|
HLA B 1502 Typing
|
Facility
|
OP
|
$417.00
|
|
|
Service Code
|
CPT 81381
|
| Hospital Charge Code |
4318601
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$103.22 |
| Max. Negotiated Rate |
$679.60 |
| Rate for Payer: Aetna Commercial |
$375.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$358.62
|
| Rate for Payer: Aetna Managed Medicare |
$169.90
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$637.12
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$297.32
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$282.03
|
| Rate for Payer: Anthem Medicaid |
$103.22
|
| Rate for Payer: Anthem Medicare Advantage |
$169.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$221.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$169.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$169.90
|
| Rate for Payer: Cash Price |
$125.10
|
| Rate for Payer: Cash Price |
$125.10
|
| Rate for Payer: Cigna Commercial |
$383.64
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$169.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$103.22
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$233.35
|
| Rate for Payer: Dean Health Medicaid |
$103.22
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$169.90
|
| Rate for Payer: Health EOS Commercial |
$371.13
|
| Rate for Payer: HFN Commercial |
$383.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$632.03
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$169.90
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$103.22
|
| Rate for Payer: Independent Care Health Plan Medicare |
$169.90
|
| Rate for Payer: Managed Health Services Medicaid |
$107.35
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$169.90
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$169.90
|
| Rate for Payer: Multiplan Commercial |
$333.60
|
| Rate for Payer: NAPHCARE Commercial |
$254.85
|
| Rate for Payer: Preferred Network Access Commercial |
$383.64
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$103.22
|
| Rate for Payer: Quartz Beloit One Network |
$204.33
|
| Rate for Payer: Quartz Commercial |
$271.05
|
| Rate for Payer: Quartz Medicare Advantage |
$169.90
|
| Rate for Payer: The Alliance Commercial |
$679.60
|
| Rate for Payer: United Healthcare Medicaid |
$103.22
|
| Rate for Payer: United Healthcare Medicare Advantage |
$169.90
|
| Rate for Payer: United Healthcare PPO |
$312.75
|
| Rate for Payer: WEA Trust Commercial |
$229.35
|
| Rate for Payer: Wellcare Medicare |
$169.90
|
| Rate for Payer: WMAP Medicaid |
$103.22
|
| Rate for Payer: WPS Commercial |
$308.87
|
|
|
HLA B 1502 Typing
|
Professional
|
Both
|
$417.00
|
|
|
Service Code
|
CPT 81381
|
| Hospital Charge Code |
4318601
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$183.48 |
| Max. Negotiated Rate |
$599.75 |
| Rate for Payer: Aetna Commercial |
$396.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$358.62
|
| Rate for Payer: Cash Price |
$125.10
|
| Rate for Payer: Cash Price |
$125.10
|
| Rate for Payer: Cigna Commercial |
$396.15
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$208.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$250.20
|
| Rate for Payer: Health EOS Commercial |
$379.47
|
| Rate for Payer: HFN Commercial |
$396.15
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$599.75
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$599.75
|
| Rate for Payer: Multiplan Commercial |
$333.60
|
| Rate for Payer: Preferred Network Access Commercial |
$396.15
|
| Rate for Payer: Quartz Beloit One Network |
$183.48
|
| Rate for Payer: Quartz Commercial |
$237.69
|
| Rate for Payer: The Alliance Commercial |
$208.50
|
| Rate for Payer: WEA Trust Commercial |
$229.35
|
| Rate for Payer: WPS Commercial |
$308.87
|
|
|
HLA B 1502 Typing
|
Facility
|
IP
|
$417.00
|
|
|
Service Code
|
CPT 81381
|
| Hospital Charge Code |
4318601
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$204.33 |
| Max. Negotiated Rate |
$383.64 |
| Rate for Payer: Aetna Commercial |
$375.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$358.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$221.01
|
| Rate for Payer: Cash Price |
$125.10
|
| Rate for Payer: Cigna Commercial |
$383.64
|
| Rate for Payer: Health EOS Commercial |
$371.13
|
| Rate for Payer: HFN Commercial |
$383.64
|
| Rate for Payer: Multiplan Commercial |
$333.60
|
| Rate for Payer: NAPHCARE Commercial |
$250.20
|
| Rate for Payer: Preferred Network Access Commercial |
$383.64
|
| Rate for Payer: Quartz Beloit One Network |
$204.33
|
| Rate for Payer: Quartz Commercial |
$250.20
|
| Rate for Payer: WEA Trust Commercial |
$229.35
|
| Rate for Payer: WPS Commercial |
$308.87
|
|
|
HLA B-27 Antigen
|
Professional
|
Both
|
$655.00
|
|
|
Service Code
|
CPT 86812
|
| Hospital Charge Code |
1039190
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$91.11 |
| 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 |
$91.11
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$91.11
|
| 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
|
|
|
HLA B-27 Antigen
|
Facility
|
OP
|
$655.00
|
|
|
Service Code
|
CPT 86812
|
| Hospital Charge Code |
1039190
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$25.81 |
| 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 |
$25.81
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$96.79
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$45.17
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$42.84
|
| Rate for Payer: Anthem Medicaid |
$26.67
|
| Rate for Payer: Anthem Medicare Advantage |
$25.81
|
| 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 |
$25.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$25.81
|
| 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 |
$25.81
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$26.67
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$366.54
|
| Rate for Payer: Dean Health Medicaid |
$26.67
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$25.81
|
| Rate for Payer: Health EOS Commercial |
$582.95
|
| Rate for Payer: HFN Commercial |
$602.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$96.01
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$25.81
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$26.67
|
| Rate for Payer: Independent Care Health Plan Medicare |
$25.81
|
| Rate for Payer: Managed Health Services Medicaid |
$27.74
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$25.81
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$25.81
|
| Rate for Payer: Multiplan Commercial |
$524.00
|
| Rate for Payer: NAPHCARE Commercial |
$38.72
|
| Rate for Payer: Preferred Network Access Commercial |
$602.60
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$26.67
|
| Rate for Payer: Quartz Beloit One Network |
$320.95
|
| Rate for Payer: Quartz Commercial |
$425.75
|
| Rate for Payer: Quartz Medicare Advantage |
$25.81
|
| Rate for Payer: The Alliance Commercial |
$103.24
|
| Rate for Payer: United Healthcare Medicaid |
$26.67
|
| Rate for Payer: United Healthcare Medicare Advantage |
$25.81
|
| Rate for Payer: United Healthcare PPO |
$491.25
|
| Rate for Payer: WEA Trust Commercial |
$360.25
|
| Rate for Payer: Wellcare Medicare |
$25.81
|
| Rate for Payer: WMAP Medicaid |
$26.67
|
| Rate for Payer: WPS Commercial |
$485.16
|
|
|
HLA B-27 Antigen
|
Facility
|
IP
|
$655.00
|
|
|
Service Code
|
CPT 86812
|
| Hospital Charge Code |
1039190
|
|
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
|
|
|
HLA B-51 DNA Typing
|
Facility
|
OP
|
$619.00
|
|
|
Service Code
|
CPT 81381
|
| Hospital Charge Code |
1039194
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$103.22 |
| Max. Negotiated Rate |
$679.60 |
| Rate for Payer: Aetna Commercial |
$557.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$532.34
|
| Rate for Payer: Aetna Managed Medicare |
$169.90
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$637.12
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$297.32
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$282.03
|
| Rate for Payer: Anthem Medicaid |
$103.22
|
| Rate for Payer: Anthem Medicare Advantage |
$169.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$328.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$169.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$169.90
|
| Rate for Payer: Cash Price |
$185.70
|
| Rate for Payer: Cash Price |
$185.70
|
| Rate for Payer: Cigna Commercial |
$569.48
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$169.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$103.22
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$346.39
|
| Rate for Payer: Dean Health Medicaid |
$103.22
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$169.90
|
| Rate for Payer: Health EOS Commercial |
$550.91
|
| Rate for Payer: HFN Commercial |
$569.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$632.03
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$169.90
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$103.22
|
| Rate for Payer: Independent Care Health Plan Medicare |
$169.90
|
| Rate for Payer: Managed Health Services Medicaid |
$107.35
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$169.90
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$169.90
|
| Rate for Payer: Multiplan Commercial |
$495.20
|
| Rate for Payer: NAPHCARE Commercial |
$254.85
|
| Rate for Payer: Preferred Network Access Commercial |
$569.48
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$103.22
|
| Rate for Payer: Quartz Beloit One Network |
$303.31
|
| Rate for Payer: Quartz Commercial |
$402.35
|
| Rate for Payer: Quartz Medicare Advantage |
$169.90
|
| Rate for Payer: The Alliance Commercial |
$679.60
|
| Rate for Payer: United Healthcare Medicaid |
$103.22
|
| Rate for Payer: United Healthcare Medicare Advantage |
$169.90
|
| Rate for Payer: United Healthcare PPO |
$464.25
|
| Rate for Payer: WEA Trust Commercial |
$340.45
|
| Rate for Payer: Wellcare Medicare |
$169.90
|
| Rate for Payer: WMAP Medicaid |
$103.22
|
| Rate for Payer: WPS Commercial |
$458.49
|
|
|
HLA B-51 DNA Typing
|
Professional
|
Both
|
$619.00
|
|
|
Service Code
|
CPT 81381
|
| Hospital Charge Code |
1039194
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$272.36 |
| Max. Negotiated Rate |
$599.75 |
| Rate for Payer: Aetna Commercial |
$588.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$532.34
|
| Rate for Payer: Cash Price |
$185.70
|
| Rate for Payer: Cash Price |
$185.70
|
| Rate for Payer: Cigna Commercial |
$588.05
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$309.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$371.40
|
| Rate for Payer: Health EOS Commercial |
$563.29
|
| Rate for Payer: HFN Commercial |
$588.05
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$599.75
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$599.75
|
| Rate for Payer: Multiplan Commercial |
$495.20
|
| Rate for Payer: Preferred Network Access Commercial |
$588.05
|
| Rate for Payer: Quartz Beloit One Network |
$272.36
|
| Rate for Payer: Quartz Commercial |
$352.83
|
| Rate for Payer: The Alliance Commercial |
$309.50
|
| Rate for Payer: WEA Trust Commercial |
$340.45
|
| Rate for Payer: WPS Commercial |
$458.49
|
|
|
HLA B-51 DNA Typing
|
Facility
|
IP
|
$619.00
|
|
|
Service Code
|
CPT 81381
|
| Hospital Charge Code |
1039194
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$303.31 |
| Max. Negotiated Rate |
$569.48 |
| Rate for Payer: Aetna Commercial |
$557.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$532.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$328.07
|
| Rate for Payer: Cash Price |
$185.70
|
| Rate for Payer: Cigna Commercial |
$569.48
|
| Rate for Payer: Health EOS Commercial |
$550.91
|
| Rate for Payer: HFN Commercial |
$569.48
|
| Rate for Payer: Multiplan Commercial |
$495.20
|
| Rate for Payer: NAPHCARE Commercial |
$371.40
|
| Rate for Payer: Preferred Network Access Commercial |
$569.48
|
| Rate for Payer: Quartz Beloit One Network |
$303.31
|
| Rate for Payer: Quartz Commercial |
$371.40
|
| Rate for Payer: WEA Trust Commercial |
$340.45
|
| Rate for Payer: WPS Commercial |
$458.49
|
|
|
HLA B 5701 Typing
|
Facility
|
OP
|
$333.00
|
|
|
Service Code
|
CPT 81381
|
| Hospital Charge Code |
4532697
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$103.22 |
| Max. Negotiated Rate |
$679.60 |
| Rate for Payer: Aetna Commercial |
$299.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$286.38
|
| Rate for Payer: Aetna Managed Medicare |
$169.90
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$637.12
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$297.32
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$282.03
|
| Rate for Payer: Anthem Medicaid |
$103.22
|
| Rate for Payer: Anthem Medicare Advantage |
$169.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$176.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$169.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$169.90
|
| Rate for Payer: Cash Price |
$99.90
|
| Rate for Payer: Cash Price |
$99.90
|
| Rate for Payer: Cigna Commercial |
$306.36
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$169.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$103.22
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$186.35
|
| Rate for Payer: Dean Health Medicaid |
$103.22
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$169.90
|
| Rate for Payer: Health EOS Commercial |
$296.37
|
| Rate for Payer: HFN Commercial |
$306.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$632.03
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$169.90
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$103.22
|
| Rate for Payer: Independent Care Health Plan Medicare |
$169.90
|
| Rate for Payer: Managed Health Services Medicaid |
$107.35
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$169.90
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$169.90
|
| Rate for Payer: Multiplan Commercial |
$266.40
|
| Rate for Payer: NAPHCARE Commercial |
$254.85
|
| Rate for Payer: Preferred Network Access Commercial |
$306.36
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$103.22
|
| Rate for Payer: Quartz Beloit One Network |
$163.17
|
| Rate for Payer: Quartz Commercial |
$216.45
|
| Rate for Payer: Quartz Medicare Advantage |
$169.90
|
| Rate for Payer: The Alliance Commercial |
$679.60
|
| Rate for Payer: United Healthcare Medicaid |
$103.22
|
| Rate for Payer: United Healthcare Medicare Advantage |
$169.90
|
| Rate for Payer: United Healthcare PPO |
$249.75
|
| Rate for Payer: WEA Trust Commercial |
$183.15
|
| Rate for Payer: Wellcare Medicare |
$169.90
|
| Rate for Payer: WMAP Medicaid |
$103.22
|
| Rate for Payer: WPS Commercial |
$246.65
|
|
|
HLA B 5701 Typing
|
Facility
|
IP
|
$333.00
|
|
|
Service Code
|
CPT 81381
|
| Hospital Charge Code |
4532697
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$163.17 |
| Max. Negotiated Rate |
$306.36 |
| Rate for Payer: Aetna Commercial |
$299.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$286.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$176.49
|
| Rate for Payer: Cash Price |
$99.90
|
| Rate for Payer: Cigna Commercial |
$306.36
|
| Rate for Payer: Health EOS Commercial |
$296.37
|
| Rate for Payer: HFN Commercial |
$306.36
|
| Rate for Payer: Multiplan Commercial |
$266.40
|
| Rate for Payer: NAPHCARE Commercial |
$199.80
|
| Rate for Payer: Preferred Network Access Commercial |
$306.36
|
| Rate for Payer: Quartz Beloit One Network |
$163.17
|
| Rate for Payer: Quartz Commercial |
$199.80
|
| Rate for Payer: WEA Trust Commercial |
$183.15
|
| Rate for Payer: WPS Commercial |
$246.65
|
|
|
HLA B 5701 Typing
|
Professional
|
Both
|
$333.00
|
|
|
Service Code
|
CPT 81381
|
| Hospital Charge Code |
4532697
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$146.52 |
| Max. Negotiated Rate |
$599.75 |
| Rate for Payer: Aetna Commercial |
$316.35
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$286.38
|
| Rate for Payer: Cash Price |
$99.90
|
| Rate for Payer: Cash Price |
$99.90
|
| Rate for Payer: Cigna Commercial |
$316.35
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$166.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$199.80
|
| Rate for Payer: Health EOS Commercial |
$303.03
|
| Rate for Payer: HFN Commercial |
$316.35
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$599.75
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$599.75
|
| Rate for Payer: Multiplan Commercial |
$266.40
|
| Rate for Payer: Preferred Network Access Commercial |
$316.35
|
| Rate for Payer: Quartz Beloit One Network |
$146.52
|
| Rate for Payer: Quartz Commercial |
$189.81
|
| Rate for Payer: The Alliance Commercial |
$166.50
|
| Rate for Payer: WEA Trust Commercial |
$183.15
|
| Rate for Payer: WPS Commercial |
$246.65
|
|
|
HLA B 5801 Genotype
|
Facility
|
OP
|
$744.00
|
|
|
Service Code
|
CPT 81381
|
| Hospital Charge Code |
6174506
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$103.22 |
| Max. Negotiated Rate |
$684.48 |
| Rate for Payer: Aetna Commercial |
$669.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$639.84
|
| Rate for Payer: Aetna Managed Medicare |
$169.90
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$637.12
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$297.32
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$282.03
|
| Rate for Payer: Anthem Medicaid |
$103.22
|
| Rate for Payer: Anthem Medicare Advantage |
$169.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$394.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$169.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$169.90
|
| Rate for Payer: Cash Price |
$223.20
|
| Rate for Payer: Cash Price |
$223.20
|
| Rate for Payer: Cigna Commercial |
$684.48
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$169.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$103.22
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$416.34
|
| Rate for Payer: Dean Health Medicaid |
$103.22
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$169.90
|
| Rate for Payer: Health EOS Commercial |
$662.16
|
| Rate for Payer: HFN Commercial |
$684.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$632.03
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$169.90
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$103.22
|
| Rate for Payer: Independent Care Health Plan Medicare |
$169.90
|
| Rate for Payer: Managed Health Services Medicaid |
$107.35
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$169.90
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$169.90
|
| Rate for Payer: Multiplan Commercial |
$595.20
|
| Rate for Payer: NAPHCARE Commercial |
$254.85
|
| Rate for Payer: Preferred Network Access Commercial |
$684.48
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$103.22
|
| Rate for Payer: Quartz Beloit One Network |
$364.56
|
| Rate for Payer: Quartz Commercial |
$483.60
|
| Rate for Payer: Quartz Medicare Advantage |
$169.90
|
| Rate for Payer: The Alliance Commercial |
$679.60
|
| Rate for Payer: United Healthcare Medicaid |
$103.22
|
| Rate for Payer: United Healthcare Medicare Advantage |
$169.90
|
| Rate for Payer: United Healthcare PPO |
$558.00
|
| Rate for Payer: WEA Trust Commercial |
$409.20
|
| Rate for Payer: Wellcare Medicare |
$169.90
|
| Rate for Payer: WMAP Medicaid |
$103.22
|
| Rate for Payer: WPS Commercial |
$551.08
|
|
|
HLA B 5801 Genotype
|
Facility
|
IP
|
$744.00
|
|
|
Service Code
|
CPT 81381
|
| Hospital Charge Code |
6174506
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$364.56 |
| Max. Negotiated Rate |
$684.48 |
| Rate for Payer: Aetna Commercial |
$669.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$639.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$394.32
|
| Rate for Payer: Cash Price |
$223.20
|
| Rate for Payer: Cigna Commercial |
$684.48
|
| Rate for Payer: Health EOS Commercial |
$662.16
|
| Rate for Payer: HFN Commercial |
$684.48
|
| Rate for Payer: Multiplan Commercial |
$595.20
|
| Rate for Payer: NAPHCARE Commercial |
$446.40
|
| Rate for Payer: Preferred Network Access Commercial |
$684.48
|
| Rate for Payer: Quartz Beloit One Network |
$364.56
|
| Rate for Payer: Quartz Commercial |
$446.40
|
| Rate for Payer: WEA Trust Commercial |
$409.20
|
| Rate for Payer: WPS Commercial |
$551.08
|
|
|
HLA B 5801 Genotype
|
Professional
|
Both
|
$744.00
|
|
|
Service Code
|
CPT 81381
|
| Hospital Charge Code |
6174506
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$327.36 |
| Max. Negotiated Rate |
$706.80 |
| Rate for Payer: Aetna Commercial |
$706.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$639.84
|
| Rate for Payer: Cash Price |
$223.20
|
| Rate for Payer: Cash Price |
$223.20
|
| Rate for Payer: Cigna Commercial |
$706.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$372.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$446.40
|
| Rate for Payer: Health EOS Commercial |
$677.04
|
| Rate for Payer: HFN Commercial |
$706.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$599.75
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$599.75
|
| Rate for Payer: Multiplan Commercial |
$595.20
|
| Rate for Payer: Preferred Network Access Commercial |
$706.80
|
| Rate for Payer: Quartz Beloit One Network |
$327.36
|
| Rate for Payer: Quartz Commercial |
$424.08
|
| Rate for Payer: The Alliance Commercial |
$372.00
|
| Rate for Payer: WEA Trust Commercial |
$409.20
|
| Rate for Payer: WPS Commercial |
$551.08
|
|
|
HLA DQ2
|
Facility
|
IP
|
$102.00
|
|
|
Service Code
|
CPT 81376
|
| Hospital Charge Code |
5438975
|
|
Hospital Revenue Code
|
300
|
| 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
|
|
|
HLA DQ2
|
Professional
|
Both
|
$102.00
|
|
|
Service Code
|
CPT 81376
|
| Hospital Charge Code |
5438975
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$44.88 |
| Max. Negotiated Rate |
$431.44 |
| 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: 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 |
$431.44
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$431.44
|
| 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
|
|
|
HLA DQ2
|
Facility
|
OP
|
$102.00
|
|
|
Service Code
|
CPT 81376
|
| Hospital Charge Code |
5438975
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$49.98 |
| Max. Negotiated Rate |
$488.88 |
| Rate for Payer: Aetna Commercial |
$91.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$87.72
|
| Rate for Payer: Aetna Managed Medicare |
$122.22
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$458.32
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$213.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$202.89
|
| Rate for Payer: Anthem Medicaid |
$126.29
|
| Rate for Payer: Anthem Medicare Advantage |
$122.22
|
| 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 |
$122.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$122.22
|
| 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 |
$122.22
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$126.29
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$57.08
|
| Rate for Payer: Dean Health Medicaid |
$126.29
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$122.22
|
| Rate for Payer: Health EOS Commercial |
$90.78
|
| Rate for Payer: HFN Commercial |
$93.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$454.66
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$122.22
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$126.29
|
| Rate for Payer: Independent Care Health Plan Medicare |
$122.22
|
| Rate for Payer: Managed Health Services Medicaid |
$131.34
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$122.22
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$122.22
|
| Rate for Payer: Multiplan Commercial |
$81.60
|
| Rate for Payer: NAPHCARE Commercial |
$183.33
|
| Rate for Payer: Preferred Network Access Commercial |
$93.84
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$126.29
|
| Rate for Payer: Quartz Beloit One Network |
$49.98
|
| Rate for Payer: Quartz Commercial |
$66.30
|
| Rate for Payer: Quartz Medicare Advantage |
$122.22
|
| Rate for Payer: The Alliance Commercial |
$488.88
|
| Rate for Payer: United Healthcare Medicaid |
$126.29
|
| Rate for Payer: United Healthcare Medicare Advantage |
$122.22
|
| Rate for Payer: United Healthcare PPO |
$76.50
|
| Rate for Payer: WEA Trust Commercial |
$56.10
|
| Rate for Payer: Wellcare Medicare |
$122.22
|
| Rate for Payer: WMAP Medicaid |
$126.29
|
| Rate for Payer: WPS Commercial |
$75.55
|
|
|
HLA DQA1
|
Facility
|
IP
|
$102.00
|
|
|
Service Code
|
CPT 81376
|
| Hospital Charge Code |
5438974
|
|
Hospital Revenue Code
|
300
|
| 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
|
|
|
HLA DQA1
|
Facility
|
OP
|
$102.00
|
|
|
Service Code
|
CPT 81376
|
| Hospital Charge Code |
5438974
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$49.98 |
| Max. Negotiated Rate |
$488.88 |
| Rate for Payer: Aetna Commercial |
$91.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$87.72
|
| Rate for Payer: Aetna Managed Medicare |
$122.22
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$458.32
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$213.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$202.89
|
| Rate for Payer: Anthem Medicaid |
$126.29
|
| Rate for Payer: Anthem Medicare Advantage |
$122.22
|
| 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 |
$122.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$122.22
|
| 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 |
$122.22
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$126.29
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$57.08
|
| Rate for Payer: Dean Health Medicaid |
$126.29
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$122.22
|
| Rate for Payer: Health EOS Commercial |
$90.78
|
| Rate for Payer: HFN Commercial |
$93.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$454.66
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$122.22
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$126.29
|
| Rate for Payer: Independent Care Health Plan Medicare |
$122.22
|
| Rate for Payer: Managed Health Services Medicaid |
$131.34
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$122.22
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$122.22
|
| Rate for Payer: Multiplan Commercial |
$81.60
|
| Rate for Payer: NAPHCARE Commercial |
$183.33
|
| Rate for Payer: Preferred Network Access Commercial |
$93.84
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$126.29
|
| Rate for Payer: Quartz Beloit One Network |
$49.98
|
| Rate for Payer: Quartz Commercial |
$66.30
|
| Rate for Payer: Quartz Medicare Advantage |
$122.22
|
| Rate for Payer: The Alliance Commercial |
$488.88
|
| Rate for Payer: United Healthcare Medicaid |
$126.29
|
| Rate for Payer: United Healthcare Medicare Advantage |
$122.22
|
| Rate for Payer: United Healthcare PPO |
$76.50
|
| Rate for Payer: WEA Trust Commercial |
$56.10
|
| Rate for Payer: Wellcare Medicare |
$122.22
|
| Rate for Payer: WMAP Medicaid |
$126.29
|
| Rate for Payer: WPS Commercial |
$75.55
|
|
|
HLA DQA1
|
Professional
|
Both
|
$102.00
|
|
|
Service Code
|
CPT 81376
|
| Hospital Charge Code |
5438974
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$44.88 |
| Max. Negotiated Rate |
$431.44 |
| 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: 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 |
$431.44
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$431.44
|
| 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
|
|
|
HLA DQB1
|
Professional
|
Both
|
$102.00
|
|
|
Service Code
|
CPT 81382
|
| Hospital Charge Code |
5438973
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$44.88 |
| Max. Negotiated Rate |
$436.59 |
| 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: 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 |
$436.59
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$436.59
|
| 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
|
|
|
HLA DQB1
|
Facility
|
OP
|
$102.00
|
|
|
Service Code
|
CPT 81382
|
| Hospital Charge Code |
5438973
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$49.98 |
| Max. Negotiated Rate |
$494.72 |
| Rate for Payer: Aetna Commercial |
$91.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$87.72
|
| Rate for Payer: Aetna Managed Medicare |
$123.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$463.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$216.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$205.31
|
| Rate for Payer: Anthem Medicaid |
$127.80
|
| Rate for Payer: Anthem Medicare Advantage |
$123.68
|
| 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 |
$123.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$123.68
|
| 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 |
$123.68
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$127.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$57.08
|
| Rate for Payer: Dean Health Medicaid |
$127.80
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$123.68
|
| Rate for Payer: Health EOS Commercial |
$90.78
|
| Rate for Payer: HFN Commercial |
$93.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$460.09
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$123.68
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$127.80
|
| Rate for Payer: Independent Care Health Plan Medicare |
$123.68
|
| Rate for Payer: Managed Health Services Medicaid |
$132.91
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$123.68
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$123.68
|
| Rate for Payer: Multiplan Commercial |
$81.60
|
| Rate for Payer: NAPHCARE Commercial |
$185.52
|
| Rate for Payer: Preferred Network Access Commercial |
$93.84
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$127.80
|
| Rate for Payer: Quartz Beloit One Network |
$49.98
|
| Rate for Payer: Quartz Commercial |
$66.30
|
| Rate for Payer: Quartz Medicare Advantage |
$123.68
|
| Rate for Payer: The Alliance Commercial |
$494.72
|
| Rate for Payer: United Healthcare Medicaid |
$127.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$123.68
|
| Rate for Payer: United Healthcare PPO |
$76.50
|
| Rate for Payer: WEA Trust Commercial |
$56.10
|
| Rate for Payer: Wellcare Medicare |
$123.68
|
| Rate for Payer: WMAP Medicaid |
$127.80
|
| Rate for Payer: WPS Commercial |
$75.55
|
|
|
HLA DQB1
|
Facility
|
IP
|
$102.00
|
|
|
Service Code
|
CPT 81382
|
| Hospital Charge Code |
5438973
|
|
Hospital Revenue Code
|
300
|
| 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
|
|
|
HLA-DR/DQ Low Resolution
|
Facility
|
OP
|
$535.00
|
|
|
Service Code
|
CPT 81376
|
| Hospital Charge Code |
4852610
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$122.22 |
| Max. Negotiated Rate |
$492.20 |
| Rate for Payer: Aetna Commercial |
$481.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$460.10
|
| Rate for Payer: Aetna Managed Medicare |
$122.22
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$458.32
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$213.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$202.89
|
| Rate for Payer: Anthem Medicaid |
$126.29
|
| Rate for Payer: Anthem Medicare Advantage |
$122.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$283.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$122.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$122.22
|
| Rate for Payer: Cash Price |
$160.50
|
| Rate for Payer: Cash Price |
$160.50
|
| Rate for Payer: Cigna Commercial |
$492.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$122.22
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$126.29
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$299.39
|
| Rate for Payer: Dean Health Medicaid |
$126.29
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$122.22
|
| Rate for Payer: Health EOS Commercial |
$476.15
|
| Rate for Payer: HFN Commercial |
$492.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$454.66
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$122.22
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$126.29
|
| Rate for Payer: Independent Care Health Plan Medicare |
$122.22
|
| Rate for Payer: Managed Health Services Medicaid |
$131.34
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$122.22
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$122.22
|
| Rate for Payer: Multiplan Commercial |
$428.00
|
| Rate for Payer: NAPHCARE Commercial |
$183.33
|
| Rate for Payer: Preferred Network Access Commercial |
$492.20
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$126.29
|
| Rate for Payer: Quartz Beloit One Network |
$262.15
|
| Rate for Payer: Quartz Commercial |
$347.75
|
| Rate for Payer: Quartz Medicare Advantage |
$122.22
|
| Rate for Payer: The Alliance Commercial |
$488.88
|
| Rate for Payer: United Healthcare Medicaid |
$126.29
|
| Rate for Payer: United Healthcare Medicare Advantage |
$122.22
|
| Rate for Payer: United Healthcare PPO |
$401.25
|
| Rate for Payer: WEA Trust Commercial |
$294.25
|
| Rate for Payer: Wellcare Medicare |
$122.22
|
| Rate for Payer: WMAP Medicaid |
$126.29
|
| Rate for Payer: WPS Commercial |
$396.27
|
|
