|
Holter Monitor Inclusive
|
Facility
|
OP
|
$2,895.00
|
|
|
Service Code
|
CPT 93224
|
| Hospital Charge Code |
2982413
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$810.60 |
| Max. Negotiated Rate |
$11,580.00 |
| Rate for Payer: Aetna Commercial |
$2,605.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,489.70
|
| Rate for Payer: Aetna Managed Medicare |
$810.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,881.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,447.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,389.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,534.35
|
| Rate for Payer: Cash Price |
$868.50
|
| Rate for Payer: Cigna Commercial |
$2,663.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,620.04
|
| Rate for Payer: Health EOS Commercial |
$2,576.55
|
| Rate for Payer: HFN Commercial |
$2,663.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,171.25
|
| Rate for Payer: Multiplan Commercial |
$2,316.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,737.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,663.40
|
| Rate for Payer: Quartz Beloit One Network |
$1,418.55
|
| Rate for Payer: Quartz Commercial |
$1,881.75
|
| Rate for Payer: Quartz Medicare Advantage |
$1,737.00
|
| Rate for Payer: The Alliance Commercial |
$11,580.00
|
| Rate for Payer: WEA Trust Commercial |
$1,592.25
|
| Rate for Payer: WPS Commercial |
$2,144.33
|
|
|
Holter Monitor Inclusive
|
Facility
|
IP
|
$2,895.00
|
|
|
Service Code
|
CPT 93224
|
| Hospital Charge Code |
2982413
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$1,418.55 |
| Max. Negotiated Rate |
$2,663.40 |
| Rate for Payer: Aetna Commercial |
$2,605.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,489.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,534.35
|
| Rate for Payer: Cash Price |
$868.50
|
| Rate for Payer: Cigna Commercial |
$2,663.40
|
| Rate for Payer: Health EOS Commercial |
$2,576.55
|
| Rate for Payer: HFN Commercial |
$2,663.40
|
| Rate for Payer: Multiplan Commercial |
$2,316.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,737.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,663.40
|
| Rate for Payer: Quartz Beloit One Network |
$1,418.55
|
| Rate for Payer: Quartz Commercial |
$1,737.00
|
| Rate for Payer: WEA Trust Commercial |
$1,592.25
|
| Rate for Payer: WPS Commercial |
$2,144.33
|
|
|
Holter Monitor Interpretation
|
Facility
|
IP
|
$1,401.00
|
|
|
Service Code
|
CPT 93226
|
| Hospital Charge Code |
2982416
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$686.49 |
| Max. Negotiated Rate |
$1,288.92 |
| Rate for Payer: Aetna Commercial |
$1,260.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,204.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$742.53
|
| Rate for Payer: Cash Price |
$420.30
|
| Rate for Payer: Cigna Commercial |
$1,288.92
|
| Rate for Payer: Health EOS Commercial |
$1,246.89
|
| Rate for Payer: HFN Commercial |
$1,288.92
|
| Rate for Payer: Multiplan Commercial |
$1,120.80
|
| Rate for Payer: NAPHCARE Commercial |
$840.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,288.92
|
| Rate for Payer: Quartz Beloit One Network |
$686.49
|
| Rate for Payer: Quartz Commercial |
$840.60
|
| Rate for Payer: WEA Trust Commercial |
$770.55
|
| Rate for Payer: WPS Commercial |
$1,037.72
|
|
|
Holter Monitor Interpretation
|
Facility
|
OP
|
$1,401.00
|
|
|
Service Code
|
CPT 93226
|
| Hospital Charge Code |
2982416
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$60.46 |
| Max. Negotiated Rate |
$1,288.92 |
| Rate for Payer: Aetna Commercial |
$1,260.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,204.86
|
| Rate for Payer: Aetna Managed Medicare |
$60.46
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$910.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$700.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$672.48
|
| Rate for Payer: Anthem Medicare Advantage |
$60.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$742.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$60.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$60.46
|
| Rate for Payer: Cash Price |
$420.30
|
| Rate for Payer: Cash Price |
$420.30
|
| Rate for Payer: Cigna Commercial |
$1,288.92
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$60.46
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$784.00
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$60.46
|
| Rate for Payer: Health EOS Commercial |
$1,246.89
|
| Rate for Payer: HFN Commercial |
$1,288.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$224.91
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$60.46
|
| Rate for Payer: Independent Care Health Plan Medicare |
$60.46
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$60.46
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$60.46
|
| Rate for Payer: Multiplan Commercial |
$1,120.80
|
| Rate for Payer: NAPHCARE Commercial |
$90.69
|
| Rate for Payer: Preferred Network Access Commercial |
$1,288.92
|
| Rate for Payer: Quartz Beloit One Network |
$686.49
|
| Rate for Payer: Quartz Commercial |
$910.65
|
| Rate for Payer: Quartz Medicare Advantage |
$60.46
|
| Rate for Payer: The Alliance Commercial |
$241.84
|
| Rate for Payer: United Healthcare Medicare Advantage |
$60.46
|
| Rate for Payer: United Healthcare PPO |
$1,050.75
|
| Rate for Payer: WEA Trust Commercial |
$770.55
|
| Rate for Payer: Wellcare Medicare |
$60.46
|
| Rate for Payer: WPS Commercial |
$1,037.72
|
|
|
Holter Monitor Interpretation 93227
|
Professional
|
Both
|
$846.00
|
|
|
Service Code
|
CPT 93227
|
| Hospital Charge Code |
3595541
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$64.63 |
| Max. Negotiated Rate |
$803.70 |
| Rate for Payer: Aetna Commercial |
$803.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$727.56
|
| Rate for Payer: Cash Price |
$253.80
|
| Rate for Payer: Cash Price |
$253.80
|
| Rate for Payer: Cash Price |
$253.80
|
| Rate for Payer: Cigna Commercial |
$803.70
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$423.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$507.60
|
| Rate for Payer: Health EOS Commercial |
$769.86
|
| Rate for Payer: HFN Commercial |
$803.70
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$64.63
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$64.63
|
| Rate for Payer: Multiplan Commercial |
$676.80
|
| Rate for Payer: Preferred Network Access Commercial |
$803.70
|
| Rate for Payer: Quartz Beloit One Network |
$372.24
|
| Rate for Payer: Quartz Commercial |
$482.22
|
| Rate for Payer: The Alliance Commercial |
$423.00
|
| Rate for Payer: WEA Trust Commercial |
$465.30
|
| Rate for Payer: WPS Commercial |
$626.63
|
|
|
Holter Monitor Recording Sheet #1
|
Facility
|
IP
|
$704.00
|
|
|
Service Code
|
CPT 93225
|
| Hospital Charge Code |
2982414
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$344.96 |
| Max. Negotiated Rate |
$647.68 |
| Rate for Payer: Aetna Commercial |
$633.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$605.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$373.12
|
| Rate for Payer: Cash Price |
$211.20
|
| Rate for Payer: Cigna Commercial |
$647.68
|
| Rate for Payer: Health EOS Commercial |
$626.56
|
| Rate for Payer: HFN Commercial |
$647.68
|
| Rate for Payer: Multiplan Commercial |
$563.20
|
| Rate for Payer: NAPHCARE Commercial |
$422.40
|
| Rate for Payer: Preferred Network Access Commercial |
$647.68
|
| Rate for Payer: Quartz Beloit One Network |
$344.96
|
| Rate for Payer: Quartz Commercial |
$422.40
|
| Rate for Payer: WEA Trust Commercial |
$387.20
|
| Rate for Payer: WPS Commercial |
$521.45
|
|
|
Holter Monitor Recording Sheet #1
|
Facility
|
OP
|
$704.00
|
|
|
Service Code
|
CPT 93225
|
| Hospital Charge Code |
2982414
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$126.26 |
| Max. Negotiated Rate |
$647.68 |
| Rate for Payer: Aetna Commercial |
$633.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$605.44
|
| Rate for Payer: Aetna Managed Medicare |
$126.26
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$457.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$352.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$337.92
|
| Rate for Payer: Anthem Medicare Advantage |
$126.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$373.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$126.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$126.26
|
| Rate for Payer: Cash Price |
$211.20
|
| Rate for Payer: Cash Price |
$211.20
|
| Rate for Payer: Cigna Commercial |
$647.68
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$126.26
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$393.96
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$126.26
|
| Rate for Payer: Health EOS Commercial |
$626.56
|
| Rate for Payer: HFN Commercial |
$647.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$469.69
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$126.26
|
| Rate for Payer: Independent Care Health Plan Medicare |
$126.26
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$126.26
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$126.26
|
| Rate for Payer: Multiplan Commercial |
$563.20
|
| Rate for Payer: NAPHCARE Commercial |
$189.39
|
| Rate for Payer: Preferred Network Access Commercial |
$647.68
|
| Rate for Payer: Quartz Beloit One Network |
$344.96
|
| Rate for Payer: Quartz Commercial |
$457.60
|
| Rate for Payer: Quartz Medicare Advantage |
$126.26
|
| Rate for Payer: The Alliance Commercial |
$505.04
|
| Rate for Payer: United Healthcare Medicare Advantage |
$126.26
|
| Rate for Payer: WEA Trust Commercial |
$387.20
|
| Rate for Payer: Wellcare Medicare |
$126.26
|
| Rate for Payer: WPS Commercial |
$521.45
|
|
|
Holter Monitor Scan
|
Facility
|
IP
|
$1,401.00
|
|
|
Service Code
|
CPT 93226
|
| Hospital Charge Code |
2982415
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$686.49 |
| Max. Negotiated Rate |
$1,288.92 |
| Rate for Payer: Aetna Commercial |
$1,260.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,204.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$742.53
|
| Rate for Payer: Cash Price |
$420.30
|
| Rate for Payer: Cigna Commercial |
$1,288.92
|
| Rate for Payer: Health EOS Commercial |
$1,246.89
|
| Rate for Payer: HFN Commercial |
$1,288.92
|
| Rate for Payer: Multiplan Commercial |
$1,120.80
|
| Rate for Payer: NAPHCARE Commercial |
$840.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,288.92
|
| Rate for Payer: Quartz Beloit One Network |
$686.49
|
| Rate for Payer: Quartz Commercial |
$840.60
|
| Rate for Payer: WEA Trust Commercial |
$770.55
|
| Rate for Payer: WPS Commercial |
$1,037.72
|
|
|
Holter Monitor Scan
|
Facility
|
OP
|
$1,401.00
|
|
|
Service Code
|
CPT 93226
|
| Hospital Charge Code |
2982415
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$60.46 |
| Max. Negotiated Rate |
$1,288.92 |
| Rate for Payer: Aetna Commercial |
$1,260.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,204.86
|
| Rate for Payer: Aetna Managed Medicare |
$60.46
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$910.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$700.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$672.48
|
| Rate for Payer: Anthem Medicare Advantage |
$60.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$742.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$60.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$60.46
|
| Rate for Payer: Cash Price |
$420.30
|
| Rate for Payer: Cash Price |
$420.30
|
| Rate for Payer: Cigna Commercial |
$1,288.92
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$60.46
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$784.00
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$60.46
|
| Rate for Payer: Health EOS Commercial |
$1,246.89
|
| Rate for Payer: HFN Commercial |
$1,288.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$224.91
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$60.46
|
| Rate for Payer: Independent Care Health Plan Medicare |
$60.46
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$60.46
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$60.46
|
| Rate for Payer: Multiplan Commercial |
$1,120.80
|
| Rate for Payer: NAPHCARE Commercial |
$90.69
|
| Rate for Payer: Preferred Network Access Commercial |
$1,288.92
|
| Rate for Payer: Quartz Beloit One Network |
$686.49
|
| Rate for Payer: Quartz Commercial |
$910.65
|
| Rate for Payer: Quartz Medicare Advantage |
$60.46
|
| Rate for Payer: The Alliance Commercial |
$241.84
|
| Rate for Payer: United Healthcare Medicare Advantage |
$60.46
|
| Rate for Payer: United Healthcare PPO |
$1,050.75
|
| Rate for Payer: WEA Trust Commercial |
$770.55
|
| Rate for Payer: Wellcare Medicare |
$60.46
|
| Rate for Payer: WPS Commercial |
$1,037.72
|
|
|
Holter Monitor Scan w/ Report
|
Professional
|
Both
|
$1,485.00
|
|
|
Service Code
|
CPT 93226
|
| Hospital Charge Code |
4596643
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$137.28 |
| Max. Negotiated Rate |
$1,410.75 |
| Rate for Payer: Aetna Commercial |
$1,410.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,277.10
|
| Rate for Payer: Cash Price |
$445.50
|
| Rate for Payer: Cash Price |
$445.50
|
| Rate for Payer: Cash Price |
$445.50
|
| Rate for Payer: Cigna Commercial |
$1,410.75
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$742.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$891.00
|
| Rate for Payer: Health EOS Commercial |
$1,351.35
|
| Rate for Payer: HFN Commercial |
$1,410.75
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$137.28
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$137.28
|
| Rate for Payer: Multiplan Commercial |
$1,188.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,410.75
|
| Rate for Payer: Quartz Beloit One Network |
$653.40
|
| Rate for Payer: Quartz Commercial |
$846.45
|
| Rate for Payer: The Alliance Commercial |
$742.50
|
| Rate for Payer: WEA Trust Commercial |
$816.75
|
| Rate for Payer: WPS Commercial |
$1,099.94
|
|
|
Holter Monitor Scan w/ Report
|
Facility
|
IP
|
$1,485.00
|
|
|
Service Code
|
CPT 93226
|
| Hospital Charge Code |
4596643
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$727.65 |
| Max. Negotiated Rate |
$1,366.20 |
| Rate for Payer: Aetna Commercial |
$1,336.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,277.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$787.05
|
| Rate for Payer: Cash Price |
$445.50
|
| Rate for Payer: Cigna Commercial |
$1,366.20
|
| Rate for Payer: Health EOS Commercial |
$1,321.65
|
| Rate for Payer: HFN Commercial |
$1,366.20
|
| Rate for Payer: Multiplan Commercial |
$1,188.00
|
| Rate for Payer: NAPHCARE Commercial |
$891.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,366.20
|
| Rate for Payer: Quartz Beloit One Network |
$727.65
|
| Rate for Payer: Quartz Commercial |
$891.00
|
| Rate for Payer: WEA Trust Commercial |
$816.75
|
| Rate for Payer: WPS Commercial |
$1,099.94
|
|
|
Holter Monitor Scan w/ Report
|
Facility
|
OP
|
$1,485.00
|
|
|
Service Code
|
CPT 93226
|
| Hospital Charge Code |
4596643
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$60.46 |
| Max. Negotiated Rate |
$1,366.20 |
| Rate for Payer: Aetna Commercial |
$1,336.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,277.10
|
| Rate for Payer: Aetna Managed Medicare |
$60.46
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$965.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$742.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$712.80
|
| Rate for Payer: Anthem Medicare Advantage |
$60.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$787.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$60.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$60.46
|
| Rate for Payer: Cash Price |
$445.50
|
| Rate for Payer: Cash Price |
$445.50
|
| Rate for Payer: Cigna Commercial |
$1,366.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$60.46
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$831.01
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$60.46
|
| Rate for Payer: Health EOS Commercial |
$1,321.65
|
| Rate for Payer: HFN Commercial |
$1,366.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$224.91
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$60.46
|
| Rate for Payer: Independent Care Health Plan Medicare |
$60.46
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$60.46
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$60.46
|
| Rate for Payer: Multiplan Commercial |
$1,188.00
|
| Rate for Payer: NAPHCARE Commercial |
$90.69
|
| Rate for Payer: Preferred Network Access Commercial |
$1,366.20
|
| Rate for Payer: Quartz Beloit One Network |
$727.65
|
| Rate for Payer: Quartz Commercial |
$965.25
|
| Rate for Payer: Quartz Medicare Advantage |
$60.46
|
| Rate for Payer: The Alliance Commercial |
$241.84
|
| Rate for Payer: United Healthcare Medicare Advantage |
$60.46
|
| Rate for Payer: United Healthcare PPO |
$1,113.75
|
| Rate for Payer: WEA Trust Commercial |
$816.75
|
| Rate for Payer: Wellcare Medicare |
$60.46
|
| Rate for Payer: WPS Commercial |
$1,099.94
|
|
|
Home Sleep Test
|
Facility
|
OP
|
$927.00
|
|
|
Service Code
|
CPT 95806
|
| Hospital Charge Code |
3801364
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$154.39 |
| Max. Negotiated Rate |
$1,397.00 |
| Rate for Payer: Aetna Commercial |
$834.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$797.22
|
| Rate for Payer: Aetna Managed Medicare |
$154.39
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,397.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,149.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,091.00
|
| Rate for Payer: Anthem Medicare Advantage |
$154.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$491.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$154.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$154.39
|
| Rate for Payer: Cash Price |
$278.10
|
| Rate for Payer: Cash Price |
$278.10
|
| Rate for Payer: Cash Price |
$278.10
|
| Rate for Payer: Cigna Commercial |
$852.84
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$154.39
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$518.75
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$154.39
|
| Rate for Payer: Health EOS Commercial |
$825.03
|
| Rate for Payer: HFN Commercial |
$852.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$574.33
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$154.39
|
| Rate for Payer: Independent Care Health Plan Medicare |
$154.39
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$154.39
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$154.39
|
| Rate for Payer: Multiplan Commercial |
$741.60
|
| Rate for Payer: NAPHCARE Commercial |
$231.58
|
| Rate for Payer: Preferred Network Access Commercial |
$852.84
|
| Rate for Payer: Quartz Beloit One Network |
$454.23
|
| Rate for Payer: Quartz Commercial |
$602.55
|
| Rate for Payer: Quartz Medicare Advantage |
$154.39
|
| Rate for Payer: The Alliance Commercial |
$617.56
|
| Rate for Payer: United Healthcare Medicare Advantage |
$154.39
|
| Rate for Payer: United Healthcare PPO |
$695.25
|
| Rate for Payer: WEA Trust Commercial |
$509.85
|
| Rate for Payer: Wellcare Medicare |
$154.39
|
| Rate for Payer: WPS Commercial |
$686.63
|
|
|
Home Sleep Test
|
Facility
|
IP
|
$927.00
|
|
|
Service Code
|
CPT 95806
|
| Hospital Charge Code |
3801364
|
|
Hospital Revenue Code
|
740
|
| Min. Negotiated Rate |
$454.23 |
| Max. Negotiated Rate |
$852.84 |
| Rate for Payer: Aetna Commercial |
$834.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$797.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$491.31
|
| Rate for Payer: Cash Price |
$278.10
|
| Rate for Payer: Cigna Commercial |
$852.84
|
| Rate for Payer: Health EOS Commercial |
$825.03
|
| Rate for Payer: HFN Commercial |
$852.84
|
| Rate for Payer: Multiplan Commercial |
$741.60
|
| Rate for Payer: NAPHCARE Commercial |
$556.20
|
| Rate for Payer: Preferred Network Access Commercial |
$852.84
|
| Rate for Payer: Quartz Beloit One Network |
$454.23
|
| Rate for Payer: Quartz Commercial |
$556.20
|
| Rate for Payer: WEA Trust Commercial |
$509.85
|
| Rate for Payer: WPS Commercial |
$686.63
|
|
|
Homocysteine, Cardio
|
Professional
|
Both
|
$323.00
|
|
|
Service Code
|
CPT 83090
|
| Hospital Charge Code |
5749631
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$63.26 |
| Max. Negotiated Rate |
$306.85 |
| Rate for Payer: Aetna Commercial |
$306.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$277.78
|
| Rate for Payer: Cash Price |
$96.90
|
| Rate for Payer: Cash Price |
$96.90
|
| Rate for Payer: Cigna Commercial |
$306.85
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$161.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$193.80
|
| Rate for Payer: Health EOS Commercial |
$293.93
|
| Rate for Payer: HFN Commercial |
$306.85
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$63.26
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$63.26
|
| Rate for Payer: Multiplan Commercial |
$258.40
|
| Rate for Payer: Preferred Network Access Commercial |
$306.85
|
| Rate for Payer: Quartz Beloit One Network |
$142.12
|
| Rate for Payer: Quartz Commercial |
$184.11
|
| Rate for Payer: The Alliance Commercial |
$161.50
|
| Rate for Payer: WEA Trust Commercial |
$177.65
|
| Rate for Payer: WPS Commercial |
$239.25
|
|
|
Homocysteine, Cardio
|
Facility
|
OP
|
$323.00
|
|
|
Service Code
|
CPT 83090
|
| Hospital Charge Code |
5749631
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.92 |
| Max. Negotiated Rate |
$297.16 |
| Rate for Payer: Aetna Commercial |
$290.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$277.78
|
| Rate for Payer: Aetna Managed Medicare |
$17.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$67.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$31.36
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$29.75
|
| Rate for Payer: Anthem Medicaid |
$18.52
|
| Rate for Payer: Anthem Medicare Advantage |
$17.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$171.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$17.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$17.92
|
| Rate for Payer: Cash Price |
$96.90
|
| Rate for Payer: Cash Price |
$96.90
|
| Rate for Payer: Cigna Commercial |
$297.16
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$17.92
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$18.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$180.75
|
| Rate for Payer: Dean Health Medicaid |
$18.52
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$17.92
|
| Rate for Payer: Health EOS Commercial |
$287.47
|
| Rate for Payer: HFN Commercial |
$297.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$66.66
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$17.92
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$18.52
|
| Rate for Payer: Independent Care Health Plan Medicare |
$17.92
|
| Rate for Payer: Managed Health Services Medicaid |
$19.26
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$17.92
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$17.92
|
| Rate for Payer: Multiplan Commercial |
$258.40
|
| Rate for Payer: NAPHCARE Commercial |
$26.88
|
| Rate for Payer: Preferred Network Access Commercial |
$297.16
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$18.52
|
| Rate for Payer: Quartz Beloit One Network |
$158.27
|
| Rate for Payer: Quartz Commercial |
$209.95
|
| Rate for Payer: Quartz Medicare Advantage |
$17.92
|
| Rate for Payer: The Alliance Commercial |
$71.68
|
| Rate for Payer: United Healthcare Medicaid |
$18.52
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17.92
|
| Rate for Payer: United Healthcare PPO |
$242.25
|
| Rate for Payer: WEA Trust Commercial |
$177.65
|
| Rate for Payer: Wellcare Medicare |
$17.92
|
| Rate for Payer: WMAP Medicaid |
$18.52
|
| Rate for Payer: WPS Commercial |
$239.25
|
|
|
Homocysteine, Cardio
|
Facility
|
IP
|
$323.00
|
|
|
Service Code
|
CPT 83090
|
| Hospital Charge Code |
5749631
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$158.27 |
| Max. Negotiated Rate |
$297.16 |
| Rate for Payer: Aetna Commercial |
$290.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$277.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$171.19
|
| Rate for Payer: Cash Price |
$96.90
|
| Rate for Payer: Cigna Commercial |
$297.16
|
| Rate for Payer: Health EOS Commercial |
$287.47
|
| Rate for Payer: HFN Commercial |
$297.16
|
| Rate for Payer: Multiplan Commercial |
$258.40
|
| Rate for Payer: NAPHCARE Commercial |
$193.80
|
| Rate for Payer: Preferred Network Access Commercial |
$297.16
|
| Rate for Payer: Quartz Beloit One Network |
$158.27
|
| Rate for Payer: Quartz Commercial |
$193.80
|
| Rate for Payer: WEA Trust Commercial |
$177.65
|
| Rate for Payer: WPS Commercial |
$239.25
|
|
|
Homocysteine, Cardiovascular
|
Facility
|
OP
|
$630.00
|
|
|
Service Code
|
CPT 83090
|
| Hospital Charge Code |
1039201
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.92 |
| Max. Negotiated Rate |
$579.60 |
| Rate for Payer: Aetna Commercial |
$567.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$541.80
|
| Rate for Payer: Aetna Managed Medicare |
$17.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$67.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$31.36
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$29.75
|
| Rate for Payer: Anthem Medicaid |
$18.52
|
| Rate for Payer: Anthem Medicare Advantage |
$17.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$333.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$17.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$17.92
|
| Rate for Payer: Cash Price |
$189.00
|
| Rate for Payer: Cash Price |
$189.00
|
| Rate for Payer: Cigna Commercial |
$579.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$17.92
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$18.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$352.55
|
| Rate for Payer: Dean Health Medicaid |
$18.52
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$17.92
|
| Rate for Payer: Health EOS Commercial |
$560.70
|
| Rate for Payer: HFN Commercial |
$579.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$66.66
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$17.92
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$18.52
|
| Rate for Payer: Independent Care Health Plan Medicare |
$17.92
|
| Rate for Payer: Managed Health Services Medicaid |
$19.26
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$17.92
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$17.92
|
| Rate for Payer: Multiplan Commercial |
$504.00
|
| Rate for Payer: NAPHCARE Commercial |
$26.88
|
| Rate for Payer: Preferred Network Access Commercial |
$579.60
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$18.52
|
| Rate for Payer: Quartz Beloit One Network |
$308.70
|
| Rate for Payer: Quartz Commercial |
$409.50
|
| Rate for Payer: Quartz Medicare Advantage |
$17.92
|
| Rate for Payer: The Alliance Commercial |
$71.68
|
| Rate for Payer: United Healthcare Medicaid |
$18.52
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17.92
|
| Rate for Payer: United Healthcare PPO |
$472.50
|
| Rate for Payer: WEA Trust Commercial |
$346.50
|
| Rate for Payer: Wellcare Medicare |
$17.92
|
| Rate for Payer: WMAP Medicaid |
$18.52
|
| Rate for Payer: WPS Commercial |
$466.64
|
|
|
Homocysteine, Cardiovascular
|
Professional
|
Both
|
$630.00
|
|
|
Service Code
|
CPT 83090
|
| Hospital Charge Code |
1039201
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$63.26 |
| Max. Negotiated Rate |
$598.50 |
| Rate for Payer: Aetna Commercial |
$598.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$541.80
|
| Rate for Payer: Cash Price |
$189.00
|
| Rate for Payer: Cash Price |
$189.00
|
| Rate for Payer: Cigna Commercial |
$598.50
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$315.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$378.00
|
| Rate for Payer: Health EOS Commercial |
$573.30
|
| Rate for Payer: HFN Commercial |
$598.50
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$63.26
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$63.26
|
| Rate for Payer: Multiplan Commercial |
$504.00
|
| Rate for Payer: Preferred Network Access Commercial |
$598.50
|
| Rate for Payer: Quartz Beloit One Network |
$277.20
|
| Rate for Payer: Quartz Commercial |
$359.10
|
| Rate for Payer: The Alliance Commercial |
$315.00
|
| Rate for Payer: WEA Trust Commercial |
$346.50
|
| Rate for Payer: WPS Commercial |
$466.64
|
|
|
Homocysteine, Cardiovascular
|
Facility
|
IP
|
$630.00
|
|
|
Service Code
|
CPT 83090
|
| Hospital Charge Code |
1039201
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$308.70 |
| Max. Negotiated Rate |
$579.60 |
| Rate for Payer: Aetna Commercial |
$567.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$541.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$333.90
|
| Rate for Payer: Cash Price |
$189.00
|
| Rate for Payer: Cigna Commercial |
$579.60
|
| Rate for Payer: Health EOS Commercial |
$560.70
|
| Rate for Payer: HFN Commercial |
$579.60
|
| Rate for Payer: Multiplan Commercial |
$504.00
|
| Rate for Payer: NAPHCARE Commercial |
$378.00
|
| Rate for Payer: Preferred Network Access Commercial |
$579.60
|
| Rate for Payer: Quartz Beloit One Network |
$308.70
|
| Rate for Payer: Quartz Commercial |
$378.00
|
| Rate for Payer: WEA Trust Commercial |
$346.50
|
| Rate for Payer: WPS Commercial |
$466.64
|
|
|
Homovanillic Acid 24 Hour Urine
|
Facility
|
IP
|
$46.92
|
|
|
Service Code
|
CPT 83150
|
| Hospital Charge Code |
977983
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$22.99 |
| Max. Negotiated Rate |
$43.17 |
| Rate for Payer: Aetna Commercial |
$42.23
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$40.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$24.87
|
| Rate for Payer: Cash Price |
$14.08
|
| Rate for Payer: Cigna Commercial |
$43.17
|
| Rate for Payer: Health EOS Commercial |
$41.76
|
| Rate for Payer: HFN Commercial |
$43.17
|
| Rate for Payer: Multiplan Commercial |
$37.54
|
| Rate for Payer: NAPHCARE Commercial |
$28.15
|
| Rate for Payer: Preferred Network Access Commercial |
$43.17
|
| Rate for Payer: Quartz Beloit One Network |
$22.99
|
| Rate for Payer: Quartz Commercial |
$28.15
|
| Rate for Payer: WEA Trust Commercial |
$25.81
|
| Rate for Payer: WPS Commercial |
$34.75
|
|
|
Homovanillic Acid 24 Hour Urine
|
Professional
|
Both
|
$46.92
|
|
|
Service Code
|
CPT 83150
|
| Hospital Charge Code |
977983
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$20.64 |
| Max. Negotiated Rate |
$79.11 |
| Rate for Payer: Aetna Commercial |
$44.57
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$40.35
|
| Rate for Payer: Cash Price |
$14.08
|
| Rate for Payer: Cash Price |
$14.08
|
| Rate for Payer: Cigna Commercial |
$44.57
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$23.46
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$28.15
|
| Rate for Payer: Health EOS Commercial |
$42.70
|
| Rate for Payer: HFN Commercial |
$44.57
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$79.11
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$79.11
|
| Rate for Payer: Multiplan Commercial |
$37.54
|
| Rate for Payer: Preferred Network Access Commercial |
$44.57
|
| Rate for Payer: Quartz Beloit One Network |
$20.64
|
| Rate for Payer: Quartz Commercial |
$26.74
|
| Rate for Payer: The Alliance Commercial |
$23.46
|
| Rate for Payer: WEA Trust Commercial |
$25.81
|
| Rate for Payer: WPS Commercial |
$34.75
|
|
|
Homovanillic Acid 24 Hour Urine
|
Facility
|
OP
|
$46.92
|
|
|
Service Code
|
CPT 83150
|
| Hospital Charge Code |
977983
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$19.62 |
| Max. Negotiated Rate |
$89.64 |
| Rate for Payer: Aetna Commercial |
$42.23
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$40.35
|
| Rate for Payer: Aetna Managed Medicare |
$22.41
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$84.04
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$39.22
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$37.20
|
| Rate for Payer: Anthem Medicaid |
$19.62
|
| Rate for Payer: Anthem Medicare Advantage |
$22.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$24.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$22.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$22.41
|
| Rate for Payer: Cash Price |
$14.08
|
| Rate for Payer: Cash Price |
$14.08
|
| Rate for Payer: Cigna Commercial |
$43.17
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$22.41
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$19.62
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$26.26
|
| Rate for Payer: Dean Health Medicaid |
$19.62
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$22.41
|
| Rate for Payer: Health EOS Commercial |
$41.76
|
| Rate for Payer: HFN Commercial |
$43.17
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$83.37
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$22.41
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$19.62
|
| Rate for Payer: Independent Care Health Plan Medicare |
$22.41
|
| Rate for Payer: Managed Health Services Medicaid |
$20.40
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$22.41
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$22.41
|
| Rate for Payer: Multiplan Commercial |
$37.54
|
| Rate for Payer: NAPHCARE Commercial |
$33.62
|
| Rate for Payer: Preferred Network Access Commercial |
$43.17
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$19.62
|
| Rate for Payer: Quartz Beloit One Network |
$22.99
|
| Rate for Payer: Quartz Commercial |
$30.50
|
| Rate for Payer: Quartz Medicare Advantage |
$22.41
|
| Rate for Payer: The Alliance Commercial |
$89.64
|
| Rate for Payer: United Healthcare Medicaid |
$19.62
|
| Rate for Payer: United Healthcare Medicare Advantage |
$22.41
|
| Rate for Payer: United Healthcare PPO |
$35.19
|
| Rate for Payer: WEA Trust Commercial |
$25.81
|
| Rate for Payer: Wellcare Medicare |
$22.41
|
| Rate for Payer: WMAP Medicaid |
$19.62
|
| Rate for Payer: WPS Commercial |
$34.75
|
|
|
Homovanillic Acid, Random Urine
|
Professional
|
Both
|
$46.59
|
|
|
Service Code
|
CPT 82570
|
| Hospital Charge Code |
4076076
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.29 |
| Max. Negotiated Rate |
$44.26 |
| Rate for Payer: Aetna Commercial |
$44.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$40.07
|
| Rate for Payer: Cash Price |
$13.98
|
| Rate for Payer: Cash Price |
$13.98
|
| Rate for Payer: Cigna Commercial |
$44.26
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$23.30
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$27.95
|
| Rate for Payer: Health EOS Commercial |
$42.40
|
| Rate for Payer: HFN Commercial |
$44.26
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$18.29
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$18.29
|
| Rate for Payer: Multiplan Commercial |
$37.27
|
| Rate for Payer: Preferred Network Access Commercial |
$44.26
|
| Rate for Payer: Quartz Beloit One Network |
$20.50
|
| Rate for Payer: Quartz Commercial |
$26.56
|
| Rate for Payer: The Alliance Commercial |
$23.30
|
| Rate for Payer: WEA Trust Commercial |
$25.62
|
| Rate for Payer: WPS Commercial |
$34.51
|
|
|
Homovanillic Acid, Random Urine
|
Facility
|
OP
|
$46.59
|
|
|
Service Code
|
CPT 82570
|
| Hospital Charge Code |
4076076
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.18 |
| Max. Negotiated Rate |
$42.86 |
| Rate for Payer: Aetna Commercial |
$41.93
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$40.07
|
| Rate for Payer: Aetna Managed Medicare |
$5.18
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$19.42
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$9.06
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$8.60
|
| Rate for Payer: Anthem Medicaid |
$5.35
|
| Rate for Payer: Anthem Medicare Advantage |
$5.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$24.69
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5.18
|
| Rate for Payer: Cash Price |
$13.98
|
| Rate for Payer: Cash Price |
$13.98
|
| Rate for Payer: Cigna Commercial |
$42.86
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$5.18
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$5.35
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$26.07
|
| Rate for Payer: Dean Health Medicaid |
$5.35
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$5.18
|
| Rate for Payer: Health EOS Commercial |
$41.47
|
| Rate for Payer: HFN Commercial |
$42.86
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$19.27
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$5.18
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$5.35
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5.18
|
| Rate for Payer: Managed Health Services Medicaid |
$5.56
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$5.18
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$5.18
|
| Rate for Payer: Multiplan Commercial |
$37.27
|
| Rate for Payer: NAPHCARE Commercial |
$7.77
|
| Rate for Payer: Preferred Network Access Commercial |
$42.86
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$5.35
|
| Rate for Payer: Quartz Beloit One Network |
$22.83
|
| Rate for Payer: Quartz Commercial |
$30.28
|
| Rate for Payer: Quartz Medicare Advantage |
$5.18
|
| Rate for Payer: The Alliance Commercial |
$20.72
|
| Rate for Payer: United Healthcare Medicaid |
$5.35
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.18
|
| Rate for Payer: United Healthcare PPO |
$34.94
|
| Rate for Payer: WEA Trust Commercial |
$25.62
|
| Rate for Payer: Wellcare Medicare |
$5.18
|
| Rate for Payer: WMAP Medicaid |
$5.35
|
| Rate for Payer: WPS Commercial |
$34.51
|
|
