|
Cyclospora and Isospora / 10018
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
CPT 87015
|
| Hospital Charge Code |
3444888
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.27 |
| Max. Negotiated Rate |
$21.16 |
| Rate for Payer: Aetna Commercial |
$20.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$19.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$12.19
|
| Rate for Payer: Cash Price |
$6.90
|
| Rate for Payer: Cigna Commercial |
$21.16
|
| Rate for Payer: Health EOS Commercial |
$20.47
|
| Rate for Payer: HFN Commercial |
$21.16
|
| Rate for Payer: Multiplan Commercial |
$18.40
|
| Rate for Payer: NAPHCARE Commercial |
$13.80
|
| Rate for Payer: Preferred Network Access Commercial |
$21.16
|
| Rate for Payer: Quartz Beloit One Network |
$11.27
|
| Rate for Payer: Quartz Commercial |
$13.80
|
| Rate for Payer: WEA Trust Commercial |
$12.65
|
| Rate for Payer: WPS Commercial |
$17.04
|
|
|
Cyclospora and Isospora / 10018
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
CPT 87015
|
| Hospital Charge Code |
3444888
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.25 |
| Max. Negotiated Rate |
$26.72 |
| Rate for Payer: Aetna Commercial |
$20.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$19.78
|
| Rate for Payer: Aetna Managed Medicare |
$6.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$25.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$11.69
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$11.09
|
| Rate for Payer: Anthem Medicaid |
$5.25
|
| Rate for Payer: Anthem Medicare Advantage |
$6.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$12.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$6.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$6.68
|
| Rate for Payer: Cash Price |
$6.90
|
| Rate for Payer: Cash Price |
$6.90
|
| Rate for Payer: Cigna Commercial |
$21.16
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$6.68
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$5.25
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12.87
|
| Rate for Payer: Dean Health Medicaid |
$5.25
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$6.68
|
| Rate for Payer: Health EOS Commercial |
$20.47
|
| Rate for Payer: HFN Commercial |
$21.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$24.85
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$6.68
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$5.25
|
| Rate for Payer: Independent Care Health Plan Medicare |
$6.68
|
| Rate for Payer: Managed Health Services Medicaid |
$5.46
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$6.68
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$6.68
|
| Rate for Payer: Multiplan Commercial |
$18.40
|
| Rate for Payer: NAPHCARE Commercial |
$10.02
|
| Rate for Payer: Preferred Network Access Commercial |
$21.16
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$5.25
|
| Rate for Payer: Quartz Beloit One Network |
$11.27
|
| Rate for Payer: Quartz Commercial |
$14.95
|
| Rate for Payer: Quartz Medicare Advantage |
$6.68
|
| Rate for Payer: The Alliance Commercial |
$26.72
|
| Rate for Payer: United Healthcare Medicaid |
$5.25
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6.68
|
| Rate for Payer: United Healthcare PPO |
$17.25
|
| Rate for Payer: WEA Trust Commercial |
$12.65
|
| Rate for Payer: Wellcare Medicare |
$6.68
|
| Rate for Payer: WMAP Medicaid |
$5.25
|
| Rate for Payer: WPS Commercial |
$17.04
|
|
|
Cyclosporine Level
|
Facility
|
IP
|
$316.00
|
|
|
Service Code
|
CPT 80158
|
| Hospital Charge Code |
977919
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$154.84 |
| Max. Negotiated Rate |
$290.72 |
| Rate for Payer: Aetna Commercial |
$284.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$271.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$167.48
|
| Rate for Payer: Cash Price |
$94.80
|
| Rate for Payer: Cigna Commercial |
$290.72
|
| Rate for Payer: Health EOS Commercial |
$281.24
|
| Rate for Payer: HFN Commercial |
$290.72
|
| Rate for Payer: Multiplan Commercial |
$252.80
|
| Rate for Payer: NAPHCARE Commercial |
$189.60
|
| Rate for Payer: Preferred Network Access Commercial |
$290.72
|
| Rate for Payer: Quartz Beloit One Network |
$154.84
|
| Rate for Payer: Quartz Commercial |
$189.60
|
| Rate for Payer: WEA Trust Commercial |
$173.80
|
| Rate for Payer: WPS Commercial |
$234.06
|
|
|
Cyclosporine Level
|
Professional
|
Both
|
$316.00
|
|
|
Service Code
|
CPT 80158
|
| Hospital Charge Code |
977919
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$63.72 |
| Max. Negotiated Rate |
$300.20 |
| Rate for Payer: Aetna Commercial |
$300.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$271.76
|
| Rate for Payer: Cash Price |
$94.80
|
| Rate for Payer: Cash Price |
$94.80
|
| Rate for Payer: Cigna Commercial |
$300.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$158.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$189.60
|
| Rate for Payer: Health EOS Commercial |
$287.56
|
| Rate for Payer: HFN Commercial |
$300.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$63.72
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$63.72
|
| Rate for Payer: Multiplan Commercial |
$252.80
|
| Rate for Payer: Preferred Network Access Commercial |
$300.20
|
| Rate for Payer: Quartz Beloit One Network |
$139.04
|
| Rate for Payer: Quartz Commercial |
$180.12
|
| Rate for Payer: The Alliance Commercial |
$158.00
|
| Rate for Payer: WEA Trust Commercial |
$173.80
|
| Rate for Payer: WPS Commercial |
$234.06
|
|
|
Cyclosporine Level
|
Facility
|
OP
|
$316.00
|
|
|
Service Code
|
CPT 80158
|
| Hospital Charge Code |
977919
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.05 |
| Max. Negotiated Rate |
$290.72 |
| Rate for Payer: Aetna Commercial |
$284.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$271.76
|
| Rate for Payer: Aetna Managed Medicare |
$18.05
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$67.69
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$31.59
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$29.96
|
| Rate for Payer: Anthem Medicaid |
$18.65
|
| Rate for Payer: Anthem Medicare Advantage |
$18.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$167.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$18.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$18.05
|
| Rate for Payer: Cash Price |
$94.80
|
| Rate for Payer: Cash Price |
$94.80
|
| Rate for Payer: Cigna Commercial |
$290.72
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$18.05
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$18.65
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$176.83
|
| Rate for Payer: Dean Health Medicaid |
$18.65
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$18.05
|
| Rate for Payer: Health EOS Commercial |
$281.24
|
| Rate for Payer: HFN Commercial |
$290.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$67.15
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$18.05
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$18.65
|
| Rate for Payer: Independent Care Health Plan Medicare |
$18.05
|
| Rate for Payer: Managed Health Services Medicaid |
$19.40
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$18.05
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$18.05
|
| Rate for Payer: Multiplan Commercial |
$252.80
|
| Rate for Payer: NAPHCARE Commercial |
$27.08
|
| Rate for Payer: Preferred Network Access Commercial |
$290.72
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$18.65
|
| Rate for Payer: Quartz Beloit One Network |
$154.84
|
| Rate for Payer: Quartz Commercial |
$205.40
|
| Rate for Payer: Quartz Medicare Advantage |
$18.05
|
| Rate for Payer: The Alliance Commercial |
$72.20
|
| Rate for Payer: United Healthcare Medicaid |
$18.65
|
| Rate for Payer: United Healthcare Medicare Advantage |
$18.05
|
| Rate for Payer: United Healthcare PPO |
$237.00
|
| Rate for Payer: WEA Trust Commercial |
$173.80
|
| Rate for Payer: Wellcare Medicare |
$18.05
|
| Rate for Payer: WMAP Medicaid |
$18.65
|
| Rate for Payer: WPS Commercial |
$234.06
|
|
|
Cyclosporine Level to Mayo
|
Professional
|
Both
|
$274.00
|
|
|
Service Code
|
CPT 80158
|
| Hospital Charge Code |
3331570
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$63.72 |
| Max. Negotiated Rate |
$260.30 |
| Rate for Payer: Aetna Commercial |
$260.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$235.64
|
| Rate for Payer: Cash Price |
$82.20
|
| Rate for Payer: Cash Price |
$82.20
|
| Rate for Payer: Cigna Commercial |
$260.30
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$137.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$164.40
|
| Rate for Payer: Health EOS Commercial |
$249.34
|
| Rate for Payer: HFN Commercial |
$260.30
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$63.72
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$63.72
|
| Rate for Payer: Multiplan Commercial |
$219.20
|
| Rate for Payer: Preferred Network Access Commercial |
$260.30
|
| Rate for Payer: Quartz Beloit One Network |
$120.56
|
| Rate for Payer: Quartz Commercial |
$156.18
|
| Rate for Payer: The Alliance Commercial |
$137.00
|
| Rate for Payer: WEA Trust Commercial |
$150.70
|
| Rate for Payer: WPS Commercial |
$202.95
|
|
|
Cyclosporine Level to Mayo
|
Facility
|
OP
|
$274.00
|
|
|
Service Code
|
CPT 80158
|
| Hospital Charge Code |
3331570
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.05 |
| Max. Negotiated Rate |
$252.08 |
| Rate for Payer: Aetna Commercial |
$246.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$235.64
|
| Rate for Payer: Aetna Managed Medicare |
$18.05
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$67.69
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$31.59
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$29.96
|
| Rate for Payer: Anthem Medicaid |
$18.65
|
| Rate for Payer: Anthem Medicare Advantage |
$18.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$145.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$18.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$18.05
|
| Rate for Payer: Cash Price |
$82.20
|
| Rate for Payer: Cash Price |
$82.20
|
| Rate for Payer: Cigna Commercial |
$252.08
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$18.05
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$18.65
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$153.33
|
| Rate for Payer: Dean Health Medicaid |
$18.65
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$18.05
|
| Rate for Payer: Health EOS Commercial |
$243.86
|
| Rate for Payer: HFN Commercial |
$252.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$67.15
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$18.05
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$18.65
|
| Rate for Payer: Independent Care Health Plan Medicare |
$18.05
|
| Rate for Payer: Managed Health Services Medicaid |
$19.40
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$18.05
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$18.05
|
| Rate for Payer: Multiplan Commercial |
$219.20
|
| Rate for Payer: NAPHCARE Commercial |
$27.08
|
| Rate for Payer: Preferred Network Access Commercial |
$252.08
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$18.65
|
| Rate for Payer: Quartz Beloit One Network |
$134.26
|
| Rate for Payer: Quartz Commercial |
$178.10
|
| Rate for Payer: Quartz Medicare Advantage |
$18.05
|
| Rate for Payer: The Alliance Commercial |
$72.20
|
| Rate for Payer: United Healthcare Medicaid |
$18.65
|
| Rate for Payer: United Healthcare Medicare Advantage |
$18.05
|
| Rate for Payer: United Healthcare PPO |
$205.50
|
| Rate for Payer: WEA Trust Commercial |
$150.70
|
| Rate for Payer: Wellcare Medicare |
$18.05
|
| Rate for Payer: WMAP Medicaid |
$18.65
|
| Rate for Payer: WPS Commercial |
$202.95
|
|
|
Cyclosporine Level to Mayo
|
Facility
|
IP
|
$274.00
|
|
|
Service Code
|
CPT 80158
|
| Hospital Charge Code |
3331570
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$134.26 |
| Max. Negotiated Rate |
$252.08 |
| Rate for Payer: Aetna Commercial |
$246.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$235.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$145.22
|
| Rate for Payer: Cash Price |
$82.20
|
| Rate for Payer: Cigna Commercial |
$252.08
|
| Rate for Payer: Health EOS Commercial |
$243.86
|
| Rate for Payer: HFN Commercial |
$252.08
|
| Rate for Payer: Multiplan Commercial |
$219.20
|
| Rate for Payer: NAPHCARE Commercial |
$164.40
|
| Rate for Payer: Preferred Network Access Commercial |
$252.08
|
| Rate for Payer: Quartz Beloit One Network |
$134.26
|
| Rate for Payer: Quartz Commercial |
$164.40
|
| Rate for Payer: WEA Trust Commercial |
$150.70
|
| Rate for Payer: WPS Commercial |
$202.95
|
|
|
CYLINDER TANK HOLDER PORTABLE
|
Facility
|
IP
|
$333.00
|
|
| Hospital Charge Code |
2972315
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$163.17 |
| Max. Negotiated Rate |
$306.36 |
| Rate for Payer: Aetna Commercial |
$299.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$286.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$176.49
|
| Rate for Payer: Cash Price |
$99.90
|
| Rate for Payer: Cigna Commercial |
$306.36
|
| Rate for Payer: Health EOS Commercial |
$296.37
|
| Rate for Payer: HFN Commercial |
$306.36
|
| Rate for Payer: Multiplan Commercial |
$266.40
|
| Rate for Payer: NAPHCARE Commercial |
$199.80
|
| Rate for Payer: Preferred Network Access Commercial |
$306.36
|
| Rate for Payer: Quartz Beloit One Network |
$163.17
|
| Rate for Payer: Quartz Commercial |
$199.80
|
| Rate for Payer: WEA Trust Commercial |
$183.15
|
| Rate for Payer: WPS Commercial |
$246.65
|
|
|
CYLINDER TANK HOLDER PORTABLE
|
Facility
|
OP
|
$333.00
|
|
| Hospital Charge Code |
2972315
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$93.24 |
| Max. Negotiated Rate |
$1,332.00 |
| Rate for Payer: Aetna Commercial |
$299.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$286.38
|
| Rate for Payer: Aetna Managed Medicare |
$93.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$216.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$166.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$159.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$176.49
|
| Rate for Payer: Cash Price |
$99.90
|
| Rate for Payer: Cigna Commercial |
$306.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$186.35
|
| Rate for Payer: Health EOS Commercial |
$296.37
|
| Rate for Payer: HFN Commercial |
$306.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$249.75
|
| Rate for Payer: Multiplan Commercial |
$266.40
|
| Rate for Payer: NAPHCARE Commercial |
$199.80
|
| Rate for Payer: Preferred Network Access Commercial |
$306.36
|
| Rate for Payer: Quartz Beloit One Network |
$163.17
|
| Rate for Payer: Quartz Commercial |
$216.45
|
| Rate for Payer: Quartz Medicare Advantage |
$199.80
|
| Rate for Payer: The Alliance Commercial |
$1,332.00
|
| Rate for Payer: WEA Trust Commercial |
$183.15
|
| Rate for Payer: WPS Commercial |
$246.65
|
|
|
Cystatin C w/ eGFR
|
Facility
|
OP
|
$178.00
|
|
|
Service Code
|
CPT 82610
|
| Hospital Charge Code |
5547024
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.52 |
| Max. Negotiated Rate |
$163.76 |
| Rate for Payer: Aetna Commercial |
$160.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$153.08
|
| Rate for Payer: Aetna Managed Medicare |
$18.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$69.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$32.41
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$30.74
|
| Rate for Payer: Anthem Medicaid |
$19.00
|
| Rate for Payer: Anthem Medicare Advantage |
$18.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$94.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$18.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$18.52
|
| Rate for Payer: Cash Price |
$53.40
|
| Rate for Payer: Cash Price |
$53.40
|
| Rate for Payer: Cigna Commercial |
$163.76
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$18.52
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$19.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$99.61
|
| Rate for Payer: Dean Health Medicaid |
$19.00
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$18.52
|
| Rate for Payer: Health EOS Commercial |
$158.42
|
| Rate for Payer: HFN Commercial |
$163.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$68.89
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$18.52
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$19.00
|
| Rate for Payer: Independent Care Health Plan Medicare |
$18.52
|
| Rate for Payer: Managed Health Services Medicaid |
$19.76
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$18.52
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$18.52
|
| Rate for Payer: Multiplan Commercial |
$142.40
|
| Rate for Payer: NAPHCARE Commercial |
$27.78
|
| Rate for Payer: Preferred Network Access Commercial |
$163.76
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$19.00
|
| Rate for Payer: Quartz Beloit One Network |
$87.22
|
| Rate for Payer: Quartz Commercial |
$115.70
|
| Rate for Payer: Quartz Medicare Advantage |
$18.52
|
| Rate for Payer: The Alliance Commercial |
$74.08
|
| Rate for Payer: United Healthcare Medicaid |
$19.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$18.52
|
| Rate for Payer: United Healthcare PPO |
$133.50
|
| Rate for Payer: WEA Trust Commercial |
$97.90
|
| Rate for Payer: Wellcare Medicare |
$18.52
|
| Rate for Payer: WMAP Medicaid |
$19.00
|
| Rate for Payer: WPS Commercial |
$131.84
|
|
|
Cystatin C w/ eGFR
|
Facility
|
IP
|
$178.00
|
|
|
Service Code
|
CPT 82610
|
| Hospital Charge Code |
5547024
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$87.22 |
| Max. Negotiated Rate |
$163.76 |
| Rate for Payer: Aetna Commercial |
$160.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$153.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$94.34
|
| Rate for Payer: Cash Price |
$53.40
|
| Rate for Payer: Cigna Commercial |
$163.76
|
| Rate for Payer: Health EOS Commercial |
$158.42
|
| Rate for Payer: HFN Commercial |
$163.76
|
| Rate for Payer: Multiplan Commercial |
$142.40
|
| Rate for Payer: NAPHCARE Commercial |
$106.80
|
| Rate for Payer: Preferred Network Access Commercial |
$163.76
|
| Rate for Payer: Quartz Beloit One Network |
$87.22
|
| Rate for Payer: Quartz Commercial |
$106.80
|
| Rate for Payer: WEA Trust Commercial |
$97.90
|
| Rate for Payer: WPS Commercial |
$131.84
|
|
|
Cystatin C w/ eGFR
|
Professional
|
Both
|
$178.00
|
|
|
Service Code
|
CPT 82610
|
| Hospital Charge Code |
5547024
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$65.38 |
| Max. Negotiated Rate |
$169.10 |
| Rate for Payer: Aetna Commercial |
$169.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$153.08
|
| Rate for Payer: Cash Price |
$53.40
|
| Rate for Payer: Cash Price |
$53.40
|
| Rate for Payer: Cigna Commercial |
$169.10
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$89.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$106.80
|
| Rate for Payer: Health EOS Commercial |
$161.98
|
| Rate for Payer: HFN Commercial |
$169.10
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$65.38
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$65.38
|
| Rate for Payer: Multiplan Commercial |
$142.40
|
| Rate for Payer: Preferred Network Access Commercial |
$169.10
|
| Rate for Payer: Quartz Beloit One Network |
$78.32
|
| Rate for Payer: Quartz Commercial |
$101.46
|
| Rate for Payer: The Alliance Commercial |
$89.00
|
| Rate for Payer: WEA Trust Commercial |
$97.90
|
| Rate for Payer: WPS Commercial |
$131.84
|
|
|
CYSTECTOMY
|
Facility
|
IP
|
$7,956.00
|
|
| Hospital Charge Code |
2959975
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,898.44 |
| Max. Negotiated Rate |
$7,319.52 |
| Rate for Payer: Aetna Commercial |
$7,160.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,842.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,216.68
|
| Rate for Payer: Cash Price |
$2,386.80
|
| Rate for Payer: Cigna Commercial |
$7,319.52
|
| Rate for Payer: Health EOS Commercial |
$7,080.84
|
| Rate for Payer: HFN Commercial |
$7,319.52
|
| Rate for Payer: Multiplan Commercial |
$6,364.80
|
| Rate for Payer: NAPHCARE Commercial |
$4,773.60
|
| Rate for Payer: Preferred Network Access Commercial |
$7,319.52
|
| Rate for Payer: Quartz Beloit One Network |
$3,898.44
|
| Rate for Payer: Quartz Commercial |
$4,773.60
|
| Rate for Payer: WEA Trust Commercial |
$4,375.80
|
| Rate for Payer: WPS Commercial |
$5,893.01
|
|
|
CYSTECTOMY
|
Facility
|
OP
|
$7,956.00
|
|
| Hospital Charge Code |
2959975
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,227.68 |
| Max. Negotiated Rate |
$31,824.00 |
| Rate for Payer: Aetna Commercial |
$7,160.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,842.16
|
| Rate for Payer: Aetna Managed Medicare |
$2,227.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,171.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,978.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,818.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,216.68
|
| Rate for Payer: Cash Price |
$2,386.80
|
| Rate for Payer: Cigna Commercial |
$7,319.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,452.18
|
| Rate for Payer: Health EOS Commercial |
$7,080.84
|
| Rate for Payer: HFN Commercial |
$7,319.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,967.00
|
| Rate for Payer: Multiplan Commercial |
$6,364.80
|
| Rate for Payer: NAPHCARE Commercial |
$4,773.60
|
| Rate for Payer: Preferred Network Access Commercial |
$7,319.52
|
| Rate for Payer: Quartz Beloit One Network |
$3,898.44
|
| Rate for Payer: Quartz Commercial |
$5,171.40
|
| Rate for Payer: Quartz Medicare Advantage |
$4,773.60
|
| Rate for Payer: The Alliance Commercial |
$31,824.00
|
| Rate for Payer: WEA Trust Commercial |
$4,375.80
|
| Rate for Payer: WPS Commercial |
$5,893.01
|
|
|
Cysticercus Antibody
|
Professional
|
Both
|
$475.00
|
|
|
Service Code
|
CPT 86682
|
| Hospital Charge Code |
3449632
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$45.93 |
| Max. Negotiated Rate |
$451.25 |
| Rate for Payer: Aetna Commercial |
$451.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$408.50
|
| Rate for Payer: Cash Price |
$142.50
|
| Rate for Payer: Cash Price |
$142.50
|
| Rate for Payer: Cigna Commercial |
$451.25
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$237.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$285.00
|
| Rate for Payer: Health EOS Commercial |
$432.25
|
| Rate for Payer: HFN Commercial |
$451.25
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$45.93
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$45.93
|
| Rate for Payer: Multiplan Commercial |
$380.00
|
| Rate for Payer: Preferred Network Access Commercial |
$451.25
|
| Rate for Payer: Quartz Beloit One Network |
$209.00
|
| Rate for Payer: Quartz Commercial |
$270.75
|
| Rate for Payer: The Alliance Commercial |
$237.50
|
| Rate for Payer: WEA Trust Commercial |
$261.25
|
| Rate for Payer: WPS Commercial |
$351.83
|
|
|
Cysticercus Antibody
|
Facility
|
OP
|
$475.00
|
|
|
Service Code
|
CPT 86682
|
| Hospital Charge Code |
3449632
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.17 |
| Max. Negotiated Rate |
$437.00 |
| Rate for Payer: Aetna Commercial |
$427.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$408.50
|
| Rate for Payer: Aetna Managed Medicare |
$13.01
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$48.79
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$22.77
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$21.60
|
| Rate for Payer: Anthem Medicaid |
$8.17
|
| Rate for Payer: Anthem Medicare Advantage |
$13.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$251.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$13.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$13.01
|
| Rate for Payer: Cash Price |
$142.50
|
| Rate for Payer: Cash Price |
$142.50
|
| Rate for Payer: Cigna Commercial |
$437.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$13.01
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$8.17
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$265.81
|
| Rate for Payer: Dean Health Medicaid |
$8.17
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$13.01
|
| Rate for Payer: Health EOS Commercial |
$422.75
|
| Rate for Payer: HFN Commercial |
$437.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$48.40
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$13.01
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$8.17
|
| Rate for Payer: Independent Care Health Plan Medicare |
$13.01
|
| Rate for Payer: Managed Health Services Medicaid |
$8.50
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$13.01
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$13.01
|
| Rate for Payer: Multiplan Commercial |
$380.00
|
| Rate for Payer: NAPHCARE Commercial |
$19.52
|
| Rate for Payer: Preferred Network Access Commercial |
$437.00
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$8.17
|
| Rate for Payer: Quartz Beloit One Network |
$232.75
|
| Rate for Payer: Quartz Commercial |
$308.75
|
| Rate for Payer: Quartz Medicare Advantage |
$13.01
|
| Rate for Payer: The Alliance Commercial |
$52.04
|
| Rate for Payer: United Healthcare Medicaid |
$8.17
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.01
|
| Rate for Payer: United Healthcare PPO |
$356.25
|
| Rate for Payer: WEA Trust Commercial |
$261.25
|
| Rate for Payer: Wellcare Medicare |
$13.01
|
| Rate for Payer: WMAP Medicaid |
$8.17
|
| Rate for Payer: WPS Commercial |
$351.83
|
|
|
Cysticercus Antibody
|
Facility
|
IP
|
$475.00
|
|
|
Service Code
|
CPT 86682
|
| Hospital Charge Code |
3449632
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$232.75 |
| Max. Negotiated Rate |
$437.00 |
| Rate for Payer: Aetna Commercial |
$427.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$408.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$251.75
|
| Rate for Payer: Cash Price |
$142.50
|
| Rate for Payer: Cigna Commercial |
$437.00
|
| Rate for Payer: Health EOS Commercial |
$422.75
|
| Rate for Payer: HFN Commercial |
$437.00
|
| Rate for Payer: Multiplan Commercial |
$380.00
|
| Rate for Payer: NAPHCARE Commercial |
$285.00
|
| Rate for Payer: Preferred Network Access Commercial |
$437.00
|
| Rate for Payer: Quartz Beloit One Network |
$232.75
|
| Rate for Payer: Quartz Commercial |
$285.00
|
| Rate for Payer: WEA Trust Commercial |
$261.25
|
| Rate for Payer: WPS Commercial |
$351.83
|
|
|
Cysticercus Antibody, ELISA, CSF
|
Facility
|
IP
|
$133.00
|
|
|
Service Code
|
CPT 86682
|
| Hospital Charge Code |
3949336
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$65.17 |
| Max. Negotiated Rate |
$122.36 |
| Rate for Payer: Aetna Commercial |
$119.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$114.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$70.49
|
| Rate for Payer: Cash Price |
$39.90
|
| Rate for Payer: Cigna Commercial |
$122.36
|
| Rate for Payer: Health EOS Commercial |
$118.37
|
| Rate for Payer: HFN Commercial |
$122.36
|
| Rate for Payer: Multiplan Commercial |
$106.40
|
| Rate for Payer: NAPHCARE Commercial |
$79.80
|
| Rate for Payer: Preferred Network Access Commercial |
$122.36
|
| Rate for Payer: Quartz Beloit One Network |
$65.17
|
| Rate for Payer: Quartz Commercial |
$79.80
|
| Rate for Payer: WEA Trust Commercial |
$73.15
|
| Rate for Payer: WPS Commercial |
$98.51
|
|
|
Cysticercus Antibody, ELISA, CSF
|
Facility
|
OP
|
$133.00
|
|
|
Service Code
|
CPT 86682
|
| Hospital Charge Code |
3949336
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.17 |
| Max. Negotiated Rate |
$122.36 |
| Rate for Payer: Aetna Commercial |
$119.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$114.38
|
| Rate for Payer: Aetna Managed Medicare |
$13.01
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$48.79
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$22.77
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$21.60
|
| Rate for Payer: Anthem Medicaid |
$8.17
|
| Rate for Payer: Anthem Medicare Advantage |
$13.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$70.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$13.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$13.01
|
| Rate for Payer: Cash Price |
$39.90
|
| Rate for Payer: Cash Price |
$39.90
|
| Rate for Payer: Cigna Commercial |
$122.36
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$13.01
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$8.17
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$74.43
|
| Rate for Payer: Dean Health Medicaid |
$8.17
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$13.01
|
| Rate for Payer: Health EOS Commercial |
$118.37
|
| Rate for Payer: HFN Commercial |
$122.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$48.40
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$13.01
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$8.17
|
| Rate for Payer: Independent Care Health Plan Medicare |
$13.01
|
| Rate for Payer: Managed Health Services Medicaid |
$8.50
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$13.01
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$13.01
|
| Rate for Payer: Multiplan Commercial |
$106.40
|
| Rate for Payer: NAPHCARE Commercial |
$19.52
|
| Rate for Payer: Preferred Network Access Commercial |
$122.36
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$8.17
|
| Rate for Payer: Quartz Beloit One Network |
$65.17
|
| Rate for Payer: Quartz Commercial |
$86.45
|
| Rate for Payer: Quartz Medicare Advantage |
$13.01
|
| Rate for Payer: The Alliance Commercial |
$52.04
|
| Rate for Payer: United Healthcare Medicaid |
$8.17
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.01
|
| Rate for Payer: United Healthcare PPO |
$99.75
|
| Rate for Payer: WEA Trust Commercial |
$73.15
|
| Rate for Payer: Wellcare Medicare |
$13.01
|
| Rate for Payer: WMAP Medicaid |
$8.17
|
| Rate for Payer: WPS Commercial |
$98.51
|
|
|
Cysticercus Antibody, ELISA, CSF
|
Professional
|
Both
|
$133.00
|
|
|
Service Code
|
CPT 86682
|
| Hospital Charge Code |
3949336
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$45.93 |
| Max. Negotiated Rate |
$126.35 |
| Rate for Payer: Aetna Commercial |
$126.35
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$114.38
|
| Rate for Payer: Cash Price |
$39.90
|
| Rate for Payer: Cash Price |
$39.90
|
| Rate for Payer: Cigna Commercial |
$126.35
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$66.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$79.80
|
| Rate for Payer: Health EOS Commercial |
$121.03
|
| Rate for Payer: HFN Commercial |
$126.35
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$45.93
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$45.93
|
| Rate for Payer: Multiplan Commercial |
$106.40
|
| Rate for Payer: Preferred Network Access Commercial |
$126.35
|
| Rate for Payer: Quartz Beloit One Network |
$58.52
|
| Rate for Payer: Quartz Commercial |
$75.81
|
| Rate for Payer: The Alliance Commercial |
$66.50
|
| Rate for Payer: WEA Trust Commercial |
$73.15
|
| Rate for Payer: WPS Commercial |
$98.51
|
|
|
Cystic Fibrosis Interpretation
|
Facility
|
IP
|
$8.00
|
|
| Hospital Charge Code |
2798799
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.92 |
| Max. Negotiated Rate |
$7.36 |
| Rate for Payer: Aetna Commercial |
$7.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4.24
|
| Rate for Payer: Cash Price |
$2.40
|
| Rate for Payer: Cigna Commercial |
$7.36
|
| Rate for Payer: Health EOS Commercial |
$7.12
|
| Rate for Payer: HFN Commercial |
$7.36
|
| Rate for Payer: Multiplan Commercial |
$6.40
|
| Rate for Payer: NAPHCARE Commercial |
$4.80
|
| Rate for Payer: Preferred Network Access Commercial |
$7.36
|
| Rate for Payer: Quartz Beloit One Network |
$3.92
|
| Rate for Payer: Quartz Commercial |
$4.80
|
| Rate for Payer: WEA Trust Commercial |
$4.40
|
| Rate for Payer: WPS Commercial |
$5.93
|
|
|
Cystic Fibrosis Interpretation
|
Facility
|
OP
|
$8.00
|
|
| Hospital Charge Code |
2798799
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$2.24 |
| Max. Negotiated Rate |
$32.00 |
| Rate for Payer: Aetna Commercial |
$7.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6.88
|
| Rate for Payer: Aetna Managed Medicare |
$2.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4.24
|
| Rate for Payer: Cash Price |
$2.40
|
| Rate for Payer: Cigna Commercial |
$7.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4.48
|
| Rate for Payer: Health EOS Commercial |
$7.12
|
| Rate for Payer: HFN Commercial |
$7.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6.00
|
| Rate for Payer: Multiplan Commercial |
$6.40
|
| Rate for Payer: NAPHCARE Commercial |
$4.80
|
| Rate for Payer: Preferred Network Access Commercial |
$7.36
|
| Rate for Payer: Quartz Beloit One Network |
$3.92
|
| Rate for Payer: Quartz Commercial |
$5.20
|
| Rate for Payer: Quartz Medicare Advantage |
$4.80
|
| Rate for Payer: The Alliance Commercial |
$32.00
|
| Rate for Payer: United Healthcare PPO |
$6.00
|
| Rate for Payer: WEA Trust Commercial |
$4.40
|
| Rate for Payer: WPS Commercial |
$5.93
|
|
|
Cystic Fibrosis Interpretation
|
Professional
|
Both
|
$8.00
|
|
| Hospital Charge Code |
2798799
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.52 |
| Max. Negotiated Rate |
$7.60 |
| Rate for Payer: Aetna Commercial |
$7.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6.88
|
| Rate for Payer: Cash Price |
$2.40
|
| Rate for Payer: Cigna Commercial |
$7.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$4.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4.80
|
| Rate for Payer: Health EOS Commercial |
$7.28
|
| Rate for Payer: HFN Commercial |
$7.60
|
| Rate for Payer: Multiplan Commercial |
$6.40
|
| Rate for Payer: Preferred Network Access Commercial |
$7.60
|
| Rate for Payer: Quartz Beloit One Network |
$3.52
|
| Rate for Payer: Quartz Commercial |
$4.56
|
| Rate for Payer: The Alliance Commercial |
$4.00
|
| Rate for Payer: WEA Trust Commercial |
$4.40
|
| Rate for Payer: WPS Commercial |
$5.93
|
|
|
Cystic Fibrosis Mutation DNA Analysis
|
Facility
|
OP
|
$580.00
|
|
|
Service Code
|
CPT 81220
|
| Hospital Charge Code |
977920
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$210.00 |
| Max. Negotiated Rate |
$2,226.40 |
| Rate for Payer: Aetna Commercial |
$522.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$498.80
|
| Rate for Payer: Aetna Managed Medicare |
$556.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,087.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$974.05
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$923.96
|
| Rate for Payer: Anthem Medicaid |
$210.00
|
| Rate for Payer: Anthem Medicare Advantage |
$556.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$307.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$556.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$556.60
|
| Rate for Payer: Cash Price |
$174.00
|
| Rate for Payer: Cash Price |
$174.00
|
| Rate for Payer: Cigna Commercial |
$533.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$556.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$210.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$324.57
|
| Rate for Payer: Dean Health Medicaid |
$210.00
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$556.60
|
| Rate for Payer: Health EOS Commercial |
$516.20
|
| Rate for Payer: HFN Commercial |
$533.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,070.55
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$556.60
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$210.00
|
| Rate for Payer: Independent Care Health Plan Medicare |
$556.60
|
| Rate for Payer: Managed Health Services Medicaid |
$218.40
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$556.60
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$556.60
|
| Rate for Payer: Multiplan Commercial |
$464.00
|
| Rate for Payer: NAPHCARE Commercial |
$834.90
|
| Rate for Payer: Preferred Network Access Commercial |
$533.60
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$210.00
|
| Rate for Payer: Quartz Beloit One Network |
$284.20
|
| Rate for Payer: Quartz Commercial |
$377.00
|
| Rate for Payer: Quartz Medicare Advantage |
$556.60
|
| Rate for Payer: The Alliance Commercial |
$2,226.40
|
| Rate for Payer: United Healthcare Medicaid |
$210.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$556.60
|
| Rate for Payer: United Healthcare PPO |
$435.00
|
| Rate for Payer: WEA Trust Commercial |
$319.00
|
| Rate for Payer: Wellcare Medicare |
$556.60
|
| Rate for Payer: WMAP Medicaid |
$210.00
|
| Rate for Payer: WPS Commercial |
$429.61
|
|
