|
U Porphyrins, Fract, Qnt / 36592
|
Facility
OP
|
$119.00
|
|
|
Service Code
|
CPT 84120
|
| Hospital Charge Code |
3423526
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.71 |
| Max. Negotiated Rate |
$476.00 |
| Rate for Payer: Aetna Commercial |
$107.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$102.34
|
| Rate for Payer: Aetna Managed Medicare |
$14.71
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$55.16
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$25.74
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$24.42
|
| Rate for Payer: Anthem Medicaid |
$15.20
|
| Rate for Payer: Anthem Medicare Advantage |
$14.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$63.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$14.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$14.71
|
| Rate for Payer: Cash Price |
$35.70
|
| Rate for Payer: Cash Price |
$35.70
|
| Rate for Payer: Cigna Commercial |
$109.48
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$14.71
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$15.20
|
| Rate for Payer: Dean Health Medicaid |
$15.20
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$14.71
|
| Rate for Payer: Health EOS Commercial |
$105.91
|
| Rate for Payer: HFN Commercial |
$109.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$54.72
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$14.71
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$15.20
|
| Rate for Payer: Independent Care Health Plan Medicare |
$14.71
|
| Rate for Payer: Managed Health Services Medicaid |
$15.81
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$14.71
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$14.71
|
| Rate for Payer: Multiplan Commercial |
$95.20
|
| Rate for Payer: NAPHCARE Commercial |
$22.06
|
| Rate for Payer: Preferred Network Access Commercial |
$109.48
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$15.20
|
| Rate for Payer: Quartz Beloit One Network |
$58.31
|
| Rate for Payer: Quartz Commercial |
$77.35
|
| Rate for Payer: Quartz Medicare Advantage |
$14.71
|
| Rate for Payer: The Alliance Commercial |
$476.00
|
| Rate for Payer: United Healthcare Medicaid |
$15.20
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14.71
|
| Rate for Payer: United Healthcare PPO |
$89.25
|
| Rate for Payer: WEA Trust Commercial |
$65.45
|
| Rate for Payer: Wellcare Medicare |
$14.71
|
| Rate for Payer: WMAP Medicaid |
$15.20
|
| Rate for Payer: WPS Commercial |
$88.14
|
|
|
U Porphyrins, Fract, Qnt / 36592
|
Professional
|
$119.00
|
|
|
Service Code
|
CPT 84120
|
| Hospital Charge Code |
3423526
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.71 |
| Max. Negotiated Rate |
$113.05 |
| Rate for Payer: Aetna Commercial |
$113.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$102.34
|
| Rate for Payer: Aetna Managed Medicare |
$14.71
|
| Rate for Payer: Anthem Medicare Advantage |
$14.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$14.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$14.71
|
| Rate for Payer: Cash Price |
$35.70
|
| Rate for Payer: Cash Price |
$35.70
|
| Rate for Payer: Cigna Commercial |
$113.05
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$59.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$14.71
|
| Rate for Payer: Health EOS Commercial |
$108.29
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$51.93
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$51.93
|
| Rate for Payer: Independent Care Health Plan Medicare |
$14.71
|
| Rate for Payer: Multiplan Commercial |
$95.20
|
| Rate for Payer: Preferred Network Access Commercial |
$113.05
|
| Rate for Payer: Quartz Beloit One Network |
$52.36
|
| Rate for Payer: Quartz Commercial |
$67.83
|
| Rate for Payer: Quartz Medicare Advantage |
$14.71
|
| Rate for Payer: The Alliance Commercial |
$58.10
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14.71
|
| Rate for Payer: WEA Trust Commercial |
$65.45
|
| Rate for Payer: WPS Commercial |
$64.72
|
|
|
U-POUCH FLUID COLLECTION STERI-DRAPE 3M 1067
|
Facility
IP
|
$107.00
|
|
| Hospital Charge Code |
2963482
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$52.43 |
| Max. Negotiated Rate |
$98.44 |
| Rate for Payer: Aetna Commercial |
$96.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$56.71
|
| Rate for Payer: Cash Price |
$32.10
|
| Rate for Payer: Cigna Commercial |
$98.44
|
| Rate for Payer: Health EOS Commercial |
$95.23
|
| Rate for Payer: HFN Commercial |
$98.44
|
| Rate for Payer: Multiplan Commercial |
$85.60
|
| Rate for Payer: NAPHCARE Commercial |
$64.20
|
| Rate for Payer: Preferred Network Access Commercial |
$98.44
|
| Rate for Payer: Quartz Beloit One Network |
$52.43
|
| Rate for Payer: Quartz Commercial |
$64.20
|
| Rate for Payer: WEA Trust Commercial |
$58.85
|
| Rate for Payer: WPS Commercial |
$79.25
|
|
|
U-POUCH FLUID COLLECTION STERI-DRAPE 3M 1067
|
Facility
OP
|
$107.00
|
|
| Hospital Charge Code |
2963482
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$29.96 |
| Max. Negotiated Rate |
$428.00 |
| Rate for Payer: Aetna Commercial |
$96.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$92.02
|
| Rate for Payer: Aetna Managed Medicare |
$29.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$69.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$53.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$51.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$56.71
|
| Rate for Payer: Cash Price |
$32.10
|
| Rate for Payer: Cigna Commercial |
$98.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$59.88
|
| Rate for Payer: Health EOS Commercial |
$95.23
|
| Rate for Payer: HFN Commercial |
$98.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$80.25
|
| Rate for Payer: Multiplan Commercial |
$85.60
|
| Rate for Payer: NAPHCARE Commercial |
$64.20
|
| Rate for Payer: Preferred Network Access Commercial |
$98.44
|
| Rate for Payer: Quartz Beloit One Network |
$52.43
|
| Rate for Payer: Quartz Commercial |
$69.55
|
| Rate for Payer: Quartz Medicare Advantage |
$64.20
|
| Rate for Payer: The Alliance Commercial |
$428.00
|
| Rate for Payer: WEA Trust Commercial |
$58.85
|
| Rate for Payer: WPS Commercial |
$79.25
|
|
|
UPPER GI ENDOSCOPY, BIOPSY 43239
|
Professional
|
$1,747.00
|
|
|
Service Code
|
CPT 43239
|
| Hospital Charge Code |
3014656
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$128.50 |
| Max. Negotiated Rate |
$1,659.65 |
| Rate for Payer: Aetna Commercial |
$1,659.65
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,502.42
|
| Rate for Payer: Aetna Managed Medicare |
$128.50
|
| Rate for Payer: Anthem Medicare Advantage |
$128.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$128.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$128.50
|
| Rate for Payer: Cash Price |
$524.10
|
| Rate for Payer: Cash Price |
$524.10
|
| Rate for Payer: Cigna Commercial |
$1,659.65
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$873.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$128.50
|
| Rate for Payer: Health EOS Commercial |
$1,589.77
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$462.82
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$462.82
|
| Rate for Payer: Independent Care Health Plan Medicare |
$128.50
|
| Rate for Payer: Multiplan Commercial |
$1,397.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,659.65
|
| Rate for Payer: Quartz Beloit One Network |
$768.68
|
| Rate for Payer: Quartz Commercial |
$995.79
|
| Rate for Payer: Quartz Medicare Advantage |
$128.50
|
| Rate for Payer: The Alliance Commercial |
$546.12
|
| Rate for Payer: United Healthcare Medicaid |
$301.74
|
| Rate for Payer: United Healthcare Medicare Advantage |
$128.50
|
| Rate for Payer: WEA Trust Commercial |
$960.85
|
| Rate for Payer: WPS Commercial |
$578.25
|
|
|
UPPER LIMB AND TOE AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS WITH CC
|
Facility
IP
|
$43,913.00
|
|
|
Service Code
|
MS-DRG 256
|
| Min. Negotiated Rate |
$15,796.20 |
| Max. Negotiated Rate |
$43,913.00 |
| Rate for Payer: Aetna Managed Medicare |
$15,796.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$34,407.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$26,372.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$25,055.92
|
| Rate for Payer: Anthem Medicare Advantage |
$15,796.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$15,796.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$15,796.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$15,796.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$27,814.37
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$15,796.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$31,974.15
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$15,796.20
|
| Rate for Payer: Independent Care Health Plan Medicare |
$15,796.20
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$15,796.20
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$15,796.20
|
| Rate for Payer: NAPHCARE Commercial |
$23,694.30
|
| Rate for Payer: Quartz Medicare Advantage |
$15,796.20
|
| Rate for Payer: The Alliance Commercial |
$43,913.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$15,796.20
|
| Rate for Payer: United Healthcare PPO |
$24,892.29
|
| Rate for Payer: Wellcare Medicare |
$15,796.20
|
|
|
UPPER LIMB AND TOE AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS WITH MCC
|
Facility
IP
|
$73,363.00
|
|
|
Service Code
|
MS-DRG 255
|
| Min. Negotiated Rate |
$26,389.48 |
| Max. Negotiated Rate |
$73,363.00 |
| Rate for Payer: Aetna Managed Medicare |
$26,389.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$57,695.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$44,222.75
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$42,014.50
|
| Rate for Payer: Anthem Medicare Advantage |
$26,389.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$26,389.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$26,389.48
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$26,389.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$46,639.94
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$26,389.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$53,574.30
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$26,389.48
|
| Rate for Payer: Independent Care Health Plan Medicare |
$26,389.48
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$26,389.48
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$26,389.48
|
| Rate for Payer: NAPHCARE Commercial |
$39,584.22
|
| Rate for Payer: Quartz Medicare Advantage |
$26,389.48
|
| Rate for Payer: The Alliance Commercial |
$73,363.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$26,389.48
|
| Rate for Payer: United Healthcare PPO |
$41,708.28
|
| Rate for Payer: Wellcare Medicare |
$26,389.48
|
|
|
UPPER LIMB AND TOE AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS WITHOUT CC/MCC
|
Facility
IP
|
$26,667.00
|
|
|
Service Code
|
MS-DRG 257
|
| Min. Negotiated Rate |
$9,592.50 |
| Max. Negotiated Rate |
$26,667.00 |
| Rate for Payer: Aetna Managed Medicare |
$9,592.50
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$20,770.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$15,920.19
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$15,125.22
|
| Rate for Payer: Anthem Medicare Advantage |
$9,592.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$9,592.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$9,592.50
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$9,592.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$16,790.38
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$9,592.50
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$19,324.50
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$9,592.50
|
| Rate for Payer: Independent Care Health Plan Medicare |
$9,592.50
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$9,592.50
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$9,592.50
|
| Rate for Payer: NAPHCARE Commercial |
$14,388.75
|
| Rate for Payer: Quartz Medicare Advantage |
$9,592.50
|
| Rate for Payer: The Alliance Commercial |
$26,667.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$9,592.50
|
| Rate for Payer: United Healthcare PPO |
$15,044.37
|
| Rate for Payer: Wellcare Medicare |
$9,592.50
|
|
|
Upper limb orthosis NOS L3999
|
Facility
IP
|
$568.00
|
|
|
Service Code
|
HCPCS L3999
|
| Hospital Charge Code |
3165660
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$278.32 |
| Max. Negotiated Rate |
$522.56 |
| Rate for Payer: Aetna Commercial |
$511.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$301.04
|
| Rate for Payer: Cash Price |
$170.40
|
| Rate for Payer: Cigna Commercial |
$522.56
|
| Rate for Payer: Health EOS Commercial |
$505.52
|
| Rate for Payer: HFN Commercial |
$522.56
|
| Rate for Payer: Multiplan Commercial |
$454.40
|
| Rate for Payer: NAPHCARE Commercial |
$340.80
|
| Rate for Payer: Preferred Network Access Commercial |
$522.56
|
| Rate for Payer: Quartz Beloit One Network |
$278.32
|
| Rate for Payer: Quartz Commercial |
$340.80
|
| Rate for Payer: WEA Trust Commercial |
$312.40
|
| Rate for Payer: WPS Commercial |
$420.72
|
|
|
Upper limb orthosis NOS L3999
|
Facility
OP
|
$568.00
|
|
|
Service Code
|
HCPCS L3999
|
| Hospital Charge Code |
3165660
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$159.04 |
| Max. Negotiated Rate |
$2,272.00 |
| Rate for Payer: Aetna Commercial |
$511.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$488.48
|
| Rate for Payer: Aetna Managed Medicare |
$159.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$369.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$284.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$272.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$301.04
|
| Rate for Payer: Cash Price |
$170.40
|
| Rate for Payer: Cigna Commercial |
$522.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$317.85
|
| Rate for Payer: Health EOS Commercial |
$505.52
|
| Rate for Payer: HFN Commercial |
$522.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$426.00
|
| Rate for Payer: Multiplan Commercial |
$454.40
|
| Rate for Payer: NAPHCARE Commercial |
$340.80
|
| Rate for Payer: Preferred Network Access Commercial |
$522.56
|
| Rate for Payer: Quartz Beloit One Network |
$278.32
|
| Rate for Payer: Quartz Commercial |
$369.20
|
| Rate for Payer: Quartz Medicare Advantage |
$340.80
|
| Rate for Payer: The Alliance Commercial |
$2,272.00
|
| Rate for Payer: WEA Trust Commercial |
$312.40
|
| Rate for Payer: WPS Commercial |
$420.72
|
|
|
Upper limb orthosis NOS L3999
|
Professional
|
$568.00
|
|
|
Service Code
|
HCPCS L3999
|
| Hospital Charge Code |
3165660
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$249.92 |
| Max. Negotiated Rate |
$539.60 |
| Rate for Payer: Aetna Commercial |
$539.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$488.48
|
| Rate for Payer: Cash Price |
$170.40
|
| Rate for Payer: Cigna Commercial |
$539.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$284.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$340.80
|
| Rate for Payer: Health EOS Commercial |
$516.88
|
| Rate for Payer: Multiplan Commercial |
$454.40
|
| Rate for Payer: Preferred Network Access Commercial |
$539.60
|
| Rate for Payer: Quartz Beloit One Network |
$249.92
|
| Rate for Payer: Quartz Commercial |
$323.76
|
| Rate for Payer: The Alliance Commercial |
$284.00
|
| Rate for Payer: WEA Trust Commercial |
$312.40
|
| Rate for Payer: WPS Commercial |
$420.72
|
|
|
Upp ext fx orthosis humeral L3980
|
Facility
OP
|
$248.00
|
|
|
Service Code
|
HCPCS L3980
|
| Hospital Charge Code |
3353515
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$69.44 |
| Max. Negotiated Rate |
$992.00 |
| Rate for Payer: Aetna Commercial |
$223.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$213.28
|
| Rate for Payer: Aetna Managed Medicare |
$69.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$200.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$200.35
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$200.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$131.44
|
| Rate for Payer: Cash Price |
$74.40
|
| Rate for Payer: Cash Price |
$74.40
|
| Rate for Payer: Cigna Commercial |
$228.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$138.78
|
| Rate for Payer: Health EOS Commercial |
$220.72
|
| Rate for Payer: HFN Commercial |
$228.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$186.00
|
| Rate for Payer: Multiplan Commercial |
$198.40
|
| Rate for Payer: NAPHCARE Commercial |
$148.80
|
| Rate for Payer: Preferred Network Access Commercial |
$228.16
|
| Rate for Payer: Quartz Beloit One Network |
$121.52
|
| Rate for Payer: Quartz Commercial |
$161.20
|
| Rate for Payer: Quartz Medicare Advantage |
$148.80
|
| Rate for Payer: The Alliance Commercial |
$992.00
|
| Rate for Payer: WEA Trust Commercial |
$136.40
|
| Rate for Payer: WPS Commercial |
$183.69
|
|
|
Upp ext fx orthosis humeral L3980
|
Professional
|
$248.00
|
|
|
Service Code
|
HCPCS L3980
|
| Hospital Charge Code |
3353515
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$109.12 |
| Max. Negotiated Rate |
$1,247.61 |
| Rate for Payer: Aetna Commercial |
$235.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$213.28
|
| Rate for Payer: Cash Price |
$74.40
|
| Rate for Payer: Cash Price |
$74.40
|
| Rate for Payer: Cigna Commercial |
$235.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$124.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$148.80
|
| Rate for Payer: Health EOS Commercial |
$225.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,247.61
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,247.61
|
| Rate for Payer: Multiplan Commercial |
$198.40
|
| Rate for Payer: Preferred Network Access Commercial |
$235.60
|
| Rate for Payer: Quartz Beloit One Network |
$109.12
|
| Rate for Payer: Quartz Commercial |
$141.36
|
| Rate for Payer: The Alliance Commercial |
$124.00
|
| Rate for Payer: WEA Trust Commercial |
$136.40
|
| Rate for Payer: WPS Commercial |
$183.69
|
|
|
Upp ext fx orthosis humeral L3980
|
Facility
IP
|
$248.00
|
|
|
Service Code
|
HCPCS L3980
|
| Hospital Charge Code |
3353515
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$121.52 |
| Max. Negotiated Rate |
$228.16 |
| Rate for Payer: Aetna Commercial |
$223.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$131.44
|
| Rate for Payer: Cash Price |
$74.40
|
| Rate for Payer: Cigna Commercial |
$228.16
|
| Rate for Payer: Health EOS Commercial |
$220.72
|
| Rate for Payer: HFN Commercial |
$228.16
|
| Rate for Payer: Multiplan Commercial |
$198.40
|
| Rate for Payer: NAPHCARE Commercial |
$148.80
|
| Rate for Payer: Preferred Network Access Commercial |
$228.16
|
| Rate for Payer: Quartz Beloit One Network |
$121.52
|
| Rate for Payer: Quartz Commercial |
$148.80
|
| Rate for Payer: WEA Trust Commercial |
$136.40
|
| Rate for Payer: WPS Commercial |
$183.69
|
|
|
UPPR GI ENDOSCOPY, DIAGNOSIS 43235
|
Professional
|
$1,581.00
|
|
|
Service Code
|
CPT 43235
|
| Hospital Charge Code |
3014654
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$113.83 |
| Max. Negotiated Rate |
$1,501.95 |
| Rate for Payer: Aetna Commercial |
$1,501.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,359.66
|
| Rate for Payer: Aetna Managed Medicare |
$113.83
|
| Rate for Payer: Anthem Medicare Advantage |
$113.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$113.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$113.83
|
| Rate for Payer: Cash Price |
$474.30
|
| Rate for Payer: Cash Price |
$474.30
|
| Rate for Payer: Cigna Commercial |
$1,501.95
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$790.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$113.83
|
| Rate for Payer: Health EOS Commercial |
$1,438.71
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$409.27
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$409.27
|
| Rate for Payer: Independent Care Health Plan Medicare |
$113.83
|
| Rate for Payer: Multiplan Commercial |
$1,264.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,501.95
|
| Rate for Payer: Quartz Beloit One Network |
$695.64
|
| Rate for Payer: Quartz Commercial |
$901.17
|
| Rate for Payer: Quartz Medicare Advantage |
$113.83
|
| Rate for Payer: The Alliance Commercial |
$483.78
|
| Rate for Payer: United Healthcare Medicaid |
$260.40
|
| Rate for Payer: United Healthcare Medicare Advantage |
$113.83
|
| Rate for Payer: WEA Trust Commercial |
$869.55
|
| Rate for Payer: WPS Commercial |
$512.24
|
|
|
Urea Nitrogen 24 Hour Urine
|
Professional
|
$118.00
|
|
|
Service Code
|
CPT 84540
|
| Hospital Charge Code |
633856
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.56 |
| Max. Negotiated Rate |
$112.10 |
| Rate for Payer: Aetna Commercial |
$112.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$101.48
|
| Rate for Payer: Aetna Managed Medicare |
$5.56
|
| Rate for Payer: Anthem Medicare Advantage |
$5.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5.56
|
| Rate for Payer: Cash Price |
$35.40
|
| Rate for Payer: Cash Price |
$35.40
|
| Rate for Payer: Cigna Commercial |
$112.10
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$59.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5.56
|
| Rate for Payer: Health EOS Commercial |
$107.38
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$19.63
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$19.63
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5.56
|
| Rate for Payer: Multiplan Commercial |
$94.40
|
| Rate for Payer: Preferred Network Access Commercial |
$112.10
|
| Rate for Payer: Quartz Beloit One Network |
$51.92
|
| Rate for Payer: Quartz Commercial |
$67.26
|
| Rate for Payer: Quartz Medicare Advantage |
$5.56
|
| Rate for Payer: The Alliance Commercial |
$21.96
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.56
|
| Rate for Payer: WEA Trust Commercial |
$64.90
|
| Rate for Payer: WPS Commercial |
$24.46
|
|
|
Urea Nitrogen 24 Hour Urine
|
Facility
IP
|
$118.00
|
|
|
Service Code
|
CPT 84540
|
| Hospital Charge Code |
633856
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$57.82 |
| Max. Negotiated Rate |
$108.56 |
| Rate for Payer: Aetna Commercial |
$106.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$62.54
|
| Rate for Payer: Cash Price |
$35.40
|
| Rate for Payer: Cigna Commercial |
$108.56
|
| Rate for Payer: Health EOS Commercial |
$105.02
|
| Rate for Payer: HFN Commercial |
$108.56
|
| Rate for Payer: Multiplan Commercial |
$94.40
|
| Rate for Payer: NAPHCARE Commercial |
$70.80
|
| Rate for Payer: Preferred Network Access Commercial |
$108.56
|
| Rate for Payer: Quartz Beloit One Network |
$57.82
|
| Rate for Payer: Quartz Commercial |
$70.80
|
| Rate for Payer: WEA Trust Commercial |
$64.90
|
| Rate for Payer: WPS Commercial |
$87.40
|
|
|
Urea Nitrogen 24 Hour Urine
|
Facility
OP
|
$118.00
|
|
|
Service Code
|
CPT 84540
|
| Hospital Charge Code |
633856
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.56 |
| Max. Negotiated Rate |
$472.00 |
| Rate for Payer: Aetna Commercial |
$106.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$101.48
|
| Rate for Payer: Aetna Managed Medicare |
$5.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$20.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$9.73
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$9.23
|
| Rate for Payer: Anthem Medicaid |
$5.75
|
| Rate for Payer: Anthem Medicare Advantage |
$5.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$62.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5.56
|
| Rate for Payer: Cash Price |
$35.40
|
| Rate for Payer: Cash Price |
$35.40
|
| Rate for Payer: Cigna Commercial |
$108.56
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$5.56
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$5.75
|
| Rate for Payer: Dean Health Medicaid |
$5.75
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$5.56
|
| Rate for Payer: Health EOS Commercial |
$105.02
|
| Rate for Payer: HFN Commercial |
$108.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$20.68
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$5.56
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$5.75
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5.56
|
| Rate for Payer: Managed Health Services Medicaid |
$5.98
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$5.56
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$5.56
|
| Rate for Payer: Multiplan Commercial |
$94.40
|
| Rate for Payer: NAPHCARE Commercial |
$8.34
|
| Rate for Payer: Preferred Network Access Commercial |
$108.56
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$5.75
|
| Rate for Payer: Quartz Beloit One Network |
$57.82
|
| Rate for Payer: Quartz Commercial |
$76.70
|
| Rate for Payer: Quartz Medicare Advantage |
$5.56
|
| Rate for Payer: The Alliance Commercial |
$472.00
|
| Rate for Payer: United Healthcare Medicaid |
$5.75
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.56
|
| Rate for Payer: United Healthcare PPO |
$88.50
|
| Rate for Payer: WEA Trust Commercial |
$64.90
|
| Rate for Payer: Wellcare Medicare |
$5.56
|
| Rate for Payer: WMAP Medicaid |
$5.75
|
| Rate for Payer: WPS Commercial |
$87.40
|
|
|
Urea Nitrogen, PDI Fluid
|
Professional
|
$66.00
|
|
|
Service Code
|
CPT 84520
|
| Hospital Charge Code |
3172168
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.95 |
| Max. Negotiated Rate |
$62.70 |
| Rate for Payer: Aetna Commercial |
$62.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$56.76
|
| Rate for Payer: Aetna Managed Medicare |
$3.95
|
| Rate for Payer: Anthem Medicare Advantage |
$3.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$3.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$3.95
|
| Rate for Payer: Cash Price |
$19.80
|
| Rate for Payer: Cash Price |
$19.80
|
| Rate for Payer: Cigna Commercial |
$62.70
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$33.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3.95
|
| Rate for Payer: Health EOS Commercial |
$60.06
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$13.94
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$13.94
|
| Rate for Payer: Independent Care Health Plan Medicare |
$3.95
|
| Rate for Payer: Multiplan Commercial |
$52.80
|
| Rate for Payer: Preferred Network Access Commercial |
$62.70
|
| Rate for Payer: Quartz Beloit One Network |
$29.04
|
| Rate for Payer: Quartz Commercial |
$37.62
|
| Rate for Payer: Quartz Medicare Advantage |
$3.95
|
| Rate for Payer: The Alliance Commercial |
$15.60
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3.95
|
| Rate for Payer: WEA Trust Commercial |
$36.30
|
| Rate for Payer: WPS Commercial |
$17.38
|
|
|
Urea Nitrogen, PDI Fluid
|
Facility
OP
|
$66.00
|
|
|
Service Code
|
CPT 84520
|
| Hospital Charge Code |
3172168
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.95 |
| Max. Negotiated Rate |
$264.00 |
| Rate for Payer: Aetna Commercial |
$59.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$56.76
|
| Rate for Payer: Aetna Managed Medicare |
$3.95
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$14.81
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$6.91
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$6.56
|
| Rate for Payer: Anthem Medicaid |
$4.08
|
| Rate for Payer: Anthem Medicare Advantage |
$3.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$34.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$3.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$3.95
|
| Rate for Payer: Cash Price |
$19.80
|
| Rate for Payer: Cash Price |
$19.80
|
| Rate for Payer: Cigna Commercial |
$60.72
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$3.95
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$4.08
|
| Rate for Payer: Dean Health Medicaid |
$4.08
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$3.95
|
| Rate for Payer: Health EOS Commercial |
$58.74
|
| Rate for Payer: HFN Commercial |
$60.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$14.69
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$3.95
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$4.08
|
| Rate for Payer: Independent Care Health Plan Medicare |
$3.95
|
| Rate for Payer: Managed Health Services Medicaid |
$4.24
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$3.95
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$3.95
|
| Rate for Payer: Multiplan Commercial |
$52.80
|
| Rate for Payer: NAPHCARE Commercial |
$5.92
|
| Rate for Payer: Preferred Network Access Commercial |
$60.72
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$4.08
|
| Rate for Payer: Quartz Beloit One Network |
$32.34
|
| Rate for Payer: Quartz Commercial |
$42.90
|
| Rate for Payer: Quartz Medicare Advantage |
$3.95
|
| Rate for Payer: The Alliance Commercial |
$264.00
|
| Rate for Payer: United Healthcare Medicaid |
$4.08
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3.95
|
| Rate for Payer: United Healthcare PPO |
$49.50
|
| Rate for Payer: WEA Trust Commercial |
$36.30
|
| Rate for Payer: Wellcare Medicare |
$3.95
|
| Rate for Payer: WMAP Medicaid |
$4.08
|
| Rate for Payer: WPS Commercial |
$48.89
|
|
|
Urea Nitrogen, PDI Fluid
|
Facility
IP
|
$66.00
|
|
|
Service Code
|
CPT 84520
|
| Hospital Charge Code |
3172168
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$32.34 |
| Max. Negotiated Rate |
$60.72 |
| Rate for Payer: Aetna Commercial |
$59.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$34.98
|
| Rate for Payer: Cash Price |
$19.80
|
| Rate for Payer: Cigna Commercial |
$60.72
|
| Rate for Payer: Health EOS Commercial |
$58.74
|
| Rate for Payer: HFN Commercial |
$60.72
|
| Rate for Payer: Multiplan Commercial |
$52.80
|
| Rate for Payer: NAPHCARE Commercial |
$39.60
|
| Rate for Payer: Preferred Network Access Commercial |
$60.72
|
| Rate for Payer: Quartz Beloit One Network |
$32.34
|
| Rate for Payer: Quartz Commercial |
$39.60
|
| Rate for Payer: WEA Trust Commercial |
$36.30
|
| Rate for Payer: WPS Commercial |
$48.89
|
|
|
Urea Nitrogen Urine
|
Facility
IP
|
$76.00
|
|
|
Service Code
|
CPT 84520
|
| Hospital Charge Code |
633857
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$37.24 |
| Max. Negotiated Rate |
$69.92 |
| Rate for Payer: Aetna Commercial |
$68.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$40.28
|
| Rate for Payer: Cash Price |
$22.80
|
| Rate for Payer: Cigna Commercial |
$69.92
|
| Rate for Payer: Health EOS Commercial |
$67.64
|
| Rate for Payer: HFN Commercial |
$69.92
|
| Rate for Payer: Multiplan Commercial |
$60.80
|
| Rate for Payer: NAPHCARE Commercial |
$45.60
|
| Rate for Payer: Preferred Network Access Commercial |
$69.92
|
| Rate for Payer: Quartz Beloit One Network |
$37.24
|
| Rate for Payer: Quartz Commercial |
$45.60
|
| Rate for Payer: WEA Trust Commercial |
$41.80
|
| Rate for Payer: WPS Commercial |
$56.29
|
|
|
Urea Nitrogen Urine
|
Professional
|
$76.00
|
|
|
Service Code
|
CPT 84520
|
| Hospital Charge Code |
633857
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.95 |
| Max. Negotiated Rate |
$72.20 |
| Rate for Payer: Aetna Commercial |
$72.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$65.36
|
| Rate for Payer: Aetna Managed Medicare |
$3.95
|
| Rate for Payer: Anthem Medicare Advantage |
$3.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$3.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$3.95
|
| Rate for Payer: Cash Price |
$22.80
|
| Rate for Payer: Cash Price |
$22.80
|
| Rate for Payer: Cigna Commercial |
$72.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$38.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3.95
|
| Rate for Payer: Health EOS Commercial |
$69.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$13.94
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$13.94
|
| Rate for Payer: Independent Care Health Plan Medicare |
$3.95
|
| Rate for Payer: Multiplan Commercial |
$60.80
|
| Rate for Payer: Preferred Network Access Commercial |
$72.20
|
| Rate for Payer: Quartz Beloit One Network |
$33.44
|
| Rate for Payer: Quartz Commercial |
$43.32
|
| Rate for Payer: Quartz Medicare Advantage |
$3.95
|
| Rate for Payer: The Alliance Commercial |
$15.60
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3.95
|
| Rate for Payer: WEA Trust Commercial |
$41.80
|
| Rate for Payer: WPS Commercial |
$17.38
|
|
|
Urea Nitrogen Urine
|
Facility
OP
|
$76.00
|
|
|
Service Code
|
CPT 84520
|
| Hospital Charge Code |
633857
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.95 |
| Max. Negotiated Rate |
$304.00 |
| Rate for Payer: Aetna Commercial |
$68.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$65.36
|
| Rate for Payer: Aetna Managed Medicare |
$3.95
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$14.81
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$6.91
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$6.56
|
| Rate for Payer: Anthem Medicaid |
$4.08
|
| Rate for Payer: Anthem Medicare Advantage |
$3.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$40.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$3.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$3.95
|
| Rate for Payer: Cash Price |
$22.80
|
| Rate for Payer: Cash Price |
$22.80
|
| Rate for Payer: Cigna Commercial |
$69.92
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$3.95
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$4.08
|
| Rate for Payer: Dean Health Medicaid |
$4.08
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$3.95
|
| Rate for Payer: Health EOS Commercial |
$67.64
|
| Rate for Payer: HFN Commercial |
$69.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$14.69
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$3.95
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$4.08
|
| Rate for Payer: Independent Care Health Plan Medicare |
$3.95
|
| Rate for Payer: Managed Health Services Medicaid |
$4.24
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$3.95
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$3.95
|
| Rate for Payer: Multiplan Commercial |
$60.80
|
| Rate for Payer: NAPHCARE Commercial |
$5.92
|
| Rate for Payer: Preferred Network Access Commercial |
$69.92
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$4.08
|
| Rate for Payer: Quartz Beloit One Network |
$37.24
|
| Rate for Payer: Quartz Commercial |
$49.40
|
| Rate for Payer: Quartz Medicare Advantage |
$3.95
|
| Rate for Payer: The Alliance Commercial |
$304.00
|
| Rate for Payer: United Healthcare Medicaid |
$4.08
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3.95
|
| Rate for Payer: United Healthcare PPO |
$57.00
|
| Rate for Payer: WEA Trust Commercial |
$41.80
|
| Rate for Payer: Wellcare Medicare |
$3.95
|
| Rate for Payer: WMAP Medicaid |
$4.08
|
| Rate for Payer: WPS Commercial |
$56.29
|
|
|
Urea Nitrogen, Urine
|
Professional
|
$30.00
|
|
|
Service Code
|
CPT 84540
|
| Hospital Charge Code |
5474701
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.56 |
| Max. Negotiated Rate |
$28.50 |
| Rate for Payer: Aetna Commercial |
$28.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$25.80
|
| Rate for Payer: Aetna Managed Medicare |
$5.56
|
| Rate for Payer: Anthem Medicare Advantage |
$5.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5.56
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Cigna Commercial |
$28.50
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$15.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5.56
|
| Rate for Payer: Health EOS Commercial |
$27.30
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$19.63
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$19.63
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5.56
|
| Rate for Payer: Multiplan Commercial |
$24.00
|
| Rate for Payer: Preferred Network Access Commercial |
$28.50
|
| Rate for Payer: Quartz Beloit One Network |
$13.20
|
| Rate for Payer: Quartz Commercial |
$17.10
|
| Rate for Payer: Quartz Medicare Advantage |
$5.56
|
| Rate for Payer: The Alliance Commercial |
$21.96
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.56
|
| Rate for Payer: WEA Trust Commercial |
$16.50
|
| Rate for Payer: WPS Commercial |
$24.46
|
|
