|
Urine Creatinine, Stone Risk Diagnostic Profile
|
Professional
|
$102.00
|
|
|
Service Code
|
CPT 82570
|
| Hospital Charge Code |
2943038
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.18 |
| Max. Negotiated Rate |
$96.90 |
| Rate for Payer: Aetna Commercial |
$96.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$87.72
|
| Rate for Payer: Aetna Managed Medicare |
$5.18
|
| Rate for Payer: Anthem Medicare Advantage |
$5.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5.18
|
| Rate for Payer: Cash Price |
$30.60
|
| Rate for Payer: Cash Price |
$30.60
|
| Rate for Payer: Cigna Commercial |
$96.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$51.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5.18
|
| Rate for Payer: Health EOS Commercial |
$92.82
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$18.29
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$18.29
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5.18
|
| Rate for Payer: Multiplan Commercial |
$81.60
|
| Rate for Payer: Preferred Network Access Commercial |
$96.90
|
| Rate for Payer: Quartz Beloit One Network |
$44.88
|
| Rate for Payer: Quartz Commercial |
$58.14
|
| Rate for Payer: Quartz Medicare Advantage |
$5.18
|
| Rate for Payer: The Alliance Commercial |
$20.46
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.18
|
| Rate for Payer: WEA Trust Commercial |
$56.10
|
| Rate for Payer: WPS Commercial |
$22.79
|
|
|
Urine Creatinine, Stone Risk Diagnostic Profile
|
Facility
OP
|
$102.00
|
|
|
Service Code
|
CPT 82570
|
| Hospital Charge Code |
2943038
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.18 |
| Max. Negotiated Rate |
$408.00 |
| Rate for Payer: Aetna Commercial |
$91.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$87.72
|
| Rate for Payer: Aetna Managed Medicare |
$5.18
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$19.42
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$9.06
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$8.60
|
| Rate for Payer: Anthem Medicaid |
$5.35
|
| Rate for Payer: Anthem Medicare Advantage |
$5.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$54.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5.18
|
| Rate for Payer: Cash Price |
$30.60
|
| Rate for Payer: Cash Price |
$30.60
|
| Rate for Payer: Cigna Commercial |
$93.84
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$5.18
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$5.35
|
| Rate for Payer: Dean Health Medicaid |
$5.35
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$5.18
|
| Rate for Payer: Health EOS Commercial |
$90.78
|
| Rate for Payer: HFN Commercial |
$93.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$19.27
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$5.18
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$5.35
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5.18
|
| Rate for Payer: Managed Health Services Medicaid |
$5.56
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$5.18
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$5.18
|
| Rate for Payer: Multiplan Commercial |
$81.60
|
| Rate for Payer: NAPHCARE Commercial |
$7.77
|
| Rate for Payer: Preferred Network Access Commercial |
$93.84
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$5.35
|
| Rate for Payer: Quartz Beloit One Network |
$49.98
|
| Rate for Payer: Quartz Commercial |
$66.30
|
| Rate for Payer: Quartz Medicare Advantage |
$5.18
|
| Rate for Payer: The Alliance Commercial |
$408.00
|
| Rate for Payer: United Healthcare Medicaid |
$5.35
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.18
|
| Rate for Payer: United Healthcare PPO |
$76.50
|
| Rate for Payer: WEA Trust Commercial |
$56.10
|
| Rate for Payer: Wellcare Medicare |
$5.18
|
| Rate for Payer: WMAP Medicaid |
$5.35
|
| Rate for Payer: WPS Commercial |
$75.55
|
|
|
Urine Creatinine, Stone Risk Diagnostic Profile
|
Facility
IP
|
$102.00
|
|
|
Service Code
|
CPT 82570
|
| Hospital Charge Code |
2943038
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$49.98 |
| Max. Negotiated Rate |
$93.84 |
| Rate for Payer: Aetna Commercial |
$91.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$54.06
|
| Rate for Payer: Cash Price |
$30.60
|
| Rate for Payer: Cigna Commercial |
$93.84
|
| Rate for Payer: Health EOS Commercial |
$90.78
|
| Rate for Payer: HFN Commercial |
$93.84
|
| Rate for Payer: Multiplan Commercial |
$81.60
|
| Rate for Payer: NAPHCARE Commercial |
$61.20
|
| Rate for Payer: Preferred Network Access Commercial |
$93.84
|
| Rate for Payer: Quartz Beloit One Network |
$49.98
|
| Rate for Payer: Quartz Commercial |
$61.20
|
| Rate for Payer: WEA Trust Commercial |
$56.10
|
| Rate for Payer: WPS Commercial |
$75.55
|
|
|
Urine Culture
|
Professional
|
$201.00
|
|
|
Service Code
|
CPT 87086
|
| Hospital Charge Code |
633907
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.07 |
| Max. Negotiated Rate |
$190.95 |
| Rate for Payer: Aetna Commercial |
$190.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$172.86
|
| Rate for Payer: Aetna Managed Medicare |
$8.07
|
| Rate for Payer: Anthem Medicare Advantage |
$8.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$8.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$8.07
|
| Rate for Payer: Cash Price |
$60.30
|
| Rate for Payer: Cash Price |
$60.30
|
| Rate for Payer: Cigna Commercial |
$190.95
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$100.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$8.07
|
| Rate for Payer: Health EOS Commercial |
$182.91
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$28.49
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$28.49
|
| Rate for Payer: Independent Care Health Plan Medicare |
$8.07
|
| Rate for Payer: Multiplan Commercial |
$160.80
|
| Rate for Payer: Preferred Network Access Commercial |
$190.95
|
| Rate for Payer: Quartz Beloit One Network |
$88.44
|
| Rate for Payer: Quartz Commercial |
$114.57
|
| Rate for Payer: Quartz Medicare Advantage |
$8.07
|
| Rate for Payer: The Alliance Commercial |
$31.88
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8.07
|
| Rate for Payer: WEA Trust Commercial |
$110.55
|
| Rate for Payer: WPS Commercial |
$35.51
|
|
|
Urine Culture
|
Facility
IP
|
$201.00
|
|
|
Service Code
|
CPT 87086
|
| Hospital Charge Code |
633907
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$98.49 |
| Max. Negotiated Rate |
$184.92 |
| Rate for Payer: Aetna Commercial |
$180.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$106.53
|
| Rate for Payer: Cash Price |
$60.30
|
| Rate for Payer: Cigna Commercial |
$184.92
|
| Rate for Payer: Health EOS Commercial |
$178.89
|
| Rate for Payer: HFN Commercial |
$184.92
|
| Rate for Payer: Multiplan Commercial |
$160.80
|
| Rate for Payer: NAPHCARE Commercial |
$120.60
|
| Rate for Payer: Preferred Network Access Commercial |
$184.92
|
| Rate for Payer: Quartz Beloit One Network |
$98.49
|
| Rate for Payer: Quartz Commercial |
$120.60
|
| Rate for Payer: WEA Trust Commercial |
$110.55
|
| Rate for Payer: WPS Commercial |
$148.88
|
|
|
Urine Culture
|
Facility
OP
|
$201.00
|
|
|
Service Code
|
CPT 87086
|
| Hospital Charge Code |
633907
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.07 |
| Max. Negotiated Rate |
$804.00 |
| Rate for Payer: Aetna Commercial |
$180.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$172.86
|
| Rate for Payer: Aetna Managed Medicare |
$8.07
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$30.26
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$14.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$13.40
|
| Rate for Payer: Anthem Medicaid |
$8.34
|
| Rate for Payer: Anthem Medicare Advantage |
$8.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$106.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$8.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$8.07
|
| Rate for Payer: Cash Price |
$60.30
|
| Rate for Payer: Cash Price |
$60.30
|
| Rate for Payer: Cigna Commercial |
$184.92
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$8.07
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$8.34
|
| Rate for Payer: Dean Health Medicaid |
$8.34
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$8.07
|
| Rate for Payer: Health EOS Commercial |
$178.89
|
| Rate for Payer: HFN Commercial |
$184.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$30.02
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$8.07
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$8.34
|
| Rate for Payer: Independent Care Health Plan Medicare |
$8.07
|
| Rate for Payer: Managed Health Services Medicaid |
$8.67
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$8.07
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$8.07
|
| Rate for Payer: Multiplan Commercial |
$160.80
|
| Rate for Payer: NAPHCARE Commercial |
$12.10
|
| Rate for Payer: Preferred Network Access Commercial |
$184.92
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$8.34
|
| Rate for Payer: Quartz Beloit One Network |
$98.49
|
| Rate for Payer: Quartz Commercial |
$130.65
|
| Rate for Payer: Quartz Medicare Advantage |
$8.07
|
| Rate for Payer: The Alliance Commercial |
$804.00
|
| Rate for Payer: United Healthcare Medicaid |
$8.34
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8.07
|
| Rate for Payer: United Healthcare PPO |
$150.75
|
| Rate for Payer: WEA Trust Commercial |
$110.55
|
| Rate for Payer: Wellcare Medicare |
$8.07
|
| Rate for Payer: WMAP Medicaid |
$8.34
|
| Rate for Payer: WPS Commercial |
$148.88
|
|
|
Urine Cytology to US Labs
|
Facility
IP
|
$383.00
|
|
|
Service Code
|
CPT 88112
|
| Hospital Charge Code |
1043295
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$187.67 |
| Max. Negotiated Rate |
$352.36 |
| Rate for Payer: Aetna Commercial |
$344.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$202.99
|
| Rate for Payer: Cash Price |
$114.90
|
| Rate for Payer: Cigna Commercial |
$352.36
|
| Rate for Payer: Health EOS Commercial |
$340.87
|
| Rate for Payer: HFN Commercial |
$352.36
|
| Rate for Payer: Multiplan Commercial |
$306.40
|
| Rate for Payer: NAPHCARE Commercial |
$229.80
|
| Rate for Payer: Preferred Network Access Commercial |
$352.36
|
| Rate for Payer: Quartz Beloit One Network |
$187.67
|
| Rate for Payer: Quartz Commercial |
$229.80
|
| Rate for Payer: WEA Trust Commercial |
$210.65
|
| Rate for Payer: WPS Commercial |
$283.69
|
|
|
Urine Cytology to US Labs
|
Professional
|
$383.00
|
|
|
Service Code
|
CPT 88112
|
| Hospital Charge Code |
1043295
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$63.81 |
| Max. Negotiated Rate |
$363.85 |
| Rate for Payer: Aetna Commercial |
$363.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$329.38
|
| Rate for Payer: Aetna Managed Medicare |
$64.58
|
| Rate for Payer: Anthem Commercial |
$63.81
|
| Rate for Payer: Anthem Medicare Advantage |
$64.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$64.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$64.58
|
| Rate for Payer: Cash Price |
$114.90
|
| Rate for Payer: Cash Price |
$114.90
|
| Rate for Payer: Cigna Commercial |
$363.85
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$191.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$64.58
|
| Rate for Payer: Health EOS Commercial |
$348.53
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$227.51
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$227.51
|
| Rate for Payer: Independent Care Health Plan Medicare |
$64.58
|
| Rate for Payer: Multiplan Commercial |
$306.40
|
| Rate for Payer: Preferred Network Access Commercial |
$363.85
|
| Rate for Payer: Quartz Beloit One Network |
$168.52
|
| Rate for Payer: Quartz Commercial |
$218.31
|
| Rate for Payer: Quartz Medicare Advantage |
$64.58
|
| Rate for Payer: The Alliance Commercial |
$255.09
|
| Rate for Payer: United Healthcare Medicare Advantage |
$64.58
|
| Rate for Payer: WEA Trust Commercial |
$210.65
|
| Rate for Payer: WPS Commercial |
$284.15
|
|
|
Urine Cytology to US Labs
|
Facility
OP
|
$383.00
|
|
|
Service Code
|
CPT 88112
|
| Hospital Charge Code |
1043295
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$53.56 |
| Max. Negotiated Rate |
$352.36 |
| Rate for Payer: Aetna Commercial |
$344.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$329.38
|
| Rate for Payer: Aetna Managed Medicare |
$53.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$200.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$93.73
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$88.91
|
| Rate for Payer: Anthem Medicare Advantage |
$53.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$202.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$53.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$53.56
|
| Rate for Payer: Cash Price |
$114.90
|
| Rate for Payer: Cash Price |
$114.90
|
| Rate for Payer: Cigna Commercial |
$352.36
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$53.56
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$53.56
|
| Rate for Payer: Health EOS Commercial |
$340.87
|
| Rate for Payer: HFN Commercial |
$352.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$199.24
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$53.56
|
| Rate for Payer: Independent Care Health Plan Medicare |
$53.56
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$53.56
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$53.56
|
| Rate for Payer: Multiplan Commercial |
$306.40
|
| Rate for Payer: NAPHCARE Commercial |
$80.34
|
| Rate for Payer: Preferred Network Access Commercial |
$352.36
|
| Rate for Payer: Quartz Beloit One Network |
$187.67
|
| Rate for Payer: Quartz Commercial |
$248.95
|
| Rate for Payer: Quartz Medicare Advantage |
$53.56
|
| Rate for Payer: United Healthcare Medicare Advantage |
$53.56
|
| Rate for Payer: United Healthcare PPO |
$287.25
|
| Rate for Payer: WEA Trust Commercial |
$210.65
|
| Rate for Payer: Wellcare Medicare |
$53.56
|
| Rate for Payer: WPS Commercial |
$283.69
|
|
|
Urine Dipstick POC Amb
|
Professional
|
$86.00
|
|
|
Service Code
|
CPT 81003
|
| Hospital Charge Code |
1190880
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$2.25 |
| Max. Negotiated Rate |
$81.70 |
| Rate for Payer: Aetna Commercial |
$81.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$73.96
|
| Rate for Payer: Aetna Managed Medicare |
$2.25
|
| Rate for Payer: Anthem Medicare Advantage |
$2.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$2.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$2.25
|
| Rate for Payer: Cash Price |
$25.80
|
| Rate for Payer: Cash Price |
$25.80
|
| Rate for Payer: Cigna Commercial |
$81.70
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$43.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2.25
|
| Rate for Payer: Health EOS Commercial |
$78.26
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7.94
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$7.94
|
| Rate for Payer: Independent Care Health Plan Medicare |
$2.25
|
| Rate for Payer: Multiplan Commercial |
$68.80
|
| Rate for Payer: Preferred Network Access Commercial |
$81.70
|
| Rate for Payer: Quartz Beloit One Network |
$37.84
|
| Rate for Payer: Quartz Commercial |
$49.02
|
| Rate for Payer: Quartz Medicare Advantage |
$2.25
|
| Rate for Payer: The Alliance Commercial |
$8.89
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2.25
|
| Rate for Payer: WEA Trust Commercial |
$47.30
|
| Rate for Payer: WPS Commercial |
$9.90
|
|
|
Urine Dipstick POC Amb
|
Facility
OP
|
$86.00
|
|
|
Service Code
|
CPT 81003
|
| Hospital Charge Code |
1190880
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$2.25 |
| Max. Negotiated Rate |
$344.00 |
| Rate for Payer: Aetna Commercial |
$77.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$73.96
|
| Rate for Payer: Aetna Managed Medicare |
$2.25
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$8.44
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3.94
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3.74
|
| Rate for Payer: Anthem Medicaid |
$2.32
|
| Rate for Payer: Anthem Medicare Advantage |
$2.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$45.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$2.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$2.25
|
| Rate for Payer: Cash Price |
$25.80
|
| Rate for Payer: Cash Price |
$25.80
|
| Rate for Payer: Cigna Commercial |
$79.12
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$2.25
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2.32
|
| Rate for Payer: Dean Health Medicaid |
$2.32
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$2.25
|
| Rate for Payer: Health EOS Commercial |
$76.54
|
| Rate for Payer: HFN Commercial |
$79.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$8.37
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$2.25
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$2.32
|
| Rate for Payer: Independent Care Health Plan Medicare |
$2.25
|
| Rate for Payer: Managed Health Services Medicaid |
$2.41
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$2.25
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$2.25
|
| Rate for Payer: Multiplan Commercial |
$68.80
|
| Rate for Payer: NAPHCARE Commercial |
$3.38
|
| Rate for Payer: Preferred Network Access Commercial |
$79.12
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$2.32
|
| Rate for Payer: Quartz Beloit One Network |
$42.14
|
| Rate for Payer: Quartz Commercial |
$55.90
|
| Rate for Payer: Quartz Medicare Advantage |
$2.25
|
| Rate for Payer: The Alliance Commercial |
$344.00
|
| Rate for Payer: United Healthcare Medicaid |
$2.32
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2.25
|
| Rate for Payer: United Healthcare PPO |
$64.50
|
| Rate for Payer: WEA Trust Commercial |
$47.30
|
| Rate for Payer: Wellcare Medicare |
$2.25
|
| Rate for Payer: WMAP Medicaid |
$2.32
|
| Rate for Payer: WPS Commercial |
$63.70
|
|
|
Urine Dipstick POC Amb
|
Facility
IP
|
$86.00
|
|
|
Service Code
|
CPT 81003
|
| Hospital Charge Code |
1190880
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$42.14 |
| Max. Negotiated Rate |
$79.12 |
| Rate for Payer: Aetna Commercial |
$77.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$45.58
|
| Rate for Payer: Cash Price |
$25.80
|
| Rate for Payer: Cigna Commercial |
$79.12
|
| Rate for Payer: Health EOS Commercial |
$76.54
|
| Rate for Payer: HFN Commercial |
$79.12
|
| Rate for Payer: Multiplan Commercial |
$68.80
|
| Rate for Payer: NAPHCARE Commercial |
$51.60
|
| Rate for Payer: Preferred Network Access Commercial |
$79.12
|
| Rate for Payer: Quartz Beloit One Network |
$42.14
|
| Rate for Payer: Quartz Commercial |
$51.60
|
| Rate for Payer: WEA Trust Commercial |
$47.30
|
| Rate for Payer: WPS Commercial |
$63.70
|
|
|
Urine Drug Screen POC Amb
|
Facility
OP
|
$26.00
|
|
|
Service Code
|
CPT 80305
|
| Hospital Charge Code |
6187008
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.60 |
| Max. Negotiated Rate |
$104.00 |
| Rate for Payer: Aetna Commercial |
$23.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$22.36
|
| Rate for Payer: Aetna Managed Medicare |
$12.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$47.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$22.05
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$20.92
|
| Rate for Payer: Anthem Medicaid |
$13.02
|
| Rate for Payer: Anthem Medicare Advantage |
$12.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$13.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$12.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$12.60
|
| Rate for Payer: Cash Price |
$7.80
|
| Rate for Payer: Cash Price |
$7.80
|
| Rate for Payer: Cigna Commercial |
$23.92
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$12.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$13.02
|
| Rate for Payer: Dean Health Medicaid |
$13.02
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$12.60
|
| Rate for Payer: Health EOS Commercial |
$23.14
|
| Rate for Payer: HFN Commercial |
$23.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$46.87
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$12.60
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$13.02
|
| Rate for Payer: Independent Care Health Plan Medicare |
$12.60
|
| Rate for Payer: Managed Health Services Medicaid |
$13.54
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$12.60
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$12.60
|
| Rate for Payer: Multiplan Commercial |
$20.80
|
| Rate for Payer: NAPHCARE Commercial |
$18.90
|
| Rate for Payer: Preferred Network Access Commercial |
$23.92
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$13.02
|
| Rate for Payer: Quartz Beloit One Network |
$12.74
|
| Rate for Payer: Quartz Commercial |
$16.90
|
| Rate for Payer: Quartz Medicare Advantage |
$12.60
|
| Rate for Payer: The Alliance Commercial |
$104.00
|
| Rate for Payer: United Healthcare Medicaid |
$13.02
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.60
|
| Rate for Payer: United Healthcare PPO |
$19.50
|
| Rate for Payer: WEA Trust Commercial |
$14.30
|
| Rate for Payer: Wellcare Medicare |
$12.60
|
| Rate for Payer: WMAP Medicaid |
$13.02
|
| Rate for Payer: WPS Commercial |
$19.26
|
|
|
Urine Drug Screen POC Amb
|
Facility
IP
|
$26.00
|
|
|
Service Code
|
CPT 80305
|
| Hospital Charge Code |
6187008
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.74 |
| Max. Negotiated Rate |
$23.92 |
| Rate for Payer: Aetna Commercial |
$23.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$13.78
|
| Rate for Payer: Cash Price |
$7.80
|
| Rate for Payer: Cigna Commercial |
$23.92
|
| Rate for Payer: Health EOS Commercial |
$23.14
|
| Rate for Payer: HFN Commercial |
$23.92
|
| Rate for Payer: Multiplan Commercial |
$20.80
|
| Rate for Payer: NAPHCARE Commercial |
$15.60
|
| Rate for Payer: Preferred Network Access Commercial |
$23.92
|
| Rate for Payer: Quartz Beloit One Network |
$12.74
|
| Rate for Payer: Quartz Commercial |
$15.60
|
| Rate for Payer: WEA Trust Commercial |
$14.30
|
| Rate for Payer: WPS Commercial |
$19.26
|
|
|
Urine Drug Screen POC Amb
|
Professional
|
$26.00
|
|
|
Service Code
|
CPT 80305
|
| Hospital Charge Code |
6187008
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.44 |
| Max. Negotiated Rate |
$55.44 |
| Rate for Payer: Aetna Commercial |
$24.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$22.36
|
| Rate for Payer: Aetna Managed Medicare |
$12.60
|
| Rate for Payer: Anthem Medicare Advantage |
$12.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$12.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$12.60
|
| Rate for Payer: Cash Price |
$7.80
|
| Rate for Payer: Cash Price |
$7.80
|
| Rate for Payer: Cigna Commercial |
$24.70
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$13.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12.60
|
| Rate for Payer: Health EOS Commercial |
$23.66
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$44.48
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$44.48
|
| Rate for Payer: Independent Care Health Plan Medicare |
$12.60
|
| Rate for Payer: Multiplan Commercial |
$20.80
|
| Rate for Payer: Preferred Network Access Commercial |
$24.70
|
| Rate for Payer: Quartz Beloit One Network |
$11.44
|
| Rate for Payer: Quartz Commercial |
$14.82
|
| Rate for Payer: Quartz Medicare Advantage |
$12.60
|
| Rate for Payer: The Alliance Commercial |
$49.77
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.60
|
| Rate for Payer: WEA Trust Commercial |
$14.30
|
| Rate for Payer: WPS Commercial |
$55.44
|
|
|
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 |
$492.00 |
| 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 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 |
$492.00
|
| 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: 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 Homovanillic Acid
|
Professional
|
$123.00
|
|
|
Service Code
|
CPT 83150
|
| Hospital Charge Code |
4076081
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$22.41 |
| Max. Negotiated Rate |
$116.85 |
| Rate for Payer: Aetna Commercial |
$116.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$105.78
|
| Rate for Payer: Aetna Managed Medicare |
$22.41
|
| Rate for Payer: Anthem Medicare Advantage |
$22.41
|
| 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 |
$116.85
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$61.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$22.41
|
| Rate for Payer: Health EOS Commercial |
$111.93
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$79.11
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$79.11
|
| Rate for Payer: Independent Care Health Plan Medicare |
$22.41
|
| Rate for Payer: Multiplan Commercial |
$98.40
|
| Rate for Payer: Preferred Network Access Commercial |
$116.85
|
| Rate for Payer: Quartz Beloit One Network |
$54.12
|
| Rate for Payer: Quartz Commercial |
$70.11
|
| Rate for Payer: Quartz Medicare Advantage |
$22.41
|
| Rate for Payer: The Alliance Commercial |
$88.52
|
| Rate for Payer: United Healthcare Medicare Advantage |
$22.41
|
| Rate for Payer: WEA Trust Commercial |
$67.65
|
| Rate for Payer: WPS Commercial |
$98.60
|
|
|
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: 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 |
$744.00 |
| 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 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 |
$744.00
|
| 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 Lambda Light Chain
|
Professional
|
$186.00
|
|
|
Service Code
|
CPT 83883
|
| Hospital Charge Code |
2942948
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.60 |
| Max. Negotiated Rate |
$176.70 |
| Rate for Payer: Aetna Commercial |
$176.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$159.96
|
| Rate for Payer: Aetna Managed Medicare |
$13.60
|
| Rate for Payer: Anthem Medicare Advantage |
$13.60
|
| 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 |
$176.70
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$93.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$13.60
|
| Rate for Payer: Health EOS Commercial |
$169.26
|
| 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: Independent Care Health Plan Medicare |
$13.60
|
| 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: Quartz Medicare Advantage |
$13.60
|
| Rate for Payer: The Alliance Commercial |
$53.72
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.60
|
| Rate for Payer: WEA Trust Commercial |
$102.30
|
| Rate for Payer: WPS Commercial |
$59.84
|
|
|
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 |
$332.00 |
| 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 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 |
$332.00
|
| 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 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: 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 |
$2,488.00 |
| 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 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 |
$2,488.00
|
| 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
|
Professional
|
$622.00
|
|
|
Service Code
|
CPT 83655
|
| Hospital Charge Code |
2942907
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.11 |
| Max. Negotiated Rate |
$590.90 |
| Rate for Payer: Aetna Commercial |
$590.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$534.92
|
| Rate for Payer: Aetna Managed Medicare |
$12.11
|
| Rate for Payer: Anthem Medicare Advantage |
$12.11
|
| 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 |
$590.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$311.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12.11
|
| Rate for Payer: Health EOS Commercial |
$566.02
|
| 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: Independent Care Health Plan Medicare |
$12.11
|
| 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: Quartz Medicare Advantage |
$12.11
|
| Rate for Payer: The Alliance Commercial |
$47.83
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.11
|
| Rate for Payer: WEA Trust Commercial |
$342.10
|
| Rate for Payer: WPS Commercial |
$53.28
|
|
