|
Tricyclic Antidepressants ID & Quant, Serum
|
Facility
|
IP
|
$125.00
|
|
|
Service Code
|
CPT 80337
|
| Hospital Charge Code |
4075935
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$63.70 |
| Max. Negotiated Rate |
$119.60 |
| Rate for Payer: Aetna Commercial |
$117.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$111.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$68.90
|
| Rate for Payer: Cash Price |
$37.50
|
| Rate for Payer: Cigna Commercial |
$119.60
|
| Rate for Payer: Health EOS Commercial |
$115.70
|
| Rate for Payer: HFN Commercial |
$119.60
|
| Rate for Payer: Multiplan Commercial |
$104.00
|
| Rate for Payer: Preferred Network Access Commercial |
$119.60
|
| Rate for Payer: Quartz Beloit One Network |
$63.70
|
| Rate for Payer: Quartz Commercial |
$78.00
|
| Rate for Payer: WEA Trust Commercial |
$71.50
|
| Rate for Payer: WPS Commercial |
$96.29
|
|
|
Tricyclic Antidepressants ID & Quant, Serum
|
Professional
|
Both
|
$125.00
|
|
|
Service Code
|
CPT 80337
|
| Hospital Charge Code |
4075935
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$38.00 |
| Max. Negotiated Rate |
$123.50 |
| Rate for Payer: Aetna Commercial |
$123.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$111.80
|
| Rate for Payer: Cash Price |
$37.50
|
| Rate for Payer: Cash Price |
$37.50
|
| Rate for Payer: Cigna Commercial |
$123.50
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$65.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$78.00
|
| Rate for Payer: Health EOS Commercial |
$118.30
|
| Rate for Payer: HFN Commercial |
$123.50
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$38.00
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$38.00
|
| Rate for Payer: Multiplan Commercial |
$104.00
|
| Rate for Payer: Preferred Network Access Commercial |
$123.50
|
| Rate for Payer: Quartz Beloit One Network |
$57.20
|
| Rate for Payer: Quartz Commercial |
$74.10
|
| Rate for Payer: The Alliance Commercial |
$65.00
|
| Rate for Payer: WEA Trust Commercial |
$71.50
|
| Rate for Payer: WPS Commercial |
$96.29
|
|
|
Tricyclic Antidepressants ID & Quant, Serum
|
Facility
|
OP
|
$125.00
|
|
|
Service Code
|
CPT 80337
|
| Hospital Charge Code |
4075935
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$36.40 |
| Max. Negotiated Rate |
$119.60 |
| Rate for Payer: Aetna Commercial |
$117.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$111.80
|
| Rate for Payer: Aetna Managed Medicare |
$36.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$84.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$65.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$62.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$68.90
|
| Rate for Payer: Cash Price |
$37.50
|
| Rate for Payer: Cigna Commercial |
$119.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$72.75
|
| Rate for Payer: Health EOS Commercial |
$115.70
|
| Rate for Payer: HFN Commercial |
$119.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$97.50
|
| Rate for Payer: Multiplan Commercial |
$104.00
|
| Rate for Payer: NAPHCARE Commercial |
$78.00
|
| Rate for Payer: Preferred Network Access Commercial |
$119.60
|
| Rate for Payer: Quartz Beloit One Network |
$63.70
|
| Rate for Payer: Quartz Commercial |
$84.50
|
| Rate for Payer: Quartz Medicare Advantage |
$78.00
|
| Rate for Payer: The Alliance Commercial |
$65.00
|
| Rate for Payer: United Healthcare PPO |
$97.50
|
| Rate for Payer: WEA Trust Commercial |
$71.50
|
| Rate for Payer: WPS Commercial |
$96.29
|
|
|
Tricyclic Antidepressants, Quant, Urine
|
Facility
|
IP
|
$265.00
|
|
|
Service Code
|
CPT 80335
|
| Hospital Charge Code |
983429
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$135.04 |
| Max. Negotiated Rate |
$253.55 |
| Rate for Payer: Aetna Commercial |
$248.04
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$237.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$146.07
|
| Rate for Payer: Cash Price |
$79.50
|
| Rate for Payer: Cigna Commercial |
$253.55
|
| Rate for Payer: Health EOS Commercial |
$245.28
|
| Rate for Payer: HFN Commercial |
$253.55
|
| Rate for Payer: Multiplan Commercial |
$220.48
|
| Rate for Payer: Preferred Network Access Commercial |
$253.55
|
| Rate for Payer: Quartz Beloit One Network |
$135.04
|
| Rate for Payer: Quartz Commercial |
$165.36
|
| Rate for Payer: WEA Trust Commercial |
$151.58
|
| Rate for Payer: WPS Commercial |
$204.13
|
|
|
Tricyclic Antidepressants, Quant, Urine
|
Professional
|
Both
|
$265.00
|
|
|
Service Code
|
CPT 80335
|
| Hospital Charge Code |
983429
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$83.26 |
| Max. Negotiated Rate |
$261.82 |
| Rate for Payer: Aetna Commercial |
$261.82
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$237.02
|
| Rate for Payer: Cash Price |
$79.50
|
| Rate for Payer: Cash Price |
$79.50
|
| Rate for Payer: Cigna Commercial |
$261.82
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$137.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$165.36
|
| Rate for Payer: Health EOS Commercial |
$250.80
|
| Rate for Payer: HFN Commercial |
$261.82
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$83.26
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$83.26
|
| Rate for Payer: Multiplan Commercial |
$220.48
|
| Rate for Payer: Preferred Network Access Commercial |
$261.82
|
| Rate for Payer: Quartz Beloit One Network |
$121.26
|
| Rate for Payer: Quartz Commercial |
$157.09
|
| Rate for Payer: The Alliance Commercial |
$137.80
|
| Rate for Payer: WEA Trust Commercial |
$151.58
|
| Rate for Payer: WPS Commercial |
$204.13
|
|
|
Tricyclic Antidepressants, Quant, Urine
|
Facility
|
OP
|
$265.00
|
|
|
Service Code
|
CPT 80335
|
| Hospital Charge Code |
983429
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$77.17 |
| Max. Negotiated Rate |
$253.55 |
| Rate for Payer: Aetna Commercial |
$248.04
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$237.02
|
| Rate for Payer: Aetna Managed Medicare |
$77.17
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$179.14
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$137.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$132.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$146.07
|
| Rate for Payer: Cash Price |
$79.50
|
| Rate for Payer: Cigna Commercial |
$253.55
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$154.23
|
| Rate for Payer: Health EOS Commercial |
$245.28
|
| Rate for Payer: HFN Commercial |
$253.55
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$206.70
|
| Rate for Payer: Multiplan Commercial |
$220.48
|
| Rate for Payer: NAPHCARE Commercial |
$165.36
|
| Rate for Payer: Preferred Network Access Commercial |
$253.55
|
| Rate for Payer: Quartz Beloit One Network |
$135.04
|
| Rate for Payer: Quartz Commercial |
$179.14
|
| Rate for Payer: Quartz Medicare Advantage |
$165.36
|
| Rate for Payer: The Alliance Commercial |
$137.80
|
| Rate for Payer: United Healthcare PPO |
$206.70
|
| Rate for Payer: WEA Trust Commercial |
$151.58
|
| Rate for Payer: WPS Commercial |
$204.13
|
|
|
Tricyclic Antidepressants Screen
|
Professional
|
Both
|
$48.00
|
|
| Hospital Charge Code |
2942886
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$21.96 |
| Max. Negotiated Rate |
$47.42 |
| Rate for Payer: Aetna Commercial |
$47.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$42.93
|
| Rate for Payer: Cash Price |
$14.40
|
| Rate for Payer: Cigna Commercial |
$47.42
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$24.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$29.95
|
| Rate for Payer: Health EOS Commercial |
$45.43
|
| Rate for Payer: HFN Commercial |
$47.42
|
| Rate for Payer: Multiplan Commercial |
$39.94
|
| Rate for Payer: Preferred Network Access Commercial |
$47.42
|
| Rate for Payer: Quartz Beloit One Network |
$21.96
|
| Rate for Payer: Quartz Commercial |
$28.45
|
| Rate for Payer: The Alliance Commercial |
$24.96
|
| Rate for Payer: WEA Trust Commercial |
$27.46
|
| Rate for Payer: WPS Commercial |
$36.97
|
|
|
Tricyclic Antidepressants Screen
|
Facility
|
OP
|
$48.00
|
|
| Hospital Charge Code |
2942886
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.98 |
| Max. Negotiated Rate |
$45.93 |
| Rate for Payer: Aetna Commercial |
$44.93
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$42.93
|
| Rate for Payer: Aetna Managed Medicare |
$13.98
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$32.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$24.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$23.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$26.46
|
| Rate for Payer: Cash Price |
$14.40
|
| Rate for Payer: Cigna Commercial |
$45.93
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$27.94
|
| Rate for Payer: Health EOS Commercial |
$44.43
|
| Rate for Payer: HFN Commercial |
$45.93
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$37.44
|
| Rate for Payer: Multiplan Commercial |
$39.94
|
| Rate for Payer: NAPHCARE Commercial |
$29.95
|
| Rate for Payer: Preferred Network Access Commercial |
$45.93
|
| Rate for Payer: Quartz Beloit One Network |
$24.46
|
| Rate for Payer: Quartz Commercial |
$32.45
|
| Rate for Payer: Quartz Medicare Advantage |
$29.95
|
| Rate for Payer: The Alliance Commercial |
$24.96
|
| Rate for Payer: United Healthcare PPO |
$37.44
|
| Rate for Payer: WEA Trust Commercial |
$27.46
|
| Rate for Payer: WPS Commercial |
$36.97
|
|
|
Tricyclic Antidepressants Screen
|
Facility
|
IP
|
$48.00
|
|
| Hospital Charge Code |
2942886
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$24.46 |
| Max. Negotiated Rate |
$45.93 |
| Rate for Payer: Aetna Commercial |
$44.93
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$42.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$26.46
|
| Rate for Payer: Cash Price |
$14.40
|
| Rate for Payer: Cigna Commercial |
$45.93
|
| Rate for Payer: Health EOS Commercial |
$44.43
|
| Rate for Payer: HFN Commercial |
$45.93
|
| Rate for Payer: Multiplan Commercial |
$39.94
|
| Rate for Payer: Preferred Network Access Commercial |
$45.93
|
| Rate for Payer: Quartz Beloit One Network |
$24.46
|
| Rate for Payer: Quartz Commercial |
$29.95
|
| Rate for Payer: WEA Trust Commercial |
$27.46
|
| Rate for Payer: WPS Commercial |
$36.97
|
|
|
TRIGGER FINGER RELEASE
|
Facility
|
OP
|
$1,337.00
|
|
| Hospital Charge Code |
2960453
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$389.33 |
| Max. Negotiated Rate |
$1,279.24 |
| Rate for Payer: Aetna Commercial |
$1,251.43
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,195.81
|
| Rate for Payer: Aetna Managed Medicare |
$389.33
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$903.81
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$695.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$667.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$736.95
|
| Rate for Payer: Cash Price |
$401.10
|
| Rate for Payer: Cigna Commercial |
$1,279.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$778.13
|
| Rate for Payer: Health EOS Commercial |
$1,237.53
|
| Rate for Payer: HFN Commercial |
$1,279.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,042.86
|
| Rate for Payer: Multiplan Commercial |
$1,112.38
|
| Rate for Payer: NAPHCARE Commercial |
$834.29
|
| Rate for Payer: Preferred Network Access Commercial |
$1,279.24
|
| Rate for Payer: Quartz Beloit One Network |
$681.34
|
| Rate for Payer: Quartz Commercial |
$903.81
|
| Rate for Payer: Quartz Medicare Advantage |
$834.29
|
| Rate for Payer: The Alliance Commercial |
$695.24
|
| Rate for Payer: WEA Trust Commercial |
$764.76
|
| Rate for Payer: WPS Commercial |
$1,029.89
|
|
|
TRIGGER FINGER RELEASE
|
Facility
|
IP
|
$1,337.00
|
|
| Hospital Charge Code |
2960453
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$681.34 |
| Max. Negotiated Rate |
$1,279.24 |
| Rate for Payer: Aetna Commercial |
$1,251.43
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,195.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$736.95
|
| Rate for Payer: Cash Price |
$401.10
|
| Rate for Payer: Cigna Commercial |
$1,279.24
|
| Rate for Payer: Health EOS Commercial |
$1,237.53
|
| Rate for Payer: HFN Commercial |
$1,279.24
|
| Rate for Payer: Multiplan Commercial |
$1,112.38
|
| Rate for Payer: Preferred Network Access Commercial |
$1,279.24
|
| Rate for Payer: Quartz Beloit One Network |
$681.34
|
| Rate for Payer: Quartz Commercial |
$834.29
|
| Rate for Payer: WEA Trust Commercial |
$764.76
|
| Rate for Payer: WPS Commercial |
$1,029.89
|
|
|
TRIGGER POINT INJECTION, PAIN
|
Facility
|
IP
|
$291.00
|
|
| Hospital Charge Code |
2960454
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$148.29 |
| Max. Negotiated Rate |
$278.43 |
| Rate for Payer: Aetna Commercial |
$272.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$260.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$160.40
|
| Rate for Payer: Cash Price |
$87.30
|
| Rate for Payer: Cigna Commercial |
$278.43
|
| Rate for Payer: Health EOS Commercial |
$269.35
|
| Rate for Payer: HFN Commercial |
$278.43
|
| Rate for Payer: Multiplan Commercial |
$242.11
|
| Rate for Payer: Preferred Network Access Commercial |
$278.43
|
| Rate for Payer: Quartz Beloit One Network |
$148.29
|
| Rate for Payer: Quartz Commercial |
$181.58
|
| Rate for Payer: WEA Trust Commercial |
$166.45
|
| Rate for Payer: WPS Commercial |
$224.16
|
|
|
TRIGGER POINT INJECTION, PAIN
|
Facility
|
OP
|
$291.00
|
|
| Hospital Charge Code |
2960454
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$84.74 |
| Max. Negotiated Rate |
$278.43 |
| Rate for Payer: Aetna Commercial |
$272.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$260.27
|
| Rate for Payer: Aetna Managed Medicare |
$84.74
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$196.72
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$151.32
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$145.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$160.40
|
| Rate for Payer: Cash Price |
$87.30
|
| Rate for Payer: Cigna Commercial |
$278.43
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$169.36
|
| Rate for Payer: Health EOS Commercial |
$269.35
|
| Rate for Payer: HFN Commercial |
$278.43
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$226.98
|
| Rate for Payer: Multiplan Commercial |
$242.11
|
| Rate for Payer: NAPHCARE Commercial |
$181.58
|
| Rate for Payer: Preferred Network Access Commercial |
$278.43
|
| Rate for Payer: Quartz Beloit One Network |
$148.29
|
| Rate for Payer: Quartz Commercial |
$196.72
|
| Rate for Payer: Quartz Medicare Advantage |
$181.58
|
| Rate for Payer: The Alliance Commercial |
$151.32
|
| Rate for Payer: WEA Trust Commercial |
$166.45
|
| Rate for Payer: WPS Commercial |
$224.16
|
|
|
Triglycerides
|
Facility
|
IP
|
$113.00
|
|
|
Service Code
|
CPT 84478
|
| Hospital Charge Code |
633852
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$57.58 |
| Max. Negotiated Rate |
$108.12 |
| Rate for Payer: Aetna Commercial |
$105.77
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$101.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$62.29
|
| Rate for Payer: Cash Price |
$33.90
|
| Rate for Payer: Cigna Commercial |
$108.12
|
| Rate for Payer: Health EOS Commercial |
$104.59
|
| Rate for Payer: HFN Commercial |
$108.12
|
| Rate for Payer: Multiplan Commercial |
$94.02
|
| Rate for Payer: Preferred Network Access Commercial |
$108.12
|
| Rate for Payer: Quartz Beloit One Network |
$57.58
|
| Rate for Payer: Quartz Commercial |
$70.51
|
| Rate for Payer: WEA Trust Commercial |
$64.64
|
| Rate for Payer: WPS Commercial |
$87.04
|
|
|
Triglycerides
|
Professional
|
Both
|
$113.00
|
|
|
Service Code
|
CPT 84478
|
| Hospital Charge Code |
633852
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.97 |
| Max. Negotiated Rate |
$111.64 |
| Rate for Payer: Aetna Commercial |
$111.64
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$101.07
|
| Rate for Payer: Aetna Managed Medicare |
$5.97
|
| Rate for Payer: Anthem Medicare Advantage |
$5.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5.97
|
| Rate for Payer: Cash Price |
$33.90
|
| Rate for Payer: Cash Price |
$33.90
|
| Rate for Payer: Cigna Commercial |
$111.64
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$58.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5.97
|
| Rate for Payer: Health EOS Commercial |
$106.94
|
| Rate for Payer: HFN Commercial |
$111.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$21.07
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$21.07
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5.97
|
| Rate for Payer: Multiplan Commercial |
$94.02
|
| Rate for Payer: NAPHCARE Commercial |
$8.95
|
| Rate for Payer: Preferred Network Access Commercial |
$111.64
|
| Rate for Payer: Quartz Beloit One Network |
$51.71
|
| Rate for Payer: Quartz Commercial |
$66.99
|
| Rate for Payer: Quartz Medicare Advantage |
$5.97
|
| Rate for Payer: The Alliance Commercial |
$23.58
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.97
|
| Rate for Payer: WEA Trust Commercial |
$64.64
|
| Rate for Payer: WPS Commercial |
$26.27
|
|
|
Triglycerides
|
Facility
|
OP
|
$113.00
|
|
|
Service Code
|
CPT 84478
|
| Hospital Charge Code |
633852
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.97 |
| Max. Negotiated Rate |
$108.12 |
| Rate for Payer: Aetna Commercial |
$105.77
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$101.07
|
| Rate for Payer: Aetna Managed Medicare |
$5.97
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$22.39
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$10.45
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$9.91
|
| Rate for Payer: Anthem Medicare Advantage |
$5.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$62.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5.97
|
| Rate for Payer: Cash Price |
$33.90
|
| Rate for Payer: Cash Price |
$33.90
|
| Rate for Payer: Cigna Commercial |
$108.12
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$5.97
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$65.77
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$5.97
|
| Rate for Payer: Health EOS Commercial |
$104.59
|
| Rate for Payer: HFN Commercial |
$108.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$22.21
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$5.97
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5.97
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$5.97
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$5.97
|
| Rate for Payer: Multiplan Commercial |
$94.02
|
| Rate for Payer: NAPHCARE Commercial |
$8.95
|
| Rate for Payer: Preferred Network Access Commercial |
$108.12
|
| Rate for Payer: Quartz Beloit One Network |
$57.58
|
| Rate for Payer: Quartz Commercial |
$76.39
|
| Rate for Payer: Quartz Medicare Advantage |
$5.97
|
| Rate for Payer: The Alliance Commercial |
$23.88
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.97
|
| Rate for Payer: United Healthcare PPO |
$88.14
|
| Rate for Payer: WEA Trust Commercial |
$64.64
|
| Rate for Payer: Wellcare Medicare |
$5.97
|
| Rate for Payer: WPS Commercial |
$87.04
|
|
|
Triglycerides (LPE)
|
Facility
|
OP
|
$114.00
|
|
|
Service Code
|
CPT 84478
|
| Hospital Charge Code |
2942941
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.97 |
| Max. Negotiated Rate |
$109.08 |
| Rate for Payer: Aetna Commercial |
$106.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$101.96
|
| Rate for Payer: Aetna Managed Medicare |
$5.97
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$22.39
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$10.45
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$9.91
|
| Rate for Payer: Anthem Medicare Advantage |
$5.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$62.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5.97
|
| Rate for Payer: Cash Price |
$34.20
|
| Rate for Payer: Cash Price |
$34.20
|
| Rate for Payer: Cigna Commercial |
$109.08
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$5.97
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$66.35
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$5.97
|
| Rate for Payer: Health EOS Commercial |
$105.52
|
| Rate for Payer: HFN Commercial |
$109.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$22.21
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$5.97
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5.97
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$5.97
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$5.97
|
| Rate for Payer: Multiplan Commercial |
$94.85
|
| Rate for Payer: NAPHCARE Commercial |
$8.95
|
| Rate for Payer: Preferred Network Access Commercial |
$109.08
|
| Rate for Payer: Quartz Beloit One Network |
$58.09
|
| Rate for Payer: Quartz Commercial |
$77.06
|
| Rate for Payer: Quartz Medicare Advantage |
$5.97
|
| Rate for Payer: The Alliance Commercial |
$23.88
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.97
|
| Rate for Payer: United Healthcare PPO |
$88.92
|
| Rate for Payer: WEA Trust Commercial |
$65.21
|
| Rate for Payer: Wellcare Medicare |
$5.97
|
| Rate for Payer: WPS Commercial |
$87.81
|
|
|
Triglycerides (LPE)
|
Professional
|
Both
|
$114.00
|
|
|
Service Code
|
CPT 84478
|
| Hospital Charge Code |
2942941
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.97 |
| Max. Negotiated Rate |
$112.63 |
| Rate for Payer: Aetna Commercial |
$112.63
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$101.96
|
| Rate for Payer: Aetna Managed Medicare |
$5.97
|
| Rate for Payer: Anthem Medicare Advantage |
$5.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5.97
|
| Rate for Payer: Cash Price |
$34.20
|
| Rate for Payer: Cash Price |
$34.20
|
| Rate for Payer: Cigna Commercial |
$112.63
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$59.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5.97
|
| Rate for Payer: Health EOS Commercial |
$107.89
|
| Rate for Payer: HFN Commercial |
$112.63
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$21.07
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$21.07
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5.97
|
| Rate for Payer: Multiplan Commercial |
$94.85
|
| Rate for Payer: NAPHCARE Commercial |
$8.95
|
| Rate for Payer: Preferred Network Access Commercial |
$112.63
|
| Rate for Payer: Quartz Beloit One Network |
$52.17
|
| Rate for Payer: Quartz Commercial |
$67.58
|
| Rate for Payer: Quartz Medicare Advantage |
$5.97
|
| Rate for Payer: The Alliance Commercial |
$23.58
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.97
|
| Rate for Payer: WEA Trust Commercial |
$65.21
|
| Rate for Payer: WPS Commercial |
$26.27
|
|
|
Triglycerides (LPE)
|
Facility
|
IP
|
$114.00
|
|
|
Service Code
|
CPT 84478
|
| Hospital Charge Code |
2942941
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$58.09 |
| Max. Negotiated Rate |
$109.08 |
| Rate for Payer: Aetna Commercial |
$106.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$101.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$62.84
|
| Rate for Payer: Cash Price |
$34.20
|
| Rate for Payer: Cigna Commercial |
$109.08
|
| Rate for Payer: Health EOS Commercial |
$105.52
|
| Rate for Payer: HFN Commercial |
$109.08
|
| Rate for Payer: Multiplan Commercial |
$94.85
|
| Rate for Payer: Preferred Network Access Commercial |
$109.08
|
| Rate for Payer: Quartz Beloit One Network |
$58.09
|
| Rate for Payer: Quartz Commercial |
$71.14
|
| Rate for Payer: WEA Trust Commercial |
$65.21
|
| Rate for Payer: WPS Commercial |
$87.81
|
|
|
Triglycerides, Peritoneal Fluid
|
Professional
|
Both
|
$49.00
|
|
|
Service Code
|
CPT 84478
|
| Hospital Charge Code |
3154857
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.97 |
| Max. Negotiated Rate |
$48.41 |
| Rate for Payer: Aetna Commercial |
$48.41
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$43.83
|
| Rate for Payer: Aetna Managed Medicare |
$5.97
|
| Rate for Payer: Anthem Medicare Advantage |
$5.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5.97
|
| Rate for Payer: Cash Price |
$14.70
|
| Rate for Payer: Cash Price |
$14.70
|
| Rate for Payer: Cigna Commercial |
$48.41
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$25.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5.97
|
| Rate for Payer: Health EOS Commercial |
$46.37
|
| Rate for Payer: HFN Commercial |
$48.41
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$21.07
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$21.07
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5.97
|
| Rate for Payer: Multiplan Commercial |
$40.77
|
| Rate for Payer: NAPHCARE Commercial |
$8.95
|
| Rate for Payer: Preferred Network Access Commercial |
$48.41
|
| Rate for Payer: Quartz Beloit One Network |
$22.42
|
| Rate for Payer: Quartz Commercial |
$29.05
|
| Rate for Payer: Quartz Medicare Advantage |
$5.97
|
| Rate for Payer: The Alliance Commercial |
$23.58
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.97
|
| Rate for Payer: WEA Trust Commercial |
$28.03
|
| Rate for Payer: WPS Commercial |
$26.27
|
|
|
Triglycerides, Peritoneal Fluid
|
Facility
|
OP
|
$49.00
|
|
|
Service Code
|
CPT 84478
|
| Hospital Charge Code |
3154857
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.97 |
| Max. Negotiated Rate |
$46.88 |
| Rate for Payer: Aetna Commercial |
$45.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$43.83
|
| Rate for Payer: Aetna Managed Medicare |
$5.97
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$22.39
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$10.45
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$9.91
|
| Rate for Payer: Anthem Medicare Advantage |
$5.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$27.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5.97
|
| Rate for Payer: Cash Price |
$14.70
|
| Rate for Payer: Cash Price |
$14.70
|
| Rate for Payer: Cigna Commercial |
$46.88
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$5.97
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$28.52
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$5.97
|
| Rate for Payer: Health EOS Commercial |
$45.35
|
| Rate for Payer: HFN Commercial |
$46.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$22.21
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$5.97
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5.97
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$5.97
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$5.97
|
| Rate for Payer: Multiplan Commercial |
$40.77
|
| Rate for Payer: NAPHCARE Commercial |
$8.95
|
| Rate for Payer: Preferred Network Access Commercial |
$46.88
|
| Rate for Payer: Quartz Beloit One Network |
$24.97
|
| Rate for Payer: Quartz Commercial |
$33.12
|
| Rate for Payer: Quartz Medicare Advantage |
$5.97
|
| Rate for Payer: The Alliance Commercial |
$23.88
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.97
|
| Rate for Payer: United Healthcare PPO |
$38.22
|
| Rate for Payer: WEA Trust Commercial |
$28.03
|
| Rate for Payer: Wellcare Medicare |
$5.97
|
| Rate for Payer: WPS Commercial |
$37.74
|
|
|
Triglycerides, Peritoneal Fluid
|
Facility
|
IP
|
$49.00
|
|
|
Service Code
|
CPT 84478
|
| Hospital Charge Code |
3154857
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$24.97 |
| Max. Negotiated Rate |
$46.88 |
| Rate for Payer: Aetna Commercial |
$45.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$43.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$27.01
|
| Rate for Payer: Cash Price |
$14.70
|
| Rate for Payer: Cigna Commercial |
$46.88
|
| Rate for Payer: Health EOS Commercial |
$45.35
|
| Rate for Payer: HFN Commercial |
$46.88
|
| Rate for Payer: Multiplan Commercial |
$40.77
|
| Rate for Payer: Preferred Network Access Commercial |
$46.88
|
| Rate for Payer: Quartz Beloit One Network |
$24.97
|
| Rate for Payer: Quartz Commercial |
$30.58
|
| Rate for Payer: WEA Trust Commercial |
$28.03
|
| Rate for Payer: WPS Commercial |
$37.74
|
|
|
Triglycerides, Pleural Fluid
|
Facility
|
OP
|
$49.00
|
|
|
Service Code
|
CPT 84478
|
| Hospital Charge Code |
3154856
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.97 |
| Max. Negotiated Rate |
$46.88 |
| Rate for Payer: Aetna Commercial |
$45.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$43.83
|
| Rate for Payer: Aetna Managed Medicare |
$5.97
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$22.39
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$10.45
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$9.91
|
| Rate for Payer: Anthem Medicare Advantage |
$5.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$27.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5.97
|
| Rate for Payer: Cash Price |
$14.70
|
| Rate for Payer: Cash Price |
$14.70
|
| Rate for Payer: Cigna Commercial |
$46.88
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$5.97
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$28.52
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$5.97
|
| Rate for Payer: Health EOS Commercial |
$45.35
|
| Rate for Payer: HFN Commercial |
$46.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$22.21
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$5.97
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5.97
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$5.97
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$5.97
|
| Rate for Payer: Multiplan Commercial |
$40.77
|
| Rate for Payer: NAPHCARE Commercial |
$8.95
|
| Rate for Payer: Preferred Network Access Commercial |
$46.88
|
| Rate for Payer: Quartz Beloit One Network |
$24.97
|
| Rate for Payer: Quartz Commercial |
$33.12
|
| Rate for Payer: Quartz Medicare Advantage |
$5.97
|
| Rate for Payer: The Alliance Commercial |
$23.88
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.97
|
| Rate for Payer: United Healthcare PPO |
$38.22
|
| Rate for Payer: WEA Trust Commercial |
$28.03
|
| Rate for Payer: Wellcare Medicare |
$5.97
|
| Rate for Payer: WPS Commercial |
$37.74
|
|
|
Triglycerides, Pleural Fluid
|
Facility
|
IP
|
$49.00
|
|
|
Service Code
|
CPT 84478
|
| Hospital Charge Code |
3154856
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$24.97 |
| Max. Negotiated Rate |
$46.88 |
| Rate for Payer: Aetna Commercial |
$45.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$43.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$27.01
|
| Rate for Payer: Cash Price |
$14.70
|
| Rate for Payer: Cigna Commercial |
$46.88
|
| Rate for Payer: Health EOS Commercial |
$45.35
|
| Rate for Payer: HFN Commercial |
$46.88
|
| Rate for Payer: Multiplan Commercial |
$40.77
|
| Rate for Payer: Preferred Network Access Commercial |
$46.88
|
| Rate for Payer: Quartz Beloit One Network |
$24.97
|
| Rate for Payer: Quartz Commercial |
$30.58
|
| Rate for Payer: WEA Trust Commercial |
$28.03
|
| Rate for Payer: WPS Commercial |
$37.74
|
|
|
Triglycerides, Pleural Fluid
|
Professional
|
Both
|
$49.00
|
|
|
Service Code
|
CPT 84478
|
| Hospital Charge Code |
3154856
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.97 |
| Max. Negotiated Rate |
$48.41 |
| Rate for Payer: Aetna Commercial |
$48.41
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$43.83
|
| Rate for Payer: Aetna Managed Medicare |
$5.97
|
| Rate for Payer: Anthem Medicare Advantage |
$5.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5.97
|
| Rate for Payer: Cash Price |
$14.70
|
| Rate for Payer: Cash Price |
$14.70
|
| Rate for Payer: Cigna Commercial |
$48.41
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$25.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5.97
|
| Rate for Payer: Health EOS Commercial |
$46.37
|
| Rate for Payer: HFN Commercial |
$48.41
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$21.07
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$21.07
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5.97
|
| Rate for Payer: Multiplan Commercial |
$40.77
|
| Rate for Payer: NAPHCARE Commercial |
$8.95
|
| Rate for Payer: Preferred Network Access Commercial |
$48.41
|
| Rate for Payer: Quartz Beloit One Network |
$22.42
|
| Rate for Payer: Quartz Commercial |
$29.05
|
| Rate for Payer: Quartz Medicare Advantage |
$5.97
|
| Rate for Payer: The Alliance Commercial |
$23.58
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.97
|
| Rate for Payer: WEA Trust Commercial |
$28.03
|
| Rate for Payer: WPS Commercial |
$26.27
|
|
