|
ACTH Stimulation, 3 Specimens
|
Facility
IP
|
$114.00
|
|
|
Service Code
|
CPT 82533
|
| Hospital Charge Code |
3162776
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$55.86 |
| Max. Negotiated Rate |
$104.88 |
| Rate for Payer: Aetna Commercial |
$102.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$60.42
|
| Rate for Payer: Cash Price |
$34.20
|
| Rate for Payer: Cigna Commercial |
$104.88
|
| Rate for Payer: Health EOS Commercial |
$101.46
|
| Rate for Payer: HFN Commercial |
$104.88
|
| Rate for Payer: Multiplan Commercial |
$91.20
|
| Rate for Payer: NAPHCARE Commercial |
$68.40
|
| Rate for Payer: Preferred Network Access Commercial |
$104.88
|
| Rate for Payer: Quartz Beloit One Network |
$55.86
|
| Rate for Payer: Quartz Commercial |
$68.40
|
| Rate for Payer: WEA Trust Commercial |
$62.70
|
| Rate for Payer: WPS Commercial |
$84.44
|
|
|
ACTH Stimulation, 3 Specimens
|
Professional
|
$114.00
|
|
|
Service Code
|
CPT 82533
|
| Hospital Charge Code |
3162776
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$16.30 |
| Max. Negotiated Rate |
$108.30 |
| Rate for Payer: Aetna Commercial |
$108.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$98.04
|
| Rate for Payer: Aetna Managed Medicare |
$16.30
|
| Rate for Payer: Anthem Medicare Advantage |
$16.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$16.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$16.30
|
| Rate for Payer: Cash Price |
$34.20
|
| Rate for Payer: Cash Price |
$34.20
|
| Rate for Payer: Cigna Commercial |
$108.30
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$57.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$16.30
|
| Rate for Payer: Health EOS Commercial |
$103.74
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$57.54
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$57.54
|
| Rate for Payer: Independent Care Health Plan Medicare |
$16.30
|
| Rate for Payer: Multiplan Commercial |
$91.20
|
| Rate for Payer: Preferred Network Access Commercial |
$108.30
|
| Rate for Payer: Quartz Beloit One Network |
$50.16
|
| Rate for Payer: Quartz Commercial |
$64.98
|
| Rate for Payer: Quartz Medicare Advantage |
$16.30
|
| Rate for Payer: The Alliance Commercial |
$64.38
|
| Rate for Payer: United Healthcare Medicare Advantage |
$16.30
|
| Rate for Payer: WEA Trust Commercial |
$62.70
|
| Rate for Payer: WPS Commercial |
$71.72
|
|
|
Actigraphy Monitoring
|
Facility
IP
|
$631.00
|
|
|
Service Code
|
CPT 95803
|
| Hospital Charge Code |
5518706
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$309.19 |
| Max. Negotiated Rate |
$580.52 |
| Rate for Payer: Aetna Commercial |
$567.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$334.43
|
| Rate for Payer: Cash Price |
$189.30
|
| Rate for Payer: Cigna Commercial |
$580.52
|
| Rate for Payer: Health EOS Commercial |
$561.59
|
| Rate for Payer: HFN Commercial |
$580.52
|
| Rate for Payer: Multiplan Commercial |
$504.80
|
| Rate for Payer: NAPHCARE Commercial |
$378.60
|
| Rate for Payer: Preferred Network Access Commercial |
$580.52
|
| Rate for Payer: Quartz Beloit One Network |
$309.19
|
| Rate for Payer: Quartz Commercial |
$378.60
|
| Rate for Payer: WEA Trust Commercial |
$347.05
|
| Rate for Payer: WPS Commercial |
$467.38
|
|
|
Actigraphy Monitoring
|
Facility
OP
|
$631.00
|
|
|
Service Code
|
CPT 95803
|
| Hospital Charge Code |
5518706
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$60.46 |
| Max. Negotiated Rate |
$3,496.00 |
| Rate for Payer: Aetna Commercial |
$567.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$542.66
|
| Rate for Payer: Aetna Managed Medicare |
$60.46
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,496.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,871.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,726.00
|
| Rate for Payer: Anthem Medicare Advantage |
$60.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$334.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$60.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$60.46
|
| Rate for Payer: Cash Price |
$189.30
|
| Rate for Payer: Cash Price |
$189.30
|
| Rate for Payer: Cash Price |
$189.30
|
| Rate for Payer: Cigna Commercial |
$580.52
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$60.46
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$353.11
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$60.46
|
| Rate for Payer: Health EOS Commercial |
$561.59
|
| Rate for Payer: HFN Commercial |
$580.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$224.91
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$60.46
|
| Rate for Payer: Independent Care Health Plan Medicare |
$60.46
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$60.46
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$60.46
|
| Rate for Payer: Multiplan Commercial |
$504.80
|
| Rate for Payer: NAPHCARE Commercial |
$90.69
|
| Rate for Payer: Preferred Network Access Commercial |
$580.52
|
| Rate for Payer: Quartz Beloit One Network |
$309.19
|
| Rate for Payer: Quartz Commercial |
$410.15
|
| Rate for Payer: Quartz Medicare Advantage |
$60.46
|
| Rate for Payer: United Healthcare Medicare Advantage |
$60.46
|
| Rate for Payer: United Healthcare PPO |
$473.25
|
| Rate for Payer: WEA Trust Commercial |
$347.05
|
| Rate for Payer: Wellcare Medicare |
$60.46
|
| Rate for Payer: WPS Commercial |
$467.38
|
|
|
Actin (Smooth Muscle) Antibody IgG
|
Facility
IP
|
$56.00
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
5030606
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$27.44 |
| Max. Negotiated Rate |
$51.52 |
| Rate for Payer: Aetna Commercial |
$50.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$29.68
|
| Rate for Payer: Cash Price |
$16.80
|
| Rate for Payer: Cigna Commercial |
$51.52
|
| Rate for Payer: Health EOS Commercial |
$49.84
|
| Rate for Payer: HFN Commercial |
$51.52
|
| Rate for Payer: Multiplan Commercial |
$44.80
|
| Rate for Payer: NAPHCARE Commercial |
$33.60
|
| Rate for Payer: Preferred Network Access Commercial |
$51.52
|
| Rate for Payer: Quartz Beloit One Network |
$27.44
|
| Rate for Payer: Quartz Commercial |
$33.60
|
| Rate for Payer: WEA Trust Commercial |
$30.80
|
| Rate for Payer: WPS Commercial |
$41.48
|
|
|
Actin (Smooth Muscle) Antibody IgG
|
Professional
|
$56.00
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
5030606
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.53 |
| Max. Negotiated Rate |
$53.20 |
| Rate for Payer: Aetna Commercial |
$53.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$48.16
|
| Rate for Payer: Aetna Managed Medicare |
$11.53
|
| Rate for Payer: Anthem Medicare Advantage |
$11.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$11.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$11.53
|
| Rate for Payer: Cash Price |
$16.80
|
| Rate for Payer: Cash Price |
$16.80
|
| Rate for Payer: Cigna Commercial |
$53.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$28.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$11.53
|
| Rate for Payer: Health EOS Commercial |
$50.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$40.70
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$40.70
|
| Rate for Payer: Independent Care Health Plan Medicare |
$11.53
|
| Rate for Payer: Multiplan Commercial |
$44.80
|
| Rate for Payer: Preferred Network Access Commercial |
$53.20
|
| Rate for Payer: Quartz Beloit One Network |
$24.64
|
| Rate for Payer: Quartz Commercial |
$31.92
|
| Rate for Payer: Quartz Medicare Advantage |
$11.53
|
| Rate for Payer: The Alliance Commercial |
$45.54
|
| Rate for Payer: United Healthcare Medicare Advantage |
$11.53
|
| Rate for Payer: WEA Trust Commercial |
$30.80
|
| Rate for Payer: WPS Commercial |
$50.73
|
|
|
Actin (Smooth Muscle) Antibody IgG
|
Facility
OP
|
$56.00
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
5030606
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.53 |
| Max. Negotiated Rate |
$224.00 |
| Rate for Payer: Aetna Commercial |
$50.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$48.16
|
| Rate for Payer: Aetna Managed Medicare |
$11.53
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$43.24
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$20.18
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$19.14
|
| Rate for Payer: Anthem Medicaid |
$11.91
|
| Rate for Payer: Anthem Medicare Advantage |
$11.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$29.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$11.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$11.53
|
| Rate for Payer: Cash Price |
$16.80
|
| Rate for Payer: Cash Price |
$16.80
|
| Rate for Payer: Cigna Commercial |
$51.52
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$11.53
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$11.91
|
| Rate for Payer: Dean Health Medicaid |
$11.91
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$11.53
|
| Rate for Payer: Health EOS Commercial |
$49.84
|
| Rate for Payer: HFN Commercial |
$51.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$42.89
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$11.53
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$11.91
|
| Rate for Payer: Independent Care Health Plan Medicare |
$11.53
|
| Rate for Payer: Managed Health Services Medicaid |
$12.39
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$11.53
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$11.53
|
| Rate for Payer: Multiplan Commercial |
$44.80
|
| Rate for Payer: NAPHCARE Commercial |
$17.30
|
| Rate for Payer: Preferred Network Access Commercial |
$51.52
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$11.91
|
| Rate for Payer: Quartz Beloit One Network |
$27.44
|
| Rate for Payer: Quartz Commercial |
$36.40
|
| Rate for Payer: Quartz Medicare Advantage |
$11.53
|
| Rate for Payer: The Alliance Commercial |
$224.00
|
| Rate for Payer: United Healthcare Medicaid |
$11.91
|
| Rate for Payer: United Healthcare Medicare Advantage |
$11.53
|
| Rate for Payer: United Healthcare PPO |
$42.00
|
| Rate for Payer: WEA Trust Commercial |
$30.80
|
| Rate for Payer: Wellcare Medicare |
$11.53
|
| Rate for Payer: WMAP Medicaid |
$11.91
|
| Rate for Payer: WPS Commercial |
$41.48
|
|
|
Activated Protein C Resistance
|
Facility
OP
|
$323.00
|
|
|
Service Code
|
CPT 85307
|
| Hospital Charge Code |
5749633
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.32 |
| Max. Negotiated Rate |
$1,292.00 |
| Rate for Payer: Aetna Commercial |
$290.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$277.78
|
| Rate for Payer: Aetna Managed Medicare |
$15.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$57.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$26.81
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$25.43
|
| Rate for Payer: Anthem Medicaid |
$15.83
|
| Rate for Payer: Anthem Medicare Advantage |
$15.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$171.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$15.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$15.32
|
| Rate for Payer: Cash Price |
$96.90
|
| Rate for Payer: Cash Price |
$96.90
|
| Rate for Payer: Cigna Commercial |
$297.16
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$15.32
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$15.83
|
| Rate for Payer: Dean Health Medicaid |
$15.83
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$15.32
|
| Rate for Payer: Health EOS Commercial |
$287.47
|
| Rate for Payer: HFN Commercial |
$297.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$56.99
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$15.32
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$15.83
|
| Rate for Payer: Independent Care Health Plan Medicare |
$15.32
|
| Rate for Payer: Managed Health Services Medicaid |
$16.46
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$15.32
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$15.32
|
| Rate for Payer: Multiplan Commercial |
$258.40
|
| Rate for Payer: NAPHCARE Commercial |
$22.98
|
| Rate for Payer: Preferred Network Access Commercial |
$297.16
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$15.83
|
| Rate for Payer: Quartz Beloit One Network |
$158.27
|
| Rate for Payer: Quartz Commercial |
$209.95
|
| Rate for Payer: Quartz Medicare Advantage |
$15.32
|
| Rate for Payer: The Alliance Commercial |
$1,292.00
|
| Rate for Payer: United Healthcare Medicaid |
$15.83
|
| Rate for Payer: United Healthcare Medicare Advantage |
$15.32
|
| Rate for Payer: United Healthcare PPO |
$242.25
|
| Rate for Payer: WEA Trust Commercial |
$177.65
|
| Rate for Payer: Wellcare Medicare |
$15.32
|
| Rate for Payer: WMAP Medicaid |
$15.83
|
| Rate for Payer: WPS Commercial |
$239.25
|
|
|
Activated Protein C Resistance
|
Professional
|
$323.00
|
|
|
Service Code
|
CPT 85307
|
| Hospital Charge Code |
5749633
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.32 |
| Max. Negotiated Rate |
$306.85 |
| Rate for Payer: Aetna Commercial |
$306.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$277.78
|
| Rate for Payer: Aetna Managed Medicare |
$15.32
|
| Rate for Payer: Anthem Medicare Advantage |
$15.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$15.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$15.32
|
| Rate for Payer: Cash Price |
$96.90
|
| Rate for Payer: Cash Price |
$96.90
|
| Rate for Payer: Cigna Commercial |
$306.85
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$161.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$15.32
|
| Rate for Payer: Health EOS Commercial |
$293.93
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$54.08
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$54.08
|
| Rate for Payer: Independent Care Health Plan Medicare |
$15.32
|
| Rate for Payer: Multiplan Commercial |
$258.40
|
| Rate for Payer: Preferred Network Access Commercial |
$306.85
|
| Rate for Payer: Quartz Beloit One Network |
$142.12
|
| Rate for Payer: Quartz Commercial |
$184.11
|
| Rate for Payer: Quartz Medicare Advantage |
$15.32
|
| Rate for Payer: The Alliance Commercial |
$60.51
|
| Rate for Payer: United Healthcare Medicare Advantage |
$15.32
|
| Rate for Payer: WEA Trust Commercial |
$177.65
|
| Rate for Payer: WPS Commercial |
$67.41
|
|
|
Activated Protein C Resistance
|
Facility
OP
|
$345.00
|
|
|
Service Code
|
CPT 85307
|
| Hospital Charge Code |
980012
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.32 |
| Max. Negotiated Rate |
$1,380.00 |
| Rate for Payer: Aetna Commercial |
$310.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$296.70
|
| Rate for Payer: Aetna Managed Medicare |
$15.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$57.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$26.81
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$25.43
|
| Rate for Payer: Anthem Medicaid |
$15.83
|
| Rate for Payer: Anthem Medicare Advantage |
$15.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$182.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$15.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$15.32
|
| Rate for Payer: Cash Price |
$103.50
|
| Rate for Payer: Cash Price |
$103.50
|
| Rate for Payer: Cigna Commercial |
$317.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$15.32
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$15.83
|
| Rate for Payer: Dean Health Medicaid |
$15.83
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$15.32
|
| Rate for Payer: Health EOS Commercial |
$307.05
|
| Rate for Payer: HFN Commercial |
$317.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$56.99
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$15.32
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$15.83
|
| Rate for Payer: Independent Care Health Plan Medicare |
$15.32
|
| Rate for Payer: Managed Health Services Medicaid |
$16.46
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$15.32
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$15.32
|
| Rate for Payer: Multiplan Commercial |
$276.00
|
| Rate for Payer: NAPHCARE Commercial |
$22.98
|
| Rate for Payer: Preferred Network Access Commercial |
$317.40
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$15.83
|
| Rate for Payer: Quartz Beloit One Network |
$169.05
|
| Rate for Payer: Quartz Commercial |
$224.25
|
| Rate for Payer: Quartz Medicare Advantage |
$15.32
|
| Rate for Payer: The Alliance Commercial |
$1,380.00
|
| Rate for Payer: United Healthcare Medicaid |
$15.83
|
| Rate for Payer: United Healthcare Medicare Advantage |
$15.32
|
| Rate for Payer: United Healthcare PPO |
$258.75
|
| Rate for Payer: WEA Trust Commercial |
$189.75
|
| Rate for Payer: Wellcare Medicare |
$15.32
|
| Rate for Payer: WMAP Medicaid |
$15.83
|
| Rate for Payer: WPS Commercial |
$255.54
|
|
|
Activated Protein C Resistance
|
Professional
|
$345.00
|
|
|
Service Code
|
CPT 85307
|
| Hospital Charge Code |
980012
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.32 |
| Max. Negotiated Rate |
$327.75 |
| Rate for Payer: Aetna Commercial |
$327.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$296.70
|
| Rate for Payer: Aetna Managed Medicare |
$15.32
|
| Rate for Payer: Anthem Medicare Advantage |
$15.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$15.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$15.32
|
| Rate for Payer: Cash Price |
$103.50
|
| Rate for Payer: Cash Price |
$103.50
|
| Rate for Payer: Cigna Commercial |
$327.75
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$172.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$15.32
|
| Rate for Payer: Health EOS Commercial |
$313.95
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$54.08
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$54.08
|
| Rate for Payer: Independent Care Health Plan Medicare |
$15.32
|
| Rate for Payer: Multiplan Commercial |
$276.00
|
| Rate for Payer: Preferred Network Access Commercial |
$327.75
|
| Rate for Payer: Quartz Beloit One Network |
$151.80
|
| Rate for Payer: Quartz Commercial |
$196.65
|
| Rate for Payer: Quartz Medicare Advantage |
$15.32
|
| Rate for Payer: The Alliance Commercial |
$60.51
|
| Rate for Payer: United Healthcare Medicare Advantage |
$15.32
|
| Rate for Payer: WEA Trust Commercial |
$189.75
|
| Rate for Payer: WPS Commercial |
$67.41
|
|
|
Activated Protein C Resistance
|
Facility
IP
|
$345.00
|
|
|
Service Code
|
CPT 85307
|
| Hospital Charge Code |
980012
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$169.05 |
| Max. Negotiated Rate |
$317.40 |
| Rate for Payer: Aetna Commercial |
$310.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$182.85
|
| Rate for Payer: Cash Price |
$103.50
|
| Rate for Payer: Cigna Commercial |
$317.40
|
| Rate for Payer: Health EOS Commercial |
$307.05
|
| Rate for Payer: HFN Commercial |
$317.40
|
| Rate for Payer: Multiplan Commercial |
$276.00
|
| Rate for Payer: NAPHCARE Commercial |
$207.00
|
| Rate for Payer: Preferred Network Access Commercial |
$317.40
|
| Rate for Payer: Quartz Beloit One Network |
$169.05
|
| Rate for Payer: Quartz Commercial |
$207.00
|
| Rate for Payer: WEA Trust Commercial |
$189.75
|
| Rate for Payer: WPS Commercial |
$255.54
|
|
|
Activated Protein C Resistance
|
Facility
IP
|
$323.00
|
|
|
Service Code
|
CPT 85307
|
| Hospital Charge Code |
5749633
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$158.27 |
| Max. Negotiated Rate |
$297.16 |
| Rate for Payer: Aetna Commercial |
$290.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$171.19
|
| Rate for Payer: Cash Price |
$96.90
|
| Rate for Payer: Cigna Commercial |
$297.16
|
| Rate for Payer: Health EOS Commercial |
$287.47
|
| Rate for Payer: HFN Commercial |
$297.16
|
| Rate for Payer: Multiplan Commercial |
$258.40
|
| Rate for Payer: NAPHCARE Commercial |
$193.80
|
| Rate for Payer: Preferred Network Access Commercial |
$297.16
|
| Rate for Payer: Quartz Beloit One Network |
$158.27
|
| Rate for Payer: Quartz Commercial |
$193.80
|
| Rate for Payer: WEA Trust Commercial |
$177.65
|
| Rate for Payer: WPS Commercial |
$239.25
|
|
|
ACTIVATION TOOL S0457-000
|
Facility
OP
|
$1,553.00
|
|
| Hospital Charge Code |
6232145
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$434.84 |
| Max. Negotiated Rate |
$6,212.00 |
| Rate for Payer: Aetna Commercial |
$1,397.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,335.58
|
| Rate for Payer: Aetna Managed Medicare |
$434.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,009.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$776.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$745.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$823.09
|
| Rate for Payer: Cash Price |
$465.90
|
| Rate for Payer: Cigna Commercial |
$1,428.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$869.06
|
| Rate for Payer: Health EOS Commercial |
$1,382.17
|
| Rate for Payer: HFN Commercial |
$1,428.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,164.75
|
| Rate for Payer: Multiplan Commercial |
$1,242.40
|
| Rate for Payer: NAPHCARE Commercial |
$931.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,428.76
|
| Rate for Payer: Quartz Beloit One Network |
$760.97
|
| Rate for Payer: Quartz Commercial |
$1,009.45
|
| Rate for Payer: Quartz Medicare Advantage |
$931.80
|
| Rate for Payer: The Alliance Commercial |
$6,212.00
|
| Rate for Payer: WEA Trust Commercial |
$854.15
|
| Rate for Payer: WPS Commercial |
$1,150.31
|
|
|
ACTIVATION TOOL S0457-000
|
Facility
IP
|
$1,553.00
|
|
| Hospital Charge Code |
6232145
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$760.97 |
| Max. Negotiated Rate |
$1,428.76 |
| Rate for Payer: Aetna Commercial |
$1,397.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$823.09
|
| Rate for Payer: Cash Price |
$465.90
|
| Rate for Payer: Cigna Commercial |
$1,428.76
|
| Rate for Payer: Health EOS Commercial |
$1,382.17
|
| Rate for Payer: HFN Commercial |
$1,428.76
|
| Rate for Payer: Multiplan Commercial |
$1,242.40
|
| Rate for Payer: NAPHCARE Commercial |
$931.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,428.76
|
| Rate for Payer: Quartz Beloit One Network |
$760.97
|
| Rate for Payer: Quartz Commercial |
$931.80
|
| Rate for Payer: WEA Trust Commercial |
$854.15
|
| Rate for Payer: WPS Commercial |
$1,150.31
|
|
|
ACT Testing
|
Facility
OP
|
$153.00
|
|
|
Service Code
|
CPT 85347
|
| Hospital Charge Code |
3052459
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.28 |
| Max. Negotiated Rate |
$612.00 |
| Rate for Payer: Aetna Commercial |
$137.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$131.58
|
| Rate for Payer: Aetna Managed Medicare |
$4.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$16.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$7.49
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7.10
|
| Rate for Payer: Anthem Medicaid |
$4.42
|
| Rate for Payer: Anthem Medicare Advantage |
$4.28
|
| 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 |
$4.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$4.28
|
| 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 |
$4.28
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$4.42
|
| Rate for Payer: Dean Health Medicaid |
$4.42
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$4.28
|
| Rate for Payer: Health EOS Commercial |
$136.17
|
| Rate for Payer: HFN Commercial |
$140.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$15.92
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$4.28
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$4.42
|
| Rate for Payer: Independent Care Health Plan Medicare |
$4.28
|
| Rate for Payer: Managed Health Services Medicaid |
$4.60
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$4.28
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$4.28
|
| Rate for Payer: Multiplan Commercial |
$122.40
|
| Rate for Payer: NAPHCARE Commercial |
$6.42
|
| Rate for Payer: Preferred Network Access Commercial |
$140.76
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$4.42
|
| Rate for Payer: Quartz Beloit One Network |
$74.97
|
| Rate for Payer: Quartz Commercial |
$99.45
|
| Rate for Payer: Quartz Medicare Advantage |
$4.28
|
| Rate for Payer: The Alliance Commercial |
$612.00
|
| Rate for Payer: United Healthcare Medicaid |
$4.42
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4.28
|
| Rate for Payer: United Healthcare PPO |
$114.75
|
| Rate for Payer: WEA Trust Commercial |
$84.15
|
| Rate for Payer: Wellcare Medicare |
$4.28
|
| Rate for Payer: WMAP Medicaid |
$4.42
|
| Rate for Payer: WPS Commercial |
$113.33
|
|
|
ACT Testing
|
Facility
IP
|
$153.00
|
|
|
Service Code
|
CPT 85347
|
| Hospital Charge Code |
3052459
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$74.97 |
| Max. Negotiated Rate |
$140.76 |
| Rate for Payer: Aetna Commercial |
$137.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$81.09
|
| Rate for Payer: Cash Price |
$45.90
|
| Rate for Payer: Cigna Commercial |
$140.76
|
| Rate for Payer: Health EOS Commercial |
$136.17
|
| Rate for Payer: HFN Commercial |
$140.76
|
| Rate for Payer: Multiplan Commercial |
$122.40
|
| Rate for Payer: NAPHCARE Commercial |
$91.80
|
| Rate for Payer: Preferred Network Access Commercial |
$140.76
|
| Rate for Payer: Quartz Beloit One Network |
$74.97
|
| Rate for Payer: Quartz Commercial |
$91.80
|
| Rate for Payer: WEA Trust Commercial |
$84.15
|
| Rate for Payer: WPS Commercial |
$113.33
|
|
|
ACUTE ADJUSTMENT REACTION AND PSYCHOSOCIAL DYSFUNCTION
|
Facility
IP
|
$25,699.00
|
|
|
Service Code
|
MS-DRG 880
|
| Min. Negotiated Rate |
$9,244.39 |
| Max. Negotiated Rate |
$25,699.00 |
| Rate for Payer: Aetna Managed Medicare |
$9,244.39
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$19,931.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$15,276.95
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$14,514.10
|
| Rate for Payer: Anthem Medicare Advantage |
$9,244.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$9,244.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$9,244.39
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$9,244.39
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$16,111.98
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$9,244.39
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$18,614.70
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$9,244.39
|
| Rate for Payer: Independent Care Health Plan Medicare |
$9,244.39
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$9,244.39
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$9,244.39
|
| Rate for Payer: NAPHCARE Commercial |
$13,866.58
|
| Rate for Payer: Quartz Medicare Advantage |
$9,244.39
|
| Rate for Payer: The Alliance Commercial |
$25,699.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$9,244.39
|
| Rate for Payer: United Healthcare PPO |
$14,491.78
|
| Rate for Payer: Wellcare Medicare |
$9,244.39
|
|
|
ACUTE AND SUBACUTE ENDOCARDITIS WITH CC
|
Facility
IP
|
$39,606.00
|
|
|
Service Code
|
MS-DRG 289
|
| Min. Negotiated Rate |
$14,246.94 |
| Max. Negotiated Rate |
$39,606.00 |
| Rate for Payer: Aetna Managed Medicare |
$14,246.94
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$31,050.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$23,799.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$22,611.44
|
| Rate for Payer: Anthem Medicare Advantage |
$14,246.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$14,246.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$14,246.94
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$14,246.94
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$25,100.77
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$14,246.94
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$28,815.15
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$14,246.94
|
| Rate for Payer: Independent Care Health Plan Medicare |
$14,246.94
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$14,246.94
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$14,246.94
|
| Rate for Payer: NAPHCARE Commercial |
$21,370.41
|
| Rate for Payer: Quartz Medicare Advantage |
$14,246.94
|
| Rate for Payer: The Alliance Commercial |
$39,606.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14,246.94
|
| Rate for Payer: United Healthcare PPO |
$22,432.96
|
| Rate for Payer: Wellcare Medicare |
$14,246.94
|
|
|
ACUTE AND SUBACUTE ENDOCARDITIS WITH MCC
|
Facility
IP
|
$69,258.00
|
|
|
Service Code
|
MS-DRG 288
|
| Min. Negotiated Rate |
$24,912.88 |
| Max. Negotiated Rate |
$69,258.00 |
| Rate for Payer: Aetna Managed Medicare |
$24,912.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$54,338.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$41,649.79
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$39,570.02
|
| Rate for Payer: Anthem Medicare Advantage |
$24,912.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$24,912.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$24,912.88
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$24,912.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$43,926.35
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$24,912.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$50,563.50
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$24,912.88
|
| Rate for Payer: Independent Care Health Plan Medicare |
$24,912.88
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$24,912.88
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$24,912.88
|
| Rate for Payer: NAPHCARE Commercial |
$37,369.32
|
| Rate for Payer: Quartz Medicare Advantage |
$24,912.88
|
| Rate for Payer: The Alliance Commercial |
$69,258.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$24,912.88
|
| Rate for Payer: United Healthcare PPO |
$39,364.33
|
| Rate for Payer: Wellcare Medicare |
$24,912.88
|
|
|
ACUTE AND SUBACUTE ENDOCARDITIS WITHOUT CC/MCC
|
Facility
IP
|
$29,169.00
|
|
|
Service Code
|
MS-DRG 290
|
| Min. Negotiated Rate |
$10,492.39 |
| Max. Negotiated Rate |
$29,169.00 |
| Rate for Payer: Aetna Managed Medicare |
$10,492.39
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$21,609.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$16,563.43
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$15,736.34
|
| Rate for Payer: Anthem Medicare Advantage |
$10,492.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$10,492.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$10,492.39
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$10,492.39
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$17,468.78
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$10,492.39
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$19,991.40
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$10,492.39
|
| Rate for Payer: Independent Care Health Plan Medicare |
$10,492.39
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$10,492.39
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$10,492.39
|
| Rate for Payer: NAPHCARE Commercial |
$15,738.58
|
| Rate for Payer: Quartz Medicare Advantage |
$10,492.39
|
| Rate for Payer: The Alliance Commercial |
$29,169.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$10,492.39
|
| Rate for Payer: United Healthcare PPO |
$15,563.56
|
| Rate for Payer: Wellcare Medicare |
$10,492.39
|
|
|
Acute Hemodialysis
|
Facility
IP
|
$2,195.00
|
|
| Hospital Charge Code |
3005574
|
|
Hospital Revenue Code
|
801
|
| Min. Negotiated Rate |
$1,075.55 |
| Max. Negotiated Rate |
$2,019.40 |
| Rate for Payer: Aetna Commercial |
$1,975.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,163.35
|
| Rate for Payer: Cash Price |
$658.50
|
| Rate for Payer: Cigna Commercial |
$2,019.40
|
| Rate for Payer: Health EOS Commercial |
$1,953.55
|
| Rate for Payer: HFN Commercial |
$2,019.40
|
| Rate for Payer: Multiplan Commercial |
$1,756.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,317.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,019.40
|
| Rate for Payer: Quartz Beloit One Network |
$1,075.55
|
| Rate for Payer: Quartz Commercial |
$1,317.00
|
| Rate for Payer: WEA Trust Commercial |
$1,207.25
|
| Rate for Payer: WPS Commercial |
$1,625.84
|
|
|
Acute Hemodialysis
|
Facility
OP
|
$2,195.00
|
|
| Hospital Charge Code |
3005574
|
|
Hospital Revenue Code
|
801
|
| Min. Negotiated Rate |
$614.60 |
| Max. Negotiated Rate |
$8,780.00 |
| Rate for Payer: Aetna Commercial |
$1,975.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,887.70
|
| Rate for Payer: Aetna Managed Medicare |
$614.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,426.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,097.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,053.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,163.35
|
| Rate for Payer: Cash Price |
$658.50
|
| Rate for Payer: Cigna Commercial |
$2,019.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,228.32
|
| Rate for Payer: Health EOS Commercial |
$1,953.55
|
| Rate for Payer: HFN Commercial |
$2,019.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,646.25
|
| Rate for Payer: Multiplan Commercial |
$1,756.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,317.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,019.40
|
| Rate for Payer: Quartz Beloit One Network |
$1,075.55
|
| Rate for Payer: Quartz Commercial |
$1,426.75
|
| Rate for Payer: Quartz Medicare Advantage |
$1,317.00
|
| Rate for Payer: The Alliance Commercial |
$8,780.00
|
| Rate for Payer: WEA Trust Commercial |
$1,207.25
|
| Rate for Payer: WPS Commercial |
$1,625.84
|
|
|
Acute Hepatitis Panel
|
Professional
|
$563.00
|
|
|
Service Code
|
CPT 80074
|
| Hospital Charge Code |
633756
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$47.63 |
| Max. Negotiated Rate |
$534.85 |
| Rate for Payer: Aetna Commercial |
$534.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$484.18
|
| Rate for Payer: Aetna Managed Medicare |
$47.63
|
| Rate for Payer: Anthem Medicare Advantage |
$47.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$47.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$47.63
|
| Rate for Payer: Cash Price |
$168.90
|
| Rate for Payer: Cash Price |
$168.90
|
| Rate for Payer: Cigna Commercial |
$534.85
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$281.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$47.63
|
| Rate for Payer: Health EOS Commercial |
$512.33
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$168.13
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$168.13
|
| Rate for Payer: Independent Care Health Plan Medicare |
$47.63
|
| Rate for Payer: Multiplan Commercial |
$450.40
|
| Rate for Payer: Preferred Network Access Commercial |
$534.85
|
| Rate for Payer: Quartz Beloit One Network |
$247.72
|
| Rate for Payer: Quartz Commercial |
$320.91
|
| Rate for Payer: Quartz Medicare Advantage |
$47.63
|
| Rate for Payer: The Alliance Commercial |
$188.14
|
| Rate for Payer: United Healthcare Medicare Advantage |
$47.63
|
| Rate for Payer: WEA Trust Commercial |
$309.65
|
| Rate for Payer: WPS Commercial |
$209.57
|
|
|
Acute Hepatitis Panel
|
Facility
OP
|
$563.00
|
|
|
Service Code
|
CPT 80074
|
| Hospital Charge Code |
633756
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$47.63 |
| Max. Negotiated Rate |
$2,252.00 |
| Rate for Payer: Aetna Commercial |
$506.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$484.18
|
| Rate for Payer: Aetna Managed Medicare |
$47.63
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$178.61
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$83.35
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$79.07
|
| Rate for Payer: Anthem Medicaid |
$49.22
|
| Rate for Payer: Anthem Medicare Advantage |
$47.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$298.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$47.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$47.63
|
| Rate for Payer: Cash Price |
$168.90
|
| Rate for Payer: Cash Price |
$168.90
|
| Rate for Payer: Cigna Commercial |
$517.96
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$47.63
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$49.22
|
| Rate for Payer: Dean Health Medicaid |
$49.22
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$47.63
|
| Rate for Payer: Health EOS Commercial |
$501.07
|
| Rate for Payer: HFN Commercial |
$517.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$177.18
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$47.63
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$49.22
|
| Rate for Payer: Independent Care Health Plan Medicare |
$47.63
|
| Rate for Payer: Managed Health Services Medicaid |
$51.19
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$47.63
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$47.63
|
| Rate for Payer: Multiplan Commercial |
$450.40
|
| Rate for Payer: NAPHCARE Commercial |
$71.44
|
| Rate for Payer: Preferred Network Access Commercial |
$517.96
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$49.22
|
| Rate for Payer: Quartz Beloit One Network |
$275.87
|
| Rate for Payer: Quartz Commercial |
$365.95
|
| Rate for Payer: Quartz Medicare Advantage |
$47.63
|
| Rate for Payer: The Alliance Commercial |
$2,252.00
|
| Rate for Payer: United Healthcare Medicaid |
$49.22
|
| Rate for Payer: United Healthcare Medicare Advantage |
$47.63
|
| Rate for Payer: United Healthcare PPO |
$422.25
|
| Rate for Payer: WEA Trust Commercial |
$309.65
|
| Rate for Payer: Wellcare Medicare |
$47.63
|
| Rate for Payer: WMAP Medicaid |
$49.22
|
| Rate for Payer: WPS Commercial |
$417.01
|
|
