|
Hepatitis A Antibody IgG + IgM
|
Professional
|
Both
|
$286.00
|
|
|
Service Code
|
CPT 86708
|
| Hospital Charge Code |
633745
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$43.74 |
| Max. Negotiated Rate |
$271.70 |
| Rate for Payer: Aetna Commercial |
$271.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$245.96
|
| Rate for Payer: Cash Price |
$85.80
|
| Rate for Payer: Cash Price |
$85.80
|
| Rate for Payer: Cigna Commercial |
$271.70
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$143.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$171.60
|
| Rate for Payer: Health EOS Commercial |
$260.26
|
| Rate for Payer: HFN Commercial |
$271.70
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$43.74
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$43.74
|
| Rate for Payer: Multiplan Commercial |
$228.80
|
| Rate for Payer: Preferred Network Access Commercial |
$271.70
|
| Rate for Payer: Quartz Beloit One Network |
$125.84
|
| Rate for Payer: Quartz Commercial |
$163.02
|
| Rate for Payer: The Alliance Commercial |
$143.00
|
| Rate for Payer: WEA Trust Commercial |
$157.30
|
| Rate for Payer: WPS Commercial |
$211.84
|
|
|
Hepatitis A Antibody IgG + IgM
|
Facility
|
OP
|
$286.00
|
|
|
Service Code
|
CPT 86708
|
| Hospital Charge Code |
633745
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.39 |
| Max. Negotiated Rate |
$263.12 |
| Rate for Payer: Aetna Commercial |
$257.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$245.96
|
| Rate for Payer: Aetna Managed Medicare |
$12.39
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$46.46
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$21.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$20.57
|
| Rate for Payer: Anthem Medicaid |
$12.80
|
| Rate for Payer: Anthem Medicare Advantage |
$12.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$151.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$12.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$12.39
|
| Rate for Payer: Cash Price |
$85.80
|
| Rate for Payer: Cash Price |
$85.80
|
| Rate for Payer: Cigna Commercial |
$263.12
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$12.39
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$12.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$160.05
|
| Rate for Payer: Dean Health Medicaid |
$12.80
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$12.39
|
| Rate for Payer: Health EOS Commercial |
$254.54
|
| Rate for Payer: HFN Commercial |
$263.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$46.09
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$12.39
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$12.80
|
| Rate for Payer: Independent Care Health Plan Medicare |
$12.39
|
| Rate for Payer: Managed Health Services Medicaid |
$13.31
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$12.39
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$12.39
|
| Rate for Payer: Multiplan Commercial |
$228.80
|
| Rate for Payer: NAPHCARE Commercial |
$18.58
|
| Rate for Payer: Preferred Network Access Commercial |
$263.12
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$12.80
|
| Rate for Payer: Quartz Beloit One Network |
$140.14
|
| Rate for Payer: Quartz Commercial |
$185.90
|
| Rate for Payer: Quartz Medicare Advantage |
$12.39
|
| Rate for Payer: The Alliance Commercial |
$49.56
|
| Rate for Payer: United Healthcare Medicaid |
$12.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.39
|
| Rate for Payer: United Healthcare PPO |
$214.50
|
| Rate for Payer: WEA Trust Commercial |
$157.30
|
| Rate for Payer: Wellcare Medicare |
$12.39
|
| Rate for Payer: WMAP Medicaid |
$12.80
|
| Rate for Payer: WPS Commercial |
$211.84
|
|
|
Hepatitis A Antibody IgG + IgM
|
Facility
|
IP
|
$286.00
|
|
|
Service Code
|
CPT 86708
|
| Hospital Charge Code |
633745
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$140.14 |
| Max. Negotiated Rate |
$263.12 |
| Rate for Payer: Aetna Commercial |
$257.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$245.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$151.58
|
| Rate for Payer: Cash Price |
$85.80
|
| Rate for Payer: Cigna Commercial |
$263.12
|
| Rate for Payer: Health EOS Commercial |
$254.54
|
| Rate for Payer: HFN Commercial |
$263.12
|
| Rate for Payer: Multiplan Commercial |
$228.80
|
| Rate for Payer: NAPHCARE Commercial |
$171.60
|
| Rate for Payer: Preferred Network Access Commercial |
$263.12
|
| Rate for Payer: Quartz Beloit One Network |
$140.14
|
| Rate for Payer: Quartz Commercial |
$171.60
|
| Rate for Payer: WEA Trust Commercial |
$157.30
|
| Rate for Payer: WPS Commercial |
$211.84
|
|
|
Hepatitis A Antibody IgM Acute Titer
|
Professional
|
Both
|
$386.00
|
|
|
Service Code
|
CPT 86709
|
| Hospital Charge Code |
633747
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$39.75 |
| Max. Negotiated Rate |
$366.70 |
| Rate for Payer: Aetna Commercial |
$366.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$331.96
|
| Rate for Payer: Cash Price |
$115.80
|
| Rate for Payer: Cash Price |
$115.80
|
| Rate for Payer: Cigna Commercial |
$366.70
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$193.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$231.60
|
| Rate for Payer: Health EOS Commercial |
$351.26
|
| Rate for Payer: HFN Commercial |
$366.70
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$39.75
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$39.75
|
| Rate for Payer: Multiplan Commercial |
$308.80
|
| Rate for Payer: Preferred Network Access Commercial |
$366.70
|
| Rate for Payer: Quartz Beloit One Network |
$169.84
|
| Rate for Payer: Quartz Commercial |
$220.02
|
| Rate for Payer: The Alliance Commercial |
$193.00
|
| Rate for Payer: WEA Trust Commercial |
$212.30
|
| Rate for Payer: WPS Commercial |
$285.91
|
|
|
Hepatitis A Antibody IgM Acute Titer
|
Facility
|
IP
|
$386.00
|
|
|
Service Code
|
CPT 86709
|
| Hospital Charge Code |
633747
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$189.14 |
| Max. Negotiated Rate |
$355.12 |
| Rate for Payer: Aetna Commercial |
$347.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$331.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$204.58
|
| Rate for Payer: Cash Price |
$115.80
|
| Rate for Payer: Cigna Commercial |
$355.12
|
| Rate for Payer: Health EOS Commercial |
$343.54
|
| Rate for Payer: HFN Commercial |
$355.12
|
| Rate for Payer: Multiplan Commercial |
$308.80
|
| Rate for Payer: NAPHCARE Commercial |
$231.60
|
| Rate for Payer: Preferred Network Access Commercial |
$355.12
|
| Rate for Payer: Quartz Beloit One Network |
$189.14
|
| Rate for Payer: Quartz Commercial |
$231.60
|
| Rate for Payer: WEA Trust Commercial |
$212.30
|
| Rate for Payer: WPS Commercial |
$285.91
|
|
|
Hepatitis A Antibody IgM Acute Titer
|
Facility
|
OP
|
$386.00
|
|
|
Service Code
|
CPT 86709
|
| Hospital Charge Code |
633747
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.26 |
| Max. Negotiated Rate |
$355.12 |
| Rate for Payer: Aetna Commercial |
$347.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$331.96
|
| Rate for Payer: Aetna Managed Medicare |
$11.26
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$42.22
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$19.70
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$18.69
|
| Rate for Payer: Anthem Medicaid |
$11.63
|
| Rate for Payer: Anthem Medicare Advantage |
$11.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$204.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$11.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$11.26
|
| Rate for Payer: Cash Price |
$115.80
|
| Rate for Payer: Cash Price |
$115.80
|
| Rate for Payer: Cigna Commercial |
$355.12
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$11.26
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$11.63
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$216.01
|
| Rate for Payer: Dean Health Medicaid |
$11.63
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$11.26
|
| Rate for Payer: Health EOS Commercial |
$343.54
|
| Rate for Payer: HFN Commercial |
$355.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$41.89
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$11.26
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$11.63
|
| Rate for Payer: Independent Care Health Plan Medicare |
$11.26
|
| Rate for Payer: Managed Health Services Medicaid |
$12.10
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$11.26
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$11.26
|
| Rate for Payer: Multiplan Commercial |
$308.80
|
| Rate for Payer: NAPHCARE Commercial |
$16.89
|
| Rate for Payer: Preferred Network Access Commercial |
$355.12
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$11.63
|
| Rate for Payer: Quartz Beloit One Network |
$189.14
|
| Rate for Payer: Quartz Commercial |
$250.90
|
| Rate for Payer: Quartz Medicare Advantage |
$11.26
|
| Rate for Payer: The Alliance Commercial |
$45.04
|
| Rate for Payer: United Healthcare Medicaid |
$11.63
|
| Rate for Payer: United Healthcare Medicare Advantage |
$11.26
|
| Rate for Payer: United Healthcare PPO |
$289.50
|
| Rate for Payer: WEA Trust Commercial |
$212.30
|
| Rate for Payer: Wellcare Medicare |
$11.26
|
| Rate for Payer: WMAP Medicaid |
$11.63
|
| Rate for Payer: WPS Commercial |
$285.91
|
|
|
Hepatitis A Antibody Total w/ Reflex IgM
|
Professional
|
Both
|
$129.00
|
|
|
Service Code
|
CPT 86708
|
| Hospital Charge Code |
1039129
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$43.74 |
| Max. Negotiated Rate |
$122.55 |
| Rate for Payer: Aetna Commercial |
$122.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$110.94
|
| Rate for Payer: Cash Price |
$38.70
|
| Rate for Payer: Cash Price |
$38.70
|
| Rate for Payer: Cigna Commercial |
$122.55
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$64.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$77.40
|
| Rate for Payer: Health EOS Commercial |
$117.39
|
| Rate for Payer: HFN Commercial |
$122.55
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$43.74
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$43.74
|
| Rate for Payer: Multiplan Commercial |
$103.20
|
| Rate for Payer: Preferred Network Access Commercial |
$122.55
|
| Rate for Payer: Quartz Beloit One Network |
$56.76
|
| Rate for Payer: Quartz Commercial |
$73.53
|
| Rate for Payer: The Alliance Commercial |
$64.50
|
| Rate for Payer: WEA Trust Commercial |
$70.95
|
| Rate for Payer: WPS Commercial |
$95.55
|
|
|
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 |
$12.39 |
| Max. Negotiated Rate |
$118.68 |
| Rate for Payer: Aetna Commercial |
$116.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$110.94
|
| Rate for Payer: Aetna Managed Medicare |
$12.39
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$46.46
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$21.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$20.57
|
| Rate for Payer: Anthem Medicaid |
$12.80
|
| Rate for Payer: Anthem Medicare Advantage |
$12.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$68.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$12.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$12.39
|
| Rate for Payer: Cash Price |
$38.70
|
| Rate for Payer: Cash Price |
$38.70
|
| Rate for Payer: Cigna Commercial |
$118.68
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$12.39
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$12.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$72.19
|
| Rate for Payer: Dean Health Medicaid |
$12.80
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$12.39
|
| Rate for Payer: Health EOS Commercial |
$114.81
|
| Rate for Payer: HFN Commercial |
$118.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$46.09
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$12.39
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$12.80
|
| Rate for Payer: Independent Care Health Plan Medicare |
$12.39
|
| Rate for Payer: Managed Health Services Medicaid |
$13.31
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$12.39
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$12.39
|
| Rate for Payer: Multiplan Commercial |
$103.20
|
| Rate for Payer: NAPHCARE Commercial |
$18.58
|
| Rate for Payer: Preferred Network Access Commercial |
$118.68
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$12.80
|
| Rate for Payer: Quartz Beloit One Network |
$63.21
|
| Rate for Payer: Quartz Commercial |
$83.85
|
| Rate for Payer: Quartz Medicare Advantage |
$12.39
|
| Rate for Payer: The Alliance Commercial |
$49.56
|
| Rate for Payer: United Healthcare Medicaid |
$12.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.39
|
| Rate for Payer: United Healthcare PPO |
$96.75
|
| Rate for Payer: WEA Trust Commercial |
$70.95
|
| Rate for Payer: Wellcare Medicare |
$12.39
|
| Rate for Payer: WMAP Medicaid |
$12.80
|
| Rate for Payer: WPS Commercial |
$95.55
|
|
|
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 |
$63.21 |
| Max. Negotiated Rate |
$118.68 |
| Rate for Payer: Aetna Commercial |
$116.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$110.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$68.37
|
| Rate for Payer: Cash Price |
$38.70
|
| Rate for Payer: Cigna Commercial |
$118.68
|
| Rate for Payer: Health EOS Commercial |
$114.81
|
| Rate for Payer: HFN Commercial |
$118.68
|
| Rate for Payer: Multiplan Commercial |
$103.20
|
| Rate for Payer: NAPHCARE Commercial |
$77.40
|
| Rate for Payer: Preferred Network Access Commercial |
$118.68
|
| Rate for Payer: Quartz Beloit One Network |
$63.21
|
| Rate for Payer: Quartz Commercial |
$77.40
|
| Rate for Payer: WEA Trust Commercial |
$70.95
|
| Rate for Payer: WPS Commercial |
$95.55
|
|
|
Hepatitis B by PCR Quantitative
|
Facility
|
IP
|
$563.00
|
|
|
Service Code
|
CPT 87517
|
| Hospital Charge Code |
977969
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$275.87 |
| Max. Negotiated Rate |
$517.96 |
| Rate for Payer: Aetna Commercial |
$506.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$484.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$298.39
|
| Rate for Payer: Cash Price |
$168.90
|
| Rate for Payer: Cigna Commercial |
$517.96
|
| Rate for Payer: Health EOS Commercial |
$501.07
|
| Rate for Payer: HFN Commercial |
$517.96
|
| Rate for Payer: Multiplan Commercial |
$450.40
|
| Rate for Payer: NAPHCARE Commercial |
$337.80
|
| Rate for Payer: Preferred Network Access Commercial |
$517.96
|
| Rate for Payer: Quartz Beloit One Network |
$275.87
|
| Rate for Payer: Quartz Commercial |
$337.80
|
| Rate for Payer: WEA Trust Commercial |
$309.65
|
| Rate for Payer: WPS Commercial |
$417.01
|
|
|
Hepatitis B by PCR Quantitative
|
Professional
|
Both
|
$563.00
|
|
|
Service Code
|
CPT 87517
|
| Hospital Charge Code |
977969
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$151.23 |
| Max. Negotiated Rate |
$534.85 |
| Rate for Payer: Aetna Commercial |
$534.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$484.18
|
| Rate for Payer: Cash Price |
$168.90
|
| Rate for Payer: Cash Price |
$168.90
|
| Rate for Payer: Cigna Commercial |
$534.85
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$281.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$337.80
|
| Rate for Payer: Health EOS Commercial |
$512.33
|
| Rate for Payer: HFN Commercial |
$534.85
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$151.23
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$151.23
|
| Rate for Payer: Multiplan Commercial |
$450.40
|
| Rate for Payer: Preferred Network Access Commercial |
$534.85
|
| Rate for Payer: Quartz Beloit One Network |
$247.72
|
| Rate for Payer: Quartz Commercial |
$320.91
|
| Rate for Payer: The Alliance Commercial |
$281.50
|
| Rate for Payer: WEA Trust Commercial |
$309.65
|
| Rate for Payer: WPS Commercial |
$417.01
|
|
|
Hepatitis B by PCR Quantitative
|
Facility
|
OP
|
$563.00
|
|
|
Service Code
|
CPT 87517
|
| Hospital Charge Code |
977969
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$42.84 |
| Max. Negotiated Rate |
$517.96 |
| Rate for Payer: Aetna Commercial |
$506.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$484.18
|
| Rate for Payer: Aetna Managed Medicare |
$42.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$160.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$74.97
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$71.11
|
| Rate for Payer: Anthem Medicaid |
$44.27
|
| Rate for Payer: Anthem Medicare Advantage |
$42.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$298.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$42.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$42.84
|
| Rate for Payer: Cash Price |
$168.90
|
| Rate for Payer: Cash Price |
$168.90
|
| Rate for Payer: Cigna Commercial |
$517.96
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$42.84
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$44.27
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$315.05
|
| Rate for Payer: Dean Health Medicaid |
$44.27
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$42.84
|
| Rate for Payer: Health EOS Commercial |
$501.07
|
| Rate for Payer: HFN Commercial |
$517.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$159.36
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$42.84
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$44.27
|
| Rate for Payer: Independent Care Health Plan Medicare |
$42.84
|
| Rate for Payer: Managed Health Services Medicaid |
$46.04
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$42.84
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$42.84
|
| Rate for Payer: Multiplan Commercial |
$450.40
|
| Rate for Payer: NAPHCARE Commercial |
$64.26
|
| Rate for Payer: Preferred Network Access Commercial |
$517.96
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$44.27
|
| Rate for Payer: Quartz Beloit One Network |
$275.87
|
| Rate for Payer: Quartz Commercial |
$365.95
|
| Rate for Payer: Quartz Medicare Advantage |
$42.84
|
| Rate for Payer: The Alliance Commercial |
$171.36
|
| Rate for Payer: United Healthcare Medicaid |
$44.27
|
| Rate for Payer: United Healthcare Medicare Advantage |
$42.84
|
| Rate for Payer: United Healthcare PPO |
$422.25
|
| Rate for Payer: WEA Trust Commercial |
$309.65
|
| Rate for Payer: Wellcare Medicare |
$42.84
|
| Rate for Payer: WMAP Medicaid |
$44.27
|
| Rate for Payer: WPS Commercial |
$417.01
|
|
|
Hepatitis B Core Antibody
|
Facility
|
OP
|
$191.00
|
|
|
Service Code
|
CPT 86704
|
| Hospital Charge Code |
633748
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.05 |
| Max. Negotiated Rate |
$175.72 |
| Rate for Payer: Aetna Commercial |
$171.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$164.26
|
| Rate for Payer: Aetna Managed Medicare |
$12.05
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$45.19
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$21.09
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$20.00
|
| Rate for Payer: Anthem Medicaid |
$12.45
|
| Rate for Payer: Anthem Medicare Advantage |
$12.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$101.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$12.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$12.05
|
| Rate for Payer: Cash Price |
$57.30
|
| Rate for Payer: Cash Price |
$57.30
|
| Rate for Payer: Cigna Commercial |
$175.72
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$12.05
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$12.45
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$106.88
|
| Rate for Payer: Dean Health Medicaid |
$12.45
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$12.05
|
| Rate for Payer: Health EOS Commercial |
$169.99
|
| Rate for Payer: HFN Commercial |
$175.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$44.83
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$12.05
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$12.45
|
| Rate for Payer: Independent Care Health Plan Medicare |
$12.05
|
| Rate for Payer: Managed Health Services Medicaid |
$12.95
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$12.05
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$12.05
|
| Rate for Payer: Multiplan Commercial |
$152.80
|
| Rate for Payer: NAPHCARE Commercial |
$18.08
|
| Rate for Payer: Preferred Network Access Commercial |
$175.72
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$12.45
|
| Rate for Payer: Quartz Beloit One Network |
$93.59
|
| Rate for Payer: Quartz Commercial |
$124.15
|
| Rate for Payer: Quartz Medicare Advantage |
$12.05
|
| Rate for Payer: The Alliance Commercial |
$48.20
|
| Rate for Payer: United Healthcare Medicaid |
$12.45
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.05
|
| Rate for Payer: United Healthcare PPO |
$143.25
|
| Rate for Payer: WEA Trust Commercial |
$105.05
|
| Rate for Payer: Wellcare Medicare |
$12.05
|
| Rate for Payer: WMAP Medicaid |
$12.45
|
| Rate for Payer: WPS Commercial |
$141.47
|
|
|
Hepatitis B Core Antibody
|
Professional
|
Both
|
$191.00
|
|
|
Service Code
|
CPT 86704
|
| Hospital Charge Code |
633748
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$42.54 |
| Max. Negotiated Rate |
$181.45 |
| Rate for Payer: Aetna Commercial |
$181.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$164.26
|
| Rate for Payer: Cash Price |
$57.30
|
| Rate for Payer: Cash Price |
$57.30
|
| Rate for Payer: Cigna Commercial |
$181.45
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$95.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$114.60
|
| Rate for Payer: Health EOS Commercial |
$173.81
|
| Rate for Payer: HFN Commercial |
$181.45
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$42.54
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$42.54
|
| Rate for Payer: Multiplan Commercial |
$152.80
|
| Rate for Payer: Preferred Network Access Commercial |
$181.45
|
| Rate for Payer: Quartz Beloit One Network |
$84.04
|
| Rate for Payer: Quartz Commercial |
$108.87
|
| Rate for Payer: The Alliance Commercial |
$95.50
|
| Rate for Payer: WEA Trust Commercial |
$105.05
|
| Rate for Payer: WPS Commercial |
$141.47
|
|
|
Hepatitis B Core Antibody
|
Facility
|
IP
|
$191.00
|
|
|
Service Code
|
CPT 86704
|
| Hospital Charge Code |
633748
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$93.59 |
| Max. Negotiated Rate |
$175.72 |
| Rate for Payer: Aetna Commercial |
$171.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$164.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$101.23
|
| Rate for Payer: Cash Price |
$57.30
|
| Rate for Payer: Cigna Commercial |
$175.72
|
| Rate for Payer: Health EOS Commercial |
$169.99
|
| Rate for Payer: HFN Commercial |
$175.72
|
| Rate for Payer: Multiplan Commercial |
$152.80
|
| Rate for Payer: NAPHCARE Commercial |
$114.60
|
| Rate for Payer: Preferred Network Access Commercial |
$175.72
|
| Rate for Payer: Quartz Beloit One Network |
$93.59
|
| Rate for Payer: Quartz Commercial |
$114.60
|
| Rate for Payer: WEA Trust Commercial |
$105.05
|
| Rate for Payer: WPS Commercial |
$141.47
|
|
|
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 |
$100.45 |
| Max. Negotiated Rate |
$188.60 |
| Rate for Payer: Aetna Commercial |
$184.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$176.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$108.65
|
| Rate for Payer: Cash Price |
$61.50
|
| Rate for Payer: Cigna Commercial |
$188.60
|
| Rate for Payer: Health EOS Commercial |
$182.45
|
| Rate for Payer: HFN Commercial |
$188.60
|
| Rate for Payer: Multiplan Commercial |
$164.00
|
| Rate for Payer: NAPHCARE Commercial |
$123.00
|
| Rate for Payer: Preferred Network Access Commercial |
$188.60
|
| Rate for Payer: Quartz Beloit One Network |
$100.45
|
| Rate for Payer: Quartz Commercial |
$123.00
|
| Rate for Payer: WEA Trust Commercial |
$112.75
|
| Rate for Payer: WPS Commercial |
$151.84
|
|
|
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 |
$41.55 |
| Max. Negotiated Rate |
$194.75 |
| Rate for Payer: Aetna Commercial |
$194.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$176.30
|
| Rate for Payer: Cash Price |
$61.50
|
| Rate for Payer: Cash Price |
$61.50
|
| Rate for Payer: Cigna Commercial |
$194.75
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$102.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$123.00
|
| Rate for Payer: Health EOS Commercial |
$186.55
|
| Rate for Payer: HFN Commercial |
$194.75
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$41.55
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$41.55
|
| Rate for Payer: Multiplan Commercial |
$164.00
|
| Rate for Payer: Preferred Network Access Commercial |
$194.75
|
| Rate for Payer: Quartz Beloit One Network |
$90.20
|
| Rate for Payer: Quartz Commercial |
$116.85
|
| Rate for Payer: The Alliance Commercial |
$102.50
|
| Rate for Payer: WEA Trust Commercial |
$112.75
|
| Rate for Payer: WPS Commercial |
$151.84
|
|
|
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 |
$11.77 |
| Max. Negotiated Rate |
$188.60 |
| Rate for Payer: Aetna Commercial |
$184.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$176.30
|
| Rate for Payer: Aetna Managed Medicare |
$11.77
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$44.14
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$20.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$19.54
|
| Rate for Payer: Anthem Medicaid |
$12.16
|
| Rate for Payer: Anthem Medicare Advantage |
$11.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$108.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$11.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$11.77
|
| Rate for Payer: Cash Price |
$61.50
|
| Rate for Payer: Cash Price |
$61.50
|
| Rate for Payer: Cigna Commercial |
$188.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$11.77
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$12.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$114.72
|
| Rate for Payer: Dean Health Medicaid |
$12.16
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$11.77
|
| Rate for Payer: Health EOS Commercial |
$182.45
|
| Rate for Payer: HFN Commercial |
$188.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$43.78
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$11.77
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$12.16
|
| Rate for Payer: Independent Care Health Plan Medicare |
$11.77
|
| Rate for Payer: Managed Health Services Medicaid |
$12.65
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$11.77
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$11.77
|
| Rate for Payer: Multiplan Commercial |
$164.00
|
| Rate for Payer: NAPHCARE Commercial |
$17.66
|
| Rate for Payer: Preferred Network Access Commercial |
$188.60
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$12.16
|
| Rate for Payer: Quartz Beloit One Network |
$100.45
|
| Rate for Payer: Quartz Commercial |
$133.25
|
| Rate for Payer: Quartz Medicare Advantage |
$11.77
|
| Rate for Payer: The Alliance Commercial |
$47.08
|
| Rate for Payer: United Healthcare Medicaid |
$12.16
|
| Rate for Payer: United Healthcare Medicare Advantage |
$11.77
|
| Rate for Payer: United Healthcare PPO |
$153.75
|
| Rate for Payer: WEA Trust Commercial |
$112.75
|
| Rate for Payer: Wellcare Medicare |
$11.77
|
| Rate for Payer: WMAP Medicaid |
$12.16
|
| Rate for Payer: WPS Commercial |
$151.84
|
|
|
Hepatitis Be Antibody
|
Facility
|
OP
|
$186.00
|
|
|
Service Code
|
CPT 86707
|
| Hospital Charge Code |
633753
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.57 |
| Max. Negotiated Rate |
$171.12 |
| Rate for Payer: Aetna Commercial |
$167.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$159.96
|
| Rate for Payer: Aetna Managed Medicare |
$11.57
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$43.39
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$20.25
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$19.21
|
| Rate for Payer: Anthem Medicaid |
$11.96
|
| Rate for Payer: Anthem Medicare Advantage |
$11.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$98.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$11.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$11.57
|
| Rate for Payer: Cash Price |
$55.80
|
| Rate for Payer: Cash Price |
$55.80
|
| Rate for Payer: Cigna Commercial |
$171.12
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$11.57
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$11.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$104.09
|
| Rate for Payer: Dean Health Medicaid |
$11.96
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$11.57
|
| Rate for Payer: Health EOS Commercial |
$165.54
|
| Rate for Payer: HFN Commercial |
$171.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$43.04
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$11.57
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$11.96
|
| Rate for Payer: Independent Care Health Plan Medicare |
$11.57
|
| Rate for Payer: Managed Health Services Medicaid |
$12.44
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$11.57
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$11.57
|
| Rate for Payer: Multiplan Commercial |
$148.80
|
| Rate for Payer: NAPHCARE Commercial |
$17.36
|
| Rate for Payer: Preferred Network Access Commercial |
$171.12
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$11.96
|
| Rate for Payer: Quartz Beloit One Network |
$91.14
|
| Rate for Payer: Quartz Commercial |
$120.90
|
| Rate for Payer: Quartz Medicare Advantage |
$11.57
|
| Rate for Payer: The Alliance Commercial |
$46.28
|
| Rate for Payer: United Healthcare Medicaid |
$11.96
|
| Rate for Payer: United Healthcare Medicare Advantage |
$11.57
|
| Rate for Payer: United Healthcare PPO |
$139.50
|
| Rate for Payer: WEA Trust Commercial |
$102.30
|
| Rate for Payer: Wellcare Medicare |
$11.57
|
| Rate for Payer: WMAP Medicaid |
$11.96
|
| Rate for Payer: WPS Commercial |
$137.77
|
|
|
Hepatitis Be Antibody
|
Facility
|
IP
|
$186.00
|
|
|
Service Code
|
CPT 86707
|
| Hospital Charge Code |
633753
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$91.14 |
| Max. Negotiated Rate |
$171.12 |
| Rate for Payer: Aetna Commercial |
$167.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$159.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$98.58
|
| Rate for Payer: Cash Price |
$55.80
|
| Rate for Payer: Cigna Commercial |
$171.12
|
| Rate for Payer: Health EOS Commercial |
$165.54
|
| Rate for Payer: HFN Commercial |
$171.12
|
| Rate for Payer: Multiplan Commercial |
$148.80
|
| Rate for Payer: NAPHCARE Commercial |
$111.60
|
| Rate for Payer: Preferred Network Access Commercial |
$171.12
|
| Rate for Payer: Quartz Beloit One Network |
$91.14
|
| Rate for Payer: Quartz Commercial |
$111.60
|
| Rate for Payer: WEA Trust Commercial |
$102.30
|
| Rate for Payer: WPS Commercial |
$137.77
|
|
|
Hepatitis Be Antibody
|
Professional
|
Both
|
$186.00
|
|
|
Service Code
|
CPT 86707
|
| Hospital Charge Code |
633753
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$40.84 |
| Max. Negotiated Rate |
$176.70 |
| Rate for Payer: Aetna Commercial |
$176.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$159.96
|
| Rate for Payer: Cash Price |
$55.80
|
| Rate for Payer: Cash Price |
$55.80
|
| Rate for Payer: Cigna Commercial |
$176.70
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$93.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$111.60
|
| Rate for Payer: Health EOS Commercial |
$169.26
|
| Rate for Payer: HFN Commercial |
$176.70
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$40.84
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$40.84
|
| Rate for Payer: Multiplan Commercial |
$148.80
|
| Rate for Payer: Preferred Network Access Commercial |
$176.70
|
| Rate for Payer: Quartz Beloit One Network |
$81.84
|
| Rate for Payer: Quartz Commercial |
$106.02
|
| Rate for Payer: The Alliance Commercial |
$93.00
|
| Rate for Payer: WEA Trust Commercial |
$102.30
|
| Rate for Payer: WPS Commercial |
$137.77
|
|
|
Hepatitis Be Antigen
|
Facility
|
IP
|
$286.00
|
|
|
Service Code
|
CPT 87350
|
| Hospital Charge Code |
633754
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$140.14 |
| Max. Negotiated Rate |
$263.12 |
| Rate for Payer: Aetna Commercial |
$257.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$245.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$151.58
|
| Rate for Payer: Cash Price |
$85.80
|
| Rate for Payer: Cigna Commercial |
$263.12
|
| Rate for Payer: Health EOS Commercial |
$254.54
|
| Rate for Payer: HFN Commercial |
$263.12
|
| Rate for Payer: Multiplan Commercial |
$228.80
|
| Rate for Payer: NAPHCARE Commercial |
$171.60
|
| Rate for Payer: Preferred Network Access Commercial |
$263.12
|
| Rate for Payer: Quartz Beloit One Network |
$140.14
|
| Rate for Payer: Quartz Commercial |
$171.60
|
| Rate for Payer: WEA Trust Commercial |
$157.30
|
| Rate for Payer: WPS Commercial |
$211.84
|
|
|
Hepatitis Be Antigen
|
Professional
|
Both
|
$286.00
|
|
|
Service Code
|
CPT 87350
|
| Hospital Charge Code |
633754
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$40.70 |
| Max. Negotiated Rate |
$271.70 |
| Rate for Payer: Aetna Commercial |
$271.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$245.96
|
| Rate for Payer: Cash Price |
$85.80
|
| Rate for Payer: Cash Price |
$85.80
|
| Rate for Payer: Cigna Commercial |
$271.70
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$143.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$171.60
|
| Rate for Payer: Health EOS Commercial |
$260.26
|
| Rate for Payer: HFN Commercial |
$271.70
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$40.70
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$40.70
|
| Rate for Payer: Multiplan Commercial |
$228.80
|
| Rate for Payer: Preferred Network Access Commercial |
$271.70
|
| Rate for Payer: Quartz Beloit One Network |
$125.84
|
| Rate for Payer: Quartz Commercial |
$163.02
|
| Rate for Payer: The Alliance Commercial |
$143.00
|
| Rate for Payer: WEA Trust Commercial |
$157.30
|
| Rate for Payer: WPS Commercial |
$211.84
|
|
|
Hepatitis Be Antigen
|
Facility
|
OP
|
$286.00
|
|
|
Service Code
|
CPT 87350
|
| Hospital Charge Code |
633754
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.53 |
| Max. Negotiated Rate |
$263.12 |
| Rate for Payer: Aetna Commercial |
$257.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$245.96
|
| Rate for Payer: Aetna Managed Medicare |
$11.53
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$43.24
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$20.18
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$19.14
|
| Rate for Payer: Anthem Medicaid |
$11.91
|
| Rate for Payer: Anthem Medicare Advantage |
$11.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$151.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$11.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$11.53
|
| Rate for Payer: Cash Price |
$85.80
|
| Rate for Payer: Cash Price |
$85.80
|
| Rate for Payer: Cigna Commercial |
$263.12
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$11.53
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$11.91
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$160.05
|
| Rate for Payer: Dean Health Medicaid |
$11.91
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$11.53
|
| Rate for Payer: Health EOS Commercial |
$254.54
|
| Rate for Payer: HFN Commercial |
$263.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$42.89
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$11.53
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$11.91
|
| Rate for Payer: Independent Care Health Plan Medicare |
$11.53
|
| Rate for Payer: Managed Health Services Medicaid |
$12.39
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$11.53
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$11.53
|
| Rate for Payer: Multiplan Commercial |
$228.80
|
| Rate for Payer: NAPHCARE Commercial |
$17.30
|
| Rate for Payer: Preferred Network Access Commercial |
$263.12
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$11.91
|
| Rate for Payer: Quartz Beloit One Network |
$140.14
|
| Rate for Payer: Quartz Commercial |
$185.90
|
| Rate for Payer: Quartz Medicare Advantage |
$11.53
|
| Rate for Payer: The Alliance Commercial |
$46.12
|
| Rate for Payer: United Healthcare Medicaid |
$11.91
|
| Rate for Payer: United Healthcare Medicare Advantage |
$11.53
|
| Rate for Payer: United Healthcare PPO |
$214.50
|
| Rate for Payer: WEA Trust Commercial |
$157.30
|
| Rate for Payer: Wellcare Medicare |
$11.53
|
| Rate for Payer: WMAP Medicaid |
$11.91
|
| Rate for Payer: WPS Commercial |
$211.84
|
|
|
Hepatitis B Surface Antibody, Qualitative
|
Facility
|
OP
|
$204.00
|
|
|
Service Code
|
CPT 86706
|
| Hospital Charge Code |
1039133
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.74 |
| Max. Negotiated Rate |
$187.68 |
| Rate for Payer: Aetna Commercial |
$183.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$175.44
|
| Rate for Payer: Aetna Managed Medicare |
$10.74
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$40.28
|
| 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 Medicaid |
$11.10
|
| Rate for Payer: Anthem Medicare Advantage |
$10.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$108.12
|
| 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 |
$61.20
|
| Rate for Payer: Cash Price |
$61.20
|
| Rate for Payer: Cigna Commercial |
$187.68
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$10.74
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$11.10
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$114.16
|
| Rate for Payer: Dean Health Medicaid |
$11.10
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$10.74
|
| Rate for Payer: Health EOS Commercial |
$181.56
|
| Rate for Payer: HFN Commercial |
$187.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$39.95
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$10.74
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$11.10
|
| Rate for Payer: Independent Care Health Plan Medicare |
$10.74
|
| Rate for Payer: Managed Health Services Medicaid |
$11.54
|
| 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 |
$163.20
|
| Rate for Payer: NAPHCARE Commercial |
$16.11
|
| Rate for Payer: Preferred Network Access Commercial |
$187.68
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$11.10
|
| Rate for Payer: Quartz Beloit One Network |
$99.96
|
| Rate for Payer: Quartz Commercial |
$132.60
|
| Rate for Payer: Quartz Medicare Advantage |
$10.74
|
| Rate for Payer: The Alliance Commercial |
$42.96
|
| Rate for Payer: United Healthcare Medicaid |
$11.10
|
| Rate for Payer: United Healthcare Medicare Advantage |
$10.74
|
| Rate for Payer: United Healthcare PPO |
$153.00
|
| Rate for Payer: WEA Trust Commercial |
$112.20
|
| Rate for Payer: Wellcare Medicare |
$10.74
|
| Rate for Payer: WMAP Medicaid |
$11.10
|
| Rate for Payer: WPS Commercial |
$151.10
|
|
