|
Protein Urine
|
Professional
|
Both
|
$77.00
|
|
|
Service Code
|
CPT 84156
|
| Hospital Charge Code |
633819
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.96 |
| Max. Negotiated Rate |
$73.15 |
| Rate for Payer: Aetna Commercial |
$73.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$66.22
|
| Rate for Payer: Cash Price |
$23.10
|
| Rate for Payer: Cash Price |
$23.10
|
| Rate for Payer: Cigna Commercial |
$73.15
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$38.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$46.20
|
| Rate for Payer: Health EOS Commercial |
$70.07
|
| Rate for Payer: HFN Commercial |
$73.15
|
| 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 |
$61.60
|
| Rate for Payer: Preferred Network Access Commercial |
$73.15
|
| Rate for Payer: Quartz Beloit One Network |
$33.88
|
| Rate for Payer: Quartz Commercial |
$43.89
|
| Rate for Payer: The Alliance Commercial |
$38.50
|
| Rate for Payer: WEA Trust Commercial |
$42.35
|
| Rate for Payer: WPS Commercial |
$57.03
|
|
|
Protein Urine
|
Facility
|
OP
|
$77.00
|
|
|
Service Code
|
CPT 84156
|
| Hospital Charge Code |
633819
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.67 |
| Max. Negotiated Rate |
$70.84 |
| Rate for Payer: Aetna Commercial |
$69.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$66.22
|
| 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 |
$40.81
|
| 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 |
$23.10
|
| Rate for Payer: Cash Price |
$23.10
|
| Rate for Payer: Cigna Commercial |
$70.84
|
| 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 |
$43.09
|
| 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 |
$68.53
|
| Rate for Payer: HFN Commercial |
$70.84
|
| 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 |
$61.60
|
| Rate for Payer: NAPHCARE Commercial |
$5.50
|
| Rate for Payer: Preferred Network Access Commercial |
$70.84
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$3.79
|
| Rate for Payer: Quartz Beloit One Network |
$37.73
|
| Rate for Payer: Quartz Commercial |
$50.05
|
| 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 |
$57.75
|
| Rate for Payer: WEA Trust Commercial |
$42.35
|
| Rate for Payer: Wellcare Medicare |
$3.67
|
| Rate for Payer: WMAP Medicaid |
$3.79
|
| Rate for Payer: WPS Commercial |
$57.03
|
|
|
Protein Urine
|
Facility
|
IP
|
$77.00
|
|
|
Service Code
|
CPT 84156
|
| Hospital Charge Code |
633819
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$37.73 |
| Max. Negotiated Rate |
$70.84 |
| Rate for Payer: Aetna Commercial |
$69.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$66.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$40.81
|
| Rate for Payer: Cash Price |
$23.10
|
| Rate for Payer: Cigna Commercial |
$70.84
|
| Rate for Payer: Health EOS Commercial |
$68.53
|
| Rate for Payer: HFN Commercial |
$70.84
|
| Rate for Payer: Multiplan Commercial |
$61.60
|
| Rate for Payer: NAPHCARE Commercial |
$46.20
|
| Rate for Payer: Preferred Network Access Commercial |
$70.84
|
| Rate for Payer: Quartz Beloit One Network |
$37.73
|
| Rate for Payer: Quartz Commercial |
$46.20
|
| Rate for Payer: WEA Trust Commercial |
$42.35
|
| Rate for Payer: WPS Commercial |
$57.03
|
|
|
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 |
$53.70 |
| Max. Negotiated Rate |
$994.52 |
| Rate for Payer: Aetna Commercial |
$972.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$929.66
|
| Rate for Payer: Aetna Managed Medicare |
$65.69
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$246.34
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$114.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$109.05
|
| Rate for Payer: Anthem Medicaid |
$53.70
|
| Rate for Payer: Anthem Medicare Advantage |
$65.69
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$572.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$65.69
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$65.69
|
| Rate for Payer: Cash Price |
$324.30
|
| Rate for Payer: Cash Price |
$324.30
|
| Rate for Payer: Cigna Commercial |
$994.52
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$65.69
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$53.70
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$604.93
|
| Rate for Payer: Dean Health Medicaid |
$53.70
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$65.69
|
| Rate for Payer: Health EOS Commercial |
$962.09
|
| Rate for Payer: HFN Commercial |
$994.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$244.37
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$65.69
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$53.70
|
| Rate for Payer: Independent Care Health Plan Medicare |
$65.69
|
| Rate for Payer: Managed Health Services Medicaid |
$55.85
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$65.69
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$65.69
|
| Rate for Payer: Multiplan Commercial |
$864.80
|
| Rate for Payer: NAPHCARE Commercial |
$98.54
|
| Rate for Payer: Preferred Network Access Commercial |
$994.52
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$53.70
|
| Rate for Payer: Quartz Beloit One Network |
$529.69
|
| Rate for Payer: Quartz Commercial |
$702.65
|
| Rate for Payer: Quartz Medicare Advantage |
$65.69
|
| Rate for Payer: The Alliance Commercial |
$262.76
|
| Rate for Payer: United Healthcare Medicaid |
$53.70
|
| Rate for Payer: United Healthcare Medicare Advantage |
$65.69
|
| Rate for Payer: United Healthcare PPO |
$810.75
|
| Rate for Payer: WEA Trust Commercial |
$594.55
|
| Rate for Payer: Wellcare Medicare |
$65.69
|
| Rate for Payer: WMAP Medicaid |
$53.70
|
| Rate for Payer: WPS Commercial |
$800.70
|
|
|
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 |
$529.69 |
| Max. Negotiated Rate |
$994.52 |
| Rate for Payer: Aetna Commercial |
$972.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$929.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$572.93
|
| Rate for Payer: Cash Price |
$324.30
|
| Rate for Payer: Cigna Commercial |
$994.52
|
| Rate for Payer: Health EOS Commercial |
$962.09
|
| Rate for Payer: HFN Commercial |
$994.52
|
| Rate for Payer: Multiplan Commercial |
$864.80
|
| Rate for Payer: NAPHCARE Commercial |
$648.60
|
| Rate for Payer: Preferred Network Access Commercial |
$994.52
|
| Rate for Payer: Quartz Beloit One Network |
$529.69
|
| Rate for Payer: Quartz Commercial |
$648.60
|
| Rate for Payer: WEA Trust Commercial |
$594.55
|
| Rate for Payer: WPS Commercial |
$800.70
|
|
|
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 |
$231.89 |
| Max. Negotiated Rate |
$1,026.95 |
| Rate for Payer: Aetna Commercial |
$1,026.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$929.66
|
| Rate for Payer: Cash Price |
$324.30
|
| Rate for Payer: Cash Price |
$324.30
|
| Rate for Payer: Cigna Commercial |
$1,026.95
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$540.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$648.60
|
| Rate for Payer: Health EOS Commercial |
$983.71
|
| Rate for Payer: HFN Commercial |
$1,026.95
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$231.89
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$231.89
|
| Rate for Payer: Multiplan Commercial |
$864.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,026.95
|
| Rate for Payer: Quartz Beloit One Network |
$475.64
|
| Rate for Payer: Quartz Commercial |
$616.17
|
| Rate for Payer: The Alliance Commercial |
$540.50
|
| Rate for Payer: WEA Trust Commercial |
$594.55
|
| Rate for Payer: WPS Commercial |
$800.70
|
|
|
Prothrombin Time
|
Facility
|
OP
|
$107.00
|
|
|
Service Code
|
CPT 85610
|
| Hospital Charge Code |
633793
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.29 |
| Max. Negotiated Rate |
$98.44 |
| Rate for Payer: Aetna Commercial |
$96.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$92.02
|
| Rate for Payer: Aetna Managed Medicare |
$4.29
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$16.09
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$7.51
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7.12
|
| Rate for Payer: Anthem Medicaid |
$4.43
|
| Rate for Payer: Anthem Medicare Advantage |
$4.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$56.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$4.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$4.29
|
| Rate for Payer: Cash Price |
$32.10
|
| Rate for Payer: Cash Price |
$32.10
|
| Rate for Payer: Cigna Commercial |
$98.44
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$4.29
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$4.43
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$59.88
|
| Rate for Payer: Dean Health Medicaid |
$4.43
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$4.29
|
| Rate for Payer: Health EOS Commercial |
$95.23
|
| Rate for Payer: HFN Commercial |
$98.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$15.96
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$4.29
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$4.43
|
| Rate for Payer: Independent Care Health Plan Medicare |
$4.29
|
| Rate for Payer: Managed Health Services Medicaid |
$4.61
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$4.29
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$4.29
|
| Rate for Payer: Multiplan Commercial |
$85.60
|
| Rate for Payer: NAPHCARE Commercial |
$6.44
|
| Rate for Payer: Preferred Network Access Commercial |
$98.44
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$4.43
|
| Rate for Payer: Quartz Beloit One Network |
$52.43
|
| Rate for Payer: Quartz Commercial |
$69.55
|
| Rate for Payer: Quartz Medicare Advantage |
$4.29
|
| Rate for Payer: The Alliance Commercial |
$17.16
|
| Rate for Payer: United Healthcare Medicaid |
$4.43
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4.29
|
| Rate for Payer: United Healthcare PPO |
$80.25
|
| Rate for Payer: WEA Trust Commercial |
$58.85
|
| Rate for Payer: Wellcare Medicare |
$4.29
|
| Rate for Payer: WMAP Medicaid |
$4.43
|
| Rate for Payer: WPS Commercial |
$79.25
|
|
|
Prothrombin Time
|
Facility
|
IP
|
$107.00
|
|
|
Service Code
|
CPT 85610
|
| Hospital Charge Code |
633793
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$52.43 |
| Max. Negotiated Rate |
$98.44 |
| Rate for Payer: Aetna Commercial |
$96.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$92.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$56.71
|
| Rate for Payer: Cash Price |
$32.10
|
| Rate for Payer: Cigna Commercial |
$98.44
|
| Rate for Payer: Health EOS Commercial |
$95.23
|
| Rate for Payer: HFN Commercial |
$98.44
|
| Rate for Payer: Multiplan Commercial |
$85.60
|
| Rate for Payer: NAPHCARE Commercial |
$64.20
|
| Rate for Payer: Preferred Network Access Commercial |
$98.44
|
| Rate for Payer: Quartz Beloit One Network |
$52.43
|
| Rate for Payer: Quartz Commercial |
$64.20
|
| Rate for Payer: WEA Trust Commercial |
$58.85
|
| Rate for Payer: WPS Commercial |
$79.25
|
|
|
Prothrombin Time
|
Professional
|
Both
|
$107.00
|
|
|
Service Code
|
CPT 85610
|
| Hospital Charge Code |
633793
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.14 |
| Max. Negotiated Rate |
$101.65 |
| Rate for Payer: Aetna Commercial |
$101.65
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$92.02
|
| Rate for Payer: Cash Price |
$32.10
|
| Rate for Payer: Cash Price |
$32.10
|
| Rate for Payer: Cigna Commercial |
$101.65
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$53.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$64.20
|
| Rate for Payer: Health EOS Commercial |
$97.37
|
| Rate for Payer: HFN Commercial |
$101.65
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$15.14
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$15.14
|
| Rate for Payer: Multiplan Commercial |
$85.60
|
| Rate for Payer: Preferred Network Access Commercial |
$101.65
|
| Rate for Payer: Quartz Beloit One Network |
$47.08
|
| Rate for Payer: Quartz Commercial |
$60.99
|
| Rate for Payer: The Alliance Commercial |
$53.50
|
| Rate for Payer: WEA Trust Commercial |
$58.85
|
| Rate for Payer: WPS Commercial |
$79.25
|
|
|
Prothrombin Time POC
|
Professional
|
Both
|
$33.00
|
|
|
Service Code
|
CPT 85610
|
| Hospital Charge Code |
2580845
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.52 |
| Max. Negotiated Rate |
$31.35 |
| Rate for Payer: Aetna Commercial |
$31.35
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$28.38
|
| Rate for Payer: Cash Price |
$9.90
|
| Rate for Payer: Cash Price |
$9.90
|
| Rate for Payer: Cigna Commercial |
$31.35
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$16.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$19.80
|
| Rate for Payer: Health EOS Commercial |
$30.03
|
| Rate for Payer: HFN Commercial |
$31.35
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$15.14
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$15.14
|
| Rate for Payer: Multiplan Commercial |
$26.40
|
| Rate for Payer: Preferred Network Access Commercial |
$31.35
|
| Rate for Payer: Quartz Beloit One Network |
$14.52
|
| Rate for Payer: Quartz Commercial |
$18.81
|
| Rate for Payer: The Alliance Commercial |
$16.50
|
| Rate for Payer: WEA Trust Commercial |
$18.15
|
| Rate for Payer: WPS Commercial |
$24.44
|
|
|
PROTITANICA FOOT FILE CHEC'L
|
Facility
|
OP
|
$355.00
|
|
| Hospital Charge Code |
2970986
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$99.40 |
| Max. Negotiated Rate |
$1,420.00 |
| Rate for Payer: Aetna Commercial |
$319.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$305.30
|
| Rate for Payer: Aetna Managed Medicare |
$99.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$230.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$177.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$170.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$188.15
|
| Rate for Payer: Cash Price |
$106.50
|
| Rate for Payer: Cigna Commercial |
$326.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$198.66
|
| Rate for Payer: Health EOS Commercial |
$315.95
|
| Rate for Payer: HFN Commercial |
$326.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$266.25
|
| Rate for Payer: Multiplan Commercial |
$284.00
|
| Rate for Payer: NAPHCARE Commercial |
$213.00
|
| Rate for Payer: Preferred Network Access Commercial |
$326.60
|
| Rate for Payer: Quartz Beloit One Network |
$173.95
|
| Rate for Payer: Quartz Commercial |
$230.75
|
| Rate for Payer: Quartz Medicare Advantage |
$213.00
|
| Rate for Payer: The Alliance Commercial |
$1,420.00
|
| Rate for Payer: WEA Trust Commercial |
$195.25
|
| Rate for Payer: WPS Commercial |
$262.95
|
|
|
PROTITANICA FOOT FILE CHEC'L
|
Facility
|
IP
|
$355.00
|
|
| Hospital Charge Code |
2970986
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$173.95 |
| Max. Negotiated Rate |
$326.60 |
| Rate for Payer: Aetna Commercial |
$319.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$305.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$188.15
|
| Rate for Payer: Cash Price |
$106.50
|
| Rate for Payer: Cigna Commercial |
$326.60
|
| Rate for Payer: Health EOS Commercial |
$315.95
|
| Rate for Payer: HFN Commercial |
$326.60
|
| Rate for Payer: Multiplan Commercial |
$284.00
|
| Rate for Payer: NAPHCARE Commercial |
$213.00
|
| Rate for Payer: Preferred Network Access Commercial |
$326.60
|
| Rate for Payer: Quartz Beloit One Network |
$173.95
|
| Rate for Payer: Quartz Commercial |
$213.00
|
| Rate for Payer: WEA Trust Commercial |
$195.25
|
| Rate for Payer: WPS Commercial |
$262.95
|
|
|
Provay Blue 50mg/10ml (Med)
|
Facility
|
IP
|
$209.00
|
|
|
Service Code
|
HCPCS Q9968
|
| Hospital Charge Code |
5617790
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$102.41 |
| Max. Negotiated Rate |
$192.28 |
| Rate for Payer: Aetna Commercial |
$188.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$179.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$110.77
|
| Rate for Payer: Cash Price |
$62.70
|
| Rate for Payer: Cigna Commercial |
$192.28
|
| Rate for Payer: Health EOS Commercial |
$186.01
|
| Rate for Payer: HFN Commercial |
$192.28
|
| Rate for Payer: Multiplan Commercial |
$167.20
|
| Rate for Payer: NAPHCARE Commercial |
$125.40
|
| Rate for Payer: Preferred Network Access Commercial |
$192.28
|
| Rate for Payer: Quartz Beloit One Network |
$102.41
|
| Rate for Payer: Quartz Commercial |
$125.40
|
| Rate for Payer: WEA Trust Commercial |
$114.95
|
| Rate for Payer: WPS Commercial |
$154.81
|
|
|
Provay Blue 50mg/10ml (Med)
|
Facility
|
OP
|
$209.00
|
|
|
Service Code
|
HCPCS Q9968
|
| Hospital Charge Code |
5617790
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.95 |
| Max. Negotiated Rate |
$192.28 |
| Rate for Payer: Aetna Commercial |
$188.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$179.74
|
| Rate for Payer: Aetna Managed Medicare |
$7.95
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$135.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$104.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$100.32
|
| Rate for Payer: Anthem Medicare Advantage |
$7.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$110.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$7.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$7.95
|
| Rate for Payer: Cash Price |
$62.70
|
| Rate for Payer: Cash Price |
$62.70
|
| Rate for Payer: Cigna Commercial |
$192.28
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$7.95
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$116.96
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$7.95
|
| Rate for Payer: Health EOS Commercial |
$186.01
|
| Rate for Payer: HFN Commercial |
$192.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$29.57
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$7.95
|
| Rate for Payer: Independent Care Health Plan Medicare |
$7.95
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$7.95
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$7.95
|
| Rate for Payer: Multiplan Commercial |
$167.20
|
| Rate for Payer: NAPHCARE Commercial |
$11.92
|
| Rate for Payer: Preferred Network Access Commercial |
$192.28
|
| Rate for Payer: Quartz Beloit One Network |
$102.41
|
| Rate for Payer: Quartz Commercial |
$135.85
|
| Rate for Payer: Quartz Medicare Advantage |
$7.95
|
| Rate for Payer: The Alliance Commercial |
$31.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$7.95
|
| Rate for Payer: WEA Trust Commercial |
$114.95
|
| Rate for Payer: Wellcare Medicare |
$7.95
|
| Rate for Payer: WPS Commercial |
$154.81
|
|
|
PROVIDONE IODINE TOP 10% SOL 8OZ (MED)
|
Facility
|
IP
|
$10.00
|
|
| Hospital Charge Code |
3162775
|
|
Hospital Revenue Code
|
367
|
| Min. Negotiated Rate |
$4.90 |
| Max. Negotiated Rate |
$9.20 |
| Rate for Payer: Aetna Commercial |
$9.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5.30
|
| Rate for Payer: Cash Price |
$3.00
|
| Rate for Payer: Cigna Commercial |
$9.20
|
| Rate for Payer: Health EOS Commercial |
$8.90
|
| Rate for Payer: HFN Commercial |
$9.20
|
| Rate for Payer: Multiplan Commercial |
$8.00
|
| Rate for Payer: NAPHCARE Commercial |
$6.00
|
| Rate for Payer: Preferred Network Access Commercial |
$9.20
|
| Rate for Payer: Quartz Beloit One Network |
$4.90
|
| Rate for Payer: Quartz Commercial |
$6.00
|
| Rate for Payer: WEA Trust Commercial |
$5.50
|
| Rate for Payer: WPS Commercial |
$7.41
|
|
|
PROVIDONE IODINE TOP 10% SOL 8OZ (MED)
|
Facility
|
OP
|
$10.00
|
|
| Hospital Charge Code |
3162775
|
|
Hospital Revenue Code
|
367
|
| Min. Negotiated Rate |
$2.80 |
| Max. Negotiated Rate |
$40.00 |
| Rate for Payer: Aetna Commercial |
$9.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8.60
|
| Rate for Payer: Aetna Managed Medicare |
$2.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5.30
|
| Rate for Payer: Cash Price |
$3.00
|
| Rate for Payer: Cigna Commercial |
$9.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5.60
|
| Rate for Payer: Health EOS Commercial |
$8.90
|
| Rate for Payer: HFN Commercial |
$9.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7.50
|
| Rate for Payer: Multiplan Commercial |
$8.00
|
| Rate for Payer: NAPHCARE Commercial |
$6.00
|
| Rate for Payer: Preferred Network Access Commercial |
$9.20
|
| Rate for Payer: Quartz Beloit One Network |
$4.90
|
| Rate for Payer: Quartz Commercial |
$6.50
|
| Rate for Payer: Quartz Medicare Advantage |
$6.00
|
| Rate for Payer: The Alliance Commercial |
$40.00
|
| Rate for Payer: WEA Trust Commercial |
$5.50
|
| Rate for Payer: WPS Commercial |
$7.41
|
|
|
PROVISC 0004510128
|
Facility
|
IP
|
$509.00
|
|
| Hospital Charge Code |
5895726
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$249.41 |
| Max. Negotiated Rate |
$468.28 |
| Rate for Payer: Aetna Commercial |
$458.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$437.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$269.77
|
| Rate for Payer: Cash Price |
$152.70
|
| Rate for Payer: Cigna Commercial |
$468.28
|
| Rate for Payer: Health EOS Commercial |
$453.01
|
| Rate for Payer: HFN Commercial |
$468.28
|
| Rate for Payer: Multiplan Commercial |
$407.20
|
| Rate for Payer: NAPHCARE Commercial |
$305.40
|
| Rate for Payer: Preferred Network Access Commercial |
$468.28
|
| Rate for Payer: Quartz Beloit One Network |
$249.41
|
| Rate for Payer: Quartz Commercial |
$305.40
|
| Rate for Payer: WEA Trust Commercial |
$279.95
|
| Rate for Payer: WPS Commercial |
$377.02
|
|
|
PROVISC 0004510128
|
Facility
|
OP
|
$509.00
|
|
| Hospital Charge Code |
5895726
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$142.52 |
| Max. Negotiated Rate |
$2,036.00 |
| Rate for Payer: Aetna Commercial |
$458.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$437.74
|
| Rate for Payer: Aetna Managed Medicare |
$142.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$330.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$254.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$244.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$269.77
|
| Rate for Payer: Cash Price |
$152.70
|
| Rate for Payer: Cigna Commercial |
$468.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$284.84
|
| Rate for Payer: Health EOS Commercial |
$453.01
|
| Rate for Payer: HFN Commercial |
$468.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$381.75
|
| Rate for Payer: Multiplan Commercial |
$407.20
|
| Rate for Payer: NAPHCARE Commercial |
$305.40
|
| Rate for Payer: Preferred Network Access Commercial |
$468.28
|
| Rate for Payer: Quartz Beloit One Network |
$249.41
|
| Rate for Payer: Quartz Commercial |
$330.85
|
| Rate for Payer: Quartz Medicare Advantage |
$305.40
|
| Rate for Payer: The Alliance Commercial |
$2,036.00
|
| Rate for Payer: WEA Trust Commercial |
$279.95
|
| Rate for Payer: WPS Commercial |
$377.02
|
|
|
PROVOX LIFE HOME HME 8311
|
Facility
|
IP
|
$99.00
|
|
| Hospital Charge Code |
6175028
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$48.51 |
| Max. Negotiated Rate |
$91.08 |
| Rate for Payer: Aetna Commercial |
$89.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$85.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$52.47
|
| Rate for Payer: Cash Price |
$29.70
|
| Rate for Payer: Cigna Commercial |
$91.08
|
| Rate for Payer: Health EOS Commercial |
$88.11
|
| Rate for Payer: HFN Commercial |
$91.08
|
| Rate for Payer: Multiplan Commercial |
$79.20
|
| Rate for Payer: NAPHCARE Commercial |
$59.40
|
| Rate for Payer: Preferred Network Access Commercial |
$91.08
|
| Rate for Payer: Quartz Beloit One Network |
$48.51
|
| Rate for Payer: Quartz Commercial |
$59.40
|
| Rate for Payer: WEA Trust Commercial |
$54.45
|
| Rate for Payer: WPS Commercial |
$73.33
|
|
|
PROVOX LIFE HOME HME 8311
|
Facility
|
OP
|
$99.00
|
|
| Hospital Charge Code |
6175028
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$27.72 |
| Max. Negotiated Rate |
$396.00 |
| Rate for Payer: Aetna Commercial |
$89.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$85.14
|
| Rate for Payer: Aetna Managed Medicare |
$27.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$64.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$49.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$47.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$52.47
|
| Rate for Payer: Cash Price |
$29.70
|
| Rate for Payer: Cigna Commercial |
$91.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$55.40
|
| Rate for Payer: Health EOS Commercial |
$88.11
|
| Rate for Payer: HFN Commercial |
$91.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$74.25
|
| Rate for Payer: Multiplan Commercial |
$79.20
|
| Rate for Payer: NAPHCARE Commercial |
$59.40
|
| Rate for Payer: Preferred Network Access Commercial |
$91.08
|
| Rate for Payer: Quartz Beloit One Network |
$48.51
|
| Rate for Payer: Quartz Commercial |
$64.35
|
| Rate for Payer: Quartz Medicare Advantage |
$59.40
|
| Rate for Payer: The Alliance Commercial |
$396.00
|
| Rate for Payer: WEA Trust Commercial |
$54.45
|
| Rate for Payer: WPS Commercial |
$73.33
|
|
|
PROVOX LIFE LARYTUBE STANDARD 10/55 7417
|
Facility
|
OP
|
$1,712.00
|
|
| Hospital Charge Code |
6175032
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$479.36 |
| Max. Negotiated Rate |
$6,848.00 |
| Rate for Payer: Aetna Commercial |
$1,540.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,472.32
|
| Rate for Payer: Aetna Managed Medicare |
$479.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,112.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$856.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$821.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$907.36
|
| Rate for Payer: Cash Price |
$513.60
|
| Rate for Payer: Cigna Commercial |
$1,575.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$958.04
|
| Rate for Payer: Health EOS Commercial |
$1,523.68
|
| Rate for Payer: HFN Commercial |
$1,575.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,284.00
|
| Rate for Payer: Multiplan Commercial |
$1,369.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,027.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,575.04
|
| Rate for Payer: Quartz Beloit One Network |
$838.88
|
| Rate for Payer: Quartz Commercial |
$1,112.80
|
| Rate for Payer: Quartz Medicare Advantage |
$1,027.20
|
| Rate for Payer: The Alliance Commercial |
$6,848.00
|
| Rate for Payer: WEA Trust Commercial |
$941.60
|
| Rate for Payer: WPS Commercial |
$1,268.08
|
|
|
PROVOX LIFE LARYTUBE STANDARD 10/55 7417
|
Facility
|
IP
|
$1,712.00
|
|
| Hospital Charge Code |
6175032
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$838.88 |
| Max. Negotiated Rate |
$1,575.04 |
| Rate for Payer: Aetna Commercial |
$1,540.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,472.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$907.36
|
| Rate for Payer: Cash Price |
$513.60
|
| Rate for Payer: Cigna Commercial |
$1,575.04
|
| Rate for Payer: Health EOS Commercial |
$1,523.68
|
| Rate for Payer: HFN Commercial |
$1,575.04
|
| Rate for Payer: Multiplan Commercial |
$1,369.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,027.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,575.04
|
| Rate for Payer: Quartz Beloit One Network |
$838.88
|
| Rate for Payer: Quartz Commercial |
$1,027.20
|
| Rate for Payer: WEA Trust Commercial |
$941.60
|
| Rate for Payer: WPS Commercial |
$1,268.08
|
|
|
PROVOX LIFE NIGHT HME 8262
|
Facility
|
OP
|
$121.00
|
|
| Hospital Charge Code |
6175030
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$33.88 |
| Max. Negotiated Rate |
$484.00 |
| Rate for Payer: Aetna Commercial |
$108.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$104.06
|
| Rate for Payer: Aetna Managed Medicare |
$33.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$78.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$60.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$58.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$64.13
|
| Rate for Payer: Cash Price |
$36.30
|
| Rate for Payer: Cigna Commercial |
$111.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$67.71
|
| Rate for Payer: Health EOS Commercial |
$107.69
|
| Rate for Payer: HFN Commercial |
$111.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$90.75
|
| Rate for Payer: Multiplan Commercial |
$96.80
|
| Rate for Payer: NAPHCARE Commercial |
$72.60
|
| Rate for Payer: Preferred Network Access Commercial |
$111.32
|
| Rate for Payer: Quartz Beloit One Network |
$59.29
|
| Rate for Payer: Quartz Commercial |
$78.65
|
| Rate for Payer: Quartz Medicare Advantage |
$72.60
|
| Rate for Payer: The Alliance Commercial |
$484.00
|
| Rate for Payer: WEA Trust Commercial |
$66.55
|
| Rate for Payer: WPS Commercial |
$89.62
|
|
|
PROVOX LIFE NIGHT HME 8262
|
Facility
|
IP
|
$121.00
|
|
| Hospital Charge Code |
6175030
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$59.29 |
| Max. Negotiated Rate |
$111.32 |
| Rate for Payer: Aetna Commercial |
$108.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$104.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$64.13
|
| Rate for Payer: Cash Price |
$36.30
|
| Rate for Payer: Cigna Commercial |
$111.32
|
| Rate for Payer: Health EOS Commercial |
$107.69
|
| Rate for Payer: HFN Commercial |
$111.32
|
| Rate for Payer: Multiplan Commercial |
$96.80
|
| Rate for Payer: NAPHCARE Commercial |
$72.60
|
| Rate for Payer: Preferred Network Access Commercial |
$111.32
|
| Rate for Payer: Quartz Beloit One Network |
$59.29
|
| Rate for Payer: Quartz Commercial |
$72.60
|
| Rate for Payer: WEA Trust Commercial |
$66.55
|
| Rate for Payer: WPS Commercial |
$89.62
|
|
|
PROVOX LIFE SHOWER 8308
|
Facility
|
IP
|
$721.00
|
|
| Hospital Charge Code |
6175031
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$353.29 |
| Max. Negotiated Rate |
$663.32 |
| Rate for Payer: Aetna Commercial |
$648.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$620.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$382.13
|
| Rate for Payer: Cash Price |
$216.30
|
| Rate for Payer: Cigna Commercial |
$663.32
|
| Rate for Payer: Health EOS Commercial |
$641.69
|
| Rate for Payer: HFN Commercial |
$663.32
|
| Rate for Payer: Multiplan Commercial |
$576.80
|
| Rate for Payer: NAPHCARE Commercial |
$432.60
|
| Rate for Payer: Preferred Network Access Commercial |
$663.32
|
| Rate for Payer: Quartz Beloit One Network |
$353.29
|
| Rate for Payer: Quartz Commercial |
$432.60
|
| Rate for Payer: WEA Trust Commercial |
$396.55
|
| Rate for Payer: WPS Commercial |
$534.04
|
|
