|
Hemoglobin Electrophoresis
|
Facility
|
OP
|
$105.00
|
|
|
Service Code
|
CPT 83020
|
| Hospital Charge Code |
3525523
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.38 |
| Max. Negotiated Rate |
$100.46 |
| Rate for Payer: Aetna Commercial |
$98.28
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$93.91
|
| 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 |
$57.88
|
| 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 |
$31.50
|
| Rate for Payer: Cash Price |
$31.50
|
| Rate for Payer: Cigna Commercial |
$100.46
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$13.38
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$61.11
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$13.38
|
| Rate for Payer: Health EOS Commercial |
$97.19
|
| Rate for Payer: HFN Commercial |
$100.46
|
| 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 |
$87.36
|
| Rate for Payer: NAPHCARE Commercial |
$20.08
|
| Rate for Payer: Preferred Network Access Commercial |
$100.46
|
| Rate for Payer: Quartz Beloit One Network |
$53.51
|
| Rate for Payer: Quartz Commercial |
$70.98
|
| 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 |
$81.90
|
| Rate for Payer: WEA Trust Commercial |
$60.06
|
| Rate for Payer: Wellcare Medicare |
$13.38
|
| Rate for Payer: WPS Commercial |
$80.88
|
|
|
Hemoglobin Electrophoresis
|
Facility
|
IP
|
$105.00
|
|
|
Service Code
|
CPT 83020
|
| Hospital Charge Code |
3525523
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$53.51 |
| Max. Negotiated Rate |
$100.46 |
| Rate for Payer: Aetna Commercial |
$98.28
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$93.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$57.88
|
| Rate for Payer: Cash Price |
$31.50
|
| Rate for Payer: Cigna Commercial |
$100.46
|
| Rate for Payer: Health EOS Commercial |
$97.19
|
| Rate for Payer: HFN Commercial |
$100.46
|
| Rate for Payer: Multiplan Commercial |
$87.36
|
| Rate for Payer: Preferred Network Access Commercial |
$100.46
|
| Rate for Payer: Quartz Beloit One Network |
$53.51
|
| Rate for Payer: Quartz Commercial |
$65.52
|
| Rate for Payer: WEA Trust Commercial |
$60.06
|
| Rate for Payer: WPS Commercial |
$80.88
|
|
|
Hemoglobin Electrophoresis
|
Professional
|
Both
|
$123.00
|
|
|
Service Code
|
CPT 85041
|
| Hospital Charge Code |
977965
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.14 |
| Max. Negotiated Rate |
$121.52 |
| Rate for Payer: Aetna Commercial |
$121.52
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$110.01
|
| Rate for Payer: Aetna Managed Medicare |
$3.14
|
| Rate for Payer: Anthem Medicare Advantage |
$3.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$3.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$3.14
|
| Rate for Payer: Cash Price |
$36.90
|
| Rate for Payer: Cash Price |
$36.90
|
| Rate for Payer: Cigna Commercial |
$121.52
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$63.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3.14
|
| Rate for Payer: Health EOS Commercial |
$116.41
|
| Rate for Payer: HFN Commercial |
$121.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$11.09
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$11.09
|
| Rate for Payer: Independent Care Health Plan Medicare |
$3.14
|
| Rate for Payer: Multiplan Commercial |
$102.34
|
| Rate for Payer: NAPHCARE Commercial |
$4.71
|
| Rate for Payer: Preferred Network Access Commercial |
$121.52
|
| Rate for Payer: Quartz Beloit One Network |
$56.28
|
| Rate for Payer: Quartz Commercial |
$72.91
|
| Rate for Payer: Quartz Medicare Advantage |
$3.14
|
| Rate for Payer: The Alliance Commercial |
$12.41
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3.14
|
| Rate for Payer: WEA Trust Commercial |
$70.36
|
| Rate for Payer: WPS Commercial |
$13.82
|
|
|
Hemoglobin Electrophoresis
|
Professional
|
Both
|
$105.00
|
|
|
Service Code
|
CPT 83020
|
| Hospital Charge Code |
3525523
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.38 |
| Max. Negotiated Rate |
$103.74 |
| Rate for Payer: Aetna Commercial |
$103.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$93.91
|
| Rate for Payer: Aetna Managed Medicare |
$13.38
|
| Rate for Payer: Anthem Commercial |
$17.27
|
| 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 |
$31.50
|
| Rate for Payer: Cash Price |
$31.50
|
| Rate for Payer: Cigna Commercial |
$103.74
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$54.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$13.38
|
| Rate for Payer: Health EOS Commercial |
$99.37
|
| Rate for Payer: HFN Commercial |
$103.74
|
| 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 |
$87.36
|
| Rate for Payer: NAPHCARE Commercial |
$20.08
|
| Rate for Payer: Preferred Network Access Commercial |
$103.74
|
| Rate for Payer: Quartz Beloit One Network |
$48.05
|
| Rate for Payer: Quartz Commercial |
$62.24
|
| 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 |
$60.06
|
| Rate for Payer: WPS Commercial |
$58.89
|
|
|
Hemoglobin Electrophoresis
|
Facility
|
OP
|
$123.00
|
|
|
Service Code
|
CPT 85041
|
| Hospital Charge Code |
977965
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.14 |
| Max. Negotiated Rate |
$117.69 |
| Rate for Payer: Aetna Commercial |
$115.13
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$110.01
|
| Rate for Payer: Aetna Managed Medicare |
$3.14
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$11.78
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5.21
|
| Rate for Payer: Anthem Medicare Advantage |
$3.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$67.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$3.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$3.14
|
| Rate for Payer: Cash Price |
$36.90
|
| Rate for Payer: Cash Price |
$36.90
|
| Rate for Payer: Cigna Commercial |
$117.69
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$3.14
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$71.59
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$3.14
|
| Rate for Payer: Health EOS Commercial |
$113.85
|
| Rate for Payer: HFN Commercial |
$117.69
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$11.68
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$3.14
|
| Rate for Payer: Independent Care Health Plan Medicare |
$3.14
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$3.14
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$3.14
|
| Rate for Payer: Multiplan Commercial |
$102.34
|
| Rate for Payer: NAPHCARE Commercial |
$4.71
|
| Rate for Payer: Preferred Network Access Commercial |
$117.69
|
| Rate for Payer: Quartz Beloit One Network |
$62.68
|
| Rate for Payer: Quartz Commercial |
$83.15
|
| Rate for Payer: Quartz Medicare Advantage |
$3.14
|
| Rate for Payer: The Alliance Commercial |
$12.56
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3.14
|
| Rate for Payer: United Healthcare PPO |
$95.94
|
| Rate for Payer: WEA Trust Commercial |
$70.36
|
| Rate for Payer: Wellcare Medicare |
$3.14
|
| Rate for Payer: WPS Commercial |
$94.75
|
|
|
Hemoglobin Electrophoresis
|
Facility
|
IP
|
$123.00
|
|
|
Service Code
|
CPT 85041
|
| Hospital Charge Code |
977965
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$62.68 |
| Max. Negotiated Rate |
$117.69 |
| Rate for Payer: Aetna Commercial |
$115.13
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$110.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$67.80
|
| Rate for Payer: Cash Price |
$36.90
|
| Rate for Payer: Cigna Commercial |
$117.69
|
| Rate for Payer: Health EOS Commercial |
$113.85
|
| Rate for Payer: HFN Commercial |
$117.69
|
| Rate for Payer: Multiplan Commercial |
$102.34
|
| Rate for Payer: Preferred Network Access Commercial |
$117.69
|
| Rate for Payer: Quartz Beloit One Network |
$62.68
|
| Rate for Payer: Quartz Commercial |
$76.75
|
| Rate for Payer: WEA Trust Commercial |
$70.36
|
| Rate for Payer: WPS Commercial |
$94.75
|
|
|
Hemoglobin Electrophoresis Interpretation
|
Professional
|
Both
|
$186.00
|
|
|
Service Code
|
CPT 83021
|
| Hospital Charge Code |
2942911
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.78 |
| Max. Negotiated Rate |
$183.77 |
| Rate for Payer: Aetna Commercial |
$183.77
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$166.36
|
| 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 |
$55.80
|
| Rate for Payer: Cash Price |
$55.80
|
| Rate for Payer: Cigna Commercial |
$183.77
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$96.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$18.78
|
| Rate for Payer: Health EOS Commercial |
$176.03
|
| Rate for Payer: HFN Commercial |
$183.77
|
| 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 |
$154.75
|
| Rate for Payer: NAPHCARE Commercial |
$28.17
|
| Rate for Payer: Preferred Network Access Commercial |
$183.77
|
| Rate for Payer: Quartz Beloit One Network |
$85.11
|
| Rate for Payer: Quartz Commercial |
$110.26
|
| 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 |
$106.39
|
| Rate for Payer: WPS Commercial |
$82.64
|
|
|
Hemoglobin Electrophoresis Interpretation
|
Facility
|
IP
|
$186.00
|
|
|
Service Code
|
CPT 83021
|
| Hospital Charge Code |
2942911
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$94.79 |
| Max. Negotiated Rate |
$177.96 |
| Rate for Payer: Aetna Commercial |
$174.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$166.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$102.52
|
| Rate for Payer: Cash Price |
$55.80
|
| Rate for Payer: Cigna Commercial |
$177.96
|
| Rate for Payer: Health EOS Commercial |
$172.16
|
| Rate for Payer: HFN Commercial |
$177.96
|
| Rate for Payer: Multiplan Commercial |
$154.75
|
| Rate for Payer: Preferred Network Access Commercial |
$177.96
|
| Rate for Payer: Quartz Beloit One Network |
$94.79
|
| Rate for Payer: Quartz Commercial |
$116.06
|
| Rate for Payer: WEA Trust Commercial |
$106.39
|
| Rate for Payer: WPS Commercial |
$143.28
|
|
|
Hemoglobin Electrophoresis Interpretation
|
Facility
|
OP
|
$186.00
|
|
|
Service Code
|
CPT 83021
|
| Hospital Charge Code |
2942911
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.78 |
| Max. Negotiated Rate |
$177.96 |
| Rate for Payer: Aetna Commercial |
$174.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$166.36
|
| 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 |
$102.52
|
| 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 |
$55.80
|
| Rate for Payer: Cash Price |
$55.80
|
| Rate for Payer: Cigna Commercial |
$177.96
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$18.78
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$108.25
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$18.78
|
| Rate for Payer: Health EOS Commercial |
$172.16
|
| Rate for Payer: HFN Commercial |
$177.96
|
| 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 |
$154.75
|
| Rate for Payer: NAPHCARE Commercial |
$28.17
|
| Rate for Payer: Preferred Network Access Commercial |
$177.96
|
| Rate for Payer: Quartz Beloit One Network |
$94.79
|
| Rate for Payer: Quartz Commercial |
$125.74
|
| 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 |
$145.08
|
| Rate for Payer: WEA Trust Commercial |
$106.39
|
| Rate for Payer: Wellcare Medicare |
$18.78
|
| Rate for Payer: WPS Commercial |
$143.28
|
|
|
Hemoglobin Fetal Qualitative
|
Facility
|
OP
|
$418.00
|
|
|
Service Code
|
CPT 83021
|
| Hospital Charge Code |
978119
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.78 |
| Max. Negotiated Rate |
$399.94 |
| Rate for Payer: Aetna Commercial |
$391.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$373.86
|
| 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 |
$230.40
|
| 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 |
$125.40
|
| Rate for Payer: Cash Price |
$125.40
|
| Rate for Payer: Cigna Commercial |
$399.94
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$18.78
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$243.28
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$18.78
|
| Rate for Payer: Health EOS Commercial |
$386.90
|
| Rate for Payer: HFN Commercial |
$399.94
|
| 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 |
$347.78
|
| Rate for Payer: NAPHCARE Commercial |
$28.17
|
| Rate for Payer: Preferred Network Access Commercial |
$399.94
|
| Rate for Payer: Quartz Beloit One Network |
$213.01
|
| Rate for Payer: Quartz Commercial |
$282.57
|
| 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 |
$326.04
|
| Rate for Payer: WEA Trust Commercial |
$239.10
|
| Rate for Payer: Wellcare Medicare |
$18.78
|
| Rate for Payer: WPS Commercial |
$321.99
|
|
|
Hemoglobin Fetal Qualitative
|
Facility
|
IP
|
$418.00
|
|
|
Service Code
|
CPT 83021
|
| Hospital Charge Code |
978119
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$213.01 |
| Max. Negotiated Rate |
$399.94 |
| Rate for Payer: Aetna Commercial |
$391.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$373.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$230.40
|
| Rate for Payer: Cash Price |
$125.40
|
| Rate for Payer: Cigna Commercial |
$399.94
|
| Rate for Payer: Health EOS Commercial |
$386.90
|
| Rate for Payer: HFN Commercial |
$399.94
|
| Rate for Payer: Multiplan Commercial |
$347.78
|
| Rate for Payer: Preferred Network Access Commercial |
$399.94
|
| Rate for Payer: Quartz Beloit One Network |
$213.01
|
| Rate for Payer: Quartz Commercial |
$260.83
|
| Rate for Payer: WEA Trust Commercial |
$239.10
|
| Rate for Payer: WPS Commercial |
$321.99
|
|
|
Hemoglobin Fetal Qualitative
|
Professional
|
Both
|
$418.00
|
|
|
Service Code
|
CPT 83021
|
| Hospital Charge Code |
978119
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.78 |
| Max. Negotiated Rate |
$412.98 |
| Rate for Payer: Aetna Commercial |
$412.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$373.86
|
| 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 |
$125.40
|
| Rate for Payer: Cash Price |
$125.40
|
| Rate for Payer: Cigna Commercial |
$412.98
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$217.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$18.78
|
| Rate for Payer: Health EOS Commercial |
$395.60
|
| Rate for Payer: HFN Commercial |
$412.98
|
| 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 |
$347.78
|
| Rate for Payer: NAPHCARE Commercial |
$28.17
|
| Rate for Payer: Preferred Network Access Commercial |
$412.98
|
| Rate for Payer: Quartz Beloit One Network |
$191.28
|
| Rate for Payer: Quartz Commercial |
$247.79
|
| 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 |
$239.10
|
| Rate for Payer: WPS Commercial |
$82.64
|
|
|
Hemoglobin Free, Plasma
|
Professional
|
Both
|
$67.00
|
|
|
Service Code
|
CPT 83051
|
| Hospital Charge Code |
3256229
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$7.60 |
| Max. Negotiated Rate |
$66.20 |
| Rate for Payer: Aetna Commercial |
$66.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$59.92
|
| Rate for Payer: Aetna Managed Medicare |
$7.60
|
| Rate for Payer: Anthem Medicare Advantage |
$7.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$7.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$7.60
|
| Rate for Payer: Cash Price |
$20.10
|
| Rate for Payer: Cash Price |
$20.10
|
| Rate for Payer: Cigna Commercial |
$66.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$34.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$7.60
|
| Rate for Payer: Health EOS Commercial |
$63.41
|
| Rate for Payer: HFN Commercial |
$66.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$26.83
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$26.83
|
| Rate for Payer: Independent Care Health Plan Medicare |
$7.60
|
| Rate for Payer: Multiplan Commercial |
$55.74
|
| Rate for Payer: NAPHCARE Commercial |
$11.40
|
| Rate for Payer: Preferred Network Access Commercial |
$66.20
|
| Rate for Payer: Quartz Beloit One Network |
$30.66
|
| Rate for Payer: Quartz Commercial |
$39.72
|
| Rate for Payer: Quartz Medicare Advantage |
$7.60
|
| Rate for Payer: The Alliance Commercial |
$30.03
|
| Rate for Payer: United Healthcare Medicare Advantage |
$7.60
|
| Rate for Payer: WEA Trust Commercial |
$38.32
|
| Rate for Payer: WPS Commercial |
$33.45
|
|
|
Hemoglobin Free, Plasma
|
Facility
|
OP
|
$67.00
|
|
|
Service Code
|
CPT 83051
|
| Hospital Charge Code |
3256229
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$7.60 |
| Max. Negotiated Rate |
$64.11 |
| Rate for Payer: Aetna Commercial |
$62.71
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$59.92
|
| Rate for Payer: Aetna Managed Medicare |
$7.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$28.51
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$13.30
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$12.62
|
| Rate for Payer: Anthem Medicare Advantage |
$7.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$36.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$7.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$7.60
|
| Rate for Payer: Cash Price |
$20.10
|
| Rate for Payer: Cash Price |
$20.10
|
| Rate for Payer: Cigna Commercial |
$64.11
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$7.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$38.99
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$7.60
|
| Rate for Payer: Health EOS Commercial |
$62.02
|
| Rate for Payer: HFN Commercial |
$64.11
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$28.28
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$7.60
|
| Rate for Payer: Independent Care Health Plan Medicare |
$7.60
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$7.60
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$7.60
|
| Rate for Payer: Multiplan Commercial |
$55.74
|
| Rate for Payer: NAPHCARE Commercial |
$11.40
|
| Rate for Payer: Preferred Network Access Commercial |
$64.11
|
| Rate for Payer: Quartz Beloit One Network |
$34.14
|
| Rate for Payer: Quartz Commercial |
$45.29
|
| Rate for Payer: Quartz Medicare Advantage |
$7.60
|
| Rate for Payer: The Alliance Commercial |
$30.41
|
| Rate for Payer: United Healthcare Medicare Advantage |
$7.60
|
| Rate for Payer: United Healthcare PPO |
$52.26
|
| Rate for Payer: WEA Trust Commercial |
$38.32
|
| Rate for Payer: Wellcare Medicare |
$7.60
|
| Rate for Payer: WPS Commercial |
$51.61
|
|
|
Hemoglobin Free, Plasma
|
Facility
|
IP
|
$67.00
|
|
|
Service Code
|
CPT 83051
|
| Hospital Charge Code |
3256229
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$34.14 |
| Max. Negotiated Rate |
$64.11 |
| Rate for Payer: Aetna Commercial |
$62.71
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$59.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$36.93
|
| Rate for Payer: Cash Price |
$20.10
|
| Rate for Payer: Cigna Commercial |
$64.11
|
| Rate for Payer: Health EOS Commercial |
$62.02
|
| Rate for Payer: HFN Commercial |
$64.11
|
| Rate for Payer: Multiplan Commercial |
$55.74
|
| Rate for Payer: Preferred Network Access Commercial |
$64.11
|
| Rate for Payer: Quartz Beloit One Network |
$34.14
|
| Rate for Payer: Quartz Commercial |
$41.81
|
| Rate for Payer: WEA Trust Commercial |
$38.32
|
| Rate for Payer: WPS Commercial |
$51.61
|
|
|
Hemoglobin Free Urine
|
Facility
|
OP
|
$138.00
|
|
|
Service Code
|
CPT 83069
|
| Hospital Charge Code |
977967
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.11 |
| Max. Negotiated Rate |
$132.04 |
| Rate for Payer: Aetna Commercial |
$129.17
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$123.43
|
| Rate for Payer: Aetna Managed Medicare |
$4.11
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$15.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$7.19
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$6.82
|
| Rate for Payer: Anthem Medicare Advantage |
$4.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$76.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$4.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$4.11
|
| Rate for Payer: Cash Price |
$41.40
|
| Rate for Payer: Cash Price |
$41.40
|
| Rate for Payer: Cigna Commercial |
$132.04
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$4.11
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$80.32
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$4.11
|
| Rate for Payer: Health EOS Commercial |
$127.73
|
| Rate for Payer: HFN Commercial |
$132.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$15.28
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$4.11
|
| Rate for Payer: Independent Care Health Plan Medicare |
$4.11
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$4.11
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$4.11
|
| Rate for Payer: Multiplan Commercial |
$114.82
|
| Rate for Payer: NAPHCARE Commercial |
$6.16
|
| Rate for Payer: Preferred Network Access Commercial |
$132.04
|
| Rate for Payer: Quartz Beloit One Network |
$70.32
|
| Rate for Payer: Quartz Commercial |
$93.29
|
| Rate for Payer: Quartz Medicare Advantage |
$4.11
|
| Rate for Payer: The Alliance Commercial |
$16.43
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4.11
|
| Rate for Payer: United Healthcare PPO |
$107.64
|
| Rate for Payer: WEA Trust Commercial |
$78.94
|
| Rate for Payer: Wellcare Medicare |
$4.11
|
| Rate for Payer: WPS Commercial |
$106.30
|
|
|
Hemoglobin Free Urine
|
Facility
|
IP
|
$138.00
|
|
|
Service Code
|
CPT 83069
|
| Hospital Charge Code |
977967
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$70.32 |
| Max. Negotiated Rate |
$132.04 |
| Rate for Payer: Aetna Commercial |
$129.17
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$123.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$76.07
|
| Rate for Payer: Cash Price |
$41.40
|
| Rate for Payer: Cigna Commercial |
$132.04
|
| Rate for Payer: Health EOS Commercial |
$127.73
|
| Rate for Payer: HFN Commercial |
$132.04
|
| Rate for Payer: Multiplan Commercial |
$114.82
|
| Rate for Payer: Preferred Network Access Commercial |
$132.04
|
| Rate for Payer: Quartz Beloit One Network |
$70.32
|
| Rate for Payer: Quartz Commercial |
$86.11
|
| Rate for Payer: WEA Trust Commercial |
$78.94
|
| Rate for Payer: WPS Commercial |
$106.30
|
|
|
Hemoglobin Free Urine
|
Professional
|
Both
|
$138.00
|
|
|
Service Code
|
CPT 83069
|
| Hospital Charge Code |
977967
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.11 |
| Max. Negotiated Rate |
$136.34 |
| Rate for Payer: Aetna Commercial |
$136.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$123.43
|
| Rate for Payer: Aetna Managed Medicare |
$4.11
|
| Rate for Payer: Anthem Medicare Advantage |
$4.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$4.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$4.11
|
| Rate for Payer: Cash Price |
$41.40
|
| Rate for Payer: Cash Price |
$41.40
|
| Rate for Payer: Cigna Commercial |
$136.34
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$71.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4.11
|
| Rate for Payer: Health EOS Commercial |
$130.60
|
| Rate for Payer: HFN Commercial |
$136.34
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$14.50
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$14.50
|
| Rate for Payer: Independent Care Health Plan Medicare |
$4.11
|
| Rate for Payer: Multiplan Commercial |
$114.82
|
| Rate for Payer: NAPHCARE Commercial |
$6.16
|
| Rate for Payer: Preferred Network Access Commercial |
$136.34
|
| Rate for Payer: Quartz Beloit One Network |
$63.15
|
| Rate for Payer: Quartz Commercial |
$81.81
|
| Rate for Payer: Quartz Medicare Advantage |
$4.11
|
| Rate for Payer: The Alliance Commercial |
$16.23
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4.11
|
| Rate for Payer: WEA Trust Commercial |
$78.94
|
| Rate for Payer: WPS Commercial |
$18.08
|
|
|
Hemoglobin POC
|
Facility
|
OP
|
$38.00
|
|
|
Service Code
|
CPT 85018
|
| Hospital Charge Code |
2580821
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$2.46 |
| Max. Negotiated Rate |
$36.36 |
| Rate for Payer: Aetna Commercial |
$35.57
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$33.99
|
| 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 |
$20.95
|
| 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 |
$11.40
|
| Rate for Payer: Cash Price |
$11.40
|
| Rate for Payer: Cigna Commercial |
$36.36
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$2.46
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$22.12
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$2.46
|
| Rate for Payer: Health EOS Commercial |
$35.17
|
| Rate for Payer: HFN Commercial |
$36.36
|
| 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 |
$31.62
|
| Rate for Payer: NAPHCARE Commercial |
$3.70
|
| Rate for Payer: Preferred Network Access Commercial |
$36.36
|
| Rate for Payer: Quartz Beloit One Network |
$19.36
|
| Rate for Payer: Quartz Commercial |
$25.69
|
| 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 |
$29.64
|
| Rate for Payer: WEA Trust Commercial |
$21.74
|
| Rate for Payer: Wellcare Medicare |
$2.46
|
| Rate for Payer: WPS Commercial |
$29.27
|
|
|
Hemoglobin POC
|
Professional
|
Both
|
$38.00
|
|
|
Service Code
|
CPT 85018
|
| Hospital Charge Code |
2580821
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$2.46 |
| Max. Negotiated Rate |
$37.54 |
| Rate for Payer: Aetna Commercial |
$37.54
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$33.99
|
| 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 |
$11.40
|
| Rate for Payer: Cash Price |
$11.40
|
| Rate for Payer: Cigna Commercial |
$37.54
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$19.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2.46
|
| Rate for Payer: Health EOS Commercial |
$35.96
|
| Rate for Payer: HFN Commercial |
$37.54
|
| 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 |
$31.62
|
| Rate for Payer: NAPHCARE Commercial |
$3.70
|
| Rate for Payer: Preferred Network Access Commercial |
$37.54
|
| Rate for Payer: Quartz Beloit One Network |
$17.39
|
| Rate for Payer: Quartz Commercial |
$22.53
|
| 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 |
$21.74
|
| Rate for Payer: WPS Commercial |
$10.85
|
|
|
Hemoglobin POC
|
Facility
|
IP
|
$38.00
|
|
|
Service Code
|
CPT 85018
|
| Hospital Charge Code |
2580821
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$19.36 |
| Max. Negotiated Rate |
$36.36 |
| Rate for Payer: Aetna Commercial |
$35.57
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$33.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$20.95
|
| Rate for Payer: Cash Price |
$11.40
|
| Rate for Payer: Cigna Commercial |
$36.36
|
| Rate for Payer: Health EOS Commercial |
$35.17
|
| Rate for Payer: HFN Commercial |
$36.36
|
| Rate for Payer: Multiplan Commercial |
$31.62
|
| Rate for Payer: Preferred Network Access Commercial |
$36.36
|
| Rate for Payer: Quartz Beloit One Network |
$19.36
|
| Rate for Payer: Quartz Commercial |
$23.71
|
| Rate for Payer: WEA Trust Commercial |
$21.74
|
| Rate for Payer: WPS Commercial |
$29.27
|
|
|
Hemogram
|
Facility
|
OP
|
$174.00
|
|
|
Service Code
|
CPT 85027
|
| Hospital Charge Code |
979866
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.73 |
| Max. Negotiated Rate |
$166.48 |
| Rate for Payer: Aetna Commercial |
$162.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$155.63
|
| Rate for Payer: Aetna Managed Medicare |
$6.73
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$25.23
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$11.78
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$11.17
|
| Rate for Payer: Anthem Medicare Advantage |
$6.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$95.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$6.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$6.73
|
| Rate for Payer: Cash Price |
$52.20
|
| Rate for Payer: Cash Price |
$52.20
|
| Rate for Payer: Cigna Commercial |
$166.48
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$6.73
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$101.27
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$6.73
|
| Rate for Payer: Health EOS Commercial |
$161.05
|
| Rate for Payer: HFN Commercial |
$166.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$25.03
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$6.73
|
| Rate for Payer: Independent Care Health Plan Medicare |
$6.73
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$6.73
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$6.73
|
| Rate for Payer: Multiplan Commercial |
$144.77
|
| Rate for Payer: NAPHCARE Commercial |
$10.09
|
| Rate for Payer: Preferred Network Access Commercial |
$166.48
|
| Rate for Payer: Quartz Beloit One Network |
$88.67
|
| Rate for Payer: Quartz Commercial |
$117.62
|
| Rate for Payer: Quartz Medicare Advantage |
$6.73
|
| Rate for Payer: The Alliance Commercial |
$26.92
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6.73
|
| Rate for Payer: United Healthcare PPO |
$135.72
|
| Rate for Payer: WEA Trust Commercial |
$99.53
|
| Rate for Payer: Wellcare Medicare |
$6.73
|
| Rate for Payer: WPS Commercial |
$134.03
|
|
|
Hemogram
|
Facility
|
IP
|
$151.00
|
|
|
Service Code
|
CPT 85027
|
| Hospital Charge Code |
2975837
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$76.95 |
| Max. Negotiated Rate |
$144.48 |
| Rate for Payer: Aetna Commercial |
$141.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$135.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$83.23
|
| Rate for Payer: Cash Price |
$45.30
|
| Rate for Payer: Cigna Commercial |
$144.48
|
| Rate for Payer: Health EOS Commercial |
$139.77
|
| Rate for Payer: HFN Commercial |
$144.48
|
| Rate for Payer: Multiplan Commercial |
$125.63
|
| Rate for Payer: Preferred Network Access Commercial |
$144.48
|
| Rate for Payer: Quartz Beloit One Network |
$76.95
|
| Rate for Payer: Quartz Commercial |
$94.22
|
| Rate for Payer: WEA Trust Commercial |
$86.37
|
| Rate for Payer: WPS Commercial |
$116.32
|
|
|
Hemogram
|
Facility
|
IP
|
$174.00
|
|
|
Service Code
|
CPT 85027
|
| Hospital Charge Code |
979866
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$88.67 |
| Max. Negotiated Rate |
$166.48 |
| Rate for Payer: Aetna Commercial |
$162.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$155.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$95.91
|
| Rate for Payer: Cash Price |
$52.20
|
| Rate for Payer: Cigna Commercial |
$166.48
|
| Rate for Payer: Health EOS Commercial |
$161.05
|
| Rate for Payer: HFN Commercial |
$166.48
|
| Rate for Payer: Multiplan Commercial |
$144.77
|
| Rate for Payer: Preferred Network Access Commercial |
$166.48
|
| Rate for Payer: Quartz Beloit One Network |
$88.67
|
| Rate for Payer: Quartz Commercial |
$108.58
|
| Rate for Payer: WEA Trust Commercial |
$99.53
|
| Rate for Payer: WPS Commercial |
$134.03
|
|
|
Hemogram
|
Facility
|
OP
|
$151.00
|
|
|
Service Code
|
CPT 85027
|
| Hospital Charge Code |
2975837
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.73 |
| Max. Negotiated Rate |
$144.48 |
| Rate for Payer: Aetna Commercial |
$141.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$135.05
|
| Rate for Payer: Aetna Managed Medicare |
$6.73
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$25.23
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$11.78
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$11.17
|
| Rate for Payer: Anthem Medicare Advantage |
$6.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$83.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$6.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$6.73
|
| Rate for Payer: Cash Price |
$45.30
|
| Rate for Payer: Cash Price |
$45.30
|
| Rate for Payer: Cigna Commercial |
$144.48
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$6.73
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$87.88
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$6.73
|
| Rate for Payer: Health EOS Commercial |
$139.77
|
| Rate for Payer: HFN Commercial |
$144.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$25.03
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$6.73
|
| Rate for Payer: Independent Care Health Plan Medicare |
$6.73
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$6.73
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$6.73
|
| Rate for Payer: Multiplan Commercial |
$125.63
|
| Rate for Payer: NAPHCARE Commercial |
$10.09
|
| Rate for Payer: Preferred Network Access Commercial |
$144.48
|
| Rate for Payer: Quartz Beloit One Network |
$76.95
|
| Rate for Payer: Quartz Commercial |
$102.08
|
| Rate for Payer: Quartz Medicare Advantage |
$6.73
|
| Rate for Payer: The Alliance Commercial |
$26.92
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6.73
|
| Rate for Payer: United Healthcare PPO |
$117.78
|
| Rate for Payer: WEA Trust Commercial |
$86.37
|
| Rate for Payer: Wellcare Medicare |
$6.73
|
| Rate for Payer: WPS Commercial |
$116.32
|
|
