|
Protein Electrophoresis Urine
|
Facility
|
OP
|
$64.00
|
|
|
Service Code
|
CPT 84156
|
| Hospital Charge Code |
633817
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.82 |
| Max. Negotiated Rate |
$61.24 |
| Rate for Payer: Aetna Commercial |
$59.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$57.24
|
| Rate for Payer: Aetna Managed Medicare |
$3.82
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$14.31
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$6.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$6.34
|
| Rate for Payer: Anthem Medicare Advantage |
$3.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$35.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$3.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$3.82
|
| Rate for Payer: Cash Price |
$19.20
|
| Rate for Payer: Cash Price |
$19.20
|
| Rate for Payer: Cigna Commercial |
$61.24
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$3.82
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$37.25
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$3.82
|
| Rate for Payer: Health EOS Commercial |
$59.24
|
| Rate for Payer: HFN Commercial |
$61.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$14.20
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$3.82
|
| Rate for Payer: Independent Care Health Plan Medicare |
$3.82
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$3.82
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$3.82
|
| Rate for Payer: Multiplan Commercial |
$53.25
|
| Rate for Payer: NAPHCARE Commercial |
$5.73
|
| Rate for Payer: Preferred Network Access Commercial |
$61.24
|
| Rate for Payer: Quartz Beloit One Network |
$32.61
|
| Rate for Payer: Quartz Commercial |
$43.26
|
| Rate for Payer: Quartz Medicare Advantage |
$3.82
|
| Rate for Payer: The Alliance Commercial |
$15.27
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3.82
|
| Rate for Payer: United Healthcare PPO |
$49.92
|
| Rate for Payer: WEA Trust Commercial |
$36.61
|
| Rate for Payer: Wellcare Medicare |
$3.82
|
| Rate for Payer: WPS Commercial |
$49.30
|
|
|
Protein Electrophoresis w/ Immunofixation
|
Professional
|
Both
|
$271.00
|
|
|
Service Code
|
CPT 84155
|
| Hospital Charge Code |
983372
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.82 |
| Max. Negotiated Rate |
$267.75 |
| Rate for Payer: Aetna Commercial |
$267.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$242.38
|
| Rate for Payer: Aetna Managed Medicare |
$3.82
|
| Rate for Payer: Anthem Medicare Advantage |
$3.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$3.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$3.82
|
| Rate for Payer: Cash Price |
$81.30
|
| Rate for Payer: Cash Price |
$81.30
|
| Rate for Payer: Cigna Commercial |
$267.75
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$140.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3.82
|
| Rate for Payer: Health EOS Commercial |
$256.47
|
| Rate for Payer: HFN Commercial |
$267.75
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$13.48
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$13.48
|
| Rate for Payer: Independent Care Health Plan Medicare |
$3.82
|
| Rate for Payer: Multiplan Commercial |
$225.47
|
| Rate for Payer: NAPHCARE Commercial |
$5.73
|
| Rate for Payer: Preferred Network Access Commercial |
$267.75
|
| Rate for Payer: Quartz Beloit One Network |
$124.01
|
| Rate for Payer: Quartz Commercial |
$160.65
|
| Rate for Payer: Quartz Medicare Advantage |
$3.82
|
| Rate for Payer: The Alliance Commercial |
$15.08
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3.82
|
| Rate for Payer: WEA Trust Commercial |
$155.01
|
| Rate for Payer: WPS Commercial |
$16.79
|
|
|
Protein Electrophoresis w/ Immunofixation
|
Facility
|
OP
|
$271.00
|
|
|
Service Code
|
CPT 84155
|
| Hospital Charge Code |
983372
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.82 |
| Max. Negotiated Rate |
$259.29 |
| Rate for Payer: Aetna Commercial |
$253.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$242.38
|
| Rate for Payer: Aetna Managed Medicare |
$3.82
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$14.31
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$6.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$6.34
|
| Rate for Payer: Anthem Medicare Advantage |
$3.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$149.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$3.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$3.82
|
| Rate for Payer: Cash Price |
$81.30
|
| Rate for Payer: Cash Price |
$81.30
|
| Rate for Payer: Cigna Commercial |
$259.29
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$3.82
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$157.72
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$3.82
|
| Rate for Payer: Health EOS Commercial |
$250.84
|
| Rate for Payer: HFN Commercial |
$259.29
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$14.20
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$3.82
|
| Rate for Payer: Independent Care Health Plan Medicare |
$3.82
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$3.82
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$3.82
|
| Rate for Payer: Multiplan Commercial |
$225.47
|
| Rate for Payer: NAPHCARE Commercial |
$5.73
|
| Rate for Payer: Preferred Network Access Commercial |
$259.29
|
| Rate for Payer: Quartz Beloit One Network |
$138.10
|
| Rate for Payer: Quartz Commercial |
$183.20
|
| Rate for Payer: Quartz Medicare Advantage |
$3.82
|
| Rate for Payer: The Alliance Commercial |
$15.27
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3.82
|
| Rate for Payer: United Healthcare PPO |
$211.38
|
| Rate for Payer: WEA Trust Commercial |
$155.01
|
| Rate for Payer: Wellcare Medicare |
$3.82
|
| Rate for Payer: WPS Commercial |
$208.75
|
|
|
Protein Electrophoresis w/ Immunofixation
|
Facility
|
IP
|
$271.00
|
|
|
Service Code
|
CPT 84155
|
| Hospital Charge Code |
983372
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$138.10 |
| Max. Negotiated Rate |
$259.29 |
| Rate for Payer: Aetna Commercial |
$253.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$242.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$149.38
|
| Rate for Payer: Cash Price |
$81.30
|
| Rate for Payer: Cigna Commercial |
$259.29
|
| Rate for Payer: Health EOS Commercial |
$250.84
|
| Rate for Payer: HFN Commercial |
$259.29
|
| Rate for Payer: Multiplan Commercial |
$225.47
|
| Rate for Payer: Preferred Network Access Commercial |
$259.29
|
| Rate for Payer: Quartz Beloit One Network |
$138.10
|
| Rate for Payer: Quartz Commercial |
$169.10
|
| Rate for Payer: WEA Trust Commercial |
$155.01
|
| Rate for Payer: WPS Commercial |
$208.75
|
|
|
Protein Electrophoresis with Immunofixation 24 hour Urine
|
Professional
|
Both
|
$168.00
|
|
|
Service Code
|
CPT 86335
|
| Hospital Charge Code |
5711632
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.27 |
| Max. Negotiated Rate |
$165.98 |
| Rate for Payer: Aetna Commercial |
$165.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$150.26
|
| Rate for Payer: Aetna Managed Medicare |
$30.52
|
| Rate for Payer: Anthem Commercial |
$17.27
|
| Rate for Payer: Anthem Medicare Advantage |
$30.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$30.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$30.52
|
| Rate for Payer: Cash Price |
$50.40
|
| Rate for Payer: Cash Price |
$50.40
|
| Rate for Payer: Cigna Commercial |
$165.98
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$87.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$30.52
|
| Rate for Payer: Health EOS Commercial |
$159.00
|
| Rate for Payer: HFN Commercial |
$165.98
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$107.75
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$107.75
|
| Rate for Payer: Independent Care Health Plan Medicare |
$30.52
|
| Rate for Payer: Multiplan Commercial |
$139.78
|
| Rate for Payer: NAPHCARE Commercial |
$45.79
|
| Rate for Payer: Preferred Network Access Commercial |
$165.98
|
| Rate for Payer: Quartz Beloit One Network |
$76.88
|
| Rate for Payer: Quartz Commercial |
$99.59
|
| Rate for Payer: Quartz Medicare Advantage |
$30.52
|
| Rate for Payer: The Alliance Commercial |
$120.57
|
| Rate for Payer: United Healthcare Medicare Advantage |
$30.52
|
| Rate for Payer: WEA Trust Commercial |
$96.10
|
| Rate for Payer: WPS Commercial |
$134.31
|
|
|
Protein Electrophoresis with Immunofixation 24 hour Urine
|
Facility
|
OP
|
$168.00
|
|
|
Service Code
|
CPT 86335
|
| Hospital Charge Code |
5711632
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$30.52 |
| Max. Negotiated Rate |
$160.74 |
| Rate for Payer: Aetna Commercial |
$157.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$150.26
|
| Rate for Payer: Aetna Managed Medicare |
$30.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$114.47
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$53.42
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$50.67
|
| Rate for Payer: Anthem Medicare Advantage |
$30.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$92.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$30.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$30.52
|
| Rate for Payer: Cash Price |
$50.40
|
| Rate for Payer: Cash Price |
$50.40
|
| Rate for Payer: Cigna Commercial |
$160.74
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$30.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$97.78
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$30.52
|
| Rate for Payer: Health EOS Commercial |
$155.50
|
| Rate for Payer: HFN Commercial |
$160.74
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$113.55
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$30.52
|
| Rate for Payer: Independent Care Health Plan Medicare |
$30.52
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$30.52
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$30.52
|
| Rate for Payer: Multiplan Commercial |
$139.78
|
| Rate for Payer: NAPHCARE Commercial |
$45.79
|
| Rate for Payer: Preferred Network Access Commercial |
$160.74
|
| Rate for Payer: Quartz Beloit One Network |
$85.61
|
| Rate for Payer: Quartz Commercial |
$113.57
|
| Rate for Payer: Quartz Medicare Advantage |
$30.52
|
| Rate for Payer: The Alliance Commercial |
$122.10
|
| Rate for Payer: United Healthcare Medicare Advantage |
$30.52
|
| Rate for Payer: United Healthcare PPO |
$131.04
|
| Rate for Payer: WEA Trust Commercial |
$96.10
|
| Rate for Payer: Wellcare Medicare |
$30.52
|
| Rate for Payer: WPS Commercial |
$129.41
|
|
|
Protein Electrophoresis with Immunofixation 24 hour Urine
|
Facility
|
IP
|
$168.00
|
|
|
Service Code
|
CPT 86335
|
| Hospital Charge Code |
5711632
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$85.61 |
| Max. Negotiated Rate |
$160.74 |
| Rate for Payer: Aetna Commercial |
$157.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$150.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$92.60
|
| Rate for Payer: Cash Price |
$50.40
|
| Rate for Payer: Cigna Commercial |
$160.74
|
| Rate for Payer: Health EOS Commercial |
$155.50
|
| Rate for Payer: HFN Commercial |
$160.74
|
| Rate for Payer: Multiplan Commercial |
$139.78
|
| Rate for Payer: Preferred Network Access Commercial |
$160.74
|
| Rate for Payer: Quartz Beloit One Network |
$85.61
|
| Rate for Payer: Quartz Commercial |
$104.83
|
| Rate for Payer: WEA Trust Commercial |
$96.10
|
| Rate for Payer: WPS Commercial |
$129.41
|
|
|
Protein Electrophoresis w/ Reflex IFE
|
Facility
|
OP
|
$271.00
|
|
|
Service Code
|
CPT 84155
|
| Hospital Charge Code |
983373
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.82 |
| Max. Negotiated Rate |
$259.29 |
| Rate for Payer: Aetna Commercial |
$253.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$242.38
|
| Rate for Payer: Aetna Managed Medicare |
$3.82
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$14.31
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$6.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$6.34
|
| Rate for Payer: Anthem Medicare Advantage |
$3.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$149.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$3.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$3.82
|
| Rate for Payer: Cash Price |
$81.30
|
| Rate for Payer: Cash Price |
$81.30
|
| Rate for Payer: Cigna Commercial |
$259.29
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$3.82
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$157.72
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$3.82
|
| Rate for Payer: Health EOS Commercial |
$250.84
|
| Rate for Payer: HFN Commercial |
$259.29
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$14.20
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$3.82
|
| Rate for Payer: Independent Care Health Plan Medicare |
$3.82
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$3.82
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$3.82
|
| Rate for Payer: Multiplan Commercial |
$225.47
|
| Rate for Payer: NAPHCARE Commercial |
$5.73
|
| Rate for Payer: Preferred Network Access Commercial |
$259.29
|
| Rate for Payer: Quartz Beloit One Network |
$138.10
|
| Rate for Payer: Quartz Commercial |
$183.20
|
| Rate for Payer: Quartz Medicare Advantage |
$3.82
|
| Rate for Payer: The Alliance Commercial |
$15.27
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3.82
|
| Rate for Payer: United Healthcare PPO |
$211.38
|
| Rate for Payer: WEA Trust Commercial |
$155.01
|
| Rate for Payer: Wellcare Medicare |
$3.82
|
| Rate for Payer: WPS Commercial |
$208.75
|
|
|
Protein Electrophoresis w/ Reflex IFE
|
Facility
|
IP
|
$271.00
|
|
|
Service Code
|
CPT 84155
|
| Hospital Charge Code |
983373
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$138.10 |
| Max. Negotiated Rate |
$259.29 |
| Rate for Payer: Aetna Commercial |
$253.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$242.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$149.38
|
| Rate for Payer: Cash Price |
$81.30
|
| Rate for Payer: Cigna Commercial |
$259.29
|
| Rate for Payer: Health EOS Commercial |
$250.84
|
| Rate for Payer: HFN Commercial |
$259.29
|
| Rate for Payer: Multiplan Commercial |
$225.47
|
| Rate for Payer: Preferred Network Access Commercial |
$259.29
|
| Rate for Payer: Quartz Beloit One Network |
$138.10
|
| Rate for Payer: Quartz Commercial |
$169.10
|
| Rate for Payer: WEA Trust Commercial |
$155.01
|
| Rate for Payer: WPS Commercial |
$208.75
|
|
|
Protein Electrophoresis w/ Reflex IFE
|
Professional
|
Both
|
$271.00
|
|
|
Service Code
|
CPT 84155
|
| Hospital Charge Code |
983373
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.82 |
| Max. Negotiated Rate |
$267.75 |
| Rate for Payer: Aetna Commercial |
$267.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$242.38
|
| Rate for Payer: Aetna Managed Medicare |
$3.82
|
| Rate for Payer: Anthem Medicare Advantage |
$3.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$3.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$3.82
|
| Rate for Payer: Cash Price |
$81.30
|
| Rate for Payer: Cash Price |
$81.30
|
| Rate for Payer: Cigna Commercial |
$267.75
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$140.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3.82
|
| Rate for Payer: Health EOS Commercial |
$256.47
|
| Rate for Payer: HFN Commercial |
$267.75
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$13.48
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$13.48
|
| Rate for Payer: Independent Care Health Plan Medicare |
$3.82
|
| Rate for Payer: Multiplan Commercial |
$225.47
|
| Rate for Payer: NAPHCARE Commercial |
$5.73
|
| Rate for Payer: Preferred Network Access Commercial |
$267.75
|
| Rate for Payer: Quartz Beloit One Network |
$124.01
|
| Rate for Payer: Quartz Commercial |
$160.65
|
| Rate for Payer: Quartz Medicare Advantage |
$3.82
|
| Rate for Payer: The Alliance Commercial |
$15.08
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3.82
|
| Rate for Payer: WEA Trust Commercial |
$155.01
|
| Rate for Payer: WPS Commercial |
$16.79
|
|
|
Protein S Activity
|
Facility
|
OP
|
$724.00
|
|
|
Service Code
|
CPT 85306
|
| Hospital Charge Code |
983376
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.93 |
| Max. Negotiated Rate |
$692.72 |
| Rate for Payer: Aetna Commercial |
$677.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$647.55
|
| Rate for Payer: Aetna Managed Medicare |
$15.93
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$59.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$27.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$26.45
|
| Rate for Payer: Anthem Medicare Advantage |
$15.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$399.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$15.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$15.93
|
| Rate for Payer: Cash Price |
$217.20
|
| Rate for Payer: Cash Price |
$217.20
|
| Rate for Payer: Cigna Commercial |
$692.72
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$15.93
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$421.37
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$15.93
|
| Rate for Payer: Health EOS Commercial |
$670.13
|
| Rate for Payer: HFN Commercial |
$692.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$59.27
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$15.93
|
| Rate for Payer: Independent Care Health Plan Medicare |
$15.93
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$15.93
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$15.93
|
| Rate for Payer: Multiplan Commercial |
$602.37
|
| Rate for Payer: NAPHCARE Commercial |
$23.90
|
| Rate for Payer: Preferred Network Access Commercial |
$692.72
|
| Rate for Payer: Quartz Beloit One Network |
$368.95
|
| Rate for Payer: Quartz Commercial |
$489.42
|
| Rate for Payer: Quartz Medicare Advantage |
$15.93
|
| Rate for Payer: The Alliance Commercial |
$63.73
|
| Rate for Payer: United Healthcare Medicare Advantage |
$15.93
|
| Rate for Payer: United Healthcare PPO |
$564.72
|
| Rate for Payer: WEA Trust Commercial |
$414.13
|
| Rate for Payer: Wellcare Medicare |
$15.93
|
| Rate for Payer: WPS Commercial |
$557.70
|
|
|
Protein S Activity
|
Facility
|
IP
|
$724.00
|
|
|
Service Code
|
CPT 85306
|
| Hospital Charge Code |
983376
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$368.95 |
| Max. Negotiated Rate |
$692.72 |
| Rate for Payer: Aetna Commercial |
$677.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$647.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$399.07
|
| Rate for Payer: Cash Price |
$217.20
|
| Rate for Payer: Cigna Commercial |
$692.72
|
| Rate for Payer: Health EOS Commercial |
$670.13
|
| Rate for Payer: HFN Commercial |
$692.72
|
| Rate for Payer: Multiplan Commercial |
$602.37
|
| Rate for Payer: Preferred Network Access Commercial |
$692.72
|
| Rate for Payer: Quartz Beloit One Network |
$368.95
|
| Rate for Payer: Quartz Commercial |
$451.78
|
| Rate for Payer: WEA Trust Commercial |
$414.13
|
| Rate for Payer: WPS Commercial |
$557.70
|
|
|
Protein S Activity
|
Professional
|
Both
|
$724.00
|
|
|
Service Code
|
CPT 85306
|
| Hospital Charge Code |
983376
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.93 |
| Max. Negotiated Rate |
$715.31 |
| Rate for Payer: Aetna Commercial |
$715.31
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$647.55
|
| Rate for Payer: Aetna Managed Medicare |
$15.93
|
| Rate for Payer: Anthem Medicare Advantage |
$15.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$15.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$15.93
|
| Rate for Payer: Cash Price |
$217.20
|
| Rate for Payer: Cash Price |
$217.20
|
| Rate for Payer: Cigna Commercial |
$715.31
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$376.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$15.93
|
| Rate for Payer: Health EOS Commercial |
$685.19
|
| Rate for Payer: HFN Commercial |
$715.31
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$56.24
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$56.24
|
| Rate for Payer: Independent Care Health Plan Medicare |
$15.93
|
| Rate for Payer: Multiplan Commercial |
$602.37
|
| Rate for Payer: NAPHCARE Commercial |
$23.90
|
| Rate for Payer: Preferred Network Access Commercial |
$715.31
|
| Rate for Payer: Quartz Beloit One Network |
$331.30
|
| Rate for Payer: Quartz Commercial |
$429.19
|
| Rate for Payer: Quartz Medicare Advantage |
$15.93
|
| Rate for Payer: The Alliance Commercial |
$62.93
|
| Rate for Payer: United Healthcare Medicare Advantage |
$15.93
|
| Rate for Payer: WEA Trust Commercial |
$414.13
|
| Rate for Payer: WPS Commercial |
$70.10
|
|
|
Protein S Antigen
|
Professional
|
Both
|
$323.00
|
|
|
Service Code
|
CPT 85305
|
| Hospital Charge Code |
5749632
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.07 |
| Max. Negotiated Rate |
$319.12 |
| Rate for Payer: Aetna Commercial |
$319.12
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$288.89
|
| Rate for Payer: Aetna Managed Medicare |
$12.07
|
| Rate for Payer: Anthem Medicare Advantage |
$12.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$12.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$12.07
|
| Rate for Payer: Cash Price |
$96.90
|
| Rate for Payer: Cash Price |
$96.90
|
| Rate for Payer: Cigna Commercial |
$319.12
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$167.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12.07
|
| Rate for Payer: Health EOS Commercial |
$305.69
|
| Rate for Payer: HFN Commercial |
$319.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$42.62
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$42.62
|
| Rate for Payer: Independent Care Health Plan Medicare |
$12.07
|
| Rate for Payer: Multiplan Commercial |
$268.74
|
| Rate for Payer: NAPHCARE Commercial |
$18.11
|
| Rate for Payer: Preferred Network Access Commercial |
$319.12
|
| Rate for Payer: Quartz Beloit One Network |
$147.80
|
| Rate for Payer: Quartz Commercial |
$191.47
|
| Rate for Payer: Quartz Medicare Advantage |
$12.07
|
| Rate for Payer: The Alliance Commercial |
$47.69
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.07
|
| Rate for Payer: WEA Trust Commercial |
$184.76
|
| Rate for Payer: WPS Commercial |
$53.13
|
|
|
Protein S Antigen
|
Facility
|
OP
|
$323.00
|
|
|
Service Code
|
CPT 85305
|
| Hospital Charge Code |
5749632
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.07 |
| Max. Negotiated Rate |
$309.05 |
| Rate for Payer: Aetna Commercial |
$302.33
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$288.89
|
| Rate for Payer: Aetna Managed Medicare |
$12.07
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$45.28
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$21.13
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$20.04
|
| Rate for Payer: Anthem Medicare Advantage |
$12.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$178.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$12.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$12.07
|
| Rate for Payer: Cash Price |
$96.90
|
| Rate for Payer: Cash Price |
$96.90
|
| Rate for Payer: Cigna Commercial |
$309.05
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$12.07
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$187.99
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$12.07
|
| Rate for Payer: Health EOS Commercial |
$298.97
|
| Rate for Payer: HFN Commercial |
$309.05
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$44.92
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$12.07
|
| Rate for Payer: Independent Care Health Plan Medicare |
$12.07
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$12.07
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$12.07
|
| Rate for Payer: Multiplan Commercial |
$268.74
|
| Rate for Payer: NAPHCARE Commercial |
$18.11
|
| Rate for Payer: Preferred Network Access Commercial |
$309.05
|
| Rate for Payer: Quartz Beloit One Network |
$164.60
|
| Rate for Payer: Quartz Commercial |
$218.35
|
| Rate for Payer: Quartz Medicare Advantage |
$12.07
|
| Rate for Payer: The Alliance Commercial |
$48.30
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.07
|
| Rate for Payer: United Healthcare PPO |
$251.94
|
| Rate for Payer: WEA Trust Commercial |
$184.76
|
| Rate for Payer: Wellcare Medicare |
$12.07
|
| Rate for Payer: WPS Commercial |
$248.81
|
|
|
Protein S Antigen
|
Facility
|
IP
|
$323.00
|
|
|
Service Code
|
CPT 85305
|
| Hospital Charge Code |
5749632
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$164.60 |
| Max. Negotiated Rate |
$309.05 |
| Rate for Payer: Aetna Commercial |
$302.33
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$288.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$178.04
|
| Rate for Payer: Cash Price |
$96.90
|
| Rate for Payer: Cigna Commercial |
$309.05
|
| Rate for Payer: Health EOS Commercial |
$298.97
|
| Rate for Payer: HFN Commercial |
$309.05
|
| Rate for Payer: Multiplan Commercial |
$268.74
|
| Rate for Payer: Preferred Network Access Commercial |
$309.05
|
| Rate for Payer: Quartz Beloit One Network |
$164.60
|
| Rate for Payer: Quartz Commercial |
$201.55
|
| Rate for Payer: WEA Trust Commercial |
$184.76
|
| Rate for Payer: WPS Commercial |
$248.81
|
|
|
Protein S Antigen Free
|
Facility
|
IP
|
$382.00
|
|
|
Service Code
|
CPT 85306
|
| Hospital Charge Code |
1102821
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$194.67 |
| Max. Negotiated Rate |
$365.50 |
| Rate for Payer: Aetna Commercial |
$357.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$341.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$210.56
|
| Rate for Payer: Cash Price |
$114.60
|
| Rate for Payer: Cigna Commercial |
$365.50
|
| Rate for Payer: Health EOS Commercial |
$353.58
|
| Rate for Payer: HFN Commercial |
$365.50
|
| Rate for Payer: Multiplan Commercial |
$317.82
|
| Rate for Payer: Preferred Network Access Commercial |
$365.50
|
| Rate for Payer: Quartz Beloit One Network |
$194.67
|
| Rate for Payer: Quartz Commercial |
$238.37
|
| Rate for Payer: WEA Trust Commercial |
$218.50
|
| Rate for Payer: WPS Commercial |
$294.25
|
|
|
Protein S Antigen Free
|
Professional
|
Both
|
$382.00
|
|
|
Service Code
|
CPT 85306
|
| Hospital Charge Code |
1102821
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.93 |
| Max. Negotiated Rate |
$377.42 |
| Rate for Payer: Aetna Commercial |
$377.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$341.66
|
| Rate for Payer: Aetna Managed Medicare |
$15.93
|
| Rate for Payer: Anthem Medicare Advantage |
$15.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$15.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$15.93
|
| Rate for Payer: Cash Price |
$114.60
|
| Rate for Payer: Cash Price |
$114.60
|
| Rate for Payer: Cigna Commercial |
$377.42
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$198.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$15.93
|
| Rate for Payer: Health EOS Commercial |
$361.52
|
| Rate for Payer: HFN Commercial |
$377.42
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$56.24
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$56.24
|
| Rate for Payer: Independent Care Health Plan Medicare |
$15.93
|
| Rate for Payer: Multiplan Commercial |
$317.82
|
| Rate for Payer: NAPHCARE Commercial |
$23.90
|
| Rate for Payer: Preferred Network Access Commercial |
$377.42
|
| Rate for Payer: Quartz Beloit One Network |
$174.80
|
| Rate for Payer: Quartz Commercial |
$226.45
|
| Rate for Payer: Quartz Medicare Advantage |
$15.93
|
| Rate for Payer: The Alliance Commercial |
$62.93
|
| Rate for Payer: United Healthcare Medicare Advantage |
$15.93
|
| Rate for Payer: WEA Trust Commercial |
$218.50
|
| Rate for Payer: WPS Commercial |
$70.10
|
|
|
Protein S Antigen Free
|
Facility
|
OP
|
$382.00
|
|
|
Service Code
|
CPT 85306
|
| Hospital Charge Code |
1102821
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.93 |
| Max. Negotiated Rate |
$365.50 |
| Rate for Payer: Aetna Commercial |
$357.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$341.66
|
| Rate for Payer: Aetna Managed Medicare |
$15.93
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$59.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$27.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$26.45
|
| Rate for Payer: Anthem Medicare Advantage |
$15.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$210.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$15.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$15.93
|
| Rate for Payer: Cash Price |
$114.60
|
| Rate for Payer: Cash Price |
$114.60
|
| Rate for Payer: Cigna Commercial |
$365.50
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$15.93
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$222.32
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$15.93
|
| Rate for Payer: Health EOS Commercial |
$353.58
|
| Rate for Payer: HFN Commercial |
$365.50
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$59.27
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$15.93
|
| Rate for Payer: Independent Care Health Plan Medicare |
$15.93
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$15.93
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$15.93
|
| Rate for Payer: Multiplan Commercial |
$317.82
|
| Rate for Payer: NAPHCARE Commercial |
$23.90
|
| Rate for Payer: Preferred Network Access Commercial |
$365.50
|
| Rate for Payer: Quartz Beloit One Network |
$194.67
|
| Rate for Payer: Quartz Commercial |
$258.23
|
| Rate for Payer: Quartz Medicare Advantage |
$15.93
|
| Rate for Payer: The Alliance Commercial |
$63.73
|
| Rate for Payer: United Healthcare Medicare Advantage |
$15.93
|
| Rate for Payer: United Healthcare PPO |
$297.96
|
| Rate for Payer: WEA Trust Commercial |
$218.50
|
| Rate for Payer: Wellcare Medicare |
$15.93
|
| Rate for Payer: WPS Commercial |
$294.25
|
|
|
Protein S Antigen, Total
|
Facility
|
IP
|
$383.00
|
|
|
Service Code
|
CPT 85305
|
| Hospital Charge Code |
983377
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$195.18 |
| Max. Negotiated Rate |
$366.45 |
| Rate for Payer: Aetna Commercial |
$358.49
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$342.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$211.11
|
| Rate for Payer: Cash Price |
$114.90
|
| Rate for Payer: Cigna Commercial |
$366.45
|
| Rate for Payer: Health EOS Commercial |
$354.50
|
| Rate for Payer: HFN Commercial |
$366.45
|
| Rate for Payer: Multiplan Commercial |
$318.66
|
| Rate for Payer: Preferred Network Access Commercial |
$366.45
|
| Rate for Payer: Quartz Beloit One Network |
$195.18
|
| Rate for Payer: Quartz Commercial |
$238.99
|
| Rate for Payer: WEA Trust Commercial |
$219.08
|
| Rate for Payer: WPS Commercial |
$295.02
|
|
|
Protein S Antigen, Total
|
Professional
|
Both
|
$383.00
|
|
|
Service Code
|
CPT 85305
|
| Hospital Charge Code |
983377
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.07 |
| Max. Negotiated Rate |
$378.40 |
| Rate for Payer: Aetna Commercial |
$378.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$342.56
|
| Rate for Payer: Aetna Managed Medicare |
$12.07
|
| Rate for Payer: Anthem Medicare Advantage |
$12.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$12.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$12.07
|
| Rate for Payer: Cash Price |
$114.90
|
| Rate for Payer: Cash Price |
$114.90
|
| Rate for Payer: Cigna Commercial |
$378.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$199.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12.07
|
| Rate for Payer: Health EOS Commercial |
$362.47
|
| Rate for Payer: HFN Commercial |
$378.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$42.62
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$42.62
|
| Rate for Payer: Independent Care Health Plan Medicare |
$12.07
|
| Rate for Payer: Multiplan Commercial |
$318.66
|
| Rate for Payer: NAPHCARE Commercial |
$18.11
|
| Rate for Payer: Preferred Network Access Commercial |
$378.40
|
| Rate for Payer: Quartz Beloit One Network |
$175.26
|
| Rate for Payer: Quartz Commercial |
$227.04
|
| Rate for Payer: Quartz Medicare Advantage |
$12.07
|
| Rate for Payer: The Alliance Commercial |
$47.69
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.07
|
| Rate for Payer: WEA Trust Commercial |
$219.08
|
| Rate for Payer: WPS Commercial |
$53.13
|
|
|
Protein S Antigen, Total
|
Facility
|
OP
|
$383.00
|
|
|
Service Code
|
CPT 85305
|
| Hospital Charge Code |
983377
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.07 |
| Max. Negotiated Rate |
$366.45 |
| Rate for Payer: Aetna Commercial |
$358.49
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$342.56
|
| Rate for Payer: Aetna Managed Medicare |
$12.07
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$45.28
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$21.13
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$20.04
|
| Rate for Payer: Anthem Medicare Advantage |
$12.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$211.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$12.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$12.07
|
| Rate for Payer: Cash Price |
$114.90
|
| Rate for Payer: Cash Price |
$114.90
|
| Rate for Payer: Cigna Commercial |
$366.45
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$12.07
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$222.91
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$12.07
|
| Rate for Payer: Health EOS Commercial |
$354.50
|
| Rate for Payer: HFN Commercial |
$366.45
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$44.92
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$12.07
|
| Rate for Payer: Independent Care Health Plan Medicare |
$12.07
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$12.07
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$12.07
|
| Rate for Payer: Multiplan Commercial |
$318.66
|
| Rate for Payer: NAPHCARE Commercial |
$18.11
|
| Rate for Payer: Preferred Network Access Commercial |
$366.45
|
| Rate for Payer: Quartz Beloit One Network |
$195.18
|
| Rate for Payer: Quartz Commercial |
$258.91
|
| Rate for Payer: Quartz Medicare Advantage |
$12.07
|
| Rate for Payer: The Alliance Commercial |
$48.30
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.07
|
| Rate for Payer: United Healthcare PPO |
$298.74
|
| Rate for Payer: WEA Trust Commercial |
$219.08
|
| Rate for Payer: Wellcare Medicare |
$12.07
|
| Rate for Payer: WPS Commercial |
$295.02
|
|
|
Protein S Antigen, Total & Free
|
Professional
|
Both
|
$383.00
|
|
|
Service Code
|
CPT 85305
|
| Hospital Charge Code |
983378
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.07 |
| Max. Negotiated Rate |
$378.40 |
| Rate for Payer: Aetna Commercial |
$378.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$342.56
|
| Rate for Payer: Aetna Managed Medicare |
$12.07
|
| Rate for Payer: Anthem Medicare Advantage |
$12.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$12.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$12.07
|
| Rate for Payer: Cash Price |
$114.90
|
| Rate for Payer: Cash Price |
$114.90
|
| Rate for Payer: Cigna Commercial |
$378.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$199.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12.07
|
| Rate for Payer: Health EOS Commercial |
$362.47
|
| Rate for Payer: HFN Commercial |
$378.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$42.62
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$42.62
|
| Rate for Payer: Independent Care Health Plan Medicare |
$12.07
|
| Rate for Payer: Multiplan Commercial |
$318.66
|
| Rate for Payer: NAPHCARE Commercial |
$18.11
|
| Rate for Payer: Preferred Network Access Commercial |
$378.40
|
| Rate for Payer: Quartz Beloit One Network |
$175.26
|
| Rate for Payer: Quartz Commercial |
$227.04
|
| Rate for Payer: Quartz Medicare Advantage |
$12.07
|
| Rate for Payer: The Alliance Commercial |
$47.69
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.07
|
| Rate for Payer: WEA Trust Commercial |
$219.08
|
| Rate for Payer: WPS Commercial |
$53.13
|
|
|
Protein S Antigen, Total & Free
|
Facility
|
IP
|
$383.00
|
|
|
Service Code
|
CPT 85305
|
| Hospital Charge Code |
983378
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$195.18 |
| Max. Negotiated Rate |
$366.45 |
| Rate for Payer: Aetna Commercial |
$358.49
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$342.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$211.11
|
| Rate for Payer: Cash Price |
$114.90
|
| Rate for Payer: Cigna Commercial |
$366.45
|
| Rate for Payer: Health EOS Commercial |
$354.50
|
| Rate for Payer: HFN Commercial |
$366.45
|
| Rate for Payer: Multiplan Commercial |
$318.66
|
| Rate for Payer: Preferred Network Access Commercial |
$366.45
|
| Rate for Payer: Quartz Beloit One Network |
$195.18
|
| Rate for Payer: Quartz Commercial |
$238.99
|
| Rate for Payer: WEA Trust Commercial |
$219.08
|
| Rate for Payer: WPS Commercial |
$295.02
|
|
|
Protein S Antigen, Total & Free
|
Facility
|
OP
|
$383.00
|
|
|
Service Code
|
CPT 85305
|
| Hospital Charge Code |
983378
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.07 |
| Max. Negotiated Rate |
$366.45 |
| Rate for Payer: Aetna Commercial |
$358.49
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$342.56
|
| Rate for Payer: Aetna Managed Medicare |
$12.07
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$45.28
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$21.13
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$20.04
|
| Rate for Payer: Anthem Medicare Advantage |
$12.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$211.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$12.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$12.07
|
| Rate for Payer: Cash Price |
$114.90
|
| Rate for Payer: Cash Price |
$114.90
|
| Rate for Payer: Cigna Commercial |
$366.45
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$12.07
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$222.91
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$12.07
|
| Rate for Payer: Health EOS Commercial |
$354.50
|
| Rate for Payer: HFN Commercial |
$366.45
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$44.92
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$12.07
|
| Rate for Payer: Independent Care Health Plan Medicare |
$12.07
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$12.07
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$12.07
|
| Rate for Payer: Multiplan Commercial |
$318.66
|
| Rate for Payer: NAPHCARE Commercial |
$18.11
|
| Rate for Payer: Preferred Network Access Commercial |
$366.45
|
| Rate for Payer: Quartz Beloit One Network |
$195.18
|
| Rate for Payer: Quartz Commercial |
$258.91
|
| Rate for Payer: Quartz Medicare Advantage |
$12.07
|
| Rate for Payer: The Alliance Commercial |
$48.30
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.07
|
| Rate for Payer: United Healthcare PPO |
$298.74
|
| Rate for Payer: WEA Trust Commercial |
$219.08
|
| Rate for Payer: Wellcare Medicare |
$12.07
|
| Rate for Payer: WPS Commercial |
$295.02
|
|
