|
glucagon 1 mg Charge
|
Facility
|
OP
|
$1,535.00
|
|
|
Service Code
|
HCPCS J1610
|
| Hospital Charge Code |
2958930
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$171.45 |
| Max. Negotiated Rate |
$1,468.69 |
| Rate for Payer: Aetna Commercial |
$1,436.76
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,372.90
|
| Rate for Payer: Aetna Managed Medicare |
$171.45
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,037.66
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$798.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$766.27
|
| Rate for Payer: Anthem Medicare Advantage |
$171.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$846.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$171.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$171.45
|
| Rate for Payer: Cash Price |
$460.50
|
| Rate for Payer: Cash Price |
$460.50
|
| Rate for Payer: Cigna Commercial |
$1,468.69
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$171.45
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$263.51
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$171.45
|
| Rate for Payer: Health EOS Commercial |
$1,420.80
|
| Rate for Payer: HFN Commercial |
$1,468.69
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$637.81
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$171.45
|
| Rate for Payer: Independent Care Health Plan Medicare |
$171.45
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$171.45
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$171.45
|
| Rate for Payer: Multiplan Commercial |
$1,277.12
|
| Rate for Payer: NAPHCARE Commercial |
$257.18
|
| Rate for Payer: Preferred Network Access Commercial |
$1,468.69
|
| Rate for Payer: Quartz Beloit One Network |
$782.24
|
| Rate for Payer: Quartz Commercial |
$1,037.66
|
| Rate for Payer: Quartz Medicare Advantage |
$171.45
|
| Rate for Payer: The Alliance Commercial |
$685.82
|
| Rate for Payer: United Healthcare Medicare Advantage |
$171.45
|
| Rate for Payer: WEA Trust Commercial |
$878.02
|
| Rate for Payer: Wellcare Medicare |
$171.45
|
| Rate for Payer: WPS Commercial |
$497.95
|
|
|
Glucagon Level
|
Professional
|
Both
|
$698.00
|
|
|
Service Code
|
CPT 82943
|
| Hospital Charge Code |
633738
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.86 |
| Max. Negotiated Rate |
$689.62 |
| Rate for Payer: Aetna Commercial |
$689.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$624.29
|
| Rate for Payer: Aetna Managed Medicare |
$14.86
|
| Rate for Payer: Anthem Medicare Advantage |
$14.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$14.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$14.86
|
| Rate for Payer: Cash Price |
$209.40
|
| Rate for Payer: Cash Price |
$209.40
|
| Rate for Payer: Cigna Commercial |
$689.62
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$362.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$14.86
|
| Rate for Payer: Health EOS Commercial |
$660.59
|
| Rate for Payer: HFN Commercial |
$689.62
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$52.46
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$52.46
|
| Rate for Payer: Independent Care Health Plan Medicare |
$14.86
|
| Rate for Payer: Multiplan Commercial |
$580.74
|
| Rate for Payer: NAPHCARE Commercial |
$22.29
|
| Rate for Payer: Preferred Network Access Commercial |
$689.62
|
| Rate for Payer: Quartz Beloit One Network |
$319.40
|
| Rate for Payer: Quartz Commercial |
$413.77
|
| Rate for Payer: Quartz Medicare Advantage |
$14.86
|
| Rate for Payer: The Alliance Commercial |
$58.70
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14.86
|
| Rate for Payer: WEA Trust Commercial |
$399.26
|
| Rate for Payer: WPS Commercial |
$65.39
|
|
|
Glucagon Level
|
Facility
|
IP
|
$698.00
|
|
|
Service Code
|
CPT 82943
|
| Hospital Charge Code |
633738
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$355.70 |
| Max. Negotiated Rate |
$667.85 |
| Rate for Payer: Aetna Commercial |
$653.33
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$624.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$384.74
|
| Rate for Payer: Cash Price |
$209.40
|
| Rate for Payer: Cigna Commercial |
$667.85
|
| Rate for Payer: Health EOS Commercial |
$646.07
|
| Rate for Payer: HFN Commercial |
$667.85
|
| Rate for Payer: Multiplan Commercial |
$580.74
|
| Rate for Payer: Preferred Network Access Commercial |
$667.85
|
| Rate for Payer: Quartz Beloit One Network |
$355.70
|
| Rate for Payer: Quartz Commercial |
$435.55
|
| Rate for Payer: WEA Trust Commercial |
$399.26
|
| Rate for Payer: WPS Commercial |
$537.67
|
|
|
Glucagon Level
|
Facility
|
OP
|
$698.00
|
|
|
Service Code
|
CPT 82943
|
| Hospital Charge Code |
633738
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.86 |
| Max. Negotiated Rate |
$667.85 |
| Rate for Payer: Aetna Commercial |
$653.33
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$624.29
|
| Rate for Payer: Aetna Managed Medicare |
$14.86
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$55.73
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$26.01
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$24.67
|
| Rate for Payer: Anthem Medicare Advantage |
$14.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$384.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$14.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$14.86
|
| Rate for Payer: Cash Price |
$209.40
|
| Rate for Payer: Cash Price |
$209.40
|
| Rate for Payer: Cigna Commercial |
$667.85
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$14.86
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$406.24
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$14.86
|
| Rate for Payer: Health EOS Commercial |
$646.07
|
| Rate for Payer: HFN Commercial |
$667.85
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$55.29
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$14.86
|
| Rate for Payer: Independent Care Health Plan Medicare |
$14.86
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$14.86
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$14.86
|
| Rate for Payer: Multiplan Commercial |
$580.74
|
| Rate for Payer: NAPHCARE Commercial |
$22.29
|
| Rate for Payer: Preferred Network Access Commercial |
$667.85
|
| Rate for Payer: Quartz Beloit One Network |
$355.70
|
| Rate for Payer: Quartz Commercial |
$471.85
|
| Rate for Payer: Quartz Medicare Advantage |
$14.86
|
| Rate for Payer: The Alliance Commercial |
$59.45
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14.86
|
| Rate for Payer: United Healthcare PPO |
$544.44
|
| Rate for Payer: WEA Trust Commercial |
$399.26
|
| Rate for Payer: Wellcare Medicare |
$14.86
|
| Rate for Payer: WPS Commercial |
$537.67
|
|
|
glucagon recombinant 1 mg Inj [Med]
|
Facility
|
OP
|
$1,200.00
|
|
|
Service Code
|
HCPCS J1610
|
| Hospital Charge Code |
2983107
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$171.45 |
| Max. Negotiated Rate |
$1,148.16 |
| Rate for Payer: Aetna Commercial |
$1,123.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,073.28
|
| Rate for Payer: Aetna Managed Medicare |
$171.45
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$811.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$624.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$599.04
|
| Rate for Payer: Anthem Medicare Advantage |
$171.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$661.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$171.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$171.45
|
| Rate for Payer: Cash Price |
$360.00
|
| Rate for Payer: Cash Price |
$360.00
|
| Rate for Payer: Cigna Commercial |
$1,148.16
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$171.45
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$263.51
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$171.45
|
| Rate for Payer: Health EOS Commercial |
$1,110.72
|
| Rate for Payer: HFN Commercial |
$1,148.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$637.81
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$171.45
|
| Rate for Payer: Independent Care Health Plan Medicare |
$171.45
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$171.45
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$171.45
|
| Rate for Payer: Multiplan Commercial |
$998.40
|
| Rate for Payer: NAPHCARE Commercial |
$257.18
|
| Rate for Payer: Preferred Network Access Commercial |
$1,148.16
|
| Rate for Payer: Quartz Beloit One Network |
$611.52
|
| Rate for Payer: Quartz Commercial |
$811.20
|
| Rate for Payer: Quartz Medicare Advantage |
$171.45
|
| Rate for Payer: The Alliance Commercial |
$685.82
|
| Rate for Payer: United Healthcare Medicare Advantage |
$171.45
|
| Rate for Payer: WEA Trust Commercial |
$686.40
|
| Rate for Payer: Wellcare Medicare |
$171.45
|
| Rate for Payer: WPS Commercial |
$497.95
|
|
|
glucagon recombinant 1 mg Inj [Med]
|
Facility
|
IP
|
$1,200.00
|
|
|
Service Code
|
HCPCS J1610
|
| Hospital Charge Code |
2983107
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$611.52 |
| Max. Negotiated Rate |
$1,148.16 |
| Rate for Payer: Aetna Commercial |
$1,123.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,073.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$661.44
|
| Rate for Payer: Cash Price |
$360.00
|
| Rate for Payer: Cigna Commercial |
$1,148.16
|
| Rate for Payer: Health EOS Commercial |
$1,110.72
|
| Rate for Payer: HFN Commercial |
$1,148.16
|
| Rate for Payer: Multiplan Commercial |
$998.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,148.16
|
| Rate for Payer: Quartz Beloit One Network |
$611.52
|
| Rate for Payer: Quartz Commercial |
$748.80
|
| Rate for Payer: WEA Trust Commercial |
$686.40
|
| Rate for Payer: WPS Commercial |
$924.36
|
|
|
Glucerna 1.2 Rth 1000 mL
|
Facility
|
IP
|
$126.00
|
|
|
Service Code
|
HCPCS B4154
|
| Hospital Charge Code |
3031436
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$64.21 |
| Max. Negotiated Rate |
$120.56 |
| Rate for Payer: Aetna Commercial |
$117.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$112.69
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$69.45
|
| Rate for Payer: Cash Price |
$37.80
|
| Rate for Payer: Cigna Commercial |
$120.56
|
| Rate for Payer: Health EOS Commercial |
$116.63
|
| Rate for Payer: HFN Commercial |
$120.56
|
| Rate for Payer: Multiplan Commercial |
$104.83
|
| Rate for Payer: Preferred Network Access Commercial |
$120.56
|
| Rate for Payer: Quartz Beloit One Network |
$64.21
|
| Rate for Payer: Quartz Commercial |
$78.62
|
| Rate for Payer: WEA Trust Commercial |
$72.07
|
| Rate for Payer: WPS Commercial |
$97.06
|
|
|
Glucerna 1.2 Rth 1000 mL
|
Facility
|
OP
|
$126.00
|
|
|
Service Code
|
HCPCS B4154
|
| Hospital Charge Code |
3031436
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$36.69 |
| Max. Negotiated Rate |
$120.56 |
| Rate for Payer: Aetna Commercial |
$117.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$112.69
|
| Rate for Payer: Aetna Managed Medicare |
$36.69
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$85.18
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$65.52
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$62.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$69.45
|
| Rate for Payer: Cash Price |
$37.80
|
| Rate for Payer: Cigna Commercial |
$120.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$73.33
|
| Rate for Payer: Health EOS Commercial |
$116.63
|
| Rate for Payer: HFN Commercial |
$120.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$98.28
|
| Rate for Payer: Multiplan Commercial |
$104.83
|
| Rate for Payer: NAPHCARE Commercial |
$78.62
|
| Rate for Payer: Preferred Network Access Commercial |
$120.56
|
| Rate for Payer: Quartz Beloit One Network |
$64.21
|
| Rate for Payer: Quartz Commercial |
$85.18
|
| Rate for Payer: Quartz Medicare Advantage |
$78.62
|
| Rate for Payer: The Alliance Commercial |
$65.52
|
| Rate for Payer: WEA Trust Commercial |
$72.07
|
| Rate for Payer: WPS Commercial |
$97.06
|
|
|
Glucerna Shake
|
Facility
|
IP
|
$35.00
|
|
| Hospital Charge Code |
3031437
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$17.84 |
| Max. Negotiated Rate |
$33.49 |
| Rate for Payer: Aetna Commercial |
$32.76
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$31.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$19.29
|
| Rate for Payer: Cash Price |
$10.50
|
| Rate for Payer: Cigna Commercial |
$33.49
|
| Rate for Payer: Health EOS Commercial |
$32.40
|
| Rate for Payer: HFN Commercial |
$33.49
|
| Rate for Payer: Multiplan Commercial |
$29.12
|
| Rate for Payer: Preferred Network Access Commercial |
$33.49
|
| Rate for Payer: Quartz Beloit One Network |
$17.84
|
| Rate for Payer: Quartz Commercial |
$21.84
|
| Rate for Payer: WEA Trust Commercial |
$20.02
|
| Rate for Payer: WPS Commercial |
$26.96
|
|
|
Glucerna Shake
|
Facility
|
OP
|
$35.00
|
|
| Hospital Charge Code |
3031437
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.19 |
| Max. Negotiated Rate |
$33.49 |
| Rate for Payer: Aetna Commercial |
$32.76
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$31.30
|
| Rate for Payer: Aetna Managed Medicare |
$10.19
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$23.66
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$18.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$17.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$19.29
|
| Rate for Payer: Cash Price |
$10.50
|
| Rate for Payer: Cigna Commercial |
$33.49
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$20.37
|
| Rate for Payer: Health EOS Commercial |
$32.40
|
| Rate for Payer: HFN Commercial |
$33.49
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$27.30
|
| Rate for Payer: Multiplan Commercial |
$29.12
|
| Rate for Payer: NAPHCARE Commercial |
$21.84
|
| Rate for Payer: Preferred Network Access Commercial |
$33.49
|
| Rate for Payer: Quartz Beloit One Network |
$17.84
|
| Rate for Payer: Quartz Commercial |
$23.66
|
| Rate for Payer: Quartz Medicare Advantage |
$21.84
|
| Rate for Payer: The Alliance Commercial |
$18.20
|
| Rate for Payer: WEA Trust Commercial |
$20.02
|
| Rate for Payer: WPS Commercial |
$26.96
|
|
|
Gluc, Finger
|
Professional
|
Both
|
$76.00
|
|
|
Service Code
|
CPT 82948
|
| Hospital Charge Code |
979898
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.24 |
| Max. Negotiated Rate |
$75.09 |
| Rate for Payer: Aetna Commercial |
$75.09
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$67.97
|
| Rate for Payer: Aetna Managed Medicare |
$5.24
|
| Rate for Payer: Anthem Medicare Advantage |
$5.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5.24
|
| Rate for Payer: Cash Price |
$22.80
|
| Rate for Payer: Cash Price |
$22.80
|
| Rate for Payer: Cigna Commercial |
$75.09
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$39.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5.24
|
| Rate for Payer: Health EOS Commercial |
$71.93
|
| Rate for Payer: HFN Commercial |
$75.09
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$18.50
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$18.50
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5.24
|
| Rate for Payer: Multiplan Commercial |
$63.23
|
| Rate for Payer: NAPHCARE Commercial |
$7.86
|
| Rate for Payer: Preferred Network Access Commercial |
$75.09
|
| Rate for Payer: Quartz Beloit One Network |
$34.78
|
| Rate for Payer: Quartz Commercial |
$45.05
|
| Rate for Payer: Quartz Medicare Advantage |
$5.24
|
| Rate for Payer: The Alliance Commercial |
$20.70
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.24
|
| Rate for Payer: WEA Trust Commercial |
$43.47
|
| Rate for Payer: WPS Commercial |
$23.06
|
|
|
Gluc, Finger
|
Facility
|
OP
|
$76.00
|
|
|
Service Code
|
CPT 82948
|
| Hospital Charge Code |
979898
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.24 |
| Max. Negotiated Rate |
$72.72 |
| Rate for Payer: Aetna Commercial |
$71.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$67.97
|
| Rate for Payer: Aetna Managed Medicare |
$5.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$19.66
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$9.17
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$8.70
|
| Rate for Payer: Anthem Medicare Advantage |
$5.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$41.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5.24
|
| Rate for Payer: Cash Price |
$22.80
|
| Rate for Payer: Cash Price |
$22.80
|
| Rate for Payer: Cigna Commercial |
$72.72
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$5.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$44.23
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$5.24
|
| Rate for Payer: Health EOS Commercial |
$70.35
|
| Rate for Payer: HFN Commercial |
$72.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$19.50
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$5.24
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5.24
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$5.24
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$5.24
|
| Rate for Payer: Multiplan Commercial |
$63.23
|
| Rate for Payer: NAPHCARE Commercial |
$7.86
|
| Rate for Payer: Preferred Network Access Commercial |
$72.72
|
| Rate for Payer: Quartz Beloit One Network |
$38.73
|
| Rate for Payer: Quartz Commercial |
$51.38
|
| Rate for Payer: Quartz Medicare Advantage |
$5.24
|
| Rate for Payer: The Alliance Commercial |
$20.97
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.24
|
| Rate for Payer: United Healthcare PPO |
$59.28
|
| Rate for Payer: WEA Trust Commercial |
$43.47
|
| Rate for Payer: Wellcare Medicare |
$5.24
|
| Rate for Payer: WPS Commercial |
$58.54
|
|
|
Gluc, Finger
|
Facility
|
IP
|
$76.00
|
|
|
Service Code
|
CPT 82948
|
| Hospital Charge Code |
979898
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$38.73 |
| Max. Negotiated Rate |
$72.72 |
| Rate for Payer: Aetna Commercial |
$71.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$67.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$41.89
|
| Rate for Payer: Cash Price |
$22.80
|
| Rate for Payer: Cigna Commercial |
$72.72
|
| Rate for Payer: Health EOS Commercial |
$70.35
|
| Rate for Payer: HFN Commercial |
$72.72
|
| Rate for Payer: Multiplan Commercial |
$63.23
|
| Rate for Payer: Preferred Network Access Commercial |
$72.72
|
| Rate for Payer: Quartz Beloit One Network |
$38.73
|
| Rate for Payer: Quartz Commercial |
$47.42
|
| Rate for Payer: WEA Trust Commercial |
$43.47
|
| Rate for Payer: WPS Commercial |
$58.54
|
|
|
Glucometer fingerstick for blood sugar POC
|
Professional
|
Both
|
$77.00
|
|
|
Service Code
|
CPT 82948
|
| Hospital Charge Code |
1190875
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.24 |
| Max. Negotiated Rate |
$76.08 |
| Rate for Payer: Aetna Commercial |
$76.08
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$68.87
|
| Rate for Payer: Aetna Managed Medicare |
$5.24
|
| Rate for Payer: Anthem Medicare Advantage |
$5.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5.24
|
| Rate for Payer: Cash Price |
$23.10
|
| Rate for Payer: Cash Price |
$23.10
|
| Rate for Payer: Cigna Commercial |
$76.08
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$40.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5.24
|
| Rate for Payer: Health EOS Commercial |
$72.87
|
| Rate for Payer: HFN Commercial |
$76.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$18.50
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$18.50
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5.24
|
| Rate for Payer: Multiplan Commercial |
$64.06
|
| Rate for Payer: NAPHCARE Commercial |
$7.86
|
| Rate for Payer: Preferred Network Access Commercial |
$76.08
|
| Rate for Payer: Quartz Beloit One Network |
$35.24
|
| Rate for Payer: Quartz Commercial |
$45.65
|
| Rate for Payer: Quartz Medicare Advantage |
$5.24
|
| Rate for Payer: The Alliance Commercial |
$20.70
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.24
|
| Rate for Payer: WEA Trust Commercial |
$44.04
|
| Rate for Payer: WPS Commercial |
$23.06
|
|
|
Glucometer fingerstick for blood sugar POC
|
Facility
|
OP
|
$77.00
|
|
|
Service Code
|
CPT 82948
|
| Hospital Charge Code |
1190875
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.24 |
| Max. Negotiated Rate |
$73.67 |
| Rate for Payer: Aetna Commercial |
$72.07
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$68.87
|
| Rate for Payer: Aetna Managed Medicare |
$5.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$19.66
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$9.17
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$8.70
|
| Rate for Payer: Anthem Medicare Advantage |
$5.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$42.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5.24
|
| Rate for Payer: Cash Price |
$23.10
|
| Rate for Payer: Cash Price |
$23.10
|
| Rate for Payer: Cigna Commercial |
$73.67
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$5.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$44.81
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$5.24
|
| Rate for Payer: Health EOS Commercial |
$71.27
|
| Rate for Payer: HFN Commercial |
$73.67
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$19.50
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$5.24
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5.24
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$5.24
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$5.24
|
| Rate for Payer: Multiplan Commercial |
$64.06
|
| Rate for Payer: NAPHCARE Commercial |
$7.86
|
| Rate for Payer: Preferred Network Access Commercial |
$73.67
|
| Rate for Payer: Quartz Beloit One Network |
$39.24
|
| Rate for Payer: Quartz Commercial |
$52.05
|
| Rate for Payer: Quartz Medicare Advantage |
$5.24
|
| Rate for Payer: The Alliance Commercial |
$20.97
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.24
|
| Rate for Payer: United Healthcare PPO |
$60.06
|
| Rate for Payer: WEA Trust Commercial |
$44.04
|
| Rate for Payer: Wellcare Medicare |
$5.24
|
| Rate for Payer: WPS Commercial |
$59.31
|
|
|
Glucometer fingerstick for blood sugar POC
|
Facility
|
IP
|
$77.00
|
|
|
Service Code
|
CPT 82948
|
| Hospital Charge Code |
1190875
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$39.24 |
| Max. Negotiated Rate |
$73.67 |
| Rate for Payer: Aetna Commercial |
$72.07
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$68.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$42.44
|
| Rate for Payer: Cash Price |
$23.10
|
| Rate for Payer: Cigna Commercial |
$73.67
|
| Rate for Payer: Health EOS Commercial |
$71.27
|
| Rate for Payer: HFN Commercial |
$73.67
|
| Rate for Payer: Multiplan Commercial |
$64.06
|
| Rate for Payer: Preferred Network Access Commercial |
$73.67
|
| Rate for Payer: Quartz Beloit One Network |
$39.24
|
| Rate for Payer: Quartz Commercial |
$48.05
|
| Rate for Payer: WEA Trust Commercial |
$44.04
|
| Rate for Payer: WPS Commercial |
$59.31
|
|
|
Glucose 1 1/2 Hr
|
Professional
|
Both
|
$74.00
|
|
|
Service Code
|
CPT 82952
|
| Hospital Charge Code |
1090820
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.08 |
| Max. Negotiated Rate |
$73.11 |
| Rate for Payer: Aetna Commercial |
$73.11
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$66.19
|
| Rate for Payer: Aetna Managed Medicare |
$4.08
|
| Rate for Payer: Anthem Medicare Advantage |
$4.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$4.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$4.08
|
| Rate for Payer: Cash Price |
$22.20
|
| Rate for Payer: Cash Price |
$22.20
|
| Rate for Payer: Cigna Commercial |
$73.11
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$38.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4.08
|
| Rate for Payer: Health EOS Commercial |
$70.03
|
| Rate for Payer: HFN Commercial |
$73.11
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$14.39
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$14.39
|
| Rate for Payer: Independent Care Health Plan Medicare |
$4.08
|
| Rate for Payer: Multiplan Commercial |
$61.57
|
| Rate for Payer: NAPHCARE Commercial |
$6.12
|
| Rate for Payer: Preferred Network Access Commercial |
$73.11
|
| Rate for Payer: Quartz Beloit One Network |
$33.86
|
| Rate for Payer: Quartz Commercial |
$43.87
|
| Rate for Payer: Quartz Medicare Advantage |
$4.08
|
| Rate for Payer: The Alliance Commercial |
$16.10
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4.08
|
| Rate for Payer: WEA Trust Commercial |
$42.33
|
| Rate for Payer: WPS Commercial |
$17.94
|
|
|
Glucose 1 1/2 Hr
|
Facility
|
IP
|
$74.00
|
|
|
Service Code
|
CPT 82952
|
| Hospital Charge Code |
1090820
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$37.71 |
| Max. Negotiated Rate |
$70.80 |
| Rate for Payer: Aetna Commercial |
$69.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$66.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$40.79
|
| Rate for Payer: Cash Price |
$22.20
|
| Rate for Payer: Cigna Commercial |
$70.80
|
| Rate for Payer: Health EOS Commercial |
$68.49
|
| Rate for Payer: HFN Commercial |
$70.80
|
| Rate for Payer: Multiplan Commercial |
$61.57
|
| Rate for Payer: Preferred Network Access Commercial |
$70.80
|
| Rate for Payer: Quartz Beloit One Network |
$37.71
|
| Rate for Payer: Quartz Commercial |
$46.18
|
| Rate for Payer: WEA Trust Commercial |
$42.33
|
| Rate for Payer: WPS Commercial |
$57.00
|
|
|
Glucose 1 1/2 Hr
|
Facility
|
OP
|
$74.00
|
|
|
Service Code
|
CPT 82952
|
| Hospital Charge Code |
1090820
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.08 |
| Max. Negotiated Rate |
$70.80 |
| Rate for Payer: Aetna Commercial |
$69.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$66.19
|
| Rate for Payer: Aetna Managed Medicare |
$4.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$15.29
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$7.13
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$6.77
|
| Rate for Payer: Anthem Medicare Advantage |
$4.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$40.79
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$4.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$4.08
|
| Rate for Payer: Cash Price |
$22.20
|
| Rate for Payer: Cash Price |
$22.20
|
| Rate for Payer: Cigna Commercial |
$70.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$4.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$43.07
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$4.08
|
| Rate for Payer: Health EOS Commercial |
$68.49
|
| Rate for Payer: HFN Commercial |
$70.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$15.17
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$4.08
|
| Rate for Payer: Independent Care Health Plan Medicare |
$4.08
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$4.08
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$4.08
|
| Rate for Payer: Multiplan Commercial |
$61.57
|
| Rate for Payer: NAPHCARE Commercial |
$6.12
|
| Rate for Payer: Preferred Network Access Commercial |
$70.80
|
| Rate for Payer: Quartz Beloit One Network |
$37.71
|
| Rate for Payer: Quartz Commercial |
$50.02
|
| Rate for Payer: Quartz Medicare Advantage |
$4.08
|
| Rate for Payer: The Alliance Commercial |
$16.31
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4.08
|
| Rate for Payer: United Healthcare PPO |
$57.72
|
| Rate for Payer: WEA Trust Commercial |
$42.33
|
| Rate for Payer: Wellcare Medicare |
$4.08
|
| Rate for Payer: WPS Commercial |
$57.00
|
|
|
Glucose 2 Hour Post Prandial
|
Facility
|
IP
|
$73.00
|
|
|
Service Code
|
CPT 82947
|
| Hospital Charge Code |
633598
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$37.20 |
| Max. Negotiated Rate |
$69.85 |
| Rate for Payer: Aetna Commercial |
$68.33
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$65.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$40.24
|
| Rate for Payer: Cash Price |
$21.90
|
| Rate for Payer: Cigna Commercial |
$69.85
|
| Rate for Payer: Health EOS Commercial |
$67.57
|
| Rate for Payer: HFN Commercial |
$69.85
|
| Rate for Payer: Multiplan Commercial |
$60.74
|
| Rate for Payer: Preferred Network Access Commercial |
$69.85
|
| Rate for Payer: Quartz Beloit One Network |
$37.20
|
| Rate for Payer: Quartz Commercial |
$45.55
|
| Rate for Payer: WEA Trust Commercial |
$41.76
|
| Rate for Payer: WPS Commercial |
$56.23
|
|
|
Glucose 2 Hour Post Prandial
|
Facility
|
OP
|
$73.00
|
|
|
Service Code
|
CPT 82947
|
| Hospital Charge Code |
633598
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.09 |
| Max. Negotiated Rate |
$69.85 |
| Rate for Payer: Aetna Commercial |
$68.33
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$65.29
|
| Rate for Payer: Aetna Managed Medicare |
$4.09
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$15.33
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$7.15
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$6.78
|
| Rate for Payer: Anthem Medicare Advantage |
$4.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$40.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$4.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$4.09
|
| Rate for Payer: Cash Price |
$21.90
|
| Rate for Payer: Cash Price |
$21.90
|
| Rate for Payer: Cigna Commercial |
$69.85
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$4.09
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$42.49
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$4.09
|
| Rate for Payer: Health EOS Commercial |
$67.57
|
| Rate for Payer: HFN Commercial |
$69.85
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$15.20
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$4.09
|
| Rate for Payer: Independent Care Health Plan Medicare |
$4.09
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$4.09
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$4.09
|
| Rate for Payer: Multiplan Commercial |
$60.74
|
| Rate for Payer: NAPHCARE Commercial |
$6.13
|
| Rate for Payer: Preferred Network Access Commercial |
$69.85
|
| Rate for Payer: Quartz Beloit One Network |
$37.20
|
| Rate for Payer: Quartz Commercial |
$49.35
|
| Rate for Payer: Quartz Medicare Advantage |
$4.09
|
| Rate for Payer: The Alliance Commercial |
$16.35
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4.09
|
| Rate for Payer: United Healthcare PPO |
$56.94
|
| Rate for Payer: WEA Trust Commercial |
$41.76
|
| Rate for Payer: Wellcare Medicare |
$4.09
|
| Rate for Payer: WPS Commercial |
$56.23
|
|
|
Glucose 2 Hour Post Prandial
|
Professional
|
Both
|
$73.00
|
|
|
Service Code
|
CPT 82947
|
| Hospital Charge Code |
633598
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.09 |
| Max. Negotiated Rate |
$72.12 |
| Rate for Payer: Aetna Commercial |
$72.12
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$65.29
|
| Rate for Payer: Aetna Managed Medicare |
$4.09
|
| Rate for Payer: Anthem Medicare Advantage |
$4.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$4.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$4.09
|
| Rate for Payer: Cash Price |
$21.90
|
| Rate for Payer: Cash Price |
$21.90
|
| Rate for Payer: Cigna Commercial |
$72.12
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$37.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4.09
|
| Rate for Payer: Health EOS Commercial |
$69.09
|
| Rate for Payer: HFN Commercial |
$72.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$14.42
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$14.42
|
| Rate for Payer: Independent Care Health Plan Medicare |
$4.09
|
| Rate for Payer: Multiplan Commercial |
$60.74
|
| Rate for Payer: NAPHCARE Commercial |
$6.13
|
| Rate for Payer: Preferred Network Access Commercial |
$72.12
|
| Rate for Payer: Quartz Beloit One Network |
$33.40
|
| Rate for Payer: Quartz Commercial |
$43.27
|
| Rate for Payer: Quartz Medicare Advantage |
$4.09
|
| Rate for Payer: The Alliance Commercial |
$16.14
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4.09
|
| Rate for Payer: WEA Trust Commercial |
$41.76
|
| Rate for Payer: WPS Commercial |
$17.98
|
|
|
Glucose 2 Hr
|
Facility
|
IP
|
$210.00
|
|
|
Service Code
|
CPT 82951
|
| Hospital Charge Code |
1090802
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$107.02 |
| Max. Negotiated Rate |
$200.93 |
| Rate for Payer: Aetna Commercial |
$196.56
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$187.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$115.75
|
| Rate for Payer: Cash Price |
$63.00
|
| Rate for Payer: Cigna Commercial |
$200.93
|
| Rate for Payer: Health EOS Commercial |
$194.38
|
| Rate for Payer: HFN Commercial |
$200.93
|
| Rate for Payer: Multiplan Commercial |
$174.72
|
| Rate for Payer: Preferred Network Access Commercial |
$200.93
|
| Rate for Payer: Quartz Beloit One Network |
$107.02
|
| Rate for Payer: Quartz Commercial |
$131.04
|
| Rate for Payer: WEA Trust Commercial |
$120.12
|
| Rate for Payer: WPS Commercial |
$161.76
|
|
|
Glucose 2 Hr
|
Facility
|
OP
|
$210.00
|
|
|
Service Code
|
CPT 82951
|
| Hospital Charge Code |
1090802
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.38 |
| Max. Negotiated Rate |
$200.93 |
| Rate for Payer: Aetna Commercial |
$196.56
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$187.82
|
| Rate for Payer: Aetna Managed Medicare |
$13.38
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$50.19
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$23.42
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$22.22
|
| Rate for Payer: Anthem Medicare Advantage |
$13.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$115.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$13.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$13.38
|
| Rate for Payer: Cash Price |
$63.00
|
| Rate for Payer: Cash Price |
$63.00
|
| Rate for Payer: Cigna Commercial |
$200.93
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$13.38
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$122.22
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$13.38
|
| Rate for Payer: Health EOS Commercial |
$194.38
|
| Rate for Payer: HFN Commercial |
$200.93
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$49.79
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$13.38
|
| Rate for Payer: Independent Care Health Plan Medicare |
$13.38
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$13.38
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$13.38
|
| Rate for Payer: Multiplan Commercial |
$174.72
|
| Rate for Payer: NAPHCARE Commercial |
$20.08
|
| Rate for Payer: Preferred Network Access Commercial |
$200.93
|
| Rate for Payer: Quartz Beloit One Network |
$107.02
|
| Rate for Payer: Quartz Commercial |
$141.96
|
| Rate for Payer: Quartz Medicare Advantage |
$13.38
|
| Rate for Payer: The Alliance Commercial |
$53.54
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.38
|
| Rate for Payer: United Healthcare PPO |
$163.80
|
| Rate for Payer: WEA Trust Commercial |
$120.12
|
| Rate for Payer: Wellcare Medicare |
$13.38
|
| Rate for Payer: WPS Commercial |
$161.76
|
|
|
Glucose 2 Hr
|
Professional
|
Both
|
$210.00
|
|
|
Service Code
|
CPT 82951
|
| Hospital Charge Code |
1090802
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.38 |
| Max. Negotiated Rate |
$207.48 |
| Rate for Payer: Aetna Commercial |
$207.48
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$187.82
|
| Rate for Payer: Aetna Managed Medicare |
$13.38
|
| Rate for Payer: Anthem Medicare Advantage |
$13.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$13.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$13.38
|
| Rate for Payer: Cash Price |
$63.00
|
| Rate for Payer: Cash Price |
$63.00
|
| Rate for Payer: Cigna Commercial |
$207.48
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$109.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$13.38
|
| Rate for Payer: Health EOS Commercial |
$198.74
|
| Rate for Payer: HFN Commercial |
$207.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$47.25
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$47.25
|
| Rate for Payer: Independent Care Health Plan Medicare |
$13.38
|
| Rate for Payer: Multiplan Commercial |
$174.72
|
| Rate for Payer: NAPHCARE Commercial |
$20.08
|
| Rate for Payer: Preferred Network Access Commercial |
$207.48
|
| Rate for Payer: Quartz Beloit One Network |
$96.10
|
| Rate for Payer: Quartz Commercial |
$124.49
|
| Rate for Payer: Quartz Medicare Advantage |
$13.38
|
| Rate for Payer: The Alliance Commercial |
$52.87
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.38
|
| Rate for Payer: WEA Trust Commercial |
$120.12
|
| Rate for Payer: WPS Commercial |
$58.89
|
|
