|
Aph RBC CP2D AS3 LR Irr 2
|
Facility
|
OP
|
$567.00
|
|
|
Service Code
|
HCPCS P9021
|
| Hospital Charge Code |
1052838
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$155.10 |
| Max. Negotiated Rate |
$620.38 |
| Rate for Payer: Aetna Commercial |
$530.71
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$507.12
|
| Rate for Payer: Aetna Managed Medicare |
$155.10
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$383.29
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$294.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$283.05
|
| Rate for Payer: Anthem Medicare Advantage |
$155.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$312.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$155.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$155.10
|
| Rate for Payer: Cash Price |
$170.10
|
| Rate for Payer: Cash Price |
$170.10
|
| Rate for Payer: Cigna Commercial |
$542.51
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$155.10
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$329.99
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$155.10
|
| Rate for Payer: Health EOS Commercial |
$524.82
|
| Rate for Payer: HFN Commercial |
$542.51
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$576.95
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$155.10
|
| Rate for Payer: Independent Care Health Plan Medicare |
$155.10
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$155.10
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$155.10
|
| Rate for Payer: Multiplan Commercial |
$471.74
|
| Rate for Payer: NAPHCARE Commercial |
$232.64
|
| Rate for Payer: Preferred Network Access Commercial |
$542.51
|
| Rate for Payer: Quartz Beloit One Network |
$288.94
|
| Rate for Payer: Quartz Commercial |
$383.29
|
| Rate for Payer: Quartz Medicare Advantage |
$155.10
|
| Rate for Payer: The Alliance Commercial |
$620.38
|
| Rate for Payer: United Healthcare Medicare Advantage |
$155.10
|
| Rate for Payer: United Healthcare PPO |
$442.26
|
| Rate for Payer: WEA Trust Commercial |
$324.32
|
| Rate for Payer: Wellcare Medicare |
$155.10
|
| Rate for Payer: WPS Commercial |
$436.76
|
|
|
Aph RBC CP2D AS3 LR Irr 2
|
Facility
|
IP
|
$567.00
|
|
|
Service Code
|
HCPCS P9021
|
| Hospital Charge Code |
1052838
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$288.94 |
| Max. Negotiated Rate |
$542.51 |
| Rate for Payer: Aetna Commercial |
$530.71
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$507.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$312.53
|
| Rate for Payer: Cash Price |
$170.10
|
| Rate for Payer: Cigna Commercial |
$542.51
|
| Rate for Payer: Health EOS Commercial |
$524.82
|
| Rate for Payer: HFN Commercial |
$542.51
|
| Rate for Payer: Multiplan Commercial |
$471.74
|
| Rate for Payer: Preferred Network Access Commercial |
$542.51
|
| Rate for Payer: Quartz Beloit One Network |
$288.94
|
| Rate for Payer: Quartz Commercial |
$353.81
|
| Rate for Payer: WEA Trust Commercial |
$324.32
|
| Rate for Payer: WPS Commercial |
$436.76
|
|
|
Apixaban Lvl
|
Facility
|
OP
|
$229.00
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
5502688
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$19.39 |
| Max. Negotiated Rate |
$219.11 |
| Rate for Payer: Aetna Commercial |
$214.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$204.82
|
| Rate for Payer: Aetna Managed Medicare |
$19.39
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$72.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$33.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$32.18
|
| Rate for Payer: Anthem Medicare Advantage |
$19.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$126.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$19.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$19.39
|
| Rate for Payer: Cash Price |
$68.70
|
| Rate for Payer: Cash Price |
$68.70
|
| Rate for Payer: Cigna Commercial |
$219.11
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$19.39
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$133.28
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$19.39
|
| Rate for Payer: Health EOS Commercial |
$211.96
|
| Rate for Payer: HFN Commercial |
$219.11
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$72.11
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$19.39
|
| Rate for Payer: Independent Care Health Plan Medicare |
$19.39
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$19.39
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$19.39
|
| Rate for Payer: Multiplan Commercial |
$190.53
|
| Rate for Payer: NAPHCARE Commercial |
$29.08
|
| Rate for Payer: Preferred Network Access Commercial |
$219.11
|
| Rate for Payer: Quartz Beloit One Network |
$116.70
|
| Rate for Payer: Quartz Commercial |
$154.80
|
| Rate for Payer: Quartz Medicare Advantage |
$19.39
|
| Rate for Payer: The Alliance Commercial |
$77.54
|
| Rate for Payer: United Healthcare Medicare Advantage |
$19.39
|
| Rate for Payer: United Healthcare PPO |
$178.62
|
| Rate for Payer: WEA Trust Commercial |
$130.99
|
| Rate for Payer: Wellcare Medicare |
$19.39
|
| Rate for Payer: WPS Commercial |
$176.40
|
|
|
Apixaban Lvl
|
Facility
|
IP
|
$229.00
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
5502688
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$116.70 |
| Max. Negotiated Rate |
$219.11 |
| Rate for Payer: Aetna Commercial |
$214.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$204.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$126.22
|
| Rate for Payer: Cash Price |
$68.70
|
| Rate for Payer: Cigna Commercial |
$219.11
|
| Rate for Payer: Health EOS Commercial |
$211.96
|
| Rate for Payer: HFN Commercial |
$219.11
|
| Rate for Payer: Multiplan Commercial |
$190.53
|
| Rate for Payer: Preferred Network Access Commercial |
$219.11
|
| Rate for Payer: Quartz Beloit One Network |
$116.70
|
| Rate for Payer: Quartz Commercial |
$142.90
|
| Rate for Payer: WEA Trust Commercial |
$130.99
|
| Rate for Payer: WPS Commercial |
$176.40
|
|
|
Apixaban Lvl
|
Professional
|
Both
|
$229.00
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
5502688
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$19.39 |
| Max. Negotiated Rate |
$226.25 |
| Rate for Payer: Aetna Commercial |
$226.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$204.82
|
| Rate for Payer: Aetna Managed Medicare |
$19.39
|
| Rate for Payer: Anthem Medicare Advantage |
$19.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$19.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$19.39
|
| Rate for Payer: Cash Price |
$68.70
|
| Rate for Payer: Cash Price |
$68.70
|
| Rate for Payer: Cigna Commercial |
$226.25
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$119.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$19.39
|
| Rate for Payer: Health EOS Commercial |
$216.73
|
| Rate for Payer: HFN Commercial |
$226.25
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$68.43
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$68.43
|
| Rate for Payer: Independent Care Health Plan Medicare |
$19.39
|
| Rate for Payer: Multiplan Commercial |
$190.53
|
| Rate for Payer: NAPHCARE Commercial |
$29.08
|
| Rate for Payer: Preferred Network Access Commercial |
$226.25
|
| Rate for Payer: Quartz Beloit One Network |
$104.79
|
| Rate for Payer: Quartz Commercial |
$135.75
|
| Rate for Payer: Quartz Medicare Advantage |
$19.39
|
| Rate for Payer: The Alliance Commercial |
$76.57
|
| Rate for Payer: United Healthcare Medicare Advantage |
$19.39
|
| Rate for Payer: WEA Trust Commercial |
$130.99
|
| Rate for Payer: WPS Commercial |
$85.30
|
|
|
APLIGRAF PROCESS A 11USCOM01
|
Facility
|
IP
|
$8,210.00
|
|
|
Service Code
|
HCPCS Q4101
|
| Hospital Charge Code |
2965441
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,183.82 |
| Max. Negotiated Rate |
$7,855.33 |
| Rate for Payer: Aetna Commercial |
$7,684.56
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,343.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,525.35
|
| Rate for Payer: Cash Price |
$2,463.00
|
| Rate for Payer: Cigna Commercial |
$7,855.33
|
| Rate for Payer: Health EOS Commercial |
$7,599.18
|
| Rate for Payer: HFN Commercial |
$7,855.33
|
| Rate for Payer: Multiplan Commercial |
$6,830.72
|
| Rate for Payer: Preferred Network Access Commercial |
$7,855.33
|
| Rate for Payer: Quartz Beloit One Network |
$4,183.82
|
| Rate for Payer: Quartz Commercial |
$5,123.04
|
| Rate for Payer: WEA Trust Commercial |
$4,696.12
|
| Rate for Payer: WPS Commercial |
$6,324.16
|
|
|
APLIGRAF PROCESS A 11USCOM01
|
Facility
|
OP
|
$8,210.00
|
|
|
Service Code
|
HCPCS Q4101
|
| Hospital Charge Code |
2965441
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$42.13 |
| Max. Negotiated Rate |
$7,855.33 |
| Rate for Payer: Aetna Commercial |
$7,684.56
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,343.02
|
| Rate for Payer: Aetna Managed Medicare |
$130.97
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,549.96
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,269.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,098.43
|
| Rate for Payer: Anthem Medicare Advantage |
$130.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,525.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$130.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$130.97
|
| Rate for Payer: Cash Price |
$2,463.00
|
| Rate for Payer: Cash Price |
$2,463.00
|
| Rate for Payer: Cigna Commercial |
$7,855.33
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$130.97
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$42.13
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$130.97
|
| Rate for Payer: Health EOS Commercial |
$7,599.18
|
| Rate for Payer: HFN Commercial |
$7,855.33
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$487.20
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$130.97
|
| Rate for Payer: Independent Care Health Plan Medicare |
$130.97
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$130.97
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$130.97
|
| Rate for Payer: Multiplan Commercial |
$6,830.72
|
| Rate for Payer: NAPHCARE Commercial |
$196.45
|
| Rate for Payer: Preferred Network Access Commercial |
$7,855.33
|
| Rate for Payer: Quartz Beloit One Network |
$4,183.82
|
| Rate for Payer: Quartz Commercial |
$5,549.96
|
| Rate for Payer: Quartz Medicare Advantage |
$130.97
|
| Rate for Payer: The Alliance Commercial |
$523.87
|
| Rate for Payer: United Healthcare Medicare Advantage |
$130.97
|
| Rate for Payer: WEA Trust Commercial |
$4,696.12
|
| Rate for Payer: Wellcare Medicare |
$130.97
|
| Rate for Payer: WPS Commercial |
$6,324.16
|
|
|
APLIGRAFT APPLICATION
|
Facility
|
OP
|
$1,084.00
|
|
| Hospital Charge Code |
2960520
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$315.66 |
| Max. Negotiated Rate |
$1,037.17 |
| Rate for Payer: Aetna Commercial |
$1,014.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$969.53
|
| Rate for Payer: Aetna Managed Medicare |
$315.66
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$732.78
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$563.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$541.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$597.50
|
| Rate for Payer: Cash Price |
$325.20
|
| Rate for Payer: Cigna Commercial |
$1,037.17
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$630.89
|
| Rate for Payer: Health EOS Commercial |
$1,003.35
|
| Rate for Payer: HFN Commercial |
$1,037.17
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$845.52
|
| Rate for Payer: Multiplan Commercial |
$901.89
|
| Rate for Payer: NAPHCARE Commercial |
$676.42
|
| Rate for Payer: Preferred Network Access Commercial |
$1,037.17
|
| Rate for Payer: Quartz Beloit One Network |
$552.41
|
| Rate for Payer: Quartz Commercial |
$732.78
|
| Rate for Payer: Quartz Medicare Advantage |
$676.42
|
| Rate for Payer: The Alliance Commercial |
$563.68
|
| Rate for Payer: WEA Trust Commercial |
$620.05
|
| Rate for Payer: WPS Commercial |
$835.01
|
|
|
APLIGRAFT APPLICATION
|
Facility
|
IP
|
$1,084.00
|
|
| Hospital Charge Code |
2960520
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$552.41 |
| Max. Negotiated Rate |
$1,037.17 |
| Rate for Payer: Aetna Commercial |
$1,014.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$969.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$597.50
|
| Rate for Payer: Cash Price |
$325.20
|
| Rate for Payer: Cigna Commercial |
$1,037.17
|
| Rate for Payer: Health EOS Commercial |
$1,003.35
|
| Rate for Payer: HFN Commercial |
$1,037.17
|
| Rate for Payer: Multiplan Commercial |
$901.89
|
| Rate for Payer: Preferred Network Access Commercial |
$1,037.17
|
| Rate for Payer: Quartz Beloit One Network |
$552.41
|
| Rate for Payer: Quartz Commercial |
$676.42
|
| Rate for Payer: WEA Trust Commercial |
$620.05
|
| Rate for Payer: WPS Commercial |
$835.01
|
|
|
Apolipoprotein
|
Facility
|
OP
|
$94.00
|
|
|
Service Code
|
CPT 82172
|
| Hospital Charge Code |
4812606
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$21.93 |
| Max. Negotiated Rate |
$89.94 |
| Rate for Payer: Aetna Commercial |
$87.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$84.07
|
| Rate for Payer: Aetna Managed Medicare |
$21.93
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$82.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$38.38
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$36.41
|
| Rate for Payer: Anthem Medicare Advantage |
$21.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$51.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$21.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$21.93
|
| Rate for Payer: Cash Price |
$28.20
|
| Rate for Payer: Cash Price |
$28.20
|
| Rate for Payer: Cigna Commercial |
$89.94
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$21.93
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$54.71
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$21.93
|
| Rate for Payer: Health EOS Commercial |
$87.01
|
| Rate for Payer: HFN Commercial |
$89.94
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$81.59
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$21.93
|
| Rate for Payer: Independent Care Health Plan Medicare |
$21.93
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$21.93
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$21.93
|
| Rate for Payer: Multiplan Commercial |
$78.21
|
| Rate for Payer: NAPHCARE Commercial |
$32.90
|
| Rate for Payer: Preferred Network Access Commercial |
$89.94
|
| Rate for Payer: Quartz Beloit One Network |
$47.90
|
| Rate for Payer: Quartz Commercial |
$63.54
|
| Rate for Payer: Quartz Medicare Advantage |
$21.93
|
| Rate for Payer: The Alliance Commercial |
$87.73
|
| Rate for Payer: United Healthcare Medicare Advantage |
$21.93
|
| Rate for Payer: United Healthcare PPO |
$73.32
|
| Rate for Payer: WEA Trust Commercial |
$53.77
|
| Rate for Payer: Wellcare Medicare |
$21.93
|
| Rate for Payer: WPS Commercial |
$72.41
|
|
|
Apolipoprotein
|
Professional
|
Both
|
$94.00
|
|
|
Service Code
|
CPT 82172
|
| Hospital Charge Code |
4812606
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$21.93 |
| Max. Negotiated Rate |
$96.51 |
| Rate for Payer: Aetna Commercial |
$92.87
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$84.07
|
| Rate for Payer: Aetna Managed Medicare |
$21.93
|
| Rate for Payer: Anthem Medicare Advantage |
$21.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$21.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$21.93
|
| Rate for Payer: Cash Price |
$28.20
|
| Rate for Payer: Cash Price |
$28.20
|
| Rate for Payer: Cigna Commercial |
$92.87
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$48.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$21.93
|
| Rate for Payer: Health EOS Commercial |
$88.96
|
| Rate for Payer: HFN Commercial |
$92.87
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$77.43
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$77.43
|
| Rate for Payer: Independent Care Health Plan Medicare |
$21.93
|
| Rate for Payer: Multiplan Commercial |
$78.21
|
| Rate for Payer: NAPHCARE Commercial |
$32.90
|
| Rate for Payer: Preferred Network Access Commercial |
$92.87
|
| Rate for Payer: Quartz Beloit One Network |
$43.01
|
| Rate for Payer: Quartz Commercial |
$55.72
|
| Rate for Payer: Quartz Medicare Advantage |
$21.93
|
| Rate for Payer: The Alliance Commercial |
$86.64
|
| Rate for Payer: United Healthcare Medicare Advantage |
$21.93
|
| Rate for Payer: WEA Trust Commercial |
$53.77
|
| Rate for Payer: WPS Commercial |
$96.51
|
|
|
Apolipoprotein
|
Facility
|
IP
|
$94.00
|
|
|
Service Code
|
CPT 82172
|
| Hospital Charge Code |
4812606
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$47.90 |
| Max. Negotiated Rate |
$89.94 |
| Rate for Payer: Aetna Commercial |
$87.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$84.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$51.81
|
| Rate for Payer: Cash Price |
$28.20
|
| Rate for Payer: Cigna Commercial |
$89.94
|
| Rate for Payer: Health EOS Commercial |
$87.01
|
| Rate for Payer: HFN Commercial |
$89.94
|
| Rate for Payer: Multiplan Commercial |
$78.21
|
| Rate for Payer: Preferred Network Access Commercial |
$89.94
|
| Rate for Payer: Quartz Beloit One Network |
$47.90
|
| Rate for Payer: Quartz Commercial |
$58.66
|
| Rate for Payer: WEA Trust Commercial |
$53.77
|
| Rate for Payer: WPS Commercial |
$72.41
|
|
|
Apolipoprotein A1
|
Facility
|
IP
|
$111.00
|
|
|
Service Code
|
CPT 82172
|
| Hospital Charge Code |
3256221
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$56.57 |
| Max. Negotiated Rate |
$106.20 |
| Rate for Payer: Aetna Commercial |
$103.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$99.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$61.18
|
| Rate for Payer: Cash Price |
$33.30
|
| Rate for Payer: Cigna Commercial |
$106.20
|
| Rate for Payer: Health EOS Commercial |
$102.74
|
| Rate for Payer: HFN Commercial |
$106.20
|
| Rate for Payer: Multiplan Commercial |
$92.35
|
| Rate for Payer: Preferred Network Access Commercial |
$106.20
|
| Rate for Payer: Quartz Beloit One Network |
$56.57
|
| Rate for Payer: Quartz Commercial |
$69.26
|
| Rate for Payer: WEA Trust Commercial |
$63.49
|
| Rate for Payer: WPS Commercial |
$85.50
|
|
|
Apolipoprotein A1
|
Professional
|
Both
|
$111.00
|
|
|
Service Code
|
CPT 82172
|
| Hospital Charge Code |
3256221
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$21.93 |
| Max. Negotiated Rate |
$109.67 |
| Rate for Payer: Aetna Commercial |
$109.67
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$99.28
|
| Rate for Payer: Aetna Managed Medicare |
$21.93
|
| Rate for Payer: Anthem Medicare Advantage |
$21.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$21.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$21.93
|
| Rate for Payer: Cash Price |
$33.30
|
| Rate for Payer: Cash Price |
$33.30
|
| Rate for Payer: Cigna Commercial |
$109.67
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$57.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$21.93
|
| Rate for Payer: Health EOS Commercial |
$105.05
|
| Rate for Payer: HFN Commercial |
$109.67
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$77.43
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$77.43
|
| Rate for Payer: Independent Care Health Plan Medicare |
$21.93
|
| Rate for Payer: Multiplan Commercial |
$92.35
|
| Rate for Payer: NAPHCARE Commercial |
$32.90
|
| Rate for Payer: Preferred Network Access Commercial |
$109.67
|
| Rate for Payer: Quartz Beloit One Network |
$50.79
|
| Rate for Payer: Quartz Commercial |
$65.80
|
| Rate for Payer: Quartz Medicare Advantage |
$21.93
|
| Rate for Payer: The Alliance Commercial |
$86.64
|
| Rate for Payer: United Healthcare Medicare Advantage |
$21.93
|
| Rate for Payer: WEA Trust Commercial |
$63.49
|
| Rate for Payer: WPS Commercial |
$96.51
|
|
|
Apolipoprotein A1
|
Facility
|
OP
|
$111.00
|
|
|
Service Code
|
CPT 82172
|
| Hospital Charge Code |
3256221
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$21.93 |
| Max. Negotiated Rate |
$106.20 |
| Rate for Payer: Aetna Commercial |
$103.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$99.28
|
| Rate for Payer: Aetna Managed Medicare |
$21.93
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$82.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$38.38
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$36.41
|
| Rate for Payer: Anthem Medicare Advantage |
$21.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$61.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$21.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$21.93
|
| Rate for Payer: Cash Price |
$33.30
|
| Rate for Payer: Cash Price |
$33.30
|
| Rate for Payer: Cigna Commercial |
$106.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$21.93
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$64.60
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$21.93
|
| Rate for Payer: Health EOS Commercial |
$102.74
|
| Rate for Payer: HFN Commercial |
$106.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$81.59
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$21.93
|
| Rate for Payer: Independent Care Health Plan Medicare |
$21.93
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$21.93
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$21.93
|
| Rate for Payer: Multiplan Commercial |
$92.35
|
| Rate for Payer: NAPHCARE Commercial |
$32.90
|
| Rate for Payer: Preferred Network Access Commercial |
$106.20
|
| Rate for Payer: Quartz Beloit One Network |
$56.57
|
| Rate for Payer: Quartz Commercial |
$75.04
|
| Rate for Payer: Quartz Medicare Advantage |
$21.93
|
| Rate for Payer: The Alliance Commercial |
$87.73
|
| Rate for Payer: United Healthcare Medicare Advantage |
$21.93
|
| Rate for Payer: United Healthcare PPO |
$86.58
|
| Rate for Payer: WEA Trust Commercial |
$63.49
|
| Rate for Payer: Wellcare Medicare |
$21.93
|
| Rate for Payer: WPS Commercial |
$85.50
|
|
|
Apolipoprotein B / 5224
|
Facility
|
OP
|
$252.00
|
|
|
Service Code
|
CPT 82172
|
| Hospital Charge Code |
977871
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$21.93 |
| Max. Negotiated Rate |
$241.11 |
| Rate for Payer: Aetna Commercial |
$235.87
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$225.39
|
| Rate for Payer: Aetna Managed Medicare |
$21.93
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$82.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$38.38
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$36.41
|
| Rate for Payer: Anthem Medicare Advantage |
$21.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$138.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$21.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$21.93
|
| Rate for Payer: Cash Price |
$75.60
|
| Rate for Payer: Cash Price |
$75.60
|
| Rate for Payer: Cigna Commercial |
$241.11
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$21.93
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$146.66
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$21.93
|
| Rate for Payer: Health EOS Commercial |
$233.25
|
| Rate for Payer: HFN Commercial |
$241.11
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$81.59
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$21.93
|
| Rate for Payer: Independent Care Health Plan Medicare |
$21.93
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$21.93
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$21.93
|
| Rate for Payer: Multiplan Commercial |
$209.66
|
| Rate for Payer: NAPHCARE Commercial |
$32.90
|
| Rate for Payer: Preferred Network Access Commercial |
$241.11
|
| Rate for Payer: Quartz Beloit One Network |
$128.42
|
| Rate for Payer: Quartz Commercial |
$170.35
|
| Rate for Payer: Quartz Medicare Advantage |
$21.93
|
| Rate for Payer: The Alliance Commercial |
$87.73
|
| Rate for Payer: United Healthcare Medicare Advantage |
$21.93
|
| Rate for Payer: United Healthcare PPO |
$196.56
|
| Rate for Payer: WEA Trust Commercial |
$144.14
|
| Rate for Payer: Wellcare Medicare |
$21.93
|
| Rate for Payer: WPS Commercial |
$194.12
|
|
|
Apolipoprotein B / 5224
|
Professional
|
Both
|
$252.00
|
|
|
Service Code
|
CPT 82172
|
| Hospital Charge Code |
977871
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$21.93 |
| Max. Negotiated Rate |
$248.98 |
| Rate for Payer: Aetna Commercial |
$248.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$225.39
|
| Rate for Payer: Aetna Managed Medicare |
$21.93
|
| Rate for Payer: Anthem Medicare Advantage |
$21.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$21.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$21.93
|
| Rate for Payer: Cash Price |
$75.60
|
| Rate for Payer: Cash Price |
$75.60
|
| Rate for Payer: Cigna Commercial |
$248.98
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$131.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$21.93
|
| Rate for Payer: Health EOS Commercial |
$238.49
|
| Rate for Payer: HFN Commercial |
$248.98
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$77.43
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$77.43
|
| Rate for Payer: Independent Care Health Plan Medicare |
$21.93
|
| Rate for Payer: Multiplan Commercial |
$209.66
|
| Rate for Payer: NAPHCARE Commercial |
$32.90
|
| Rate for Payer: Preferred Network Access Commercial |
$248.98
|
| Rate for Payer: Quartz Beloit One Network |
$115.32
|
| Rate for Payer: Quartz Commercial |
$149.39
|
| Rate for Payer: Quartz Medicare Advantage |
$21.93
|
| Rate for Payer: The Alliance Commercial |
$86.64
|
| Rate for Payer: United Healthcare Medicare Advantage |
$21.93
|
| Rate for Payer: WEA Trust Commercial |
$144.14
|
| Rate for Payer: WPS Commercial |
$96.51
|
|
|
Apolipoprotein B / 5224
|
Facility
|
IP
|
$252.00
|
|
|
Service Code
|
CPT 82172
|
| Hospital Charge Code |
977871
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$128.42 |
| Max. Negotiated Rate |
$241.11 |
| Rate for Payer: Aetna Commercial |
$235.87
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$225.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$138.90
|
| Rate for Payer: Cash Price |
$75.60
|
| Rate for Payer: Cigna Commercial |
$241.11
|
| Rate for Payer: Health EOS Commercial |
$233.25
|
| Rate for Payer: HFN Commercial |
$241.11
|
| Rate for Payer: Multiplan Commercial |
$209.66
|
| Rate for Payer: Preferred Network Access Commercial |
$241.11
|
| Rate for Payer: Quartz Beloit One Network |
$128.42
|
| Rate for Payer: Quartz Commercial |
$157.25
|
| Rate for Payer: WEA Trust Commercial |
$144.14
|
| Rate for Payer: WPS Commercial |
$194.12
|
|
|
Apolipoprotein (FSURE)
|
Facility
|
IP
|
$96.00
|
|
|
Service Code
|
CPT 82172
|
| Hospital Charge Code |
4538811
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$48.92 |
| Max. Negotiated Rate |
$91.85 |
| Rate for Payer: Aetna Commercial |
$89.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$85.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$52.92
|
| Rate for Payer: Cash Price |
$28.80
|
| Rate for Payer: Cigna Commercial |
$91.85
|
| Rate for Payer: Health EOS Commercial |
$88.86
|
| Rate for Payer: HFN Commercial |
$91.85
|
| Rate for Payer: Multiplan Commercial |
$79.87
|
| Rate for Payer: Preferred Network Access Commercial |
$91.85
|
| Rate for Payer: Quartz Beloit One Network |
$48.92
|
| Rate for Payer: Quartz Commercial |
$59.90
|
| Rate for Payer: WEA Trust Commercial |
$54.91
|
| Rate for Payer: WPS Commercial |
$73.95
|
|
|
Apolipoprotein (FSURE)
|
Professional
|
Both
|
$96.00
|
|
|
Service Code
|
CPT 82172
|
| Hospital Charge Code |
4538811
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$21.93 |
| Max. Negotiated Rate |
$96.51 |
| Rate for Payer: Aetna Commercial |
$94.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$85.86
|
| Rate for Payer: Aetna Managed Medicare |
$21.93
|
| Rate for Payer: Anthem Medicare Advantage |
$21.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$21.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$21.93
|
| Rate for Payer: Cash Price |
$28.80
|
| Rate for Payer: Cash Price |
$28.80
|
| Rate for Payer: Cigna Commercial |
$94.85
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$49.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$21.93
|
| Rate for Payer: Health EOS Commercial |
$90.85
|
| Rate for Payer: HFN Commercial |
$94.85
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$77.43
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$77.43
|
| Rate for Payer: Independent Care Health Plan Medicare |
$21.93
|
| Rate for Payer: Multiplan Commercial |
$79.87
|
| Rate for Payer: NAPHCARE Commercial |
$32.90
|
| Rate for Payer: Preferred Network Access Commercial |
$94.85
|
| Rate for Payer: Quartz Beloit One Network |
$43.93
|
| Rate for Payer: Quartz Commercial |
$56.91
|
| Rate for Payer: Quartz Medicare Advantage |
$21.93
|
| Rate for Payer: The Alliance Commercial |
$86.64
|
| Rate for Payer: United Healthcare Medicare Advantage |
$21.93
|
| Rate for Payer: WEA Trust Commercial |
$54.91
|
| Rate for Payer: WPS Commercial |
$96.51
|
|
|
Apolipoprotein (FSURE)
|
Facility
|
OP
|
$96.00
|
|
|
Service Code
|
CPT 82172
|
| Hospital Charge Code |
4538811
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$21.93 |
| Max. Negotiated Rate |
$91.85 |
| Rate for Payer: Aetna Commercial |
$89.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$85.86
|
| Rate for Payer: Aetna Managed Medicare |
$21.93
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$82.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$38.38
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$36.41
|
| Rate for Payer: Anthem Medicare Advantage |
$21.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$52.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$21.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$21.93
|
| Rate for Payer: Cash Price |
$28.80
|
| Rate for Payer: Cash Price |
$28.80
|
| Rate for Payer: Cigna Commercial |
$91.85
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$21.93
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$55.87
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$21.93
|
| Rate for Payer: Health EOS Commercial |
$88.86
|
| Rate for Payer: HFN Commercial |
$91.85
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$81.59
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$21.93
|
| Rate for Payer: Independent Care Health Plan Medicare |
$21.93
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$21.93
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$21.93
|
| Rate for Payer: Multiplan Commercial |
$79.87
|
| Rate for Payer: NAPHCARE Commercial |
$32.90
|
| Rate for Payer: Preferred Network Access Commercial |
$91.85
|
| Rate for Payer: Quartz Beloit One Network |
$48.92
|
| Rate for Payer: Quartz Commercial |
$64.90
|
| Rate for Payer: Quartz Medicare Advantage |
$21.93
|
| Rate for Payer: The Alliance Commercial |
$87.73
|
| Rate for Payer: United Healthcare Medicare Advantage |
$21.93
|
| Rate for Payer: United Healthcare PPO |
$74.88
|
| Rate for Payer: WEA Trust Commercial |
$54.91
|
| Rate for Payer: Wellcare Medicare |
$21.93
|
| Rate for Payer: WPS Commercial |
$73.95
|
|
|
Apoliprotein
|
Facility
|
OP
|
$90.00
|
|
|
Service Code
|
CPT 82172
|
| Hospital Charge Code |
4566649
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$21.93 |
| Max. Negotiated Rate |
$87.73 |
| Rate for Payer: Aetna Commercial |
$84.24
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$80.50
|
| Rate for Payer: Aetna Managed Medicare |
$21.93
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$82.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$38.38
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$36.41
|
| Rate for Payer: Anthem Medicare Advantage |
$21.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$49.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$21.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$21.93
|
| Rate for Payer: Cash Price |
$27.00
|
| Rate for Payer: Cash Price |
$27.00
|
| Rate for Payer: Cigna Commercial |
$86.11
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$21.93
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$52.38
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$21.93
|
| Rate for Payer: Health EOS Commercial |
$83.30
|
| Rate for Payer: HFN Commercial |
$86.11
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$81.59
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$21.93
|
| Rate for Payer: Independent Care Health Plan Medicare |
$21.93
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$21.93
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$21.93
|
| Rate for Payer: Multiplan Commercial |
$74.88
|
| Rate for Payer: NAPHCARE Commercial |
$32.90
|
| Rate for Payer: Preferred Network Access Commercial |
$86.11
|
| Rate for Payer: Quartz Beloit One Network |
$45.86
|
| Rate for Payer: Quartz Commercial |
$60.84
|
| Rate for Payer: Quartz Medicare Advantage |
$21.93
|
| Rate for Payer: The Alliance Commercial |
$87.73
|
| Rate for Payer: United Healthcare Medicare Advantage |
$21.93
|
| Rate for Payer: United Healthcare PPO |
$70.20
|
| Rate for Payer: WEA Trust Commercial |
$51.48
|
| Rate for Payer: Wellcare Medicare |
$21.93
|
| Rate for Payer: WPS Commercial |
$69.33
|
|
|
Apoliprotein
|
Professional
|
Both
|
$90.00
|
|
|
Service Code
|
CPT 82172
|
| Hospital Charge Code |
4566649
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$21.93 |
| Max. Negotiated Rate |
$96.51 |
| Rate for Payer: Aetna Commercial |
$88.92
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$80.50
|
| Rate for Payer: Aetna Managed Medicare |
$21.93
|
| Rate for Payer: Anthem Medicare Advantage |
$21.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$21.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$21.93
|
| Rate for Payer: Cash Price |
$27.00
|
| Rate for Payer: Cash Price |
$27.00
|
| Rate for Payer: Cigna Commercial |
$88.92
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$46.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$21.93
|
| Rate for Payer: Health EOS Commercial |
$85.18
|
| Rate for Payer: HFN Commercial |
$88.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$77.43
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$77.43
|
| Rate for Payer: Independent Care Health Plan Medicare |
$21.93
|
| Rate for Payer: Multiplan Commercial |
$74.88
|
| Rate for Payer: NAPHCARE Commercial |
$32.90
|
| Rate for Payer: Preferred Network Access Commercial |
$88.92
|
| Rate for Payer: Quartz Beloit One Network |
$41.18
|
| Rate for Payer: Quartz Commercial |
$53.35
|
| Rate for Payer: Quartz Medicare Advantage |
$21.93
|
| Rate for Payer: The Alliance Commercial |
$86.64
|
| Rate for Payer: United Healthcare Medicare Advantage |
$21.93
|
| Rate for Payer: WEA Trust Commercial |
$51.48
|
| Rate for Payer: WPS Commercial |
$96.51
|
|
|
Apoliprotein
|
Facility
|
IP
|
$90.00
|
|
|
Service Code
|
CPT 82172
|
| Hospital Charge Code |
4566649
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$45.86 |
| Max. Negotiated Rate |
$86.11 |
| Rate for Payer: Aetna Commercial |
$84.24
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$80.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$49.61
|
| Rate for Payer: Cash Price |
$27.00
|
| Rate for Payer: Cigna Commercial |
$86.11
|
| Rate for Payer: Health EOS Commercial |
$83.30
|
| Rate for Payer: HFN Commercial |
$86.11
|
| Rate for Payer: Multiplan Commercial |
$74.88
|
| Rate for Payer: Preferred Network Access Commercial |
$86.11
|
| Rate for Payer: Quartz Beloit One Network |
$45.86
|
| Rate for Payer: Quartz Commercial |
$56.16
|
| Rate for Payer: WEA Trust Commercial |
$51.48
|
| Rate for Payer: WPS Commercial |
$69.33
|
|
|
APPENDECTOMY, OPEN
|
Facility
|
OP
|
$4,238.00
|
|
| Hospital Charge Code |
2959811
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,234.11 |
| Max. Negotiated Rate |
$4,054.92 |
| Rate for Payer: Aetna Commercial |
$3,966.77
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,790.47
|
| Rate for Payer: Aetna Managed Medicare |
$1,234.11
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,864.89
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,203.76
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,115.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,335.99
|
| Rate for Payer: Cash Price |
$1,271.40
|
| Rate for Payer: Cigna Commercial |
$4,054.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,466.52
|
| Rate for Payer: Health EOS Commercial |
$3,922.69
|
| Rate for Payer: HFN Commercial |
$4,054.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,305.64
|
| Rate for Payer: Multiplan Commercial |
$3,526.02
|
| Rate for Payer: NAPHCARE Commercial |
$2,644.51
|
| Rate for Payer: Preferred Network Access Commercial |
$4,054.92
|
| Rate for Payer: Quartz Beloit One Network |
$2,159.68
|
| Rate for Payer: Quartz Commercial |
$2,864.89
|
| Rate for Payer: Quartz Medicare Advantage |
$2,644.51
|
| Rate for Payer: The Alliance Commercial |
$2,203.76
|
| Rate for Payer: WEA Trust Commercial |
$2,424.14
|
| Rate for Payer: WPS Commercial |
$3,264.53
|
|
