|
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 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
|
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 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 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
|
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
|
|
|
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 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 |
$16.66 |
| Max. Negotiated Rate |
$31.28 |
| Rate for Payer: Aetna Commercial |
$30.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$29.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$18.02
|
| Rate for Payer: Cash Price |
$10.20
|
| Rate for Payer: Cigna Commercial |
$31.28
|
| Rate for Payer: Health EOS Commercial |
$30.26
|
| Rate for Payer: HFN Commercial |
$31.28
|
| Rate for Payer: Multiplan Commercial |
$27.20
|
| Rate for Payer: NAPHCARE Commercial |
$20.40
|
| Rate for Payer: Preferred Network Access Commercial |
$31.28
|
| Rate for Payer: Quartz Beloit One Network |
$16.66
|
| Rate for Payer: Quartz Commercial |
$20.40
|
| Rate for Payer: WEA Trust Commercial |
$18.70
|
| Rate for Payer: WPS Commercial |
$25.18
|
|
|
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 |
$14.96 |
| Max. Negotiated Rate |
$104.49 |
| Rate for Payer: Aetna Commercial |
$32.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$29.24
|
| Rate for Payer: Cash Price |
$10.20
|
| Rate for Payer: Cash Price |
$10.20
|
| Rate for Payer: Cigna Commercial |
$32.30
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$17.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$20.40
|
| Rate for Payer: Health EOS Commercial |
$30.94
|
| Rate for Payer: HFN Commercial |
$32.30
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$104.49
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$104.49
|
| Rate for Payer: Multiplan Commercial |
$27.20
|
| Rate for Payer: Preferred Network Access Commercial |
$32.30
|
| Rate for Payer: Quartz Beloit One Network |
$14.96
|
| Rate for Payer: Quartz Commercial |
$19.38
|
| Rate for Payer: The Alliance Commercial |
$17.00
|
| Rate for Payer: WEA Trust Commercial |
$18.70
|
| Rate for Payer: WPS Commercial |
$25.18
|
|
|
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 |
$16.66 |
| Max. Negotiated Rate |
$118.40 |
| Rate for Payer: Aetna Commercial |
$30.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$29.24
|
| Rate for Payer: Aetna Managed Medicare |
$29.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$111.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$51.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$49.14
|
| Rate for Payer: Anthem Medicaid |
$30.59
|
| Rate for Payer: Anthem Medicare Advantage |
$29.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$18.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$29.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$29.60
|
| Rate for Payer: Cash Price |
$10.20
|
| Rate for Payer: Cash Price |
$10.20
|
| Rate for Payer: Cigna Commercial |
$31.28
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$29.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$30.59
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$19.03
|
| Rate for Payer: Dean Health Medicaid |
$30.59
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$29.60
|
| Rate for Payer: Health EOS Commercial |
$30.26
|
| Rate for Payer: HFN Commercial |
$31.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$110.11
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$29.60
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$30.59
|
| Rate for Payer: Independent Care Health Plan Medicare |
$29.60
|
| Rate for Payer: Managed Health Services Medicaid |
$31.81
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$29.60
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$29.60
|
| Rate for Payer: Multiplan Commercial |
$27.20
|
| Rate for Payer: NAPHCARE Commercial |
$44.40
|
| Rate for Payer: Preferred Network Access Commercial |
$31.28
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$30.59
|
| Rate for Payer: Quartz Beloit One Network |
$16.66
|
| Rate for Payer: Quartz Commercial |
$22.10
|
| Rate for Payer: Quartz Medicare Advantage |
$29.60
|
| Rate for Payer: The Alliance Commercial |
$118.40
|
| Rate for Payer: United Healthcare Medicaid |
$30.59
|
| Rate for Payer: United Healthcare Medicare Advantage |
$29.60
|
| Rate for Payer: United Healthcare PPO |
$25.50
|
| Rate for Payer: WEA Trust Commercial |
$18.70
|
| Rate for Payer: Wellcare Medicare |
$29.60
|
| Rate for Payer: WMAP Medicaid |
$30.59
|
| Rate for Payer: WPS Commercial |
$25.18
|
|
|
Vitamin D 25 Hydroxy Level
|
Facility
|
IP
|
$345.00
|
|
|
Service Code
|
CPT 82306
|
| Hospital Charge Code |
633872
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$169.05 |
| Max. Negotiated Rate |
$317.40 |
| Rate for Payer: Aetna Commercial |
$310.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$296.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$182.85
|
| Rate for Payer: Cash Price |
$103.50
|
| Rate for Payer: Cigna Commercial |
$317.40
|
| Rate for Payer: Health EOS Commercial |
$307.05
|
| Rate for Payer: HFN Commercial |
$317.40
|
| Rate for Payer: Multiplan Commercial |
$276.00
|
| Rate for Payer: NAPHCARE Commercial |
$207.00
|
| Rate for Payer: Preferred Network Access Commercial |
$317.40
|
| Rate for Payer: Quartz Beloit One Network |
$169.05
|
| Rate for Payer: Quartz Commercial |
$207.00
|
| Rate for Payer: WEA Trust Commercial |
$189.75
|
| Rate for Payer: WPS Commercial |
$255.54
|
|
|
Vitamin D 25 Hydroxy Level
|
Facility
|
OP
|
$345.00
|
|
|
Service Code
|
CPT 82306
|
| Hospital Charge Code |
633872
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$29.60 |
| Max. Negotiated Rate |
$317.40 |
| Rate for Payer: Aetna Commercial |
$310.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$296.70
|
| Rate for Payer: Aetna Managed Medicare |
$29.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$111.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$51.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$49.14
|
| Rate for Payer: Anthem Medicaid |
$30.59
|
| Rate for Payer: Anthem Medicare Advantage |
$29.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$182.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$29.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$29.60
|
| Rate for Payer: Cash Price |
$103.50
|
| Rate for Payer: Cash Price |
$103.50
|
| Rate for Payer: Cigna Commercial |
$317.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$29.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$30.59
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$193.06
|
| Rate for Payer: Dean Health Medicaid |
$30.59
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$29.60
|
| Rate for Payer: Health EOS Commercial |
$307.05
|
| Rate for Payer: HFN Commercial |
$317.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$110.11
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$29.60
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$30.59
|
| Rate for Payer: Independent Care Health Plan Medicare |
$29.60
|
| Rate for Payer: Managed Health Services Medicaid |
$31.81
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$29.60
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$29.60
|
| Rate for Payer: Multiplan Commercial |
$276.00
|
| Rate for Payer: NAPHCARE Commercial |
$44.40
|
| Rate for Payer: Preferred Network Access Commercial |
$317.40
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$30.59
|
| Rate for Payer: Quartz Beloit One Network |
$169.05
|
| Rate for Payer: Quartz Commercial |
$224.25
|
| Rate for Payer: Quartz Medicare Advantage |
$29.60
|
| Rate for Payer: The Alliance Commercial |
$118.40
|
| Rate for Payer: United Healthcare Medicaid |
$30.59
|
| Rate for Payer: United Healthcare Medicare Advantage |
$29.60
|
| Rate for Payer: United Healthcare PPO |
$258.75
|
| Rate for Payer: WEA Trust Commercial |
$189.75
|
| Rate for Payer: Wellcare Medicare |
$29.60
|
| Rate for Payer: WMAP Medicaid |
$30.59
|
| Rate for Payer: WPS Commercial |
$255.54
|
|
|
Vitamin D 25 Hydroxy Level
|
Professional
|
Both
|
$345.00
|
|
|
Service Code
|
CPT 82306
|
| Hospital Charge Code |
633872
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$104.49 |
| Max. Negotiated Rate |
$327.75 |
| Rate for Payer: Aetna Commercial |
$327.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$296.70
|
| Rate for Payer: Cash Price |
$103.50
|
| Rate for Payer: Cash Price |
$103.50
|
| Rate for Payer: Cigna Commercial |
$327.75
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$172.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$207.00
|
| Rate for Payer: Health EOS Commercial |
$313.95
|
| Rate for Payer: HFN Commercial |
$327.75
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$104.49
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$104.49
|
| Rate for Payer: Multiplan Commercial |
$276.00
|
| Rate for Payer: Preferred Network Access Commercial |
$327.75
|
| Rate for Payer: Quartz Beloit One Network |
$151.80
|
| Rate for Payer: Quartz Commercial |
$196.65
|
| Rate for Payer: The Alliance Commercial |
$172.50
|
| Rate for Payer: WEA Trust Commercial |
$189.75
|
| Rate for Payer: WPS Commercial |
$255.54
|
|
|
Vitamin E Beta/Gamma Tocopherol
|
Facility
|
IP
|
$118.00
|
|
|
Service Code
|
CPT 84591
|
| Hospital Charge Code |
2943024
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$57.82 |
| Max. Negotiated Rate |
$108.56 |
| Rate for Payer: Aetna Commercial |
$106.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$101.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$62.54
|
| Rate for Payer: Cash Price |
$35.40
|
| Rate for Payer: Cigna Commercial |
$108.56
|
| Rate for Payer: Health EOS Commercial |
$105.02
|
| Rate for Payer: HFN Commercial |
$108.56
|
| Rate for Payer: Multiplan Commercial |
$94.40
|
| Rate for Payer: NAPHCARE Commercial |
$70.80
|
| Rate for Payer: Preferred Network Access Commercial |
$108.56
|
| Rate for Payer: Quartz Beloit One Network |
$57.82
|
| Rate for Payer: Quartz Commercial |
$70.80
|
| Rate for Payer: WEA Trust Commercial |
$64.90
|
| Rate for Payer: WPS Commercial |
$87.40
|
|
|
Vitamin E Beta/Gamma Tocopherol
|
Professional
|
Both
|
$118.00
|
|
|
Service Code
|
CPT 84591
|
| Hospital Charge Code |
2943024
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$51.92 |
| Max. Negotiated Rate |
$112.10 |
| Rate for Payer: Aetna Commercial |
$112.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$101.48
|
| Rate for Payer: Cash Price |
$35.40
|
| Rate for Payer: Cash Price |
$35.40
|
| Rate for Payer: Cigna Commercial |
$112.10
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$59.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$70.80
|
| Rate for Payer: Health EOS Commercial |
$107.38
|
| Rate for Payer: HFN Commercial |
$112.10
|
| 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 |
$94.40
|
| Rate for Payer: Preferred Network Access Commercial |
$112.10
|
| Rate for Payer: Quartz Beloit One Network |
$51.92
|
| Rate for Payer: Quartz Commercial |
$67.26
|
| Rate for Payer: The Alliance Commercial |
$59.00
|
| Rate for Payer: WEA Trust Commercial |
$64.90
|
| Rate for Payer: WPS Commercial |
$87.40
|
|
|
Vitamin E Beta/Gamma Tocopherol
|
Facility
|
OP
|
$118.00
|
|
|
Service Code
|
CPT 84591
|
| Hospital Charge Code |
2943024
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$16.32 |
| Max. Negotiated Rate |
$108.56 |
| Rate for Payer: Aetna Commercial |
$106.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$101.48
|
| 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 |
$62.54
|
| 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 |
$35.40
|
| Rate for Payer: Cash Price |
$35.40
|
| Rate for Payer: Cigna Commercial |
$108.56
|
| 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 |
$66.03
|
| 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 |
$105.02
|
| Rate for Payer: HFN Commercial |
$108.56
|
| 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 |
$94.40
|
| Rate for Payer: NAPHCARE Commercial |
$25.59
|
| Rate for Payer: Preferred Network Access Commercial |
$108.56
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$16.32
|
| Rate for Payer: Quartz Beloit One Network |
$57.82
|
| Rate for Payer: Quartz Commercial |
$76.70
|
| 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 |
$88.50
|
| Rate for Payer: WEA Trust Commercial |
$64.90
|
| Rate for Payer: Wellcare Medicare |
$17.06
|
| Rate for Payer: WMAP Medicaid |
$16.32
|
| Rate for Payer: WPS Commercial |
$87.40
|
|
|
Vitamin E Level
|
Facility
|
IP
|
$191.00
|
|
|
Service Code
|
CPT 84446
|
| Hospital Charge Code |
978094
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$93.59 |
| Max. Negotiated Rate |
$175.72 |
| Rate for Payer: Aetna Commercial |
$171.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$164.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$101.23
|
| Rate for Payer: Cash Price |
$57.30
|
| Rate for Payer: Cigna Commercial |
$175.72
|
| Rate for Payer: Health EOS Commercial |
$169.99
|
| Rate for Payer: HFN Commercial |
$175.72
|
| Rate for Payer: Multiplan Commercial |
$152.80
|
| Rate for Payer: NAPHCARE Commercial |
$114.60
|
| Rate for Payer: Preferred Network Access Commercial |
$175.72
|
| Rate for Payer: Quartz Beloit One Network |
$93.59
|
| Rate for Payer: Quartz Commercial |
$114.60
|
| Rate for Payer: WEA Trust Commercial |
$105.05
|
| Rate for Payer: WPS Commercial |
$141.47
|
|
|
Vitamin E Level
|
Facility
|
OP
|
$191.00
|
|
|
Service Code
|
CPT 84446
|
| Hospital Charge Code |
978094
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.18 |
| Max. Negotiated Rate |
$175.72 |
| Rate for Payer: Aetna Commercial |
$171.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$164.26
|
| Rate for Payer: Aetna Managed Medicare |
$14.18
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$53.18
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$24.82
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$23.54
|
| Rate for Payer: Anthem Medicaid |
$14.65
|
| Rate for Payer: Anthem Medicare Advantage |
$14.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$101.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$14.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$14.18
|
| Rate for Payer: Cash Price |
$57.30
|
| Rate for Payer: Cash Price |
$57.30
|
| Rate for Payer: Cigna Commercial |
$175.72
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$14.18
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$14.65
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$106.88
|
| Rate for Payer: Dean Health Medicaid |
$14.65
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$14.18
|
| Rate for Payer: Health EOS Commercial |
$169.99
|
| Rate for Payer: HFN Commercial |
$175.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$52.75
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$14.18
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$14.65
|
| Rate for Payer: Independent Care Health Plan Medicare |
$14.18
|
| Rate for Payer: Managed Health Services Medicaid |
$15.24
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$14.18
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$14.18
|
| Rate for Payer: Multiplan Commercial |
$152.80
|
| Rate for Payer: NAPHCARE Commercial |
$21.27
|
| Rate for Payer: Preferred Network Access Commercial |
$175.72
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$14.65
|
| Rate for Payer: Quartz Beloit One Network |
$93.59
|
| Rate for Payer: Quartz Commercial |
$124.15
|
| Rate for Payer: Quartz Medicare Advantage |
$14.18
|
| Rate for Payer: The Alliance Commercial |
$56.72
|
| Rate for Payer: United Healthcare Medicaid |
$14.65
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14.18
|
| Rate for Payer: United Healthcare PPO |
$143.25
|
| Rate for Payer: WEA Trust Commercial |
$105.05
|
| Rate for Payer: Wellcare Medicare |
$14.18
|
| Rate for Payer: WMAP Medicaid |
$14.65
|
| Rate for Payer: WPS Commercial |
$141.47
|
|
|
Vitamin E Level
|
Professional
|
Both
|
$191.00
|
|
|
Service Code
|
CPT 84446
|
| Hospital Charge Code |
978094
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$50.06 |
| Max. Negotiated Rate |
$181.45 |
| Rate for Payer: Aetna Commercial |
$181.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$164.26
|
| Rate for Payer: Cash Price |
$57.30
|
| Rate for Payer: Cash Price |
$57.30
|
| Rate for Payer: Cigna Commercial |
$181.45
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$95.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$114.60
|
| Rate for Payer: Health EOS Commercial |
$173.81
|
| Rate for Payer: HFN Commercial |
$181.45
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$50.06
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$50.06
|
| Rate for Payer: Multiplan Commercial |
$152.80
|
| Rate for Payer: Preferred Network Access Commercial |
$181.45
|
| Rate for Payer: Quartz Beloit One Network |
$84.04
|
| Rate for Payer: Quartz Commercial |
$108.87
|
| Rate for Payer: The Alliance Commercial |
$95.50
|
| Rate for Payer: WEA Trust Commercial |
$105.05
|
| Rate for Payer: WPS Commercial |
$141.47
|
|
|
Vitamin K
|
Facility
|
OP
|
$437.00
|
|
|
Service Code
|
CPT 84597
|
| Hospital Charge Code |
983438
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.72 |
| Max. Negotiated Rate |
$402.04 |
| Rate for Payer: Aetna Commercial |
$393.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$375.82
|
| Rate for Payer: Aetna Managed Medicare |
$13.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$51.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$24.01
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$22.78
|
| Rate for Payer: Anthem Medicaid |
$14.18
|
| Rate for Payer: Anthem Medicare Advantage |
$13.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$231.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$13.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$13.72
|
| Rate for Payer: Cash Price |
$131.10
|
| Rate for Payer: Cash Price |
$131.10
|
| Rate for Payer: Cigna Commercial |
$402.04
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$13.72
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$14.18
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$244.55
|
| Rate for Payer: Dean Health Medicaid |
$14.18
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$13.72
|
| Rate for Payer: Health EOS Commercial |
$388.93
|
| Rate for Payer: HFN Commercial |
$402.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$51.04
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$13.72
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$14.18
|
| Rate for Payer: Independent Care Health Plan Medicare |
$13.72
|
| Rate for Payer: Managed Health Services Medicaid |
$14.75
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$13.72
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$13.72
|
| Rate for Payer: Multiplan Commercial |
$349.60
|
| Rate for Payer: NAPHCARE Commercial |
$20.58
|
| Rate for Payer: Preferred Network Access Commercial |
$402.04
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$14.18
|
| Rate for Payer: Quartz Beloit One Network |
$214.13
|
| Rate for Payer: Quartz Commercial |
$284.05
|
| Rate for Payer: Quartz Medicare Advantage |
$13.72
|
| Rate for Payer: The Alliance Commercial |
$54.88
|
| Rate for Payer: United Healthcare Medicaid |
$14.18
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.72
|
| Rate for Payer: United Healthcare PPO |
$327.75
|
| Rate for Payer: WEA Trust Commercial |
$240.35
|
| Rate for Payer: Wellcare Medicare |
$13.72
|
| Rate for Payer: WMAP Medicaid |
$14.18
|
| Rate for Payer: WPS Commercial |
$323.69
|
|
|
Vitamin K
|
Facility
|
IP
|
$437.00
|
|
|
Service Code
|
CPT 84597
|
| Hospital Charge Code |
983438
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$214.13 |
| Max. Negotiated Rate |
$402.04 |
| Rate for Payer: Aetna Commercial |
$393.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$375.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$231.61
|
| Rate for Payer: Cash Price |
$131.10
|
| Rate for Payer: Cigna Commercial |
$402.04
|
| Rate for Payer: Health EOS Commercial |
$388.93
|
| Rate for Payer: HFN Commercial |
$402.04
|
| Rate for Payer: Multiplan Commercial |
$349.60
|
| Rate for Payer: NAPHCARE Commercial |
$262.20
|
| Rate for Payer: Preferred Network Access Commercial |
$402.04
|
| Rate for Payer: Quartz Beloit One Network |
$214.13
|
| Rate for Payer: Quartz Commercial |
$262.20
|
| Rate for Payer: WEA Trust Commercial |
$240.35
|
| Rate for Payer: WPS Commercial |
$323.69
|
|
|
Vitamin K
|
Professional
|
Both
|
$437.00
|
|
|
Service Code
|
CPT 84597
|
| Hospital Charge Code |
983438
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$48.43 |
| Max. Negotiated Rate |
$415.15 |
| Rate for Payer: Aetna Commercial |
$415.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$375.82
|
| Rate for Payer: Cash Price |
$131.10
|
| Rate for Payer: Cash Price |
$131.10
|
| Rate for Payer: Cigna Commercial |
$415.15
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$218.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$262.20
|
| Rate for Payer: Health EOS Commercial |
$397.67
|
| Rate for Payer: HFN Commercial |
$415.15
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$48.43
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$48.43
|
| Rate for Payer: Multiplan Commercial |
$349.60
|
| Rate for Payer: Preferred Network Access Commercial |
$415.15
|
| Rate for Payer: Quartz Beloit One Network |
$192.28
|
| Rate for Payer: Quartz Commercial |
$249.09
|
| Rate for Payer: The Alliance Commercial |
$218.50
|
| Rate for Payer: WEA Trust Commercial |
$240.35
|
| Rate for Payer: WPS Commercial |
$323.69
|
|
|
Vitamin K 1 mg Charge
|
Facility
|
OP
|
$7.00
|
|
|
Service Code
|
HCPCS J3430
|
| Hospital Charge Code |
2958928
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.96 |
| Max. Negotiated Rate |
$28.00 |
| Rate for Payer: Aetna Commercial |
$6.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6.02
|
| Rate for Payer: Aetna Managed Medicare |
$1.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3.71
|
| Rate for Payer: Cash Price |
$2.10
|
| Rate for Payer: Cash Price |
$2.10
|
| Rate for Payer: Cigna Commercial |
$6.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3.71
|
| Rate for Payer: Health EOS Commercial |
$6.23
|
| Rate for Payer: HFN Commercial |
$6.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5.25
|
| Rate for Payer: Multiplan Commercial |
$5.60
|
| Rate for Payer: NAPHCARE Commercial |
$4.20
|
| Rate for Payer: Preferred Network Access Commercial |
$6.44
|
| Rate for Payer: Quartz Beloit One Network |
$3.43
|
| Rate for Payer: Quartz Commercial |
$4.55
|
| Rate for Payer: Quartz Medicare Advantage |
$4.20
|
| Rate for Payer: The Alliance Commercial |
$28.00
|
| Rate for Payer: WEA Trust Commercial |
$3.85
|
| Rate for Payer: WPS Commercial |
$7.01
|
|
|
Vitamin K 1 mg Charge
|
Professional
|
Both
|
$7.00
|
|
|
Service Code
|
HCPCS J3430
|
| Hospital Charge Code |
2958928
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.80 |
| Max. Negotiated Rate |
$7.01 |
| Rate for Payer: Aetna Commercial |
$6.65
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6.02
|
| Rate for Payer: Cash Price |
$2.10
|
| Rate for Payer: Cash Price |
$2.10
|
| Rate for Payer: Cigna Commercial |
$6.65
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2.80
|
| Rate for Payer: Health EOS Commercial |
$6.37
|
| Rate for Payer: HFN Commercial |
$6.65
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5.46
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$5.46
|
| Rate for Payer: Multiplan Commercial |
$5.60
|
| Rate for Payer: Preferred Network Access Commercial |
$6.65
|
| Rate for Payer: Quartz Beloit One Network |
$3.08
|
| Rate for Payer: Quartz Commercial |
$3.99
|
| Rate for Payer: The Alliance Commercial |
$3.50
|
| Rate for Payer: United Healthcare Medicaid |
$2.80
|
| Rate for Payer: WEA Trust Commercial |
$3.85
|
| Rate for Payer: WPS Commercial |
$7.01
|
|
|
Vitamin K 1 mg Charge
|
Facility
|
IP
|
$7.00
|
|
|
Service Code
|
HCPCS J3430
|
| Hospital Charge Code |
2958928
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.43 |
| Max. Negotiated Rate |
$6.44 |
| Rate for Payer: Aetna Commercial |
$6.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3.71
|
| Rate for Payer: Cash Price |
$2.10
|
| Rate for Payer: Cigna Commercial |
$6.44
|
| Rate for Payer: Health EOS Commercial |
$6.23
|
| Rate for Payer: HFN Commercial |
$6.44
|
| Rate for Payer: Multiplan Commercial |
$5.60
|
| Rate for Payer: NAPHCARE Commercial |
$4.20
|
| Rate for Payer: Preferred Network Access Commercial |
$6.44
|
| Rate for Payer: Quartz Beloit One Network |
$3.43
|
| Rate for Payer: Quartz Commercial |
$4.20
|
| Rate for Payer: WEA Trust Commercial |
$3.85
|
| Rate for Payer: WPS Commercial |
$5.18
|
|
