|
Hepatitis C RNA by PCR Quantitiative
|
Facility
|
IP
|
$542.00
|
|
|
Service Code
|
CPT 87522
|
| Hospital Charge Code |
2942912
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$276.20 |
| Max. Negotiated Rate |
$518.59 |
| Rate for Payer: Aetna Commercial |
$507.31
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$484.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$298.75
|
| Rate for Payer: Cash Price |
$162.60
|
| Rate for Payer: Cigna Commercial |
$518.59
|
| Rate for Payer: Health EOS Commercial |
$501.68
|
| Rate for Payer: HFN Commercial |
$518.59
|
| Rate for Payer: Multiplan Commercial |
$450.94
|
| Rate for Payer: Preferred Network Access Commercial |
$518.59
|
| Rate for Payer: Quartz Beloit One Network |
$276.20
|
| Rate for Payer: Quartz Commercial |
$338.21
|
| Rate for Payer: WEA Trust Commercial |
$310.02
|
| Rate for Payer: WPS Commercial |
$417.50
|
|
|
Hepatitis C RNA by PCR Quantitiative
|
Facility
|
OP
|
$542.00
|
|
|
Service Code
|
CPT 87522
|
| Hospital Charge Code |
2942912
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$44.55 |
| Max. Negotiated Rate |
$518.59 |
| Rate for Payer: Aetna Commercial |
$507.31
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$484.76
|
| 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 |
$298.75
|
| 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 |
$518.59
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$44.55
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$315.44
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$44.55
|
| Rate for Payer: Health EOS Commercial |
$501.68
|
| Rate for Payer: HFN Commercial |
$518.59
|
| 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 |
$450.94
|
| Rate for Payer: NAPHCARE Commercial |
$66.83
|
| Rate for Payer: Preferred Network Access Commercial |
$518.59
|
| Rate for Payer: Quartz Beloit One Network |
$276.20
|
| Rate for Payer: Quartz Commercial |
$366.39
|
| 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 |
$422.76
|
| Rate for Payer: WEA Trust Commercial |
$310.02
|
| Rate for Payer: Wellcare Medicare |
$44.55
|
| Rate for Payer: WPS Commercial |
$417.50
|
|
|
Hepatitis C RNA NS5a Drug Resistance
|
Facility
|
IP
|
$1,255.00
|
|
|
Service Code
|
CPT 87902
|
| Hospital Charge Code |
4570618
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$639.55 |
| Max. Negotiated Rate |
$1,200.78 |
| Rate for Payer: Aetna Commercial |
$1,174.68
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,122.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$691.76
|
| Rate for Payer: Cash Price |
$376.50
|
| Rate for Payer: Cigna Commercial |
$1,200.78
|
| Rate for Payer: Health EOS Commercial |
$1,161.63
|
| Rate for Payer: HFN Commercial |
$1,200.78
|
| Rate for Payer: Multiplan Commercial |
$1,044.16
|
| Rate for Payer: Preferred Network Access Commercial |
$1,200.78
|
| Rate for Payer: Quartz Beloit One Network |
$639.55
|
| Rate for Payer: Quartz Commercial |
$783.12
|
| Rate for Payer: WEA Trust Commercial |
$717.86
|
| Rate for Payer: WPS Commercial |
$966.73
|
|
|
Hepatitis C RNA NS5a Drug Resistance
|
Professional
|
Both
|
$1,255.00
|
|
|
Service Code
|
CPT 87902
|
| Hospital Charge Code |
4570618
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$267.75 |
| Max. Negotiated Rate |
$1,239.94 |
| Rate for Payer: Aetna Commercial |
$1,239.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,122.47
|
| 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 |
$376.50
|
| Rate for Payer: Cash Price |
$376.50
|
| Rate for Payer: Cigna Commercial |
$1,239.94
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$652.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$267.75
|
| Rate for Payer: Health EOS Commercial |
$1,187.73
|
| Rate for Payer: HFN Commercial |
$1,239.94
|
| 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 |
$1,044.16
|
| Rate for Payer: NAPHCARE Commercial |
$401.62
|
| Rate for Payer: Preferred Network Access Commercial |
$1,239.94
|
| Rate for Payer: Quartz Beloit One Network |
$574.29
|
| Rate for Payer: Quartz Commercial |
$743.96
|
| 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 |
$717.86
|
| Rate for Payer: WPS Commercial |
$1,178.09
|
|
|
Hepatitis C RNA NS5a Drug Resistance
|
Facility
|
OP
|
$1,255.00
|
|
|
Service Code
|
CPT 87902
|
| Hospital Charge Code |
4570618
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$267.75 |
| Max. Negotiated Rate |
$1,200.78 |
| Rate for Payer: Aetna Commercial |
$1,174.68
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,122.47
|
| 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 |
$691.76
|
| 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 |
$376.50
|
| Rate for Payer: Cash Price |
$376.50
|
| Rate for Payer: Cigna Commercial |
$1,200.78
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$267.75
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$730.41
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$267.75
|
| Rate for Payer: Health EOS Commercial |
$1,161.63
|
| Rate for Payer: HFN Commercial |
$1,200.78
|
| 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 |
$1,044.16
|
| Rate for Payer: NAPHCARE Commercial |
$401.62
|
| Rate for Payer: Preferred Network Access Commercial |
$1,200.78
|
| Rate for Payer: Quartz Beloit One Network |
$639.55
|
| Rate for Payer: Quartz Commercial |
$848.38
|
| 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 |
$978.90
|
| Rate for Payer: WEA Trust Commercial |
$717.86
|
| Rate for Payer: Wellcare Medicare |
$267.75
|
| Rate for Payer: WPS Commercial |
$966.73
|
|
|
Hepatitis C RNA NS5b Drug Resistance
|
Professional
|
Both
|
$1,154.00
|
|
|
Service Code
|
CPT 87902
|
| Hospital Charge Code |
4570619
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$267.75 |
| Max. Negotiated Rate |
$1,178.09 |
| Rate for Payer: Aetna Commercial |
$1,140.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,032.14
|
| 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 |
$346.20
|
| Rate for Payer: Cash Price |
$346.20
|
| Rate for Payer: Cigna Commercial |
$1,140.15
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$600.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$267.75
|
| Rate for Payer: Health EOS Commercial |
$1,092.15
|
| Rate for Payer: HFN Commercial |
$1,140.15
|
| 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 |
$960.13
|
| Rate for Payer: NAPHCARE Commercial |
$401.62
|
| Rate for Payer: Preferred Network Access Commercial |
$1,140.15
|
| Rate for Payer: Quartz Beloit One Network |
$528.07
|
| Rate for Payer: Quartz Commercial |
$684.09
|
| 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 |
$660.09
|
| Rate for Payer: WPS Commercial |
$1,178.09
|
|
|
Hepatitis C RNA NS5b Drug Resistance
|
Facility
|
IP
|
$1,154.00
|
|
|
Service Code
|
CPT 87902
|
| Hospital Charge Code |
4570619
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$588.08 |
| Max. Negotiated Rate |
$1,104.15 |
| Rate for Payer: Aetna Commercial |
$1,080.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,032.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$636.08
|
| Rate for Payer: Cash Price |
$346.20
|
| Rate for Payer: Cigna Commercial |
$1,104.15
|
| Rate for Payer: Health EOS Commercial |
$1,068.14
|
| Rate for Payer: HFN Commercial |
$1,104.15
|
| Rate for Payer: Multiplan Commercial |
$960.13
|
| Rate for Payer: Preferred Network Access Commercial |
$1,104.15
|
| Rate for Payer: Quartz Beloit One Network |
$588.08
|
| Rate for Payer: Quartz Commercial |
$720.10
|
| Rate for Payer: WEA Trust Commercial |
$660.09
|
| Rate for Payer: WPS Commercial |
$888.93
|
|
|
Hepatitis C RNA NS5b Drug Resistance
|
Facility
|
OP
|
$1,154.00
|
|
|
Service Code
|
CPT 87902
|
| Hospital Charge Code |
4570619
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$267.75 |
| Max. Negotiated Rate |
$1,104.15 |
| Rate for Payer: Aetna Commercial |
$1,080.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,032.14
|
| 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 |
$636.08
|
| 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 |
$346.20
|
| Rate for Payer: Cash Price |
$346.20
|
| Rate for Payer: Cigna Commercial |
$1,104.15
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$267.75
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$671.63
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$267.75
|
| Rate for Payer: Health EOS Commercial |
$1,068.14
|
| Rate for Payer: HFN Commercial |
$1,104.15
|
| 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 |
$960.13
|
| Rate for Payer: NAPHCARE Commercial |
$401.62
|
| Rate for Payer: Preferred Network Access Commercial |
$1,104.15
|
| Rate for Payer: Quartz Beloit One Network |
$588.08
|
| Rate for Payer: Quartz Commercial |
$780.10
|
| 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 |
$900.12
|
| Rate for Payer: WEA Trust Commercial |
$660.09
|
| Rate for Payer: Wellcare Medicare |
$267.75
|
| Rate for Payer: WPS Commercial |
$888.93
|
|
|
Hepatitis C RNA PCR Quantitative
|
Facility
|
OP
|
$541.00
|
|
|
Service Code
|
CPT 87522
|
| Hospital Charge Code |
977972
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$44.55 |
| Max. Negotiated Rate |
$517.63 |
| Rate for Payer: Aetna Commercial |
$506.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$483.87
|
| 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 |
$298.20
|
| 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 |
$162.30
|
| Rate for Payer: Cash Price |
$162.30
|
| Rate for Payer: Cigna Commercial |
$517.63
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$44.55
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$314.86
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$44.55
|
| Rate for Payer: Health EOS Commercial |
$500.75
|
| Rate for Payer: HFN Commercial |
$517.63
|
| 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 |
$450.11
|
| Rate for Payer: NAPHCARE Commercial |
$66.83
|
| Rate for Payer: Preferred Network Access Commercial |
$517.63
|
| Rate for Payer: Quartz Beloit One Network |
$275.69
|
| Rate for Payer: Quartz Commercial |
$365.72
|
| 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 |
$421.98
|
| Rate for Payer: WEA Trust Commercial |
$309.45
|
| Rate for Payer: Wellcare Medicare |
$44.55
|
| Rate for Payer: WPS Commercial |
$416.73
|
|
|
Hepatitis C RNA PCR Quantitative
|
Facility
|
IP
|
$541.00
|
|
|
Service Code
|
CPT 87522
|
| Hospital Charge Code |
977972
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$275.69 |
| Max. Negotiated Rate |
$517.63 |
| Rate for Payer: Aetna Commercial |
$506.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$483.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$298.20
|
| Rate for Payer: Cash Price |
$162.30
|
| Rate for Payer: Cigna Commercial |
$517.63
|
| Rate for Payer: Health EOS Commercial |
$500.75
|
| Rate for Payer: HFN Commercial |
$517.63
|
| Rate for Payer: Multiplan Commercial |
$450.11
|
| Rate for Payer: Preferred Network Access Commercial |
$517.63
|
| Rate for Payer: Quartz Beloit One Network |
$275.69
|
| Rate for Payer: Quartz Commercial |
$337.58
|
| Rate for Payer: WEA Trust Commercial |
$309.45
|
| Rate for Payer: WPS Commercial |
$416.73
|
|
|
Hepatitis C RNA PCR Quantitative
|
Professional
|
Both
|
$541.00
|
|
|
Service Code
|
CPT 87522
|
| Hospital Charge Code |
977972
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$44.55 |
| Max. Negotiated Rate |
$534.51 |
| Rate for Payer: Aetna Commercial |
$534.51
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$483.87
|
| 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 |
$162.30
|
| Rate for Payer: Cash Price |
$162.30
|
| Rate for Payer: Cigna Commercial |
$534.51
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$281.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$44.55
|
| Rate for Payer: Health EOS Commercial |
$512.00
|
| Rate for Payer: HFN Commercial |
$534.51
|
| 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 |
$450.11
|
| Rate for Payer: NAPHCARE Commercial |
$66.83
|
| Rate for Payer: Preferred Network Access Commercial |
$534.51
|
| Rate for Payer: Quartz Beloit One Network |
$247.56
|
| Rate for Payer: Quartz Commercial |
$320.70
|
| 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 |
$309.45
|
| Rate for Payer: WPS Commercial |
$196.04
|
|
|
Hepatitis C RNA PCR Quantitative w/ Reflexes
|
Facility
|
OP
|
$541.00
|
|
|
Service Code
|
CPT 87522
|
| Hospital Charge Code |
4109315
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$44.55 |
| Max. Negotiated Rate |
$517.63 |
| Rate for Payer: Aetna Commercial |
$506.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$483.87
|
| 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 |
$298.20
|
| 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 |
$162.30
|
| Rate for Payer: Cash Price |
$162.30
|
| Rate for Payer: Cigna Commercial |
$517.63
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$44.55
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$314.86
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$44.55
|
| Rate for Payer: Health EOS Commercial |
$500.75
|
| Rate for Payer: HFN Commercial |
$517.63
|
| 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 |
$450.11
|
| Rate for Payer: NAPHCARE Commercial |
$66.83
|
| Rate for Payer: Preferred Network Access Commercial |
$517.63
|
| Rate for Payer: Quartz Beloit One Network |
$275.69
|
| Rate for Payer: Quartz Commercial |
$365.72
|
| 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 |
$421.98
|
| Rate for Payer: WEA Trust Commercial |
$309.45
|
| Rate for Payer: Wellcare Medicare |
$44.55
|
| Rate for Payer: WPS Commercial |
$416.73
|
|
|
Hepatitis C RNA PCR Quantitative w/ Reflexes
|
Professional
|
Both
|
$541.00
|
|
|
Service Code
|
CPT 87522
|
| Hospital Charge Code |
4109315
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$44.55 |
| Max. Negotiated Rate |
$534.51 |
| Rate for Payer: Aetna Commercial |
$534.51
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$483.87
|
| 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 |
$162.30
|
| Rate for Payer: Cash Price |
$162.30
|
| Rate for Payer: Cigna Commercial |
$534.51
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$281.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$44.55
|
| Rate for Payer: Health EOS Commercial |
$512.00
|
| Rate for Payer: HFN Commercial |
$534.51
|
| 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 |
$450.11
|
| Rate for Payer: NAPHCARE Commercial |
$66.83
|
| Rate for Payer: Preferred Network Access Commercial |
$534.51
|
| Rate for Payer: Quartz Beloit One Network |
$247.56
|
| Rate for Payer: Quartz Commercial |
$320.70
|
| 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 |
$309.45
|
| Rate for Payer: WPS Commercial |
$196.04
|
|
|
Hepatitis C RNA PCR Quantitative w/ Reflexes
|
Facility
|
IP
|
$541.00
|
|
|
Service Code
|
CPT 87522
|
| Hospital Charge Code |
4109315
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$275.69 |
| Max. Negotiated Rate |
$517.63 |
| Rate for Payer: Aetna Commercial |
$506.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$483.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$298.20
|
| Rate for Payer: Cash Price |
$162.30
|
| Rate for Payer: Cigna Commercial |
$517.63
|
| Rate for Payer: Health EOS Commercial |
$500.75
|
| Rate for Payer: HFN Commercial |
$517.63
|
| Rate for Payer: Multiplan Commercial |
$450.11
|
| Rate for Payer: Preferred Network Access Commercial |
$517.63
|
| Rate for Payer: Quartz Beloit One Network |
$275.69
|
| Rate for Payer: Quartz Commercial |
$337.58
|
| Rate for Payer: WEA Trust Commercial |
$309.45
|
| Rate for Payer: WPS Commercial |
$416.73
|
|
|
.Hepatitis C RNA, Quant PCR
|
Professional
|
Both
|
$541.00
|
|
|
Service Code
|
CPT 87522
|
| Hospital Charge Code |
4568681
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$44.55 |
| Max. Negotiated Rate |
$534.51 |
| Rate for Payer: Aetna Commercial |
$534.51
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$483.87
|
| 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 |
$162.30
|
| Rate for Payer: Cash Price |
$162.30
|
| Rate for Payer: Cigna Commercial |
$534.51
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$281.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$44.55
|
| Rate for Payer: Health EOS Commercial |
$512.00
|
| Rate for Payer: HFN Commercial |
$534.51
|
| 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 |
$450.11
|
| Rate for Payer: NAPHCARE Commercial |
$66.83
|
| Rate for Payer: Preferred Network Access Commercial |
$534.51
|
| Rate for Payer: Quartz Beloit One Network |
$247.56
|
| Rate for Payer: Quartz Commercial |
$320.70
|
| 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 |
$309.45
|
| Rate for Payer: WPS Commercial |
$196.04
|
|
|
.Hepatitis C RNA, Quant PCR
|
Facility
|
OP
|
$541.00
|
|
|
Service Code
|
CPT 87522
|
| Hospital Charge Code |
4568681
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$44.55 |
| Max. Negotiated Rate |
$517.63 |
| Rate for Payer: Aetna Commercial |
$506.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$483.87
|
| 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 |
$298.20
|
| 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 |
$162.30
|
| Rate for Payer: Cash Price |
$162.30
|
| Rate for Payer: Cigna Commercial |
$517.63
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$44.55
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$314.86
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$44.55
|
| Rate for Payer: Health EOS Commercial |
$500.75
|
| Rate for Payer: HFN Commercial |
$517.63
|
| 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 |
$450.11
|
| Rate for Payer: NAPHCARE Commercial |
$66.83
|
| Rate for Payer: Preferred Network Access Commercial |
$517.63
|
| Rate for Payer: Quartz Beloit One Network |
$275.69
|
| Rate for Payer: Quartz Commercial |
$365.72
|
| 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 |
$421.98
|
| Rate for Payer: WEA Trust Commercial |
$309.45
|
| Rate for Payer: Wellcare Medicare |
$44.55
|
| Rate for Payer: WPS Commercial |
$416.73
|
|
|
.Hepatitis C RNA, Quant PCR
|
Facility
|
IP
|
$541.00
|
|
|
Service Code
|
CPT 87522
|
| Hospital Charge Code |
4568681
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$275.69 |
| Max. Negotiated Rate |
$517.63 |
| Rate for Payer: Aetna Commercial |
$506.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$483.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$298.20
|
| Rate for Payer: Cash Price |
$162.30
|
| Rate for Payer: Cigna Commercial |
$517.63
|
| Rate for Payer: Health EOS Commercial |
$500.75
|
| Rate for Payer: HFN Commercial |
$517.63
|
| Rate for Payer: Multiplan Commercial |
$450.11
|
| Rate for Payer: Preferred Network Access Commercial |
$517.63
|
| Rate for Payer: Quartz Beloit One Network |
$275.69
|
| Rate for Payer: Quartz Commercial |
$337.58
|
| Rate for Payer: WEA Trust Commercial |
$309.45
|
| Rate for Payer: WPS Commercial |
$416.73
|
|
|
.Hepatitis C RNA w/Rfx NS5a Drug Resist
|
Facility
|
IP
|
$1,519.00
|
|
|
Service Code
|
CPT 87902
|
| Hospital Charge Code |
5246606
|
|
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 RNA w/Rfx NS5a Drug Resist
|
Professional
|
Both
|
$1,519.00
|
|
|
Service Code
|
CPT 87902
|
| Hospital Charge Code |
5246606
|
|
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 RNA w/Rfx NS5a Drug Resist
|
Facility
|
OP
|
$1,519.00
|
|
|
Service Code
|
CPT 87902
|
| Hospital Charge Code |
5246606
|
|
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 Viral RNA Genotype, LIPA
|
Facility
|
OP
|
$251.00
|
|
|
Service Code
|
CPT 87902
|
| Hospital Charge Code |
4494993
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$127.91 |
| Max. Negotiated Rate |
$1,070.99 |
| Rate for Payer: Aetna Commercial |
$234.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$224.49
|
| 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 |
$138.35
|
| 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 |
$75.30
|
| Rate for Payer: Cash Price |
$75.30
|
| Rate for Payer: Cigna Commercial |
$240.16
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$267.75
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$146.08
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$267.75
|
| Rate for Payer: Health EOS Commercial |
$232.33
|
| Rate for Payer: HFN Commercial |
$240.16
|
| 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 |
$208.83
|
| Rate for Payer: NAPHCARE Commercial |
$401.62
|
| Rate for Payer: Preferred Network Access Commercial |
$240.16
|
| Rate for Payer: Quartz Beloit One Network |
$127.91
|
| Rate for Payer: Quartz Commercial |
$169.68
|
| 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 |
$195.78
|
| Rate for Payer: WEA Trust Commercial |
$143.57
|
| Rate for Payer: Wellcare Medicare |
$267.75
|
| Rate for Payer: WPS Commercial |
$193.35
|
|
|
.Hepatitis C Viral RNA Genotype, LIPA
|
Facility
|
IP
|
$251.00
|
|
|
Service Code
|
CPT 87902
|
| Hospital Charge Code |
4494993
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$127.91 |
| Max. Negotiated Rate |
$240.16 |
| Rate for Payer: Aetna Commercial |
$234.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$224.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$138.35
|
| Rate for Payer: Cash Price |
$75.30
|
| Rate for Payer: Cigna Commercial |
$240.16
|
| Rate for Payer: Health EOS Commercial |
$232.33
|
| Rate for Payer: HFN Commercial |
$240.16
|
| Rate for Payer: Multiplan Commercial |
$208.83
|
| Rate for Payer: Preferred Network Access Commercial |
$240.16
|
| Rate for Payer: Quartz Beloit One Network |
$127.91
|
| Rate for Payer: Quartz Commercial |
$156.62
|
| Rate for Payer: WEA Trust Commercial |
$143.57
|
| Rate for Payer: WPS Commercial |
$193.35
|
|
|
.Hepatitis C Viral RNA Genotype, LIPA
|
Professional
|
Both
|
$251.00
|
|
|
Service Code
|
CPT 87902
|
| Hospital Charge Code |
4494993
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$114.86 |
| Max. Negotiated Rate |
$1,178.09 |
| Rate for Payer: Aetna Commercial |
$247.99
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$224.49
|
| 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 |
$75.30
|
| Rate for Payer: Cash Price |
$75.30
|
| Rate for Payer: Cigna Commercial |
$247.99
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$130.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$267.75
|
| Rate for Payer: Health EOS Commercial |
$237.55
|
| Rate for Payer: HFN Commercial |
$247.99
|
| 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 |
$208.83
|
| Rate for Payer: NAPHCARE Commercial |
$401.62
|
| Rate for Payer: Preferred Network Access Commercial |
$247.99
|
| Rate for Payer: Quartz Beloit One Network |
$114.86
|
| Rate for Payer: Quartz Commercial |
$148.79
|
| 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 |
$143.57
|
| Rate for Payer: WPS Commercial |
$1,178.09
|
|
|
Hepatitis D Antibody IgM
|
Professional
|
Both
|
$290.00
|
|
|
Service Code
|
CPT 86692
|
| Hospital Charge Code |
977973
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.85 |
| Max. Negotiated Rate |
$286.52 |
| Rate for Payer: Aetna Commercial |
$286.52
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$259.38
|
| Rate for Payer: Aetna Managed Medicare |
$17.85
|
| Rate for Payer: Anthem Medicare Advantage |
$17.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$17.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$17.85
|
| Rate for Payer: Cash Price |
$87.00
|
| Rate for Payer: Cash Price |
$87.00
|
| Rate for Payer: Cigna Commercial |
$286.52
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$150.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$17.85
|
| Rate for Payer: Health EOS Commercial |
$274.46
|
| Rate for Payer: HFN Commercial |
$286.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$62.99
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$62.99
|
| Rate for Payer: Independent Care Health Plan Medicare |
$17.85
|
| Rate for Payer: Multiplan Commercial |
$241.28
|
| Rate for Payer: NAPHCARE Commercial |
$26.77
|
| Rate for Payer: Preferred Network Access Commercial |
$286.52
|
| Rate for Payer: Quartz Beloit One Network |
$132.70
|
| Rate for Payer: Quartz Commercial |
$171.91
|
| Rate for Payer: Quartz Medicare Advantage |
$17.85
|
| Rate for Payer: The Alliance Commercial |
$70.49
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17.85
|
| Rate for Payer: WEA Trust Commercial |
$165.88
|
| Rate for Payer: WPS Commercial |
$78.52
|
|
|
Hepatitis D Antibody IgM
|
Facility
|
OP
|
$290.00
|
|
|
Service Code
|
CPT 86692
|
| Hospital Charge Code |
977973
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.85 |
| Max. Negotiated Rate |
$277.47 |
| Rate for Payer: Aetna Commercial |
$271.44
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$259.38
|
| Rate for Payer: Aetna Managed Medicare |
$17.85
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$66.92
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$31.23
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$29.63
|
| Rate for Payer: Anthem Medicare Advantage |
$17.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$159.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$17.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$17.85
|
| Rate for Payer: Cash Price |
$87.00
|
| Rate for Payer: Cash Price |
$87.00
|
| Rate for Payer: Cigna Commercial |
$277.47
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$17.85
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$168.78
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$17.85
|
| Rate for Payer: Health EOS Commercial |
$268.42
|
| Rate for Payer: HFN Commercial |
$277.47
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$66.39
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$17.85
|
| Rate for Payer: Independent Care Health Plan Medicare |
$17.85
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$17.85
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$17.85
|
| Rate for Payer: Multiplan Commercial |
$241.28
|
| Rate for Payer: NAPHCARE Commercial |
$26.77
|
| Rate for Payer: Preferred Network Access Commercial |
$277.47
|
| Rate for Payer: Quartz Beloit One Network |
$147.78
|
| Rate for Payer: Quartz Commercial |
$196.04
|
| Rate for Payer: Quartz Medicare Advantage |
$17.85
|
| Rate for Payer: The Alliance Commercial |
$71.39
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17.85
|
| Rate for Payer: United Healthcare PPO |
$226.20
|
| Rate for Payer: WEA Trust Commercial |
$165.88
|
| Rate for Payer: Wellcare Medicare |
$17.85
|
| Rate for Payer: WPS Commercial |
$223.39
|
|
