|
IgVH Mutation Status, Cell-based
|
Facility
|
IP
|
$673.00
|
|
|
Service Code
|
CPT 81263
|
| Hospital Charge Code |
5432850
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$329.77 |
| Max. Negotiated Rate |
$619.16 |
| Rate for Payer: Aetna Commercial |
$605.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$578.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$356.69
|
| Rate for Payer: Cash Price |
$201.90
|
| Rate for Payer: Cigna Commercial |
$619.16
|
| Rate for Payer: Health EOS Commercial |
$598.97
|
| Rate for Payer: HFN Commercial |
$619.16
|
| Rate for Payer: Multiplan Commercial |
$538.40
|
| Rate for Payer: NAPHCARE Commercial |
$403.80
|
| Rate for Payer: Preferred Network Access Commercial |
$619.16
|
| Rate for Payer: Quartz Beloit One Network |
$329.77
|
| Rate for Payer: Quartz Commercial |
$403.80
|
| Rate for Payer: WEA Trust Commercial |
$370.15
|
| Rate for Payer: WPS Commercial |
$498.49
|
|
|
IgVH Mutation Status, Cell-based
|
Facility
|
OP
|
$673.00
|
|
|
Service Code
|
CPT 81263
|
| Hospital Charge Code |
5432850
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$294.52 |
| Max. Negotiated Rate |
$1,178.08 |
| Rate for Payer: Aetna Commercial |
$605.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$578.78
|
| Rate for Payer: Aetna Managed Medicare |
$294.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,104.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$515.41
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$488.90
|
| Rate for Payer: Anthem Medicaid |
$304.33
|
| Rate for Payer: Anthem Medicare Advantage |
$294.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$356.69
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$294.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$294.52
|
| Rate for Payer: Cash Price |
$201.90
|
| Rate for Payer: Cash Price |
$201.90
|
| Rate for Payer: Cigna Commercial |
$619.16
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$294.52
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$304.33
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$376.61
|
| Rate for Payer: Dean Health Medicaid |
$304.33
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$294.52
|
| Rate for Payer: Health EOS Commercial |
$598.97
|
| Rate for Payer: HFN Commercial |
$619.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,095.61
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$294.52
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$304.33
|
| Rate for Payer: Independent Care Health Plan Medicare |
$294.52
|
| Rate for Payer: Managed Health Services Medicaid |
$316.50
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$294.52
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$294.52
|
| Rate for Payer: Multiplan Commercial |
$538.40
|
| Rate for Payer: NAPHCARE Commercial |
$441.78
|
| Rate for Payer: Preferred Network Access Commercial |
$619.16
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$304.33
|
| Rate for Payer: Quartz Beloit One Network |
$329.77
|
| Rate for Payer: Quartz Commercial |
$437.45
|
| Rate for Payer: Quartz Medicare Advantage |
$294.52
|
| Rate for Payer: The Alliance Commercial |
$1,178.08
|
| Rate for Payer: United Healthcare Medicaid |
$304.33
|
| Rate for Payer: United Healthcare Medicare Advantage |
$294.52
|
| Rate for Payer: United Healthcare PPO |
$504.75
|
| Rate for Payer: WEA Trust Commercial |
$370.15
|
| Rate for Payer: Wellcare Medicare |
$294.52
|
| Rate for Payer: WMAP Medicaid |
$304.33
|
| Rate for Payer: WPS Commercial |
$498.49
|
|
|
IgVH Mutation Status, Cell-based
|
Professional
|
Both
|
$673.00
|
|
|
Service Code
|
CPT 81263
|
| Hospital Charge Code |
5432850
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$296.12 |
| Max. Negotiated Rate |
$1,039.66 |
| Rate for Payer: Aetna Commercial |
$639.35
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$578.78
|
| Rate for Payer: Cash Price |
$201.90
|
| Rate for Payer: Cash Price |
$201.90
|
| Rate for Payer: Cigna Commercial |
$639.35
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$336.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$403.80
|
| Rate for Payer: Health EOS Commercial |
$612.43
|
| Rate for Payer: HFN Commercial |
$639.35
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,039.66
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,039.66
|
| Rate for Payer: Multiplan Commercial |
$538.40
|
| Rate for Payer: Preferred Network Access Commercial |
$639.35
|
| Rate for Payer: Quartz Beloit One Network |
$296.12
|
| Rate for Payer: Quartz Commercial |
$383.61
|
| Rate for Payer: The Alliance Commercial |
$336.50
|
| Rate for Payer: WEA Trust Commercial |
$370.15
|
| Rate for Payer: WPS Commercial |
$498.49
|
|
|
IgVh Mutation to US Labs
|
Professional
|
Both
|
$2,844.00
|
|
|
Service Code
|
CPT 81263
|
| Hospital Charge Code |
1040843
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$1,039.66 |
| Max. Negotiated Rate |
$2,701.80 |
| Rate for Payer: Aetna Commercial |
$2,701.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,445.84
|
| Rate for Payer: Cash Price |
$853.20
|
| Rate for Payer: Cash Price |
$853.20
|
| Rate for Payer: Cigna Commercial |
$2,701.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,422.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,706.40
|
| Rate for Payer: Health EOS Commercial |
$2,588.04
|
| Rate for Payer: HFN Commercial |
$2,701.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,039.66
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,039.66
|
| Rate for Payer: Multiplan Commercial |
$2,275.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,701.80
|
| Rate for Payer: Quartz Beloit One Network |
$1,251.36
|
| Rate for Payer: Quartz Commercial |
$1,621.08
|
| Rate for Payer: The Alliance Commercial |
$1,422.00
|
| Rate for Payer: WEA Trust Commercial |
$1,564.20
|
| Rate for Payer: WPS Commercial |
$2,106.55
|
|
|
IgVh Mutation to US Labs
|
Facility
|
IP
|
$2,844.00
|
|
|
Service Code
|
CPT 81263
|
| Hospital Charge Code |
1040843
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$1,393.56 |
| Max. Negotiated Rate |
$2,616.48 |
| Rate for Payer: Aetna Commercial |
$2,559.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,445.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,507.32
|
| Rate for Payer: Cash Price |
$853.20
|
| Rate for Payer: Cigna Commercial |
$2,616.48
|
| Rate for Payer: Health EOS Commercial |
$2,531.16
|
| Rate for Payer: HFN Commercial |
$2,616.48
|
| Rate for Payer: Multiplan Commercial |
$2,275.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,706.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,616.48
|
| Rate for Payer: Quartz Beloit One Network |
$1,393.56
|
| Rate for Payer: Quartz Commercial |
$1,706.40
|
| Rate for Payer: WEA Trust Commercial |
$1,564.20
|
| Rate for Payer: WPS Commercial |
$2,106.55
|
|
|
IgVh Mutation to US Labs
|
Facility
|
OP
|
$2,844.00
|
|
|
Service Code
|
CPT 81263
|
| Hospital Charge Code |
1040843
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$294.52 |
| Max. Negotiated Rate |
$2,616.48 |
| Rate for Payer: Aetna Commercial |
$2,559.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,445.84
|
| Rate for Payer: Aetna Managed Medicare |
$294.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,104.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$515.41
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$488.90
|
| Rate for Payer: Anthem Medicaid |
$304.33
|
| Rate for Payer: Anthem Medicare Advantage |
$294.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,507.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$294.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$294.52
|
| Rate for Payer: Cash Price |
$853.20
|
| Rate for Payer: Cash Price |
$853.20
|
| Rate for Payer: Cigna Commercial |
$2,616.48
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$294.52
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$304.33
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,591.50
|
| Rate for Payer: Dean Health Medicaid |
$304.33
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$294.52
|
| Rate for Payer: Health EOS Commercial |
$2,531.16
|
| Rate for Payer: HFN Commercial |
$2,616.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,095.61
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$294.52
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$304.33
|
| Rate for Payer: Independent Care Health Plan Medicare |
$294.52
|
| Rate for Payer: Managed Health Services Medicaid |
$316.50
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$294.52
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$294.52
|
| Rate for Payer: Multiplan Commercial |
$2,275.20
|
| Rate for Payer: NAPHCARE Commercial |
$441.78
|
| Rate for Payer: Preferred Network Access Commercial |
$2,616.48
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$304.33
|
| Rate for Payer: Quartz Beloit One Network |
$1,393.56
|
| Rate for Payer: Quartz Commercial |
$1,848.60
|
| Rate for Payer: Quartz Medicare Advantage |
$294.52
|
| Rate for Payer: The Alliance Commercial |
$1,178.08
|
| Rate for Payer: United Healthcare Medicaid |
$304.33
|
| Rate for Payer: United Healthcare Medicare Advantage |
$294.52
|
| Rate for Payer: United Healthcare PPO |
$2,133.00
|
| Rate for Payer: WEA Trust Commercial |
$1,564.20
|
| Rate for Payer: Wellcare Medicare |
$294.52
|
| Rate for Payer: WMAP Medicaid |
$304.33
|
| Rate for Payer: WPS Commercial |
$2,106.55
|
|
|
IgVh Nucleic Acid Amplification 83898
|
Facility
|
OP
|
$151.00
|
|
| Hospital Charge Code |
2776815
|
|
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 Nucleic Acid Amplification 83898
|
Professional
|
Both
|
$151.00
|
|
| Hospital Charge Code |
2776815
|
|
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 Nucleic Acid Amplification 83898
|
Facility
|
IP
|
$151.00
|
|
| Hospital Charge Code |
2776815
|
|
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
|
|
|
IgVh Nucleic Acid Amplification 83900
|
Facility
|
OP
|
$151.00
|
|
| Hospital Charge Code |
2776810
|
|
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 Nucleic Acid Amplification 83900
|
Professional
|
Both
|
$151.00
|
|
| Hospital Charge Code |
2776810
|
|
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 Nucleic Acid Amplification 83900
|
Facility
|
IP
|
$151.00
|
|
| Hospital Charge Code |
2776810
|
|
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
|
|
|
IgVh Nucleic Acid Amplification 83901
|
Facility
|
IP
|
$285.00
|
|
| Hospital Charge Code |
2776811
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$139.65 |
| Max. Negotiated Rate |
$262.20 |
| Rate for Payer: Aetna Commercial |
$256.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$245.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$151.05
|
| Rate for Payer: Cash Price |
$85.50
|
| Rate for Payer: Cigna Commercial |
$262.20
|
| Rate for Payer: Health EOS Commercial |
$253.65
|
| Rate for Payer: HFN Commercial |
$262.20
|
| Rate for Payer: Multiplan Commercial |
$228.00
|
| Rate for Payer: NAPHCARE Commercial |
$171.00
|
| Rate for Payer: Preferred Network Access Commercial |
$262.20
|
| Rate for Payer: Quartz Beloit One Network |
$139.65
|
| Rate for Payer: Quartz Commercial |
$171.00
|
| Rate for Payer: WEA Trust Commercial |
$156.75
|
| Rate for Payer: WPS Commercial |
$211.10
|
|
|
IgVh Nucleic Acid Amplification 83901
|
Facility
|
OP
|
$285.00
|
|
| Hospital Charge Code |
2776811
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$79.80 |
| Max. Negotiated Rate |
$1,140.00 |
| Rate for Payer: Aetna Commercial |
$256.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$245.10
|
| Rate for Payer: Aetna Managed Medicare |
$79.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$185.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$142.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$136.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$151.05
|
| Rate for Payer: Cash Price |
$85.50
|
| Rate for Payer: Cigna Commercial |
$262.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$159.49
|
| Rate for Payer: Health EOS Commercial |
$253.65
|
| Rate for Payer: HFN Commercial |
$262.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$213.75
|
| Rate for Payer: Multiplan Commercial |
$228.00
|
| Rate for Payer: NAPHCARE Commercial |
$171.00
|
| Rate for Payer: Preferred Network Access Commercial |
$262.20
|
| Rate for Payer: Quartz Beloit One Network |
$139.65
|
| Rate for Payer: Quartz Commercial |
$185.25
|
| Rate for Payer: Quartz Medicare Advantage |
$171.00
|
| Rate for Payer: The Alliance Commercial |
$1,140.00
|
| Rate for Payer: United Healthcare PPO |
$213.75
|
| Rate for Payer: WEA Trust Commercial |
$156.75
|
| Rate for Payer: WPS Commercial |
$211.10
|
|
|
IgVh Nucleic Acid Amplification 83901
|
Professional
|
Both
|
$285.00
|
|
| Hospital Charge Code |
2776811
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$125.40 |
| Max. Negotiated Rate |
$270.75 |
| Rate for Payer: Aetna Commercial |
$270.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$245.10
|
| Rate for Payer: Cash Price |
$85.50
|
| Rate for Payer: Cigna Commercial |
$270.75
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$142.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$171.00
|
| Rate for Payer: Health EOS Commercial |
$259.35
|
| Rate for Payer: HFN Commercial |
$270.75
|
| Rate for Payer: Multiplan Commercial |
$228.00
|
| Rate for Payer: Preferred Network Access Commercial |
$270.75
|
| Rate for Payer: Quartz Beloit One Network |
$125.40
|
| Rate for Payer: Quartz Commercial |
$162.45
|
| Rate for Payer: The Alliance Commercial |
$142.50
|
| Rate for Payer: WEA Trust Commercial |
$156.75
|
| Rate for Payer: WPS Commercial |
$211.10
|
|
|
IgVh Nucleic Acid Extration
|
Professional
|
Both
|
$8.00
|
|
| Hospital Charge Code |
2776816
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.52 |
| Max. Negotiated Rate |
$7.60 |
| Rate for Payer: Aetna Commercial |
$7.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6.88
|
| Rate for Payer: Cash Price |
$2.40
|
| Rate for Payer: Cigna Commercial |
$7.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$4.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4.80
|
| Rate for Payer: Health EOS Commercial |
$7.28
|
| Rate for Payer: HFN Commercial |
$7.60
|
| Rate for Payer: Multiplan Commercial |
$6.40
|
| Rate for Payer: Preferred Network Access Commercial |
$7.60
|
| Rate for Payer: Quartz Beloit One Network |
$3.52
|
| Rate for Payer: Quartz Commercial |
$4.56
|
| Rate for Payer: The Alliance Commercial |
$4.00
|
| Rate for Payer: WEA Trust Commercial |
$4.40
|
| Rate for Payer: WPS Commercial |
$5.93
|
|
|
IgVh Nucleic Acid Extration
|
Facility
|
OP
|
$8.00
|
|
| Hospital Charge Code |
2776816
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$2.24 |
| Max. Negotiated Rate |
$32.00 |
| Rate for Payer: Aetna Commercial |
$7.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6.88
|
| Rate for Payer: Aetna Managed Medicare |
$2.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4.24
|
| Rate for Payer: Cash Price |
$2.40
|
| Rate for Payer: Cigna Commercial |
$7.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4.48
|
| Rate for Payer: Health EOS Commercial |
$7.12
|
| Rate for Payer: HFN Commercial |
$7.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6.00
|
| Rate for Payer: Multiplan Commercial |
$6.40
|
| Rate for Payer: NAPHCARE Commercial |
$4.80
|
| Rate for Payer: Preferred Network Access Commercial |
$7.36
|
| Rate for Payer: Quartz Beloit One Network |
$3.92
|
| Rate for Payer: Quartz Commercial |
$5.20
|
| Rate for Payer: Quartz Medicare Advantage |
$4.80
|
| Rate for Payer: The Alliance Commercial |
$32.00
|
| Rate for Payer: United Healthcare PPO |
$6.00
|
| Rate for Payer: WEA Trust Commercial |
$4.40
|
| Rate for Payer: WPS Commercial |
$5.93
|
|
|
IgVh Nucleic Acid Extration
|
Facility
|
IP
|
$8.00
|
|
| Hospital Charge Code |
2776816
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.92 |
| Max. Negotiated Rate |
$7.36 |
| Rate for Payer: Aetna Commercial |
$7.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4.24
|
| Rate for Payer: Cash Price |
$2.40
|
| Rate for Payer: Cigna Commercial |
$7.36
|
| Rate for Payer: Health EOS Commercial |
$7.12
|
| Rate for Payer: HFN Commercial |
$7.36
|
| Rate for Payer: Multiplan Commercial |
$6.40
|
| Rate for Payer: NAPHCARE Commercial |
$4.80
|
| Rate for Payer: Preferred Network Access Commercial |
$7.36
|
| Rate for Payer: Quartz Beloit One Network |
$3.92
|
| Rate for Payer: Quartz Commercial |
$4.80
|
| Rate for Payer: WEA Trust Commercial |
$4.40
|
| Rate for Payer: WPS Commercial |
$5.93
|
|
|
IgVh Nucleic Acid Gel Electrophoresis
|
Professional
|
Both
|
$151.00
|
|
| Hospital Charge Code |
2776817
|
|
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 Nucleic Acid Gel Electrophoresis
|
Facility
|
IP
|
$151.00
|
|
| Hospital Charge Code |
2776817
|
|
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
|
|
|
IgVh Nucleic Acid Gel Electrophoresis
|
Facility
|
OP
|
$151.00
|
|
| Hospital Charge Code |
2776817
|
|
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 Nucleic Acid Separation
|
Facility
|
IP
|
$151.00
|
|
| Hospital Charge Code |
2776818
|
|
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
|
|
|
IgVh Nucleic Acid Separation
|
Professional
|
Both
|
$151.00
|
|
| Hospital Charge Code |
2776818
|
|
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 Nucleic Acid Separation
|
Facility
|
OP
|
$151.00
|
|
| Hospital Charge Code |
2776818
|
|
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
|
|
|
IIBD Serology 7 Prom
|
Professional
|
Both
|
$288.00
|
|
|
Service Code
|
CPT 88346
|
| Hospital Charge Code |
2776819
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$33.43 |
| Max. Negotiated Rate |
$488.69 |
| Rate for Payer: Aetna Commercial |
$273.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$247.68
|
| Rate for Payer: Anthem Commercial |
$33.43
|
| Rate for Payer: Cash Price |
$86.40
|
| Rate for Payer: Cash Price |
$86.40
|
| Rate for Payer: Cigna Commercial |
$273.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$144.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$172.80
|
| Rate for Payer: Health EOS Commercial |
$262.08
|
| Rate for Payer: HFN Commercial |
$273.60
|
| 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 |
$230.40
|
| Rate for Payer: Preferred Network Access Commercial |
$273.60
|
| Rate for Payer: Quartz Beloit One Network |
$126.72
|
| Rate for Payer: Quartz Commercial |
$164.16
|
| Rate for Payer: The Alliance Commercial |
$144.00
|
| Rate for Payer: WEA Trust Commercial |
$158.40
|
| Rate for Payer: WPS Commercial |
$213.32
|
|
