|
Anaplasma phagocytophilum Antibody IgG
|
Facility
|
OP
|
$414.00
|
|
|
Service Code
|
CPT 86666
|
| Hospital Charge Code |
5679629
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.59 |
| Max. Negotiated Rate |
$396.12 |
| Rate for Payer: Aetna Commercial |
$387.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$370.28
|
| Rate for Payer: Aetna Managed Medicare |
$10.59
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$39.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$18.53
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$17.57
|
| Rate for Payer: Anthem Medicare Advantage |
$10.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$228.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$10.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$10.59
|
| Rate for Payer: Cash Price |
$124.20
|
| Rate for Payer: Cash Price |
$124.20
|
| Rate for Payer: Cigna Commercial |
$396.12
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$10.59
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$240.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$10.59
|
| Rate for Payer: Health EOS Commercial |
$383.20
|
| Rate for Payer: HFN Commercial |
$396.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$39.38
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$10.59
|
| Rate for Payer: Independent Care Health Plan Medicare |
$10.59
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$10.59
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$10.59
|
| Rate for Payer: Multiplan Commercial |
$344.45
|
| Rate for Payer: NAPHCARE Commercial |
$15.88
|
| Rate for Payer: Preferred Network Access Commercial |
$396.12
|
| Rate for Payer: Quartz Beloit One Network |
$210.97
|
| Rate for Payer: Quartz Commercial |
$279.86
|
| Rate for Payer: Quartz Medicare Advantage |
$10.59
|
| Rate for Payer: The Alliance Commercial |
$42.35
|
| Rate for Payer: United Healthcare Medicare Advantage |
$10.59
|
| Rate for Payer: United Healthcare PPO |
$322.92
|
| Rate for Payer: WEA Trust Commercial |
$236.81
|
| Rate for Payer: Wellcare Medicare |
$10.59
|
| Rate for Payer: WPS Commercial |
$318.90
|
|
|
Anaplasma phagocytophilum Antibody IgM
|
Facility
|
OP
|
$414.00
|
|
|
Service Code
|
CPT 86666
|
| Hospital Charge Code |
5679630
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.59 |
| Max. Negotiated Rate |
$396.12 |
| Rate for Payer: Aetna Commercial |
$387.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$370.28
|
| Rate for Payer: Aetna Managed Medicare |
$10.59
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$39.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$18.53
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$17.57
|
| Rate for Payer: Anthem Medicare Advantage |
$10.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$228.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$10.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$10.59
|
| Rate for Payer: Cash Price |
$124.20
|
| Rate for Payer: Cash Price |
$124.20
|
| Rate for Payer: Cigna Commercial |
$396.12
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$10.59
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$240.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$10.59
|
| Rate for Payer: Health EOS Commercial |
$383.20
|
| Rate for Payer: HFN Commercial |
$396.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$39.38
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$10.59
|
| Rate for Payer: Independent Care Health Plan Medicare |
$10.59
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$10.59
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$10.59
|
| Rate for Payer: Multiplan Commercial |
$344.45
|
| Rate for Payer: NAPHCARE Commercial |
$15.88
|
| Rate for Payer: Preferred Network Access Commercial |
$396.12
|
| Rate for Payer: Quartz Beloit One Network |
$210.97
|
| Rate for Payer: Quartz Commercial |
$279.86
|
| Rate for Payer: Quartz Medicare Advantage |
$10.59
|
| Rate for Payer: The Alliance Commercial |
$42.35
|
| Rate for Payer: United Healthcare Medicare Advantage |
$10.59
|
| Rate for Payer: United Healthcare PPO |
$322.92
|
| Rate for Payer: WEA Trust Commercial |
$236.81
|
| Rate for Payer: Wellcare Medicare |
$10.59
|
| Rate for Payer: WPS Commercial |
$318.90
|
|
|
Anaplasma phagocytophilum Antibody IgM
|
Facility
|
IP
|
$414.00
|
|
|
Service Code
|
CPT 86666
|
| Hospital Charge Code |
5679630
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$210.97 |
| Max. Negotiated Rate |
$396.12 |
| Rate for Payer: Aetna Commercial |
$387.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$370.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$228.20
|
| Rate for Payer: Cash Price |
$124.20
|
| Rate for Payer: Cigna Commercial |
$396.12
|
| Rate for Payer: Health EOS Commercial |
$383.20
|
| Rate for Payer: HFN Commercial |
$396.12
|
| Rate for Payer: Multiplan Commercial |
$344.45
|
| Rate for Payer: Preferred Network Access Commercial |
$396.12
|
| Rate for Payer: Quartz Beloit One Network |
$210.97
|
| Rate for Payer: Quartz Commercial |
$258.34
|
| Rate for Payer: WEA Trust Commercial |
$236.81
|
| Rate for Payer: WPS Commercial |
$318.90
|
|
|
Anaplasma phagocytophilum Antibody IgM
|
Professional
|
Both
|
$414.00
|
|
|
Service Code
|
CPT 86666
|
| Hospital Charge Code |
5679630
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.59 |
| Max. Negotiated Rate |
$409.03 |
| Rate for Payer: Aetna Commercial |
$409.03
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$370.28
|
| Rate for Payer: Aetna Managed Medicare |
$10.59
|
| Rate for Payer: Anthem Medicare Advantage |
$10.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$10.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$10.59
|
| Rate for Payer: Cash Price |
$124.20
|
| Rate for Payer: Cash Price |
$124.20
|
| Rate for Payer: Cigna Commercial |
$409.03
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$215.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$10.59
|
| Rate for Payer: Health EOS Commercial |
$391.81
|
| Rate for Payer: HFN Commercial |
$409.03
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$37.38
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$37.38
|
| Rate for Payer: Independent Care Health Plan Medicare |
$10.59
|
| Rate for Payer: Multiplan Commercial |
$344.45
|
| Rate for Payer: NAPHCARE Commercial |
$15.88
|
| Rate for Payer: Preferred Network Access Commercial |
$409.03
|
| Rate for Payer: Quartz Beloit One Network |
$189.45
|
| Rate for Payer: Quartz Commercial |
$245.42
|
| Rate for Payer: Quartz Medicare Advantage |
$10.59
|
| Rate for Payer: The Alliance Commercial |
$41.82
|
| Rate for Payer: United Healthcare Medicare Advantage |
$10.59
|
| Rate for Payer: WEA Trust Commercial |
$236.81
|
| Rate for Payer: WPS Commercial |
$46.58
|
|
|
Anaplasma phagocytophilum, IgG/IgM
|
Facility
|
IP
|
$172.00
|
|
|
Service Code
|
CPT 86666
|
| Hospital Charge Code |
980022
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$87.65 |
| Max. Negotiated Rate |
$164.57 |
| Rate for Payer: Aetna Commercial |
$160.99
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$153.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$94.81
|
| Rate for Payer: Cash Price |
$51.60
|
| Rate for Payer: Cigna Commercial |
$164.57
|
| Rate for Payer: Health EOS Commercial |
$159.20
|
| Rate for Payer: HFN Commercial |
$164.57
|
| Rate for Payer: Multiplan Commercial |
$143.10
|
| Rate for Payer: Preferred Network Access Commercial |
$164.57
|
| Rate for Payer: Quartz Beloit One Network |
$87.65
|
| Rate for Payer: Quartz Commercial |
$107.33
|
| Rate for Payer: WEA Trust Commercial |
$98.38
|
| Rate for Payer: WPS Commercial |
$132.49
|
|
|
Anaplasma phagocytophilum, IgG/IgM
|
Facility
|
OP
|
$172.00
|
|
|
Service Code
|
CPT 86666
|
| Hospital Charge Code |
980022
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.59 |
| Max. Negotiated Rate |
$164.57 |
| Rate for Payer: Aetna Commercial |
$160.99
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$153.84
|
| Rate for Payer: Aetna Managed Medicare |
$10.59
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$39.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$18.53
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$17.57
|
| Rate for Payer: Anthem Medicare Advantage |
$10.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$94.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$10.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$10.59
|
| Rate for Payer: Cash Price |
$51.60
|
| Rate for Payer: Cash Price |
$51.60
|
| Rate for Payer: Cigna Commercial |
$164.57
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$10.59
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$100.10
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$10.59
|
| Rate for Payer: Health EOS Commercial |
$159.20
|
| Rate for Payer: HFN Commercial |
$164.57
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$39.38
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$10.59
|
| Rate for Payer: Independent Care Health Plan Medicare |
$10.59
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$10.59
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$10.59
|
| Rate for Payer: Multiplan Commercial |
$143.10
|
| Rate for Payer: NAPHCARE Commercial |
$15.88
|
| Rate for Payer: Preferred Network Access Commercial |
$164.57
|
| Rate for Payer: Quartz Beloit One Network |
$87.65
|
| Rate for Payer: Quartz Commercial |
$116.27
|
| Rate for Payer: Quartz Medicare Advantage |
$10.59
|
| Rate for Payer: The Alliance Commercial |
$42.35
|
| Rate for Payer: United Healthcare Medicare Advantage |
$10.59
|
| Rate for Payer: United Healthcare PPO |
$134.16
|
| Rate for Payer: WEA Trust Commercial |
$98.38
|
| Rate for Payer: Wellcare Medicare |
$10.59
|
| Rate for Payer: WPS Commercial |
$132.49
|
|
|
Anaplasma phagocytophilum, IgG/IgM
|
Professional
|
Both
|
$172.00
|
|
|
Service Code
|
CPT 86666
|
| Hospital Charge Code |
980022
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.59 |
| Max. Negotiated Rate |
$169.94 |
| Rate for Payer: Aetna Commercial |
$169.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$153.84
|
| Rate for Payer: Aetna Managed Medicare |
$10.59
|
| Rate for Payer: Anthem Medicare Advantage |
$10.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$10.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$10.59
|
| Rate for Payer: Cash Price |
$51.60
|
| Rate for Payer: Cash Price |
$51.60
|
| Rate for Payer: Cigna Commercial |
$169.94
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$89.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$10.59
|
| Rate for Payer: Health EOS Commercial |
$162.78
|
| Rate for Payer: HFN Commercial |
$169.94
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$37.38
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$37.38
|
| Rate for Payer: Independent Care Health Plan Medicare |
$10.59
|
| Rate for Payer: Multiplan Commercial |
$143.10
|
| Rate for Payer: NAPHCARE Commercial |
$15.88
|
| Rate for Payer: Preferred Network Access Commercial |
$169.94
|
| Rate for Payer: Quartz Beloit One Network |
$78.71
|
| Rate for Payer: Quartz Commercial |
$101.96
|
| Rate for Payer: Quartz Medicare Advantage |
$10.59
|
| Rate for Payer: The Alliance Commercial |
$41.82
|
| Rate for Payer: United Healthcare Medicare Advantage |
$10.59
|
| Rate for Payer: WEA Trust Commercial |
$98.38
|
| Rate for Payer: WPS Commercial |
$46.58
|
|
|
Anaplasma phagocytophilum IgM
|
Facility
|
OP
|
$116.00
|
|
|
Service Code
|
CPT 86666
|
| Hospital Charge Code |
2942861
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.59 |
| Max. Negotiated Rate |
$110.99 |
| Rate for Payer: Aetna Commercial |
$108.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$103.75
|
| Rate for Payer: Aetna Managed Medicare |
$10.59
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$39.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$18.53
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$17.57
|
| Rate for Payer: Anthem Medicare Advantage |
$10.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$63.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$10.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$10.59
|
| Rate for Payer: Cash Price |
$34.80
|
| Rate for Payer: Cash Price |
$34.80
|
| Rate for Payer: Cigna Commercial |
$110.99
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$10.59
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$67.51
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$10.59
|
| Rate for Payer: Health EOS Commercial |
$107.37
|
| Rate for Payer: HFN Commercial |
$110.99
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$39.38
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$10.59
|
| Rate for Payer: Independent Care Health Plan Medicare |
$10.59
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$10.59
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$10.59
|
| Rate for Payer: Multiplan Commercial |
$96.51
|
| Rate for Payer: NAPHCARE Commercial |
$15.88
|
| Rate for Payer: Preferred Network Access Commercial |
$110.99
|
| Rate for Payer: Quartz Beloit One Network |
$59.11
|
| Rate for Payer: Quartz Commercial |
$78.42
|
| Rate for Payer: Quartz Medicare Advantage |
$10.59
|
| Rate for Payer: The Alliance Commercial |
$42.35
|
| Rate for Payer: United Healthcare Medicare Advantage |
$10.59
|
| Rate for Payer: United Healthcare PPO |
$90.48
|
| Rate for Payer: WEA Trust Commercial |
$66.35
|
| Rate for Payer: Wellcare Medicare |
$10.59
|
| Rate for Payer: WPS Commercial |
$89.35
|
|
|
Anaplasma phagocytophilum IgM
|
Facility
|
IP
|
$116.00
|
|
|
Service Code
|
CPT 86666
|
| Hospital Charge Code |
2942861
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$59.11 |
| Max. Negotiated Rate |
$110.99 |
| Rate for Payer: Aetna Commercial |
$108.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$103.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$63.94
|
| Rate for Payer: Cash Price |
$34.80
|
| Rate for Payer: Cigna Commercial |
$110.99
|
| Rate for Payer: Health EOS Commercial |
$107.37
|
| Rate for Payer: HFN Commercial |
$110.99
|
| Rate for Payer: Multiplan Commercial |
$96.51
|
| Rate for Payer: Preferred Network Access Commercial |
$110.99
|
| Rate for Payer: Quartz Beloit One Network |
$59.11
|
| Rate for Payer: Quartz Commercial |
$72.38
|
| Rate for Payer: WEA Trust Commercial |
$66.35
|
| Rate for Payer: WPS Commercial |
$89.35
|
|
|
Anaplasma phagocytophilum IgM
|
Professional
|
Both
|
$116.00
|
|
|
Service Code
|
CPT 86666
|
| Hospital Charge Code |
2942861
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.59 |
| Max. Negotiated Rate |
$114.61 |
| Rate for Payer: Aetna Commercial |
$114.61
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$103.75
|
| Rate for Payer: Aetna Managed Medicare |
$10.59
|
| Rate for Payer: Anthem Medicare Advantage |
$10.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$10.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$10.59
|
| Rate for Payer: Cash Price |
$34.80
|
| Rate for Payer: Cash Price |
$34.80
|
| Rate for Payer: Cigna Commercial |
$114.61
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$60.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$10.59
|
| Rate for Payer: Health EOS Commercial |
$109.78
|
| Rate for Payer: HFN Commercial |
$114.61
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$37.38
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$37.38
|
| Rate for Payer: Independent Care Health Plan Medicare |
$10.59
|
| Rate for Payer: Multiplan Commercial |
$96.51
|
| Rate for Payer: NAPHCARE Commercial |
$15.88
|
| Rate for Payer: Preferred Network Access Commercial |
$114.61
|
| Rate for Payer: Quartz Beloit One Network |
$53.08
|
| Rate for Payer: Quartz Commercial |
$68.76
|
| Rate for Payer: Quartz Medicare Advantage |
$10.59
|
| Rate for Payer: The Alliance Commercial |
$41.82
|
| Rate for Payer: United Healthcare Medicare Advantage |
$10.59
|
| Rate for Payer: WEA Trust Commercial |
$66.35
|
| Rate for Payer: WPS Commercial |
$46.58
|
|
|
ANA Screen IFA, w/Rfx Mutiplex Cascade
|
Professional
|
Both
|
$174.00
|
|
|
Service Code
|
CPT 86038
|
| Hospital Charge Code |
5313565
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.57 |
| Max. Negotiated Rate |
$171.91 |
| Rate for Payer: Aetna Commercial |
$171.91
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$155.63
|
| Rate for Payer: Aetna Managed Medicare |
$12.57
|
| Rate for Payer: Anthem Medicare Advantage |
$12.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$12.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$12.57
|
| Rate for Payer: Cash Price |
$52.20
|
| Rate for Payer: Cash Price |
$52.20
|
| Rate for Payer: Cigna Commercial |
$171.91
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$90.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12.57
|
| Rate for Payer: Health EOS Commercial |
$164.67
|
| Rate for Payer: HFN Commercial |
$171.91
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$44.39
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$44.39
|
| Rate for Payer: Independent Care Health Plan Medicare |
$12.57
|
| Rate for Payer: Multiplan Commercial |
$144.77
|
| Rate for Payer: NAPHCARE Commercial |
$18.86
|
| Rate for Payer: Preferred Network Access Commercial |
$171.91
|
| Rate for Payer: Quartz Beloit One Network |
$79.62
|
| Rate for Payer: Quartz Commercial |
$103.15
|
| Rate for Payer: Quartz Medicare Advantage |
$12.57
|
| Rate for Payer: The Alliance Commercial |
$49.67
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.57
|
| Rate for Payer: WEA Trust Commercial |
$99.53
|
| Rate for Payer: WPS Commercial |
$55.32
|
|
|
ANA Screen IFA, w/Rfx Mutiplex Cascade
|
Facility
|
IP
|
$174.00
|
|
|
Service Code
|
CPT 86038
|
| Hospital Charge Code |
5313565
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$88.67 |
| Max. Negotiated Rate |
$166.48 |
| Rate for Payer: Aetna Commercial |
$162.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$155.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$95.91
|
| Rate for Payer: Cash Price |
$52.20
|
| Rate for Payer: Cigna Commercial |
$166.48
|
| Rate for Payer: Health EOS Commercial |
$161.05
|
| Rate for Payer: HFN Commercial |
$166.48
|
| Rate for Payer: Multiplan Commercial |
$144.77
|
| Rate for Payer: Preferred Network Access Commercial |
$166.48
|
| Rate for Payer: Quartz Beloit One Network |
$88.67
|
| Rate for Payer: Quartz Commercial |
$108.58
|
| Rate for Payer: WEA Trust Commercial |
$99.53
|
| Rate for Payer: WPS Commercial |
$134.03
|
|
|
ANA Screen IFA, w/Rfx Mutiplex Cascade
|
Facility
|
OP
|
$174.00
|
|
|
Service Code
|
CPT 86038
|
| Hospital Charge Code |
5313565
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.57 |
| Max. Negotiated Rate |
$166.48 |
| Rate for Payer: Aetna Commercial |
$162.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$155.63
|
| Rate for Payer: Aetna Managed Medicare |
$12.57
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$47.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$22.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$20.87
|
| Rate for Payer: Anthem Medicare Advantage |
$12.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$95.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$12.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$12.57
|
| Rate for Payer: Cash Price |
$52.20
|
| Rate for Payer: Cash Price |
$52.20
|
| Rate for Payer: Cigna Commercial |
$166.48
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$12.57
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$101.27
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$12.57
|
| Rate for Payer: Health EOS Commercial |
$161.05
|
| Rate for Payer: HFN Commercial |
$166.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$46.77
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$12.57
|
| Rate for Payer: Independent Care Health Plan Medicare |
$12.57
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$12.57
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$12.57
|
| Rate for Payer: Multiplan Commercial |
$144.77
|
| Rate for Payer: NAPHCARE Commercial |
$18.86
|
| Rate for Payer: Preferred Network Access Commercial |
$166.48
|
| Rate for Payer: Quartz Beloit One Network |
$88.67
|
| Rate for Payer: Quartz Commercial |
$117.62
|
| Rate for Payer: Quartz Medicare Advantage |
$12.57
|
| Rate for Payer: The Alliance Commercial |
$50.29
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.57
|
| Rate for Payer: United Healthcare PPO |
$135.72
|
| Rate for Payer: WEA Trust Commercial |
$99.53
|
| Rate for Payer: Wellcare Medicare |
$12.57
|
| Rate for Payer: WPS Commercial |
$134.03
|
|
|
ANA Screen IFA w/ Rfx Titer & Pattern
|
Professional
|
Both
|
$174.00
|
|
|
Service Code
|
CPT 86038
|
| Hospital Charge Code |
1027822
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.57 |
| Max. Negotiated Rate |
$171.91 |
| Rate for Payer: Aetna Commercial |
$171.91
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$155.63
|
| Rate for Payer: Aetna Managed Medicare |
$12.57
|
| Rate for Payer: Anthem Medicare Advantage |
$12.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$12.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$12.57
|
| Rate for Payer: Cash Price |
$52.20
|
| Rate for Payer: Cash Price |
$52.20
|
| Rate for Payer: Cigna Commercial |
$171.91
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$90.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12.57
|
| Rate for Payer: Health EOS Commercial |
$164.67
|
| Rate for Payer: HFN Commercial |
$171.91
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$44.39
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$44.39
|
| Rate for Payer: Independent Care Health Plan Medicare |
$12.57
|
| Rate for Payer: Multiplan Commercial |
$144.77
|
| Rate for Payer: NAPHCARE Commercial |
$18.86
|
| Rate for Payer: Preferred Network Access Commercial |
$171.91
|
| Rate for Payer: Quartz Beloit One Network |
$79.62
|
| Rate for Payer: Quartz Commercial |
$103.15
|
| Rate for Payer: Quartz Medicare Advantage |
$12.57
|
| Rate for Payer: The Alliance Commercial |
$49.67
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.57
|
| Rate for Payer: WEA Trust Commercial |
$99.53
|
| Rate for Payer: WPS Commercial |
$55.32
|
|
|
ANA Screen IFA w/ Rfx Titer & Pattern
|
Facility
|
IP
|
$174.00
|
|
|
Service Code
|
CPT 86038
|
| Hospital Charge Code |
1027822
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$88.67 |
| Max. Negotiated Rate |
$166.48 |
| Rate for Payer: Aetna Commercial |
$162.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$155.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$95.91
|
| Rate for Payer: Cash Price |
$52.20
|
| Rate for Payer: Cigna Commercial |
$166.48
|
| Rate for Payer: Health EOS Commercial |
$161.05
|
| Rate for Payer: HFN Commercial |
$166.48
|
| Rate for Payer: Multiplan Commercial |
$144.77
|
| Rate for Payer: Preferred Network Access Commercial |
$166.48
|
| Rate for Payer: Quartz Beloit One Network |
$88.67
|
| Rate for Payer: Quartz Commercial |
$108.58
|
| Rate for Payer: WEA Trust Commercial |
$99.53
|
| Rate for Payer: WPS Commercial |
$134.03
|
|
|
ANA Screen IFA w/ Rfx Titer & Pattern
|
Facility
|
OP
|
$174.00
|
|
|
Service Code
|
CPT 86038
|
| Hospital Charge Code |
1027822
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.57 |
| Max. Negotiated Rate |
$166.48 |
| Rate for Payer: Aetna Commercial |
$162.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$155.63
|
| Rate for Payer: Aetna Managed Medicare |
$12.57
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$47.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$22.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$20.87
|
| Rate for Payer: Anthem Medicare Advantage |
$12.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$95.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$12.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$12.57
|
| Rate for Payer: Cash Price |
$52.20
|
| Rate for Payer: Cash Price |
$52.20
|
| Rate for Payer: Cigna Commercial |
$166.48
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$12.57
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$101.27
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$12.57
|
| Rate for Payer: Health EOS Commercial |
$161.05
|
| Rate for Payer: HFN Commercial |
$166.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$46.77
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$12.57
|
| Rate for Payer: Independent Care Health Plan Medicare |
$12.57
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$12.57
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$12.57
|
| Rate for Payer: Multiplan Commercial |
$144.77
|
| Rate for Payer: NAPHCARE Commercial |
$18.86
|
| Rate for Payer: Preferred Network Access Commercial |
$166.48
|
| Rate for Payer: Quartz Beloit One Network |
$88.67
|
| Rate for Payer: Quartz Commercial |
$117.62
|
| Rate for Payer: Quartz Medicare Advantage |
$12.57
|
| Rate for Payer: The Alliance Commercial |
$50.29
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.57
|
| Rate for Payer: United Healthcare PPO |
$135.72
|
| Rate for Payer: WEA Trust Commercial |
$99.53
|
| Rate for Payer: Wellcare Medicare |
$12.57
|
| Rate for Payer: WPS Commercial |
$134.03
|
|
|
.ANA Tier 1 Cascade
|
Facility
|
OP
|
$197.00
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
5313566
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.65 |
| Max. Negotiated Rate |
$188.49 |
| Rate for Payer: Aetna Commercial |
$184.39
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$176.20
|
| Rate for Payer: Aetna Managed Medicare |
$18.65
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$69.93
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$32.63
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$30.95
|
| Rate for Payer: Anthem Medicare Advantage |
$18.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$108.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$18.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$18.65
|
| Rate for Payer: Cash Price |
$59.10
|
| Rate for Payer: Cash Price |
$59.10
|
| Rate for Payer: Cigna Commercial |
$188.49
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$18.65
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$114.65
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$18.65
|
| Rate for Payer: Health EOS Commercial |
$182.34
|
| Rate for Payer: HFN Commercial |
$188.49
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$69.37
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$18.65
|
| Rate for Payer: Independent Care Health Plan Medicare |
$18.65
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$18.65
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$18.65
|
| Rate for Payer: Multiplan Commercial |
$163.90
|
| Rate for Payer: NAPHCARE Commercial |
$27.97
|
| Rate for Payer: Preferred Network Access Commercial |
$188.49
|
| Rate for Payer: Quartz Beloit One Network |
$100.39
|
| Rate for Payer: Quartz Commercial |
$133.17
|
| Rate for Payer: Quartz Medicare Advantage |
$18.65
|
| Rate for Payer: The Alliance Commercial |
$74.59
|
| Rate for Payer: United Healthcare Medicare Advantage |
$18.65
|
| Rate for Payer: United Healthcare PPO |
$153.66
|
| Rate for Payer: WEA Trust Commercial |
$112.68
|
| Rate for Payer: Wellcare Medicare |
$18.65
|
| Rate for Payer: WPS Commercial |
$151.75
|
|
|
.ANA Tier 1 Cascade
|
Professional
|
Both
|
$197.00
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
5313566
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.65 |
| Max. Negotiated Rate |
$194.64 |
| Rate for Payer: Aetna Commercial |
$194.64
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$176.20
|
| Rate for Payer: Aetna Managed Medicare |
$18.65
|
| Rate for Payer: Anthem Medicare Advantage |
$18.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$18.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$18.65
|
| Rate for Payer: Cash Price |
$59.10
|
| Rate for Payer: Cash Price |
$59.10
|
| Rate for Payer: Cigna Commercial |
$194.64
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$102.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$18.65
|
| Rate for Payer: Health EOS Commercial |
$186.44
|
| Rate for Payer: HFN Commercial |
$194.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$65.82
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$65.82
|
| Rate for Payer: Independent Care Health Plan Medicare |
$18.65
|
| Rate for Payer: Multiplan Commercial |
$163.90
|
| Rate for Payer: NAPHCARE Commercial |
$27.97
|
| Rate for Payer: Preferred Network Access Commercial |
$194.64
|
| Rate for Payer: Quartz Beloit One Network |
$90.15
|
| Rate for Payer: Quartz Commercial |
$116.78
|
| Rate for Payer: Quartz Medicare Advantage |
$18.65
|
| Rate for Payer: The Alliance Commercial |
$73.66
|
| Rate for Payer: United Healthcare Medicare Advantage |
$18.65
|
| Rate for Payer: WEA Trust Commercial |
$112.68
|
| Rate for Payer: WPS Commercial |
$82.05
|
|
|
.ANA Tier 1 Cascade
|
Facility
|
IP
|
$197.00
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
5313566
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$100.39 |
| Max. Negotiated Rate |
$188.49 |
| Rate for Payer: Aetna Commercial |
$184.39
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$176.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$108.59
|
| Rate for Payer: Cash Price |
$59.10
|
| Rate for Payer: Cigna Commercial |
$188.49
|
| Rate for Payer: Health EOS Commercial |
$182.34
|
| Rate for Payer: HFN Commercial |
$188.49
|
| Rate for Payer: Multiplan Commercial |
$163.90
|
| Rate for Payer: Preferred Network Access Commercial |
$188.49
|
| Rate for Payer: Quartz Beloit One Network |
$100.39
|
| Rate for Payer: Quartz Commercial |
$122.93
|
| Rate for Payer: WEA Trust Commercial |
$112.68
|
| Rate for Payer: WPS Commercial |
$151.75
|
|
|
.ANA Tier 2 Cascade
|
Facility
|
IP
|
$197.00
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
5313567
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$100.39 |
| Max. Negotiated Rate |
$188.49 |
| Rate for Payer: Aetna Commercial |
$184.39
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$176.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$108.59
|
| Rate for Payer: Cash Price |
$59.10
|
| Rate for Payer: Cigna Commercial |
$188.49
|
| Rate for Payer: Health EOS Commercial |
$182.34
|
| Rate for Payer: HFN Commercial |
$188.49
|
| Rate for Payer: Multiplan Commercial |
$163.90
|
| Rate for Payer: Preferred Network Access Commercial |
$188.49
|
| Rate for Payer: Quartz Beloit One Network |
$100.39
|
| Rate for Payer: Quartz Commercial |
$122.93
|
| Rate for Payer: WEA Trust Commercial |
$112.68
|
| Rate for Payer: WPS Commercial |
$151.75
|
|
|
.ANA Tier 2 Cascade
|
Facility
|
OP
|
$197.00
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
5313567
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.65 |
| Max. Negotiated Rate |
$188.49 |
| Rate for Payer: Aetna Commercial |
$184.39
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$176.20
|
| Rate for Payer: Aetna Managed Medicare |
$18.65
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$69.93
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$32.63
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$30.95
|
| Rate for Payer: Anthem Medicare Advantage |
$18.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$108.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$18.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$18.65
|
| Rate for Payer: Cash Price |
$59.10
|
| Rate for Payer: Cash Price |
$59.10
|
| Rate for Payer: Cigna Commercial |
$188.49
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$18.65
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$114.65
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$18.65
|
| Rate for Payer: Health EOS Commercial |
$182.34
|
| Rate for Payer: HFN Commercial |
$188.49
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$69.37
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$18.65
|
| Rate for Payer: Independent Care Health Plan Medicare |
$18.65
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$18.65
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$18.65
|
| Rate for Payer: Multiplan Commercial |
$163.90
|
| Rate for Payer: NAPHCARE Commercial |
$27.97
|
| Rate for Payer: Preferred Network Access Commercial |
$188.49
|
| Rate for Payer: Quartz Beloit One Network |
$100.39
|
| Rate for Payer: Quartz Commercial |
$133.17
|
| Rate for Payer: Quartz Medicare Advantage |
$18.65
|
| Rate for Payer: The Alliance Commercial |
$74.59
|
| Rate for Payer: United Healthcare Medicare Advantage |
$18.65
|
| Rate for Payer: United Healthcare PPO |
$153.66
|
| Rate for Payer: WEA Trust Commercial |
$112.68
|
| Rate for Payer: Wellcare Medicare |
$18.65
|
| Rate for Payer: WPS Commercial |
$151.75
|
|
|
.ANA Tier 2 Cascade
|
Professional
|
Both
|
$197.00
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
5313567
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.65 |
| Max. Negotiated Rate |
$194.64 |
| Rate for Payer: Aetna Commercial |
$194.64
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$176.20
|
| Rate for Payer: Aetna Managed Medicare |
$18.65
|
| Rate for Payer: Anthem Medicare Advantage |
$18.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$18.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$18.65
|
| Rate for Payer: Cash Price |
$59.10
|
| Rate for Payer: Cash Price |
$59.10
|
| Rate for Payer: Cigna Commercial |
$194.64
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$102.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$18.65
|
| Rate for Payer: Health EOS Commercial |
$186.44
|
| Rate for Payer: HFN Commercial |
$194.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$65.82
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$65.82
|
| Rate for Payer: Independent Care Health Plan Medicare |
$18.65
|
| Rate for Payer: Multiplan Commercial |
$163.90
|
| Rate for Payer: NAPHCARE Commercial |
$27.97
|
| Rate for Payer: Preferred Network Access Commercial |
$194.64
|
| Rate for Payer: Quartz Beloit One Network |
$90.15
|
| Rate for Payer: Quartz Commercial |
$116.78
|
| Rate for Payer: Quartz Medicare Advantage |
$18.65
|
| Rate for Payer: The Alliance Commercial |
$73.66
|
| Rate for Payer: United Healthcare Medicare Advantage |
$18.65
|
| Rate for Payer: WEA Trust Commercial |
$112.68
|
| Rate for Payer: WPS Commercial |
$82.05
|
|
|
.ANA Tier 3 Cascade
|
Facility
|
OP
|
$60.00
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
5313568
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.65 |
| Max. Negotiated Rate |
$74.59 |
| Rate for Payer: Aetna Commercial |
$56.16
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$53.66
|
| Rate for Payer: Aetna Managed Medicare |
$18.65
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$69.93
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$32.63
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$30.95
|
| Rate for Payer: Anthem Medicare Advantage |
$18.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$33.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$18.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$18.65
|
| Rate for Payer: Cash Price |
$18.00
|
| Rate for Payer: Cash Price |
$18.00
|
| Rate for Payer: Cigna Commercial |
$57.41
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$18.65
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$34.92
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$18.65
|
| Rate for Payer: Health EOS Commercial |
$55.54
|
| Rate for Payer: HFN Commercial |
$57.41
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$69.37
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$18.65
|
| Rate for Payer: Independent Care Health Plan Medicare |
$18.65
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$18.65
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$18.65
|
| Rate for Payer: Multiplan Commercial |
$49.92
|
| Rate for Payer: NAPHCARE Commercial |
$27.97
|
| Rate for Payer: Preferred Network Access Commercial |
$57.41
|
| Rate for Payer: Quartz Beloit One Network |
$30.58
|
| Rate for Payer: Quartz Commercial |
$40.56
|
| Rate for Payer: Quartz Medicare Advantage |
$18.65
|
| Rate for Payer: The Alliance Commercial |
$74.59
|
| Rate for Payer: United Healthcare Medicare Advantage |
$18.65
|
| Rate for Payer: United Healthcare PPO |
$46.80
|
| Rate for Payer: WEA Trust Commercial |
$34.32
|
| Rate for Payer: Wellcare Medicare |
$18.65
|
| Rate for Payer: WPS Commercial |
$46.22
|
|
|
.ANA Tier 3 Cascade
|
Facility
|
IP
|
$60.00
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
5313568
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$30.58 |
| Max. Negotiated Rate |
$57.41 |
| Rate for Payer: Aetna Commercial |
$56.16
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$53.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$33.07
|
| Rate for Payer: Cash Price |
$18.00
|
| Rate for Payer: Cigna Commercial |
$57.41
|
| Rate for Payer: Health EOS Commercial |
$55.54
|
| Rate for Payer: HFN Commercial |
$57.41
|
| Rate for Payer: Multiplan Commercial |
$49.92
|
| Rate for Payer: Preferred Network Access Commercial |
$57.41
|
| Rate for Payer: Quartz Beloit One Network |
$30.58
|
| Rate for Payer: Quartz Commercial |
$37.44
|
| Rate for Payer: WEA Trust Commercial |
$34.32
|
| Rate for Payer: WPS Commercial |
$46.22
|
|
|
.ANA Tier 3 Cascade
|
Professional
|
Both
|
$60.00
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
5313568
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.65 |
| Max. Negotiated Rate |
$82.05 |
| Rate for Payer: Aetna Commercial |
$59.28
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$53.66
|
| Rate for Payer: Aetna Managed Medicare |
$18.65
|
| Rate for Payer: Anthem Medicare Advantage |
$18.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$18.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$18.65
|
| Rate for Payer: Cash Price |
$18.00
|
| Rate for Payer: Cash Price |
$18.00
|
| Rate for Payer: Cigna Commercial |
$59.28
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$31.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$18.65
|
| Rate for Payer: Health EOS Commercial |
$56.78
|
| Rate for Payer: HFN Commercial |
$59.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$65.82
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$65.82
|
| Rate for Payer: Independent Care Health Plan Medicare |
$18.65
|
| Rate for Payer: Multiplan Commercial |
$49.92
|
| Rate for Payer: NAPHCARE Commercial |
$27.97
|
| Rate for Payer: Preferred Network Access Commercial |
$59.28
|
| Rate for Payer: Quartz Beloit One Network |
$27.46
|
| Rate for Payer: Quartz Commercial |
$35.57
|
| Rate for Payer: Quartz Medicare Advantage |
$18.65
|
| Rate for Payer: The Alliance Commercial |
$73.66
|
| Rate for Payer: United Healthcare Medicare Advantage |
$18.65
|
| Rate for Payer: WEA Trust Commercial |
$34.32
|
| Rate for Payer: WPS Commercial |
$82.05
|
|
