|
Ammonium, Urine
|
Facility
|
OP
|
$86.00
|
|
|
Service Code
|
CPT 82140
|
| Hospital Charge Code |
5474700
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.15 |
| Max. Negotiated Rate |
$82.28 |
| Rate for Payer: Aetna Commercial |
$80.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$76.92
|
| Rate for Payer: Aetna Managed Medicare |
$15.15
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$56.82
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$26.52
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$25.15
|
| Rate for Payer: Anthem Medicare Advantage |
$15.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$47.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$15.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$15.15
|
| Rate for Payer: Cash Price |
$25.80
|
| Rate for Payer: Cash Price |
$25.80
|
| Rate for Payer: Cigna Commercial |
$82.28
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$15.15
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$50.05
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$15.15
|
| Rate for Payer: Health EOS Commercial |
$79.60
|
| Rate for Payer: HFN Commercial |
$82.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$56.37
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$15.15
|
| Rate for Payer: Independent Care Health Plan Medicare |
$15.15
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$15.15
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$15.15
|
| Rate for Payer: Multiplan Commercial |
$71.55
|
| Rate for Payer: NAPHCARE Commercial |
$22.73
|
| Rate for Payer: Preferred Network Access Commercial |
$82.28
|
| Rate for Payer: Quartz Beloit One Network |
$43.83
|
| Rate for Payer: Quartz Commercial |
$58.14
|
| Rate for Payer: Quartz Medicare Advantage |
$15.15
|
| Rate for Payer: The Alliance Commercial |
$60.61
|
| Rate for Payer: United Healthcare Medicare Advantage |
$15.15
|
| Rate for Payer: United Healthcare PPO |
$67.08
|
| Rate for Payer: WEA Trust Commercial |
$49.19
|
| Rate for Payer: Wellcare Medicare |
$15.15
|
| Rate for Payer: WPS Commercial |
$66.25
|
|
|
AMNIHOOK AMNIOTIC MEMBRANE
|
Facility
|
OP
|
$66.00
|
|
| Hospital Charge Code |
2963413
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$19.22 |
| Max. Negotiated Rate |
$63.15 |
| Rate for Payer: Aetna Commercial |
$61.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$59.03
|
| Rate for Payer: Aetna Managed Medicare |
$19.22
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$44.62
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$34.32
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$32.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$36.38
|
| Rate for Payer: Cash Price |
$19.80
|
| Rate for Payer: Cigna Commercial |
$63.15
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$38.41
|
| Rate for Payer: Health EOS Commercial |
$61.09
|
| Rate for Payer: HFN Commercial |
$63.15
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$51.48
|
| Rate for Payer: Multiplan Commercial |
$54.91
|
| Rate for Payer: NAPHCARE Commercial |
$41.18
|
| Rate for Payer: Preferred Network Access Commercial |
$63.15
|
| Rate for Payer: Quartz Beloit One Network |
$33.63
|
| Rate for Payer: Quartz Commercial |
$44.62
|
| Rate for Payer: Quartz Medicare Advantage |
$41.18
|
| Rate for Payer: The Alliance Commercial |
$34.32
|
| Rate for Payer: WEA Trust Commercial |
$37.75
|
| Rate for Payer: WPS Commercial |
$50.84
|
|
|
AMNIHOOK AMNIOTIC MEMBRANE
|
Facility
|
IP
|
$66.00
|
|
| Hospital Charge Code |
2963413
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$33.63 |
| Max. Negotiated Rate |
$63.15 |
| Rate for Payer: Aetna Commercial |
$61.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$59.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$36.38
|
| Rate for Payer: Cash Price |
$19.80
|
| Rate for Payer: Cigna Commercial |
$63.15
|
| Rate for Payer: Health EOS Commercial |
$61.09
|
| Rate for Payer: HFN Commercial |
$63.15
|
| Rate for Payer: Multiplan Commercial |
$54.91
|
| Rate for Payer: Preferred Network Access Commercial |
$63.15
|
| Rate for Payer: Quartz Beloit One Network |
$33.63
|
| Rate for Payer: Quartz Commercial |
$41.18
|
| Rate for Payer: WEA Trust Commercial |
$37.75
|
| Rate for Payer: WPS Commercial |
$50.84
|
|
|
AMNIOCENTESIS, DIAGNOSTIC 59000
|
Professional
|
Both
|
$447.00
|
|
|
Service Code
|
CPT 59000
|
| Hospital Charge Code |
3015147
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$57.01 |
| Max. Negotiated Rate |
$441.64 |
| Rate for Payer: Aetna Commercial |
$441.64
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$399.80
|
| Rate for Payer: Aetna Managed Medicare |
$65.15
|
| Rate for Payer: Anthem Medicare Advantage |
$65.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$65.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$65.15
|
| Rate for Payer: Cash Price |
$134.10
|
| Rate for Payer: Cash Price |
$134.10
|
| Rate for Payer: Cash Price |
$134.10
|
| Rate for Payer: Cigna Commercial |
$441.64
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$57.01
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$65.15
|
| Rate for Payer: Health EOS Commercial |
$423.04
|
| Rate for Payer: HFN Commercial |
$441.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$262.67
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$262.67
|
| Rate for Payer: Independent Care Health Plan Medicare |
$65.15
|
| Rate for Payer: Multiplan Commercial |
$371.90
|
| Rate for Payer: NAPHCARE Commercial |
$97.72
|
| Rate for Payer: Preferred Network Access Commercial |
$441.64
|
| Rate for Payer: Quartz Beloit One Network |
$204.55
|
| Rate for Payer: Quartz Commercial |
$264.98
|
| Rate for Payer: Quartz Medicare Advantage |
$65.15
|
| Rate for Payer: The Alliance Commercial |
$276.87
|
| Rate for Payer: United Healthcare Medicaid |
$57.01
|
| Rate for Payer: United Healthcare Medicare Advantage |
$65.15
|
| Rate for Payer: WEA Trust Commercial |
$255.68
|
| Rate for Payer: WPS Commercial |
$293.16
|
|
|
Amniocentesis, Diagnostic 5900026
|
Professional
|
Both
|
$447.00
|
|
|
Service Code
|
CPT 59000 26
|
| Hospital Charge Code |
5102647
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$57.01 |
| Max. Negotiated Rate |
$441.64 |
| Rate for Payer: Aetna Commercial |
$441.64
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$399.80
|
| Rate for Payer: Cash Price |
$134.10
|
| Rate for Payer: Cash Price |
$134.10
|
| Rate for Payer: Cash Price |
$134.10
|
| Rate for Payer: Cigna Commercial |
$441.64
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$57.01
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$278.93
|
| Rate for Payer: Health EOS Commercial |
$423.04
|
| Rate for Payer: HFN Commercial |
$441.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$262.67
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$262.67
|
| Rate for Payer: Multiplan Commercial |
$371.90
|
| Rate for Payer: Preferred Network Access Commercial |
$441.64
|
| Rate for Payer: Quartz Beloit One Network |
$204.55
|
| Rate for Payer: Quartz Commercial |
$264.98
|
| Rate for Payer: The Alliance Commercial |
$232.44
|
| Rate for Payer: United Healthcare Medicaid |
$57.01
|
| Rate for Payer: WEA Trust Commercial |
$255.68
|
| Rate for Payer: WPS Commercial |
$344.32
|
|
|
Amniocentesis - Individual Charges
|
Facility
|
OP
|
$361.00
|
|
|
Service Code
|
CPT 59000
|
| Hospital Charge Code |
3040451
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$180.21 |
| Max. Negotiated Rate |
$4,386.95 |
| Rate for Payer: Aetna Commercial |
$337.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$322.88
|
| Rate for Payer: Aetna Managed Medicare |
$969.30
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$244.04
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$187.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$180.21
|
| Rate for Payer: Anthem Medicare Advantage |
$969.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$198.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$969.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$969.30
|
| Rate for Payer: Cash Price |
$108.30
|
| Rate for Payer: Cash Price |
$108.30
|
| Rate for Payer: Cigna Commercial |
$345.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$969.30
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$969.30
|
| Rate for Payer: Health EOS Commercial |
$334.14
|
| Rate for Payer: HFN Commercial |
$345.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,605.80
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$969.30
|
| Rate for Payer: Independent Care Health Plan Medicare |
$969.30
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$969.30
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$969.30
|
| Rate for Payer: Multiplan Commercial |
$300.35
|
| Rate for Payer: NAPHCARE Commercial |
$1,453.95
|
| Rate for Payer: Preferred Network Access Commercial |
$345.40
|
| Rate for Payer: Quartz Beloit One Network |
$183.97
|
| Rate for Payer: Quartz Commercial |
$244.04
|
| Rate for Payer: Quartz Medicare Advantage |
$969.30
|
| Rate for Payer: The Alliance Commercial |
$3,877.20
|
| Rate for Payer: United Healthcare Medicare Advantage |
$969.30
|
| Rate for Payer: United Healthcare PPO |
$281.58
|
| Rate for Payer: WEA Trust Commercial |
$206.49
|
| Rate for Payer: Wellcare Medicare |
$969.30
|
| Rate for Payer: WPS Commercial |
$278.08
|
|
|
Amniocentesis - Individual Charges
|
Facility
|
IP
|
$361.00
|
|
|
Service Code
|
CPT 59000
|
| Hospital Charge Code |
3040451
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$183.97 |
| Max. Negotiated Rate |
$345.40 |
| Rate for Payer: Aetna Commercial |
$337.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$322.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$198.98
|
| Rate for Payer: Cash Price |
$108.30
|
| Rate for Payer: Cigna Commercial |
$345.40
|
| Rate for Payer: Health EOS Commercial |
$334.14
|
| Rate for Payer: HFN Commercial |
$345.40
|
| Rate for Payer: Multiplan Commercial |
$300.35
|
| Rate for Payer: Preferred Network Access Commercial |
$345.40
|
| Rate for Payer: Quartz Beloit One Network |
$183.97
|
| Rate for Payer: Quartz Commercial |
$225.26
|
| Rate for Payer: WEA Trust Commercial |
$206.49
|
| Rate for Payer: WPS Commercial |
$278.08
|
|
|
Amnioinfusion - Individual Charges
|
Facility
|
OP
|
$1,178.00
|
|
|
Service Code
|
CPT 59070
|
| Hospital Charge Code |
6187681
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$320.69 |
| Max. Negotiated Rate |
$1,282.78 |
| Rate for Payer: Aetna Commercial |
$1,102.61
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,053.60
|
| Rate for Payer: Aetna Managed Medicare |
$320.69
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$796.33
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$612.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$588.06
|
| Rate for Payer: Anthem Medicare Advantage |
$320.69
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$649.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$320.69
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$320.69
|
| Rate for Payer: Cash Price |
$353.40
|
| Rate for Payer: Cash Price |
$353.40
|
| Rate for Payer: Cash Price |
$353.40
|
| Rate for Payer: Cigna Commercial |
$1,127.11
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$320.69
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$320.69
|
| Rate for Payer: Health EOS Commercial |
$1,090.36
|
| Rate for Payer: HFN Commercial |
$1,127.11
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,192.98
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$320.69
|
| Rate for Payer: Independent Care Health Plan Medicare |
$320.69
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$320.69
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$320.69
|
| Rate for Payer: Multiplan Commercial |
$980.10
|
| Rate for Payer: NAPHCARE Commercial |
$481.04
|
| Rate for Payer: Preferred Network Access Commercial |
$1,127.11
|
| Rate for Payer: Quartz Beloit One Network |
$600.31
|
| Rate for Payer: Quartz Commercial |
$796.33
|
| Rate for Payer: Quartz Medicare Advantage |
$320.69
|
| Rate for Payer: The Alliance Commercial |
$1,282.78
|
| Rate for Payer: United Healthcare Medicare Advantage |
$320.69
|
| Rate for Payer: United Healthcare PPO |
$918.84
|
| Rate for Payer: WEA Trust Commercial |
$673.82
|
| Rate for Payer: Wellcare Medicare |
$320.69
|
| Rate for Payer: WPS Commercial |
$907.41
|
|
|
Amnioinfusion - Individual Charges
|
Facility
|
IP
|
$1,178.00
|
|
|
Service Code
|
CPT 59070
|
| Hospital Charge Code |
6187681
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$600.31 |
| Max. Negotiated Rate |
$1,127.11 |
| Rate for Payer: Aetna Commercial |
$1,102.61
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,053.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$649.31
|
| Rate for Payer: Cash Price |
$353.40
|
| Rate for Payer: Cigna Commercial |
$1,127.11
|
| Rate for Payer: Health EOS Commercial |
$1,090.36
|
| Rate for Payer: HFN Commercial |
$1,127.11
|
| Rate for Payer: Multiplan Commercial |
$980.10
|
| Rate for Payer: Preferred Network Access Commercial |
$1,127.11
|
| Rate for Payer: Quartz Beloit One Network |
$600.31
|
| Rate for Payer: Quartz Commercial |
$735.07
|
| Rate for Payer: WEA Trust Commercial |
$673.82
|
| Rate for Payer: WPS Commercial |
$907.41
|
|
|
Amniotomy (ROM) - Individual Charges
|
Facility
|
OP
|
$70.00
|
|
| Hospital Charge Code |
3003917
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$20.38 |
| Max. Negotiated Rate |
$66.98 |
| Rate for Payer: Aetna Commercial |
$65.52
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$62.61
|
| Rate for Payer: Aetna Managed Medicare |
$20.38
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$47.32
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$36.40
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$34.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$38.58
|
| Rate for Payer: Cash Price |
$21.00
|
| Rate for Payer: Cigna Commercial |
$66.98
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$40.74
|
| Rate for Payer: Health EOS Commercial |
$64.79
|
| Rate for Payer: HFN Commercial |
$66.98
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$54.60
|
| Rate for Payer: Multiplan Commercial |
$58.24
|
| Rate for Payer: NAPHCARE Commercial |
$43.68
|
| Rate for Payer: Preferred Network Access Commercial |
$66.98
|
| Rate for Payer: Quartz Beloit One Network |
$35.67
|
| Rate for Payer: Quartz Commercial |
$47.32
|
| Rate for Payer: Quartz Medicare Advantage |
$43.68
|
| Rate for Payer: The Alliance Commercial |
$36.40
|
| Rate for Payer: WEA Trust Commercial |
$40.04
|
| Rate for Payer: WPS Commercial |
$53.92
|
|
|
Amniotomy (ROM) - Individual Charges
|
Facility
|
IP
|
$70.00
|
|
| Hospital Charge Code |
3003917
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$35.67 |
| Max. Negotiated Rate |
$66.98 |
| Rate for Payer: Aetna Commercial |
$65.52
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$62.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$38.58
|
| Rate for Payer: Cash Price |
$21.00
|
| Rate for Payer: Cigna Commercial |
$66.98
|
| Rate for Payer: Health EOS Commercial |
$64.79
|
| Rate for Payer: HFN Commercial |
$66.98
|
| Rate for Payer: Multiplan Commercial |
$58.24
|
| Rate for Payer: Preferred Network Access Commercial |
$66.98
|
| Rate for Payer: Quartz Beloit One Network |
$35.67
|
| Rate for Payer: Quartz Commercial |
$43.68
|
| Rate for Payer: WEA Trust Commercial |
$40.04
|
| Rate for Payer: WPS Commercial |
$53.92
|
|
|
Amnisure
|
Facility
|
IP
|
$282.00
|
|
|
Service Code
|
CPT 84112
|
| Hospital Charge Code |
979908
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$143.71 |
| Max. Negotiated Rate |
$269.82 |
| Rate for Payer: Aetna Commercial |
$263.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$252.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$155.44
|
| Rate for Payer: Cash Price |
$84.60
|
| Rate for Payer: Cigna Commercial |
$269.82
|
| Rate for Payer: Health EOS Commercial |
$261.02
|
| Rate for Payer: HFN Commercial |
$269.82
|
| Rate for Payer: Multiplan Commercial |
$234.62
|
| Rate for Payer: Preferred Network Access Commercial |
$269.82
|
| Rate for Payer: Quartz Beloit One Network |
$143.71
|
| Rate for Payer: Quartz Commercial |
$175.97
|
| Rate for Payer: WEA Trust Commercial |
$161.30
|
| Rate for Payer: WPS Commercial |
$217.22
|
|
|
Amnisure
|
Facility
|
OP
|
$282.00
|
|
|
Service Code
|
CPT 84112
|
| Hospital Charge Code |
979908
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$102.03 |
| Max. Negotiated Rate |
$408.14 |
| Rate for Payer: Aetna Commercial |
$263.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$252.22
|
| Rate for Payer: Aetna Managed Medicare |
$102.03
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$382.63
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$178.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$169.38
|
| Rate for Payer: Anthem Medicare Advantage |
$102.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$155.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$102.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$102.03
|
| Rate for Payer: Cash Price |
$84.60
|
| Rate for Payer: Cash Price |
$84.60
|
| Rate for Payer: Cigna Commercial |
$269.82
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$102.03
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$164.12
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$102.03
|
| Rate for Payer: Health EOS Commercial |
$261.02
|
| Rate for Payer: HFN Commercial |
$269.82
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$379.57
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$102.03
|
| Rate for Payer: Independent Care Health Plan Medicare |
$102.03
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$102.03
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$102.03
|
| Rate for Payer: Multiplan Commercial |
$234.62
|
| Rate for Payer: NAPHCARE Commercial |
$153.05
|
| Rate for Payer: Preferred Network Access Commercial |
$269.82
|
| Rate for Payer: Quartz Beloit One Network |
$143.71
|
| Rate for Payer: Quartz Commercial |
$190.63
|
| Rate for Payer: Quartz Medicare Advantage |
$102.03
|
| Rate for Payer: The Alliance Commercial |
$408.14
|
| Rate for Payer: United Healthcare Medicare Advantage |
$102.03
|
| Rate for Payer: United Healthcare PPO |
$219.96
|
| Rate for Payer: WEA Trust Commercial |
$161.30
|
| Rate for Payer: Wellcare Medicare |
$102.03
|
| Rate for Payer: WPS Commercial |
$217.22
|
|
|
Amnisure
|
Professional
|
Both
|
$282.00
|
|
|
Service Code
|
CPT 84112
|
| Hospital Charge Code |
979908
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$102.03 |
| Max. Negotiated Rate |
$448.95 |
| Rate for Payer: Aetna Commercial |
$278.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$252.22
|
| Rate for Payer: Aetna Managed Medicare |
$102.03
|
| Rate for Payer: Anthem Medicare Advantage |
$102.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$102.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$102.03
|
| Rate for Payer: Cash Price |
$84.60
|
| Rate for Payer: Cash Price |
$84.60
|
| Rate for Payer: Cigna Commercial |
$278.62
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$146.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$102.03
|
| Rate for Payer: Health EOS Commercial |
$266.88
|
| Rate for Payer: HFN Commercial |
$278.62
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$360.18
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$360.18
|
| Rate for Payer: Independent Care Health Plan Medicare |
$102.03
|
| Rate for Payer: Multiplan Commercial |
$234.62
|
| Rate for Payer: NAPHCARE Commercial |
$153.05
|
| Rate for Payer: Preferred Network Access Commercial |
$278.62
|
| Rate for Payer: Quartz Beloit One Network |
$129.04
|
| Rate for Payer: Quartz Commercial |
$167.17
|
| Rate for Payer: Quartz Medicare Advantage |
$102.03
|
| Rate for Payer: The Alliance Commercial |
$403.04
|
| Rate for Payer: United Healthcare Medicare Advantage |
$102.03
|
| Rate for Payer: WEA Trust Commercial |
$161.30
|
| Rate for Payer: WPS Commercial |
$448.95
|
|
|
Amoxicillin IgE
|
Facility
|
OP
|
$30.00
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
5230631
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.43 |
| Max. Negotiated Rate |
$28.70 |
| Rate for Payer: Aetna Commercial |
$28.08
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$26.83
|
| Rate for Payer: Aetna Managed Medicare |
$5.43
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$20.36
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$9.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$9.01
|
| Rate for Payer: Anthem Medicare Advantage |
$5.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$16.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5.43
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Cigna Commercial |
$28.70
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$5.43
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$17.46
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$5.43
|
| Rate for Payer: Health EOS Commercial |
$27.77
|
| Rate for Payer: HFN Commercial |
$28.70
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$20.20
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$5.43
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5.43
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$5.43
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$5.43
|
| Rate for Payer: Multiplan Commercial |
$24.96
|
| Rate for Payer: NAPHCARE Commercial |
$8.14
|
| Rate for Payer: Preferred Network Access Commercial |
$28.70
|
| Rate for Payer: Quartz Beloit One Network |
$15.29
|
| Rate for Payer: Quartz Commercial |
$20.28
|
| Rate for Payer: Quartz Medicare Advantage |
$5.43
|
| Rate for Payer: The Alliance Commercial |
$21.72
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.43
|
| Rate for Payer: United Healthcare PPO |
$23.40
|
| Rate for Payer: WEA Trust Commercial |
$17.16
|
| Rate for Payer: Wellcare Medicare |
$5.43
|
| Rate for Payer: WPS Commercial |
$23.11
|
|
|
Amoxicillin IgE
|
Professional
|
Both
|
$30.00
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
5230631
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.43 |
| Max. Negotiated Rate |
$29.64 |
| Rate for Payer: Aetna Commercial |
$29.64
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$26.83
|
| Rate for Payer: Aetna Managed Medicare |
$5.43
|
| Rate for Payer: Anthem Medicare Advantage |
$5.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5.43
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Cigna Commercial |
$29.64
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$15.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5.43
|
| Rate for Payer: Health EOS Commercial |
$28.39
|
| Rate for Payer: HFN Commercial |
$29.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$19.17
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$19.17
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5.43
|
| Rate for Payer: Multiplan Commercial |
$24.96
|
| Rate for Payer: NAPHCARE Commercial |
$8.14
|
| Rate for Payer: Preferred Network Access Commercial |
$29.64
|
| Rate for Payer: Quartz Beloit One Network |
$13.73
|
| Rate for Payer: Quartz Commercial |
$17.78
|
| Rate for Payer: Quartz Medicare Advantage |
$5.43
|
| Rate for Payer: The Alliance Commercial |
$21.44
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.43
|
| Rate for Payer: WEA Trust Commercial |
$17.16
|
| Rate for Payer: WPS Commercial |
$23.89
|
|
|
Amoxicillin IgE
|
Facility
|
IP
|
$30.00
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
5230631
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.29 |
| Max. Negotiated Rate |
$28.70 |
| Rate for Payer: Aetna Commercial |
$28.08
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$26.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$16.54
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Cigna Commercial |
$28.70
|
| Rate for Payer: Health EOS Commercial |
$27.77
|
| Rate for Payer: HFN Commercial |
$28.70
|
| Rate for Payer: Multiplan Commercial |
$24.96
|
| Rate for Payer: Preferred Network Access Commercial |
$28.70
|
| Rate for Payer: Quartz Beloit One Network |
$15.29
|
| Rate for Payer: Quartz Commercial |
$18.72
|
| Rate for Payer: WEA Trust Commercial |
$17.16
|
| Rate for Payer: WPS Commercial |
$23.11
|
|
|
Amphetamine Level
|
Professional
|
Both
|
$331.00
|
|
|
Service Code
|
CPT 80324
|
| Hospital Charge Code |
633649
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$83.26 |
| Max. Negotiated Rate |
$327.03 |
| Rate for Payer: Aetna Commercial |
$327.03
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$296.05
|
| Rate for Payer: Cash Price |
$99.30
|
| Rate for Payer: Cash Price |
$99.30
|
| Rate for Payer: Cigna Commercial |
$327.03
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$172.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$206.54
|
| Rate for Payer: Health EOS Commercial |
$313.26
|
| Rate for Payer: HFN Commercial |
$327.03
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$83.26
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$83.26
|
| Rate for Payer: Multiplan Commercial |
$275.39
|
| Rate for Payer: Preferred Network Access Commercial |
$327.03
|
| Rate for Payer: Quartz Beloit One Network |
$151.47
|
| Rate for Payer: Quartz Commercial |
$196.22
|
| Rate for Payer: The Alliance Commercial |
$172.12
|
| Rate for Payer: WEA Trust Commercial |
$189.33
|
| Rate for Payer: WPS Commercial |
$254.97
|
|
|
Amphetamine Level
|
Facility
|
OP
|
$331.00
|
|
|
Service Code
|
CPT 80324
|
| Hospital Charge Code |
633649
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$96.39 |
| Max. Negotiated Rate |
$316.70 |
| Rate for Payer: Aetna Commercial |
$309.82
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$296.05
|
| Rate for Payer: Aetna Managed Medicare |
$96.39
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$223.76
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$172.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$165.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$182.45
|
| Rate for Payer: Cash Price |
$99.30
|
| Rate for Payer: Cigna Commercial |
$316.70
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$192.64
|
| Rate for Payer: Health EOS Commercial |
$306.37
|
| Rate for Payer: HFN Commercial |
$316.70
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$258.18
|
| Rate for Payer: Multiplan Commercial |
$275.39
|
| Rate for Payer: NAPHCARE Commercial |
$206.54
|
| Rate for Payer: Preferred Network Access Commercial |
$316.70
|
| Rate for Payer: Quartz Beloit One Network |
$168.68
|
| Rate for Payer: Quartz Commercial |
$223.76
|
| Rate for Payer: Quartz Medicare Advantage |
$206.54
|
| Rate for Payer: The Alliance Commercial |
$172.12
|
| Rate for Payer: United Healthcare PPO |
$258.18
|
| Rate for Payer: WEA Trust Commercial |
$189.33
|
| Rate for Payer: WPS Commercial |
$254.97
|
|
|
Amphetamine Level
|
Facility
|
IP
|
$331.00
|
|
|
Service Code
|
CPT 80324
|
| Hospital Charge Code |
633649
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$168.68 |
| Max. Negotiated Rate |
$316.70 |
| Rate for Payer: Aetna Commercial |
$309.82
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$296.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$182.45
|
| Rate for Payer: Cash Price |
$99.30
|
| Rate for Payer: Cigna Commercial |
$316.70
|
| Rate for Payer: Health EOS Commercial |
$306.37
|
| Rate for Payer: HFN Commercial |
$316.70
|
| Rate for Payer: Multiplan Commercial |
$275.39
|
| Rate for Payer: Preferred Network Access Commercial |
$316.70
|
| Rate for Payer: Quartz Beloit One Network |
$168.68
|
| Rate for Payer: Quartz Commercial |
$206.54
|
| Rate for Payer: WEA Trust Commercial |
$189.33
|
| Rate for Payer: WPS Commercial |
$254.97
|
|
|
Amphetamine Quantitative Urine
|
Facility
|
IP
|
$340.00
|
|
|
Service Code
|
CPT 80324
|
| Hospital Charge Code |
977867
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$173.26 |
| Max. Negotiated Rate |
$325.31 |
| Rate for Payer: Aetna Commercial |
$318.24
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$304.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$187.41
|
| Rate for Payer: Cash Price |
$102.00
|
| Rate for Payer: Cigna Commercial |
$325.31
|
| Rate for Payer: Health EOS Commercial |
$314.70
|
| Rate for Payer: HFN Commercial |
$325.31
|
| Rate for Payer: Multiplan Commercial |
$282.88
|
| Rate for Payer: Preferred Network Access Commercial |
$325.31
|
| Rate for Payer: Quartz Beloit One Network |
$173.26
|
| Rate for Payer: Quartz Commercial |
$212.16
|
| Rate for Payer: WEA Trust Commercial |
$194.48
|
| Rate for Payer: WPS Commercial |
$261.90
|
|
|
Amphetamine Quantitative Urine
|
Facility
|
OP
|
$340.00
|
|
|
Service Code
|
CPT 80324
|
| Hospital Charge Code |
977867
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$99.01 |
| Max. Negotiated Rate |
$325.31 |
| Rate for Payer: Aetna Commercial |
$318.24
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$304.10
|
| Rate for Payer: Aetna Managed Medicare |
$99.01
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$229.84
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$176.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$169.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$187.41
|
| Rate for Payer: Cash Price |
$102.00
|
| Rate for Payer: Cigna Commercial |
$325.31
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$197.88
|
| Rate for Payer: Health EOS Commercial |
$314.70
|
| Rate for Payer: HFN Commercial |
$325.31
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$265.20
|
| Rate for Payer: Multiplan Commercial |
$282.88
|
| Rate for Payer: NAPHCARE Commercial |
$212.16
|
| Rate for Payer: Preferred Network Access Commercial |
$325.31
|
| Rate for Payer: Quartz Beloit One Network |
$173.26
|
| Rate for Payer: Quartz Commercial |
$229.84
|
| Rate for Payer: Quartz Medicare Advantage |
$212.16
|
| Rate for Payer: The Alliance Commercial |
$176.80
|
| Rate for Payer: United Healthcare PPO |
$265.20
|
| Rate for Payer: WEA Trust Commercial |
$194.48
|
| Rate for Payer: WPS Commercial |
$261.90
|
|
|
Amphetamine Quantitative Urine
|
Professional
|
Both
|
$340.00
|
|
|
Service Code
|
CPT 80324
|
| Hospital Charge Code |
977867
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$83.26 |
| Max. Negotiated Rate |
$335.92 |
| Rate for Payer: Aetna Commercial |
$335.92
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$304.10
|
| Rate for Payer: Cash Price |
$102.00
|
| Rate for Payer: Cash Price |
$102.00
|
| Rate for Payer: Cigna Commercial |
$335.92
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$176.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$212.16
|
| Rate for Payer: Health EOS Commercial |
$321.78
|
| Rate for Payer: HFN Commercial |
$335.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$83.26
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$83.26
|
| Rate for Payer: Multiplan Commercial |
$282.88
|
| Rate for Payer: Preferred Network Access Commercial |
$335.92
|
| Rate for Payer: Quartz Beloit One Network |
$155.58
|
| Rate for Payer: Quartz Commercial |
$201.55
|
| Rate for Payer: The Alliance Commercial |
$176.80
|
| Rate for Payer: WEA Trust Commercial |
$194.48
|
| Rate for Payer: WPS Commercial |
$261.90
|
|
|
Amphetamines Screen
|
Facility
|
OP
|
$48.00
|
|
| Hospital Charge Code |
2942891
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.98 |
| Max. Negotiated Rate |
$45.93 |
| Rate for Payer: Aetna Commercial |
$44.93
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$42.93
|
| Rate for Payer: Aetna Managed Medicare |
$13.98
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$32.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$24.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$23.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$26.46
|
| Rate for Payer: Cash Price |
$14.40
|
| Rate for Payer: Cigna Commercial |
$45.93
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$27.94
|
| Rate for Payer: Health EOS Commercial |
$44.43
|
| Rate for Payer: HFN Commercial |
$45.93
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$37.44
|
| Rate for Payer: Multiplan Commercial |
$39.94
|
| Rate for Payer: NAPHCARE Commercial |
$29.95
|
| Rate for Payer: Preferred Network Access Commercial |
$45.93
|
| Rate for Payer: Quartz Beloit One Network |
$24.46
|
| Rate for Payer: Quartz Commercial |
$32.45
|
| Rate for Payer: Quartz Medicare Advantage |
$29.95
|
| Rate for Payer: The Alliance Commercial |
$24.96
|
| Rate for Payer: United Healthcare PPO |
$37.44
|
| Rate for Payer: WEA Trust Commercial |
$27.46
|
| Rate for Payer: WPS Commercial |
$36.97
|
|
|
Amphetamines Screen
|
Facility
|
IP
|
$48.00
|
|
| Hospital Charge Code |
2942891
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$24.46 |
| Max. Negotiated Rate |
$45.93 |
| Rate for Payer: Aetna Commercial |
$44.93
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$42.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$26.46
|
| Rate for Payer: Cash Price |
$14.40
|
| Rate for Payer: Cigna Commercial |
$45.93
|
| Rate for Payer: Health EOS Commercial |
$44.43
|
| Rate for Payer: HFN Commercial |
$45.93
|
| Rate for Payer: Multiplan Commercial |
$39.94
|
| Rate for Payer: Preferred Network Access Commercial |
$45.93
|
| Rate for Payer: Quartz Beloit One Network |
$24.46
|
| Rate for Payer: Quartz Commercial |
$29.95
|
| Rate for Payer: WEA Trust Commercial |
$27.46
|
| Rate for Payer: WPS Commercial |
$36.97
|
|
