.49
|
|
|
Coccidioides Antibody, CSF
|
Facility
|
OP
|
$109.00
|
|
|
Service Code
|
CPT 86635
|
| Hospital Charge Code |
5274882
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.93 |
| Max. Negotiated Rate |
$104.29 |
| Rate for Payer: Aetna Commercial |
$102.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$97.49
|
| Rate for Payer: Aetna Managed Medicare |
$11.93
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$44.73
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$20.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$19.80
|
| Rate for Payer: Anthem Medicare Advantage |
$11.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$60.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$11.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$11.93
|
| Rate for Payer: Cash Price |
$32.70
|
| Rate for Payer: Cash Price |
$32.70
|
| Rate for Payer: Cigna Commercial |
$104.29
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$11.93
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$63.44
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$11.93
|
| Rate for Payer: Health EOS Commercial |
$100.89
|
| Rate for Payer: HFN Commercial |
$104.29
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$44.38
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$11.93
|
| Rate for Payer: Independent Care Health Plan Medicare |
$11.93
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$11.93
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$11.93
|
| Rate for Payer: Multiplan Commercial |
$90.69
|
| Rate for Payer: NAPHCARE Commercial |
$17.89
|
| Rate for Payer: Preferred Network Access Commercial |
$104.29
|
| Rate for Payer: Quartz Beloit One Network |
$55.55
|
| Rate for Payer: Quartz Commercial |
$73.68
|
| Rate for Payer: Quartz Medicare Advantage |
$11.93
|
| Rate for Payer: The Alliance Commercial |
$47.72
|
| Rate for Payer: United Healthcare Medicare Advantage |
$11.93
|
| Rate for Payer: United Healthcare PPO |
$85.02
|
| Rate for Payer: WEA Trust Commercial |
$62.35
|
| Rate for Payer: Wellcare Medicare |
$11.93
|
| Rate for Payer: WPS Commercial |
$83.96
|
|
|
Coccidioides Antibody, CSF
|
Facility
|
IP
|
$109.00
|
|
|
Service Code
|
CPT 86635
|
| Hospital Charge Code |
5274882
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$55.55 |
| Max. Negotiated Rate |
$104.29 |
| Rate for Payer: Aetna Commercial |
$102.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$97.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$60.08
|
| Rate for Payer: Cash Price |
$32.70
|
| Rate for Payer: Cigna Commercial |
$104.29
|
| Rate for Payer: Health EOS Commercial |
$100.89
|
| Rate for Payer: HFN Commercial |
$104.29
|
| Rate for Payer: Multiplan Commercial |
$90.69
|
| Rate for Payer: Preferred Network Access Commercial |
$104.29
|
| Rate for Payer: Quartz Beloit One Network |
$55.55
|
| Rate for Payer: Quartz Commercial |
$68.02
|
| Rate for Payer: WEA Trust Commercial |
$62.35
|
| Rate for Payer: WPS Commercial |
$83.96
|
|
|
Coccidioides Antibody, CSF
|
Professional
|
Both
|
$109.00
|
|
|
Service Code
|
CPT 86635
|
| Hospital Charge Code |
5274882
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.93 |
| Max. Negotiated Rate |
$107.69 |
| Rate for Payer: Aetna Commercial |
$107.69
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$97.49
|
| Rate for Payer: Aetna Managed Medicare |
$11.93
|
| Rate for Payer: Anthem Medicare Advantage |
$11.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$11.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$11.93
|
| Rate for Payer: Cash Price |
$32.70
|
| Rate for Payer: Cash Price |
$32.70
|
| Rate for Payer: Cigna Commercial |
$107.69
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$56.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$11.93
|
| Rate for Payer: Health EOS Commercial |
$103.16
|
| Rate for Payer: HFN Commercial |
$107.69
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$42.11
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$42.11
|
| Rate for Payer: Independent Care Health Plan Medicare |
$11.93
|
| Rate for Payer: Multiplan Commercial |
$90.69
|
| Rate for Payer: NAPHCARE Commercial |
$17.89
|
| Rate for Payer: Preferred Network Access Commercial |
$107.69
|
| Rate for Payer: Quartz Beloit One Network |
$49.88
|
| Rate for Payer: Quartz Commercial |
$64.62
|
| Rate for Payer: Quartz Medicare Advantage |
$11.93
|
| Rate for Payer: The Alliance Commercial |
$47.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$11.93
|
| Rate for Payer: WEA Trust Commercial |
$62.35
|
| Rate for Payer: WPS Commercial |
$52.49
|
|
|
Coccidioides Antibody ID
|
Facility
|
IP
|
$75.00
|
|
|
Service Code
|
CPT 86635
|
| Hospital Charge Code |
4392617
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$38.22 |
| Max. Negotiated Rate |
$71.76 |
| Rate for Payer: Aetna Commercial |
$70.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$67.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$41.34
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Cigna Commercial |
$71.76
|
| Rate for Payer: Health EOS Commercial |
$69.42
|
| Rate for Payer: HFN Commercial |
$71.76
|
| Rate for Payer: Multiplan Commercial |
$62.40
|
| Rate for Payer: Preferred Network Access Commercial |
$71.76
|
| Rate for Payer: Quartz Beloit One Network |
$38.22
|
| Rate for Payer: Quartz Commercial |
$46.80
|
| Rate for Payer: WEA Trust Commercial |
$42.90
|
| Rate for Payer: WPS Commercial |
$57.77
|
|
|
Coccidioides Antibody ID
|
Facility
|
OP
|
$75.00
|
|
|
Service Code
|
CPT 86635
|
| Hospital Charge Code |
4392617
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.93 |
| Max. Negotiated Rate |
$71.76 |
| Rate for Payer: Aetna Commercial |
$70.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$67.08
|
| Rate for Payer: Aetna Managed Medicare |
$11.93
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$44.73
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$20.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$19.80
|
| Rate for Payer: Anthem Medicare Advantage |
$11.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$41.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$11.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$11.93
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Cigna Commercial |
$71.76
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$11.93
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$43.65
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$11.93
|
| Rate for Payer: Health EOS Commercial |
$69.42
|
| Rate for Payer: HFN Commercial |
$71.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$44.38
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$11.93
|
| Rate for Payer: Independent Care Health Plan Medicare |
$11.93
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$11.93
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$11.93
|
| Rate for Payer: Multiplan Commercial |
$62.40
|
| Rate for Payer: NAPHCARE Commercial |
$17.89
|
| Rate for Payer: Preferred Network Access Commercial |
$71.76
|
| Rate for Payer: Quartz Beloit One Network |
$38.22
|
| Rate for Payer: Quartz Commercial |
$50.70
|
| Rate for Payer: Quartz Medicare Advantage |
$11.93
|
| Rate for Payer: The Alliance Commercial |
$47.72
|
| Rate for Payer: United Healthcare Medicare Advantage |
$11.93
|
| Rate for Payer: United Healthcare PPO |
$58.50
|
| Rate for Payer: WEA Trust Commercial |
$42.90
|
| Rate for Payer: Wellcare Medicare |
$11.93
|
| Rate for Payer: WPS Commercial |
$57.77
|
|
|
Coccidioides Antibody ID
|
Professional
|
Both
|
$75.00
|
|
|
Service Code
|
CPT 86635
|
| Hospital Charge Code |
4392617
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.93 |
| Max. Negotiated Rate |
$74.10 |
| Rate for Payer: Aetna Commercial |
$74.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$67.08
|
| Rate for Payer: Aetna Managed Medicare |
$11.93
|
| Rate for Payer: Anthem Medicare Advantage |
$11.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$11.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$11.93
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Cigna Commercial |
$74.10
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$39.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$11.93
|
| Rate for Payer: Health EOS Commercial |
$70.98
|
| Rate for Payer: HFN Commercial |
$74.10
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$42.11
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$42.11
|
| Rate for Payer: Independent Care Health Plan Medicare |
$11.93
|
| Rate for Payer: Multiplan Commercial |
$62.40
|
| Rate for Payer: NAPHCARE Commercial |
$17.89
|
| Rate for Payer: Preferred Network Access Commercial |
$74.10
|
| Rate for Payer: Quartz Beloit One Network |
$34.32
|
| Rate for Payer: Quartz Commercial |
$44.46
|
| Rate for Payer: Quartz Medicare Advantage |
$11.93
|
| Rate for Payer: The Alliance Commercial |
$47.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$11.93
|
| Rate for Payer: WEA Trust Commercial |
$42.90
|
| Rate for Payer: WPS Commercial |
$52.49
|
|
|
COCHLEAR DEVICE IMPLANTATION
|
Facility
|
OP
|
$22,070.69
|
|
|
Service Code
|
EAPG 00250
|
| Min. Negotiated Rate |
$21,221.76 |
| Max. Negotiated Rate |
$22,070.69 |
| Rate for Payer: Anthem Medicaid |
$21,221.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$21,221.76
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$21,221.76
|
| Rate for Payer: Dean Health Medicaid |
$21,221.76
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$21,221.76
|
| Rate for Payer: Managed Health Services Medicaid |
$22,070.69
|
| Rate for Payer: Molina Healthcare Medicaid |
$21,221.76
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$21,221.76
|
| Rate for Payer: United Healthcare Medicaid |
$21,221.76
|
|
|
Coenzyme Q10 Level
|
Facility
|
IP
|
$172.00
|
|
|
Service Code
|
CPT 82542
|
| Hospital Charge Code |
1038902
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$87.65 |
| Max. Negotiated Rate |
$164.57 |
| Rate for Payer: Aetna Commercial |
$160.99
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$153.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$94.81
|
| Rate for Payer: Cash Price |
$51.60
|
| Rate for Payer: Cigna Commercial |
$164.57
|
| Rate for Payer: Health EOS Commercial |
$159.20
|
| Rate for Payer: HFN Commercial |
$164.57
|
| Rate for Payer: Multiplan Commercial |
$143.10
|
| Rate for Payer: Preferred Network Access Commercial |
$164.57
|
| Rate for Payer: Quartz Beloit One Network |
$87.65
|
| Rate for Payer: Quartz Commercial |
$107.33
|
| Rate for Payer: WEA Trust Commercial |
$98.38
|
| Rate for Payer: WPS Commercial |
$132.49
|
|
|
Coenzyme Q10 Level
|
Professional
|
Both
|
$172.00
|
|
|
Service Code
|
CPT 82542
|
| Hospital Charge Code |
1038902
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$25.05 |
| Max. Negotiated Rate |
$169.94 |
| Rate for Payer: Aetna Commercial |
$169.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$153.84
|
| Rate for Payer: Aetna Managed Medicare |
$25.05
|
| Rate for Payer: Anthem Medicare Advantage |
$25.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$25.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$25.05
|
| Rate for Payer: Cash Price |
$51.60
|
| Rate for Payer: Cash Price |
$51.60
|
| Rate for Payer: Cigna Commercial |
$169.94
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$89.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$25.05
|
| Rate for Payer: Health EOS Commercial |
$162.78
|
| Rate for Payer: HFN Commercial |
$169.94
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$88.44
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$88.44
|
| Rate for Payer: Independent Care Health Plan Medicare |
$25.05
|
| Rate for Payer: Multiplan Commercial |
$143.10
|
| Rate for Payer: NAPHCARE Commercial |
$37.58
|
| Rate for Payer: Preferred Network Access Commercial |
$169.94
|
| Rate for Payer: Quartz Beloit One Network |
$78.71
|
| Rate for Payer: Quartz Commercial |
$101.96
|
| Rate for Payer: Quartz Medicare Advantage |
$25.05
|
| Rate for Payer: The Alliance Commercial |
$98.96
|
| Rate for Payer: United Healthcare Medicare Advantage |
$25.05
|
| Rate for Payer: WEA Trust Commercial |
$98.38
|
| Rate for Payer: WPS Commercial |
$110.24
|
|
|
Coenzyme Q10 Level
|
Facility
|
OP
|
$172.00
|
|
|
Service Code
|
CPT 82542
|
| Hospital Charge Code |
1038902
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$25.05 |
| Max. Negotiated Rate |
$164.57 |
| Rate for Payer: Aetna Commercial |
$160.99
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$153.84
|
| Rate for Payer: Aetna Managed Medicare |
$25.05
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$93.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$43.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$41.59
|
| Rate for Payer: Anthem Medicare Advantage |
$25.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$94.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$25.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$25.05
|
| Rate for Payer: Cash Price |
$51.60
|
| Rate for Payer: Cash Price |
$51.60
|
| Rate for Payer: Cigna Commercial |
$164.57
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$25.05
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$100.10
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$25.05
|
| Rate for Payer: Health EOS Commercial |
$159.20
|
| Rate for Payer: HFN Commercial |
$164.57
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$93.20
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$25.05
|
| Rate for Payer: Independent Care Health Plan Medicare |
$25.05
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$25.05
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$25.05
|
| Rate for Payer: Multiplan Commercial |
$143.10
|
| Rate for Payer: NAPHCARE Commercial |
$37.58
|
| Rate for Payer: Preferred Network Access Commercial |
$164.57
|
| Rate for Payer: Quartz Beloit One Network |
$87.65
|
| Rate for Payer: Quartz Commercial |
$116.27
|
| Rate for Payer: Quartz Medicare Advantage |
$25.05
|
| Rate for Payer: The Alliance Commercial |
$100.21
|
| Rate for Payer: United Healthcare Medicare Advantage |
$25.05
|
| Rate for Payer: United Healthcare PPO |
$134.16
|
| Rate for Payer: WEA Trust Commercial |
$98.38
|
| Rate for Payer: Wellcare Medicare |
$25.05
|
| Rate for Payer: WPS Commercial |
$132.49
|
|
|
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 |
$640.93 |
| Max. Negotiated Rate |
$2,105.92 |
| Rate for Payer: Aetna Commercial |
$2,060.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,968.57
|
| Rate for Payer: Aetna Managed Medicare |
$640.93
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,487.88
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,144.52
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,098.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,213.19
|
| Rate for Payer: Cash Price |
$660.30
|
| Rate for Payer: Cigna Commercial |
$2,105.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,280.98
|
| Rate for Payer: Health EOS Commercial |
$2,037.25
|
| Rate for Payer: HFN Commercial |
$2,105.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,716.78
|
| Rate for Payer: Multiplan Commercial |
$1,831.23
|
| Rate for Payer: NAPHCARE Commercial |
$1,373.42
|
| Rate for Payer: Preferred Network Access Commercial |
$2,105.92
|
| Rate for Payer: Quartz Beloit One Network |
$1,121.63
|
| Rate for Payer: Quartz Commercial |
$1,487.88
|
| Rate for Payer: Quartz Medicare Advantage |
$1,373.42
|
| Rate for Payer: The Alliance Commercial |
$1,144.52
|
| Rate for Payer: WEA Trust Commercial |
$1,258.97
|
| Rate for Payer: WPS Commercial |
$1,695.43
|
|
|
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 |
$1,121.63 |
| Max. Negotiated Rate |
$2,105.92 |
| Rate for Payer: Aetna Commercial |
$2,060.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,968.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,213.19
|
| Rate for Payer: Cash Price |
$660.30
|
| Rate for Payer: Cigna Commercial |
$2,105.92
|
| Rate for Payer: Health EOS Commercial |
$2,037.25
|
| Rate for Payer: HFN Commercial |
$2,105.92
|
| Rate for Payer: Multiplan Commercial |
$1,831.23
|
| Rate for Payer: Preferred Network Access Commercial |
$2,105.92
|
| Rate for Payer: Quartz Beloit One Network |
$1,121.63
|
| Rate for Payer: Quartz Commercial |
$1,373.42
|
| Rate for Payer: WEA Trust Commercial |
$1,258.97
|
| Rate for Payer: WPS Commercial |
$1,695.43
|
|
|
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 |
$637.00 |
| Max. Negotiated Rate |
$1,196.00 |
| Rate for Payer: Aetna Commercial |
$1,170.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,118.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$689.00
|
| Rate for Payer: Cash Price |
$375.00
|
| Rate for Payer: Cigna Commercial |
$1,196.00
|
| Rate for Payer: Health EOS Commercial |
$1,157.00
|
| Rate for Payer: HFN Commercial |
$1,196.00
|
| Rate for Payer: Multiplan Commercial |
$1,040.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,196.00
|
| Rate for Payer: Quartz Beloit One Network |
$637.00
|
| Rate for Payer: Quartz Commercial |
$780.00
|
| Rate for Payer: WEA Trust Commercial |
$715.00
|
| Rate for Payer: WPS Commercial |
$962.88
|
|
|
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 |
$364.00 |
| Max. Negotiated Rate |
$1,196.00 |
| Rate for Payer: Aetna Commercial |
$1,170.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,118.00
|
| Rate for Payer: Aetna Managed Medicare |
$364.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$845.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$650.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$624.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$689.00
|
| Rate for Payer: Cash Price |
$375.00
|
| Rate for Payer: Cigna Commercial |
$1,196.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$727.50
|
| Rate for Payer: Health EOS Commercial |
$1,157.00
|
| Rate for Payer: HFN Commercial |
$1,196.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$975.00
|
| Rate for Payer: Multiplan Commercial |
$1,040.00
|
| Rate for Payer: NAPHCARE Commercial |
$780.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,196.00
|
| Rate for Payer: Quartz Beloit One Network |
$637.00
|
| Rate for Payer: Quartz Commercial |
$845.00
|
| Rate for Payer: Quartz Medicare Advantage |
$780.00
|
| Rate for Payer: The Alliance Commercial |
$650.00
|
| Rate for Payer: WEA Trust Commercial |
$715.00
|
| Rate for Payer: WPS Commercial |
$962.88
|
|
|
COIL MREYE EMBOLIZATION 5CM X 6MM .035 2.6 LOOP G20291
|
Facility
|
IP
|
$1,250.00
|
|
|
Service Code
|
HCPCS C1889
|
| Hospital Charge Code |
6200995
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$637.00 |
| Max. Negotiated Rate |
$1,196.00 |
| Rate for Payer: Aetna Commercial |
$1,170.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,118.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$689.00
|
| Rate for Payer: Cash Price |
$375.00
|
| Rate for Payer: Cigna Commercial |
$1,196.00
|
| Rate for Payer: Health EOS Commercial |
$1,157.00
|
| Rate for Payer: HFN Commercial |
$1,196.00
|
| Rate for Payer: Multiplan Commercial |
$1,040.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,196.00
|
| Rate for Payer: Quartz Beloit One Network |
$637.00
|
| Rate for Payer: Quartz Commercial |
$780.00
|
| Rate for Payer: WEA Trust Commercial |
$715.00
|
| Rate for Payer: WPS Commercial |
$962.88
|
|
|
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 |
$364.00 |
| Max. Negotiated Rate |
$1,196.00 |
| Rate for Payer: Aetna Commercial |
$1,170.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,118.00
|
| Rate for Payer: Aetna Managed Medicare |
$364.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$845.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$650.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$624.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$689.00
|
| Rate for Payer: Cash Price |
$375.00
|
| Rate for Payer: Cigna Commercial |
$1,196.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$727.50
|
| Rate for Payer: Health EOS Commercial |
$1,157.00
|
| Rate for Payer: HFN Commercial |
$1,196.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$975.00
|
| Rate for Payer: Multiplan Commercial |
$1,040.00
|
| Rate for Payer: NAPHCARE Commercial |
$780.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,196.00
|
| Rate for Payer: Quartz Beloit One Network |
$637.00
|
| Rate for Payer: Quartz Commercial |
$845.00
|
| Rate for Payer: Quartz Medicare Advantage |
$780.00
|
| Rate for Payer: The Alliance Commercial |
$650.00
|
| Rate for Payer: WEA Trust Commercial |
$715.00
|
| Rate for Payer: WPS Commercial |
$962.88
|
|
|
COIL NESTER 14-10 #G26991
|
Facility
|
IP
|
$1,791.00
|
|
| Hospital Charge Code |
2972455
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$912.69 |
| Max. Negotiated Rate |
$1,713.63 |
| Rate for Payer: Aetna Commercial |
$1,676.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,601.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$987.20
|
| Rate for Payer: Cash Price |
$537.30
|
| Rate for Payer: Cigna Commercial |
$1,713.63
|
| Rate for Payer: Health EOS Commercial |
$1,657.75
|
| Rate for Payer: HFN Commercial |
$1,713.63
|
| Rate for Payer: Multiplan Commercial |
$1,490.11
|
| Rate for Payer: Preferred Network Access Commercial |
$1,713.63
|
| Rate for Payer: Quartz Beloit One Network |
$912.69
|
| Rate for Payer: Quartz Commercial |
$1,117.58
|
| Rate for Payer: WEA Trust Commercial |
$1,024.45
|
| Rate for Payer: WPS Commercial |
$1,379.61
|
|
