|
Hepatitis B Surface Antibody, Qualitative
|
Facility
|
IP
|
$204.00
|
|
|
Service Code
|
CPT 86706
|
| Hospital Charge Code |
1039133
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$99.96 |
| Max. Negotiated Rate |
$187.68 |
| Rate for Payer: Aetna Commercial |
$183.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$175.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$108.12
|
| Rate for Payer: Cash Price |
$61.20
|
| Rate for Payer: Cigna Commercial |
$187.68
|
| Rate for Payer: Health EOS Commercial |
$181.56
|
| Rate for Payer: HFN Commercial |
$187.68
|
| Rate for Payer: Multiplan Commercial |
$163.20
|
| Rate for Payer: NAPHCARE Commercial |
$122.40
|
| Rate for Payer: Preferred Network Access Commercial |
$187.68
|
| Rate for Payer: Quartz Beloit One Network |
$99.96
|
| Rate for Payer: Quartz Commercial |
$122.40
|
| Rate for Payer: WEA Trust Commercial |
$112.20
|
| Rate for Payer: WPS Commercial |
$151.10
|
|
|
Hepatitis B Surface Antibody, Qualitative
|
Professional
|
Both
|
$204.00
|
|
|
Service Code
|
CPT 86706
|
| Hospital Charge Code |
1039133
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$37.91 |
| Max. Negotiated Rate |
$193.80 |
| Rate for Payer: Aetna Commercial |
$193.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$175.44
|
| Rate for Payer: Cash Price |
$61.20
|
| Rate for Payer: Cash Price |
$61.20
|
| Rate for Payer: Cigna Commercial |
$193.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$102.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$122.40
|
| Rate for Payer: Health EOS Commercial |
$185.64
|
| Rate for Payer: HFN Commercial |
$193.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$37.91
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$37.91
|
| Rate for Payer: Multiplan Commercial |
$163.20
|
| Rate for Payer: Preferred Network Access Commercial |
$193.80
|
| Rate for Payer: Quartz Beloit One Network |
$89.76
|
| Rate for Payer: Quartz Commercial |
$116.28
|
| Rate for Payer: The Alliance Commercial |
$102.00
|
| Rate for Payer: WEA Trust Commercial |
$112.20
|
| Rate for Payer: WPS Commercial |
$151.10
|
|
|
Hepatitis B Surface Antibody, Quantitative
|
Facility
|
IP
|
$204.00
|
|
|
Service Code
|
CPT 86317
|
| Hospital Charge Code |
1039134
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$99.96 |
| Max. Negotiated Rate |
$187.68 |
| Rate for Payer: Aetna Commercial |
$183.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$175.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$108.12
|
| Rate for Payer: Cash Price |
$61.20
|
| Rate for Payer: Cigna Commercial |
$187.68
|
| Rate for Payer: Health EOS Commercial |
$181.56
|
| Rate for Payer: HFN Commercial |
$187.68
|
| Rate for Payer: Multiplan Commercial |
$163.20
|
| Rate for Payer: NAPHCARE Commercial |
$122.40
|
| Rate for Payer: Preferred Network Access Commercial |
$187.68
|
| Rate for Payer: Quartz Beloit One Network |
$99.96
|
| Rate for Payer: Quartz Commercial |
$122.40
|
| Rate for Payer: WEA Trust Commercial |
$112.20
|
| Rate for Payer: WPS Commercial |
$151.10
|
|
|
Hepatitis B Surface Antibody, Quantitative
|
Professional
|
Both
|
$204.00
|
|
|
Service Code
|
CPT 86317
|
| Hospital Charge Code |
1039134
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$52.91 |
| Max. Negotiated Rate |
$193.80 |
| Rate for Payer: Aetna Commercial |
$193.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$175.44
|
| Rate for Payer: Cash Price |
$61.20
|
| Rate for Payer: Cash Price |
$61.20
|
| Rate for Payer: Cigna Commercial |
$193.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$102.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$122.40
|
| Rate for Payer: Health EOS Commercial |
$185.64
|
| Rate for Payer: HFN Commercial |
$193.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$52.91
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$52.91
|
| Rate for Payer: Multiplan Commercial |
$163.20
|
| Rate for Payer: Preferred Network Access Commercial |
$193.80
|
| Rate for Payer: Quartz Beloit One Network |
$89.76
|
| Rate for Payer: Quartz Commercial |
$116.28
|
| Rate for Payer: The Alliance Commercial |
$102.00
|
| Rate for Payer: WEA Trust Commercial |
$112.20
|
| Rate for Payer: WPS Commercial |
$151.10
|
|
|
Hepatitis B Surface Antibody, Quantitative
|
Facility
|
OP
|
$204.00
|
|
|
Service Code
|
CPT 86317
|
| Hospital Charge Code |
1039134
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.99 |
| 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 |
$14.99
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$56.21
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$26.23
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$24.88
|
| Rate for Payer: Anthem Medicaid |
$15.49
|
| Rate for Payer: Anthem Medicare Advantage |
$14.99
|
| 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 |
$14.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$14.99
|
| 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 |
$14.99
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$15.49
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$114.16
|
| Rate for Payer: Dean Health Medicaid |
$15.49
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$14.99
|
| Rate for Payer: Health EOS Commercial |
$181.56
|
| Rate for Payer: HFN Commercial |
$187.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$55.76
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$14.99
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$15.49
|
| Rate for Payer: Independent Care Health Plan Medicare |
$14.99
|
| Rate for Payer: Managed Health Services Medicaid |
$16.11
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$14.99
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$14.99
|
| Rate for Payer: Multiplan Commercial |
$163.20
|
| Rate for Payer: NAPHCARE Commercial |
$22.48
|
| Rate for Payer: Preferred Network Access Commercial |
$187.68
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$15.49
|
| Rate for Payer: Quartz Beloit One Network |
$99.96
|
| Rate for Payer: Quartz Commercial |
$132.60
|
| Rate for Payer: Quartz Medicare Advantage |
$14.99
|
| Rate for Payer: The Alliance Commercial |
$59.96
|
| Rate for Payer: United Healthcare Medicaid |
$15.49
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14.99
|
| Rate for Payer: United Healthcare PPO |
$153.00
|
| Rate for Payer: WEA Trust Commercial |
$112.20
|
| Rate for Payer: Wellcare Medicare |
$14.99
|
| Rate for Payer: WMAP Medicaid |
$15.49
|
| Rate for Payer: WPS Commercial |
$151.10
|
|
|
Hepatitis B Surface Antigen
|
Facility
|
IP
|
$161.00
|
|
|
Service Code
|
CPT 87340
|
| Hospital Charge Code |
633752
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$78.89 |
| Max. Negotiated Rate |
$148.12 |
| Rate for Payer: Aetna Commercial |
$144.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$138.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$85.33
|
| Rate for Payer: Cash Price |
$48.30
|
| Rate for Payer: Cigna Commercial |
$148.12
|
| Rate for Payer: Health EOS Commercial |
$143.29
|
| Rate for Payer: HFN Commercial |
$148.12
|
| Rate for Payer: Multiplan Commercial |
$128.80
|
| Rate for Payer: NAPHCARE Commercial |
$96.60
|
| Rate for Payer: Preferred Network Access Commercial |
$148.12
|
| Rate for Payer: Quartz Beloit One Network |
$78.89
|
| Rate for Payer: Quartz Commercial |
$96.60
|
| Rate for Payer: WEA Trust Commercial |
$88.55
|
| Rate for Payer: WPS Commercial |
$119.25
|
|
|
Hepatitis B Surface Antigen
|
Facility
|
OP
|
$161.00
|
|
|
Service Code
|
CPT 87340
|
| Hospital Charge Code |
633752
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.33 |
| Max. Negotiated Rate |
$148.12 |
| Rate for Payer: Aetna Commercial |
$144.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$138.46
|
| Rate for Payer: Aetna Managed Medicare |
$10.33
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$38.74
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$18.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$17.15
|
| Rate for Payer: Anthem Medicaid |
$10.67
|
| Rate for Payer: Anthem Medicare Advantage |
$10.33
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$85.33
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$10.33
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$10.33
|
| Rate for Payer: Cash Price |
$48.30
|
| Rate for Payer: Cash Price |
$48.30
|
| Rate for Payer: Cigna Commercial |
$148.12
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$10.33
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$10.67
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$90.10
|
| Rate for Payer: Dean Health Medicaid |
$10.67
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$10.33
|
| Rate for Payer: Health EOS Commercial |
$143.29
|
| Rate for Payer: HFN Commercial |
$148.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$38.43
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$10.33
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$10.67
|
| Rate for Payer: Independent Care Health Plan Medicare |
$10.33
|
| Rate for Payer: Managed Health Services Medicaid |
$11.10
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$10.33
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$10.33
|
| Rate for Payer: Multiplan Commercial |
$128.80
|
| Rate for Payer: NAPHCARE Commercial |
$15.50
|
| Rate for Payer: Preferred Network Access Commercial |
$148.12
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$10.67
|
| Rate for Payer: Quartz Beloit One Network |
$78.89
|
| Rate for Payer: Quartz Commercial |
$104.65
|
| Rate for Payer: Quartz Medicare Advantage |
$10.33
|
| Rate for Payer: The Alliance Commercial |
$41.32
|
| Rate for Payer: United Healthcare Medicaid |
$10.67
|
| Rate for Payer: United Healthcare Medicare Advantage |
$10.33
|
| Rate for Payer: United Healthcare PPO |
$120.75
|
| Rate for Payer: WEA Trust Commercial |
$88.55
|
| Rate for Payer: Wellcare Medicare |
$10.33
|
| Rate for Payer: WMAP Medicaid |
$10.67
|
| Rate for Payer: WPS Commercial |
$119.25
|
|
|
Hepatitis B Surface Antigen
|
Professional
|
Both
|
$161.00
|
|
|
Service Code
|
CPT 87340
|
| Hospital Charge Code |
633752
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$36.46 |
| Max. Negotiated Rate |
$152.95 |
| Rate for Payer: Aetna Commercial |
$152.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$138.46
|
| Rate for Payer: Cash Price |
$48.30
|
| Rate for Payer: Cash Price |
$48.30
|
| Rate for Payer: Cigna Commercial |
$152.95
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$80.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$96.60
|
| Rate for Payer: Health EOS Commercial |
$146.51
|
| Rate for Payer: HFN Commercial |
$152.95
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$36.46
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$36.46
|
| Rate for Payer: Multiplan Commercial |
$128.80
|
| Rate for Payer: Preferred Network Access Commercial |
$152.95
|
| Rate for Payer: Quartz Beloit One Network |
$70.84
|
| Rate for Payer: Quartz Commercial |
$91.77
|
| Rate for Payer: The Alliance Commercial |
$80.50
|
| Rate for Payer: WEA Trust Commercial |
$88.55
|
| Rate for Payer: WPS Commercial |
$119.25
|
|
|
Hepatitis B Surface Antigen, Qualitative
|
Facility
|
OP
|
$202.00
|
|
|
Service Code
|
CPT 87340
|
| Hospital Charge Code |
5372664
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.33 |
| Max. Negotiated Rate |
$185.84 |
| Rate for Payer: Aetna Commercial |
$181.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$173.72
|
| Rate for Payer: Aetna Managed Medicare |
$10.33
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$38.74
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$18.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$17.15
|
| Rate for Payer: Anthem Medicaid |
$10.67
|
| Rate for Payer: Anthem Medicare Advantage |
$10.33
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$107.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$10.33
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$10.33
|
| Rate for Payer: Cash Price |
$60.60
|
| Rate for Payer: Cash Price |
$60.60
|
| Rate for Payer: Cigna Commercial |
$185.84
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$10.33
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$10.67
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$113.04
|
| Rate for Payer: Dean Health Medicaid |
$10.67
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$10.33
|
| Rate for Payer: Health EOS Commercial |
$179.78
|
| Rate for Payer: HFN Commercial |
$185.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$38.43
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$10.33
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$10.67
|
| Rate for Payer: Independent Care Health Plan Medicare |
$10.33
|
| Rate for Payer: Managed Health Services Medicaid |
$11.10
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$10.33
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$10.33
|
| Rate for Payer: Multiplan Commercial |
$161.60
|
| Rate for Payer: NAPHCARE Commercial |
$15.50
|
| Rate for Payer: Preferred Network Access Commercial |
$185.84
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$10.67
|
| Rate for Payer: Quartz Beloit One Network |
$98.98
|
| Rate for Payer: Quartz Commercial |
$131.30
|
| Rate for Payer: Quartz Medicare Advantage |
$10.33
|
| Rate for Payer: The Alliance Commercial |
$41.32
|
| Rate for Payer: United Healthcare Medicaid |
$10.67
|
| Rate for Payer: United Healthcare Medicare Advantage |
$10.33
|
| Rate for Payer: United Healthcare PPO |
$151.50
|
| Rate for Payer: WEA Trust Commercial |
$111.10
|
| Rate for Payer: Wellcare Medicare |
$10.33
|
| Rate for Payer: WMAP Medicaid |
$10.67
|
| Rate for Payer: WPS Commercial |
$149.62
|
|
|
Hepatitis B Surface Antigen, Qualitative
|
Professional
|
Both
|
$202.00
|
|
|
Service Code
|
CPT 87340
|
| Hospital Charge Code |
5372664
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$36.46 |
| Max. Negotiated Rate |
$191.90 |
| Rate for Payer: Aetna Commercial |
$191.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$173.72
|
| Rate for Payer: Cash Price |
$60.60
|
| Rate for Payer: Cash Price |
$60.60
|
| Rate for Payer: Cigna Commercial |
$191.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$101.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$121.20
|
| Rate for Payer: Health EOS Commercial |
$183.82
|
| Rate for Payer: HFN Commercial |
$191.90
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$36.46
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$36.46
|
| Rate for Payer: Multiplan Commercial |
$161.60
|
| Rate for Payer: Preferred Network Access Commercial |
$191.90
|
| Rate for Payer: Quartz Beloit One Network |
$88.88
|
| Rate for Payer: Quartz Commercial |
$115.14
|
| Rate for Payer: The Alliance Commercial |
$101.00
|
| Rate for Payer: WEA Trust Commercial |
$111.10
|
| Rate for Payer: WPS Commercial |
$149.62
|
|
|
Hepatitis B Surface Antigen, Qualitative
|
Facility
|
IP
|
$202.00
|
|
|
Service Code
|
CPT 87340
|
| Hospital Charge Code |
5372664
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$98.98 |
| Max. Negotiated Rate |
$185.84 |
| Rate for Payer: Aetna Commercial |
$181.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$173.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$107.06
|
| Rate for Payer: Cash Price |
$60.60
|
| Rate for Payer: Cigna Commercial |
$185.84
|
| Rate for Payer: Health EOS Commercial |
$179.78
|
| Rate for Payer: HFN Commercial |
$185.84
|
| Rate for Payer: Multiplan Commercial |
$161.60
|
| Rate for Payer: NAPHCARE Commercial |
$121.20
|
| Rate for Payer: Preferred Network Access Commercial |
$185.84
|
| Rate for Payer: Quartz Beloit One Network |
$98.98
|
| Rate for Payer: Quartz Commercial |
$121.20
|
| Rate for Payer: WEA Trust Commercial |
$111.10
|
| Rate for Payer: WPS Commercial |
$149.62
|
|
|
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 |
$151.23 |
| Max. Negotiated Rate |
$515.85 |
| Rate for Payer: Aetna Commercial |
$515.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$466.98
|
| Rate for Payer: Cash Price |
$162.90
|
| Rate for Payer: Cash Price |
$162.90
|
| Rate for Payer: Cigna Commercial |
$515.85
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$271.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$325.80
|
| Rate for Payer: Health EOS Commercial |
$494.13
|
| Rate for Payer: HFN Commercial |
$515.85
|
| 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 |
$434.40
|
| Rate for Payer: Preferred Network Access Commercial |
$515.85
|
| Rate for Payer: Quartz Beloit One Network |
$238.92
|
| Rate for Payer: Quartz Commercial |
$309.51
|
| Rate for Payer: The Alliance Commercial |
$271.50
|
| Rate for Payer: WEA Trust Commercial |
$298.65
|
| Rate for Payer: WPS Commercial |
$402.20
|
|
|
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 |
$42.84 |
| Max. Negotiated Rate |
$499.56 |
| Rate for Payer: Aetna Commercial |
$488.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$466.98
|
| 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 |
$287.79
|
| 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 |
$162.90
|
| Rate for Payer: Cash Price |
$162.90
|
| Rate for Payer: Cigna Commercial |
$499.56
|
| 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 |
$303.86
|
| 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 |
$483.27
|
| Rate for Payer: HFN Commercial |
$499.56
|
| 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 |
$434.40
|
| Rate for Payer: NAPHCARE Commercial |
$64.26
|
| Rate for Payer: Preferred Network Access Commercial |
$499.56
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$44.27
|
| Rate for Payer: Quartz Beloit One Network |
$266.07
|
| Rate for Payer: Quartz Commercial |
$352.95
|
| 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 |
$407.25
|
| Rate for Payer: WEA Trust Commercial |
$298.65
|
| Rate for Payer: Wellcare Medicare |
$42.84
|
| Rate for Payer: WMAP Medicaid |
$44.27
|
| Rate for Payer: WPS Commercial |
$402.20
|
|
|
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 |
$266.07 |
| Max. Negotiated Rate |
$499.56 |
| Rate for Payer: Aetna Commercial |
$488.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$466.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$287.79
|
| Rate for Payer: Cash Price |
$162.90
|
| Rate for Payer: Cigna Commercial |
$499.56
|
| Rate for Payer: Health EOS Commercial |
$483.27
|
| Rate for Payer: HFN Commercial |
$499.56
|
| Rate for Payer: Multiplan Commercial |
$434.40
|
| Rate for Payer: NAPHCARE Commercial |
$325.80
|
| Rate for Payer: Preferred Network Access Commercial |
$499.56
|
| Rate for Payer: Quartz Beloit One Network |
$266.07
|
| Rate for Payer: Quartz Commercial |
$325.80
|
| Rate for Payer: WEA Trust Commercial |
$298.65
|
| Rate for Payer: WPS Commercial |
$402.20
|
|
|
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 |
$257.45 |
| Max. Negotiated Rate |
$1,029.80 |
| Rate for Payer: Aetna Commercial |
$633.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$605.44
|
| Rate for Payer: Aetna Managed Medicare |
$257.45
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$965.44
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$450.54
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$427.37
|
| Rate for Payer: Anthem Medicaid |
$266.02
|
| Rate for Payer: Anthem Medicare Advantage |
$257.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$373.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$257.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$257.45
|
| Rate for Payer: Cash Price |
$211.20
|
| Rate for Payer: Cash Price |
$211.20
|
| Rate for Payer: Cigna Commercial |
$647.68
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$257.45
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$266.02
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$393.96
|
| Rate for Payer: Dean Health Medicaid |
$266.02
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$257.45
|
| Rate for Payer: Health EOS Commercial |
$626.56
|
| Rate for Payer: HFN Commercial |
$647.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$957.71
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$257.45
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$266.02
|
| Rate for Payer: Independent Care Health Plan Medicare |
$257.45
|
| Rate for Payer: Managed Health Services Medicaid |
$276.66
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$257.45
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$257.45
|
| Rate for Payer: Multiplan Commercial |
$563.20
|
| Rate for Payer: NAPHCARE Commercial |
$386.18
|
| Rate for Payer: Preferred Network Access Commercial |
$647.68
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$266.02
|
| Rate for Payer: Quartz Beloit One Network |
$344.96
|
| Rate for Payer: Quartz Commercial |
$457.60
|
| Rate for Payer: Quartz Medicare Advantage |
$257.45
|
| Rate for Payer: The Alliance Commercial |
$1,029.80
|
| Rate for Payer: United Healthcare Medicaid |
$266.02
|
| Rate for Payer: United Healthcare Medicare Advantage |
$257.45
|
| Rate for Payer: United Healthcare PPO |
$528.00
|
| Rate for Payer: WEA Trust Commercial |
$387.20
|
| Rate for Payer: Wellcare Medicare |
$257.45
|
| Rate for Payer: WMAP Medicaid |
$266.02
|
| Rate for Payer: WPS Commercial |
$521.45
|
|
|
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 |
$344.96 |
| Max. Negotiated Rate |
$647.68 |
| Rate for Payer: Aetna Commercial |
$633.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$605.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$373.12
|
| Rate for Payer: Cash Price |
$211.20
|
| Rate for Payer: Cigna Commercial |
$647.68
|
| Rate for Payer: Health EOS Commercial |
$626.56
|
| Rate for Payer: HFN Commercial |
$647.68
|
| Rate for Payer: Multiplan Commercial |
$563.20
|
| Rate for Payer: NAPHCARE Commercial |
$422.40
|
| Rate for Payer: Preferred Network Access Commercial |
$647.68
|
| Rate for Payer: Quartz Beloit One Network |
$344.96
|
| Rate for Payer: Quartz Commercial |
$422.40
|
| Rate for Payer: WEA Trust Commercial |
$387.20
|
| Rate for Payer: WPS Commercial |
$521.45
|
|
|
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 |
$309.76 |
| Max. Negotiated Rate |
$908.80 |
| Rate for Payer: Aetna Commercial |
$668.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$605.44
|
| Rate for Payer: Cash Price |
$211.20
|
| Rate for Payer: Cash Price |
$211.20
|
| Rate for Payer: Cigna Commercial |
$668.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$352.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$422.40
|
| Rate for Payer: Health EOS Commercial |
$640.64
|
| Rate for Payer: HFN Commercial |
$668.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$908.80
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$908.80
|
| Rate for Payer: Multiplan Commercial |
$563.20
|
| Rate for Payer: Preferred Network Access Commercial |
$668.80
|
| Rate for Payer: Quartz Beloit One Network |
$309.76
|
| Rate for Payer: Quartz Commercial |
$401.28
|
| Rate for Payer: The Alliance Commercial |
$352.00
|
| Rate for Payer: WEA Trust Commercial |
$387.20
|
| Rate for Payer: WPS Commercial |
$521.45
|
|
|
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 |
$165.13 |
| Max. Negotiated Rate |
$310.04 |
| Rate for Payer: Aetna Commercial |
$303.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$289.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$178.61
|
| Rate for Payer: Cash Price |
$101.10
|
| Rate for Payer: Cigna Commercial |
$310.04
|
| Rate for Payer: Health EOS Commercial |
$299.93
|
| Rate for Payer: HFN Commercial |
$310.04
|
| Rate for Payer: Multiplan Commercial |
$269.60
|
| Rate for Payer: NAPHCARE Commercial |
$202.20
|
| Rate for Payer: Preferred Network Access Commercial |
$310.04
|
| Rate for Payer: Quartz Beloit One Network |
$165.13
|
| Rate for Payer: Quartz Commercial |
$202.20
|
| Rate for Payer: WEA Trust Commercial |
$185.35
|
| Rate for Payer: WPS Commercial |
$249.62
|
|
|
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 |
$50.37 |
| Max. Negotiated Rate |
$320.15 |
| Rate for Payer: Aetna Commercial |
$320.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$289.82
|
| Rate for Payer: Cash Price |
$101.10
|
| Rate for Payer: Cash Price |
$101.10
|
| Rate for Payer: Cigna Commercial |
$320.15
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$168.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$202.20
|
| Rate for Payer: Health EOS Commercial |
$306.67
|
| Rate for Payer: HFN Commercial |
$320.15
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$50.37
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$50.37
|
| Rate for Payer: Multiplan Commercial |
$269.60
|
| Rate for Payer: Preferred Network Access Commercial |
$320.15
|
| Rate for Payer: Quartz Beloit One Network |
$148.28
|
| Rate for Payer: Quartz Commercial |
$192.09
|
| Rate for Payer: The Alliance Commercial |
$168.50
|
| Rate for Payer: WEA Trust Commercial |
$185.35
|
| Rate for Payer: WPS Commercial |
$249.62
|
|
|
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 |
$14.27 |
| Max. Negotiated Rate |
$310.04 |
| Rate for Payer: Aetna Commercial |
$303.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$289.82
|
| Rate for Payer: Aetna Managed Medicare |
$14.27
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$53.51
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$24.97
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$23.69
|
| Rate for Payer: Anthem Medicaid |
$14.75
|
| Rate for Payer: Anthem Medicare Advantage |
$14.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$178.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$14.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$14.27
|
| Rate for Payer: Cash Price |
$101.10
|
| Rate for Payer: Cash Price |
$101.10
|
| Rate for Payer: Cigna Commercial |
$310.04
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$14.27
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$14.75
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$188.59
|
| Rate for Payer: Dean Health Medicaid |
$14.75
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$14.27
|
| Rate for Payer: Health EOS Commercial |
$299.93
|
| Rate for Payer: HFN Commercial |
$310.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$53.08
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$14.27
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$14.75
|
| Rate for Payer: Independent Care Health Plan Medicare |
$14.27
|
| Rate for Payer: Managed Health Services Medicaid |
$15.34
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$14.27
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$14.27
|
| Rate for Payer: Multiplan Commercial |
$269.60
|
| Rate for Payer: NAPHCARE Commercial |
$21.40
|
| Rate for Payer: Preferred Network Access Commercial |
$310.04
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$14.75
|
| Rate for Payer: Quartz Beloit One Network |
$165.13
|
| Rate for Payer: Quartz Commercial |
$219.05
|
| Rate for Payer: Quartz Medicare Advantage |
$14.27
|
| Rate for Payer: The Alliance Commercial |
$57.08
|
| Rate for Payer: United Healthcare Medicaid |
$14.75
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14.27
|
| Rate for Payer: United Healthcare PPO |
$252.75
|
| Rate for Payer: WEA Trust Commercial |
$185.35
|
| Rate for Payer: Wellcare Medicare |
$14.27
|
| Rate for Payer: WMAP Medicaid |
$14.75
|
| Rate for Payer: WPS Commercial |
$249.62
|
|
|
Hepatitis C Antibody, Qualitative
|
Facility
|
IP
|
$337.00
|
|
|
Service Code
|
CPT 86803
|
| Hospital Charge Code |
5372665
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$165.13 |
| Max. Negotiated Rate |
$310.04 |
| Rate for Payer: Aetna Commercial |
$303.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$289.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$178.61
|
| Rate for Payer: Cash Price |
$101.10
|
| Rate for Payer: Cigna Commercial |
$310.04
|
| Rate for Payer: Health EOS Commercial |
$299.93
|
| Rate for Payer: HFN Commercial |
$310.04
|
| Rate for Payer: Multiplan Commercial |
$269.60
|
| Rate for Payer: NAPHCARE Commercial |
$202.20
|
| Rate for Payer: Preferred Network Access Commercial |
$310.04
|
| Rate for Payer: Quartz Beloit One Network |
$165.13
|
| Rate for Payer: Quartz Commercial |
$202.20
|
| Rate for Payer: WEA Trust Commercial |
$185.35
|
| Rate for Payer: WPS Commercial |
$249.62
|
|
|
Hepatitis C Antibody, Qualitative
|
Professional
|
Both
|
$337.00
|
|
|
Service Code
|
CPT 86803
|
| Hospital Charge Code |
5372665
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$50.37 |
| Max. Negotiated Rate |
$320.15 |
| Rate for Payer: Aetna Commercial |
$320.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$289.82
|
| Rate for Payer: Cash Price |
$101.10
|
| Rate for Payer: Cash Price |
$101.10
|
| Rate for Payer: Cigna Commercial |
$320.15
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$168.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$202.20
|
| Rate for Payer: Health EOS Commercial |
$306.67
|
| Rate for Payer: HFN Commercial |
$320.15
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$50.37
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$50.37
|
| Rate for Payer: Multiplan Commercial |
$269.60
|
| Rate for Payer: Preferred Network Access Commercial |
$320.15
|
| Rate for Payer: Quartz Beloit One Network |
$148.28
|
| Rate for Payer: Quartz Commercial |
$192.09
|
| Rate for Payer: The Alliance Commercial |
$168.50
|
| Rate for Payer: WEA Trust Commercial |
$185.35
|
| Rate for Payer: WPS Commercial |
$249.62
|
|
|
Hepatitis C Antibody, Qualitative
|
Facility
|
OP
|
$337.00
|
|
|
Service Code
|
CPT 86803
|
| Hospital Charge Code |
5372665
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.27 |
| Max. Negotiated Rate |
$310.04 |
| Rate for Payer: Aetna Commercial |
$303.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$289.82
|
| Rate for Payer: Aetna Managed Medicare |
$14.27
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$53.51
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$24.97
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$23.69
|
| Rate for Payer: Anthem Medicaid |
$14.75
|
| Rate for Payer: Anthem Medicare Advantage |
$14.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$178.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$14.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$14.27
|
| Rate for Payer: Cash Price |
$101.10
|
| Rate for Payer: Cash Price |
$101.10
|
| Rate for Payer: Cigna Commercial |
$310.04
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$14.27
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$14.75
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$188.59
|
| Rate for Payer: Dean Health Medicaid |
$14.75
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$14.27
|
| Rate for Payer: Health EOS Commercial |
$299.93
|
| Rate for Payer: HFN Commercial |
$310.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$53.08
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$14.27
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$14.75
|
| Rate for Payer: Independent Care Health Plan Medicare |
$14.27
|
| Rate for Payer: Managed Health Services Medicaid |
$15.34
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$14.27
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$14.27
|
| Rate for Payer: Multiplan Commercial |
$269.60
|
| Rate for Payer: NAPHCARE Commercial |
$21.40
|
| Rate for Payer: Preferred Network Access Commercial |
$310.04
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$14.75
|
| Rate for Payer: Quartz Beloit One Network |
$165.13
|
| Rate for Payer: Quartz Commercial |
$219.05
|
| Rate for Payer: Quartz Medicare Advantage |
$14.27
|
| Rate for Payer: The Alliance Commercial |
$57.08
|
| Rate for Payer: United Healthcare Medicaid |
$14.75
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14.27
|
| Rate for Payer: United Healthcare PPO |
$252.75
|
| Rate for Payer: WEA Trust Commercial |
$185.35
|
| Rate for Payer: Wellcare Medicare |
$14.27
|
| Rate for Payer: WMAP Medicaid |
$14.75
|
| Rate for Payer: WPS Commercial |
$249.62
|
|
|
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 |
$908.80 |
| Max. Negotiated Rate |
$2,312.30 |
| Rate for Payer: Aetna Commercial |
$2,312.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,093.24
|
| Rate for Payer: Cash Price |
$730.20
|
| Rate for Payer: Cash Price |
$730.20
|
| Rate for Payer: Cigna Commercial |
$2,312.30
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,217.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,460.40
|
| Rate for Payer: Health EOS Commercial |
$2,214.94
|
| Rate for Payer: HFN Commercial |
$2,312.30
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$908.80
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$908.80
|
| Rate for Payer: Multiplan Commercial |
$1,947.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,312.30
|
| Rate for Payer: Quartz Beloit One Network |
$1,070.96
|
| Rate for Payer: Quartz Commercial |
$1,387.38
|
| Rate for Payer: The Alliance Commercial |
$1,217.00
|
| Rate for Payer: WEA Trust Commercial |
$1,338.70
|
| Rate for Payer: WPS Commercial |
$1,802.86
|
|
|
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 |
$257.45 |
| Max. Negotiated Rate |
$2,239.28 |
| Rate for Payer: Aetna Commercial |
$2,190.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,093.24
|
| Rate for Payer: Aetna Managed Medicare |
$257.45
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$965.44
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$450.54
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$427.37
|
| Rate for Payer: Anthem Medicaid |
$266.02
|
| Rate for Payer: Anthem Medicare Advantage |
$257.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,290.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$257.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$257.45
|
| Rate for Payer: Cash Price |
$730.20
|
| Rate for Payer: Cash Price |
$730.20
|
| Rate for Payer: Cigna Commercial |
$2,239.28
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$257.45
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$266.02
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,362.07
|
| Rate for Payer: Dean Health Medicaid |
$266.02
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$257.45
|
| Rate for Payer: Health EOS Commercial |
$2,166.26
|
| Rate for Payer: HFN Commercial |
$2,239.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$957.71
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$257.45
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$266.02
|
| Rate for Payer: Independent Care Health Plan Medicare |
$257.45
|
| Rate for Payer: Managed Health Services Medicaid |
$276.66
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$257.45
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$257.45
|
| Rate for Payer: Multiplan Commercial |
$1,947.20
|
| Rate for Payer: NAPHCARE Commercial |
$386.18
|
| Rate for Payer: Preferred Network Access Commercial |
$2,239.28
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$266.02
|
| Rate for Payer: Quartz Beloit One Network |
$1,192.66
|
| Rate for Payer: Quartz Commercial |
$1,582.10
|
| Rate for Payer: Quartz Medicare Advantage |
$257.45
|
| Rate for Payer: The Alliance Commercial |
$1,029.80
|
| Rate for Payer: United Healthcare Medicaid |
$266.02
|
| Rate for Payer: United Healthcare Medicare Advantage |
$257.45
|
| Rate for Payer: United Healthcare PPO |
$1,825.50
|
| Rate for Payer: WEA Trust Commercial |
$1,338.70
|
| Rate for Payer: Wellcare Medicare |
$257.45
|
| Rate for Payer: WMAP Medicaid |
$266.02
|
| Rate for Payer: WPS Commercial |
$1,802.86
|
|
