|
RSV IG, IM, 50MG 90378
|
Facility
|
IP
|
$2,944.00
|
|
|
Service Code
|
CPT 90378
|
| Hospital Charge Code |
3873516
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,500.26 |
| Max. Negotiated Rate |
$2,816.82 |
| Rate for Payer: Aetna Commercial |
$2,755.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,633.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,622.73
|
| Rate for Payer: Cash Price |
$883.20
|
| Rate for Payer: Cigna Commercial |
$2,816.82
|
| Rate for Payer: Health EOS Commercial |
$2,724.97
|
| Rate for Payer: HFN Commercial |
$2,816.82
|
| Rate for Payer: Multiplan Commercial |
$2,449.41
|
| Rate for Payer: Preferred Network Access Commercial |
$2,816.82
|
| Rate for Payer: Quartz Beloit One Network |
$1,500.26
|
| Rate for Payer: Quartz Commercial |
$1,837.06
|
| Rate for Payer: WEA Trust Commercial |
$1,683.97
|
| Rate for Payer: WPS Commercial |
$2,267.76
|
|
|
RSV IG, IM, 50MG 90378
|
Professional
|
Both
|
$2,944.00
|
|
|
Service Code
|
CPT 90378
|
| Hospital Charge Code |
3873516
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,347.17 |
| Max. Negotiated Rate |
$2,908.67 |
| Rate for Payer: Aetna Commercial |
$2,908.67
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,633.11
|
| Rate for Payer: Cash Price |
$883.20
|
| Rate for Payer: Cash Price |
$883.20
|
| Rate for Payer: Cigna Commercial |
$2,908.67
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,530.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,837.06
|
| Rate for Payer: Health EOS Commercial |
$2,786.20
|
| Rate for Payer: HFN Commercial |
$2,908.67
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,448.49
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$2,448.49
|
| Rate for Payer: Multiplan Commercial |
$2,449.41
|
| Rate for Payer: Preferred Network Access Commercial |
$2,908.67
|
| Rate for Payer: Quartz Beloit One Network |
$1,347.17
|
| Rate for Payer: Quartz Commercial |
$1,745.20
|
| Rate for Payer: The Alliance Commercial |
$1,530.88
|
| Rate for Payer: WEA Trust Commercial |
$1,683.97
|
| Rate for Payer: WPS Commercial |
$2,267.76
|
|
|
RSV PCR
|
Professional
|
Both
|
$229.00
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
4566788
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$36.49 |
| Max. Negotiated Rate |
$226.25 |
| Rate for Payer: Aetna Commercial |
$226.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$204.82
|
| 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 |
$68.70
|
| Rate for Payer: Cash Price |
$68.70
|
| Rate for Payer: Cigna Commercial |
$226.25
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$119.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$36.49
|
| Rate for Payer: Health EOS Commercial |
$216.73
|
| Rate for Payer: HFN Commercial |
$226.25
|
| 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 |
$190.53
|
| Rate for Payer: NAPHCARE Commercial |
$54.74
|
| Rate for Payer: Preferred Network Access Commercial |
$226.25
|
| Rate for Payer: Quartz Beloit One Network |
$104.79
|
| Rate for Payer: Quartz Commercial |
$135.75
|
| 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 |
$130.99
|
| Rate for Payer: WPS Commercial |
$160.57
|
|
|
RSV PCR
|
Facility
|
OP
|
$229.00
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
4566788
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$36.49 |
| Max. Negotiated Rate |
$219.11 |
| Rate for Payer: Aetna Commercial |
$214.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$204.82
|
| 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 |
$126.22
|
| 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 |
$68.70
|
| Rate for Payer: Cash Price |
$68.70
|
| Rate for Payer: Cigna Commercial |
$219.11
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$36.49
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$133.28
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$36.49
|
| Rate for Payer: Health EOS Commercial |
$211.96
|
| Rate for Payer: HFN Commercial |
$219.11
|
| 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 |
$190.53
|
| Rate for Payer: NAPHCARE Commercial |
$54.74
|
| Rate for Payer: Preferred Network Access Commercial |
$219.11
|
| Rate for Payer: Quartz Beloit One Network |
$116.70
|
| Rate for Payer: Quartz Commercial |
$154.80
|
| 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 |
$178.62
|
| Rate for Payer: WEA Trust Commercial |
$130.99
|
| Rate for Payer: Wellcare Medicare |
$36.49
|
| Rate for Payer: WPS Commercial |
$176.40
|
|
|
RSV PCR
|
Facility
|
IP
|
$229.00
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
4566788
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$116.70 |
| Max. Negotiated Rate |
$219.11 |
| Rate for Payer: Aetna Commercial |
$214.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$204.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$126.22
|
| Rate for Payer: Cash Price |
$68.70
|
| Rate for Payer: Cigna Commercial |
$219.11
|
| Rate for Payer: Health EOS Commercial |
$211.96
|
| Rate for Payer: HFN Commercial |
$219.11
|
| Rate for Payer: Multiplan Commercial |
$190.53
|
| Rate for Payer: Preferred Network Access Commercial |
$219.11
|
| Rate for Payer: Quartz Beloit One Network |
$116.70
|
| Rate for Payer: Quartz Commercial |
$142.90
|
| Rate for Payer: WEA Trust Commercial |
$130.99
|
| Rate for Payer: WPS Commercial |
$176.40
|
|
|
Rubella Antibody IgM
|
Facility
|
OP
|
$166.00
|
|
|
Service Code
|
CPT 86762
|
| Hospital Charge Code |
978060
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.97 |
| Max. Negotiated Rate |
$158.83 |
| Rate for Payer: Aetna Commercial |
$155.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$148.47
|
| Rate for Payer: Aetna Managed Medicare |
$14.97
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$56.12
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$26.19
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$24.84
|
| Rate for Payer: Anthem Medicare Advantage |
$14.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$91.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$14.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$14.97
|
| Rate for Payer: Cash Price |
$49.80
|
| Rate for Payer: Cash Price |
$49.80
|
| Rate for Payer: Cigna Commercial |
$158.83
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$14.97
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$96.61
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$14.97
|
| Rate for Payer: Health EOS Commercial |
$153.65
|
| Rate for Payer: HFN Commercial |
$158.83
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$55.67
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$14.97
|
| Rate for Payer: Independent Care Health Plan Medicare |
$14.97
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$14.97
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$14.97
|
| Rate for Payer: Multiplan Commercial |
$138.11
|
| Rate for Payer: NAPHCARE Commercial |
$22.45
|
| Rate for Payer: Preferred Network Access Commercial |
$158.83
|
| Rate for Payer: Quartz Beloit One Network |
$84.59
|
| Rate for Payer: Quartz Commercial |
$112.22
|
| Rate for Payer: Quartz Medicare Advantage |
$14.97
|
| Rate for Payer: The Alliance Commercial |
$59.86
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14.97
|
| Rate for Payer: United Healthcare PPO |
$129.48
|
| Rate for Payer: WEA Trust Commercial |
$94.95
|
| Rate for Payer: Wellcare Medicare |
$14.97
|
| Rate for Payer: WPS Commercial |
$127.87
|
|
|
Rubella Antibody IgM
|
Professional
|
Both
|
$166.00
|
|
|
Service Code
|
CPT 86762
|
| Hospital Charge Code |
978060
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.97 |
| Max. Negotiated Rate |
$164.01 |
| Rate for Payer: Aetna Commercial |
$164.01
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$148.47
|
| Rate for Payer: Aetna Managed Medicare |
$14.97
|
| Rate for Payer: Anthem Medicare Advantage |
$14.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$14.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$14.97
|
| Rate for Payer: Cash Price |
$49.80
|
| Rate for Payer: Cash Price |
$49.80
|
| Rate for Payer: Cigna Commercial |
$164.01
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$86.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$14.97
|
| Rate for Payer: Health EOS Commercial |
$157.10
|
| Rate for Payer: HFN Commercial |
$164.01
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$52.83
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$52.83
|
| Rate for Payer: Independent Care Health Plan Medicare |
$14.97
|
| Rate for Payer: Multiplan Commercial |
$138.11
|
| Rate for Payer: NAPHCARE Commercial |
$22.45
|
| Rate for Payer: Preferred Network Access Commercial |
$164.01
|
| Rate for Payer: Quartz Beloit One Network |
$75.96
|
| Rate for Payer: Quartz Commercial |
$98.40
|
| Rate for Payer: Quartz Medicare Advantage |
$14.97
|
| Rate for Payer: The Alliance Commercial |
$59.11
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14.97
|
| Rate for Payer: WEA Trust Commercial |
$94.95
|
| Rate for Payer: WPS Commercial |
$65.85
|
|
|
Rubella Antibody IgM
|
Facility
|
IP
|
$166.00
|
|
|
Service Code
|
CPT 86762
|
| Hospital Charge Code |
978060
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$84.59 |
| Max. Negotiated Rate |
$158.83 |
| Rate for Payer: Aetna Commercial |
$155.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$148.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$91.50
|
| Rate for Payer: Cash Price |
$49.80
|
| Rate for Payer: Cigna Commercial |
$158.83
|
| Rate for Payer: Health EOS Commercial |
$153.65
|
| Rate for Payer: HFN Commercial |
$158.83
|
| Rate for Payer: Multiplan Commercial |
$138.11
|
| Rate for Payer: Preferred Network Access Commercial |
$158.83
|
| Rate for Payer: Quartz Beloit One Network |
$84.59
|
| Rate for Payer: Quartz Commercial |
$103.58
|
| Rate for Payer: WEA Trust Commercial |
$94.95
|
| Rate for Payer: WPS Commercial |
$127.87
|
|
|
Rubella Imm Status
|
Professional
|
Both
|
$166.00
|
|
|
Service Code
|
CPT 86762
|
| Hospital Charge Code |
4590769
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.97 |
| Max. Negotiated Rate |
$164.01 |
| Rate for Payer: Aetna Commercial |
$164.01
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$148.47
|
| Rate for Payer: Aetna Managed Medicare |
$14.97
|
| Rate for Payer: Anthem Medicare Advantage |
$14.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$14.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$14.97
|
| Rate for Payer: Cash Price |
$49.80
|
| Rate for Payer: Cash Price |
$49.80
|
| Rate for Payer: Cigna Commercial |
$164.01
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$86.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$14.97
|
| Rate for Payer: Health EOS Commercial |
$157.10
|
| Rate for Payer: HFN Commercial |
$164.01
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$52.83
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$52.83
|
| Rate for Payer: Independent Care Health Plan Medicare |
$14.97
|
| Rate for Payer: Multiplan Commercial |
$138.11
|
| Rate for Payer: NAPHCARE Commercial |
$22.45
|
| Rate for Payer: Preferred Network Access Commercial |
$164.01
|
| Rate for Payer: Quartz Beloit One Network |
$75.96
|
| Rate for Payer: Quartz Commercial |
$98.40
|
| Rate for Payer: Quartz Medicare Advantage |
$14.97
|
| Rate for Payer: The Alliance Commercial |
$59.11
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14.97
|
| Rate for Payer: WEA Trust Commercial |
$94.95
|
| Rate for Payer: WPS Commercial |
$65.85
|
|
|
Rubella Imm Status
|
Facility
|
OP
|
$166.00
|
|
|
Service Code
|
CPT 86762
|
| Hospital Charge Code |
4590769
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.97 |
| Max. Negotiated Rate |
$158.83 |
| Rate for Payer: Aetna Commercial |
$155.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$148.47
|
| Rate for Payer: Aetna Managed Medicare |
$14.97
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$56.12
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$26.19
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$24.84
|
| Rate for Payer: Anthem Medicare Advantage |
$14.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$91.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$14.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$14.97
|
| Rate for Payer: Cash Price |
$49.80
|
| Rate for Payer: Cash Price |
$49.80
|
| Rate for Payer: Cigna Commercial |
$158.83
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$14.97
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$96.61
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$14.97
|
| Rate for Payer: Health EOS Commercial |
$153.65
|
| Rate for Payer: HFN Commercial |
$158.83
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$55.67
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$14.97
|
| Rate for Payer: Independent Care Health Plan Medicare |
$14.97
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$14.97
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$14.97
|
| Rate for Payer: Multiplan Commercial |
$138.11
|
| Rate for Payer: NAPHCARE Commercial |
$22.45
|
| Rate for Payer: Preferred Network Access Commercial |
$158.83
|
| Rate for Payer: Quartz Beloit One Network |
$84.59
|
| Rate for Payer: Quartz Commercial |
$112.22
|
| Rate for Payer: Quartz Medicare Advantage |
$14.97
|
| Rate for Payer: The Alliance Commercial |
$59.86
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14.97
|
| Rate for Payer: United Healthcare PPO |
$129.48
|
| Rate for Payer: WEA Trust Commercial |
$94.95
|
| Rate for Payer: Wellcare Medicare |
$14.97
|
| Rate for Payer: WPS Commercial |
$127.87
|
|
|
Rubella Imm Status
|
Facility
|
IP
|
$166.00
|
|
|
Service Code
|
CPT 86762
|
| Hospital Charge Code |
4590769
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$84.59 |
| Max. Negotiated Rate |
$158.83 |
| Rate for Payer: Aetna Commercial |
$155.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$148.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$91.50
|
| Rate for Payer: Cash Price |
$49.80
|
| Rate for Payer: Cigna Commercial |
$158.83
|
| Rate for Payer: Health EOS Commercial |
$153.65
|
| Rate for Payer: HFN Commercial |
$158.83
|
| Rate for Payer: Multiplan Commercial |
$138.11
|
| Rate for Payer: Preferred Network Access Commercial |
$158.83
|
| Rate for Payer: Quartz Beloit One Network |
$84.59
|
| Rate for Payer: Quartz Commercial |
$103.58
|
| Rate for Payer: WEA Trust Commercial |
$94.95
|
| Rate for Payer: WPS Commercial |
$127.87
|
|
|
Rubicon Support Catheter
|
Facility
|
IP
|
$1,696.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
4606626
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$864.28 |
| Max. Negotiated Rate |
$1,622.73 |
| Rate for Payer: Aetna Commercial |
$1,587.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,516.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$934.84
|
| Rate for Payer: Cash Price |
$508.80
|
| Rate for Payer: Cigna Commercial |
$1,622.73
|
| Rate for Payer: Health EOS Commercial |
$1,569.82
|
| Rate for Payer: HFN Commercial |
$1,622.73
|
| Rate for Payer: Multiplan Commercial |
$1,411.07
|
| Rate for Payer: Preferred Network Access Commercial |
$1,622.73
|
| Rate for Payer: Quartz Beloit One Network |
$864.28
|
| Rate for Payer: Quartz Commercial |
$1,058.30
|
| Rate for Payer: WEA Trust Commercial |
$970.11
|
| Rate for Payer: WPS Commercial |
$1,306.43
|
|
|
Rubicon Support Catheter
|
Facility
|
OP
|
$1,696.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
4606626
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$493.88 |
| Max. Negotiated Rate |
$1,622.73 |
| Rate for Payer: Aetna Commercial |
$1,587.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,516.90
|
| Rate for Payer: Aetna Managed Medicare |
$493.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,146.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$881.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$846.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$934.84
|
| Rate for Payer: Cash Price |
$508.80
|
| Rate for Payer: Cigna Commercial |
$1,622.73
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$987.07
|
| Rate for Payer: Health EOS Commercial |
$1,569.82
|
| Rate for Payer: HFN Commercial |
$1,622.73
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,322.88
|
| Rate for Payer: Multiplan Commercial |
$1,411.07
|
| Rate for Payer: NAPHCARE Commercial |
$1,058.30
|
| Rate for Payer: Preferred Network Access Commercial |
$1,622.73
|
| Rate for Payer: Quartz Beloit One Network |
$864.28
|
| Rate for Payer: Quartz Commercial |
$1,146.50
|
| Rate for Payer: Quartz Medicare Advantage |
$1,058.30
|
| Rate for Payer: The Alliance Commercial |
$881.92
|
| Rate for Payer: WEA Trust Commercial |
$970.11
|
| Rate for Payer: WPS Commercial |
$1,306.43
|
|
|
Rufinamide (Banzel) Level
|
Facility
|
IP
|
$236.00
|
|
|
Service Code
|
CPT 80210
|
| Hospital Charge Code |
3404973
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$120.27 |
| Max. Negotiated Rate |
$225.80 |
| Rate for Payer: Aetna Commercial |
$220.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$211.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$130.08
|
| Rate for Payer: Cash Price |
$70.80
|
| Rate for Payer: Cigna Commercial |
$225.80
|
| Rate for Payer: Health EOS Commercial |
$218.44
|
| Rate for Payer: HFN Commercial |
$225.80
|
| Rate for Payer: Multiplan Commercial |
$196.35
|
| Rate for Payer: Preferred Network Access Commercial |
$225.80
|
| Rate for Payer: Quartz Beloit One Network |
$120.27
|
| Rate for Payer: Quartz Commercial |
$147.26
|
| Rate for Payer: WEA Trust Commercial |
$134.99
|
| Rate for Payer: WPS Commercial |
$181.79
|
|
|
Rufinamide (Banzel) Level
|
Facility
|
OP
|
$236.00
|
|
|
Service Code
|
CPT 80210
|
| Hospital Charge Code |
3404973
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$28.19 |
| Max. Negotiated Rate |
$225.80 |
| Rate for Payer: Aetna Commercial |
$220.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$211.08
|
| Rate for Payer: Aetna Managed Medicare |
$28.19
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$105.73
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$49.34
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$46.80
|
| Rate for Payer: Anthem Medicare Advantage |
$28.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$130.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$28.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$28.19
|
| Rate for Payer: Cash Price |
$70.80
|
| Rate for Payer: Cash Price |
$70.80
|
| Rate for Payer: Cigna Commercial |
$225.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$28.19
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$137.35
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$28.19
|
| Rate for Payer: Health EOS Commercial |
$218.44
|
| Rate for Payer: HFN Commercial |
$225.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$104.88
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$28.19
|
| Rate for Payer: Independent Care Health Plan Medicare |
$28.19
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$28.19
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$28.19
|
| Rate for Payer: Multiplan Commercial |
$196.35
|
| Rate for Payer: NAPHCARE Commercial |
$42.29
|
| Rate for Payer: Preferred Network Access Commercial |
$225.80
|
| Rate for Payer: Quartz Beloit One Network |
$120.27
|
| Rate for Payer: Quartz Commercial |
$159.54
|
| Rate for Payer: Quartz Medicare Advantage |
$28.19
|
| Rate for Payer: The Alliance Commercial |
$112.78
|
| Rate for Payer: United Healthcare Medicare Advantage |
$28.19
|
| Rate for Payer: United Healthcare PPO |
$184.08
|
| Rate for Payer: WEA Trust Commercial |
$134.99
|
| Rate for Payer: Wellcare Medicare |
$28.19
|
| Rate for Payer: WPS Commercial |
$181.79
|
|
|
Rufinamide (Banzel) Level
|
Professional
|
Both
|
$236.00
|
|
|
Service Code
|
CPT 80210
|
| Hospital Charge Code |
3404973
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$28.19 |
| Max. Negotiated Rate |
$233.17 |
| Rate for Payer: Aetna Commercial |
$233.17
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$211.08
|
| Rate for Payer: Aetna Managed Medicare |
$28.19
|
| Rate for Payer: Anthem Medicare Advantage |
$28.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$28.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$28.19
|
| Rate for Payer: Cash Price |
$70.80
|
| Rate for Payer: Cash Price |
$70.80
|
| Rate for Payer: Cigna Commercial |
$233.17
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$122.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$28.19
|
| Rate for Payer: Health EOS Commercial |
$223.35
|
| Rate for Payer: HFN Commercial |
$233.17
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$99.53
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$99.53
|
| Rate for Payer: Independent Care Health Plan Medicare |
$28.19
|
| Rate for Payer: Multiplan Commercial |
$196.35
|
| Rate for Payer: NAPHCARE Commercial |
$42.29
|
| Rate for Payer: Preferred Network Access Commercial |
$233.17
|
| Rate for Payer: Quartz Beloit One Network |
$107.99
|
| Rate for Payer: Quartz Commercial |
$139.90
|
| Rate for Payer: Quartz Medicare Advantage |
$28.19
|
| Rate for Payer: The Alliance Commercial |
$111.37
|
| Rate for Payer: United Healthcare Medicare Advantage |
$28.19
|
| Rate for Payer: WEA Trust Commercial |
$134.99
|
| Rate for Payer: WPS Commercial |
$124.06
|
|
|
RUSH ROD X 3/32 X 9 1/2
|
Facility
|
IP
|
$1,020.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2967807
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$519.79 |
| Max. Negotiated Rate |
$975.94 |
| Rate for Payer: Aetna Commercial |
$954.72
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$912.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$562.22
|
| Rate for Payer: Cash Price |
$306.00
|
| Rate for Payer: Cigna Commercial |
$975.94
|
| Rate for Payer: Health EOS Commercial |
$944.11
|
| Rate for Payer: HFN Commercial |
$975.94
|
| Rate for Payer: Multiplan Commercial |
$848.64
|
| Rate for Payer: Preferred Network Access Commercial |
$975.94
|
| Rate for Payer: Quartz Beloit One Network |
$519.79
|
| Rate for Payer: Quartz Commercial |
$636.48
|
| Rate for Payer: WEA Trust Commercial |
$583.44
|
| Rate for Payer: WPS Commercial |
$785.71
|
|
|
RUSH ROD X 3/32 X 9 1/2
|
Facility
|
OP
|
$1,020.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2967807
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$297.02 |
| Max. Negotiated Rate |
$975.94 |
| Rate for Payer: Aetna Commercial |
$954.72
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$912.29
|
| Rate for Payer: Aetna Managed Medicare |
$297.02
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$689.52
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$530.40
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$509.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$562.22
|
| Rate for Payer: Cash Price |
$306.00
|
| Rate for Payer: Cigna Commercial |
$975.94
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$593.64
|
| Rate for Payer: Health EOS Commercial |
$944.11
|
| Rate for Payer: HFN Commercial |
$975.94
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$795.60
|
| Rate for Payer: Multiplan Commercial |
$848.64
|
| Rate for Payer: NAPHCARE Commercial |
$636.48
|
| Rate for Payer: Preferred Network Access Commercial |
$975.94
|
| Rate for Payer: Quartz Beloit One Network |
$519.79
|
| Rate for Payer: Quartz Commercial |
$689.52
|
| Rate for Payer: Quartz Medicare Advantage |
$636.48
|
| Rate for Payer: The Alliance Commercial |
$530.40
|
| Rate for Payer: WEA Trust Commercial |
$583.44
|
| Rate for Payer: WPS Commercial |
$785.71
|
|
|
RV1 VACCINE 2 DOSE SCHEDULE LIVE FOR ORAL USE 90681 - VFC
|
Facility
|
IP
|
$20.83
|
|
|
Service Code
|
CPT 90681
|
| Hospital Charge Code |
5949631
|
|
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
|
|
|
RV1 VACCINE 2 DOSE SCHEDULE LIVE FOR ORAL USE 90681 - VFC
|
Facility
|
OP
|
$20.83
|
|
|
Service Code
|
CPT 90681
|
| Hospital Charge Code |
5949631
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.07 |
| Max. Negotiated Rate |
$19.93 |
| 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: Cigna Commercial |
$19.93
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12.12
|
| 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 |
$16.05
|
|
|
RV1 VACCINE 2 DOSE SCHEDULE LIVE FOR ORAL USE 90681 - VFC
|
Professional
|
Both
|
$20.83
|
|
|
Service Code
|
CPT 90681
|
| Hospital Charge Code |
5949631
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.53 |
| Max. Negotiated Rate |
$219.68 |
| 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 |
$152.90
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$13.00
|
| Rate for Payer: Health EOS Commercial |
$19.71
|
| Rate for Payer: HFN Commercial |
$20.58
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$219.68
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$219.68
|
| 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: United Healthcare Medicaid |
$152.90
|
| Rate for Payer: WEA Trust Commercial |
$11.91
|
| Rate for Payer: WPS Commercial |
$16.05
|
|
|
RV/RA Angiogram
|
Facility
|
IP
|
$788.00
|
|
|
Service Code
|
CPT 93566
|
| Hospital Charge Code |
5218698
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$401.56 |
| Max. Negotiated Rate |
$753.96 |
| Rate for Payer: Aetna Commercial |
$737.57
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$704.79
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$434.35
|
| Rate for Payer: Cash Price |
$236.40
|
| Rate for Payer: Cigna Commercial |
$753.96
|
| Rate for Payer: Health EOS Commercial |
$729.37
|
| Rate for Payer: HFN Commercial |
$753.96
|
| Rate for Payer: Multiplan Commercial |
$655.62
|
| Rate for Payer: Preferred Network Access Commercial |
$753.96
|
| Rate for Payer: Quartz Beloit One Network |
$401.56
|
| Rate for Payer: Quartz Commercial |
$491.71
|
| Rate for Payer: WEA Trust Commercial |
$450.74
|
| Rate for Payer: WPS Commercial |
$607.00
|
|
|
RV/RA Angiogram
|
Facility
|
OP
|
$788.00
|
|
|
Service Code
|
CPT 93566
|
| Hospital Charge Code |
5218698
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$84.82 |
| Max. Negotiated Rate |
$753.96 |
| Rate for Payer: Aetna Commercial |
$737.57
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$704.79
|
| Rate for Payer: Aetna Managed Medicare |
$229.47
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$532.69
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$409.76
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$393.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$434.35
|
| Rate for Payer: Cash Price |
$236.40
|
| Rate for Payer: Cash Price |
$236.40
|
| Rate for Payer: Cigna Commercial |
$753.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$458.62
|
| Rate for Payer: Health EOS Commercial |
$729.37
|
| Rate for Payer: HFN Commercial |
$753.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$614.64
|
| Rate for Payer: Multiplan Commercial |
$655.62
|
| Rate for Payer: NAPHCARE Commercial |
$491.71
|
| Rate for Payer: Preferred Network Access Commercial |
$753.96
|
| Rate for Payer: Quartz Beloit One Network |
$401.56
|
| Rate for Payer: Quartz Commercial |
$532.69
|
| Rate for Payer: Quartz Medicare Advantage |
$491.71
|
| Rate for Payer: The Alliance Commercial |
$84.82
|
| Rate for Payer: WEA Trust Commercial |
$450.74
|
| Rate for Payer: WPS Commercial |
$607.00
|
|
|
Saccharomyces cerevisiae Antibodies (ASCA)
|
Facility
|
OP
|
$76.00
|
|
|
Service Code
|
CPT 86671
|
| Hospital Charge Code |
5438795
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.74 |
| Max. Negotiated Rate |
$72.72 |
| Rate for Payer: Aetna Commercial |
$71.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$67.97
|
| Rate for Payer: Aetna Managed Medicare |
$12.74
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$47.77
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$22.30
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$21.15
|
| Rate for Payer: Anthem Medicare Advantage |
$12.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$41.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$12.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$12.74
|
| Rate for Payer: Cash Price |
$22.80
|
| Rate for Payer: Cash Price |
$22.80
|
| Rate for Payer: Cigna Commercial |
$72.72
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$12.74
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$44.23
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$12.74
|
| Rate for Payer: Health EOS Commercial |
$70.35
|
| Rate for Payer: HFN Commercial |
$72.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$47.39
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$12.74
|
| Rate for Payer: Independent Care Health Plan Medicare |
$12.74
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$12.74
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$12.74
|
| Rate for Payer: Multiplan Commercial |
$63.23
|
| Rate for Payer: NAPHCARE Commercial |
$19.11
|
| Rate for Payer: Preferred Network Access Commercial |
$72.72
|
| Rate for Payer: Quartz Beloit One Network |
$38.73
|
| Rate for Payer: Quartz Commercial |
$51.38
|
| Rate for Payer: Quartz Medicare Advantage |
$12.74
|
| Rate for Payer: The Alliance Commercial |
$50.96
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.74
|
| Rate for Payer: United Healthcare PPO |
$59.28
|
| Rate for Payer: WEA Trust Commercial |
$43.47
|
| Rate for Payer: Wellcare Medicare |
$12.74
|
| Rate for Payer: WPS Commercial |
$58.54
|
|
|
Saccharomyces cerevisiae Antibodies (ASCA)
|
Facility
|
IP
|
$76.00
|
|
|
Service Code
|
CPT 86671
|
| Hospital Charge Code |
5438795
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$38.73 |
| Max. Negotiated Rate |
$72.72 |
| Rate for Payer: Aetna Commercial |
$71.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$67.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$41.89
|
| Rate for Payer: Cash Price |
$22.80
|
| Rate for Payer: Cigna Commercial |
$72.72
|
| Rate for Payer: Health EOS Commercial |
$70.35
|
| Rate for Payer: HFN Commercial |
$72.72
|
| Rate for Payer: Multiplan Commercial |
$63.23
|
| Rate for Payer: Preferred Network Access Commercial |
$72.72
|
| Rate for Payer: Quartz Beloit One Network |
$38.73
|
| Rate for Payer: Quartz Commercial |
$47.42
|
| Rate for Payer: WEA Trust Commercial |
$43.47
|
| Rate for Payer: WPS Commercial |
$58.54
|
|
