|
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
|
|
|
Alpha Melanocyte Stimulating Hormone
|
Facility
OP
|
$282.00
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
5242623
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.27 |
| Max. Negotiated Rate |
$1,128.00 |
| Rate for Payer: Aetna Commercial |
$253.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$242.52
|
| Rate for Payer: Aetna Managed Medicare |
$17.27
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$64.76
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$30.22
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$28.67
|
| Rate for Payer: Anthem Medicaid |
$17.85
|
| Rate for Payer: Anthem Medicare Advantage |
$17.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$149.46
|
| 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 |
$259.44
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$17.27
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$17.85
|
| Rate for Payer: Dean Health Medicaid |
$17.85
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$17.27
|
| Rate for Payer: Health EOS Commercial |
$250.98
|
| Rate for Payer: HFN Commercial |
$259.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$64.24
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$17.27
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$17.85
|
| Rate for Payer: Independent Care Health Plan Medicare |
$17.27
|
| Rate for Payer: Managed Health Services Medicaid |
$18.56
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$17.27
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$17.27
|
| Rate for Payer: Multiplan Commercial |
$225.60
|
| Rate for Payer: NAPHCARE Commercial |
$25.90
|
| Rate for Payer: Preferred Network Access Commercial |
$259.44
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$17.85
|
| Rate for Payer: Quartz Beloit One Network |
$138.18
|
| Rate for Payer: Quartz Commercial |
$183.30
|
| Rate for Payer: Quartz Medicare Advantage |
$17.27
|
| Rate for Payer: The Alliance Commercial |
$1,128.00
|
| Rate for Payer: United Healthcare Medicaid |
$17.85
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17.27
|
| Rate for Payer: United Healthcare PPO |
$211.50
|
| Rate for Payer: WEA Trust Commercial |
$155.10
|
| Rate for Payer: Wellcare Medicare |
$17.27
|
| Rate for Payer: WMAP Medicaid |
$17.85
|
| Rate for Payer: WPS Commercial |
$208.88
|
|
|
Alpha Subunit
|
Professional
|
$440.00
|
|
|
Service Code
|
CPT 83519
|
| Hospital Charge Code |
980019
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.40 |
| Max. Negotiated Rate |
$418.00 |
| Rate for Payer: Aetna Commercial |
$418.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$378.40
|
| Rate for Payer: Aetna Managed Medicare |
$18.40
|
| Rate for Payer: Anthem Medicare Advantage |
$18.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$18.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$18.40
|
| Rate for Payer: Cash Price |
$132.00
|
| Rate for Payer: Cash Price |
$132.00
|
| Rate for Payer: Cigna Commercial |
$418.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$220.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$18.40
|
| Rate for Payer: Health EOS Commercial |
$400.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$64.95
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$64.95
|
| Rate for Payer: Independent Care Health Plan Medicare |
$18.40
|
| Rate for Payer: Multiplan Commercial |
$352.00
|
| Rate for Payer: Preferred Network Access Commercial |
$418.00
|
| Rate for Payer: Quartz Beloit One Network |
$193.60
|
| Rate for Payer: Quartz Commercial |
$250.80
|
| Rate for Payer: Quartz Medicare Advantage |
$18.40
|
| Rate for Payer: The Alliance Commercial |
$72.68
|
| Rate for Payer: United Healthcare Medicare Advantage |
$18.40
|
| Rate for Payer: WEA Trust Commercial |
$242.00
|
| Rate for Payer: WPS Commercial |
$80.96
|
|
|
Alpha Subunit
|
Facility
OP
|
$440.00
|
|
|
Service Code
|
CPT 83519
|
| Hospital Charge Code |
980019
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.40 |
| Max. Negotiated Rate |
$1,760.00 |
| Rate for Payer: Aetna Commercial |
$396.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$378.40
|
| Rate for Payer: Aetna Managed Medicare |
$18.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$69.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$32.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$30.54
|
| Rate for Payer: Anthem Medicaid |
$19.00
|
| Rate for Payer: Anthem Medicare Advantage |
$18.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$233.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$18.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$18.40
|
| Rate for Payer: Cash Price |
$132.00
|
| Rate for Payer: Cash Price |
$132.00
|
| Rate for Payer: Cigna Commercial |
$404.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$18.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$19.00
|
| Rate for Payer: Dean Health Medicaid |
$19.00
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$18.40
|
| Rate for Payer: Health EOS Commercial |
$391.60
|
| Rate for Payer: HFN Commercial |
$404.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$68.45
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$18.40
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$19.00
|
| Rate for Payer: Independent Care Health Plan Medicare |
$18.40
|
| Rate for Payer: Managed Health Services Medicaid |
$19.76
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$18.40
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$18.40
|
| Rate for Payer: Multiplan Commercial |
$352.00
|
| Rate for Payer: NAPHCARE Commercial |
$27.60
|
| Rate for Payer: Preferred Network Access Commercial |
$404.80
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$19.00
|
| Rate for Payer: Quartz Beloit One Network |
$215.60
|
| Rate for Payer: Quartz Commercial |
$286.00
|
| Rate for Payer: Quartz Medicare Advantage |
$18.40
|
| Rate for Payer: The Alliance Commercial |
$1,760.00
|
| Rate for Payer: United Healthcare Medicaid |
$19.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$18.40
|
| Rate for Payer: United Healthcare PPO |
$330.00
|
| Rate for Payer: WEA Trust Commercial |
$242.00
|
| Rate for Payer: Wellcare Medicare |
$18.40
|
| Rate for Payer: WMAP Medicaid |
$19.00
|
| Rate for Payer: WPS Commercial |
$325.91
|
|
|
Alpha Subunit
|
Facility
IP
|
$440.00
|
|
|
Service Code
|
CPT 83519
|
| Hospital Charge Code |
980019
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$215.60 |
| Max. Negotiated Rate |
$404.80 |
| Rate for Payer: Aetna Commercial |
$396.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$233.20
|
| Rate for Payer: Cash Price |
$132.00
|
| Rate for Payer: Cigna Commercial |
$404.80
|
| Rate for Payer: Health EOS Commercial |
$391.60
|
| Rate for Payer: HFN Commercial |
$404.80
|
| Rate for Payer: Multiplan Commercial |
$352.00
|
| Rate for Payer: NAPHCARE Commercial |
$264.00
|
| Rate for Payer: Preferred Network Access Commercial |
$404.80
|
| Rate for Payer: Quartz Beloit One Network |
$215.60
|
| Rate for Payer: Quartz Commercial |
$264.00
|
| Rate for Payer: WEA Trust Commercial |
$242.00
|
| Rate for Payer: WPS Commercial |
$325.91
|
|
|
.Alpha Thalassemia DNA Mutation Analysis
|
Facility
IP
|
$851.00
|
|
|
Service Code
|
CPT 81257
|
| Hospital Charge Code |
4494978
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$416.99 |
| Max. Negotiated Rate |
$782.92 |
| Rate for Payer: Aetna Commercial |
$765.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$451.03
|
| Rate for Payer: Cash Price |
$255.30
|
| Rate for Payer: Cigna Commercial |
$782.92
|
| Rate for Payer: Health EOS Commercial |
$757.39
|
| Rate for Payer: HFN Commercial |
$782.92
|
| Rate for Payer: Multiplan Commercial |
$680.80
|
| Rate for Payer: NAPHCARE Commercial |
$510.60
|
| Rate for Payer: Preferred Network Access Commercial |
$782.92
|
| Rate for Payer: Quartz Beloit One Network |
$416.99
|
| Rate for Payer: Quartz Commercial |
$510.60
|
| Rate for Payer: WEA Trust Commercial |
$468.05
|
| Rate for Payer: WPS Commercial |
$630.34
|
|
|
.Alpha Thalassemia DNA Mutation Analysis
|
Professional
|
$851.00
|
|
|
Service Code
|
CPT 81257
|
| Hospital Charge Code |
4494978
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$102.26 |
| Max. Negotiated Rate |
$808.45 |
| Rate for Payer: Aetna Commercial |
$808.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$731.86
|
| Rate for Payer: Aetna Managed Medicare |
$102.26
|
| Rate for Payer: Anthem Medicare Advantage |
$102.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$102.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$102.26
|
| Rate for Payer: Cash Price |
$255.30
|
| Rate for Payer: Cash Price |
$255.30
|
| Rate for Payer: Cigna Commercial |
$808.45
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$425.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$102.26
|
| Rate for Payer: Health EOS Commercial |
$774.41
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$360.98
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$360.98
|
| Rate for Payer: Independent Care Health Plan Medicare |
$102.26
|
| Rate for Payer: Multiplan Commercial |
$680.80
|
| Rate for Payer: Preferred Network Access Commercial |
$808.45
|
| Rate for Payer: Quartz Beloit One Network |
$374.44
|
| Rate for Payer: Quartz Commercial |
$485.07
|
| Rate for Payer: Quartz Medicare Advantage |
$102.26
|
| Rate for Payer: The Alliance Commercial |
$403.93
|
| Rate for Payer: United Healthcare Medicare Advantage |
$102.26
|
| Rate for Payer: WEA Trust Commercial |
$468.05
|
| Rate for Payer: WPS Commercial |
$449.94
|
|
|
.Alpha Thalassemia DNA Mutation Analysis
|
Facility
OP
|
$851.00
|
|
|
Service Code
|
CPT 81257
|
| Hospital Charge Code |
4494978
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$102.26 |
| Max. Negotiated Rate |
$3,404.00 |
| Rate for Payer: Aetna Commercial |
$765.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$731.86
|
| Rate for Payer: Aetna Managed Medicare |
$102.26
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$383.48
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$178.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$169.75
|
| Rate for Payer: Anthem Medicaid |
$105.67
|
| Rate for Payer: Anthem Medicare Advantage |
$102.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$451.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$102.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$102.26
|
| Rate for Payer: Cash Price |
$255.30
|
| Rate for Payer: Cash Price |
$255.30
|
| Rate for Payer: Cigna Commercial |
$782.92
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$102.26
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$105.67
|
| Rate for Payer: Dean Health Medicaid |
$105.67
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$102.26
|
| Rate for Payer: Health EOS Commercial |
$757.39
|
| Rate for Payer: HFN Commercial |
$782.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$380.41
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$102.26
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$105.67
|
| Rate for Payer: Independent Care Health Plan Medicare |
$102.26
|
| Rate for Payer: Managed Health Services Medicaid |
$109.90
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$102.26
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$102.26
|
| Rate for Payer: Multiplan Commercial |
$680.80
|
| Rate for Payer: NAPHCARE Commercial |
$153.39
|
| Rate for Payer: Preferred Network Access Commercial |
$782.92
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$105.67
|
| Rate for Payer: Quartz Beloit One Network |
$416.99
|
| Rate for Payer: Quartz Commercial |
$553.15
|
| Rate for Payer: Quartz Medicare Advantage |
$102.26
|
| Rate for Payer: The Alliance Commercial |
$3,404.00
|
| Rate for Payer: United Healthcare Medicaid |
$105.67
|
| Rate for Payer: United Healthcare Medicare Advantage |
$102.26
|
| Rate for Payer: United Healthcare PPO |
$638.25
|
| Rate for Payer: WEA Trust Commercial |
$468.05
|
| Rate for Payer: Wellcare Medicare |
$102.26
|
| Rate for Payer: WMAP Medicaid |
$105.67
|
| Rate for Payer: WPS Commercial |
$630.34
|
|
|
ALT
|
Facility
IP
|
$44.00
|
|
|
Service Code
|
CPT 84460
|
| Hospital Charge Code |
4812611
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$21.56 |
| Max. Negotiated Rate |
$40.48 |
| Rate for Payer: Aetna Commercial |
$39.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$23.32
|
| Rate for Payer: Cash Price |
$13.20
|
| Rate for Payer: Cigna Commercial |
$40.48
|
| Rate for Payer: Health EOS Commercial |
$39.16
|
| Rate for Payer: HFN Commercial |
$40.48
|
| Rate for Payer: Multiplan Commercial |
$35.20
|
| Rate for Payer: NAPHCARE Commercial |
$26.40
|
| Rate for Payer: Preferred Network Access Commercial |
$40.48
|
| Rate for Payer: Quartz Beloit One Network |
$21.56
|
| Rate for Payer: Quartz Commercial |
$26.40
|
| Rate for Payer: WEA Trust Commercial |
$24.20
|
| Rate for Payer: WPS Commercial |
$32.59
|
|
|
ALT
|
Facility
OP
|
$44.00
|
|
|
Service Code
|
CPT 84460
|
| Hospital Charge Code |
4812611
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.30 |
| Max. Negotiated Rate |
$176.00 |
| Rate for Payer: Aetna Commercial |
$39.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$37.84
|
| Rate for Payer: Aetna Managed Medicare |
$5.30
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$19.88
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$9.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$8.80
|
| Rate for Payer: Anthem Medicaid |
$5.48
|
| Rate for Payer: Anthem Medicare Advantage |
$5.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$23.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5.30
|
| Rate for Payer: Cash Price |
$13.20
|
| Rate for Payer: Cash Price |
$13.20
|
| Rate for Payer: Cigna Commercial |
$40.48
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$5.30
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$5.48
|
| Rate for Payer: Dean Health Medicaid |
$5.48
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$5.30
|
| Rate for Payer: Health EOS Commercial |
$39.16
|
| Rate for Payer: HFN Commercial |
$40.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$19.72
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$5.30
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$5.48
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5.30
|
| Rate for Payer: Managed Health Services Medicaid |
$5.70
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$5.30
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$5.30
|
| Rate for Payer: Multiplan Commercial |
$35.20
|
| Rate for Payer: NAPHCARE Commercial |
$7.95
|
| Rate for Payer: Preferred Network Access Commercial |
$40.48
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$5.48
|
| Rate for Payer: Quartz Beloit One Network |
$21.56
|
| Rate for Payer: Quartz Commercial |
$28.60
|
| Rate for Payer: Quartz Medicare Advantage |
$5.30
|
| Rate for Payer: The Alliance Commercial |
$176.00
|
| Rate for Payer: United Healthcare Medicaid |
$5.48
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.30
|
| Rate for Payer: United Healthcare PPO |
$33.00
|
| Rate for Payer: WEA Trust Commercial |
$24.20
|
| Rate for Payer: Wellcare Medicare |
$5.30
|
| Rate for Payer: WMAP Medicaid |
$5.48
|
| Rate for Payer: WPS Commercial |
$32.59
|
|
|
ALT
|
Professional
|
$44.00
|
|
|
Service Code
|
CPT 84460
|
| Hospital Charge Code |
4812611
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.30 |
| Max. Negotiated Rate |
$41.80 |
| Rate for Payer: Aetna Commercial |
$41.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$37.84
|
| Rate for Payer: Aetna Managed Medicare |
$5.30
|
| Rate for Payer: Anthem Medicare Advantage |
$5.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5.30
|
| Rate for Payer: Cash Price |
$13.20
|
| Rate for Payer: Cash Price |
$13.20
|
| Rate for Payer: Cigna Commercial |
$41.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$22.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5.30
|
| Rate for Payer: Health EOS Commercial |
$40.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$18.71
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$18.71
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5.30
|
| Rate for Payer: Multiplan Commercial |
$35.20
|
| Rate for Payer: Preferred Network Access Commercial |
$41.80
|
| Rate for Payer: Quartz Beloit One Network |
$19.36
|
| Rate for Payer: Quartz Commercial |
$25.08
|
| Rate for Payer: Quartz Medicare Advantage |
$5.30
|
| Rate for Payer: The Alliance Commercial |
$20.94
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.30
|
| Rate for Payer: WEA Trust Commercial |
$24.20
|
| Rate for Payer: WPS Commercial |
$23.32
|
|
|
Alt Binaural Loudness Balance
|
Professional
|
$160.00
|
|
|
Service Code
|
CPT 92562
|
| Hospital Charge Code |
3203480
|
|
Hospital Revenue Code
|
470
|
| Min. Negotiated Rate |
$45.82 |
| Max. Negotiated Rate |
$183.28 |
| Rate for Payer: Aetna Commercial |
$152.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$137.60
|
| Rate for Payer: Aetna Managed Medicare |
$45.82
|
| Rate for Payer: Anthem Medicare Advantage |
$45.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$45.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$45.82
|
| Rate for Payer: Cash Price |
$48.00
|
| Rate for Payer: Cash Price |
$48.00
|
| Rate for Payer: Cigna Commercial |
$152.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$80.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$45.82
|
| Rate for Payer: Health EOS Commercial |
$145.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$155.85
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$155.85
|
| Rate for Payer: Independent Care Health Plan Medicare |
$45.82
|
| Rate for Payer: Multiplan Commercial |
$128.00
|
| Rate for Payer: Preferred Network Access Commercial |
$152.00
|
| Rate for Payer: Quartz Beloit One Network |
$70.40
|
| Rate for Payer: Quartz Commercial |
$91.20
|
| Rate for Payer: Quartz Medicare Advantage |
$45.82
|
| Rate for Payer: The Alliance Commercial |
$114.55
|
| Rate for Payer: United Healthcare Medicare Advantage |
$45.82
|
| Rate for Payer: WEA Trust Commercial |
$88.00
|
| Rate for Payer: WPS Commercial |
$183.28
|
|
|
Alt Binaural Loudness Balance
|
Facility
IP
|
$160.00
|
|
|
Service Code
|
CPT 92562
|
| Hospital Charge Code |
3203480
|
|
Hospital Revenue Code
|
470
|
| Min. Negotiated Rate |
$78.40 |
| Max. Negotiated Rate |
$147.20 |
| Rate for Payer: Aetna Commercial |
$144.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$84.80
|
| Rate for Payer: Cash Price |
$48.00
|
| Rate for Payer: Cigna Commercial |
$147.20
|
| Rate for Payer: Health EOS Commercial |
$142.40
|
| Rate for Payer: HFN Commercial |
$147.20
|
| Rate for Payer: Multiplan Commercial |
$128.00
|
| Rate for Payer: NAPHCARE Commercial |
$96.00
|
| Rate for Payer: Preferred Network Access Commercial |
$147.20
|
| Rate for Payer: Quartz Beloit One Network |
$78.40
|
| Rate for Payer: Quartz Commercial |
$96.00
|
| Rate for Payer: WEA Trust Commercial |
$88.00
|
| Rate for Payer: WPS Commercial |
$118.51
|
|
|
Alt Binaural Loudness Balance
|
Facility
OP
|
$160.00
|
|
|
Service Code
|
CPT 92562
|
| Hospital Charge Code |
3203480
|
|
Hospital Revenue Code
|
470
|
| Min. Negotiated Rate |
$76.80 |
| Max. Negotiated Rate |
$1,154.09 |
| Rate for Payer: Aetna Commercial |
$144.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$137.60
|
| Rate for Payer: Aetna Managed Medicare |
$310.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$104.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$80.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$76.80
|
| Rate for Payer: Anthem Medicare Advantage |
$310.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$84.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$310.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$310.24
|
| Rate for Payer: Cash Price |
$48.00
|
| Rate for Payer: Cash Price |
$48.00
|
| Rate for Payer: Cigna Commercial |
$147.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$310.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$89.54
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$310.24
|
| Rate for Payer: Health EOS Commercial |
$142.40
|
| Rate for Payer: HFN Commercial |
$147.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,154.09
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$310.24
|
| Rate for Payer: Independent Care Health Plan Medicare |
$310.24
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$310.24
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$310.24
|
| Rate for Payer: Multiplan Commercial |
$128.00
|
| Rate for Payer: NAPHCARE Commercial |
$465.36
|
| Rate for Payer: Preferred Network Access Commercial |
$147.20
|
| Rate for Payer: Quartz Beloit One Network |
$78.40
|
| Rate for Payer: Quartz Commercial |
$104.00
|
| Rate for Payer: Quartz Medicare Advantage |
$310.24
|
| Rate for Payer: United Healthcare Medicare Advantage |
$310.24
|
| Rate for Payer: United Healthcare PPO |
$120.00
|
| Rate for Payer: WEA Trust Commercial |
$88.00
|
| Rate for Payer: Wellcare Medicare |
$310.24
|
| Rate for Payer: WPS Commercial |
$118.51
|
|
|
ALT (FS)
|
Facility
OP
|
$5.00
|
|
|
Service Code
|
CPT 84460
|
| Hospital Charge Code |
4538807
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$2.45 |
| Max. Negotiated Rate |
$20.00 |
| Rate for Payer: Aetna Commercial |
$4.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4.30
|
| Rate for Payer: Aetna Managed Medicare |
$5.30
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$19.88
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$9.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$8.80
|
| Rate for Payer: Anthem Medicaid |
$5.48
|
| Rate for Payer: Anthem Medicare Advantage |
$5.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5.30
|
| Rate for Payer: Cash Price |
$1.50
|
| Rate for Payer: Cash Price |
$1.50
|
| Rate for Payer: Cigna Commercial |
$4.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$5.30
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$5.48
|
| Rate for Payer: Dean Health Medicaid |
$5.48
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$5.30
|
| Rate for Payer: Health EOS Commercial |
$4.45
|
| Rate for Payer: HFN Commercial |
$4.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$19.72
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$5.30
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$5.48
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5.30
|
| Rate for Payer: Managed Health Services Medicaid |
$5.70
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$5.30
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$5.30
|
| Rate for Payer: Multiplan Commercial |
$4.00
|
| Rate for Payer: NAPHCARE Commercial |
$7.95
|
| Rate for Payer: Preferred Network Access Commercial |
$4.60
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$5.48
|
| Rate for Payer: Quartz Beloit One Network |
$2.45
|
| Rate for Payer: Quartz Commercial |
$3.25
|
| Rate for Payer: Quartz Medicare Advantage |
$5.30
|
| Rate for Payer: The Alliance Commercial |
$20.00
|
| Rate for Payer: United Healthcare Medicaid |
$5.48
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.30
|
| Rate for Payer: United Healthcare PPO |
$3.75
|
| Rate for Payer: WEA Trust Commercial |
$2.75
|
| Rate for Payer: Wellcare Medicare |
$5.30
|
| Rate for Payer: WMAP Medicaid |
$5.48
|
| Rate for Payer: WPS Commercial |
$3.70
|
|
|
ALT (FS)
|
Facility
IP
|
$5.00
|
|
|
Service Code
|
CPT 84460
|
| Hospital Charge Code |
4538807
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$2.45 |
| Max. Negotiated Rate |
$4.60 |
| Rate for Payer: Aetna Commercial |
$4.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2.65
|
| Rate for Payer: Cash Price |
$1.50
|
| Rate for Payer: Cigna Commercial |
$4.60
|
| Rate for Payer: Health EOS Commercial |
$4.45
|
| Rate for Payer: HFN Commercial |
$4.60
|
| Rate for Payer: Multiplan Commercial |
$4.00
|
| Rate for Payer: NAPHCARE Commercial |
$3.00
|
| Rate for Payer: Preferred Network Access Commercial |
$4.60
|
| Rate for Payer: Quartz Beloit One Network |
$2.45
|
| Rate for Payer: Quartz Commercial |
$3.00
|
| Rate for Payer: WEA Trust Commercial |
$2.75
|
| Rate for Payer: WPS Commercial |
$3.70
|
|
|
ALT (FS)
|
Professional
|
$5.00
|
|
|
Service Code
|
CPT 84460
|
| Hospital Charge Code |
4538807
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$2.20 |
| Max. Negotiated Rate |
$23.32 |
| Rate for Payer: Aetna Commercial |
$4.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4.30
|
| Rate for Payer: Aetna Managed Medicare |
$5.30
|
| Rate for Payer: Anthem Medicare Advantage |
$5.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5.30
|
| Rate for Payer: Cash Price |
$1.50
|
| Rate for Payer: Cash Price |
$1.50
|
| Rate for Payer: Cigna Commercial |
$4.75
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5.30
|
| Rate for Payer: Health EOS Commercial |
$4.55
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$18.71
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$18.71
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5.30
|
| Rate for Payer: Multiplan Commercial |
$4.00
|
| Rate for Payer: Preferred Network Access Commercial |
$4.75
|
| Rate for Payer: Quartz Beloit One Network |
$2.20
|
| Rate for Payer: Quartz Commercial |
$2.85
|
| Rate for Payer: Quartz Medicare Advantage |
$5.30
|
| Rate for Payer: The Alliance Commercial |
$20.94
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.30
|
| Rate for Payer: WEA Trust Commercial |
$2.75
|
| Rate for Payer: WPS Commercial |
$23.32
|
|
|
ALT (FSURE)
|
Facility
IP
|
$62.00
|
|
|
Service Code
|
CPT 84460
|
| Hospital Charge Code |
4538814
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$30.38 |
| Max. Negotiated Rate |
$57.04 |
| Rate for Payer: Aetna Commercial |
$55.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$32.86
|
| Rate for Payer: Cash Price |
$18.60
|
| Rate for Payer: Cigna Commercial |
$57.04
|
| Rate for Payer: Health EOS Commercial |
$55.18
|
| Rate for Payer: HFN Commercial |
$57.04
|
| Rate for Payer: Multiplan Commercial |
$49.60
|
| Rate for Payer: NAPHCARE Commercial |
$37.20
|
| Rate for Payer: Preferred Network Access Commercial |
$57.04
|
| Rate for Payer: Quartz Beloit One Network |
$30.38
|
| Rate for Payer: Quartz Commercial |
$37.20
|
| Rate for Payer: WEA Trust Commercial |
$34.10
|
| Rate for Payer: WPS Commercial |
$45.92
|
|
|
ALT (FSURE)
|
Facility
OP
|
$62.00
|
|
|
Service Code
|
CPT 84460
|
| Hospital Charge Code |
4538814
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.30 |
| Max. Negotiated Rate |
$248.00 |
| Rate for Payer: Aetna Commercial |
$55.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$53.32
|
| Rate for Payer: Aetna Managed Medicare |
$5.30
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$19.88
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$9.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$8.80
|
| Rate for Payer: Anthem Medicaid |
$5.48
|
| Rate for Payer: Anthem Medicare Advantage |
$5.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$32.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5.30
|
| Rate for Payer: Cash Price |
$18.60
|
| Rate for Payer: Cash Price |
$18.60
|
| Rate for Payer: Cigna Commercial |
$57.04
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$5.30
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$5.48
|
| Rate for Payer: Dean Health Medicaid |
$5.48
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$5.30
|
| Rate for Payer: Health EOS Commercial |
$55.18
|
| Rate for Payer: HFN Commercial |
$57.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$19.72
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$5.30
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$5.48
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5.30
|
| Rate for Payer: Managed Health Services Medicaid |
$5.70
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$5.30
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$5.30
|
| Rate for Payer: Multiplan Commercial |
$49.60
|
| Rate for Payer: NAPHCARE Commercial |
$7.95
|
| Rate for Payer: Preferred Network Access Commercial |
$57.04
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$5.48
|
| Rate for Payer: Quartz Beloit One Network |
$30.38
|
| Rate for Payer: Quartz Commercial |
$40.30
|
| Rate for Payer: Quartz Medicare Advantage |
$5.30
|
| Rate for Payer: The Alliance Commercial |
$248.00
|
| Rate for Payer: United Healthcare Medicaid |
$5.48
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.30
|
| Rate for Payer: United Healthcare PPO |
$46.50
|
| Rate for Payer: WEA Trust Commercial |
$34.10
|
| Rate for Payer: Wellcare Medicare |
$5.30
|
| Rate for Payer: WMAP Medicaid |
$5.48
|
| Rate for Payer: WPS Commercial |
$45.92
|
|
|
ALT (FSURE)
|
Professional
|
$62.00
|
|
|
Service Code
|
CPT 84460
|
| Hospital Charge Code |
4538814
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.30 |
| Max. Negotiated Rate |
$58.90 |
| Rate for Payer: Aetna Commercial |
$58.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$53.32
|
| Rate for Payer: Aetna Managed Medicare |
$5.30
|
| Rate for Payer: Anthem Medicare Advantage |
$5.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5.30
|
| Rate for Payer: Cash Price |
$18.60
|
| Rate for Payer: Cash Price |
$18.60
|
| Rate for Payer: Cigna Commercial |
$58.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$31.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5.30
|
| Rate for Payer: Health EOS Commercial |
$56.42
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$18.71
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$18.71
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5.30
|
| Rate for Payer: Multiplan Commercial |
$49.60
|
| Rate for Payer: Preferred Network Access Commercial |
$58.90
|
| Rate for Payer: Quartz Beloit One Network |
$27.28
|
| Rate for Payer: Quartz Commercial |
$35.34
|
| Rate for Payer: Quartz Medicare Advantage |
$5.30
|
| Rate for Payer: The Alliance Commercial |
$20.94
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.30
|
| Rate for Payer: WEA Trust Commercial |
$34.10
|
| Rate for Payer: WPS Commercial |
$23.32
|
|
|
Aluminum Level
|
Facility
IP
|
$321.00
|
|
|
Service Code
|
CPT 82108
|
| Hospital Charge Code |
633644
|
|
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
|
|
|
Aluminum Level
|
Professional
|
$321.00
|
|
|
Service Code
|
CPT 82108
|
| Hospital Charge Code |
633644
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$25.48 |
| 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 |
$25.48
|
| Rate for Payer: Anthem Medicare Advantage |
$25.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$25.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$25.48
|
| 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 |
$25.48
|
| Rate for Payer: Health EOS Commercial |
$292.11
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$89.94
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$89.94
|
| Rate for Payer: Independent Care Health Plan Medicare |
$25.48
|
| 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 |
$25.48
|
| Rate for Payer: The Alliance Commercial |
$100.65
|
| Rate for Payer: United Healthcare Medicare Advantage |
$25.48
|
| Rate for Payer: WEA Trust Commercial |
$176.55
|
| Rate for Payer: WPS Commercial |
$112.11
|
|
|
Aluminum Level
|
Facility
OP
|
$321.00
|
|
|
Service Code
|
CPT 82108
|
| Hospital Charge Code |
633644
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$25.48 |
| 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 |
$25.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$95.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$44.59
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$42.30
|
| Rate for Payer: Anthem Medicaid |
$26.33
|
| Rate for Payer: Anthem Medicare Advantage |
$25.48
|
| 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 |
$25.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$25.48
|
| 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 |
$25.48
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$26.33
|
| Rate for Payer: Dean Health Medicaid |
$26.33
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$25.48
|
| Rate for Payer: Health EOS Commercial |
$285.69
|
| Rate for Payer: HFN Commercial |
$295.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$94.79
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$25.48
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$26.33
|
| Rate for Payer: Independent Care Health Plan Medicare |
$25.48
|
| Rate for Payer: Managed Health Services Medicaid |
$27.38
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$25.48
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$25.48
|
| Rate for Payer: Multiplan Commercial |
$256.80
|
| Rate for Payer: NAPHCARE Commercial |
$38.22
|
| Rate for Payer: Preferred Network Access Commercial |
$295.32
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$26.33
|
| Rate for Payer: Quartz Beloit One Network |
$157.29
|
| Rate for Payer: Quartz Commercial |
$208.65
|
| Rate for Payer: Quartz Medicare Advantage |
$25.48
|
| Rate for Payer: The Alliance Commercial |
$1,284.00
|
| Rate for Payer: United Healthcare Medicaid |
$26.33
|
| Rate for Payer: United Healthcare Medicare Advantage |
$25.48
|
| Rate for Payer: United Healthcare PPO |
$240.75
|
| Rate for Payer: WEA Trust Commercial |
$176.55
|
| Rate for Payer: Wellcare Medicare |
$25.48
|
| Rate for Payer: WMAP Medicaid |
$26.33
|
| Rate for Payer: WPS Commercial |
$237.76
|
|
|
Aluminum Level 24 Hour Urine
|
Facility
OP
|
$126.00
|
|
|
Service Code
|
CPT 82108
|
| Hospital Charge Code |
977863
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$25.48 |
| Max. Negotiated Rate |
$504.00 |
| Rate for Payer: Aetna Commercial |
$113.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$108.36
|
| Rate for Payer: Aetna Managed Medicare |
$25.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$95.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$44.59
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$42.30
|
| Rate for Payer: Anthem Medicaid |
$26.33
|
| Rate for Payer: Anthem Medicare Advantage |
$25.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$66.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$25.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$25.48
|
| Rate for Payer: Cash Price |
$37.80
|
| Rate for Payer: Cash Price |
$37.80
|
| Rate for Payer: Cigna Commercial |
$115.92
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$25.48
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$26.33
|
| Rate for Payer: Dean Health Medicaid |
$26.33
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$25.48
|
| Rate for Payer: Health EOS Commercial |
$112.14
|
| Rate for Payer: HFN Commercial |
$115.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$94.79
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$25.48
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$26.33
|
| Rate for Payer: Independent Care Health Plan Medicare |
$25.48
|
| Rate for Payer: Managed Health Services Medicaid |
$27.38
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$25.48
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$25.48
|
| Rate for Payer: Multiplan Commercial |
$100.80
|
| Rate for Payer: NAPHCARE Commercial |
$38.22
|
| Rate for Payer: Preferred Network Access Commercial |
$115.92
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$26.33
|
| Rate for Payer: Quartz Beloit One Network |
$61.74
|
| Rate for Payer: Quartz Commercial |
$81.90
|
| Rate for Payer: Quartz Medicare Advantage |
$25.48
|
| Rate for Payer: The Alliance Commercial |
$504.00
|
| Rate for Payer: United Healthcare Medicaid |
$26.33
|
| Rate for Payer: United Healthcare Medicare Advantage |
$25.48
|
| Rate for Payer: United Healthcare PPO |
$94.50
|
| Rate for Payer: WEA Trust Commercial |
$69.30
|
| Rate for Payer: Wellcare Medicare |
$25.48
|
| Rate for Payer: WMAP Medicaid |
$26.33
|
| Rate for Payer: WPS Commercial |
$93.33
|
|
|
Aluminum Level 24 Hour Urine
|
Professional
|
$126.00
|
|
|
Service Code
|
CPT 82108
|
| Hospital Charge Code |
977863
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$25.48 |
| Max. Negotiated Rate |
$119.70 |
| Rate for Payer: Aetna Commercial |
$119.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$108.36
|
| Rate for Payer: Aetna Managed Medicare |
$25.48
|
| Rate for Payer: Anthem Medicare Advantage |
$25.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$25.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$25.48
|
| Rate for Payer: Cash Price |
$37.80
|
| Rate for Payer: Cash Price |
$37.80
|
| Rate for Payer: Cigna Commercial |
$119.70
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$63.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$25.48
|
| Rate for Payer: Health EOS Commercial |
$114.66
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$89.94
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$89.94
|
| Rate for Payer: Independent Care Health Plan Medicare |
$25.48
|
| Rate for Payer: Multiplan Commercial |
$100.80
|
| Rate for Payer: Preferred Network Access Commercial |
$119.70
|
| Rate for Payer: Quartz Beloit One Network |
$55.44
|
| Rate for Payer: Quartz Commercial |
$71.82
|
| Rate for Payer: Quartz Medicare Advantage |
$25.48
|
| Rate for Payer: The Alliance Commercial |
$100.65
|
| Rate for Payer: United Healthcare Medicare Advantage |
$25.48
|
| Rate for Payer: WEA Trust Commercial |
$69.30
|
| Rate for Payer: WPS Commercial |
$112.11
|
|
