|
Vitamin B5 Level
|
Facility
|
OP
|
$123.00
|
|
|
Service Code
|
CPT 84591
|
| Hospital Charge Code |
5412827
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.74 |
| Max. Negotiated Rate |
$117.69 |
| Rate for Payer: Aetna Commercial |
$115.13
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$110.01
|
| Rate for Payer: Aetna Managed Medicare |
$17.74
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$66.53
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$31.05
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$29.45
|
| Rate for Payer: Anthem Medicare Advantage |
$17.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$67.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$17.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$17.74
|
| Rate for Payer: Cash Price |
$36.90
|
| Rate for Payer: Cash Price |
$36.90
|
| Rate for Payer: Cigna Commercial |
$117.69
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$17.74
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$71.59
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$17.74
|
| Rate for Payer: Health EOS Commercial |
$113.85
|
| Rate for Payer: HFN Commercial |
$117.69
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$66.00
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$17.74
|
| Rate for Payer: Independent Care Health Plan Medicare |
$17.74
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$17.74
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$17.74
|
| Rate for Payer: Multiplan Commercial |
$102.34
|
| Rate for Payer: NAPHCARE Commercial |
$26.61
|
| Rate for Payer: Preferred Network Access Commercial |
$117.69
|
| Rate for Payer: Quartz Beloit One Network |
$62.68
|
| Rate for Payer: Quartz Commercial |
$83.15
|
| Rate for Payer: Quartz Medicare Advantage |
$17.74
|
| Rate for Payer: The Alliance Commercial |
$70.97
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17.74
|
| Rate for Payer: United Healthcare PPO |
$95.94
|
| Rate for Payer: WEA Trust Commercial |
$70.36
|
| Rate for Payer: Wellcare Medicare |
$17.74
|
| Rate for Payer: WPS Commercial |
$94.75
|
|
|
Vitamin B6 Level
|
Facility
|
IP
|
$395.00
|
|
|
Service Code
|
CPT 84207
|
| Hospital Charge Code |
978092
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$201.29 |
| Max. Negotiated Rate |
$377.94 |
| Rate for Payer: Aetna Commercial |
$369.72
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$353.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$217.72
|
| Rate for Payer: Cash Price |
$118.50
|
| Rate for Payer: Cigna Commercial |
$377.94
|
| Rate for Payer: Health EOS Commercial |
$365.61
|
| Rate for Payer: HFN Commercial |
$377.94
|
| Rate for Payer: Multiplan Commercial |
$328.64
|
| Rate for Payer: Preferred Network Access Commercial |
$377.94
|
| Rate for Payer: Quartz Beloit One Network |
$201.29
|
| Rate for Payer: Quartz Commercial |
$246.48
|
| Rate for Payer: WEA Trust Commercial |
$225.94
|
| Rate for Payer: WPS Commercial |
$304.27
|
|
|
Vitamin B6 Level
|
Professional
|
Both
|
$395.00
|
|
|
Service Code
|
CPT 84207
|
| Hospital Charge Code |
978092
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$29.22 |
| Max. Negotiated Rate |
$390.26 |
| Rate for Payer: Aetna Commercial |
$390.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$353.29
|
| Rate for Payer: Aetna Managed Medicare |
$29.22
|
| Rate for Payer: Anthem Medicare Advantage |
$29.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$29.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$29.22
|
| Rate for Payer: Cash Price |
$118.50
|
| Rate for Payer: Cash Price |
$118.50
|
| Rate for Payer: Cigna Commercial |
$390.26
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$205.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$29.22
|
| Rate for Payer: Health EOS Commercial |
$373.83
|
| Rate for Payer: HFN Commercial |
$390.26
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$103.16
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$103.16
|
| Rate for Payer: Independent Care Health Plan Medicare |
$29.22
|
| Rate for Payer: Multiplan Commercial |
$328.64
|
| Rate for Payer: NAPHCARE Commercial |
$43.84
|
| Rate for Payer: Preferred Network Access Commercial |
$390.26
|
| Rate for Payer: Quartz Beloit One Network |
$180.75
|
| Rate for Payer: Quartz Commercial |
$234.16
|
| Rate for Payer: Quartz Medicare Advantage |
$29.22
|
| Rate for Payer: The Alliance Commercial |
$115.43
|
| Rate for Payer: United Healthcare Medicare Advantage |
$29.22
|
| Rate for Payer: WEA Trust Commercial |
$225.94
|
| Rate for Payer: WPS Commercial |
$128.59
|
|
|
Vitamin B6 Level
|
Facility
|
OP
|
$395.00
|
|
|
Service Code
|
CPT 84207
|
| Hospital Charge Code |
978092
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$29.22 |
| Max. Negotiated Rate |
$377.94 |
| Rate for Payer: Aetna Commercial |
$369.72
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$353.29
|
| Rate for Payer: Aetna Managed Medicare |
$29.22
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$109.59
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$51.14
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$48.51
|
| Rate for Payer: Anthem Medicare Advantage |
$29.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$217.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$29.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$29.22
|
| Rate for Payer: Cash Price |
$118.50
|
| Rate for Payer: Cash Price |
$118.50
|
| Rate for Payer: Cigna Commercial |
$377.94
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$29.22
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$229.89
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$29.22
|
| Rate for Payer: Health EOS Commercial |
$365.61
|
| Rate for Payer: HFN Commercial |
$377.94
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$108.71
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$29.22
|
| Rate for Payer: Independent Care Health Plan Medicare |
$29.22
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$29.22
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$29.22
|
| Rate for Payer: Multiplan Commercial |
$328.64
|
| Rate for Payer: NAPHCARE Commercial |
$43.84
|
| Rate for Payer: Preferred Network Access Commercial |
$377.94
|
| Rate for Payer: Quartz Beloit One Network |
$201.29
|
| Rate for Payer: Quartz Commercial |
$267.02
|
| Rate for Payer: Quartz Medicare Advantage |
$29.22
|
| Rate for Payer: The Alliance Commercial |
$116.90
|
| Rate for Payer: United Healthcare Medicare Advantage |
$29.22
|
| Rate for Payer: United Healthcare PPO |
$308.10
|
| Rate for Payer: WEA Trust Commercial |
$225.94
|
| Rate for Payer: Wellcare Medicare |
$29.22
|
| Rate for Payer: WPS Commercial |
$304.27
|
|
|
Vitamin B7
|
Facility
|
IP
|
$102.00
|
|
|
Service Code
|
CPT 84591
|
| Hospital Charge Code |
6181432
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$51.98 |
| Max. Negotiated Rate |
$97.59 |
| Rate for Payer: Aetna Commercial |
$95.47
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$91.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$56.22
|
| Rate for Payer: Cash Price |
$30.60
|
| Rate for Payer: Cigna Commercial |
$97.59
|
| Rate for Payer: Health EOS Commercial |
$94.41
|
| Rate for Payer: HFN Commercial |
$97.59
|
| Rate for Payer: Multiplan Commercial |
$84.86
|
| Rate for Payer: Preferred Network Access Commercial |
$97.59
|
| Rate for Payer: Quartz Beloit One Network |
$51.98
|
| Rate for Payer: Quartz Commercial |
$63.65
|
| Rate for Payer: WEA Trust Commercial |
$58.34
|
| Rate for Payer: WPS Commercial |
$78.57
|
|
|
Vitamin B7
|
Facility
|
OP
|
$102.00
|
|
|
Service Code
|
CPT 84591
|
| Hospital Charge Code |
6181432
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.74 |
| Max. Negotiated Rate |
$97.59 |
| Rate for Payer: Aetna Commercial |
$95.47
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$91.23
|
| Rate for Payer: Aetna Managed Medicare |
$17.74
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$66.53
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$31.05
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$29.45
|
| Rate for Payer: Anthem Medicare Advantage |
$17.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$56.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$17.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$17.74
|
| Rate for Payer: Cash Price |
$30.60
|
| Rate for Payer: Cash Price |
$30.60
|
| Rate for Payer: Cigna Commercial |
$97.59
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$17.74
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$59.36
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$17.74
|
| Rate for Payer: Health EOS Commercial |
$94.41
|
| Rate for Payer: HFN Commercial |
$97.59
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$66.00
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$17.74
|
| Rate for Payer: Independent Care Health Plan Medicare |
$17.74
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$17.74
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$17.74
|
| Rate for Payer: Multiplan Commercial |
$84.86
|
| Rate for Payer: NAPHCARE Commercial |
$26.61
|
| Rate for Payer: Preferred Network Access Commercial |
$97.59
|
| Rate for Payer: Quartz Beloit One Network |
$51.98
|
| Rate for Payer: Quartz Commercial |
$68.95
|
| Rate for Payer: Quartz Medicare Advantage |
$17.74
|
| Rate for Payer: The Alliance Commercial |
$70.97
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17.74
|
| Rate for Payer: United Healthcare PPO |
$79.56
|
| Rate for Payer: WEA Trust Commercial |
$58.34
|
| Rate for Payer: Wellcare Medicare |
$17.74
|
| Rate for Payer: WPS Commercial |
$78.57
|
|
|
Vitamin B7
|
Professional
|
Both
|
$102.00
|
|
|
Service Code
|
CPT 84591
|
| Hospital Charge Code |
6181432
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.74 |
| Max. Negotiated Rate |
$100.78 |
| Rate for Payer: Aetna Commercial |
$100.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$91.23
|
| Rate for Payer: Aetna Managed Medicare |
$17.74
|
| Rate for Payer: Anthem Medicare Advantage |
$17.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$17.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$17.74
|
| Rate for Payer: Cash Price |
$30.60
|
| Rate for Payer: Cash Price |
$30.60
|
| Rate for Payer: Cigna Commercial |
$100.78
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$53.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$17.74
|
| Rate for Payer: Health EOS Commercial |
$96.53
|
| Rate for Payer: HFN Commercial |
$100.78
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$62.63
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$62.63
|
| Rate for Payer: Independent Care Health Plan Medicare |
$17.74
|
| Rate for Payer: Multiplan Commercial |
$84.86
|
| Rate for Payer: NAPHCARE Commercial |
$26.61
|
| Rate for Payer: Preferred Network Access Commercial |
$100.78
|
| Rate for Payer: Quartz Beloit One Network |
$46.68
|
| Rate for Payer: Quartz Commercial |
$60.47
|
| Rate for Payer: Quartz Medicare Advantage |
$17.74
|
| Rate for Payer: The Alliance Commercial |
$70.08
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17.74
|
| Rate for Payer: WEA Trust Commercial |
$58.34
|
| Rate for Payer: WPS Commercial |
$78.07
|
|
|
Vitamin C Level
|
Professional
|
Both
|
$213.00
|
|
|
Service Code
|
CPT 82180
|
| Hospital Charge Code |
978093
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.29 |
| Max. Negotiated Rate |
$210.44 |
| Rate for Payer: Aetna Commercial |
$210.44
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$190.51
|
| Rate for Payer: Aetna Managed Medicare |
$10.29
|
| Rate for Payer: Anthem Medicare Advantage |
$10.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$10.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$10.29
|
| Rate for Payer: Cash Price |
$63.90
|
| Rate for Payer: Cash Price |
$63.90
|
| Rate for Payer: Cigna Commercial |
$210.44
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$110.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$10.29
|
| Rate for Payer: Health EOS Commercial |
$201.58
|
| Rate for Payer: HFN Commercial |
$210.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$36.31
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$36.31
|
| Rate for Payer: Independent Care Health Plan Medicare |
$10.29
|
| Rate for Payer: Multiplan Commercial |
$177.22
|
| Rate for Payer: NAPHCARE Commercial |
$15.43
|
| Rate for Payer: Preferred Network Access Commercial |
$210.44
|
| Rate for Payer: Quartz Beloit One Network |
$97.47
|
| Rate for Payer: Quartz Commercial |
$126.27
|
| Rate for Payer: Quartz Medicare Advantage |
$10.29
|
| Rate for Payer: The Alliance Commercial |
$40.63
|
| Rate for Payer: United Healthcare Medicare Advantage |
$10.29
|
| Rate for Payer: WEA Trust Commercial |
$121.84
|
| Rate for Payer: WPS Commercial |
$45.26
|
|
|
Vitamin C Level
|
Facility
|
IP
|
$213.00
|
|
|
Service Code
|
CPT 82180
|
| Hospital Charge Code |
978093
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$108.54 |
| Max. Negotiated Rate |
$203.80 |
| Rate for Payer: Aetna Commercial |
$199.37
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$190.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$117.41
|
| Rate for Payer: Cash Price |
$63.90
|
| Rate for Payer: Cigna Commercial |
$203.80
|
| Rate for Payer: Health EOS Commercial |
$197.15
|
| Rate for Payer: HFN Commercial |
$203.80
|
| Rate for Payer: Multiplan Commercial |
$177.22
|
| Rate for Payer: Preferred Network Access Commercial |
$203.80
|
| Rate for Payer: Quartz Beloit One Network |
$108.54
|
| Rate for Payer: Quartz Commercial |
$132.91
|
| Rate for Payer: WEA Trust Commercial |
$121.84
|
| Rate for Payer: WPS Commercial |
$164.07
|
|
|
Vitamin C Level
|
Facility
|
OP
|
$213.00
|
|
|
Service Code
|
CPT 82180
|
| Hospital Charge Code |
978093
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.29 |
| Max. Negotiated Rate |
$203.80 |
| Rate for Payer: Aetna Commercial |
$199.37
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$190.51
|
| Rate for Payer: Aetna Managed Medicare |
$10.29
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$38.57
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$18.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$17.07
|
| Rate for Payer: Anthem Medicare Advantage |
$10.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$117.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$10.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$10.29
|
| Rate for Payer: Cash Price |
$63.90
|
| Rate for Payer: Cash Price |
$63.90
|
| Rate for Payer: Cigna Commercial |
$203.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$10.29
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$123.97
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$10.29
|
| Rate for Payer: Health EOS Commercial |
$197.15
|
| Rate for Payer: HFN Commercial |
$203.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$38.26
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$10.29
|
| Rate for Payer: Independent Care Health Plan Medicare |
$10.29
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$10.29
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$10.29
|
| Rate for Payer: Multiplan Commercial |
$177.22
|
| Rate for Payer: NAPHCARE Commercial |
$15.43
|
| Rate for Payer: Preferred Network Access Commercial |
$203.80
|
| Rate for Payer: Quartz Beloit One Network |
$108.54
|
| Rate for Payer: Quartz Commercial |
$143.99
|
| Rate for Payer: Quartz Medicare Advantage |
$10.29
|
| Rate for Payer: The Alliance Commercial |
$41.14
|
| Rate for Payer: United Healthcare Medicare Advantage |
$10.29
|
| Rate for Payer: United Healthcare PPO |
$166.14
|
| Rate for Payer: WEA Trust Commercial |
$121.84
|
| Rate for Payer: Wellcare Medicare |
$10.29
|
| Rate for Payer: WPS Commercial |
$164.07
|
|
|
Vitamin D 25 (D2, D3) LC/MS/MS
|
Professional
|
Both
|
$34.00
|
|
|
Service Code
|
CPT 82306
|
| Hospital Charge Code |
5426747
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.56 |
| Max. Negotiated Rate |
$135.45 |
| Rate for Payer: Aetna Commercial |
$33.59
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$30.41
|
| Rate for Payer: Aetna Managed Medicare |
$30.78
|
| Rate for Payer: Anthem Medicare Advantage |
$30.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$30.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$30.78
|
| Rate for Payer: Cash Price |
$10.20
|
| Rate for Payer: Cash Price |
$10.20
|
| Rate for Payer: Cigna Commercial |
$33.59
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$17.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$30.78
|
| Rate for Payer: Health EOS Commercial |
$32.18
|
| Rate for Payer: HFN Commercial |
$33.59
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$108.67
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$108.67
|
| Rate for Payer: Independent Care Health Plan Medicare |
$30.78
|
| Rate for Payer: Multiplan Commercial |
$28.29
|
| Rate for Payer: NAPHCARE Commercial |
$46.18
|
| Rate for Payer: Preferred Network Access Commercial |
$33.59
|
| Rate for Payer: Quartz Beloit One Network |
$15.56
|
| Rate for Payer: Quartz Commercial |
$20.16
|
| Rate for Payer: Quartz Medicare Advantage |
$30.78
|
| Rate for Payer: The Alliance Commercial |
$121.60
|
| Rate for Payer: United Healthcare Medicare Advantage |
$30.78
|
| Rate for Payer: WEA Trust Commercial |
$19.45
|
| Rate for Payer: WPS Commercial |
$135.45
|
|
|
Vitamin D 25 (D2, D3) LC/MS/MS
|
Facility
|
OP
|
$34.00
|
|
|
Service Code
|
CPT 82306
|
| Hospital Charge Code |
5426747
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.33 |
| Max. Negotiated Rate |
$123.14 |
| Rate for Payer: Aetna Commercial |
$31.82
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$30.41
|
| Rate for Payer: Aetna Managed Medicare |
$30.78
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$115.44
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$53.87
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$51.10
|
| Rate for Payer: Anthem Medicare Advantage |
$30.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$18.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$30.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$30.78
|
| Rate for Payer: Cash Price |
$10.20
|
| Rate for Payer: Cash Price |
$10.20
|
| Rate for Payer: Cigna Commercial |
$32.53
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$30.78
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$19.79
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$30.78
|
| Rate for Payer: Health EOS Commercial |
$31.47
|
| Rate for Payer: HFN Commercial |
$32.53
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$114.52
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$30.78
|
| Rate for Payer: Independent Care Health Plan Medicare |
$30.78
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$30.78
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$30.78
|
| Rate for Payer: Multiplan Commercial |
$28.29
|
| Rate for Payer: NAPHCARE Commercial |
$46.18
|
| Rate for Payer: Preferred Network Access Commercial |
$32.53
|
| Rate for Payer: Quartz Beloit One Network |
$17.33
|
| Rate for Payer: Quartz Commercial |
$22.98
|
| Rate for Payer: Quartz Medicare Advantage |
$30.78
|
| Rate for Payer: The Alliance Commercial |
$123.14
|
| Rate for Payer: United Healthcare Medicare Advantage |
$30.78
|
| Rate for Payer: United Healthcare PPO |
$26.52
|
| Rate for Payer: WEA Trust Commercial |
$19.45
|
| Rate for Payer: Wellcare Medicare |
$30.78
|
| Rate for Payer: WPS Commercial |
$26.19
|
|
|
Vitamin D 25 (D2, D3) LC/MS/MS
|
Facility
|
IP
|
$34.00
|
|
|
Service Code
|
CPT 82306
|
| Hospital Charge Code |
5426747
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.33 |
| Max. Negotiated Rate |
$32.53 |
| Rate for Payer: Aetna Commercial |
$31.82
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$30.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$18.74
|
| Rate for Payer: Cash Price |
$10.20
|
| Rate for Payer: Cigna Commercial |
$32.53
|
| Rate for Payer: Health EOS Commercial |
$31.47
|
| Rate for Payer: HFN Commercial |
$32.53
|
| Rate for Payer: Multiplan Commercial |
$28.29
|
| Rate for Payer: Preferred Network Access Commercial |
$32.53
|
| Rate for Payer: Quartz Beloit One Network |
$17.33
|
| Rate for Payer: Quartz Commercial |
$21.22
|
| Rate for Payer: WEA Trust Commercial |
$19.45
|
| Rate for Payer: WPS Commercial |
$26.19
|
|
|
Vitamin D 25 Hydroxy Level
|
Facility
|
IP
|
$345.00
|
|
|
Service Code
|
CPT 82306
|
| Hospital Charge Code |
633872
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$175.81 |
| Max. Negotiated Rate |
$330.10 |
| Rate for Payer: Aetna Commercial |
$322.92
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$308.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$190.16
|
| Rate for Payer: Cash Price |
$103.50
|
| Rate for Payer: Cigna Commercial |
$330.10
|
| Rate for Payer: Health EOS Commercial |
$319.33
|
| Rate for Payer: HFN Commercial |
$330.10
|
| Rate for Payer: Multiplan Commercial |
$287.04
|
| Rate for Payer: Preferred Network Access Commercial |
$330.10
|
| Rate for Payer: Quartz Beloit One Network |
$175.81
|
| Rate for Payer: Quartz Commercial |
$215.28
|
| Rate for Payer: WEA Trust Commercial |
$197.34
|
| Rate for Payer: WPS Commercial |
$265.75
|
|
|
Vitamin D 25 Hydroxy Level
|
Facility
|
OP
|
$345.00
|
|
|
Service Code
|
CPT 82306
|
| Hospital Charge Code |
633872
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$30.78 |
| Max. Negotiated Rate |
$330.10 |
| Rate for Payer: Aetna Commercial |
$322.92
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$308.57
|
| Rate for Payer: Aetna Managed Medicare |
$30.78
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$115.44
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$53.87
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$51.10
|
| Rate for Payer: Anthem Medicare Advantage |
$30.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$190.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$30.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$30.78
|
| Rate for Payer: Cash Price |
$103.50
|
| Rate for Payer: Cash Price |
$103.50
|
| Rate for Payer: Cigna Commercial |
$330.10
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$30.78
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$200.79
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$30.78
|
| Rate for Payer: Health EOS Commercial |
$319.33
|
| Rate for Payer: HFN Commercial |
$330.10
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$114.52
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$30.78
|
| Rate for Payer: Independent Care Health Plan Medicare |
$30.78
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$30.78
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$30.78
|
| Rate for Payer: Multiplan Commercial |
$287.04
|
| Rate for Payer: NAPHCARE Commercial |
$46.18
|
| Rate for Payer: Preferred Network Access Commercial |
$330.10
|
| Rate for Payer: Quartz Beloit One Network |
$175.81
|
| Rate for Payer: Quartz Commercial |
$233.22
|
| Rate for Payer: Quartz Medicare Advantage |
$30.78
|
| Rate for Payer: The Alliance Commercial |
$123.14
|
| Rate for Payer: United Healthcare Medicare Advantage |
$30.78
|
| Rate for Payer: United Healthcare PPO |
$269.10
|
| Rate for Payer: WEA Trust Commercial |
$197.34
|
| Rate for Payer: Wellcare Medicare |
$30.78
|
| Rate for Payer: WPS Commercial |
$265.75
|
|
|
Vitamin D 25 Hydroxy Level
|
Professional
|
Both
|
$345.00
|
|
|
Service Code
|
CPT 82306
|
| Hospital Charge Code |
633872
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$30.78 |
| Max. Negotiated Rate |
$340.86 |
| Rate for Payer: Aetna Commercial |
$340.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$308.57
|
| Rate for Payer: Aetna Managed Medicare |
$30.78
|
| Rate for Payer: Anthem Medicare Advantage |
$30.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$30.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$30.78
|
| Rate for Payer: Cash Price |
$103.50
|
| Rate for Payer: Cash Price |
$103.50
|
| Rate for Payer: Cigna Commercial |
$340.86
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$179.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$30.78
|
| Rate for Payer: Health EOS Commercial |
$326.51
|
| Rate for Payer: HFN Commercial |
$340.86
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$108.67
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$108.67
|
| Rate for Payer: Independent Care Health Plan Medicare |
$30.78
|
| Rate for Payer: Multiplan Commercial |
$287.04
|
| Rate for Payer: NAPHCARE Commercial |
$46.18
|
| Rate for Payer: Preferred Network Access Commercial |
$340.86
|
| Rate for Payer: Quartz Beloit One Network |
$157.87
|
| Rate for Payer: Quartz Commercial |
$204.52
|
| Rate for Payer: Quartz Medicare Advantage |
$30.78
|
| Rate for Payer: The Alliance Commercial |
$121.60
|
| Rate for Payer: United Healthcare Medicare Advantage |
$30.78
|
| Rate for Payer: WEA Trust Commercial |
$197.34
|
| Rate for Payer: WPS Commercial |
$135.45
|
|
|
Vitamin E Beta/Gamma Tocopherol
|
Facility
|
IP
|
$118.00
|
|
|
Service Code
|
CPT 84591
|
| Hospital Charge Code |
2943024
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$60.13 |
| Max. Negotiated Rate |
$112.90 |
| Rate for Payer: Aetna Commercial |
$110.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$105.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$65.04
|
| Rate for Payer: Cash Price |
$35.40
|
| Rate for Payer: Cigna Commercial |
$112.90
|
| Rate for Payer: Health EOS Commercial |
$109.22
|
| Rate for Payer: HFN Commercial |
$112.90
|
| Rate for Payer: Multiplan Commercial |
$98.18
|
| Rate for Payer: Preferred Network Access Commercial |
$112.90
|
| Rate for Payer: Quartz Beloit One Network |
$60.13
|
| Rate for Payer: Quartz Commercial |
$73.63
|
| Rate for Payer: WEA Trust Commercial |
$67.50
|
| Rate for Payer: WPS Commercial |
$90.90
|
|
|
Vitamin E Beta/Gamma Tocopherol
|
Facility
|
OP
|
$118.00
|
|
|
Service Code
|
CPT 84591
|
| Hospital Charge Code |
2943024
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.74 |
| Max. Negotiated Rate |
$112.90 |
| Rate for Payer: Aetna Commercial |
$110.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$105.54
|
| Rate for Payer: Aetna Managed Medicare |
$17.74
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$66.53
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$31.05
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$29.45
|
| Rate for Payer: Anthem Medicare Advantage |
$17.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$65.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$17.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$17.74
|
| Rate for Payer: Cash Price |
$35.40
|
| Rate for Payer: Cash Price |
$35.40
|
| Rate for Payer: Cigna Commercial |
$112.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$17.74
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$68.68
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$17.74
|
| Rate for Payer: Health EOS Commercial |
$109.22
|
| Rate for Payer: HFN Commercial |
$112.90
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$66.00
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$17.74
|
| Rate for Payer: Independent Care Health Plan Medicare |
$17.74
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$17.74
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$17.74
|
| Rate for Payer: Multiplan Commercial |
$98.18
|
| Rate for Payer: NAPHCARE Commercial |
$26.61
|
| Rate for Payer: Preferred Network Access Commercial |
$112.90
|
| Rate for Payer: Quartz Beloit One Network |
$60.13
|
| Rate for Payer: Quartz Commercial |
$79.77
|
| Rate for Payer: Quartz Medicare Advantage |
$17.74
|
| Rate for Payer: The Alliance Commercial |
$70.97
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17.74
|
| Rate for Payer: United Healthcare PPO |
$92.04
|
| Rate for Payer: WEA Trust Commercial |
$67.50
|
| Rate for Payer: Wellcare Medicare |
$17.74
|
| Rate for Payer: WPS Commercial |
$90.90
|
|
|
Vitamin E Beta/Gamma Tocopherol
|
Professional
|
Both
|
$118.00
|
|
|
Service Code
|
CPT 84591
|
| Hospital Charge Code |
2943024
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.74 |
| Max. Negotiated Rate |
$116.58 |
| Rate for Payer: Aetna Commercial |
$116.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$105.54
|
| Rate for Payer: Aetna Managed Medicare |
$17.74
|
| Rate for Payer: Anthem Medicare Advantage |
$17.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$17.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$17.74
|
| Rate for Payer: Cash Price |
$35.40
|
| Rate for Payer: Cash Price |
$35.40
|
| Rate for Payer: Cigna Commercial |
$116.58
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$61.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$17.74
|
| Rate for Payer: Health EOS Commercial |
$111.68
|
| Rate for Payer: HFN Commercial |
$116.58
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$62.63
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$62.63
|
| Rate for Payer: Independent Care Health Plan Medicare |
$17.74
|
| Rate for Payer: Multiplan Commercial |
$98.18
|
| Rate for Payer: NAPHCARE Commercial |
$26.61
|
| Rate for Payer: Preferred Network Access Commercial |
$116.58
|
| Rate for Payer: Quartz Beloit One Network |
$54.00
|
| Rate for Payer: Quartz Commercial |
$69.95
|
| Rate for Payer: Quartz Medicare Advantage |
$17.74
|
| Rate for Payer: The Alliance Commercial |
$70.08
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17.74
|
| Rate for Payer: WEA Trust Commercial |
$67.50
|
| Rate for Payer: WPS Commercial |
$78.07
|
|
|
Vitamin E Level
|
Professional
|
Both
|
$191.00
|
|
|
Service Code
|
CPT 84446
|
| Hospital Charge Code |
978094
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.75 |
| Max. Negotiated Rate |
$188.71 |
| Rate for Payer: Aetna Commercial |
$188.71
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$170.83
|
| Rate for Payer: Aetna Managed Medicare |
$14.75
|
| Rate for Payer: Anthem Medicare Advantage |
$14.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$14.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$14.75
|
| Rate for Payer: Cash Price |
$57.30
|
| Rate for Payer: Cash Price |
$57.30
|
| Rate for Payer: Cigna Commercial |
$188.71
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$99.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$14.75
|
| Rate for Payer: Health EOS Commercial |
$180.76
|
| Rate for Payer: HFN Commercial |
$188.71
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$52.06
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$52.06
|
| Rate for Payer: Independent Care Health Plan Medicare |
$14.75
|
| Rate for Payer: Multiplan Commercial |
$158.91
|
| Rate for Payer: NAPHCARE Commercial |
$22.12
|
| Rate for Payer: Preferred Network Access Commercial |
$188.71
|
| Rate for Payer: Quartz Beloit One Network |
$87.40
|
| Rate for Payer: Quartz Commercial |
$113.22
|
| Rate for Payer: Quartz Medicare Advantage |
$14.75
|
| Rate for Payer: The Alliance Commercial |
$58.25
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14.75
|
| Rate for Payer: WEA Trust Commercial |
$109.25
|
| Rate for Payer: WPS Commercial |
$64.89
|
|
|
Vitamin E Level
|
Facility
|
OP
|
$191.00
|
|
|
Service Code
|
CPT 84446
|
| Hospital Charge Code |
978094
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.75 |
| Max. Negotiated Rate |
$182.75 |
| Rate for Payer: Aetna Commercial |
$178.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$170.83
|
| Rate for Payer: Aetna Managed Medicare |
$14.75
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$55.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$25.81
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$24.48
|
| Rate for Payer: Anthem Medicare Advantage |
$14.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$105.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$14.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$14.75
|
| Rate for Payer: Cash Price |
$57.30
|
| Rate for Payer: Cash Price |
$57.30
|
| Rate for Payer: Cigna Commercial |
$182.75
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$14.75
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$111.16
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$14.75
|
| Rate for Payer: Health EOS Commercial |
$176.79
|
| Rate for Payer: HFN Commercial |
$182.75
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$54.86
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$14.75
|
| Rate for Payer: Independent Care Health Plan Medicare |
$14.75
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$14.75
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$14.75
|
| Rate for Payer: Multiplan Commercial |
$158.91
|
| Rate for Payer: NAPHCARE Commercial |
$22.12
|
| Rate for Payer: Preferred Network Access Commercial |
$182.75
|
| Rate for Payer: Quartz Beloit One Network |
$97.33
|
| Rate for Payer: Quartz Commercial |
$129.12
|
| Rate for Payer: Quartz Medicare Advantage |
$14.75
|
| Rate for Payer: The Alliance Commercial |
$58.99
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14.75
|
| Rate for Payer: United Healthcare PPO |
$148.98
|
| Rate for Payer: WEA Trust Commercial |
$109.25
|
| Rate for Payer: Wellcare Medicare |
$14.75
|
| Rate for Payer: WPS Commercial |
$147.13
|
|
|
Vitamin E Level
|
Facility
|
IP
|
$191.00
|
|
|
Service Code
|
CPT 84446
|
| Hospital Charge Code |
978094
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$97.33 |
| Max. Negotiated Rate |
$182.75 |
| Rate for Payer: Aetna Commercial |
$178.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$170.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$105.28
|
| Rate for Payer: Cash Price |
$57.30
|
| Rate for Payer: Cigna Commercial |
$182.75
|
| Rate for Payer: Health EOS Commercial |
$176.79
|
| Rate for Payer: HFN Commercial |
$182.75
|
| Rate for Payer: Multiplan Commercial |
$158.91
|
| Rate for Payer: Preferred Network Access Commercial |
$182.75
|
| Rate for Payer: Quartz Beloit One Network |
$97.33
|
| Rate for Payer: Quartz Commercial |
$119.18
|
| Rate for Payer: WEA Trust Commercial |
$109.25
|
| Rate for Payer: WPS Commercial |
$147.13
|
|
|
Vitamin K
|
Facility
|
IP
|
$437.00
|
|
|
Service Code
|
CPT 84597
|
| Hospital Charge Code |
983438
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$222.70 |
| Max. Negotiated Rate |
$418.12 |
| Rate for Payer: Aetna Commercial |
$409.03
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$390.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$240.87
|
| Rate for Payer: Cash Price |
$131.10
|
| Rate for Payer: Cigna Commercial |
$418.12
|
| Rate for Payer: Health EOS Commercial |
$404.49
|
| Rate for Payer: HFN Commercial |
$418.12
|
| Rate for Payer: Multiplan Commercial |
$363.58
|
| Rate for Payer: Preferred Network Access Commercial |
$418.12
|
| Rate for Payer: Quartz Beloit One Network |
$222.70
|
| Rate for Payer: Quartz Commercial |
$272.69
|
| Rate for Payer: WEA Trust Commercial |
$249.96
|
| Rate for Payer: WPS Commercial |
$336.62
|
|
|
Vitamin K
|
Facility
|
OP
|
$437.00
|
|
|
Service Code
|
CPT 84597
|
| Hospital Charge Code |
983438
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.27 |
| Max. Negotiated Rate |
$418.12 |
| Rate for Payer: Aetna Commercial |
$409.03
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$390.85
|
| Rate for Payer: Aetna Managed Medicare |
$14.27
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$53.51
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$24.97
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$23.69
|
| Rate for Payer: Anthem Medicare Advantage |
$14.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$240.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$14.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$14.27
|
| Rate for Payer: Cash Price |
$131.10
|
| Rate for Payer: Cash Price |
$131.10
|
| Rate for Payer: Cigna Commercial |
$418.12
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$14.27
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$254.33
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$14.27
|
| Rate for Payer: Health EOS Commercial |
$404.49
|
| Rate for Payer: HFN Commercial |
$418.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$53.08
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$14.27
|
| Rate for Payer: Independent Care Health Plan Medicare |
$14.27
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$14.27
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$14.27
|
| Rate for Payer: Multiplan Commercial |
$363.58
|
| Rate for Payer: NAPHCARE Commercial |
$21.40
|
| Rate for Payer: Preferred Network Access Commercial |
$418.12
|
| Rate for Payer: Quartz Beloit One Network |
$222.70
|
| Rate for Payer: Quartz Commercial |
$295.41
|
| Rate for Payer: Quartz Medicare Advantage |
$14.27
|
| Rate for Payer: The Alliance Commercial |
$57.08
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14.27
|
| Rate for Payer: United Healthcare PPO |
$340.86
|
| Rate for Payer: WEA Trust Commercial |
$249.96
|
| Rate for Payer: Wellcare Medicare |
$14.27
|
| Rate for Payer: WPS Commercial |
$336.62
|
|
|
Vitamin K
|
Professional
|
Both
|
$437.00
|
|
|
Service Code
|
CPT 84597
|
| Hospital Charge Code |
983438
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.27 |
| Max. Negotiated Rate |
$431.76 |
| Rate for Payer: Aetna Commercial |
$431.76
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$390.85
|
| Rate for Payer: Aetna Managed Medicare |
$14.27
|
| Rate for Payer: Anthem Medicare Advantage |
$14.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$14.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$14.27
|
| Rate for Payer: Cash Price |
$131.10
|
| Rate for Payer: Cash Price |
$131.10
|
| Rate for Payer: Cigna Commercial |
$431.76
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$227.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$14.27
|
| Rate for Payer: Health EOS Commercial |
$413.58
|
| Rate for Payer: HFN Commercial |
$431.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$50.37
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$50.37
|
| Rate for Payer: Independent Care Health Plan Medicare |
$14.27
|
| Rate for Payer: Multiplan Commercial |
$363.58
|
| Rate for Payer: NAPHCARE Commercial |
$21.40
|
| Rate for Payer: Preferred Network Access Commercial |
$431.76
|
| Rate for Payer: Quartz Beloit One Network |
$199.97
|
| Rate for Payer: Quartz Commercial |
$259.05
|
| Rate for Payer: Quartz Medicare Advantage |
$14.27
|
| Rate for Payer: The Alliance Commercial |
$56.36
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14.27
|
| Rate for Payer: WEA Trust Commercial |
$249.96
|
| Rate for Payer: WPS Commercial |
$62.78
|
|
