|
Urine Homovanillic Acid
|
Facility
|
OP
|
$123.00
|
|
|
Service Code
|
CPT 83150
|
| Hospital Charge Code |
4076081
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$19.62 |
| 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 |
$22.41
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$84.04
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$39.22
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$37.20
|
| Rate for Payer: Anthem Medicaid |
$19.62
|
| Rate for Payer: Anthem Medicare Advantage |
$22.41
|
| 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 |
$22.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$22.41
|
| 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 |
$22.41
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$19.62
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$68.83
|
| Rate for Payer: Dean Health Medicaid |
$19.62
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$22.41
|
| Rate for Payer: Health EOS Commercial |
$109.47
|
| Rate for Payer: HFN Commercial |
$113.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$83.37
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$22.41
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$19.62
|
| Rate for Payer: Independent Care Health Plan Medicare |
$22.41
|
| Rate for Payer: Managed Health Services Medicaid |
$20.40
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$22.41
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$22.41
|
| Rate for Payer: Multiplan Commercial |
$98.40
|
| Rate for Payer: NAPHCARE Commercial |
$33.62
|
| Rate for Payer: Preferred Network Access Commercial |
$113.16
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$19.62
|
| Rate for Payer: Quartz Beloit One Network |
$60.27
|
| Rate for Payer: Quartz Commercial |
$79.95
|
| Rate for Payer: Quartz Medicare Advantage |
$22.41
|
| Rate for Payer: The Alliance Commercial |
$89.64
|
| Rate for Payer: United Healthcare Medicaid |
$19.62
|
| Rate for Payer: United Healthcare Medicare Advantage |
$22.41
|
| Rate for Payer: United Healthcare PPO |
$92.25
|
| Rate for Payer: WEA Trust Commercial |
$67.65
|
| Rate for Payer: Wellcare Medicare |
$22.41
|
| Rate for Payer: WMAP Medicaid |
$19.62
|
| Rate for Payer: WPS Commercial |
$91.11
|
|
|
Urine Homovanillic Acid
|
Facility
|
IP
|
$123.00
|
|
|
Service Code
|
CPT 83150
|
| Hospital Charge Code |
4076081
|
|
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
|
|
|
Urine Lambda Light Chain
|
Professional
|
Both
|
$186.00
|
|
|
Service Code
|
CPT 83883
|
| Hospital Charge Code |
2942948
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$48.01 |
| Max. Negotiated Rate |
$176.70 |
| Rate for Payer: Aetna Commercial |
$176.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$159.96
|
| Rate for Payer: Cash Price |
$55.80
|
| Rate for Payer: Cash Price |
$55.80
|
| Rate for Payer: Cigna Commercial |
$176.70
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$93.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$111.60
|
| Rate for Payer: Health EOS Commercial |
$169.26
|
| Rate for Payer: HFN Commercial |
$176.70
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$48.01
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$48.01
|
| Rate for Payer: Multiplan Commercial |
$148.80
|
| Rate for Payer: Preferred Network Access Commercial |
$176.70
|
| Rate for Payer: Quartz Beloit One Network |
$81.84
|
| Rate for Payer: Quartz Commercial |
$106.02
|
| Rate for Payer: The Alliance Commercial |
$93.00
|
| Rate for Payer: WEA Trust Commercial |
$102.30
|
| Rate for Payer: WPS Commercial |
$137.77
|
|
|
Urine Lambda Light Chain
|
Facility
|
IP
|
$186.00
|
|
|
Service Code
|
CPT 83883
|
| Hospital Charge Code |
2942948
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$91.14 |
| Max. Negotiated Rate |
$171.12 |
| Rate for Payer: Aetna Commercial |
$167.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$159.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$98.58
|
| Rate for Payer: Cash Price |
$55.80
|
| Rate for Payer: Cigna Commercial |
$171.12
|
| Rate for Payer: Health EOS Commercial |
$165.54
|
| Rate for Payer: HFN Commercial |
$171.12
|
| Rate for Payer: Multiplan Commercial |
$148.80
|
| Rate for Payer: NAPHCARE Commercial |
$111.60
|
| Rate for Payer: Preferred Network Access Commercial |
$171.12
|
| Rate for Payer: Quartz Beloit One Network |
$91.14
|
| Rate for Payer: Quartz Commercial |
$111.60
|
| Rate for Payer: WEA Trust Commercial |
$102.30
|
| Rate for Payer: WPS Commercial |
$137.77
|
|
|
Urine Lambda Light Chain
|
Facility
|
OP
|
$186.00
|
|
|
Service Code
|
CPT 83883
|
| Hospital Charge Code |
2942948
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.60 |
| Max. Negotiated Rate |
$171.12 |
| Rate for Payer: Aetna Commercial |
$167.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$159.96
|
| Rate for Payer: Aetna Managed Medicare |
$13.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$51.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$23.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$22.58
|
| Rate for Payer: Anthem Medicaid |
$14.05
|
| Rate for Payer: Anthem Medicare Advantage |
$13.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$98.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$13.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$13.60
|
| Rate for Payer: Cash Price |
$55.80
|
| Rate for Payer: Cash Price |
$55.80
|
| Rate for Payer: Cigna Commercial |
$171.12
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$13.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$14.05
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$104.09
|
| Rate for Payer: Dean Health Medicaid |
$14.05
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$13.60
|
| Rate for Payer: Health EOS Commercial |
$165.54
|
| Rate for Payer: HFN Commercial |
$171.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$50.59
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$13.60
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$14.05
|
| Rate for Payer: Independent Care Health Plan Medicare |
$13.60
|
| Rate for Payer: Managed Health Services Medicaid |
$14.61
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$13.60
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$13.60
|
| Rate for Payer: Multiplan Commercial |
$148.80
|
| Rate for Payer: NAPHCARE Commercial |
$20.40
|
| Rate for Payer: Preferred Network Access Commercial |
$171.12
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$14.05
|
| Rate for Payer: Quartz Beloit One Network |
$91.14
|
| Rate for Payer: Quartz Commercial |
$120.90
|
| Rate for Payer: Quartz Medicare Advantage |
$13.60
|
| Rate for Payer: The Alliance Commercial |
$54.40
|
| Rate for Payer: United Healthcare Medicaid |
$14.05
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.60
|
| Rate for Payer: United Healthcare PPO |
$139.50
|
| Rate for Payer: WEA Trust Commercial |
$102.30
|
| Rate for Payer: Wellcare Medicare |
$13.60
|
| Rate for Payer: WMAP Medicaid |
$14.05
|
| Rate for Payer: WPS Commercial |
$137.77
|
|
|
Urine Lead Level
|
Facility
|
IP
|
$83.00
|
|
|
Service Code
|
CPT 83655
|
| Hospital Charge Code |
3986162
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$40.67 |
| Max. Negotiated Rate |
$76.36 |
| Rate for Payer: Aetna Commercial |
$74.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$71.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$43.99
|
| Rate for Payer: Cash Price |
$24.90
|
| Rate for Payer: Cigna Commercial |
$76.36
|
| Rate for Payer: Health EOS Commercial |
$73.87
|
| Rate for Payer: HFN Commercial |
$76.36
|
| Rate for Payer: Multiplan Commercial |
$66.40
|
| Rate for Payer: NAPHCARE Commercial |
$49.80
|
| Rate for Payer: Preferred Network Access Commercial |
$76.36
|
| Rate for Payer: Quartz Beloit One Network |
$40.67
|
| Rate for Payer: Quartz Commercial |
$49.80
|
| Rate for Payer: WEA Trust Commercial |
$45.65
|
| Rate for Payer: WPS Commercial |
$61.48
|
|
|
Urine Lead Level
|
Professional
|
Both
|
$83.00
|
|
|
Service Code
|
CPT 83655
|
| Hospital Charge Code |
3986162
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$36.52 |
| Max. Negotiated Rate |
$78.85 |
| Rate for Payer: Aetna Commercial |
$78.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$71.38
|
| Rate for Payer: Cash Price |
$24.90
|
| Rate for Payer: Cash Price |
$24.90
|
| Rate for Payer: Cigna Commercial |
$78.85
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$41.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$49.80
|
| Rate for Payer: Health EOS Commercial |
$75.53
|
| Rate for Payer: HFN Commercial |
$78.85
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$42.75
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$42.75
|
| Rate for Payer: Multiplan Commercial |
$66.40
|
| Rate for Payer: Preferred Network Access Commercial |
$78.85
|
| Rate for Payer: Quartz Beloit One Network |
$36.52
|
| Rate for Payer: Quartz Commercial |
$47.31
|
| Rate for Payer: The Alliance Commercial |
$41.50
|
| Rate for Payer: WEA Trust Commercial |
$45.65
|
| Rate for Payer: WPS Commercial |
$61.48
|
|
|
Urine Lead Level
|
Professional
|
Both
|
$622.00
|
|
|
Service Code
|
CPT 83655
|
| Hospital Charge Code |
2942907
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$42.75 |
| Max. Negotiated Rate |
$590.90 |
| Rate for Payer: Aetna Commercial |
$590.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$534.92
|
| Rate for Payer: Cash Price |
$186.60
|
| Rate for Payer: Cash Price |
$186.60
|
| Rate for Payer: Cigna Commercial |
$590.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$311.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$373.20
|
| Rate for Payer: Health EOS Commercial |
$566.02
|
| Rate for Payer: HFN Commercial |
$590.90
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$42.75
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$42.75
|
| Rate for Payer: Multiplan Commercial |
$497.60
|
| Rate for Payer: Preferred Network Access Commercial |
$590.90
|
| Rate for Payer: Quartz Beloit One Network |
$273.68
|
| Rate for Payer: Quartz Commercial |
$354.54
|
| Rate for Payer: The Alliance Commercial |
$311.00
|
| Rate for Payer: WEA Trust Commercial |
$342.10
|
| Rate for Payer: WPS Commercial |
$460.72
|
|
|
Urine Lead Level
|
Facility
|
IP
|
$622.00
|
|
|
Service Code
|
CPT 83655
|
| Hospital Charge Code |
2942907
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$304.78 |
| Max. Negotiated Rate |
$572.24 |
| Rate for Payer: Aetna Commercial |
$559.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$534.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$329.66
|
| Rate for Payer: Cash Price |
$186.60
|
| Rate for Payer: Cigna Commercial |
$572.24
|
| Rate for Payer: Health EOS Commercial |
$553.58
|
| Rate for Payer: HFN Commercial |
$572.24
|
| Rate for Payer: Multiplan Commercial |
$497.60
|
| Rate for Payer: NAPHCARE Commercial |
$373.20
|
| Rate for Payer: Preferred Network Access Commercial |
$572.24
|
| Rate for Payer: Quartz Beloit One Network |
$304.78
|
| Rate for Payer: Quartz Commercial |
$373.20
|
| Rate for Payer: WEA Trust Commercial |
$342.10
|
| Rate for Payer: WPS Commercial |
$460.72
|
|
|
Urine Lead Level
|
Facility
|
OP
|
$622.00
|
|
|
Service Code
|
CPT 83655
|
| Hospital Charge Code |
2942907
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.11 |
| Max. Negotiated Rate |
$572.24 |
| Rate for Payer: Aetna Commercial |
$559.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$534.92
|
| Rate for Payer: Aetna Managed Medicare |
$12.11
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$45.41
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$21.19
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$20.10
|
| Rate for Payer: Anthem Medicaid |
$12.51
|
| Rate for Payer: Anthem Medicare Advantage |
$12.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$329.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$12.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$12.11
|
| Rate for Payer: Cash Price |
$186.60
|
| Rate for Payer: Cash Price |
$186.60
|
| Rate for Payer: Cigna Commercial |
$572.24
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$12.11
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$12.51
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$348.07
|
| Rate for Payer: Dean Health Medicaid |
$12.51
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$12.11
|
| Rate for Payer: Health EOS Commercial |
$553.58
|
| Rate for Payer: HFN Commercial |
$572.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$45.05
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$12.11
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$12.51
|
| Rate for Payer: Independent Care Health Plan Medicare |
$12.11
|
| Rate for Payer: Managed Health Services Medicaid |
$13.01
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$12.11
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$12.11
|
| Rate for Payer: Multiplan Commercial |
$497.60
|
| Rate for Payer: NAPHCARE Commercial |
$18.16
|
| Rate for Payer: Preferred Network Access Commercial |
$572.24
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$12.51
|
| Rate for Payer: Quartz Beloit One Network |
$304.78
|
| Rate for Payer: Quartz Commercial |
$404.30
|
| Rate for Payer: Quartz Medicare Advantage |
$12.11
|
| Rate for Payer: The Alliance Commercial |
$48.44
|
| Rate for Payer: United Healthcare Medicaid |
$12.51
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.11
|
| Rate for Payer: United Healthcare PPO |
$466.50
|
| Rate for Payer: WEA Trust Commercial |
$342.10
|
| Rate for Payer: Wellcare Medicare |
$12.11
|
| Rate for Payer: WMAP Medicaid |
$12.51
|
| Rate for Payer: WPS Commercial |
$460.72
|
|
|
Urine Lead Level
|
Facility
|
OP
|
$83.00
|
|
|
Service Code
|
CPT 83655
|
| Hospital Charge Code |
3986162
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.11 |
| Max. Negotiated Rate |
$76.36 |
| Rate for Payer: Aetna Commercial |
$74.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$71.38
|
| Rate for Payer: Aetna Managed Medicare |
$12.11
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$45.41
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$21.19
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$20.10
|
| Rate for Payer: Anthem Medicaid |
$12.51
|
| Rate for Payer: Anthem Medicare Advantage |
$12.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$43.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$12.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$12.11
|
| Rate for Payer: Cash Price |
$24.90
|
| Rate for Payer: Cash Price |
$24.90
|
| Rate for Payer: Cigna Commercial |
$76.36
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$12.11
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$12.51
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$46.45
|
| Rate for Payer: Dean Health Medicaid |
$12.51
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$12.11
|
| Rate for Payer: Health EOS Commercial |
$73.87
|
| Rate for Payer: HFN Commercial |
$76.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$45.05
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$12.11
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$12.51
|
| Rate for Payer: Independent Care Health Plan Medicare |
$12.11
|
| Rate for Payer: Managed Health Services Medicaid |
$13.01
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$12.11
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$12.11
|
| Rate for Payer: Multiplan Commercial |
$66.40
|
| Rate for Payer: NAPHCARE Commercial |
$18.16
|
| Rate for Payer: Preferred Network Access Commercial |
$76.36
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$12.51
|
| Rate for Payer: Quartz Beloit One Network |
$40.67
|
| Rate for Payer: Quartz Commercial |
$53.95
|
| Rate for Payer: Quartz Medicare Advantage |
$12.11
|
| Rate for Payer: The Alliance Commercial |
$48.44
|
| Rate for Payer: United Healthcare Medicaid |
$12.51
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.11
|
| Rate for Payer: United Healthcare PPO |
$62.25
|
| Rate for Payer: WEA Trust Commercial |
$45.65
|
| Rate for Payer: Wellcare Medicare |
$12.11
|
| Rate for Payer: WMAP Medicaid |
$12.51
|
| Rate for Payer: WPS Commercial |
$61.48
|
|
|
Urine Magnesium
|
Facility
|
IP
|
$42.00
|
|
|
Service Code
|
CPT 83735
|
| Hospital Charge Code |
2942997
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$20.58 |
| Max. Negotiated Rate |
$38.64 |
| Rate for Payer: Aetna Commercial |
$37.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$36.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$22.26
|
| Rate for Payer: Cash Price |
$12.60
|
| Rate for Payer: Cigna Commercial |
$38.64
|
| Rate for Payer: Health EOS Commercial |
$37.38
|
| Rate for Payer: HFN Commercial |
$38.64
|
| Rate for Payer: Multiplan Commercial |
$33.60
|
| Rate for Payer: NAPHCARE Commercial |
$25.20
|
| Rate for Payer: Preferred Network Access Commercial |
$38.64
|
| Rate for Payer: Quartz Beloit One Network |
$20.58
|
| Rate for Payer: Quartz Commercial |
$25.20
|
| Rate for Payer: WEA Trust Commercial |
$23.10
|
| Rate for Payer: WPS Commercial |
$31.11
|
|
|
Urine Magnesium
|
Facility
|
OP
|
$42.00
|
|
|
Service Code
|
CPT 83735
|
| Hospital Charge Code |
2942997
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.70 |
| Max. Negotiated Rate |
$38.64 |
| Rate for Payer: Aetna Commercial |
$37.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$36.12
|
| Rate for Payer: Aetna Managed Medicare |
$6.70
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$25.12
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$11.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$11.12
|
| Rate for Payer: Anthem Medicaid |
$6.92
|
| Rate for Payer: Anthem Medicare Advantage |
$6.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$22.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$6.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$6.70
|
| Rate for Payer: Cash Price |
$12.60
|
| Rate for Payer: Cash Price |
$12.60
|
| Rate for Payer: Cigna Commercial |
$38.64
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$6.70
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$6.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$23.50
|
| Rate for Payer: Dean Health Medicaid |
$6.92
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$6.70
|
| Rate for Payer: Health EOS Commercial |
$37.38
|
| Rate for Payer: HFN Commercial |
$38.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$24.92
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$6.70
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$6.92
|
| Rate for Payer: Independent Care Health Plan Medicare |
$6.70
|
| Rate for Payer: Managed Health Services Medicaid |
$7.20
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$6.70
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$6.70
|
| Rate for Payer: Multiplan Commercial |
$33.60
|
| Rate for Payer: NAPHCARE Commercial |
$10.05
|
| Rate for Payer: Preferred Network Access Commercial |
$38.64
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$6.92
|
| Rate for Payer: Quartz Beloit One Network |
$20.58
|
| Rate for Payer: Quartz Commercial |
$27.30
|
| Rate for Payer: Quartz Medicare Advantage |
$6.70
|
| Rate for Payer: The Alliance Commercial |
$26.80
|
| Rate for Payer: United Healthcare Medicaid |
$6.92
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6.70
|
| Rate for Payer: United Healthcare PPO |
$31.50
|
| Rate for Payer: WEA Trust Commercial |
$23.10
|
| Rate for Payer: Wellcare Medicare |
$6.70
|
| Rate for Payer: WMAP Medicaid |
$6.92
|
| Rate for Payer: WPS Commercial |
$31.11
|
|
|
Urine Magnesium
|
Facility
|
OP
|
$21.00
|
|
|
Service Code
|
CPT 83735
|
| Hospital Charge Code |
3813065
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.70 |
| Max. Negotiated Rate |
$26.80 |
| Rate for Payer: Aetna Commercial |
$18.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$18.06
|
| Rate for Payer: Aetna Managed Medicare |
$6.70
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$25.12
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$11.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$11.12
|
| Rate for Payer: Anthem Medicaid |
$6.92
|
| Rate for Payer: Anthem Medicare Advantage |
$6.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$11.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$6.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$6.70
|
| Rate for Payer: Cash Price |
$6.30
|
| Rate for Payer: Cash Price |
$6.30
|
| Rate for Payer: Cigna Commercial |
$19.32
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$6.70
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$6.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$11.75
|
| Rate for Payer: Dean Health Medicaid |
$6.92
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$6.70
|
| Rate for Payer: Health EOS Commercial |
$18.69
|
| Rate for Payer: HFN Commercial |
$19.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$24.92
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$6.70
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$6.92
|
| Rate for Payer: Independent Care Health Plan Medicare |
$6.70
|
| Rate for Payer: Managed Health Services Medicaid |
$7.20
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$6.70
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$6.70
|
| Rate for Payer: Multiplan Commercial |
$16.80
|
| Rate for Payer: NAPHCARE Commercial |
$10.05
|
| Rate for Payer: Preferred Network Access Commercial |
$19.32
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$6.92
|
| Rate for Payer: Quartz Beloit One Network |
$10.29
|
| Rate for Payer: Quartz Commercial |
$13.65
|
| Rate for Payer: Quartz Medicare Advantage |
$6.70
|
| Rate for Payer: The Alliance Commercial |
$26.80
|
| Rate for Payer: United Healthcare Medicaid |
$6.92
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6.70
|
| Rate for Payer: United Healthcare PPO |
$15.75
|
| Rate for Payer: WEA Trust Commercial |
$11.55
|
| Rate for Payer: Wellcare Medicare |
$6.70
|
| Rate for Payer: WMAP Medicaid |
$6.92
|
| Rate for Payer: WPS Commercial |
$15.55
|
|
|
Urine Magnesium
|
Professional
|
Both
|
$42.00
|
|
|
Service Code
|
CPT 83735
|
| Hospital Charge Code |
2942997
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.48 |
| Max. Negotiated Rate |
$39.90 |
| Rate for Payer: Aetna Commercial |
$39.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$36.12
|
| Rate for Payer: Cash Price |
$12.60
|
| Rate for Payer: Cash Price |
$12.60
|
| Rate for Payer: Cigna Commercial |
$39.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$21.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$25.20
|
| Rate for Payer: Health EOS Commercial |
$38.22
|
| Rate for Payer: HFN Commercial |
$39.90
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$23.65
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$23.65
|
| Rate for Payer: Multiplan Commercial |
$33.60
|
| Rate for Payer: Preferred Network Access Commercial |
$39.90
|
| Rate for Payer: Quartz Beloit One Network |
$18.48
|
| Rate for Payer: Quartz Commercial |
$23.94
|
| Rate for Payer: The Alliance Commercial |
$21.00
|
| Rate for Payer: WEA Trust Commercial |
$23.10
|
| Rate for Payer: WPS Commercial |
$31.11
|
|
|
Urine Magnesium
|
Facility
|
IP
|
$21.00
|
|
|
Service Code
|
CPT 83735
|
| Hospital Charge Code |
3813065
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.29 |
| Max. Negotiated Rate |
$19.32 |
| Rate for Payer: Aetna Commercial |
$18.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$18.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$11.13
|
| Rate for Payer: Cash Price |
$6.30
|
| Rate for Payer: Cigna Commercial |
$19.32
|
| Rate for Payer: Health EOS Commercial |
$18.69
|
| Rate for Payer: HFN Commercial |
$19.32
|
| Rate for Payer: Multiplan Commercial |
$16.80
|
| Rate for Payer: NAPHCARE Commercial |
$12.60
|
| Rate for Payer: Preferred Network Access Commercial |
$19.32
|
| Rate for Payer: Quartz Beloit One Network |
$10.29
|
| Rate for Payer: Quartz Commercial |
$12.60
|
| Rate for Payer: WEA Trust Commercial |
$11.55
|
| Rate for Payer: WPS Commercial |
$15.55
|
|
|
Urine Magnesium
|
Professional
|
Both
|
$21.00
|
|
|
Service Code
|
CPT 83735
|
| Hospital Charge Code |
3813065
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.24 |
| Max. Negotiated Rate |
$23.65 |
| Rate for Payer: Aetna Commercial |
$19.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$18.06
|
| Rate for Payer: Cash Price |
$6.30
|
| Rate for Payer: Cash Price |
$6.30
|
| Rate for Payer: Cigna Commercial |
$19.95
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$10.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12.60
|
| Rate for Payer: Health EOS Commercial |
$19.11
|
| Rate for Payer: HFN Commercial |
$19.95
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$23.65
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$23.65
|
| Rate for Payer: Multiplan Commercial |
$16.80
|
| Rate for Payer: Preferred Network Access Commercial |
$19.95
|
| Rate for Payer: Quartz Beloit One Network |
$9.24
|
| Rate for Payer: Quartz Commercial |
$11.97
|
| Rate for Payer: The Alliance Commercial |
$10.50
|
| Rate for Payer: WEA Trust Commercial |
$11.55
|
| Rate for Payer: WPS Commercial |
$15.55
|
|
|
Urine Mercury Level
|
Facility
|
OP
|
$621.00
|
|
|
Service Code
|
CPT 83825
|
| Hospital Charge Code |
2942908
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$16.26 |
| Max. Negotiated Rate |
$571.32 |
| Rate for Payer: Aetna Commercial |
$558.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$534.06
|
| Rate for Payer: Aetna Managed Medicare |
$16.26
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$60.98
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$28.46
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$26.99
|
| Rate for Payer: Anthem Medicaid |
$16.80
|
| Rate for Payer: Anthem Medicare Advantage |
$16.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$329.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$16.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$16.26
|
| Rate for Payer: Cash Price |
$186.30
|
| Rate for Payer: Cash Price |
$186.30
|
| Rate for Payer: Cigna Commercial |
$571.32
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$16.26
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$16.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$347.51
|
| Rate for Payer: Dean Health Medicaid |
$16.80
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$16.26
|
| Rate for Payer: Health EOS Commercial |
$552.69
|
| Rate for Payer: HFN Commercial |
$571.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$60.49
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$16.26
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$16.80
|
| Rate for Payer: Independent Care Health Plan Medicare |
$16.26
|
| Rate for Payer: Managed Health Services Medicaid |
$17.47
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$16.26
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$16.26
|
| Rate for Payer: Multiplan Commercial |
$496.80
|
| Rate for Payer: NAPHCARE Commercial |
$24.39
|
| Rate for Payer: Preferred Network Access Commercial |
$571.32
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$16.80
|
| Rate for Payer: Quartz Beloit One Network |
$304.29
|
| Rate for Payer: Quartz Commercial |
$403.65
|
| Rate for Payer: Quartz Medicare Advantage |
$16.26
|
| Rate for Payer: The Alliance Commercial |
$65.04
|
| Rate for Payer: United Healthcare Medicaid |
$16.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$16.26
|
| Rate for Payer: United Healthcare PPO |
$465.75
|
| Rate for Payer: WEA Trust Commercial |
$341.55
|
| Rate for Payer: Wellcare Medicare |
$16.26
|
| Rate for Payer: WMAP Medicaid |
$16.80
|
| Rate for Payer: WPS Commercial |
$459.97
|
|
|
Urine Mercury Level
|
Professional
|
Both
|
$621.00
|
|
|
Service Code
|
CPT 83825
|
| Hospital Charge Code |
2942908
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$57.40 |
| Max. Negotiated Rate |
$589.95 |
| Rate for Payer: Aetna Commercial |
$589.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$534.06
|
| Rate for Payer: Cash Price |
$186.30
|
| Rate for Payer: Cash Price |
$186.30
|
| Rate for Payer: Cigna Commercial |
$589.95
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$310.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$372.60
|
| Rate for Payer: Health EOS Commercial |
$565.11
|
| Rate for Payer: HFN Commercial |
$589.95
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$57.40
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$57.40
|
| Rate for Payer: Multiplan Commercial |
$496.80
|
| Rate for Payer: Preferred Network Access Commercial |
$589.95
|
| Rate for Payer: Quartz Beloit One Network |
$273.24
|
| Rate for Payer: Quartz Commercial |
$353.97
|
| Rate for Payer: The Alliance Commercial |
$310.50
|
| Rate for Payer: WEA Trust Commercial |
$341.55
|
| Rate for Payer: WPS Commercial |
$459.97
|
|
|
Urine Mercury Level
|
Facility
|
IP
|
$621.00
|
|
|
Service Code
|
CPT 83825
|
| Hospital Charge Code |
2942908
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$304.29 |
| Max. Negotiated Rate |
$571.32 |
| Rate for Payer: Aetna Commercial |
$558.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$534.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$329.13
|
| Rate for Payer: Cash Price |
$186.30
|
| Rate for Payer: Cigna Commercial |
$571.32
|
| Rate for Payer: Health EOS Commercial |
$552.69
|
| Rate for Payer: HFN Commercial |
$571.32
|
| Rate for Payer: Multiplan Commercial |
$496.80
|
| Rate for Payer: NAPHCARE Commercial |
$372.60
|
| Rate for Payer: Preferred Network Access Commercial |
$571.32
|
| Rate for Payer: Quartz Beloit One Network |
$304.29
|
| Rate for Payer: Quartz Commercial |
$372.60
|
| Rate for Payer: WEA Trust Commercial |
$341.55
|
| Rate for Payer: WPS Commercial |
$459.97
|
|
|
Urine Mercury Level
|
Facility
|
OP
|
$83.00
|
|
|
Service Code
|
CPT 83825
|
| Hospital Charge Code |
3986165
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$16.26 |
| Max. Negotiated Rate |
$76.36 |
| Rate for Payer: Aetna Commercial |
$74.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$71.38
|
| Rate for Payer: Aetna Managed Medicare |
$16.26
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$60.98
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$28.46
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$26.99
|
| Rate for Payer: Anthem Medicaid |
$16.80
|
| Rate for Payer: Anthem Medicare Advantage |
$16.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$43.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$16.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$16.26
|
| Rate for Payer: Cash Price |
$24.90
|
| Rate for Payer: Cash Price |
$24.90
|
| Rate for Payer: Cigna Commercial |
$76.36
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$16.26
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$16.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$46.45
|
| Rate for Payer: Dean Health Medicaid |
$16.80
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$16.26
|
| Rate for Payer: Health EOS Commercial |
$73.87
|
| Rate for Payer: HFN Commercial |
$76.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$60.49
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$16.26
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$16.80
|
| Rate for Payer: Independent Care Health Plan Medicare |
$16.26
|
| Rate for Payer: Managed Health Services Medicaid |
$17.47
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$16.26
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$16.26
|
| Rate for Payer: Multiplan Commercial |
$66.40
|
| Rate for Payer: NAPHCARE Commercial |
$24.39
|
| Rate for Payer: Preferred Network Access Commercial |
$76.36
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$16.80
|
| Rate for Payer: Quartz Beloit One Network |
$40.67
|
| Rate for Payer: Quartz Commercial |
$53.95
|
| Rate for Payer: Quartz Medicare Advantage |
$16.26
|
| Rate for Payer: The Alliance Commercial |
$65.04
|
| Rate for Payer: United Healthcare Medicaid |
$16.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$16.26
|
| Rate for Payer: United Healthcare PPO |
$62.25
|
| Rate for Payer: WEA Trust Commercial |
$45.65
|
| Rate for Payer: Wellcare Medicare |
$16.26
|
| Rate for Payer: WMAP Medicaid |
$16.80
|
| Rate for Payer: WPS Commercial |
$61.48
|
|
|
Urine Mercury Level
|
Professional
|
Both
|
$83.00
|
|
|
Service Code
|
CPT 83825
|
| Hospital Charge Code |
3986165
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$36.52 |
| Max. Negotiated Rate |
$78.85 |
| Rate for Payer: Aetna Commercial |
$78.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$71.38
|
| Rate for Payer: Cash Price |
$24.90
|
| Rate for Payer: Cash Price |
$24.90
|
| Rate for Payer: Cigna Commercial |
$78.85
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$41.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$49.80
|
| Rate for Payer: Health EOS Commercial |
$75.53
|
| Rate for Payer: HFN Commercial |
$78.85
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$57.40
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$57.40
|
| Rate for Payer: Multiplan Commercial |
$66.40
|
| Rate for Payer: Preferred Network Access Commercial |
$78.85
|
| Rate for Payer: Quartz Beloit One Network |
$36.52
|
| Rate for Payer: Quartz Commercial |
$47.31
|
| Rate for Payer: The Alliance Commercial |
$41.50
|
| Rate for Payer: WEA Trust Commercial |
$45.65
|
| Rate for Payer: WPS Commercial |
$61.48
|
|
|
Urine Mercury Level
|
Facility
|
IP
|
$83.00
|
|
|
Service Code
|
CPT 83825
|
| Hospital Charge Code |
3986165
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$40.67 |
| Max. Negotiated Rate |
$76.36 |
| Rate for Payer: Aetna Commercial |
$74.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$71.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$43.99
|
| Rate for Payer: Cash Price |
$24.90
|
| Rate for Payer: Cigna Commercial |
$76.36
|
| Rate for Payer: Health EOS Commercial |
$73.87
|
| Rate for Payer: HFN Commercial |
$76.36
|
| Rate for Payer: Multiplan Commercial |
$66.40
|
| Rate for Payer: NAPHCARE Commercial |
$49.80
|
| Rate for Payer: Preferred Network Access Commercial |
$76.36
|
| Rate for Payer: Quartz Beloit One Network |
$40.67
|
| Rate for Payer: Quartz Commercial |
$49.80
|
| Rate for Payer: WEA Trust Commercial |
$45.65
|
| Rate for Payer: WPS Commercial |
$61.48
|
|
|
URINEMETER LF SURESTEP WO FOLEY A304400A
|
Facility
|
IP
|
$399.00
|
|
| Hospital Charge Code |
5384736
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$195.51 |
| Max. Negotiated Rate |
$367.08 |
| Rate for Payer: Aetna Commercial |
$359.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$343.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$211.47
|
| Rate for Payer: Cash Price |
$119.70
|
| Rate for Payer: Cigna Commercial |
$367.08
|
| Rate for Payer: Health EOS Commercial |
$355.11
|
| Rate for Payer: HFN Commercial |
$367.08
|
| Rate for Payer: Multiplan Commercial |
$319.20
|
| Rate for Payer: NAPHCARE Commercial |
$239.40
|
| Rate for Payer: Preferred Network Access Commercial |
$367.08
|
| Rate for Payer: Quartz Beloit One Network |
$195.51
|
| Rate for Payer: Quartz Commercial |
$239.40
|
| Rate for Payer: WEA Trust Commercial |
$219.45
|
| Rate for Payer: WPS Commercial |
$295.54
|
|
|
URINEMETER LF SURESTEP WO FOLEY A304400A
|
Facility
|
OP
|
$399.00
|
|
| Hospital Charge Code |
5384736
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$111.72 |
| Max. Negotiated Rate |
$1,596.00 |
| Rate for Payer: Aetna Commercial |
$359.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$343.14
|
| Rate for Payer: Aetna Managed Medicare |
$111.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$259.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$199.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$191.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$211.47
|
| Rate for Payer: Cash Price |
$119.70
|
| Rate for Payer: Cigna Commercial |
$367.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$223.28
|
| Rate for Payer: Health EOS Commercial |
$355.11
|
| Rate for Payer: HFN Commercial |
$367.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$299.25
|
| Rate for Payer: Multiplan Commercial |
$319.20
|
| Rate for Payer: NAPHCARE Commercial |
$239.40
|
| Rate for Payer: Preferred Network Access Commercial |
$367.08
|
| Rate for Payer: Quartz Beloit One Network |
$195.51
|
| Rate for Payer: Quartz Commercial |
$259.35
|
| Rate for Payer: Quartz Medicare Advantage |
$239.40
|
| Rate for Payer: The Alliance Commercial |
$1,596.00
|
| Rate for Payer: WEA Trust Commercial |
$219.45
|
| Rate for Payer: WPS Commercial |
$295.54
|
|
