|
Hepatitis C Genotype 3 NS5a Drug Resistance
|
Facility
|
IP
|
$2,434.00
|
|
|
Service Code
|
CPT 87902
|
| Hospital Charge Code |
5598601
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$1,192.66 |
| 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: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,290.02
|
| Rate for Payer: Cash Price |
$730.20
|
| Rate for Payer: Cigna Commercial |
$2,239.28
|
| Rate for Payer: Health EOS Commercial |
$2,166.26
|
| Rate for Payer: HFN Commercial |
$2,239.28
|
| Rate for Payer: Multiplan Commercial |
$1,947.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,460.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,239.28
|
| Rate for Payer: Quartz Beloit One Network |
$1,192.66
|
| Rate for Payer: Quartz Commercial |
$1,460.40
|
| Rate for Payer: WEA Trust Commercial |
$1,338.70
|
| Rate for Payer: WPS Commercial |
$1,802.86
|
|
|
Hepatitis C Genotyping
|
Facility
|
OP
|
$1,519.00
|
|
|
Service Code
|
CPT 87902
|
| Hospital Charge Code |
977970
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$257.45 |
| Max. Negotiated Rate |
$1,397.48 |
| Rate for Payer: Aetna Commercial |
$1,367.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,306.34
|
| 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 |
$805.07
|
| 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 |
$455.70
|
| Rate for Payer: Cash Price |
$455.70
|
| Rate for Payer: Cigna Commercial |
$1,397.48
|
| 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 |
$850.03
|
| 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 |
$1,351.91
|
| Rate for Payer: HFN Commercial |
$1,397.48
|
| 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 |
$1,215.20
|
| Rate for Payer: NAPHCARE Commercial |
$386.18
|
| Rate for Payer: Preferred Network Access Commercial |
$1,397.48
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$266.02
|
| Rate for Payer: Quartz Beloit One Network |
$744.31
|
| Rate for Payer: Quartz Commercial |
$987.35
|
| 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 |
$1,139.25
|
| Rate for Payer: WEA Trust Commercial |
$835.45
|
| Rate for Payer: Wellcare Medicare |
$257.45
|
| Rate for Payer: WMAP Medicaid |
$266.02
|
| Rate for Payer: WPS Commercial |
$1,125.12
|
|
|
Hepatitis C Genotyping
|
Facility
|
IP
|
$1,519.00
|
|
|
Service Code
|
CPT 87902
|
| Hospital Charge Code |
977970
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$744.31 |
| Max. Negotiated Rate |
$1,397.48 |
| Rate for Payer: Aetna Commercial |
$1,367.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,306.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$805.07
|
| Rate for Payer: Cash Price |
$455.70
|
| Rate for Payer: Cigna Commercial |
$1,397.48
|
| Rate for Payer: Health EOS Commercial |
$1,351.91
|
| Rate for Payer: HFN Commercial |
$1,397.48
|
| Rate for Payer: Multiplan Commercial |
$1,215.20
|
| Rate for Payer: NAPHCARE Commercial |
$911.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,397.48
|
| Rate for Payer: Quartz Beloit One Network |
$744.31
|
| Rate for Payer: Quartz Commercial |
$911.40
|
| Rate for Payer: WEA Trust Commercial |
$835.45
|
| Rate for Payer: WPS Commercial |
$1,125.12
|
|
|
Hepatitis C Genotyping
|
Professional
|
Both
|
$1,519.00
|
|
|
Service Code
|
CPT 87902
|
| Hospital Charge Code |
977970
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$668.36 |
| Max. Negotiated Rate |
$1,443.05 |
| Rate for Payer: HFN Commercial |
$1,443.05
|
| Rate for Payer: Health EOS Commercial |
$1,382.29
|
| Rate for Payer: Aetna Commercial |
$1,443.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,306.34
|
| Rate for Payer: Cash Price |
$455.70
|
| Rate for Payer: Cash Price |
$455.70
|
| Rate for Payer: Cigna Commercial |
$1,443.05
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$759.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$911.40
|
| 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 |
$1,215.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,443.05
|
| Rate for Payer: Quartz Beloit One Network |
$668.36
|
| Rate for Payer: Quartz Commercial |
$865.83
|
| Rate for Payer: The Alliance Commercial |
$759.50
|
| Rate for Payer: WEA Trust Commercial |
$835.45
|
| Rate for Payer: WPS Commercial |
$1,125.12
|
|
|
Hepatitis C Qnt PCR w/rfx Genotype LiPA
|
Facility
|
OP
|
$105.00
|
|
|
Service Code
|
CPT 87522
|
| Hospital Charge Code |
6224257
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$42.84 |
| Max. Negotiated Rate |
$171.36 |
| Rate for Payer: Aetna Commercial |
$94.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$90.30
|
| 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 |
$55.65
|
| 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 |
$31.50
|
| Rate for Payer: Cash Price |
$31.50
|
| Rate for Payer: Cigna Commercial |
$96.60
|
| 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 |
$58.76
|
| 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 |
$93.45
|
| Rate for Payer: HFN Commercial |
$96.60
|
| 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 |
$84.00
|
| Rate for Payer: NAPHCARE Commercial |
$64.26
|
| Rate for Payer: Preferred Network Access Commercial |
$96.60
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$44.27
|
| Rate for Payer: Quartz Beloit One Network |
$51.45
|
| Rate for Payer: Quartz Commercial |
$68.25
|
| 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 |
$78.75
|
| Rate for Payer: WEA Trust Commercial |
$57.75
|
| Rate for Payer: Wellcare Medicare |
$42.84
|
| Rate for Payer: WMAP Medicaid |
$44.27
|
| Rate for Payer: WPS Commercial |
$77.77
|
|
|
Hepatitis C Qnt PCR w/rfx Genotype LiPA
|
Facility
|
IP
|
$105.00
|
|
|
Service Code
|
CPT 87522
|
| Hospital Charge Code |
6224257
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$51.45 |
| Max. Negotiated Rate |
$96.60 |
| Rate for Payer: Aetna Commercial |
$94.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$90.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$55.65
|
| Rate for Payer: Cash Price |
$31.50
|
| Rate for Payer: Cigna Commercial |
$96.60
|
| Rate for Payer: Health EOS Commercial |
$93.45
|
| Rate for Payer: HFN Commercial |
$96.60
|
| Rate for Payer: Multiplan Commercial |
$84.00
|
| Rate for Payer: NAPHCARE Commercial |
$63.00
|
| Rate for Payer: Preferred Network Access Commercial |
$96.60
|
| Rate for Payer: Quartz Beloit One Network |
$51.45
|
| Rate for Payer: Quartz Commercial |
$63.00
|
| Rate for Payer: WEA Trust Commercial |
$57.75
|
| Rate for Payer: WPS Commercial |
$77.77
|
|
|
Hepatitis C RNA by PCR Quantitiative
|
Professional
|
Both
|
$542.00
|
|
|
Service Code
|
CPT 87522
|
| Hospital Charge Code |
2942912
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$151.23 |
| Max. Negotiated Rate |
$514.90 |
| Rate for Payer: Aetna Commercial |
$514.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$466.12
|
| Rate for Payer: Cash Price |
$162.60
|
| Rate for Payer: Cash Price |
$162.60
|
| Rate for Payer: Cigna Commercial |
$514.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$271.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$325.20
|
| Rate for Payer: Health EOS Commercial |
$493.22
|
| Rate for Payer: HFN Commercial |
$514.90
|
| 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 |
$433.60
|
| Rate for Payer: Preferred Network Access Commercial |
$514.90
|
| Rate for Payer: Quartz Beloit One Network |
$238.48
|
| Rate for Payer: Quartz Commercial |
$308.94
|
| Rate for Payer: The Alliance Commercial |
$271.00
|
| Rate for Payer: WEA Trust Commercial |
$298.10
|
| Rate for Payer: WPS Commercial |
$401.46
|
|
|
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 |
$265.58 |
| Max. Negotiated Rate |
$498.64 |
| Rate for Payer: Aetna Commercial |
$487.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$466.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$287.26
|
| Rate for Payer: Cash Price |
$162.60
|
| Rate for Payer: Cigna Commercial |
$498.64
|
| Rate for Payer: Health EOS Commercial |
$482.38
|
| Rate for Payer: HFN Commercial |
$498.64
|
| Rate for Payer: Multiplan Commercial |
$433.60
|
| Rate for Payer: NAPHCARE Commercial |
$325.20
|
| Rate for Payer: Preferred Network Access Commercial |
$498.64
|
| Rate for Payer: Quartz Beloit One Network |
$265.58
|
| Rate for Payer: Quartz Commercial |
$325.20
|
| Rate for Payer: WEA Trust Commercial |
$298.10
|
| Rate for Payer: WPS Commercial |
$401.46
|
|
|
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 |
$42.84 |
| Max. Negotiated Rate |
$498.64 |
| Rate for Payer: Aetna Commercial |
$487.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$466.12
|
| 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 |
$287.26
|
| 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 |
$162.60
|
| Rate for Payer: Cash Price |
$162.60
|
| Rate for Payer: Cigna Commercial |
$498.64
|
| 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 |
$303.30
|
| 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 |
$482.38
|
| Rate for Payer: HFN Commercial |
$498.64
|
| 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 |
$433.60
|
| Rate for Payer: NAPHCARE Commercial |
$64.26
|
| Rate for Payer: Preferred Network Access Commercial |
$498.64
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$44.27
|
| Rate for Payer: Quartz Beloit One Network |
$265.58
|
| Rate for Payer: Quartz Commercial |
$352.30
|
| 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 |
$406.50
|
| Rate for Payer: WEA Trust Commercial |
$298.10
|
| Rate for Payer: Wellcare Medicare |
$42.84
|
| Rate for Payer: WMAP Medicaid |
$44.27
|
| Rate for Payer: WPS Commercial |
$401.46
|
|
|
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 |
$614.95 |
| Max. Negotiated Rate |
$1,154.60 |
| Rate for Payer: Aetna Commercial |
$1,129.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,079.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$665.15
|
| Rate for Payer: Cash Price |
$376.50
|
| Rate for Payer: Cigna Commercial |
$1,154.60
|
| Rate for Payer: Health EOS Commercial |
$1,116.95
|
| Rate for Payer: HFN Commercial |
$1,154.60
|
| Rate for Payer: Multiplan Commercial |
$1,004.00
|
| Rate for Payer: NAPHCARE Commercial |
$753.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,154.60
|
| Rate for Payer: Quartz Beloit One Network |
$614.95
|
| Rate for Payer: Quartz Commercial |
$753.00
|
| Rate for Payer: WEA Trust Commercial |
$690.25
|
| Rate for Payer: WPS Commercial |
$929.58
|
|
|
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 |
$552.20 |
| Max. Negotiated Rate |
$1,192.25 |
| Rate for Payer: Aetna Commercial |
$1,192.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,079.30
|
| Rate for Payer: Cash Price |
$376.50
|
| Rate for Payer: Cash Price |
$376.50
|
| Rate for Payer: Cigna Commercial |
$1,192.25
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$627.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$753.00
|
| Rate for Payer: Health EOS Commercial |
$1,142.05
|
| Rate for Payer: HFN Commercial |
$1,192.25
|
| 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 |
$1,004.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,192.25
|
| Rate for Payer: Quartz Beloit One Network |
$552.20
|
| Rate for Payer: Quartz Commercial |
$715.35
|
| Rate for Payer: The Alliance Commercial |
$627.50
|
| Rate for Payer: WEA Trust Commercial |
$690.25
|
| Rate for Payer: WPS Commercial |
$929.58
|
|
|
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 |
$257.45 |
| Max. Negotiated Rate |
$1,154.60 |
| Rate for Payer: Aetna Commercial |
$1,129.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,079.30
|
| 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 |
$665.15
|
| 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 |
$376.50
|
| Rate for Payer: Cash Price |
$376.50
|
| Rate for Payer: Cigna Commercial |
$1,154.60
|
| 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 |
$702.30
|
| 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 |
$1,116.95
|
| Rate for Payer: HFN Commercial |
$1,154.60
|
| 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 |
$1,004.00
|
| Rate for Payer: NAPHCARE Commercial |
$386.18
|
| Rate for Payer: Preferred Network Access Commercial |
$1,154.60
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$266.02
|
| Rate for Payer: Quartz Beloit One Network |
$614.95
|
| Rate for Payer: Quartz Commercial |
$815.75
|
| 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 |
$941.25
|
| Rate for Payer: WEA Trust Commercial |
$690.25
|
| Rate for Payer: Wellcare Medicare |
$257.45
|
| Rate for Payer: WMAP Medicaid |
$266.02
|
| Rate for Payer: WPS Commercial |
$929.58
|
|
|
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 |
$257.45 |
| Max. Negotiated Rate |
$1,061.68 |
| Rate for Payer: Aetna Commercial |
$1,038.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$992.44
|
| 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 |
$611.62
|
| 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 |
$346.20
|
| Rate for Payer: Cash Price |
$346.20
|
| Rate for Payer: Cigna Commercial |
$1,061.68
|
| 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 |
$645.78
|
| 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 |
$1,027.06
|
| Rate for Payer: HFN Commercial |
$1,061.68
|
| 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 |
$923.20
|
| Rate for Payer: NAPHCARE Commercial |
$386.18
|
| Rate for Payer: Preferred Network Access Commercial |
$1,061.68
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$266.02
|
| Rate for Payer: Quartz Beloit One Network |
$565.46
|
| Rate for Payer: Quartz Commercial |
$750.10
|
| 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 |
$865.50
|
| Rate for Payer: WEA Trust Commercial |
$634.70
|
| Rate for Payer: Wellcare Medicare |
$257.45
|
| Rate for Payer: WMAP Medicaid |
$266.02
|
| Rate for Payer: WPS Commercial |
$854.77
|
|
|
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 |
$507.76 |
| Max. Negotiated Rate |
$1,096.30 |
| Rate for Payer: Aetna Commercial |
$1,096.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$992.44
|
| Rate for Payer: Cash Price |
$346.20
|
| Rate for Payer: Cash Price |
$346.20
|
| Rate for Payer: Cigna Commercial |
$1,096.30
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$577.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$692.40
|
| Rate for Payer: Health EOS Commercial |
$1,050.14
|
| Rate for Payer: HFN Commercial |
$1,096.30
|
| 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 |
$923.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,096.30
|
| Rate for Payer: Quartz Beloit One Network |
$507.76
|
| Rate for Payer: Quartz Commercial |
$657.78
|
| Rate for Payer: The Alliance Commercial |
$577.00
|
| Rate for Payer: WEA Trust Commercial |
$634.70
|
| Rate for Payer: WPS Commercial |
$854.77
|
|
|
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 |
$565.46 |
| Max. Negotiated Rate |
$1,061.68 |
| Rate for Payer: Aetna Commercial |
$1,038.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$992.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$611.62
|
| Rate for Payer: Cash Price |
$346.20
|
| Rate for Payer: Cigna Commercial |
$1,061.68
|
| Rate for Payer: Health EOS Commercial |
$1,027.06
|
| Rate for Payer: HFN Commercial |
$1,061.68
|
| Rate for Payer: Multiplan Commercial |
$923.20
|
| Rate for Payer: NAPHCARE Commercial |
$692.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,061.68
|
| Rate for Payer: Quartz Beloit One Network |
$565.46
|
| Rate for Payer: Quartz Commercial |
$692.40
|
| Rate for Payer: WEA Trust Commercial |
$634.70
|
| Rate for Payer: WPS Commercial |
$854.77
|
|
|
Hepatitis C RNA PCR Quantitative
|
Facility
|
OP
|
$541.00
|
|
|
Service Code
|
CPT 87522
|
| Hospital Charge Code |
977972
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$42.84 |
| Max. Negotiated Rate |
$497.72 |
| Rate for Payer: Aetna Commercial |
$486.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$465.26
|
| 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 |
$286.73
|
| 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 |
$162.30
|
| Rate for Payer: Cash Price |
$162.30
|
| Rate for Payer: Cigna Commercial |
$497.72
|
| 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 |
$302.74
|
| 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 |
$481.49
|
| Rate for Payer: HFN Commercial |
$497.72
|
| 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 |
$432.80
|
| Rate for Payer: NAPHCARE Commercial |
$64.26
|
| Rate for Payer: Preferred Network Access Commercial |
$497.72
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$44.27
|
| Rate for Payer: Quartz Beloit One Network |
$265.09
|
| Rate for Payer: Quartz Commercial |
$351.65
|
| 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 |
$405.75
|
| Rate for Payer: WEA Trust Commercial |
$297.55
|
| Rate for Payer: Wellcare Medicare |
$42.84
|
| Rate for Payer: WMAP Medicaid |
$44.27
|
| Rate for Payer: WPS Commercial |
$400.72
|
|
|
Hepatitis C RNA PCR Quantitative
|
Professional
|
Both
|
$541.00
|
|
|
Service Code
|
CPT 87522
|
| Hospital Charge Code |
977972
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$151.23 |
| Max. Negotiated Rate |
$513.95 |
| Rate for Payer: The Alliance Commercial |
$270.50
|
| Rate for Payer: WEA Trust Commercial |
$297.55
|
| Rate for Payer: WPS Commercial |
$400.72
|
| Rate for Payer: Aetna Commercial |
$513.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$465.26
|
| Rate for Payer: Cash Price |
$162.30
|
| Rate for Payer: Cash Price |
$162.30
|
| Rate for Payer: Cigna Commercial |
$513.95
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$270.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$324.60
|
| Rate for Payer: Health EOS Commercial |
$492.31
|
| Rate for Payer: HFN Commercial |
$513.95
|
| 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 |
$432.80
|
| Rate for Payer: Preferred Network Access Commercial |
$513.95
|
| Rate for Payer: Quartz Beloit One Network |
$238.04
|
| Rate for Payer: Quartz Commercial |
$308.37
|
|
|
Hepatitis C RNA PCR Quantitative
|
Facility
|
IP
|
$541.00
|
|
|
Service Code
|
CPT 87522
|
| Hospital Charge Code |
977972
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$265.09 |
| Max. Negotiated Rate |
$497.72 |
| Rate for Payer: Aetna Commercial |
$486.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$465.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$286.73
|
| Rate for Payer: Cash Price |
$162.30
|
| Rate for Payer: Cigna Commercial |
$497.72
|
| Rate for Payer: Health EOS Commercial |
$481.49
|
| Rate for Payer: HFN Commercial |
$497.72
|
| Rate for Payer: Multiplan Commercial |
$432.80
|
| Rate for Payer: NAPHCARE Commercial |
$324.60
|
| Rate for Payer: Preferred Network Access Commercial |
$497.72
|
| Rate for Payer: Quartz Beloit One Network |
$265.09
|
| Rate for Payer: Quartz Commercial |
$324.60
|
| Rate for Payer: WEA Trust Commercial |
$297.55
|
| Rate for Payer: WPS Commercial |
$400.72
|
|
|
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 |
$42.84 |
| Max. Negotiated Rate |
$497.72 |
| Rate for Payer: Aetna Commercial |
$486.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$465.26
|
| 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 |
$286.73
|
| 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 |
$162.30
|
| Rate for Payer: Cash Price |
$162.30
|
| Rate for Payer: Cigna Commercial |
$497.72
|
| 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 |
$302.74
|
| 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 |
$481.49
|
| Rate for Payer: HFN Commercial |
$497.72
|
| 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 |
$432.80
|
| Rate for Payer: NAPHCARE Commercial |
$64.26
|
| Rate for Payer: Preferred Network Access Commercial |
$497.72
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$44.27
|
| Rate for Payer: Quartz Beloit One Network |
$265.09
|
| Rate for Payer: Quartz Commercial |
$351.65
|
| 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 |
$405.75
|
| Rate for Payer: WEA Trust Commercial |
$297.55
|
| Rate for Payer: Wellcare Medicare |
$42.84
|
| Rate for Payer: WMAP Medicaid |
$44.27
|
| Rate for Payer: WPS Commercial |
$400.72
|
|
|
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 |
$265.09 |
| Max. Negotiated Rate |
$497.72 |
| Rate for Payer: Aetna Commercial |
$486.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$465.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$286.73
|
| Rate for Payer: Cash Price |
$162.30
|
| Rate for Payer: Cigna Commercial |
$497.72
|
| Rate for Payer: Health EOS Commercial |
$481.49
|
| Rate for Payer: HFN Commercial |
$497.72
|
| Rate for Payer: Multiplan Commercial |
$432.80
|
| Rate for Payer: NAPHCARE Commercial |
$324.60
|
| Rate for Payer: Preferred Network Access Commercial |
$497.72
|
| Rate for Payer: Quartz Beloit One Network |
$265.09
|
| Rate for Payer: Quartz Commercial |
$324.60
|
| Rate for Payer: WEA Trust Commercial |
$297.55
|
| Rate for Payer: WPS Commercial |
$400.72
|
|
|
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 |
$151.23 |
| Max. Negotiated Rate |
$513.95 |
| Rate for Payer: Aetna Commercial |
$513.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$465.26
|
| Rate for Payer: Cash Price |
$162.30
|
| Rate for Payer: Cash Price |
$162.30
|
| Rate for Payer: Cigna Commercial |
$513.95
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$270.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$324.60
|
| Rate for Payer: Health EOS Commercial |
$492.31
|
| Rate for Payer: HFN Commercial |
$513.95
|
| 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 |
$432.80
|
| Rate for Payer: Preferred Network Access Commercial |
$513.95
|
| Rate for Payer: Quartz Beloit One Network |
$238.04
|
| Rate for Payer: Quartz Commercial |
$308.37
|
| Rate for Payer: The Alliance Commercial |
$270.50
|
| Rate for Payer: WEA Trust Commercial |
$297.55
|
| Rate for Payer: WPS Commercial |
$400.72
|
|
|
.Hepatitis C RNA, Quant PCR
|
Professional
|
Both
|
$541.00
|
|
|
Service Code
|
CPT 87522
|
| Hospital Charge Code |
4568681
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$151.23 |
| Max. Negotiated Rate |
$513.95 |
| Rate for Payer: Aetna Commercial |
$513.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$465.26
|
| Rate for Payer: Cash Price |
$162.30
|
| Rate for Payer: Cash Price |
$162.30
|
| Rate for Payer: Cigna Commercial |
$513.95
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$270.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$324.60
|
| Rate for Payer: Health EOS Commercial |
$492.31
|
| Rate for Payer: HFN Commercial |
$513.95
|
| 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 |
$432.80
|
| Rate for Payer: Preferred Network Access Commercial |
$513.95
|
| Rate for Payer: Quartz Beloit One Network |
$238.04
|
| Rate for Payer: Quartz Commercial |
$308.37
|
| Rate for Payer: The Alliance Commercial |
$270.50
|
| Rate for Payer: WEA Trust Commercial |
$297.55
|
| Rate for Payer: WPS Commercial |
$400.72
|
|
|
.Hepatitis C RNA, Quant PCR
|
Facility
|
IP
|
$541.00
|
|
|
Service Code
|
CPT 87522
|
| Hospital Charge Code |
4568681
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$265.09 |
| Max. Negotiated Rate |
$497.72 |
| Rate for Payer: Aetna Commercial |
$486.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$465.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$286.73
|
| Rate for Payer: Cash Price |
$162.30
|
| Rate for Payer: Cigna Commercial |
$497.72
|
| Rate for Payer: Health EOS Commercial |
$481.49
|
| Rate for Payer: HFN Commercial |
$497.72
|
| Rate for Payer: Multiplan Commercial |
$432.80
|
| Rate for Payer: NAPHCARE Commercial |
$324.60
|
| Rate for Payer: Preferred Network Access Commercial |
$497.72
|
| Rate for Payer: Quartz Beloit One Network |
$265.09
|
| Rate for Payer: Quartz Commercial |
$324.60
|
| Rate for Payer: WEA Trust Commercial |
$297.55
|
| Rate for Payer: WPS Commercial |
$400.72
|
|
|
.Hepatitis C RNA, Quant PCR
|
Facility
|
OP
|
$541.00
|
|
|
Service Code
|
CPT 87522
|
| Hospital Charge Code |
4568681
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$42.84 |
| Max. Negotiated Rate |
$497.72 |
| Rate for Payer: Aetna Commercial |
$486.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$465.26
|
| 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 |
$286.73
|
| 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 |
$162.30
|
| Rate for Payer: Cash Price |
$162.30
|
| Rate for Payer: Cigna Commercial |
$497.72
|
| 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 |
$302.74
|
| 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 |
$481.49
|
| Rate for Payer: HFN Commercial |
$497.72
|
| 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 |
$432.80
|
| Rate for Payer: NAPHCARE Commercial |
$64.26
|
| Rate for Payer: Preferred Network Access Commercial |
$497.72
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$44.27
|
| Rate for Payer: Quartz Beloit One Network |
$265.09
|
| Rate for Payer: Quartz Commercial |
$351.65
|
| 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 |
$405.75
|
| Rate for Payer: WEA Trust Commercial |
$297.55
|
| Rate for Payer: Wellcare Medicare |
$42.84
|
| Rate for Payer: WMAP Medicaid |
$44.27
|
| Rate for Payer: WPS Commercial |
$400.72
|
|
|
.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 |
$257.45 |
| Max. Negotiated Rate |
$1,397.48 |
| Rate for Payer: Aetna Commercial |
$1,367.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,306.34
|
| 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 |
$805.07
|
| 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 |
$455.70
|
| Rate for Payer: Cash Price |
$455.70
|
| Rate for Payer: Cigna Commercial |
$1,397.48
|
| 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 |
$850.03
|
| 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 |
$1,351.91
|
| Rate for Payer: HFN Commercial |
$1,397.48
|
| 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 |
$1,215.20
|
| Rate for Payer: NAPHCARE Commercial |
$386.18
|
| Rate for Payer: Preferred Network Access Commercial |
$1,397.48
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$266.02
|
| Rate for Payer: Quartz Beloit One Network |
$744.31
|
| Rate for Payer: Quartz Commercial |
$987.35
|
| 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 |
$1,139.25
|
| Rate for Payer: WEA Trust Commercial |
$835.45
|
| Rate for Payer: Wellcare Medicare |
$257.45
|
| Rate for Payer: WMAP Medicaid |
$266.02
|
| Rate for Payer: WPS Commercial |
$1,125.12
|
|
