|
Visual Reinforcement Audiometry
|
Professional
|
Both
|
$83.00
|
|
|
Service Code
|
CPT 92579
|
| Hospital Charge Code |
1188814
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$30.39 |
| Max. Negotiated Rate |
$135.83 |
| Rate for Payer: Aetna Commercial |
$82.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$74.24
|
| Rate for Payer: Aetna Managed Medicare |
$30.39
|
| Rate for Payer: Anthem Medicare Advantage |
$30.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$30.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$30.39
|
| Rate for Payer: Cash Price |
$24.90
|
| Rate for Payer: Cash Price |
$24.90
|
| Rate for Payer: Cigna Commercial |
$82.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$43.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$30.39
|
| Rate for Payer: Health EOS Commercial |
$78.55
|
| Rate for Payer: HFN Commercial |
$82.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$135.83
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$135.83
|
| Rate for Payer: Independent Care Health Plan Medicare |
$30.39
|
| Rate for Payer: Multiplan Commercial |
$69.06
|
| Rate for Payer: NAPHCARE Commercial |
$45.58
|
| Rate for Payer: Preferred Network Access Commercial |
$82.00
|
| Rate for Payer: Quartz Beloit One Network |
$37.98
|
| Rate for Payer: Quartz Commercial |
$49.20
|
| Rate for Payer: Quartz Medicare Advantage |
$30.39
|
| Rate for Payer: The Alliance Commercial |
$75.97
|
| Rate for Payer: United Healthcare Medicare Advantage |
$30.39
|
| Rate for Payer: WEA Trust Commercial |
$47.48
|
| Rate for Payer: WPS Commercial |
$121.56
|
|
|
Visual Reinforcement Audiometry
|
Facility
|
OP
|
$83.00
|
|
|
Service Code
|
CPT 92579
|
| Hospital Charge Code |
1188814
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$41.43 |
| Max. Negotiated Rate |
$908.96 |
| Rate for Payer: Aetna Commercial |
$77.69
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$74.24
|
| Rate for Payer: Aetna Managed Medicare |
$227.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$56.11
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$43.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$41.43
|
| Rate for Payer: Anthem Medicare Advantage |
$227.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$45.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$227.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$227.24
|
| Rate for Payer: Cash Price |
$24.90
|
| Rate for Payer: Cash Price |
$24.90
|
| Rate for Payer: Cigna Commercial |
$79.41
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$227.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$48.31
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$227.24
|
| Rate for Payer: Health EOS Commercial |
$76.82
|
| Rate for Payer: HFN Commercial |
$79.41
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$845.33
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$227.24
|
| Rate for Payer: Independent Care Health Plan Medicare |
$227.24
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$227.24
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$227.24
|
| Rate for Payer: Multiplan Commercial |
$69.06
|
| Rate for Payer: NAPHCARE Commercial |
$340.86
|
| Rate for Payer: Preferred Network Access Commercial |
$79.41
|
| Rate for Payer: Quartz Beloit One Network |
$42.30
|
| Rate for Payer: Quartz Commercial |
$56.11
|
| Rate for Payer: Quartz Medicare Advantage |
$227.24
|
| Rate for Payer: The Alliance Commercial |
$908.96
|
| Rate for Payer: United Healthcare Medicare Advantage |
$227.24
|
| Rate for Payer: WEA Trust Commercial |
$47.48
|
| Rate for Payer: Wellcare Medicare |
$227.24
|
| Rate for Payer: WPS Commercial |
$63.93
|
|
|
Visual Reinforcement Audiometry
|
Facility
|
IP
|
$83.00
|
|
|
Service Code
|
CPT 92579
|
| Hospital Charge Code |
1188814
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$42.30 |
| Max. Negotiated Rate |
$79.41 |
| Rate for Payer: Aetna Commercial |
$77.69
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$74.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$45.75
|
| Rate for Payer: Cash Price |
$24.90
|
| Rate for Payer: Cigna Commercial |
$79.41
|
| Rate for Payer: Health EOS Commercial |
$76.82
|
| Rate for Payer: HFN Commercial |
$79.41
|
| Rate for Payer: Multiplan Commercial |
$69.06
|
| Rate for Payer: Preferred Network Access Commercial |
$79.41
|
| Rate for Payer: Quartz Beloit One Network |
$42.30
|
| Rate for Payer: Quartz Commercial |
$51.79
|
| Rate for Payer: WEA Trust Commercial |
$47.48
|
| Rate for Payer: WPS Commercial |
$63.93
|
|
|
Visual Reinforcement Audiomety
|
Professional
|
Both
|
$83.00
|
|
|
Service Code
|
CPT 92579
|
| Hospital Charge Code |
3203506
|
|
Hospital Revenue Code
|
470
|
| Min. Negotiated Rate |
$30.39 |
| Max. Negotiated Rate |
$135.83 |
| Rate for Payer: Aetna Commercial |
$82.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$74.24
|
| Rate for Payer: Aetna Managed Medicare |
$30.39
|
| Rate for Payer: Anthem Medicare Advantage |
$30.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$30.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$30.39
|
| Rate for Payer: Cash Price |
$24.90
|
| Rate for Payer: Cash Price |
$24.90
|
| Rate for Payer: Cigna Commercial |
$82.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$43.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$30.39
|
| Rate for Payer: Health EOS Commercial |
$78.55
|
| Rate for Payer: HFN Commercial |
$82.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$135.83
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$135.83
|
| Rate for Payer: Independent Care Health Plan Medicare |
$30.39
|
| Rate for Payer: Multiplan Commercial |
$69.06
|
| Rate for Payer: NAPHCARE Commercial |
$45.58
|
| Rate for Payer: Preferred Network Access Commercial |
$82.00
|
| Rate for Payer: Quartz Beloit One Network |
$37.98
|
| Rate for Payer: Quartz Commercial |
$49.20
|
| Rate for Payer: Quartz Medicare Advantage |
$30.39
|
| Rate for Payer: The Alliance Commercial |
$75.97
|
| Rate for Payer: United Healthcare Medicare Advantage |
$30.39
|
| Rate for Payer: WEA Trust Commercial |
$47.48
|
| Rate for Payer: WPS Commercial |
$121.56
|
|
|
Visual Reinforcement Audiomety
|
Facility
|
OP
|
$83.00
|
|
|
Service Code
|
CPT 92579
|
| Hospital Charge Code |
3203506
|
|
Hospital Revenue Code
|
470
|
| Min. Negotiated Rate |
$41.43 |
| Max. Negotiated Rate |
$908.96 |
| Rate for Payer: Aetna Commercial |
$77.69
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$74.24
|
| Rate for Payer: Aetna Managed Medicare |
$227.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$56.11
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$43.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$41.43
|
| Rate for Payer: Anthem Medicare Advantage |
$227.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$45.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$227.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$227.24
|
| Rate for Payer: Cash Price |
$24.90
|
| Rate for Payer: Cash Price |
$24.90
|
| Rate for Payer: Cigna Commercial |
$79.41
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$227.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$48.31
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$227.24
|
| Rate for Payer: Health EOS Commercial |
$76.82
|
| Rate for Payer: HFN Commercial |
$79.41
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$845.33
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$227.24
|
| Rate for Payer: Independent Care Health Plan Medicare |
$227.24
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$227.24
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$227.24
|
| Rate for Payer: Multiplan Commercial |
$69.06
|
| Rate for Payer: NAPHCARE Commercial |
$340.86
|
| Rate for Payer: Preferred Network Access Commercial |
$79.41
|
| Rate for Payer: Quartz Beloit One Network |
$42.30
|
| Rate for Payer: Quartz Commercial |
$56.11
|
| Rate for Payer: Quartz Medicare Advantage |
$227.24
|
| Rate for Payer: The Alliance Commercial |
$908.96
|
| Rate for Payer: United Healthcare Medicare Advantage |
$227.24
|
| Rate for Payer: United Healthcare PPO |
$64.74
|
| Rate for Payer: WEA Trust Commercial |
$47.48
|
| Rate for Payer: Wellcare Medicare |
$227.24
|
| Rate for Payer: WPS Commercial |
$63.93
|
|
|
Visual Reinforcement Audiomety
|
Facility
|
IP
|
$83.00
|
|
|
Service Code
|
CPT 92579
|
| Hospital Charge Code |
3203506
|
|
Hospital Revenue Code
|
470
|
| Min. Negotiated Rate |
$42.30 |
| Max. Negotiated Rate |
$79.41 |
| Rate for Payer: Aetna Commercial |
$77.69
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$74.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$45.75
|
| Rate for Payer: Cash Price |
$24.90
|
| Rate for Payer: Cigna Commercial |
$79.41
|
| Rate for Payer: Health EOS Commercial |
$76.82
|
| Rate for Payer: HFN Commercial |
$79.41
|
| Rate for Payer: Multiplan Commercial |
$69.06
|
| Rate for Payer: Preferred Network Access Commercial |
$79.41
|
| Rate for Payer: Quartz Beloit One Network |
$42.30
|
| Rate for Payer: Quartz Commercial |
$51.79
|
| Rate for Payer: WEA Trust Commercial |
$47.48
|
| Rate for Payer: WPS Commercial |
$63.93
|
|
|
Vital 1.0
|
Facility
|
OP
|
$77.00
|
|
|
Service Code
|
HCPCS B4153
|
| Hospital Charge Code |
3031455
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$22.42 |
| Max. Negotiated Rate |
$73.67 |
| Rate for Payer: Aetna Commercial |
$72.07
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$68.87
|
| Rate for Payer: Aetna Managed Medicare |
$22.42
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$52.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$40.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$38.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$42.44
|
| Rate for Payer: Cash Price |
$23.10
|
| Rate for Payer: Cigna Commercial |
$73.67
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$44.81
|
| Rate for Payer: Health EOS Commercial |
$71.27
|
| Rate for Payer: HFN Commercial |
$73.67
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$60.06
|
| Rate for Payer: Multiplan Commercial |
$64.06
|
| Rate for Payer: NAPHCARE Commercial |
$48.05
|
| Rate for Payer: Preferred Network Access Commercial |
$73.67
|
| Rate for Payer: Quartz Beloit One Network |
$39.24
|
| Rate for Payer: Quartz Commercial |
$52.05
|
| Rate for Payer: Quartz Medicare Advantage |
$48.05
|
| Rate for Payer: The Alliance Commercial |
$40.04
|
| Rate for Payer: WEA Trust Commercial |
$44.04
|
| Rate for Payer: WPS Commercial |
$59.31
|
|
|
Vital 1.0
|
Facility
|
IP
|
$77.00
|
|
|
Service Code
|
HCPCS B4153
|
| Hospital Charge Code |
3031455
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$39.24 |
| Max. Negotiated Rate |
$73.67 |
| Rate for Payer: Aetna Commercial |
$72.07
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$68.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$42.44
|
| Rate for Payer: Cash Price |
$23.10
|
| Rate for Payer: Cigna Commercial |
$73.67
|
| Rate for Payer: Health EOS Commercial |
$71.27
|
| Rate for Payer: HFN Commercial |
$73.67
|
| Rate for Payer: Multiplan Commercial |
$64.06
|
| Rate for Payer: Preferred Network Access Commercial |
$73.67
|
| Rate for Payer: Quartz Beloit One Network |
$39.24
|
| Rate for Payer: Quartz Commercial |
$48.05
|
| Rate for Payer: WEA Trust Commercial |
$44.04
|
| Rate for Payer: WPS Commercial |
$59.31
|
|
|
VITAL CAPACITY TEST 94150
|
Professional
|
Both
|
$22.00
|
|
|
Service Code
|
CPT 94150
|
| Hospital Charge Code |
3015454
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$10.07 |
| Max. Negotiated Rate |
$86.98 |
| Rate for Payer: Aetna Commercial |
$21.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$19.68
|
| Rate for Payer: Cash Price |
$6.60
|
| Rate for Payer: Cash Price |
$6.60
|
| Rate for Payer: Cigna Commercial |
$21.74
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$19.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$13.73
|
| Rate for Payer: Health EOS Commercial |
$20.82
|
| Rate for Payer: HFN Commercial |
$21.74
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$86.98
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$86.98
|
| Rate for Payer: Multiplan Commercial |
$18.30
|
| Rate for Payer: Preferred Network Access Commercial |
$21.74
|
| Rate for Payer: Quartz Beloit One Network |
$10.07
|
| Rate for Payer: Quartz Commercial |
$13.04
|
| Rate for Payer: The Alliance Commercial |
$11.44
|
| Rate for Payer: United Healthcare Medicaid |
$19.92
|
| Rate for Payer: WEA Trust Commercial |
$12.58
|
| Rate for Payer: WPS Commercial |
$16.95
|
|
|
Vital Signs Monitor Dymap
|
Facility
|
OP
|
$371.00
|
|
| Hospital Charge Code |
3101752
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$108.04 |
| Max. Negotiated Rate |
$354.97 |
| Rate for Payer: Aetna Commercial |
$347.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$331.82
|
| Rate for Payer: Aetna Managed Medicare |
$108.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$250.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$192.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$185.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$204.50
|
| Rate for Payer: Cash Price |
$111.30
|
| Rate for Payer: Cigna Commercial |
$354.97
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$215.92
|
| Rate for Payer: Health EOS Commercial |
$343.40
|
| Rate for Payer: HFN Commercial |
$354.97
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$289.38
|
| Rate for Payer: Multiplan Commercial |
$308.67
|
| Rate for Payer: NAPHCARE Commercial |
$231.50
|
| Rate for Payer: Preferred Network Access Commercial |
$354.97
|
| Rate for Payer: Quartz Beloit One Network |
$189.06
|
| Rate for Payer: Quartz Commercial |
$250.80
|
| Rate for Payer: Quartz Medicare Advantage |
$231.50
|
| Rate for Payer: The Alliance Commercial |
$192.92
|
| Rate for Payer: WEA Trust Commercial |
$212.21
|
| Rate for Payer: WPS Commercial |
$285.78
|
|
|
Vital Signs Monitor Dymap
|
Facility
|
IP
|
$371.00
|
|
| Hospital Charge Code |
3101752
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$189.06 |
| Max. Negotiated Rate |
$354.97 |
| Rate for Payer: Aetna Commercial |
$347.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$331.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$204.50
|
| Rate for Payer: Cash Price |
$111.30
|
| Rate for Payer: Cigna Commercial |
$354.97
|
| Rate for Payer: Health EOS Commercial |
$343.40
|
| Rate for Payer: HFN Commercial |
$354.97
|
| Rate for Payer: Multiplan Commercial |
$308.67
|
| Rate for Payer: Preferred Network Access Commercial |
$354.97
|
| Rate for Payer: Quartz Beloit One Network |
$189.06
|
| Rate for Payer: Quartz Commercial |
$231.50
|
| Rate for Payer: WEA Trust Commercial |
$212.21
|
| Rate for Payer: WPS Commercial |
$285.78
|
|
|
Vitamin A Level
|
Professional
|
Both
|
$219.00
|
|
|
Service Code
|
CPT 84590
|
| Hospital Charge Code |
978090
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.07 |
| Max. Negotiated Rate |
$216.37 |
| Rate for Payer: Aetna Commercial |
$216.37
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$195.87
|
| Rate for Payer: Aetna Managed Medicare |
$12.07
|
| Rate for Payer: Anthem Medicare Advantage |
$12.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$12.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$12.07
|
| Rate for Payer: Cash Price |
$65.70
|
| Rate for Payer: Cash Price |
$65.70
|
| Rate for Payer: Cigna Commercial |
$216.37
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$113.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12.07
|
| Rate for Payer: Health EOS Commercial |
$207.26
|
| Rate for Payer: HFN Commercial |
$216.37
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$42.62
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$42.62
|
| Rate for Payer: Independent Care Health Plan Medicare |
$12.07
|
| Rate for Payer: Multiplan Commercial |
$182.21
|
| Rate for Payer: NAPHCARE Commercial |
$18.11
|
| Rate for Payer: Preferred Network Access Commercial |
$216.37
|
| Rate for Payer: Quartz Beloit One Network |
$100.21
|
| Rate for Payer: Quartz Commercial |
$129.82
|
| Rate for Payer: Quartz Medicare Advantage |
$12.07
|
| Rate for Payer: The Alliance Commercial |
$47.69
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.07
|
| Rate for Payer: WEA Trust Commercial |
$125.27
|
| Rate for Payer: WPS Commercial |
$53.13
|
|
|
Vitamin A Level
|
Facility
|
IP
|
$219.00
|
|
|
Service Code
|
CPT 84590
|
| Hospital Charge Code |
978090
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$111.60 |
| Max. Negotiated Rate |
$209.54 |
| Rate for Payer: Aetna Commercial |
$204.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$195.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$120.71
|
| Rate for Payer: Cash Price |
$65.70
|
| Rate for Payer: Cigna Commercial |
$209.54
|
| Rate for Payer: Health EOS Commercial |
$202.71
|
| Rate for Payer: HFN Commercial |
$209.54
|
| Rate for Payer: Multiplan Commercial |
$182.21
|
| Rate for Payer: Preferred Network Access Commercial |
$209.54
|
| Rate for Payer: Quartz Beloit One Network |
$111.60
|
| Rate for Payer: Quartz Commercial |
$136.66
|
| Rate for Payer: WEA Trust Commercial |
$125.27
|
| Rate for Payer: WPS Commercial |
$168.70
|
|
|
Vitamin A Level
|
Facility
|
OP
|
$219.00
|
|
|
Service Code
|
CPT 84590
|
| Hospital Charge Code |
978090
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.07 |
| Max. Negotiated Rate |
$209.54 |
| Rate for Payer: Aetna Commercial |
$204.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$195.87
|
| Rate for Payer: Aetna Managed Medicare |
$12.07
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$45.28
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$21.13
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$20.04
|
| Rate for Payer: Anthem Medicare Advantage |
$12.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$120.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$12.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$12.07
|
| Rate for Payer: Cash Price |
$65.70
|
| Rate for Payer: Cash Price |
$65.70
|
| Rate for Payer: Cigna Commercial |
$209.54
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$12.07
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$127.46
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$12.07
|
| Rate for Payer: Health EOS Commercial |
$202.71
|
| Rate for Payer: HFN Commercial |
$209.54
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$44.92
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$12.07
|
| Rate for Payer: Independent Care Health Plan Medicare |
$12.07
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$12.07
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$12.07
|
| Rate for Payer: Multiplan Commercial |
$182.21
|
| Rate for Payer: NAPHCARE Commercial |
$18.11
|
| Rate for Payer: Preferred Network Access Commercial |
$209.54
|
| Rate for Payer: Quartz Beloit One Network |
$111.60
|
| Rate for Payer: Quartz Commercial |
$148.04
|
| Rate for Payer: Quartz Medicare Advantage |
$12.07
|
| Rate for Payer: The Alliance Commercial |
$48.30
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.07
|
| Rate for Payer: United Healthcare PPO |
$170.82
|
| Rate for Payer: WEA Trust Commercial |
$125.27
|
| Rate for Payer: Wellcare Medicare |
$12.07
|
| Rate for Payer: WPS Commercial |
$168.70
|
|
|
Vitamin B12 Binding Capacity
|
Facility
|
OP
|
$302.00
|
|
|
Service Code
|
CPT 82608
|
| Hospital Charge Code |
983436
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.89 |
| Max. Negotiated Rate |
$288.95 |
| Rate for Payer: Aetna Commercial |
$282.67
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$270.11
|
| Rate for Payer: Aetna Managed Medicare |
$14.89
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$55.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$26.06
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$24.72
|
| Rate for Payer: Anthem Medicare Advantage |
$14.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$166.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$14.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$14.89
|
| Rate for Payer: Cash Price |
$90.60
|
| Rate for Payer: Cash Price |
$90.60
|
| Rate for Payer: Cigna Commercial |
$288.95
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$14.89
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$175.76
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$14.89
|
| Rate for Payer: Health EOS Commercial |
$279.53
|
| Rate for Payer: HFN Commercial |
$288.95
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$55.40
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$14.89
|
| Rate for Payer: Independent Care Health Plan Medicare |
$14.89
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$14.89
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$14.89
|
| Rate for Payer: Multiplan Commercial |
$251.26
|
| Rate for Payer: NAPHCARE Commercial |
$22.34
|
| Rate for Payer: Preferred Network Access Commercial |
$288.95
|
| Rate for Payer: Quartz Beloit One Network |
$153.90
|
| Rate for Payer: Quartz Commercial |
$204.15
|
| Rate for Payer: Quartz Medicare Advantage |
$14.89
|
| Rate for Payer: The Alliance Commercial |
$59.57
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14.89
|
| Rate for Payer: United Healthcare PPO |
$235.56
|
| Rate for Payer: WEA Trust Commercial |
$172.74
|
| Rate for Payer: Wellcare Medicare |
$14.89
|
| Rate for Payer: WPS Commercial |
$232.63
|
|
|
Vitamin B12 Binding Capacity
|
Facility
|
IP
|
$302.00
|
|
|
Service Code
|
CPT 82608
|
| Hospital Charge Code |
983436
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$153.90 |
| Max. Negotiated Rate |
$288.95 |
| Rate for Payer: Aetna Commercial |
$282.67
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$270.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$166.46
|
| Rate for Payer: Cash Price |
$90.60
|
| Rate for Payer: Cigna Commercial |
$288.95
|
| Rate for Payer: Health EOS Commercial |
$279.53
|
| Rate for Payer: HFN Commercial |
$288.95
|
| Rate for Payer: Multiplan Commercial |
$251.26
|
| Rate for Payer: Preferred Network Access Commercial |
$288.95
|
| Rate for Payer: Quartz Beloit One Network |
$153.90
|
| Rate for Payer: Quartz Commercial |
$188.45
|
| Rate for Payer: WEA Trust Commercial |
$172.74
|
| Rate for Payer: WPS Commercial |
$232.63
|
|
|
Vitamin B12 Binding Capacity
|
Professional
|
Both
|
$302.00
|
|
|
Service Code
|
CPT 82608
|
| Hospital Charge Code |
983436
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.89 |
| Max. Negotiated Rate |
$298.38 |
| Rate for Payer: Aetna Commercial |
$298.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$270.11
|
| Rate for Payer: Aetna Managed Medicare |
$14.89
|
| Rate for Payer: Anthem Medicare Advantage |
$14.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$14.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$14.89
|
| Rate for Payer: Cash Price |
$90.60
|
| Rate for Payer: Cash Price |
$90.60
|
| Rate for Payer: Cigna Commercial |
$298.38
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$157.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$14.89
|
| Rate for Payer: Health EOS Commercial |
$285.81
|
| Rate for Payer: HFN Commercial |
$298.38
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$52.57
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$52.57
|
| Rate for Payer: Independent Care Health Plan Medicare |
$14.89
|
| Rate for Payer: Multiplan Commercial |
$251.26
|
| Rate for Payer: NAPHCARE Commercial |
$22.34
|
| Rate for Payer: Preferred Network Access Commercial |
$298.38
|
| Rate for Payer: Quartz Beloit One Network |
$138.20
|
| Rate for Payer: Quartz Commercial |
$179.03
|
| Rate for Payer: Quartz Medicare Advantage |
$14.89
|
| Rate for Payer: The Alliance Commercial |
$58.83
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14.89
|
| Rate for Payer: WEA Trust Commercial |
$172.74
|
| Rate for Payer: WPS Commercial |
$65.53
|
|
|
Vitamin b12 inj 1000 mg J3420 man
|
Facility
|
IP
|
$9.00
|
|
|
Service Code
|
HCPCS J3420
|
| Hospital Charge Code |
3373556
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.59 |
| Max. Negotiated Rate |
$8.61 |
| Rate for Payer: Aetna Commercial |
$8.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4.96
|
| Rate for Payer: Cash Price |
$2.70
|
| Rate for Payer: Cigna Commercial |
$8.61
|
| Rate for Payer: Health EOS Commercial |
$8.33
|
| Rate for Payer: HFN Commercial |
$8.61
|
| Rate for Payer: Multiplan Commercial |
$7.49
|
| Rate for Payer: Preferred Network Access Commercial |
$8.61
|
| Rate for Payer: Quartz Beloit One Network |
$4.59
|
| Rate for Payer: Quartz Commercial |
$5.62
|
| Rate for Payer: WEA Trust Commercial |
$5.15
|
| Rate for Payer: WPS Commercial |
$6.93
|
|
|
Vitamin b12 inj 1000 mg J3420 man
|
Facility
|
OP
|
$9.00
|
|
|
Service Code
|
HCPCS J3420
|
| Hospital Charge Code |
3373556
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.96 |
| Max. Negotiated Rate |
$8.61 |
| Rate for Payer: Aetna Commercial |
$8.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8.05
|
| Rate for Payer: Aetna Managed Medicare |
$2.62
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6.08
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4.96
|
| Rate for Payer: Cash Price |
$2.70
|
| Rate for Payer: Cash Price |
$2.70
|
| Rate for Payer: Cigna Commercial |
$8.61
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1.96
|
| Rate for Payer: Health EOS Commercial |
$8.33
|
| Rate for Payer: HFN Commercial |
$8.61
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7.02
|
| Rate for Payer: Multiplan Commercial |
$7.49
|
| Rate for Payer: NAPHCARE Commercial |
$5.62
|
| Rate for Payer: Preferred Network Access Commercial |
$8.61
|
| Rate for Payer: Quartz Beloit One Network |
$4.59
|
| Rate for Payer: Quartz Commercial |
$6.08
|
| Rate for Payer: Quartz Medicare Advantage |
$5.62
|
| Rate for Payer: The Alliance Commercial |
$2.83
|
| Rate for Payer: WEA Trust Commercial |
$5.15
|
| Rate for Payer: WPS Commercial |
$3.70
|
|
|
Vitamin b12 inj 1000 mg J3420 man
|
Professional
|
Both
|
$9.00
|
|
|
Service Code
|
HCPCS J3420
|
| Hospital Charge Code |
3373556
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.67 |
| Max. Negotiated Rate |
$8.89 |
| Rate for Payer: Aetna Commercial |
$8.89
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8.05
|
| Rate for Payer: Aetna Managed Medicare |
$0.71
|
| Rate for Payer: Anthem Medicare Advantage |
$0.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$0.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$0.71
|
| Rate for Payer: Cash Price |
$2.70
|
| Rate for Payer: Cash Price |
$2.70
|
| Rate for Payer: Cigna Commercial |
$8.89
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$0.67
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1.48
|
| Rate for Payer: Health EOS Commercial |
$8.52
|
| Rate for Payer: HFN Commercial |
$8.89
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3.03
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$3.03
|
| Rate for Payer: Independent Care Health Plan Medicare |
$0.71
|
| Rate for Payer: Multiplan Commercial |
$7.49
|
| Rate for Payer: NAPHCARE Commercial |
$1.06
|
| Rate for Payer: Preferred Network Access Commercial |
$8.89
|
| Rate for Payer: Quartz Beloit One Network |
$4.12
|
| Rate for Payer: Quartz Commercial |
$5.34
|
| Rate for Payer: Quartz Medicare Advantage |
$0.71
|
| Rate for Payer: The Alliance Commercial |
$1.94
|
| Rate for Payer: United Healthcare Medicaid |
$0.67
|
| Rate for Payer: United Healthcare Medicare Advantage |
$0.71
|
| Rate for Payer: WEA Trust Commercial |
$5.15
|
| Rate for Payer: WPS Commercial |
$3.70
|
|
|
Vitamin B12 Level
|
Professional
|
Both
|
$216.00
|
|
|
Service Code
|
CPT 82607
|
| Hospital Charge Code |
633871
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.68 |
| Max. Negotiated Rate |
$213.41 |
| Rate for Payer: Dean Health DHI/DHP/ASO |
$15.68
|
| Rate for Payer: Aetna Commercial |
$213.41
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$193.19
|
| Rate for Payer: Aetna Managed Medicare |
$15.68
|
| Rate for Payer: Anthem Medicare Advantage |
$15.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$15.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$15.68
|
| Rate for Payer: Cash Price |
$64.80
|
| Rate for Payer: Cash Price |
$64.80
|
| Rate for Payer: Cigna Commercial |
$213.41
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$112.32
|
| Rate for Payer: Health EOS Commercial |
$204.42
|
| Rate for Payer: HFN Commercial |
$213.41
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$55.36
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$55.36
|
| Rate for Payer: Independent Care Health Plan Medicare |
$15.68
|
| Rate for Payer: Multiplan Commercial |
$179.71
|
| Rate for Payer: NAPHCARE Commercial |
$23.52
|
| Rate for Payer: Preferred Network Access Commercial |
$213.41
|
| Rate for Payer: Quartz Beloit One Network |
$98.84
|
| Rate for Payer: Quartz Commercial |
$128.04
|
| Rate for Payer: Quartz Medicare Advantage |
$15.68
|
| Rate for Payer: The Alliance Commercial |
$61.95
|
| Rate for Payer: United Healthcare Medicare Advantage |
$15.68
|
| Rate for Payer: WEA Trust Commercial |
$123.55
|
| Rate for Payer: WPS Commercial |
$69.01
|
|
|
Vitamin B12 Level
|
Facility
|
OP
|
$216.00
|
|
|
Service Code
|
CPT 82607
|
| Hospital Charge Code |
633871
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.68 |
| Max. Negotiated Rate |
$206.67 |
| Rate for Payer: Aetna Commercial |
$202.18
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$193.19
|
| Rate for Payer: Aetna Managed Medicare |
$15.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$58.81
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$27.45
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$26.03
|
| Rate for Payer: Anthem Medicare Advantage |
$15.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$119.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$15.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$15.68
|
| Rate for Payer: Cash Price |
$64.80
|
| Rate for Payer: Cash Price |
$64.80
|
| Rate for Payer: Cigna Commercial |
$206.67
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$15.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$125.71
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$15.68
|
| Rate for Payer: Health EOS Commercial |
$199.93
|
| Rate for Payer: HFN Commercial |
$206.67
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$58.34
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$15.68
|
| Rate for Payer: Independent Care Health Plan Medicare |
$15.68
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$15.68
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$15.68
|
| Rate for Payer: Multiplan Commercial |
$179.71
|
| Rate for Payer: NAPHCARE Commercial |
$23.52
|
| Rate for Payer: Preferred Network Access Commercial |
$206.67
|
| Rate for Payer: Quartz Beloit One Network |
$110.07
|
| Rate for Payer: Quartz Commercial |
$146.02
|
| Rate for Payer: Quartz Medicare Advantage |
$15.68
|
| Rate for Payer: The Alliance Commercial |
$62.73
|
| Rate for Payer: United Healthcare Medicare Advantage |
$15.68
|
| Rate for Payer: United Healthcare PPO |
$168.48
|
| Rate for Payer: WEA Trust Commercial |
$123.55
|
| Rate for Payer: Wellcare Medicare |
$15.68
|
| Rate for Payer: WPS Commercial |
$166.38
|
|
|
Vitamin B12 Level
|
Facility
|
IP
|
$216.00
|
|
|
Service Code
|
CPT 82607
|
| Hospital Charge Code |
633871
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$110.07 |
| Max. Negotiated Rate |
$206.67 |
| Rate for Payer: Aetna Commercial |
$202.18
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$193.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$119.06
|
| Rate for Payer: Cash Price |
$64.80
|
| Rate for Payer: Cigna Commercial |
$206.67
|
| Rate for Payer: Health EOS Commercial |
$199.93
|
| Rate for Payer: HFN Commercial |
$206.67
|
| Rate for Payer: Multiplan Commercial |
$179.71
|
| Rate for Payer: Preferred Network Access Commercial |
$206.67
|
| Rate for Payer: Quartz Beloit One Network |
$110.07
|
| Rate for Payer: Quartz Commercial |
$134.78
|
| Rate for Payer: WEA Trust Commercial |
$123.55
|
| Rate for Payer: WPS Commercial |
$166.38
|
|
|
Vitamin B1, (Thiamin), Blood
|
Facility
|
OP
|
$376.00
|
|
|
Service Code
|
CPT 84425
|
| Hospital Charge Code |
983435
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$22.08 |
| Max. Negotiated Rate |
$359.76 |
| Rate for Payer: Dean Health DHI/DHP/ASO |
$218.83
|
| Rate for Payer: Aetna Commercial |
$351.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$336.29
|
| Rate for Payer: Aetna Managed Medicare |
$22.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$82.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$38.64
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$36.65
|
| Rate for Payer: Anthem Medicare Advantage |
$22.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$207.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$22.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$22.08
|
| Rate for Payer: Cash Price |
$112.80
|
| Rate for Payer: Cash Price |
$112.80
|
| Rate for Payer: Cigna Commercial |
$359.76
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$22.08
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$22.08
|
| Rate for Payer: Health EOS Commercial |
$348.03
|
| Rate for Payer: HFN Commercial |
$359.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$82.13
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$22.08
|
| Rate for Payer: Independent Care Health Plan Medicare |
$22.08
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$22.08
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$22.08
|
| Rate for Payer: Multiplan Commercial |
$312.83
|
| Rate for Payer: NAPHCARE Commercial |
$33.12
|
| Rate for Payer: Preferred Network Access Commercial |
$359.76
|
| Rate for Payer: Quartz Beloit One Network |
$191.61
|
| Rate for Payer: Quartz Commercial |
$254.18
|
| Rate for Payer: Quartz Medicare Advantage |
$22.08
|
| Rate for Payer: The Alliance Commercial |
$88.32
|
| Rate for Payer: United Healthcare Medicare Advantage |
$22.08
|
| Rate for Payer: United Healthcare PPO |
$293.28
|
| Rate for Payer: WEA Trust Commercial |
$215.07
|
| Rate for Payer: Wellcare Medicare |
$22.08
|
| Rate for Payer: WPS Commercial |
$289.63
|
|
|
Vitamin B1, (Thiamin), Blood
|
Facility
|
IP
|
$376.00
|
|
|
Service Code
|
CPT 84425
|
| Hospital Charge Code |
983435
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$191.61 |
| Max. Negotiated Rate |
$359.76 |
| Rate for Payer: Aetna Commercial |
$351.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$336.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$207.25
|
| Rate for Payer: Cash Price |
$112.80
|
| Rate for Payer: Cigna Commercial |
$359.76
|
| Rate for Payer: Health EOS Commercial |
$348.03
|
| Rate for Payer: HFN Commercial |
$359.76
|
| Rate for Payer: Multiplan Commercial |
$312.83
|
| Rate for Payer: Preferred Network Access Commercial |
$359.76
|
| Rate for Payer: Quartz Beloit One Network |
$191.61
|
| Rate for Payer: Quartz Commercial |
$234.62
|
| Rate for Payer: WEA Trust Commercial |
$215.07
|
| Rate for Payer: WPS Commercial |
$289.63
|
|
