|
POLYSOMNOGRAPHY, 4 OR MORE 9581026
|
Professional
|
Both
|
$2,008.00
|
|
|
Service Code
|
CPT 95810 26
|
| Hospital Charge Code |
3015464
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$120.21 |
| Max. Negotiated Rate |
$1,983.90 |
| Rate for Payer: Aetna Commercial |
$1,983.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,795.96
|
| Rate for Payer: Aetna Managed Medicare |
$120.21
|
| Rate for Payer: Anthem Medicare Advantage |
$120.21
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$120.21
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$120.21
|
| Rate for Payer: Cash Price |
$602.40
|
| Rate for Payer: Cash Price |
$602.40
|
| Rate for Payer: Cash Price |
$602.40
|
| Rate for Payer: Cigna Commercial |
$1,983.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$125.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$120.21
|
| Rate for Payer: Health EOS Commercial |
$1,900.37
|
| Rate for Payer: HFN Commercial |
$1,983.90
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$431.07
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$431.07
|
| Rate for Payer: Independent Care Health Plan Medicare |
$120.21
|
| Rate for Payer: Multiplan Commercial |
$1,670.66
|
| Rate for Payer: NAPHCARE Commercial |
$180.32
|
| Rate for Payer: Preferred Network Access Commercial |
$1,983.90
|
| Rate for Payer: Quartz Beloit One Network |
$918.86
|
| Rate for Payer: Quartz Commercial |
$1,190.34
|
| Rate for Payer: Quartz Medicare Advantage |
$120.21
|
| Rate for Payer: The Alliance Commercial |
$300.53
|
| Rate for Payer: United Healthcare Medicaid |
$125.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$120.21
|
| Rate for Payer: WEA Trust Commercial |
$1,148.58
|
| Rate for Payer: WPS Commercial |
$480.85
|
|
|
Pooled Cryo AHF
|
Facility
|
OP
|
$578.00
|
|
|
Service Code
|
HCPCS P9012
|
| Hospital Charge Code |
1052824
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$74.11 |
| Max. Negotiated Rate |
$553.03 |
| Rate for Payer: Aetna Commercial |
$541.01
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$516.96
|
| Rate for Payer: Aetna Managed Medicare |
$74.11
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$390.73
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$300.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$288.54
|
| Rate for Payer: Anthem Medicare Advantage |
$74.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$318.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$74.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$74.11
|
| Rate for Payer: Cash Price |
$173.40
|
| Rate for Payer: Cash Price |
$173.40
|
| Rate for Payer: Cigna Commercial |
$553.03
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$74.11
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$336.40
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$74.11
|
| Rate for Payer: Health EOS Commercial |
$535.00
|
| Rate for Payer: HFN Commercial |
$553.03
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$275.69
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$74.11
|
| Rate for Payer: Independent Care Health Plan Medicare |
$74.11
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$74.11
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$74.11
|
| Rate for Payer: Multiplan Commercial |
$480.90
|
| Rate for Payer: NAPHCARE Commercial |
$111.17
|
| Rate for Payer: Preferred Network Access Commercial |
$553.03
|
| Rate for Payer: Quartz Beloit One Network |
$294.55
|
| Rate for Payer: Quartz Commercial |
$390.73
|
| Rate for Payer: Quartz Medicare Advantage |
$74.11
|
| Rate for Payer: The Alliance Commercial |
$296.44
|
| Rate for Payer: United Healthcare Medicare Advantage |
$74.11
|
| Rate for Payer: United Healthcare PPO |
$450.84
|
| Rate for Payer: WEA Trust Commercial |
$330.62
|
| Rate for Payer: Wellcare Medicare |
$74.11
|
| Rate for Payer: WPS Commercial |
$445.23
|
|
|
Pooled Cryo AHF
|
Facility
|
IP
|
$578.00
|
|
|
Service Code
|
HCPCS P9012
|
| Hospital Charge Code |
1052824
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$294.55 |
| Max. Negotiated Rate |
$553.03 |
| Rate for Payer: Aetna Commercial |
$541.01
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$516.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$318.59
|
| Rate for Payer: Cash Price |
$173.40
|
| Rate for Payer: Cigna Commercial |
$553.03
|
| Rate for Payer: Health EOS Commercial |
$535.00
|
| Rate for Payer: HFN Commercial |
$553.03
|
| Rate for Payer: Multiplan Commercial |
$480.90
|
| Rate for Payer: Preferred Network Access Commercial |
$553.03
|
| Rate for Payer: Quartz Beloit One Network |
$294.55
|
| Rate for Payer: Quartz Commercial |
$360.67
|
| Rate for Payer: WEA Trust Commercial |
$330.62
|
| Rate for Payer: WPS Commercial |
$445.23
|
|
|
Porphobilinogen Quantitative Urine 24 Hour
|
Professional
|
Both
|
$333.00
|
|
|
Service Code
|
CPT 84110
|
| Hospital Charge Code |
978041
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.78 |
| Max. Negotiated Rate |
$329.00 |
| Rate for Payer: Aetna Commercial |
$329.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$297.84
|
| Rate for Payer: Aetna Managed Medicare |
$8.78
|
| Rate for Payer: Anthem Medicare Advantage |
$8.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$8.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$8.78
|
| Rate for Payer: Cash Price |
$99.90
|
| Rate for Payer: Cash Price |
$99.90
|
| Rate for Payer: Cigna Commercial |
$329.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$173.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$8.78
|
| Rate for Payer: Health EOS Commercial |
$315.15
|
| Rate for Payer: HFN Commercial |
$329.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$30.98
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$30.98
|
| Rate for Payer: Independent Care Health Plan Medicare |
$8.78
|
| Rate for Payer: Multiplan Commercial |
$277.06
|
| Rate for Payer: NAPHCARE Commercial |
$13.17
|
| Rate for Payer: Preferred Network Access Commercial |
$329.00
|
| Rate for Payer: Quartz Beloit One Network |
$152.38
|
| Rate for Payer: Quartz Commercial |
$197.40
|
| Rate for Payer: Quartz Medicare Advantage |
$8.78
|
| Rate for Payer: The Alliance Commercial |
$34.67
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8.78
|
| Rate for Payer: WEA Trust Commercial |
$190.48
|
| Rate for Payer: WPS Commercial |
$38.62
|
|
|
Porphobilinogen Quantitative Urine 24 Hour
|
Facility
|
OP
|
$333.00
|
|
|
Service Code
|
CPT 84110
|
| Hospital Charge Code |
978041
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.78 |
| Max. Negotiated Rate |
$318.61 |
| Rate for Payer: Aetna Commercial |
$311.69
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$297.84
|
| Rate for Payer: Aetna Managed Medicare |
$8.78
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$32.92
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$15.36
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$14.57
|
| Rate for Payer: Anthem Medicare Advantage |
$8.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$183.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$8.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$8.78
|
| Rate for Payer: Cash Price |
$99.90
|
| Rate for Payer: Cash Price |
$99.90
|
| Rate for Payer: Cigna Commercial |
$318.61
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$8.78
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$193.81
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$8.78
|
| Rate for Payer: Health EOS Commercial |
$308.22
|
| Rate for Payer: HFN Commercial |
$318.61
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$32.65
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$8.78
|
| Rate for Payer: Independent Care Health Plan Medicare |
$8.78
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$8.78
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$8.78
|
| Rate for Payer: Multiplan Commercial |
$277.06
|
| Rate for Payer: NAPHCARE Commercial |
$13.17
|
| Rate for Payer: Preferred Network Access Commercial |
$318.61
|
| Rate for Payer: Quartz Beloit One Network |
$169.70
|
| Rate for Payer: Quartz Commercial |
$225.11
|
| Rate for Payer: Quartz Medicare Advantage |
$8.78
|
| Rate for Payer: The Alliance Commercial |
$35.11
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8.78
|
| Rate for Payer: United Healthcare PPO |
$259.74
|
| Rate for Payer: WEA Trust Commercial |
$190.48
|
| Rate for Payer: Wellcare Medicare |
$8.78
|
| Rate for Payer: WPS Commercial |
$256.51
|
|
|
Porphobilinogen Quantitative Urine 24 Hour
|
Facility
|
IP
|
$333.00
|
|
|
Service Code
|
CPT 84110
|
| Hospital Charge Code |
978041
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$169.70 |
| Max. Negotiated Rate |
$318.61 |
| Rate for Payer: Aetna Commercial |
$311.69
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$297.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$183.55
|
| Rate for Payer: Cash Price |
$99.90
|
| Rate for Payer: Cigna Commercial |
$318.61
|
| Rate for Payer: Health EOS Commercial |
$308.22
|
| Rate for Payer: HFN Commercial |
$318.61
|
| Rate for Payer: Multiplan Commercial |
$277.06
|
| Rate for Payer: Preferred Network Access Commercial |
$318.61
|
| Rate for Payer: Quartz Beloit One Network |
$169.70
|
| Rate for Payer: Quartz Commercial |
$207.79
|
| Rate for Payer: WEA Trust Commercial |
$190.48
|
| Rate for Payer: WPS Commercial |
$256.51
|
|
|
Porphobilinogen, Quant, Random Urine
|
Facility
|
IP
|
$57.00
|
|
|
Service Code
|
CPT 84110
|
| Hospital Charge Code |
3423550
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$29.05 |
| Max. Negotiated Rate |
$54.54 |
| Rate for Payer: Aetna Commercial |
$53.35
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$50.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$31.42
|
| Rate for Payer: Cash Price |
$17.10
|
| Rate for Payer: Cigna Commercial |
$54.54
|
| Rate for Payer: Health EOS Commercial |
$52.76
|
| Rate for Payer: HFN Commercial |
$54.54
|
| Rate for Payer: Multiplan Commercial |
$47.42
|
| Rate for Payer: Preferred Network Access Commercial |
$54.54
|
| Rate for Payer: Quartz Beloit One Network |
$29.05
|
| Rate for Payer: Quartz Commercial |
$35.57
|
| Rate for Payer: WEA Trust Commercial |
$32.60
|
| Rate for Payer: WPS Commercial |
$43.91
|
|
|
Porphobilinogen, Quant, Random Urine
|
Professional
|
Both
|
$57.00
|
|
|
Service Code
|
CPT 84110
|
| Hospital Charge Code |
3423550
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.78 |
| Max. Negotiated Rate |
$56.32 |
| Rate for Payer: Aetna Commercial |
$56.32
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$50.98
|
| Rate for Payer: Aetna Managed Medicare |
$8.78
|
| Rate for Payer: Anthem Medicare Advantage |
$8.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$8.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$8.78
|
| Rate for Payer: Cash Price |
$17.10
|
| Rate for Payer: Cash Price |
$17.10
|
| Rate for Payer: Cigna Commercial |
$56.32
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$29.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$8.78
|
| Rate for Payer: Health EOS Commercial |
$53.94
|
| Rate for Payer: HFN Commercial |
$56.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$30.98
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$30.98
|
| Rate for Payer: Independent Care Health Plan Medicare |
$8.78
|
| Rate for Payer: Multiplan Commercial |
$47.42
|
| Rate for Payer: NAPHCARE Commercial |
$13.17
|
| Rate for Payer: Preferred Network Access Commercial |
$56.32
|
| Rate for Payer: Quartz Beloit One Network |
$26.08
|
| Rate for Payer: Quartz Commercial |
$33.79
|
| Rate for Payer: Quartz Medicare Advantage |
$8.78
|
| Rate for Payer: The Alliance Commercial |
$34.67
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8.78
|
| Rate for Payer: WEA Trust Commercial |
$32.60
|
| Rate for Payer: WPS Commercial |
$38.62
|
|
|
Porphobilinogen, Quant, Random Urine
|
Facility
|
OP
|
$57.00
|
|
|
Service Code
|
CPT 84110
|
| Hospital Charge Code |
3423550
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.78 |
| Max. Negotiated Rate |
$54.54 |
| Rate for Payer: Aetna Commercial |
$53.35
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$50.98
|
| Rate for Payer: Aetna Managed Medicare |
$8.78
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$32.92
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$15.36
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$14.57
|
| Rate for Payer: Anthem Medicare Advantage |
$8.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$31.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$8.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$8.78
|
| Rate for Payer: Cash Price |
$17.10
|
| Rate for Payer: Cash Price |
$17.10
|
| Rate for Payer: Cigna Commercial |
$54.54
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$8.78
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$33.17
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$8.78
|
| Rate for Payer: Health EOS Commercial |
$52.76
|
| Rate for Payer: HFN Commercial |
$54.54
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$32.65
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$8.78
|
| Rate for Payer: Independent Care Health Plan Medicare |
$8.78
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$8.78
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$8.78
|
| Rate for Payer: Multiplan Commercial |
$47.42
|
| Rate for Payer: NAPHCARE Commercial |
$13.17
|
| Rate for Payer: Preferred Network Access Commercial |
$54.54
|
| Rate for Payer: Quartz Beloit One Network |
$29.05
|
| Rate for Payer: Quartz Commercial |
$38.53
|
| Rate for Payer: Quartz Medicare Advantage |
$8.78
|
| Rate for Payer: The Alliance Commercial |
$35.11
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8.78
|
| Rate for Payer: United Healthcare PPO |
$44.46
|
| Rate for Payer: WEA Trust Commercial |
$32.60
|
| Rate for Payer: Wellcare Medicare |
$8.78
|
| Rate for Payer: WPS Commercial |
$43.91
|
|
|
Porphyrins, Fractionated, Plasma
|
Facility
|
IP
|
$423.00
|
|
|
Service Code
|
CPT 82542
|
| Hospital Charge Code |
983364
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$215.56 |
| Max. Negotiated Rate |
$404.73 |
| Rate for Payer: Aetna Commercial |
$395.93
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$378.33
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$233.16
|
| Rate for Payer: Cash Price |
$126.90
|
| Rate for Payer: Cigna Commercial |
$404.73
|
| Rate for Payer: Health EOS Commercial |
$391.53
|
| Rate for Payer: HFN Commercial |
$404.73
|
| Rate for Payer: Multiplan Commercial |
$351.94
|
| Rate for Payer: Preferred Network Access Commercial |
$404.73
|
| Rate for Payer: Quartz Beloit One Network |
$215.56
|
| Rate for Payer: Quartz Commercial |
$263.95
|
| Rate for Payer: WEA Trust Commercial |
$241.96
|
| Rate for Payer: WPS Commercial |
$325.84
|
|
|
Porphyrins, Fractionated, Plasma
|
Facility
|
OP
|
$423.00
|
|
|
Service Code
|
CPT 82542
|
| Hospital Charge Code |
983364
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$25.05 |
| Max. Negotiated Rate |
$404.73 |
| Rate for Payer: Aetna Commercial |
$395.93
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$378.33
|
| Rate for Payer: Aetna Managed Medicare |
$25.05
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$93.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$43.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$41.59
|
| Rate for Payer: Anthem Medicare Advantage |
$25.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$233.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$25.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$25.05
|
| Rate for Payer: Cash Price |
$126.90
|
| Rate for Payer: Cash Price |
$126.90
|
| Rate for Payer: Cigna Commercial |
$404.73
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$25.05
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$246.19
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$25.05
|
| Rate for Payer: Health EOS Commercial |
$391.53
|
| Rate for Payer: HFN Commercial |
$404.73
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$93.20
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$25.05
|
| Rate for Payer: Independent Care Health Plan Medicare |
$25.05
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$25.05
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$25.05
|
| Rate for Payer: Multiplan Commercial |
$351.94
|
| Rate for Payer: NAPHCARE Commercial |
$37.58
|
| Rate for Payer: Preferred Network Access Commercial |
$404.73
|
| Rate for Payer: Quartz Beloit One Network |
$215.56
|
| Rate for Payer: Quartz Commercial |
$285.95
|
| Rate for Payer: Quartz Medicare Advantage |
$25.05
|
| Rate for Payer: The Alliance Commercial |
$100.21
|
| Rate for Payer: United Healthcare Medicare Advantage |
$25.05
|
| Rate for Payer: United Healthcare PPO |
$329.94
|
| Rate for Payer: WEA Trust Commercial |
$241.96
|
| Rate for Payer: Wellcare Medicare |
$25.05
|
| Rate for Payer: WPS Commercial |
$325.84
|
|
|
Porphyrins, Fractionated, Plasma
|
Professional
|
Both
|
$423.00
|
|
|
Service Code
|
CPT 82542
|
| Hospital Charge Code |
983364
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$25.05 |
| Max. Negotiated Rate |
$417.92 |
| Rate for Payer: Aetna Commercial |
$417.92
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$378.33
|
| Rate for Payer: Aetna Managed Medicare |
$25.05
|
| Rate for Payer: Anthem Medicare Advantage |
$25.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$25.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$25.05
|
| Rate for Payer: Cash Price |
$126.90
|
| Rate for Payer: Cash Price |
$126.90
|
| Rate for Payer: Cigna Commercial |
$417.92
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$219.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$25.05
|
| Rate for Payer: Health EOS Commercial |
$400.33
|
| Rate for Payer: HFN Commercial |
$417.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$88.44
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$88.44
|
| Rate for Payer: Independent Care Health Plan Medicare |
$25.05
|
| Rate for Payer: Multiplan Commercial |
$351.94
|
| Rate for Payer: NAPHCARE Commercial |
$37.58
|
| Rate for Payer: Preferred Network Access Commercial |
$417.92
|
| Rate for Payer: Quartz Beloit One Network |
$193.56
|
| Rate for Payer: Quartz Commercial |
$250.75
|
| Rate for Payer: Quartz Medicare Advantage |
$25.05
|
| Rate for Payer: The Alliance Commercial |
$98.96
|
| Rate for Payer: United Healthcare Medicare Advantage |
$25.05
|
| Rate for Payer: WEA Trust Commercial |
$241.96
|
| Rate for Payer: WPS Commercial |
$110.24
|
|
|
Porphyrins Fractionation, 24 Hr Stool
|
Facility
|
IP
|
$621.00
|
|
|
Service Code
|
CPT 84126
|
| Hospital Charge Code |
3674174
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$316.46 |
| Max. Negotiated Rate |
$594.17 |
| Rate for Payer: Aetna Commercial |
$581.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$555.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$342.30
|
| Rate for Payer: Cash Price |
$186.30
|
| Rate for Payer: Cigna Commercial |
$594.17
|
| Rate for Payer: Health EOS Commercial |
$574.80
|
| Rate for Payer: HFN Commercial |
$594.17
|
| Rate for Payer: Multiplan Commercial |
$516.67
|
| Rate for Payer: Preferred Network Access Commercial |
$594.17
|
| Rate for Payer: Quartz Beloit One Network |
$316.46
|
| Rate for Payer: Quartz Commercial |
$387.50
|
| Rate for Payer: WEA Trust Commercial |
$355.21
|
| Rate for Payer: WPS Commercial |
$478.36
|
|
|
Porphyrins Fractionation, 24 Hr Stool
|
Facility
|
OP
|
$621.00
|
|
|
Service Code
|
CPT 84126
|
| Hospital Charge Code |
3674174
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$40.67 |
| Max. Negotiated Rate |
$594.17 |
| Rate for Payer: Aetna Commercial |
$581.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$555.42
|
| Rate for Payer: Aetna Managed Medicare |
$40.67
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$152.53
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$71.18
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$67.52
|
| Rate for Payer: Anthem Medicare Advantage |
$40.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$342.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$40.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$40.67
|
| Rate for Payer: Cash Price |
$186.30
|
| Rate for Payer: Cash Price |
$186.30
|
| Rate for Payer: Cigna Commercial |
$594.17
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$40.67
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$361.42
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$40.67
|
| Rate for Payer: Health EOS Commercial |
$574.80
|
| Rate for Payer: HFN Commercial |
$594.17
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$151.31
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$40.67
|
| Rate for Payer: Independent Care Health Plan Medicare |
$40.67
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$40.67
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$40.67
|
| Rate for Payer: Multiplan Commercial |
$516.67
|
| Rate for Payer: NAPHCARE Commercial |
$61.01
|
| Rate for Payer: Preferred Network Access Commercial |
$594.17
|
| Rate for Payer: Quartz Beloit One Network |
$316.46
|
| Rate for Payer: Quartz Commercial |
$419.80
|
| Rate for Payer: Quartz Medicare Advantage |
$40.67
|
| Rate for Payer: The Alliance Commercial |
$162.70
|
| Rate for Payer: United Healthcare Medicare Advantage |
$40.67
|
| Rate for Payer: United Healthcare PPO |
$484.38
|
| Rate for Payer: WEA Trust Commercial |
$355.21
|
| Rate for Payer: Wellcare Medicare |
$40.67
|
| Rate for Payer: WPS Commercial |
$478.36
|
|
|
Porphyrins Fractionation, 24 Hr Stool
|
Professional
|
Both
|
$621.00
|
|
|
Service Code
|
CPT 84126
|
| Hospital Charge Code |
3674174
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$40.67 |
| Max. Negotiated Rate |
$613.55 |
| Rate for Payer: Aetna Commercial |
$613.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$555.42
|
| Rate for Payer: Aetna Managed Medicare |
$40.67
|
| Rate for Payer: Anthem Medicare Advantage |
$40.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$40.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$40.67
|
| Rate for Payer: Cash Price |
$186.30
|
| Rate for Payer: Cash Price |
$186.30
|
| Rate for Payer: Cigna Commercial |
$613.55
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$322.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$40.67
|
| Rate for Payer: Health EOS Commercial |
$587.71
|
| Rate for Payer: HFN Commercial |
$613.55
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$143.58
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$143.58
|
| Rate for Payer: Independent Care Health Plan Medicare |
$40.67
|
| Rate for Payer: Multiplan Commercial |
$516.67
|
| Rate for Payer: NAPHCARE Commercial |
$61.01
|
| Rate for Payer: Preferred Network Access Commercial |
$613.55
|
| Rate for Payer: Quartz Beloit One Network |
$284.17
|
| Rate for Payer: Quartz Commercial |
$368.13
|
| Rate for Payer: Quartz Medicare Advantage |
$40.67
|
| Rate for Payer: The Alliance Commercial |
$160.66
|
| Rate for Payer: United Healthcare Medicare Advantage |
$40.67
|
| Rate for Payer: WEA Trust Commercial |
$355.21
|
| Rate for Payer: WPS Commercial |
$178.97
|
|
|
Port Declotting Rad Onc
|
Facility
|
OP
|
$153.00
|
|
|
Service Code
|
CPT 36593
|
| Hospital Charge Code |
4494654
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$76.38 |
| Max. Negotiated Rate |
$4,386.95 |
| Rate for Payer: Aetna Commercial |
$143.21
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$136.84
|
| Rate for Payer: Aetna Managed Medicare |
$347.61
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$103.43
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$79.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$76.38
|
| Rate for Payer: Anthem Medicare Advantage |
$347.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$84.33
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$347.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$347.61
|
| Rate for Payer: Cash Price |
$45.90
|
| Rate for Payer: Cash Price |
$45.90
|
| Rate for Payer: Cigna Commercial |
$146.39
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$347.61
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$347.61
|
| Rate for Payer: Health EOS Commercial |
$141.62
|
| Rate for Payer: HFN Commercial |
$146.39
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,293.11
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$347.61
|
| Rate for Payer: Independent Care Health Plan Medicare |
$347.61
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$347.61
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$347.61
|
| Rate for Payer: Multiplan Commercial |
$127.30
|
| Rate for Payer: NAPHCARE Commercial |
$521.41
|
| Rate for Payer: Preferred Network Access Commercial |
$146.39
|
| Rate for Payer: Quartz Beloit One Network |
$77.97
|
| Rate for Payer: Quartz Commercial |
$103.43
|
| Rate for Payer: Quartz Medicare Advantage |
$347.61
|
| Rate for Payer: The Alliance Commercial |
$1,390.44
|
| Rate for Payer: United Healthcare Medicare Advantage |
$347.61
|
| Rate for Payer: United Healthcare PPO |
$119.34
|
| Rate for Payer: WEA Trust Commercial |
$87.52
|
| Rate for Payer: Wellcare Medicare |
$347.61
|
| Rate for Payer: WPS Commercial |
$117.86
|
|
|
Port Declotting Rad Onc
|
Facility
|
IP
|
$153.00
|
|
|
Service Code
|
CPT 36593
|
| Hospital Charge Code |
4494654
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$77.97 |
| Max. Negotiated Rate |
$146.39 |
| Rate for Payer: Aetna Commercial |
$143.21
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$136.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$84.33
|
| Rate for Payer: Cash Price |
$45.90
|
| Rate for Payer: Cigna Commercial |
$146.39
|
| Rate for Payer: Health EOS Commercial |
$141.62
|
| Rate for Payer: HFN Commercial |
$146.39
|
| Rate for Payer: Multiplan Commercial |
$127.30
|
| Rate for Payer: Preferred Network Access Commercial |
$146.39
|
| Rate for Payer: Quartz Beloit One Network |
$77.97
|
| Rate for Payer: Quartz Commercial |
$95.47
|
| Rate for Payer: WEA Trust Commercial |
$87.52
|
| Rate for Payer: WPS Commercial |
$117.86
|
|
|
Port Film(s)
|
Facility
|
IP
|
$619.00
|
|
|
Service Code
|
CPT 77417
|
| Hospital Charge Code |
3040406
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$315.44 |
| Max. Negotiated Rate |
$592.26 |
| Rate for Payer: Aetna Commercial |
$579.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$553.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$341.19
|
| Rate for Payer: Cash Price |
$185.70
|
| Rate for Payer: Cigna Commercial |
$592.26
|
| Rate for Payer: Health EOS Commercial |
$572.95
|
| Rate for Payer: HFN Commercial |
$592.26
|
| Rate for Payer: Multiplan Commercial |
$515.01
|
| Rate for Payer: Preferred Network Access Commercial |
$592.26
|
| Rate for Payer: Quartz Beloit One Network |
$315.44
|
| Rate for Payer: Quartz Commercial |
$386.26
|
| Rate for Payer: WEA Trust Commercial |
$354.07
|
| Rate for Payer: WPS Commercial |
$476.82
|
|
|
Port Film(s)
|
Facility
|
OP
|
$619.00
|
|
|
Service Code
|
CPT 77417
|
| Hospital Charge Code |
3040406
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$180.25 |
| Max. Negotiated Rate |
$592.26 |
| Rate for Payer: Aetna Commercial |
$579.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$553.63
|
| Rate for Payer: Aetna Managed Medicare |
$180.25
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$418.44
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$321.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$309.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$341.19
|
| Rate for Payer: Cash Price |
$185.70
|
| Rate for Payer: Cigna Commercial |
$592.26
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$360.26
|
| Rate for Payer: Health EOS Commercial |
$572.95
|
| Rate for Payer: HFN Commercial |
$592.26
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$482.82
|
| Rate for Payer: Multiplan Commercial |
$515.01
|
| Rate for Payer: NAPHCARE Commercial |
$386.26
|
| Rate for Payer: Preferred Network Access Commercial |
$592.26
|
| Rate for Payer: Quartz Beloit One Network |
$315.44
|
| Rate for Payer: Quartz Commercial |
$418.44
|
| Rate for Payer: Quartz Medicare Advantage |
$386.26
|
| Rate for Payer: The Alliance Commercial |
$321.88
|
| Rate for Payer: United Healthcare PPO |
$482.82
|
| Rate for Payer: WEA Trust Commercial |
$354.07
|
| Rate for Payer: WPS Commercial |
$476.82
|
|
|
Port Flush Rad Onc
|
Facility
|
IP
|
$214.00
|
|
|
Service Code
|
CPT 96523
|
| Hospital Charge Code |
4494653
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$109.05 |
| Max. Negotiated Rate |
$204.76 |
| Rate for Payer: Aetna Commercial |
$200.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$191.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$117.96
|
| Rate for Payer: Cash Price |
$64.20
|
| Rate for Payer: Cigna Commercial |
$204.76
|
| Rate for Payer: Health EOS Commercial |
$198.08
|
| Rate for Payer: HFN Commercial |
$204.76
|
| Rate for Payer: Multiplan Commercial |
$178.05
|
| Rate for Payer: Preferred Network Access Commercial |
$204.76
|
| Rate for Payer: Quartz Beloit One Network |
$109.05
|
| Rate for Payer: Quartz Commercial |
$133.54
|
| Rate for Payer: WEA Trust Commercial |
$122.41
|
| Rate for Payer: WPS Commercial |
$164.84
|
|
|
Port Flush Rad Onc
|
Facility
|
OP
|
$214.00
|
|
|
Service Code
|
CPT 96523
|
| Hospital Charge Code |
4494653
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$62.09 |
| Max. Negotiated Rate |
$248.35 |
| Rate for Payer: Aetna Commercial |
$200.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$191.40
|
| Rate for Payer: Aetna Managed Medicare |
$62.09
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$144.66
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$111.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$106.83
|
| Rate for Payer: Anthem Medicare Advantage |
$62.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$117.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$62.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$62.09
|
| Rate for Payer: Cash Price |
$64.20
|
| Rate for Payer: Cash Price |
$64.20
|
| Rate for Payer: Cigna Commercial |
$204.76
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$62.09
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$124.55
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$62.09
|
| Rate for Payer: Health EOS Commercial |
$198.08
|
| Rate for Payer: HFN Commercial |
$204.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$230.97
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$62.09
|
| Rate for Payer: Independent Care Health Plan Medicare |
$62.09
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$62.09
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$62.09
|
| Rate for Payer: Multiplan Commercial |
$178.05
|
| Rate for Payer: NAPHCARE Commercial |
$93.13
|
| Rate for Payer: Preferred Network Access Commercial |
$204.76
|
| Rate for Payer: Quartz Beloit One Network |
$109.05
|
| Rate for Payer: Quartz Commercial |
$144.66
|
| Rate for Payer: Quartz Medicare Advantage |
$62.09
|
| Rate for Payer: The Alliance Commercial |
$248.35
|
| Rate for Payer: United Healthcare Medicare Advantage |
$62.09
|
| Rate for Payer: United Healthcare PPO |
$166.92
|
| Rate for Payer: WEA Trust Commercial |
$122.41
|
| Rate for Payer: Wellcare Medicare |
$62.09
|
| Rate for Payer: WPS Commercial |
$164.84
|
|
|
PORT MARS 19x60MM STRAIGHT
|
Facility
|
IP
|
$4,882.00
|
|
| Hospital Charge Code |
2965121
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,487.87 |
| Max. Negotiated Rate |
$4,671.10 |
| Rate for Payer: Aetna Commercial |
$4,569.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,366.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,690.96
|
| Rate for Payer: Cash Price |
$1,464.60
|
| Rate for Payer: Cigna Commercial |
$4,671.10
|
| Rate for Payer: Health EOS Commercial |
$4,518.78
|
| Rate for Payer: HFN Commercial |
$4,671.10
|
| Rate for Payer: Multiplan Commercial |
$4,061.82
|
| Rate for Payer: Preferred Network Access Commercial |
$4,671.10
|
| Rate for Payer: Quartz Beloit One Network |
$2,487.87
|
| Rate for Payer: Quartz Commercial |
$3,046.37
|
| Rate for Payer: WEA Trust Commercial |
$2,792.50
|
| Rate for Payer: WPS Commercial |
$3,760.60
|
|
|
PORT MARS 19x60MM STRAIGHT
|
Facility
|
OP
|
$4,882.00
|
|
| Hospital Charge Code |
2965121
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,421.64 |
| Max. Negotiated Rate |
$4,671.10 |
| Rate for Payer: Aetna Commercial |
$4,569.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,366.46
|
| Rate for Payer: Aetna Managed Medicare |
$1,421.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,300.23
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,538.64
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,437.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,690.96
|
| Rate for Payer: Cash Price |
$1,464.60
|
| Rate for Payer: Cigna Commercial |
$4,671.10
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,841.32
|
| Rate for Payer: Health EOS Commercial |
$4,518.78
|
| Rate for Payer: HFN Commercial |
$4,671.10
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,807.96
|
| Rate for Payer: Multiplan Commercial |
$4,061.82
|
| Rate for Payer: NAPHCARE Commercial |
$3,046.37
|
| Rate for Payer: Preferred Network Access Commercial |
$4,671.10
|
| Rate for Payer: Quartz Beloit One Network |
$2,487.87
|
| Rate for Payer: Quartz Commercial |
$3,300.23
|
| Rate for Payer: Quartz Medicare Advantage |
$3,046.37
|
| Rate for Payer: The Alliance Commercial |
$2,538.64
|
| Rate for Payer: WEA Trust Commercial |
$2,792.50
|
| Rate for Payer: WPS Commercial |
$3,760.60
|
|
|
Posaconazole, LC/MS/MS
|
Facility
|
OP
|
$327.00
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
5094644
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$19.39 |
| Max. Negotiated Rate |
$312.87 |
| Rate for Payer: Aetna Commercial |
$306.07
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$292.47
|
| Rate for Payer: Aetna Managed Medicare |
$19.39
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$72.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$33.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$32.18
|
| Rate for Payer: Anthem Medicare Advantage |
$19.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$180.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$19.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$19.39
|
| Rate for Payer: Cash Price |
$98.10
|
| Rate for Payer: Cash Price |
$98.10
|
| Rate for Payer: Cigna Commercial |
$312.87
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$19.39
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$190.31
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$19.39
|
| Rate for Payer: Health EOS Commercial |
$302.67
|
| Rate for Payer: HFN Commercial |
$312.87
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$72.11
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$19.39
|
| Rate for Payer: Independent Care Health Plan Medicare |
$19.39
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$19.39
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$19.39
|
| Rate for Payer: Multiplan Commercial |
$272.06
|
| Rate for Payer: NAPHCARE Commercial |
$29.08
|
| Rate for Payer: Preferred Network Access Commercial |
$312.87
|
| Rate for Payer: Quartz Beloit One Network |
$166.64
|
| Rate for Payer: Quartz Commercial |
$221.05
|
| Rate for Payer: Quartz Medicare Advantage |
$19.39
|
| Rate for Payer: The Alliance Commercial |
$77.54
|
| Rate for Payer: United Healthcare Medicare Advantage |
$19.39
|
| Rate for Payer: United Healthcare PPO |
$255.06
|
| Rate for Payer: WEA Trust Commercial |
$187.04
|
| Rate for Payer: Wellcare Medicare |
$19.39
|
| Rate for Payer: WPS Commercial |
$251.89
|
|
|
Posaconazole, LC/MS/MS
|
Professional
|
Both
|
$327.00
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
5094644
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$19.39 |
| Max. Negotiated Rate |
$323.08 |
| Rate for Payer: Aetna Commercial |
$323.08
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$292.47
|
| Rate for Payer: Aetna Managed Medicare |
$19.39
|
| Rate for Payer: Anthem Medicare Advantage |
$19.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$19.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$19.39
|
| Rate for Payer: Cash Price |
$98.10
|
| Rate for Payer: Cash Price |
$98.10
|
| Rate for Payer: Cigna Commercial |
$323.08
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$170.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$19.39
|
| Rate for Payer: Health EOS Commercial |
$309.47
|
| Rate for Payer: HFN Commercial |
$323.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$68.43
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$68.43
|
| Rate for Payer: Independent Care Health Plan Medicare |
$19.39
|
| Rate for Payer: Multiplan Commercial |
$272.06
|
| Rate for Payer: NAPHCARE Commercial |
$29.08
|
| Rate for Payer: Preferred Network Access Commercial |
$323.08
|
| Rate for Payer: Quartz Beloit One Network |
$149.64
|
| Rate for Payer: Quartz Commercial |
$193.85
|
| Rate for Payer: Quartz Medicare Advantage |
$19.39
|
| Rate for Payer: The Alliance Commercial |
$76.57
|
| Rate for Payer: United Healthcare Medicare Advantage |
$19.39
|
| Rate for Payer: WEA Trust Commercial |
$187.04
|
| Rate for Payer: WPS Commercial |
$85.30
|
|
