|
Aloxi 25 mcg Charge
|
Facility
IP
|
$182.00
|
|
|
Service Code
|
HCPCS J2469
|
| Hospital Charge Code |
2958937
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$89.18 |
| Max. Negotiated Rate |
$167.44 |
| Rate for Payer: Aetna Commercial |
$163.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$96.46
|
| Rate for Payer: Cash Price |
$54.60
|
| Rate for Payer: Cigna Commercial |
$167.44
|
| Rate for Payer: Health EOS Commercial |
$161.98
|
| Rate for Payer: HFN Commercial |
$167.44
|
| Rate for Payer: Multiplan Commercial |
$145.60
|
| Rate for Payer: NAPHCARE Commercial |
$109.20
|
| Rate for Payer: Preferred Network Access Commercial |
$167.44
|
| Rate for Payer: Quartz Beloit One Network |
$89.18
|
| Rate for Payer: Quartz Commercial |
$109.20
|
| Rate for Payer: WEA Trust Commercial |
$100.10
|
| Rate for Payer: WPS Commercial |
$134.81
|
|
|
Aloxi 25 mcg Charge
|
Professional
|
$182.00
|
|
|
Service Code
|
HCPCS J2469
|
| Hospital Charge Code |
2958937
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.85 |
| Max. Negotiated Rate |
$172.90 |
| Rate for Payer: Aetna Commercial |
$172.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$156.52
|
| Rate for Payer: Aetna Managed Medicare |
$1.00
|
| Rate for Payer: Anthem Medicare Advantage |
$1.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$1.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$1.00
|
| Rate for Payer: Cash Price |
$54.60
|
| Rate for Payer: Cash Price |
$54.60
|
| Rate for Payer: Cigna Commercial |
$172.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$91.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1.19
|
| Rate for Payer: Health EOS Commercial |
$165.62
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4.03
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$4.03
|
| Rate for Payer: Independent Care Health Plan Medicare |
$1.00
|
| Rate for Payer: Multiplan Commercial |
$145.60
|
| Rate for Payer: Preferred Network Access Commercial |
$172.90
|
| Rate for Payer: Quartz Beloit One Network |
$80.08
|
| Rate for Payer: Quartz Commercial |
$103.74
|
| Rate for Payer: Quartz Medicare Advantage |
$1.00
|
| Rate for Payer: The Alliance Commercial |
$2.75
|
| Rate for Payer: United Healthcare Medicaid |
$0.85
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1.00
|
| Rate for Payer: WEA Trust Commercial |
$100.10
|
| Rate for Payer: WPS Commercial |
$2.98
|
|
|
Aloxi 25 mcg Charge
|
Facility
OP
|
$182.00
|
|
|
Service Code
|
HCPCS J2469
|
| Hospital Charge Code |
2958937
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.58 |
| Max. Negotiated Rate |
$2,042.72 |
| Rate for Payer: Aetna Commercial |
$163.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$156.52
|
| Rate for Payer: Aetna Managed Medicare |
$50.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$118.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$91.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$87.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$96.46
|
| Rate for Payer: Cash Price |
$54.60
|
| Rate for Payer: Cash Price |
$54.60
|
| Rate for Payer: Cigna Commercial |
$167.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1.58
|
| Rate for Payer: Health EOS Commercial |
$161.98
|
| Rate for Payer: HFN Commercial |
$167.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$136.50
|
| Rate for Payer: Multiplan Commercial |
$145.60
|
| Rate for Payer: NAPHCARE Commercial |
$109.20
|
| Rate for Payer: Preferred Network Access Commercial |
$167.44
|
| Rate for Payer: Quartz Beloit One Network |
$89.18
|
| Rate for Payer: Quartz Commercial |
$118.30
|
| Rate for Payer: Quartz Medicare Advantage |
$109.20
|
| Rate for Payer: The Alliance Commercial |
$2,042.72
|
| Rate for Payer: WEA Trust Commercial |
$100.10
|
| Rate for Payer: WPS Commercial |
$2.98
|
|
|
Alpha-1-Antitrypsin
|
Facility
OP
|
$277.00
|
|
|
Service Code
|
CPT 82103
|
| Hospital Charge Code |
977861
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.44 |
| Max. Negotiated Rate |
$1,108.00 |
| Rate for Payer: Aetna Commercial |
$249.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$238.22
|
| Rate for Payer: Aetna Managed Medicare |
$13.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$50.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$23.52
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$22.31
|
| Rate for Payer: Anthem Medicaid |
$13.89
|
| Rate for Payer: Anthem Medicare Advantage |
$13.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$146.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$13.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$13.44
|
| Rate for Payer: Cash Price |
$83.10
|
| Rate for Payer: Cash Price |
$83.10
|
| Rate for Payer: Cigna Commercial |
$254.84
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$13.44
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$13.89
|
| Rate for Payer: Dean Health Medicaid |
$13.89
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$13.44
|
| Rate for Payer: Health EOS Commercial |
$246.53
|
| Rate for Payer: HFN Commercial |
$254.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$50.00
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$13.44
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$13.89
|
| Rate for Payer: Independent Care Health Plan Medicare |
$13.44
|
| Rate for Payer: Managed Health Services Medicaid |
$14.45
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$13.44
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$13.44
|
| Rate for Payer: Multiplan Commercial |
$221.60
|
| Rate for Payer: NAPHCARE Commercial |
$20.16
|
| Rate for Payer: Preferred Network Access Commercial |
$254.84
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$13.89
|
| Rate for Payer: Quartz Beloit One Network |
$135.73
|
| Rate for Payer: Quartz Commercial |
$180.05
|
| Rate for Payer: Quartz Medicare Advantage |
$13.44
|
| Rate for Payer: The Alliance Commercial |
$1,108.00
|
| Rate for Payer: United Healthcare Medicaid |
$13.89
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.44
|
| Rate for Payer: United Healthcare PPO |
$207.75
|
| Rate for Payer: WEA Trust Commercial |
$152.35
|
| Rate for Payer: Wellcare Medicare |
$13.44
|
| Rate for Payer: WMAP Medicaid |
$13.89
|
| Rate for Payer: WPS Commercial |
$205.17
|
|
|
Alpha-1-Antitrypsin
|
Facility
IP
|
$277.00
|
|
|
Service Code
|
CPT 82103
|
| Hospital Charge Code |
977861
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$135.73 |
| Max. Negotiated Rate |
$254.84 |
| Rate for Payer: Aetna Commercial |
$249.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$146.81
|
| Rate for Payer: Cash Price |
$83.10
|
| Rate for Payer: Cigna Commercial |
$254.84
|
| Rate for Payer: Health EOS Commercial |
$246.53
|
| Rate for Payer: HFN Commercial |
$254.84
|
| Rate for Payer: Multiplan Commercial |
$221.60
|
| Rate for Payer: NAPHCARE Commercial |
$166.20
|
| Rate for Payer: Preferred Network Access Commercial |
$254.84
|
| Rate for Payer: Quartz Beloit One Network |
$135.73
|
| Rate for Payer: Quartz Commercial |
$166.20
|
| Rate for Payer: WEA Trust Commercial |
$152.35
|
| Rate for Payer: WPS Commercial |
$205.17
|
|
|
Alpha-1-Antitrypsin
|
Professional
|
$277.00
|
|
|
Service Code
|
CPT 82103
|
| Hospital Charge Code |
977861
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.44 |
| Max. Negotiated Rate |
$263.15 |
| Rate for Payer: Aetna Commercial |
$263.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$238.22
|
| Rate for Payer: Aetna Managed Medicare |
$13.44
|
| Rate for Payer: Anthem Medicare Advantage |
$13.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$13.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$13.44
|
| Rate for Payer: Cash Price |
$83.10
|
| Rate for Payer: Cash Price |
$83.10
|
| Rate for Payer: Cigna Commercial |
$263.15
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$138.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$13.44
|
| Rate for Payer: Health EOS Commercial |
$252.07
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$47.44
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$47.44
|
| Rate for Payer: Independent Care Health Plan Medicare |
$13.44
|
| Rate for Payer: Multiplan Commercial |
$221.60
|
| Rate for Payer: Preferred Network Access Commercial |
$263.15
|
| Rate for Payer: Quartz Beloit One Network |
$121.88
|
| Rate for Payer: Quartz Commercial |
$157.89
|
| Rate for Payer: Quartz Medicare Advantage |
$13.44
|
| Rate for Payer: The Alliance Commercial |
$53.09
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.44
|
| Rate for Payer: WEA Trust Commercial |
$152.35
|
| Rate for Payer: WPS Commercial |
$59.14
|
|
|
Alpha-1-Antitrypsin Phenotype
|
Facility
OP
|
$321.00
|
|
|
Service Code
|
CPT 82104
|
| Hospital Charge Code |
977862
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.46 |
| Max. Negotiated Rate |
$1,284.00 |
| Rate for Payer: Aetna Commercial |
$288.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$276.06
|
| Rate for Payer: Aetna Managed Medicare |
$14.46
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$54.22
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$25.30
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$24.00
|
| Rate for Payer: Anthem Medicaid |
$14.94
|
| Rate for Payer: Anthem Medicare Advantage |
$14.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$170.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$14.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$14.46
|
| Rate for Payer: Cash Price |
$96.30
|
| Rate for Payer: Cash Price |
$96.30
|
| Rate for Payer: Cigna Commercial |
$295.32
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$14.46
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$14.94
|
| Rate for Payer: Dean Health Medicaid |
$14.94
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$14.46
|
| Rate for Payer: Health EOS Commercial |
$285.69
|
| Rate for Payer: HFN Commercial |
$295.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$53.79
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$14.46
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$14.94
|
| Rate for Payer: Independent Care Health Plan Medicare |
$14.46
|
| Rate for Payer: Managed Health Services Medicaid |
$15.54
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$14.46
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$14.46
|
| Rate for Payer: Multiplan Commercial |
$256.80
|
| Rate for Payer: NAPHCARE Commercial |
$21.69
|
| Rate for Payer: Preferred Network Access Commercial |
$295.32
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$14.94
|
| Rate for Payer: Quartz Beloit One Network |
$157.29
|
| Rate for Payer: Quartz Commercial |
$208.65
|
| Rate for Payer: Quartz Medicare Advantage |
$14.46
|
| Rate for Payer: The Alliance Commercial |
$1,284.00
|
| Rate for Payer: United Healthcare Medicaid |
$14.94
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14.46
|
| Rate for Payer: United Healthcare PPO |
$240.75
|
| Rate for Payer: WEA Trust Commercial |
$176.55
|
| Rate for Payer: Wellcare Medicare |
$14.46
|
| Rate for Payer: WMAP Medicaid |
$14.94
|
| Rate for Payer: WPS Commercial |
$237.76
|
|
|
Alpha-1-Antitrypsin Phenotype
|
Facility
IP
|
$321.00
|
|
|
Service Code
|
CPT 82104
|
| Hospital Charge Code |
977862
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$157.29 |
| Max. Negotiated Rate |
$295.32 |
| Rate for Payer: Aetna Commercial |
$288.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$170.13
|
| Rate for Payer: Cash Price |
$96.30
|
| Rate for Payer: Cigna Commercial |
$295.32
|
| Rate for Payer: Health EOS Commercial |
$285.69
|
| Rate for Payer: HFN Commercial |
$295.32
|
| Rate for Payer: Multiplan Commercial |
$256.80
|
| Rate for Payer: NAPHCARE Commercial |
$192.60
|
| Rate for Payer: Preferred Network Access Commercial |
$295.32
|
| Rate for Payer: Quartz Beloit One Network |
$157.29
|
| Rate for Payer: Quartz Commercial |
$192.60
|
| Rate for Payer: WEA Trust Commercial |
$176.55
|
| Rate for Payer: WPS Commercial |
$237.76
|
|
|
Alpha-1-Antitrypsin Phenotype
|
Professional
|
$321.00
|
|
|
Service Code
|
CPT 82104
|
| Hospital Charge Code |
977862
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.46 |
| Max. Negotiated Rate |
$304.95 |
| Rate for Payer: Aetna Commercial |
$304.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$276.06
|
| Rate for Payer: Aetna Managed Medicare |
$14.46
|
| Rate for Payer: Anthem Medicare Advantage |
$14.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$14.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$14.46
|
| Rate for Payer: Cash Price |
$96.30
|
| Rate for Payer: Cash Price |
$96.30
|
| Rate for Payer: Cigna Commercial |
$304.95
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$160.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$14.46
|
| Rate for Payer: Health EOS Commercial |
$292.11
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$51.04
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$51.04
|
| Rate for Payer: Independent Care Health Plan Medicare |
$14.46
|
| Rate for Payer: Multiplan Commercial |
$256.80
|
| Rate for Payer: Preferred Network Access Commercial |
$304.95
|
| Rate for Payer: Quartz Beloit One Network |
$141.24
|
| Rate for Payer: Quartz Commercial |
$182.97
|
| Rate for Payer: Quartz Medicare Advantage |
$14.46
|
| Rate for Payer: The Alliance Commercial |
$57.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14.46
|
| Rate for Payer: WEA Trust Commercial |
$176.55
|
| Rate for Payer: WPS Commercial |
$63.62
|
|
|
Alpha-2-Macroglobins (FSURE)
|
Facility
OP
|
$89.00
|
|
|
Service Code
|
CPT 83883
|
| Hospital Charge Code |
4538815
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.60 |
| Max. Negotiated Rate |
$356.00 |
| Rate for Payer: Aetna Commercial |
$80.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$76.54
|
| Rate for Payer: Aetna Managed Medicare |
$13.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$51.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$23.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$22.58
|
| Rate for Payer: Anthem Medicaid |
$14.05
|
| Rate for Payer: Anthem Medicare Advantage |
$13.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$47.17
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$13.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$13.60
|
| Rate for Payer: Cash Price |
$26.70
|
| Rate for Payer: Cash Price |
$26.70
|
| Rate for Payer: Cigna Commercial |
$81.88
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$13.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$14.05
|
| Rate for Payer: Dean Health Medicaid |
$14.05
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$13.60
|
| Rate for Payer: Health EOS Commercial |
$79.21
|
| Rate for Payer: HFN Commercial |
$81.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$50.59
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$13.60
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$14.05
|
| Rate for Payer: Independent Care Health Plan Medicare |
$13.60
|
| Rate for Payer: Managed Health Services Medicaid |
$14.61
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$13.60
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$13.60
|
| Rate for Payer: Multiplan Commercial |
$71.20
|
| Rate for Payer: NAPHCARE Commercial |
$20.40
|
| Rate for Payer: Preferred Network Access Commercial |
$81.88
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$14.05
|
| Rate for Payer: Quartz Beloit One Network |
$43.61
|
| Rate for Payer: Quartz Commercial |
$57.85
|
| Rate for Payer: Quartz Medicare Advantage |
$13.60
|
| Rate for Payer: The Alliance Commercial |
$356.00
|
| Rate for Payer: United Healthcare Medicaid |
$14.05
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.60
|
| Rate for Payer: United Healthcare PPO |
$66.75
|
| Rate for Payer: WEA Trust Commercial |
$48.95
|
| Rate for Payer: Wellcare Medicare |
$13.60
|
| Rate for Payer: WMAP Medicaid |
$14.05
|
| Rate for Payer: WPS Commercial |
$65.92
|
|
|
Alpha-2-Macroglobins (FSURE)
|
Professional
|
$89.00
|
|
|
Service Code
|
CPT 83883
|
| Hospital Charge Code |
4538815
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.60 |
| Max. Negotiated Rate |
$84.55 |
| Rate for Payer: Aetna Commercial |
$84.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$76.54
|
| Rate for Payer: Aetna Managed Medicare |
$13.60
|
| Rate for Payer: Anthem Medicare Advantage |
$13.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$13.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$13.60
|
| Rate for Payer: Cash Price |
$26.70
|
| Rate for Payer: Cash Price |
$26.70
|
| Rate for Payer: Cigna Commercial |
$84.55
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$44.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$13.60
|
| Rate for Payer: Health EOS Commercial |
$80.99
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$48.01
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$48.01
|
| Rate for Payer: Independent Care Health Plan Medicare |
$13.60
|
| Rate for Payer: Multiplan Commercial |
$71.20
|
| Rate for Payer: Preferred Network Access Commercial |
$84.55
|
| Rate for Payer: Quartz Beloit One Network |
$39.16
|
| Rate for Payer: Quartz Commercial |
$50.73
|
| Rate for Payer: Quartz Medicare Advantage |
$13.60
|
| Rate for Payer: The Alliance Commercial |
$53.72
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.60
|
| Rate for Payer: WEA Trust Commercial |
$48.95
|
| Rate for Payer: WPS Commercial |
$59.84
|
|
|
Alpha-2-Macroglobins (FSURE)
|
Facility
IP
|
$89.00
|
|
|
Service Code
|
CPT 83883
|
| Hospital Charge Code |
4538815
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$43.61 |
| Max. Negotiated Rate |
$81.88 |
| Rate for Payer: Aetna Commercial |
$80.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$47.17
|
| Rate for Payer: Cash Price |
$26.70
|
| Rate for Payer: Cigna Commercial |
$81.88
|
| Rate for Payer: Health EOS Commercial |
$79.21
|
| Rate for Payer: HFN Commercial |
$81.88
|
| Rate for Payer: Multiplan Commercial |
$71.20
|
| Rate for Payer: NAPHCARE Commercial |
$53.40
|
| Rate for Payer: Preferred Network Access Commercial |
$81.88
|
| Rate for Payer: Quartz Beloit One Network |
$43.61
|
| Rate for Payer: Quartz Commercial |
$53.40
|
| Rate for Payer: WEA Trust Commercial |
$48.95
|
| Rate for Payer: WPS Commercial |
$65.92
|
|
|
Alpha 2 Macroglobulin
|
Facility
IP
|
$76.00
|
|
|
Service Code
|
CPT 83883
|
| Hospital Charge Code |
4812610
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$37.24 |
| Max. Negotiated Rate |
$69.92 |
| Rate for Payer: Aetna Commercial |
$68.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$40.28
|
| Rate for Payer: Cash Price |
$22.80
|
| Rate for Payer: Cigna Commercial |
$69.92
|
| Rate for Payer: Health EOS Commercial |
$67.64
|
| Rate for Payer: HFN Commercial |
$69.92
|
| Rate for Payer: Multiplan Commercial |
$60.80
|
| Rate for Payer: NAPHCARE Commercial |
$45.60
|
| Rate for Payer: Preferred Network Access Commercial |
$69.92
|
| Rate for Payer: Quartz Beloit One Network |
$37.24
|
| Rate for Payer: Quartz Commercial |
$45.60
|
| Rate for Payer: WEA Trust Commercial |
$41.80
|
| Rate for Payer: WPS Commercial |
$56.29
|
|
|
Alpha 2 Macroglobulin
|
Professional
|
$76.00
|
|
|
Service Code
|
CPT 83883
|
| Hospital Charge Code |
4812610
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.60 |
| Max. Negotiated Rate |
$72.20 |
| Rate for Payer: Aetna Commercial |
$72.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$65.36
|
| Rate for Payer: Aetna Managed Medicare |
$13.60
|
| Rate for Payer: Anthem Medicare Advantage |
$13.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$13.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$13.60
|
| Rate for Payer: Cash Price |
$22.80
|
| Rate for Payer: Cash Price |
$22.80
|
| Rate for Payer: Cigna Commercial |
$72.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$38.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$13.60
|
| Rate for Payer: Health EOS Commercial |
$69.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$48.01
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$48.01
|
| Rate for Payer: Independent Care Health Plan Medicare |
$13.60
|
| Rate for Payer: Multiplan Commercial |
$60.80
|
| Rate for Payer: Preferred Network Access Commercial |
$72.20
|
| Rate for Payer: Quartz Beloit One Network |
$33.44
|
| Rate for Payer: Quartz Commercial |
$43.32
|
| Rate for Payer: Quartz Medicare Advantage |
$13.60
|
| Rate for Payer: The Alliance Commercial |
$53.72
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.60
|
| Rate for Payer: WEA Trust Commercial |
$41.80
|
| Rate for Payer: WPS Commercial |
$59.84
|
|
|
Alpha 2 Macroglobulin
|
Facility
OP
|
$76.00
|
|
|
Service Code
|
CPT 83883
|
| Hospital Charge Code |
4812610
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.60 |
| Max. Negotiated Rate |
$304.00 |
| Rate for Payer: Aetna Commercial |
$68.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$65.36
|
| Rate for Payer: Aetna Managed Medicare |
$13.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$51.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$23.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$22.58
|
| Rate for Payer: Anthem Medicaid |
$14.05
|
| Rate for Payer: Anthem Medicare Advantage |
$13.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$40.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$13.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$13.60
|
| Rate for Payer: Cash Price |
$22.80
|
| Rate for Payer: Cash Price |
$22.80
|
| Rate for Payer: Cigna Commercial |
$69.92
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$13.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$14.05
|
| Rate for Payer: Dean Health Medicaid |
$14.05
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$13.60
|
| Rate for Payer: Health EOS Commercial |
$67.64
|
| Rate for Payer: HFN Commercial |
$69.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$50.59
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$13.60
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$14.05
|
| Rate for Payer: Independent Care Health Plan Medicare |
$13.60
|
| Rate for Payer: Managed Health Services Medicaid |
$14.61
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$13.60
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$13.60
|
| Rate for Payer: Multiplan Commercial |
$60.80
|
| Rate for Payer: NAPHCARE Commercial |
$20.40
|
| Rate for Payer: Preferred Network Access Commercial |
$69.92
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$14.05
|
| Rate for Payer: Quartz Beloit One Network |
$37.24
|
| Rate for Payer: Quartz Commercial |
$49.40
|
| Rate for Payer: Quartz Medicare Advantage |
$13.60
|
| Rate for Payer: The Alliance Commercial |
$304.00
|
| Rate for Payer: United Healthcare Medicaid |
$14.05
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.60
|
| Rate for Payer: United Healthcare PPO |
$57.00
|
| Rate for Payer: WEA Trust Commercial |
$41.80
|
| Rate for Payer: Wellcare Medicare |
$13.60
|
| Rate for Payer: WMAP Medicaid |
$14.05
|
| Rate for Payer: WPS Commercial |
$56.29
|
|
|
Alpha-Fetoprotein & AFP-L3
|
Professional
|
$201.00
|
|
|
Service Code
|
CPT 82107
|
| Hospital Charge Code |
4109314
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$64.41 |
| Max. Negotiated Rate |
$283.40 |
| Rate for Payer: Aetna Commercial |
$190.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$172.86
|
| Rate for Payer: Aetna Managed Medicare |
$64.41
|
| Rate for Payer: Anthem Medicare Advantage |
$64.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$64.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$64.41
|
| Rate for Payer: Cash Price |
$60.30
|
| Rate for Payer: Cash Price |
$60.30
|
| Rate for Payer: Cigna Commercial |
$190.95
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$100.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$64.41
|
| Rate for Payer: Health EOS Commercial |
$182.91
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$227.37
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$227.37
|
| Rate for Payer: Independent Care Health Plan Medicare |
$64.41
|
| Rate for Payer: Multiplan Commercial |
$160.80
|
| Rate for Payer: Preferred Network Access Commercial |
$190.95
|
| Rate for Payer: Quartz Beloit One Network |
$88.44
|
| Rate for Payer: Quartz Commercial |
$114.57
|
| Rate for Payer: Quartz Medicare Advantage |
$64.41
|
| Rate for Payer: The Alliance Commercial |
$254.42
|
| Rate for Payer: United Healthcare Medicare Advantage |
$64.41
|
| Rate for Payer: WEA Trust Commercial |
$110.55
|
| Rate for Payer: WPS Commercial |
$283.40
|
|
|
Alpha-Fetoprotein & AFP-L3
|
Facility
OP
|
$201.00
|
|
|
Service Code
|
CPT 82107
|
| Hospital Charge Code |
4109314
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$64.41 |
| Max. Negotiated Rate |
$804.00 |
| Rate for Payer: Aetna Commercial |
$180.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$172.86
|
| Rate for Payer: Aetna Managed Medicare |
$64.41
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$241.54
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$112.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$106.92
|
| Rate for Payer: Anthem Medicaid |
$66.55
|
| Rate for Payer: Anthem Medicare Advantage |
$64.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$106.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$64.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$64.41
|
| Rate for Payer: Cash Price |
$60.30
|
| Rate for Payer: Cash Price |
$60.30
|
| Rate for Payer: Cigna Commercial |
$184.92
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$64.41
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$66.55
|
| Rate for Payer: Dean Health Medicaid |
$66.55
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$64.41
|
| Rate for Payer: Health EOS Commercial |
$178.89
|
| Rate for Payer: HFN Commercial |
$184.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$239.61
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$64.41
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$66.55
|
| Rate for Payer: Independent Care Health Plan Medicare |
$64.41
|
| Rate for Payer: Managed Health Services Medicaid |
$69.21
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$64.41
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$64.41
|
| Rate for Payer: Multiplan Commercial |
$160.80
|
| Rate for Payer: NAPHCARE Commercial |
$96.62
|
| Rate for Payer: Preferred Network Access Commercial |
$184.92
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$66.55
|
| Rate for Payer: Quartz Beloit One Network |
$98.49
|
| Rate for Payer: Quartz Commercial |
$130.65
|
| Rate for Payer: Quartz Medicare Advantage |
$64.41
|
| Rate for Payer: The Alliance Commercial |
$804.00
|
| Rate for Payer: United Healthcare Medicaid |
$66.55
|
| Rate for Payer: United Healthcare Medicare Advantage |
$64.41
|
| Rate for Payer: United Healthcare PPO |
$150.75
|
| Rate for Payer: WEA Trust Commercial |
$110.55
|
| Rate for Payer: Wellcare Medicare |
$64.41
|
| Rate for Payer: WMAP Medicaid |
$66.55
|
| Rate for Payer: WPS Commercial |
$148.88
|
|
|
Alpha-Fetoprotein & AFP-L3
|
Facility
IP
|
$201.00
|
|
|
Service Code
|
CPT 82107
|
| Hospital Charge Code |
4109314
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$98.49 |
| Max. Negotiated Rate |
$184.92 |
| Rate for Payer: Aetna Commercial |
$180.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$106.53
|
| Rate for Payer: Cash Price |
$60.30
|
| Rate for Payer: Cigna Commercial |
$184.92
|
| Rate for Payer: Health EOS Commercial |
$178.89
|
| Rate for Payer: HFN Commercial |
$184.92
|
| Rate for Payer: Multiplan Commercial |
$160.80
|
| Rate for Payer: NAPHCARE Commercial |
$120.60
|
| Rate for Payer: Preferred Network Access Commercial |
$184.92
|
| Rate for Payer: Quartz Beloit One Network |
$98.49
|
| Rate for Payer: Quartz Commercial |
$120.60
|
| Rate for Payer: WEA Trust Commercial |
$110.55
|
| Rate for Payer: WPS Commercial |
$148.88
|
|
|
Alpha-Fetoprotein, Pleural Fluid
|
Facility
OP
|
$78.00
|
|
|
Service Code
|
CPT 86316
|
| Hospital Charge Code |
5290652
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$20.81 |
| Max. Negotiated Rate |
$312.00 |
| Rate for Payer: Aetna Commercial |
$70.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$67.08
|
| Rate for Payer: Aetna Managed Medicare |
$20.81
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$78.04
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$36.42
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$34.54
|
| Rate for Payer: Anthem Medicaid |
$21.50
|
| Rate for Payer: Anthem Medicare Advantage |
$20.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$41.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$20.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$20.81
|
| Rate for Payer: Cash Price |
$23.40
|
| Rate for Payer: Cash Price |
$23.40
|
| Rate for Payer: Cigna Commercial |
$71.76
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$20.81
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$21.50
|
| Rate for Payer: Dean Health Medicaid |
$21.50
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$20.81
|
| Rate for Payer: Health EOS Commercial |
$69.42
|
| Rate for Payer: HFN Commercial |
$71.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$77.41
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$20.81
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$21.50
|
| Rate for Payer: Independent Care Health Plan Medicare |
$20.81
|
| Rate for Payer: Managed Health Services Medicaid |
$22.36
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$20.81
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$20.81
|
| Rate for Payer: Multiplan Commercial |
$62.40
|
| Rate for Payer: NAPHCARE Commercial |
$31.22
|
| Rate for Payer: Preferred Network Access Commercial |
$71.76
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$21.50
|
| Rate for Payer: Quartz Beloit One Network |
$38.22
|
| Rate for Payer: Quartz Commercial |
$50.70
|
| Rate for Payer: Quartz Medicare Advantage |
$20.81
|
| Rate for Payer: The Alliance Commercial |
$312.00
|
| Rate for Payer: United Healthcare Medicaid |
$21.50
|
| Rate for Payer: United Healthcare Medicare Advantage |
$20.81
|
| Rate for Payer: United Healthcare PPO |
$58.50
|
| Rate for Payer: WEA Trust Commercial |
$42.90
|
| Rate for Payer: Wellcare Medicare |
$20.81
|
| Rate for Payer: WMAP Medicaid |
$21.50
|
| Rate for Payer: WPS Commercial |
$57.77
|
|
|
Alpha-Fetoprotein, Pleural Fluid
|
Professional
|
$78.00
|
|
|
Service Code
|
CPT 86316
|
| Hospital Charge Code |
5290652
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$20.81 |
| Max. Negotiated Rate |
$91.56 |
| Rate for Payer: Aetna Commercial |
$74.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$67.08
|
| Rate for Payer: Aetna Managed Medicare |
$20.81
|
| Rate for Payer: Anthem Medicare Advantage |
$20.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$20.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$20.81
|
| Rate for Payer: Cash Price |
$23.40
|
| Rate for Payer: Cash Price |
$23.40
|
| Rate for Payer: Cigna Commercial |
$74.10
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$39.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$20.81
|
| Rate for Payer: Health EOS Commercial |
$70.98
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$73.46
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$73.46
|
| Rate for Payer: Independent Care Health Plan Medicare |
$20.81
|
| Rate for Payer: Multiplan Commercial |
$62.40
|
| Rate for Payer: Preferred Network Access Commercial |
$74.10
|
| Rate for Payer: Quartz Beloit One Network |
$34.32
|
| Rate for Payer: Quartz Commercial |
$44.46
|
| Rate for Payer: Quartz Medicare Advantage |
$20.81
|
| Rate for Payer: The Alliance Commercial |
$82.20
|
| Rate for Payer: United Healthcare Medicare Advantage |
$20.81
|
| Rate for Payer: WEA Trust Commercial |
$42.90
|
| Rate for Payer: WPS Commercial |
$91.56
|
|
|
Alpha-Fetoprotein, Pleural Fluid
|
Facility
IP
|
$78.00
|
|
|
Service Code
|
CPT 86316
|
| Hospital Charge Code |
5290652
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$38.22 |
| Max. Negotiated Rate |
$71.76 |
| Rate for Payer: Aetna Commercial |
$70.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$41.34
|
| Rate for Payer: Cash Price |
$23.40
|
| Rate for Payer: Cigna Commercial |
$71.76
|
| Rate for Payer: Health EOS Commercial |
$69.42
|
| Rate for Payer: HFN Commercial |
$71.76
|
| Rate for Payer: Multiplan Commercial |
$62.40
|
| Rate for Payer: NAPHCARE Commercial |
$46.80
|
| Rate for Payer: Preferred Network Access Commercial |
$71.76
|
| Rate for Payer: Quartz Beloit One Network |
$38.22
|
| Rate for Payer: Quartz Commercial |
$46.80
|
| Rate for Payer: WEA Trust Commercial |
$42.90
|
| Rate for Payer: WPS Commercial |
$57.77
|
|
|
Alpha Fetoprotein Tumor Marker
|
Facility
OP
|
$245.00
|
|
|
Service Code
|
CPT 82105
|
| Hospital Charge Code |
633643
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$16.77 |
| Max. Negotiated Rate |
$980.00 |
| Rate for Payer: Aetna Commercial |
$220.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$210.70
|
| Rate for Payer: Aetna Managed Medicare |
$16.77
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$62.89
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$29.35
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$27.84
|
| Rate for Payer: Anthem Medicaid |
$17.33
|
| Rate for Payer: Anthem Medicare Advantage |
$16.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$129.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$16.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$16.77
|
| Rate for Payer: Cash Price |
$73.50
|
| Rate for Payer: Cash Price |
$73.50
|
| Rate for Payer: Cigna Commercial |
$225.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$16.77
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$17.33
|
| Rate for Payer: Dean Health Medicaid |
$17.33
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$16.77
|
| Rate for Payer: Health EOS Commercial |
$218.05
|
| Rate for Payer: HFN Commercial |
$225.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$62.38
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$16.77
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$17.33
|
| Rate for Payer: Independent Care Health Plan Medicare |
$16.77
|
| Rate for Payer: Managed Health Services Medicaid |
$18.02
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$16.77
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$16.77
|
| Rate for Payer: Multiplan Commercial |
$196.00
|
| Rate for Payer: NAPHCARE Commercial |
$25.16
|
| Rate for Payer: Preferred Network Access Commercial |
$225.40
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$17.33
|
| Rate for Payer: Quartz Beloit One Network |
$120.05
|
| Rate for Payer: Quartz Commercial |
$159.25
|
| Rate for Payer: Quartz Medicare Advantage |
$16.77
|
| Rate for Payer: The Alliance Commercial |
$980.00
|
| Rate for Payer: United Healthcare Medicaid |
$17.33
|
| Rate for Payer: United Healthcare Medicare Advantage |
$16.77
|
| Rate for Payer: United Healthcare PPO |
$183.75
|
| Rate for Payer: WEA Trust Commercial |
$134.75
|
| Rate for Payer: Wellcare Medicare |
$16.77
|
| Rate for Payer: WMAP Medicaid |
$17.33
|
| Rate for Payer: WPS Commercial |
$181.47
|
|
|
Alpha Fetoprotein Tumor Marker
|
Professional
|
$245.00
|
|
|
Service Code
|
CPT 82105
|
| Hospital Charge Code |
633643
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$16.77 |
| Max. Negotiated Rate |
$232.75 |
| Rate for Payer: Aetna Commercial |
$232.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$210.70
|
| Rate for Payer: Aetna Managed Medicare |
$16.77
|
| Rate for Payer: Anthem Medicare Advantage |
$16.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$16.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$16.77
|
| Rate for Payer: Cash Price |
$73.50
|
| Rate for Payer: Cash Price |
$73.50
|
| Rate for Payer: Cigna Commercial |
$232.75
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$122.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$16.77
|
| Rate for Payer: Health EOS Commercial |
$222.95
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$59.20
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$59.20
|
| Rate for Payer: Independent Care Health Plan Medicare |
$16.77
|
| Rate for Payer: Multiplan Commercial |
$196.00
|
| Rate for Payer: Preferred Network Access Commercial |
$232.75
|
| Rate for Payer: Quartz Beloit One Network |
$107.80
|
| Rate for Payer: Quartz Commercial |
$139.65
|
| Rate for Payer: Quartz Medicare Advantage |
$16.77
|
| Rate for Payer: The Alliance Commercial |
$66.24
|
| Rate for Payer: United Healthcare Medicare Advantage |
$16.77
|
| Rate for Payer: WEA Trust Commercial |
$134.75
|
| Rate for Payer: WPS Commercial |
$73.79
|
|
|
Alpha Fetoprotein Tumor Marker
|
Facility
IP
|
$245.00
|
|
|
Service Code
|
CPT 82105
|
| Hospital Charge Code |
633643
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$120.05 |
| Max. Negotiated Rate |
$225.40 |
| Rate for Payer: Aetna Commercial |
$220.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$129.85
|
| Rate for Payer: Cash Price |
$73.50
|
| Rate for Payer: Cigna Commercial |
$225.40
|
| Rate for Payer: Health EOS Commercial |
$218.05
|
| Rate for Payer: HFN Commercial |
$225.40
|
| Rate for Payer: Multiplan Commercial |
$196.00
|
| Rate for Payer: NAPHCARE Commercial |
$147.00
|
| Rate for Payer: Preferred Network Access Commercial |
$225.40
|
| Rate for Payer: Quartz Beloit One Network |
$120.05
|
| Rate for Payer: Quartz Commercial |
$147.00
|
| Rate for Payer: WEA Trust Commercial |
$134.75
|
| Rate for Payer: WPS Commercial |
$181.47
|
|
|
Alpha Melanocyte Stimulating Hormone
|
Professional
|
$282.00
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
5242623
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.27 |
| Max. Negotiated Rate |
$267.90 |
| Rate for Payer: Aetna Commercial |
$267.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$242.52
|
| Rate for Payer: Aetna Managed Medicare |
$17.27
|
| Rate for Payer: Anthem Medicare Advantage |
$17.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$17.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$17.27
|
| Rate for Payer: Cash Price |
$84.60
|
| Rate for Payer: Cash Price |
$84.60
|
| Rate for Payer: Cigna Commercial |
$267.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$141.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$17.27
|
| Rate for Payer: Health EOS Commercial |
$256.62
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$60.96
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$60.96
|
| Rate for Payer: Independent Care Health Plan Medicare |
$17.27
|
| Rate for Payer: Multiplan Commercial |
$225.60
|
| Rate for Payer: Preferred Network Access Commercial |
$267.90
|
| Rate for Payer: Quartz Beloit One Network |
$124.08
|
| Rate for Payer: Quartz Commercial |
$160.74
|
| Rate for Payer: Quartz Medicare Advantage |
$17.27
|
| Rate for Payer: The Alliance Commercial |
$68.22
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17.27
|
| Rate for Payer: WEA Trust Commercial |
$155.10
|
| Rate for Payer: WPS Commercial |
$75.99
|
|
