|
Protein S Free
|
Facility
|
OP
|
$190.00
|
|
|
Service Code
|
CPT 85306
|
| Hospital Charge Code |
2942982
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.32 |
| Max. Negotiated Rate |
$174.80 |
| Rate for Payer: Aetna Commercial |
$171.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$163.40
|
| Rate for Payer: Aetna Managed Medicare |
$15.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$57.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$26.81
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$25.43
|
| Rate for Payer: Anthem Medicaid |
$15.83
|
| Rate for Payer: Anthem Medicare Advantage |
$15.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$100.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$15.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$15.32
|
| Rate for Payer: Cash Price |
$57.00
|
| Rate for Payer: Cash Price |
$57.00
|
| Rate for Payer: Cigna Commercial |
$174.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$15.32
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$15.83
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$106.32
|
| Rate for Payer: Dean Health Medicaid |
$15.83
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$15.32
|
| Rate for Payer: Health EOS Commercial |
$169.10
|
| Rate for Payer: HFN Commercial |
$174.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$56.99
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$15.32
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$15.83
|
| Rate for Payer: Independent Care Health Plan Medicare |
$15.32
|
| Rate for Payer: Managed Health Services Medicaid |
$16.46
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$15.32
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$15.32
|
| Rate for Payer: Multiplan Commercial |
$152.00
|
| Rate for Payer: NAPHCARE Commercial |
$22.98
|
| Rate for Payer: Preferred Network Access Commercial |
$174.80
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$15.83
|
| Rate for Payer: Quartz Beloit One Network |
$93.10
|
| Rate for Payer: Quartz Commercial |
$123.50
|
| Rate for Payer: Quartz Medicare Advantage |
$15.32
|
| Rate for Payer: The Alliance Commercial |
$61.28
|
| Rate for Payer: United Healthcare Medicaid |
$15.83
|
| Rate for Payer: United Healthcare Medicare Advantage |
$15.32
|
| Rate for Payer: United Healthcare PPO |
$142.50
|
| Rate for Payer: WEA Trust Commercial |
$104.50
|
| Rate for Payer: Wellcare Medicare |
$15.32
|
| Rate for Payer: WMAP Medicaid |
$15.83
|
| Rate for Payer: WPS Commercial |
$140.73
|
|
|
Protein S Free
|
Facility
|
IP
|
$190.00
|
|
|
Service Code
|
CPT 85306
|
| Hospital Charge Code |
2942982
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$93.10 |
| Max. Negotiated Rate |
$174.80 |
| Rate for Payer: Aetna Commercial |
$171.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$163.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$100.70
|
| Rate for Payer: Cash Price |
$57.00
|
| Rate for Payer: Cigna Commercial |
$174.80
|
| Rate for Payer: Health EOS Commercial |
$169.10
|
| Rate for Payer: HFN Commercial |
$174.80
|
| Rate for Payer: Multiplan Commercial |
$152.00
|
| Rate for Payer: NAPHCARE Commercial |
$114.00
|
| Rate for Payer: Preferred Network Access Commercial |
$174.80
|
| Rate for Payer: Quartz Beloit One Network |
$93.10
|
| Rate for Payer: Quartz Commercial |
$114.00
|
| Rate for Payer: WEA Trust Commercial |
$104.50
|
| Rate for Payer: WPS Commercial |
$140.73
|
|
|
Protein S Free
|
Professional
|
Both
|
$190.00
|
|
|
Service Code
|
CPT 85306
|
| Hospital Charge Code |
2942982
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$54.08 |
| Max. Negotiated Rate |
$180.50 |
| Rate for Payer: Aetna Commercial |
$180.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$163.40
|
| Rate for Payer: Cash Price |
$57.00
|
| Rate for Payer: Cash Price |
$57.00
|
| Rate for Payer: Cigna Commercial |
$180.50
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$95.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$114.00
|
| Rate for Payer: Health EOS Commercial |
$172.90
|
| Rate for Payer: HFN Commercial |
$180.50
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$54.08
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$54.08
|
| Rate for Payer: Multiplan Commercial |
$152.00
|
| Rate for Payer: Preferred Network Access Commercial |
$180.50
|
| Rate for Payer: Quartz Beloit One Network |
$83.60
|
| Rate for Payer: Quartz Commercial |
$108.30
|
| Rate for Payer: The Alliance Commercial |
$95.00
|
| Rate for Payer: WEA Trust Commercial |
$104.50
|
| Rate for Payer: WPS Commercial |
$140.73
|
|
|
Protein Total
|
Facility
|
IP
|
$77.00
|
|
|
Service Code
|
CPT 84155
|
| Hospital Charge Code |
633818
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$37.73 |
| Max. Negotiated Rate |
$70.84 |
| Rate for Payer: Aetna Commercial |
$69.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$66.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$40.81
|
| Rate for Payer: Cash Price |
$23.10
|
| Rate for Payer: Cigna Commercial |
$70.84
|
| Rate for Payer: Health EOS Commercial |
$68.53
|
| Rate for Payer: HFN Commercial |
$70.84
|
| Rate for Payer: Multiplan Commercial |
$61.60
|
| Rate for Payer: NAPHCARE Commercial |
$46.20
|
| Rate for Payer: Preferred Network Access Commercial |
$70.84
|
| Rate for Payer: Quartz Beloit One Network |
$37.73
|
| Rate for Payer: Quartz Commercial |
$46.20
|
| Rate for Payer: WEA Trust Commercial |
$42.35
|
| Rate for Payer: WPS Commercial |
$57.03
|
|
|
Protein Total
|
Professional
|
Both
|
$77.00
|
|
|
Service Code
|
CPT 84155
|
| Hospital Charge Code |
633818
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.96 |
| Max. Negotiated Rate |
$73.15 |
| Rate for Payer: Aetna Commercial |
$73.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$66.22
|
| Rate for Payer: Cash Price |
$23.10
|
| Rate for Payer: Cash Price |
$23.10
|
| Rate for Payer: Cigna Commercial |
$73.15
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$38.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$46.20
|
| Rate for Payer: Health EOS Commercial |
$70.07
|
| Rate for Payer: HFN Commercial |
$73.15
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$12.96
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$12.96
|
| Rate for Payer: Multiplan Commercial |
$61.60
|
| Rate for Payer: Preferred Network Access Commercial |
$73.15
|
| Rate for Payer: Quartz Beloit One Network |
$33.88
|
| Rate for Payer: Quartz Commercial |
$43.89
|
| Rate for Payer: The Alliance Commercial |
$38.50
|
| Rate for Payer: WEA Trust Commercial |
$42.35
|
| Rate for Payer: WPS Commercial |
$57.03
|
|
|
Protein Total
|
Facility
|
OP
|
$77.00
|
|
|
Service Code
|
CPT 84155
|
| Hospital Charge Code |
633818
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.67 |
| Max. Negotiated Rate |
$70.84 |
| Rate for Payer: Aetna Commercial |
$69.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$66.22
|
| Rate for Payer: Aetna Managed Medicare |
$3.67
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$13.76
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$6.42
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$6.09
|
| Rate for Payer: Anthem Medicaid |
$3.79
|
| Rate for Payer: Anthem Medicare Advantage |
$3.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$40.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$3.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$3.67
|
| Rate for Payer: Cash Price |
$23.10
|
| Rate for Payer: Cash Price |
$23.10
|
| Rate for Payer: Cigna Commercial |
$70.84
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$3.67
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$3.79
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$43.09
|
| Rate for Payer: Dean Health Medicaid |
$3.79
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$3.67
|
| Rate for Payer: Health EOS Commercial |
$68.53
|
| Rate for Payer: HFN Commercial |
$70.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$13.65
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$3.67
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$3.79
|
| Rate for Payer: Independent Care Health Plan Medicare |
$3.67
|
| Rate for Payer: Managed Health Services Medicaid |
$3.94
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$3.67
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$3.67
|
| Rate for Payer: Multiplan Commercial |
$61.60
|
| Rate for Payer: NAPHCARE Commercial |
$5.50
|
| Rate for Payer: Preferred Network Access Commercial |
$70.84
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$3.79
|
| Rate for Payer: Quartz Beloit One Network |
$37.73
|
| Rate for Payer: Quartz Commercial |
$50.05
|
| Rate for Payer: Quartz Medicare Advantage |
$3.67
|
| Rate for Payer: The Alliance Commercial |
$14.68
|
| Rate for Payer: United Healthcare Medicaid |
$3.79
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3.67
|
| Rate for Payer: United Healthcare PPO |
$57.75
|
| Rate for Payer: WEA Trust Commercial |
$42.35
|
| Rate for Payer: Wellcare Medicare |
$3.67
|
| Rate for Payer: WMAP Medicaid |
$3.79
|
| Rate for Payer: WPS Commercial |
$57.03
|
|
|
Protein, Total, Pericardial Fluid
|
Professional
|
Both
|
$52.00
|
|
|
Service Code
|
CPT 84157
|
| Hospital Charge Code |
3154859
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.12 |
| Max. Negotiated Rate |
$49.40 |
| Rate for Payer: Aetna Commercial |
$49.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$44.72
|
| Rate for Payer: Cash Price |
$15.60
|
| Rate for Payer: Cash Price |
$15.60
|
| Rate for Payer: Cigna Commercial |
$49.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$26.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$31.20
|
| Rate for Payer: Health EOS Commercial |
$47.32
|
| Rate for Payer: HFN Commercial |
$49.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$14.12
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$14.12
|
| Rate for Payer: Multiplan Commercial |
$41.60
|
| Rate for Payer: Preferred Network Access Commercial |
$49.40
|
| Rate for Payer: Quartz Beloit One Network |
$22.88
|
| Rate for Payer: Quartz Commercial |
$29.64
|
| Rate for Payer: The Alliance Commercial |
$26.00
|
| Rate for Payer: WEA Trust Commercial |
$28.60
|
| Rate for Payer: WPS Commercial |
$38.52
|
|
|
Protein, Total, Pericardial Fluid
|
Facility
|
IP
|
$52.00
|
|
|
Service Code
|
CPT 84157
|
| Hospital Charge Code |
3154859
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$25.48 |
| Max. Negotiated Rate |
$47.84 |
| Rate for Payer: Aetna Commercial |
$46.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$44.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$27.56
|
| Rate for Payer: Cash Price |
$15.60
|
| Rate for Payer: Cigna Commercial |
$47.84
|
| Rate for Payer: Health EOS Commercial |
$46.28
|
| Rate for Payer: HFN Commercial |
$47.84
|
| Rate for Payer: Multiplan Commercial |
$41.60
|
| Rate for Payer: NAPHCARE Commercial |
$31.20
|
| Rate for Payer: Preferred Network Access Commercial |
$47.84
|
| Rate for Payer: Quartz Beloit One Network |
$25.48
|
| Rate for Payer: Quartz Commercial |
$31.20
|
| Rate for Payer: WEA Trust Commercial |
$28.60
|
| Rate for Payer: WPS Commercial |
$38.52
|
|
|
Protein, Total, Pericardial Fluid
|
Facility
|
OP
|
$52.00
|
|
|
Service Code
|
CPT 84157
|
| Hospital Charge Code |
3154859
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.00 |
| Max. Negotiated Rate |
$47.84 |
| Rate for Payer: Aetna Commercial |
$46.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$44.72
|
| Rate for Payer: Aetna Managed Medicare |
$4.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$15.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$7.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$6.64
|
| Rate for Payer: Anthem Medicaid |
$4.13
|
| Rate for Payer: Anthem Medicare Advantage |
$4.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$27.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$4.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$4.00
|
| Rate for Payer: Cash Price |
$15.60
|
| Rate for Payer: Cash Price |
$15.60
|
| Rate for Payer: Cigna Commercial |
$47.84
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$4.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$4.13
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$29.10
|
| Rate for Payer: Dean Health Medicaid |
$4.13
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$4.00
|
| Rate for Payer: Health EOS Commercial |
$46.28
|
| Rate for Payer: HFN Commercial |
$47.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$14.88
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$4.00
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$4.13
|
| Rate for Payer: Independent Care Health Plan Medicare |
$4.00
|
| Rate for Payer: Managed Health Services Medicaid |
$4.30
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$4.00
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$4.00
|
| Rate for Payer: Multiplan Commercial |
$41.60
|
| Rate for Payer: NAPHCARE Commercial |
$6.00
|
| Rate for Payer: Preferred Network Access Commercial |
$47.84
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$4.13
|
| Rate for Payer: Quartz Beloit One Network |
$25.48
|
| Rate for Payer: Quartz Commercial |
$33.80
|
| Rate for Payer: Quartz Medicare Advantage |
$4.00
|
| Rate for Payer: The Alliance Commercial |
$16.00
|
| Rate for Payer: United Healthcare Medicaid |
$4.13
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4.00
|
| Rate for Payer: United Healthcare PPO |
$39.00
|
| Rate for Payer: WEA Trust Commercial |
$28.60
|
| Rate for Payer: Wellcare Medicare |
$4.00
|
| Rate for Payer: WMAP Medicaid |
$4.13
|
| Rate for Payer: WPS Commercial |
$38.52
|
|
|
Protein, Total, Peritoneal Fluid
|
Facility
|
OP
|
$52.00
|
|
|
Service Code
|
CPT 84157
|
| Hospital Charge Code |
3154858
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.00 |
| Max. Negotiated Rate |
$47.84 |
| Rate for Payer: Aetna Commercial |
$46.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$44.72
|
| Rate for Payer: Aetna Managed Medicare |
$4.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$15.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$7.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$6.64
|
| Rate for Payer: Anthem Medicaid |
$4.13
|
| Rate for Payer: Anthem Medicare Advantage |
$4.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$27.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$4.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$4.00
|
| Rate for Payer: Cash Price |
$15.60
|
| Rate for Payer: Cash Price |
$15.60
|
| Rate for Payer: Cigna Commercial |
$47.84
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$4.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$4.13
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$29.10
|
| Rate for Payer: Dean Health Medicaid |
$4.13
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$4.00
|
| Rate for Payer: Health EOS Commercial |
$46.28
|
| Rate for Payer: HFN Commercial |
$47.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$14.88
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$4.00
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$4.13
|
| Rate for Payer: Independent Care Health Plan Medicare |
$4.00
|
| Rate for Payer: Managed Health Services Medicaid |
$4.30
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$4.00
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$4.00
|
| Rate for Payer: Multiplan Commercial |
$41.60
|
| Rate for Payer: NAPHCARE Commercial |
$6.00
|
| Rate for Payer: Preferred Network Access Commercial |
$47.84
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$4.13
|
| Rate for Payer: Quartz Beloit One Network |
$25.48
|
| Rate for Payer: Quartz Commercial |
$33.80
|
| Rate for Payer: Quartz Medicare Advantage |
$4.00
|
| Rate for Payer: The Alliance Commercial |
$16.00
|
| Rate for Payer: United Healthcare Medicaid |
$4.13
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4.00
|
| Rate for Payer: United Healthcare PPO |
$39.00
|
| Rate for Payer: WEA Trust Commercial |
$28.60
|
| Rate for Payer: Wellcare Medicare |
$4.00
|
| Rate for Payer: WMAP Medicaid |
$4.13
|
| Rate for Payer: WPS Commercial |
$38.52
|
|
|
Protein, Total, Peritoneal Fluid
|
Facility
|
IP
|
$52.00
|
|
|
Service Code
|
CPT 84157
|
| Hospital Charge Code |
3154858
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$25.48 |
| Max. Negotiated Rate |
$47.84 |
| Rate for Payer: Aetna Commercial |
$46.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$44.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$27.56
|
| Rate for Payer: Cash Price |
$15.60
|
| Rate for Payer: Cigna Commercial |
$47.84
|
| Rate for Payer: Health EOS Commercial |
$46.28
|
| Rate for Payer: HFN Commercial |
$47.84
|
| Rate for Payer: Multiplan Commercial |
$41.60
|
| Rate for Payer: NAPHCARE Commercial |
$31.20
|
| Rate for Payer: Preferred Network Access Commercial |
$47.84
|
| Rate for Payer: Quartz Beloit One Network |
$25.48
|
| Rate for Payer: Quartz Commercial |
$31.20
|
| Rate for Payer: WEA Trust Commercial |
$28.60
|
| Rate for Payer: WPS Commercial |
$38.52
|
|
|
Protein, Total, Peritoneal Fluid
|
Professional
|
Both
|
$52.00
|
|
|
Service Code
|
CPT 84157
|
| Hospital Charge Code |
3154858
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.12 |
| Max. Negotiated Rate |
$49.40 |
| Rate for Payer: Aetna Commercial |
$49.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$44.72
|
| Rate for Payer: Cash Price |
$15.60
|
| Rate for Payer: Cash Price |
$15.60
|
| Rate for Payer: Cigna Commercial |
$49.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$26.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$31.20
|
| Rate for Payer: Health EOS Commercial |
$47.32
|
| Rate for Payer: HFN Commercial |
$49.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$14.12
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$14.12
|
| Rate for Payer: Multiplan Commercial |
$41.60
|
| Rate for Payer: Preferred Network Access Commercial |
$49.40
|
| Rate for Payer: Quartz Beloit One Network |
$22.88
|
| Rate for Payer: Quartz Commercial |
$29.64
|
| Rate for Payer: The Alliance Commercial |
$26.00
|
| Rate for Payer: WEA Trust Commercial |
$28.60
|
| Rate for Payer: WPS Commercial |
$38.52
|
|
|
Protein, Total, Pleural Fluid
|
Facility
|
OP
|
$52.00
|
|
|
Service Code
|
CPT 84157
|
| Hospital Charge Code |
3154854
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.00 |
| Max. Negotiated Rate |
$47.84 |
| Rate for Payer: Aetna Commercial |
$46.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$44.72
|
| Rate for Payer: Aetna Managed Medicare |
$4.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$15.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$7.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$6.64
|
| Rate for Payer: Anthem Medicaid |
$4.13
|
| Rate for Payer: Anthem Medicare Advantage |
$4.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$27.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$4.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$4.00
|
| Rate for Payer: Cash Price |
$15.60
|
| Rate for Payer: Cash Price |
$15.60
|
| Rate for Payer: Cigna Commercial |
$47.84
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$4.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$4.13
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$29.10
|
| Rate for Payer: Dean Health Medicaid |
$4.13
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$4.00
|
| Rate for Payer: Health EOS Commercial |
$46.28
|
| Rate for Payer: HFN Commercial |
$47.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$14.88
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$4.00
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$4.13
|
| Rate for Payer: Independent Care Health Plan Medicare |
$4.00
|
| Rate for Payer: Managed Health Services Medicaid |
$4.30
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$4.00
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$4.00
|
| Rate for Payer: Multiplan Commercial |
$41.60
|
| Rate for Payer: NAPHCARE Commercial |
$6.00
|
| Rate for Payer: Preferred Network Access Commercial |
$47.84
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$4.13
|
| Rate for Payer: Quartz Beloit One Network |
$25.48
|
| Rate for Payer: Quartz Commercial |
$33.80
|
| Rate for Payer: Quartz Medicare Advantage |
$4.00
|
| Rate for Payer: The Alliance Commercial |
$16.00
|
| Rate for Payer: United Healthcare Medicaid |
$4.13
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4.00
|
| Rate for Payer: United Healthcare PPO |
$39.00
|
| Rate for Payer: WEA Trust Commercial |
$28.60
|
| Rate for Payer: Wellcare Medicare |
$4.00
|
| Rate for Payer: WMAP Medicaid |
$4.13
|
| Rate for Payer: WPS Commercial |
$38.52
|
|
|
Protein, Total, Pleural Fluid
|
Facility
|
IP
|
$52.00
|
|
|
Service Code
|
CPT 84157
|
| Hospital Charge Code |
3154854
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$25.48 |
| Max. Negotiated Rate |
$47.84 |
| Rate for Payer: Aetna Commercial |
$46.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$44.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$27.56
|
| Rate for Payer: Cash Price |
$15.60
|
| Rate for Payer: Cigna Commercial |
$47.84
|
| Rate for Payer: Health EOS Commercial |
$46.28
|
| Rate for Payer: HFN Commercial |
$47.84
|
| Rate for Payer: Multiplan Commercial |
$41.60
|
| Rate for Payer: NAPHCARE Commercial |
$31.20
|
| Rate for Payer: Preferred Network Access Commercial |
$47.84
|
| Rate for Payer: Quartz Beloit One Network |
$25.48
|
| Rate for Payer: Quartz Commercial |
$31.20
|
| Rate for Payer: WEA Trust Commercial |
$28.60
|
| Rate for Payer: WPS Commercial |
$38.52
|
|
|
Protein, Total, Pleural Fluid
|
Professional
|
Both
|
$52.00
|
|
|
Service Code
|
CPT 84157
|
| Hospital Charge Code |
3154854
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.12 |
| Max. Negotiated Rate |
$49.40 |
| Rate for Payer: Aetna Commercial |
$49.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$44.72
|
| Rate for Payer: Cash Price |
$15.60
|
| Rate for Payer: Cash Price |
$15.60
|
| Rate for Payer: Cigna Commercial |
$49.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$26.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$31.20
|
| Rate for Payer: Health EOS Commercial |
$47.32
|
| Rate for Payer: HFN Commercial |
$49.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$14.12
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$14.12
|
| Rate for Payer: Multiplan Commercial |
$41.60
|
| Rate for Payer: Preferred Network Access Commercial |
$49.40
|
| Rate for Payer: Quartz Beloit One Network |
$22.88
|
| Rate for Payer: Quartz Commercial |
$29.64
|
| Rate for Payer: The Alliance Commercial |
$26.00
|
| Rate for Payer: WEA Trust Commercial |
$28.60
|
| Rate for Payer: WPS Commercial |
$38.52
|
|
|
Protein, Total, Synovial Fluid
|
Facility
|
IP
|
$52.00
|
|
|
Service Code
|
CPT 84157
|
| Hospital Charge Code |
3154860
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$25.48 |
| Max. Negotiated Rate |
$47.84 |
| Rate for Payer: Aetna Commercial |
$46.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$44.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$27.56
|
| Rate for Payer: Cash Price |
$15.60
|
| Rate for Payer: Cigna Commercial |
$47.84
|
| Rate for Payer: Health EOS Commercial |
$46.28
|
| Rate for Payer: HFN Commercial |
$47.84
|
| Rate for Payer: Multiplan Commercial |
$41.60
|
| Rate for Payer: NAPHCARE Commercial |
$31.20
|
| Rate for Payer: Preferred Network Access Commercial |
$47.84
|
| Rate for Payer: Quartz Beloit One Network |
$25.48
|
| Rate for Payer: Quartz Commercial |
$31.20
|
| Rate for Payer: WEA Trust Commercial |
$28.60
|
| Rate for Payer: WPS Commercial |
$38.52
|
|
|
Protein, Total, Synovial Fluid
|
Professional
|
Both
|
$52.00
|
|
|
Service Code
|
CPT 84157
|
| Hospital Charge Code |
3154860
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.12 |
| Max. Negotiated Rate |
$49.40 |
| Rate for Payer: Aetna Commercial |
$49.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$44.72
|
| Rate for Payer: Cash Price |
$15.60
|
| Rate for Payer: Cash Price |
$15.60
|
| Rate for Payer: Cigna Commercial |
$49.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$26.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$31.20
|
| Rate for Payer: Health EOS Commercial |
$47.32
|
| Rate for Payer: HFN Commercial |
$49.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$14.12
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$14.12
|
| Rate for Payer: Multiplan Commercial |
$41.60
|
| Rate for Payer: Preferred Network Access Commercial |
$49.40
|
| Rate for Payer: Quartz Beloit One Network |
$22.88
|
| Rate for Payer: Quartz Commercial |
$29.64
|
| Rate for Payer: The Alliance Commercial |
$26.00
|
| Rate for Payer: WEA Trust Commercial |
$28.60
|
| Rate for Payer: WPS Commercial |
$38.52
|
|
|
Protein, Total, Synovial Fluid
|
Facility
|
OP
|
$52.00
|
|
|
Service Code
|
CPT 84157
|
| Hospital Charge Code |
3154860
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.00 |
| Max. Negotiated Rate |
$47.84 |
| Rate for Payer: Aetna Commercial |
$46.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$44.72
|
| Rate for Payer: Aetna Managed Medicare |
$4.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$15.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$7.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$6.64
|
| Rate for Payer: Anthem Medicaid |
$4.13
|
| Rate for Payer: Anthem Medicare Advantage |
$4.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$27.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$4.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$4.00
|
| Rate for Payer: Cash Price |
$15.60
|
| Rate for Payer: Cash Price |
$15.60
|
| Rate for Payer: Cigna Commercial |
$47.84
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$4.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$4.13
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$29.10
|
| Rate for Payer: Dean Health Medicaid |
$4.13
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$4.00
|
| Rate for Payer: Health EOS Commercial |
$46.28
|
| Rate for Payer: HFN Commercial |
$47.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$14.88
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$4.00
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$4.13
|
| Rate for Payer: Independent Care Health Plan Medicare |
$4.00
|
| Rate for Payer: Managed Health Services Medicaid |
$4.30
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$4.00
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$4.00
|
| Rate for Payer: Multiplan Commercial |
$41.60
|
| Rate for Payer: NAPHCARE Commercial |
$6.00
|
| Rate for Payer: Preferred Network Access Commercial |
$47.84
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$4.13
|
| Rate for Payer: Quartz Beloit One Network |
$25.48
|
| Rate for Payer: Quartz Commercial |
$33.80
|
| Rate for Payer: Quartz Medicare Advantage |
$4.00
|
| Rate for Payer: The Alliance Commercial |
$16.00
|
| Rate for Payer: United Healthcare Medicaid |
$4.13
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4.00
|
| Rate for Payer: United Healthcare PPO |
$39.00
|
| Rate for Payer: WEA Trust Commercial |
$28.60
|
| Rate for Payer: Wellcare Medicare |
$4.00
|
| Rate for Payer: WMAP Medicaid |
$4.13
|
| Rate for Payer: WPS Commercial |
$38.52
|
|
|
Protein Urine
|
Professional
|
Both
|
$77.00
|
|
|
Service Code
|
CPT 84156
|
| Hospital Charge Code |
633819
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.96 |
| Max. Negotiated Rate |
$73.15 |
| Rate for Payer: Aetna Commercial |
$73.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$66.22
|
| Rate for Payer: Cash Price |
$23.10
|
| Rate for Payer: Cash Price |
$23.10
|
| Rate for Payer: Cigna Commercial |
$73.15
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$38.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$46.20
|
| Rate for Payer: Health EOS Commercial |
$70.07
|
| Rate for Payer: HFN Commercial |
$73.15
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$12.96
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$12.96
|
| Rate for Payer: Multiplan Commercial |
$61.60
|
| Rate for Payer: Preferred Network Access Commercial |
$73.15
|
| Rate for Payer: Quartz Beloit One Network |
$33.88
|
| Rate for Payer: Quartz Commercial |
$43.89
|
| Rate for Payer: The Alliance Commercial |
$38.50
|
| Rate for Payer: WEA Trust Commercial |
$42.35
|
| Rate for Payer: WPS Commercial |
$57.03
|
|
|
Protein Urine
|
Facility
|
IP
|
$77.00
|
|
|
Service Code
|
CPT 84156
|
| Hospital Charge Code |
633819
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$37.73 |
| Max. Negotiated Rate |
$70.84 |
| Rate for Payer: Aetna Commercial |
$69.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$66.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$40.81
|
| Rate for Payer: Cash Price |
$23.10
|
| Rate for Payer: Cigna Commercial |
$70.84
|
| Rate for Payer: Health EOS Commercial |
$68.53
|
| Rate for Payer: HFN Commercial |
$70.84
|
| Rate for Payer: Multiplan Commercial |
$61.60
|
| Rate for Payer: NAPHCARE Commercial |
$46.20
|
| Rate for Payer: Preferred Network Access Commercial |
$70.84
|
| Rate for Payer: Quartz Beloit One Network |
$37.73
|
| Rate for Payer: Quartz Commercial |
$46.20
|
| Rate for Payer: WEA Trust Commercial |
$42.35
|
| Rate for Payer: WPS Commercial |
$57.03
|
|
|
Protein Urine
|
Facility
|
OP
|
$77.00
|
|
|
Service Code
|
CPT 84156
|
| Hospital Charge Code |
633819
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.67 |
| Max. Negotiated Rate |
$70.84 |
| Rate for Payer: Aetna Commercial |
$69.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$66.22
|
| Rate for Payer: Aetna Managed Medicare |
$3.67
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$13.76
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$6.42
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$6.09
|
| Rate for Payer: Anthem Medicaid |
$3.79
|
| Rate for Payer: Anthem Medicare Advantage |
$3.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$40.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$3.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$3.67
|
| Rate for Payer: Cash Price |
$23.10
|
| Rate for Payer: Cash Price |
$23.10
|
| Rate for Payer: Cigna Commercial |
$70.84
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$3.67
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$3.79
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$43.09
|
| Rate for Payer: Dean Health Medicaid |
$3.79
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$3.67
|
| Rate for Payer: Health EOS Commercial |
$68.53
|
| Rate for Payer: HFN Commercial |
$70.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$13.65
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$3.67
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$3.79
|
| Rate for Payer: Independent Care Health Plan Medicare |
$3.67
|
| Rate for Payer: Managed Health Services Medicaid |
$3.94
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$3.67
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$3.67
|
| Rate for Payer: Multiplan Commercial |
$61.60
|
| Rate for Payer: NAPHCARE Commercial |
$5.50
|
| Rate for Payer: Preferred Network Access Commercial |
$70.84
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$3.79
|
| Rate for Payer: Quartz Beloit One Network |
$37.73
|
| Rate for Payer: Quartz Commercial |
$50.05
|
| Rate for Payer: Quartz Medicare Advantage |
$3.67
|
| Rate for Payer: The Alliance Commercial |
$14.68
|
| Rate for Payer: United Healthcare Medicaid |
$3.79
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3.67
|
| Rate for Payer: United Healthcare PPO |
$57.75
|
| Rate for Payer: WEA Trust Commercial |
$42.35
|
| Rate for Payer: Wellcare Medicare |
$3.67
|
| Rate for Payer: WMAP Medicaid |
$3.79
|
| Rate for Payer: WPS Commercial |
$57.03
|
|
|
Prothrombin (Factor II) 20210G -> A Mutation Analysis
|
Facility
|
IP
|
$1,081.00
|
|
|
Service Code
|
CPT 81240
|
| Hospital Charge Code |
983379
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$529.69 |
| Max. Negotiated Rate |
$994.52 |
| Rate for Payer: Multiplan Commercial |
$864.80
|
| Rate for Payer: NAPHCARE Commercial |
$648.60
|
| Rate for Payer: Aetna Commercial |
$972.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$929.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$572.93
|
| Rate for Payer: Cash Price |
$324.30
|
| Rate for Payer: Cigna Commercial |
$994.52
|
| Rate for Payer: Health EOS Commercial |
$962.09
|
| Rate for Payer: HFN Commercial |
$994.52
|
| Rate for Payer: Preferred Network Access Commercial |
$994.52
|
| Rate for Payer: Quartz Beloit One Network |
$529.69
|
| Rate for Payer: Quartz Commercial |
$648.60
|
| Rate for Payer: WEA Trust Commercial |
$594.55
|
| Rate for Payer: WPS Commercial |
$800.70
|
|
|
Prothrombin (Factor II) 20210G -> A Mutation Analysis
|
Facility
|
OP
|
$1,081.00
|
|
|
Service Code
|
CPT 81240
|
| Hospital Charge Code |
983379
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$53.70 |
| Max. Negotiated Rate |
$994.52 |
| Rate for Payer: Aetna Commercial |
$972.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$929.66
|
| Rate for Payer: Aetna Managed Medicare |
$65.69
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$246.34
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$114.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$109.05
|
| Rate for Payer: Anthem Medicaid |
$53.70
|
| Rate for Payer: Anthem Medicare Advantage |
$65.69
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$572.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$65.69
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$65.69
|
| Rate for Payer: Cash Price |
$324.30
|
| Rate for Payer: Cash Price |
$324.30
|
| Rate for Payer: Cigna Commercial |
$994.52
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$65.69
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$53.70
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$604.93
|
| Rate for Payer: Dean Health Medicaid |
$53.70
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$65.69
|
| Rate for Payer: Health EOS Commercial |
$962.09
|
| Rate for Payer: HFN Commercial |
$994.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$244.37
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$65.69
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$53.70
|
| Rate for Payer: Independent Care Health Plan Medicare |
$65.69
|
| Rate for Payer: Managed Health Services Medicaid |
$55.85
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$65.69
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$65.69
|
| Rate for Payer: Multiplan Commercial |
$864.80
|
| Rate for Payer: NAPHCARE Commercial |
$98.54
|
| Rate for Payer: Preferred Network Access Commercial |
$994.52
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$53.70
|
| Rate for Payer: Quartz Beloit One Network |
$529.69
|
| Rate for Payer: Quartz Commercial |
$702.65
|
| Rate for Payer: Quartz Medicare Advantage |
$65.69
|
| Rate for Payer: The Alliance Commercial |
$262.76
|
| Rate for Payer: United Healthcare Medicaid |
$53.70
|
| Rate for Payer: United Healthcare Medicare Advantage |
$65.69
|
| Rate for Payer: United Healthcare PPO |
$810.75
|
| Rate for Payer: WEA Trust Commercial |
$594.55
|
| Rate for Payer: Wellcare Medicare |
$65.69
|
| Rate for Payer: WMAP Medicaid |
$53.70
|
| Rate for Payer: WPS Commercial |
$800.70
|
|
|
Prothrombin (Factor II) 20210G -> A Mutation Analysis
|
Professional
|
Both
|
$1,081.00
|
|
|
Service Code
|
CPT 81240
|
| Hospital Charge Code |
983379
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$231.89 |
| Max. Negotiated Rate |
$1,026.95 |
| Rate for Payer: Aetna Commercial |
$1,026.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$929.66
|
| Rate for Payer: Cash Price |
$324.30
|
| Rate for Payer: Cash Price |
$324.30
|
| Rate for Payer: Cigna Commercial |
$1,026.95
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$540.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$648.60
|
| Rate for Payer: Health EOS Commercial |
$983.71
|
| Rate for Payer: HFN Commercial |
$1,026.95
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$231.89
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$231.89
|
| Rate for Payer: Multiplan Commercial |
$864.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,026.95
|
| Rate for Payer: Quartz Beloit One Network |
$475.64
|
| Rate for Payer: Quartz Commercial |
$616.17
|
| Rate for Payer: The Alliance Commercial |
$540.50
|
| Rate for Payer: WEA Trust Commercial |
$594.55
|
| Rate for Payer: WPS Commercial |
$800.70
|
|
|
Prothrombin Time
|
Facility
|
OP
|
$107.00
|
|
|
Service Code
|
CPT 85610
|
| Hospital Charge Code |
633793
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.29 |
| Max. Negotiated Rate |
$98.44 |
| Rate for Payer: Aetna Commercial |
$96.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$92.02
|
| Rate for Payer: Aetna Managed Medicare |
$4.29
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$16.09
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$7.51
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7.12
|
| Rate for Payer: Anthem Medicaid |
$4.43
|
| Rate for Payer: Anthem Medicare Advantage |
$4.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$56.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$4.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$4.29
|
| Rate for Payer: Cash Price |
$32.10
|
| Rate for Payer: Cash Price |
$32.10
|
| Rate for Payer: Cigna Commercial |
$98.44
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$4.29
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$4.43
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$59.88
|
| Rate for Payer: Dean Health Medicaid |
$4.43
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$4.29
|
| Rate for Payer: Health EOS Commercial |
$95.23
|
| Rate for Payer: HFN Commercial |
$98.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$15.96
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$4.29
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$4.43
|
| Rate for Payer: Independent Care Health Plan Medicare |
$4.29
|
| Rate for Payer: Managed Health Services Medicaid |
$4.61
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$4.29
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$4.29
|
| Rate for Payer: Multiplan Commercial |
$85.60
|
| Rate for Payer: NAPHCARE Commercial |
$6.44
|
| Rate for Payer: Preferred Network Access Commercial |
$98.44
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$4.43
|
| Rate for Payer: Quartz Beloit One Network |
$52.43
|
| Rate for Payer: Quartz Commercial |
$69.55
|
| Rate for Payer: Quartz Medicare Advantage |
$4.29
|
| Rate for Payer: The Alliance Commercial |
$17.16
|
| Rate for Payer: United Healthcare Medicaid |
$4.43
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4.29
|
| Rate for Payer: United Healthcare PPO |
$80.25
|
| Rate for Payer: WEA Trust Commercial |
$58.85
|
| Rate for Payer: Wellcare Medicare |
$4.29
|
| Rate for Payer: WMAP Medicaid |
$4.43
|
| Rate for Payer: WPS Commercial |
$79.25
|
|
