|
Alpha-1-Antitrypsin Phenotype
|
Facility
|
OP
|
$321.00
|
|
|
Service Code
|
CPT 82104
|
| Hospital Charge Code |
977862
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.04 |
| Max. Negotiated Rate |
$307.13 |
| Rate for Payer: Aetna Commercial |
$300.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$287.10
|
| Rate for Payer: Aetna Managed Medicare |
$15.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$56.39
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$26.32
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$24.96
|
| Rate for Payer: Anthem Medicare Advantage |
$15.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$176.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$15.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$15.04
|
| Rate for Payer: Cash Price |
$96.30
|
| Rate for Payer: Cash Price |
$96.30
|
| Rate for Payer: Cigna Commercial |
$307.13
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$15.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$186.82
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$15.04
|
| Rate for Payer: Health EOS Commercial |
$297.12
|
| Rate for Payer: HFN Commercial |
$307.13
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$55.94
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$15.04
|
| Rate for Payer: Independent Care Health Plan Medicare |
$15.04
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$15.04
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$15.04
|
| Rate for Payer: Multiplan Commercial |
$267.07
|
| Rate for Payer: NAPHCARE Commercial |
$22.56
|
| Rate for Payer: Preferred Network Access Commercial |
$307.13
|
| Rate for Payer: Quartz Beloit One Network |
$163.58
|
| Rate for Payer: Quartz Commercial |
$217.00
|
| Rate for Payer: Quartz Medicare Advantage |
$15.04
|
| Rate for Payer: The Alliance Commercial |
$60.15
|
| Rate for Payer: United Healthcare Medicare Advantage |
$15.04
|
| Rate for Payer: United Healthcare PPO |
$250.38
|
| Rate for Payer: WEA Trust Commercial |
$183.61
|
| Rate for Payer: Wellcare Medicare |
$15.04
|
| Rate for Payer: WPS Commercial |
$247.27
|
|
|
Alpha-1-Antitrypsin Phenotype
|
Facility
|
IP
|
$321.00
|
|
|
Service Code
|
CPT 82104
|
| Hospital Charge Code |
977862
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$163.58 |
| Max. Negotiated Rate |
$307.13 |
| Rate for Payer: Aetna Commercial |
$300.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$287.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$176.94
|
| Rate for Payer: Cash Price |
$96.30
|
| Rate for Payer: Cigna Commercial |
$307.13
|
| Rate for Payer: Health EOS Commercial |
$297.12
|
| Rate for Payer: HFN Commercial |
$307.13
|
| Rate for Payer: Multiplan Commercial |
$267.07
|
| Rate for Payer: Preferred Network Access Commercial |
$307.13
|
| Rate for Payer: Quartz Beloit One Network |
$163.58
|
| Rate for Payer: Quartz Commercial |
$200.30
|
| Rate for Payer: WEA Trust Commercial |
$183.61
|
| Rate for Payer: WPS Commercial |
$247.27
|
|
|
Alpha-1-Antitrypsin Phenotype
|
Professional
|
Both
|
$321.00
|
|
|
Service Code
|
CPT 82104
|
| Hospital Charge Code |
977862
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.04 |
| Max. Negotiated Rate |
$317.15 |
| Rate for Payer: Aetna Commercial |
$317.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$287.10
|
| Rate for Payer: Aetna Managed Medicare |
$15.04
|
| Rate for Payer: Anthem Medicare Advantage |
$15.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$15.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$15.04
|
| Rate for Payer: Cash Price |
$96.30
|
| Rate for Payer: Cash Price |
$96.30
|
| Rate for Payer: Cigna Commercial |
$317.15
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$166.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$15.04
|
| Rate for Payer: Health EOS Commercial |
$303.79
|
| Rate for Payer: HFN Commercial |
$317.15
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$53.08
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$53.08
|
| Rate for Payer: Independent Care Health Plan Medicare |
$15.04
|
| Rate for Payer: Multiplan Commercial |
$267.07
|
| Rate for Payer: NAPHCARE Commercial |
$22.56
|
| Rate for Payer: Preferred Network Access Commercial |
$317.15
|
| Rate for Payer: Quartz Beloit One Network |
$146.89
|
| Rate for Payer: Quartz Commercial |
$190.29
|
| Rate for Payer: Quartz Medicare Advantage |
$15.04
|
| Rate for Payer: The Alliance Commercial |
$59.40
|
| Rate for Payer: United Healthcare Medicare Advantage |
$15.04
|
| Rate for Payer: WEA Trust Commercial |
$183.61
|
| Rate for Payer: WPS Commercial |
$66.17
|
|
|
Alpha-2-Macroglobins (FSURE)
|
Facility
|
IP
|
$89.00
|
|
|
Service Code
|
CPT 83883
|
| Hospital Charge Code |
4538815
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$45.35 |
| Max. Negotiated Rate |
$85.16 |
| Rate for Payer: Aetna Commercial |
$83.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$79.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$49.06
|
| Rate for Payer: Cash Price |
$26.70
|
| Rate for Payer: Cigna Commercial |
$85.16
|
| Rate for Payer: Health EOS Commercial |
$82.38
|
| Rate for Payer: HFN Commercial |
$85.16
|
| Rate for Payer: Multiplan Commercial |
$74.05
|
| Rate for Payer: Preferred Network Access Commercial |
$85.16
|
| Rate for Payer: Quartz Beloit One Network |
$45.35
|
| Rate for Payer: Quartz Commercial |
$55.54
|
| Rate for Payer: WEA Trust Commercial |
$50.91
|
| Rate for Payer: WPS Commercial |
$68.56
|
|
|
Alpha-2-Macroglobins (FSURE)
|
Facility
|
OP
|
$89.00
|
|
|
Service Code
|
CPT 83883
|
| Hospital Charge Code |
4538815
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.14 |
| Max. Negotiated Rate |
$85.16 |
| Rate for Payer: Aetna Commercial |
$83.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$79.60
|
| Rate for Payer: Aetna Managed Medicare |
$14.14
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$53.04
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$24.75
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$23.48
|
| Rate for Payer: Anthem Medicare Advantage |
$14.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$49.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$14.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$14.14
|
| Rate for Payer: Cash Price |
$26.70
|
| Rate for Payer: Cash Price |
$26.70
|
| Rate for Payer: Cigna Commercial |
$85.16
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$14.14
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$51.80
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$14.14
|
| Rate for Payer: Health EOS Commercial |
$82.38
|
| Rate for Payer: HFN Commercial |
$85.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$52.62
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$14.14
|
| Rate for Payer: Independent Care Health Plan Medicare |
$14.14
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$14.14
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$14.14
|
| Rate for Payer: Multiplan Commercial |
$74.05
|
| Rate for Payer: NAPHCARE Commercial |
$21.22
|
| Rate for Payer: Preferred Network Access Commercial |
$85.16
|
| Rate for Payer: Quartz Beloit One Network |
$45.35
|
| Rate for Payer: Quartz Commercial |
$60.16
|
| Rate for Payer: Quartz Medicare Advantage |
$14.14
|
| Rate for Payer: The Alliance Commercial |
$56.58
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14.14
|
| Rate for Payer: United Healthcare PPO |
$69.42
|
| Rate for Payer: WEA Trust Commercial |
$50.91
|
| Rate for Payer: Wellcare Medicare |
$14.14
|
| Rate for Payer: WPS Commercial |
$68.56
|
|
|
Alpha-2-Macroglobins (FSURE)
|
Professional
|
Both
|
$89.00
|
|
|
Service Code
|
CPT 83883
|
| Hospital Charge Code |
4538815
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.14 |
| Max. Negotiated Rate |
$87.93 |
| Rate for Payer: Aetna Commercial |
$87.93
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$79.60
|
| Rate for Payer: Aetna Managed Medicare |
$14.14
|
| Rate for Payer: Anthem Medicare Advantage |
$14.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$14.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$14.14
|
| Rate for Payer: Cash Price |
$26.70
|
| Rate for Payer: Cash Price |
$26.70
|
| Rate for Payer: Cigna Commercial |
$87.93
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$46.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$14.14
|
| Rate for Payer: Health EOS Commercial |
$84.23
|
| Rate for Payer: HFN Commercial |
$87.93
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$49.93
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$49.93
|
| Rate for Payer: Independent Care Health Plan Medicare |
$14.14
|
| Rate for Payer: Multiplan Commercial |
$74.05
|
| Rate for Payer: NAPHCARE Commercial |
$21.22
|
| Rate for Payer: Preferred Network Access Commercial |
$87.93
|
| Rate for Payer: Quartz Beloit One Network |
$40.73
|
| Rate for Payer: Quartz Commercial |
$52.76
|
| Rate for Payer: Quartz Medicare Advantage |
$14.14
|
| Rate for Payer: The Alliance Commercial |
$55.87
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14.14
|
| Rate for Payer: WEA Trust Commercial |
$50.91
|
| Rate for Payer: WPS Commercial |
$62.23
|
|
|
Alpha 2 Macroglobulin
|
Facility
|
IP
|
$76.00
|
|
|
Service Code
|
CPT 83883
|
| Hospital Charge Code |
4812610
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$38.73 |
| Max. Negotiated Rate |
$72.72 |
| Rate for Payer: Aetna Commercial |
$71.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$67.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$41.89
|
| Rate for Payer: Cash Price |
$22.80
|
| Rate for Payer: Cigna Commercial |
$72.72
|
| Rate for Payer: Health EOS Commercial |
$70.35
|
| Rate for Payer: HFN Commercial |
$72.72
|
| Rate for Payer: Multiplan Commercial |
$63.23
|
| Rate for Payer: Preferred Network Access Commercial |
$72.72
|
| Rate for Payer: Quartz Beloit One Network |
$38.73
|
| Rate for Payer: Quartz Commercial |
$47.42
|
| Rate for Payer: WEA Trust Commercial |
$43.47
|
| Rate for Payer: WPS Commercial |
$58.54
|
|
|
Alpha 2 Macroglobulin
|
Professional
|
Both
|
$76.00
|
|
|
Service Code
|
CPT 83883
|
| Hospital Charge Code |
4812610
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.14 |
| Max. Negotiated Rate |
$75.09 |
| Rate for Payer: Aetna Commercial |
$75.09
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$67.97
|
| Rate for Payer: Aetna Managed Medicare |
$14.14
|
| Rate for Payer: Anthem Medicare Advantage |
$14.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$14.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$14.14
|
| Rate for Payer: Cash Price |
$22.80
|
| Rate for Payer: Cash Price |
$22.80
|
| Rate for Payer: Cigna Commercial |
$75.09
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$39.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$14.14
|
| Rate for Payer: Health EOS Commercial |
$71.93
|
| Rate for Payer: HFN Commercial |
$75.09
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$49.93
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$49.93
|
| Rate for Payer: Independent Care Health Plan Medicare |
$14.14
|
| Rate for Payer: Multiplan Commercial |
$63.23
|
| Rate for Payer: NAPHCARE Commercial |
$21.22
|
| Rate for Payer: Preferred Network Access Commercial |
$75.09
|
| Rate for Payer: Quartz Beloit One Network |
$34.78
|
| Rate for Payer: Quartz Commercial |
$45.05
|
| Rate for Payer: Quartz Medicare Advantage |
$14.14
|
| Rate for Payer: The Alliance Commercial |
$55.87
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14.14
|
| Rate for Payer: WEA Trust Commercial |
$43.47
|
| Rate for Payer: WPS Commercial |
$62.23
|
|
|
Alpha 2 Macroglobulin
|
Facility
|
OP
|
$76.00
|
|
|
Service Code
|
CPT 83883
|
| Hospital Charge Code |
4812610
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.14 |
| Max. Negotiated Rate |
$72.72 |
| Rate for Payer: Aetna Commercial |
$71.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$67.97
|
| Rate for Payer: Aetna Managed Medicare |
$14.14
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$53.04
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$24.75
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$23.48
|
| Rate for Payer: Anthem Medicare Advantage |
$14.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$41.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$14.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$14.14
|
| Rate for Payer: Cash Price |
$22.80
|
| Rate for Payer: Cash Price |
$22.80
|
| Rate for Payer: Cigna Commercial |
$72.72
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$14.14
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$44.23
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$14.14
|
| Rate for Payer: Health EOS Commercial |
$70.35
|
| Rate for Payer: HFN Commercial |
$72.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$52.62
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$14.14
|
| Rate for Payer: Independent Care Health Plan Medicare |
$14.14
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$14.14
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$14.14
|
| Rate for Payer: Multiplan Commercial |
$63.23
|
| Rate for Payer: NAPHCARE Commercial |
$21.22
|
| Rate for Payer: Preferred Network Access Commercial |
$72.72
|
| Rate for Payer: Quartz Beloit One Network |
$38.73
|
| Rate for Payer: Quartz Commercial |
$51.38
|
| Rate for Payer: Quartz Medicare Advantage |
$14.14
|
| Rate for Payer: The Alliance Commercial |
$56.58
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14.14
|
| Rate for Payer: United Healthcare PPO |
$59.28
|
| Rate for Payer: WEA Trust Commercial |
$43.47
|
| Rate for Payer: Wellcare Medicare |
$14.14
|
| Rate for Payer: WPS Commercial |
$58.54
|
|
|
Alpha-Fetoprotein & AFP-L3
|
Facility
|
IP
|
$201.00
|
|
|
Service Code
|
CPT 82107
|
| Hospital Charge Code |
4109314
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$102.43 |
| Max. Negotiated Rate |
$192.32 |
| Rate for Payer: Aetna Commercial |
$188.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$179.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$110.79
|
| Rate for Payer: Cash Price |
$60.30
|
| Rate for Payer: Cigna Commercial |
$192.32
|
| Rate for Payer: Health EOS Commercial |
$186.05
|
| Rate for Payer: HFN Commercial |
$192.32
|
| Rate for Payer: Multiplan Commercial |
$167.23
|
| Rate for Payer: Preferred Network Access Commercial |
$192.32
|
| Rate for Payer: Quartz Beloit One Network |
$102.43
|
| Rate for Payer: Quartz Commercial |
$125.42
|
| Rate for Payer: WEA Trust Commercial |
$114.97
|
| Rate for Payer: WPS Commercial |
$154.83
|
|
|
Alpha-Fetoprotein & AFP-L3
|
Professional
|
Both
|
$201.00
|
|
|
Service Code
|
CPT 82107
|
| Hospital Charge Code |
4109314
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$66.99 |
| Max. Negotiated Rate |
$294.74 |
| Rate for Payer: Aetna Commercial |
$198.59
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$179.77
|
| Rate for Payer: Aetna Managed Medicare |
$66.99
|
| Rate for Payer: Anthem Medicare Advantage |
$66.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$66.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$66.99
|
| Rate for Payer: Cash Price |
$60.30
|
| Rate for Payer: Cash Price |
$60.30
|
| Rate for Payer: Cigna Commercial |
$198.59
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$104.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$66.99
|
| Rate for Payer: Health EOS Commercial |
$190.23
|
| Rate for Payer: HFN Commercial |
$198.59
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$236.46
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$236.46
|
| Rate for Payer: Independent Care Health Plan Medicare |
$66.99
|
| Rate for Payer: Multiplan Commercial |
$167.23
|
| Rate for Payer: NAPHCARE Commercial |
$100.48
|
| Rate for Payer: Preferred Network Access Commercial |
$198.59
|
| Rate for Payer: Quartz Beloit One Network |
$91.98
|
| Rate for Payer: Quartz Commercial |
$119.15
|
| Rate for Payer: Quartz Medicare Advantage |
$66.99
|
| Rate for Payer: The Alliance Commercial |
$264.60
|
| Rate for Payer: United Healthcare Medicare Advantage |
$66.99
|
| Rate for Payer: WEA Trust Commercial |
$114.97
|
| Rate for Payer: WPS Commercial |
$294.74
|
|
|
Alpha-Fetoprotein & AFP-L3
|
Facility
|
OP
|
$201.00
|
|
|
Service Code
|
CPT 82107
|
| Hospital Charge Code |
4109314
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$66.99 |
| Max. Negotiated Rate |
$267.95 |
| Rate for Payer: Aetna Commercial |
$188.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$179.77
|
| Rate for Payer: Aetna Managed Medicare |
$66.99
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$251.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$117.23
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$111.20
|
| Rate for Payer: Anthem Medicare Advantage |
$66.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$110.79
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$66.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$66.99
|
| Rate for Payer: Cash Price |
$60.30
|
| Rate for Payer: Cash Price |
$60.30
|
| Rate for Payer: Cigna Commercial |
$192.32
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$66.99
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$116.98
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$66.99
|
| Rate for Payer: Health EOS Commercial |
$186.05
|
| Rate for Payer: HFN Commercial |
$192.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$249.19
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$66.99
|
| Rate for Payer: Independent Care Health Plan Medicare |
$66.99
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$66.99
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$66.99
|
| Rate for Payer: Multiplan Commercial |
$167.23
|
| Rate for Payer: NAPHCARE Commercial |
$100.48
|
| Rate for Payer: Preferred Network Access Commercial |
$192.32
|
| Rate for Payer: Quartz Beloit One Network |
$102.43
|
| Rate for Payer: Quartz Commercial |
$135.88
|
| Rate for Payer: Quartz Medicare Advantage |
$66.99
|
| Rate for Payer: The Alliance Commercial |
$267.95
|
| Rate for Payer: United Healthcare Medicare Advantage |
$66.99
|
| Rate for Payer: United Healthcare PPO |
$156.78
|
| Rate for Payer: WEA Trust Commercial |
$114.97
|
| Rate for Payer: Wellcare Medicare |
$66.99
|
| Rate for Payer: WPS Commercial |
$154.83
|
|
|
Alpha-Fetoprotein, Pleural Fluid
|
Professional
|
Both
|
$78.00
|
|
|
Service Code
|
CPT 86316
|
| Hospital Charge Code |
5290652
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$21.64 |
| Max. Negotiated Rate |
$95.23 |
| Rate for Payer: Aetna Commercial |
$77.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$69.76
|
| Rate for Payer: Aetna Managed Medicare |
$21.64
|
| Rate for Payer: Anthem Medicare Advantage |
$21.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$21.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$21.64
|
| Rate for Payer: Cash Price |
$23.40
|
| Rate for Payer: Cash Price |
$23.40
|
| Rate for Payer: Cigna Commercial |
$77.06
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$40.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$21.64
|
| Rate for Payer: Health EOS Commercial |
$73.82
|
| Rate for Payer: HFN Commercial |
$77.06
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$76.40
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$76.40
|
| Rate for Payer: Independent Care Health Plan Medicare |
$21.64
|
| Rate for Payer: Multiplan Commercial |
$64.90
|
| Rate for Payer: NAPHCARE Commercial |
$32.46
|
| Rate for Payer: Preferred Network Access Commercial |
$77.06
|
| Rate for Payer: Quartz Beloit One Network |
$35.69
|
| Rate for Payer: Quartz Commercial |
$46.24
|
| Rate for Payer: Quartz Medicare Advantage |
$21.64
|
| Rate for Payer: The Alliance Commercial |
$85.49
|
| Rate for Payer: United Healthcare Medicare Advantage |
$21.64
|
| Rate for Payer: WEA Trust Commercial |
$44.62
|
| Rate for Payer: WPS Commercial |
$95.23
|
|
|
Alpha-Fetoprotein, Pleural Fluid
|
Facility
|
IP
|
$78.00
|
|
|
Service Code
|
CPT 86316
|
| Hospital Charge Code |
5290652
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$39.75 |
| Max. Negotiated Rate |
$74.63 |
| Rate for Payer: Aetna Commercial |
$73.01
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$69.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$42.99
|
| Rate for Payer: Cash Price |
$23.40
|
| Rate for Payer: Cigna Commercial |
$74.63
|
| Rate for Payer: Health EOS Commercial |
$72.20
|
| Rate for Payer: HFN Commercial |
$74.63
|
| Rate for Payer: Multiplan Commercial |
$64.90
|
| Rate for Payer: Preferred Network Access Commercial |
$74.63
|
| Rate for Payer: Quartz Beloit One Network |
$39.75
|
| Rate for Payer: Quartz Commercial |
$48.67
|
| Rate for Payer: WEA Trust Commercial |
$44.62
|
| Rate for Payer: WPS Commercial |
$60.08
|
|
|
Alpha-Fetoprotein, Pleural Fluid
|
Facility
|
OP
|
$78.00
|
|
|
Service Code
|
CPT 86316
|
| Hospital Charge Code |
5290652
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$21.64 |
| Max. Negotiated Rate |
$86.57 |
| Rate for Payer: Aetna Commercial |
$73.01
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$69.76
|
| Rate for Payer: Aetna Managed Medicare |
$21.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$81.16
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$37.87
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$35.93
|
| Rate for Payer: Anthem Medicare Advantage |
$21.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$42.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$21.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$21.64
|
| Rate for Payer: Cash Price |
$23.40
|
| Rate for Payer: Cash Price |
$23.40
|
| Rate for Payer: Cigna Commercial |
$74.63
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$21.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$45.40
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$21.64
|
| Rate for Payer: Health EOS Commercial |
$72.20
|
| Rate for Payer: HFN Commercial |
$74.63
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$80.51
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$21.64
|
| Rate for Payer: Independent Care Health Plan Medicare |
$21.64
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$21.64
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$21.64
|
| Rate for Payer: Multiplan Commercial |
$64.90
|
| Rate for Payer: NAPHCARE Commercial |
$32.46
|
| Rate for Payer: Preferred Network Access Commercial |
$74.63
|
| Rate for Payer: Quartz Beloit One Network |
$39.75
|
| Rate for Payer: Quartz Commercial |
$52.73
|
| Rate for Payer: Quartz Medicare Advantage |
$21.64
|
| Rate for Payer: The Alliance Commercial |
$86.57
|
| Rate for Payer: United Healthcare Medicare Advantage |
$21.64
|
| Rate for Payer: United Healthcare PPO |
$60.84
|
| Rate for Payer: WEA Trust Commercial |
$44.62
|
| Rate for Payer: Wellcare Medicare |
$21.64
|
| Rate for Payer: WPS Commercial |
$60.08
|
|
|
Alpha Fetoprotein Tumor Marker
|
Professional
|
Both
|
$245.00
|
|
|
Service Code
|
CPT 82105
|
| Hospital Charge Code |
633643
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.44 |
| Max. Negotiated Rate |
$242.06 |
| Rate for Payer: Aetna Commercial |
$242.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$219.13
|
| Rate for Payer: Aetna Managed Medicare |
$17.44
|
| Rate for Payer: Anthem Medicare Advantage |
$17.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$17.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$17.44
|
| Rate for Payer: Cash Price |
$73.50
|
| Rate for Payer: Cash Price |
$73.50
|
| Rate for Payer: Cigna Commercial |
$242.06
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$127.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$17.44
|
| Rate for Payer: Health EOS Commercial |
$231.87
|
| Rate for Payer: HFN Commercial |
$242.06
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$61.57
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$61.57
|
| Rate for Payer: Independent Care Health Plan Medicare |
$17.44
|
| Rate for Payer: Multiplan Commercial |
$203.84
|
| Rate for Payer: NAPHCARE Commercial |
$26.16
|
| Rate for Payer: Preferred Network Access Commercial |
$242.06
|
| Rate for Payer: Quartz Beloit One Network |
$112.11
|
| Rate for Payer: Quartz Commercial |
$145.24
|
| Rate for Payer: Quartz Medicare Advantage |
$17.44
|
| Rate for Payer: The Alliance Commercial |
$68.89
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17.44
|
| Rate for Payer: WEA Trust Commercial |
$140.14
|
| Rate for Payer: WPS Commercial |
$76.74
|
|
|
Alpha Fetoprotein Tumor Marker
|
Facility
|
IP
|
$245.00
|
|
|
Service Code
|
CPT 82105
|
| Hospital Charge Code |
633643
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$124.85 |
| Max. Negotiated Rate |
$234.42 |
| Rate for Payer: Aetna Commercial |
$229.32
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$219.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$135.04
|
| Rate for Payer: Cash Price |
$73.50
|
| Rate for Payer: Cigna Commercial |
$234.42
|
| Rate for Payer: Health EOS Commercial |
$226.77
|
| Rate for Payer: HFN Commercial |
$234.42
|
| Rate for Payer: Multiplan Commercial |
$203.84
|
| Rate for Payer: Preferred Network Access Commercial |
$234.42
|
| Rate for Payer: Quartz Beloit One Network |
$124.85
|
| Rate for Payer: Quartz Commercial |
$152.88
|
| Rate for Payer: WEA Trust Commercial |
$140.14
|
| Rate for Payer: WPS Commercial |
$188.72
|
|
|
Alpha Fetoprotein Tumor Marker
|
Facility
|
OP
|
$245.00
|
|
|
Service Code
|
CPT 82105
|
| Hospital Charge Code |
633643
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.44 |
| Max. Negotiated Rate |
$234.42 |
| Rate for Payer: Aetna Commercial |
$229.32
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$219.13
|
| Rate for Payer: Aetna Managed Medicare |
$17.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$65.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$30.52
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$28.95
|
| Rate for Payer: Anthem Medicare Advantage |
$17.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$135.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$17.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$17.44
|
| Rate for Payer: Cash Price |
$73.50
|
| Rate for Payer: Cash Price |
$73.50
|
| Rate for Payer: Cigna Commercial |
$234.42
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$17.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$142.59
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$17.44
|
| Rate for Payer: Health EOS Commercial |
$226.77
|
| Rate for Payer: HFN Commercial |
$234.42
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$64.88
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$17.44
|
| Rate for Payer: Independent Care Health Plan Medicare |
$17.44
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$17.44
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$17.44
|
| Rate for Payer: Multiplan Commercial |
$203.84
|
| Rate for Payer: NAPHCARE Commercial |
$26.16
|
| Rate for Payer: Preferred Network Access Commercial |
$234.42
|
| Rate for Payer: Quartz Beloit One Network |
$124.85
|
| Rate for Payer: Quartz Commercial |
$165.62
|
| Rate for Payer: Quartz Medicare Advantage |
$17.44
|
| Rate for Payer: The Alliance Commercial |
$69.76
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17.44
|
| Rate for Payer: United Healthcare PPO |
$191.10
|
| Rate for Payer: WEA Trust Commercial |
$140.14
|
| Rate for Payer: Wellcare Medicare |
$17.44
|
| Rate for Payer: WPS Commercial |
$188.72
|
|
|
Alpha Melanocyte Stimulating Hormone
|
Professional
|
Both
|
$282.00
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
5242623
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.96 |
| Max. Negotiated Rate |
$278.62 |
| Rate for Payer: Aetna Commercial |
$278.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$252.22
|
| Rate for Payer: Aetna Managed Medicare |
$17.96
|
| Rate for Payer: Anthem Medicare Advantage |
$17.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$17.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$17.96
|
| Rate for Payer: Cash Price |
$84.60
|
| Rate for Payer: Cash Price |
$84.60
|
| Rate for Payer: Cigna Commercial |
$278.62
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$146.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$17.96
|
| Rate for Payer: Health EOS Commercial |
$266.88
|
| Rate for Payer: HFN Commercial |
$278.62
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$63.40
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$63.40
|
| Rate for Payer: Independent Care Health Plan Medicare |
$17.96
|
| Rate for Payer: Multiplan Commercial |
$234.62
|
| Rate for Payer: NAPHCARE Commercial |
$26.94
|
| Rate for Payer: Preferred Network Access Commercial |
$278.62
|
| Rate for Payer: Quartz Beloit One Network |
$129.04
|
| Rate for Payer: Quartz Commercial |
$167.17
|
| Rate for Payer: Quartz Medicare Advantage |
$17.96
|
| Rate for Payer: The Alliance Commercial |
$70.95
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17.96
|
| Rate for Payer: WEA Trust Commercial |
$161.30
|
| Rate for Payer: WPS Commercial |
$79.03
|
|
|
Alpha Melanocyte Stimulating Hormone
|
Facility
|
IP
|
$282.00
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
5242623
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$143.71 |
| Max. Negotiated Rate |
$269.82 |
| Rate for Payer: Aetna Commercial |
$263.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$252.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$155.44
|
| Rate for Payer: Cash Price |
$84.60
|
| Rate for Payer: Cigna Commercial |
$269.82
|
| Rate for Payer: Health EOS Commercial |
$261.02
|
| Rate for Payer: HFN Commercial |
$269.82
|
| Rate for Payer: Multiplan Commercial |
$234.62
|
| Rate for Payer: Preferred Network Access Commercial |
$269.82
|
| Rate for Payer: Quartz Beloit One Network |
$143.71
|
| Rate for Payer: Quartz Commercial |
$175.97
|
| Rate for Payer: WEA Trust Commercial |
$161.30
|
| Rate for Payer: WPS Commercial |
$217.22
|
|
|
Alpha Melanocyte Stimulating Hormone
|
Facility
|
OP
|
$282.00
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
5242623
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.96 |
| Max. Negotiated Rate |
$269.82 |
| Rate for Payer: Aetna Commercial |
$263.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$252.22
|
| Rate for Payer: Aetna Managed Medicare |
$17.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$67.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$31.43
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$29.81
|
| Rate for Payer: Anthem Medicare Advantage |
$17.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$155.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$17.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$17.96
|
| Rate for Payer: Cash Price |
$84.60
|
| Rate for Payer: Cash Price |
$84.60
|
| Rate for Payer: Cigna Commercial |
$269.82
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$17.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$164.12
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$17.96
|
| Rate for Payer: Health EOS Commercial |
$261.02
|
| Rate for Payer: HFN Commercial |
$269.82
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$66.81
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$17.96
|
| Rate for Payer: Independent Care Health Plan Medicare |
$17.96
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$17.96
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$17.96
|
| Rate for Payer: Multiplan Commercial |
$234.62
|
| Rate for Payer: NAPHCARE Commercial |
$26.94
|
| Rate for Payer: Preferred Network Access Commercial |
$269.82
|
| Rate for Payer: Quartz Beloit One Network |
$143.71
|
| Rate for Payer: Quartz Commercial |
$190.63
|
| Rate for Payer: Quartz Medicare Advantage |
$17.96
|
| Rate for Payer: The Alliance Commercial |
$71.84
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17.96
|
| Rate for Payer: United Healthcare PPO |
$219.96
|
| Rate for Payer: WEA Trust Commercial |
$161.30
|
| Rate for Payer: Wellcare Medicare |
$17.96
|
| Rate for Payer: WPS Commercial |
$217.22
|
|
|
Alpha Subunit
|
Facility
|
OP
|
$440.00
|
|
|
Service Code
|
CPT 83519
|
| Hospital Charge Code |
980019
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$19.14 |
| Max. Negotiated Rate |
$420.99 |
| Rate for Payer: Aetna Commercial |
$411.84
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$393.54
|
| 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 |
$242.53
|
| 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 |
$132.00
|
| Rate for Payer: Cash Price |
$132.00
|
| Rate for Payer: Cigna Commercial |
$420.99
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$19.14
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$256.08
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$19.14
|
| Rate for Payer: Health EOS Commercial |
$407.26
|
| Rate for Payer: HFN Commercial |
$420.99
|
| 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 |
$366.08
|
| Rate for Payer: NAPHCARE Commercial |
$28.70
|
| Rate for Payer: Preferred Network Access Commercial |
$420.99
|
| Rate for Payer: Quartz Beloit One Network |
$224.22
|
| Rate for Payer: Quartz Commercial |
$297.44
|
| 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 |
$343.20
|
| Rate for Payer: WEA Trust Commercial |
$251.68
|
| Rate for Payer: Wellcare Medicare |
$19.14
|
| Rate for Payer: WPS Commercial |
$338.93
|
|
|
Alpha Subunit
|
Facility
|
IP
|
$440.00
|
|
|
Service Code
|
CPT 83519
|
| Hospital Charge Code |
980019
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$224.22 |
| Max. Negotiated Rate |
$420.99 |
| Rate for Payer: Aetna Commercial |
$411.84
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$393.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$242.53
|
| Rate for Payer: Cash Price |
$132.00
|
| Rate for Payer: Cigna Commercial |
$420.99
|
| Rate for Payer: Health EOS Commercial |
$407.26
|
| Rate for Payer: HFN Commercial |
$420.99
|
| Rate for Payer: Multiplan Commercial |
$366.08
|
| Rate for Payer: Preferred Network Access Commercial |
$420.99
|
| Rate for Payer: Quartz Beloit One Network |
$224.22
|
| Rate for Payer: Quartz Commercial |
$274.56
|
| Rate for Payer: WEA Trust Commercial |
$251.68
|
| Rate for Payer: WPS Commercial |
$338.93
|
|
|
Alpha Subunit
|
Professional
|
Both
|
$440.00
|
|
|
Service Code
|
CPT 83519
|
| Hospital Charge Code |
980019
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$19.14 |
| Max. Negotiated Rate |
$434.72 |
| Rate for Payer: Aetna Commercial |
$434.72
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$393.54
|
| 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 |
$132.00
|
| Rate for Payer: Cash Price |
$132.00
|
| Rate for Payer: Cigna Commercial |
$434.72
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$228.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$19.14
|
| Rate for Payer: Health EOS Commercial |
$416.42
|
| Rate for Payer: HFN Commercial |
$434.72
|
| 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 |
$366.08
|
| Rate for Payer: NAPHCARE Commercial |
$28.70
|
| Rate for Payer: Preferred Network Access Commercial |
$434.72
|
| Rate for Payer: Quartz Beloit One Network |
$201.34
|
| Rate for Payer: Quartz Commercial |
$260.83
|
| 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 |
$251.68
|
| Rate for Payer: WPS Commercial |
$84.20
|
|
|
.Alpha Thalassemia DNA Mutation Analysis
|
Professional
|
Both
|
$851.00
|
|
|
Service Code
|
CPT 81257
|
| Hospital Charge Code |
4494978
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$106.35 |
| Max. Negotiated Rate |
$840.79 |
| Rate for Payer: Aetna Commercial |
$840.79
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$761.13
|
| Rate for Payer: Aetna Managed Medicare |
$106.35
|
| Rate for Payer: Anthem Medicare Advantage |
$106.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$106.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$106.35
|
| Rate for Payer: Cash Price |
$255.30
|
| Rate for Payer: Cash Price |
$255.30
|
| Rate for Payer: Cigna Commercial |
$840.79
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$442.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$106.35
|
| Rate for Payer: Health EOS Commercial |
$805.39
|
| Rate for Payer: HFN Commercial |
$840.79
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$375.42
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$375.42
|
| Rate for Payer: Independent Care Health Plan Medicare |
$106.35
|
| Rate for Payer: Multiplan Commercial |
$708.03
|
| Rate for Payer: NAPHCARE Commercial |
$159.53
|
| Rate for Payer: Preferred Network Access Commercial |
$840.79
|
| Rate for Payer: Quartz Beloit One Network |
$389.42
|
| Rate for Payer: Quartz Commercial |
$504.47
|
| Rate for Payer: Quartz Medicare Advantage |
$106.35
|
| Rate for Payer: The Alliance Commercial |
$420.08
|
| Rate for Payer: United Healthcare Medicare Advantage |
$106.35
|
| Rate for Payer: WEA Trust Commercial |
$486.77
|
| Rate for Payer: WPS Commercial |
$467.94
|
|
