|
SEPTIC ARTHRITIS WITH CC
|
Facility
|
IP
|
$32,388.00
|
|
|
Service Code
|
MSDRG 549
|
| Min. Negotiated Rate |
$11,650.51 |
| Max. Negotiated Rate |
$32,388.00 |
| Rate for Payer: Aetna Managed Medicare |
$11,650.51
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$25,385.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$19,458.01
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$18,486.38
|
| Rate for Payer: Anthem Medicare Advantage |
$11,650.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$11,650.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$11,650.51
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$11,650.51
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$20,521.58
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$11,650.51
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$23,520.90
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$11,650.51
|
| Rate for Payer: Independent Care Health Plan Medicare |
$11,650.51
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$11,650.51
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$11,650.51
|
| Rate for Payer: NAPHCARE Commercial |
$17,475.76
|
| Rate for Payer: Quartz Medicare Advantage |
$11,650.51
|
| Rate for Payer: The Alliance Commercial |
$32,388.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$11,650.51
|
| Rate for Payer: United Healthcare PPO |
$18,311.32
|
| Rate for Payer: Wellcare Medicare |
$11,650.51
|
|
|
SEPTIC ARTHRITIS WITH MCC
|
Facility
|
IP
|
$52,158.00
|
|
|
Service Code
|
MSDRG 548
|
| Min. Negotiated Rate |
$18,761.78 |
| Max. Negotiated Rate |
$52,158.00 |
| Rate for Payer: Aetna Managed Medicare |
$18,761.78
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$40,911.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$31,357.95
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$29,792.10
|
| Rate for Payer: Anthem Medicare Advantage |
$18,761.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$18,761.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$18,761.78
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$18,761.78
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$33,071.96
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$18,761.78
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$38,021.10
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$18,761.78
|
| Rate for Payer: Independent Care Health Plan Medicare |
$18,761.78
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$18,761.78
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$18,761.78
|
| Rate for Payer: NAPHCARE Commercial |
$28,142.67
|
| Rate for Payer: Quartz Medicare Advantage |
$18,761.78
|
| Rate for Payer: The Alliance Commercial |
$52,158.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$18,761.78
|
| Rate for Payer: United Healthcare PPO |
$29,599.91
|
| Rate for Payer: Wellcare Medicare |
$18,761.78
|
|
|
SEPTIC ARTHRITIS WITHOUT CC/MCC
|
Facility
|
IP
|
$25,404.00
|
|
|
Service Code
|
MSDRG 550
|
| Min. Negotiated Rate |
$9,138.24 |
| Max. Negotiated Rate |
$25,404.00 |
| Rate for Payer: Aetna Managed Medicare |
$9,138.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$19,301.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$14,794.52
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$14,055.76
|
| Rate for Payer: Anthem Medicare Advantage |
$9,138.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$9,138.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$9,138.24
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$9,138.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$15,603.18
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$9,138.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$17,955.60
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$9,138.24
|
| Rate for Payer: Independent Care Health Plan Medicare |
$9,138.24
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$9,138.24
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$9,138.24
|
| Rate for Payer: NAPHCARE Commercial |
$13,707.36
|
| Rate for Payer: Quartz Medicare Advantage |
$9,138.24
|
| Rate for Payer: The Alliance Commercial |
$25,404.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$9,138.24
|
| Rate for Payer: United Healthcare PPO |
$13,978.66
|
| Rate for Payer: Wellcare Medicare |
$9,138.24
|
|
|
SEPTICEMIA OR SEVERE SEPSIS WITH MV >96 HOURS
|
Facility
|
IP
|
$185,489.00
|
|
|
Service Code
|
MSDRG 870
|
| Min. Negotiated Rate |
$66,722.65 |
| Max. Negotiated Rate |
$185,489.00 |
| Rate for Payer: Aetna Managed Medicare |
$66,722.65
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$146,020.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$111,923.76
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$106,334.88
|
| Rate for Payer: Anthem Medicare Advantage |
$66,722.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$66,722.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$66,722.65
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$66,722.65
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$118,041.46
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$66,722.65
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$135,815.60
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$66,722.65
|
| Rate for Payer: Independent Care Health Plan Medicare |
$66,722.65
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$66,722.65
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$66,722.65
|
| Rate for Payer: NAPHCARE Commercial |
$100,083.98
|
| Rate for Payer: Quartz Medicare Advantage |
$66,722.65
|
| Rate for Payer: The Alliance Commercial |
$185,489.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$66,722.65
|
| Rate for Payer: United Healthcare PPO |
$105,734.15
|
| Rate for Payer: Wellcare Medicare |
$66,722.65
|
|
|
SEPTICEMIA OR SEVERE SEPSIS WITHOUT MV >96 HOURS WITH MCC
|
Facility
|
IP
|
$53,030.00
|
|
|
Service Code
|
MSDRG 871
|
| Min. Negotiated Rate |
$19,075.45 |
| Max. Negotiated Rate |
$53,030.00 |
| Rate for Payer: Aetna Managed Medicare |
$19,075.45
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$41,540.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$31,840.38
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$30,250.44
|
| Rate for Payer: Anthem Medicare Advantage |
$19,075.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$19,075.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$19,075.45
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$19,075.45
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$33,580.76
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$19,075.45
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$38,660.70
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$19,075.45
|
| Rate for Payer: Independent Care Health Plan Medicare |
$19,075.45
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$19,075.45
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$19,075.45
|
| Rate for Payer: NAPHCARE Commercial |
$28,613.18
|
| Rate for Payer: Quartz Medicare Advantage |
$19,075.45
|
| Rate for Payer: The Alliance Commercial |
$53,030.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$19,075.45
|
| Rate for Payer: United Healthcare PPO |
$30,097.85
|
| Rate for Payer: Wellcare Medicare |
$19,075.45
|
|
|
SEPTICEMIA OR SEVERE SEPSIS WITHOUT MV >96 HOURS WITHOUT MCC
|
Facility
|
IP
|
$27,701.00
|
|
|
Service Code
|
MSDRG 872
|
| Min. Negotiated Rate |
$9,964.51 |
| Max. Negotiated Rate |
$27,701.00 |
| Rate for Payer: Aetna Managed Medicare |
$9,964.51
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$21,609.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$16,563.43
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$15,736.34
|
| Rate for Payer: Anthem Medicare Advantage |
$9,964.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$9,964.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$9,964.51
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$9,964.51
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$17,468.78
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$9,964.51
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$20,083.05
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$9,964.51
|
| Rate for Payer: Independent Care Health Plan Medicare |
$9,964.51
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$9,964.51
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$9,964.51
|
| Rate for Payer: NAPHCARE Commercial |
$14,946.76
|
| Rate for Payer: Quartz Medicare Advantage |
$9,964.51
|
| Rate for Payer: The Alliance Commercial |
$27,701.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$9,964.51
|
| Rate for Payer: United Healthcare PPO |
$15,634.91
|
| Rate for Payer: Wellcare Medicare |
$9,964.51
|
|
|
SEPTOPLASTY
|
Facility
|
OP
|
$4,238.00
|
|
| Hospital Charge Code |
2960370
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,186.64 |
| Max. Negotiated Rate |
$16,952.00 |
| Rate for Payer: Aetna Commercial |
$3,814.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,644.68
|
| Rate for Payer: Aetna Managed Medicare |
$1,186.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,754.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,119.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,034.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,246.14
|
| Rate for Payer: Cash Price |
$1,271.40
|
| Rate for Payer: Cigna Commercial |
$3,898.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,371.58
|
| Rate for Payer: Health EOS Commercial |
$3,771.82
|
| Rate for Payer: HFN Commercial |
$3,898.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,178.50
|
| Rate for Payer: Multiplan Commercial |
$3,390.40
|
| Rate for Payer: NAPHCARE Commercial |
$2,542.80
|
| Rate for Payer: Preferred Network Access Commercial |
$3,898.96
|
| Rate for Payer: Quartz Beloit One Network |
$2,076.62
|
| Rate for Payer: Quartz Commercial |
$2,754.70
|
| Rate for Payer: Quartz Medicare Advantage |
$2,542.80
|
| Rate for Payer: The Alliance Commercial |
$16,952.00
|
| Rate for Payer: WEA Trust Commercial |
$2,330.90
|
| Rate for Payer: WPS Commercial |
$3,139.09
|
|
|
SEPTOPLASTY
|
Facility
|
IP
|
$4,238.00
|
|
| Hospital Charge Code |
2960370
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,076.62 |
| Max. Negotiated Rate |
$3,898.96 |
| Rate for Payer: Aetna Commercial |
$3,814.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,644.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,246.14
|
| Rate for Payer: Cash Price |
$1,271.40
|
| Rate for Payer: Cigna Commercial |
$3,898.96
|
| Rate for Payer: Health EOS Commercial |
$3,771.82
|
| Rate for Payer: HFN Commercial |
$3,898.96
|
| Rate for Payer: Multiplan Commercial |
$3,390.40
|
| Rate for Payer: NAPHCARE Commercial |
$2,542.80
|
| Rate for Payer: Preferred Network Access Commercial |
$3,898.96
|
| Rate for Payer: Quartz Beloit One Network |
$2,076.62
|
| Rate for Payer: Quartz Commercial |
$2,542.80
|
| Rate for Payer: WEA Trust Commercial |
$2,330.90
|
| Rate for Payer: WPS Commercial |
$3,139.09
|
|
|
SEPTOPLASTY OR SUBMUCOUS RESECTION, WITH OR WITHOUT CARTILAGE SCORING, CONTOURING OR REPLACEMENT WITH GRAFT
|
Facility
|
OP
|
$12,729.16
|
|
|
Service Code
|
CPT 30520
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,726.00 |
| Max. Negotiated Rate |
$12,729.16 |
| Rate for Payer: Aetna Managed Medicare |
$3,182.29
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,496.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,871.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,726.00
|
| Rate for Payer: Anthem Medicare Advantage |
$3,182.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$3,182.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$3,182.29
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$3,182.29
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$7,795.33
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$3,182.29
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$11,838.12
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$3,182.29
|
| Rate for Payer: Independent Care Health Plan Medicare |
$3,182.29
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$3,182.29
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$3,182.29
|
| Rate for Payer: NAPHCARE Commercial |
$4,773.44
|
| Rate for Payer: Quartz Medicare Advantage |
$3,182.29
|
| Rate for Payer: The Alliance Commercial |
$12,729.16
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,182.29
|
| Rate for Payer: United Healthcare PPO |
$3,583.00
|
| Rate for Payer: Wellcare Medicare |
$3,182.29
|
|
|
SEPTORHINOPLASTY
|
Facility
|
OP
|
$3,935.00
|
|
| Hospital Charge Code |
2960371
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,101.80 |
| Max. Negotiated Rate |
$15,740.00 |
| Rate for Payer: Aetna Commercial |
$3,541.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,384.10
|
| Rate for Payer: Aetna Managed Medicare |
$1,101.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,557.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,967.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,888.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,085.55
|
| Rate for Payer: Cash Price |
$1,180.50
|
| Rate for Payer: Cigna Commercial |
$3,620.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,202.03
|
| Rate for Payer: Health EOS Commercial |
$3,502.15
|
| Rate for Payer: HFN Commercial |
$3,620.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,951.25
|
| Rate for Payer: Multiplan Commercial |
$3,148.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,361.00
|
| Rate for Payer: Preferred Network Access Commercial |
$3,620.20
|
| Rate for Payer: Quartz Beloit One Network |
$1,928.15
|
| Rate for Payer: Quartz Commercial |
$2,557.75
|
| Rate for Payer: Quartz Medicare Advantage |
$2,361.00
|
| Rate for Payer: The Alliance Commercial |
$15,740.00
|
| Rate for Payer: WEA Trust Commercial |
$2,164.25
|
| Rate for Payer: WPS Commercial |
$2,914.65
|
|
|
SEPTORHINOPLASTY
|
Facility
|
IP
|
$3,935.00
|
|
| Hospital Charge Code |
2960371
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,928.15 |
| Max. Negotiated Rate |
$3,620.20 |
| Rate for Payer: Aetna Commercial |
$3,541.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,384.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,085.55
|
| Rate for Payer: Cash Price |
$1,180.50
|
| Rate for Payer: Cigna Commercial |
$3,620.20
|
| Rate for Payer: Health EOS Commercial |
$3,502.15
|
| Rate for Payer: HFN Commercial |
$3,620.20
|
| Rate for Payer: Multiplan Commercial |
$3,148.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,361.00
|
| Rate for Payer: Preferred Network Access Commercial |
$3,620.20
|
| Rate for Payer: Quartz Beloit One Network |
$1,928.15
|
| Rate for Payer: Quartz Commercial |
$2,361.00
|
| Rate for Payer: WEA Trust Commercial |
$2,164.25
|
| Rate for Payer: WPS Commercial |
$2,914.65
|
|
|
Serial Tonometry Exam
|
Professional
|
Both
|
$193.00
|
|
|
Service Code
|
CPT 92100
|
| Hospital Charge Code |
1190812
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$8.08 |
| Max. Negotiated Rate |
$183.35 |
| Rate for Payer: Aetna Commercial |
$183.35
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$165.98
|
| Rate for Payer: Cash Price |
$57.90
|
| Rate for Payer: Cash Price |
$57.90
|
| Rate for Payer: Cigna Commercial |
$183.35
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$8.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$115.80
|
| Rate for Payer: Health EOS Commercial |
$175.63
|
| Rate for Payer: HFN Commercial |
$183.35
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$113.00
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$113.00
|
| Rate for Payer: Multiplan Commercial |
$154.40
|
| Rate for Payer: Preferred Network Access Commercial |
$183.35
|
| Rate for Payer: Quartz Beloit One Network |
$84.92
|
| Rate for Payer: Quartz Commercial |
$110.01
|
| Rate for Payer: The Alliance Commercial |
$96.50
|
| Rate for Payer: United Healthcare Medicaid |
$8.08
|
| Rate for Payer: WEA Trust Commercial |
$106.15
|
| Rate for Payer: WPS Commercial |
$142.96
|
|
|
Serotonin Level, Blood
|
Facility
|
OP
|
$1,756.00
|
|
|
Service Code
|
CPT 84260
|
| Hospital Charge Code |
978065
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$30.98 |
| Max. Negotiated Rate |
$1,615.52 |
| Rate for Payer: Aetna Commercial |
$1,580.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,510.16
|
| Rate for Payer: Aetna Managed Medicare |
$30.98
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$116.18
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$54.22
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$51.43
|
| Rate for Payer: Anthem Medicaid |
$32.01
|
| Rate for Payer: Anthem Medicare Advantage |
$30.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$930.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$30.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$30.98
|
| Rate for Payer: Cash Price |
$526.80
|
| Rate for Payer: Cash Price |
$526.80
|
| Rate for Payer: Cigna Commercial |
$1,615.52
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$30.98
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$32.01
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$982.66
|
| Rate for Payer: Dean Health Medicaid |
$32.01
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$30.98
|
| Rate for Payer: Health EOS Commercial |
$1,562.84
|
| Rate for Payer: HFN Commercial |
$1,615.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$115.25
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$30.98
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$32.01
|
| Rate for Payer: Independent Care Health Plan Medicare |
$30.98
|
| Rate for Payer: Managed Health Services Medicaid |
$33.29
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$30.98
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$30.98
|
| Rate for Payer: Multiplan Commercial |
$1,404.80
|
| Rate for Payer: NAPHCARE Commercial |
$46.47
|
| Rate for Payer: Preferred Network Access Commercial |
$1,615.52
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$32.01
|
| Rate for Payer: Quartz Beloit One Network |
$860.44
|
| Rate for Payer: Quartz Commercial |
$1,141.40
|
| Rate for Payer: Quartz Medicare Advantage |
$30.98
|
| Rate for Payer: The Alliance Commercial |
$123.92
|
| Rate for Payer: United Healthcare Medicaid |
$32.01
|
| Rate for Payer: United Healthcare Medicare Advantage |
$30.98
|
| Rate for Payer: United Healthcare PPO |
$1,317.00
|
| Rate for Payer: WEA Trust Commercial |
$965.80
|
| Rate for Payer: Wellcare Medicare |
$30.98
|
| Rate for Payer: WMAP Medicaid |
$32.01
|
| Rate for Payer: WPS Commercial |
$1,300.67
|
|
|
Serotonin Level, Blood
|
Facility
|
IP
|
$1,756.00
|
|
|
Service Code
|
CPT 84260
|
| Hospital Charge Code |
978065
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$860.44 |
| Max. Negotiated Rate |
$1,615.52 |
| Rate for Payer: Aetna Commercial |
$1,580.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,510.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$930.68
|
| Rate for Payer: Cash Price |
$526.80
|
| Rate for Payer: Cigna Commercial |
$1,615.52
|
| Rate for Payer: Health EOS Commercial |
$1,562.84
|
| Rate for Payer: HFN Commercial |
$1,615.52
|
| Rate for Payer: Multiplan Commercial |
$1,404.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,053.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,615.52
|
| Rate for Payer: Quartz Beloit One Network |
$860.44
|
| Rate for Payer: Quartz Commercial |
$1,053.60
|
| Rate for Payer: WEA Trust Commercial |
$965.80
|
| Rate for Payer: WPS Commercial |
$1,300.67
|
|
|
Serotonin Level, Blood
|
Professional
|
Both
|
$1,756.00
|
|
|
Service Code
|
CPT 84260
|
| Hospital Charge Code |
978065
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$109.36 |
| Max. Negotiated Rate |
$1,668.20 |
| Rate for Payer: Aetna Commercial |
$1,668.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,510.16
|
| Rate for Payer: Cash Price |
$526.80
|
| Rate for Payer: Cash Price |
$526.80
|
| Rate for Payer: Cigna Commercial |
$1,668.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$878.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,053.60
|
| Rate for Payer: Health EOS Commercial |
$1,597.96
|
| Rate for Payer: HFN Commercial |
$1,668.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$109.36
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$109.36
|
| Rate for Payer: Multiplan Commercial |
$1,404.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,668.20
|
| Rate for Payer: Quartz Beloit One Network |
$772.64
|
| Rate for Payer: Quartz Commercial |
$1,000.92
|
| Rate for Payer: The Alliance Commercial |
$878.00
|
| Rate for Payer: WEA Trust Commercial |
$965.80
|
| Rate for Payer: WPS Commercial |
$1,300.67
|
|
|
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 |
$18.37 |
| Max. Negotiated Rate |
$564.88 |
| Rate for Payer: Aetna Commercial |
$552.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$528.04
|
| Rate for Payer: Aetna Managed Medicare |
$18.37
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$68.89
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$32.15
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$30.49
|
| Rate for Payer: Anthem Medicaid |
$18.98
|
| Rate for Payer: Anthem Medicare Advantage |
$18.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$325.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$18.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$18.37
|
| Rate for Payer: Cash Price |
$184.20
|
| Rate for Payer: Cash Price |
$184.20
|
| Rate for Payer: Cigna Commercial |
$564.88
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$18.37
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$18.98
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$343.59
|
| Rate for Payer: Dean Health Medicaid |
$18.98
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$18.37
|
| Rate for Payer: Health EOS Commercial |
$546.46
|
| Rate for Payer: HFN Commercial |
$564.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$68.34
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$18.37
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$18.98
|
| Rate for Payer: Independent Care Health Plan Medicare |
$18.37
|
| Rate for Payer: Managed Health Services Medicaid |
$19.74
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$18.37
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$18.37
|
| Rate for Payer: Multiplan Commercial |
$491.20
|
| Rate for Payer: NAPHCARE Commercial |
$27.56
|
| Rate for Payer: Preferred Network Access Commercial |
$564.88
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$18.98
|
| Rate for Payer: Quartz Beloit One Network |
$300.86
|
| Rate for Payer: Quartz Commercial |
$399.10
|
| Rate for Payer: Quartz Medicare Advantage |
$18.37
|
| Rate for Payer: The Alliance Commercial |
$73.48
|
| Rate for Payer: United Healthcare Medicaid |
$18.98
|
| Rate for Payer: United Healthcare Medicare Advantage |
$18.37
|
| Rate for Payer: United Healthcare PPO |
$460.50
|
| Rate for Payer: WEA Trust Commercial |
$337.70
|
| Rate for Payer: Wellcare Medicare |
$18.37
|
| Rate for Payer: WMAP Medicaid |
$18.98
|
| Rate for Payer: WPS Commercial |
$454.79
|
|
|
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 |
$64.85 |
| Max. Negotiated Rate |
$583.30 |
| Rate for Payer: Aetna Commercial |
$583.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$528.04
|
| Rate for Payer: Cash Price |
$184.20
|
| Rate for Payer: Cash Price |
$184.20
|
| Rate for Payer: Cigna Commercial |
$583.30
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$307.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$368.40
|
| Rate for Payer: Health EOS Commercial |
$558.74
|
| Rate for Payer: HFN Commercial |
$583.30
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$64.85
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$64.85
|
| Rate for Payer: Multiplan Commercial |
$491.20
|
| Rate for Payer: Preferred Network Access Commercial |
$583.30
|
| Rate for Payer: Quartz Beloit One Network |
$270.16
|
| Rate for Payer: Quartz Commercial |
$349.98
|
| Rate for Payer: The Alliance Commercial |
$307.00
|
| Rate for Payer: WEA Trust Commercial |
$337.70
|
| Rate for Payer: WPS Commercial |
$454.79
|
|
|
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 |
$300.86 |
| Max. Negotiated Rate |
$564.88 |
| Rate for Payer: Aetna Commercial |
$552.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$528.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$325.42
|
| Rate for Payer: Cash Price |
$184.20
|
| Rate for Payer: Cigna Commercial |
$564.88
|
| Rate for Payer: Health EOS Commercial |
$546.46
|
| Rate for Payer: HFN Commercial |
$564.88
|
| Rate for Payer: Multiplan Commercial |
$491.20
|
| Rate for Payer: NAPHCARE Commercial |
$368.40
|
| Rate for Payer: Preferred Network Access Commercial |
$564.88
|
| Rate for Payer: Quartz Beloit One Network |
$300.86
|
| Rate for Payer: Quartz Commercial |
$368.40
|
| Rate for Payer: WEA Trust Commercial |
$337.70
|
| Rate for Payer: WPS Commercial |
$454.79
|
|
|
Serotype 12
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
CPT 86317
|
| Hospital Charge Code |
2943005
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.27 |
| Max. Negotiated Rate |
$21.16 |
| Rate for Payer: Aetna Commercial |
$20.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$19.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$12.19
|
| Rate for Payer: Cash Price |
$6.90
|
| Rate for Payer: Cigna Commercial |
$21.16
|
| Rate for Payer: Health EOS Commercial |
$20.47
|
| Rate for Payer: HFN Commercial |
$21.16
|
| Rate for Payer: Multiplan Commercial |
$18.40
|
| Rate for Payer: NAPHCARE Commercial |
$13.80
|
| Rate for Payer: Preferred Network Access Commercial |
$21.16
|
| Rate for Payer: Quartz Beloit One Network |
$11.27
|
| Rate for Payer: Quartz Commercial |
$13.80
|
| Rate for Payer: WEA Trust Commercial |
$12.65
|
| Rate for Payer: WPS Commercial |
$17.04
|
|
|
Serotype 12
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
CPT 86317
|
| Hospital Charge Code |
2943005
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.27 |
| Max. Negotiated Rate |
$59.96 |
| Rate for Payer: Aetna Commercial |
$20.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$19.78
|
| Rate for Payer: Aetna Managed Medicare |
$14.99
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$56.21
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$26.23
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$24.88
|
| Rate for Payer: Anthem Medicaid |
$15.49
|
| Rate for Payer: Anthem Medicare Advantage |
$14.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$12.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$14.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$14.99
|
| Rate for Payer: Cash Price |
$6.90
|
| Rate for Payer: Cash Price |
$6.90
|
| Rate for Payer: Cigna Commercial |
$21.16
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$14.99
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$15.49
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12.87
|
| Rate for Payer: Dean Health Medicaid |
$15.49
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$14.99
|
| Rate for Payer: Health EOS Commercial |
$20.47
|
| Rate for Payer: HFN Commercial |
$21.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$55.76
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$14.99
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$15.49
|
| Rate for Payer: Independent Care Health Plan Medicare |
$14.99
|
| Rate for Payer: Managed Health Services Medicaid |
$16.11
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$14.99
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$14.99
|
| Rate for Payer: Multiplan Commercial |
$18.40
|
| Rate for Payer: NAPHCARE Commercial |
$22.48
|
| Rate for Payer: Preferred Network Access Commercial |
$21.16
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$15.49
|
| Rate for Payer: Quartz Beloit One Network |
$11.27
|
| Rate for Payer: Quartz Commercial |
$14.95
|
| Rate for Payer: Quartz Medicare Advantage |
$14.99
|
| Rate for Payer: The Alliance Commercial |
$59.96
|
| Rate for Payer: United Healthcare Medicaid |
$15.49
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14.99
|
| Rate for Payer: United Healthcare PPO |
$17.25
|
| Rate for Payer: WEA Trust Commercial |
$12.65
|
| Rate for Payer: Wellcare Medicare |
$14.99
|
| Rate for Payer: WMAP Medicaid |
$15.49
|
| Rate for Payer: WPS Commercial |
$17.04
|
|
|
Serotype 12
|
Professional
|
Both
|
$23.00
|
|
|
Service Code
|
CPT 86317
|
| Hospital Charge Code |
2943005
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.12 |
| Max. Negotiated Rate |
$52.91 |
| Rate for Payer: Aetna Commercial |
$21.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$19.78
|
| Rate for Payer: Cash Price |
$6.90
|
| Rate for Payer: Cash Price |
$6.90
|
| Rate for Payer: Cigna Commercial |
$21.85
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$11.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$13.80
|
| Rate for Payer: Health EOS Commercial |
$20.93
|
| Rate for Payer: HFN Commercial |
$21.85
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$52.91
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$52.91
|
| Rate for Payer: Multiplan Commercial |
$18.40
|
| Rate for Payer: Preferred Network Access Commercial |
$21.85
|
| Rate for Payer: Quartz Beloit One Network |
$10.12
|
| Rate for Payer: Quartz Commercial |
$13.11
|
| Rate for Payer: The Alliance Commercial |
$11.50
|
| Rate for Payer: WEA Trust Commercial |
$12.65
|
| Rate for Payer: WPS Commercial |
$17.04
|
|
|
Serotype 14
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
CPT 86317
|
| Hospital Charge Code |
2943006
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.27 |
| Max. Negotiated Rate |
$59.96 |
| Rate for Payer: Aetna Commercial |
$20.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$19.78
|
| Rate for Payer: Aetna Managed Medicare |
$14.99
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$56.21
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$26.23
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$24.88
|
| Rate for Payer: Anthem Medicaid |
$15.49
|
| Rate for Payer: Anthem Medicare Advantage |
$14.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$12.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$14.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$14.99
|
| Rate for Payer: Cash Price |
$6.90
|
| Rate for Payer: Cash Price |
$6.90
|
| Rate for Payer: Cigna Commercial |
$21.16
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$14.99
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$15.49
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12.87
|
| Rate for Payer: Dean Health Medicaid |
$15.49
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$14.99
|
| Rate for Payer: Health EOS Commercial |
$20.47
|
| Rate for Payer: HFN Commercial |
$21.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$55.76
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$14.99
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$15.49
|
| Rate for Payer: Independent Care Health Plan Medicare |
$14.99
|
| Rate for Payer: Managed Health Services Medicaid |
$16.11
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$14.99
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$14.99
|
| Rate for Payer: Multiplan Commercial |
$18.40
|
| Rate for Payer: NAPHCARE Commercial |
$22.48
|
| Rate for Payer: Preferred Network Access Commercial |
$21.16
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$15.49
|
| Rate for Payer: Quartz Beloit One Network |
$11.27
|
| Rate for Payer: Quartz Commercial |
$14.95
|
| Rate for Payer: Quartz Medicare Advantage |
$14.99
|
| Rate for Payer: The Alliance Commercial |
$59.96
|
| Rate for Payer: United Healthcare Medicaid |
$15.49
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14.99
|
| Rate for Payer: United Healthcare PPO |
$17.25
|
| Rate for Payer: WEA Trust Commercial |
$12.65
|
| Rate for Payer: Wellcare Medicare |
$14.99
|
| Rate for Payer: WMAP Medicaid |
$15.49
|
| Rate for Payer: WPS Commercial |
$17.04
|
|
|
Serotype 14
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
CPT 86317
|
| Hospital Charge Code |
2943006
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.27 |
| Max. Negotiated Rate |
$21.16 |
| Rate for Payer: Aetna Commercial |
$20.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$19.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$12.19
|
| Rate for Payer: Cash Price |
$6.90
|
| Rate for Payer: Cigna Commercial |
$21.16
|
| Rate for Payer: Health EOS Commercial |
$20.47
|
| Rate for Payer: HFN Commercial |
$21.16
|
| Rate for Payer: Multiplan Commercial |
$18.40
|
| Rate for Payer: NAPHCARE Commercial |
$13.80
|
| Rate for Payer: Preferred Network Access Commercial |
$21.16
|
| Rate for Payer: Quartz Beloit One Network |
$11.27
|
| Rate for Payer: Quartz Commercial |
$13.80
|
| Rate for Payer: WEA Trust Commercial |
$12.65
|
| Rate for Payer: WPS Commercial |
$17.04
|
|
|
Serotype 14
|
Professional
|
Both
|
$23.00
|
|
|
Service Code
|
CPT 86317
|
| Hospital Charge Code |
2943006
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.12 |
| Max. Negotiated Rate |
$52.91 |
| Rate for Payer: Aetna Commercial |
$21.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$19.78
|
| Rate for Payer: Cash Price |
$6.90
|
| Rate for Payer: Cash Price |
$6.90
|
| Rate for Payer: Cigna Commercial |
$21.85
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$11.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$13.80
|
| Rate for Payer: Health EOS Commercial |
$20.93
|
| Rate for Payer: HFN Commercial |
$21.85
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$52.91
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$52.91
|
| Rate for Payer: Multiplan Commercial |
$18.40
|
| Rate for Payer: Preferred Network Access Commercial |
$21.85
|
| Rate for Payer: Quartz Beloit One Network |
$10.12
|
| Rate for Payer: Quartz Commercial |
$13.11
|
| Rate for Payer: The Alliance Commercial |
$11.50
|
| Rate for Payer: WEA Trust Commercial |
$12.65
|
| Rate for Payer: WPS Commercial |
$17.04
|
|
|
Serotype 19
|
Professional
|
Both
|
$23.00
|
|
|
Service Code
|
CPT 86317
|
| Hospital Charge Code |
2943007
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.12 |
| Max. Negotiated Rate |
$52.91 |
| Rate for Payer: Aetna Commercial |
$21.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$19.78
|
| Rate for Payer: Cash Price |
$6.90
|
| Rate for Payer: Cash Price |
$6.90
|
| Rate for Payer: Cigna Commercial |
$21.85
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$11.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$13.80
|
| Rate for Payer: Health EOS Commercial |
$20.93
|
| Rate for Payer: HFN Commercial |
$21.85
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$52.91
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$52.91
|
| Rate for Payer: Multiplan Commercial |
$18.40
|
| Rate for Payer: Preferred Network Access Commercial |
$21.85
|
| Rate for Payer: Quartz Beloit One Network |
$10.12
|
| Rate for Payer: Quartz Commercial |
$13.11
|
| Rate for Payer: The Alliance Commercial |
$11.50
|
| Rate for Payer: WEA Trust Commercial |
$12.65
|
| Rate for Payer: WPS Commercial |
$17.04
|
|
