|
Protein Electrophoresis
|
Facility
|
OP
|
$135.00
|
|
|
Service Code
|
CPT 84155
|
| Hospital Charge Code |
633816
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.67 |
| Max. Negotiated Rate |
$124.20 |
| Rate for Payer: Aetna Commercial |
$121.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$116.10
|
| 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 |
$71.55
|
| 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 |
$40.50
|
| Rate for Payer: Cash Price |
$40.50
|
| Rate for Payer: Cigna Commercial |
$124.20
|
| 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 |
$75.55
|
| 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 |
$120.15
|
| Rate for Payer: HFN Commercial |
$124.20
|
| 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 |
$108.00
|
| Rate for Payer: NAPHCARE Commercial |
$5.50
|
| Rate for Payer: Preferred Network Access Commercial |
$124.20
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$3.79
|
| Rate for Payer: Quartz Beloit One Network |
$66.15
|
| Rate for Payer: Quartz Commercial |
$87.75
|
| 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 |
$101.25
|
| Rate for Payer: WEA Trust Commercial |
$74.25
|
| Rate for Payer: Wellcare Medicare |
$3.67
|
| Rate for Payer: WMAP Medicaid |
$3.79
|
| Rate for Payer: WPS Commercial |
$99.99
|
|
|
Protein Electrophoresis
|
Professional
|
Both
|
$135.00
|
|
|
Service Code
|
CPT 84155
|
| Hospital Charge Code |
633816
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.96 |
| Max. Negotiated Rate |
$128.25 |
| Rate for Payer: Aetna Commercial |
$128.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$116.10
|
| Rate for Payer: Cash Price |
$40.50
|
| Rate for Payer: Cash Price |
$40.50
|
| Rate for Payer: Cigna Commercial |
$128.25
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$67.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$81.00
|
| Rate for Payer: Health EOS Commercial |
$122.85
|
| Rate for Payer: HFN Commercial |
$128.25
|
| 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 |
$108.00
|
| Rate for Payer: Preferred Network Access Commercial |
$128.25
|
| Rate for Payer: Quartz Beloit One Network |
$59.40
|
| Rate for Payer: Quartz Commercial |
$76.95
|
| Rate for Payer: The Alliance Commercial |
$67.50
|
| Rate for Payer: WEA Trust Commercial |
$74.25
|
| Rate for Payer: WPS Commercial |
$99.99
|
|
|
Protein Electrophoresis 24 Hour Urine
|
Professional
|
Both
|
$126.00
|
|
|
Service Code
|
CPT 82570
|
| Hospital Charge Code |
978047
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.29 |
| Max. Negotiated Rate |
$119.70 |
| Rate for Payer: Aetna Commercial |
$119.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$108.36
|
| Rate for Payer: Cash Price |
$37.80
|
| Rate for Payer: Cash Price |
$37.80
|
| Rate for Payer: Cigna Commercial |
$119.70
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$63.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$75.60
|
| Rate for Payer: Health EOS Commercial |
$114.66
|
| Rate for Payer: HFN Commercial |
$119.70
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$18.29
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$18.29
|
| Rate for Payer: Multiplan Commercial |
$100.80
|
| Rate for Payer: Preferred Network Access Commercial |
$119.70
|
| Rate for Payer: Quartz Beloit One Network |
$55.44
|
| Rate for Payer: Quartz Commercial |
$71.82
|
| Rate for Payer: The Alliance Commercial |
$63.00
|
| Rate for Payer: WEA Trust Commercial |
$69.30
|
| Rate for Payer: WPS Commercial |
$93.33
|
|
|
Protein Electrophoresis 24 Hour Urine
|
Facility
|
OP
|
$126.00
|
|
|
Service Code
|
CPT 82570
|
| Hospital Charge Code |
978047
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.18 |
| Max. Negotiated Rate |
$115.92 |
| Rate for Payer: Aetna Commercial |
$113.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$108.36
|
| Rate for Payer: Aetna Managed Medicare |
$5.18
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$19.42
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$9.06
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$8.60
|
| Rate for Payer: Anthem Medicaid |
$5.35
|
| Rate for Payer: Anthem Medicare Advantage |
$5.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$66.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5.18
|
| Rate for Payer: Cash Price |
$37.80
|
| Rate for Payer: Cash Price |
$37.80
|
| Rate for Payer: Cigna Commercial |
$115.92
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$5.18
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$5.35
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$70.51
|
| Rate for Payer: Dean Health Medicaid |
$5.35
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$5.18
|
| Rate for Payer: Health EOS Commercial |
$112.14
|
| Rate for Payer: HFN Commercial |
$115.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$19.27
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$5.18
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$5.35
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5.18
|
| Rate for Payer: Managed Health Services Medicaid |
$5.56
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$5.18
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$5.18
|
| Rate for Payer: Multiplan Commercial |
$100.80
|
| Rate for Payer: NAPHCARE Commercial |
$7.77
|
| Rate for Payer: Preferred Network Access Commercial |
$115.92
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$5.35
|
| Rate for Payer: Quartz Beloit One Network |
$61.74
|
| Rate for Payer: Quartz Commercial |
$81.90
|
| Rate for Payer: Quartz Medicare Advantage |
$5.18
|
| Rate for Payer: The Alliance Commercial |
$20.72
|
| Rate for Payer: United Healthcare Medicaid |
$5.35
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.18
|
| Rate for Payer: United Healthcare PPO |
$94.50
|
| Rate for Payer: WEA Trust Commercial |
$69.30
|
| Rate for Payer: Wellcare Medicare |
$5.18
|
| Rate for Payer: WMAP Medicaid |
$5.35
|
| Rate for Payer: WPS Commercial |
$93.33
|
|
|
Protein Electrophoresis 24 Hour Urine
|
Facility
|
IP
|
$126.00
|
|
|
Service Code
|
CPT 82570
|
| Hospital Charge Code |
978047
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$61.74 |
| Max. Negotiated Rate |
$115.92 |
| Rate for Payer: Aetna Commercial |
$113.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$108.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$66.78
|
| Rate for Payer: Cash Price |
$37.80
|
| Rate for Payer: Cigna Commercial |
$115.92
|
| Rate for Payer: Health EOS Commercial |
$112.14
|
| Rate for Payer: HFN Commercial |
$115.92
|
| Rate for Payer: Multiplan Commercial |
$100.80
|
| Rate for Payer: NAPHCARE Commercial |
$75.60
|
| Rate for Payer: Preferred Network Access Commercial |
$115.92
|
| Rate for Payer: Quartz Beloit One Network |
$61.74
|
| Rate for Payer: Quartz Commercial |
$75.60
|
| Rate for Payer: WEA Trust Commercial |
$69.30
|
| Rate for Payer: WPS Commercial |
$93.33
|
|
|
Protein Electrophoresis Urine
|
Facility
|
IP
|
$64.00
|
|
|
Service Code
|
CPT 84156
|
| Hospital Charge Code |
633817
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$31.36 |
| Max. Negotiated Rate |
$58.88 |
| Rate for Payer: Aetna Commercial |
$57.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$55.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$33.92
|
| Rate for Payer: Cash Price |
$19.20
|
| Rate for Payer: Cigna Commercial |
$58.88
|
| Rate for Payer: Health EOS Commercial |
$56.96
|
| Rate for Payer: HFN Commercial |
$58.88
|
| Rate for Payer: Multiplan Commercial |
$51.20
|
| Rate for Payer: NAPHCARE Commercial |
$38.40
|
| Rate for Payer: Preferred Network Access Commercial |
$58.88
|
| Rate for Payer: Quartz Beloit One Network |
$31.36
|
| Rate for Payer: Quartz Commercial |
$38.40
|
| Rate for Payer: WEA Trust Commercial |
$35.20
|
| Rate for Payer: WPS Commercial |
$47.40
|
|
|
Protein Electrophoresis Urine
|
Facility
|
OP
|
$64.00
|
|
|
Service Code
|
CPT 84156
|
| Hospital Charge Code |
633817
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.67 |
| Max. Negotiated Rate |
$58.88 |
| Rate for Payer: Aetna Commercial |
$57.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$55.04
|
| 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 |
$33.92
|
| 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 |
$19.20
|
| Rate for Payer: Cash Price |
$19.20
|
| Rate for Payer: Cigna Commercial |
$58.88
|
| 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 |
$35.81
|
| 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 |
$56.96
|
| Rate for Payer: HFN Commercial |
$58.88
|
| 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 |
$51.20
|
| Rate for Payer: NAPHCARE Commercial |
$5.50
|
| Rate for Payer: Preferred Network Access Commercial |
$58.88
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$3.79
|
| Rate for Payer: Quartz Beloit One Network |
$31.36
|
| Rate for Payer: Quartz Commercial |
$41.60
|
| 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 |
$48.00
|
| Rate for Payer: WEA Trust Commercial |
$35.20
|
| Rate for Payer: Wellcare Medicare |
$3.67
|
| Rate for Payer: WMAP Medicaid |
$3.79
|
| Rate for Payer: WPS Commercial |
$47.40
|
|
|
Protein Electrophoresis Urine
|
Professional
|
Both
|
$64.00
|
|
|
Service Code
|
CPT 84156
|
| Hospital Charge Code |
633817
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.96 |
| Max. Negotiated Rate |
$60.80 |
| Rate for Payer: Aetna Commercial |
$60.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$55.04
|
| Rate for Payer: Cash Price |
$19.20
|
| Rate for Payer: Cash Price |
$19.20
|
| Rate for Payer: Cigna Commercial |
$60.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$32.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$38.40
|
| Rate for Payer: Health EOS Commercial |
$58.24
|
| Rate for Payer: HFN Commercial |
$60.80
|
| 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 |
$51.20
|
| Rate for Payer: Preferred Network Access Commercial |
$60.80
|
| Rate for Payer: Quartz Beloit One Network |
$28.16
|
| Rate for Payer: Quartz Commercial |
$36.48
|
| Rate for Payer: The Alliance Commercial |
$32.00
|
| Rate for Payer: WEA Trust Commercial |
$35.20
|
| Rate for Payer: WPS Commercial |
$47.40
|
|
|
Protein Electrophoresis w/ Immunofixation
|
Facility
|
OP
|
$271.00
|
|
|
Service Code
|
CPT 84155
|
| Hospital Charge Code |
983372
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.67 |
| Max. Negotiated Rate |
$249.32 |
| Rate for Payer: Aetna Commercial |
$243.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$233.06
|
| 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 |
$143.63
|
| 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 |
$81.30
|
| Rate for Payer: Cash Price |
$81.30
|
| Rate for Payer: Cigna Commercial |
$249.32
|
| 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 |
$151.65
|
| 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 |
$241.19
|
| Rate for Payer: HFN Commercial |
$249.32
|
| 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 |
$216.80
|
| Rate for Payer: NAPHCARE Commercial |
$5.50
|
| Rate for Payer: Preferred Network Access Commercial |
$249.32
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$3.79
|
| Rate for Payer: Quartz Beloit One Network |
$132.79
|
| Rate for Payer: Quartz Commercial |
$176.15
|
| 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 |
$203.25
|
| Rate for Payer: WEA Trust Commercial |
$149.05
|
| Rate for Payer: Wellcare Medicare |
$3.67
|
| Rate for Payer: WMAP Medicaid |
$3.79
|
| Rate for Payer: WPS Commercial |
$200.73
|
|
|
Protein Electrophoresis w/ Immunofixation
|
Facility
|
IP
|
$271.00
|
|
|
Service Code
|
CPT 84155
|
| Hospital Charge Code |
983372
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$132.79 |
| Max. Negotiated Rate |
$249.32 |
| Rate for Payer: Aetna Commercial |
$243.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$233.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$143.63
|
| Rate for Payer: Cash Price |
$81.30
|
| Rate for Payer: Cigna Commercial |
$249.32
|
| Rate for Payer: Health EOS Commercial |
$241.19
|
| Rate for Payer: HFN Commercial |
$249.32
|
| Rate for Payer: Multiplan Commercial |
$216.80
|
| Rate for Payer: NAPHCARE Commercial |
$162.60
|
| Rate for Payer: Preferred Network Access Commercial |
$249.32
|
| Rate for Payer: Quartz Beloit One Network |
$132.79
|
| Rate for Payer: Quartz Commercial |
$162.60
|
| Rate for Payer: WEA Trust Commercial |
$149.05
|
| Rate for Payer: WPS Commercial |
$200.73
|
|
|
Protein Electrophoresis w/ Immunofixation
|
Professional
|
Both
|
$271.00
|
|
|
Service Code
|
CPT 84155
|
| Hospital Charge Code |
983372
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.96 |
| Max. Negotiated Rate |
$257.45 |
| Rate for Payer: Aetna Commercial |
$257.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$233.06
|
| Rate for Payer: Cash Price |
$81.30
|
| Rate for Payer: Cash Price |
$81.30
|
| Rate for Payer: Cigna Commercial |
$257.45
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$135.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$162.60
|
| Rate for Payer: Health EOS Commercial |
$246.61
|
| Rate for Payer: HFN Commercial |
$257.45
|
| 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 |
$216.80
|
| Rate for Payer: Preferred Network Access Commercial |
$257.45
|
| Rate for Payer: Quartz Beloit One Network |
$119.24
|
| Rate for Payer: Quartz Commercial |
$154.47
|
| Rate for Payer: The Alliance Commercial |
$135.50
|
| Rate for Payer: WEA Trust Commercial |
$149.05
|
| Rate for Payer: WPS Commercial |
$200.73
|
|
|
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 |
$29.35 |
| Max. Negotiated Rate |
$154.56 |
| Rate for Payer: Aetna Commercial |
$151.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$144.48
|
| Rate for Payer: Aetna Managed Medicare |
$29.35
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$110.06
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$51.36
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$48.72
|
| Rate for Payer: Anthem Medicaid |
$30.33
|
| Rate for Payer: Anthem Medicare Advantage |
$29.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$89.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$29.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$29.35
|
| Rate for Payer: Cash Price |
$50.40
|
| Rate for Payer: Cash Price |
$50.40
|
| Rate for Payer: Cigna Commercial |
$154.56
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$29.35
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$30.33
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$94.01
|
| Rate for Payer: Dean Health Medicaid |
$30.33
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$29.35
|
| Rate for Payer: Health EOS Commercial |
$149.52
|
| Rate for Payer: HFN Commercial |
$154.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$109.18
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$29.35
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$30.33
|
| Rate for Payer: Independent Care Health Plan Medicare |
$29.35
|
| Rate for Payer: Managed Health Services Medicaid |
$31.54
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$29.35
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$29.35
|
| Rate for Payer: Multiplan Commercial |
$134.40
|
| Rate for Payer: NAPHCARE Commercial |
$44.02
|
| Rate for Payer: Preferred Network Access Commercial |
$154.56
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$30.33
|
| Rate for Payer: Quartz Beloit One Network |
$82.32
|
| Rate for Payer: Quartz Commercial |
$109.20
|
| Rate for Payer: Quartz Medicare Advantage |
$29.35
|
| Rate for Payer: The Alliance Commercial |
$117.40
|
| Rate for Payer: United Healthcare Medicaid |
$30.33
|
| Rate for Payer: United Healthcare Medicare Advantage |
$29.35
|
| Rate for Payer: United Healthcare PPO |
$126.00
|
| Rate for Payer: WEA Trust Commercial |
$92.40
|
| Rate for Payer: Wellcare Medicare |
$29.35
|
| Rate for Payer: WMAP Medicaid |
$30.33
|
| Rate for Payer: WPS Commercial |
$124.44
|
|
|
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 |
$16.61 |
| Max. Negotiated Rate |
$159.60 |
| Rate for Payer: Aetna Commercial |
$159.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$144.48
|
| Rate for Payer: Anthem Commercial |
$16.61
|
| Rate for Payer: Cash Price |
$50.40
|
| Rate for Payer: Cash Price |
$50.40
|
| Rate for Payer: Cigna Commercial |
$159.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$84.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$100.80
|
| Rate for Payer: Health EOS Commercial |
$152.88
|
| Rate for Payer: HFN Commercial |
$159.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$103.61
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$103.61
|
| Rate for Payer: Multiplan Commercial |
$134.40
|
| Rate for Payer: Preferred Network Access Commercial |
$159.60
|
| Rate for Payer: Quartz Beloit One Network |
$73.92
|
| Rate for Payer: Quartz Commercial |
$95.76
|
| Rate for Payer: The Alliance Commercial |
$84.00
|
| Rate for Payer: WEA Trust Commercial |
$92.40
|
| Rate for Payer: WPS Commercial |
$124.44
|
|
|
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 |
$82.32 |
| Max. Negotiated Rate |
$154.56 |
| Rate for Payer: Aetna Commercial |
$151.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$144.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$89.04
|
| Rate for Payer: Cash Price |
$50.40
|
| Rate for Payer: Cigna Commercial |
$154.56
|
| Rate for Payer: Health EOS Commercial |
$149.52
|
| Rate for Payer: HFN Commercial |
$154.56
|
| Rate for Payer: Multiplan Commercial |
$134.40
|
| Rate for Payer: NAPHCARE Commercial |
$100.80
|
| Rate for Payer: Preferred Network Access Commercial |
$154.56
|
| Rate for Payer: Quartz Beloit One Network |
$82.32
|
| Rate for Payer: Quartz Commercial |
$100.80
|
| Rate for Payer: WEA Trust Commercial |
$92.40
|
| Rate for Payer: WPS Commercial |
$124.44
|
|
|
Protein Electrophoresis w/ Reflex IFE
|
Facility
|
OP
|
$271.00
|
|
|
Service Code
|
CPT 84155
|
| Hospital Charge Code |
983373
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.67 |
| Max. Negotiated Rate |
$249.32 |
| Rate for Payer: Aetna Commercial |
$243.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$233.06
|
| 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 |
$143.63
|
| 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 |
$81.30
|
| Rate for Payer: Cash Price |
$81.30
|
| Rate for Payer: Cigna Commercial |
$249.32
|
| 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 |
$151.65
|
| 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 |
$241.19
|
| Rate for Payer: HFN Commercial |
$249.32
|
| 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 |
$216.80
|
| Rate for Payer: NAPHCARE Commercial |
$5.50
|
| Rate for Payer: Preferred Network Access Commercial |
$249.32
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$3.79
|
| Rate for Payer: Quartz Beloit One Network |
$132.79
|
| Rate for Payer: Quartz Commercial |
$176.15
|
| 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 |
$203.25
|
| Rate for Payer: WEA Trust Commercial |
$149.05
|
| Rate for Payer: Wellcare Medicare |
$3.67
|
| Rate for Payer: WMAP Medicaid |
$3.79
|
| Rate for Payer: WPS Commercial |
$200.73
|
|
|
Protein Electrophoresis w/ Reflex IFE
|
Facility
|
IP
|
$271.00
|
|
|
Service Code
|
CPT 84155
|
| Hospital Charge Code |
983373
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$132.79 |
| Max. Negotiated Rate |
$249.32 |
| Rate for Payer: Aetna Commercial |
$243.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$233.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$143.63
|
| Rate for Payer: Cash Price |
$81.30
|
| Rate for Payer: Cigna Commercial |
$249.32
|
| Rate for Payer: Health EOS Commercial |
$241.19
|
| Rate for Payer: HFN Commercial |
$249.32
|
| Rate for Payer: Multiplan Commercial |
$216.80
|
| Rate for Payer: NAPHCARE Commercial |
$162.60
|
| Rate for Payer: Preferred Network Access Commercial |
$249.32
|
| Rate for Payer: Quartz Beloit One Network |
$132.79
|
| Rate for Payer: Quartz Commercial |
$162.60
|
| Rate for Payer: WEA Trust Commercial |
$149.05
|
| Rate for Payer: WPS Commercial |
$200.73
|
|
|
Protein Electrophoresis w/ Reflex IFE
|
Professional
|
Both
|
$271.00
|
|
|
Service Code
|
CPT 84155
|
| Hospital Charge Code |
983373
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.96 |
| Max. Negotiated Rate |
$257.45 |
| Rate for Payer: Aetna Commercial |
$257.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$233.06
|
| Rate for Payer: Cash Price |
$81.30
|
| Rate for Payer: Cash Price |
$81.30
|
| Rate for Payer: Cigna Commercial |
$257.45
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$135.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$162.60
|
| Rate for Payer: Health EOS Commercial |
$246.61
|
| Rate for Payer: HFN Commercial |
$257.45
|
| 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 |
$216.80
|
| Rate for Payer: Preferred Network Access Commercial |
$257.45
|
| Rate for Payer: Quartz Beloit One Network |
$119.24
|
| Rate for Payer: Quartz Commercial |
$154.47
|
| Rate for Payer: The Alliance Commercial |
$135.50
|
| Rate for Payer: WEA Trust Commercial |
$149.05
|
| Rate for Payer: WPS Commercial |
$200.73
|
|
|
Protein S Activity
|
Professional
|
Both
|
$724.00
|
|
|
Service Code
|
CPT 85306
|
| Hospital Charge Code |
983376
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$54.08 |
| Max. Negotiated Rate |
$687.80 |
| Rate for Payer: Aetna Commercial |
$687.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$622.64
|
| Rate for Payer: Cash Price |
$217.20
|
| Rate for Payer: Cash Price |
$217.20
|
| Rate for Payer: Cigna Commercial |
$687.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$362.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$434.40
|
| Rate for Payer: Health EOS Commercial |
$658.84
|
| Rate for Payer: HFN Commercial |
$687.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$54.08
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$54.08
|
| Rate for Payer: Multiplan Commercial |
$579.20
|
| Rate for Payer: Preferred Network Access Commercial |
$687.80
|
| Rate for Payer: Quartz Beloit One Network |
$318.56
|
| Rate for Payer: Quartz Commercial |
$412.68
|
| Rate for Payer: The Alliance Commercial |
$362.00
|
| Rate for Payer: WEA Trust Commercial |
$398.20
|
| Rate for Payer: WPS Commercial |
$536.27
|
|
|
Protein S Activity
|
Facility
|
OP
|
$724.00
|
|
|
Service Code
|
CPT 85306
|
| Hospital Charge Code |
983376
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.32 |
| Max. Negotiated Rate |
$666.08 |
| Rate for Payer: Aetna Commercial |
$651.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$622.64
|
| Rate for Payer: Aetna Managed Medicare |
$15.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$57.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$26.81
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$25.43
|
| Rate for Payer: Anthem Medicaid |
$15.83
|
| Rate for Payer: Anthem Medicare Advantage |
$15.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$383.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$15.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$15.32
|
| Rate for Payer: Cash Price |
$217.20
|
| Rate for Payer: Cash Price |
$217.20
|
| Rate for Payer: Cigna Commercial |
$666.08
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$15.32
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$15.83
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$405.15
|
| Rate for Payer: Dean Health Medicaid |
$15.83
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$15.32
|
| Rate for Payer: Health EOS Commercial |
$644.36
|
| Rate for Payer: HFN Commercial |
$666.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$56.99
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$15.32
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$15.83
|
| Rate for Payer: Independent Care Health Plan Medicare |
$15.32
|
| Rate for Payer: Managed Health Services Medicaid |
$16.46
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$15.32
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$15.32
|
| Rate for Payer: Multiplan Commercial |
$579.20
|
| Rate for Payer: NAPHCARE Commercial |
$22.98
|
| Rate for Payer: Preferred Network Access Commercial |
$666.08
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$15.83
|
| Rate for Payer: Quartz Beloit One Network |
$354.76
|
| Rate for Payer: Quartz Commercial |
$470.60
|
| Rate for Payer: Quartz Medicare Advantage |
$15.32
|
| Rate for Payer: The Alliance Commercial |
$61.28
|
| Rate for Payer: United Healthcare Medicaid |
$15.83
|
| Rate for Payer: United Healthcare Medicare Advantage |
$15.32
|
| Rate for Payer: United Healthcare PPO |
$543.00
|
| Rate for Payer: WEA Trust Commercial |
$398.20
|
| Rate for Payer: Wellcare Medicare |
$15.32
|
| Rate for Payer: WMAP Medicaid |
$15.83
|
| Rate for Payer: WPS Commercial |
$536.27
|
|
|
Protein S Activity
|
Facility
|
IP
|
$724.00
|
|
|
Service Code
|
CPT 85306
|
| Hospital Charge Code |
983376
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$354.76 |
| Max. Negotiated Rate |
$666.08 |
| Rate for Payer: Aetna Commercial |
$651.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$622.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$383.72
|
| Rate for Payer: Cash Price |
$217.20
|
| Rate for Payer: Cigna Commercial |
$666.08
|
| Rate for Payer: Health EOS Commercial |
$644.36
|
| Rate for Payer: HFN Commercial |
$666.08
|
| Rate for Payer: Multiplan Commercial |
$579.20
|
| Rate for Payer: NAPHCARE Commercial |
$434.40
|
| Rate for Payer: Preferred Network Access Commercial |
$666.08
|
| Rate for Payer: Quartz Beloit One Network |
$354.76
|
| Rate for Payer: Quartz Commercial |
$434.40
|
| Rate for Payer: WEA Trust Commercial |
$398.20
|
| Rate for Payer: WPS Commercial |
$536.27
|
|
|
Protein S Antigen
|
Facility
|
IP
|
$323.00
|
|
|
Service Code
|
CPT 85305
|
| Hospital Charge Code |
5749632
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$158.27 |
| Max. Negotiated Rate |
$297.16 |
| Rate for Payer: Aetna Commercial |
$290.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$277.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$171.19
|
| Rate for Payer: Cash Price |
$96.90
|
| Rate for Payer: Cigna Commercial |
$297.16
|
| Rate for Payer: Health EOS Commercial |
$287.47
|
| Rate for Payer: HFN Commercial |
$297.16
|
| Rate for Payer: Multiplan Commercial |
$258.40
|
| Rate for Payer: NAPHCARE Commercial |
$193.80
|
| Rate for Payer: Preferred Network Access Commercial |
$297.16
|
| Rate for Payer: Quartz Beloit One Network |
$158.27
|
| Rate for Payer: Quartz Commercial |
$193.80
|
| Rate for Payer: WEA Trust Commercial |
$177.65
|
| Rate for Payer: WPS Commercial |
$239.25
|
|
|
Protein S Antigen
|
Facility
|
OP
|
$323.00
|
|
|
Service Code
|
CPT 85305
|
| Hospital Charge Code |
5749632
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.61 |
| Max. Negotiated Rate |
$297.16 |
| Rate for Payer: Aetna Commercial |
$290.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$277.78
|
| Rate for Payer: Aetna Managed Medicare |
$11.61
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$43.54
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$20.32
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$19.27
|
| Rate for Payer: Anthem Medicaid |
$12.00
|
| Rate for Payer: Anthem Medicare Advantage |
$11.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$171.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$11.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$11.61
|
| Rate for Payer: Cash Price |
$96.90
|
| Rate for Payer: Cash Price |
$96.90
|
| Rate for Payer: Cigna Commercial |
$297.16
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$11.61
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$12.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$180.75
|
| Rate for Payer: Dean Health Medicaid |
$12.00
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$11.61
|
| Rate for Payer: Health EOS Commercial |
$287.47
|
| Rate for Payer: HFN Commercial |
$297.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$43.19
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$11.61
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$12.00
|
| Rate for Payer: Independent Care Health Plan Medicare |
$11.61
|
| Rate for Payer: Managed Health Services Medicaid |
$12.48
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$11.61
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$11.61
|
| Rate for Payer: Multiplan Commercial |
$258.40
|
| Rate for Payer: NAPHCARE Commercial |
$17.42
|
| Rate for Payer: Preferred Network Access Commercial |
$297.16
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$12.00
|
| Rate for Payer: Quartz Beloit One Network |
$158.27
|
| Rate for Payer: Quartz Commercial |
$209.95
|
| Rate for Payer: Quartz Medicare Advantage |
$11.61
|
| Rate for Payer: The Alliance Commercial |
$46.44
|
| Rate for Payer: United Healthcare Medicaid |
$12.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$11.61
|
| Rate for Payer: United Healthcare PPO |
$242.25
|
| Rate for Payer: WEA Trust Commercial |
$177.65
|
| Rate for Payer: Wellcare Medicare |
$11.61
|
| Rate for Payer: WMAP Medicaid |
$12.00
|
| Rate for Payer: WPS Commercial |
$239.25
|
|
|
Protein S Antigen
|
Professional
|
Both
|
$323.00
|
|
|
Service Code
|
CPT 85305
|
| Hospital Charge Code |
5749632
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$40.98 |
| Max. Negotiated Rate |
$306.85 |
| Rate for Payer: Aetna Commercial |
$306.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$277.78
|
| Rate for Payer: Cash Price |
$96.90
|
| Rate for Payer: Cash Price |
$96.90
|
| Rate for Payer: Cigna Commercial |
$306.85
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$161.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$193.80
|
| Rate for Payer: Health EOS Commercial |
$293.93
|
| Rate for Payer: HFN Commercial |
$306.85
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$40.98
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$40.98
|
| Rate for Payer: Multiplan Commercial |
$258.40
|
| Rate for Payer: Preferred Network Access Commercial |
$306.85
|
| Rate for Payer: Quartz Beloit One Network |
$142.12
|
| Rate for Payer: Quartz Commercial |
$184.11
|
| Rate for Payer: The Alliance Commercial |
$161.50
|
| Rate for Payer: WEA Trust Commercial |
$177.65
|
| Rate for Payer: WPS Commercial |
$239.25
|
|
|
Protein S Antigen Free
|
Facility
|
OP
|
$382.00
|
|
|
Service Code
|
CPT 85306
|
| Hospital Charge Code |
1102821
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.32 |
| Max. Negotiated Rate |
$351.44 |
| Rate for Payer: Aetna Commercial |
$343.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$328.52
|
| Rate for Payer: Aetna Managed Medicare |
$15.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$57.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$26.81
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$25.43
|
| Rate for Payer: Anthem Medicaid |
$15.83
|
| Rate for Payer: Anthem Medicare Advantage |
$15.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$202.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$15.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$15.32
|
| Rate for Payer: Cash Price |
$114.60
|
| Rate for Payer: Cash Price |
$114.60
|
| Rate for Payer: Cigna Commercial |
$351.44
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$15.32
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$15.83
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$213.77
|
| Rate for Payer: Dean Health Medicaid |
$15.83
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$15.32
|
| Rate for Payer: Health EOS Commercial |
$339.98
|
| Rate for Payer: HFN Commercial |
$351.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$56.99
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$15.32
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$15.83
|
| Rate for Payer: Independent Care Health Plan Medicare |
$15.32
|
| Rate for Payer: Managed Health Services Medicaid |
$16.46
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$15.32
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$15.32
|
| Rate for Payer: Multiplan Commercial |
$305.60
|
| Rate for Payer: NAPHCARE Commercial |
$22.98
|
| Rate for Payer: Preferred Network Access Commercial |
$351.44
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$15.83
|
| Rate for Payer: Quartz Beloit One Network |
$187.18
|
| Rate for Payer: Quartz Commercial |
$248.30
|
| Rate for Payer: Quartz Medicare Advantage |
$15.32
|
| Rate for Payer: The Alliance Commercial |
$61.28
|
| Rate for Payer: United Healthcare Medicaid |
$15.83
|
| Rate for Payer: United Healthcare Medicare Advantage |
$15.32
|
| Rate for Payer: United Healthcare PPO |
$286.50
|
| Rate for Payer: WEA Trust Commercial |
$210.10
|
| Rate for Payer: Wellcare Medicare |
$15.32
|
| Rate for Payer: WMAP Medicaid |
$15.83
|
| Rate for Payer: WPS Commercial |
$282.95
|
|
|
Protein S Antigen Free
|
Facility
|
IP
|
$382.00
|
|
|
Service Code
|
CPT 85306
|
| Hospital Charge Code |
1102821
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$187.18 |
| Max. Negotiated Rate |
$351.44 |
| Rate for Payer: Aetna Commercial |
$343.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$328.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$202.46
|
| Rate for Payer: Cash Price |
$114.60
|
| Rate for Payer: Cigna Commercial |
$351.44
|
| Rate for Payer: Health EOS Commercial |
$339.98
|
| Rate for Payer: HFN Commercial |
$351.44
|
| Rate for Payer: Multiplan Commercial |
$305.60
|
| Rate for Payer: NAPHCARE Commercial |
$229.20
|
| Rate for Payer: Preferred Network Access Commercial |
$351.44
|
| Rate for Payer: Quartz Beloit One Network |
$187.18
|
| Rate for Payer: Quartz Commercial |
$229.20
|
| Rate for Payer: WEA Trust Commercial |
$210.10
|
| Rate for Payer: WPS Commercial |
$282.95
|
|
