|
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
|
|
|
Albuterol non-comp unit J7613
|
Facility
IP
|
$3.00
|
|
| Hospital Charge Code |
4506702
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.47 |
| Max. Negotiated Rate |
$2.76 |
| Rate for Payer: Aetna Commercial |
$2.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1.59
|
| Rate for Payer: Cash Price |
$0.90
|
| Rate for Payer: Cigna Commercial |
$2.76
|
| Rate for Payer: Health EOS Commercial |
$2.67
|
| Rate for Payer: HFN Commercial |
$2.76
|
| Rate for Payer: Multiplan Commercial |
$2.40
|
| Rate for Payer: NAPHCARE Commercial |
$1.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2.76
|
| Rate for Payer: Quartz Beloit One Network |
$1.47
|
| Rate for Payer: Quartz Commercial |
$1.80
|
| Rate for Payer: WEA Trust Commercial |
$1.65
|
| Rate for Payer: WPS Commercial |
$2.22
|
|
|
Albuterol non-comp unit J7613
|
Professional
|
$3.00
|
|
| Hospital Charge Code |
4506702
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.32 |
| Max. Negotiated Rate |
$2.85 |
| Rate for Payer: Aetna Commercial |
$2.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2.58
|
| Rate for Payer: Cash Price |
$0.90
|
| Rate for Payer: Cigna Commercial |
$2.85
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1.80
|
| Rate for Payer: Health EOS Commercial |
$2.73
|
| Rate for Payer: Multiplan Commercial |
$2.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2.85
|
| Rate for Payer: Quartz Beloit One Network |
$1.32
|
| Rate for Payer: Quartz Commercial |
$1.71
|
| Rate for Payer: The Alliance Commercial |
$1.50
|
| Rate for Payer: WEA Trust Commercial |
$1.65
|
| Rate for Payer: WPS Commercial |
$2.22
|
|
|
Albuterol non-comp unit J7613
|
Facility
OP
|
$3.00
|
|
| Hospital Charge Code |
4506702
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.84 |
| Max. Negotiated Rate |
$12.00 |
| Rate for Payer: Aetna Commercial |
$2.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2.58
|
| Rate for Payer: Aetna Managed Medicare |
$0.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1.59
|
| Rate for Payer: Cash Price |
$0.90
|
| Rate for Payer: Cigna Commercial |
$2.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1.68
|
| Rate for Payer: Health EOS Commercial |
$2.67
|
| Rate for Payer: HFN Commercial |
$2.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2.25
|
| Rate for Payer: Multiplan Commercial |
$2.40
|
| Rate for Payer: NAPHCARE Commercial |
$1.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2.76
|
| Rate for Payer: Quartz Beloit One Network |
$1.47
|
| Rate for Payer: Quartz Commercial |
$1.95
|
| Rate for Payer: Quartz Medicare Advantage |
$1.80
|
| Rate for Payer: The Alliance Commercial |
$12.00
|
| Rate for Payer: WEA Trust Commercial |
$1.65
|
| Rate for Payer: WPS Commercial |
$2.22
|
|
|
ALCOHOL, DRUG ABUSE OR DEPENDENCE, LEFT AMA
|
Facility
IP
|
$15,594.00
|
|
|
Service Code
|
MS-DRG 894
|
| Min. Negotiated Rate |
$5,609.37 |
| Max. Negotiated Rate |
$15,594.00 |
| Rate for Payer: Aetna Managed Medicare |
$5,609.37
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$11,958.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$9,166.17
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$8,708.46
|
| Rate for Payer: Anthem Medicare Advantage |
$5,609.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5,609.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5,609.37
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$5,609.37
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$9,667.19
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$5,609.37
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$11,202.75
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$5,609.37
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5,609.37
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$5,609.37
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$5,609.37
|
| Rate for Payer: NAPHCARE Commercial |
$8,414.06
|
| Rate for Payer: Quartz Medicare Advantage |
$5,609.37
|
| Rate for Payer: The Alliance Commercial |
$15,594.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5,609.37
|
| Rate for Payer: United Healthcare PPO |
$8,721.48
|
| Rate for Payer: Wellcare Medicare |
$5,609.37
|
|
|
ALCOHOL, DRUG ABUSE OR DEPENDENCE WITHOUT REHABILITATION THERAPY WITH MCC
|
Facility
IP
|
$47,593.00
|
|
|
Service Code
|
MS-DRG 896
|
| Min. Negotiated Rate |
$17,119.76 |
| Max. Negotiated Rate |
$47,593.00 |
| Rate for Payer: Aetna Managed Medicare |
$17,119.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$37,344.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$28,624.18
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$27,194.84
|
| Rate for Payer: Anthem Medicare Advantage |
$17,119.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$17,119.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$17,119.76
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$17,119.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$30,188.76
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$17,119.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$34,672.95
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$17,119.76
|
| Rate for Payer: Independent Care Health Plan Medicare |
$17,119.76
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$17,119.76
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$17,119.76
|
| Rate for Payer: NAPHCARE Commercial |
$25,679.64
|
| Rate for Payer: Quartz Medicare Advantage |
$17,119.76
|
| Rate for Payer: The Alliance Commercial |
$47,593.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17,119.76
|
| Rate for Payer: United Healthcare PPO |
$26,993.34
|
| Rate for Payer: Wellcare Medicare |
$17,119.76
|
|
|
ALCOHOL, DRUG ABUSE OR DEPENDENCE WITHOUT REHABILITATION THERAPY WITHOUT MCC
|
Facility
IP
|
$23,067.00
|
|
|
Service Code
|
MS-DRG 897
|
| Min. Negotiated Rate |
$8,297.61 |
| Max. Negotiated Rate |
$23,067.00 |
| Rate for Payer: Aetna Managed Medicare |
$8,297.61
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$18,042.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$13,829.66
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$13,139.08
|
| Rate for Payer: Anthem Medicare Advantage |
$8,297.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$8,297.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$8,297.61
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$8,297.61
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$14,585.58
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$8,297.61
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$16,684.20
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$8,297.61
|
| Rate for Payer: Independent Care Health Plan Medicare |
$8,297.61
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$8,297.61
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$8,297.61
|
| Rate for Payer: NAPHCARE Commercial |
$12,446.42
|
| Rate for Payer: Quartz Medicare Advantage |
$8,297.61
|
| Rate for Payer: The Alliance Commercial |
$23,067.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8,297.61
|
| Rate for Payer: United Healthcare PPO |
$12,988.86
|
| Rate for Payer: Wellcare Medicare |
$8,297.61
|
|
|
ALCOHOL, DRUG ABUSE OR DEPENDENCE WITH REHABILITATION THERAPY
|
Facility
IP
|
$43,092.00
|
|
|
Service Code
|
MS-DRG 895
|
| Min. Negotiated Rate |
$15,500.69 |
| Max. Negotiated Rate |
$43,092.00 |
| Rate for Payer: Aetna Managed Medicare |
$15,500.69
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$33,777.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$25,890.41
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$24,597.58
|
| Rate for Payer: Anthem Medicare Advantage |
$15,500.69
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$15,500.69
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$15,500.69
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$15,500.69
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$27,305.57
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$15,500.69
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$31,371.60
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$15,500.69
|
| Rate for Payer: Independent Care Health Plan Medicare |
$15,500.69
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$15,500.69
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$15,500.69
|
| Rate for Payer: NAPHCARE Commercial |
$23,251.04
|
| Rate for Payer: Quartz Medicare Advantage |
$15,500.69
|
| Rate for Payer: The Alliance Commercial |
$43,092.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$15,500.69
|
| Rate for Payer: United Healthcare PPO |
$24,423.19
|
| Rate for Payer: Wellcare Medicare |
$15,500.69
|
|
|
Alcohol Isopropyl 16oz [Med]
|
Facility
IP
|
$19.00
|
|
|
Service Code
|
HCPCS A4244
|
| Hospital Charge Code |
2974906
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.31 |
| Max. Negotiated Rate |
$17.48 |
| Rate for Payer: Aetna Commercial |
$17.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$10.07
|
| Rate for Payer: Cash Price |
$5.70
|
| Rate for Payer: Cigna Commercial |
$17.48
|
| Rate for Payer: Health EOS Commercial |
$16.91
|
| Rate for Payer: HFN Commercial |
$17.48
|
| Rate for Payer: Multiplan Commercial |
$15.20
|
| Rate for Payer: NAPHCARE Commercial |
$11.40
|
| Rate for Payer: Preferred Network Access Commercial |
$17.48
|
| Rate for Payer: Quartz Beloit One Network |
$9.31
|
| Rate for Payer: Quartz Commercial |
$11.40
|
| Rate for Payer: WEA Trust Commercial |
$10.45
|
| Rate for Payer: WPS Commercial |
$14.07
|
|
|
Alcohol Isopropyl 16oz [Med]
|
Facility
OP
|
$19.00
|
|
|
Service Code
|
HCPCS A4244
|
| Hospital Charge Code |
2974906
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.32 |
| Max. Negotiated Rate |
$17.48 |
| Rate for Payer: Aetna Commercial |
$17.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$16.34
|
| Rate for Payer: Aetna Managed Medicare |
$5.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$12.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$9.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$9.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$10.07
|
| Rate for Payer: Cash Price |
$5.70
|
| Rate for Payer: Cigna Commercial |
$17.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$10.63
|
| Rate for Payer: Health EOS Commercial |
$16.91
|
| Rate for Payer: HFN Commercial |
$17.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$14.25
|
| Rate for Payer: Multiplan Commercial |
$15.20
|
| Rate for Payer: NAPHCARE Commercial |
$11.40
|
| Rate for Payer: Preferred Network Access Commercial |
$17.48
|
| Rate for Payer: Quartz Beloit One Network |
$9.31
|
| Rate for Payer: Quartz Commercial |
$12.35
|
| Rate for Payer: Quartz Medicare Advantage |
$11.40
|
| Rate for Payer: WEA Trust Commercial |
$10.45
|
| Rate for Payer: WPS Commercial |
$14.07
|
|
|
Alcohol, Isopropyl, Blood
|
Facility
OP
|
$120.00
|
|
|
Service Code
|
CPT 80320
|
| Hospital Charge Code |
5358628
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$33.60 |
| Max. Negotiated Rate |
$110.40 |
| Rate for Payer: Aetna Commercial |
$108.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$103.20
|
| Rate for Payer: Aetna Managed Medicare |
$33.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$78.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$60.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$57.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$63.60
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Cigna Commercial |
$110.40
|
| Rate for Payer: Health EOS Commercial |
$106.80
|
| Rate for Payer: HFN Commercial |
$110.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$90.00
|
| Rate for Payer: Multiplan Commercial |
$96.00
|
| Rate for Payer: NAPHCARE Commercial |
$72.00
|
| Rate for Payer: Preferred Network Access Commercial |
$110.40
|
| Rate for Payer: Quartz Beloit One Network |
$58.80
|
| Rate for Payer: Quartz Commercial |
$78.00
|
| Rate for Payer: Quartz Medicare Advantage |
$72.00
|
| Rate for Payer: United Healthcare PPO |
$90.00
|
| Rate for Payer: WEA Trust Commercial |
$66.00
|
| Rate for Payer: WPS Commercial |
$88.88
|
|
|
Alcohol, Isopropyl, Blood
|
Professional
|
$120.00
|
|
|
Service Code
|
CPT 80320
|
| Hospital Charge Code |
5358628
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$52.80 |
| Max. Negotiated Rate |
$114.00 |
| Rate for Payer: Aetna Commercial |
$114.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$103.20
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Cigna Commercial |
$114.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$60.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$72.00
|
| Rate for Payer: Health EOS Commercial |
$109.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$80.06
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$80.06
|
| Rate for Payer: Multiplan Commercial |
$96.00
|
| Rate for Payer: Preferred Network Access Commercial |
$114.00
|
| Rate for Payer: Quartz Beloit One Network |
$52.80
|
| Rate for Payer: Quartz Commercial |
$68.40
|
| Rate for Payer: The Alliance Commercial |
$60.00
|
| Rate for Payer: WEA Trust Commercial |
$66.00
|
| Rate for Payer: WPS Commercial |
$88.88
|
|
|
Alcohol, Isopropyl, Blood
|
Facility
IP
|
$120.00
|
|
|
Service Code
|
CPT 80320
|
| Hospital Charge Code |
5358628
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$58.80 |
| Max. Negotiated Rate |
$110.40 |
| Rate for Payer: Aetna Commercial |
$108.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$63.60
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Cigna Commercial |
$110.40
|
| Rate for Payer: Health EOS Commercial |
$106.80
|
| Rate for Payer: HFN Commercial |
$110.40
|
| Rate for Payer: Multiplan Commercial |
$96.00
|
| Rate for Payer: NAPHCARE Commercial |
$72.00
|
| Rate for Payer: Preferred Network Access Commercial |
$110.40
|
| Rate for Payer: Quartz Beloit One Network |
$58.80
|
| Rate for Payer: Quartz Commercial |
$72.00
|
| Rate for Payer: WEA Trust Commercial |
$66.00
|
| Rate for Payer: WPS Commercial |
$88.88
|
|
|
Alcohol, Methyl, Blood
|
Professional
|
$141.00
|
|
|
Service Code
|
CPT 80320
|
| Hospital Charge Code |
4243289
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$62.04 |
| Max. Negotiated Rate |
$133.95 |
| Rate for Payer: Aetna Commercial |
$133.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$121.26
|
| Rate for Payer: Cash Price |
$42.30
|
| Rate for Payer: Cash Price |
$42.30
|
| Rate for Payer: Cigna Commercial |
$133.95
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$70.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$84.60
|
| Rate for Payer: Health EOS Commercial |
$128.31
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$80.06
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$80.06
|
| Rate for Payer: Multiplan Commercial |
$112.80
|
| Rate for Payer: Preferred Network Access Commercial |
$133.95
|
| Rate for Payer: Quartz Beloit One Network |
$62.04
|
| Rate for Payer: Quartz Commercial |
$80.37
|
| Rate for Payer: The Alliance Commercial |
$70.50
|
| Rate for Payer: WEA Trust Commercial |
$77.55
|
| Rate for Payer: WPS Commercial |
$104.44
|
|
|
Alcohol, Methyl, Blood
|
Facility
OP
|
$141.00
|
|
|
Service Code
|
CPT 80320
|
| Hospital Charge Code |
4243289
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$39.48 |
| Max. Negotiated Rate |
$129.72 |
| Rate for Payer: Aetna Commercial |
$126.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$121.26
|
| Rate for Payer: Aetna Managed Medicare |
$39.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$91.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$70.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$67.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$74.73
|
| Rate for Payer: Cash Price |
$42.30
|
| Rate for Payer: Cash Price |
$42.30
|
| Rate for Payer: Cigna Commercial |
$129.72
|
| Rate for Payer: Health EOS Commercial |
$125.49
|
| Rate for Payer: HFN Commercial |
$129.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$105.75
|
| Rate for Payer: Multiplan Commercial |
$112.80
|
| Rate for Payer: NAPHCARE Commercial |
$84.60
|
| Rate for Payer: Preferred Network Access Commercial |
$129.72
|
| Rate for Payer: Quartz Beloit One Network |
$69.09
|
| Rate for Payer: Quartz Commercial |
$91.65
|
| Rate for Payer: Quartz Medicare Advantage |
$84.60
|
| Rate for Payer: United Healthcare PPO |
$105.75
|
| Rate for Payer: WEA Trust Commercial |
$77.55
|
| Rate for Payer: WPS Commercial |
$104.44
|
|
|
Alcohol, Methyl, Blood
|
Facility
IP
|
$141.00
|
|
|
Service Code
|
CPT 80320
|
| Hospital Charge Code |
4243289
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$69.09 |
| Max. Negotiated Rate |
$129.72 |
| Rate for Payer: Aetna Commercial |
$126.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$74.73
|
| Rate for Payer: Cash Price |
$42.30
|
| Rate for Payer: Cigna Commercial |
$129.72
|
| Rate for Payer: Health EOS Commercial |
$125.49
|
| Rate for Payer: HFN Commercial |
$129.72
|
| Rate for Payer: Multiplan Commercial |
$112.80
|
| Rate for Payer: NAPHCARE Commercial |
$84.60
|
| Rate for Payer: Preferred Network Access Commercial |
$129.72
|
| Rate for Payer: Quartz Beloit One Network |
$69.09
|
| Rate for Payer: Quartz Commercial |
$84.60
|
| Rate for Payer: WEA Trust Commercial |
$77.55
|
| Rate for Payer: WPS Commercial |
$104.44
|
|
|
ALCO-SCREEN ALCOHOL TESTING 55001-25
|
Facility
OP
|
$61.00
|
|
| Hospital Charge Code |
2970143
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$17.08 |
| Max. Negotiated Rate |
$244.00 |
| Rate for Payer: Aetna Commercial |
$54.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$52.46
|
| Rate for Payer: Aetna Managed Medicare |
$17.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$39.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$30.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$29.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$32.33
|
| Rate for Payer: Cash Price |
$18.30
|
| Rate for Payer: Cigna Commercial |
$56.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$34.14
|
| Rate for Payer: Health EOS Commercial |
$54.29
|
| Rate for Payer: HFN Commercial |
$56.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$45.75
|
| Rate for Payer: Multiplan Commercial |
$48.80
|
| Rate for Payer: NAPHCARE Commercial |
$36.60
|
| Rate for Payer: Preferred Network Access Commercial |
$56.12
|
| Rate for Payer: Quartz Beloit One Network |
$29.89
|
| Rate for Payer: Quartz Commercial |
$39.65
|
| Rate for Payer: Quartz Medicare Advantage |
$36.60
|
| Rate for Payer: The Alliance Commercial |
$244.00
|
| Rate for Payer: WEA Trust Commercial |
$33.55
|
| Rate for Payer: WPS Commercial |
$45.18
|
|
|
ALCO-SCREEN ALCOHOL TESTING 55001-25
|
Facility
IP
|
$61.00
|
|
| Hospital Charge Code |
2970143
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$29.89 |
| Max. Negotiated Rate |
$56.12 |
| Rate for Payer: Aetna Commercial |
$54.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$32.33
|
| Rate for Payer: Cash Price |
$18.30
|
| Rate for Payer: Cigna Commercial |
$56.12
|
| Rate for Payer: Health EOS Commercial |
$54.29
|
| Rate for Payer: HFN Commercial |
$56.12
|
| Rate for Payer: Multiplan Commercial |
$48.80
|
| Rate for Payer: NAPHCARE Commercial |
$36.60
|
| Rate for Payer: Preferred Network Access Commercial |
$56.12
|
| Rate for Payer: Quartz Beloit One Network |
$29.89
|
| Rate for Payer: Quartz Commercial |
$36.60
|
| Rate for Payer: WEA Trust Commercial |
$33.55
|
| Rate for Payer: WPS Commercial |
$45.18
|
|
|
Aldolase
|
Facility
IP
|
$168.00
|
|
|
Service Code
|
CPT 82085
|
| Hospital Charge Code |
633639
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$82.32 |
| Max. Negotiated Rate |
$154.56 |
| Rate for Payer: Aetna Commercial |
$151.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$89.04
|
| Rate for Payer: Cash Price |
$50.40
|
| Rate for Payer: Cigna Commercial |
$154.56
|
| Rate for Payer: Health EOS Commercial |
$149.52
|
| Rate for Payer: HFN Commercial |
$154.56
|
| Rate for Payer: Multiplan Commercial |
$134.40
|
| Rate for Payer: NAPHCARE Commercial |
$100.80
|
| Rate for Payer: Preferred Network Access Commercial |
$154.56
|
| Rate for Payer: Quartz Beloit One Network |
$82.32
|
| Rate for Payer: Quartz Commercial |
$100.80
|
| Rate for Payer: WEA Trust Commercial |
$92.40
|
| Rate for Payer: WPS Commercial |
$124.44
|
|
|
Aldolase
|
Facility
OP
|
$168.00
|
|
|
Service Code
|
CPT 82085
|
| Hospital Charge Code |
633639
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.71 |
| Max. Negotiated Rate |
$672.00 |
| Rate for Payer: Aetna Commercial |
$151.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$144.48
|
| Rate for Payer: Aetna Managed Medicare |
$9.71
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$36.41
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$16.99
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$16.12
|
| Rate for Payer: Anthem Medicaid |
$10.03
|
| Rate for Payer: Anthem Medicare Advantage |
$9.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$89.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$9.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$9.71
|
| Rate for Payer: Cash Price |
$50.40
|
| Rate for Payer: Cash Price |
$50.40
|
| Rate for Payer: Cigna Commercial |
$154.56
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$9.71
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$10.03
|
| Rate for Payer: Dean Health Medicaid |
$10.03
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$9.71
|
| Rate for Payer: Health EOS Commercial |
$149.52
|
| Rate for Payer: HFN Commercial |
$154.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$36.12
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$9.71
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$10.03
|
| Rate for Payer: Independent Care Health Plan Medicare |
$9.71
|
| Rate for Payer: Managed Health Services Medicaid |
$10.43
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$9.71
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$9.71
|
| Rate for Payer: Multiplan Commercial |
$134.40
|
| Rate for Payer: NAPHCARE Commercial |
$14.56
|
| Rate for Payer: Preferred Network Access Commercial |
$154.56
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$10.03
|
| Rate for Payer: Quartz Beloit One Network |
$82.32
|
| Rate for Payer: Quartz Commercial |
$109.20
|
| Rate for Payer: Quartz Medicare Advantage |
$9.71
|
| Rate for Payer: The Alliance Commercial |
$672.00
|
| Rate for Payer: United Healthcare Medicaid |
$10.03
|
| Rate for Payer: United Healthcare Medicare Advantage |
$9.71
|
| Rate for Payer: United Healthcare PPO |
$126.00
|
| Rate for Payer: WEA Trust Commercial |
$92.40
|
| Rate for Payer: Wellcare Medicare |
$9.71
|
| Rate for Payer: WMAP Medicaid |
$10.03
|
| Rate for Payer: WPS Commercial |
$124.44
|
|
|
Aldolase
|
Professional
|
$168.00
|
|
|
Service Code
|
CPT 82085
|
| Hospital Charge Code |
633639
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.71 |
| Max. Negotiated Rate |
$159.60 |
| Rate for Payer: Aetna Commercial |
$159.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$144.48
|
| Rate for Payer: Aetna Managed Medicare |
$9.71
|
| Rate for Payer: Anthem Medicare Advantage |
$9.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$9.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$9.71
|
| Rate for Payer: Cash Price |
$50.40
|
| Rate for Payer: Cash Price |
$50.40
|
| Rate for Payer: Cigna Commercial |
$159.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$84.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$9.71
|
| Rate for Payer: Health EOS Commercial |
$152.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$34.28
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$34.28
|
| Rate for Payer: Independent Care Health Plan Medicare |
$9.71
|
| Rate for Payer: Multiplan Commercial |
$134.40
|
| Rate for Payer: Preferred Network Access Commercial |
$159.60
|
| Rate for Payer: Quartz Beloit One Network |
$73.92
|
| Rate for Payer: Quartz Commercial |
$95.76
|
| Rate for Payer: Quartz Medicare Advantage |
$9.71
|
| Rate for Payer: The Alliance Commercial |
$38.35
|
| Rate for Payer: United Healthcare Medicare Advantage |
$9.71
|
| Rate for Payer: WEA Trust Commercial |
$92.40
|
| Rate for Payer: WPS Commercial |
$42.72
|
|
|
Aldosterone
|
Facility
IP
|
$737.00
|
|
|
Service Code
|
CPT 82088
|
| Hospital Charge Code |
633640
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$361.13 |
| Max. Negotiated Rate |
$678.04 |
| Rate for Payer: Aetna Commercial |
$663.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$390.61
|
| Rate for Payer: Cash Price |
$221.10
|
| Rate for Payer: Cigna Commercial |
$678.04
|
| Rate for Payer: Health EOS Commercial |
$655.93
|
| Rate for Payer: HFN Commercial |
$678.04
|
| Rate for Payer: Multiplan Commercial |
$589.60
|
| Rate for Payer: NAPHCARE Commercial |
$442.20
|
| Rate for Payer: Preferred Network Access Commercial |
$678.04
|
| Rate for Payer: Quartz Beloit One Network |
$361.13
|
| Rate for Payer: Quartz Commercial |
$442.20
|
| Rate for Payer: WEA Trust Commercial |
$405.35
|
| Rate for Payer: WPS Commercial |
$545.90
|
|
|
Aldosterone
|
Facility
OP
|
$737.00
|
|
|
Service Code
|
CPT 82088
|
| Hospital Charge Code |
633640
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$40.75 |
| Max. Negotiated Rate |
$2,948.00 |
| Rate for Payer: Aetna Commercial |
$663.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$633.82
|
| Rate for Payer: Aetna Managed Medicare |
$40.75
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$152.81
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$71.31
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$67.64
|
| Rate for Payer: Anthem Medicaid |
$42.11
|
| Rate for Payer: Anthem Medicare Advantage |
$40.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$390.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$40.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$40.75
|
| Rate for Payer: Cash Price |
$221.10
|
| Rate for Payer: Cash Price |
$221.10
|
| Rate for Payer: Cigna Commercial |
$678.04
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$40.75
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$42.11
|
| Rate for Payer: Dean Health Medicaid |
$42.11
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$40.75
|
| Rate for Payer: Health EOS Commercial |
$655.93
|
| Rate for Payer: HFN Commercial |
$678.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$151.59
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$40.75
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$42.11
|
| Rate for Payer: Independent Care Health Plan Medicare |
$40.75
|
| Rate for Payer: Managed Health Services Medicaid |
$43.79
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$40.75
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$40.75
|
| Rate for Payer: Multiplan Commercial |
$589.60
|
| Rate for Payer: NAPHCARE Commercial |
$61.12
|
| Rate for Payer: Preferred Network Access Commercial |
$678.04
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$42.11
|
| Rate for Payer: Quartz Beloit One Network |
$361.13
|
| Rate for Payer: Quartz Commercial |
$479.05
|
| Rate for Payer: Quartz Medicare Advantage |
$40.75
|
| Rate for Payer: The Alliance Commercial |
$2,948.00
|
| Rate for Payer: United Healthcare Medicaid |
$42.11
|
| Rate for Payer: United Healthcare Medicare Advantage |
$40.75
|
| Rate for Payer: United Healthcare PPO |
$552.75
|
| Rate for Payer: WEA Trust Commercial |
$405.35
|
| Rate for Payer: Wellcare Medicare |
$40.75
|
| Rate for Payer: WMAP Medicaid |
$42.11
|
| Rate for Payer: WPS Commercial |
$545.90
|
|
|
Aldosterone
|
Professional
|
$737.00
|
|
|
Service Code
|
CPT 82088
|
| Hospital Charge Code |
633640
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$40.75 |
| Max. Negotiated Rate |
$700.15 |
| Rate for Payer: Aetna Commercial |
$700.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$633.82
|
| Rate for Payer: Aetna Managed Medicare |
$40.75
|
| Rate for Payer: Anthem Medicare Advantage |
$40.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$40.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$40.75
|
| Rate for Payer: Cash Price |
$221.10
|
| Rate for Payer: Cash Price |
$221.10
|
| Rate for Payer: Cigna Commercial |
$700.15
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$368.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$40.75
|
| Rate for Payer: Health EOS Commercial |
$670.67
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$143.85
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$143.85
|
| Rate for Payer: Independent Care Health Plan Medicare |
$40.75
|
| Rate for Payer: Multiplan Commercial |
$589.60
|
| Rate for Payer: Preferred Network Access Commercial |
$700.15
|
| Rate for Payer: Quartz Beloit One Network |
$324.28
|
| Rate for Payer: Quartz Commercial |
$420.09
|
| Rate for Payer: Quartz Medicare Advantage |
$40.75
|
| Rate for Payer: The Alliance Commercial |
$160.96
|
| Rate for Payer: United Healthcare Medicare Advantage |
$40.75
|
| Rate for Payer: WEA Trust Commercial |
$405.35
|
| Rate for Payer: WPS Commercial |
$179.30
|
|
|
Aldosterone 24 Hour Urine
|
Facility
IP
|
$442.00
|
|
|
Service Code
|
CPT 82088
|
| Hospital Charge Code |
977775
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$216.58 |
| Max. Negotiated Rate |
$406.64 |
| Rate for Payer: Aetna Commercial |
$397.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$234.26
|
| Rate for Payer: Cash Price |
$132.60
|
| Rate for Payer: Cigna Commercial |
$406.64
|
| Rate for Payer: Health EOS Commercial |
$393.38
|
| Rate for Payer: HFN Commercial |
$406.64
|
| Rate for Payer: Multiplan Commercial |
$353.60
|
| Rate for Payer: NAPHCARE Commercial |
$265.20
|
| Rate for Payer: Preferred Network Access Commercial |
$406.64
|
| Rate for Payer: Quartz Beloit One Network |
$216.58
|
| Rate for Payer: Quartz Commercial |
$265.20
|
| Rate for Payer: WEA Trust Commercial |
$243.10
|
| Rate for Payer: WPS Commercial |
$327.39
|
|
