|
Hereditary Erythrocytosis Mutations
|
Facility
|
IP
|
$1,282.00
|
|
|
Service Code
|
CPT 81479
|
| Hospital Charge Code |
4606696
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$653.31 |
| Max. Negotiated Rate |
$1,226.62 |
| Rate for Payer: Aetna Commercial |
$1,199.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,146.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$706.64
|
| Rate for Payer: Cash Price |
$384.60
|
| Rate for Payer: Cigna Commercial |
$1,226.62
|
| Rate for Payer: Health EOS Commercial |
$1,186.62
|
| Rate for Payer: HFN Commercial |
$1,226.62
|
| Rate for Payer: Multiplan Commercial |
$1,066.62
|
| Rate for Payer: Preferred Network Access Commercial |
$1,226.62
|
| Rate for Payer: Quartz Beloit One Network |
$653.31
|
| Rate for Payer: Quartz Commercial |
$799.97
|
| Rate for Payer: WEA Trust Commercial |
$733.30
|
| Rate for Payer: WPS Commercial |
$987.52
|
|
|
Hereditary Erythrocytosis Mutations
|
Professional
|
Both
|
$1,282.00
|
|
|
Service Code
|
CPT 81479
|
| Hospital Charge Code |
4606696
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$586.64 |
| Max. Negotiated Rate |
$1,266.62 |
| Rate for Payer: Aetna Commercial |
$1,266.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,146.62
|
| Rate for Payer: Cash Price |
$384.60
|
| Rate for Payer: Cigna Commercial |
$1,266.62
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$666.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$799.97
|
| Rate for Payer: Health EOS Commercial |
$1,213.28
|
| Rate for Payer: HFN Commercial |
$1,266.62
|
| Rate for Payer: Multiplan Commercial |
$1,066.62
|
| Rate for Payer: Preferred Network Access Commercial |
$1,266.62
|
| Rate for Payer: Quartz Beloit One Network |
$586.64
|
| Rate for Payer: Quartz Commercial |
$759.97
|
| Rate for Payer: The Alliance Commercial |
$666.64
|
| Rate for Payer: WEA Trust Commercial |
$733.30
|
| Rate for Payer: WPS Commercial |
$987.52
|
|
|
Hereditary Erythrocytosis Mutations
|
Facility
|
OP
|
$1,282.00
|
|
|
Service Code
|
CPT 81479
|
| Hospital Charge Code |
4606696
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$373.32 |
| Max. Negotiated Rate |
$1,226.62 |
| Rate for Payer: Aetna Commercial |
$1,199.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,146.62
|
| Rate for Payer: Aetna Managed Medicare |
$373.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$866.63
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$666.64
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$639.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$706.64
|
| Rate for Payer: Cash Price |
$384.60
|
| Rate for Payer: Cigna Commercial |
$1,226.62
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$746.12
|
| Rate for Payer: Health EOS Commercial |
$1,186.62
|
| Rate for Payer: HFN Commercial |
$1,226.62
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$999.96
|
| Rate for Payer: Multiplan Commercial |
$1,066.62
|
| Rate for Payer: NAPHCARE Commercial |
$799.97
|
| Rate for Payer: Preferred Network Access Commercial |
$1,226.62
|
| Rate for Payer: Quartz Beloit One Network |
$653.31
|
| Rate for Payer: Quartz Commercial |
$866.63
|
| Rate for Payer: Quartz Medicare Advantage |
$799.97
|
| Rate for Payer: The Alliance Commercial |
$666.64
|
| Rate for Payer: United Healthcare PPO |
$999.96
|
| Rate for Payer: WEA Trust Commercial |
$733.30
|
| Rate for Payer: WPS Commercial |
$987.52
|
|
|
Hereditary Hemochromatosis DNA Analysis
|
Facility
|
IP
|
$870.00
|
|
|
Service Code
|
CPT 81256
|
| Hospital Charge Code |
1039145
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$443.35 |
| Max. Negotiated Rate |
$832.42 |
| Rate for Payer: Aetna Commercial |
$814.32
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$778.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$479.54
|
| Rate for Payer: Cash Price |
$261.00
|
| Rate for Payer: Cigna Commercial |
$832.42
|
| Rate for Payer: Health EOS Commercial |
$805.27
|
| Rate for Payer: HFN Commercial |
$832.42
|
| Rate for Payer: Multiplan Commercial |
$723.84
|
| Rate for Payer: Preferred Network Access Commercial |
$832.42
|
| Rate for Payer: Quartz Beloit One Network |
$443.35
|
| Rate for Payer: Quartz Commercial |
$542.88
|
| Rate for Payer: WEA Trust Commercial |
$497.64
|
| Rate for Payer: WPS Commercial |
$670.16
|
|
|
Hereditary Hemochromatosis DNA Analysis
|
Professional
|
Both
|
$870.00
|
|
|
Service Code
|
CPT 81256
|
| Hospital Charge Code |
1039145
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$67.97 |
| Max. Negotiated Rate |
$859.56 |
| Rate for Payer: Aetna Commercial |
$859.56
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$778.13
|
| Rate for Payer: Aetna Managed Medicare |
$67.97
|
| Rate for Payer: Anthem Medicare Advantage |
$67.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$67.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$67.97
|
| Rate for Payer: Cash Price |
$261.00
|
| Rate for Payer: Cash Price |
$261.00
|
| Rate for Payer: Cigna Commercial |
$859.56
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$452.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$67.97
|
| Rate for Payer: Health EOS Commercial |
$823.37
|
| Rate for Payer: HFN Commercial |
$859.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$239.95
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$239.95
|
| Rate for Payer: Independent Care Health Plan Medicare |
$67.97
|
| Rate for Payer: Multiplan Commercial |
$723.84
|
| Rate for Payer: NAPHCARE Commercial |
$101.96
|
| Rate for Payer: Preferred Network Access Commercial |
$859.56
|
| Rate for Payer: Quartz Beloit One Network |
$398.11
|
| Rate for Payer: Quartz Commercial |
$515.74
|
| Rate for Payer: Quartz Medicare Advantage |
$67.97
|
| Rate for Payer: The Alliance Commercial |
$268.50
|
| Rate for Payer: United Healthcare Medicare Advantage |
$67.97
|
| Rate for Payer: WEA Trust Commercial |
$497.64
|
| Rate for Payer: WPS Commercial |
$299.09
|
|
|
Hereditary Hemochromatosis DNA Analysis
|
Facility
|
OP
|
$870.00
|
|
|
Service Code
|
CPT 81256
|
| Hospital Charge Code |
1039145
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$67.97 |
| Max. Negotiated Rate |
$832.42 |
| Rate for Payer: Aetna Commercial |
$814.32
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$778.13
|
| Rate for Payer: Aetna Managed Medicare |
$67.97
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$254.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$118.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$112.84
|
| Rate for Payer: Anthem Medicare Advantage |
$67.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$479.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$67.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$67.97
|
| Rate for Payer: Cash Price |
$261.00
|
| Rate for Payer: Cash Price |
$261.00
|
| Rate for Payer: Cigna Commercial |
$832.42
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$67.97
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$506.34
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$67.97
|
| Rate for Payer: Health EOS Commercial |
$805.27
|
| Rate for Payer: HFN Commercial |
$832.42
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$252.86
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$67.97
|
| Rate for Payer: Independent Care Health Plan Medicare |
$67.97
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$67.97
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$67.97
|
| Rate for Payer: Multiplan Commercial |
$723.84
|
| Rate for Payer: NAPHCARE Commercial |
$101.96
|
| Rate for Payer: Preferred Network Access Commercial |
$832.42
|
| Rate for Payer: Quartz Beloit One Network |
$443.35
|
| Rate for Payer: Quartz Commercial |
$588.12
|
| Rate for Payer: Quartz Medicare Advantage |
$67.97
|
| Rate for Payer: The Alliance Commercial |
$271.90
|
| Rate for Payer: United Healthcare Medicare Advantage |
$67.97
|
| Rate for Payer: United Healthcare PPO |
$678.60
|
| Rate for Payer: WEA Trust Commercial |
$497.64
|
| Rate for Payer: Wellcare Medicare |
$67.97
|
| Rate for Payer: WPS Commercial |
$670.16
|
|
|
Hereditary Hemolytic Anemia Seq, V
|
Professional
|
Both
|
$6,949.00
|
|
|
Service Code
|
CPT 81443
|
| Hospital Charge Code |
6157631
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$2,546.50 |
| Max. Negotiated Rate |
$11,204.61 |
| Rate for Payer: Aetna Commercial |
$6,865.61
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,215.19
|
| Rate for Payer: Aetna Managed Medicare |
$2,546.50
|
| Rate for Payer: Anthem Medicare Advantage |
$2,546.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$2,546.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$2,546.50
|
| Rate for Payer: Cash Price |
$2,084.70
|
| Rate for Payer: Cash Price |
$2,084.70
|
| Rate for Payer: Cigna Commercial |
$6,865.61
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$3,613.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,546.50
|
| Rate for Payer: Health EOS Commercial |
$6,576.53
|
| Rate for Payer: HFN Commercial |
$6,865.61
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$8,989.16
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$8,989.16
|
| Rate for Payer: Independent Care Health Plan Medicare |
$2,546.50
|
| Rate for Payer: Multiplan Commercial |
$5,781.57
|
| Rate for Payer: NAPHCARE Commercial |
$3,819.75
|
| Rate for Payer: Preferred Network Access Commercial |
$6,865.61
|
| Rate for Payer: Quartz Beloit One Network |
$3,179.86
|
| Rate for Payer: Quartz Commercial |
$4,119.37
|
| Rate for Payer: Quartz Medicare Advantage |
$2,546.50
|
| Rate for Payer: The Alliance Commercial |
$10,058.68
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,546.50
|
| Rate for Payer: WEA Trust Commercial |
$3,974.83
|
| Rate for Payer: WPS Commercial |
$11,204.61
|
|
|
Hereditary Hemolytic Anemia Seq, V
|
Facility
|
OP
|
$6,949.00
|
|
|
Service Code
|
CPT 81443
|
| Hospital Charge Code |
6157631
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$2,546.50 |
| Max. Negotiated Rate |
$10,186.01 |
| Rate for Payer: Aetna Commercial |
$6,504.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,215.19
|
| Rate for Payer: Aetna Managed Medicare |
$2,546.50
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$9,549.38
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,456.38
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,227.19
|
| Rate for Payer: Anthem Medicare Advantage |
$2,546.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,830.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$2,546.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$2,546.50
|
| Rate for Payer: Cash Price |
$2,084.70
|
| Rate for Payer: Cash Price |
$2,084.70
|
| Rate for Payer: Cigna Commercial |
$6,648.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$2,546.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,044.32
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$2,546.50
|
| Rate for Payer: Health EOS Commercial |
$6,431.99
|
| Rate for Payer: HFN Commercial |
$6,648.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$9,472.99
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$2,546.50
|
| Rate for Payer: Independent Care Health Plan Medicare |
$2,546.50
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$2,546.50
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$2,546.50
|
| Rate for Payer: Multiplan Commercial |
$5,781.57
|
| Rate for Payer: NAPHCARE Commercial |
$3,819.75
|
| Rate for Payer: Preferred Network Access Commercial |
$6,648.80
|
| Rate for Payer: Quartz Beloit One Network |
$3,541.21
|
| Rate for Payer: Quartz Commercial |
$4,697.52
|
| Rate for Payer: Quartz Medicare Advantage |
$2,546.50
|
| Rate for Payer: The Alliance Commercial |
$10,186.01
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,546.50
|
| Rate for Payer: United Healthcare PPO |
$5,420.22
|
| Rate for Payer: WEA Trust Commercial |
$3,974.83
|
| Rate for Payer: Wellcare Medicare |
$2,546.50
|
| Rate for Payer: WPS Commercial |
$5,352.81
|
|
|
Hereditary Hemolytic Anemia Seq, V
|
Facility
|
IP
|
$6,949.00
|
|
|
Service Code
|
CPT 81443
|
| Hospital Charge Code |
6157631
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3,541.21 |
| Max. Negotiated Rate |
$6,648.80 |
| Rate for Payer: Aetna Commercial |
$6,504.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,215.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,830.29
|
| Rate for Payer: Cash Price |
$2,084.70
|
| Rate for Payer: Cigna Commercial |
$6,648.80
|
| Rate for Payer: Health EOS Commercial |
$6,431.99
|
| Rate for Payer: HFN Commercial |
$6,648.80
|
| Rate for Payer: Multiplan Commercial |
$5,781.57
|
| Rate for Payer: Preferred Network Access Commercial |
$6,648.80
|
| Rate for Payer: Quartz Beloit One Network |
$3,541.21
|
| Rate for Payer: Quartz Commercial |
$4,336.18
|
| Rate for Payer: WEA Trust Commercial |
$3,974.83
|
| Rate for Payer: WPS Commercial |
$5,352.81
|
|
|
Her Hem Amp Target Nuclic Acid
|
Professional
|
Both
|
$285.00
|
|
| Hospital Charge Code |
2808802
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$130.42 |
| Max. Negotiated Rate |
$281.58 |
| Rate for Payer: Aetna Commercial |
$281.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$254.90
|
| Rate for Payer: Cash Price |
$85.50
|
| Rate for Payer: Cigna Commercial |
$281.58
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$148.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$177.84
|
| Rate for Payer: Health EOS Commercial |
$269.72
|
| Rate for Payer: HFN Commercial |
$281.58
|
| Rate for Payer: Multiplan Commercial |
$237.12
|
| Rate for Payer: Preferred Network Access Commercial |
$281.58
|
| Rate for Payer: Quartz Beloit One Network |
$130.42
|
| Rate for Payer: Quartz Commercial |
$168.95
|
| Rate for Payer: The Alliance Commercial |
$148.20
|
| Rate for Payer: WEA Trust Commercial |
$163.02
|
| Rate for Payer: WPS Commercial |
$219.54
|
|
|
Her Hem Amp Target Nuclic Acid
|
Facility
|
OP
|
$285.00
|
|
| Hospital Charge Code |
2808802
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$82.99 |
| Max. Negotiated Rate |
$272.69 |
| Rate for Payer: Aetna Commercial |
$266.76
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$254.90
|
| Rate for Payer: Aetna Managed Medicare |
$82.99
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$192.66
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$148.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$142.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$157.09
|
| Rate for Payer: Cash Price |
$85.50
|
| Rate for Payer: Cigna Commercial |
$272.69
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$165.87
|
| Rate for Payer: Health EOS Commercial |
$263.80
|
| Rate for Payer: HFN Commercial |
$272.69
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$222.30
|
| Rate for Payer: Multiplan Commercial |
$237.12
|
| Rate for Payer: NAPHCARE Commercial |
$177.84
|
| Rate for Payer: Preferred Network Access Commercial |
$272.69
|
| Rate for Payer: Quartz Beloit One Network |
$145.24
|
| Rate for Payer: Quartz Commercial |
$192.66
|
| Rate for Payer: Quartz Medicare Advantage |
$177.84
|
| Rate for Payer: The Alliance Commercial |
$148.20
|
| Rate for Payer: United Healthcare PPO |
$222.30
|
| Rate for Payer: WEA Trust Commercial |
$163.02
|
| Rate for Payer: WPS Commercial |
$219.54
|
|
|
Her Hem Amp Target Nuclic Acid
|
Facility
|
IP
|
$285.00
|
|
| Hospital Charge Code |
2808802
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$145.24 |
| Max. Negotiated Rate |
$272.69 |
| Rate for Payer: Aetna Commercial |
$266.76
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$254.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$157.09
|
| Rate for Payer: Cash Price |
$85.50
|
| Rate for Payer: Cigna Commercial |
$272.69
|
| Rate for Payer: Health EOS Commercial |
$263.80
|
| Rate for Payer: HFN Commercial |
$272.69
|
| Rate for Payer: Multiplan Commercial |
$237.12
|
| Rate for Payer: Preferred Network Access Commercial |
$272.69
|
| Rate for Payer: Quartz Beloit One Network |
$145.24
|
| Rate for Payer: Quartz Commercial |
$177.84
|
| Rate for Payer: WEA Trust Commercial |
$163.02
|
| Rate for Payer: WPS Commercial |
$219.54
|
|
|
Her Hem Enzymatic Digestion
|
Professional
|
Both
|
$92.00
|
|
| Hospital Charge Code |
2808803
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$42.10 |
| Max. Negotiated Rate |
$90.90 |
| Rate for Payer: Aetna Commercial |
$90.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$82.28
|
| Rate for Payer: Cash Price |
$27.60
|
| Rate for Payer: Cigna Commercial |
$90.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$47.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$57.41
|
| Rate for Payer: Health EOS Commercial |
$87.07
|
| Rate for Payer: HFN Commercial |
$90.90
|
| Rate for Payer: Multiplan Commercial |
$76.54
|
| Rate for Payer: Preferred Network Access Commercial |
$90.90
|
| Rate for Payer: Quartz Beloit One Network |
$42.10
|
| Rate for Payer: Quartz Commercial |
$54.54
|
| Rate for Payer: The Alliance Commercial |
$47.84
|
| Rate for Payer: WEA Trust Commercial |
$52.62
|
| Rate for Payer: WPS Commercial |
$70.87
|
|
|
Her Hem Enzymatic Digestion
|
Facility
|
OP
|
$92.00
|
|
| Hospital Charge Code |
2808803
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$26.79 |
| Max. Negotiated Rate |
$88.03 |
| Rate for Payer: Aetna Commercial |
$86.11
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$82.28
|
| Rate for Payer: Aetna Managed Medicare |
$26.79
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$62.19
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$47.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$45.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$50.71
|
| Rate for Payer: Cash Price |
$27.60
|
| Rate for Payer: Cigna Commercial |
$88.03
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$53.54
|
| Rate for Payer: Health EOS Commercial |
$85.16
|
| Rate for Payer: HFN Commercial |
$88.03
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$71.76
|
| Rate for Payer: Multiplan Commercial |
$76.54
|
| Rate for Payer: NAPHCARE Commercial |
$57.41
|
| Rate for Payer: Preferred Network Access Commercial |
$88.03
|
| Rate for Payer: Quartz Beloit One Network |
$46.88
|
| Rate for Payer: Quartz Commercial |
$62.19
|
| Rate for Payer: Quartz Medicare Advantage |
$57.41
|
| Rate for Payer: The Alliance Commercial |
$47.84
|
| Rate for Payer: United Healthcare PPO |
$71.76
|
| Rate for Payer: WEA Trust Commercial |
$52.62
|
| Rate for Payer: WPS Commercial |
$70.87
|
|
|
Her Hem Enzymatic Digestion
|
Facility
|
IP
|
$92.00
|
|
| Hospital Charge Code |
2808803
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$46.88 |
| Max. Negotiated Rate |
$88.03 |
| Rate for Payer: Aetna Commercial |
$86.11
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$82.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$50.71
|
| Rate for Payer: Cash Price |
$27.60
|
| Rate for Payer: Cigna Commercial |
$88.03
|
| Rate for Payer: Health EOS Commercial |
$85.16
|
| Rate for Payer: HFN Commercial |
$88.03
|
| Rate for Payer: Multiplan Commercial |
$76.54
|
| Rate for Payer: Preferred Network Access Commercial |
$88.03
|
| Rate for Payer: Quartz Beloit One Network |
$46.88
|
| Rate for Payer: Quartz Commercial |
$57.41
|
| Rate for Payer: WEA Trust Commercial |
$52.62
|
| Rate for Payer: WPS Commercial |
$70.87
|
|
|
Her Hem Interp & Report
|
Professional
|
Both
|
$114.00
|
|
| Hospital Charge Code |
2808804
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$52.17 |
| Max. Negotiated Rate |
$112.63 |
| Rate for Payer: Aetna Commercial |
$112.63
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$101.96
|
| Rate for Payer: Cash Price |
$34.20
|
| Rate for Payer: Cigna Commercial |
$112.63
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$59.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$71.14
|
| Rate for Payer: Health EOS Commercial |
$107.89
|
| Rate for Payer: HFN Commercial |
$112.63
|
| Rate for Payer: Multiplan Commercial |
$94.85
|
| Rate for Payer: Preferred Network Access Commercial |
$112.63
|
| Rate for Payer: Quartz Beloit One Network |
$52.17
|
| Rate for Payer: Quartz Commercial |
$67.58
|
| Rate for Payer: The Alliance Commercial |
$59.28
|
| Rate for Payer: WEA Trust Commercial |
$65.21
|
| Rate for Payer: WPS Commercial |
$87.81
|
|
|
Her Hem Interp & Report
|
Facility
|
OP
|
$114.00
|
|
| Hospital Charge Code |
2808804
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$33.20 |
| Max. Negotiated Rate |
$109.08 |
| Rate for Payer: Aetna Commercial |
$106.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$101.96
|
| Rate for Payer: Aetna Managed Medicare |
$33.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$77.06
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$59.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$56.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$62.84
|
| Rate for Payer: Cash Price |
$34.20
|
| Rate for Payer: Cigna Commercial |
$109.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$66.35
|
| Rate for Payer: Health EOS Commercial |
$105.52
|
| Rate for Payer: HFN Commercial |
$109.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$88.92
|
| Rate for Payer: Multiplan Commercial |
$94.85
|
| Rate for Payer: NAPHCARE Commercial |
$71.14
|
| Rate for Payer: Preferred Network Access Commercial |
$109.08
|
| Rate for Payer: Quartz Beloit One Network |
$58.09
|
| Rate for Payer: Quartz Commercial |
$77.06
|
| Rate for Payer: Quartz Medicare Advantage |
$71.14
|
| Rate for Payer: The Alliance Commercial |
$59.28
|
| Rate for Payer: United Healthcare PPO |
$88.92
|
| Rate for Payer: WEA Trust Commercial |
$65.21
|
| Rate for Payer: WPS Commercial |
$87.81
|
|
|
Her Hem Interp & Report
|
Facility
|
IP
|
$114.00
|
|
| Hospital Charge Code |
2808804
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$58.09 |
| Max. Negotiated Rate |
$109.08 |
| Rate for Payer: Aetna Commercial |
$106.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$101.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$62.84
|
| Rate for Payer: Cash Price |
$34.20
|
| Rate for Payer: Cigna Commercial |
$109.08
|
| Rate for Payer: Health EOS Commercial |
$105.52
|
| Rate for Payer: HFN Commercial |
$109.08
|
| Rate for Payer: Multiplan Commercial |
$94.85
|
| Rate for Payer: Preferred Network Access Commercial |
$109.08
|
| Rate for Payer: Quartz Beloit One Network |
$58.09
|
| Rate for Payer: Quartz Commercial |
$71.14
|
| Rate for Payer: WEA Trust Commercial |
$65.21
|
| Rate for Payer: WPS Commercial |
$87.81
|
|
|
Her Hem ISP/Extract Nucleric Acid
|
Professional
|
Both
|
$79.00
|
|
| Hospital Charge Code |
2808805
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$36.15 |
| Max. Negotiated Rate |
$78.05 |
| Rate for Payer: Aetna Commercial |
$78.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$70.66
|
| Rate for Payer: Cash Price |
$23.70
|
| Rate for Payer: Cigna Commercial |
$78.05
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$41.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$49.30
|
| Rate for Payer: Health EOS Commercial |
$74.77
|
| Rate for Payer: HFN Commercial |
$78.05
|
| Rate for Payer: Multiplan Commercial |
$65.73
|
| Rate for Payer: Preferred Network Access Commercial |
$78.05
|
| Rate for Payer: Quartz Beloit One Network |
$36.15
|
| Rate for Payer: Quartz Commercial |
$46.83
|
| Rate for Payer: The Alliance Commercial |
$41.08
|
| Rate for Payer: WEA Trust Commercial |
$45.19
|
| Rate for Payer: WPS Commercial |
$60.85
|
|
|
Her Hem ISP/Extract Nucleric Acid
|
Facility
|
OP
|
$79.00
|
|
| Hospital Charge Code |
2808805
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$23.00 |
| Max. Negotiated Rate |
$75.59 |
| Rate for Payer: Aetna Commercial |
$73.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$70.66
|
| Rate for Payer: Aetna Managed Medicare |
$23.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$53.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$41.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$39.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$43.54
|
| Rate for Payer: Cash Price |
$23.70
|
| Rate for Payer: Cigna Commercial |
$75.59
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$45.98
|
| Rate for Payer: Health EOS Commercial |
$73.12
|
| Rate for Payer: HFN Commercial |
$75.59
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$61.62
|
| Rate for Payer: Multiplan Commercial |
$65.73
|
| Rate for Payer: NAPHCARE Commercial |
$49.30
|
| Rate for Payer: Preferred Network Access Commercial |
$75.59
|
| Rate for Payer: Quartz Beloit One Network |
$40.26
|
| Rate for Payer: Quartz Commercial |
$53.40
|
| Rate for Payer: Quartz Medicare Advantage |
$49.30
|
| Rate for Payer: The Alliance Commercial |
$41.08
|
| Rate for Payer: United Healthcare PPO |
$61.62
|
| Rate for Payer: WEA Trust Commercial |
$45.19
|
| Rate for Payer: WPS Commercial |
$60.85
|
|
|
Her Hem ISP/Extract Nucleric Acid
|
Facility
|
IP
|
$79.00
|
|
| Hospital Charge Code |
2808805
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$40.26 |
| Max. Negotiated Rate |
$75.59 |
| Rate for Payer: Aetna Commercial |
$73.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$70.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$43.54
|
| Rate for Payer: Cash Price |
$23.70
|
| Rate for Payer: Cigna Commercial |
$75.59
|
| Rate for Payer: Health EOS Commercial |
$73.12
|
| Rate for Payer: HFN Commercial |
$75.59
|
| Rate for Payer: Multiplan Commercial |
$65.73
|
| Rate for Payer: Preferred Network Access Commercial |
$75.59
|
| Rate for Payer: Quartz Beloit One Network |
$40.26
|
| Rate for Payer: Quartz Commercial |
$49.30
|
| Rate for Payer: WEA Trust Commercial |
$45.19
|
| Rate for Payer: WPS Commercial |
$60.85
|
|
|
Her Hem Sep & ID High Res
|
Professional
|
Both
|
$285.00
|
|
| Hospital Charge Code |
2808806
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$130.42 |
| Max. Negotiated Rate |
$281.58 |
| Rate for Payer: Aetna Commercial |
$281.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$254.90
|
| Rate for Payer: Cash Price |
$85.50
|
| Rate for Payer: Cigna Commercial |
$281.58
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$148.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$177.84
|
| Rate for Payer: Health EOS Commercial |
$269.72
|
| Rate for Payer: HFN Commercial |
$281.58
|
| Rate for Payer: Multiplan Commercial |
$237.12
|
| Rate for Payer: Preferred Network Access Commercial |
$281.58
|
| Rate for Payer: Quartz Beloit One Network |
$130.42
|
| Rate for Payer: Quartz Commercial |
$168.95
|
| Rate for Payer: The Alliance Commercial |
$148.20
|
| Rate for Payer: WEA Trust Commercial |
$163.02
|
| Rate for Payer: WPS Commercial |
$219.54
|
|
|
Her Hem Sep & ID High Res
|
Facility
|
IP
|
$285.00
|
|
| Hospital Charge Code |
2808806
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$145.24 |
| Max. Negotiated Rate |
$272.69 |
| Rate for Payer: Aetna Commercial |
$266.76
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$254.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$157.09
|
| Rate for Payer: Cash Price |
$85.50
|
| Rate for Payer: Cigna Commercial |
$272.69
|
| Rate for Payer: Health EOS Commercial |
$263.80
|
| Rate for Payer: HFN Commercial |
$272.69
|
| Rate for Payer: Multiplan Commercial |
$237.12
|
| Rate for Payer: Preferred Network Access Commercial |
$272.69
|
| Rate for Payer: Quartz Beloit One Network |
$145.24
|
| Rate for Payer: Quartz Commercial |
$177.84
|
| Rate for Payer: WEA Trust Commercial |
$163.02
|
| Rate for Payer: WPS Commercial |
$219.54
|
|
|
Her Hem Sep & ID High Res
|
Facility
|
OP
|
$285.00
|
|
| Hospital Charge Code |
2808806
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$82.99 |
| Max. Negotiated Rate |
$272.69 |
| Rate for Payer: Aetna Commercial |
$266.76
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$254.90
|
| Rate for Payer: Aetna Managed Medicare |
$82.99
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$192.66
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$148.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$142.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$157.09
|
| Rate for Payer: Cash Price |
$85.50
|
| Rate for Payer: Cigna Commercial |
$272.69
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$165.87
|
| Rate for Payer: Health EOS Commercial |
$263.80
|
| Rate for Payer: HFN Commercial |
$272.69
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$222.30
|
| Rate for Payer: Multiplan Commercial |
$237.12
|
| Rate for Payer: NAPHCARE Commercial |
$177.84
|
| Rate for Payer: Preferred Network Access Commercial |
$272.69
|
| Rate for Payer: Quartz Beloit One Network |
$145.24
|
| Rate for Payer: Quartz Commercial |
$192.66
|
| Rate for Payer: Quartz Medicare Advantage |
$177.84
|
| Rate for Payer: The Alliance Commercial |
$148.20
|
| Rate for Payer: United Healthcare PPO |
$222.30
|
| Rate for Payer: WEA Trust Commercial |
$163.02
|
| Rate for Payer: WPS Commercial |
$219.54
|
|
|
HERNIA
|
Facility
|
OP
|
$33.05
|
|
|
Service Code
|
EAPG 00631
|
| Min. Negotiated Rate |
$31.78 |
| Max. Negotiated Rate |
$33.05 |
| Rate for Payer: Anthem Medicaid |
$31.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$31.78
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$31.78
|
| Rate for Payer: Dean Health Medicaid |
$31.78
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$31.78
|
| Rate for Payer: Managed Health Services Medicaid |
$33.05
|
| Rate for Payer: Molina Healthcare Medicaid |
$31.78
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$31.78
|
| Rate for Payer: United Healthcare Medicaid |
$31.78
|
|
