|
Acromio/clavicular canvas&we L3670
|
Professional
|
Both
|
$223.00
|
|
|
Service Code
|
HCPCS L3670
|
| Hospital Charge Code |
3303498
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$102.04 |
| Max. Negotiated Rate |
$381.30 |
| Rate for Payer: Aetna Commercial |
$220.32
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$199.45
|
| Rate for Payer: Aetna Managed Medicare |
$132.24
|
| Rate for Payer: Anthem Medicare Advantage |
$132.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$132.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$132.24
|
| Rate for Payer: Cash Price |
$66.90
|
| Rate for Payer: Cash Price |
$66.90
|
| Rate for Payer: Cigna Commercial |
$220.32
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$115.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$132.24
|
| Rate for Payer: Health EOS Commercial |
$211.05
|
| Rate for Payer: HFN Commercial |
$220.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$381.30
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$381.30
|
| Rate for Payer: Independent Care Health Plan Medicare |
$132.24
|
| Rate for Payer: Multiplan Commercial |
$185.54
|
| Rate for Payer: NAPHCARE Commercial |
$198.35
|
| Rate for Payer: Preferred Network Access Commercial |
$220.32
|
| Rate for Payer: Quartz Beloit One Network |
$102.04
|
| Rate for Payer: Quartz Commercial |
$132.19
|
| Rate for Payer: Quartz Medicare Advantage |
$132.24
|
| Rate for Payer: The Alliance Commercial |
$363.65
|
| Rate for Payer: United Healthcare Medicare Advantage |
$132.24
|
| Rate for Payer: WEA Trust Commercial |
$127.56
|
| Rate for Payer: WPS Commercial |
$231.41
|
|
|
Acromio/clavicular canvas&we L3670
|
Facility
|
IP
|
$223.00
|
|
|
Service Code
|
HCPCS L3670
|
| Hospital Charge Code |
3303498
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$113.64 |
| Max. Negotiated Rate |
$213.37 |
| Rate for Payer: Aetna Commercial |
$208.73
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$199.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$122.92
|
| Rate for Payer: Cash Price |
$66.90
|
| Rate for Payer: Cigna Commercial |
$213.37
|
| Rate for Payer: Health EOS Commercial |
$206.41
|
| Rate for Payer: HFN Commercial |
$213.37
|
| Rate for Payer: Multiplan Commercial |
$185.54
|
| Rate for Payer: Preferred Network Access Commercial |
$213.37
|
| Rate for Payer: Quartz Beloit One Network |
$113.64
|
| Rate for Payer: Quartz Commercial |
$139.15
|
| Rate for Payer: WEA Trust Commercial |
$127.56
|
| Rate for Payer: WPS Commercial |
$171.78
|
|
|
Acromio/clavicular canvas&we L3670
|
Facility
|
OP
|
$223.00
|
|
|
Service Code
|
HCPCS L3670
|
| Hospital Charge Code |
3303498
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$64.94 |
| Max. Negotiated Rate |
$528.94 |
| Rate for Payer: Aetna Commercial |
$208.73
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$199.45
|
| Rate for Payer: Aetna Managed Medicare |
$64.94
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$80.37
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$80.37
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$80.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$122.92
|
| Rate for Payer: Cash Price |
$66.90
|
| Rate for Payer: Cash Price |
$66.90
|
| Rate for Payer: Cigna Commercial |
$213.37
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$129.79
|
| Rate for Payer: Health EOS Commercial |
$206.41
|
| Rate for Payer: HFN Commercial |
$213.37
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$173.94
|
| Rate for Payer: Multiplan Commercial |
$185.54
|
| Rate for Payer: NAPHCARE Commercial |
$139.15
|
| Rate for Payer: Preferred Network Access Commercial |
$213.37
|
| Rate for Payer: Quartz Beloit One Network |
$113.64
|
| Rate for Payer: Quartz Commercial |
$150.75
|
| Rate for Payer: Quartz Medicare Advantage |
$139.15
|
| Rate for Payer: The Alliance Commercial |
$528.94
|
| Rate for Payer: WEA Trust Commercial |
$127.56
|
| Rate for Payer: WPS Commercial |
$171.78
|
|
|
ACROMIOPLASTY OR ACROMIONECTOMY, PARTIAL, WITH OR WITHOUT CORACOACROMIAL LIGAMENT RELEASE
|
Facility
|
OP
|
$13,773.68
|
|
|
Service Code
|
CPT 23130
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,443.42 |
| Max. Negotiated Rate |
$13,773.68 |
| Rate for Payer: Aetna Managed Medicare |
$3,443.42
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$10,303.28
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8,364.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7,944.56
|
| Rate for Payer: Anthem Medicare Advantage |
$3,443.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$3,443.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$3,443.42
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$3,443.42
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$8,673.35
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$3,443.42
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$12,809.52
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$3,443.42
|
| Rate for Payer: Independent Care Health Plan Medicare |
$3,443.42
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$3,443.42
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$3,443.42
|
| Rate for Payer: NAPHCARE Commercial |
$5,165.13
|
| Rate for Payer: Quartz Medicare Advantage |
$3,443.42
|
| Rate for Payer: The Alliance Commercial |
$13,773.68
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,443.42
|
| Rate for Payer: United Healthcare PPO |
$4,267.12
|
| Rate for Payer: Wellcare Medicare |
$3,443.42
|
|
|
ACTH Stimulation, 2 Specimens
|
Facility
|
OP
|
$121.00
|
|
|
Service Code
|
CPT 82533
|
| Hospital Charge Code |
980010
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$16.95 |
| Max. Negotiated Rate |
$115.77 |
| Rate for Payer: Aetna Commercial |
$113.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$108.22
|
| Rate for Payer: Aetna Managed Medicare |
$16.95
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$63.57
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$29.67
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$28.14
|
| Rate for Payer: Anthem Medicare Advantage |
$16.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$66.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$16.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$16.95
|
| Rate for Payer: Cash Price |
$36.30
|
| Rate for Payer: Cash Price |
$36.30
|
| Rate for Payer: Cigna Commercial |
$115.77
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$16.95
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$70.42
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$16.95
|
| Rate for Payer: Health EOS Commercial |
$112.00
|
| Rate for Payer: HFN Commercial |
$115.77
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$63.06
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$16.95
|
| Rate for Payer: Independent Care Health Plan Medicare |
$16.95
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$16.95
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$16.95
|
| Rate for Payer: Multiplan Commercial |
$100.67
|
| Rate for Payer: NAPHCARE Commercial |
$25.43
|
| Rate for Payer: Preferred Network Access Commercial |
$115.77
|
| Rate for Payer: Quartz Beloit One Network |
$61.66
|
| Rate for Payer: Quartz Commercial |
$81.80
|
| Rate for Payer: Quartz Medicare Advantage |
$16.95
|
| Rate for Payer: The Alliance Commercial |
$67.81
|
| Rate for Payer: United Healthcare Medicare Advantage |
$16.95
|
| Rate for Payer: United Healthcare PPO |
$94.38
|
| Rate for Payer: WEA Trust Commercial |
$69.21
|
| Rate for Payer: Wellcare Medicare |
$16.95
|
| Rate for Payer: WPS Commercial |
$93.21
|
|
|
ACTH Stimulation, 2 Specimens
|
Facility
|
IP
|
$121.00
|
|
|
Service Code
|
CPT 82533
|
| Hospital Charge Code |
980010
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$61.66 |
| Max. Negotiated Rate |
$115.77 |
| Rate for Payer: Aetna Commercial |
$113.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$108.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$66.70
|
| Rate for Payer: Cash Price |
$36.30
|
| Rate for Payer: Cigna Commercial |
$115.77
|
| Rate for Payer: Health EOS Commercial |
$112.00
|
| Rate for Payer: HFN Commercial |
$115.77
|
| Rate for Payer: Multiplan Commercial |
$100.67
|
| Rate for Payer: Preferred Network Access Commercial |
$115.77
|
| Rate for Payer: Quartz Beloit One Network |
$61.66
|
| Rate for Payer: Quartz Commercial |
$75.50
|
| Rate for Payer: WEA Trust Commercial |
$69.21
|
| Rate for Payer: WPS Commercial |
$93.21
|
|
|
ACTH Stimulation, 2 Specimens
|
Professional
|
Both
|
$121.00
|
|
|
Service Code
|
CPT 82533
|
| Hospital Charge Code |
980010
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$16.95 |
| Max. Negotiated Rate |
$119.55 |
| Rate for Payer: Aetna Commercial |
$119.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$108.22
|
| Rate for Payer: Aetna Managed Medicare |
$16.95
|
| Rate for Payer: Anthem Medicare Advantage |
$16.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$16.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$16.95
|
| Rate for Payer: Cash Price |
$36.30
|
| Rate for Payer: Cash Price |
$36.30
|
| Rate for Payer: Cigna Commercial |
$119.55
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$62.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$16.95
|
| Rate for Payer: Health EOS Commercial |
$114.51
|
| Rate for Payer: HFN Commercial |
$119.55
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$59.84
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$59.84
|
| Rate for Payer: Independent Care Health Plan Medicare |
$16.95
|
| Rate for Payer: Multiplan Commercial |
$100.67
|
| Rate for Payer: NAPHCARE Commercial |
$25.43
|
| Rate for Payer: Preferred Network Access Commercial |
$119.55
|
| Rate for Payer: Quartz Beloit One Network |
$55.37
|
| Rate for Payer: Quartz Commercial |
$71.73
|
| Rate for Payer: Quartz Medicare Advantage |
$16.95
|
| Rate for Payer: The Alliance Commercial |
$66.96
|
| Rate for Payer: United Healthcare Medicare Advantage |
$16.95
|
| Rate for Payer: WEA Trust Commercial |
$69.21
|
| Rate for Payer: WPS Commercial |
$74.59
|
|
|
ACTH Stimulation, 3 Specimens
|
Facility
|
IP
|
$114.00
|
|
|
Service Code
|
CPT 82533
|
| Hospital Charge Code |
3162776
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$58.09 |
| Max. Negotiated Rate |
$109.08 |
| Rate for Payer: Aetna Commercial |
$106.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$101.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$62.84
|
| Rate for Payer: Cash Price |
$34.20
|
| Rate for Payer: Cigna Commercial |
$109.08
|
| Rate for Payer: Health EOS Commercial |
$105.52
|
| Rate for Payer: HFN Commercial |
$109.08
|
| Rate for Payer: Multiplan Commercial |
$94.85
|
| Rate for Payer: Preferred Network Access Commercial |
$109.08
|
| Rate for Payer: Quartz Beloit One Network |
$58.09
|
| Rate for Payer: Quartz Commercial |
$71.14
|
| Rate for Payer: WEA Trust Commercial |
$65.21
|
| Rate for Payer: WPS Commercial |
$87.81
|
|
|
ACTH Stimulation, 3 Specimens
|
Facility
|
OP
|
$114.00
|
|
|
Service Code
|
CPT 82533
|
| Hospital Charge Code |
3162776
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$16.95 |
| Max. Negotiated Rate |
$109.08 |
| Rate for Payer: Aetna Commercial |
$106.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$101.96
|
| Rate for Payer: Aetna Managed Medicare |
$16.95
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$63.57
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$29.67
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$28.14
|
| Rate for Payer: Anthem Medicare Advantage |
$16.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$62.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$16.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$16.95
|
| Rate for Payer: Cash Price |
$34.20
|
| Rate for Payer: Cash Price |
$34.20
|
| Rate for Payer: Cigna Commercial |
$109.08
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$16.95
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$66.35
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$16.95
|
| Rate for Payer: Health EOS Commercial |
$105.52
|
| Rate for Payer: HFN Commercial |
$109.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$63.06
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$16.95
|
| Rate for Payer: Independent Care Health Plan Medicare |
$16.95
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$16.95
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$16.95
|
| Rate for Payer: Multiplan Commercial |
$94.85
|
| Rate for Payer: NAPHCARE Commercial |
$25.43
|
| Rate for Payer: Preferred Network Access Commercial |
$109.08
|
| Rate for Payer: Quartz Beloit One Network |
$58.09
|
| Rate for Payer: Quartz Commercial |
$77.06
|
| Rate for Payer: Quartz Medicare Advantage |
$16.95
|
| Rate for Payer: The Alliance Commercial |
$67.81
|
| Rate for Payer: United Healthcare Medicare Advantage |
$16.95
|
| Rate for Payer: United Healthcare PPO |
$88.92
|
| Rate for Payer: WEA Trust Commercial |
$65.21
|
| Rate for Payer: Wellcare Medicare |
$16.95
|
| Rate for Payer: WPS Commercial |
$87.81
|
|
|
ACTH Stimulation, 3 Specimens
|
Professional
|
Both
|
$114.00
|
|
|
Service Code
|
CPT 82533
|
| Hospital Charge Code |
3162776
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$16.95 |
| Max. Negotiated Rate |
$112.63 |
| Rate for Payer: Aetna Commercial |
$112.63
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$101.96
|
| Rate for Payer: Aetna Managed Medicare |
$16.95
|
| Rate for Payer: Anthem Medicare Advantage |
$16.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$16.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$16.95
|
| Rate for Payer: Cash Price |
$34.20
|
| Rate for Payer: Cash Price |
$34.20
|
| Rate for Payer: Cigna Commercial |
$112.63
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$59.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$16.95
|
| Rate for Payer: Health EOS Commercial |
$107.89
|
| Rate for Payer: HFN Commercial |
$112.63
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$59.84
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$59.84
|
| Rate for Payer: Independent Care Health Plan Medicare |
$16.95
|
| Rate for Payer: Multiplan Commercial |
$94.85
|
| Rate for Payer: NAPHCARE Commercial |
$25.43
|
| Rate for Payer: Preferred Network Access Commercial |
$112.63
|
| Rate for Payer: Quartz Beloit One Network |
$52.17
|
| Rate for Payer: Quartz Commercial |
$67.58
|
| Rate for Payer: Quartz Medicare Advantage |
$16.95
|
| Rate for Payer: The Alliance Commercial |
$66.96
|
| Rate for Payer: United Healthcare Medicare Advantage |
$16.95
|
| Rate for Payer: WEA Trust Commercial |
$65.21
|
| Rate for Payer: WPS Commercial |
$74.59
|
|
|
Actigraphy Monitoring
|
Facility
|
OP
|
$631.00
|
|
|
Service Code
|
CPT 95803
|
| Hospital Charge Code |
5518706
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$62.09 |
| Max. Negotiated Rate |
$3,635.84 |
| Rate for Payer: Aetna Commercial |
$590.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$564.37
|
| Rate for Payer: Aetna Managed Medicare |
$62.09
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,635.84
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,985.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,835.04
|
| Rate for Payer: Anthem Medicare Advantage |
$62.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$347.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$62.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$62.09
|
| 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 |
$603.74
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$62.09
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$367.24
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$62.09
|
| Rate for Payer: Health EOS Commercial |
$584.05
|
| Rate for Payer: HFN Commercial |
$603.74
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$230.97
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$62.09
|
| Rate for Payer: Independent Care Health Plan Medicare |
$62.09
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$62.09
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$62.09
|
| Rate for Payer: Multiplan Commercial |
$524.99
|
| Rate for Payer: NAPHCARE Commercial |
$93.13
|
| Rate for Payer: Preferred Network Access Commercial |
$603.74
|
| Rate for Payer: Quartz Beloit One Network |
$321.56
|
| Rate for Payer: Quartz Commercial |
$426.56
|
| Rate for Payer: Quartz Medicare Advantage |
$62.09
|
| Rate for Payer: The Alliance Commercial |
$248.35
|
| Rate for Payer: United Healthcare Medicare Advantage |
$62.09
|
| Rate for Payer: United Healthcare PPO |
$492.18
|
| Rate for Payer: WEA Trust Commercial |
$360.93
|
| Rate for Payer: Wellcare Medicare |
$62.09
|
| Rate for Payer: WPS Commercial |
$486.06
|
|
|
Actigraphy Monitoring
|
Facility
|
IP
|
$631.00
|
|
|
Service Code
|
CPT 95803
|
| Hospital Charge Code |
5518706
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$321.56 |
| Max. Negotiated Rate |
$603.74 |
| Rate for Payer: Aetna Commercial |
$590.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$564.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$347.81
|
| Rate for Payer: Cash Price |
$189.30
|
| Rate for Payer: Cigna Commercial |
$603.74
|
| Rate for Payer: Health EOS Commercial |
$584.05
|
| Rate for Payer: HFN Commercial |
$603.74
|
| Rate for Payer: Multiplan Commercial |
$524.99
|
| Rate for Payer: Preferred Network Access Commercial |
$603.74
|
| Rate for Payer: Quartz Beloit One Network |
$321.56
|
| Rate for Payer: Quartz Commercial |
$393.74
|
| Rate for Payer: WEA Trust Commercial |
$360.93
|
| Rate for Payer: WPS Commercial |
$486.06
|
|
|
Actin (Smooth Muscle) Antibody IgG
|
Professional
|
Both
|
$56.00
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
5030606
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.99 |
| Max. Negotiated Rate |
$55.33 |
| Rate for Payer: Aetna Commercial |
$55.33
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$50.09
|
| Rate for Payer: Aetna Managed Medicare |
$11.99
|
| Rate for Payer: Anthem Medicare Advantage |
$11.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$11.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$11.99
|
| Rate for Payer: Cash Price |
$16.80
|
| Rate for Payer: Cash Price |
$16.80
|
| Rate for Payer: Cigna Commercial |
$55.33
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$29.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$11.99
|
| Rate for Payer: Health EOS Commercial |
$53.00
|
| Rate for Payer: HFN Commercial |
$55.33
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$42.33
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$42.33
|
| Rate for Payer: Independent Care Health Plan Medicare |
$11.99
|
| Rate for Payer: Multiplan Commercial |
$46.59
|
| Rate for Payer: NAPHCARE Commercial |
$17.99
|
| Rate for Payer: Preferred Network Access Commercial |
$55.33
|
| Rate for Payer: Quartz Beloit One Network |
$25.63
|
| Rate for Payer: Quartz Commercial |
$33.20
|
| Rate for Payer: Quartz Medicare Advantage |
$11.99
|
| Rate for Payer: The Alliance Commercial |
$47.37
|
| Rate for Payer: United Healthcare Medicare Advantage |
$11.99
|
| Rate for Payer: WEA Trust Commercial |
$32.03
|
| Rate for Payer: WPS Commercial |
$52.76
|
|
|
Actin (Smooth Muscle) Antibody IgG
|
Facility
|
IP
|
$56.00
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
5030606
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$28.54 |
| Max. Negotiated Rate |
$53.58 |
| Rate for Payer: Aetna Commercial |
$52.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$50.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$30.87
|
| Rate for Payer: Cash Price |
$16.80
|
| Rate for Payer: Cigna Commercial |
$53.58
|
| Rate for Payer: Health EOS Commercial |
$51.83
|
| Rate for Payer: HFN Commercial |
$53.58
|
| Rate for Payer: Multiplan Commercial |
$46.59
|
| Rate for Payer: Preferred Network Access Commercial |
$53.58
|
| Rate for Payer: Quartz Beloit One Network |
$28.54
|
| Rate for Payer: Quartz Commercial |
$34.94
|
| Rate for Payer: WEA Trust Commercial |
$32.03
|
| Rate for Payer: WPS Commercial |
$43.14
|
|
|
Actin (Smooth Muscle) Antibody IgG
|
Facility
|
OP
|
$56.00
|
|
|
Service Code
|
CPT 83516
|
| Hospital Charge Code |
5030606
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.99 |
| Max. Negotiated Rate |
$53.58 |
| Rate for Payer: Aetna Commercial |
$52.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$50.09
|
| Rate for Payer: Aetna Managed Medicare |
$11.99
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$44.97
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$20.98
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$19.91
|
| Rate for Payer: Anthem Medicare Advantage |
$11.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$30.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$11.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$11.99
|
| Rate for Payer: Cash Price |
$16.80
|
| Rate for Payer: Cash Price |
$16.80
|
| Rate for Payer: Cigna Commercial |
$53.58
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$11.99
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$32.59
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$11.99
|
| Rate for Payer: Health EOS Commercial |
$51.83
|
| Rate for Payer: HFN Commercial |
$53.58
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$44.61
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$11.99
|
| Rate for Payer: Independent Care Health Plan Medicare |
$11.99
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$11.99
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$11.99
|
| Rate for Payer: Multiplan Commercial |
$46.59
|
| Rate for Payer: NAPHCARE Commercial |
$17.99
|
| Rate for Payer: Preferred Network Access Commercial |
$53.58
|
| Rate for Payer: Quartz Beloit One Network |
$28.54
|
| Rate for Payer: Quartz Commercial |
$37.86
|
| Rate for Payer: Quartz Medicare Advantage |
$11.99
|
| Rate for Payer: The Alliance Commercial |
$47.96
|
| Rate for Payer: United Healthcare Medicare Advantage |
$11.99
|
| Rate for Payer: United Healthcare PPO |
$43.68
|
| Rate for Payer: WEA Trust Commercial |
$32.03
|
| Rate for Payer: Wellcare Medicare |
$11.99
|
| Rate for Payer: WPS Commercial |
$43.14
|
|
|
Activated Protein C Resistance
|
Facility
|
IP
|
$345.00
|
|
|
Service Code
|
CPT 85307
|
| Hospital Charge Code |
980012
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$175.81 |
| Max. Negotiated Rate |
$330.10 |
| Rate for Payer: Aetna Commercial |
$322.92
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$308.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$190.16
|
| Rate for Payer: Cash Price |
$103.50
|
| Rate for Payer: Cigna Commercial |
$330.10
|
| Rate for Payer: Health EOS Commercial |
$319.33
|
| Rate for Payer: HFN Commercial |
$330.10
|
| Rate for Payer: Multiplan Commercial |
$287.04
|
| Rate for Payer: Preferred Network Access Commercial |
$330.10
|
| Rate for Payer: Quartz Beloit One Network |
$175.81
|
| Rate for Payer: Quartz Commercial |
$215.28
|
| Rate for Payer: WEA Trust Commercial |
$197.34
|
| Rate for Payer: WPS Commercial |
$265.75
|
|
|
Activated Protein C Resistance
|
Facility
|
OP
|
$345.00
|
|
|
Service Code
|
CPT 85307
|
| Hospital Charge Code |
980012
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.93 |
| Max. Negotiated Rate |
$330.10 |
| Rate for Payer: Aetna Commercial |
$322.92
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$308.57
|
| Rate for Payer: Aetna Managed Medicare |
$15.93
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$59.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$27.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$26.45
|
| Rate for Payer: Anthem Medicare Advantage |
$15.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$190.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$15.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$15.93
|
| Rate for Payer: Cash Price |
$103.50
|
| Rate for Payer: Cash Price |
$103.50
|
| Rate for Payer: Cigna Commercial |
$330.10
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$15.93
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$200.79
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$15.93
|
| Rate for Payer: Health EOS Commercial |
$319.33
|
| Rate for Payer: HFN Commercial |
$330.10
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$59.27
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$15.93
|
| Rate for Payer: Independent Care Health Plan Medicare |
$15.93
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$15.93
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$15.93
|
| Rate for Payer: Multiplan Commercial |
$287.04
|
| Rate for Payer: NAPHCARE Commercial |
$23.90
|
| Rate for Payer: Preferred Network Access Commercial |
$330.10
|
| Rate for Payer: Quartz Beloit One Network |
$175.81
|
| Rate for Payer: Quartz Commercial |
$233.22
|
| Rate for Payer: Quartz Medicare Advantage |
$15.93
|
| Rate for Payer: The Alliance Commercial |
$63.73
|
| Rate for Payer: United Healthcare Medicare Advantage |
$15.93
|
| Rate for Payer: United Healthcare PPO |
$269.10
|
| Rate for Payer: WEA Trust Commercial |
$197.34
|
| Rate for Payer: Wellcare Medicare |
$15.93
|
| Rate for Payer: WPS Commercial |
$265.75
|
|
|
Activated Protein C Resistance
|
Facility
|
IP
|
$323.00
|
|
|
Service Code
|
CPT 85307
|
| Hospital Charge Code |
5749633
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$164.60 |
| Max. Negotiated Rate |
$309.05 |
| Rate for Payer: Aetna Commercial |
$302.33
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$288.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$178.04
|
| Rate for Payer: Cash Price |
$96.90
|
| Rate for Payer: Cigna Commercial |
$309.05
|
| Rate for Payer: Health EOS Commercial |
$298.97
|
| Rate for Payer: HFN Commercial |
$309.05
|
| Rate for Payer: Multiplan Commercial |
$268.74
|
| Rate for Payer: Preferred Network Access Commercial |
$309.05
|
| Rate for Payer: Quartz Beloit One Network |
$164.60
|
| Rate for Payer: Quartz Commercial |
$201.55
|
| Rate for Payer: WEA Trust Commercial |
$184.76
|
| Rate for Payer: WPS Commercial |
$248.81
|
|
|
Activated Protein C Resistance
|
Facility
|
OP
|
$323.00
|
|
|
Service Code
|
CPT 85307
|
| Hospital Charge Code |
5749633
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.93 |
| Max. Negotiated Rate |
$309.05 |
| Rate for Payer: Aetna Commercial |
$302.33
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$288.89
|
| Rate for Payer: Aetna Managed Medicare |
$15.93
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$59.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$27.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$26.45
|
| Rate for Payer: Anthem Medicare Advantage |
$15.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$178.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$15.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$15.93
|
| Rate for Payer: Cash Price |
$96.90
|
| Rate for Payer: Cash Price |
$96.90
|
| Rate for Payer: Cigna Commercial |
$309.05
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$15.93
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$187.99
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$15.93
|
| Rate for Payer: Health EOS Commercial |
$298.97
|
| Rate for Payer: HFN Commercial |
$309.05
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$59.27
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$15.93
|
| Rate for Payer: Independent Care Health Plan Medicare |
$15.93
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$15.93
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$15.93
|
| Rate for Payer: Multiplan Commercial |
$268.74
|
| Rate for Payer: NAPHCARE Commercial |
$23.90
|
| Rate for Payer: Preferred Network Access Commercial |
$309.05
|
| Rate for Payer: Quartz Beloit One Network |
$164.60
|
| Rate for Payer: Quartz Commercial |
$218.35
|
| Rate for Payer: Quartz Medicare Advantage |
$15.93
|
| Rate for Payer: The Alliance Commercial |
$63.73
|
| Rate for Payer: United Healthcare Medicare Advantage |
$15.93
|
| Rate for Payer: United Healthcare PPO |
$251.94
|
| Rate for Payer: WEA Trust Commercial |
$184.76
|
| Rate for Payer: Wellcare Medicare |
$15.93
|
| Rate for Payer: WPS Commercial |
$248.81
|
|
|
Activated Protein C Resistance
|
Professional
|
Both
|
$345.00
|
|
|
Service Code
|
CPT 85307
|
| Hospital Charge Code |
980012
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.93 |
| Max. Negotiated Rate |
$340.86 |
| Rate for Payer: Aetna Commercial |
$340.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$308.57
|
| Rate for Payer: Aetna Managed Medicare |
$15.93
|
| Rate for Payer: Anthem Medicare Advantage |
$15.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$15.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$15.93
|
| Rate for Payer: Cash Price |
$103.50
|
| Rate for Payer: Cash Price |
$103.50
|
| Rate for Payer: Cigna Commercial |
$340.86
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$179.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$15.93
|
| Rate for Payer: Health EOS Commercial |
$326.51
|
| Rate for Payer: HFN Commercial |
$340.86
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$56.24
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$56.24
|
| Rate for Payer: Independent Care Health Plan Medicare |
$15.93
|
| Rate for Payer: Multiplan Commercial |
$287.04
|
| Rate for Payer: NAPHCARE Commercial |
$23.90
|
| Rate for Payer: Preferred Network Access Commercial |
$340.86
|
| Rate for Payer: Quartz Beloit One Network |
$157.87
|
| Rate for Payer: Quartz Commercial |
$204.52
|
| Rate for Payer: Quartz Medicare Advantage |
$15.93
|
| Rate for Payer: The Alliance Commercial |
$62.93
|
| Rate for Payer: United Healthcare Medicare Advantage |
$15.93
|
| Rate for Payer: WEA Trust Commercial |
$197.34
|
| Rate for Payer: WPS Commercial |
$70.10
|
|
|
Activated Protein C Resistance
|
Professional
|
Both
|
$323.00
|
|
|
Service Code
|
CPT 85307
|
| Hospital Charge Code |
5749633
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.93 |
| Max. Negotiated Rate |
$319.12 |
| Rate for Payer: Aetna Commercial |
$319.12
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$288.89
|
| Rate for Payer: Aetna Managed Medicare |
$15.93
|
| Rate for Payer: Anthem Medicare Advantage |
$15.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$15.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$15.93
|
| Rate for Payer: Cash Price |
$96.90
|
| Rate for Payer: Cash Price |
$96.90
|
| Rate for Payer: Cigna Commercial |
$319.12
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$167.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$15.93
|
| Rate for Payer: Health EOS Commercial |
$305.69
|
| Rate for Payer: HFN Commercial |
$319.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$56.24
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$56.24
|
| Rate for Payer: Independent Care Health Plan Medicare |
$15.93
|
| Rate for Payer: Multiplan Commercial |
$268.74
|
| Rate for Payer: NAPHCARE Commercial |
$23.90
|
| Rate for Payer: Preferred Network Access Commercial |
$319.12
|
| Rate for Payer: Quartz Beloit One Network |
$147.80
|
| Rate for Payer: Quartz Commercial |
$191.47
|
| Rate for Payer: Quartz Medicare Advantage |
$15.93
|
| Rate for Payer: The Alliance Commercial |
$62.93
|
| Rate for Payer: United Healthcare Medicare Advantage |
$15.93
|
| Rate for Payer: WEA Trust Commercial |
$184.76
|
| Rate for Payer: WPS Commercial |
$70.10
|
|
|
ACTIVATION TOOL S0457-000
|
Facility
|
IP
|
$1,553.00
|
|
| Hospital Charge Code |
6232145
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$791.41 |
| Max. Negotiated Rate |
$1,485.91 |
| Rate for Payer: Aetna Commercial |
$1,453.61
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,389.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$856.01
|
| Rate for Payer: Cash Price |
$465.90
|
| Rate for Payer: Cigna Commercial |
$1,485.91
|
| Rate for Payer: Health EOS Commercial |
$1,437.46
|
| Rate for Payer: HFN Commercial |
$1,485.91
|
| Rate for Payer: Multiplan Commercial |
$1,292.10
|
| Rate for Payer: Preferred Network Access Commercial |
$1,485.91
|
| Rate for Payer: Quartz Beloit One Network |
$791.41
|
| Rate for Payer: Quartz Commercial |
$969.07
|
| Rate for Payer: WEA Trust Commercial |
$888.32
|
| Rate for Payer: WPS Commercial |
$1,196.28
|
|
|
ACTIVATION TOOL S0457-000
|
Facility
|
OP
|
$1,553.00
|
|
| Hospital Charge Code |
6232145
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$452.23 |
| Max. Negotiated Rate |
$1,485.91 |
| Rate for Payer: Aetna Commercial |
$1,453.61
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,389.00
|
| Rate for Payer: Aetna Managed Medicare |
$452.23
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,049.83
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$807.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$775.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$856.01
|
| Rate for Payer: Cash Price |
$465.90
|
| Rate for Payer: Cigna Commercial |
$1,485.91
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$903.85
|
| Rate for Payer: Health EOS Commercial |
$1,437.46
|
| Rate for Payer: HFN Commercial |
$1,485.91
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,211.34
|
| Rate for Payer: Multiplan Commercial |
$1,292.10
|
| Rate for Payer: NAPHCARE Commercial |
$969.07
|
| Rate for Payer: Preferred Network Access Commercial |
$1,485.91
|
| Rate for Payer: Quartz Beloit One Network |
$791.41
|
| Rate for Payer: Quartz Commercial |
$1,049.83
|
| Rate for Payer: Quartz Medicare Advantage |
$969.07
|
| Rate for Payer: The Alliance Commercial |
$807.56
|
| Rate for Payer: WEA Trust Commercial |
$888.32
|
| Rate for Payer: WPS Commercial |
$1,196.28
|
|
|
ACT Testing
|
Facility
|
IP
|
$153.00
|
|
|
Service Code
|
CPT 85347
|
| Hospital Charge Code |
3052459
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$77.97 |
| Max. Negotiated Rate |
$146.39 |
| Rate for Payer: Aetna Commercial |
$143.21
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$136.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$84.33
|
| Rate for Payer: Cash Price |
$45.90
|
| Rate for Payer: Cigna Commercial |
$146.39
|
| Rate for Payer: Health EOS Commercial |
$141.62
|
| Rate for Payer: HFN Commercial |
$146.39
|
| Rate for Payer: Multiplan Commercial |
$127.30
|
| Rate for Payer: Preferred Network Access Commercial |
$146.39
|
| Rate for Payer: Quartz Beloit One Network |
$77.97
|
| Rate for Payer: Quartz Commercial |
$95.47
|
| Rate for Payer: WEA Trust Commercial |
$87.52
|
| Rate for Payer: WPS Commercial |
$117.86
|
|
|
ACT Testing
|
Facility
|
OP
|
$153.00
|
|
|
Service Code
|
CPT 85347
|
| Hospital Charge Code |
3052459
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.45 |
| Max. Negotiated Rate |
$146.39 |
| Rate for Payer: Aetna Commercial |
$143.21
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$136.84
|
| Rate for Payer: Aetna Managed Medicare |
$4.45
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$16.69
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$7.79
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7.39
|
| Rate for Payer: Anthem Medicare Advantage |
$4.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$84.33
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$4.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$4.45
|
| Rate for Payer: Cash Price |
$45.90
|
| Rate for Payer: Cash Price |
$45.90
|
| Rate for Payer: Cigna Commercial |
$146.39
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$4.45
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$89.05
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$4.45
|
| Rate for Payer: Health EOS Commercial |
$141.62
|
| Rate for Payer: HFN Commercial |
$146.39
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$16.56
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$4.45
|
| Rate for Payer: Independent Care Health Plan Medicare |
$4.45
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$4.45
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$4.45
|
| Rate for Payer: Multiplan Commercial |
$127.30
|
| Rate for Payer: NAPHCARE Commercial |
$6.68
|
| Rate for Payer: Preferred Network Access Commercial |
$146.39
|
| Rate for Payer: Quartz Beloit One Network |
$77.97
|
| Rate for Payer: Quartz Commercial |
$103.43
|
| Rate for Payer: Quartz Medicare Advantage |
$4.45
|
| Rate for Payer: The Alliance Commercial |
$17.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4.45
|
| Rate for Payer: United Healthcare PPO |
$119.34
|
| Rate for Payer: WEA Trust Commercial |
$87.52
|
| Rate for Payer: Wellcare Medicare |
$4.45
|
| Rate for Payer: WPS Commercial |
$117.86
|
|
