|
LINER LONGEVITY 46X28 10 DEG 6310-46-28
|
Facility
|
IP
|
$1,212.00
|
|
| Hospital Charge Code |
2967724
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$617.64 |
| Max. Negotiated Rate |
$1,159.64 |
| Rate for Payer: Aetna Commercial |
$1,134.43
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,084.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$668.05
|
| Rate for Payer: Cash Price |
$363.60
|
| Rate for Payer: Cigna Commercial |
$1,159.64
|
| Rate for Payer: Health EOS Commercial |
$1,121.83
|
| Rate for Payer: HFN Commercial |
$1,159.64
|
| Rate for Payer: Multiplan Commercial |
$1,008.38
|
| Rate for Payer: Preferred Network Access Commercial |
$1,159.64
|
| Rate for Payer: Quartz Beloit One Network |
$617.64
|
| Rate for Payer: Quartz Commercial |
$756.29
|
| Rate for Payer: WEA Trust Commercial |
$693.26
|
| Rate for Payer: WPS Commercial |
$933.60
|
|
|
LINER LONGEVITY 46X28 10 DEG 6310-46-28
|
Facility
|
OP
|
$1,212.00
|
|
| Hospital Charge Code |
2967724
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$352.93 |
| Max. Negotiated Rate |
$1,159.64 |
| Rate for Payer: Aetna Commercial |
$1,134.43
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,084.01
|
| Rate for Payer: Aetna Managed Medicare |
$352.93
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$819.31
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$630.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$605.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$668.05
|
| Rate for Payer: Cash Price |
$363.60
|
| Rate for Payer: Cigna Commercial |
$1,159.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$705.38
|
| Rate for Payer: Health EOS Commercial |
$1,121.83
|
| Rate for Payer: HFN Commercial |
$1,159.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$945.36
|
| Rate for Payer: Multiplan Commercial |
$1,008.38
|
| Rate for Payer: NAPHCARE Commercial |
$756.29
|
| Rate for Payer: Preferred Network Access Commercial |
$1,159.64
|
| Rate for Payer: Quartz Beloit One Network |
$617.64
|
| Rate for Payer: Quartz Commercial |
$819.31
|
| Rate for Payer: Quartz Medicare Advantage |
$756.29
|
| Rate for Payer: The Alliance Commercial |
$630.24
|
| Rate for Payer: WEA Trust Commercial |
$693.26
|
| Rate for Payer: WPS Commercial |
$933.60
|
|
|
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 |
$903.88 |
| Max. Negotiated Rate |
$2,969.91 |
| Rate for Payer: Aetna Commercial |
$2,905.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,776.22
|
| Rate for Payer: Aetna Managed Medicare |
$903.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,098.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,614.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,549.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,710.92
|
| Rate for Payer: Cash Price |
$931.20
|
| Rate for Payer: Cigna Commercial |
$2,969.91
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,806.53
|
| Rate for Payer: Health EOS Commercial |
$2,873.06
|
| Rate for Payer: HFN Commercial |
$2,969.91
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,421.12
|
| Rate for Payer: Multiplan Commercial |
$2,582.53
|
| Rate for Payer: NAPHCARE Commercial |
$1,936.90
|
| Rate for Payer: Preferred Network Access Commercial |
$2,969.91
|
| Rate for Payer: Quartz Beloit One Network |
$1,581.80
|
| Rate for Payer: Quartz Commercial |
$2,098.30
|
| Rate for Payer: Quartz Medicare Advantage |
$1,936.90
|
| Rate for Payer: The Alliance Commercial |
$1,614.08
|
| Rate for Payer: WEA Trust Commercial |
$1,775.49
|
| Rate for Payer: WPS Commercial |
$2,391.01
|
|
|
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 |
$1,581.80 |
| Max. Negotiated Rate |
$2,969.91 |
| Rate for Payer: Aetna Commercial |
$2,905.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,776.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,710.92
|
| Rate for Payer: Cash Price |
$931.20
|
| Rate for Payer: Cigna Commercial |
$2,969.91
|
| Rate for Payer: Health EOS Commercial |
$2,873.06
|
| Rate for Payer: HFN Commercial |
$2,969.91
|
| Rate for Payer: Multiplan Commercial |
$2,582.53
|
| Rate for Payer: Preferred Network Access Commercial |
$2,969.91
|
| Rate for Payer: Quartz Beloit One Network |
$1,581.80
|
| Rate for Payer: Quartz Commercial |
$1,936.90
|
| Rate for Payer: WEA Trust Commercial |
$1,775.49
|
| Rate for Payer: WPS Commercial |
$2,391.01
|
|
|
Lipase Level
|
Facility
|
IP
|
$226.00
|
|
|
Service Code
|
CPT 83690
|
| Hospital Charge Code |
633776
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$115.17 |
| Max. Negotiated Rate |
$216.24 |
| Rate for Payer: Aetna Commercial |
$211.54
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$202.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$124.57
|
| Rate for Payer: Cash Price |
$67.80
|
| Rate for Payer: Cigna Commercial |
$216.24
|
| Rate for Payer: Health EOS Commercial |
$209.19
|
| Rate for Payer: HFN Commercial |
$216.24
|
| Rate for Payer: Multiplan Commercial |
$188.03
|
| Rate for Payer: Preferred Network Access Commercial |
$216.24
|
| Rate for Payer: Quartz Beloit One Network |
$115.17
|
| Rate for Payer: Quartz Commercial |
$141.02
|
| Rate for Payer: WEA Trust Commercial |
$129.27
|
| Rate for Payer: WPS Commercial |
$174.09
|
|
|
Lipase Level
|
Facility
|
OP
|
$226.00
|
|
|
Service Code
|
CPT 83690
|
| Hospital Charge Code |
633776
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$7.17 |
| Max. Negotiated Rate |
$216.24 |
| Rate for Payer: Aetna Commercial |
$211.54
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$202.13
|
| Rate for Payer: Aetna Managed Medicare |
$7.17
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$26.87
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$12.54
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$11.89
|
| Rate for Payer: Anthem Medicare Advantage |
$7.17
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$124.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$7.17
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$7.17
|
| Rate for Payer: Cash Price |
$67.80
|
| Rate for Payer: Cash Price |
$67.80
|
| Rate for Payer: Cigna Commercial |
$216.24
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$7.17
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$131.53
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$7.17
|
| Rate for Payer: Health EOS Commercial |
$209.19
|
| Rate for Payer: HFN Commercial |
$216.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$26.66
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$7.17
|
| Rate for Payer: Independent Care Health Plan Medicare |
$7.17
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$7.17
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$7.17
|
| Rate for Payer: Multiplan Commercial |
$188.03
|
| Rate for Payer: NAPHCARE Commercial |
$10.75
|
| Rate for Payer: Preferred Network Access Commercial |
$216.24
|
| Rate for Payer: Quartz Beloit One Network |
$115.17
|
| Rate for Payer: Quartz Commercial |
$152.78
|
| Rate for Payer: Quartz Medicare Advantage |
$7.17
|
| Rate for Payer: The Alliance Commercial |
$28.66
|
| Rate for Payer: United Healthcare Medicare Advantage |
$7.17
|
| Rate for Payer: United Healthcare PPO |
$176.28
|
| Rate for Payer: WEA Trust Commercial |
$129.27
|
| Rate for Payer: Wellcare Medicare |
$7.17
|
| Rate for Payer: WPS Commercial |
$174.09
|
|
|
Lipase Level
|
Professional
|
Both
|
$226.00
|
|
|
Service Code
|
CPT 83690
|
| Hospital Charge Code |
633776
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$7.17 |
| Max. Negotiated Rate |
$223.29 |
| Rate for Payer: Aetna Commercial |
$223.29
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$202.13
|
| Rate for Payer: Aetna Managed Medicare |
$7.17
|
| Rate for Payer: Anthem Medicare Advantage |
$7.17
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$7.17
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$7.17
|
| Rate for Payer: Cash Price |
$67.80
|
| Rate for Payer: Cash Price |
$67.80
|
| Rate for Payer: Cigna Commercial |
$223.29
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$117.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$7.17
|
| Rate for Payer: Health EOS Commercial |
$213.89
|
| Rate for Payer: HFN Commercial |
$223.29
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$25.29
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$25.29
|
| Rate for Payer: Independent Care Health Plan Medicare |
$7.17
|
| Rate for Payer: Multiplan Commercial |
$188.03
|
| Rate for Payer: NAPHCARE Commercial |
$10.75
|
| Rate for Payer: Preferred Network Access Commercial |
$223.29
|
| Rate for Payer: Quartz Beloit One Network |
$103.42
|
| Rate for Payer: Quartz Commercial |
$133.97
|
| Rate for Payer: Quartz Medicare Advantage |
$7.17
|
| Rate for Payer: The Alliance Commercial |
$28.30
|
| Rate for Payer: United Healthcare Medicare Advantage |
$7.17
|
| Rate for Payer: WEA Trust Commercial |
$129.27
|
| Rate for Payer: WPS Commercial |
$31.53
|
|
|
Lipase, Pancreatic Fluid
|
Professional
|
Both
|
$31.00
|
|
|
Service Code
|
CPT 83690
|
| Hospital Charge Code |
3154878
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$7.17 |
| Max. Negotiated Rate |
$31.53 |
| Rate for Payer: Aetna Commercial |
$30.63
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$27.73
|
| Rate for Payer: Aetna Managed Medicare |
$7.17
|
| Rate for Payer: Anthem Medicare Advantage |
$7.17
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$7.17
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$7.17
|
| Rate for Payer: Cash Price |
$9.30
|
| Rate for Payer: Cash Price |
$9.30
|
| Rate for Payer: Cigna Commercial |
$30.63
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$16.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$7.17
|
| Rate for Payer: Health EOS Commercial |
$29.34
|
| Rate for Payer: HFN Commercial |
$30.63
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$25.29
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$25.29
|
| Rate for Payer: Independent Care Health Plan Medicare |
$7.17
|
| Rate for Payer: Multiplan Commercial |
$25.79
|
| Rate for Payer: NAPHCARE Commercial |
$10.75
|
| Rate for Payer: Preferred Network Access Commercial |
$30.63
|
| Rate for Payer: Quartz Beloit One Network |
$14.19
|
| Rate for Payer: Quartz Commercial |
$18.38
|
| Rate for Payer: Quartz Medicare Advantage |
$7.17
|
| Rate for Payer: The Alliance Commercial |
$28.30
|
| Rate for Payer: United Healthcare Medicare Advantage |
$7.17
|
| Rate for Payer: WEA Trust Commercial |
$17.73
|
| Rate for Payer: WPS Commercial |
$31.53
|
|
|
Lipase, Pancreatic Fluid
|
Facility
|
IP
|
$31.00
|
|
|
Service Code
|
CPT 83690
|
| Hospital Charge Code |
3154878
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.80 |
| Max. Negotiated Rate |
$29.66 |
| Rate for Payer: Aetna Commercial |
$29.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$27.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$17.09
|
| Rate for Payer: Cash Price |
$9.30
|
| Rate for Payer: Cigna Commercial |
$29.66
|
| Rate for Payer: Health EOS Commercial |
$28.69
|
| Rate for Payer: HFN Commercial |
$29.66
|
| Rate for Payer: Multiplan Commercial |
$25.79
|
| Rate for Payer: Preferred Network Access Commercial |
$29.66
|
| Rate for Payer: Quartz Beloit One Network |
$15.80
|
| Rate for Payer: Quartz Commercial |
$19.34
|
| Rate for Payer: WEA Trust Commercial |
$17.73
|
| Rate for Payer: WPS Commercial |
$23.88
|
|
|
Lipase, Pancreatic Fluid
|
Facility
|
OP
|
$31.00
|
|
|
Service Code
|
CPT 83690
|
| Hospital Charge Code |
3154878
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$7.17 |
| Max. Negotiated Rate |
$29.66 |
| Rate for Payer: Aetna Commercial |
$29.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$27.73
|
| Rate for Payer: Aetna Managed Medicare |
$7.17
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$26.87
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$12.54
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$11.89
|
| Rate for Payer: Anthem Medicare Advantage |
$7.17
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$17.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$7.17
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$7.17
|
| Rate for Payer: Cash Price |
$9.30
|
| Rate for Payer: Cash Price |
$9.30
|
| Rate for Payer: Cigna Commercial |
$29.66
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$7.17
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$18.04
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$7.17
|
| Rate for Payer: Health EOS Commercial |
$28.69
|
| Rate for Payer: HFN Commercial |
$29.66
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$26.66
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$7.17
|
| Rate for Payer: Independent Care Health Plan Medicare |
$7.17
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$7.17
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$7.17
|
| Rate for Payer: Multiplan Commercial |
$25.79
|
| Rate for Payer: NAPHCARE Commercial |
$10.75
|
| Rate for Payer: Preferred Network Access Commercial |
$29.66
|
| Rate for Payer: Quartz Beloit One Network |
$15.80
|
| Rate for Payer: Quartz Commercial |
$20.96
|
| Rate for Payer: Quartz Medicare Advantage |
$7.17
|
| Rate for Payer: The Alliance Commercial |
$28.66
|
| Rate for Payer: United Healthcare Medicare Advantage |
$7.17
|
| Rate for Payer: United Healthcare PPO |
$24.18
|
| Rate for Payer: WEA Trust Commercial |
$17.73
|
| Rate for Payer: Wellcare Medicare |
$7.17
|
| Rate for Payer: WPS Commercial |
$23.88
|
|
|
Lipase, Peritoneal Fluid
|
Facility
|
IP
|
$31.00
|
|
|
Service Code
|
CPT 83690
|
| Hospital Charge Code |
3154880
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.80 |
| Max. Negotiated Rate |
$29.66 |
| Rate for Payer: Aetna Commercial |
$29.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$27.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$17.09
|
| Rate for Payer: Cash Price |
$9.30
|
| Rate for Payer: Cigna Commercial |
$29.66
|
| Rate for Payer: Health EOS Commercial |
$28.69
|
| Rate for Payer: HFN Commercial |
$29.66
|
| Rate for Payer: Multiplan Commercial |
$25.79
|
| Rate for Payer: Preferred Network Access Commercial |
$29.66
|
| Rate for Payer: Quartz Beloit One Network |
$15.80
|
| Rate for Payer: Quartz Commercial |
$19.34
|
| Rate for Payer: WEA Trust Commercial |
$17.73
|
| Rate for Payer: WPS Commercial |
$23.88
|
|
|
Lipase, Peritoneal Fluid
|
Facility
|
OP
|
$31.00
|
|
|
Service Code
|
CPT 83690
|
| Hospital Charge Code |
3154880
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$7.17 |
| Max. Negotiated Rate |
$29.66 |
| Rate for Payer: Aetna Commercial |
$29.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$27.73
|
| Rate for Payer: Aetna Managed Medicare |
$7.17
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$26.87
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$12.54
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$11.89
|
| Rate for Payer: Anthem Medicare Advantage |
$7.17
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$17.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$7.17
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$7.17
|
| Rate for Payer: Cash Price |
$9.30
|
| Rate for Payer: Cash Price |
$9.30
|
| Rate for Payer: Cigna Commercial |
$29.66
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$7.17
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$18.04
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$7.17
|
| Rate for Payer: Health EOS Commercial |
$28.69
|
| Rate for Payer: HFN Commercial |
$29.66
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$26.66
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$7.17
|
| Rate for Payer: Independent Care Health Plan Medicare |
$7.17
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$7.17
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$7.17
|
| Rate for Payer: Multiplan Commercial |
$25.79
|
| Rate for Payer: NAPHCARE Commercial |
$10.75
|
| Rate for Payer: Preferred Network Access Commercial |
$29.66
|
| Rate for Payer: Quartz Beloit One Network |
$15.80
|
| Rate for Payer: Quartz Commercial |
$20.96
|
| Rate for Payer: Quartz Medicare Advantage |
$7.17
|
| Rate for Payer: The Alliance Commercial |
$28.66
|
| Rate for Payer: United Healthcare Medicare Advantage |
$7.17
|
| Rate for Payer: United Healthcare PPO |
$24.18
|
| Rate for Payer: WEA Trust Commercial |
$17.73
|
| Rate for Payer: Wellcare Medicare |
$7.17
|
| Rate for Payer: WPS Commercial |
$23.88
|
|
|
Lipase, Peritoneal Fluid
|
Professional
|
Both
|
$31.00
|
|
|
Service Code
|
CPT 83690
|
| Hospital Charge Code |
3154880
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$7.17 |
| Max. Negotiated Rate |
$31.53 |
| Rate for Payer: Aetna Commercial |
$30.63
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$27.73
|
| Rate for Payer: Aetna Managed Medicare |
$7.17
|
| Rate for Payer: Anthem Medicare Advantage |
$7.17
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$7.17
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$7.17
|
| Rate for Payer: Cash Price |
$9.30
|
| Rate for Payer: Cash Price |
$9.30
|
| Rate for Payer: Cigna Commercial |
$30.63
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$16.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$7.17
|
| Rate for Payer: Health EOS Commercial |
$29.34
|
| Rate for Payer: HFN Commercial |
$30.63
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$25.29
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$25.29
|
| Rate for Payer: Independent Care Health Plan Medicare |
$7.17
|
| Rate for Payer: Multiplan Commercial |
$25.79
|
| Rate for Payer: NAPHCARE Commercial |
$10.75
|
| Rate for Payer: Preferred Network Access Commercial |
$30.63
|
| Rate for Payer: Quartz Beloit One Network |
$14.19
|
| Rate for Payer: Quartz Commercial |
$18.38
|
| Rate for Payer: Quartz Medicare Advantage |
$7.17
|
| Rate for Payer: The Alliance Commercial |
$28.30
|
| Rate for Payer: United Healthcare Medicare Advantage |
$7.17
|
| Rate for Payer: WEA Trust Commercial |
$17.73
|
| Rate for Payer: WPS Commercial |
$31.53
|
|
|
Lipase, Pleural Fluid
|
Professional
|
Both
|
$31.00
|
|
|
Service Code
|
CPT 83690
|
| Hospital Charge Code |
3154879
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$7.17 |
| Max. Negotiated Rate |
$31.53 |
| Rate for Payer: Aetna Commercial |
$30.63
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$27.73
|
| Rate for Payer: Aetna Managed Medicare |
$7.17
|
| Rate for Payer: Anthem Medicare Advantage |
$7.17
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$7.17
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$7.17
|
| Rate for Payer: Cash Price |
$9.30
|
| Rate for Payer: Cash Price |
$9.30
|
| Rate for Payer: Cigna Commercial |
$30.63
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$16.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$7.17
|
| Rate for Payer: Health EOS Commercial |
$29.34
|
| Rate for Payer: HFN Commercial |
$30.63
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$25.29
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$25.29
|
| Rate for Payer: Independent Care Health Plan Medicare |
$7.17
|
| Rate for Payer: Multiplan Commercial |
$25.79
|
| Rate for Payer: NAPHCARE Commercial |
$10.75
|
| Rate for Payer: Preferred Network Access Commercial |
$30.63
|
| Rate for Payer: Quartz Beloit One Network |
$14.19
|
| Rate for Payer: Quartz Commercial |
$18.38
|
| Rate for Payer: Quartz Medicare Advantage |
$7.17
|
| Rate for Payer: The Alliance Commercial |
$28.30
|
| Rate for Payer: United Healthcare Medicare Advantage |
$7.17
|
| Rate for Payer: WEA Trust Commercial |
$17.73
|
| Rate for Payer: WPS Commercial |
$31.53
|
|
|
Lipase, Pleural Fluid
|
Facility
|
OP
|
$31.00
|
|
|
Service Code
|
CPT 83690
|
| Hospital Charge Code |
3154879
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$7.17 |
| Max. Negotiated Rate |
$29.66 |
| Rate for Payer: Aetna Commercial |
$29.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$27.73
|
| Rate for Payer: Aetna Managed Medicare |
$7.17
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$26.87
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$12.54
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$11.89
|
| Rate for Payer: Anthem Medicare Advantage |
$7.17
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$17.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$7.17
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$7.17
|
| Rate for Payer: Cash Price |
$9.30
|
| Rate for Payer: Cash Price |
$9.30
|
| Rate for Payer: Cigna Commercial |
$29.66
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$7.17
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$18.04
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$7.17
|
| Rate for Payer: Health EOS Commercial |
$28.69
|
| Rate for Payer: HFN Commercial |
$29.66
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$26.66
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$7.17
|
| Rate for Payer: Independent Care Health Plan Medicare |
$7.17
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$7.17
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$7.17
|
| Rate for Payer: Multiplan Commercial |
$25.79
|
| Rate for Payer: NAPHCARE Commercial |
$10.75
|
| Rate for Payer: Preferred Network Access Commercial |
$29.66
|
| Rate for Payer: Quartz Beloit One Network |
$15.80
|
| Rate for Payer: Quartz Commercial |
$20.96
|
| Rate for Payer: Quartz Medicare Advantage |
$7.17
|
| Rate for Payer: The Alliance Commercial |
$28.66
|
| Rate for Payer: United Healthcare Medicare Advantage |
$7.17
|
| Rate for Payer: United Healthcare PPO |
$24.18
|
| Rate for Payer: WEA Trust Commercial |
$17.73
|
| Rate for Payer: Wellcare Medicare |
$7.17
|
| Rate for Payer: WPS Commercial |
$23.88
|
|
|
Lipase, Pleural Fluid
|
Facility
|
IP
|
$31.00
|
|
|
Service Code
|
CPT 83690
|
| Hospital Charge Code |
3154879
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.80 |
| Max. Negotiated Rate |
$29.66 |
| Rate for Payer: Aetna Commercial |
$29.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$27.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$17.09
|
| Rate for Payer: Cash Price |
$9.30
|
| Rate for Payer: Cigna Commercial |
$29.66
|
| Rate for Payer: Health EOS Commercial |
$28.69
|
| Rate for Payer: HFN Commercial |
$29.66
|
| Rate for Payer: Multiplan Commercial |
$25.79
|
| Rate for Payer: Preferred Network Access Commercial |
$29.66
|
| Rate for Payer: Quartz Beloit One Network |
$15.80
|
| Rate for Payer: Quartz Commercial |
$19.34
|
| Rate for Payer: WEA Trust Commercial |
$17.73
|
| Rate for Payer: WPS Commercial |
$23.88
|
|
|
Lipid Panel
|
Facility
|
OP
|
$315.00
|
|
|
Service Code
|
CPT 80061
|
| Hospital Charge Code |
633777
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.93 |
| Max. Negotiated Rate |
$301.39 |
| Rate for Payer: Aetna Commercial |
$294.84
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$281.74
|
| Rate for Payer: Aetna Managed Medicare |
$13.93
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$52.22
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$24.37
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$23.12
|
| Rate for Payer: Anthem Medicare Advantage |
$13.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$173.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$13.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$13.93
|
| Rate for Payer: Cash Price |
$94.50
|
| Rate for Payer: Cash Price |
$94.50
|
| Rate for Payer: Cigna Commercial |
$301.39
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$13.93
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$183.33
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$13.93
|
| Rate for Payer: Health EOS Commercial |
$291.56
|
| Rate for Payer: HFN Commercial |
$301.39
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$51.80
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$13.93
|
| Rate for Payer: Independent Care Health Plan Medicare |
$13.93
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$13.93
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$13.93
|
| Rate for Payer: Multiplan Commercial |
$262.08
|
| Rate for Payer: NAPHCARE Commercial |
$20.89
|
| Rate for Payer: Preferred Network Access Commercial |
$301.39
|
| Rate for Payer: Quartz Beloit One Network |
$160.52
|
| Rate for Payer: Quartz Commercial |
$212.94
|
| Rate for Payer: Quartz Medicare Advantage |
$13.93
|
| Rate for Payer: The Alliance Commercial |
$55.70
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.93
|
| Rate for Payer: United Healthcare PPO |
$245.70
|
| Rate for Payer: WEA Trust Commercial |
$180.18
|
| Rate for Payer: Wellcare Medicare |
$13.93
|
| Rate for Payer: WPS Commercial |
$242.64
|
|
|
Lipid Panel
|
Facility
|
IP
|
$315.00
|
|
|
Service Code
|
CPT 80061
|
| Hospital Charge Code |
633777
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$160.52 |
| Max. Negotiated Rate |
$301.39 |
| Rate for Payer: Aetna Commercial |
$294.84
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$281.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$173.63
|
| Rate for Payer: Cash Price |
$94.50
|
| Rate for Payer: Cigna Commercial |
$301.39
|
| Rate for Payer: Health EOS Commercial |
$291.56
|
| Rate for Payer: HFN Commercial |
$301.39
|
| Rate for Payer: Multiplan Commercial |
$262.08
|
| Rate for Payer: Preferred Network Access Commercial |
$301.39
|
| Rate for Payer: Quartz Beloit One Network |
$160.52
|
| Rate for Payer: Quartz Commercial |
$196.56
|
| Rate for Payer: WEA Trust Commercial |
$180.18
|
| Rate for Payer: WPS Commercial |
$242.64
|
|
|
Lipid Panel
|
Professional
|
Both
|
$315.00
|
|
|
Service Code
|
CPT 80061
|
| Hospital Charge Code |
633777
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.93 |
| Max. Negotiated Rate |
$311.22 |
| Rate for Payer: Aetna Commercial |
$311.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$281.74
|
| Rate for Payer: Aetna Managed Medicare |
$13.93
|
| Rate for Payer: Anthem Medicare Advantage |
$13.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$13.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$13.93
|
| Rate for Payer: Cash Price |
$94.50
|
| Rate for Payer: Cash Price |
$94.50
|
| Rate for Payer: Cigna Commercial |
$311.22
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$163.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$13.93
|
| Rate for Payer: Health EOS Commercial |
$298.12
|
| Rate for Payer: HFN Commercial |
$311.22
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$49.16
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$49.16
|
| Rate for Payer: Independent Care Health Plan Medicare |
$13.93
|
| Rate for Payer: Multiplan Commercial |
$262.08
|
| Rate for Payer: NAPHCARE Commercial |
$20.89
|
| Rate for Payer: Preferred Network Access Commercial |
$311.22
|
| Rate for Payer: Quartz Beloit One Network |
$144.14
|
| Rate for Payer: Quartz Commercial |
$186.73
|
| Rate for Payer: Quartz Medicare Advantage |
$13.93
|
| Rate for Payer: The Alliance Commercial |
$55.01
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.93
|
| Rate for Payer: WEA Trust Commercial |
$180.18
|
| Rate for Payer: WPS Commercial |
$61.27
|
|
|
Lipoprotein (a)
|
Facility
|
IP
|
$571.00
|
|
|
Service Code
|
CPT 83695
|
| Hospital Charge Code |
978009
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$290.98 |
| Max. Negotiated Rate |
$546.33 |
| Rate for Payer: Aetna Commercial |
$534.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$510.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$314.74
|
| Rate for Payer: Cash Price |
$171.30
|
| Rate for Payer: Cigna Commercial |
$546.33
|
| Rate for Payer: Health EOS Commercial |
$528.52
|
| Rate for Payer: HFN Commercial |
$546.33
|
| Rate for Payer: Multiplan Commercial |
$475.07
|
| Rate for Payer: Preferred Network Access Commercial |
$546.33
|
| Rate for Payer: Quartz Beloit One Network |
$290.98
|
| Rate for Payer: Quartz Commercial |
$356.30
|
| Rate for Payer: WEA Trust Commercial |
$326.61
|
| Rate for Payer: WPS Commercial |
$439.84
|
|
|
Lipoprotein (a)
|
Professional
|
Both
|
$571.00
|
|
|
Service Code
|
CPT 83695
|
| Hospital Charge Code |
978009
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.89 |
| Max. Negotiated Rate |
$564.15 |
| Rate for Payer: Aetna Commercial |
$564.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$510.70
|
| Rate for Payer: Aetna Managed Medicare |
$14.89
|
| Rate for Payer: Anthem Medicare Advantage |
$14.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$14.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$14.89
|
| Rate for Payer: Cash Price |
$171.30
|
| Rate for Payer: Cash Price |
$171.30
|
| Rate for Payer: Cigna Commercial |
$564.15
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$296.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$14.89
|
| Rate for Payer: Health EOS Commercial |
$540.39
|
| Rate for Payer: HFN Commercial |
$564.15
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$52.57
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$52.57
|
| Rate for Payer: Independent Care Health Plan Medicare |
$14.89
|
| Rate for Payer: Multiplan Commercial |
$475.07
|
| Rate for Payer: NAPHCARE Commercial |
$22.34
|
| Rate for Payer: Preferred Network Access Commercial |
$564.15
|
| Rate for Payer: Quartz Beloit One Network |
$261.29
|
| Rate for Payer: Quartz Commercial |
$338.49
|
| Rate for Payer: Quartz Medicare Advantage |
$14.89
|
| Rate for Payer: The Alliance Commercial |
$58.83
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14.89
|
| Rate for Payer: WEA Trust Commercial |
$326.61
|
| Rate for Payer: WPS Commercial |
$65.53
|
|
|
Lipoprotein (a)
|
Facility
|
OP
|
$571.00
|
|
|
Service Code
|
CPT 83695
|
| Hospital Charge Code |
978009
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.89 |
| Max. Negotiated Rate |
$546.33 |
| Rate for Payer: Aetna Commercial |
$534.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$510.70
|
| Rate for Payer: Aetna Managed Medicare |
$14.89
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$55.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$26.06
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$24.72
|
| Rate for Payer: Anthem Medicare Advantage |
$14.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$314.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$14.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$14.89
|
| Rate for Payer: Cash Price |
$171.30
|
| Rate for Payer: Cash Price |
$171.30
|
| Rate for Payer: Cigna Commercial |
$546.33
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$14.89
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$332.32
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$14.89
|
| Rate for Payer: Health EOS Commercial |
$528.52
|
| Rate for Payer: HFN Commercial |
$546.33
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$55.40
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$14.89
|
| Rate for Payer: Independent Care Health Plan Medicare |
$14.89
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$14.89
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$14.89
|
| Rate for Payer: Multiplan Commercial |
$475.07
|
| Rate for Payer: NAPHCARE Commercial |
$22.34
|
| Rate for Payer: Preferred Network Access Commercial |
$546.33
|
| Rate for Payer: Quartz Beloit One Network |
$290.98
|
| Rate for Payer: Quartz Commercial |
$386.00
|
| Rate for Payer: Quartz Medicare Advantage |
$14.89
|
| Rate for Payer: The Alliance Commercial |
$59.57
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14.89
|
| Rate for Payer: United Healthcare PPO |
$445.38
|
| Rate for Payer: WEA Trust Commercial |
$326.61
|
| Rate for Payer: Wellcare Medicare |
$14.89
|
| Rate for Payer: WPS Commercial |
$439.84
|
|
|
Lipoprotein B
|
Facility
|
IP
|
$79.00
|
|
|
Service Code
|
CPT 80061
|
| Hospital Charge Code |
4566647
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$40.26 |
| Max. Negotiated Rate |
$75.59 |
| Rate for Payer: Aetna Commercial |
$73.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$70.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$43.54
|
| Rate for Payer: Cash Price |
$23.70
|
| Rate for Payer: Cigna Commercial |
$75.59
|
| Rate for Payer: Health EOS Commercial |
$73.12
|
| Rate for Payer: HFN Commercial |
$75.59
|
| Rate for Payer: Multiplan Commercial |
$65.73
|
| Rate for Payer: Preferred Network Access Commercial |
$75.59
|
| Rate for Payer: Quartz Beloit One Network |
$40.26
|
| Rate for Payer: Quartz Commercial |
$49.30
|
| Rate for Payer: WEA Trust Commercial |
$45.19
|
| Rate for Payer: WPS Commercial |
$60.85
|
|
|
Lipoprotein B
|
Facility
|
OP
|
$79.00
|
|
|
Service Code
|
CPT 80061
|
| Hospital Charge Code |
4566647
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.93 |
| Max. Negotiated Rate |
$75.59 |
| Rate for Payer: Aetna Commercial |
$73.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$70.66
|
| Rate for Payer: Aetna Managed Medicare |
$13.93
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$52.22
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$24.37
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$23.12
|
| Rate for Payer: Anthem Medicare Advantage |
$13.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$43.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$13.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$13.93
|
| Rate for Payer: Cash Price |
$23.70
|
| Rate for Payer: Cash Price |
$23.70
|
| Rate for Payer: Cigna Commercial |
$75.59
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$13.93
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$45.98
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$13.93
|
| Rate for Payer: Health EOS Commercial |
$73.12
|
| Rate for Payer: HFN Commercial |
$75.59
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$51.80
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$13.93
|
| Rate for Payer: Independent Care Health Plan Medicare |
$13.93
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$13.93
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$13.93
|
| Rate for Payer: Multiplan Commercial |
$65.73
|
| Rate for Payer: NAPHCARE Commercial |
$20.89
|
| Rate for Payer: Preferred Network Access Commercial |
$75.59
|
| Rate for Payer: Quartz Beloit One Network |
$40.26
|
| Rate for Payer: Quartz Commercial |
$53.40
|
| Rate for Payer: Quartz Medicare Advantage |
$13.93
|
| Rate for Payer: The Alliance Commercial |
$55.70
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.93
|
| Rate for Payer: United Healthcare PPO |
$61.62
|
| Rate for Payer: WEA Trust Commercial |
$45.19
|
| Rate for Payer: Wellcare Medicare |
$13.93
|
| Rate for Payer: WPS Commercial |
$60.85
|
|
|
Lipoprotein B
|
Professional
|
Both
|
$79.00
|
|
|
Service Code
|
CPT 80061
|
| Hospital Charge Code |
4566647
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.93 |
| Max. Negotiated Rate |
$78.05 |
| Rate for Payer: Aetna Commercial |
$78.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$70.66
|
| Rate for Payer: Aetna Managed Medicare |
$13.93
|
| Rate for Payer: Anthem Medicare Advantage |
$13.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$13.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$13.93
|
| Rate for Payer: Cash Price |
$23.70
|
| Rate for Payer: Cash Price |
$23.70
|
| Rate for Payer: Cigna Commercial |
$78.05
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$41.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$13.93
|
| Rate for Payer: Health EOS Commercial |
$74.77
|
| Rate for Payer: HFN Commercial |
$78.05
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$49.16
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$49.16
|
| Rate for Payer: Independent Care Health Plan Medicare |
$13.93
|
| Rate for Payer: Multiplan Commercial |
$65.73
|
| Rate for Payer: NAPHCARE Commercial |
$20.89
|
| Rate for Payer: Preferred Network Access Commercial |
$78.05
|
| Rate for Payer: Quartz Beloit One Network |
$36.15
|
| Rate for Payer: Quartz Commercial |
$46.83
|
| Rate for Payer: Quartz Medicare Advantage |
$13.93
|
| Rate for Payer: The Alliance Commercial |
$55.01
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.93
|
| Rate for Payer: WEA Trust Commercial |
$45.19
|
| Rate for Payer: WPS Commercial |
$61.27
|
|
