|
IgG Subclasses
|
Facility
|
OP
|
$359.00
|
|
|
Service Code
|
CPT 82787
|
| Hospital Charge Code |
977990
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.90 |
| Max. Negotiated Rate |
$330.28 |
| Rate for Payer: Aetna Commercial |
$323.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$308.74
|
| 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 |
$190.27
|
| 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 |
$107.70
|
| Rate for Payer: Cash Price |
$107.70
|
| Rate for Payer: Cigna Commercial |
$330.28
|
| 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 |
$200.90
|
| 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 |
$319.51
|
| Rate for Payer: HFN Commercial |
$330.28
|
| 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 |
$287.20
|
| Rate for Payer: NAPHCARE Commercial |
$12.03
|
| Rate for Payer: Preferred Network Access Commercial |
$330.28
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$5.90
|
| Rate for Payer: Quartz Beloit One Network |
$175.91
|
| Rate for Payer: Quartz Commercial |
$233.35
|
| 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 |
$269.25
|
| Rate for Payer: WEA Trust Commercial |
$197.45
|
| Rate for Payer: Wellcare Medicare |
$8.02
|
| Rate for Payer: WMAP Medicaid |
$5.90
|
| Rate for Payer: WPS Commercial |
$265.91
|
|
|
IgG Synthesis Rate/Index, CSF
|
Facility
|
OP
|
$42.59
|
|
|
Service Code
|
CPT 82040
|
| Hospital Charge Code |
4109303
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.95 |
| Max. Negotiated Rate |
$39.18 |
| Rate for Payer: Aetna Commercial |
$38.33
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$36.63
|
| Rate for Payer: Aetna Managed Medicare |
$4.95
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$18.56
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8.66
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$8.22
|
| Rate for Payer: Anthem Medicaid |
$5.11
|
| Rate for Payer: Anthem Medicare Advantage |
$4.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$22.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$4.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$4.95
|
| Rate for Payer: Cash Price |
$12.78
|
| Rate for Payer: Cash Price |
$12.78
|
| Rate for Payer: Cigna Commercial |
$39.18
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$4.95
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$5.11
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$23.83
|
| Rate for Payer: Dean Health Medicaid |
$5.11
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$4.95
|
| Rate for Payer: Health EOS Commercial |
$37.91
|
| Rate for Payer: HFN Commercial |
$39.18
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$18.41
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$4.95
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$5.11
|
| Rate for Payer: Independent Care Health Plan Medicare |
$4.95
|
| Rate for Payer: Managed Health Services Medicaid |
$5.31
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$4.95
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$4.95
|
| Rate for Payer: Multiplan Commercial |
$34.07
|
| Rate for Payer: NAPHCARE Commercial |
$7.42
|
| Rate for Payer: Preferred Network Access Commercial |
$39.18
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$5.11
|
| Rate for Payer: Quartz Beloit One Network |
$20.87
|
| Rate for Payer: Quartz Commercial |
$27.68
|
| Rate for Payer: Quartz Medicare Advantage |
$4.95
|
| Rate for Payer: The Alliance Commercial |
$19.80
|
| Rate for Payer: United Healthcare Medicaid |
$5.11
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4.95
|
| Rate for Payer: United Healthcare PPO |
$31.94
|
| Rate for Payer: WEA Trust Commercial |
$23.42
|
| Rate for Payer: Wellcare Medicare |
$4.95
|
| Rate for Payer: WMAP Medicaid |
$5.11
|
| Rate for Payer: WPS Commercial |
$31.55
|
|
|
IgG Synthesis Rate/Index, CSF
|
Professional
|
Both
|
$42.59
|
|
|
Service Code
|
CPT 82040
|
| Hospital Charge Code |
4109303
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.47 |
| Max. Negotiated Rate |
$40.46 |
| Rate for Payer: Aetna Commercial |
$40.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$36.63
|
| Rate for Payer: Cash Price |
$12.78
|
| Rate for Payer: Cash Price |
$12.78
|
| Rate for Payer: Cigna Commercial |
$40.46
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$21.30
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$25.55
|
| Rate for Payer: Health EOS Commercial |
$38.76
|
| Rate for Payer: HFN Commercial |
$40.46
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$17.47
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$17.47
|
| Rate for Payer: Multiplan Commercial |
$34.07
|
| Rate for Payer: Preferred Network Access Commercial |
$40.46
|
| Rate for Payer: Quartz Beloit One Network |
$18.74
|
| Rate for Payer: Quartz Commercial |
$24.28
|
| Rate for Payer: The Alliance Commercial |
$21.30
|
| Rate for Payer: WEA Trust Commercial |
$23.42
|
| Rate for Payer: WPS Commercial |
$31.55
|
|
|
IgG Synthesis Rate/Index, CSF
|
Facility
|
IP
|
$42.59
|
|
|
Service Code
|
CPT 82040
|
| Hospital Charge Code |
4109303
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$20.87 |
| Max. Negotiated Rate |
$39.18 |
| Rate for Payer: Aetna Commercial |
$38.33
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$36.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$22.57
|
| Rate for Payer: Cash Price |
$12.78
|
| Rate for Payer: Cigna Commercial |
$39.18
|
| Rate for Payer: Health EOS Commercial |
$37.91
|
| Rate for Payer: HFN Commercial |
$39.18
|
| Rate for Payer: Multiplan Commercial |
$34.07
|
| Rate for Payer: NAPHCARE Commercial |
$25.55
|
| Rate for Payer: Preferred Network Access Commercial |
$39.18
|
| Rate for Payer: Quartz Beloit One Network |
$20.87
|
| Rate for Payer: Quartz Commercial |
$25.55
|
| Rate for Payer: WEA Trust Commercial |
$23.42
|
| Rate for Payer: WPS Commercial |
$31.55
|
|
|
IgG Total
|
Facility
|
OP
|
$129.00
|
|
|
Service Code
|
CPT 82784
|
| Hospital Charge Code |
2942927
|
|
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 Total
|
Facility
|
IP
|
$129.00
|
|
|
Service Code
|
CPT 82784
|
| Hospital Charge Code |
2942927
|
|
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 Total
|
Professional
|
Both
|
$129.00
|
|
|
Service Code
|
CPT 82784
|
| Hospital Charge Code |
2942927
|
|
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
|
|
|
IGH/BCL-2 Cytogenetics 88271
|
Professional
|
Both
|
$227.00
|
|
|
Service Code
|
CPT 88271
|
| Hospital Charge Code |
2776802
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$75.61 |
| 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 |
$75.61
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$75.61
|
| 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
|
|
|
IGH/BCL-2 Cytogenetics 88271
|
Facility
|
OP
|
$227.00
|
|
|
Service Code
|
CPT 88271
|
| Hospital Charge Code |
2776802
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$20.36 |
| 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 |
$21.42
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$80.32
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$37.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$35.56
|
| Rate for Payer: Anthem Medicaid |
$20.36
|
| Rate for Payer: Anthem Medicare Advantage |
$21.42
|
| 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 |
$21.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$21.42
|
| 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 |
$21.42
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$20.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$127.03
|
| Rate for Payer: Dean Health Medicaid |
$20.36
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$21.42
|
| Rate for Payer: Health EOS Commercial |
$202.03
|
| Rate for Payer: HFN Commercial |
$208.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$79.68
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$21.42
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$20.36
|
| Rate for Payer: Independent Care Health Plan Medicare |
$21.42
|
| Rate for Payer: Managed Health Services Medicaid |
$21.17
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$21.42
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$21.42
|
| Rate for Payer: Multiplan Commercial |
$181.60
|
| Rate for Payer: NAPHCARE Commercial |
$32.13
|
| Rate for Payer: Preferred Network Access Commercial |
$208.84
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$20.36
|
| Rate for Payer: Quartz Beloit One Network |
$111.23
|
| Rate for Payer: Quartz Commercial |
$147.55
|
| Rate for Payer: Quartz Medicare Advantage |
$21.42
|
| Rate for Payer: The Alliance Commercial |
$85.68
|
| Rate for Payer: United Healthcare Medicaid |
$20.36
|
| Rate for Payer: United Healthcare Medicare Advantage |
$21.42
|
| Rate for Payer: United Healthcare PPO |
$170.25
|
| Rate for Payer: WEA Trust Commercial |
$124.85
|
| Rate for Payer: Wellcare Medicare |
$21.42
|
| Rate for Payer: WMAP Medicaid |
$20.36
|
| Rate for Payer: WPS Commercial |
$168.14
|
|
|
IGH/BCL-2 Cytogenetics 88271
|
Facility
|
IP
|
$227.00
|
|
|
Service Code
|
CPT 88271
|
| Hospital Charge Code |
2776802
|
|
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
|
|
|
IGH/BCL-2 Cytogenetics 88275
|
Facility
|
OP
|
$227.00
|
|
|
Service Code
|
CPT 88275
|
| Hospital Charge Code |
2776803
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$51.19 |
| 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 |
$51.19
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$191.96
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$89.58
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$84.98
|
| Rate for Payer: Anthem Medicaid |
$52.89
|
| Rate for Payer: Anthem Medicare Advantage |
$51.19
|
| 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 |
$51.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$51.19
|
| 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 |
$51.19
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$52.89
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$127.03
|
| Rate for Payer: Dean Health Medicaid |
$52.89
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$51.19
|
| Rate for Payer: Health EOS Commercial |
$202.03
|
| Rate for Payer: HFN Commercial |
$208.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$190.43
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$51.19
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$52.89
|
| Rate for Payer: Independent Care Health Plan Medicare |
$51.19
|
| Rate for Payer: Managed Health Services Medicaid |
$55.01
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$51.19
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$51.19
|
| Rate for Payer: Multiplan Commercial |
$181.60
|
| Rate for Payer: NAPHCARE Commercial |
$76.78
|
| Rate for Payer: Preferred Network Access Commercial |
$208.84
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$52.89
|
| Rate for Payer: Quartz Beloit One Network |
$111.23
|
| Rate for Payer: Quartz Commercial |
$147.55
|
| Rate for Payer: Quartz Medicare Advantage |
$51.19
|
| Rate for Payer: The Alliance Commercial |
$204.76
|
| Rate for Payer: United Healthcare Medicaid |
$52.89
|
| Rate for Payer: United Healthcare Medicare Advantage |
$51.19
|
| Rate for Payer: United Healthcare PPO |
$170.25
|
| Rate for Payer: WEA Trust Commercial |
$124.85
|
| Rate for Payer: Wellcare Medicare |
$51.19
|
| Rate for Payer: WMAP Medicaid |
$52.89
|
| Rate for Payer: WPS Commercial |
$168.14
|
|
|
IGH/BCL-2 Cytogenetics 88275
|
Facility
|
IP
|
$227.00
|
|
|
Service Code
|
CPT 88275
|
| Hospital Charge Code |
2776803
|
|
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
|
|
|
IGH/BCL-2 Cytogenetics 88275
|
Professional
|
Both
|
$227.00
|
|
|
Service Code
|
CPT 88275
|
| Hospital Charge Code |
2776803
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$99.88 |
| 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 |
$180.70
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$180.70
|
| 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
|
|
|
IGH/BCL-2 Interp & Report
|
Facility
|
OP
|
$186.00
|
|
|
Service Code
|
CPT 88291
|
| Hospital Charge Code |
2776804
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$52.08 |
| Max. Negotiated Rate |
$744.00 |
| Rate for Payer: Aetna Commercial |
$167.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$159.96
|
| Rate for Payer: Aetna Managed Medicare |
$52.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$120.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$93.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$89.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$98.58
|
| Rate for Payer: Cash Price |
$55.80
|
| Rate for Payer: Cigna Commercial |
$171.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$104.09
|
| Rate for Payer: Health EOS Commercial |
$165.54
|
| Rate for Payer: HFN Commercial |
$171.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$139.50
|
| Rate for Payer: Multiplan Commercial |
$148.80
|
| Rate for Payer: NAPHCARE Commercial |
$111.60
|
| Rate for Payer: Preferred Network Access Commercial |
$171.12
|
| Rate for Payer: Quartz Beloit One Network |
$91.14
|
| Rate for Payer: Quartz Commercial |
$120.90
|
| Rate for Payer: Quartz Medicare Advantage |
$111.60
|
| Rate for Payer: The Alliance Commercial |
$744.00
|
| Rate for Payer: United Healthcare PPO |
$139.50
|
| Rate for Payer: WEA Trust Commercial |
$102.30
|
| Rate for Payer: WPS Commercial |
$137.77
|
|
|
IGH/BCL-2 Interp & Report
|
Facility
|
IP
|
$186.00
|
|
|
Service Code
|
CPT 88291
|
| Hospital Charge Code |
2776804
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$91.14 |
| Max. Negotiated Rate |
$171.12 |
| Rate for Payer: Aetna Commercial |
$167.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$159.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$98.58
|
| Rate for Payer: Cash Price |
$55.80
|
| Rate for Payer: Cigna Commercial |
$171.12
|
| Rate for Payer: Health EOS Commercial |
$165.54
|
| Rate for Payer: HFN Commercial |
$171.12
|
| Rate for Payer: Multiplan Commercial |
$148.80
|
| Rate for Payer: NAPHCARE Commercial |
$111.60
|
| Rate for Payer: Preferred Network Access Commercial |
$171.12
|
| Rate for Payer: Quartz Beloit One Network |
$91.14
|
| Rate for Payer: Quartz Commercial |
$111.60
|
| Rate for Payer: WEA Trust Commercial |
$102.30
|
| Rate for Payer: WPS Commercial |
$137.77
|
|
|
IGH/BCL-2 Interp & Report
|
Professional
|
Both
|
$186.00
|
|
|
Service Code
|
CPT 88291
|
| Hospital Charge Code |
2776804
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.66 |
| Max. Negotiated Rate |
$176.70 |
| Rate for Payer: Aetna Commercial |
$176.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$159.96
|
| Rate for Payer: Anthem Commercial |
$5.66
|
| Rate for Payer: Cash Price |
$55.80
|
| Rate for Payer: Cash Price |
$55.80
|
| Rate for Payer: Cigna Commercial |
$176.70
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$93.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$111.60
|
| Rate for Payer: Health EOS Commercial |
$169.26
|
| Rate for Payer: HFN Commercial |
$176.70
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$113.07
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$113.07
|
| Rate for Payer: Multiplan Commercial |
$148.80
|
| Rate for Payer: Preferred Network Access Commercial |
$176.70
|
| Rate for Payer: Quartz Beloit One Network |
$81.84
|
| Rate for Payer: Quartz Commercial |
$106.02
|
| Rate for Payer: The Alliance Commercial |
$93.00
|
| Rate for Payer: WEA Trust Commercial |
$102.30
|
| Rate for Payer: WPS Commercial |
$137.77
|
|
|
IgM
|
Professional
|
Both
|
$177.00
|
|
|
Service Code
|
CPT 82784
|
| Hospital Charge Code |
2942928
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$32.83 |
| Max. Negotiated Rate |
$168.15 |
| Rate for Payer: Aetna Commercial |
$168.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$152.22
|
| Rate for Payer: Cash Price |
$53.10
|
| Rate for Payer: Cash Price |
$53.10
|
| Rate for Payer: Cigna Commercial |
$168.15
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$88.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$106.20
|
| Rate for Payer: Health EOS Commercial |
$161.07
|
| Rate for Payer: HFN Commercial |
$168.15
|
| 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 |
$141.60
|
| Rate for Payer: Preferred Network Access Commercial |
$168.15
|
| Rate for Payer: Quartz Beloit One Network |
$77.88
|
| Rate for Payer: Quartz Commercial |
$100.89
|
| Rate for Payer: The Alliance Commercial |
$88.50
|
| Rate for Payer: WEA Trust Commercial |
$97.35
|
| Rate for Payer: WPS Commercial |
$131.10
|
|
|
IgM
|
Facility
|
IP
|
$245.00
|
|
|
Service Code
|
CPT 82784
|
| Hospital Charge Code |
977991
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$120.05 |
| Max. Negotiated Rate |
$225.40 |
| Rate for Payer: Multiplan Commercial |
$196.00
|
| Rate for Payer: NAPHCARE Commercial |
$147.00
|
| 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: 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
|
|
|
IgM
|
Facility
|
OP
|
$245.00
|
|
|
Service Code
|
CPT 82784
|
| Hospital Charge Code |
977991
|
|
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
|
|
|
IgM
|
Facility
|
IP
|
$177.00
|
|
|
Service Code
|
CPT 82784
|
| Hospital Charge Code |
2942928
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$86.73 |
| Max. Negotiated Rate |
$162.84 |
| Rate for Payer: Aetna Commercial |
$159.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$152.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$93.81
|
| Rate for Payer: Cash Price |
$53.10
|
| Rate for Payer: Cigna Commercial |
$162.84
|
| Rate for Payer: Health EOS Commercial |
$157.53
|
| Rate for Payer: HFN Commercial |
$162.84
|
| Rate for Payer: Multiplan Commercial |
$141.60
|
| Rate for Payer: NAPHCARE Commercial |
$106.20
|
| Rate for Payer: Preferred Network Access Commercial |
$162.84
|
| Rate for Payer: Quartz Beloit One Network |
$86.73
|
| Rate for Payer: Quartz Commercial |
$106.20
|
| Rate for Payer: WEA Trust Commercial |
$97.35
|
| Rate for Payer: WPS Commercial |
$131.10
|
|
|
IgM
|
Facility
|
OP
|
$177.00
|
|
|
Service Code
|
CPT 82784
|
| Hospital Charge Code |
2942928
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.30 |
| Max. Negotiated Rate |
$162.84 |
| Rate for Payer: Aetna Commercial |
$159.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$152.22
|
| 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 |
$93.81
|
| 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 |
$53.10
|
| Rate for Payer: Cash Price |
$53.10
|
| Rate for Payer: Cigna Commercial |
$162.84
|
| 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 |
$99.05
|
| 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 |
$157.53
|
| Rate for Payer: HFN Commercial |
$162.84
|
| 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 |
$141.60
|
| Rate for Payer: NAPHCARE Commercial |
$13.95
|
| Rate for Payer: Preferred Network Access Commercial |
$162.84
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$9.61
|
| Rate for Payer: Quartz Beloit One Network |
$86.73
|
| Rate for Payer: Quartz Commercial |
$115.05
|
| 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 |
$132.75
|
| Rate for Payer: WEA Trust Commercial |
$97.35
|
| Rate for Payer: Wellcare Medicare |
$9.30
|
| Rate for Payer: WMAP Medicaid |
$9.61
|
| Rate for Payer: WPS Commercial |
$131.10
|
|
|
IgM
|
Professional
|
Both
|
$245.00
|
|
|
Service Code
|
CPT 82784
|
| Hospital Charge Code |
977991
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$32.83 |
| Max. Negotiated Rate |
$232.75 |
| 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
|
| Rate for Payer: The Alliance Commercial |
$122.50
|
| Rate for Payer: WEA Trust Commercial |
$134.75
|
| Rate for Payer: WPS Commercial |
$181.47
|
|
|
IgVh Interp & Report
|
Facility
|
OP
|
$151.00
|
|
| Hospital Charge Code |
2776806
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$42.28 |
| Max. Negotiated Rate |
$604.00 |
| Rate for Payer: Aetna Commercial |
$135.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$129.86
|
| Rate for Payer: Aetna Managed Medicare |
$42.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$98.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$75.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$72.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$80.03
|
| Rate for Payer: Cash Price |
$45.30
|
| Rate for Payer: Cigna Commercial |
$138.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$84.50
|
| Rate for Payer: Health EOS Commercial |
$134.39
|
| Rate for Payer: HFN Commercial |
$138.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$113.25
|
| Rate for Payer: Multiplan Commercial |
$120.80
|
| Rate for Payer: NAPHCARE Commercial |
$90.60
|
| Rate for Payer: Preferred Network Access Commercial |
$138.92
|
| Rate for Payer: Quartz Beloit One Network |
$73.99
|
| Rate for Payer: Quartz Commercial |
$98.15
|
| Rate for Payer: Quartz Medicare Advantage |
$90.60
|
| Rate for Payer: The Alliance Commercial |
$604.00
|
| Rate for Payer: United Healthcare PPO |
$113.25
|
| Rate for Payer: WEA Trust Commercial |
$83.05
|
| Rate for Payer: WPS Commercial |
$111.85
|
|
|
IgVh Interp & Report
|
Professional
|
Both
|
$151.00
|
|
| Hospital Charge Code |
2776806
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$66.44 |
| Max. Negotiated Rate |
$143.45 |
| Rate for Payer: Aetna Commercial |
$143.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$129.86
|
| Rate for Payer: Cash Price |
$45.30
|
| Rate for Payer: Cigna Commercial |
$143.45
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$75.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$90.60
|
| Rate for Payer: Health EOS Commercial |
$137.41
|
| Rate for Payer: HFN Commercial |
$143.45
|
| Rate for Payer: Multiplan Commercial |
$120.80
|
| Rate for Payer: Preferred Network Access Commercial |
$143.45
|
| Rate for Payer: Quartz Beloit One Network |
$66.44
|
| Rate for Payer: Quartz Commercial |
$86.07
|
| Rate for Payer: The Alliance Commercial |
$75.50
|
| Rate for Payer: WEA Trust Commercial |
$83.05
|
| Rate for Payer: WPS Commercial |
$111.85
|
|
|
IgVh Interp & Report
|
Facility
|
IP
|
$151.00
|
|
| Hospital Charge Code |
2776806
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$73.99 |
| Max. Negotiated Rate |
$138.92 |
| Rate for Payer: Aetna Commercial |
$135.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$129.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$80.03
|
| Rate for Payer: Cash Price |
$45.30
|
| Rate for Payer: Cigna Commercial |
$138.92
|
| Rate for Payer: Health EOS Commercial |
$134.39
|
| Rate for Payer: HFN Commercial |
$138.92
|
| Rate for Payer: Multiplan Commercial |
$120.80
|
| Rate for Payer: NAPHCARE Commercial |
$90.60
|
| Rate for Payer: Preferred Network Access Commercial |
$138.92
|
| Rate for Payer: Quartz Beloit One Network |
$73.99
|
| Rate for Payer: Quartz Commercial |
$90.60
|
| Rate for Payer: WEA Trust Commercial |
$83.05
|
| Rate for Payer: WPS Commercial |
$111.85
|
|
