|
IgG
|
Facility
|
IP
|
$172.00
|
|
|
Service Code
|
CPT 82784
|
| Hospital Charge Code |
1114853
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$87.65 |
| Max. Negotiated Rate |
$164.57 |
| Rate for Payer: Aetna Commercial |
$160.99
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$153.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$94.81
|
| Rate for Payer: Cash Price |
$51.60
|
| Rate for Payer: Cigna Commercial |
$164.57
|
| Rate for Payer: Health EOS Commercial |
$159.20
|
| Rate for Payer: HFN Commercial |
$164.57
|
| Rate for Payer: Multiplan Commercial |
$143.10
|
| Rate for Payer: Preferred Network Access Commercial |
$164.57
|
| Rate for Payer: Quartz Beloit One Network |
$87.65
|
| Rate for Payer: Quartz Commercial |
$107.33
|
| Rate for Payer: WEA Trust Commercial |
$98.38
|
| Rate for Payer: WPS Commercial |
$132.49
|
|
|
IgG
|
Professional
|
Both
|
$138.00
|
|
|
Service Code
|
CPT 82784
|
| Hospital Charge Code |
2958999
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.67 |
| Max. Negotiated Rate |
$136.34 |
| Rate for Payer: Aetna Commercial |
$136.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$123.43
|
| Rate for Payer: Aetna Managed Medicare |
$9.67
|
| Rate for Payer: Anthem Medicare Advantage |
$9.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$9.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$9.67
|
| Rate for Payer: Cash Price |
$41.40
|
| Rate for Payer: Cash Price |
$41.40
|
| Rate for Payer: Cigna Commercial |
$136.34
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$71.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$9.67
|
| Rate for Payer: Health EOS Commercial |
$130.60
|
| Rate for Payer: HFN Commercial |
$136.34
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$34.14
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$34.14
|
| Rate for Payer: Independent Care Health Plan Medicare |
$9.67
|
| Rate for Payer: Multiplan Commercial |
$114.82
|
| Rate for Payer: NAPHCARE Commercial |
$14.51
|
| Rate for Payer: Preferred Network Access Commercial |
$136.34
|
| Rate for Payer: Quartz Beloit One Network |
$63.15
|
| Rate for Payer: Quartz Commercial |
$81.81
|
| Rate for Payer: Quartz Medicare Advantage |
$9.67
|
| Rate for Payer: The Alliance Commercial |
$38.20
|
| Rate for Payer: United Healthcare Medicare Advantage |
$9.67
|
| Rate for Payer: WEA Trust Commercial |
$78.94
|
| Rate for Payer: WPS Commercial |
$42.56
|
|
|
IgG CSF
|
Facility
|
OP
|
$175.00
|
|
|
Service Code
|
CPT 82784
|
| Hospital Charge Code |
2959000
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.67 |
| Max. Negotiated Rate |
$167.44 |
| Rate for Payer: Aetna Commercial |
$163.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$156.52
|
| Rate for Payer: Aetna Managed Medicare |
$9.67
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$36.27
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$16.93
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$16.06
|
| Rate for Payer: Anthem Medicare Advantage |
$9.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$96.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$9.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$9.67
|
| Rate for Payer: Cash Price |
$52.50
|
| Rate for Payer: Cash Price |
$52.50
|
| Rate for Payer: Cigna Commercial |
$167.44
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$9.67
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$101.85
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$9.67
|
| Rate for Payer: Health EOS Commercial |
$161.98
|
| Rate for Payer: HFN Commercial |
$167.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$35.98
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$9.67
|
| Rate for Payer: Independent Care Health Plan Medicare |
$9.67
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$9.67
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$9.67
|
| Rate for Payer: Multiplan Commercial |
$145.60
|
| Rate for Payer: NAPHCARE Commercial |
$14.51
|
| Rate for Payer: Preferred Network Access Commercial |
$167.44
|
| Rate for Payer: Quartz Beloit One Network |
$89.18
|
| Rate for Payer: Quartz Commercial |
$118.30
|
| Rate for Payer: Quartz Medicare Advantage |
$9.67
|
| Rate for Payer: The Alliance Commercial |
$38.69
|
| Rate for Payer: United Healthcare Medicare Advantage |
$9.67
|
| Rate for Payer: United Healthcare PPO |
$136.50
|
| Rate for Payer: WEA Trust Commercial |
$100.10
|
| Rate for Payer: Wellcare Medicare |
$9.67
|
| Rate for Payer: WPS Commercial |
$134.80
|
|
|
IgG CSF
|
Professional
|
Both
|
$175.00
|
|
|
Service Code
|
CPT 82784
|
| Hospital Charge Code |
2959000
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.67 |
| Max. Negotiated Rate |
$172.90 |
| Rate for Payer: Aetna Commercial |
$172.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$156.52
|
| Rate for Payer: Aetna Managed Medicare |
$9.67
|
| Rate for Payer: Anthem Medicare Advantage |
$9.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$9.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$9.67
|
| Rate for Payer: Cash Price |
$52.50
|
| Rate for Payer: Cash Price |
$52.50
|
| Rate for Payer: Cigna Commercial |
$172.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$91.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$9.67
|
| Rate for Payer: Health EOS Commercial |
$165.62
|
| Rate for Payer: HFN Commercial |
$172.90
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$34.14
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$34.14
|
| Rate for Payer: Independent Care Health Plan Medicare |
$9.67
|
| Rate for Payer: Multiplan Commercial |
$145.60
|
| Rate for Payer: NAPHCARE Commercial |
$14.51
|
| Rate for Payer: Preferred Network Access Commercial |
$172.90
|
| Rate for Payer: Quartz Beloit One Network |
$80.08
|
| Rate for Payer: Quartz Commercial |
$103.74
|
| Rate for Payer: Quartz Medicare Advantage |
$9.67
|
| Rate for Payer: The Alliance Commercial |
$38.20
|
| Rate for Payer: United Healthcare Medicare Advantage |
$9.67
|
| Rate for Payer: WEA Trust Commercial |
$100.10
|
| Rate for Payer: WPS Commercial |
$42.56
|
|
|
IgG CSF
|
Facility
|
OP
|
$175.00
|
|
|
Service Code
|
CPT 82784
|
| Hospital Charge Code |
4109307
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.67 |
| Max. Negotiated Rate |
$167.44 |
| Rate for Payer: Aetna Commercial |
$163.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$156.52
|
| Rate for Payer: Aetna Managed Medicare |
$9.67
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$36.27
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$16.93
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$16.06
|
| Rate for Payer: Anthem Medicare Advantage |
$9.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$96.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$9.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$9.67
|
| Rate for Payer: Cash Price |
$52.50
|
| Rate for Payer: Cash Price |
$52.50
|
| Rate for Payer: Cigna Commercial |
$167.44
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$9.67
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$101.85
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$9.67
|
| Rate for Payer: Health EOS Commercial |
$161.98
|
| Rate for Payer: HFN Commercial |
$167.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$35.98
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$9.67
|
| Rate for Payer: Independent Care Health Plan Medicare |
$9.67
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$9.67
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$9.67
|
| Rate for Payer: Multiplan Commercial |
$145.60
|
| Rate for Payer: NAPHCARE Commercial |
$14.51
|
| Rate for Payer: Preferred Network Access Commercial |
$167.44
|
| Rate for Payer: Quartz Beloit One Network |
$89.18
|
| Rate for Payer: Quartz Commercial |
$118.30
|
| Rate for Payer: Quartz Medicare Advantage |
$9.67
|
| Rate for Payer: The Alliance Commercial |
$38.69
|
| Rate for Payer: United Healthcare Medicare Advantage |
$9.67
|
| Rate for Payer: United Healthcare PPO |
$136.50
|
| Rate for Payer: WEA Trust Commercial |
$100.10
|
| Rate for Payer: Wellcare Medicare |
$9.67
|
| Rate for Payer: WPS Commercial |
$134.80
|
|
|
IgG CSF
|
Facility
|
IP
|
$175.00
|
|
|
Service Code
|
CPT 82784
|
| Hospital Charge Code |
4109307
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$89.18 |
| Max. Negotiated Rate |
$167.44 |
| Rate for Payer: Aetna Commercial |
$163.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$156.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$96.46
|
| Rate for Payer: Cash Price |
$52.50
|
| Rate for Payer: Cigna Commercial |
$167.44
|
| Rate for Payer: Health EOS Commercial |
$161.98
|
| Rate for Payer: HFN Commercial |
$167.44
|
| Rate for Payer: Multiplan Commercial |
$145.60
|
| Rate for Payer: Preferred Network Access Commercial |
$167.44
|
| Rate for Payer: Quartz Beloit One Network |
$89.18
|
| Rate for Payer: Quartz Commercial |
$109.20
|
| Rate for Payer: WEA Trust Commercial |
$100.10
|
| Rate for Payer: WPS Commercial |
$134.80
|
|
|
IgG CSF
|
Professional
|
Both
|
$175.00
|
|
|
Service Code
|
CPT 82784
|
| Hospital Charge Code |
4109307
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.67 |
| Max. Negotiated Rate |
$172.90 |
| Rate for Payer: Aetna Commercial |
$172.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$156.52
|
| Rate for Payer: Aetna Managed Medicare |
$9.67
|
| Rate for Payer: Anthem Medicare Advantage |
$9.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$9.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$9.67
|
| Rate for Payer: Cash Price |
$52.50
|
| Rate for Payer: Cash Price |
$52.50
|
| Rate for Payer: Cigna Commercial |
$172.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$91.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$9.67
|
| Rate for Payer: Health EOS Commercial |
$165.62
|
| Rate for Payer: HFN Commercial |
$172.90
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$34.14
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$34.14
|
| Rate for Payer: Independent Care Health Plan Medicare |
$9.67
|
| Rate for Payer: Multiplan Commercial |
$145.60
|
| Rate for Payer: NAPHCARE Commercial |
$14.51
|
| Rate for Payer: Preferred Network Access Commercial |
$172.90
|
| Rate for Payer: Quartz Beloit One Network |
$80.08
|
| Rate for Payer: Quartz Commercial |
$103.74
|
| Rate for Payer: Quartz Medicare Advantage |
$9.67
|
| Rate for Payer: The Alliance Commercial |
$38.20
|
| Rate for Payer: United Healthcare Medicare Advantage |
$9.67
|
| Rate for Payer: WEA Trust Commercial |
$100.10
|
| Rate for Payer: WPS Commercial |
$42.56
|
|
|
IgG CSF
|
Facility
|
IP
|
$175.00
|
|
|
Service Code
|
CPT 82784
|
| Hospital Charge Code |
2959000
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$89.18 |
| Max. Negotiated Rate |
$167.44 |
| Rate for Payer: Aetna Commercial |
$163.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$156.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$96.46
|
| Rate for Payer: Cash Price |
$52.50
|
| Rate for Payer: Cigna Commercial |
$167.44
|
| Rate for Payer: Health EOS Commercial |
$161.98
|
| Rate for Payer: HFN Commercial |
$167.44
|
| Rate for Payer: Multiplan Commercial |
$145.60
|
| Rate for Payer: Preferred Network Access Commercial |
$167.44
|
| Rate for Payer: Quartz Beloit One Network |
$89.18
|
| Rate for Payer: Quartz Commercial |
$109.20
|
| Rate for Payer: WEA Trust Commercial |
$100.10
|
| Rate for Payer: WPS Commercial |
$134.80
|
|
|
IgG, IgA, Indirect Immunofluorescence
|
Facility
|
OP
|
$176.00
|
|
|
Service Code
|
CPT 88346
|
| Hospital Charge Code |
1124806
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$89.69 |
| Max. Negotiated Rate |
$717.18 |
| Rate for Payer: Aetna Commercial |
$164.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$157.41
|
| Rate for Payer: Aetna Managed Medicare |
$179.30
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$658.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$307.25
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$291.45
|
| Rate for Payer: Anthem Medicare Advantage |
$179.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$97.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$179.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$179.30
|
| Rate for Payer: Cash Price |
$52.80
|
| Rate for Payer: Cash Price |
$52.80
|
| Rate for Payer: Cigna Commercial |
$168.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$179.30
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$102.43
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$179.30
|
| Rate for Payer: Health EOS Commercial |
$162.91
|
| Rate for Payer: HFN Commercial |
$168.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$666.98
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$179.30
|
| Rate for Payer: Independent Care Health Plan Medicare |
$179.30
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$179.30
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$179.30
|
| Rate for Payer: Multiplan Commercial |
$146.43
|
| Rate for Payer: NAPHCARE Commercial |
$268.94
|
| Rate for Payer: Preferred Network Access Commercial |
$168.40
|
| Rate for Payer: Quartz Beloit One Network |
$89.69
|
| Rate for Payer: Quartz Commercial |
$118.98
|
| Rate for Payer: Quartz Medicare Advantage |
$179.30
|
| Rate for Payer: The Alliance Commercial |
$717.18
|
| Rate for Payer: United Healthcare Medicare Advantage |
$179.30
|
| Rate for Payer: United Healthcare PPO |
$137.28
|
| Rate for Payer: WEA Trust Commercial |
$100.67
|
| Rate for Payer: Wellcare Medicare |
$179.30
|
| Rate for Payer: WPS Commercial |
$135.57
|
|
|
IgG, IgA, Indirect Immunofluorescence
|
Professional
|
Both
|
$176.00
|
|
|
Service Code
|
CPT 88346
|
| Hospital Charge Code |
1124806
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$34.77 |
| Max. Negotiated Rate |
$601.97 |
| Rate for Payer: Aetna Commercial |
$173.89
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$157.41
|
| Rate for Payer: Aetna Managed Medicare |
$136.81
|
| Rate for Payer: Anthem Commercial |
$34.77
|
| Rate for Payer: Anthem Medicare Advantage |
$136.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$136.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$136.81
|
| Rate for Payer: Cash Price |
$52.80
|
| Rate for Payer: Cash Price |
$52.80
|
| Rate for Payer: Cigna Commercial |
$173.89
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$91.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$136.81
|
| Rate for Payer: Health EOS Commercial |
$166.57
|
| Rate for Payer: HFN Commercial |
$173.89
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$508.24
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$508.24
|
| Rate for Payer: Independent Care Health Plan Medicare |
$136.81
|
| Rate for Payer: Multiplan Commercial |
$146.43
|
| Rate for Payer: NAPHCARE Commercial |
$205.22
|
| Rate for Payer: Preferred Network Access Commercial |
$173.89
|
| Rate for Payer: Quartz Beloit One Network |
$80.54
|
| Rate for Payer: Quartz Commercial |
$104.33
|
| Rate for Payer: Quartz Medicare Advantage |
$136.81
|
| Rate for Payer: The Alliance Commercial |
$540.41
|
| Rate for Payer: United Healthcare Medicare Advantage |
$136.81
|
| Rate for Payer: WEA Trust Commercial |
$100.67
|
| Rate for Payer: WPS Commercial |
$601.97
|
|
|
IgG, IgA, Indirect Immunofluorescence
|
Facility
|
IP
|
$176.00
|
|
|
Service Code
|
CPT 88346
|
| Hospital Charge Code |
1124806
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$89.69 |
| Max. Negotiated Rate |
$168.40 |
| Rate for Payer: Aetna Commercial |
$164.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$157.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$97.01
|
| Rate for Payer: Cash Price |
$52.80
|
| Rate for Payer: Cigna Commercial |
$168.40
|
| Rate for Payer: Health EOS Commercial |
$162.91
|
| Rate for Payer: HFN Commercial |
$168.40
|
| Rate for Payer: Multiplan Commercial |
$146.43
|
| Rate for Payer: Preferred Network Access Commercial |
$168.40
|
| Rate for Payer: Quartz Beloit One Network |
$89.69
|
| Rate for Payer: Quartz Commercial |
$109.82
|
| Rate for Payer: WEA Trust Commercial |
$100.67
|
| Rate for Payer: WPS Commercial |
$135.57
|
|
|
IgG Index CSF
|
Professional
|
Both
|
$175.00
|
|
|
Service Code
|
CPT 82784
|
| Hospital Charge Code |
2959001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.67 |
| Max. Negotiated Rate |
$172.90 |
| Rate for Payer: Aetna Commercial |
$172.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$156.52
|
| Rate for Payer: Aetna Managed Medicare |
$9.67
|
| Rate for Payer: Anthem Medicare Advantage |
$9.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$9.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$9.67
|
| Rate for Payer: Cash Price |
$52.50
|
| Rate for Payer: Cash Price |
$52.50
|
| Rate for Payer: Cigna Commercial |
$172.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$91.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$9.67
|
| Rate for Payer: Health EOS Commercial |
$165.62
|
| Rate for Payer: HFN Commercial |
$172.90
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$34.14
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$34.14
|
| Rate for Payer: Independent Care Health Plan Medicare |
$9.67
|
| Rate for Payer: Multiplan Commercial |
$145.60
|
| Rate for Payer: NAPHCARE Commercial |
$14.51
|
| Rate for Payer: Preferred Network Access Commercial |
$172.90
|
| Rate for Payer: Quartz Beloit One Network |
$80.08
|
| Rate for Payer: Quartz Commercial |
$103.74
|
| Rate for Payer: Quartz Medicare Advantage |
$9.67
|
| Rate for Payer: The Alliance Commercial |
$38.20
|
| Rate for Payer: United Healthcare Medicare Advantage |
$9.67
|
| Rate for Payer: WEA Trust Commercial |
$100.10
|
| Rate for Payer: WPS Commercial |
$42.56
|
|
|
IgG Index CSF
|
Facility
|
IP
|
$175.00
|
|
|
Service Code
|
CPT 82784
|
| Hospital Charge Code |
2959001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$89.18 |
| Max. Negotiated Rate |
$167.44 |
| Rate for Payer: Aetna Commercial |
$163.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$156.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$96.46
|
| Rate for Payer: Cash Price |
$52.50
|
| Rate for Payer: Cigna Commercial |
$167.44
|
| Rate for Payer: Health EOS Commercial |
$161.98
|
| Rate for Payer: HFN Commercial |
$167.44
|
| Rate for Payer: Multiplan Commercial |
$145.60
|
| Rate for Payer: Preferred Network Access Commercial |
$167.44
|
| Rate for Payer: Quartz Beloit One Network |
$89.18
|
| Rate for Payer: Quartz Commercial |
$109.20
|
| Rate for Payer: WEA Trust Commercial |
$100.10
|
| Rate for Payer: WPS Commercial |
$134.80
|
|
|
IgG Index CSF
|
Facility
|
OP
|
$175.00
|
|
|
Service Code
|
CPT 82784
|
| Hospital Charge Code |
2959001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.67 |
| Max. Negotiated Rate |
$167.44 |
| Rate for Payer: Aetna Commercial |
$163.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$156.52
|
| Rate for Payer: Aetna Managed Medicare |
$9.67
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$36.27
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$16.93
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$16.06
|
| Rate for Payer: Anthem Medicare Advantage |
$9.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$96.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$9.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$9.67
|
| Rate for Payer: Cash Price |
$52.50
|
| Rate for Payer: Cash Price |
$52.50
|
| Rate for Payer: Cigna Commercial |
$167.44
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$9.67
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$101.85
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$9.67
|
| Rate for Payer: Health EOS Commercial |
$161.98
|
| Rate for Payer: HFN Commercial |
$167.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$35.98
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$9.67
|
| Rate for Payer: Independent Care Health Plan Medicare |
$9.67
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$9.67
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$9.67
|
| Rate for Payer: Multiplan Commercial |
$145.60
|
| Rate for Payer: NAPHCARE Commercial |
$14.51
|
| Rate for Payer: Preferred Network Access Commercial |
$167.44
|
| Rate for Payer: Quartz Beloit One Network |
$89.18
|
| Rate for Payer: Quartz Commercial |
$118.30
|
| Rate for Payer: Quartz Medicare Advantage |
$9.67
|
| Rate for Payer: The Alliance Commercial |
$38.69
|
| Rate for Payer: United Healthcare Medicare Advantage |
$9.67
|
| Rate for Payer: United Healthcare PPO |
$136.50
|
| Rate for Payer: WEA Trust Commercial |
$100.10
|
| Rate for Payer: Wellcare Medicare |
$9.67
|
| Rate for Payer: WPS Commercial |
$134.80
|
|
|
IgG MS Pnl 2
|
Facility
|
IP
|
$188.00
|
|
|
Service Code
|
CPT 82784
|
| Hospital Charge Code |
4109308
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$95.80 |
| Max. Negotiated Rate |
$179.88 |
| Rate for Payer: Aetna Commercial |
$175.97
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$168.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$103.63
|
| Rate for Payer: Cash Price |
$56.40
|
| Rate for Payer: Cigna Commercial |
$179.88
|
| Rate for Payer: Health EOS Commercial |
$174.01
|
| Rate for Payer: HFN Commercial |
$179.88
|
| Rate for Payer: Multiplan Commercial |
$156.42
|
| Rate for Payer: Preferred Network Access Commercial |
$179.88
|
| Rate for Payer: Quartz Beloit One Network |
$95.80
|
| Rate for Payer: Quartz Commercial |
$117.31
|
| Rate for Payer: WEA Trust Commercial |
$107.54
|
| Rate for Payer: WPS Commercial |
$144.82
|
|
|
IgG MS Pnl 2
|
Facility
|
OP
|
$188.00
|
|
|
Service Code
|
CPT 82784
|
| Hospital Charge Code |
4109308
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.67 |
| Max. Negotiated Rate |
$179.88 |
| Rate for Payer: Aetna Commercial |
$175.97
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$168.15
|
| Rate for Payer: Aetna Managed Medicare |
$9.67
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$36.27
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$16.93
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$16.06
|
| Rate for Payer: Anthem Medicare Advantage |
$9.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$103.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$9.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$9.67
|
| Rate for Payer: Cash Price |
$56.40
|
| Rate for Payer: Cash Price |
$56.40
|
| Rate for Payer: Cigna Commercial |
$179.88
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$9.67
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$109.42
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$9.67
|
| Rate for Payer: Health EOS Commercial |
$174.01
|
| Rate for Payer: HFN Commercial |
$179.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$35.98
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$9.67
|
| Rate for Payer: Independent Care Health Plan Medicare |
$9.67
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$9.67
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$9.67
|
| Rate for Payer: Multiplan Commercial |
$156.42
|
| Rate for Payer: NAPHCARE Commercial |
$14.51
|
| Rate for Payer: Preferred Network Access Commercial |
$179.88
|
| Rate for Payer: Quartz Beloit One Network |
$95.80
|
| Rate for Payer: Quartz Commercial |
$127.09
|
| Rate for Payer: Quartz Medicare Advantage |
$9.67
|
| Rate for Payer: The Alliance Commercial |
$38.69
|
| Rate for Payer: United Healthcare Medicare Advantage |
$9.67
|
| Rate for Payer: United Healthcare PPO |
$146.64
|
| Rate for Payer: WEA Trust Commercial |
$107.54
|
| Rate for Payer: Wellcare Medicare |
$9.67
|
| Rate for Payer: WPS Commercial |
$144.82
|
|
|
IgG MS Pnl 2
|
Professional
|
Both
|
$188.00
|
|
|
Service Code
|
CPT 82784
|
| Hospital Charge Code |
4109308
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.67 |
| Max. Negotiated Rate |
$185.74 |
| Rate for Payer: Aetna Commercial |
$185.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$168.15
|
| Rate for Payer: Aetna Managed Medicare |
$9.67
|
| Rate for Payer: Anthem Medicare Advantage |
$9.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$9.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$9.67
|
| Rate for Payer: Cash Price |
$56.40
|
| Rate for Payer: Cash Price |
$56.40
|
| Rate for Payer: Cigna Commercial |
$185.74
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$97.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$9.67
|
| Rate for Payer: Health EOS Commercial |
$177.92
|
| Rate for Payer: HFN Commercial |
$185.74
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$34.14
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$34.14
|
| Rate for Payer: Independent Care Health Plan Medicare |
$9.67
|
| Rate for Payer: Multiplan Commercial |
$156.42
|
| Rate for Payer: NAPHCARE Commercial |
$14.51
|
| Rate for Payer: Preferred Network Access Commercial |
$185.74
|
| Rate for Payer: Quartz Beloit One Network |
$86.03
|
| Rate for Payer: Quartz Commercial |
$111.45
|
| Rate for Payer: Quartz Medicare Advantage |
$9.67
|
| Rate for Payer: The Alliance Commercial |
$38.20
|
| Rate for Payer: United Healthcare Medicare Advantage |
$9.67
|
| Rate for Payer: WEA Trust Commercial |
$107.54
|
| Rate for Payer: WPS Commercial |
$42.56
|
|
|
IgG Subclass 2
|
Facility
|
OP
|
$242.00
|
|
|
Service Code
|
CPT 82787
|
| Hospital Charge Code |
2942924
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.34 |
| Max. Negotiated Rate |
$231.55 |
| Rate for Payer: Aetna Commercial |
$226.51
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$216.44
|
| Rate for Payer: Aetna Managed Medicare |
$8.34
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$31.28
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$14.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$13.85
|
| Rate for Payer: Anthem Medicare Advantage |
$8.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$133.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$8.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$8.34
|
| Rate for Payer: Cash Price |
$72.60
|
| Rate for Payer: Cash Price |
$72.60
|
| Rate for Payer: Cigna Commercial |
$231.55
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$8.34
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$140.84
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$8.34
|
| Rate for Payer: Health EOS Commercial |
$224.00
|
| Rate for Payer: HFN Commercial |
$231.55
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$31.03
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$8.34
|
| Rate for Payer: Independent Care Health Plan Medicare |
$8.34
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$8.34
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$8.34
|
| Rate for Payer: Multiplan Commercial |
$201.34
|
| Rate for Payer: NAPHCARE Commercial |
$12.51
|
| Rate for Payer: Preferred Network Access Commercial |
$231.55
|
| Rate for Payer: Quartz Beloit One Network |
$123.32
|
| Rate for Payer: Quartz Commercial |
$163.59
|
| Rate for Payer: Quartz Medicare Advantage |
$8.34
|
| Rate for Payer: The Alliance Commercial |
$33.36
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8.34
|
| Rate for Payer: United Healthcare PPO |
$188.76
|
| Rate for Payer: WEA Trust Commercial |
$138.42
|
| Rate for Payer: Wellcare Medicare |
$8.34
|
| Rate for Payer: WPS Commercial |
$186.41
|
|
|
IgG Subclass 2
|
Professional
|
Both
|
$242.00
|
|
|
Service Code
|
CPT 82787
|
| Hospital Charge Code |
2942924
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.34 |
| Max. Negotiated Rate |
$239.10 |
| Rate for Payer: Aetna Commercial |
$239.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$216.44
|
| Rate for Payer: Aetna Managed Medicare |
$8.34
|
| Rate for Payer: Anthem Medicare Advantage |
$8.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$8.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$8.34
|
| Rate for Payer: Cash Price |
$72.60
|
| Rate for Payer: Cash Price |
$72.60
|
| Rate for Payer: Cigna Commercial |
$239.10
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$125.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$8.34
|
| Rate for Payer: Health EOS Commercial |
$229.03
|
| Rate for Payer: HFN Commercial |
$239.10
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$29.44
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$29.44
|
| Rate for Payer: Independent Care Health Plan Medicare |
$8.34
|
| Rate for Payer: Multiplan Commercial |
$201.34
|
| Rate for Payer: NAPHCARE Commercial |
$12.51
|
| Rate for Payer: Preferred Network Access Commercial |
$239.10
|
| Rate for Payer: Quartz Beloit One Network |
$110.74
|
| Rate for Payer: Quartz Commercial |
$143.46
|
| Rate for Payer: Quartz Medicare Advantage |
$8.34
|
| Rate for Payer: The Alliance Commercial |
$32.95
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8.34
|
| Rate for Payer: WEA Trust Commercial |
$138.42
|
| Rate for Payer: WPS Commercial |
$36.70
|
|
|
IgG Subclass 2
|
Facility
|
IP
|
$242.00
|
|
|
Service Code
|
CPT 82787
|
| Hospital Charge Code |
2942924
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$123.32 |
| Max. Negotiated Rate |
$231.55 |
| Rate for Payer: Aetna Commercial |
$226.51
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$216.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$133.39
|
| Rate for Payer: Cash Price |
$72.60
|
| Rate for Payer: Cigna Commercial |
$231.55
|
| Rate for Payer: Health EOS Commercial |
$224.00
|
| Rate for Payer: HFN Commercial |
$231.55
|
| Rate for Payer: Multiplan Commercial |
$201.34
|
| Rate for Payer: Preferred Network Access Commercial |
$231.55
|
| Rate for Payer: Quartz Beloit One Network |
$123.32
|
| Rate for Payer: Quartz Commercial |
$151.01
|
| Rate for Payer: WEA Trust Commercial |
$138.42
|
| Rate for Payer: WPS Commercial |
$186.41
|
|
|
IgG Subclass 3
|
Professional
|
Both
|
$242.00
|
|
|
Service Code
|
CPT 82787
|
| Hospital Charge Code |
2942925
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.34 |
| Max. Negotiated Rate |
$239.10 |
| Rate for Payer: Aetna Commercial |
$239.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$216.44
|
| Rate for Payer: Aetna Managed Medicare |
$8.34
|
| Rate for Payer: Anthem Medicare Advantage |
$8.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$8.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$8.34
|
| Rate for Payer: Cash Price |
$72.60
|
| Rate for Payer: Cash Price |
$72.60
|
| Rate for Payer: Cigna Commercial |
$239.10
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$125.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$8.34
|
| Rate for Payer: Health EOS Commercial |
$229.03
|
| Rate for Payer: HFN Commercial |
$239.10
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$29.44
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$29.44
|
| Rate for Payer: Independent Care Health Plan Medicare |
$8.34
|
| Rate for Payer: Multiplan Commercial |
$201.34
|
| Rate for Payer: NAPHCARE Commercial |
$12.51
|
| Rate for Payer: Preferred Network Access Commercial |
$239.10
|
| Rate for Payer: Quartz Beloit One Network |
$110.74
|
| Rate for Payer: Quartz Commercial |
$143.46
|
| Rate for Payer: Quartz Medicare Advantage |
$8.34
|
| Rate for Payer: The Alliance Commercial |
$32.95
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8.34
|
| Rate for Payer: WEA Trust Commercial |
$138.42
|
| Rate for Payer: WPS Commercial |
$36.70
|
|
|
IgG Subclass 3
|
Facility
|
OP
|
$242.00
|
|
|
Service Code
|
CPT 82787
|
| Hospital Charge Code |
2942925
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.34 |
| Max. Negotiated Rate |
$231.55 |
| Rate for Payer: Aetna Commercial |
$226.51
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$216.44
|
| Rate for Payer: Aetna Managed Medicare |
$8.34
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$31.28
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$14.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$13.85
|
| Rate for Payer: Anthem Medicare Advantage |
$8.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$133.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$8.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$8.34
|
| Rate for Payer: Cash Price |
$72.60
|
| Rate for Payer: Cash Price |
$72.60
|
| Rate for Payer: Cigna Commercial |
$231.55
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$8.34
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$140.84
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$8.34
|
| Rate for Payer: Health EOS Commercial |
$224.00
|
| Rate for Payer: HFN Commercial |
$231.55
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$31.03
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$8.34
|
| Rate for Payer: Independent Care Health Plan Medicare |
$8.34
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$8.34
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$8.34
|
| Rate for Payer: Multiplan Commercial |
$201.34
|
| Rate for Payer: NAPHCARE Commercial |
$12.51
|
| Rate for Payer: Preferred Network Access Commercial |
$231.55
|
| Rate for Payer: Quartz Beloit One Network |
$123.32
|
| Rate for Payer: Quartz Commercial |
$163.59
|
| Rate for Payer: Quartz Medicare Advantage |
$8.34
|
| Rate for Payer: The Alliance Commercial |
$33.36
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8.34
|
| Rate for Payer: United Healthcare PPO |
$188.76
|
| Rate for Payer: WEA Trust Commercial |
$138.42
|
| Rate for Payer: Wellcare Medicare |
$8.34
|
| Rate for Payer: WPS Commercial |
$186.41
|
|
|
IgG Subclass 3
|
Facility
|
IP
|
$242.00
|
|
|
Service Code
|
CPT 82787
|
| Hospital Charge Code |
2942925
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$123.32 |
| Max. Negotiated Rate |
$231.55 |
| Rate for Payer: Aetna Commercial |
$226.51
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$216.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$133.39
|
| Rate for Payer: Cash Price |
$72.60
|
| Rate for Payer: Cigna Commercial |
$231.55
|
| Rate for Payer: Health EOS Commercial |
$224.00
|
| Rate for Payer: HFN Commercial |
$231.55
|
| Rate for Payer: Multiplan Commercial |
$201.34
|
| Rate for Payer: Preferred Network Access Commercial |
$231.55
|
| Rate for Payer: Quartz Beloit One Network |
$123.32
|
| Rate for Payer: Quartz Commercial |
$151.01
|
| Rate for Payer: WEA Trust Commercial |
$138.42
|
| Rate for Payer: WPS Commercial |
$186.41
|
|
|
IgG Subclass 4
|
Facility
|
OP
|
$242.00
|
|
|
Service Code
|
CPT 82787
|
| Hospital Charge Code |
2942926
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.34 |
| Max. Negotiated Rate |
$231.55 |
| Rate for Payer: Aetna Commercial |
$226.51
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$216.44
|
| Rate for Payer: Aetna Managed Medicare |
$8.34
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$31.28
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$14.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$13.85
|
| Rate for Payer: Anthem Medicare Advantage |
$8.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$133.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$8.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$8.34
|
| Rate for Payer: Cash Price |
$72.60
|
| Rate for Payer: Cash Price |
$72.60
|
| Rate for Payer: Cigna Commercial |
$231.55
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$8.34
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$140.84
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$8.34
|
| Rate for Payer: Health EOS Commercial |
$224.00
|
| Rate for Payer: HFN Commercial |
$231.55
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$31.03
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$8.34
|
| Rate for Payer: Independent Care Health Plan Medicare |
$8.34
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$8.34
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$8.34
|
| Rate for Payer: Multiplan Commercial |
$201.34
|
| Rate for Payer: NAPHCARE Commercial |
$12.51
|
| Rate for Payer: Preferred Network Access Commercial |
$231.55
|
| Rate for Payer: Quartz Beloit One Network |
$123.32
|
| Rate for Payer: Quartz Commercial |
$163.59
|
| Rate for Payer: Quartz Medicare Advantage |
$8.34
|
| Rate for Payer: The Alliance Commercial |
$33.36
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8.34
|
| Rate for Payer: United Healthcare PPO |
$188.76
|
| Rate for Payer: WEA Trust Commercial |
$138.42
|
| Rate for Payer: Wellcare Medicare |
$8.34
|
| Rate for Payer: WPS Commercial |
$186.41
|
|
|
IgG Subclass 4
|
Professional
|
Both
|
$242.00
|
|
|
Service Code
|
CPT 82787
|
| Hospital Charge Code |
2942926
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.34 |
| Max. Negotiated Rate |
$239.10 |
| Rate for Payer: Aetna Commercial |
$239.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$216.44
|
| Rate for Payer: Aetna Managed Medicare |
$8.34
|
| Rate for Payer: Anthem Medicare Advantage |
$8.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$8.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$8.34
|
| Rate for Payer: Cash Price |
$72.60
|
| Rate for Payer: Cash Price |
$72.60
|
| Rate for Payer: Cigna Commercial |
$239.10
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$125.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$8.34
|
| Rate for Payer: Health EOS Commercial |
$229.03
|
| Rate for Payer: HFN Commercial |
$239.10
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$29.44
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$29.44
|
| Rate for Payer: Independent Care Health Plan Medicare |
$8.34
|
| Rate for Payer: Multiplan Commercial |
$201.34
|
| Rate for Payer: NAPHCARE Commercial |
$12.51
|
| Rate for Payer: Preferred Network Access Commercial |
$239.10
|
| Rate for Payer: Quartz Beloit One Network |
$110.74
|
| Rate for Payer: Quartz Commercial |
$143.46
|
| Rate for Payer: Quartz Medicare Advantage |
$8.34
|
| Rate for Payer: The Alliance Commercial |
$32.95
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8.34
|
| Rate for Payer: WEA Trust Commercial |
$138.42
|
| Rate for Payer: WPS Commercial |
$36.70
|
|
