|
.RPR Titer
|
Facility
|
OP
|
$21.00
|
|
|
Service Code
|
CPT 86593
|
| Hospital Charge Code |
5208633
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.40 |
| Max. Negotiated Rate |
$19.32 |
| Rate for Payer: Aetna Commercial |
$18.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$18.06
|
| Rate for Payer: Aetna Managed Medicare |
$4.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$16.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$7.70
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7.30
|
| Rate for Payer: Anthem Medicaid |
$4.55
|
| Rate for Payer: Anthem Medicare Advantage |
$4.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$11.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$4.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$4.40
|
| Rate for Payer: Cash Price |
$6.30
|
| Rate for Payer: Cash Price |
$6.30
|
| Rate for Payer: Cigna Commercial |
$19.32
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$4.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$4.55
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$11.75
|
| Rate for Payer: Dean Health Medicaid |
$4.55
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$4.40
|
| Rate for Payer: Health EOS Commercial |
$18.69
|
| Rate for Payer: HFN Commercial |
$19.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$16.37
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$4.40
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$4.55
|
| Rate for Payer: Independent Care Health Plan Medicare |
$4.40
|
| Rate for Payer: Managed Health Services Medicaid |
$4.73
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$4.40
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$4.40
|
| Rate for Payer: Multiplan Commercial |
$16.80
|
| Rate for Payer: NAPHCARE Commercial |
$6.60
|
| Rate for Payer: Preferred Network Access Commercial |
$19.32
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$4.55
|
| Rate for Payer: Quartz Beloit One Network |
$10.29
|
| Rate for Payer: Quartz Commercial |
$13.65
|
| Rate for Payer: Quartz Medicare Advantage |
$4.40
|
| Rate for Payer: The Alliance Commercial |
$17.60
|
| Rate for Payer: United Healthcare Medicaid |
$4.55
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4.40
|
| Rate for Payer: United Healthcare PPO |
$15.75
|
| Rate for Payer: WEA Trust Commercial |
$11.55
|
| Rate for Payer: Wellcare Medicare |
$4.40
|
| Rate for Payer: WMAP Medicaid |
$4.55
|
| Rate for Payer: WPS Commercial |
$15.55
|
|
|
.RPR Titer
|
Professional
|
Both
|
$21.00
|
|
|
Service Code
|
CPT 86593
|
| Hospital Charge Code |
5208633
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.24 |
| Max. Negotiated Rate |
$19.95 |
| Rate for Payer: Aetna Commercial |
$19.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$18.06
|
| Rate for Payer: Cash Price |
$6.30
|
| Rate for Payer: Cash Price |
$6.30
|
| Rate for Payer: Cigna Commercial |
$19.95
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$10.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12.60
|
| Rate for Payer: Health EOS Commercial |
$19.11
|
| Rate for Payer: HFN Commercial |
$19.95
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$15.53
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$15.53
|
| Rate for Payer: Multiplan Commercial |
$16.80
|
| Rate for Payer: Preferred Network Access Commercial |
$19.95
|
| Rate for Payer: Quartz Beloit One Network |
$9.24
|
| Rate for Payer: Quartz Commercial |
$11.97
|
| Rate for Payer: The Alliance Commercial |
$10.50
|
| Rate for Payer: WEA Trust Commercial |
$11.55
|
| Rate for Payer: WPS Commercial |
$15.55
|
|
|
RPR w/Rfx Titer and Treponema Pallidum
|
Facility
|
IP
|
$80.00
|
|
|
Service Code
|
CPT 86592
|
| Hospital Charge Code |
5432852
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$39.20 |
| Max. Negotiated Rate |
$73.60 |
| Rate for Payer: Aetna Commercial |
$72.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$68.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$42.40
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Cigna Commercial |
$73.60
|
| Rate for Payer: Health EOS Commercial |
$71.20
|
| Rate for Payer: HFN Commercial |
$73.60
|
| Rate for Payer: Multiplan Commercial |
$64.00
|
| Rate for Payer: NAPHCARE Commercial |
$48.00
|
| Rate for Payer: Preferred Network Access Commercial |
$73.60
|
| Rate for Payer: Quartz Beloit One Network |
$39.20
|
| Rate for Payer: Quartz Commercial |
$48.00
|
| Rate for Payer: WEA Trust Commercial |
$44.00
|
| Rate for Payer: WPS Commercial |
$59.26
|
|
|
RPR w/Rfx Titer and Treponema Pallidum
|
Professional
|
Both
|
$80.00
|
|
|
Service Code
|
CPT 86592
|
| Hospital Charge Code |
5432852
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.07 |
| Max. Negotiated Rate |
$76.00 |
| Rate for Payer: Aetna Commercial |
$76.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$68.80
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Cigna Commercial |
$76.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$40.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$48.00
|
| Rate for Payer: Health EOS Commercial |
$72.80
|
| Rate for Payer: HFN Commercial |
$76.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$15.07
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$15.07
|
| Rate for Payer: Multiplan Commercial |
$64.00
|
| Rate for Payer: Preferred Network Access Commercial |
$76.00
|
| Rate for Payer: Quartz Beloit One Network |
$35.20
|
| Rate for Payer: Quartz Commercial |
$45.60
|
| Rate for Payer: The Alliance Commercial |
$40.00
|
| Rate for Payer: WEA Trust Commercial |
$44.00
|
| Rate for Payer: WPS Commercial |
$59.26
|
|
|
RPR w/Rfx Titer and Treponema Pallidum
|
Facility
|
OP
|
$80.00
|
|
|
Service Code
|
CPT 86592
|
| Hospital Charge Code |
5432852
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.27 |
| Max. Negotiated Rate |
$73.60 |
| Rate for Payer: Aetna Commercial |
$72.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$68.80
|
| Rate for Payer: Aetna Managed Medicare |
$4.27
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$16.01
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$7.47
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7.09
|
| Rate for Payer: Anthem Medicaid |
$4.41
|
| Rate for Payer: Anthem Medicare Advantage |
$4.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$42.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$4.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$4.27
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Cigna Commercial |
$73.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$4.27
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$4.41
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$44.77
|
| Rate for Payer: Dean Health Medicaid |
$4.41
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$4.27
|
| Rate for Payer: Health EOS Commercial |
$71.20
|
| Rate for Payer: HFN Commercial |
$73.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$15.88
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$4.27
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$4.41
|
| Rate for Payer: Independent Care Health Plan Medicare |
$4.27
|
| Rate for Payer: Managed Health Services Medicaid |
$4.59
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$4.27
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$4.27
|
| Rate for Payer: Multiplan Commercial |
$64.00
|
| Rate for Payer: NAPHCARE Commercial |
$6.40
|
| Rate for Payer: Preferred Network Access Commercial |
$73.60
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$4.41
|
| Rate for Payer: Quartz Beloit One Network |
$39.20
|
| Rate for Payer: Quartz Commercial |
$52.00
|
| Rate for Payer: Quartz Medicare Advantage |
$4.27
|
| Rate for Payer: The Alliance Commercial |
$17.08
|
| Rate for Payer: United Healthcare Medicaid |
$4.41
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4.27
|
| Rate for Payer: United Healthcare PPO |
$60.00
|
| Rate for Payer: WEA Trust Commercial |
$44.00
|
| Rate for Payer: Wellcare Medicare |
$4.27
|
| Rate for Payer: WMAP Medicaid |
$4.41
|
| Rate for Payer: WPS Commercial |
$59.26
|
|
|
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 |
$1,442.56 |
| Max. Negotiated Rate |
$2,708.48 |
| Rate for Payer: Aetna Commercial |
$2,649.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,531.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,560.32
|
| Rate for Payer: Cash Price |
$883.20
|
| Rate for Payer: Cigna Commercial |
$2,708.48
|
| Rate for Payer: Health EOS Commercial |
$2,620.16
|
| Rate for Payer: HFN Commercial |
$2,708.48
|
| Rate for Payer: Multiplan Commercial |
$2,355.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,766.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,708.48
|
| Rate for Payer: Quartz Beloit One Network |
$1,442.56
|
| Rate for Payer: Quartz Commercial |
$1,766.40
|
| Rate for Payer: WEA Trust Commercial |
$1,619.20
|
| Rate for Payer: WPS Commercial |
$2,180.62
|
|
|
RSV IG, IM, 50MG 90378
|
Facility
|
OP
|
$2,944.00
|
|
|
Service Code
|
CPT 90378
|
| Hospital Charge Code |
3873516
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$339.68 |
| Max. Negotiated Rate |
$2,708.48 |
| Rate for Payer: Aetna Commercial |
$2,649.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,531.84
|
| Rate for Payer: Aetna Managed Medicare |
$339.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,913.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,472.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,413.12
|
| Rate for Payer: Anthem Medicare Advantage |
$339.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,560.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$339.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$339.68
|
| Rate for Payer: Cash Price |
$883.20
|
| Rate for Payer: Cash Price |
$883.20
|
| Rate for Payer: Cigna Commercial |
$2,708.48
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$339.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,647.46
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$339.68
|
| Rate for Payer: Health EOS Commercial |
$2,620.16
|
| Rate for Payer: HFN Commercial |
$2,708.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,263.61
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$339.68
|
| Rate for Payer: Independent Care Health Plan Medicare |
$339.68
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$339.68
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$339.68
|
| Rate for Payer: Multiplan Commercial |
$2,355.20
|
| Rate for Payer: NAPHCARE Commercial |
$509.52
|
| Rate for Payer: Preferred Network Access Commercial |
$2,708.48
|
| Rate for Payer: Quartz Beloit One Network |
$1,442.56
|
| Rate for Payer: Quartz Commercial |
$1,913.60
|
| Rate for Payer: Quartz Medicare Advantage |
$339.68
|
| Rate for Payer: The Alliance Commercial |
$1,358.72
|
| Rate for Payer: United Healthcare Medicare Advantage |
$339.68
|
| Rate for Payer: WEA Trust Commercial |
$1,619.20
|
| Rate for Payer: Wellcare Medicare |
$339.68
|
| Rate for Payer: WPS Commercial |
$2,180.62
|
|
|
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 |
$1,295.36 |
| Max. Negotiated Rate |
$2,796.80 |
| Rate for Payer: Aetna Commercial |
$2,796.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,531.84
|
| Rate for Payer: Cash Price |
$883.20
|
| Rate for Payer: Cash Price |
$883.20
|
| Rate for Payer: Cigna Commercial |
$2,796.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,699.02
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,766.40
|
| Rate for Payer: Health EOS Commercial |
$2,679.04
|
| Rate for Payer: HFN Commercial |
$2,796.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,354.32
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$2,354.32
|
| Rate for Payer: Multiplan Commercial |
$2,355.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,796.80
|
| Rate for Payer: Quartz Beloit One Network |
$1,295.36
|
| Rate for Payer: Quartz Commercial |
$1,678.08
|
| Rate for Payer: The Alliance Commercial |
$1,472.00
|
| Rate for Payer: United Healthcare Medicaid |
$1,699.02
|
| Rate for Payer: WEA Trust Commercial |
$1,619.20
|
| Rate for Payer: WPS Commercial |
$2,180.62
|
|
|
RSV PCR
|
Professional
|
Both
|
$229.00
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
4566788
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$100.76 |
| Max. Negotiated Rate |
$217.55 |
| Rate for Payer: Aetna Commercial |
$217.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$196.94
|
| Rate for Payer: Cash Price |
$68.70
|
| Rate for Payer: Cash Price |
$68.70
|
| Rate for Payer: Cigna Commercial |
$217.55
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$114.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$137.40
|
| Rate for Payer: Health EOS Commercial |
$208.39
|
| Rate for Payer: HFN Commercial |
$217.55
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$123.87
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$123.87
|
| Rate for Payer: Multiplan Commercial |
$183.20
|
| Rate for Payer: Preferred Network Access Commercial |
$217.55
|
| Rate for Payer: Quartz Beloit One Network |
$100.76
|
| Rate for Payer: Quartz Commercial |
$130.53
|
| Rate for Payer: The Alliance Commercial |
$114.50
|
| Rate for Payer: WEA Trust Commercial |
$125.95
|
| Rate for Payer: WPS Commercial |
$169.62
|
|
|
RSV PCR
|
Facility
|
IP
|
$229.00
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
4566788
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$112.21 |
| Max. Negotiated Rate |
$210.68 |
| Rate for Payer: Aetna Commercial |
$206.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$196.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$121.37
|
| Rate for Payer: Cash Price |
$68.70
|
| Rate for Payer: Cigna Commercial |
$210.68
|
| Rate for Payer: Health EOS Commercial |
$203.81
|
| Rate for Payer: HFN Commercial |
$210.68
|
| Rate for Payer: Multiplan Commercial |
$183.20
|
| Rate for Payer: NAPHCARE Commercial |
$137.40
|
| Rate for Payer: Preferred Network Access Commercial |
$210.68
|
| Rate for Payer: Quartz Beloit One Network |
$112.21
|
| Rate for Payer: Quartz Commercial |
$137.40
|
| Rate for Payer: WEA Trust Commercial |
$125.95
|
| Rate for Payer: WPS Commercial |
$169.62
|
|
|
RSV PCR
|
Facility
|
OP
|
$229.00
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
4566788
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$35.09 |
| Max. Negotiated Rate |
$210.68 |
| Rate for Payer: Aetna Commercial |
$206.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$196.94
|
| Rate for Payer: Aetna Managed Medicare |
$35.09
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$131.59
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$61.41
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$58.25
|
| Rate for Payer: Anthem Medicaid |
$36.26
|
| Rate for Payer: Anthem Medicare Advantage |
$35.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$121.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$35.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$35.09
|
| Rate for Payer: Cash Price |
$68.70
|
| Rate for Payer: Cash Price |
$68.70
|
| Rate for Payer: Cigna Commercial |
$210.68
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$35.09
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$36.26
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$128.15
|
| Rate for Payer: Dean Health Medicaid |
$36.26
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$35.09
|
| Rate for Payer: Health EOS Commercial |
$203.81
|
| Rate for Payer: HFN Commercial |
$210.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$130.53
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$35.09
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$36.26
|
| Rate for Payer: Independent Care Health Plan Medicare |
$35.09
|
| Rate for Payer: Managed Health Services Medicaid |
$37.71
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$35.09
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$35.09
|
| Rate for Payer: Multiplan Commercial |
$183.20
|
| Rate for Payer: NAPHCARE Commercial |
$52.64
|
| Rate for Payer: Preferred Network Access Commercial |
$210.68
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$36.26
|
| Rate for Payer: Quartz Beloit One Network |
$112.21
|
| Rate for Payer: Quartz Commercial |
$148.85
|
| Rate for Payer: Quartz Medicare Advantage |
$35.09
|
| Rate for Payer: The Alliance Commercial |
$140.36
|
| Rate for Payer: United Healthcare Medicaid |
$36.26
|
| Rate for Payer: United Healthcare Medicare Advantage |
$35.09
|
| Rate for Payer: United Healthcare PPO |
$171.75
|
| Rate for Payer: WEA Trust Commercial |
$125.95
|
| Rate for Payer: Wellcare Medicare |
$35.09
|
| Rate for Payer: WMAP Medicaid |
$36.26
|
| Rate for Payer: WPS Commercial |
$169.62
|
|
|
Rubella Antibody IgM
|
Facility
|
OP
|
$166.00
|
|
|
Service Code
|
CPT 86762
|
| Hospital Charge Code |
978060
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.39 |
| Max. Negotiated Rate |
$152.72 |
| Rate for Payer: Aetna Commercial |
$149.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$142.76
|
| Rate for Payer: Aetna Managed Medicare |
$14.39
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$53.96
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$25.18
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$23.89
|
| Rate for Payer: Anthem Medicaid |
$14.87
|
| Rate for Payer: Anthem Medicare Advantage |
$14.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$87.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$14.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$14.39
|
| Rate for Payer: Cash Price |
$49.80
|
| Rate for Payer: Cash Price |
$49.80
|
| Rate for Payer: Cigna Commercial |
$152.72
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$14.39
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$14.87
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$92.89
|
| Rate for Payer: Dean Health Medicaid |
$14.87
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$14.39
|
| Rate for Payer: Health EOS Commercial |
$147.74
|
| Rate for Payer: HFN Commercial |
$152.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$53.53
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$14.39
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$14.87
|
| Rate for Payer: Independent Care Health Plan Medicare |
$14.39
|
| Rate for Payer: Managed Health Services Medicaid |
$15.46
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$14.39
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$14.39
|
| Rate for Payer: Multiplan Commercial |
$132.80
|
| Rate for Payer: NAPHCARE Commercial |
$21.58
|
| Rate for Payer: Preferred Network Access Commercial |
$152.72
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$14.87
|
| Rate for Payer: Quartz Beloit One Network |
$81.34
|
| Rate for Payer: Quartz Commercial |
$107.90
|
| Rate for Payer: Quartz Medicare Advantage |
$14.39
|
| Rate for Payer: The Alliance Commercial |
$57.56
|
| Rate for Payer: United Healthcare Medicaid |
$14.87
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14.39
|
| Rate for Payer: United Healthcare PPO |
$124.50
|
| Rate for Payer: WEA Trust Commercial |
$91.30
|
| Rate for Payer: Wellcare Medicare |
$14.39
|
| Rate for Payer: WMAP Medicaid |
$14.87
|
| Rate for Payer: WPS Commercial |
$122.96
|
|
|
Rubella Antibody IgM
|
Facility
|
IP
|
$166.00
|
|
|
Service Code
|
CPT 86762
|
| Hospital Charge Code |
978060
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$81.34 |
| Max. Negotiated Rate |
$152.72 |
| Rate for Payer: Aetna Commercial |
$149.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$142.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$87.98
|
| Rate for Payer: Cash Price |
$49.80
|
| Rate for Payer: Cigna Commercial |
$152.72
|
| Rate for Payer: Health EOS Commercial |
$147.74
|
| Rate for Payer: HFN Commercial |
$152.72
|
| Rate for Payer: Multiplan Commercial |
$132.80
|
| Rate for Payer: NAPHCARE Commercial |
$99.60
|
| Rate for Payer: Preferred Network Access Commercial |
$152.72
|
| Rate for Payer: Quartz Beloit One Network |
$81.34
|
| Rate for Payer: Quartz Commercial |
$99.60
|
| Rate for Payer: WEA Trust Commercial |
$91.30
|
| Rate for Payer: WPS Commercial |
$122.96
|
|
|
Rubella Antibody IgM
|
Professional
|
Both
|
$166.00
|
|
|
Service Code
|
CPT 86762
|
| Hospital Charge Code |
978060
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$50.80 |
| Max. Negotiated Rate |
$157.70 |
| Rate for Payer: Aetna Commercial |
$157.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$142.76
|
| Rate for Payer: Cash Price |
$49.80
|
| Rate for Payer: Cash Price |
$49.80
|
| Rate for Payer: Cigna Commercial |
$157.70
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$83.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$99.60
|
| Rate for Payer: Health EOS Commercial |
$151.06
|
| Rate for Payer: HFN Commercial |
$157.70
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$50.80
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$50.80
|
| Rate for Payer: Multiplan Commercial |
$132.80
|
| Rate for Payer: Preferred Network Access Commercial |
$157.70
|
| Rate for Payer: Quartz Beloit One Network |
$73.04
|
| Rate for Payer: Quartz Commercial |
$94.62
|
| Rate for Payer: The Alliance Commercial |
$83.00
|
| Rate for Payer: WEA Trust Commercial |
$91.30
|
| Rate for Payer: WPS Commercial |
$122.96
|
|
|
Rubella Imm Status
|
Professional
|
Both
|
$166.00
|
|
|
Service Code
|
CPT 86762
|
| Hospital Charge Code |
4590769
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$50.80 |
| Max. Negotiated Rate |
$157.70 |
| Rate for Payer: Aetna Commercial |
$157.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$142.76
|
| Rate for Payer: Cash Price |
$49.80
|
| Rate for Payer: Cash Price |
$49.80
|
| Rate for Payer: Cigna Commercial |
$157.70
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$83.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$99.60
|
| Rate for Payer: Health EOS Commercial |
$151.06
|
| Rate for Payer: HFN Commercial |
$157.70
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$50.80
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$50.80
|
| Rate for Payer: Multiplan Commercial |
$132.80
|
| Rate for Payer: Preferred Network Access Commercial |
$157.70
|
| Rate for Payer: Quartz Beloit One Network |
$73.04
|
| Rate for Payer: Quartz Commercial |
$94.62
|
| Rate for Payer: The Alliance Commercial |
$83.00
|
| Rate for Payer: WEA Trust Commercial |
$91.30
|
| Rate for Payer: WPS Commercial |
$122.96
|
|
|
Rubella Imm Status
|
Facility
|
IP
|
$166.00
|
|
|
Service Code
|
CPT 86762
|
| Hospital Charge Code |
4590769
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$81.34 |
| Max. Negotiated Rate |
$152.72 |
| Rate for Payer: Aetna Commercial |
$149.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$142.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$87.98
|
| Rate for Payer: Cash Price |
$49.80
|
| Rate for Payer: Cigna Commercial |
$152.72
|
| Rate for Payer: Health EOS Commercial |
$147.74
|
| Rate for Payer: HFN Commercial |
$152.72
|
| Rate for Payer: Multiplan Commercial |
$132.80
|
| Rate for Payer: NAPHCARE Commercial |
$99.60
|
| Rate for Payer: Preferred Network Access Commercial |
$152.72
|
| Rate for Payer: Quartz Beloit One Network |
$81.34
|
| Rate for Payer: Quartz Commercial |
$99.60
|
| Rate for Payer: WEA Trust Commercial |
$91.30
|
| Rate for Payer: WPS Commercial |
$122.96
|
|
|
Rubella Imm Status
|
Facility
|
OP
|
$166.00
|
|
|
Service Code
|
CPT 86762
|
| Hospital Charge Code |
4590769
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.39 |
| Max. Negotiated Rate |
$152.72 |
| Rate for Payer: Aetna Commercial |
$149.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$142.76
|
| Rate for Payer: Aetna Managed Medicare |
$14.39
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$53.96
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$25.18
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$23.89
|
| Rate for Payer: Anthem Medicaid |
$14.87
|
| Rate for Payer: Anthem Medicare Advantage |
$14.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$87.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$14.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$14.39
|
| Rate for Payer: Cash Price |
$49.80
|
| Rate for Payer: Cash Price |
$49.80
|
| Rate for Payer: Cigna Commercial |
$152.72
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$14.39
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$14.87
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$92.89
|
| Rate for Payer: Dean Health Medicaid |
$14.87
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$14.39
|
| Rate for Payer: Health EOS Commercial |
$147.74
|
| Rate for Payer: HFN Commercial |
$152.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$53.53
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$14.39
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$14.87
|
| Rate for Payer: Independent Care Health Plan Medicare |
$14.39
|
| Rate for Payer: Managed Health Services Medicaid |
$15.46
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$14.39
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$14.39
|
| Rate for Payer: Multiplan Commercial |
$132.80
|
| Rate for Payer: NAPHCARE Commercial |
$21.58
|
| Rate for Payer: Preferred Network Access Commercial |
$152.72
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$14.87
|
| Rate for Payer: Quartz Beloit One Network |
$81.34
|
| Rate for Payer: Quartz Commercial |
$107.90
|
| Rate for Payer: Quartz Medicare Advantage |
$14.39
|
| Rate for Payer: The Alliance Commercial |
$57.56
|
| Rate for Payer: United Healthcare Medicaid |
$14.87
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14.39
|
| Rate for Payer: United Healthcare PPO |
$124.50
|
| Rate for Payer: WEA Trust Commercial |
$91.30
|
| Rate for Payer: Wellcare Medicare |
$14.39
|
| Rate for Payer: WMAP Medicaid |
$14.87
|
| Rate for Payer: WPS Commercial |
$122.96
|
|
|
Rubicon Support Catheter
|
Facility
|
OP
|
$1,696.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
4606626
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$474.88 |
| Max. Negotiated Rate |
$6,784.00 |
| Rate for Payer: Aetna Commercial |
$1,526.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,458.56
|
| Rate for Payer: Aetna Managed Medicare |
$474.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,102.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$848.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$814.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$898.88
|
| Rate for Payer: Cash Price |
$508.80
|
| Rate for Payer: Cigna Commercial |
$1,560.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$949.08
|
| Rate for Payer: Health EOS Commercial |
$1,509.44
|
| Rate for Payer: HFN Commercial |
$1,560.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,272.00
|
| Rate for Payer: Multiplan Commercial |
$1,356.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,017.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,560.32
|
| Rate for Payer: Quartz Beloit One Network |
$831.04
|
| Rate for Payer: Quartz Commercial |
$1,102.40
|
| Rate for Payer: Quartz Medicare Advantage |
$1,017.60
|
| Rate for Payer: The Alliance Commercial |
$6,784.00
|
| Rate for Payer: WEA Trust Commercial |
$932.80
|
| Rate for Payer: WPS Commercial |
$1,256.23
|
|
|
Rubicon Support Catheter
|
Facility
|
IP
|
$1,696.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
4606626
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$831.04 |
| Max. Negotiated Rate |
$1,560.32 |
| Rate for Payer: Aetna Commercial |
$1,526.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,458.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$898.88
|
| Rate for Payer: Cash Price |
$508.80
|
| Rate for Payer: Cigna Commercial |
$1,560.32
|
| Rate for Payer: Health EOS Commercial |
$1,509.44
|
| Rate for Payer: HFN Commercial |
$1,560.32
|
| Rate for Payer: Multiplan Commercial |
$1,356.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,017.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,560.32
|
| Rate for Payer: Quartz Beloit One Network |
$831.04
|
| Rate for Payer: Quartz Commercial |
$1,017.60
|
| Rate for Payer: WEA Trust Commercial |
$932.80
|
| Rate for Payer: WPS Commercial |
$1,256.23
|
|
|
Rufinamide (Banzel) Level
|
Professional
|
Both
|
$236.00
|
|
|
Service Code
|
CPT 80210
|
| Hospital Charge Code |
3404973
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$95.70 |
| Max. Negotiated Rate |
$224.20 |
| Rate for Payer: Aetna Commercial |
$224.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$202.96
|
| Rate for Payer: Cash Price |
$70.80
|
| Rate for Payer: Cash Price |
$70.80
|
| Rate for Payer: Cigna Commercial |
$224.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$118.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$141.60
|
| Rate for Payer: Health EOS Commercial |
$214.76
|
| Rate for Payer: HFN Commercial |
$224.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$95.70
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$95.70
|
| Rate for Payer: Multiplan Commercial |
$188.80
|
| Rate for Payer: Preferred Network Access Commercial |
$224.20
|
| Rate for Payer: Quartz Beloit One Network |
$103.84
|
| Rate for Payer: Quartz Commercial |
$134.52
|
| Rate for Payer: The Alliance Commercial |
$118.00
|
| Rate for Payer: WEA Trust Commercial |
$129.80
|
| Rate for Payer: WPS Commercial |
$174.81
|
|
|
Rufinamide (Banzel) Level
|
Facility
|
OP
|
$236.00
|
|
|
Service Code
|
CPT 80210
|
| Hospital Charge Code |
3404973
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$21.69 |
| Max. Negotiated Rate |
$217.12 |
| Rate for Payer: Aetna Commercial |
$212.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$202.96
|
| Rate for Payer: Aetna Managed Medicare |
$27.11
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$101.66
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$47.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$45.00
|
| Rate for Payer: Anthem Medicaid |
$21.69
|
| Rate for Payer: Anthem Medicare Advantage |
$27.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$125.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$27.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$27.11
|
| Rate for Payer: Cash Price |
$70.80
|
| Rate for Payer: Cash Price |
$70.80
|
| Rate for Payer: Cigna Commercial |
$217.12
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$27.11
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$21.69
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$132.07
|
| Rate for Payer: Dean Health Medicaid |
$21.69
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$27.11
|
| Rate for Payer: Health EOS Commercial |
$210.04
|
| Rate for Payer: HFN Commercial |
$217.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$100.85
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$27.11
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$21.69
|
| Rate for Payer: Independent Care Health Plan Medicare |
$27.11
|
| Rate for Payer: Managed Health Services Medicaid |
$22.56
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$27.11
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$27.11
|
| Rate for Payer: Multiplan Commercial |
$188.80
|
| Rate for Payer: NAPHCARE Commercial |
$40.66
|
| Rate for Payer: Preferred Network Access Commercial |
$217.12
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$21.69
|
| Rate for Payer: Quartz Beloit One Network |
$115.64
|
| Rate for Payer: Quartz Commercial |
$153.40
|
| Rate for Payer: Quartz Medicare Advantage |
$27.11
|
| Rate for Payer: The Alliance Commercial |
$108.44
|
| Rate for Payer: United Healthcare Medicaid |
$21.69
|
| Rate for Payer: United Healthcare Medicare Advantage |
$27.11
|
| Rate for Payer: United Healthcare PPO |
$177.00
|
| Rate for Payer: WEA Trust Commercial |
$129.80
|
| Rate for Payer: Wellcare Medicare |
$27.11
|
| Rate for Payer: WMAP Medicaid |
$21.69
|
| Rate for Payer: WPS Commercial |
$174.81
|
|
|
Rufinamide (Banzel) Level
|
Facility
|
IP
|
$236.00
|
|
|
Service Code
|
CPT 80210
|
| Hospital Charge Code |
3404973
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$115.64 |
| Max. Negotiated Rate |
$217.12 |
| Rate for Payer: Aetna Commercial |
$212.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$202.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$125.08
|
| Rate for Payer: Cash Price |
$70.80
|
| Rate for Payer: Cigna Commercial |
$217.12
|
| Rate for Payer: Health EOS Commercial |
$210.04
|
| Rate for Payer: HFN Commercial |
$217.12
|
| Rate for Payer: Multiplan Commercial |
$188.80
|
| Rate for Payer: NAPHCARE Commercial |
$141.60
|
| Rate for Payer: Preferred Network Access Commercial |
$217.12
|
| Rate for Payer: Quartz Beloit One Network |
$115.64
|
| Rate for Payer: Quartz Commercial |
$141.60
|
| Rate for Payer: WEA Trust Commercial |
$129.80
|
| Rate for Payer: WPS Commercial |
$174.81
|
|
|
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 |
$499.80 |
| Max. Negotiated Rate |
$938.40 |
| Rate for Payer: Aetna Commercial |
$918.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$877.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$540.60
|
| Rate for Payer: Cash Price |
$306.00
|
| Rate for Payer: Cigna Commercial |
$938.40
|
| Rate for Payer: Health EOS Commercial |
$907.80
|
| Rate for Payer: HFN Commercial |
$938.40
|
| Rate for Payer: Multiplan Commercial |
$816.00
|
| Rate for Payer: NAPHCARE Commercial |
$612.00
|
| Rate for Payer: Preferred Network Access Commercial |
$938.40
|
| Rate for Payer: Quartz Beloit One Network |
$499.80
|
| Rate for Payer: Quartz Commercial |
$612.00
|
| Rate for Payer: WEA Trust Commercial |
$561.00
|
| Rate for Payer: WPS Commercial |
$755.51
|
|
|
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 |
$285.60 |
| Max. Negotiated Rate |
$4,080.00 |
| Rate for Payer: Aetna Commercial |
$918.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$877.20
|
| Rate for Payer: Aetna Managed Medicare |
$285.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$663.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$510.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$489.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$540.60
|
| Rate for Payer: Cash Price |
$306.00
|
| Rate for Payer: Cigna Commercial |
$938.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$570.79
|
| Rate for Payer: Health EOS Commercial |
$907.80
|
| Rate for Payer: HFN Commercial |
$938.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$765.00
|
| Rate for Payer: Multiplan Commercial |
$816.00
|
| Rate for Payer: NAPHCARE Commercial |
$612.00
|
| Rate for Payer: Preferred Network Access Commercial |
$938.40
|
| Rate for Payer: Quartz Beloit One Network |
$499.80
|
| Rate for Payer: Quartz Commercial |
$663.00
|
| Rate for Payer: Quartz Medicare Advantage |
$612.00
|
| Rate for Payer: The Alliance Commercial |
$4,080.00
|
| Rate for Payer: WEA Trust Commercial |
$561.00
|
| Rate for Payer: WPS Commercial |
$755.51
|
|
|
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 |
$9.17 |
| Max. Negotiated Rate |
$211.23 |
| Rate for Payer: Aetna Commercial |
$19.79
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$17.91
|
| Rate for Payer: Cash Price |
$6.25
|
| Rate for Payer: Cash Price |
$6.25
|
| Rate for Payer: Cigna Commercial |
$19.79
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$15.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12.50
|
| Rate for Payer: Health EOS Commercial |
$18.96
|
| Rate for Payer: HFN Commercial |
$19.79
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$211.23
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$211.23
|
| Rate for Payer: Multiplan Commercial |
$16.66
|
| Rate for Payer: Preferred Network Access Commercial |
$19.79
|
| Rate for Payer: Quartz Beloit One Network |
$9.17
|
| Rate for Payer: Quartz Commercial |
$11.87
|
| Rate for Payer: The Alliance Commercial |
$10.42
|
| Rate for Payer: United Healthcare Medicaid |
$15.00
|
| Rate for Payer: WEA Trust Commercial |
$11.46
|
| Rate for Payer: WPS Commercial |
$15.43
|
|
