|
FINGER TRAP ALLEN MEDIUM STERILE 30522-4-A1
|
Facility
|
OP
|
$562.00
|
|
| Hospital Charge Code |
4067891
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$157.36 |
| Max. Negotiated Rate |
$2,248.00 |
| Rate for Payer: Aetna Commercial |
$505.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$483.32
|
| Rate for Payer: Aetna Managed Medicare |
$157.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$365.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$281.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$269.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$297.86
|
| Rate for Payer: Cash Price |
$168.60
|
| Rate for Payer: Cigna Commercial |
$517.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$314.50
|
| Rate for Payer: Health EOS Commercial |
$500.18
|
| Rate for Payer: HFN Commercial |
$517.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$421.50
|
| Rate for Payer: Multiplan Commercial |
$449.60
|
| Rate for Payer: NAPHCARE Commercial |
$337.20
|
| Rate for Payer: Preferred Network Access Commercial |
$517.04
|
| Rate for Payer: Quartz Beloit One Network |
$275.38
|
| Rate for Payer: Quartz Commercial |
$365.30
|
| Rate for Payer: Quartz Medicare Advantage |
$337.20
|
| Rate for Payer: The Alliance Commercial |
$2,248.00
|
| Rate for Payer: WEA Trust Commercial |
$309.10
|
| Rate for Payer: WPS Commercial |
$416.27
|
|
|
FINGER TRIGGER SOLUTIONS MED
|
Facility
|
OP
|
$245.00
|
|
| Hospital Charge Code |
2970747
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$68.60 |
| Max. Negotiated Rate |
$980.00 |
| Rate for Payer: Aetna Commercial |
$220.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$210.70
|
| Rate for Payer: Aetna Managed Medicare |
$68.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$159.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$122.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$117.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$129.85
|
| Rate for Payer: Cash Price |
$73.50
|
| Rate for Payer: Cigna Commercial |
$225.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$137.10
|
| Rate for Payer: Health EOS Commercial |
$218.05
|
| Rate for Payer: HFN Commercial |
$225.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$183.75
|
| Rate for Payer: Multiplan Commercial |
$196.00
|
| Rate for Payer: NAPHCARE Commercial |
$147.00
|
| Rate for Payer: Preferred Network Access Commercial |
$225.40
|
| Rate for Payer: Quartz Beloit One Network |
$120.05
|
| Rate for Payer: Quartz Commercial |
$159.25
|
| Rate for Payer: Quartz Medicare Advantage |
$147.00
|
| Rate for Payer: The Alliance Commercial |
$980.00
|
| Rate for Payer: WEA Trust Commercial |
$134.75
|
| Rate for Payer: WPS Commercial |
$181.47
|
|
|
FINGER TRIGGER SOLUTIONS MED
|
Facility
|
IP
|
$245.00
|
|
| Hospital Charge Code |
2970747
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$120.05 |
| Max. Negotiated Rate |
$225.40 |
| Rate for Payer: Aetna Commercial |
$220.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$210.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$129.85
|
| Rate for Payer: Cash Price |
$73.50
|
| Rate for Payer: Cigna Commercial |
$225.40
|
| Rate for Payer: Health EOS Commercial |
$218.05
|
| Rate for Payer: HFN Commercial |
$225.40
|
| Rate for Payer: Multiplan Commercial |
$196.00
|
| Rate for Payer: NAPHCARE Commercial |
$147.00
|
| Rate for Payer: Preferred Network Access Commercial |
$225.40
|
| Rate for Payer: Quartz Beloit One Network |
$120.05
|
| Rate for Payer: Quartz Commercial |
$147.00
|
| Rate for Payer: WEA Trust Commercial |
$134.75
|
| Rate for Payer: WPS Commercial |
$181.47
|
|
|
First Vaccine 90471 - Admin Hep B Charge
|
Facility
|
OP
|
$102.00
|
|
|
Service Code
|
CPT 90471
|
| Hospital Charge Code |
3013439
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$48.96 |
| Max. Negotiated Rate |
$278.52 |
| Rate for Payer: Aetna Commercial |
$91.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$87.72
|
| Rate for Payer: Aetna Managed Medicare |
$69.63
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$66.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$51.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$48.96
|
| Rate for Payer: Anthem Medicare Advantage |
$69.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$54.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$69.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$69.63
|
| Rate for Payer: Cash Price |
$30.60
|
| Rate for Payer: Cash Price |
$30.60
|
| Rate for Payer: Cigna Commercial |
$93.84
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$69.63
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$57.08
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$69.63
|
| Rate for Payer: Health EOS Commercial |
$90.78
|
| Rate for Payer: HFN Commercial |
$93.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$259.02
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$69.63
|
| Rate for Payer: Independent Care Health Plan Medicare |
$69.63
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$69.63
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$69.63
|
| Rate for Payer: Multiplan Commercial |
$81.60
|
| Rate for Payer: NAPHCARE Commercial |
$104.44
|
| Rate for Payer: Preferred Network Access Commercial |
$93.84
|
| Rate for Payer: Quartz Beloit One Network |
$49.98
|
| Rate for Payer: Quartz Commercial |
$66.30
|
| Rate for Payer: Quartz Medicare Advantage |
$69.63
|
| Rate for Payer: The Alliance Commercial |
$278.52
|
| Rate for Payer: United Healthcare Medicare Advantage |
$69.63
|
| Rate for Payer: United Healthcare PPO |
$76.50
|
| Rate for Payer: WEA Trust Commercial |
$56.10
|
| Rate for Payer: Wellcare Medicare |
$69.63
|
| Rate for Payer: WPS Commercial |
$75.55
|
|
|
First Vaccine 90471 - Admin Hep B Charge
|
Facility
|
IP
|
$102.00
|
|
|
Service Code
|
CPT 90471
|
| Hospital Charge Code |
3013439
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$49.98 |
| Max. Negotiated Rate |
$93.84 |
| Rate for Payer: Aetna Commercial |
$91.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$87.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$54.06
|
| Rate for Payer: Cash Price |
$30.60
|
| Rate for Payer: Cigna Commercial |
$93.84
|
| Rate for Payer: Health EOS Commercial |
$90.78
|
| Rate for Payer: HFN Commercial |
$93.84
|
| Rate for Payer: Multiplan Commercial |
$81.60
|
| Rate for Payer: NAPHCARE Commercial |
$61.20
|
| Rate for Payer: Preferred Network Access Commercial |
$93.84
|
| Rate for Payer: Quartz Beloit One Network |
$49.98
|
| Rate for Payer: Quartz Commercial |
$61.20
|
| Rate for Payer: WEA Trust Commercial |
$56.10
|
| Rate for Payer: WPS Commercial |
$75.55
|
|
|
First Vaccine 90471 - Admin Hep B Charge
|
Professional
|
Both
|
$102.00
|
|
|
Service Code
|
CPT 90471
|
| Hospital Charge Code |
3013439
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$23.68 |
| Max. Negotiated Rate |
$96.90 |
| Rate for Payer: Aetna Commercial |
$96.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$87.72
|
| Rate for Payer: Cash Price |
$30.60
|
| Rate for Payer: Cash Price |
$30.60
|
| Rate for Payer: Cash Price |
$30.60
|
| Rate for Payer: Cigna Commercial |
$96.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$51.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$61.20
|
| Rate for Payer: Health EOS Commercial |
$92.82
|
| Rate for Payer: HFN Commercial |
$96.90
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$23.68
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$23.68
|
| Rate for Payer: Multiplan Commercial |
$81.60
|
| Rate for Payer: Preferred Network Access Commercial |
$96.90
|
| Rate for Payer: Quartz Beloit One Network |
$44.88
|
| Rate for Payer: Quartz Commercial |
$58.14
|
| Rate for Payer: The Alliance Commercial |
$51.00
|
| Rate for Payer: WEA Trust Commercial |
$56.10
|
| Rate for Payer: WPS Commercial |
$75.55
|
|
|
First Vaccine 90471 - Admin Immunization Charge
|
Facility
|
IP
|
$102.00
|
|
|
Service Code
|
CPT 90471
|
| Hospital Charge Code |
2473258
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$49.98 |
| Max. Negotiated Rate |
$93.84 |
| Rate for Payer: Aetna Commercial |
$91.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$87.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$54.06
|
| Rate for Payer: Cash Price |
$30.60
|
| Rate for Payer: Cigna Commercial |
$93.84
|
| Rate for Payer: Health EOS Commercial |
$90.78
|
| Rate for Payer: HFN Commercial |
$93.84
|
| Rate for Payer: Multiplan Commercial |
$81.60
|
| Rate for Payer: NAPHCARE Commercial |
$61.20
|
| Rate for Payer: Preferred Network Access Commercial |
$93.84
|
| Rate for Payer: Quartz Beloit One Network |
$49.98
|
| Rate for Payer: Quartz Commercial |
$61.20
|
| Rate for Payer: WEA Trust Commercial |
$56.10
|
| Rate for Payer: WPS Commercial |
$75.55
|
|
|
First Vaccine 90471 - Admin Immunization Charge
|
Facility
|
OP
|
$102.00
|
|
|
Service Code
|
CPT 90471
|
| Hospital Charge Code |
2473258
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$48.96 |
| Max. Negotiated Rate |
$278.52 |
| Rate for Payer: Aetna Commercial |
$91.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$87.72
|
| Rate for Payer: Aetna Managed Medicare |
$69.63
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$66.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$51.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$48.96
|
| Rate for Payer: Anthem Medicare Advantage |
$69.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$54.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$69.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$69.63
|
| Rate for Payer: Cash Price |
$30.60
|
| Rate for Payer: Cash Price |
$30.60
|
| Rate for Payer: Cigna Commercial |
$93.84
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$69.63
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$57.08
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$69.63
|
| Rate for Payer: Health EOS Commercial |
$90.78
|
| Rate for Payer: HFN Commercial |
$93.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$259.02
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$69.63
|
| Rate for Payer: Independent Care Health Plan Medicare |
$69.63
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$69.63
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$69.63
|
| Rate for Payer: Multiplan Commercial |
$81.60
|
| Rate for Payer: NAPHCARE Commercial |
$104.44
|
| Rate for Payer: Preferred Network Access Commercial |
$93.84
|
| Rate for Payer: Quartz Beloit One Network |
$49.98
|
| Rate for Payer: Quartz Commercial |
$66.30
|
| Rate for Payer: Quartz Medicare Advantage |
$69.63
|
| Rate for Payer: The Alliance Commercial |
$278.52
|
| Rate for Payer: United Healthcare Medicare Advantage |
$69.63
|
| Rate for Payer: United Healthcare PPO |
$76.50
|
| Rate for Payer: WEA Trust Commercial |
$56.10
|
| Rate for Payer: Wellcare Medicare |
$69.63
|
| Rate for Payer: WPS Commercial |
$75.55
|
|
|
First Vaccine 90471 - Admin Immunization Charge
|
Professional
|
Both
|
$102.00
|
|
|
Service Code
|
CPT 90471
|
| Hospital Charge Code |
2473258
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$23.68 |
| Max. Negotiated Rate |
$96.90 |
| Rate for Payer: Aetna Commercial |
$96.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$87.72
|
| Rate for Payer: Cash Price |
$30.60
|
| Rate for Payer: Cash Price |
$30.60
|
| Rate for Payer: Cash Price |
$30.60
|
| Rate for Payer: Cigna Commercial |
$96.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$51.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$61.20
|
| Rate for Payer: Health EOS Commercial |
$92.82
|
| Rate for Payer: HFN Commercial |
$96.90
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$23.68
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$23.68
|
| Rate for Payer: Multiplan Commercial |
$81.60
|
| Rate for Payer: Preferred Network Access Commercial |
$96.90
|
| Rate for Payer: Quartz Beloit One Network |
$44.88
|
| Rate for Payer: Quartz Commercial |
$58.14
|
| Rate for Payer: The Alliance Commercial |
$51.00
|
| Rate for Payer: WEA Trust Commercial |
$56.10
|
| Rate for Payer: WPS Commercial |
$75.55
|
|
|
First Vaccine 90471 - Pnuemococcal 23, 2 years+
|
Professional
|
Both
|
$97.00
|
|
|
Service Code
|
CPT 90471
|
| Hospital Charge Code |
3013445
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$23.68 |
| Max. Negotiated Rate |
$92.15 |
| Rate for Payer: Aetna Commercial |
$92.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$83.42
|
| Rate for Payer: Cash Price |
$29.10
|
| Rate for Payer: Cash Price |
$29.10
|
| Rate for Payer: Cash Price |
$29.10
|
| Rate for Payer: Cigna Commercial |
$92.15
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$48.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$58.20
|
| Rate for Payer: Health EOS Commercial |
$88.27
|
| Rate for Payer: HFN Commercial |
$92.15
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$23.68
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$23.68
|
| Rate for Payer: Multiplan Commercial |
$77.60
|
| Rate for Payer: Preferred Network Access Commercial |
$92.15
|
| Rate for Payer: Quartz Beloit One Network |
$42.68
|
| Rate for Payer: Quartz Commercial |
$55.29
|
| Rate for Payer: The Alliance Commercial |
$48.50
|
| Rate for Payer: WEA Trust Commercial |
$53.35
|
| Rate for Payer: WPS Commercial |
$71.85
|
|
|
First Vaccine 90471 - Pnuemococcal 23, 2 years+
|
Facility
|
OP
|
$97.00
|
|
|
Service Code
|
CPT 90471
|
| Hospital Charge Code |
3013445
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$46.56 |
| Max. Negotiated Rate |
$278.52 |
| Rate for Payer: Aetna Commercial |
$87.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$83.42
|
| Rate for Payer: Aetna Managed Medicare |
$69.63
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$63.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$48.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$46.56
|
| Rate for Payer: Anthem Medicare Advantage |
$69.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$51.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$69.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$69.63
|
| Rate for Payer: Cash Price |
$29.10
|
| Rate for Payer: Cash Price |
$29.10
|
| Rate for Payer: Cigna Commercial |
$89.24
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$69.63
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$54.28
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$69.63
|
| Rate for Payer: Health EOS Commercial |
$86.33
|
| Rate for Payer: HFN Commercial |
$89.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$259.02
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$69.63
|
| Rate for Payer: Independent Care Health Plan Medicare |
$69.63
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$69.63
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$69.63
|
| Rate for Payer: Multiplan Commercial |
$77.60
|
| Rate for Payer: NAPHCARE Commercial |
$104.44
|
| Rate for Payer: Preferred Network Access Commercial |
$89.24
|
| Rate for Payer: Quartz Beloit One Network |
$47.53
|
| Rate for Payer: Quartz Commercial |
$63.05
|
| Rate for Payer: Quartz Medicare Advantage |
$69.63
|
| Rate for Payer: The Alliance Commercial |
$278.52
|
| Rate for Payer: United Healthcare Medicare Advantage |
$69.63
|
| Rate for Payer: United Healthcare PPO |
$72.75
|
| Rate for Payer: WEA Trust Commercial |
$53.35
|
| Rate for Payer: Wellcare Medicare |
$69.63
|
| Rate for Payer: WPS Commercial |
$71.85
|
|
|
First Vaccine 90471 - Pnuemococcal 23, 2 years+
|
Facility
|
IP
|
$97.00
|
|
|
Service Code
|
CPT 90471
|
| Hospital Charge Code |
3013445
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$47.53 |
| Max. Negotiated Rate |
$89.24 |
| Rate for Payer: Aetna Commercial |
$87.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$83.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$51.41
|
| Rate for Payer: Cash Price |
$29.10
|
| Rate for Payer: Cigna Commercial |
$89.24
|
| Rate for Payer: Health EOS Commercial |
$86.33
|
| Rate for Payer: HFN Commercial |
$89.24
|
| Rate for Payer: Multiplan Commercial |
$77.60
|
| Rate for Payer: NAPHCARE Commercial |
$58.20
|
| Rate for Payer: Preferred Network Access Commercial |
$89.24
|
| Rate for Payer: Quartz Beloit One Network |
$47.53
|
| Rate for Payer: Quartz Commercial |
$58.20
|
| Rate for Payer: WEA Trust Commercial |
$53.35
|
| Rate for Payer: WPS Commercial |
$71.85
|
|
|
FISH, HES/Leukemia, 4q12 Rearrangement
|
Facility
|
IP
|
$655.00
|
|
|
Service Code
|
CPT 88271
|
| Hospital Charge Code |
5455203
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$320.95 |
| Max. Negotiated Rate |
$602.60 |
| Rate for Payer: Aetna Commercial |
$589.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$563.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$347.15
|
| Rate for Payer: Cash Price |
$196.50
|
| Rate for Payer: Cigna Commercial |
$602.60
|
| Rate for Payer: Health EOS Commercial |
$582.95
|
| Rate for Payer: HFN Commercial |
$602.60
|
| Rate for Payer: Multiplan Commercial |
$524.00
|
| Rate for Payer: NAPHCARE Commercial |
$393.00
|
| Rate for Payer: Preferred Network Access Commercial |
$602.60
|
| Rate for Payer: Quartz Beloit One Network |
$320.95
|
| Rate for Payer: Quartz Commercial |
$393.00
|
| Rate for Payer: WEA Trust Commercial |
$360.25
|
| Rate for Payer: WPS Commercial |
$485.16
|
|
|
FISH, HES/Leukemia, 4q12 Rearrangement
|
Facility
|
OP
|
$655.00
|
|
|
Service Code
|
CPT 88271
|
| Hospital Charge Code |
5455203
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$20.36 |
| Max. Negotiated Rate |
$602.60 |
| Rate for Payer: Aetna Commercial |
$589.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$563.30
|
| Rate for Payer: Aetna Managed Medicare |
$21.42
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$80.32
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$37.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$35.56
|
| Rate for Payer: Anthem Medicaid |
$20.36
|
| Rate for Payer: Anthem Medicare Advantage |
$21.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$347.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$21.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$21.42
|
| Rate for Payer: Cash Price |
$196.50
|
| Rate for Payer: Cash Price |
$196.50
|
| Rate for Payer: Cigna Commercial |
$602.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$21.42
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$20.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$366.54
|
| Rate for Payer: Dean Health Medicaid |
$20.36
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$21.42
|
| Rate for Payer: Health EOS Commercial |
$582.95
|
| Rate for Payer: HFN Commercial |
$602.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$79.68
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$21.42
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$20.36
|
| Rate for Payer: Independent Care Health Plan Medicare |
$21.42
|
| Rate for Payer: Managed Health Services Medicaid |
$21.17
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$21.42
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$21.42
|
| Rate for Payer: Multiplan Commercial |
$524.00
|
| Rate for Payer: NAPHCARE Commercial |
$32.13
|
| Rate for Payer: Preferred Network Access Commercial |
$602.60
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$20.36
|
| Rate for Payer: Quartz Beloit One Network |
$320.95
|
| Rate for Payer: Quartz Commercial |
$425.75
|
| Rate for Payer: Quartz Medicare Advantage |
$21.42
|
| Rate for Payer: The Alliance Commercial |
$85.68
|
| Rate for Payer: United Healthcare Medicaid |
$20.36
|
| Rate for Payer: United Healthcare Medicare Advantage |
$21.42
|
| Rate for Payer: United Healthcare PPO |
$491.25
|
| Rate for Payer: WEA Trust Commercial |
$360.25
|
| Rate for Payer: Wellcare Medicare |
$21.42
|
| Rate for Payer: WMAP Medicaid |
$20.36
|
| Rate for Payer: WPS Commercial |
$485.16
|
|
|
FISH, HES/Leukemia, 4q12 Rearrangement
|
Professional
|
Both
|
$655.00
|
|
|
Service Code
|
CPT 88271
|
| Hospital Charge Code |
5455203
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$75.61 |
| Max. Negotiated Rate |
$622.25 |
| Rate for Payer: Aetna Commercial |
$622.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$563.30
|
| Rate for Payer: Cash Price |
$196.50
|
| Rate for Payer: Cash Price |
$196.50
|
| Rate for Payer: Cigna Commercial |
$622.25
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$327.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$393.00
|
| Rate for Payer: Health EOS Commercial |
$596.05
|
| Rate for Payer: HFN Commercial |
$622.25
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$75.61
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$75.61
|
| Rate for Payer: Multiplan Commercial |
$524.00
|
| Rate for Payer: Preferred Network Access Commercial |
$622.25
|
| Rate for Payer: Quartz Beloit One Network |
$288.20
|
| Rate for Payer: Quartz Commercial |
$373.35
|
| Rate for Payer: The Alliance Commercial |
$327.50
|
| Rate for Payer: WEA Trust Commercial |
$360.25
|
| Rate for Payer: WPS Commercial |
$485.16
|
|
|
FISH, IGH/CCND1, t(11;14)
|
Professional
|
Both
|
$1,583.00
|
|
|
Service Code
|
CPT 88275
|
| Hospital Charge Code |
5613542
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$180.70 |
| Max. Negotiated Rate |
$1,503.85 |
| Rate for Payer: Aetna Commercial |
$1,503.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,361.38
|
| Rate for Payer: Cash Price |
$474.90
|
| Rate for Payer: Cash Price |
$474.90
|
| Rate for Payer: Cigna Commercial |
$1,503.85
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$791.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$949.80
|
| Rate for Payer: Health EOS Commercial |
$1,440.53
|
| Rate for Payer: HFN Commercial |
$1,503.85
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$180.70
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$180.70
|
| Rate for Payer: Multiplan Commercial |
$1,266.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,503.85
|
| Rate for Payer: Quartz Beloit One Network |
$696.52
|
| Rate for Payer: Quartz Commercial |
$902.31
|
| Rate for Payer: The Alliance Commercial |
$791.50
|
| Rate for Payer: WEA Trust Commercial |
$870.65
|
| Rate for Payer: WPS Commercial |
$1,172.53
|
|
|
FISH, IGH/CCND1, t(11;14)
|
Facility
|
IP
|
$1,583.00
|
|
|
Service Code
|
CPT 88275
|
| Hospital Charge Code |
5613542
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$775.67 |
| Max. Negotiated Rate |
$1,456.36 |
| Rate for Payer: Aetna Commercial |
$1,424.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,361.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$838.99
|
| Rate for Payer: Cash Price |
$474.90
|
| Rate for Payer: Cigna Commercial |
$1,456.36
|
| Rate for Payer: Health EOS Commercial |
$1,408.87
|
| Rate for Payer: HFN Commercial |
$1,456.36
|
| Rate for Payer: Multiplan Commercial |
$1,266.40
|
| Rate for Payer: NAPHCARE Commercial |
$949.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,456.36
|
| Rate for Payer: Quartz Beloit One Network |
$775.67
|
| Rate for Payer: Quartz Commercial |
$949.80
|
| Rate for Payer: WEA Trust Commercial |
$870.65
|
| Rate for Payer: WPS Commercial |
$1,172.53
|
|
|
FISH, IGH/CCND1, t(11;14)
|
Facility
|
OP
|
$1,583.00
|
|
|
Service Code
|
CPT 88275
|
| Hospital Charge Code |
5613542
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$51.19 |
| Max. Negotiated Rate |
$1,456.36 |
| Rate for Payer: Aetna Commercial |
$1,424.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,361.38
|
| Rate for Payer: Aetna Managed Medicare |
$51.19
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$191.96
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$89.58
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$84.98
|
| Rate for Payer: Anthem Medicaid |
$52.89
|
| Rate for Payer: Anthem Medicare Advantage |
$51.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$838.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$51.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$51.19
|
| Rate for Payer: Cash Price |
$474.90
|
| Rate for Payer: Cash Price |
$474.90
|
| Rate for Payer: Cigna Commercial |
$1,456.36
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$51.19
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$52.89
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$885.85
|
| Rate for Payer: Dean Health Medicaid |
$52.89
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$51.19
|
| Rate for Payer: Health EOS Commercial |
$1,408.87
|
| Rate for Payer: HFN Commercial |
$1,456.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$190.43
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$51.19
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$52.89
|
| Rate for Payer: Independent Care Health Plan Medicare |
$51.19
|
| Rate for Payer: Managed Health Services Medicaid |
$55.01
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$51.19
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$51.19
|
| Rate for Payer: Multiplan Commercial |
$1,266.40
|
| Rate for Payer: NAPHCARE Commercial |
$76.78
|
| Rate for Payer: Preferred Network Access Commercial |
$1,456.36
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$52.89
|
| Rate for Payer: Quartz Beloit One Network |
$775.67
|
| Rate for Payer: Quartz Commercial |
$1,028.95
|
| Rate for Payer: Quartz Medicare Advantage |
$51.19
|
| Rate for Payer: The Alliance Commercial |
$204.76
|
| Rate for Payer: United Healthcare Medicaid |
$52.89
|
| Rate for Payer: United Healthcare Medicare Advantage |
$51.19
|
| Rate for Payer: United Healthcare PPO |
$1,187.25
|
| Rate for Payer: WEA Trust Commercial |
$870.65
|
| Rate for Payer: Wellcare Medicare |
$51.19
|
| Rate for Payer: WMAP Medicaid |
$52.89
|
| Rate for Payer: WPS Commercial |
$1,172.53
|
|
|
FISH, SRY/X 10-30 cells
|
Professional
|
Both
|
$184.00
|
|
|
Service Code
|
CPT 88273
|
| Hospital Charge Code |
4253609
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$80.96 |
| Max. Negotiated Rate |
$174.80 |
| Rate for Payer: Aetna Commercial |
$174.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$158.24
|
| Rate for Payer: Cash Price |
$55.20
|
| Rate for Payer: Cash Price |
$55.20
|
| Rate for Payer: Cigna Commercial |
$174.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$92.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$110.40
|
| Rate for Payer: Health EOS Commercial |
$167.44
|
| Rate for Payer: HFN Commercial |
$174.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$122.88
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$122.88
|
| Rate for Payer: Multiplan Commercial |
$147.20
|
| Rate for Payer: Preferred Network Access Commercial |
$174.80
|
| Rate for Payer: Quartz Beloit One Network |
$80.96
|
| Rate for Payer: Quartz Commercial |
$104.88
|
| Rate for Payer: The Alliance Commercial |
$92.00
|
| Rate for Payer: WEA Trust Commercial |
$101.20
|
| Rate for Payer: WPS Commercial |
$136.29
|
|
|
FISH, SRY/X 10-30 cells
|
Facility
|
OP
|
$184.00
|
|
|
Service Code
|
CPT 88273
|
| Hospital Charge Code |
4253609
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$34.81 |
| Max. Negotiated Rate |
$169.28 |
| Rate for Payer: Aetna Commercial |
$165.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$158.24
|
| Rate for Payer: Aetna Managed Medicare |
$34.81
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$130.54
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$60.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$57.78
|
| Rate for Payer: Anthem Medicaid |
$35.97
|
| Rate for Payer: Anthem Medicare Advantage |
$34.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$97.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$34.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$34.81
|
| Rate for Payer: Cash Price |
$55.20
|
| Rate for Payer: Cash Price |
$55.20
|
| Rate for Payer: Cigna Commercial |
$169.28
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$34.81
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$35.97
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$102.97
|
| Rate for Payer: Dean Health Medicaid |
$35.97
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$34.81
|
| Rate for Payer: Health EOS Commercial |
$163.76
|
| Rate for Payer: HFN Commercial |
$169.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$129.49
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$34.81
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$35.97
|
| Rate for Payer: Independent Care Health Plan Medicare |
$34.81
|
| Rate for Payer: Managed Health Services Medicaid |
$37.41
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$34.81
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$34.81
|
| Rate for Payer: Multiplan Commercial |
$147.20
|
| Rate for Payer: NAPHCARE Commercial |
$52.22
|
| Rate for Payer: Preferred Network Access Commercial |
$169.28
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$35.97
|
| Rate for Payer: Quartz Beloit One Network |
$90.16
|
| Rate for Payer: Quartz Commercial |
$119.60
|
| Rate for Payer: Quartz Medicare Advantage |
$34.81
|
| Rate for Payer: The Alliance Commercial |
$139.24
|
| Rate for Payer: United Healthcare Medicaid |
$35.97
|
| Rate for Payer: United Healthcare Medicare Advantage |
$34.81
|
| Rate for Payer: United Healthcare PPO |
$138.00
|
| Rate for Payer: WEA Trust Commercial |
$101.20
|
| Rate for Payer: Wellcare Medicare |
$34.81
|
| Rate for Payer: WMAP Medicaid |
$35.97
|
| Rate for Payer: WPS Commercial |
$136.29
|
|
|
FISH, SRY/X 10-30 cells
|
Facility
|
IP
|
$184.00
|
|
|
Service Code
|
CPT 88273
|
| Hospital Charge Code |
4253609
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$90.16 |
| Max. Negotiated Rate |
$169.28 |
| Rate for Payer: Aetna Commercial |
$165.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$158.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$97.52
|
| Rate for Payer: Cash Price |
$55.20
|
| Rate for Payer: Cigna Commercial |
$169.28
|
| Rate for Payer: Health EOS Commercial |
$163.76
|
| Rate for Payer: HFN Commercial |
$169.28
|
| Rate for Payer: Multiplan Commercial |
$147.20
|
| Rate for Payer: NAPHCARE Commercial |
$110.40
|
| Rate for Payer: Preferred Network Access Commercial |
$169.28
|
| Rate for Payer: Quartz Beloit One Network |
$90.16
|
| Rate for Payer: Quartz Commercial |
$110.40
|
| Rate for Payer: WEA Trust Commercial |
$101.20
|
| Rate for Payer: WPS Commercial |
$136.29
|
|
|
FISH, SRY/X Centromere
|
Professional
|
Both
|
$216.00
|
|
|
Service Code
|
CPT 88271
|
| Hospital Charge Code |
4253422
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$75.61 |
| Max. Negotiated Rate |
$205.20 |
| Rate for Payer: Aetna Commercial |
$205.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$185.76
|
| Rate for Payer: Cash Price |
$64.80
|
| Rate for Payer: Cash Price |
$64.80
|
| Rate for Payer: Cigna Commercial |
$205.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$108.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$129.60
|
| Rate for Payer: Health EOS Commercial |
$196.56
|
| Rate for Payer: HFN Commercial |
$205.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$75.61
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$75.61
|
| Rate for Payer: Multiplan Commercial |
$172.80
|
| Rate for Payer: Preferred Network Access Commercial |
$205.20
|
| Rate for Payer: Quartz Beloit One Network |
$95.04
|
| Rate for Payer: Quartz Commercial |
$123.12
|
| Rate for Payer: The Alliance Commercial |
$108.00
|
| Rate for Payer: WEA Trust Commercial |
$118.80
|
| Rate for Payer: WPS Commercial |
$159.99
|
|
|
FISH, SRY/X Centromere
|
Facility
|
IP
|
$216.00
|
|
|
Service Code
|
CPT 88271
|
| Hospital Charge Code |
4253422
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$105.84 |
| Max. Negotiated Rate |
$198.72 |
| Rate for Payer: Aetna Commercial |
$194.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$185.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$114.48
|
| Rate for Payer: Cash Price |
$64.80
|
| Rate for Payer: Cigna Commercial |
$198.72
|
| Rate for Payer: Health EOS Commercial |
$192.24
|
| Rate for Payer: HFN Commercial |
$198.72
|
| Rate for Payer: Multiplan Commercial |
$172.80
|
| Rate for Payer: NAPHCARE Commercial |
$129.60
|
| Rate for Payer: Preferred Network Access Commercial |
$198.72
|
| Rate for Payer: Quartz Beloit One Network |
$105.84
|
| Rate for Payer: Quartz Commercial |
$129.60
|
| Rate for Payer: WEA Trust Commercial |
$118.80
|
| Rate for Payer: WPS Commercial |
$159.99
|
|
|
FISH, SRY/X Centromere
|
Facility
|
OP
|
$216.00
|
|
|
Service Code
|
CPT 88271
|
| Hospital Charge Code |
4253422
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$20.36 |
| Max. Negotiated Rate |
$198.72 |
| Rate for Payer: Aetna Commercial |
$194.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$185.76
|
| Rate for Payer: Aetna Managed Medicare |
$21.42
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$80.32
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$37.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$35.56
|
| Rate for Payer: Anthem Medicaid |
$20.36
|
| Rate for Payer: Anthem Medicare Advantage |
$21.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$114.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$21.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$21.42
|
| Rate for Payer: Cash Price |
$64.80
|
| Rate for Payer: Cash Price |
$64.80
|
| Rate for Payer: Cigna Commercial |
$198.72
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$21.42
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$20.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$120.87
|
| Rate for Payer: Dean Health Medicaid |
$20.36
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$21.42
|
| Rate for Payer: Health EOS Commercial |
$192.24
|
| Rate for Payer: HFN Commercial |
$198.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$79.68
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$21.42
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$20.36
|
| Rate for Payer: Independent Care Health Plan Medicare |
$21.42
|
| Rate for Payer: Managed Health Services Medicaid |
$21.17
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$21.42
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$21.42
|
| Rate for Payer: Multiplan Commercial |
$172.80
|
| Rate for Payer: NAPHCARE Commercial |
$32.13
|
| Rate for Payer: Preferred Network Access Commercial |
$198.72
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$20.36
|
| Rate for Payer: Quartz Beloit One Network |
$105.84
|
| Rate for Payer: Quartz Commercial |
$140.40
|
| Rate for Payer: Quartz Medicare Advantage |
$21.42
|
| Rate for Payer: The Alliance Commercial |
$85.68
|
| Rate for Payer: United Healthcare Medicaid |
$20.36
|
| Rate for Payer: United Healthcare Medicare Advantage |
$21.42
|
| Rate for Payer: United Healthcare PPO |
$162.00
|
| Rate for Payer: WEA Trust Commercial |
$118.80
|
| Rate for Payer: Wellcare Medicare |
$21.42
|
| Rate for Payer: WMAP Medicaid |
$20.36
|
| Rate for Payer: WPS Commercial |
$159.99
|
|
|
FISH, SRY/X DNA Probe
|
Professional
|
Both
|
$271.00
|
|
|
Service Code
|
CPT 88271
|
| Hospital Charge Code |
4253608
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$75.61 |
| Max. Negotiated Rate |
$257.45 |
| Rate for Payer: Aetna Commercial |
$257.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$233.06
|
| Rate for Payer: Cash Price |
$81.30
|
| Rate for Payer: Cash Price |
$81.30
|
| Rate for Payer: Cigna Commercial |
$257.45
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$135.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$162.60
|
| Rate for Payer: Health EOS Commercial |
$246.61
|
| Rate for Payer: HFN Commercial |
$257.45
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$75.61
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$75.61
|
| Rate for Payer: Multiplan Commercial |
$216.80
|
| Rate for Payer: Preferred Network Access Commercial |
$257.45
|
| Rate for Payer: Quartz Beloit One Network |
$119.24
|
| Rate for Payer: Quartz Commercial |
$154.47
|
| Rate for Payer: The Alliance Commercial |
$135.50
|
| Rate for Payer: WEA Trust Commercial |
$149.05
|
| Rate for Payer: WPS Commercial |
$200.73
|
|
