|
HPV mRNA E6/E7, Rectal w/Rfx Genotype
|
Professional
|
Both
|
$118.00
|
|
|
Service Code
|
CPT 87624
|
| Hospital Charge Code |
5455202
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$51.92 |
| Max. Negotiated Rate |
$123.87 |
| Rate for Payer: Aetna Commercial |
$112.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$101.48
|
| Rate for Payer: Cash Price |
$35.40
|
| Rate for Payer: Cash Price |
$35.40
|
| Rate for Payer: Cigna Commercial |
$112.10
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$59.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$70.80
|
| Rate for Payer: Health EOS Commercial |
$107.38
|
| Rate for Payer: HFN Commercial |
$112.10
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$123.87
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$123.87
|
| Rate for Payer: Multiplan Commercial |
$94.40
|
| Rate for Payer: Preferred Network Access Commercial |
$112.10
|
| Rate for Payer: Quartz Beloit One Network |
$51.92
|
| Rate for Payer: Quartz Commercial |
$67.26
|
| Rate for Payer: The Alliance Commercial |
$59.00
|
| Rate for Payer: WEA Trust Commercial |
$64.90
|
| Rate for Payer: WPS Commercial |
$87.40
|
|
|
HPV mRNA E6/E7, Rectal w/Rfx Genotype
|
Facility
|
OP
|
$118.00
|
|
|
Service Code
|
CPT 87624
|
| Hospital Charge Code |
5455202
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$35.09 |
| Max. Negotiated Rate |
$140.36 |
| Rate for Payer: Aetna Commercial |
$106.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$101.48
|
| Rate for Payer: Aetna Managed Medicare |
$35.09
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$131.59
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$61.41
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$58.25
|
| Rate for Payer: Anthem Medicaid |
$36.26
|
| Rate for Payer: Anthem Medicare Advantage |
$35.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$62.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$35.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$35.09
|
| Rate for Payer: Cash Price |
$35.40
|
| Rate for Payer: Cash Price |
$35.40
|
| Rate for Payer: Cigna Commercial |
$108.56
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$35.09
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$36.26
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$66.03
|
| Rate for Payer: Dean Health Medicaid |
$36.26
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$35.09
|
| Rate for Payer: Health EOS Commercial |
$105.02
|
| Rate for Payer: HFN Commercial |
$108.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$130.53
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$35.09
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$36.26
|
| Rate for Payer: Independent Care Health Plan Medicare |
$35.09
|
| Rate for Payer: Managed Health Services Medicaid |
$37.71
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$35.09
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$35.09
|
| Rate for Payer: Multiplan Commercial |
$94.40
|
| Rate for Payer: NAPHCARE Commercial |
$52.64
|
| Rate for Payer: Preferred Network Access Commercial |
$108.56
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$36.26
|
| Rate for Payer: Quartz Beloit One Network |
$57.82
|
| Rate for Payer: Quartz Commercial |
$76.70
|
| Rate for Payer: Quartz Medicare Advantage |
$35.09
|
| Rate for Payer: The Alliance Commercial |
$140.36
|
| Rate for Payer: United Healthcare Medicaid |
$36.26
|
| Rate for Payer: United Healthcare Medicare Advantage |
$35.09
|
| Rate for Payer: United Healthcare PPO |
$88.50
|
| Rate for Payer: WEA Trust Commercial |
$64.90
|
| Rate for Payer: Wellcare Medicare |
$35.09
|
| Rate for Payer: WMAP Medicaid |
$36.26
|
| Rate for Payer: WPS Commercial |
$87.40
|
|
|
HPV mRNA E6/E7, Rectal w/Rfx Genotype
|
Facility
|
IP
|
$118.00
|
|
|
Service Code
|
CPT 87624
|
| Hospital Charge Code |
5455202
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$57.82 |
| Max. Negotiated Rate |
$108.56 |
| Rate for Payer: Aetna Commercial |
$106.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$101.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$62.54
|
| Rate for Payer: Cash Price |
$35.40
|
| Rate for Payer: Cigna Commercial |
$108.56
|
| Rate for Payer: Health EOS Commercial |
$105.02
|
| Rate for Payer: HFN Commercial |
$108.56
|
| Rate for Payer: Multiplan Commercial |
$94.40
|
| Rate for Payer: NAPHCARE Commercial |
$70.80
|
| Rate for Payer: Preferred Network Access Commercial |
$108.56
|
| Rate for Payer: Quartz Beloit One Network |
$57.82
|
| Rate for Payer: Quartz Commercial |
$70.80
|
| Rate for Payer: WEA Trust Commercial |
$64.90
|
| Rate for Payer: WPS Commercial |
$87.40
|
|
|
HPV mRNA E6/E7 w/Rfx HPV 16, 18/45
|
Facility
|
IP
|
$93.00
|
|
|
Service Code
|
CPT 87624
|
| Hospital Charge Code |
5484832
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$45.57 |
| Max. Negotiated Rate |
$85.56 |
| Rate for Payer: Aetna Commercial |
$83.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$79.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$49.29
|
| Rate for Payer: Cash Price |
$27.90
|
| Rate for Payer: Cigna Commercial |
$85.56
|
| Rate for Payer: Health EOS Commercial |
$82.77
|
| Rate for Payer: HFN Commercial |
$85.56
|
| Rate for Payer: Multiplan Commercial |
$74.40
|
| Rate for Payer: NAPHCARE Commercial |
$55.80
|
| Rate for Payer: Preferred Network Access Commercial |
$85.56
|
| Rate for Payer: Quartz Beloit One Network |
$45.57
|
| Rate for Payer: Quartz Commercial |
$55.80
|
| Rate for Payer: WEA Trust Commercial |
$51.15
|
| Rate for Payer: WPS Commercial |
$68.89
|
|
|
HPV mRNA E6/E7 w/Rfx HPV 16, 18/45
|
Facility
|
OP
|
$93.00
|
|
|
Service Code
|
CPT 87624
|
| Hospital Charge Code |
5484832
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$35.09 |
| Max. Negotiated Rate |
$140.36 |
| Rate for Payer: Aetna Commercial |
$83.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$79.98
|
| Rate for Payer: Aetna Managed Medicare |
$35.09
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$131.59
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$61.41
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$58.25
|
| Rate for Payer: Anthem Medicaid |
$36.26
|
| Rate for Payer: Anthem Medicare Advantage |
$35.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$49.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$35.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$35.09
|
| Rate for Payer: Cash Price |
$27.90
|
| Rate for Payer: Cash Price |
$27.90
|
| Rate for Payer: Cigna Commercial |
$85.56
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$35.09
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$36.26
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$52.04
|
| Rate for Payer: Dean Health Medicaid |
$36.26
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$35.09
|
| Rate for Payer: Health EOS Commercial |
$82.77
|
| Rate for Payer: HFN Commercial |
$85.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$130.53
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$35.09
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$36.26
|
| Rate for Payer: Independent Care Health Plan Medicare |
$35.09
|
| Rate for Payer: Managed Health Services Medicaid |
$37.71
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$35.09
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$35.09
|
| Rate for Payer: Multiplan Commercial |
$74.40
|
| Rate for Payer: NAPHCARE Commercial |
$52.64
|
| Rate for Payer: Preferred Network Access Commercial |
$85.56
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$36.26
|
| Rate for Payer: Quartz Beloit One Network |
$45.57
|
| Rate for Payer: Quartz Commercial |
$60.45
|
| Rate for Payer: Quartz Medicare Advantage |
$35.09
|
| Rate for Payer: The Alliance Commercial |
$140.36
|
| Rate for Payer: United Healthcare Medicaid |
$36.26
|
| Rate for Payer: United Healthcare Medicare Advantage |
$35.09
|
| Rate for Payer: United Healthcare PPO |
$69.75
|
| Rate for Payer: WEA Trust Commercial |
$51.15
|
| Rate for Payer: Wellcare Medicare |
$35.09
|
| Rate for Payer: WMAP Medicaid |
$36.26
|
| Rate for Payer: WPS Commercial |
$68.89
|
|
|
HPV mRNA E6/E7 w/Rfx HPV 16, 18/45
|
Professional
|
Both
|
$93.00
|
|
|
Service Code
|
CPT 87624
|
| Hospital Charge Code |
5484832
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$40.92 |
| Max. Negotiated Rate |
$123.87 |
| Rate for Payer: Aetna Commercial |
$88.35
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$79.98
|
| Rate for Payer: Cash Price |
$27.90
|
| Rate for Payer: Cash Price |
$27.90
|
| Rate for Payer: Cigna Commercial |
$88.35
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$46.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$55.80
|
| Rate for Payer: Health EOS Commercial |
$84.63
|
| Rate for Payer: HFN Commercial |
$88.35
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$123.87
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$123.87
|
| Rate for Payer: Multiplan Commercial |
$74.40
|
| Rate for Payer: Preferred Network Access Commercial |
$88.35
|
| Rate for Payer: Quartz Beloit One Network |
$40.92
|
| Rate for Payer: Quartz Commercial |
$53.01
|
| Rate for Payer: The Alliance Commercial |
$46.50
|
| Rate for Payer: WEA Trust Commercial |
$51.15
|
| Rate for Payer: WPS Commercial |
$68.89
|
|
|
H pylori culture
|
Facility
|
OP
|
$208.00
|
|
|
Service Code
|
CPT 87205
|
| Hospital Charge Code |
3813023
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.27 |
| Max. Negotiated Rate |
$191.36 |
| Rate for Payer: Aetna Commercial |
$187.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$178.88
|
| Rate for Payer: Aetna Managed Medicare |
$4.27
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$16.01
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$7.47
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7.09
|
| Rate for Payer: Anthem Medicaid |
$4.41
|
| Rate for Payer: Anthem Medicare Advantage |
$4.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$110.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$4.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$4.27
|
| Rate for Payer: Cash Price |
$62.40
|
| Rate for Payer: Cash Price |
$62.40
|
| Rate for Payer: Cigna Commercial |
$191.36
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$4.27
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$4.41
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$116.40
|
| Rate for Payer: Dean Health Medicaid |
$4.41
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$4.27
|
| Rate for Payer: Health EOS Commercial |
$185.12
|
| Rate for Payer: HFN Commercial |
$191.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$15.88
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$4.27
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$4.41
|
| Rate for Payer: Independent Care Health Plan Medicare |
$4.27
|
| Rate for Payer: Managed Health Services Medicaid |
$4.59
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$4.27
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$4.27
|
| Rate for Payer: Multiplan Commercial |
$166.40
|
| Rate for Payer: NAPHCARE Commercial |
$6.40
|
| Rate for Payer: Preferred Network Access Commercial |
$191.36
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$4.41
|
| Rate for Payer: Quartz Beloit One Network |
$101.92
|
| Rate for Payer: Quartz Commercial |
$135.20
|
| Rate for Payer: Quartz Medicare Advantage |
$4.27
|
| Rate for Payer: The Alliance Commercial |
$17.08
|
| Rate for Payer: United Healthcare Medicaid |
$4.41
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4.27
|
| Rate for Payer: United Healthcare PPO |
$156.00
|
| Rate for Payer: WEA Trust Commercial |
$114.40
|
| Rate for Payer: Wellcare Medicare |
$4.27
|
| Rate for Payer: WMAP Medicaid |
$4.41
|
| Rate for Payer: WPS Commercial |
$154.07
|
|
|
H pylori culture
|
Professional
|
Both
|
$208.00
|
|
|
Service Code
|
CPT 87205
|
| Hospital Charge Code |
3813023
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.07 |
| Max. Negotiated Rate |
$197.60 |
| Rate for Payer: Aetna Commercial |
$197.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$178.88
|
| Rate for Payer: Cash Price |
$62.40
|
| Rate for Payer: Cash Price |
$62.40
|
| Rate for Payer: Cigna Commercial |
$197.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$104.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$124.80
|
| Rate for Payer: Health EOS Commercial |
$189.28
|
| Rate for Payer: HFN Commercial |
$197.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$15.07
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$15.07
|
| Rate for Payer: Multiplan Commercial |
$166.40
|
| Rate for Payer: Preferred Network Access Commercial |
$197.60
|
| Rate for Payer: Quartz Beloit One Network |
$91.52
|
| Rate for Payer: Quartz Commercial |
$118.56
|
| Rate for Payer: The Alliance Commercial |
$104.00
|
| Rate for Payer: WEA Trust Commercial |
$114.40
|
| Rate for Payer: WPS Commercial |
$154.07
|
|
|
H pylori culture
|
Facility
|
IP
|
$208.00
|
|
|
Service Code
|
CPT 87205
|
| Hospital Charge Code |
3813023
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$101.92 |
| Max. Negotiated Rate |
$191.36 |
| Rate for Payer: Aetna Commercial |
$187.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$178.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$110.24
|
| Rate for Payer: Cash Price |
$62.40
|
| Rate for Payer: Cigna Commercial |
$191.36
|
| Rate for Payer: Health EOS Commercial |
$185.12
|
| Rate for Payer: HFN Commercial |
$191.36
|
| Rate for Payer: Multiplan Commercial |
$166.40
|
| Rate for Payer: NAPHCARE Commercial |
$124.80
|
| Rate for Payer: Preferred Network Access Commercial |
$191.36
|
| Rate for Payer: Quartz Beloit One Network |
$101.92
|
| Rate for Payer: Quartz Commercial |
$124.80
|
| Rate for Payer: WEA Trust Commercial |
$114.40
|
| Rate for Payer: WPS Commercial |
$154.07
|
|
|
H pylori susceptibility
|
Facility
|
IP
|
$160.00
|
|
|
Service Code
|
CPT 87181
|
| Hospital Charge Code |
3813024
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$78.40 |
| Max. Negotiated Rate |
$147.20 |
| Rate for Payer: Aetna Commercial |
$144.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$137.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$84.80
|
| Rate for Payer: Cash Price |
$48.00
|
| Rate for Payer: Cigna Commercial |
$147.20
|
| Rate for Payer: Health EOS Commercial |
$142.40
|
| Rate for Payer: HFN Commercial |
$147.20
|
| Rate for Payer: Multiplan Commercial |
$128.00
|
| Rate for Payer: NAPHCARE Commercial |
$96.00
|
| Rate for Payer: Preferred Network Access Commercial |
$147.20
|
| Rate for Payer: Quartz Beloit One Network |
$78.40
|
| Rate for Payer: Quartz Commercial |
$96.00
|
| Rate for Payer: WEA Trust Commercial |
$88.00
|
| Rate for Payer: WPS Commercial |
$118.51
|
|
|
H pylori susceptibility
|
Professional
|
Both
|
$160.00
|
|
|
Service Code
|
CPT 87181
|
| Hospital Charge Code |
3813024
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$16.77 |
| Max. Negotiated Rate |
$152.00 |
| Rate for Payer: Aetna Commercial |
$152.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$137.60
|
| Rate for Payer: Cash Price |
$48.00
|
| Rate for Payer: Cash Price |
$48.00
|
| Rate for Payer: Cigna Commercial |
$152.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$80.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$96.00
|
| Rate for Payer: Health EOS Commercial |
$145.60
|
| Rate for Payer: HFN Commercial |
$152.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$16.77
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$16.77
|
| Rate for Payer: Multiplan Commercial |
$128.00
|
| Rate for Payer: Preferred Network Access Commercial |
$152.00
|
| Rate for Payer: Quartz Beloit One Network |
$70.40
|
| Rate for Payer: Quartz Commercial |
$91.20
|
| Rate for Payer: The Alliance Commercial |
$80.00
|
| Rate for Payer: WEA Trust Commercial |
$88.00
|
| Rate for Payer: WPS Commercial |
$118.51
|
|
|
H pylori susceptibility
|
Facility
|
OP
|
$160.00
|
|
|
Service Code
|
CPT 87181
|
| Hospital Charge Code |
3813024
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.75 |
| Max. Negotiated Rate |
$147.20 |
| Rate for Payer: Aetna Commercial |
$144.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$137.60
|
| Rate for Payer: Aetna Managed Medicare |
$4.75
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$17.81
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8.31
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7.88
|
| Rate for Payer: Anthem Medicaid |
$4.91
|
| Rate for Payer: Anthem Medicare Advantage |
$4.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$84.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$4.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$4.75
|
| Rate for Payer: Cash Price |
$48.00
|
| Rate for Payer: Cash Price |
$48.00
|
| Rate for Payer: Cigna Commercial |
$147.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$4.75
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$4.91
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$89.54
|
| Rate for Payer: Dean Health Medicaid |
$4.91
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$4.75
|
| Rate for Payer: Health EOS Commercial |
$142.40
|
| Rate for Payer: HFN Commercial |
$147.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$17.67
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$4.75
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$4.91
|
| Rate for Payer: Independent Care Health Plan Medicare |
$4.75
|
| Rate for Payer: Managed Health Services Medicaid |
$5.11
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$4.75
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$4.75
|
| Rate for Payer: Multiplan Commercial |
$128.00
|
| Rate for Payer: NAPHCARE Commercial |
$7.12
|
| Rate for Payer: Preferred Network Access Commercial |
$147.20
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$4.91
|
| Rate for Payer: Quartz Beloit One Network |
$78.40
|
| Rate for Payer: Quartz Commercial |
$104.00
|
| Rate for Payer: Quartz Medicare Advantage |
$4.75
|
| Rate for Payer: The Alliance Commercial |
$19.00
|
| Rate for Payer: United Healthcare Medicaid |
$4.91
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4.75
|
| Rate for Payer: United Healthcare PPO |
$120.00
|
| Rate for Payer: WEA Trust Commercial |
$88.00
|
| Rate for Payer: Wellcare Medicare |
$4.75
|
| Rate for Payer: WMAP Medicaid |
$4.91
|
| Rate for Payer: WPS Commercial |
$118.51
|
|
|
H pylori Susceptibility MIC Panel
|
Professional
|
Both
|
$128.00
|
|
|
Service Code
|
CPT 87181
|
| Hospital Charge Code |
3811604
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$16.77 |
| Max. Negotiated Rate |
$121.60 |
| Rate for Payer: Aetna Commercial |
$121.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$110.08
|
| Rate for Payer: Cash Price |
$38.40
|
| Rate for Payer: Cash Price |
$38.40
|
| Rate for Payer: Cigna Commercial |
$121.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$64.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$76.80
|
| Rate for Payer: Health EOS Commercial |
$116.48
|
| Rate for Payer: HFN Commercial |
$121.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$16.77
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$16.77
|
| Rate for Payer: Multiplan Commercial |
$102.40
|
| Rate for Payer: Preferred Network Access Commercial |
$121.60
|
| Rate for Payer: Quartz Beloit One Network |
$56.32
|
| Rate for Payer: Quartz Commercial |
$72.96
|
| Rate for Payer: The Alliance Commercial |
$64.00
|
| Rate for Payer: WEA Trust Commercial |
$70.40
|
| Rate for Payer: WPS Commercial |
$94.81
|
|
|
H pylori Susceptibility MIC Panel
|
Facility
|
OP
|
$128.00
|
|
|
Service Code
|
CPT 87181
|
| Hospital Charge Code |
3811604
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.75 |
| Max. Negotiated Rate |
$117.76 |
| Rate for Payer: Aetna Commercial |
$115.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$110.08
|
| Rate for Payer: Aetna Managed Medicare |
$4.75
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$17.81
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8.31
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7.88
|
| Rate for Payer: Anthem Medicaid |
$4.91
|
| Rate for Payer: Anthem Medicare Advantage |
$4.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$67.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$4.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$4.75
|
| Rate for Payer: Cash Price |
$38.40
|
| Rate for Payer: Cash Price |
$38.40
|
| Rate for Payer: Cigna Commercial |
$117.76
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$4.75
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$4.91
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$71.63
|
| Rate for Payer: Dean Health Medicaid |
$4.91
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$4.75
|
| Rate for Payer: Health EOS Commercial |
$113.92
|
| Rate for Payer: HFN Commercial |
$117.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$17.67
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$4.75
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$4.91
|
| Rate for Payer: Independent Care Health Plan Medicare |
$4.75
|
| Rate for Payer: Managed Health Services Medicaid |
$5.11
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$4.75
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$4.75
|
| Rate for Payer: Multiplan Commercial |
$102.40
|
| Rate for Payer: NAPHCARE Commercial |
$7.12
|
| Rate for Payer: Preferred Network Access Commercial |
$117.76
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$4.91
|
| Rate for Payer: Quartz Beloit One Network |
$62.72
|
| Rate for Payer: Quartz Commercial |
$83.20
|
| Rate for Payer: Quartz Medicare Advantage |
$4.75
|
| Rate for Payer: The Alliance Commercial |
$19.00
|
| Rate for Payer: United Healthcare Medicaid |
$4.91
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4.75
|
| Rate for Payer: United Healthcare PPO |
$96.00
|
| Rate for Payer: WEA Trust Commercial |
$70.40
|
| Rate for Payer: Wellcare Medicare |
$4.75
|
| Rate for Payer: WMAP Medicaid |
$4.91
|
| Rate for Payer: WPS Commercial |
$94.81
|
|
|
H pylori Susceptibility MIC Panel
|
Facility
|
IP
|
$128.00
|
|
|
Service Code
|
CPT 87181
|
| Hospital Charge Code |
3811604
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$62.72 |
| Max. Negotiated Rate |
$117.76 |
| Rate for Payer: Aetna Commercial |
$115.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$110.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$67.84
|
| Rate for Payer: Cash Price |
$38.40
|
| Rate for Payer: Cigna Commercial |
$117.76
|
| Rate for Payer: Health EOS Commercial |
$113.92
|
| Rate for Payer: HFN Commercial |
$117.76
|
| Rate for Payer: Multiplan Commercial |
$102.40
|
| Rate for Payer: NAPHCARE Commercial |
$76.80
|
| Rate for Payer: Preferred Network Access Commercial |
$117.76
|
| Rate for Payer: Quartz Beloit One Network |
$62.72
|
| Rate for Payer: Quartz Commercial |
$76.80
|
| Rate for Payer: WEA Trust Commercial |
$70.40
|
| Rate for Payer: WPS Commercial |
$94.81
|
|
|
HSP-70 Antibody
|
Professional
|
Both
|
$223.00
|
|
|
Service Code
|
CPT 84181
|
| Hospital Charge Code |
5382910
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$16.61 |
| Max. Negotiated Rate |
$211.85 |
| Rate for Payer: Aetna Commercial |
$211.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$191.78
|
| Rate for Payer: Anthem Commercial |
$16.61
|
| Rate for Payer: Cash Price |
$66.90
|
| Rate for Payer: Cash Price |
$66.90
|
| Rate for Payer: Cigna Commercial |
$211.85
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$111.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$133.80
|
| Rate for Payer: Health EOS Commercial |
$202.93
|
| Rate for Payer: HFN Commercial |
$211.85
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$60.12
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$60.12
|
| Rate for Payer: Multiplan Commercial |
$178.40
|
| Rate for Payer: Preferred Network Access Commercial |
$211.85
|
| Rate for Payer: Quartz Beloit One Network |
$98.12
|
| Rate for Payer: Quartz Commercial |
$127.11
|
| Rate for Payer: The Alliance Commercial |
$111.50
|
| Rate for Payer: WEA Trust Commercial |
$122.65
|
| Rate for Payer: WPS Commercial |
$165.18
|
|
|
HSP-70 Antibody
|
Facility
|
OP
|
$223.00
|
|
|
Service Code
|
CPT 84181
|
| Hospital Charge Code |
5382910
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.03 |
| Max. Negotiated Rate |
$205.16 |
| Rate for Payer: Aetna Commercial |
$200.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$191.78
|
| Rate for Payer: Aetna Managed Medicare |
$17.03
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$63.86
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$29.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$28.27
|
| Rate for Payer: Anthem Medicaid |
$17.60
|
| Rate for Payer: Anthem Medicare Advantage |
$17.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$118.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$17.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$17.03
|
| Rate for Payer: Cash Price |
$66.90
|
| Rate for Payer: Cash Price |
$66.90
|
| Rate for Payer: Cigna Commercial |
$205.16
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$17.03
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$17.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$124.79
|
| Rate for Payer: Dean Health Medicaid |
$17.60
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$17.03
|
| Rate for Payer: Health EOS Commercial |
$198.47
|
| Rate for Payer: HFN Commercial |
$205.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$63.35
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$17.03
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$17.60
|
| Rate for Payer: Independent Care Health Plan Medicare |
$17.03
|
| Rate for Payer: Managed Health Services Medicaid |
$18.30
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$17.03
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$17.03
|
| Rate for Payer: Multiplan Commercial |
$178.40
|
| Rate for Payer: NAPHCARE Commercial |
$25.54
|
| Rate for Payer: Preferred Network Access Commercial |
$205.16
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$17.60
|
| Rate for Payer: Quartz Beloit One Network |
$109.27
|
| Rate for Payer: Quartz Commercial |
$144.95
|
| Rate for Payer: Quartz Medicare Advantage |
$17.03
|
| Rate for Payer: The Alliance Commercial |
$68.12
|
| Rate for Payer: United Healthcare Medicaid |
$17.60
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17.03
|
| Rate for Payer: United Healthcare PPO |
$167.25
|
| Rate for Payer: WEA Trust Commercial |
$122.65
|
| Rate for Payer: Wellcare Medicare |
$17.03
|
| Rate for Payer: WMAP Medicaid |
$17.60
|
| Rate for Payer: WPS Commercial |
$165.18
|
|
|
HSP-70 Antibody
|
Facility
|
IP
|
$223.00
|
|
|
Service Code
|
CPT 84181
|
| Hospital Charge Code |
5382910
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$109.27 |
| Max. Negotiated Rate |
$205.16 |
| Rate for Payer: Aetna Commercial |
$200.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$191.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$118.19
|
| Rate for Payer: Cash Price |
$66.90
|
| Rate for Payer: Cigna Commercial |
$205.16
|
| Rate for Payer: Health EOS Commercial |
$198.47
|
| Rate for Payer: HFN Commercial |
$205.16
|
| Rate for Payer: Multiplan Commercial |
$178.40
|
| Rate for Payer: NAPHCARE Commercial |
$133.80
|
| Rate for Payer: Preferred Network Access Commercial |
$205.16
|
| Rate for Payer: Quartz Beloit One Network |
$109.27
|
| Rate for Payer: Quartz Commercial |
$133.80
|
| Rate for Payer: WEA Trust Commercial |
$122.65
|
| Rate for Payer: WPS Commercial |
$165.18
|
|
|
HSV Type I & II PCR / 34257
|
Facility
|
OP
|
$275.00
|
|
|
Service Code
|
CPT 87529
|
| Hospital Charge Code |
1039240
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$35.09 |
| Max. Negotiated Rate |
$253.00 |
| Rate for Payer: Aetna Commercial |
$247.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$236.50
|
| Rate for Payer: Aetna Managed Medicare |
$35.09
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$131.59
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$61.41
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$58.25
|
| Rate for Payer: Anthem Medicaid |
$36.26
|
| Rate for Payer: Anthem Medicare Advantage |
$35.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$145.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$35.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$35.09
|
| Rate for Payer: Cash Price |
$82.50
|
| Rate for Payer: Cash Price |
$82.50
|
| Rate for Payer: Cigna Commercial |
$253.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$35.09
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$36.26
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$153.89
|
| Rate for Payer: Dean Health Medicaid |
$36.26
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$35.09
|
| Rate for Payer: Health EOS Commercial |
$244.75
|
| Rate for Payer: HFN Commercial |
$253.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$130.53
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$35.09
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$36.26
|
| Rate for Payer: Independent Care Health Plan Medicare |
$35.09
|
| Rate for Payer: Managed Health Services Medicaid |
$37.71
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$35.09
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$35.09
|
| Rate for Payer: Multiplan Commercial |
$220.00
|
| Rate for Payer: NAPHCARE Commercial |
$52.64
|
| Rate for Payer: Preferred Network Access Commercial |
$253.00
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$36.26
|
| Rate for Payer: Quartz Beloit One Network |
$134.75
|
| Rate for Payer: Quartz Commercial |
$178.75
|
| Rate for Payer: Quartz Medicare Advantage |
$35.09
|
| Rate for Payer: The Alliance Commercial |
$140.36
|
| Rate for Payer: United Healthcare Medicaid |
$36.26
|
| Rate for Payer: United Healthcare Medicare Advantage |
$35.09
|
| Rate for Payer: United Healthcare PPO |
$206.25
|
| Rate for Payer: WEA Trust Commercial |
$151.25
|
| Rate for Payer: Wellcare Medicare |
$35.09
|
| Rate for Payer: WMAP Medicaid |
$36.26
|
| Rate for Payer: WPS Commercial |
$203.69
|
|
|
HSV Type I & II PCR / 34257
|
Professional
|
Both
|
$275.00
|
|
|
Service Code
|
CPT 87529
|
| Hospital Charge Code |
1039240
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$121.00 |
| Max. Negotiated Rate |
$261.25 |
| Rate for Payer: Aetna Commercial |
$261.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$236.50
|
| Rate for Payer: Cash Price |
$82.50
|
| Rate for Payer: Cash Price |
$82.50
|
| Rate for Payer: Cigna Commercial |
$261.25
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$137.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$165.00
|
| Rate for Payer: Health EOS Commercial |
$250.25
|
| Rate for Payer: HFN Commercial |
$261.25
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$123.87
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$123.87
|
| Rate for Payer: Multiplan Commercial |
$220.00
|
| Rate for Payer: Preferred Network Access Commercial |
$261.25
|
| Rate for Payer: Quartz Beloit One Network |
$121.00
|
| Rate for Payer: Quartz Commercial |
$156.75
|
| Rate for Payer: The Alliance Commercial |
$137.50
|
| Rate for Payer: WEA Trust Commercial |
$151.25
|
| Rate for Payer: WPS Commercial |
$203.69
|
|
|
HSV Type I & II PCR / 34257
|
Facility
|
IP
|
$275.00
|
|
|
Service Code
|
CPT 87529
|
| Hospital Charge Code |
1039240
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$134.75 |
| Max. Negotiated Rate |
$253.00 |
| Rate for Payer: Aetna Commercial |
$247.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$236.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$145.75
|
| Rate for Payer: Cash Price |
$82.50
|
| Rate for Payer: Cigna Commercial |
$253.00
|
| Rate for Payer: Health EOS Commercial |
$244.75
|
| Rate for Payer: HFN Commercial |
$253.00
|
| Rate for Payer: Multiplan Commercial |
$220.00
|
| Rate for Payer: NAPHCARE Commercial |
$165.00
|
| Rate for Payer: Preferred Network Access Commercial |
$253.00
|
| Rate for Payer: Quartz Beloit One Network |
$134.75
|
| Rate for Payer: Quartz Commercial |
$165.00
|
| Rate for Payer: WEA Trust Commercial |
$151.25
|
| Rate for Payer: WPS Commercial |
$203.69
|
|
|
HTA GENESYS PROCERVA 580211
|
Facility
|
IP
|
$2,779.00
|
|
| Hospital Charge Code |
2973953
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,361.71 |
| Max. Negotiated Rate |
$2,556.68 |
| Rate for Payer: Aetna Commercial |
$2,501.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,389.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,472.87
|
| Rate for Payer: Cash Price |
$833.70
|
| Rate for Payer: Cigna Commercial |
$2,556.68
|
| Rate for Payer: Health EOS Commercial |
$2,473.31
|
| Rate for Payer: HFN Commercial |
$2,556.68
|
| Rate for Payer: Multiplan Commercial |
$2,223.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,667.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,556.68
|
| Rate for Payer: Quartz Beloit One Network |
$1,361.71
|
| Rate for Payer: Quartz Commercial |
$1,667.40
|
| Rate for Payer: WEA Trust Commercial |
$1,528.45
|
| Rate for Payer: WPS Commercial |
$2,058.41
|
|
|
HTA GENESYS PROCERVA 580211
|
Facility
|
OP
|
$2,779.00
|
|
| Hospital Charge Code |
2973953
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$778.12 |
| Max. Negotiated Rate |
$11,116.00 |
| Rate for Payer: Aetna Commercial |
$2,501.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,389.94
|
| Rate for Payer: Aetna Managed Medicare |
$778.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,806.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,389.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,333.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,472.87
|
| Rate for Payer: Cash Price |
$833.70
|
| Rate for Payer: Cigna Commercial |
$2,556.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,555.13
|
| Rate for Payer: Health EOS Commercial |
$2,473.31
|
| Rate for Payer: HFN Commercial |
$2,556.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,084.25
|
| Rate for Payer: Multiplan Commercial |
$2,223.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,667.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,556.68
|
| Rate for Payer: Quartz Beloit One Network |
$1,361.71
|
| Rate for Payer: Quartz Commercial |
$1,806.35
|
| Rate for Payer: Quartz Medicare Advantage |
$1,667.40
|
| Rate for Payer: The Alliance Commercial |
$11,116.00
|
| Rate for Payer: WEA Trust Commercial |
$1,528.45
|
| Rate for Payer: WPS Commercial |
$2,058.41
|
|
|
HTLV I/II Antibody w/ Reflex
|
Professional
|
Both
|
$132.00
|
|
|
Service Code
|
CPT 86790
|
| Hospital Charge Code |
1039265
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$45.47 |
| Max. Negotiated Rate |
$125.40 |
| Rate for Payer: Aetna Commercial |
$125.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$113.52
|
| Rate for Payer: Cash Price |
$39.60
|
| Rate for Payer: Cash Price |
$39.60
|
| Rate for Payer: Cigna Commercial |
$125.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$66.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$79.20
|
| Rate for Payer: Health EOS Commercial |
$120.12
|
| Rate for Payer: HFN Commercial |
$125.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$45.47
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$45.47
|
| Rate for Payer: Multiplan Commercial |
$105.60
|
| Rate for Payer: Preferred Network Access Commercial |
$125.40
|
| Rate for Payer: Quartz Beloit One Network |
$58.08
|
| Rate for Payer: Quartz Commercial |
$75.24
|
| Rate for Payer: The Alliance Commercial |
$66.00
|
| Rate for Payer: WEA Trust Commercial |
$72.60
|
| Rate for Payer: WPS Commercial |
$97.77
|
|
|
HTLV I/II Antibody w/ Reflex
|
Facility
|
OP
|
$132.00
|
|
|
Service Code
|
CPT 86790
|
| Hospital Charge Code |
1039265
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.88 |
| Max. Negotiated Rate |
$121.44 |
| Rate for Payer: Aetna Commercial |
$118.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$113.52
|
| Rate for Payer: Aetna Managed Medicare |
$12.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$48.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$22.54
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$21.38
|
| Rate for Payer: Anthem Medicare Advantage |
$12.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$69.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$12.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$12.88
|
| Rate for Payer: Cash Price |
$39.60
|
| Rate for Payer: Cash Price |
$39.60
|
| Rate for Payer: Cigna Commercial |
$121.44
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$12.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$73.87
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$12.88
|
| Rate for Payer: Health EOS Commercial |
$117.48
|
| Rate for Payer: HFN Commercial |
$121.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$47.91
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$12.88
|
| Rate for Payer: Independent Care Health Plan Medicare |
$12.88
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$12.88
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$12.88
|
| Rate for Payer: Multiplan Commercial |
$105.60
|
| Rate for Payer: NAPHCARE Commercial |
$19.32
|
| Rate for Payer: Preferred Network Access Commercial |
$121.44
|
| Rate for Payer: Quartz Beloit One Network |
$64.68
|
| Rate for Payer: Quartz Commercial |
$85.80
|
| Rate for Payer: Quartz Medicare Advantage |
$12.88
|
| Rate for Payer: The Alliance Commercial |
$51.52
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.88
|
| Rate for Payer: United Healthcare PPO |
$99.00
|
| Rate for Payer: WEA Trust Commercial |
$72.60
|
| Rate for Payer: Wellcare Medicare |
$12.88
|
| Rate for Payer: WPS Commercial |
$97.77
|
|
