|
Hemoglobin
|
Facility
|
OP
|
$132.00
|
|
|
Service Code
|
CPT 85018
|
| Hospital Charge Code |
2942909
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$2.37 |
| Max. Negotiated Rate |
$121.44 |
| Rate for Payer: Aetna Commercial |
$118.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$113.52
|
| Rate for Payer: Aetna Managed Medicare |
$2.37
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$8.89
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4.15
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3.93
|
| Rate for Payer: Anthem Medicaid |
$2.45
|
| Rate for Payer: Anthem Medicare Advantage |
$2.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$69.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$2.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$2.37
|
| Rate for Payer: Cash Price |
$39.60
|
| Rate for Payer: Cash Price |
$39.60
|
| Rate for Payer: Cigna Commercial |
$121.44
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$2.37
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2.45
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$73.87
|
| Rate for Payer: Dean Health Medicaid |
$2.45
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$2.37
|
| Rate for Payer: Health EOS Commercial |
$117.48
|
| Rate for Payer: HFN Commercial |
$121.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$8.82
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$2.37
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$2.45
|
| Rate for Payer: Independent Care Health Plan Medicare |
$2.37
|
| Rate for Payer: Managed Health Services Medicaid |
$2.55
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$2.37
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$2.37
|
| Rate for Payer: Multiplan Commercial |
$105.60
|
| Rate for Payer: NAPHCARE Commercial |
$3.56
|
| Rate for Payer: Preferred Network Access Commercial |
$121.44
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$2.45
|
| Rate for Payer: Quartz Beloit One Network |
$64.68
|
| Rate for Payer: Quartz Commercial |
$85.80
|
| Rate for Payer: Quartz Medicare Advantage |
$2.37
|
| Rate for Payer: The Alliance Commercial |
$9.48
|
| Rate for Payer: United Healthcare Medicaid |
$2.45
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2.37
|
| Rate for Payer: United Healthcare PPO |
$99.00
|
| Rate for Payer: WEA Trust Commercial |
$72.60
|
| Rate for Payer: Wellcare Medicare |
$2.37
|
| Rate for Payer: WMAP Medicaid |
$2.45
|
| Rate for Payer: WPS Commercial |
$97.77
|
|
|
Hemoglobin
|
Professional
|
Both
|
$132.00
|
|
|
Service Code
|
CPT 85018
|
| Hospital Charge Code |
2942909
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.37 |
| Max. Negotiated Rate |
$125.40 |
| Rate for Payer: Aetna Commercial |
$125.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$113.52
|
| Rate for Payer: Cash Price |
$39.60
|
| Rate for Payer: Cash Price |
$39.60
|
| Rate for Payer: Cigna Commercial |
$125.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$66.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$79.20
|
| Rate for Payer: Health EOS Commercial |
$120.12
|
| Rate for Payer: HFN Commercial |
$125.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$8.37
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$8.37
|
| Rate for Payer: Multiplan Commercial |
$105.60
|
| Rate for Payer: Preferred Network Access Commercial |
$125.40
|
| Rate for Payer: Quartz Beloit One Network |
$58.08
|
| Rate for Payer: Quartz Commercial |
$75.24
|
| Rate for Payer: The Alliance Commercial |
$66.00
|
| Rate for Payer: WEA Trust Commercial |
$72.60
|
| Rate for Payer: WPS Commercial |
$97.77
|
|
|
Hemoglobin
|
Facility
|
OP
|
$60.00
|
|
|
Service Code
|
CPT 85018
|
| Hospital Charge Code |
633741
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$2.37 |
| Max. Negotiated Rate |
$55.20 |
| Rate for Payer: Aetna Commercial |
$54.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$51.60
|
| Rate for Payer: Aetna Managed Medicare |
$2.37
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$8.89
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4.15
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3.93
|
| Rate for Payer: Anthem Medicaid |
$2.45
|
| Rate for Payer: Anthem Medicare Advantage |
$2.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$31.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$2.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$2.37
|
| Rate for Payer: Cash Price |
$18.00
|
| Rate for Payer: Cash Price |
$18.00
|
| Rate for Payer: Cigna Commercial |
$55.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$2.37
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2.45
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$33.58
|
| Rate for Payer: Dean Health Medicaid |
$2.45
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$2.37
|
| Rate for Payer: Health EOS Commercial |
$53.40
|
| Rate for Payer: HFN Commercial |
$55.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$8.82
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$2.37
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$2.45
|
| Rate for Payer: Independent Care Health Plan Medicare |
$2.37
|
| Rate for Payer: Managed Health Services Medicaid |
$2.55
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$2.37
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$2.37
|
| Rate for Payer: Multiplan Commercial |
$48.00
|
| Rate for Payer: NAPHCARE Commercial |
$3.56
|
| Rate for Payer: Preferred Network Access Commercial |
$55.20
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$2.45
|
| Rate for Payer: Quartz Beloit One Network |
$29.40
|
| Rate for Payer: Quartz Commercial |
$39.00
|
| Rate for Payer: Quartz Medicare Advantage |
$2.37
|
| Rate for Payer: The Alliance Commercial |
$9.48
|
| Rate for Payer: United Healthcare Medicaid |
$2.45
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2.37
|
| Rate for Payer: United Healthcare PPO |
$45.00
|
| Rate for Payer: WEA Trust Commercial |
$33.00
|
| Rate for Payer: Wellcare Medicare |
$2.37
|
| Rate for Payer: WMAP Medicaid |
$2.45
|
| Rate for Payer: WPS Commercial |
$44.44
|
|
|
Hemoglobin
|
Professional
|
Both
|
$60.00
|
|
|
Service Code
|
CPT 85018
|
| Hospital Charge Code |
633741
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.37 |
| Max. Negotiated Rate |
$57.00 |
| Rate for Payer: Aetna Commercial |
$57.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$51.60
|
| Rate for Payer: Cash Price |
$18.00
|
| Rate for Payer: Cash Price |
$18.00
|
| Rate for Payer: Cigna Commercial |
$57.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$30.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$36.00
|
| Rate for Payer: Health EOS Commercial |
$54.60
|
| Rate for Payer: HFN Commercial |
$57.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$8.37
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$8.37
|
| Rate for Payer: Multiplan Commercial |
$48.00
|
| Rate for Payer: Preferred Network Access Commercial |
$57.00
|
| Rate for Payer: Quartz Beloit One Network |
$26.40
|
| Rate for Payer: Quartz Commercial |
$34.20
|
| Rate for Payer: The Alliance Commercial |
$30.00
|
| Rate for Payer: WEA Trust Commercial |
$33.00
|
| Rate for Payer: WPS Commercial |
$44.44
|
|
|
Hemoglobin
|
Facility
|
IP
|
$132.00
|
|
|
Service Code
|
CPT 85018
|
| Hospital Charge Code |
2942909
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$64.68 |
| Max. Negotiated Rate |
$121.44 |
| Rate for Payer: Aetna Commercial |
$118.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$113.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$69.96
|
| Rate for Payer: Cash Price |
$39.60
|
| Rate for Payer: Cigna Commercial |
$121.44
|
| Rate for Payer: Health EOS Commercial |
$117.48
|
| Rate for Payer: HFN Commercial |
$121.44
|
| Rate for Payer: Multiplan Commercial |
$105.60
|
| Rate for Payer: NAPHCARE Commercial |
$79.20
|
| Rate for Payer: Preferred Network Access Commercial |
$121.44
|
| Rate for Payer: Quartz Beloit One Network |
$64.68
|
| Rate for Payer: Quartz Commercial |
$79.20
|
| Rate for Payer: WEA Trust Commercial |
$72.60
|
| Rate for Payer: WPS Commercial |
$97.77
|
|
|
Hemoglobin
|
Facility
|
IP
|
$60.00
|
|
|
Service Code
|
CPT 85018
|
| Hospital Charge Code |
633741
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$29.40 |
| Max. Negotiated Rate |
$55.20 |
| Rate for Payer: Aetna Commercial |
$54.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$51.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$31.80
|
| Rate for Payer: Cash Price |
$18.00
|
| Rate for Payer: Cigna Commercial |
$55.20
|
| Rate for Payer: Health EOS Commercial |
$53.40
|
| Rate for Payer: HFN Commercial |
$55.20
|
| Rate for Payer: Multiplan Commercial |
$48.00
|
| Rate for Payer: NAPHCARE Commercial |
$36.00
|
| Rate for Payer: Preferred Network Access Commercial |
$55.20
|
| Rate for Payer: Quartz Beloit One Network |
$29.40
|
| Rate for Payer: Quartz Commercial |
$36.00
|
| Rate for Payer: WEA Trust Commercial |
$33.00
|
| Rate for Payer: WPS Commercial |
$44.44
|
|
|
Hemoglobin A1c
|
Professional
|
Both
|
$240.00
|
|
|
Service Code
|
CPT 83036
|
| Hospital Charge Code |
633743
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$34.28 |
| Max. Negotiated Rate |
$228.00 |
| Rate for Payer: Aetna Commercial |
$228.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$206.40
|
| Rate for Payer: Cash Price |
$72.00
|
| Rate for Payer: Cash Price |
$72.00
|
| Rate for Payer: Cigna Commercial |
$228.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$120.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$144.00
|
| Rate for Payer: Health EOS Commercial |
$218.40
|
| Rate for Payer: HFN Commercial |
$228.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$34.28
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$34.28
|
| Rate for Payer: Multiplan Commercial |
$192.00
|
| Rate for Payer: Preferred Network Access Commercial |
$228.00
|
| Rate for Payer: Quartz Beloit One Network |
$105.60
|
| Rate for Payer: Quartz Commercial |
$136.80
|
| Rate for Payer: The Alliance Commercial |
$120.00
|
| Rate for Payer: WEA Trust Commercial |
$132.00
|
| Rate for Payer: WPS Commercial |
$177.77
|
|
|
Hemoglobin A1c
|
Facility
|
OP
|
$240.00
|
|
|
Service Code
|
CPT 83036
|
| Hospital Charge Code |
633743
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.71 |
| Max. Negotiated Rate |
$220.80 |
| Rate for Payer: Aetna Commercial |
$216.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$206.40
|
| Rate for Payer: Aetna Managed Medicare |
$9.71
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$36.41
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$16.99
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$16.12
|
| Rate for Payer: Anthem Medicaid |
$10.03
|
| Rate for Payer: Anthem Medicare Advantage |
$9.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$127.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$9.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$9.71
|
| Rate for Payer: Cash Price |
$72.00
|
| Rate for Payer: Cash Price |
$72.00
|
| Rate for Payer: Cigna Commercial |
$220.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$9.71
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$10.03
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$134.30
|
| Rate for Payer: Dean Health Medicaid |
$10.03
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$9.71
|
| Rate for Payer: Health EOS Commercial |
$213.60
|
| Rate for Payer: HFN Commercial |
$220.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$36.12
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$9.71
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$10.03
|
| Rate for Payer: Independent Care Health Plan Medicare |
$9.71
|
| Rate for Payer: Managed Health Services Medicaid |
$10.43
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$9.71
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$9.71
|
| Rate for Payer: Multiplan Commercial |
$192.00
|
| Rate for Payer: NAPHCARE Commercial |
$14.56
|
| Rate for Payer: Preferred Network Access Commercial |
$220.80
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$10.03
|
| Rate for Payer: Quartz Beloit One Network |
$117.60
|
| Rate for Payer: Quartz Commercial |
$156.00
|
| Rate for Payer: Quartz Medicare Advantage |
$9.71
|
| Rate for Payer: The Alliance Commercial |
$38.84
|
| Rate for Payer: United Healthcare Medicaid |
$10.03
|
| Rate for Payer: United Healthcare Medicare Advantage |
$9.71
|
| Rate for Payer: United Healthcare PPO |
$180.00
|
| Rate for Payer: WEA Trust Commercial |
$132.00
|
| Rate for Payer: Wellcare Medicare |
$9.71
|
| Rate for Payer: WMAP Medicaid |
$10.03
|
| Rate for Payer: WPS Commercial |
$177.77
|
|
|
Hemoglobin A1c
|
Facility
|
IP
|
$240.00
|
|
|
Service Code
|
CPT 83036
|
| Hospital Charge Code |
633743
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$117.60 |
| Max. Negotiated Rate |
$220.80 |
| Rate for Payer: Aetna Commercial |
$216.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$206.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$127.20
|
| Rate for Payer: Cash Price |
$72.00
|
| Rate for Payer: Cigna Commercial |
$220.80
|
| Rate for Payer: Health EOS Commercial |
$213.60
|
| Rate for Payer: HFN Commercial |
$220.80
|
| Rate for Payer: Multiplan Commercial |
$192.00
|
| Rate for Payer: NAPHCARE Commercial |
$144.00
|
| Rate for Payer: Preferred Network Access Commercial |
$220.80
|
| Rate for Payer: Quartz Beloit One Network |
$117.60
|
| Rate for Payer: Quartz Commercial |
$144.00
|
| Rate for Payer: WEA Trust Commercial |
$132.00
|
| Rate for Payer: WPS Commercial |
$177.77
|
|
|
Hemoglobin A2
|
Facility
|
IP
|
$510.00
|
|
|
Service Code
|
CPT 83021
|
| Hospital Charge Code |
977964
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$249.90 |
| Max. Negotiated Rate |
$469.20 |
| Rate for Payer: Aetna Commercial |
$459.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$438.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$270.30
|
| Rate for Payer: Cash Price |
$153.00
|
| Rate for Payer: Cigna Commercial |
$469.20
|
| Rate for Payer: Health EOS Commercial |
$453.90
|
| Rate for Payer: HFN Commercial |
$469.20
|
| Rate for Payer: Multiplan Commercial |
$408.00
|
| Rate for Payer: NAPHCARE Commercial |
$306.00
|
| Rate for Payer: Preferred Network Access Commercial |
$469.20
|
| Rate for Payer: Quartz Beloit One Network |
$249.90
|
| Rate for Payer: Quartz Commercial |
$306.00
|
| Rate for Payer: WEA Trust Commercial |
$280.50
|
| Rate for Payer: WPS Commercial |
$377.76
|
|
|
Hemoglobin A2
|
Professional
|
Both
|
$510.00
|
|
|
Service Code
|
CPT 83021
|
| Hospital Charge Code |
977964
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$63.75 |
| Max. Negotiated Rate |
$484.50 |
| Rate for Payer: Aetna Commercial |
$484.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$438.60
|
| Rate for Payer: Cash Price |
$153.00
|
| Rate for Payer: Cash Price |
$153.00
|
| Rate for Payer: Cigna Commercial |
$484.50
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$255.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$306.00
|
| Rate for Payer: Health EOS Commercial |
$464.10
|
| Rate for Payer: HFN Commercial |
$484.50
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$63.75
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$63.75
|
| Rate for Payer: Multiplan Commercial |
$408.00
|
| Rate for Payer: Preferred Network Access Commercial |
$484.50
|
| Rate for Payer: Quartz Beloit One Network |
$224.40
|
| Rate for Payer: Quartz Commercial |
$290.70
|
| Rate for Payer: The Alliance Commercial |
$255.00
|
| Rate for Payer: WEA Trust Commercial |
$280.50
|
| Rate for Payer: WPS Commercial |
$377.76
|
|
|
Hemoglobin A2
|
Facility
|
OP
|
$510.00
|
|
|
Service Code
|
CPT 83021
|
| Hospital Charge Code |
977964
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.06 |
| Max. Negotiated Rate |
$469.20 |
| Rate for Payer: HFN Commercial |
$469.20
|
| Rate for Payer: Aetna Commercial |
$459.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$438.60
|
| Rate for Payer: Aetna Managed Medicare |
$18.06
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$67.72
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$31.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$29.98
|
| Rate for Payer: Anthem Medicaid |
$18.66
|
| Rate for Payer: Anthem Medicare Advantage |
$18.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$270.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$18.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$18.06
|
| Rate for Payer: Cash Price |
$153.00
|
| Rate for Payer: Cash Price |
$153.00
|
| Rate for Payer: Cigna Commercial |
$469.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$18.06
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$18.66
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$285.40
|
| Rate for Payer: Dean Health Medicaid |
$18.66
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$18.06
|
| Rate for Payer: Health EOS Commercial |
$453.90
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$67.18
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$18.06
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$18.66
|
| Rate for Payer: Independent Care Health Plan Medicare |
$18.06
|
| Rate for Payer: Managed Health Services Medicaid |
$19.41
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$18.06
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$18.06
|
| Rate for Payer: Multiplan Commercial |
$408.00
|
| Rate for Payer: NAPHCARE Commercial |
$27.09
|
| Rate for Payer: Preferred Network Access Commercial |
$469.20
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$18.66
|
| Rate for Payer: Quartz Beloit One Network |
$249.90
|
| Rate for Payer: Quartz Commercial |
$331.50
|
| Rate for Payer: Quartz Medicare Advantage |
$18.06
|
| Rate for Payer: The Alliance Commercial |
$72.24
|
| Rate for Payer: United Healthcare Medicaid |
$18.66
|
| Rate for Payer: United Healthcare Medicare Advantage |
$18.06
|
| Rate for Payer: United Healthcare PPO |
$382.50
|
| Rate for Payer: WEA Trust Commercial |
$280.50
|
| Rate for Payer: Wellcare Medicare |
$18.06
|
| Rate for Payer: WMAP Medicaid |
$18.66
|
| Rate for Payer: WPS Commercial |
$377.76
|
|
|
Hemoglobin A2 and F
|
Facility
|
OP
|
$322.00
|
|
|
Service Code
|
CPT 83021
|
| Hospital Charge Code |
3525524
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.06 |
| Max. Negotiated Rate |
$296.24 |
| Rate for Payer: Aetna Commercial |
$289.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$276.92
|
| Rate for Payer: Aetna Managed Medicare |
$18.06
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$67.72
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$31.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$29.98
|
| Rate for Payer: Anthem Medicaid |
$18.66
|
| Rate for Payer: Anthem Medicare Advantage |
$18.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$170.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$18.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$18.06
|
| Rate for Payer: Cash Price |
$96.60
|
| Rate for Payer: Cash Price |
$96.60
|
| Rate for Payer: Cigna Commercial |
$296.24
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$18.06
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$18.66
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$180.19
|
| Rate for Payer: Dean Health Medicaid |
$18.66
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$18.06
|
| Rate for Payer: Health EOS Commercial |
$286.58
|
| Rate for Payer: HFN Commercial |
$296.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$67.18
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$18.06
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$18.66
|
| Rate for Payer: Independent Care Health Plan Medicare |
$18.06
|
| Rate for Payer: Managed Health Services Medicaid |
$19.41
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$18.06
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$18.06
|
| Rate for Payer: Multiplan Commercial |
$257.60
|
| Rate for Payer: NAPHCARE Commercial |
$27.09
|
| Rate for Payer: Preferred Network Access Commercial |
$296.24
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$18.66
|
| Rate for Payer: Quartz Beloit One Network |
$157.78
|
| Rate for Payer: Quartz Commercial |
$209.30
|
| Rate for Payer: Quartz Medicare Advantage |
$18.06
|
| Rate for Payer: The Alliance Commercial |
$72.24
|
| Rate for Payer: United Healthcare Medicaid |
$18.66
|
| Rate for Payer: United Healthcare Medicare Advantage |
$18.06
|
| Rate for Payer: United Healthcare PPO |
$241.50
|
| Rate for Payer: WEA Trust Commercial |
$177.10
|
| Rate for Payer: Wellcare Medicare |
$18.06
|
| Rate for Payer: WMAP Medicaid |
$18.66
|
| Rate for Payer: WPS Commercial |
$238.51
|
|
|
Hemoglobin A2 and F
|
Professional
|
Both
|
$322.00
|
|
|
Service Code
|
CPT 83021
|
| Hospital Charge Code |
3525524
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$63.75 |
| Max. Negotiated Rate |
$305.90 |
| Rate for Payer: Aetna Commercial |
$305.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$276.92
|
| Rate for Payer: Cash Price |
$96.60
|
| Rate for Payer: Cash Price |
$96.60
|
| Rate for Payer: Cigna Commercial |
$305.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$161.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$193.20
|
| Rate for Payer: Health EOS Commercial |
$293.02
|
| Rate for Payer: HFN Commercial |
$305.90
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$63.75
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$63.75
|
| Rate for Payer: Multiplan Commercial |
$257.60
|
| Rate for Payer: Preferred Network Access Commercial |
$305.90
|
| Rate for Payer: Quartz Beloit One Network |
$141.68
|
| Rate for Payer: Quartz Commercial |
$183.54
|
| Rate for Payer: The Alliance Commercial |
$161.00
|
| Rate for Payer: WEA Trust Commercial |
$177.10
|
| Rate for Payer: WPS Commercial |
$238.51
|
|
|
Hemoglobin A2 and F
|
Facility
|
IP
|
$322.00
|
|
|
Service Code
|
CPT 83021
|
| Hospital Charge Code |
3525524
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$157.78 |
| Max. Negotiated Rate |
$296.24 |
| Rate for Payer: Aetna Commercial |
$289.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$276.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$170.66
|
| Rate for Payer: Cash Price |
$96.60
|
| Rate for Payer: Cigna Commercial |
$296.24
|
| Rate for Payer: Health EOS Commercial |
$286.58
|
| Rate for Payer: HFN Commercial |
$296.24
|
| Rate for Payer: Multiplan Commercial |
$257.60
|
| Rate for Payer: NAPHCARE Commercial |
$193.20
|
| Rate for Payer: Preferred Network Access Commercial |
$296.24
|
| Rate for Payer: Quartz Beloit One Network |
$157.78
|
| Rate for Payer: Quartz Commercial |
$193.20
|
| Rate for Payer: WEA Trust Commercial |
$177.10
|
| Rate for Payer: WPS Commercial |
$238.51
|
|
|
Hemoglobin Electrophoresis
|
Professional
|
Both
|
$105.00
|
|
|
Service Code
|
CPT 83020
|
| Hospital Charge Code |
3525523
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$16.61 |
| Max. Negotiated Rate |
$99.75 |
| Rate for Payer: Aetna Commercial |
$99.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$90.30
|
| Rate for Payer: Anthem Commercial |
$16.61
|
| Rate for Payer: Cash Price |
$31.50
|
| Rate for Payer: Cash Price |
$31.50
|
| Rate for Payer: Cigna Commercial |
$99.75
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$52.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$63.00
|
| Rate for Payer: Health EOS Commercial |
$95.55
|
| Rate for Payer: HFN Commercial |
$99.75
|
| 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 |
$84.00
|
| Rate for Payer: Preferred Network Access Commercial |
$99.75
|
| Rate for Payer: Quartz Beloit One Network |
$46.20
|
| Rate for Payer: Quartz Commercial |
$59.85
|
| Rate for Payer: The Alliance Commercial |
$52.50
|
| Rate for Payer: WEA Trust Commercial |
$57.75
|
| Rate for Payer: WPS Commercial |
$77.77
|
|
|
Hemoglobin Electrophoresis
|
Facility
|
IP
|
$123.00
|
|
|
Service Code
|
CPT 85041
|
| Hospital Charge Code |
977965
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$60.27 |
| Max. Negotiated Rate |
$113.16 |
| Rate for Payer: Aetna Commercial |
$110.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$105.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$65.19
|
| Rate for Payer: Cash Price |
$36.90
|
| Rate for Payer: Cigna Commercial |
$113.16
|
| Rate for Payer: Health EOS Commercial |
$109.47
|
| Rate for Payer: HFN Commercial |
$113.16
|
| Rate for Payer: Multiplan Commercial |
$98.40
|
| Rate for Payer: NAPHCARE Commercial |
$73.80
|
| Rate for Payer: Preferred Network Access Commercial |
$113.16
|
| Rate for Payer: Quartz Beloit One Network |
$60.27
|
| Rate for Payer: Quartz Commercial |
$73.80
|
| Rate for Payer: WEA Trust Commercial |
$67.65
|
| Rate for Payer: WPS Commercial |
$91.11
|
|
|
Hemoglobin Electrophoresis
|
Facility
|
IP
|
$105.00
|
|
|
Service Code
|
CPT 83020
|
| Hospital Charge Code |
3525523
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$51.45 |
| Max. Negotiated Rate |
$96.60 |
| Rate for Payer: Aetna Commercial |
$94.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$90.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$55.65
|
| Rate for Payer: Cash Price |
$31.50
|
| Rate for Payer: Cigna Commercial |
$96.60
|
| Rate for Payer: Health EOS Commercial |
$93.45
|
| Rate for Payer: HFN Commercial |
$96.60
|
| Rate for Payer: Multiplan Commercial |
$84.00
|
| Rate for Payer: NAPHCARE Commercial |
$63.00
|
| Rate for Payer: Preferred Network Access Commercial |
$96.60
|
| Rate for Payer: Quartz Beloit One Network |
$51.45
|
| Rate for Payer: Quartz Commercial |
$63.00
|
| Rate for Payer: WEA Trust Commercial |
$57.75
|
| Rate for Payer: WPS Commercial |
$77.77
|
|
|
Hemoglobin Electrophoresis
|
Facility
|
OP
|
$123.00
|
|
|
Service Code
|
CPT 85041
|
| Hospital Charge Code |
977965
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.02 |
| Max. Negotiated Rate |
$113.16 |
| Rate for Payer: Aetna Commercial |
$110.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$105.78
|
| Rate for Payer: Aetna Managed Medicare |
$3.02
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$11.32
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5.01
|
| Rate for Payer: Anthem Medicaid |
$3.12
|
| Rate for Payer: Anthem Medicare Advantage |
$3.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$65.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$3.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$3.02
|
| Rate for Payer: Cash Price |
$36.90
|
| Rate for Payer: Cash Price |
$36.90
|
| Rate for Payer: Cigna Commercial |
$113.16
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$3.02
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$3.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$68.83
|
| Rate for Payer: Dean Health Medicaid |
$3.12
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$3.02
|
| Rate for Payer: Health EOS Commercial |
$109.47
|
| Rate for Payer: HFN Commercial |
$113.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$11.23
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$3.02
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$3.12
|
| Rate for Payer: Independent Care Health Plan Medicare |
$3.02
|
| Rate for Payer: Managed Health Services Medicaid |
$3.24
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$3.02
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$3.02
|
| Rate for Payer: Multiplan Commercial |
$98.40
|
| Rate for Payer: NAPHCARE Commercial |
$4.53
|
| Rate for Payer: Preferred Network Access Commercial |
$113.16
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$3.12
|
| Rate for Payer: Quartz Beloit One Network |
$60.27
|
| Rate for Payer: Quartz Commercial |
$79.95
|
| Rate for Payer: Quartz Medicare Advantage |
$3.02
|
| Rate for Payer: The Alliance Commercial |
$12.08
|
| Rate for Payer: United Healthcare Medicaid |
$3.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3.02
|
| Rate for Payer: United Healthcare PPO |
$92.25
|
| Rate for Payer: WEA Trust Commercial |
$67.65
|
| Rate for Payer: Wellcare Medicare |
$3.02
|
| Rate for Payer: WMAP Medicaid |
$3.12
|
| Rate for Payer: WPS Commercial |
$91.11
|
|
|
Hemoglobin Electrophoresis
|
Facility
|
OP
|
$105.00
|
|
|
Service Code
|
CPT 83020
|
| Hospital Charge Code |
3525523
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.41 |
| Max. Negotiated Rate |
$96.60 |
| Rate for Payer: Aetna Commercial |
$94.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$90.30
|
| 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 |
$6.41
|
| Rate for Payer: Anthem Medicare Advantage |
$12.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$55.65
|
| 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 |
$31.50
|
| Rate for Payer: Cash Price |
$31.50
|
| Rate for Payer: Cigna Commercial |
$96.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$12.87
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$6.41
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$58.76
|
| Rate for Payer: Dean Health Medicaid |
$6.41
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$12.87
|
| Rate for Payer: Health EOS Commercial |
$93.45
|
| Rate for Payer: HFN Commercial |
$96.60
|
| 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 |
$6.41
|
| Rate for Payer: Independent Care Health Plan Medicare |
$12.87
|
| Rate for Payer: Managed Health Services Medicaid |
$6.67
|
| 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 |
$84.00
|
| Rate for Payer: NAPHCARE Commercial |
$19.30
|
| Rate for Payer: Preferred Network Access Commercial |
$96.60
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$6.41
|
| Rate for Payer: Quartz Beloit One Network |
$51.45
|
| Rate for Payer: Quartz Commercial |
$68.25
|
| Rate for Payer: Quartz Medicare Advantage |
$12.87
|
| Rate for Payer: The Alliance Commercial |
$51.48
|
| Rate for Payer: United Healthcare Medicaid |
$6.41
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.87
|
| Rate for Payer: United Healthcare PPO |
$78.75
|
| Rate for Payer: WEA Trust Commercial |
$57.75
|
| Rate for Payer: Wellcare Medicare |
$12.87
|
| Rate for Payer: WMAP Medicaid |
$6.41
|
| Rate for Payer: WPS Commercial |
$77.77
|
|
|
Hemoglobin Electrophoresis
|
Professional
|
Both
|
$123.00
|
|
|
Service Code
|
CPT 85041
|
| Hospital Charge Code |
977965
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.66 |
| Max. Negotiated Rate |
$116.85 |
| Rate for Payer: Aetna Commercial |
$116.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$105.78
|
| Rate for Payer: Cash Price |
$36.90
|
| Rate for Payer: Cash Price |
$36.90
|
| Rate for Payer: Cigna Commercial |
$116.85
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$61.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$73.80
|
| Rate for Payer: Health EOS Commercial |
$111.93
|
| Rate for Payer: HFN Commercial |
$116.85
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$10.66
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$10.66
|
| Rate for Payer: Multiplan Commercial |
$98.40
|
| Rate for Payer: Preferred Network Access Commercial |
$116.85
|
| Rate for Payer: Quartz Beloit One Network |
$54.12
|
| Rate for Payer: Quartz Commercial |
$70.11
|
| Rate for Payer: The Alliance Commercial |
$61.50
|
| Rate for Payer: WEA Trust Commercial |
$67.65
|
| Rate for Payer: WPS Commercial |
$91.11
|
|
|
Hemoglobin Electrophoresis Interpretation
|
Professional
|
Both
|
$186.00
|
|
|
Service Code
|
CPT 83021
|
| Hospital Charge Code |
2942911
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$63.75 |
| Max. Negotiated Rate |
$176.70 |
| Rate for Payer: Aetna Commercial |
$176.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$159.96
|
| Rate for Payer: Cash Price |
$55.80
|
| Rate for Payer: Cash Price |
$55.80
|
| Rate for Payer: Cigna Commercial |
$176.70
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$93.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$111.60
|
| Rate for Payer: Health EOS Commercial |
$169.26
|
| Rate for Payer: HFN Commercial |
$176.70
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$63.75
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$63.75
|
| Rate for Payer: Multiplan Commercial |
$148.80
|
| Rate for Payer: Preferred Network Access Commercial |
$176.70
|
| Rate for Payer: Quartz Beloit One Network |
$81.84
|
| Rate for Payer: Quartz Commercial |
$106.02
|
| Rate for Payer: The Alliance Commercial |
$93.00
|
| Rate for Payer: WEA Trust Commercial |
$102.30
|
| Rate for Payer: WPS Commercial |
$137.77
|
|
|
Hemoglobin Electrophoresis Interpretation
|
Facility
|
OP
|
$186.00
|
|
|
Service Code
|
CPT 83021
|
| Hospital Charge Code |
2942911
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.06 |
| Max. Negotiated Rate |
$171.12 |
| Rate for Payer: Aetna Commercial |
$167.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$159.96
|
| Rate for Payer: Aetna Managed Medicare |
$18.06
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$67.72
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$31.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$29.98
|
| Rate for Payer: Anthem Medicaid |
$18.66
|
| Rate for Payer: Anthem Medicare Advantage |
$18.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$98.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$18.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$18.06
|
| Rate for Payer: Cash Price |
$55.80
|
| Rate for Payer: Cash Price |
$55.80
|
| Rate for Payer: Cigna Commercial |
$171.12
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$18.06
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$18.66
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$104.09
|
| Rate for Payer: Dean Health Medicaid |
$18.66
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$18.06
|
| Rate for Payer: Health EOS Commercial |
$165.54
|
| Rate for Payer: HFN Commercial |
$171.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$67.18
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$18.06
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$18.66
|
| Rate for Payer: Independent Care Health Plan Medicare |
$18.06
|
| Rate for Payer: Managed Health Services Medicaid |
$19.41
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$18.06
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$18.06
|
| Rate for Payer: Multiplan Commercial |
$148.80
|
| Rate for Payer: NAPHCARE Commercial |
$27.09
|
| Rate for Payer: Preferred Network Access Commercial |
$171.12
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$18.66
|
| Rate for Payer: Quartz Beloit One Network |
$91.14
|
| Rate for Payer: Quartz Commercial |
$120.90
|
| Rate for Payer: Quartz Medicare Advantage |
$18.06
|
| Rate for Payer: The Alliance Commercial |
$72.24
|
| Rate for Payer: United Healthcare Medicaid |
$18.66
|
| Rate for Payer: United Healthcare Medicare Advantage |
$18.06
|
| Rate for Payer: United Healthcare PPO |
$139.50
|
| Rate for Payer: WEA Trust Commercial |
$102.30
|
| Rate for Payer: Wellcare Medicare |
$18.06
|
| Rate for Payer: WMAP Medicaid |
$18.66
|
| Rate for Payer: WPS Commercial |
$137.77
|
|
|
Hemoglobin Electrophoresis Interpretation
|
Facility
|
IP
|
$186.00
|
|
|
Service Code
|
CPT 83021
|
| Hospital Charge Code |
2942911
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$91.14 |
| Max. Negotiated Rate |
$171.12 |
| Rate for Payer: Aetna Commercial |
$167.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$159.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$98.58
|
| Rate for Payer: Cash Price |
$55.80
|
| Rate for Payer: Cigna Commercial |
$171.12
|
| Rate for Payer: Health EOS Commercial |
$165.54
|
| Rate for Payer: HFN Commercial |
$171.12
|
| Rate for Payer: Multiplan Commercial |
$148.80
|
| Rate for Payer: NAPHCARE Commercial |
$111.60
|
| Rate for Payer: Preferred Network Access Commercial |
$171.12
|
| Rate for Payer: Quartz Beloit One Network |
$91.14
|
| Rate for Payer: Quartz Commercial |
$111.60
|
| Rate for Payer: WEA Trust Commercial |
$102.30
|
| Rate for Payer: WPS Commercial |
$137.77
|
|
|
Hemoglobin Fetal Qualitative
|
Facility
|
OP
|
$418.00
|
|
|
Service Code
|
CPT 83021
|
| Hospital Charge Code |
978119
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.06 |
| Max. Negotiated Rate |
$384.56 |
| Rate for Payer: Aetna Commercial |
$376.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$359.48
|
| Rate for Payer: Aetna Managed Medicare |
$18.06
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$67.72
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$31.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$29.98
|
| Rate for Payer: Anthem Medicaid |
$18.66
|
| Rate for Payer: Anthem Medicare Advantage |
$18.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$221.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$18.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$18.06
|
| Rate for Payer: Cash Price |
$125.40
|
| Rate for Payer: Cash Price |
$125.40
|
| Rate for Payer: Cigna Commercial |
$384.56
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$18.06
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$18.66
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$233.91
|
| Rate for Payer: Dean Health Medicaid |
$18.66
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$18.06
|
| Rate for Payer: Health EOS Commercial |
$372.02
|
| Rate for Payer: HFN Commercial |
$384.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$67.18
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$18.06
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$18.66
|
| Rate for Payer: Independent Care Health Plan Medicare |
$18.06
|
| Rate for Payer: Managed Health Services Medicaid |
$19.41
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$18.06
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$18.06
|
| Rate for Payer: Multiplan Commercial |
$334.40
|
| Rate for Payer: NAPHCARE Commercial |
$27.09
|
| Rate for Payer: Preferred Network Access Commercial |
$384.56
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$18.66
|
| Rate for Payer: Quartz Beloit One Network |
$204.82
|
| Rate for Payer: Quartz Commercial |
$271.70
|
| Rate for Payer: Quartz Medicare Advantage |
$18.06
|
| Rate for Payer: The Alliance Commercial |
$72.24
|
| Rate for Payer: United Healthcare Medicaid |
$18.66
|
| Rate for Payer: United Healthcare Medicare Advantage |
$18.06
|
| Rate for Payer: United Healthcare PPO |
$313.50
|
| Rate for Payer: WEA Trust Commercial |
$229.90
|
| Rate for Payer: Wellcare Medicare |
$18.06
|
| Rate for Payer: WMAP Medicaid |
$18.66
|
| Rate for Payer: WPS Commercial |
$309.61
|
|
