|
PNEUMATIC WALK(L) SHORT 01A-L
|
Facility
|
IP
|
$872.00
|
|
| Hospital Charge Code |
2972440
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$444.37 |
| Max. Negotiated Rate |
$834.33 |
| Rate for Payer: Aetna Commercial |
$816.19
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$779.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$480.65
|
| Rate for Payer: Cash Price |
$261.60
|
| Rate for Payer: Cigna Commercial |
$834.33
|
| Rate for Payer: Health EOS Commercial |
$807.12
|
| Rate for Payer: HFN Commercial |
$834.33
|
| Rate for Payer: Multiplan Commercial |
$725.50
|
| Rate for Payer: Preferred Network Access Commercial |
$834.33
|
| Rate for Payer: Quartz Beloit One Network |
$444.37
|
| Rate for Payer: Quartz Commercial |
$544.13
|
| Rate for Payer: WEA Trust Commercial |
$498.78
|
| Rate for Payer: WPS Commercial |
$671.70
|
|
|
PNEUMATIC WALK(M) SHORT 01-AM
|
Facility
|
OP
|
$872.00
|
|
| Hospital Charge Code |
2972439
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$253.93 |
| Max. Negotiated Rate |
$834.33 |
| Rate for Payer: Aetna Commercial |
$816.19
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$779.92
|
| Rate for Payer: Aetna Managed Medicare |
$253.93
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$589.47
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$453.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$435.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$480.65
|
| Rate for Payer: Cash Price |
$261.60
|
| Rate for Payer: Cigna Commercial |
$834.33
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$507.50
|
| Rate for Payer: Health EOS Commercial |
$807.12
|
| Rate for Payer: HFN Commercial |
$834.33
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$680.16
|
| Rate for Payer: Multiplan Commercial |
$725.50
|
| Rate for Payer: NAPHCARE Commercial |
$544.13
|
| Rate for Payer: Preferred Network Access Commercial |
$834.33
|
| Rate for Payer: Quartz Beloit One Network |
$444.37
|
| Rate for Payer: Quartz Commercial |
$589.47
|
| Rate for Payer: Quartz Medicare Advantage |
$544.13
|
| Rate for Payer: The Alliance Commercial |
$453.44
|
| Rate for Payer: WEA Trust Commercial |
$498.78
|
| Rate for Payer: WPS Commercial |
$671.70
|
|
|
PNEUMATIC WALK(M) SHORT 01-AM
|
Facility
|
IP
|
$872.00
|
|
| Hospital Charge Code |
2972439
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$444.37 |
| Max. Negotiated Rate |
$834.33 |
| Rate for Payer: Aetna Commercial |
$816.19
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$779.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$480.65
|
| Rate for Payer: Cash Price |
$261.60
|
| Rate for Payer: Cigna Commercial |
$834.33
|
| Rate for Payer: Health EOS Commercial |
$807.12
|
| Rate for Payer: HFN Commercial |
$834.33
|
| Rate for Payer: Multiplan Commercial |
$725.50
|
| Rate for Payer: Preferred Network Access Commercial |
$834.33
|
| Rate for Payer: Quartz Beloit One Network |
$444.37
|
| Rate for Payer: Quartz Commercial |
$544.13
|
| Rate for Payer: WEA Trust Commercial |
$498.78
|
| Rate for Payer: WPS Commercial |
$671.70
|
|
|
PNEUMATIC WALK(S) SHORT 01A-S
|
Facility
|
OP
|
$872.00
|
|
| Hospital Charge Code |
2972377
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$253.93 |
| Max. Negotiated Rate |
$834.33 |
| Rate for Payer: Aetna Commercial |
$816.19
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$779.92
|
| Rate for Payer: Aetna Managed Medicare |
$253.93
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$589.47
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$453.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$435.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$480.65
|
| Rate for Payer: Cash Price |
$261.60
|
| Rate for Payer: Cigna Commercial |
$834.33
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$507.50
|
| Rate for Payer: Health EOS Commercial |
$807.12
|
| Rate for Payer: HFN Commercial |
$834.33
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$680.16
|
| Rate for Payer: Multiplan Commercial |
$725.50
|
| Rate for Payer: NAPHCARE Commercial |
$544.13
|
| Rate for Payer: Preferred Network Access Commercial |
$834.33
|
| Rate for Payer: Quartz Beloit One Network |
$444.37
|
| Rate for Payer: Quartz Commercial |
$589.47
|
| Rate for Payer: Quartz Medicare Advantage |
$544.13
|
| Rate for Payer: The Alliance Commercial |
$453.44
|
| Rate for Payer: WEA Trust Commercial |
$498.78
|
| Rate for Payer: WPS Commercial |
$671.70
|
|
|
PNEUMATIC WALK(S) SHORT 01A-S
|
Facility
|
IP
|
$872.00
|
|
| Hospital Charge Code |
2972377
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$444.37 |
| Max. Negotiated Rate |
$834.33 |
| Rate for Payer: Aetna Commercial |
$816.19
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$779.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$480.65
|
| Rate for Payer: Cash Price |
$261.60
|
| Rate for Payer: Cigna Commercial |
$834.33
|
| Rate for Payer: Health EOS Commercial |
$807.12
|
| Rate for Payer: HFN Commercial |
$834.33
|
| Rate for Payer: Multiplan Commercial |
$725.50
|
| Rate for Payer: Preferred Network Access Commercial |
$834.33
|
| Rate for Payer: Quartz Beloit One Network |
$444.37
|
| Rate for Payer: Quartz Commercial |
$544.13
|
| Rate for Payer: WEA Trust Commercial |
$498.78
|
| Rate for Payer: WPS Commercial |
$671.70
|
|
|
Pneuma/vac walk boot pre ots L4361
|
Facility
|
IP
|
$790.00
|
|
|
Service Code
|
HCPCS L4361
|
| Hospital Charge Code |
4498697
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$402.58 |
| Max. Negotiated Rate |
$755.87 |
| Rate for Payer: Aetna Commercial |
$739.44
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$706.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$435.45
|
| Rate for Payer: Cash Price |
$237.00
|
| Rate for Payer: Cigna Commercial |
$755.87
|
| Rate for Payer: Health EOS Commercial |
$731.22
|
| Rate for Payer: HFN Commercial |
$755.87
|
| Rate for Payer: Multiplan Commercial |
$657.28
|
| Rate for Payer: Preferred Network Access Commercial |
$755.87
|
| Rate for Payer: Quartz Beloit One Network |
$402.58
|
| Rate for Payer: Quartz Commercial |
$492.96
|
| Rate for Payer: WEA Trust Commercial |
$451.88
|
| Rate for Payer: WPS Commercial |
$608.54
|
|
|
Pneuma/vac walk boot pre ots L4361
|
Professional
|
Both
|
$790.00
|
|
|
Service Code
|
HCPCS L4361
|
| Hospital Charge Code |
4498697
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$330.91 |
| Max. Negotiated Rate |
$954.11 |
| Rate for Payer: Aetna Commercial |
$780.52
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$706.58
|
| Rate for Payer: Aetna Managed Medicare |
$330.91
|
| Rate for Payer: Anthem Medicare Advantage |
$330.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$330.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$330.91
|
| Rate for Payer: Cash Price |
$237.00
|
| Rate for Payer: Cash Price |
$237.00
|
| Rate for Payer: Cigna Commercial |
$780.52
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$410.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$330.91
|
| Rate for Payer: Health EOS Commercial |
$747.66
|
| Rate for Payer: HFN Commercial |
$780.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$954.11
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$954.11
|
| Rate for Payer: Independent Care Health Plan Medicare |
$330.91
|
| Rate for Payer: Multiplan Commercial |
$657.28
|
| Rate for Payer: NAPHCARE Commercial |
$496.36
|
| Rate for Payer: Preferred Network Access Commercial |
$780.52
|
| Rate for Payer: Quartz Beloit One Network |
$361.50
|
| Rate for Payer: Quartz Commercial |
$468.31
|
| Rate for Payer: Quartz Medicare Advantage |
$330.91
|
| Rate for Payer: The Alliance Commercial |
$909.99
|
| Rate for Payer: United Healthcare Medicare Advantage |
$330.91
|
| Rate for Payer: WEA Trust Commercial |
$451.88
|
| Rate for Payer: WPS Commercial |
$579.09
|
|
|
Pneuma/vac walk boot pre ots L4361
|
Facility
|
OP
|
$790.00
|
|
|
Service Code
|
HCPCS L4361
|
| Hospital Charge Code |
4498697
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$159.21 |
| Max. Negotiated Rate |
$1,323.63 |
| Rate for Payer: Aetna Commercial |
$739.44
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$706.58
|
| Rate for Payer: Aetna Managed Medicare |
$230.05
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$159.21
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$159.21
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$159.21
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$435.45
|
| Rate for Payer: Cash Price |
$237.00
|
| Rate for Payer: Cash Price |
$237.00
|
| Rate for Payer: Cigna Commercial |
$755.87
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$459.78
|
| Rate for Payer: Health EOS Commercial |
$731.22
|
| Rate for Payer: HFN Commercial |
$755.87
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$616.20
|
| Rate for Payer: Multiplan Commercial |
$657.28
|
| Rate for Payer: NAPHCARE Commercial |
$492.96
|
| Rate for Payer: Preferred Network Access Commercial |
$755.87
|
| Rate for Payer: Quartz Beloit One Network |
$402.58
|
| Rate for Payer: Quartz Commercial |
$534.04
|
| Rate for Payer: Quartz Medicare Advantage |
$492.96
|
| Rate for Payer: The Alliance Commercial |
$1,323.63
|
| Rate for Payer: WEA Trust Commercial |
$451.88
|
| Rate for Payer: WPS Commercial |
$608.54
|
|
|
Pneumococcal vaccine
|
Facility
|
IP
|
$100.00
|
|
|
Service Code
|
CPT 90732
|
| Hospital Charge Code |
3353526
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$50.96 |
| Max. Negotiated Rate |
$95.68 |
| Rate for Payer: Aetna Commercial |
$93.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$89.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$55.12
|
| Rate for Payer: Cash Price |
$30.00
|
| Rate for Payer: Cigna Commercial |
$95.68
|
| Rate for Payer: Health EOS Commercial |
$92.56
|
| Rate for Payer: HFN Commercial |
$95.68
|
| Rate for Payer: Multiplan Commercial |
$83.20
|
| Rate for Payer: Preferred Network Access Commercial |
$95.68
|
| Rate for Payer: Quartz Beloit One Network |
$50.96
|
| Rate for Payer: Quartz Commercial |
$62.40
|
| Rate for Payer: WEA Trust Commercial |
$57.20
|
| Rate for Payer: WPS Commercial |
$77.03
|
|
|
Pneumococcal vaccine
|
Facility
|
OP
|
$100.00
|
|
|
Service Code
|
CPT 90732
|
| Hospital Charge Code |
3353526
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$29.12 |
| Max. Negotiated Rate |
$555.24 |
| Rate for Payer: Aetna Commercial |
$93.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$89.44
|
| Rate for Payer: Aetna Managed Medicare |
$29.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$67.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$52.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$49.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$55.12
|
| Rate for Payer: Cash Price |
$30.00
|
| Rate for Payer: Cash Price |
$30.00
|
| Rate for Payer: Cigna Commercial |
$95.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$183.64
|
| Rate for Payer: Health EOS Commercial |
$92.56
|
| Rate for Payer: HFN Commercial |
$95.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$78.00
|
| Rate for Payer: Multiplan Commercial |
$83.20
|
| Rate for Payer: NAPHCARE Commercial |
$62.40
|
| Rate for Payer: Preferred Network Access Commercial |
$95.68
|
| Rate for Payer: Quartz Beloit One Network |
$50.96
|
| Rate for Payer: Quartz Commercial |
$67.60
|
| Rate for Payer: Quartz Medicare Advantage |
$62.40
|
| Rate for Payer: The Alliance Commercial |
$555.24
|
| Rate for Payer: WEA Trust Commercial |
$57.20
|
| Rate for Payer: WPS Commercial |
$347.03
|
|
|
Pneumococcal Vaccine
|
Facility
|
OP
|
$100.00
|
|
|
Service Code
|
CPT 90732
|
| Hospital Charge Code |
3005584
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$29.12 |
| Max. Negotiated Rate |
$555.24 |
| Rate for Payer: Aetna Commercial |
$93.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$89.44
|
| Rate for Payer: Aetna Managed Medicare |
$29.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$67.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$52.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$49.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$55.12
|
| Rate for Payer: Cash Price |
$30.00
|
| Rate for Payer: Cash Price |
$30.00
|
| Rate for Payer: Cigna Commercial |
$95.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$183.64
|
| Rate for Payer: Health EOS Commercial |
$92.56
|
| Rate for Payer: HFN Commercial |
$95.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$78.00
|
| Rate for Payer: Multiplan Commercial |
$83.20
|
| Rate for Payer: NAPHCARE Commercial |
$62.40
|
| Rate for Payer: Preferred Network Access Commercial |
$95.68
|
| Rate for Payer: Quartz Beloit One Network |
$50.96
|
| Rate for Payer: Quartz Commercial |
$67.60
|
| Rate for Payer: Quartz Medicare Advantage |
$62.40
|
| Rate for Payer: The Alliance Commercial |
$555.24
|
| Rate for Payer: WEA Trust Commercial |
$57.20
|
| Rate for Payer: WPS Commercial |
$347.03
|
|
|
Pneumococcal Vaccine
|
Facility
|
IP
|
$100.00
|
|
|
Service Code
|
CPT 90732
|
| Hospital Charge Code |
3005584
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$50.96 |
| Max. Negotiated Rate |
$95.68 |
| Rate for Payer: Aetna Commercial |
$93.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$89.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$55.12
|
| Rate for Payer: Cash Price |
$30.00
|
| Rate for Payer: Cigna Commercial |
$95.68
|
| Rate for Payer: Health EOS Commercial |
$92.56
|
| Rate for Payer: HFN Commercial |
$95.68
|
| Rate for Payer: Multiplan Commercial |
$83.20
|
| Rate for Payer: Preferred Network Access Commercial |
$95.68
|
| Rate for Payer: Quartz Beloit One Network |
$50.96
|
| Rate for Payer: Quartz Commercial |
$62.40
|
| Rate for Payer: WEA Trust Commercial |
$57.20
|
| Rate for Payer: WPS Commercial |
$77.03
|
|
|
Pneumococcal Vaccine 90732 man
|
Facility
|
IP
|
$186.00
|
|
|
Service Code
|
CPT 90732
|
| Hospital Charge Code |
3369602
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$94.79 |
| Max. Negotiated Rate |
$177.96 |
| Rate for Payer: Aetna Commercial |
$174.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$166.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$102.52
|
| Rate for Payer: Cash Price |
$55.80
|
| Rate for Payer: Cigna Commercial |
$177.96
|
| Rate for Payer: Health EOS Commercial |
$172.16
|
| Rate for Payer: HFN Commercial |
$177.96
|
| Rate for Payer: Multiplan Commercial |
$154.75
|
| Rate for Payer: Preferred Network Access Commercial |
$177.96
|
| Rate for Payer: Quartz Beloit One Network |
$94.79
|
| Rate for Payer: Quartz Commercial |
$116.06
|
| Rate for Payer: WEA Trust Commercial |
$106.39
|
| Rate for Payer: WPS Commercial |
$143.28
|
|
|
Pneumococcal Vaccine 90732 man
|
Professional
|
Both
|
$186.00
|
|
|
Service Code
|
CPT 90732
|
| Hospital Charge Code |
3369602
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$85.11 |
| Max. Negotiated Rate |
$347.03 |
| Rate for Payer: Aetna Commercial |
$183.77
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$166.36
|
| Rate for Payer: Aetna Managed Medicare |
$138.81
|
| Rate for Payer: Anthem Medicare Advantage |
$138.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$138.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$138.81
|
| Rate for Payer: Cash Price |
$55.80
|
| Rate for Payer: Cash Price |
$55.80
|
| Rate for Payer: Cigna Commercial |
$183.77
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$121.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$138.81
|
| Rate for Payer: Health EOS Commercial |
$176.03
|
| Rate for Payer: HFN Commercial |
$183.77
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$191.19
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$191.19
|
| Rate for Payer: Independent Care Health Plan Medicare |
$138.81
|
| Rate for Payer: Multiplan Commercial |
$154.75
|
| Rate for Payer: NAPHCARE Commercial |
$208.21
|
| Rate for Payer: Preferred Network Access Commercial |
$183.77
|
| Rate for Payer: Quartz Beloit One Network |
$85.11
|
| Rate for Payer: Quartz Commercial |
$110.26
|
| Rate for Payer: Quartz Medicare Advantage |
$138.81
|
| Rate for Payer: The Alliance Commercial |
$347.02
|
| Rate for Payer: United Healthcare Medicaid |
$121.76
|
| Rate for Payer: United Healthcare Medicare Advantage |
$138.81
|
| Rate for Payer: WEA Trust Commercial |
$106.39
|
| Rate for Payer: WPS Commercial |
$347.03
|
|
|
Pneumococcal Vaccine 90732 man
|
Facility
|
OP
|
$186.00
|
|
|
Service Code
|
CPT 90732
|
| Hospital Charge Code |
3369602
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$54.16 |
| Max. Negotiated Rate |
$555.24 |
| Rate for Payer: Aetna Commercial |
$174.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$166.36
|
| Rate for Payer: Aetna Managed Medicare |
$54.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$125.74
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$96.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$92.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$102.52
|
| Rate for Payer: Cash Price |
$55.80
|
| Rate for Payer: Cash Price |
$55.80
|
| Rate for Payer: Cigna Commercial |
$177.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$183.64
|
| Rate for Payer: Health EOS Commercial |
$172.16
|
| Rate for Payer: HFN Commercial |
$177.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$145.08
|
| Rate for Payer: Multiplan Commercial |
$154.75
|
| Rate for Payer: NAPHCARE Commercial |
$116.06
|
| Rate for Payer: Preferred Network Access Commercial |
$177.96
|
| Rate for Payer: Quartz Beloit One Network |
$94.79
|
| Rate for Payer: Quartz Commercial |
$125.74
|
| Rate for Payer: Quartz Medicare Advantage |
$116.06
|
| Rate for Payer: The Alliance Commercial |
$555.24
|
| Rate for Payer: WEA Trust Commercial |
$106.39
|
| Rate for Payer: WPS Commercial |
$347.03
|
|
|
Pneumococcal Vacc, Ped <5 13 Valent 90670
|
Facility
|
IP
|
$388.00
|
|
|
Service Code
|
CPT 90670
|
| Hospital Charge Code |
3397516
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$197.72 |
| Max. Negotiated Rate |
$371.24 |
| Rate for Payer: Aetna Commercial |
$363.17
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$347.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$213.87
|
| Rate for Payer: Cash Price |
$116.40
|
| Rate for Payer: Cigna Commercial |
$371.24
|
| Rate for Payer: Health EOS Commercial |
$359.13
|
| Rate for Payer: HFN Commercial |
$371.24
|
| Rate for Payer: Multiplan Commercial |
$322.82
|
| Rate for Payer: Preferred Network Access Commercial |
$371.24
|
| Rate for Payer: Quartz Beloit One Network |
$197.72
|
| Rate for Payer: Quartz Commercial |
$242.11
|
| Rate for Payer: WEA Trust Commercial |
$221.94
|
| Rate for Payer: WPS Commercial |
$298.88
|
|
|
Pneumococcal Vacc, Ped <5 13 Valent 90670
|
Facility
|
OP
|
$388.00
|
|
|
Service Code
|
CPT 90670
|
| Hospital Charge Code |
3397516
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$112.99 |
| Max. Negotiated Rate |
$670.77 |
| Rate for Payer: Aetna Commercial |
$363.17
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$347.03
|
| Rate for Payer: Aetna Managed Medicare |
$112.99
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$262.29
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$201.76
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$193.69
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$213.87
|
| Rate for Payer: Cash Price |
$116.40
|
| Rate for Payer: Cash Price |
$116.40
|
| Rate for Payer: Cigna Commercial |
$371.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$354.97
|
| Rate for Payer: Health EOS Commercial |
$359.13
|
| Rate for Payer: HFN Commercial |
$371.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$302.64
|
| Rate for Payer: Multiplan Commercial |
$322.82
|
| Rate for Payer: NAPHCARE Commercial |
$242.11
|
| Rate for Payer: Preferred Network Access Commercial |
$371.24
|
| Rate for Payer: Quartz Beloit One Network |
$197.72
|
| Rate for Payer: Quartz Commercial |
$262.29
|
| Rate for Payer: Quartz Medicare Advantage |
$242.11
|
| Rate for Payer: The Alliance Commercial |
$201.76
|
| Rate for Payer: WEA Trust Commercial |
$221.94
|
| Rate for Payer: WPS Commercial |
$670.77
|
|
|
Pneumococcal Vacc, Ped <5 13 Valent 90670
|
Professional
|
Both
|
$388.00
|
|
|
Service Code
|
CPT 90670
|
| Hospital Charge Code |
3397516
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$177.55 |
| Max. Negotiated Rate |
$670.77 |
| Rate for Payer: Aetna Commercial |
$383.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$347.03
|
| Rate for Payer: Cash Price |
$116.40
|
| Rate for Payer: Cash Price |
$116.40
|
| Rate for Payer: Cigna Commercial |
$383.34
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$201.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$268.31
|
| Rate for Payer: Health EOS Commercial |
$367.20
|
| Rate for Payer: HFN Commercial |
$383.34
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$366.51
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$366.51
|
| Rate for Payer: Multiplan Commercial |
$322.82
|
| Rate for Payer: Preferred Network Access Commercial |
$383.34
|
| Rate for Payer: Quartz Beloit One Network |
$177.55
|
| Rate for Payer: Quartz Commercial |
$230.01
|
| Rate for Payer: The Alliance Commercial |
$201.76
|
| Rate for Payer: WEA Trust Commercial |
$221.94
|
| Rate for Payer: WPS Commercial |
$670.77
|
|
|
Pneumococcal Vacc, Ped <5 13 Valent - 90670 VFC
|
Professional
|
Both
|
$20.83
|
|
|
Service Code
|
CPT 90670
|
| Hospital Charge Code |
5905647
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.53 |
| Max. Negotiated Rate |
$670.77 |
| Rate for Payer: Aetna Commercial |
$20.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$18.63
|
| Rate for Payer: Cash Price |
$6.25
|
| Rate for Payer: Cash Price |
$6.25
|
| Rate for Payer: Cigna Commercial |
$20.58
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$10.83
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$268.31
|
| Rate for Payer: Health EOS Commercial |
$19.71
|
| Rate for Payer: HFN Commercial |
$20.58
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$366.51
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$366.51
|
| Rate for Payer: Multiplan Commercial |
$17.33
|
| Rate for Payer: Preferred Network Access Commercial |
$20.58
|
| Rate for Payer: Quartz Beloit One Network |
$9.53
|
| Rate for Payer: Quartz Commercial |
$12.35
|
| Rate for Payer: The Alliance Commercial |
$10.83
|
| Rate for Payer: WEA Trust Commercial |
$11.91
|
| Rate for Payer: WPS Commercial |
$670.77
|
|
|
Pneumococcal Vacc, Ped <5 13 Valent - 90670 VFC
|
Facility
|
IP
|
$20.83
|
|
|
Service Code
|
CPT 90670
|
| Hospital Charge Code |
5905647
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.61 |
| Max. Negotiated Rate |
$19.93 |
| Rate for Payer: Aetna Commercial |
$19.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$18.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$11.48
|
| Rate for Payer: Cash Price |
$6.25
|
| Rate for Payer: Cigna Commercial |
$19.93
|
| Rate for Payer: Health EOS Commercial |
$19.28
|
| Rate for Payer: HFN Commercial |
$19.93
|
| Rate for Payer: Multiplan Commercial |
$17.33
|
| Rate for Payer: Preferred Network Access Commercial |
$19.93
|
| Rate for Payer: Quartz Beloit One Network |
$10.61
|
| Rate for Payer: Quartz Commercial |
$13.00
|
| Rate for Payer: WEA Trust Commercial |
$11.91
|
| Rate for Payer: WPS Commercial |
$16.05
|
|
|
Pneumococcal Vacc, Ped <5 13 Valent - 90670 VFC
|
Facility
|
OP
|
$20.83
|
|
|
Service Code
|
CPT 90670
|
| Hospital Charge Code |
5905647
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.07 |
| Max. Negotiated Rate |
$670.77 |
| Rate for Payer: Aetna Commercial |
$19.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$18.63
|
| Rate for Payer: Aetna Managed Medicare |
$6.07
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$14.08
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$10.83
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$10.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$11.48
|
| Rate for Payer: Cash Price |
$6.25
|
| Rate for Payer: Cash Price |
$6.25
|
| Rate for Payer: Cigna Commercial |
$19.93
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$354.97
|
| Rate for Payer: Health EOS Commercial |
$19.28
|
| Rate for Payer: HFN Commercial |
$19.93
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$16.25
|
| Rate for Payer: Multiplan Commercial |
$17.33
|
| Rate for Payer: NAPHCARE Commercial |
$13.00
|
| Rate for Payer: Preferred Network Access Commercial |
$19.93
|
| Rate for Payer: Quartz Beloit One Network |
$10.61
|
| Rate for Payer: Quartz Commercial |
$14.08
|
| Rate for Payer: Quartz Medicare Advantage |
$13.00
|
| Rate for Payer: The Alliance Commercial |
$10.83
|
| Rate for Payer: WEA Trust Commercial |
$11.91
|
| Rate for Payer: WPS Commercial |
$670.77
|
|
|
Pneumococcal valent 13
|
Facility
|
OP
|
$457.00
|
|
|
Service Code
|
CPT 90670
|
| Hospital Charge Code |
5621732
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$133.08 |
| Max. Negotiated Rate |
$670.77 |
| Rate for Payer: Aetna Commercial |
$427.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$408.74
|
| Rate for Payer: Aetna Managed Medicare |
$133.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$308.93
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$237.64
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$228.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$251.90
|
| Rate for Payer: Cash Price |
$137.10
|
| Rate for Payer: Cash Price |
$137.10
|
| Rate for Payer: Cigna Commercial |
$437.26
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$354.97
|
| Rate for Payer: Health EOS Commercial |
$423.00
|
| Rate for Payer: HFN Commercial |
$437.26
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$356.46
|
| Rate for Payer: Multiplan Commercial |
$380.22
|
| Rate for Payer: NAPHCARE Commercial |
$285.17
|
| Rate for Payer: Preferred Network Access Commercial |
$437.26
|
| Rate for Payer: Quartz Beloit One Network |
$232.89
|
| Rate for Payer: Quartz Commercial |
$308.93
|
| Rate for Payer: Quartz Medicare Advantage |
$285.17
|
| Rate for Payer: The Alliance Commercial |
$237.64
|
| Rate for Payer: WEA Trust Commercial |
$261.40
|
| Rate for Payer: WPS Commercial |
$670.77
|
|
|
Pneumococcal valent 13
|
Facility
|
IP
|
$457.00
|
|
|
Service Code
|
CPT 90670
|
| Hospital Charge Code |
5621732
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$232.89 |
| Max. Negotiated Rate |
$437.26 |
| Rate for Payer: Aetna Commercial |
$427.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$408.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$251.90
|
| Rate for Payer: Cash Price |
$137.10
|
| Rate for Payer: Cigna Commercial |
$437.26
|
| Rate for Payer: Health EOS Commercial |
$423.00
|
| Rate for Payer: HFN Commercial |
$437.26
|
| Rate for Payer: Multiplan Commercial |
$380.22
|
| Rate for Payer: Preferred Network Access Commercial |
$437.26
|
| Rate for Payer: Quartz Beloit One Network |
$232.89
|
| Rate for Payer: Quartz Commercial |
$285.17
|
| Rate for Payer: WEA Trust Commercial |
$261.40
|
| Rate for Payer: WPS Commercial |
$352.03
|
|
|
Pneumococcal valent13
|
Facility
|
OP
|
$457.00
|
|
|
Service Code
|
CPT 90670
|
| Hospital Charge Code |
5621737
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$133.08 |
| Max. Negotiated Rate |
$670.77 |
| Rate for Payer: Aetna Commercial |
$427.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$408.74
|
| Rate for Payer: Aetna Managed Medicare |
$133.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$308.93
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$237.64
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$228.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$251.90
|
| Rate for Payer: Cash Price |
$137.10
|
| Rate for Payer: Cash Price |
$137.10
|
| Rate for Payer: Cigna Commercial |
$437.26
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$354.97
|
| Rate for Payer: Health EOS Commercial |
$423.00
|
| Rate for Payer: HFN Commercial |
$437.26
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$356.46
|
| Rate for Payer: Multiplan Commercial |
$380.22
|
| Rate for Payer: NAPHCARE Commercial |
$285.17
|
| Rate for Payer: Preferred Network Access Commercial |
$437.26
|
| Rate for Payer: Quartz Beloit One Network |
$232.89
|
| Rate for Payer: Quartz Commercial |
$308.93
|
| Rate for Payer: Quartz Medicare Advantage |
$285.17
|
| Rate for Payer: The Alliance Commercial |
$237.64
|
| Rate for Payer: WEA Trust Commercial |
$261.40
|
| Rate for Payer: WPS Commercial |
$670.77
|
|
|
Pneumococcal valent13
|
Facility
|
IP
|
$457.00
|
|
|
Service Code
|
CPT 90670
|
| Hospital Charge Code |
5621737
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$232.89 |
| Max. Negotiated Rate |
$437.26 |
| Rate for Payer: Aetna Commercial |
$427.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$408.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$251.90
|
| Rate for Payer: Cash Price |
$137.10
|
| Rate for Payer: Cigna Commercial |
$437.26
|
| Rate for Payer: Health EOS Commercial |
$423.00
|
| Rate for Payer: HFN Commercial |
$437.26
|
| Rate for Payer: Multiplan Commercial |
$380.22
|
| Rate for Payer: Preferred Network Access Commercial |
$437.26
|
| Rate for Payer: Quartz Beloit One Network |
$232.89
|
| Rate for Payer: Quartz Commercial |
$285.17
|
| Rate for Payer: WEA Trust Commercial |
$261.40
|
| Rate for Payer: WPS Commercial |
$352.03
|
|
