|
Hepatitis A Antibody Total w/ Reflex IgM
|
Facility
|
IP
|
$129.00
|
|
|
Service Code
|
CPT 86708
|
| Hospital Charge Code |
1039129
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$65.74 |
| Max. Negotiated Rate |
$123.43 |
| Rate for Payer: Aetna Commercial |
$120.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$115.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$71.10
|
| Rate for Payer: Cash Price |
$38.70
|
| Rate for Payer: Cigna Commercial |
$123.43
|
| Rate for Payer: Health EOS Commercial |
$119.40
|
| Rate for Payer: HFN Commercial |
$123.43
|
| Rate for Payer: Multiplan Commercial |
$107.33
|
| Rate for Payer: Preferred Network Access Commercial |
$123.43
|
| Rate for Payer: Quartz Beloit One Network |
$65.74
|
| Rate for Payer: Quartz Commercial |
$80.50
|
| Rate for Payer: WEA Trust Commercial |
$73.79
|
| Rate for Payer: WPS Commercial |
$99.37
|
|
|
Hepatitis A Antibody Total w/ Reflex IgM
|
Facility
|
OP
|
$129.00
|
|
|
Service Code
|
CPT 86708
|
| Hospital Charge Code |
1039129
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.89 |
| Max. Negotiated Rate |
$123.43 |
| Rate for Payer: Aetna Commercial |
$120.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$115.38
|
| Rate for Payer: Aetna Managed Medicare |
$12.89
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$48.32
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$22.55
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$21.39
|
| Rate for Payer: Anthem Medicare Advantage |
$12.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$71.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$12.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$12.89
|
| Rate for Payer: Cash Price |
$38.70
|
| Rate for Payer: Cash Price |
$38.70
|
| Rate for Payer: Cigna Commercial |
$123.43
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$12.89
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$75.08
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$12.89
|
| Rate for Payer: Health EOS Commercial |
$119.40
|
| Rate for Payer: HFN Commercial |
$123.43
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$47.93
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$12.89
|
| Rate for Payer: Independent Care Health Plan Medicare |
$12.89
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$12.89
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$12.89
|
| Rate for Payer: Multiplan Commercial |
$107.33
|
| Rate for Payer: NAPHCARE Commercial |
$19.33
|
| Rate for Payer: Preferred Network Access Commercial |
$123.43
|
| Rate for Payer: Quartz Beloit One Network |
$65.74
|
| Rate for Payer: Quartz Commercial |
$87.20
|
| Rate for Payer: Quartz Medicare Advantage |
$12.89
|
| Rate for Payer: The Alliance Commercial |
$51.54
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.89
|
| Rate for Payer: United Healthcare PPO |
$100.62
|
| Rate for Payer: WEA Trust Commercial |
$73.79
|
| Rate for Payer: Wellcare Medicare |
$12.89
|
| Rate for Payer: WPS Commercial |
$99.37
|
|
|
Hepatitis B by PCR Quantitative
|
Facility
|
OP
|
$563.00
|
|
|
Service Code
|
CPT 87517
|
| Hospital Charge Code |
977969
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$44.55 |
| Max. Negotiated Rate |
$538.68 |
| Rate for Payer: Aetna Commercial |
$526.97
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$503.55
|
| Rate for Payer: Aetna Managed Medicare |
$44.55
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$167.08
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$77.97
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$73.96
|
| Rate for Payer: Anthem Medicare Advantage |
$44.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$310.33
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$44.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$44.55
|
| Rate for Payer: Cash Price |
$168.90
|
| Rate for Payer: Cash Price |
$168.90
|
| Rate for Payer: Cigna Commercial |
$538.68
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$44.55
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$327.67
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$44.55
|
| Rate for Payer: Health EOS Commercial |
$521.11
|
| Rate for Payer: HFN Commercial |
$538.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$165.74
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$44.55
|
| Rate for Payer: Independent Care Health Plan Medicare |
$44.55
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$44.55
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$44.55
|
| Rate for Payer: Multiplan Commercial |
$468.42
|
| Rate for Payer: NAPHCARE Commercial |
$66.83
|
| Rate for Payer: Preferred Network Access Commercial |
$538.68
|
| Rate for Payer: Quartz Beloit One Network |
$286.90
|
| Rate for Payer: Quartz Commercial |
$380.59
|
| Rate for Payer: Quartz Medicare Advantage |
$44.55
|
| Rate for Payer: The Alliance Commercial |
$178.21
|
| Rate for Payer: United Healthcare Medicare Advantage |
$44.55
|
| Rate for Payer: United Healthcare PPO |
$439.14
|
| Rate for Payer: WEA Trust Commercial |
$322.04
|
| Rate for Payer: Wellcare Medicare |
$44.55
|
| Rate for Payer: WPS Commercial |
$433.68
|
|
|
Hepatitis B by PCR Quantitative
|
Facility
|
IP
|
$563.00
|
|
|
Service Code
|
CPT 87517
|
| Hospital Charge Code |
977969
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$286.90 |
| Max. Negotiated Rate |
$538.68 |
| Rate for Payer: Aetna Commercial |
$526.97
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$503.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$310.33
|
| Rate for Payer: Cash Price |
$168.90
|
| Rate for Payer: Cigna Commercial |
$538.68
|
| Rate for Payer: Health EOS Commercial |
$521.11
|
| Rate for Payer: HFN Commercial |
$538.68
|
| Rate for Payer: Multiplan Commercial |
$468.42
|
| Rate for Payer: Preferred Network Access Commercial |
$538.68
|
| Rate for Payer: Quartz Beloit One Network |
$286.90
|
| Rate for Payer: Quartz Commercial |
$351.31
|
| Rate for Payer: WEA Trust Commercial |
$322.04
|
| Rate for Payer: WPS Commercial |
$433.68
|
|
|
Hepatitis B by PCR Quantitative
|
Professional
|
Both
|
$563.00
|
|
|
Service Code
|
CPT 87517
|
| Hospital Charge Code |
977969
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$44.55 |
| Max. Negotiated Rate |
$556.24 |
| Rate for Payer: Aetna Commercial |
$556.24
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$503.55
|
| Rate for Payer: Aetna Managed Medicare |
$44.55
|
| Rate for Payer: Anthem Medicare Advantage |
$44.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$44.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$44.55
|
| Rate for Payer: Cash Price |
$168.90
|
| Rate for Payer: Cash Price |
$168.90
|
| Rate for Payer: Cigna Commercial |
$556.24
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$292.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$44.55
|
| Rate for Payer: Health EOS Commercial |
$532.82
|
| Rate for Payer: HFN Commercial |
$556.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$157.28
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$157.28
|
| Rate for Payer: Independent Care Health Plan Medicare |
$44.55
|
| Rate for Payer: Multiplan Commercial |
$468.42
|
| Rate for Payer: NAPHCARE Commercial |
$66.83
|
| Rate for Payer: Preferred Network Access Commercial |
$556.24
|
| Rate for Payer: Quartz Beloit One Network |
$257.63
|
| Rate for Payer: Quartz Commercial |
$333.75
|
| Rate for Payer: Quartz Medicare Advantage |
$44.55
|
| Rate for Payer: The Alliance Commercial |
$175.99
|
| Rate for Payer: United Healthcare Medicare Advantage |
$44.55
|
| Rate for Payer: WEA Trust Commercial |
$322.04
|
| Rate for Payer: WPS Commercial |
$196.04
|
|
|
Hepatitis B Core Antibody
|
Professional
|
Both
|
$191.00
|
|
|
Service Code
|
CPT 86704
|
| Hospital Charge Code |
633748
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.53 |
| Max. Negotiated Rate |
$188.71 |
| Rate for Payer: Aetna Commercial |
$188.71
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$170.83
|
| Rate for Payer: Aetna Managed Medicare |
$12.53
|
| Rate for Payer: Anthem Medicare Advantage |
$12.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$12.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$12.53
|
| Rate for Payer: Cash Price |
$57.30
|
| Rate for Payer: Cash Price |
$57.30
|
| Rate for Payer: Cigna Commercial |
$188.71
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$99.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12.53
|
| Rate for Payer: Health EOS Commercial |
$180.76
|
| Rate for Payer: HFN Commercial |
$188.71
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$44.24
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$44.24
|
| Rate for Payer: Independent Care Health Plan Medicare |
$12.53
|
| Rate for Payer: Multiplan Commercial |
$158.91
|
| Rate for Payer: NAPHCARE Commercial |
$18.80
|
| Rate for Payer: Preferred Network Access Commercial |
$188.71
|
| Rate for Payer: Quartz Beloit One Network |
$87.40
|
| Rate for Payer: Quartz Commercial |
$113.22
|
| Rate for Payer: Quartz Medicare Advantage |
$12.53
|
| Rate for Payer: The Alliance Commercial |
$49.50
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.53
|
| Rate for Payer: WEA Trust Commercial |
$109.25
|
| Rate for Payer: WPS Commercial |
$55.14
|
|
|
Hepatitis B Core Antibody
|
Facility
|
OP
|
$191.00
|
|
|
Service Code
|
CPT 86704
|
| Hospital Charge Code |
633748
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.53 |
| Max. Negotiated Rate |
$182.75 |
| Rate for Payer: Aetna Commercial |
$178.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$170.83
|
| Rate for Payer: Aetna Managed Medicare |
$12.53
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$46.99
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$21.93
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$20.80
|
| Rate for Payer: Anthem Medicare Advantage |
$12.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$105.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$12.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$12.53
|
| Rate for Payer: Cash Price |
$57.30
|
| Rate for Payer: Cash Price |
$57.30
|
| Rate for Payer: Cigna Commercial |
$182.75
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$12.53
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$111.16
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$12.53
|
| Rate for Payer: Health EOS Commercial |
$176.79
|
| Rate for Payer: HFN Commercial |
$182.75
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$46.62
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$12.53
|
| Rate for Payer: Independent Care Health Plan Medicare |
$12.53
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$12.53
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$12.53
|
| Rate for Payer: Multiplan Commercial |
$158.91
|
| Rate for Payer: NAPHCARE Commercial |
$18.80
|
| Rate for Payer: Preferred Network Access Commercial |
$182.75
|
| Rate for Payer: Quartz Beloit One Network |
$97.33
|
| Rate for Payer: Quartz Commercial |
$129.12
|
| Rate for Payer: Quartz Medicare Advantage |
$12.53
|
| Rate for Payer: The Alliance Commercial |
$50.13
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.53
|
| Rate for Payer: United Healthcare PPO |
$148.98
|
| Rate for Payer: WEA Trust Commercial |
$109.25
|
| Rate for Payer: Wellcare Medicare |
$12.53
|
| Rate for Payer: WPS Commercial |
$147.13
|
|
|
Hepatitis B Core Antibody
|
Facility
|
IP
|
$191.00
|
|
|
Service Code
|
CPT 86704
|
| Hospital Charge Code |
633748
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$97.33 |
| Max. Negotiated Rate |
$182.75 |
| Rate for Payer: Aetna Commercial |
$178.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$170.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$105.28
|
| Rate for Payer: Cash Price |
$57.30
|
| Rate for Payer: Cigna Commercial |
$182.75
|
| Rate for Payer: Health EOS Commercial |
$176.79
|
| Rate for Payer: HFN Commercial |
$182.75
|
| Rate for Payer: Multiplan Commercial |
$158.91
|
| Rate for Payer: Preferred Network Access Commercial |
$182.75
|
| Rate for Payer: Quartz Beloit One Network |
$97.33
|
| Rate for Payer: Quartz Commercial |
$119.18
|
| Rate for Payer: WEA Trust Commercial |
$109.25
|
| Rate for Payer: WPS Commercial |
$147.13
|
|
|
Hepatitis B Core Antibody IgM Acute Titer
|
Professional
|
Both
|
$205.00
|
|
|
Service Code
|
CPT 86705
|
| Hospital Charge Code |
633750
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.24 |
| Max. Negotiated Rate |
$202.54 |
| Rate for Payer: Aetna Commercial |
$202.54
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$183.35
|
| Rate for Payer: Aetna Managed Medicare |
$12.24
|
| Rate for Payer: Anthem Medicare Advantage |
$12.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$12.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$12.24
|
| Rate for Payer: Cash Price |
$61.50
|
| Rate for Payer: Cash Price |
$61.50
|
| Rate for Payer: Cigna Commercial |
$202.54
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$106.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12.24
|
| Rate for Payer: Health EOS Commercial |
$194.01
|
| Rate for Payer: HFN Commercial |
$202.54
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$43.21
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$43.21
|
| Rate for Payer: Independent Care Health Plan Medicare |
$12.24
|
| Rate for Payer: Multiplan Commercial |
$170.56
|
| Rate for Payer: NAPHCARE Commercial |
$18.36
|
| Rate for Payer: Preferred Network Access Commercial |
$202.54
|
| Rate for Payer: Quartz Beloit One Network |
$93.81
|
| Rate for Payer: Quartz Commercial |
$121.52
|
| Rate for Payer: Quartz Medicare Advantage |
$12.24
|
| Rate for Payer: The Alliance Commercial |
$48.35
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.24
|
| Rate for Payer: WEA Trust Commercial |
$117.26
|
| Rate for Payer: WPS Commercial |
$53.86
|
|
|
Hepatitis B Core Antibody IgM Acute Titer
|
Facility
|
IP
|
$205.00
|
|
|
Service Code
|
CPT 86705
|
| Hospital Charge Code |
633750
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$104.47 |
| Max. Negotiated Rate |
$196.14 |
| Rate for Payer: Aetna Commercial |
$191.88
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$183.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$113.00
|
| Rate for Payer: Cash Price |
$61.50
|
| Rate for Payer: Cigna Commercial |
$196.14
|
| Rate for Payer: Health EOS Commercial |
$189.75
|
| Rate for Payer: HFN Commercial |
$196.14
|
| Rate for Payer: Multiplan Commercial |
$170.56
|
| Rate for Payer: Preferred Network Access Commercial |
$196.14
|
| Rate for Payer: Quartz Beloit One Network |
$104.47
|
| Rate for Payer: Quartz Commercial |
$127.92
|
| Rate for Payer: WEA Trust Commercial |
$117.26
|
| Rate for Payer: WPS Commercial |
$157.91
|
|
|
Hepatitis B Core Antibody IgM Acute Titer
|
Facility
|
OP
|
$205.00
|
|
|
Service Code
|
CPT 86705
|
| Hospital Charge Code |
633750
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.24 |
| Max. Negotiated Rate |
$196.14 |
| Rate for Payer: Aetna Commercial |
$191.88
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$183.35
|
| Rate for Payer: Aetna Managed Medicare |
$12.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$45.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$21.42
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$20.32
|
| Rate for Payer: Anthem Medicare Advantage |
$12.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$113.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$12.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$12.24
|
| Rate for Payer: Cash Price |
$61.50
|
| Rate for Payer: Cash Price |
$61.50
|
| Rate for Payer: Cigna Commercial |
$196.14
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$12.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$119.31
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$12.24
|
| Rate for Payer: Health EOS Commercial |
$189.75
|
| Rate for Payer: HFN Commercial |
$196.14
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$45.54
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$12.24
|
| Rate for Payer: Independent Care Health Plan Medicare |
$12.24
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$12.24
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$12.24
|
| Rate for Payer: Multiplan Commercial |
$170.56
|
| Rate for Payer: NAPHCARE Commercial |
$18.36
|
| Rate for Payer: Preferred Network Access Commercial |
$196.14
|
| Rate for Payer: Quartz Beloit One Network |
$104.47
|
| Rate for Payer: Quartz Commercial |
$138.58
|
| Rate for Payer: Quartz Medicare Advantage |
$12.24
|
| Rate for Payer: The Alliance Commercial |
$48.96
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.24
|
| Rate for Payer: United Healthcare PPO |
$159.90
|
| Rate for Payer: WEA Trust Commercial |
$117.26
|
| Rate for Payer: Wellcare Medicare |
$12.24
|
| Rate for Payer: WPS Commercial |
$157.91
|
|
|
Hepatitis Be Antibody
|
Professional
|
Both
|
$186.00
|
|
|
Service Code
|
CPT 86707
|
| Hospital Charge Code |
633753
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.03 |
| 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 |
$12.03
|
| Rate for Payer: Anthem Medicare Advantage |
$12.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$12.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$12.03
|
| 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 |
$12.03
|
| Rate for Payer: Health EOS Commercial |
$176.03
|
| Rate for Payer: HFN Commercial |
$183.77
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$42.47
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$42.47
|
| Rate for Payer: Independent Care Health Plan Medicare |
$12.03
|
| Rate for Payer: Multiplan Commercial |
$154.75
|
| Rate for Payer: NAPHCARE Commercial |
$18.05
|
| 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 |
$12.03
|
| Rate for Payer: The Alliance Commercial |
$47.53
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.03
|
| Rate for Payer: WEA Trust Commercial |
$106.39
|
| Rate for Payer: WPS Commercial |
$52.94
|
|
|
Hepatitis Be Antibody
|
Facility
|
IP
|
$186.00
|
|
|
Service Code
|
CPT 86707
|
| Hospital Charge Code |
633753
|
|
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
|
|
|
Hepatitis Be Antibody
|
Facility
|
OP
|
$186.00
|
|
|
Service Code
|
CPT 86707
|
| Hospital Charge Code |
633753
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.03 |
| 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 |
$12.03
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$45.12
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$21.06
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$19.97
|
| Rate for Payer: Anthem Medicare Advantage |
$12.03
|
| 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 |
$12.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$12.03
|
| 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 |
$12.03
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$108.25
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$12.03
|
| Rate for Payer: Health EOS Commercial |
$172.16
|
| Rate for Payer: HFN Commercial |
$177.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$44.76
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$12.03
|
| Rate for Payer: Independent Care Health Plan Medicare |
$12.03
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$12.03
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$12.03
|
| Rate for Payer: Multiplan Commercial |
$154.75
|
| Rate for Payer: NAPHCARE Commercial |
$18.05
|
| 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 |
$12.03
|
| Rate for Payer: The Alliance Commercial |
$48.13
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.03
|
| Rate for Payer: United Healthcare PPO |
$145.08
|
| Rate for Payer: WEA Trust Commercial |
$106.39
|
| Rate for Payer: Wellcare Medicare |
$12.03
|
| Rate for Payer: WPS Commercial |
$143.28
|
|
|
Hepatitis Be Antigen
|
Professional
|
Both
|
$286.00
|
|
|
Service Code
|
CPT 87350
|
| Hospital Charge Code |
633754
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.99 |
| Max. Negotiated Rate |
$282.57 |
| Rate for Payer: Aetna Commercial |
$282.57
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$255.80
|
| Rate for Payer: Aetna Managed Medicare |
$11.99
|
| Rate for Payer: Anthem Medicare Advantage |
$11.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$11.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$11.99
|
| Rate for Payer: Cash Price |
$85.80
|
| Rate for Payer: Cash Price |
$85.80
|
| Rate for Payer: Cigna Commercial |
$282.57
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$148.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$11.99
|
| Rate for Payer: Health EOS Commercial |
$270.67
|
| Rate for Payer: HFN Commercial |
$282.57
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$42.33
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$42.33
|
| Rate for Payer: Independent Care Health Plan Medicare |
$11.99
|
| Rate for Payer: Multiplan Commercial |
$237.95
|
| Rate for Payer: NAPHCARE Commercial |
$17.99
|
| Rate for Payer: Preferred Network Access Commercial |
$282.57
|
| Rate for Payer: Quartz Beloit One Network |
$130.87
|
| Rate for Payer: Quartz Commercial |
$169.54
|
| Rate for Payer: Quartz Medicare Advantage |
$11.99
|
| Rate for Payer: The Alliance Commercial |
$47.37
|
| Rate for Payer: United Healthcare Medicare Advantage |
$11.99
|
| Rate for Payer: WEA Trust Commercial |
$163.59
|
| Rate for Payer: WPS Commercial |
$52.76
|
|
|
Hepatitis Be Antigen
|
Facility
|
IP
|
$286.00
|
|
|
Service Code
|
CPT 87350
|
| Hospital Charge Code |
633754
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$145.75 |
| Max. Negotiated Rate |
$273.64 |
| Rate for Payer: Aetna Commercial |
$267.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$255.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$157.64
|
| Rate for Payer: Cash Price |
$85.80
|
| Rate for Payer: Cigna Commercial |
$273.64
|
| Rate for Payer: Health EOS Commercial |
$264.72
|
| Rate for Payer: HFN Commercial |
$273.64
|
| Rate for Payer: Multiplan Commercial |
$237.95
|
| Rate for Payer: Preferred Network Access Commercial |
$273.64
|
| Rate for Payer: Quartz Beloit One Network |
$145.75
|
| Rate for Payer: Quartz Commercial |
$178.46
|
| Rate for Payer: WEA Trust Commercial |
$163.59
|
| Rate for Payer: WPS Commercial |
$220.31
|
|
|
Hepatitis Be Antigen
|
Facility
|
OP
|
$286.00
|
|
|
Service Code
|
CPT 87350
|
| Hospital Charge Code |
633754
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.99 |
| Max. Negotiated Rate |
$273.64 |
| Rate for Payer: Aetna Commercial |
$267.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$255.80
|
| Rate for Payer: Aetna Managed Medicare |
$11.99
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$44.97
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$20.98
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$19.91
|
| Rate for Payer: Anthem Medicare Advantage |
$11.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$157.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$11.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$11.99
|
| Rate for Payer: Cash Price |
$85.80
|
| Rate for Payer: Cash Price |
$85.80
|
| Rate for Payer: Cigna Commercial |
$273.64
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$11.99
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$166.45
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$11.99
|
| Rate for Payer: Health EOS Commercial |
$264.72
|
| Rate for Payer: HFN Commercial |
$273.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$44.61
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$11.99
|
| Rate for Payer: Independent Care Health Plan Medicare |
$11.99
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$11.99
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$11.99
|
| Rate for Payer: Multiplan Commercial |
$237.95
|
| Rate for Payer: NAPHCARE Commercial |
$17.99
|
| Rate for Payer: Preferred Network Access Commercial |
$273.64
|
| Rate for Payer: Quartz Beloit One Network |
$145.75
|
| Rate for Payer: Quartz Commercial |
$193.34
|
| Rate for Payer: Quartz Medicare Advantage |
$11.99
|
| Rate for Payer: The Alliance Commercial |
$47.96
|
| Rate for Payer: United Healthcare Medicare Advantage |
$11.99
|
| Rate for Payer: United Healthcare PPO |
$223.08
|
| Rate for Payer: WEA Trust Commercial |
$163.59
|
| Rate for Payer: Wellcare Medicare |
$11.99
|
| Rate for Payer: WPS Commercial |
$220.31
|
|
|
Hepatitis B Surface Antibody, Qualitative
|
Facility
|
OP
|
$204.00
|
|
|
Service Code
|
CPT 86706
|
| Hospital Charge Code |
1039133
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.17 |
| Max. Negotiated Rate |
$195.19 |
| Rate for Payer: Aetna Commercial |
$190.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$182.46
|
| Rate for Payer: Aetna Managed Medicare |
$11.17
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$41.89
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$19.55
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$18.54
|
| Rate for Payer: Anthem Medicare Advantage |
$11.17
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$112.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$11.17
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$11.17
|
| Rate for Payer: Cash Price |
$61.20
|
| Rate for Payer: Cash Price |
$61.20
|
| Rate for Payer: Cigna Commercial |
$195.19
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$11.17
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$118.73
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$11.17
|
| Rate for Payer: Health EOS Commercial |
$188.82
|
| Rate for Payer: HFN Commercial |
$195.19
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$41.55
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$11.17
|
| Rate for Payer: Independent Care Health Plan Medicare |
$11.17
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$11.17
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$11.17
|
| Rate for Payer: Multiplan Commercial |
$169.73
|
| Rate for Payer: NAPHCARE Commercial |
$16.75
|
| Rate for Payer: Preferred Network Access Commercial |
$195.19
|
| Rate for Payer: Quartz Beloit One Network |
$103.96
|
| Rate for Payer: Quartz Commercial |
$137.90
|
| Rate for Payer: Quartz Medicare Advantage |
$11.17
|
| Rate for Payer: The Alliance Commercial |
$44.68
|
| Rate for Payer: United Healthcare Medicare Advantage |
$11.17
|
| Rate for Payer: United Healthcare PPO |
$159.12
|
| Rate for Payer: WEA Trust Commercial |
$116.69
|
| Rate for Payer: Wellcare Medicare |
$11.17
|
| Rate for Payer: WPS Commercial |
$157.14
|
|
|
Hepatitis B Surface Antibody, Qualitative
|
Professional
|
Both
|
$204.00
|
|
|
Service Code
|
CPT 86706
|
| Hospital Charge Code |
1039133
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.17 |
| Max. Negotiated Rate |
$201.55 |
| Rate for Payer: Aetna Commercial |
$201.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$182.46
|
| Rate for Payer: Aetna Managed Medicare |
$11.17
|
| Rate for Payer: Anthem Medicare Advantage |
$11.17
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$11.17
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$11.17
|
| Rate for Payer: Cash Price |
$61.20
|
| Rate for Payer: Cash Price |
$61.20
|
| Rate for Payer: Cigna Commercial |
$201.55
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$106.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$11.17
|
| Rate for Payer: Health EOS Commercial |
$193.07
|
| Rate for Payer: HFN Commercial |
$201.55
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$39.43
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$39.43
|
| Rate for Payer: Independent Care Health Plan Medicare |
$11.17
|
| Rate for Payer: Multiplan Commercial |
$169.73
|
| Rate for Payer: NAPHCARE Commercial |
$16.75
|
| Rate for Payer: Preferred Network Access Commercial |
$201.55
|
| Rate for Payer: Quartz Beloit One Network |
$93.35
|
| Rate for Payer: Quartz Commercial |
$120.93
|
| Rate for Payer: Quartz Medicare Advantage |
$11.17
|
| Rate for Payer: The Alliance Commercial |
$44.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$11.17
|
| Rate for Payer: WEA Trust Commercial |
$116.69
|
| Rate for Payer: WPS Commercial |
$49.15
|
|
|
Hepatitis B Surface Antibody, Qualitative
|
Facility
|
IP
|
$204.00
|
|
|
Service Code
|
CPT 86706
|
| Hospital Charge Code |
1039133
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$103.96 |
| Max. Negotiated Rate |
$195.19 |
| Rate for Payer: Aetna Commercial |
$190.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$182.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$112.44
|
| Rate for Payer: Cash Price |
$61.20
|
| Rate for Payer: Cigna Commercial |
$195.19
|
| Rate for Payer: Health EOS Commercial |
$188.82
|
| Rate for Payer: HFN Commercial |
$195.19
|
| Rate for Payer: Multiplan Commercial |
$169.73
|
| Rate for Payer: Preferred Network Access Commercial |
$195.19
|
| Rate for Payer: Quartz Beloit One Network |
$103.96
|
| Rate for Payer: Quartz Commercial |
$127.30
|
| Rate for Payer: WEA Trust Commercial |
$116.69
|
| Rate for Payer: WPS Commercial |
$157.14
|
|
|
Hepatitis B Surface Antibody, Quantitative
|
Professional
|
Both
|
$204.00
|
|
|
Service Code
|
CPT 86317
|
| Hospital Charge Code |
1039134
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.59 |
| Max. Negotiated Rate |
$201.55 |
| Rate for Payer: Aetna Commercial |
$201.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$182.46
|
| Rate for Payer: Aetna Managed Medicare |
$15.59
|
| Rate for Payer: Anthem Medicare Advantage |
$15.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$15.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$15.59
|
| Rate for Payer: Cash Price |
$61.20
|
| Rate for Payer: Cash Price |
$61.20
|
| Rate for Payer: Cigna Commercial |
$201.55
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$106.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$15.59
|
| Rate for Payer: Health EOS Commercial |
$193.07
|
| Rate for Payer: HFN Commercial |
$201.55
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$55.03
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$55.03
|
| Rate for Payer: Independent Care Health Plan Medicare |
$15.59
|
| Rate for Payer: Multiplan Commercial |
$169.73
|
| Rate for Payer: NAPHCARE Commercial |
$23.38
|
| Rate for Payer: Preferred Network Access Commercial |
$201.55
|
| Rate for Payer: Quartz Beloit One Network |
$93.35
|
| Rate for Payer: Quartz Commercial |
$120.93
|
| Rate for Payer: Quartz Medicare Advantage |
$15.59
|
| Rate for Payer: The Alliance Commercial |
$61.58
|
| Rate for Payer: United Healthcare Medicare Advantage |
$15.59
|
| Rate for Payer: WEA Trust Commercial |
$116.69
|
| Rate for Payer: WPS Commercial |
$68.59
|
|
|
Hepatitis B Surface Antibody, Quantitative
|
Facility
|
OP
|
$204.00
|
|
|
Service Code
|
CPT 86317
|
| Hospital Charge Code |
1039134
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.59 |
| Max. Negotiated Rate |
$195.19 |
| Rate for Payer: Aetna Commercial |
$190.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$182.46
|
| Rate for Payer: Aetna Managed Medicare |
$15.59
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$58.46
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$27.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$25.88
|
| Rate for Payer: Anthem Medicare Advantage |
$15.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$112.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$15.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$15.59
|
| Rate for Payer: Cash Price |
$61.20
|
| Rate for Payer: Cash Price |
$61.20
|
| Rate for Payer: Cigna Commercial |
$195.19
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$15.59
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$118.73
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$15.59
|
| Rate for Payer: Health EOS Commercial |
$188.82
|
| Rate for Payer: HFN Commercial |
$195.19
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$57.99
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$15.59
|
| Rate for Payer: Independent Care Health Plan Medicare |
$15.59
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$15.59
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$15.59
|
| Rate for Payer: Multiplan Commercial |
$169.73
|
| Rate for Payer: NAPHCARE Commercial |
$23.38
|
| Rate for Payer: Preferred Network Access Commercial |
$195.19
|
| Rate for Payer: Quartz Beloit One Network |
$103.96
|
| Rate for Payer: Quartz Commercial |
$137.90
|
| Rate for Payer: Quartz Medicare Advantage |
$15.59
|
| Rate for Payer: The Alliance Commercial |
$62.36
|
| Rate for Payer: United Healthcare Medicare Advantage |
$15.59
|
| Rate for Payer: United Healthcare PPO |
$159.12
|
| Rate for Payer: WEA Trust Commercial |
$116.69
|
| Rate for Payer: Wellcare Medicare |
$15.59
|
| Rate for Payer: WPS Commercial |
$157.14
|
|
|
Hepatitis B Surface Antibody, Quantitative
|
Facility
|
IP
|
$204.00
|
|
|
Service Code
|
CPT 86317
|
| Hospital Charge Code |
1039134
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$103.96 |
| Max. Negotiated Rate |
$195.19 |
| Rate for Payer: Aetna Commercial |
$190.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$182.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$112.44
|
| Rate for Payer: Cash Price |
$61.20
|
| Rate for Payer: Cigna Commercial |
$195.19
|
| Rate for Payer: Health EOS Commercial |
$188.82
|
| Rate for Payer: HFN Commercial |
$195.19
|
| Rate for Payer: Multiplan Commercial |
$169.73
|
| Rate for Payer: Preferred Network Access Commercial |
$195.19
|
| Rate for Payer: Quartz Beloit One Network |
$103.96
|
| Rate for Payer: Quartz Commercial |
$127.30
|
| Rate for Payer: WEA Trust Commercial |
$116.69
|
| Rate for Payer: WPS Commercial |
$157.14
|
|
|
Hepatitis B Surface Antigen
|
Facility
|
OP
|
$161.00
|
|
|
Service Code
|
CPT 87340
|
| Hospital Charge Code |
633752
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.74 |
| Max. Negotiated Rate |
$154.04 |
| Rate for Payer: Aetna Commercial |
$150.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$144.00
|
| Rate for Payer: Aetna Managed Medicare |
$10.74
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$40.29
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$18.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$17.83
|
| Rate for Payer: Anthem Medicare Advantage |
$10.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$88.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$10.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$10.74
|
| Rate for Payer: Cash Price |
$48.30
|
| Rate for Payer: Cash Price |
$48.30
|
| Rate for Payer: Cigna Commercial |
$154.04
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$10.74
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$93.70
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$10.74
|
| Rate for Payer: Health EOS Commercial |
$149.02
|
| Rate for Payer: HFN Commercial |
$154.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$39.96
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$10.74
|
| Rate for Payer: Independent Care Health Plan Medicare |
$10.74
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$10.74
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$10.74
|
| Rate for Payer: Multiplan Commercial |
$133.95
|
| Rate for Payer: NAPHCARE Commercial |
$16.11
|
| Rate for Payer: Preferred Network Access Commercial |
$154.04
|
| Rate for Payer: Quartz Beloit One Network |
$82.05
|
| Rate for Payer: Quartz Commercial |
$108.84
|
| Rate for Payer: Quartz Medicare Advantage |
$10.74
|
| Rate for Payer: The Alliance Commercial |
$42.97
|
| Rate for Payer: United Healthcare Medicare Advantage |
$10.74
|
| Rate for Payer: United Healthcare PPO |
$125.58
|
| Rate for Payer: WEA Trust Commercial |
$92.09
|
| Rate for Payer: Wellcare Medicare |
$10.74
|
| Rate for Payer: WPS Commercial |
$124.02
|
|
|
Hepatitis B Surface Antigen
|
Facility
|
IP
|
$161.00
|
|
|
Service Code
|
CPT 87340
|
| Hospital Charge Code |
633752
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$82.05 |
| Max. Negotiated Rate |
$154.04 |
| Rate for Payer: Aetna Commercial |
$150.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$144.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$88.74
|
| Rate for Payer: Cash Price |
$48.30
|
| Rate for Payer: Cigna Commercial |
$154.04
|
| Rate for Payer: Health EOS Commercial |
$149.02
|
| Rate for Payer: HFN Commercial |
$154.04
|
| Rate for Payer: Multiplan Commercial |
$133.95
|
| Rate for Payer: Preferred Network Access Commercial |
$154.04
|
| Rate for Payer: Quartz Beloit One Network |
$82.05
|
| Rate for Payer: Quartz Commercial |
$100.46
|
| Rate for Payer: WEA Trust Commercial |
$92.09
|
| Rate for Payer: WPS Commercial |
$124.02
|
|
