|
Chlamydophila pneumoniae Antibodies
|
Professional
|
Both
|
$16.00
|
|
|
Service Code
|
CPT 86631
|
| Hospital Charge Code |
5569258
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$7.32 |
| Max. Negotiated Rate |
$54.09 |
| Rate for Payer: Aetna Commercial |
$15.81
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$14.31
|
| Rate for Payer: Aetna Managed Medicare |
$12.29
|
| Rate for Payer: Anthem Medicare Advantage |
$12.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$12.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$12.29
|
| Rate for Payer: Cash Price |
$4.80
|
| Rate for Payer: Cash Price |
$4.80
|
| Rate for Payer: Cigna Commercial |
$15.81
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$8.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12.29
|
| Rate for Payer: Health EOS Commercial |
$15.14
|
| Rate for Payer: HFN Commercial |
$15.81
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$43.39
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$43.39
|
| Rate for Payer: Independent Care Health Plan Medicare |
$12.29
|
| Rate for Payer: Multiplan Commercial |
$13.31
|
| Rate for Payer: NAPHCARE Commercial |
$18.44
|
| Rate for Payer: Preferred Network Access Commercial |
$15.81
|
| Rate for Payer: Quartz Beloit One Network |
$7.32
|
| Rate for Payer: Quartz Commercial |
$9.48
|
| Rate for Payer: Quartz Medicare Advantage |
$12.29
|
| Rate for Payer: The Alliance Commercial |
$48.56
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.29
|
| Rate for Payer: WEA Trust Commercial |
$9.15
|
| Rate for Payer: WPS Commercial |
$54.09
|
|
|
Chlamydophila pneumoniae Antibodies
|
Facility
|
IP
|
$16.00
|
|
|
Service Code
|
CPT 86631
|
| Hospital Charge Code |
5569258
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.15 |
| Max. Negotiated Rate |
$15.31 |
| Rate for Payer: Aetna Commercial |
$14.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$14.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$8.82
|
| Rate for Payer: Cash Price |
$4.80
|
| Rate for Payer: Cigna Commercial |
$15.31
|
| Rate for Payer: Health EOS Commercial |
$14.81
|
| Rate for Payer: HFN Commercial |
$15.31
|
| Rate for Payer: Multiplan Commercial |
$13.31
|
| Rate for Payer: Preferred Network Access Commercial |
$15.31
|
| Rate for Payer: Quartz Beloit One Network |
$8.15
|
| Rate for Payer: Quartz Commercial |
$9.98
|
| Rate for Payer: WEA Trust Commercial |
$9.15
|
| Rate for Payer: WPS Commercial |
$12.32
|
|
|
Chlamydophila pneumoniae Antibodies
|
Facility
|
OP
|
$16.00
|
|
|
Service Code
|
CPT 86631
|
| Hospital Charge Code |
5569258
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.15 |
| Max. Negotiated Rate |
$49.17 |
| Rate for Payer: Aetna Commercial |
$14.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$14.31
|
| Rate for Payer: Aetna Managed Medicare |
$12.29
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$46.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$21.51
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$20.41
|
| Rate for Payer: Anthem Medicare Advantage |
$12.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$8.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$12.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$12.29
|
| Rate for Payer: Cash Price |
$4.80
|
| Rate for Payer: Cash Price |
$4.80
|
| Rate for Payer: Cigna Commercial |
$15.31
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$12.29
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$9.31
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$12.29
|
| Rate for Payer: Health EOS Commercial |
$14.81
|
| Rate for Payer: HFN Commercial |
$15.31
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$45.73
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$12.29
|
| Rate for Payer: Independent Care Health Plan Medicare |
$12.29
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$12.29
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$12.29
|
| Rate for Payer: Multiplan Commercial |
$13.31
|
| Rate for Payer: NAPHCARE Commercial |
$18.44
|
| Rate for Payer: Preferred Network Access Commercial |
$15.31
|
| Rate for Payer: Quartz Beloit One Network |
$8.15
|
| Rate for Payer: Quartz Commercial |
$10.82
|
| Rate for Payer: Quartz Medicare Advantage |
$12.29
|
| Rate for Payer: The Alliance Commercial |
$49.17
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.29
|
| Rate for Payer: United Healthcare PPO |
$12.48
|
| Rate for Payer: WEA Trust Commercial |
$9.15
|
| Rate for Payer: Wellcare Medicare |
$12.29
|
| Rate for Payer: WPS Commercial |
$12.32
|
|
|
Chlamydophila pneumoniae IgA
|
Professional
|
Both
|
$16.00
|
|
|
Service Code
|
CPT 86631
|
| Hospital Charge Code |
5569281
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$7.32 |
| Max. Negotiated Rate |
$54.09 |
| Rate for Payer: Aetna Commercial |
$15.81
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$14.31
|
| Rate for Payer: Aetna Managed Medicare |
$12.29
|
| Rate for Payer: Anthem Medicare Advantage |
$12.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$12.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$12.29
|
| Rate for Payer: Cash Price |
$4.80
|
| Rate for Payer: Cash Price |
$4.80
|
| Rate for Payer: Cigna Commercial |
$15.81
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$8.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12.29
|
| Rate for Payer: Health EOS Commercial |
$15.14
|
| Rate for Payer: HFN Commercial |
$15.81
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$43.39
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$43.39
|
| Rate for Payer: Independent Care Health Plan Medicare |
$12.29
|
| Rate for Payer: Multiplan Commercial |
$13.31
|
| Rate for Payer: NAPHCARE Commercial |
$18.44
|
| Rate for Payer: Preferred Network Access Commercial |
$15.81
|
| Rate for Payer: Quartz Beloit One Network |
$7.32
|
| Rate for Payer: Quartz Commercial |
$9.48
|
| Rate for Payer: Quartz Medicare Advantage |
$12.29
|
| Rate for Payer: The Alliance Commercial |
$48.56
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.29
|
| Rate for Payer: WEA Trust Commercial |
$9.15
|
| Rate for Payer: WPS Commercial |
$54.09
|
|
|
Chlamydophila pneumoniae IgA
|
Facility
|
IP
|
$16.00
|
|
|
Service Code
|
CPT 86631
|
| Hospital Charge Code |
5569281
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.15 |
| Max. Negotiated Rate |
$15.31 |
| Rate for Payer: Aetna Commercial |
$14.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$14.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$8.82
|
| Rate for Payer: Cash Price |
$4.80
|
| Rate for Payer: Cigna Commercial |
$15.31
|
| Rate for Payer: Health EOS Commercial |
$14.81
|
| Rate for Payer: HFN Commercial |
$15.31
|
| Rate for Payer: Multiplan Commercial |
$13.31
|
| Rate for Payer: Preferred Network Access Commercial |
$15.31
|
| Rate for Payer: Quartz Beloit One Network |
$8.15
|
| Rate for Payer: Quartz Commercial |
$9.98
|
| Rate for Payer: WEA Trust Commercial |
$9.15
|
| Rate for Payer: WPS Commercial |
$12.32
|
|
|
Chlamydophila pneumoniae IgA
|
Facility
|
OP
|
$16.00
|
|
|
Service Code
|
CPT 86631
|
| Hospital Charge Code |
5569281
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.15 |
| Max. Negotiated Rate |
$49.17 |
| Rate for Payer: Aetna Commercial |
$14.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$14.31
|
| Rate for Payer: Aetna Managed Medicare |
$12.29
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$46.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$21.51
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$20.41
|
| Rate for Payer: Anthem Medicare Advantage |
$12.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$8.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$12.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$12.29
|
| Rate for Payer: Cash Price |
$4.80
|
| Rate for Payer: Cash Price |
$4.80
|
| Rate for Payer: Cigna Commercial |
$15.31
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$12.29
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$9.31
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$12.29
|
| Rate for Payer: Health EOS Commercial |
$14.81
|
| Rate for Payer: HFN Commercial |
$15.31
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$45.73
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$12.29
|
| Rate for Payer: Independent Care Health Plan Medicare |
$12.29
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$12.29
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$12.29
|
| Rate for Payer: Multiplan Commercial |
$13.31
|
| Rate for Payer: NAPHCARE Commercial |
$18.44
|
| Rate for Payer: Preferred Network Access Commercial |
$15.31
|
| Rate for Payer: Quartz Beloit One Network |
$8.15
|
| Rate for Payer: Quartz Commercial |
$10.82
|
| Rate for Payer: Quartz Medicare Advantage |
$12.29
|
| Rate for Payer: The Alliance Commercial |
$49.17
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.29
|
| Rate for Payer: United Healthcare PPO |
$12.48
|
| Rate for Payer: WEA Trust Commercial |
$9.15
|
| Rate for Payer: Wellcare Medicare |
$12.29
|
| Rate for Payer: WPS Commercial |
$12.32
|
|
|
Chlamydophila pneumoniae IgM
|
Facility
|
OP
|
$16.00
|
|
|
Service Code
|
CPT 86632
|
| Hospital Charge Code |
5569282
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.15 |
| Max. Negotiated Rate |
$52.75 |
| Rate for Payer: Aetna Commercial |
$14.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$14.31
|
| Rate for Payer: Aetna Managed Medicare |
$13.19
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$49.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$23.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$21.89
|
| Rate for Payer: Anthem Medicare Advantage |
$13.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$8.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$13.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$13.19
|
| Rate for Payer: Cash Price |
$4.80
|
| Rate for Payer: Cash Price |
$4.80
|
| Rate for Payer: Cigna Commercial |
$15.31
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$13.19
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$9.31
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$13.19
|
| Rate for Payer: Health EOS Commercial |
$14.81
|
| Rate for Payer: HFN Commercial |
$15.31
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$49.06
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$13.19
|
| Rate for Payer: Independent Care Health Plan Medicare |
$13.19
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$13.19
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$13.19
|
| Rate for Payer: Multiplan Commercial |
$13.31
|
| Rate for Payer: NAPHCARE Commercial |
$19.78
|
| Rate for Payer: Preferred Network Access Commercial |
$15.31
|
| Rate for Payer: Quartz Beloit One Network |
$8.15
|
| Rate for Payer: Quartz Commercial |
$10.82
|
| Rate for Payer: Quartz Medicare Advantage |
$13.19
|
| Rate for Payer: The Alliance Commercial |
$52.75
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.19
|
| Rate for Payer: United Healthcare PPO |
$12.48
|
| Rate for Payer: WEA Trust Commercial |
$9.15
|
| Rate for Payer: Wellcare Medicare |
$13.19
|
| Rate for Payer: WPS Commercial |
$12.32
|
|
|
Chlamydophila pneumoniae IgM
|
Professional
|
Both
|
$16.00
|
|
|
Service Code
|
CPT 86632
|
| Hospital Charge Code |
5569282
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$7.32 |
| Max. Negotiated Rate |
$58.02 |
| Rate for Payer: Aetna Commercial |
$15.81
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$14.31
|
| Rate for Payer: Aetna Managed Medicare |
$13.19
|
| Rate for Payer: Anthem Medicare Advantage |
$13.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$13.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$13.19
|
| Rate for Payer: Cash Price |
$4.80
|
| Rate for Payer: Cash Price |
$4.80
|
| Rate for Payer: Cigna Commercial |
$15.81
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$8.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$13.19
|
| Rate for Payer: Health EOS Commercial |
$15.14
|
| Rate for Payer: HFN Commercial |
$15.81
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$46.55
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$46.55
|
| Rate for Payer: Independent Care Health Plan Medicare |
$13.19
|
| Rate for Payer: Multiplan Commercial |
$13.31
|
| Rate for Payer: NAPHCARE Commercial |
$19.78
|
| Rate for Payer: Preferred Network Access Commercial |
$15.81
|
| Rate for Payer: Quartz Beloit One Network |
$7.32
|
| Rate for Payer: Quartz Commercial |
$9.48
|
| Rate for Payer: Quartz Medicare Advantage |
$13.19
|
| Rate for Payer: The Alliance Commercial |
$52.09
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.19
|
| Rate for Payer: WEA Trust Commercial |
$9.15
|
| Rate for Payer: WPS Commercial |
$58.02
|
|
|
Chlamydophila pneumoniae IgM
|
Facility
|
IP
|
$16.00
|
|
|
Service Code
|
CPT 86632
|
| Hospital Charge Code |
5569282
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.15 |
| Max. Negotiated Rate |
$15.31 |
| Rate for Payer: Aetna Commercial |
$14.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$14.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$8.82
|
| Rate for Payer: Cash Price |
$4.80
|
| Rate for Payer: Cigna Commercial |
$15.31
|
| Rate for Payer: Health EOS Commercial |
$14.81
|
| Rate for Payer: HFN Commercial |
$15.31
|
| Rate for Payer: Multiplan Commercial |
$13.31
|
| Rate for Payer: Preferred Network Access Commercial |
$15.31
|
| Rate for Payer: Quartz Beloit One Network |
$8.15
|
| Rate for Payer: Quartz Commercial |
$9.98
|
| Rate for Payer: WEA Trust Commercial |
$9.15
|
| Rate for Payer: WPS Commercial |
$12.32
|
|
|
Chloride Level
|
Facility
|
IP
|
$70.00
|
|
|
Service Code
|
CPT 82435
|
| Hospital Charge Code |
633621
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$35.67 |
| Max. Negotiated Rate |
$66.98 |
| Rate for Payer: Aetna Commercial |
$65.52
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$62.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$38.58
|
| Rate for Payer: Cash Price |
$21.00
|
| Rate for Payer: Cigna Commercial |
$66.98
|
| Rate for Payer: Health EOS Commercial |
$64.79
|
| Rate for Payer: HFN Commercial |
$66.98
|
| Rate for Payer: Multiplan Commercial |
$58.24
|
| Rate for Payer: Preferred Network Access Commercial |
$66.98
|
| Rate for Payer: Quartz Beloit One Network |
$35.67
|
| Rate for Payer: Quartz Commercial |
$43.68
|
| Rate for Payer: WEA Trust Commercial |
$40.04
|
| Rate for Payer: WPS Commercial |
$53.92
|
|
|
Chloride Level
|
Professional
|
Both
|
$70.00
|
|
|
Service Code
|
CPT 82435
|
| Hospital Charge Code |
633621
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.78 |
| Max. Negotiated Rate |
$69.16 |
| Rate for Payer: Aetna Commercial |
$69.16
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$62.61
|
| Rate for Payer: Aetna Managed Medicare |
$4.78
|
| Rate for Payer: Anthem Medicare Advantage |
$4.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$4.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$4.78
|
| Rate for Payer: Cash Price |
$21.00
|
| Rate for Payer: Cash Price |
$21.00
|
| Rate for Payer: Cigna Commercial |
$69.16
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$36.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4.78
|
| Rate for Payer: Health EOS Commercial |
$66.25
|
| Rate for Payer: HFN Commercial |
$69.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$16.89
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$16.89
|
| Rate for Payer: Independent Care Health Plan Medicare |
$4.78
|
| Rate for Payer: Multiplan Commercial |
$58.24
|
| Rate for Payer: NAPHCARE Commercial |
$7.18
|
| Rate for Payer: Preferred Network Access Commercial |
$69.16
|
| Rate for Payer: Quartz Beloit One Network |
$32.03
|
| Rate for Payer: Quartz Commercial |
$41.50
|
| Rate for Payer: Quartz Medicare Advantage |
$4.78
|
| Rate for Payer: The Alliance Commercial |
$18.90
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4.78
|
| Rate for Payer: WEA Trust Commercial |
$40.04
|
| Rate for Payer: WPS Commercial |
$21.05
|
|
|
Chloride Level
|
Facility
|
OP
|
$70.00
|
|
|
Service Code
|
CPT 82435
|
| Hospital Charge Code |
633621
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.78 |
| Max. Negotiated Rate |
$66.98 |
| Rate for Payer: Aetna Commercial |
$65.52
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$62.61
|
| Rate for Payer: Aetna Managed Medicare |
$4.78
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$17.94
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8.37
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7.94
|
| Rate for Payer: Anthem Medicare Advantage |
$4.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$38.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$4.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$4.78
|
| Rate for Payer: Cash Price |
$21.00
|
| Rate for Payer: Cash Price |
$21.00
|
| Rate for Payer: Cigna Commercial |
$66.98
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$4.78
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$40.74
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$4.78
|
| Rate for Payer: Health EOS Commercial |
$64.79
|
| Rate for Payer: HFN Commercial |
$66.98
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$17.80
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$4.78
|
| Rate for Payer: Independent Care Health Plan Medicare |
$4.78
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$4.78
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$4.78
|
| Rate for Payer: Multiplan Commercial |
$58.24
|
| Rate for Payer: NAPHCARE Commercial |
$7.18
|
| Rate for Payer: Preferred Network Access Commercial |
$66.98
|
| Rate for Payer: Quartz Beloit One Network |
$35.67
|
| Rate for Payer: Quartz Commercial |
$47.32
|
| Rate for Payer: Quartz Medicare Advantage |
$4.78
|
| Rate for Payer: The Alliance Commercial |
$19.14
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4.78
|
| Rate for Payer: United Healthcare PPO |
$54.60
|
| Rate for Payer: WEA Trust Commercial |
$40.04
|
| Rate for Payer: Wellcare Medicare |
$4.78
|
| Rate for Payer: WPS Commercial |
$53.92
|
|
|
Chloride Random Urine
|
Facility
|
OP
|
$38.00
|
|
|
Service Code
|
CPT 82436
|
| Hospital Charge Code |
3304824
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.98 |
| Max. Negotiated Rate |
$36.36 |
| Rate for Payer: Aetna Commercial |
$35.57
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$33.99
|
| Rate for Payer: Aetna Managed Medicare |
$5.98
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$22.43
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$10.46
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$9.93
|
| Rate for Payer: Anthem Medicare Advantage |
$5.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$20.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5.98
|
| Rate for Payer: Cash Price |
$11.40
|
| Rate for Payer: Cash Price |
$11.40
|
| Rate for Payer: Cigna Commercial |
$36.36
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$5.98
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$22.12
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$5.98
|
| Rate for Payer: Health EOS Commercial |
$35.17
|
| Rate for Payer: HFN Commercial |
$36.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$22.25
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$5.98
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5.98
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$5.98
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$5.98
|
| Rate for Payer: Multiplan Commercial |
$31.62
|
| Rate for Payer: NAPHCARE Commercial |
$8.97
|
| Rate for Payer: Preferred Network Access Commercial |
$36.36
|
| Rate for Payer: Quartz Beloit One Network |
$19.36
|
| Rate for Payer: Quartz Commercial |
$25.69
|
| Rate for Payer: Quartz Medicare Advantage |
$5.98
|
| Rate for Payer: The Alliance Commercial |
$23.92
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.98
|
| Rate for Payer: United Healthcare PPO |
$29.64
|
| Rate for Payer: WEA Trust Commercial |
$21.74
|
| Rate for Payer: Wellcare Medicare |
$5.98
|
| Rate for Payer: WPS Commercial |
$29.27
|
|
|
Chloride Random Urine
|
Facility
|
IP
|
$38.00
|
|
|
Service Code
|
CPT 82436
|
| Hospital Charge Code |
3304824
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$19.36 |
| Max. Negotiated Rate |
$36.36 |
| Rate for Payer: Aetna Commercial |
$35.57
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$33.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$20.95
|
| Rate for Payer: Cash Price |
$11.40
|
| Rate for Payer: Cigna Commercial |
$36.36
|
| Rate for Payer: Health EOS Commercial |
$35.17
|
| Rate for Payer: HFN Commercial |
$36.36
|
| Rate for Payer: Multiplan Commercial |
$31.62
|
| Rate for Payer: Preferred Network Access Commercial |
$36.36
|
| Rate for Payer: Quartz Beloit One Network |
$19.36
|
| Rate for Payer: Quartz Commercial |
$23.71
|
| Rate for Payer: WEA Trust Commercial |
$21.74
|
| Rate for Payer: WPS Commercial |
$29.27
|
|
|
Chloride Random Urine
|
Professional
|
Both
|
$38.00
|
|
|
Service Code
|
CPT 82436
|
| Hospital Charge Code |
3304824
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.98 |
| Max. Negotiated Rate |
$37.54 |
| Rate for Payer: Aetna Commercial |
$37.54
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$33.99
|
| Rate for Payer: Aetna Managed Medicare |
$5.98
|
| Rate for Payer: Anthem Medicare Advantage |
$5.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5.98
|
| Rate for Payer: Cash Price |
$11.40
|
| Rate for Payer: Cash Price |
$11.40
|
| Rate for Payer: Cigna Commercial |
$37.54
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$19.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5.98
|
| Rate for Payer: Health EOS Commercial |
$35.96
|
| Rate for Payer: HFN Commercial |
$37.54
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$21.11
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$21.11
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5.98
|
| Rate for Payer: Multiplan Commercial |
$31.62
|
| Rate for Payer: NAPHCARE Commercial |
$8.97
|
| Rate for Payer: Preferred Network Access Commercial |
$37.54
|
| Rate for Payer: Quartz Beloit One Network |
$17.39
|
| Rate for Payer: Quartz Commercial |
$22.53
|
| Rate for Payer: Quartz Medicare Advantage |
$5.98
|
| Rate for Payer: The Alliance Commercial |
$23.62
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.98
|
| Rate for Payer: WEA Trust Commercial |
$21.74
|
| Rate for Payer: WPS Commercial |
$26.31
|
|
|
Chloride Stool
|
Facility
|
OP
|
$145.00
|
|
|
Service Code
|
CPT 82438
|
| Hospital Charge Code |
2942897
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.20 |
| Max. Negotiated Rate |
$138.74 |
| Rate for Payer: Aetna Commercial |
$135.72
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$129.69
|
| Rate for Payer: Aetna Managed Medicare |
$5.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$19.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$9.10
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$8.63
|
| Rate for Payer: Anthem Medicare Advantage |
$5.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$79.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5.20
|
| Rate for Payer: Cash Price |
$43.50
|
| Rate for Payer: Cash Price |
$43.50
|
| Rate for Payer: Cigna Commercial |
$138.74
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$5.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$84.39
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$5.20
|
| Rate for Payer: Health EOS Commercial |
$134.21
|
| Rate for Payer: HFN Commercial |
$138.74
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$19.34
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$5.20
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5.20
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$5.20
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$5.20
|
| Rate for Payer: Multiplan Commercial |
$120.64
|
| Rate for Payer: NAPHCARE Commercial |
$7.80
|
| Rate for Payer: Preferred Network Access Commercial |
$138.74
|
| Rate for Payer: Quartz Beloit One Network |
$73.89
|
| Rate for Payer: Quartz Commercial |
$98.02
|
| Rate for Payer: Quartz Medicare Advantage |
$5.20
|
| Rate for Payer: The Alliance Commercial |
$20.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.20
|
| Rate for Payer: United Healthcare PPO |
$113.10
|
| Rate for Payer: WEA Trust Commercial |
$82.94
|
| Rate for Payer: Wellcare Medicare |
$5.20
|
| Rate for Payer: WPS Commercial |
$111.69
|
|
|
Chloride Stool
|
Facility
|
IP
|
$145.00
|
|
|
Service Code
|
CPT 82438
|
| Hospital Charge Code |
2942897
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$73.89 |
| Max. Negotiated Rate |
$138.74 |
| Rate for Payer: Aetna Commercial |
$135.72
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$129.69
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$79.92
|
| Rate for Payer: Cash Price |
$43.50
|
| Rate for Payer: Cigna Commercial |
$138.74
|
| Rate for Payer: Health EOS Commercial |
$134.21
|
| Rate for Payer: HFN Commercial |
$138.74
|
| Rate for Payer: Multiplan Commercial |
$120.64
|
| Rate for Payer: Preferred Network Access Commercial |
$138.74
|
| Rate for Payer: Quartz Beloit One Network |
$73.89
|
| Rate for Payer: Quartz Commercial |
$90.48
|
| Rate for Payer: WEA Trust Commercial |
$82.94
|
| Rate for Payer: WPS Commercial |
$111.69
|
|
|
Chloride Stool
|
Professional
|
Both
|
$145.00
|
|
|
Service Code
|
CPT 82438
|
| Hospital Charge Code |
2942897
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.20 |
| Max. Negotiated Rate |
$143.26 |
| Rate for Payer: Aetna Commercial |
$143.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$129.69
|
| Rate for Payer: Aetna Managed Medicare |
$5.20
|
| Rate for Payer: Anthem Medicare Advantage |
$5.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5.20
|
| Rate for Payer: Cash Price |
$43.50
|
| Rate for Payer: Cash Price |
$43.50
|
| Rate for Payer: Cigna Commercial |
$143.26
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$75.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5.20
|
| Rate for Payer: Health EOS Commercial |
$137.23
|
| Rate for Payer: HFN Commercial |
$143.26
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$18.36
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$18.36
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5.20
|
| Rate for Payer: Multiplan Commercial |
$120.64
|
| Rate for Payer: NAPHCARE Commercial |
$7.80
|
| Rate for Payer: Preferred Network Access Commercial |
$143.26
|
| Rate for Payer: Quartz Beloit One Network |
$66.35
|
| Rate for Payer: Quartz Commercial |
$85.96
|
| Rate for Payer: Quartz Medicare Advantage |
$5.20
|
| Rate for Payer: The Alliance Commercial |
$20.54
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.20
|
| Rate for Payer: WEA Trust Commercial |
$82.94
|
| Rate for Payer: WPS Commercial |
$22.88
|
|
|
Chloride, Stool
|
Facility
|
OP
|
$40.00
|
|
|
Service Code
|
CPT 82438
|
| Hospital Charge Code |
4732606
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.20 |
| Max. Negotiated Rate |
$38.27 |
| Rate for Payer: Aetna Commercial |
$37.44
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$35.78
|
| Rate for Payer: Aetna Managed Medicare |
$5.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$19.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$9.10
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$8.63
|
| Rate for Payer: Anthem Medicare Advantage |
$5.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$22.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5.20
|
| Rate for Payer: Cash Price |
$12.00
|
| Rate for Payer: Cash Price |
$12.00
|
| Rate for Payer: Cigna Commercial |
$38.27
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$5.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$23.28
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$5.20
|
| Rate for Payer: Health EOS Commercial |
$37.02
|
| Rate for Payer: HFN Commercial |
$38.27
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$19.34
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$5.20
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5.20
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$5.20
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$5.20
|
| Rate for Payer: Multiplan Commercial |
$33.28
|
| Rate for Payer: NAPHCARE Commercial |
$7.80
|
| Rate for Payer: Preferred Network Access Commercial |
$38.27
|
| Rate for Payer: Quartz Beloit One Network |
$20.38
|
| Rate for Payer: Quartz Commercial |
$27.04
|
| Rate for Payer: Quartz Medicare Advantage |
$5.20
|
| Rate for Payer: The Alliance Commercial |
$20.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.20
|
| Rate for Payer: United Healthcare PPO |
$31.20
|
| Rate for Payer: WEA Trust Commercial |
$22.88
|
| Rate for Payer: Wellcare Medicare |
$5.20
|
| Rate for Payer: WPS Commercial |
$30.81
|
|
|
Chloride, Stool
|
Facility
|
IP
|
$40.00
|
|
|
Service Code
|
CPT 82438
|
| Hospital Charge Code |
4732606
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$20.38 |
| Max. Negotiated Rate |
$38.27 |
| Rate for Payer: Aetna Commercial |
$37.44
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$35.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$22.05
|
| Rate for Payer: Cash Price |
$12.00
|
| Rate for Payer: Cigna Commercial |
$38.27
|
| Rate for Payer: Health EOS Commercial |
$37.02
|
| Rate for Payer: HFN Commercial |
$38.27
|
| Rate for Payer: Multiplan Commercial |
$33.28
|
| Rate for Payer: Preferred Network Access Commercial |
$38.27
|
| Rate for Payer: Quartz Beloit One Network |
$20.38
|
| Rate for Payer: Quartz Commercial |
$24.96
|
| Rate for Payer: WEA Trust Commercial |
$22.88
|
| Rate for Payer: WPS Commercial |
$30.81
|
|
|
Chloride, Stool
|
Professional
|
Both
|
$40.00
|
|
|
Service Code
|
CPT 82438
|
| Hospital Charge Code |
4732606
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.20 |
| Max. Negotiated Rate |
$39.52 |
| Rate for Payer: Aetna Commercial |
$39.52
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$35.78
|
| Rate for Payer: Aetna Managed Medicare |
$5.20
|
| Rate for Payer: Anthem Medicare Advantage |
$5.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5.20
|
| Rate for Payer: Cash Price |
$12.00
|
| Rate for Payer: Cash Price |
$12.00
|
| Rate for Payer: Cigna Commercial |
$39.52
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$20.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5.20
|
| Rate for Payer: Health EOS Commercial |
$37.86
|
| Rate for Payer: HFN Commercial |
$39.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$18.36
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$18.36
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5.20
|
| Rate for Payer: Multiplan Commercial |
$33.28
|
| Rate for Payer: NAPHCARE Commercial |
$7.80
|
| Rate for Payer: Preferred Network Access Commercial |
$39.52
|
| Rate for Payer: Quartz Beloit One Network |
$18.30
|
| Rate for Payer: Quartz Commercial |
$23.71
|
| Rate for Payer: Quartz Medicare Advantage |
$5.20
|
| Rate for Payer: The Alliance Commercial |
$20.54
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.20
|
| Rate for Payer: WEA Trust Commercial |
$22.88
|
| Rate for Payer: WPS Commercial |
$22.88
|
|
|
Chloride, Urine
|
Facility
|
OP
|
$30.00
|
|
|
Service Code
|
CPT 82436
|
| Hospital Charge Code |
5474689
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$5.98 |
| Max. Negotiated Rate |
$28.70 |
| Rate for Payer: Aetna Commercial |
$28.08
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$26.83
|
| Rate for Payer: Aetna Managed Medicare |
$5.98
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$20.28
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$15.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$14.98
|
| Rate for Payer: Anthem Medicare Advantage |
$5.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$16.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5.98
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Cigna Commercial |
$28.70
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$5.98
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$17.46
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$5.98
|
| Rate for Payer: Health EOS Commercial |
$27.77
|
| Rate for Payer: HFN Commercial |
$28.70
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$22.25
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$5.98
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5.98
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$5.98
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$5.98
|
| Rate for Payer: Multiplan Commercial |
$24.96
|
| Rate for Payer: NAPHCARE Commercial |
$8.97
|
| Rate for Payer: Preferred Network Access Commercial |
$28.70
|
| Rate for Payer: Quartz Beloit One Network |
$15.29
|
| Rate for Payer: Quartz Commercial |
$20.28
|
| Rate for Payer: Quartz Medicare Advantage |
$5.98
|
| Rate for Payer: The Alliance Commercial |
$23.92
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.98
|
| Rate for Payer: WEA Trust Commercial |
$17.16
|
| Rate for Payer: Wellcare Medicare |
$5.98
|
| Rate for Payer: WPS Commercial |
$23.11
|
|
|
Chloride, Urine
|
Professional
|
Both
|
$30.00
|
|
|
Service Code
|
CPT 82436
|
| Hospital Charge Code |
5474689
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$5.98 |
| Max. Negotiated Rate |
$29.64 |
| Rate for Payer: Aetna Commercial |
$29.64
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$26.83
|
| Rate for Payer: Aetna Managed Medicare |
$5.98
|
| Rate for Payer: Anthem Medicare Advantage |
$5.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5.98
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Cigna Commercial |
$29.64
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$15.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5.98
|
| Rate for Payer: Health EOS Commercial |
$28.39
|
| Rate for Payer: HFN Commercial |
$29.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$21.11
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$21.11
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5.98
|
| Rate for Payer: Multiplan Commercial |
$24.96
|
| Rate for Payer: NAPHCARE Commercial |
$8.97
|
| Rate for Payer: Preferred Network Access Commercial |
$29.64
|
| Rate for Payer: Quartz Beloit One Network |
$13.73
|
| Rate for Payer: Quartz Commercial |
$17.78
|
| Rate for Payer: Quartz Medicare Advantage |
$5.98
|
| Rate for Payer: The Alliance Commercial |
$23.62
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.98
|
| Rate for Payer: WEA Trust Commercial |
$17.16
|
| Rate for Payer: WPS Commercial |
$26.31
|
|
|
Chloride, Urine
|
Facility
|
IP
|
$30.00
|
|
|
Service Code
|
CPT 82436
|
| Hospital Charge Code |
5474689
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$15.29 |
| Max. Negotiated Rate |
$28.70 |
| Rate for Payer: Aetna Commercial |
$28.08
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$26.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$16.54
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Cigna Commercial |
$28.70
|
| Rate for Payer: Health EOS Commercial |
$27.77
|
| Rate for Payer: HFN Commercial |
$28.70
|
| Rate for Payer: Multiplan Commercial |
$24.96
|
| Rate for Payer: Preferred Network Access Commercial |
$28.70
|
| Rate for Payer: Quartz Beloit One Network |
$15.29
|
| Rate for Payer: Quartz Commercial |
$18.72
|
| Rate for Payer: WEA Trust Commercial |
$17.16
|
| Rate for Payer: WPS Commercial |
$23.11
|
|
|
Cholangiography &/Pancreatography IntraOp RS&I 7430026
|
Professional
|
Both
|
$229.00
|
|
|
Service Code
|
CPT 74300 26
|
| Hospital Charge Code |
5284615
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$12.68 |
| Max. Negotiated Rate |
$226.25 |
| Rate for Payer: Aetna Commercial |
$226.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$204.82
|
| Rate for Payer: Aetna Managed Medicare |
$12.68
|
| Rate for Payer: Anthem Medicare Advantage |
$12.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$12.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$12.68
|
| Rate for Payer: Cash Price |
$68.70
|
| Rate for Payer: Cash Price |
$68.70
|
| Rate for Payer: Cash Price |
$68.70
|
| Rate for Payer: Cigna Commercial |
$226.25
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$119.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12.68
|
| Rate for Payer: Health EOS Commercial |
$216.73
|
| Rate for Payer: HFN Commercial |
$226.25
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$49.82
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$49.82
|
| Rate for Payer: Independent Care Health Plan Medicare |
$12.68
|
| Rate for Payer: Multiplan Commercial |
$190.53
|
| Rate for Payer: NAPHCARE Commercial |
$19.02
|
| Rate for Payer: Preferred Network Access Commercial |
$226.25
|
| Rate for Payer: Quartz Beloit One Network |
$104.79
|
| Rate for Payer: Quartz Commercial |
$135.75
|
| Rate for Payer: Quartz Medicare Advantage |
$12.68
|
| Rate for Payer: The Alliance Commercial |
$48.17
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.68
|
| Rate for Payer: WEA Trust Commercial |
$130.99
|
| Rate for Payer: WPS Commercial |
$63.39
|
|
