|
Albumin Level CSF
|
Facility
|
OP
|
$126.00
|
|
|
Service Code
|
CPT 82042
|
| Hospital Charge Code |
4109306
|
|
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 |
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, Pericardial Fluid
|
Facility
|
IP
|
$59.00
|
|
|
Service Code
|
CPT 82042
|
| Hospital Charge Code |
3154870
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$30.07 |
| Max. Negotiated Rate |
$56.45 |
| Rate for Payer: Aetna Commercial |
$55.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$52.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$32.52
|
| Rate for Payer: Cash Price |
$17.70
|
| Rate for Payer: Cigna Commercial |
$56.45
|
| Rate for Payer: Health EOS Commercial |
$54.61
|
| Rate for Payer: HFN Commercial |
$56.45
|
| Rate for Payer: Multiplan Commercial |
$49.09
|
| Rate for Payer: Preferred Network Access Commercial |
$56.45
|
| Rate for Payer: Quartz Beloit One Network |
$30.07
|
| Rate for Payer: Quartz Commercial |
$36.82
|
| Rate for Payer: WEA Trust Commercial |
$33.75
|
| Rate for Payer: WPS Commercial |
$45.45
|
|
|
Albumin, Pericardial Fluid
|
Professional
|
Both
|
$59.00
|
|
|
Service Code
|
CPT 82042
|
| Hospital Charge Code |
3154870
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.09 |
| Max. Negotiated Rate |
$58.29 |
| Rate for Payer: Aetna Commercial |
$58.29
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$52.77
|
| 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 |
$17.70
|
| Rate for Payer: Cash Price |
$17.70
|
| Rate for Payer: Cigna Commercial |
$58.29
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$30.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$8.09
|
| Rate for Payer: Health EOS Commercial |
$55.84
|
| Rate for Payer: HFN Commercial |
$58.29
|
| 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 |
$49.09
|
| Rate for Payer: NAPHCARE Commercial |
$12.14
|
| Rate for Payer: Preferred Network Access Commercial |
$58.29
|
| Rate for Payer: Quartz Beloit One Network |
$27.00
|
| Rate for Payer: Quartz Commercial |
$34.98
|
| 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 |
$33.75
|
| Rate for Payer: WPS Commercial |
$35.60
|
|
|
Albumin, Pericardial Fluid
|
Facility
|
OP
|
$59.00
|
|
|
Service Code
|
CPT 82042
|
| Hospital Charge Code |
3154870
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.09 |
| Max. Negotiated Rate |
$56.45 |
| Rate for Payer: Aetna Commercial |
$55.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$52.77
|
| 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 |
$32.52
|
| 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 |
$17.70
|
| Rate for Payer: Cash Price |
$17.70
|
| Rate for Payer: Cigna Commercial |
$56.45
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$8.09
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$34.34
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$8.09
|
| Rate for Payer: Health EOS Commercial |
$54.61
|
| Rate for Payer: HFN Commercial |
$56.45
|
| 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 |
$49.09
|
| Rate for Payer: NAPHCARE Commercial |
$12.14
|
| Rate for Payer: Preferred Network Access Commercial |
$56.45
|
| Rate for Payer: Quartz Beloit One Network |
$30.07
|
| Rate for Payer: Quartz Commercial |
$39.88
|
| 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 |
$46.02
|
| Rate for Payer: WEA Trust Commercial |
$33.75
|
| Rate for Payer: Wellcare Medicare |
$8.09
|
| Rate for Payer: WPS Commercial |
$45.45
|
|
|
Albumin, Peritoneal Fluid
|
Facility
|
IP
|
$59.00
|
|
|
Service Code
|
CPT 82042
|
| Hospital Charge Code |
3154869
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$30.07 |
| Max. Negotiated Rate |
$56.45 |
| Rate for Payer: Aetna Commercial |
$55.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$52.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$32.52
|
| Rate for Payer: Cash Price |
$17.70
|
| Rate for Payer: Cigna Commercial |
$56.45
|
| Rate for Payer: Health EOS Commercial |
$54.61
|
| Rate for Payer: HFN Commercial |
$56.45
|
| Rate for Payer: Multiplan Commercial |
$49.09
|
| Rate for Payer: Preferred Network Access Commercial |
$56.45
|
| Rate for Payer: Quartz Beloit One Network |
$30.07
|
| Rate for Payer: Quartz Commercial |
$36.82
|
| Rate for Payer: WEA Trust Commercial |
$33.75
|
| Rate for Payer: WPS Commercial |
$45.45
|
|
|
Albumin, Peritoneal Fluid
|
Professional
|
Both
|
$59.00
|
|
|
Service Code
|
CPT 82042
|
| Hospital Charge Code |
3154869
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.09 |
| Max. Negotiated Rate |
$58.29 |
| Rate for Payer: Aetna Commercial |
$58.29
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$52.77
|
| 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 |
$17.70
|
| Rate for Payer: Cash Price |
$17.70
|
| Rate for Payer: Cigna Commercial |
$58.29
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$30.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$8.09
|
| Rate for Payer: Health EOS Commercial |
$55.84
|
| Rate for Payer: HFN Commercial |
$58.29
|
| 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 |
$49.09
|
| Rate for Payer: NAPHCARE Commercial |
$12.14
|
| Rate for Payer: Preferred Network Access Commercial |
$58.29
|
| Rate for Payer: Quartz Beloit One Network |
$27.00
|
| Rate for Payer: Quartz Commercial |
$34.98
|
| 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 |
$33.75
|
| Rate for Payer: WPS Commercial |
$35.60
|
|
|
Albumin, Peritoneal Fluid
|
Facility
|
OP
|
$59.00
|
|
|
Service Code
|
CPT 82042
|
| Hospital Charge Code |
3154869
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.09 |
| Max. Negotiated Rate |
$56.45 |
| Rate for Payer: Aetna Commercial |
$55.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$52.77
|
| 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 |
$32.52
|
| 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 |
$17.70
|
| Rate for Payer: Cash Price |
$17.70
|
| Rate for Payer: Cigna Commercial |
$56.45
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$8.09
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$34.34
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$8.09
|
| Rate for Payer: Health EOS Commercial |
$54.61
|
| Rate for Payer: HFN Commercial |
$56.45
|
| 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 |
$49.09
|
| Rate for Payer: NAPHCARE Commercial |
$12.14
|
| Rate for Payer: Preferred Network Access Commercial |
$56.45
|
| Rate for Payer: Quartz Beloit One Network |
$30.07
|
| Rate for Payer: Quartz Commercial |
$39.88
|
| 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 |
$46.02
|
| Rate for Payer: WEA Trust Commercial |
$33.75
|
| Rate for Payer: Wellcare Medicare |
$8.09
|
| Rate for Payer: WPS Commercial |
$45.45
|
|
|
Albumin, Pleural Fluid
|
Facility
|
OP
|
$59.00
|
|
|
Service Code
|
CPT 82042
|
| Hospital Charge Code |
3154868
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.09 |
| Max. Negotiated Rate |
$56.45 |
| Rate for Payer: Aetna Commercial |
$55.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$52.77
|
| 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 |
$32.52
|
| 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 |
$17.70
|
| Rate for Payer: Cash Price |
$17.70
|
| Rate for Payer: Cigna Commercial |
$56.45
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$8.09
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$34.34
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$8.09
|
| Rate for Payer: Health EOS Commercial |
$54.61
|
| Rate for Payer: HFN Commercial |
$56.45
|
| 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 |
$49.09
|
| Rate for Payer: NAPHCARE Commercial |
$12.14
|
| Rate for Payer: Preferred Network Access Commercial |
$56.45
|
| Rate for Payer: Quartz Beloit One Network |
$30.07
|
| Rate for Payer: Quartz Commercial |
$39.88
|
| 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 |
$46.02
|
| Rate for Payer: WEA Trust Commercial |
$33.75
|
| Rate for Payer: Wellcare Medicare |
$8.09
|
| Rate for Payer: WPS Commercial |
$45.45
|
|
|
Albumin, Pleural Fluid
|
Facility
|
IP
|
$59.00
|
|
|
Service Code
|
CPT 82042
|
| Hospital Charge Code |
3154868
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$30.07 |
| Max. Negotiated Rate |
$56.45 |
| Rate for Payer: Aetna Commercial |
$55.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$52.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$32.52
|
| Rate for Payer: Cash Price |
$17.70
|
| Rate for Payer: Cigna Commercial |
$56.45
|
| Rate for Payer: Health EOS Commercial |
$54.61
|
| Rate for Payer: HFN Commercial |
$56.45
|
| Rate for Payer: Multiplan Commercial |
$49.09
|
| Rate for Payer: Preferred Network Access Commercial |
$56.45
|
| Rate for Payer: Quartz Beloit One Network |
$30.07
|
| Rate for Payer: Quartz Commercial |
$36.82
|
| Rate for Payer: WEA Trust Commercial |
$33.75
|
| Rate for Payer: WPS Commercial |
$45.45
|
|
|
Albumin, Pleural Fluid
|
Professional
|
Both
|
$59.00
|
|
|
Service Code
|
CPT 82042
|
| Hospital Charge Code |
3154868
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.09 |
| Max. Negotiated Rate |
$58.29 |
| Rate for Payer: Aetna Commercial |
$58.29
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$52.77
|
| 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 |
$17.70
|
| Rate for Payer: Cash Price |
$17.70
|
| Rate for Payer: Cigna Commercial |
$58.29
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$30.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$8.09
|
| Rate for Payer: Health EOS Commercial |
$55.84
|
| Rate for Payer: HFN Commercial |
$58.29
|
| 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 |
$49.09
|
| Rate for Payer: NAPHCARE Commercial |
$12.14
|
| Rate for Payer: Preferred Network Access Commercial |
$58.29
|
| Rate for Payer: Quartz Beloit One Network |
$27.00
|
| Rate for Payer: Quartz Commercial |
$34.98
|
| 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 |
$33.75
|
| Rate for Payer: WPS Commercial |
$35.60
|
|
|
Albumin, Synovial Fluid
|
Facility
|
OP
|
$59.00
|
|
|
Service Code
|
CPT 82042
|
| Hospital Charge Code |
3154871
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.09 |
| Max. Negotiated Rate |
$56.45 |
| Rate for Payer: Aetna Commercial |
$55.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$52.77
|
| 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 |
$32.52
|
| 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 |
$17.70
|
| Rate for Payer: Cash Price |
$17.70
|
| Rate for Payer: Cigna Commercial |
$56.45
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$8.09
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$34.34
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$8.09
|
| Rate for Payer: Health EOS Commercial |
$54.61
|
| Rate for Payer: HFN Commercial |
$56.45
|
| 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 |
$49.09
|
| Rate for Payer: NAPHCARE Commercial |
$12.14
|
| Rate for Payer: Preferred Network Access Commercial |
$56.45
|
| Rate for Payer: Quartz Beloit One Network |
$30.07
|
| Rate for Payer: Quartz Commercial |
$39.88
|
| 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 |
$46.02
|
| Rate for Payer: WEA Trust Commercial |
$33.75
|
| Rate for Payer: Wellcare Medicare |
$8.09
|
| Rate for Payer: WPS Commercial |
$45.45
|
|
|
Albumin, Synovial Fluid
|
Facility
|
IP
|
$59.00
|
|
|
Service Code
|
CPT 82042
|
| Hospital Charge Code |
3154871
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$30.07 |
| Max. Negotiated Rate |
$56.45 |
| Rate for Payer: Aetna Commercial |
$55.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$52.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$32.52
|
| Rate for Payer: Cash Price |
$17.70
|
| Rate for Payer: Cigna Commercial |
$56.45
|
| Rate for Payer: Health EOS Commercial |
$54.61
|
| Rate for Payer: HFN Commercial |
$56.45
|
| Rate for Payer: Multiplan Commercial |
$49.09
|
| Rate for Payer: Preferred Network Access Commercial |
$56.45
|
| Rate for Payer: Quartz Beloit One Network |
$30.07
|
| Rate for Payer: Quartz Commercial |
$36.82
|
| Rate for Payer: WEA Trust Commercial |
$33.75
|
| Rate for Payer: WPS Commercial |
$45.45
|
|
|
Albumin, Synovial Fluid
|
Professional
|
Both
|
$59.00
|
|
|
Service Code
|
CPT 82042
|
| Hospital Charge Code |
3154871
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.09 |
| Max. Negotiated Rate |
$58.29 |
| Rate for Payer: Aetna Commercial |
$58.29
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$52.77
|
| 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 |
$17.70
|
| Rate for Payer: Cash Price |
$17.70
|
| Rate for Payer: Cigna Commercial |
$58.29
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$30.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$8.09
|
| Rate for Payer: Health EOS Commercial |
$55.84
|
| Rate for Payer: HFN Commercial |
$58.29
|
| 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 |
$49.09
|
| Rate for Payer: NAPHCARE Commercial |
$12.14
|
| Rate for Payer: Preferred Network Access Commercial |
$58.29
|
| Rate for Payer: Quartz Beloit One Network |
$27.00
|
| Rate for Payer: Quartz Commercial |
$34.98
|
| 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 |
$33.75
|
| Rate for Payer: WPS Commercial |
$35.60
|
|
|
albuterol 1 unit Charge
|
Professional
|
Both
|
$7.00
|
|
|
Service Code
|
HCPCS J7613
|
| Hospital Charge Code |
2958977
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.04 |
| Max. Negotiated Rate |
$6.92 |
| Rate for Payer: Aetna Commercial |
$6.92
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6.26
|
| Rate for Payer: Aetna Managed Medicare |
$0.07
|
| Rate for Payer: Anthem Medicare Advantage |
$0.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$0.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$0.07
|
| Rate for Payer: Cash Price |
$2.10
|
| Rate for Payer: Cash Price |
$2.10
|
| Rate for Payer: Cigna Commercial |
$6.92
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$0.07
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$0.04
|
| Rate for Payer: Health EOS Commercial |
$6.62
|
| Rate for Payer: HFN Commercial |
$6.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$0.06
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$0.06
|
| Rate for Payer: Independent Care Health Plan Medicare |
$0.07
|
| Rate for Payer: Multiplan Commercial |
$5.82
|
| Rate for Payer: NAPHCARE Commercial |
$0.11
|
| Rate for Payer: Preferred Network Access Commercial |
$6.92
|
| Rate for Payer: Quartz Beloit One Network |
$3.20
|
| Rate for Payer: Quartz Commercial |
$4.15
|
| Rate for Payer: Quartz Medicare Advantage |
$0.07
|
| Rate for Payer: The Alliance Commercial |
$0.20
|
| Rate for Payer: United Healthcare Medicaid |
$0.07
|
| Rate for Payer: United Healthcare Medicare Advantage |
$0.07
|
| Rate for Payer: WEA Trust Commercial |
$4.00
|
| Rate for Payer: WPS Commercial |
$0.10
|
|
|
albuterol 1 unit Charge
|
Facility
|
OP
|
$7.00
|
|
|
Service Code
|
HCPCS J7613
|
| Hospital Charge Code |
2958977
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.05 |
| Max. Negotiated Rate |
$6.70 |
| Rate for Payer: Aetna Commercial |
$6.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6.26
|
| Rate for Payer: Aetna Managed Medicare |
$2.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4.73
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3.64
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3.86
|
| Rate for Payer: Cash Price |
$2.10
|
| Rate for Payer: Cash Price |
$2.10
|
| Rate for Payer: Cigna Commercial |
$6.70
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$0.05
|
| Rate for Payer: Health EOS Commercial |
$6.48
|
| Rate for Payer: HFN Commercial |
$6.70
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5.46
|
| Rate for Payer: Multiplan Commercial |
$5.82
|
| Rate for Payer: NAPHCARE Commercial |
$4.37
|
| Rate for Payer: Preferred Network Access Commercial |
$6.70
|
| Rate for Payer: Quartz Beloit One Network |
$3.57
|
| Rate for Payer: Quartz Commercial |
$4.73
|
| Rate for Payer: Quartz Medicare Advantage |
$4.37
|
| Rate for Payer: The Alliance Commercial |
$0.29
|
| Rate for Payer: WEA Trust Commercial |
$4.00
|
| Rate for Payer: WPS Commercial |
$5.39
|
|
|
albuterol 1 unit Charge
|
Facility
|
IP
|
$7.00
|
|
|
Service Code
|
HCPCS J7613
|
| Hospital Charge Code |
2958977
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.57 |
| Max. Negotiated Rate |
$6.70 |
| Rate for Payer: Aetna Commercial |
$6.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3.86
|
| Rate for Payer: Cash Price |
$2.10
|
| Rate for Payer: Cigna Commercial |
$6.70
|
| Rate for Payer: Health EOS Commercial |
$6.48
|
| Rate for Payer: HFN Commercial |
$6.70
|
| Rate for Payer: Multiplan Commercial |
$5.82
|
| Rate for Payer: Preferred Network Access Commercial |
$6.70
|
| Rate for Payer: Quartz Beloit One Network |
$3.57
|
| Rate for Payer: Quartz Commercial |
$4.37
|
| Rate for Payer: WEA Trust Commercial |
$4.00
|
| Rate for Payer: WPS Commercial |
$5.39
|
|
|
Albuterol - Additional Unit Dose Medicaiton
|
Facility
|
OP
|
$36.00
|
|
| Hospital Charge Code |
5536669
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.48 |
| Max. Negotiated Rate |
$34.44 |
| Rate for Payer: Aetna Commercial |
$33.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$32.20
|
| Rate for Payer: Aetna Managed Medicare |
$10.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$24.34
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$18.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$17.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$19.84
|
| Rate for Payer: Cash Price |
$10.80
|
| Rate for Payer: Cigna Commercial |
$34.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$20.95
|
| Rate for Payer: Health EOS Commercial |
$33.32
|
| Rate for Payer: HFN Commercial |
$34.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$28.08
|
| Rate for Payer: Multiplan Commercial |
$29.95
|
| Rate for Payer: NAPHCARE Commercial |
$22.46
|
| Rate for Payer: Preferred Network Access Commercial |
$34.44
|
| Rate for Payer: Quartz Beloit One Network |
$18.35
|
| Rate for Payer: Quartz Commercial |
$24.34
|
| Rate for Payer: Quartz Medicare Advantage |
$22.46
|
| Rate for Payer: The Alliance Commercial |
$18.72
|
| Rate for Payer: WEA Trust Commercial |
$20.59
|
| Rate for Payer: WPS Commercial |
$27.73
|
|
|
Albuterol - Additional Unit Dose Medicaiton
|
Facility
|
IP
|
$36.00
|
|
| Hospital Charge Code |
5536669
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$18.35 |
| Max. Negotiated Rate |
$34.44 |
| Rate for Payer: Aetna Commercial |
$33.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$32.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$19.84
|
| Rate for Payer: Cash Price |
$10.80
|
| Rate for Payer: Cigna Commercial |
$34.44
|
| Rate for Payer: Health EOS Commercial |
$33.32
|
| Rate for Payer: HFN Commercial |
$34.44
|
| Rate for Payer: Multiplan Commercial |
$29.95
|
| Rate for Payer: Preferred Network Access Commercial |
$34.44
|
| Rate for Payer: Quartz Beloit One Network |
$18.35
|
| Rate for Payer: Quartz Commercial |
$22.46
|
| Rate for Payer: WEA Trust Commercial |
$20.59
|
| Rate for Payer: WPS Commercial |
$27.73
|
|
|
Albuterol non-comp unit J7613
|
Facility
|
OP
|
$3.00
|
|
| Hospital Charge Code |
4506702
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$0.87 |
| Max. Negotiated Rate |
$2.87 |
| Rate for Payer: Aetna Commercial |
$2.81
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2.68
|
| Rate for Payer: Aetna Managed Medicare |
$0.87
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2.03
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1.65
|
| Rate for Payer: Cash Price |
$0.90
|
| Rate for Payer: Cigna Commercial |
$2.87
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1.75
|
| Rate for Payer: Health EOS Commercial |
$2.78
|
| Rate for Payer: HFN Commercial |
$2.87
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2.34
|
| Rate for Payer: Multiplan Commercial |
$2.50
|
| Rate for Payer: NAPHCARE Commercial |
$1.87
|
| Rate for Payer: Preferred Network Access Commercial |
$2.87
|
| Rate for Payer: Quartz Beloit One Network |
$1.53
|
| Rate for Payer: Quartz Commercial |
$2.03
|
| Rate for Payer: Quartz Medicare Advantage |
$1.87
|
| Rate for Payer: The Alliance Commercial |
$1.56
|
| Rate for Payer: WEA Trust Commercial |
$1.72
|
| Rate for Payer: WPS Commercial |
$2.31
|
|
|
Albuterol non-comp unit J7613
|
Professional
|
Both
|
$3.00
|
|
| Hospital Charge Code |
4506702
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.37 |
| Max. Negotiated Rate |
$2.96 |
| Rate for Payer: Aetna Commercial |
$2.96
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2.68
|
| Rate for Payer: Cash Price |
$0.90
|
| Rate for Payer: Cigna Commercial |
$2.96
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1.87
|
| Rate for Payer: Health EOS Commercial |
$2.84
|
| Rate for Payer: HFN Commercial |
$2.96
|
| Rate for Payer: Multiplan Commercial |
$2.50
|
| Rate for Payer: Preferred Network Access Commercial |
$2.96
|
| Rate for Payer: Quartz Beloit One Network |
$1.37
|
| Rate for Payer: Quartz Commercial |
$1.78
|
| Rate for Payer: The Alliance Commercial |
$1.56
|
| Rate for Payer: WEA Trust Commercial |
$1.72
|
| Rate for Payer: WPS Commercial |
$2.31
|
|
|
Albuterol non-comp unit J7613
|
Facility
|
IP
|
$3.00
|
|
| Hospital Charge Code |
4506702
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.53 |
| Max. Negotiated Rate |
$2.87 |
| Rate for Payer: Aetna Commercial |
$2.81
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1.65
|
| Rate for Payer: Cash Price |
$0.90
|
| Rate for Payer: Cigna Commercial |
$2.87
|
| Rate for Payer: Health EOS Commercial |
$2.78
|
| Rate for Payer: HFN Commercial |
$2.87
|
| Rate for Payer: Multiplan Commercial |
$2.50
|
| Rate for Payer: Preferred Network Access Commercial |
$2.87
|
| Rate for Payer: Quartz Beloit One Network |
$1.53
|
| Rate for Payer: Quartz Commercial |
$1.87
|
| Rate for Payer: WEA Trust Commercial |
$1.72
|
| Rate for Payer: WPS Commercial |
$2.31
|
|
|
ALCOHOL ABUSE AND DEPENDENCE
|
Facility
|
IP
|
$5,348.67
|
|
|
Service Code
|
APR-DRG 7752
|
| Min. Negotiated Rate |
$4,751.02 |
| Max. Negotiated Rate |
$5,348.67 |
| Rate for Payer: Anthem Medicaid |
$5,121.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$5,121.65
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$5,121.65
|
| Rate for Payer: Dean Health Medicaid |
$5,121.65
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$4,751.02
|
| Rate for Payer: Managed Health Services Medicaid |
$5,348.67
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,121.65
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$5,121.65
|
| Rate for Payer: United Healthcare Medicaid |
$5,121.65
|
|
|
ALCOHOL ABUSE AND DEPENDENCE
|
Facility
|
IP
|
$3,507.32
|
|
|
Service Code
|
APR-DRG 7751
|
| Min. Negotiated Rate |
$3,115.42 |
| Max. Negotiated Rate |
$3,507.32 |
| Rate for Payer: Anthem Medicaid |
$3,358.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$3,358.46
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$3,358.46
|
| Rate for Payer: Dean Health Medicaid |
$3,358.46
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$3,115.42
|
| Rate for Payer: Managed Health Services Medicaid |
$3,507.32
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,358.46
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$3,358.46
|
| Rate for Payer: United Healthcare Medicaid |
$3,358.46
|
|
|
ALCOHOL ABUSE AND DEPENDENCE
|
Facility
|
IP
|
$9,732.82
|
|
|
Service Code
|
APR-DRG 7753
|
| Min. Negotiated Rate |
$8,645.30 |
| Max. Negotiated Rate |
$9,732.82 |
| Rate for Payer: Anthem Medicaid |
$9,319.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$9,319.72
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$9,319.72
|
| Rate for Payer: Dean Health Medicaid |
$9,319.72
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$8,645.30
|
| Rate for Payer: Managed Health Services Medicaid |
$9,732.82
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,319.72
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$9,319.72
|
| Rate for Payer: United Healthcare Medicaid |
$9,319.72
|
|
