|
Albumin Level
|
Professional
|
$77.00
|
|
|
Service Code
|
CPT 82040
|
| Hospital Charge Code |
633634
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.95 |
| Max. Negotiated Rate |
$73.15 |
| Rate for Payer: Aetna Commercial |
$73.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$66.22
|
| 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 |
$23.10
|
| Rate for Payer: Cash Price |
$23.10
|
| Rate for Payer: Cigna Commercial |
$73.15
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$38.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4.95
|
| Rate for Payer: Health EOS Commercial |
$70.07
|
| 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 |
$61.60
|
| Rate for Payer: Preferred Network Access Commercial |
$73.15
|
| Rate for Payer: Quartz Beloit One Network |
$33.88
|
| Rate for Payer: Quartz Commercial |
$43.89
|
| 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 |
$42.35
|
| Rate for Payer: WPS Commercial |
$21.78
|
|
|
Albumin Level
|
Facility
IP
|
$77.00
|
|
|
Service Code
|
CPT 82040
|
| Hospital Charge Code |
633634
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$37.73 |
| Max. Negotiated Rate |
$70.84 |
| Rate for Payer: Aetna Commercial |
$69.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$40.81
|
| Rate for Payer: Cash Price |
$23.10
|
| Rate for Payer: Cigna Commercial |
$70.84
|
| Rate for Payer: Health EOS Commercial |
$68.53
|
| Rate for Payer: HFN Commercial |
$70.84
|
| Rate for Payer: Multiplan Commercial |
$61.60
|
| Rate for Payer: NAPHCARE Commercial |
$46.20
|
| Rate for Payer: Preferred Network Access Commercial |
$70.84
|
| Rate for Payer: Quartz Beloit One Network |
$37.73
|
| Rate for Payer: Quartz Commercial |
$46.20
|
| Rate for Payer: WEA Trust Commercial |
$42.35
|
| Rate for Payer: WPS Commercial |
$57.03
|
|
|
Albumin Level
|
Facility
OP
|
$77.00
|
|
|
Service Code
|
CPT 82040
|
| Hospital Charge Code |
633634
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.95 |
| Max. Negotiated Rate |
$308.00 |
| Rate for Payer: Aetna Commercial |
$69.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$66.22
|
| 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 |
$40.81
|
| 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 |
$23.10
|
| Rate for Payer: Cash Price |
$23.10
|
| Rate for Payer: Cigna Commercial |
$70.84
|
| 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 |
$68.53
|
| Rate for Payer: HFN Commercial |
$70.84
|
| 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 |
$61.60
|
| Rate for Payer: NAPHCARE Commercial |
$7.42
|
| Rate for Payer: Preferred Network Access Commercial |
$70.84
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$5.11
|
| Rate for Payer: Quartz Beloit One Network |
$37.73
|
| Rate for Payer: Quartz Commercial |
$50.05
|
| Rate for Payer: Quartz Medicare Advantage |
$4.95
|
| Rate for Payer: The Alliance Commercial |
$308.00
|
| Rate for Payer: United Healthcare Medicaid |
$5.11
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4.95
|
| Rate for Payer: United Healthcare PPO |
$57.75
|
| Rate for Payer: WEA Trust Commercial |
$42.35
|
| Rate for Payer: Wellcare Medicare |
$4.95
|
| Rate for Payer: WMAP Medicaid |
$5.11
|
| Rate for Payer: WPS Commercial |
$57.03
|
|
|
Albumin Level CSF
|
Facility
OP
|
$126.00
|
|
|
Service Code
|
CPT 82042
|
| Hospital Charge Code |
2958998
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$7.27 |
| Max. Negotiated Rate |
$504.00 |
| Rate for Payer: Aetna Commercial |
$113.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$108.36
|
| Rate for Payer: Aetna Managed Medicare |
$7.78
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$29.18
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$13.62
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$12.91
|
| Rate for Payer: Anthem Medicaid |
$7.27
|
| Rate for Payer: Anthem Medicare Advantage |
$7.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$66.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$7.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$7.78
|
| Rate for Payer: Cash Price |
$37.80
|
| Rate for Payer: Cash Price |
$37.80
|
| Rate for Payer: Cigna Commercial |
$115.92
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$7.78
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$7.27
|
| Rate for Payer: Dean Health Medicaid |
$7.27
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$7.78
|
| Rate for Payer: Health EOS Commercial |
$112.14
|
| Rate for Payer: HFN Commercial |
$115.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$28.94
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$7.78
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$7.27
|
| Rate for Payer: Independent Care Health Plan Medicare |
$7.78
|
| Rate for Payer: Managed Health Services Medicaid |
$7.56
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$7.78
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$7.78
|
| Rate for Payer: Multiplan Commercial |
$100.80
|
| Rate for Payer: NAPHCARE Commercial |
$11.67
|
| Rate for Payer: Preferred Network Access Commercial |
$115.92
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$7.27
|
| Rate for Payer: Quartz Beloit One Network |
$61.74
|
| Rate for Payer: Quartz Commercial |
$81.90
|
| Rate for Payer: Quartz Medicare Advantage |
$7.78
|
| Rate for Payer: The Alliance Commercial |
$504.00
|
| Rate for Payer: United Healthcare Medicaid |
$7.27
|
| Rate for Payer: United Healthcare Medicare Advantage |
$7.78
|
| Rate for Payer: United Healthcare PPO |
$94.50
|
| Rate for Payer: WEA Trust Commercial |
$69.30
|
| Rate for Payer: Wellcare Medicare |
$7.78
|
| Rate for Payer: WMAP Medicaid |
$7.27
|
| Rate for Payer: WPS Commercial |
$93.33
|
|
|
Albumin Level CSF
|
Professional
|
$126.00
|
|
|
Service Code
|
CPT 82042
|
| Hospital Charge Code |
2958998
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$7.78 |
| Max. Negotiated Rate |
$119.70 |
| Rate for Payer: Aetna Commercial |
$119.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$108.36
|
| Rate for Payer: Aetna Managed Medicare |
$7.78
|
| Rate for Payer: Anthem Medicare Advantage |
$7.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$7.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$7.78
|
| Rate for Payer: Cash Price |
$37.80
|
| Rate for Payer: Cash Price |
$37.80
|
| Rate for Payer: Cigna Commercial |
$119.70
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$63.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$7.78
|
| Rate for Payer: Health EOS Commercial |
$114.66
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$27.46
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$27.46
|
| Rate for Payer: Independent Care Health Plan Medicare |
$7.78
|
| Rate for Payer: Multiplan Commercial |
$100.80
|
| Rate for Payer: Preferred Network Access Commercial |
$119.70
|
| Rate for Payer: Quartz Beloit One Network |
$55.44
|
| Rate for Payer: Quartz Commercial |
$71.82
|
| Rate for Payer: Quartz Medicare Advantage |
$7.78
|
| Rate for Payer: The Alliance Commercial |
$30.73
|
| Rate for Payer: United Healthcare Medicare Advantage |
$7.78
|
| Rate for Payer: WEA Trust Commercial |
$69.30
|
| Rate for Payer: WPS Commercial |
$34.23
|
|
|
Albumin Level CSF
|
Facility
IP
|
$126.00
|
|
|
Service Code
|
CPT 82042
|
| Hospital Charge Code |
2958998
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$61.74 |
| Max. Negotiated Rate |
$115.92 |
| Rate for Payer: Aetna Commercial |
$113.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$66.78
|
| Rate for Payer: Cash Price |
$37.80
|
| Rate for Payer: Cigna Commercial |
$115.92
|
| Rate for Payer: Health EOS Commercial |
$112.14
|
| Rate for Payer: HFN Commercial |
$115.92
|
| Rate for Payer: Multiplan Commercial |
$100.80
|
| Rate for Payer: NAPHCARE Commercial |
$75.60
|
| Rate for Payer: Preferred Network Access Commercial |
$115.92
|
| Rate for Payer: Quartz Beloit One Network |
$61.74
|
| Rate for Payer: Quartz Commercial |
$75.60
|
| Rate for Payer: WEA Trust Commercial |
$69.30
|
| Rate for Payer: WPS Commercial |
$93.33
|
|
|
Albumin Level CSF
|
Professional
|
$126.00
|
|
|
Service Code
|
CPT 82042
|
| Hospital Charge Code |
4109306
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$7.78 |
| Max. Negotiated Rate |
$119.70 |
| Rate for Payer: Aetna Commercial |
$119.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$108.36
|
| Rate for Payer: Aetna Managed Medicare |
$7.78
|
| Rate for Payer: Anthem Medicare Advantage |
$7.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$7.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$7.78
|
| Rate for Payer: Cash Price |
$37.80
|
| Rate for Payer: Cash Price |
$37.80
|
| Rate for Payer: Cigna Commercial |
$119.70
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$63.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$7.78
|
| Rate for Payer: Health EOS Commercial |
$114.66
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$27.46
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$27.46
|
| Rate for Payer: Independent Care Health Plan Medicare |
$7.78
|
| Rate for Payer: Multiplan Commercial |
$100.80
|
| Rate for Payer: Preferred Network Access Commercial |
$119.70
|
| Rate for Payer: Quartz Beloit One Network |
$55.44
|
| Rate for Payer: Quartz Commercial |
$71.82
|
| Rate for Payer: Quartz Medicare Advantage |
$7.78
|
| Rate for Payer: The Alliance Commercial |
$30.73
|
| Rate for Payer: United Healthcare Medicare Advantage |
$7.78
|
| Rate for Payer: WEA Trust Commercial |
$69.30
|
| Rate for Payer: WPS Commercial |
$34.23
|
|
|
Albumin Level CSF
|
Facility
IP
|
$126.00
|
|
|
Service Code
|
CPT 82042
|
| Hospital Charge Code |
4109306
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$61.74 |
| Max. Negotiated Rate |
$115.92 |
| Rate for Payer: Aetna Commercial |
$113.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$66.78
|
| Rate for Payer: Cash Price |
$37.80
|
| Rate for Payer: Cigna Commercial |
$115.92
|
| Rate for Payer: Health EOS Commercial |
$112.14
|
| Rate for Payer: HFN Commercial |
$115.92
|
| Rate for Payer: Multiplan Commercial |
$100.80
|
| Rate for Payer: NAPHCARE Commercial |
$75.60
|
| Rate for Payer: Preferred Network Access Commercial |
$115.92
|
| Rate for Payer: Quartz Beloit One Network |
$61.74
|
| Rate for Payer: Quartz Commercial |
$75.60
|
| Rate for Payer: WEA Trust Commercial |
$69.30
|
| Rate for Payer: WPS Commercial |
$93.33
|
|
|
Albumin Level CSF
|
Facility
OP
|
$126.00
|
|
|
Service Code
|
CPT 82042
|
| Hospital Charge Code |
4109306
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$7.27 |
| Max. Negotiated Rate |
$504.00 |
| Rate for Payer: Aetna Commercial |
$113.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$108.36
|
| Rate for Payer: Aetna Managed Medicare |
$7.78
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$29.18
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$13.62
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$12.91
|
| Rate for Payer: Anthem Medicaid |
$7.27
|
| Rate for Payer: Anthem Medicare Advantage |
$7.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$66.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$7.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$7.78
|
| Rate for Payer: Cash Price |
$37.80
|
| Rate for Payer: Cash Price |
$37.80
|
| Rate for Payer: Cigna Commercial |
$115.92
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$7.78
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$7.27
|
| Rate for Payer: Dean Health Medicaid |
$7.27
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$7.78
|
| Rate for Payer: Health EOS Commercial |
$112.14
|
| Rate for Payer: HFN Commercial |
$115.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$28.94
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$7.78
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$7.27
|
| Rate for Payer: Independent Care Health Plan Medicare |
$7.78
|
| Rate for Payer: Managed Health Services Medicaid |
$7.56
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$7.78
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$7.78
|
| Rate for Payer: Multiplan Commercial |
$100.80
|
| Rate for Payer: NAPHCARE Commercial |
$11.67
|
| Rate for Payer: Preferred Network Access Commercial |
$115.92
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$7.27
|
| Rate for Payer: Quartz Beloit One Network |
$61.74
|
| Rate for Payer: Quartz Commercial |
$81.90
|
| Rate for Payer: Quartz Medicare Advantage |
$7.78
|
| Rate for Payer: The Alliance Commercial |
$504.00
|
| Rate for Payer: United Healthcare Medicaid |
$7.27
|
| Rate for Payer: United Healthcare Medicare Advantage |
$7.78
|
| Rate for Payer: United Healthcare PPO |
$94.50
|
| Rate for Payer: WEA Trust Commercial |
$69.30
|
| Rate for Payer: Wellcare Medicare |
$7.78
|
| Rate for Payer: WMAP Medicaid |
$7.27
|
| Rate for Payer: WPS Commercial |
$93.33
|
|
|
Albumin, Pericardial Fluid
|
Professional
|
$59.00
|
|
|
Service Code
|
CPT 82042
|
| Hospital Charge Code |
3154870
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$7.78 |
| Max. Negotiated Rate |
$56.05 |
| Rate for Payer: Aetna Commercial |
$56.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$50.74
|
| Rate for Payer: Aetna Managed Medicare |
$7.78
|
| Rate for Payer: Anthem Medicare Advantage |
$7.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$7.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$7.78
|
| Rate for Payer: Cash Price |
$17.70
|
| Rate for Payer: Cash Price |
$17.70
|
| Rate for Payer: Cigna Commercial |
$56.05
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$29.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$7.78
|
| Rate for Payer: Health EOS Commercial |
$53.69
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$27.46
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$27.46
|
| Rate for Payer: Independent Care Health Plan Medicare |
$7.78
|
| Rate for Payer: Multiplan Commercial |
$47.20
|
| Rate for Payer: Preferred Network Access Commercial |
$56.05
|
| Rate for Payer: Quartz Beloit One Network |
$25.96
|
| Rate for Payer: Quartz Commercial |
$33.63
|
| Rate for Payer: Quartz Medicare Advantage |
$7.78
|
| Rate for Payer: The Alliance Commercial |
$30.73
|
| Rate for Payer: United Healthcare Medicare Advantage |
$7.78
|
| Rate for Payer: WEA Trust Commercial |
$32.45
|
| Rate for Payer: WPS Commercial |
$34.23
|
|
|
Albumin, Pericardial Fluid
|
Facility
IP
|
$59.00
|
|
|
Service Code
|
CPT 82042
|
| Hospital Charge Code |
3154870
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$28.91 |
| Max. Negotiated Rate |
$54.28 |
| Rate for Payer: Aetna Commercial |
$53.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$31.27
|
| Rate for Payer: Cash Price |
$17.70
|
| Rate for Payer: Cigna Commercial |
$54.28
|
| Rate for Payer: Health EOS Commercial |
$52.51
|
| Rate for Payer: HFN Commercial |
$54.28
|
| Rate for Payer: Multiplan Commercial |
$47.20
|
| Rate for Payer: NAPHCARE Commercial |
$35.40
|
| Rate for Payer: Preferred Network Access Commercial |
$54.28
|
| Rate for Payer: Quartz Beloit One Network |
$28.91
|
| Rate for Payer: Quartz Commercial |
$35.40
|
| Rate for Payer: WEA Trust Commercial |
$32.45
|
| Rate for Payer: WPS Commercial |
$43.70
|
|
|
Albumin, Pericardial Fluid
|
Facility
OP
|
$59.00
|
|
|
Service Code
|
CPT 82042
|
| Hospital Charge Code |
3154870
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$7.27 |
| Max. Negotiated Rate |
$236.00 |
| Rate for Payer: Aetna Commercial |
$53.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$50.74
|
| Rate for Payer: Aetna Managed Medicare |
$7.78
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$29.18
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$13.62
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$12.91
|
| Rate for Payer: Anthem Medicaid |
$7.27
|
| Rate for Payer: Anthem Medicare Advantage |
$7.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$31.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$7.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$7.78
|
| Rate for Payer: Cash Price |
$17.70
|
| Rate for Payer: Cash Price |
$17.70
|
| Rate for Payer: Cigna Commercial |
$54.28
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$7.78
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$7.27
|
| Rate for Payer: Dean Health Medicaid |
$7.27
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$7.78
|
| Rate for Payer: Health EOS Commercial |
$52.51
|
| Rate for Payer: HFN Commercial |
$54.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$28.94
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$7.78
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$7.27
|
| Rate for Payer: Independent Care Health Plan Medicare |
$7.78
|
| Rate for Payer: Managed Health Services Medicaid |
$7.56
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$7.78
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$7.78
|
| Rate for Payer: Multiplan Commercial |
$47.20
|
| Rate for Payer: NAPHCARE Commercial |
$11.67
|
| Rate for Payer: Preferred Network Access Commercial |
$54.28
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$7.27
|
| Rate for Payer: Quartz Beloit One Network |
$28.91
|
| Rate for Payer: Quartz Commercial |
$38.35
|
| Rate for Payer: Quartz Medicare Advantage |
$7.78
|
| Rate for Payer: The Alliance Commercial |
$236.00
|
| Rate for Payer: United Healthcare Medicaid |
$7.27
|
| Rate for Payer: United Healthcare Medicare Advantage |
$7.78
|
| Rate for Payer: United Healthcare PPO |
$44.25
|
| Rate for Payer: WEA Trust Commercial |
$32.45
|
| Rate for Payer: Wellcare Medicare |
$7.78
|
| Rate for Payer: WMAP Medicaid |
$7.27
|
| Rate for Payer: WPS Commercial |
$43.70
|
|
|
Albumin, Peritoneal Fluid
|
Facility
OP
|
$59.00
|
|
|
Service Code
|
CPT 82042
|
| Hospital Charge Code |
3154869
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$7.27 |
| Max. Negotiated Rate |
$236.00 |
| Rate for Payer: Aetna Commercial |
$53.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$50.74
|
| Rate for Payer: Aetna Managed Medicare |
$7.78
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$29.18
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$13.62
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$12.91
|
| Rate for Payer: Anthem Medicaid |
$7.27
|
| Rate for Payer: Anthem Medicare Advantage |
$7.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$31.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$7.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$7.78
|
| Rate for Payer: Cash Price |
$17.70
|
| Rate for Payer: Cash Price |
$17.70
|
| Rate for Payer: Cigna Commercial |
$54.28
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$7.78
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$7.27
|
| Rate for Payer: Dean Health Medicaid |
$7.27
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$7.78
|
| Rate for Payer: Health EOS Commercial |
$52.51
|
| Rate for Payer: HFN Commercial |
$54.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$28.94
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$7.78
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$7.27
|
| Rate for Payer: Independent Care Health Plan Medicare |
$7.78
|
| Rate for Payer: Managed Health Services Medicaid |
$7.56
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$7.78
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$7.78
|
| Rate for Payer: Multiplan Commercial |
$47.20
|
| Rate for Payer: NAPHCARE Commercial |
$11.67
|
| Rate for Payer: Preferred Network Access Commercial |
$54.28
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$7.27
|
| Rate for Payer: Quartz Beloit One Network |
$28.91
|
| Rate for Payer: Quartz Commercial |
$38.35
|
| Rate for Payer: Quartz Medicare Advantage |
$7.78
|
| Rate for Payer: The Alliance Commercial |
$236.00
|
| Rate for Payer: United Healthcare Medicaid |
$7.27
|
| Rate for Payer: United Healthcare Medicare Advantage |
$7.78
|
| Rate for Payer: United Healthcare PPO |
$44.25
|
| Rate for Payer: WEA Trust Commercial |
$32.45
|
| Rate for Payer: Wellcare Medicare |
$7.78
|
| Rate for Payer: WMAP Medicaid |
$7.27
|
| Rate for Payer: WPS Commercial |
$43.70
|
|
|
Albumin, Peritoneal Fluid
|
Professional
|
$59.00
|
|
|
Service Code
|
CPT 82042
|
| Hospital Charge Code |
3154869
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$7.78 |
| Max. Negotiated Rate |
$56.05 |
| Rate for Payer: Aetna Commercial |
$56.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$50.74
|
| Rate for Payer: Aetna Managed Medicare |
$7.78
|
| Rate for Payer: Anthem Medicare Advantage |
$7.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$7.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$7.78
|
| Rate for Payer: Cash Price |
$17.70
|
| Rate for Payer: Cash Price |
$17.70
|
| Rate for Payer: Cigna Commercial |
$56.05
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$29.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$7.78
|
| Rate for Payer: Health EOS Commercial |
$53.69
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$27.46
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$27.46
|
| Rate for Payer: Independent Care Health Plan Medicare |
$7.78
|
| Rate for Payer: Multiplan Commercial |
$47.20
|
| Rate for Payer: Preferred Network Access Commercial |
$56.05
|
| Rate for Payer: Quartz Beloit One Network |
$25.96
|
| Rate for Payer: Quartz Commercial |
$33.63
|
| Rate for Payer: Quartz Medicare Advantage |
$7.78
|
| Rate for Payer: The Alliance Commercial |
$30.73
|
| Rate for Payer: United Healthcare Medicare Advantage |
$7.78
|
| Rate for Payer: WEA Trust Commercial |
$32.45
|
| Rate for Payer: WPS Commercial |
$34.23
|
|
|
Albumin, Peritoneal Fluid
|
Facility
IP
|
$59.00
|
|
|
Service Code
|
CPT 82042
|
| Hospital Charge Code |
3154869
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$28.91 |
| Max. Negotiated Rate |
$54.28 |
| Rate for Payer: Aetna Commercial |
$53.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$31.27
|
| Rate for Payer: Cash Price |
$17.70
|
| Rate for Payer: Cigna Commercial |
$54.28
|
| Rate for Payer: Health EOS Commercial |
$52.51
|
| Rate for Payer: HFN Commercial |
$54.28
|
| Rate for Payer: Multiplan Commercial |
$47.20
|
| Rate for Payer: NAPHCARE Commercial |
$35.40
|
| Rate for Payer: Preferred Network Access Commercial |
$54.28
|
| Rate for Payer: Quartz Beloit One Network |
$28.91
|
| Rate for Payer: Quartz Commercial |
$35.40
|
| Rate for Payer: WEA Trust Commercial |
$32.45
|
| Rate for Payer: WPS Commercial |
$43.70
|
|
|
Albumin, Pleural Fluid
|
Facility
OP
|
$59.00
|
|
|
Service Code
|
CPT 82042
|
| Hospital Charge Code |
3154868
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$7.27 |
| Max. Negotiated Rate |
$236.00 |
| Rate for Payer: Aetna Commercial |
$53.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$50.74
|
| Rate for Payer: Aetna Managed Medicare |
$7.78
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$29.18
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$13.62
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$12.91
|
| Rate for Payer: Anthem Medicaid |
$7.27
|
| Rate for Payer: Anthem Medicare Advantage |
$7.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$31.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$7.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$7.78
|
| Rate for Payer: Cash Price |
$17.70
|
| Rate for Payer: Cash Price |
$17.70
|
| Rate for Payer: Cigna Commercial |
$54.28
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$7.78
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$7.27
|
| Rate for Payer: Dean Health Medicaid |
$7.27
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$7.78
|
| Rate for Payer: Health EOS Commercial |
$52.51
|
| Rate for Payer: HFN Commercial |
$54.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$28.94
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$7.78
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$7.27
|
| Rate for Payer: Independent Care Health Plan Medicare |
$7.78
|
| Rate for Payer: Managed Health Services Medicaid |
$7.56
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$7.78
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$7.78
|
| Rate for Payer: Multiplan Commercial |
$47.20
|
| Rate for Payer: NAPHCARE Commercial |
$11.67
|
| Rate for Payer: Preferred Network Access Commercial |
$54.28
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$7.27
|
| Rate for Payer: Quartz Beloit One Network |
$28.91
|
| Rate for Payer: Quartz Commercial |
$38.35
|
| Rate for Payer: Quartz Medicare Advantage |
$7.78
|
| Rate for Payer: The Alliance Commercial |
$236.00
|
| Rate for Payer: United Healthcare Medicaid |
$7.27
|
| Rate for Payer: United Healthcare Medicare Advantage |
$7.78
|
| Rate for Payer: United Healthcare PPO |
$44.25
|
| Rate for Payer: WEA Trust Commercial |
$32.45
|
| Rate for Payer: Wellcare Medicare |
$7.78
|
| Rate for Payer: WMAP Medicaid |
$7.27
|
| Rate for Payer: WPS Commercial |
$43.70
|
|
|
Albumin, Pleural Fluid
|
Professional
|
$59.00
|
|
|
Service Code
|
CPT 82042
|
| Hospital Charge Code |
3154868
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$7.78 |
| Max. Negotiated Rate |
$56.05 |
| Rate for Payer: Aetna Commercial |
$56.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$50.74
|
| Rate for Payer: Aetna Managed Medicare |
$7.78
|
| Rate for Payer: Anthem Medicare Advantage |
$7.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$7.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$7.78
|
| Rate for Payer: Cash Price |
$17.70
|
| Rate for Payer: Cash Price |
$17.70
|
| Rate for Payer: Cigna Commercial |
$56.05
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$29.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$7.78
|
| Rate for Payer: Health EOS Commercial |
$53.69
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$27.46
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$27.46
|
| Rate for Payer: Independent Care Health Plan Medicare |
$7.78
|
| Rate for Payer: Multiplan Commercial |
$47.20
|
| Rate for Payer: Preferred Network Access Commercial |
$56.05
|
| Rate for Payer: Quartz Beloit One Network |
$25.96
|
| Rate for Payer: Quartz Commercial |
$33.63
|
| Rate for Payer: Quartz Medicare Advantage |
$7.78
|
| Rate for Payer: The Alliance Commercial |
$30.73
|
| Rate for Payer: United Healthcare Medicare Advantage |
$7.78
|
| Rate for Payer: WEA Trust Commercial |
$32.45
|
| Rate for Payer: WPS Commercial |
$34.23
|
|
|
Albumin, Pleural Fluid
|
Facility
IP
|
$59.00
|
|
|
Service Code
|
CPT 82042
|
| Hospital Charge Code |
3154868
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$28.91 |
| Max. Negotiated Rate |
$54.28 |
| Rate for Payer: Aetna Commercial |
$53.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$31.27
|
| Rate for Payer: Cash Price |
$17.70
|
| Rate for Payer: Cigna Commercial |
$54.28
|
| Rate for Payer: Health EOS Commercial |
$52.51
|
| Rate for Payer: HFN Commercial |
$54.28
|
| Rate for Payer: Multiplan Commercial |
$47.20
|
| Rate for Payer: NAPHCARE Commercial |
$35.40
|
| Rate for Payer: Preferred Network Access Commercial |
$54.28
|
| Rate for Payer: Quartz Beloit One Network |
$28.91
|
| Rate for Payer: Quartz Commercial |
$35.40
|
| Rate for Payer: WEA Trust Commercial |
$32.45
|
| Rate for Payer: WPS Commercial |
$43.70
|
|
|
Albumin, Synovial Fluid
|
Professional
|
$59.00
|
|
|
Service Code
|
CPT 82042
|
| Hospital Charge Code |
3154871
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$7.78 |
| Max. Negotiated Rate |
$56.05 |
| Rate for Payer: Aetna Commercial |
$56.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$50.74
|
| Rate for Payer: Aetna Managed Medicare |
$7.78
|
| Rate for Payer: Anthem Medicare Advantage |
$7.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$7.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$7.78
|
| Rate for Payer: Cash Price |
$17.70
|
| Rate for Payer: Cash Price |
$17.70
|
| Rate for Payer: Cigna Commercial |
$56.05
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$29.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$7.78
|
| Rate for Payer: Health EOS Commercial |
$53.69
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$27.46
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$27.46
|
| Rate for Payer: Independent Care Health Plan Medicare |
$7.78
|
| Rate for Payer: Multiplan Commercial |
$47.20
|
| Rate for Payer: Preferred Network Access Commercial |
$56.05
|
| Rate for Payer: Quartz Beloit One Network |
$25.96
|
| Rate for Payer: Quartz Commercial |
$33.63
|
| Rate for Payer: Quartz Medicare Advantage |
$7.78
|
| Rate for Payer: The Alliance Commercial |
$30.73
|
| Rate for Payer: United Healthcare Medicare Advantage |
$7.78
|
| Rate for Payer: WEA Trust Commercial |
$32.45
|
| Rate for Payer: WPS Commercial |
$34.23
|
|
|
Albumin, Synovial Fluid
|
Facility
OP
|
$59.00
|
|
|
Service Code
|
CPT 82042
|
| Hospital Charge Code |
3154871
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$7.27 |
| Max. Negotiated Rate |
$236.00 |
| Rate for Payer: Aetna Commercial |
$53.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$50.74
|
| Rate for Payer: Aetna Managed Medicare |
$7.78
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$29.18
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$13.62
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$12.91
|
| Rate for Payer: Anthem Medicaid |
$7.27
|
| Rate for Payer: Anthem Medicare Advantage |
$7.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$31.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$7.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$7.78
|
| Rate for Payer: Cash Price |
$17.70
|
| Rate for Payer: Cash Price |
$17.70
|
| Rate for Payer: Cigna Commercial |
$54.28
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$7.78
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$7.27
|
| Rate for Payer: Dean Health Medicaid |
$7.27
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$7.78
|
| Rate for Payer: Health EOS Commercial |
$52.51
|
| Rate for Payer: HFN Commercial |
$54.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$28.94
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$7.78
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$7.27
|
| Rate for Payer: Independent Care Health Plan Medicare |
$7.78
|
| Rate for Payer: Managed Health Services Medicaid |
$7.56
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$7.78
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$7.78
|
| Rate for Payer: Multiplan Commercial |
$47.20
|
| Rate for Payer: NAPHCARE Commercial |
$11.67
|
| Rate for Payer: Preferred Network Access Commercial |
$54.28
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$7.27
|
| Rate for Payer: Quartz Beloit One Network |
$28.91
|
| Rate for Payer: Quartz Commercial |
$38.35
|
| Rate for Payer: Quartz Medicare Advantage |
$7.78
|
| Rate for Payer: The Alliance Commercial |
$236.00
|
| Rate for Payer: United Healthcare Medicaid |
$7.27
|
| Rate for Payer: United Healthcare Medicare Advantage |
$7.78
|
| Rate for Payer: United Healthcare PPO |
$44.25
|
| Rate for Payer: WEA Trust Commercial |
$32.45
|
| Rate for Payer: Wellcare Medicare |
$7.78
|
| Rate for Payer: WMAP Medicaid |
$7.27
|
| Rate for Payer: WPS Commercial |
$43.70
|
|
|
Albumin, Synovial Fluid
|
Facility
IP
|
$59.00
|
|
|
Service Code
|
CPT 82042
|
| Hospital Charge Code |
3154871
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$28.91 |
| Max. Negotiated Rate |
$54.28 |
| Rate for Payer: Aetna Commercial |
$53.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$31.27
|
| Rate for Payer: Cash Price |
$17.70
|
| Rate for Payer: Cigna Commercial |
$54.28
|
| Rate for Payer: Health EOS Commercial |
$52.51
|
| Rate for Payer: HFN Commercial |
$54.28
|
| Rate for Payer: Multiplan Commercial |
$47.20
|
| Rate for Payer: NAPHCARE Commercial |
$35.40
|
| Rate for Payer: Preferred Network Access Commercial |
$54.28
|
| Rate for Payer: Quartz Beloit One Network |
$28.91
|
| Rate for Payer: Quartz Commercial |
$35.40
|
| Rate for Payer: WEA Trust Commercial |
$32.45
|
| Rate for Payer: WPS Commercial |
$43.70
|
|
|
albuterol 1 unit Charge
|
Facility
OP
|
$7.00
|
|
|
Service Code
|
HCPCS J7613
|
| Hospital Charge Code |
2958977
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$28.00 |
| Rate for Payer: Aetna Commercial |
$6.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6.02
|
| Rate for Payer: Aetna Managed Medicare |
$1.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3.71
|
| Rate for Payer: Cash Price |
$2.10
|
| Rate for Payer: Cash Price |
$2.10
|
| Rate for Payer: Cigna Commercial |
$6.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$0.05
|
| Rate for Payer: Health EOS Commercial |
$6.23
|
| Rate for Payer: HFN Commercial |
$6.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5.25
|
| Rate for Payer: Multiplan Commercial |
$5.60
|
| Rate for Payer: NAPHCARE Commercial |
$4.20
|
| Rate for Payer: Preferred Network Access Commercial |
$6.44
|
| Rate for Payer: Quartz Beloit One Network |
$3.43
|
| Rate for Payer: Quartz Commercial |
$4.55
|
| Rate for Payer: Quartz Medicare Advantage |
$4.20
|
| Rate for Payer: The Alliance Commercial |
$28.00
|
| Rate for Payer: WEA Trust Commercial |
$3.85
|
| Rate for Payer: WPS Commercial |
$5.18
|
|
|
albuterol 1 unit Charge
|
Facility
IP
|
$7.00
|
|
|
Service Code
|
HCPCS J7613
|
| Hospital Charge Code |
2958977
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.43 |
| Max. Negotiated Rate |
$6.44 |
| Rate for Payer: Aetna Commercial |
$6.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3.71
|
| Rate for Payer: Cash Price |
$2.10
|
| Rate for Payer: Cigna Commercial |
$6.44
|
| Rate for Payer: Health EOS Commercial |
$6.23
|
| Rate for Payer: HFN Commercial |
$6.44
|
| Rate for Payer: Multiplan Commercial |
$5.60
|
| Rate for Payer: NAPHCARE Commercial |
$4.20
|
| Rate for Payer: Preferred Network Access Commercial |
$6.44
|
| Rate for Payer: Quartz Beloit One Network |
$3.43
|
| Rate for Payer: Quartz Commercial |
$4.20
|
| Rate for Payer: WEA Trust Commercial |
$3.85
|
| Rate for Payer: WPS Commercial |
$5.18
|
|
|
albuterol 1 unit Charge
|
Professional
|
$7.00
|
|
|
Service Code
|
HCPCS J7613
|
| Hospital Charge Code |
2958977
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.03 |
| Max. Negotiated Rate |
$6.65 |
| Rate for Payer: Aetna Commercial |
$6.65
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6.02
|
| Rate for Payer: Aetna Managed Medicare |
$0.03
|
| Rate for Payer: Anthem Medicare Advantage |
$0.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$0.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$0.03
|
| Rate for Payer: Cash Price |
$2.10
|
| Rate for Payer: Cash Price |
$2.10
|
| Rate for Payer: Cigna Commercial |
$6.65
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$3.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$0.04
|
| Rate for Payer: Health EOS Commercial |
$6.37
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$0.06
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$0.06
|
| Rate for Payer: Independent Care Health Plan Medicare |
$0.03
|
| Rate for Payer: Multiplan Commercial |
$5.60
|
| Rate for Payer: Preferred Network Access Commercial |
$6.65
|
| Rate for Payer: Quartz Beloit One Network |
$3.08
|
| Rate for Payer: Quartz Commercial |
$3.99
|
| Rate for Payer: Quartz Medicare Advantage |
$0.03
|
| Rate for Payer: The Alliance Commercial |
$0.08
|
| Rate for Payer: United Healthcare Medicaid |
$0.04
|
| Rate for Payer: United Healthcare Medicare Advantage |
$0.03
|
| Rate for Payer: WEA Trust Commercial |
$3.85
|
| Rate for Payer: WPS Commercial |
$0.10
|
|
|
Albuterol - Additional Unit Dose Medicaiton
|
Facility
IP
|
$36.00
|
|
| Hospital Charge Code |
5536669
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$17.64 |
| Max. Negotiated Rate |
$33.12 |
| Rate for Payer: Aetna Commercial |
$32.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$19.08
|
| Rate for Payer: Cash Price |
$10.80
|
| Rate for Payer: Cigna Commercial |
$33.12
|
| Rate for Payer: Health EOS Commercial |
$32.04
|
| Rate for Payer: HFN Commercial |
$33.12
|
| Rate for Payer: Multiplan Commercial |
$28.80
|
| Rate for Payer: NAPHCARE Commercial |
$21.60
|
| Rate for Payer: Preferred Network Access Commercial |
$33.12
|
| Rate for Payer: Quartz Beloit One Network |
$17.64
|
| Rate for Payer: Quartz Commercial |
$21.60
|
| Rate for Payer: WEA Trust Commercial |
$19.80
|
| Rate for Payer: WPS Commercial |
$26.67
|
|
