|
Hematocrit
|
Facility
|
IP
|
$58.00
|
|
|
Service Code
|
CPT 85014
|
| Hospital Charge Code |
633742
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$29.56 |
| Max. Negotiated Rate |
$55.49 |
| Rate for Payer: Aetna Commercial |
$54.29
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$51.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$31.97
|
| Rate for Payer: Cash Price |
$17.40
|
| Rate for Payer: Cigna Commercial |
$55.49
|
| Rate for Payer: Health EOS Commercial |
$53.68
|
| Rate for Payer: HFN Commercial |
$55.49
|
| Rate for Payer: Multiplan Commercial |
$48.26
|
| Rate for Payer: Preferred Network Access Commercial |
$55.49
|
| Rate for Payer: Quartz Beloit One Network |
$29.56
|
| Rate for Payer: Quartz Commercial |
$36.19
|
| Rate for Payer: WEA Trust Commercial |
$33.18
|
| Rate for Payer: WPS Commercial |
$44.68
|
|
|
Hematocrit
|
Facility
|
OP
|
$120.00
|
|
|
Service Code
|
CPT 85014
|
| Hospital Charge Code |
2942910
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$2.46 |
| Max. Negotiated Rate |
$114.82 |
| Rate for Payer: Aetna Commercial |
$112.32
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$107.33
|
| Rate for Payer: Aetna Managed Medicare |
$2.46
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$9.24
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4.31
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4.09
|
| Rate for Payer: Anthem Medicare Advantage |
$2.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$66.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$2.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$2.46
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Cigna Commercial |
$114.82
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$2.46
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$69.84
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$2.46
|
| Rate for Payer: Health EOS Commercial |
$111.07
|
| Rate for Payer: HFN Commercial |
$114.82
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$9.17
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$2.46
|
| Rate for Payer: Independent Care Health Plan Medicare |
$2.46
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$2.46
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$2.46
|
| Rate for Payer: Multiplan Commercial |
$99.84
|
| Rate for Payer: NAPHCARE Commercial |
$3.70
|
| Rate for Payer: Preferred Network Access Commercial |
$114.82
|
| Rate for Payer: Quartz Beloit One Network |
$61.15
|
| Rate for Payer: Quartz Commercial |
$81.12
|
| Rate for Payer: Quartz Medicare Advantage |
$2.46
|
| Rate for Payer: The Alliance Commercial |
$9.86
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2.46
|
| Rate for Payer: United Healthcare PPO |
$93.60
|
| Rate for Payer: WEA Trust Commercial |
$68.64
|
| Rate for Payer: Wellcare Medicare |
$2.46
|
| Rate for Payer: WPS Commercial |
$92.44
|
|
|
Hematocrit
|
Professional
|
Both
|
$120.00
|
|
|
Service Code
|
CPT 85014
|
| Hospital Charge Code |
2942910
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$2.46 |
| Max. Negotiated Rate |
$118.56 |
| Rate for Payer: Aetna Commercial |
$118.56
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$107.33
|
| Rate for Payer: Aetna Managed Medicare |
$2.46
|
| Rate for Payer: Anthem Medicare Advantage |
$2.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$2.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$2.46
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Cigna Commercial |
$118.56
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$62.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2.46
|
| Rate for Payer: Health EOS Commercial |
$113.57
|
| Rate for Payer: HFN Commercial |
$118.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$8.70
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$8.70
|
| Rate for Payer: Independent Care Health Plan Medicare |
$2.46
|
| Rate for Payer: Multiplan Commercial |
$99.84
|
| Rate for Payer: NAPHCARE Commercial |
$3.70
|
| Rate for Payer: Preferred Network Access Commercial |
$118.56
|
| Rate for Payer: Quartz Beloit One Network |
$54.91
|
| Rate for Payer: Quartz Commercial |
$71.14
|
| Rate for Payer: Quartz Medicare Advantage |
$2.46
|
| Rate for Payer: The Alliance Commercial |
$9.74
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2.46
|
| Rate for Payer: WEA Trust Commercial |
$68.64
|
| Rate for Payer: WPS Commercial |
$10.85
|
|
|
Hematologic Neoplasms, TP53 Somatic Mutation
|
Facility
|
IP
|
$814.00
|
|
|
Service Code
|
CPT 81405
|
| Hospital Charge Code |
5543225
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$414.81 |
| Max. Negotiated Rate |
$778.84 |
| Rate for Payer: Aetna Commercial |
$761.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$728.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$448.68
|
| Rate for Payer: Cash Price |
$244.20
|
| Rate for Payer: Cigna Commercial |
$778.84
|
| Rate for Payer: Health EOS Commercial |
$753.44
|
| Rate for Payer: HFN Commercial |
$778.84
|
| Rate for Payer: Multiplan Commercial |
$677.25
|
| Rate for Payer: Preferred Network Access Commercial |
$778.84
|
| Rate for Payer: Quartz Beloit One Network |
$414.81
|
| Rate for Payer: Quartz Commercial |
$507.94
|
| Rate for Payer: WEA Trust Commercial |
$465.61
|
| Rate for Payer: WPS Commercial |
$627.02
|
|
|
Hematologic Neoplasms, TP53 Somatic Mutation
|
Facility
|
OP
|
$814.00
|
|
|
Service Code
|
CPT 81405
|
| Hospital Charge Code |
5543225
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$313.40 |
| Max. Negotiated Rate |
$1,253.62 |
| Rate for Payer: Aetna Commercial |
$761.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$728.04
|
| Rate for Payer: Aetna Managed Medicare |
$313.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,175.27
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$548.46
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$520.25
|
| Rate for Payer: Anthem Medicare Advantage |
$313.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$448.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$313.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$313.40
|
| Rate for Payer: Cash Price |
$244.20
|
| Rate for Payer: Cash Price |
$244.20
|
| Rate for Payer: Cigna Commercial |
$778.84
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$313.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$473.75
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$313.40
|
| Rate for Payer: Health EOS Commercial |
$753.44
|
| Rate for Payer: HFN Commercial |
$778.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,165.86
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$313.40
|
| Rate for Payer: Independent Care Health Plan Medicare |
$313.40
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$313.40
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$313.40
|
| Rate for Payer: Multiplan Commercial |
$677.25
|
| Rate for Payer: NAPHCARE Commercial |
$470.11
|
| Rate for Payer: Preferred Network Access Commercial |
$778.84
|
| Rate for Payer: Quartz Beloit One Network |
$414.81
|
| Rate for Payer: Quartz Commercial |
$550.26
|
| Rate for Payer: Quartz Medicare Advantage |
$313.40
|
| Rate for Payer: The Alliance Commercial |
$1,253.62
|
| Rate for Payer: United Healthcare Medicare Advantage |
$313.40
|
| Rate for Payer: United Healthcare PPO |
$634.92
|
| Rate for Payer: WEA Trust Commercial |
$465.61
|
| Rate for Payer: Wellcare Medicare |
$313.40
|
| Rate for Payer: WPS Commercial |
$627.02
|
|
|
Hematologic Neoplasms, TP53 Somatic Mutation
|
Professional
|
Both
|
$814.00
|
|
|
Service Code
|
CPT 81405
|
| Hospital Charge Code |
5543225
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$313.40 |
| Max. Negotiated Rate |
$1,378.98 |
| Rate for Payer: Aetna Commercial |
$804.23
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$728.04
|
| Rate for Payer: Aetna Managed Medicare |
$313.40
|
| Rate for Payer: Anthem Medicare Advantage |
$313.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$313.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$313.40
|
| Rate for Payer: Cash Price |
$244.20
|
| Rate for Payer: Cash Price |
$244.20
|
| Rate for Payer: Cigna Commercial |
$804.23
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$423.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$313.40
|
| Rate for Payer: Health EOS Commercial |
$770.37
|
| Rate for Payer: HFN Commercial |
$804.23
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,106.32
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,106.32
|
| Rate for Payer: Independent Care Health Plan Medicare |
$313.40
|
| Rate for Payer: Multiplan Commercial |
$677.25
|
| Rate for Payer: NAPHCARE Commercial |
$470.11
|
| Rate for Payer: Preferred Network Access Commercial |
$804.23
|
| Rate for Payer: Quartz Beloit One Network |
$372.49
|
| Rate for Payer: Quartz Commercial |
$482.54
|
| Rate for Payer: Quartz Medicare Advantage |
$313.40
|
| Rate for Payer: The Alliance Commercial |
$1,237.95
|
| Rate for Payer: United Healthcare Medicare Advantage |
$313.40
|
| Rate for Payer: WEA Trust Commercial |
$465.61
|
| Rate for Payer: WPS Commercial |
$1,378.98
|
|
|
HEMICOLECTOMY/TRANSVERSE COLECTOMY/COLECTOMY
|
Facility
|
IP
|
$4,803.00
|
|
| Hospital Charge Code |
2950473
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,447.61 |
| Max. Negotiated Rate |
$4,595.51 |
| Rate for Payer: Aetna Commercial |
$4,495.61
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,295.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,647.41
|
| Rate for Payer: Cash Price |
$1,440.90
|
| Rate for Payer: Cigna Commercial |
$4,595.51
|
| Rate for Payer: Health EOS Commercial |
$4,445.66
|
| Rate for Payer: HFN Commercial |
$4,595.51
|
| Rate for Payer: Multiplan Commercial |
$3,996.10
|
| Rate for Payer: Preferred Network Access Commercial |
$4,595.51
|
| Rate for Payer: Quartz Beloit One Network |
$2,447.61
|
| Rate for Payer: Quartz Commercial |
$2,997.07
|
| Rate for Payer: WEA Trust Commercial |
$2,747.32
|
| Rate for Payer: WPS Commercial |
$3,699.75
|
|
|
HEMICOLECTOMY/TRANSVERSE COLECTOMY/COLECTOMY
|
Facility
|
OP
|
$4,803.00
|
|
| Hospital Charge Code |
2950473
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,398.63 |
| Max. Negotiated Rate |
$4,595.51 |
| Rate for Payer: Aetna Commercial |
$4,495.61
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,295.80
|
| Rate for Payer: Aetna Managed Medicare |
$1,398.63
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,246.83
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,497.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,397.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,647.41
|
| Rate for Payer: Cash Price |
$1,440.90
|
| Rate for Payer: Cigna Commercial |
$4,595.51
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,795.35
|
| Rate for Payer: Health EOS Commercial |
$4,445.66
|
| Rate for Payer: HFN Commercial |
$4,595.51
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,746.34
|
| Rate for Payer: Multiplan Commercial |
$3,996.10
|
| Rate for Payer: NAPHCARE Commercial |
$2,997.07
|
| Rate for Payer: Preferred Network Access Commercial |
$4,595.51
|
| Rate for Payer: Quartz Beloit One Network |
$2,447.61
|
| Rate for Payer: Quartz Commercial |
$3,246.83
|
| Rate for Payer: Quartz Medicare Advantage |
$2,997.07
|
| Rate for Payer: The Alliance Commercial |
$2,497.56
|
| Rate for Payer: WEA Trust Commercial |
$2,747.32
|
| Rate for Payer: WPS Commercial |
$3,699.75
|
|
|
HEMO CONCENTRATOR HPH-400TS
|
Facility
|
IP
|
$1,751.00
|
|
| Hospital Charge Code |
2965303
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$892.31 |
| Max. Negotiated Rate |
$1,675.36 |
| Rate for Payer: Aetna Commercial |
$1,638.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,566.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$965.15
|
| Rate for Payer: Cash Price |
$525.30
|
| Rate for Payer: Cigna Commercial |
$1,675.36
|
| Rate for Payer: Health EOS Commercial |
$1,620.73
|
| Rate for Payer: HFN Commercial |
$1,675.36
|
| Rate for Payer: Multiplan Commercial |
$1,456.83
|
| Rate for Payer: Preferred Network Access Commercial |
$1,675.36
|
| Rate for Payer: Quartz Beloit One Network |
$892.31
|
| Rate for Payer: Quartz Commercial |
$1,092.62
|
| Rate for Payer: WEA Trust Commercial |
$1,001.57
|
| Rate for Payer: WPS Commercial |
$1,348.80
|
|
|
HEMO CONCENTRATOR HPH-400TS
|
Facility
|
OP
|
$1,751.00
|
|
| Hospital Charge Code |
2965303
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$509.89 |
| Max. Negotiated Rate |
$1,675.36 |
| Rate for Payer: Aetna Commercial |
$1,638.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,566.09
|
| Rate for Payer: Aetna Managed Medicare |
$509.89
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,183.68
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$910.52
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$874.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$965.15
|
| Rate for Payer: Cash Price |
$525.30
|
| Rate for Payer: Cigna Commercial |
$1,675.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,019.08
|
| Rate for Payer: Health EOS Commercial |
$1,620.73
|
| Rate for Payer: HFN Commercial |
$1,675.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,365.78
|
| Rate for Payer: Multiplan Commercial |
$1,456.83
|
| Rate for Payer: NAPHCARE Commercial |
$1,092.62
|
| Rate for Payer: Preferred Network Access Commercial |
$1,675.36
|
| Rate for Payer: Quartz Beloit One Network |
$892.31
|
| Rate for Payer: Quartz Commercial |
$1,183.68
|
| Rate for Payer: Quartz Medicare Advantage |
$1,092.62
|
| Rate for Payer: The Alliance Commercial |
$910.52
|
| Rate for Payer: WEA Trust Commercial |
$1,001.57
|
| Rate for Payer: WPS Commercial |
$1,348.80
|
|
|
Hemoglobin
|
Facility
|
OP
|
$132.00
|
|
|
Service Code
|
CPT 85018
|
| Hospital Charge Code |
2942909
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$2.46 |
| Max. Negotiated Rate |
$126.30 |
| Rate for Payer: Aetna Commercial |
$123.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$118.06
|
| Rate for Payer: Aetna Managed Medicare |
$2.46
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$9.24
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4.31
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4.09
|
| Rate for Payer: Anthem Medicare Advantage |
$2.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$72.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$2.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$2.46
|
| Rate for Payer: Cash Price |
$39.60
|
| Rate for Payer: Cash Price |
$39.60
|
| Rate for Payer: Cigna Commercial |
$126.30
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$2.46
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$76.82
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$2.46
|
| Rate for Payer: Health EOS Commercial |
$122.18
|
| Rate for Payer: HFN Commercial |
$126.30
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$9.17
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$2.46
|
| Rate for Payer: Independent Care Health Plan Medicare |
$2.46
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$2.46
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$2.46
|
| Rate for Payer: Multiplan Commercial |
$109.82
|
| Rate for Payer: NAPHCARE Commercial |
$3.70
|
| Rate for Payer: Preferred Network Access Commercial |
$126.30
|
| Rate for Payer: Quartz Beloit One Network |
$67.27
|
| Rate for Payer: Quartz Commercial |
$89.23
|
| Rate for Payer: Quartz Medicare Advantage |
$2.46
|
| Rate for Payer: The Alliance Commercial |
$9.86
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2.46
|
| Rate for Payer: United Healthcare PPO |
$102.96
|
| Rate for Payer: WEA Trust Commercial |
$75.50
|
| Rate for Payer: Wellcare Medicare |
$2.46
|
| Rate for Payer: WPS Commercial |
$101.68
|
|
|
Hemoglobin
|
Facility
|
OP
|
$60.00
|
|
|
Service Code
|
CPT 85018
|
| Hospital Charge Code |
633741
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$2.46 |
| Max. Negotiated Rate |
$57.41 |
| Rate for Payer: Aetna Commercial |
$56.16
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$53.66
|
| Rate for Payer: Aetna Managed Medicare |
$2.46
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$9.24
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4.31
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4.09
|
| Rate for Payer: Anthem Medicare Advantage |
$2.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$33.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$2.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$2.46
|
| Rate for Payer: Cash Price |
$18.00
|
| Rate for Payer: Cash Price |
$18.00
|
| Rate for Payer: Cigna Commercial |
$57.41
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$2.46
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$34.92
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$2.46
|
| Rate for Payer: Health EOS Commercial |
$55.54
|
| Rate for Payer: HFN Commercial |
$57.41
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$9.17
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$2.46
|
| Rate for Payer: Independent Care Health Plan Medicare |
$2.46
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$2.46
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$2.46
|
| Rate for Payer: Multiplan Commercial |
$49.92
|
| Rate for Payer: NAPHCARE Commercial |
$3.70
|
| Rate for Payer: Preferred Network Access Commercial |
$57.41
|
| Rate for Payer: Quartz Beloit One Network |
$30.58
|
| Rate for Payer: Quartz Commercial |
$40.56
|
| Rate for Payer: Quartz Medicare Advantage |
$2.46
|
| Rate for Payer: The Alliance Commercial |
$9.86
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2.46
|
| Rate for Payer: United Healthcare PPO |
$46.80
|
| Rate for Payer: WEA Trust Commercial |
$34.32
|
| Rate for Payer: Wellcare Medicare |
$2.46
|
| Rate for Payer: WPS Commercial |
$46.22
|
|
|
Hemoglobin
|
Professional
|
Both
|
$60.00
|
|
|
Service Code
|
CPT 85018
|
| Hospital Charge Code |
633741
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$2.46 |
| Max. Negotiated Rate |
$59.28 |
| Rate for Payer: Aetna Commercial |
$59.28
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$53.66
|
| Rate for Payer: Aetna Managed Medicare |
$2.46
|
| Rate for Payer: Anthem Medicare Advantage |
$2.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$2.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$2.46
|
| Rate for Payer: Cash Price |
$18.00
|
| Rate for Payer: Cash Price |
$18.00
|
| Rate for Payer: Cigna Commercial |
$59.28
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$31.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2.46
|
| Rate for Payer: Health EOS Commercial |
$56.78
|
| Rate for Payer: HFN Commercial |
$59.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$8.70
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$8.70
|
| Rate for Payer: Independent Care Health Plan Medicare |
$2.46
|
| Rate for Payer: Multiplan Commercial |
$49.92
|
| Rate for Payer: NAPHCARE Commercial |
$3.70
|
| Rate for Payer: Preferred Network Access Commercial |
$59.28
|
| Rate for Payer: Quartz Beloit One Network |
$27.46
|
| Rate for Payer: Quartz Commercial |
$35.57
|
| Rate for Payer: Quartz Medicare Advantage |
$2.46
|
| Rate for Payer: The Alliance Commercial |
$9.74
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2.46
|
| Rate for Payer: WEA Trust Commercial |
$34.32
|
| Rate for Payer: WPS Commercial |
$10.85
|
|
|
Hemoglobin
|
Facility
|
IP
|
$132.00
|
|
|
Service Code
|
CPT 85018
|
| Hospital Charge Code |
2942909
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$67.27 |
| Max. Negotiated Rate |
$126.30 |
| Rate for Payer: Aetna Commercial |
$123.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$118.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$72.76
|
| Rate for Payer: Cash Price |
$39.60
|
| Rate for Payer: Cigna Commercial |
$126.30
|
| Rate for Payer: Health EOS Commercial |
$122.18
|
| Rate for Payer: HFN Commercial |
$126.30
|
| Rate for Payer: Multiplan Commercial |
$109.82
|
| Rate for Payer: Preferred Network Access Commercial |
$126.30
|
| Rate for Payer: Quartz Beloit One Network |
$67.27
|
| Rate for Payer: Quartz Commercial |
$82.37
|
| Rate for Payer: WEA Trust Commercial |
$75.50
|
| Rate for Payer: WPS Commercial |
$101.68
|
|
|
Hemoglobin
|
Facility
|
IP
|
$60.00
|
|
|
Service Code
|
CPT 85018
|
| Hospital Charge Code |
633741
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$30.58 |
| Max. Negotiated Rate |
$57.41 |
| Rate for Payer: Aetna Commercial |
$56.16
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$53.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$33.07
|
| Rate for Payer: Cash Price |
$18.00
|
| Rate for Payer: Cigna Commercial |
$57.41
|
| Rate for Payer: Health EOS Commercial |
$55.54
|
| Rate for Payer: HFN Commercial |
$57.41
|
| Rate for Payer: Multiplan Commercial |
$49.92
|
| Rate for Payer: Preferred Network Access Commercial |
$57.41
|
| Rate for Payer: Quartz Beloit One Network |
$30.58
|
| Rate for Payer: Quartz Commercial |
$37.44
|
| Rate for Payer: WEA Trust Commercial |
$34.32
|
| Rate for Payer: WPS Commercial |
$46.22
|
|
|
Hemoglobin
|
Professional
|
Both
|
$132.00
|
|
|
Service Code
|
CPT 85018
|
| Hospital Charge Code |
2942909
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$2.46 |
| Max. Negotiated Rate |
$130.42 |
| Rate for Payer: Aetna Commercial |
$130.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$118.06
|
| Rate for Payer: Aetna Managed Medicare |
$2.46
|
| Rate for Payer: Anthem Medicare Advantage |
$2.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$2.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$2.46
|
| Rate for Payer: Cash Price |
$39.60
|
| Rate for Payer: Cash Price |
$39.60
|
| Rate for Payer: Cigna Commercial |
$130.42
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$68.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2.46
|
| Rate for Payer: Health EOS Commercial |
$124.92
|
| Rate for Payer: HFN Commercial |
$130.42
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$8.70
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$8.70
|
| Rate for Payer: Independent Care Health Plan Medicare |
$2.46
|
| Rate for Payer: Multiplan Commercial |
$109.82
|
| Rate for Payer: NAPHCARE Commercial |
$3.70
|
| Rate for Payer: Preferred Network Access Commercial |
$130.42
|
| Rate for Payer: Quartz Beloit One Network |
$60.40
|
| Rate for Payer: Quartz Commercial |
$78.25
|
| Rate for Payer: Quartz Medicare Advantage |
$2.46
|
| Rate for Payer: The Alliance Commercial |
$9.74
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2.46
|
| Rate for Payer: WEA Trust Commercial |
$75.50
|
| Rate for Payer: WPS Commercial |
$10.85
|
|
|
Hemoglobin A1c
|
Facility
|
IP
|
$240.00
|
|
|
Service Code
|
CPT 83036
|
| Hospital Charge Code |
633743
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$122.30 |
| Max. Negotiated Rate |
$229.63 |
| Rate for Payer: Aetna Commercial |
$224.64
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$214.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$132.29
|
| Rate for Payer: Cash Price |
$72.00
|
| Rate for Payer: Cigna Commercial |
$229.63
|
| Rate for Payer: Health EOS Commercial |
$222.14
|
| Rate for Payer: HFN Commercial |
$229.63
|
| Rate for Payer: Multiplan Commercial |
$199.68
|
| Rate for Payer: Preferred Network Access Commercial |
$229.63
|
| Rate for Payer: Quartz Beloit One Network |
$122.30
|
| Rate for Payer: Quartz Commercial |
$149.76
|
| Rate for Payer: WEA Trust Commercial |
$137.28
|
| Rate for Payer: WPS Commercial |
$184.87
|
|
|
Hemoglobin A1c
|
Professional
|
Both
|
$240.00
|
|
|
Service Code
|
CPT 83036
|
| Hospital Charge Code |
633743
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.10 |
| Max. Negotiated Rate |
$237.12 |
| Rate for Payer: Aetna Commercial |
$237.12
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$214.66
|
| Rate for Payer: Aetna Managed Medicare |
$10.10
|
| Rate for Payer: Anthem Medicare Advantage |
$10.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$10.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$10.10
|
| Rate for Payer: Cash Price |
$72.00
|
| Rate for Payer: Cash Price |
$72.00
|
| Rate for Payer: Cigna Commercial |
$237.12
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$124.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$10.10
|
| Rate for Payer: Health EOS Commercial |
$227.14
|
| Rate for Payer: HFN Commercial |
$237.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$35.65
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$35.65
|
| Rate for Payer: Independent Care Health Plan Medicare |
$10.10
|
| Rate for Payer: Multiplan Commercial |
$199.68
|
| Rate for Payer: NAPHCARE Commercial |
$15.15
|
| Rate for Payer: Preferred Network Access Commercial |
$237.12
|
| Rate for Payer: Quartz Beloit One Network |
$109.82
|
| Rate for Payer: Quartz Commercial |
$142.27
|
| Rate for Payer: Quartz Medicare Advantage |
$10.10
|
| Rate for Payer: The Alliance Commercial |
$39.89
|
| Rate for Payer: United Healthcare Medicare Advantage |
$10.10
|
| Rate for Payer: WEA Trust Commercial |
$137.28
|
| Rate for Payer: WPS Commercial |
$44.43
|
|
|
Hemoglobin A1c
|
Facility
|
OP
|
$240.00
|
|
|
Service Code
|
CPT 83036
|
| Hospital Charge Code |
633743
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.10 |
| Max. Negotiated Rate |
$229.63 |
| Rate for Payer: Aetna Commercial |
$224.64
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$214.66
|
| Rate for Payer: Aetna Managed Medicare |
$10.10
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$37.87
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$17.67
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$16.76
|
| Rate for Payer: Anthem Medicare Advantage |
$10.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$132.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$10.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$10.10
|
| Rate for Payer: Cash Price |
$72.00
|
| Rate for Payer: Cash Price |
$72.00
|
| Rate for Payer: Cigna Commercial |
$229.63
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$10.10
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$139.68
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$10.10
|
| Rate for Payer: Health EOS Commercial |
$222.14
|
| Rate for Payer: HFN Commercial |
$229.63
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$37.57
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$10.10
|
| Rate for Payer: Independent Care Health Plan Medicare |
$10.10
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$10.10
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$10.10
|
| Rate for Payer: Multiplan Commercial |
$199.68
|
| Rate for Payer: NAPHCARE Commercial |
$15.15
|
| Rate for Payer: Preferred Network Access Commercial |
$229.63
|
| Rate for Payer: Quartz Beloit One Network |
$122.30
|
| Rate for Payer: Quartz Commercial |
$162.24
|
| Rate for Payer: Quartz Medicare Advantage |
$10.10
|
| Rate for Payer: The Alliance Commercial |
$40.39
|
| Rate for Payer: United Healthcare Medicare Advantage |
$10.10
|
| Rate for Payer: United Healthcare PPO |
$187.20
|
| Rate for Payer: WEA Trust Commercial |
$137.28
|
| Rate for Payer: Wellcare Medicare |
$10.10
|
| Rate for Payer: WPS Commercial |
$184.87
|
|
|
Hemoglobin A2
|
Professional
|
Both
|
$510.00
|
|
|
Service Code
|
CPT 83021
|
| Hospital Charge Code |
977964
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.78 |
| Max. Negotiated Rate |
$503.88 |
| Rate for Payer: Aetna Commercial |
$503.88
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$456.14
|
| Rate for Payer: Aetna Managed Medicare |
$18.78
|
| Rate for Payer: Anthem Medicare Advantage |
$18.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$18.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$18.78
|
| Rate for Payer: Cash Price |
$153.00
|
| Rate for Payer: Cash Price |
$153.00
|
| Rate for Payer: Cigna Commercial |
$503.88
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$265.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$18.78
|
| Rate for Payer: Health EOS Commercial |
$482.66
|
| Rate for Payer: HFN Commercial |
$503.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$66.30
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$66.30
|
| Rate for Payer: Independent Care Health Plan Medicare |
$18.78
|
| Rate for Payer: Multiplan Commercial |
$424.32
|
| Rate for Payer: NAPHCARE Commercial |
$28.17
|
| Rate for Payer: Preferred Network Access Commercial |
$503.88
|
| Rate for Payer: Quartz Beloit One Network |
$233.38
|
| Rate for Payer: Quartz Commercial |
$302.33
|
| Rate for Payer: Quartz Medicare Advantage |
$18.78
|
| Rate for Payer: The Alliance Commercial |
$74.19
|
| Rate for Payer: United Healthcare Medicare Advantage |
$18.78
|
| Rate for Payer: WEA Trust Commercial |
$291.72
|
| Rate for Payer: WPS Commercial |
$82.64
|
|
|
Hemoglobin A2
|
Facility
|
OP
|
$510.00
|
|
|
Service Code
|
CPT 83021
|
| Hospital Charge Code |
977964
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.78 |
| Max. Negotiated Rate |
$487.97 |
| Rate for Payer: Aetna Commercial |
$477.36
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$456.14
|
| Rate for Payer: Aetna Managed Medicare |
$18.78
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$70.43
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$32.87
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$31.18
|
| Rate for Payer: Anthem Medicare Advantage |
$18.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$281.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$18.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$18.78
|
| Rate for Payer: Cash Price |
$153.00
|
| Rate for Payer: Cash Price |
$153.00
|
| Rate for Payer: Cigna Commercial |
$487.97
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$18.78
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$296.82
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$18.78
|
| Rate for Payer: Health EOS Commercial |
$472.06
|
| Rate for Payer: HFN Commercial |
$487.97
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$69.87
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$18.78
|
| Rate for Payer: Independent Care Health Plan Medicare |
$18.78
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$18.78
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$18.78
|
| Rate for Payer: Multiplan Commercial |
$424.32
|
| Rate for Payer: NAPHCARE Commercial |
$28.17
|
| Rate for Payer: Preferred Network Access Commercial |
$487.97
|
| Rate for Payer: Quartz Beloit One Network |
$259.90
|
| Rate for Payer: Quartz Commercial |
$344.76
|
| Rate for Payer: Quartz Medicare Advantage |
$18.78
|
| Rate for Payer: The Alliance Commercial |
$75.13
|
| Rate for Payer: United Healthcare Medicare Advantage |
$18.78
|
| Rate for Payer: United Healthcare PPO |
$397.80
|
| Rate for Payer: WEA Trust Commercial |
$291.72
|
| Rate for Payer: Wellcare Medicare |
$18.78
|
| Rate for Payer: WPS Commercial |
$392.85
|
|
|
Hemoglobin A2
|
Facility
|
IP
|
$510.00
|
|
|
Service Code
|
CPT 83021
|
| Hospital Charge Code |
977964
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$259.90 |
| Max. Negotiated Rate |
$487.97 |
| Rate for Payer: Aetna Commercial |
$477.36
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$456.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$281.11
|
| Rate for Payer: Cash Price |
$153.00
|
| Rate for Payer: Cigna Commercial |
$487.97
|
| Rate for Payer: Health EOS Commercial |
$472.06
|
| Rate for Payer: HFN Commercial |
$487.97
|
| Rate for Payer: Multiplan Commercial |
$424.32
|
| Rate for Payer: Preferred Network Access Commercial |
$487.97
|
| Rate for Payer: Quartz Beloit One Network |
$259.90
|
| Rate for Payer: Quartz Commercial |
$318.24
|
| Rate for Payer: WEA Trust Commercial |
$291.72
|
| Rate for Payer: WPS Commercial |
$392.85
|
|
|
Hemoglobin A2 and F
|
Professional
|
Both
|
$322.00
|
|
|
Service Code
|
CPT 83021
|
| Hospital Charge Code |
3525524
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.78 |
| Max. Negotiated Rate |
$318.14 |
| Rate for Payer: Aetna Commercial |
$318.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$288.00
|
| Rate for Payer: Aetna Managed Medicare |
$18.78
|
| Rate for Payer: Anthem Medicare Advantage |
$18.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$18.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$18.78
|
| Rate for Payer: Cash Price |
$96.60
|
| Rate for Payer: Cash Price |
$96.60
|
| Rate for Payer: Cigna Commercial |
$318.14
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$167.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$18.78
|
| Rate for Payer: Health EOS Commercial |
$304.74
|
| Rate for Payer: HFN Commercial |
$318.14
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$66.30
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$66.30
|
| Rate for Payer: Independent Care Health Plan Medicare |
$18.78
|
| Rate for Payer: Multiplan Commercial |
$267.90
|
| Rate for Payer: NAPHCARE Commercial |
$28.17
|
| Rate for Payer: Preferred Network Access Commercial |
$318.14
|
| Rate for Payer: Quartz Beloit One Network |
$147.35
|
| Rate for Payer: Quartz Commercial |
$190.88
|
| Rate for Payer: Quartz Medicare Advantage |
$18.78
|
| Rate for Payer: The Alliance Commercial |
$74.19
|
| Rate for Payer: United Healthcare Medicare Advantage |
$18.78
|
| Rate for Payer: WEA Trust Commercial |
$184.18
|
| Rate for Payer: WPS Commercial |
$82.64
|
|
|
Hemoglobin A2 and F
|
Facility
|
IP
|
$322.00
|
|
|
Service Code
|
CPT 83021
|
| Hospital Charge Code |
3525524
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$164.09 |
| Max. Negotiated Rate |
$308.09 |
| Rate for Payer: Aetna Commercial |
$301.39
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$288.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$177.49
|
| Rate for Payer: Cash Price |
$96.60
|
| Rate for Payer: Cigna Commercial |
$308.09
|
| Rate for Payer: Health EOS Commercial |
$298.04
|
| Rate for Payer: HFN Commercial |
$308.09
|
| Rate for Payer: Multiplan Commercial |
$267.90
|
| Rate for Payer: Preferred Network Access Commercial |
$308.09
|
| Rate for Payer: Quartz Beloit One Network |
$164.09
|
| Rate for Payer: Quartz Commercial |
$200.93
|
| Rate for Payer: WEA Trust Commercial |
$184.18
|
| Rate for Payer: WPS Commercial |
$248.04
|
|
|
Hemoglobin A2 and F
|
Facility
|
OP
|
$322.00
|
|
|
Service Code
|
CPT 83021
|
| Hospital Charge Code |
3525524
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.78 |
| Max. Negotiated Rate |
$308.09 |
| Rate for Payer: Aetna Commercial |
$301.39
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$288.00
|
| Rate for Payer: Aetna Managed Medicare |
$18.78
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$70.43
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$32.87
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$31.18
|
| Rate for Payer: Anthem Medicare Advantage |
$18.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$177.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$18.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$18.78
|
| Rate for Payer: Cash Price |
$96.60
|
| Rate for Payer: Cash Price |
$96.60
|
| Rate for Payer: Cigna Commercial |
$308.09
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$18.78
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$187.40
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$18.78
|
| Rate for Payer: Health EOS Commercial |
$298.04
|
| Rate for Payer: HFN Commercial |
$308.09
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$69.87
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$18.78
|
| Rate for Payer: Independent Care Health Plan Medicare |
$18.78
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$18.78
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$18.78
|
| Rate for Payer: Multiplan Commercial |
$267.90
|
| Rate for Payer: NAPHCARE Commercial |
$28.17
|
| Rate for Payer: Preferred Network Access Commercial |
$308.09
|
| Rate for Payer: Quartz Beloit One Network |
$164.09
|
| Rate for Payer: Quartz Commercial |
$217.67
|
| Rate for Payer: Quartz Medicare Advantage |
$18.78
|
| Rate for Payer: The Alliance Commercial |
$75.13
|
| Rate for Payer: United Healthcare Medicare Advantage |
$18.78
|
| Rate for Payer: United Healthcare PPO |
$251.16
|
| Rate for Payer: WEA Trust Commercial |
$184.18
|
| Rate for Payer: Wellcare Medicare |
$18.78
|
| Rate for Payer: WPS Commercial |
$248.04
|
|
