|
Carbamazepine-10,11-Epoxide Level
|
Facility
|
OP
|
$111.00
|
|
|
Service Code
|
CPT 80339
|
| Hospital Charge Code |
3398168
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$32.32 |
| Max. Negotiated Rate |
$106.20 |
| Rate for Payer: Aetna Commercial |
$103.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$99.28
|
| Rate for Payer: Aetna Managed Medicare |
$32.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$75.04
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$57.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$55.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$61.18
|
| Rate for Payer: Cash Price |
$33.30
|
| Rate for Payer: Cigna Commercial |
$106.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$64.60
|
| Rate for Payer: Health EOS Commercial |
$102.74
|
| Rate for Payer: HFN Commercial |
$106.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$86.58
|
| Rate for Payer: Multiplan Commercial |
$92.35
|
| Rate for Payer: NAPHCARE Commercial |
$69.26
|
| Rate for Payer: Preferred Network Access Commercial |
$106.20
|
| Rate for Payer: Quartz Beloit One Network |
$56.57
|
| Rate for Payer: Quartz Commercial |
$75.04
|
| Rate for Payer: Quartz Medicare Advantage |
$69.26
|
| Rate for Payer: The Alliance Commercial |
$57.72
|
| Rate for Payer: United Healthcare PPO |
$86.58
|
| Rate for Payer: WEA Trust Commercial |
$63.49
|
| Rate for Payer: WPS Commercial |
$85.50
|
|
|
Carbamazepine-10,11-Epoxide Level
|
Facility
|
IP
|
$111.00
|
|
|
Service Code
|
CPT 80339
|
| Hospital Charge Code |
3398168
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$56.57 |
| Max. Negotiated Rate |
$106.20 |
| Rate for Payer: Aetna Commercial |
$103.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$99.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$61.18
|
| Rate for Payer: Cash Price |
$33.30
|
| Rate for Payer: Cigna Commercial |
$106.20
|
| Rate for Payer: Health EOS Commercial |
$102.74
|
| Rate for Payer: HFN Commercial |
$106.20
|
| Rate for Payer: Multiplan Commercial |
$92.35
|
| Rate for Payer: Preferred Network Access Commercial |
$106.20
|
| Rate for Payer: Quartz Beloit One Network |
$56.57
|
| Rate for Payer: Quartz Commercial |
$69.26
|
| Rate for Payer: WEA Trust Commercial |
$63.49
|
| Rate for Payer: WPS Commercial |
$85.50
|
|
|
Carbamazepine-10,11-Epoxide Level
|
Professional
|
Both
|
$111.00
|
|
|
Service Code
|
CPT 80339
|
| Hospital Charge Code |
3398168
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$50.79 |
| Max. Negotiated Rate |
$109.67 |
| Rate for Payer: Aetna Commercial |
$109.67
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$99.28
|
| Rate for Payer: Cash Price |
$33.30
|
| Rate for Payer: Cash Price |
$33.30
|
| Rate for Payer: Cigna Commercial |
$109.67
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$57.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$69.26
|
| Rate for Payer: Health EOS Commercial |
$105.05
|
| Rate for Payer: HFN Commercial |
$109.67
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$83.26
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$83.26
|
| Rate for Payer: Multiplan Commercial |
$92.35
|
| Rate for Payer: Preferred Network Access Commercial |
$109.67
|
| Rate for Payer: Quartz Beloit One Network |
$50.79
|
| Rate for Payer: Quartz Commercial |
$65.80
|
| Rate for Payer: The Alliance Commercial |
$57.72
|
| Rate for Payer: WEA Trust Commercial |
$63.49
|
| Rate for Payer: WPS Commercial |
$85.50
|
|
|
Carbamazepine Level
|
Professional
|
Both
|
$313.00
|
|
|
Service Code
|
CPT 80156
|
| Hospital Charge Code |
633694
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.15 |
| Max. Negotiated Rate |
$309.24 |
| Rate for Payer: Aetna Commercial |
$309.24
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$279.95
|
| Rate for Payer: Aetna Managed Medicare |
$15.15
|
| Rate for Payer: Anthem Medicare Advantage |
$15.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$15.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$15.15
|
| Rate for Payer: Cash Price |
$93.90
|
| Rate for Payer: Cash Price |
$93.90
|
| Rate for Payer: Cigna Commercial |
$309.24
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$162.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$15.15
|
| Rate for Payer: Health EOS Commercial |
$296.22
|
| Rate for Payer: HFN Commercial |
$309.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$53.49
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$53.49
|
| Rate for Payer: Independent Care Health Plan Medicare |
$15.15
|
| Rate for Payer: Multiplan Commercial |
$260.42
|
| Rate for Payer: NAPHCARE Commercial |
$22.73
|
| Rate for Payer: Preferred Network Access Commercial |
$309.24
|
| Rate for Payer: Quartz Beloit One Network |
$143.23
|
| Rate for Payer: Quartz Commercial |
$185.55
|
| Rate for Payer: Quartz Medicare Advantage |
$15.15
|
| Rate for Payer: The Alliance Commercial |
$59.85
|
| Rate for Payer: United Healthcare Medicare Advantage |
$15.15
|
| Rate for Payer: WEA Trust Commercial |
$179.04
|
| Rate for Payer: WPS Commercial |
$66.67
|
|
|
Carbamazepine Level
|
Facility
|
IP
|
$313.00
|
|
|
Service Code
|
CPT 80156
|
| Hospital Charge Code |
633694
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$159.50 |
| Max. Negotiated Rate |
$299.48 |
| Rate for Payer: Aetna Commercial |
$292.97
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$279.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$172.53
|
| Rate for Payer: Cash Price |
$93.90
|
| Rate for Payer: Cigna Commercial |
$299.48
|
| Rate for Payer: Health EOS Commercial |
$289.71
|
| Rate for Payer: HFN Commercial |
$299.48
|
| Rate for Payer: Multiplan Commercial |
$260.42
|
| Rate for Payer: Preferred Network Access Commercial |
$299.48
|
| Rate for Payer: Quartz Beloit One Network |
$159.50
|
| Rate for Payer: Quartz Commercial |
$195.31
|
| Rate for Payer: WEA Trust Commercial |
$179.04
|
| Rate for Payer: WPS Commercial |
$241.10
|
|
|
Carbamazepine Level
|
Facility
|
OP
|
$313.00
|
|
|
Service Code
|
CPT 80156
|
| Hospital Charge Code |
633694
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.15 |
| Max. Negotiated Rate |
$299.48 |
| Rate for Payer: Aetna Commercial |
$292.97
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$279.95
|
| Rate for Payer: Aetna Managed Medicare |
$15.15
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$56.82
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$26.52
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$25.15
|
| Rate for Payer: Anthem Medicare Advantage |
$15.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$172.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$15.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$15.15
|
| Rate for Payer: Cash Price |
$93.90
|
| Rate for Payer: Cash Price |
$93.90
|
| Rate for Payer: Cigna Commercial |
$299.48
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$15.15
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$182.17
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$15.15
|
| Rate for Payer: Health EOS Commercial |
$289.71
|
| Rate for Payer: HFN Commercial |
$299.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$56.37
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$15.15
|
| Rate for Payer: Independent Care Health Plan Medicare |
$15.15
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$15.15
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$15.15
|
| Rate for Payer: Multiplan Commercial |
$260.42
|
| Rate for Payer: NAPHCARE Commercial |
$22.73
|
| Rate for Payer: Preferred Network Access Commercial |
$299.48
|
| Rate for Payer: Quartz Beloit One Network |
$159.50
|
| Rate for Payer: Quartz Commercial |
$211.59
|
| Rate for Payer: Quartz Medicare Advantage |
$15.15
|
| Rate for Payer: The Alliance Commercial |
$60.61
|
| Rate for Payer: United Healthcare Medicare Advantage |
$15.15
|
| Rate for Payer: United Healthcare PPO |
$244.14
|
| Rate for Payer: WEA Trust Commercial |
$179.04
|
| Rate for Payer: Wellcare Medicare |
$15.15
|
| Rate for Payer: WPS Commercial |
$241.10
|
|
|
Carbapenem Resist Enterobact Cx Scr / 91669
|
Facility
|
IP
|
$148.00
|
|
|
Service Code
|
CPT 87081
|
| Hospital Charge Code |
3838961
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$75.42 |
| Max. Negotiated Rate |
$141.61 |
| Rate for Payer: Aetna Commercial |
$138.53
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$132.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$81.58
|
| Rate for Payer: Cash Price |
$44.40
|
| Rate for Payer: Cigna Commercial |
$141.61
|
| Rate for Payer: Health EOS Commercial |
$136.99
|
| Rate for Payer: HFN Commercial |
$141.61
|
| Rate for Payer: Multiplan Commercial |
$123.14
|
| Rate for Payer: Preferred Network Access Commercial |
$141.61
|
| Rate for Payer: Quartz Beloit One Network |
$75.42
|
| Rate for Payer: Quartz Commercial |
$92.35
|
| Rate for Payer: WEA Trust Commercial |
$84.66
|
| Rate for Payer: WPS Commercial |
$114.00
|
|
|
Carbapenem Resist Enterobact Cx Scr / 91669
|
Professional
|
Both
|
$148.00
|
|
|
Service Code
|
CPT 87081
|
| Hospital Charge Code |
3838961
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.90 |
| Max. Negotiated Rate |
$146.22 |
| Rate for Payer: Aetna Commercial |
$146.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$132.37
|
| Rate for Payer: Aetna Managed Medicare |
$6.90
|
| Rate for Payer: Anthem Medicare Advantage |
$6.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$6.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$6.90
|
| Rate for Payer: Cash Price |
$44.40
|
| Rate for Payer: Cash Price |
$44.40
|
| Rate for Payer: Cigna Commercial |
$146.22
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$76.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6.90
|
| Rate for Payer: Health EOS Commercial |
$140.07
|
| Rate for Payer: HFN Commercial |
$146.22
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$24.34
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$24.34
|
| Rate for Payer: Independent Care Health Plan Medicare |
$6.90
|
| Rate for Payer: Multiplan Commercial |
$123.14
|
| Rate for Payer: NAPHCARE Commercial |
$10.34
|
| Rate for Payer: Preferred Network Access Commercial |
$146.22
|
| Rate for Payer: Quartz Beloit One Network |
$67.72
|
| Rate for Payer: Quartz Commercial |
$87.73
|
| Rate for Payer: Quartz Medicare Advantage |
$6.90
|
| Rate for Payer: The Alliance Commercial |
$27.24
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6.90
|
| Rate for Payer: WEA Trust Commercial |
$84.66
|
| Rate for Payer: WPS Commercial |
$30.34
|
|
|
Carbapenem Resist Enterobact Cx Scr / 91669
|
Facility
|
OP
|
$148.00
|
|
|
Service Code
|
CPT 87081
|
| Hospital Charge Code |
3838961
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.90 |
| Max. Negotiated Rate |
$141.61 |
| Rate for Payer: Aetna Commercial |
$138.53
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$132.37
|
| Rate for Payer: Aetna Managed Medicare |
$6.90
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$25.86
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$12.07
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$11.45
|
| Rate for Payer: Anthem Medicare Advantage |
$6.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$81.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$6.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$6.90
|
| Rate for Payer: Cash Price |
$44.40
|
| Rate for Payer: Cash Price |
$44.40
|
| Rate for Payer: Cigna Commercial |
$141.61
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$6.90
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$86.14
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$6.90
|
| Rate for Payer: Health EOS Commercial |
$136.99
|
| Rate for Payer: HFN Commercial |
$141.61
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$25.65
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$6.90
|
| Rate for Payer: Independent Care Health Plan Medicare |
$6.90
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$6.90
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$6.90
|
| Rate for Payer: Multiplan Commercial |
$123.14
|
| Rate for Payer: NAPHCARE Commercial |
$10.34
|
| Rate for Payer: Preferred Network Access Commercial |
$141.61
|
| Rate for Payer: Quartz Beloit One Network |
$75.42
|
| Rate for Payer: Quartz Commercial |
$100.05
|
| Rate for Payer: Quartz Medicare Advantage |
$6.90
|
| Rate for Payer: The Alliance Commercial |
$27.58
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6.90
|
| Rate for Payer: United Healthcare PPO |
$115.44
|
| Rate for Payer: WEA Trust Commercial |
$84.66
|
| Rate for Payer: Wellcare Medicare |
$6.90
|
| Rate for Payer: WPS Commercial |
$114.00
|
|
|
Carb Free Lvl / 18948
|
Facility
|
OP
|
$93.00
|
|
|
Service Code
|
CPT 80157
|
| Hospital Charge Code |
3398169
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.78 |
| Max. Negotiated Rate |
$88.98 |
| Rate for Payer: Aetna Commercial |
$87.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$83.18
|
| Rate for Payer: Aetna Managed Medicare |
$13.78
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$51.67
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$24.11
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$22.87
|
| Rate for Payer: Anthem Medicare Advantage |
$13.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$51.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$13.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$13.78
|
| Rate for Payer: Cash Price |
$27.90
|
| Rate for Payer: Cash Price |
$27.90
|
| Rate for Payer: Cigna Commercial |
$88.98
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$13.78
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$54.13
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$13.78
|
| Rate for Payer: Health EOS Commercial |
$86.08
|
| Rate for Payer: HFN Commercial |
$88.98
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$51.26
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$13.78
|
| Rate for Payer: Independent Care Health Plan Medicare |
$13.78
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$13.78
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$13.78
|
| Rate for Payer: Multiplan Commercial |
$77.38
|
| Rate for Payer: NAPHCARE Commercial |
$20.67
|
| Rate for Payer: Preferred Network Access Commercial |
$88.98
|
| Rate for Payer: Quartz Beloit One Network |
$47.39
|
| Rate for Payer: Quartz Commercial |
$62.87
|
| Rate for Payer: Quartz Medicare Advantage |
$13.78
|
| Rate for Payer: The Alliance Commercial |
$55.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.78
|
| Rate for Payer: United Healthcare PPO |
$72.54
|
| Rate for Payer: WEA Trust Commercial |
$53.20
|
| Rate for Payer: Wellcare Medicare |
$13.78
|
| Rate for Payer: WPS Commercial |
$71.64
|
|
|
Carb Free Lvl / 18948
|
Professional
|
Both
|
$93.00
|
|
|
Service Code
|
CPT 80157
|
| Hospital Charge Code |
3398169
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.78 |
| Max. Negotiated Rate |
$91.88 |
| Rate for Payer: Aetna Commercial |
$91.88
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$83.18
|
| Rate for Payer: Aetna Managed Medicare |
$13.78
|
| Rate for Payer: Anthem Medicare Advantage |
$13.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$13.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$13.78
|
| Rate for Payer: Cash Price |
$27.90
|
| Rate for Payer: Cash Price |
$27.90
|
| Rate for Payer: Cigna Commercial |
$91.88
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$48.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$13.78
|
| Rate for Payer: Health EOS Commercial |
$88.02
|
| Rate for Payer: HFN Commercial |
$91.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$48.64
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$48.64
|
| Rate for Payer: Independent Care Health Plan Medicare |
$13.78
|
| Rate for Payer: Multiplan Commercial |
$77.38
|
| Rate for Payer: NAPHCARE Commercial |
$20.67
|
| Rate for Payer: Preferred Network Access Commercial |
$91.88
|
| Rate for Payer: Quartz Beloit One Network |
$42.56
|
| Rate for Payer: Quartz Commercial |
$55.13
|
| Rate for Payer: Quartz Medicare Advantage |
$13.78
|
| Rate for Payer: The Alliance Commercial |
$54.43
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.78
|
| Rate for Payer: WEA Trust Commercial |
$53.20
|
| Rate for Payer: WPS Commercial |
$60.63
|
|
|
Carb Free Lvl / 18948
|
Facility
|
IP
|
$93.00
|
|
|
Service Code
|
CPT 80157
|
| Hospital Charge Code |
3398169
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$47.39 |
| Max. Negotiated Rate |
$88.98 |
| Rate for Payer: Aetna Commercial |
$87.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$83.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$51.26
|
| Rate for Payer: Cash Price |
$27.90
|
| Rate for Payer: Cigna Commercial |
$88.98
|
| Rate for Payer: Health EOS Commercial |
$86.08
|
| Rate for Payer: HFN Commercial |
$88.98
|
| Rate for Payer: Multiplan Commercial |
$77.38
|
| Rate for Payer: Preferred Network Access Commercial |
$88.98
|
| Rate for Payer: Quartz Beloit One Network |
$47.39
|
| Rate for Payer: Quartz Commercial |
$58.03
|
| Rate for Payer: WEA Trust Commercial |
$53.20
|
| Rate for Payer: WPS Commercial |
$71.64
|
|
|
Carbohydrate Antigen 15-3
|
Facility
|
OP
|
$281.00
|
|
|
Service Code
|
CPT 86300
|
| Hospital Charge Code |
977888
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$21.64 |
| Max. Negotiated Rate |
$268.86 |
| Rate for Payer: Aetna Commercial |
$263.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$251.33
|
| Rate for Payer: Aetna Managed Medicare |
$21.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$81.16
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$37.87
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$35.93
|
| Rate for Payer: Anthem Medicare Advantage |
$21.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$154.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$21.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$21.64
|
| Rate for Payer: Cash Price |
$84.30
|
| Rate for Payer: Cash Price |
$84.30
|
| Rate for Payer: Cigna Commercial |
$268.86
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$21.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$163.54
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$21.64
|
| Rate for Payer: Health EOS Commercial |
$260.09
|
| Rate for Payer: HFN Commercial |
$268.86
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$80.51
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$21.64
|
| Rate for Payer: Independent Care Health Plan Medicare |
$21.64
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$21.64
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$21.64
|
| Rate for Payer: Multiplan Commercial |
$233.79
|
| Rate for Payer: NAPHCARE Commercial |
$32.46
|
| Rate for Payer: Preferred Network Access Commercial |
$268.86
|
| Rate for Payer: Quartz Beloit One Network |
$143.20
|
| Rate for Payer: Quartz Commercial |
$189.96
|
| Rate for Payer: Quartz Medicare Advantage |
$21.64
|
| Rate for Payer: The Alliance Commercial |
$86.57
|
| Rate for Payer: United Healthcare Medicare Advantage |
$21.64
|
| Rate for Payer: United Healthcare PPO |
$219.18
|
| Rate for Payer: WEA Trust Commercial |
$160.73
|
| Rate for Payer: Wellcare Medicare |
$21.64
|
| Rate for Payer: WPS Commercial |
$216.45
|
|
|
Carbohydrate Antigen 15-3
|
Professional
|
Both
|
$281.00
|
|
|
Service Code
|
CPT 86300
|
| Hospital Charge Code |
977888
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$21.64 |
| Max. Negotiated Rate |
$277.63 |
| Rate for Payer: Aetna Commercial |
$277.63
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$251.33
|
| Rate for Payer: Aetna Managed Medicare |
$21.64
|
| Rate for Payer: Anthem Medicare Advantage |
$21.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$21.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$21.64
|
| Rate for Payer: Cash Price |
$84.30
|
| Rate for Payer: Cash Price |
$84.30
|
| Rate for Payer: Cigna Commercial |
$277.63
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$146.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$21.64
|
| Rate for Payer: Health EOS Commercial |
$265.94
|
| Rate for Payer: HFN Commercial |
$277.63
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$76.40
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$76.40
|
| Rate for Payer: Independent Care Health Plan Medicare |
$21.64
|
| Rate for Payer: Multiplan Commercial |
$233.79
|
| Rate for Payer: NAPHCARE Commercial |
$32.46
|
| Rate for Payer: Preferred Network Access Commercial |
$277.63
|
| Rate for Payer: Quartz Beloit One Network |
$128.59
|
| Rate for Payer: Quartz Commercial |
$166.58
|
| Rate for Payer: Quartz Medicare Advantage |
$21.64
|
| Rate for Payer: The Alliance Commercial |
$85.49
|
| Rate for Payer: United Healthcare Medicare Advantage |
$21.64
|
| Rate for Payer: WEA Trust Commercial |
$160.73
|
| Rate for Payer: WPS Commercial |
$95.23
|
|
|
Carbohydrate Antigen 15-3
|
Facility
|
IP
|
$281.00
|
|
|
Service Code
|
CPT 86300
|
| Hospital Charge Code |
977888
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$143.20 |
| Max. Negotiated Rate |
$268.86 |
| Rate for Payer: Aetna Commercial |
$263.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$251.33
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$154.89
|
| Rate for Payer: Cash Price |
$84.30
|
| Rate for Payer: Cigna Commercial |
$268.86
|
| Rate for Payer: Health EOS Commercial |
$260.09
|
| Rate for Payer: HFN Commercial |
$268.86
|
| Rate for Payer: Multiplan Commercial |
$233.79
|
| Rate for Payer: Preferred Network Access Commercial |
$268.86
|
| Rate for Payer: Quartz Beloit One Network |
$143.20
|
| Rate for Payer: Quartz Commercial |
$175.34
|
| Rate for Payer: WEA Trust Commercial |
$160.73
|
| Rate for Payer: WPS Commercial |
$216.45
|
|
|
Carbohydrate Antigen 19-9
|
Professional
|
Both
|
$376.00
|
|
|
Service Code
|
CPT 86301
|
| Hospital Charge Code |
977889
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$21.64 |
| Max. Negotiated Rate |
$371.49 |
| Rate for Payer: Aetna Commercial |
$371.49
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$336.29
|
| Rate for Payer: Aetna Managed Medicare |
$21.64
|
| Rate for Payer: Anthem Medicare Advantage |
$21.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$21.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$21.64
|
| Rate for Payer: Cash Price |
$112.80
|
| Rate for Payer: Cash Price |
$112.80
|
| Rate for Payer: Cigna Commercial |
$371.49
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$195.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$21.64
|
| Rate for Payer: Health EOS Commercial |
$355.85
|
| Rate for Payer: HFN Commercial |
$371.49
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$76.40
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$76.40
|
| Rate for Payer: Independent Care Health Plan Medicare |
$21.64
|
| Rate for Payer: Multiplan Commercial |
$312.83
|
| Rate for Payer: NAPHCARE Commercial |
$32.46
|
| Rate for Payer: Preferred Network Access Commercial |
$371.49
|
| Rate for Payer: Quartz Beloit One Network |
$172.06
|
| Rate for Payer: Quartz Commercial |
$222.89
|
| Rate for Payer: Quartz Medicare Advantage |
$21.64
|
| Rate for Payer: The Alliance Commercial |
$85.49
|
| Rate for Payer: United Healthcare Medicare Advantage |
$21.64
|
| Rate for Payer: WEA Trust Commercial |
$215.07
|
| Rate for Payer: WPS Commercial |
$95.23
|
|
|
Carbohydrate Antigen 19-9
|
Facility
|
OP
|
$376.00
|
|
|
Service Code
|
CPT 86301
|
| Hospital Charge Code |
977889
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$21.64 |
| Max. Negotiated Rate |
$359.76 |
| Rate for Payer: Aetna Commercial |
$351.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$336.29
|
| Rate for Payer: Aetna Managed Medicare |
$21.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$81.16
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$37.87
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$35.93
|
| Rate for Payer: Anthem Medicare Advantage |
$21.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$207.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$21.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$21.64
|
| Rate for Payer: Cash Price |
$112.80
|
| Rate for Payer: Cash Price |
$112.80
|
| Rate for Payer: Cigna Commercial |
$359.76
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$21.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$218.83
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$21.64
|
| Rate for Payer: Health EOS Commercial |
$348.03
|
| Rate for Payer: HFN Commercial |
$359.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$80.51
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$21.64
|
| Rate for Payer: Independent Care Health Plan Medicare |
$21.64
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$21.64
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$21.64
|
| Rate for Payer: Multiplan Commercial |
$312.83
|
| Rate for Payer: NAPHCARE Commercial |
$32.46
|
| Rate for Payer: Preferred Network Access Commercial |
$359.76
|
| Rate for Payer: Quartz Beloit One Network |
$191.61
|
| Rate for Payer: Quartz Commercial |
$254.18
|
| Rate for Payer: Quartz Medicare Advantage |
$21.64
|
| Rate for Payer: The Alliance Commercial |
$86.57
|
| Rate for Payer: United Healthcare Medicare Advantage |
$21.64
|
| Rate for Payer: United Healthcare PPO |
$293.28
|
| Rate for Payer: WEA Trust Commercial |
$215.07
|
| Rate for Payer: Wellcare Medicare |
$21.64
|
| Rate for Payer: WPS Commercial |
$289.63
|
|
|
Carbohydrate Antigen 19-9
|
Facility
|
IP
|
$376.00
|
|
|
Service Code
|
CPT 86301
|
| Hospital Charge Code |
977889
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$191.61 |
| Max. Negotiated Rate |
$359.76 |
| Rate for Payer: Aetna Commercial |
$351.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$336.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$207.25
|
| Rate for Payer: Cash Price |
$112.80
|
| Rate for Payer: Cigna Commercial |
$359.76
|
| Rate for Payer: Health EOS Commercial |
$348.03
|
| Rate for Payer: HFN Commercial |
$359.76
|
| Rate for Payer: Multiplan Commercial |
$312.83
|
| Rate for Payer: Preferred Network Access Commercial |
$359.76
|
| Rate for Payer: Quartz Beloit One Network |
$191.61
|
| Rate for Payer: Quartz Commercial |
$234.62
|
| Rate for Payer: WEA Trust Commercial |
$215.07
|
| Rate for Payer: WPS Commercial |
$289.63
|
|
|
Carbohydrate Deficient Transferrin, Alcohol Use
|
Facility
|
OP
|
$76.00
|
|
|
Service Code
|
CPT 82373
|
| Hospital Charge Code |
5528671
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.78 |
| Max. Negotiated Rate |
$75.13 |
| Rate for Payer: Aetna Commercial |
$71.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$67.97
|
| Rate for Payer: Aetna Managed Medicare |
$18.78
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$70.43
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$32.87
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$31.18
|
| Rate for Payer: Anthem Medicare Advantage |
$18.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$41.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$18.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$18.78
|
| Rate for Payer: Cash Price |
$22.80
|
| Rate for Payer: Cash Price |
$22.80
|
| Rate for Payer: Cigna Commercial |
$72.72
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$18.78
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$44.23
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$18.78
|
| Rate for Payer: Health EOS Commercial |
$70.35
|
| Rate for Payer: HFN Commercial |
$72.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$69.87
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$18.78
|
| Rate for Payer: Independent Care Health Plan Medicare |
$18.78
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$18.78
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$18.78
|
| Rate for Payer: Multiplan Commercial |
$63.23
|
| Rate for Payer: NAPHCARE Commercial |
$28.17
|
| Rate for Payer: Preferred Network Access Commercial |
$72.72
|
| Rate for Payer: Quartz Beloit One Network |
$38.73
|
| Rate for Payer: Quartz Commercial |
$51.38
|
| Rate for Payer: Quartz Medicare Advantage |
$18.78
|
| Rate for Payer: The Alliance Commercial |
$75.13
|
| Rate for Payer: United Healthcare Medicare Advantage |
$18.78
|
| Rate for Payer: United Healthcare PPO |
$59.28
|
| Rate for Payer: WEA Trust Commercial |
$43.47
|
| Rate for Payer: Wellcare Medicare |
$18.78
|
| Rate for Payer: WPS Commercial |
$58.54
|
|
|
Carbohydrate Deficient Transferrin, Alcohol Use
|
Professional
|
Both
|
$76.00
|
|
|
Service Code
|
CPT 82373
|
| Hospital Charge Code |
5528671
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.78 |
| Max. Negotiated Rate |
$82.64 |
| Rate for Payer: Aetna Commercial |
$75.09
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$67.97
|
| Rate for Payer: Aetna Managed Medicare |
$18.78
|
| Rate for Payer: Anthem Medicare Advantage |
$18.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$18.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$18.78
|
| Rate for Payer: Cash Price |
$22.80
|
| Rate for Payer: Cash Price |
$22.80
|
| Rate for Payer: Cigna Commercial |
$75.09
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$39.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$18.78
|
| Rate for Payer: Health EOS Commercial |
$71.93
|
| Rate for Payer: HFN Commercial |
$75.09
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$66.30
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$66.30
|
| Rate for Payer: Independent Care Health Plan Medicare |
$18.78
|
| Rate for Payer: Multiplan Commercial |
$63.23
|
| Rate for Payer: NAPHCARE Commercial |
$28.17
|
| Rate for Payer: Preferred Network Access Commercial |
$75.09
|
| Rate for Payer: Quartz Beloit One Network |
$34.78
|
| Rate for Payer: Quartz Commercial |
$45.05
|
| Rate for Payer: Quartz Medicare Advantage |
$18.78
|
| Rate for Payer: The Alliance Commercial |
$74.19
|
| Rate for Payer: United Healthcare Medicare Advantage |
$18.78
|
| Rate for Payer: WEA Trust Commercial |
$43.47
|
| Rate for Payer: WPS Commercial |
$82.64
|
|
|
Carbohydrate Deficient Transferrin, Alcohol Use
|
Facility
|
IP
|
$76.00
|
|
|
Service Code
|
CPT 82373
|
| Hospital Charge Code |
5528671
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$38.73 |
| Max. Negotiated Rate |
$72.72 |
| Rate for Payer: Aetna Commercial |
$71.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$67.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$41.89
|
| Rate for Payer: Cash Price |
$22.80
|
| Rate for Payer: Cigna Commercial |
$72.72
|
| Rate for Payer: Health EOS Commercial |
$70.35
|
| Rate for Payer: HFN Commercial |
$72.72
|
| Rate for Payer: Multiplan Commercial |
$63.23
|
| Rate for Payer: Preferred Network Access Commercial |
$72.72
|
| Rate for Payer: Quartz Beloit One Network |
$38.73
|
| Rate for Payer: Quartz Commercial |
$47.42
|
| Rate for Payer: WEA Trust Commercial |
$43.47
|
| Rate for Payer: WPS Commercial |
$58.54
|
|
|
Carbohydrate Deficient Transferrin, Congenital Disorders
|
Professional
|
Both
|
$136.00
|
|
|
Service Code
|
CPT 82373
|
| Hospital Charge Code |
5484746
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.78 |
| Max. Negotiated Rate |
$134.37 |
| Rate for Payer: Aetna Commercial |
$134.37
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$121.64
|
| Rate for Payer: Aetna Managed Medicare |
$18.78
|
| Rate for Payer: Anthem Medicare Advantage |
$18.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$18.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$18.78
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cigna Commercial |
$134.37
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$70.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$18.78
|
| Rate for Payer: Health EOS Commercial |
$128.71
|
| Rate for Payer: HFN Commercial |
$134.37
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$66.30
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$66.30
|
| Rate for Payer: Independent Care Health Plan Medicare |
$18.78
|
| Rate for Payer: Multiplan Commercial |
$113.15
|
| Rate for Payer: NAPHCARE Commercial |
$28.17
|
| Rate for Payer: Preferred Network Access Commercial |
$134.37
|
| Rate for Payer: Quartz Beloit One Network |
$62.23
|
| Rate for Payer: Quartz Commercial |
$80.62
|
| Rate for Payer: Quartz Medicare Advantage |
$18.78
|
| Rate for Payer: The Alliance Commercial |
$74.19
|
| Rate for Payer: United Healthcare Medicare Advantage |
$18.78
|
| Rate for Payer: WEA Trust Commercial |
$77.79
|
| Rate for Payer: WPS Commercial |
$82.64
|
|
|
Carbohydrate Deficient Transferrin, Congenital Disorders
|
Facility
|
IP
|
$136.00
|
|
|
Service Code
|
CPT 82373
|
| Hospital Charge Code |
5484746
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$69.31 |
| Max. Negotiated Rate |
$130.12 |
| Rate for Payer: Aetna Commercial |
$127.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$121.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$74.96
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cigna Commercial |
$130.12
|
| Rate for Payer: Health EOS Commercial |
$125.88
|
| Rate for Payer: HFN Commercial |
$130.12
|
| Rate for Payer: Multiplan Commercial |
$113.15
|
| Rate for Payer: Preferred Network Access Commercial |
$130.12
|
| Rate for Payer: Quartz Beloit One Network |
$69.31
|
| Rate for Payer: Quartz Commercial |
$84.86
|
| Rate for Payer: WEA Trust Commercial |
$77.79
|
| Rate for Payer: WPS Commercial |
$104.76
|
|
|
Carbohydrate Deficient Transferrin, Congenital Disorders
|
Facility
|
OP
|
$136.00
|
|
|
Service Code
|
CPT 82373
|
| Hospital Charge Code |
5484746
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.78 |
| Max. Negotiated Rate |
$130.12 |
| Rate for Payer: Aetna Commercial |
$127.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$121.64
|
| Rate for Payer: Aetna Managed Medicare |
$18.78
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$70.43
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$32.87
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$31.18
|
| Rate for Payer: Anthem Medicare Advantage |
$18.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$74.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$18.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$18.78
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cash Price |
$40.80
|
| Rate for Payer: Cigna Commercial |
$130.12
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$18.78
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$79.15
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$18.78
|
| Rate for Payer: Health EOS Commercial |
$125.88
|
| Rate for Payer: HFN Commercial |
$130.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$69.87
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$18.78
|
| Rate for Payer: Independent Care Health Plan Medicare |
$18.78
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$18.78
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$18.78
|
| Rate for Payer: Multiplan Commercial |
$113.15
|
| Rate for Payer: NAPHCARE Commercial |
$28.17
|
| Rate for Payer: Preferred Network Access Commercial |
$130.12
|
| Rate for Payer: Quartz Beloit One Network |
$69.31
|
| Rate for Payer: Quartz Commercial |
$91.94
|
| Rate for Payer: Quartz Medicare Advantage |
$18.78
|
| Rate for Payer: The Alliance Commercial |
$75.13
|
| Rate for Payer: United Healthcare Medicare Advantage |
$18.78
|
| Rate for Payer: United Healthcare PPO |
$106.08
|
| Rate for Payer: WEA Trust Commercial |
$77.79
|
| Rate for Payer: Wellcare Medicare |
$18.78
|
| Rate for Payer: WPS Commercial |
$104.76
|
|
|
Carbon Dioxide Level
|
Professional
|
Both
|
$74.00
|
|
|
Service Code
|
CPT 82374
|
| Hospital Charge Code |
633626
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.08 |
| Max. Negotiated Rate |
$73.11 |
| Rate for Payer: Aetna Commercial |
$73.11
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$66.19
|
| Rate for Payer: Aetna Managed Medicare |
$5.08
|
| Rate for Payer: Anthem Medicare Advantage |
$5.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5.08
|
| Rate for Payer: Cash Price |
$22.20
|
| Rate for Payer: Cash Price |
$22.20
|
| Rate for Payer: Cigna Commercial |
$73.11
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$38.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5.08
|
| Rate for Payer: Health EOS Commercial |
$70.03
|
| Rate for Payer: HFN Commercial |
$73.11
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$17.92
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$17.92
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5.08
|
| Rate for Payer: Multiplan Commercial |
$61.57
|
| Rate for Payer: NAPHCARE Commercial |
$7.61
|
| Rate for Payer: Preferred Network Access Commercial |
$73.11
|
| Rate for Payer: Quartz Beloit One Network |
$33.86
|
| Rate for Payer: Quartz Commercial |
$43.87
|
| Rate for Payer: Quartz Medicare Advantage |
$5.08
|
| Rate for Payer: The Alliance Commercial |
$20.05
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.08
|
| Rate for Payer: WEA Trust Commercial |
$42.33
|
| Rate for Payer: WPS Commercial |
$22.33
|
|
