|
LINER MULTIPOLAR BIPOLAR CUP 44/45/46 5001-44-28
|
Facility
|
OP
|
$3,104.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
3138909
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$869.12 |
| Max. Negotiated Rate |
$12,416.00 |
| Rate for Payer: Aetna Commercial |
$2,793.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,669.44
|
| Rate for Payer: Aetna Managed Medicare |
$869.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,017.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,552.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,489.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,645.12
|
| Rate for Payer: Cash Price |
$931.20
|
| Rate for Payer: Cigna Commercial |
$2,855.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,737.00
|
| Rate for Payer: Health EOS Commercial |
$2,762.56
|
| Rate for Payer: HFN Commercial |
$2,855.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,328.00
|
| Rate for Payer: Multiplan Commercial |
$2,483.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,862.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,855.68
|
| Rate for Payer: Quartz Beloit One Network |
$1,520.96
|
| Rate for Payer: Quartz Commercial |
$2,017.60
|
| Rate for Payer: Quartz Medicare Advantage |
$1,862.40
|
| Rate for Payer: The Alliance Commercial |
$12,416.00
|
| Rate for Payer: WEA Trust Commercial |
$1,707.20
|
| Rate for Payer: WPS Commercial |
$2,299.13
|
|
|
LINER MULTIPOLAR BIPOLAR CUP 44/45/46 5001-44-28
|
Facility
|
IP
|
$3,104.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
3138909
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,520.96 |
| Max. Negotiated Rate |
$2,855.68 |
| Rate for Payer: Aetna Commercial |
$2,793.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,669.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,645.12
|
| Rate for Payer: Cash Price |
$931.20
|
| Rate for Payer: Cigna Commercial |
$2,855.68
|
| Rate for Payer: Health EOS Commercial |
$2,762.56
|
| Rate for Payer: HFN Commercial |
$2,855.68
|
| Rate for Payer: Multiplan Commercial |
$2,483.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,862.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,855.68
|
| Rate for Payer: Quartz Beloit One Network |
$1,520.96
|
| Rate for Payer: Quartz Commercial |
$1,862.40
|
| Rate for Payer: WEA Trust Commercial |
$1,707.20
|
| Rate for Payer: WPS Commercial |
$2,299.13
|
|
|
Lipase Level
|
Professional
|
Both
|
$226.00
|
|
|
Service Code
|
CPT 83690
|
| Hospital Charge Code |
633776
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$24.32 |
| Max. Negotiated Rate |
$214.70 |
| Rate for Payer: Aetna Commercial |
$214.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$194.36
|
| Rate for Payer: Cash Price |
$67.80
|
| Rate for Payer: Cash Price |
$67.80
|
| Rate for Payer: Cigna Commercial |
$214.70
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$113.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$135.60
|
| Rate for Payer: Health EOS Commercial |
$205.66
|
| Rate for Payer: HFN Commercial |
$214.70
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$24.32
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$24.32
|
| Rate for Payer: Multiplan Commercial |
$180.80
|
| Rate for Payer: Preferred Network Access Commercial |
$214.70
|
| Rate for Payer: Quartz Beloit One Network |
$99.44
|
| Rate for Payer: Quartz Commercial |
$128.82
|
| Rate for Payer: The Alliance Commercial |
$113.00
|
| Rate for Payer: WEA Trust Commercial |
$124.30
|
| Rate for Payer: WPS Commercial |
$167.40
|
|
|
Lipase Level
|
Facility
|
OP
|
$226.00
|
|
|
Service Code
|
CPT 83690
|
| Hospital Charge Code |
633776
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.89 |
| Max. Negotiated Rate |
$207.92 |
| Rate for Payer: Aetna Commercial |
$203.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$194.36
|
| Rate for Payer: Aetna Managed Medicare |
$6.89
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$25.84
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$12.06
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$11.44
|
| Rate for Payer: Anthem Medicaid |
$7.12
|
| Rate for Payer: Anthem Medicare Advantage |
$6.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$119.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$6.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$6.89
|
| Rate for Payer: Cash Price |
$67.80
|
| Rate for Payer: Cash Price |
$67.80
|
| Rate for Payer: Cigna Commercial |
$207.92
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$6.89
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$7.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$126.47
|
| Rate for Payer: Dean Health Medicaid |
$7.12
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$6.89
|
| Rate for Payer: Health EOS Commercial |
$201.14
|
| Rate for Payer: HFN Commercial |
$207.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$25.63
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$6.89
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$7.12
|
| Rate for Payer: Independent Care Health Plan Medicare |
$6.89
|
| Rate for Payer: Managed Health Services Medicaid |
$7.40
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$6.89
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$6.89
|
| Rate for Payer: Multiplan Commercial |
$180.80
|
| Rate for Payer: NAPHCARE Commercial |
$10.34
|
| Rate for Payer: Preferred Network Access Commercial |
$207.92
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$7.12
|
| Rate for Payer: Quartz Beloit One Network |
$110.74
|
| Rate for Payer: Quartz Commercial |
$146.90
|
| Rate for Payer: Quartz Medicare Advantage |
$6.89
|
| Rate for Payer: The Alliance Commercial |
$27.56
|
| Rate for Payer: United Healthcare Medicaid |
$7.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6.89
|
| Rate for Payer: United Healthcare PPO |
$169.50
|
| Rate for Payer: WEA Trust Commercial |
$124.30
|
| Rate for Payer: Wellcare Medicare |
$6.89
|
| Rate for Payer: WMAP Medicaid |
$7.12
|
| Rate for Payer: WPS Commercial |
$167.40
|
|
|
Lipase Level
|
Facility
|
IP
|
$226.00
|
|
|
Service Code
|
CPT 83690
|
| Hospital Charge Code |
633776
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$110.74 |
| Max. Negotiated Rate |
$207.92 |
| Rate for Payer: Aetna Commercial |
$203.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$194.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$119.78
|
| Rate for Payer: Cash Price |
$67.80
|
| Rate for Payer: Cigna Commercial |
$207.92
|
| Rate for Payer: Health EOS Commercial |
$201.14
|
| Rate for Payer: HFN Commercial |
$207.92
|
| Rate for Payer: Multiplan Commercial |
$180.80
|
| Rate for Payer: NAPHCARE Commercial |
$135.60
|
| Rate for Payer: Preferred Network Access Commercial |
$207.92
|
| Rate for Payer: Quartz Beloit One Network |
$110.74
|
| Rate for Payer: Quartz Commercial |
$135.60
|
| Rate for Payer: WEA Trust Commercial |
$124.30
|
| Rate for Payer: WPS Commercial |
$167.40
|
|
|
Lipase, Pancreatic Fluid
|
Professional
|
Both
|
$31.00
|
|
|
Service Code
|
CPT 83690
|
| Hospital Charge Code |
3154878
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.64 |
| Max. Negotiated Rate |
$29.45 |
| Rate for Payer: Aetna Commercial |
$29.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$26.66
|
| Rate for Payer: Cash Price |
$9.30
|
| Rate for Payer: Cash Price |
$9.30
|
| Rate for Payer: Cigna Commercial |
$29.45
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$15.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$18.60
|
| Rate for Payer: Health EOS Commercial |
$28.21
|
| Rate for Payer: HFN Commercial |
$29.45
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$24.32
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$24.32
|
| Rate for Payer: Multiplan Commercial |
$24.80
|
| Rate for Payer: Preferred Network Access Commercial |
$29.45
|
| Rate for Payer: Quartz Beloit One Network |
$13.64
|
| Rate for Payer: Quartz Commercial |
$17.67
|
| Rate for Payer: The Alliance Commercial |
$15.50
|
| Rate for Payer: WEA Trust Commercial |
$17.05
|
| Rate for Payer: WPS Commercial |
$22.96
|
|
|
Lipase, Pancreatic Fluid
|
Facility
|
OP
|
$31.00
|
|
|
Service Code
|
CPT 83690
|
| Hospital Charge Code |
3154878
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.89 |
| Max. Negotiated Rate |
$28.52 |
| Rate for Payer: Aetna Commercial |
$27.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$26.66
|
| Rate for Payer: Aetna Managed Medicare |
$6.89
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$25.84
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$12.06
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$11.44
|
| Rate for Payer: Anthem Medicaid |
$7.12
|
| Rate for Payer: Anthem Medicare Advantage |
$6.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$16.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$6.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$6.89
|
| Rate for Payer: Cash Price |
$9.30
|
| Rate for Payer: Cash Price |
$9.30
|
| Rate for Payer: Cigna Commercial |
$28.52
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$6.89
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$7.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$17.35
|
| Rate for Payer: Dean Health Medicaid |
$7.12
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$6.89
|
| Rate for Payer: Health EOS Commercial |
$27.59
|
| Rate for Payer: HFN Commercial |
$28.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$25.63
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$6.89
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$7.12
|
| Rate for Payer: Independent Care Health Plan Medicare |
$6.89
|
| Rate for Payer: Managed Health Services Medicaid |
$7.40
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$6.89
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$6.89
|
| Rate for Payer: Multiplan Commercial |
$24.80
|
| Rate for Payer: NAPHCARE Commercial |
$10.34
|
| Rate for Payer: Preferred Network Access Commercial |
$28.52
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$7.12
|
| Rate for Payer: Quartz Beloit One Network |
$15.19
|
| Rate for Payer: Quartz Commercial |
$20.15
|
| Rate for Payer: Quartz Medicare Advantage |
$6.89
|
| Rate for Payer: The Alliance Commercial |
$27.56
|
| Rate for Payer: United Healthcare Medicaid |
$7.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6.89
|
| Rate for Payer: United Healthcare PPO |
$23.25
|
| Rate for Payer: WEA Trust Commercial |
$17.05
|
| Rate for Payer: Wellcare Medicare |
$6.89
|
| Rate for Payer: WMAP Medicaid |
$7.12
|
| Rate for Payer: WPS Commercial |
$22.96
|
|
|
Lipase, Pancreatic Fluid
|
Facility
|
IP
|
$31.00
|
|
|
Service Code
|
CPT 83690
|
| Hospital Charge Code |
3154878
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.19 |
| Max. Negotiated Rate |
$28.52 |
| Rate for Payer: Aetna Commercial |
$27.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$26.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$16.43
|
| Rate for Payer: Cash Price |
$9.30
|
| Rate for Payer: Cigna Commercial |
$28.52
|
| Rate for Payer: Health EOS Commercial |
$27.59
|
| Rate for Payer: HFN Commercial |
$28.52
|
| Rate for Payer: Multiplan Commercial |
$24.80
|
| Rate for Payer: NAPHCARE Commercial |
$18.60
|
| Rate for Payer: Preferred Network Access Commercial |
$28.52
|
| Rate for Payer: Quartz Beloit One Network |
$15.19
|
| Rate for Payer: Quartz Commercial |
$18.60
|
| Rate for Payer: WEA Trust Commercial |
$17.05
|
| Rate for Payer: WPS Commercial |
$22.96
|
|
|
Lipase, Peritoneal Fluid
|
Facility
|
IP
|
$31.00
|
|
|
Service Code
|
CPT 83690
|
| Hospital Charge Code |
3154880
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.19 |
| Max. Negotiated Rate |
$28.52 |
| Rate for Payer: Aetna Commercial |
$27.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$26.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$16.43
|
| Rate for Payer: Cash Price |
$9.30
|
| Rate for Payer: Cigna Commercial |
$28.52
|
| Rate for Payer: Health EOS Commercial |
$27.59
|
| Rate for Payer: HFN Commercial |
$28.52
|
| Rate for Payer: Multiplan Commercial |
$24.80
|
| Rate for Payer: NAPHCARE Commercial |
$18.60
|
| Rate for Payer: Preferred Network Access Commercial |
$28.52
|
| Rate for Payer: Quartz Beloit One Network |
$15.19
|
| Rate for Payer: Quartz Commercial |
$18.60
|
| Rate for Payer: WEA Trust Commercial |
$17.05
|
| Rate for Payer: WPS Commercial |
$22.96
|
|
|
Lipase, Peritoneal Fluid
|
Facility
|
OP
|
$31.00
|
|
|
Service Code
|
CPT 83690
|
| Hospital Charge Code |
3154880
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.89 |
| Max. Negotiated Rate |
$28.52 |
| Rate for Payer: Aetna Commercial |
$27.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$26.66
|
| Rate for Payer: Aetna Managed Medicare |
$6.89
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$25.84
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$12.06
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$11.44
|
| Rate for Payer: Anthem Medicaid |
$7.12
|
| Rate for Payer: Anthem Medicare Advantage |
$6.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$16.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$6.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$6.89
|
| Rate for Payer: Cash Price |
$9.30
|
| Rate for Payer: Cash Price |
$9.30
|
| Rate for Payer: Cigna Commercial |
$28.52
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$6.89
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$7.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$17.35
|
| Rate for Payer: Dean Health Medicaid |
$7.12
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$6.89
|
| Rate for Payer: Health EOS Commercial |
$27.59
|
| Rate for Payer: HFN Commercial |
$28.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$25.63
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$6.89
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$7.12
|
| Rate for Payer: Independent Care Health Plan Medicare |
$6.89
|
| Rate for Payer: Managed Health Services Medicaid |
$7.40
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$6.89
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$6.89
|
| Rate for Payer: Multiplan Commercial |
$24.80
|
| Rate for Payer: NAPHCARE Commercial |
$10.34
|
| Rate for Payer: Preferred Network Access Commercial |
$28.52
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$7.12
|
| Rate for Payer: Quartz Beloit One Network |
$15.19
|
| Rate for Payer: Quartz Commercial |
$20.15
|
| Rate for Payer: Quartz Medicare Advantage |
$6.89
|
| Rate for Payer: The Alliance Commercial |
$27.56
|
| Rate for Payer: United Healthcare Medicaid |
$7.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6.89
|
| Rate for Payer: United Healthcare PPO |
$23.25
|
| Rate for Payer: WEA Trust Commercial |
$17.05
|
| Rate for Payer: Wellcare Medicare |
$6.89
|
| Rate for Payer: WMAP Medicaid |
$7.12
|
| Rate for Payer: WPS Commercial |
$22.96
|
|
|
Lipase, Peritoneal Fluid
|
Professional
|
Both
|
$31.00
|
|
|
Service Code
|
CPT 83690
|
| Hospital Charge Code |
3154880
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.64 |
| Max. Negotiated Rate |
$29.45 |
| Rate for Payer: Aetna Commercial |
$29.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$26.66
|
| Rate for Payer: Cash Price |
$9.30
|
| Rate for Payer: Cash Price |
$9.30
|
| Rate for Payer: Cigna Commercial |
$29.45
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$15.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$18.60
|
| Rate for Payer: Health EOS Commercial |
$28.21
|
| Rate for Payer: HFN Commercial |
$29.45
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$24.32
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$24.32
|
| Rate for Payer: Multiplan Commercial |
$24.80
|
| Rate for Payer: Preferred Network Access Commercial |
$29.45
|
| Rate for Payer: Quartz Beloit One Network |
$13.64
|
| Rate for Payer: Quartz Commercial |
$17.67
|
| Rate for Payer: The Alliance Commercial |
$15.50
|
| Rate for Payer: WEA Trust Commercial |
$17.05
|
| Rate for Payer: WPS Commercial |
$22.96
|
|
|
Lipase, Pleural Fluid
|
Facility
|
OP
|
$31.00
|
|
|
Service Code
|
CPT 83690
|
| Hospital Charge Code |
3154879
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.89 |
| Max. Negotiated Rate |
$28.52 |
| Rate for Payer: Aetna Commercial |
$27.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$26.66
|
| Rate for Payer: Aetna Managed Medicare |
$6.89
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$25.84
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$12.06
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$11.44
|
| Rate for Payer: Anthem Medicaid |
$7.12
|
| Rate for Payer: Anthem Medicare Advantage |
$6.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$16.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$6.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$6.89
|
| Rate for Payer: Cash Price |
$9.30
|
| Rate for Payer: Cash Price |
$9.30
|
| Rate for Payer: Cigna Commercial |
$28.52
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$6.89
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$7.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$17.35
|
| Rate for Payer: Dean Health Medicaid |
$7.12
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$6.89
|
| Rate for Payer: Health EOS Commercial |
$27.59
|
| Rate for Payer: HFN Commercial |
$28.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$25.63
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$6.89
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$7.12
|
| Rate for Payer: Independent Care Health Plan Medicare |
$6.89
|
| Rate for Payer: Managed Health Services Medicaid |
$7.40
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$6.89
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$6.89
|
| Rate for Payer: Multiplan Commercial |
$24.80
|
| Rate for Payer: NAPHCARE Commercial |
$10.34
|
| Rate for Payer: Preferred Network Access Commercial |
$28.52
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$7.12
|
| Rate for Payer: Quartz Beloit One Network |
$15.19
|
| Rate for Payer: Quartz Commercial |
$20.15
|
| Rate for Payer: Quartz Medicare Advantage |
$6.89
|
| Rate for Payer: The Alliance Commercial |
$27.56
|
| Rate for Payer: United Healthcare Medicaid |
$7.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6.89
|
| Rate for Payer: United Healthcare PPO |
$23.25
|
| Rate for Payer: WEA Trust Commercial |
$17.05
|
| Rate for Payer: Wellcare Medicare |
$6.89
|
| Rate for Payer: WMAP Medicaid |
$7.12
|
| Rate for Payer: WPS Commercial |
$22.96
|
|
|
Lipase, Pleural Fluid
|
Facility
|
IP
|
$31.00
|
|
|
Service Code
|
CPT 83690
|
| Hospital Charge Code |
3154879
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.19 |
| Max. Negotiated Rate |
$28.52 |
| Rate for Payer: Aetna Commercial |
$27.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$26.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$16.43
|
| Rate for Payer: Cash Price |
$9.30
|
| Rate for Payer: Cigna Commercial |
$28.52
|
| Rate for Payer: Health EOS Commercial |
$27.59
|
| Rate for Payer: HFN Commercial |
$28.52
|
| Rate for Payer: Multiplan Commercial |
$24.80
|
| Rate for Payer: NAPHCARE Commercial |
$18.60
|
| Rate for Payer: Preferred Network Access Commercial |
$28.52
|
| Rate for Payer: Quartz Beloit One Network |
$15.19
|
| Rate for Payer: Quartz Commercial |
$18.60
|
| Rate for Payer: WEA Trust Commercial |
$17.05
|
| Rate for Payer: WPS Commercial |
$22.96
|
|
|
Lipase, Pleural Fluid
|
Professional
|
Both
|
$31.00
|
|
|
Service Code
|
CPT 83690
|
| Hospital Charge Code |
3154879
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.64 |
| Max. Negotiated Rate |
$29.45 |
| Rate for Payer: Aetna Commercial |
$29.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$26.66
|
| Rate for Payer: Cash Price |
$9.30
|
| Rate for Payer: Cash Price |
$9.30
|
| Rate for Payer: Cigna Commercial |
$29.45
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$15.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$18.60
|
| Rate for Payer: Health EOS Commercial |
$28.21
|
| Rate for Payer: HFN Commercial |
$29.45
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$24.32
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$24.32
|
| Rate for Payer: Multiplan Commercial |
$24.80
|
| Rate for Payer: Preferred Network Access Commercial |
$29.45
|
| Rate for Payer: Quartz Beloit One Network |
$13.64
|
| Rate for Payer: Quartz Commercial |
$17.67
|
| Rate for Payer: The Alliance Commercial |
$15.50
|
| Rate for Payer: WEA Trust Commercial |
$17.05
|
| Rate for Payer: WPS Commercial |
$22.96
|
|
|
Lipid Panel
|
Facility
|
OP
|
$315.00
|
|
|
Service Code
|
CPT 80061
|
| Hospital Charge Code |
633777
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.39 |
| Max. Negotiated Rate |
$289.80 |
| Rate for Payer: Aetna Commercial |
$283.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$270.90
|
| Rate for Payer: Aetna Managed Medicare |
$13.39
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$50.21
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$23.43
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$22.23
|
| Rate for Payer: Anthem Medicaid |
$13.84
|
| Rate for Payer: Anthem Medicare Advantage |
$13.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$166.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$13.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$13.39
|
| Rate for Payer: Cash Price |
$94.50
|
| Rate for Payer: Cash Price |
$94.50
|
| Rate for Payer: Cigna Commercial |
$289.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$13.39
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$13.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$176.27
|
| Rate for Payer: Dean Health Medicaid |
$13.84
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$13.39
|
| Rate for Payer: Health EOS Commercial |
$280.35
|
| Rate for Payer: HFN Commercial |
$289.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$49.81
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$13.39
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$13.84
|
| Rate for Payer: Independent Care Health Plan Medicare |
$13.39
|
| Rate for Payer: Managed Health Services Medicaid |
$14.39
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$13.39
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$13.39
|
| Rate for Payer: Multiplan Commercial |
$252.00
|
| Rate for Payer: NAPHCARE Commercial |
$20.08
|
| Rate for Payer: Preferred Network Access Commercial |
$289.80
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$13.84
|
| Rate for Payer: Quartz Beloit One Network |
$154.35
|
| Rate for Payer: Quartz Commercial |
$204.75
|
| Rate for Payer: Quartz Medicare Advantage |
$13.39
|
| Rate for Payer: The Alliance Commercial |
$53.56
|
| Rate for Payer: United Healthcare Medicaid |
$13.84
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.39
|
| Rate for Payer: United Healthcare PPO |
$236.25
|
| Rate for Payer: WEA Trust Commercial |
$173.25
|
| Rate for Payer: Wellcare Medicare |
$13.39
|
| Rate for Payer: WMAP Medicaid |
$13.84
|
| Rate for Payer: WPS Commercial |
$233.32
|
|
|
Lipid Panel
|
Professional
|
Both
|
$315.00
|
|
|
Service Code
|
CPT 80061
|
| Hospital Charge Code |
633777
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$47.27 |
| Max. Negotiated Rate |
$299.25 |
| Rate for Payer: Aetna Commercial |
$299.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$270.90
|
| Rate for Payer: Cash Price |
$94.50
|
| Rate for Payer: Cash Price |
$94.50
|
| Rate for Payer: Cigna Commercial |
$299.25
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$157.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$189.00
|
| Rate for Payer: Health EOS Commercial |
$286.65
|
| Rate for Payer: HFN Commercial |
$299.25
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$47.27
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$47.27
|
| Rate for Payer: Multiplan Commercial |
$252.00
|
| Rate for Payer: Preferred Network Access Commercial |
$299.25
|
| Rate for Payer: Quartz Beloit One Network |
$138.60
|
| Rate for Payer: Quartz Commercial |
$179.55
|
| Rate for Payer: The Alliance Commercial |
$157.50
|
| Rate for Payer: WEA Trust Commercial |
$173.25
|
| Rate for Payer: WPS Commercial |
$233.32
|
|
|
Lipid Panel
|
Facility
|
IP
|
$315.00
|
|
|
Service Code
|
CPT 80061
|
| Hospital Charge Code |
633777
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$154.35 |
| Max. Negotiated Rate |
$289.80 |
| Rate for Payer: Aetna Commercial |
$283.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$270.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$166.95
|
| Rate for Payer: Cash Price |
$94.50
|
| Rate for Payer: Cigna Commercial |
$289.80
|
| Rate for Payer: Health EOS Commercial |
$280.35
|
| Rate for Payer: HFN Commercial |
$289.80
|
| Rate for Payer: Multiplan Commercial |
$252.00
|
| Rate for Payer: NAPHCARE Commercial |
$189.00
|
| Rate for Payer: Preferred Network Access Commercial |
$289.80
|
| Rate for Payer: Quartz Beloit One Network |
$154.35
|
| Rate for Payer: Quartz Commercial |
$189.00
|
| Rate for Payer: WEA Trust Commercial |
$173.25
|
| Rate for Payer: WPS Commercial |
$233.32
|
|
|
Lipoprotein (a)
|
Professional
|
Both
|
$571.00
|
|
|
Service Code
|
CPT 83695
|
| Hospital Charge Code |
978009
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$50.55 |
| Max. Negotiated Rate |
$542.45 |
| Rate for Payer: Aetna Commercial |
$542.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$491.06
|
| Rate for Payer: Cash Price |
$171.30
|
| Rate for Payer: Cash Price |
$171.30
|
| Rate for Payer: Cigna Commercial |
$542.45
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$285.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$342.60
|
| Rate for Payer: Health EOS Commercial |
$519.61
|
| Rate for Payer: HFN Commercial |
$542.45
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$50.55
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$50.55
|
| Rate for Payer: Multiplan Commercial |
$456.80
|
| Rate for Payer: Preferred Network Access Commercial |
$542.45
|
| Rate for Payer: Quartz Beloit One Network |
$251.24
|
| Rate for Payer: Quartz Commercial |
$325.47
|
| Rate for Payer: The Alliance Commercial |
$285.50
|
| Rate for Payer: WEA Trust Commercial |
$314.05
|
| Rate for Payer: WPS Commercial |
$422.94
|
|
|
Lipoprotein (a)
|
Facility
|
OP
|
$571.00
|
|
|
Service Code
|
CPT 83695
|
| Hospital Charge Code |
978009
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.32 |
| Max. Negotiated Rate |
$525.32 |
| Rate for Payer: Aetna Commercial |
$513.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$491.06
|
| Rate for Payer: Aetna Managed Medicare |
$14.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$53.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$25.06
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$23.77
|
| Rate for Payer: Anthem Medicaid |
$14.80
|
| Rate for Payer: Anthem Medicare Advantage |
$14.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$302.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$14.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$14.32
|
| Rate for Payer: Cash Price |
$171.30
|
| Rate for Payer: Cash Price |
$171.30
|
| Rate for Payer: Cigna Commercial |
$525.32
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$14.32
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$14.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$319.53
|
| Rate for Payer: Dean Health Medicaid |
$14.80
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$14.32
|
| Rate for Payer: Health EOS Commercial |
$508.19
|
| Rate for Payer: HFN Commercial |
$525.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$53.27
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$14.32
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$14.80
|
| Rate for Payer: Independent Care Health Plan Medicare |
$14.32
|
| Rate for Payer: Managed Health Services Medicaid |
$15.39
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$14.32
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$14.32
|
| Rate for Payer: Multiplan Commercial |
$456.80
|
| Rate for Payer: NAPHCARE Commercial |
$21.48
|
| Rate for Payer: Preferred Network Access Commercial |
$525.32
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$14.80
|
| Rate for Payer: Quartz Beloit One Network |
$279.79
|
| Rate for Payer: Quartz Commercial |
$371.15
|
| Rate for Payer: Quartz Medicare Advantage |
$14.32
|
| Rate for Payer: The Alliance Commercial |
$57.28
|
| Rate for Payer: United Healthcare Medicaid |
$14.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14.32
|
| Rate for Payer: United Healthcare PPO |
$428.25
|
| Rate for Payer: WEA Trust Commercial |
$314.05
|
| Rate for Payer: Wellcare Medicare |
$14.32
|
| Rate for Payer: WMAP Medicaid |
$14.80
|
| Rate for Payer: WPS Commercial |
$422.94
|
|
|
Lipoprotein (a)
|
Facility
|
IP
|
$571.00
|
|
|
Service Code
|
CPT 83695
|
| Hospital Charge Code |
978009
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$279.79 |
| Max. Negotiated Rate |
$525.32 |
| Rate for Payer: Aetna Commercial |
$513.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$491.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$302.63
|
| Rate for Payer: Cash Price |
$171.30
|
| Rate for Payer: Cigna Commercial |
$525.32
|
| Rate for Payer: Health EOS Commercial |
$508.19
|
| Rate for Payer: HFN Commercial |
$525.32
|
| Rate for Payer: Multiplan Commercial |
$456.80
|
| Rate for Payer: NAPHCARE Commercial |
$342.60
|
| Rate for Payer: Preferred Network Access Commercial |
$525.32
|
| Rate for Payer: Quartz Beloit One Network |
$279.79
|
| Rate for Payer: Quartz Commercial |
$342.60
|
| Rate for Payer: WEA Trust Commercial |
$314.05
|
| Rate for Payer: WPS Commercial |
$422.94
|
|
|
Lipoprotein B
|
Facility
|
OP
|
$79.00
|
|
|
Service Code
|
CPT 80061
|
| Hospital Charge Code |
4566647
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.39 |
| Max. Negotiated Rate |
$72.68 |
| Rate for Payer: Aetna Commercial |
$71.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$67.94
|
| Rate for Payer: Aetna Managed Medicare |
$13.39
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$50.21
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$23.43
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$22.23
|
| Rate for Payer: Anthem Medicaid |
$13.84
|
| Rate for Payer: Anthem Medicare Advantage |
$13.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$41.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$13.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$13.39
|
| Rate for Payer: Cash Price |
$23.70
|
| Rate for Payer: Cash Price |
$23.70
|
| Rate for Payer: Cigna Commercial |
$72.68
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$13.39
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$13.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$44.21
|
| Rate for Payer: Dean Health Medicaid |
$13.84
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$13.39
|
| Rate for Payer: Health EOS Commercial |
$70.31
|
| Rate for Payer: HFN Commercial |
$72.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$49.81
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$13.39
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$13.84
|
| Rate for Payer: Independent Care Health Plan Medicare |
$13.39
|
| Rate for Payer: Managed Health Services Medicaid |
$14.39
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$13.39
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$13.39
|
| Rate for Payer: Multiplan Commercial |
$63.20
|
| Rate for Payer: NAPHCARE Commercial |
$20.08
|
| Rate for Payer: Preferred Network Access Commercial |
$72.68
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$13.84
|
| Rate for Payer: Quartz Beloit One Network |
$38.71
|
| Rate for Payer: Quartz Commercial |
$51.35
|
| Rate for Payer: Quartz Medicare Advantage |
$13.39
|
| Rate for Payer: The Alliance Commercial |
$53.56
|
| Rate for Payer: United Healthcare Medicaid |
$13.84
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.39
|
| Rate for Payer: United Healthcare PPO |
$59.25
|
| Rate for Payer: WEA Trust Commercial |
$43.45
|
| Rate for Payer: Wellcare Medicare |
$13.39
|
| Rate for Payer: WMAP Medicaid |
$13.84
|
| Rate for Payer: WPS Commercial |
$58.52
|
|
|
Lipoprotein B
|
Facility
|
IP
|
$79.00
|
|
|
Service Code
|
CPT 80061
|
| Hospital Charge Code |
4566647
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$38.71 |
| Max. Negotiated Rate |
$72.68 |
| Rate for Payer: Aetna Commercial |
$71.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$67.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$41.87
|
| Rate for Payer: Cash Price |
$23.70
|
| Rate for Payer: Cigna Commercial |
$72.68
|
| Rate for Payer: Health EOS Commercial |
$70.31
|
| Rate for Payer: HFN Commercial |
$72.68
|
| Rate for Payer: Multiplan Commercial |
$63.20
|
| Rate for Payer: NAPHCARE Commercial |
$47.40
|
| Rate for Payer: Preferred Network Access Commercial |
$72.68
|
| Rate for Payer: Quartz Beloit One Network |
$38.71
|
| Rate for Payer: Quartz Commercial |
$47.40
|
| Rate for Payer: WEA Trust Commercial |
$43.45
|
| Rate for Payer: WPS Commercial |
$58.52
|
|
|
Lipoprotein B
|
Professional
|
Both
|
$79.00
|
|
|
Service Code
|
CPT 80061
|
| Hospital Charge Code |
4566647
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$34.76 |
| Max. Negotiated Rate |
$75.05 |
| Rate for Payer: Aetna Commercial |
$75.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$67.94
|
| Rate for Payer: Cash Price |
$23.70
|
| Rate for Payer: Cash Price |
$23.70
|
| Rate for Payer: Cigna Commercial |
$75.05
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$39.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$47.40
|
| Rate for Payer: Health EOS Commercial |
$71.89
|
| Rate for Payer: HFN Commercial |
$75.05
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$47.27
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$47.27
|
| Rate for Payer: Multiplan Commercial |
$63.20
|
| Rate for Payer: Preferred Network Access Commercial |
$75.05
|
| Rate for Payer: Quartz Beloit One Network |
$34.76
|
| Rate for Payer: Quartz Commercial |
$45.03
|
| Rate for Payer: The Alliance Commercial |
$39.50
|
| Rate for Payer: WEA Trust Commercial |
$43.45
|
| Rate for Payer: WPS Commercial |
$58.52
|
|
|
Lipoprotein Electrophoresis
|
Facility
|
IP
|
$123.00
|
|
|
Service Code
|
CPT 82465
|
| Hospital Charge Code |
978010
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$60.27 |
| Max. Negotiated Rate |
$113.16 |
| Rate for Payer: Aetna Commercial |
$110.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$105.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$65.19
|
| Rate for Payer: Cash Price |
$36.90
|
| Rate for Payer: Cigna Commercial |
$113.16
|
| Rate for Payer: Health EOS Commercial |
$109.47
|
| Rate for Payer: HFN Commercial |
$113.16
|
| Rate for Payer: Multiplan Commercial |
$98.40
|
| Rate for Payer: NAPHCARE Commercial |
$73.80
|
| Rate for Payer: Preferred Network Access Commercial |
$113.16
|
| Rate for Payer: Quartz Beloit One Network |
$60.27
|
| Rate for Payer: Quartz Commercial |
$73.80
|
| Rate for Payer: WEA Trust Commercial |
$67.65
|
| Rate for Payer: WPS Commercial |
$91.11
|
|
|
Lipoprotein Electrophoresis
|
Facility
|
OP
|
$123.00
|
|
|
Service Code
|
CPT 82465
|
| Hospital Charge Code |
978010
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.35 |
| Max. Negotiated Rate |
$113.16 |
| Rate for Payer: Aetna Commercial |
$110.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$105.78
|
| Rate for Payer: Aetna Managed Medicare |
$4.35
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$16.31
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$7.61
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7.22
|
| Rate for Payer: Anthem Medicaid |
$4.49
|
| Rate for Payer: Anthem Medicare Advantage |
$4.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$65.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$4.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$4.35
|
| Rate for Payer: Cash Price |
$36.90
|
| Rate for Payer: Cash Price |
$36.90
|
| Rate for Payer: Cigna Commercial |
$113.16
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$4.35
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$4.49
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$68.83
|
| Rate for Payer: Dean Health Medicaid |
$4.49
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$4.35
|
| Rate for Payer: Health EOS Commercial |
$109.47
|
| Rate for Payer: HFN Commercial |
$113.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$16.18
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$4.35
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$4.49
|
| Rate for Payer: Independent Care Health Plan Medicare |
$4.35
|
| Rate for Payer: Managed Health Services Medicaid |
$4.67
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$4.35
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$4.35
|
| Rate for Payer: Multiplan Commercial |
$98.40
|
| Rate for Payer: NAPHCARE Commercial |
$6.52
|
| Rate for Payer: Preferred Network Access Commercial |
$113.16
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$4.49
|
| Rate for Payer: Quartz Beloit One Network |
$60.27
|
| Rate for Payer: Quartz Commercial |
$79.95
|
| Rate for Payer: Quartz Medicare Advantage |
$4.35
|
| Rate for Payer: The Alliance Commercial |
$17.40
|
| Rate for Payer: United Healthcare Medicaid |
$4.49
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4.35
|
| Rate for Payer: United Healthcare PPO |
$92.25
|
| Rate for Payer: WEA Trust Commercial |
$67.65
|
| Rate for Payer: Wellcare Medicare |
$4.35
|
| Rate for Payer: WMAP Medicaid |
$4.49
|
| Rate for Payer: WPS Commercial |
$91.11
|
|
