|
Gluc, Finger
|
Facility
|
OP
|
$76.00
|
|
|
Service Code
|
CPT 82948
|
| Hospital Charge Code |
979898
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.45 |
| Max. Negotiated Rate |
$69.92 |
| Rate for Payer: Cigna Commercial |
$69.92
|
| Rate for Payer: Aetna Commercial |
$68.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$65.36
|
| Rate for Payer: Aetna Managed Medicare |
$5.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$18.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8.82
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$8.37
|
| Rate for Payer: Anthem Medicaid |
$4.45
|
| Rate for Payer: Anthem Medicare Advantage |
$5.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$40.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5.04
|
| Rate for Payer: Cash Price |
$22.80
|
| Rate for Payer: Cash Price |
$22.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$5.04
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$4.45
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$42.53
|
| Rate for Payer: Dean Health Medicaid |
$4.45
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$5.04
|
| Rate for Payer: Health EOS Commercial |
$67.64
|
| Rate for Payer: HFN Commercial |
$69.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$18.75
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$5.04
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$4.45
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5.04
|
| Rate for Payer: Managed Health Services Medicaid |
$4.63
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$5.04
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$5.04
|
| Rate for Payer: Multiplan Commercial |
$60.80
|
| Rate for Payer: NAPHCARE Commercial |
$7.56
|
| Rate for Payer: Preferred Network Access Commercial |
$69.92
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$4.45
|
| Rate for Payer: Quartz Beloit One Network |
$37.24
|
| Rate for Payer: Quartz Commercial |
$49.40
|
| Rate for Payer: Quartz Medicare Advantage |
$5.04
|
| Rate for Payer: The Alliance Commercial |
$20.16
|
| Rate for Payer: United Healthcare Medicaid |
$4.45
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.04
|
| Rate for Payer: United Healthcare PPO |
$57.00
|
| Rate for Payer: WEA Trust Commercial |
$41.80
|
| Rate for Payer: Wellcare Medicare |
$5.04
|
| Rate for Payer: WMAP Medicaid |
$4.45
|
| Rate for Payer: WPS Commercial |
$56.29
|
|
|
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 |
$37.73 |
| Max. Negotiated Rate |
$70.84 |
| Rate for Payer: Aetna Commercial |
$69.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$66.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$40.81
|
| Rate for Payer: Cash Price |
$23.10
|
| Rate for Payer: Cigna Commercial |
$70.84
|
| Rate for Payer: Health EOS Commercial |
$68.53
|
| Rate for Payer: HFN Commercial |
$70.84
|
| Rate for Payer: Multiplan Commercial |
$61.60
|
| Rate for Payer: NAPHCARE Commercial |
$46.20
|
| Rate for Payer: Preferred Network Access Commercial |
$70.84
|
| Rate for Payer: Quartz Beloit One Network |
$37.73
|
| Rate for Payer: Quartz Commercial |
$46.20
|
| Rate for Payer: WEA Trust Commercial |
$42.35
|
| Rate for Payer: WPS Commercial |
$57.03
|
|
|
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 |
$17.79 |
| Max. Negotiated Rate |
$73.15 |
| Rate for Payer: Aetna Commercial |
$73.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$66.22
|
| Rate for Payer: Cash Price |
$23.10
|
| Rate for Payer: Cash Price |
$23.10
|
| Rate for Payer: Cigna Commercial |
$73.15
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$38.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$46.20
|
| Rate for Payer: Health EOS Commercial |
$70.07
|
| Rate for Payer: HFN Commercial |
$73.15
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$17.79
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$17.79
|
| Rate for Payer: Multiplan Commercial |
$61.60
|
| Rate for Payer: Preferred Network Access Commercial |
$73.15
|
| Rate for Payer: Quartz Beloit One Network |
$33.88
|
| Rate for Payer: Quartz Commercial |
$43.89
|
| Rate for Payer: The Alliance Commercial |
$38.50
|
| Rate for Payer: WEA Trust Commercial |
$42.35
|
| Rate for Payer: WPS Commercial |
$57.03
|
|
|
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 |
$4.45 |
| Max. Negotiated Rate |
$70.84 |
| Rate for Payer: Aetna Commercial |
$69.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$66.22
|
| Rate for Payer: Aetna Managed Medicare |
$5.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$18.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8.82
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$8.37
|
| Rate for Payer: Anthem Medicaid |
$4.45
|
| Rate for Payer: Anthem Medicare Advantage |
$5.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$40.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5.04
|
| Rate for Payer: Cash Price |
$23.10
|
| Rate for Payer: Cash Price |
$23.10
|
| Rate for Payer: Cigna Commercial |
$70.84
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$5.04
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$4.45
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$43.09
|
| Rate for Payer: Dean Health Medicaid |
$4.45
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$5.04
|
| Rate for Payer: Health EOS Commercial |
$68.53
|
| Rate for Payer: HFN Commercial |
$70.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$18.75
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$5.04
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$4.45
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5.04
|
| Rate for Payer: Managed Health Services Medicaid |
$4.63
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$5.04
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$5.04
|
| Rate for Payer: Multiplan Commercial |
$61.60
|
| Rate for Payer: NAPHCARE Commercial |
$7.56
|
| Rate for Payer: Preferred Network Access Commercial |
$70.84
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$4.45
|
| Rate for Payer: Quartz Beloit One Network |
$37.73
|
| Rate for Payer: Quartz Commercial |
$50.05
|
| Rate for Payer: Quartz Medicare Advantage |
$5.04
|
| Rate for Payer: The Alliance Commercial |
$20.16
|
| Rate for Payer: United Healthcare Medicaid |
$4.45
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.04
|
| Rate for Payer: United Healthcare PPO |
$57.75
|
| Rate for Payer: WEA Trust Commercial |
$42.35
|
| Rate for Payer: Wellcare Medicare |
$5.04
|
| Rate for Payer: WMAP Medicaid |
$4.45
|
| Rate for Payer: WPS Commercial |
$57.03
|
|
|
Glucose 1 1/2 Hr
|
Facility
|
OP
|
$74.00
|
|
|
Service Code
|
CPT 82952
|
| Hospital Charge Code |
1090820
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.92 |
| Max. Negotiated Rate |
$68.08 |
| Rate for Payer: Aetna Commercial |
$66.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$63.64
|
| Rate for Payer: Aetna Managed Medicare |
$3.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$14.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$6.86
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$6.51
|
| Rate for Payer: Anthem Medicaid |
$4.05
|
| Rate for Payer: Anthem Medicare Advantage |
$3.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$39.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$3.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$3.92
|
| Rate for Payer: Cash Price |
$22.20
|
| Rate for Payer: Cash Price |
$22.20
|
| Rate for Payer: Cigna Commercial |
$68.08
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$3.92
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$4.05
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$41.41
|
| Rate for Payer: Dean Health Medicaid |
$4.05
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$3.92
|
| Rate for Payer: Health EOS Commercial |
$65.86
|
| Rate for Payer: HFN Commercial |
$68.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$14.58
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$3.92
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$4.05
|
| Rate for Payer: Independent Care Health Plan Medicare |
$3.92
|
| Rate for Payer: Managed Health Services Medicaid |
$4.21
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$3.92
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$3.92
|
| Rate for Payer: Multiplan Commercial |
$59.20
|
| Rate for Payer: NAPHCARE Commercial |
$5.88
|
| Rate for Payer: Preferred Network Access Commercial |
$68.08
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$4.05
|
| Rate for Payer: Quartz Beloit One Network |
$36.26
|
| Rate for Payer: Quartz Commercial |
$48.10
|
| Rate for Payer: Quartz Medicare Advantage |
$3.92
|
| Rate for Payer: The Alliance Commercial |
$15.68
|
| Rate for Payer: United Healthcare Medicaid |
$4.05
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3.92
|
| Rate for Payer: United Healthcare PPO |
$55.50
|
| Rate for Payer: WEA Trust Commercial |
$40.70
|
| Rate for Payer: Wellcare Medicare |
$3.92
|
| Rate for Payer: WMAP Medicaid |
$4.05
|
| Rate for Payer: WPS Commercial |
$54.81
|
|
|
Glucose 1 1/2 Hr
|
Facility
|
IP
|
$74.00
|
|
|
Service Code
|
CPT 82952
|
| Hospital Charge Code |
1090820
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$36.26 |
| Max. Negotiated Rate |
$68.08 |
| Rate for Payer: Aetna Commercial |
$66.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$63.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$39.22
|
| Rate for Payer: Cash Price |
$22.20
|
| Rate for Payer: Cigna Commercial |
$68.08
|
| Rate for Payer: Health EOS Commercial |
$65.86
|
| Rate for Payer: HFN Commercial |
$68.08
|
| Rate for Payer: Multiplan Commercial |
$59.20
|
| Rate for Payer: NAPHCARE Commercial |
$44.40
|
| Rate for Payer: Preferred Network Access Commercial |
$68.08
|
| Rate for Payer: Quartz Beloit One Network |
$36.26
|
| Rate for Payer: Quartz Commercial |
$44.40
|
| Rate for Payer: WEA Trust Commercial |
$40.70
|
| Rate for Payer: WPS Commercial |
$54.81
|
|
|
Glucose 1 1/2 Hr
|
Professional
|
Both
|
$74.00
|
|
|
Service Code
|
CPT 82952
|
| Hospital Charge Code |
1090820
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.84 |
| Max. Negotiated Rate |
$70.30 |
| Rate for Payer: Aetna Commercial |
$70.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$63.64
|
| Rate for Payer: Cash Price |
$22.20
|
| Rate for Payer: Cash Price |
$22.20
|
| Rate for Payer: Cigna Commercial |
$70.30
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$37.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$44.40
|
| Rate for Payer: Health EOS Commercial |
$67.34
|
| Rate for Payer: HFN Commercial |
$70.30
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$13.84
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$13.84
|
| Rate for Payer: Multiplan Commercial |
$59.20
|
| Rate for Payer: Preferred Network Access Commercial |
$70.30
|
| Rate for Payer: Quartz Beloit One Network |
$32.56
|
| Rate for Payer: Quartz Commercial |
$42.18
|
| Rate for Payer: The Alliance Commercial |
$37.00
|
| Rate for Payer: WEA Trust Commercial |
$40.70
|
| Rate for Payer: WPS Commercial |
$54.81
|
|
|
Glucose 2 Hour Post Prandial
|
Facility
|
IP
|
$73.00
|
|
|
Service Code
|
CPT 82947
|
| Hospital Charge Code |
633598
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$35.77 |
| Max. Negotiated Rate |
$67.16 |
| Rate for Payer: Aetna Commercial |
$65.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$62.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$38.69
|
| Rate for Payer: Cash Price |
$21.90
|
| Rate for Payer: Cigna Commercial |
$67.16
|
| Rate for Payer: Health EOS Commercial |
$64.97
|
| Rate for Payer: HFN Commercial |
$67.16
|
| Rate for Payer: Multiplan Commercial |
$58.40
|
| Rate for Payer: NAPHCARE Commercial |
$43.80
|
| Rate for Payer: Preferred Network Access Commercial |
$67.16
|
| Rate for Payer: Quartz Beloit One Network |
$35.77
|
| Rate for Payer: Quartz Commercial |
$43.80
|
| Rate for Payer: WEA Trust Commercial |
$40.15
|
| Rate for Payer: WPS Commercial |
$54.07
|
|
|
Glucose 2 Hour Post Prandial
|
Facility
|
OP
|
$73.00
|
|
|
Service Code
|
CPT 82947
|
| Hospital Charge Code |
633598
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.93 |
| Max. Negotiated Rate |
$67.16 |
| Rate for Payer: Aetna Commercial |
$65.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$62.78
|
| Rate for Payer: Aetna Managed Medicare |
$3.93
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$14.74
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$6.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$6.52
|
| Rate for Payer: Anthem Medicaid |
$4.06
|
| Rate for Payer: Anthem Medicare Advantage |
$3.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$38.69
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$3.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$3.93
|
| Rate for Payer: Cash Price |
$21.90
|
| Rate for Payer: Cash Price |
$21.90
|
| Rate for Payer: Cigna Commercial |
$67.16
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$3.93
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$4.06
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$40.85
|
| Rate for Payer: Dean Health Medicaid |
$4.06
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$3.93
|
| Rate for Payer: Health EOS Commercial |
$64.97
|
| Rate for Payer: HFN Commercial |
$67.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$14.62
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$3.93
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$4.06
|
| Rate for Payer: Independent Care Health Plan Medicare |
$3.93
|
| Rate for Payer: Managed Health Services Medicaid |
$4.22
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$3.93
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$3.93
|
| Rate for Payer: Multiplan Commercial |
$58.40
|
| Rate for Payer: NAPHCARE Commercial |
$5.90
|
| Rate for Payer: Preferred Network Access Commercial |
$67.16
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$4.06
|
| Rate for Payer: Quartz Beloit One Network |
$35.77
|
| Rate for Payer: Quartz Commercial |
$47.45
|
| Rate for Payer: Quartz Medicare Advantage |
$3.93
|
| Rate for Payer: The Alliance Commercial |
$15.72
|
| Rate for Payer: United Healthcare Medicaid |
$4.06
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3.93
|
| Rate for Payer: United Healthcare PPO |
$54.75
|
| Rate for Payer: WEA Trust Commercial |
$40.15
|
| Rate for Payer: Wellcare Medicare |
$3.93
|
| Rate for Payer: WMAP Medicaid |
$4.06
|
| Rate for Payer: WPS Commercial |
$54.07
|
|
|
Glucose 2 Hour Post Prandial
|
Professional
|
Both
|
$73.00
|
|
|
Service Code
|
CPT 82947
|
| Hospital Charge Code |
633598
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.87 |
| Max. Negotiated Rate |
$69.35 |
| Rate for Payer: Aetna Commercial |
$69.35
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$62.78
|
| Rate for Payer: Cash Price |
$21.90
|
| Rate for Payer: Cash Price |
$21.90
|
| Rate for Payer: Cigna Commercial |
$69.35
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$36.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$43.80
|
| Rate for Payer: Health EOS Commercial |
$66.43
|
| Rate for Payer: HFN Commercial |
$69.35
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$13.87
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$13.87
|
| Rate for Payer: Multiplan Commercial |
$58.40
|
| Rate for Payer: Preferred Network Access Commercial |
$69.35
|
| Rate for Payer: Quartz Beloit One Network |
$32.12
|
| Rate for Payer: Quartz Commercial |
$41.61
|
| Rate for Payer: The Alliance Commercial |
$36.50
|
| Rate for Payer: WEA Trust Commercial |
$40.15
|
| Rate for Payer: WPS Commercial |
$54.07
|
|
|
Glucose 2 Hr
|
Professional
|
Both
|
$210.00
|
|
|
Service Code
|
CPT 82951
|
| Hospital Charge Code |
1090802
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$45.43 |
| Max. Negotiated Rate |
$199.50 |
| Rate for Payer: Aetna Commercial |
$199.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$180.60
|
| Rate for Payer: Cash Price |
$63.00
|
| Rate for Payer: Cash Price |
$63.00
|
| Rate for Payer: Cigna Commercial |
$199.50
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$105.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$126.00
|
| Rate for Payer: Health EOS Commercial |
$191.10
|
| Rate for Payer: HFN Commercial |
$199.50
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$45.43
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$45.43
|
| Rate for Payer: Multiplan Commercial |
$168.00
|
| Rate for Payer: Preferred Network Access Commercial |
$199.50
|
| Rate for Payer: Quartz Beloit One Network |
$92.40
|
| Rate for Payer: Quartz Commercial |
$119.70
|
| Rate for Payer: The Alliance Commercial |
$105.00
|
| Rate for Payer: WEA Trust Commercial |
$115.50
|
| Rate for Payer: WPS Commercial |
$155.55
|
|
|
Glucose 2 Hr
|
Facility
|
OP
|
$210.00
|
|
|
Service Code
|
CPT 82951
|
| Hospital Charge Code |
1090802
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.87 |
| Max. Negotiated Rate |
$193.20 |
| Rate for Payer: Aetna Commercial |
$189.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$180.60
|
| Rate for Payer: Aetna Managed Medicare |
$12.87
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$48.26
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$22.52
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$21.36
|
| Rate for Payer: Anthem Medicaid |
$13.30
|
| Rate for Payer: Anthem Medicare Advantage |
$12.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$111.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$12.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$12.87
|
| Rate for Payer: Cash Price |
$63.00
|
| Rate for Payer: Cash Price |
$63.00
|
| Rate for Payer: Cigna Commercial |
$193.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$12.87
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$13.30
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$117.52
|
| Rate for Payer: Dean Health Medicaid |
$13.30
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$12.87
|
| Rate for Payer: Health EOS Commercial |
$186.90
|
| Rate for Payer: HFN Commercial |
$193.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$47.88
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$12.87
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$13.30
|
| Rate for Payer: Independent Care Health Plan Medicare |
$12.87
|
| Rate for Payer: Managed Health Services Medicaid |
$13.83
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$12.87
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$12.87
|
| Rate for Payer: Multiplan Commercial |
$168.00
|
| Rate for Payer: NAPHCARE Commercial |
$19.30
|
| Rate for Payer: Preferred Network Access Commercial |
$193.20
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$13.30
|
| Rate for Payer: Quartz Beloit One Network |
$102.90
|
| Rate for Payer: Quartz Commercial |
$136.50
|
| Rate for Payer: Quartz Medicare Advantage |
$12.87
|
| Rate for Payer: The Alliance Commercial |
$51.48
|
| Rate for Payer: United Healthcare Medicaid |
$13.30
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.87
|
| Rate for Payer: United Healthcare PPO |
$157.50
|
| Rate for Payer: WEA Trust Commercial |
$115.50
|
| Rate for Payer: Wellcare Medicare |
$12.87
|
| Rate for Payer: WMAP Medicaid |
$13.30
|
| Rate for Payer: WPS Commercial |
$155.55
|
|
|
Glucose 2 Hr
|
Facility
|
IP
|
$210.00
|
|
|
Service Code
|
CPT 82951
|
| Hospital Charge Code |
1090802
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$102.90 |
| Max. Negotiated Rate |
$193.20 |
| Rate for Payer: Aetna Commercial |
$189.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$180.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$111.30
|
| Rate for Payer: Cash Price |
$63.00
|
| Rate for Payer: Cigna Commercial |
$193.20
|
| Rate for Payer: Health EOS Commercial |
$186.90
|
| Rate for Payer: HFN Commercial |
$193.20
|
| Rate for Payer: Multiplan Commercial |
$168.00
|
| Rate for Payer: NAPHCARE Commercial |
$126.00
|
| Rate for Payer: Preferred Network Access Commercial |
$193.20
|
| Rate for Payer: Quartz Beloit One Network |
$102.90
|
| Rate for Payer: Quartz Commercial |
$126.00
|
| Rate for Payer: WEA Trust Commercial |
$115.50
|
| Rate for Payer: WPS Commercial |
$155.55
|
|
|
Glucose 3 Hr
|
Facility
|
OP
|
$74.00
|
|
|
Service Code
|
CPT 82952
|
| Hospital Charge Code |
1090803
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.92 |
| Max. Negotiated Rate |
$68.08 |
| Rate for Payer: Aetna Commercial |
$66.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$63.64
|
| Rate for Payer: Aetna Managed Medicare |
$3.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$14.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$6.86
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$6.51
|
| Rate for Payer: Anthem Medicaid |
$4.05
|
| Rate for Payer: Anthem Medicare Advantage |
$3.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$39.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$3.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$3.92
|
| Rate for Payer: Cash Price |
$22.20
|
| Rate for Payer: Cash Price |
$22.20
|
| Rate for Payer: Cigna Commercial |
$68.08
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$3.92
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$4.05
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$41.41
|
| Rate for Payer: Dean Health Medicaid |
$4.05
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$3.92
|
| Rate for Payer: Health EOS Commercial |
$65.86
|
| Rate for Payer: HFN Commercial |
$68.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$14.58
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$3.92
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$4.05
|
| Rate for Payer: Independent Care Health Plan Medicare |
$3.92
|
| Rate for Payer: Managed Health Services Medicaid |
$4.21
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$3.92
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$3.92
|
| Rate for Payer: Multiplan Commercial |
$59.20
|
| Rate for Payer: NAPHCARE Commercial |
$5.88
|
| Rate for Payer: Preferred Network Access Commercial |
$68.08
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$4.05
|
| Rate for Payer: Quartz Beloit One Network |
$36.26
|
| Rate for Payer: Quartz Commercial |
$48.10
|
| Rate for Payer: Quartz Medicare Advantage |
$3.92
|
| Rate for Payer: The Alliance Commercial |
$15.68
|
| Rate for Payer: United Healthcare Medicaid |
$4.05
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3.92
|
| Rate for Payer: United Healthcare PPO |
$55.50
|
| Rate for Payer: WEA Trust Commercial |
$40.70
|
| Rate for Payer: Wellcare Medicare |
$3.92
|
| Rate for Payer: WMAP Medicaid |
$4.05
|
| Rate for Payer: WPS Commercial |
$54.81
|
|
|
Glucose 3 Hr
|
Facility
|
IP
|
$74.00
|
|
|
Service Code
|
CPT 82952
|
| Hospital Charge Code |
1090803
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$36.26 |
| Max. Negotiated Rate |
$68.08 |
| Rate for Payer: Aetna Commercial |
$66.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$63.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$39.22
|
| Rate for Payer: Cash Price |
$22.20
|
| Rate for Payer: Cigna Commercial |
$68.08
|
| Rate for Payer: Health EOS Commercial |
$65.86
|
| Rate for Payer: HFN Commercial |
$68.08
|
| Rate for Payer: Multiplan Commercial |
$59.20
|
| Rate for Payer: NAPHCARE Commercial |
$44.40
|
| Rate for Payer: Preferred Network Access Commercial |
$68.08
|
| Rate for Payer: Quartz Beloit One Network |
$36.26
|
| Rate for Payer: Quartz Commercial |
$44.40
|
| Rate for Payer: WEA Trust Commercial |
$40.70
|
| Rate for Payer: WPS Commercial |
$54.81
|
|
|
Glucose 3 Hr
|
Professional
|
Both
|
$74.00
|
|
|
Service Code
|
CPT 82952
|
| Hospital Charge Code |
1090803
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.84 |
| Max. Negotiated Rate |
$70.30 |
| Rate for Payer: Aetna Commercial |
$70.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$63.64
|
| Rate for Payer: Cash Price |
$22.20
|
| Rate for Payer: Cash Price |
$22.20
|
| Rate for Payer: Cigna Commercial |
$70.30
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$37.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$44.40
|
| Rate for Payer: Health EOS Commercial |
$67.34
|
| Rate for Payer: HFN Commercial |
$70.30
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$13.84
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$13.84
|
| Rate for Payer: Multiplan Commercial |
$59.20
|
| Rate for Payer: Preferred Network Access Commercial |
$70.30
|
| Rate for Payer: Quartz Beloit One Network |
$32.56
|
| Rate for Payer: Quartz Commercial |
$42.18
|
| Rate for Payer: The Alliance Commercial |
$37.00
|
| Rate for Payer: WEA Trust Commercial |
$40.70
|
| Rate for Payer: WPS Commercial |
$54.81
|
|
|
Glucose 4 Hr
|
Facility
|
OP
|
$74.00
|
|
|
Service Code
|
CPT 82952
|
| Hospital Charge Code |
1090804
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.92 |
| Max. Negotiated Rate |
$68.08 |
| Rate for Payer: Aetna Commercial |
$66.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$63.64
|
| Rate for Payer: Aetna Managed Medicare |
$3.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$14.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$6.86
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$6.51
|
| Rate for Payer: Anthem Medicaid |
$4.05
|
| Rate for Payer: Anthem Medicare Advantage |
$3.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$39.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$3.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$3.92
|
| Rate for Payer: Cash Price |
$22.20
|
| Rate for Payer: Cash Price |
$22.20
|
| Rate for Payer: Cigna Commercial |
$68.08
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$3.92
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$4.05
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$41.41
|
| Rate for Payer: Dean Health Medicaid |
$4.05
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$3.92
|
| Rate for Payer: Health EOS Commercial |
$65.86
|
| Rate for Payer: HFN Commercial |
$68.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$14.58
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$3.92
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$4.05
|
| Rate for Payer: Independent Care Health Plan Medicare |
$3.92
|
| Rate for Payer: Managed Health Services Medicaid |
$4.21
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$3.92
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$3.92
|
| Rate for Payer: Multiplan Commercial |
$59.20
|
| Rate for Payer: NAPHCARE Commercial |
$5.88
|
| Rate for Payer: Preferred Network Access Commercial |
$68.08
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$4.05
|
| Rate for Payer: Quartz Beloit One Network |
$36.26
|
| Rate for Payer: Quartz Commercial |
$48.10
|
| Rate for Payer: Quartz Medicare Advantage |
$3.92
|
| Rate for Payer: The Alliance Commercial |
$15.68
|
| Rate for Payer: United Healthcare Medicaid |
$4.05
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3.92
|
| Rate for Payer: United Healthcare PPO |
$55.50
|
| Rate for Payer: WEA Trust Commercial |
$40.70
|
| Rate for Payer: Wellcare Medicare |
$3.92
|
| Rate for Payer: WMAP Medicaid |
$4.05
|
| Rate for Payer: WPS Commercial |
$54.81
|
|
|
Glucose 4 Hr
|
Professional
|
Both
|
$74.00
|
|
|
Service Code
|
CPT 82952
|
| Hospital Charge Code |
1090804
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.84 |
| Max. Negotiated Rate |
$70.30 |
| Rate for Payer: Aetna Commercial |
$70.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$63.64
|
| Rate for Payer: Cash Price |
$22.20
|
| Rate for Payer: Cash Price |
$22.20
|
| Rate for Payer: Cigna Commercial |
$70.30
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$37.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$44.40
|
| Rate for Payer: Health EOS Commercial |
$67.34
|
| Rate for Payer: HFN Commercial |
$70.30
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$13.84
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$13.84
|
| Rate for Payer: Multiplan Commercial |
$59.20
|
| Rate for Payer: Preferred Network Access Commercial |
$70.30
|
| Rate for Payer: Quartz Beloit One Network |
$32.56
|
| Rate for Payer: Quartz Commercial |
$42.18
|
| Rate for Payer: The Alliance Commercial |
$37.00
|
| Rate for Payer: WEA Trust Commercial |
$40.70
|
| Rate for Payer: WPS Commercial |
$54.81
|
|
|
Glucose 4 Hr
|
Facility
|
IP
|
$74.00
|
|
|
Service Code
|
CPT 82952
|
| Hospital Charge Code |
1090804
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$36.26 |
| Max. Negotiated Rate |
$68.08 |
| Rate for Payer: Aetna Commercial |
$66.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$63.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$39.22
|
| Rate for Payer: Cash Price |
$22.20
|
| Rate for Payer: Cigna Commercial |
$68.08
|
| Rate for Payer: Health EOS Commercial |
$65.86
|
| Rate for Payer: HFN Commercial |
$68.08
|
| Rate for Payer: Multiplan Commercial |
$59.20
|
| Rate for Payer: NAPHCARE Commercial |
$44.40
|
| Rate for Payer: Preferred Network Access Commercial |
$68.08
|
| Rate for Payer: Quartz Beloit One Network |
$36.26
|
| Rate for Payer: Quartz Commercial |
$44.40
|
| Rate for Payer: WEA Trust Commercial |
$40.70
|
| Rate for Payer: WPS Commercial |
$54.81
|
|
|
Glucose 5 Hr
|
Facility
|
IP
|
$70.00
|
|
|
Service Code
|
CPT 82952
|
| Hospital Charge Code |
1090805
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$34.30 |
| Max. Negotiated Rate |
$64.40 |
| Rate for Payer: Aetna Commercial |
$63.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$60.20
|
| 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
|
|
|
Glucose 5 Hr
|
Facility
|
OP
|
$70.00
|
|
|
Service Code
|
CPT 82952
|
| Hospital Charge Code |
1090805
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.92 |
| Max. Negotiated Rate |
$64.40 |
| Rate for Payer: Aetna Commercial |
$63.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$60.20
|
| Rate for Payer: Aetna Managed Medicare |
$3.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$14.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$6.86
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$6.51
|
| Rate for Payer: Anthem Medicaid |
$4.05
|
| Rate for Payer: Anthem Medicare Advantage |
$3.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$37.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$3.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$3.92
|
| Rate for Payer: Cash Price |
$21.00
|
| Rate for Payer: Cash Price |
$21.00
|
| Rate for Payer: Cigna Commercial |
$64.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$3.92
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$4.05
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$39.17
|
| Rate for Payer: Dean Health Medicaid |
$4.05
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$3.92
|
| Rate for Payer: Health EOS Commercial |
$62.30
|
| Rate for Payer: HFN Commercial |
$64.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$14.58
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$3.92
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$4.05
|
| Rate for Payer: Independent Care Health Plan Medicare |
$3.92
|
| Rate for Payer: Managed Health Services Medicaid |
$4.21
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$3.92
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$3.92
|
| Rate for Payer: Multiplan Commercial |
$56.00
|
| Rate for Payer: NAPHCARE Commercial |
$5.88
|
| Rate for Payer: Preferred Network Access Commercial |
$64.40
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$4.05
|
| Rate for Payer: Quartz Beloit One Network |
$34.30
|
| Rate for Payer: Quartz Commercial |
$45.50
|
| Rate for Payer: Quartz Medicare Advantage |
$3.92
|
| Rate for Payer: The Alliance Commercial |
$15.68
|
| Rate for Payer: United Healthcare Medicaid |
$4.05
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3.92
|
| Rate for Payer: United Healthcare PPO |
$52.50
|
| Rate for Payer: WEA Trust Commercial |
$38.50
|
| Rate for Payer: Wellcare Medicare |
$3.92
|
| Rate for Payer: WMAP Medicaid |
$4.05
|
| Rate for Payer: WPS Commercial |
$51.85
|
|
|
Glucose 5 Hr
|
Professional
|
Both
|
$70.00
|
|
|
Service Code
|
CPT 82952
|
| Hospital Charge Code |
1090805
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.84 |
| Max. Negotiated Rate |
$66.50 |
| Rate for Payer: Aetna Commercial |
$66.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$60.20
|
| Rate for Payer: Cash Price |
$21.00
|
| Rate for Payer: Cash Price |
$21.00
|
| Rate for Payer: Cigna Commercial |
$66.50
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$35.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$42.00
|
| Rate for Payer: Health EOS Commercial |
$63.70
|
| Rate for Payer: HFN Commercial |
$66.50
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$13.84
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$13.84
|
| Rate for Payer: Multiplan Commercial |
$56.00
|
| Rate for Payer: Preferred Network Access Commercial |
$66.50
|
| Rate for Payer: Quartz Beloit One Network |
$30.80
|
| Rate for Payer: Quartz Commercial |
$39.90
|
| Rate for Payer: The Alliance Commercial |
$35.00
|
| Rate for Payer: WEA Trust Commercial |
$38.50
|
| Rate for Payer: WPS Commercial |
$51.85
|
|
|
Glucose-6-PD Quantitative
|
Facility
|
OP
|
$388.00
|
|
|
Service Code
|
CPT 82955
|
| Hospital Charge Code |
977958
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.70 |
| Max. Negotiated Rate |
$356.96 |
| Rate for Payer: Aetna Commercial |
$349.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$333.68
|
| Rate for Payer: Aetna Managed Medicare |
$9.70
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$36.38
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$16.98
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$16.10
|
| Rate for Payer: Anthem Medicaid |
$10.02
|
| Rate for Payer: Anthem Medicare Advantage |
$9.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$205.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$9.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$9.70
|
| Rate for Payer: Cash Price |
$116.40
|
| Rate for Payer: Cash Price |
$116.40
|
| Rate for Payer: Cigna Commercial |
$356.96
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$9.70
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$10.02
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$217.12
|
| Rate for Payer: Dean Health Medicaid |
$10.02
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$9.70
|
| Rate for Payer: Health EOS Commercial |
$345.32
|
| Rate for Payer: HFN Commercial |
$356.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$36.08
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$9.70
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$10.02
|
| Rate for Payer: Independent Care Health Plan Medicare |
$9.70
|
| Rate for Payer: Managed Health Services Medicaid |
$10.42
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$9.70
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$9.70
|
| Rate for Payer: Multiplan Commercial |
$310.40
|
| Rate for Payer: NAPHCARE Commercial |
$14.55
|
| Rate for Payer: Preferred Network Access Commercial |
$356.96
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$10.02
|
| Rate for Payer: Quartz Beloit One Network |
$190.12
|
| Rate for Payer: Quartz Commercial |
$252.20
|
| Rate for Payer: Quartz Medicare Advantage |
$9.70
|
| Rate for Payer: The Alliance Commercial |
$38.80
|
| Rate for Payer: United Healthcare Medicaid |
$10.02
|
| Rate for Payer: United Healthcare Medicare Advantage |
$9.70
|
| Rate for Payer: United Healthcare PPO |
$291.00
|
| Rate for Payer: WEA Trust Commercial |
$213.40
|
| Rate for Payer: Wellcare Medicare |
$9.70
|
| Rate for Payer: WMAP Medicaid |
$10.02
|
| Rate for Payer: WPS Commercial |
$287.39
|
|
|
Glucose-6-PD Quantitative
|
Facility
|
IP
|
$388.00
|
|
|
Service Code
|
CPT 82955
|
| Hospital Charge Code |
977958
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$190.12 |
| Max. Negotiated Rate |
$356.96 |
| Rate for Payer: Multiplan Commercial |
$310.40
|
| Rate for Payer: NAPHCARE Commercial |
$232.80
|
| Rate for Payer: Aetna Commercial |
$349.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$333.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$205.64
|
| Rate for Payer: Cash Price |
$116.40
|
| Rate for Payer: Cigna Commercial |
$356.96
|
| Rate for Payer: Health EOS Commercial |
$345.32
|
| Rate for Payer: HFN Commercial |
$356.96
|
| Rate for Payer: Preferred Network Access Commercial |
$356.96
|
| Rate for Payer: Quartz Beloit One Network |
$190.12
|
| Rate for Payer: Quartz Commercial |
$232.80
|
| Rate for Payer: WEA Trust Commercial |
$213.40
|
| Rate for Payer: WPS Commercial |
$287.39
|
|
|
Glucose-6-PD Quantitative
|
Professional
|
Both
|
$388.00
|
|
|
Service Code
|
CPT 82955
|
| Hospital Charge Code |
977958
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$34.24 |
| Max. Negotiated Rate |
$368.60 |
| Rate for Payer: Aetna Commercial |
$368.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$333.68
|
| Rate for Payer: Cash Price |
$116.40
|
| Rate for Payer: Cash Price |
$116.40
|
| Rate for Payer: Cigna Commercial |
$368.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$194.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$232.80
|
| Rate for Payer: Health EOS Commercial |
$353.08
|
| Rate for Payer: HFN Commercial |
$368.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$34.24
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$34.24
|
| Rate for Payer: Multiplan Commercial |
$310.40
|
| Rate for Payer: Preferred Network Access Commercial |
$368.60
|
| Rate for Payer: Quartz Beloit One Network |
$170.72
|
| Rate for Payer: Quartz Commercial |
$221.16
|
| Rate for Payer: The Alliance Commercial |
$194.00
|
| Rate for Payer: WEA Trust Commercial |
$213.40
|
| Rate for Payer: WPS Commercial |
$287.39
|
|
