|
Tc-99m Sestamibi
|
Facility
|
OP
|
$397.00
|
|
|
Service Code
|
HCPCS A9500
|
| Hospital Charge Code |
5381841
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$115.61 |
| Max. Negotiated Rate |
$379.85 |
| Rate for Payer: Aetna Commercial |
$371.59
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$355.08
|
| Rate for Payer: Aetna Managed Medicare |
$115.61
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$268.37
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$206.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$198.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$218.83
|
| Rate for Payer: Cash Price |
$119.10
|
| Rate for Payer: Cigna Commercial |
$379.85
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$231.05
|
| Rate for Payer: Health EOS Commercial |
$367.46
|
| Rate for Payer: HFN Commercial |
$379.85
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$309.66
|
| Rate for Payer: Multiplan Commercial |
$330.30
|
| Rate for Payer: NAPHCARE Commercial |
$247.73
|
| Rate for Payer: Preferred Network Access Commercial |
$379.85
|
| Rate for Payer: Quartz Beloit One Network |
$202.31
|
| Rate for Payer: Quartz Commercial |
$268.37
|
| Rate for Payer: Quartz Medicare Advantage |
$247.73
|
| Rate for Payer: The Alliance Commercial |
$206.44
|
| Rate for Payer: WEA Trust Commercial |
$227.08
|
| Rate for Payer: WPS Commercial |
$305.81
|
|
|
Tc-99m Sulfur Colloid
|
Facility
|
IP
|
$84.00
|
|
|
Service Code
|
HCPCS A9541
|
| Hospital Charge Code |
1486850
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$42.81 |
| Max. Negotiated Rate |
$80.37 |
| Rate for Payer: Aetna Commercial |
$78.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$75.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$46.30
|
| Rate for Payer: Cash Price |
$25.20
|
| Rate for Payer: Cigna Commercial |
$80.37
|
| Rate for Payer: Health EOS Commercial |
$77.75
|
| Rate for Payer: HFN Commercial |
$80.37
|
| Rate for Payer: Multiplan Commercial |
$69.89
|
| Rate for Payer: Preferred Network Access Commercial |
$80.37
|
| Rate for Payer: Quartz Beloit One Network |
$42.81
|
| Rate for Payer: Quartz Commercial |
$52.42
|
| Rate for Payer: WEA Trust Commercial |
$48.05
|
| Rate for Payer: WPS Commercial |
$64.71
|
|
|
Tc-99m Sulfur Colloid
|
Facility
|
OP
|
$84.00
|
|
|
Service Code
|
HCPCS A9541
|
| Hospital Charge Code |
1486850
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$24.46 |
| Max. Negotiated Rate |
$80.37 |
| Rate for Payer: Aetna Commercial |
$78.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$75.13
|
| Rate for Payer: Aetna Managed Medicare |
$24.46
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$56.78
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$43.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$41.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$46.30
|
| Rate for Payer: Cash Price |
$25.20
|
| Rate for Payer: Cigna Commercial |
$80.37
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$48.89
|
| Rate for Payer: Health EOS Commercial |
$77.75
|
| Rate for Payer: HFN Commercial |
$80.37
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$65.52
|
| Rate for Payer: Multiplan Commercial |
$69.89
|
| Rate for Payer: NAPHCARE Commercial |
$52.42
|
| Rate for Payer: Preferred Network Access Commercial |
$80.37
|
| Rate for Payer: Quartz Beloit One Network |
$42.81
|
| Rate for Payer: Quartz Commercial |
$56.78
|
| Rate for Payer: Quartz Medicare Advantage |
$52.42
|
| Rate for Payer: The Alliance Commercial |
$43.68
|
| Rate for Payer: WEA Trust Commercial |
$48.05
|
| Rate for Payer: WPS Commercial |
$64.71
|
|
|
Tc-99m Sulfur Colloid
|
Professional
|
Both
|
$84.00
|
|
|
Service Code
|
HCPCS A9541
|
| Hospital Charge Code |
1486850
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$38.44 |
| Max. Negotiated Rate |
$487.17 |
| Rate for Payer: Aetna Commercial |
$82.99
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$75.13
|
| Rate for Payer: Cash Price |
$25.20
|
| Rate for Payer: Cash Price |
$25.20
|
| Rate for Payer: Cigna Commercial |
$82.99
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$44.26
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$52.42
|
| Rate for Payer: Health EOS Commercial |
$79.50
|
| Rate for Payer: HFN Commercial |
$82.99
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$487.17
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$487.17
|
| Rate for Payer: Multiplan Commercial |
$69.89
|
| Rate for Payer: Preferred Network Access Commercial |
$82.99
|
| Rate for Payer: Quartz Beloit One Network |
$38.44
|
| Rate for Payer: Quartz Commercial |
$49.80
|
| Rate for Payer: The Alliance Commercial |
$43.68
|
| Rate for Payer: United Healthcare Medicaid |
$44.26
|
| Rate for Payer: WEA Trust Commercial |
$48.05
|
| Rate for Payer: WPS Commercial |
$64.71
|
|
|
T candidus
|
Professional
|
Both
|
$105.00
|
|
|
Service Code
|
CPT 86609
|
| Hospital Charge Code |
2942920
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.40 |
| Max. Negotiated Rate |
$103.74 |
| Rate for Payer: Aetna Commercial |
$103.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$93.91
|
| Rate for Payer: Aetna Managed Medicare |
$13.40
|
| Rate for Payer: Anthem Medicare Advantage |
$13.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$13.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$13.40
|
| Rate for Payer: Cash Price |
$31.50
|
| Rate for Payer: Cash Price |
$31.50
|
| Rate for Payer: Cigna Commercial |
$103.74
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$54.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$13.40
|
| Rate for Payer: Health EOS Commercial |
$99.37
|
| Rate for Payer: HFN Commercial |
$103.74
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$47.29
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$47.29
|
| Rate for Payer: Independent Care Health Plan Medicare |
$13.40
|
| Rate for Payer: Multiplan Commercial |
$87.36
|
| Rate for Payer: NAPHCARE Commercial |
$20.09
|
| Rate for Payer: Preferred Network Access Commercial |
$103.74
|
| Rate for Payer: Quartz Beloit One Network |
$48.05
|
| Rate for Payer: Quartz Commercial |
$62.24
|
| Rate for Payer: Quartz Medicare Advantage |
$13.40
|
| Rate for Payer: The Alliance Commercial |
$52.91
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.40
|
| Rate for Payer: WEA Trust Commercial |
$60.06
|
| Rate for Payer: WPS Commercial |
$58.94
|
|
|
T candidus
|
Facility
|
OP
|
$105.00
|
|
|
Service Code
|
CPT 86609
|
| Hospital Charge Code |
2942920
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.40 |
| Max. Negotiated Rate |
$100.46 |
| Rate for Payer: Aetna Commercial |
$98.28
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$93.91
|
| Rate for Payer: Aetna Managed Medicare |
$13.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$50.23
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$23.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$22.24
|
| Rate for Payer: Anthem Medicare Advantage |
$13.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$57.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$13.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$13.40
|
| Rate for Payer: Cash Price |
$31.50
|
| Rate for Payer: Cash Price |
$31.50
|
| Rate for Payer: Cigna Commercial |
$100.46
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$13.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$61.11
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$13.40
|
| Rate for Payer: Health EOS Commercial |
$97.19
|
| Rate for Payer: HFN Commercial |
$100.46
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$49.83
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$13.40
|
| Rate for Payer: Independent Care Health Plan Medicare |
$13.40
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$13.40
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$13.40
|
| Rate for Payer: Multiplan Commercial |
$87.36
|
| Rate for Payer: NAPHCARE Commercial |
$20.09
|
| Rate for Payer: Preferred Network Access Commercial |
$100.46
|
| Rate for Payer: Quartz Beloit One Network |
$53.51
|
| Rate for Payer: Quartz Commercial |
$70.98
|
| Rate for Payer: Quartz Medicare Advantage |
$13.40
|
| Rate for Payer: The Alliance Commercial |
$53.58
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.40
|
| Rate for Payer: United Healthcare PPO |
$81.90
|
| Rate for Payer: WEA Trust Commercial |
$60.06
|
| Rate for Payer: Wellcare Medicare |
$13.40
|
| Rate for Payer: WPS Commercial |
$80.88
|
|
|
T candidus
|
Facility
|
IP
|
$105.00
|
|
|
Service Code
|
CPT 86609
|
| Hospital Charge Code |
2942920
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$53.51 |
| Max. Negotiated Rate |
$100.46 |
| Rate for Payer: Aetna Commercial |
$98.28
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$93.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$57.88
|
| Rate for Payer: Cash Price |
$31.50
|
| Rate for Payer: Cigna Commercial |
$100.46
|
| Rate for Payer: Health EOS Commercial |
$97.19
|
| Rate for Payer: HFN Commercial |
$100.46
|
| Rate for Payer: Multiplan Commercial |
$87.36
|
| Rate for Payer: Preferred Network Access Commercial |
$100.46
|
| Rate for Payer: Quartz Beloit One Network |
$53.51
|
| Rate for Payer: Quartz Commercial |
$65.52
|
| Rate for Payer: WEA Trust Commercial |
$60.06
|
| Rate for Payer: WPS Commercial |
$80.88
|
|
|
T Cell Gene Receptor
|
Facility
|
OP
|
$248.00
|
|
|
Service Code
|
CPT 81342
|
| Hospital Charge Code |
4444793
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$126.38 |
| Max. Negotiated Rate |
$838.24 |
| Rate for Payer: Aetna Commercial |
$232.13
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$221.81
|
| Rate for Payer: Aetna Managed Medicare |
$209.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$785.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$366.73
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$347.87
|
| Rate for Payer: Anthem Medicare Advantage |
$209.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$136.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$209.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$209.56
|
| Rate for Payer: Cash Price |
$74.40
|
| Rate for Payer: Cash Price |
$74.40
|
| Rate for Payer: Cigna Commercial |
$237.29
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$209.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$144.34
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$209.56
|
| Rate for Payer: Health EOS Commercial |
$229.55
|
| Rate for Payer: HFN Commercial |
$237.29
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$779.56
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$209.56
|
| Rate for Payer: Independent Care Health Plan Medicare |
$209.56
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$209.56
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$209.56
|
| Rate for Payer: Multiplan Commercial |
$206.34
|
| Rate for Payer: NAPHCARE Commercial |
$314.34
|
| Rate for Payer: Preferred Network Access Commercial |
$237.29
|
| Rate for Payer: Quartz Beloit One Network |
$126.38
|
| Rate for Payer: Quartz Commercial |
$167.65
|
| Rate for Payer: Quartz Medicare Advantage |
$209.56
|
| Rate for Payer: The Alliance Commercial |
$838.24
|
| Rate for Payer: United Healthcare Medicare Advantage |
$209.56
|
| Rate for Payer: United Healthcare PPO |
$193.44
|
| Rate for Payer: WEA Trust Commercial |
$141.86
|
| Rate for Payer: Wellcare Medicare |
$209.56
|
| Rate for Payer: WPS Commercial |
$191.03
|
|
|
T Cell Gene Receptor
|
Professional
|
Both
|
$248.00
|
|
|
Service Code
|
CPT 81342
|
| Hospital Charge Code |
4444793
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$113.48 |
| Max. Negotiated Rate |
$922.06 |
| Rate for Payer: Aetna Commercial |
$245.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$221.81
|
| Rate for Payer: Aetna Managed Medicare |
$209.56
|
| Rate for Payer: Anthem Medicare Advantage |
$209.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$209.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$209.56
|
| Rate for Payer: Cash Price |
$74.40
|
| Rate for Payer: Cash Price |
$74.40
|
| Rate for Payer: Cigna Commercial |
$245.02
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$128.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$209.56
|
| Rate for Payer: Health EOS Commercial |
$234.71
|
| Rate for Payer: HFN Commercial |
$245.02
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$739.75
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$739.75
|
| Rate for Payer: Independent Care Health Plan Medicare |
$209.56
|
| Rate for Payer: Multiplan Commercial |
$206.34
|
| Rate for Payer: NAPHCARE Commercial |
$314.34
|
| Rate for Payer: Preferred Network Access Commercial |
$245.02
|
| Rate for Payer: Quartz Beloit One Network |
$113.48
|
| Rate for Payer: Quartz Commercial |
$147.01
|
| Rate for Payer: Quartz Medicare Advantage |
$209.56
|
| Rate for Payer: The Alliance Commercial |
$827.76
|
| Rate for Payer: United Healthcare Medicare Advantage |
$209.56
|
| Rate for Payer: WEA Trust Commercial |
$141.86
|
| Rate for Payer: WPS Commercial |
$922.06
|
|
|
T Cell Gene Receptor
|
Facility
|
IP
|
$248.00
|
|
|
Service Code
|
CPT 81342
|
| Hospital Charge Code |
4444793
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$126.38 |
| Max. Negotiated Rate |
$237.29 |
| Rate for Payer: Aetna Commercial |
$232.13
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$221.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$136.70
|
| Rate for Payer: Cash Price |
$74.40
|
| Rate for Payer: Cigna Commercial |
$237.29
|
| Rate for Payer: Health EOS Commercial |
$229.55
|
| Rate for Payer: HFN Commercial |
$237.29
|
| Rate for Payer: Multiplan Commercial |
$206.34
|
| Rate for Payer: Preferred Network Access Commercial |
$237.29
|
| Rate for Payer: Quartz Beloit One Network |
$126.38
|
| Rate for Payer: Quartz Commercial |
$154.75
|
| Rate for Payer: WEA Trust Commercial |
$141.86
|
| Rate for Payer: WPS Commercial |
$191.03
|
|
|
TCM < 14 Days 99495
|
Professional
|
Both
|
$314.00
|
|
|
Service Code
|
CPT 99495
|
| Hospital Charge Code |
3096919
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$121.57 |
| Max. Negotiated Rate |
$508.57 |
| Rate for Payer: Aetna Commercial |
$310.23
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$280.84
|
| Rate for Payer: Aetna Managed Medicare |
$121.57
|
| Rate for Payer: Anthem Medicare Advantage |
$121.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$121.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$121.57
|
| Rate for Payer: Cash Price |
$94.20
|
| Rate for Payer: Cash Price |
$94.20
|
| Rate for Payer: Cash Price |
$94.20
|
| Rate for Payer: Cigna Commercial |
$310.23
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$163.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$121.57
|
| Rate for Payer: Health EOS Commercial |
$297.17
|
| Rate for Payer: HFN Commercial |
$310.23
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$508.57
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$508.57
|
| Rate for Payer: Independent Care Health Plan Medicare |
$121.57
|
| Rate for Payer: Multiplan Commercial |
$261.25
|
| Rate for Payer: NAPHCARE Commercial |
$182.35
|
| Rate for Payer: Preferred Network Access Commercial |
$310.23
|
| Rate for Payer: Quartz Beloit One Network |
$143.69
|
| Rate for Payer: Quartz Commercial |
$186.14
|
| Rate for Payer: Quartz Medicare Advantage |
$121.57
|
| Rate for Payer: The Alliance Commercial |
$291.76
|
| Rate for Payer: United Healthcare Medicare Advantage |
$121.57
|
| Rate for Payer: WEA Trust Commercial |
$179.61
|
| Rate for Payer: WPS Commercial |
$334.31
|
|
|
TCM < 14 days 99495RVU
|
Professional
|
Both
|
$314.00
|
|
|
Service Code
|
CPT 99495
|
| Hospital Charge Code |
4512594
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$121.57 |
| Max. Negotiated Rate |
$508.57 |
| Rate for Payer: Aetna Commercial |
$310.23
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$280.84
|
| Rate for Payer: Aetna Managed Medicare |
$121.57
|
| Rate for Payer: Anthem Medicare Advantage |
$121.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$121.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$121.57
|
| Rate for Payer: Cash Price |
$94.20
|
| Rate for Payer: Cash Price |
$94.20
|
| Rate for Payer: Cash Price |
$94.20
|
| Rate for Payer: Cigna Commercial |
$310.23
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$163.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$121.57
|
| Rate for Payer: Health EOS Commercial |
$297.17
|
| Rate for Payer: HFN Commercial |
$310.23
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$508.57
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$508.57
|
| Rate for Payer: Independent Care Health Plan Medicare |
$121.57
|
| Rate for Payer: Multiplan Commercial |
$261.25
|
| Rate for Payer: NAPHCARE Commercial |
$182.35
|
| Rate for Payer: Preferred Network Access Commercial |
$310.23
|
| Rate for Payer: Quartz Beloit One Network |
$143.69
|
| Rate for Payer: Quartz Commercial |
$186.14
|
| Rate for Payer: Quartz Medicare Advantage |
$121.57
|
| Rate for Payer: The Alliance Commercial |
$291.76
|
| Rate for Payer: United Healthcare Medicare Advantage |
$121.57
|
| Rate for Payer: WEA Trust Commercial |
$179.61
|
| Rate for Payer: WPS Commercial |
$334.31
|
|
|
TCM < 7 Days 99496
|
Professional
|
Both
|
$364.00
|
|
|
Service Code
|
CPT 99496
|
| Hospital Charge Code |
3096918
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$165.84 |
| Max. Negotiated Rate |
$692.13 |
| Rate for Payer: Aetna Commercial |
$359.63
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$325.56
|
| Rate for Payer: Aetna Managed Medicare |
$165.84
|
| Rate for Payer: Anthem Medicare Advantage |
$165.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$165.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$165.84
|
| Rate for Payer: Cash Price |
$109.20
|
| Rate for Payer: Cash Price |
$109.20
|
| Rate for Payer: Cash Price |
$109.20
|
| Rate for Payer: Cigna Commercial |
$359.63
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$189.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$165.84
|
| Rate for Payer: Health EOS Commercial |
$344.49
|
| Rate for Payer: HFN Commercial |
$359.63
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$692.13
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$692.13
|
| Rate for Payer: Independent Care Health Plan Medicare |
$165.84
|
| Rate for Payer: Multiplan Commercial |
$302.85
|
| Rate for Payer: NAPHCARE Commercial |
$248.76
|
| Rate for Payer: Preferred Network Access Commercial |
$359.63
|
| Rate for Payer: Quartz Beloit One Network |
$166.57
|
| Rate for Payer: Quartz Commercial |
$215.78
|
| Rate for Payer: Quartz Medicare Advantage |
$165.84
|
| Rate for Payer: The Alliance Commercial |
$398.01
|
| Rate for Payer: United Healthcare Medicare Advantage |
$165.84
|
| Rate for Payer: WEA Trust Commercial |
$208.21
|
| Rate for Payer: WPS Commercial |
$456.06
|
|
|
TCM < 7 Days 99496RVU
|
Professional
|
Both
|
$364.00
|
|
|
Service Code
|
CPT 99496
|
| Hospital Charge Code |
4512595
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$165.84 |
| Max. Negotiated Rate |
$692.13 |
| Rate for Payer: Aetna Commercial |
$359.63
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$325.56
|
| Rate for Payer: Aetna Managed Medicare |
$165.84
|
| Rate for Payer: Anthem Medicare Advantage |
$165.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$165.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$165.84
|
| Rate for Payer: Cash Price |
$109.20
|
| Rate for Payer: Cash Price |
$109.20
|
| Rate for Payer: Cash Price |
$109.20
|
| Rate for Payer: Cigna Commercial |
$359.63
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$189.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$165.84
|
| Rate for Payer: Health EOS Commercial |
$344.49
|
| Rate for Payer: HFN Commercial |
$359.63
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$692.13
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$692.13
|
| Rate for Payer: Independent Care Health Plan Medicare |
$165.84
|
| Rate for Payer: Multiplan Commercial |
$302.85
|
| Rate for Payer: NAPHCARE Commercial |
$248.76
|
| Rate for Payer: Preferred Network Access Commercial |
$359.63
|
| Rate for Payer: Quartz Beloit One Network |
$166.57
|
| Rate for Payer: Quartz Commercial |
$215.78
|
| Rate for Payer: Quartz Medicare Advantage |
$165.84
|
| Rate for Payer: The Alliance Commercial |
$398.01
|
| Rate for Payer: United Healthcare Medicare Advantage |
$165.84
|
| Rate for Payer: WEA Trust Commercial |
$208.21
|
| Rate for Payer: WPS Commercial |
$456.06
|
|
|
TCRB Result
|
Facility
|
OP
|
$694.00
|
|
|
Service Code
|
CPT 81340
|
| Hospital Charge Code |
4498644
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$217.28 |
| Max. Negotiated Rate |
$869.11 |
| Rate for Payer: Aetna Commercial |
$649.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$620.71
|
| Rate for Payer: Aetna Managed Medicare |
$217.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$814.79
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$380.23
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$360.68
|
| Rate for Payer: Anthem Medicare Advantage |
$217.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$382.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$217.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$217.28
|
| Rate for Payer: Cash Price |
$208.20
|
| Rate for Payer: Cash Price |
$208.20
|
| Rate for Payer: Cigna Commercial |
$664.02
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$217.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$403.91
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$217.28
|
| Rate for Payer: Health EOS Commercial |
$642.37
|
| Rate for Payer: HFN Commercial |
$664.02
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$808.27
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$217.28
|
| Rate for Payer: Independent Care Health Plan Medicare |
$217.28
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$217.28
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$217.28
|
| Rate for Payer: Multiplan Commercial |
$577.41
|
| Rate for Payer: NAPHCARE Commercial |
$325.92
|
| Rate for Payer: Preferred Network Access Commercial |
$664.02
|
| Rate for Payer: Quartz Beloit One Network |
$353.66
|
| Rate for Payer: Quartz Commercial |
$469.14
|
| Rate for Payer: Quartz Medicare Advantage |
$217.28
|
| Rate for Payer: The Alliance Commercial |
$869.11
|
| Rate for Payer: United Healthcare Medicare Advantage |
$217.28
|
| Rate for Payer: United Healthcare PPO |
$541.32
|
| Rate for Payer: WEA Trust Commercial |
$396.97
|
| Rate for Payer: Wellcare Medicare |
$217.28
|
| Rate for Payer: WPS Commercial |
$534.59
|
|
|
TCRB Result
|
Facility
|
IP
|
$694.00
|
|
|
Service Code
|
CPT 81340
|
| Hospital Charge Code |
4498644
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$353.66 |
| Max. Negotiated Rate |
$664.02 |
| Rate for Payer: Aetna Commercial |
$649.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$620.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$382.53
|
| Rate for Payer: Cash Price |
$208.20
|
| Rate for Payer: Cigna Commercial |
$664.02
|
| Rate for Payer: Health EOS Commercial |
$642.37
|
| Rate for Payer: HFN Commercial |
$664.02
|
| Rate for Payer: Multiplan Commercial |
$577.41
|
| Rate for Payer: Preferred Network Access Commercial |
$664.02
|
| Rate for Payer: Quartz Beloit One Network |
$353.66
|
| Rate for Payer: Quartz Commercial |
$433.06
|
| Rate for Payer: WEA Trust Commercial |
$396.97
|
| Rate for Payer: WPS Commercial |
$534.59
|
|
|
TCRB Result
|
Professional
|
Both
|
$694.00
|
|
|
Service Code
|
CPT 81340
|
| Hospital Charge Code |
4498644
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$217.28 |
| Max. Negotiated Rate |
$956.02 |
| Rate for Payer: Aetna Commercial |
$685.67
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$620.71
|
| Rate for Payer: Aetna Managed Medicare |
$217.28
|
| Rate for Payer: Anthem Medicare Advantage |
$217.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$217.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$217.28
|
| Rate for Payer: Cash Price |
$208.20
|
| Rate for Payer: Cash Price |
$208.20
|
| Rate for Payer: Cigna Commercial |
$685.67
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$360.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$217.28
|
| Rate for Payer: Health EOS Commercial |
$656.80
|
| Rate for Payer: HFN Commercial |
$685.67
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$766.99
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$766.99
|
| Rate for Payer: Independent Care Health Plan Medicare |
$217.28
|
| Rate for Payer: Multiplan Commercial |
$577.41
|
| Rate for Payer: NAPHCARE Commercial |
$325.92
|
| Rate for Payer: Preferred Network Access Commercial |
$685.67
|
| Rate for Payer: Quartz Beloit One Network |
$317.57
|
| Rate for Payer: Quartz Commercial |
$411.40
|
| Rate for Payer: Quartz Medicare Advantage |
$217.28
|
| Rate for Payer: The Alliance Commercial |
$858.24
|
| Rate for Payer: United Healthcare Medicare Advantage |
$217.28
|
| Rate for Payer: WEA Trust Commercial |
$396.97
|
| Rate for Payer: WPS Commercial |
$956.02
|
|
|
TCRG Result
|
Facility
|
OP
|
$694.00
|
|
|
Service Code
|
CPT 81342
|
| Hospital Charge Code |
4498643
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$209.56 |
| Max. Negotiated Rate |
$838.24 |
| Rate for Payer: Aetna Commercial |
$649.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$620.71
|
| Rate for Payer: Aetna Managed Medicare |
$209.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$785.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$366.73
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$347.87
|
| Rate for Payer: Anthem Medicare Advantage |
$209.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$382.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$209.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$209.56
|
| Rate for Payer: Cash Price |
$208.20
|
| Rate for Payer: Cash Price |
$208.20
|
| Rate for Payer: Cigna Commercial |
$664.02
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$209.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$403.91
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$209.56
|
| Rate for Payer: Health EOS Commercial |
$642.37
|
| Rate for Payer: HFN Commercial |
$664.02
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$779.56
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$209.56
|
| Rate for Payer: Independent Care Health Plan Medicare |
$209.56
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$209.56
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$209.56
|
| Rate for Payer: Multiplan Commercial |
$577.41
|
| Rate for Payer: NAPHCARE Commercial |
$314.34
|
| Rate for Payer: Preferred Network Access Commercial |
$664.02
|
| Rate for Payer: Quartz Beloit One Network |
$353.66
|
| Rate for Payer: Quartz Commercial |
$469.14
|
| Rate for Payer: Quartz Medicare Advantage |
$209.56
|
| Rate for Payer: The Alliance Commercial |
$838.24
|
| Rate for Payer: United Healthcare Medicare Advantage |
$209.56
|
| Rate for Payer: United Healthcare PPO |
$541.32
|
| Rate for Payer: WEA Trust Commercial |
$396.97
|
| Rate for Payer: Wellcare Medicare |
$209.56
|
| Rate for Payer: WPS Commercial |
$534.59
|
|
|
TCRG Result
|
Professional
|
Both
|
$694.00
|
|
|
Service Code
|
CPT 81342
|
| Hospital Charge Code |
4498643
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$209.56 |
| Max. Negotiated Rate |
$922.06 |
| Rate for Payer: Aetna Commercial |
$685.67
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$620.71
|
| Rate for Payer: Aetna Managed Medicare |
$209.56
|
| Rate for Payer: Anthem Medicare Advantage |
$209.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$209.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$209.56
|
| Rate for Payer: Cash Price |
$208.20
|
| Rate for Payer: Cash Price |
$208.20
|
| Rate for Payer: Cigna Commercial |
$685.67
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$360.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$209.56
|
| Rate for Payer: Health EOS Commercial |
$656.80
|
| Rate for Payer: HFN Commercial |
$685.67
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$739.75
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$739.75
|
| Rate for Payer: Independent Care Health Plan Medicare |
$209.56
|
| Rate for Payer: Multiplan Commercial |
$577.41
|
| Rate for Payer: NAPHCARE Commercial |
$314.34
|
| Rate for Payer: Preferred Network Access Commercial |
$685.67
|
| Rate for Payer: Quartz Beloit One Network |
$317.57
|
| Rate for Payer: Quartz Commercial |
$411.40
|
| Rate for Payer: Quartz Medicare Advantage |
$209.56
|
| Rate for Payer: The Alliance Commercial |
$827.76
|
| Rate for Payer: United Healthcare Medicare Advantage |
$209.56
|
| Rate for Payer: WEA Trust Commercial |
$396.97
|
| Rate for Payer: WPS Commercial |
$922.06
|
|
|
TCRG Result
|
Facility
|
IP
|
$694.00
|
|
|
Service Code
|
CPT 81342
|
| Hospital Charge Code |
4498643
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$353.66 |
| Max. Negotiated Rate |
$664.02 |
| Rate for Payer: Aetna Commercial |
$649.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$620.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$382.53
|
| Rate for Payer: Cash Price |
$208.20
|
| Rate for Payer: Cigna Commercial |
$664.02
|
| Rate for Payer: Health EOS Commercial |
$642.37
|
| Rate for Payer: HFN Commercial |
$664.02
|
| Rate for Payer: Multiplan Commercial |
$577.41
|
| Rate for Payer: Preferred Network Access Commercial |
$664.02
|
| Rate for Payer: Quartz Beloit One Network |
$353.66
|
| Rate for Payer: Quartz Commercial |
$433.06
|
| Rate for Payer: WEA Trust Commercial |
$396.97
|
| Rate for Payer: WPS Commercial |
$534.59
|
|
|
TDAP Vaccine > 7 IM 90715
|
Facility
|
OP
|
$93.00
|
|
|
Service Code
|
CPT 90715
|
| Hospital Charge Code |
3382847
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$27.08 |
| Max. Negotiated Rate |
$165.11 |
| Rate for Payer: Aetna Commercial |
$87.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$83.18
|
| Rate for Payer: Aetna Managed Medicare |
$27.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$62.87
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$48.36
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$46.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$51.26
|
| Rate for Payer: Cash Price |
$27.90
|
| Rate for Payer: Cash Price |
$27.90
|
| Rate for Payer: Cigna Commercial |
$88.98
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$53.78
|
| Rate for Payer: Health EOS Commercial |
$86.08
|
| Rate for Payer: HFN Commercial |
$88.98
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$72.54
|
| Rate for Payer: Multiplan Commercial |
$77.38
|
| Rate for Payer: NAPHCARE Commercial |
$58.03
|
| Rate for Payer: Preferred Network Access Commercial |
$88.98
|
| Rate for Payer: Quartz Beloit One Network |
$47.39
|
| Rate for Payer: Quartz Commercial |
$62.87
|
| Rate for Payer: Quartz Medicare Advantage |
$58.03
|
| Rate for Payer: The Alliance Commercial |
$165.11
|
| Rate for Payer: WEA Trust Commercial |
$53.20
|
| Rate for Payer: WPS Commercial |
$101.62
|
|
|
TDAP Vaccine > 7 IM 90715
|
Facility
|
IP
|
$93.00
|
|
|
Service Code
|
CPT 90715
|
| Hospital Charge Code |
3382847
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$47.39 |
| Max. Negotiated Rate |
$88.98 |
| Rate for Payer: Aetna Commercial |
$87.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$83.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$51.26
|
| Rate for Payer: Cash Price |
$27.90
|
| Rate for Payer: Cigna Commercial |
$88.98
|
| Rate for Payer: Health EOS Commercial |
$86.08
|
| Rate for Payer: HFN Commercial |
$88.98
|
| Rate for Payer: Multiplan Commercial |
$77.38
|
| Rate for Payer: Preferred Network Access Commercial |
$88.98
|
| Rate for Payer: Quartz Beloit One Network |
$47.39
|
| Rate for Payer: Quartz Commercial |
$58.03
|
| Rate for Payer: WEA Trust Commercial |
$53.20
|
| Rate for Payer: WPS Commercial |
$71.64
|
|
|
TDAP Vaccine > 7 IM 90715
|
Professional
|
Both
|
$93.00
|
|
|
Service Code
|
CPT 90715
|
| Hospital Charge Code |
3382847
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$40.65 |
| Max. Negotiated Rate |
$103.19 |
| Rate for Payer: Aetna Commercial |
$91.88
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$83.18
|
| Rate for Payer: Aetna Managed Medicare |
$41.28
|
| Rate for Payer: Anthem Medicare Advantage |
$41.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$41.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$41.28
|
| Rate for Payer: Cash Price |
$27.90
|
| Rate for Payer: Cash Price |
$27.90
|
| Rate for Payer: Cigna Commercial |
$91.88
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$51.17
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$40.65
|
| Rate for Payer: Health EOS Commercial |
$88.02
|
| Rate for Payer: HFN Commercial |
$91.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$50.44
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$50.44
|
| Rate for Payer: Independent Care Health Plan Medicare |
$41.28
|
| Rate for Payer: Multiplan Commercial |
$77.38
|
| Rate for Payer: NAPHCARE Commercial |
$61.92
|
| Rate for Payer: Preferred Network Access Commercial |
$91.88
|
| Rate for Payer: Quartz Beloit One Network |
$42.56
|
| Rate for Payer: Quartz Commercial |
$55.13
|
| Rate for Payer: Quartz Medicare Advantage |
$41.28
|
| Rate for Payer: The Alliance Commercial |
$103.19
|
| Rate for Payer: United Healthcare Medicaid |
$51.17
|
| Rate for Payer: United Healthcare Medicare Advantage |
$41.28
|
| Rate for Payer: WEA Trust Commercial |
$53.20
|
| Rate for Payer: WPS Commercial |
$101.62
|
|
|
TDAP Vaccine >7 IM 90715 VFC
|
Facility
|
IP
|
$20.83
|
|
|
Service Code
|
CPT 90715
|
| Hospital Charge Code |
5076614
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.61 |
| Max. Negotiated Rate |
$19.93 |
| Rate for Payer: Aetna Commercial |
$19.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$18.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$11.48
|
| Rate for Payer: Cash Price |
$6.25
|
| Rate for Payer: Cigna Commercial |
$19.93
|
| Rate for Payer: Health EOS Commercial |
$19.28
|
| Rate for Payer: HFN Commercial |
$19.93
|
| Rate for Payer: Multiplan Commercial |
$17.33
|
| Rate for Payer: Preferred Network Access Commercial |
$19.93
|
| Rate for Payer: Quartz Beloit One Network |
$10.61
|
| Rate for Payer: Quartz Commercial |
$13.00
|
| Rate for Payer: WEA Trust Commercial |
$11.91
|
| Rate for Payer: WPS Commercial |
$16.05
|
|
|
TDAP Vaccine >7 IM 90715 VFC
|
Professional
|
Both
|
$20.83
|
|
|
Service Code
|
CPT 90715
|
| Hospital Charge Code |
5076614
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.53 |
| Max. Negotiated Rate |
$103.19 |
| Rate for Payer: Aetna Commercial |
$20.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$18.63
|
| Rate for Payer: Aetna Managed Medicare |
$41.28
|
| Rate for Payer: Anthem Medicare Advantage |
$41.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$41.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$41.28
|
| Rate for Payer: Cash Price |
$6.25
|
| Rate for Payer: Cash Price |
$6.25
|
| Rate for Payer: Cigna Commercial |
$20.58
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$51.17
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$40.65
|
| Rate for Payer: Health EOS Commercial |
$19.71
|
| Rate for Payer: HFN Commercial |
$20.58
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$50.44
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$50.44
|
| Rate for Payer: Independent Care Health Plan Medicare |
$41.28
|
| Rate for Payer: Multiplan Commercial |
$17.33
|
| Rate for Payer: NAPHCARE Commercial |
$61.92
|
| Rate for Payer: Preferred Network Access Commercial |
$20.58
|
| Rate for Payer: Quartz Beloit One Network |
$9.53
|
| Rate for Payer: Quartz Commercial |
$12.35
|
| Rate for Payer: Quartz Medicare Advantage |
$41.28
|
| Rate for Payer: The Alliance Commercial |
$103.19
|
| Rate for Payer: United Healthcare Medicaid |
$51.17
|
| Rate for Payer: United Healthcare Medicare Advantage |
$41.28
|
| Rate for Payer: WEA Trust Commercial |
$11.91
|
| Rate for Payer: WPS Commercial |
$101.62
|
|
