|
Urine Nortriptyline
|
Professional
|
$212.00
|
|
| Hospital Charge Code |
2943022
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$93.28 |
| Max. Negotiated Rate |
$201.40 |
| Rate for Payer: Aetna Commercial |
$201.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$182.32
|
| Rate for Payer: Cash Price |
$63.60
|
| Rate for Payer: Cigna Commercial |
$201.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$106.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$127.20
|
| Rate for Payer: Health EOS Commercial |
$192.92
|
| Rate for Payer: Multiplan Commercial |
$169.60
|
| Rate for Payer: Preferred Network Access Commercial |
$201.40
|
| Rate for Payer: Quartz Beloit One Network |
$93.28
|
| Rate for Payer: Quartz Commercial |
$120.84
|
| Rate for Payer: The Alliance Commercial |
$106.00
|
| Rate for Payer: WEA Trust Commercial |
$116.60
|
| Rate for Payer: WPS Commercial |
$157.03
|
|
|
Urine Nortriptyline
|
Facility
OP
|
$212.00
|
|
| Hospital Charge Code |
2943022
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$59.36 |
| Max. Negotiated Rate |
$848.00 |
| Rate for Payer: Aetna Commercial |
$190.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$182.32
|
| Rate for Payer: Aetna Managed Medicare |
$59.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$137.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$106.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$101.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$112.36
|
| Rate for Payer: Cash Price |
$63.60
|
| Rate for Payer: Cigna Commercial |
$195.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$118.64
|
| Rate for Payer: Health EOS Commercial |
$188.68
|
| Rate for Payer: HFN Commercial |
$195.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$159.00
|
| Rate for Payer: Multiplan Commercial |
$169.60
|
| Rate for Payer: NAPHCARE Commercial |
$127.20
|
| Rate for Payer: Preferred Network Access Commercial |
$195.04
|
| Rate for Payer: Quartz Beloit One Network |
$103.88
|
| Rate for Payer: Quartz Commercial |
$137.80
|
| Rate for Payer: Quartz Medicare Advantage |
$127.20
|
| Rate for Payer: The Alliance Commercial |
$848.00
|
| Rate for Payer: United Healthcare PPO |
$159.00
|
| Rate for Payer: WEA Trust Commercial |
$116.60
|
| Rate for Payer: WPS Commercial |
$157.03
|
|
|
Urine Nortriptyline
|
Facility
IP
|
$212.00
|
|
| Hospital Charge Code |
2943022
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$103.88 |
| Max. Negotiated Rate |
$195.04 |
| Rate for Payer: Aetna Commercial |
$190.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$112.36
|
| Rate for Payer: Cash Price |
$63.60
|
| Rate for Payer: Cigna Commercial |
$195.04
|
| Rate for Payer: Health EOS Commercial |
$188.68
|
| Rate for Payer: HFN Commercial |
$195.04
|
| Rate for Payer: Multiplan Commercial |
$169.60
|
| Rate for Payer: NAPHCARE Commercial |
$127.20
|
| Rate for Payer: Preferred Network Access Commercial |
$195.04
|
| Rate for Payer: Quartz Beloit One Network |
$103.88
|
| Rate for Payer: Quartz Commercial |
$127.20
|
| Rate for Payer: WEA Trust Commercial |
$116.60
|
| Rate for Payer: WPS Commercial |
$157.03
|
|
|
Urine Oxalate
|
Facility
OP
|
$93.00
|
|
|
Service Code
|
CPT 83945
|
| Hospital Charge Code |
2942990
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.45 |
| Max. Negotiated Rate |
$372.00 |
| Rate for Payer: Aetna Commercial |
$83.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$79.98
|
| Rate for Payer: Aetna Managed Medicare |
$14.45
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$54.19
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$25.29
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$23.99
|
| Rate for Payer: Anthem Medicaid |
$14.93
|
| Rate for Payer: Anthem Medicare Advantage |
$14.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$49.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$14.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$14.45
|
| Rate for Payer: Cash Price |
$27.90
|
| Rate for Payer: Cash Price |
$27.90
|
| Rate for Payer: Cigna Commercial |
$85.56
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$14.45
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$14.93
|
| Rate for Payer: Dean Health Medicaid |
$14.93
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$14.45
|
| Rate for Payer: Health EOS Commercial |
$82.77
|
| Rate for Payer: HFN Commercial |
$85.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$53.75
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$14.45
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$14.93
|
| Rate for Payer: Independent Care Health Plan Medicare |
$14.45
|
| Rate for Payer: Managed Health Services Medicaid |
$15.53
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$14.45
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$14.45
|
| Rate for Payer: Multiplan Commercial |
$74.40
|
| Rate for Payer: NAPHCARE Commercial |
$21.68
|
| Rate for Payer: Preferred Network Access Commercial |
$85.56
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$14.93
|
| Rate for Payer: Quartz Beloit One Network |
$45.57
|
| Rate for Payer: Quartz Commercial |
$60.45
|
| Rate for Payer: Quartz Medicare Advantage |
$14.45
|
| Rate for Payer: The Alliance Commercial |
$372.00
|
| Rate for Payer: United Healthcare Medicaid |
$14.93
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14.45
|
| Rate for Payer: United Healthcare PPO |
$69.75
|
| Rate for Payer: WEA Trust Commercial |
$51.15
|
| Rate for Payer: Wellcare Medicare |
$14.45
|
| Rate for Payer: WMAP Medicaid |
$14.93
|
| Rate for Payer: WPS Commercial |
$68.89
|
|
|
Urine Oxalate
|
Facility
IP
|
$93.00
|
|
|
Service Code
|
CPT 83945
|
| Hospital Charge Code |
2942990
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$45.57 |
| Max. Negotiated Rate |
$85.56 |
| Rate for Payer: Aetna Commercial |
$83.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$49.29
|
| Rate for Payer: Cash Price |
$27.90
|
| Rate for Payer: Cigna Commercial |
$85.56
|
| Rate for Payer: Health EOS Commercial |
$82.77
|
| Rate for Payer: HFN Commercial |
$85.56
|
| Rate for Payer: Multiplan Commercial |
$74.40
|
| Rate for Payer: NAPHCARE Commercial |
$55.80
|
| Rate for Payer: Preferred Network Access Commercial |
$85.56
|
| Rate for Payer: Quartz Beloit One Network |
$45.57
|
| Rate for Payer: Quartz Commercial |
$55.80
|
| Rate for Payer: WEA Trust Commercial |
$51.15
|
| Rate for Payer: WPS Commercial |
$68.89
|
|
|
Urine Oxalate
|
Professional
|
$93.00
|
|
|
Service Code
|
CPT 83945
|
| Hospital Charge Code |
2942990
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.45 |
| Max. Negotiated Rate |
$88.35 |
| Rate for Payer: Aetna Commercial |
$88.35
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$79.98
|
| Rate for Payer: Aetna Managed Medicare |
$14.45
|
| Rate for Payer: Anthem Medicare Advantage |
$14.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$14.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$14.45
|
| Rate for Payer: Cash Price |
$27.90
|
| Rate for Payer: Cash Price |
$27.90
|
| Rate for Payer: Cigna Commercial |
$88.35
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$46.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$14.45
|
| Rate for Payer: Health EOS Commercial |
$84.63
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$51.01
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$51.01
|
| Rate for Payer: Independent Care Health Plan Medicare |
$14.45
|
| Rate for Payer: Multiplan Commercial |
$74.40
|
| Rate for Payer: Preferred Network Access Commercial |
$88.35
|
| Rate for Payer: Quartz Beloit One Network |
$40.92
|
| Rate for Payer: Quartz Commercial |
$53.01
|
| Rate for Payer: Quartz Medicare Advantage |
$14.45
|
| Rate for Payer: The Alliance Commercial |
$57.08
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14.45
|
| Rate for Payer: WEA Trust Commercial |
$51.15
|
| Rate for Payer: WPS Commercial |
$63.58
|
|
|
Urine Oxalate
|
Facility
IP
|
$21.00
|
|
|
Service Code
|
CPT 83945
|
| Hospital Charge Code |
3813058
|
|
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 Oxalate
|
Facility
OP
|
$21.00
|
|
|
Service Code
|
CPT 83945
|
| Hospital Charge Code |
3813058
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.29 |
| 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 |
$14.45
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$54.19
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$25.29
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$23.99
|
| Rate for Payer: Anthem Medicaid |
$14.93
|
| Rate for Payer: Anthem Medicare Advantage |
$14.45
|
| 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 |
$14.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$14.45
|
| 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 |
$14.45
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$14.93
|
| Rate for Payer: Dean Health Medicaid |
$14.93
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$14.45
|
| Rate for Payer: Health EOS Commercial |
$18.69
|
| Rate for Payer: HFN Commercial |
$19.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$53.75
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$14.45
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$14.93
|
| Rate for Payer: Independent Care Health Plan Medicare |
$14.45
|
| Rate for Payer: Managed Health Services Medicaid |
$15.53
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$14.45
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$14.45
|
| Rate for Payer: Multiplan Commercial |
$16.80
|
| Rate for Payer: NAPHCARE Commercial |
$21.68
|
| Rate for Payer: Preferred Network Access Commercial |
$19.32
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$14.93
|
| Rate for Payer: Quartz Beloit One Network |
$10.29
|
| Rate for Payer: Quartz Commercial |
$13.65
|
| Rate for Payer: Quartz Medicare Advantage |
$14.45
|
| Rate for Payer: The Alliance Commercial |
$84.00
|
| Rate for Payer: United Healthcare Medicaid |
$14.93
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14.45
|
| Rate for Payer: United Healthcare PPO |
$15.75
|
| Rate for Payer: WEA Trust Commercial |
$11.55
|
| Rate for Payer: Wellcare Medicare |
$14.45
|
| Rate for Payer: WMAP Medicaid |
$14.93
|
| Rate for Payer: WPS Commercial |
$15.55
|
|
|
Urine Oxalate
|
Professional
|
$21.00
|
|
|
Service Code
|
CPT 83945
|
| Hospital Charge Code |
3813058
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.24 |
| Max. Negotiated Rate |
$63.58 |
| Rate for Payer: Aetna Commercial |
$19.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$18.06
|
| Rate for Payer: Aetna Managed Medicare |
$14.45
|
| Rate for Payer: Anthem Medicare Advantage |
$14.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$14.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$14.45
|
| 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 |
$14.45
|
| Rate for Payer: Health EOS Commercial |
$19.11
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$51.01
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$51.01
|
| Rate for Payer: Independent Care Health Plan Medicare |
$14.45
|
| 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 |
$14.45
|
| Rate for Payer: The Alliance Commercial |
$57.08
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14.45
|
| Rate for Payer: WEA Trust Commercial |
$11.55
|
| Rate for Payer: WPS Commercial |
$63.58
|
|
|
Urine pH
|
Professional
|
$45.00
|
|
|
Service Code
|
CPT 83986
|
| Hospital Charge Code |
2942993
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.58 |
| Max. Negotiated Rate |
$42.75 |
| Rate for Payer: Aetna Commercial |
$42.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$38.70
|
| Rate for Payer: Aetna Managed Medicare |
$3.58
|
| Rate for Payer: Anthem Medicare Advantage |
$3.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$3.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$3.58
|
| Rate for Payer: Cash Price |
$13.50
|
| Rate for Payer: Cash Price |
$13.50
|
| Rate for Payer: Cigna Commercial |
$42.75
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$22.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3.58
|
| Rate for Payer: Health EOS Commercial |
$40.95
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$12.64
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$12.64
|
| Rate for Payer: Independent Care Health Plan Medicare |
$3.58
|
| Rate for Payer: Multiplan Commercial |
$36.00
|
| Rate for Payer: Preferred Network Access Commercial |
$42.75
|
| Rate for Payer: Quartz Beloit One Network |
$19.80
|
| Rate for Payer: Quartz Commercial |
$25.65
|
| Rate for Payer: Quartz Medicare Advantage |
$3.58
|
| Rate for Payer: The Alliance Commercial |
$14.14
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3.58
|
| Rate for Payer: WEA Trust Commercial |
$24.75
|
| Rate for Payer: WPS Commercial |
$15.75
|
|
|
Urine pH
|
Professional
|
$21.00
|
|
|
Service Code
|
CPT 83986
|
| Hospital Charge Code |
3813061
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.58 |
| Max. Negotiated Rate |
$19.95 |
| Rate for Payer: Aetna Commercial |
$19.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$18.06
|
| Rate for Payer: Aetna Managed Medicare |
$3.58
|
| Rate for Payer: Anthem Medicare Advantage |
$3.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$3.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$3.58
|
| 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 |
$3.58
|
| Rate for Payer: Health EOS Commercial |
$19.11
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$12.64
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$12.64
|
| Rate for Payer: Independent Care Health Plan Medicare |
$3.58
|
| 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 |
$3.58
|
| Rate for Payer: The Alliance Commercial |
$14.14
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3.58
|
| Rate for Payer: WEA Trust Commercial |
$11.55
|
| Rate for Payer: WPS Commercial |
$15.75
|
|
|
Urine pH
|
Facility
IP
|
$45.00
|
|
|
Service Code
|
CPT 83986
|
| Hospital Charge Code |
2942993
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$22.05 |
| Max. Negotiated Rate |
$41.40 |
| Rate for Payer: Aetna Commercial |
$40.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$23.85
|
| Rate for Payer: Cash Price |
$13.50
|
| Rate for Payer: Cigna Commercial |
$41.40
|
| Rate for Payer: Health EOS Commercial |
$40.05
|
| Rate for Payer: HFN Commercial |
$41.40
|
| Rate for Payer: Multiplan Commercial |
$36.00
|
| Rate for Payer: NAPHCARE Commercial |
$27.00
|
| Rate for Payer: Preferred Network Access Commercial |
$41.40
|
| Rate for Payer: Quartz Beloit One Network |
$22.05
|
| Rate for Payer: Quartz Commercial |
$27.00
|
| Rate for Payer: WEA Trust Commercial |
$24.75
|
| Rate for Payer: WPS Commercial |
$33.33
|
|
|
Urine pH
|
Facility
OP
|
$45.00
|
|
|
Service Code
|
CPT 83986
|
| Hospital Charge Code |
2942993
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.58 |
| Max. Negotiated Rate |
$180.00 |
| Rate for Payer: Aetna Commercial |
$40.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$38.70
|
| Rate for Payer: Aetna Managed Medicare |
$3.58
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$13.42
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$6.26
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5.94
|
| Rate for Payer: Anthem Medicaid |
$3.70
|
| Rate for Payer: Anthem Medicare Advantage |
$3.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$23.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$3.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$3.58
|
| Rate for Payer: Cash Price |
$13.50
|
| Rate for Payer: Cash Price |
$13.50
|
| Rate for Payer: Cigna Commercial |
$41.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$3.58
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$3.70
|
| Rate for Payer: Dean Health Medicaid |
$3.70
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$3.58
|
| Rate for Payer: Health EOS Commercial |
$40.05
|
| Rate for Payer: HFN Commercial |
$41.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$13.32
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$3.58
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$3.70
|
| Rate for Payer: Independent Care Health Plan Medicare |
$3.58
|
| Rate for Payer: Managed Health Services Medicaid |
$3.85
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$3.58
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$3.58
|
| Rate for Payer: Multiplan Commercial |
$36.00
|
| Rate for Payer: NAPHCARE Commercial |
$5.37
|
| Rate for Payer: Preferred Network Access Commercial |
$41.40
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$3.70
|
| Rate for Payer: Quartz Beloit One Network |
$22.05
|
| Rate for Payer: Quartz Commercial |
$29.25
|
| Rate for Payer: Quartz Medicare Advantage |
$3.58
|
| Rate for Payer: The Alliance Commercial |
$180.00
|
| Rate for Payer: United Healthcare Medicaid |
$3.70
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3.58
|
| Rate for Payer: United Healthcare PPO |
$33.75
|
| Rate for Payer: WEA Trust Commercial |
$24.75
|
| Rate for Payer: Wellcare Medicare |
$3.58
|
| Rate for Payer: WMAP Medicaid |
$3.70
|
| Rate for Payer: WPS Commercial |
$33.33
|
|
|
Urine pH
|
Facility
IP
|
$21.00
|
|
|
Service Code
|
CPT 83986
|
| Hospital Charge Code |
3813061
|
|
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 pH
|
Facility
OP
|
$21.00
|
|
|
Service Code
|
CPT 83986
|
| Hospital Charge Code |
3813061
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.58 |
| 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 |
$3.58
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$13.42
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$6.26
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5.94
|
| Rate for Payer: Anthem Medicaid |
$3.70
|
| Rate for Payer: Anthem Medicare Advantage |
$3.58
|
| 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 |
$3.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$3.58
|
| 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 |
$3.58
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$3.70
|
| Rate for Payer: Dean Health Medicaid |
$3.70
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$3.58
|
| Rate for Payer: Health EOS Commercial |
$18.69
|
| Rate for Payer: HFN Commercial |
$19.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$13.32
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$3.58
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$3.70
|
| Rate for Payer: Independent Care Health Plan Medicare |
$3.58
|
| Rate for Payer: Managed Health Services Medicaid |
$3.85
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$3.58
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$3.58
|
| Rate for Payer: Multiplan Commercial |
$16.80
|
| Rate for Payer: NAPHCARE Commercial |
$5.37
|
| Rate for Payer: Preferred Network Access Commercial |
$19.32
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$3.70
|
| Rate for Payer: Quartz Beloit One Network |
$10.29
|
| Rate for Payer: Quartz Commercial |
$13.65
|
| Rate for Payer: Quartz Medicare Advantage |
$3.58
|
| Rate for Payer: The Alliance Commercial |
$84.00
|
| Rate for Payer: United Healthcare Medicaid |
$3.70
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3.58
|
| Rate for Payer: United Healthcare PPO |
$15.75
|
| Rate for Payer: WEA Trust Commercial |
$11.55
|
| Rate for Payer: Wellcare Medicare |
$3.58
|
| Rate for Payer: WMAP Medicaid |
$3.70
|
| Rate for Payer: WPS Commercial |
$15.55
|
|
|
Urine Phosphorus
|
Facility
OP
|
$60.00
|
|
|
Service Code
|
CPT 84105
|
| Hospital Charge Code |
2942996
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.78 |
| Max. Negotiated Rate |
$240.00 |
| Rate for Payer: Aetna Commercial |
$54.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$51.60
|
| 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 |
$31.80
|
| 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 |
$18.00
|
| Rate for Payer: Cash Price |
$18.00
|
| Rate for Payer: Cigna Commercial |
$55.20
|
| 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 |
$53.40
|
| Rate for Payer: HFN Commercial |
$55.20
|
| 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 |
$48.00
|
| Rate for Payer: NAPHCARE Commercial |
$8.67
|
| Rate for Payer: Preferred Network Access Commercial |
$55.20
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$5.97
|
| Rate for Payer: Quartz Beloit One Network |
$29.40
|
| Rate for Payer: Quartz Commercial |
$39.00
|
| Rate for Payer: Quartz Medicare Advantage |
$5.78
|
| Rate for Payer: The Alliance Commercial |
$240.00
|
| Rate for Payer: United Healthcare Medicaid |
$5.97
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.78
|
| Rate for Payer: United Healthcare PPO |
$45.00
|
| Rate for Payer: WEA Trust Commercial |
$33.00
|
| Rate for Payer: Wellcare Medicare |
$5.78
|
| Rate for Payer: WMAP Medicaid |
$5.97
|
| Rate for Payer: WPS Commercial |
$44.44
|
|
|
Urine Phosphorus
|
Professional
|
$60.00
|
|
|
Service Code
|
CPT 84105
|
| Hospital Charge Code |
2942996
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.78 |
| Max. Negotiated Rate |
$57.00 |
| Rate for Payer: Aetna Commercial |
$57.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$51.60
|
| 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 |
$18.00
|
| Rate for Payer: Cash Price |
$18.00
|
| Rate for Payer: Cigna Commercial |
$57.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$30.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5.78
|
| Rate for Payer: Health EOS Commercial |
$54.60
|
| 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 |
$48.00
|
| Rate for Payer: Preferred Network Access Commercial |
$57.00
|
| Rate for Payer: Quartz Beloit One Network |
$26.40
|
| Rate for Payer: Quartz Commercial |
$34.20
|
| 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 |
$33.00
|
| Rate for Payer: WPS Commercial |
$25.43
|
|
|
Urine Phosphorus
|
Facility
IP
|
$21.00
|
|
|
Service Code
|
CPT 84105
|
| Hospital Charge Code |
3813064
|
|
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 Phosphorus
|
Professional
|
$21.00
|
|
|
Service Code
|
CPT 84105
|
| Hospital Charge Code |
3813064
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.78 |
| Max. Negotiated Rate |
$25.43 |
| Rate for Payer: Aetna Commercial |
$19.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$18.06
|
| 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 |
$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 |
$5.78
|
| Rate for Payer: Health EOS Commercial |
$19.11
|
| 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 |
$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 |
$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 |
$11.55
|
| Rate for Payer: WPS Commercial |
$25.43
|
|
|
Urine Phosphorus
|
Facility
IP
|
$60.00
|
|
|
Service Code
|
CPT 84105
|
| Hospital Charge Code |
2942996
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$29.40 |
| Max. Negotiated Rate |
$55.20 |
| Rate for Payer: Aetna Commercial |
$54.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$31.80
|
| Rate for Payer: Cash Price |
$18.00
|
| Rate for Payer: Cigna Commercial |
$55.20
|
| Rate for Payer: Health EOS Commercial |
$53.40
|
| Rate for Payer: HFN Commercial |
$55.20
|
| Rate for Payer: Multiplan Commercial |
$48.00
|
| Rate for Payer: NAPHCARE Commercial |
$36.00
|
| Rate for Payer: Preferred Network Access Commercial |
$55.20
|
| Rate for Payer: Quartz Beloit One Network |
$29.40
|
| Rate for Payer: Quartz Commercial |
$36.00
|
| Rate for Payer: WEA Trust Commercial |
$33.00
|
| Rate for Payer: WPS Commercial |
$44.44
|
|
|
Urine Phosphorus
|
Facility
OP
|
$21.00
|
|
|
Service Code
|
CPT 84105
|
| Hospital Charge Code |
3813064
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.78 |
| 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 |
$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 |
$11.13
|
| 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 |
$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 |
$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 |
$18.69
|
| Rate for Payer: HFN Commercial |
$19.32
|
| 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 |
$16.80
|
| Rate for Payer: NAPHCARE Commercial |
$8.67
|
| Rate for Payer: Preferred Network Access Commercial |
$19.32
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$5.97
|
| Rate for Payer: Quartz Beloit One Network |
$10.29
|
| Rate for Payer: Quartz Commercial |
$13.65
|
| Rate for Payer: Quartz Medicare Advantage |
$5.78
|
| Rate for Payer: The Alliance Commercial |
$84.00
|
| Rate for Payer: United Healthcare Medicaid |
$5.97
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.78
|
| Rate for Payer: United Healthcare PPO |
$15.75
|
| Rate for Payer: WEA Trust Commercial |
$11.55
|
| Rate for Payer: Wellcare Medicare |
$5.78
|
| Rate for Payer: WMAP Medicaid |
$5.97
|
| Rate for Payer: WPS Commercial |
$15.55
|
|
|
Urine Potassium
|
Facility
IP
|
$21.00
|
|
|
Service Code
|
CPT 84133
|
| Hospital Charge Code |
3813066
|
|
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 Potassium
|
Professional
|
$21.00
|
|
|
Service Code
|
CPT 84133
|
| Hospital Charge Code |
3813066
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.73 |
| Max. Negotiated Rate |
$20.81 |
| Rate for Payer: Aetna Commercial |
$19.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$18.06
|
| Rate for Payer: Aetna Managed Medicare |
$4.73
|
| Rate for Payer: Anthem Medicare Advantage |
$4.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$4.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$4.73
|
| 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 |
$4.73
|
| Rate for Payer: Health EOS Commercial |
$19.11
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$16.70
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$16.70
|
| Rate for Payer: Independent Care Health Plan Medicare |
$4.73
|
| 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 |
$4.73
|
| Rate for Payer: The Alliance Commercial |
$18.68
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4.73
|
| Rate for Payer: WEA Trust Commercial |
$11.55
|
| Rate for Payer: WPS Commercial |
$20.81
|
|
|
Urine Potassium
|
Professional
|
$53.00
|
|
|
Service Code
|
CPT 84133
|
| Hospital Charge Code |
2942999
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.73 |
| Max. Negotiated Rate |
$50.35 |
| Rate for Payer: Aetna Commercial |
$50.35
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$45.58
|
| Rate for Payer: Aetna Managed Medicare |
$4.73
|
| Rate for Payer: Anthem Medicare Advantage |
$4.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$4.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$4.73
|
| Rate for Payer: Cash Price |
$15.90
|
| Rate for Payer: Cash Price |
$15.90
|
| Rate for Payer: Cigna Commercial |
$50.35
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$26.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4.73
|
| Rate for Payer: Health EOS Commercial |
$48.23
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$16.70
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$16.70
|
| Rate for Payer: Independent Care Health Plan Medicare |
$4.73
|
| Rate for Payer: Multiplan Commercial |
$42.40
|
| Rate for Payer: Preferred Network Access Commercial |
$50.35
|
| Rate for Payer: Quartz Beloit One Network |
$23.32
|
| Rate for Payer: Quartz Commercial |
$30.21
|
| Rate for Payer: Quartz Medicare Advantage |
$4.73
|
| Rate for Payer: The Alliance Commercial |
$18.68
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4.73
|
| Rate for Payer: WEA Trust Commercial |
$29.15
|
| Rate for Payer: WPS Commercial |
$20.81
|
|
|
Urine Potassium
|
Facility
OP
|
$53.00
|
|
|
Service Code
|
CPT 84133
|
| Hospital Charge Code |
2942999
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.73 |
| Max. Negotiated Rate |
$212.00 |
| Rate for Payer: Aetna Commercial |
$47.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$45.58
|
| Rate for Payer: Aetna Managed Medicare |
$4.73
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$17.74
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7.85
|
| Rate for Payer: Anthem Medicaid |
$4.89
|
| Rate for Payer: Anthem Medicare Advantage |
$4.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$28.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$4.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$4.73
|
| Rate for Payer: Cash Price |
$15.90
|
| Rate for Payer: Cash Price |
$15.90
|
| Rate for Payer: Cigna Commercial |
$48.76
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$4.73
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$4.89
|
| Rate for Payer: Dean Health Medicaid |
$4.89
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$4.73
|
| Rate for Payer: Health EOS Commercial |
$47.17
|
| Rate for Payer: HFN Commercial |
$48.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$17.60
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$4.73
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$4.89
|
| Rate for Payer: Independent Care Health Plan Medicare |
$4.73
|
| Rate for Payer: Managed Health Services Medicaid |
$5.09
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$4.73
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$4.73
|
| Rate for Payer: Multiplan Commercial |
$42.40
|
| Rate for Payer: NAPHCARE Commercial |
$7.10
|
| Rate for Payer: Preferred Network Access Commercial |
$48.76
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$4.89
|
| Rate for Payer: Quartz Beloit One Network |
$25.97
|
| Rate for Payer: Quartz Commercial |
$34.45
|
| Rate for Payer: Quartz Medicare Advantage |
$4.73
|
| Rate for Payer: The Alliance Commercial |
$212.00
|
| Rate for Payer: United Healthcare Medicaid |
$4.89
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4.73
|
| Rate for Payer: United Healthcare PPO |
$39.75
|
| Rate for Payer: WEA Trust Commercial |
$29.15
|
| Rate for Payer: Wellcare Medicare |
$4.73
|
| Rate for Payer: WMAP Medicaid |
$4.89
|
| Rate for Payer: WPS Commercial |
$39.26
|
|
