|
Vitamin B12 Level
|
Professional
|
Both
|
$216.00
|
|
|
Service Code
|
CPT 82607
|
| Hospital Charge Code |
633871
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$53.23 |
| Max. Negotiated Rate |
$205.20 |
| Rate for Payer: Aetna Commercial |
$205.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$185.76
|
| Rate for Payer: Cash Price |
$64.80
|
| Rate for Payer: Cash Price |
$64.80
|
| Rate for Payer: Cigna Commercial |
$205.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$108.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$129.60
|
| Rate for Payer: Health EOS Commercial |
$196.56
|
| Rate for Payer: HFN Commercial |
$205.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$53.23
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$53.23
|
| Rate for Payer: Multiplan Commercial |
$172.80
|
| Rate for Payer: Preferred Network Access Commercial |
$205.20
|
| Rate for Payer: Quartz Beloit One Network |
$95.04
|
| Rate for Payer: Quartz Commercial |
$123.12
|
| Rate for Payer: The Alliance Commercial |
$108.00
|
| Rate for Payer: WEA Trust Commercial |
$118.80
|
| Rate for Payer: WPS Commercial |
$159.99
|
|
|
Vitamin B1, (Thiamin), Blood
|
Professional
|
Both
|
$376.00
|
|
|
Service Code
|
CPT 84425
|
| Hospital Charge Code |
983435
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$74.94 |
| Max. Negotiated Rate |
$357.20 |
| Rate for Payer: Aetna Commercial |
$357.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$323.36
|
| Rate for Payer: Cash Price |
$112.80
|
| Rate for Payer: Cash Price |
$112.80
|
| Rate for Payer: Cigna Commercial |
$357.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$188.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$225.60
|
| Rate for Payer: Health EOS Commercial |
$342.16
|
| Rate for Payer: HFN Commercial |
$357.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$74.94
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$74.94
|
| Rate for Payer: Multiplan Commercial |
$300.80
|
| Rate for Payer: Preferred Network Access Commercial |
$357.20
|
| Rate for Payer: Quartz Beloit One Network |
$165.44
|
| Rate for Payer: Quartz Commercial |
$214.32
|
| Rate for Payer: The Alliance Commercial |
$188.00
|
| Rate for Payer: WEA Trust Commercial |
$206.80
|
| Rate for Payer: WPS Commercial |
$278.50
|
|
|
Vitamin B1, (Thiamin), Blood
|
Facility
|
IP
|
$376.00
|
|
|
Service Code
|
CPT 84425
|
| Hospital Charge Code |
983435
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$184.24 |
| Max. Negotiated Rate |
$345.92 |
| Rate for Payer: Multiplan Commercial |
$300.80
|
| Rate for Payer: NAPHCARE Commercial |
$225.60
|
| Rate for Payer: Aetna Commercial |
$338.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$323.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$199.28
|
| Rate for Payer: Cash Price |
$112.80
|
| Rate for Payer: Cigna Commercial |
$345.92
|
| Rate for Payer: Health EOS Commercial |
$334.64
|
| Rate for Payer: HFN Commercial |
$345.92
|
| Rate for Payer: Preferred Network Access Commercial |
$345.92
|
| Rate for Payer: Quartz Beloit One Network |
$184.24
|
| Rate for Payer: Quartz Commercial |
$225.60
|
| Rate for Payer: WEA Trust Commercial |
$206.80
|
| Rate for Payer: WPS Commercial |
$278.50
|
|
|
Vitamin B1, (Thiamin), Blood
|
Facility
|
OP
|
$376.00
|
|
|
Service Code
|
CPT 84425
|
| Hospital Charge Code |
983435
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$21.23 |
| Max. Negotiated Rate |
$345.92 |
| Rate for Payer: Aetna Commercial |
$338.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$323.36
|
| Rate for Payer: Aetna Managed Medicare |
$21.23
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$79.61
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$37.15
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$35.24
|
| Rate for Payer: Anthem Medicaid |
$21.94
|
| Rate for Payer: Anthem Medicare Advantage |
$21.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$199.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$21.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$21.23
|
| Rate for Payer: Cash Price |
$112.80
|
| Rate for Payer: Cash Price |
$112.80
|
| Rate for Payer: Cigna Commercial |
$345.92
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$21.23
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$21.94
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$210.41
|
| Rate for Payer: Dean Health Medicaid |
$21.94
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$21.23
|
| Rate for Payer: Health EOS Commercial |
$334.64
|
| Rate for Payer: HFN Commercial |
$345.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$78.98
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$21.23
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$21.94
|
| Rate for Payer: Independent Care Health Plan Medicare |
$21.23
|
| Rate for Payer: Managed Health Services Medicaid |
$22.82
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$21.23
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$21.23
|
| Rate for Payer: Multiplan Commercial |
$300.80
|
| Rate for Payer: NAPHCARE Commercial |
$31.84
|
| Rate for Payer: Preferred Network Access Commercial |
$345.92
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$21.94
|
| Rate for Payer: Quartz Beloit One Network |
$184.24
|
| Rate for Payer: Quartz Commercial |
$244.40
|
| Rate for Payer: Quartz Medicare Advantage |
$21.23
|
| Rate for Payer: The Alliance Commercial |
$84.92
|
| Rate for Payer: United Healthcare Medicaid |
$21.94
|
| Rate for Payer: United Healthcare Medicare Advantage |
$21.23
|
| Rate for Payer: United Healthcare PPO |
$282.00
|
| Rate for Payer: WEA Trust Commercial |
$206.80
|
| Rate for Payer: Wellcare Medicare |
$21.23
|
| Rate for Payer: WMAP Medicaid |
$21.94
|
| Rate for Payer: WPS Commercial |
$278.50
|
|
|
Vitamin B1 (Thiamin), Plasma
|
Facility
|
OP
|
$204.00
|
|
|
Service Code
|
CPT 84425
|
| Hospital Charge Code |
983434
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$21.23 |
| Max. Negotiated Rate |
$187.68 |
| Rate for Payer: Aetna Commercial |
$183.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$175.44
|
| Rate for Payer: Aetna Managed Medicare |
$21.23
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$79.61
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$37.15
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$35.24
|
| Rate for Payer: Anthem Medicaid |
$21.94
|
| Rate for Payer: Anthem Medicare Advantage |
$21.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$108.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$21.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$21.23
|
| Rate for Payer: Cash Price |
$61.20
|
| Rate for Payer: Cash Price |
$61.20
|
| Rate for Payer: Cigna Commercial |
$187.68
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$21.23
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$21.94
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$114.16
|
| Rate for Payer: Dean Health Medicaid |
$21.94
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$21.23
|
| Rate for Payer: Health EOS Commercial |
$181.56
|
| Rate for Payer: HFN Commercial |
$187.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$78.98
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$21.23
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$21.94
|
| Rate for Payer: Independent Care Health Plan Medicare |
$21.23
|
| Rate for Payer: Managed Health Services Medicaid |
$22.82
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$21.23
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$21.23
|
| Rate for Payer: Multiplan Commercial |
$163.20
|
| Rate for Payer: NAPHCARE Commercial |
$31.84
|
| Rate for Payer: Preferred Network Access Commercial |
$187.68
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$21.94
|
| Rate for Payer: Quartz Beloit One Network |
$99.96
|
| Rate for Payer: Quartz Commercial |
$132.60
|
| Rate for Payer: Quartz Medicare Advantage |
$21.23
|
| Rate for Payer: The Alliance Commercial |
$84.92
|
| Rate for Payer: United Healthcare Medicaid |
$21.94
|
| Rate for Payer: United Healthcare Medicare Advantage |
$21.23
|
| Rate for Payer: United Healthcare PPO |
$153.00
|
| Rate for Payer: WEA Trust Commercial |
$112.20
|
| Rate for Payer: Wellcare Medicare |
$21.23
|
| Rate for Payer: WMAP Medicaid |
$21.94
|
| Rate for Payer: WPS Commercial |
$151.10
|
|
|
Vitamin B1 (Thiamin), Plasma
|
Professional
|
Both
|
$204.00
|
|
|
Service Code
|
CPT 84425
|
| Hospital Charge Code |
983434
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$74.94 |
| Max. Negotiated Rate |
$193.80 |
| Rate for Payer: Aetna Commercial |
$193.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$175.44
|
| Rate for Payer: Cash Price |
$61.20
|
| Rate for Payer: Cash Price |
$61.20
|
| Rate for Payer: Cigna Commercial |
$193.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$102.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$122.40
|
| Rate for Payer: Health EOS Commercial |
$185.64
|
| Rate for Payer: HFN Commercial |
$193.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$74.94
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$74.94
|
| Rate for Payer: Multiplan Commercial |
$163.20
|
| Rate for Payer: Preferred Network Access Commercial |
$193.80
|
| Rate for Payer: Quartz Beloit One Network |
$89.76
|
| Rate for Payer: Quartz Commercial |
$116.28
|
| Rate for Payer: The Alliance Commercial |
$102.00
|
| Rate for Payer: WEA Trust Commercial |
$112.20
|
| Rate for Payer: WPS Commercial |
$151.10
|
|
|
Vitamin B1 (Thiamin), Plasma
|
Facility
|
IP
|
$204.00
|
|
|
Service Code
|
CPT 84425
|
| Hospital Charge Code |
983434
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$99.96 |
| Max. Negotiated Rate |
$187.68 |
| Rate for Payer: Aetna Commercial |
$183.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$175.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$108.12
|
| Rate for Payer: Cash Price |
$61.20
|
| Rate for Payer: Cigna Commercial |
$187.68
|
| Rate for Payer: Health EOS Commercial |
$181.56
|
| Rate for Payer: HFN Commercial |
$187.68
|
| Rate for Payer: Multiplan Commercial |
$163.20
|
| Rate for Payer: NAPHCARE Commercial |
$122.40
|
| Rate for Payer: Preferred Network Access Commercial |
$187.68
|
| Rate for Payer: Quartz Beloit One Network |
$99.96
|
| Rate for Payer: Quartz Commercial |
$122.40
|
| Rate for Payer: WEA Trust Commercial |
$112.20
|
| Rate for Payer: WPS Commercial |
$151.10
|
|
|
Vitamin B2
|
Facility
|
IP
|
$367.00
|
|
|
Service Code
|
CPT 84252
|
| Hospital Charge Code |
978091
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$179.83 |
| Max. Negotiated Rate |
$337.64 |
| Rate for Payer: Aetna Commercial |
$330.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$315.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$194.51
|
| Rate for Payer: Cash Price |
$110.10
|
| Rate for Payer: Cigna Commercial |
$337.64
|
| Rate for Payer: Health EOS Commercial |
$326.63
|
| Rate for Payer: HFN Commercial |
$337.64
|
| Rate for Payer: Multiplan Commercial |
$293.60
|
| Rate for Payer: NAPHCARE Commercial |
$220.20
|
| Rate for Payer: Preferred Network Access Commercial |
$337.64
|
| Rate for Payer: Quartz Beloit One Network |
$179.83
|
| Rate for Payer: Quartz Commercial |
$220.20
|
| Rate for Payer: WEA Trust Commercial |
$201.85
|
| Rate for Payer: WPS Commercial |
$271.84
|
|
|
Vitamin B2
|
Professional
|
Both
|
$367.00
|
|
|
Service Code
|
CPT 84252
|
| Hospital Charge Code |
978091
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$71.45 |
| Max. Negotiated Rate |
$348.65 |
| Rate for Payer: Aetna Commercial |
$348.65
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$315.62
|
| Rate for Payer: Cash Price |
$110.10
|
| Rate for Payer: Cash Price |
$110.10
|
| Rate for Payer: Cigna Commercial |
$348.65
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$183.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$220.20
|
| Rate for Payer: Health EOS Commercial |
$333.97
|
| Rate for Payer: HFN Commercial |
$348.65
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$71.45
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$71.45
|
| Rate for Payer: Multiplan Commercial |
$293.60
|
| Rate for Payer: Preferred Network Access Commercial |
$348.65
|
| Rate for Payer: Quartz Beloit One Network |
$161.48
|
| Rate for Payer: Quartz Commercial |
$209.19
|
| Rate for Payer: The Alliance Commercial |
$183.50
|
| Rate for Payer: WEA Trust Commercial |
$201.85
|
| Rate for Payer: WPS Commercial |
$271.84
|
|
|
Vitamin B2
|
Facility
|
OP
|
$367.00
|
|
|
Service Code
|
CPT 84252
|
| Hospital Charge Code |
978091
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$20.24 |
| Max. Negotiated Rate |
$337.64 |
| Rate for Payer: Aetna Commercial |
$330.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$315.62
|
| Rate for Payer: Aetna Managed Medicare |
$20.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$75.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$35.42
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$33.60
|
| Rate for Payer: Anthem Medicaid |
$20.91
|
| Rate for Payer: Anthem Medicare Advantage |
$20.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$194.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$20.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$20.24
|
| Rate for Payer: Cash Price |
$110.10
|
| Rate for Payer: Cash Price |
$110.10
|
| Rate for Payer: Cigna Commercial |
$337.64
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$20.24
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$20.91
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$205.37
|
| Rate for Payer: Dean Health Medicaid |
$20.91
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$20.24
|
| Rate for Payer: Health EOS Commercial |
$326.63
|
| Rate for Payer: HFN Commercial |
$337.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$75.29
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$20.24
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$20.91
|
| Rate for Payer: Independent Care Health Plan Medicare |
$20.24
|
| Rate for Payer: Managed Health Services Medicaid |
$21.75
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$20.24
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$20.24
|
| Rate for Payer: Multiplan Commercial |
$293.60
|
| Rate for Payer: NAPHCARE Commercial |
$30.36
|
| Rate for Payer: Preferred Network Access Commercial |
$337.64
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$20.91
|
| Rate for Payer: Quartz Beloit One Network |
$179.83
|
| Rate for Payer: Quartz Commercial |
$238.55
|
| Rate for Payer: Quartz Medicare Advantage |
$20.24
|
| Rate for Payer: The Alliance Commercial |
$80.96
|
| Rate for Payer: United Healthcare Medicaid |
$20.91
|
| Rate for Payer: United Healthcare Medicare Advantage |
$20.24
|
| Rate for Payer: United Healthcare PPO |
$275.25
|
| Rate for Payer: WEA Trust Commercial |
$201.85
|
| Rate for Payer: Wellcare Medicare |
$20.24
|
| Rate for Payer: WMAP Medicaid |
$20.91
|
| Rate for Payer: WPS Commercial |
$271.84
|
|
|
Vitamin B3 (Niacin and Metabolites)
|
Facility
|
IP
|
$313.00
|
|
|
Service Code
|
CPT 84591
|
| Hospital Charge Code |
983437
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$153.37 |
| Max. Negotiated Rate |
$287.96 |
| Rate for Payer: Aetna Commercial |
$281.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$269.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$165.89
|
| Rate for Payer: Cash Price |
$93.90
|
| Rate for Payer: Cigna Commercial |
$287.96
|
| Rate for Payer: Health EOS Commercial |
$278.57
|
| Rate for Payer: HFN Commercial |
$287.96
|
| Rate for Payer: Multiplan Commercial |
$250.40
|
| Rate for Payer: NAPHCARE Commercial |
$187.80
|
| Rate for Payer: Preferred Network Access Commercial |
$287.96
|
| Rate for Payer: Quartz Beloit One Network |
$153.37
|
| Rate for Payer: Quartz Commercial |
$187.80
|
| Rate for Payer: WEA Trust Commercial |
$172.15
|
| Rate for Payer: WPS Commercial |
$231.84
|
|
|
Vitamin B3 (Niacin and Metabolites)
|
Professional
|
Both
|
$313.00
|
|
|
Service Code
|
CPT 84591
|
| Hospital Charge Code |
983437
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$60.22 |
| Max. Negotiated Rate |
$297.35 |
| Rate for Payer: Aetna Commercial |
$297.35
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$269.18
|
| Rate for Payer: Cash Price |
$93.90
|
| Rate for Payer: Cash Price |
$93.90
|
| Rate for Payer: Cigna Commercial |
$297.35
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$156.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$187.80
|
| Rate for Payer: Health EOS Commercial |
$284.83
|
| Rate for Payer: HFN Commercial |
$297.35
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$60.22
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$60.22
|
| Rate for Payer: Multiplan Commercial |
$250.40
|
| Rate for Payer: Preferred Network Access Commercial |
$297.35
|
| Rate for Payer: Quartz Beloit One Network |
$137.72
|
| Rate for Payer: Quartz Commercial |
$178.41
|
| Rate for Payer: The Alliance Commercial |
$156.50
|
| Rate for Payer: WEA Trust Commercial |
$172.15
|
| Rate for Payer: WPS Commercial |
$231.84
|
|
|
Vitamin B3 (Niacin and Metabolites)
|
Facility
|
OP
|
$313.00
|
|
|
Service Code
|
CPT 84591
|
| Hospital Charge Code |
983437
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$16.32 |
| Max. Negotiated Rate |
$287.96 |
| Rate for Payer: Anthem Medicare Advantage |
$17.06
|
| Rate for Payer: Aetna Commercial |
$281.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$269.18
|
| Rate for Payer: Aetna Managed Medicare |
$17.06
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$63.98
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$29.86
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$28.32
|
| Rate for Payer: Anthem Medicaid |
$16.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$165.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$17.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$17.06
|
| Rate for Payer: Cash Price |
$93.90
|
| Rate for Payer: Cash Price |
$93.90
|
| Rate for Payer: Cigna Commercial |
$287.96
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$17.06
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$16.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$175.15
|
| Rate for Payer: Dean Health Medicaid |
$16.32
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$17.06
|
| Rate for Payer: Health EOS Commercial |
$278.57
|
| Rate for Payer: HFN Commercial |
$287.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$63.46
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$17.06
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$16.32
|
| Rate for Payer: Independent Care Health Plan Medicare |
$17.06
|
| Rate for Payer: Managed Health Services Medicaid |
$16.97
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$17.06
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$17.06
|
| Rate for Payer: Multiplan Commercial |
$250.40
|
| Rate for Payer: NAPHCARE Commercial |
$25.59
|
| Rate for Payer: Preferred Network Access Commercial |
$287.96
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$16.32
|
| Rate for Payer: Quartz Beloit One Network |
$153.37
|
| Rate for Payer: Quartz Commercial |
$203.45
|
| Rate for Payer: Quartz Medicare Advantage |
$17.06
|
| Rate for Payer: The Alliance Commercial |
$68.24
|
| Rate for Payer: United Healthcare Medicaid |
$16.32
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17.06
|
| Rate for Payer: United Healthcare PPO |
$234.75
|
| Rate for Payer: WEA Trust Commercial |
$172.15
|
| Rate for Payer: Wellcare Medicare |
$17.06
|
| Rate for Payer: WMAP Medicaid |
$16.32
|
| Rate for Payer: WPS Commercial |
$231.84
|
|
|
Vitamin B5 Level
|
Facility
|
OP
|
$123.00
|
|
|
Service Code
|
CPT 84591
|
| Hospital Charge Code |
5412827
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$16.32 |
| Max. Negotiated Rate |
$113.16 |
| Rate for Payer: Aetna Commercial |
$110.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$105.78
|
| Rate for Payer: Aetna Managed Medicare |
$17.06
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$63.98
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$29.86
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$28.32
|
| Rate for Payer: Anthem Medicaid |
$16.32
|
| Rate for Payer: Anthem Medicare Advantage |
$17.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$65.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$17.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$17.06
|
| Rate for Payer: Cash Price |
$36.90
|
| Rate for Payer: Cash Price |
$36.90
|
| Rate for Payer: Cigna Commercial |
$113.16
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$17.06
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$16.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$68.83
|
| Rate for Payer: Dean Health Medicaid |
$16.32
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$17.06
|
| Rate for Payer: Health EOS Commercial |
$109.47
|
| Rate for Payer: HFN Commercial |
$113.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$63.46
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$17.06
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$16.32
|
| Rate for Payer: Independent Care Health Plan Medicare |
$17.06
|
| Rate for Payer: Managed Health Services Medicaid |
$16.97
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$17.06
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$17.06
|
| Rate for Payer: Multiplan Commercial |
$98.40
|
| Rate for Payer: NAPHCARE Commercial |
$25.59
|
| Rate for Payer: Preferred Network Access Commercial |
$113.16
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$16.32
|
| Rate for Payer: Quartz Beloit One Network |
$60.27
|
| Rate for Payer: Quartz Commercial |
$79.95
|
| Rate for Payer: Quartz Medicare Advantage |
$17.06
|
| Rate for Payer: The Alliance Commercial |
$68.24
|
| Rate for Payer: United Healthcare Medicaid |
$16.32
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17.06
|
| Rate for Payer: United Healthcare PPO |
$92.25
|
| Rate for Payer: WEA Trust Commercial |
$67.65
|
| Rate for Payer: Wellcare Medicare |
$17.06
|
| Rate for Payer: WMAP Medicaid |
$16.32
|
| Rate for Payer: WPS Commercial |
$91.11
|
|
|
Vitamin B5 Level
|
Professional
|
Both
|
$123.00
|
|
|
Service Code
|
CPT 84591
|
| Hospital Charge Code |
5412827
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$54.12 |
| Max. Negotiated Rate |
$116.85 |
| Rate for Payer: Aetna Commercial |
$116.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$105.78
|
| Rate for Payer: Cash Price |
$36.90
|
| Rate for Payer: Cash Price |
$36.90
|
| Rate for Payer: Cigna Commercial |
$116.85
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$61.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$73.80
|
| Rate for Payer: Health EOS Commercial |
$111.93
|
| Rate for Payer: HFN Commercial |
$116.85
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$60.22
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$60.22
|
| Rate for Payer: Multiplan Commercial |
$98.40
|
| Rate for Payer: Preferred Network Access Commercial |
$116.85
|
| Rate for Payer: Quartz Beloit One Network |
$54.12
|
| Rate for Payer: Quartz Commercial |
$70.11
|
| Rate for Payer: The Alliance Commercial |
$61.50
|
| Rate for Payer: WEA Trust Commercial |
$67.65
|
| Rate for Payer: WPS Commercial |
$91.11
|
|
|
Vitamin B5 Level
|
Facility
|
IP
|
$123.00
|
|
|
Service Code
|
CPT 84591
|
| Hospital Charge Code |
5412827
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$60.27 |
| Max. Negotiated Rate |
$113.16 |
| Rate for Payer: Aetna Commercial |
$110.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$105.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$65.19
|
| Rate for Payer: Cash Price |
$36.90
|
| Rate for Payer: Cigna Commercial |
$113.16
|
| Rate for Payer: Health EOS Commercial |
$109.47
|
| Rate for Payer: HFN Commercial |
$113.16
|
| Rate for Payer: Multiplan Commercial |
$98.40
|
| Rate for Payer: NAPHCARE Commercial |
$73.80
|
| Rate for Payer: Preferred Network Access Commercial |
$113.16
|
| Rate for Payer: Quartz Beloit One Network |
$60.27
|
| Rate for Payer: Quartz Commercial |
$73.80
|
| Rate for Payer: WEA Trust Commercial |
$67.65
|
| Rate for Payer: WPS Commercial |
$91.11
|
|
|
Vitamin B6 Level
|
Facility
|
IP
|
$395.00
|
|
|
Service Code
|
CPT 84207
|
| Hospital Charge Code |
978092
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$193.55 |
| Max. Negotiated Rate |
$363.40 |
| Rate for Payer: Aetna Commercial |
$355.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$339.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$209.35
|
| Rate for Payer: Cash Price |
$118.50
|
| Rate for Payer: Cigna Commercial |
$363.40
|
| Rate for Payer: Health EOS Commercial |
$351.55
|
| Rate for Payer: HFN Commercial |
$363.40
|
| Rate for Payer: Multiplan Commercial |
$316.00
|
| Rate for Payer: NAPHCARE Commercial |
$237.00
|
| Rate for Payer: Preferred Network Access Commercial |
$363.40
|
| Rate for Payer: Quartz Beloit One Network |
$193.55
|
| Rate for Payer: Quartz Commercial |
$237.00
|
| Rate for Payer: WEA Trust Commercial |
$217.25
|
| Rate for Payer: WPS Commercial |
$292.58
|
|
|
Vitamin B6 Level
|
Professional
|
Both
|
$395.00
|
|
|
Service Code
|
CPT 84207
|
| Hospital Charge Code |
978092
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$99.19 |
| Max. Negotiated Rate |
$375.25 |
| Rate for Payer: Aetna Commercial |
$375.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$339.70
|
| Rate for Payer: Cash Price |
$118.50
|
| Rate for Payer: Cash Price |
$118.50
|
| Rate for Payer: Cigna Commercial |
$375.25
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$197.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$237.00
|
| Rate for Payer: Health EOS Commercial |
$359.45
|
| Rate for Payer: HFN Commercial |
$375.25
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$99.19
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$99.19
|
| Rate for Payer: Multiplan Commercial |
$316.00
|
| Rate for Payer: Preferred Network Access Commercial |
$375.25
|
| Rate for Payer: Quartz Beloit One Network |
$173.80
|
| Rate for Payer: Quartz Commercial |
$225.15
|
| Rate for Payer: The Alliance Commercial |
$197.50
|
| Rate for Payer: WEA Trust Commercial |
$217.25
|
| Rate for Payer: WPS Commercial |
$292.58
|
|
|
Vitamin B6 Level
|
Facility
|
OP
|
$395.00
|
|
|
Service Code
|
CPT 84207
|
| Hospital Charge Code |
978092
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$28.10 |
| Max. Negotiated Rate |
$363.40 |
| Rate for Payer: Aetna Commercial |
$355.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$339.70
|
| Rate for Payer: Aetna Managed Medicare |
$28.10
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$105.38
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$49.18
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$46.65
|
| Rate for Payer: Anthem Medicaid |
$29.04
|
| Rate for Payer: Anthem Medicare Advantage |
$28.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$209.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$28.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$28.10
|
| Rate for Payer: Cash Price |
$118.50
|
| Rate for Payer: Cash Price |
$118.50
|
| Rate for Payer: Cigna Commercial |
$363.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$28.10
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$29.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$221.04
|
| Rate for Payer: Dean Health Medicaid |
$29.04
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$28.10
|
| Rate for Payer: Health EOS Commercial |
$351.55
|
| Rate for Payer: HFN Commercial |
$363.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$104.53
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$28.10
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$29.04
|
| Rate for Payer: Independent Care Health Plan Medicare |
$28.10
|
| Rate for Payer: Managed Health Services Medicaid |
$30.20
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$28.10
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$28.10
|
| Rate for Payer: Multiplan Commercial |
$316.00
|
| Rate for Payer: NAPHCARE Commercial |
$42.15
|
| Rate for Payer: Preferred Network Access Commercial |
$363.40
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$29.04
|
| Rate for Payer: Quartz Beloit One Network |
$193.55
|
| Rate for Payer: Quartz Commercial |
$256.75
|
| Rate for Payer: Quartz Medicare Advantage |
$28.10
|
| Rate for Payer: The Alliance Commercial |
$112.40
|
| Rate for Payer: United Healthcare Medicaid |
$29.04
|
| Rate for Payer: United Healthcare Medicare Advantage |
$28.10
|
| Rate for Payer: United Healthcare PPO |
$296.25
|
| Rate for Payer: WEA Trust Commercial |
$217.25
|
| Rate for Payer: Wellcare Medicare |
$28.10
|
| Rate for Payer: WMAP Medicaid |
$29.04
|
| Rate for Payer: WPS Commercial |
$292.58
|
|
|
Vitamin B7
|
Facility
|
OP
|
$102.00
|
|
|
Service Code
|
CPT 84591
|
| Hospital Charge Code |
6181432
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$16.32 |
| Max. Negotiated Rate |
$93.84 |
| Rate for Payer: Aetna Commercial |
$91.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$87.72
|
| Rate for Payer: Aetna Managed Medicare |
$17.06
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$63.98
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$29.86
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$28.32
|
| Rate for Payer: Anthem Medicaid |
$16.32
|
| Rate for Payer: Anthem Medicare Advantage |
$17.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$54.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$17.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$17.06
|
| Rate for Payer: Cash Price |
$30.60
|
| Rate for Payer: Cash Price |
$30.60
|
| Rate for Payer: Cigna Commercial |
$93.84
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$17.06
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$16.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$57.08
|
| Rate for Payer: Dean Health Medicaid |
$16.32
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$17.06
|
| Rate for Payer: Health EOS Commercial |
$90.78
|
| Rate for Payer: HFN Commercial |
$93.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$63.46
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$17.06
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$16.32
|
| Rate for Payer: Independent Care Health Plan Medicare |
$17.06
|
| Rate for Payer: Managed Health Services Medicaid |
$16.97
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$17.06
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$17.06
|
| Rate for Payer: Multiplan Commercial |
$81.60
|
| Rate for Payer: NAPHCARE Commercial |
$25.59
|
| Rate for Payer: Preferred Network Access Commercial |
$93.84
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$16.32
|
| Rate for Payer: Quartz Beloit One Network |
$49.98
|
| Rate for Payer: Quartz Commercial |
$66.30
|
| Rate for Payer: Quartz Medicare Advantage |
$17.06
|
| Rate for Payer: The Alliance Commercial |
$68.24
|
| Rate for Payer: United Healthcare Medicaid |
$16.32
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17.06
|
| Rate for Payer: United Healthcare PPO |
$76.50
|
| Rate for Payer: WEA Trust Commercial |
$56.10
|
| Rate for Payer: Wellcare Medicare |
$17.06
|
| Rate for Payer: WMAP Medicaid |
$16.32
|
| Rate for Payer: WPS Commercial |
$75.55
|
|
|
Vitamin B7
|
Facility
|
IP
|
$102.00
|
|
|
Service Code
|
CPT 84591
|
| Hospital Charge Code |
6181432
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$49.98 |
| Max. Negotiated Rate |
$93.84 |
| Rate for Payer: Aetna Commercial |
$91.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$87.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$54.06
|
| Rate for Payer: Cash Price |
$30.60
|
| Rate for Payer: Cigna Commercial |
$93.84
|
| Rate for Payer: Health EOS Commercial |
$90.78
|
| Rate for Payer: HFN Commercial |
$93.84
|
| Rate for Payer: Multiplan Commercial |
$81.60
|
| Rate for Payer: NAPHCARE Commercial |
$61.20
|
| Rate for Payer: Preferred Network Access Commercial |
$93.84
|
| Rate for Payer: Quartz Beloit One Network |
$49.98
|
| Rate for Payer: Quartz Commercial |
$61.20
|
| Rate for Payer: WEA Trust Commercial |
$56.10
|
| Rate for Payer: WPS Commercial |
$75.55
|
|
|
Vitamin B7
|
Professional
|
Both
|
$102.00
|
|
|
Service Code
|
CPT 84591
|
| Hospital Charge Code |
6181432
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$44.88 |
| Max. Negotiated Rate |
$96.90 |
| Rate for Payer: Aetna Commercial |
$96.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$87.72
|
| Rate for Payer: Cash Price |
$30.60
|
| Rate for Payer: Cash Price |
$30.60
|
| Rate for Payer: Cigna Commercial |
$96.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$51.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$61.20
|
| Rate for Payer: Health EOS Commercial |
$92.82
|
| Rate for Payer: HFN Commercial |
$96.90
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$60.22
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$60.22
|
| Rate for Payer: Multiplan Commercial |
$81.60
|
| Rate for Payer: Preferred Network Access Commercial |
$96.90
|
| Rate for Payer: Quartz Beloit One Network |
$44.88
|
| Rate for Payer: Quartz Commercial |
$58.14
|
| Rate for Payer: The Alliance Commercial |
$51.00
|
| Rate for Payer: WEA Trust Commercial |
$56.10
|
| Rate for Payer: WPS Commercial |
$75.55
|
|
|
Vitamin C Level
|
Professional
|
Both
|
$213.00
|
|
|
Service Code
|
CPT 82180
|
| Hospital Charge Code |
978093
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$34.91 |
| Max. Negotiated Rate |
$202.35 |
| Rate for Payer: Aetna Commercial |
$202.35
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$183.18
|
| Rate for Payer: Cash Price |
$63.90
|
| Rate for Payer: Cash Price |
$63.90
|
| Rate for Payer: Cigna Commercial |
$202.35
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$106.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$127.80
|
| Rate for Payer: Health EOS Commercial |
$193.83
|
| Rate for Payer: HFN Commercial |
$202.35
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$34.91
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$34.91
|
| Rate for Payer: Multiplan Commercial |
$170.40
|
| Rate for Payer: Preferred Network Access Commercial |
$202.35
|
| Rate for Payer: Quartz Beloit One Network |
$93.72
|
| Rate for Payer: Quartz Commercial |
$121.41
|
| Rate for Payer: The Alliance Commercial |
$106.50
|
| Rate for Payer: WEA Trust Commercial |
$117.15
|
| Rate for Payer: WPS Commercial |
$157.77
|
|
|
Vitamin C Level
|
Facility
|
OP
|
$213.00
|
|
|
Service Code
|
CPT 82180
|
| Hospital Charge Code |
978093
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.89 |
| Max. Negotiated Rate |
$195.96 |
| Rate for Payer: Aetna Commercial |
$191.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$183.18
|
| Rate for Payer: Aetna Managed Medicare |
$9.89
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$37.09
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$17.31
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$16.42
|
| Rate for Payer: Anthem Medicaid |
$10.22
|
| Rate for Payer: Anthem Medicare Advantage |
$9.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$112.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$9.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$9.89
|
| Rate for Payer: Cash Price |
$63.90
|
| Rate for Payer: Cash Price |
$63.90
|
| Rate for Payer: Cigna Commercial |
$195.96
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$9.89
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$10.22
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$119.19
|
| Rate for Payer: Dean Health Medicaid |
$10.22
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$9.89
|
| Rate for Payer: Health EOS Commercial |
$189.57
|
| Rate for Payer: HFN Commercial |
$195.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$36.79
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$9.89
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$10.22
|
| Rate for Payer: Independent Care Health Plan Medicare |
$9.89
|
| Rate for Payer: Managed Health Services Medicaid |
$10.63
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$9.89
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$9.89
|
| Rate for Payer: Multiplan Commercial |
$170.40
|
| Rate for Payer: NAPHCARE Commercial |
$14.84
|
| Rate for Payer: Preferred Network Access Commercial |
$195.96
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$10.22
|
| Rate for Payer: Quartz Beloit One Network |
$104.37
|
| Rate for Payer: Quartz Commercial |
$138.45
|
| Rate for Payer: Quartz Medicare Advantage |
$9.89
|
| Rate for Payer: The Alliance Commercial |
$39.56
|
| Rate for Payer: United Healthcare Medicaid |
$10.22
|
| Rate for Payer: United Healthcare Medicare Advantage |
$9.89
|
| Rate for Payer: United Healthcare PPO |
$159.75
|
| Rate for Payer: WEA Trust Commercial |
$117.15
|
| Rate for Payer: Wellcare Medicare |
$9.89
|
| Rate for Payer: WMAP Medicaid |
$10.22
|
| Rate for Payer: WPS Commercial |
$157.77
|
|
|
Vitamin C Level
|
Facility
|
IP
|
$213.00
|
|
|
Service Code
|
CPT 82180
|
| Hospital Charge Code |
978093
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$104.37 |
| Max. Negotiated Rate |
$195.96 |
| Rate for Payer: Aetna Commercial |
$191.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$183.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$112.89
|
| Rate for Payer: Cash Price |
$63.90
|
| Rate for Payer: Cigna Commercial |
$195.96
|
| Rate for Payer: Health EOS Commercial |
$189.57
|
| Rate for Payer: HFN Commercial |
$195.96
|
| Rate for Payer: Multiplan Commercial |
$170.40
|
| Rate for Payer: NAPHCARE Commercial |
$127.80
|
| Rate for Payer: Preferred Network Access Commercial |
$195.96
|
| Rate for Payer: Quartz Beloit One Network |
$104.37
|
| Rate for Payer: Quartz Commercial |
$127.80
|
| Rate for Payer: WEA Trust Commercial |
$117.15
|
| Rate for Payer: WPS Commercial |
$157.77
|
|
