|
Aldolase
|
Facility
|
OP
|
$168.00
|
|
|
Service Code
|
CPT 82085
|
| Hospital Charge Code |
633639
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.10 |
| Max. Negotiated Rate |
$160.74 |
| Rate for Payer: Aetna Commercial |
$157.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$150.26
|
| Rate for Payer: Aetna Managed Medicare |
$10.10
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$37.87
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$17.67
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$16.76
|
| Rate for Payer: Anthem Medicare Advantage |
$10.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$92.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$10.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$10.10
|
| Rate for Payer: Cash Price |
$50.40
|
| Rate for Payer: Cash Price |
$50.40
|
| Rate for Payer: Cigna Commercial |
$160.74
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$10.10
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$97.78
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$10.10
|
| Rate for Payer: Health EOS Commercial |
$155.50
|
| Rate for Payer: HFN Commercial |
$160.74
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$37.57
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$10.10
|
| Rate for Payer: Independent Care Health Plan Medicare |
$10.10
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$10.10
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$10.10
|
| Rate for Payer: Multiplan Commercial |
$139.78
|
| Rate for Payer: NAPHCARE Commercial |
$15.15
|
| Rate for Payer: Preferred Network Access Commercial |
$160.74
|
| Rate for Payer: Quartz Beloit One Network |
$85.61
|
| Rate for Payer: Quartz Commercial |
$113.57
|
| Rate for Payer: Quartz Medicare Advantage |
$10.10
|
| Rate for Payer: The Alliance Commercial |
$40.39
|
| Rate for Payer: United Healthcare Medicare Advantage |
$10.10
|
| Rate for Payer: United Healthcare PPO |
$131.04
|
| Rate for Payer: WEA Trust Commercial |
$96.10
|
| Rate for Payer: Wellcare Medicare |
$10.10
|
| Rate for Payer: WPS Commercial |
$129.41
|
|
|
Aldolase
|
Facility
|
IP
|
$168.00
|
|
|
Service Code
|
CPT 82085
|
| Hospital Charge Code |
633639
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$85.61 |
| Max. Negotiated Rate |
$160.74 |
| Rate for Payer: Aetna Commercial |
$157.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$150.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$92.60
|
| Rate for Payer: Cash Price |
$50.40
|
| Rate for Payer: Cigna Commercial |
$160.74
|
| Rate for Payer: Health EOS Commercial |
$155.50
|
| Rate for Payer: HFN Commercial |
$160.74
|
| Rate for Payer: Multiplan Commercial |
$139.78
|
| Rate for Payer: Preferred Network Access Commercial |
$160.74
|
| Rate for Payer: Quartz Beloit One Network |
$85.61
|
| Rate for Payer: Quartz Commercial |
$104.83
|
| Rate for Payer: WEA Trust Commercial |
$96.10
|
| Rate for Payer: WPS Commercial |
$129.41
|
|
|
Aldolase
|
Professional
|
Both
|
$168.00
|
|
|
Service Code
|
CPT 82085
|
| Hospital Charge Code |
633639
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.10 |
| Max. Negotiated Rate |
$165.98 |
| Rate for Payer: Aetna Commercial |
$165.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$150.26
|
| Rate for Payer: Aetna Managed Medicare |
$10.10
|
| Rate for Payer: Anthem Medicare Advantage |
$10.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$10.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$10.10
|
| Rate for Payer: Cash Price |
$50.40
|
| Rate for Payer: Cash Price |
$50.40
|
| Rate for Payer: Cigna Commercial |
$165.98
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$87.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$10.10
|
| Rate for Payer: Health EOS Commercial |
$159.00
|
| Rate for Payer: HFN Commercial |
$165.98
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$35.65
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$35.65
|
| Rate for Payer: Independent Care Health Plan Medicare |
$10.10
|
| Rate for Payer: Multiplan Commercial |
$139.78
|
| Rate for Payer: NAPHCARE Commercial |
$15.15
|
| Rate for Payer: Preferred Network Access Commercial |
$165.98
|
| Rate for Payer: Quartz Beloit One Network |
$76.88
|
| Rate for Payer: Quartz Commercial |
$99.59
|
| Rate for Payer: Quartz Medicare Advantage |
$10.10
|
| Rate for Payer: The Alliance Commercial |
$39.89
|
| Rate for Payer: United Healthcare Medicare Advantage |
$10.10
|
| Rate for Payer: WEA Trust Commercial |
$96.10
|
| Rate for Payer: WPS Commercial |
$44.43
|
|
|
Aldosterone
|
Facility
|
OP
|
$737.00
|
|
|
Service Code
|
CPT 82088
|
| Hospital Charge Code |
633640
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$42.38 |
| Max. Negotiated Rate |
$705.16 |
| Rate for Payer: Aetna Commercial |
$689.83
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$659.17
|
| Rate for Payer: Aetna Managed Medicare |
$42.38
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$158.93
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$74.17
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$70.35
|
| Rate for Payer: Anthem Medicare Advantage |
$42.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$406.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$42.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$42.38
|
| Rate for Payer: Cash Price |
$221.10
|
| Rate for Payer: Cash Price |
$221.10
|
| Rate for Payer: Cigna Commercial |
$705.16
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$42.38
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$428.93
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$42.38
|
| Rate for Payer: Health EOS Commercial |
$682.17
|
| Rate for Payer: HFN Commercial |
$705.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$157.65
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$42.38
|
| Rate for Payer: Independent Care Health Plan Medicare |
$42.38
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$42.38
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$42.38
|
| Rate for Payer: Multiplan Commercial |
$613.18
|
| Rate for Payer: NAPHCARE Commercial |
$63.57
|
| Rate for Payer: Preferred Network Access Commercial |
$705.16
|
| Rate for Payer: Quartz Beloit One Network |
$375.58
|
| Rate for Payer: Quartz Commercial |
$498.21
|
| Rate for Payer: Quartz Medicare Advantage |
$42.38
|
| Rate for Payer: The Alliance Commercial |
$169.52
|
| Rate for Payer: United Healthcare Medicare Advantage |
$42.38
|
| Rate for Payer: United Healthcare PPO |
$574.86
|
| Rate for Payer: WEA Trust Commercial |
$421.56
|
| Rate for Payer: Wellcare Medicare |
$42.38
|
| Rate for Payer: WPS Commercial |
$567.71
|
|
|
Aldosterone
|
Professional
|
Both
|
$737.00
|
|
|
Service Code
|
CPT 82088
|
| Hospital Charge Code |
633640
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$42.38 |
| Max. Negotiated Rate |
$728.16 |
| Rate for Payer: Aetna Commercial |
$728.16
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$659.17
|
| Rate for Payer: Aetna Managed Medicare |
$42.38
|
| Rate for Payer: Anthem Medicare Advantage |
$42.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$42.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$42.38
|
| Rate for Payer: Cash Price |
$221.10
|
| Rate for Payer: Cash Price |
$221.10
|
| Rate for Payer: Cigna Commercial |
$728.16
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$383.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$42.38
|
| Rate for Payer: Health EOS Commercial |
$697.50
|
| Rate for Payer: HFN Commercial |
$728.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$149.60
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$149.60
|
| Rate for Payer: Independent Care Health Plan Medicare |
$42.38
|
| Rate for Payer: Multiplan Commercial |
$613.18
|
| Rate for Payer: NAPHCARE Commercial |
$63.57
|
| Rate for Payer: Preferred Network Access Commercial |
$728.16
|
| Rate for Payer: Quartz Beloit One Network |
$337.25
|
| Rate for Payer: Quartz Commercial |
$436.89
|
| Rate for Payer: Quartz Medicare Advantage |
$42.38
|
| Rate for Payer: The Alliance Commercial |
$167.40
|
| Rate for Payer: United Healthcare Medicare Advantage |
$42.38
|
| Rate for Payer: WEA Trust Commercial |
$421.56
|
| Rate for Payer: WPS Commercial |
$186.47
|
|
|
Aldosterone
|
Facility
|
IP
|
$737.00
|
|
|
Service Code
|
CPT 82088
|
| Hospital Charge Code |
633640
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$375.58 |
| Max. Negotiated Rate |
$705.16 |
| Rate for Payer: Aetna Commercial |
$689.83
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$659.17
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$406.23
|
| Rate for Payer: Cash Price |
$221.10
|
| Rate for Payer: Cigna Commercial |
$705.16
|
| Rate for Payer: Health EOS Commercial |
$682.17
|
| Rate for Payer: HFN Commercial |
$705.16
|
| Rate for Payer: Multiplan Commercial |
$613.18
|
| Rate for Payer: Preferred Network Access Commercial |
$705.16
|
| Rate for Payer: Quartz Beloit One Network |
$375.58
|
| Rate for Payer: Quartz Commercial |
$459.89
|
| Rate for Payer: WEA Trust Commercial |
$421.56
|
| Rate for Payer: WPS Commercial |
$567.71
|
|
|
Aldosterone 24 Hour Urine
|
Facility
|
OP
|
$442.00
|
|
|
Service Code
|
CPT 82088
|
| Hospital Charge Code |
977775
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$42.38 |
| Max. Negotiated Rate |
$422.91 |
| Rate for Payer: Aetna Commercial |
$413.71
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$395.32
|
| Rate for Payer: Aetna Managed Medicare |
$42.38
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$158.93
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$74.17
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$70.35
|
| Rate for Payer: Anthem Medicare Advantage |
$42.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$243.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$42.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$42.38
|
| Rate for Payer: Cash Price |
$132.60
|
| Rate for Payer: Cash Price |
$132.60
|
| Rate for Payer: Cigna Commercial |
$422.91
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$42.38
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$257.24
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$42.38
|
| Rate for Payer: Health EOS Commercial |
$409.12
|
| Rate for Payer: HFN Commercial |
$422.91
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$157.65
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$42.38
|
| Rate for Payer: Independent Care Health Plan Medicare |
$42.38
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$42.38
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$42.38
|
| Rate for Payer: Multiplan Commercial |
$367.74
|
| Rate for Payer: NAPHCARE Commercial |
$63.57
|
| Rate for Payer: Preferred Network Access Commercial |
$422.91
|
| Rate for Payer: Quartz Beloit One Network |
$225.24
|
| Rate for Payer: Quartz Commercial |
$298.79
|
| Rate for Payer: Quartz Medicare Advantage |
$42.38
|
| Rate for Payer: The Alliance Commercial |
$169.52
|
| Rate for Payer: United Healthcare Medicare Advantage |
$42.38
|
| Rate for Payer: United Healthcare PPO |
$344.76
|
| Rate for Payer: WEA Trust Commercial |
$252.82
|
| Rate for Payer: Wellcare Medicare |
$42.38
|
| Rate for Payer: WPS Commercial |
$340.47
|
|
|
Aldosterone 24 Hour Urine
|
Professional
|
Both
|
$442.00
|
|
|
Service Code
|
CPT 82088
|
| Hospital Charge Code |
977775
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$42.38 |
| Max. Negotiated Rate |
$436.70 |
| Rate for Payer: Aetna Commercial |
$436.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$395.32
|
| Rate for Payer: Aetna Managed Medicare |
$42.38
|
| Rate for Payer: Anthem Medicare Advantage |
$42.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$42.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$42.38
|
| Rate for Payer: Cash Price |
$132.60
|
| Rate for Payer: Cash Price |
$132.60
|
| Rate for Payer: Cigna Commercial |
$436.70
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$229.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$42.38
|
| Rate for Payer: Health EOS Commercial |
$418.31
|
| Rate for Payer: HFN Commercial |
$436.70
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$149.60
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$149.60
|
| Rate for Payer: Independent Care Health Plan Medicare |
$42.38
|
| Rate for Payer: Multiplan Commercial |
$367.74
|
| Rate for Payer: NAPHCARE Commercial |
$63.57
|
| Rate for Payer: Preferred Network Access Commercial |
$436.70
|
| Rate for Payer: Quartz Beloit One Network |
$202.26
|
| Rate for Payer: Quartz Commercial |
$262.02
|
| Rate for Payer: Quartz Medicare Advantage |
$42.38
|
| Rate for Payer: The Alliance Commercial |
$167.40
|
| Rate for Payer: United Healthcare Medicare Advantage |
$42.38
|
| Rate for Payer: WEA Trust Commercial |
$252.82
|
| Rate for Payer: WPS Commercial |
$186.47
|
|
|
Aldosterone 24 Hour Urine
|
Facility
|
IP
|
$442.00
|
|
|
Service Code
|
CPT 82088
|
| Hospital Charge Code |
977775
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$225.24 |
| Max. Negotiated Rate |
$422.91 |
| Rate for Payer: Aetna Commercial |
$413.71
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$395.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$243.63
|
| Rate for Payer: Cash Price |
$132.60
|
| Rate for Payer: Cigna Commercial |
$422.91
|
| Rate for Payer: Health EOS Commercial |
$409.12
|
| Rate for Payer: HFN Commercial |
$422.91
|
| Rate for Payer: Multiplan Commercial |
$367.74
|
| Rate for Payer: Preferred Network Access Commercial |
$422.91
|
| Rate for Payer: Quartz Beloit One Network |
$225.24
|
| Rate for Payer: Quartz Commercial |
$275.81
|
| Rate for Payer: WEA Trust Commercial |
$252.82
|
| Rate for Payer: WPS Commercial |
$340.47
|
|
|
Aldosterone/Plasma Renin Activity Ratio
|
Professional
|
Both
|
$329.00
|
|
|
Service Code
|
CPT 82088
|
| Hospital Charge Code |
980015
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$42.38 |
| Max. Negotiated Rate |
$325.05 |
| Rate for Payer: Aetna Commercial |
$325.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$294.26
|
| Rate for Payer: Aetna Managed Medicare |
$42.38
|
| Rate for Payer: Anthem Medicare Advantage |
$42.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$42.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$42.38
|
| Rate for Payer: Cash Price |
$98.70
|
| Rate for Payer: Cash Price |
$98.70
|
| Rate for Payer: Cigna Commercial |
$325.05
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$171.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$42.38
|
| Rate for Payer: Health EOS Commercial |
$311.37
|
| Rate for Payer: HFN Commercial |
$325.05
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$149.60
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$149.60
|
| Rate for Payer: Independent Care Health Plan Medicare |
$42.38
|
| Rate for Payer: Multiplan Commercial |
$273.73
|
| Rate for Payer: NAPHCARE Commercial |
$63.57
|
| Rate for Payer: Preferred Network Access Commercial |
$325.05
|
| Rate for Payer: Quartz Beloit One Network |
$150.55
|
| Rate for Payer: Quartz Commercial |
$195.03
|
| Rate for Payer: Quartz Medicare Advantage |
$42.38
|
| Rate for Payer: The Alliance Commercial |
$167.40
|
| Rate for Payer: United Healthcare Medicare Advantage |
$42.38
|
| Rate for Payer: WEA Trust Commercial |
$188.19
|
| Rate for Payer: WPS Commercial |
$186.47
|
|
|
Aldosterone/Plasma Renin Activity Ratio
|
Facility
|
IP
|
$329.00
|
|
|
Service Code
|
CPT 82088
|
| Hospital Charge Code |
980015
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$167.66 |
| Max. Negotiated Rate |
$314.79 |
| Rate for Payer: Aetna Commercial |
$307.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$294.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$181.34
|
| Rate for Payer: Cash Price |
$98.70
|
| Rate for Payer: Cigna Commercial |
$314.79
|
| Rate for Payer: Health EOS Commercial |
$304.52
|
| Rate for Payer: HFN Commercial |
$314.79
|
| Rate for Payer: Multiplan Commercial |
$273.73
|
| Rate for Payer: Preferred Network Access Commercial |
$314.79
|
| Rate for Payer: Quartz Beloit One Network |
$167.66
|
| Rate for Payer: Quartz Commercial |
$205.30
|
| Rate for Payer: WEA Trust Commercial |
$188.19
|
| Rate for Payer: WPS Commercial |
$253.43
|
|
|
Aldosterone/Plasma Renin Activity Ratio
|
Facility
|
OP
|
$329.00
|
|
|
Service Code
|
CPT 82088
|
| Hospital Charge Code |
980015
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$42.38 |
| Max. Negotiated Rate |
$314.79 |
| Rate for Payer: Aetna Commercial |
$307.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$294.26
|
| Rate for Payer: Aetna Managed Medicare |
$42.38
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$158.93
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$74.17
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$70.35
|
| Rate for Payer: Anthem Medicare Advantage |
$42.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$181.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$42.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$42.38
|
| Rate for Payer: Cash Price |
$98.70
|
| Rate for Payer: Cash Price |
$98.70
|
| Rate for Payer: Cigna Commercial |
$314.79
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$42.38
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$191.48
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$42.38
|
| Rate for Payer: Health EOS Commercial |
$304.52
|
| Rate for Payer: HFN Commercial |
$314.79
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$157.65
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$42.38
|
| Rate for Payer: Independent Care Health Plan Medicare |
$42.38
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$42.38
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$42.38
|
| Rate for Payer: Multiplan Commercial |
$273.73
|
| Rate for Payer: NAPHCARE Commercial |
$63.57
|
| Rate for Payer: Preferred Network Access Commercial |
$314.79
|
| Rate for Payer: Quartz Beloit One Network |
$167.66
|
| Rate for Payer: Quartz Commercial |
$222.40
|
| Rate for Payer: Quartz Medicare Advantage |
$42.38
|
| Rate for Payer: The Alliance Commercial |
$169.52
|
| Rate for Payer: United Healthcare Medicare Advantage |
$42.38
|
| Rate for Payer: United Healthcare PPO |
$256.62
|
| Rate for Payer: WEA Trust Commercial |
$188.19
|
| Rate for Payer: Wellcare Medicare |
$42.38
|
| Rate for Payer: WPS Commercial |
$253.43
|
|
|
ALD, TV Amplifier, Any Type
|
Professional
|
Both
|
$243.00
|
|
|
Service Code
|
HCPCS V5270
|
| Hospital Charge Code |
3243677
|
|
Hospital Revenue Code
|
470
|
| Min. Negotiated Rate |
$111.20 |
| Max. Negotiated Rate |
$240.08 |
| Rate for Payer: Aetna Commercial |
$240.08
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$217.34
|
| Rate for Payer: Cash Price |
$72.90
|
| Rate for Payer: Cigna Commercial |
$240.08
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$126.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$151.63
|
| Rate for Payer: Health EOS Commercial |
$229.98
|
| Rate for Payer: HFN Commercial |
$240.08
|
| Rate for Payer: Multiplan Commercial |
$202.18
|
| Rate for Payer: Preferred Network Access Commercial |
$240.08
|
| Rate for Payer: Quartz Beloit One Network |
$111.20
|
| Rate for Payer: Quartz Commercial |
$144.05
|
| Rate for Payer: The Alliance Commercial |
$126.36
|
| Rate for Payer: WEA Trust Commercial |
$139.00
|
| Rate for Payer: WPS Commercial |
$187.18
|
|
|
ALD, TV Amplifier, Any Type
|
Facility
|
IP
|
$243.00
|
|
|
Service Code
|
HCPCS V5270
|
| Hospital Charge Code |
3243677
|
|
Hospital Revenue Code
|
470
|
| Min. Negotiated Rate |
$123.83 |
| Max. Negotiated Rate |
$232.50 |
| Rate for Payer: Aetna Commercial |
$227.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$217.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$133.94
|
| Rate for Payer: Cash Price |
$72.90
|
| Rate for Payer: Cigna Commercial |
$232.50
|
| Rate for Payer: Health EOS Commercial |
$224.92
|
| Rate for Payer: HFN Commercial |
$232.50
|
| Rate for Payer: Multiplan Commercial |
$202.18
|
| Rate for Payer: Preferred Network Access Commercial |
$232.50
|
| Rate for Payer: Quartz Beloit One Network |
$123.83
|
| Rate for Payer: Quartz Commercial |
$151.63
|
| Rate for Payer: WEA Trust Commercial |
$139.00
|
| Rate for Payer: WPS Commercial |
$187.18
|
|
|
ALD, TV Amplifier, Any Type
|
Facility
|
OP
|
$243.00
|
|
|
Service Code
|
HCPCS V5270
|
| Hospital Charge Code |
3243677
|
|
Hospital Revenue Code
|
470
|
| Min. Negotiated Rate |
$70.76 |
| Max. Negotiated Rate |
$232.50 |
| Rate for Payer: Aetna Commercial |
$227.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$217.34
|
| Rate for Payer: Aetna Managed Medicare |
$70.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$164.27
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$126.36
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$121.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$133.94
|
| Rate for Payer: Cash Price |
$72.90
|
| Rate for Payer: Cigna Commercial |
$232.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$141.43
|
| Rate for Payer: Health EOS Commercial |
$224.92
|
| Rate for Payer: HFN Commercial |
$232.50
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$189.54
|
| Rate for Payer: Multiplan Commercial |
$202.18
|
| Rate for Payer: NAPHCARE Commercial |
$151.63
|
| Rate for Payer: Preferred Network Access Commercial |
$232.50
|
| Rate for Payer: Quartz Beloit One Network |
$123.83
|
| Rate for Payer: Quartz Commercial |
$164.27
|
| Rate for Payer: Quartz Medicare Advantage |
$151.63
|
| Rate for Payer: The Alliance Commercial |
$126.36
|
| Rate for Payer: United Healthcare PPO |
$189.54
|
| Rate for Payer: WEA Trust Commercial |
$139.00
|
| Rate for Payer: WPS Commercial |
$187.18
|
|
|
ALD Unspecified
|
Facility
|
OP
|
$309.00
|
|
|
Service Code
|
HCPCS V5274
|
| Hospital Charge Code |
3243684
|
|
Hospital Revenue Code
|
470
|
| Min. Negotiated Rate |
$89.98 |
| Max. Negotiated Rate |
$295.65 |
| Rate for Payer: Aetna Commercial |
$289.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$276.37
|
| Rate for Payer: Aetna Managed Medicare |
$89.98
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$208.88
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$160.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$154.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$170.32
|
| Rate for Payer: Cash Price |
$92.70
|
| Rate for Payer: Cigna Commercial |
$295.65
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$179.84
|
| Rate for Payer: Health EOS Commercial |
$286.01
|
| Rate for Payer: HFN Commercial |
$295.65
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$241.02
|
| Rate for Payer: Multiplan Commercial |
$257.09
|
| Rate for Payer: NAPHCARE Commercial |
$192.82
|
| Rate for Payer: Preferred Network Access Commercial |
$295.65
|
| Rate for Payer: Quartz Beloit One Network |
$157.47
|
| Rate for Payer: Quartz Commercial |
$208.88
|
| Rate for Payer: Quartz Medicare Advantage |
$192.82
|
| Rate for Payer: The Alliance Commercial |
$160.68
|
| Rate for Payer: United Healthcare PPO |
$241.02
|
| Rate for Payer: WEA Trust Commercial |
$176.75
|
| Rate for Payer: WPS Commercial |
$238.02
|
|
|
ALD Unspecified
|
Facility
|
IP
|
$309.00
|
|
|
Service Code
|
HCPCS V5274
|
| Hospital Charge Code |
3243684
|
|
Hospital Revenue Code
|
470
|
| Min. Negotiated Rate |
$157.47 |
| Max. Negotiated Rate |
$295.65 |
| Rate for Payer: Aetna Commercial |
$289.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$276.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$170.32
|
| Rate for Payer: Cash Price |
$92.70
|
| Rate for Payer: Cigna Commercial |
$295.65
|
| Rate for Payer: Health EOS Commercial |
$286.01
|
| Rate for Payer: HFN Commercial |
$295.65
|
| Rate for Payer: Multiplan Commercial |
$257.09
|
| Rate for Payer: Preferred Network Access Commercial |
$295.65
|
| Rate for Payer: Quartz Beloit One Network |
$157.47
|
| Rate for Payer: Quartz Commercial |
$192.82
|
| Rate for Payer: WEA Trust Commercial |
$176.75
|
| Rate for Payer: WPS Commercial |
$238.02
|
|
|
ALD Unspecified
|
Professional
|
Both
|
$309.00
|
|
|
Service Code
|
HCPCS V5274
|
| Hospital Charge Code |
3243684
|
|
Hospital Revenue Code
|
470
|
| Min. Negotiated Rate |
$141.40 |
| Max. Negotiated Rate |
$305.29 |
| Rate for Payer: Aetna Commercial |
$305.29
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$276.37
|
| Rate for Payer: Cash Price |
$92.70
|
| Rate for Payer: Cigna Commercial |
$305.29
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$160.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$192.82
|
| Rate for Payer: Health EOS Commercial |
$292.44
|
| Rate for Payer: HFN Commercial |
$305.29
|
| Rate for Payer: Multiplan Commercial |
$257.09
|
| Rate for Payer: Preferred Network Access Commercial |
$305.29
|
| Rate for Payer: Quartz Beloit One Network |
$141.40
|
| Rate for Payer: Quartz Commercial |
$183.18
|
| Rate for Payer: The Alliance Commercial |
$160.68
|
| Rate for Payer: WEA Trust Commercial |
$176.75
|
| Rate for Payer: WPS Commercial |
$238.02
|
|
|
Alginate charge
|
Facility
|
IP
|
$308.00
|
|
| Hospital Charge Code |
3006902
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$156.96 |
| Max. Negotiated Rate |
$294.69 |
| Rate for Payer: Aetna Commercial |
$288.29
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$275.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$169.77
|
| Rate for Payer: Cash Price |
$92.40
|
| Rate for Payer: Cigna Commercial |
$294.69
|
| Rate for Payer: Health EOS Commercial |
$285.08
|
| Rate for Payer: HFN Commercial |
$294.69
|
| Rate for Payer: Multiplan Commercial |
$256.26
|
| Rate for Payer: Preferred Network Access Commercial |
$294.69
|
| Rate for Payer: Quartz Beloit One Network |
$156.96
|
| Rate for Payer: Quartz Commercial |
$192.19
|
| Rate for Payer: WEA Trust Commercial |
$176.18
|
| Rate for Payer: WPS Commercial |
$237.25
|
|
|
Alginate charge
|
Facility
|
OP
|
$308.00
|
|
| Hospital Charge Code |
3006902
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$89.69 |
| Max. Negotiated Rate |
$294.69 |
| Rate for Payer: Aetna Commercial |
$288.29
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$275.48
|
| Rate for Payer: Aetna Managed Medicare |
$89.69
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$208.21
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$160.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$153.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$169.77
|
| Rate for Payer: Cash Price |
$92.40
|
| Rate for Payer: Cigna Commercial |
$294.69
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$179.26
|
| Rate for Payer: Health EOS Commercial |
$285.08
|
| Rate for Payer: HFN Commercial |
$294.69
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$240.24
|
| Rate for Payer: Multiplan Commercial |
$256.26
|
| Rate for Payer: NAPHCARE Commercial |
$192.19
|
| Rate for Payer: Preferred Network Access Commercial |
$294.69
|
| Rate for Payer: Quartz Beloit One Network |
$156.96
|
| Rate for Payer: Quartz Commercial |
$208.21
|
| Rate for Payer: Quartz Medicare Advantage |
$192.19
|
| Rate for Payer: The Alliance Commercial |
$160.16
|
| Rate for Payer: WEA Trust Commercial |
$176.18
|
| Rate for Payer: WPS Commercial |
$237.25
|
|
|
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 |
$2,251.85 |
| Max. Negotiated Rate |
$7,398.93 |
| Rate for Payer: Aetna Commercial |
$7,238.09
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,916.40
|
| Rate for Payer: Aetna Managed Medicare |
$2,251.85
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,227.51
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,021.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,860.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,262.43
|
| Rate for Payer: Cash Price |
$2,319.90
|
| Rate for Payer: Cigna Commercial |
$7,398.93
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,500.61
|
| Rate for Payer: Health EOS Commercial |
$7,157.66
|
| Rate for Payer: HFN Commercial |
$7,398.93
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,031.74
|
| Rate for Payer: Multiplan Commercial |
$6,433.86
|
| Rate for Payer: NAPHCARE Commercial |
$4,825.39
|
| Rate for Payer: Preferred Network Access Commercial |
$7,398.93
|
| Rate for Payer: Quartz Beloit One Network |
$3,940.74
|
| Rate for Payer: Quartz Commercial |
$5,227.51
|
| Rate for Payer: Quartz Medicare Advantage |
$4,825.39
|
| Rate for Payer: The Alliance Commercial |
$4,021.16
|
| Rate for Payer: WEA Trust Commercial |
$4,423.28
|
| Rate for Payer: WPS Commercial |
$5,956.73
|
|
|
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 |
$3,940.74 |
| Max. Negotiated Rate |
$7,398.93 |
| Rate for Payer: Aetna Commercial |
$7,238.09
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,916.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,262.43
|
| Rate for Payer: Cash Price |
$2,319.90
|
| Rate for Payer: Cigna Commercial |
$7,398.93
|
| Rate for Payer: Health EOS Commercial |
$7,157.66
|
| Rate for Payer: HFN Commercial |
$7,398.93
|
| Rate for Payer: Multiplan Commercial |
$6,433.86
|
| Rate for Payer: Preferred Network Access Commercial |
$7,398.93
|
| Rate for Payer: Quartz Beloit One Network |
$3,940.74
|
| Rate for Payer: Quartz Commercial |
$4,825.39
|
| Rate for Payer: WEA Trust Commercial |
$4,423.28
|
| Rate for Payer: WPS Commercial |
$5,956.73
|
|
|
ALIMENTARY TESTS AND TUBE INSERTION OR PLACEMENT
|
Facility
|
OP
|
$359.02
|
|
|
Service Code
|
EAPG 00130
|
| Min. Negotiated Rate |
$345.21 |
| Max. Negotiated Rate |
$359.02 |
| Rate for Payer: Anthem Medicaid |
$345.21
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$345.21
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$345.21
|
| Rate for Payer: Dean Health Medicaid |
$345.21
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$345.21
|
| Rate for Payer: Managed Health Services Medicaid |
$359.02
|
| Rate for Payer: Molina Healthcare Medicaid |
$345.21
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$345.21
|
| Rate for Payer: United Healthcare Medicaid |
$345.21
|
|
|
Alimta 10 mg Charge
|
Facility
|
IP
|
$235.00
|
|
|
Service Code
|
HCPCS J9305
|
| Hospital Charge Code |
2958861
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$119.76 |
| Max. Negotiated Rate |
$224.85 |
| Rate for Payer: Aetna Commercial |
$219.96
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$210.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$129.53
|
| Rate for Payer: Cash Price |
$70.50
|
| Rate for Payer: Cigna Commercial |
$224.85
|
| Rate for Payer: Health EOS Commercial |
$217.52
|
| Rate for Payer: HFN Commercial |
$224.85
|
| Rate for Payer: Multiplan Commercial |
$195.52
|
| Rate for Payer: Preferred Network Access Commercial |
$224.85
|
| Rate for Payer: Quartz Beloit One Network |
$119.76
|
| Rate for Payer: Quartz Commercial |
$146.64
|
| Rate for Payer: WEA Trust Commercial |
$134.42
|
| Rate for Payer: WPS Commercial |
$181.02
|
|
|
Alimta 10 mg Charge
|
Professional
|
Both
|
$235.00
|
|
|
Service Code
|
HCPCS J9305
|
| Hospital Charge Code |
2958861
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.73 |
| Max. Negotiated Rate |
$232.18 |
| Rate for Payer: Aetna Commercial |
$232.18
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$210.18
|
| Rate for Payer: Aetna Managed Medicare |
$3.73
|
| Rate for Payer: Anthem Medicare Advantage |
$3.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$3.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$3.73
|
| Rate for Payer: Cash Price |
$70.50
|
| Rate for Payer: Cash Price |
$70.50
|
| Rate for Payer: Cigna Commercial |
$232.18
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$3.73
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4.13
|
| Rate for Payer: Health EOS Commercial |
$222.40
|
| Rate for Payer: HFN Commercial |
$232.18
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$110.72
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$110.72
|
| Rate for Payer: Independent Care Health Plan Medicare |
$3.73
|
| Rate for Payer: Multiplan Commercial |
$195.52
|
| Rate for Payer: NAPHCARE Commercial |
$5.60
|
| Rate for Payer: Preferred Network Access Commercial |
$232.18
|
| Rate for Payer: Quartz Beloit One Network |
$107.54
|
| Rate for Payer: Quartz Commercial |
$139.31
|
| Rate for Payer: Quartz Medicare Advantage |
$3.73
|
| Rate for Payer: The Alliance Commercial |
$10.27
|
| Rate for Payer: United Healthcare Medicaid |
$3.73
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3.73
|
| Rate for Payer: WEA Trust Commercial |
$134.42
|
| Rate for Payer: WPS Commercial |
$10.32
|
|
