|
Gliadin Ab
|
Professional
|
Both
|
$58.00
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
4592875
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.99 |
| Max. Negotiated Rate |
$57.30 |
| Rate for Payer: Aetna Commercial |
$57.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$51.88
|
| Rate for Payer: Aetna Managed Medicare |
$11.99
|
| Rate for Payer: Anthem Medicare Advantage |
$11.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$11.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$11.99
|
| Rate for Payer: Cash Price |
$17.40
|
| Rate for Payer: Cash Price |
$17.40
|
| Rate for Payer: Cigna Commercial |
$57.30
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$30.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$11.99
|
| Rate for Payer: Health EOS Commercial |
$54.89
|
| Rate for Payer: HFN Commercial |
$57.30
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$42.33
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$42.33
|
| Rate for Payer: Independent Care Health Plan Medicare |
$11.99
|
| Rate for Payer: Multiplan Commercial |
$48.26
|
| Rate for Payer: NAPHCARE Commercial |
$17.99
|
| Rate for Payer: Preferred Network Access Commercial |
$57.30
|
| Rate for Payer: Quartz Beloit One Network |
$26.54
|
| Rate for Payer: Quartz Commercial |
$34.38
|
| Rate for Payer: Quartz Medicare Advantage |
$11.99
|
| Rate for Payer: The Alliance Commercial |
$47.37
|
| Rate for Payer: United Healthcare Medicare Advantage |
$11.99
|
| Rate for Payer: WEA Trust Commercial |
$33.18
|
| Rate for Payer: WPS Commercial |
$52.76
|
|
|
Gliadin Ab
|
Facility
|
IP
|
$58.00
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
4592875
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$29.56 |
| Max. Negotiated Rate |
$55.49 |
| Rate for Payer: Aetna Commercial |
$54.29
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$51.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$31.97
|
| Rate for Payer: Cash Price |
$17.40
|
| Rate for Payer: Cigna Commercial |
$55.49
|
| Rate for Payer: Health EOS Commercial |
$53.68
|
| Rate for Payer: HFN Commercial |
$55.49
|
| Rate for Payer: Multiplan Commercial |
$48.26
|
| Rate for Payer: Preferred Network Access Commercial |
$55.49
|
| Rate for Payer: Quartz Beloit One Network |
$29.56
|
| Rate for Payer: Quartz Commercial |
$36.19
|
| Rate for Payer: WEA Trust Commercial |
$33.18
|
| Rate for Payer: WPS Commercial |
$44.68
|
|
|
Gliadin Ab
|
Facility
|
OP
|
$58.00
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
4592875
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.99 |
| Max. Negotiated Rate |
$55.49 |
| Rate for Payer: Aetna Commercial |
$54.29
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$51.88
|
| Rate for Payer: Aetna Managed Medicare |
$11.99
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$44.97
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$20.98
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$19.91
|
| Rate for Payer: Anthem Medicare Advantage |
$11.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$31.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$11.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$11.99
|
| Rate for Payer: Cash Price |
$17.40
|
| Rate for Payer: Cash Price |
$17.40
|
| Rate for Payer: Cigna Commercial |
$55.49
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$11.99
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$33.76
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$11.99
|
| Rate for Payer: Health EOS Commercial |
$53.68
|
| Rate for Payer: HFN Commercial |
$55.49
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$44.61
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$11.99
|
| Rate for Payer: Independent Care Health Plan Medicare |
$11.99
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$11.99
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$11.99
|
| Rate for Payer: Multiplan Commercial |
$48.26
|
| Rate for Payer: NAPHCARE Commercial |
$17.99
|
| Rate for Payer: Preferred Network Access Commercial |
$55.49
|
| Rate for Payer: Quartz Beloit One Network |
$29.56
|
| Rate for Payer: Quartz Commercial |
$39.21
|
| Rate for Payer: Quartz Medicare Advantage |
$11.99
|
| Rate for Payer: The Alliance Commercial |
$47.96
|
| Rate for Payer: United Healthcare Medicare Advantage |
$11.99
|
| Rate for Payer: United Healthcare PPO |
$45.24
|
| Rate for Payer: WEA Trust Commercial |
$33.18
|
| Rate for Payer: Wellcare Medicare |
$11.99
|
| Rate for Payer: WPS Commercial |
$44.68
|
|
|
Gliadin Antibody
|
Facility
|
IP
|
$170.00
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
977955
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$86.63 |
| Max. Negotiated Rate |
$162.66 |
| Rate for Payer: Aetna Commercial |
$159.12
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$152.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$93.70
|
| Rate for Payer: Cash Price |
$51.00
|
| Rate for Payer: Cigna Commercial |
$162.66
|
| Rate for Payer: Health EOS Commercial |
$157.35
|
| Rate for Payer: HFN Commercial |
$162.66
|
| Rate for Payer: Multiplan Commercial |
$141.44
|
| Rate for Payer: Preferred Network Access Commercial |
$162.66
|
| Rate for Payer: Quartz Beloit One Network |
$86.63
|
| Rate for Payer: Quartz Commercial |
$106.08
|
| Rate for Payer: WEA Trust Commercial |
$97.24
|
| Rate for Payer: WPS Commercial |
$130.95
|
|
|
Gliadin Antibody
|
Facility
|
OP
|
$170.00
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
977955
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.99 |
| Max. Negotiated Rate |
$162.66 |
| Rate for Payer: Aetna Commercial |
$159.12
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$152.05
|
| Rate for Payer: Aetna Managed Medicare |
$11.99
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$44.97
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$20.98
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$19.91
|
| Rate for Payer: Anthem Medicare Advantage |
$11.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$93.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$11.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$11.99
|
| Rate for Payer: Cash Price |
$51.00
|
| Rate for Payer: Cash Price |
$51.00
|
| Rate for Payer: Cigna Commercial |
$162.66
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$11.99
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$98.94
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$11.99
|
| Rate for Payer: Health EOS Commercial |
$157.35
|
| Rate for Payer: HFN Commercial |
$162.66
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$44.61
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$11.99
|
| Rate for Payer: Independent Care Health Plan Medicare |
$11.99
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$11.99
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$11.99
|
| Rate for Payer: Multiplan Commercial |
$141.44
|
| Rate for Payer: NAPHCARE Commercial |
$17.99
|
| Rate for Payer: Preferred Network Access Commercial |
$162.66
|
| Rate for Payer: Quartz Beloit One Network |
$86.63
|
| Rate for Payer: Quartz Commercial |
$114.92
|
| Rate for Payer: Quartz Medicare Advantage |
$11.99
|
| Rate for Payer: The Alliance Commercial |
$47.96
|
| Rate for Payer: United Healthcare Medicare Advantage |
$11.99
|
| Rate for Payer: United Healthcare PPO |
$132.60
|
| Rate for Payer: WEA Trust Commercial |
$97.24
|
| Rate for Payer: Wellcare Medicare |
$11.99
|
| Rate for Payer: WPS Commercial |
$130.95
|
|
|
Gliadin Antibody
|
Professional
|
Both
|
$170.00
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
977955
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.99 |
| Max. Negotiated Rate |
$167.96 |
| Rate for Payer: Aetna Commercial |
$167.96
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$152.05
|
| Rate for Payer: Aetna Managed Medicare |
$11.99
|
| Rate for Payer: Anthem Medicare Advantage |
$11.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$11.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$11.99
|
| Rate for Payer: Cash Price |
$51.00
|
| Rate for Payer: Cash Price |
$51.00
|
| Rate for Payer: Cigna Commercial |
$167.96
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$88.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$11.99
|
| Rate for Payer: Health EOS Commercial |
$160.89
|
| Rate for Payer: HFN Commercial |
$167.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$42.33
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$42.33
|
| Rate for Payer: Independent Care Health Plan Medicare |
$11.99
|
| Rate for Payer: Multiplan Commercial |
$141.44
|
| Rate for Payer: NAPHCARE Commercial |
$17.99
|
| Rate for Payer: Preferred Network Access Commercial |
$167.96
|
| Rate for Payer: Quartz Beloit One Network |
$77.79
|
| Rate for Payer: Quartz Commercial |
$100.78
|
| Rate for Payer: Quartz Medicare Advantage |
$11.99
|
| Rate for Payer: The Alliance Commercial |
$47.37
|
| Rate for Payer: United Healthcare Medicare Advantage |
$11.99
|
| Rate for Payer: WEA Trust Commercial |
$97.24
|
| Rate for Payer: WPS Commercial |
$52.76
|
|
|
Gliadin Antibody IgG
|
Facility
|
IP
|
$21.00
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
5156617
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.70 |
| Max. Negotiated Rate |
$20.09 |
| Rate for Payer: Aetna Commercial |
$19.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$18.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$11.58
|
| Rate for Payer: Cash Price |
$6.30
|
| Rate for Payer: Cigna Commercial |
$20.09
|
| Rate for Payer: Health EOS Commercial |
$19.44
|
| Rate for Payer: HFN Commercial |
$20.09
|
| Rate for Payer: Multiplan Commercial |
$17.47
|
| Rate for Payer: Preferred Network Access Commercial |
$20.09
|
| Rate for Payer: Quartz Beloit One Network |
$10.70
|
| Rate for Payer: Quartz Commercial |
$13.10
|
| Rate for Payer: WEA Trust Commercial |
$12.01
|
| Rate for Payer: WPS Commercial |
$16.18
|
|
|
Gliadin Antibody IgG
|
Facility
|
OP
|
$21.00
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
5156617
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.70 |
| Max. Negotiated Rate |
$47.96 |
| Rate for Payer: Aetna Commercial |
$19.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$18.78
|
| Rate for Payer: Aetna Managed Medicare |
$11.99
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$44.97
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$20.98
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$19.91
|
| Rate for Payer: Anthem Medicare Advantage |
$11.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$11.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$11.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$11.99
|
| Rate for Payer: Cash Price |
$6.30
|
| Rate for Payer: Cash Price |
$6.30
|
| Rate for Payer: Cigna Commercial |
$20.09
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$11.99
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12.22
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$11.99
|
| Rate for Payer: Health EOS Commercial |
$19.44
|
| Rate for Payer: HFN Commercial |
$20.09
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$44.61
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$11.99
|
| Rate for Payer: Independent Care Health Plan Medicare |
$11.99
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$11.99
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$11.99
|
| Rate for Payer: Multiplan Commercial |
$17.47
|
| Rate for Payer: NAPHCARE Commercial |
$17.99
|
| Rate for Payer: Preferred Network Access Commercial |
$20.09
|
| Rate for Payer: Quartz Beloit One Network |
$10.70
|
| Rate for Payer: Quartz Commercial |
$14.20
|
| Rate for Payer: Quartz Medicare Advantage |
$11.99
|
| Rate for Payer: The Alliance Commercial |
$47.96
|
| Rate for Payer: United Healthcare Medicare Advantage |
$11.99
|
| Rate for Payer: United Healthcare PPO |
$16.38
|
| Rate for Payer: WEA Trust Commercial |
$12.01
|
| Rate for Payer: Wellcare Medicare |
$11.99
|
| Rate for Payer: WPS Commercial |
$16.18
|
|
|
Gliadin Antibody IgG
|
Professional
|
Both
|
$21.00
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
5156617
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.61 |
| Max. Negotiated Rate |
$52.76 |
| Rate for Payer: Aetna Commercial |
$20.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$18.78
|
| Rate for Payer: Aetna Managed Medicare |
$11.99
|
| Rate for Payer: Anthem Medicare Advantage |
$11.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$11.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$11.99
|
| Rate for Payer: Cash Price |
$6.30
|
| Rate for Payer: Cash Price |
$6.30
|
| Rate for Payer: Cigna Commercial |
$20.75
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$10.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$11.99
|
| Rate for Payer: Health EOS Commercial |
$19.87
|
| Rate for Payer: HFN Commercial |
$20.75
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$42.33
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$42.33
|
| Rate for Payer: Independent Care Health Plan Medicare |
$11.99
|
| Rate for Payer: Multiplan Commercial |
$17.47
|
| Rate for Payer: NAPHCARE Commercial |
$17.99
|
| Rate for Payer: Preferred Network Access Commercial |
$20.75
|
| Rate for Payer: Quartz Beloit One Network |
$9.61
|
| Rate for Payer: Quartz Commercial |
$12.45
|
| Rate for Payer: Quartz Medicare Advantage |
$11.99
|
| Rate for Payer: The Alliance Commercial |
$47.37
|
| Rate for Payer: United Healthcare Medicare Advantage |
$11.99
|
| Rate for Payer: WEA Trust Commercial |
$12.01
|
| Rate for Payer: WPS Commercial |
$52.76
|
|
|
Gliadin IgA Antibody
|
Facility
|
IP
|
$177.00
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
2942878
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$90.20 |
| Max. Negotiated Rate |
$169.35 |
| Rate for Payer: Aetna Commercial |
$165.67
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$158.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$97.56
|
| Rate for Payer: Cash Price |
$53.10
|
| Rate for Payer: Cigna Commercial |
$169.35
|
| Rate for Payer: Health EOS Commercial |
$163.83
|
| Rate for Payer: HFN Commercial |
$169.35
|
| Rate for Payer: Multiplan Commercial |
$147.26
|
| Rate for Payer: Preferred Network Access Commercial |
$169.35
|
| Rate for Payer: Quartz Beloit One Network |
$90.20
|
| Rate for Payer: Quartz Commercial |
$110.45
|
| Rate for Payer: WEA Trust Commercial |
$101.24
|
| Rate for Payer: WPS Commercial |
$136.34
|
|
|
Gliadin IgA Antibody
|
Professional
|
Both
|
$177.00
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
2942878
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.99 |
| Max. Negotiated Rate |
$174.88 |
| Rate for Payer: Aetna Commercial |
$174.88
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$158.31
|
| Rate for Payer: Aetna Managed Medicare |
$11.99
|
| Rate for Payer: Anthem Medicare Advantage |
$11.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$11.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$11.99
|
| Rate for Payer: Cash Price |
$53.10
|
| Rate for Payer: Cash Price |
$53.10
|
| Rate for Payer: Cigna Commercial |
$174.88
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$92.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$11.99
|
| Rate for Payer: Health EOS Commercial |
$167.51
|
| Rate for Payer: HFN Commercial |
$174.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$42.33
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$42.33
|
| Rate for Payer: Independent Care Health Plan Medicare |
$11.99
|
| Rate for Payer: Multiplan Commercial |
$147.26
|
| Rate for Payer: NAPHCARE Commercial |
$17.99
|
| Rate for Payer: Preferred Network Access Commercial |
$174.88
|
| Rate for Payer: Quartz Beloit One Network |
$81.00
|
| Rate for Payer: Quartz Commercial |
$104.93
|
| Rate for Payer: Quartz Medicare Advantage |
$11.99
|
| Rate for Payer: The Alliance Commercial |
$47.37
|
| Rate for Payer: United Healthcare Medicare Advantage |
$11.99
|
| Rate for Payer: WEA Trust Commercial |
$101.24
|
| Rate for Payer: WPS Commercial |
$52.76
|
|
|
Gliadin IgA Antibody
|
Facility
|
OP
|
$177.00
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
2942878
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.99 |
| Max. Negotiated Rate |
$169.35 |
| Rate for Payer: Aetna Commercial |
$165.67
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$158.31
|
| Rate for Payer: Aetna Managed Medicare |
$11.99
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$44.97
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$20.98
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$19.91
|
| Rate for Payer: Anthem Medicare Advantage |
$11.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$97.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$11.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$11.99
|
| Rate for Payer: Cash Price |
$53.10
|
| Rate for Payer: Cash Price |
$53.10
|
| Rate for Payer: Cigna Commercial |
$169.35
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$11.99
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$103.01
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$11.99
|
| Rate for Payer: Health EOS Commercial |
$163.83
|
| Rate for Payer: HFN Commercial |
$169.35
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$44.61
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$11.99
|
| Rate for Payer: Independent Care Health Plan Medicare |
$11.99
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$11.99
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$11.99
|
| Rate for Payer: Multiplan Commercial |
$147.26
|
| Rate for Payer: NAPHCARE Commercial |
$17.99
|
| Rate for Payer: Preferred Network Access Commercial |
$169.35
|
| Rate for Payer: Quartz Beloit One Network |
$90.20
|
| Rate for Payer: Quartz Commercial |
$119.65
|
| Rate for Payer: Quartz Medicare Advantage |
$11.99
|
| Rate for Payer: The Alliance Commercial |
$47.96
|
| Rate for Payer: United Healthcare Medicare Advantage |
$11.99
|
| Rate for Payer: United Healthcare PPO |
$138.06
|
| Rate for Payer: WEA Trust Commercial |
$101.24
|
| Rate for Payer: Wellcare Medicare |
$11.99
|
| Rate for Payer: WPS Commercial |
$136.34
|
|
|
Gliadin IgG Antibody
|
Facility
|
IP
|
$177.00
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
2942901
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$90.20 |
| Max. Negotiated Rate |
$169.35 |
| Rate for Payer: Aetna Commercial |
$165.67
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$158.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$97.56
|
| Rate for Payer: Cash Price |
$53.10
|
| Rate for Payer: Cigna Commercial |
$169.35
|
| Rate for Payer: Health EOS Commercial |
$163.83
|
| Rate for Payer: HFN Commercial |
$169.35
|
| Rate for Payer: Multiplan Commercial |
$147.26
|
| Rate for Payer: Preferred Network Access Commercial |
$169.35
|
| Rate for Payer: Quartz Beloit One Network |
$90.20
|
| Rate for Payer: Quartz Commercial |
$110.45
|
| Rate for Payer: WEA Trust Commercial |
$101.24
|
| Rate for Payer: WPS Commercial |
$136.34
|
|
|
Gliadin IgG Antibody
|
Professional
|
Both
|
$177.00
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
2942901
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.99 |
| Max. Negotiated Rate |
$174.88 |
| Rate for Payer: Aetna Commercial |
$174.88
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$158.31
|
| Rate for Payer: Aetna Managed Medicare |
$11.99
|
| Rate for Payer: Anthem Medicare Advantage |
$11.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$11.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$11.99
|
| Rate for Payer: Cash Price |
$53.10
|
| Rate for Payer: Cash Price |
$53.10
|
| Rate for Payer: Cigna Commercial |
$174.88
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$92.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$11.99
|
| Rate for Payer: Health EOS Commercial |
$167.51
|
| Rate for Payer: HFN Commercial |
$174.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$42.33
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$42.33
|
| Rate for Payer: Independent Care Health Plan Medicare |
$11.99
|
| Rate for Payer: Multiplan Commercial |
$147.26
|
| Rate for Payer: NAPHCARE Commercial |
$17.99
|
| Rate for Payer: Preferred Network Access Commercial |
$174.88
|
| Rate for Payer: Quartz Beloit One Network |
$81.00
|
| Rate for Payer: Quartz Commercial |
$104.93
|
| Rate for Payer: Quartz Medicare Advantage |
$11.99
|
| Rate for Payer: The Alliance Commercial |
$47.37
|
| Rate for Payer: United Healthcare Medicare Advantage |
$11.99
|
| Rate for Payer: WEA Trust Commercial |
$101.24
|
| Rate for Payer: WPS Commercial |
$52.76
|
|
|
Gliadin IgG Antibody
|
Facility
|
OP
|
$177.00
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
2942901
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.99 |
| Max. Negotiated Rate |
$169.35 |
| Rate for Payer: Aetna Commercial |
$165.67
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$158.31
|
| Rate for Payer: Aetna Managed Medicare |
$11.99
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$44.97
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$20.98
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$19.91
|
| Rate for Payer: Anthem Medicare Advantage |
$11.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$97.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$11.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$11.99
|
| Rate for Payer: Cash Price |
$53.10
|
| Rate for Payer: Cash Price |
$53.10
|
| Rate for Payer: Cigna Commercial |
$169.35
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$11.99
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$103.01
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$11.99
|
| Rate for Payer: Health EOS Commercial |
$163.83
|
| Rate for Payer: HFN Commercial |
$169.35
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$44.61
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$11.99
|
| Rate for Payer: Independent Care Health Plan Medicare |
$11.99
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$11.99
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$11.99
|
| Rate for Payer: Multiplan Commercial |
$147.26
|
| Rate for Payer: NAPHCARE Commercial |
$17.99
|
| Rate for Payer: Preferred Network Access Commercial |
$169.35
|
| Rate for Payer: Quartz Beloit One Network |
$90.20
|
| Rate for Payer: Quartz Commercial |
$119.65
|
| Rate for Payer: Quartz Medicare Advantage |
$11.99
|
| Rate for Payer: The Alliance Commercial |
$47.96
|
| Rate for Payer: United Healthcare Medicare Advantage |
$11.99
|
| Rate for Payer: United Healthcare PPO |
$138.06
|
| Rate for Payer: WEA Trust Commercial |
$101.24
|
| Rate for Payer: Wellcare Medicare |
$11.99
|
| Rate for Payer: WPS Commercial |
$136.34
|
|
|
GLIDE .035 150cm STIFF SHAFT
|
Facility
|
OP
|
$922.00
|
|
| Hospital Charge Code |
2973281
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$268.49 |
| Max. Negotiated Rate |
$882.17 |
| Rate for Payer: Aetna Commercial |
$862.99
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$824.64
|
| Rate for Payer: Aetna Managed Medicare |
$268.49
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$623.27
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$479.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$460.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$508.21
|
| Rate for Payer: Cash Price |
$276.60
|
| Rate for Payer: Cigna Commercial |
$882.17
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$536.60
|
| Rate for Payer: Health EOS Commercial |
$853.40
|
| Rate for Payer: HFN Commercial |
$882.17
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$719.16
|
| Rate for Payer: Multiplan Commercial |
$767.10
|
| Rate for Payer: NAPHCARE Commercial |
$575.33
|
| Rate for Payer: Preferred Network Access Commercial |
$882.17
|
| Rate for Payer: Quartz Beloit One Network |
$469.85
|
| Rate for Payer: Quartz Commercial |
$623.27
|
| Rate for Payer: Quartz Medicare Advantage |
$575.33
|
| Rate for Payer: The Alliance Commercial |
$479.44
|
| Rate for Payer: WEA Trust Commercial |
$527.38
|
| Rate for Payer: WPS Commercial |
$710.22
|
|
|
GLIDE .035 150cm STIFF SHAFT
|
Facility
|
IP
|
$922.00
|
|
| Hospital Charge Code |
2973281
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$469.85 |
| Max. Negotiated Rate |
$882.17 |
| Rate for Payer: Aetna Commercial |
$862.99
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$824.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$508.21
|
| Rate for Payer: Cash Price |
$276.60
|
| Rate for Payer: Cigna Commercial |
$882.17
|
| Rate for Payer: Health EOS Commercial |
$853.40
|
| Rate for Payer: HFN Commercial |
$882.17
|
| Rate for Payer: Multiplan Commercial |
$767.10
|
| Rate for Payer: Preferred Network Access Commercial |
$882.17
|
| Rate for Payer: Quartz Beloit One Network |
$469.85
|
| Rate for Payer: Quartz Commercial |
$575.33
|
| Rate for Payer: WEA Trust Commercial |
$527.38
|
| Rate for Payer: WPS Commercial |
$710.22
|
|
|
Glidesheath Slender
|
Facility
|
IP
|
$1,280.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
4534607
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$652.29 |
| Max. Negotiated Rate |
$1,224.70 |
| Rate for Payer: Aetna Commercial |
$1,198.08
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,144.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$705.54
|
| Rate for Payer: Cash Price |
$384.00
|
| Rate for Payer: Cigna Commercial |
$1,224.70
|
| Rate for Payer: Health EOS Commercial |
$1,184.77
|
| Rate for Payer: HFN Commercial |
$1,224.70
|
| Rate for Payer: Multiplan Commercial |
$1,064.96
|
| Rate for Payer: Preferred Network Access Commercial |
$1,224.70
|
| Rate for Payer: Quartz Beloit One Network |
$652.29
|
| Rate for Payer: Quartz Commercial |
$798.72
|
| Rate for Payer: WEA Trust Commercial |
$732.16
|
| Rate for Payer: WPS Commercial |
$985.98
|
|
|
Glidesheath Slender
|
Facility
|
OP
|
$1,280.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
4534607
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$372.74 |
| Max. Negotiated Rate |
$1,224.70 |
| Rate for Payer: Aetna Commercial |
$1,198.08
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,144.83
|
| Rate for Payer: Aetna Managed Medicare |
$372.74
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$865.28
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$665.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$638.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$705.54
|
| Rate for Payer: Cash Price |
$384.00
|
| Rate for Payer: Cigna Commercial |
$1,224.70
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$744.96
|
| Rate for Payer: Health EOS Commercial |
$1,184.77
|
| Rate for Payer: HFN Commercial |
$1,224.70
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$998.40
|
| Rate for Payer: Multiplan Commercial |
$1,064.96
|
| Rate for Payer: NAPHCARE Commercial |
$798.72
|
| Rate for Payer: Preferred Network Access Commercial |
$1,224.70
|
| Rate for Payer: Quartz Beloit One Network |
$652.29
|
| Rate for Payer: Quartz Commercial |
$865.28
|
| Rate for Payer: Quartz Medicare Advantage |
$798.72
|
| Rate for Payer: The Alliance Commercial |
$665.60
|
| Rate for Payer: WEA Trust Commercial |
$732.16
|
| Rate for Payer: WPS Commercial |
$985.98
|
|
|
GLIDE SHEET 50 1200LBS 7294"
|
Facility
|
IP
|
$2,524.00
|
|
| Hospital Charge Code |
5563689
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,286.23 |
| Max. Negotiated Rate |
$2,414.96 |
| Rate for Payer: Aetna Commercial |
$2,362.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,257.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,391.23
|
| Rate for Payer: Cash Price |
$757.20
|
| Rate for Payer: Cigna Commercial |
$2,414.96
|
| Rate for Payer: Health EOS Commercial |
$2,336.21
|
| Rate for Payer: HFN Commercial |
$2,414.96
|
| Rate for Payer: Multiplan Commercial |
$2,099.97
|
| Rate for Payer: Preferred Network Access Commercial |
$2,414.96
|
| Rate for Payer: Quartz Beloit One Network |
$1,286.23
|
| Rate for Payer: Quartz Commercial |
$1,574.98
|
| Rate for Payer: WEA Trust Commercial |
$1,443.73
|
| Rate for Payer: WPS Commercial |
$1,944.24
|
|
|
GLIDE SHEET 50 1200LBS 7294"
|
Facility
|
OP
|
$2,524.00
|
|
| Hospital Charge Code |
5563689
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$734.99 |
| Max. Negotiated Rate |
$2,414.96 |
| Rate for Payer: Aetna Commercial |
$2,362.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,257.47
|
| Rate for Payer: Aetna Managed Medicare |
$734.99
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,706.22
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,312.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,259.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,391.23
|
| Rate for Payer: Cash Price |
$757.20
|
| Rate for Payer: Cigna Commercial |
$2,414.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,468.97
|
| Rate for Payer: Health EOS Commercial |
$2,336.21
|
| Rate for Payer: HFN Commercial |
$2,414.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,968.72
|
| Rate for Payer: Multiplan Commercial |
$2,099.97
|
| Rate for Payer: NAPHCARE Commercial |
$1,574.98
|
| Rate for Payer: Preferred Network Access Commercial |
$2,414.96
|
| Rate for Payer: Quartz Beloit One Network |
$1,286.23
|
| Rate for Payer: Quartz Commercial |
$1,706.22
|
| Rate for Payer: Quartz Medicare Advantage |
$1,574.98
|
| Rate for Payer: The Alliance Commercial |
$1,312.48
|
| Rate for Payer: WEA Trust Commercial |
$1,443.73
|
| Rate for Payer: WPS Commercial |
$1,944.24
|
|
|
GLIDEWIRE .018 ANGLED #GR1805
|
Facility
|
IP
|
$1,020.00
|
|
| Hospital Charge Code |
2969702
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$519.79 |
| Max. Negotiated Rate |
$975.94 |
| Rate for Payer: Aetna Commercial |
$954.72
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$912.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$562.22
|
| Rate for Payer: Cash Price |
$306.00
|
| Rate for Payer: Cigna Commercial |
$975.94
|
| Rate for Payer: Health EOS Commercial |
$944.11
|
| Rate for Payer: HFN Commercial |
$975.94
|
| Rate for Payer: Multiplan Commercial |
$848.64
|
| Rate for Payer: Preferred Network Access Commercial |
$975.94
|
| Rate for Payer: Quartz Beloit One Network |
$519.79
|
| Rate for Payer: Quartz Commercial |
$636.48
|
| Rate for Payer: WEA Trust Commercial |
$583.44
|
| Rate for Payer: WPS Commercial |
$785.71
|
|
|
GLIDEWIRE .018 ANGLED #GR1805
|
Facility
|
OP
|
$1,020.00
|
|
| Hospital Charge Code |
2969702
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$297.02 |
| Max. Negotiated Rate |
$975.94 |
| Rate for Payer: Aetna Commercial |
$954.72
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$912.29
|
| Rate for Payer: Aetna Managed Medicare |
$297.02
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$689.52
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$530.40
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$509.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$562.22
|
| Rate for Payer: Cash Price |
$306.00
|
| Rate for Payer: Cigna Commercial |
$975.94
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$593.64
|
| Rate for Payer: Health EOS Commercial |
$944.11
|
| Rate for Payer: HFN Commercial |
$975.94
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$795.60
|
| Rate for Payer: Multiplan Commercial |
$848.64
|
| Rate for Payer: NAPHCARE Commercial |
$636.48
|
| Rate for Payer: Preferred Network Access Commercial |
$975.94
|
| Rate for Payer: Quartz Beloit One Network |
$519.79
|
| Rate for Payer: Quartz Commercial |
$689.52
|
| Rate for Payer: Quartz Medicare Advantage |
$636.48
|
| Rate for Payer: The Alliance Commercial |
$530.40
|
| Rate for Payer: WEA Trust Commercial |
$583.44
|
| Rate for Payer: WPS Commercial |
$785.71
|
|
|
GLIDEWIRE .025 NITINOL G30477
|
Facility
|
IP
|
$1,034.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
2965534
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$526.93 |
| Max. Negotiated Rate |
$989.33 |
| Rate for Payer: Aetna Commercial |
$967.82
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$924.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$569.94
|
| Rate for Payer: Cash Price |
$310.20
|
| Rate for Payer: Cigna Commercial |
$989.33
|
| Rate for Payer: Health EOS Commercial |
$957.07
|
| Rate for Payer: HFN Commercial |
$989.33
|
| Rate for Payer: Multiplan Commercial |
$860.29
|
| Rate for Payer: Preferred Network Access Commercial |
$989.33
|
| Rate for Payer: Quartz Beloit One Network |
$526.93
|
| Rate for Payer: Quartz Commercial |
$645.22
|
| Rate for Payer: WEA Trust Commercial |
$591.45
|
| Rate for Payer: WPS Commercial |
$796.49
|
|
|
GLIDEWIRE .025 NITINOL G30477
|
Facility
|
OP
|
$1,034.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
2965534
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$301.10 |
| Max. Negotiated Rate |
$989.33 |
| Rate for Payer: Aetna Commercial |
$967.82
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$924.81
|
| Rate for Payer: Aetna Managed Medicare |
$301.10
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$698.98
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$537.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$516.17
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$569.94
|
| Rate for Payer: Cash Price |
$310.20
|
| Rate for Payer: Cigna Commercial |
$989.33
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$601.79
|
| Rate for Payer: Health EOS Commercial |
$957.07
|
| Rate for Payer: HFN Commercial |
$989.33
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$806.52
|
| Rate for Payer: Multiplan Commercial |
$860.29
|
| Rate for Payer: NAPHCARE Commercial |
$645.22
|
| Rate for Payer: Preferred Network Access Commercial |
$989.33
|
| Rate for Payer: Quartz Beloit One Network |
$526.93
|
| Rate for Payer: Quartz Commercial |
$698.98
|
| Rate for Payer: Quartz Medicare Advantage |
$645.22
|
| Rate for Payer: The Alliance Commercial |
$537.68
|
| Rate for Payer: WEA Trust Commercial |
$591.45
|
| Rate for Payer: WPS Commercial |
$796.49
|
|
