|
HLA B-27 Antigen
|
Facility
|
OP
|
$655.00
|
|
|
Service Code
|
CPT 86812
|
| Hospital Charge Code |
1039190
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$26.84 |
| Max. Negotiated Rate |
$626.70 |
| Rate for Payer: Aetna Commercial |
$613.08
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$585.83
|
| Rate for Payer: Aetna Managed Medicare |
$26.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$100.66
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$46.97
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$44.56
|
| Rate for Payer: Anthem Medicare Advantage |
$26.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$361.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$26.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$26.84
|
| Rate for Payer: Cash Price |
$196.50
|
| Rate for Payer: Cash Price |
$196.50
|
| Rate for Payer: Cigna Commercial |
$626.70
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$26.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$381.21
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$26.84
|
| Rate for Payer: Health EOS Commercial |
$606.27
|
| Rate for Payer: HFN Commercial |
$626.70
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$99.85
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$26.84
|
| Rate for Payer: Independent Care Health Plan Medicare |
$26.84
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$26.84
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$26.84
|
| Rate for Payer: Multiplan Commercial |
$544.96
|
| Rate for Payer: NAPHCARE Commercial |
$40.26
|
| Rate for Payer: Preferred Network Access Commercial |
$626.70
|
| Rate for Payer: Quartz Beloit One Network |
$333.79
|
| Rate for Payer: Quartz Commercial |
$442.78
|
| Rate for Payer: Quartz Medicare Advantage |
$26.84
|
| Rate for Payer: The Alliance Commercial |
$107.37
|
| Rate for Payer: United Healthcare Medicare Advantage |
$26.84
|
| Rate for Payer: United Healthcare PPO |
$510.90
|
| Rate for Payer: WEA Trust Commercial |
$374.66
|
| Rate for Payer: Wellcare Medicare |
$26.84
|
| Rate for Payer: WPS Commercial |
$504.55
|
|
|
HLA B-27 Antigen
|
Professional
|
Both
|
$655.00
|
|
|
Service Code
|
CPT 86812
|
| Hospital Charge Code |
1039190
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$26.84 |
| Max. Negotiated Rate |
$647.14 |
| Rate for Payer: Aetna Commercial |
$647.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$585.83
|
| Rate for Payer: Aetna Managed Medicare |
$26.84
|
| Rate for Payer: Anthem Medicare Advantage |
$26.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$26.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$26.84
|
| Rate for Payer: Cash Price |
$196.50
|
| Rate for Payer: Cash Price |
$196.50
|
| Rate for Payer: Cigna Commercial |
$647.14
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$340.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$26.84
|
| Rate for Payer: Health EOS Commercial |
$619.89
|
| Rate for Payer: HFN Commercial |
$647.14
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$94.75
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$94.75
|
| Rate for Payer: Independent Care Health Plan Medicare |
$26.84
|
| Rate for Payer: Multiplan Commercial |
$544.96
|
| Rate for Payer: NAPHCARE Commercial |
$40.26
|
| Rate for Payer: Preferred Network Access Commercial |
$647.14
|
| Rate for Payer: Quartz Beloit One Network |
$299.73
|
| Rate for Payer: Quartz Commercial |
$388.28
|
| Rate for Payer: Quartz Medicare Advantage |
$26.84
|
| Rate for Payer: The Alliance Commercial |
$106.03
|
| Rate for Payer: United Healthcare Medicare Advantage |
$26.84
|
| Rate for Payer: WEA Trust Commercial |
$374.66
|
| Rate for Payer: WPS Commercial |
$118.11
|
|
|
HLA B-51 DNA Typing
|
Professional
|
Both
|
$619.00
|
|
|
Service Code
|
CPT 81381
|
| Hospital Charge Code |
1039194
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$176.70 |
| Max. Negotiated Rate |
$777.46 |
| Rate for Payer: Aetna Commercial |
$611.57
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$553.63
|
| Rate for Payer: Aetna Managed Medicare |
$176.70
|
| Rate for Payer: Anthem Medicare Advantage |
$176.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$176.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$176.70
|
| Rate for Payer: Cash Price |
$185.70
|
| Rate for Payer: Cash Price |
$185.70
|
| Rate for Payer: Cigna Commercial |
$611.57
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$321.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$176.70
|
| Rate for Payer: Health EOS Commercial |
$585.82
|
| Rate for Payer: HFN Commercial |
$611.57
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$623.74
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$623.74
|
| Rate for Payer: Independent Care Health Plan Medicare |
$176.70
|
| Rate for Payer: Multiplan Commercial |
$515.01
|
| Rate for Payer: NAPHCARE Commercial |
$265.04
|
| Rate for Payer: Preferred Network Access Commercial |
$611.57
|
| Rate for Payer: Quartz Beloit One Network |
$283.25
|
| Rate for Payer: Quartz Commercial |
$366.94
|
| Rate for Payer: Quartz Medicare Advantage |
$176.70
|
| Rate for Payer: The Alliance Commercial |
$697.95
|
| Rate for Payer: United Healthcare Medicare Advantage |
$176.70
|
| Rate for Payer: WEA Trust Commercial |
$354.07
|
| Rate for Payer: WPS Commercial |
$777.46
|
|
|
HLA B-51 DNA Typing
|
Facility
|
IP
|
$619.00
|
|
|
Service Code
|
CPT 81381
|
| Hospital Charge Code |
1039194
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$315.44 |
| Max. Negotiated Rate |
$592.26 |
| Rate for Payer: Aetna Commercial |
$579.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$553.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$341.19
|
| Rate for Payer: Cash Price |
$185.70
|
| Rate for Payer: Cigna Commercial |
$592.26
|
| Rate for Payer: Health EOS Commercial |
$572.95
|
| Rate for Payer: HFN Commercial |
$592.26
|
| Rate for Payer: Multiplan Commercial |
$515.01
|
| Rate for Payer: Preferred Network Access Commercial |
$592.26
|
| Rate for Payer: Quartz Beloit One Network |
$315.44
|
| Rate for Payer: Quartz Commercial |
$386.26
|
| Rate for Payer: WEA Trust Commercial |
$354.07
|
| Rate for Payer: WPS Commercial |
$476.82
|
|
|
HLA B-51 DNA Typing
|
Facility
|
OP
|
$619.00
|
|
|
Service Code
|
CPT 81381
|
| Hospital Charge Code |
1039194
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$176.70 |
| Max. Negotiated Rate |
$706.78 |
| Rate for Payer: Aetna Commercial |
$579.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$553.63
|
| Rate for Payer: Aetna Managed Medicare |
$176.70
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$662.61
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$309.22
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$293.32
|
| Rate for Payer: Anthem Medicare Advantage |
$176.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$341.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$176.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$176.70
|
| Rate for Payer: Cash Price |
$185.70
|
| Rate for Payer: Cash Price |
$185.70
|
| Rate for Payer: Cigna Commercial |
$592.26
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$176.70
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$360.26
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$176.70
|
| Rate for Payer: Health EOS Commercial |
$572.95
|
| Rate for Payer: HFN Commercial |
$592.26
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$657.31
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$176.70
|
| Rate for Payer: Independent Care Health Plan Medicare |
$176.70
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$176.70
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$176.70
|
| Rate for Payer: Multiplan Commercial |
$515.01
|
| Rate for Payer: NAPHCARE Commercial |
$265.04
|
| Rate for Payer: Preferred Network Access Commercial |
$592.26
|
| Rate for Payer: Quartz Beloit One Network |
$315.44
|
| Rate for Payer: Quartz Commercial |
$418.44
|
| Rate for Payer: Quartz Medicare Advantage |
$176.70
|
| Rate for Payer: The Alliance Commercial |
$706.78
|
| Rate for Payer: United Healthcare Medicare Advantage |
$176.70
|
| Rate for Payer: United Healthcare PPO |
$482.82
|
| Rate for Payer: WEA Trust Commercial |
$354.07
|
| Rate for Payer: Wellcare Medicare |
$176.70
|
| Rate for Payer: WPS Commercial |
$476.82
|
|
|
HLA B 5701 Typing
|
Facility
|
OP
|
$333.00
|
|
|
Service Code
|
CPT 81381
|
| Hospital Charge Code |
4532697
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$169.70 |
| Max. Negotiated Rate |
$706.78 |
| Rate for Payer: Aetna Commercial |
$311.69
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$297.84
|
| Rate for Payer: Aetna Managed Medicare |
$176.70
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$662.61
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$309.22
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$293.32
|
| Rate for Payer: Anthem Medicare Advantage |
$176.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$183.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$176.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$176.70
|
| Rate for Payer: Cash Price |
$99.90
|
| Rate for Payer: Cash Price |
$99.90
|
| Rate for Payer: Cigna Commercial |
$318.61
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$176.70
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$193.81
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$176.70
|
| Rate for Payer: Health EOS Commercial |
$308.22
|
| Rate for Payer: HFN Commercial |
$318.61
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$657.31
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$176.70
|
| Rate for Payer: Independent Care Health Plan Medicare |
$176.70
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$176.70
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$176.70
|
| Rate for Payer: Multiplan Commercial |
$277.06
|
| Rate for Payer: NAPHCARE Commercial |
$265.04
|
| Rate for Payer: Preferred Network Access Commercial |
$318.61
|
| Rate for Payer: Quartz Beloit One Network |
$169.70
|
| Rate for Payer: Quartz Commercial |
$225.11
|
| Rate for Payer: Quartz Medicare Advantage |
$176.70
|
| Rate for Payer: The Alliance Commercial |
$706.78
|
| Rate for Payer: United Healthcare Medicare Advantage |
$176.70
|
| Rate for Payer: United Healthcare PPO |
$259.74
|
| Rate for Payer: WEA Trust Commercial |
$190.48
|
| Rate for Payer: Wellcare Medicare |
$176.70
|
| Rate for Payer: WPS Commercial |
$256.51
|
|
|
HLA B 5701 Typing
|
Facility
|
IP
|
$333.00
|
|
|
Service Code
|
CPT 81381
|
| Hospital Charge Code |
4532697
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$169.70 |
| Max. Negotiated Rate |
$318.61 |
| Rate for Payer: Aetna Commercial |
$311.69
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$297.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$183.55
|
| Rate for Payer: Cash Price |
$99.90
|
| Rate for Payer: Cigna Commercial |
$318.61
|
| Rate for Payer: Health EOS Commercial |
$308.22
|
| Rate for Payer: HFN Commercial |
$318.61
|
| Rate for Payer: Multiplan Commercial |
$277.06
|
| Rate for Payer: Preferred Network Access Commercial |
$318.61
|
| Rate for Payer: Quartz Beloit One Network |
$169.70
|
| Rate for Payer: Quartz Commercial |
$207.79
|
| Rate for Payer: WEA Trust Commercial |
$190.48
|
| Rate for Payer: WPS Commercial |
$256.51
|
|
|
HLA B 5701 Typing
|
Professional
|
Both
|
$333.00
|
|
|
Service Code
|
CPT 81381
|
| Hospital Charge Code |
4532697
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$152.38 |
| Max. Negotiated Rate |
$777.46 |
| Rate for Payer: Aetna Commercial |
$329.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$297.84
|
| Rate for Payer: Aetna Managed Medicare |
$176.70
|
| Rate for Payer: Anthem Medicare Advantage |
$176.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$176.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$176.70
|
| Rate for Payer: Cash Price |
$99.90
|
| Rate for Payer: Cash Price |
$99.90
|
| Rate for Payer: Cigna Commercial |
$329.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$173.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$176.70
|
| Rate for Payer: Health EOS Commercial |
$315.15
|
| Rate for Payer: HFN Commercial |
$329.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$623.74
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$623.74
|
| Rate for Payer: Independent Care Health Plan Medicare |
$176.70
|
| Rate for Payer: Multiplan Commercial |
$277.06
|
| Rate for Payer: NAPHCARE Commercial |
$265.04
|
| Rate for Payer: Preferred Network Access Commercial |
$329.00
|
| Rate for Payer: Quartz Beloit One Network |
$152.38
|
| Rate for Payer: Quartz Commercial |
$197.40
|
| Rate for Payer: Quartz Medicare Advantage |
$176.70
|
| Rate for Payer: The Alliance Commercial |
$697.95
|
| Rate for Payer: United Healthcare Medicare Advantage |
$176.70
|
| Rate for Payer: WEA Trust Commercial |
$190.48
|
| Rate for Payer: WPS Commercial |
$777.46
|
|
|
HLA B 5801 Genotype
|
Facility
|
OP
|
$744.00
|
|
|
Service Code
|
CPT 81381
|
| Hospital Charge Code |
6174506
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$176.70 |
| Max. Negotiated Rate |
$711.86 |
| Rate for Payer: Aetna Commercial |
$696.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$665.43
|
| Rate for Payer: Aetna Managed Medicare |
$176.70
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$662.61
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$309.22
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$293.32
|
| Rate for Payer: Anthem Medicare Advantage |
$176.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$410.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$176.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$176.70
|
| Rate for Payer: Cash Price |
$223.20
|
| Rate for Payer: Cash Price |
$223.20
|
| Rate for Payer: Cigna Commercial |
$711.86
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$176.70
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$433.01
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$176.70
|
| Rate for Payer: Health EOS Commercial |
$688.65
|
| Rate for Payer: HFN Commercial |
$711.86
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$657.31
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$176.70
|
| Rate for Payer: Independent Care Health Plan Medicare |
$176.70
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$176.70
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$176.70
|
| Rate for Payer: Multiplan Commercial |
$619.01
|
| Rate for Payer: NAPHCARE Commercial |
$265.04
|
| Rate for Payer: Preferred Network Access Commercial |
$711.86
|
| Rate for Payer: Quartz Beloit One Network |
$379.14
|
| Rate for Payer: Quartz Commercial |
$502.94
|
| Rate for Payer: Quartz Medicare Advantage |
$176.70
|
| Rate for Payer: The Alliance Commercial |
$706.78
|
| Rate for Payer: United Healthcare Medicare Advantage |
$176.70
|
| Rate for Payer: United Healthcare PPO |
$580.32
|
| Rate for Payer: WEA Trust Commercial |
$425.57
|
| Rate for Payer: Wellcare Medicare |
$176.70
|
| Rate for Payer: WPS Commercial |
$573.10
|
|
|
HLA B 5801 Genotype
|
Professional
|
Both
|
$744.00
|
|
|
Service Code
|
CPT 81381
|
| Hospital Charge Code |
6174506
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$176.70 |
| Max. Negotiated Rate |
$777.46 |
| Rate for Payer: Aetna Commercial |
$735.07
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$665.43
|
| Rate for Payer: Aetna Managed Medicare |
$176.70
|
| Rate for Payer: Anthem Medicare Advantage |
$176.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$176.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$176.70
|
| Rate for Payer: Cash Price |
$223.20
|
| Rate for Payer: Cash Price |
$223.20
|
| Rate for Payer: Cigna Commercial |
$735.07
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$386.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$176.70
|
| Rate for Payer: Health EOS Commercial |
$704.12
|
| Rate for Payer: HFN Commercial |
$735.07
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$623.74
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$623.74
|
| Rate for Payer: Independent Care Health Plan Medicare |
$176.70
|
| Rate for Payer: Multiplan Commercial |
$619.01
|
| Rate for Payer: NAPHCARE Commercial |
$265.04
|
| Rate for Payer: Preferred Network Access Commercial |
$735.07
|
| Rate for Payer: Quartz Beloit One Network |
$340.45
|
| Rate for Payer: Quartz Commercial |
$441.04
|
| Rate for Payer: Quartz Medicare Advantage |
$176.70
|
| Rate for Payer: The Alliance Commercial |
$697.95
|
| Rate for Payer: United Healthcare Medicare Advantage |
$176.70
|
| Rate for Payer: WEA Trust Commercial |
$425.57
|
| Rate for Payer: WPS Commercial |
$777.46
|
|
|
HLA B 5801 Genotype
|
Facility
|
IP
|
$744.00
|
|
|
Service Code
|
CPT 81381
|
| Hospital Charge Code |
6174506
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$379.14 |
| Max. Negotiated Rate |
$711.86 |
| Rate for Payer: Aetna Commercial |
$696.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$665.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$410.09
|
| Rate for Payer: Cash Price |
$223.20
|
| Rate for Payer: Cigna Commercial |
$711.86
|
| Rate for Payer: Health EOS Commercial |
$688.65
|
| Rate for Payer: HFN Commercial |
$711.86
|
| Rate for Payer: Multiplan Commercial |
$619.01
|
| Rate for Payer: Preferred Network Access Commercial |
$711.86
|
| Rate for Payer: Quartz Beloit One Network |
$379.14
|
| Rate for Payer: Quartz Commercial |
$464.26
|
| Rate for Payer: WEA Trust Commercial |
$425.57
|
| Rate for Payer: WPS Commercial |
$573.10
|
|
|
HLA DQ2
|
Professional
|
Both
|
$102.00
|
|
|
Service Code
|
CPT 81376
|
| Hospital Charge Code |
5438975
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$46.68 |
| Max. Negotiated Rate |
$559.28 |
| Rate for Payer: Aetna Commercial |
$100.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$91.23
|
| Rate for Payer: Aetna Managed Medicare |
$127.11
|
| Rate for Payer: Anthem Medicare Advantage |
$127.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$127.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$127.11
|
| Rate for Payer: Cash Price |
$30.60
|
| Rate for Payer: Cash Price |
$30.60
|
| Rate for Payer: Cigna Commercial |
$100.78
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$53.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$127.11
|
| Rate for Payer: Health EOS Commercial |
$96.53
|
| Rate for Payer: HFN Commercial |
$100.78
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$448.70
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$448.70
|
| Rate for Payer: Independent Care Health Plan Medicare |
$127.11
|
| Rate for Payer: Multiplan Commercial |
$84.86
|
| Rate for Payer: NAPHCARE Commercial |
$190.66
|
| Rate for Payer: Preferred Network Access Commercial |
$100.78
|
| Rate for Payer: Quartz Beloit One Network |
$46.68
|
| Rate for Payer: Quartz Commercial |
$60.47
|
| Rate for Payer: Quartz Medicare Advantage |
$127.11
|
| Rate for Payer: The Alliance Commercial |
$502.08
|
| Rate for Payer: United Healthcare Medicare Advantage |
$127.11
|
| Rate for Payer: WEA Trust Commercial |
$58.34
|
| Rate for Payer: WPS Commercial |
$559.28
|
|
|
HLA DQ2
|
Facility
|
OP
|
$102.00
|
|
|
Service Code
|
CPT 81376
|
| Hospital Charge Code |
5438975
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$51.98 |
| Max. Negotiated Rate |
$508.44 |
| Rate for Payer: Aetna Commercial |
$95.47
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$91.23
|
| Rate for Payer: Aetna Managed Medicare |
$127.11
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$476.66
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$222.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$211.00
|
| Rate for Payer: Anthem Medicare Advantage |
$127.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$56.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$127.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$127.11
|
| Rate for Payer: Cash Price |
$30.60
|
| Rate for Payer: Cash Price |
$30.60
|
| Rate for Payer: Cigna Commercial |
$97.59
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$127.11
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$59.36
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$127.11
|
| Rate for Payer: Health EOS Commercial |
$94.41
|
| Rate for Payer: HFN Commercial |
$97.59
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$472.84
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$127.11
|
| Rate for Payer: Independent Care Health Plan Medicare |
$127.11
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$127.11
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$127.11
|
| Rate for Payer: Multiplan Commercial |
$84.86
|
| Rate for Payer: NAPHCARE Commercial |
$190.66
|
| Rate for Payer: Preferred Network Access Commercial |
$97.59
|
| Rate for Payer: Quartz Beloit One Network |
$51.98
|
| Rate for Payer: Quartz Commercial |
$68.95
|
| Rate for Payer: Quartz Medicare Advantage |
$127.11
|
| Rate for Payer: The Alliance Commercial |
$508.44
|
| Rate for Payer: United Healthcare Medicare Advantage |
$127.11
|
| Rate for Payer: United Healthcare PPO |
$79.56
|
| Rate for Payer: WEA Trust Commercial |
$58.34
|
| Rate for Payer: Wellcare Medicare |
$127.11
|
| Rate for Payer: WPS Commercial |
$78.57
|
|
|
HLA DQ2
|
Facility
|
IP
|
$102.00
|
|
|
Service Code
|
CPT 81376
|
| Hospital Charge Code |
5438975
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$51.98 |
| Max. Negotiated Rate |
$97.59 |
| Rate for Payer: Aetna Commercial |
$95.47
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$91.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$56.22
|
| Rate for Payer: Cash Price |
$30.60
|
| Rate for Payer: Cigna Commercial |
$97.59
|
| Rate for Payer: Health EOS Commercial |
$94.41
|
| Rate for Payer: HFN Commercial |
$97.59
|
| Rate for Payer: Multiplan Commercial |
$84.86
|
| Rate for Payer: Preferred Network Access Commercial |
$97.59
|
| Rate for Payer: Quartz Beloit One Network |
$51.98
|
| Rate for Payer: Quartz Commercial |
$63.65
|
| Rate for Payer: WEA Trust Commercial |
$58.34
|
| Rate for Payer: WPS Commercial |
$78.57
|
|
|
HLA DQA1
|
Facility
|
IP
|
$102.00
|
|
|
Service Code
|
CPT 81376
|
| Hospital Charge Code |
5438974
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$51.98 |
| Max. Negotiated Rate |
$97.59 |
| Rate for Payer: Aetna Commercial |
$95.47
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$91.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$56.22
|
| Rate for Payer: Cash Price |
$30.60
|
| Rate for Payer: Cigna Commercial |
$97.59
|
| Rate for Payer: Health EOS Commercial |
$94.41
|
| Rate for Payer: HFN Commercial |
$97.59
|
| Rate for Payer: Multiplan Commercial |
$84.86
|
| Rate for Payer: Preferred Network Access Commercial |
$97.59
|
| Rate for Payer: Quartz Beloit One Network |
$51.98
|
| Rate for Payer: Quartz Commercial |
$63.65
|
| Rate for Payer: WEA Trust Commercial |
$58.34
|
| Rate for Payer: WPS Commercial |
$78.57
|
|
|
HLA DQA1
|
Professional
|
Both
|
$102.00
|
|
|
Service Code
|
CPT 81376
|
| Hospital Charge Code |
5438974
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$46.68 |
| Max. Negotiated Rate |
$559.28 |
| Rate for Payer: Aetna Commercial |
$100.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$91.23
|
| Rate for Payer: Aetna Managed Medicare |
$127.11
|
| Rate for Payer: Anthem Medicare Advantage |
$127.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$127.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$127.11
|
| Rate for Payer: Cash Price |
$30.60
|
| Rate for Payer: Cash Price |
$30.60
|
| Rate for Payer: Cigna Commercial |
$100.78
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$53.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$127.11
|
| Rate for Payer: Health EOS Commercial |
$96.53
|
| Rate for Payer: HFN Commercial |
$100.78
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$448.70
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$448.70
|
| Rate for Payer: Independent Care Health Plan Medicare |
$127.11
|
| Rate for Payer: Multiplan Commercial |
$84.86
|
| Rate for Payer: NAPHCARE Commercial |
$190.66
|
| Rate for Payer: Preferred Network Access Commercial |
$100.78
|
| Rate for Payer: Quartz Beloit One Network |
$46.68
|
| Rate for Payer: Quartz Commercial |
$60.47
|
| Rate for Payer: Quartz Medicare Advantage |
$127.11
|
| Rate for Payer: The Alliance Commercial |
$502.08
|
| Rate for Payer: United Healthcare Medicare Advantage |
$127.11
|
| Rate for Payer: WEA Trust Commercial |
$58.34
|
| Rate for Payer: WPS Commercial |
$559.28
|
|
|
HLA DQA1
|
Facility
|
OP
|
$102.00
|
|
|
Service Code
|
CPT 81376
|
| Hospital Charge Code |
5438974
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$51.98 |
| Max. Negotiated Rate |
$508.44 |
| Rate for Payer: Aetna Commercial |
$95.47
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$91.23
|
| Rate for Payer: Aetna Managed Medicare |
$127.11
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$476.66
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$222.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$211.00
|
| Rate for Payer: Anthem Medicare Advantage |
$127.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$56.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$127.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$127.11
|
| Rate for Payer: Cash Price |
$30.60
|
| Rate for Payer: Cash Price |
$30.60
|
| Rate for Payer: Cigna Commercial |
$97.59
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$127.11
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$59.36
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$127.11
|
| Rate for Payer: Health EOS Commercial |
$94.41
|
| Rate for Payer: HFN Commercial |
$97.59
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$472.84
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$127.11
|
| Rate for Payer: Independent Care Health Plan Medicare |
$127.11
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$127.11
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$127.11
|
| Rate for Payer: Multiplan Commercial |
$84.86
|
| Rate for Payer: NAPHCARE Commercial |
$190.66
|
| Rate for Payer: Preferred Network Access Commercial |
$97.59
|
| Rate for Payer: Quartz Beloit One Network |
$51.98
|
| Rate for Payer: Quartz Commercial |
$68.95
|
| Rate for Payer: Quartz Medicare Advantage |
$127.11
|
| Rate for Payer: The Alliance Commercial |
$508.44
|
| Rate for Payer: United Healthcare Medicare Advantage |
$127.11
|
| Rate for Payer: United Healthcare PPO |
$79.56
|
| Rate for Payer: WEA Trust Commercial |
$58.34
|
| Rate for Payer: Wellcare Medicare |
$127.11
|
| Rate for Payer: WPS Commercial |
$78.57
|
|
|
HLA DQB1
|
Facility
|
IP
|
$102.00
|
|
|
Service Code
|
CPT 81382
|
| Hospital Charge Code |
5438973
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$51.98 |
| Max. Negotiated Rate |
$97.59 |
| Rate for Payer: Aetna Commercial |
$95.47
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$91.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$56.22
|
| Rate for Payer: Cash Price |
$30.60
|
| Rate for Payer: Cigna Commercial |
$97.59
|
| Rate for Payer: Health EOS Commercial |
$94.41
|
| Rate for Payer: HFN Commercial |
$97.59
|
| Rate for Payer: Multiplan Commercial |
$84.86
|
| Rate for Payer: Preferred Network Access Commercial |
$97.59
|
| Rate for Payer: Quartz Beloit One Network |
$51.98
|
| Rate for Payer: Quartz Commercial |
$63.65
|
| Rate for Payer: WEA Trust Commercial |
$58.34
|
| Rate for Payer: WPS Commercial |
$78.57
|
|
|
HLA DQB1
|
Facility
|
OP
|
$102.00
|
|
|
Service Code
|
CPT 81382
|
| Hospital Charge Code |
5438973
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$51.98 |
| Max. Negotiated Rate |
$514.51 |
| Rate for Payer: Aetna Commercial |
$95.47
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$91.23
|
| Rate for Payer: Aetna Managed Medicare |
$128.63
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$482.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$225.10
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$213.52
|
| Rate for Payer: Anthem Medicare Advantage |
$128.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$56.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$128.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$128.63
|
| Rate for Payer: Cash Price |
$30.60
|
| Rate for Payer: Cash Price |
$30.60
|
| Rate for Payer: Cigna Commercial |
$97.59
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$128.63
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$59.36
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$128.63
|
| Rate for Payer: Health EOS Commercial |
$94.41
|
| Rate for Payer: HFN Commercial |
$97.59
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$478.49
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$128.63
|
| Rate for Payer: Independent Care Health Plan Medicare |
$128.63
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$128.63
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$128.63
|
| Rate for Payer: Multiplan Commercial |
$84.86
|
| Rate for Payer: NAPHCARE Commercial |
$192.94
|
| Rate for Payer: Preferred Network Access Commercial |
$97.59
|
| Rate for Payer: Quartz Beloit One Network |
$51.98
|
| Rate for Payer: Quartz Commercial |
$68.95
|
| Rate for Payer: Quartz Medicare Advantage |
$128.63
|
| Rate for Payer: The Alliance Commercial |
$514.51
|
| Rate for Payer: United Healthcare Medicare Advantage |
$128.63
|
| Rate for Payer: United Healthcare PPO |
$79.56
|
| Rate for Payer: WEA Trust Commercial |
$58.34
|
| Rate for Payer: Wellcare Medicare |
$128.63
|
| Rate for Payer: WPS Commercial |
$78.57
|
|
|
HLA DQB1
|
Professional
|
Both
|
$102.00
|
|
|
Service Code
|
CPT 81382
|
| Hospital Charge Code |
5438973
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$46.68 |
| Max. Negotiated Rate |
$565.96 |
| Rate for Payer: Aetna Commercial |
$100.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$91.23
|
| Rate for Payer: Aetna Managed Medicare |
$128.63
|
| Rate for Payer: Anthem Medicare Advantage |
$128.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$128.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$128.63
|
| Rate for Payer: Cash Price |
$30.60
|
| Rate for Payer: Cash Price |
$30.60
|
| Rate for Payer: Cigna Commercial |
$100.78
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$53.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$128.63
|
| Rate for Payer: Health EOS Commercial |
$96.53
|
| Rate for Payer: HFN Commercial |
$100.78
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$454.05
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$454.05
|
| Rate for Payer: Independent Care Health Plan Medicare |
$128.63
|
| Rate for Payer: Multiplan Commercial |
$84.86
|
| Rate for Payer: NAPHCARE Commercial |
$192.94
|
| Rate for Payer: Preferred Network Access Commercial |
$100.78
|
| Rate for Payer: Quartz Beloit One Network |
$46.68
|
| Rate for Payer: Quartz Commercial |
$60.47
|
| Rate for Payer: Quartz Medicare Advantage |
$128.63
|
| Rate for Payer: The Alliance Commercial |
$508.08
|
| Rate for Payer: United Healthcare Medicare Advantage |
$128.63
|
| Rate for Payer: WEA Trust Commercial |
$58.34
|
| Rate for Payer: WPS Commercial |
$565.96
|
|
|
HLA-DR/DQ Low Resolution
|
Professional
|
Both
|
$535.00
|
|
|
Service Code
|
CPT 81376
|
| Hospital Charge Code |
4852610
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$127.11 |
| Max. Negotiated Rate |
$559.28 |
| Rate for Payer: Aetna Commercial |
$528.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$478.50
|
| Rate for Payer: Aetna Managed Medicare |
$127.11
|
| Rate for Payer: Anthem Medicare Advantage |
$127.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$127.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$127.11
|
| Rate for Payer: Cash Price |
$160.50
|
| Rate for Payer: Cash Price |
$160.50
|
| Rate for Payer: Cigna Commercial |
$528.58
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$278.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$127.11
|
| Rate for Payer: Health EOS Commercial |
$506.32
|
| Rate for Payer: HFN Commercial |
$528.58
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$448.70
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$448.70
|
| Rate for Payer: Independent Care Health Plan Medicare |
$127.11
|
| Rate for Payer: Multiplan Commercial |
$445.12
|
| Rate for Payer: NAPHCARE Commercial |
$190.66
|
| Rate for Payer: Preferred Network Access Commercial |
$528.58
|
| Rate for Payer: Quartz Beloit One Network |
$244.82
|
| Rate for Payer: Quartz Commercial |
$317.15
|
| Rate for Payer: Quartz Medicare Advantage |
$127.11
|
| Rate for Payer: The Alliance Commercial |
$502.08
|
| Rate for Payer: United Healthcare Medicare Advantage |
$127.11
|
| Rate for Payer: WEA Trust Commercial |
$306.02
|
| Rate for Payer: WPS Commercial |
$559.28
|
|
|
HLA-DR/DQ Low Resolution
|
Facility
|
OP
|
$535.00
|
|
|
Service Code
|
CPT 81376
|
| Hospital Charge Code |
4852610
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$127.11 |
| Max. Negotiated Rate |
$511.89 |
| Rate for Payer: Aetna Commercial |
$500.76
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$478.50
|
| Rate for Payer: Aetna Managed Medicare |
$127.11
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$476.66
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$222.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$211.00
|
| Rate for Payer: Anthem Medicare Advantage |
$127.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$294.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$127.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$127.11
|
| Rate for Payer: Cash Price |
$160.50
|
| Rate for Payer: Cash Price |
$160.50
|
| Rate for Payer: Cigna Commercial |
$511.89
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$127.11
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$311.37
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$127.11
|
| Rate for Payer: Health EOS Commercial |
$495.20
|
| Rate for Payer: HFN Commercial |
$511.89
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$472.84
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$127.11
|
| Rate for Payer: Independent Care Health Plan Medicare |
$127.11
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$127.11
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$127.11
|
| Rate for Payer: Multiplan Commercial |
$445.12
|
| Rate for Payer: NAPHCARE Commercial |
$190.66
|
| Rate for Payer: Preferred Network Access Commercial |
$511.89
|
| Rate for Payer: Quartz Beloit One Network |
$272.64
|
| Rate for Payer: Quartz Commercial |
$361.66
|
| Rate for Payer: Quartz Medicare Advantage |
$127.11
|
| Rate for Payer: The Alliance Commercial |
$508.44
|
| Rate for Payer: United Healthcare Medicare Advantage |
$127.11
|
| Rate for Payer: United Healthcare PPO |
$417.30
|
| Rate for Payer: WEA Trust Commercial |
$306.02
|
| Rate for Payer: Wellcare Medicare |
$127.11
|
| Rate for Payer: WPS Commercial |
$412.11
|
|
|
HLA-DR/DQ Low Resolution
|
Facility
|
IP
|
$535.00
|
|
|
Service Code
|
CPT 81376
|
| Hospital Charge Code |
4852610
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$272.64 |
| Max. Negotiated Rate |
$511.89 |
| Rate for Payer: Aetna Commercial |
$500.76
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$478.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$294.89
|
| Rate for Payer: Cash Price |
$160.50
|
| Rate for Payer: Cigna Commercial |
$511.89
|
| Rate for Payer: Health EOS Commercial |
$495.20
|
| Rate for Payer: HFN Commercial |
$511.89
|
| Rate for Payer: Multiplan Commercial |
$445.12
|
| Rate for Payer: Preferred Network Access Commercial |
$511.89
|
| Rate for Payer: Quartz Beloit One Network |
$272.64
|
| Rate for Payer: Quartz Commercial |
$333.84
|
| Rate for Payer: WEA Trust Commercial |
$306.02
|
| Rate for Payer: WPS Commercial |
$412.11
|
|
|
HME Filter
|
Facility
|
OP
|
$57.00
|
|
| Hospital Charge Code |
3101739
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$16.60 |
| Max. Negotiated Rate |
$54.54 |
| Rate for Payer: Aetna Commercial |
$53.35
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$50.98
|
| Rate for Payer: Aetna Managed Medicare |
$16.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$38.53
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$29.64
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$28.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$31.42
|
| Rate for Payer: Cash Price |
$17.10
|
| Rate for Payer: Cigna Commercial |
$54.54
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$33.17
|
| Rate for Payer: Health EOS Commercial |
$52.76
|
| Rate for Payer: HFN Commercial |
$54.54
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$44.46
|
| Rate for Payer: Multiplan Commercial |
$47.42
|
| Rate for Payer: NAPHCARE Commercial |
$35.57
|
| Rate for Payer: Preferred Network Access Commercial |
$54.54
|
| Rate for Payer: Quartz Beloit One Network |
$29.05
|
| Rate for Payer: Quartz Commercial |
$38.53
|
| Rate for Payer: Quartz Medicare Advantage |
$35.57
|
| Rate for Payer: The Alliance Commercial |
$29.64
|
| Rate for Payer: WEA Trust Commercial |
$32.60
|
| Rate for Payer: WPS Commercial |
$43.91
|
|
|
HME Filter
|
Facility
|
IP
|
$57.00
|
|
| Hospital Charge Code |
3101739
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$29.05 |
| Max. Negotiated Rate |
$54.54 |
| Rate for Payer: Aetna Commercial |
$53.35
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$50.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$31.42
|
| Rate for Payer: Cash Price |
$17.10
|
| Rate for Payer: Cigna Commercial |
$54.54
|
| Rate for Payer: Health EOS Commercial |
$52.76
|
| Rate for Payer: HFN Commercial |
$54.54
|
| Rate for Payer: Multiplan Commercial |
$47.42
|
| Rate for Payer: Preferred Network Access Commercial |
$54.54
|
| Rate for Payer: Quartz Beloit One Network |
$29.05
|
| Rate for Payer: Quartz Commercial |
$35.57
|
| Rate for Payer: WEA Trust Commercial |
$32.60
|
| Rate for Payer: WPS Commercial |
$43.91
|
|
