|
SEPTOPLASTY OR SUBMUCOUS RESECTION, WITH OR WITHOUT CARTILAGE SCORING, CONTOURING OR REPLACEMENT WITH GRAFT
|
Facility
|
OP
|
$13,956.63
|
|
|
Service Code
|
CPT 30520
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,835.04 |
| Max. Negotiated Rate |
$13,956.63 |
| Rate for Payer: Aetna Managed Medicare |
$3,489.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,635.84
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,985.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,835.04
|
| Rate for Payer: Anthem Medicare Advantage |
$3,489.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$3,489.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$3,489.16
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$3,489.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$8,107.14
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$3,489.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$12,979.67
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$3,489.16
|
| Rate for Payer: Independent Care Health Plan Medicare |
$3,489.16
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$3,489.16
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$3,489.16
|
| Rate for Payer: NAPHCARE Commercial |
$5,233.74
|
| Rate for Payer: Quartz Medicare Advantage |
$3,489.16
|
| Rate for Payer: The Alliance Commercial |
$13,956.63
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,489.16
|
| Rate for Payer: United Healthcare PPO |
$3,726.32
|
| Rate for Payer: Wellcare Medicare |
$3,489.16
|
|
|
SEPTORHINOPLASTY
|
Facility
|
OP
|
$3,935.00
|
|
| Hospital Charge Code |
2960371
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,145.87 |
| Max. Negotiated Rate |
$3,765.01 |
| Rate for Payer: Aetna Commercial |
$3,683.16
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,519.46
|
| Rate for Payer: Aetna Managed Medicare |
$1,145.87
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,660.06
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,046.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,964.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,168.97
|
| Rate for Payer: Cash Price |
$1,180.50
|
| Rate for Payer: Cigna Commercial |
$3,765.01
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,290.17
|
| Rate for Payer: Health EOS Commercial |
$3,642.24
|
| Rate for Payer: HFN Commercial |
$3,765.01
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,069.30
|
| Rate for Payer: Multiplan Commercial |
$3,273.92
|
| Rate for Payer: NAPHCARE Commercial |
$2,455.44
|
| Rate for Payer: Preferred Network Access Commercial |
$3,765.01
|
| Rate for Payer: Quartz Beloit One Network |
$2,005.28
|
| Rate for Payer: Quartz Commercial |
$2,660.06
|
| Rate for Payer: Quartz Medicare Advantage |
$2,455.44
|
| Rate for Payer: The Alliance Commercial |
$2,046.20
|
| Rate for Payer: WEA Trust Commercial |
$2,250.82
|
| Rate for Payer: WPS Commercial |
$3,031.13
|
|
|
SEPTORHINOPLASTY
|
Facility
|
IP
|
$3,935.00
|
|
| Hospital Charge Code |
2960371
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,005.28 |
| Max. Negotiated Rate |
$3,765.01 |
| Rate for Payer: Aetna Commercial |
$3,683.16
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,519.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,168.97
|
| Rate for Payer: Cash Price |
$1,180.50
|
| Rate for Payer: Cigna Commercial |
$3,765.01
|
| Rate for Payer: Health EOS Commercial |
$3,642.24
|
| Rate for Payer: HFN Commercial |
$3,765.01
|
| Rate for Payer: Multiplan Commercial |
$3,273.92
|
| Rate for Payer: Preferred Network Access Commercial |
$3,765.01
|
| Rate for Payer: Quartz Beloit One Network |
$2,005.28
|
| Rate for Payer: Quartz Commercial |
$2,455.44
|
| Rate for Payer: WEA Trust Commercial |
$2,250.82
|
| Rate for Payer: WPS Commercial |
$3,031.13
|
|
|
Serial Tonometry Exam
|
Professional
|
Both
|
$193.00
|
|
|
Service Code
|
CPT 92100
|
| Hospital Charge Code |
1190812
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$8.40 |
| Max. Negotiated Rate |
$190.68 |
| Rate for Payer: Aetna Commercial |
$190.68
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$172.62
|
| Rate for Payer: Aetna Managed Medicare |
$26.36
|
| Rate for Payer: Anthem Medicare Advantage |
$26.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$26.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$26.36
|
| Rate for Payer: Cash Price |
$57.90
|
| Rate for Payer: Cash Price |
$57.90
|
| Rate for Payer: Cash Price |
$57.90
|
| Rate for Payer: Cigna Commercial |
$190.68
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$8.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$26.36
|
| Rate for Payer: Health EOS Commercial |
$182.66
|
| Rate for Payer: HFN Commercial |
$190.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$117.52
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$117.52
|
| Rate for Payer: Independent Care Health Plan Medicare |
$26.36
|
| Rate for Payer: Multiplan Commercial |
$160.58
|
| Rate for Payer: NAPHCARE Commercial |
$39.55
|
| Rate for Payer: Preferred Network Access Commercial |
$190.68
|
| Rate for Payer: Quartz Beloit One Network |
$88.32
|
| Rate for Payer: Quartz Commercial |
$114.41
|
| Rate for Payer: Quartz Medicare Advantage |
$26.36
|
| Rate for Payer: The Alliance Commercial |
$65.91
|
| Rate for Payer: United Healthcare Medicaid |
$8.40
|
| Rate for Payer: United Healthcare Medicare Advantage |
$26.36
|
| Rate for Payer: WEA Trust Commercial |
$110.40
|
| Rate for Payer: WPS Commercial |
$105.46
|
|
|
Serotonin Level, Blood
|
Facility
|
OP
|
$1,756.00
|
|
|
Service Code
|
CPT 84260
|
| Hospital Charge Code |
978065
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$32.22 |
| Max. Negotiated Rate |
$1,680.14 |
| Rate for Payer: Aetna Commercial |
$1,643.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,570.57
|
| Rate for Payer: Aetna Managed Medicare |
$32.22
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$120.82
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$56.38
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$53.48
|
| Rate for Payer: Anthem Medicare Advantage |
$32.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$967.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$32.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$32.22
|
| Rate for Payer: Cash Price |
$526.80
|
| Rate for Payer: Cash Price |
$526.80
|
| Rate for Payer: Cigna Commercial |
$1,680.14
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$32.22
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,021.99
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$32.22
|
| Rate for Payer: Health EOS Commercial |
$1,625.35
|
| Rate for Payer: HFN Commercial |
$1,680.14
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$119.86
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$32.22
|
| Rate for Payer: Independent Care Health Plan Medicare |
$32.22
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$32.22
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$32.22
|
| Rate for Payer: Multiplan Commercial |
$1,460.99
|
| Rate for Payer: NAPHCARE Commercial |
$48.33
|
| Rate for Payer: Preferred Network Access Commercial |
$1,680.14
|
| Rate for Payer: Quartz Beloit One Network |
$894.86
|
| Rate for Payer: Quartz Commercial |
$1,187.06
|
| Rate for Payer: Quartz Medicare Advantage |
$32.22
|
| Rate for Payer: The Alliance Commercial |
$128.88
|
| Rate for Payer: United Healthcare Medicare Advantage |
$32.22
|
| Rate for Payer: United Healthcare PPO |
$1,369.68
|
| Rate for Payer: WEA Trust Commercial |
$1,004.43
|
| Rate for Payer: Wellcare Medicare |
$32.22
|
| Rate for Payer: WPS Commercial |
$1,352.65
|
|
|
Serotonin Level, Blood
|
Professional
|
Both
|
$1,756.00
|
|
|
Service Code
|
CPT 84260
|
| Hospital Charge Code |
978065
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$32.22 |
| Max. Negotiated Rate |
$1,734.93 |
| Rate for Payer: Aetna Commercial |
$1,734.93
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,570.57
|
| Rate for Payer: Aetna Managed Medicare |
$32.22
|
| Rate for Payer: Anthem Medicare Advantage |
$32.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$32.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$32.22
|
| Rate for Payer: Cash Price |
$526.80
|
| Rate for Payer: Cash Price |
$526.80
|
| Rate for Payer: Cigna Commercial |
$1,734.93
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$913.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$32.22
|
| Rate for Payer: Health EOS Commercial |
$1,661.88
|
| Rate for Payer: HFN Commercial |
$1,734.93
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$113.73
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$113.73
|
| Rate for Payer: Independent Care Health Plan Medicare |
$32.22
|
| Rate for Payer: Multiplan Commercial |
$1,460.99
|
| Rate for Payer: NAPHCARE Commercial |
$48.33
|
| Rate for Payer: Preferred Network Access Commercial |
$1,734.93
|
| Rate for Payer: Quartz Beloit One Network |
$803.55
|
| Rate for Payer: Quartz Commercial |
$1,040.96
|
| Rate for Payer: Quartz Medicare Advantage |
$32.22
|
| Rate for Payer: The Alliance Commercial |
$127.27
|
| Rate for Payer: United Healthcare Medicare Advantage |
$32.22
|
| Rate for Payer: WEA Trust Commercial |
$1,004.43
|
| Rate for Payer: WPS Commercial |
$141.76
|
|
|
Serotonin Level, Blood
|
Facility
|
IP
|
$1,756.00
|
|
|
Service Code
|
CPT 84260
|
| Hospital Charge Code |
978065
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$894.86 |
| Max. Negotiated Rate |
$1,680.14 |
| Rate for Payer: Aetna Commercial |
$1,643.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,570.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$967.91
|
| Rate for Payer: Cash Price |
$526.80
|
| Rate for Payer: Cigna Commercial |
$1,680.14
|
| Rate for Payer: Health EOS Commercial |
$1,625.35
|
| Rate for Payer: HFN Commercial |
$1,680.14
|
| Rate for Payer: Multiplan Commercial |
$1,460.99
|
| Rate for Payer: Preferred Network Access Commercial |
$1,680.14
|
| Rate for Payer: Quartz Beloit One Network |
$894.86
|
| Rate for Payer: Quartz Commercial |
$1,095.74
|
| Rate for Payer: WEA Trust Commercial |
$1,004.43
|
| Rate for Payer: WPS Commercial |
$1,352.65
|
|
|
Serotonin Release Assay (SRA), Unfractionated Heparin
|
Facility
|
IP
|
$614.00
|
|
|
Service Code
|
CPT 86022
|
| Hospital Charge Code |
3256239
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$312.89 |
| Max. Negotiated Rate |
$587.48 |
| Rate for Payer: Aetna Commercial |
$574.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$549.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$338.44
|
| Rate for Payer: Cash Price |
$184.20
|
| Rate for Payer: Cigna Commercial |
$587.48
|
| Rate for Payer: Health EOS Commercial |
$568.32
|
| Rate for Payer: HFN Commercial |
$587.48
|
| Rate for Payer: Multiplan Commercial |
$510.85
|
| Rate for Payer: Preferred Network Access Commercial |
$587.48
|
| Rate for Payer: Quartz Beloit One Network |
$312.89
|
| Rate for Payer: Quartz Commercial |
$383.14
|
| Rate for Payer: WEA Trust Commercial |
$351.21
|
| Rate for Payer: WPS Commercial |
$472.96
|
|
|
Serotonin Release Assay (SRA), Unfractionated Heparin
|
Facility
|
OP
|
$614.00
|
|
|
Service Code
|
CPT 86022
|
| Hospital Charge Code |
3256239
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$19.10 |
| Max. Negotiated Rate |
$587.48 |
| Rate for Payer: Aetna Commercial |
$574.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$549.16
|
| Rate for Payer: Aetna Managed Medicare |
$19.10
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$71.64
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$33.43
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$31.71
|
| Rate for Payer: Anthem Medicare Advantage |
$19.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$338.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$19.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$19.10
|
| Rate for Payer: Cash Price |
$184.20
|
| Rate for Payer: Cash Price |
$184.20
|
| Rate for Payer: Cigna Commercial |
$587.48
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$19.10
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$357.35
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$19.10
|
| Rate for Payer: Health EOS Commercial |
$568.32
|
| Rate for Payer: HFN Commercial |
$587.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$71.07
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$19.10
|
| Rate for Payer: Independent Care Health Plan Medicare |
$19.10
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$19.10
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$19.10
|
| Rate for Payer: Multiplan Commercial |
$510.85
|
| Rate for Payer: NAPHCARE Commercial |
$28.66
|
| Rate for Payer: Preferred Network Access Commercial |
$587.48
|
| Rate for Payer: Quartz Beloit One Network |
$312.89
|
| Rate for Payer: Quartz Commercial |
$415.06
|
| Rate for Payer: Quartz Medicare Advantage |
$19.10
|
| Rate for Payer: The Alliance Commercial |
$76.42
|
| Rate for Payer: United Healthcare Medicare Advantage |
$19.10
|
| Rate for Payer: United Healthcare PPO |
$478.92
|
| Rate for Payer: WEA Trust Commercial |
$351.21
|
| Rate for Payer: Wellcare Medicare |
$19.10
|
| Rate for Payer: WPS Commercial |
$472.96
|
|
|
Serotonin Release Assay (SRA), Unfractionated Heparin
|
Professional
|
Both
|
$614.00
|
|
|
Service Code
|
CPT 86022
|
| Hospital Charge Code |
3256239
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$19.10 |
| Max. Negotiated Rate |
$606.63 |
| Rate for Payer: Aetna Commercial |
$606.63
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$549.16
|
| Rate for Payer: Aetna Managed Medicare |
$19.10
|
| Rate for Payer: Anthem Medicare Advantage |
$19.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$19.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$19.10
|
| Rate for Payer: Cash Price |
$184.20
|
| Rate for Payer: Cash Price |
$184.20
|
| Rate for Payer: Cigna Commercial |
$606.63
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$319.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$19.10
|
| Rate for Payer: Health EOS Commercial |
$581.09
|
| Rate for Payer: HFN Commercial |
$606.63
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$67.44
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$67.44
|
| Rate for Payer: Independent Care Health Plan Medicare |
$19.10
|
| Rate for Payer: Multiplan Commercial |
$510.85
|
| Rate for Payer: NAPHCARE Commercial |
$28.66
|
| Rate for Payer: Preferred Network Access Commercial |
$606.63
|
| Rate for Payer: Quartz Beloit One Network |
$280.97
|
| Rate for Payer: Quartz Commercial |
$363.98
|
| Rate for Payer: Quartz Medicare Advantage |
$19.10
|
| Rate for Payer: The Alliance Commercial |
$75.46
|
| Rate for Payer: United Healthcare Medicare Advantage |
$19.10
|
| Rate for Payer: WEA Trust Commercial |
$351.21
|
| Rate for Payer: WPS Commercial |
$84.06
|
|
|
Serotype 12
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
CPT 86317
|
| Hospital Charge Code |
2943005
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.72 |
| Max. Negotiated Rate |
$22.01 |
| Rate for Payer: Aetna Commercial |
$21.53
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$20.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$12.68
|
| Rate for Payer: Cash Price |
$6.90
|
| Rate for Payer: Cigna Commercial |
$22.01
|
| Rate for Payer: Health EOS Commercial |
$21.29
|
| Rate for Payer: HFN Commercial |
$22.01
|
| Rate for Payer: Multiplan Commercial |
$19.14
|
| Rate for Payer: Preferred Network Access Commercial |
$22.01
|
| Rate for Payer: Quartz Beloit One Network |
$11.72
|
| Rate for Payer: Quartz Commercial |
$14.35
|
| Rate for Payer: WEA Trust Commercial |
$13.16
|
| Rate for Payer: WPS Commercial |
$17.72
|
|
|
Serotype 12
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
CPT 86317
|
| Hospital Charge Code |
2943005
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.72 |
| Max. Negotiated Rate |
$62.36 |
| Rate for Payer: Aetna Commercial |
$21.53
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$20.57
|
| Rate for Payer: Aetna Managed Medicare |
$15.59
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$58.46
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$27.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$25.88
|
| Rate for Payer: Anthem Medicare Advantage |
$15.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$12.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$15.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$15.59
|
| Rate for Payer: Cash Price |
$6.90
|
| Rate for Payer: Cash Price |
$6.90
|
| Rate for Payer: Cigna Commercial |
$22.01
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$15.59
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$13.39
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$15.59
|
| Rate for Payer: Health EOS Commercial |
$21.29
|
| Rate for Payer: HFN Commercial |
$22.01
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$57.99
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$15.59
|
| Rate for Payer: Independent Care Health Plan Medicare |
$15.59
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$15.59
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$15.59
|
| Rate for Payer: Multiplan Commercial |
$19.14
|
| Rate for Payer: NAPHCARE Commercial |
$23.38
|
| Rate for Payer: Preferred Network Access Commercial |
$22.01
|
| Rate for Payer: Quartz Beloit One Network |
$11.72
|
| Rate for Payer: Quartz Commercial |
$15.55
|
| Rate for Payer: Quartz Medicare Advantage |
$15.59
|
| Rate for Payer: The Alliance Commercial |
$62.36
|
| Rate for Payer: United Healthcare Medicare Advantage |
$15.59
|
| Rate for Payer: United Healthcare PPO |
$17.94
|
| Rate for Payer: WEA Trust Commercial |
$13.16
|
| Rate for Payer: Wellcare Medicare |
$15.59
|
| Rate for Payer: WPS Commercial |
$17.72
|
|
|
Serotype 12
|
Professional
|
Both
|
$23.00
|
|
|
Service Code
|
CPT 86317
|
| Hospital Charge Code |
2943005
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.52 |
| Max. Negotiated Rate |
$68.59 |
| Rate for Payer: Aetna Commercial |
$22.72
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$20.57
|
| Rate for Payer: Aetna Managed Medicare |
$15.59
|
| Rate for Payer: Anthem Medicare Advantage |
$15.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$15.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$15.59
|
| Rate for Payer: Cash Price |
$6.90
|
| Rate for Payer: Cash Price |
$6.90
|
| Rate for Payer: Cigna Commercial |
$22.72
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$11.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$15.59
|
| Rate for Payer: Health EOS Commercial |
$21.77
|
| Rate for Payer: HFN Commercial |
$22.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$55.03
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$55.03
|
| Rate for Payer: Independent Care Health Plan Medicare |
$15.59
|
| Rate for Payer: Multiplan Commercial |
$19.14
|
| Rate for Payer: NAPHCARE Commercial |
$23.38
|
| Rate for Payer: Preferred Network Access Commercial |
$22.72
|
| Rate for Payer: Quartz Beloit One Network |
$10.52
|
| Rate for Payer: Quartz Commercial |
$13.63
|
| Rate for Payer: Quartz Medicare Advantage |
$15.59
|
| Rate for Payer: The Alliance Commercial |
$61.58
|
| Rate for Payer: United Healthcare Medicare Advantage |
$15.59
|
| Rate for Payer: WEA Trust Commercial |
$13.16
|
| Rate for Payer: WPS Commercial |
$68.59
|
|
|
Serotype 14
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
CPT 86317
|
| Hospital Charge Code |
2943006
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.72 |
| Max. Negotiated Rate |
$22.01 |
| Rate for Payer: Aetna Commercial |
$21.53
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$20.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$12.68
|
| Rate for Payer: Cash Price |
$6.90
|
| Rate for Payer: Cigna Commercial |
$22.01
|
| Rate for Payer: Health EOS Commercial |
$21.29
|
| Rate for Payer: HFN Commercial |
$22.01
|
| Rate for Payer: Multiplan Commercial |
$19.14
|
| Rate for Payer: Preferred Network Access Commercial |
$22.01
|
| Rate for Payer: Quartz Beloit One Network |
$11.72
|
| Rate for Payer: Quartz Commercial |
$14.35
|
| Rate for Payer: WEA Trust Commercial |
$13.16
|
| Rate for Payer: WPS Commercial |
$17.72
|
|
|
Serotype 14
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
CPT 86317
|
| Hospital Charge Code |
2943006
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.72 |
| Max. Negotiated Rate |
$62.36 |
| Rate for Payer: Aetna Commercial |
$21.53
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$20.57
|
| Rate for Payer: Aetna Managed Medicare |
$15.59
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$58.46
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$27.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$25.88
|
| Rate for Payer: Anthem Medicare Advantage |
$15.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$12.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$15.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$15.59
|
| Rate for Payer: Cash Price |
$6.90
|
| Rate for Payer: Cash Price |
$6.90
|
| Rate for Payer: Cigna Commercial |
$22.01
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$15.59
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$13.39
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$15.59
|
| Rate for Payer: Health EOS Commercial |
$21.29
|
| Rate for Payer: HFN Commercial |
$22.01
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$57.99
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$15.59
|
| Rate for Payer: Independent Care Health Plan Medicare |
$15.59
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$15.59
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$15.59
|
| Rate for Payer: Multiplan Commercial |
$19.14
|
| Rate for Payer: NAPHCARE Commercial |
$23.38
|
| Rate for Payer: Preferred Network Access Commercial |
$22.01
|
| Rate for Payer: Quartz Beloit One Network |
$11.72
|
| Rate for Payer: Quartz Commercial |
$15.55
|
| Rate for Payer: Quartz Medicare Advantage |
$15.59
|
| Rate for Payer: The Alliance Commercial |
$62.36
|
| Rate for Payer: United Healthcare Medicare Advantage |
$15.59
|
| Rate for Payer: United Healthcare PPO |
$17.94
|
| Rate for Payer: WEA Trust Commercial |
$13.16
|
| Rate for Payer: Wellcare Medicare |
$15.59
|
| Rate for Payer: WPS Commercial |
$17.72
|
|
|
Serotype 14
|
Professional
|
Both
|
$23.00
|
|
|
Service Code
|
CPT 86317
|
| Hospital Charge Code |
2943006
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.52 |
| Max. Negotiated Rate |
$68.59 |
| Rate for Payer: Aetna Commercial |
$22.72
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$20.57
|
| Rate for Payer: Aetna Managed Medicare |
$15.59
|
| Rate for Payer: Anthem Medicare Advantage |
$15.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$15.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$15.59
|
| Rate for Payer: Cash Price |
$6.90
|
| Rate for Payer: Cash Price |
$6.90
|
| Rate for Payer: Cigna Commercial |
$22.72
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$11.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$15.59
|
| Rate for Payer: Health EOS Commercial |
$21.77
|
| Rate for Payer: HFN Commercial |
$22.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$55.03
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$55.03
|
| Rate for Payer: Independent Care Health Plan Medicare |
$15.59
|
| Rate for Payer: Multiplan Commercial |
$19.14
|
| Rate for Payer: NAPHCARE Commercial |
$23.38
|
| Rate for Payer: Preferred Network Access Commercial |
$22.72
|
| Rate for Payer: Quartz Beloit One Network |
$10.52
|
| Rate for Payer: Quartz Commercial |
$13.63
|
| Rate for Payer: Quartz Medicare Advantage |
$15.59
|
| Rate for Payer: The Alliance Commercial |
$61.58
|
| Rate for Payer: United Healthcare Medicare Advantage |
$15.59
|
| Rate for Payer: WEA Trust Commercial |
$13.16
|
| Rate for Payer: WPS Commercial |
$68.59
|
|
|
Serotype 19
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
CPT 86317
|
| Hospital Charge Code |
2943007
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.72 |
| Max. Negotiated Rate |
$22.01 |
| Rate for Payer: Aetna Commercial |
$21.53
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$20.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$12.68
|
| Rate for Payer: Cash Price |
$6.90
|
| Rate for Payer: Cigna Commercial |
$22.01
|
| Rate for Payer: Health EOS Commercial |
$21.29
|
| Rate for Payer: HFN Commercial |
$22.01
|
| Rate for Payer: Multiplan Commercial |
$19.14
|
| Rate for Payer: Preferred Network Access Commercial |
$22.01
|
| Rate for Payer: Quartz Beloit One Network |
$11.72
|
| Rate for Payer: Quartz Commercial |
$14.35
|
| Rate for Payer: WEA Trust Commercial |
$13.16
|
| Rate for Payer: WPS Commercial |
$17.72
|
|
|
Serotype 19
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
CPT 86317
|
| Hospital Charge Code |
2943007
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.72 |
| Max. Negotiated Rate |
$62.36 |
| Rate for Payer: Aetna Commercial |
$21.53
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$20.57
|
| Rate for Payer: Aetna Managed Medicare |
$15.59
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$58.46
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$27.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$25.88
|
| Rate for Payer: Anthem Medicare Advantage |
$15.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$12.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$15.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$15.59
|
| Rate for Payer: Cash Price |
$6.90
|
| Rate for Payer: Cash Price |
$6.90
|
| Rate for Payer: Cigna Commercial |
$22.01
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$15.59
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$13.39
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$15.59
|
| Rate for Payer: Health EOS Commercial |
$21.29
|
| Rate for Payer: HFN Commercial |
$22.01
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$57.99
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$15.59
|
| Rate for Payer: Independent Care Health Plan Medicare |
$15.59
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$15.59
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$15.59
|
| Rate for Payer: Multiplan Commercial |
$19.14
|
| Rate for Payer: NAPHCARE Commercial |
$23.38
|
| Rate for Payer: Preferred Network Access Commercial |
$22.01
|
| Rate for Payer: Quartz Beloit One Network |
$11.72
|
| Rate for Payer: Quartz Commercial |
$15.55
|
| Rate for Payer: Quartz Medicare Advantage |
$15.59
|
| Rate for Payer: The Alliance Commercial |
$62.36
|
| Rate for Payer: United Healthcare Medicare Advantage |
$15.59
|
| Rate for Payer: United Healthcare PPO |
$17.94
|
| Rate for Payer: WEA Trust Commercial |
$13.16
|
| Rate for Payer: Wellcare Medicare |
$15.59
|
| Rate for Payer: WPS Commercial |
$17.72
|
|
|
Serotype 19
|
Professional
|
Both
|
$23.00
|
|
|
Service Code
|
CPT 86317
|
| Hospital Charge Code |
2943007
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.52 |
| Max. Negotiated Rate |
$68.59 |
| Rate for Payer: Aetna Commercial |
$22.72
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$20.57
|
| Rate for Payer: Aetna Managed Medicare |
$15.59
|
| Rate for Payer: Anthem Medicare Advantage |
$15.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$15.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$15.59
|
| Rate for Payer: Cash Price |
$6.90
|
| Rate for Payer: Cash Price |
$6.90
|
| Rate for Payer: Cigna Commercial |
$22.72
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$11.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$15.59
|
| Rate for Payer: Health EOS Commercial |
$21.77
|
| Rate for Payer: HFN Commercial |
$22.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$55.03
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$55.03
|
| Rate for Payer: Independent Care Health Plan Medicare |
$15.59
|
| Rate for Payer: Multiplan Commercial |
$19.14
|
| Rate for Payer: NAPHCARE Commercial |
$23.38
|
| Rate for Payer: Preferred Network Access Commercial |
$22.72
|
| Rate for Payer: Quartz Beloit One Network |
$10.52
|
| Rate for Payer: Quartz Commercial |
$13.63
|
| Rate for Payer: Quartz Medicare Advantage |
$15.59
|
| Rate for Payer: The Alliance Commercial |
$61.58
|
| Rate for Payer: United Healthcare Medicare Advantage |
$15.59
|
| Rate for Payer: WEA Trust Commercial |
$13.16
|
| Rate for Payer: WPS Commercial |
$68.59
|
|
|
Serotype 23
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
CPT 86317
|
| Hospital Charge Code |
2943008
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.72 |
| Max. Negotiated Rate |
$62.36 |
| Rate for Payer: Aetna Commercial |
$21.53
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$20.57
|
| Rate for Payer: Aetna Managed Medicare |
$15.59
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$58.46
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$27.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$25.88
|
| Rate for Payer: Anthem Medicare Advantage |
$15.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$12.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$15.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$15.59
|
| Rate for Payer: Cash Price |
$6.90
|
| Rate for Payer: Cash Price |
$6.90
|
| Rate for Payer: Cigna Commercial |
$22.01
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$15.59
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$13.39
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$15.59
|
| Rate for Payer: Health EOS Commercial |
$21.29
|
| Rate for Payer: HFN Commercial |
$22.01
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$57.99
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$15.59
|
| Rate for Payer: Independent Care Health Plan Medicare |
$15.59
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$15.59
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$15.59
|
| Rate for Payer: Multiplan Commercial |
$19.14
|
| Rate for Payer: NAPHCARE Commercial |
$23.38
|
| Rate for Payer: Preferred Network Access Commercial |
$22.01
|
| Rate for Payer: Quartz Beloit One Network |
$11.72
|
| Rate for Payer: Quartz Commercial |
$15.55
|
| Rate for Payer: Quartz Medicare Advantage |
$15.59
|
| Rate for Payer: The Alliance Commercial |
$62.36
|
| Rate for Payer: United Healthcare Medicare Advantage |
$15.59
|
| Rate for Payer: United Healthcare PPO |
$17.94
|
| Rate for Payer: WEA Trust Commercial |
$13.16
|
| Rate for Payer: Wellcare Medicare |
$15.59
|
| Rate for Payer: WPS Commercial |
$17.72
|
|
|
Serotype 23
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
CPT 86317
|
| Hospital Charge Code |
2943008
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.72 |
| Max. Negotiated Rate |
$22.01 |
| Rate for Payer: Aetna Commercial |
$21.53
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$20.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$12.68
|
| Rate for Payer: Cash Price |
$6.90
|
| Rate for Payer: Cigna Commercial |
$22.01
|
| Rate for Payer: Health EOS Commercial |
$21.29
|
| Rate for Payer: HFN Commercial |
$22.01
|
| Rate for Payer: Multiplan Commercial |
$19.14
|
| Rate for Payer: Preferred Network Access Commercial |
$22.01
|
| Rate for Payer: Quartz Beloit One Network |
$11.72
|
| Rate for Payer: Quartz Commercial |
$14.35
|
| Rate for Payer: WEA Trust Commercial |
$13.16
|
| Rate for Payer: WPS Commercial |
$17.72
|
|
|
Serotype 23
|
Professional
|
Both
|
$23.00
|
|
|
Service Code
|
CPT 86317
|
| Hospital Charge Code |
2943008
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.52 |
| Max. Negotiated Rate |
$68.59 |
| Rate for Payer: Aetna Commercial |
$22.72
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$20.57
|
| Rate for Payer: Aetna Managed Medicare |
$15.59
|
| Rate for Payer: Anthem Medicare Advantage |
$15.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$15.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$15.59
|
| Rate for Payer: Cash Price |
$6.90
|
| Rate for Payer: Cash Price |
$6.90
|
| Rate for Payer: Cigna Commercial |
$22.72
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$11.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$15.59
|
| Rate for Payer: Health EOS Commercial |
$21.77
|
| Rate for Payer: HFN Commercial |
$22.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$55.03
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$55.03
|
| Rate for Payer: Independent Care Health Plan Medicare |
$15.59
|
| Rate for Payer: Multiplan Commercial |
$19.14
|
| Rate for Payer: NAPHCARE Commercial |
$23.38
|
| Rate for Payer: Preferred Network Access Commercial |
$22.72
|
| Rate for Payer: Quartz Beloit One Network |
$10.52
|
| Rate for Payer: Quartz Commercial |
$13.63
|
| Rate for Payer: Quartz Medicare Advantage |
$15.59
|
| Rate for Payer: The Alliance Commercial |
$61.58
|
| Rate for Payer: United Healthcare Medicare Advantage |
$15.59
|
| Rate for Payer: WEA Trust Commercial |
$13.16
|
| Rate for Payer: WPS Commercial |
$68.59
|
|
|
Serotype 26
|
Professional
|
Both
|
$23.00
|
|
|
Service Code
|
CPT 86317
|
| Hospital Charge Code |
2943009
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.52 |
| Max. Negotiated Rate |
$68.59 |
| Rate for Payer: Aetna Commercial |
$22.72
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$20.57
|
| Rate for Payer: Aetna Managed Medicare |
$15.59
|
| Rate for Payer: Anthem Medicare Advantage |
$15.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$15.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$15.59
|
| Rate for Payer: Cash Price |
$6.90
|
| Rate for Payer: Cash Price |
$6.90
|
| Rate for Payer: Cigna Commercial |
$22.72
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$11.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$15.59
|
| Rate for Payer: Health EOS Commercial |
$21.77
|
| Rate for Payer: HFN Commercial |
$22.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$55.03
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$55.03
|
| Rate for Payer: Independent Care Health Plan Medicare |
$15.59
|
| Rate for Payer: Multiplan Commercial |
$19.14
|
| Rate for Payer: NAPHCARE Commercial |
$23.38
|
| Rate for Payer: Preferred Network Access Commercial |
$22.72
|
| Rate for Payer: Quartz Beloit One Network |
$10.52
|
| Rate for Payer: Quartz Commercial |
$13.63
|
| Rate for Payer: Quartz Medicare Advantage |
$15.59
|
| Rate for Payer: The Alliance Commercial |
$61.58
|
| Rate for Payer: United Healthcare Medicare Advantage |
$15.59
|
| Rate for Payer: WEA Trust Commercial |
$13.16
|
| Rate for Payer: WPS Commercial |
$68.59
|
|
|
Serotype 26
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
CPT 86317
|
| Hospital Charge Code |
2943009
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.72 |
| Max. Negotiated Rate |
$22.01 |
| Rate for Payer: Aetna Commercial |
$21.53
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$20.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$12.68
|
| Rate for Payer: Cash Price |
$6.90
|
| Rate for Payer: Cigna Commercial |
$22.01
|
| Rate for Payer: Health EOS Commercial |
$21.29
|
| Rate for Payer: HFN Commercial |
$22.01
|
| Rate for Payer: Multiplan Commercial |
$19.14
|
| Rate for Payer: Preferred Network Access Commercial |
$22.01
|
| Rate for Payer: Quartz Beloit One Network |
$11.72
|
| Rate for Payer: Quartz Commercial |
$14.35
|
| Rate for Payer: WEA Trust Commercial |
$13.16
|
| Rate for Payer: WPS Commercial |
$17.72
|
|
|
Serotype 26
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
CPT 86317
|
| Hospital Charge Code |
2943009
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.72 |
| Max. Negotiated Rate |
$62.36 |
| Rate for Payer: Aetna Commercial |
$21.53
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$20.57
|
| Rate for Payer: Aetna Managed Medicare |
$15.59
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$58.46
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$27.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$25.88
|
| Rate for Payer: Anthem Medicare Advantage |
$15.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$12.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$15.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$15.59
|
| Rate for Payer: Cash Price |
$6.90
|
| Rate for Payer: Cash Price |
$6.90
|
| Rate for Payer: Cigna Commercial |
$22.01
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$15.59
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$13.39
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$15.59
|
| Rate for Payer: Health EOS Commercial |
$21.29
|
| Rate for Payer: HFN Commercial |
$22.01
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$57.99
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$15.59
|
| Rate for Payer: Independent Care Health Plan Medicare |
$15.59
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$15.59
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$15.59
|
| Rate for Payer: Multiplan Commercial |
$19.14
|
| Rate for Payer: NAPHCARE Commercial |
$23.38
|
| Rate for Payer: Preferred Network Access Commercial |
$22.01
|
| Rate for Payer: Quartz Beloit One Network |
$11.72
|
| Rate for Payer: Quartz Commercial |
$15.55
|
| Rate for Payer: Quartz Medicare Advantage |
$15.59
|
| Rate for Payer: The Alliance Commercial |
$62.36
|
| Rate for Payer: United Healthcare Medicare Advantage |
$15.59
|
| Rate for Payer: United Healthcare PPO |
$17.94
|
| Rate for Payer: WEA Trust Commercial |
$13.16
|
| Rate for Payer: Wellcare Medicare |
$15.59
|
| Rate for Payer: WPS Commercial |
$17.72
|
|
