|
Distal Protection Device 6mm
|
Facility
IP
|
$10,710.00
|
|
|
Service Code
|
HCPCS C1884
|
| Hospital Charge Code |
2549112
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,247.90 |
| Max. Negotiated Rate |
$9,853.20 |
| Rate for Payer: Aetna Commercial |
$9,639.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,676.30
|
| Rate for Payer: Cash Price |
$3,213.00
|
| Rate for Payer: Cigna Commercial |
$9,853.20
|
| Rate for Payer: Health EOS Commercial |
$9,531.90
|
| Rate for Payer: HFN Commercial |
$9,853.20
|
| Rate for Payer: Multiplan Commercial |
$8,568.00
|
| Rate for Payer: NAPHCARE Commercial |
$6,426.00
|
| Rate for Payer: Preferred Network Access Commercial |
$9,853.20
|
| Rate for Payer: Quartz Beloit One Network |
$5,247.90
|
| Rate for Payer: Quartz Commercial |
$6,426.00
|
| Rate for Payer: WEA Trust Commercial |
$5,890.50
|
| Rate for Payer: WPS Commercial |
$7,932.90
|
|
|
Distal Protection Device 6mm
|
Facility
OP
|
$10,710.00
|
|
|
Service Code
|
HCPCS C1884
|
| Hospital Charge Code |
2549112
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,998.80 |
| Max. Negotiated Rate |
$9,853.20 |
| Rate for Payer: Aetna Commercial |
$9,639.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,210.60
|
| Rate for Payer: Aetna Managed Medicare |
$2,998.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6,961.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5,355.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5,140.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,676.30
|
| Rate for Payer: Cash Price |
$3,213.00
|
| Rate for Payer: Cigna Commercial |
$9,853.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,993.32
|
| Rate for Payer: Health EOS Commercial |
$9,531.90
|
| Rate for Payer: HFN Commercial |
$9,853.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$8,032.50
|
| Rate for Payer: Multiplan Commercial |
$8,568.00
|
| Rate for Payer: NAPHCARE Commercial |
$6,426.00
|
| Rate for Payer: Preferred Network Access Commercial |
$9,853.20
|
| Rate for Payer: Quartz Beloit One Network |
$5,247.90
|
| Rate for Payer: Quartz Commercial |
$6,961.50
|
| Rate for Payer: Quartz Medicare Advantage |
$6,426.00
|
| Rate for Payer: WEA Trust Commercial |
$5,890.50
|
| Rate for Payer: WPS Commercial |
$7,932.90
|
|
|
Distal Protection Device 6mm
|
Professional
|
$10,710.00
|
|
|
Service Code
|
HCPCS C1884
|
| Hospital Charge Code |
2549112
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,712.40 |
| Max. Negotiated Rate |
$10,174.50 |
| Rate for Payer: Aetna Commercial |
$10,174.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,210.60
|
| Rate for Payer: Cash Price |
$3,213.00
|
| Rate for Payer: Cigna Commercial |
$10,174.50
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$5,355.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,426.00
|
| Rate for Payer: Health EOS Commercial |
$9,746.10
|
| Rate for Payer: Multiplan Commercial |
$8,568.00
|
| Rate for Payer: Preferred Network Access Commercial |
$10,174.50
|
| Rate for Payer: Quartz Beloit One Network |
$4,712.40
|
| Rate for Payer: Quartz Commercial |
$6,104.70
|
| Rate for Payer: The Alliance Commercial |
$5,355.00
|
| Rate for Payer: WEA Trust Commercial |
$5,890.50
|
| Rate for Payer: WPS Commercial |
$7,932.90
|
|
|
Distal Protection Device 7mm
|
Facility
OP
|
$10,710.00
|
|
|
Service Code
|
HCPCS C1884
|
| Hospital Charge Code |
2549114
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,998.80 |
| Max. Negotiated Rate |
$9,853.20 |
| Rate for Payer: Aetna Commercial |
$9,639.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,210.60
|
| Rate for Payer: Aetna Managed Medicare |
$2,998.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6,961.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5,355.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5,140.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,676.30
|
| Rate for Payer: Cash Price |
$3,213.00
|
| Rate for Payer: Cigna Commercial |
$9,853.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,993.32
|
| Rate for Payer: Health EOS Commercial |
$9,531.90
|
| Rate for Payer: HFN Commercial |
$9,853.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$8,032.50
|
| Rate for Payer: Multiplan Commercial |
$8,568.00
|
| Rate for Payer: NAPHCARE Commercial |
$6,426.00
|
| Rate for Payer: Preferred Network Access Commercial |
$9,853.20
|
| Rate for Payer: Quartz Beloit One Network |
$5,247.90
|
| Rate for Payer: Quartz Commercial |
$6,961.50
|
| Rate for Payer: Quartz Medicare Advantage |
$6,426.00
|
| Rate for Payer: WEA Trust Commercial |
$5,890.50
|
| Rate for Payer: WPS Commercial |
$7,932.90
|
|
|
Distal Protection Device 7mm
|
Professional
|
$10,710.00
|
|
|
Service Code
|
HCPCS C1884
|
| Hospital Charge Code |
2549114
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,712.40 |
| Max. Negotiated Rate |
$10,174.50 |
| Rate for Payer: Aetna Commercial |
$10,174.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,210.60
|
| Rate for Payer: Cash Price |
$3,213.00
|
| Rate for Payer: Cigna Commercial |
$10,174.50
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$5,355.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,426.00
|
| Rate for Payer: Health EOS Commercial |
$9,746.10
|
| Rate for Payer: Multiplan Commercial |
$8,568.00
|
| Rate for Payer: Preferred Network Access Commercial |
$10,174.50
|
| Rate for Payer: Quartz Beloit One Network |
$4,712.40
|
| Rate for Payer: Quartz Commercial |
$6,104.70
|
| Rate for Payer: The Alliance Commercial |
$5,355.00
|
| Rate for Payer: WEA Trust Commercial |
$5,890.50
|
| Rate for Payer: WPS Commercial |
$7,932.90
|
|
|
Distal Protection Device 7mm
|
Facility
IP
|
$10,710.00
|
|
|
Service Code
|
HCPCS C1884
|
| Hospital Charge Code |
2549114
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,247.90 |
| Max. Negotiated Rate |
$9,853.20 |
| Rate for Payer: Aetna Commercial |
$9,639.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,676.30
|
| Rate for Payer: Cash Price |
$3,213.00
|
| Rate for Payer: Cigna Commercial |
$9,853.20
|
| Rate for Payer: Health EOS Commercial |
$9,531.90
|
| Rate for Payer: HFN Commercial |
$9,853.20
|
| Rate for Payer: Multiplan Commercial |
$8,568.00
|
| Rate for Payer: NAPHCARE Commercial |
$6,426.00
|
| Rate for Payer: Preferred Network Access Commercial |
$9,853.20
|
| Rate for Payer: Quartz Beloit One Network |
$5,247.90
|
| Rate for Payer: Quartz Commercial |
$6,426.00
|
| Rate for Payer: WEA Trust Commercial |
$5,890.50
|
| Rate for Payer: WPS Commercial |
$7,932.90
|
|
|
DISTAL SPACER ACCOLADE LG 13MM 1059-6713
|
Facility
OP
|
$860.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5813623
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$240.80 |
| Max. Negotiated Rate |
$791.20 |
| Rate for Payer: Aetna Commercial |
$774.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$739.60
|
| Rate for Payer: Aetna Managed Medicare |
$240.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$559.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$430.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$412.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$455.80
|
| Rate for Payer: Cash Price |
$258.00
|
| Rate for Payer: Cigna Commercial |
$791.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$481.26
|
| Rate for Payer: Health EOS Commercial |
$765.40
|
| Rate for Payer: HFN Commercial |
$791.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$645.00
|
| Rate for Payer: Multiplan Commercial |
$688.00
|
| Rate for Payer: NAPHCARE Commercial |
$516.00
|
| Rate for Payer: Preferred Network Access Commercial |
$791.20
|
| Rate for Payer: Quartz Beloit One Network |
$421.40
|
| Rate for Payer: Quartz Commercial |
$559.00
|
| Rate for Payer: Quartz Medicare Advantage |
$516.00
|
| Rate for Payer: WEA Trust Commercial |
$473.00
|
| Rate for Payer: WPS Commercial |
$637.00
|
|
|
DISTAL SPACER ACCOLADE LG 13MM 1059-6713
|
Facility
IP
|
$860.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5813623
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$421.40 |
| Max. Negotiated Rate |
$791.20 |
| Rate for Payer: Aetna Commercial |
$774.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$455.80
|
| Rate for Payer: Cash Price |
$258.00
|
| Rate for Payer: Cigna Commercial |
$791.20
|
| Rate for Payer: Health EOS Commercial |
$765.40
|
| Rate for Payer: HFN Commercial |
$791.20
|
| Rate for Payer: Multiplan Commercial |
$688.00
|
| Rate for Payer: NAPHCARE Commercial |
$516.00
|
| Rate for Payer: Preferred Network Access Commercial |
$791.20
|
| Rate for Payer: Quartz Beloit One Network |
$421.40
|
| Rate for Payer: Quartz Commercial |
$516.00
|
| Rate for Payer: WEA Trust Commercial |
$473.00
|
| Rate for Payer: WPS Commercial |
$637.00
|
|
|
DISTRACTOR UC HIP SUPINE 72202207
|
Facility
OP
|
$5,533.00
|
|
| Hospital Charge Code |
5286795
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$1,549.24 |
| Max. Negotiated Rate |
$22,132.00 |
| Rate for Payer: Aetna Commercial |
$4,979.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,758.38
|
| Rate for Payer: Aetna Managed Medicare |
$1,549.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,596.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,766.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,655.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,932.49
|
| Rate for Payer: Cash Price |
$1,659.90
|
| Rate for Payer: Cigna Commercial |
$5,090.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,096.27
|
| Rate for Payer: Health EOS Commercial |
$4,924.37
|
| Rate for Payer: HFN Commercial |
$5,090.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,149.75
|
| Rate for Payer: Multiplan Commercial |
$4,426.40
|
| Rate for Payer: NAPHCARE Commercial |
$3,319.80
|
| Rate for Payer: Preferred Network Access Commercial |
$5,090.36
|
| Rate for Payer: Quartz Beloit One Network |
$2,711.17
|
| Rate for Payer: Quartz Commercial |
$3,596.45
|
| Rate for Payer: Quartz Medicare Advantage |
$3,319.80
|
| Rate for Payer: The Alliance Commercial |
$22,132.00
|
| Rate for Payer: WEA Trust Commercial |
$3,043.15
|
| Rate for Payer: WPS Commercial |
$4,098.29
|
|
|
DISTRACTOR UC HIP SUPINE 72202207
|
Facility
IP
|
$5,533.00
|
|
| Hospital Charge Code |
5286795
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$2,711.17 |
| Max. Negotiated Rate |
$5,090.36 |
| Rate for Payer: Aetna Commercial |
$4,979.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,932.49
|
| Rate for Payer: Cash Price |
$1,659.90
|
| Rate for Payer: Cigna Commercial |
$5,090.36
|
| Rate for Payer: Health EOS Commercial |
$4,924.37
|
| Rate for Payer: HFN Commercial |
$5,090.36
|
| Rate for Payer: Multiplan Commercial |
$4,426.40
|
| Rate for Payer: NAPHCARE Commercial |
$3,319.80
|
| Rate for Payer: Preferred Network Access Commercial |
$5,090.36
|
| Rate for Payer: Quartz Beloit One Network |
$2,711.17
|
| Rate for Payer: Quartz Commercial |
$3,319.80
|
| Rate for Payer: WEA Trust Commercial |
$3,043.15
|
| Rate for Payer: WPS Commercial |
$4,098.29
|
|
|
Disulfiram Level
|
Professional
|
$241.00
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
4010555
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.64 |
| Max. Negotiated Rate |
$228.95 |
| Rate for Payer: Aetna Commercial |
$228.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$207.26
|
| Rate for Payer: Aetna Managed Medicare |
$18.64
|
| Rate for Payer: Anthem Medicare Advantage |
$18.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$18.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$18.64
|
| Rate for Payer: Cash Price |
$72.30
|
| Rate for Payer: Cash Price |
$72.30
|
| Rate for Payer: Cigna Commercial |
$228.95
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$120.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$18.64
|
| Rate for Payer: Health EOS Commercial |
$219.31
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$65.80
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$65.80
|
| Rate for Payer: Independent Care Health Plan Medicare |
$18.64
|
| Rate for Payer: Multiplan Commercial |
$192.80
|
| Rate for Payer: Preferred Network Access Commercial |
$228.95
|
| Rate for Payer: Quartz Beloit One Network |
$106.04
|
| Rate for Payer: Quartz Commercial |
$137.37
|
| Rate for Payer: Quartz Medicare Advantage |
$18.64
|
| Rate for Payer: The Alliance Commercial |
$73.63
|
| Rate for Payer: United Healthcare Medicare Advantage |
$18.64
|
| Rate for Payer: WEA Trust Commercial |
$132.55
|
| Rate for Payer: WPS Commercial |
$82.02
|
|
|
Disulfiram Level
|
Facility
IP
|
$241.00
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
4010555
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$118.09 |
| Max. Negotiated Rate |
$221.72 |
| Rate for Payer: Aetna Commercial |
$216.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$127.73
|
| Rate for Payer: Cash Price |
$72.30
|
| Rate for Payer: Cigna Commercial |
$221.72
|
| Rate for Payer: Health EOS Commercial |
$214.49
|
| Rate for Payer: HFN Commercial |
$221.72
|
| Rate for Payer: Multiplan Commercial |
$192.80
|
| Rate for Payer: NAPHCARE Commercial |
$144.60
|
| Rate for Payer: Preferred Network Access Commercial |
$221.72
|
| Rate for Payer: Quartz Beloit One Network |
$118.09
|
| Rate for Payer: Quartz Commercial |
$144.60
|
| Rate for Payer: WEA Trust Commercial |
$132.55
|
| Rate for Payer: WPS Commercial |
$178.51
|
|
|
Disulfiram Level
|
Facility
OP
|
$241.00
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
4010555
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.64 |
| Max. Negotiated Rate |
$964.00 |
| Rate for Payer: Aetna Commercial |
$216.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$207.26
|
| Rate for Payer: Aetna Managed Medicare |
$18.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$69.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$32.62
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$30.94
|
| Rate for Payer: Anthem Medicaid |
$19.26
|
| Rate for Payer: Anthem Medicare Advantage |
$18.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$127.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$18.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$18.64
|
| Rate for Payer: Cash Price |
$72.30
|
| Rate for Payer: Cash Price |
$72.30
|
| Rate for Payer: Cigna Commercial |
$221.72
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$18.64
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$19.26
|
| Rate for Payer: Dean Health Medicaid |
$19.26
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$18.64
|
| Rate for Payer: Health EOS Commercial |
$214.49
|
| Rate for Payer: HFN Commercial |
$221.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$69.34
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$18.64
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$19.26
|
| Rate for Payer: Independent Care Health Plan Medicare |
$18.64
|
| Rate for Payer: Managed Health Services Medicaid |
$20.03
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$18.64
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$18.64
|
| Rate for Payer: Multiplan Commercial |
$192.80
|
| Rate for Payer: NAPHCARE Commercial |
$27.96
|
| Rate for Payer: Preferred Network Access Commercial |
$221.72
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$19.26
|
| Rate for Payer: Quartz Beloit One Network |
$118.09
|
| Rate for Payer: Quartz Commercial |
$156.65
|
| Rate for Payer: Quartz Medicare Advantage |
$18.64
|
| Rate for Payer: The Alliance Commercial |
$964.00
|
| Rate for Payer: United Healthcare Medicaid |
$19.26
|
| Rate for Payer: United Healthcare Medicare Advantage |
$18.64
|
| Rate for Payer: United Healthcare PPO |
$180.75
|
| Rate for Payer: WEA Trust Commercial |
$132.55
|
| Rate for Payer: Wellcare Medicare |
$18.64
|
| Rate for Payer: WMAP Medicaid |
$19.26
|
| Rate for Payer: WPS Commercial |
$178.51
|
|
|
.DNA Ab (DS) Crithidia Titer
|
Facility
OP
|
$14.43
|
|
|
Service Code
|
CPT 86256
|
| Hospital Charge Code |
6224218
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$7.07 |
| Max. Negotiated Rate |
$57.72 |
| Rate for Payer: Aetna Commercial |
$12.99
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$12.41
|
| Rate for Payer: Aetna Managed Medicare |
$12.05
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$45.19
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$21.09
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$20.00
|
| Rate for Payer: Anthem Medicaid |
$12.45
|
| Rate for Payer: Anthem Medicare Advantage |
$12.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$7.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$12.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$12.05
|
| Rate for Payer: Cash Price |
$4.33
|
| Rate for Payer: Cash Price |
$4.33
|
| Rate for Payer: Cigna Commercial |
$13.28
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$12.05
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$12.45
|
| Rate for Payer: Dean Health Medicaid |
$12.45
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$12.05
|
| Rate for Payer: Health EOS Commercial |
$12.84
|
| Rate for Payer: HFN Commercial |
$13.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$44.83
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$12.05
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$12.45
|
| Rate for Payer: Independent Care Health Plan Medicare |
$12.05
|
| Rate for Payer: Managed Health Services Medicaid |
$12.95
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$12.05
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$12.05
|
| Rate for Payer: Multiplan Commercial |
$11.54
|
| Rate for Payer: NAPHCARE Commercial |
$18.08
|
| Rate for Payer: Preferred Network Access Commercial |
$13.28
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$12.45
|
| Rate for Payer: Quartz Beloit One Network |
$7.07
|
| Rate for Payer: Quartz Commercial |
$9.38
|
| Rate for Payer: Quartz Medicare Advantage |
$12.05
|
| Rate for Payer: The Alliance Commercial |
$57.72
|
| Rate for Payer: United Healthcare Medicaid |
$12.45
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.05
|
| Rate for Payer: United Healthcare PPO |
$10.82
|
| Rate for Payer: WEA Trust Commercial |
$7.94
|
| Rate for Payer: Wellcare Medicare |
$12.05
|
| Rate for Payer: WMAP Medicaid |
$12.45
|
| Rate for Payer: WPS Commercial |
$10.69
|
|
|
.DNA Ab (DS) Crithidia Titer
|
Professional
|
$14.43
|
|
|
Service Code
|
CPT 86256
|
| Hospital Charge Code |
6224218
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.35 |
| Max. Negotiated Rate |
$53.02 |
| Rate for Payer: Aetna Commercial |
$13.71
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$12.41
|
| Rate for Payer: Aetna Managed Medicare |
$12.05
|
| Rate for Payer: Anthem Commercial |
$16.61
|
| Rate for Payer: Anthem Medicare Advantage |
$12.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$12.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$12.05
|
| Rate for Payer: Cash Price |
$4.33
|
| Rate for Payer: Cash Price |
$4.33
|
| Rate for Payer: Cigna Commercial |
$13.71
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$7.22
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12.05
|
| Rate for Payer: Health EOS Commercial |
$13.13
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$42.54
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$42.54
|
| Rate for Payer: Independent Care Health Plan Medicare |
$12.05
|
| Rate for Payer: Multiplan Commercial |
$11.54
|
| Rate for Payer: Preferred Network Access Commercial |
$13.71
|
| Rate for Payer: Quartz Beloit One Network |
$6.35
|
| Rate for Payer: Quartz Commercial |
$8.23
|
| Rate for Payer: Quartz Medicare Advantage |
$12.05
|
| Rate for Payer: The Alliance Commercial |
$47.60
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.05
|
| Rate for Payer: WEA Trust Commercial |
$7.94
|
| Rate for Payer: WPS Commercial |
$53.02
|
|
|
.DNA Ab (DS) Crithidia Titer
|
Facility
IP
|
$14.43
|
|
|
Service Code
|
CPT 86256
|
| Hospital Charge Code |
6224218
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$7.07 |
| Max. Negotiated Rate |
$13.28 |
| Rate for Payer: Aetna Commercial |
$12.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$7.65
|
| Rate for Payer: Cash Price |
$4.33
|
| Rate for Payer: Cigna Commercial |
$13.28
|
| Rate for Payer: Health EOS Commercial |
$12.84
|
| Rate for Payer: HFN Commercial |
$13.28
|
| Rate for Payer: Multiplan Commercial |
$11.54
|
| Rate for Payer: NAPHCARE Commercial |
$8.66
|
| Rate for Payer: Preferred Network Access Commercial |
$13.28
|
| Rate for Payer: Quartz Beloit One Network |
$7.07
|
| Rate for Payer: Quartz Commercial |
$8.66
|
| Rate for Payer: WEA Trust Commercial |
$7.94
|
| Rate for Payer: WPS Commercial |
$10.69
|
|
|
DNA Antibody (Double-stranded)
|
Professional
|
$190.00
|
|
|
Service Code
|
CPT 86225
|
| Hospital Charge Code |
977928
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.74 |
| Max. Negotiated Rate |
$180.50 |
| Rate for Payer: Aetna Commercial |
$180.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$163.40
|
| Rate for Payer: Aetna Managed Medicare |
$13.74
|
| Rate for Payer: Anthem Medicare Advantage |
$13.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$13.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$13.74
|
| Rate for Payer: Cash Price |
$57.00
|
| Rate for Payer: Cash Price |
$57.00
|
| Rate for Payer: Cigna Commercial |
$180.50
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$95.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$13.74
|
| Rate for Payer: Health EOS Commercial |
$172.90
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$48.50
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$48.50
|
| Rate for Payer: Independent Care Health Plan Medicare |
$13.74
|
| Rate for Payer: Multiplan Commercial |
$152.00
|
| Rate for Payer: Preferred Network Access Commercial |
$180.50
|
| Rate for Payer: Quartz Beloit One Network |
$83.60
|
| Rate for Payer: Quartz Commercial |
$108.30
|
| Rate for Payer: Quartz Medicare Advantage |
$13.74
|
| Rate for Payer: The Alliance Commercial |
$54.27
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.74
|
| Rate for Payer: WEA Trust Commercial |
$104.50
|
| Rate for Payer: WPS Commercial |
$60.46
|
|
|
DNA Antibody (Double-stranded)
|
Facility
IP
|
$190.00
|
|
|
Service Code
|
CPT 86225
|
| Hospital Charge Code |
977928
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$93.10 |
| Max. Negotiated Rate |
$174.80 |
| Rate for Payer: Aetna Commercial |
$171.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$100.70
|
| Rate for Payer: Cash Price |
$57.00
|
| Rate for Payer: Cigna Commercial |
$174.80
|
| Rate for Payer: Health EOS Commercial |
$169.10
|
| Rate for Payer: HFN Commercial |
$174.80
|
| Rate for Payer: Multiplan Commercial |
$152.00
|
| Rate for Payer: NAPHCARE Commercial |
$114.00
|
| Rate for Payer: Preferred Network Access Commercial |
$174.80
|
| Rate for Payer: Quartz Beloit One Network |
$93.10
|
| Rate for Payer: Quartz Commercial |
$114.00
|
| Rate for Payer: WEA Trust Commercial |
$104.50
|
| Rate for Payer: WPS Commercial |
$140.73
|
|
|
DNA Antibody (Double-stranded)
|
Facility
OP
|
$190.00
|
|
|
Service Code
|
CPT 86225
|
| Hospital Charge Code |
977928
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.74 |
| Max. Negotiated Rate |
$760.00 |
| Rate for Payer: Aetna Commercial |
$171.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$163.40
|
| Rate for Payer: Aetna Managed Medicare |
$13.74
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$51.52
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$24.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$22.81
|
| Rate for Payer: Anthem Medicaid |
$14.20
|
| Rate for Payer: Anthem Medicare Advantage |
$13.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$100.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$13.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$13.74
|
| Rate for Payer: Cash Price |
$57.00
|
| Rate for Payer: Cash Price |
$57.00
|
| Rate for Payer: Cigna Commercial |
$174.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$13.74
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$14.20
|
| Rate for Payer: Dean Health Medicaid |
$14.20
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$13.74
|
| Rate for Payer: Health EOS Commercial |
$169.10
|
| Rate for Payer: HFN Commercial |
$174.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$51.11
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$13.74
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$14.20
|
| Rate for Payer: Independent Care Health Plan Medicare |
$13.74
|
| Rate for Payer: Managed Health Services Medicaid |
$14.77
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$13.74
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$13.74
|
| Rate for Payer: Multiplan Commercial |
$152.00
|
| Rate for Payer: NAPHCARE Commercial |
$20.61
|
| Rate for Payer: Preferred Network Access Commercial |
$174.80
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$14.20
|
| Rate for Payer: Quartz Beloit One Network |
$93.10
|
| Rate for Payer: Quartz Commercial |
$123.50
|
| Rate for Payer: Quartz Medicare Advantage |
$13.74
|
| Rate for Payer: The Alliance Commercial |
$760.00
|
| Rate for Payer: United Healthcare Medicaid |
$14.20
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.74
|
| Rate for Payer: United Healthcare PPO |
$142.50
|
| Rate for Payer: WEA Trust Commercial |
$104.50
|
| Rate for Payer: Wellcare Medicare |
$13.74
|
| Rate for Payer: WMAP Medicaid |
$14.20
|
| Rate for Payer: WPS Commercial |
$140.73
|
|
|
DNA Antibody (Double-stranded)
|
Facility
IP
|
$280.00
|
|
|
Service Code
|
CPT 86225
|
| Hospital Charge Code |
3403540
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$137.20 |
| Max. Negotiated Rate |
$257.60 |
| Rate for Payer: Aetna Commercial |
$252.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$148.40
|
| Rate for Payer: Cash Price |
$84.00
|
| Rate for Payer: Cigna Commercial |
$257.60
|
| Rate for Payer: Health EOS Commercial |
$249.20
|
| Rate for Payer: HFN Commercial |
$257.60
|
| Rate for Payer: Multiplan Commercial |
$224.00
|
| Rate for Payer: NAPHCARE Commercial |
$168.00
|
| Rate for Payer: Preferred Network Access Commercial |
$257.60
|
| Rate for Payer: Quartz Beloit One Network |
$137.20
|
| Rate for Payer: Quartz Commercial |
$168.00
|
| Rate for Payer: WEA Trust Commercial |
$154.00
|
| Rate for Payer: WPS Commercial |
$207.40
|
|
|
DNA Antibody (Double-stranded)
|
Professional
|
$280.00
|
|
|
Service Code
|
CPT 86225
|
| Hospital Charge Code |
3403540
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.74 |
| Max. Negotiated Rate |
$266.00 |
| Rate for Payer: Aetna Commercial |
$266.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$240.80
|
| Rate for Payer: Aetna Managed Medicare |
$13.74
|
| Rate for Payer: Anthem Medicare Advantage |
$13.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$13.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$13.74
|
| Rate for Payer: Cash Price |
$84.00
|
| Rate for Payer: Cash Price |
$84.00
|
| Rate for Payer: Cigna Commercial |
$266.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$140.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$13.74
|
| Rate for Payer: Health EOS Commercial |
$254.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$48.50
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$48.50
|
| Rate for Payer: Independent Care Health Plan Medicare |
$13.74
|
| Rate for Payer: Multiplan Commercial |
$224.00
|
| Rate for Payer: Preferred Network Access Commercial |
$266.00
|
| Rate for Payer: Quartz Beloit One Network |
$123.20
|
| Rate for Payer: Quartz Commercial |
$159.60
|
| Rate for Payer: Quartz Medicare Advantage |
$13.74
|
| Rate for Payer: The Alliance Commercial |
$54.27
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.74
|
| Rate for Payer: WEA Trust Commercial |
$154.00
|
| Rate for Payer: WPS Commercial |
$60.46
|
|
|
DNA Antibody (Double-stranded)
|
Facility
OP
|
$280.00
|
|
|
Service Code
|
CPT 86225
|
| Hospital Charge Code |
3403540
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.74 |
| Max. Negotiated Rate |
$1,120.00 |
| Rate for Payer: Aetna Commercial |
$252.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$240.80
|
| Rate for Payer: Aetna Managed Medicare |
$13.74
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$51.52
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$24.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$22.81
|
| Rate for Payer: Anthem Medicaid |
$14.20
|
| Rate for Payer: Anthem Medicare Advantage |
$13.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$148.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$13.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$13.74
|
| Rate for Payer: Cash Price |
$84.00
|
| Rate for Payer: Cash Price |
$84.00
|
| Rate for Payer: Cigna Commercial |
$257.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$13.74
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$14.20
|
| Rate for Payer: Dean Health Medicaid |
$14.20
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$13.74
|
| Rate for Payer: Health EOS Commercial |
$249.20
|
| Rate for Payer: HFN Commercial |
$257.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$51.11
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$13.74
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$14.20
|
| Rate for Payer: Independent Care Health Plan Medicare |
$13.74
|
| Rate for Payer: Managed Health Services Medicaid |
$14.77
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$13.74
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$13.74
|
| Rate for Payer: Multiplan Commercial |
$224.00
|
| Rate for Payer: NAPHCARE Commercial |
$20.61
|
| Rate for Payer: Preferred Network Access Commercial |
$257.60
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$14.20
|
| Rate for Payer: Quartz Beloit One Network |
$137.20
|
| Rate for Payer: Quartz Commercial |
$182.00
|
| Rate for Payer: Quartz Medicare Advantage |
$13.74
|
| Rate for Payer: The Alliance Commercial |
$1,120.00
|
| Rate for Payer: United Healthcare Medicaid |
$14.20
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.74
|
| Rate for Payer: United Healthcare PPO |
$210.00
|
| Rate for Payer: WEA Trust Commercial |
$154.00
|
| Rate for Payer: Wellcare Medicare |
$13.74
|
| Rate for Payer: WMAP Medicaid |
$14.20
|
| Rate for Payer: WPS Commercial |
$207.40
|
|
|
DNA (ds) Ab, IFA w/ Rfx Titer
|
Facility
OP
|
$48.00
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
6179909
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.05 |
| 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 |
$12.05
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$45.19
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$21.09
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$20.00
|
| Rate for Payer: Anthem Medicaid |
$12.45
|
| Rate for Payer: Anthem Medicare Advantage |
$12.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$25.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$12.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$12.05
|
| Rate for Payer: Cash Price |
$14.40
|
| Rate for Payer: Cash Price |
$14.40
|
| Rate for Payer: Cigna Commercial |
$44.16
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$12.05
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$12.45
|
| Rate for Payer: Dean Health Medicaid |
$12.45
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$12.05
|
| Rate for Payer: Health EOS Commercial |
$42.72
|
| Rate for Payer: HFN Commercial |
$44.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$44.83
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$12.05
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$12.45
|
| Rate for Payer: Independent Care Health Plan Medicare |
$12.05
|
| Rate for Payer: Managed Health Services Medicaid |
$12.95
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$12.05
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$12.05
|
| Rate for Payer: Multiplan Commercial |
$38.40
|
| Rate for Payer: NAPHCARE Commercial |
$18.08
|
| Rate for Payer: Preferred Network Access Commercial |
$44.16
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$12.45
|
| Rate for Payer: Quartz Beloit One Network |
$23.52
|
| Rate for Payer: Quartz Commercial |
$31.20
|
| Rate for Payer: Quartz Medicare Advantage |
$12.05
|
| Rate for Payer: The Alliance Commercial |
$192.00
|
| Rate for Payer: United Healthcare Medicaid |
$12.45
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.05
|
| Rate for Payer: United Healthcare PPO |
$36.00
|
| Rate for Payer: WEA Trust Commercial |
$26.40
|
| Rate for Payer: Wellcare Medicare |
$12.05
|
| Rate for Payer: WMAP Medicaid |
$12.45
|
| Rate for Payer: WPS Commercial |
$35.55
|
|
|
DNA (ds) Ab, IFA w/ Rfx Titer
|
Professional
|
$48.00
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
6179909
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.05 |
| Max. Negotiated Rate |
$53.02 |
| Rate for Payer: Aetna Commercial |
$45.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$41.28
|
| Rate for Payer: Aetna Managed Medicare |
$12.05
|
| Rate for Payer: Anthem Commercial |
$16.61
|
| Rate for Payer: Anthem Medicare Advantage |
$12.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$12.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$12.05
|
| Rate for Payer: Cash Price |
$14.40
|
| 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 |
$12.05
|
| Rate for Payer: Health EOS Commercial |
$43.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$42.54
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$42.54
|
| Rate for Payer: Independent Care Health Plan Medicare |
$12.05
|
| 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: Quartz Medicare Advantage |
$12.05
|
| Rate for Payer: The Alliance Commercial |
$47.60
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.05
|
| Rate for Payer: WEA Trust Commercial |
$26.40
|
| Rate for Payer: WPS Commercial |
$53.02
|
|
|
DNA (ds) Ab, IFA w/ Rfx Titer
|
Facility
IP
|
$48.00
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
6179909
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$23.52 |
| Max. Negotiated Rate |
$44.16 |
| Rate for Payer: Aetna Commercial |
$43.20
|
| 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
|
|
