|
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: 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
|
$83.00
|
|
|
Service Code
|
CPT 83655
|
| Hospital Charge Code |
3986162
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.11 |
| Max. Negotiated Rate |
$78.85 |
| Rate for Payer: Aetna Commercial |
$78.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$71.38
|
| 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 |
$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 |
$12.11
|
| Rate for Payer: Health EOS Commercial |
$75.53
|
| 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 |
$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: 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 |
$45.65
|
| Rate for Payer: WPS Commercial |
$53.28
|
|
|
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 |
$84.00 |
| 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 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 |
$84.00
|
| 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
|
$21.00
|
|
|
Service Code
|
CPT 83735
|
| Hospital Charge Code |
3813065
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.70 |
| Max. Negotiated Rate |
$29.48 |
| Rate for Payer: Aetna Commercial |
$19.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$18.06
|
| Rate for Payer: Aetna Managed Medicare |
$6.70
|
| Rate for Payer: Anthem Medicare Advantage |
$6.70
|
| 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 |
$19.95
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$10.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6.70
|
| Rate for Payer: Health EOS Commercial |
$19.11
|
| 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: Independent Care Health Plan Medicare |
$6.70
|
| 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: Quartz Medicare Advantage |
$6.70
|
| Rate for Payer: The Alliance Commercial |
$26.46
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6.70
|
| Rate for Payer: WEA Trust Commercial |
$11.55
|
| Rate for Payer: WPS Commercial |
$29.48
|
|
|
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: 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 |
$168.00 |
| 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 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 |
$168.00
|
| 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
|
Professional
|
$42.00
|
|
|
Service Code
|
CPT 83735
|
| Hospital Charge Code |
2942997
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.70 |
| Max. Negotiated Rate |
$39.90 |
| Rate for Payer: Aetna Commercial |
$39.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$36.12
|
| Rate for Payer: Aetna Managed Medicare |
$6.70
|
| Rate for Payer: Anthem Medicare Advantage |
$6.70
|
| 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 |
$39.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$21.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6.70
|
| Rate for Payer: Health EOS Commercial |
$38.22
|
| 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: Independent Care Health Plan Medicare |
$6.70
|
| 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: Quartz Medicare Advantage |
$6.70
|
| Rate for Payer: The Alliance Commercial |
$26.46
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6.70
|
| Rate for Payer: WEA Trust Commercial |
$23.10
|
| Rate for Payer: WPS Commercial |
$29.48
|
|
|
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: 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 Mercury Level
|
Professional
|
$83.00
|
|
|
Service Code
|
CPT 83825
|
| Hospital Charge Code |
3986165
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$16.26 |
| Max. Negotiated Rate |
$78.85 |
| Rate for Payer: Aetna Commercial |
$78.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$71.38
|
| Rate for Payer: Aetna Managed Medicare |
$16.26
|
| Rate for Payer: Anthem Medicare Advantage |
$16.26
|
| 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 |
$78.85
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$41.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$16.26
|
| Rate for Payer: Health EOS Commercial |
$75.53
|
| 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: Independent Care Health Plan Medicare |
$16.26
|
| 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: Quartz Medicare Advantage |
$16.26
|
| Rate for Payer: The Alliance Commercial |
$64.23
|
| Rate for Payer: United Healthcare Medicare Advantage |
$16.26
|
| Rate for Payer: WEA Trust Commercial |
$45.65
|
| Rate for Payer: WPS Commercial |
$71.54
|
|
|
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: 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
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: 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 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 |
$332.00 |
| 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 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 |
$332.00
|
| 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
|
Facility
OP
|
$621.00
|
|
|
Service Code
|
CPT 83825
|
| Hospital Charge Code |
2942908
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$16.26 |
| Max. Negotiated Rate |
$2,484.00 |
| 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 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 |
$2,484.00
|
| 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
|
$621.00
|
|
|
Service Code
|
CPT 83825
|
| Hospital Charge Code |
2942908
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$16.26 |
| Max. Negotiated Rate |
$589.95 |
| Rate for Payer: Aetna Commercial |
$589.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$534.06
|
| Rate for Payer: Aetna Managed Medicare |
$16.26
|
| Rate for Payer: Anthem Medicare Advantage |
$16.26
|
| 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 |
$589.95
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$310.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$16.26
|
| Rate for Payer: Health EOS Commercial |
$565.11
|
| 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: Independent Care Health Plan Medicare |
$16.26
|
| 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: Quartz Medicare Advantage |
$16.26
|
| Rate for Payer: The Alliance Commercial |
$64.23
|
| Rate for Payer: United Healthcare Medicare Advantage |
$16.26
|
| Rate for Payer: WEA Trust Commercial |
$341.55
|
| Rate for Payer: WPS Commercial |
$71.54
|
|
|
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
|
|
|
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: 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
|
|
|
Urine Microalbumin
|
Professional
|
$114.00
|
|
|
Service Code
|
CPT 82043
|
| Hospital Charge Code |
3705510
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.78 |
| Max. Negotiated Rate |
$108.30 |
| Rate for Payer: Aetna Commercial |
$108.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$98.04
|
| Rate for Payer: Aetna Managed Medicare |
$5.78
|
| Rate for Payer: Anthem Medicare Advantage |
$5.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5.78
|
| Rate for Payer: Cash Price |
$34.20
|
| Rate for Payer: Cash Price |
$34.20
|
| Rate for Payer: Cigna Commercial |
$108.30
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$57.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5.78
|
| Rate for Payer: Health EOS Commercial |
$103.74
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$20.40
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$20.40
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5.78
|
| Rate for Payer: Multiplan Commercial |
$91.20
|
| Rate for Payer: Preferred Network Access Commercial |
$108.30
|
| Rate for Payer: Quartz Beloit One Network |
$50.16
|
| Rate for Payer: Quartz Commercial |
$64.98
|
| Rate for Payer: Quartz Medicare Advantage |
$5.78
|
| Rate for Payer: The Alliance Commercial |
$22.83
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.78
|
| Rate for Payer: WEA Trust Commercial |
$62.70
|
| Rate for Payer: WPS Commercial |
$25.43
|
|
|
Urine Microalbumin
|
Facility
OP
|
$158.00
|
|
|
Service Code
|
CPT 82043
|
| Hospital Charge Code |
982628
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.78 |
| Max. Negotiated Rate |
$632.00 |
| Rate for Payer: Aetna Commercial |
$142.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$135.88
|
| Rate for Payer: Aetna Managed Medicare |
$5.78
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$21.68
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$10.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$9.59
|
| Rate for Payer: Anthem Medicaid |
$5.97
|
| Rate for Payer: Anthem Medicare Advantage |
$5.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$83.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5.78
|
| Rate for Payer: Cash Price |
$47.40
|
| Rate for Payer: Cash Price |
$47.40
|
| Rate for Payer: Cigna Commercial |
$145.36
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$5.78
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$5.97
|
| Rate for Payer: Dean Health Medicaid |
$5.97
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$5.78
|
| Rate for Payer: Health EOS Commercial |
$140.62
|
| Rate for Payer: HFN Commercial |
$145.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$21.50
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$5.78
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$5.97
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5.78
|
| Rate for Payer: Managed Health Services Medicaid |
$6.21
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$5.78
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$5.78
|
| Rate for Payer: Multiplan Commercial |
$126.40
|
| Rate for Payer: NAPHCARE Commercial |
$8.67
|
| Rate for Payer: Preferred Network Access Commercial |
$145.36
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$5.97
|
| Rate for Payer: Quartz Beloit One Network |
$77.42
|
| Rate for Payer: Quartz Commercial |
$102.70
|
| Rate for Payer: Quartz Medicare Advantage |
$5.78
|
| Rate for Payer: The Alliance Commercial |
$632.00
|
| Rate for Payer: United Healthcare Medicaid |
$5.97
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.78
|
| Rate for Payer: United Healthcare PPO |
$118.50
|
| Rate for Payer: WEA Trust Commercial |
$86.90
|
| Rate for Payer: Wellcare Medicare |
$5.78
|
| Rate for Payer: WMAP Medicaid |
$5.97
|
| Rate for Payer: WPS Commercial |
$117.03
|
|
|
Urine Microalbumin
|
Facility
IP
|
$114.00
|
|
|
Service Code
|
CPT 82043
|
| Hospital Charge Code |
3705510
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$55.86 |
| Max. Negotiated Rate |
$104.88 |
| Rate for Payer: Aetna Commercial |
$102.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$60.42
|
| Rate for Payer: Cash Price |
$34.20
|
| Rate for Payer: Cigna Commercial |
$104.88
|
| Rate for Payer: Health EOS Commercial |
$101.46
|
| Rate for Payer: HFN Commercial |
$104.88
|
| Rate for Payer: Multiplan Commercial |
$91.20
|
| Rate for Payer: NAPHCARE Commercial |
$68.40
|
| Rate for Payer: Preferred Network Access Commercial |
$104.88
|
| Rate for Payer: Quartz Beloit One Network |
$55.86
|
| Rate for Payer: Quartz Commercial |
$68.40
|
| Rate for Payer: WEA Trust Commercial |
$62.70
|
| Rate for Payer: WPS Commercial |
$84.44
|
|
|
Urine Microalbumin
|
Facility
OP
|
$114.00
|
|
|
Service Code
|
CPT 82043
|
| Hospital Charge Code |
3705510
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.78 |
| Max. Negotiated Rate |
$456.00 |
| Rate for Payer: Aetna Commercial |
$102.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$98.04
|
| Rate for Payer: Aetna Managed Medicare |
$5.78
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$21.68
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$10.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$9.59
|
| Rate for Payer: Anthem Medicaid |
$5.97
|
| Rate for Payer: Anthem Medicare Advantage |
$5.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$60.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5.78
|
| Rate for Payer: Cash Price |
$34.20
|
| Rate for Payer: Cash Price |
$34.20
|
| Rate for Payer: Cigna Commercial |
$104.88
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$5.78
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$5.97
|
| Rate for Payer: Dean Health Medicaid |
$5.97
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$5.78
|
| Rate for Payer: Health EOS Commercial |
$101.46
|
| Rate for Payer: HFN Commercial |
$104.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$21.50
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$5.78
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$5.97
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5.78
|
| Rate for Payer: Managed Health Services Medicaid |
$6.21
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$5.78
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$5.78
|
| Rate for Payer: Multiplan Commercial |
$91.20
|
| Rate for Payer: NAPHCARE Commercial |
$8.67
|
| Rate for Payer: Preferred Network Access Commercial |
$104.88
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$5.97
|
| Rate for Payer: Quartz Beloit One Network |
$55.86
|
| Rate for Payer: Quartz Commercial |
$74.10
|
| Rate for Payer: Quartz Medicare Advantage |
$5.78
|
| Rate for Payer: The Alliance Commercial |
$456.00
|
| Rate for Payer: United Healthcare Medicaid |
$5.97
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.78
|
| Rate for Payer: United Healthcare PPO |
$85.50
|
| Rate for Payer: WEA Trust Commercial |
$62.70
|
| Rate for Payer: Wellcare Medicare |
$5.78
|
| Rate for Payer: WMAP Medicaid |
$5.97
|
| Rate for Payer: WPS Commercial |
$84.44
|
|
|
Urine Microalbumin
|
Facility
IP
|
$158.00
|
|
|
Service Code
|
CPT 82043
|
| Hospital Charge Code |
982628
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$77.42 |
| Max. Negotiated Rate |
$145.36 |
| Rate for Payer: Aetna Commercial |
$142.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$83.74
|
| Rate for Payer: Cash Price |
$47.40
|
| Rate for Payer: Cigna Commercial |
$145.36
|
| Rate for Payer: Health EOS Commercial |
$140.62
|
| Rate for Payer: HFN Commercial |
$145.36
|
| Rate for Payer: Multiplan Commercial |
$126.40
|
| Rate for Payer: NAPHCARE Commercial |
$94.80
|
| Rate for Payer: Preferred Network Access Commercial |
$145.36
|
| Rate for Payer: Quartz Beloit One Network |
$77.42
|
| Rate for Payer: Quartz Commercial |
$94.80
|
| Rate for Payer: WEA Trust Commercial |
$86.90
|
| Rate for Payer: WPS Commercial |
$117.03
|
|
|
Urine Microalbumin
|
Professional
|
$158.00
|
|
|
Service Code
|
CPT 82043
|
| Hospital Charge Code |
982628
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.78 |
| Max. Negotiated Rate |
$150.10 |
| Rate for Payer: Aetna Commercial |
$150.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$135.88
|
| Rate for Payer: Aetna Managed Medicare |
$5.78
|
| Rate for Payer: Anthem Medicare Advantage |
$5.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5.78
|
| Rate for Payer: Cash Price |
$47.40
|
| Rate for Payer: Cash Price |
$47.40
|
| Rate for Payer: Cigna Commercial |
$150.10
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$79.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5.78
|
| Rate for Payer: Health EOS Commercial |
$143.78
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$20.40
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$20.40
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5.78
|
| Rate for Payer: Multiplan Commercial |
$126.40
|
| Rate for Payer: Preferred Network Access Commercial |
$150.10
|
| Rate for Payer: Quartz Beloit One Network |
$69.52
|
| Rate for Payer: Quartz Commercial |
$90.06
|
| Rate for Payer: Quartz Medicare Advantage |
$5.78
|
| Rate for Payer: The Alliance Commercial |
$22.83
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.78
|
| Rate for Payer: WEA Trust Commercial |
$86.90
|
| Rate for Payer: WPS Commercial |
$25.43
|
|
|
.Urine Microscopic
|
Professional
|
$131.00
|
|
|
Service Code
|
CPT 81001
|
| Hospital Charge Code |
1172799
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.17 |
| Max. Negotiated Rate |
$124.45 |
| Rate for Payer: Aetna Commercial |
$124.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$112.66
|
| Rate for Payer: Aetna Managed Medicare |
$3.17
|
| Rate for Payer: Anthem Medicare Advantage |
$3.17
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$3.17
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$3.17
|
| Rate for Payer: Cash Price |
$39.30
|
| Rate for Payer: Cash Price |
$39.30
|
| Rate for Payer: Cigna Commercial |
$124.45
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$65.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3.17
|
| Rate for Payer: Health EOS Commercial |
$119.21
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$11.19
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$11.19
|
| Rate for Payer: Independent Care Health Plan Medicare |
$3.17
|
| Rate for Payer: Multiplan Commercial |
$104.80
|
| Rate for Payer: Preferred Network Access Commercial |
$124.45
|
| Rate for Payer: Quartz Beloit One Network |
$57.64
|
| Rate for Payer: Quartz Commercial |
$74.67
|
| Rate for Payer: Quartz Medicare Advantage |
$3.17
|
| Rate for Payer: The Alliance Commercial |
$12.52
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3.17
|
| Rate for Payer: WEA Trust Commercial |
$72.05
|
| Rate for Payer: WPS Commercial |
$13.95
|
|
|
.Urine Microscopic
|
Facility
IP
|
$131.00
|
|
|
Service Code
|
CPT 81001
|
| Hospital Charge Code |
1172799
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$64.19 |
| Max. Negotiated Rate |
$120.52 |
| Rate for Payer: Aetna Commercial |
$117.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$69.43
|
| Rate for Payer: Cash Price |
$39.30
|
| Rate for Payer: Cigna Commercial |
$120.52
|
| Rate for Payer: Health EOS Commercial |
$116.59
|
| Rate for Payer: HFN Commercial |
$120.52
|
| Rate for Payer: Multiplan Commercial |
$104.80
|
| Rate for Payer: NAPHCARE Commercial |
$78.60
|
| Rate for Payer: Preferred Network Access Commercial |
$120.52
|
| Rate for Payer: Quartz Beloit One Network |
$64.19
|
| Rate for Payer: Quartz Commercial |
$78.60
|
| Rate for Payer: WEA Trust Commercial |
$72.05
|
| Rate for Payer: WPS Commercial |
$97.03
|
|
|
.Urine Microscopic
|
Facility
OP
|
$131.00
|
|
|
Service Code
|
CPT 81001
|
| Hospital Charge Code |
1172799
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.17 |
| Max. Negotiated Rate |
$524.00 |
| Rate for Payer: Aetna Commercial |
$117.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$112.66
|
| Rate for Payer: Aetna Managed Medicare |
$3.17
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$11.89
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5.55
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5.26
|
| Rate for Payer: Anthem Medicaid |
$3.28
|
| Rate for Payer: Anthem Medicare Advantage |
$3.17
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$69.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$3.17
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$3.17
|
| Rate for Payer: Cash Price |
$39.30
|
| Rate for Payer: Cash Price |
$39.30
|
| Rate for Payer: Cigna Commercial |
$120.52
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$3.17
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$3.28
|
| Rate for Payer: Dean Health Medicaid |
$3.28
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$3.17
|
| Rate for Payer: Health EOS Commercial |
$116.59
|
| Rate for Payer: HFN Commercial |
$120.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$11.79
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$3.17
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$3.28
|
| Rate for Payer: Independent Care Health Plan Medicare |
$3.17
|
| Rate for Payer: Managed Health Services Medicaid |
$3.41
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$3.17
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$3.17
|
| Rate for Payer: Multiplan Commercial |
$104.80
|
| Rate for Payer: NAPHCARE Commercial |
$4.76
|
| Rate for Payer: Preferred Network Access Commercial |
$120.52
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$3.28
|
| Rate for Payer: Quartz Beloit One Network |
$64.19
|
| Rate for Payer: Quartz Commercial |
$85.15
|
| Rate for Payer: Quartz Medicare Advantage |
$3.17
|
| Rate for Payer: The Alliance Commercial |
$524.00
|
| Rate for Payer: United Healthcare Medicaid |
$3.28
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3.17
|
| Rate for Payer: United Healthcare PPO |
$98.25
|
| Rate for Payer: WEA Trust Commercial |
$72.05
|
| Rate for Payer: Wellcare Medicare |
$3.17
|
| Rate for Payer: WMAP Medicaid |
$3.28
|
| Rate for Payer: WPS Commercial |
$97.03
|
|
