|
Protein S Free
|
Facility
|
OP
|
$190.00
|
|
|
Service Code
|
CPT 85306
|
| Hospital Charge Code |
2942982
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.93 |
| Max. Negotiated Rate |
$181.79 |
| Rate for Payer: Aetna Commercial |
$177.84
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$169.94
|
| 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 |
$104.73
|
| 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 |
$57.00
|
| Rate for Payer: Cash Price |
$57.00
|
| Rate for Payer: Cigna Commercial |
$181.79
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$15.93
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$110.58
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$15.93
|
| Rate for Payer: Health EOS Commercial |
$175.86
|
| Rate for Payer: HFN Commercial |
$181.79
|
| 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 |
$158.08
|
| Rate for Payer: NAPHCARE Commercial |
$23.90
|
| Rate for Payer: Preferred Network Access Commercial |
$181.79
|
| Rate for Payer: Quartz Beloit One Network |
$96.82
|
| Rate for Payer: Quartz Commercial |
$128.44
|
| 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 |
$148.20
|
| Rate for Payer: WEA Trust Commercial |
$108.68
|
| Rate for Payer: Wellcare Medicare |
$15.93
|
| Rate for Payer: WPS Commercial |
$146.36
|
|
|
Protein S Free
|
Professional
|
Both
|
$190.00
|
|
|
Service Code
|
CPT 85306
|
| Hospital Charge Code |
2942982
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.93 |
| Max. Negotiated Rate |
$187.72 |
| Rate for Payer: Aetna Commercial |
$187.72
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$169.94
|
| 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 |
$57.00
|
| Rate for Payer: Cash Price |
$57.00
|
| Rate for Payer: Cigna Commercial |
$187.72
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$98.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$15.93
|
| Rate for Payer: Health EOS Commercial |
$179.82
|
| Rate for Payer: HFN Commercial |
$187.72
|
| 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 |
$158.08
|
| Rate for Payer: NAPHCARE Commercial |
$23.90
|
| Rate for Payer: Preferred Network Access Commercial |
$187.72
|
| Rate for Payer: Quartz Beloit One Network |
$86.94
|
| Rate for Payer: Quartz Commercial |
$112.63
|
| 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 |
$108.68
|
| Rate for Payer: WPS Commercial |
$70.10
|
|
|
Protein S Free
|
Facility
|
IP
|
$190.00
|
|
|
Service Code
|
CPT 85306
|
| Hospital Charge Code |
2942982
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$96.82 |
| Max. Negotiated Rate |
$181.79 |
| Rate for Payer: Aetna Commercial |
$177.84
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$169.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$104.73
|
| Rate for Payer: Cash Price |
$57.00
|
| Rate for Payer: Cigna Commercial |
$181.79
|
| Rate for Payer: Health EOS Commercial |
$175.86
|
| Rate for Payer: HFN Commercial |
$181.79
|
| Rate for Payer: Multiplan Commercial |
$158.08
|
| Rate for Payer: Preferred Network Access Commercial |
$181.79
|
| Rate for Payer: Quartz Beloit One Network |
$96.82
|
| Rate for Payer: Quartz Commercial |
$118.56
|
| Rate for Payer: WEA Trust Commercial |
$108.68
|
| Rate for Payer: WPS Commercial |
$146.36
|
|
|
Protein Total
|
Facility
|
OP
|
$77.00
|
|
|
Service Code
|
CPT 84155
|
| Hospital Charge Code |
633818
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.82 |
| Max. Negotiated Rate |
$73.67 |
| Rate for Payer: Aetna Commercial |
$72.07
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$68.87
|
| 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 |
$42.44
|
| 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 |
$23.10
|
| Rate for Payer: Cash Price |
$23.10
|
| Rate for Payer: Cigna Commercial |
$73.67
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$3.82
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$44.81
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$3.82
|
| Rate for Payer: Health EOS Commercial |
$71.27
|
| Rate for Payer: HFN Commercial |
$73.67
|
| 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 |
$64.06
|
| Rate for Payer: NAPHCARE Commercial |
$5.73
|
| Rate for Payer: Preferred Network Access Commercial |
$73.67
|
| Rate for Payer: Quartz Beloit One Network |
$39.24
|
| Rate for Payer: Quartz Commercial |
$52.05
|
| 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 |
$60.06
|
| Rate for Payer: WEA Trust Commercial |
$44.04
|
| Rate for Payer: Wellcare Medicare |
$3.82
|
| Rate for Payer: WPS Commercial |
$59.31
|
|
|
Protein Total
|
Professional
|
Both
|
$77.00
|
|
|
Service Code
|
CPT 84155
|
| Hospital Charge Code |
633818
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.82 |
| Max. Negotiated Rate |
$76.08 |
| Rate for Payer: Aetna Commercial |
$76.08
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$68.87
|
| 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 |
$23.10
|
| Rate for Payer: Cash Price |
$23.10
|
| Rate for Payer: Cigna Commercial |
$76.08
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$40.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3.82
|
| Rate for Payer: Health EOS Commercial |
$72.87
|
| Rate for Payer: HFN Commercial |
$76.08
|
| 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 |
$64.06
|
| Rate for Payer: NAPHCARE Commercial |
$5.73
|
| Rate for Payer: Preferred Network Access Commercial |
$76.08
|
| Rate for Payer: Quartz Beloit One Network |
$35.24
|
| Rate for Payer: Quartz Commercial |
$45.65
|
| 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 |
$44.04
|
| Rate for Payer: WPS Commercial |
$16.79
|
|
|
Protein Total
|
Facility
|
IP
|
$77.00
|
|
|
Service Code
|
CPT 84155
|
| Hospital Charge Code |
633818
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$39.24 |
| Max. Negotiated Rate |
$73.67 |
| Rate for Payer: Aetna Commercial |
$72.07
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$68.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$42.44
|
| Rate for Payer: Cash Price |
$23.10
|
| Rate for Payer: Cigna Commercial |
$73.67
|
| Rate for Payer: Health EOS Commercial |
$71.27
|
| Rate for Payer: HFN Commercial |
$73.67
|
| Rate for Payer: Multiplan Commercial |
$64.06
|
| Rate for Payer: Preferred Network Access Commercial |
$73.67
|
| Rate for Payer: Quartz Beloit One Network |
$39.24
|
| Rate for Payer: Quartz Commercial |
$48.05
|
| Rate for Payer: WEA Trust Commercial |
$44.04
|
| Rate for Payer: WPS Commercial |
$59.31
|
|
|
Protein, Total, Pericardial Fluid
|
Professional
|
Both
|
$52.00
|
|
|
Service Code
|
CPT 84157
|
| Hospital Charge Code |
3154859
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.16 |
| Max. Negotiated Rate |
$51.38 |
| Rate for Payer: Aetna Commercial |
$51.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$46.51
|
| Rate for Payer: Aetna Managed Medicare |
$4.16
|
| Rate for Payer: Anthem Medicare Advantage |
$4.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$4.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$4.16
|
| Rate for Payer: Cash Price |
$15.60
|
| Rate for Payer: Cash Price |
$15.60
|
| Rate for Payer: Cigna Commercial |
$51.38
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$27.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4.16
|
| Rate for Payer: Health EOS Commercial |
$49.21
|
| Rate for Payer: HFN Commercial |
$51.38
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$14.68
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$14.68
|
| Rate for Payer: Independent Care Health Plan Medicare |
$4.16
|
| Rate for Payer: Multiplan Commercial |
$43.26
|
| Rate for Payer: NAPHCARE Commercial |
$6.24
|
| Rate for Payer: Preferred Network Access Commercial |
$51.38
|
| Rate for Payer: Quartz Beloit One Network |
$23.80
|
| Rate for Payer: Quartz Commercial |
$30.83
|
| Rate for Payer: Quartz Medicare Advantage |
$4.16
|
| Rate for Payer: The Alliance Commercial |
$16.43
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4.16
|
| Rate for Payer: WEA Trust Commercial |
$29.74
|
| Rate for Payer: WPS Commercial |
$18.30
|
|
|
Protein, Total, Pericardial Fluid
|
Facility
|
OP
|
$52.00
|
|
|
Service Code
|
CPT 84157
|
| Hospital Charge Code |
3154859
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.16 |
| Max. Negotiated Rate |
$49.75 |
| Rate for Payer: Aetna Commercial |
$48.67
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$46.51
|
| Rate for Payer: Aetna Managed Medicare |
$4.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$15.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$7.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$6.91
|
| Rate for Payer: Anthem Medicare Advantage |
$4.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$28.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$4.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$4.16
|
| Rate for Payer: Cash Price |
$15.60
|
| Rate for Payer: Cash Price |
$15.60
|
| Rate for Payer: Cigna Commercial |
$49.75
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$4.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$30.26
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$4.16
|
| Rate for Payer: Health EOS Commercial |
$48.13
|
| Rate for Payer: HFN Commercial |
$49.75
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$15.48
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$4.16
|
| Rate for Payer: Independent Care Health Plan Medicare |
$4.16
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$4.16
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$4.16
|
| Rate for Payer: Multiplan Commercial |
$43.26
|
| Rate for Payer: NAPHCARE Commercial |
$6.24
|
| Rate for Payer: Preferred Network Access Commercial |
$49.75
|
| Rate for Payer: Quartz Beloit One Network |
$26.50
|
| Rate for Payer: Quartz Commercial |
$35.15
|
| Rate for Payer: Quartz Medicare Advantage |
$4.16
|
| Rate for Payer: The Alliance Commercial |
$16.64
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4.16
|
| Rate for Payer: United Healthcare PPO |
$40.56
|
| Rate for Payer: WEA Trust Commercial |
$29.74
|
| Rate for Payer: Wellcare Medicare |
$4.16
|
| Rate for Payer: WPS Commercial |
$40.06
|
|
|
Protein, Total, Pericardial Fluid
|
Facility
|
IP
|
$52.00
|
|
|
Service Code
|
CPT 84157
|
| Hospital Charge Code |
3154859
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$26.50 |
| Max. Negotiated Rate |
$49.75 |
| Rate for Payer: Aetna Commercial |
$48.67
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$46.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$28.66
|
| Rate for Payer: Cash Price |
$15.60
|
| Rate for Payer: Cigna Commercial |
$49.75
|
| Rate for Payer: Health EOS Commercial |
$48.13
|
| Rate for Payer: HFN Commercial |
$49.75
|
| Rate for Payer: Multiplan Commercial |
$43.26
|
| Rate for Payer: Preferred Network Access Commercial |
$49.75
|
| Rate for Payer: Quartz Beloit One Network |
$26.50
|
| Rate for Payer: Quartz Commercial |
$32.45
|
| Rate for Payer: WEA Trust Commercial |
$29.74
|
| Rate for Payer: WPS Commercial |
$40.06
|
|
|
Protein, Total, Peritoneal Fluid
|
Professional
|
Both
|
$52.00
|
|
|
Service Code
|
CPT 84157
|
| Hospital Charge Code |
3154858
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.16 |
| Max. Negotiated Rate |
$51.38 |
| Rate for Payer: Aetna Commercial |
$51.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$46.51
|
| Rate for Payer: Aetna Managed Medicare |
$4.16
|
| Rate for Payer: Anthem Medicare Advantage |
$4.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$4.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$4.16
|
| Rate for Payer: Cash Price |
$15.60
|
| Rate for Payer: Cash Price |
$15.60
|
| Rate for Payer: Cigna Commercial |
$51.38
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$27.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4.16
|
| Rate for Payer: Health EOS Commercial |
$49.21
|
| Rate for Payer: HFN Commercial |
$51.38
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$14.68
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$14.68
|
| Rate for Payer: Independent Care Health Plan Medicare |
$4.16
|
| Rate for Payer: Multiplan Commercial |
$43.26
|
| Rate for Payer: NAPHCARE Commercial |
$6.24
|
| Rate for Payer: Preferred Network Access Commercial |
$51.38
|
| Rate for Payer: Quartz Beloit One Network |
$23.80
|
| Rate for Payer: Quartz Commercial |
$30.83
|
| Rate for Payer: Quartz Medicare Advantage |
$4.16
|
| Rate for Payer: The Alliance Commercial |
$16.43
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4.16
|
| Rate for Payer: WEA Trust Commercial |
$29.74
|
| Rate for Payer: WPS Commercial |
$18.30
|
|
|
Protein, Total, Peritoneal Fluid
|
Facility
|
IP
|
$52.00
|
|
|
Service Code
|
CPT 84157
|
| Hospital Charge Code |
3154858
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$26.50 |
| Max. Negotiated Rate |
$49.75 |
| Rate for Payer: Aetna Commercial |
$48.67
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$46.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$28.66
|
| Rate for Payer: Cash Price |
$15.60
|
| Rate for Payer: Cigna Commercial |
$49.75
|
| Rate for Payer: Health EOS Commercial |
$48.13
|
| Rate for Payer: HFN Commercial |
$49.75
|
| Rate for Payer: Multiplan Commercial |
$43.26
|
| Rate for Payer: Preferred Network Access Commercial |
$49.75
|
| Rate for Payer: Quartz Beloit One Network |
$26.50
|
| Rate for Payer: Quartz Commercial |
$32.45
|
| Rate for Payer: WEA Trust Commercial |
$29.74
|
| Rate for Payer: WPS Commercial |
$40.06
|
|
|
Protein, Total, Peritoneal Fluid
|
Facility
|
OP
|
$52.00
|
|
|
Service Code
|
CPT 84157
|
| Hospital Charge Code |
3154858
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.16 |
| Max. Negotiated Rate |
$49.75 |
| Rate for Payer: Aetna Commercial |
$48.67
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$46.51
|
| Rate for Payer: Aetna Managed Medicare |
$4.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$15.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$7.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$6.91
|
| Rate for Payer: Anthem Medicare Advantage |
$4.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$28.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$4.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$4.16
|
| Rate for Payer: Cash Price |
$15.60
|
| Rate for Payer: Cash Price |
$15.60
|
| Rate for Payer: Cigna Commercial |
$49.75
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$4.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$30.26
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$4.16
|
| Rate for Payer: Health EOS Commercial |
$48.13
|
| Rate for Payer: HFN Commercial |
$49.75
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$15.48
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$4.16
|
| Rate for Payer: Independent Care Health Plan Medicare |
$4.16
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$4.16
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$4.16
|
| Rate for Payer: Multiplan Commercial |
$43.26
|
| Rate for Payer: NAPHCARE Commercial |
$6.24
|
| Rate for Payer: Preferred Network Access Commercial |
$49.75
|
| Rate for Payer: Quartz Beloit One Network |
$26.50
|
| Rate for Payer: Quartz Commercial |
$35.15
|
| Rate for Payer: Quartz Medicare Advantage |
$4.16
|
| Rate for Payer: The Alliance Commercial |
$16.64
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4.16
|
| Rate for Payer: United Healthcare PPO |
$40.56
|
| Rate for Payer: WEA Trust Commercial |
$29.74
|
| Rate for Payer: Wellcare Medicare |
$4.16
|
| Rate for Payer: WPS Commercial |
$40.06
|
|
|
Protein, Total, Pleural Fluid
|
Professional
|
Both
|
$52.00
|
|
|
Service Code
|
CPT 84157
|
| Hospital Charge Code |
3154854
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.16 |
| Max. Negotiated Rate |
$51.38 |
| Rate for Payer: Aetna Commercial |
$51.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$46.51
|
| Rate for Payer: Aetna Managed Medicare |
$4.16
|
| Rate for Payer: Anthem Medicare Advantage |
$4.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$4.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$4.16
|
| Rate for Payer: Cash Price |
$15.60
|
| Rate for Payer: Cash Price |
$15.60
|
| Rate for Payer: Cigna Commercial |
$51.38
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$27.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4.16
|
| Rate for Payer: Health EOS Commercial |
$49.21
|
| Rate for Payer: HFN Commercial |
$51.38
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$14.68
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$14.68
|
| Rate for Payer: Independent Care Health Plan Medicare |
$4.16
|
| Rate for Payer: Multiplan Commercial |
$43.26
|
| Rate for Payer: NAPHCARE Commercial |
$6.24
|
| Rate for Payer: Preferred Network Access Commercial |
$51.38
|
| Rate for Payer: Quartz Beloit One Network |
$23.80
|
| Rate for Payer: Quartz Commercial |
$30.83
|
| Rate for Payer: Quartz Medicare Advantage |
$4.16
|
| Rate for Payer: The Alliance Commercial |
$16.43
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4.16
|
| Rate for Payer: WEA Trust Commercial |
$29.74
|
| Rate for Payer: WPS Commercial |
$18.30
|
|
|
Protein, Total, Pleural Fluid
|
Facility
|
OP
|
$52.00
|
|
|
Service Code
|
CPT 84157
|
| Hospital Charge Code |
3154854
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.16 |
| Max. Negotiated Rate |
$49.75 |
| Rate for Payer: Aetna Commercial |
$48.67
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$46.51
|
| Rate for Payer: Aetna Managed Medicare |
$4.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$15.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$7.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$6.91
|
| Rate for Payer: Anthem Medicare Advantage |
$4.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$28.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$4.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$4.16
|
| Rate for Payer: Cash Price |
$15.60
|
| Rate for Payer: Cash Price |
$15.60
|
| Rate for Payer: Cigna Commercial |
$49.75
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$4.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$30.26
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$4.16
|
| Rate for Payer: Health EOS Commercial |
$48.13
|
| Rate for Payer: HFN Commercial |
$49.75
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$15.48
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$4.16
|
| Rate for Payer: Independent Care Health Plan Medicare |
$4.16
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$4.16
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$4.16
|
| Rate for Payer: Multiplan Commercial |
$43.26
|
| Rate for Payer: NAPHCARE Commercial |
$6.24
|
| Rate for Payer: Preferred Network Access Commercial |
$49.75
|
| Rate for Payer: Quartz Beloit One Network |
$26.50
|
| Rate for Payer: Quartz Commercial |
$35.15
|
| Rate for Payer: Quartz Medicare Advantage |
$4.16
|
| Rate for Payer: The Alliance Commercial |
$16.64
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4.16
|
| Rate for Payer: United Healthcare PPO |
$40.56
|
| Rate for Payer: WEA Trust Commercial |
$29.74
|
| Rate for Payer: Wellcare Medicare |
$4.16
|
| Rate for Payer: WPS Commercial |
$40.06
|
|
|
Protein, Total, Pleural Fluid
|
Facility
|
IP
|
$52.00
|
|
|
Service Code
|
CPT 84157
|
| Hospital Charge Code |
3154854
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$26.50 |
| Max. Negotiated Rate |
$49.75 |
| Rate for Payer: Aetna Commercial |
$48.67
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$46.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$28.66
|
| Rate for Payer: Cash Price |
$15.60
|
| Rate for Payer: Cigna Commercial |
$49.75
|
| Rate for Payer: Health EOS Commercial |
$48.13
|
| Rate for Payer: HFN Commercial |
$49.75
|
| Rate for Payer: Multiplan Commercial |
$43.26
|
| Rate for Payer: Preferred Network Access Commercial |
$49.75
|
| Rate for Payer: Quartz Beloit One Network |
$26.50
|
| Rate for Payer: Quartz Commercial |
$32.45
|
| Rate for Payer: WEA Trust Commercial |
$29.74
|
| Rate for Payer: WPS Commercial |
$40.06
|
|
|
Protein, Total, Synovial Fluid
|
Facility
|
IP
|
$52.00
|
|
|
Service Code
|
CPT 84157
|
| Hospital Charge Code |
3154860
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$26.50 |
| Max. Negotiated Rate |
$49.75 |
| Rate for Payer: Aetna Commercial |
$48.67
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$46.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$28.66
|
| Rate for Payer: Cash Price |
$15.60
|
| Rate for Payer: Cigna Commercial |
$49.75
|
| Rate for Payer: Health EOS Commercial |
$48.13
|
| Rate for Payer: HFN Commercial |
$49.75
|
| Rate for Payer: Multiplan Commercial |
$43.26
|
| Rate for Payer: Preferred Network Access Commercial |
$49.75
|
| Rate for Payer: Quartz Beloit One Network |
$26.50
|
| Rate for Payer: Quartz Commercial |
$32.45
|
| Rate for Payer: WEA Trust Commercial |
$29.74
|
| Rate for Payer: WPS Commercial |
$40.06
|
|
|
Protein, Total, Synovial Fluid
|
Facility
|
OP
|
$52.00
|
|
|
Service Code
|
CPT 84157
|
| Hospital Charge Code |
3154860
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.16 |
| Max. Negotiated Rate |
$49.75 |
| Rate for Payer: Aetna Commercial |
$48.67
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$46.51
|
| Rate for Payer: Aetna Managed Medicare |
$4.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$15.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$7.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$6.91
|
| Rate for Payer: Anthem Medicare Advantage |
$4.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$28.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$4.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$4.16
|
| Rate for Payer: Cash Price |
$15.60
|
| Rate for Payer: Cash Price |
$15.60
|
| Rate for Payer: Cigna Commercial |
$49.75
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$4.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$30.26
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$4.16
|
| Rate for Payer: Health EOS Commercial |
$48.13
|
| Rate for Payer: HFN Commercial |
$49.75
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$15.48
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$4.16
|
| Rate for Payer: Independent Care Health Plan Medicare |
$4.16
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$4.16
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$4.16
|
| Rate for Payer: Multiplan Commercial |
$43.26
|
| Rate for Payer: NAPHCARE Commercial |
$6.24
|
| Rate for Payer: Preferred Network Access Commercial |
$49.75
|
| Rate for Payer: Quartz Beloit One Network |
$26.50
|
| Rate for Payer: Quartz Commercial |
$35.15
|
| Rate for Payer: Quartz Medicare Advantage |
$4.16
|
| Rate for Payer: The Alliance Commercial |
$16.64
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4.16
|
| Rate for Payer: United Healthcare PPO |
$40.56
|
| Rate for Payer: WEA Trust Commercial |
$29.74
|
| Rate for Payer: Wellcare Medicare |
$4.16
|
| Rate for Payer: WPS Commercial |
$40.06
|
|
|
Protein, Total, Synovial Fluid
|
Professional
|
Both
|
$52.00
|
|
|
Service Code
|
CPT 84157
|
| Hospital Charge Code |
3154860
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.16 |
| Max. Negotiated Rate |
$51.38 |
| Rate for Payer: Aetna Commercial |
$51.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$46.51
|
| Rate for Payer: Aetna Managed Medicare |
$4.16
|
| Rate for Payer: Anthem Medicare Advantage |
$4.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$4.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$4.16
|
| Rate for Payer: Cash Price |
$15.60
|
| Rate for Payer: Cash Price |
$15.60
|
| Rate for Payer: Cigna Commercial |
$51.38
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$27.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4.16
|
| Rate for Payer: Health EOS Commercial |
$49.21
|
| Rate for Payer: HFN Commercial |
$51.38
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$14.68
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$14.68
|
| Rate for Payer: Independent Care Health Plan Medicare |
$4.16
|
| Rate for Payer: Multiplan Commercial |
$43.26
|
| Rate for Payer: NAPHCARE Commercial |
$6.24
|
| Rate for Payer: Preferred Network Access Commercial |
$51.38
|
| Rate for Payer: Quartz Beloit One Network |
$23.80
|
| Rate for Payer: Quartz Commercial |
$30.83
|
| Rate for Payer: Quartz Medicare Advantage |
$4.16
|
| Rate for Payer: The Alliance Commercial |
$16.43
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4.16
|
| Rate for Payer: WEA Trust Commercial |
$29.74
|
| Rate for Payer: WPS Commercial |
$18.30
|
|
|
Protein Urine
|
Facility
|
IP
|
$77.00
|
|
|
Service Code
|
CPT 84156
|
| Hospital Charge Code |
633819
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$39.24 |
| Max. Negotiated Rate |
$73.67 |
| Rate for Payer: Aetna Commercial |
$72.07
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$68.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$42.44
|
| Rate for Payer: Cash Price |
$23.10
|
| Rate for Payer: Cigna Commercial |
$73.67
|
| Rate for Payer: Health EOS Commercial |
$71.27
|
| Rate for Payer: HFN Commercial |
$73.67
|
| Rate for Payer: Multiplan Commercial |
$64.06
|
| Rate for Payer: Preferred Network Access Commercial |
$73.67
|
| Rate for Payer: Quartz Beloit One Network |
$39.24
|
| Rate for Payer: Quartz Commercial |
$48.05
|
| Rate for Payer: WEA Trust Commercial |
$44.04
|
| Rate for Payer: WPS Commercial |
$59.31
|
|
|
Protein Urine
|
Facility
|
OP
|
$77.00
|
|
|
Service Code
|
CPT 84156
|
| Hospital Charge Code |
633819
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.82 |
| Max. Negotiated Rate |
$73.67 |
| Rate for Payer: Aetna Commercial |
$72.07
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$68.87
|
| 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 |
$42.44
|
| 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 |
$23.10
|
| Rate for Payer: Cash Price |
$23.10
|
| Rate for Payer: Cigna Commercial |
$73.67
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$3.82
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$44.81
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$3.82
|
| Rate for Payer: Health EOS Commercial |
$71.27
|
| Rate for Payer: HFN Commercial |
$73.67
|
| 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 |
$64.06
|
| Rate for Payer: NAPHCARE Commercial |
$5.73
|
| Rate for Payer: Preferred Network Access Commercial |
$73.67
|
| Rate for Payer: Quartz Beloit One Network |
$39.24
|
| Rate for Payer: Quartz Commercial |
$52.05
|
| 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 |
$60.06
|
| Rate for Payer: WEA Trust Commercial |
$44.04
|
| Rate for Payer: Wellcare Medicare |
$3.82
|
| Rate for Payer: WPS Commercial |
$59.31
|
|
|
Protein Urine
|
Professional
|
Both
|
$77.00
|
|
|
Service Code
|
CPT 84156
|
| Hospital Charge Code |
633819
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.82 |
| Max. Negotiated Rate |
$76.08 |
| Rate for Payer: Aetna Commercial |
$76.08
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$68.87
|
| 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 |
$23.10
|
| Rate for Payer: Cash Price |
$23.10
|
| Rate for Payer: Cigna Commercial |
$76.08
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$40.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3.82
|
| Rate for Payer: Health EOS Commercial |
$72.87
|
| Rate for Payer: HFN Commercial |
$76.08
|
| 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 |
$64.06
|
| Rate for Payer: NAPHCARE Commercial |
$5.73
|
| Rate for Payer: Preferred Network Access Commercial |
$76.08
|
| Rate for Payer: Quartz Beloit One Network |
$35.24
|
| Rate for Payer: Quartz Commercial |
$45.65
|
| 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 |
$44.04
|
| Rate for Payer: WPS Commercial |
$16.79
|
|
|
Prothrombin (Factor II) 20210G -> A Mutation Analysis
|
Facility
|
IP
|
$1,081.00
|
|
|
Service Code
|
CPT 81240
|
| Hospital Charge Code |
983379
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$550.88 |
| Max. Negotiated Rate |
$1,034.30 |
| Rate for Payer: Aetna Commercial |
$1,011.82
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$966.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$595.85
|
| Rate for Payer: Cash Price |
$324.30
|
| Rate for Payer: Cigna Commercial |
$1,034.30
|
| Rate for Payer: Health EOS Commercial |
$1,000.57
|
| Rate for Payer: HFN Commercial |
$1,034.30
|
| Rate for Payer: Multiplan Commercial |
$899.39
|
| Rate for Payer: Preferred Network Access Commercial |
$1,034.30
|
| Rate for Payer: Quartz Beloit One Network |
$550.88
|
| Rate for Payer: Quartz Commercial |
$674.54
|
| Rate for Payer: WEA Trust Commercial |
$618.33
|
| Rate for Payer: WPS Commercial |
$832.69
|
|
|
Prothrombin (Factor II) 20210G -> A Mutation Analysis
|
Facility
|
OP
|
$1,081.00
|
|
|
Service Code
|
CPT 81240
|
| Hospital Charge Code |
983379
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$68.32 |
| Max. Negotiated Rate |
$1,034.30 |
| Rate for Payer: Aetna Commercial |
$1,011.82
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$966.85
|
| Rate for Payer: Aetna Managed Medicare |
$68.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$256.19
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$119.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$113.41
|
| Rate for Payer: Anthem Medicare Advantage |
$68.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$595.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$68.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$68.32
|
| Rate for Payer: Cash Price |
$324.30
|
| Rate for Payer: Cash Price |
$324.30
|
| Rate for Payer: Cigna Commercial |
$1,034.30
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$68.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$629.14
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$68.32
|
| Rate for Payer: Health EOS Commercial |
$1,000.57
|
| Rate for Payer: HFN Commercial |
$1,034.30
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$254.14
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$68.32
|
| Rate for Payer: Independent Care Health Plan Medicare |
$68.32
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$68.32
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$68.32
|
| Rate for Payer: Multiplan Commercial |
$899.39
|
| Rate for Payer: NAPHCARE Commercial |
$102.48
|
| Rate for Payer: Preferred Network Access Commercial |
$1,034.30
|
| Rate for Payer: Quartz Beloit One Network |
$550.88
|
| Rate for Payer: Quartz Commercial |
$730.76
|
| Rate for Payer: Quartz Medicare Advantage |
$68.32
|
| Rate for Payer: The Alliance Commercial |
$273.27
|
| Rate for Payer: United Healthcare Medicare Advantage |
$68.32
|
| Rate for Payer: United Healthcare PPO |
$843.18
|
| Rate for Payer: WEA Trust Commercial |
$618.33
|
| Rate for Payer: Wellcare Medicare |
$68.32
|
| Rate for Payer: WPS Commercial |
$832.69
|
|
|
Prothrombin (Factor II) 20210G -> A Mutation Analysis
|
Professional
|
Both
|
$1,081.00
|
|
|
Service Code
|
CPT 81240
|
| Hospital Charge Code |
983379
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$68.32 |
| Max. Negotiated Rate |
$1,068.03 |
| Rate for Payer: Aetna Commercial |
$1,068.03
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$966.85
|
| Rate for Payer: Aetna Managed Medicare |
$68.32
|
| Rate for Payer: Anthem Medicare Advantage |
$68.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$68.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$68.32
|
| Rate for Payer: Cash Price |
$324.30
|
| Rate for Payer: Cash Price |
$324.30
|
| Rate for Payer: Cigna Commercial |
$1,068.03
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$562.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$68.32
|
| Rate for Payer: Health EOS Commercial |
$1,023.06
|
| Rate for Payer: HFN Commercial |
$1,068.03
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$241.17
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$241.17
|
| Rate for Payer: Independent Care Health Plan Medicare |
$68.32
|
| Rate for Payer: Multiplan Commercial |
$899.39
|
| Rate for Payer: NAPHCARE Commercial |
$102.48
|
| Rate for Payer: Preferred Network Access Commercial |
$1,068.03
|
| Rate for Payer: Quartz Beloit One Network |
$494.67
|
| Rate for Payer: Quartz Commercial |
$640.82
|
| Rate for Payer: Quartz Medicare Advantage |
$68.32
|
| Rate for Payer: The Alliance Commercial |
$269.85
|
| Rate for Payer: United Healthcare Medicare Advantage |
$68.32
|
| Rate for Payer: WEA Trust Commercial |
$618.33
|
| Rate for Payer: WPS Commercial |
$300.60
|
|
|
Prothrombin Time
|
Professional
|
Both
|
$107.00
|
|
|
Service Code
|
CPT 85610
|
| Hospital Charge Code |
633793
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.46 |
| Max. Negotiated Rate |
$105.72 |
| Rate for Payer: Aetna Commercial |
$105.72
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$95.70
|
| Rate for Payer: Aetna Managed Medicare |
$4.46
|
| Rate for Payer: Anthem Medicare Advantage |
$4.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$4.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$4.46
|
| Rate for Payer: Cash Price |
$32.10
|
| Rate for Payer: Cash Price |
$32.10
|
| Rate for Payer: Cigna Commercial |
$105.72
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$55.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4.46
|
| Rate for Payer: Health EOS Commercial |
$101.26
|
| Rate for Payer: HFN Commercial |
$105.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$15.75
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$15.75
|
| Rate for Payer: Independent Care Health Plan Medicare |
$4.46
|
| Rate for Payer: Multiplan Commercial |
$89.02
|
| Rate for Payer: NAPHCARE Commercial |
$6.69
|
| Rate for Payer: Preferred Network Access Commercial |
$105.72
|
| Rate for Payer: Quartz Beloit One Network |
$48.96
|
| Rate for Payer: Quartz Commercial |
$63.43
|
| Rate for Payer: Quartz Medicare Advantage |
$4.46
|
| Rate for Payer: The Alliance Commercial |
$17.62
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4.46
|
| Rate for Payer: WEA Trust Commercial |
$61.20
|
| Rate for Payer: WPS Commercial |
$19.63
|
|
