|
Amikacin Level Trough
|
Professional
|
$219.00
|
|
|
Service Code
|
CPT 80150
|
| Hospital Charge Code |
633647
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.08 |
| Max. Negotiated Rate |
$208.05 |
| Rate for Payer: Aetna Commercial |
$208.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$188.34
|
| Rate for Payer: Aetna Managed Medicare |
$15.08
|
| Rate for Payer: Anthem Medicare Advantage |
$15.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$15.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$15.08
|
| Rate for Payer: Cash Price |
$65.70
|
| Rate for Payer: Cash Price |
$65.70
|
| Rate for Payer: Cigna Commercial |
$208.05
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$109.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$15.08
|
| Rate for Payer: Health EOS Commercial |
$199.29
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$53.23
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$53.23
|
| Rate for Payer: Independent Care Health Plan Medicare |
$15.08
|
| Rate for Payer: Multiplan Commercial |
$175.20
|
| Rate for Payer: Preferred Network Access Commercial |
$208.05
|
| Rate for Payer: Quartz Beloit One Network |
$96.36
|
| Rate for Payer: Quartz Commercial |
$124.83
|
| Rate for Payer: Quartz Medicare Advantage |
$15.08
|
| Rate for Payer: The Alliance Commercial |
$59.57
|
| Rate for Payer: United Healthcare Medicare Advantage |
$15.08
|
| Rate for Payer: WEA Trust Commercial |
$120.45
|
| Rate for Payer: WPS Commercial |
$66.35
|
|
|
Amikacin Level Trough
|
Facility
IP
|
$219.00
|
|
|
Service Code
|
CPT 80150
|
| Hospital Charge Code |
633647
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$107.31 |
| Max. Negotiated Rate |
$201.48 |
| Rate for Payer: Aetna Commercial |
$197.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$116.07
|
| Rate for Payer: Cash Price |
$65.70
|
| Rate for Payer: Cigna Commercial |
$201.48
|
| Rate for Payer: Health EOS Commercial |
$194.91
|
| Rate for Payer: HFN Commercial |
$201.48
|
| Rate for Payer: Multiplan Commercial |
$175.20
|
| Rate for Payer: NAPHCARE Commercial |
$131.40
|
| Rate for Payer: Preferred Network Access Commercial |
$201.48
|
| Rate for Payer: Quartz Beloit One Network |
$107.31
|
| Rate for Payer: Quartz Commercial |
$131.40
|
| Rate for Payer: WEA Trust Commercial |
$120.45
|
| Rate for Payer: WPS Commercial |
$162.21
|
|
|
Amikacin Peak & Trough Level
|
Professional
|
$326.00
|
|
|
Service Code
|
CPT 80150
|
| Hospital Charge Code |
633645
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.08 |
| Max. Negotiated Rate |
$309.70 |
| Rate for Payer: Aetna Commercial |
$309.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$280.36
|
| Rate for Payer: Aetna Managed Medicare |
$15.08
|
| Rate for Payer: Anthem Medicare Advantage |
$15.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$15.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$15.08
|
| Rate for Payer: Cash Price |
$97.80
|
| Rate for Payer: Cash Price |
$97.80
|
| Rate for Payer: Cigna Commercial |
$309.70
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$163.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$15.08
|
| Rate for Payer: Health EOS Commercial |
$296.66
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$53.23
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$53.23
|
| Rate for Payer: Independent Care Health Plan Medicare |
$15.08
|
| Rate for Payer: Multiplan Commercial |
$260.80
|
| Rate for Payer: Preferred Network Access Commercial |
$309.70
|
| Rate for Payer: Quartz Beloit One Network |
$143.44
|
| Rate for Payer: Quartz Commercial |
$185.82
|
| Rate for Payer: Quartz Medicare Advantage |
$15.08
|
| Rate for Payer: The Alliance Commercial |
$59.57
|
| Rate for Payer: United Healthcare Medicare Advantage |
$15.08
|
| Rate for Payer: WEA Trust Commercial |
$179.30
|
| Rate for Payer: WPS Commercial |
$66.35
|
|
|
Amikacin Peak & Trough Level
|
Facility
OP
|
$326.00
|
|
|
Service Code
|
CPT 80150
|
| Hospital Charge Code |
633645
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.08 |
| Max. Negotiated Rate |
$1,304.00 |
| Rate for Payer: Aetna Commercial |
$293.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$280.36
|
| Rate for Payer: Aetna Managed Medicare |
$15.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$56.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$26.39
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$25.03
|
| Rate for Payer: Anthem Medicaid |
$15.58
|
| Rate for Payer: Anthem Medicare Advantage |
$15.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$172.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$15.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$15.08
|
| Rate for Payer: Cash Price |
$97.80
|
| Rate for Payer: Cash Price |
$97.80
|
| Rate for Payer: Cigna Commercial |
$299.92
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$15.08
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$15.58
|
| Rate for Payer: Dean Health Medicaid |
$15.58
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$15.08
|
| Rate for Payer: Health EOS Commercial |
$290.14
|
| Rate for Payer: HFN Commercial |
$299.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$56.10
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$15.08
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$15.58
|
| Rate for Payer: Independent Care Health Plan Medicare |
$15.08
|
| Rate for Payer: Managed Health Services Medicaid |
$16.20
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$15.08
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$15.08
|
| Rate for Payer: Multiplan Commercial |
$260.80
|
| Rate for Payer: NAPHCARE Commercial |
$22.62
|
| Rate for Payer: Preferred Network Access Commercial |
$299.92
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$15.58
|
| Rate for Payer: Quartz Beloit One Network |
$159.74
|
| Rate for Payer: Quartz Commercial |
$211.90
|
| Rate for Payer: Quartz Medicare Advantage |
$15.08
|
| Rate for Payer: The Alliance Commercial |
$1,304.00
|
| Rate for Payer: United Healthcare Medicaid |
$15.58
|
| Rate for Payer: United Healthcare Medicare Advantage |
$15.08
|
| Rate for Payer: United Healthcare PPO |
$244.50
|
| Rate for Payer: WEA Trust Commercial |
$179.30
|
| Rate for Payer: Wellcare Medicare |
$15.08
|
| Rate for Payer: WMAP Medicaid |
$15.58
|
| Rate for Payer: WPS Commercial |
$241.47
|
|
|
Amikacin Peak & Trough Level
|
Facility
IP
|
$326.00
|
|
|
Service Code
|
CPT 80150
|
| Hospital Charge Code |
633645
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$159.74 |
| Max. Negotiated Rate |
$299.92 |
| Rate for Payer: Aetna Commercial |
$293.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$172.78
|
| Rate for Payer: Cash Price |
$97.80
|
| Rate for Payer: Cigna Commercial |
$299.92
|
| Rate for Payer: Health EOS Commercial |
$290.14
|
| Rate for Payer: HFN Commercial |
$299.92
|
| Rate for Payer: Multiplan Commercial |
$260.80
|
| Rate for Payer: NAPHCARE Commercial |
$195.60
|
| Rate for Payer: Preferred Network Access Commercial |
$299.92
|
| Rate for Payer: Quartz Beloit One Network |
$159.74
|
| Rate for Payer: Quartz Commercial |
$195.60
|
| Rate for Payer: WEA Trust Commercial |
$179.30
|
| Rate for Payer: WPS Commercial |
$241.47
|
|
|
Amino Acid
|
Facility
OP
|
$217.00
|
|
|
Service Code
|
CPT 82570
|
| Hospital Charge Code |
4422799
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.18 |
| Max. Negotiated Rate |
$868.00 |
| Rate for Payer: Aetna Commercial |
$195.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$186.62
|
| 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 |
$115.01
|
| 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 |
$65.10
|
| Rate for Payer: Cash Price |
$65.10
|
| Rate for Payer: Cigna Commercial |
$199.64
|
| 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 Medicaid |
$5.35
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$5.18
|
| Rate for Payer: Health EOS Commercial |
$193.13
|
| Rate for Payer: HFN Commercial |
$199.64
|
| 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 |
$173.60
|
| Rate for Payer: NAPHCARE Commercial |
$7.77
|
| Rate for Payer: Preferred Network Access Commercial |
$199.64
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$5.35
|
| Rate for Payer: Quartz Beloit One Network |
$106.33
|
| Rate for Payer: Quartz Commercial |
$141.05
|
| Rate for Payer: Quartz Medicare Advantage |
$5.18
|
| Rate for Payer: The Alliance Commercial |
$868.00
|
| Rate for Payer: United Healthcare Medicaid |
$5.35
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.18
|
| Rate for Payer: United Healthcare PPO |
$162.75
|
| Rate for Payer: WEA Trust Commercial |
$119.35
|
| Rate for Payer: Wellcare Medicare |
$5.18
|
| Rate for Payer: WMAP Medicaid |
$5.35
|
| Rate for Payer: WPS Commercial |
$160.73
|
|
|
Amino Acid
|
Professional
|
$217.00
|
|
|
Service Code
|
CPT 82570
|
| Hospital Charge Code |
4422799
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.18 |
| Max. Negotiated Rate |
$206.15 |
| Rate for Payer: Aetna Commercial |
$206.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$186.62
|
| Rate for Payer: Aetna Managed Medicare |
$5.18
|
| Rate for Payer: Anthem Medicare Advantage |
$5.18
|
| 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 |
$65.10
|
| Rate for Payer: Cash Price |
$65.10
|
| Rate for Payer: Cigna Commercial |
$206.15
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$108.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5.18
|
| Rate for Payer: Health EOS Commercial |
$197.47
|
| 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: Independent Care Health Plan Medicare |
$5.18
|
| Rate for Payer: Multiplan Commercial |
$173.60
|
| Rate for Payer: Preferred Network Access Commercial |
$206.15
|
| Rate for Payer: Quartz Beloit One Network |
$95.48
|
| Rate for Payer: Quartz Commercial |
$123.69
|
| Rate for Payer: Quartz Medicare Advantage |
$5.18
|
| Rate for Payer: The Alliance Commercial |
$20.46
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.18
|
| Rate for Payer: WEA Trust Commercial |
$119.35
|
| Rate for Payer: WPS Commercial |
$22.79
|
|
|
Amino Acid
|
Facility
IP
|
$217.00
|
|
|
Service Code
|
CPT 82570
|
| Hospital Charge Code |
4422799
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$106.33 |
| Max. Negotiated Rate |
$199.64 |
| Rate for Payer: Aetna Commercial |
$195.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$115.01
|
| Rate for Payer: Cash Price |
$65.10
|
| Rate for Payer: Cigna Commercial |
$199.64
|
| Rate for Payer: Health EOS Commercial |
$193.13
|
| Rate for Payer: HFN Commercial |
$199.64
|
| Rate for Payer: Multiplan Commercial |
$173.60
|
| Rate for Payer: NAPHCARE Commercial |
$130.20
|
| Rate for Payer: Preferred Network Access Commercial |
$199.64
|
| Rate for Payer: Quartz Beloit One Network |
$106.33
|
| Rate for Payer: Quartz Commercial |
$130.20
|
| Rate for Payer: WEA Trust Commercial |
$119.35
|
| Rate for Payer: WPS Commercial |
$160.73
|
|
|
Amino Acid Analysis, Urine
|
Facility
IP
|
$266.00
|
|
|
Service Code
|
CPT 82139
|
| Hospital Charge Code |
4392645
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$130.34 |
| Max. Negotiated Rate |
$244.72 |
| Rate for Payer: Aetna Commercial |
$239.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$140.98
|
| Rate for Payer: Cash Price |
$79.80
|
| Rate for Payer: Cigna Commercial |
$244.72
|
| Rate for Payer: Health EOS Commercial |
$236.74
|
| Rate for Payer: HFN Commercial |
$244.72
|
| Rate for Payer: Multiplan Commercial |
$212.80
|
| Rate for Payer: NAPHCARE Commercial |
$159.60
|
| Rate for Payer: Preferred Network Access Commercial |
$244.72
|
| Rate for Payer: Quartz Beloit One Network |
$130.34
|
| Rate for Payer: Quartz Commercial |
$159.60
|
| Rate for Payer: WEA Trust Commercial |
$146.30
|
| Rate for Payer: WPS Commercial |
$197.03
|
|
|
Amino Acid Analysis, Urine
|
Professional
|
$266.00
|
|
|
Service Code
|
CPT 82139
|
| Hospital Charge Code |
4392645
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$16.87 |
| Max. Negotiated Rate |
$252.70 |
| Rate for Payer: Aetna Commercial |
$252.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$228.76
|
| Rate for Payer: Aetna Managed Medicare |
$16.87
|
| Rate for Payer: Anthem Medicare Advantage |
$16.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$16.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$16.87
|
| Rate for Payer: Cash Price |
$79.80
|
| Rate for Payer: Cash Price |
$79.80
|
| Rate for Payer: Cigna Commercial |
$252.70
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$133.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$16.87
|
| Rate for Payer: Health EOS Commercial |
$242.06
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$59.55
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$59.55
|
| Rate for Payer: Independent Care Health Plan Medicare |
$16.87
|
| Rate for Payer: Multiplan Commercial |
$212.80
|
| Rate for Payer: Preferred Network Access Commercial |
$252.70
|
| Rate for Payer: Quartz Beloit One Network |
$117.04
|
| Rate for Payer: Quartz Commercial |
$151.62
|
| Rate for Payer: Quartz Medicare Advantage |
$16.87
|
| Rate for Payer: The Alliance Commercial |
$66.64
|
| Rate for Payer: United Healthcare Medicare Advantage |
$16.87
|
| Rate for Payer: WEA Trust Commercial |
$146.30
|
| Rate for Payer: WPS Commercial |
$74.23
|
|
|
Amino Acid Analysis, Urine
|
Facility
OP
|
$266.00
|
|
|
Service Code
|
CPT 82139
|
| Hospital Charge Code |
4392645
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$16.87 |
| Max. Negotiated Rate |
$1,064.00 |
| Rate for Payer: Aetna Commercial |
$239.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$228.76
|
| Rate for Payer: Aetna Managed Medicare |
$16.87
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$63.26
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$29.52
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$28.00
|
| Rate for Payer: Anthem Medicaid |
$17.43
|
| Rate for Payer: Anthem Medicare Advantage |
$16.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$140.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$16.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$16.87
|
| Rate for Payer: Cash Price |
$79.80
|
| Rate for Payer: Cash Price |
$79.80
|
| Rate for Payer: Cigna Commercial |
$244.72
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$16.87
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$17.43
|
| Rate for Payer: Dean Health Medicaid |
$17.43
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$16.87
|
| Rate for Payer: Health EOS Commercial |
$236.74
|
| Rate for Payer: HFN Commercial |
$244.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$62.76
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$16.87
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$17.43
|
| Rate for Payer: Independent Care Health Plan Medicare |
$16.87
|
| Rate for Payer: Managed Health Services Medicaid |
$18.13
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$16.87
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$16.87
|
| Rate for Payer: Multiplan Commercial |
$212.80
|
| Rate for Payer: NAPHCARE Commercial |
$25.30
|
| Rate for Payer: Preferred Network Access Commercial |
$244.72
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$17.43
|
| Rate for Payer: Quartz Beloit One Network |
$130.34
|
| Rate for Payer: Quartz Commercial |
$172.90
|
| Rate for Payer: Quartz Medicare Advantage |
$16.87
|
| Rate for Payer: The Alliance Commercial |
$1,064.00
|
| Rate for Payer: United Healthcare Medicaid |
$17.43
|
| Rate for Payer: United Healthcare Medicare Advantage |
$16.87
|
| Rate for Payer: United Healthcare PPO |
$199.50
|
| Rate for Payer: WEA Trust Commercial |
$146.30
|
| Rate for Payer: Wellcare Medicare |
$16.87
|
| Rate for Payer: WMAP Medicaid |
$17.43
|
| Rate for Payer: WPS Commercial |
$197.03
|
|
|
Amino Acid Quantitative
|
Facility
OP
|
$787.00
|
|
|
Service Code
|
CPT 82139
|
| Hospital Charge Code |
977864
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$16.87 |
| Max. Negotiated Rate |
$3,148.00 |
| Rate for Payer: Aetna Commercial |
$708.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$676.82
|
| Rate for Payer: Aetna Managed Medicare |
$16.87
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$63.26
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$29.52
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$28.00
|
| Rate for Payer: Anthem Medicaid |
$17.43
|
| Rate for Payer: Anthem Medicare Advantage |
$16.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$417.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$16.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$16.87
|
| Rate for Payer: Cash Price |
$236.10
|
| Rate for Payer: Cash Price |
$236.10
|
| Rate for Payer: Cigna Commercial |
$724.04
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$16.87
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$17.43
|
| Rate for Payer: Dean Health Medicaid |
$17.43
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$16.87
|
| Rate for Payer: Health EOS Commercial |
$700.43
|
| Rate for Payer: HFN Commercial |
$724.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$62.76
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$16.87
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$17.43
|
| Rate for Payer: Independent Care Health Plan Medicare |
$16.87
|
| Rate for Payer: Managed Health Services Medicaid |
$18.13
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$16.87
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$16.87
|
| Rate for Payer: Multiplan Commercial |
$629.60
|
| Rate for Payer: NAPHCARE Commercial |
$25.30
|
| Rate for Payer: Preferred Network Access Commercial |
$724.04
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$17.43
|
| Rate for Payer: Quartz Beloit One Network |
$385.63
|
| Rate for Payer: Quartz Commercial |
$511.55
|
| Rate for Payer: Quartz Medicare Advantage |
$16.87
|
| Rate for Payer: The Alliance Commercial |
$3,148.00
|
| Rate for Payer: United Healthcare Medicaid |
$17.43
|
| Rate for Payer: United Healthcare Medicare Advantage |
$16.87
|
| Rate for Payer: United Healthcare PPO |
$590.25
|
| Rate for Payer: WEA Trust Commercial |
$432.85
|
| Rate for Payer: Wellcare Medicare |
$16.87
|
| Rate for Payer: WMAP Medicaid |
$17.43
|
| Rate for Payer: WPS Commercial |
$582.93
|
|
|
Amino Acid Quantitative
|
Facility
IP
|
$787.00
|
|
|
Service Code
|
CPT 82139
|
| Hospital Charge Code |
977864
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$385.63 |
| Max. Negotiated Rate |
$724.04 |
| Rate for Payer: Aetna Commercial |
$708.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$417.11
|
| Rate for Payer: Cash Price |
$236.10
|
| Rate for Payer: Cigna Commercial |
$724.04
|
| Rate for Payer: Health EOS Commercial |
$700.43
|
| Rate for Payer: HFN Commercial |
$724.04
|
| Rate for Payer: Multiplan Commercial |
$629.60
|
| Rate for Payer: NAPHCARE Commercial |
$472.20
|
| Rate for Payer: Preferred Network Access Commercial |
$724.04
|
| Rate for Payer: Quartz Beloit One Network |
$385.63
|
| Rate for Payer: Quartz Commercial |
$472.20
|
| Rate for Payer: WEA Trust Commercial |
$432.85
|
| Rate for Payer: WPS Commercial |
$582.93
|
|
|
Amino Acid Quantitative
|
Professional
|
$787.00
|
|
|
Service Code
|
CPT 82139
|
| Hospital Charge Code |
977864
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$16.87 |
| Max. Negotiated Rate |
$747.65 |
| Rate for Payer: Aetna Commercial |
$747.65
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$676.82
|
| Rate for Payer: Aetna Managed Medicare |
$16.87
|
| Rate for Payer: Anthem Medicare Advantage |
$16.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$16.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$16.87
|
| Rate for Payer: Cash Price |
$236.10
|
| Rate for Payer: Cash Price |
$236.10
|
| Rate for Payer: Cigna Commercial |
$747.65
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$393.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$16.87
|
| Rate for Payer: Health EOS Commercial |
$716.17
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$59.55
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$59.55
|
| Rate for Payer: Independent Care Health Plan Medicare |
$16.87
|
| Rate for Payer: Multiplan Commercial |
$629.60
|
| Rate for Payer: Preferred Network Access Commercial |
$747.65
|
| Rate for Payer: Quartz Beloit One Network |
$346.28
|
| Rate for Payer: Quartz Commercial |
$448.59
|
| Rate for Payer: Quartz Medicare Advantage |
$16.87
|
| Rate for Payer: The Alliance Commercial |
$66.64
|
| Rate for Payer: United Healthcare Medicare Advantage |
$16.87
|
| Rate for Payer: WEA Trust Commercial |
$432.85
|
| Rate for Payer: WPS Commercial |
$74.23
|
|
|
Amiodarone Level
|
Facility
IP
|
$279.00
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
977865
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$136.71 |
| Max. Negotiated Rate |
$256.68 |
| Rate for Payer: Aetna Commercial |
$251.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$147.87
|
| Rate for Payer: Cash Price |
$83.70
|
| Rate for Payer: Cigna Commercial |
$256.68
|
| Rate for Payer: Health EOS Commercial |
$248.31
|
| Rate for Payer: HFN Commercial |
$256.68
|
| Rate for Payer: Multiplan Commercial |
$223.20
|
| Rate for Payer: NAPHCARE Commercial |
$167.40
|
| Rate for Payer: Preferred Network Access Commercial |
$256.68
|
| Rate for Payer: Quartz Beloit One Network |
$136.71
|
| Rate for Payer: Quartz Commercial |
$167.40
|
| Rate for Payer: WEA Trust Commercial |
$153.45
|
| Rate for Payer: WPS Commercial |
$206.66
|
|
|
Amiodarone Level
|
Facility
OP
|
$279.00
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
977865
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.64 |
| Max. Negotiated Rate |
$1,116.00 |
| Rate for Payer: Aetna Commercial |
$251.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$239.94
|
| Rate for Payer: Aetna Managed Medicare |
$18.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$69.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$32.62
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$30.94
|
| Rate for Payer: Anthem Medicaid |
$19.26
|
| Rate for Payer: Anthem Medicare Advantage |
$18.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$147.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$18.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$18.64
|
| Rate for Payer: Cash Price |
$83.70
|
| Rate for Payer: Cash Price |
$83.70
|
| Rate for Payer: Cigna Commercial |
$256.68
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$18.64
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$19.26
|
| Rate for Payer: Dean Health Medicaid |
$19.26
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$18.64
|
| Rate for Payer: Health EOS Commercial |
$248.31
|
| Rate for Payer: HFN Commercial |
$256.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$69.34
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$18.64
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$19.26
|
| Rate for Payer: Independent Care Health Plan Medicare |
$18.64
|
| Rate for Payer: Managed Health Services Medicaid |
$20.03
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$18.64
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$18.64
|
| Rate for Payer: Multiplan Commercial |
$223.20
|
| Rate for Payer: NAPHCARE Commercial |
$27.96
|
| Rate for Payer: Preferred Network Access Commercial |
$256.68
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$19.26
|
| Rate for Payer: Quartz Beloit One Network |
$136.71
|
| Rate for Payer: Quartz Commercial |
$181.35
|
| Rate for Payer: Quartz Medicare Advantage |
$18.64
|
| Rate for Payer: The Alliance Commercial |
$1,116.00
|
| Rate for Payer: United Healthcare Medicaid |
$19.26
|
| Rate for Payer: United Healthcare Medicare Advantage |
$18.64
|
| Rate for Payer: United Healthcare PPO |
$209.25
|
| Rate for Payer: WEA Trust Commercial |
$153.45
|
| Rate for Payer: Wellcare Medicare |
$18.64
|
| Rate for Payer: WMAP Medicaid |
$19.26
|
| Rate for Payer: WPS Commercial |
$206.66
|
|
|
Amiodarone Level
|
Professional
|
$279.00
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
977865
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.64 |
| Max. Negotiated Rate |
$265.05 |
| Rate for Payer: Aetna Commercial |
$265.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$239.94
|
| Rate for Payer: Aetna Managed Medicare |
$18.64
|
| Rate for Payer: Anthem Medicare Advantage |
$18.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$18.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$18.64
|
| Rate for Payer: Cash Price |
$83.70
|
| Rate for Payer: Cash Price |
$83.70
|
| Rate for Payer: Cigna Commercial |
$265.05
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$139.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$18.64
|
| Rate for Payer: Health EOS Commercial |
$253.89
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$65.80
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$65.80
|
| Rate for Payer: Independent Care Health Plan Medicare |
$18.64
|
| Rate for Payer: Multiplan Commercial |
$223.20
|
| Rate for Payer: Preferred Network Access Commercial |
$265.05
|
| Rate for Payer: Quartz Beloit One Network |
$122.76
|
| Rate for Payer: Quartz Commercial |
$159.03
|
| Rate for Payer: Quartz Medicare Advantage |
$18.64
|
| Rate for Payer: The Alliance Commercial |
$73.63
|
| Rate for Payer: United Healthcare Medicare Advantage |
$18.64
|
| Rate for Payer: WEA Trust Commercial |
$153.45
|
| Rate for Payer: WPS Commercial |
$82.02
|
|
|
Amitriptyline and Nortriptyline Levels
|
Professional
|
$479.00
|
|
|
Service Code
|
CPT 80335
|
| Hospital Charge Code |
977866
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$80.06 |
| Max. Negotiated Rate |
$455.05 |
| Rate for Payer: Aetna Commercial |
$455.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$411.94
|
| Rate for Payer: Cash Price |
$143.70
|
| Rate for Payer: Cash Price |
$143.70
|
| Rate for Payer: Cigna Commercial |
$455.05
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$239.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$287.40
|
| Rate for Payer: Health EOS Commercial |
$435.89
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$80.06
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$80.06
|
| Rate for Payer: Multiplan Commercial |
$383.20
|
| Rate for Payer: Preferred Network Access Commercial |
$455.05
|
| Rate for Payer: Quartz Beloit One Network |
$210.76
|
| Rate for Payer: Quartz Commercial |
$273.03
|
| Rate for Payer: The Alliance Commercial |
$239.50
|
| Rate for Payer: WEA Trust Commercial |
$263.45
|
| Rate for Payer: WPS Commercial |
$354.80
|
|
|
Amitriptyline and Nortriptyline Levels
|
Facility
IP
|
$479.00
|
|
|
Service Code
|
CPT 80335
|
| Hospital Charge Code |
977866
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$234.71 |
| Max. Negotiated Rate |
$440.68 |
| Rate for Payer: Aetna Commercial |
$431.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$253.87
|
| Rate for Payer: Cash Price |
$143.70
|
| Rate for Payer: Cigna Commercial |
$440.68
|
| Rate for Payer: Health EOS Commercial |
$426.31
|
| Rate for Payer: HFN Commercial |
$440.68
|
| Rate for Payer: Multiplan Commercial |
$383.20
|
| Rate for Payer: NAPHCARE Commercial |
$287.40
|
| Rate for Payer: Preferred Network Access Commercial |
$440.68
|
| Rate for Payer: Quartz Beloit One Network |
$234.71
|
| Rate for Payer: Quartz Commercial |
$287.40
|
| Rate for Payer: WEA Trust Commercial |
$263.45
|
| Rate for Payer: WPS Commercial |
$354.80
|
|
|
Amitriptyline and Nortriptyline Levels
|
Facility
OP
|
$479.00
|
|
|
Service Code
|
CPT 80335
|
| Hospital Charge Code |
977866
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$134.12 |
| Max. Negotiated Rate |
$440.68 |
| Rate for Payer: Aetna Commercial |
$431.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$411.94
|
| Rate for Payer: Aetna Managed Medicare |
$134.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$311.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$239.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$229.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$253.87
|
| Rate for Payer: Cash Price |
$143.70
|
| Rate for Payer: Cash Price |
$143.70
|
| Rate for Payer: Cigna Commercial |
$440.68
|
| Rate for Payer: Health EOS Commercial |
$426.31
|
| Rate for Payer: HFN Commercial |
$440.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$359.25
|
| Rate for Payer: Multiplan Commercial |
$383.20
|
| Rate for Payer: NAPHCARE Commercial |
$287.40
|
| Rate for Payer: Preferred Network Access Commercial |
$440.68
|
| Rate for Payer: Quartz Beloit One Network |
$234.71
|
| Rate for Payer: Quartz Commercial |
$311.35
|
| Rate for Payer: Quartz Medicare Advantage |
$287.40
|
| Rate for Payer: United Healthcare PPO |
$359.25
|
| Rate for Payer: WEA Trust Commercial |
$263.45
|
| Rate for Payer: WPS Commercial |
$354.80
|
|
|
Ammonia Level
|
Facility
IP
|
$220.00
|
|
|
Service Code
|
CPT 82140
|
| Hospital Charge Code |
633648
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$107.80 |
| Max. Negotiated Rate |
$202.40 |
| Rate for Payer: Aetna Commercial |
$198.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$116.60
|
| Rate for Payer: Cash Price |
$66.00
|
| Rate for Payer: Cigna Commercial |
$202.40
|
| Rate for Payer: Health EOS Commercial |
$195.80
|
| Rate for Payer: HFN Commercial |
$202.40
|
| Rate for Payer: Multiplan Commercial |
$176.00
|
| Rate for Payer: NAPHCARE Commercial |
$132.00
|
| Rate for Payer: Preferred Network Access Commercial |
$202.40
|
| Rate for Payer: Quartz Beloit One Network |
$107.80
|
| Rate for Payer: Quartz Commercial |
$132.00
|
| Rate for Payer: WEA Trust Commercial |
$121.00
|
| Rate for Payer: WPS Commercial |
$162.95
|
|
|
Ammonia Level
|
Facility
OP
|
$220.00
|
|
|
Service Code
|
CPT 82140
|
| Hospital Charge Code |
633648
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.57 |
| Max. Negotiated Rate |
$880.00 |
| Rate for Payer: Aetna Commercial |
$198.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$189.20
|
| Rate for Payer: Aetna Managed Medicare |
$14.57
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$54.64
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$25.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$24.19
|
| Rate for Payer: Anthem Medicaid |
$15.06
|
| Rate for Payer: Anthem Medicare Advantage |
$14.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$116.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$14.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$14.57
|
| Rate for Payer: Cash Price |
$66.00
|
| Rate for Payer: Cash Price |
$66.00
|
| Rate for Payer: Cigna Commercial |
$202.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$14.57
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$15.06
|
| Rate for Payer: Dean Health Medicaid |
$15.06
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$14.57
|
| Rate for Payer: Health EOS Commercial |
$195.80
|
| Rate for Payer: HFN Commercial |
$202.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$54.20
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$14.57
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$15.06
|
| Rate for Payer: Independent Care Health Plan Medicare |
$14.57
|
| Rate for Payer: Managed Health Services Medicaid |
$15.66
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$14.57
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$14.57
|
| Rate for Payer: Multiplan Commercial |
$176.00
|
| Rate for Payer: NAPHCARE Commercial |
$21.86
|
| Rate for Payer: Preferred Network Access Commercial |
$202.40
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$15.06
|
| Rate for Payer: Quartz Beloit One Network |
$107.80
|
| Rate for Payer: Quartz Commercial |
$143.00
|
| Rate for Payer: Quartz Medicare Advantage |
$14.57
|
| Rate for Payer: The Alliance Commercial |
$880.00
|
| Rate for Payer: United Healthcare Medicaid |
$15.06
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14.57
|
| Rate for Payer: United Healthcare PPO |
$165.00
|
| Rate for Payer: WEA Trust Commercial |
$121.00
|
| Rate for Payer: Wellcare Medicare |
$14.57
|
| Rate for Payer: WMAP Medicaid |
$15.06
|
| Rate for Payer: WPS Commercial |
$162.95
|
|
|
Ammonia Level
|
Professional
|
$220.00
|
|
|
Service Code
|
CPT 82140
|
| Hospital Charge Code |
633648
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.57 |
| Max. Negotiated Rate |
$209.00 |
| Rate for Payer: Aetna Commercial |
$209.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$189.20
|
| Rate for Payer: Aetna Managed Medicare |
$14.57
|
| Rate for Payer: Anthem Medicare Advantage |
$14.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$14.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$14.57
|
| Rate for Payer: Cash Price |
$66.00
|
| Rate for Payer: Cash Price |
$66.00
|
| Rate for Payer: Cigna Commercial |
$209.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$110.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$14.57
|
| Rate for Payer: Health EOS Commercial |
$200.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$51.43
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$51.43
|
| Rate for Payer: Independent Care Health Plan Medicare |
$14.57
|
| Rate for Payer: Multiplan Commercial |
$176.00
|
| Rate for Payer: Preferred Network Access Commercial |
$209.00
|
| Rate for Payer: Quartz Beloit One Network |
$96.80
|
| Rate for Payer: Quartz Commercial |
$125.40
|
| Rate for Payer: Quartz Medicare Advantage |
$14.57
|
| Rate for Payer: The Alliance Commercial |
$57.55
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14.57
|
| Rate for Payer: WEA Trust Commercial |
$121.00
|
| Rate for Payer: WPS Commercial |
$64.11
|
|
|
Ammonium, Urine
|
Professional
|
$86.00
|
|
|
Service Code
|
CPT 82140
|
| Hospital Charge Code |
5474700
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.57 |
| Max. Negotiated Rate |
$81.70 |
| Rate for Payer: Aetna Commercial |
$81.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$73.96
|
| Rate for Payer: Aetna Managed Medicare |
$14.57
|
| Rate for Payer: Anthem Medicare Advantage |
$14.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$14.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$14.57
|
| Rate for Payer: Cash Price |
$25.80
|
| Rate for Payer: Cash Price |
$25.80
|
| Rate for Payer: Cigna Commercial |
$81.70
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$43.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$14.57
|
| Rate for Payer: Health EOS Commercial |
$78.26
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$51.43
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$51.43
|
| Rate for Payer: Independent Care Health Plan Medicare |
$14.57
|
| Rate for Payer: Multiplan Commercial |
$68.80
|
| Rate for Payer: Preferred Network Access Commercial |
$81.70
|
| Rate for Payer: Quartz Beloit One Network |
$37.84
|
| Rate for Payer: Quartz Commercial |
$49.02
|
| Rate for Payer: Quartz Medicare Advantage |
$14.57
|
| Rate for Payer: The Alliance Commercial |
$57.55
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14.57
|
| Rate for Payer: WEA Trust Commercial |
$47.30
|
| Rate for Payer: WPS Commercial |
$64.11
|
|
|
Ammonium, Urine
|
Facility
IP
|
$86.00
|
|
|
Service Code
|
CPT 82140
|
| Hospital Charge Code |
5474700
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$42.14 |
| Max. Negotiated Rate |
$79.12 |
| Rate for Payer: Aetna Commercial |
$77.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$45.58
|
| Rate for Payer: Cash Price |
$25.80
|
| Rate for Payer: Cigna Commercial |
$79.12
|
| Rate for Payer: Health EOS Commercial |
$76.54
|
| Rate for Payer: HFN Commercial |
$79.12
|
| Rate for Payer: Multiplan Commercial |
$68.80
|
| Rate for Payer: NAPHCARE Commercial |
$51.60
|
| Rate for Payer: Preferred Network Access Commercial |
$79.12
|
| Rate for Payer: Quartz Beloit One Network |
$42.14
|
| Rate for Payer: Quartz Commercial |
$51.60
|
| Rate for Payer: WEA Trust Commercial |
$47.30
|
| Rate for Payer: WPS Commercial |
$63.70
|
|
