|
Calcium, Ionized to Quest
|
Facility
|
IP
|
$272.00
|
|
|
Service Code
|
CPT 82330
|
| Hospital Charge Code |
3091491
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$133.28 |
| Max. Negotiated Rate |
$250.24 |
| Rate for Payer: Aetna Commercial |
$244.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$233.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$144.16
|
| Rate for Payer: Cash Price |
$81.60
|
| Rate for Payer: Cigna Commercial |
$250.24
|
| Rate for Payer: Health EOS Commercial |
$242.08
|
| Rate for Payer: HFN Commercial |
$250.24
|
| Rate for Payer: Multiplan Commercial |
$217.60
|
| Rate for Payer: NAPHCARE Commercial |
$163.20
|
| Rate for Payer: Preferred Network Access Commercial |
$250.24
|
| Rate for Payer: Quartz Beloit One Network |
$133.28
|
| Rate for Payer: Quartz Commercial |
$163.20
|
| Rate for Payer: WEA Trust Commercial |
$149.60
|
| Rate for Payer: WPS Commercial |
$201.47
|
|
|
Calcium Level 24 Hour Urine
|
Facility
|
OP
|
$105.00
|
|
|
Service Code
|
CPT 82340
|
| Hospital Charge Code |
633687
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.03 |
| Max. Negotiated Rate |
$96.60 |
| Rate for Payer: Aetna Commercial |
$94.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$90.30
|
| Rate for Payer: Aetna Managed Medicare |
$6.03
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$22.61
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$10.55
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$10.01
|
| Rate for Payer: Anthem Medicaid |
$6.23
|
| Rate for Payer: Anthem Medicare Advantage |
$6.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$55.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$6.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$6.03
|
| Rate for Payer: Cash Price |
$31.50
|
| Rate for Payer: Cash Price |
$31.50
|
| Rate for Payer: Cigna Commercial |
$96.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$6.03
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$6.23
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$58.76
|
| Rate for Payer: Dean Health Medicaid |
$6.23
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$6.03
|
| Rate for Payer: Health EOS Commercial |
$93.45
|
| Rate for Payer: HFN Commercial |
$96.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$22.43
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$6.03
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$6.23
|
| Rate for Payer: Independent Care Health Plan Medicare |
$6.03
|
| Rate for Payer: Managed Health Services Medicaid |
$6.48
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$6.03
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$6.03
|
| Rate for Payer: Multiplan Commercial |
$84.00
|
| Rate for Payer: NAPHCARE Commercial |
$9.04
|
| Rate for Payer: Preferred Network Access Commercial |
$96.60
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$6.23
|
| Rate for Payer: Quartz Beloit One Network |
$51.45
|
| Rate for Payer: Quartz Commercial |
$68.25
|
| Rate for Payer: Quartz Medicare Advantage |
$6.03
|
| Rate for Payer: The Alliance Commercial |
$24.12
|
| Rate for Payer: United Healthcare Medicaid |
$6.23
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6.03
|
| Rate for Payer: United Healthcare PPO |
$78.75
|
| Rate for Payer: WEA Trust Commercial |
$57.75
|
| Rate for Payer: Wellcare Medicare |
$6.03
|
| Rate for Payer: WMAP Medicaid |
$6.23
|
| Rate for Payer: WPS Commercial |
$77.77
|
|
|
Calcium Level 24 Hour Urine
|
Facility
|
IP
|
$105.00
|
|
|
Service Code
|
CPT 82340
|
| Hospital Charge Code |
633687
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$51.45 |
| Max. Negotiated Rate |
$96.60 |
| Rate for Payer: Aetna Commercial |
$94.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$90.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$55.65
|
| Rate for Payer: Cash Price |
$31.50
|
| Rate for Payer: Cigna Commercial |
$96.60
|
| Rate for Payer: Health EOS Commercial |
$93.45
|
| Rate for Payer: HFN Commercial |
$96.60
|
| Rate for Payer: Multiplan Commercial |
$84.00
|
| Rate for Payer: NAPHCARE Commercial |
$63.00
|
| Rate for Payer: Preferred Network Access Commercial |
$96.60
|
| Rate for Payer: Quartz Beloit One Network |
$51.45
|
| Rate for Payer: Quartz Commercial |
$63.00
|
| Rate for Payer: WEA Trust Commercial |
$57.75
|
| Rate for Payer: WPS Commercial |
$77.77
|
|
|
Calcium Level 24 Hour Urine
|
Professional
|
Both
|
$105.00
|
|
|
Service Code
|
CPT 82340
|
| Hospital Charge Code |
633687
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$21.29 |
| Max. Negotiated Rate |
$99.75 |
| Rate for Payer: Aetna Commercial |
$99.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$90.30
|
| Rate for Payer: Cash Price |
$31.50
|
| Rate for Payer: Cash Price |
$31.50
|
| Rate for Payer: Cigna Commercial |
$99.75
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$52.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$63.00
|
| Rate for Payer: Health EOS Commercial |
$95.55
|
| Rate for Payer: HFN Commercial |
$99.75
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$21.29
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$21.29
|
| Rate for Payer: Multiplan Commercial |
$84.00
|
| Rate for Payer: Preferred Network Access Commercial |
$99.75
|
| Rate for Payer: Quartz Beloit One Network |
$46.20
|
| Rate for Payer: Quartz Commercial |
$59.85
|
| Rate for Payer: The Alliance Commercial |
$52.50
|
| Rate for Payer: WEA Trust Commercial |
$57.75
|
| Rate for Payer: WPS Commercial |
$77.77
|
|
|
Calcium Level Ionized
|
Facility
|
IP
|
$233.00
|
|
|
Service Code
|
CPT 82330
|
| Hospital Charge Code |
633689
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$114.17 |
| Max. Negotiated Rate |
$214.36 |
| Rate for Payer: Aetna Commercial |
$209.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$200.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$123.49
|
| Rate for Payer: Cash Price |
$69.90
|
| Rate for Payer: Cigna Commercial |
$214.36
|
| Rate for Payer: Health EOS Commercial |
$207.37
|
| Rate for Payer: HFN Commercial |
$214.36
|
| Rate for Payer: Multiplan Commercial |
$186.40
|
| Rate for Payer: NAPHCARE Commercial |
$139.80
|
| Rate for Payer: Preferred Network Access Commercial |
$214.36
|
| Rate for Payer: Quartz Beloit One Network |
$114.17
|
| Rate for Payer: Quartz Commercial |
$139.80
|
| Rate for Payer: WEA Trust Commercial |
$128.15
|
| Rate for Payer: WPS Commercial |
$172.58
|
|
|
Calcium Level Ionized
|
Professional
|
Both
|
$233.00
|
|
|
Service Code
|
CPT 82330
|
| Hospital Charge Code |
633689
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$48.29 |
| Max. Negotiated Rate |
$221.35 |
| Rate for Payer: Aetna Commercial |
$221.35
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$200.38
|
| Rate for Payer: Cash Price |
$69.90
|
| Rate for Payer: Cash Price |
$69.90
|
| Rate for Payer: Cigna Commercial |
$221.35
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$116.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$139.80
|
| Rate for Payer: Health EOS Commercial |
$212.03
|
| Rate for Payer: HFN Commercial |
$221.35
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$48.29
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$48.29
|
| Rate for Payer: Multiplan Commercial |
$186.40
|
| Rate for Payer: Preferred Network Access Commercial |
$221.35
|
| Rate for Payer: Quartz Beloit One Network |
$102.52
|
| Rate for Payer: Quartz Commercial |
$132.81
|
| Rate for Payer: The Alliance Commercial |
$116.50
|
| Rate for Payer: WEA Trust Commercial |
$128.15
|
| Rate for Payer: WPS Commercial |
$172.58
|
|
|
Calcium Level Ionized
|
Facility
|
OP
|
$233.00
|
|
|
Service Code
|
CPT 82330
|
| Hospital Charge Code |
633689
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.68 |
| Max. Negotiated Rate |
$214.36 |
| Rate for Payer: Aetna Commercial |
$209.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$200.38
|
| Rate for Payer: Aetna Managed Medicare |
$13.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$51.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$23.94
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$22.71
|
| Rate for Payer: Anthem Medicaid |
$14.14
|
| Rate for Payer: Anthem Medicare Advantage |
$13.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$123.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$13.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$13.68
|
| Rate for Payer: Cash Price |
$69.90
|
| Rate for Payer: Cash Price |
$69.90
|
| Rate for Payer: Cigna Commercial |
$214.36
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$13.68
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$14.14
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$130.39
|
| Rate for Payer: Dean Health Medicaid |
$14.14
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$13.68
|
| Rate for Payer: Health EOS Commercial |
$207.37
|
| Rate for Payer: HFN Commercial |
$214.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$50.89
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$13.68
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$14.14
|
| Rate for Payer: Independent Care Health Plan Medicare |
$13.68
|
| Rate for Payer: Managed Health Services Medicaid |
$14.71
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$13.68
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$13.68
|
| Rate for Payer: Multiplan Commercial |
$186.40
|
| Rate for Payer: NAPHCARE Commercial |
$20.52
|
| Rate for Payer: Preferred Network Access Commercial |
$214.36
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$14.14
|
| Rate for Payer: Quartz Beloit One Network |
$114.17
|
| Rate for Payer: Quartz Commercial |
$151.45
|
| Rate for Payer: Quartz Medicare Advantage |
$13.68
|
| Rate for Payer: The Alliance Commercial |
$54.72
|
| Rate for Payer: United Healthcare Medicaid |
$14.14
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.68
|
| Rate for Payer: United Healthcare PPO |
$174.75
|
| Rate for Payer: WEA Trust Commercial |
$128.15
|
| Rate for Payer: Wellcare Medicare |
$13.68
|
| Rate for Payer: WMAP Medicaid |
$14.14
|
| Rate for Payer: WPS Commercial |
$172.58
|
|
|
Calcium Level Total
|
Facility
|
OP
|
$86.00
|
|
|
Service Code
|
CPT 82310
|
| Hospital Charge Code |
633690
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.16 |
| Max. Negotiated Rate |
$79.12 |
| Rate for Payer: Aetna Commercial |
$77.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$73.96
|
| Rate for Payer: Aetna Managed Medicare |
$5.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$19.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$9.03
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$8.57
|
| Rate for Payer: Anthem Medicaid |
$5.33
|
| Rate for Payer: Anthem Medicare Advantage |
$5.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$45.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5.16
|
| Rate for Payer: Cash Price |
$25.80
|
| Rate for Payer: Cash Price |
$25.80
|
| Rate for Payer: Cigna Commercial |
$79.12
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$5.16
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$5.33
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$48.13
|
| Rate for Payer: Dean Health Medicaid |
$5.33
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$5.16
|
| Rate for Payer: Health EOS Commercial |
$76.54
|
| Rate for Payer: HFN Commercial |
$79.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$19.20
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$5.16
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$5.33
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5.16
|
| Rate for Payer: Managed Health Services Medicaid |
$5.54
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$5.16
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$5.16
|
| Rate for Payer: Multiplan Commercial |
$68.80
|
| Rate for Payer: NAPHCARE Commercial |
$7.74
|
| Rate for Payer: Preferred Network Access Commercial |
$79.12
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$5.33
|
| Rate for Payer: Quartz Beloit One Network |
$42.14
|
| Rate for Payer: Quartz Commercial |
$55.90
|
| Rate for Payer: Quartz Medicare Advantage |
$5.16
|
| Rate for Payer: The Alliance Commercial |
$20.64
|
| Rate for Payer: United Healthcare Medicaid |
$5.33
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.16
|
| Rate for Payer: United Healthcare PPO |
$64.50
|
| Rate for Payer: WEA Trust Commercial |
$47.30
|
| Rate for Payer: Wellcare Medicare |
$5.16
|
| Rate for Payer: WMAP Medicaid |
$5.33
|
| Rate for Payer: WPS Commercial |
$63.70
|
|
|
Calcium Level Total
|
Professional
|
Both
|
$86.00
|
|
|
Service Code
|
CPT 82310
|
| Hospital Charge Code |
633690
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.21 |
| Max. Negotiated Rate |
$81.70 |
| Rate for Payer: Aetna Commercial |
$81.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$73.96
|
| Rate for Payer: Cash Price |
$25.80
|
| Rate for Payer: Cash Price |
$25.80
|
| Rate for Payer: Cigna Commercial |
$81.70
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$43.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$51.60
|
| Rate for Payer: Health EOS Commercial |
$78.26
|
| Rate for Payer: HFN Commercial |
$81.70
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$18.21
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$18.21
|
| Rate for Payer: Multiplan Commercial |
$68.80
|
| Rate for Payer: Preferred Network Access Commercial |
$81.70
|
| Rate for Payer: Quartz Beloit One Network |
$37.84
|
| Rate for Payer: Quartz Commercial |
$49.02
|
| Rate for Payer: The Alliance Commercial |
$43.00
|
| Rate for Payer: WEA Trust Commercial |
$47.30
|
| Rate for Payer: WPS Commercial |
$63.70
|
|
|
Calcium Level Total
|
Facility
|
IP
|
$86.00
|
|
|
Service Code
|
CPT 82310
|
| Hospital Charge Code |
633690
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$42.14 |
| Max. Negotiated Rate |
$79.12 |
| Rate for Payer: Aetna Commercial |
$77.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$73.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$45.58
|
| Rate for Payer: Cash Price |
$25.80
|
| Rate for Payer: Cigna Commercial |
$79.12
|
| Rate for Payer: Health EOS Commercial |
$76.54
|
| Rate for Payer: HFN Commercial |
$79.12
|
| Rate for Payer: Multiplan Commercial |
$68.80
|
| Rate for Payer: NAPHCARE Commercial |
$51.60
|
| Rate for Payer: Preferred Network Access Commercial |
$79.12
|
| Rate for Payer: Quartz Beloit One Network |
$42.14
|
| Rate for Payer: Quartz Commercial |
$51.60
|
| Rate for Payer: WEA Trust Commercial |
$47.30
|
| Rate for Payer: WPS Commercial |
$63.70
|
|
|
Calcium Level Urine
|
Facility
|
IP
|
$89.00
|
|
|
Service Code
|
CPT 82340
|
| Hospital Charge Code |
633691
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$43.61 |
| Max. Negotiated Rate |
$81.88 |
| Rate for Payer: Aetna Commercial |
$80.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$76.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$47.17
|
| Rate for Payer: Cash Price |
$26.70
|
| Rate for Payer: Cigna Commercial |
$81.88
|
| Rate for Payer: Health EOS Commercial |
$79.21
|
| Rate for Payer: HFN Commercial |
$81.88
|
| Rate for Payer: Multiplan Commercial |
$71.20
|
| Rate for Payer: NAPHCARE Commercial |
$53.40
|
| Rate for Payer: Preferred Network Access Commercial |
$81.88
|
| Rate for Payer: Quartz Beloit One Network |
$43.61
|
| Rate for Payer: Quartz Commercial |
$53.40
|
| Rate for Payer: WEA Trust Commercial |
$48.95
|
| Rate for Payer: WPS Commercial |
$65.92
|
|
|
Calcium Level Urine
|
Professional
|
Both
|
$89.00
|
|
|
Service Code
|
CPT 82340
|
| Hospital Charge Code |
633691
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$21.29 |
| Max. Negotiated Rate |
$84.55 |
| Rate for Payer: Aetna Commercial |
$84.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$76.54
|
| Rate for Payer: Cash Price |
$26.70
|
| Rate for Payer: Cash Price |
$26.70
|
| Rate for Payer: Cigna Commercial |
$84.55
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$44.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$53.40
|
| Rate for Payer: Health EOS Commercial |
$80.99
|
| Rate for Payer: HFN Commercial |
$84.55
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$21.29
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$21.29
|
| Rate for Payer: Multiplan Commercial |
$71.20
|
| Rate for Payer: Preferred Network Access Commercial |
$84.55
|
| Rate for Payer: Quartz Beloit One Network |
$39.16
|
| Rate for Payer: Quartz Commercial |
$50.73
|
| Rate for Payer: The Alliance Commercial |
$44.50
|
| Rate for Payer: WEA Trust Commercial |
$48.95
|
| Rate for Payer: WPS Commercial |
$65.92
|
|
|
Calcium Level Urine
|
Facility
|
OP
|
$89.00
|
|
|
Service Code
|
CPT 82340
|
| Hospital Charge Code |
633691
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.03 |
| Max. Negotiated Rate |
$81.88 |
| Rate for Payer: Aetna Commercial |
$80.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$76.54
|
| Rate for Payer: Aetna Managed Medicare |
$6.03
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$22.61
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$10.55
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$10.01
|
| Rate for Payer: Anthem Medicaid |
$6.23
|
| Rate for Payer: Anthem Medicare Advantage |
$6.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$47.17
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$6.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$6.03
|
| Rate for Payer: Cash Price |
$26.70
|
| Rate for Payer: Cash Price |
$26.70
|
| Rate for Payer: Cigna Commercial |
$81.88
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$6.03
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$6.23
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$49.80
|
| Rate for Payer: Dean Health Medicaid |
$6.23
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$6.03
|
| Rate for Payer: Health EOS Commercial |
$79.21
|
| Rate for Payer: HFN Commercial |
$81.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$22.43
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$6.03
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$6.23
|
| Rate for Payer: Independent Care Health Plan Medicare |
$6.03
|
| Rate for Payer: Managed Health Services Medicaid |
$6.48
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$6.03
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$6.03
|
| Rate for Payer: Multiplan Commercial |
$71.20
|
| Rate for Payer: NAPHCARE Commercial |
$9.04
|
| Rate for Payer: Preferred Network Access Commercial |
$81.88
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$6.23
|
| Rate for Payer: Quartz Beloit One Network |
$43.61
|
| Rate for Payer: Quartz Commercial |
$57.85
|
| Rate for Payer: Quartz Medicare Advantage |
$6.03
|
| Rate for Payer: The Alliance Commercial |
$24.12
|
| Rate for Payer: United Healthcare Medicaid |
$6.23
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6.03
|
| Rate for Payer: United Healthcare PPO |
$66.75
|
| Rate for Payer: WEA Trust Commercial |
$48.95
|
| Rate for Payer: Wellcare Medicare |
$6.03
|
| Rate for Payer: WMAP Medicaid |
$6.23
|
| Rate for Payer: WPS Commercial |
$65.92
|
|
|
Calcium, Urine
|
Facility
|
IP
|
$35.00
|
|
|
Service Code
|
CPT 82340
|
| Hospital Charge Code |
5474698
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.15 |
| Max. Negotiated Rate |
$32.20 |
| Rate for Payer: Aetna Commercial |
$31.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$30.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$18.55
|
| Rate for Payer: Cash Price |
$10.50
|
| Rate for Payer: Cigna Commercial |
$32.20
|
| Rate for Payer: Health EOS Commercial |
$31.15
|
| Rate for Payer: HFN Commercial |
$32.20
|
| Rate for Payer: Multiplan Commercial |
$28.00
|
| Rate for Payer: NAPHCARE Commercial |
$21.00
|
| Rate for Payer: Preferred Network Access Commercial |
$32.20
|
| Rate for Payer: Quartz Beloit One Network |
$17.15
|
| Rate for Payer: Quartz Commercial |
$21.00
|
| Rate for Payer: WEA Trust Commercial |
$19.25
|
| Rate for Payer: WPS Commercial |
$25.92
|
|
|
Calcium, Urine
|
Facility
|
OP
|
$35.00
|
|
|
Service Code
|
CPT 82340
|
| Hospital Charge Code |
5474698
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.03 |
| Max. Negotiated Rate |
$32.20 |
| Rate for Payer: Aetna Commercial |
$31.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$30.10
|
| Rate for Payer: Aetna Managed Medicare |
$6.03
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$22.61
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$10.55
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$10.01
|
| Rate for Payer: Anthem Medicaid |
$6.23
|
| Rate for Payer: Anthem Medicare Advantage |
$6.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$18.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$6.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$6.03
|
| Rate for Payer: Cash Price |
$10.50
|
| Rate for Payer: Cash Price |
$10.50
|
| Rate for Payer: Cigna Commercial |
$32.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$6.03
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$6.23
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$19.59
|
| Rate for Payer: Dean Health Medicaid |
$6.23
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$6.03
|
| Rate for Payer: Health EOS Commercial |
$31.15
|
| Rate for Payer: HFN Commercial |
$32.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$22.43
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$6.03
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$6.23
|
| Rate for Payer: Independent Care Health Plan Medicare |
$6.03
|
| Rate for Payer: Managed Health Services Medicaid |
$6.48
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$6.03
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$6.03
|
| Rate for Payer: Multiplan Commercial |
$28.00
|
| Rate for Payer: NAPHCARE Commercial |
$9.04
|
| Rate for Payer: Preferred Network Access Commercial |
$32.20
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$6.23
|
| Rate for Payer: Quartz Beloit One Network |
$17.15
|
| Rate for Payer: Quartz Commercial |
$22.75
|
| Rate for Payer: Quartz Medicare Advantage |
$6.03
|
| Rate for Payer: The Alliance Commercial |
$24.12
|
| Rate for Payer: United Healthcare Medicaid |
$6.23
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6.03
|
| Rate for Payer: United Healthcare PPO |
$26.25
|
| Rate for Payer: WEA Trust Commercial |
$19.25
|
| Rate for Payer: Wellcare Medicare |
$6.03
|
| Rate for Payer: WMAP Medicaid |
$6.23
|
| Rate for Payer: WPS Commercial |
$25.92
|
|
|
Calcium, Urine
|
Professional
|
Both
|
$35.00
|
|
|
Service Code
|
CPT 82340
|
| Hospital Charge Code |
5474698
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.40 |
| Max. Negotiated Rate |
$33.25 |
| Rate for Payer: Aetna Commercial |
$33.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$30.10
|
| Rate for Payer: Cash Price |
$10.50
|
| Rate for Payer: Cash Price |
$10.50
|
| Rate for Payer: Cigna Commercial |
$33.25
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$17.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$21.00
|
| Rate for Payer: Health EOS Commercial |
$31.85
|
| Rate for Payer: HFN Commercial |
$33.25
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$21.29
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$21.29
|
| Rate for Payer: Multiplan Commercial |
$28.00
|
| Rate for Payer: Preferred Network Access Commercial |
$33.25
|
| Rate for Payer: Quartz Beloit One Network |
$15.40
|
| Rate for Payer: Quartz Commercial |
$19.95
|
| Rate for Payer: The Alliance Commercial |
$17.50
|
| Rate for Payer: WEA Trust Commercial |
$19.25
|
| Rate for Payer: WPS Commercial |
$25.92
|
|
|
Calcofluor Stain Report
|
Facility
|
OP
|
$83.00
|
|
|
Service Code
|
CPT 87206
|
| Hospital Charge Code |
634219
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.39 |
| Max. Negotiated Rate |
$76.36 |
| Rate for Payer: Aetna Commercial |
$74.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$71.38
|
| Rate for Payer: Aetna Managed Medicare |
$5.39
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$20.21
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$9.43
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$8.95
|
| Rate for Payer: Anthem Medicaid |
$5.57
|
| Rate for Payer: Anthem Medicare Advantage |
$5.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$43.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5.39
|
| Rate for Payer: Cash Price |
$24.90
|
| Rate for Payer: Cash Price |
$24.90
|
| Rate for Payer: Cigna Commercial |
$76.36
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$5.39
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$5.57
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$46.45
|
| Rate for Payer: Dean Health Medicaid |
$5.57
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$5.39
|
| Rate for Payer: Health EOS Commercial |
$73.87
|
| Rate for Payer: HFN Commercial |
$76.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$20.05
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$5.39
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$5.57
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5.39
|
| Rate for Payer: Managed Health Services Medicaid |
$5.79
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$5.39
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$5.39
|
| Rate for Payer: Multiplan Commercial |
$66.40
|
| Rate for Payer: NAPHCARE Commercial |
$8.08
|
| Rate for Payer: Preferred Network Access Commercial |
$76.36
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$5.57
|
| Rate for Payer: Quartz Beloit One Network |
$40.67
|
| Rate for Payer: Quartz Commercial |
$53.95
|
| Rate for Payer: Quartz Medicare Advantage |
$5.39
|
| Rate for Payer: The Alliance Commercial |
$21.56
|
| Rate for Payer: United Healthcare Medicaid |
$5.57
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.39
|
| Rate for Payer: United Healthcare PPO |
$62.25
|
| Rate for Payer: WEA Trust Commercial |
$45.65
|
| Rate for Payer: Wellcare Medicare |
$5.39
|
| Rate for Payer: WMAP Medicaid |
$5.57
|
| Rate for Payer: WPS Commercial |
$61.48
|
|
|
Calcofluor Stain Report
|
Facility
|
IP
|
$83.00
|
|
|
Service Code
|
CPT 87206
|
| Hospital Charge Code |
634219
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$40.67 |
| Max. Negotiated Rate |
$76.36 |
| Rate for Payer: Aetna Commercial |
$74.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$71.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$43.99
|
| Rate for Payer: Cash Price |
$24.90
|
| Rate for Payer: Cigna Commercial |
$76.36
|
| Rate for Payer: Health EOS Commercial |
$73.87
|
| Rate for Payer: HFN Commercial |
$76.36
|
| Rate for Payer: Multiplan Commercial |
$66.40
|
| Rate for Payer: NAPHCARE Commercial |
$49.80
|
| Rate for Payer: Preferred Network Access Commercial |
$76.36
|
| Rate for Payer: Quartz Beloit One Network |
$40.67
|
| Rate for Payer: Quartz Commercial |
$49.80
|
| Rate for Payer: WEA Trust Commercial |
$45.65
|
| Rate for Payer: WPS Commercial |
$61.48
|
|
|
Calcofluor Stain Report
|
Professional
|
Both
|
$83.00
|
|
|
Service Code
|
CPT 87206
|
| Hospital Charge Code |
634219
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$19.03 |
| Max. Negotiated Rate |
$78.85 |
| Rate for Payer: Aetna Commercial |
$78.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$71.38
|
| Rate for Payer: Cash Price |
$24.90
|
| Rate for Payer: Cash Price |
$24.90
|
| Rate for Payer: Cigna Commercial |
$78.85
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$41.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$49.80
|
| Rate for Payer: Health EOS Commercial |
$75.53
|
| Rate for Payer: HFN Commercial |
$78.85
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$19.03
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$19.03
|
| Rate for Payer: Multiplan Commercial |
$66.40
|
| Rate for Payer: Preferred Network Access Commercial |
$78.85
|
| Rate for Payer: Quartz Beloit One Network |
$36.52
|
| Rate for Payer: Quartz Commercial |
$47.31
|
| Rate for Payer: The Alliance Commercial |
$41.50
|
| Rate for Payer: WEA Trust Commercial |
$45.65
|
| Rate for Payer: WPS Commercial |
$61.48
|
|
|
CALDWELL LUC PROCEDURE
|
Facility
|
OP
|
$3,935.00
|
|
| Hospital Charge Code |
2959904
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,101.80 |
| Max. Negotiated Rate |
$15,740.00 |
| Rate for Payer: Aetna Commercial |
$3,541.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,384.10
|
| Rate for Payer: Aetna Managed Medicare |
$1,101.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,557.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,967.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,888.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,085.55
|
| Rate for Payer: Cash Price |
$1,180.50
|
| Rate for Payer: Cigna Commercial |
$3,620.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,202.03
|
| Rate for Payer: Health EOS Commercial |
$3,502.15
|
| Rate for Payer: HFN Commercial |
$3,620.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,951.25
|
| Rate for Payer: Multiplan Commercial |
$3,148.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,361.00
|
| Rate for Payer: Preferred Network Access Commercial |
$3,620.20
|
| Rate for Payer: Quartz Beloit One Network |
$1,928.15
|
| Rate for Payer: Quartz Commercial |
$2,557.75
|
| Rate for Payer: Quartz Medicare Advantage |
$2,361.00
|
| Rate for Payer: The Alliance Commercial |
$15,740.00
|
| Rate for Payer: WEA Trust Commercial |
$2,164.25
|
| Rate for Payer: WPS Commercial |
$2,914.65
|
|
|
CALDWELL LUC PROCEDURE
|
Facility
|
IP
|
$3,935.00
|
|
| Hospital Charge Code |
2959904
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,928.15 |
| Max. Negotiated Rate |
$3,620.20 |
| Rate for Payer: Aetna Commercial |
$3,541.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,384.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,085.55
|
| Rate for Payer: Cash Price |
$1,180.50
|
| Rate for Payer: Cigna Commercial |
$3,620.20
|
| Rate for Payer: Health EOS Commercial |
$3,502.15
|
| Rate for Payer: HFN Commercial |
$3,620.20
|
| Rate for Payer: Multiplan Commercial |
$3,148.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,361.00
|
| Rate for Payer: Preferred Network Access Commercial |
$3,620.20
|
| Rate for Payer: Quartz Beloit One Network |
$1,928.15
|
| Rate for Payer: Quartz Commercial |
$2,361.00
|
| Rate for Payer: WEA Trust Commercial |
$2,164.25
|
| Rate for Payer: WPS Commercial |
$2,914.65
|
|
|
CALIBRATOR GLENOID TSA VIP GC 5D-1
|
Facility
|
IP
|
$4,091.00
|
|
| Hospital Charge Code |
5659649
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,004.59 |
| Max. Negotiated Rate |
$3,763.72 |
| Rate for Payer: Aetna Commercial |
$3,681.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,518.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,168.23
|
| Rate for Payer: Cash Price |
$1,227.30
|
| Rate for Payer: Cigna Commercial |
$3,763.72
|
| Rate for Payer: Health EOS Commercial |
$3,640.99
|
| Rate for Payer: HFN Commercial |
$3,763.72
|
| Rate for Payer: Multiplan Commercial |
$3,272.80
|
| Rate for Payer: NAPHCARE Commercial |
$2,454.60
|
| Rate for Payer: Preferred Network Access Commercial |
$3,763.72
|
| Rate for Payer: Quartz Beloit One Network |
$2,004.59
|
| Rate for Payer: Quartz Commercial |
$2,454.60
|
| Rate for Payer: WEA Trust Commercial |
$2,250.05
|
| Rate for Payer: WPS Commercial |
$3,030.20
|
|
|
CALIBRATOR GLENOID TSA VIP GC 5D-1
|
Facility
|
OP
|
$4,091.00
|
|
| Hospital Charge Code |
5659649
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,145.48 |
| Max. Negotiated Rate |
$16,364.00 |
| Rate for Payer: Aetna Commercial |
$3,681.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,518.26
|
| Rate for Payer: Aetna Managed Medicare |
$1,145.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,659.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,045.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,963.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,168.23
|
| Rate for Payer: Cash Price |
$1,227.30
|
| Rate for Payer: Cigna Commercial |
$3,763.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,289.32
|
| Rate for Payer: Health EOS Commercial |
$3,640.99
|
| Rate for Payer: HFN Commercial |
$3,763.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,068.25
|
| Rate for Payer: Multiplan Commercial |
$3,272.80
|
| Rate for Payer: NAPHCARE Commercial |
$2,454.60
|
| Rate for Payer: Preferred Network Access Commercial |
$3,763.72
|
| Rate for Payer: Quartz Beloit One Network |
$2,004.59
|
| Rate for Payer: Quartz Commercial |
$2,659.15
|
| Rate for Payer: Quartz Medicare Advantage |
$2,454.60
|
| Rate for Payer: The Alliance Commercial |
$16,364.00
|
| Rate for Payer: WEA Trust Commercial |
$2,250.05
|
| Rate for Payer: WPS Commercial |
$3,030.20
|
|
|
California encephalitis virus IgG
|
Professional
|
Both
|
$53.00
|
|
|
Service Code
|
CPT 86651
|
| Hospital Charge Code |
5547100
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$23.32 |
| Max. Negotiated Rate |
$50.35 |
| Rate for Payer: Aetna Commercial |
$50.35
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$45.58
|
| Rate for Payer: Cash Price |
$15.90
|
| Rate for Payer: Cash Price |
$15.90
|
| Rate for Payer: Cigna Commercial |
$50.35
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$26.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$31.80
|
| Rate for Payer: Health EOS Commercial |
$48.23
|
| Rate for Payer: HFN Commercial |
$50.35
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$46.56
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$46.56
|
| Rate for Payer: Multiplan Commercial |
$42.40
|
| Rate for Payer: Preferred Network Access Commercial |
$50.35
|
| Rate for Payer: Quartz Beloit One Network |
$23.32
|
| Rate for Payer: Quartz Commercial |
$30.21
|
| Rate for Payer: The Alliance Commercial |
$26.50
|
| Rate for Payer: WEA Trust Commercial |
$29.15
|
| Rate for Payer: WPS Commercial |
$39.26
|
|
|
California encephalitis virus IgG
|
Facility
|
IP
|
$53.00
|
|
|
Service Code
|
CPT 86651
|
| Hospital Charge Code |
5547100
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$25.97 |
| Max. Negotiated Rate |
$48.76 |
| Rate for Payer: Aetna Commercial |
$47.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$45.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$28.09
|
| Rate for Payer: Cash Price |
$15.90
|
| Rate for Payer: Cigna Commercial |
$48.76
|
| Rate for Payer: Health EOS Commercial |
$47.17
|
| Rate for Payer: HFN Commercial |
$48.76
|
| Rate for Payer: Multiplan Commercial |
$42.40
|
| Rate for Payer: NAPHCARE Commercial |
$31.80
|
| Rate for Payer: Preferred Network Access Commercial |
$48.76
|
| Rate for Payer: Quartz Beloit One Network |
$25.97
|
| Rate for Payer: Quartz Commercial |
$31.80
|
| Rate for Payer: WEA Trust Commercial |
$29.15
|
| Rate for Payer: WPS Commercial |
$39.26
|
|
