|
Hepatitis B Surface Antigen
|
Professional
|
Both
|
$161.00
|
|
|
Service Code
|
CPT 87340
|
| Hospital Charge Code |
633752
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.74 |
| Max. Negotiated Rate |
$159.07 |
| Rate for Payer: Aetna Commercial |
$159.07
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$144.00
|
| Rate for Payer: Aetna Managed Medicare |
$10.74
|
| Rate for Payer: Anthem Medicare Advantage |
$10.74
|
| 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 |
$159.07
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$83.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$10.74
|
| Rate for Payer: Health EOS Commercial |
$152.37
|
| Rate for Payer: HFN Commercial |
$159.07
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$37.92
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$37.92
|
| Rate for Payer: Independent Care Health Plan Medicare |
$10.74
|
| Rate for Payer: Multiplan Commercial |
$133.95
|
| Rate for Payer: NAPHCARE Commercial |
$16.11
|
| Rate for Payer: Preferred Network Access Commercial |
$159.07
|
| Rate for Payer: Quartz Beloit One Network |
$73.67
|
| Rate for Payer: Quartz Commercial |
$95.44
|
| Rate for Payer: Quartz Medicare Advantage |
$10.74
|
| Rate for Payer: The Alliance Commercial |
$42.44
|
| Rate for Payer: United Healthcare Medicare Advantage |
$10.74
|
| Rate for Payer: WEA Trust Commercial |
$92.09
|
| Rate for Payer: WPS Commercial |
$47.27
|
|
|
Hepatitis B Surface Antigen, Qualitative
|
Professional
|
Both
|
$202.00
|
|
|
Service Code
|
CPT 87340
|
| Hospital Charge Code |
5372664
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.74 |
| Max. Negotiated Rate |
$199.58 |
| Rate for Payer: Aetna Commercial |
$199.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$180.67
|
| Rate for Payer: Aetna Managed Medicare |
$10.74
|
| Rate for Payer: Anthem Medicare Advantage |
$10.74
|
| 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 |
$60.60
|
| Rate for Payer: Cash Price |
$60.60
|
| Rate for Payer: Cigna Commercial |
$199.58
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$105.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$10.74
|
| Rate for Payer: Health EOS Commercial |
$191.17
|
| Rate for Payer: HFN Commercial |
$199.58
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$37.92
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$37.92
|
| Rate for Payer: Independent Care Health Plan Medicare |
$10.74
|
| Rate for Payer: Multiplan Commercial |
$168.06
|
| Rate for Payer: NAPHCARE Commercial |
$16.11
|
| Rate for Payer: Preferred Network Access Commercial |
$199.58
|
| Rate for Payer: Quartz Beloit One Network |
$92.44
|
| Rate for Payer: Quartz Commercial |
$119.75
|
| Rate for Payer: Quartz Medicare Advantage |
$10.74
|
| Rate for Payer: The Alliance Commercial |
$42.44
|
| Rate for Payer: United Healthcare Medicare Advantage |
$10.74
|
| Rate for Payer: WEA Trust Commercial |
$115.54
|
| Rate for Payer: WPS Commercial |
$47.27
|
|
|
Hepatitis B Surface Antigen, Qualitative
|
Facility
|
OP
|
$202.00
|
|
|
Service Code
|
CPT 87340
|
| Hospital Charge Code |
5372664
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.74 |
| Max. Negotiated Rate |
$193.27 |
| Rate for Payer: Aetna Commercial |
$189.07
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$180.67
|
| 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 |
$111.34
|
| 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 |
$60.60
|
| Rate for Payer: Cash Price |
$60.60
|
| Rate for Payer: Cigna Commercial |
$193.27
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$10.74
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$117.56
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$10.74
|
| Rate for Payer: Health EOS Commercial |
$186.97
|
| Rate for Payer: HFN Commercial |
$193.27
|
| 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 |
$168.06
|
| Rate for Payer: NAPHCARE Commercial |
$16.11
|
| Rate for Payer: Preferred Network Access Commercial |
$193.27
|
| Rate for Payer: Quartz Beloit One Network |
$102.94
|
| Rate for Payer: Quartz Commercial |
$136.55
|
| 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 |
$157.56
|
| Rate for Payer: WEA Trust Commercial |
$115.54
|
| Rate for Payer: Wellcare Medicare |
$10.74
|
| Rate for Payer: WPS Commercial |
$155.60
|
|
|
Hepatitis B Surface Antigen, Qualitative
|
Facility
|
IP
|
$202.00
|
|
|
Service Code
|
CPT 87340
|
| Hospital Charge Code |
5372664
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$102.94 |
| Max. Negotiated Rate |
$193.27 |
| Rate for Payer: Aetna Commercial |
$189.07
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$180.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$111.34
|
| Rate for Payer: Cash Price |
$60.60
|
| Rate for Payer: Cigna Commercial |
$193.27
|
| Rate for Payer: Health EOS Commercial |
$186.97
|
| Rate for Payer: HFN Commercial |
$193.27
|
| Rate for Payer: Multiplan Commercial |
$168.06
|
| Rate for Payer: Preferred Network Access Commercial |
$193.27
|
| Rate for Payer: Quartz Beloit One Network |
$102.94
|
| Rate for Payer: Quartz Commercial |
$126.05
|
| Rate for Payer: WEA Trust Commercial |
$115.54
|
| Rate for Payer: WPS Commercial |
$155.60
|
|
|
Hepatitis B Virus DNA, Quant PCR w/ Reflex HBV Genotype
|
Professional
|
Both
|
$543.00
|
|
|
Service Code
|
CPT 87517
|
| Hospital Charge Code |
3256230
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$44.55 |
| Max. Negotiated Rate |
$536.48 |
| Rate for Payer: Aetna Commercial |
$536.48
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$485.66
|
| 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 |
$162.90
|
| Rate for Payer: Cash Price |
$162.90
|
| Rate for Payer: Cigna Commercial |
$536.48
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$282.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$44.55
|
| Rate for Payer: Health EOS Commercial |
$513.90
|
| Rate for Payer: HFN Commercial |
$536.48
|
| 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 |
$451.78
|
| Rate for Payer: NAPHCARE Commercial |
$66.83
|
| Rate for Payer: Preferred Network Access Commercial |
$536.48
|
| Rate for Payer: Quartz Beloit One Network |
$248.48
|
| Rate for Payer: Quartz Commercial |
$321.89
|
| 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 |
$310.60
|
| Rate for Payer: WPS Commercial |
$196.04
|
|
|
Hepatitis B Virus DNA, Quant PCR w/ Reflex HBV Genotype
|
Facility
|
IP
|
$543.00
|
|
|
Service Code
|
CPT 87517
|
| Hospital Charge Code |
3256230
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$276.71 |
| Max. Negotiated Rate |
$519.54 |
| Rate for Payer: Aetna Commercial |
$508.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$485.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$299.30
|
| Rate for Payer: Cash Price |
$162.90
|
| Rate for Payer: Cigna Commercial |
$519.54
|
| Rate for Payer: Health EOS Commercial |
$502.60
|
| Rate for Payer: HFN Commercial |
$519.54
|
| Rate for Payer: Multiplan Commercial |
$451.78
|
| Rate for Payer: Preferred Network Access Commercial |
$519.54
|
| Rate for Payer: Quartz Beloit One Network |
$276.71
|
| Rate for Payer: Quartz Commercial |
$338.83
|
| Rate for Payer: WEA Trust Commercial |
$310.60
|
| Rate for Payer: WPS Commercial |
$418.27
|
|
|
Hepatitis B Virus DNA, Quant PCR w/ Reflex HBV Genotype
|
Facility
|
OP
|
$543.00
|
|
|
Service Code
|
CPT 87517
|
| Hospital Charge Code |
3256230
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$44.55 |
| Max. Negotiated Rate |
$519.54 |
| Rate for Payer: Aetna Commercial |
$508.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$485.66
|
| 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 |
$299.30
|
| 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 |
$162.90
|
| Rate for Payer: Cash Price |
$162.90
|
| Rate for Payer: Cigna Commercial |
$519.54
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$44.55
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$316.03
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$44.55
|
| Rate for Payer: Health EOS Commercial |
$502.60
|
| Rate for Payer: HFN Commercial |
$519.54
|
| 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 |
$451.78
|
| Rate for Payer: NAPHCARE Commercial |
$66.83
|
| Rate for Payer: Preferred Network Access Commercial |
$519.54
|
| Rate for Payer: Quartz Beloit One Network |
$276.71
|
| Rate for Payer: Quartz Commercial |
$367.07
|
| 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 |
$423.54
|
| Rate for Payer: WEA Trust Commercial |
$310.60
|
| Rate for Payer: Wellcare Medicare |
$44.55
|
| Rate for Payer: WPS Commercial |
$418.27
|
|
|
Hepatitis B Virus Drug Resistance, Genotype & BCP/Precore Mutations
|
Professional
|
Both
|
$704.00
|
|
|
Service Code
|
CPT 87912
|
| Hospital Charge Code |
4966608
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$267.75 |
| Max. Negotiated Rate |
$1,178.09 |
| Rate for Payer: Aetna Commercial |
$695.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$629.66
|
| Rate for Payer: Aetna Managed Medicare |
$267.75
|
| Rate for Payer: Anthem Medicare Advantage |
$267.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$267.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$267.75
|
| Rate for Payer: Cash Price |
$211.20
|
| Rate for Payer: Cash Price |
$211.20
|
| Rate for Payer: Cigna Commercial |
$695.55
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$366.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$267.75
|
| Rate for Payer: Health EOS Commercial |
$666.27
|
| Rate for Payer: HFN Commercial |
$695.55
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$945.15
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$945.15
|
| Rate for Payer: Independent Care Health Plan Medicare |
$267.75
|
| Rate for Payer: Multiplan Commercial |
$585.73
|
| Rate for Payer: NAPHCARE Commercial |
$401.62
|
| Rate for Payer: Preferred Network Access Commercial |
$695.55
|
| Rate for Payer: Quartz Beloit One Network |
$322.15
|
| Rate for Payer: Quartz Commercial |
$417.33
|
| Rate for Payer: Quartz Medicare Advantage |
$267.75
|
| Rate for Payer: The Alliance Commercial |
$1,057.60
|
| Rate for Payer: United Healthcare Medicare Advantage |
$267.75
|
| Rate for Payer: WEA Trust Commercial |
$402.69
|
| Rate for Payer: WPS Commercial |
$1,178.09
|
|
|
Hepatitis B Virus Drug Resistance, Genotype & BCP/Precore Mutations
|
Facility
|
OP
|
$704.00
|
|
|
Service Code
|
CPT 87912
|
| Hospital Charge Code |
4966608
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$267.75 |
| Max. Negotiated Rate |
$1,070.99 |
| Rate for Payer: Aetna Commercial |
$658.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$629.66
|
| Rate for Payer: Aetna Managed Medicare |
$267.75
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,004.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$468.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$444.46
|
| Rate for Payer: Anthem Medicare Advantage |
$267.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$388.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$267.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$267.75
|
| Rate for Payer: Cash Price |
$211.20
|
| Rate for Payer: Cash Price |
$211.20
|
| Rate for Payer: Cigna Commercial |
$673.59
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$267.75
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$409.73
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$267.75
|
| Rate for Payer: Health EOS Commercial |
$651.62
|
| Rate for Payer: HFN Commercial |
$673.59
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$996.02
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$267.75
|
| Rate for Payer: Independent Care Health Plan Medicare |
$267.75
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$267.75
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$267.75
|
| Rate for Payer: Multiplan Commercial |
$585.73
|
| Rate for Payer: NAPHCARE Commercial |
$401.62
|
| Rate for Payer: Preferred Network Access Commercial |
$673.59
|
| Rate for Payer: Quartz Beloit One Network |
$358.76
|
| Rate for Payer: Quartz Commercial |
$475.90
|
| Rate for Payer: Quartz Medicare Advantage |
$267.75
|
| Rate for Payer: The Alliance Commercial |
$1,070.99
|
| Rate for Payer: United Healthcare Medicare Advantage |
$267.75
|
| Rate for Payer: United Healthcare PPO |
$549.12
|
| Rate for Payer: WEA Trust Commercial |
$402.69
|
| Rate for Payer: Wellcare Medicare |
$267.75
|
| Rate for Payer: WPS Commercial |
$542.29
|
|
|
Hepatitis B Virus Drug Resistance, Genotype & BCP/Precore Mutations
|
Facility
|
IP
|
$704.00
|
|
|
Service Code
|
CPT 87912
|
| Hospital Charge Code |
4966608
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$358.76 |
| Max. Negotiated Rate |
$673.59 |
| Rate for Payer: Aetna Commercial |
$658.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$629.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$388.04
|
| Rate for Payer: Cash Price |
$211.20
|
| Rate for Payer: Cigna Commercial |
$673.59
|
| Rate for Payer: Health EOS Commercial |
$651.62
|
| Rate for Payer: HFN Commercial |
$673.59
|
| Rate for Payer: Multiplan Commercial |
$585.73
|
| Rate for Payer: Preferred Network Access Commercial |
$673.59
|
| Rate for Payer: Quartz Beloit One Network |
$358.76
|
| Rate for Payer: Quartz Commercial |
$439.30
|
| Rate for Payer: WEA Trust Commercial |
$402.69
|
| Rate for Payer: WPS Commercial |
$542.29
|
|
|
Hepatitis C Ab w/Rfx Viral Load Confirm
|
Facility
|
OP
|
$337.00
|
|
|
Service Code
|
CPT 86803
|
| Hospital Charge Code |
5372666
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.84 |
| Max. Negotiated Rate |
$322.44 |
| Rate for Payer: Aetna Commercial |
$315.43
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$301.41
|
| Rate for Payer: Aetna Managed Medicare |
$14.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$55.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$25.97
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$24.64
|
| Rate for Payer: Anthem Medicare Advantage |
$14.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$185.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$14.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$14.84
|
| Rate for Payer: Cash Price |
$101.10
|
| Rate for Payer: Cash Price |
$101.10
|
| Rate for Payer: Cigna Commercial |
$322.44
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$14.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$196.13
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$14.84
|
| Rate for Payer: Health EOS Commercial |
$311.93
|
| Rate for Payer: HFN Commercial |
$322.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$55.21
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$14.84
|
| Rate for Payer: Independent Care Health Plan Medicare |
$14.84
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$14.84
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$14.84
|
| Rate for Payer: Multiplan Commercial |
$280.38
|
| Rate for Payer: NAPHCARE Commercial |
$22.26
|
| Rate for Payer: Preferred Network Access Commercial |
$322.44
|
| Rate for Payer: Quartz Beloit One Network |
$171.74
|
| Rate for Payer: Quartz Commercial |
$227.81
|
| Rate for Payer: Quartz Medicare Advantage |
$14.84
|
| Rate for Payer: The Alliance Commercial |
$59.36
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14.84
|
| Rate for Payer: United Healthcare PPO |
$262.86
|
| Rate for Payer: WEA Trust Commercial |
$192.76
|
| Rate for Payer: Wellcare Medicare |
$14.84
|
| Rate for Payer: WPS Commercial |
$259.59
|
|
|
Hepatitis C Ab w/Rfx Viral Load Confirm
|
Facility
|
IP
|
$337.00
|
|
|
Service Code
|
CPT 86803
|
| Hospital Charge Code |
5372666
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$171.74 |
| Max. Negotiated Rate |
$322.44 |
| Rate for Payer: Aetna Commercial |
$315.43
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$301.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$185.75
|
| Rate for Payer: Cash Price |
$101.10
|
| Rate for Payer: Cigna Commercial |
$322.44
|
| Rate for Payer: Health EOS Commercial |
$311.93
|
| Rate for Payer: HFN Commercial |
$322.44
|
| Rate for Payer: Multiplan Commercial |
$280.38
|
| Rate for Payer: Preferred Network Access Commercial |
$322.44
|
| Rate for Payer: Quartz Beloit One Network |
$171.74
|
| Rate for Payer: Quartz Commercial |
$210.29
|
| Rate for Payer: WEA Trust Commercial |
$192.76
|
| Rate for Payer: WPS Commercial |
$259.59
|
|
|
Hepatitis C Ab w/Rfx Viral Load Confirm
|
Professional
|
Both
|
$337.00
|
|
|
Service Code
|
CPT 86803
|
| Hospital Charge Code |
5372666
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.84 |
| Max. Negotiated Rate |
$332.96 |
| Rate for Payer: Aetna Commercial |
$332.96
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$301.41
|
| Rate for Payer: Aetna Managed Medicare |
$14.84
|
| Rate for Payer: Anthem Medicare Advantage |
$14.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$14.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$14.84
|
| Rate for Payer: Cash Price |
$101.10
|
| Rate for Payer: Cash Price |
$101.10
|
| Rate for Payer: Cigna Commercial |
$332.96
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$175.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$14.84
|
| Rate for Payer: Health EOS Commercial |
$318.94
|
| Rate for Payer: HFN Commercial |
$332.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$52.38
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$52.38
|
| Rate for Payer: Independent Care Health Plan Medicare |
$14.84
|
| Rate for Payer: Multiplan Commercial |
$280.38
|
| Rate for Payer: NAPHCARE Commercial |
$22.26
|
| Rate for Payer: Preferred Network Access Commercial |
$332.96
|
| Rate for Payer: Quartz Beloit One Network |
$154.21
|
| Rate for Payer: Quartz Commercial |
$199.77
|
| Rate for Payer: Quartz Medicare Advantage |
$14.84
|
| Rate for Payer: The Alliance Commercial |
$58.62
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14.84
|
| Rate for Payer: WEA Trust Commercial |
$192.76
|
| Rate for Payer: WPS Commercial |
$65.30
|
|
|
Hepatitis C Antibody, Qualitative
|
Facility
|
OP
|
$337.00
|
|
|
Service Code
|
CPT 86803
|
| Hospital Charge Code |
5372665
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.84 |
| Max. Negotiated Rate |
$322.44 |
| Rate for Payer: Aetna Commercial |
$315.43
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$301.41
|
| Rate for Payer: Aetna Managed Medicare |
$14.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$55.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$25.97
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$24.64
|
| Rate for Payer: Anthem Medicare Advantage |
$14.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$185.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$14.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$14.84
|
| Rate for Payer: Cash Price |
$101.10
|
| Rate for Payer: Cash Price |
$101.10
|
| Rate for Payer: Cigna Commercial |
$322.44
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$14.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$196.13
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$14.84
|
| Rate for Payer: Health EOS Commercial |
$311.93
|
| Rate for Payer: HFN Commercial |
$322.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$55.21
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$14.84
|
| Rate for Payer: Independent Care Health Plan Medicare |
$14.84
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$14.84
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$14.84
|
| Rate for Payer: Multiplan Commercial |
$280.38
|
| Rate for Payer: NAPHCARE Commercial |
$22.26
|
| Rate for Payer: Preferred Network Access Commercial |
$322.44
|
| Rate for Payer: Quartz Beloit One Network |
$171.74
|
| Rate for Payer: Quartz Commercial |
$227.81
|
| Rate for Payer: Quartz Medicare Advantage |
$14.84
|
| Rate for Payer: The Alliance Commercial |
$59.36
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14.84
|
| Rate for Payer: United Healthcare PPO |
$262.86
|
| Rate for Payer: WEA Trust Commercial |
$192.76
|
| Rate for Payer: Wellcare Medicare |
$14.84
|
| Rate for Payer: WPS Commercial |
$259.59
|
|
|
Hepatitis C Antibody, Qualitative
|
Professional
|
Both
|
$337.00
|
|
|
Service Code
|
CPT 86803
|
| Hospital Charge Code |
5372665
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.84 |
| Max. Negotiated Rate |
$332.96 |
| Rate for Payer: Aetna Commercial |
$332.96
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$301.41
|
| Rate for Payer: Aetna Managed Medicare |
$14.84
|
| Rate for Payer: Anthem Medicare Advantage |
$14.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$14.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$14.84
|
| Rate for Payer: Cash Price |
$101.10
|
| Rate for Payer: Cash Price |
$101.10
|
| Rate for Payer: Cigna Commercial |
$332.96
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$175.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$14.84
|
| Rate for Payer: Health EOS Commercial |
$318.94
|
| Rate for Payer: HFN Commercial |
$332.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$52.38
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$52.38
|
| Rate for Payer: Independent Care Health Plan Medicare |
$14.84
|
| Rate for Payer: Multiplan Commercial |
$280.38
|
| Rate for Payer: NAPHCARE Commercial |
$22.26
|
| Rate for Payer: Preferred Network Access Commercial |
$332.96
|
| Rate for Payer: Quartz Beloit One Network |
$154.21
|
| Rate for Payer: Quartz Commercial |
$199.77
|
| Rate for Payer: Quartz Medicare Advantage |
$14.84
|
| Rate for Payer: The Alliance Commercial |
$58.62
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14.84
|
| Rate for Payer: WEA Trust Commercial |
$192.76
|
| Rate for Payer: WPS Commercial |
$65.30
|
|
|
Hepatitis C Antibody, Qualitative
|
Facility
|
IP
|
$337.00
|
|
|
Service Code
|
CPT 86803
|
| Hospital Charge Code |
5372665
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$171.74 |
| Max. Negotiated Rate |
$322.44 |
| Rate for Payer: Aetna Commercial |
$315.43
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$301.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$185.75
|
| Rate for Payer: Cash Price |
$101.10
|
| Rate for Payer: Cigna Commercial |
$322.44
|
| Rate for Payer: Health EOS Commercial |
$311.93
|
| Rate for Payer: HFN Commercial |
$322.44
|
| Rate for Payer: Multiplan Commercial |
$280.38
|
| Rate for Payer: Preferred Network Access Commercial |
$322.44
|
| Rate for Payer: Quartz Beloit One Network |
$171.74
|
| Rate for Payer: Quartz Commercial |
$210.29
|
| Rate for Payer: WEA Trust Commercial |
$192.76
|
| Rate for Payer: WPS Commercial |
$259.59
|
|
|
Hepatitis C Genotype 3 NS5a Drug Resistance
|
Professional
|
Both
|
$2,434.00
|
|
|
Service Code
|
CPT 87902
|
| Hospital Charge Code |
5598601
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$267.75 |
| Max. Negotiated Rate |
$2,404.79 |
| Rate for Payer: Aetna Commercial |
$2,404.79
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,176.97
|
| Rate for Payer: Aetna Managed Medicare |
$267.75
|
| Rate for Payer: Anthem Medicare Advantage |
$267.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$267.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$267.75
|
| Rate for Payer: Cash Price |
$730.20
|
| Rate for Payer: Cash Price |
$730.20
|
| Rate for Payer: Cigna Commercial |
$2,404.79
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,265.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$267.75
|
| Rate for Payer: Health EOS Commercial |
$2,303.54
|
| Rate for Payer: HFN Commercial |
$2,404.79
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$945.15
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$945.15
|
| Rate for Payer: Independent Care Health Plan Medicare |
$267.75
|
| Rate for Payer: Multiplan Commercial |
$2,025.09
|
| Rate for Payer: NAPHCARE Commercial |
$401.62
|
| Rate for Payer: Preferred Network Access Commercial |
$2,404.79
|
| Rate for Payer: Quartz Beloit One Network |
$1,113.80
|
| Rate for Payer: Quartz Commercial |
$1,442.88
|
| Rate for Payer: Quartz Medicare Advantage |
$267.75
|
| Rate for Payer: The Alliance Commercial |
$1,057.60
|
| Rate for Payer: United Healthcare Medicare Advantage |
$267.75
|
| Rate for Payer: WEA Trust Commercial |
$1,392.25
|
| Rate for Payer: WPS Commercial |
$1,178.09
|
|
|
Hepatitis C Genotype 3 NS5a Drug Resistance
|
Facility
|
OP
|
$2,434.00
|
|
|
Service Code
|
CPT 87902
|
| Hospital Charge Code |
5598601
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$267.75 |
| Max. Negotiated Rate |
$2,328.85 |
| Rate for Payer: Aetna Commercial |
$2,278.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,176.97
|
| Rate for Payer: Aetna Managed Medicare |
$267.75
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,004.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$468.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$444.46
|
| Rate for Payer: Anthem Medicare Advantage |
$267.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,341.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$267.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$267.75
|
| Rate for Payer: Cash Price |
$730.20
|
| Rate for Payer: Cash Price |
$730.20
|
| Rate for Payer: Cigna Commercial |
$2,328.85
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$267.75
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,416.59
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$267.75
|
| Rate for Payer: Health EOS Commercial |
$2,252.91
|
| Rate for Payer: HFN Commercial |
$2,328.85
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$996.02
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$267.75
|
| Rate for Payer: Independent Care Health Plan Medicare |
$267.75
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$267.75
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$267.75
|
| Rate for Payer: Multiplan Commercial |
$2,025.09
|
| Rate for Payer: NAPHCARE Commercial |
$401.62
|
| Rate for Payer: Preferred Network Access Commercial |
$2,328.85
|
| Rate for Payer: Quartz Beloit One Network |
$1,240.37
|
| Rate for Payer: Quartz Commercial |
$1,645.38
|
| Rate for Payer: Quartz Medicare Advantage |
$267.75
|
| Rate for Payer: The Alliance Commercial |
$1,070.99
|
| Rate for Payer: United Healthcare Medicare Advantage |
$267.75
|
| Rate for Payer: United Healthcare PPO |
$1,898.52
|
| Rate for Payer: WEA Trust Commercial |
$1,392.25
|
| Rate for Payer: Wellcare Medicare |
$267.75
|
| Rate for Payer: WPS Commercial |
$1,874.91
|
|
|
Hepatitis C Genotype 3 NS5a Drug Resistance
|
Facility
|
IP
|
$2,434.00
|
|
|
Service Code
|
CPT 87902
|
| Hospital Charge Code |
5598601
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$1,240.37 |
| Max. Negotiated Rate |
$2,328.85 |
| Rate for Payer: Aetna Commercial |
$2,278.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,176.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,341.62
|
| Rate for Payer: Cash Price |
$730.20
|
| Rate for Payer: Cigna Commercial |
$2,328.85
|
| Rate for Payer: Health EOS Commercial |
$2,252.91
|
| Rate for Payer: HFN Commercial |
$2,328.85
|
| Rate for Payer: Multiplan Commercial |
$2,025.09
|
| Rate for Payer: Preferred Network Access Commercial |
$2,328.85
|
| Rate for Payer: Quartz Beloit One Network |
$1,240.37
|
| Rate for Payer: Quartz Commercial |
$1,518.82
|
| Rate for Payer: WEA Trust Commercial |
$1,392.25
|
| Rate for Payer: WPS Commercial |
$1,874.91
|
|
|
Hepatitis C Genotyping
|
Facility
|
OP
|
$1,519.00
|
|
|
Service Code
|
CPT 87902
|
| Hospital Charge Code |
977970
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$267.75 |
| Max. Negotiated Rate |
$1,453.38 |
| Rate for Payer: Aetna Commercial |
$1,421.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,358.59
|
| Rate for Payer: Aetna Managed Medicare |
$267.75
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,004.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$468.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$444.46
|
| Rate for Payer: Anthem Medicare Advantage |
$267.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$837.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$267.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$267.75
|
| Rate for Payer: Cash Price |
$455.70
|
| Rate for Payer: Cash Price |
$455.70
|
| Rate for Payer: Cigna Commercial |
$1,453.38
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$267.75
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$884.06
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$267.75
|
| Rate for Payer: Health EOS Commercial |
$1,405.99
|
| Rate for Payer: HFN Commercial |
$1,453.38
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$996.02
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$267.75
|
| Rate for Payer: Independent Care Health Plan Medicare |
$267.75
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$267.75
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$267.75
|
| Rate for Payer: Multiplan Commercial |
$1,263.81
|
| Rate for Payer: NAPHCARE Commercial |
$401.62
|
| Rate for Payer: Preferred Network Access Commercial |
$1,453.38
|
| Rate for Payer: Quartz Beloit One Network |
$774.08
|
| Rate for Payer: Quartz Commercial |
$1,026.84
|
| Rate for Payer: Quartz Medicare Advantage |
$267.75
|
| Rate for Payer: The Alliance Commercial |
$1,070.99
|
| Rate for Payer: United Healthcare Medicare Advantage |
$267.75
|
| Rate for Payer: United Healthcare PPO |
$1,184.82
|
| Rate for Payer: WEA Trust Commercial |
$868.87
|
| Rate for Payer: Wellcare Medicare |
$267.75
|
| Rate for Payer: WPS Commercial |
$1,170.09
|
|
|
Hepatitis C Genotyping
|
Facility
|
IP
|
$1,519.00
|
|
|
Service Code
|
CPT 87902
|
| Hospital Charge Code |
977970
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$774.08 |
| Max. Negotiated Rate |
$1,453.38 |
| Rate for Payer: Aetna Commercial |
$1,421.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,358.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$837.27
|
| Rate for Payer: Cash Price |
$455.70
|
| Rate for Payer: Cigna Commercial |
$1,453.38
|
| Rate for Payer: Health EOS Commercial |
$1,405.99
|
| Rate for Payer: HFN Commercial |
$1,453.38
|
| Rate for Payer: Multiplan Commercial |
$1,263.81
|
| Rate for Payer: Preferred Network Access Commercial |
$1,453.38
|
| Rate for Payer: Quartz Beloit One Network |
$774.08
|
| Rate for Payer: Quartz Commercial |
$947.86
|
| Rate for Payer: WEA Trust Commercial |
$868.87
|
| Rate for Payer: WPS Commercial |
$1,170.09
|
|
|
Hepatitis C Genotyping
|
Professional
|
Both
|
$1,519.00
|
|
|
Service Code
|
CPT 87902
|
| Hospital Charge Code |
977970
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$267.75 |
| Max. Negotiated Rate |
$1,500.77 |
| Rate for Payer: Aetna Commercial |
$1,500.77
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,358.59
|
| Rate for Payer: Aetna Managed Medicare |
$267.75
|
| Rate for Payer: Anthem Medicare Advantage |
$267.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$267.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$267.75
|
| Rate for Payer: Cash Price |
$455.70
|
| Rate for Payer: Cash Price |
$455.70
|
| Rate for Payer: Cigna Commercial |
$1,500.77
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$789.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$267.75
|
| Rate for Payer: Health EOS Commercial |
$1,437.58
|
| Rate for Payer: HFN Commercial |
$1,500.77
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$945.15
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$945.15
|
| Rate for Payer: Independent Care Health Plan Medicare |
$267.75
|
| Rate for Payer: Multiplan Commercial |
$1,263.81
|
| Rate for Payer: NAPHCARE Commercial |
$401.62
|
| Rate for Payer: Preferred Network Access Commercial |
$1,500.77
|
| Rate for Payer: Quartz Beloit One Network |
$695.09
|
| Rate for Payer: Quartz Commercial |
$900.46
|
| Rate for Payer: Quartz Medicare Advantage |
$267.75
|
| Rate for Payer: The Alliance Commercial |
$1,057.60
|
| Rate for Payer: United Healthcare Medicare Advantage |
$267.75
|
| Rate for Payer: WEA Trust Commercial |
$868.87
|
| Rate for Payer: WPS Commercial |
$1,178.09
|
|
|
Hepatitis C Qnt PCR w/rfx Genotype LiPA
|
Facility
|
OP
|
$105.00
|
|
|
Service Code
|
CPT 87522
|
| Hospital Charge Code |
6224257
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$44.55 |
| Max. Negotiated Rate |
$178.21 |
| Rate for Payer: Aetna Commercial |
$98.28
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$93.91
|
| 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 |
$57.88
|
| 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 |
$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 |
$44.55
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$61.11
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$44.55
|
| Rate for Payer: Health EOS Commercial |
$97.19
|
| Rate for Payer: HFN Commercial |
$100.46
|
| 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 |
$87.36
|
| Rate for Payer: NAPHCARE Commercial |
$66.83
|
| 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 |
$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 |
$81.90
|
| Rate for Payer: WEA Trust Commercial |
$60.06
|
| Rate for Payer: Wellcare Medicare |
$44.55
|
| Rate for Payer: WPS Commercial |
$80.88
|
|
|
Hepatitis C Qnt PCR w/rfx Genotype LiPA
|
Facility
|
IP
|
$105.00
|
|
|
Service Code
|
CPT 87522
|
| Hospital Charge Code |
6224257
|
|
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
|
|
|
Hepatitis C RNA by PCR Quantitiative
|
Professional
|
Both
|
$542.00
|
|
|
Service Code
|
CPT 87522
|
| Hospital Charge Code |
2942912
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$44.55 |
| Max. Negotiated Rate |
$535.50 |
| Rate for Payer: Aetna Commercial |
$535.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$484.76
|
| 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 |
$162.60
|
| Rate for Payer: Cash Price |
$162.60
|
| Rate for Payer: Cigna Commercial |
$535.50
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$281.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$44.55
|
| Rate for Payer: Health EOS Commercial |
$512.95
|
| Rate for Payer: HFN Commercial |
$535.50
|
| 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 |
$450.94
|
| Rate for Payer: NAPHCARE Commercial |
$66.83
|
| Rate for Payer: Preferred Network Access Commercial |
$535.50
|
| Rate for Payer: Quartz Beloit One Network |
$248.02
|
| Rate for Payer: Quartz Commercial |
$321.30
|
| 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 |
$310.02
|
| Rate for Payer: WPS Commercial |
$196.04
|
|
