|
AIRWAY NASOPHARYNGEAL 19 FR
|
Facility
IP
|
$101.00
|
|
| Hospital Charge Code |
2963756
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$49.49 |
| Max. Negotiated Rate |
$92.92 |
| Rate for Payer: Aetna Commercial |
$90.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$53.53
|
| Rate for Payer: Cash Price |
$30.30
|
| Rate for Payer: Cigna Commercial |
$92.92
|
| Rate for Payer: Health EOS Commercial |
$89.89
|
| Rate for Payer: HFN Commercial |
$92.92
|
| Rate for Payer: Multiplan Commercial |
$80.80
|
| Rate for Payer: NAPHCARE Commercial |
$60.60
|
| Rate for Payer: Preferred Network Access Commercial |
$92.92
|
| Rate for Payer: Quartz Beloit One Network |
$49.49
|
| Rate for Payer: Quartz Commercial |
$60.60
|
| Rate for Payer: WEA Trust Commercial |
$55.55
|
| Rate for Payer: WPS Commercial |
$74.81
|
|
|
AIRWAY NASOPHARYNGEAL 19 FR
|
Facility
OP
|
$101.00
|
|
| Hospital Charge Code |
2963756
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$28.28 |
| Max. Negotiated Rate |
$404.00 |
| Rate for Payer: Aetna Commercial |
$90.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$86.86
|
| Rate for Payer: Aetna Managed Medicare |
$28.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$65.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$50.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$48.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$53.53
|
| Rate for Payer: Cash Price |
$30.30
|
| Rate for Payer: Cigna Commercial |
$92.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$56.52
|
| Rate for Payer: Health EOS Commercial |
$89.89
|
| Rate for Payer: HFN Commercial |
$92.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$75.75
|
| Rate for Payer: Multiplan Commercial |
$80.80
|
| Rate for Payer: NAPHCARE Commercial |
$60.60
|
| Rate for Payer: Preferred Network Access Commercial |
$92.92
|
| Rate for Payer: Quartz Beloit One Network |
$49.49
|
| Rate for Payer: Quartz Commercial |
$65.65
|
| Rate for Payer: Quartz Medicare Advantage |
$60.60
|
| Rate for Payer: The Alliance Commercial |
$404.00
|
| Rate for Payer: WEA Trust Commercial |
$55.55
|
| Rate for Payer: WPS Commercial |
$74.81
|
|
|
AIRWAY NASOPHARYNGEAL 20FR
|
Facility
OP
|
$101.00
|
|
| Hospital Charge Code |
2969237
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$28.28 |
| Max. Negotiated Rate |
$404.00 |
| Rate for Payer: Aetna Commercial |
$90.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$86.86
|
| Rate for Payer: Aetna Managed Medicare |
$28.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$65.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$50.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$48.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$53.53
|
| Rate for Payer: Cash Price |
$30.30
|
| Rate for Payer: Cigna Commercial |
$92.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$56.52
|
| Rate for Payer: Health EOS Commercial |
$89.89
|
| Rate for Payer: HFN Commercial |
$92.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$75.75
|
| Rate for Payer: Multiplan Commercial |
$80.80
|
| Rate for Payer: NAPHCARE Commercial |
$60.60
|
| Rate for Payer: Preferred Network Access Commercial |
$92.92
|
| Rate for Payer: Quartz Beloit One Network |
$49.49
|
| Rate for Payer: Quartz Commercial |
$65.65
|
| Rate for Payer: Quartz Medicare Advantage |
$60.60
|
| Rate for Payer: The Alliance Commercial |
$404.00
|
| Rate for Payer: WEA Trust Commercial |
$55.55
|
| Rate for Payer: WPS Commercial |
$74.81
|
|
|
AIRWAY NASOPHARYNGEAL 20FR
|
Facility
IP
|
$101.00
|
|
| Hospital Charge Code |
2969237
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$49.49 |
| Max. Negotiated Rate |
$92.92 |
| Rate for Payer: Aetna Commercial |
$90.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$53.53
|
| Rate for Payer: Cash Price |
$30.30
|
| Rate for Payer: Cigna Commercial |
$92.92
|
| Rate for Payer: Health EOS Commercial |
$89.89
|
| Rate for Payer: HFN Commercial |
$92.92
|
| Rate for Payer: Multiplan Commercial |
$80.80
|
| Rate for Payer: NAPHCARE Commercial |
$60.60
|
| Rate for Payer: Preferred Network Access Commercial |
$92.92
|
| Rate for Payer: Quartz Beloit One Network |
$49.49
|
| Rate for Payer: Quartz Commercial |
$60.60
|
| Rate for Payer: WEA Trust Commercial |
$55.55
|
| Rate for Payer: WPS Commercial |
$74.81
|
|
|
AIRWAY NASOPHARYNGEAL 24 FR
|
Facility
OP
|
$101.00
|
|
| Hospital Charge Code |
2969208
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$28.28 |
| Max. Negotiated Rate |
$404.00 |
| Rate for Payer: Aetna Commercial |
$90.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$86.86
|
| Rate for Payer: Aetna Managed Medicare |
$28.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$65.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$50.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$48.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$53.53
|
| Rate for Payer: Cash Price |
$30.30
|
| Rate for Payer: Cigna Commercial |
$92.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$56.52
|
| Rate for Payer: Health EOS Commercial |
$89.89
|
| Rate for Payer: HFN Commercial |
$92.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$75.75
|
| Rate for Payer: Multiplan Commercial |
$80.80
|
| Rate for Payer: NAPHCARE Commercial |
$60.60
|
| Rate for Payer: Preferred Network Access Commercial |
$92.92
|
| Rate for Payer: Quartz Beloit One Network |
$49.49
|
| Rate for Payer: Quartz Commercial |
$65.65
|
| Rate for Payer: Quartz Medicare Advantage |
$60.60
|
| Rate for Payer: The Alliance Commercial |
$404.00
|
| Rate for Payer: WEA Trust Commercial |
$55.55
|
| Rate for Payer: WPS Commercial |
$74.81
|
|
|
AIRWAY NASOPHARYNGEAL 24 FR
|
Facility
IP
|
$101.00
|
|
| Hospital Charge Code |
2969208
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$49.49 |
| Max. Negotiated Rate |
$92.92 |
| Rate for Payer: Aetna Commercial |
$90.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$53.53
|
| Rate for Payer: Cash Price |
$30.30
|
| Rate for Payer: Cigna Commercial |
$92.92
|
| Rate for Payer: Health EOS Commercial |
$89.89
|
| Rate for Payer: HFN Commercial |
$92.92
|
| Rate for Payer: Multiplan Commercial |
$80.80
|
| Rate for Payer: NAPHCARE Commercial |
$60.60
|
| Rate for Payer: Preferred Network Access Commercial |
$92.92
|
| Rate for Payer: Quartz Beloit One Network |
$49.49
|
| Rate for Payer: Quartz Commercial |
$60.60
|
| Rate for Payer: WEA Trust Commercial |
$55.55
|
| Rate for Payer: WPS Commercial |
$74.81
|
|
|
Airway Resistance - Pulmonary Function Test Charge
|
Facility
IP
|
$977.00
|
|
|
Service Code
|
CPT 94726
|
| Hospital Charge Code |
3007000
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$478.73 |
| Max. Negotiated Rate |
$898.84 |
| Rate for Payer: Aetna Commercial |
$879.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$517.81
|
| Rate for Payer: Cash Price |
$293.10
|
| Rate for Payer: Cigna Commercial |
$898.84
|
| Rate for Payer: Health EOS Commercial |
$869.53
|
| Rate for Payer: HFN Commercial |
$898.84
|
| Rate for Payer: Multiplan Commercial |
$781.60
|
| Rate for Payer: NAPHCARE Commercial |
$586.20
|
| Rate for Payer: Preferred Network Access Commercial |
$898.84
|
| Rate for Payer: Quartz Beloit One Network |
$478.73
|
| Rate for Payer: Quartz Commercial |
$586.20
|
| Rate for Payer: WEA Trust Commercial |
$537.35
|
| Rate for Payer: WPS Commercial |
$723.66
|
|
|
Airway Resistance - Pulmonary Function Test Charge
|
Facility
OP
|
$977.00
|
|
|
Service Code
|
CPT 94726
|
| Hospital Charge Code |
3007000
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$310.24 |
| Max. Negotiated Rate |
$1,154.09 |
| Rate for Payer: Aetna Commercial |
$879.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$840.22
|
| Rate for Payer: Aetna Managed Medicare |
$310.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$635.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$488.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$468.96
|
| Rate for Payer: Anthem Medicare Advantage |
$310.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$517.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$310.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$310.24
|
| Rate for Payer: Cash Price |
$293.10
|
| Rate for Payer: Cash Price |
$293.10
|
| Rate for Payer: Cigna Commercial |
$898.84
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$310.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$546.73
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$310.24
|
| Rate for Payer: Health EOS Commercial |
$869.53
|
| Rate for Payer: HFN Commercial |
$898.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,154.09
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$310.24
|
| Rate for Payer: Independent Care Health Plan Medicare |
$310.24
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$310.24
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$310.24
|
| Rate for Payer: Multiplan Commercial |
$781.60
|
| Rate for Payer: NAPHCARE Commercial |
$465.36
|
| Rate for Payer: Preferred Network Access Commercial |
$898.84
|
| Rate for Payer: Quartz Beloit One Network |
$478.73
|
| Rate for Payer: Quartz Commercial |
$635.05
|
| Rate for Payer: Quartz Medicare Advantage |
$310.24
|
| Rate for Payer: United Healthcare Medicare Advantage |
$310.24
|
| Rate for Payer: United Healthcare PPO |
$732.75
|
| Rate for Payer: WEA Trust Commercial |
$537.35
|
| Rate for Payer: Wellcare Medicare |
$310.24
|
| Rate for Payer: WPS Commercial |
$723.66
|
|
|
Alanine Aminotransferase
|
Facility
IP
|
$86.00
|
|
|
Service Code
|
CPT 84460
|
| Hospital Charge Code |
633632
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$42.14 |
| Max. Negotiated Rate |
$79.12 |
| Rate for Payer: Aetna Commercial |
$77.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$45.58
|
| Rate for Payer: Cash Price |
$25.80
|
| Rate for Payer: Cigna Commercial |
$79.12
|
| Rate for Payer: Health EOS Commercial |
$76.54
|
| Rate for Payer: HFN Commercial |
$79.12
|
| Rate for Payer: Multiplan Commercial |
$68.80
|
| Rate for Payer: NAPHCARE Commercial |
$51.60
|
| Rate for Payer: Preferred Network Access Commercial |
$79.12
|
| Rate for Payer: Quartz Beloit One Network |
$42.14
|
| Rate for Payer: Quartz Commercial |
$51.60
|
| Rate for Payer: WEA Trust Commercial |
$47.30
|
| Rate for Payer: WPS Commercial |
$63.70
|
|
|
Alanine Aminotransferase
|
Professional
|
$86.00
|
|
|
Service Code
|
CPT 84460
|
| Hospital Charge Code |
633632
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.30 |
| Max. Negotiated Rate |
$81.70 |
| Rate for Payer: Aetna Commercial |
$81.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$73.96
|
| Rate for Payer: Aetna Managed Medicare |
$5.30
|
| Rate for Payer: Anthem Medicare Advantage |
$5.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5.30
|
| Rate for Payer: Cash Price |
$25.80
|
| Rate for Payer: Cash Price |
$25.80
|
| Rate for Payer: Cigna Commercial |
$81.70
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$43.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5.30
|
| Rate for Payer: Health EOS Commercial |
$78.26
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$18.71
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$18.71
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5.30
|
| Rate for Payer: Multiplan Commercial |
$68.80
|
| Rate for Payer: Preferred Network Access Commercial |
$81.70
|
| Rate for Payer: Quartz Beloit One Network |
$37.84
|
| Rate for Payer: Quartz Commercial |
$49.02
|
| Rate for Payer: Quartz Medicare Advantage |
$5.30
|
| Rate for Payer: The Alliance Commercial |
$20.94
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.30
|
| Rate for Payer: WEA Trust Commercial |
$47.30
|
| Rate for Payer: WPS Commercial |
$23.32
|
|
|
Alanine Aminotransferase
|
Facility
OP
|
$86.00
|
|
|
Service Code
|
CPT 84460
|
| Hospital Charge Code |
633632
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.30 |
| Max. Negotiated Rate |
$344.00 |
| Rate for Payer: Aetna Commercial |
$77.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$73.96
|
| Rate for Payer: Aetna Managed Medicare |
$5.30
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$19.88
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$9.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$8.80
|
| Rate for Payer: Anthem Medicaid |
$5.48
|
| Rate for Payer: Anthem Medicare Advantage |
$5.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$45.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5.30
|
| Rate for Payer: Cash Price |
$25.80
|
| Rate for Payer: Cash Price |
$25.80
|
| Rate for Payer: Cigna Commercial |
$79.12
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$5.30
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$5.48
|
| Rate for Payer: Dean Health Medicaid |
$5.48
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$5.30
|
| Rate for Payer: Health EOS Commercial |
$76.54
|
| Rate for Payer: HFN Commercial |
$79.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$19.72
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$5.30
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$5.48
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5.30
|
| Rate for Payer: Managed Health Services Medicaid |
$5.70
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$5.30
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$5.30
|
| Rate for Payer: Multiplan Commercial |
$68.80
|
| Rate for Payer: NAPHCARE Commercial |
$7.95
|
| Rate for Payer: Preferred Network Access Commercial |
$79.12
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$5.48
|
| Rate for Payer: Quartz Beloit One Network |
$42.14
|
| Rate for Payer: Quartz Commercial |
$55.90
|
| Rate for Payer: Quartz Medicare Advantage |
$5.30
|
| Rate for Payer: The Alliance Commercial |
$344.00
|
| Rate for Payer: United Healthcare Medicaid |
$5.48
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.30
|
| Rate for Payer: United Healthcare PPO |
$64.50
|
| Rate for Payer: WEA Trust Commercial |
$47.30
|
| Rate for Payer: Wellcare Medicare |
$5.30
|
| Rate for Payer: WMAP Medicaid |
$5.48
|
| Rate for Payer: WPS Commercial |
$63.70
|
|
|
Albumin
|
Facility
IP
|
$55.00
|
|
|
Service Code
|
CPT 82040
|
| Hospital Charge Code |
4109309
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$26.95 |
| Max. Negotiated Rate |
$50.60 |
| Rate for Payer: Aetna Commercial |
$49.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$29.15
|
| Rate for Payer: Cash Price |
$16.50
|
| Rate for Payer: Cigna Commercial |
$50.60
|
| Rate for Payer: Health EOS Commercial |
$48.95
|
| Rate for Payer: HFN Commercial |
$50.60
|
| Rate for Payer: Multiplan Commercial |
$44.00
|
| Rate for Payer: NAPHCARE Commercial |
$33.00
|
| Rate for Payer: Preferred Network Access Commercial |
$50.60
|
| Rate for Payer: Quartz Beloit One Network |
$26.95
|
| Rate for Payer: Quartz Commercial |
$33.00
|
| Rate for Payer: WEA Trust Commercial |
$30.25
|
| Rate for Payer: WPS Commercial |
$40.74
|
|
|
Albumin
|
Professional
|
$55.00
|
|
|
Service Code
|
CPT 82040
|
| Hospital Charge Code |
4109309
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.95 |
| Max. Negotiated Rate |
$52.25 |
| Rate for Payer: Aetna Commercial |
$52.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$47.30
|
| Rate for Payer: Aetna Managed Medicare |
$4.95
|
| Rate for Payer: Anthem Medicare Advantage |
$4.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$4.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$4.95
|
| Rate for Payer: Cash Price |
$16.50
|
| Rate for Payer: Cash Price |
$16.50
|
| Rate for Payer: Cigna Commercial |
$52.25
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$27.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4.95
|
| Rate for Payer: Health EOS Commercial |
$50.05
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$17.47
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$17.47
|
| Rate for Payer: Independent Care Health Plan Medicare |
$4.95
|
| Rate for Payer: Multiplan Commercial |
$44.00
|
| Rate for Payer: Preferred Network Access Commercial |
$52.25
|
| Rate for Payer: Quartz Beloit One Network |
$24.20
|
| Rate for Payer: Quartz Commercial |
$31.35
|
| Rate for Payer: Quartz Medicare Advantage |
$4.95
|
| Rate for Payer: The Alliance Commercial |
$19.55
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4.95
|
| Rate for Payer: WEA Trust Commercial |
$30.25
|
| Rate for Payer: WPS Commercial |
$21.78
|
|
|
Albumin
|
Professional
|
$49.00
|
|
|
Service Code
|
CPT 82040
|
| Hospital Charge Code |
2943015
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.95 |
| Max. Negotiated Rate |
$46.55 |
| Rate for Payer: Aetna Commercial |
$46.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$42.14
|
| Rate for Payer: Aetna Managed Medicare |
$4.95
|
| Rate for Payer: Anthem Medicare Advantage |
$4.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$4.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$4.95
|
| Rate for Payer: Cash Price |
$14.70
|
| Rate for Payer: Cash Price |
$14.70
|
| Rate for Payer: Cigna Commercial |
$46.55
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$24.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4.95
|
| Rate for Payer: Health EOS Commercial |
$44.59
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$17.47
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$17.47
|
| Rate for Payer: Independent Care Health Plan Medicare |
$4.95
|
| Rate for Payer: Multiplan Commercial |
$39.20
|
| Rate for Payer: Preferred Network Access Commercial |
$46.55
|
| Rate for Payer: Quartz Beloit One Network |
$21.56
|
| Rate for Payer: Quartz Commercial |
$27.93
|
| Rate for Payer: Quartz Medicare Advantage |
$4.95
|
| Rate for Payer: The Alliance Commercial |
$19.55
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4.95
|
| Rate for Payer: WEA Trust Commercial |
$26.95
|
| Rate for Payer: WPS Commercial |
$21.78
|
|
|
Albumin
|
Facility
IP
|
$55.00
|
|
|
Service Code
|
CPT 82040
|
| Hospital Charge Code |
2959004
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$26.95 |
| Max. Negotiated Rate |
$50.60 |
| Rate for Payer: Aetna Commercial |
$49.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$29.15
|
| Rate for Payer: Cash Price |
$16.50
|
| Rate for Payer: Cigna Commercial |
$50.60
|
| Rate for Payer: Health EOS Commercial |
$48.95
|
| Rate for Payer: HFN Commercial |
$50.60
|
| Rate for Payer: Multiplan Commercial |
$44.00
|
| Rate for Payer: NAPHCARE Commercial |
$33.00
|
| Rate for Payer: Preferred Network Access Commercial |
$50.60
|
| Rate for Payer: Quartz Beloit One Network |
$26.95
|
| Rate for Payer: Quartz Commercial |
$33.00
|
| Rate for Payer: WEA Trust Commercial |
$30.25
|
| Rate for Payer: WPS Commercial |
$40.74
|
|
|
Albumin
|
Facility
IP
|
$49.00
|
|
|
Service Code
|
CPT 82040
|
| Hospital Charge Code |
2943015
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$24.01 |
| Max. Negotiated Rate |
$45.08 |
| Rate for Payer: Aetna Commercial |
$44.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$25.97
|
| Rate for Payer: Cash Price |
$14.70
|
| Rate for Payer: Cigna Commercial |
$45.08
|
| Rate for Payer: Health EOS Commercial |
$43.61
|
| Rate for Payer: HFN Commercial |
$45.08
|
| Rate for Payer: Multiplan Commercial |
$39.20
|
| Rate for Payer: NAPHCARE Commercial |
$29.40
|
| Rate for Payer: Preferred Network Access Commercial |
$45.08
|
| Rate for Payer: Quartz Beloit One Network |
$24.01
|
| Rate for Payer: Quartz Commercial |
$29.40
|
| Rate for Payer: WEA Trust Commercial |
$26.95
|
| Rate for Payer: WPS Commercial |
$36.29
|
|
|
Albumin
|
Facility
OP
|
$55.00
|
|
|
Service Code
|
CPT 82040
|
| Hospital Charge Code |
4109309
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.95 |
| Max. Negotiated Rate |
$220.00 |
| Rate for Payer: Aetna Commercial |
$49.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$47.30
|
| Rate for Payer: Aetna Managed Medicare |
$4.95
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$18.56
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8.66
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$8.22
|
| Rate for Payer: Anthem Medicaid |
$5.11
|
| Rate for Payer: Anthem Medicare Advantage |
$4.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$29.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$4.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$4.95
|
| Rate for Payer: Cash Price |
$16.50
|
| Rate for Payer: Cash Price |
$16.50
|
| Rate for Payer: Cigna Commercial |
$50.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$4.95
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$5.11
|
| Rate for Payer: Dean Health Medicaid |
$5.11
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$4.95
|
| Rate for Payer: Health EOS Commercial |
$48.95
|
| Rate for Payer: HFN Commercial |
$50.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$18.41
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$4.95
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$5.11
|
| Rate for Payer: Independent Care Health Plan Medicare |
$4.95
|
| Rate for Payer: Managed Health Services Medicaid |
$5.31
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$4.95
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$4.95
|
| Rate for Payer: Multiplan Commercial |
$44.00
|
| Rate for Payer: NAPHCARE Commercial |
$7.42
|
| Rate for Payer: Preferred Network Access Commercial |
$50.60
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$5.11
|
| Rate for Payer: Quartz Beloit One Network |
$26.95
|
| Rate for Payer: Quartz Commercial |
$35.75
|
| Rate for Payer: Quartz Medicare Advantage |
$4.95
|
| Rate for Payer: The Alliance Commercial |
$220.00
|
| Rate for Payer: United Healthcare Medicaid |
$5.11
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4.95
|
| Rate for Payer: United Healthcare PPO |
$41.25
|
| Rate for Payer: WEA Trust Commercial |
$30.25
|
| Rate for Payer: Wellcare Medicare |
$4.95
|
| Rate for Payer: WMAP Medicaid |
$5.11
|
| Rate for Payer: WPS Commercial |
$40.74
|
|
|
Albumin
|
Facility
OP
|
$49.00
|
|
|
Service Code
|
CPT 82040
|
| Hospital Charge Code |
2943015
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.95 |
| Max. Negotiated Rate |
$196.00 |
| Rate for Payer: Aetna Commercial |
$44.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$42.14
|
| Rate for Payer: Aetna Managed Medicare |
$4.95
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$18.56
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8.66
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$8.22
|
| Rate for Payer: Anthem Medicaid |
$5.11
|
| Rate for Payer: Anthem Medicare Advantage |
$4.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$25.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$4.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$4.95
|
| Rate for Payer: Cash Price |
$14.70
|
| Rate for Payer: Cash Price |
$14.70
|
| Rate for Payer: Cigna Commercial |
$45.08
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$4.95
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$5.11
|
| Rate for Payer: Dean Health Medicaid |
$5.11
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$4.95
|
| Rate for Payer: Health EOS Commercial |
$43.61
|
| Rate for Payer: HFN Commercial |
$45.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$18.41
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$4.95
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$5.11
|
| Rate for Payer: Independent Care Health Plan Medicare |
$4.95
|
| Rate for Payer: Managed Health Services Medicaid |
$5.31
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$4.95
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$4.95
|
| Rate for Payer: Multiplan Commercial |
$39.20
|
| Rate for Payer: NAPHCARE Commercial |
$7.42
|
| Rate for Payer: Preferred Network Access Commercial |
$45.08
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$5.11
|
| Rate for Payer: Quartz Beloit One Network |
$24.01
|
| Rate for Payer: Quartz Commercial |
$31.85
|
| Rate for Payer: Quartz Medicare Advantage |
$4.95
|
| Rate for Payer: The Alliance Commercial |
$196.00
|
| Rate for Payer: United Healthcare Medicaid |
$5.11
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4.95
|
| Rate for Payer: United Healthcare PPO |
$36.75
|
| Rate for Payer: WEA Trust Commercial |
$26.95
|
| Rate for Payer: Wellcare Medicare |
$4.95
|
| Rate for Payer: WMAP Medicaid |
$5.11
|
| Rate for Payer: WPS Commercial |
$36.29
|
|
|
Albumin
|
Professional
|
$55.00
|
|
|
Service Code
|
CPT 82040
|
| Hospital Charge Code |
2959004
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.95 |
| Max. Negotiated Rate |
$52.25 |
| Rate for Payer: Aetna Commercial |
$52.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$47.30
|
| Rate for Payer: Aetna Managed Medicare |
$4.95
|
| Rate for Payer: Anthem Medicare Advantage |
$4.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$4.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$4.95
|
| Rate for Payer: Cash Price |
$16.50
|
| Rate for Payer: Cash Price |
$16.50
|
| Rate for Payer: Cigna Commercial |
$52.25
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$27.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4.95
|
| Rate for Payer: Health EOS Commercial |
$50.05
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$17.47
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$17.47
|
| Rate for Payer: Independent Care Health Plan Medicare |
$4.95
|
| Rate for Payer: Multiplan Commercial |
$44.00
|
| Rate for Payer: Preferred Network Access Commercial |
$52.25
|
| Rate for Payer: Quartz Beloit One Network |
$24.20
|
| Rate for Payer: Quartz Commercial |
$31.35
|
| Rate for Payer: Quartz Medicare Advantage |
$4.95
|
| Rate for Payer: The Alliance Commercial |
$19.55
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4.95
|
| Rate for Payer: WEA Trust Commercial |
$30.25
|
| Rate for Payer: WPS Commercial |
$21.78
|
|
|
Albumin
|
Facility
OP
|
$55.00
|
|
|
Service Code
|
CPT 82040
|
| Hospital Charge Code |
2959004
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.95 |
| Max. Negotiated Rate |
$220.00 |
| Rate for Payer: Aetna Commercial |
$49.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$47.30
|
| Rate for Payer: Aetna Managed Medicare |
$4.95
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$18.56
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8.66
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$8.22
|
| Rate for Payer: Anthem Medicaid |
$5.11
|
| Rate for Payer: Anthem Medicare Advantage |
$4.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$29.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$4.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$4.95
|
| Rate for Payer: Cash Price |
$16.50
|
| Rate for Payer: Cash Price |
$16.50
|
| Rate for Payer: Cigna Commercial |
$50.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$4.95
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$5.11
|
| Rate for Payer: Dean Health Medicaid |
$5.11
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$4.95
|
| Rate for Payer: Health EOS Commercial |
$48.95
|
| Rate for Payer: HFN Commercial |
$50.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$18.41
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$4.95
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$5.11
|
| Rate for Payer: Independent Care Health Plan Medicare |
$4.95
|
| Rate for Payer: Managed Health Services Medicaid |
$5.31
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$4.95
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$4.95
|
| Rate for Payer: Multiplan Commercial |
$44.00
|
| Rate for Payer: NAPHCARE Commercial |
$7.42
|
| Rate for Payer: Preferred Network Access Commercial |
$50.60
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$5.11
|
| Rate for Payer: Quartz Beloit One Network |
$26.95
|
| Rate for Payer: Quartz Commercial |
$35.75
|
| Rate for Payer: Quartz Medicare Advantage |
$4.95
|
| Rate for Payer: The Alliance Commercial |
$220.00
|
| Rate for Payer: United Healthcare Medicaid |
$5.11
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4.95
|
| Rate for Payer: United Healthcare PPO |
$41.25
|
| Rate for Payer: WEA Trust Commercial |
$30.25
|
| Rate for Payer: Wellcare Medicare |
$4.95
|
| Rate for Payer: WMAP Medicaid |
$5.11
|
| Rate for Payer: WPS Commercial |
$40.74
|
|
|
Albumin (FS)
|
Facility
OP
|
$8.00
|
|
|
Service Code
|
CPT 82040
|
| Hospital Charge Code |
4538809
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.92 |
| Max. Negotiated Rate |
$32.00 |
| Rate for Payer: Aetna Commercial |
$7.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6.88
|
| Rate for Payer: Aetna Managed Medicare |
$4.95
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$18.56
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8.66
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$8.22
|
| Rate for Payer: Anthem Medicaid |
$5.11
|
| Rate for Payer: Anthem Medicare Advantage |
$4.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$4.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$4.95
|
| Rate for Payer: Cash Price |
$2.40
|
| Rate for Payer: Cash Price |
$2.40
|
| Rate for Payer: Cigna Commercial |
$7.36
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$4.95
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$5.11
|
| Rate for Payer: Dean Health Medicaid |
$5.11
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$4.95
|
| Rate for Payer: Health EOS Commercial |
$7.12
|
| Rate for Payer: HFN Commercial |
$7.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$18.41
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$4.95
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$5.11
|
| Rate for Payer: Independent Care Health Plan Medicare |
$4.95
|
| Rate for Payer: Managed Health Services Medicaid |
$5.31
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$4.95
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$4.95
|
| Rate for Payer: Multiplan Commercial |
$6.40
|
| Rate for Payer: NAPHCARE Commercial |
$7.42
|
| Rate for Payer: Preferred Network Access Commercial |
$7.36
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$5.11
|
| Rate for Payer: Quartz Beloit One Network |
$3.92
|
| Rate for Payer: Quartz Commercial |
$5.20
|
| Rate for Payer: Quartz Medicare Advantage |
$4.95
|
| Rate for Payer: The Alliance Commercial |
$32.00
|
| Rate for Payer: United Healthcare Medicaid |
$5.11
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4.95
|
| Rate for Payer: United Healthcare PPO |
$6.00
|
| Rate for Payer: WEA Trust Commercial |
$4.40
|
| Rate for Payer: Wellcare Medicare |
$4.95
|
| Rate for Payer: WMAP Medicaid |
$5.11
|
| Rate for Payer: WPS Commercial |
$5.93
|
|
|
Albumin (FS)
|
Facility
IP
|
$8.00
|
|
|
Service Code
|
CPT 82040
|
| Hospital Charge Code |
4538809
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.92 |
| Max. Negotiated Rate |
$7.36 |
| Rate for Payer: Aetna Commercial |
$7.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4.24
|
| Rate for Payer: Cash Price |
$2.40
|
| Rate for Payer: Cigna Commercial |
$7.36
|
| Rate for Payer: Health EOS Commercial |
$7.12
|
| Rate for Payer: HFN Commercial |
$7.36
|
| Rate for Payer: Multiplan Commercial |
$6.40
|
| Rate for Payer: NAPHCARE Commercial |
$4.80
|
| Rate for Payer: Preferred Network Access Commercial |
$7.36
|
| Rate for Payer: Quartz Beloit One Network |
$3.92
|
| Rate for Payer: Quartz Commercial |
$4.80
|
| Rate for Payer: WEA Trust Commercial |
$4.40
|
| Rate for Payer: WPS Commercial |
$5.93
|
|
|
Albumin (FS)
|
Professional
|
$8.00
|
|
|
Service Code
|
CPT 82040
|
| Hospital Charge Code |
4538809
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.52 |
| Max. Negotiated Rate |
$21.78 |
| Rate for Payer: Aetna Commercial |
$7.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6.88
|
| Rate for Payer: Aetna Managed Medicare |
$4.95
|
| Rate for Payer: Anthem Medicare Advantage |
$4.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$4.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$4.95
|
| Rate for Payer: Cash Price |
$2.40
|
| Rate for Payer: Cash Price |
$2.40
|
| Rate for Payer: Cigna Commercial |
$7.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$4.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4.95
|
| Rate for Payer: Health EOS Commercial |
$7.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$17.47
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$17.47
|
| Rate for Payer: Independent Care Health Plan Medicare |
$4.95
|
| Rate for Payer: Multiplan Commercial |
$6.40
|
| Rate for Payer: Preferred Network Access Commercial |
$7.60
|
| Rate for Payer: Quartz Beloit One Network |
$3.52
|
| Rate for Payer: Quartz Commercial |
$4.56
|
| Rate for Payer: Quartz Medicare Advantage |
$4.95
|
| Rate for Payer: The Alliance Commercial |
$19.55
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4.95
|
| Rate for Payer: WEA Trust Commercial |
$4.40
|
| Rate for Payer: WPS Commercial |
$21.78
|
|
|
albumin human 5% IV Sol 250 mL [MED]
|
Facility
OP
|
$915.00
|
|
|
Service Code
|
HCPCS P9045
|
| Hospital Charge Code |
3103303
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$53.08 |
| Max. Negotiated Rate |
$1,196.24 |
| Rate for Payer: Aetna Commercial |
$823.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$786.90
|
| Rate for Payer: Aetna Managed Medicare |
$53.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$594.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$457.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$439.20
|
| Rate for Payer: Anthem Medicare Advantage |
$53.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$484.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$53.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$53.08
|
| Rate for Payer: Cash Price |
$274.50
|
| Rate for Payer: Cash Price |
$274.50
|
| Rate for Payer: Cigna Commercial |
$841.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$53.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$70.22
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$53.08
|
| Rate for Payer: Health EOS Commercial |
$814.35
|
| Rate for Payer: HFN Commercial |
$841.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$197.45
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$53.08
|
| Rate for Payer: Independent Care Health Plan Medicare |
$53.08
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$53.08
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$53.08
|
| Rate for Payer: Multiplan Commercial |
$732.00
|
| Rate for Payer: NAPHCARE Commercial |
$79.62
|
| Rate for Payer: Preferred Network Access Commercial |
$841.80
|
| Rate for Payer: Quartz Beloit One Network |
$448.35
|
| Rate for Payer: Quartz Commercial |
$594.75
|
| Rate for Payer: Quartz Medicare Advantage |
$53.08
|
| Rate for Payer: The Alliance Commercial |
$1,196.24
|
| Rate for Payer: United Healthcare Medicare Advantage |
$53.08
|
| Rate for Payer: United Healthcare PPO |
$686.25
|
| Rate for Payer: WEA Trust Commercial |
$503.25
|
| Rate for Payer: Wellcare Medicare |
$53.08
|
| Rate for Payer: WPS Commercial |
$677.74
|
|
|
albumin human 5% IV Sol 250 mL [MED]
|
Facility
IP
|
$915.00
|
|
|
Service Code
|
HCPCS P9045
|
| Hospital Charge Code |
3103303
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$448.35 |
| Max. Negotiated Rate |
$841.80 |
| Rate for Payer: Aetna Commercial |
$823.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$484.95
|
| Rate for Payer: Cash Price |
$274.50
|
| Rate for Payer: Cigna Commercial |
$841.80
|
| Rate for Payer: Health EOS Commercial |
$814.35
|
| Rate for Payer: HFN Commercial |
$841.80
|
| Rate for Payer: Multiplan Commercial |
$732.00
|
| Rate for Payer: NAPHCARE Commercial |
$549.00
|
| Rate for Payer: Preferred Network Access Commercial |
$841.80
|
| Rate for Payer: Quartz Beloit One Network |
$448.35
|
| Rate for Payer: Quartz Commercial |
$549.00
|
| Rate for Payer: WEA Trust Commercial |
$503.25
|
| Rate for Payer: WPS Commercial |
$677.74
|
|
