benzocaine top 20% mucous membrane SPRAY [MED]
|
Facility
|
IP
|
$109.00
|
|
Hospital Charge Code |
3331510
|
Hospital Revenue Code
|
250
|
Min. Negotiated Rate |
$53.41 |
Max. Negotiated Rate |
$100.28 |
Rate for Payer: Aetna Commercial |
$98.10
|
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$93.74
|
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$57.77
|
Rate for Payer: Cash Price |
$32.70
|
Rate for Payer: Cigna Commercial |
$100.28
|
Rate for Payer: Health EOS Commercial |
$97.01
|
Rate for Payer: HFN Commercial |
$100.28
|
Rate for Payer: Multiplan Commercial |
$87.20
|
Rate for Payer: NAPHCARE Commercial |
$65.40
|
Rate for Payer: Preferred Network Access Commercial |
$100.28
|
Rate for Payer: Quartz Beloit One Network |
$53.41
|
Rate for Payer: Quartz Commercial |
$65.40
|
Rate for Payer: WEA Trust Commercial |
$59.95
|
Rate for Payer: WPS Commercial |
$80.74
|
|
benzocaine top 20% mucous membrane SPRAY [MED]
|
Facility
|
OP
|
$109.00
|
|
Hospital Charge Code |
3331510
|
Hospital Revenue Code
|
250
|
Min. Negotiated Rate |
$30.52 |
Max. Negotiated Rate |
$436.00 |
Rate for Payer: Aetna Commercial |
$98.10
|
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$93.74
|
Rate for Payer: Aetna Managed Medicare |
$30.52
|
Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$70.85
|
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$54.50
|
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$52.32
|
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$57.77
|
Rate for Payer: Cash Price |
$32.70
|
Rate for Payer: Cigna Commercial |
$100.28
|
Rate for Payer: Dean Health DHI/DHP/ASO |
$61.00
|
Rate for Payer: Health EOS Commercial |
$97.01
|
Rate for Payer: HFN Commercial |
$100.28
|
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$81.75
|
Rate for Payer: Multiplan Commercial |
$87.20
|
Rate for Payer: NAPHCARE Commercial |
$65.40
|
Rate for Payer: Preferred Network Access Commercial |
$100.28
|
Rate for Payer: Quartz Beloit One Network |
$53.41
|
Rate for Payer: Quartz Commercial |
$70.85
|
Rate for Payer: Quartz Medicare Advantage |
$65.40
|
Rate for Payer: The Alliance Commercial |
$436.00
|
Rate for Payer: WEA Trust Commercial |
$59.95
|
Rate for Payer: WPS Commercial |
$80.74
|
|
Benzodiazepine Screen
|
Facility
|
OP
|
$48.00
|
|
Hospital Charge Code |
2942885
|
Hospital Revenue Code
|
300
|
Min. Negotiated Rate |
$13.44 |
Max. Negotiated Rate |
$192.00 |
Rate for Payer: Aetna Commercial |
$43.20
|
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$41.28
|
Rate for Payer: Aetna Managed Medicare |
$13.44
|
Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$31.20
|
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$24.00
|
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$23.04
|
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$25.44
|
Rate for Payer: Cash Price |
$14.40
|
Rate for Payer: Cigna Commercial |
$44.16
|
Rate for Payer: Dean Health DHI/DHP/ASO |
$26.86
|
Rate for Payer: Health EOS Commercial |
$42.72
|
Rate for Payer: HFN Commercial |
$44.16
|
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$36.00
|
Rate for Payer: Multiplan Commercial |
$38.40
|
Rate for Payer: NAPHCARE Commercial |
$28.80
|
Rate for Payer: Preferred Network Access Commercial |
$44.16
|
Rate for Payer: Quartz Beloit One Network |
$23.52
|
Rate for Payer: Quartz Commercial |
$31.20
|
Rate for Payer: Quartz Medicare Advantage |
$28.80
|
Rate for Payer: The Alliance Commercial |
$192.00
|
Rate for Payer: United Healthcare PPO |
$36.00
|
Rate for Payer: WEA Trust Commercial |
$26.40
|
Rate for Payer: WPS Commercial |
$35.55
|
|
Benzodiazepine Screen
|
Professional
|
Both
|
$48.00
|
|
Hospital Charge Code |
2942885
|
Hospital Revenue Code
|
300
|
Min. Negotiated Rate |
$21.12 |
Max. Negotiated Rate |
$45.60 |
Rate for Payer: Aetna Commercial |
$45.60
|
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$41.28
|
Rate for Payer: Cash Price |
$14.40
|
Rate for Payer: Cigna Commercial |
$45.60
|
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$24.00
|
Rate for Payer: Dean Health DHI/DHP/ASO |
$28.80
|
Rate for Payer: Health EOS Commercial |
$43.68
|
Rate for Payer: HFN Commercial |
$45.60
|
Rate for Payer: Multiplan Commercial |
$38.40
|
Rate for Payer: Preferred Network Access Commercial |
$45.60
|
Rate for Payer: Quartz Beloit One Network |
$21.12
|
Rate for Payer: Quartz Commercial |
$27.36
|
Rate for Payer: The Alliance Commercial |
$24.00
|
Rate for Payer: WEA Trust Commercial |
$26.40
|
Rate for Payer: WPS Commercial |
$35.55
|
|
Benzodiazepine Screen
|
Facility
|
IP
|
$48.00
|
|
Hospital Charge Code |
2942885
|
Hospital Revenue Code
|
300
|
Min. Negotiated Rate |
$23.52 |
Max. Negotiated Rate |
$44.16 |
Rate for Payer: Aetna Commercial |
$43.20
|
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$41.28
|
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$25.44
|
Rate for Payer: Cash Price |
$14.40
|
Rate for Payer: Cigna Commercial |
$44.16
|
Rate for Payer: Health EOS Commercial |
$42.72
|
Rate for Payer: HFN Commercial |
$44.16
|
Rate for Payer: Multiplan Commercial |
$38.40
|
Rate for Payer: NAPHCARE Commercial |
$28.80
|
Rate for Payer: Preferred Network Access Commercial |
$44.16
|
Rate for Payer: Quartz Beloit One Network |
$23.52
|
Rate for Payer: Quartz Commercial |
$28.80
|
Rate for Payer: WEA Trust Commercial |
$26.40
|
Rate for Payer: WPS Commercial |
$35.55
|
|
Benzodiazepines, Quant, Urine
|
Facility
|
OP
|
$126.00
|
|
Service Code
|
CPT 80346
|
Hospital Charge Code |
4619089
|
Hospital Revenue Code
|
300
|
Min. Negotiated Rate |
$60.48 |
Max. Negotiated Rate |
$457.72 |
Rate for Payer: Aetna Commercial |
$113.40
|
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$108.36
|
Rate for Payer: Aetna Managed Medicare |
$114.43
|
Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$81.90
|
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$63.00
|
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$60.48
|
Rate for Payer: Anthem Medicaid |
$63.95
|
Rate for Payer: Anthem Medicare Advantage |
$114.43
|
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 |
$114.43
|
Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$114.43
|
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 |
$114.43
|
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$63.95
|
Rate for Payer: Dean Health DHI/DHP/ASO |
$70.51
|
Rate for Payer: Dean Health Medicaid |
$63.95
|
Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$114.43
|
Rate for Payer: Health EOS Commercial |
$112.14
|
Rate for Payer: HFN Commercial |
$115.92
|
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$425.68
|
Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$114.43
|
Rate for Payer: Independent Care Health Plan Medicaid |
$63.95
|
Rate for Payer: Independent Care Health Plan Medicare |
$114.43
|
Rate for Payer: Managed Health Services Medicaid |
$66.51
|
Rate for Payer: Managed Health Services Medicare Advantage |
$114.43
|
Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$114.43
|
Rate for Payer: Multiplan Commercial |
$100.80
|
Rate for Payer: NAPHCARE Commercial |
$171.64
|
Rate for Payer: Preferred Network Access Commercial |
$115.92
|
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$63.95
|
Rate for Payer: Quartz Beloit One Network |
$61.74
|
Rate for Payer: Quartz Commercial |
$81.90
|
Rate for Payer: Quartz Medicare Advantage |
$114.43
|
Rate for Payer: The Alliance Commercial |
$457.72
|
Rate for Payer: United Healthcare Medicaid |
$63.95
|
Rate for Payer: United Healthcare Medicare Advantage |
$114.43
|
Rate for Payer: United Healthcare PPO |
$94.50
|
Rate for Payer: WEA Trust Commercial |
$69.30
|
Rate for Payer: Wellcare Medicare |
$114.43
|
Rate for Payer: WMAP Medicaid |
$63.95
|
Rate for Payer: WPS Commercial |
$93.33
|
|
Benzodiazepines, Quant, Urine
|
Facility
|
IP
|
$126.00
|
|
Service Code
|
CPT 80346
|
Hospital Charge Code |
4619089
|
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
|
|
Benzodiazepines, Quant, Urine
|
Professional
|
Both
|
$126.00
|
|
Service Code
|
CPT 80346
|
Hospital Charge Code |
4619089
|
Hospital Revenue Code
|
300
|
Min. Negotiated Rate |
$55.44 |
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 |
$80.06
|
Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$80.06
|
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
|
|
Benzodiazepines, Urine Confirmation
|
Professional
|
Both
|
$188.00
|
|
Service Code
|
CPT 80346
|
Hospital Charge Code |
983500
|
Hospital Revenue Code
|
300
|
Min. Negotiated Rate |
$80.06 |
Max. Negotiated Rate |
$178.60 |
Rate for Payer: Aetna Commercial |
$178.60
|
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$161.68
|
Rate for Payer: Cash Price |
$56.40
|
Rate for Payer: Cash Price |
$56.40
|
Rate for Payer: Cigna Commercial |
$178.60
|
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$94.00
|
Rate for Payer: Dean Health DHI/DHP/ASO |
$112.80
|
Rate for Payer: Health EOS Commercial |
$171.08
|
Rate for Payer: HFN Commercial |
$178.60
|
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$80.06
|
Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$80.06
|
Rate for Payer: Multiplan Commercial |
$150.40
|
Rate for Payer: Preferred Network Access Commercial |
$178.60
|
Rate for Payer: Quartz Beloit One Network |
$82.72
|
Rate for Payer: Quartz Commercial |
$107.16
|
Rate for Payer: The Alliance Commercial |
$94.00
|
Rate for Payer: WEA Trust Commercial |
$103.40
|
Rate for Payer: WPS Commercial |
$139.25
|
|
Benzodiazepines, Urine Confirmation
|
Facility
|
IP
|
$188.00
|
|
Service Code
|
CPT 80346
|
Hospital Charge Code |
983500
|
Hospital Revenue Code
|
300
|
Min. Negotiated Rate |
$92.12 |
Max. Negotiated Rate |
$172.96 |
Rate for Payer: Aetna Commercial |
$169.20
|
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$161.68
|
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$99.64
|
Rate for Payer: Cash Price |
$56.40
|
Rate for Payer: Cigna Commercial |
$172.96
|
Rate for Payer: Health EOS Commercial |
$167.32
|
Rate for Payer: HFN Commercial |
$172.96
|
Rate for Payer: Multiplan Commercial |
$150.40
|
Rate for Payer: NAPHCARE Commercial |
$112.80
|
Rate for Payer: Preferred Network Access Commercial |
$172.96
|
Rate for Payer: Quartz Beloit One Network |
$92.12
|
Rate for Payer: Quartz Commercial |
$112.80
|
Rate for Payer: WEA Trust Commercial |
$103.40
|
Rate for Payer: WPS Commercial |
$139.25
|
|
Benzodiazepines, Urine Confirmation
|
Facility
|
OP
|
$188.00
|
|
Service Code
|
CPT 80346
|
Hospital Charge Code |
983500
|
Hospital Revenue Code
|
300
|
Min. Negotiated Rate |
$52.64 |
Max. Negotiated Rate |
$752.00 |
Rate for Payer: Aetna Commercial |
$169.20
|
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$161.68
|
Rate for Payer: Aetna Managed Medicare |
$52.64
|
Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$122.20
|
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$94.00
|
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$90.24
|
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$99.64
|
Rate for Payer: Cash Price |
$56.40
|
Rate for Payer: Cigna Commercial |
$172.96
|
Rate for Payer: Dean Health DHI/DHP/ASO |
$105.20
|
Rate for Payer: Health EOS Commercial |
$167.32
|
Rate for Payer: HFN Commercial |
$172.96
|
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$141.00
|
Rate for Payer: Multiplan Commercial |
$150.40
|
Rate for Payer: NAPHCARE Commercial |
$112.80
|
Rate for Payer: Preferred Network Access Commercial |
$172.96
|
Rate for Payer: Quartz Beloit One Network |
$92.12
|
Rate for Payer: Quartz Commercial |
$122.20
|
Rate for Payer: Quartz Medicare Advantage |
$112.80
|
Rate for Payer: The Alliance Commercial |
$752.00
|
Rate for Payer: United Healthcare PPO |
$141.00
|
Rate for Payer: WEA Trust Commercial |
$103.40
|
Rate for Payer: WPS Commercial |
$139.25
|
|
Benztropine JW Waste Charge per 1 mg
|
Facility
|
IP
|
$119.00
|
|
Service Code
|
HCPCS J0515 JW
|
Hospital Charge Code |
5266716
|
Hospital Revenue Code
|
636
|
Min. Negotiated Rate |
$58.31 |
Max. Negotiated Rate |
$109.48 |
Rate for Payer: Aetna Commercial |
$107.10
|
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$102.34
|
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$63.07
|
Rate for Payer: Cash Price |
$35.70
|
Rate for Payer: Cigna Commercial |
$109.48
|
Rate for Payer: Health EOS Commercial |
$105.91
|
Rate for Payer: HFN Commercial |
$109.48
|
Rate for Payer: Multiplan Commercial |
$95.20
|
Rate for Payer: NAPHCARE Commercial |
$71.40
|
Rate for Payer: Preferred Network Access Commercial |
$109.48
|
Rate for Payer: Quartz Beloit One Network |
$58.31
|
Rate for Payer: Quartz Commercial |
$71.40
|
Rate for Payer: WEA Trust Commercial |
$65.45
|
Rate for Payer: WPS Commercial |
$88.14
|
|
Benztropine JW Waste Charge per 1 mg
|
Facility
|
OP
|
$119.00
|
|
Service Code
|
HCPCS J0515 JW
|
Hospital Charge Code |
5266716
|
Hospital Revenue Code
|
636
|
Min. Negotiated Rate |
$33.32 |
Max. Negotiated Rate |
$476.00 |
Rate for Payer: Aetna Commercial |
$107.10
|
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$102.34
|
Rate for Payer: Aetna Managed Medicare |
$33.32
|
Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$77.35
|
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$59.50
|
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$57.12
|
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$63.07
|
Rate for Payer: Cash Price |
$35.70
|
Rate for Payer: Cigna Commercial |
$109.48
|
Rate for Payer: Dean Health DHI/DHP/ASO |
$66.59
|
Rate for Payer: Health EOS Commercial |
$105.91
|
Rate for Payer: HFN Commercial |
$109.48
|
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$89.25
|
Rate for Payer: Multiplan Commercial |
$95.20
|
Rate for Payer: NAPHCARE Commercial |
$71.40
|
Rate for Payer: Preferred Network Access Commercial |
$109.48
|
Rate for Payer: Quartz Beloit One Network |
$58.31
|
Rate for Payer: Quartz Commercial |
$77.35
|
Rate for Payer: Quartz Medicare Advantage |
$71.40
|
Rate for Payer: The Alliance Commercial |
$476.00
|
Rate for Payer: WEA Trust Commercial |
$65.45
|
Rate for Payer: WPS Commercial |
$88.14
|
|
Beta 2 Creatinine Urine
|
Facility
|
IP
|
$125.00
|
|
Service Code
|
CPT 82570
|
Hospital Charge Code |
2942875
|
Hospital Revenue Code
|
300
|
Min. Negotiated Rate |
$61.25 |
Max. Negotiated Rate |
$115.00 |
Rate for Payer: Aetna Commercial |
$112.50
|
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$107.50
|
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$66.25
|
Rate for Payer: Cash Price |
$37.50
|
Rate for Payer: Cigna Commercial |
$115.00
|
Rate for Payer: Health EOS Commercial |
$111.25
|
Rate for Payer: HFN Commercial |
$115.00
|
Rate for Payer: Multiplan Commercial |
$100.00
|
Rate for Payer: NAPHCARE Commercial |
$75.00
|
Rate for Payer: Preferred Network Access Commercial |
$115.00
|
Rate for Payer: Quartz Beloit One Network |
$61.25
|
Rate for Payer: Quartz Commercial |
$75.00
|
Rate for Payer: WEA Trust Commercial |
$68.75
|
Rate for Payer: WPS Commercial |
$92.59
|
|
Beta 2 Creatinine Urine
|
Professional
|
Both
|
$125.00
|
|
Service Code
|
CPT 82570
|
Hospital Charge Code |
2942875
|
Hospital Revenue Code
|
300
|
Min. Negotiated Rate |
$18.29 |
Max. Negotiated Rate |
$118.75 |
Rate for Payer: Aetna Commercial |
$118.75
|
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$107.50
|
Rate for Payer: Cash Price |
$37.50
|
Rate for Payer: Cash Price |
$37.50
|
Rate for Payer: Cigna Commercial |
$118.75
|
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$62.50
|
Rate for Payer: Dean Health DHI/DHP/ASO |
$75.00
|
Rate for Payer: Health EOS Commercial |
$113.75
|
Rate for Payer: HFN Commercial |
$118.75
|
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 |
$100.00
|
Rate for Payer: Preferred Network Access Commercial |
$118.75
|
Rate for Payer: Quartz Beloit One Network |
$55.00
|
Rate for Payer: Quartz Commercial |
$71.25
|
Rate for Payer: The Alliance Commercial |
$62.50
|
Rate for Payer: WEA Trust Commercial |
$68.75
|
Rate for Payer: WPS Commercial |
$92.59
|
|
Beta 2 Creatinine Urine
|
Facility
|
OP
|
$125.00
|
|
Service Code
|
CPT 82570
|
Hospital Charge Code |
2942875
|
Hospital Revenue Code
|
300
|
Min. Negotiated Rate |
$5.18 |
Max. Negotiated Rate |
$115.00 |
Rate for Payer: Aetna Commercial |
$112.50
|
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$107.50
|
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 |
$66.25
|
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 |
$37.50
|
Rate for Payer: Cash Price |
$37.50
|
Rate for Payer: Cigna Commercial |
$115.00
|
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 |
$69.95
|
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 |
$111.25
|
Rate for Payer: HFN Commercial |
$115.00
|
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 |
$100.00
|
Rate for Payer: NAPHCARE Commercial |
$7.77
|
Rate for Payer: Preferred Network Access Commercial |
$115.00
|
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$5.35
|
Rate for Payer: Quartz Beloit One Network |
$61.25
|
Rate for Payer: Quartz Commercial |
$81.25
|
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 |
$93.75
|
Rate for Payer: WEA Trust Commercial |
$68.75
|
Rate for Payer: Wellcare Medicare |
$5.18
|
Rate for Payer: WMAP Medicaid |
$5.35
|
Rate for Payer: WPS Commercial |
$92.59
|
|
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 |
$289.80 |
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 DHI/DHP/ASO |
$176.27
|
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 |
$101.80
|
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 glycoprotein I Antibodies
|
Professional
|
Both
|
$315.00
|
|
Service Code
|
CPT 86146
|
Hospital Charge Code |
980035
|
Hospital Revenue Code
|
300
|
Min. Negotiated Rate |
$89.84 |
Max. Negotiated Rate |
$299.25 |
Rate for Payer: Aetna Commercial |
$299.25
|
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$270.90
|
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 |
$189.00
|
Rate for Payer: Health EOS Commercial |
$286.65
|
Rate for Payer: HFN Commercial |
$299.25
|
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: 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: The Alliance Commercial |
$157.50
|
Rate for Payer: WEA Trust Commercial |
$173.25
|
Rate for Payer: WPS Commercial |
$233.32
|
|
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: Aetna Gatekeeper/Not Gatekeeper |
$270.90
|
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 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 |
$209.76 |
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 DHI/DHP/ASO |
$127.59
|
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 |
$64.72
|
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: Aetna Gatekeeper/Not Gatekeeper |
$196.08
|
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
|
Both
|
$228.00
|
|
Service Code
|
CPT 82232
|
Hospital Charge Code |
977878
|
Hospital Revenue Code
|
300
|
Min. Negotiated Rate |
$57.12 |
Max. Negotiated Rate |
$216.60 |
Rate for Payer: Aetna Commercial |
$216.60
|
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$196.08
|
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 |
$136.80
|
Rate for Payer: Health EOS Commercial |
$207.48
|
Rate for Payer: HFN Commercial |
$216.60
|
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: 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: The Alliance Commercial |
$114.00
|
Rate for Payer: WEA Trust Commercial |
$125.40
|
Rate for Payer: WPS Commercial |
$168.88
|
|
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: Aetna Gatekeeper/Not Gatekeeper |
$131.58
|
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 |
$140.76 |
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 DHI/DHP/ASO |
$85.62
|
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 |
$64.72
|
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
|
Both
|
$153.00
|
|
Service Code
|
CPT 82232
|
Hospital Charge Code |
977879
|
Hospital Revenue Code
|
300
|
Min. Negotiated Rate |
$57.12 |
Max. Negotiated Rate |
$145.35 |
Rate for Payer: Aetna Commercial |
$145.35
|
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$131.58
|
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 |
$91.80
|
Rate for Payer: Health EOS Commercial |
$139.23
|
Rate for Payer: HFN Commercial |
$145.35
|
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: 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: The Alliance Commercial |
$76.50
|
Rate for Payer: WEA Trust Commercial |
$84.15
|
Rate for Payer: WPS Commercial |
$113.33
|
|