|
Beta 2 glycoprotein I Antibodies
|
Facility
IP
|
$315.00
|
|
|
Service Code
|
CPT 86146
|
| Hospital Charge Code |
980035
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$154.35 |
| Max. Negotiated Rate |
$289.80 |
| Rate for Payer: Aetna Commercial |
$283.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$166.95
|
| Rate for Payer: Cash Price |
$94.50
|
| Rate for Payer: Cigna Commercial |
$289.80
|
| Rate for Payer: Health EOS Commercial |
$280.35
|
| Rate for Payer: HFN Commercial |
$289.80
|
| Rate for Payer: Multiplan Commercial |
$252.00
|
| Rate for Payer: NAPHCARE Commercial |
$189.00
|
| Rate for Payer: Preferred Network Access Commercial |
$289.80
|
| Rate for Payer: Quartz Beloit One Network |
$154.35
|
| Rate for Payer: Quartz Commercial |
$189.00
|
| Rate for Payer: WEA Trust Commercial |
$173.25
|
| Rate for Payer: WPS Commercial |
$233.32
|
|
|
Beta 2 glycoprotein I Antibodies
|
Professional
|
$315.00
|
|
|
Service Code
|
CPT 86146
|
| Hospital Charge Code |
980035
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$25.45 |
| Max. Negotiated Rate |
$299.25 |
| Rate for Payer: Aetna Commercial |
$299.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$270.90
|
| Rate for Payer: Aetna Managed Medicare |
$25.45
|
| Rate for Payer: Anthem Medicare Advantage |
$25.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$25.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$25.45
|
| Rate for Payer: Cash Price |
$94.50
|
| Rate for Payer: Cash Price |
$94.50
|
| Rate for Payer: Cigna Commercial |
$299.25
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$157.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$25.45
|
| Rate for Payer: Health EOS Commercial |
$286.65
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$89.84
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$89.84
|
| Rate for Payer: Independent Care Health Plan Medicare |
$25.45
|
| Rate for Payer: Multiplan Commercial |
$252.00
|
| Rate for Payer: Preferred Network Access Commercial |
$299.25
|
| Rate for Payer: Quartz Beloit One Network |
$138.60
|
| Rate for Payer: Quartz Commercial |
$179.55
|
| Rate for Payer: Quartz Medicare Advantage |
$25.45
|
| Rate for Payer: The Alliance Commercial |
$100.53
|
| Rate for Payer: United Healthcare Medicare Advantage |
$25.45
|
| Rate for Payer: WEA Trust Commercial |
$173.25
|
| Rate for Payer: WPS Commercial |
$111.98
|
|
|
Beta 2 glycoprotein I Antibodies
|
Facility
OP
|
$315.00
|
|
|
Service Code
|
CPT 86146
|
| Hospital Charge Code |
980035
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.17 |
| Max. Negotiated Rate |
$1,260.00 |
| Rate for Payer: Aetna Commercial |
$283.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$270.90
|
| Rate for Payer: Aetna Managed Medicare |
$25.45
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$95.44
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$44.54
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$42.25
|
| Rate for Payer: Anthem Medicaid |
$8.17
|
| Rate for Payer: Anthem Medicare Advantage |
$25.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$166.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$25.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$25.45
|
| Rate for Payer: Cash Price |
$94.50
|
| Rate for Payer: Cash Price |
$94.50
|
| Rate for Payer: Cigna Commercial |
$289.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$25.45
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$8.17
|
| Rate for Payer: Dean Health Medicaid |
$8.17
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$25.45
|
| Rate for Payer: Health EOS Commercial |
$280.35
|
| Rate for Payer: HFN Commercial |
$289.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$94.67
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$25.45
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$8.17
|
| Rate for Payer: Independent Care Health Plan Medicare |
$25.45
|
| Rate for Payer: Managed Health Services Medicaid |
$8.50
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$25.45
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$25.45
|
| Rate for Payer: Multiplan Commercial |
$252.00
|
| Rate for Payer: NAPHCARE Commercial |
$38.18
|
| Rate for Payer: Preferred Network Access Commercial |
$289.80
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$8.17
|
| Rate for Payer: Quartz Beloit One Network |
$154.35
|
| Rate for Payer: Quartz Commercial |
$204.75
|
| Rate for Payer: Quartz Medicare Advantage |
$25.45
|
| Rate for Payer: The Alliance Commercial |
$1,260.00
|
| Rate for Payer: United Healthcare Medicaid |
$8.17
|
| Rate for Payer: United Healthcare Medicare Advantage |
$25.45
|
| Rate for Payer: United Healthcare PPO |
$236.25
|
| Rate for Payer: WEA Trust Commercial |
$173.25
|
| Rate for Payer: Wellcare Medicare |
$25.45
|
| Rate for Payer: WMAP Medicaid |
$8.17
|
| Rate for Payer: WPS Commercial |
$233.32
|
|
|
Beta 2 Microglobulin
|
Facility
OP
|
$228.00
|
|
|
Service Code
|
CPT 82232
|
| Hospital Charge Code |
977878
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$16.18 |
| Max. Negotiated Rate |
$912.00 |
| Rate for Payer: Aetna Commercial |
$205.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$196.08
|
| Rate for Payer: Aetna Managed Medicare |
$16.18
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$60.68
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$28.32
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$26.86
|
| Rate for Payer: Anthem Medicaid |
$16.72
|
| Rate for Payer: Anthem Medicare Advantage |
$16.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$120.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$16.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$16.18
|
| Rate for Payer: Cash Price |
$68.40
|
| Rate for Payer: Cash Price |
$68.40
|
| Rate for Payer: Cigna Commercial |
$209.76
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$16.18
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$16.72
|
| Rate for Payer: Dean Health Medicaid |
$16.72
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$16.18
|
| Rate for Payer: Health EOS Commercial |
$202.92
|
| Rate for Payer: HFN Commercial |
$209.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$60.19
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$16.18
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$16.72
|
| Rate for Payer: Independent Care Health Plan Medicare |
$16.18
|
| Rate for Payer: Managed Health Services Medicaid |
$17.39
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$16.18
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$16.18
|
| Rate for Payer: Multiplan Commercial |
$182.40
|
| Rate for Payer: NAPHCARE Commercial |
$24.27
|
| Rate for Payer: Preferred Network Access Commercial |
$209.76
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$16.72
|
| Rate for Payer: Quartz Beloit One Network |
$111.72
|
| Rate for Payer: Quartz Commercial |
$148.20
|
| Rate for Payer: Quartz Medicare Advantage |
$16.18
|
| Rate for Payer: The Alliance Commercial |
$912.00
|
| Rate for Payer: United Healthcare Medicaid |
$16.72
|
| Rate for Payer: United Healthcare Medicare Advantage |
$16.18
|
| Rate for Payer: United Healthcare PPO |
$171.00
|
| Rate for Payer: WEA Trust Commercial |
$125.40
|
| Rate for Payer: Wellcare Medicare |
$16.18
|
| Rate for Payer: WMAP Medicaid |
$16.72
|
| Rate for Payer: WPS Commercial |
$168.88
|
|
|
Beta 2 Microglobulin
|
Facility
IP
|
$228.00
|
|
|
Service Code
|
CPT 82232
|
| Hospital Charge Code |
977878
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$111.72 |
| Max. Negotiated Rate |
$209.76 |
| Rate for Payer: Aetna Commercial |
$205.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$120.84
|
| Rate for Payer: Cash Price |
$68.40
|
| Rate for Payer: Cigna Commercial |
$209.76
|
| Rate for Payer: Health EOS Commercial |
$202.92
|
| Rate for Payer: HFN Commercial |
$209.76
|
| Rate for Payer: Multiplan Commercial |
$182.40
|
| Rate for Payer: NAPHCARE Commercial |
$136.80
|
| Rate for Payer: Preferred Network Access Commercial |
$209.76
|
| Rate for Payer: Quartz Beloit One Network |
$111.72
|
| Rate for Payer: Quartz Commercial |
$136.80
|
| Rate for Payer: WEA Trust Commercial |
$125.40
|
| Rate for Payer: WPS Commercial |
$168.88
|
|
|
Beta 2 Microglobulin
|
Professional
|
$228.00
|
|
|
Service Code
|
CPT 82232
|
| Hospital Charge Code |
977878
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$16.18 |
| Max. Negotiated Rate |
$216.60 |
| Rate for Payer: Aetna Commercial |
$216.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$196.08
|
| Rate for Payer: Aetna Managed Medicare |
$16.18
|
| Rate for Payer: Anthem Medicare Advantage |
$16.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$16.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$16.18
|
| Rate for Payer: Cash Price |
$68.40
|
| Rate for Payer: Cash Price |
$68.40
|
| Rate for Payer: Cigna Commercial |
$216.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$114.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$16.18
|
| Rate for Payer: Health EOS Commercial |
$207.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$57.12
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$57.12
|
| Rate for Payer: Independent Care Health Plan Medicare |
$16.18
|
| Rate for Payer: Multiplan Commercial |
$182.40
|
| Rate for Payer: Preferred Network Access Commercial |
$216.60
|
| Rate for Payer: Quartz Beloit One Network |
$100.32
|
| Rate for Payer: Quartz Commercial |
$129.96
|
| Rate for Payer: Quartz Medicare Advantage |
$16.18
|
| Rate for Payer: The Alliance Commercial |
$63.91
|
| Rate for Payer: United Healthcare Medicare Advantage |
$16.18
|
| Rate for Payer: WEA Trust Commercial |
$125.40
|
| Rate for Payer: WPS Commercial |
$71.19
|
|
|
Beta 2 Microglobulin Urine
|
Facility
IP
|
$153.00
|
|
|
Service Code
|
CPT 82232
|
| Hospital Charge Code |
977879
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$74.97 |
| Max. Negotiated Rate |
$140.76 |
| Rate for Payer: Aetna Commercial |
$137.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$81.09
|
| Rate for Payer: Cash Price |
$45.90
|
| Rate for Payer: Cigna Commercial |
$140.76
|
| Rate for Payer: Health EOS Commercial |
$136.17
|
| Rate for Payer: HFN Commercial |
$140.76
|
| Rate for Payer: Multiplan Commercial |
$122.40
|
| Rate for Payer: NAPHCARE Commercial |
$91.80
|
| Rate for Payer: Preferred Network Access Commercial |
$140.76
|
| Rate for Payer: Quartz Beloit One Network |
$74.97
|
| Rate for Payer: Quartz Commercial |
$91.80
|
| Rate for Payer: WEA Trust Commercial |
$84.15
|
| Rate for Payer: WPS Commercial |
$113.33
|
|
|
Beta 2 Microglobulin Urine
|
Facility
OP
|
$153.00
|
|
|
Service Code
|
CPT 82232
|
| Hospital Charge Code |
977879
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$16.18 |
| Max. Negotiated Rate |
$612.00 |
| Rate for Payer: Aetna Commercial |
$137.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$131.58
|
| Rate for Payer: Aetna Managed Medicare |
$16.18
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$60.68
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$28.32
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$26.86
|
| Rate for Payer: Anthem Medicaid |
$16.72
|
| Rate for Payer: Anthem Medicare Advantage |
$16.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$81.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$16.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$16.18
|
| Rate for Payer: Cash Price |
$45.90
|
| Rate for Payer: Cash Price |
$45.90
|
| Rate for Payer: Cigna Commercial |
$140.76
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$16.18
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$16.72
|
| Rate for Payer: Dean Health Medicaid |
$16.72
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$16.18
|
| Rate for Payer: Health EOS Commercial |
$136.17
|
| Rate for Payer: HFN Commercial |
$140.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$60.19
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$16.18
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$16.72
|
| Rate for Payer: Independent Care Health Plan Medicare |
$16.18
|
| Rate for Payer: Managed Health Services Medicaid |
$17.39
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$16.18
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$16.18
|
| Rate for Payer: Multiplan Commercial |
$122.40
|
| Rate for Payer: NAPHCARE Commercial |
$24.27
|
| Rate for Payer: Preferred Network Access Commercial |
$140.76
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$16.72
|
| Rate for Payer: Quartz Beloit One Network |
$74.97
|
| Rate for Payer: Quartz Commercial |
$99.45
|
| Rate for Payer: Quartz Medicare Advantage |
$16.18
|
| Rate for Payer: The Alliance Commercial |
$612.00
|
| Rate for Payer: United Healthcare Medicaid |
$16.72
|
| Rate for Payer: United Healthcare Medicare Advantage |
$16.18
|
| Rate for Payer: United Healthcare PPO |
$114.75
|
| Rate for Payer: WEA Trust Commercial |
$84.15
|
| Rate for Payer: Wellcare Medicare |
$16.18
|
| Rate for Payer: WMAP Medicaid |
$16.72
|
| Rate for Payer: WPS Commercial |
$113.33
|
|
|
Beta 2 Microglobulin Urine
|
Professional
|
$153.00
|
|
|
Service Code
|
CPT 82232
|
| Hospital Charge Code |
977879
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$16.18 |
| Max. Negotiated Rate |
$145.35 |
| Rate for Payer: Aetna Commercial |
$145.35
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$131.58
|
| Rate for Payer: Aetna Managed Medicare |
$16.18
|
| Rate for Payer: Anthem Medicare Advantage |
$16.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$16.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$16.18
|
| Rate for Payer: Cash Price |
$45.90
|
| Rate for Payer: Cash Price |
$45.90
|
| Rate for Payer: Cigna Commercial |
$145.35
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$76.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$16.18
|
| Rate for Payer: Health EOS Commercial |
$139.23
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$57.12
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$57.12
|
| Rate for Payer: Independent Care Health Plan Medicare |
$16.18
|
| Rate for Payer: Multiplan Commercial |
$122.40
|
| Rate for Payer: Preferred Network Access Commercial |
$145.35
|
| Rate for Payer: Quartz Beloit One Network |
$67.32
|
| Rate for Payer: Quartz Commercial |
$87.21
|
| Rate for Payer: Quartz Medicare Advantage |
$16.18
|
| Rate for Payer: The Alliance Commercial |
$63.91
|
| Rate for Payer: United Healthcare Medicare Advantage |
$16.18
|
| Rate for Payer: WEA Trust Commercial |
$84.15
|
| Rate for Payer: WPS Commercial |
$71.19
|
|
|
Beta-2 Transferrin
|
Professional
|
$417.00
|
|
|
Service Code
|
CPT 86335
|
| Hospital Charge Code |
980036
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$16.61 |
| Max. Negotiated Rate |
$396.15 |
| Rate for Payer: Aetna Commercial |
$396.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$358.62
|
| Rate for Payer: Aetna Managed Medicare |
$29.35
|
| Rate for Payer: Anthem Commercial |
$16.61
|
| Rate for Payer: Anthem Medicare Advantage |
$29.35
|
| 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 |
$125.10
|
| Rate for Payer: Cash Price |
$125.10
|
| Rate for Payer: Cigna Commercial |
$396.15
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$208.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$29.35
|
| Rate for Payer: Health EOS Commercial |
$379.47
|
| 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: Independent Care Health Plan Medicare |
$29.35
|
| Rate for Payer: Multiplan Commercial |
$333.60
|
| Rate for Payer: Preferred Network Access Commercial |
$396.15
|
| Rate for Payer: Quartz Beloit One Network |
$183.48
|
| Rate for Payer: Quartz Commercial |
$237.69
|
| Rate for Payer: Quartz Medicare Advantage |
$29.35
|
| Rate for Payer: The Alliance Commercial |
$115.93
|
| Rate for Payer: United Healthcare Medicare Advantage |
$29.35
|
| Rate for Payer: WEA Trust Commercial |
$229.35
|
| Rate for Payer: WPS Commercial |
$129.14
|
|
|
Beta-2 Transferrin
|
Facility
IP
|
$417.00
|
|
|
Service Code
|
CPT 86335
|
| Hospital Charge Code |
980036
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$204.33 |
| Max. Negotiated Rate |
$383.64 |
| Rate for Payer: Aetna Commercial |
$375.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$221.01
|
| Rate for Payer: Cash Price |
$125.10
|
| Rate for Payer: Cigna Commercial |
$383.64
|
| Rate for Payer: Health EOS Commercial |
$371.13
|
| Rate for Payer: HFN Commercial |
$383.64
|
| Rate for Payer: Multiplan Commercial |
$333.60
|
| Rate for Payer: NAPHCARE Commercial |
$250.20
|
| Rate for Payer: Preferred Network Access Commercial |
$383.64
|
| Rate for Payer: Quartz Beloit One Network |
$204.33
|
| Rate for Payer: Quartz Commercial |
$250.20
|
| Rate for Payer: WEA Trust Commercial |
$229.35
|
| Rate for Payer: WPS Commercial |
$308.87
|
|
|
Beta-2 Transferrin
|
Facility
OP
|
$417.00
|
|
|
Service Code
|
CPT 86335
|
| Hospital Charge Code |
980036
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$29.35 |
| Max. Negotiated Rate |
$1,668.00 |
| Rate for Payer: Aetna Commercial |
$375.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$358.62
|
| 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 |
$221.01
|
| 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 |
$125.10
|
| Rate for Payer: Cash Price |
$125.10
|
| Rate for Payer: Cigna Commercial |
$383.64
|
| 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 Medicaid |
$30.33
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$29.35
|
| Rate for Payer: Health EOS Commercial |
$371.13
|
| Rate for Payer: HFN Commercial |
$383.64
|
| 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 |
$333.60
|
| Rate for Payer: NAPHCARE Commercial |
$44.02
|
| Rate for Payer: Preferred Network Access Commercial |
$383.64
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$30.33
|
| Rate for Payer: Quartz Beloit One Network |
$204.33
|
| Rate for Payer: Quartz Commercial |
$271.05
|
| Rate for Payer: Quartz Medicare Advantage |
$29.35
|
| Rate for Payer: The Alliance Commercial |
$1,668.00
|
| Rate for Payer: United Healthcare Medicaid |
$30.33
|
| Rate for Payer: United Healthcare Medicare Advantage |
$29.35
|
| Rate for Payer: United Healthcare PPO |
$312.75
|
| Rate for Payer: WEA Trust Commercial |
$229.35
|
| Rate for Payer: Wellcare Medicare |
$29.35
|
| Rate for Payer: WMAP Medicaid |
$30.33
|
| Rate for Payer: WPS Commercial |
$308.87
|
|
|
Beta-Amloid 42/40 Ratio, CSF
|
Professional
|
$1,147.00
|
|
|
Service Code
|
CPT 82542
|
| Hospital Charge Code |
5613541
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$24.09 |
| Max. Negotiated Rate |
$1,089.65 |
| Rate for Payer: Aetna Commercial |
$1,089.65
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$986.42
|
| Rate for Payer: Aetna Managed Medicare |
$24.09
|
| Rate for Payer: Anthem Medicare Advantage |
$24.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$24.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$24.09
|
| Rate for Payer: Cash Price |
$344.10
|
| Rate for Payer: Cash Price |
$344.10
|
| Rate for Payer: Cigna Commercial |
$1,089.65
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$573.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$24.09
|
| Rate for Payer: Health EOS Commercial |
$1,043.77
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$85.04
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$85.04
|
| Rate for Payer: Independent Care Health Plan Medicare |
$24.09
|
| Rate for Payer: Multiplan Commercial |
$917.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,089.65
|
| Rate for Payer: Quartz Beloit One Network |
$504.68
|
| Rate for Payer: Quartz Commercial |
$653.79
|
| Rate for Payer: Quartz Medicare Advantage |
$24.09
|
| Rate for Payer: The Alliance Commercial |
$95.16
|
| Rate for Payer: United Healthcare Medicare Advantage |
$24.09
|
| Rate for Payer: WEA Trust Commercial |
$630.85
|
| Rate for Payer: WPS Commercial |
$106.00
|
|
|
Beta-Amloid 42/40 Ratio, CSF
|
Facility
IP
|
$1,147.00
|
|
|
Service Code
|
CPT 82542
|
| Hospital Charge Code |
5613541
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$562.03 |
| Max. Negotiated Rate |
$1,055.24 |
| Rate for Payer: Aetna Commercial |
$1,032.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$607.91
|
| Rate for Payer: Cash Price |
$344.10
|
| Rate for Payer: Cigna Commercial |
$1,055.24
|
| Rate for Payer: Health EOS Commercial |
$1,020.83
|
| Rate for Payer: HFN Commercial |
$1,055.24
|
| Rate for Payer: Multiplan Commercial |
$917.60
|
| Rate for Payer: NAPHCARE Commercial |
$688.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,055.24
|
| Rate for Payer: Quartz Beloit One Network |
$562.03
|
| Rate for Payer: Quartz Commercial |
$688.20
|
| Rate for Payer: WEA Trust Commercial |
$630.85
|
| Rate for Payer: WPS Commercial |
$849.58
|
|
|
Beta-Amloid 42/40 Ratio, CSF
|
Facility
OP
|
$1,147.00
|
|
|
Service Code
|
CPT 82542
|
| Hospital Charge Code |
5613541
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$24.09 |
| Max. Negotiated Rate |
$4,588.00 |
| Rate for Payer: Aetna Commercial |
$1,032.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$986.42
|
| Rate for Payer: Aetna Managed Medicare |
$24.09
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$90.34
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$42.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$39.99
|
| Rate for Payer: Anthem Medicaid |
$24.89
|
| Rate for Payer: Anthem Medicare Advantage |
$24.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$607.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$24.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$24.09
|
| Rate for Payer: Cash Price |
$344.10
|
| Rate for Payer: Cash Price |
$344.10
|
| Rate for Payer: Cigna Commercial |
$1,055.24
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$24.09
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$24.89
|
| Rate for Payer: Dean Health Medicaid |
$24.89
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$24.09
|
| Rate for Payer: Health EOS Commercial |
$1,020.83
|
| Rate for Payer: HFN Commercial |
$1,055.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$89.61
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$24.09
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$24.89
|
| Rate for Payer: Independent Care Health Plan Medicare |
$24.09
|
| Rate for Payer: Managed Health Services Medicaid |
$25.89
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$24.09
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$24.09
|
| Rate for Payer: Multiplan Commercial |
$917.60
|
| Rate for Payer: NAPHCARE Commercial |
$36.14
|
| Rate for Payer: Preferred Network Access Commercial |
$1,055.24
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$24.89
|
| Rate for Payer: Quartz Beloit One Network |
$562.03
|
| Rate for Payer: Quartz Commercial |
$745.55
|
| Rate for Payer: Quartz Medicare Advantage |
$24.09
|
| Rate for Payer: The Alliance Commercial |
$4,588.00
|
| Rate for Payer: United Healthcare Medicaid |
$24.89
|
| Rate for Payer: United Healthcare Medicare Advantage |
$24.09
|
| Rate for Payer: United Healthcare PPO |
$860.25
|
| Rate for Payer: WEA Trust Commercial |
$630.85
|
| Rate for Payer: Wellcare Medicare |
$24.09
|
| Rate for Payer: WMAP Medicaid |
$24.89
|
| Rate for Payer: WPS Commercial |
$849.58
|
|
|
Beta-Globin Complete
|
Facility
IP
|
$1,344.00
|
|
|
Service Code
|
CPT 81364
|
| Hospital Charge Code |
4253861
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$658.56 |
| Max. Negotiated Rate |
$1,236.48 |
| Rate for Payer: Aetna Commercial |
$1,209.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$712.32
|
| Rate for Payer: Cash Price |
$403.20
|
| Rate for Payer: Cigna Commercial |
$1,236.48
|
| Rate for Payer: Health EOS Commercial |
$1,196.16
|
| Rate for Payer: HFN Commercial |
$1,236.48
|
| Rate for Payer: Multiplan Commercial |
$1,075.20
|
| Rate for Payer: NAPHCARE Commercial |
$806.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,236.48
|
| Rate for Payer: Quartz Beloit One Network |
$658.56
|
| Rate for Payer: Quartz Commercial |
$806.40
|
| Rate for Payer: WEA Trust Commercial |
$739.20
|
| Rate for Payer: WPS Commercial |
$995.50
|
|
|
Beta-Globin Complete
|
Professional
|
$1,344.00
|
|
|
Service Code
|
CPT 81364
|
| Hospital Charge Code |
4253861
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$324.58 |
| Max. Negotiated Rate |
$1,428.15 |
| Rate for Payer: Aetna Commercial |
$1,276.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,155.84
|
| Rate for Payer: Aetna Managed Medicare |
$324.58
|
| Rate for Payer: Anthem Medicare Advantage |
$324.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$324.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$324.58
|
| Rate for Payer: Cash Price |
$403.20
|
| Rate for Payer: Cash Price |
$403.20
|
| Rate for Payer: Cigna Commercial |
$1,276.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$672.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$324.58
|
| Rate for Payer: Health EOS Commercial |
$1,223.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,145.77
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,145.77
|
| Rate for Payer: Independent Care Health Plan Medicare |
$324.58
|
| Rate for Payer: Multiplan Commercial |
$1,075.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,276.80
|
| Rate for Payer: Quartz Beloit One Network |
$591.36
|
| Rate for Payer: Quartz Commercial |
$766.08
|
| Rate for Payer: Quartz Medicare Advantage |
$324.58
|
| Rate for Payer: The Alliance Commercial |
$1,282.09
|
| Rate for Payer: United Healthcare Medicare Advantage |
$324.58
|
| Rate for Payer: WEA Trust Commercial |
$739.20
|
| Rate for Payer: WPS Commercial |
$1,428.15
|
|
|
Beta-Globin Complete
|
Facility
OP
|
$1,344.00
|
|
|
Service Code
|
CPT 81364
|
| Hospital Charge Code |
4253861
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$259.66 |
| Max. Negotiated Rate |
$5,376.00 |
| Rate for Payer: Aetna Commercial |
$1,209.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,155.84
|
| Rate for Payer: Aetna Managed Medicare |
$324.58
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,217.18
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$568.02
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$538.80
|
| Rate for Payer: Anthem Medicaid |
$259.66
|
| Rate for Payer: Anthem Medicare Advantage |
$324.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$712.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$324.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$324.58
|
| Rate for Payer: Cash Price |
$403.20
|
| Rate for Payer: Cash Price |
$403.20
|
| Rate for Payer: Cigna Commercial |
$1,236.48
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$324.58
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$259.66
|
| Rate for Payer: Dean Health Medicaid |
$259.66
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$324.58
|
| Rate for Payer: Health EOS Commercial |
$1,196.16
|
| Rate for Payer: HFN Commercial |
$1,236.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,207.44
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$324.58
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$259.66
|
| Rate for Payer: Independent Care Health Plan Medicare |
$324.58
|
| Rate for Payer: Managed Health Services Medicaid |
$270.05
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$324.58
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$324.58
|
| Rate for Payer: Multiplan Commercial |
$1,075.20
|
| Rate for Payer: NAPHCARE Commercial |
$486.87
|
| Rate for Payer: Preferred Network Access Commercial |
$1,236.48
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$259.66
|
| Rate for Payer: Quartz Beloit One Network |
$658.56
|
| Rate for Payer: Quartz Commercial |
$873.60
|
| Rate for Payer: Quartz Medicare Advantage |
$324.58
|
| Rate for Payer: The Alliance Commercial |
$5,376.00
|
| Rate for Payer: United Healthcare Medicaid |
$259.66
|
| Rate for Payer: United Healthcare Medicare Advantage |
$324.58
|
| Rate for Payer: United Healthcare PPO |
$1,008.00
|
| Rate for Payer: WEA Trust Commercial |
$739.20
|
| Rate for Payer: Wellcare Medicare |
$324.58
|
| Rate for Payer: WMAP Medicaid |
$259.66
|
| Rate for Payer: WPS Commercial |
$995.50
|
|
|
Beta Human Chorionic Gonadotropin Quantitative
|
Facility
OP
|
$259.00
|
|
|
Service Code
|
CPT 84702
|
| Hospital Charge Code |
633665
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.05 |
| Max. Negotiated Rate |
$1,036.00 |
| Rate for Payer: Aetna Commercial |
$233.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$222.74
|
| 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 |
$137.27
|
| 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 |
$77.70
|
| Rate for Payer: Cash Price |
$77.70
|
| Rate for Payer: Cigna Commercial |
$238.28
|
| 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 Medicaid |
$15.55
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$15.05
|
| Rate for Payer: Health EOS Commercial |
$230.51
|
| Rate for Payer: HFN Commercial |
$238.28
|
| 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 |
$207.20
|
| Rate for Payer: NAPHCARE Commercial |
$22.58
|
| Rate for Payer: Preferred Network Access Commercial |
$238.28
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$15.55
|
| Rate for Payer: Quartz Beloit One Network |
$126.91
|
| Rate for Payer: Quartz Commercial |
$168.35
|
| Rate for Payer: Quartz Medicare Advantage |
$15.05
|
| Rate for Payer: The Alliance Commercial |
$1,036.00
|
| Rate for Payer: United Healthcare Medicaid |
$15.55
|
| Rate for Payer: United Healthcare Medicare Advantage |
$15.05
|
| Rate for Payer: United Healthcare PPO |
$194.25
|
| Rate for Payer: WEA Trust Commercial |
$142.45
|
| Rate for Payer: Wellcare Medicare |
$15.05
|
| Rate for Payer: WMAP Medicaid |
$15.55
|
| Rate for Payer: WPS Commercial |
$191.84
|
|
|
Beta Human Chorionic Gonadotropin Quantitative
|
Facility
IP
|
$259.00
|
|
|
Service Code
|
CPT 84702
|
| Hospital Charge Code |
633665
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$126.91 |
| Max. Negotiated Rate |
$238.28 |
| Rate for Payer: Aetna Commercial |
$233.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$137.27
|
| Rate for Payer: Cash Price |
$77.70
|
| Rate for Payer: Cigna Commercial |
$238.28
|
| Rate for Payer: Health EOS Commercial |
$230.51
|
| Rate for Payer: HFN Commercial |
$238.28
|
| Rate for Payer: Multiplan Commercial |
$207.20
|
| Rate for Payer: NAPHCARE Commercial |
$155.40
|
| Rate for Payer: Preferred Network Access Commercial |
$238.28
|
| Rate for Payer: Quartz Beloit One Network |
$126.91
|
| Rate for Payer: Quartz Commercial |
$155.40
|
| Rate for Payer: WEA Trust Commercial |
$142.45
|
| Rate for Payer: WPS Commercial |
$191.84
|
|
|
Beta Human Chorionic Gonadotropin Quantitative
|
Professional
|
$259.00
|
|
|
Service Code
|
CPT 84702
|
| Hospital Charge Code |
633665
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.05 |
| Max. Negotiated Rate |
$246.05 |
| Rate for Payer: Aetna Commercial |
$246.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$222.74
|
| Rate for Payer: Aetna Managed Medicare |
$15.05
|
| Rate for Payer: Anthem Medicare Advantage |
$15.05
|
| 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 |
$77.70
|
| Rate for Payer: Cash Price |
$77.70
|
| Rate for Payer: Cigna Commercial |
$246.05
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$129.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$15.05
|
| Rate for Payer: Health EOS Commercial |
$235.69
|
| 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: Independent Care Health Plan Medicare |
$15.05
|
| Rate for Payer: Multiplan Commercial |
$207.20
|
| Rate for Payer: Preferred Network Access Commercial |
$246.05
|
| Rate for Payer: Quartz Beloit One Network |
$113.96
|
| Rate for Payer: Quartz Commercial |
$147.63
|
| Rate for Payer: Quartz Medicare Advantage |
$15.05
|
| Rate for Payer: The Alliance Commercial |
$59.45
|
| Rate for Payer: United Healthcare Medicare Advantage |
$15.05
|
| Rate for Payer: WEA Trust Commercial |
$142.45
|
| Rate for Payer: WPS Commercial |
$66.22
|
|
|
Beta Human Chorionic Gonadotropin Tumor Marker
|
Professional
|
$44.00
|
|
|
Service Code
|
CPT 84702
|
| Hospital Charge Code |
3473533
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.05 |
| Max. Negotiated Rate |
$66.22 |
| Rate for Payer: Aetna Commercial |
$41.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$37.84
|
| Rate for Payer: Aetna Managed Medicare |
$15.05
|
| Rate for Payer: Anthem Medicare Advantage |
$15.05
|
| 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 |
$13.20
|
| Rate for Payer: Cash Price |
$13.20
|
| Rate for Payer: Cigna Commercial |
$41.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$22.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$15.05
|
| Rate for Payer: Health EOS Commercial |
$40.04
|
| 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: Independent Care Health Plan Medicare |
$15.05
|
| Rate for Payer: Multiplan Commercial |
$35.20
|
| Rate for Payer: Preferred Network Access Commercial |
$41.80
|
| Rate for Payer: Quartz Beloit One Network |
$19.36
|
| Rate for Payer: Quartz Commercial |
$25.08
|
| Rate for Payer: Quartz Medicare Advantage |
$15.05
|
| Rate for Payer: The Alliance Commercial |
$59.45
|
| Rate for Payer: United Healthcare Medicare Advantage |
$15.05
|
| Rate for Payer: WEA Trust Commercial |
$24.20
|
| Rate for Payer: WPS Commercial |
$66.22
|
|
|
Beta Human Chorionic Gonadotropin Tumor Marker
|
Facility
IP
|
$44.00
|
|
|
Service Code
|
CPT 84702
|
| Hospital Charge Code |
3473533
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$21.56 |
| Max. Negotiated Rate |
$40.48 |
| Rate for Payer: Aetna Commercial |
$39.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$23.32
|
| Rate for Payer: Cash Price |
$13.20
|
| Rate for Payer: Cigna Commercial |
$40.48
|
| Rate for Payer: Health EOS Commercial |
$39.16
|
| Rate for Payer: HFN Commercial |
$40.48
|
| Rate for Payer: Multiplan Commercial |
$35.20
|
| Rate for Payer: NAPHCARE Commercial |
$26.40
|
| Rate for Payer: Preferred Network Access Commercial |
$40.48
|
| Rate for Payer: Quartz Beloit One Network |
$21.56
|
| Rate for Payer: Quartz Commercial |
$26.40
|
| Rate for Payer: WEA Trust Commercial |
$24.20
|
| Rate for Payer: WPS Commercial |
$32.59
|
|
|
Beta Human Chorionic Gonadotropin Tumor Marker
|
Facility
OP
|
$44.00
|
|
|
Service Code
|
CPT 84702
|
| Hospital Charge Code |
3473533
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.05 |
| Max. Negotiated Rate |
$176.00 |
| Rate for Payer: Aetna Commercial |
$39.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$37.84
|
| 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 |
$23.32
|
| 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 |
$13.20
|
| Rate for Payer: Cash Price |
$13.20
|
| Rate for Payer: Cigna Commercial |
$40.48
|
| 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 Medicaid |
$15.55
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$15.05
|
| Rate for Payer: Health EOS Commercial |
$39.16
|
| Rate for Payer: HFN Commercial |
$40.48
|
| 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 |
$35.20
|
| Rate for Payer: NAPHCARE Commercial |
$22.58
|
| Rate for Payer: Preferred Network Access Commercial |
$40.48
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$15.55
|
| Rate for Payer: Quartz Beloit One Network |
$21.56
|
| Rate for Payer: Quartz Commercial |
$28.60
|
| Rate for Payer: Quartz Medicare Advantage |
$15.05
|
| Rate for Payer: The Alliance Commercial |
$176.00
|
| Rate for Payer: United Healthcare Medicaid |
$15.55
|
| Rate for Payer: United Healthcare Medicare Advantage |
$15.05
|
| Rate for Payer: United Healthcare PPO |
$33.00
|
| Rate for Payer: WEA Trust Commercial |
$24.20
|
| Rate for Payer: Wellcare Medicare |
$15.05
|
| Rate for Payer: WMAP Medicaid |
$15.55
|
| Rate for Payer: WPS Commercial |
$32.59
|
|
|
Beta Hydroxybutyrate
|
Professional
|
$107.00
|
|
|
Service Code
|
CPT 82010
|
| Hospital Charge Code |
4676607
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.17 |
| Max. Negotiated Rate |
$101.65 |
| Rate for Payer: Aetna Commercial |
$101.65
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$92.02
|
| Rate for Payer: Aetna Managed Medicare |
$8.17
|
| Rate for Payer: Anthem Medicare Advantage |
$8.17
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$8.17
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$8.17
|
| 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 |
$8.17
|
| Rate for Payer: Health EOS Commercial |
$97.37
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$28.84
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$28.84
|
| Rate for Payer: Independent Care Health Plan Medicare |
$8.17
|
| 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: Quartz Medicare Advantage |
$8.17
|
| Rate for Payer: The Alliance Commercial |
$32.27
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8.17
|
| Rate for Payer: WEA Trust Commercial |
$58.85
|
| Rate for Payer: WPS Commercial |
$35.95
|
|
