|
Varicella-Zoster PCR Occular
|
Facility
|
IP
|
$370.00
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
6196143
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$181.30 |
| Max. Negotiated Rate |
$340.40 |
| Rate for Payer: Aetna Commercial |
$333.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$318.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$196.10
|
| Rate for Payer: Cash Price |
$111.00
|
| Rate for Payer: Cigna Commercial |
$340.40
|
| Rate for Payer: Health EOS Commercial |
$329.30
|
| Rate for Payer: HFN Commercial |
$340.40
|
| Rate for Payer: Multiplan Commercial |
$296.00
|
| Rate for Payer: NAPHCARE Commercial |
$222.00
|
| Rate for Payer: Preferred Network Access Commercial |
$340.40
|
| Rate for Payer: Quartz Beloit One Network |
$181.30
|
| Rate for Payer: Quartz Commercial |
$222.00
|
| Rate for Payer: WEA Trust Commercial |
$203.50
|
| Rate for Payer: WPS Commercial |
$274.06
|
|
|
Varicella-Zoster PCR Occular
|
Facility
|
OP
|
$370.00
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
6196143
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$35.09 |
| Max. Negotiated Rate |
$340.40 |
| Rate for Payer: Aetna Commercial |
$333.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$318.20
|
| Rate for Payer: Aetna Managed Medicare |
$35.09
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$131.59
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$61.41
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$58.25
|
| Rate for Payer: Anthem Medicaid |
$36.26
|
| Rate for Payer: Anthem Medicare Advantage |
$35.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$196.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$35.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$35.09
|
| Rate for Payer: Cash Price |
$111.00
|
| Rate for Payer: Cash Price |
$111.00
|
| Rate for Payer: Cigna Commercial |
$340.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$35.09
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$36.26
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$207.05
|
| Rate for Payer: Dean Health Medicaid |
$36.26
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$35.09
|
| Rate for Payer: Health EOS Commercial |
$329.30
|
| Rate for Payer: HFN Commercial |
$340.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$130.53
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$35.09
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$36.26
|
| Rate for Payer: Independent Care Health Plan Medicare |
$35.09
|
| Rate for Payer: Managed Health Services Medicaid |
$37.71
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$35.09
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$35.09
|
| Rate for Payer: Multiplan Commercial |
$296.00
|
| Rate for Payer: NAPHCARE Commercial |
$52.64
|
| Rate for Payer: Preferred Network Access Commercial |
$340.40
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$36.26
|
| Rate for Payer: Quartz Beloit One Network |
$181.30
|
| Rate for Payer: Quartz Commercial |
$240.50
|
| Rate for Payer: Quartz Medicare Advantage |
$35.09
|
| Rate for Payer: The Alliance Commercial |
$140.36
|
| Rate for Payer: United Healthcare Medicaid |
$36.26
|
| Rate for Payer: United Healthcare Medicare Advantage |
$35.09
|
| Rate for Payer: United Healthcare PPO |
$277.50
|
| Rate for Payer: WEA Trust Commercial |
$203.50
|
| Rate for Payer: Wellcare Medicare |
$35.09
|
| Rate for Payer: WMAP Medicaid |
$36.26
|
| Rate for Payer: WPS Commercial |
$274.06
|
|
|
Varicella-Zoster PCR Occular
|
Professional
|
Both
|
$370.00
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
6196143
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$123.87 |
| Max. Negotiated Rate |
$351.50 |
| Rate for Payer: Aetna Commercial |
$351.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$318.20
|
| Rate for Payer: Cash Price |
$111.00
|
| Rate for Payer: Cash Price |
$111.00
|
| Rate for Payer: Cigna Commercial |
$351.50
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$185.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$222.00
|
| Rate for Payer: Health EOS Commercial |
$336.70
|
| Rate for Payer: HFN Commercial |
$351.50
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$123.87
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$123.87
|
| Rate for Payer: Multiplan Commercial |
$296.00
|
| Rate for Payer: Preferred Network Access Commercial |
$351.50
|
| Rate for Payer: Quartz Beloit One Network |
$162.80
|
| Rate for Payer: Quartz Commercial |
$210.90
|
| Rate for Payer: The Alliance Commercial |
$185.00
|
| Rate for Payer: WEA Trust Commercial |
$203.50
|
| Rate for Payer: WPS Commercial |
$274.06
|
|
|
Varicella Zoster Virus Ab CSF
|
Professional
|
Both
|
$53.00
|
|
|
Service Code
|
CPT 86787
|
| Hospital Charge Code |
4378581
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$23.32 |
| Max. Negotiated Rate |
$50.35 |
| Rate for Payer: Aetna Commercial |
$50.35
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$45.58
|
| Rate for Payer: Cash Price |
$15.90
|
| Rate for Payer: Cash Price |
$15.90
|
| Rate for Payer: Cigna Commercial |
$50.35
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$26.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$31.80
|
| Rate for Payer: Health EOS Commercial |
$48.23
|
| Rate for Payer: HFN Commercial |
$50.35
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$45.47
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$45.47
|
| Rate for Payer: Multiplan Commercial |
$42.40
|
| Rate for Payer: Preferred Network Access Commercial |
$50.35
|
| Rate for Payer: Quartz Beloit One Network |
$23.32
|
| Rate for Payer: Quartz Commercial |
$30.21
|
| Rate for Payer: The Alliance Commercial |
$26.50
|
| Rate for Payer: WEA Trust Commercial |
$29.15
|
| Rate for Payer: WPS Commercial |
$39.26
|
|
|
Varicella Zoster Virus Ab CSF
|
Facility
|
IP
|
$53.00
|
|
|
Service Code
|
CPT 86787
|
| Hospital Charge Code |
4378581
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$25.97 |
| Max. Negotiated Rate |
$48.76 |
| Rate for Payer: Aetna Commercial |
$47.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$45.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$28.09
|
| Rate for Payer: Cash Price |
$15.90
|
| Rate for Payer: Cigna Commercial |
$48.76
|
| Rate for Payer: Health EOS Commercial |
$47.17
|
| Rate for Payer: HFN Commercial |
$48.76
|
| Rate for Payer: Multiplan Commercial |
$42.40
|
| Rate for Payer: NAPHCARE Commercial |
$31.80
|
| Rate for Payer: Preferred Network Access Commercial |
$48.76
|
| Rate for Payer: Quartz Beloit One Network |
$25.97
|
| Rate for Payer: Quartz Commercial |
$31.80
|
| Rate for Payer: WEA Trust Commercial |
$29.15
|
| Rate for Payer: WPS Commercial |
$39.26
|
|
|
Varicella Zoster Virus Ab CSF
|
Facility
|
OP
|
$53.00
|
|
|
Service Code
|
CPT 86787
|
| Hospital Charge Code |
4378581
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.17 |
| Max. Negotiated Rate |
$51.52 |
| Rate for Payer: Aetna Commercial |
$47.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$45.58
|
| Rate for Payer: Aetna Managed Medicare |
$12.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$48.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$22.54
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$21.38
|
| Rate for Payer: Anthem Medicaid |
$8.17
|
| Rate for Payer: Anthem Medicare Advantage |
$12.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$28.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$12.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$12.88
|
| Rate for Payer: Cash Price |
$15.90
|
| Rate for Payer: Cash Price |
$15.90
|
| Rate for Payer: Cigna Commercial |
$48.76
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$12.88
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$8.17
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$29.66
|
| Rate for Payer: Dean Health Medicaid |
$8.17
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$12.88
|
| Rate for Payer: Health EOS Commercial |
$47.17
|
| Rate for Payer: HFN Commercial |
$48.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$47.91
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$12.88
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$8.17
|
| Rate for Payer: Independent Care Health Plan Medicare |
$12.88
|
| Rate for Payer: Managed Health Services Medicaid |
$8.50
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$12.88
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$12.88
|
| Rate for Payer: Multiplan Commercial |
$42.40
|
| Rate for Payer: NAPHCARE Commercial |
$19.32
|
| Rate for Payer: Preferred Network Access Commercial |
$48.76
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$8.17
|
| Rate for Payer: Quartz Beloit One Network |
$25.97
|
| Rate for Payer: Quartz Commercial |
$34.45
|
| Rate for Payer: Quartz Medicare Advantage |
$12.88
|
| Rate for Payer: The Alliance Commercial |
$51.52
|
| Rate for Payer: United Healthcare Medicaid |
$8.17
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.88
|
| Rate for Payer: United Healthcare PPO |
$39.75
|
| Rate for Payer: WEA Trust Commercial |
$29.15
|
| Rate for Payer: Wellcare Medicare |
$12.88
|
| Rate for Payer: WMAP Medicaid |
$8.17
|
| Rate for Payer: WPS Commercial |
$39.26
|
|
|
Varicella Zoster Virus Antibody CSF
|
Facility
|
OP
|
$78.00
|
|
|
Service Code
|
CPT 86787
|
| Hospital Charge Code |
4374623
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$8.17 |
| Max. Negotiated Rate |
$71.76 |
| Rate for Payer: Aetna Commercial |
$70.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$67.08
|
| Rate for Payer: Aetna Managed Medicare |
$12.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$48.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$22.54
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$21.38
|
| Rate for Payer: Anthem Medicaid |
$8.17
|
| Rate for Payer: Anthem Medicare Advantage |
$12.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$41.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$12.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$12.88
|
| Rate for Payer: Cash Price |
$23.40
|
| Rate for Payer: Cash Price |
$23.40
|
| Rate for Payer: Cigna Commercial |
$71.76
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$12.88
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$8.17
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$43.65
|
| Rate for Payer: Dean Health Medicaid |
$8.17
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$12.88
|
| Rate for Payer: Health EOS Commercial |
$69.42
|
| Rate for Payer: HFN Commercial |
$71.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$47.91
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$12.88
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$8.17
|
| Rate for Payer: Independent Care Health Plan Medicare |
$12.88
|
| Rate for Payer: Managed Health Services Medicaid |
$8.50
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$12.88
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$12.88
|
| Rate for Payer: Multiplan Commercial |
$62.40
|
| Rate for Payer: NAPHCARE Commercial |
$19.32
|
| Rate for Payer: Preferred Network Access Commercial |
$71.76
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$8.17
|
| Rate for Payer: Quartz Beloit One Network |
$38.22
|
| Rate for Payer: Quartz Commercial |
$50.70
|
| Rate for Payer: Quartz Medicare Advantage |
$12.88
|
| Rate for Payer: The Alliance Commercial |
$51.52
|
| Rate for Payer: United Healthcare Medicaid |
$8.17
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.88
|
| Rate for Payer: United Healthcare PPO |
$58.50
|
| Rate for Payer: WEA Trust Commercial |
$42.90
|
| Rate for Payer: Wellcare Medicare |
$12.88
|
| Rate for Payer: WMAP Medicaid |
$8.17
|
| Rate for Payer: WPS Commercial |
$57.77
|
|
|
Varicella Zoster Virus Antibody CSF
|
Professional
|
Both
|
$78.00
|
|
|
Service Code
|
CPT 86787
|
| Hospital Charge Code |
4374623
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$34.32 |
| Max. Negotiated Rate |
$74.10 |
| Rate for Payer: Aetna Commercial |
$74.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$67.08
|
| Rate for Payer: Cash Price |
$23.40
|
| Rate for Payer: Cash Price |
$23.40
|
| Rate for Payer: Cigna Commercial |
$74.10
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$39.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$46.80
|
| Rate for Payer: Health EOS Commercial |
$70.98
|
| Rate for Payer: HFN Commercial |
$74.10
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$45.47
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$45.47
|
| Rate for Payer: Multiplan Commercial |
$62.40
|
| Rate for Payer: Preferred Network Access Commercial |
$74.10
|
| Rate for Payer: Quartz Beloit One Network |
$34.32
|
| Rate for Payer: Quartz Commercial |
$44.46
|
| Rate for Payer: The Alliance Commercial |
$39.00
|
| Rate for Payer: WEA Trust Commercial |
$42.90
|
| Rate for Payer: WPS Commercial |
$57.77
|
|
|
Varicella Zoster Virus Antibody CSF
|
Facility
|
IP
|
$78.00
|
|
|
Service Code
|
CPT 86787
|
| Hospital Charge Code |
4374623
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$38.22 |
| Max. Negotiated Rate |
$71.76 |
| Rate for Payer: Aetna Commercial |
$70.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$67.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$41.34
|
| Rate for Payer: Cash Price |
$23.40
|
| Rate for Payer: Cigna Commercial |
$71.76
|
| Rate for Payer: Health EOS Commercial |
$69.42
|
| Rate for Payer: HFN Commercial |
$71.76
|
| Rate for Payer: Multiplan Commercial |
$62.40
|
| Rate for Payer: NAPHCARE Commercial |
$46.80
|
| Rate for Payer: Preferred Network Access Commercial |
$71.76
|
| Rate for Payer: Quartz Beloit One Network |
$38.22
|
| Rate for Payer: Quartz Commercial |
$46.80
|
| Rate for Payer: WEA Trust Commercial |
$42.90
|
| Rate for Payer: WPS Commercial |
$57.77
|
|
|
Varicella Zoster Virus DNA, Quant Real Time PCR
|
Professional
|
Both
|
$552.00
|
|
|
Service Code
|
CPT 87799
|
| Hospital Charge Code |
3961341
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$151.23 |
| Max. Negotiated Rate |
$524.40 |
| Rate for Payer: Aetna Commercial |
$524.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$474.72
|
| Rate for Payer: Cash Price |
$165.60
|
| Rate for Payer: Cash Price |
$165.60
|
| Rate for Payer: Cigna Commercial |
$524.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$276.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$331.20
|
| Rate for Payer: Health EOS Commercial |
$502.32
|
| Rate for Payer: HFN Commercial |
$524.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$151.23
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$151.23
|
| Rate for Payer: Multiplan Commercial |
$441.60
|
| Rate for Payer: Preferred Network Access Commercial |
$524.40
|
| Rate for Payer: Quartz Beloit One Network |
$242.88
|
| Rate for Payer: Quartz Commercial |
$314.64
|
| Rate for Payer: The Alliance Commercial |
$276.00
|
| Rate for Payer: WEA Trust Commercial |
$303.60
|
| Rate for Payer: WPS Commercial |
$408.87
|
|
|
Varicella Zoster Virus DNA, Quant Real Time PCR
|
Facility
|
IP
|
$552.00
|
|
|
Service Code
|
CPT 87799
|
| Hospital Charge Code |
3961341
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$270.48 |
| Max. Negotiated Rate |
$507.84 |
| Rate for Payer: Aetna Commercial |
$496.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$474.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$292.56
|
| Rate for Payer: Cash Price |
$165.60
|
| Rate for Payer: Cigna Commercial |
$507.84
|
| Rate for Payer: Health EOS Commercial |
$491.28
|
| Rate for Payer: HFN Commercial |
$507.84
|
| Rate for Payer: Multiplan Commercial |
$441.60
|
| Rate for Payer: NAPHCARE Commercial |
$331.20
|
| Rate for Payer: Preferred Network Access Commercial |
$507.84
|
| Rate for Payer: Quartz Beloit One Network |
$270.48
|
| Rate for Payer: Quartz Commercial |
$331.20
|
| Rate for Payer: WEA Trust Commercial |
$303.60
|
| Rate for Payer: WPS Commercial |
$408.87
|
|
|
Varicella Zoster Virus DNA, Quant Real Time PCR
|
Facility
|
OP
|
$552.00
|
|
|
Service Code
|
CPT 87799
|
| Hospital Charge Code |
3961341
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$42.84 |
| Max. Negotiated Rate |
$507.84 |
| Rate for Payer: Aetna Commercial |
$496.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$474.72
|
| Rate for Payer: Aetna Managed Medicare |
$42.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$160.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$74.97
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$71.11
|
| Rate for Payer: Anthem Medicaid |
$44.27
|
| Rate for Payer: Anthem Medicare Advantage |
$42.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$292.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$42.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$42.84
|
| Rate for Payer: Cash Price |
$165.60
|
| Rate for Payer: Cash Price |
$165.60
|
| Rate for Payer: Cigna Commercial |
$507.84
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$42.84
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$44.27
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$308.90
|
| Rate for Payer: Dean Health Medicaid |
$44.27
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$42.84
|
| Rate for Payer: Health EOS Commercial |
$491.28
|
| Rate for Payer: HFN Commercial |
$507.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$159.36
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$42.84
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$44.27
|
| Rate for Payer: Independent Care Health Plan Medicare |
$42.84
|
| Rate for Payer: Managed Health Services Medicaid |
$46.04
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$42.84
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$42.84
|
| Rate for Payer: Multiplan Commercial |
$441.60
|
| Rate for Payer: NAPHCARE Commercial |
$64.26
|
| Rate for Payer: Preferred Network Access Commercial |
$507.84
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$44.27
|
| Rate for Payer: Quartz Beloit One Network |
$270.48
|
| Rate for Payer: Quartz Commercial |
$358.80
|
| Rate for Payer: Quartz Medicare Advantage |
$42.84
|
| Rate for Payer: The Alliance Commercial |
$171.36
|
| Rate for Payer: United Healthcare Medicaid |
$44.27
|
| Rate for Payer: United Healthcare Medicare Advantage |
$42.84
|
| Rate for Payer: United Healthcare PPO |
$414.00
|
| Rate for Payer: WEA Trust Commercial |
$303.60
|
| Rate for Payer: Wellcare Medicare |
$42.84
|
| Rate for Payer: WMAP Medicaid |
$44.27
|
| Rate for Payer: WPS Commercial |
$408.87
|
|
|
VARICOCELECTOMY
|
Facility
|
OP
|
$1,084.00
|
|
| Hospital Charge Code |
2960494
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$303.52 |
| Max. Negotiated Rate |
$4,336.00 |
| Rate for Payer: Aetna Commercial |
$975.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$932.24
|
| Rate for Payer: Aetna Managed Medicare |
$303.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$704.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$542.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$520.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$574.52
|
| Rate for Payer: Cash Price |
$325.20
|
| Rate for Payer: Cigna Commercial |
$997.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$606.61
|
| Rate for Payer: Health EOS Commercial |
$964.76
|
| Rate for Payer: HFN Commercial |
$997.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$813.00
|
| Rate for Payer: Multiplan Commercial |
$867.20
|
| Rate for Payer: NAPHCARE Commercial |
$650.40
|
| Rate for Payer: Preferred Network Access Commercial |
$997.28
|
| Rate for Payer: Quartz Beloit One Network |
$531.16
|
| Rate for Payer: Quartz Commercial |
$704.60
|
| Rate for Payer: Quartz Medicare Advantage |
$650.40
|
| Rate for Payer: The Alliance Commercial |
$4,336.00
|
| Rate for Payer: WEA Trust Commercial |
$596.20
|
| Rate for Payer: WPS Commercial |
$802.92
|
|
|
VARICOCELECTOMY
|
Facility
|
IP
|
$1,084.00
|
|
| Hospital Charge Code |
2960494
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$531.16 |
| Max. Negotiated Rate |
$997.28 |
| Rate for Payer: Aetna Commercial |
$975.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$932.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$574.52
|
| Rate for Payer: Cash Price |
$325.20
|
| Rate for Payer: Cigna Commercial |
$997.28
|
| Rate for Payer: Health EOS Commercial |
$964.76
|
| Rate for Payer: HFN Commercial |
$997.28
|
| Rate for Payer: Multiplan Commercial |
$867.20
|
| Rate for Payer: NAPHCARE Commercial |
$650.40
|
| Rate for Payer: Preferred Network Access Commercial |
$997.28
|
| Rate for Payer: Quartz Beloit One Network |
$531.16
|
| Rate for Payer: Quartz Commercial |
$650.40
|
| Rate for Payer: WEA Trust Commercial |
$596.20
|
| Rate for Payer: WPS Commercial |
$802.92
|
|
|
Vascular Acquisition
|
Facility
|
IP
|
$1,692.00
|
|
|
Service Code
|
CPT 93930
|
| Hospital Charge Code |
5376698
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$829.08 |
| Max. Negotiated Rate |
$1,556.64 |
| Rate for Payer: Aetna Commercial |
$1,522.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,455.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$896.76
|
| Rate for Payer: Cash Price |
$507.60
|
| Rate for Payer: Cigna Commercial |
$1,556.64
|
| Rate for Payer: Health EOS Commercial |
$1,505.88
|
| Rate for Payer: HFN Commercial |
$1,556.64
|
| Rate for Payer: Multiplan Commercial |
$1,353.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,015.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,556.64
|
| Rate for Payer: Quartz Beloit One Network |
$829.08
|
| Rate for Payer: Quartz Commercial |
$1,015.20
|
| Rate for Payer: WEA Trust Commercial |
$930.60
|
| Rate for Payer: WPS Commercial |
$1,253.26
|
|
|
Vascular Acquisition
|
Facility
|
OP
|
$1,493.00
|
|
|
Service Code
|
CPT 76942
|
| Hospital Charge Code |
5375872
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$418.04 |
| Max. Negotiated Rate |
$5,972.00 |
| Rate for Payer: Aetna Commercial |
$1,343.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,283.98
|
| Rate for Payer: Aetna Managed Medicare |
$418.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$970.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$746.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$716.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$791.29
|
| Rate for Payer: Cash Price |
$447.90
|
| Rate for Payer: Cigna Commercial |
$1,373.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$835.48
|
| Rate for Payer: Health EOS Commercial |
$1,328.77
|
| Rate for Payer: HFN Commercial |
$1,373.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,119.75
|
| Rate for Payer: Multiplan Commercial |
$1,194.40
|
| Rate for Payer: NAPHCARE Commercial |
$895.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,373.56
|
| Rate for Payer: Quartz Beloit One Network |
$731.57
|
| Rate for Payer: Quartz Commercial |
$970.45
|
| Rate for Payer: Quartz Medicare Advantage |
$895.80
|
| Rate for Payer: The Alliance Commercial |
$5,972.00
|
| Rate for Payer: United Healthcare PPO |
$1,119.75
|
| Rate for Payer: WEA Trust Commercial |
$821.15
|
| Rate for Payer: WPS Commercial |
$1,105.87
|
|
|
Vascular Acquisition
|
Facility
|
IP
|
$1,227.00
|
|
|
Service Code
|
CPT 93923
|
| Hospital Charge Code |
5376737
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$601.23 |
| Max. Negotiated Rate |
$1,128.84 |
| Rate for Payer: Aetna Commercial |
$1,104.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,055.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$650.31
|
| Rate for Payer: Cash Price |
$368.10
|
| Rate for Payer: Cigna Commercial |
$1,128.84
|
| Rate for Payer: Health EOS Commercial |
$1,092.03
|
| Rate for Payer: HFN Commercial |
$1,128.84
|
| Rate for Payer: Multiplan Commercial |
$981.60
|
| Rate for Payer: NAPHCARE Commercial |
$736.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,128.84
|
| Rate for Payer: Quartz Beloit One Network |
$601.23
|
| Rate for Payer: Quartz Commercial |
$736.20
|
| Rate for Payer: WEA Trust Commercial |
$674.85
|
| Rate for Payer: WPS Commercial |
$908.84
|
|
|
Vascular Acquisition
|
Facility
|
OP
|
$1,641.00
|
|
|
Service Code
|
CPT 93971 RT
|
| Hospital Charge Code |
5376677
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$108.67 |
| Max. Negotiated Rate |
$1,509.72 |
| Rate for Payer: Aetna Commercial |
$1,476.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,411.26
|
| Rate for Payer: Aetna Managed Medicare |
$108.67
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,066.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$820.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$787.68
|
| Rate for Payer: Anthem Medicare Advantage |
$108.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$869.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$108.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$108.67
|
| Rate for Payer: Cash Price |
$492.30
|
| Rate for Payer: Cash Price |
$492.30
|
| Rate for Payer: Cigna Commercial |
$1,509.72
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$108.67
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$918.30
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$108.67
|
| Rate for Payer: Health EOS Commercial |
$1,460.49
|
| Rate for Payer: HFN Commercial |
$1,509.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$404.25
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$108.67
|
| Rate for Payer: Independent Care Health Plan Medicare |
$108.67
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$108.67
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$108.67
|
| Rate for Payer: Multiplan Commercial |
$1,312.80
|
| Rate for Payer: NAPHCARE Commercial |
$163.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,509.72
|
| Rate for Payer: Quartz Beloit One Network |
$804.09
|
| Rate for Payer: Quartz Commercial |
$1,066.65
|
| Rate for Payer: Quartz Medicare Advantage |
$108.67
|
| Rate for Payer: The Alliance Commercial |
$434.68
|
| Rate for Payer: United Healthcare Medicare Advantage |
$108.67
|
| Rate for Payer: United Healthcare PPO |
$1,230.75
|
| Rate for Payer: WEA Trust Commercial |
$902.55
|
| Rate for Payer: Wellcare Medicare |
$108.67
|
| Rate for Payer: WPS Commercial |
$1,215.49
|
|
|
Vascular Acquisition
|
Facility
|
OP
|
$1,826.00
|
|
|
Service Code
|
CPT 93975
|
| Hospital Charge Code |
5375866
|
|
Hospital Revenue Code
|
402
|
| Min. Negotiated Rate |
$242.20 |
| Max. Negotiated Rate |
$1,679.92 |
| Rate for Payer: Aetna Commercial |
$1,643.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,570.36
|
| Rate for Payer: Aetna Managed Medicare |
$242.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$816.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$689.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$655.00
|
| Rate for Payer: Anthem Medicare Advantage |
$242.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$967.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$242.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$242.20
|
| Rate for Payer: Cash Price |
$547.80
|
| Rate for Payer: Cash Price |
$547.80
|
| Rate for Payer: Cash Price |
$547.80
|
| Rate for Payer: Cigna Commercial |
$1,679.92
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$242.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,021.83
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$242.20
|
| Rate for Payer: Health EOS Commercial |
$1,625.14
|
| Rate for Payer: HFN Commercial |
$1,679.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$900.98
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$242.20
|
| Rate for Payer: Independent Care Health Plan Medicare |
$242.20
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$242.20
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$242.20
|
| Rate for Payer: Multiplan Commercial |
$1,460.80
|
| Rate for Payer: NAPHCARE Commercial |
$363.30
|
| Rate for Payer: Preferred Network Access Commercial |
$1,679.92
|
| Rate for Payer: Quartz Beloit One Network |
$894.74
|
| Rate for Payer: Quartz Commercial |
$1,186.90
|
| Rate for Payer: Quartz Medicare Advantage |
$242.20
|
| Rate for Payer: The Alliance Commercial |
$968.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$242.20
|
| Rate for Payer: United Healthcare PPO |
$574.00
|
| Rate for Payer: WEA Trust Commercial |
$1,004.30
|
| Rate for Payer: Wellcare Medicare |
$242.20
|
| Rate for Payer: WPS Commercial |
$1,352.52
|
|
|
Vascular Acquisition
|
Facility
|
IP
|
$1,342.00
|
|
|
Service Code
|
CPT 93931 LT
|
| Hospital Charge Code |
5376701
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$657.58 |
| Max. Negotiated Rate |
$1,234.64 |
| Rate for Payer: Aetna Commercial |
$1,207.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,154.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$711.26
|
| Rate for Payer: Cash Price |
$402.60
|
| Rate for Payer: Cigna Commercial |
$1,234.64
|
| Rate for Payer: Health EOS Commercial |
$1,194.38
|
| Rate for Payer: HFN Commercial |
$1,234.64
|
| Rate for Payer: Multiplan Commercial |
$1,073.60
|
| Rate for Payer: NAPHCARE Commercial |
$805.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,234.64
|
| Rate for Payer: Quartz Beloit One Network |
$657.58
|
| Rate for Payer: Quartz Commercial |
$805.20
|
| Rate for Payer: WEA Trust Commercial |
$738.10
|
| Rate for Payer: WPS Commercial |
$994.02
|
|
|
Vascular Acquisition
|
Facility
|
IP
|
$1,641.00
|
|
|
Service Code
|
CPT 93971 LT
|
| Hospital Charge Code |
6195114
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$804.09 |
| Max. Negotiated Rate |
$1,509.72 |
| Rate for Payer: Aetna Commercial |
$1,476.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,411.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$869.73
|
| Rate for Payer: Cash Price |
$492.30
|
| Rate for Payer: Cigna Commercial |
$1,509.72
|
| Rate for Payer: Health EOS Commercial |
$1,460.49
|
| Rate for Payer: HFN Commercial |
$1,509.72
|
| Rate for Payer: Multiplan Commercial |
$1,312.80
|
| Rate for Payer: NAPHCARE Commercial |
$984.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,509.72
|
| Rate for Payer: Quartz Beloit One Network |
$804.09
|
| Rate for Payer: Quartz Commercial |
$984.60
|
| Rate for Payer: WEA Trust Commercial |
$902.55
|
| Rate for Payer: WPS Commercial |
$1,215.49
|
|
|
Vascular Acquisition
|
Facility
|
OP
|
$1,641.00
|
|
|
Service Code
|
CPT 93971 RT
|
| Hospital Charge Code |
5376686
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$108.67 |
| Max. Negotiated Rate |
$1,509.72 |
| Rate for Payer: Aetna Commercial |
$1,476.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,411.26
|
| Rate for Payer: Aetna Managed Medicare |
$108.67
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,066.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$820.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$787.68
|
| Rate for Payer: Anthem Medicare Advantage |
$108.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$869.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$108.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$108.67
|
| Rate for Payer: Cash Price |
$492.30
|
| Rate for Payer: Cash Price |
$492.30
|
| Rate for Payer: Cigna Commercial |
$1,509.72
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$108.67
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$918.30
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$108.67
|
| Rate for Payer: Health EOS Commercial |
$1,460.49
|
| Rate for Payer: HFN Commercial |
$1,509.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$404.25
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$108.67
|
| Rate for Payer: Independent Care Health Plan Medicare |
$108.67
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$108.67
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$108.67
|
| Rate for Payer: Multiplan Commercial |
$1,312.80
|
| Rate for Payer: NAPHCARE Commercial |
$163.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,509.72
|
| Rate for Payer: Quartz Beloit One Network |
$804.09
|
| Rate for Payer: Quartz Commercial |
$1,066.65
|
| Rate for Payer: Quartz Medicare Advantage |
$108.67
|
| Rate for Payer: The Alliance Commercial |
$434.68
|
| Rate for Payer: United Healthcare Medicare Advantage |
$108.67
|
| Rate for Payer: United Healthcare PPO |
$1,230.75
|
| Rate for Payer: WEA Trust Commercial |
$902.55
|
| Rate for Payer: Wellcare Medicare |
$108.67
|
| Rate for Payer: WPS Commercial |
$1,215.49
|
|
|
Vascular Acquisition
|
Facility
|
OP
|
$1,376.00
|
|
| Hospital Charge Code |
5375875
|
| Min. Negotiated Rate |
$385.28 |
| Max. Negotiated Rate |
$5,504.00 |
| Rate for Payer: Aetna Commercial |
$1,238.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,183.36
|
| Rate for Payer: Aetna Managed Medicare |
$385.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$894.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$688.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$660.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$729.28
|
| Rate for Payer: Cash Price |
$412.80
|
| Rate for Payer: Cigna Commercial |
$1,265.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$770.01
|
| Rate for Payer: Health EOS Commercial |
$1,224.64
|
| Rate for Payer: HFN Commercial |
$1,265.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,032.00
|
| Rate for Payer: Multiplan Commercial |
$1,100.80
|
| Rate for Payer: NAPHCARE Commercial |
$825.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,265.92
|
| Rate for Payer: Quartz Beloit One Network |
$674.24
|
| Rate for Payer: Quartz Commercial |
$894.40
|
| Rate for Payer: Quartz Medicare Advantage |
$825.60
|
| Rate for Payer: The Alliance Commercial |
$5,504.00
|
| Rate for Payer: WEA Trust Commercial |
$756.80
|
| Rate for Payer: WPS Commercial |
$1,019.20
|
|
|
Vascular Acquisition
|
Facility
|
OP
|
$1,329.00
|
|
|
Service Code
|
CPT 93978
|
| Hospital Charge Code |
5376637
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$242.20 |
| Max. Negotiated Rate |
$1,222.68 |
| Rate for Payer: Aetna Commercial |
$1,196.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,142.94
|
| Rate for Payer: Aetna Managed Medicare |
$242.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$863.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$664.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$637.92
|
| Rate for Payer: Anthem Medicare Advantage |
$242.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$704.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$242.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$242.20
|
| Rate for Payer: Cash Price |
$398.70
|
| Rate for Payer: Cash Price |
$398.70
|
| Rate for Payer: Cigna Commercial |
$1,222.68
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$242.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$743.71
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$242.20
|
| Rate for Payer: Health EOS Commercial |
$1,182.81
|
| Rate for Payer: HFN Commercial |
$1,222.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$900.98
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$242.20
|
| Rate for Payer: Independent Care Health Plan Medicare |
$242.20
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$242.20
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$242.20
|
| Rate for Payer: Multiplan Commercial |
$1,063.20
|
| Rate for Payer: NAPHCARE Commercial |
$363.30
|
| Rate for Payer: Preferred Network Access Commercial |
$1,222.68
|
| Rate for Payer: Quartz Beloit One Network |
$651.21
|
| Rate for Payer: Quartz Commercial |
$863.85
|
| Rate for Payer: Quartz Medicare Advantage |
$242.20
|
| Rate for Payer: The Alliance Commercial |
$968.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$242.20
|
| Rate for Payer: United Healthcare PPO |
$996.75
|
| Rate for Payer: WEA Trust Commercial |
$730.95
|
| Rate for Payer: Wellcare Medicare |
$242.20
|
| Rate for Payer: WPS Commercial |
$984.39
|
|
|
Vascular Acquisition
|
Facility
|
IP
|
$812.00
|
|
|
Service Code
|
CPT 93990
|
| Hospital Charge Code |
5375869
|
|
Hospital Revenue Code
|
921
|
| Min. Negotiated Rate |
$397.88 |
| Max. Negotiated Rate |
$747.04 |
| Rate for Payer: Aetna Commercial |
$730.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$698.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$430.36
|
| Rate for Payer: Cash Price |
$243.60
|
| Rate for Payer: Cigna Commercial |
$747.04
|
| Rate for Payer: Health EOS Commercial |
$722.68
|
| Rate for Payer: HFN Commercial |
$747.04
|
| Rate for Payer: Multiplan Commercial |
$649.60
|
| Rate for Payer: NAPHCARE Commercial |
$487.20
|
| Rate for Payer: Preferred Network Access Commercial |
$747.04
|
| Rate for Payer: Quartz Beloit One Network |
$397.88
|
| Rate for Payer: Quartz Commercial |
$487.20
|
| Rate for Payer: WEA Trust Commercial |
$446.60
|
| Rate for Payer: WPS Commercial |
$601.45
|
|
