|
HPV mRNA E6/E7
|
Facility
|
OP
|
$93.00
|
|
|
Service Code
|
CPT 87624
|
| Hospital Charge Code |
5462699
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$36.49 |
| Max. Negotiated Rate |
$145.97 |
| Rate for Payer: Aetna Commercial |
$87.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$83.18
|
| Rate for Payer: Aetna Managed Medicare |
$36.49
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$136.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$63.86
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$60.58
|
| Rate for Payer: Anthem Medicare Advantage |
$36.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$51.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$36.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$36.49
|
| Rate for Payer: Cash Price |
$27.90
|
| Rate for Payer: Cash Price |
$27.90
|
| Rate for Payer: Cigna Commercial |
$88.98
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$36.49
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$54.13
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$36.49
|
| Rate for Payer: Health EOS Commercial |
$86.08
|
| Rate for Payer: HFN Commercial |
$88.98
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$135.76
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$36.49
|
| Rate for Payer: Independent Care Health Plan Medicare |
$36.49
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$36.49
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$36.49
|
| Rate for Payer: Multiplan Commercial |
$77.38
|
| Rate for Payer: NAPHCARE Commercial |
$54.74
|
| Rate for Payer: Preferred Network Access Commercial |
$88.98
|
| Rate for Payer: Quartz Beloit One Network |
$47.39
|
| Rate for Payer: Quartz Commercial |
$62.87
|
| Rate for Payer: Quartz Medicare Advantage |
$36.49
|
| Rate for Payer: The Alliance Commercial |
$145.97
|
| Rate for Payer: United Healthcare Medicare Advantage |
$36.49
|
| Rate for Payer: United Healthcare PPO |
$72.54
|
| Rate for Payer: WEA Trust Commercial |
$53.20
|
| Rate for Payer: Wellcare Medicare |
$36.49
|
| Rate for Payer: WPS Commercial |
$71.64
|
|
|
HPV mRNA E6/E7
|
Professional
|
Both
|
$93.00
|
|
|
Service Code
|
CPT 87624
|
| Hospital Charge Code |
5462699
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$36.49 |
| Max. Negotiated Rate |
$160.57 |
| Rate for Payer: Aetna Commercial |
$91.88
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$83.18
|
| Rate for Payer: Aetna Managed Medicare |
$36.49
|
| Rate for Payer: Anthem Medicare Advantage |
$36.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$36.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$36.49
|
| Rate for Payer: Cash Price |
$27.90
|
| Rate for Payer: Cash Price |
$27.90
|
| Rate for Payer: Cigna Commercial |
$91.88
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$48.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$36.49
|
| Rate for Payer: Health EOS Commercial |
$88.02
|
| Rate for Payer: HFN Commercial |
$91.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$128.82
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$128.82
|
| Rate for Payer: Independent Care Health Plan Medicare |
$36.49
|
| Rate for Payer: Multiplan Commercial |
$77.38
|
| Rate for Payer: NAPHCARE Commercial |
$54.74
|
| Rate for Payer: Preferred Network Access Commercial |
$91.88
|
| Rate for Payer: Quartz Beloit One Network |
$42.56
|
| Rate for Payer: Quartz Commercial |
$55.13
|
| Rate for Payer: Quartz Medicare Advantage |
$36.49
|
| Rate for Payer: The Alliance Commercial |
$144.15
|
| Rate for Payer: United Healthcare Medicare Advantage |
$36.49
|
| Rate for Payer: WEA Trust Commercial |
$53.20
|
| Rate for Payer: WPS Commercial |
$160.57
|
|
|
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 |
$36.49 |
| Max. Negotiated Rate |
$145.97 |
| Rate for Payer: Aetna Commercial |
$110.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$105.54
|
| Rate for Payer: Aetna Managed Medicare |
$36.49
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$136.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$63.86
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$60.58
|
| Rate for Payer: Anthem Medicare Advantage |
$36.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$65.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$36.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$36.49
|
| Rate for Payer: Cash Price |
$35.40
|
| Rate for Payer: Cash Price |
$35.40
|
| Rate for Payer: Cigna Commercial |
$112.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$36.49
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$68.68
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$36.49
|
| Rate for Payer: Health EOS Commercial |
$109.22
|
| Rate for Payer: HFN Commercial |
$112.90
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$135.76
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$36.49
|
| Rate for Payer: Independent Care Health Plan Medicare |
$36.49
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$36.49
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$36.49
|
| Rate for Payer: Multiplan Commercial |
$98.18
|
| Rate for Payer: NAPHCARE Commercial |
$54.74
|
| Rate for Payer: Preferred Network Access Commercial |
$112.90
|
| Rate for Payer: Quartz Beloit One Network |
$60.13
|
| Rate for Payer: Quartz Commercial |
$79.77
|
| Rate for Payer: Quartz Medicare Advantage |
$36.49
|
| Rate for Payer: The Alliance Commercial |
$145.97
|
| Rate for Payer: United Healthcare Medicare Advantage |
$36.49
|
| Rate for Payer: United Healthcare PPO |
$92.04
|
| Rate for Payer: WEA Trust Commercial |
$67.50
|
| Rate for Payer: Wellcare Medicare |
$36.49
|
| Rate for Payer: WPS Commercial |
$90.90
|
|
|
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 |
$60.13 |
| Max. Negotiated Rate |
$112.90 |
| Rate for Payer: Aetna Commercial |
$110.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$105.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$65.04
|
| Rate for Payer: Cash Price |
$35.40
|
| Rate for Payer: Cigna Commercial |
$112.90
|
| Rate for Payer: Health EOS Commercial |
$109.22
|
| Rate for Payer: HFN Commercial |
$112.90
|
| Rate for Payer: Multiplan Commercial |
$98.18
|
| Rate for Payer: Preferred Network Access Commercial |
$112.90
|
| Rate for Payer: Quartz Beloit One Network |
$60.13
|
| Rate for Payer: Quartz Commercial |
$73.63
|
| Rate for Payer: WEA Trust Commercial |
$67.50
|
| Rate for Payer: WPS Commercial |
$90.90
|
|
|
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 |
$36.49 |
| Max. Negotiated Rate |
$160.57 |
| Rate for Payer: Aetna Commercial |
$116.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$105.54
|
| Rate for Payer: Aetna Managed Medicare |
$36.49
|
| Rate for Payer: Anthem Medicare Advantage |
$36.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$36.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$36.49
|
| Rate for Payer: Cash Price |
$35.40
|
| Rate for Payer: Cash Price |
$35.40
|
| Rate for Payer: Cigna Commercial |
$116.58
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$61.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$36.49
|
| Rate for Payer: Health EOS Commercial |
$111.68
|
| Rate for Payer: HFN Commercial |
$116.58
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$128.82
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$128.82
|
| Rate for Payer: Independent Care Health Plan Medicare |
$36.49
|
| Rate for Payer: Multiplan Commercial |
$98.18
|
| Rate for Payer: NAPHCARE Commercial |
$54.74
|
| Rate for Payer: Preferred Network Access Commercial |
$116.58
|
| Rate for Payer: Quartz Beloit One Network |
$54.00
|
| Rate for Payer: Quartz Commercial |
$69.95
|
| Rate for Payer: Quartz Medicare Advantage |
$36.49
|
| Rate for Payer: The Alliance Commercial |
$144.15
|
| Rate for Payer: United Healthcare Medicare Advantage |
$36.49
|
| Rate for Payer: WEA Trust Commercial |
$67.50
|
| Rate for Payer: WPS Commercial |
$160.57
|
|
|
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 |
$36.49 |
| Max. Negotiated Rate |
$145.97 |
| Rate for Payer: Aetna Commercial |
$87.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$83.18
|
| Rate for Payer: Aetna Managed Medicare |
$36.49
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$136.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$63.86
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$60.58
|
| Rate for Payer: Anthem Medicare Advantage |
$36.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$51.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$36.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$36.49
|
| Rate for Payer: Cash Price |
$27.90
|
| Rate for Payer: Cash Price |
$27.90
|
| Rate for Payer: Cigna Commercial |
$88.98
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$36.49
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$54.13
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$36.49
|
| Rate for Payer: Health EOS Commercial |
$86.08
|
| Rate for Payer: HFN Commercial |
$88.98
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$135.76
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$36.49
|
| Rate for Payer: Independent Care Health Plan Medicare |
$36.49
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$36.49
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$36.49
|
| Rate for Payer: Multiplan Commercial |
$77.38
|
| Rate for Payer: NAPHCARE Commercial |
$54.74
|
| Rate for Payer: Preferred Network Access Commercial |
$88.98
|
| Rate for Payer: Quartz Beloit One Network |
$47.39
|
| Rate for Payer: Quartz Commercial |
$62.87
|
| Rate for Payer: Quartz Medicare Advantage |
$36.49
|
| Rate for Payer: The Alliance Commercial |
$145.97
|
| Rate for Payer: United Healthcare Medicare Advantage |
$36.49
|
| Rate for Payer: United Healthcare PPO |
$72.54
|
| Rate for Payer: WEA Trust Commercial |
$53.20
|
| Rate for Payer: Wellcare Medicare |
$36.49
|
| Rate for Payer: WPS Commercial |
$71.64
|
|
|
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 |
$47.39 |
| Max. Negotiated Rate |
$88.98 |
| Rate for Payer: Aetna Commercial |
$87.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$83.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$51.26
|
| Rate for Payer: Cash Price |
$27.90
|
| Rate for Payer: Cigna Commercial |
$88.98
|
| Rate for Payer: Health EOS Commercial |
$86.08
|
| Rate for Payer: HFN Commercial |
$88.98
|
| Rate for Payer: Multiplan Commercial |
$77.38
|
| Rate for Payer: Preferred Network Access Commercial |
$88.98
|
| Rate for Payer: Quartz Beloit One Network |
$47.39
|
| Rate for Payer: Quartz Commercial |
$58.03
|
| Rate for Payer: WEA Trust Commercial |
$53.20
|
| Rate for Payer: WPS Commercial |
$71.64
|
|
|
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 |
$36.49 |
| Max. Negotiated Rate |
$160.57 |
| Rate for Payer: Aetna Commercial |
$91.88
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$83.18
|
| Rate for Payer: Aetna Managed Medicare |
$36.49
|
| Rate for Payer: Anthem Medicare Advantage |
$36.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$36.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$36.49
|
| Rate for Payer: Cash Price |
$27.90
|
| Rate for Payer: Cash Price |
$27.90
|
| Rate for Payer: Cigna Commercial |
$91.88
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$48.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$36.49
|
| Rate for Payer: Health EOS Commercial |
$88.02
|
| Rate for Payer: HFN Commercial |
$91.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$128.82
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$128.82
|
| Rate for Payer: Independent Care Health Plan Medicare |
$36.49
|
| Rate for Payer: Multiplan Commercial |
$77.38
|
| Rate for Payer: NAPHCARE Commercial |
$54.74
|
| Rate for Payer: Preferred Network Access Commercial |
$91.88
|
| Rate for Payer: Quartz Beloit One Network |
$42.56
|
| Rate for Payer: Quartz Commercial |
$55.13
|
| Rate for Payer: Quartz Medicare Advantage |
$36.49
|
| Rate for Payer: The Alliance Commercial |
$144.15
|
| Rate for Payer: United Healthcare Medicare Advantage |
$36.49
|
| Rate for Payer: WEA Trust Commercial |
$53.20
|
| Rate for Payer: WPS Commercial |
$160.57
|
|
|
H pylori culture
|
Facility
|
OP
|
$208.00
|
|
|
Service Code
|
CPT 87205
|
| Hospital Charge Code |
3813023
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.44 |
| Max. Negotiated Rate |
$199.01 |
| Rate for Payer: Aetna Commercial |
$194.69
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$186.04
|
| Rate for Payer: Aetna Managed Medicare |
$4.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$16.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$7.77
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7.37
|
| Rate for Payer: Anthem Medicare Advantage |
$4.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$114.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$4.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$4.44
|
| Rate for Payer: Cash Price |
$62.40
|
| Rate for Payer: Cash Price |
$62.40
|
| Rate for Payer: Cigna Commercial |
$199.01
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$4.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$121.06
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$4.44
|
| Rate for Payer: Health EOS Commercial |
$192.52
|
| Rate for Payer: HFN Commercial |
$199.01
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$16.52
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$4.44
|
| Rate for Payer: Independent Care Health Plan Medicare |
$4.44
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$4.44
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$4.44
|
| Rate for Payer: Multiplan Commercial |
$173.06
|
| Rate for Payer: NAPHCARE Commercial |
$6.66
|
| Rate for Payer: Preferred Network Access Commercial |
$199.01
|
| Rate for Payer: Quartz Beloit One Network |
$106.00
|
| Rate for Payer: Quartz Commercial |
$140.61
|
| Rate for Payer: Quartz Medicare Advantage |
$4.44
|
| Rate for Payer: The Alliance Commercial |
$17.76
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4.44
|
| Rate for Payer: United Healthcare PPO |
$162.24
|
| Rate for Payer: WEA Trust Commercial |
$118.98
|
| Rate for Payer: Wellcare Medicare |
$4.44
|
| Rate for Payer: WPS Commercial |
$160.22
|
|
|
H pylori culture
|
Professional
|
Both
|
$208.00
|
|
|
Service Code
|
CPT 87205
|
| Hospital Charge Code |
3813023
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.44 |
| Max. Negotiated Rate |
$205.50 |
| Rate for Payer: Aetna Commercial |
$205.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$186.04
|
| Rate for Payer: Aetna Managed Medicare |
$4.44
|
| Rate for Payer: Anthem Medicare Advantage |
$4.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$4.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$4.44
|
| Rate for Payer: Cash Price |
$62.40
|
| Rate for Payer: Cash Price |
$62.40
|
| Rate for Payer: Cigna Commercial |
$205.50
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$108.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4.44
|
| Rate for Payer: Health EOS Commercial |
$196.85
|
| Rate for Payer: HFN Commercial |
$205.50
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$15.67
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$15.67
|
| Rate for Payer: Independent Care Health Plan Medicare |
$4.44
|
| Rate for Payer: Multiplan Commercial |
$173.06
|
| Rate for Payer: NAPHCARE Commercial |
$6.66
|
| Rate for Payer: Preferred Network Access Commercial |
$205.50
|
| Rate for Payer: Quartz Beloit One Network |
$95.18
|
| Rate for Payer: Quartz Commercial |
$123.30
|
| Rate for Payer: Quartz Medicare Advantage |
$4.44
|
| Rate for Payer: The Alliance Commercial |
$17.54
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4.44
|
| Rate for Payer: WEA Trust Commercial |
$118.98
|
| Rate for Payer: WPS Commercial |
$19.54
|
|
|
H pylori culture
|
Facility
|
IP
|
$208.00
|
|
|
Service Code
|
CPT 87205
|
| Hospital Charge Code |
3813023
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$106.00 |
| Max. Negotiated Rate |
$199.01 |
| Rate for Payer: Aetna Commercial |
$194.69
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$186.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$114.65
|
| Rate for Payer: Cash Price |
$62.40
|
| Rate for Payer: Cigna Commercial |
$199.01
|
| Rate for Payer: Health EOS Commercial |
$192.52
|
| Rate for Payer: HFN Commercial |
$199.01
|
| Rate for Payer: Multiplan Commercial |
$173.06
|
| Rate for Payer: Preferred Network Access Commercial |
$199.01
|
| Rate for Payer: Quartz Beloit One Network |
$106.00
|
| Rate for Payer: Quartz Commercial |
$129.79
|
| Rate for Payer: WEA Trust Commercial |
$118.98
|
| Rate for Payer: WPS Commercial |
$160.22
|
|
|
H. PYLORI INFECTION
|
Facility
|
OP
|
$26.94
|
|
|
Service Code
|
EAPG 00810
|
| Min. Negotiated Rate |
$25.90 |
| Max. Negotiated Rate |
$26.94 |
| Rate for Payer: Anthem Medicaid |
$25.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$25.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$25.90
|
| Rate for Payer: Dean Health Medicaid |
$25.90
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$25.90
|
| Rate for Payer: Managed Health Services Medicaid |
$26.94
|
| Rate for Payer: Molina Healthcare Medicaid |
$25.90
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$25.90
|
| Rate for Payer: United Healthcare Medicaid |
$25.90
|
|
|
H pylori susceptibility
|
Facility
|
IP
|
$160.00
|
|
|
Service Code
|
CPT 87181
|
| Hospital Charge Code |
3813024
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$81.54 |
| Max. Negotiated Rate |
$153.09 |
| Rate for Payer: Aetna Commercial |
$149.76
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$143.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$88.19
|
| Rate for Payer: Cash Price |
$48.00
|
| Rate for Payer: Cigna Commercial |
$153.09
|
| Rate for Payer: Health EOS Commercial |
$148.10
|
| Rate for Payer: HFN Commercial |
$153.09
|
| Rate for Payer: Multiplan Commercial |
$133.12
|
| Rate for Payer: Preferred Network Access Commercial |
$153.09
|
| Rate for Payer: Quartz Beloit One Network |
$81.54
|
| Rate for Payer: Quartz Commercial |
$99.84
|
| Rate for Payer: WEA Trust Commercial |
$91.52
|
| Rate for Payer: WPS Commercial |
$123.25
|
|
|
H pylori susceptibility
|
Facility
|
OP
|
$160.00
|
|
|
Service Code
|
CPT 87181
|
| Hospital Charge Code |
3813024
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.94 |
| Max. Negotiated Rate |
$153.09 |
| Rate for Payer: Aetna Commercial |
$149.76
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$143.10
|
| Rate for Payer: Aetna Managed Medicare |
$4.94
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$18.52
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8.64
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$8.20
|
| Rate for Payer: Anthem Medicare Advantage |
$4.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$88.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$4.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$4.94
|
| Rate for Payer: Cash Price |
$48.00
|
| Rate for Payer: Cash Price |
$48.00
|
| Rate for Payer: Cigna Commercial |
$153.09
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$4.94
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$93.12
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$4.94
|
| Rate for Payer: Health EOS Commercial |
$148.10
|
| Rate for Payer: HFN Commercial |
$153.09
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$18.38
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$4.94
|
| Rate for Payer: Independent Care Health Plan Medicare |
$4.94
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$4.94
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$4.94
|
| Rate for Payer: Multiplan Commercial |
$133.12
|
| Rate for Payer: NAPHCARE Commercial |
$7.41
|
| Rate for Payer: Preferred Network Access Commercial |
$153.09
|
| Rate for Payer: Quartz Beloit One Network |
$81.54
|
| Rate for Payer: Quartz Commercial |
$108.16
|
| Rate for Payer: Quartz Medicare Advantage |
$4.94
|
| Rate for Payer: The Alliance Commercial |
$19.76
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4.94
|
| Rate for Payer: United Healthcare PPO |
$124.80
|
| Rate for Payer: WEA Trust Commercial |
$91.52
|
| Rate for Payer: Wellcare Medicare |
$4.94
|
| Rate for Payer: WPS Commercial |
$123.25
|
|
|
H pylori susceptibility
|
Professional
|
Both
|
$160.00
|
|
|
Service Code
|
CPT 87181
|
| Hospital Charge Code |
3813024
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.94 |
| Max. Negotiated Rate |
$158.08 |
| Rate for Payer: Aetna Commercial |
$158.08
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$143.10
|
| Rate for Payer: Aetna Managed Medicare |
$4.94
|
| Rate for Payer: Anthem Medicare Advantage |
$4.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$4.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$4.94
|
| Rate for Payer: Cash Price |
$48.00
|
| Rate for Payer: Cash Price |
$48.00
|
| Rate for Payer: Cigna Commercial |
$158.08
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$83.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4.94
|
| Rate for Payer: Health EOS Commercial |
$151.42
|
| Rate for Payer: HFN Commercial |
$158.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$17.44
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$17.44
|
| Rate for Payer: Independent Care Health Plan Medicare |
$4.94
|
| Rate for Payer: Multiplan Commercial |
$133.12
|
| Rate for Payer: NAPHCARE Commercial |
$7.41
|
| Rate for Payer: Preferred Network Access Commercial |
$158.08
|
| Rate for Payer: Quartz Beloit One Network |
$73.22
|
| Rate for Payer: Quartz Commercial |
$94.85
|
| Rate for Payer: Quartz Medicare Advantage |
$4.94
|
| Rate for Payer: The Alliance Commercial |
$19.51
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4.94
|
| Rate for Payer: WEA Trust Commercial |
$91.52
|
| Rate for Payer: WPS Commercial |
$21.74
|
|
|
H pylori Susceptibility MIC Panel
|
Facility
|
OP
|
$128.00
|
|
|
Service Code
|
CPT 87181
|
| Hospital Charge Code |
3811604
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.94 |
| Max. Negotiated Rate |
$122.47 |
| Rate for Payer: Aetna Commercial |
$119.81
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$114.48
|
| Rate for Payer: Aetna Managed Medicare |
$4.94
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$18.52
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8.64
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$8.20
|
| Rate for Payer: Anthem Medicare Advantage |
$4.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$70.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$4.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$4.94
|
| Rate for Payer: Cash Price |
$38.40
|
| Rate for Payer: Cash Price |
$38.40
|
| Rate for Payer: Cigna Commercial |
$122.47
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$4.94
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$74.50
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$4.94
|
| Rate for Payer: Health EOS Commercial |
$118.48
|
| Rate for Payer: HFN Commercial |
$122.47
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$18.38
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$4.94
|
| Rate for Payer: Independent Care Health Plan Medicare |
$4.94
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$4.94
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$4.94
|
| Rate for Payer: Multiplan Commercial |
$106.50
|
| Rate for Payer: NAPHCARE Commercial |
$7.41
|
| Rate for Payer: Preferred Network Access Commercial |
$122.47
|
| Rate for Payer: Quartz Beloit One Network |
$65.23
|
| Rate for Payer: Quartz Commercial |
$86.53
|
| Rate for Payer: Quartz Medicare Advantage |
$4.94
|
| Rate for Payer: The Alliance Commercial |
$19.76
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4.94
|
| Rate for Payer: United Healthcare PPO |
$99.84
|
| Rate for Payer: WEA Trust Commercial |
$73.22
|
| Rate for Payer: Wellcare Medicare |
$4.94
|
| Rate for Payer: WPS Commercial |
$98.60
|
|
|
H pylori Susceptibility MIC Panel
|
Professional
|
Both
|
$128.00
|
|
|
Service Code
|
CPT 87181
|
| Hospital Charge Code |
3811604
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.94 |
| Max. Negotiated Rate |
$126.46 |
| Rate for Payer: Aetna Commercial |
$126.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$114.48
|
| Rate for Payer: Aetna Managed Medicare |
$4.94
|
| Rate for Payer: Anthem Medicare Advantage |
$4.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$4.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$4.94
|
| Rate for Payer: Cash Price |
$38.40
|
| Rate for Payer: Cash Price |
$38.40
|
| Rate for Payer: Cigna Commercial |
$126.46
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$66.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4.94
|
| Rate for Payer: Health EOS Commercial |
$121.14
|
| Rate for Payer: HFN Commercial |
$126.46
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$17.44
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$17.44
|
| Rate for Payer: Independent Care Health Plan Medicare |
$4.94
|
| Rate for Payer: Multiplan Commercial |
$106.50
|
| Rate for Payer: NAPHCARE Commercial |
$7.41
|
| Rate for Payer: Preferred Network Access Commercial |
$126.46
|
| Rate for Payer: Quartz Beloit One Network |
$58.57
|
| Rate for Payer: Quartz Commercial |
$75.88
|
| Rate for Payer: Quartz Medicare Advantage |
$4.94
|
| Rate for Payer: The Alliance Commercial |
$19.51
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4.94
|
| Rate for Payer: WEA Trust Commercial |
$73.22
|
| Rate for Payer: WPS Commercial |
$21.74
|
|
|
H pylori Susceptibility MIC Panel
|
Facility
|
IP
|
$128.00
|
|
|
Service Code
|
CPT 87181
|
| Hospital Charge Code |
3811604
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$65.23 |
| Max. Negotiated Rate |
$122.47 |
| Rate for Payer: Aetna Commercial |
$119.81
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$114.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$70.55
|
| Rate for Payer: Cash Price |
$38.40
|
| Rate for Payer: Cigna Commercial |
$122.47
|
| Rate for Payer: Health EOS Commercial |
$118.48
|
| Rate for Payer: HFN Commercial |
$122.47
|
| Rate for Payer: Multiplan Commercial |
$106.50
|
| Rate for Payer: Preferred Network Access Commercial |
$122.47
|
| Rate for Payer: Quartz Beloit One Network |
$65.23
|
| Rate for Payer: Quartz Commercial |
$79.87
|
| Rate for Payer: WEA Trust Commercial |
$73.22
|
| Rate for Payer: WPS Commercial |
$98.60
|
|
|
HSP-70 Antibody
|
Facility
|
IP
|
$223.00
|
|
|
Service Code
|
CPT 84181
|
| Hospital Charge Code |
5382910
|
|
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
|
|
|
HSP-70 Antibody
|
Facility
|
OP
|
$223.00
|
|
|
Service Code
|
CPT 84181
|
| Hospital Charge Code |
5382910
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.71 |
| 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 |
$17.71
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$66.42
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$30.99
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$29.40
|
| Rate for Payer: Anthem Medicare Advantage |
$17.71
|
| 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 |
$17.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$17.71
|
| 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 |
$17.71
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$129.79
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$17.71
|
| Rate for Payer: Health EOS Commercial |
$206.41
|
| Rate for Payer: HFN Commercial |
$213.37
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$65.89
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$17.71
|
| Rate for Payer: Independent Care Health Plan Medicare |
$17.71
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$17.71
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$17.71
|
| Rate for Payer: Multiplan Commercial |
$185.54
|
| Rate for Payer: NAPHCARE Commercial |
$26.57
|
| 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 |
$17.71
|
| Rate for Payer: The Alliance Commercial |
$70.84
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17.71
|
| Rate for Payer: United Healthcare PPO |
$173.94
|
| Rate for Payer: WEA Trust Commercial |
$127.56
|
| Rate for Payer: Wellcare Medicare |
$17.71
|
| Rate for Payer: WPS Commercial |
$171.78
|
|
|
HSP-70 Antibody
|
Professional
|
Both
|
$223.00
|
|
|
Service Code
|
CPT 84181
|
| Hospital Charge Code |
5382910
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.27 |
| 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 |
$17.71
|
| Rate for Payer: Anthem Commercial |
$17.27
|
| Rate for Payer: Anthem Medicare Advantage |
$17.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$17.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$17.71
|
| 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 |
$17.71
|
| Rate for Payer: Health EOS Commercial |
$211.05
|
| Rate for Payer: HFN Commercial |
$220.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$62.52
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$62.52
|
| Rate for Payer: Independent Care Health Plan Medicare |
$17.71
|
| Rate for Payer: Multiplan Commercial |
$185.54
|
| Rate for Payer: NAPHCARE Commercial |
$26.57
|
| 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 |
$17.71
|
| Rate for Payer: The Alliance Commercial |
$69.96
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17.71
|
| Rate for Payer: WEA Trust Commercial |
$127.56
|
| Rate for Payer: WPS Commercial |
$77.93
|
|
|
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 |
$140.14 |
| Max. Negotiated Rate |
$263.12 |
| Rate for Payer: Aetna Commercial |
$257.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$245.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$151.58
|
| Rate for Payer: Cash Price |
$82.50
|
| Rate for Payer: Cigna Commercial |
$263.12
|
| Rate for Payer: Health EOS Commercial |
$254.54
|
| Rate for Payer: HFN Commercial |
$263.12
|
| Rate for Payer: Multiplan Commercial |
$228.80
|
| Rate for Payer: Preferred Network Access Commercial |
$263.12
|
| Rate for Payer: Quartz Beloit One Network |
$140.14
|
| Rate for Payer: Quartz Commercial |
$171.60
|
| Rate for Payer: WEA Trust Commercial |
$157.30
|
| Rate for Payer: WPS Commercial |
$211.83
|
|
|
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 |
$36.49 |
| Max. Negotiated Rate |
$263.12 |
| Rate for Payer: Aetna Commercial |
$257.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$245.96
|
| Rate for Payer: Aetna Managed Medicare |
$36.49
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$136.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$63.86
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$60.58
|
| Rate for Payer: Anthem Medicare Advantage |
$36.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$151.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$36.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$36.49
|
| Rate for Payer: Cash Price |
$82.50
|
| Rate for Payer: Cash Price |
$82.50
|
| Rate for Payer: Cigna Commercial |
$263.12
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$36.49
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$160.05
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$36.49
|
| Rate for Payer: Health EOS Commercial |
$254.54
|
| Rate for Payer: HFN Commercial |
$263.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$135.76
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$36.49
|
| Rate for Payer: Independent Care Health Plan Medicare |
$36.49
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$36.49
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$36.49
|
| Rate for Payer: Multiplan Commercial |
$228.80
|
| Rate for Payer: NAPHCARE Commercial |
$54.74
|
| Rate for Payer: Preferred Network Access Commercial |
$263.12
|
| Rate for Payer: Quartz Beloit One Network |
$140.14
|
| Rate for Payer: Quartz Commercial |
$185.90
|
| Rate for Payer: Quartz Medicare Advantage |
$36.49
|
| Rate for Payer: The Alliance Commercial |
$145.97
|
| Rate for Payer: United Healthcare Medicare Advantage |
$36.49
|
| Rate for Payer: United Healthcare PPO |
$214.50
|
| Rate for Payer: WEA Trust Commercial |
$157.30
|
| Rate for Payer: Wellcare Medicare |
$36.49
|
| Rate for Payer: WPS Commercial |
$211.83
|
|
|
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 |
$36.49 |
| Max. Negotiated Rate |
$271.70 |
| Rate for Payer: Aetna Commercial |
$271.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$245.96
|
| Rate for Payer: Aetna Managed Medicare |
$36.49
|
| Rate for Payer: Anthem Medicare Advantage |
$36.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$36.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$36.49
|
| Rate for Payer: Cash Price |
$82.50
|
| Rate for Payer: Cash Price |
$82.50
|
| Rate for Payer: Cigna Commercial |
$271.70
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$143.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$36.49
|
| Rate for Payer: Health EOS Commercial |
$260.26
|
| Rate for Payer: HFN Commercial |
$271.70
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$128.82
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$128.82
|
| Rate for Payer: Independent Care Health Plan Medicare |
$36.49
|
| Rate for Payer: Multiplan Commercial |
$228.80
|
| Rate for Payer: NAPHCARE Commercial |
$54.74
|
| Rate for Payer: Preferred Network Access Commercial |
$271.70
|
| Rate for Payer: Quartz Beloit One Network |
$125.84
|
| Rate for Payer: Quartz Commercial |
$163.02
|
| Rate for Payer: Quartz Medicare Advantage |
$36.49
|
| Rate for Payer: The Alliance Commercial |
$144.15
|
| Rate for Payer: United Healthcare Medicare Advantage |
$36.49
|
| Rate for Payer: WEA Trust Commercial |
$157.30
|
| Rate for Payer: WPS Commercial |
$160.57
|
|
|
HTA GENESYS PROCERVA 580211
|
Facility
|
IP
|
$2,779.00
|
|
| Hospital Charge Code |
2973953
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,416.18 |
| Max. Negotiated Rate |
$2,658.95 |
| Rate for Payer: Aetna Commercial |
$2,601.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,485.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,531.78
|
| Rate for Payer: Cash Price |
$833.70
|
| Rate for Payer: Cigna Commercial |
$2,658.95
|
| Rate for Payer: Health EOS Commercial |
$2,572.24
|
| Rate for Payer: HFN Commercial |
$2,658.95
|
| Rate for Payer: Multiplan Commercial |
$2,312.13
|
| Rate for Payer: Preferred Network Access Commercial |
$2,658.95
|
| Rate for Payer: Quartz Beloit One Network |
$1,416.18
|
| Rate for Payer: Quartz Commercial |
$1,734.10
|
| Rate for Payer: WEA Trust Commercial |
$1,589.59
|
| Rate for Payer: WPS Commercial |
$2,140.66
|
|
