|
ProtÈgÈ 9mm x 80mm 80cm
|
Professional
|
Both
|
$9,879.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
2548896
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,346.76 |
| Max. Negotiated Rate |
$9,385.05 |
| Rate for Payer: Aetna Commercial |
$9,385.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,495.94
|
| Rate for Payer: Cash Price |
$2,963.70
|
| Rate for Payer: Cigna Commercial |
$9,385.05
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$4,939.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,927.40
|
| Rate for Payer: Health EOS Commercial |
$8,989.89
|
| Rate for Payer: HFN Commercial |
$9,385.05
|
| Rate for Payer: Multiplan Commercial |
$7,903.20
|
| Rate for Payer: Preferred Network Access Commercial |
$9,385.05
|
| Rate for Payer: Quartz Beloit One Network |
$4,346.76
|
| Rate for Payer: Quartz Commercial |
$5,631.03
|
| Rate for Payer: The Alliance Commercial |
$4,939.50
|
| Rate for Payer: WEA Trust Commercial |
$5,433.45
|
| Rate for Payer: WPS Commercial |
$7,317.38
|
|
|
ProtÈgÈ 9mm x 80mm 80cm
|
Facility
|
OP
|
$9,879.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
2548896
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,766.12 |
| Max. Negotiated Rate |
$39,516.00 |
| Rate for Payer: Aetna Commercial |
$8,891.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,495.94
|
| Rate for Payer: Aetna Managed Medicare |
$2,766.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6,421.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,939.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,741.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,235.87
|
| Rate for Payer: Cash Price |
$2,963.70
|
| Rate for Payer: Cigna Commercial |
$9,088.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,528.29
|
| Rate for Payer: Health EOS Commercial |
$8,792.31
|
| Rate for Payer: HFN Commercial |
$9,088.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7,409.25
|
| Rate for Payer: Multiplan Commercial |
$7,903.20
|
| Rate for Payer: NAPHCARE Commercial |
$5,927.40
|
| Rate for Payer: Preferred Network Access Commercial |
$9,088.68
|
| Rate for Payer: Quartz Beloit One Network |
$4,840.71
|
| Rate for Payer: Quartz Commercial |
$6,421.35
|
| Rate for Payer: Quartz Medicare Advantage |
$5,927.40
|
| Rate for Payer: The Alliance Commercial |
$39,516.00
|
| Rate for Payer: WEA Trust Commercial |
$5,433.45
|
| Rate for Payer: WPS Commercial |
$7,317.38
|
|
|
ProtÈgÈ 9mm x 80mm 80cm
|
Facility
|
IP
|
$9,879.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
2548896
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,840.71 |
| Max. Negotiated Rate |
$9,088.68 |
| Rate for Payer: Aetna Commercial |
$8,891.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,495.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,235.87
|
| Rate for Payer: Cash Price |
$2,963.70
|
| Rate for Payer: Cigna Commercial |
$9,088.68
|
| Rate for Payer: Health EOS Commercial |
$8,792.31
|
| Rate for Payer: HFN Commercial |
$9,088.68
|
| Rate for Payer: Multiplan Commercial |
$7,903.20
|
| Rate for Payer: NAPHCARE Commercial |
$5,927.40
|
| Rate for Payer: Preferred Network Access Commercial |
$9,088.68
|
| Rate for Payer: Quartz Beloit One Network |
$4,840.71
|
| Rate for Payer: Quartz Commercial |
$5,927.40
|
| Rate for Payer: WEA Trust Commercial |
$5,433.45
|
| Rate for Payer: WPS Commercial |
$7,317.38
|
|
|
Protein 24 Hour Urine
|
Facility
|
OP
|
$101.00
|
|
|
Service Code
|
CPT 84156
|
| Hospital Charge Code |
633811
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.67 |
| Max. Negotiated Rate |
$92.92 |
| Rate for Payer: Aetna Commercial |
$90.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$86.86
|
| Rate for Payer: Aetna Managed Medicare |
$3.67
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$13.76
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$6.42
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$6.09
|
| Rate for Payer: Anthem Medicaid |
$3.79
|
| Rate for Payer: Anthem Medicare Advantage |
$3.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$53.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$3.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$3.67
|
| Rate for Payer: Cash Price |
$30.30
|
| Rate for Payer: Cash Price |
$30.30
|
| Rate for Payer: Cigna Commercial |
$92.92
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$3.67
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$3.79
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$56.52
|
| Rate for Payer: Dean Health Medicaid |
$3.79
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$3.67
|
| Rate for Payer: Health EOS Commercial |
$89.89
|
| Rate for Payer: HFN Commercial |
$92.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$13.65
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$3.67
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$3.79
|
| Rate for Payer: Independent Care Health Plan Medicare |
$3.67
|
| Rate for Payer: Managed Health Services Medicaid |
$3.94
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$3.67
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$3.67
|
| Rate for Payer: Multiplan Commercial |
$80.80
|
| Rate for Payer: NAPHCARE Commercial |
$5.50
|
| Rate for Payer: Preferred Network Access Commercial |
$92.92
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$3.79
|
| Rate for Payer: Quartz Beloit One Network |
$49.49
|
| Rate for Payer: Quartz Commercial |
$65.65
|
| Rate for Payer: Quartz Medicare Advantage |
$3.67
|
| Rate for Payer: The Alliance Commercial |
$14.68
|
| Rate for Payer: United Healthcare Medicaid |
$3.79
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3.67
|
| Rate for Payer: United Healthcare PPO |
$75.75
|
| Rate for Payer: WEA Trust Commercial |
$55.55
|
| Rate for Payer: Wellcare Medicare |
$3.67
|
| Rate for Payer: WMAP Medicaid |
$3.79
|
| Rate for Payer: WPS Commercial |
$74.81
|
|
|
Protein 24 Hour Urine
|
Facility
|
IP
|
$101.00
|
|
|
Service Code
|
CPT 84156
|
| Hospital Charge Code |
633811
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$49.49 |
| Max. Negotiated Rate |
$92.92 |
| Rate for Payer: Aetna Commercial |
$90.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$86.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$53.53
|
| Rate for Payer: Cash Price |
$30.30
|
| Rate for Payer: Cigna Commercial |
$92.92
|
| Rate for Payer: Health EOS Commercial |
$89.89
|
| Rate for Payer: HFN Commercial |
$92.92
|
| Rate for Payer: Multiplan Commercial |
$80.80
|
| Rate for Payer: NAPHCARE Commercial |
$60.60
|
| Rate for Payer: Preferred Network Access Commercial |
$92.92
|
| Rate for Payer: Quartz Beloit One Network |
$49.49
|
| Rate for Payer: Quartz Commercial |
$60.60
|
| Rate for Payer: WEA Trust Commercial |
$55.55
|
| Rate for Payer: WPS Commercial |
$74.81
|
|
|
Protein 24 Hour Urine
|
Professional
|
Both
|
$101.00
|
|
|
Service Code
|
CPT 84156
|
| Hospital Charge Code |
633811
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.96 |
| Max. Negotiated Rate |
$95.95 |
| Rate for Payer: Aetna Commercial |
$95.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$86.86
|
| Rate for Payer: Cash Price |
$30.30
|
| Rate for Payer: Cash Price |
$30.30
|
| Rate for Payer: Cigna Commercial |
$95.95
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$50.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$60.60
|
| Rate for Payer: Health EOS Commercial |
$91.91
|
| Rate for Payer: HFN Commercial |
$95.95
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$12.96
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$12.96
|
| Rate for Payer: Multiplan Commercial |
$80.80
|
| Rate for Payer: Preferred Network Access Commercial |
$95.95
|
| Rate for Payer: Quartz Beloit One Network |
$44.44
|
| Rate for Payer: Quartz Commercial |
$57.57
|
| Rate for Payer: The Alliance Commercial |
$50.50
|
| Rate for Payer: WEA Trust Commercial |
$55.55
|
| Rate for Payer: WPS Commercial |
$74.81
|
|
|
Proteinase-3 Ab
|
Facility
|
OP
|
$120.00
|
|
|
Service Code
|
CPT 86021
|
| Hospital Charge Code |
5438977
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.05 |
| Max. Negotiated Rate |
$110.40 |
| Rate for Payer: Aetna Commercial |
$108.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$103.20
|
| Rate for Payer: Aetna Managed Medicare |
$15.05
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$56.44
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$26.34
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$24.98
|
| Rate for Payer: Anthem Medicaid |
$15.55
|
| Rate for Payer: Anthem Medicare Advantage |
$15.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$63.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$15.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$15.05
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Cigna Commercial |
$110.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$15.05
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$15.55
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$67.15
|
| Rate for Payer: Dean Health Medicaid |
$15.55
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$15.05
|
| Rate for Payer: Health EOS Commercial |
$106.80
|
| Rate for Payer: HFN Commercial |
$110.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$55.99
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$15.05
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$15.55
|
| Rate for Payer: Independent Care Health Plan Medicare |
$15.05
|
| Rate for Payer: Managed Health Services Medicaid |
$16.17
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$15.05
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$15.05
|
| Rate for Payer: Multiplan Commercial |
$96.00
|
| Rate for Payer: NAPHCARE Commercial |
$22.58
|
| Rate for Payer: Preferred Network Access Commercial |
$110.40
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$15.55
|
| Rate for Payer: Quartz Beloit One Network |
$58.80
|
| Rate for Payer: Quartz Commercial |
$78.00
|
| Rate for Payer: Quartz Medicare Advantage |
$15.05
|
| Rate for Payer: The Alliance Commercial |
$60.20
|
| Rate for Payer: United Healthcare Medicaid |
$15.55
|
| Rate for Payer: United Healthcare Medicare Advantage |
$15.05
|
| Rate for Payer: United Healthcare PPO |
$90.00
|
| Rate for Payer: WEA Trust Commercial |
$66.00
|
| Rate for Payer: Wellcare Medicare |
$15.05
|
| Rate for Payer: WMAP Medicaid |
$15.55
|
| Rate for Payer: WPS Commercial |
$88.88
|
|
|
Proteinase-3 Ab
|
Facility
|
IP
|
$120.00
|
|
|
Service Code
|
CPT 86021
|
| Hospital Charge Code |
5438977
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$58.80 |
| Max. Negotiated Rate |
$110.40 |
| Rate for Payer: Aetna Commercial |
$108.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$103.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$63.60
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Cigna Commercial |
$110.40
|
| Rate for Payer: Health EOS Commercial |
$106.80
|
| Rate for Payer: HFN Commercial |
$110.40
|
| Rate for Payer: Multiplan Commercial |
$96.00
|
| Rate for Payer: NAPHCARE Commercial |
$72.00
|
| Rate for Payer: Preferred Network Access Commercial |
$110.40
|
| Rate for Payer: Quartz Beloit One Network |
$58.80
|
| Rate for Payer: Quartz Commercial |
$72.00
|
| Rate for Payer: WEA Trust Commercial |
$66.00
|
| Rate for Payer: WPS Commercial |
$88.88
|
|
|
Proteinase-3 Ab
|
Professional
|
Both
|
$120.00
|
|
|
Service Code
|
CPT 86021
|
| Hospital Charge Code |
5438977
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$52.80 |
| Max. Negotiated Rate |
$114.00 |
| Rate for Payer: Aetna Commercial |
$114.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$103.20
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Cigna Commercial |
$114.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$60.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$72.00
|
| Rate for Payer: Health EOS Commercial |
$109.20
|
| Rate for Payer: HFN Commercial |
$114.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$53.13
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$53.13
|
| Rate for Payer: Multiplan Commercial |
$96.00
|
| Rate for Payer: Preferred Network Access Commercial |
$114.00
|
| Rate for Payer: Quartz Beloit One Network |
$52.80
|
| Rate for Payer: Quartz Commercial |
$68.40
|
| Rate for Payer: The Alliance Commercial |
$60.00
|
| Rate for Payer: WEA Trust Commercial |
$66.00
|
| Rate for Payer: WPS Commercial |
$88.88
|
|
|
Proteinase-3 Antibody
|
Facility
|
IP
|
$67.00
|
|
|
Service Code
|
CPT 86021
|
| Hospital Charge Code |
4076115
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$32.83 |
| Max. Negotiated Rate |
$61.64 |
| Rate for Payer: Aetna Commercial |
$60.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$57.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$35.51
|
| Rate for Payer: Cash Price |
$20.10
|
| Rate for Payer: Cigna Commercial |
$61.64
|
| Rate for Payer: Health EOS Commercial |
$59.63
|
| Rate for Payer: HFN Commercial |
$61.64
|
| Rate for Payer: Multiplan Commercial |
$53.60
|
| Rate for Payer: NAPHCARE Commercial |
$40.20
|
| Rate for Payer: Preferred Network Access Commercial |
$61.64
|
| Rate for Payer: Quartz Beloit One Network |
$32.83
|
| Rate for Payer: Quartz Commercial |
$40.20
|
| Rate for Payer: WEA Trust Commercial |
$36.85
|
| Rate for Payer: WPS Commercial |
$49.63
|
|
|
Proteinase-3 Antibody
|
Facility
|
OP
|
$67.00
|
|
|
Service Code
|
CPT 86021
|
| Hospital Charge Code |
4076115
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.05 |
| Max. Negotiated Rate |
$61.64 |
| Rate for Payer: Aetna Commercial |
$60.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$57.62
|
| Rate for Payer: Aetna Managed Medicare |
$15.05
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$56.44
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$26.34
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$24.98
|
| Rate for Payer: Anthem Medicaid |
$15.55
|
| Rate for Payer: Anthem Medicare Advantage |
$15.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$35.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$15.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$15.05
|
| Rate for Payer: Cash Price |
$20.10
|
| Rate for Payer: Cash Price |
$20.10
|
| Rate for Payer: Cigna Commercial |
$61.64
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$15.05
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$15.55
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$37.49
|
| Rate for Payer: Dean Health Medicaid |
$15.55
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$15.05
|
| Rate for Payer: Health EOS Commercial |
$59.63
|
| Rate for Payer: HFN Commercial |
$61.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$55.99
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$15.05
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$15.55
|
| Rate for Payer: Independent Care Health Plan Medicare |
$15.05
|
| Rate for Payer: Managed Health Services Medicaid |
$16.17
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$15.05
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$15.05
|
| Rate for Payer: Multiplan Commercial |
$53.60
|
| Rate for Payer: NAPHCARE Commercial |
$22.58
|
| Rate for Payer: Preferred Network Access Commercial |
$61.64
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$15.55
|
| Rate for Payer: Quartz Beloit One Network |
$32.83
|
| Rate for Payer: Quartz Commercial |
$43.55
|
| Rate for Payer: Quartz Medicare Advantage |
$15.05
|
| Rate for Payer: The Alliance Commercial |
$60.20
|
| Rate for Payer: United Healthcare Medicaid |
$15.55
|
| Rate for Payer: United Healthcare Medicare Advantage |
$15.05
|
| Rate for Payer: United Healthcare PPO |
$50.25
|
| Rate for Payer: WEA Trust Commercial |
$36.85
|
| Rate for Payer: Wellcare Medicare |
$15.05
|
| Rate for Payer: WMAP Medicaid |
$15.55
|
| Rate for Payer: WPS Commercial |
$49.63
|
|
|
Proteinase-3 Antibody
|
Professional
|
Both
|
$67.00
|
|
|
Service Code
|
CPT 86021
|
| Hospital Charge Code |
4076115
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$29.48 |
| Max. Negotiated Rate |
$63.65 |
| Rate for Payer: Aetna Commercial |
$63.65
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$57.62
|
| Rate for Payer: Cash Price |
$20.10
|
| Rate for Payer: Cash Price |
$20.10
|
| Rate for Payer: Cigna Commercial |
$63.65
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$33.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$40.20
|
| Rate for Payer: Health EOS Commercial |
$60.97
|
| Rate for Payer: HFN Commercial |
$63.65
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$53.13
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$53.13
|
| Rate for Payer: Multiplan Commercial |
$53.60
|
| Rate for Payer: Preferred Network Access Commercial |
$63.65
|
| Rate for Payer: Quartz Beloit One Network |
$29.48
|
| Rate for Payer: Quartz Commercial |
$38.19
|
| Rate for Payer: The Alliance Commercial |
$33.50
|
| Rate for Payer: WEA Trust Commercial |
$36.85
|
| Rate for Payer: WPS Commercial |
$49.63
|
|
|
Protein C Activity
|
Facility
|
IP
|
$936.00
|
|
|
Service Code
|
CPT 85303
|
| Hospital Charge Code |
978046
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$458.64 |
| Max. Negotiated Rate |
$861.12 |
| Rate for Payer: Aetna Commercial |
$842.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$804.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$496.08
|
| Rate for Payer: Cash Price |
$280.80
|
| Rate for Payer: Cigna Commercial |
$861.12
|
| Rate for Payer: Health EOS Commercial |
$833.04
|
| Rate for Payer: HFN Commercial |
$861.12
|
| Rate for Payer: Multiplan Commercial |
$748.80
|
| Rate for Payer: NAPHCARE Commercial |
$561.60
|
| Rate for Payer: Preferred Network Access Commercial |
$861.12
|
| Rate for Payer: Quartz Beloit One Network |
$458.64
|
| Rate for Payer: Quartz Commercial |
$561.60
|
| Rate for Payer: WEA Trust Commercial |
$514.80
|
| Rate for Payer: WPS Commercial |
$693.30
|
|
|
Protein C Activity
|
Facility
|
OP
|
$936.00
|
|
|
Service Code
|
CPT 85303
|
| Hospital Charge Code |
978046
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.84 |
| Max. Negotiated Rate |
$861.12 |
| Rate for Payer: Aetna Commercial |
$842.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$804.96
|
| Rate for Payer: Aetna Managed Medicare |
$13.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$51.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$24.22
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$22.97
|
| Rate for Payer: Anthem Medicaid |
$14.30
|
| Rate for Payer: Anthem Medicare Advantage |
$13.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$496.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$13.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$13.84
|
| Rate for Payer: Cash Price |
$280.80
|
| Rate for Payer: Cash Price |
$280.80
|
| Rate for Payer: Cigna Commercial |
$861.12
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$13.84
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$14.30
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$523.79
|
| Rate for Payer: Dean Health Medicaid |
$14.30
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$13.84
|
| Rate for Payer: Health EOS Commercial |
$833.04
|
| Rate for Payer: HFN Commercial |
$861.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$51.48
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$13.84
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$14.30
|
| Rate for Payer: Independent Care Health Plan Medicare |
$13.84
|
| Rate for Payer: Managed Health Services Medicaid |
$14.87
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$13.84
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$13.84
|
| Rate for Payer: Multiplan Commercial |
$748.80
|
| Rate for Payer: NAPHCARE Commercial |
$20.76
|
| Rate for Payer: Preferred Network Access Commercial |
$861.12
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$14.30
|
| Rate for Payer: Quartz Beloit One Network |
$458.64
|
| Rate for Payer: Quartz Commercial |
$608.40
|
| Rate for Payer: Quartz Medicare Advantage |
$13.84
|
| Rate for Payer: The Alliance Commercial |
$55.36
|
| Rate for Payer: United Healthcare Medicaid |
$14.30
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.84
|
| Rate for Payer: United Healthcare PPO |
$702.00
|
| Rate for Payer: WEA Trust Commercial |
$514.80
|
| Rate for Payer: Wellcare Medicare |
$13.84
|
| Rate for Payer: WMAP Medicaid |
$14.30
|
| Rate for Payer: WPS Commercial |
$693.30
|
|
|
Protein C Activity
|
Professional
|
Both
|
$936.00
|
|
|
Service Code
|
CPT 85303
|
| Hospital Charge Code |
978046
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$48.86 |
| Max. Negotiated Rate |
$889.20 |
| Rate for Payer: Aetna Commercial |
$889.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$804.96
|
| Rate for Payer: Cash Price |
$280.80
|
| Rate for Payer: Cash Price |
$280.80
|
| Rate for Payer: Cigna Commercial |
$889.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$468.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$561.60
|
| Rate for Payer: Health EOS Commercial |
$851.76
|
| Rate for Payer: HFN Commercial |
$889.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$48.86
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$48.86
|
| Rate for Payer: Multiplan Commercial |
$748.80
|
| Rate for Payer: Preferred Network Access Commercial |
$889.20
|
| Rate for Payer: Quartz Beloit One Network |
$411.84
|
| Rate for Payer: Quartz Commercial |
$533.52
|
| Rate for Payer: The Alliance Commercial |
$468.00
|
| Rate for Payer: WEA Trust Commercial |
$514.80
|
| Rate for Payer: WPS Commercial |
$693.30
|
|
|
Protein C Antigen
|
Professional
|
Both
|
$335.00
|
|
|
Service Code
|
CPT 85302
|
| Hospital Charge Code |
983371
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$42.40 |
| Max. Negotiated Rate |
$318.25 |
| Rate for Payer: Aetna Commercial |
$318.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$288.10
|
| Rate for Payer: Cash Price |
$100.50
|
| Rate for Payer: Cash Price |
$100.50
|
| Rate for Payer: Cigna Commercial |
$318.25
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$167.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$201.00
|
| Rate for Payer: Health EOS Commercial |
$304.85
|
| Rate for Payer: HFN Commercial |
$318.25
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$42.40
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$42.40
|
| Rate for Payer: Multiplan Commercial |
$268.00
|
| Rate for Payer: Preferred Network Access Commercial |
$318.25
|
| Rate for Payer: Quartz Beloit One Network |
$147.40
|
| Rate for Payer: Quartz Commercial |
$190.95
|
| Rate for Payer: The Alliance Commercial |
$167.50
|
| Rate for Payer: WEA Trust Commercial |
$184.25
|
| Rate for Payer: WPS Commercial |
$248.13
|
|
|
Protein C Antigen
|
Facility
|
IP
|
$335.00
|
|
|
Service Code
|
CPT 85302
|
| Hospital Charge Code |
983371
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$164.15 |
| Max. Negotiated Rate |
$308.20 |
| Rate for Payer: Aetna Commercial |
$301.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$288.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$177.55
|
| Rate for Payer: Cash Price |
$100.50
|
| Rate for Payer: Cigna Commercial |
$308.20
|
| Rate for Payer: Health EOS Commercial |
$298.15
|
| Rate for Payer: HFN Commercial |
$308.20
|
| Rate for Payer: Multiplan Commercial |
$268.00
|
| Rate for Payer: NAPHCARE Commercial |
$201.00
|
| Rate for Payer: Preferred Network Access Commercial |
$308.20
|
| Rate for Payer: Quartz Beloit One Network |
$164.15
|
| Rate for Payer: Quartz Commercial |
$201.00
|
| Rate for Payer: WEA Trust Commercial |
$184.25
|
| Rate for Payer: WPS Commercial |
$248.13
|
|
|
Protein C Antigen
|
Facility
|
OP
|
$335.00
|
|
|
Service Code
|
CPT 85302
|
| Hospital Charge Code |
983371
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.01 |
| Max. Negotiated Rate |
$308.20 |
| Rate for Payer: Aetna Commercial |
$301.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$288.10
|
| Rate for Payer: Aetna Managed Medicare |
$12.01
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$45.04
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$21.02
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$19.94
|
| Rate for Payer: Anthem Medicaid |
$12.41
|
| Rate for Payer: Anthem Medicare Advantage |
$12.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$177.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$12.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$12.01
|
| Rate for Payer: Cash Price |
$100.50
|
| Rate for Payer: Cash Price |
$100.50
|
| Rate for Payer: Cigna Commercial |
$308.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$12.01
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$12.41
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$187.47
|
| Rate for Payer: Dean Health Medicaid |
$12.41
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$12.01
|
| Rate for Payer: Health EOS Commercial |
$298.15
|
| Rate for Payer: HFN Commercial |
$308.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$44.68
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$12.01
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$12.41
|
| Rate for Payer: Independent Care Health Plan Medicare |
$12.01
|
| Rate for Payer: Managed Health Services Medicaid |
$12.91
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$12.01
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$12.01
|
| Rate for Payer: Multiplan Commercial |
$268.00
|
| Rate for Payer: NAPHCARE Commercial |
$18.02
|
| Rate for Payer: Preferred Network Access Commercial |
$308.20
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$12.41
|
| Rate for Payer: Quartz Beloit One Network |
$164.15
|
| Rate for Payer: Quartz Commercial |
$217.75
|
| Rate for Payer: Quartz Medicare Advantage |
$12.01
|
| Rate for Payer: The Alliance Commercial |
$48.04
|
| Rate for Payer: United Healthcare Medicaid |
$12.41
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.01
|
| Rate for Payer: United Healthcare PPO |
$251.25
|
| Rate for Payer: WEA Trust Commercial |
$184.25
|
| Rate for Payer: Wellcare Medicare |
$12.01
|
| Rate for Payer: WMAP Medicaid |
$12.41
|
| Rate for Payer: WPS Commercial |
$248.13
|
|
|
Protein Cerebrospinal Fluid
|
Professional
|
Both
|
$139.00
|
|
|
Service Code
|
CPT 84157
|
| Hospital Charge Code |
633813
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.12 |
| Max. Negotiated Rate |
$132.05 |
| Rate for Payer: Aetna Commercial |
$132.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$119.54
|
| Rate for Payer: Cash Price |
$41.70
|
| Rate for Payer: Cash Price |
$41.70
|
| Rate for Payer: Cigna Commercial |
$132.05
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$69.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$83.40
|
| Rate for Payer: Health EOS Commercial |
$126.49
|
| Rate for Payer: HFN Commercial |
$132.05
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$14.12
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$14.12
|
| Rate for Payer: Multiplan Commercial |
$111.20
|
| Rate for Payer: Preferred Network Access Commercial |
$132.05
|
| Rate for Payer: Quartz Beloit One Network |
$61.16
|
| Rate for Payer: Quartz Commercial |
$79.23
|
| Rate for Payer: The Alliance Commercial |
$69.50
|
| Rate for Payer: WEA Trust Commercial |
$76.45
|
| Rate for Payer: WPS Commercial |
$102.96
|
|
|
Protein Cerebrospinal Fluid
|
Facility
|
OP
|
$139.00
|
|
|
Service Code
|
CPT 84157
|
| Hospital Charge Code |
633813
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.00 |
| Max. Negotiated Rate |
$127.88 |
| Rate for Payer: Aetna Commercial |
$125.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$119.54
|
| Rate for Payer: Aetna Managed Medicare |
$4.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$15.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$7.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$6.64
|
| Rate for Payer: Anthem Medicaid |
$4.13
|
| Rate for Payer: Anthem Medicare Advantage |
$4.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$73.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$4.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$4.00
|
| Rate for Payer: Cash Price |
$41.70
|
| Rate for Payer: Cash Price |
$41.70
|
| Rate for Payer: Cigna Commercial |
$127.88
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$4.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$4.13
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$77.78
|
| Rate for Payer: Dean Health Medicaid |
$4.13
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$4.00
|
| Rate for Payer: Health EOS Commercial |
$123.71
|
| Rate for Payer: HFN Commercial |
$127.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$14.88
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$4.00
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$4.13
|
| Rate for Payer: Independent Care Health Plan Medicare |
$4.00
|
| Rate for Payer: Managed Health Services Medicaid |
$4.30
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$4.00
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$4.00
|
| Rate for Payer: Multiplan Commercial |
$111.20
|
| Rate for Payer: NAPHCARE Commercial |
$6.00
|
| Rate for Payer: Preferred Network Access Commercial |
$127.88
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$4.13
|
| Rate for Payer: Quartz Beloit One Network |
$68.11
|
| Rate for Payer: Quartz Commercial |
$90.35
|
| Rate for Payer: Quartz Medicare Advantage |
$4.00
|
| Rate for Payer: The Alliance Commercial |
$16.00
|
| Rate for Payer: United Healthcare Medicaid |
$4.13
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4.00
|
| Rate for Payer: United Healthcare PPO |
$104.25
|
| Rate for Payer: WEA Trust Commercial |
$76.45
|
| Rate for Payer: Wellcare Medicare |
$4.00
|
| Rate for Payer: WMAP Medicaid |
$4.13
|
| Rate for Payer: WPS Commercial |
$102.96
|
|
|
Protein Cerebrospinal Fluid
|
Facility
|
IP
|
$139.00
|
|
|
Service Code
|
CPT 84157
|
| Hospital Charge Code |
633813
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$68.11 |
| Max. Negotiated Rate |
$127.88 |
| Rate for Payer: Aetna Commercial |
$125.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$119.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$73.67
|
| Rate for Payer: Cash Price |
$41.70
|
| Rate for Payer: Cigna Commercial |
$127.88
|
| Rate for Payer: Health EOS Commercial |
$123.71
|
| Rate for Payer: HFN Commercial |
$127.88
|
| Rate for Payer: Multiplan Commercial |
$111.20
|
| Rate for Payer: NAPHCARE Commercial |
$83.40
|
| Rate for Payer: Preferred Network Access Commercial |
$127.88
|
| Rate for Payer: Quartz Beloit One Network |
$68.11
|
| Rate for Payer: Quartz Commercial |
$83.40
|
| Rate for Payer: WEA Trust Commercial |
$76.45
|
| Rate for Payer: WPS Commercial |
$102.96
|
|
|
Protein Cyst Fluid to Mayo
|
Professional
|
Both
|
$79.00
|
|
|
Service Code
|
CPT 84157
|
| Hospital Charge Code |
5128607
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.12 |
| Max. Negotiated Rate |
$75.05 |
| Rate for Payer: Aetna Commercial |
$75.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$67.94
|
| Rate for Payer: Cash Price |
$23.70
|
| Rate for Payer: Cash Price |
$23.70
|
| Rate for Payer: Cigna Commercial |
$75.05
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$39.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$47.40
|
| Rate for Payer: Health EOS Commercial |
$71.89
|
| Rate for Payer: HFN Commercial |
$75.05
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$14.12
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$14.12
|
| Rate for Payer: Multiplan Commercial |
$63.20
|
| Rate for Payer: Preferred Network Access Commercial |
$75.05
|
| Rate for Payer: Quartz Beloit One Network |
$34.76
|
| Rate for Payer: Quartz Commercial |
$45.03
|
| Rate for Payer: The Alliance Commercial |
$39.50
|
| Rate for Payer: WEA Trust Commercial |
$43.45
|
| Rate for Payer: WPS Commercial |
$58.52
|
|
|
Protein Cyst Fluid to Mayo
|
Facility
|
IP
|
$79.00
|
|
|
Service Code
|
CPT 84157
|
| Hospital Charge Code |
5128607
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$38.71 |
| Max. Negotiated Rate |
$72.68 |
| Rate for Payer: Aetna Commercial |
$71.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$67.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$41.87
|
| Rate for Payer: Cash Price |
$23.70
|
| Rate for Payer: Cigna Commercial |
$72.68
|
| Rate for Payer: Health EOS Commercial |
$70.31
|
| Rate for Payer: HFN Commercial |
$72.68
|
| Rate for Payer: Multiplan Commercial |
$63.20
|
| Rate for Payer: NAPHCARE Commercial |
$47.40
|
| Rate for Payer: Preferred Network Access Commercial |
$72.68
|
| Rate for Payer: Quartz Beloit One Network |
$38.71
|
| Rate for Payer: Quartz Commercial |
$47.40
|
| Rate for Payer: WEA Trust Commercial |
$43.45
|
| Rate for Payer: WPS Commercial |
$58.52
|
|
|
Protein Cyst Fluid to Mayo
|
Facility
|
OP
|
$79.00
|
|
|
Service Code
|
CPT 84157
|
| Hospital Charge Code |
5128607
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.00 |
| Max. Negotiated Rate |
$72.68 |
| Rate for Payer: Aetna Commercial |
$71.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$67.94
|
| Rate for Payer: Aetna Managed Medicare |
$4.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$15.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$7.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$6.64
|
| Rate for Payer: Anthem Medicaid |
$4.13
|
| Rate for Payer: Anthem Medicare Advantage |
$4.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$41.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$4.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$4.00
|
| Rate for Payer: Cash Price |
$23.70
|
| Rate for Payer: Cash Price |
$23.70
|
| Rate for Payer: Cigna Commercial |
$72.68
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$4.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$4.13
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$44.21
|
| Rate for Payer: Dean Health Medicaid |
$4.13
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$4.00
|
| Rate for Payer: Health EOS Commercial |
$70.31
|
| Rate for Payer: HFN Commercial |
$72.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$14.88
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$4.00
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$4.13
|
| Rate for Payer: Independent Care Health Plan Medicare |
$4.00
|
| Rate for Payer: Managed Health Services Medicaid |
$4.30
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$4.00
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$4.00
|
| Rate for Payer: Multiplan Commercial |
$63.20
|
| Rate for Payer: NAPHCARE Commercial |
$6.00
|
| Rate for Payer: Preferred Network Access Commercial |
$72.68
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$4.13
|
| Rate for Payer: Quartz Beloit One Network |
$38.71
|
| Rate for Payer: Quartz Commercial |
$51.35
|
| Rate for Payer: Quartz Medicare Advantage |
$4.00
|
| Rate for Payer: The Alliance Commercial |
$16.00
|
| Rate for Payer: United Healthcare Medicaid |
$4.13
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4.00
|
| Rate for Payer: United Healthcare PPO |
$59.25
|
| Rate for Payer: WEA Trust Commercial |
$43.45
|
| Rate for Payer: Wellcare Medicare |
$4.00
|
| Rate for Payer: WMAP Medicaid |
$4.13
|
| Rate for Payer: WPS Commercial |
$58.52
|
|
|
Protein Electrophoresis
|
Facility
|
IP
|
$135.00
|
|
|
Service Code
|
CPT 84155
|
| Hospital Charge Code |
633816
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$66.15 |
| Max. Negotiated Rate |
$124.20 |
| Rate for Payer: Aetna Commercial |
$121.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$116.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$71.55
|
| Rate for Payer: Cash Price |
$40.50
|
| Rate for Payer: Cigna Commercial |
$124.20
|
| Rate for Payer: Health EOS Commercial |
$120.15
|
| Rate for Payer: HFN Commercial |
$124.20
|
| Rate for Payer: Multiplan Commercial |
$108.00
|
| Rate for Payer: NAPHCARE Commercial |
$81.00
|
| Rate for Payer: Preferred Network Access Commercial |
$124.20
|
| Rate for Payer: Quartz Beloit One Network |
$66.15
|
| Rate for Payer: Quartz Commercial |
$81.00
|
| Rate for Payer: WEA Trust Commercial |
$74.25
|
| Rate for Payer: WPS Commercial |
$99.99
|
|
