|
.Alpha Thalassemia DNA Mutation Analysis
|
Facility
|
OP
|
$851.00
|
|
|
Service Code
|
CPT 81257
|
| Hospital Charge Code |
4494978
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$106.35 |
| Max. Negotiated Rate |
$814.24 |
| Rate for Payer: Aetna Commercial |
$796.54
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$761.13
|
| Rate for Payer: Aetna Managed Medicare |
$106.35
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$398.81
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$186.11
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$176.54
|
| Rate for Payer: Anthem Medicare Advantage |
$106.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$469.07
|
| 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 |
$814.24
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$106.35
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$495.28
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$106.35
|
| Rate for Payer: Health EOS Commercial |
$787.69
|
| Rate for Payer: HFN Commercial |
$814.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$395.62
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$106.35
|
| Rate for Payer: Independent Care Health Plan Medicare |
$106.35
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$106.35
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$106.35
|
| Rate for Payer: Multiplan Commercial |
$708.03
|
| Rate for Payer: NAPHCARE Commercial |
$159.53
|
| Rate for Payer: Preferred Network Access Commercial |
$814.24
|
| Rate for Payer: Quartz Beloit One Network |
$433.67
|
| Rate for Payer: Quartz Commercial |
$575.28
|
| Rate for Payer: Quartz Medicare Advantage |
$106.35
|
| Rate for Payer: The Alliance Commercial |
$425.40
|
| Rate for Payer: United Healthcare Medicare Advantage |
$106.35
|
| Rate for Payer: United Healthcare PPO |
$663.78
|
| Rate for Payer: WEA Trust Commercial |
$486.77
|
| Rate for Payer: Wellcare Medicare |
$106.35
|
| Rate for Payer: WPS Commercial |
$655.53
|
|
|
.Alpha Thalassemia DNA Mutation Analysis
|
Facility
|
IP
|
$851.00
|
|
|
Service Code
|
CPT 81257
|
| Hospital Charge Code |
4494978
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$433.67 |
| Max. Negotiated Rate |
$814.24 |
| Rate for Payer: Aetna Commercial |
$796.54
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$761.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$469.07
|
| Rate for Payer: Cash Price |
$255.30
|
| Rate for Payer: Cigna Commercial |
$814.24
|
| Rate for Payer: Health EOS Commercial |
$787.69
|
| Rate for Payer: HFN Commercial |
$814.24
|
| Rate for Payer: Multiplan Commercial |
$708.03
|
| Rate for Payer: Preferred Network Access Commercial |
$814.24
|
| Rate for Payer: Quartz Beloit One Network |
$433.67
|
| Rate for Payer: Quartz Commercial |
$531.02
|
| Rate for Payer: WEA Trust Commercial |
$486.77
|
| Rate for Payer: WPS Commercial |
$655.53
|
|
|
ALT
|
Facility
|
OP
|
$44.00
|
|
|
Service Code
|
CPT 84460
|
| Hospital Charge Code |
4812611
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.51 |
| Max. Negotiated Rate |
$42.10 |
| Rate for Payer: Aetna Commercial |
$41.18
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$39.35
|
| Rate for Payer: Aetna Managed Medicare |
$5.51
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$20.67
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$9.65
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$9.15
|
| Rate for Payer: Anthem Medicare Advantage |
$5.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$24.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5.51
|
| Rate for Payer: Cash Price |
$13.20
|
| Rate for Payer: Cash Price |
$13.20
|
| Rate for Payer: Cigna Commercial |
$42.10
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$5.51
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$25.61
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$5.51
|
| Rate for Payer: Health EOS Commercial |
$40.73
|
| Rate for Payer: HFN Commercial |
$42.10
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$20.50
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$5.51
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5.51
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$5.51
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$5.51
|
| Rate for Payer: Multiplan Commercial |
$36.61
|
| Rate for Payer: NAPHCARE Commercial |
$8.27
|
| Rate for Payer: Preferred Network Access Commercial |
$42.10
|
| Rate for Payer: Quartz Beloit One Network |
$22.42
|
| Rate for Payer: Quartz Commercial |
$29.74
|
| Rate for Payer: Quartz Medicare Advantage |
$5.51
|
| Rate for Payer: The Alliance Commercial |
$22.05
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.51
|
| Rate for Payer: United Healthcare PPO |
$34.32
|
| Rate for Payer: WEA Trust Commercial |
$25.17
|
| Rate for Payer: Wellcare Medicare |
$5.51
|
| Rate for Payer: WPS Commercial |
$33.89
|
|
|
ALT
|
Professional
|
Both
|
$44.00
|
|
|
Service Code
|
CPT 84460
|
| Hospital Charge Code |
4812611
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.51 |
| Max. Negotiated Rate |
$43.47 |
| Rate for Payer: Aetna Commercial |
$43.47
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$39.35
|
| Rate for Payer: Aetna Managed Medicare |
$5.51
|
| Rate for Payer: Anthem Medicare Advantage |
$5.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5.51
|
| Rate for Payer: Cash Price |
$13.20
|
| Rate for Payer: Cash Price |
$13.20
|
| Rate for Payer: Cigna Commercial |
$43.47
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$22.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5.51
|
| Rate for Payer: Health EOS Commercial |
$41.64
|
| Rate for Payer: HFN Commercial |
$43.47
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$19.46
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$19.46
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5.51
|
| Rate for Payer: Multiplan Commercial |
$36.61
|
| Rate for Payer: NAPHCARE Commercial |
$8.27
|
| Rate for Payer: Preferred Network Access Commercial |
$43.47
|
| Rate for Payer: Quartz Beloit One Network |
$20.13
|
| Rate for Payer: Quartz Commercial |
$26.08
|
| Rate for Payer: Quartz Medicare Advantage |
$5.51
|
| Rate for Payer: The Alliance Commercial |
$21.77
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.51
|
| Rate for Payer: WEA Trust Commercial |
$25.17
|
| Rate for Payer: WPS Commercial |
$24.25
|
|
|
ALT
|
Facility
|
IP
|
$44.00
|
|
|
Service Code
|
CPT 84460
|
| Hospital Charge Code |
4812611
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$22.42 |
| Max. Negotiated Rate |
$42.10 |
| Rate for Payer: Aetna Commercial |
$41.18
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$39.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$24.25
|
| Rate for Payer: Cash Price |
$13.20
|
| Rate for Payer: Cigna Commercial |
$42.10
|
| Rate for Payer: Health EOS Commercial |
$40.73
|
| Rate for Payer: HFN Commercial |
$42.10
|
| Rate for Payer: Multiplan Commercial |
$36.61
|
| Rate for Payer: Preferred Network Access Commercial |
$42.10
|
| Rate for Payer: Quartz Beloit One Network |
$22.42
|
| Rate for Payer: Quartz Commercial |
$27.46
|
| Rate for Payer: WEA Trust Commercial |
$25.17
|
| Rate for Payer: WPS Commercial |
$33.89
|
|
|
Alt Binaural Loudness Balance
|
Facility
|
IP
|
$160.00
|
|
|
Service Code
|
CPT 92562
|
| Hospital Charge Code |
3203480
|
|
Hospital Revenue Code
|
470
|
| Min. Negotiated Rate |
$81.54 |
| Max. Negotiated Rate |
$153.09 |
| Rate for Payer: Aetna Commercial |
$149.76
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$143.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$88.19
|
| Rate for Payer: Cash Price |
$48.00
|
| Rate for Payer: Cigna Commercial |
$153.09
|
| Rate for Payer: Health EOS Commercial |
$148.10
|
| Rate for Payer: HFN Commercial |
$153.09
|
| Rate for Payer: Multiplan Commercial |
$133.12
|
| Rate for Payer: Preferred Network Access Commercial |
$153.09
|
| Rate for Payer: Quartz Beloit One Network |
$81.54
|
| Rate for Payer: Quartz Commercial |
$99.84
|
| Rate for Payer: WEA Trust Commercial |
$91.52
|
| Rate for Payer: WPS Commercial |
$123.25
|
|
|
Alt Binaural Loudness Balance
|
Professional
|
Both
|
$160.00
|
|
|
Service Code
|
CPT 92562
|
| Hospital Charge Code |
3203480
|
|
Hospital Revenue Code
|
470
|
| Min. Negotiated Rate |
$48.69 |
| Max. Negotiated Rate |
$194.77 |
| Rate for Payer: Aetna Commercial |
$158.08
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$143.10
|
| Rate for Payer: Aetna Managed Medicare |
$48.69
|
| Rate for Payer: Anthem Medicare Advantage |
$48.69
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$48.69
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$48.69
|
| Rate for Payer: Cash Price |
$48.00
|
| Rate for Payer: Cash Price |
$48.00
|
| Rate for Payer: Cigna Commercial |
$158.08
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$83.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$48.69
|
| Rate for Payer: Health EOS Commercial |
$151.42
|
| Rate for Payer: HFN Commercial |
$158.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$162.08
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$162.08
|
| Rate for Payer: Independent Care Health Plan Medicare |
$48.69
|
| Rate for Payer: Multiplan Commercial |
$133.12
|
| Rate for Payer: NAPHCARE Commercial |
$73.04
|
| Rate for Payer: Preferred Network Access Commercial |
$158.08
|
| Rate for Payer: Quartz Beloit One Network |
$73.22
|
| Rate for Payer: Quartz Commercial |
$94.85
|
| Rate for Payer: Quartz Medicare Advantage |
$48.69
|
| Rate for Payer: The Alliance Commercial |
$121.73
|
| Rate for Payer: United Healthcare Medicare Advantage |
$48.69
|
| Rate for Payer: WEA Trust Commercial |
$91.52
|
| Rate for Payer: WPS Commercial |
$194.77
|
|
|
Alt Binaural Loudness Balance
|
Facility
|
OP
|
$160.00
|
|
|
Service Code
|
CPT 92562
|
| Hospital Charge Code |
3203480
|
|
Hospital Revenue Code
|
470
|
| Min. Negotiated Rate |
$79.87 |
| Max. Negotiated Rate |
$908.96 |
| Rate for Payer: Aetna Commercial |
$149.76
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$143.10
|
| Rate for Payer: Aetna Managed Medicare |
$227.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$108.16
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$83.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$79.87
|
| Rate for Payer: Anthem Medicare Advantage |
$227.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$88.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$227.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$227.24
|
| Rate for Payer: Cash Price |
$48.00
|
| Rate for Payer: Cash Price |
$48.00
|
| Rate for Payer: Cigna Commercial |
$153.09
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$227.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$93.12
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$227.24
|
| Rate for Payer: Health EOS Commercial |
$148.10
|
| Rate for Payer: HFN Commercial |
$153.09
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$845.33
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$227.24
|
| Rate for Payer: Independent Care Health Plan Medicare |
$227.24
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$227.24
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$227.24
|
| Rate for Payer: Multiplan Commercial |
$133.12
|
| Rate for Payer: NAPHCARE Commercial |
$340.86
|
| Rate for Payer: Preferred Network Access Commercial |
$153.09
|
| Rate for Payer: Quartz Beloit One Network |
$81.54
|
| Rate for Payer: Quartz Commercial |
$108.16
|
| Rate for Payer: Quartz Medicare Advantage |
$227.24
|
| Rate for Payer: The Alliance Commercial |
$908.96
|
| Rate for Payer: United Healthcare Medicare Advantage |
$227.24
|
| Rate for Payer: United Healthcare PPO |
$124.80
|
| Rate for Payer: WEA Trust Commercial |
$91.52
|
| Rate for Payer: Wellcare Medicare |
$227.24
|
| Rate for Payer: WPS Commercial |
$123.25
|
|
|
ALTERATION IN CONSCIOUSNESS
|
Facility
|
IP
|
$5,611.72
|
|
|
Service Code
|
APR-DRG 0521
|
| Min. Negotiated Rate |
$4,984.68 |
| Max. Negotiated Rate |
$5,611.72 |
| Rate for Payer: Anthem Medicaid |
$5,373.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$5,373.53
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$5,373.53
|
| Rate for Payer: Dean Health Medicaid |
$5,373.53
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$4,984.68
|
| Rate for Payer: Managed Health Services Medicaid |
$5,611.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,373.53
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$5,373.53
|
| Rate for Payer: United Healthcare Medicaid |
$5,373.53
|
|
|
ALTERATION IN CONSCIOUSNESS
|
Facility
|
IP
|
$18,325.77
|
|
|
Service Code
|
APR-DRG 0524
|
| Min. Negotiated Rate |
$16,278.09 |
| Max. Negotiated Rate |
$18,325.77 |
| Rate for Payer: Anthem Medicaid |
$17,547.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$17,547.93
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$17,547.93
|
| Rate for Payer: Dean Health Medicaid |
$17,547.93
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$16,278.09
|
| Rate for Payer: Managed Health Services Medicaid |
$18,325.77
|
| Rate for Payer: Molina Healthcare Medicaid |
$17,547.93
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$17,547.93
|
| Rate for Payer: United Healthcare Medicaid |
$17,547.93
|
|
|
ALTERATION IN CONSCIOUSNESS
|
Facility
|
IP
|
$7,277.70
|
|
|
Service Code
|
APR-DRG 0522
|
| Min. Negotiated Rate |
$6,464.50 |
| Max. Negotiated Rate |
$7,277.70 |
| Rate for Payer: Anthem Medicaid |
$6,968.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$6,968.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$6,968.80
|
| Rate for Payer: Dean Health Medicaid |
$6,968.80
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$6,464.50
|
| Rate for Payer: Managed Health Services Medicaid |
$7,277.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,968.80
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$6,968.80
|
| Rate for Payer: United Healthcare Medicaid |
$6,968.80
|
|
|
ALTERATION IN CONSCIOUSNESS
|
Facility
|
OP
|
$108.75
|
|
|
Service Code
|
EAPG 00883
|
| Min. Negotiated Rate |
$104.57 |
| Max. Negotiated Rate |
$108.75 |
| Rate for Payer: Anthem Medicaid |
$104.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$104.57
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$104.57
|
| Rate for Payer: Dean Health Medicaid |
$104.57
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$104.57
|
| Rate for Payer: Managed Health Services Medicaid |
$108.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$104.57
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$104.57
|
| Rate for Payer: United Healthcare Medicaid |
$104.57
|
|
|
ALTERATION IN CONSCIOUSNESS
|
Facility
|
IP
|
$10,521.97
|
|
|
Service Code
|
APR-DRG 0523
|
| Min. Negotiated Rate |
$9,346.27 |
| Max. Negotiated Rate |
$10,521.97 |
| Rate for Payer: Anthem Medicaid |
$10,075.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$10,075.37
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$10,075.37
|
| Rate for Payer: Dean Health Medicaid |
$10,075.37
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$9,346.27
|
| Rate for Payer: Managed Health Services Medicaid |
$10,521.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$10,075.37
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$10,075.37
|
| Rate for Payer: United Healthcare Medicaid |
$10,075.37
|
|
|
ALT (FS)
|
Professional
|
Both
|
$5.00
|
|
|
Service Code
|
CPT 84460
|
| Hospital Charge Code |
4538807
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$2.29 |
| Max. Negotiated Rate |
$24.25 |
| Rate for Payer: Aetna Commercial |
$4.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4.47
|
| Rate for Payer: Aetna Managed Medicare |
$5.51
|
| Rate for Payer: Anthem Medicare Advantage |
$5.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5.51
|
| Rate for Payer: Cash Price |
$1.50
|
| Rate for Payer: Cash Price |
$1.50
|
| Rate for Payer: Cigna Commercial |
$4.94
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5.51
|
| Rate for Payer: Health EOS Commercial |
$4.73
|
| Rate for Payer: HFN Commercial |
$4.94
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$19.46
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$19.46
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5.51
|
| Rate for Payer: Multiplan Commercial |
$4.16
|
| Rate for Payer: NAPHCARE Commercial |
$8.27
|
| Rate for Payer: Preferred Network Access Commercial |
$4.94
|
| Rate for Payer: Quartz Beloit One Network |
$2.29
|
| Rate for Payer: Quartz Commercial |
$2.96
|
| Rate for Payer: Quartz Medicare Advantage |
$5.51
|
| Rate for Payer: The Alliance Commercial |
$21.77
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.51
|
| Rate for Payer: WEA Trust Commercial |
$2.86
|
| Rate for Payer: WPS Commercial |
$24.25
|
|
|
ALT (FS)
|
Facility
|
OP
|
$5.00
|
|
|
Service Code
|
CPT 84460
|
| Hospital Charge Code |
4538807
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$2.55 |
| Max. Negotiated Rate |
$22.05 |
| Rate for Payer: Aetna Commercial |
$4.68
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4.47
|
| Rate for Payer: Aetna Managed Medicare |
$5.51
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$20.67
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$9.65
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$9.15
|
| Rate for Payer: Anthem Medicare Advantage |
$5.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5.51
|
| Rate for Payer: Cash Price |
$1.50
|
| Rate for Payer: Cash Price |
$1.50
|
| Rate for Payer: Cigna Commercial |
$4.78
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$5.51
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2.91
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$5.51
|
| Rate for Payer: Health EOS Commercial |
$4.63
|
| Rate for Payer: HFN Commercial |
$4.78
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$20.50
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$5.51
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5.51
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$5.51
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$5.51
|
| Rate for Payer: Multiplan Commercial |
$4.16
|
| Rate for Payer: NAPHCARE Commercial |
$8.27
|
| Rate for Payer: Preferred Network Access Commercial |
$4.78
|
| Rate for Payer: Quartz Beloit One Network |
$2.55
|
| Rate for Payer: Quartz Commercial |
$3.38
|
| Rate for Payer: Quartz Medicare Advantage |
$5.51
|
| Rate for Payer: The Alliance Commercial |
$22.05
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.51
|
| Rate for Payer: United Healthcare PPO |
$3.90
|
| Rate for Payer: WEA Trust Commercial |
$2.86
|
| Rate for Payer: Wellcare Medicare |
$5.51
|
| Rate for Payer: WPS Commercial |
$3.85
|
|
|
ALT (FS)
|
Facility
|
IP
|
$5.00
|
|
|
Service Code
|
CPT 84460
|
| Hospital Charge Code |
4538807
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$2.55 |
| Max. Negotiated Rate |
$4.78 |
| Rate for Payer: Aetna Commercial |
$4.68
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2.76
|
| Rate for Payer: Cash Price |
$1.50
|
| Rate for Payer: Cigna Commercial |
$4.78
|
| Rate for Payer: Health EOS Commercial |
$4.63
|
| Rate for Payer: HFN Commercial |
$4.78
|
| Rate for Payer: Multiplan Commercial |
$4.16
|
| Rate for Payer: Preferred Network Access Commercial |
$4.78
|
| Rate for Payer: Quartz Beloit One Network |
$2.55
|
| Rate for Payer: Quartz Commercial |
$3.12
|
| Rate for Payer: WEA Trust Commercial |
$2.86
|
| Rate for Payer: WPS Commercial |
$3.85
|
|
|
ALT (FSURE)
|
Facility
|
OP
|
$62.00
|
|
|
Service Code
|
CPT 84460
|
| Hospital Charge Code |
4538814
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.51 |
| Max. Negotiated Rate |
$59.32 |
| Rate for Payer: Aetna Commercial |
$58.03
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$55.45
|
| Rate for Payer: Aetna Managed Medicare |
$5.51
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$20.67
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$9.65
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$9.15
|
| Rate for Payer: Anthem Medicare Advantage |
$5.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$34.17
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5.51
|
| Rate for Payer: Cash Price |
$18.60
|
| Rate for Payer: Cash Price |
$18.60
|
| Rate for Payer: Cigna Commercial |
$59.32
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$5.51
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$36.08
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$5.51
|
| Rate for Payer: Health EOS Commercial |
$57.39
|
| Rate for Payer: HFN Commercial |
$59.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$20.50
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$5.51
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5.51
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$5.51
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$5.51
|
| Rate for Payer: Multiplan Commercial |
$51.58
|
| Rate for Payer: NAPHCARE Commercial |
$8.27
|
| Rate for Payer: Preferred Network Access Commercial |
$59.32
|
| Rate for Payer: Quartz Beloit One Network |
$31.60
|
| Rate for Payer: Quartz Commercial |
$41.91
|
| Rate for Payer: Quartz Medicare Advantage |
$5.51
|
| Rate for Payer: The Alliance Commercial |
$22.05
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.51
|
| Rate for Payer: United Healthcare PPO |
$48.36
|
| Rate for Payer: WEA Trust Commercial |
$35.46
|
| Rate for Payer: Wellcare Medicare |
$5.51
|
| Rate for Payer: WPS Commercial |
$47.76
|
|
|
ALT (FSURE)
|
Facility
|
IP
|
$62.00
|
|
|
Service Code
|
CPT 84460
|
| Hospital Charge Code |
4538814
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$31.60 |
| Max. Negotiated Rate |
$59.32 |
| Rate for Payer: Aetna Commercial |
$58.03
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$55.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$34.17
|
| Rate for Payer: Cash Price |
$18.60
|
| Rate for Payer: Cigna Commercial |
$59.32
|
| Rate for Payer: Health EOS Commercial |
$57.39
|
| Rate for Payer: HFN Commercial |
$59.32
|
| Rate for Payer: Multiplan Commercial |
$51.58
|
| Rate for Payer: Preferred Network Access Commercial |
$59.32
|
| Rate for Payer: Quartz Beloit One Network |
$31.60
|
| Rate for Payer: Quartz Commercial |
$38.69
|
| Rate for Payer: WEA Trust Commercial |
$35.46
|
| Rate for Payer: WPS Commercial |
$47.76
|
|
|
ALT (FSURE)
|
Professional
|
Both
|
$62.00
|
|
|
Service Code
|
CPT 84460
|
| Hospital Charge Code |
4538814
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.51 |
| Max. Negotiated Rate |
$61.26 |
| Rate for Payer: Aetna Commercial |
$61.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$55.45
|
| Rate for Payer: Aetna Managed Medicare |
$5.51
|
| Rate for Payer: Anthem Medicare Advantage |
$5.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5.51
|
| Rate for Payer: Cash Price |
$18.60
|
| Rate for Payer: Cash Price |
$18.60
|
| Rate for Payer: Cigna Commercial |
$61.26
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$32.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5.51
|
| Rate for Payer: Health EOS Commercial |
$58.68
|
| Rate for Payer: HFN Commercial |
$61.26
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$19.46
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$19.46
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5.51
|
| Rate for Payer: Multiplan Commercial |
$51.58
|
| Rate for Payer: NAPHCARE Commercial |
$8.27
|
| Rate for Payer: Preferred Network Access Commercial |
$61.26
|
| Rate for Payer: Quartz Beloit One Network |
$28.37
|
| Rate for Payer: Quartz Commercial |
$36.75
|
| Rate for Payer: Quartz Medicare Advantage |
$5.51
|
| Rate for Payer: The Alliance Commercial |
$21.77
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.51
|
| Rate for Payer: WEA Trust Commercial |
$35.46
|
| Rate for Payer: WPS Commercial |
$24.25
|
|
|
Aluminum Level
|
Facility
|
OP
|
$321.00
|
|
|
Service Code
|
CPT 82108
|
| Hospital Charge Code |
633644
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$26.50 |
| 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 |
$26.50
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$99.37
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$46.37
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$43.99
|
| Rate for Payer: Anthem Medicare Advantage |
$26.50
|
| 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 |
$26.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$26.50
|
| 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 |
$26.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$186.82
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$26.50
|
| Rate for Payer: Health EOS Commercial |
$297.12
|
| Rate for Payer: HFN Commercial |
$307.13
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$98.58
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$26.50
|
| Rate for Payer: Independent Care Health Plan Medicare |
$26.50
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$26.50
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$26.50
|
| Rate for Payer: Multiplan Commercial |
$267.07
|
| Rate for Payer: NAPHCARE Commercial |
$39.75
|
| 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 |
$26.50
|
| Rate for Payer: The Alliance Commercial |
$106.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$26.50
|
| Rate for Payer: United Healthcare PPO |
$250.38
|
| Rate for Payer: WEA Trust Commercial |
$183.61
|
| Rate for Payer: Wellcare Medicare |
$26.50
|
| Rate for Payer: WPS Commercial |
$247.27
|
|
|
Aluminum Level
|
Facility
|
IP
|
$321.00
|
|
|
Service Code
|
CPT 82108
|
| Hospital Charge Code |
633644
|
|
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
|
|
|
Aluminum Level
|
Professional
|
Both
|
$321.00
|
|
|
Service Code
|
CPT 82108
|
| Hospital Charge Code |
633644
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$26.50 |
| 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 |
$26.50
|
| Rate for Payer: Anthem Medicare Advantage |
$26.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$26.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$26.50
|
| 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 |
$26.50
|
| Rate for Payer: Health EOS Commercial |
$303.79
|
| Rate for Payer: HFN Commercial |
$317.15
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$93.54
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$93.54
|
| Rate for Payer: Independent Care Health Plan Medicare |
$26.50
|
| Rate for Payer: Multiplan Commercial |
$267.07
|
| Rate for Payer: NAPHCARE Commercial |
$39.75
|
| 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 |
$26.50
|
| Rate for Payer: The Alliance Commercial |
$104.67
|
| Rate for Payer: United Healthcare Medicare Advantage |
$26.50
|
| Rate for Payer: WEA Trust Commercial |
$183.61
|
| Rate for Payer: WPS Commercial |
$116.60
|
|
|
Aluminum Level 24 Hour Urine
|
Facility
|
OP
|
$126.00
|
|
|
Service Code
|
CPT 82108
|
| Hospital Charge Code |
977863
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$26.50 |
| Max. Negotiated Rate |
$120.56 |
| Rate for Payer: Aetna Commercial |
$117.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$112.69
|
| Rate for Payer: Aetna Managed Medicare |
$26.50
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$99.37
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$46.37
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$43.99
|
| Rate for Payer: Anthem Medicare Advantage |
$26.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$69.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$26.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$26.50
|
| Rate for Payer: Cash Price |
$37.80
|
| Rate for Payer: Cash Price |
$37.80
|
| Rate for Payer: Cigna Commercial |
$120.56
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$26.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$73.33
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$26.50
|
| Rate for Payer: Health EOS Commercial |
$116.63
|
| Rate for Payer: HFN Commercial |
$120.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$98.58
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$26.50
|
| Rate for Payer: Independent Care Health Plan Medicare |
$26.50
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$26.50
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$26.50
|
| Rate for Payer: Multiplan Commercial |
$104.83
|
| Rate for Payer: NAPHCARE Commercial |
$39.75
|
| Rate for Payer: Preferred Network Access Commercial |
$120.56
|
| Rate for Payer: Quartz Beloit One Network |
$64.21
|
| Rate for Payer: Quartz Commercial |
$85.18
|
| Rate for Payer: Quartz Medicare Advantage |
$26.50
|
| Rate for Payer: The Alliance Commercial |
$106.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$26.50
|
| Rate for Payer: United Healthcare PPO |
$98.28
|
| Rate for Payer: WEA Trust Commercial |
$72.07
|
| Rate for Payer: Wellcare Medicare |
$26.50
|
| Rate for Payer: WPS Commercial |
$97.06
|
|
|
Aluminum Level 24 Hour Urine
|
Professional
|
Both
|
$126.00
|
|
|
Service Code
|
CPT 82108
|
| Hospital Charge Code |
977863
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$26.50 |
| Max. Negotiated Rate |
$124.49 |
| Rate for Payer: Aetna Commercial |
$124.49
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$112.69
|
| Rate for Payer: Aetna Managed Medicare |
$26.50
|
| Rate for Payer: Anthem Medicare Advantage |
$26.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$26.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$26.50
|
| Rate for Payer: Cash Price |
$37.80
|
| Rate for Payer: Cash Price |
$37.80
|
| Rate for Payer: Cigna Commercial |
$124.49
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$65.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$26.50
|
| Rate for Payer: Health EOS Commercial |
$119.25
|
| Rate for Payer: HFN Commercial |
$124.49
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$93.54
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$93.54
|
| Rate for Payer: Independent Care Health Plan Medicare |
$26.50
|
| Rate for Payer: Multiplan Commercial |
$104.83
|
| Rate for Payer: NAPHCARE Commercial |
$39.75
|
| Rate for Payer: Preferred Network Access Commercial |
$124.49
|
| Rate for Payer: Quartz Beloit One Network |
$57.66
|
| Rate for Payer: Quartz Commercial |
$74.69
|
| Rate for Payer: Quartz Medicare Advantage |
$26.50
|
| Rate for Payer: The Alliance Commercial |
$104.67
|
| Rate for Payer: United Healthcare Medicare Advantage |
$26.50
|
| Rate for Payer: WEA Trust Commercial |
$72.07
|
| Rate for Payer: WPS Commercial |
$116.60
|
|
|
Aluminum Level 24 Hour Urine
|
Facility
|
IP
|
$126.00
|
|
|
Service Code
|
CPT 82108
|
| Hospital Charge Code |
977863
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$64.21 |
| Max. Negotiated Rate |
$120.56 |
| Rate for Payer: Aetna Commercial |
$117.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$112.69
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$69.45
|
| Rate for Payer: Cash Price |
$37.80
|
| Rate for Payer: Cigna Commercial |
$120.56
|
| Rate for Payer: Health EOS Commercial |
$116.63
|
| Rate for Payer: HFN Commercial |
$120.56
|
| Rate for Payer: Multiplan Commercial |
$104.83
|
| Rate for Payer: Preferred Network Access Commercial |
$120.56
|
| Rate for Payer: Quartz Beloit One Network |
$64.21
|
| Rate for Payer: Quartz Commercial |
$78.62
|
| Rate for Payer: WEA Trust Commercial |
$72.07
|
| Rate for Payer: WPS Commercial |
$97.06
|
|
