|
.Urine Microscopic
|
Facility
|
OP
|
$131.00
|
|
|
Service Code
|
CPT 81001
|
| Hospital Charge Code |
1172799
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.30 |
| Max. Negotiated Rate |
$125.34 |
| Rate for Payer: Aetna Commercial |
$122.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$117.17
|
| Rate for Payer: Aetna Managed Medicare |
$3.30
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$12.36
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5.77
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5.47
|
| Rate for Payer: Anthem Medicare Advantage |
$3.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$72.21
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$3.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$3.30
|
| Rate for Payer: Cash Price |
$39.30
|
| Rate for Payer: Cash Price |
$39.30
|
| Rate for Payer: Cigna Commercial |
$125.34
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$3.30
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$76.24
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$3.30
|
| Rate for Payer: Health EOS Commercial |
$121.25
|
| Rate for Payer: HFN Commercial |
$125.34
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$12.26
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$3.30
|
| Rate for Payer: Independent Care Health Plan Medicare |
$3.30
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$3.30
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$3.30
|
| Rate for Payer: Multiplan Commercial |
$108.99
|
| Rate for Payer: NAPHCARE Commercial |
$4.95
|
| Rate for Payer: Preferred Network Access Commercial |
$125.34
|
| Rate for Payer: Quartz Beloit One Network |
$66.76
|
| Rate for Payer: Quartz Commercial |
$88.56
|
| Rate for Payer: Quartz Medicare Advantage |
$3.30
|
| Rate for Payer: The Alliance Commercial |
$13.19
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3.30
|
| Rate for Payer: United Healthcare PPO |
$102.18
|
| Rate for Payer: WEA Trust Commercial |
$74.93
|
| Rate for Payer: Wellcare Medicare |
$3.30
|
| Rate for Payer: WPS Commercial |
$100.91
|
|
|
.Urine Microscopic
|
Professional
|
Both
|
$131.00
|
|
|
Service Code
|
CPT 81001
|
| Hospital Charge Code |
1172799
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.30 |
| Max. Negotiated Rate |
$129.43 |
| Rate for Payer: Aetna Commercial |
$129.43
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$117.17
|
| Rate for Payer: Aetna Managed Medicare |
$3.30
|
| Rate for Payer: Anthem Medicare Advantage |
$3.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$3.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$3.30
|
| Rate for Payer: Cash Price |
$39.30
|
| Rate for Payer: Cash Price |
$39.30
|
| Rate for Payer: Cigna Commercial |
$129.43
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$68.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3.30
|
| Rate for Payer: Health EOS Commercial |
$123.98
|
| Rate for Payer: HFN Commercial |
$129.43
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$11.64
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$11.64
|
| Rate for Payer: Independent Care Health Plan Medicare |
$3.30
|
| Rate for Payer: Multiplan Commercial |
$108.99
|
| Rate for Payer: NAPHCARE Commercial |
$4.95
|
| Rate for Payer: Preferred Network Access Commercial |
$129.43
|
| Rate for Payer: Quartz Beloit One Network |
$59.95
|
| Rate for Payer: Quartz Commercial |
$77.66
|
| Rate for Payer: Quartz Medicare Advantage |
$3.30
|
| Rate for Payer: The Alliance Commercial |
$13.02
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3.30
|
| Rate for Payer: WEA Trust Commercial |
$74.93
|
| Rate for Payer: WPS Commercial |
$14.51
|
|
|
Urine Nortriptyline
|
Facility
|
OP
|
$212.00
|
|
| Hospital Charge Code |
2943022
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$61.73 |
| Max. Negotiated Rate |
$202.84 |
| Rate for Payer: Aetna Commercial |
$198.43
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$189.61
|
| Rate for Payer: Aetna Managed Medicare |
$61.73
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$143.31
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$110.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$105.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$116.85
|
| Rate for Payer: Cash Price |
$63.60
|
| Rate for Payer: Cigna Commercial |
$202.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$123.38
|
| Rate for Payer: Health EOS Commercial |
$196.23
|
| Rate for Payer: HFN Commercial |
$202.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$165.36
|
| Rate for Payer: Multiplan Commercial |
$176.38
|
| Rate for Payer: NAPHCARE Commercial |
$132.29
|
| Rate for Payer: Preferred Network Access Commercial |
$202.84
|
| Rate for Payer: Quartz Beloit One Network |
$108.04
|
| Rate for Payer: Quartz Commercial |
$143.31
|
| Rate for Payer: Quartz Medicare Advantage |
$132.29
|
| Rate for Payer: The Alliance Commercial |
$110.24
|
| Rate for Payer: United Healthcare PPO |
$165.36
|
| Rate for Payer: WEA Trust Commercial |
$121.26
|
| Rate for Payer: WPS Commercial |
$163.30
|
|
|
Urine Nortriptyline
|
Facility
|
IP
|
$212.00
|
|
| Hospital Charge Code |
2943022
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$108.04 |
| Max. Negotiated Rate |
$202.84 |
| Rate for Payer: Aetna Commercial |
$198.43
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$189.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$116.85
|
| Rate for Payer: Cash Price |
$63.60
|
| Rate for Payer: Cigna Commercial |
$202.84
|
| Rate for Payer: Health EOS Commercial |
$196.23
|
| Rate for Payer: HFN Commercial |
$202.84
|
| Rate for Payer: Multiplan Commercial |
$176.38
|
| Rate for Payer: Preferred Network Access Commercial |
$202.84
|
| Rate for Payer: Quartz Beloit One Network |
$108.04
|
| Rate for Payer: Quartz Commercial |
$132.29
|
| Rate for Payer: WEA Trust Commercial |
$121.26
|
| Rate for Payer: WPS Commercial |
$163.30
|
|
|
Urine Nortriptyline
|
Professional
|
Both
|
$212.00
|
|
| Hospital Charge Code |
2943022
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$97.01 |
| Max. Negotiated Rate |
$209.46 |
| Rate for Payer: Aetna Commercial |
$209.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$189.61
|
| Rate for Payer: Cash Price |
$63.60
|
| Rate for Payer: Cigna Commercial |
$209.46
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$110.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$132.29
|
| Rate for Payer: Health EOS Commercial |
$200.64
|
| Rate for Payer: HFN Commercial |
$209.46
|
| Rate for Payer: Multiplan Commercial |
$176.38
|
| Rate for Payer: Preferred Network Access Commercial |
$209.46
|
| Rate for Payer: Quartz Beloit One Network |
$97.01
|
| Rate for Payer: Quartz Commercial |
$125.67
|
| Rate for Payer: The Alliance Commercial |
$110.24
|
| Rate for Payer: WEA Trust Commercial |
$121.26
|
| Rate for Payer: WPS Commercial |
$163.30
|
|
|
Urine Oxalate
|
Facility
|
OP
|
$21.00
|
|
|
Service Code
|
CPT 83945
|
| Hospital Charge Code |
3813058
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.70 |
| Max. Negotiated Rate |
$60.11 |
| Rate for Payer: Aetna Commercial |
$19.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$18.78
|
| Rate for Payer: Aetna Managed Medicare |
$15.03
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$56.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$26.30
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$24.95
|
| Rate for Payer: Anthem Medicare Advantage |
$15.03
|
| 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 |
$15.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$15.03
|
| 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 |
$15.03
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12.22
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$15.03
|
| Rate for Payer: Health EOS Commercial |
$19.44
|
| Rate for Payer: HFN Commercial |
$20.09
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$55.90
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$15.03
|
| Rate for Payer: Independent Care Health Plan Medicare |
$15.03
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$15.03
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$15.03
|
| Rate for Payer: Multiplan Commercial |
$17.47
|
| Rate for Payer: NAPHCARE Commercial |
$22.54
|
| 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 |
$15.03
|
| Rate for Payer: The Alliance Commercial |
$60.11
|
| Rate for Payer: United Healthcare Medicare Advantage |
$15.03
|
| Rate for Payer: United Healthcare PPO |
$16.38
|
| Rate for Payer: WEA Trust Commercial |
$12.01
|
| Rate for Payer: Wellcare Medicare |
$15.03
|
| Rate for Payer: WPS Commercial |
$16.18
|
|
|
Urine Oxalate
|
Facility
|
IP
|
$21.00
|
|
|
Service Code
|
CPT 83945
|
| Hospital Charge Code |
3813058
|
|
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 Oxalate
|
Professional
|
Both
|
$21.00
|
|
|
Service Code
|
CPT 83945
|
| Hospital Charge Code |
3813058
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.61 |
| Max. Negotiated Rate |
$66.12 |
| Rate for Payer: Aetna Commercial |
$20.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$18.78
|
| Rate for Payer: Aetna Managed Medicare |
$15.03
|
| Rate for Payer: Anthem Medicare Advantage |
$15.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$15.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$15.03
|
| 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 |
$15.03
|
| Rate for Payer: Health EOS Commercial |
$19.87
|
| Rate for Payer: HFN Commercial |
$20.75
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$53.05
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$53.05
|
| Rate for Payer: Independent Care Health Plan Medicare |
$15.03
|
| Rate for Payer: Multiplan Commercial |
$17.47
|
| Rate for Payer: NAPHCARE Commercial |
$22.54
|
| 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 |
$15.03
|
| Rate for Payer: The Alliance Commercial |
$59.36
|
| Rate for Payer: United Healthcare Medicare Advantage |
$15.03
|
| Rate for Payer: WEA Trust Commercial |
$12.01
|
| Rate for Payer: WPS Commercial |
$66.12
|
|
|
Urine Oxalate
|
Facility
|
OP
|
$93.00
|
|
|
Service Code
|
CPT 83945
|
| Hospital Charge Code |
2942990
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.03 |
| Max. Negotiated Rate |
$88.98 |
| Rate for Payer: Aetna Commercial |
$87.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$83.18
|
| Rate for Payer: Aetna Managed Medicare |
$15.03
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$56.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$26.30
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$24.95
|
| Rate for Payer: Anthem Medicare Advantage |
$15.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$51.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$15.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$15.03
|
| Rate for Payer: Cash Price |
$27.90
|
| Rate for Payer: Cash Price |
$27.90
|
| Rate for Payer: Cigna Commercial |
$88.98
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$15.03
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$54.13
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$15.03
|
| Rate for Payer: Health EOS Commercial |
$86.08
|
| Rate for Payer: HFN Commercial |
$88.98
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$55.90
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$15.03
|
| Rate for Payer: Independent Care Health Plan Medicare |
$15.03
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$15.03
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$15.03
|
| Rate for Payer: Multiplan Commercial |
$77.38
|
| Rate for Payer: NAPHCARE Commercial |
$22.54
|
| Rate for Payer: Preferred Network Access Commercial |
$88.98
|
| Rate for Payer: Quartz Beloit One Network |
$47.39
|
| Rate for Payer: Quartz Commercial |
$62.87
|
| Rate for Payer: Quartz Medicare Advantage |
$15.03
|
| Rate for Payer: The Alliance Commercial |
$60.11
|
| Rate for Payer: United Healthcare Medicare Advantage |
$15.03
|
| Rate for Payer: United Healthcare PPO |
$72.54
|
| Rate for Payer: WEA Trust Commercial |
$53.20
|
| Rate for Payer: Wellcare Medicare |
$15.03
|
| Rate for Payer: WPS Commercial |
$71.64
|
|
|
Urine Oxalate
|
Professional
|
Both
|
$93.00
|
|
|
Service Code
|
CPT 83945
|
| Hospital Charge Code |
2942990
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.03 |
| Max. Negotiated Rate |
$91.88 |
| Rate for Payer: Aetna Commercial |
$91.88
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$83.18
|
| Rate for Payer: Aetna Managed Medicare |
$15.03
|
| Rate for Payer: Anthem Medicare Advantage |
$15.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$15.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$15.03
|
| Rate for Payer: Cash Price |
$27.90
|
| Rate for Payer: Cash Price |
$27.90
|
| Rate for Payer: Cigna Commercial |
$91.88
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$48.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$15.03
|
| Rate for Payer: Health EOS Commercial |
$88.02
|
| Rate for Payer: HFN Commercial |
$91.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$53.05
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$53.05
|
| Rate for Payer: Independent Care Health Plan Medicare |
$15.03
|
| Rate for Payer: Multiplan Commercial |
$77.38
|
| Rate for Payer: NAPHCARE Commercial |
$22.54
|
| Rate for Payer: Preferred Network Access Commercial |
$91.88
|
| Rate for Payer: Quartz Beloit One Network |
$42.56
|
| Rate for Payer: Quartz Commercial |
$55.13
|
| Rate for Payer: Quartz Medicare Advantage |
$15.03
|
| Rate for Payer: The Alliance Commercial |
$59.36
|
| Rate for Payer: United Healthcare Medicare Advantage |
$15.03
|
| Rate for Payer: WEA Trust Commercial |
$53.20
|
| Rate for Payer: WPS Commercial |
$66.12
|
|
|
Urine Oxalate
|
Facility
|
IP
|
$93.00
|
|
|
Service Code
|
CPT 83945
|
| Hospital Charge Code |
2942990
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$47.39 |
| Max. Negotiated Rate |
$88.98 |
| Rate for Payer: Aetna Commercial |
$87.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$83.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$51.26
|
| Rate for Payer: Cash Price |
$27.90
|
| Rate for Payer: Cigna Commercial |
$88.98
|
| Rate for Payer: Health EOS Commercial |
$86.08
|
| Rate for Payer: HFN Commercial |
$88.98
|
| Rate for Payer: Multiplan Commercial |
$77.38
|
| Rate for Payer: Preferred Network Access Commercial |
$88.98
|
| Rate for Payer: Quartz Beloit One Network |
$47.39
|
| Rate for Payer: Quartz Commercial |
$58.03
|
| Rate for Payer: WEA Trust Commercial |
$53.20
|
| Rate for Payer: WPS Commercial |
$71.64
|
|
|
Urine pH
|
Facility
|
OP
|
$21.00
|
|
|
Service Code
|
CPT 83986
|
| Hospital Charge Code |
3813061
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.72 |
| Max. Negotiated Rate |
$20.09 |
| Rate for Payer: Aetna Commercial |
$19.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$18.78
|
| Rate for Payer: Aetna Managed Medicare |
$3.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$13.96
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$6.52
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$6.18
|
| Rate for Payer: Anthem Medicare Advantage |
$3.72
|
| 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 |
$3.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$3.72
|
| 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 |
$3.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12.22
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$3.72
|
| Rate for Payer: Health EOS Commercial |
$19.44
|
| Rate for Payer: HFN Commercial |
$20.09
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$13.85
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$3.72
|
| Rate for Payer: Independent Care Health Plan Medicare |
$3.72
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$3.72
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$3.72
|
| Rate for Payer: Multiplan Commercial |
$17.47
|
| Rate for Payer: NAPHCARE Commercial |
$5.58
|
| 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 |
$3.72
|
| Rate for Payer: The Alliance Commercial |
$14.89
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3.72
|
| Rate for Payer: United Healthcare PPO |
$16.38
|
| Rate for Payer: WEA Trust Commercial |
$12.01
|
| Rate for Payer: Wellcare Medicare |
$3.72
|
| Rate for Payer: WPS Commercial |
$16.18
|
|
|
Urine pH
|
Professional
|
Both
|
$45.00
|
|
|
Service Code
|
CPT 83986
|
| Hospital Charge Code |
2942993
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.72 |
| Max. Negotiated Rate |
$44.46 |
| Rate for Payer: Aetna Commercial |
$44.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$40.25
|
| Rate for Payer: Aetna Managed Medicare |
$3.72
|
| Rate for Payer: Anthem Medicare Advantage |
$3.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$3.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$3.72
|
| Rate for Payer: Cash Price |
$13.50
|
| Rate for Payer: Cash Price |
$13.50
|
| Rate for Payer: Cigna Commercial |
$44.46
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$23.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3.72
|
| Rate for Payer: Health EOS Commercial |
$42.59
|
| Rate for Payer: HFN Commercial |
$44.46
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$13.15
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$13.15
|
| Rate for Payer: Independent Care Health Plan Medicare |
$3.72
|
| Rate for Payer: Multiplan Commercial |
$37.44
|
| Rate for Payer: NAPHCARE Commercial |
$5.58
|
| Rate for Payer: Preferred Network Access Commercial |
$44.46
|
| Rate for Payer: Quartz Beloit One Network |
$20.59
|
| Rate for Payer: Quartz Commercial |
$26.68
|
| Rate for Payer: Quartz Medicare Advantage |
$3.72
|
| Rate for Payer: The Alliance Commercial |
$14.71
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3.72
|
| Rate for Payer: WEA Trust Commercial |
$25.74
|
| Rate for Payer: WPS Commercial |
$16.38
|
|
|
Urine pH
|
Professional
|
Both
|
$21.00
|
|
|
Service Code
|
CPT 83986
|
| Hospital Charge Code |
3813061
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.72 |
| Max. Negotiated Rate |
$20.75 |
| Rate for Payer: Aetna Commercial |
$20.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$18.78
|
| Rate for Payer: Aetna Managed Medicare |
$3.72
|
| Rate for Payer: Anthem Medicare Advantage |
$3.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$3.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$3.72
|
| 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 |
$3.72
|
| Rate for Payer: Health EOS Commercial |
$19.87
|
| Rate for Payer: HFN Commercial |
$20.75
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$13.15
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$13.15
|
| Rate for Payer: Independent Care Health Plan Medicare |
$3.72
|
| Rate for Payer: Multiplan Commercial |
$17.47
|
| Rate for Payer: NAPHCARE Commercial |
$5.58
|
| 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 |
$3.72
|
| Rate for Payer: The Alliance Commercial |
$14.71
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3.72
|
| Rate for Payer: WEA Trust Commercial |
$12.01
|
| Rate for Payer: WPS Commercial |
$16.38
|
|
|
Urine pH
|
Facility
|
OP
|
$45.00
|
|
|
Service Code
|
CPT 83986
|
| Hospital Charge Code |
2942993
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.72 |
| Max. Negotiated Rate |
$43.06 |
| Rate for Payer: Aetna Commercial |
$42.12
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$40.25
|
| Rate for Payer: Aetna Managed Medicare |
$3.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$13.96
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$6.52
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$6.18
|
| Rate for Payer: Anthem Medicare Advantage |
$3.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$24.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$3.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$3.72
|
| Rate for Payer: Cash Price |
$13.50
|
| Rate for Payer: Cash Price |
$13.50
|
| Rate for Payer: Cigna Commercial |
$43.06
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$3.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$26.19
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$3.72
|
| Rate for Payer: Health EOS Commercial |
$41.65
|
| Rate for Payer: HFN Commercial |
$43.06
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$13.85
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$3.72
|
| Rate for Payer: Independent Care Health Plan Medicare |
$3.72
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$3.72
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$3.72
|
| Rate for Payer: Multiplan Commercial |
$37.44
|
| Rate for Payer: NAPHCARE Commercial |
$5.58
|
| Rate for Payer: Preferred Network Access Commercial |
$43.06
|
| Rate for Payer: Quartz Beloit One Network |
$22.93
|
| Rate for Payer: Quartz Commercial |
$30.42
|
| Rate for Payer: Quartz Medicare Advantage |
$3.72
|
| Rate for Payer: The Alliance Commercial |
$14.89
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3.72
|
| Rate for Payer: United Healthcare PPO |
$35.10
|
| Rate for Payer: WEA Trust Commercial |
$25.74
|
| Rate for Payer: Wellcare Medicare |
$3.72
|
| Rate for Payer: WPS Commercial |
$34.66
|
|
|
Urine pH
|
Facility
|
IP
|
$21.00
|
|
|
Service Code
|
CPT 83986
|
| Hospital Charge Code |
3813061
|
|
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 pH
|
Facility
|
IP
|
$45.00
|
|
|
Service Code
|
CPT 83986
|
| Hospital Charge Code |
2942993
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$22.93 |
| Max. Negotiated Rate |
$43.06 |
| Rate for Payer: Aetna Commercial |
$42.12
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$40.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$24.80
|
| Rate for Payer: Cash Price |
$13.50
|
| Rate for Payer: Cigna Commercial |
$43.06
|
| Rate for Payer: Health EOS Commercial |
$41.65
|
| Rate for Payer: HFN Commercial |
$43.06
|
| Rate for Payer: Multiplan Commercial |
$37.44
|
| Rate for Payer: Preferred Network Access Commercial |
$43.06
|
| Rate for Payer: Quartz Beloit One Network |
$22.93
|
| Rate for Payer: Quartz Commercial |
$28.08
|
| Rate for Payer: WEA Trust Commercial |
$25.74
|
| Rate for Payer: WPS Commercial |
$34.66
|
|
|
Urine Phosphorus
|
Facility
|
IP
|
$60.00
|
|
|
Service Code
|
CPT 84105
|
| Hospital Charge Code |
2942996
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$30.58 |
| Max. Negotiated Rate |
$57.41 |
| Rate for Payer: Aetna Commercial |
$56.16
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$53.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$33.07
|
| Rate for Payer: Cash Price |
$18.00
|
| Rate for Payer: Cigna Commercial |
$57.41
|
| Rate for Payer: Health EOS Commercial |
$55.54
|
| Rate for Payer: HFN Commercial |
$57.41
|
| Rate for Payer: Multiplan Commercial |
$49.92
|
| Rate for Payer: Preferred Network Access Commercial |
$57.41
|
| Rate for Payer: Quartz Beloit One Network |
$30.58
|
| Rate for Payer: Quartz Commercial |
$37.44
|
| Rate for Payer: WEA Trust Commercial |
$34.32
|
| Rate for Payer: WPS Commercial |
$46.22
|
|
|
Urine Phosphorus
|
Facility
|
OP
|
$60.00
|
|
|
Service Code
|
CPT 84105
|
| Hospital Charge Code |
2942996
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.01 |
| Max. Negotiated Rate |
$57.41 |
| Rate for Payer: Aetna Commercial |
$56.16
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$53.66
|
| Rate for Payer: Aetna Managed Medicare |
$6.01
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$22.54
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$10.52
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$9.98
|
| Rate for Payer: Anthem Medicare Advantage |
$6.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$33.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$6.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$6.01
|
| Rate for Payer: Cash Price |
$18.00
|
| Rate for Payer: Cash Price |
$18.00
|
| Rate for Payer: Cigna Commercial |
$57.41
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$6.01
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$34.92
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$6.01
|
| Rate for Payer: Health EOS Commercial |
$55.54
|
| Rate for Payer: HFN Commercial |
$57.41
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$22.36
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$6.01
|
| Rate for Payer: Independent Care Health Plan Medicare |
$6.01
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$6.01
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$6.01
|
| Rate for Payer: Multiplan Commercial |
$49.92
|
| Rate for Payer: NAPHCARE Commercial |
$9.02
|
| Rate for Payer: Preferred Network Access Commercial |
$57.41
|
| Rate for Payer: Quartz Beloit One Network |
$30.58
|
| Rate for Payer: Quartz Commercial |
$40.56
|
| Rate for Payer: Quartz Medicare Advantage |
$6.01
|
| Rate for Payer: The Alliance Commercial |
$24.04
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6.01
|
| Rate for Payer: United Healthcare PPO |
$46.80
|
| Rate for Payer: WEA Trust Commercial |
$34.32
|
| Rate for Payer: Wellcare Medicare |
$6.01
|
| Rate for Payer: WPS Commercial |
$46.22
|
|
|
Urine Phosphorus
|
Facility
|
OP
|
$21.00
|
|
|
Service Code
|
CPT 84105
|
| Hospital Charge Code |
3813064
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.01 |
| Max. Negotiated Rate |
$24.04 |
| Rate for Payer: Aetna Commercial |
$19.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$18.78
|
| Rate for Payer: Aetna Managed Medicare |
$6.01
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$22.54
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$10.52
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$9.98
|
| Rate for Payer: Anthem Medicare Advantage |
$6.01
|
| 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 |
$6.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$6.01
|
| 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 |
$6.01
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12.22
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$6.01
|
| Rate for Payer: Health EOS Commercial |
$19.44
|
| Rate for Payer: HFN Commercial |
$20.09
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$22.36
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$6.01
|
| Rate for Payer: Independent Care Health Plan Medicare |
$6.01
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$6.01
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$6.01
|
| Rate for Payer: Multiplan Commercial |
$17.47
|
| Rate for Payer: NAPHCARE Commercial |
$9.02
|
| 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 |
$6.01
|
| Rate for Payer: The Alliance Commercial |
$24.04
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6.01
|
| Rate for Payer: United Healthcare PPO |
$16.38
|
| Rate for Payer: WEA Trust Commercial |
$12.01
|
| Rate for Payer: Wellcare Medicare |
$6.01
|
| Rate for Payer: WPS Commercial |
$16.18
|
|
|
Urine Phosphorus
|
Facility
|
IP
|
$21.00
|
|
|
Service Code
|
CPT 84105
|
| Hospital Charge Code |
3813064
|
|
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 Phosphorus
|
Professional
|
Both
|
$21.00
|
|
|
Service Code
|
CPT 84105
|
| Hospital Charge Code |
3813064
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.01 |
| Max. Negotiated Rate |
$26.45 |
| Rate for Payer: Aetna Commercial |
$20.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$18.78
|
| Rate for Payer: Aetna Managed Medicare |
$6.01
|
| Rate for Payer: Anthem Medicare Advantage |
$6.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$6.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$6.01
|
| 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 |
$6.01
|
| Rate for Payer: Health EOS Commercial |
$19.87
|
| Rate for Payer: HFN Commercial |
$20.75
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$21.22
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$21.22
|
| Rate for Payer: Independent Care Health Plan Medicare |
$6.01
|
| Rate for Payer: Multiplan Commercial |
$17.47
|
| Rate for Payer: NAPHCARE Commercial |
$9.02
|
| 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 |
$6.01
|
| Rate for Payer: The Alliance Commercial |
$23.74
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6.01
|
| Rate for Payer: WEA Trust Commercial |
$12.01
|
| Rate for Payer: WPS Commercial |
$26.45
|
|
|
Urine Phosphorus
|
Professional
|
Both
|
$60.00
|
|
|
Service Code
|
CPT 84105
|
| Hospital Charge Code |
2942996
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.01 |
| Max. Negotiated Rate |
$59.28 |
| Rate for Payer: Aetna Commercial |
$59.28
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$53.66
|
| Rate for Payer: Aetna Managed Medicare |
$6.01
|
| Rate for Payer: Anthem Medicare Advantage |
$6.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$6.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$6.01
|
| Rate for Payer: Cash Price |
$18.00
|
| Rate for Payer: Cash Price |
$18.00
|
| Rate for Payer: Cigna Commercial |
$59.28
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$31.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6.01
|
| Rate for Payer: Health EOS Commercial |
$56.78
|
| Rate for Payer: HFN Commercial |
$59.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$21.22
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$21.22
|
| Rate for Payer: Independent Care Health Plan Medicare |
$6.01
|
| Rate for Payer: Multiplan Commercial |
$49.92
|
| Rate for Payer: NAPHCARE Commercial |
$9.02
|
| Rate for Payer: Preferred Network Access Commercial |
$59.28
|
| Rate for Payer: Quartz Beloit One Network |
$27.46
|
| Rate for Payer: Quartz Commercial |
$35.57
|
| Rate for Payer: Quartz Medicare Advantage |
$6.01
|
| Rate for Payer: The Alliance Commercial |
$23.74
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6.01
|
| Rate for Payer: WEA Trust Commercial |
$34.32
|
| Rate for Payer: WPS Commercial |
$26.45
|
|
|
Urine Potassium
|
Facility
|
OP
|
$21.00
|
|
|
Service Code
|
CPT 84133
|
| Hospital Charge Code |
3813066
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.92 |
| Max. Negotiated Rate |
$20.09 |
| Rate for Payer: Aetna Commercial |
$19.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$18.78
|
| Rate for Payer: Aetna Managed Medicare |
$4.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$18.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8.61
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$8.17
|
| Rate for Payer: Anthem Medicare Advantage |
$4.92
|
| 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 |
$4.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$4.92
|
| 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 |
$4.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12.22
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$4.92
|
| Rate for Payer: Health EOS Commercial |
$19.44
|
| Rate for Payer: HFN Commercial |
$20.09
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$18.30
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$4.92
|
| Rate for Payer: Independent Care Health Plan Medicare |
$4.92
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$4.92
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$4.92
|
| Rate for Payer: Multiplan Commercial |
$17.47
|
| Rate for Payer: NAPHCARE Commercial |
$7.38
|
| 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 |
$4.92
|
| Rate for Payer: The Alliance Commercial |
$19.68
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4.92
|
| Rate for Payer: United Healthcare PPO |
$16.38
|
| Rate for Payer: WEA Trust Commercial |
$12.01
|
| Rate for Payer: Wellcare Medicare |
$4.92
|
| Rate for Payer: WPS Commercial |
$16.18
|
|
|
Urine Potassium
|
Professional
|
Both
|
$21.00
|
|
|
Service Code
|
CPT 84133
|
| Hospital Charge Code |
3813066
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.92 |
| Max. Negotiated Rate |
$21.64 |
| Rate for Payer: Aetna Commercial |
$20.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$18.78
|
| Rate for Payer: Aetna Managed Medicare |
$4.92
|
| Rate for Payer: Anthem Medicare Advantage |
$4.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$4.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$4.92
|
| 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 |
$4.92
|
| Rate for Payer: Health EOS Commercial |
$19.87
|
| Rate for Payer: HFN Commercial |
$20.75
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$17.37
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$17.37
|
| Rate for Payer: Independent Care Health Plan Medicare |
$4.92
|
| Rate for Payer: Multiplan Commercial |
$17.47
|
| Rate for Payer: NAPHCARE Commercial |
$7.38
|
| 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 |
$4.92
|
| Rate for Payer: The Alliance Commercial |
$19.43
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4.92
|
| Rate for Payer: WEA Trust Commercial |
$12.01
|
| Rate for Payer: WPS Commercial |
$21.64
|
|
