|
Urine Protein
|
Professional
|
Both
|
$52.00
|
|
|
Service Code
|
CPT 84156
|
| Hospital Charge Code |
3119373
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.82 |
| Max. Negotiated Rate |
$51.38 |
| Rate for Payer: Aetna Commercial |
$51.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$46.51
|
| Rate for Payer: Aetna Managed Medicare |
$3.82
|
| Rate for Payer: Anthem Medicare Advantage |
$3.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$3.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$3.82
|
| Rate for Payer: Cash Price |
$15.60
|
| Rate for Payer: Cash Price |
$15.60
|
| Rate for Payer: Cigna Commercial |
$51.38
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$27.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3.82
|
| Rate for Payer: Health EOS Commercial |
$49.21
|
| Rate for Payer: HFN Commercial |
$51.38
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$13.48
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$13.48
|
| Rate for Payer: Independent Care Health Plan Medicare |
$3.82
|
| Rate for Payer: Multiplan Commercial |
$43.26
|
| Rate for Payer: NAPHCARE Commercial |
$5.73
|
| Rate for Payer: Preferred Network Access Commercial |
$51.38
|
| Rate for Payer: Quartz Beloit One Network |
$23.80
|
| Rate for Payer: Quartz Commercial |
$30.83
|
| Rate for Payer: Quartz Medicare Advantage |
$3.82
|
| Rate for Payer: The Alliance Commercial |
$15.08
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3.82
|
| Rate for Payer: WEA Trust Commercial |
$29.74
|
| Rate for Payer: WPS Commercial |
$16.79
|
|
|
Urine Protein
|
Professional
|
Both
|
$77.00
|
|
|
Service Code
|
CPT 84156
|
| Hospital Charge Code |
982777
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.82 |
| Max. Negotiated Rate |
$76.08 |
| Rate for Payer: Aetna Commercial |
$76.08
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$68.87
|
| Rate for Payer: Aetna Managed Medicare |
$3.82
|
| Rate for Payer: Anthem Medicare Advantage |
$3.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$3.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$3.82
|
| Rate for Payer: Cash Price |
$23.10
|
| Rate for Payer: Cash Price |
$23.10
|
| Rate for Payer: Cigna Commercial |
$76.08
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$40.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3.82
|
| Rate for Payer: Health EOS Commercial |
$72.87
|
| Rate for Payer: HFN Commercial |
$76.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$13.48
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$13.48
|
| Rate for Payer: Independent Care Health Plan Medicare |
$3.82
|
| Rate for Payer: Multiplan Commercial |
$64.06
|
| Rate for Payer: NAPHCARE Commercial |
$5.73
|
| Rate for Payer: Preferred Network Access Commercial |
$76.08
|
| Rate for Payer: Quartz Beloit One Network |
$35.24
|
| Rate for Payer: Quartz Commercial |
$45.65
|
| Rate for Payer: Quartz Medicare Advantage |
$3.82
|
| Rate for Payer: The Alliance Commercial |
$15.08
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3.82
|
| Rate for Payer: WEA Trust Commercial |
$44.04
|
| Rate for Payer: WPS Commercial |
$16.79
|
|
|
Urine Sodium
|
Facility
|
OP
|
$21.00
|
|
|
Service Code
|
CPT 84300
|
| Hospital Charge Code |
3813062
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.26 |
| Max. Negotiated Rate |
$21.05 |
| Rate for Payer: Aetna Commercial |
$19.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$18.78
|
| Rate for Payer: Aetna Managed Medicare |
$5.26
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$19.73
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$9.21
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$8.74
|
| Rate for Payer: Anthem Medicare Advantage |
$5.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$11.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5.26
|
| Rate for Payer: Cash Price |
$6.30
|
| Rate for Payer: Cash Price |
$6.30
|
| Rate for Payer: Cigna Commercial |
$20.09
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$5.26
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12.22
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$5.26
|
| Rate for Payer: Health EOS Commercial |
$19.44
|
| Rate for Payer: HFN Commercial |
$20.09
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$19.58
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$5.26
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5.26
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$5.26
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$5.26
|
| Rate for Payer: Multiplan Commercial |
$17.47
|
| Rate for Payer: NAPHCARE Commercial |
$7.89
|
| Rate for Payer: Preferred Network Access Commercial |
$20.09
|
| Rate for Payer: Quartz Beloit One Network |
$10.70
|
| Rate for Payer: Quartz Commercial |
$14.20
|
| Rate for Payer: Quartz Medicare Advantage |
$5.26
|
| Rate for Payer: The Alliance Commercial |
$21.05
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.26
|
| Rate for Payer: United Healthcare PPO |
$16.38
|
| Rate for Payer: WEA Trust Commercial |
$12.01
|
| Rate for Payer: Wellcare Medicare |
$5.26
|
| Rate for Payer: WPS Commercial |
$16.18
|
|
|
Urine Sodium
|
Professional
|
Both
|
$21.00
|
|
|
Service Code
|
CPT 84300
|
| Hospital Charge Code |
3813062
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.26 |
| Max. Negotiated Rate |
$23.15 |
| Rate for Payer: Aetna Commercial |
$20.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$18.78
|
| Rate for Payer: Aetna Managed Medicare |
$5.26
|
| Rate for Payer: Anthem Medicare Advantage |
$5.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5.26
|
| Rate for Payer: Cash Price |
$6.30
|
| Rate for Payer: Cash Price |
$6.30
|
| Rate for Payer: Cigna Commercial |
$20.75
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$10.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5.26
|
| Rate for Payer: Health EOS Commercial |
$19.87
|
| Rate for Payer: HFN Commercial |
$20.75
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$18.57
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$18.57
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5.26
|
| Rate for Payer: Multiplan Commercial |
$17.47
|
| Rate for Payer: NAPHCARE Commercial |
$7.89
|
| Rate for Payer: Preferred Network Access Commercial |
$20.75
|
| Rate for Payer: Quartz Beloit One Network |
$9.61
|
| Rate for Payer: Quartz Commercial |
$12.45
|
| Rate for Payer: Quartz Medicare Advantage |
$5.26
|
| Rate for Payer: The Alliance Commercial |
$20.79
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.26
|
| Rate for Payer: WEA Trust Commercial |
$12.01
|
| Rate for Payer: WPS Commercial |
$23.15
|
|
|
Urine Sodium
|
Facility
|
OP
|
$100.00
|
|
|
Service Code
|
CPT 84300
|
| Hospital Charge Code |
2942994
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.26 |
| Max. Negotiated Rate |
$95.68 |
| Rate for Payer: Aetna Commercial |
$93.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$89.44
|
| Rate for Payer: Aetna Managed Medicare |
$5.26
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$19.73
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$9.21
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$8.74
|
| Rate for Payer: Anthem Medicare Advantage |
$5.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$55.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5.26
|
| Rate for Payer: Cash Price |
$30.00
|
| Rate for Payer: Cash Price |
$30.00
|
| Rate for Payer: Cigna Commercial |
$95.68
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$5.26
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$58.20
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$5.26
|
| Rate for Payer: Health EOS Commercial |
$92.56
|
| Rate for Payer: HFN Commercial |
$95.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$19.58
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$5.26
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5.26
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$5.26
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$5.26
|
| Rate for Payer: Multiplan Commercial |
$83.20
|
| Rate for Payer: NAPHCARE Commercial |
$7.89
|
| Rate for Payer: Preferred Network Access Commercial |
$95.68
|
| Rate for Payer: Quartz Beloit One Network |
$50.96
|
| Rate for Payer: Quartz Commercial |
$67.60
|
| Rate for Payer: Quartz Medicare Advantage |
$5.26
|
| Rate for Payer: The Alliance Commercial |
$21.05
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.26
|
| Rate for Payer: United Healthcare PPO |
$78.00
|
| Rate for Payer: WEA Trust Commercial |
$57.20
|
| Rate for Payer: Wellcare Medicare |
$5.26
|
| Rate for Payer: WPS Commercial |
$77.03
|
|
|
Urine Sodium
|
Facility
|
IP
|
$21.00
|
|
|
Service Code
|
CPT 84300
|
| Hospital Charge Code |
3813062
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.70 |
| Max. Negotiated Rate |
$20.09 |
| Rate for Payer: Aetna Commercial |
$19.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$18.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$11.58
|
| Rate for Payer: Cash Price |
$6.30
|
| Rate for Payer: Cigna Commercial |
$20.09
|
| Rate for Payer: Health EOS Commercial |
$19.44
|
| Rate for Payer: HFN Commercial |
$20.09
|
| Rate for Payer: Multiplan Commercial |
$17.47
|
| Rate for Payer: Preferred Network Access Commercial |
$20.09
|
| Rate for Payer: Quartz Beloit One Network |
$10.70
|
| Rate for Payer: Quartz Commercial |
$13.10
|
| Rate for Payer: WEA Trust Commercial |
$12.01
|
| Rate for Payer: WPS Commercial |
$16.18
|
|
|
Urine Sodium
|
Professional
|
Both
|
$100.00
|
|
|
Service Code
|
CPT 84300
|
| Hospital Charge Code |
2942994
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.26 |
| Max. Negotiated Rate |
$98.80 |
| Rate for Payer: Aetna Commercial |
$98.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$89.44
|
| Rate for Payer: Aetna Managed Medicare |
$5.26
|
| Rate for Payer: Anthem Medicare Advantage |
$5.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5.26
|
| Rate for Payer: Cash Price |
$30.00
|
| Rate for Payer: Cash Price |
$30.00
|
| Rate for Payer: Cigna Commercial |
$98.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$52.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5.26
|
| Rate for Payer: Health EOS Commercial |
$94.64
|
| Rate for Payer: HFN Commercial |
$98.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$18.57
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$18.57
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5.26
|
| Rate for Payer: Multiplan Commercial |
$83.20
|
| Rate for Payer: NAPHCARE Commercial |
$7.89
|
| Rate for Payer: Preferred Network Access Commercial |
$98.80
|
| Rate for Payer: Quartz Beloit One Network |
$45.76
|
| Rate for Payer: Quartz Commercial |
$59.28
|
| Rate for Payer: Quartz Medicare Advantage |
$5.26
|
| Rate for Payer: The Alliance Commercial |
$20.79
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.26
|
| Rate for Payer: WEA Trust Commercial |
$57.20
|
| Rate for Payer: WPS Commercial |
$23.15
|
|
|
Urine Sodium
|
Facility
|
IP
|
$100.00
|
|
|
Service Code
|
CPT 84300
|
| Hospital Charge Code |
2942994
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$50.96 |
| Max. Negotiated Rate |
$95.68 |
| Rate for Payer: Aetna Commercial |
$93.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$89.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$55.12
|
| Rate for Payer: Cash Price |
$30.00
|
| Rate for Payer: Cigna Commercial |
$95.68
|
| Rate for Payer: Health EOS Commercial |
$92.56
|
| Rate for Payer: HFN Commercial |
$95.68
|
| Rate for Payer: Multiplan Commercial |
$83.20
|
| Rate for Payer: Preferred Network Access Commercial |
$95.68
|
| Rate for Payer: Quartz Beloit One Network |
$50.96
|
| Rate for Payer: Quartz Commercial |
$62.40
|
| Rate for Payer: WEA Trust Commercial |
$57.20
|
| Rate for Payer: WPS Commercial |
$77.03
|
|
|
Urine Sulfate
|
Professional
|
Both
|
$55.00
|
|
|
Service Code
|
CPT 84392
|
| Hospital Charge Code |
2942995
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.71 |
| Max. Negotiated Rate |
$54.34 |
| Rate for Payer: Aetna Commercial |
$54.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$49.19
|
| Rate for Payer: Aetna Managed Medicare |
$5.71
|
| Rate for Payer: Anthem Medicare Advantage |
$5.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5.71
|
| Rate for Payer: Cash Price |
$16.50
|
| Rate for Payer: Cash Price |
$16.50
|
| Rate for Payer: Cigna Commercial |
$54.34
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$28.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5.71
|
| Rate for Payer: Health EOS Commercial |
$52.05
|
| Rate for Payer: HFN Commercial |
$54.34
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$20.16
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$20.16
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5.71
|
| Rate for Payer: Multiplan Commercial |
$45.76
|
| Rate for Payer: NAPHCARE Commercial |
$8.56
|
| Rate for Payer: Preferred Network Access Commercial |
$54.34
|
| Rate for Payer: Quartz Beloit One Network |
$25.17
|
| Rate for Payer: Quartz Commercial |
$32.60
|
| Rate for Payer: Quartz Medicare Advantage |
$5.71
|
| Rate for Payer: The Alliance Commercial |
$22.55
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.71
|
| Rate for Payer: WEA Trust Commercial |
$31.46
|
| Rate for Payer: WPS Commercial |
$25.12
|
|
|
Urine Sulfate
|
Facility
|
OP
|
$55.00
|
|
|
Service Code
|
CPT 84392
|
| Hospital Charge Code |
2942995
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.71 |
| Max. Negotiated Rate |
$52.62 |
| Rate for Payer: Aetna Commercial |
$51.48
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$49.19
|
| Rate for Payer: Aetna Managed Medicare |
$5.71
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$21.41
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$9.99
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$9.48
|
| Rate for Payer: Anthem Medicare Advantage |
$5.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$30.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5.71
|
| Rate for Payer: Cash Price |
$16.50
|
| Rate for Payer: Cash Price |
$16.50
|
| Rate for Payer: Cigna Commercial |
$52.62
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$5.71
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$32.01
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$5.71
|
| Rate for Payer: Health EOS Commercial |
$50.91
|
| Rate for Payer: HFN Commercial |
$52.62
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$21.24
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$5.71
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5.71
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$5.71
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$5.71
|
| Rate for Payer: Multiplan Commercial |
$45.76
|
| Rate for Payer: NAPHCARE Commercial |
$8.56
|
| Rate for Payer: Preferred Network Access Commercial |
$52.62
|
| Rate for Payer: Quartz Beloit One Network |
$28.03
|
| Rate for Payer: Quartz Commercial |
$37.18
|
| Rate for Payer: Quartz Medicare Advantage |
$5.71
|
| Rate for Payer: The Alliance Commercial |
$22.84
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.71
|
| Rate for Payer: United Healthcare PPO |
$42.90
|
| Rate for Payer: WEA Trust Commercial |
$31.46
|
| Rate for Payer: Wellcare Medicare |
$5.71
|
| Rate for Payer: WPS Commercial |
$42.37
|
|
|
Urine Sulfate
|
Facility
|
IP
|
$55.00
|
|
|
Service Code
|
CPT 84392
|
| Hospital Charge Code |
2942995
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$28.03 |
| Max. Negotiated Rate |
$52.62 |
| Rate for Payer: Aetna Commercial |
$51.48
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$49.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$30.32
|
| Rate for Payer: Cash Price |
$16.50
|
| Rate for Payer: Cigna Commercial |
$52.62
|
| Rate for Payer: Health EOS Commercial |
$50.91
|
| Rate for Payer: HFN Commercial |
$52.62
|
| Rate for Payer: Multiplan Commercial |
$45.76
|
| Rate for Payer: Preferred Network Access Commercial |
$52.62
|
| Rate for Payer: Quartz Beloit One Network |
$28.03
|
| Rate for Payer: Quartz Commercial |
$34.32
|
| Rate for Payer: WEA Trust Commercial |
$31.46
|
| Rate for Payer: WPS Commercial |
$42.37
|
|
|
Urine Uric Acid
|
Professional
|
Both
|
$62.00
|
|
|
Service Code
|
CPT 84560
|
| Hospital Charge Code |
2942991
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.28 |
| Max. Negotiated Rate |
$61.26 |
| Rate for Payer: Aetna Commercial |
$61.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$55.45
|
| Rate for Payer: Aetna Managed Medicare |
$5.28
|
| Rate for Payer: Anthem Medicare Advantage |
$5.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5.28
|
| Rate for Payer: Cash Price |
$18.60
|
| Rate for Payer: Cash Price |
$18.60
|
| Rate for Payer: Cigna Commercial |
$61.26
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$32.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5.28
|
| Rate for Payer: Health EOS Commercial |
$58.68
|
| Rate for Payer: HFN Commercial |
$61.26
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$18.65
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$18.65
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5.28
|
| Rate for Payer: Multiplan Commercial |
$51.58
|
| Rate for Payer: NAPHCARE Commercial |
$7.92
|
| Rate for Payer: Preferred Network Access Commercial |
$61.26
|
| Rate for Payer: Quartz Beloit One Network |
$28.37
|
| Rate for Payer: Quartz Commercial |
$36.75
|
| Rate for Payer: Quartz Medicare Advantage |
$5.28
|
| Rate for Payer: The Alliance Commercial |
$20.87
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.28
|
| Rate for Payer: WEA Trust Commercial |
$35.46
|
| Rate for Payer: WPS Commercial |
$23.25
|
|
|
Urine Uric Acid
|
Facility
|
IP
|
$62.00
|
|
|
Service Code
|
CPT 84560
|
| Hospital Charge Code |
2942991
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$31.60 |
| Max. Negotiated Rate |
$59.32 |
| Rate for Payer: Aetna Commercial |
$58.03
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$55.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$34.17
|
| Rate for Payer: Cash Price |
$18.60
|
| Rate for Payer: Cigna Commercial |
$59.32
|
| Rate for Payer: Health EOS Commercial |
$57.39
|
| Rate for Payer: HFN Commercial |
$59.32
|
| Rate for Payer: Multiplan Commercial |
$51.58
|
| Rate for Payer: Preferred Network Access Commercial |
$59.32
|
| Rate for Payer: Quartz Beloit One Network |
$31.60
|
| Rate for Payer: Quartz Commercial |
$38.69
|
| Rate for Payer: WEA Trust Commercial |
$35.46
|
| Rate for Payer: WPS Commercial |
$47.76
|
|
|
Urine Uric Acid
|
Facility
|
OP
|
$62.00
|
|
|
Service Code
|
CPT 84560
|
| Hospital Charge Code |
2942991
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.28 |
| Max. Negotiated Rate |
$59.32 |
| Rate for Payer: Aetna Commercial |
$58.03
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$55.45
|
| Rate for Payer: Aetna Managed Medicare |
$5.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$19.81
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$9.25
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$8.77
|
| Rate for Payer: Anthem Medicare Advantage |
$5.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$34.17
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5.28
|
| Rate for Payer: Cash Price |
$18.60
|
| Rate for Payer: Cash Price |
$18.60
|
| Rate for Payer: Cigna Commercial |
$59.32
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$5.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$36.08
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$5.28
|
| Rate for Payer: Health EOS Commercial |
$57.39
|
| Rate for Payer: HFN Commercial |
$59.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$19.65
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$5.28
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5.28
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$5.28
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$5.28
|
| Rate for Payer: Multiplan Commercial |
$51.58
|
| Rate for Payer: NAPHCARE Commercial |
$7.92
|
| Rate for Payer: Preferred Network Access Commercial |
$59.32
|
| Rate for Payer: Quartz Beloit One Network |
$31.60
|
| Rate for Payer: Quartz Commercial |
$41.91
|
| Rate for Payer: Quartz Medicare Advantage |
$5.28
|
| Rate for Payer: The Alliance Commercial |
$21.13
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.28
|
| Rate for Payer: United Healthcare PPO |
$48.36
|
| Rate for Payer: WEA Trust Commercial |
$35.46
|
| Rate for Payer: Wellcare Medicare |
$5.28
|
| Rate for Payer: WPS Commercial |
$47.76
|
|
|
Urine Uric Acid
|
Facility
|
IP
|
$21.00
|
|
|
Service Code
|
CPT 84560
|
| Hospital Charge Code |
3813071
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.70 |
| Max. Negotiated Rate |
$20.09 |
| Rate for Payer: Aetna Commercial |
$19.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$18.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$11.58
|
| Rate for Payer: Cash Price |
$6.30
|
| Rate for Payer: Cigna Commercial |
$20.09
|
| Rate for Payer: Health EOS Commercial |
$19.44
|
| Rate for Payer: HFN Commercial |
$20.09
|
| Rate for Payer: Multiplan Commercial |
$17.47
|
| Rate for Payer: Preferred Network Access Commercial |
$20.09
|
| Rate for Payer: Quartz Beloit One Network |
$10.70
|
| Rate for Payer: Quartz Commercial |
$13.10
|
| Rate for Payer: WEA Trust Commercial |
$12.01
|
| Rate for Payer: WPS Commercial |
$16.18
|
|
|
Urine Uric Acid
|
Professional
|
Both
|
$21.00
|
|
|
Service Code
|
CPT 84560
|
| Hospital Charge Code |
3813071
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.28 |
| Max. Negotiated Rate |
$23.25 |
| Rate for Payer: Aetna Commercial |
$20.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$18.78
|
| Rate for Payer: Aetna Managed Medicare |
$5.28
|
| Rate for Payer: Anthem Medicare Advantage |
$5.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5.28
|
| Rate for Payer: Cash Price |
$6.30
|
| Rate for Payer: Cash Price |
$6.30
|
| Rate for Payer: Cigna Commercial |
$20.75
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$10.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5.28
|
| Rate for Payer: Health EOS Commercial |
$19.87
|
| Rate for Payer: HFN Commercial |
$20.75
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$18.65
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$18.65
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5.28
|
| Rate for Payer: Multiplan Commercial |
$17.47
|
| Rate for Payer: NAPHCARE Commercial |
$7.92
|
| Rate for Payer: Preferred Network Access Commercial |
$20.75
|
| Rate for Payer: Quartz Beloit One Network |
$9.61
|
| Rate for Payer: Quartz Commercial |
$12.45
|
| Rate for Payer: Quartz Medicare Advantage |
$5.28
|
| Rate for Payer: The Alliance Commercial |
$20.87
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.28
|
| Rate for Payer: WEA Trust Commercial |
$12.01
|
| Rate for Payer: WPS Commercial |
$23.25
|
|
|
Urine Uric Acid
|
Facility
|
OP
|
$21.00
|
|
|
Service Code
|
CPT 84560
|
| Hospital Charge Code |
3813071
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.28 |
| Max. Negotiated Rate |
$21.13 |
| Rate for Payer: Aetna Commercial |
$19.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$18.78
|
| Rate for Payer: Aetna Managed Medicare |
$5.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$19.81
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$9.25
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$8.77
|
| Rate for Payer: Anthem Medicare Advantage |
$5.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$11.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5.28
|
| Rate for Payer: Cash Price |
$6.30
|
| Rate for Payer: Cash Price |
$6.30
|
| Rate for Payer: Cigna Commercial |
$20.09
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$5.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12.22
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$5.28
|
| Rate for Payer: Health EOS Commercial |
$19.44
|
| Rate for Payer: HFN Commercial |
$20.09
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$19.65
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$5.28
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5.28
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$5.28
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$5.28
|
| Rate for Payer: Multiplan Commercial |
$17.47
|
| Rate for Payer: NAPHCARE Commercial |
$7.92
|
| Rate for Payer: Preferred Network Access Commercial |
$20.09
|
| Rate for Payer: Quartz Beloit One Network |
$10.70
|
| Rate for Payer: Quartz Commercial |
$14.20
|
| Rate for Payer: Quartz Medicare Advantage |
$5.28
|
| Rate for Payer: The Alliance Commercial |
$21.13
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.28
|
| Rate for Payer: United Healthcare PPO |
$16.38
|
| Rate for Payer: WEA Trust Commercial |
$12.01
|
| Rate for Payer: Wellcare Medicare |
$5.28
|
| Rate for Payer: WPS Commercial |
$16.18
|
|
|
Urine Vanillylmandelic Acid
|
Facility
|
OP
|
$36.00
|
|
|
Service Code
|
CPT 84585
|
| Hospital Charge Code |
4076085
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$16.12 |
| Max. Negotiated Rate |
$64.48 |
| Rate for Payer: Aetna Commercial |
$33.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$32.20
|
| Rate for Payer: Aetna Managed Medicare |
$16.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$60.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$28.21
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$26.76
|
| Rate for Payer: Anthem Medicare Advantage |
$16.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$19.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$16.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$16.12
|
| Rate for Payer: Cash Price |
$10.80
|
| Rate for Payer: Cash Price |
$10.80
|
| Rate for Payer: Cigna Commercial |
$34.44
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$16.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$20.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$16.12
|
| Rate for Payer: Health EOS Commercial |
$33.32
|
| Rate for Payer: HFN Commercial |
$34.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$59.97
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$16.12
|
| Rate for Payer: Independent Care Health Plan Medicare |
$16.12
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$16.12
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$16.12
|
| Rate for Payer: Multiplan Commercial |
$29.95
|
| Rate for Payer: NAPHCARE Commercial |
$24.18
|
| Rate for Payer: Preferred Network Access Commercial |
$34.44
|
| Rate for Payer: Quartz Beloit One Network |
$18.35
|
| Rate for Payer: Quartz Commercial |
$24.34
|
| Rate for Payer: Quartz Medicare Advantage |
$16.12
|
| Rate for Payer: The Alliance Commercial |
$64.48
|
| Rate for Payer: United Healthcare Medicare Advantage |
$16.12
|
| Rate for Payer: United Healthcare PPO |
$28.08
|
| Rate for Payer: WEA Trust Commercial |
$20.59
|
| Rate for Payer: Wellcare Medicare |
$16.12
|
| Rate for Payer: WPS Commercial |
$27.73
|
|
|
Urine Vanillylmandelic Acid
|
Professional
|
Both
|
$36.00
|
|
|
Service Code
|
CPT 84585
|
| Hospital Charge Code |
4076085
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$16.12 |
| Max. Negotiated Rate |
$70.93 |
| Rate for Payer: Aetna Commercial |
$35.57
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$32.20
|
| Rate for Payer: Aetna Managed Medicare |
$16.12
|
| Rate for Payer: Anthem Medicare Advantage |
$16.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$16.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$16.12
|
| Rate for Payer: Cash Price |
$10.80
|
| Rate for Payer: Cash Price |
$10.80
|
| Rate for Payer: Cigna Commercial |
$35.57
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$18.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$16.12
|
| Rate for Payer: Health EOS Commercial |
$34.07
|
| Rate for Payer: HFN Commercial |
$35.57
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$56.91
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$56.91
|
| Rate for Payer: Independent Care Health Plan Medicare |
$16.12
|
| Rate for Payer: Multiplan Commercial |
$29.95
|
| Rate for Payer: NAPHCARE Commercial |
$24.18
|
| Rate for Payer: Preferred Network Access Commercial |
$35.57
|
| Rate for Payer: Quartz Beloit One Network |
$16.47
|
| Rate for Payer: Quartz Commercial |
$21.34
|
| Rate for Payer: Quartz Medicare Advantage |
$16.12
|
| Rate for Payer: The Alliance Commercial |
$63.67
|
| Rate for Payer: United Healthcare Medicare Advantage |
$16.12
|
| Rate for Payer: WEA Trust Commercial |
$20.59
|
| Rate for Payer: WPS Commercial |
$70.93
|
|
|
Urine Vanillylmandelic Acid
|
Facility
|
IP
|
$36.00
|
|
|
Service Code
|
CPT 84585
|
| Hospital Charge Code |
4076085
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.35 |
| Max. Negotiated Rate |
$34.44 |
| Rate for Payer: Aetna Commercial |
$33.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$32.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$19.84
|
| Rate for Payer: Cash Price |
$10.80
|
| Rate for Payer: Cigna Commercial |
$34.44
|
| Rate for Payer: Health EOS Commercial |
$33.32
|
| Rate for Payer: HFN Commercial |
$34.44
|
| Rate for Payer: Multiplan Commercial |
$29.95
|
| Rate for Payer: Preferred Network Access Commercial |
$34.44
|
| Rate for Payer: Quartz Beloit One Network |
$18.35
|
| Rate for Payer: Quartz Commercial |
$22.46
|
| Rate for Payer: WEA Trust Commercial |
$20.59
|
| Rate for Payer: WPS Commercial |
$27.73
|
|
|
URO Flow Testing
|
Facility
|
OP
|
$227.00
|
|
|
Service Code
|
CPT 51741
|
| Hospital Charge Code |
3005560
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$113.32 |
| Max. Negotiated Rate |
$4,386.95 |
| Rate for Payer: Aetna Commercial |
$212.47
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$203.03
|
| Rate for Payer: Aetna Managed Medicare |
$227.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$153.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$118.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$113.32
|
| Rate for Payer: Anthem Medicare Advantage |
$227.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$125.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$227.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$227.24
|
| Rate for Payer: Cash Price |
$68.10
|
| Rate for Payer: Cash Price |
$68.10
|
| Rate for Payer: Cigna Commercial |
$217.19
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$227.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$227.24
|
| Rate for Payer: Health EOS Commercial |
$210.11
|
| Rate for Payer: HFN Commercial |
$217.19
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$845.33
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$227.24
|
| Rate for Payer: Independent Care Health Plan Medicare |
$227.24
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$227.24
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$227.24
|
| Rate for Payer: Multiplan Commercial |
$188.86
|
| Rate for Payer: NAPHCARE Commercial |
$340.86
|
| Rate for Payer: Preferred Network Access Commercial |
$217.19
|
| Rate for Payer: Quartz Beloit One Network |
$115.68
|
| Rate for Payer: Quartz Commercial |
$153.45
|
| Rate for Payer: Quartz Medicare Advantage |
$227.24
|
| Rate for Payer: The Alliance Commercial |
$908.96
|
| Rate for Payer: United Healthcare Medicare Advantage |
$227.24
|
| Rate for Payer: United Healthcare PPO |
$177.06
|
| Rate for Payer: WEA Trust Commercial |
$129.84
|
| Rate for Payer: Wellcare Medicare |
$227.24
|
| Rate for Payer: WPS Commercial |
$174.86
|
|
|
URO Flow Testing
|
Facility
|
IP
|
$227.00
|
|
|
Service Code
|
CPT 51741
|
| Hospital Charge Code |
3005560
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$115.68 |
| Max. Negotiated Rate |
$217.19 |
| Rate for Payer: Aetna Commercial |
$212.47
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$203.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$125.12
|
| Rate for Payer: Cash Price |
$68.10
|
| Rate for Payer: Cigna Commercial |
$217.19
|
| Rate for Payer: Health EOS Commercial |
$210.11
|
| Rate for Payer: HFN Commercial |
$217.19
|
| Rate for Payer: Multiplan Commercial |
$188.86
|
| Rate for Payer: Preferred Network Access Commercial |
$217.19
|
| Rate for Payer: Quartz Beloit One Network |
$115.68
|
| Rate for Payer: Quartz Commercial |
$141.65
|
| Rate for Payer: WEA Trust Commercial |
$129.84
|
| Rate for Payer: WPS Commercial |
$174.86
|
|
|
UROSTOMY STERILE KIT 19252
|
Facility
|
IP
|
$217.00
|
|
| Hospital Charge Code |
2963705
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$110.58 |
| Max. Negotiated Rate |
$207.63 |
| Rate for Payer: Aetna Commercial |
$203.11
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$194.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$119.61
|
| Rate for Payer: Cash Price |
$65.10
|
| Rate for Payer: Cigna Commercial |
$207.63
|
| Rate for Payer: Health EOS Commercial |
$200.86
|
| Rate for Payer: HFN Commercial |
$207.63
|
| Rate for Payer: Multiplan Commercial |
$180.54
|
| Rate for Payer: Preferred Network Access Commercial |
$207.63
|
| Rate for Payer: Quartz Beloit One Network |
$110.58
|
| Rate for Payer: Quartz Commercial |
$135.41
|
| Rate for Payer: WEA Trust Commercial |
$124.12
|
| Rate for Payer: WPS Commercial |
$167.16
|
|
|
UROSTOMY STERILE KIT 19252
|
Facility
|
OP
|
$217.00
|
|
| Hospital Charge Code |
2963705
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$63.19 |
| Max. Negotiated Rate |
$207.63 |
| Rate for Payer: Aetna Commercial |
$203.11
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$194.08
|
| Rate for Payer: Aetna Managed Medicare |
$63.19
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$146.69
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$112.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$108.33
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$119.61
|
| Rate for Payer: Cash Price |
$65.10
|
| Rate for Payer: Cigna Commercial |
$207.63
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$126.29
|
| Rate for Payer: Health EOS Commercial |
$200.86
|
| Rate for Payer: HFN Commercial |
$207.63
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$169.26
|
| Rate for Payer: Multiplan Commercial |
$180.54
|
| Rate for Payer: NAPHCARE Commercial |
$135.41
|
| Rate for Payer: Preferred Network Access Commercial |
$207.63
|
| Rate for Payer: Quartz Beloit One Network |
$110.58
|
| Rate for Payer: Quartz Commercial |
$146.69
|
| Rate for Payer: Quartz Medicare Advantage |
$135.41
|
| Rate for Payer: The Alliance Commercial |
$112.84
|
| Rate for Payer: WEA Trust Commercial |
$124.12
|
| Rate for Payer: WPS Commercial |
$167.16
|
|
|
UroVysion, Detection of Bladder Cancer
|
Professional
|
Both
|
$1,997.00
|
|
|
Service Code
|
CPT 88120
|
| Hospital Charge Code |
5543245
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$39.80 |
| Max. Negotiated Rate |
$2,378.97 |
| Rate for Payer: Aetna Commercial |
$1,973.04
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,786.12
|
| Rate for Payer: Aetna Managed Medicare |
$540.68
|
| Rate for Payer: Anthem Commercial |
$39.80
|
| Rate for Payer: Anthem Medicare Advantage |
$540.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$540.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$540.68
|
| Rate for Payer: Cash Price |
$599.10
|
| Rate for Payer: Cash Price |
$599.10
|
| Rate for Payer: Cigna Commercial |
$1,973.04
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,038.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$540.68
|
| Rate for Payer: Health EOS Commercial |
$1,889.96
|
| Rate for Payer: HFN Commercial |
$1,973.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,194.57
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$2,194.57
|
| Rate for Payer: Independent Care Health Plan Medicare |
$540.68
|
| Rate for Payer: Multiplan Commercial |
$1,661.50
|
| Rate for Payer: NAPHCARE Commercial |
$811.01
|
| Rate for Payer: Preferred Network Access Commercial |
$1,973.04
|
| Rate for Payer: Quartz Beloit One Network |
$913.83
|
| Rate for Payer: Quartz Commercial |
$1,183.82
|
| Rate for Payer: Quartz Medicare Advantage |
$540.68
|
| Rate for Payer: The Alliance Commercial |
$2,135.67
|
| Rate for Payer: United Healthcare Medicare Advantage |
$540.68
|
| Rate for Payer: WEA Trust Commercial |
$1,142.28
|
| Rate for Payer: WPS Commercial |
$2,378.97
|
|
