|
.Hepatitis C RNA w/Rfx NS5a Drug Resist
|
Facility
|
IP
|
$1,519.00
|
|
|
Service Code
|
CPT 87902
|
| Hospital Charge Code |
5246606
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$774.08 |
| Max. Negotiated Rate |
$1,453.38 |
| Rate for Payer: Aetna Commercial |
$1,421.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,358.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$837.27
|
| Rate for Payer: Cash Price |
$455.70
|
| Rate for Payer: Cigna Commercial |
$1,453.38
|
| Rate for Payer: Health EOS Commercial |
$1,405.99
|
| Rate for Payer: HFN Commercial |
$1,453.38
|
| Rate for Payer: Multiplan Commercial |
$1,263.81
|
| Rate for Payer: Preferred Network Access Commercial |
$1,453.38
|
| Rate for Payer: Quartz Beloit One Network |
$774.08
|
| Rate for Payer: Quartz Commercial |
$947.86
|
| Rate for Payer: WEA Trust Commercial |
$868.87
|
| Rate for Payer: WPS Commercial |
$1,170.09
|
|
|
.Hepatitis C RNA w/Rfx NS5a Drug Resist
|
Facility
|
OP
|
$1,519.00
|
|
|
Service Code
|
CPT 87902
|
| Hospital Charge Code |
5246606
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$267.75 |
| Max. Negotiated Rate |
$1,453.38 |
| Rate for Payer: Aetna Commercial |
$1,421.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,358.59
|
| Rate for Payer: Aetna Managed Medicare |
$267.75
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,004.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$468.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$444.46
|
| Rate for Payer: Anthem Medicare Advantage |
$267.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$837.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$267.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$267.75
|
| Rate for Payer: Cash Price |
$455.70
|
| Rate for Payer: Cash Price |
$455.70
|
| Rate for Payer: Cigna Commercial |
$1,453.38
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$267.75
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$884.06
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$267.75
|
| Rate for Payer: Health EOS Commercial |
$1,405.99
|
| Rate for Payer: HFN Commercial |
$1,453.38
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$996.02
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$267.75
|
| Rate for Payer: Independent Care Health Plan Medicare |
$267.75
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$267.75
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$267.75
|
| Rate for Payer: Multiplan Commercial |
$1,263.81
|
| Rate for Payer: NAPHCARE Commercial |
$401.62
|
| Rate for Payer: Preferred Network Access Commercial |
$1,453.38
|
| Rate for Payer: Quartz Beloit One Network |
$774.08
|
| Rate for Payer: Quartz Commercial |
$1,026.84
|
| Rate for Payer: Quartz Medicare Advantage |
$267.75
|
| Rate for Payer: The Alliance Commercial |
$1,070.99
|
| Rate for Payer: United Healthcare Medicare Advantage |
$267.75
|
| Rate for Payer: United Healthcare PPO |
$1,184.82
|
| Rate for Payer: WEA Trust Commercial |
$868.87
|
| Rate for Payer: Wellcare Medicare |
$267.75
|
| Rate for Payer: WPS Commercial |
$1,170.09
|
|
|
.Hepatitis C Viral RNA Genotype, LIPA
|
Professional
|
Both
|
$251.00
|
|
|
Service Code
|
CPT 87902
|
| Hospital Charge Code |
4494993
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$114.86 |
| Max. Negotiated Rate |
$1,178.09 |
| Rate for Payer: Aetna Commercial |
$247.99
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$224.49
|
| Rate for Payer: Aetna Managed Medicare |
$267.75
|
| Rate for Payer: Anthem Medicare Advantage |
$267.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$267.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$267.75
|
| Rate for Payer: Cash Price |
$75.30
|
| Rate for Payer: Cash Price |
$75.30
|
| Rate for Payer: Cigna Commercial |
$247.99
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$130.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$267.75
|
| Rate for Payer: Health EOS Commercial |
$237.55
|
| Rate for Payer: HFN Commercial |
$247.99
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$945.15
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$945.15
|
| Rate for Payer: Independent Care Health Plan Medicare |
$267.75
|
| Rate for Payer: Multiplan Commercial |
$208.83
|
| Rate for Payer: NAPHCARE Commercial |
$401.62
|
| Rate for Payer: Preferred Network Access Commercial |
$247.99
|
| Rate for Payer: Quartz Beloit One Network |
$114.86
|
| Rate for Payer: Quartz Commercial |
$148.79
|
| Rate for Payer: Quartz Medicare Advantage |
$267.75
|
| Rate for Payer: The Alliance Commercial |
$1,057.60
|
| Rate for Payer: United Healthcare Medicare Advantage |
$267.75
|
| Rate for Payer: WEA Trust Commercial |
$143.57
|
| Rate for Payer: WPS Commercial |
$1,178.09
|
|
|
.Hepatitis C Viral RNA Genotype, LIPA
|
Facility
|
OP
|
$251.00
|
|
|
Service Code
|
CPT 87902
|
| Hospital Charge Code |
4494993
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$127.91 |
| Max. Negotiated Rate |
$1,070.99 |
| Rate for Payer: Aetna Commercial |
$234.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$224.49
|
| Rate for Payer: Aetna Managed Medicare |
$267.75
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,004.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$468.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$444.46
|
| Rate for Payer: Anthem Medicare Advantage |
$267.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$138.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$267.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$267.75
|
| Rate for Payer: Cash Price |
$75.30
|
| Rate for Payer: Cash Price |
$75.30
|
| Rate for Payer: Cigna Commercial |
$240.16
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$267.75
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$146.08
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$267.75
|
| Rate for Payer: Health EOS Commercial |
$232.33
|
| Rate for Payer: HFN Commercial |
$240.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$996.02
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$267.75
|
| Rate for Payer: Independent Care Health Plan Medicare |
$267.75
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$267.75
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$267.75
|
| Rate for Payer: Multiplan Commercial |
$208.83
|
| Rate for Payer: NAPHCARE Commercial |
$401.62
|
| Rate for Payer: Preferred Network Access Commercial |
$240.16
|
| Rate for Payer: Quartz Beloit One Network |
$127.91
|
| Rate for Payer: Quartz Commercial |
$169.68
|
| Rate for Payer: Quartz Medicare Advantage |
$267.75
|
| Rate for Payer: The Alliance Commercial |
$1,070.99
|
| Rate for Payer: United Healthcare Medicare Advantage |
$267.75
|
| Rate for Payer: United Healthcare PPO |
$195.78
|
| Rate for Payer: WEA Trust Commercial |
$143.57
|
| Rate for Payer: Wellcare Medicare |
$267.75
|
| Rate for Payer: WPS Commercial |
$193.35
|
|
|
.Hepatitis C Viral RNA Genotype, LIPA
|
Facility
|
IP
|
$251.00
|
|
|
Service Code
|
CPT 87902
|
| Hospital Charge Code |
4494993
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$127.91 |
| Max. Negotiated Rate |
$240.16 |
| Rate for Payer: Aetna Commercial |
$234.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$224.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$138.35
|
| Rate for Payer: Cash Price |
$75.30
|
| Rate for Payer: Cigna Commercial |
$240.16
|
| Rate for Payer: Health EOS Commercial |
$232.33
|
| Rate for Payer: HFN Commercial |
$240.16
|
| Rate for Payer: Multiplan Commercial |
$208.83
|
| Rate for Payer: Preferred Network Access Commercial |
$240.16
|
| Rate for Payer: Quartz Beloit One Network |
$127.91
|
| Rate for Payer: Quartz Commercial |
$156.62
|
| Rate for Payer: WEA Trust Commercial |
$143.57
|
| Rate for Payer: WPS Commercial |
$193.35
|
|
|
Hepatitis D Antibody IgM
|
Professional
|
Both
|
$290.00
|
|
|
Service Code
|
CPT 86692
|
| Hospital Charge Code |
977973
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.85 |
| Max. Negotiated Rate |
$286.52 |
| Rate for Payer: Aetna Commercial |
$286.52
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$259.38
|
| Rate for Payer: Aetna Managed Medicare |
$17.85
|
| Rate for Payer: Anthem Medicare Advantage |
$17.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$17.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$17.85
|
| Rate for Payer: Cash Price |
$87.00
|
| Rate for Payer: Cash Price |
$87.00
|
| Rate for Payer: Cigna Commercial |
$286.52
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$150.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$17.85
|
| Rate for Payer: Health EOS Commercial |
$274.46
|
| Rate for Payer: HFN Commercial |
$286.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$62.99
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$62.99
|
| Rate for Payer: Independent Care Health Plan Medicare |
$17.85
|
| Rate for Payer: Multiplan Commercial |
$241.28
|
| Rate for Payer: NAPHCARE Commercial |
$26.77
|
| Rate for Payer: Preferred Network Access Commercial |
$286.52
|
| Rate for Payer: Quartz Beloit One Network |
$132.70
|
| Rate for Payer: Quartz Commercial |
$171.91
|
| Rate for Payer: Quartz Medicare Advantage |
$17.85
|
| Rate for Payer: The Alliance Commercial |
$70.49
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17.85
|
| Rate for Payer: WEA Trust Commercial |
$165.88
|
| Rate for Payer: WPS Commercial |
$78.52
|
|
|
Hepatitis D Antibody IgM
|
Facility
|
IP
|
$290.00
|
|
|
Service Code
|
CPT 86692
|
| Hospital Charge Code |
977973
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$147.78 |
| Max. Negotiated Rate |
$277.47 |
| Rate for Payer: Aetna Commercial |
$271.44
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$259.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$159.85
|
| Rate for Payer: Cash Price |
$87.00
|
| Rate for Payer: Cigna Commercial |
$277.47
|
| Rate for Payer: Health EOS Commercial |
$268.42
|
| Rate for Payer: HFN Commercial |
$277.47
|
| Rate for Payer: Multiplan Commercial |
$241.28
|
| Rate for Payer: Preferred Network Access Commercial |
$277.47
|
| Rate for Payer: Quartz Beloit One Network |
$147.78
|
| Rate for Payer: Quartz Commercial |
$180.96
|
| Rate for Payer: WEA Trust Commercial |
$165.88
|
| Rate for Payer: WPS Commercial |
$223.39
|
|
|
Hepatitis D Antibody IgM
|
Facility
|
OP
|
$290.00
|
|
|
Service Code
|
CPT 86692
|
| Hospital Charge Code |
977973
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.85 |
| Max. Negotiated Rate |
$277.47 |
| Rate for Payer: Aetna Commercial |
$271.44
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$259.38
|
| Rate for Payer: Aetna Managed Medicare |
$17.85
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$66.92
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$31.23
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$29.63
|
| Rate for Payer: Anthem Medicare Advantage |
$17.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$159.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$17.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$17.85
|
| Rate for Payer: Cash Price |
$87.00
|
| Rate for Payer: Cash Price |
$87.00
|
| Rate for Payer: Cigna Commercial |
$277.47
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$17.85
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$168.78
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$17.85
|
| Rate for Payer: Health EOS Commercial |
$268.42
|
| Rate for Payer: HFN Commercial |
$277.47
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$66.39
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$17.85
|
| Rate for Payer: Independent Care Health Plan Medicare |
$17.85
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$17.85
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$17.85
|
| Rate for Payer: Multiplan Commercial |
$241.28
|
| Rate for Payer: NAPHCARE Commercial |
$26.77
|
| Rate for Payer: Preferred Network Access Commercial |
$277.47
|
| Rate for Payer: Quartz Beloit One Network |
$147.78
|
| Rate for Payer: Quartz Commercial |
$196.04
|
| Rate for Payer: Quartz Medicare Advantage |
$17.85
|
| Rate for Payer: The Alliance Commercial |
$71.39
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17.85
|
| Rate for Payer: United Healthcare PPO |
$226.20
|
| Rate for Payer: WEA Trust Commercial |
$165.88
|
| Rate for Payer: Wellcare Medicare |
$17.85
|
| Rate for Payer: WPS Commercial |
$223.39
|
|
|
Hepatitis E Antibody, IgG & IgM
|
Facility
|
IP
|
$223.00
|
|
|
Service Code
|
CPT 86790
|
| Hospital Charge Code |
1039149
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$113.64 |
| Max. Negotiated Rate |
$213.37 |
| Rate for Payer: Aetna Commercial |
$208.73
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$199.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$122.92
|
| Rate for Payer: Cash Price |
$66.90
|
| Rate for Payer: Cigna Commercial |
$213.37
|
| Rate for Payer: Health EOS Commercial |
$206.41
|
| Rate for Payer: HFN Commercial |
$213.37
|
| Rate for Payer: Multiplan Commercial |
$185.54
|
| Rate for Payer: Preferred Network Access Commercial |
$213.37
|
| Rate for Payer: Quartz Beloit One Network |
$113.64
|
| Rate for Payer: Quartz Commercial |
$139.15
|
| Rate for Payer: WEA Trust Commercial |
$127.56
|
| Rate for Payer: WPS Commercial |
$171.78
|
|
|
Hepatitis E Antibody, IgG & IgM
|
Professional
|
Both
|
$223.00
|
|
|
Service Code
|
CPT 86790
|
| Hospital Charge Code |
1039149
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.40 |
| Max. Negotiated Rate |
$220.32 |
| Rate for Payer: Aetna Commercial |
$220.32
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$199.45
|
| Rate for Payer: Aetna Managed Medicare |
$13.40
|
| Rate for Payer: Anthem Medicare Advantage |
$13.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$13.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$13.40
|
| Rate for Payer: Cash Price |
$66.90
|
| Rate for Payer: Cash Price |
$66.90
|
| Rate for Payer: Cigna Commercial |
$220.32
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$115.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$13.40
|
| Rate for Payer: Health EOS Commercial |
$211.05
|
| Rate for Payer: HFN Commercial |
$220.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$47.29
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$47.29
|
| Rate for Payer: Independent Care Health Plan Medicare |
$13.40
|
| Rate for Payer: Multiplan Commercial |
$185.54
|
| Rate for Payer: NAPHCARE Commercial |
$20.09
|
| Rate for Payer: Preferred Network Access Commercial |
$220.32
|
| Rate for Payer: Quartz Beloit One Network |
$102.04
|
| Rate for Payer: Quartz Commercial |
$132.19
|
| Rate for Payer: Quartz Medicare Advantage |
$13.40
|
| Rate for Payer: The Alliance Commercial |
$52.91
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.40
|
| Rate for Payer: WEA Trust Commercial |
$127.56
|
| Rate for Payer: WPS Commercial |
$58.94
|
|
|
Hepatitis E Antibody, IgG & IgM
|
Facility
|
OP
|
$223.00
|
|
|
Service Code
|
CPT 86790
|
| Hospital Charge Code |
1039149
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.40 |
| Max. Negotiated Rate |
$213.37 |
| Rate for Payer: Aetna Commercial |
$208.73
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$199.45
|
| Rate for Payer: Aetna Managed Medicare |
$13.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$50.23
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$23.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$22.24
|
| Rate for Payer: Anthem Medicare Advantage |
$13.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$122.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$13.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$13.40
|
| Rate for Payer: Cash Price |
$66.90
|
| Rate for Payer: Cash Price |
$66.90
|
| Rate for Payer: Cigna Commercial |
$213.37
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$13.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$129.79
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$13.40
|
| Rate for Payer: Health EOS Commercial |
$206.41
|
| Rate for Payer: HFN Commercial |
$213.37
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$49.83
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$13.40
|
| Rate for Payer: Independent Care Health Plan Medicare |
$13.40
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$13.40
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$13.40
|
| Rate for Payer: Multiplan Commercial |
$185.54
|
| Rate for Payer: NAPHCARE Commercial |
$20.09
|
| Rate for Payer: Preferred Network Access Commercial |
$213.37
|
| Rate for Payer: Quartz Beloit One Network |
$113.64
|
| Rate for Payer: Quartz Commercial |
$150.75
|
| Rate for Payer: Quartz Medicare Advantage |
$13.40
|
| Rate for Payer: The Alliance Commercial |
$53.58
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.40
|
| Rate for Payer: United Healthcare PPO |
$173.94
|
| Rate for Payer: WEA Trust Commercial |
$127.56
|
| Rate for Payer: Wellcare Medicare |
$13.40
|
| Rate for Payer: WPS Commercial |
$171.78
|
|
|
Hepatitis E IgM Antibody
|
Facility
|
OP
|
$279.00
|
|
|
Service Code
|
CPT 86790
|
| Hospital Charge Code |
2942913
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.40 |
| Max. Negotiated Rate |
$266.95 |
| Rate for Payer: Aetna Commercial |
$261.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$249.54
|
| Rate for Payer: Aetna Managed Medicare |
$13.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$50.23
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$23.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$22.24
|
| Rate for Payer: Anthem Medicare Advantage |
$13.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$153.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$13.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$13.40
|
| Rate for Payer: Cash Price |
$83.70
|
| Rate for Payer: Cash Price |
$83.70
|
| Rate for Payer: Cigna Commercial |
$266.95
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$13.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$162.38
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$13.40
|
| Rate for Payer: Health EOS Commercial |
$258.24
|
| Rate for Payer: HFN Commercial |
$266.95
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$49.83
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$13.40
|
| Rate for Payer: Independent Care Health Plan Medicare |
$13.40
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$13.40
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$13.40
|
| Rate for Payer: Multiplan Commercial |
$232.13
|
| Rate for Payer: NAPHCARE Commercial |
$20.09
|
| Rate for Payer: Preferred Network Access Commercial |
$266.95
|
| Rate for Payer: Quartz Beloit One Network |
$142.18
|
| Rate for Payer: Quartz Commercial |
$188.60
|
| Rate for Payer: Quartz Medicare Advantage |
$13.40
|
| Rate for Payer: The Alliance Commercial |
$53.58
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.40
|
| Rate for Payer: United Healthcare PPO |
$217.62
|
| Rate for Payer: WEA Trust Commercial |
$159.59
|
| Rate for Payer: Wellcare Medicare |
$13.40
|
| Rate for Payer: WPS Commercial |
$214.91
|
|
|
Hepatitis E IgM Antibody
|
Facility
|
IP
|
$279.00
|
|
|
Service Code
|
CPT 86790
|
| Hospital Charge Code |
2942913
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$142.18 |
| Max. Negotiated Rate |
$266.95 |
| Rate for Payer: Aetna Commercial |
$261.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$249.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$153.78
|
| Rate for Payer: Cash Price |
$83.70
|
| Rate for Payer: Cigna Commercial |
$266.95
|
| Rate for Payer: Health EOS Commercial |
$258.24
|
| Rate for Payer: HFN Commercial |
$266.95
|
| Rate for Payer: Multiplan Commercial |
$232.13
|
| Rate for Payer: Preferred Network Access Commercial |
$266.95
|
| Rate for Payer: Quartz Beloit One Network |
$142.18
|
| Rate for Payer: Quartz Commercial |
$174.10
|
| Rate for Payer: WEA Trust Commercial |
$159.59
|
| Rate for Payer: WPS Commercial |
$214.91
|
|
|
Hepatitis E IgM Antibody
|
Professional
|
Both
|
$279.00
|
|
|
Service Code
|
CPT 86790
|
| Hospital Charge Code |
2942913
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.40 |
| Max. Negotiated Rate |
$275.65 |
| Rate for Payer: Aetna Commercial |
$275.65
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$249.54
|
| Rate for Payer: Aetna Managed Medicare |
$13.40
|
| Rate for Payer: Anthem Medicare Advantage |
$13.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$13.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$13.40
|
| Rate for Payer: Cash Price |
$83.70
|
| Rate for Payer: Cash Price |
$83.70
|
| Rate for Payer: Cigna Commercial |
$275.65
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$145.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$13.40
|
| Rate for Payer: Health EOS Commercial |
$264.05
|
| Rate for Payer: HFN Commercial |
$275.65
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$47.29
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$47.29
|
| Rate for Payer: Independent Care Health Plan Medicare |
$13.40
|
| Rate for Payer: Multiplan Commercial |
$232.13
|
| Rate for Payer: NAPHCARE Commercial |
$20.09
|
| Rate for Payer: Preferred Network Access Commercial |
$275.65
|
| Rate for Payer: Quartz Beloit One Network |
$127.67
|
| Rate for Payer: Quartz Commercial |
$165.39
|
| Rate for Payer: Quartz Medicare Advantage |
$13.40
|
| Rate for Payer: The Alliance Commercial |
$52.91
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.40
|
| Rate for Payer: WEA Trust Commercial |
$159.59
|
| Rate for Payer: WPS Commercial |
$58.94
|
|
|
Hepatitis Vaccine Supplies (Peritoneal Dialysis)
|
Facility
|
OP
|
$5.00
|
|
|
Service Code
|
CPT 90471
|
| Hospital Charge Code |
3026464
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$2.50 |
| Max. Negotiated Rate |
$303.10 |
| Rate for Payer: Aetna Commercial |
$4.68
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4.47
|
| Rate for Payer: Aetna Managed Medicare |
$75.77
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3.38
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2.50
|
| Rate for Payer: Anthem Medicare Advantage |
$75.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$75.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$75.77
|
| Rate for Payer: Cash Price |
$1.50
|
| Rate for Payer: Cash Price |
$1.50
|
| Rate for Payer: Cigna Commercial |
$4.78
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$75.77
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2.91
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$75.77
|
| Rate for Payer: Health EOS Commercial |
$4.63
|
| Rate for Payer: HFN Commercial |
$4.78
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$281.88
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$75.77
|
| Rate for Payer: Independent Care Health Plan Medicare |
$75.77
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$75.77
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$75.77
|
| Rate for Payer: Multiplan Commercial |
$4.16
|
| Rate for Payer: NAPHCARE Commercial |
$113.66
|
| Rate for Payer: Preferred Network Access Commercial |
$4.78
|
| Rate for Payer: Quartz Beloit One Network |
$2.55
|
| Rate for Payer: Quartz Commercial |
$3.38
|
| Rate for Payer: Quartz Medicare Advantage |
$75.77
|
| Rate for Payer: The Alliance Commercial |
$303.10
|
| Rate for Payer: United Healthcare Medicare Advantage |
$75.77
|
| Rate for Payer: WEA Trust Commercial |
$2.86
|
| Rate for Payer: Wellcare Medicare |
$75.77
|
| Rate for Payer: WPS Commercial |
$3.85
|
|
|
Hepatitis Vaccine Supplies (Peritoneal Dialysis)
|
Facility
|
IP
|
$5.00
|
|
|
Service Code
|
CPT 90471
|
| Hospital Charge Code |
3026464
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$2.55 |
| Max. Negotiated Rate |
$4.78 |
| Rate for Payer: Aetna Commercial |
$4.68
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2.76
|
| Rate for Payer: Cash Price |
$1.50
|
| Rate for Payer: Cigna Commercial |
$4.78
|
| Rate for Payer: Health EOS Commercial |
$4.63
|
| Rate for Payer: HFN Commercial |
$4.78
|
| Rate for Payer: Multiplan Commercial |
$4.16
|
| Rate for Payer: Preferred Network Access Commercial |
$4.78
|
| Rate for Payer: Quartz Beloit One Network |
$2.55
|
| Rate for Payer: Quartz Commercial |
$3.12
|
| Rate for Payer: WEA Trust Commercial |
$2.86
|
| Rate for Payer: WPS Commercial |
$3.85
|
|
|
HEPATITIS WITHOUT COMA
|
Facility
|
OP
|
$36.96
|
|
|
Service Code
|
EAPG 00636
|
| Min. Negotiated Rate |
$35.54 |
| Max. Negotiated Rate |
$36.96 |
| Rate for Payer: Anthem Medicaid |
$35.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$35.54
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$35.54
|
| Rate for Payer: Dean Health Medicaid |
$35.54
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$35.54
|
| Rate for Payer: Managed Health Services Medicaid |
$36.96
|
| Rate for Payer: Molina Healthcare Medicaid |
$35.54
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$35.54
|
| Rate for Payer: United Healthcare Medicaid |
$35.54
|
|
|
HEPATOBILIARY DIAGNOSTIC PROCEDURES WITH CC
|
Facility
|
IP
|
$47,602.88
|
|
|
Service Code
|
MSDRG 421
|
| Min. Negotiated Rate |
$13,812.90 |
| Max. Negotiated Rate |
$47,602.88 |
| Rate for Payer: Aetna Managed Medicare |
$13,812.90
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$37,910.86
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$29,058.37
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$27,607.35
|
| Rate for Payer: Anthem Medicare Advantage |
$13,812.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$13,812.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$13,812.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$13,812.90
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$30,646.69
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$13,812.90
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$34,670.69
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$13,812.90
|
| Rate for Payer: Independent Care Health Plan Medicare |
$13,812.90
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$13,812.90
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$13,812.90
|
| Rate for Payer: NAPHCARE Commercial |
$20,719.34
|
| Rate for Payer: Quartz Medicare Advantage |
$13,812.90
|
| Rate for Payer: The Alliance Commercial |
$47,602.88
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13,812.90
|
| Rate for Payer: United Healthcare PPO |
$26,991.58
|
| Rate for Payer: Wellcare Medicare |
$13,812.90
|
|
|
HEPATOBILIARY DIAGNOSTIC PROCEDURES WITH MCC
|
Facility
|
IP
|
$88,833.68
|
|
|
Service Code
|
MSDRG 420
|
| Min. Negotiated Rate |
$26,599.03 |
| Max. Negotiated Rate |
$88,833.68 |
| Rate for Payer: Aetna Managed Medicare |
$26,599.03
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$74,340.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$56,981.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$54,135.82
|
| Rate for Payer: Anthem Medicare Advantage |
$26,599.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$26,599.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$26,599.03
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$26,599.03
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$60,095.72
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$26,599.03
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$64,912.22
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$26,599.03
|
| Rate for Payer: Independent Care Health Plan Medicare |
$26,599.03
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$26,599.03
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$26,599.03
|
| Rate for Payer: NAPHCARE Commercial |
$39,898.54
|
| Rate for Payer: Quartz Medicare Advantage |
$26,599.03
|
| Rate for Payer: The Alliance Commercial |
$88,833.68
|
| Rate for Payer: United Healthcare Medicare Advantage |
$26,599.03
|
| Rate for Payer: United Healthcare PPO |
$50,534.99
|
| Rate for Payer: Wellcare Medicare |
$26,599.03
|
|
|
HEPATOBILIARY DIAGNOSTIC PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$39,346.32
|
|
|
Service Code
|
MSDRG 422
|
| Min. Negotiated Rate |
$11,224.44 |
| Max. Negotiated Rate |
$39,346.32 |
| Rate for Payer: Aetna Managed Medicare |
$11,224.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$30,535.97
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$23,405.57
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$22,236.82
|
| Rate for Payer: Anthem Medicare Advantage |
$11,224.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$11,224.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$11,224.44
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$11,224.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$24,684.91
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$11,224.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$28,615.08
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$11,224.44
|
| Rate for Payer: Independent Care Health Plan Medicare |
$11,224.44
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$11,224.44
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$11,224.44
|
| Rate for Payer: NAPHCARE Commercial |
$16,836.66
|
| Rate for Payer: Quartz Medicare Advantage |
$11,224.44
|
| Rate for Payer: The Alliance Commercial |
$39,346.32
|
| Rate for Payer: United Healthcare Medicare Advantage |
$11,224.44
|
| Rate for Payer: United Healthcare PPO |
$22,277.21
|
| Rate for Payer: Wellcare Medicare |
$11,224.44
|
|
|
Hep A Vaccine, Adult IM 90632
|
Facility
|
OP
|
$201.00
|
|
|
Service Code
|
CPT 90632
|
| Hospital Charge Code |
3382894
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$58.53 |
| Max. Negotiated Rate |
$315.08 |
| Rate for Payer: Aetna Commercial |
$188.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$179.77
|
| Rate for Payer: Aetna Managed Medicare |
$58.53
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$135.88
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$104.52
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$100.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$110.79
|
| Rate for Payer: Cash Price |
$60.30
|
| Rate for Payer: Cash Price |
$60.30
|
| Rate for Payer: Cigna Commercial |
$192.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$97.06
|
| Rate for Payer: Health EOS Commercial |
$186.05
|
| Rate for Payer: HFN Commercial |
$192.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$156.78
|
| Rate for Payer: Multiplan Commercial |
$167.23
|
| Rate for Payer: NAPHCARE Commercial |
$125.42
|
| Rate for Payer: Preferred Network Access Commercial |
$192.32
|
| Rate for Payer: Quartz Beloit One Network |
$102.43
|
| Rate for Payer: Quartz Commercial |
$135.88
|
| Rate for Payer: Quartz Medicare Advantage |
$125.42
|
| Rate for Payer: The Alliance Commercial |
$315.08
|
| Rate for Payer: WEA Trust Commercial |
$114.97
|
| Rate for Payer: WPS Commercial |
$183.41
|
|
|
Hep A Vaccine, Adult IM 90632
|
Professional
|
Both
|
$201.00
|
|
|
Service Code
|
CPT 90632
|
| Hospital Charge Code |
3382894
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$73.36 |
| Max. Negotiated Rate |
$198.59 |
| Rate for Payer: Aetna Commercial |
$198.59
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$179.77
|
| Rate for Payer: Aetna Managed Medicare |
$78.77
|
| Rate for Payer: Anthem Medicare Advantage |
$78.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$78.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$78.77
|
| Rate for Payer: Cash Price |
$60.30
|
| Rate for Payer: Cash Price |
$60.30
|
| Rate for Payer: Cigna Commercial |
$198.59
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$89.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$73.36
|
| Rate for Payer: Health EOS Commercial |
$190.23
|
| Rate for Payer: HFN Commercial |
$198.59
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$89.22
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$89.22
|
| Rate for Payer: Independent Care Health Plan Medicare |
$78.77
|
| Rate for Payer: Multiplan Commercial |
$167.23
|
| Rate for Payer: NAPHCARE Commercial |
$118.15
|
| Rate for Payer: Preferred Network Access Commercial |
$198.59
|
| Rate for Payer: Quartz Beloit One Network |
$91.98
|
| Rate for Payer: Quartz Commercial |
$119.15
|
| Rate for Payer: Quartz Medicare Advantage |
$78.77
|
| Rate for Payer: The Alliance Commercial |
$196.92
|
| Rate for Payer: United Healthcare Medicaid |
$89.60
|
| Rate for Payer: United Healthcare Medicare Advantage |
$78.77
|
| Rate for Payer: WEA Trust Commercial |
$114.97
|
| Rate for Payer: WPS Commercial |
$183.41
|
|
|
Hep A Vaccine, Adult IM 90632
|
Facility
|
IP
|
$201.00
|
|
|
Service Code
|
CPT 90632
|
| Hospital Charge Code |
3382894
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$102.43 |
| Max. Negotiated Rate |
$192.32 |
| Rate for Payer: Aetna Commercial |
$188.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$179.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$110.79
|
| Rate for Payer: Cash Price |
$60.30
|
| Rate for Payer: Cigna Commercial |
$192.32
|
| Rate for Payer: Health EOS Commercial |
$186.05
|
| Rate for Payer: HFN Commercial |
$192.32
|
| Rate for Payer: Multiplan Commercial |
$167.23
|
| Rate for Payer: Preferred Network Access Commercial |
$192.32
|
| Rate for Payer: Quartz Beloit One Network |
$102.43
|
| Rate for Payer: Quartz Commercial |
$125.42
|
| Rate for Payer: WEA Trust Commercial |
$114.97
|
| Rate for Payer: WPS Commercial |
$154.83
|
|
|
Hep A Vacc, Ped/Addl, 2 Dose 90633
|
Facility
|
OP
|
$139.00
|
|
|
Service Code
|
CPT 90633
|
| Hospital Charge Code |
3397514
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$40.48 |
| Max. Negotiated Rate |
$133.00 |
| Rate for Payer: Aetna Commercial |
$130.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$124.32
|
| Rate for Payer: Aetna Managed Medicare |
$40.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$93.96
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$72.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$69.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$76.62
|
| Rate for Payer: Cash Price |
$41.70
|
| Rate for Payer: Cigna Commercial |
$133.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$80.90
|
| Rate for Payer: Health EOS Commercial |
$128.66
|
| Rate for Payer: HFN Commercial |
$133.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$108.42
|
| Rate for Payer: Multiplan Commercial |
$115.65
|
| Rate for Payer: NAPHCARE Commercial |
$86.74
|
| Rate for Payer: Preferred Network Access Commercial |
$133.00
|
| Rate for Payer: Quartz Beloit One Network |
$70.83
|
| Rate for Payer: Quartz Commercial |
$93.96
|
| Rate for Payer: Quartz Medicare Advantage |
$86.74
|
| Rate for Payer: The Alliance Commercial |
$72.28
|
| Rate for Payer: WEA Trust Commercial |
$79.51
|
| Rate for Payer: WPS Commercial |
$107.07
|
|
|
Hep A Vacc, Ped/Addl, 2 Dose 90633
|
Facility
|
IP
|
$139.00
|
|
|
Service Code
|
CPT 90633
|
| Hospital Charge Code |
3397514
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$70.83 |
| Max. Negotiated Rate |
$133.00 |
| Rate for Payer: Aetna Commercial |
$130.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$124.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$76.62
|
| Rate for Payer: Cash Price |
$41.70
|
| Rate for Payer: Cigna Commercial |
$133.00
|
| Rate for Payer: Health EOS Commercial |
$128.66
|
| Rate for Payer: HFN Commercial |
$133.00
|
| Rate for Payer: Multiplan Commercial |
$115.65
|
| Rate for Payer: Preferred Network Access Commercial |
$133.00
|
| Rate for Payer: Quartz Beloit One Network |
$70.83
|
| Rate for Payer: Quartz Commercial |
$86.74
|
| Rate for Payer: WEA Trust Commercial |
$79.51
|
| Rate for Payer: WPS Commercial |
$107.07
|
|
