|
IgG CSF
|
Professional
|
Both
|
$175.00
|
|
|
Service Code
|
CPT 82784
|
| Hospital Charge Code |
4109307
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$32.83 |
| Max. Negotiated Rate |
$166.25 |
| Rate for Payer: Aetna Commercial |
$166.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$150.50
|
| Rate for Payer: Cash Price |
$52.50
|
| Rate for Payer: Cash Price |
$52.50
|
| Rate for Payer: Cigna Commercial |
$166.25
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$87.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$105.00
|
| Rate for Payer: Health EOS Commercial |
$159.25
|
| Rate for Payer: HFN Commercial |
$166.25
|
| 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 |
$140.00
|
| Rate for Payer: Preferred Network Access Commercial |
$166.25
|
| Rate for Payer: Quartz Beloit One Network |
$77.00
|
| Rate for Payer: Quartz Commercial |
$99.75
|
| Rate for Payer: The Alliance Commercial |
$87.50
|
| Rate for Payer: WEA Trust Commercial |
$96.25
|
| Rate for Payer: WPS Commercial |
$129.62
|
|
|
IgG CSF
|
Facility
|
IP
|
$175.00
|
|
|
Service Code
|
CPT 82784
|
| Hospital Charge Code |
4109307
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$85.75 |
| Max. Negotiated Rate |
$161.00 |
| Rate for Payer: Aetna Commercial |
$157.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$150.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$92.75
|
| Rate for Payer: Cash Price |
$52.50
|
| Rate for Payer: Cigna Commercial |
$161.00
|
| Rate for Payer: Health EOS Commercial |
$155.75
|
| Rate for Payer: HFN Commercial |
$161.00
|
| Rate for Payer: Multiplan Commercial |
$140.00
|
| Rate for Payer: NAPHCARE Commercial |
$105.00
|
| Rate for Payer: Preferred Network Access Commercial |
$161.00
|
| Rate for Payer: Quartz Beloit One Network |
$85.75
|
| Rate for Payer: Quartz Commercial |
$105.00
|
| Rate for Payer: WEA Trust Commercial |
$96.25
|
| Rate for Payer: WPS Commercial |
$129.62
|
|
|
IgG CSF
|
Facility
|
OP
|
$175.00
|
|
|
Service Code
|
CPT 82784
|
| Hospital Charge Code |
2959000
|
|
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
|
|
|
IgG CSF
|
Facility
|
IP
|
$175.00
|
|
|
Service Code
|
CPT 82784
|
| Hospital Charge Code |
2959000
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$85.75 |
| Max. Negotiated Rate |
$161.00 |
| Rate for Payer: Aetna Commercial |
$157.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$150.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$92.75
|
| Rate for Payer: Cash Price |
$52.50
|
| Rate for Payer: Cigna Commercial |
$161.00
|
| Rate for Payer: Health EOS Commercial |
$155.75
|
| Rate for Payer: HFN Commercial |
$161.00
|
| Rate for Payer: Multiplan Commercial |
$140.00
|
| Rate for Payer: NAPHCARE Commercial |
$105.00
|
| Rate for Payer: Preferred Network Access Commercial |
$161.00
|
| Rate for Payer: Quartz Beloit One Network |
$85.75
|
| Rate for Payer: Quartz Commercial |
$105.00
|
| Rate for Payer: WEA Trust Commercial |
$96.25
|
| Rate for Payer: WPS Commercial |
$129.62
|
|
|
IgG CSF
|
Professional
|
Both
|
$175.00
|
|
|
Service Code
|
CPT 82784
|
| Hospital Charge Code |
2959000
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$32.83 |
| Max. Negotiated Rate |
$166.25 |
| Rate for Payer: Aetna Commercial |
$166.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$150.50
|
| Rate for Payer: Cash Price |
$52.50
|
| Rate for Payer: Cash Price |
$52.50
|
| Rate for Payer: Cigna Commercial |
$166.25
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$87.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$105.00
|
| Rate for Payer: Health EOS Commercial |
$159.25
|
| Rate for Payer: HFN Commercial |
$166.25
|
| 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 |
$140.00
|
| Rate for Payer: Preferred Network Access Commercial |
$166.25
|
| Rate for Payer: Quartz Beloit One Network |
$77.00
|
| Rate for Payer: Quartz Commercial |
$99.75
|
| Rate for Payer: The Alliance Commercial |
$87.50
|
| Rate for Payer: WEA Trust Commercial |
$96.25
|
| Rate for Payer: WPS Commercial |
$129.62
|
|
|
IgG, IgA, Indirect Immunofluorescence
|
Facility
|
OP
|
$176.00
|
|
|
Service Code
|
CPT 88346
|
| Hospital Charge Code |
1124806
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$86.24 |
| Max. Negotiated Rate |
$675.28 |
| Rate for Payer: Aetna Commercial |
$158.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$151.36
|
| Rate for Payer: Aetna Managed Medicare |
$168.82
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$633.08
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$295.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$280.24
|
| Rate for Payer: Anthem Medicare Advantage |
$168.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$93.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$168.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$168.82
|
| Rate for Payer: Cash Price |
$52.80
|
| Rate for Payer: Cash Price |
$52.80
|
| Rate for Payer: Cigna Commercial |
$161.92
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$168.82
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$98.49
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$168.82
|
| Rate for Payer: Health EOS Commercial |
$156.64
|
| Rate for Payer: HFN Commercial |
$161.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$628.01
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$168.82
|
| Rate for Payer: Independent Care Health Plan Medicare |
$168.82
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$168.82
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$168.82
|
| Rate for Payer: Multiplan Commercial |
$140.80
|
| Rate for Payer: NAPHCARE Commercial |
$253.23
|
| Rate for Payer: Preferred Network Access Commercial |
$161.92
|
| Rate for Payer: Quartz Beloit One Network |
$86.24
|
| Rate for Payer: Quartz Commercial |
$114.40
|
| Rate for Payer: Quartz Medicare Advantage |
$168.82
|
| Rate for Payer: The Alliance Commercial |
$675.28
|
| Rate for Payer: United Healthcare Medicare Advantage |
$168.82
|
| Rate for Payer: United Healthcare PPO |
$132.00
|
| Rate for Payer: WEA Trust Commercial |
$96.80
|
| Rate for Payer: Wellcare Medicare |
$168.82
|
| Rate for Payer: WPS Commercial |
$130.36
|
|
|
IgG, IgA, Indirect Immunofluorescence
|
Facility
|
IP
|
$176.00
|
|
|
Service Code
|
CPT 88346
|
| Hospital Charge Code |
1124806
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$86.24 |
| Max. Negotiated Rate |
$161.92 |
| Rate for Payer: Aetna Commercial |
$158.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$151.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$93.28
|
| Rate for Payer: Cash Price |
$52.80
|
| Rate for Payer: Cigna Commercial |
$161.92
|
| Rate for Payer: Health EOS Commercial |
$156.64
|
| Rate for Payer: HFN Commercial |
$161.92
|
| Rate for Payer: Multiplan Commercial |
$140.80
|
| Rate for Payer: NAPHCARE Commercial |
$105.60
|
| Rate for Payer: Preferred Network Access Commercial |
$161.92
|
| Rate for Payer: Quartz Beloit One Network |
$86.24
|
| Rate for Payer: Quartz Commercial |
$105.60
|
| Rate for Payer: WEA Trust Commercial |
$96.80
|
| Rate for Payer: WPS Commercial |
$130.36
|
|
|
IgG, IgA, Indirect Immunofluorescence
|
Professional
|
Both
|
$176.00
|
|
|
Service Code
|
CPT 88346
|
| Hospital Charge Code |
1124806
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$33.43 |
| Max. Negotiated Rate |
$488.69 |
| Rate for Payer: Aetna Commercial |
$167.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$151.36
|
| Rate for Payer: Anthem Commercial |
$33.43
|
| Rate for Payer: Cash Price |
$52.80
|
| Rate for Payer: Cash Price |
$52.80
|
| Rate for Payer: Cigna Commercial |
$167.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$88.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$105.60
|
| Rate for Payer: Health EOS Commercial |
$160.16
|
| Rate for Payer: HFN Commercial |
$167.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$488.69
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$488.69
|
| Rate for Payer: Multiplan Commercial |
$140.80
|
| Rate for Payer: Preferred Network Access Commercial |
$167.20
|
| Rate for Payer: Quartz Beloit One Network |
$77.44
|
| Rate for Payer: Quartz Commercial |
$100.32
|
| Rate for Payer: The Alliance Commercial |
$88.00
|
| Rate for Payer: WEA Trust Commercial |
$96.80
|
| Rate for Payer: WPS Commercial |
$130.36
|
|
|
IgG Index CSF
|
Facility
|
IP
|
$175.00
|
|
|
Service Code
|
CPT 82784
|
| Hospital Charge Code |
2959001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$85.75 |
| Max. Negotiated Rate |
$161.00 |
| Rate for Payer: Aetna Commercial |
$157.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$150.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$92.75
|
| Rate for Payer: Cash Price |
$52.50
|
| Rate for Payer: Cigna Commercial |
$161.00
|
| Rate for Payer: Health EOS Commercial |
$155.75
|
| Rate for Payer: HFN Commercial |
$161.00
|
| Rate for Payer: Multiplan Commercial |
$140.00
|
| Rate for Payer: NAPHCARE Commercial |
$105.00
|
| Rate for Payer: Preferred Network Access Commercial |
$161.00
|
| Rate for Payer: Quartz Beloit One Network |
$85.75
|
| Rate for Payer: Quartz Commercial |
$105.00
|
| Rate for Payer: WEA Trust Commercial |
$96.25
|
| Rate for Payer: WPS Commercial |
$129.62
|
|
|
IgG Index CSF
|
Professional
|
Both
|
$175.00
|
|
|
Service Code
|
CPT 82784
|
| Hospital Charge Code |
2959001
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$32.83 |
| Max. Negotiated Rate |
$166.25 |
| Rate for Payer: Aetna Commercial |
$166.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$150.50
|
| Rate for Payer: Cash Price |
$52.50
|
| Rate for Payer: Cash Price |
$52.50
|
| Rate for Payer: Cigna Commercial |
$166.25
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$87.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$105.00
|
| Rate for Payer: Health EOS Commercial |
$159.25
|
| Rate for Payer: HFN Commercial |
$166.25
|
| 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 |
$140.00
|
| Rate for Payer: Preferred Network Access Commercial |
$166.25
|
| Rate for Payer: Quartz Beloit One Network |
$77.00
|
| Rate for Payer: Quartz Commercial |
$99.75
|
| Rate for Payer: The Alliance Commercial |
$87.50
|
| Rate for Payer: WEA Trust Commercial |
$96.25
|
| Rate for Payer: WPS Commercial |
$129.62
|
|
|
IgG Index CSF
|
Facility
|
OP
|
$175.00
|
|
|
Service Code
|
CPT 82784
|
| Hospital Charge Code |
2959001
|
|
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
|
|
|
IgG MS Pnl 2
|
Facility
|
OP
|
$188.00
|
|
|
Service Code
|
CPT 82784
|
| Hospital Charge Code |
4109308
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.30 |
| Max. Negotiated Rate |
$172.96 |
| Rate for Payer: Aetna Commercial |
$169.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$161.68
|
| 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 |
$99.64
|
| 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 |
$56.40
|
| Rate for Payer: Cash Price |
$56.40
|
| Rate for Payer: Cigna Commercial |
$172.96
|
| 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 |
$105.20
|
| 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 |
$167.32
|
| Rate for Payer: HFN Commercial |
$172.96
|
| 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 |
$150.40
|
| Rate for Payer: NAPHCARE Commercial |
$13.95
|
| Rate for Payer: Preferred Network Access Commercial |
$172.96
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$9.61
|
| Rate for Payer: Quartz Beloit One Network |
$92.12
|
| Rate for Payer: Quartz Commercial |
$122.20
|
| 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 |
$141.00
|
| Rate for Payer: WEA Trust Commercial |
$103.40
|
| Rate for Payer: Wellcare Medicare |
$9.30
|
| Rate for Payer: WMAP Medicaid |
$9.61
|
| Rate for Payer: WPS Commercial |
$139.25
|
|
|
IgG MS Pnl 2
|
Professional
|
Both
|
$188.00
|
|
|
Service Code
|
CPT 82784
|
| Hospital Charge Code |
4109308
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$32.83 |
| Max. Negotiated Rate |
$178.60 |
| Rate for Payer: Aetna Commercial |
$178.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$161.68
|
| Rate for Payer: Cash Price |
$56.40
|
| Rate for Payer: Cash Price |
$56.40
|
| Rate for Payer: Cigna Commercial |
$178.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$94.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$112.80
|
| Rate for Payer: Health EOS Commercial |
$171.08
|
| Rate for Payer: HFN Commercial |
$178.60
|
| 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 |
$150.40
|
| Rate for Payer: Preferred Network Access Commercial |
$178.60
|
| Rate for Payer: Quartz Beloit One Network |
$82.72
|
| Rate for Payer: Quartz Commercial |
$107.16
|
| Rate for Payer: The Alliance Commercial |
$94.00
|
| Rate for Payer: WEA Trust Commercial |
$103.40
|
| Rate for Payer: WPS Commercial |
$139.25
|
|
|
IgG MS Pnl 2
|
Facility
|
IP
|
$188.00
|
|
|
Service Code
|
CPT 82784
|
| Hospital Charge Code |
4109308
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$92.12 |
| Max. Negotiated Rate |
$172.96 |
| Rate for Payer: Aetna Commercial |
$169.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$161.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$99.64
|
| Rate for Payer: Cash Price |
$56.40
|
| Rate for Payer: Cigna Commercial |
$172.96
|
| Rate for Payer: Health EOS Commercial |
$167.32
|
| Rate for Payer: HFN Commercial |
$172.96
|
| Rate for Payer: Multiplan Commercial |
$150.40
|
| Rate for Payer: NAPHCARE Commercial |
$112.80
|
| Rate for Payer: Preferred Network Access Commercial |
$172.96
|
| Rate for Payer: Quartz Beloit One Network |
$92.12
|
| Rate for Payer: Quartz Commercial |
$112.80
|
| Rate for Payer: WEA Trust Commercial |
$103.40
|
| Rate for Payer: WPS Commercial |
$139.25
|
|
|
IgG Subclass 2
|
Facility
|
IP
|
$242.00
|
|
|
Service Code
|
CPT 82787
|
| Hospital Charge Code |
2942924
|
|
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
|
|
|
IgG Subclass 2
|
Facility
|
OP
|
$242.00
|
|
|
Service Code
|
CPT 82787
|
| Hospital Charge Code |
2942924
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.90 |
| 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 |
$8.02
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$30.08
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$14.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$13.31
|
| Rate for Payer: Anthem Medicaid |
$5.90
|
| Rate for Payer: Anthem Medicare Advantage |
$8.02
|
| 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 |
$8.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$8.02
|
| 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 |
$8.02
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$5.90
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$135.42
|
| Rate for Payer: Dean Health Medicaid |
$5.90
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$8.02
|
| Rate for Payer: Health EOS Commercial |
$215.38
|
| Rate for Payer: HFN Commercial |
$222.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$29.83
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$8.02
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$5.90
|
| Rate for Payer: Independent Care Health Plan Medicare |
$8.02
|
| Rate for Payer: Managed Health Services Medicaid |
$6.14
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$8.02
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$8.02
|
| Rate for Payer: Multiplan Commercial |
$193.60
|
| Rate for Payer: NAPHCARE Commercial |
$12.03
|
| Rate for Payer: Preferred Network Access Commercial |
$222.64
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$5.90
|
| Rate for Payer: Quartz Beloit One Network |
$118.58
|
| Rate for Payer: Quartz Commercial |
$157.30
|
| Rate for Payer: Quartz Medicare Advantage |
$8.02
|
| Rate for Payer: The Alliance Commercial |
$32.08
|
| Rate for Payer: United Healthcare Medicaid |
$5.90
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8.02
|
| Rate for Payer: United Healthcare PPO |
$181.50
|
| Rate for Payer: WEA Trust Commercial |
$133.10
|
| Rate for Payer: Wellcare Medicare |
$8.02
|
| Rate for Payer: WMAP Medicaid |
$5.90
|
| Rate for Payer: WPS Commercial |
$179.25
|
|
|
IgG Subclass 2
|
Professional
|
Both
|
$242.00
|
|
|
Service Code
|
CPT 82787
|
| Hospital Charge Code |
2942924
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$28.31 |
| 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 |
$28.31
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$28.31
|
| 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
|
|
|
IgG Subclass 3
|
Professional
|
Both
|
$242.00
|
|
|
Service Code
|
CPT 82787
|
| Hospital Charge Code |
2942925
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$28.31 |
| 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 |
$28.31
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$28.31
|
| 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
|
|
|
IgG Subclass 3
|
Facility
|
IP
|
$242.00
|
|
|
Service Code
|
CPT 82787
|
| Hospital Charge Code |
2942925
|
|
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
|
|
|
IgG Subclass 3
|
Facility
|
OP
|
$242.00
|
|
|
Service Code
|
CPT 82787
|
| Hospital Charge Code |
2942925
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.90 |
| 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 |
$8.02
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$30.08
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$14.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$13.31
|
| Rate for Payer: Anthem Medicaid |
$5.90
|
| Rate for Payer: Anthem Medicare Advantage |
$8.02
|
| 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 |
$8.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$8.02
|
| 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 |
$8.02
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$5.90
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$135.42
|
| Rate for Payer: Dean Health Medicaid |
$5.90
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$8.02
|
| Rate for Payer: Health EOS Commercial |
$215.38
|
| Rate for Payer: HFN Commercial |
$222.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$29.83
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$8.02
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$5.90
|
| Rate for Payer: Independent Care Health Plan Medicare |
$8.02
|
| Rate for Payer: Managed Health Services Medicaid |
$6.14
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$8.02
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$8.02
|
| Rate for Payer: Multiplan Commercial |
$193.60
|
| Rate for Payer: NAPHCARE Commercial |
$12.03
|
| Rate for Payer: Preferred Network Access Commercial |
$222.64
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$5.90
|
| Rate for Payer: Quartz Beloit One Network |
$118.58
|
| Rate for Payer: Quartz Commercial |
$157.30
|
| Rate for Payer: Quartz Medicare Advantage |
$8.02
|
| Rate for Payer: The Alliance Commercial |
$32.08
|
| Rate for Payer: United Healthcare Medicaid |
$5.90
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8.02
|
| Rate for Payer: United Healthcare PPO |
$181.50
|
| Rate for Payer: WEA Trust Commercial |
$133.10
|
| Rate for Payer: Wellcare Medicare |
$8.02
|
| Rate for Payer: WMAP Medicaid |
$5.90
|
| Rate for Payer: WPS Commercial |
$179.25
|
|
|
IgG Subclass 4
|
Facility
|
OP
|
$242.00
|
|
|
Service Code
|
CPT 82787
|
| Hospital Charge Code |
2942926
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.90 |
| 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 |
$8.02
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$30.08
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$14.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$13.31
|
| Rate for Payer: Anthem Medicaid |
$5.90
|
| Rate for Payer: Anthem Medicare Advantage |
$8.02
|
| 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 |
$8.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$8.02
|
| 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 |
$8.02
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$5.90
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$135.42
|
| Rate for Payer: Dean Health Medicaid |
$5.90
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$8.02
|
| Rate for Payer: Health EOS Commercial |
$215.38
|
| Rate for Payer: HFN Commercial |
$222.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$29.83
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$8.02
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$5.90
|
| Rate for Payer: Independent Care Health Plan Medicare |
$8.02
|
| Rate for Payer: Managed Health Services Medicaid |
$6.14
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$8.02
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$8.02
|
| Rate for Payer: Multiplan Commercial |
$193.60
|
| Rate for Payer: NAPHCARE Commercial |
$12.03
|
| Rate for Payer: Preferred Network Access Commercial |
$222.64
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$5.90
|
| Rate for Payer: Quartz Beloit One Network |
$118.58
|
| Rate for Payer: Quartz Commercial |
$157.30
|
| Rate for Payer: Quartz Medicare Advantage |
$8.02
|
| Rate for Payer: The Alliance Commercial |
$32.08
|
| Rate for Payer: United Healthcare Medicaid |
$5.90
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8.02
|
| Rate for Payer: United Healthcare PPO |
$181.50
|
| Rate for Payer: WEA Trust Commercial |
$133.10
|
| Rate for Payer: Wellcare Medicare |
$8.02
|
| Rate for Payer: WMAP Medicaid |
$5.90
|
| Rate for Payer: WPS Commercial |
$179.25
|
|
|
IgG Subclass 4
|
Facility
|
IP
|
$242.00
|
|
|
Service Code
|
CPT 82787
|
| Hospital Charge Code |
2942926
|
|
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
|
|
|
IgG Subclass 4
|
Professional
|
Both
|
$242.00
|
|
|
Service Code
|
CPT 82787
|
| Hospital Charge Code |
2942926
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$28.31 |
| 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 |
$28.31
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$28.31
|
| 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
|
|
|
IgG Subclasses
|
Professional
|
Both
|
$359.00
|
|
|
Service Code
|
CPT 82787
|
| Hospital Charge Code |
977990
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$28.31 |
| Max. Negotiated Rate |
$341.05 |
| Rate for Payer: Aetna Commercial |
$341.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$308.74
|
| Rate for Payer: Cash Price |
$107.70
|
| Rate for Payer: Cash Price |
$107.70
|
| Rate for Payer: Cigna Commercial |
$341.05
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$179.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$215.40
|
| Rate for Payer: Health EOS Commercial |
$326.69
|
| Rate for Payer: HFN Commercial |
$341.05
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$28.31
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$28.31
|
| Rate for Payer: Multiplan Commercial |
$287.20
|
| Rate for Payer: Preferred Network Access Commercial |
$341.05
|
| Rate for Payer: Quartz Beloit One Network |
$157.96
|
| Rate for Payer: Quartz Commercial |
$204.63
|
| Rate for Payer: The Alliance Commercial |
$179.50
|
| Rate for Payer: WEA Trust Commercial |
$197.45
|
| Rate for Payer: WPS Commercial |
$265.91
|
|
|
IgG Subclasses
|
Facility
|
IP
|
$359.00
|
|
|
Service Code
|
CPT 82787
|
| Hospital Charge Code |
977990
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$175.91 |
| Max. Negotiated Rate |
$330.28 |
| Rate for Payer: Aetna Commercial |
$323.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$308.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$190.27
|
| Rate for Payer: Cash Price |
$107.70
|
| Rate for Payer: Cigna Commercial |
$330.28
|
| Rate for Payer: Health EOS Commercial |
$319.51
|
| Rate for Payer: HFN Commercial |
$330.28
|
| Rate for Payer: Multiplan Commercial |
$287.20
|
| Rate for Payer: NAPHCARE Commercial |
$215.40
|
| Rate for Payer: Preferred Network Access Commercial |
$330.28
|
| Rate for Payer: Quartz Beloit One Network |
$175.91
|
| Rate for Payer: Quartz Commercial |
$215.40
|
| Rate for Payer: WEA Trust Commercial |
$197.45
|
| Rate for Payer: WPS Commercial |
$265.91
|
|
