|
Porphobilinogen Quantitative Urine 24 Hour
|
Facility
|
OP
|
$333.00
|
|
|
Service Code
|
CPT 84110
|
| Hospital Charge Code |
978041
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.44 |
| Max. Negotiated Rate |
$306.36 |
| Rate for Payer: Aetna Commercial |
$299.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$286.38
|
| Rate for Payer: Aetna Managed Medicare |
$8.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$31.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$14.77
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$14.01
|
| Rate for Payer: Anthem Medicaid |
$8.72
|
| Rate for Payer: Anthem Medicare Advantage |
$8.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$176.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$8.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$8.44
|
| Rate for Payer: Cash Price |
$99.90
|
| Rate for Payer: Cash Price |
$99.90
|
| Rate for Payer: Cigna Commercial |
$306.36
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$8.44
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$8.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$186.35
|
| Rate for Payer: Dean Health Medicaid |
$8.72
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$8.44
|
| Rate for Payer: Health EOS Commercial |
$296.37
|
| Rate for Payer: HFN Commercial |
$306.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$31.40
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$8.44
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$8.72
|
| Rate for Payer: Independent Care Health Plan Medicare |
$8.44
|
| Rate for Payer: Managed Health Services Medicaid |
$9.07
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$8.44
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$8.44
|
| Rate for Payer: Multiplan Commercial |
$266.40
|
| Rate for Payer: NAPHCARE Commercial |
$12.66
|
| Rate for Payer: Preferred Network Access Commercial |
$306.36
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$8.72
|
| Rate for Payer: Quartz Beloit One Network |
$163.17
|
| Rate for Payer: Quartz Commercial |
$216.45
|
| Rate for Payer: Quartz Medicare Advantage |
$8.44
|
| Rate for Payer: The Alliance Commercial |
$33.76
|
| Rate for Payer: United Healthcare Medicaid |
$8.72
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8.44
|
| Rate for Payer: United Healthcare PPO |
$249.75
|
| Rate for Payer: WEA Trust Commercial |
$183.15
|
| Rate for Payer: Wellcare Medicare |
$8.44
|
| Rate for Payer: WMAP Medicaid |
$8.72
|
| Rate for Payer: WPS Commercial |
$246.65
|
|
|
Porphobilinogen, Quant, Random Urine
|
Facility
|
IP
|
$57.00
|
|
|
Service Code
|
CPT 84110
|
| Hospital Charge Code |
3423550
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$27.93 |
| Max. Negotiated Rate |
$52.44 |
| Rate for Payer: Aetna Commercial |
$51.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$49.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$30.21
|
| Rate for Payer: Cash Price |
$17.10
|
| Rate for Payer: Cigna Commercial |
$52.44
|
| Rate for Payer: Health EOS Commercial |
$50.73
|
| Rate for Payer: HFN Commercial |
$52.44
|
| Rate for Payer: Multiplan Commercial |
$45.60
|
| Rate for Payer: NAPHCARE Commercial |
$34.20
|
| Rate for Payer: Preferred Network Access Commercial |
$52.44
|
| Rate for Payer: Quartz Beloit One Network |
$27.93
|
| Rate for Payer: Quartz Commercial |
$34.20
|
| Rate for Payer: WEA Trust Commercial |
$31.35
|
| Rate for Payer: WPS Commercial |
$42.22
|
|
|
Porphobilinogen, Quant, Random Urine
|
Professional
|
Both
|
$57.00
|
|
|
Service Code
|
CPT 84110
|
| Hospital Charge Code |
3423550
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$25.08 |
| Max. Negotiated Rate |
$54.15 |
| Rate for Payer: Aetna Commercial |
$54.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$49.02
|
| Rate for Payer: Cash Price |
$17.10
|
| Rate for Payer: Cash Price |
$17.10
|
| Rate for Payer: Cigna Commercial |
$54.15
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$28.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$34.20
|
| Rate for Payer: Health EOS Commercial |
$51.87
|
| Rate for Payer: HFN Commercial |
$54.15
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$29.79
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$29.79
|
| Rate for Payer: Multiplan Commercial |
$45.60
|
| Rate for Payer: Preferred Network Access Commercial |
$54.15
|
| Rate for Payer: Quartz Beloit One Network |
$25.08
|
| Rate for Payer: Quartz Commercial |
$32.49
|
| Rate for Payer: The Alliance Commercial |
$28.50
|
| Rate for Payer: WEA Trust Commercial |
$31.35
|
| Rate for Payer: WPS Commercial |
$42.22
|
|
|
Porphobilinogen, Quant, Random Urine
|
Facility
|
OP
|
$57.00
|
|
|
Service Code
|
CPT 84110
|
| Hospital Charge Code |
3423550
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.44 |
| Max. Negotiated Rate |
$52.44 |
| Rate for Payer: Aetna Commercial |
$51.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$49.02
|
| Rate for Payer: Aetna Managed Medicare |
$8.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$31.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$14.77
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$14.01
|
| Rate for Payer: Anthem Medicaid |
$8.72
|
| Rate for Payer: Anthem Medicare Advantage |
$8.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$30.21
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$8.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$8.44
|
| Rate for Payer: Cash Price |
$17.10
|
| Rate for Payer: Cash Price |
$17.10
|
| Rate for Payer: Cigna Commercial |
$52.44
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$8.44
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$8.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$31.90
|
| Rate for Payer: Dean Health Medicaid |
$8.72
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$8.44
|
| Rate for Payer: Health EOS Commercial |
$50.73
|
| Rate for Payer: HFN Commercial |
$52.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$31.40
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$8.44
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$8.72
|
| Rate for Payer: Independent Care Health Plan Medicare |
$8.44
|
| Rate for Payer: Managed Health Services Medicaid |
$9.07
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$8.44
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$8.44
|
| Rate for Payer: Multiplan Commercial |
$45.60
|
| Rate for Payer: NAPHCARE Commercial |
$12.66
|
| Rate for Payer: Preferred Network Access Commercial |
$52.44
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$8.72
|
| Rate for Payer: Quartz Beloit One Network |
$27.93
|
| Rate for Payer: Quartz Commercial |
$37.05
|
| Rate for Payer: Quartz Medicare Advantage |
$8.44
|
| Rate for Payer: The Alliance Commercial |
$33.76
|
| Rate for Payer: United Healthcare Medicaid |
$8.72
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8.44
|
| Rate for Payer: United Healthcare PPO |
$42.75
|
| Rate for Payer: WEA Trust Commercial |
$31.35
|
| Rate for Payer: Wellcare Medicare |
$8.44
|
| Rate for Payer: WMAP Medicaid |
$8.72
|
| Rate for Payer: WPS Commercial |
$42.22
|
|
|
Porphyrins, Fractionated, Plasma
|
Facility
|
OP
|
$423.00
|
|
|
Service Code
|
CPT 82542
|
| Hospital Charge Code |
983364
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$24.09 |
| Max. Negotiated Rate |
$389.16 |
| Rate for Payer: Aetna Commercial |
$380.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$363.78
|
| Rate for Payer: Aetna Managed Medicare |
$24.09
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$90.34
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$42.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$39.99
|
| Rate for Payer: Anthem Medicaid |
$24.89
|
| Rate for Payer: Anthem Medicare Advantage |
$24.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$224.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$24.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$24.09
|
| Rate for Payer: Cash Price |
$126.90
|
| Rate for Payer: Cash Price |
$126.90
|
| Rate for Payer: Cigna Commercial |
$389.16
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$24.09
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$24.89
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$236.71
|
| Rate for Payer: Dean Health Medicaid |
$24.89
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$24.09
|
| Rate for Payer: Health EOS Commercial |
$376.47
|
| Rate for Payer: HFN Commercial |
$389.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$89.61
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$24.09
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$24.89
|
| Rate for Payer: Independent Care Health Plan Medicare |
$24.09
|
| Rate for Payer: Managed Health Services Medicaid |
$25.89
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$24.09
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$24.09
|
| Rate for Payer: Multiplan Commercial |
$338.40
|
| Rate for Payer: NAPHCARE Commercial |
$36.14
|
| Rate for Payer: Preferred Network Access Commercial |
$389.16
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$24.89
|
| Rate for Payer: Quartz Beloit One Network |
$207.27
|
| Rate for Payer: Quartz Commercial |
$274.95
|
| Rate for Payer: Quartz Medicare Advantage |
$24.09
|
| Rate for Payer: The Alliance Commercial |
$96.36
|
| Rate for Payer: United Healthcare Medicaid |
$24.89
|
| Rate for Payer: United Healthcare Medicare Advantage |
$24.09
|
| Rate for Payer: United Healthcare PPO |
$317.25
|
| Rate for Payer: WEA Trust Commercial |
$232.65
|
| Rate for Payer: Wellcare Medicare |
$24.09
|
| Rate for Payer: WMAP Medicaid |
$24.89
|
| Rate for Payer: WPS Commercial |
$313.32
|
|
|
Porphyrins, Fractionated, Plasma
|
Professional
|
Both
|
$423.00
|
|
|
Service Code
|
CPT 82542
|
| Hospital Charge Code |
983364
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$85.04 |
| Max. Negotiated Rate |
$401.85 |
| Rate for Payer: Aetna Commercial |
$401.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$363.78
|
| Rate for Payer: Cash Price |
$126.90
|
| Rate for Payer: Cash Price |
$126.90
|
| Rate for Payer: Cigna Commercial |
$401.85
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$211.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$253.80
|
| Rate for Payer: Health EOS Commercial |
$384.93
|
| Rate for Payer: HFN Commercial |
$401.85
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$85.04
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$85.04
|
| Rate for Payer: Multiplan Commercial |
$338.40
|
| Rate for Payer: Preferred Network Access Commercial |
$401.85
|
| Rate for Payer: Quartz Beloit One Network |
$186.12
|
| Rate for Payer: Quartz Commercial |
$241.11
|
| Rate for Payer: The Alliance Commercial |
$211.50
|
| Rate for Payer: WEA Trust Commercial |
$232.65
|
| Rate for Payer: WPS Commercial |
$313.32
|
|
|
Porphyrins, Fractionated, Plasma
|
Facility
|
IP
|
$423.00
|
|
|
Service Code
|
CPT 82542
|
| Hospital Charge Code |
983364
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$207.27 |
| Max. Negotiated Rate |
$389.16 |
| Rate for Payer: Aetna Commercial |
$380.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$363.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$224.19
|
| Rate for Payer: Cash Price |
$126.90
|
| Rate for Payer: Cigna Commercial |
$389.16
|
| Rate for Payer: Health EOS Commercial |
$376.47
|
| Rate for Payer: HFN Commercial |
$389.16
|
| Rate for Payer: Multiplan Commercial |
$338.40
|
| Rate for Payer: NAPHCARE Commercial |
$253.80
|
| Rate for Payer: Preferred Network Access Commercial |
$389.16
|
| Rate for Payer: Quartz Beloit One Network |
$207.27
|
| Rate for Payer: Quartz Commercial |
$253.80
|
| Rate for Payer: WEA Trust Commercial |
$232.65
|
| Rate for Payer: WPS Commercial |
$313.32
|
|
|
Porphyrins Fractionation, 24 Hr Stool
|
Facility
|
OP
|
$621.00
|
|
|
Service Code
|
CPT 84126
|
| Hospital Charge Code |
3674174
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$35.81 |
| Max. Negotiated Rate |
$571.32 |
| Rate for Payer: Aetna Commercial |
$558.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$534.06
|
| Rate for Payer: Aetna Managed Medicare |
$39.11
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$146.66
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$68.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$64.92
|
| Rate for Payer: Anthem Medicaid |
$35.81
|
| Rate for Payer: Anthem Medicare Advantage |
$39.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$329.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$39.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$39.11
|
| Rate for Payer: Cash Price |
$186.30
|
| Rate for Payer: Cash Price |
$186.30
|
| Rate for Payer: Cigna Commercial |
$571.32
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$39.11
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$35.81
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$347.51
|
| Rate for Payer: Dean Health Medicaid |
$35.81
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$39.11
|
| Rate for Payer: Health EOS Commercial |
$552.69
|
| Rate for Payer: HFN Commercial |
$571.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$145.49
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$39.11
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$35.81
|
| Rate for Payer: Independent Care Health Plan Medicare |
$39.11
|
| Rate for Payer: Managed Health Services Medicaid |
$37.24
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$39.11
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$39.11
|
| Rate for Payer: Multiplan Commercial |
$496.80
|
| Rate for Payer: NAPHCARE Commercial |
$58.66
|
| Rate for Payer: Preferred Network Access Commercial |
$571.32
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$35.81
|
| Rate for Payer: Quartz Beloit One Network |
$304.29
|
| Rate for Payer: Quartz Commercial |
$403.65
|
| Rate for Payer: Quartz Medicare Advantage |
$39.11
|
| Rate for Payer: The Alliance Commercial |
$156.44
|
| Rate for Payer: United Healthcare Medicaid |
$35.81
|
| Rate for Payer: United Healthcare Medicare Advantage |
$39.11
|
| Rate for Payer: United Healthcare PPO |
$465.75
|
| Rate for Payer: WEA Trust Commercial |
$341.55
|
| Rate for Payer: Wellcare Medicare |
$39.11
|
| Rate for Payer: WMAP Medicaid |
$35.81
|
| Rate for Payer: WPS Commercial |
$459.97
|
|
|
Porphyrins Fractionation, 24 Hr Stool
|
Facility
|
IP
|
$621.00
|
|
|
Service Code
|
CPT 84126
|
| Hospital Charge Code |
3674174
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$304.29 |
| Max. Negotiated Rate |
$571.32 |
| Rate for Payer: Aetna Commercial |
$558.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$534.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$329.13
|
| Rate for Payer: Cash Price |
$186.30
|
| Rate for Payer: Cigna Commercial |
$571.32
|
| Rate for Payer: Health EOS Commercial |
$552.69
|
| Rate for Payer: HFN Commercial |
$571.32
|
| Rate for Payer: Multiplan Commercial |
$496.80
|
| Rate for Payer: NAPHCARE Commercial |
$372.60
|
| Rate for Payer: Preferred Network Access Commercial |
$571.32
|
| Rate for Payer: Quartz Beloit One Network |
$304.29
|
| Rate for Payer: Quartz Commercial |
$372.60
|
| Rate for Payer: WEA Trust Commercial |
$341.55
|
| Rate for Payer: WPS Commercial |
$459.97
|
|
|
Porphyrins Fractionation, 24 Hr Stool
|
Professional
|
Both
|
$621.00
|
|
|
Service Code
|
CPT 84126
|
| Hospital Charge Code |
3674174
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$138.06 |
| Max. Negotiated Rate |
$589.95 |
| Rate for Payer: Aetna Commercial |
$589.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$534.06
|
| Rate for Payer: Cash Price |
$186.30
|
| Rate for Payer: Cash Price |
$186.30
|
| Rate for Payer: Cigna Commercial |
$589.95
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$310.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$372.60
|
| Rate for Payer: Health EOS Commercial |
$565.11
|
| Rate for Payer: HFN Commercial |
$589.95
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$138.06
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$138.06
|
| Rate for Payer: Multiplan Commercial |
$496.80
|
| Rate for Payer: Preferred Network Access Commercial |
$589.95
|
| Rate for Payer: Quartz Beloit One Network |
$273.24
|
| Rate for Payer: Quartz Commercial |
$353.97
|
| Rate for Payer: The Alliance Commercial |
$310.50
|
| Rate for Payer: WEA Trust Commercial |
$341.55
|
| Rate for Payer: WPS Commercial |
$459.97
|
|
|
Port Declotting Rad Onc
|
Facility
|
OP
|
$153.00
|
|
|
Service Code
|
CPT 36593
|
| Hospital Charge Code |
4494654
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$73.44 |
| Max. Negotiated Rate |
$4,218.22 |
| Rate for Payer: Aetna Commercial |
$137.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$131.58
|
| Rate for Payer: Aetna Managed Medicare |
$334.74
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$99.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$76.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$73.44
|
| Rate for Payer: Anthem Medicare Advantage |
$334.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$81.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$334.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$334.74
|
| Rate for Payer: Cash Price |
$45.90
|
| Rate for Payer: Cash Price |
$45.90
|
| Rate for Payer: Cigna Commercial |
$140.76
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$334.74
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,218.22
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$334.74
|
| Rate for Payer: Health EOS Commercial |
$136.17
|
| Rate for Payer: HFN Commercial |
$140.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,245.23
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$334.74
|
| Rate for Payer: Independent Care Health Plan Medicare |
$334.74
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$334.74
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$334.74
|
| Rate for Payer: Multiplan Commercial |
$122.40
|
| Rate for Payer: NAPHCARE Commercial |
$502.11
|
| Rate for Payer: Preferred Network Access Commercial |
$140.76
|
| Rate for Payer: Quartz Beloit One Network |
$74.97
|
| Rate for Payer: Quartz Commercial |
$99.45
|
| Rate for Payer: Quartz Medicare Advantage |
$334.74
|
| Rate for Payer: The Alliance Commercial |
$1,338.96
|
| Rate for Payer: United Healthcare Medicare Advantage |
$334.74
|
| Rate for Payer: United Healthcare PPO |
$114.75
|
| Rate for Payer: WEA Trust Commercial |
$84.15
|
| Rate for Payer: Wellcare Medicare |
$334.74
|
| Rate for Payer: WPS Commercial |
$113.33
|
|
|
Port Declotting Rad Onc
|
Facility
|
IP
|
$153.00
|
|
|
Service Code
|
CPT 36593
|
| Hospital Charge Code |
4494654
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$74.97 |
| Max. Negotiated Rate |
$140.76 |
| Rate for Payer: Aetna Commercial |
$137.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$131.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$81.09
|
| Rate for Payer: Cash Price |
$45.90
|
| Rate for Payer: Cigna Commercial |
$140.76
|
| Rate for Payer: Health EOS Commercial |
$136.17
|
| Rate for Payer: HFN Commercial |
$140.76
|
| Rate for Payer: Multiplan Commercial |
$122.40
|
| Rate for Payer: NAPHCARE Commercial |
$91.80
|
| Rate for Payer: Preferred Network Access Commercial |
$140.76
|
| Rate for Payer: Quartz Beloit One Network |
$74.97
|
| Rate for Payer: Quartz Commercial |
$91.80
|
| Rate for Payer: WEA Trust Commercial |
$84.15
|
| Rate for Payer: WPS Commercial |
$113.33
|
|
|
Port Film(s)
|
Facility
|
IP
|
$619.00
|
|
|
Service Code
|
CPT 77417
|
| Hospital Charge Code |
3040406
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$303.31 |
| Max. Negotiated Rate |
$569.48 |
| Rate for Payer: Aetna Commercial |
$557.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$532.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$328.07
|
| Rate for Payer: Cash Price |
$185.70
|
| Rate for Payer: Cigna Commercial |
$569.48
|
| Rate for Payer: Health EOS Commercial |
$550.91
|
| Rate for Payer: HFN Commercial |
$569.48
|
| Rate for Payer: Multiplan Commercial |
$495.20
|
| Rate for Payer: NAPHCARE Commercial |
$371.40
|
| Rate for Payer: Preferred Network Access Commercial |
$569.48
|
| Rate for Payer: Quartz Beloit One Network |
$303.31
|
| Rate for Payer: Quartz Commercial |
$371.40
|
| Rate for Payer: WEA Trust Commercial |
$340.45
|
| Rate for Payer: WPS Commercial |
$458.49
|
|
|
Port Film(s)
|
Facility
|
OP
|
$619.00
|
|
|
Service Code
|
CPT 77417
|
| Hospital Charge Code |
3040406
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$173.32 |
| Max. Negotiated Rate |
$2,476.00 |
| Rate for Payer: Aetna Commercial |
$557.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$532.34
|
| Rate for Payer: Aetna Managed Medicare |
$173.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$402.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$309.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$297.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$328.07
|
| Rate for Payer: Cash Price |
$185.70
|
| Rate for Payer: Cigna Commercial |
$569.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$346.39
|
| Rate for Payer: Health EOS Commercial |
$550.91
|
| Rate for Payer: HFN Commercial |
$569.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$464.25
|
| Rate for Payer: Multiplan Commercial |
$495.20
|
| Rate for Payer: NAPHCARE Commercial |
$371.40
|
| Rate for Payer: Preferred Network Access Commercial |
$569.48
|
| Rate for Payer: Quartz Beloit One Network |
$303.31
|
| Rate for Payer: Quartz Commercial |
$402.35
|
| Rate for Payer: Quartz Medicare Advantage |
$371.40
|
| Rate for Payer: The Alliance Commercial |
$2,476.00
|
| Rate for Payer: United Healthcare PPO |
$464.25
|
| Rate for Payer: WEA Trust Commercial |
$340.45
|
| Rate for Payer: WPS Commercial |
$458.49
|
|
|
Port Flush Rad Onc
|
Facility
|
OP
|
$214.00
|
|
|
Service Code
|
CPT 96523
|
| Hospital Charge Code |
4494653
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$60.46 |
| Max. Negotiated Rate |
$241.84 |
| Rate for Payer: Aetna Commercial |
$192.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$184.04
|
| Rate for Payer: Aetna Managed Medicare |
$60.46
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$139.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$107.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$102.72
|
| Rate for Payer: Anthem Medicare Advantage |
$60.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$113.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$60.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$60.46
|
| Rate for Payer: Cash Price |
$64.20
|
| Rate for Payer: Cash Price |
$64.20
|
| Rate for Payer: Cigna Commercial |
$196.88
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$60.46
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$119.75
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$60.46
|
| Rate for Payer: Health EOS Commercial |
$190.46
|
| Rate for Payer: HFN Commercial |
$196.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$224.91
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$60.46
|
| Rate for Payer: Independent Care Health Plan Medicare |
$60.46
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$60.46
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$60.46
|
| Rate for Payer: Multiplan Commercial |
$171.20
|
| Rate for Payer: NAPHCARE Commercial |
$90.69
|
| Rate for Payer: Preferred Network Access Commercial |
$196.88
|
| Rate for Payer: Quartz Beloit One Network |
$104.86
|
| Rate for Payer: Quartz Commercial |
$139.10
|
| Rate for Payer: Quartz Medicare Advantage |
$60.46
|
| Rate for Payer: The Alliance Commercial |
$241.84
|
| Rate for Payer: United Healthcare Medicare Advantage |
$60.46
|
| Rate for Payer: United Healthcare PPO |
$160.50
|
| Rate for Payer: WEA Trust Commercial |
$117.70
|
| Rate for Payer: Wellcare Medicare |
$60.46
|
| Rate for Payer: WPS Commercial |
$158.51
|
|
|
Port Flush Rad Onc
|
Facility
|
IP
|
$214.00
|
|
|
Service Code
|
CPT 96523
|
| Hospital Charge Code |
4494653
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$104.86 |
| Max. Negotiated Rate |
$196.88 |
| Rate for Payer: Aetna Commercial |
$192.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$184.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$113.42
|
| Rate for Payer: Cash Price |
$64.20
|
| Rate for Payer: Cigna Commercial |
$196.88
|
| Rate for Payer: Health EOS Commercial |
$190.46
|
| Rate for Payer: HFN Commercial |
$196.88
|
| Rate for Payer: Multiplan Commercial |
$171.20
|
| Rate for Payer: NAPHCARE Commercial |
$128.40
|
| Rate for Payer: Preferred Network Access Commercial |
$196.88
|
| Rate for Payer: Quartz Beloit One Network |
$104.86
|
| Rate for Payer: Quartz Commercial |
$128.40
|
| Rate for Payer: WEA Trust Commercial |
$117.70
|
| Rate for Payer: WPS Commercial |
$158.51
|
|
|
PORT MARS 19x60MM STRAIGHT
|
Facility
|
IP
|
$4,882.00
|
|
| Hospital Charge Code |
2965121
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,392.18 |
| Max. Negotiated Rate |
$4,491.44 |
| Rate for Payer: Aetna Commercial |
$4,393.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,198.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,587.46
|
| Rate for Payer: Cash Price |
$1,464.60
|
| Rate for Payer: Cigna Commercial |
$4,491.44
|
| Rate for Payer: Health EOS Commercial |
$4,344.98
|
| Rate for Payer: HFN Commercial |
$4,491.44
|
| Rate for Payer: Multiplan Commercial |
$3,905.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,929.20
|
| Rate for Payer: Preferred Network Access Commercial |
$4,491.44
|
| Rate for Payer: Quartz Beloit One Network |
$2,392.18
|
| Rate for Payer: Quartz Commercial |
$2,929.20
|
| Rate for Payer: WEA Trust Commercial |
$2,685.10
|
| Rate for Payer: WPS Commercial |
$3,616.10
|
|
|
PORT MARS 19x60MM STRAIGHT
|
Facility
|
OP
|
$4,882.00
|
|
| Hospital Charge Code |
2965121
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,366.96 |
| Max. Negotiated Rate |
$19,528.00 |
| Rate for Payer: Aetna Commercial |
$4,393.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,198.52
|
| Rate for Payer: Aetna Managed Medicare |
$1,366.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,173.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,441.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,343.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,587.46
|
| Rate for Payer: Cash Price |
$1,464.60
|
| Rate for Payer: Cigna Commercial |
$4,491.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,731.97
|
| Rate for Payer: Health EOS Commercial |
$4,344.98
|
| Rate for Payer: HFN Commercial |
$4,491.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,661.50
|
| Rate for Payer: Multiplan Commercial |
$3,905.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,929.20
|
| Rate for Payer: Preferred Network Access Commercial |
$4,491.44
|
| Rate for Payer: Quartz Beloit One Network |
$2,392.18
|
| Rate for Payer: Quartz Commercial |
$3,173.30
|
| Rate for Payer: Quartz Medicare Advantage |
$2,929.20
|
| Rate for Payer: The Alliance Commercial |
$19,528.00
|
| Rate for Payer: WEA Trust Commercial |
$2,685.10
|
| Rate for Payer: WPS Commercial |
$3,616.10
|
|
|
Posaconazole, LC/MS/MS
|
Professional
|
Both
|
$327.00
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
5094644
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$65.80 |
| Max. Negotiated Rate |
$310.65 |
| Rate for Payer: Aetna Commercial |
$310.65
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$281.22
|
| Rate for Payer: Cash Price |
$98.10
|
| Rate for Payer: Cash Price |
$98.10
|
| Rate for Payer: Cigna Commercial |
$310.65
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$163.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$196.20
|
| Rate for Payer: Health EOS Commercial |
$297.57
|
| Rate for Payer: HFN Commercial |
$310.65
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$65.80
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$65.80
|
| Rate for Payer: Multiplan Commercial |
$261.60
|
| Rate for Payer: Preferred Network Access Commercial |
$310.65
|
| Rate for Payer: Quartz Beloit One Network |
$143.88
|
| Rate for Payer: Quartz Commercial |
$186.39
|
| Rate for Payer: The Alliance Commercial |
$163.50
|
| Rate for Payer: WEA Trust Commercial |
$179.85
|
| Rate for Payer: WPS Commercial |
$242.21
|
|
|
Posaconazole, LC/MS/MS
|
Facility
|
OP
|
$327.00
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
5094644
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.64 |
| Max. Negotiated Rate |
$300.84 |
| Rate for Payer: Aetna Commercial |
$294.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$281.22
|
| Rate for Payer: Aetna Managed Medicare |
$18.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$69.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$32.62
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$30.94
|
| Rate for Payer: Anthem Medicaid |
$19.26
|
| Rate for Payer: Anthem Medicare Advantage |
$18.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$173.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$18.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$18.64
|
| Rate for Payer: Cash Price |
$98.10
|
| Rate for Payer: Cash Price |
$98.10
|
| Rate for Payer: Cigna Commercial |
$300.84
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$18.64
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$19.26
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$182.99
|
| Rate for Payer: Dean Health Medicaid |
$19.26
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$18.64
|
| Rate for Payer: Health EOS Commercial |
$291.03
|
| Rate for Payer: HFN Commercial |
$300.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$69.34
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$18.64
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$19.26
|
| Rate for Payer: Independent Care Health Plan Medicare |
$18.64
|
| Rate for Payer: Managed Health Services Medicaid |
$20.03
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$18.64
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$18.64
|
| Rate for Payer: Multiplan Commercial |
$261.60
|
| Rate for Payer: NAPHCARE Commercial |
$27.96
|
| Rate for Payer: Preferred Network Access Commercial |
$300.84
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$19.26
|
| Rate for Payer: Quartz Beloit One Network |
$160.23
|
| Rate for Payer: Quartz Commercial |
$212.55
|
| Rate for Payer: Quartz Medicare Advantage |
$18.64
|
| Rate for Payer: The Alliance Commercial |
$74.56
|
| Rate for Payer: United Healthcare Medicaid |
$19.26
|
| Rate for Payer: United Healthcare Medicare Advantage |
$18.64
|
| Rate for Payer: United Healthcare PPO |
$245.25
|
| Rate for Payer: WEA Trust Commercial |
$179.85
|
| Rate for Payer: Wellcare Medicare |
$18.64
|
| Rate for Payer: WMAP Medicaid |
$19.26
|
| Rate for Payer: WPS Commercial |
$242.21
|
|
|
Posaconazole, LC/MS/MS
|
Facility
|
IP
|
$327.00
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
5094644
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$160.23 |
| Max. Negotiated Rate |
$300.84 |
| Rate for Payer: Aetna Commercial |
$294.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$281.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$173.31
|
| Rate for Payer: Cash Price |
$98.10
|
| Rate for Payer: Cigna Commercial |
$300.84
|
| Rate for Payer: Health EOS Commercial |
$291.03
|
| Rate for Payer: HFN Commercial |
$300.84
|
| Rate for Payer: Multiplan Commercial |
$261.60
|
| Rate for Payer: NAPHCARE Commercial |
$196.20
|
| Rate for Payer: Preferred Network Access Commercial |
$300.84
|
| Rate for Payer: Quartz Beloit One Network |
$160.23
|
| Rate for Payer: Quartz Commercial |
$196.20
|
| Rate for Payer: WEA Trust Commercial |
$179.85
|
| Rate for Payer: WPS Commercial |
$242.21
|
|
|
Pos Combo Panel Type 34
|
Facility
|
IP
|
$187.00
|
|
|
Service Code
|
CPT 87186
|
| Hospital Charge Code |
1562824
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$91.63 |
| Max. Negotiated Rate |
$172.04 |
| Rate for Payer: Aetna Commercial |
$168.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$160.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$99.11
|
| Rate for Payer: Cash Price |
$56.10
|
| Rate for Payer: Cigna Commercial |
$172.04
|
| Rate for Payer: Health EOS Commercial |
$166.43
|
| Rate for Payer: HFN Commercial |
$172.04
|
| Rate for Payer: Multiplan Commercial |
$149.60
|
| Rate for Payer: NAPHCARE Commercial |
$112.20
|
| Rate for Payer: Preferred Network Access Commercial |
$172.04
|
| Rate for Payer: Quartz Beloit One Network |
$91.63
|
| Rate for Payer: Quartz Commercial |
$112.20
|
| Rate for Payer: WEA Trust Commercial |
$102.85
|
| Rate for Payer: WPS Commercial |
$138.51
|
|
|
Pos Combo Panel Type 34
|
Facility
|
OP
|
$187.00
|
|
|
Service Code
|
CPT 87186
|
| Hospital Charge Code |
1562824
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.65 |
| Max. Negotiated Rate |
$172.04 |
| Rate for Payer: Aetna Commercial |
$168.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$160.82
|
| Rate for Payer: Aetna Managed Medicare |
$8.65
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$32.44
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$15.14
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$14.36
|
| Rate for Payer: Anthem Medicaid |
$8.94
|
| Rate for Payer: Anthem Medicare Advantage |
$8.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$99.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$8.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$8.65
|
| Rate for Payer: Cash Price |
$56.10
|
| Rate for Payer: Cash Price |
$56.10
|
| Rate for Payer: Cigna Commercial |
$172.04
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$8.65
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$8.94
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$104.65
|
| Rate for Payer: Dean Health Medicaid |
$8.94
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$8.65
|
| Rate for Payer: Health EOS Commercial |
$166.43
|
| Rate for Payer: HFN Commercial |
$172.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$32.18
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$8.65
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$8.94
|
| Rate for Payer: Independent Care Health Plan Medicare |
$8.65
|
| Rate for Payer: Managed Health Services Medicaid |
$9.30
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$8.65
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$8.65
|
| Rate for Payer: Multiplan Commercial |
$149.60
|
| Rate for Payer: NAPHCARE Commercial |
$12.98
|
| Rate for Payer: Preferred Network Access Commercial |
$172.04
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$8.94
|
| Rate for Payer: Quartz Beloit One Network |
$91.63
|
| Rate for Payer: Quartz Commercial |
$121.55
|
| Rate for Payer: Quartz Medicare Advantage |
$8.65
|
| Rate for Payer: The Alliance Commercial |
$34.60
|
| Rate for Payer: United Healthcare Medicaid |
$8.94
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8.65
|
| Rate for Payer: United Healthcare PPO |
$140.25
|
| Rate for Payer: WEA Trust Commercial |
$102.85
|
| Rate for Payer: Wellcare Medicare |
$8.65
|
| Rate for Payer: WMAP Medicaid |
$8.94
|
| Rate for Payer: WPS Commercial |
$138.51
|
|
|
Pos Combo Panel Type 34
|
Professional
|
Both
|
$187.00
|
|
|
Service Code
|
CPT 87186
|
| Hospital Charge Code |
1562824
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$30.53 |
| Max. Negotiated Rate |
$177.65 |
| Rate for Payer: Aetna Commercial |
$177.65
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$160.82
|
| Rate for Payer: Cash Price |
$56.10
|
| Rate for Payer: Cash Price |
$56.10
|
| Rate for Payer: Cigna Commercial |
$177.65
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$93.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$112.20
|
| Rate for Payer: Health EOS Commercial |
$170.17
|
| Rate for Payer: HFN Commercial |
$177.65
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$30.53
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$30.53
|
| Rate for Payer: Multiplan Commercial |
$149.60
|
| Rate for Payer: Preferred Network Access Commercial |
$177.65
|
| Rate for Payer: Quartz Beloit One Network |
$82.28
|
| Rate for Payer: Quartz Commercial |
$106.59
|
| Rate for Payer: The Alliance Commercial |
$93.50
|
| Rate for Payer: WEA Trust Commercial |
$102.85
|
| Rate for Payer: WPS Commercial |
$138.51
|
|
|
Pos Combo Panel Type 44
|
Facility
|
IP
|
$187.00
|
|
|
Service Code
|
CPT 87186
|
| Hospital Charge Code |
4619022
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$91.63 |
| Max. Negotiated Rate |
$172.04 |
| Rate for Payer: Aetna Commercial |
$168.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$160.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$99.11
|
| Rate for Payer: Cash Price |
$56.10
|
| Rate for Payer: Cigna Commercial |
$172.04
|
| Rate for Payer: Health EOS Commercial |
$166.43
|
| Rate for Payer: HFN Commercial |
$172.04
|
| Rate for Payer: Multiplan Commercial |
$149.60
|
| Rate for Payer: NAPHCARE Commercial |
$112.20
|
| Rate for Payer: Preferred Network Access Commercial |
$172.04
|
| Rate for Payer: Quartz Beloit One Network |
$91.63
|
| Rate for Payer: Quartz Commercial |
$112.20
|
| Rate for Payer: WEA Trust Commercial |
$102.85
|
| Rate for Payer: WPS Commercial |
$138.51
|
|
