|
ARM SLING MEDIUM TX990204
|
Facility
|
IP
|
$109.00
|
|
|
Service Code
|
HCPCS A4565
|
| Hospital Charge Code |
2974222
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$55.55 |
| Max. Negotiated Rate |
$104.29 |
| Rate for Payer: Aetna Commercial |
$102.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$97.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$60.08
|
| Rate for Payer: Cash Price |
$32.70
|
| Rate for Payer: Cigna Commercial |
$104.29
|
| Rate for Payer: Health EOS Commercial |
$100.89
|
| Rate for Payer: HFN Commercial |
$104.29
|
| Rate for Payer: Multiplan Commercial |
$90.69
|
| Rate for Payer: Preferred Network Access Commercial |
$104.29
|
| Rate for Payer: Quartz Beloit One Network |
$55.55
|
| Rate for Payer: Quartz Commercial |
$68.02
|
| Rate for Payer: WEA Trust Commercial |
$62.35
|
| Rate for Payer: WPS Commercial |
$83.96
|
|
|
ARM SLING SMALL TX990203
|
Facility
|
IP
|
$109.00
|
|
| Hospital Charge Code |
2974221
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$55.55 |
| Max. Negotiated Rate |
$104.29 |
| Rate for Payer: Aetna Commercial |
$102.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$97.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$60.08
|
| Rate for Payer: Cash Price |
$32.70
|
| Rate for Payer: Cigna Commercial |
$104.29
|
| Rate for Payer: Health EOS Commercial |
$100.89
|
| Rate for Payer: HFN Commercial |
$104.29
|
| Rate for Payer: Multiplan Commercial |
$90.69
|
| Rate for Payer: Preferred Network Access Commercial |
$104.29
|
| Rate for Payer: Quartz Beloit One Network |
$55.55
|
| Rate for Payer: Quartz Commercial |
$68.02
|
| Rate for Payer: WEA Trust Commercial |
$62.35
|
| Rate for Payer: WPS Commercial |
$83.96
|
|
|
ARM SLING SMALL TX990203
|
Facility
|
OP
|
$109.00
|
|
| Hospital Charge Code |
2974221
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$31.74 |
| Max. Negotiated Rate |
$104.29 |
| Rate for Payer: Aetna Commercial |
$102.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$97.49
|
| Rate for Payer: Aetna Managed Medicare |
$31.74
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$73.68
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$56.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$54.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$60.08
|
| Rate for Payer: Cash Price |
$32.70
|
| Rate for Payer: Cigna Commercial |
$104.29
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$63.44
|
| Rate for Payer: Health EOS Commercial |
$100.89
|
| Rate for Payer: HFN Commercial |
$104.29
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$85.02
|
| Rate for Payer: Multiplan Commercial |
$90.69
|
| Rate for Payer: NAPHCARE Commercial |
$68.02
|
| Rate for Payer: Preferred Network Access Commercial |
$104.29
|
| Rate for Payer: Quartz Beloit One Network |
$55.55
|
| Rate for Payer: Quartz Commercial |
$73.68
|
| Rate for Payer: Quartz Medicare Advantage |
$68.02
|
| Rate for Payer: The Alliance Commercial |
$56.68
|
| Rate for Payer: WEA Trust Commercial |
$62.35
|
| Rate for Payer: WPS Commercial |
$83.96
|
|
|
ARM SLING (TX990206) XLARGE
|
Facility
|
IP
|
$110.00
|
|
|
Service Code
|
HCPCS A4565
|
| Hospital Charge Code |
2974224
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$56.06 |
| Max. Negotiated Rate |
$105.25 |
| Rate for Payer: Aetna Commercial |
$102.96
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$98.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$60.63
|
| Rate for Payer: Cash Price |
$33.00
|
| Rate for Payer: Cigna Commercial |
$105.25
|
| Rate for Payer: Health EOS Commercial |
$101.82
|
| Rate for Payer: HFN Commercial |
$105.25
|
| Rate for Payer: Multiplan Commercial |
$91.52
|
| Rate for Payer: Preferred Network Access Commercial |
$105.25
|
| Rate for Payer: Quartz Beloit One Network |
$56.06
|
| Rate for Payer: Quartz Commercial |
$68.64
|
| Rate for Payer: WEA Trust Commercial |
$62.92
|
| Rate for Payer: WPS Commercial |
$84.73
|
|
|
ARM SLING (TX990206) XLARGE
|
Facility
|
OP
|
$110.00
|
|
|
Service Code
|
HCPCS A4565
|
| Hospital Charge Code |
2974224
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$32.03 |
| Max. Negotiated Rate |
$105.25 |
| Rate for Payer: Aetna Commercial |
$102.96
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$98.38
|
| Rate for Payer: Aetna Managed Medicare |
$32.03
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$74.36
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$57.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$54.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$60.63
|
| Rate for Payer: Cash Price |
$33.00
|
| Rate for Payer: Cash Price |
$33.00
|
| Rate for Payer: Cigna Commercial |
$105.25
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$64.02
|
| Rate for Payer: Health EOS Commercial |
$101.82
|
| Rate for Payer: HFN Commercial |
$105.25
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$85.80
|
| Rate for Payer: Multiplan Commercial |
$91.52
|
| Rate for Payer: NAPHCARE Commercial |
$68.64
|
| Rate for Payer: Preferred Network Access Commercial |
$105.25
|
| Rate for Payer: Quartz Beloit One Network |
$56.06
|
| Rate for Payer: Quartz Commercial |
$74.36
|
| Rate for Payer: Quartz Medicare Advantage |
$68.64
|
| Rate for Payer: The Alliance Commercial |
$45.68
|
| Rate for Payer: WEA Trust Commercial |
$62.92
|
| Rate for Payer: WPS Commercial |
$84.73
|
|
|
ARM UNIT TRIBUTE #UE-CG
|
Facility
|
OP
|
$5,035.00
|
|
| Hospital Charge Code |
2973640
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$1,466.19 |
| Max. Negotiated Rate |
$4,817.49 |
| Rate for Payer: Aetna Commercial |
$4,712.76
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,503.30
|
| Rate for Payer: Aetna Managed Medicare |
$1,466.19
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,403.66
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,618.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,513.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,775.29
|
| Rate for Payer: Cash Price |
$1,510.50
|
| Rate for Payer: Cigna Commercial |
$4,817.49
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,930.37
|
| Rate for Payer: Health EOS Commercial |
$4,660.40
|
| Rate for Payer: HFN Commercial |
$4,817.49
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,927.30
|
| Rate for Payer: Multiplan Commercial |
$4,189.12
|
| Rate for Payer: NAPHCARE Commercial |
$3,141.84
|
| Rate for Payer: Preferred Network Access Commercial |
$4,817.49
|
| Rate for Payer: Quartz Beloit One Network |
$2,565.84
|
| Rate for Payer: Quartz Commercial |
$3,403.66
|
| Rate for Payer: Quartz Medicare Advantage |
$3,141.84
|
| Rate for Payer: The Alliance Commercial |
$2,618.20
|
| Rate for Payer: WEA Trust Commercial |
$2,880.02
|
| Rate for Payer: WPS Commercial |
$3,878.46
|
|
|
ARM UNIT TRIBUTE #UE-CG
|
Facility
|
IP
|
$5,035.00
|
|
| Hospital Charge Code |
2973640
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$2,565.84 |
| Max. Negotiated Rate |
$4,817.49 |
| Rate for Payer: Aetna Commercial |
$4,712.76
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,503.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,775.29
|
| Rate for Payer: Cash Price |
$1,510.50
|
| Rate for Payer: Cigna Commercial |
$4,817.49
|
| Rate for Payer: Health EOS Commercial |
$4,660.40
|
| Rate for Payer: HFN Commercial |
$4,817.49
|
| Rate for Payer: Multiplan Commercial |
$4,189.12
|
| Rate for Payer: Preferred Network Access Commercial |
$4,817.49
|
| Rate for Payer: Quartz Beloit One Network |
$2,565.84
|
| Rate for Payer: Quartz Commercial |
$3,141.84
|
| Rate for Payer: WEA Trust Commercial |
$2,880.02
|
| Rate for Payer: WPS Commercial |
$3,878.46
|
|
|
ARM WRAP MCCONNELL 12401
|
Facility
|
IP
|
$875.00
|
|
|
Service Code
|
HCPCS A6449
|
| Hospital Charge Code |
2965285
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$445.90 |
| Max. Negotiated Rate |
$837.20 |
| Rate for Payer: Aetna Commercial |
$819.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$782.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$482.30
|
| Rate for Payer: Cash Price |
$262.50
|
| Rate for Payer: Cigna Commercial |
$837.20
|
| Rate for Payer: Health EOS Commercial |
$809.90
|
| Rate for Payer: HFN Commercial |
$837.20
|
| Rate for Payer: Multiplan Commercial |
$728.00
|
| Rate for Payer: Preferred Network Access Commercial |
$837.20
|
| Rate for Payer: Quartz Beloit One Network |
$445.90
|
| Rate for Payer: Quartz Commercial |
$546.00
|
| Rate for Payer: WEA Trust Commercial |
$500.50
|
| Rate for Payer: WPS Commercial |
$674.01
|
|
|
ARM WRAP MCCONNELL 12401
|
Facility
|
OP
|
$875.00
|
|
|
Service Code
|
HCPCS A6449
|
| Hospital Charge Code |
2965285
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$10.40 |
| Max. Negotiated Rate |
$837.20 |
| Rate for Payer: Aetna Commercial |
$819.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$782.60
|
| Rate for Payer: Aetna Managed Medicare |
$254.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$591.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$455.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$436.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$482.30
|
| Rate for Payer: Cash Price |
$262.50
|
| Rate for Payer: Cash Price |
$262.50
|
| Rate for Payer: Cigna Commercial |
$837.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$509.25
|
| Rate for Payer: Health EOS Commercial |
$809.90
|
| Rate for Payer: HFN Commercial |
$837.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$682.50
|
| Rate for Payer: Multiplan Commercial |
$728.00
|
| Rate for Payer: NAPHCARE Commercial |
$546.00
|
| Rate for Payer: Preferred Network Access Commercial |
$837.20
|
| Rate for Payer: Quartz Beloit One Network |
$445.90
|
| Rate for Payer: Quartz Commercial |
$591.50
|
| Rate for Payer: Quartz Medicare Advantage |
$546.00
|
| Rate for Payer: The Alliance Commercial |
$10.40
|
| Rate for Payer: WEA Trust Commercial |
$500.50
|
| Rate for Payer: WPS Commercial |
$674.01
|
|
|
Arrow Sure Shot Epidural Ndle
|
Facility
|
OP
|
$120.00
|
|
| Hospital Charge Code |
3101766
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$34.94 |
| Max. Negotiated Rate |
$114.82 |
| Rate for Payer: Aetna Commercial |
$112.32
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$107.33
|
| Rate for Payer: Aetna Managed Medicare |
$34.94
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$81.12
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$62.40
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$59.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$66.14
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Cigna Commercial |
$114.82
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$69.84
|
| Rate for Payer: Health EOS Commercial |
$111.07
|
| Rate for Payer: HFN Commercial |
$114.82
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$93.60
|
| Rate for Payer: Multiplan Commercial |
$99.84
|
| Rate for Payer: NAPHCARE Commercial |
$74.88
|
| Rate for Payer: Preferred Network Access Commercial |
$114.82
|
| Rate for Payer: Quartz Beloit One Network |
$61.15
|
| Rate for Payer: Quartz Commercial |
$81.12
|
| Rate for Payer: Quartz Medicare Advantage |
$74.88
|
| Rate for Payer: The Alliance Commercial |
$62.40
|
| Rate for Payer: WEA Trust Commercial |
$68.64
|
| Rate for Payer: WPS Commercial |
$92.44
|
|
|
Arrow Sure Shot Epidural Ndle
|
Facility
|
IP
|
$120.00
|
|
| Hospital Charge Code |
3101766
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$61.15 |
| Max. Negotiated Rate |
$114.82 |
| Rate for Payer: Aetna Commercial |
$112.32
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$107.33
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$66.14
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Cigna Commercial |
$114.82
|
| Rate for Payer: Health EOS Commercial |
$111.07
|
| Rate for Payer: HFN Commercial |
$114.82
|
| Rate for Payer: Multiplan Commercial |
$99.84
|
| Rate for Payer: Preferred Network Access Commercial |
$114.82
|
| Rate for Payer: Quartz Beloit One Network |
$61.15
|
| Rate for Payer: Quartz Commercial |
$74.88
|
| Rate for Payer: WEA Trust Commercial |
$68.64
|
| Rate for Payer: WPS Commercial |
$92.44
|
|
|
Arsenic Level
|
Facility
|
OP
|
$360.00
|
|
|
Service Code
|
CPT 82175
|
| Hospital Charge Code |
633660
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$19.73 |
| Max. Negotiated Rate |
$344.45 |
| Rate for Payer: Aetna Commercial |
$336.96
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$321.98
|
| Rate for Payer: Aetna Managed Medicare |
$19.73
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$73.98
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$34.53
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$32.75
|
| Rate for Payer: Anthem Medicare Advantage |
$19.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$198.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$19.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$19.73
|
| Rate for Payer: Cash Price |
$108.00
|
| Rate for Payer: Cash Price |
$108.00
|
| Rate for Payer: Cigna Commercial |
$344.45
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$19.73
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$209.52
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$19.73
|
| Rate for Payer: Health EOS Commercial |
$333.22
|
| Rate for Payer: HFN Commercial |
$344.45
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$73.39
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$19.73
|
| Rate for Payer: Independent Care Health Plan Medicare |
$19.73
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$19.73
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$19.73
|
| Rate for Payer: Multiplan Commercial |
$299.52
|
| Rate for Payer: NAPHCARE Commercial |
$29.59
|
| Rate for Payer: Preferred Network Access Commercial |
$344.45
|
| Rate for Payer: Quartz Beloit One Network |
$183.46
|
| Rate for Payer: Quartz Commercial |
$243.36
|
| Rate for Payer: Quartz Medicare Advantage |
$19.73
|
| Rate for Payer: The Alliance Commercial |
$78.92
|
| Rate for Payer: United Healthcare Medicare Advantage |
$19.73
|
| Rate for Payer: United Healthcare PPO |
$280.80
|
| Rate for Payer: WEA Trust Commercial |
$205.92
|
| Rate for Payer: Wellcare Medicare |
$19.73
|
| Rate for Payer: WPS Commercial |
$277.31
|
|
|
Arsenic Level
|
Facility
|
IP
|
$360.00
|
|
|
Service Code
|
CPT 82175
|
| Hospital Charge Code |
633660
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$183.46 |
| Max. Negotiated Rate |
$344.45 |
| Rate for Payer: Aetna Commercial |
$336.96
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$321.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$198.43
|
| Rate for Payer: Cash Price |
$108.00
|
| Rate for Payer: Cigna Commercial |
$344.45
|
| Rate for Payer: Health EOS Commercial |
$333.22
|
| Rate for Payer: HFN Commercial |
$344.45
|
| Rate for Payer: Multiplan Commercial |
$299.52
|
| Rate for Payer: Preferred Network Access Commercial |
$344.45
|
| Rate for Payer: Quartz Beloit One Network |
$183.46
|
| Rate for Payer: Quartz Commercial |
$224.64
|
| Rate for Payer: WEA Trust Commercial |
$205.92
|
| Rate for Payer: WPS Commercial |
$277.31
|
|
|
Arsenic Level
|
Professional
|
Both
|
$360.00
|
|
|
Service Code
|
CPT 82175
|
| Hospital Charge Code |
633660
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$19.73 |
| Max. Negotiated Rate |
$355.68 |
| Rate for Payer: Aetna Commercial |
$355.68
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$321.98
|
| Rate for Payer: Aetna Managed Medicare |
$19.73
|
| Rate for Payer: Anthem Medicare Advantage |
$19.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$19.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$19.73
|
| Rate for Payer: Cash Price |
$108.00
|
| Rate for Payer: Cash Price |
$108.00
|
| Rate for Payer: Cigna Commercial |
$355.68
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$187.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$19.73
|
| Rate for Payer: Health EOS Commercial |
$340.70
|
| Rate for Payer: HFN Commercial |
$355.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$69.64
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$69.64
|
| Rate for Payer: Independent Care Health Plan Medicare |
$19.73
|
| Rate for Payer: Multiplan Commercial |
$299.52
|
| Rate for Payer: NAPHCARE Commercial |
$29.59
|
| Rate for Payer: Preferred Network Access Commercial |
$355.68
|
| Rate for Payer: Quartz Beloit One Network |
$164.74
|
| Rate for Payer: Quartz Commercial |
$213.41
|
| Rate for Payer: Quartz Medicare Advantage |
$19.73
|
| Rate for Payer: The Alliance Commercial |
$77.93
|
| Rate for Payer: United Healthcare Medicare Advantage |
$19.73
|
| Rate for Payer: WEA Trust Commercial |
$205.92
|
| Rate for Payer: WPS Commercial |
$86.81
|
|
|
Arsenic Level 24 Hr Urine
|
Facility
|
IP
|
$102.00
|
|
|
Service Code
|
CPT 82175
|
| Hospital Charge Code |
4596772
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$51.98 |
| Max. Negotiated Rate |
$97.59 |
| Rate for Payer: Aetna Commercial |
$95.47
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$91.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$56.22
|
| Rate for Payer: Cash Price |
$30.60
|
| Rate for Payer: Cigna Commercial |
$97.59
|
| Rate for Payer: Health EOS Commercial |
$94.41
|
| Rate for Payer: HFN Commercial |
$97.59
|
| Rate for Payer: Multiplan Commercial |
$84.86
|
| Rate for Payer: Preferred Network Access Commercial |
$97.59
|
| Rate for Payer: Quartz Beloit One Network |
$51.98
|
| Rate for Payer: Quartz Commercial |
$63.65
|
| Rate for Payer: WEA Trust Commercial |
$58.34
|
| Rate for Payer: WPS Commercial |
$78.57
|
|
|
Arsenic Level 24 Hr Urine
|
Professional
|
Both
|
$102.00
|
|
|
Service Code
|
CPT 82175
|
| Hospital Charge Code |
4596772
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$19.73 |
| Max. Negotiated Rate |
$100.78 |
| Rate for Payer: Aetna Commercial |
$100.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$91.23
|
| Rate for Payer: Aetna Managed Medicare |
$19.73
|
| Rate for Payer: Anthem Medicare Advantage |
$19.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$19.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$19.73
|
| Rate for Payer: Cash Price |
$30.60
|
| Rate for Payer: Cash Price |
$30.60
|
| Rate for Payer: Cigna Commercial |
$100.78
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$53.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$19.73
|
| Rate for Payer: Health EOS Commercial |
$96.53
|
| Rate for Payer: HFN Commercial |
$100.78
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$69.64
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$69.64
|
| Rate for Payer: Independent Care Health Plan Medicare |
$19.73
|
| Rate for Payer: Multiplan Commercial |
$84.86
|
| Rate for Payer: NAPHCARE Commercial |
$29.59
|
| Rate for Payer: Preferred Network Access Commercial |
$100.78
|
| Rate for Payer: Quartz Beloit One Network |
$46.68
|
| Rate for Payer: Quartz Commercial |
$60.47
|
| Rate for Payer: Quartz Medicare Advantage |
$19.73
|
| Rate for Payer: The Alliance Commercial |
$77.93
|
| Rate for Payer: United Healthcare Medicare Advantage |
$19.73
|
| Rate for Payer: WEA Trust Commercial |
$58.34
|
| Rate for Payer: WPS Commercial |
$86.81
|
|
|
Arsenic Level 24 Hr Urine
|
Facility
|
OP
|
$102.00
|
|
|
Service Code
|
CPT 82175
|
| Hospital Charge Code |
4596772
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$19.73 |
| Max. Negotiated Rate |
$97.59 |
| Rate for Payer: Aetna Commercial |
$95.47
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$91.23
|
| Rate for Payer: Aetna Managed Medicare |
$19.73
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$73.98
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$34.53
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$32.75
|
| Rate for Payer: Anthem Medicare Advantage |
$19.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$56.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$19.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$19.73
|
| Rate for Payer: Cash Price |
$30.60
|
| Rate for Payer: Cash Price |
$30.60
|
| Rate for Payer: Cigna Commercial |
$97.59
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$19.73
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$59.36
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$19.73
|
| Rate for Payer: Health EOS Commercial |
$94.41
|
| Rate for Payer: HFN Commercial |
$97.59
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$73.39
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$19.73
|
| Rate for Payer: Independent Care Health Plan Medicare |
$19.73
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$19.73
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$19.73
|
| Rate for Payer: Multiplan Commercial |
$84.86
|
| Rate for Payer: NAPHCARE Commercial |
$29.59
|
| Rate for Payer: Preferred Network Access Commercial |
$97.59
|
| Rate for Payer: Quartz Beloit One Network |
$51.98
|
| Rate for Payer: Quartz Commercial |
$68.95
|
| Rate for Payer: Quartz Medicare Advantage |
$19.73
|
| Rate for Payer: The Alliance Commercial |
$78.92
|
| Rate for Payer: United Healthcare Medicare Advantage |
$19.73
|
| Rate for Payer: United Healthcare PPO |
$79.56
|
| Rate for Payer: WEA Trust Commercial |
$58.34
|
| Rate for Payer: Wellcare Medicare |
$19.73
|
| Rate for Payer: WPS Commercial |
$78.57
|
|
|
Arsenic Level, Hair
|
Facility
|
IP
|
$350.00
|
|
|
Service Code
|
CPT 82175
|
| Hospital Charge Code |
4596774
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$178.36 |
| Max. Negotiated Rate |
$334.88 |
| Rate for Payer: Aetna Commercial |
$327.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$313.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$192.92
|
| Rate for Payer: Cash Price |
$105.00
|
| Rate for Payer: Cigna Commercial |
$334.88
|
| Rate for Payer: Health EOS Commercial |
$323.96
|
| Rate for Payer: HFN Commercial |
$334.88
|
| Rate for Payer: Multiplan Commercial |
$291.20
|
| Rate for Payer: Preferred Network Access Commercial |
$334.88
|
| Rate for Payer: Quartz Beloit One Network |
$178.36
|
| Rate for Payer: Quartz Commercial |
$218.40
|
| Rate for Payer: WEA Trust Commercial |
$200.20
|
| Rate for Payer: WPS Commercial |
$269.61
|
|
|
Arsenic Level, Hair
|
Professional
|
Both
|
$350.00
|
|
|
Service Code
|
CPT 82175
|
| Hospital Charge Code |
4596774
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$19.73 |
| Max. Negotiated Rate |
$345.80 |
| Rate for Payer: Aetna Commercial |
$345.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$313.04
|
| Rate for Payer: Aetna Managed Medicare |
$19.73
|
| Rate for Payer: Anthem Medicare Advantage |
$19.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$19.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$19.73
|
| Rate for Payer: Cash Price |
$105.00
|
| Rate for Payer: Cash Price |
$105.00
|
| Rate for Payer: Cigna Commercial |
$345.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$182.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$19.73
|
| Rate for Payer: Health EOS Commercial |
$331.24
|
| Rate for Payer: HFN Commercial |
$345.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$69.64
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$69.64
|
| Rate for Payer: Independent Care Health Plan Medicare |
$19.73
|
| Rate for Payer: Multiplan Commercial |
$291.20
|
| Rate for Payer: NAPHCARE Commercial |
$29.59
|
| Rate for Payer: Preferred Network Access Commercial |
$345.80
|
| Rate for Payer: Quartz Beloit One Network |
$160.16
|
| Rate for Payer: Quartz Commercial |
$207.48
|
| Rate for Payer: Quartz Medicare Advantage |
$19.73
|
| Rate for Payer: The Alliance Commercial |
$77.93
|
| Rate for Payer: United Healthcare Medicare Advantage |
$19.73
|
| Rate for Payer: WEA Trust Commercial |
$200.20
|
| Rate for Payer: WPS Commercial |
$86.81
|
|
|
Arsenic Level, Hair
|
Facility
|
OP
|
$350.00
|
|
|
Service Code
|
CPT 82175
|
| Hospital Charge Code |
4596774
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$19.73 |
| Max. Negotiated Rate |
$334.88 |
| Rate for Payer: Aetna Commercial |
$327.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$313.04
|
| Rate for Payer: Aetna Managed Medicare |
$19.73
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$73.98
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$34.53
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$32.75
|
| Rate for Payer: Anthem Medicare Advantage |
$19.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$192.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$19.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$19.73
|
| Rate for Payer: Cash Price |
$105.00
|
| Rate for Payer: Cash Price |
$105.00
|
| Rate for Payer: Cigna Commercial |
$334.88
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$19.73
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$203.70
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$19.73
|
| Rate for Payer: Health EOS Commercial |
$323.96
|
| Rate for Payer: HFN Commercial |
$334.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$73.39
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$19.73
|
| Rate for Payer: Independent Care Health Plan Medicare |
$19.73
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$19.73
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$19.73
|
| Rate for Payer: Multiplan Commercial |
$291.20
|
| Rate for Payer: NAPHCARE Commercial |
$29.59
|
| Rate for Payer: Preferred Network Access Commercial |
$334.88
|
| Rate for Payer: Quartz Beloit One Network |
$178.36
|
| Rate for Payer: Quartz Commercial |
$236.60
|
| Rate for Payer: Quartz Medicare Advantage |
$19.73
|
| Rate for Payer: The Alliance Commercial |
$78.92
|
| Rate for Payer: United Healthcare Medicare Advantage |
$19.73
|
| Rate for Payer: United Healthcare PPO |
$273.00
|
| Rate for Payer: WEA Trust Commercial |
$200.20
|
| Rate for Payer: Wellcare Medicare |
$19.73
|
| Rate for Payer: WPS Commercial |
$269.61
|
|
|
Arsenic Level, Nails
|
Facility
|
OP
|
$400.00
|
|
|
Service Code
|
CPT 82175
|
| Hospital Charge Code |
4596773
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$19.73 |
| Max. Negotiated Rate |
$382.72 |
| Rate for Payer: Aetna Commercial |
$374.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$357.76
|
| Rate for Payer: Aetna Managed Medicare |
$19.73
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$73.98
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$34.53
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$32.75
|
| Rate for Payer: Anthem Medicare Advantage |
$19.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$220.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$19.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$19.73
|
| Rate for Payer: Cash Price |
$120.00
|
| Rate for Payer: Cash Price |
$120.00
|
| Rate for Payer: Cigna Commercial |
$382.72
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$19.73
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$232.80
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$19.73
|
| Rate for Payer: Health EOS Commercial |
$370.24
|
| Rate for Payer: HFN Commercial |
$382.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$73.39
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$19.73
|
| Rate for Payer: Independent Care Health Plan Medicare |
$19.73
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$19.73
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$19.73
|
| Rate for Payer: Multiplan Commercial |
$332.80
|
| Rate for Payer: NAPHCARE Commercial |
$29.59
|
| Rate for Payer: Preferred Network Access Commercial |
$382.72
|
| Rate for Payer: Quartz Beloit One Network |
$203.84
|
| Rate for Payer: Quartz Commercial |
$270.40
|
| Rate for Payer: Quartz Medicare Advantage |
$19.73
|
| Rate for Payer: The Alliance Commercial |
$78.92
|
| Rate for Payer: United Healthcare Medicare Advantage |
$19.73
|
| Rate for Payer: United Healthcare PPO |
$312.00
|
| Rate for Payer: WEA Trust Commercial |
$228.80
|
| Rate for Payer: Wellcare Medicare |
$19.73
|
| Rate for Payer: WPS Commercial |
$308.12
|
|
|
Arsenic Level, Nails
|
Facility
|
IP
|
$400.00
|
|
|
Service Code
|
CPT 82175
|
| Hospital Charge Code |
4596773
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$203.84 |
| Max. Negotiated Rate |
$382.72 |
| Rate for Payer: Aetna Commercial |
$374.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$357.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$220.48
|
| Rate for Payer: Cash Price |
$120.00
|
| Rate for Payer: Cigna Commercial |
$382.72
|
| Rate for Payer: Health EOS Commercial |
$370.24
|
| Rate for Payer: HFN Commercial |
$382.72
|
| Rate for Payer: Multiplan Commercial |
$332.80
|
| Rate for Payer: Preferred Network Access Commercial |
$382.72
|
| Rate for Payer: Quartz Beloit One Network |
$203.84
|
| Rate for Payer: Quartz Commercial |
$249.60
|
| Rate for Payer: WEA Trust Commercial |
$228.80
|
| Rate for Payer: WPS Commercial |
$308.12
|
|
|
Arsenic Level, Nails
|
Professional
|
Both
|
$400.00
|
|
|
Service Code
|
CPT 82175
|
| Hospital Charge Code |
4596773
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$19.73 |
| Max. Negotiated Rate |
$395.20 |
| Rate for Payer: Aetna Commercial |
$395.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$357.76
|
| Rate for Payer: Aetna Managed Medicare |
$19.73
|
| Rate for Payer: Anthem Medicare Advantage |
$19.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$19.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$19.73
|
| Rate for Payer: Cash Price |
$120.00
|
| Rate for Payer: Cash Price |
$120.00
|
| Rate for Payer: Cigna Commercial |
$395.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$208.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$19.73
|
| Rate for Payer: Health EOS Commercial |
$378.56
|
| Rate for Payer: HFN Commercial |
$395.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$69.64
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$69.64
|
| Rate for Payer: Independent Care Health Plan Medicare |
$19.73
|
| Rate for Payer: Multiplan Commercial |
$332.80
|
| Rate for Payer: NAPHCARE Commercial |
$29.59
|
| Rate for Payer: Preferred Network Access Commercial |
$395.20
|
| Rate for Payer: Quartz Beloit One Network |
$183.04
|
| Rate for Payer: Quartz Commercial |
$237.12
|
| Rate for Payer: Quartz Medicare Advantage |
$19.73
|
| Rate for Payer: The Alliance Commercial |
$77.93
|
| Rate for Payer: United Healthcare Medicare Advantage |
$19.73
|
| Rate for Payer: WEA Trust Commercial |
$228.80
|
| Rate for Payer: WPS Commercial |
$86.81
|
|
|
Art Bld Gas CABG
|
Professional
|
Both
|
$538.00
|
|
|
Service Code
|
CPT 82805
|
| Hospital Charge Code |
3059530
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$81.92 |
| Max. Negotiated Rate |
$531.54 |
| Rate for Payer: Aetna Commercial |
$531.54
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$481.19
|
| Rate for Payer: Aetna Managed Medicare |
$81.92
|
| Rate for Payer: Anthem Medicare Advantage |
$81.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$81.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$81.92
|
| Rate for Payer: Cash Price |
$161.40
|
| Rate for Payer: Cash Price |
$161.40
|
| Rate for Payer: Cigna Commercial |
$531.54
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$279.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$81.92
|
| Rate for Payer: Health EOS Commercial |
$509.16
|
| Rate for Payer: HFN Commercial |
$531.54
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$289.18
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$289.18
|
| Rate for Payer: Independent Care Health Plan Medicare |
$81.92
|
| Rate for Payer: Multiplan Commercial |
$447.62
|
| Rate for Payer: NAPHCARE Commercial |
$122.88
|
| Rate for Payer: Preferred Network Access Commercial |
$531.54
|
| Rate for Payer: Quartz Beloit One Network |
$246.19
|
| Rate for Payer: Quartz Commercial |
$318.93
|
| Rate for Payer: Quartz Medicare Advantage |
$81.92
|
| Rate for Payer: The Alliance Commercial |
$323.59
|
| Rate for Payer: United Healthcare Medicare Advantage |
$81.92
|
| Rate for Payer: WEA Trust Commercial |
$307.74
|
| Rate for Payer: WPS Commercial |
$360.45
|
|
|
Art Bld Gas CABG
|
Facility
|
IP
|
$538.00
|
|
|
Service Code
|
CPT 82805
|
| Hospital Charge Code |
3059530
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$274.16 |
| Max. Negotiated Rate |
$514.76 |
| Rate for Payer: Aetna Commercial |
$503.57
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$481.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$296.55
|
| Rate for Payer: Cash Price |
$161.40
|
| Rate for Payer: Cigna Commercial |
$514.76
|
| Rate for Payer: Health EOS Commercial |
$497.97
|
| Rate for Payer: HFN Commercial |
$514.76
|
| Rate for Payer: Multiplan Commercial |
$447.62
|
| Rate for Payer: Preferred Network Access Commercial |
$514.76
|
| Rate for Payer: Quartz Beloit One Network |
$274.16
|
| Rate for Payer: Quartz Commercial |
$335.71
|
| Rate for Payer: WEA Trust Commercial |
$307.74
|
| Rate for Payer: WPS Commercial |
$414.42
|
|
