|
PHLEB VEINS EXTREM 10-20 37765
|
Professional
|
Both
|
$3,869.00
|
|
|
Service Code
|
CPT 37765
|
| Hospital Charge Code |
3014576
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$226.81 |
| Max. Negotiated Rate |
$3,822.57 |
| Rate for Payer: Aetna Commercial |
$3,822.57
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,460.43
|
| Rate for Payer: Aetna Managed Medicare |
$226.81
|
| Rate for Payer: Anthem Medicare Advantage |
$226.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$226.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$226.81
|
| Rate for Payer: Cash Price |
$1,160.70
|
| Rate for Payer: Cash Price |
$1,160.70
|
| Rate for Payer: Cash Price |
$1,160.70
|
| Rate for Payer: Cigna Commercial |
$3,822.57
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$469.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$226.81
|
| Rate for Payer: Health EOS Commercial |
$3,661.62
|
| Rate for Payer: HFN Commercial |
$3,822.57
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$904.91
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$904.91
|
| Rate for Payer: Independent Care Health Plan Medicare |
$226.81
|
| Rate for Payer: Multiplan Commercial |
$3,219.01
|
| Rate for Payer: NAPHCARE Commercial |
$340.22
|
| Rate for Payer: Preferred Network Access Commercial |
$3,822.57
|
| Rate for Payer: Quartz Beloit One Network |
$1,770.45
|
| Rate for Payer: Quartz Commercial |
$2,293.54
|
| Rate for Payer: Quartz Medicare Advantage |
$226.81
|
| Rate for Payer: The Alliance Commercial |
$963.96
|
| Rate for Payer: United Healthcare Medicaid |
$469.92
|
| Rate for Payer: United Healthcare Medicare Advantage |
$226.81
|
| Rate for Payer: WEA Trust Commercial |
$2,213.07
|
| Rate for Payer: WPS Commercial |
$1,020.66
|
|
|
PHLEB VEINS EXTREM 10-20 (Less than) 3779937765
|
Professional
|
Both
|
$4,702.00
|
|
|
Service Code
|
CPT 37799
|
| Hospital Charge Code |
6167698
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$2,151.64 |
| Max. Negotiated Rate |
$4,645.58 |
| Rate for Payer: Aetna Commercial |
$4,645.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,205.47
|
| Rate for Payer: Cash Price |
$1,410.60
|
| Rate for Payer: Cash Price |
$1,410.60
|
| Rate for Payer: Cigna Commercial |
$4,645.58
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,445.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,934.05
|
| Rate for Payer: Health EOS Commercial |
$4,449.97
|
| Rate for Payer: HFN Commercial |
$4,645.58
|
| Rate for Payer: Multiplan Commercial |
$3,912.06
|
| Rate for Payer: Preferred Network Access Commercial |
$4,645.58
|
| Rate for Payer: Quartz Beloit One Network |
$2,151.64
|
| Rate for Payer: Quartz Commercial |
$2,787.35
|
| Rate for Payer: The Alliance Commercial |
$2,445.04
|
| Rate for Payer: WEA Trust Commercial |
$2,689.54
|
| Rate for Payer: WPS Commercial |
$3,621.95
|
|
|
PHLEB VEINS EXTREM 20+ 37766
|
Professional
|
Both
|
$4,925.00
|
|
|
Service Code
|
CPT 37766
|
| Hospital Charge Code |
3014577
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$278.11 |
| Max. Negotiated Rate |
$4,865.90 |
| Rate for Payer: Aetna Commercial |
$4,865.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,404.92
|
| Rate for Payer: Aetna Managed Medicare |
$278.11
|
| Rate for Payer: Anthem Medicare Advantage |
$278.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$278.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$278.11
|
| Rate for Payer: Cash Price |
$1,477.50
|
| Rate for Payer: Cash Price |
$1,477.50
|
| Rate for Payer: Cash Price |
$1,477.50
|
| Rate for Payer: Cigna Commercial |
$4,865.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$572.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$278.11
|
| Rate for Payer: Health EOS Commercial |
$4,661.02
|
| Rate for Payer: HFN Commercial |
$4,865.90
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,108.01
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,108.01
|
| Rate for Payer: Independent Care Health Plan Medicare |
$278.11
|
| Rate for Payer: Multiplan Commercial |
$4,097.60
|
| Rate for Payer: NAPHCARE Commercial |
$417.16
|
| Rate for Payer: Preferred Network Access Commercial |
$4,865.90
|
| Rate for Payer: Quartz Beloit One Network |
$2,253.68
|
| Rate for Payer: Quartz Commercial |
$2,919.54
|
| Rate for Payer: Quartz Medicare Advantage |
$278.11
|
| Rate for Payer: The Alliance Commercial |
$1,181.95
|
| Rate for Payer: United Healthcare Medicaid |
$572.28
|
| Rate for Payer: United Healthcare Medicare Advantage |
$278.11
|
| Rate for Payer: WEA Trust Commercial |
$2,817.10
|
| Rate for Payer: WPS Commercial |
$1,251.48
|
|
|
Phosphate, Urine
|
Facility
|
OP
|
$16.00
|
|
|
Service Code
|
CPT 84105
|
| Hospital Charge Code |
5024609
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.01 |
| Max. Negotiated Rate |
$24.04 |
| Rate for Payer: Aetna Commercial |
$14.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$14.31
|
| Rate for Payer: Aetna Managed Medicare |
$6.01
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$22.54
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$10.52
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$9.98
|
| Rate for Payer: Anthem Medicare Advantage |
$6.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$8.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$6.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$6.01
|
| Rate for Payer: Cash Price |
$4.80
|
| Rate for Payer: Cash Price |
$4.80
|
| Rate for Payer: Cigna Commercial |
$15.31
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$6.01
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$9.31
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$6.01
|
| Rate for Payer: Health EOS Commercial |
$14.81
|
| Rate for Payer: HFN Commercial |
$15.31
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$22.36
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$6.01
|
| Rate for Payer: Independent Care Health Plan Medicare |
$6.01
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$6.01
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$6.01
|
| Rate for Payer: Multiplan Commercial |
$13.31
|
| Rate for Payer: NAPHCARE Commercial |
$9.02
|
| Rate for Payer: Preferred Network Access Commercial |
$15.31
|
| Rate for Payer: Quartz Beloit One Network |
$8.15
|
| Rate for Payer: Quartz Commercial |
$10.82
|
| Rate for Payer: Quartz Medicare Advantage |
$6.01
|
| Rate for Payer: The Alliance Commercial |
$24.04
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6.01
|
| Rate for Payer: United Healthcare PPO |
$12.48
|
| Rate for Payer: WEA Trust Commercial |
$9.15
|
| Rate for Payer: Wellcare Medicare |
$6.01
|
| Rate for Payer: WPS Commercial |
$12.32
|
|
|
Phosphate, Urine
|
Professional
|
Both
|
$16.00
|
|
|
Service Code
|
CPT 84105
|
| Hospital Charge Code |
5024609
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.01 |
| Max. Negotiated Rate |
$26.45 |
| Rate for Payer: Aetna Commercial |
$15.81
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$14.31
|
| Rate for Payer: Aetna Managed Medicare |
$6.01
|
| Rate for Payer: Anthem Medicare Advantage |
$6.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$6.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$6.01
|
| Rate for Payer: Cash Price |
$4.80
|
| Rate for Payer: Cash Price |
$4.80
|
| Rate for Payer: Cigna Commercial |
$15.81
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$8.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6.01
|
| Rate for Payer: Health EOS Commercial |
$15.14
|
| Rate for Payer: HFN Commercial |
$15.81
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$21.22
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$21.22
|
| Rate for Payer: Independent Care Health Plan Medicare |
$6.01
|
| Rate for Payer: Multiplan Commercial |
$13.31
|
| Rate for Payer: NAPHCARE Commercial |
$9.02
|
| Rate for Payer: Preferred Network Access Commercial |
$15.81
|
| Rate for Payer: Quartz Beloit One Network |
$7.32
|
| Rate for Payer: Quartz Commercial |
$9.48
|
| Rate for Payer: Quartz Medicare Advantage |
$6.01
|
| Rate for Payer: The Alliance Commercial |
$23.74
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6.01
|
| Rate for Payer: WEA Trust Commercial |
$9.15
|
| Rate for Payer: WPS Commercial |
$26.45
|
|
|
Phosphate, Urine
|
Facility
|
IP
|
$16.00
|
|
|
Service Code
|
CPT 84105
|
| Hospital Charge Code |
5024609
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.15 |
| Max. Negotiated Rate |
$15.31 |
| Rate for Payer: Aetna Commercial |
$14.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$14.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$8.82
|
| Rate for Payer: Cash Price |
$4.80
|
| Rate for Payer: Cigna Commercial |
$15.31
|
| Rate for Payer: Health EOS Commercial |
$14.81
|
| Rate for Payer: HFN Commercial |
$15.31
|
| Rate for Payer: Multiplan Commercial |
$13.31
|
| Rate for Payer: Preferred Network Access Commercial |
$15.31
|
| Rate for Payer: Quartz Beloit One Network |
$8.15
|
| Rate for Payer: Quartz Commercial |
$9.98
|
| Rate for Payer: WEA Trust Commercial |
$9.15
|
| Rate for Payer: WPS Commercial |
$12.32
|
|
|
Phosphatidylethanol (PEth)
|
Facility
|
OP
|
$199.00
|
|
|
Service Code
|
CPT 80321
|
| Hospital Charge Code |
5502669
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$57.95 |
| Max. Negotiated Rate |
$190.40 |
| Rate for Payer: Aetna Commercial |
$186.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$177.99
|
| Rate for Payer: Aetna Managed Medicare |
$57.95
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$134.52
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$103.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$99.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$109.69
|
| Rate for Payer: Cash Price |
$59.70
|
| Rate for Payer: Cigna Commercial |
$190.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$115.82
|
| Rate for Payer: Health EOS Commercial |
$184.19
|
| Rate for Payer: HFN Commercial |
$190.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$155.22
|
| Rate for Payer: Multiplan Commercial |
$165.57
|
| Rate for Payer: NAPHCARE Commercial |
$124.18
|
| Rate for Payer: Preferred Network Access Commercial |
$190.40
|
| Rate for Payer: Quartz Beloit One Network |
$101.41
|
| Rate for Payer: Quartz Commercial |
$134.52
|
| Rate for Payer: Quartz Medicare Advantage |
$124.18
|
| Rate for Payer: The Alliance Commercial |
$103.48
|
| Rate for Payer: United Healthcare PPO |
$155.22
|
| Rate for Payer: WEA Trust Commercial |
$113.83
|
| Rate for Payer: WPS Commercial |
$153.29
|
|
|
Phosphatidylethanol (PEth)
|
Professional
|
Both
|
$199.00
|
|
|
Service Code
|
CPT 80321
|
| Hospital Charge Code |
5502669
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$49.45 |
| Max. Negotiated Rate |
$196.61 |
| Rate for Payer: Aetna Commercial |
$196.61
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$177.99
|
| Rate for Payer: Cash Price |
$59.70
|
| Rate for Payer: Cash Price |
$59.70
|
| Rate for Payer: Cigna Commercial |
$196.61
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$103.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$124.18
|
| Rate for Payer: Health EOS Commercial |
$188.33
|
| Rate for Payer: HFN Commercial |
$196.61
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$49.45
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$49.45
|
| Rate for Payer: Multiplan Commercial |
$165.57
|
| Rate for Payer: Preferred Network Access Commercial |
$196.61
|
| Rate for Payer: Quartz Beloit One Network |
$91.06
|
| Rate for Payer: Quartz Commercial |
$117.97
|
| Rate for Payer: The Alliance Commercial |
$103.48
|
| Rate for Payer: WEA Trust Commercial |
$113.83
|
| Rate for Payer: WPS Commercial |
$153.29
|
|
|
Phosphatidylethanol (PEth)
|
Facility
|
IP
|
$199.00
|
|
|
Service Code
|
CPT 80321
|
| Hospital Charge Code |
5502669
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$101.41 |
| Max. Negotiated Rate |
$190.40 |
| Rate for Payer: Aetna Commercial |
$186.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$177.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$109.69
|
| Rate for Payer: Cash Price |
$59.70
|
| Rate for Payer: Cigna Commercial |
$190.40
|
| Rate for Payer: Health EOS Commercial |
$184.19
|
| Rate for Payer: HFN Commercial |
$190.40
|
| Rate for Payer: Multiplan Commercial |
$165.57
|
| Rate for Payer: Preferred Network Access Commercial |
$190.40
|
| Rate for Payer: Quartz Beloit One Network |
$101.41
|
| Rate for Payer: Quartz Commercial |
$124.18
|
| Rate for Payer: WEA Trust Commercial |
$113.83
|
| Rate for Payer: WPS Commercial |
$153.29
|
|
|
Phosphatidylserine Antibodies, IgG & IgM
|
Professional
|
Both
|
$331.00
|
|
|
Service Code
|
CPT 86148
|
| Hospital Charge Code |
983360
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$16.71 |
| Max. Negotiated Rate |
$327.03 |
| Rate for Payer: Aetna Commercial |
$327.03
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$296.05
|
| Rate for Payer: Aetna Managed Medicare |
$16.71
|
| Rate for Payer: Anthem Medicare Advantage |
$16.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$16.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$16.71
|
| Rate for Payer: Cash Price |
$99.30
|
| Rate for Payer: Cash Price |
$99.30
|
| Rate for Payer: Cigna Commercial |
$327.03
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$172.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$16.71
|
| Rate for Payer: Health EOS Commercial |
$313.26
|
| Rate for Payer: HFN Commercial |
$327.03
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$59.00
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$59.00
|
| Rate for Payer: Independent Care Health Plan Medicare |
$16.71
|
| Rate for Payer: Multiplan Commercial |
$275.39
|
| Rate for Payer: NAPHCARE Commercial |
$25.07
|
| Rate for Payer: Preferred Network Access Commercial |
$327.03
|
| Rate for Payer: Quartz Beloit One Network |
$151.47
|
| Rate for Payer: Quartz Commercial |
$196.22
|
| Rate for Payer: Quartz Medicare Advantage |
$16.71
|
| Rate for Payer: The Alliance Commercial |
$66.02
|
| Rate for Payer: United Healthcare Medicare Advantage |
$16.71
|
| Rate for Payer: WEA Trust Commercial |
$189.33
|
| Rate for Payer: WPS Commercial |
$73.54
|
|
|
Phosphatidylserine Antibodies, IgG & IgM
|
Facility
|
IP
|
$331.00
|
|
|
Service Code
|
CPT 86148
|
| Hospital Charge Code |
983360
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$168.68 |
| Max. Negotiated Rate |
$316.70 |
| Rate for Payer: Aetna Commercial |
$309.82
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$296.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$182.45
|
| Rate for Payer: Cash Price |
$99.30
|
| Rate for Payer: Cigna Commercial |
$316.70
|
| Rate for Payer: Health EOS Commercial |
$306.37
|
| Rate for Payer: HFN Commercial |
$316.70
|
| Rate for Payer: Multiplan Commercial |
$275.39
|
| Rate for Payer: Preferred Network Access Commercial |
$316.70
|
| Rate for Payer: Quartz Beloit One Network |
$168.68
|
| Rate for Payer: Quartz Commercial |
$206.54
|
| Rate for Payer: WEA Trust Commercial |
$189.33
|
| Rate for Payer: WPS Commercial |
$254.97
|
|
|
Phosphatidylserine Antibodies, IgG & IgM
|
Facility
|
OP
|
$331.00
|
|
|
Service Code
|
CPT 86148
|
| Hospital Charge Code |
983360
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$16.71 |
| Max. Negotiated Rate |
$316.70 |
| Rate for Payer: Aetna Commercial |
$309.82
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$296.05
|
| Rate for Payer: Aetna Managed Medicare |
$16.71
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$62.67
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$29.25
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$27.74
|
| Rate for Payer: Anthem Medicare Advantage |
$16.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$182.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$16.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$16.71
|
| Rate for Payer: Cash Price |
$99.30
|
| Rate for Payer: Cash Price |
$99.30
|
| Rate for Payer: Cigna Commercial |
$316.70
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$16.71
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$192.64
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$16.71
|
| Rate for Payer: Health EOS Commercial |
$306.37
|
| Rate for Payer: HFN Commercial |
$316.70
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$62.17
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$16.71
|
| Rate for Payer: Independent Care Health Plan Medicare |
$16.71
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$16.71
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$16.71
|
| Rate for Payer: Multiplan Commercial |
$275.39
|
| Rate for Payer: NAPHCARE Commercial |
$25.07
|
| Rate for Payer: Preferred Network Access Commercial |
$316.70
|
| Rate for Payer: Quartz Beloit One Network |
$168.68
|
| Rate for Payer: Quartz Commercial |
$223.76
|
| Rate for Payer: Quartz Medicare Advantage |
$16.71
|
| Rate for Payer: The Alliance Commercial |
$66.85
|
| Rate for Payer: United Healthcare Medicare Advantage |
$16.71
|
| Rate for Payer: United Healthcare PPO |
$258.18
|
| Rate for Payer: WEA Trust Commercial |
$189.33
|
| Rate for Payer: Wellcare Medicare |
$16.71
|
| Rate for Payer: WPS Commercial |
$254.97
|
|
|
Phosphatidylserine Antibody IgG
|
Facility
|
OP
|
$350.00
|
|
|
Service Code
|
CPT 86148
|
| Hospital Charge Code |
2942862
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$16.71 |
| Max. Negotiated Rate |
$334.88 |
| Rate for Payer: Aetna Commercial |
$327.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$313.04
|
| Rate for Payer: Aetna Managed Medicare |
$16.71
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$62.67
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$29.25
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$27.74
|
| Rate for Payer: Anthem Medicare Advantage |
$16.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$192.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$16.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$16.71
|
| Rate for Payer: Cash Price |
$105.00
|
| Rate for Payer: Cash Price |
$105.00
|
| Rate for Payer: Cigna Commercial |
$334.88
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$16.71
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$203.70
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$16.71
|
| Rate for Payer: Health EOS Commercial |
$323.96
|
| Rate for Payer: HFN Commercial |
$334.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$62.17
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$16.71
|
| Rate for Payer: Independent Care Health Plan Medicare |
$16.71
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$16.71
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$16.71
|
| Rate for Payer: Multiplan Commercial |
$291.20
|
| Rate for Payer: NAPHCARE Commercial |
$25.07
|
| Rate for Payer: Preferred Network Access Commercial |
$334.88
|
| Rate for Payer: Quartz Beloit One Network |
$178.36
|
| Rate for Payer: Quartz Commercial |
$236.60
|
| Rate for Payer: Quartz Medicare Advantage |
$16.71
|
| Rate for Payer: The Alliance Commercial |
$66.85
|
| Rate for Payer: United Healthcare Medicare Advantage |
$16.71
|
| Rate for Payer: United Healthcare PPO |
$273.00
|
| Rate for Payer: WEA Trust Commercial |
$200.20
|
| Rate for Payer: Wellcare Medicare |
$16.71
|
| Rate for Payer: WPS Commercial |
$269.61
|
|
|
Phosphatidylserine Antibody IgG
|
Professional
|
Both
|
$350.00
|
|
|
Service Code
|
CPT 86148
|
| Hospital Charge Code |
2942862
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$16.71 |
| Max. Negotiated Rate |
$345.80 |
| Rate for Payer: Aetna Commercial |
$345.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$313.04
|
| Rate for Payer: Aetna Managed Medicare |
$16.71
|
| Rate for Payer: Anthem Medicare Advantage |
$16.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$16.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$16.71
|
| Rate for Payer: Cash Price |
$105.00
|
| Rate for Payer: Cash Price |
$105.00
|
| Rate for Payer: Cigna Commercial |
$345.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$182.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$16.71
|
| Rate for Payer: Health EOS Commercial |
$331.24
|
| Rate for Payer: HFN Commercial |
$345.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$59.00
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$59.00
|
| Rate for Payer: Independent Care Health Plan Medicare |
$16.71
|
| Rate for Payer: Multiplan Commercial |
$291.20
|
| Rate for Payer: NAPHCARE Commercial |
$25.07
|
| Rate for Payer: Preferred Network Access Commercial |
$345.80
|
| Rate for Payer: Quartz Beloit One Network |
$160.16
|
| Rate for Payer: Quartz Commercial |
$207.48
|
| Rate for Payer: Quartz Medicare Advantage |
$16.71
|
| Rate for Payer: The Alliance Commercial |
$66.02
|
| Rate for Payer: United Healthcare Medicare Advantage |
$16.71
|
| Rate for Payer: WEA Trust Commercial |
$200.20
|
| Rate for Payer: WPS Commercial |
$73.54
|
|
|
Phosphatidylserine Antibody IgG
|
Facility
|
IP
|
$350.00
|
|
|
Service Code
|
CPT 86148
|
| Hospital Charge Code |
2942862
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$178.36 |
| Max. Negotiated Rate |
$334.88 |
| Rate for Payer: Aetna Commercial |
$327.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$313.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$192.92
|
| Rate for Payer: Cash Price |
$105.00
|
| Rate for Payer: Cigna Commercial |
$334.88
|
| Rate for Payer: Health EOS Commercial |
$323.96
|
| Rate for Payer: HFN Commercial |
$334.88
|
| Rate for Payer: Multiplan Commercial |
$291.20
|
| Rate for Payer: Preferred Network Access Commercial |
$334.88
|
| Rate for Payer: Quartz Beloit One Network |
$178.36
|
| Rate for Payer: Quartz Commercial |
$218.40
|
| Rate for Payer: WEA Trust Commercial |
$200.20
|
| Rate for Payer: WPS Commercial |
$269.61
|
|
|
Phosphatidylserine Antibody IgM
|
Facility
|
IP
|
$350.00
|
|
|
Service Code
|
CPT 86148
|
| Hospital Charge Code |
2942863
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$178.36 |
| Max. Negotiated Rate |
$334.88 |
| Rate for Payer: Aetna Commercial |
$327.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$313.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$192.92
|
| Rate for Payer: Cash Price |
$105.00
|
| Rate for Payer: Cigna Commercial |
$334.88
|
| Rate for Payer: Health EOS Commercial |
$323.96
|
| Rate for Payer: HFN Commercial |
$334.88
|
| Rate for Payer: Multiplan Commercial |
$291.20
|
| Rate for Payer: Preferred Network Access Commercial |
$334.88
|
| Rate for Payer: Quartz Beloit One Network |
$178.36
|
| Rate for Payer: Quartz Commercial |
$218.40
|
| Rate for Payer: WEA Trust Commercial |
$200.20
|
| Rate for Payer: WPS Commercial |
$269.61
|
|
|
Phosphatidylserine Antibody IgM
|
Facility
|
OP
|
$350.00
|
|
|
Service Code
|
CPT 86148
|
| Hospital Charge Code |
2942863
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$16.71 |
| Max. Negotiated Rate |
$334.88 |
| Rate for Payer: Aetna Commercial |
$327.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$313.04
|
| Rate for Payer: Aetna Managed Medicare |
$16.71
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$62.67
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$29.25
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$27.74
|
| Rate for Payer: Anthem Medicare Advantage |
$16.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$192.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$16.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$16.71
|
| Rate for Payer: Cash Price |
$105.00
|
| Rate for Payer: Cash Price |
$105.00
|
| Rate for Payer: Cigna Commercial |
$334.88
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$16.71
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$203.70
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$16.71
|
| Rate for Payer: Health EOS Commercial |
$323.96
|
| Rate for Payer: HFN Commercial |
$334.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$62.17
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$16.71
|
| Rate for Payer: Independent Care Health Plan Medicare |
$16.71
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$16.71
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$16.71
|
| Rate for Payer: Multiplan Commercial |
$291.20
|
| Rate for Payer: NAPHCARE Commercial |
$25.07
|
| Rate for Payer: Preferred Network Access Commercial |
$334.88
|
| Rate for Payer: Quartz Beloit One Network |
$178.36
|
| Rate for Payer: Quartz Commercial |
$236.60
|
| Rate for Payer: Quartz Medicare Advantage |
$16.71
|
| Rate for Payer: The Alliance Commercial |
$66.85
|
| Rate for Payer: United Healthcare Medicare Advantage |
$16.71
|
| Rate for Payer: United Healthcare PPO |
$273.00
|
| Rate for Payer: WEA Trust Commercial |
$200.20
|
| Rate for Payer: Wellcare Medicare |
$16.71
|
| Rate for Payer: WPS Commercial |
$269.61
|
|
|
Phosphatidylserine Antibody IgM
|
Professional
|
Both
|
$350.00
|
|
|
Service Code
|
CPT 86148
|
| Hospital Charge Code |
2942863
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$16.71 |
| Max. Negotiated Rate |
$345.80 |
| Rate for Payer: Aetna Commercial |
$345.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$313.04
|
| Rate for Payer: Aetna Managed Medicare |
$16.71
|
| Rate for Payer: Anthem Medicare Advantage |
$16.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$16.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$16.71
|
| Rate for Payer: Cash Price |
$105.00
|
| Rate for Payer: Cash Price |
$105.00
|
| Rate for Payer: Cigna Commercial |
$345.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$182.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$16.71
|
| Rate for Payer: Health EOS Commercial |
$331.24
|
| Rate for Payer: HFN Commercial |
$345.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$59.00
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$59.00
|
| Rate for Payer: Independent Care Health Plan Medicare |
$16.71
|
| Rate for Payer: Multiplan Commercial |
$291.20
|
| Rate for Payer: NAPHCARE Commercial |
$25.07
|
| Rate for Payer: Preferred Network Access Commercial |
$345.80
|
| Rate for Payer: Quartz Beloit One Network |
$160.16
|
| Rate for Payer: Quartz Commercial |
$207.48
|
| Rate for Payer: Quartz Medicare Advantage |
$16.71
|
| Rate for Payer: The Alliance Commercial |
$66.02
|
| Rate for Payer: United Healthcare Medicare Advantage |
$16.71
|
| Rate for Payer: WEA Trust Commercial |
$200.20
|
| Rate for Payer: WPS Commercial |
$73.54
|
|
|
Phospholipase A2 Receptor Antibody
|
Facility
|
OP
|
$684.00
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
4808607
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.53 |
| Max. Negotiated Rate |
$654.45 |
| Rate for Payer: Aetna Commercial |
$640.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$611.77
|
| Rate for Payer: Aetna Managed Medicare |
$12.53
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$46.99
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$21.93
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$20.80
|
| Rate for Payer: Anthem Medicare Advantage |
$12.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$377.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$12.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$12.53
|
| Rate for Payer: Cash Price |
$205.20
|
| Rate for Payer: Cash Price |
$205.20
|
| Rate for Payer: Cigna Commercial |
$654.45
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$12.53
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$398.09
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$12.53
|
| Rate for Payer: Health EOS Commercial |
$633.11
|
| Rate for Payer: HFN Commercial |
$654.45
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$46.62
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$12.53
|
| Rate for Payer: Independent Care Health Plan Medicare |
$12.53
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$12.53
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$12.53
|
| Rate for Payer: Multiplan Commercial |
$569.09
|
| Rate for Payer: NAPHCARE Commercial |
$18.80
|
| Rate for Payer: Preferred Network Access Commercial |
$654.45
|
| Rate for Payer: Quartz Beloit One Network |
$348.57
|
| Rate for Payer: Quartz Commercial |
$462.38
|
| Rate for Payer: Quartz Medicare Advantage |
$12.53
|
| Rate for Payer: The Alliance Commercial |
$50.13
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.53
|
| Rate for Payer: United Healthcare PPO |
$533.52
|
| Rate for Payer: WEA Trust Commercial |
$391.25
|
| Rate for Payer: Wellcare Medicare |
$12.53
|
| Rate for Payer: WPS Commercial |
$526.89
|
|
|
Phospholipase A2 Receptor Antibody
|
Professional
|
Both
|
$684.00
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
4808607
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.53 |
| Max. Negotiated Rate |
$675.79 |
| Rate for Payer: Aetna Commercial |
$675.79
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$611.77
|
| Rate for Payer: Aetna Managed Medicare |
$12.53
|
| Rate for Payer: Anthem Commercial |
$17.27
|
| Rate for Payer: Anthem Medicare Advantage |
$12.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$12.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$12.53
|
| Rate for Payer: Cash Price |
$205.20
|
| Rate for Payer: Cash Price |
$205.20
|
| Rate for Payer: Cigna Commercial |
$675.79
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$355.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12.53
|
| Rate for Payer: Health EOS Commercial |
$647.34
|
| Rate for Payer: HFN Commercial |
$675.79
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$44.24
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$44.24
|
| Rate for Payer: Independent Care Health Plan Medicare |
$12.53
|
| Rate for Payer: Multiplan Commercial |
$569.09
|
| Rate for Payer: NAPHCARE Commercial |
$18.80
|
| Rate for Payer: Preferred Network Access Commercial |
$675.79
|
| Rate for Payer: Quartz Beloit One Network |
$313.00
|
| Rate for Payer: Quartz Commercial |
$405.48
|
| Rate for Payer: Quartz Medicare Advantage |
$12.53
|
| Rate for Payer: The Alliance Commercial |
$49.50
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.53
|
| Rate for Payer: WEA Trust Commercial |
$391.25
|
| Rate for Payer: WPS Commercial |
$55.14
|
|
|
Phospholipase A2 Receptor Antibody
|
Facility
|
IP
|
$684.00
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
4808607
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$348.57 |
| Max. Negotiated Rate |
$654.45 |
| Rate for Payer: Aetna Commercial |
$640.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$611.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$377.02
|
| Rate for Payer: Cash Price |
$205.20
|
| Rate for Payer: Cigna Commercial |
$654.45
|
| Rate for Payer: Health EOS Commercial |
$633.11
|
| Rate for Payer: HFN Commercial |
$654.45
|
| Rate for Payer: Multiplan Commercial |
$569.09
|
| Rate for Payer: Preferred Network Access Commercial |
$654.45
|
| Rate for Payer: Quartz Beloit One Network |
$348.57
|
| Rate for Payer: Quartz Commercial |
$426.82
|
| Rate for Payer: WEA Trust Commercial |
$391.25
|
| Rate for Payer: WPS Commercial |
$526.89
|
|
|
Phospholipids
|
Professional
|
Both
|
$25.00
|
|
|
Service Code
|
CPT 84311
|
| Hospital Charge Code |
5581589
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.42 |
| Max. Negotiated Rate |
$37.07 |
| Rate for Payer: Aetna Commercial |
$24.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$22.36
|
| Rate for Payer: Aetna Managed Medicare |
$8.42
|
| Rate for Payer: Anthem Medicare Advantage |
$8.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$8.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$8.42
|
| Rate for Payer: Cash Price |
$7.50
|
| Rate for Payer: Cash Price |
$7.50
|
| Rate for Payer: Cigna Commercial |
$24.70
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$13.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$8.42
|
| Rate for Payer: Health EOS Commercial |
$23.66
|
| Rate for Payer: HFN Commercial |
$24.70
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$29.73
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$29.73
|
| Rate for Payer: Independent Care Health Plan Medicare |
$8.42
|
| Rate for Payer: Multiplan Commercial |
$20.80
|
| Rate for Payer: NAPHCARE Commercial |
$12.64
|
| Rate for Payer: Preferred Network Access Commercial |
$24.70
|
| Rate for Payer: Quartz Beloit One Network |
$11.44
|
| Rate for Payer: Quartz Commercial |
$14.82
|
| Rate for Payer: Quartz Medicare Advantage |
$8.42
|
| Rate for Payer: The Alliance Commercial |
$33.27
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8.42
|
| Rate for Payer: WEA Trust Commercial |
$14.30
|
| Rate for Payer: WPS Commercial |
$37.07
|
|
|
Phospholipids
|
Facility
|
OP
|
$25.00
|
|
|
Service Code
|
CPT 84311
|
| Hospital Charge Code |
5581589
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.42 |
| Max. Negotiated Rate |
$33.70 |
| Rate for Payer: Aetna Commercial |
$23.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$22.36
|
| Rate for Payer: Aetna Managed Medicare |
$8.42
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$31.59
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$14.74
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$13.98
|
| Rate for Payer: Anthem Medicare Advantage |
$8.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$13.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$8.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$8.42
|
| Rate for Payer: Cash Price |
$7.50
|
| Rate for Payer: Cash Price |
$7.50
|
| Rate for Payer: Cigna Commercial |
$23.92
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$8.42
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$14.55
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$8.42
|
| Rate for Payer: Health EOS Commercial |
$23.14
|
| Rate for Payer: HFN Commercial |
$23.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$31.34
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$8.42
|
| Rate for Payer: Independent Care Health Plan Medicare |
$8.42
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$8.42
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$8.42
|
| Rate for Payer: Multiplan Commercial |
$20.80
|
| Rate for Payer: NAPHCARE Commercial |
$12.64
|
| Rate for Payer: Preferred Network Access Commercial |
$23.92
|
| Rate for Payer: Quartz Beloit One Network |
$12.74
|
| Rate for Payer: Quartz Commercial |
$16.90
|
| Rate for Payer: Quartz Medicare Advantage |
$8.42
|
| Rate for Payer: The Alliance Commercial |
$33.70
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8.42
|
| Rate for Payer: United Healthcare PPO |
$19.50
|
| Rate for Payer: WEA Trust Commercial |
$14.30
|
| Rate for Payer: Wellcare Medicare |
$8.42
|
| Rate for Payer: WPS Commercial |
$19.26
|
|
|
Phospholipids
|
Facility
|
IP
|
$25.00
|
|
|
Service Code
|
CPT 84311
|
| Hospital Charge Code |
5581589
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.74 |
| Max. Negotiated Rate |
$23.92 |
| Rate for Payer: Aetna Commercial |
$23.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$22.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$13.78
|
| Rate for Payer: Cash Price |
$7.50
|
| Rate for Payer: Cigna Commercial |
$23.92
|
| Rate for Payer: Health EOS Commercial |
$23.14
|
| Rate for Payer: HFN Commercial |
$23.92
|
| Rate for Payer: Multiplan Commercial |
$20.80
|
| Rate for Payer: Preferred Network Access Commercial |
$23.92
|
| Rate for Payer: Quartz Beloit One Network |
$12.74
|
| Rate for Payer: Quartz Commercial |
$15.60
|
| Rate for Payer: WEA Trust Commercial |
$14.30
|
| Rate for Payer: WPS Commercial |
$19.26
|
|
|
Phosphorus Level
|
Facility
|
IP
|
$82.00
|
|
|
Service Code
|
CPT 84100
|
| Hospital Charge Code |
633803
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$41.79 |
| Max. Negotiated Rate |
$78.46 |
| Rate for Payer: Aetna Commercial |
$76.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$73.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$45.20
|
| Rate for Payer: Cash Price |
$24.60
|
| Rate for Payer: Cigna Commercial |
$78.46
|
| Rate for Payer: Health EOS Commercial |
$75.90
|
| Rate for Payer: HFN Commercial |
$78.46
|
| Rate for Payer: Multiplan Commercial |
$68.22
|
| Rate for Payer: Preferred Network Access Commercial |
$78.46
|
| Rate for Payer: Quartz Beloit One Network |
$41.79
|
| Rate for Payer: Quartz Commercial |
$51.17
|
| Rate for Payer: WEA Trust Commercial |
$46.90
|
| Rate for Payer: WPS Commercial |
$63.16
|
|
