|
IgA
|
Facility
|
OP
|
$245.00
|
|
|
Service Code
|
CPT 82784
|
| Hospital Charge Code |
977985
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.30 |
| Max. Negotiated Rate |
$225.40 |
| Rate for Payer: Aetna Commercial |
$220.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$210.70
|
| Rate for Payer: Aetna Managed Medicare |
$9.30
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$34.88
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$16.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$15.44
|
| Rate for Payer: Anthem Medicaid |
$9.61
|
| Rate for Payer: Anthem Medicare Advantage |
$9.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$129.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$9.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$9.30
|
| Rate for Payer: Cash Price |
$73.50
|
| Rate for Payer: Cash Price |
$73.50
|
| Rate for Payer: Cigna Commercial |
$225.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$9.30
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$9.61
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$137.10
|
| Rate for Payer: Dean Health Medicaid |
$9.61
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$9.30
|
| Rate for Payer: Health EOS Commercial |
$218.05
|
| Rate for Payer: HFN Commercial |
$225.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$34.60
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$9.30
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$9.61
|
| Rate for Payer: Independent Care Health Plan Medicare |
$9.30
|
| Rate for Payer: Managed Health Services Medicaid |
$9.99
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$9.30
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$9.30
|
| Rate for Payer: Multiplan Commercial |
$196.00
|
| Rate for Payer: NAPHCARE Commercial |
$13.95
|
| Rate for Payer: Preferred Network Access Commercial |
$225.40
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$9.61
|
| Rate for Payer: Quartz Beloit One Network |
$120.05
|
| Rate for Payer: Quartz Commercial |
$159.25
|
| Rate for Payer: Quartz Medicare Advantage |
$9.30
|
| Rate for Payer: The Alliance Commercial |
$37.20
|
| Rate for Payer: United Healthcare Medicaid |
$9.61
|
| Rate for Payer: United Healthcare Medicare Advantage |
$9.30
|
| Rate for Payer: United Healthcare PPO |
$183.75
|
| Rate for Payer: WEA Trust Commercial |
$134.75
|
| Rate for Payer: Wellcare Medicare |
$9.30
|
| Rate for Payer: WMAP Medicaid |
$9.61
|
| Rate for Payer: WPS Commercial |
$181.47
|
|
|
IGA
|
Professional
|
Both
|
$55.00
|
|
|
Service Code
|
CPT 82784
|
| Hospital Charge Code |
4592876
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$24.20 |
| Max. Negotiated Rate |
$52.25 |
| Rate for Payer: Aetna Commercial |
$52.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$47.30
|
| Rate for Payer: Cash Price |
$16.50
|
| Rate for Payer: Cash Price |
$16.50
|
| Rate for Payer: Cigna Commercial |
$52.25
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$27.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$33.00
|
| Rate for Payer: Health EOS Commercial |
$50.05
|
| Rate for Payer: HFN Commercial |
$52.25
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$32.83
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$32.83
|
| Rate for Payer: Multiplan Commercial |
$44.00
|
| Rate for Payer: Preferred Network Access Commercial |
$52.25
|
| Rate for Payer: Quartz Beloit One Network |
$24.20
|
| Rate for Payer: Quartz Commercial |
$31.35
|
| Rate for Payer: The Alliance Commercial |
$27.50
|
| Rate for Payer: WEA Trust Commercial |
$30.25
|
| Rate for Payer: WPS Commercial |
$40.74
|
|
|
IGA
|
Facility
|
OP
|
$55.00
|
|
|
Service Code
|
CPT 82784
|
| Hospital Charge Code |
4592876
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.30 |
| Max. Negotiated Rate |
$50.60 |
| Rate for Payer: Aetna Commercial |
$49.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$47.30
|
| Rate for Payer: Aetna Managed Medicare |
$9.30
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$34.88
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$16.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$15.44
|
| Rate for Payer: Anthem Medicaid |
$9.61
|
| Rate for Payer: Anthem Medicare Advantage |
$9.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$29.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$9.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$9.30
|
| Rate for Payer: Cash Price |
$16.50
|
| Rate for Payer: Cash Price |
$16.50
|
| Rate for Payer: Cigna Commercial |
$50.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$9.30
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$9.61
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$30.78
|
| Rate for Payer: Dean Health Medicaid |
$9.61
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$9.30
|
| Rate for Payer: Health EOS Commercial |
$48.95
|
| Rate for Payer: HFN Commercial |
$50.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$34.60
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$9.30
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$9.61
|
| Rate for Payer: Independent Care Health Plan Medicare |
$9.30
|
| Rate for Payer: Managed Health Services Medicaid |
$9.99
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$9.30
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$9.30
|
| Rate for Payer: Multiplan Commercial |
$44.00
|
| Rate for Payer: NAPHCARE Commercial |
$13.95
|
| Rate for Payer: Preferred Network Access Commercial |
$50.60
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$9.61
|
| Rate for Payer: Quartz Beloit One Network |
$26.95
|
| Rate for Payer: Quartz Commercial |
$35.75
|
| Rate for Payer: Quartz Medicare Advantage |
$9.30
|
| Rate for Payer: The Alliance Commercial |
$37.20
|
| Rate for Payer: United Healthcare Medicaid |
$9.61
|
| Rate for Payer: United Healthcare Medicare Advantage |
$9.30
|
| Rate for Payer: United Healthcare PPO |
$41.25
|
| Rate for Payer: WEA Trust Commercial |
$30.25
|
| Rate for Payer: Wellcare Medicare |
$9.30
|
| Rate for Payer: WMAP Medicaid |
$9.61
|
| Rate for Payer: WPS Commercial |
$40.74
|
|
|
IGA
|
Facility
|
IP
|
$55.00
|
|
|
Service Code
|
CPT 82784
|
| Hospital Charge Code |
4592876
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$26.95 |
| Max. Negotiated Rate |
$50.60 |
| Rate for Payer: Aetna Commercial |
$49.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$47.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$29.15
|
| Rate for Payer: Cash Price |
$16.50
|
| Rate for Payer: Cigna Commercial |
$50.60
|
| Rate for Payer: Health EOS Commercial |
$48.95
|
| Rate for Payer: HFN Commercial |
$50.60
|
| Rate for Payer: Multiplan Commercial |
$44.00
|
| Rate for Payer: NAPHCARE Commercial |
$33.00
|
| Rate for Payer: Preferred Network Access Commercial |
$50.60
|
| Rate for Payer: Quartz Beloit One Network |
$26.95
|
| Rate for Payer: Quartz Commercial |
$33.00
|
| Rate for Payer: WEA Trust Commercial |
$30.25
|
| Rate for Payer: WPS Commercial |
$40.74
|
|
|
IgD
|
Professional
|
Both
|
$146.00
|
|
|
Service Code
|
CPT 82784
|
| Hospital Charge Code |
1124801
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$32.83 |
| Max. Negotiated Rate |
$138.70 |
| Rate for Payer: Aetna Commercial |
$138.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$125.56
|
| Rate for Payer: Cash Price |
$43.80
|
| Rate for Payer: Cash Price |
$43.80
|
| Rate for Payer: Cigna Commercial |
$138.70
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$73.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$87.60
|
| Rate for Payer: Health EOS Commercial |
$132.86
|
| Rate for Payer: HFN Commercial |
$138.70
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$32.83
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$32.83
|
| Rate for Payer: Multiplan Commercial |
$116.80
|
| Rate for Payer: Preferred Network Access Commercial |
$138.70
|
| Rate for Payer: Quartz Beloit One Network |
$64.24
|
| Rate for Payer: Quartz Commercial |
$83.22
|
| Rate for Payer: The Alliance Commercial |
$73.00
|
| Rate for Payer: WEA Trust Commercial |
$80.30
|
| Rate for Payer: WPS Commercial |
$108.14
|
|
|
IgD
|
Facility
|
IP
|
$146.00
|
|
|
Service Code
|
CPT 82784
|
| Hospital Charge Code |
1124801
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$71.54 |
| Max. Negotiated Rate |
$134.32 |
| Rate for Payer: Aetna Commercial |
$131.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$125.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$77.38
|
| Rate for Payer: Cash Price |
$43.80
|
| Rate for Payer: Cigna Commercial |
$134.32
|
| Rate for Payer: Health EOS Commercial |
$129.94
|
| Rate for Payer: HFN Commercial |
$134.32
|
| Rate for Payer: Multiplan Commercial |
$116.80
|
| Rate for Payer: NAPHCARE Commercial |
$87.60
|
| Rate for Payer: Preferred Network Access Commercial |
$134.32
|
| Rate for Payer: Quartz Beloit One Network |
$71.54
|
| Rate for Payer: Quartz Commercial |
$87.60
|
| Rate for Payer: WEA Trust Commercial |
$80.30
|
| Rate for Payer: WPS Commercial |
$108.14
|
|
|
IgD
|
Facility
|
OP
|
$146.00
|
|
|
Service Code
|
CPT 82784
|
| Hospital Charge Code |
1124801
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.30 |
| Max. Negotiated Rate |
$134.32 |
| Rate for Payer: Aetna Commercial |
$131.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$125.56
|
| Rate for Payer: Aetna Managed Medicare |
$9.30
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$34.88
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$16.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$15.44
|
| Rate for Payer: Anthem Medicaid |
$9.61
|
| Rate for Payer: Anthem Medicare Advantage |
$9.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$77.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$9.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$9.30
|
| Rate for Payer: Cash Price |
$43.80
|
| Rate for Payer: Cash Price |
$43.80
|
| Rate for Payer: Cigna Commercial |
$134.32
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$9.30
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$9.61
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$81.70
|
| Rate for Payer: Dean Health Medicaid |
$9.61
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$9.30
|
| Rate for Payer: Health EOS Commercial |
$129.94
|
| Rate for Payer: HFN Commercial |
$134.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$34.60
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$9.30
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$9.61
|
| Rate for Payer: Independent Care Health Plan Medicare |
$9.30
|
| Rate for Payer: Managed Health Services Medicaid |
$9.99
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$9.30
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$9.30
|
| Rate for Payer: Multiplan Commercial |
$116.80
|
| Rate for Payer: NAPHCARE Commercial |
$13.95
|
| Rate for Payer: Preferred Network Access Commercial |
$134.32
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$9.61
|
| Rate for Payer: Quartz Beloit One Network |
$71.54
|
| Rate for Payer: Quartz Commercial |
$94.90
|
| Rate for Payer: Quartz Medicare Advantage |
$9.30
|
| Rate for Payer: The Alliance Commercial |
$37.20
|
| Rate for Payer: United Healthcare Medicaid |
$9.61
|
| Rate for Payer: United Healthcare Medicare Advantage |
$9.30
|
| Rate for Payer: United Healthcare PPO |
$109.50
|
| Rate for Payer: WEA Trust Commercial |
$80.30
|
| Rate for Payer: Wellcare Medicare |
$9.30
|
| Rate for Payer: WMAP Medicaid |
$9.61
|
| Rate for Payer: WPS Commercial |
$108.14
|
|
|
IgE
|
Facility
|
IP
|
$242.00
|
|
|
Service Code
|
CPT 82785
|
| Hospital Charge Code |
977986
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$118.58 |
| Max. Negotiated Rate |
$222.64 |
| Rate for Payer: Aetna Commercial |
$217.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$208.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$128.26
|
| Rate for Payer: Cash Price |
$72.60
|
| Rate for Payer: Cigna Commercial |
$222.64
|
| Rate for Payer: Health EOS Commercial |
$215.38
|
| Rate for Payer: HFN Commercial |
$222.64
|
| Rate for Payer: Multiplan Commercial |
$193.60
|
| Rate for Payer: NAPHCARE Commercial |
$145.20
|
| Rate for Payer: Preferred Network Access Commercial |
$222.64
|
| Rate for Payer: Quartz Beloit One Network |
$118.58
|
| Rate for Payer: Quartz Commercial |
$145.20
|
| Rate for Payer: WEA Trust Commercial |
$133.10
|
| Rate for Payer: WPS Commercial |
$179.25
|
|
|
IgE
|
Facility
|
OP
|
$227.00
|
|
|
Service Code
|
CPT 82785
|
| Hospital Charge Code |
3215515
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$16.46 |
| Max. Negotiated Rate |
$208.84 |
| Rate for Payer: Aetna Commercial |
$204.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$195.22
|
| Rate for Payer: Aetna Managed Medicare |
$16.46
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$61.72
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$28.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$27.32
|
| Rate for Payer: Anthem Medicaid |
$17.01
|
| Rate for Payer: Anthem Medicare Advantage |
$16.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$120.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$16.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$16.46
|
| Rate for Payer: Cash Price |
$68.10
|
| Rate for Payer: Cash Price |
$68.10
|
| Rate for Payer: Cigna Commercial |
$208.84
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$16.46
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$17.01
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$127.03
|
| Rate for Payer: Dean Health Medicaid |
$17.01
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$16.46
|
| Rate for Payer: Health EOS Commercial |
$202.03
|
| Rate for Payer: HFN Commercial |
$208.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$61.23
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$16.46
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$17.01
|
| Rate for Payer: Independent Care Health Plan Medicare |
$16.46
|
| Rate for Payer: Managed Health Services Medicaid |
$17.69
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$16.46
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$16.46
|
| Rate for Payer: Multiplan Commercial |
$181.60
|
| Rate for Payer: NAPHCARE Commercial |
$24.69
|
| Rate for Payer: Preferred Network Access Commercial |
$208.84
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$17.01
|
| Rate for Payer: Quartz Beloit One Network |
$111.23
|
| Rate for Payer: Quartz Commercial |
$147.55
|
| Rate for Payer: Quartz Medicare Advantage |
$16.46
|
| Rate for Payer: The Alliance Commercial |
$65.84
|
| Rate for Payer: United Healthcare Medicaid |
$17.01
|
| Rate for Payer: United Healthcare Medicare Advantage |
$16.46
|
| Rate for Payer: United Healthcare PPO |
$170.25
|
| Rate for Payer: WEA Trust Commercial |
$124.85
|
| Rate for Payer: Wellcare Medicare |
$16.46
|
| Rate for Payer: WMAP Medicaid |
$17.01
|
| Rate for Payer: WPS Commercial |
$168.14
|
|
|
IgE
|
Facility
|
IP
|
$227.00
|
|
|
Service Code
|
CPT 82785
|
| Hospital Charge Code |
3215515
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$111.23 |
| Max. Negotiated Rate |
$208.84 |
| Rate for Payer: Aetna Commercial |
$204.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$195.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$120.31
|
| Rate for Payer: Cash Price |
$68.10
|
| Rate for Payer: Cigna Commercial |
$208.84
|
| Rate for Payer: Health EOS Commercial |
$202.03
|
| Rate for Payer: HFN Commercial |
$208.84
|
| Rate for Payer: Multiplan Commercial |
$181.60
|
| Rate for Payer: NAPHCARE Commercial |
$136.20
|
| Rate for Payer: Preferred Network Access Commercial |
$208.84
|
| Rate for Payer: Quartz Beloit One Network |
$111.23
|
| Rate for Payer: Quartz Commercial |
$136.20
|
| Rate for Payer: WEA Trust Commercial |
$124.85
|
| Rate for Payer: WPS Commercial |
$168.14
|
|
|
IgE
|
Professional
|
Both
|
$242.00
|
|
|
Service Code
|
CPT 82785
|
| Hospital Charge Code |
977986
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$58.10 |
| Max. Negotiated Rate |
$229.90 |
| Rate for Payer: Aetna Commercial |
$229.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$208.12
|
| Rate for Payer: Cash Price |
$72.60
|
| Rate for Payer: Cash Price |
$72.60
|
| Rate for Payer: Cigna Commercial |
$229.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$121.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$145.20
|
| Rate for Payer: Health EOS Commercial |
$220.22
|
| Rate for Payer: HFN Commercial |
$229.90
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$58.10
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$58.10
|
| Rate for Payer: Multiplan Commercial |
$193.60
|
| Rate for Payer: Preferred Network Access Commercial |
$229.90
|
| Rate for Payer: Quartz Beloit One Network |
$106.48
|
| Rate for Payer: Quartz Commercial |
$137.94
|
| Rate for Payer: The Alliance Commercial |
$121.00
|
| Rate for Payer: WEA Trust Commercial |
$133.10
|
| Rate for Payer: WPS Commercial |
$179.25
|
|
|
IgE
|
Facility
|
OP
|
$242.00
|
|
|
Service Code
|
CPT 82785
|
| Hospital Charge Code |
977986
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$16.46 |
| Max. Negotiated Rate |
$222.64 |
| Rate for Payer: Aetna Commercial |
$217.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$208.12
|
| Rate for Payer: Aetna Managed Medicare |
$16.46
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$61.72
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$28.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$27.32
|
| Rate for Payer: Anthem Medicaid |
$17.01
|
| Rate for Payer: Anthem Medicare Advantage |
$16.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$128.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$16.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$16.46
|
| Rate for Payer: Cash Price |
$72.60
|
| Rate for Payer: Cash Price |
$72.60
|
| Rate for Payer: Cigna Commercial |
$222.64
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$16.46
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$17.01
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$135.42
|
| Rate for Payer: Dean Health Medicaid |
$17.01
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$16.46
|
| Rate for Payer: Health EOS Commercial |
$215.38
|
| Rate for Payer: HFN Commercial |
$222.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$61.23
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$16.46
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$17.01
|
| Rate for Payer: Independent Care Health Plan Medicare |
$16.46
|
| Rate for Payer: Managed Health Services Medicaid |
$17.69
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$16.46
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$16.46
|
| Rate for Payer: Multiplan Commercial |
$193.60
|
| Rate for Payer: NAPHCARE Commercial |
$24.69
|
| Rate for Payer: Preferred Network Access Commercial |
$222.64
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$17.01
|
| Rate for Payer: Quartz Beloit One Network |
$118.58
|
| Rate for Payer: Quartz Commercial |
$157.30
|
| Rate for Payer: Quartz Medicare Advantage |
$16.46
|
| Rate for Payer: The Alliance Commercial |
$65.84
|
| Rate for Payer: United Healthcare Medicaid |
$17.01
|
| Rate for Payer: United Healthcare Medicare Advantage |
$16.46
|
| Rate for Payer: United Healthcare PPO |
$181.50
|
| Rate for Payer: WEA Trust Commercial |
$133.10
|
| Rate for Payer: Wellcare Medicare |
$16.46
|
| Rate for Payer: WMAP Medicaid |
$17.01
|
| Rate for Payer: WPS Commercial |
$179.25
|
|
|
IgE
|
Professional
|
Both
|
$227.00
|
|
|
Service Code
|
CPT 82785
|
| Hospital Charge Code |
3215515
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$58.10 |
| Max. Negotiated Rate |
$215.65 |
| Rate for Payer: Aetna Commercial |
$215.65
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$195.22
|
| Rate for Payer: Cash Price |
$68.10
|
| Rate for Payer: Cash Price |
$68.10
|
| Rate for Payer: Cigna Commercial |
$215.65
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$113.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$136.20
|
| Rate for Payer: Health EOS Commercial |
$206.57
|
| Rate for Payer: HFN Commercial |
$215.65
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$58.10
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$58.10
|
| Rate for Payer: Multiplan Commercial |
$181.60
|
| Rate for Payer: Preferred Network Access Commercial |
$215.65
|
| Rate for Payer: Quartz Beloit One Network |
$99.88
|
| Rate for Payer: Quartz Commercial |
$129.39
|
| Rate for Payer: The Alliance Commercial |
$113.50
|
| Rate for Payer: WEA Trust Commercial |
$124.85
|
| Rate for Payer: WPS Commercial |
$168.14
|
|
|
IgG
|
Facility
|
IP
|
$172.00
|
|
|
Service Code
|
CPT 82784
|
| Hospital Charge Code |
1114853
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$84.28 |
| Max. Negotiated Rate |
$158.24 |
| Rate for Payer: Aetna Commercial |
$154.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$147.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$91.16
|
| Rate for Payer: Cash Price |
$51.60
|
| Rate for Payer: Cigna Commercial |
$158.24
|
| Rate for Payer: Health EOS Commercial |
$153.08
|
| Rate for Payer: HFN Commercial |
$158.24
|
| Rate for Payer: Multiplan Commercial |
$137.60
|
| Rate for Payer: NAPHCARE Commercial |
$103.20
|
| Rate for Payer: Preferred Network Access Commercial |
$158.24
|
| Rate for Payer: Quartz Beloit One Network |
$84.28
|
| Rate for Payer: Quartz Commercial |
$103.20
|
| Rate for Payer: WEA Trust Commercial |
$94.60
|
| Rate for Payer: WPS Commercial |
$127.40
|
|
|
IgG
|
Facility
|
IP
|
$138.00
|
|
|
Service Code
|
CPT 82784
|
| Hospital Charge Code |
2958999
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$67.62 |
| Max. Negotiated Rate |
$126.96 |
| Rate for Payer: Aetna Commercial |
$124.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$118.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$73.14
|
| Rate for Payer: Cash Price |
$41.40
|
| Rate for Payer: Cigna Commercial |
$126.96
|
| Rate for Payer: Health EOS Commercial |
$122.82
|
| Rate for Payer: HFN Commercial |
$126.96
|
| Rate for Payer: Multiplan Commercial |
$110.40
|
| Rate for Payer: NAPHCARE Commercial |
$82.80
|
| Rate for Payer: Preferred Network Access Commercial |
$126.96
|
| Rate for Payer: Quartz Beloit One Network |
$67.62
|
| Rate for Payer: Quartz Commercial |
$82.80
|
| Rate for Payer: WEA Trust Commercial |
$75.90
|
| Rate for Payer: WPS Commercial |
$102.22
|
|
|
IgG
|
Professional
|
Both
|
$129.00
|
|
|
Service Code
|
CPT 82784
|
| Hospital Charge Code |
3313620
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$32.83 |
| Max. Negotiated Rate |
$122.55 |
| Rate for Payer: Aetna Commercial |
$122.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$110.94
|
| Rate for Payer: Cash Price |
$38.70
|
| Rate for Payer: Cash Price |
$38.70
|
| Rate for Payer: Cigna Commercial |
$122.55
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$64.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$77.40
|
| Rate for Payer: Health EOS Commercial |
$117.39
|
| Rate for Payer: HFN Commercial |
$122.55
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$32.83
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$32.83
|
| Rate for Payer: Multiplan Commercial |
$103.20
|
| Rate for Payer: Preferred Network Access Commercial |
$122.55
|
| Rate for Payer: Quartz Beloit One Network |
$56.76
|
| Rate for Payer: Quartz Commercial |
$73.53
|
| Rate for Payer: The Alliance Commercial |
$64.50
|
| Rate for Payer: WEA Trust Commercial |
$70.95
|
| Rate for Payer: WPS Commercial |
$95.55
|
|
|
IgG
|
Facility
|
OP
|
$129.00
|
|
|
Service Code
|
CPT 82784
|
| Hospital Charge Code |
3313620
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.30 |
| Max. Negotiated Rate |
$118.68 |
| Rate for Payer: Aetna Commercial |
$116.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$110.94
|
| Rate for Payer: Aetna Managed Medicare |
$9.30
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$34.88
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$16.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$15.44
|
| Rate for Payer: Anthem Medicaid |
$9.61
|
| Rate for Payer: Anthem Medicare Advantage |
$9.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$68.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$9.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$9.30
|
| Rate for Payer: Cash Price |
$38.70
|
| Rate for Payer: Cash Price |
$38.70
|
| Rate for Payer: Cigna Commercial |
$118.68
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$9.30
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$9.61
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$72.19
|
| Rate for Payer: Dean Health Medicaid |
$9.61
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$9.30
|
| Rate for Payer: Health EOS Commercial |
$114.81
|
| Rate for Payer: HFN Commercial |
$118.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$34.60
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$9.30
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$9.61
|
| Rate for Payer: Independent Care Health Plan Medicare |
$9.30
|
| Rate for Payer: Managed Health Services Medicaid |
$9.99
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$9.30
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$9.30
|
| Rate for Payer: Multiplan Commercial |
$103.20
|
| Rate for Payer: NAPHCARE Commercial |
$13.95
|
| Rate for Payer: Preferred Network Access Commercial |
$118.68
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$9.61
|
| Rate for Payer: Quartz Beloit One Network |
$63.21
|
| Rate for Payer: Quartz Commercial |
$83.85
|
| Rate for Payer: Quartz Medicare Advantage |
$9.30
|
| Rate for Payer: The Alliance Commercial |
$37.20
|
| Rate for Payer: United Healthcare Medicaid |
$9.61
|
| Rate for Payer: United Healthcare Medicare Advantage |
$9.30
|
| Rate for Payer: United Healthcare PPO |
$96.75
|
| Rate for Payer: WEA Trust Commercial |
$70.95
|
| Rate for Payer: Wellcare Medicare |
$9.30
|
| Rate for Payer: WMAP Medicaid |
$9.61
|
| Rate for Payer: WPS Commercial |
$95.55
|
|
|
IgG
|
Facility
|
IP
|
$245.00
|
|
|
Service Code
|
CPT 82784
|
| Hospital Charge Code |
977989
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$120.05 |
| Max. Negotiated Rate |
$225.40 |
| Rate for Payer: Aetna Commercial |
$220.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$210.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$129.85
|
| Rate for Payer: Cash Price |
$73.50
|
| Rate for Payer: Cigna Commercial |
$225.40
|
| Rate for Payer: Health EOS Commercial |
$218.05
|
| Rate for Payer: HFN Commercial |
$225.40
|
| Rate for Payer: Multiplan Commercial |
$196.00
|
| Rate for Payer: NAPHCARE Commercial |
$147.00
|
| Rate for Payer: Preferred Network Access Commercial |
$225.40
|
| Rate for Payer: Quartz Beloit One Network |
$120.05
|
| Rate for Payer: Quartz Commercial |
$147.00
|
| Rate for Payer: WEA Trust Commercial |
$134.75
|
| Rate for Payer: WPS Commercial |
$181.47
|
|
|
IgG
|
Facility
|
OP
|
$138.00
|
|
|
Service Code
|
CPT 82784
|
| Hospital Charge Code |
2958999
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.30 |
| Max. Negotiated Rate |
$126.96 |
| Rate for Payer: Aetna Commercial |
$124.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$118.68
|
| Rate for Payer: Aetna Managed Medicare |
$9.30
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$34.88
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$16.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$15.44
|
| Rate for Payer: Anthem Medicaid |
$9.61
|
| Rate for Payer: Anthem Medicare Advantage |
$9.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$73.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$9.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$9.30
|
| Rate for Payer: Cash Price |
$41.40
|
| Rate for Payer: Cash Price |
$41.40
|
| Rate for Payer: Cigna Commercial |
$126.96
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$9.30
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$9.61
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$77.22
|
| Rate for Payer: Dean Health Medicaid |
$9.61
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$9.30
|
| Rate for Payer: Health EOS Commercial |
$122.82
|
| Rate for Payer: HFN Commercial |
$126.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$34.60
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$9.30
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$9.61
|
| Rate for Payer: Independent Care Health Plan Medicare |
$9.30
|
| Rate for Payer: Managed Health Services Medicaid |
$9.99
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$9.30
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$9.30
|
| Rate for Payer: Multiplan Commercial |
$110.40
|
| Rate for Payer: NAPHCARE Commercial |
$13.95
|
| Rate for Payer: Preferred Network Access Commercial |
$126.96
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$9.61
|
| Rate for Payer: Quartz Beloit One Network |
$67.62
|
| Rate for Payer: Quartz Commercial |
$89.70
|
| Rate for Payer: Quartz Medicare Advantage |
$9.30
|
| Rate for Payer: The Alliance Commercial |
$37.20
|
| Rate for Payer: United Healthcare Medicaid |
$9.61
|
| Rate for Payer: United Healthcare Medicare Advantage |
$9.30
|
| Rate for Payer: United Healthcare PPO |
$103.50
|
| Rate for Payer: WEA Trust Commercial |
$75.90
|
| Rate for Payer: Wellcare Medicare |
$9.30
|
| Rate for Payer: WMAP Medicaid |
$9.61
|
| Rate for Payer: WPS Commercial |
$102.22
|
|
|
IgG
|
Professional
|
Both
|
$245.00
|
|
|
Service Code
|
CPT 82784
|
| Hospital Charge Code |
977989
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$32.83 |
| Max. Negotiated Rate |
$232.75 |
| Rate for Payer: The Alliance Commercial |
$122.50
|
| Rate for Payer: WEA Trust Commercial |
$134.75
|
| Rate for Payer: WPS Commercial |
$181.47
|
| Rate for Payer: Aetna Commercial |
$232.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$210.70
|
| Rate for Payer: Cash Price |
$73.50
|
| Rate for Payer: Cash Price |
$73.50
|
| Rate for Payer: Cigna Commercial |
$232.75
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$122.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$147.00
|
| Rate for Payer: Health EOS Commercial |
$222.95
|
| Rate for Payer: HFN Commercial |
$232.75
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$32.83
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$32.83
|
| Rate for Payer: Multiplan Commercial |
$196.00
|
| Rate for Payer: Preferred Network Access Commercial |
$232.75
|
| Rate for Payer: Quartz Beloit One Network |
$107.80
|
| Rate for Payer: Quartz Commercial |
$139.65
|
|
|
IgG
|
Professional
|
Both
|
$138.00
|
|
|
Service Code
|
CPT 82784
|
| Hospital Charge Code |
2958999
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$32.83 |
| Max. Negotiated Rate |
$131.10 |
| Rate for Payer: Aetna Commercial |
$131.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$118.68
|
| Rate for Payer: Cash Price |
$41.40
|
| Rate for Payer: Cash Price |
$41.40
|
| Rate for Payer: Cigna Commercial |
$131.10
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$69.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$82.80
|
| Rate for Payer: Health EOS Commercial |
$125.58
|
| Rate for Payer: HFN Commercial |
$131.10
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$32.83
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$32.83
|
| Rate for Payer: Multiplan Commercial |
$110.40
|
| Rate for Payer: Preferred Network Access Commercial |
$131.10
|
| Rate for Payer: Quartz Beloit One Network |
$60.72
|
| Rate for Payer: Quartz Commercial |
$78.66
|
| Rate for Payer: The Alliance Commercial |
$69.00
|
| Rate for Payer: WEA Trust Commercial |
$75.90
|
| Rate for Payer: WPS Commercial |
$102.22
|
|
|
IgG
|
Facility
|
OP
|
$245.00
|
|
|
Service Code
|
CPT 82784
|
| Hospital Charge Code |
977989
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.30 |
| Max. Negotiated Rate |
$225.40 |
| Rate for Payer: Aetna Commercial |
$220.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$210.70
|
| Rate for Payer: Aetna Managed Medicare |
$9.30
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$34.88
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$16.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$15.44
|
| Rate for Payer: Anthem Medicaid |
$9.61
|
| Rate for Payer: Anthem Medicare Advantage |
$9.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$129.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$9.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$9.30
|
| Rate for Payer: Cash Price |
$73.50
|
| Rate for Payer: Cash Price |
$73.50
|
| Rate for Payer: Cigna Commercial |
$225.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$9.30
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$9.61
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$137.10
|
| Rate for Payer: Dean Health Medicaid |
$9.61
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$9.30
|
| Rate for Payer: Health EOS Commercial |
$218.05
|
| Rate for Payer: HFN Commercial |
$225.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$34.60
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$9.30
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$9.61
|
| Rate for Payer: Independent Care Health Plan Medicare |
$9.30
|
| Rate for Payer: Managed Health Services Medicaid |
$9.99
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$9.30
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$9.30
|
| Rate for Payer: Multiplan Commercial |
$196.00
|
| Rate for Payer: NAPHCARE Commercial |
$13.95
|
| Rate for Payer: Preferred Network Access Commercial |
$225.40
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$9.61
|
| Rate for Payer: Quartz Beloit One Network |
$120.05
|
| Rate for Payer: Quartz Commercial |
$159.25
|
| Rate for Payer: Quartz Medicare Advantage |
$9.30
|
| Rate for Payer: The Alliance Commercial |
$37.20
|
| Rate for Payer: United Healthcare Medicaid |
$9.61
|
| Rate for Payer: United Healthcare Medicare Advantage |
$9.30
|
| Rate for Payer: United Healthcare PPO |
$183.75
|
| Rate for Payer: WEA Trust Commercial |
$134.75
|
| Rate for Payer: Wellcare Medicare |
$9.30
|
| Rate for Payer: WMAP Medicaid |
$9.61
|
| Rate for Payer: WPS Commercial |
$181.47
|
|
|
IgG
|
Facility
|
OP
|
$172.00
|
|
|
Service Code
|
CPT 82784
|
| Hospital Charge Code |
1114853
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.30 |
| Max. Negotiated Rate |
$158.24 |
| Rate for Payer: Aetna Commercial |
$154.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$147.92
|
| Rate for Payer: Aetna Managed Medicare |
$9.30
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$34.88
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$16.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$15.44
|
| Rate for Payer: Anthem Medicaid |
$9.61
|
| Rate for Payer: Anthem Medicare Advantage |
$9.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$91.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$9.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$9.30
|
| Rate for Payer: Cash Price |
$51.60
|
| Rate for Payer: Cash Price |
$51.60
|
| Rate for Payer: Cigna Commercial |
$158.24
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$9.30
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$9.61
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$96.25
|
| Rate for Payer: Dean Health Medicaid |
$9.61
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$9.30
|
| Rate for Payer: Health EOS Commercial |
$153.08
|
| Rate for Payer: HFN Commercial |
$158.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$34.60
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$9.30
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$9.61
|
| Rate for Payer: Independent Care Health Plan Medicare |
$9.30
|
| Rate for Payer: Managed Health Services Medicaid |
$9.99
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$9.30
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$9.30
|
| Rate for Payer: Multiplan Commercial |
$137.60
|
| Rate for Payer: NAPHCARE Commercial |
$13.95
|
| Rate for Payer: Preferred Network Access Commercial |
$158.24
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$9.61
|
| Rate for Payer: Quartz Beloit One Network |
$84.28
|
| Rate for Payer: Quartz Commercial |
$111.80
|
| Rate for Payer: Quartz Medicare Advantage |
$9.30
|
| Rate for Payer: The Alliance Commercial |
$37.20
|
| Rate for Payer: United Healthcare Medicaid |
$9.61
|
| Rate for Payer: United Healthcare Medicare Advantage |
$9.30
|
| Rate for Payer: United Healthcare PPO |
$129.00
|
| Rate for Payer: WEA Trust Commercial |
$94.60
|
| Rate for Payer: Wellcare Medicare |
$9.30
|
| Rate for Payer: WMAP Medicaid |
$9.61
|
| Rate for Payer: WPS Commercial |
$127.40
|
|
|
IgG
|
Facility
|
IP
|
$129.00
|
|
|
Service Code
|
CPT 82784
|
| Hospital Charge Code |
3313620
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$63.21 |
| Max. Negotiated Rate |
$118.68 |
| Rate for Payer: Aetna Commercial |
$116.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$110.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$68.37
|
| Rate for Payer: Cash Price |
$38.70
|
| Rate for Payer: Cigna Commercial |
$118.68
|
| Rate for Payer: Health EOS Commercial |
$114.81
|
| Rate for Payer: HFN Commercial |
$118.68
|
| Rate for Payer: Multiplan Commercial |
$103.20
|
| Rate for Payer: NAPHCARE Commercial |
$77.40
|
| Rate for Payer: Preferred Network Access Commercial |
$118.68
|
| Rate for Payer: Quartz Beloit One Network |
$63.21
|
| Rate for Payer: Quartz Commercial |
$77.40
|
| Rate for Payer: WEA Trust Commercial |
$70.95
|
| Rate for Payer: WPS Commercial |
$95.55
|
|
|
IgG CSF
|
Facility
|
OP
|
$175.00
|
|
|
Service Code
|
CPT 82784
|
| Hospital Charge Code |
4109307
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.30 |
| Max. Negotiated Rate |
$161.00 |
| Rate for Payer: Aetna Commercial |
$157.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$150.50
|
| Rate for Payer: Aetna Managed Medicare |
$9.30
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$34.88
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$16.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$15.44
|
| Rate for Payer: Anthem Medicaid |
$9.61
|
| Rate for Payer: Anthem Medicare Advantage |
$9.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$92.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$9.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$9.30
|
| Rate for Payer: Cash Price |
$52.50
|
| Rate for Payer: Cash Price |
$52.50
|
| Rate for Payer: Cigna Commercial |
$161.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$9.30
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$9.61
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$97.93
|
| Rate for Payer: Dean Health Medicaid |
$9.61
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$9.30
|
| Rate for Payer: Health EOS Commercial |
$155.75
|
| Rate for Payer: HFN Commercial |
$161.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$34.60
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$9.30
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$9.61
|
| Rate for Payer: Independent Care Health Plan Medicare |
$9.30
|
| Rate for Payer: Managed Health Services Medicaid |
$9.99
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$9.30
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$9.30
|
| Rate for Payer: Multiplan Commercial |
$140.00
|
| Rate for Payer: NAPHCARE Commercial |
$13.95
|
| Rate for Payer: Preferred Network Access Commercial |
$161.00
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$9.61
|
| Rate for Payer: Quartz Beloit One Network |
$85.75
|
| Rate for Payer: Quartz Commercial |
$113.75
|
| Rate for Payer: Quartz Medicare Advantage |
$9.30
|
| Rate for Payer: The Alliance Commercial |
$37.20
|
| Rate for Payer: United Healthcare Medicaid |
$9.61
|
| Rate for Payer: United Healthcare Medicare Advantage |
$9.30
|
| Rate for Payer: United Healthcare PPO |
$131.25
|
| Rate for Payer: WEA Trust Commercial |
$96.25
|
| Rate for Payer: Wellcare Medicare |
$9.30
|
| Rate for Payer: WMAP Medicaid |
$9.61
|
| Rate for Payer: WPS Commercial |
$129.62
|
|
