|
Airway Resistance - Pulmonary Function Test Charge
|
Facility
|
OP
|
$977.00
|
|
|
Service Code
|
CPT 94726
|
| Hospital Charge Code |
3007000
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$392.70 |
| Max. Negotiated Rate |
$1,570.82 |
| Rate for Payer: Aetna Commercial |
$914.47
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$873.83
|
| Rate for Payer: Aetna Managed Medicare |
$392.70
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$660.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$508.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$487.72
|
| Rate for Payer: Anthem Medicare Advantage |
$392.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$538.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$392.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$392.70
|
| Rate for Payer: Cash Price |
$293.10
|
| Rate for Payer: Cash Price |
$293.10
|
| Rate for Payer: Cigna Commercial |
$934.79
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$392.70
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$568.61
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$392.70
|
| Rate for Payer: Health EOS Commercial |
$904.31
|
| Rate for Payer: HFN Commercial |
$934.79
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,460.86
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$392.70
|
| Rate for Payer: Independent Care Health Plan Medicare |
$392.70
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$392.70
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$392.70
|
| Rate for Payer: Multiplan Commercial |
$812.86
|
| Rate for Payer: NAPHCARE Commercial |
$589.06
|
| Rate for Payer: Preferred Network Access Commercial |
$934.79
|
| Rate for Payer: Quartz Beloit One Network |
$497.88
|
| Rate for Payer: Quartz Commercial |
$660.45
|
| Rate for Payer: Quartz Medicare Advantage |
$392.70
|
| Rate for Payer: The Alliance Commercial |
$1,570.82
|
| Rate for Payer: United Healthcare Medicare Advantage |
$392.70
|
| Rate for Payer: United Healthcare PPO |
$762.06
|
| Rate for Payer: WEA Trust Commercial |
$558.84
|
| Rate for Payer: Wellcare Medicare |
$392.70
|
| Rate for Payer: WPS Commercial |
$752.58
|
|
|
Alanine Aminotransferase
|
Facility
|
OP
|
$86.00
|
|
|
Service Code
|
CPT 84460
|
| Hospital Charge Code |
633632
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.51 |
| Max. Negotiated Rate |
$82.28 |
| Rate for Payer: Aetna Commercial |
$80.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$76.92
|
| Rate for Payer: Aetna Managed Medicare |
$5.51
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$20.67
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$9.65
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$9.15
|
| Rate for Payer: Anthem Medicare Advantage |
$5.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$47.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5.51
|
| Rate for Payer: Cash Price |
$25.80
|
| Rate for Payer: Cash Price |
$25.80
|
| Rate for Payer: Cigna Commercial |
$82.28
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$5.51
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$50.05
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$5.51
|
| Rate for Payer: Health EOS Commercial |
$79.60
|
| Rate for Payer: HFN Commercial |
$82.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$20.50
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$5.51
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5.51
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$5.51
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$5.51
|
| Rate for Payer: Multiplan Commercial |
$71.55
|
| Rate for Payer: NAPHCARE Commercial |
$8.27
|
| Rate for Payer: Preferred Network Access Commercial |
$82.28
|
| Rate for Payer: Quartz Beloit One Network |
$43.83
|
| Rate for Payer: Quartz Commercial |
$58.14
|
| Rate for Payer: Quartz Medicare Advantage |
$5.51
|
| Rate for Payer: The Alliance Commercial |
$22.05
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.51
|
| Rate for Payer: United Healthcare PPO |
$67.08
|
| Rate for Payer: WEA Trust Commercial |
$49.19
|
| Rate for Payer: Wellcare Medicare |
$5.51
|
| Rate for Payer: WPS Commercial |
$66.25
|
|
|
Alanine Aminotransferase
|
Professional
|
Both
|
$86.00
|
|
|
Service Code
|
CPT 84460
|
| Hospital Charge Code |
633632
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.51 |
| Max. Negotiated Rate |
$84.97 |
| Rate for Payer: Aetna Commercial |
$84.97
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$76.92
|
| Rate for Payer: Aetna Managed Medicare |
$5.51
|
| Rate for Payer: Anthem Medicare Advantage |
$5.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5.51
|
| Rate for Payer: Cash Price |
$25.80
|
| Rate for Payer: Cash Price |
$25.80
|
| Rate for Payer: Cigna Commercial |
$84.97
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$44.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5.51
|
| Rate for Payer: Health EOS Commercial |
$81.39
|
| Rate for Payer: HFN Commercial |
$84.97
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$19.46
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$19.46
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5.51
|
| Rate for Payer: Multiplan Commercial |
$71.55
|
| Rate for Payer: NAPHCARE Commercial |
$8.27
|
| Rate for Payer: Preferred Network Access Commercial |
$84.97
|
| Rate for Payer: Quartz Beloit One Network |
$39.35
|
| Rate for Payer: Quartz Commercial |
$50.98
|
| Rate for Payer: Quartz Medicare Advantage |
$5.51
|
| Rate for Payer: The Alliance Commercial |
$21.77
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.51
|
| Rate for Payer: WEA Trust Commercial |
$49.19
|
| Rate for Payer: WPS Commercial |
$24.25
|
|
|
Alanine Aminotransferase
|
Facility
|
IP
|
$86.00
|
|
|
Service Code
|
CPT 84460
|
| Hospital Charge Code |
633632
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$43.83 |
| Max. Negotiated Rate |
$82.28 |
| Rate for Payer: Aetna Commercial |
$80.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$76.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$47.40
|
| Rate for Payer: Cash Price |
$25.80
|
| Rate for Payer: Cigna Commercial |
$82.28
|
| Rate for Payer: Health EOS Commercial |
$79.60
|
| Rate for Payer: HFN Commercial |
$82.28
|
| Rate for Payer: Multiplan Commercial |
$71.55
|
| Rate for Payer: Preferred Network Access Commercial |
$82.28
|
| Rate for Payer: Quartz Beloit One Network |
$43.83
|
| Rate for Payer: Quartz Commercial |
$53.66
|
| Rate for Payer: WEA Trust Commercial |
$49.19
|
| Rate for Payer: WPS Commercial |
$66.25
|
|
|
Albumin
|
Professional
|
Both
|
$55.00
|
|
|
Service Code
|
CPT 82040
|
| Hospital Charge Code |
2959004
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.15 |
| Max. Negotiated Rate |
$54.34 |
| Rate for Payer: Aetna Commercial |
$54.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$49.19
|
| Rate for Payer: Aetna Managed Medicare |
$5.15
|
| Rate for Payer: Anthem Medicare Advantage |
$5.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5.15
|
| Rate for Payer: Cash Price |
$16.50
|
| Rate for Payer: Cash Price |
$16.50
|
| Rate for Payer: Cigna Commercial |
$54.34
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$28.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5.15
|
| Rate for Payer: Health EOS Commercial |
$52.05
|
| Rate for Payer: HFN Commercial |
$54.34
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$18.17
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$18.17
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5.15
|
| Rate for Payer: Multiplan Commercial |
$45.76
|
| Rate for Payer: NAPHCARE Commercial |
$7.72
|
| Rate for Payer: Preferred Network Access Commercial |
$54.34
|
| Rate for Payer: Quartz Beloit One Network |
$25.17
|
| Rate for Payer: Quartz Commercial |
$32.60
|
| Rate for Payer: Quartz Medicare Advantage |
$5.15
|
| Rate for Payer: The Alliance Commercial |
$20.33
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.15
|
| Rate for Payer: WEA Trust Commercial |
$31.46
|
| Rate for Payer: WPS Commercial |
$22.65
|
|
|
Albumin
|
Professional
|
Both
|
$55.00
|
|
|
Service Code
|
CPT 82040
|
| Hospital Charge Code |
4109309
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.15 |
| Max. Negotiated Rate |
$54.34 |
| Rate for Payer: Aetna Commercial |
$54.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$49.19
|
| Rate for Payer: Aetna Managed Medicare |
$5.15
|
| Rate for Payer: Anthem Medicare Advantage |
$5.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5.15
|
| Rate for Payer: Cash Price |
$16.50
|
| Rate for Payer: Cash Price |
$16.50
|
| Rate for Payer: Cigna Commercial |
$54.34
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$28.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5.15
|
| Rate for Payer: Health EOS Commercial |
$52.05
|
| Rate for Payer: HFN Commercial |
$54.34
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$18.17
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$18.17
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5.15
|
| Rate for Payer: Multiplan Commercial |
$45.76
|
| Rate for Payer: NAPHCARE Commercial |
$7.72
|
| Rate for Payer: Preferred Network Access Commercial |
$54.34
|
| Rate for Payer: Quartz Beloit One Network |
$25.17
|
| Rate for Payer: Quartz Commercial |
$32.60
|
| Rate for Payer: Quartz Medicare Advantage |
$5.15
|
| Rate for Payer: The Alliance Commercial |
$20.33
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.15
|
| Rate for Payer: WEA Trust Commercial |
$31.46
|
| Rate for Payer: WPS Commercial |
$22.65
|
|
|
Albumin
|
Facility
|
OP
|
$55.00
|
|
|
Service Code
|
CPT 82040
|
| Hospital Charge Code |
4109309
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.15 |
| Max. Negotiated Rate |
$52.62 |
| Rate for Payer: Aetna Commercial |
$51.48
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$49.19
|
| Rate for Payer: Aetna Managed Medicare |
$5.15
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$19.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$9.01
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$8.55
|
| Rate for Payer: Anthem Medicare Advantage |
$5.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$30.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5.15
|
| Rate for Payer: Cash Price |
$16.50
|
| Rate for Payer: Cash Price |
$16.50
|
| Rate for Payer: Cigna Commercial |
$52.62
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$5.15
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$32.01
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$5.15
|
| Rate for Payer: Health EOS Commercial |
$50.91
|
| Rate for Payer: HFN Commercial |
$52.62
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$19.15
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$5.15
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5.15
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$5.15
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$5.15
|
| Rate for Payer: Multiplan Commercial |
$45.76
|
| Rate for Payer: NAPHCARE Commercial |
$7.72
|
| Rate for Payer: Preferred Network Access Commercial |
$52.62
|
| Rate for Payer: Quartz Beloit One Network |
$28.03
|
| Rate for Payer: Quartz Commercial |
$37.18
|
| Rate for Payer: Quartz Medicare Advantage |
$5.15
|
| Rate for Payer: The Alliance Commercial |
$20.59
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.15
|
| Rate for Payer: United Healthcare PPO |
$42.90
|
| Rate for Payer: WEA Trust Commercial |
$31.46
|
| Rate for Payer: Wellcare Medicare |
$5.15
|
| Rate for Payer: WPS Commercial |
$42.37
|
|
|
Albumin
|
Facility
|
IP
|
$55.00
|
|
|
Service Code
|
CPT 82040
|
| Hospital Charge Code |
4109309
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$28.03 |
| Max. Negotiated Rate |
$52.62 |
| Rate for Payer: Aetna Commercial |
$51.48
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$49.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$30.32
|
| Rate for Payer: Cash Price |
$16.50
|
| Rate for Payer: Cigna Commercial |
$52.62
|
| Rate for Payer: Health EOS Commercial |
$50.91
|
| Rate for Payer: HFN Commercial |
$52.62
|
| Rate for Payer: Multiplan Commercial |
$45.76
|
| Rate for Payer: Preferred Network Access Commercial |
$52.62
|
| Rate for Payer: Quartz Beloit One Network |
$28.03
|
| Rate for Payer: Quartz Commercial |
$34.32
|
| Rate for Payer: WEA Trust Commercial |
$31.46
|
| Rate for Payer: WPS Commercial |
$42.37
|
|
|
Albumin
|
Facility
|
OP
|
$49.00
|
|
|
Service Code
|
CPT 82040
|
| Hospital Charge Code |
2943015
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.15 |
| Max. Negotiated Rate |
$46.88 |
| Rate for Payer: Aetna Commercial |
$45.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$43.83
|
| Rate for Payer: Aetna Managed Medicare |
$5.15
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$19.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$9.01
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$8.55
|
| Rate for Payer: Anthem Medicare Advantage |
$5.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$27.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5.15
|
| Rate for Payer: Cash Price |
$14.70
|
| Rate for Payer: Cash Price |
$14.70
|
| Rate for Payer: Cigna Commercial |
$46.88
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$5.15
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$28.52
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$5.15
|
| Rate for Payer: Health EOS Commercial |
$45.35
|
| Rate for Payer: HFN Commercial |
$46.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$19.15
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$5.15
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5.15
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$5.15
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$5.15
|
| Rate for Payer: Multiplan Commercial |
$40.77
|
| Rate for Payer: NAPHCARE Commercial |
$7.72
|
| Rate for Payer: Preferred Network Access Commercial |
$46.88
|
| Rate for Payer: Quartz Beloit One Network |
$24.97
|
| Rate for Payer: Quartz Commercial |
$33.12
|
| Rate for Payer: Quartz Medicare Advantage |
$5.15
|
| Rate for Payer: The Alliance Commercial |
$20.59
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.15
|
| Rate for Payer: United Healthcare PPO |
$38.22
|
| Rate for Payer: WEA Trust Commercial |
$28.03
|
| Rate for Payer: Wellcare Medicare |
$5.15
|
| Rate for Payer: WPS Commercial |
$37.74
|
|
|
Albumin
|
Facility
|
OP
|
$55.00
|
|
|
Service Code
|
CPT 82040
|
| Hospital Charge Code |
2959004
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.15 |
| Max. Negotiated Rate |
$52.62 |
| Rate for Payer: Aetna Commercial |
$51.48
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$49.19
|
| Rate for Payer: Aetna Managed Medicare |
$5.15
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$19.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$9.01
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$8.55
|
| Rate for Payer: Anthem Medicare Advantage |
$5.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$30.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5.15
|
| Rate for Payer: Cash Price |
$16.50
|
| Rate for Payer: Cash Price |
$16.50
|
| Rate for Payer: Cigna Commercial |
$52.62
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$5.15
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$32.01
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$5.15
|
| Rate for Payer: Health EOS Commercial |
$50.91
|
| Rate for Payer: HFN Commercial |
$52.62
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$19.15
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$5.15
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5.15
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$5.15
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$5.15
|
| Rate for Payer: Multiplan Commercial |
$45.76
|
| Rate for Payer: NAPHCARE Commercial |
$7.72
|
| Rate for Payer: Preferred Network Access Commercial |
$52.62
|
| Rate for Payer: Quartz Beloit One Network |
$28.03
|
| Rate for Payer: Quartz Commercial |
$37.18
|
| Rate for Payer: Quartz Medicare Advantage |
$5.15
|
| Rate for Payer: The Alliance Commercial |
$20.59
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.15
|
| Rate for Payer: United Healthcare PPO |
$42.90
|
| Rate for Payer: WEA Trust Commercial |
$31.46
|
| Rate for Payer: Wellcare Medicare |
$5.15
|
| Rate for Payer: WPS Commercial |
$42.37
|
|
|
Albumin
|
Facility
|
IP
|
$49.00
|
|
|
Service Code
|
CPT 82040
|
| Hospital Charge Code |
2943015
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$24.97 |
| Max. Negotiated Rate |
$46.88 |
| Rate for Payer: Aetna Commercial |
$45.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$43.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$27.01
|
| Rate for Payer: Cash Price |
$14.70
|
| Rate for Payer: Cigna Commercial |
$46.88
|
| Rate for Payer: Health EOS Commercial |
$45.35
|
| Rate for Payer: HFN Commercial |
$46.88
|
| Rate for Payer: Multiplan Commercial |
$40.77
|
| Rate for Payer: Preferred Network Access Commercial |
$46.88
|
| Rate for Payer: Quartz Beloit One Network |
$24.97
|
| Rate for Payer: Quartz Commercial |
$30.58
|
| Rate for Payer: WEA Trust Commercial |
$28.03
|
| Rate for Payer: WPS Commercial |
$37.74
|
|
|
Albumin
|
Facility
|
IP
|
$55.00
|
|
|
Service Code
|
CPT 82040
|
| Hospital Charge Code |
2959004
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$28.03 |
| Max. Negotiated Rate |
$52.62 |
| Rate for Payer: Aetna Commercial |
$51.48
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$49.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$30.32
|
| Rate for Payer: Cash Price |
$16.50
|
| Rate for Payer: Cigna Commercial |
$52.62
|
| Rate for Payer: Health EOS Commercial |
$50.91
|
| Rate for Payer: HFN Commercial |
$52.62
|
| Rate for Payer: Multiplan Commercial |
$45.76
|
| Rate for Payer: Preferred Network Access Commercial |
$52.62
|
| Rate for Payer: Quartz Beloit One Network |
$28.03
|
| Rate for Payer: Quartz Commercial |
$34.32
|
| Rate for Payer: WEA Trust Commercial |
$31.46
|
| Rate for Payer: WPS Commercial |
$42.37
|
|
|
Albumin
|
Professional
|
Both
|
$49.00
|
|
|
Service Code
|
CPT 82040
|
| Hospital Charge Code |
2943015
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.15 |
| Max. Negotiated Rate |
$48.41 |
| Rate for Payer: Aetna Commercial |
$48.41
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$43.83
|
| Rate for Payer: Aetna Managed Medicare |
$5.15
|
| Rate for Payer: Anthem Medicare Advantage |
$5.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5.15
|
| Rate for Payer: Cash Price |
$14.70
|
| Rate for Payer: Cash Price |
$14.70
|
| Rate for Payer: Cigna Commercial |
$48.41
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$25.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5.15
|
| Rate for Payer: Health EOS Commercial |
$46.37
|
| Rate for Payer: HFN Commercial |
$48.41
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$18.17
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$18.17
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5.15
|
| Rate for Payer: Multiplan Commercial |
$40.77
|
| Rate for Payer: NAPHCARE Commercial |
$7.72
|
| Rate for Payer: Preferred Network Access Commercial |
$48.41
|
| Rate for Payer: Quartz Beloit One Network |
$22.42
|
| Rate for Payer: Quartz Commercial |
$29.05
|
| Rate for Payer: Quartz Medicare Advantage |
$5.15
|
| Rate for Payer: The Alliance Commercial |
$20.33
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.15
|
| Rate for Payer: WEA Trust Commercial |
$28.03
|
| Rate for Payer: WPS Commercial |
$22.65
|
|
|
Albumin (FS)
|
Professional
|
Both
|
$8.00
|
|
|
Service Code
|
CPT 82040
|
| Hospital Charge Code |
4538809
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.66 |
| Max. Negotiated Rate |
$22.65 |
| Rate for Payer: Aetna Commercial |
$7.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7.16
|
| Rate for Payer: Aetna Managed Medicare |
$5.15
|
| Rate for Payer: Anthem Medicare Advantage |
$5.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5.15
|
| Rate for Payer: Cash Price |
$2.40
|
| Rate for Payer: Cash Price |
$2.40
|
| Rate for Payer: Cigna Commercial |
$7.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$4.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5.15
|
| Rate for Payer: Health EOS Commercial |
$7.57
|
| Rate for Payer: HFN Commercial |
$7.90
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$18.17
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$18.17
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5.15
|
| Rate for Payer: Multiplan Commercial |
$6.66
|
| Rate for Payer: NAPHCARE Commercial |
$7.72
|
| Rate for Payer: Preferred Network Access Commercial |
$7.90
|
| Rate for Payer: Quartz Beloit One Network |
$3.66
|
| Rate for Payer: Quartz Commercial |
$4.74
|
| Rate for Payer: Quartz Medicare Advantage |
$5.15
|
| Rate for Payer: The Alliance Commercial |
$20.33
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.15
|
| Rate for Payer: WEA Trust Commercial |
$4.58
|
| Rate for Payer: WPS Commercial |
$22.65
|
|
|
Albumin (FS)
|
Facility
|
IP
|
$8.00
|
|
|
Service Code
|
CPT 82040
|
| Hospital Charge Code |
4538809
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.08 |
| Max. Negotiated Rate |
$7.65 |
| Rate for Payer: Aetna Commercial |
$7.49
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4.41
|
| Rate for Payer: Cash Price |
$2.40
|
| Rate for Payer: Cigna Commercial |
$7.65
|
| Rate for Payer: Health EOS Commercial |
$7.40
|
| Rate for Payer: HFN Commercial |
$7.65
|
| Rate for Payer: Multiplan Commercial |
$6.66
|
| Rate for Payer: Preferred Network Access Commercial |
$7.65
|
| Rate for Payer: Quartz Beloit One Network |
$4.08
|
| Rate for Payer: Quartz Commercial |
$4.99
|
| Rate for Payer: WEA Trust Commercial |
$4.58
|
| Rate for Payer: WPS Commercial |
$6.16
|
|
|
Albumin (FS)
|
Facility
|
OP
|
$8.00
|
|
|
Service Code
|
CPT 82040
|
| Hospital Charge Code |
4538809
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.08 |
| Max. Negotiated Rate |
$20.59 |
| Rate for Payer: Aetna Commercial |
$7.49
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7.16
|
| Rate for Payer: Aetna Managed Medicare |
$5.15
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$19.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$9.01
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$8.55
|
| Rate for Payer: Anthem Medicare Advantage |
$5.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5.15
|
| Rate for Payer: Cash Price |
$2.40
|
| Rate for Payer: Cash Price |
$2.40
|
| Rate for Payer: Cigna Commercial |
$7.65
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$5.15
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4.66
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$5.15
|
| Rate for Payer: Health EOS Commercial |
$7.40
|
| Rate for Payer: HFN Commercial |
$7.65
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$19.15
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$5.15
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5.15
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$5.15
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$5.15
|
| Rate for Payer: Multiplan Commercial |
$6.66
|
| Rate for Payer: NAPHCARE Commercial |
$7.72
|
| Rate for Payer: Preferred Network Access Commercial |
$7.65
|
| Rate for Payer: Quartz Beloit One Network |
$4.08
|
| Rate for Payer: Quartz Commercial |
$5.41
|
| Rate for Payer: Quartz Medicare Advantage |
$5.15
|
| Rate for Payer: The Alliance Commercial |
$20.59
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.15
|
| Rate for Payer: United Healthcare PPO |
$6.24
|
| Rate for Payer: WEA Trust Commercial |
$4.58
|
| Rate for Payer: Wellcare Medicare |
$5.15
|
| Rate for Payer: WPS Commercial |
$6.16
|
|
|
albumin human 5% IV Sol 250 mL [MED]
|
Facility
|
OP
|
$915.00
|
|
|
Service Code
|
HCPCS P9045
|
| Hospital Charge Code |
3103303
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$55.20 |
| Max. Negotiated Rate |
$875.47 |
| Rate for Payer: Aetna Commercial |
$856.44
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$818.38
|
| Rate for Payer: Aetna Managed Medicare |
$55.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$618.54
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$475.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$456.77
|
| Rate for Payer: Anthem Medicare Advantage |
$55.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$504.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$55.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$55.20
|
| Rate for Payer: Cash Price |
$274.50
|
| Rate for Payer: Cash Price |
$274.50
|
| Rate for Payer: Cigna Commercial |
$875.47
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$55.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$73.03
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$55.20
|
| Rate for Payer: Health EOS Commercial |
$846.92
|
| Rate for Payer: HFN Commercial |
$875.47
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$205.36
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$55.20
|
| Rate for Payer: Independent Care Health Plan Medicare |
$55.20
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$55.20
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$55.20
|
| Rate for Payer: Multiplan Commercial |
$761.28
|
| Rate for Payer: NAPHCARE Commercial |
$82.80
|
| Rate for Payer: Preferred Network Access Commercial |
$875.47
|
| Rate for Payer: Quartz Beloit One Network |
$466.28
|
| Rate for Payer: Quartz Commercial |
$618.54
|
| Rate for Payer: Quartz Medicare Advantage |
$55.20
|
| Rate for Payer: The Alliance Commercial |
$220.81
|
| Rate for Payer: United Healthcare Medicare Advantage |
$55.20
|
| Rate for Payer: United Healthcare PPO |
$713.70
|
| Rate for Payer: WEA Trust Commercial |
$523.38
|
| Rate for Payer: Wellcare Medicare |
$55.20
|
| Rate for Payer: WPS Commercial |
$704.82
|
|
|
albumin human 5% IV Sol 250 mL [MED]
|
Facility
|
IP
|
$915.00
|
|
|
Service Code
|
HCPCS P9045
|
| Hospital Charge Code |
3103303
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$466.28 |
| Max. Negotiated Rate |
$875.47 |
| Rate for Payer: Aetna Commercial |
$856.44
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$818.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$504.35
|
| Rate for Payer: Cash Price |
$274.50
|
| Rate for Payer: Cigna Commercial |
$875.47
|
| Rate for Payer: Health EOS Commercial |
$846.92
|
| Rate for Payer: HFN Commercial |
$875.47
|
| Rate for Payer: Multiplan Commercial |
$761.28
|
| Rate for Payer: Preferred Network Access Commercial |
$875.47
|
| Rate for Payer: Quartz Beloit One Network |
$466.28
|
| Rate for Payer: Quartz Commercial |
$570.96
|
| Rate for Payer: WEA Trust Commercial |
$523.38
|
| Rate for Payer: WPS Commercial |
$704.82
|
|
|
Albumin Level
|
Facility
|
IP
|
$77.00
|
|
|
Service Code
|
CPT 82040
|
| Hospital Charge Code |
633634
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$39.24 |
| Max. Negotiated Rate |
$73.67 |
| Rate for Payer: Aetna Commercial |
$72.07
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$68.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$42.44
|
| Rate for Payer: Cash Price |
$23.10
|
| Rate for Payer: Cigna Commercial |
$73.67
|
| Rate for Payer: Health EOS Commercial |
$71.27
|
| Rate for Payer: HFN Commercial |
$73.67
|
| Rate for Payer: Multiplan Commercial |
$64.06
|
| Rate for Payer: Preferred Network Access Commercial |
$73.67
|
| Rate for Payer: Quartz Beloit One Network |
$39.24
|
| Rate for Payer: Quartz Commercial |
$48.05
|
| Rate for Payer: WEA Trust Commercial |
$44.04
|
| Rate for Payer: WPS Commercial |
$59.31
|
|
|
Albumin Level
|
Professional
|
Both
|
$77.00
|
|
|
Service Code
|
CPT 82040
|
| Hospital Charge Code |
633634
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.15 |
| Max. Negotiated Rate |
$76.08 |
| Rate for Payer: Aetna Commercial |
$76.08
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$68.87
|
| Rate for Payer: Aetna Managed Medicare |
$5.15
|
| Rate for Payer: Anthem Medicare Advantage |
$5.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5.15
|
| Rate for Payer: Cash Price |
$23.10
|
| Rate for Payer: Cash Price |
$23.10
|
| Rate for Payer: Cigna Commercial |
$76.08
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$40.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5.15
|
| Rate for Payer: Health EOS Commercial |
$72.87
|
| Rate for Payer: HFN Commercial |
$76.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$18.17
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$18.17
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5.15
|
| Rate for Payer: Multiplan Commercial |
$64.06
|
| Rate for Payer: NAPHCARE Commercial |
$7.72
|
| Rate for Payer: Preferred Network Access Commercial |
$76.08
|
| Rate for Payer: Quartz Beloit One Network |
$35.24
|
| Rate for Payer: Quartz Commercial |
$45.65
|
| Rate for Payer: Quartz Medicare Advantage |
$5.15
|
| Rate for Payer: The Alliance Commercial |
$20.33
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.15
|
| Rate for Payer: WEA Trust Commercial |
$44.04
|
| Rate for Payer: WPS Commercial |
$22.65
|
|
|
Albumin Level
|
Facility
|
OP
|
$77.00
|
|
|
Service Code
|
CPT 82040
|
| Hospital Charge Code |
633634
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.15 |
| Max. Negotiated Rate |
$73.67 |
| Rate for Payer: Aetna Commercial |
$72.07
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$68.87
|
| Rate for Payer: Aetna Managed Medicare |
$5.15
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$19.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$9.01
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$8.55
|
| Rate for Payer: Anthem Medicare Advantage |
$5.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$42.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5.15
|
| Rate for Payer: Cash Price |
$23.10
|
| Rate for Payer: Cash Price |
$23.10
|
| Rate for Payer: Cigna Commercial |
$73.67
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$5.15
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$44.81
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$5.15
|
| Rate for Payer: Health EOS Commercial |
$71.27
|
| Rate for Payer: HFN Commercial |
$73.67
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$19.15
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$5.15
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5.15
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$5.15
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$5.15
|
| Rate for Payer: Multiplan Commercial |
$64.06
|
| Rate for Payer: NAPHCARE Commercial |
$7.72
|
| Rate for Payer: Preferred Network Access Commercial |
$73.67
|
| Rate for Payer: Quartz Beloit One Network |
$39.24
|
| Rate for Payer: Quartz Commercial |
$52.05
|
| Rate for Payer: Quartz Medicare Advantage |
$5.15
|
| Rate for Payer: The Alliance Commercial |
$20.59
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.15
|
| Rate for Payer: United Healthcare PPO |
$60.06
|
| Rate for Payer: WEA Trust Commercial |
$44.04
|
| Rate for Payer: Wellcare Medicare |
$5.15
|
| Rate for Payer: WPS Commercial |
$59.31
|
|
|
Albumin Level CSF
|
Facility
|
OP
|
$126.00
|
|
|
Service Code
|
CPT 82042
|
| Hospital Charge Code |
2958998
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.09 |
| Max. Negotiated Rate |
$120.56 |
| Rate for Payer: Aetna Commercial |
$117.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$112.69
|
| Rate for Payer: Aetna Managed Medicare |
$8.09
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$30.34
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$14.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$13.43
|
| Rate for Payer: Anthem Medicare Advantage |
$8.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$69.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$8.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$8.09
|
| Rate for Payer: Cash Price |
$37.80
|
| Rate for Payer: Cash Price |
$37.80
|
| Rate for Payer: Cigna Commercial |
$120.56
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$8.09
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$73.33
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$8.09
|
| Rate for Payer: Health EOS Commercial |
$116.63
|
| Rate for Payer: HFN Commercial |
$120.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$30.10
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$8.09
|
| Rate for Payer: Independent Care Health Plan Medicare |
$8.09
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$8.09
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$8.09
|
| Rate for Payer: Multiplan Commercial |
$104.83
|
| Rate for Payer: NAPHCARE Commercial |
$12.14
|
| Rate for Payer: Preferred Network Access Commercial |
$120.56
|
| Rate for Payer: Quartz Beloit One Network |
$64.21
|
| Rate for Payer: Quartz Commercial |
$85.18
|
| Rate for Payer: Quartz Medicare Advantage |
$8.09
|
| Rate for Payer: The Alliance Commercial |
$32.36
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8.09
|
| Rate for Payer: United Healthcare PPO |
$98.28
|
| Rate for Payer: WEA Trust Commercial |
$72.07
|
| Rate for Payer: Wellcare Medicare |
$8.09
|
| Rate for Payer: WPS Commercial |
$97.06
|
|
|
Albumin Level CSF
|
Professional
|
Both
|
$126.00
|
|
|
Service Code
|
CPT 82042
|
| Hospital Charge Code |
4109306
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.09 |
| Max. Negotiated Rate |
$124.49 |
| Rate for Payer: Aetna Commercial |
$124.49
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$112.69
|
| Rate for Payer: Aetna Managed Medicare |
$8.09
|
| Rate for Payer: Anthem Medicare Advantage |
$8.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$8.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$8.09
|
| Rate for Payer: Cash Price |
$37.80
|
| Rate for Payer: Cash Price |
$37.80
|
| Rate for Payer: Cigna Commercial |
$124.49
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$65.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$8.09
|
| Rate for Payer: Health EOS Commercial |
$119.25
|
| Rate for Payer: HFN Commercial |
$124.49
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$28.56
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$28.56
|
| Rate for Payer: Independent Care Health Plan Medicare |
$8.09
|
| Rate for Payer: Multiplan Commercial |
$104.83
|
| Rate for Payer: NAPHCARE Commercial |
$12.14
|
| Rate for Payer: Preferred Network Access Commercial |
$124.49
|
| Rate for Payer: Quartz Beloit One Network |
$57.66
|
| Rate for Payer: Quartz Commercial |
$74.69
|
| Rate for Payer: Quartz Medicare Advantage |
$8.09
|
| Rate for Payer: The Alliance Commercial |
$31.96
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8.09
|
| Rate for Payer: WEA Trust Commercial |
$72.07
|
| Rate for Payer: WPS Commercial |
$35.60
|
|
|
Albumin Level CSF
|
Professional
|
Both
|
$126.00
|
|
|
Service Code
|
CPT 82042
|
| Hospital Charge Code |
2958998
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.09 |
| Max. Negotiated Rate |
$124.49 |
| Rate for Payer: Aetna Commercial |
$124.49
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$112.69
|
| Rate for Payer: Aetna Managed Medicare |
$8.09
|
| Rate for Payer: Anthem Medicare Advantage |
$8.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$8.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$8.09
|
| Rate for Payer: Cash Price |
$37.80
|
| Rate for Payer: Cash Price |
$37.80
|
| Rate for Payer: Cigna Commercial |
$124.49
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$65.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$8.09
|
| Rate for Payer: Health EOS Commercial |
$119.25
|
| Rate for Payer: HFN Commercial |
$124.49
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$28.56
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$28.56
|
| Rate for Payer: Independent Care Health Plan Medicare |
$8.09
|
| Rate for Payer: Multiplan Commercial |
$104.83
|
| Rate for Payer: NAPHCARE Commercial |
$12.14
|
| Rate for Payer: Preferred Network Access Commercial |
$124.49
|
| Rate for Payer: Quartz Beloit One Network |
$57.66
|
| Rate for Payer: Quartz Commercial |
$74.69
|
| Rate for Payer: Quartz Medicare Advantage |
$8.09
|
| Rate for Payer: The Alliance Commercial |
$31.96
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8.09
|
| Rate for Payer: WEA Trust Commercial |
$72.07
|
| Rate for Payer: WPS Commercial |
$35.60
|
|
|
Albumin Level CSF
|
Facility
|
IP
|
$126.00
|
|
|
Service Code
|
CPT 82042
|
| Hospital Charge Code |
2958998
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$64.21 |
| Max. Negotiated Rate |
$120.56 |
| Rate for Payer: Aetna Commercial |
$117.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$112.69
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$69.45
|
| Rate for Payer: Cash Price |
$37.80
|
| Rate for Payer: Cigna Commercial |
$120.56
|
| Rate for Payer: Health EOS Commercial |
$116.63
|
| Rate for Payer: HFN Commercial |
$120.56
|
| Rate for Payer: Multiplan Commercial |
$104.83
|
| Rate for Payer: Preferred Network Access Commercial |
$120.56
|
| Rate for Payer: Quartz Beloit One Network |
$64.21
|
| Rate for Payer: Quartz Commercial |
$78.62
|
| Rate for Payer: WEA Trust Commercial |
$72.07
|
| Rate for Payer: WPS Commercial |
$97.06
|
|
