|
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
|
|
|
Aldosterone 24 Hour Urine
|
Professional
|
$442.00
|
|
|
Service Code
|
CPT 82088
|
| Hospital Charge Code |
977775
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$40.75 |
| Max. Negotiated Rate |
$419.90 |
| Rate for Payer: Aetna Commercial |
$419.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$380.12
|
| 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 |
$132.60
|
| Rate for Payer: Cash Price |
$132.60
|
| Rate for Payer: Cigna Commercial |
$419.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$221.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$40.75
|
| Rate for Payer: Health EOS Commercial |
$402.22
|
| 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 |
$353.60
|
| Rate for Payer: Preferred Network Access Commercial |
$419.90
|
| Rate for Payer: Quartz Beloit One Network |
$194.48
|
| Rate for Payer: Quartz Commercial |
$251.94
|
| 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 |
$243.10
|
| Rate for Payer: WPS Commercial |
$179.30
|
|
|
Aldosterone/Plasma Renin Activity Ratio
|
Facility
OP
|
$329.00
|
|
|
Service Code
|
CPT 82088
|
| Hospital Charge Code |
980015
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$40.75 |
| Max. Negotiated Rate |
$1,316.00 |
| Rate for Payer: Aetna Commercial |
$296.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$282.94
|
| 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 |
$174.37
|
| 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 |
$98.70
|
| Rate for Payer: Cash Price |
$98.70
|
| Rate for Payer: Cigna Commercial |
$302.68
|
| 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 |
$292.81
|
| Rate for Payer: HFN Commercial |
$302.68
|
| 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 |
$263.20
|
| Rate for Payer: NAPHCARE Commercial |
$61.12
|
| Rate for Payer: Preferred Network Access Commercial |
$302.68
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$42.11
|
| Rate for Payer: Quartz Beloit One Network |
$161.21
|
| Rate for Payer: Quartz Commercial |
$213.85
|
| Rate for Payer: Quartz Medicare Advantage |
$40.75
|
| Rate for Payer: The Alliance Commercial |
$1,316.00
|
| Rate for Payer: United Healthcare Medicaid |
$42.11
|
| Rate for Payer: United Healthcare Medicare Advantage |
$40.75
|
| Rate for Payer: United Healthcare PPO |
$246.75
|
| Rate for Payer: WEA Trust Commercial |
$180.95
|
| Rate for Payer: Wellcare Medicare |
$40.75
|
| Rate for Payer: WMAP Medicaid |
$42.11
|
| Rate for Payer: WPS Commercial |
$243.69
|
|
|
Aldosterone/Plasma Renin Activity Ratio
|
Facility
IP
|
$329.00
|
|
|
Service Code
|
CPT 82088
|
| Hospital Charge Code |
980015
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$161.21 |
| Max. Negotiated Rate |
$302.68 |
| Rate for Payer: Aetna Commercial |
$296.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$174.37
|
| Rate for Payer: Cash Price |
$98.70
|
| Rate for Payer: Cigna Commercial |
$302.68
|
| Rate for Payer: Health EOS Commercial |
$292.81
|
| Rate for Payer: HFN Commercial |
$302.68
|
| Rate for Payer: Multiplan Commercial |
$263.20
|
| Rate for Payer: NAPHCARE Commercial |
$197.40
|
| Rate for Payer: Preferred Network Access Commercial |
$302.68
|
| Rate for Payer: Quartz Beloit One Network |
$161.21
|
| Rate for Payer: Quartz Commercial |
$197.40
|
| Rate for Payer: WEA Trust Commercial |
$180.95
|
| Rate for Payer: WPS Commercial |
$243.69
|
|
|
Aldosterone/Plasma Renin Activity Ratio
|
Professional
|
$329.00
|
|
|
Service Code
|
CPT 82088
|
| Hospital Charge Code |
980015
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$40.75 |
| Max. Negotiated Rate |
$312.55 |
| Rate for Payer: Aetna Commercial |
$312.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$282.94
|
| 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 |
$98.70
|
| Rate for Payer: Cash Price |
$98.70
|
| Rate for Payer: Cigna Commercial |
$312.55
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$164.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$40.75
|
| Rate for Payer: Health EOS Commercial |
$299.39
|
| 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 |
$263.20
|
| Rate for Payer: Preferred Network Access Commercial |
$312.55
|
| Rate for Payer: Quartz Beloit One Network |
$144.76
|
| Rate for Payer: Quartz Commercial |
$187.53
|
| 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 |
$180.95
|
| Rate for Payer: WPS Commercial |
$179.30
|
|
|
ALD, TV Amplifier, Any Type
|
Professional
|
$243.00
|
|
|
Service Code
|
HCPCS V5270
|
| Hospital Charge Code |
3243677
|
|
Hospital Revenue Code
|
470
|
| Min. Negotiated Rate |
$106.92 |
| Max. Negotiated Rate |
$230.85 |
| Rate for Payer: Aetna Commercial |
$230.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$208.98
|
| Rate for Payer: Cash Price |
$72.90
|
| Rate for Payer: Cigna Commercial |
$230.85
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$121.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$145.80
|
| Rate for Payer: Health EOS Commercial |
$221.13
|
| Rate for Payer: Multiplan Commercial |
$194.40
|
| Rate for Payer: Preferred Network Access Commercial |
$230.85
|
| Rate for Payer: Quartz Beloit One Network |
$106.92
|
| Rate for Payer: Quartz Commercial |
$138.51
|
| Rate for Payer: The Alliance Commercial |
$121.50
|
| Rate for Payer: WEA Trust Commercial |
$133.65
|
| Rate for Payer: WPS Commercial |
$179.99
|
|
|
ALD, TV Amplifier, Any Type
|
Facility
OP
|
$243.00
|
|
|
Service Code
|
HCPCS V5270
|
| Hospital Charge Code |
3243677
|
|
Hospital Revenue Code
|
470
|
| Min. Negotiated Rate |
$68.04 |
| Max. Negotiated Rate |
$972.00 |
| Rate for Payer: Aetna Commercial |
$218.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$208.98
|
| Rate for Payer: Aetna Managed Medicare |
$68.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$157.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$121.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$116.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$128.79
|
| Rate for Payer: Cash Price |
$72.90
|
| Rate for Payer: Cigna Commercial |
$223.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$135.98
|
| Rate for Payer: Health EOS Commercial |
$216.27
|
| Rate for Payer: HFN Commercial |
$223.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$182.25
|
| Rate for Payer: Multiplan Commercial |
$194.40
|
| Rate for Payer: NAPHCARE Commercial |
$145.80
|
| Rate for Payer: Preferred Network Access Commercial |
$223.56
|
| Rate for Payer: Quartz Beloit One Network |
$119.07
|
| Rate for Payer: Quartz Commercial |
$157.95
|
| Rate for Payer: Quartz Medicare Advantage |
$145.80
|
| Rate for Payer: The Alliance Commercial |
$972.00
|
| Rate for Payer: United Healthcare PPO |
$182.25
|
| Rate for Payer: WEA Trust Commercial |
$133.65
|
| Rate for Payer: WPS Commercial |
$179.99
|
|
|
ALD, TV Amplifier, Any Type
|
Facility
IP
|
$243.00
|
|
|
Service Code
|
HCPCS V5270
|
| Hospital Charge Code |
3243677
|
|
Hospital Revenue Code
|
470
|
| Min. Negotiated Rate |
$119.07 |
| Max. Negotiated Rate |
$223.56 |
| Rate for Payer: Aetna Commercial |
$218.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$128.79
|
| Rate for Payer: Cash Price |
$72.90
|
| Rate for Payer: Cigna Commercial |
$223.56
|
| Rate for Payer: Health EOS Commercial |
$216.27
|
| Rate for Payer: HFN Commercial |
$223.56
|
| Rate for Payer: Multiplan Commercial |
$194.40
|
| Rate for Payer: NAPHCARE Commercial |
$145.80
|
| Rate for Payer: Preferred Network Access Commercial |
$223.56
|
| Rate for Payer: Quartz Beloit One Network |
$119.07
|
| Rate for Payer: Quartz Commercial |
$145.80
|
| Rate for Payer: WEA Trust Commercial |
$133.65
|
| Rate for Payer: WPS Commercial |
$179.99
|
|
|
ALD Unspecified
|
Professional
|
$309.00
|
|
|
Service Code
|
HCPCS V5274
|
| Hospital Charge Code |
3243684
|
|
Hospital Revenue Code
|
470
|
| Min. Negotiated Rate |
$135.96 |
| Max. Negotiated Rate |
$293.55 |
| Rate for Payer: Aetna Commercial |
$293.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$265.74
|
| Rate for Payer: Cash Price |
$92.70
|
| Rate for Payer: Cigna Commercial |
$293.55
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$154.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$185.40
|
| Rate for Payer: Health EOS Commercial |
$281.19
|
| Rate for Payer: Multiplan Commercial |
$247.20
|
| Rate for Payer: Preferred Network Access Commercial |
$293.55
|
| Rate for Payer: Quartz Beloit One Network |
$135.96
|
| Rate for Payer: Quartz Commercial |
$176.13
|
| Rate for Payer: The Alliance Commercial |
$154.50
|
| Rate for Payer: WEA Trust Commercial |
$169.95
|
| Rate for Payer: WPS Commercial |
$228.88
|
|
|
ALD Unspecified
|
Facility
OP
|
$309.00
|
|
|
Service Code
|
HCPCS V5274
|
| Hospital Charge Code |
3243684
|
|
Hospital Revenue Code
|
470
|
| Min. Negotiated Rate |
$86.52 |
| Max. Negotiated Rate |
$1,236.00 |
| Rate for Payer: Aetna Commercial |
$278.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$265.74
|
| Rate for Payer: Aetna Managed Medicare |
$86.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$200.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$154.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$148.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$163.77
|
| Rate for Payer: Cash Price |
$92.70
|
| Rate for Payer: Cigna Commercial |
$284.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$172.92
|
| Rate for Payer: Health EOS Commercial |
$275.01
|
| Rate for Payer: HFN Commercial |
$284.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$231.75
|
| Rate for Payer: Multiplan Commercial |
$247.20
|
| Rate for Payer: NAPHCARE Commercial |
$185.40
|
| Rate for Payer: Preferred Network Access Commercial |
$284.28
|
| Rate for Payer: Quartz Beloit One Network |
$151.41
|
| Rate for Payer: Quartz Commercial |
$200.85
|
| Rate for Payer: Quartz Medicare Advantage |
$185.40
|
| Rate for Payer: The Alliance Commercial |
$1,236.00
|
| Rate for Payer: United Healthcare PPO |
$231.75
|
| Rate for Payer: WEA Trust Commercial |
$169.95
|
| Rate for Payer: WPS Commercial |
$228.88
|
|
|
ALD Unspecified
|
Facility
IP
|
$309.00
|
|
|
Service Code
|
HCPCS V5274
|
| Hospital Charge Code |
3243684
|
|
Hospital Revenue Code
|
470
|
| Min. Negotiated Rate |
$151.41 |
| Max. Negotiated Rate |
$284.28 |
| Rate for Payer: Aetna Commercial |
$278.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$163.77
|
| Rate for Payer: Cash Price |
$92.70
|
| Rate for Payer: Cigna Commercial |
$284.28
|
| Rate for Payer: Health EOS Commercial |
$275.01
|
| Rate for Payer: HFN Commercial |
$284.28
|
| Rate for Payer: Multiplan Commercial |
$247.20
|
| Rate for Payer: NAPHCARE Commercial |
$185.40
|
| Rate for Payer: Preferred Network Access Commercial |
$284.28
|
| Rate for Payer: Quartz Beloit One Network |
$151.41
|
| Rate for Payer: Quartz Commercial |
$185.40
|
| Rate for Payer: WEA Trust Commercial |
$169.95
|
| Rate for Payer: WPS Commercial |
$228.88
|
|
|
Alginate charge
|
Facility
OP
|
$308.00
|
|
| Hospital Charge Code |
3006902
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$86.24 |
| Max. Negotiated Rate |
$1,232.00 |
| Rate for Payer: Aetna Commercial |
$277.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$264.88
|
| Rate for Payer: Aetna Managed Medicare |
$86.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$200.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$154.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$147.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$163.24
|
| Rate for Payer: Cash Price |
$92.40
|
| Rate for Payer: Cigna Commercial |
$283.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$172.36
|
| Rate for Payer: Health EOS Commercial |
$274.12
|
| Rate for Payer: HFN Commercial |
$283.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$231.00
|
| Rate for Payer: Multiplan Commercial |
$246.40
|
| Rate for Payer: NAPHCARE Commercial |
$184.80
|
| Rate for Payer: Preferred Network Access Commercial |
$283.36
|
| Rate for Payer: Quartz Beloit One Network |
$150.92
|
| Rate for Payer: Quartz Commercial |
$200.20
|
| Rate for Payer: Quartz Medicare Advantage |
$184.80
|
| Rate for Payer: The Alliance Commercial |
$1,232.00
|
| Rate for Payer: WEA Trust Commercial |
$169.40
|
| Rate for Payer: WPS Commercial |
$228.14
|
|
|
Alginate charge
|
Facility
IP
|
$308.00
|
|
| Hospital Charge Code |
3006902
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$150.92 |
| Max. Negotiated Rate |
$283.36 |
| Rate for Payer: Aetna Commercial |
$277.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$163.24
|
| Rate for Payer: Cash Price |
$92.40
|
| Rate for Payer: Cigna Commercial |
$283.36
|
| Rate for Payer: Health EOS Commercial |
$274.12
|
| Rate for Payer: HFN Commercial |
$283.36
|
| Rate for Payer: Multiplan Commercial |
$246.40
|
| Rate for Payer: NAPHCARE Commercial |
$184.80
|
| Rate for Payer: Preferred Network Access Commercial |
$283.36
|
| Rate for Payer: Quartz Beloit One Network |
$150.92
|
| Rate for Payer: Quartz Commercial |
$184.80
|
| Rate for Payer: WEA Trust Commercial |
$169.40
|
| Rate for Payer: WPS Commercial |
$228.14
|
|
|
ALIGNMENT GUIDE PROPHECY INFINITY PROPINF
|
Facility
IP
|
$7,733.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5831722
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,789.17 |
| Max. Negotiated Rate |
$7,114.36 |
| Rate for Payer: Aetna Commercial |
$6,959.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,098.49
|
| Rate for Payer: Cash Price |
$2,319.90
|
| Rate for Payer: Cigna Commercial |
$7,114.36
|
| Rate for Payer: Health EOS Commercial |
$6,882.37
|
| Rate for Payer: HFN Commercial |
$7,114.36
|
| Rate for Payer: Multiplan Commercial |
$6,186.40
|
| Rate for Payer: NAPHCARE Commercial |
$4,639.80
|
| Rate for Payer: Preferred Network Access Commercial |
$7,114.36
|
| Rate for Payer: Quartz Beloit One Network |
$3,789.17
|
| Rate for Payer: Quartz Commercial |
$4,639.80
|
| Rate for Payer: WEA Trust Commercial |
$4,253.15
|
| Rate for Payer: WPS Commercial |
$5,727.83
|
|
|
ALIGNMENT GUIDE PROPHECY INFINITY PROPINF
|
Facility
OP
|
$7,733.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5831722
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,165.24 |
| Max. Negotiated Rate |
$7,114.36 |
| Rate for Payer: Aetna Commercial |
$6,959.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,650.38
|
| Rate for Payer: Aetna Managed Medicare |
$2,165.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,026.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,866.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,711.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,098.49
|
| Rate for Payer: Cash Price |
$2,319.90
|
| Rate for Payer: Cigna Commercial |
$7,114.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,327.39
|
| Rate for Payer: Health EOS Commercial |
$6,882.37
|
| Rate for Payer: HFN Commercial |
$7,114.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,799.75
|
| Rate for Payer: Multiplan Commercial |
$6,186.40
|
| Rate for Payer: NAPHCARE Commercial |
$4,639.80
|
| Rate for Payer: Preferred Network Access Commercial |
$7,114.36
|
| Rate for Payer: Quartz Beloit One Network |
$3,789.17
|
| Rate for Payer: Quartz Commercial |
$5,026.45
|
| Rate for Payer: Quartz Medicare Advantage |
$4,639.80
|
| Rate for Payer: WEA Trust Commercial |
$4,253.15
|
| Rate for Payer: WPS Commercial |
$5,727.83
|
|
|
Alimta 10 mg Charge
|
Facility
IP
|
$235.00
|
|
|
Service Code
|
HCPCS J9305
|
| Hospital Charge Code |
2958861
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$115.15 |
| Max. Negotiated Rate |
$216.20 |
| Rate for Payer: Aetna Commercial |
$211.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$124.55
|
| Rate for Payer: Cash Price |
$70.50
|
| Rate for Payer: Cigna Commercial |
$216.20
|
| Rate for Payer: Health EOS Commercial |
$209.15
|
| Rate for Payer: HFN Commercial |
$216.20
|
| Rate for Payer: Multiplan Commercial |
$188.00
|
| Rate for Payer: NAPHCARE Commercial |
$141.00
|
| Rate for Payer: Preferred Network Access Commercial |
$216.20
|
| Rate for Payer: Quartz Beloit One Network |
$115.15
|
| Rate for Payer: Quartz Commercial |
$141.00
|
| Rate for Payer: WEA Trust Commercial |
$129.25
|
| Rate for Payer: WPS Commercial |
$174.06
|
|
|
Alimta 10 mg Charge
|
Professional
|
$235.00
|
|
|
Service Code
|
HCPCS J9305
|
| Hospital Charge Code |
2958861
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.97 |
| Max. Negotiated Rate |
$223.25 |
| Rate for Payer: Aetna Commercial |
$223.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$202.10
|
| Rate for Payer: Aetna Managed Medicare |
$7.93
|
| Rate for Payer: Anthem Medicare Advantage |
$7.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$7.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$7.93
|
| Rate for Payer: Cash Price |
$70.50
|
| Rate for Payer: Cash Price |
$70.50
|
| Rate for Payer: Cigna Commercial |
$223.25
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$117.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3.97
|
| Rate for Payer: Health EOS Commercial |
$213.85
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$106.46
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$106.46
|
| Rate for Payer: Independent Care Health Plan Medicare |
$7.93
|
| Rate for Payer: Multiplan Commercial |
$188.00
|
| Rate for Payer: Preferred Network Access Commercial |
$223.25
|
| Rate for Payer: Quartz Beloit One Network |
$103.40
|
| Rate for Payer: Quartz Commercial |
$133.95
|
| Rate for Payer: Quartz Medicare Advantage |
$7.93
|
| Rate for Payer: The Alliance Commercial |
$21.82
|
| Rate for Payer: United Healthcare Medicaid |
$3.97
|
| Rate for Payer: United Healthcare Medicare Advantage |
$7.93
|
| Rate for Payer: WEA Trust Commercial |
$129.25
|
| Rate for Payer: WPS Commercial |
$9.92
|
|
|
Alimta 10 mg Charge
|
Facility
OP
|
$235.00
|
|
|
Service Code
|
HCPCS J9305
|
| Hospital Charge Code |
2958861
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.37 |
| Max. Negotiated Rate |
$595.32 |
| Rate for Payer: Aetna Commercial |
$211.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$202.10
|
| Rate for Payer: Aetna Managed Medicare |
$4.37
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$152.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$117.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$112.80
|
| Rate for Payer: Anthem Medicare Advantage |
$4.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$124.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$4.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$4.37
|
| Rate for Payer: Cash Price |
$70.50
|
| Rate for Payer: Cash Price |
$70.50
|
| Rate for Payer: Cigna Commercial |
$216.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$4.37
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5.25
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$4.37
|
| Rate for Payer: Health EOS Commercial |
$209.15
|
| Rate for Payer: HFN Commercial |
$216.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$16.26
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$4.37
|
| Rate for Payer: Independent Care Health Plan Medicare |
$4.37
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$4.37
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$4.37
|
| Rate for Payer: Multiplan Commercial |
$188.00
|
| Rate for Payer: NAPHCARE Commercial |
$6.56
|
| Rate for Payer: Preferred Network Access Commercial |
$216.20
|
| Rate for Payer: Quartz Beloit One Network |
$115.15
|
| Rate for Payer: Quartz Commercial |
$152.75
|
| Rate for Payer: Quartz Medicare Advantage |
$4.37
|
| Rate for Payer: The Alliance Commercial |
$595.32
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4.37
|
| Rate for Payer: WEA Trust Commercial |
$129.25
|
| Rate for Payer: Wellcare Medicare |
$4.37
|
| Rate for Payer: WPS Commercial |
$9.92
|
|
|
Alkaline Phosphatase
|
Facility
IP
|
$80.00
|
|
|
Service Code
|
CPT 84075
|
| Hospital Charge Code |
633642
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$39.20 |
| Max. Negotiated Rate |
$73.60 |
| Rate for Payer: Aetna Commercial |
$72.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$42.40
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Cigna Commercial |
$73.60
|
| Rate for Payer: Health EOS Commercial |
$71.20
|
| Rate for Payer: HFN Commercial |
$73.60
|
| Rate for Payer: Multiplan Commercial |
$64.00
|
| Rate for Payer: NAPHCARE Commercial |
$48.00
|
| Rate for Payer: Preferred Network Access Commercial |
$73.60
|
| Rate for Payer: Quartz Beloit One Network |
$39.20
|
| Rate for Payer: Quartz Commercial |
$48.00
|
| Rate for Payer: WEA Trust Commercial |
$44.00
|
| Rate for Payer: WPS Commercial |
$59.26
|
|
|
Alkaline Phosphatase
|
Facility
OP
|
$80.00
|
|
|
Service Code
|
CPT 84075
|
| Hospital Charge Code |
633642
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.18 |
| Max. Negotiated Rate |
$320.00 |
| Rate for Payer: Aetna Commercial |
$72.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$68.80
|
| Rate for Payer: Aetna Managed Medicare |
$5.18
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$19.42
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$9.06
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$8.60
|
| Rate for Payer: Anthem Medicaid |
$5.35
|
| Rate for Payer: Anthem Medicare Advantage |
$5.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$42.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5.18
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Cigna Commercial |
$73.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$5.18
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$5.35
|
| Rate for Payer: Dean Health Medicaid |
$5.35
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$5.18
|
| Rate for Payer: Health EOS Commercial |
$71.20
|
| Rate for Payer: HFN Commercial |
$73.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$19.27
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$5.18
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$5.35
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5.18
|
| Rate for Payer: Managed Health Services Medicaid |
$5.56
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$5.18
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$5.18
|
| Rate for Payer: Multiplan Commercial |
$64.00
|
| Rate for Payer: NAPHCARE Commercial |
$7.77
|
| Rate for Payer: Preferred Network Access Commercial |
$73.60
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$5.35
|
| Rate for Payer: Quartz Beloit One Network |
$39.20
|
| Rate for Payer: Quartz Commercial |
$52.00
|
| Rate for Payer: Quartz Medicare Advantage |
$5.18
|
| Rate for Payer: The Alliance Commercial |
$320.00
|
| Rate for Payer: United Healthcare Medicaid |
$5.35
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.18
|
| Rate for Payer: United Healthcare PPO |
$60.00
|
| Rate for Payer: WEA Trust Commercial |
$44.00
|
| Rate for Payer: Wellcare Medicare |
$5.18
|
| Rate for Payer: WMAP Medicaid |
$5.35
|
| Rate for Payer: WPS Commercial |
$59.26
|
|
|
Alkaline Phosphatase
|
Professional
|
$80.00
|
|
|
Service Code
|
CPT 84075
|
| Hospital Charge Code |
633642
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.18 |
| Max. Negotiated Rate |
$76.00 |
| Rate for Payer: Aetna Commercial |
$76.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$68.80
|
| Rate for Payer: Aetna Managed Medicare |
$5.18
|
| Rate for Payer: Anthem Medicare Advantage |
$5.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5.18
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Cigna Commercial |
$76.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$40.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5.18
|
| Rate for Payer: Health EOS Commercial |
$72.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$18.29
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$18.29
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5.18
|
| Rate for Payer: Multiplan Commercial |
$64.00
|
| Rate for Payer: Preferred Network Access Commercial |
$76.00
|
| Rate for Payer: Quartz Beloit One Network |
$35.20
|
| Rate for Payer: Quartz Commercial |
$45.60
|
| Rate for Payer: Quartz Medicare Advantage |
$5.18
|
| Rate for Payer: The Alliance Commercial |
$20.46
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.18
|
| Rate for Payer: WEA Trust Commercial |
$44.00
|
| Rate for Payer: WPS Commercial |
$22.79
|
|
|
Alkaline Phosphatase Bone Specific
|
Professional
|
$198.00
|
|
|
Service Code
|
CPT 84075
|
| Hospital Charge Code |
977776
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.18 |
| Max. Negotiated Rate |
$188.10 |
| Rate for Payer: Aetna Commercial |
$188.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$170.28
|
| Rate for Payer: Aetna Managed Medicare |
$5.18
|
| Rate for Payer: Anthem Medicare Advantage |
$5.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5.18
|
| Rate for Payer: Cash Price |
$59.40
|
| Rate for Payer: Cash Price |
$59.40
|
| Rate for Payer: Cigna Commercial |
$188.10
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$99.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5.18
|
| Rate for Payer: Health EOS Commercial |
$180.18
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$18.29
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$18.29
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5.18
|
| Rate for Payer: Multiplan Commercial |
$158.40
|
| Rate for Payer: Preferred Network Access Commercial |
$188.10
|
| Rate for Payer: Quartz Beloit One Network |
$87.12
|
| Rate for Payer: Quartz Commercial |
$112.86
|
| Rate for Payer: Quartz Medicare Advantage |
$5.18
|
| Rate for Payer: The Alliance Commercial |
$20.46
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.18
|
| Rate for Payer: WEA Trust Commercial |
$108.90
|
| Rate for Payer: WPS Commercial |
$22.79
|
|
|
Alkaline Phosphatase Bone Specific
|
Facility
OP
|
$198.00
|
|
|
Service Code
|
CPT 84075
|
| Hospital Charge Code |
977776
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.18 |
| Max. Negotiated Rate |
$792.00 |
| Rate for Payer: Aetna Commercial |
$178.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$170.28
|
| Rate for Payer: Aetna Managed Medicare |
$5.18
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$19.42
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$9.06
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$8.60
|
| Rate for Payer: Anthem Medicaid |
$5.35
|
| Rate for Payer: Anthem Medicare Advantage |
$5.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$104.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5.18
|
| Rate for Payer: Cash Price |
$59.40
|
| Rate for Payer: Cash Price |
$59.40
|
| Rate for Payer: Cigna Commercial |
$182.16
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$5.18
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$5.35
|
| Rate for Payer: Dean Health Medicaid |
$5.35
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$5.18
|
| Rate for Payer: Health EOS Commercial |
$176.22
|
| Rate for Payer: HFN Commercial |
$182.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$19.27
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$5.18
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$5.35
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5.18
|
| Rate for Payer: Managed Health Services Medicaid |
$5.56
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$5.18
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$5.18
|
| Rate for Payer: Multiplan Commercial |
$158.40
|
| Rate for Payer: NAPHCARE Commercial |
$7.77
|
| Rate for Payer: Preferred Network Access Commercial |
$182.16
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$5.35
|
| Rate for Payer: Quartz Beloit One Network |
$97.02
|
| Rate for Payer: Quartz Commercial |
$128.70
|
| Rate for Payer: Quartz Medicare Advantage |
$5.18
|
| Rate for Payer: The Alliance Commercial |
$792.00
|
| Rate for Payer: United Healthcare Medicaid |
$5.35
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.18
|
| Rate for Payer: United Healthcare PPO |
$148.50
|
| Rate for Payer: WEA Trust Commercial |
$108.90
|
| Rate for Payer: Wellcare Medicare |
$5.18
|
| Rate for Payer: WMAP Medicaid |
$5.35
|
| Rate for Payer: WPS Commercial |
$146.66
|
|
|
Alkaline Phosphatase Bone Specific
|
Facility
IP
|
$198.00
|
|
|
Service Code
|
CPT 84075
|
| Hospital Charge Code |
977776
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$97.02 |
| Max. Negotiated Rate |
$182.16 |
| Rate for Payer: Aetna Commercial |
$178.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$104.94
|
| Rate for Payer: Cash Price |
$59.40
|
| Rate for Payer: Cigna Commercial |
$182.16
|
| Rate for Payer: Health EOS Commercial |
$176.22
|
| Rate for Payer: HFN Commercial |
$182.16
|
| Rate for Payer: Multiplan Commercial |
$158.40
|
| Rate for Payer: NAPHCARE Commercial |
$118.80
|
| Rate for Payer: Preferred Network Access Commercial |
$182.16
|
| Rate for Payer: Quartz Beloit One Network |
$97.02
|
| Rate for Payer: Quartz Commercial |
$118.80
|
| Rate for Payer: WEA Trust Commercial |
$108.90
|
| Rate for Payer: WPS Commercial |
$146.66
|
|
|
Alkaline Phosphatase Isoenzymes
|
Facility
IP
|
$194.00
|
|
|
Service Code
|
CPT 84080
|
| Hospital Charge Code |
3002837
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$95.06 |
| Max. Negotiated Rate |
$178.48 |
| Rate for Payer: Aetna Commercial |
$174.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$102.82
|
| Rate for Payer: Cash Price |
$58.20
|
| Rate for Payer: Cigna Commercial |
$178.48
|
| Rate for Payer: Health EOS Commercial |
$172.66
|
| Rate for Payer: HFN Commercial |
$178.48
|
| Rate for Payer: Multiplan Commercial |
$155.20
|
| Rate for Payer: NAPHCARE Commercial |
$116.40
|
| Rate for Payer: Preferred Network Access Commercial |
$178.48
|
| Rate for Payer: Quartz Beloit One Network |
$95.06
|
| Rate for Payer: Quartz Commercial |
$116.40
|
| Rate for Payer: WEA Trust Commercial |
$106.70
|
| Rate for Payer: WPS Commercial |
$143.70
|
|
