|
Insulin Injection J1815
|
Facility
|
IP
|
$6.00
|
|
|
Service Code
|
HCPCS J1815
|
| Hospital Charge Code |
4017969
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.94 |
| Max. Negotiated Rate |
$5.52 |
| Rate for Payer: Aetna Commercial |
$5.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3.18
|
| Rate for Payer: Cash Price |
$1.80
|
| Rate for Payer: Cigna Commercial |
$5.52
|
| Rate for Payer: Health EOS Commercial |
$5.34
|
| Rate for Payer: HFN Commercial |
$5.52
|
| Rate for Payer: Multiplan Commercial |
$4.80
|
| Rate for Payer: NAPHCARE Commercial |
$3.60
|
| Rate for Payer: Preferred Network Access Commercial |
$5.52
|
| Rate for Payer: Quartz Beloit One Network |
$2.94
|
| Rate for Payer: Quartz Commercial |
$3.60
|
| Rate for Payer: WEA Trust Commercial |
$3.30
|
| Rate for Payer: WPS Commercial |
$4.44
|
|
|
Insulin Injection J1815
|
Facility
|
OP
|
$6.00
|
|
|
Service Code
|
HCPCS J1815
|
| Hospital Charge Code |
4017969
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.68 |
| Max. Negotiated Rate |
$24.00 |
| Rate for Payer: Aetna Commercial |
$5.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5.16
|
| Rate for Payer: Aetna Managed Medicare |
$1.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3.18
|
| Rate for Payer: Cash Price |
$1.80
|
| Rate for Payer: Cigna Commercial |
$5.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3.36
|
| Rate for Payer: Health EOS Commercial |
$5.34
|
| Rate for Payer: HFN Commercial |
$5.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4.50
|
| Rate for Payer: Multiplan Commercial |
$4.80
|
| Rate for Payer: NAPHCARE Commercial |
$3.60
|
| Rate for Payer: Preferred Network Access Commercial |
$5.52
|
| Rate for Payer: Quartz Beloit One Network |
$2.94
|
| Rate for Payer: Quartz Commercial |
$3.90
|
| Rate for Payer: Quartz Medicare Advantage |
$3.60
|
| Rate for Payer: The Alliance Commercial |
$24.00
|
| Rate for Payer: WEA Trust Commercial |
$3.30
|
| Rate for Payer: WPS Commercial |
$4.44
|
|
|
Insulin Level Total
|
Professional
|
Both
|
$153.00
|
|
|
Service Code
|
CPT 83525
|
| Hospital Charge Code |
977997
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$40.35 |
| Max. Negotiated Rate |
$145.35 |
| Rate for Payer: Health EOS Commercial |
$139.23
|
| Rate for Payer: HFN Commercial |
$145.35
|
| Rate for Payer: Aetna Commercial |
$145.35
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$131.58
|
| Rate for Payer: Cash Price |
$45.90
|
| Rate for Payer: Cash Price |
$45.90
|
| Rate for Payer: Cigna Commercial |
$145.35
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$76.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$91.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$40.35
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$40.35
|
| Rate for Payer: Multiplan Commercial |
$122.40
|
| Rate for Payer: Preferred Network Access Commercial |
$145.35
|
| Rate for Payer: Quartz Beloit One Network |
$67.32
|
| Rate for Payer: Quartz Commercial |
$87.21
|
| Rate for Payer: The Alliance Commercial |
$76.50
|
| Rate for Payer: WEA Trust Commercial |
$84.15
|
| Rate for Payer: WPS Commercial |
$113.33
|
|
|
Insulin Level Total
|
Facility
|
OP
|
$153.00
|
|
|
Service Code
|
CPT 83525
|
| Hospital Charge Code |
977997
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.43 |
| Max. Negotiated Rate |
$140.76 |
| Rate for Payer: Aetna Commercial |
$137.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$131.58
|
| Rate for Payer: Aetna Managed Medicare |
$11.43
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$42.86
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$20.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$18.97
|
| Rate for Payer: Anthem Medicaid |
$11.81
|
| Rate for Payer: Anthem Medicare Advantage |
$11.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$81.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$11.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$11.43
|
| Rate for Payer: Cash Price |
$45.90
|
| Rate for Payer: Cash Price |
$45.90
|
| Rate for Payer: Cigna Commercial |
$140.76
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$11.43
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$11.81
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$85.62
|
| Rate for Payer: Dean Health Medicaid |
$11.81
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$11.43
|
| Rate for Payer: Health EOS Commercial |
$136.17
|
| Rate for Payer: HFN Commercial |
$140.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$42.52
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$11.43
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$11.81
|
| Rate for Payer: Independent Care Health Plan Medicare |
$11.43
|
| Rate for Payer: Managed Health Services Medicaid |
$12.28
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$11.43
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$11.43
|
| Rate for Payer: Multiplan Commercial |
$122.40
|
| Rate for Payer: NAPHCARE Commercial |
$17.14
|
| Rate for Payer: Preferred Network Access Commercial |
$140.76
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$11.81
|
| Rate for Payer: Quartz Beloit One Network |
$74.97
|
| Rate for Payer: Quartz Commercial |
$99.45
|
| Rate for Payer: Quartz Medicare Advantage |
$11.43
|
| Rate for Payer: The Alliance Commercial |
$45.72
|
| Rate for Payer: United Healthcare Medicaid |
$11.81
|
| Rate for Payer: United Healthcare Medicare Advantage |
$11.43
|
| Rate for Payer: United Healthcare PPO |
$114.75
|
| Rate for Payer: WEA Trust Commercial |
$84.15
|
| Rate for Payer: Wellcare Medicare |
$11.43
|
| Rate for Payer: WMAP Medicaid |
$11.81
|
| Rate for Payer: WPS Commercial |
$113.33
|
|
|
Insulin Level Total
|
Facility
|
IP
|
$153.00
|
|
|
Service Code
|
CPT 83525
|
| Hospital Charge Code |
977997
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$74.97 |
| Max. Negotiated Rate |
$140.76 |
| Rate for Payer: Aetna Commercial |
$137.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$131.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$81.09
|
| Rate for Payer: Cash Price |
$45.90
|
| Rate for Payer: Cigna Commercial |
$140.76
|
| Rate for Payer: Health EOS Commercial |
$136.17
|
| Rate for Payer: HFN Commercial |
$140.76
|
| Rate for Payer: Multiplan Commercial |
$122.40
|
| Rate for Payer: NAPHCARE Commercial |
$91.80
|
| Rate for Payer: Preferred Network Access Commercial |
$140.76
|
| Rate for Payer: Quartz Beloit One Network |
$74.97
|
| Rate for Payer: Quartz Commercial |
$91.80
|
| Rate for Payer: WEA Trust Commercial |
$84.15
|
| Rate for Payer: WPS Commercial |
$113.33
|
|
|
Insulin-Like Growth Factor Binding Protein-1
|
Facility
|
IP
|
$114.00
|
|
|
Service Code
|
CPT 83519
|
| Hospital Charge Code |
977987
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$55.86 |
| Max. Negotiated Rate |
$104.88 |
| Rate for Payer: Aetna Commercial |
$102.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$98.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$60.42
|
| Rate for Payer: Cash Price |
$34.20
|
| Rate for Payer: Cigna Commercial |
$104.88
|
| Rate for Payer: Health EOS Commercial |
$101.46
|
| Rate for Payer: HFN Commercial |
$104.88
|
| Rate for Payer: Multiplan Commercial |
$91.20
|
| Rate for Payer: NAPHCARE Commercial |
$68.40
|
| Rate for Payer: Preferred Network Access Commercial |
$104.88
|
| Rate for Payer: Quartz Beloit One Network |
$55.86
|
| Rate for Payer: Quartz Commercial |
$68.40
|
| Rate for Payer: WEA Trust Commercial |
$62.70
|
| Rate for Payer: WPS Commercial |
$84.44
|
|
|
Insulin-Like Growth Factor Binding Protein-1
|
Professional
|
Both
|
$114.00
|
|
|
Service Code
|
CPT 83519
|
| Hospital Charge Code |
977987
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$50.16 |
| Max. Negotiated Rate |
$108.30 |
| Rate for Payer: Aetna Commercial |
$108.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$98.04
|
| Rate for Payer: Cash Price |
$34.20
|
| Rate for Payer: Cash Price |
$34.20
|
| Rate for Payer: Cigna Commercial |
$108.30
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$57.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$68.40
|
| Rate for Payer: Health EOS Commercial |
$103.74
|
| Rate for Payer: HFN Commercial |
$108.30
|
| 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: Multiplan Commercial |
$91.20
|
| Rate for Payer: Preferred Network Access Commercial |
$108.30
|
| Rate for Payer: Quartz Beloit One Network |
$50.16
|
| Rate for Payer: Quartz Commercial |
$64.98
|
| Rate for Payer: The Alliance Commercial |
$57.00
|
| Rate for Payer: WEA Trust Commercial |
$62.70
|
| Rate for Payer: WPS Commercial |
$84.44
|
|
|
Insulin-Like Growth Factor Binding Protein-1
|
Facility
|
OP
|
$114.00
|
|
|
Service Code
|
CPT 83519
|
| Hospital Charge Code |
977987
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.40 |
| Max. Negotiated Rate |
$104.88 |
| Rate for Payer: Aetna Commercial |
$102.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$98.04
|
| 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 |
$60.42
|
| 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 |
$34.20
|
| Rate for Payer: Cash Price |
$34.20
|
| Rate for Payer: Cigna Commercial |
$104.88
|
| 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 DHI/DHP/ASO |
$63.79
|
| 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 |
$101.46
|
| Rate for Payer: HFN Commercial |
$104.88
|
| 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 |
$91.20
|
| Rate for Payer: NAPHCARE Commercial |
$27.60
|
| Rate for Payer: Preferred Network Access Commercial |
$104.88
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$19.00
|
| Rate for Payer: Quartz Beloit One Network |
$55.86
|
| Rate for Payer: Quartz Commercial |
$74.10
|
| Rate for Payer: Quartz Medicare Advantage |
$18.40
|
| Rate for Payer: The Alliance Commercial |
$73.60
|
| Rate for Payer: United Healthcare Medicaid |
$19.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$18.40
|
| Rate for Payer: United Healthcare PPO |
$85.50
|
| Rate for Payer: WEA Trust Commercial |
$62.70
|
| Rate for Payer: Wellcare Medicare |
$18.40
|
| Rate for Payer: WMAP Medicaid |
$19.00
|
| Rate for Payer: WPS Commercial |
$84.44
|
|
|
Insulin-Like Growth Factor Binding Protein-3
|
Professional
|
Both
|
$199.00
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
977988
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$60.96 |
| Max. Negotiated Rate |
$189.05 |
| Rate for Payer: HFN Commercial |
$189.05
|
| Rate for Payer: Health EOS Commercial |
$181.09
|
| Rate for Payer: Aetna Commercial |
$189.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$171.14
|
| Rate for Payer: Cash Price |
$59.70
|
| Rate for Payer: Cash Price |
$59.70
|
| Rate for Payer: Cigna Commercial |
$189.05
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$99.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$119.40
|
| 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: Multiplan Commercial |
$159.20
|
| Rate for Payer: Preferred Network Access Commercial |
$189.05
|
| Rate for Payer: Quartz Beloit One Network |
$87.56
|
| Rate for Payer: Quartz Commercial |
$113.43
|
| Rate for Payer: The Alliance Commercial |
$99.50
|
| Rate for Payer: WEA Trust Commercial |
$109.45
|
| Rate for Payer: WPS Commercial |
$147.40
|
|
|
Insulin-Like Growth Factor Binding Protein-3
|
Facility
|
IP
|
$199.00
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
977988
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$97.51 |
| Max. Negotiated Rate |
$183.08 |
| Rate for Payer: Aetna Commercial |
$179.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$171.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$105.47
|
| Rate for Payer: Cash Price |
$59.70
|
| Rate for Payer: Cigna Commercial |
$183.08
|
| Rate for Payer: Health EOS Commercial |
$177.11
|
| Rate for Payer: HFN Commercial |
$183.08
|
| Rate for Payer: Multiplan Commercial |
$159.20
|
| Rate for Payer: NAPHCARE Commercial |
$119.40
|
| Rate for Payer: Preferred Network Access Commercial |
$183.08
|
| Rate for Payer: Quartz Beloit One Network |
$97.51
|
| Rate for Payer: Quartz Commercial |
$119.40
|
| Rate for Payer: WEA Trust Commercial |
$109.45
|
| Rate for Payer: WPS Commercial |
$147.40
|
|
|
Insulin-Like Growth Factor Binding Protein-3
|
Facility
|
OP
|
$199.00
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
977988
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.27 |
| Max. Negotiated Rate |
$183.08 |
| Rate for Payer: Aetna Commercial |
$179.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$171.14
|
| 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 |
$105.47
|
| 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 |
$59.70
|
| Rate for Payer: Cash Price |
$59.70
|
| Rate for Payer: Cigna Commercial |
$183.08
|
| 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 DHI/DHP/ASO |
$111.36
|
| 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 |
$177.11
|
| Rate for Payer: HFN Commercial |
$183.08
|
| 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 |
$159.20
|
| Rate for Payer: NAPHCARE Commercial |
$25.90
|
| Rate for Payer: Preferred Network Access Commercial |
$183.08
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$17.85
|
| Rate for Payer: Quartz Beloit One Network |
$97.51
|
| Rate for Payer: Quartz Commercial |
$129.35
|
| Rate for Payer: Quartz Medicare Advantage |
$17.27
|
| Rate for Payer: The Alliance Commercial |
$69.08
|
| Rate for Payer: United Healthcare Medicaid |
$17.85
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17.27
|
| Rate for Payer: United Healthcare PPO |
$149.25
|
| Rate for Payer: WEA Trust Commercial |
$109.45
|
| Rate for Payer: Wellcare Medicare |
$17.27
|
| Rate for Payer: WMAP Medicaid |
$17.85
|
| Rate for Payer: WPS Commercial |
$147.40
|
|
|
Insulin-Like Growth Factor-I
|
Professional
|
Both
|
$651.00
|
|
|
Service Code
|
CPT 84305
|
| Hospital Charge Code |
1039281
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$75.05 |
| Max. Negotiated Rate |
$618.45 |
| Rate for Payer: Aetna Commercial |
$618.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$559.86
|
| Rate for Payer: Cash Price |
$195.30
|
| Rate for Payer: Cash Price |
$195.30
|
| Rate for Payer: Cigna Commercial |
$618.45
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$325.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$390.60
|
| Rate for Payer: Health EOS Commercial |
$592.41
|
| Rate for Payer: HFN Commercial |
$618.45
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$75.05
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$75.05
|
| Rate for Payer: Multiplan Commercial |
$520.80
|
| Rate for Payer: Preferred Network Access Commercial |
$618.45
|
| Rate for Payer: Quartz Beloit One Network |
$286.44
|
| Rate for Payer: Quartz Commercial |
$371.07
|
| Rate for Payer: The Alliance Commercial |
$325.50
|
| Rate for Payer: WEA Trust Commercial |
$358.05
|
| Rate for Payer: WPS Commercial |
$482.20
|
|
|
Insulin-Like Growth Factor-I
|
Facility
|
IP
|
$651.00
|
|
|
Service Code
|
CPT 84305
|
| Hospital Charge Code |
1039281
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$318.99 |
| Max. Negotiated Rate |
$598.92 |
| Rate for Payer: Aetna Commercial |
$585.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$559.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$345.03
|
| Rate for Payer: Cash Price |
$195.30
|
| Rate for Payer: Cigna Commercial |
$598.92
|
| Rate for Payer: Health EOS Commercial |
$579.39
|
| Rate for Payer: HFN Commercial |
$598.92
|
| Rate for Payer: Multiplan Commercial |
$520.80
|
| Rate for Payer: NAPHCARE Commercial |
$390.60
|
| Rate for Payer: Preferred Network Access Commercial |
$598.92
|
| Rate for Payer: Quartz Beloit One Network |
$318.99
|
| Rate for Payer: Quartz Commercial |
$390.60
|
| Rate for Payer: WEA Trust Commercial |
$358.05
|
| Rate for Payer: WPS Commercial |
$482.20
|
|
|
Insulin-Like Growth Factor-I
|
Facility
|
OP
|
$651.00
|
|
|
Service Code
|
CPT 84305
|
| Hospital Charge Code |
1039281
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$21.26 |
| Max. Negotiated Rate |
$598.92 |
| Rate for Payer: Aetna Commercial |
$585.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$559.86
|
| Rate for Payer: Aetna Managed Medicare |
$21.26
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$79.72
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$37.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$35.29
|
| Rate for Payer: Anthem Medicaid |
$21.97
|
| Rate for Payer: Anthem Medicare Advantage |
$21.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$345.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$21.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$21.26
|
| Rate for Payer: Cash Price |
$195.30
|
| Rate for Payer: Cash Price |
$195.30
|
| Rate for Payer: Cigna Commercial |
$598.92
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$21.26
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$21.97
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$364.30
|
| Rate for Payer: Dean Health Medicaid |
$21.97
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$21.26
|
| Rate for Payer: Health EOS Commercial |
$579.39
|
| Rate for Payer: HFN Commercial |
$598.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$79.09
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$21.26
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$21.97
|
| Rate for Payer: Independent Care Health Plan Medicare |
$21.26
|
| Rate for Payer: Managed Health Services Medicaid |
$22.85
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$21.26
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$21.26
|
| Rate for Payer: Multiplan Commercial |
$520.80
|
| Rate for Payer: NAPHCARE Commercial |
$31.89
|
| Rate for Payer: Preferred Network Access Commercial |
$598.92
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$21.97
|
| Rate for Payer: Quartz Beloit One Network |
$318.99
|
| Rate for Payer: Quartz Commercial |
$423.15
|
| Rate for Payer: Quartz Medicare Advantage |
$21.26
|
| Rate for Payer: The Alliance Commercial |
$85.04
|
| Rate for Payer: United Healthcare Medicaid |
$21.97
|
| Rate for Payer: United Healthcare Medicare Advantage |
$21.26
|
| Rate for Payer: United Healthcare PPO |
$488.25
|
| Rate for Payer: WEA Trust Commercial |
$358.05
|
| Rate for Payer: Wellcare Medicare |
$21.26
|
| Rate for Payer: WMAP Medicaid |
$21.97
|
| Rate for Payer: WPS Commercial |
$482.20
|
|
|
Insulin-Like Growth Factor II
|
Facility
|
IP
|
$394.00
|
|
|
Service Code
|
CPT 83519
|
| Hospital Charge Code |
978125
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$193.06 |
| Max. Negotiated Rate |
$362.48 |
| Rate for Payer: HFN Commercial |
$362.48
|
| Rate for Payer: Multiplan Commercial |
$315.20
|
| Rate for Payer: NAPHCARE Commercial |
$236.40
|
| Rate for Payer: Aetna Commercial |
$354.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$338.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$208.82
|
| Rate for Payer: Cash Price |
$118.20
|
| Rate for Payer: Cigna Commercial |
$362.48
|
| Rate for Payer: Health EOS Commercial |
$350.66
|
| Rate for Payer: Preferred Network Access Commercial |
$362.48
|
| Rate for Payer: Quartz Beloit One Network |
$193.06
|
| Rate for Payer: Quartz Commercial |
$236.40
|
| Rate for Payer: WEA Trust Commercial |
$216.70
|
| Rate for Payer: WPS Commercial |
$291.84
|
|
|
Insulin-Like Growth Factor II
|
Facility
|
OP
|
$394.00
|
|
|
Service Code
|
CPT 83519
|
| Hospital Charge Code |
978125
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.40 |
| Max. Negotiated Rate |
$362.48 |
| Rate for Payer: Aetna Commercial |
$354.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$338.84
|
| 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 |
$208.82
|
| 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 |
$118.20
|
| Rate for Payer: Cash Price |
$118.20
|
| Rate for Payer: Cigna Commercial |
$362.48
|
| 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 DHI/DHP/ASO |
$220.48
|
| 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 |
$350.66
|
| Rate for Payer: HFN Commercial |
$362.48
|
| 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 |
$315.20
|
| Rate for Payer: NAPHCARE Commercial |
$27.60
|
| Rate for Payer: Preferred Network Access Commercial |
$362.48
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$19.00
|
| Rate for Payer: Quartz Beloit One Network |
$193.06
|
| Rate for Payer: Quartz Commercial |
$256.10
|
| Rate for Payer: Quartz Medicare Advantage |
$18.40
|
| Rate for Payer: The Alliance Commercial |
$73.60
|
| Rate for Payer: United Healthcare Medicaid |
$19.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$18.40
|
| Rate for Payer: United Healthcare PPO |
$295.50
|
| Rate for Payer: WEA Trust Commercial |
$216.70
|
| Rate for Payer: Wellcare Medicare |
$18.40
|
| Rate for Payer: WMAP Medicaid |
$19.00
|
| Rate for Payer: WPS Commercial |
$291.84
|
|
|
Insulin-Like Growth Factor II
|
Professional
|
Both
|
$394.00
|
|
|
Service Code
|
CPT 83519
|
| Hospital Charge Code |
978125
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$64.95 |
| Max. Negotiated Rate |
$374.30 |
| Rate for Payer: Aetna Commercial |
$374.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$338.84
|
| Rate for Payer: Cash Price |
$118.20
|
| Rate for Payer: Cash Price |
$118.20
|
| Rate for Payer: Cigna Commercial |
$374.30
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$197.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$236.40
|
| Rate for Payer: Health EOS Commercial |
$358.54
|
| Rate for Payer: HFN Commercial |
$374.30
|
| 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: Multiplan Commercial |
$315.20
|
| Rate for Payer: Preferred Network Access Commercial |
$374.30
|
| Rate for Payer: Quartz Beloit One Network |
$173.36
|
| Rate for Payer: Quartz Commercial |
$224.58
|
| Rate for Payer: The Alliance Commercial |
$197.00
|
| Rate for Payer: WEA Trust Commercial |
$216.70
|
| Rate for Payer: WPS Commercial |
$291.84
|
|
|
Intensity Mod Radiotherapy Plan 7730126
|
Professional
|
Both
|
$3,796.00
|
|
|
Service Code
|
CPT 77301 26
|
| Hospital Charge Code |
5258629
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$1,438.76 |
| Max. Negotiated Rate |
$3,606.20 |
| Rate for Payer: Aetna Commercial |
$3,606.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,264.56
|
| Rate for Payer: Cash Price |
$1,138.80
|
| Rate for Payer: Cash Price |
$1,138.80
|
| Rate for Payer: Cash Price |
$1,138.80
|
| Rate for Payer: Cigna Commercial |
$3,606.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,898.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,277.60
|
| Rate for Payer: Health EOS Commercial |
$3,454.36
|
| Rate for Payer: HFN Commercial |
$3,606.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,438.76
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,438.76
|
| Rate for Payer: Multiplan Commercial |
$3,036.80
|
| Rate for Payer: Preferred Network Access Commercial |
$3,606.20
|
| Rate for Payer: Quartz Beloit One Network |
$1,670.24
|
| Rate for Payer: Quartz Commercial |
$2,163.72
|
| Rate for Payer: The Alliance Commercial |
$1,898.00
|
| Rate for Payer: WEA Trust Commercial |
$2,087.80
|
| Rate for Payer: WPS Commercial |
$2,811.70
|
|
|
INTERCEED ABSORBABLE ADHESION BARRIER 4350
|
Facility
|
IP
|
$3,817.00
|
|
| Hospital Charge Code |
3525511
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,870.33 |
| Max. Negotiated Rate |
$3,511.64 |
| Rate for Payer: Aetna Commercial |
$3,435.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,282.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,023.01
|
| Rate for Payer: Cash Price |
$1,145.10
|
| Rate for Payer: Cigna Commercial |
$3,511.64
|
| Rate for Payer: Health EOS Commercial |
$3,397.13
|
| Rate for Payer: HFN Commercial |
$3,511.64
|
| Rate for Payer: Multiplan Commercial |
$3,053.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,290.20
|
| Rate for Payer: Preferred Network Access Commercial |
$3,511.64
|
| Rate for Payer: Quartz Beloit One Network |
$1,870.33
|
| Rate for Payer: Quartz Commercial |
$2,290.20
|
| Rate for Payer: WEA Trust Commercial |
$2,099.35
|
| Rate for Payer: WPS Commercial |
$2,827.25
|
|
|
INTERCEED ABSORBABLE ADHESION BARRIER 4350
|
Facility
|
OP
|
$3,817.00
|
|
| Hospital Charge Code |
3525511
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,068.76 |
| Max. Negotiated Rate |
$15,268.00 |
| Rate for Payer: Aetna Commercial |
$3,435.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,282.62
|
| Rate for Payer: Aetna Managed Medicare |
$1,068.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,481.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,908.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,832.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,023.01
|
| Rate for Payer: Cash Price |
$1,145.10
|
| Rate for Payer: Cigna Commercial |
$3,511.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,135.99
|
| Rate for Payer: Health EOS Commercial |
$3,397.13
|
| Rate for Payer: HFN Commercial |
$3,511.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,862.75
|
| Rate for Payer: Multiplan Commercial |
$3,053.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,290.20
|
| Rate for Payer: Preferred Network Access Commercial |
$3,511.64
|
| Rate for Payer: Quartz Beloit One Network |
$1,870.33
|
| Rate for Payer: Quartz Commercial |
$2,481.05
|
| Rate for Payer: Quartz Medicare Advantage |
$2,290.20
|
| Rate for Payer: The Alliance Commercial |
$15,268.00
|
| Rate for Payer: WEA Trust Commercial |
$2,099.35
|
| Rate for Payer: WPS Commercial |
$2,827.25
|
|
|
Interleukin 1 Beta
|
Professional
|
Both
|
$370.00
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
4464670
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$60.96 |
| Max. Negotiated Rate |
$351.50 |
| Rate for Payer: Aetna Commercial |
$351.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$318.20
|
| Rate for Payer: Cash Price |
$111.00
|
| Rate for Payer: Cash Price |
$111.00
|
| Rate for Payer: Cigna Commercial |
$351.50
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$185.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$222.00
|
| Rate for Payer: Health EOS Commercial |
$336.70
|
| Rate for Payer: HFN Commercial |
$351.50
|
| 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: Multiplan Commercial |
$296.00
|
| Rate for Payer: Preferred Network Access Commercial |
$351.50
|
| Rate for Payer: Quartz Beloit One Network |
$162.80
|
| Rate for Payer: Quartz Commercial |
$210.90
|
| Rate for Payer: The Alliance Commercial |
$185.00
|
| Rate for Payer: WEA Trust Commercial |
$203.50
|
| Rate for Payer: WPS Commercial |
$274.06
|
|
|
Interleukin 1 Beta
|
Facility
|
OP
|
$370.00
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
4464670
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.27 |
| Max. Negotiated Rate |
$340.40 |
| Rate for Payer: Aetna Commercial |
$333.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$318.20
|
| 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 |
$196.10
|
| 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 |
$111.00
|
| Rate for Payer: Cash Price |
$111.00
|
| Rate for Payer: Cigna Commercial |
$340.40
|
| 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 DHI/DHP/ASO |
$207.05
|
| 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 |
$329.30
|
| Rate for Payer: HFN Commercial |
$340.40
|
| 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 |
$296.00
|
| Rate for Payer: NAPHCARE Commercial |
$25.90
|
| Rate for Payer: Preferred Network Access Commercial |
$340.40
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$17.85
|
| Rate for Payer: Quartz Beloit One Network |
$181.30
|
| Rate for Payer: Quartz Commercial |
$240.50
|
| Rate for Payer: Quartz Medicare Advantage |
$17.27
|
| Rate for Payer: The Alliance Commercial |
$69.08
|
| Rate for Payer: United Healthcare Medicaid |
$17.85
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17.27
|
| Rate for Payer: United Healthcare PPO |
$277.50
|
| Rate for Payer: WEA Trust Commercial |
$203.50
|
| Rate for Payer: Wellcare Medicare |
$17.27
|
| Rate for Payer: WMAP Medicaid |
$17.85
|
| Rate for Payer: WPS Commercial |
$274.06
|
|
|
Interleukin 1 Beta
|
Facility
|
IP
|
$370.00
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
4464670
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$181.30 |
| Max. Negotiated Rate |
$340.40 |
| Rate for Payer: Aetna Commercial |
$333.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$318.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$196.10
|
| Rate for Payer: Cash Price |
$111.00
|
| Rate for Payer: Cigna Commercial |
$340.40
|
| Rate for Payer: Health EOS Commercial |
$329.30
|
| Rate for Payer: HFN Commercial |
$340.40
|
| Rate for Payer: Multiplan Commercial |
$296.00
|
| Rate for Payer: NAPHCARE Commercial |
$222.00
|
| Rate for Payer: Preferred Network Access Commercial |
$340.40
|
| Rate for Payer: Quartz Beloit One Network |
$181.30
|
| Rate for Payer: Quartz Commercial |
$222.00
|
| Rate for Payer: WEA Trust Commercial |
$203.50
|
| Rate for Payer: WPS Commercial |
$274.06
|
|
|
Interleukin 6 High Sensitive, ELISA
|
Facility
|
OP
|
$318.00
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
4464671
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.27 |
| Max. Negotiated Rate |
$292.56 |
| Rate for Payer: Aetna Commercial |
$286.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$273.48
|
| 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 |
$168.54
|
| 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 |
$95.40
|
| Rate for Payer: Cash Price |
$95.40
|
| Rate for Payer: Cigna Commercial |
$292.56
|
| 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 DHI/DHP/ASO |
$177.95
|
| 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 |
$283.02
|
| Rate for Payer: HFN Commercial |
$292.56
|
| 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 |
$254.40
|
| Rate for Payer: NAPHCARE Commercial |
$25.90
|
| Rate for Payer: Preferred Network Access Commercial |
$292.56
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$17.85
|
| Rate for Payer: Quartz Beloit One Network |
$155.82
|
| Rate for Payer: Quartz Commercial |
$206.70
|
| Rate for Payer: Quartz Medicare Advantage |
$17.27
|
| Rate for Payer: The Alliance Commercial |
$69.08
|
| Rate for Payer: United Healthcare Medicaid |
$17.85
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17.27
|
| Rate for Payer: United Healthcare PPO |
$238.50
|
| Rate for Payer: WEA Trust Commercial |
$174.90
|
| Rate for Payer: Wellcare Medicare |
$17.27
|
| Rate for Payer: WMAP Medicaid |
$17.85
|
| Rate for Payer: WPS Commercial |
$235.54
|
|
|
Interleukin 6 High Sensitive, ELISA
|
Professional
|
Both
|
$318.00
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
4464671
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$60.96 |
| Max. Negotiated Rate |
$302.10 |
| Rate for Payer: Aetna Commercial |
$302.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$273.48
|
| Rate for Payer: Cash Price |
$95.40
|
| Rate for Payer: Cash Price |
$95.40
|
| Rate for Payer: Cigna Commercial |
$302.10
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$159.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$190.80
|
| Rate for Payer: Health EOS Commercial |
$289.38
|
| Rate for Payer: HFN Commercial |
$302.10
|
| 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: Multiplan Commercial |
$254.40
|
| Rate for Payer: Preferred Network Access Commercial |
$302.10
|
| Rate for Payer: Quartz Beloit One Network |
$139.92
|
| Rate for Payer: Quartz Commercial |
$181.26
|
| Rate for Payer: The Alliance Commercial |
$159.00
|
| Rate for Payer: WEA Trust Commercial |
$174.90
|
| Rate for Payer: WPS Commercial |
$235.54
|
|
