|
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
|
|
|
AMNIHOOK AMNIOTIC MEMBRANE
|
Facility
OP
|
$66.00
|
|
| Hospital Charge Code |
2963413
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$18.48 |
| Max. Negotiated Rate |
$264.00 |
| Rate for Payer: Aetna Commercial |
$59.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$56.76
|
| Rate for Payer: Aetna Managed Medicare |
$18.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$42.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$33.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$31.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$34.98
|
| Rate for Payer: Cash Price |
$19.80
|
| Rate for Payer: Cigna Commercial |
$60.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$36.93
|
| Rate for Payer: Health EOS Commercial |
$58.74
|
| Rate for Payer: HFN Commercial |
$60.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$49.50
|
| Rate for Payer: Multiplan Commercial |
$52.80
|
| Rate for Payer: NAPHCARE Commercial |
$39.60
|
| Rate for Payer: Preferred Network Access Commercial |
$60.72
|
| Rate for Payer: Quartz Beloit One Network |
$32.34
|
| Rate for Payer: Quartz Commercial |
$42.90
|
| Rate for Payer: Quartz Medicare Advantage |
$39.60
|
| Rate for Payer: The Alliance Commercial |
$264.00
|
| Rate for Payer: WEA Trust Commercial |
$36.30
|
| Rate for Payer: WPS Commercial |
$48.89
|
|
|
AMNIHOOK AMNIOTIC MEMBRANE
|
Facility
IP
|
$66.00
|
|
| Hospital Charge Code |
2963413
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$32.34 |
| Max. Negotiated Rate |
$60.72 |
| Rate for Payer: Aetna Commercial |
$59.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$34.98
|
| Rate for Payer: Cash Price |
$19.80
|
| Rate for Payer: Cigna Commercial |
$60.72
|
| Rate for Payer: Health EOS Commercial |
$58.74
|
| Rate for Payer: HFN Commercial |
$60.72
|
| Rate for Payer: Multiplan Commercial |
$52.80
|
| Rate for Payer: NAPHCARE Commercial |
$39.60
|
| Rate for Payer: Preferred Network Access Commercial |
$60.72
|
| Rate for Payer: Quartz Beloit One Network |
$32.34
|
| Rate for Payer: Quartz Commercial |
$39.60
|
| Rate for Payer: WEA Trust Commercial |
$36.30
|
| Rate for Payer: WPS Commercial |
$48.89
|
|
|
AMNIOCENTESIS, DIAGNOSTIC 59000
|
Professional
|
$447.00
|
|
|
Service Code
|
CPT 59000
|
| Hospital Charge Code |
3015147
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$54.82 |
| Max. Negotiated Rate |
$424.65 |
| Rate for Payer: Aetna Commercial |
$424.65
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$384.42
|
| Rate for Payer: Aetna Managed Medicare |
$71.28
|
| Rate for Payer: Anthem Medicare Advantage |
$71.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$71.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$71.28
|
| Rate for Payer: Cash Price |
$134.10
|
| Rate for Payer: Cash Price |
$134.10
|
| Rate for Payer: Cigna Commercial |
$424.65
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$223.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$71.28
|
| Rate for Payer: Health EOS Commercial |
$406.77
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$252.57
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$252.57
|
| Rate for Payer: Independent Care Health Plan Medicare |
$71.28
|
| Rate for Payer: Multiplan Commercial |
$357.60
|
| Rate for Payer: Preferred Network Access Commercial |
$424.65
|
| Rate for Payer: Quartz Beloit One Network |
$196.68
|
| Rate for Payer: Quartz Commercial |
$254.79
|
| Rate for Payer: Quartz Medicare Advantage |
$71.28
|
| Rate for Payer: The Alliance Commercial |
$302.94
|
| Rate for Payer: United Healthcare Medicaid |
$54.82
|
| Rate for Payer: United Healthcare Medicare Advantage |
$71.28
|
| Rate for Payer: WEA Trust Commercial |
$245.85
|
| Rate for Payer: WPS Commercial |
$320.76
|
|
|
Amniocentesis, Diagnostic 5900026
|
Professional
|
$447.00
|
|
|
Service Code
|
CPT 59000 26
|
| Hospital Charge Code |
5102647
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$196.68 |
| Max. Negotiated Rate |
$424.65 |
| Rate for Payer: Aetna Commercial |
$424.65
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$384.42
|
| Rate for Payer: Cash Price |
$134.10
|
| Rate for Payer: Cash Price |
$134.10
|
| Rate for Payer: Cigna Commercial |
$424.65
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$223.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$268.20
|
| Rate for Payer: Health EOS Commercial |
$406.77
|
| Rate for Payer: Multiplan Commercial |
$357.60
|
| Rate for Payer: Preferred Network Access Commercial |
$424.65
|
| Rate for Payer: Quartz Beloit One Network |
$196.68
|
| Rate for Payer: Quartz Commercial |
$254.79
|
| Rate for Payer: The Alliance Commercial |
$223.50
|
| Rate for Payer: WEA Trust Commercial |
$245.85
|
| Rate for Payer: WPS Commercial |
$331.09
|
|
|
Amniocentesis - Individual Charges
|
Facility
IP
|
$361.00
|
|
|
Service Code
|
CPT 59000
|
| Hospital Charge Code |
3040451
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$176.89 |
| Max. Negotiated Rate |
$332.12 |
| Rate for Payer: Aetna Commercial |
$324.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$191.33
|
| Rate for Payer: Cash Price |
$108.30
|
| Rate for Payer: Cigna Commercial |
$332.12
|
| Rate for Payer: Health EOS Commercial |
$321.29
|
| Rate for Payer: HFN Commercial |
$332.12
|
| Rate for Payer: Multiplan Commercial |
$288.80
|
| Rate for Payer: NAPHCARE Commercial |
$216.60
|
| Rate for Payer: Preferred Network Access Commercial |
$332.12
|
| Rate for Payer: Quartz Beloit One Network |
$176.89
|
| Rate for Payer: Quartz Commercial |
$216.60
|
| Rate for Payer: WEA Trust Commercial |
$198.55
|
| Rate for Payer: WPS Commercial |
$267.39
|
|
|
Amniocentesis - Individual Charges
|
Facility
OP
|
$361.00
|
|
|
Service Code
|
CPT 59000
|
| Hospital Charge Code |
3040451
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$173.28 |
| Max. Negotiated Rate |
$8,881.40 |
| Rate for Payer: Aetna Commercial |
$324.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$310.46
|
| Rate for Payer: Aetna Managed Medicare |
$794.59
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$234.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$180.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$173.28
|
| Rate for Payer: Anthem Medicare Advantage |
$794.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$191.33
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$794.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$794.59
|
| Rate for Payer: Cash Price |
$108.30
|
| Rate for Payer: Cash Price |
$108.30
|
| Rate for Payer: Cigna Commercial |
$332.12
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$794.59
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,218.22
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$794.59
|
| Rate for Payer: Health EOS Commercial |
$321.29
|
| Rate for Payer: HFN Commercial |
$332.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,955.87
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$794.59
|
| Rate for Payer: Independent Care Health Plan Medicare |
$794.59
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$794.59
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$794.59
|
| Rate for Payer: Multiplan Commercial |
$288.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,191.88
|
| Rate for Payer: Preferred Network Access Commercial |
$332.12
|
| Rate for Payer: Quartz Beloit One Network |
$176.89
|
| Rate for Payer: Quartz Commercial |
$234.65
|
| Rate for Payer: Quartz Medicare Advantage |
$794.59
|
| Rate for Payer: The Alliance Commercial |
$8,881.40
|
| Rate for Payer: United Healthcare Medicare Advantage |
$794.59
|
| Rate for Payer: United Healthcare PPO |
$270.75
|
| Rate for Payer: WEA Trust Commercial |
$198.55
|
| Rate for Payer: Wellcare Medicare |
$794.59
|
| Rate for Payer: WPS Commercial |
$267.39
|
|
|
Amnioinfusion - Individual Charges
|
Facility
IP
|
$1,178.00
|
|
|
Service Code
|
CPT 59070
|
| Hospital Charge Code |
6187681
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$577.22 |
| Max. Negotiated Rate |
$1,083.76 |
| Rate for Payer: Aetna Commercial |
$1,060.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$624.34
|
| Rate for Payer: Cash Price |
$353.40
|
| Rate for Payer: Cigna Commercial |
$1,083.76
|
| Rate for Payer: Health EOS Commercial |
$1,048.42
|
| Rate for Payer: HFN Commercial |
$1,083.76
|
| Rate for Payer: Multiplan Commercial |
$942.40
|
| Rate for Payer: NAPHCARE Commercial |
$706.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,083.76
|
| Rate for Payer: Quartz Beloit One Network |
$577.22
|
| Rate for Payer: Quartz Commercial |
$706.80
|
| Rate for Payer: WEA Trust Commercial |
$647.90
|
| Rate for Payer: WPS Commercial |
$872.54
|
|
|
Amnioinfusion - Individual Charges
|
Facility
OP
|
$1,178.00
|
|
|
Service Code
|
CPT 59070
|
| Hospital Charge Code |
6187681
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$317.09 |
| Max. Negotiated Rate |
$15,495.60 |
| Rate for Payer: Aetna Commercial |
$1,060.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,013.08
|
| Rate for Payer: Aetna Managed Medicare |
$317.09
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$765.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$589.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$565.44
|
| Rate for Payer: Anthem Medicare Advantage |
$317.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$624.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$317.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$317.09
|
| Rate for Payer: Cash Price |
$353.40
|
| Rate for Payer: Cash Price |
$353.40
|
| Rate for Payer: Cigna Commercial |
$1,083.76
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$317.09
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$317.09
|
| Rate for Payer: Health EOS Commercial |
$1,048.42
|
| Rate for Payer: HFN Commercial |
$1,083.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,179.57
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$317.09
|
| Rate for Payer: Independent Care Health Plan Medicare |
$317.09
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$317.09
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$317.09
|
| Rate for Payer: Multiplan Commercial |
$942.40
|
| Rate for Payer: NAPHCARE Commercial |
$475.64
|
| Rate for Payer: Preferred Network Access Commercial |
$1,083.76
|
| Rate for Payer: Quartz Beloit One Network |
$577.22
|
| Rate for Payer: Quartz Commercial |
$765.70
|
| Rate for Payer: Quartz Medicare Advantage |
$317.09
|
| Rate for Payer: The Alliance Commercial |
$15,495.60
|
| Rate for Payer: United Healthcare Medicare Advantage |
$317.09
|
| Rate for Payer: United Healthcare PPO |
$883.50
|
| Rate for Payer: WEA Trust Commercial |
$647.90
|
| Rate for Payer: Wellcare Medicare |
$317.09
|
| Rate for Payer: WPS Commercial |
$872.54
|
|
|
Amniotomy (ROM) - Individual Charges
|
Facility
OP
|
$70.00
|
|
| Hospital Charge Code |
3003917
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$19.60 |
| Max. Negotiated Rate |
$280.00 |
| Rate for Payer: Aetna Commercial |
$63.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$60.20
|
| Rate for Payer: Aetna Managed Medicare |
$19.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$45.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$35.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$33.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$37.10
|
| Rate for Payer: Cash Price |
$21.00
|
| Rate for Payer: Cigna Commercial |
$64.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$39.17
|
| Rate for Payer: Health EOS Commercial |
$62.30
|
| Rate for Payer: HFN Commercial |
$64.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$52.50
|
| Rate for Payer: Multiplan Commercial |
$56.00
|
| Rate for Payer: NAPHCARE Commercial |
$42.00
|
| Rate for Payer: Preferred Network Access Commercial |
$64.40
|
| Rate for Payer: Quartz Beloit One Network |
$34.30
|
| Rate for Payer: Quartz Commercial |
$45.50
|
| Rate for Payer: Quartz Medicare Advantage |
$42.00
|
| Rate for Payer: The Alliance Commercial |
$280.00
|
| Rate for Payer: WEA Trust Commercial |
$38.50
|
| Rate for Payer: WPS Commercial |
$51.85
|
|
|
Amniotomy (ROM) - Individual Charges
|
Facility
IP
|
$70.00
|
|
| Hospital Charge Code |
3003917
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$34.30 |
| Max. Negotiated Rate |
$64.40 |
| Rate for Payer: Aetna Commercial |
$63.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$37.10
|
| Rate for Payer: Cash Price |
$21.00
|
| Rate for Payer: Cigna Commercial |
$64.40
|
| Rate for Payer: Health EOS Commercial |
$62.30
|
| Rate for Payer: HFN Commercial |
$64.40
|
| Rate for Payer: Multiplan Commercial |
$56.00
|
| Rate for Payer: NAPHCARE Commercial |
$42.00
|
| Rate for Payer: Preferred Network Access Commercial |
$64.40
|
| Rate for Payer: Quartz Beloit One Network |
$34.30
|
| Rate for Payer: Quartz Commercial |
$42.00
|
| Rate for Payer: WEA Trust Commercial |
$38.50
|
| Rate for Payer: WPS Commercial |
$51.85
|
|
|
Amnisure
|
Facility
IP
|
$282.00
|
|
|
Service Code
|
CPT 84112
|
| Hospital Charge Code |
979908
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$138.18 |
| Max. Negotiated Rate |
$259.44 |
| Rate for Payer: Aetna Commercial |
$253.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$149.46
|
| Rate for Payer: Cash Price |
$84.60
|
| Rate for Payer: Cigna Commercial |
$259.44
|
| Rate for Payer: Health EOS Commercial |
$250.98
|
| Rate for Payer: HFN Commercial |
$259.44
|
| Rate for Payer: Multiplan Commercial |
$225.60
|
| Rate for Payer: NAPHCARE Commercial |
$169.20
|
| Rate for Payer: Preferred Network Access Commercial |
$259.44
|
| Rate for Payer: Quartz Beloit One Network |
$138.18
|
| Rate for Payer: Quartz Commercial |
$169.20
|
| Rate for Payer: WEA Trust Commercial |
$155.10
|
| Rate for Payer: WPS Commercial |
$208.88
|
|
|
Amnisure
|
Professional
|
$282.00
|
|
|
Service Code
|
CPT 84112
|
| Hospital Charge Code |
979908
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$98.11 |
| Max. Negotiated Rate |
$431.68 |
| Rate for Payer: Aetna Commercial |
$267.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$242.52
|
| Rate for Payer: Aetna Managed Medicare |
$98.11
|
| Rate for Payer: Anthem Medicare Advantage |
$98.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$98.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$98.11
|
| Rate for Payer: Cash Price |
$84.60
|
| Rate for Payer: Cash Price |
$84.60
|
| Rate for Payer: Cigna Commercial |
$267.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$141.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$98.11
|
| Rate for Payer: Health EOS Commercial |
$256.62
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$346.33
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$346.33
|
| Rate for Payer: Independent Care Health Plan Medicare |
$98.11
|
| Rate for Payer: Multiplan Commercial |
$225.60
|
| Rate for Payer: Preferred Network Access Commercial |
$267.90
|
| Rate for Payer: Quartz Beloit One Network |
$124.08
|
| Rate for Payer: Quartz Commercial |
$160.74
|
| Rate for Payer: Quartz Medicare Advantage |
$98.11
|
| Rate for Payer: The Alliance Commercial |
$387.53
|
| Rate for Payer: United Healthcare Medicare Advantage |
$98.11
|
| Rate for Payer: WEA Trust Commercial |
$155.10
|
| Rate for Payer: WPS Commercial |
$431.68
|
|
|
Amnisure
|
Facility
OP
|
$282.00
|
|
|
Service Code
|
CPT 84112
|
| Hospital Charge Code |
979908
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$90.57 |
| Max. Negotiated Rate |
$1,128.00 |
| Rate for Payer: Aetna Commercial |
$253.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$242.52
|
| Rate for Payer: Aetna Managed Medicare |
$98.11
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$367.91
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$171.69
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$162.86
|
| Rate for Payer: Anthem Medicaid |
$90.57
|
| Rate for Payer: Anthem Medicare Advantage |
$98.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$149.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$98.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$98.11
|
| Rate for Payer: Cash Price |
$84.60
|
| Rate for Payer: Cash Price |
$84.60
|
| Rate for Payer: Cigna Commercial |
$259.44
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$98.11
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$90.57
|
| Rate for Payer: Dean Health Medicaid |
$90.57
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$98.11
|
| Rate for Payer: Health EOS Commercial |
$250.98
|
| Rate for Payer: HFN Commercial |
$259.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$364.97
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$98.11
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$90.57
|
| Rate for Payer: Independent Care Health Plan Medicare |
$98.11
|
| Rate for Payer: Managed Health Services Medicaid |
$94.19
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$98.11
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$98.11
|
| Rate for Payer: Multiplan Commercial |
$225.60
|
| Rate for Payer: NAPHCARE Commercial |
$147.16
|
| Rate for Payer: Preferred Network Access Commercial |
$259.44
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$90.57
|
| Rate for Payer: Quartz Beloit One Network |
$138.18
|
| Rate for Payer: Quartz Commercial |
$183.30
|
| Rate for Payer: Quartz Medicare Advantage |
$98.11
|
| Rate for Payer: The Alliance Commercial |
$1,128.00
|
| Rate for Payer: United Healthcare Medicaid |
$90.57
|
| Rate for Payer: United Healthcare Medicare Advantage |
$98.11
|
| Rate for Payer: United Healthcare PPO |
$211.50
|
| Rate for Payer: WEA Trust Commercial |
$155.10
|
| Rate for Payer: Wellcare Medicare |
$98.11
|
| Rate for Payer: WMAP Medicaid |
$90.57
|
| Rate for Payer: WPS Commercial |
$208.88
|
|
|
Amoxicillin IgE
|
Facility
IP
|
$30.00
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
5230631
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.70 |
| Max. Negotiated Rate |
$27.60 |
| Rate for Payer: Aetna Commercial |
$27.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$15.90
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Cigna Commercial |
$27.60
|
| Rate for Payer: Health EOS Commercial |
$26.70
|
| Rate for Payer: HFN Commercial |
$27.60
|
| Rate for Payer: Multiplan Commercial |
$24.00
|
| Rate for Payer: NAPHCARE Commercial |
$18.00
|
| Rate for Payer: Preferred Network Access Commercial |
$27.60
|
| Rate for Payer: Quartz Beloit One Network |
$14.70
|
| Rate for Payer: Quartz Commercial |
$18.00
|
| Rate for Payer: WEA Trust Commercial |
$16.50
|
| Rate for Payer: WPS Commercial |
$22.22
|
|
|
Amoxicillin IgE
|
Facility
OP
|
$30.00
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
5230631
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.57 |
| Max. Negotiated Rate |
$120.00 |
| Rate for Payer: Aetna Commercial |
$27.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$25.80
|
| Rate for Payer: Aetna Managed Medicare |
$5.22
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$19.58
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$9.14
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$8.67
|
| Rate for Payer: Anthem Medicaid |
$4.57
|
| Rate for Payer: Anthem Medicare Advantage |
$5.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$15.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5.22
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Cigna Commercial |
$27.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$5.22
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$4.57
|
| Rate for Payer: Dean Health Medicaid |
$4.57
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$5.22
|
| Rate for Payer: Health EOS Commercial |
$26.70
|
| Rate for Payer: HFN Commercial |
$27.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$19.42
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$5.22
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$4.57
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5.22
|
| Rate for Payer: Managed Health Services Medicaid |
$4.75
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$5.22
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$5.22
|
| Rate for Payer: Multiplan Commercial |
$24.00
|
| Rate for Payer: NAPHCARE Commercial |
$7.83
|
| Rate for Payer: Preferred Network Access Commercial |
$27.60
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$4.57
|
| Rate for Payer: Quartz Beloit One Network |
$14.70
|
| Rate for Payer: Quartz Commercial |
$19.50
|
| Rate for Payer: Quartz Medicare Advantage |
$5.22
|
| Rate for Payer: The Alliance Commercial |
$120.00
|
| Rate for Payer: United Healthcare Medicaid |
$4.57
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.22
|
| Rate for Payer: United Healthcare PPO |
$22.50
|
| Rate for Payer: WEA Trust Commercial |
$16.50
|
| Rate for Payer: Wellcare Medicare |
$5.22
|
| Rate for Payer: WMAP Medicaid |
$4.57
|
| Rate for Payer: WPS Commercial |
$22.22
|
|
|
Amoxicillin IgE
|
Professional
|
$30.00
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
5230631
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.22 |
| Max. Negotiated Rate |
$28.50 |
| Rate for Payer: Aetna Commercial |
$28.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$25.80
|
| Rate for Payer: Aetna Managed Medicare |
$5.22
|
| Rate for Payer: Anthem Medicare Advantage |
$5.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5.22
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Cigna Commercial |
$28.50
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$15.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5.22
|
| Rate for Payer: Health EOS Commercial |
$27.30
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$18.43
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$18.43
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5.22
|
| Rate for Payer: Multiplan Commercial |
$24.00
|
| Rate for Payer: Preferred Network Access Commercial |
$28.50
|
| Rate for Payer: Quartz Beloit One Network |
$13.20
|
| Rate for Payer: Quartz Commercial |
$17.10
|
| Rate for Payer: Quartz Medicare Advantage |
$5.22
|
| Rate for Payer: The Alliance Commercial |
$20.62
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.22
|
| Rate for Payer: WEA Trust Commercial |
$16.50
|
| Rate for Payer: WPS Commercial |
$22.97
|
|
|
Amphetamine Level
|
Facility
OP
|
$331.00
|
|
|
Service Code
|
CPT 80324
|
| Hospital Charge Code |
633649
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$92.68 |
| Max. Negotiated Rate |
$304.52 |
| Rate for Payer: Aetna Commercial |
$297.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$284.66
|
| Rate for Payer: Aetna Managed Medicare |
$92.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$215.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$165.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$158.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$175.43
|
| Rate for Payer: Cash Price |
$99.30
|
| Rate for Payer: Cash Price |
$99.30
|
| Rate for Payer: Cigna Commercial |
$304.52
|
| Rate for Payer: Health EOS Commercial |
$294.59
|
| Rate for Payer: HFN Commercial |
$304.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$248.25
|
| Rate for Payer: Multiplan Commercial |
$264.80
|
| Rate for Payer: NAPHCARE Commercial |
$198.60
|
| Rate for Payer: Preferred Network Access Commercial |
$304.52
|
| Rate for Payer: Quartz Beloit One Network |
$162.19
|
| Rate for Payer: Quartz Commercial |
$215.15
|
| Rate for Payer: Quartz Medicare Advantage |
$198.60
|
| Rate for Payer: United Healthcare PPO |
$248.25
|
| Rate for Payer: WEA Trust Commercial |
$182.05
|
| Rate for Payer: WPS Commercial |
$245.17
|
|
|
Amphetamine Level
|
Professional
|
$331.00
|
|
|
Service Code
|
CPT 80324
|
| Hospital Charge Code |
633649
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$80.06 |
| Max. Negotiated Rate |
$314.45 |
| Rate for Payer: Aetna Commercial |
$314.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$284.66
|
| Rate for Payer: Cash Price |
$99.30
|
| Rate for Payer: Cash Price |
$99.30
|
| Rate for Payer: Cigna Commercial |
$314.45
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$165.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$198.60
|
| Rate for Payer: Health EOS Commercial |
$301.21
|
| 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 |
$264.80
|
| Rate for Payer: Preferred Network Access Commercial |
$314.45
|
| Rate for Payer: Quartz Beloit One Network |
$145.64
|
| Rate for Payer: Quartz Commercial |
$188.67
|
| Rate for Payer: The Alliance Commercial |
$165.50
|
| Rate for Payer: WEA Trust Commercial |
$182.05
|
| Rate for Payer: WPS Commercial |
$245.17
|
|
|
Amphetamine Level
|
Facility
IP
|
$331.00
|
|
|
Service Code
|
CPT 80324
|
| Hospital Charge Code |
633649
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$162.19 |
| Max. Negotiated Rate |
$304.52 |
| Rate for Payer: Aetna Commercial |
$297.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$175.43
|
| Rate for Payer: Cash Price |
$99.30
|
| Rate for Payer: Cigna Commercial |
$304.52
|
| Rate for Payer: Health EOS Commercial |
$294.59
|
| Rate for Payer: HFN Commercial |
$304.52
|
| Rate for Payer: Multiplan Commercial |
$264.80
|
| Rate for Payer: NAPHCARE Commercial |
$198.60
|
| Rate for Payer: Preferred Network Access Commercial |
$304.52
|
| Rate for Payer: Quartz Beloit One Network |
$162.19
|
| Rate for Payer: Quartz Commercial |
$198.60
|
| Rate for Payer: WEA Trust Commercial |
$182.05
|
| Rate for Payer: WPS Commercial |
$245.17
|
|
|
Amphetamine Quantitative Urine
|
Facility
IP
|
$340.00
|
|
|
Service Code
|
CPT 80324
|
| Hospital Charge Code |
977867
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$166.60 |
| Max. Negotiated Rate |
$312.80 |
| Rate for Payer: Aetna Commercial |
$306.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$180.20
|
| Rate for Payer: Cash Price |
$102.00
|
| Rate for Payer: Cigna Commercial |
$312.80
|
| Rate for Payer: Health EOS Commercial |
$302.60
|
| Rate for Payer: HFN Commercial |
$312.80
|
| Rate for Payer: Multiplan Commercial |
$272.00
|
| Rate for Payer: NAPHCARE Commercial |
$204.00
|
| Rate for Payer: Preferred Network Access Commercial |
$312.80
|
| Rate for Payer: Quartz Beloit One Network |
$166.60
|
| Rate for Payer: Quartz Commercial |
$204.00
|
| Rate for Payer: WEA Trust Commercial |
$187.00
|
| Rate for Payer: WPS Commercial |
$251.84
|
|
|
Amphetamine Quantitative Urine
|
Facility
OP
|
$340.00
|
|
|
Service Code
|
CPT 80324
|
| Hospital Charge Code |
977867
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$95.20 |
| Max. Negotiated Rate |
$312.80 |
| Rate for Payer: Aetna Commercial |
$306.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$292.40
|
| Rate for Payer: Aetna Managed Medicare |
$95.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$221.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$170.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$163.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$180.20
|
| Rate for Payer: Cash Price |
$102.00
|
| Rate for Payer: Cash Price |
$102.00
|
| Rate for Payer: Cigna Commercial |
$312.80
|
| Rate for Payer: Health EOS Commercial |
$302.60
|
| Rate for Payer: HFN Commercial |
$312.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$255.00
|
| Rate for Payer: Multiplan Commercial |
$272.00
|
| Rate for Payer: NAPHCARE Commercial |
$204.00
|
| Rate for Payer: Preferred Network Access Commercial |
$312.80
|
| Rate for Payer: Quartz Beloit One Network |
$166.60
|
| Rate for Payer: Quartz Commercial |
$221.00
|
| Rate for Payer: Quartz Medicare Advantage |
$204.00
|
| Rate for Payer: United Healthcare PPO |
$255.00
|
| Rate for Payer: WEA Trust Commercial |
$187.00
|
| Rate for Payer: WPS Commercial |
$251.84
|
|
|
Amphetamine Quantitative Urine
|
Professional
|
$340.00
|
|
|
Service Code
|
CPT 80324
|
| Hospital Charge Code |
977867
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$80.06 |
| Max. Negotiated Rate |
$323.00 |
| Rate for Payer: Aetna Commercial |
$323.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$292.40
|
| Rate for Payer: Cash Price |
$102.00
|
| Rate for Payer: Cash Price |
$102.00
|
| Rate for Payer: Cigna Commercial |
$323.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$170.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$204.00
|
| Rate for Payer: Health EOS Commercial |
$309.40
|
| 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 |
$272.00
|
| Rate for Payer: Preferred Network Access Commercial |
$323.00
|
| Rate for Payer: Quartz Beloit One Network |
$149.60
|
| Rate for Payer: Quartz Commercial |
$193.80
|
| Rate for Payer: The Alliance Commercial |
$170.00
|
| Rate for Payer: WEA Trust Commercial |
$187.00
|
| Rate for Payer: WPS Commercial |
$251.84
|
|
|
Amphetamines Screen
|
Facility
IP
|
$48.00
|
|
| Hospital Charge Code |
2942891
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$23.52 |
| Max. Negotiated Rate |
$44.16 |
| Rate for Payer: Aetna Commercial |
$43.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$25.44
|
| Rate for Payer: Cash Price |
$14.40
|
| Rate for Payer: Cigna Commercial |
$44.16
|
| Rate for Payer: Health EOS Commercial |
$42.72
|
| Rate for Payer: HFN Commercial |
$44.16
|
| Rate for Payer: Multiplan Commercial |
$38.40
|
| Rate for Payer: NAPHCARE Commercial |
$28.80
|
| Rate for Payer: Preferred Network Access Commercial |
$44.16
|
| Rate for Payer: Quartz Beloit One Network |
$23.52
|
| Rate for Payer: Quartz Commercial |
$28.80
|
| Rate for Payer: WEA Trust Commercial |
$26.40
|
| Rate for Payer: WPS Commercial |
$35.55
|
|
|
Amphetamines Screen
|
Facility
OP
|
$48.00
|
|
| Hospital Charge Code |
2942891
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.44 |
| Max. Negotiated Rate |
$192.00 |
| Rate for Payer: Aetna Commercial |
$43.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$41.28
|
| Rate for Payer: Aetna Managed Medicare |
$13.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$31.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$24.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$23.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$25.44
|
| Rate for Payer: Cash Price |
$14.40
|
| Rate for Payer: Cigna Commercial |
$44.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$26.86
|
| Rate for Payer: Health EOS Commercial |
$42.72
|
| Rate for Payer: HFN Commercial |
$44.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$36.00
|
| Rate for Payer: Multiplan Commercial |
$38.40
|
| Rate for Payer: NAPHCARE Commercial |
$28.80
|
| Rate for Payer: Preferred Network Access Commercial |
$44.16
|
| Rate for Payer: Quartz Beloit One Network |
$23.52
|
| Rate for Payer: Quartz Commercial |
$31.20
|
| Rate for Payer: Quartz Medicare Advantage |
$28.80
|
| Rate for Payer: The Alliance Commercial |
$192.00
|
| Rate for Payer: United Healthcare PPO |
$36.00
|
| Rate for Payer: WEA Trust Commercial |
$26.40
|
| Rate for Payer: WPS Commercial |
$35.55
|
|
