|
Glucose, PDI Fluid
|
Facility
|
OP
|
$145.00
|
|
|
Service Code
|
CPT 82945
|
| Hospital Charge Code |
3768168
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.09 |
| Max. Negotiated Rate |
$138.74 |
| Rate for Payer: Aetna Commercial |
$135.72
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$129.69
|
| Rate for Payer: Aetna Managed Medicare |
$4.09
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$15.33
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$7.15
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$6.78
|
| Rate for Payer: Anthem Medicare Advantage |
$4.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$79.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$4.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$4.09
|
| Rate for Payer: Cash Price |
$43.50
|
| Rate for Payer: Cash Price |
$43.50
|
| Rate for Payer: Cigna Commercial |
$138.74
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$4.09
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$84.39
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$4.09
|
| Rate for Payer: Health EOS Commercial |
$134.21
|
| Rate for Payer: HFN Commercial |
$138.74
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$15.20
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$4.09
|
| Rate for Payer: Independent Care Health Plan Medicare |
$4.09
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$4.09
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$4.09
|
| Rate for Payer: Multiplan Commercial |
$120.64
|
| Rate for Payer: NAPHCARE Commercial |
$6.13
|
| Rate for Payer: Preferred Network Access Commercial |
$138.74
|
| Rate for Payer: Quartz Beloit One Network |
$73.89
|
| Rate for Payer: Quartz Commercial |
$98.02
|
| Rate for Payer: Quartz Medicare Advantage |
$4.09
|
| Rate for Payer: The Alliance Commercial |
$16.35
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4.09
|
| Rate for Payer: United Healthcare PPO |
$113.10
|
| Rate for Payer: WEA Trust Commercial |
$82.94
|
| Rate for Payer: Wellcare Medicare |
$4.09
|
| Rate for Payer: WPS Commercial |
$111.69
|
|
|
Glucose, PDI Fluid
|
Professional
|
Both
|
$145.00
|
|
|
Service Code
|
CPT 82945
|
| Hospital Charge Code |
3768168
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.09 |
| Max. Negotiated Rate |
$143.26 |
| Rate for Payer: Aetna Commercial |
$143.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$129.69
|
| Rate for Payer: Aetna Managed Medicare |
$4.09
|
| Rate for Payer: Anthem Medicare Advantage |
$4.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$4.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$4.09
|
| Rate for Payer: Cash Price |
$43.50
|
| Rate for Payer: Cash Price |
$43.50
|
| Rate for Payer: Cigna Commercial |
$143.26
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$75.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4.09
|
| Rate for Payer: Health EOS Commercial |
$137.23
|
| Rate for Payer: HFN Commercial |
$143.26
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$14.42
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$14.42
|
| Rate for Payer: Independent Care Health Plan Medicare |
$4.09
|
| Rate for Payer: Multiplan Commercial |
$120.64
|
| Rate for Payer: NAPHCARE Commercial |
$6.13
|
| Rate for Payer: Preferred Network Access Commercial |
$143.26
|
| Rate for Payer: Quartz Beloit One Network |
$66.35
|
| Rate for Payer: Quartz Commercial |
$85.96
|
| Rate for Payer: Quartz Medicare Advantage |
$4.09
|
| Rate for Payer: The Alliance Commercial |
$16.14
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4.09
|
| Rate for Payer: WEA Trust Commercial |
$82.94
|
| Rate for Payer: WPS Commercial |
$17.98
|
|
|
Glucose, Pericardial Fluid
|
Facility
|
IP
|
$114.00
|
|
|
Service Code
|
CPT 82945
|
| Hospital Charge Code |
3154861
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$58.09 |
| Max. Negotiated Rate |
$109.08 |
| Rate for Payer: Aetna Commercial |
$106.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$101.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$62.84
|
| Rate for Payer: Cash Price |
$34.20
|
| Rate for Payer: Cigna Commercial |
$109.08
|
| Rate for Payer: Health EOS Commercial |
$105.52
|
| Rate for Payer: HFN Commercial |
$109.08
|
| Rate for Payer: Multiplan Commercial |
$94.85
|
| Rate for Payer: Preferred Network Access Commercial |
$109.08
|
| Rate for Payer: Quartz Beloit One Network |
$58.09
|
| Rate for Payer: Quartz Commercial |
$71.14
|
| Rate for Payer: WEA Trust Commercial |
$65.21
|
| Rate for Payer: WPS Commercial |
$87.81
|
|
|
Glucose, Pericardial Fluid
|
Facility
|
OP
|
$114.00
|
|
|
Service Code
|
CPT 82945
|
| Hospital Charge Code |
3154861
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.09 |
| Max. Negotiated Rate |
$109.08 |
| Rate for Payer: Aetna Commercial |
$106.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$101.96
|
| Rate for Payer: Aetna Managed Medicare |
$4.09
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$15.33
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$7.15
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$6.78
|
| Rate for Payer: Anthem Medicare Advantage |
$4.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$62.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$4.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$4.09
|
| Rate for Payer: Cash Price |
$34.20
|
| Rate for Payer: Cash Price |
$34.20
|
| Rate for Payer: Cigna Commercial |
$109.08
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$4.09
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$66.35
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$4.09
|
| Rate for Payer: Health EOS Commercial |
$105.52
|
| Rate for Payer: HFN Commercial |
$109.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$15.20
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$4.09
|
| Rate for Payer: Independent Care Health Plan Medicare |
$4.09
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$4.09
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$4.09
|
| Rate for Payer: Multiplan Commercial |
$94.85
|
| Rate for Payer: NAPHCARE Commercial |
$6.13
|
| Rate for Payer: Preferred Network Access Commercial |
$109.08
|
| Rate for Payer: Quartz Beloit One Network |
$58.09
|
| Rate for Payer: Quartz Commercial |
$77.06
|
| Rate for Payer: Quartz Medicare Advantage |
$4.09
|
| Rate for Payer: The Alliance Commercial |
$16.35
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4.09
|
| Rate for Payer: United Healthcare PPO |
$88.92
|
| Rate for Payer: WEA Trust Commercial |
$65.21
|
| Rate for Payer: Wellcare Medicare |
$4.09
|
| Rate for Payer: WPS Commercial |
$87.81
|
|
|
Glucose, Pericardial Fluid
|
Professional
|
Both
|
$114.00
|
|
|
Service Code
|
CPT 82945
|
| Hospital Charge Code |
3154861
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.09 |
| Max. Negotiated Rate |
$112.63 |
| Rate for Payer: Aetna Commercial |
$112.63
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$101.96
|
| Rate for Payer: Aetna Managed Medicare |
$4.09
|
| Rate for Payer: Anthem Medicare Advantage |
$4.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$4.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$4.09
|
| Rate for Payer: Cash Price |
$34.20
|
| Rate for Payer: Cash Price |
$34.20
|
| Rate for Payer: Cigna Commercial |
$112.63
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$59.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4.09
|
| Rate for Payer: Health EOS Commercial |
$107.89
|
| Rate for Payer: HFN Commercial |
$112.63
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$14.42
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$14.42
|
| Rate for Payer: Independent Care Health Plan Medicare |
$4.09
|
| Rate for Payer: Multiplan Commercial |
$94.85
|
| Rate for Payer: NAPHCARE Commercial |
$6.13
|
| Rate for Payer: Preferred Network Access Commercial |
$112.63
|
| Rate for Payer: Quartz Beloit One Network |
$52.17
|
| Rate for Payer: Quartz Commercial |
$67.58
|
| Rate for Payer: Quartz Medicare Advantage |
$4.09
|
| Rate for Payer: The Alliance Commercial |
$16.14
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4.09
|
| Rate for Payer: WEA Trust Commercial |
$65.21
|
| Rate for Payer: WPS Commercial |
$17.98
|
|
|
Glucose, Peritoneal Fluid
|
Facility
|
OP
|
$114.00
|
|
|
Service Code
|
CPT 82945
|
| Hospital Charge Code |
3154863
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.09 |
| Max. Negotiated Rate |
$109.08 |
| Rate for Payer: Aetna Commercial |
$106.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$101.96
|
| Rate for Payer: Aetna Managed Medicare |
$4.09
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$15.33
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$7.15
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$6.78
|
| Rate for Payer: Anthem Medicare Advantage |
$4.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$62.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$4.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$4.09
|
| Rate for Payer: Cash Price |
$34.20
|
| Rate for Payer: Cash Price |
$34.20
|
| Rate for Payer: Cigna Commercial |
$109.08
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$4.09
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$66.35
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$4.09
|
| Rate for Payer: Health EOS Commercial |
$105.52
|
| Rate for Payer: HFN Commercial |
$109.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$15.20
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$4.09
|
| Rate for Payer: Independent Care Health Plan Medicare |
$4.09
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$4.09
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$4.09
|
| Rate for Payer: Multiplan Commercial |
$94.85
|
| Rate for Payer: NAPHCARE Commercial |
$6.13
|
| Rate for Payer: Preferred Network Access Commercial |
$109.08
|
| Rate for Payer: Quartz Beloit One Network |
$58.09
|
| Rate for Payer: Quartz Commercial |
$77.06
|
| Rate for Payer: Quartz Medicare Advantage |
$4.09
|
| Rate for Payer: The Alliance Commercial |
$16.35
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4.09
|
| Rate for Payer: United Healthcare PPO |
$88.92
|
| Rate for Payer: WEA Trust Commercial |
$65.21
|
| Rate for Payer: Wellcare Medicare |
$4.09
|
| Rate for Payer: WPS Commercial |
$87.81
|
|
|
Glucose, Peritoneal Fluid
|
Facility
|
IP
|
$114.00
|
|
|
Service Code
|
CPT 82945
|
| Hospital Charge Code |
3154863
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$58.09 |
| Max. Negotiated Rate |
$109.08 |
| Rate for Payer: Aetna Commercial |
$106.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$101.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$62.84
|
| Rate for Payer: Cash Price |
$34.20
|
| Rate for Payer: Cigna Commercial |
$109.08
|
| Rate for Payer: Health EOS Commercial |
$105.52
|
| Rate for Payer: HFN Commercial |
$109.08
|
| Rate for Payer: Multiplan Commercial |
$94.85
|
| Rate for Payer: Preferred Network Access Commercial |
$109.08
|
| Rate for Payer: Quartz Beloit One Network |
$58.09
|
| Rate for Payer: Quartz Commercial |
$71.14
|
| Rate for Payer: WEA Trust Commercial |
$65.21
|
| Rate for Payer: WPS Commercial |
$87.81
|
|
|
Glucose, Peritoneal Fluid
|
Professional
|
Both
|
$114.00
|
|
|
Service Code
|
CPT 82945
|
| Hospital Charge Code |
3154863
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.09 |
| Max. Negotiated Rate |
$112.63 |
| Rate for Payer: Aetna Commercial |
$112.63
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$101.96
|
| Rate for Payer: Aetna Managed Medicare |
$4.09
|
| Rate for Payer: Anthem Medicare Advantage |
$4.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$4.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$4.09
|
| Rate for Payer: Cash Price |
$34.20
|
| Rate for Payer: Cash Price |
$34.20
|
| Rate for Payer: Cigna Commercial |
$112.63
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$59.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4.09
|
| Rate for Payer: Health EOS Commercial |
$107.89
|
| Rate for Payer: HFN Commercial |
$112.63
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$14.42
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$14.42
|
| Rate for Payer: Independent Care Health Plan Medicare |
$4.09
|
| Rate for Payer: Multiplan Commercial |
$94.85
|
| Rate for Payer: NAPHCARE Commercial |
$6.13
|
| Rate for Payer: Preferred Network Access Commercial |
$112.63
|
| Rate for Payer: Quartz Beloit One Network |
$52.17
|
| Rate for Payer: Quartz Commercial |
$67.58
|
| Rate for Payer: Quartz Medicare Advantage |
$4.09
|
| Rate for Payer: The Alliance Commercial |
$16.14
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4.09
|
| Rate for Payer: WEA Trust Commercial |
$65.21
|
| Rate for Payer: WPS Commercial |
$17.98
|
|
|
Glucose, Pleural Fluid
|
Professional
|
Both
|
$114.00
|
|
|
Service Code
|
CPT 82945
|
| Hospital Charge Code |
3154862
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.09 |
| Max. Negotiated Rate |
$112.63 |
| Rate for Payer: Aetna Commercial |
$112.63
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$101.96
|
| Rate for Payer: Aetna Managed Medicare |
$4.09
|
| Rate for Payer: Anthem Medicare Advantage |
$4.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$4.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$4.09
|
| Rate for Payer: Cash Price |
$34.20
|
| Rate for Payer: Cash Price |
$34.20
|
| Rate for Payer: Cigna Commercial |
$112.63
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$59.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4.09
|
| Rate for Payer: Health EOS Commercial |
$107.89
|
| Rate for Payer: HFN Commercial |
$112.63
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$14.42
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$14.42
|
| Rate for Payer: Independent Care Health Plan Medicare |
$4.09
|
| Rate for Payer: Multiplan Commercial |
$94.85
|
| Rate for Payer: NAPHCARE Commercial |
$6.13
|
| Rate for Payer: Preferred Network Access Commercial |
$112.63
|
| Rate for Payer: Quartz Beloit One Network |
$52.17
|
| Rate for Payer: Quartz Commercial |
$67.58
|
| Rate for Payer: Quartz Medicare Advantage |
$4.09
|
| Rate for Payer: The Alliance Commercial |
$16.14
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4.09
|
| Rate for Payer: WEA Trust Commercial |
$65.21
|
| Rate for Payer: WPS Commercial |
$17.98
|
|
|
Glucose, Pleural Fluid
|
Facility
|
OP
|
$114.00
|
|
|
Service Code
|
CPT 82945
|
| Hospital Charge Code |
3154862
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.09 |
| Max. Negotiated Rate |
$109.08 |
| Rate for Payer: Aetna Commercial |
$106.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$101.96
|
| Rate for Payer: Aetna Managed Medicare |
$4.09
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$15.33
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$7.15
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$6.78
|
| Rate for Payer: Anthem Medicare Advantage |
$4.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$62.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$4.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$4.09
|
| Rate for Payer: Cash Price |
$34.20
|
| Rate for Payer: Cash Price |
$34.20
|
| Rate for Payer: Cigna Commercial |
$109.08
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$4.09
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$66.35
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$4.09
|
| Rate for Payer: Health EOS Commercial |
$105.52
|
| Rate for Payer: HFN Commercial |
$109.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$15.20
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$4.09
|
| Rate for Payer: Independent Care Health Plan Medicare |
$4.09
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$4.09
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$4.09
|
| Rate for Payer: Multiplan Commercial |
$94.85
|
| Rate for Payer: NAPHCARE Commercial |
$6.13
|
| Rate for Payer: Preferred Network Access Commercial |
$109.08
|
| Rate for Payer: Quartz Beloit One Network |
$58.09
|
| Rate for Payer: Quartz Commercial |
$77.06
|
| Rate for Payer: Quartz Medicare Advantage |
$4.09
|
| Rate for Payer: The Alliance Commercial |
$16.35
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4.09
|
| Rate for Payer: United Healthcare PPO |
$88.92
|
| Rate for Payer: WEA Trust Commercial |
$65.21
|
| Rate for Payer: Wellcare Medicare |
$4.09
|
| Rate for Payer: WPS Commercial |
$87.81
|
|
|
Glucose, Pleural Fluid
|
Facility
|
IP
|
$114.00
|
|
|
Service Code
|
CPT 82945
|
| Hospital Charge Code |
3154862
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$58.09 |
| Max. Negotiated Rate |
$109.08 |
| Rate for Payer: Aetna Commercial |
$106.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$101.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$62.84
|
| Rate for Payer: Cash Price |
$34.20
|
| Rate for Payer: Cigna Commercial |
$109.08
|
| Rate for Payer: Health EOS Commercial |
$105.52
|
| Rate for Payer: HFN Commercial |
$109.08
|
| Rate for Payer: Multiplan Commercial |
$94.85
|
| Rate for Payer: Preferred Network Access Commercial |
$109.08
|
| Rate for Payer: Quartz Beloit One Network |
$58.09
|
| Rate for Payer: Quartz Commercial |
$71.14
|
| Rate for Payer: WEA Trust Commercial |
$65.21
|
| Rate for Payer: WPS Commercial |
$87.81
|
|
|
Glucose, Synovial Fluid
|
Facility
|
IP
|
$114.00
|
|
|
Service Code
|
CPT 82945
|
| Hospital Charge Code |
3154864
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$58.09 |
| Max. Negotiated Rate |
$109.08 |
| Rate for Payer: Aetna Commercial |
$106.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$101.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$62.84
|
| Rate for Payer: Cash Price |
$34.20
|
| Rate for Payer: Cigna Commercial |
$109.08
|
| Rate for Payer: Health EOS Commercial |
$105.52
|
| Rate for Payer: HFN Commercial |
$109.08
|
| Rate for Payer: Multiplan Commercial |
$94.85
|
| Rate for Payer: Preferred Network Access Commercial |
$109.08
|
| Rate for Payer: Quartz Beloit One Network |
$58.09
|
| Rate for Payer: Quartz Commercial |
$71.14
|
| Rate for Payer: WEA Trust Commercial |
$65.21
|
| Rate for Payer: WPS Commercial |
$87.81
|
|
|
Glucose, Synovial Fluid
|
Professional
|
Both
|
$114.00
|
|
|
Service Code
|
CPT 82945
|
| Hospital Charge Code |
3154864
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.09 |
| Max. Negotiated Rate |
$112.63 |
| Rate for Payer: Aetna Commercial |
$112.63
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$101.96
|
| Rate for Payer: Aetna Managed Medicare |
$4.09
|
| Rate for Payer: Anthem Medicare Advantage |
$4.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$4.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$4.09
|
| Rate for Payer: Cash Price |
$34.20
|
| Rate for Payer: Cash Price |
$34.20
|
| Rate for Payer: Cigna Commercial |
$112.63
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$59.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4.09
|
| Rate for Payer: Health EOS Commercial |
$107.89
|
| Rate for Payer: HFN Commercial |
$112.63
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$14.42
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$14.42
|
| Rate for Payer: Independent Care Health Plan Medicare |
$4.09
|
| Rate for Payer: Multiplan Commercial |
$94.85
|
| Rate for Payer: NAPHCARE Commercial |
$6.13
|
| Rate for Payer: Preferred Network Access Commercial |
$112.63
|
| Rate for Payer: Quartz Beloit One Network |
$52.17
|
| Rate for Payer: Quartz Commercial |
$67.58
|
| Rate for Payer: Quartz Medicare Advantage |
$4.09
|
| Rate for Payer: The Alliance Commercial |
$16.14
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4.09
|
| Rate for Payer: WEA Trust Commercial |
$65.21
|
| Rate for Payer: WPS Commercial |
$17.98
|
|
|
Glucose, Synovial Fluid
|
Facility
|
OP
|
$114.00
|
|
|
Service Code
|
CPT 82945
|
| Hospital Charge Code |
3154864
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.09 |
| Max. Negotiated Rate |
$109.08 |
| Rate for Payer: Aetna Commercial |
$106.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$101.96
|
| Rate for Payer: Aetna Managed Medicare |
$4.09
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$15.33
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$7.15
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$6.78
|
| Rate for Payer: Anthem Medicare Advantage |
$4.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$62.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$4.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$4.09
|
| Rate for Payer: Cash Price |
$34.20
|
| Rate for Payer: Cash Price |
$34.20
|
| Rate for Payer: Cigna Commercial |
$109.08
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$4.09
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$66.35
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$4.09
|
| Rate for Payer: Health EOS Commercial |
$105.52
|
| Rate for Payer: HFN Commercial |
$109.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$15.20
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$4.09
|
| Rate for Payer: Independent Care Health Plan Medicare |
$4.09
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$4.09
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$4.09
|
| Rate for Payer: Multiplan Commercial |
$94.85
|
| Rate for Payer: NAPHCARE Commercial |
$6.13
|
| Rate for Payer: Preferred Network Access Commercial |
$109.08
|
| Rate for Payer: Quartz Beloit One Network |
$58.09
|
| Rate for Payer: Quartz Commercial |
$77.06
|
| Rate for Payer: Quartz Medicare Advantage |
$4.09
|
| Rate for Payer: The Alliance Commercial |
$16.35
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4.09
|
| Rate for Payer: United Healthcare PPO |
$88.92
|
| Rate for Payer: WEA Trust Commercial |
$65.21
|
| Rate for Payer: Wellcare Medicare |
$4.09
|
| Rate for Payer: WPS Commercial |
$87.81
|
|
|
Glucose Tolerance 1 Hour
|
Facility
|
OP
|
$104.00
|
|
|
Service Code
|
CPT 82950
|
| Hospital Charge Code |
633597
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.94 |
| Max. Negotiated Rate |
$99.51 |
| Rate for Payer: Aetna Commercial |
$97.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$93.02
|
| Rate for Payer: Aetna Managed Medicare |
$4.94
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$18.52
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8.64
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$8.20
|
| Rate for Payer: Anthem Medicare Advantage |
$4.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$57.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$4.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$4.94
|
| Rate for Payer: Cash Price |
$31.20
|
| Rate for Payer: Cash Price |
$31.20
|
| Rate for Payer: Cigna Commercial |
$99.51
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$4.94
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$60.53
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$4.94
|
| Rate for Payer: Health EOS Commercial |
$96.26
|
| Rate for Payer: HFN Commercial |
$99.51
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$18.38
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$4.94
|
| Rate for Payer: Independent Care Health Plan Medicare |
$4.94
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$4.94
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$4.94
|
| Rate for Payer: Multiplan Commercial |
$86.53
|
| Rate for Payer: NAPHCARE Commercial |
$7.41
|
| Rate for Payer: Preferred Network Access Commercial |
$99.51
|
| Rate for Payer: Quartz Beloit One Network |
$53.00
|
| Rate for Payer: Quartz Commercial |
$70.30
|
| Rate for Payer: Quartz Medicare Advantage |
$4.94
|
| Rate for Payer: The Alliance Commercial |
$19.76
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4.94
|
| Rate for Payer: United Healthcare PPO |
$81.12
|
| Rate for Payer: WEA Trust Commercial |
$59.49
|
| Rate for Payer: Wellcare Medicare |
$4.94
|
| Rate for Payer: WPS Commercial |
$80.11
|
|
|
Glucose Tolerance 1 Hour
|
Professional
|
Both
|
$104.00
|
|
|
Service Code
|
CPT 82950
|
| Hospital Charge Code |
633597
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.94 |
| Max. Negotiated Rate |
$102.75 |
| Rate for Payer: Aetna Commercial |
$102.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$93.02
|
| Rate for Payer: Aetna Managed Medicare |
$4.94
|
| Rate for Payer: Anthem Medicare Advantage |
$4.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$4.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$4.94
|
| Rate for Payer: Cash Price |
$31.20
|
| Rate for Payer: Cash Price |
$31.20
|
| Rate for Payer: Cigna Commercial |
$102.75
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$54.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4.94
|
| Rate for Payer: Health EOS Commercial |
$98.43
|
| Rate for Payer: HFN Commercial |
$102.75
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$17.44
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$17.44
|
| Rate for Payer: Independent Care Health Plan Medicare |
$4.94
|
| Rate for Payer: Multiplan Commercial |
$86.53
|
| Rate for Payer: NAPHCARE Commercial |
$7.41
|
| Rate for Payer: Preferred Network Access Commercial |
$102.75
|
| Rate for Payer: Quartz Beloit One Network |
$47.59
|
| Rate for Payer: Quartz Commercial |
$61.65
|
| Rate for Payer: Quartz Medicare Advantage |
$4.94
|
| Rate for Payer: The Alliance Commercial |
$19.51
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4.94
|
| Rate for Payer: WEA Trust Commercial |
$59.49
|
| Rate for Payer: WPS Commercial |
$21.74
|
|
|
Glucose Tolerance 1 Hour
|
Facility
|
IP
|
$104.00
|
|
|
Service Code
|
CPT 82950
|
| Hospital Charge Code |
633597
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$53.00 |
| Max. Negotiated Rate |
$99.51 |
| Rate for Payer: Aetna Commercial |
$97.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$93.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$57.32
|
| Rate for Payer: Cash Price |
$31.20
|
| Rate for Payer: Cigna Commercial |
$99.51
|
| Rate for Payer: Health EOS Commercial |
$96.26
|
| Rate for Payer: HFN Commercial |
$99.51
|
| Rate for Payer: Multiplan Commercial |
$86.53
|
| Rate for Payer: Preferred Network Access Commercial |
$99.51
|
| Rate for Payer: Quartz Beloit One Network |
$53.00
|
| Rate for Payer: Quartz Commercial |
$64.90
|
| Rate for Payer: WEA Trust Commercial |
$59.49
|
| Rate for Payer: WPS Commercial |
$80.11
|
|
|
Glutamic Acid Decarboxylase-65 Antibody
|
Professional
|
Both
|
$540.00
|
|
|
Service Code
|
CPT 83519
|
| Hospital Charge Code |
1039113
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$19.14 |
| Max. Negotiated Rate |
$533.52 |
| Rate for Payer: Aetna Commercial |
$533.52
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$482.98
|
| Rate for Payer: Aetna Managed Medicare |
$19.14
|
| Rate for Payer: Anthem Medicare Advantage |
$19.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$19.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$19.14
|
| Rate for Payer: Cash Price |
$162.00
|
| Rate for Payer: Cash Price |
$162.00
|
| Rate for Payer: Cigna Commercial |
$533.52
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$280.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$19.14
|
| Rate for Payer: Health EOS Commercial |
$511.06
|
| Rate for Payer: HFN Commercial |
$533.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$67.55
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$67.55
|
| Rate for Payer: Independent Care Health Plan Medicare |
$19.14
|
| Rate for Payer: Multiplan Commercial |
$449.28
|
| Rate for Payer: NAPHCARE Commercial |
$28.70
|
| Rate for Payer: Preferred Network Access Commercial |
$533.52
|
| Rate for Payer: Quartz Beloit One Network |
$247.10
|
| Rate for Payer: Quartz Commercial |
$320.11
|
| Rate for Payer: Quartz Medicare Advantage |
$19.14
|
| Rate for Payer: The Alliance Commercial |
$75.59
|
| Rate for Payer: United Healthcare Medicare Advantage |
$19.14
|
| Rate for Payer: WEA Trust Commercial |
$308.88
|
| Rate for Payer: WPS Commercial |
$84.20
|
|
|
Glutamic Acid Decarboxylase-65 Antibody
|
Facility
|
IP
|
$540.00
|
|
|
Service Code
|
CPT 83519
|
| Hospital Charge Code |
1039113
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$275.18 |
| Max. Negotiated Rate |
$516.67 |
| Rate for Payer: Aetna Commercial |
$505.44
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$482.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$297.65
|
| Rate for Payer: Cash Price |
$162.00
|
| Rate for Payer: Cigna Commercial |
$516.67
|
| Rate for Payer: Health EOS Commercial |
$499.82
|
| Rate for Payer: HFN Commercial |
$516.67
|
| Rate for Payer: Multiplan Commercial |
$449.28
|
| Rate for Payer: Preferred Network Access Commercial |
$516.67
|
| Rate for Payer: Quartz Beloit One Network |
$275.18
|
| Rate for Payer: Quartz Commercial |
$336.96
|
| Rate for Payer: WEA Trust Commercial |
$308.88
|
| Rate for Payer: WPS Commercial |
$415.96
|
|
|
Glutamic Acid Decarboxylase-65 Antibody
|
Facility
|
OP
|
$540.00
|
|
|
Service Code
|
CPT 83519
|
| Hospital Charge Code |
1039113
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$19.14 |
| Max. Negotiated Rate |
$516.67 |
| Rate for Payer: Aetna Commercial |
$505.44
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$482.98
|
| Rate for Payer: Aetna Managed Medicare |
$19.14
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$71.76
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$33.49
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$31.77
|
| Rate for Payer: Anthem Medicare Advantage |
$19.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$297.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$19.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$19.14
|
| Rate for Payer: Cash Price |
$162.00
|
| Rate for Payer: Cash Price |
$162.00
|
| Rate for Payer: Cigna Commercial |
$516.67
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$19.14
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$314.28
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$19.14
|
| Rate for Payer: Health EOS Commercial |
$499.82
|
| Rate for Payer: HFN Commercial |
$516.67
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$71.19
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$19.14
|
| Rate for Payer: Independent Care Health Plan Medicare |
$19.14
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$19.14
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$19.14
|
| Rate for Payer: Multiplan Commercial |
$449.28
|
| Rate for Payer: NAPHCARE Commercial |
$28.70
|
| Rate for Payer: Preferred Network Access Commercial |
$516.67
|
| Rate for Payer: Quartz Beloit One Network |
$275.18
|
| Rate for Payer: Quartz Commercial |
$365.04
|
| Rate for Payer: Quartz Medicare Advantage |
$19.14
|
| Rate for Payer: The Alliance Commercial |
$76.54
|
| Rate for Payer: United Healthcare Medicare Advantage |
$19.14
|
| Rate for Payer: United Healthcare PPO |
$421.20
|
| Rate for Payer: WEA Trust Commercial |
$308.88
|
| Rate for Payer: Wellcare Medicare |
$19.14
|
| Rate for Payer: WPS Commercial |
$415.96
|
|
|
GOLD PROBE BICAP 10FR M00560100
|
Facility
|
IP
|
$2,440.00
|
|
| Hospital Charge Code |
2973012
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,243.42 |
| Max. Negotiated Rate |
$2,334.59 |
| Rate for Payer: Aetna Commercial |
$2,283.84
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,182.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,344.93
|
| Rate for Payer: Cash Price |
$732.00
|
| Rate for Payer: Cigna Commercial |
$2,334.59
|
| Rate for Payer: Health EOS Commercial |
$2,258.46
|
| Rate for Payer: HFN Commercial |
$2,334.59
|
| Rate for Payer: Multiplan Commercial |
$2,030.08
|
| Rate for Payer: Preferred Network Access Commercial |
$2,334.59
|
| Rate for Payer: Quartz Beloit One Network |
$1,243.42
|
| Rate for Payer: Quartz Commercial |
$1,522.56
|
| Rate for Payer: WEA Trust Commercial |
$1,395.68
|
| Rate for Payer: WPS Commercial |
$1,879.53
|
|
|
GOLD PROBE BICAP 10FR M00560100
|
Facility
|
OP
|
$2,440.00
|
|
| Hospital Charge Code |
2973012
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$710.53 |
| Max. Negotiated Rate |
$2,334.59 |
| Rate for Payer: Aetna Commercial |
$2,283.84
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,182.34
|
| Rate for Payer: Aetna Managed Medicare |
$710.53
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,649.44
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,268.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,218.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,344.93
|
| Rate for Payer: Cash Price |
$732.00
|
| Rate for Payer: Cigna Commercial |
$2,334.59
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,420.08
|
| Rate for Payer: Health EOS Commercial |
$2,258.46
|
| Rate for Payer: HFN Commercial |
$2,334.59
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,903.20
|
| Rate for Payer: Multiplan Commercial |
$2,030.08
|
| Rate for Payer: NAPHCARE Commercial |
$1,522.56
|
| Rate for Payer: Preferred Network Access Commercial |
$2,334.59
|
| Rate for Payer: Quartz Beloit One Network |
$1,243.42
|
| Rate for Payer: Quartz Commercial |
$1,649.44
|
| Rate for Payer: Quartz Medicare Advantage |
$1,522.56
|
| Rate for Payer: The Alliance Commercial |
$1,268.80
|
| Rate for Payer: WEA Trust Commercial |
$1,395.68
|
| Rate for Payer: WPS Commercial |
$1,879.53
|
|
|
GOLD PROBE BICAP 7FR M00560070
|
Facility
|
IP
|
$2,534.00
|
|
| Hospital Charge Code |
2973011
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,291.33 |
| Max. Negotiated Rate |
$2,424.53 |
| Rate for Payer: Aetna Commercial |
$2,371.82
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,266.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,396.74
|
| Rate for Payer: Cash Price |
$760.20
|
| Rate for Payer: Cigna Commercial |
$2,424.53
|
| Rate for Payer: Health EOS Commercial |
$2,345.47
|
| Rate for Payer: HFN Commercial |
$2,424.53
|
| Rate for Payer: Multiplan Commercial |
$2,108.29
|
| Rate for Payer: Preferred Network Access Commercial |
$2,424.53
|
| Rate for Payer: Quartz Beloit One Network |
$1,291.33
|
| Rate for Payer: Quartz Commercial |
$1,581.22
|
| Rate for Payer: WEA Trust Commercial |
$1,449.45
|
| Rate for Payer: WPS Commercial |
$1,951.94
|
|
|
GOLD PROBE BICAP 7FR M00560070
|
Facility
|
OP
|
$2,534.00
|
|
| Hospital Charge Code |
2973011
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$737.90 |
| Max. Negotiated Rate |
$2,424.53 |
| Rate for Payer: Aetna Commercial |
$2,371.82
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,266.41
|
| Rate for Payer: Aetna Managed Medicare |
$737.90
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,712.98
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,317.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,264.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,396.74
|
| Rate for Payer: Cash Price |
$760.20
|
| Rate for Payer: Cigna Commercial |
$2,424.53
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,474.79
|
| Rate for Payer: Health EOS Commercial |
$2,345.47
|
| Rate for Payer: HFN Commercial |
$2,424.53
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,976.52
|
| Rate for Payer: Multiplan Commercial |
$2,108.29
|
| Rate for Payer: NAPHCARE Commercial |
$1,581.22
|
| Rate for Payer: Preferred Network Access Commercial |
$2,424.53
|
| Rate for Payer: Quartz Beloit One Network |
$1,291.33
|
| Rate for Payer: Quartz Commercial |
$1,712.98
|
| Rate for Payer: Quartz Medicare Advantage |
$1,581.22
|
| Rate for Payer: The Alliance Commercial |
$1,317.68
|
| Rate for Payer: WEA Trust Commercial |
$1,449.45
|
| Rate for Payer: WPS Commercial |
$1,951.94
|
|
|
Golimumab Level
|
Professional
|
Both
|
$556.00
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
5502668
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$19.39 |
| Max. Negotiated Rate |
$549.33 |
| Rate for Payer: Aetna Commercial |
$549.33
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$497.29
|
| Rate for Payer: Aetna Managed Medicare |
$19.39
|
| Rate for Payer: Anthem Medicare Advantage |
$19.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$19.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$19.39
|
| Rate for Payer: Cash Price |
$166.80
|
| Rate for Payer: Cash Price |
$166.80
|
| Rate for Payer: Cigna Commercial |
$549.33
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$289.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$19.39
|
| Rate for Payer: Health EOS Commercial |
$526.20
|
| Rate for Payer: HFN Commercial |
$549.33
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$68.43
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$68.43
|
| Rate for Payer: Independent Care Health Plan Medicare |
$19.39
|
| Rate for Payer: Multiplan Commercial |
$462.59
|
| Rate for Payer: NAPHCARE Commercial |
$29.08
|
| Rate for Payer: Preferred Network Access Commercial |
$549.33
|
| Rate for Payer: Quartz Beloit One Network |
$254.43
|
| Rate for Payer: Quartz Commercial |
$329.60
|
| Rate for Payer: Quartz Medicare Advantage |
$19.39
|
| Rate for Payer: The Alliance Commercial |
$76.57
|
| Rate for Payer: United Healthcare Medicare Advantage |
$19.39
|
| Rate for Payer: WEA Trust Commercial |
$318.03
|
| Rate for Payer: WPS Commercial |
$85.30
|
|
