|
Phosphatidylethanol (PEth)
|
Facility
|
IP
|
$199.00
|
|
|
Service Code
|
CPT 80321
|
| Hospital Charge Code |
5502669
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$97.51 |
| Max. Negotiated Rate |
$183.08 |
| Rate for Payer: Aetna Commercial |
$179.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$171.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$105.47
|
| Rate for Payer: Cash Price |
$59.70
|
| Rate for Payer: Cigna Commercial |
$183.08
|
| Rate for Payer: Health EOS Commercial |
$177.11
|
| Rate for Payer: HFN Commercial |
$183.08
|
| Rate for Payer: Multiplan Commercial |
$159.20
|
| Rate for Payer: NAPHCARE Commercial |
$119.40
|
| Rate for Payer: Preferred Network Access Commercial |
$183.08
|
| Rate for Payer: Quartz Beloit One Network |
$97.51
|
| Rate for Payer: Quartz Commercial |
$119.40
|
| Rate for Payer: WEA Trust Commercial |
$109.45
|
| Rate for Payer: WPS Commercial |
$147.40
|
|
|
Phosphatidylethanol (PEth)
|
Facility
|
OP
|
$199.00
|
|
|
Service Code
|
CPT 80321
|
| Hospital Charge Code |
5502669
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$55.72 |
| Max. Negotiated Rate |
$796.00 |
| Rate for Payer: Aetna Commercial |
$179.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$171.14
|
| Rate for Payer: Aetna Managed Medicare |
$55.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$129.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$99.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$95.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$105.47
|
| Rate for Payer: Cash Price |
$59.70
|
| Rate for Payer: Cigna Commercial |
$183.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$111.36
|
| Rate for Payer: Health EOS Commercial |
$177.11
|
| Rate for Payer: HFN Commercial |
$183.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$149.25
|
| Rate for Payer: Multiplan Commercial |
$159.20
|
| Rate for Payer: NAPHCARE Commercial |
$119.40
|
| Rate for Payer: Preferred Network Access Commercial |
$183.08
|
| Rate for Payer: Quartz Beloit One Network |
$97.51
|
| Rate for Payer: Quartz Commercial |
$129.35
|
| Rate for Payer: Quartz Medicare Advantage |
$119.40
|
| Rate for Payer: The Alliance Commercial |
$796.00
|
| Rate for Payer: United Healthcare PPO |
$149.25
|
| Rate for Payer: WEA Trust Commercial |
$109.45
|
| Rate for Payer: WPS Commercial |
$147.40
|
|
|
Phosphatidylethanol (PEth)
|
Professional
|
Both
|
$199.00
|
|
|
Service Code
|
CPT 80321
|
| Hospital Charge Code |
5502669
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$47.55 |
| Max. Negotiated Rate |
$189.05 |
| Rate for Payer: Aetna Commercial |
$189.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$171.14
|
| Rate for Payer: Cash Price |
$59.70
|
| Rate for Payer: Cash Price |
$59.70
|
| Rate for Payer: Cigna Commercial |
$189.05
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$99.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$119.40
|
| Rate for Payer: Health EOS Commercial |
$181.09
|
| Rate for Payer: HFN Commercial |
$189.05
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$47.55
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$47.55
|
| Rate for Payer: Multiplan Commercial |
$159.20
|
| Rate for Payer: Preferred Network Access Commercial |
$189.05
|
| Rate for Payer: Quartz Beloit One Network |
$87.56
|
| Rate for Payer: Quartz Commercial |
$113.43
|
| Rate for Payer: The Alliance Commercial |
$99.50
|
| Rate for Payer: WEA Trust Commercial |
$109.45
|
| Rate for Payer: WPS Commercial |
$147.40
|
|
|
Phosphatidylserine Antibodies, IgG & IgM
|
Facility
|
OP
|
$331.00
|
|
|
Service Code
|
CPT 86148
|
| Hospital Charge Code |
983360
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.17 |
| Max. Negotiated Rate |
$304.52 |
| Rate for Payer: Aetna Commercial |
$297.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$284.66
|
| Rate for Payer: Aetna Managed Medicare |
$16.07
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$60.26
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$28.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$26.68
|
| Rate for Payer: Anthem Medicaid |
$8.17
|
| Rate for Payer: Anthem Medicare Advantage |
$16.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$175.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$16.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$16.07
|
| Rate for Payer: Cash Price |
$99.30
|
| Rate for Payer: Cash Price |
$99.30
|
| Rate for Payer: Cigna Commercial |
$304.52
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$16.07
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$8.17
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$185.23
|
| Rate for Payer: Dean Health Medicaid |
$8.17
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$16.07
|
| Rate for Payer: Health EOS Commercial |
$294.59
|
| Rate for Payer: HFN Commercial |
$304.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$59.78
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$16.07
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$8.17
|
| Rate for Payer: Independent Care Health Plan Medicare |
$16.07
|
| Rate for Payer: Managed Health Services Medicaid |
$8.50
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$16.07
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$16.07
|
| Rate for Payer: Multiplan Commercial |
$264.80
|
| Rate for Payer: NAPHCARE Commercial |
$24.10
|
| Rate for Payer: Preferred Network Access Commercial |
$304.52
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$8.17
|
| Rate for Payer: Quartz Beloit One Network |
$162.19
|
| Rate for Payer: Quartz Commercial |
$215.15
|
| Rate for Payer: Quartz Medicare Advantage |
$16.07
|
| Rate for Payer: The Alliance Commercial |
$64.28
|
| Rate for Payer: United Healthcare Medicaid |
$8.17
|
| Rate for Payer: United Healthcare Medicare Advantage |
$16.07
|
| Rate for Payer: United Healthcare PPO |
$248.25
|
| Rate for Payer: WEA Trust Commercial |
$182.05
|
| Rate for Payer: Wellcare Medicare |
$16.07
|
| Rate for Payer: WMAP Medicaid |
$8.17
|
| Rate for Payer: WPS Commercial |
$245.17
|
|
|
Phosphatidylserine Antibodies, IgG & IgM
|
Professional
|
Both
|
$331.00
|
|
|
Service Code
|
CPT 86148
|
| Hospital Charge Code |
983360
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$56.73 |
| Max. Negotiated Rate |
$314.45 |
| Rate for Payer: Aetna Commercial |
$314.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$284.66
|
| Rate for Payer: Cash Price |
$99.30
|
| Rate for Payer: Cash Price |
$99.30
|
| Rate for Payer: Cigna Commercial |
$314.45
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$165.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$198.60
|
| Rate for Payer: Health EOS Commercial |
$301.21
|
| Rate for Payer: HFN Commercial |
$314.45
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$56.73
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$56.73
|
| Rate for Payer: Multiplan Commercial |
$264.80
|
| Rate for Payer: Preferred Network Access Commercial |
$314.45
|
| Rate for Payer: Quartz Beloit One Network |
$145.64
|
| Rate for Payer: Quartz Commercial |
$188.67
|
| Rate for Payer: The Alliance Commercial |
$165.50
|
| Rate for Payer: WEA Trust Commercial |
$182.05
|
| Rate for Payer: WPS Commercial |
$245.17
|
|
|
Phosphatidylserine Antibodies, IgG & IgM
|
Facility
|
IP
|
$331.00
|
|
|
Service Code
|
CPT 86148
|
| Hospital Charge Code |
983360
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$162.19 |
| Max. Negotiated Rate |
$304.52 |
| Rate for Payer: Aetna Commercial |
$297.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$284.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$175.43
|
| Rate for Payer: Cash Price |
$99.30
|
| Rate for Payer: Cigna Commercial |
$304.52
|
| Rate for Payer: Health EOS Commercial |
$294.59
|
| Rate for Payer: HFN Commercial |
$304.52
|
| Rate for Payer: Multiplan Commercial |
$264.80
|
| Rate for Payer: NAPHCARE Commercial |
$198.60
|
| Rate for Payer: Preferred Network Access Commercial |
$304.52
|
| Rate for Payer: Quartz Beloit One Network |
$162.19
|
| Rate for Payer: Quartz Commercial |
$198.60
|
| Rate for Payer: WEA Trust Commercial |
$182.05
|
| Rate for Payer: WPS Commercial |
$245.17
|
|
|
Phosphatidylserine Antibody IgG
|
Professional
|
Both
|
$350.00
|
|
|
Service Code
|
CPT 86148
|
| Hospital Charge Code |
2942862
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$56.73 |
| Max. Negotiated Rate |
$332.50 |
| Rate for Payer: Aetna Commercial |
$332.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$301.00
|
| Rate for Payer: Cash Price |
$105.00
|
| Rate for Payer: Cash Price |
$105.00
|
| Rate for Payer: Cigna Commercial |
$332.50
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$175.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$210.00
|
| Rate for Payer: Health EOS Commercial |
$318.50
|
| Rate for Payer: HFN Commercial |
$332.50
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$56.73
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$56.73
|
| Rate for Payer: Multiplan Commercial |
$280.00
|
| Rate for Payer: Preferred Network Access Commercial |
$332.50
|
| Rate for Payer: Quartz Beloit One Network |
$154.00
|
| Rate for Payer: Quartz Commercial |
$199.50
|
| Rate for Payer: The Alliance Commercial |
$175.00
|
| Rate for Payer: WEA Trust Commercial |
$192.50
|
| Rate for Payer: WPS Commercial |
$259.24
|
|
|
Phosphatidylserine Antibody IgG
|
Facility
|
IP
|
$350.00
|
|
|
Service Code
|
CPT 86148
|
| Hospital Charge Code |
2942862
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$171.50 |
| Max. Negotiated Rate |
$322.00 |
| Rate for Payer: Aetna Commercial |
$315.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$301.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$185.50
|
| Rate for Payer: Cash Price |
$105.00
|
| Rate for Payer: Cigna Commercial |
$322.00
|
| Rate for Payer: Health EOS Commercial |
$311.50
|
| Rate for Payer: HFN Commercial |
$322.00
|
| Rate for Payer: Multiplan Commercial |
$280.00
|
| Rate for Payer: NAPHCARE Commercial |
$210.00
|
| Rate for Payer: Preferred Network Access Commercial |
$322.00
|
| Rate for Payer: Quartz Beloit One Network |
$171.50
|
| Rate for Payer: Quartz Commercial |
$210.00
|
| Rate for Payer: WEA Trust Commercial |
$192.50
|
| Rate for Payer: WPS Commercial |
$259.24
|
|
|
Phosphatidylserine Antibody IgG
|
Facility
|
OP
|
$350.00
|
|
|
Service Code
|
CPT 86148
|
| Hospital Charge Code |
2942862
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.17 |
| Max. Negotiated Rate |
$322.00 |
| Rate for Payer: Aetna Commercial |
$315.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$301.00
|
| Rate for Payer: Aetna Managed Medicare |
$16.07
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$60.26
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$28.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$26.68
|
| Rate for Payer: Anthem Medicaid |
$8.17
|
| Rate for Payer: Anthem Medicare Advantage |
$16.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$185.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$16.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$16.07
|
| Rate for Payer: Cash Price |
$105.00
|
| Rate for Payer: Cash Price |
$105.00
|
| Rate for Payer: Cigna Commercial |
$322.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$16.07
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$8.17
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$195.86
|
| Rate for Payer: Dean Health Medicaid |
$8.17
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$16.07
|
| Rate for Payer: Health EOS Commercial |
$311.50
|
| Rate for Payer: HFN Commercial |
$322.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$59.78
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$16.07
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$8.17
|
| Rate for Payer: Independent Care Health Plan Medicare |
$16.07
|
| Rate for Payer: Managed Health Services Medicaid |
$8.50
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$16.07
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$16.07
|
| Rate for Payer: Multiplan Commercial |
$280.00
|
| Rate for Payer: NAPHCARE Commercial |
$24.10
|
| Rate for Payer: Preferred Network Access Commercial |
$322.00
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$8.17
|
| Rate for Payer: Quartz Beloit One Network |
$171.50
|
| Rate for Payer: Quartz Commercial |
$227.50
|
| Rate for Payer: Quartz Medicare Advantage |
$16.07
|
| Rate for Payer: The Alliance Commercial |
$64.28
|
| Rate for Payer: United Healthcare Medicaid |
$8.17
|
| Rate for Payer: United Healthcare Medicare Advantage |
$16.07
|
| Rate for Payer: United Healthcare PPO |
$262.50
|
| Rate for Payer: WEA Trust Commercial |
$192.50
|
| Rate for Payer: Wellcare Medicare |
$16.07
|
| Rate for Payer: WMAP Medicaid |
$8.17
|
| Rate for Payer: WPS Commercial |
$259.24
|
|
|
Phosphatidylserine Antibody IgM
|
Professional
|
Both
|
$350.00
|
|
|
Service Code
|
CPT 86148
|
| Hospital Charge Code |
2942863
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$56.73 |
| Max. Negotiated Rate |
$332.50 |
| Rate for Payer: Aetna Commercial |
$332.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$301.00
|
| Rate for Payer: Cash Price |
$105.00
|
| Rate for Payer: Cash Price |
$105.00
|
| Rate for Payer: Cigna Commercial |
$332.50
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$175.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$210.00
|
| Rate for Payer: Health EOS Commercial |
$318.50
|
| Rate for Payer: HFN Commercial |
$332.50
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$56.73
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$56.73
|
| Rate for Payer: Multiplan Commercial |
$280.00
|
| Rate for Payer: Preferred Network Access Commercial |
$332.50
|
| Rate for Payer: Quartz Beloit One Network |
$154.00
|
| Rate for Payer: Quartz Commercial |
$199.50
|
| Rate for Payer: The Alliance Commercial |
$175.00
|
| Rate for Payer: WEA Trust Commercial |
$192.50
|
| Rate for Payer: WPS Commercial |
$259.24
|
|
|
Phosphatidylserine Antibody IgM
|
Facility
|
OP
|
$350.00
|
|
|
Service Code
|
CPT 86148
|
| Hospital Charge Code |
2942863
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.17 |
| Max. Negotiated Rate |
$322.00 |
| Rate for Payer: Aetna Commercial |
$315.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$301.00
|
| Rate for Payer: Aetna Managed Medicare |
$16.07
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$60.26
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$28.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$26.68
|
| Rate for Payer: Anthem Medicaid |
$8.17
|
| Rate for Payer: Anthem Medicare Advantage |
$16.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$185.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$16.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$16.07
|
| Rate for Payer: Cash Price |
$105.00
|
| Rate for Payer: Cash Price |
$105.00
|
| Rate for Payer: Cigna Commercial |
$322.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$16.07
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$8.17
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$195.86
|
| Rate for Payer: Dean Health Medicaid |
$8.17
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$16.07
|
| Rate for Payer: Health EOS Commercial |
$311.50
|
| Rate for Payer: HFN Commercial |
$322.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$59.78
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$16.07
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$8.17
|
| Rate for Payer: Independent Care Health Plan Medicare |
$16.07
|
| Rate for Payer: Managed Health Services Medicaid |
$8.50
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$16.07
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$16.07
|
| Rate for Payer: Multiplan Commercial |
$280.00
|
| Rate for Payer: NAPHCARE Commercial |
$24.10
|
| Rate for Payer: Preferred Network Access Commercial |
$322.00
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$8.17
|
| Rate for Payer: Quartz Beloit One Network |
$171.50
|
| Rate for Payer: Quartz Commercial |
$227.50
|
| Rate for Payer: Quartz Medicare Advantage |
$16.07
|
| Rate for Payer: The Alliance Commercial |
$64.28
|
| Rate for Payer: United Healthcare Medicaid |
$8.17
|
| Rate for Payer: United Healthcare Medicare Advantage |
$16.07
|
| Rate for Payer: United Healthcare PPO |
$262.50
|
| Rate for Payer: WEA Trust Commercial |
$192.50
|
| Rate for Payer: Wellcare Medicare |
$16.07
|
| Rate for Payer: WMAP Medicaid |
$8.17
|
| Rate for Payer: WPS Commercial |
$259.24
|
|
|
Phosphatidylserine Antibody IgM
|
Facility
|
IP
|
$350.00
|
|
|
Service Code
|
CPT 86148
|
| Hospital Charge Code |
2942863
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$171.50 |
| Max. Negotiated Rate |
$322.00 |
| Rate for Payer: Aetna Commercial |
$315.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$301.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$185.50
|
| Rate for Payer: Cash Price |
$105.00
|
| Rate for Payer: Cigna Commercial |
$322.00
|
| Rate for Payer: Health EOS Commercial |
$311.50
|
| Rate for Payer: HFN Commercial |
$322.00
|
| Rate for Payer: Multiplan Commercial |
$280.00
|
| Rate for Payer: NAPHCARE Commercial |
$210.00
|
| Rate for Payer: Preferred Network Access Commercial |
$322.00
|
| Rate for Payer: Quartz Beloit One Network |
$171.50
|
| Rate for Payer: Quartz Commercial |
$210.00
|
| Rate for Payer: WEA Trust Commercial |
$192.50
|
| Rate for Payer: WPS Commercial |
$259.24
|
|
|
Phospholipase A2 Receptor Antibody
|
Facility
|
OP
|
$684.00
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
4808607
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.05 |
| Max. Negotiated Rate |
$629.28 |
| Rate for Payer: Aetna Commercial |
$615.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$588.24
|
| Rate for Payer: Aetna Managed Medicare |
$12.05
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$45.19
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$21.09
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$20.00
|
| Rate for Payer: Anthem Medicaid |
$12.45
|
| Rate for Payer: Anthem Medicare Advantage |
$12.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$362.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$12.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$12.05
|
| Rate for Payer: Cash Price |
$205.20
|
| Rate for Payer: Cash Price |
$205.20
|
| Rate for Payer: Cigna Commercial |
$629.28
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$12.05
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$12.45
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$382.77
|
| Rate for Payer: Dean Health Medicaid |
$12.45
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$12.05
|
| Rate for Payer: Health EOS Commercial |
$608.76
|
| Rate for Payer: HFN Commercial |
$629.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$44.83
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$12.05
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$12.45
|
| Rate for Payer: Independent Care Health Plan Medicare |
$12.05
|
| Rate for Payer: Managed Health Services Medicaid |
$12.95
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$12.05
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$12.05
|
| Rate for Payer: Multiplan Commercial |
$547.20
|
| Rate for Payer: NAPHCARE Commercial |
$18.08
|
| Rate for Payer: Preferred Network Access Commercial |
$629.28
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$12.45
|
| Rate for Payer: Quartz Beloit One Network |
$335.16
|
| Rate for Payer: Quartz Commercial |
$444.60
|
| Rate for Payer: Quartz Medicare Advantage |
$12.05
|
| Rate for Payer: The Alliance Commercial |
$48.20
|
| Rate for Payer: United Healthcare Medicaid |
$12.45
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.05
|
| Rate for Payer: United Healthcare PPO |
$513.00
|
| Rate for Payer: WEA Trust Commercial |
$376.20
|
| Rate for Payer: Wellcare Medicare |
$12.05
|
| Rate for Payer: WMAP Medicaid |
$12.45
|
| Rate for Payer: WPS Commercial |
$506.64
|
|
|
Phospholipase A2 Receptor Antibody
|
Facility
|
IP
|
$684.00
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
4808607
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$335.16 |
| Max. Negotiated Rate |
$629.28 |
| Rate for Payer: Aetna Commercial |
$615.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$588.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$362.52
|
| Rate for Payer: Cash Price |
$205.20
|
| Rate for Payer: Cigna Commercial |
$629.28
|
| Rate for Payer: Health EOS Commercial |
$608.76
|
| Rate for Payer: HFN Commercial |
$629.28
|
| Rate for Payer: Multiplan Commercial |
$547.20
|
| Rate for Payer: NAPHCARE Commercial |
$410.40
|
| Rate for Payer: Preferred Network Access Commercial |
$629.28
|
| Rate for Payer: Quartz Beloit One Network |
$335.16
|
| Rate for Payer: Quartz Commercial |
$410.40
|
| Rate for Payer: WEA Trust Commercial |
$376.20
|
| Rate for Payer: WPS Commercial |
$506.64
|
|
|
Phospholipase A2 Receptor Antibody
|
Professional
|
Both
|
$684.00
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
4808607
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$16.61 |
| Max. Negotiated Rate |
$649.80 |
| Rate for Payer: Aetna Commercial |
$649.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$588.24
|
| Rate for Payer: Anthem Commercial |
$16.61
|
| Rate for Payer: Cash Price |
$205.20
|
| Rate for Payer: Cash Price |
$205.20
|
| Rate for Payer: Cigna Commercial |
$649.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$342.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$410.40
|
| Rate for Payer: Health EOS Commercial |
$622.44
|
| Rate for Payer: HFN Commercial |
$649.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$42.54
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$42.54
|
| Rate for Payer: Multiplan Commercial |
$547.20
|
| Rate for Payer: Preferred Network Access Commercial |
$649.80
|
| Rate for Payer: Quartz Beloit One Network |
$300.96
|
| Rate for Payer: Quartz Commercial |
$389.88
|
| Rate for Payer: The Alliance Commercial |
$342.00
|
| Rate for Payer: WEA Trust Commercial |
$376.20
|
| Rate for Payer: WPS Commercial |
$506.64
|
|
|
Phospholipids
|
Facility
|
IP
|
$25.00
|
|
|
Service Code
|
CPT 84311
|
| Hospital Charge Code |
5581589
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.25 |
| Max. Negotiated Rate |
$23.00 |
| Rate for Payer: Aetna Commercial |
$22.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$21.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$13.25
|
| Rate for Payer: Cash Price |
$7.50
|
| Rate for Payer: Cigna Commercial |
$23.00
|
| Rate for Payer: Health EOS Commercial |
$22.25
|
| Rate for Payer: HFN Commercial |
$23.00
|
| Rate for Payer: Multiplan Commercial |
$20.00
|
| Rate for Payer: NAPHCARE Commercial |
$15.00
|
| Rate for Payer: Preferred Network Access Commercial |
$23.00
|
| Rate for Payer: Quartz Beloit One Network |
$12.25
|
| Rate for Payer: Quartz Commercial |
$15.00
|
| Rate for Payer: WEA Trust Commercial |
$13.75
|
| Rate for Payer: WPS Commercial |
$18.52
|
|
|
Phospholipids
|
Facility
|
OP
|
$25.00
|
|
|
Service Code
|
CPT 84311
|
| Hospital Charge Code |
5581589
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.10 |
| Max. Negotiated Rate |
$32.40 |
| Rate for Payer: Aetna Commercial |
$22.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$21.50
|
| Rate for Payer: Aetna Managed Medicare |
$8.10
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$30.38
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$14.18
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$13.45
|
| Rate for Payer: Anthem Medicaid |
$8.37
|
| Rate for Payer: Anthem Medicare Advantage |
$8.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$13.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$8.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$8.10
|
| Rate for Payer: Cash Price |
$7.50
|
| Rate for Payer: Cash Price |
$7.50
|
| Rate for Payer: Cigna Commercial |
$23.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$8.10
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$8.37
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$13.99
|
| Rate for Payer: Dean Health Medicaid |
$8.37
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$8.10
|
| Rate for Payer: Health EOS Commercial |
$22.25
|
| Rate for Payer: HFN Commercial |
$23.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$30.13
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$8.10
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$8.37
|
| Rate for Payer: Independent Care Health Plan Medicare |
$8.10
|
| Rate for Payer: Managed Health Services Medicaid |
$8.70
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$8.10
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$8.10
|
| Rate for Payer: Multiplan Commercial |
$20.00
|
| Rate for Payer: NAPHCARE Commercial |
$12.15
|
| Rate for Payer: Preferred Network Access Commercial |
$23.00
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$8.37
|
| Rate for Payer: Quartz Beloit One Network |
$12.25
|
| Rate for Payer: Quartz Commercial |
$16.25
|
| Rate for Payer: Quartz Medicare Advantage |
$8.10
|
| Rate for Payer: The Alliance Commercial |
$32.40
|
| Rate for Payer: United Healthcare Medicaid |
$8.37
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8.10
|
| Rate for Payer: United Healthcare PPO |
$18.75
|
| Rate for Payer: WEA Trust Commercial |
$13.75
|
| Rate for Payer: Wellcare Medicare |
$8.10
|
| Rate for Payer: WMAP Medicaid |
$8.37
|
| Rate for Payer: WPS Commercial |
$18.52
|
|
|
Phospholipids
|
Professional
|
Both
|
$25.00
|
|
|
Service Code
|
CPT 84311
|
| Hospital Charge Code |
5581589
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.00 |
| Max. Negotiated Rate |
$28.59 |
| Rate for Payer: Aetna Commercial |
$23.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$21.50
|
| Rate for Payer: Cash Price |
$7.50
|
| Rate for Payer: Cash Price |
$7.50
|
| Rate for Payer: Cigna Commercial |
$23.75
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$12.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$15.00
|
| Rate for Payer: Health EOS Commercial |
$22.75
|
| Rate for Payer: HFN Commercial |
$23.75
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$28.59
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$28.59
|
| Rate for Payer: Multiplan Commercial |
$20.00
|
| Rate for Payer: Preferred Network Access Commercial |
$23.75
|
| Rate for Payer: Quartz Beloit One Network |
$11.00
|
| Rate for Payer: Quartz Commercial |
$14.25
|
| Rate for Payer: The Alliance Commercial |
$12.50
|
| Rate for Payer: WEA Trust Commercial |
$13.75
|
| Rate for Payer: WPS Commercial |
$18.52
|
|
|
Phosphorus Level
|
Professional
|
Both
|
$82.00
|
|
|
Service Code
|
CPT 84100
|
| Hospital Charge Code |
633803
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$16.73 |
| Max. Negotiated Rate |
$77.90 |
| Rate for Payer: Aetna Commercial |
$77.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$70.52
|
| Rate for Payer: Cash Price |
$24.60
|
| Rate for Payer: Cash Price |
$24.60
|
| Rate for Payer: Cigna Commercial |
$77.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$41.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$49.20
|
| Rate for Payer: Health EOS Commercial |
$74.62
|
| Rate for Payer: HFN Commercial |
$77.90
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$16.73
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$16.73
|
| Rate for Payer: Multiplan Commercial |
$65.60
|
| Rate for Payer: Preferred Network Access Commercial |
$77.90
|
| Rate for Payer: Quartz Beloit One Network |
$36.08
|
| Rate for Payer: Quartz Commercial |
$46.74
|
| Rate for Payer: The Alliance Commercial |
$41.00
|
| Rate for Payer: WEA Trust Commercial |
$45.10
|
| Rate for Payer: WPS Commercial |
$60.74
|
|
|
Phosphorus Level
|
Facility
|
IP
|
$82.00
|
|
|
Service Code
|
CPT 84100
|
| Hospital Charge Code |
633803
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$40.18 |
| Max. Negotiated Rate |
$75.44 |
| Rate for Payer: Aetna Commercial |
$73.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$70.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$43.46
|
| Rate for Payer: Cash Price |
$24.60
|
| Rate for Payer: Cigna Commercial |
$75.44
|
| Rate for Payer: Health EOS Commercial |
$72.98
|
| Rate for Payer: HFN Commercial |
$75.44
|
| Rate for Payer: Multiplan Commercial |
$65.60
|
| Rate for Payer: NAPHCARE Commercial |
$49.20
|
| Rate for Payer: Preferred Network Access Commercial |
$75.44
|
| Rate for Payer: Quartz Beloit One Network |
$40.18
|
| Rate for Payer: Quartz Commercial |
$49.20
|
| Rate for Payer: WEA Trust Commercial |
$45.10
|
| Rate for Payer: WPS Commercial |
$60.74
|
|
|
Phosphorus Level
|
Facility
|
OP
|
$82.00
|
|
|
Service Code
|
CPT 84100
|
| Hospital Charge Code |
633803
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.74 |
| Max. Negotiated Rate |
$75.44 |
| Rate for Payer: Aetna Commercial |
$73.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$70.52
|
| Rate for Payer: Aetna Managed Medicare |
$4.74
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$17.78
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8.30
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7.87
|
| Rate for Payer: Anthem Medicaid |
$4.90
|
| Rate for Payer: Anthem Medicare Advantage |
$4.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$43.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$4.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$4.74
|
| Rate for Payer: Cash Price |
$24.60
|
| Rate for Payer: Cash Price |
$24.60
|
| Rate for Payer: Cigna Commercial |
$75.44
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$4.74
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$4.90
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$45.89
|
| Rate for Payer: Dean Health Medicaid |
$4.90
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$4.74
|
| Rate for Payer: Health EOS Commercial |
$72.98
|
| Rate for Payer: HFN Commercial |
$75.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$17.63
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$4.74
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$4.90
|
| Rate for Payer: Independent Care Health Plan Medicare |
$4.74
|
| Rate for Payer: Managed Health Services Medicaid |
$5.10
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$4.74
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$4.74
|
| Rate for Payer: Multiplan Commercial |
$65.60
|
| Rate for Payer: NAPHCARE Commercial |
$7.11
|
| Rate for Payer: Preferred Network Access Commercial |
$75.44
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$4.90
|
| Rate for Payer: Quartz Beloit One Network |
$40.18
|
| Rate for Payer: Quartz Commercial |
$53.30
|
| Rate for Payer: Quartz Medicare Advantage |
$4.74
|
| Rate for Payer: The Alliance Commercial |
$18.96
|
| Rate for Payer: United Healthcare Medicaid |
$4.90
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4.74
|
| Rate for Payer: United Healthcare PPO |
$61.50
|
| Rate for Payer: WEA Trust Commercial |
$45.10
|
| Rate for Payer: Wellcare Medicare |
$4.74
|
| Rate for Payer: WMAP Medicaid |
$4.90
|
| Rate for Payer: WPS Commercial |
$60.74
|
|
|
Phosphorus, Urine
|
Facility
|
IP
|
$31.00
|
|
|
Service Code
|
CPT 84105
|
| Hospital Charge Code |
5474690
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.19 |
| Max. Negotiated Rate |
$28.52 |
| Rate for Payer: Aetna Commercial |
$27.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$26.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$16.43
|
| Rate for Payer: Cash Price |
$9.30
|
| Rate for Payer: Cigna Commercial |
$28.52
|
| Rate for Payer: Health EOS Commercial |
$27.59
|
| Rate for Payer: HFN Commercial |
$28.52
|
| Rate for Payer: Multiplan Commercial |
$24.80
|
| Rate for Payer: NAPHCARE Commercial |
$18.60
|
| Rate for Payer: Preferred Network Access Commercial |
$28.52
|
| Rate for Payer: Quartz Beloit One Network |
$15.19
|
| Rate for Payer: Quartz Commercial |
$18.60
|
| Rate for Payer: WEA Trust Commercial |
$17.05
|
| Rate for Payer: WPS Commercial |
$22.96
|
|
|
Phosphorus, Urine
|
Professional
|
Both
|
$31.00
|
|
|
Service Code
|
CPT 84105
|
| Hospital Charge Code |
5474690
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.64 |
| Max. Negotiated Rate |
$29.45 |
| Rate for Payer: Aetna Commercial |
$29.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$26.66
|
| Rate for Payer: Cash Price |
$9.30
|
| Rate for Payer: Cash Price |
$9.30
|
| Rate for Payer: Cigna Commercial |
$29.45
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$15.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$18.60
|
| Rate for Payer: Health EOS Commercial |
$28.21
|
| Rate for Payer: HFN Commercial |
$29.45
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$20.40
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$20.40
|
| Rate for Payer: Multiplan Commercial |
$24.80
|
| Rate for Payer: Preferred Network Access Commercial |
$29.45
|
| Rate for Payer: Quartz Beloit One Network |
$13.64
|
| Rate for Payer: Quartz Commercial |
$17.67
|
| Rate for Payer: The Alliance Commercial |
$15.50
|
| Rate for Payer: WEA Trust Commercial |
$17.05
|
| Rate for Payer: WPS Commercial |
$22.96
|
|
|
Phosphorus, Urine
|
Facility
|
OP
|
$31.00
|
|
|
Service Code
|
CPT 84105
|
| Hospital Charge Code |
5474690
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.78 |
| Max. Negotiated Rate |
$28.52 |
| Rate for Payer: Aetna Commercial |
$27.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$26.66
|
| Rate for Payer: Aetna Managed Medicare |
$5.78
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$21.68
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$10.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$9.59
|
| Rate for Payer: Anthem Medicaid |
$5.97
|
| Rate for Payer: Anthem Medicare Advantage |
$5.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$16.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5.78
|
| Rate for Payer: Cash Price |
$9.30
|
| Rate for Payer: Cash Price |
$9.30
|
| Rate for Payer: Cigna Commercial |
$28.52
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$5.78
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$5.97
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$17.35
|
| Rate for Payer: Dean Health Medicaid |
$5.97
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$5.78
|
| Rate for Payer: Health EOS Commercial |
$27.59
|
| Rate for Payer: HFN Commercial |
$28.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$21.50
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$5.78
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$5.97
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5.78
|
| Rate for Payer: Managed Health Services Medicaid |
$6.21
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$5.78
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$5.78
|
| Rate for Payer: Multiplan Commercial |
$24.80
|
| Rate for Payer: NAPHCARE Commercial |
$8.67
|
| Rate for Payer: Preferred Network Access Commercial |
$28.52
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$5.97
|
| Rate for Payer: Quartz Beloit One Network |
$15.19
|
| Rate for Payer: Quartz Commercial |
$20.15
|
| Rate for Payer: Quartz Medicare Advantage |
$5.78
|
| Rate for Payer: The Alliance Commercial |
$23.12
|
| Rate for Payer: United Healthcare Medicaid |
$5.97
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.78
|
| Rate for Payer: United Healthcare PPO |
$23.25
|
| Rate for Payer: WEA Trust Commercial |
$17.05
|
| Rate for Payer: Wellcare Medicare |
$5.78
|
| Rate for Payer: WMAP Medicaid |
$5.97
|
| Rate for Payer: WPS Commercial |
$22.96
|
|
|
Photocoagulation, Prophylaxis Of Retinal Detachment
|
Professional
|
Both
|
$2,112.00
|
|
|
Service Code
|
CPT 67145
|
| Hospital Charge Code |
1188906
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$411.53 |
| Max. Negotiated Rate |
$2,006.40 |
| Rate for Payer: Aetna Commercial |
$2,006.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,816.32
|
| Rate for Payer: Cash Price |
$633.60
|
| Rate for Payer: Cash Price |
$633.60
|
| Rate for Payer: Cash Price |
$633.60
|
| Rate for Payer: Cigna Commercial |
$2,006.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$411.53
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,267.20
|
| Rate for Payer: Health EOS Commercial |
$1,921.92
|
| Rate for Payer: HFN Commercial |
$2,006.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,668.14
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,668.14
|
| Rate for Payer: Multiplan Commercial |
$1,689.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,006.40
|
| Rate for Payer: Quartz Beloit One Network |
$929.28
|
| Rate for Payer: Quartz Commercial |
$1,203.84
|
| Rate for Payer: The Alliance Commercial |
$1,056.00
|
| Rate for Payer: United Healthcare Medicaid |
$411.53
|
| Rate for Payer: WEA Trust Commercial |
$1,161.60
|
| Rate for Payer: WPS Commercial |
$1,564.36
|
|
