|
Epstein Barr Virus Capsid Antibody IgG
|
Facility
|
IP
|
$265.00
|
|
|
Service Code
|
CPT 86665
|
| Hospital Charge Code |
1039079
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$129.85 |
| Max. Negotiated Rate |
$243.80 |
| Rate for Payer: Aetna Commercial |
$238.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$227.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$140.45
|
| Rate for Payer: Cash Price |
$79.50
|
| Rate for Payer: Cigna Commercial |
$243.80
|
| Rate for Payer: Health EOS Commercial |
$235.85
|
| Rate for Payer: HFN Commercial |
$243.80
|
| Rate for Payer: Multiplan Commercial |
$212.00
|
| Rate for Payer: NAPHCARE Commercial |
$159.00
|
| Rate for Payer: Preferred Network Access Commercial |
$243.80
|
| Rate for Payer: Quartz Beloit One Network |
$129.85
|
| Rate for Payer: Quartz Commercial |
$159.00
|
| Rate for Payer: WEA Trust Commercial |
$145.75
|
| Rate for Payer: WPS Commercial |
$196.29
|
|
|
Epstein Barr Virus Capsid Antibody IgG
|
Professional
|
Both
|
$265.00
|
|
|
Service Code
|
CPT 86665
|
| Hospital Charge Code |
1039079
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$64.03 |
| Max. Negotiated Rate |
$251.75 |
| Rate for Payer: Aetna Commercial |
$251.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$227.90
|
| Rate for Payer: Cash Price |
$79.50
|
| Rate for Payer: Cash Price |
$79.50
|
| Rate for Payer: Cigna Commercial |
$251.75
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$132.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$159.00
|
| Rate for Payer: Health EOS Commercial |
$241.15
|
| Rate for Payer: HFN Commercial |
$251.75
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$64.03
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$64.03
|
| Rate for Payer: Multiplan Commercial |
$212.00
|
| Rate for Payer: Preferred Network Access Commercial |
$251.75
|
| Rate for Payer: Quartz Beloit One Network |
$116.60
|
| Rate for Payer: Quartz Commercial |
$151.05
|
| Rate for Payer: The Alliance Commercial |
$132.50
|
| Rate for Payer: WEA Trust Commercial |
$145.75
|
| Rate for Payer: WPS Commercial |
$196.29
|
|
|
Epstein Barr Virus Capsid Antibody IgG
|
Facility
|
OP
|
$265.00
|
|
|
Service Code
|
CPT 86665
|
| Hospital Charge Code |
1039079
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.14 |
| Max. Negotiated Rate |
$243.80 |
| Rate for Payer: Aetna Commercial |
$238.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$227.90
|
| Rate for Payer: Aetna Managed Medicare |
$18.14
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$68.02
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$31.74
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$30.11
|
| Rate for Payer: Anthem Medicaid |
$18.74
|
| Rate for Payer: Anthem Medicare Advantage |
$18.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$140.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$18.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$18.14
|
| Rate for Payer: Cash Price |
$79.50
|
| Rate for Payer: Cash Price |
$79.50
|
| Rate for Payer: Cigna Commercial |
$243.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$18.14
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$18.74
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$148.29
|
| Rate for Payer: Dean Health Medicaid |
$18.74
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$18.14
|
| Rate for Payer: Health EOS Commercial |
$235.85
|
| Rate for Payer: HFN Commercial |
$243.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$67.48
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$18.14
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$18.74
|
| Rate for Payer: Independent Care Health Plan Medicare |
$18.14
|
| Rate for Payer: Managed Health Services Medicaid |
$19.49
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$18.14
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$18.14
|
| Rate for Payer: Multiplan Commercial |
$212.00
|
| Rate for Payer: NAPHCARE Commercial |
$27.21
|
| Rate for Payer: Preferred Network Access Commercial |
$243.80
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$18.74
|
| Rate for Payer: Quartz Beloit One Network |
$129.85
|
| Rate for Payer: Quartz Commercial |
$172.25
|
| Rate for Payer: Quartz Medicare Advantage |
$18.14
|
| Rate for Payer: The Alliance Commercial |
$72.56
|
| Rate for Payer: United Healthcare Medicaid |
$18.74
|
| Rate for Payer: United Healthcare Medicare Advantage |
$18.14
|
| Rate for Payer: United Healthcare PPO |
$198.75
|
| Rate for Payer: WEA Trust Commercial |
$145.75
|
| Rate for Payer: Wellcare Medicare |
$18.14
|
| Rate for Payer: WMAP Medicaid |
$18.74
|
| Rate for Payer: WPS Commercial |
$196.29
|
|
|
Epstein Barr Virus Capsid Antibody IgM
|
Facility
|
OP
|
$265.00
|
|
|
Service Code
|
CPT 86665
|
| Hospital Charge Code |
1039080
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.14 |
| Max. Negotiated Rate |
$243.80 |
| Rate for Payer: Aetna Commercial |
$238.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$227.90
|
| Rate for Payer: Aetna Managed Medicare |
$18.14
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$68.02
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$31.74
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$30.11
|
| Rate for Payer: Anthem Medicaid |
$18.74
|
| Rate for Payer: Anthem Medicare Advantage |
$18.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$140.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$18.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$18.14
|
| Rate for Payer: Cash Price |
$79.50
|
| Rate for Payer: Cash Price |
$79.50
|
| Rate for Payer: Cigna Commercial |
$243.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$18.14
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$18.74
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$148.29
|
| Rate for Payer: Dean Health Medicaid |
$18.74
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$18.14
|
| Rate for Payer: Health EOS Commercial |
$235.85
|
| Rate for Payer: HFN Commercial |
$243.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$67.48
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$18.14
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$18.74
|
| Rate for Payer: Independent Care Health Plan Medicare |
$18.14
|
| Rate for Payer: Managed Health Services Medicaid |
$19.49
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$18.14
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$18.14
|
| Rate for Payer: Multiplan Commercial |
$212.00
|
| Rate for Payer: NAPHCARE Commercial |
$27.21
|
| Rate for Payer: Preferred Network Access Commercial |
$243.80
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$18.74
|
| Rate for Payer: Quartz Beloit One Network |
$129.85
|
| Rate for Payer: Quartz Commercial |
$172.25
|
| Rate for Payer: Quartz Medicare Advantage |
$18.14
|
| Rate for Payer: The Alliance Commercial |
$72.56
|
| Rate for Payer: United Healthcare Medicaid |
$18.74
|
| Rate for Payer: United Healthcare Medicare Advantage |
$18.14
|
| Rate for Payer: United Healthcare PPO |
$198.75
|
| Rate for Payer: WEA Trust Commercial |
$145.75
|
| Rate for Payer: Wellcare Medicare |
$18.14
|
| Rate for Payer: WMAP Medicaid |
$18.74
|
| Rate for Payer: WPS Commercial |
$196.29
|
|
|
Epstein Barr Virus Capsid Antibody IgM
|
Facility
|
IP
|
$265.00
|
|
|
Service Code
|
CPT 86665
|
| Hospital Charge Code |
1039080
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$129.85 |
| Max. Negotiated Rate |
$243.80 |
| Rate for Payer: Aetna Commercial |
$238.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$227.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$140.45
|
| Rate for Payer: Cash Price |
$79.50
|
| Rate for Payer: Cigna Commercial |
$243.80
|
| Rate for Payer: Health EOS Commercial |
$235.85
|
| Rate for Payer: HFN Commercial |
$243.80
|
| Rate for Payer: Multiplan Commercial |
$212.00
|
| Rate for Payer: NAPHCARE Commercial |
$159.00
|
| Rate for Payer: Preferred Network Access Commercial |
$243.80
|
| Rate for Payer: Quartz Beloit One Network |
$129.85
|
| Rate for Payer: Quartz Commercial |
$159.00
|
| Rate for Payer: WEA Trust Commercial |
$145.75
|
| Rate for Payer: WPS Commercial |
$196.29
|
|
|
Epstein Barr Virus Capsid Antibody IgM
|
Professional
|
Both
|
$265.00
|
|
|
Service Code
|
CPT 86665
|
| Hospital Charge Code |
1039080
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$64.03 |
| Max. Negotiated Rate |
$251.75 |
| Rate for Payer: Aetna Commercial |
$251.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$227.90
|
| Rate for Payer: Cash Price |
$79.50
|
| Rate for Payer: Cash Price |
$79.50
|
| Rate for Payer: Cigna Commercial |
$251.75
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$132.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$159.00
|
| Rate for Payer: Health EOS Commercial |
$241.15
|
| Rate for Payer: HFN Commercial |
$251.75
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$64.03
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$64.03
|
| Rate for Payer: Multiplan Commercial |
$212.00
|
| Rate for Payer: Preferred Network Access Commercial |
$251.75
|
| Rate for Payer: Quartz Beloit One Network |
$116.60
|
| Rate for Payer: Quartz Commercial |
$151.05
|
| Rate for Payer: The Alliance Commercial |
$132.50
|
| Rate for Payer: WEA Trust Commercial |
$145.75
|
| Rate for Payer: WPS Commercial |
$196.29
|
|
|
Epstein Barr Virus Capsid IgM Antibody
|
Facility
|
OP
|
$204.00
|
|
|
Service Code
|
CPT 86665
|
| Hospital Charge Code |
2942898
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.14 |
| Max. Negotiated Rate |
$187.68 |
| Rate for Payer: Aetna Commercial |
$183.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$175.44
|
| Rate for Payer: Aetna Managed Medicare |
$18.14
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$68.02
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$31.74
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$30.11
|
| Rate for Payer: Anthem Medicaid |
$18.74
|
| Rate for Payer: Anthem Medicare Advantage |
$18.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$108.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$18.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$18.14
|
| Rate for Payer: Cash Price |
$61.20
|
| Rate for Payer: Cash Price |
$61.20
|
| Rate for Payer: Cigna Commercial |
$187.68
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$18.14
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$18.74
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$114.16
|
| Rate for Payer: Dean Health Medicaid |
$18.74
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$18.14
|
| Rate for Payer: Health EOS Commercial |
$181.56
|
| Rate for Payer: HFN Commercial |
$187.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$67.48
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$18.14
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$18.74
|
| Rate for Payer: Independent Care Health Plan Medicare |
$18.14
|
| Rate for Payer: Managed Health Services Medicaid |
$19.49
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$18.14
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$18.14
|
| Rate for Payer: Multiplan Commercial |
$163.20
|
| Rate for Payer: NAPHCARE Commercial |
$27.21
|
| Rate for Payer: Preferred Network Access Commercial |
$187.68
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$18.74
|
| Rate for Payer: Quartz Beloit One Network |
$99.96
|
| Rate for Payer: Quartz Commercial |
$132.60
|
| Rate for Payer: Quartz Medicare Advantage |
$18.14
|
| Rate for Payer: The Alliance Commercial |
$72.56
|
| Rate for Payer: United Healthcare Medicaid |
$18.74
|
| Rate for Payer: United Healthcare Medicare Advantage |
$18.14
|
| Rate for Payer: United Healthcare PPO |
$153.00
|
| Rate for Payer: WEA Trust Commercial |
$112.20
|
| Rate for Payer: Wellcare Medicare |
$18.14
|
| Rate for Payer: WMAP Medicaid |
$18.74
|
| Rate for Payer: WPS Commercial |
$151.10
|
|
|
Epstein Barr Virus Capsid IgM Antibody
|
Professional
|
Both
|
$204.00
|
|
|
Service Code
|
CPT 86665
|
| Hospital Charge Code |
2942898
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$64.03 |
| Max. Negotiated Rate |
$193.80 |
| Rate for Payer: Aetna Commercial |
$193.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$175.44
|
| Rate for Payer: Cash Price |
$61.20
|
| Rate for Payer: Cash Price |
$61.20
|
| Rate for Payer: Cigna Commercial |
$193.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$102.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$122.40
|
| Rate for Payer: Health EOS Commercial |
$185.64
|
| Rate for Payer: HFN Commercial |
$193.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$64.03
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$64.03
|
| Rate for Payer: Multiplan Commercial |
$163.20
|
| Rate for Payer: Preferred Network Access Commercial |
$193.80
|
| Rate for Payer: Quartz Beloit One Network |
$89.76
|
| Rate for Payer: Quartz Commercial |
$116.28
|
| Rate for Payer: The Alliance Commercial |
$102.00
|
| Rate for Payer: WEA Trust Commercial |
$112.20
|
| Rate for Payer: WPS Commercial |
$151.10
|
|
|
Epstein Barr Virus Capsid IgM Antibody
|
Facility
|
IP
|
$204.00
|
|
|
Service Code
|
CPT 86665
|
| Hospital Charge Code |
2942898
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$99.96 |
| Max. Negotiated Rate |
$187.68 |
| Rate for Payer: Aetna Commercial |
$183.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$175.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$108.12
|
| Rate for Payer: Cash Price |
$61.20
|
| Rate for Payer: Cigna Commercial |
$187.68
|
| Rate for Payer: Health EOS Commercial |
$181.56
|
| Rate for Payer: HFN Commercial |
$187.68
|
| Rate for Payer: Multiplan Commercial |
$163.20
|
| Rate for Payer: NAPHCARE Commercial |
$122.40
|
| Rate for Payer: Preferred Network Access Commercial |
$187.68
|
| Rate for Payer: Quartz Beloit One Network |
$99.96
|
| Rate for Payer: Quartz Commercial |
$122.40
|
| Rate for Payer: WEA Trust Commercial |
$112.20
|
| Rate for Payer: WPS Commercial |
$151.10
|
|
|
Epstein Barr Virus DNA by PCR, Qual
|
Facility
|
IP
|
$477.00
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
1039074
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$233.73 |
| Max. Negotiated Rate |
$438.84 |
| Rate for Payer: Aetna Commercial |
$429.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$410.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$252.81
|
| Rate for Payer: Cash Price |
$143.10
|
| Rate for Payer: Cigna Commercial |
$438.84
|
| Rate for Payer: Health EOS Commercial |
$424.53
|
| Rate for Payer: HFN Commercial |
$438.84
|
| Rate for Payer: Multiplan Commercial |
$381.60
|
| Rate for Payer: NAPHCARE Commercial |
$286.20
|
| Rate for Payer: Preferred Network Access Commercial |
$438.84
|
| Rate for Payer: Quartz Beloit One Network |
$233.73
|
| Rate for Payer: Quartz Commercial |
$286.20
|
| Rate for Payer: WEA Trust Commercial |
$262.35
|
| Rate for Payer: WPS Commercial |
$353.31
|
|
|
Epstein Barr Virus DNA by PCR, Qual
|
Professional
|
Both
|
$477.00
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
1039074
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$123.87 |
| Max. Negotiated Rate |
$453.15 |
| Rate for Payer: Aetna Commercial |
$453.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$410.22
|
| Rate for Payer: Cash Price |
$143.10
|
| Rate for Payer: Cash Price |
$143.10
|
| Rate for Payer: Cigna Commercial |
$453.15
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$238.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$286.20
|
| Rate for Payer: Health EOS Commercial |
$434.07
|
| Rate for Payer: HFN Commercial |
$453.15
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$123.87
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$123.87
|
| Rate for Payer: Multiplan Commercial |
$381.60
|
| Rate for Payer: Preferred Network Access Commercial |
$453.15
|
| Rate for Payer: Quartz Beloit One Network |
$209.88
|
| Rate for Payer: Quartz Commercial |
$271.89
|
| Rate for Payer: The Alliance Commercial |
$238.50
|
| Rate for Payer: WEA Trust Commercial |
$262.35
|
| Rate for Payer: WPS Commercial |
$353.31
|
|
|
Epstein Barr Virus DNA by PCR, Qual
|
Facility
|
OP
|
$477.00
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
1039074
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$35.09 |
| Max. Negotiated Rate |
$438.84 |
| Rate for Payer: Aetna Commercial |
$429.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$410.22
|
| Rate for Payer: Aetna Managed Medicare |
$35.09
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$131.59
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$61.41
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$58.25
|
| Rate for Payer: Anthem Medicaid |
$36.26
|
| Rate for Payer: Anthem Medicare Advantage |
$35.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$252.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$35.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$35.09
|
| Rate for Payer: Cash Price |
$143.10
|
| Rate for Payer: Cash Price |
$143.10
|
| Rate for Payer: Cigna Commercial |
$438.84
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$35.09
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$36.26
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$266.93
|
| Rate for Payer: Dean Health Medicaid |
$36.26
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$35.09
|
| Rate for Payer: Health EOS Commercial |
$424.53
|
| Rate for Payer: HFN Commercial |
$438.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$130.53
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$35.09
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$36.26
|
| Rate for Payer: Independent Care Health Plan Medicare |
$35.09
|
| Rate for Payer: Managed Health Services Medicaid |
$37.71
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$35.09
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$35.09
|
| Rate for Payer: Multiplan Commercial |
$381.60
|
| Rate for Payer: NAPHCARE Commercial |
$52.64
|
| Rate for Payer: Preferred Network Access Commercial |
$438.84
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$36.26
|
| Rate for Payer: Quartz Beloit One Network |
$233.73
|
| Rate for Payer: Quartz Commercial |
$310.05
|
| Rate for Payer: Quartz Medicare Advantage |
$35.09
|
| Rate for Payer: The Alliance Commercial |
$140.36
|
| Rate for Payer: United Healthcare Medicaid |
$36.26
|
| Rate for Payer: United Healthcare Medicare Advantage |
$35.09
|
| Rate for Payer: United Healthcare PPO |
$357.75
|
| Rate for Payer: WEA Trust Commercial |
$262.35
|
| Rate for Payer: Wellcare Medicare |
$35.09
|
| Rate for Payer: WMAP Medicaid |
$36.26
|
| Rate for Payer: WPS Commercial |
$353.31
|
|
|
Epstein Barr Virus DNA by PCR, Quant
|
Facility
|
IP
|
$425.00
|
|
|
Service Code
|
CPT 87799
|
| Hospital Charge Code |
1039067
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$208.25 |
| Max. Negotiated Rate |
$391.00 |
| Rate for Payer: Aetna Commercial |
$382.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$365.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$225.25
|
| Rate for Payer: Cash Price |
$127.50
|
| Rate for Payer: Cigna Commercial |
$391.00
|
| Rate for Payer: Health EOS Commercial |
$378.25
|
| Rate for Payer: HFN Commercial |
$391.00
|
| Rate for Payer: Multiplan Commercial |
$340.00
|
| Rate for Payer: NAPHCARE Commercial |
$255.00
|
| Rate for Payer: Preferred Network Access Commercial |
$391.00
|
| Rate for Payer: Quartz Beloit One Network |
$208.25
|
| Rate for Payer: Quartz Commercial |
$255.00
|
| Rate for Payer: WEA Trust Commercial |
$233.75
|
| Rate for Payer: WPS Commercial |
$314.80
|
|
|
Epstein Barr Virus DNA by PCR, Quant
|
Facility
|
OP
|
$425.00
|
|
|
Service Code
|
CPT 87799
|
| Hospital Charge Code |
1039067
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$42.84 |
| Max. Negotiated Rate |
$391.00 |
| Rate for Payer: Aetna Commercial |
$382.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$365.50
|
| Rate for Payer: Aetna Managed Medicare |
$42.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$160.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$74.97
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$71.11
|
| Rate for Payer: Anthem Medicaid |
$44.27
|
| Rate for Payer: Anthem Medicare Advantage |
$42.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$225.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$42.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$42.84
|
| Rate for Payer: Cash Price |
$127.50
|
| Rate for Payer: Cash Price |
$127.50
|
| Rate for Payer: Cigna Commercial |
$391.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$42.84
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$44.27
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$237.83
|
| Rate for Payer: Dean Health Medicaid |
$44.27
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$42.84
|
| Rate for Payer: Health EOS Commercial |
$378.25
|
| Rate for Payer: HFN Commercial |
$391.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$159.36
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$42.84
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$44.27
|
| Rate for Payer: Independent Care Health Plan Medicare |
$42.84
|
| Rate for Payer: Managed Health Services Medicaid |
$46.04
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$42.84
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$42.84
|
| Rate for Payer: Multiplan Commercial |
$340.00
|
| Rate for Payer: NAPHCARE Commercial |
$64.26
|
| Rate for Payer: Preferred Network Access Commercial |
$391.00
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$44.27
|
| Rate for Payer: Quartz Beloit One Network |
$208.25
|
| Rate for Payer: Quartz Commercial |
$276.25
|
| Rate for Payer: Quartz Medicare Advantage |
$42.84
|
| Rate for Payer: The Alliance Commercial |
$171.36
|
| Rate for Payer: United Healthcare Medicaid |
$44.27
|
| Rate for Payer: United Healthcare Medicare Advantage |
$42.84
|
| Rate for Payer: United Healthcare PPO |
$318.75
|
| Rate for Payer: WEA Trust Commercial |
$233.75
|
| Rate for Payer: Wellcare Medicare |
$42.84
|
| Rate for Payer: WMAP Medicaid |
$44.27
|
| Rate for Payer: WPS Commercial |
$314.80
|
|
|
Epstein Barr Virus DNA by PCR, Quant
|
Professional
|
Both
|
$425.00
|
|
|
Service Code
|
CPT 87799
|
| Hospital Charge Code |
1039067
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$151.23 |
| Max. Negotiated Rate |
$403.75 |
| Rate for Payer: Aetna Commercial |
$403.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$365.50
|
| Rate for Payer: Cash Price |
$127.50
|
| Rate for Payer: Cash Price |
$127.50
|
| Rate for Payer: Cigna Commercial |
$403.75
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$212.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$255.00
|
| Rate for Payer: Health EOS Commercial |
$386.75
|
| Rate for Payer: HFN Commercial |
$403.75
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$151.23
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$151.23
|
| Rate for Payer: Multiplan Commercial |
$340.00
|
| Rate for Payer: Preferred Network Access Commercial |
$403.75
|
| Rate for Payer: Quartz Beloit One Network |
$187.00
|
| Rate for Payer: Quartz Commercial |
$242.25
|
| Rate for Payer: The Alliance Commercial |
$212.50
|
| Rate for Payer: WEA Trust Commercial |
$233.75
|
| Rate for Payer: WPS Commercial |
$314.80
|
|
|
Epstein Barr Virus Nuclear Antibody
|
Facility
|
OP
|
$189.00
|
|
|
Service Code
|
CPT 86664
|
| Hospital Charge Code |
2942899
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.29 |
| Max. Negotiated Rate |
$173.88 |
| Rate for Payer: Aetna Commercial |
$170.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$162.54
|
| Rate for Payer: Aetna Managed Medicare |
$15.29
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$57.34
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$26.76
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$25.38
|
| Rate for Payer: Anthem Medicaid |
$15.80
|
| Rate for Payer: Anthem Medicare Advantage |
$15.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$100.17
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$15.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$15.29
|
| Rate for Payer: Cash Price |
$56.70
|
| Rate for Payer: Cash Price |
$56.70
|
| Rate for Payer: Cigna Commercial |
$173.88
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$15.29
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$15.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$105.76
|
| Rate for Payer: Dean Health Medicaid |
$15.80
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$15.29
|
| Rate for Payer: Health EOS Commercial |
$168.21
|
| Rate for Payer: HFN Commercial |
$173.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$56.88
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$15.29
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$15.80
|
| Rate for Payer: Independent Care Health Plan Medicare |
$15.29
|
| Rate for Payer: Managed Health Services Medicaid |
$16.43
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$15.29
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$15.29
|
| Rate for Payer: Multiplan Commercial |
$151.20
|
| Rate for Payer: NAPHCARE Commercial |
$22.94
|
| Rate for Payer: Preferred Network Access Commercial |
$173.88
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$15.80
|
| Rate for Payer: Quartz Beloit One Network |
$92.61
|
| Rate for Payer: Quartz Commercial |
$122.85
|
| Rate for Payer: Quartz Medicare Advantage |
$15.29
|
| Rate for Payer: The Alliance Commercial |
$61.16
|
| Rate for Payer: United Healthcare Medicaid |
$15.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$15.29
|
| Rate for Payer: United Healthcare PPO |
$141.75
|
| Rate for Payer: WEA Trust Commercial |
$103.95
|
| Rate for Payer: Wellcare Medicare |
$15.29
|
| Rate for Payer: WMAP Medicaid |
$15.80
|
| Rate for Payer: WPS Commercial |
$139.99
|
|
|
Epstein Barr Virus Nuclear Antibody
|
Professional
|
Both
|
$189.00
|
|
|
Service Code
|
CPT 86664
|
| Hospital Charge Code |
2942899
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$53.97 |
| Max. Negotiated Rate |
$179.55 |
| Rate for Payer: Aetna Commercial |
$179.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$162.54
|
| Rate for Payer: Cash Price |
$56.70
|
| Rate for Payer: Cash Price |
$56.70
|
| Rate for Payer: Cigna Commercial |
$179.55
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$94.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$113.40
|
| Rate for Payer: Health EOS Commercial |
$171.99
|
| Rate for Payer: HFN Commercial |
$179.55
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$53.97
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$53.97
|
| Rate for Payer: Multiplan Commercial |
$151.20
|
| Rate for Payer: Preferred Network Access Commercial |
$179.55
|
| Rate for Payer: Quartz Beloit One Network |
$83.16
|
| Rate for Payer: Quartz Commercial |
$107.73
|
| Rate for Payer: The Alliance Commercial |
$94.50
|
| Rate for Payer: WEA Trust Commercial |
$103.95
|
| Rate for Payer: WPS Commercial |
$139.99
|
|
|
Epstein Barr Virus Nuclear Antibody
|
Facility
|
IP
|
$189.00
|
|
|
Service Code
|
CPT 86664
|
| Hospital Charge Code |
2942899
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$92.61 |
| Max. Negotiated Rate |
$173.88 |
| Rate for Payer: Aetna Commercial |
$170.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$162.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$100.17
|
| Rate for Payer: Cash Price |
$56.70
|
| Rate for Payer: Cigna Commercial |
$173.88
|
| Rate for Payer: Health EOS Commercial |
$168.21
|
| Rate for Payer: HFN Commercial |
$173.88
|
| Rate for Payer: Multiplan Commercial |
$151.20
|
| Rate for Payer: NAPHCARE Commercial |
$113.40
|
| Rate for Payer: Preferred Network Access Commercial |
$173.88
|
| Rate for Payer: Quartz Beloit One Network |
$92.61
|
| Rate for Payer: Quartz Commercial |
$113.40
|
| Rate for Payer: WEA Trust Commercial |
$103.95
|
| Rate for Payer: WPS Commercial |
$139.99
|
|
|
Epstein Barr Virus Panel
|
Professional
|
Both
|
$265.00
|
|
|
Service Code
|
CPT 86665
|
| Hospital Charge Code |
978116
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$64.03 |
| Max. Negotiated Rate |
$251.75 |
| Rate for Payer: Aetna Commercial |
$251.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$227.90
|
| Rate for Payer: Cash Price |
$79.50
|
| Rate for Payer: Cash Price |
$79.50
|
| Rate for Payer: Cigna Commercial |
$251.75
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$132.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$159.00
|
| Rate for Payer: Health EOS Commercial |
$241.15
|
| Rate for Payer: HFN Commercial |
$251.75
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$64.03
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$64.03
|
| Rate for Payer: Multiplan Commercial |
$212.00
|
| Rate for Payer: Preferred Network Access Commercial |
$251.75
|
| Rate for Payer: Quartz Beloit One Network |
$116.60
|
| Rate for Payer: Quartz Commercial |
$151.05
|
| Rate for Payer: The Alliance Commercial |
$132.50
|
| Rate for Payer: WEA Trust Commercial |
$145.75
|
| Rate for Payer: WPS Commercial |
$196.29
|
|
|
Epstein Barr Virus Panel
|
Facility
|
OP
|
$265.00
|
|
|
Service Code
|
CPT 86665
|
| Hospital Charge Code |
978116
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.14 |
| Max. Negotiated Rate |
$243.80 |
| Rate for Payer: Aetna Commercial |
$238.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$227.90
|
| Rate for Payer: Aetna Managed Medicare |
$18.14
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$68.02
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$31.74
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$30.11
|
| Rate for Payer: Anthem Medicaid |
$18.74
|
| Rate for Payer: Anthem Medicare Advantage |
$18.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$140.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$18.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$18.14
|
| Rate for Payer: Cash Price |
$79.50
|
| Rate for Payer: Cash Price |
$79.50
|
| Rate for Payer: Cigna Commercial |
$243.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$18.14
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$18.74
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$148.29
|
| Rate for Payer: Dean Health Medicaid |
$18.74
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$18.14
|
| Rate for Payer: Health EOS Commercial |
$235.85
|
| Rate for Payer: HFN Commercial |
$243.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$67.48
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$18.14
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$18.74
|
| Rate for Payer: Independent Care Health Plan Medicare |
$18.14
|
| Rate for Payer: Managed Health Services Medicaid |
$19.49
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$18.14
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$18.14
|
| Rate for Payer: Multiplan Commercial |
$212.00
|
| Rate for Payer: NAPHCARE Commercial |
$27.21
|
| Rate for Payer: Preferred Network Access Commercial |
$243.80
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$18.74
|
| Rate for Payer: Quartz Beloit One Network |
$129.85
|
| Rate for Payer: Quartz Commercial |
$172.25
|
| Rate for Payer: Quartz Medicare Advantage |
$18.14
|
| Rate for Payer: The Alliance Commercial |
$72.56
|
| Rate for Payer: United Healthcare Medicaid |
$18.74
|
| Rate for Payer: United Healthcare Medicare Advantage |
$18.14
|
| Rate for Payer: United Healthcare PPO |
$198.75
|
| Rate for Payer: WEA Trust Commercial |
$145.75
|
| Rate for Payer: Wellcare Medicare |
$18.14
|
| Rate for Payer: WMAP Medicaid |
$18.74
|
| Rate for Payer: WPS Commercial |
$196.29
|
|
|
Epstein Barr Virus Panel
|
Facility
|
IP
|
$265.00
|
|
|
Service Code
|
CPT 86665
|
| Hospital Charge Code |
978116
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$129.85 |
| Max. Negotiated Rate |
$243.80 |
| Rate for Payer: Aetna Commercial |
$238.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$227.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$140.45
|
| Rate for Payer: Cash Price |
$79.50
|
| Rate for Payer: Cigna Commercial |
$243.80
|
| Rate for Payer: Health EOS Commercial |
$235.85
|
| Rate for Payer: HFN Commercial |
$243.80
|
| Rate for Payer: Multiplan Commercial |
$212.00
|
| Rate for Payer: NAPHCARE Commercial |
$159.00
|
| Rate for Payer: Preferred Network Access Commercial |
$243.80
|
| Rate for Payer: Quartz Beloit One Network |
$129.85
|
| Rate for Payer: Quartz Commercial |
$159.00
|
| Rate for Payer: WEA Trust Commercial |
$145.75
|
| Rate for Payer: WPS Commercial |
$196.29
|
|
|
EP Stim/Pace Post IV Drug Infusion +
|
Facility
|
OP
|
$1,133.00
|
|
|
Service Code
|
CPT 93623
|
| Hospital Charge Code |
3052510
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$317.24 |
| Max. Negotiated Rate |
$29,139.00 |
| Rate for Payer: Aetna Commercial |
$1,019.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$974.38
|
| Rate for Payer: Aetna Managed Medicare |
$317.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$29,139.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$26,420.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$25,100.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$600.49
|
| Rate for Payer: Cash Price |
$339.90
|
| Rate for Payer: Cash Price |
$339.90
|
| Rate for Payer: Cigna Commercial |
$1,042.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$634.03
|
| Rate for Payer: Health EOS Commercial |
$1,008.37
|
| Rate for Payer: HFN Commercial |
$1,042.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$849.75
|
| Rate for Payer: Multiplan Commercial |
$906.40
|
| Rate for Payer: NAPHCARE Commercial |
$679.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,042.36
|
| Rate for Payer: Quartz Beloit One Network |
$555.17
|
| Rate for Payer: Quartz Commercial |
$736.45
|
| Rate for Payer: Quartz Medicare Advantage |
$679.80
|
| Rate for Payer: The Alliance Commercial |
$4,532.00
|
| Rate for Payer: WEA Trust Commercial |
$623.15
|
| Rate for Payer: WPS Commercial |
$839.21
|
|
|
EP Stim/Pace Post IV Drug Infusion +
|
Facility
|
IP
|
$1,133.00
|
|
|
Service Code
|
CPT 93623
|
| Hospital Charge Code |
3052510
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$555.17 |
| Max. Negotiated Rate |
$1,042.36 |
| Rate for Payer: Aetna Commercial |
$1,019.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$974.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$600.49
|
| Rate for Payer: Cash Price |
$339.90
|
| Rate for Payer: Cigna Commercial |
$1,042.36
|
| Rate for Payer: Health EOS Commercial |
$1,008.37
|
| Rate for Payer: HFN Commercial |
$1,042.36
|
| Rate for Payer: Multiplan Commercial |
$906.40
|
| Rate for Payer: NAPHCARE Commercial |
$679.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,042.36
|
| Rate for Payer: Quartz Beloit One Network |
$555.17
|
| Rate for Payer: Quartz Commercial |
$679.80
|
| Rate for Payer: WEA Trust Commercial |
$623.15
|
| Rate for Payer: WPS Commercial |
$839.21
|
|
|
EP Study W/Ablation for SVT
|
Facility
|
OP
|
$7,964.00
|
|
|
Service Code
|
CPT 93653
|
| Hospital Charge Code |
3052516
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$3,902.36 |
| Max. Negotiated Rate |
$93,900.28 |
| Rate for Payer: Aetna Commercial |
$7,167.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,849.04
|
| Rate for Payer: Aetna Managed Medicare |
$23,475.07
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$29,139.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$26,420.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$25,100.00
|
| Rate for Payer: Anthem Medicare Advantage |
$23,475.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,220.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$23,475.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$23,475.07
|
| Rate for Payer: Cash Price |
$2,389.20
|
| Rate for Payer: Cash Price |
$2,389.20
|
| Rate for Payer: Cash Price |
$2,389.20
|
| Rate for Payer: Cigna Commercial |
$7,326.88
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$23,475.07
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,456.65
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$23,475.07
|
| Rate for Payer: Health EOS Commercial |
$7,087.96
|
| Rate for Payer: HFN Commercial |
$7,326.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$87,327.26
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$23,475.07
|
| Rate for Payer: Independent Care Health Plan Medicare |
$23,475.07
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$23,475.07
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$23,475.07
|
| Rate for Payer: Multiplan Commercial |
$6,371.20
|
| Rate for Payer: NAPHCARE Commercial |
$35,212.60
|
| Rate for Payer: Preferred Network Access Commercial |
$7,326.88
|
| Rate for Payer: Quartz Beloit One Network |
$3,902.36
|
| Rate for Payer: Quartz Commercial |
$5,176.60
|
| Rate for Payer: Quartz Medicare Advantage |
$23,475.07
|
| Rate for Payer: The Alliance Commercial |
$93,900.28
|
| Rate for Payer: United Healthcare Medicare Advantage |
$23,475.07
|
| Rate for Payer: United Healthcare PPO |
$11,078.00
|
| Rate for Payer: WEA Trust Commercial |
$4,380.20
|
| Rate for Payer: Wellcare Medicare |
$23,475.07
|
| Rate for Payer: WPS Commercial |
$5,898.93
|
|
|
EP Study W/Ablation for SVT
|
Facility
|
IP
|
$7,964.00
|
|
|
Service Code
|
CPT 93653
|
| Hospital Charge Code |
3052516
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$3,902.36 |
| Max. Negotiated Rate |
$7,326.88 |
| Rate for Payer: Aetna Commercial |
$7,167.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,849.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,220.92
|
| Rate for Payer: Cash Price |
$2,389.20
|
| Rate for Payer: Cigna Commercial |
$7,326.88
|
| Rate for Payer: Health EOS Commercial |
$7,087.96
|
| Rate for Payer: HFN Commercial |
$7,326.88
|
| Rate for Payer: Multiplan Commercial |
$6,371.20
|
| Rate for Payer: NAPHCARE Commercial |
$4,778.40
|
| Rate for Payer: Preferred Network Access Commercial |
$7,326.88
|
| Rate for Payer: Quartz Beloit One Network |
$3,902.36
|
| Rate for Payer: Quartz Commercial |
$4,778.40
|
| Rate for Payer: WEA Trust Commercial |
$4,380.20
|
| Rate for Payer: WPS Commercial |
$5,898.93
|
|
