|
IgG Subclass 4
|
Facility
|
IP
|
$242.00
|
|
|
Service Code
|
CPT 82787
|
| Hospital Charge Code |
2942926
|
|
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 Subclasses
|
Facility
|
OP
|
$359.00
|
|
|
Service Code
|
CPT 82787
|
| Hospital Charge Code |
977990
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.34 |
| Max. Negotiated Rate |
$343.49 |
| Rate for Payer: Aetna Commercial |
$336.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$321.09
|
| 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 |
$197.88
|
| 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 |
$107.70
|
| Rate for Payer: Cash Price |
$107.70
|
| Rate for Payer: Cigna Commercial |
$343.49
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$8.34
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$208.94
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$8.34
|
| Rate for Payer: Health EOS Commercial |
$332.29
|
| Rate for Payer: HFN Commercial |
$343.49
|
| 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 |
$298.69
|
| Rate for Payer: NAPHCARE Commercial |
$12.51
|
| Rate for Payer: Preferred Network Access Commercial |
$343.49
|
| Rate for Payer: Quartz Beloit One Network |
$182.95
|
| Rate for Payer: Quartz Commercial |
$242.68
|
| 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 |
$280.02
|
| Rate for Payer: WEA Trust Commercial |
$205.35
|
| Rate for Payer: Wellcare Medicare |
$8.34
|
| Rate for Payer: WPS Commercial |
$276.54
|
|
|
IgG Subclasses
|
Professional
|
Both
|
$359.00
|
|
|
Service Code
|
CPT 82787
|
| Hospital Charge Code |
977990
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.34 |
| Max. Negotiated Rate |
$354.69 |
| Rate for Payer: Aetna Commercial |
$354.69
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$321.09
|
| 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 |
$107.70
|
| Rate for Payer: Cash Price |
$107.70
|
| Rate for Payer: Cigna Commercial |
$354.69
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$186.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$8.34
|
| Rate for Payer: Health EOS Commercial |
$339.76
|
| Rate for Payer: HFN Commercial |
$354.69
|
| 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 |
$298.69
|
| Rate for Payer: NAPHCARE Commercial |
$12.51
|
| Rate for Payer: Preferred Network Access Commercial |
$354.69
|
| Rate for Payer: Quartz Beloit One Network |
$164.28
|
| Rate for Payer: Quartz Commercial |
$212.82
|
| 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 |
$205.35
|
| Rate for Payer: WPS Commercial |
$36.70
|
|
|
IgG Subclasses
|
Facility
|
IP
|
$359.00
|
|
|
Service Code
|
CPT 82787
|
| Hospital Charge Code |
977990
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$182.95 |
| Max. Negotiated Rate |
$343.49 |
| Rate for Payer: Aetna Commercial |
$336.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$321.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$197.88
|
| Rate for Payer: Cash Price |
$107.70
|
| Rate for Payer: Cigna Commercial |
$343.49
|
| Rate for Payer: Health EOS Commercial |
$332.29
|
| Rate for Payer: HFN Commercial |
$343.49
|
| Rate for Payer: Multiplan Commercial |
$298.69
|
| Rate for Payer: Preferred Network Access Commercial |
$343.49
|
| Rate for Payer: Quartz Beloit One Network |
$182.95
|
| Rate for Payer: Quartz Commercial |
$224.02
|
| Rate for Payer: WEA Trust Commercial |
$205.35
|
| Rate for Payer: WPS Commercial |
$276.54
|
|
|
IgG Synthesis Rate/Index, CSF
|
Professional
|
Both
|
$42.59
|
|
|
Service Code
|
CPT 82040
|
| Hospital Charge Code |
4109303
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.15 |
| Max. Negotiated Rate |
$42.08 |
| Rate for Payer: Aetna Commercial |
$42.08
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$38.09
|
| Rate for Payer: Aetna Managed Medicare |
$5.15
|
| Rate for Payer: Anthem Medicare Advantage |
$5.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5.15
|
| Rate for Payer: Cash Price |
$12.78
|
| Rate for Payer: Cash Price |
$12.78
|
| Rate for Payer: Cigna Commercial |
$42.08
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$22.15
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5.15
|
| Rate for Payer: Health EOS Commercial |
$40.31
|
| Rate for Payer: HFN Commercial |
$42.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$18.17
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$18.17
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5.15
|
| Rate for Payer: Multiplan Commercial |
$35.43
|
| Rate for Payer: NAPHCARE Commercial |
$7.72
|
| Rate for Payer: Preferred Network Access Commercial |
$42.08
|
| Rate for Payer: Quartz Beloit One Network |
$19.49
|
| Rate for Payer: Quartz Commercial |
$25.25
|
| Rate for Payer: Quartz Medicare Advantage |
$5.15
|
| Rate for Payer: The Alliance Commercial |
$20.33
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.15
|
| Rate for Payer: WEA Trust Commercial |
$24.36
|
| Rate for Payer: WPS Commercial |
$22.65
|
|
|
IgG Synthesis Rate/Index, CSF
|
Facility
|
OP
|
$42.59
|
|
|
Service Code
|
CPT 82040
|
| Hospital Charge Code |
4109303
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.15 |
| Max. Negotiated Rate |
$40.75 |
| Rate for Payer: Aetna Commercial |
$39.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$38.09
|
| Rate for Payer: Aetna Managed Medicare |
$5.15
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$19.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$9.01
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$8.55
|
| Rate for Payer: Anthem Medicare Advantage |
$5.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$23.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5.15
|
| Rate for Payer: Cash Price |
$12.78
|
| Rate for Payer: Cash Price |
$12.78
|
| Rate for Payer: Cigna Commercial |
$40.75
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$5.15
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$24.79
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$5.15
|
| Rate for Payer: Health EOS Commercial |
$39.42
|
| Rate for Payer: HFN Commercial |
$40.75
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$19.15
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$5.15
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5.15
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$5.15
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$5.15
|
| Rate for Payer: Multiplan Commercial |
$35.43
|
| Rate for Payer: NAPHCARE Commercial |
$7.72
|
| Rate for Payer: Preferred Network Access Commercial |
$40.75
|
| Rate for Payer: Quartz Beloit One Network |
$21.70
|
| Rate for Payer: Quartz Commercial |
$28.79
|
| Rate for Payer: Quartz Medicare Advantage |
$5.15
|
| Rate for Payer: The Alliance Commercial |
$20.59
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.15
|
| Rate for Payer: United Healthcare PPO |
$33.22
|
| Rate for Payer: WEA Trust Commercial |
$24.36
|
| Rate for Payer: Wellcare Medicare |
$5.15
|
| Rate for Payer: WPS Commercial |
$32.81
|
|
|
IgG Synthesis Rate/Index, CSF
|
Facility
|
IP
|
$42.59
|
|
|
Service Code
|
CPT 82040
|
| Hospital Charge Code |
4109303
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$21.70 |
| Max. Negotiated Rate |
$40.75 |
| Rate for Payer: Aetna Commercial |
$39.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$38.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$23.48
|
| Rate for Payer: Cash Price |
$12.78
|
| Rate for Payer: Cigna Commercial |
$40.75
|
| Rate for Payer: Health EOS Commercial |
$39.42
|
| Rate for Payer: HFN Commercial |
$40.75
|
| Rate for Payer: Multiplan Commercial |
$35.43
|
| Rate for Payer: Preferred Network Access Commercial |
$40.75
|
| Rate for Payer: Quartz Beloit One Network |
$21.70
|
| Rate for Payer: Quartz Commercial |
$26.58
|
| Rate for Payer: WEA Trust Commercial |
$24.36
|
| Rate for Payer: WPS Commercial |
$32.81
|
|
|
IgG Total
|
Facility
|
IP
|
$129.00
|
|
|
Service Code
|
CPT 82784
|
| Hospital Charge Code |
2942927
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$65.74 |
| Max. Negotiated Rate |
$123.43 |
| Rate for Payer: Aetna Commercial |
$120.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$115.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$71.10
|
| Rate for Payer: Cash Price |
$38.70
|
| Rate for Payer: Cigna Commercial |
$123.43
|
| Rate for Payer: Health EOS Commercial |
$119.40
|
| Rate for Payer: HFN Commercial |
$123.43
|
| Rate for Payer: Multiplan Commercial |
$107.33
|
| Rate for Payer: Preferred Network Access Commercial |
$123.43
|
| Rate for Payer: Quartz Beloit One Network |
$65.74
|
| Rate for Payer: Quartz Commercial |
$80.50
|
| Rate for Payer: WEA Trust Commercial |
$73.79
|
| Rate for Payer: WPS Commercial |
$99.37
|
|
|
IgG Total
|
Professional
|
Both
|
$129.00
|
|
|
Service Code
|
CPT 82784
|
| Hospital Charge Code |
2942927
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.67 |
| Max. Negotiated Rate |
$127.45 |
| Rate for Payer: Aetna Commercial |
$127.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$115.38
|
| 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 |
$38.70
|
| Rate for Payer: Cash Price |
$38.70
|
| Rate for Payer: Cigna Commercial |
$127.45
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$67.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$9.67
|
| Rate for Payer: Health EOS Commercial |
$122.09
|
| Rate for Payer: HFN Commercial |
$127.45
|
| 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 |
$107.33
|
| Rate for Payer: NAPHCARE Commercial |
$14.51
|
| Rate for Payer: Preferred Network Access Commercial |
$127.45
|
| Rate for Payer: Quartz Beloit One Network |
$59.03
|
| Rate for Payer: Quartz Commercial |
$76.47
|
| 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 |
$73.79
|
| Rate for Payer: WPS Commercial |
$42.56
|
|
|
IgG Total
|
Facility
|
OP
|
$129.00
|
|
|
Service Code
|
CPT 82784
|
| Hospital Charge Code |
2942927
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.67 |
| Max. Negotiated Rate |
$123.43 |
| Rate for Payer: Aetna Commercial |
$120.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$115.38
|
| 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 |
$71.10
|
| 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 |
$38.70
|
| Rate for Payer: Cash Price |
$38.70
|
| Rate for Payer: Cigna Commercial |
$123.43
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$9.67
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$75.08
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$9.67
|
| Rate for Payer: Health EOS Commercial |
$119.40
|
| Rate for Payer: HFN Commercial |
$123.43
|
| 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 |
$107.33
|
| Rate for Payer: NAPHCARE Commercial |
$14.51
|
| Rate for Payer: Preferred Network Access Commercial |
$123.43
|
| Rate for Payer: Quartz Beloit One Network |
$65.74
|
| Rate for Payer: Quartz Commercial |
$87.20
|
| 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 |
$100.62
|
| Rate for Payer: WEA Trust Commercial |
$73.79
|
| Rate for Payer: Wellcare Medicare |
$9.67
|
| Rate for Payer: WPS Commercial |
$99.37
|
|
|
IGH/BCL-2 Cytogenetics 88271
|
Facility
|
IP
|
$227.00
|
|
|
Service Code
|
CPT 88271
|
| Hospital Charge Code |
2776802
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$115.68 |
| Max. Negotiated Rate |
$217.19 |
| Rate for Payer: Aetna Commercial |
$212.47
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$203.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$125.12
|
| Rate for Payer: Cash Price |
$68.10
|
| Rate for Payer: Cigna Commercial |
$217.19
|
| Rate for Payer: Health EOS Commercial |
$210.11
|
| Rate for Payer: HFN Commercial |
$217.19
|
| Rate for Payer: Multiplan Commercial |
$188.86
|
| Rate for Payer: Preferred Network Access Commercial |
$217.19
|
| Rate for Payer: Quartz Beloit One Network |
$115.68
|
| Rate for Payer: Quartz Commercial |
$141.65
|
| Rate for Payer: WEA Trust Commercial |
$129.84
|
| Rate for Payer: WPS Commercial |
$174.86
|
|
|
IGH/BCL-2 Cytogenetics 88271
|
Facility
|
OP
|
$227.00
|
|
|
Service Code
|
CPT 88271
|
| Hospital Charge Code |
2776802
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$22.28 |
| Max. Negotiated Rate |
$217.19 |
| Rate for Payer: Aetna Commercial |
$212.47
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$203.03
|
| Rate for Payer: Aetna Managed Medicare |
$22.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$83.54
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$38.98
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$36.98
|
| Rate for Payer: Anthem Medicare Advantage |
$22.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$125.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$22.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$22.28
|
| Rate for Payer: Cash Price |
$68.10
|
| Rate for Payer: Cash Price |
$68.10
|
| Rate for Payer: Cigna Commercial |
$217.19
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$22.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$132.11
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$22.28
|
| Rate for Payer: Health EOS Commercial |
$210.11
|
| Rate for Payer: HFN Commercial |
$217.19
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$82.87
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$22.28
|
| Rate for Payer: Independent Care Health Plan Medicare |
$22.28
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$22.28
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$22.28
|
| Rate for Payer: Multiplan Commercial |
$188.86
|
| Rate for Payer: NAPHCARE Commercial |
$33.42
|
| Rate for Payer: Preferred Network Access Commercial |
$217.19
|
| Rate for Payer: Quartz Beloit One Network |
$115.68
|
| Rate for Payer: Quartz Commercial |
$153.45
|
| Rate for Payer: Quartz Medicare Advantage |
$22.28
|
| Rate for Payer: The Alliance Commercial |
$89.11
|
| Rate for Payer: United Healthcare Medicare Advantage |
$22.28
|
| Rate for Payer: United Healthcare PPO |
$177.06
|
| Rate for Payer: WEA Trust Commercial |
$129.84
|
| Rate for Payer: Wellcare Medicare |
$22.28
|
| Rate for Payer: WPS Commercial |
$174.86
|
|
|
IGH/BCL-2 Cytogenetics 88271
|
Professional
|
Both
|
$227.00
|
|
|
Service Code
|
CPT 88271
|
| Hospital Charge Code |
2776802
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$22.28 |
| Max. Negotiated Rate |
$224.28 |
| Rate for Payer: Aetna Commercial |
$224.28
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$203.03
|
| Rate for Payer: Aetna Managed Medicare |
$22.28
|
| Rate for Payer: Anthem Medicare Advantage |
$22.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$22.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$22.28
|
| Rate for Payer: Cash Price |
$68.10
|
| Rate for Payer: Cash Price |
$68.10
|
| Rate for Payer: Cigna Commercial |
$224.28
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$118.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$22.28
|
| Rate for Payer: Health EOS Commercial |
$214.83
|
| Rate for Payer: HFN Commercial |
$224.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$78.63
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$78.63
|
| Rate for Payer: Independent Care Health Plan Medicare |
$22.28
|
| Rate for Payer: Multiplan Commercial |
$188.86
|
| Rate for Payer: NAPHCARE Commercial |
$33.42
|
| Rate for Payer: Preferred Network Access Commercial |
$224.28
|
| Rate for Payer: Quartz Beloit One Network |
$103.88
|
| Rate for Payer: Quartz Commercial |
$134.57
|
| Rate for Payer: Quartz Medicare Advantage |
$22.28
|
| Rate for Payer: The Alliance Commercial |
$87.99
|
| Rate for Payer: United Healthcare Medicare Advantage |
$22.28
|
| Rate for Payer: WEA Trust Commercial |
$129.84
|
| Rate for Payer: WPS Commercial |
$98.02
|
|
|
IGH/BCL-2 Cytogenetics 88275
|
Professional
|
Both
|
$227.00
|
|
|
Service Code
|
CPT 88275
|
| Hospital Charge Code |
2776803
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$53.24 |
| Max. Negotiated Rate |
$234.25 |
| Rate for Payer: Aetna Commercial |
$224.28
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$203.03
|
| Rate for Payer: Aetna Managed Medicare |
$53.24
|
| Rate for Payer: Anthem Medicare Advantage |
$53.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$53.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$53.24
|
| Rate for Payer: Cash Price |
$68.10
|
| Rate for Payer: Cash Price |
$68.10
|
| Rate for Payer: Cigna Commercial |
$224.28
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$118.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$53.24
|
| Rate for Payer: Health EOS Commercial |
$214.83
|
| Rate for Payer: HFN Commercial |
$224.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$187.93
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$187.93
|
| Rate for Payer: Independent Care Health Plan Medicare |
$53.24
|
| Rate for Payer: Multiplan Commercial |
$188.86
|
| Rate for Payer: NAPHCARE Commercial |
$79.86
|
| Rate for Payer: Preferred Network Access Commercial |
$224.28
|
| Rate for Payer: Quartz Beloit One Network |
$103.88
|
| Rate for Payer: Quartz Commercial |
$134.57
|
| Rate for Payer: Quartz Medicare Advantage |
$53.24
|
| Rate for Payer: The Alliance Commercial |
$210.29
|
| Rate for Payer: United Healthcare Medicare Advantage |
$53.24
|
| Rate for Payer: WEA Trust Commercial |
$129.84
|
| Rate for Payer: WPS Commercial |
$234.25
|
|
|
IGH/BCL-2 Cytogenetics 88275
|
Facility
|
IP
|
$227.00
|
|
|
Service Code
|
CPT 88275
|
| Hospital Charge Code |
2776803
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$115.68 |
| Max. Negotiated Rate |
$217.19 |
| Rate for Payer: Aetna Commercial |
$212.47
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$203.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$125.12
|
| Rate for Payer: Cash Price |
$68.10
|
| Rate for Payer: Cigna Commercial |
$217.19
|
| Rate for Payer: Health EOS Commercial |
$210.11
|
| Rate for Payer: HFN Commercial |
$217.19
|
| Rate for Payer: Multiplan Commercial |
$188.86
|
| Rate for Payer: Preferred Network Access Commercial |
$217.19
|
| Rate for Payer: Quartz Beloit One Network |
$115.68
|
| Rate for Payer: Quartz Commercial |
$141.65
|
| Rate for Payer: WEA Trust Commercial |
$129.84
|
| Rate for Payer: WPS Commercial |
$174.86
|
|
|
IGH/BCL-2 Cytogenetics 88275
|
Facility
|
OP
|
$227.00
|
|
|
Service Code
|
CPT 88275
|
| Hospital Charge Code |
2776803
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$53.24 |
| Max. Negotiated Rate |
$217.19 |
| Rate for Payer: Aetna Commercial |
$212.47
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$203.03
|
| Rate for Payer: Aetna Managed Medicare |
$53.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$199.64
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$93.17
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$88.37
|
| Rate for Payer: Anthem Medicare Advantage |
$53.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$125.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$53.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$53.24
|
| Rate for Payer: Cash Price |
$68.10
|
| Rate for Payer: Cash Price |
$68.10
|
| Rate for Payer: Cigna Commercial |
$217.19
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$53.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$132.11
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$53.24
|
| Rate for Payer: Health EOS Commercial |
$210.11
|
| Rate for Payer: HFN Commercial |
$217.19
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$198.04
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$53.24
|
| Rate for Payer: Independent Care Health Plan Medicare |
$53.24
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$53.24
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$53.24
|
| Rate for Payer: Multiplan Commercial |
$188.86
|
| Rate for Payer: NAPHCARE Commercial |
$79.86
|
| Rate for Payer: Preferred Network Access Commercial |
$217.19
|
| Rate for Payer: Quartz Beloit One Network |
$115.68
|
| Rate for Payer: Quartz Commercial |
$153.45
|
| Rate for Payer: Quartz Medicare Advantage |
$53.24
|
| Rate for Payer: The Alliance Commercial |
$212.95
|
| Rate for Payer: United Healthcare Medicare Advantage |
$53.24
|
| Rate for Payer: United Healthcare PPO |
$177.06
|
| Rate for Payer: WEA Trust Commercial |
$129.84
|
| Rate for Payer: Wellcare Medicare |
$53.24
|
| Rate for Payer: WPS Commercial |
$174.86
|
|
|
IGH/BCL-2 Interp & Report
|
Professional
|
Both
|
$186.00
|
|
|
Service Code
|
CPT 88291
|
| Hospital Charge Code |
2776804
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.89 |
| Max. Negotiated Rate |
$183.77 |
| Rate for Payer: Aetna Commercial |
$183.77
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$166.36
|
| Rate for Payer: Aetna Managed Medicare |
$33.24
|
| Rate for Payer: Anthem Commercial |
$5.89
|
| Rate for Payer: Anthem Medicare Advantage |
$33.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$33.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$33.24
|
| Rate for Payer: Cash Price |
$55.80
|
| Rate for Payer: Cash Price |
$55.80
|
| Rate for Payer: Cigna Commercial |
$183.77
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$96.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$33.24
|
| Rate for Payer: Health EOS Commercial |
$176.03
|
| Rate for Payer: HFN Commercial |
$183.77
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$117.59
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$117.59
|
| Rate for Payer: Independent Care Health Plan Medicare |
$33.24
|
| Rate for Payer: Multiplan Commercial |
$154.75
|
| Rate for Payer: NAPHCARE Commercial |
$49.86
|
| Rate for Payer: Preferred Network Access Commercial |
$183.77
|
| Rate for Payer: Quartz Beloit One Network |
$85.11
|
| Rate for Payer: Quartz Commercial |
$110.26
|
| Rate for Payer: Quartz Medicare Advantage |
$33.24
|
| Rate for Payer: The Alliance Commercial |
$131.29
|
| Rate for Payer: United Healthcare Medicare Advantage |
$33.24
|
| Rate for Payer: WEA Trust Commercial |
$106.39
|
| Rate for Payer: WPS Commercial |
$146.25
|
|
|
IGH/BCL-2 Interp & Report
|
Facility
|
IP
|
$186.00
|
|
|
Service Code
|
CPT 88291
|
| Hospital Charge Code |
2776804
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$94.79 |
| Max. Negotiated Rate |
$177.96 |
| Rate for Payer: Aetna Commercial |
$174.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$166.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$102.52
|
| Rate for Payer: Cash Price |
$55.80
|
| Rate for Payer: Cigna Commercial |
$177.96
|
| Rate for Payer: Health EOS Commercial |
$172.16
|
| Rate for Payer: HFN Commercial |
$177.96
|
| Rate for Payer: Multiplan Commercial |
$154.75
|
| Rate for Payer: Preferred Network Access Commercial |
$177.96
|
| Rate for Payer: Quartz Beloit One Network |
$94.79
|
| Rate for Payer: Quartz Commercial |
$116.06
|
| Rate for Payer: WEA Trust Commercial |
$106.39
|
| Rate for Payer: WPS Commercial |
$143.28
|
|
|
IGH/BCL-2 Interp & Report
|
Facility
|
OP
|
$186.00
|
|
|
Service Code
|
CPT 88291
|
| Hospital Charge Code |
2776804
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$54.16 |
| Max. Negotiated Rate |
$177.96 |
| Rate for Payer: Aetna Commercial |
$174.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$166.36
|
| Rate for Payer: Aetna Managed Medicare |
$54.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$125.74
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$96.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$92.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$102.52
|
| Rate for Payer: Cash Price |
$55.80
|
| Rate for Payer: Cash Price |
$55.80
|
| Rate for Payer: Cigna Commercial |
$177.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$108.25
|
| Rate for Payer: Health EOS Commercial |
$172.16
|
| Rate for Payer: HFN Commercial |
$177.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$145.08
|
| Rate for Payer: Multiplan Commercial |
$154.75
|
| Rate for Payer: NAPHCARE Commercial |
$116.06
|
| Rate for Payer: Preferred Network Access Commercial |
$177.96
|
| Rate for Payer: Quartz Beloit One Network |
$94.79
|
| Rate for Payer: Quartz Commercial |
$125.74
|
| Rate for Payer: Quartz Medicare Advantage |
$116.06
|
| Rate for Payer: The Alliance Commercial |
$132.95
|
| Rate for Payer: United Healthcare PPO |
$145.08
|
| Rate for Payer: WEA Trust Commercial |
$106.39
|
| Rate for Payer: WPS Commercial |
$143.28
|
|
|
IgM
|
Facility
|
IP
|
$245.00
|
|
|
Service Code
|
CPT 82784
|
| Hospital Charge Code |
977991
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$124.85 |
| Max. Negotiated Rate |
$234.42 |
| Rate for Payer: Aetna Commercial |
$229.32
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$219.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$135.04
|
| Rate for Payer: Cash Price |
$73.50
|
| Rate for Payer: Cigna Commercial |
$234.42
|
| Rate for Payer: Health EOS Commercial |
$226.77
|
| Rate for Payer: HFN Commercial |
$234.42
|
| Rate for Payer: Multiplan Commercial |
$203.84
|
| Rate for Payer: Preferred Network Access Commercial |
$234.42
|
| Rate for Payer: Quartz Beloit One Network |
$124.85
|
| Rate for Payer: Quartz Commercial |
$152.88
|
| Rate for Payer: WEA Trust Commercial |
$140.14
|
| Rate for Payer: WPS Commercial |
$188.72
|
|
|
IgM
|
Professional
|
Both
|
$245.00
|
|
|
Service Code
|
CPT 82784
|
| Hospital Charge Code |
977991
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.67 |
| Max. Negotiated Rate |
$242.06 |
| Rate for Payer: Aetna Commercial |
$242.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$219.13
|
| 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 |
$73.50
|
| Rate for Payer: Cash Price |
$73.50
|
| Rate for Payer: Cigna Commercial |
$242.06
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$127.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$9.67
|
| Rate for Payer: Health EOS Commercial |
$231.87
|
| Rate for Payer: HFN Commercial |
$242.06
|
| 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 |
$203.84
|
| Rate for Payer: NAPHCARE Commercial |
$14.51
|
| Rate for Payer: Preferred Network Access Commercial |
$242.06
|
| Rate for Payer: Quartz Beloit One Network |
$112.11
|
| Rate for Payer: Quartz Commercial |
$145.24
|
| 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 |
$140.14
|
| Rate for Payer: WPS Commercial |
$42.56
|
|
|
IgM
|
Professional
|
Both
|
$177.00
|
|
|
Service Code
|
CPT 82784
|
| Hospital Charge Code |
2942928
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.67 |
| Max. Negotiated Rate |
$174.88 |
| Rate for Payer: Aetna Commercial |
$174.88
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$158.31
|
| Rate for Payer: Aetna Managed Medicare |
$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 |
$53.10
|
| Rate for Payer: Cash Price |
$53.10
|
| Rate for Payer: Cigna Commercial |
$174.88
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$92.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$9.67
|
| Rate for Payer: Health EOS Commercial |
$167.51
|
| Rate for Payer: HFN Commercial |
$174.88
|
| 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 |
$147.26
|
| Rate for Payer: NAPHCARE Commercial |
$14.51
|
| Rate for Payer: Preferred Network Access Commercial |
$174.88
|
| Rate for Payer: Quartz Beloit One Network |
$81.00
|
| Rate for Payer: Quartz Commercial |
$104.93
|
| Rate for Payer: Quartz Medicare Advantage |
$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 |
$101.24
|
| Rate for Payer: WPS Commercial |
$42.56
|
|
|
IgM
|
Facility
|
OP
|
$177.00
|
|
|
Service Code
|
CPT 82784
|
| Hospital Charge Code |
2942928
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.67 |
| Max. Negotiated Rate |
$169.35 |
| Rate for Payer: Aetna Commercial |
$165.67
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$158.31
|
| Rate for Payer: Aetna Managed Medicare |
$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 |
$97.56
|
| 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 |
$53.10
|
| Rate for Payer: Cash Price |
$53.10
|
| Rate for Payer: Cigna Commercial |
$169.35
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$9.67
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$103.01
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$9.67
|
| Rate for Payer: Health EOS Commercial |
$163.83
|
| Rate for Payer: HFN Commercial |
$169.35
|
| 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 |
$147.26
|
| Rate for Payer: NAPHCARE Commercial |
$14.51
|
| Rate for Payer: Preferred Network Access Commercial |
$169.35
|
| Rate for Payer: Quartz Beloit One Network |
$90.20
|
| Rate for Payer: Quartz Commercial |
$119.65
|
| Rate for Payer: Quartz Medicare Advantage |
$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 |
$138.06
|
| Rate for Payer: WEA Trust Commercial |
$101.24
|
| Rate for Payer: Wellcare Medicare |
$9.67
|
| Rate for Payer: WPS Commercial |
$136.34
|
|
|
IgM
|
Facility
|
IP
|
$177.00
|
|
|
Service Code
|
CPT 82784
|
| Hospital Charge Code |
2942928
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$90.20 |
| Max. Negotiated Rate |
$169.35 |
| Rate for Payer: Aetna Commercial |
$165.67
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$158.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$97.56
|
| Rate for Payer: Cash Price |
$53.10
|
| Rate for Payer: Cigna Commercial |
$169.35
|
| Rate for Payer: Health EOS Commercial |
$163.83
|
| Rate for Payer: HFN Commercial |
$169.35
|
| Rate for Payer: Multiplan Commercial |
$147.26
|
| Rate for Payer: Preferred Network Access Commercial |
$169.35
|
| Rate for Payer: Quartz Beloit One Network |
$90.20
|
| Rate for Payer: Quartz Commercial |
$110.45
|
| Rate for Payer: WEA Trust Commercial |
$101.24
|
| Rate for Payer: WPS Commercial |
$136.34
|
|
|
IgM
|
Facility
|
OP
|
$245.00
|
|
|
Service Code
|
CPT 82784
|
| Hospital Charge Code |
977991
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.67 |
| Max. Negotiated Rate |
$234.42 |
| Rate for Payer: Aetna Commercial |
$229.32
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$219.13
|
| 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 |
$135.04
|
| 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 |
$73.50
|
| Rate for Payer: Cash Price |
$73.50
|
| Rate for Payer: Cigna Commercial |
$234.42
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$9.67
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$142.59
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$9.67
|
| Rate for Payer: Health EOS Commercial |
$226.77
|
| Rate for Payer: HFN Commercial |
$234.42
|
| 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 |
$203.84
|
| Rate for Payer: NAPHCARE Commercial |
$14.51
|
| Rate for Payer: Preferred Network Access Commercial |
$234.42
|
| Rate for Payer: Quartz Beloit One Network |
$124.85
|
| Rate for Payer: Quartz Commercial |
$165.62
|
| 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 |
$191.10
|
| Rate for Payer: WEA Trust Commercial |
$140.14
|
| Rate for Payer: Wellcare Medicare |
$9.67
|
| Rate for Payer: WPS Commercial |
$188.72
|
|
