|
Serotype 3
|
Professional
|
Both
|
$23.00
|
|
|
Service Code
|
CPT 86317
|
| Hospital Charge Code |
2943000
|
|
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 3
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
CPT 86317
|
| Hospital Charge Code |
2943000
|
|
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 3
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
CPT 86317
|
| Hospital Charge Code |
2943000
|
|
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 4
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
CPT 86317
|
| Hospital Charge Code |
2943001
|
|
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 4
|
Professional
|
Both
|
$23.00
|
|
|
Service Code
|
CPT 86317
|
| Hospital Charge Code |
2943001
|
|
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 4
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
CPT 86317
|
| Hospital Charge Code |
2943001
|
|
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 5
|
Professional
|
Both
|
$23.00
|
|
|
Service Code
|
CPT 86317
|
| Hospital Charge Code |
2943002
|
|
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 5
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
CPT 86317
|
| Hospital Charge Code |
2943002
|
|
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 5
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
CPT 86317
|
| Hospital Charge Code |
2943002
|
|
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 51
|
Professional
|
Both
|
$23.00
|
|
|
Service Code
|
CPT 86317
|
| Hospital Charge Code |
2943010
|
|
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 51
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
CPT 86317
|
| Hospital Charge Code |
2943010
|
|
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 51
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
CPT 86317
|
| Hospital Charge Code |
2943010
|
|
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 56
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
CPT 86317
|
| Hospital Charge Code |
2943011
|
|
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 56
|
Professional
|
Both
|
$23.00
|
|
|
Service Code
|
CPT 86317
|
| Hospital Charge Code |
2943011
|
|
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 56
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
CPT 86317
|
| Hospital Charge Code |
2943011
|
|
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 68
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
CPT 86317
|
| Hospital Charge Code |
2943012
|
|
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 68
|
Professional
|
Both
|
$23.00
|
|
|
Service Code
|
CPT 86317
|
| Hospital Charge Code |
2943012
|
|
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 68
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
CPT 86317
|
| Hospital Charge Code |
2943012
|
|
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 8
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
CPT 86317
|
| Hospital Charge Code |
2943003
|
|
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 8
|
Professional
|
Both
|
$23.00
|
|
|
Service Code
|
CPT 86317
|
| Hospital Charge Code |
2943003
|
|
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 8
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
CPT 86317
|
| Hospital Charge Code |
2943003
|
|
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 9
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
CPT 86317
|
| Hospital Charge Code |
2943004
|
|
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 9
|
Professional
|
Both
|
$23.00
|
|
|
Service Code
|
CPT 86317
|
| Hospital Charge Code |
2943004
|
|
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 9
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
CPT 86317
|
| Hospital Charge Code |
2943004
|
|
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
|
|
|
Sertraline (Zoloft)
|
Professional
|
Both
|
$175.00
|
|
|
Service Code
|
CPT 80332
|
| Hospital Charge Code |
983402
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$80.08 |
| Max. Negotiated Rate |
$172.90 |
| Rate for Payer: Aetna Commercial |
$172.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$156.52
|
| Rate for Payer: Cash Price |
$52.50
|
| Rate for Payer: Cash Price |
$52.50
|
| Rate for Payer: Cigna Commercial |
$172.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$91.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$109.20
|
| Rate for Payer: Health EOS Commercial |
$165.62
|
| Rate for Payer: HFN Commercial |
$172.90
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$83.26
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$83.26
|
| Rate for Payer: Multiplan Commercial |
$145.60
|
| Rate for Payer: Preferred Network Access Commercial |
$172.90
|
| Rate for Payer: Quartz Beloit One Network |
$80.08
|
| Rate for Payer: Quartz Commercial |
$103.74
|
| Rate for Payer: The Alliance Commercial |
$91.00
|
| Rate for Payer: WEA Trust Commercial |
$100.10
|
| Rate for Payer: WPS Commercial |
$134.80
|
|
