|
Valvuloplasty-Percutaneous Aortic Valve
|
Facility
|
OP
|
$11,496.00
|
|
|
Service Code
|
CPT 92986
|
| Hospital Charge Code |
5280751
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$5,858.36 |
| Max. Negotiated Rate |
$23,958.98 |
| Rate for Payer: Aetna Commercial |
$10,760.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,282.02
|
| Rate for Payer: Aetna Managed Medicare |
$5,989.74
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$16,970.72
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$14,336.40
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$13,619.84
|
| Rate for Payer: Anthem Medicare Advantage |
$5,989.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,336.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5,989.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5,989.74
|
| Rate for Payer: Cash Price |
$3,448.80
|
| Rate for Payer: Cash Price |
$3,448.80
|
| Rate for Payer: Cash Price |
$3,448.80
|
| Rate for Payer: Cigna Commercial |
$10,999.37
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$5,989.74
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,690.67
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$5,989.74
|
| Rate for Payer: Health EOS Commercial |
$10,640.70
|
| Rate for Payer: HFN Commercial |
$10,999.37
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$22,281.85
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$5,989.74
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5,989.74
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$5,989.74
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$5,989.74
|
| Rate for Payer: Multiplan Commercial |
$9,564.67
|
| Rate for Payer: NAPHCARE Commercial |
$8,984.62
|
| Rate for Payer: Preferred Network Access Commercial |
$10,999.37
|
| Rate for Payer: Quartz Beloit One Network |
$5,858.36
|
| Rate for Payer: Quartz Commercial |
$7,771.30
|
| Rate for Payer: Quartz Medicare Advantage |
$5,989.74
|
| Rate for Payer: The Alliance Commercial |
$23,958.98
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5,989.74
|
| Rate for Payer: United Healthcare PPO |
$6,400.16
|
| Rate for Payer: WEA Trust Commercial |
$6,575.71
|
| Rate for Payer: Wellcare Medicare |
$5,989.74
|
| Rate for Payer: WPS Commercial |
$8,855.37
|
|
|
Valvuloplasty-Percutaneous Aortic Valve
|
Facility
|
IP
|
$11,496.00
|
|
|
Service Code
|
CPT 92986
|
| Hospital Charge Code |
5280751
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$5,858.36 |
| Max. Negotiated Rate |
$10,999.37 |
| Rate for Payer: Aetna Commercial |
$10,760.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,282.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,336.60
|
| Rate for Payer: Cash Price |
$3,448.80
|
| Rate for Payer: Cigna Commercial |
$10,999.37
|
| Rate for Payer: Health EOS Commercial |
$10,640.70
|
| Rate for Payer: HFN Commercial |
$10,999.37
|
| Rate for Payer: Multiplan Commercial |
$9,564.67
|
| Rate for Payer: Preferred Network Access Commercial |
$10,999.37
|
| Rate for Payer: Quartz Beloit One Network |
$5,858.36
|
| Rate for Payer: Quartz Commercial |
$7,173.50
|
| Rate for Payer: WEA Trust Commercial |
$6,575.71
|
| Rate for Payer: WPS Commercial |
$8,855.37
|
|
|
VALVULOTOME TRU-INCISE TIVK2030
|
Facility
|
OP
|
$4,805.00
|
|
| Hospital Charge Code |
2973635
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,399.22 |
| Max. Negotiated Rate |
$4,597.42 |
| Rate for Payer: Aetna Commercial |
$4,497.48
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,297.59
|
| Rate for Payer: Aetna Managed Medicare |
$1,399.22
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,248.18
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,498.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,398.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,648.52
|
| Rate for Payer: Cash Price |
$1,441.50
|
| Rate for Payer: Cigna Commercial |
$4,597.42
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,796.51
|
| Rate for Payer: Health EOS Commercial |
$4,447.51
|
| Rate for Payer: HFN Commercial |
$4,597.42
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,747.90
|
| Rate for Payer: Multiplan Commercial |
$3,997.76
|
| Rate for Payer: NAPHCARE Commercial |
$2,998.32
|
| Rate for Payer: Preferred Network Access Commercial |
$4,597.42
|
| Rate for Payer: Quartz Beloit One Network |
$2,448.63
|
| Rate for Payer: Quartz Commercial |
$3,248.18
|
| Rate for Payer: Quartz Medicare Advantage |
$2,998.32
|
| Rate for Payer: The Alliance Commercial |
$2,498.60
|
| Rate for Payer: WEA Trust Commercial |
$2,748.46
|
| Rate for Payer: WPS Commercial |
$3,701.29
|
|
|
VALVULOTOME TRU-INCISE TIVK2030
|
Facility
|
IP
|
$4,805.00
|
|
| Hospital Charge Code |
2973635
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,448.63 |
| Max. Negotiated Rate |
$4,597.42 |
| Rate for Payer: Aetna Commercial |
$4,497.48
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,297.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,648.52
|
| Rate for Payer: Cash Price |
$1,441.50
|
| Rate for Payer: Cigna Commercial |
$4,597.42
|
| Rate for Payer: Health EOS Commercial |
$4,447.51
|
| Rate for Payer: HFN Commercial |
$4,597.42
|
| Rate for Payer: Multiplan Commercial |
$3,997.76
|
| Rate for Payer: Preferred Network Access Commercial |
$4,597.42
|
| Rate for Payer: Quartz Beloit One Network |
$2,448.63
|
| Rate for Payer: Quartz Commercial |
$2,998.32
|
| Rate for Payer: WEA Trust Commercial |
$2,748.46
|
| Rate for Payer: WPS Commercial |
$3,701.29
|
|
|
Vancomycin
|
Facility
|
IP
|
$32.00
|
|
|
Service Code
|
HCPCS J3370
|
| Hospital Charge Code |
4075402
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$16.31 |
| Max. Negotiated Rate |
$30.62 |
| Rate for Payer: Aetna Commercial |
$29.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$28.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$17.64
|
| Rate for Payer: Cash Price |
$9.60
|
| Rate for Payer: Cigna Commercial |
$30.62
|
| Rate for Payer: Health EOS Commercial |
$29.62
|
| Rate for Payer: HFN Commercial |
$30.62
|
| Rate for Payer: Multiplan Commercial |
$26.62
|
| Rate for Payer: Preferred Network Access Commercial |
$30.62
|
| Rate for Payer: Quartz Beloit One Network |
$16.31
|
| Rate for Payer: Quartz Commercial |
$19.97
|
| Rate for Payer: WEA Trust Commercial |
$18.30
|
| Rate for Payer: WPS Commercial |
$24.65
|
|
|
Vancomycin
|
Facility
|
OP
|
$32.00
|
|
|
Service Code
|
HCPCS J3370
|
| Hospital Charge Code |
4075402
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.55 |
| Max. Negotiated Rate |
$30.62 |
| Rate for Payer: Aetna Commercial |
$29.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$28.62
|
| Rate for Payer: Aetna Managed Medicare |
$9.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$21.63
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$16.64
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$15.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$17.64
|
| Rate for Payer: Cash Price |
$9.60
|
| Rate for Payer: Cash Price |
$9.60
|
| Rate for Payer: Cigna Commercial |
$30.62
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3.55
|
| Rate for Payer: Health EOS Commercial |
$29.62
|
| Rate for Payer: HFN Commercial |
$30.62
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$24.96
|
| Rate for Payer: Multiplan Commercial |
$26.62
|
| Rate for Payer: NAPHCARE Commercial |
$19.97
|
| Rate for Payer: Preferred Network Access Commercial |
$30.62
|
| Rate for Payer: Quartz Beloit One Network |
$16.31
|
| Rate for Payer: Quartz Commercial |
$21.63
|
| Rate for Payer: Quartz Medicare Advantage |
$19.97
|
| Rate for Payer: The Alliance Commercial |
$16.64
|
| Rate for Payer: WEA Trust Commercial |
$18.30
|
| Rate for Payer: WPS Commercial |
$6.70
|
|
|
Vancomycin, Kinetics
|
Professional
|
Both
|
$279.00
|
|
|
Service Code
|
CPT 80202
|
| Hospital Charge Code |
979882
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.08 |
| Max. Negotiated Rate |
$275.65 |
| Rate for Payer: Aetna Commercial |
$275.65
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$249.54
|
| Rate for Payer: Aetna Managed Medicare |
$14.08
|
| Rate for Payer: Anthem Medicare Advantage |
$14.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$14.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$14.08
|
| Rate for Payer: Cash Price |
$83.70
|
| Rate for Payer: Cash Price |
$83.70
|
| Rate for Payer: Cigna Commercial |
$275.65
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$145.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$14.08
|
| Rate for Payer: Health EOS Commercial |
$264.05
|
| Rate for Payer: HFN Commercial |
$275.65
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$49.71
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$49.71
|
| Rate for Payer: Independent Care Health Plan Medicare |
$14.08
|
| Rate for Payer: Multiplan Commercial |
$232.13
|
| Rate for Payer: NAPHCARE Commercial |
$21.12
|
| Rate for Payer: Preferred Network Access Commercial |
$275.65
|
| Rate for Payer: Quartz Beloit One Network |
$127.67
|
| Rate for Payer: Quartz Commercial |
$165.39
|
| Rate for Payer: Quartz Medicare Advantage |
$14.08
|
| Rate for Payer: The Alliance Commercial |
$55.62
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14.08
|
| Rate for Payer: WEA Trust Commercial |
$159.59
|
| Rate for Payer: WPS Commercial |
$61.96
|
|
|
Vancomycin, Kinetics
|
Facility
|
IP
|
$279.00
|
|
|
Service Code
|
CPT 80202
|
| Hospital Charge Code |
979882
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$142.18 |
| Max. Negotiated Rate |
$266.95 |
| Rate for Payer: Aetna Commercial |
$261.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$249.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$153.78
|
| Rate for Payer: Cash Price |
$83.70
|
| Rate for Payer: Cigna Commercial |
$266.95
|
| Rate for Payer: Health EOS Commercial |
$258.24
|
| Rate for Payer: HFN Commercial |
$266.95
|
| Rate for Payer: Multiplan Commercial |
$232.13
|
| Rate for Payer: Preferred Network Access Commercial |
$266.95
|
| Rate for Payer: Quartz Beloit One Network |
$142.18
|
| Rate for Payer: Quartz Commercial |
$174.10
|
| Rate for Payer: WEA Trust Commercial |
$159.59
|
| Rate for Payer: WPS Commercial |
$214.91
|
|
|
Vancomycin, Kinetics
|
Facility
|
OP
|
$279.00
|
|
|
Service Code
|
CPT 80202
|
| Hospital Charge Code |
979882
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.08 |
| Max. Negotiated Rate |
$266.95 |
| Rate for Payer: Aetna Commercial |
$261.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$249.54
|
| Rate for Payer: Aetna Managed Medicare |
$14.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$52.81
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$24.64
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$23.38
|
| Rate for Payer: Anthem Medicare Advantage |
$14.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$153.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$14.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$14.08
|
| Rate for Payer: Cash Price |
$83.70
|
| Rate for Payer: Cash Price |
$83.70
|
| Rate for Payer: Cigna Commercial |
$266.95
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$14.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$162.38
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$14.08
|
| Rate for Payer: Health EOS Commercial |
$258.24
|
| Rate for Payer: HFN Commercial |
$266.95
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$52.38
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$14.08
|
| Rate for Payer: Independent Care Health Plan Medicare |
$14.08
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$14.08
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$14.08
|
| Rate for Payer: Multiplan Commercial |
$232.13
|
| Rate for Payer: NAPHCARE Commercial |
$21.12
|
| Rate for Payer: Preferred Network Access Commercial |
$266.95
|
| Rate for Payer: Quartz Beloit One Network |
$142.18
|
| Rate for Payer: Quartz Commercial |
$188.60
|
| Rate for Payer: Quartz Medicare Advantage |
$14.08
|
| Rate for Payer: The Alliance Commercial |
$56.33
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14.08
|
| Rate for Payer: United Healthcare PPO |
$217.62
|
| Rate for Payer: WEA Trust Commercial |
$159.59
|
| Rate for Payer: Wellcare Medicare |
$14.08
|
| Rate for Payer: WPS Commercial |
$214.91
|
|
|
Vancomycin Level Peak
|
Facility
|
OP
|
$262.00
|
|
|
Service Code
|
CPT 80202
|
| Hospital Charge Code |
633869
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.08 |
| Max. Negotiated Rate |
$250.68 |
| Rate for Payer: Aetna Commercial |
$245.23
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$234.33
|
| Rate for Payer: Aetna Managed Medicare |
$14.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$52.81
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$24.64
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$23.38
|
| Rate for Payer: Anthem Medicare Advantage |
$14.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$144.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$14.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$14.08
|
| Rate for Payer: Cash Price |
$78.60
|
| Rate for Payer: Cash Price |
$78.60
|
| Rate for Payer: Cigna Commercial |
$250.68
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$14.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$152.48
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$14.08
|
| Rate for Payer: Health EOS Commercial |
$242.51
|
| Rate for Payer: HFN Commercial |
$250.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$52.38
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$14.08
|
| Rate for Payer: Independent Care Health Plan Medicare |
$14.08
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$14.08
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$14.08
|
| Rate for Payer: Multiplan Commercial |
$217.98
|
| Rate for Payer: NAPHCARE Commercial |
$21.12
|
| Rate for Payer: Preferred Network Access Commercial |
$250.68
|
| Rate for Payer: Quartz Beloit One Network |
$133.52
|
| Rate for Payer: Quartz Commercial |
$177.11
|
| Rate for Payer: Quartz Medicare Advantage |
$14.08
|
| Rate for Payer: The Alliance Commercial |
$56.33
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14.08
|
| Rate for Payer: United Healthcare PPO |
$204.36
|
| Rate for Payer: WEA Trust Commercial |
$149.86
|
| Rate for Payer: Wellcare Medicare |
$14.08
|
| Rate for Payer: WPS Commercial |
$201.82
|
|
|
Vancomycin Level Peak
|
Professional
|
Both
|
$262.00
|
|
|
Service Code
|
CPT 80202
|
| Hospital Charge Code |
633869
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.08 |
| Max. Negotiated Rate |
$258.86 |
| Rate for Payer: Aetna Commercial |
$258.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$234.33
|
| Rate for Payer: Aetna Managed Medicare |
$14.08
|
| Rate for Payer: Anthem Medicare Advantage |
$14.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$14.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$14.08
|
| Rate for Payer: Cash Price |
$78.60
|
| Rate for Payer: Cash Price |
$78.60
|
| Rate for Payer: Cigna Commercial |
$258.86
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$136.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$14.08
|
| Rate for Payer: Health EOS Commercial |
$247.96
|
| Rate for Payer: HFN Commercial |
$258.86
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$49.71
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$49.71
|
| Rate for Payer: Independent Care Health Plan Medicare |
$14.08
|
| Rate for Payer: Multiplan Commercial |
$217.98
|
| Rate for Payer: NAPHCARE Commercial |
$21.12
|
| Rate for Payer: Preferred Network Access Commercial |
$258.86
|
| Rate for Payer: Quartz Beloit One Network |
$119.89
|
| Rate for Payer: Quartz Commercial |
$155.31
|
| Rate for Payer: Quartz Medicare Advantage |
$14.08
|
| Rate for Payer: The Alliance Commercial |
$55.62
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14.08
|
| Rate for Payer: WEA Trust Commercial |
$149.86
|
| Rate for Payer: WPS Commercial |
$61.96
|
|
|
Vancomycin Level Peak
|
Facility
|
IP
|
$262.00
|
|
|
Service Code
|
CPT 80202
|
| Hospital Charge Code |
633869
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$133.52 |
| Max. Negotiated Rate |
$250.68 |
| Rate for Payer: Aetna Commercial |
$245.23
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$234.33
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$144.41
|
| Rate for Payer: Cash Price |
$78.60
|
| Rate for Payer: Cigna Commercial |
$250.68
|
| Rate for Payer: Health EOS Commercial |
$242.51
|
| Rate for Payer: HFN Commercial |
$250.68
|
| Rate for Payer: Multiplan Commercial |
$217.98
|
| Rate for Payer: Preferred Network Access Commercial |
$250.68
|
| Rate for Payer: Quartz Beloit One Network |
$133.52
|
| Rate for Payer: Quartz Commercial |
$163.49
|
| Rate for Payer: WEA Trust Commercial |
$149.86
|
| Rate for Payer: WPS Commercial |
$201.82
|
|
|
Vancomycin Level Trough
|
Facility
|
OP
|
$279.00
|
|
|
Service Code
|
CPT 80202
|
| Hospital Charge Code |
633870
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.08 |
| Max. Negotiated Rate |
$266.95 |
| Rate for Payer: Aetna Commercial |
$261.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$249.54
|
| Rate for Payer: Aetna Managed Medicare |
$14.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$52.81
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$24.64
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$23.38
|
| Rate for Payer: Anthem Medicare Advantage |
$14.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$153.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$14.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$14.08
|
| Rate for Payer: Cash Price |
$83.70
|
| Rate for Payer: Cash Price |
$83.70
|
| Rate for Payer: Cigna Commercial |
$266.95
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$14.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$162.38
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$14.08
|
| Rate for Payer: Health EOS Commercial |
$258.24
|
| Rate for Payer: HFN Commercial |
$266.95
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$52.38
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$14.08
|
| Rate for Payer: Independent Care Health Plan Medicare |
$14.08
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$14.08
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$14.08
|
| Rate for Payer: Multiplan Commercial |
$232.13
|
| Rate for Payer: NAPHCARE Commercial |
$21.12
|
| Rate for Payer: Preferred Network Access Commercial |
$266.95
|
| Rate for Payer: Quartz Beloit One Network |
$142.18
|
| Rate for Payer: Quartz Commercial |
$188.60
|
| Rate for Payer: Quartz Medicare Advantage |
$14.08
|
| Rate for Payer: The Alliance Commercial |
$56.33
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14.08
|
| Rate for Payer: United Healthcare PPO |
$217.62
|
| Rate for Payer: WEA Trust Commercial |
$159.59
|
| Rate for Payer: Wellcare Medicare |
$14.08
|
| Rate for Payer: WPS Commercial |
$214.91
|
|
|
Vancomycin Level Trough
|
Facility
|
IP
|
$279.00
|
|
|
Service Code
|
CPT 80202
|
| Hospital Charge Code |
633870
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$142.18 |
| Max. Negotiated Rate |
$266.95 |
| Rate for Payer: Aetna Commercial |
$261.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$249.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$153.78
|
| Rate for Payer: Cash Price |
$83.70
|
| Rate for Payer: Cigna Commercial |
$266.95
|
| Rate for Payer: Health EOS Commercial |
$258.24
|
| Rate for Payer: HFN Commercial |
$266.95
|
| Rate for Payer: Multiplan Commercial |
$232.13
|
| Rate for Payer: Preferred Network Access Commercial |
$266.95
|
| Rate for Payer: Quartz Beloit One Network |
$142.18
|
| Rate for Payer: Quartz Commercial |
$174.10
|
| Rate for Payer: WEA Trust Commercial |
$159.59
|
| Rate for Payer: WPS Commercial |
$214.91
|
|
|
Vancomycin Level Trough
|
Professional
|
Both
|
$279.00
|
|
|
Service Code
|
CPT 80202
|
| Hospital Charge Code |
633870
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.08 |
| Max. Negotiated Rate |
$275.65 |
| Rate for Payer: Aetna Commercial |
$275.65
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$249.54
|
| Rate for Payer: Aetna Managed Medicare |
$14.08
|
| Rate for Payer: Anthem Medicare Advantage |
$14.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$14.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$14.08
|
| Rate for Payer: Cash Price |
$83.70
|
| Rate for Payer: Cash Price |
$83.70
|
| Rate for Payer: Cigna Commercial |
$275.65
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$145.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$14.08
|
| Rate for Payer: Health EOS Commercial |
$264.05
|
| Rate for Payer: HFN Commercial |
$275.65
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$49.71
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$49.71
|
| Rate for Payer: Independent Care Health Plan Medicare |
$14.08
|
| Rate for Payer: Multiplan Commercial |
$232.13
|
| Rate for Payer: NAPHCARE Commercial |
$21.12
|
| Rate for Payer: Preferred Network Access Commercial |
$275.65
|
| Rate for Payer: Quartz Beloit One Network |
$127.67
|
| Rate for Payer: Quartz Commercial |
$165.39
|
| Rate for Payer: Quartz Medicare Advantage |
$14.08
|
| Rate for Payer: The Alliance Commercial |
$55.62
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14.08
|
| Rate for Payer: WEA Trust Commercial |
$159.59
|
| Rate for Payer: WPS Commercial |
$61.96
|
|
|
Vancomycin Powder 1gm Vial (MED)
|
Facility
|
IP
|
$185.00
|
|
|
Service Code
|
HCPCS J3370
|
| Hospital Charge Code |
5298713
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$94.28 |
| Max. Negotiated Rate |
$177.01 |
| Rate for Payer: Aetna Commercial |
$173.16
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$165.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$101.97
|
| Rate for Payer: Cash Price |
$55.50
|
| Rate for Payer: Cigna Commercial |
$177.01
|
| Rate for Payer: Health EOS Commercial |
$171.24
|
| Rate for Payer: HFN Commercial |
$177.01
|
| Rate for Payer: Multiplan Commercial |
$153.92
|
| Rate for Payer: Preferred Network Access Commercial |
$177.01
|
| Rate for Payer: Quartz Beloit One Network |
$94.28
|
| Rate for Payer: Quartz Commercial |
$115.44
|
| Rate for Payer: WEA Trust Commercial |
$105.82
|
| Rate for Payer: WPS Commercial |
$142.51
|
|
|
Vancomycin Powder 1gm Vial (MED)
|
Facility
|
OP
|
$185.00
|
|
|
Service Code
|
HCPCS J3370
|
| Hospital Charge Code |
5298713
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.55 |
| Max. Negotiated Rate |
$177.01 |
| Rate for Payer: Aetna Commercial |
$173.16
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$165.46
|
| Rate for Payer: Aetna Managed Medicare |
$53.87
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$125.06
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$96.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$92.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$101.97
|
| Rate for Payer: Cash Price |
$55.50
|
| Rate for Payer: Cash Price |
$55.50
|
| Rate for Payer: Cigna Commercial |
$177.01
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3.55
|
| Rate for Payer: Health EOS Commercial |
$171.24
|
| Rate for Payer: HFN Commercial |
$177.01
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$144.30
|
| Rate for Payer: Multiplan Commercial |
$153.92
|
| Rate for Payer: NAPHCARE Commercial |
$115.44
|
| Rate for Payer: Preferred Network Access Commercial |
$177.01
|
| Rate for Payer: Quartz Beloit One Network |
$94.28
|
| Rate for Payer: Quartz Commercial |
$125.06
|
| Rate for Payer: Quartz Medicare Advantage |
$115.44
|
| Rate for Payer: The Alliance Commercial |
$96.20
|
| Rate for Payer: WEA Trust Commercial |
$105.82
|
| Rate for Payer: WPS Commercial |
$6.70
|
|
|
Vanillylmandelic Acid 24 Hour Urine
|
Professional
|
Both
|
$450.00
|
|
|
Service Code
|
CPT 84585
|
| Hospital Charge Code |
978095
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$16.12 |
| Max. Negotiated Rate |
$444.60 |
| Rate for Payer: Aetna Commercial |
$444.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$402.48
|
| Rate for Payer: Aetna Managed Medicare |
$16.12
|
| Rate for Payer: Anthem Medicare Advantage |
$16.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$16.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$16.12
|
| Rate for Payer: Cash Price |
$135.00
|
| Rate for Payer: Cash Price |
$135.00
|
| Rate for Payer: Cigna Commercial |
$444.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$234.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$16.12
|
| Rate for Payer: Health EOS Commercial |
$425.88
|
| Rate for Payer: HFN Commercial |
$444.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$56.91
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$56.91
|
| Rate for Payer: Independent Care Health Plan Medicare |
$16.12
|
| Rate for Payer: Multiplan Commercial |
$374.40
|
| Rate for Payer: NAPHCARE Commercial |
$24.18
|
| Rate for Payer: Preferred Network Access Commercial |
$444.60
|
| Rate for Payer: Quartz Beloit One Network |
$205.92
|
| Rate for Payer: Quartz Commercial |
$266.76
|
| Rate for Payer: Quartz Medicare Advantage |
$16.12
|
| Rate for Payer: The Alliance Commercial |
$63.67
|
| Rate for Payer: United Healthcare Medicare Advantage |
$16.12
|
| Rate for Payer: WEA Trust Commercial |
$257.40
|
| Rate for Payer: WPS Commercial |
$70.93
|
|
|
Vanillylmandelic Acid 24 Hour Urine
|
Facility
|
IP
|
$450.00
|
|
|
Service Code
|
CPT 84585
|
| Hospital Charge Code |
978095
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$229.32 |
| Max. Negotiated Rate |
$430.56 |
| Rate for Payer: Aetna Commercial |
$421.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$402.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$248.04
|
| Rate for Payer: Cash Price |
$135.00
|
| Rate for Payer: Cigna Commercial |
$430.56
|
| Rate for Payer: Health EOS Commercial |
$416.52
|
| Rate for Payer: HFN Commercial |
$430.56
|
| Rate for Payer: Multiplan Commercial |
$374.40
|
| Rate for Payer: Preferred Network Access Commercial |
$430.56
|
| Rate for Payer: Quartz Beloit One Network |
$229.32
|
| Rate for Payer: Quartz Commercial |
$280.80
|
| Rate for Payer: WEA Trust Commercial |
$257.40
|
| Rate for Payer: WPS Commercial |
$346.63
|
|
|
Vanillylmandelic Acid 24 Hour Urine
|
Facility
|
OP
|
$450.00
|
|
|
Service Code
|
CPT 84585
|
| Hospital Charge Code |
978095
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$16.12 |
| Max. Negotiated Rate |
$430.56 |
| Rate for Payer: Aetna Commercial |
$421.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$402.48
|
| Rate for Payer: Aetna Managed Medicare |
$16.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$60.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$28.21
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$26.76
|
| Rate for Payer: Anthem Medicare Advantage |
$16.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$248.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$16.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$16.12
|
| Rate for Payer: Cash Price |
$135.00
|
| Rate for Payer: Cash Price |
$135.00
|
| Rate for Payer: Cigna Commercial |
$430.56
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$16.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$261.90
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$16.12
|
| Rate for Payer: Health EOS Commercial |
$416.52
|
| Rate for Payer: HFN Commercial |
$430.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$59.97
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$16.12
|
| Rate for Payer: Independent Care Health Plan Medicare |
$16.12
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$16.12
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$16.12
|
| Rate for Payer: Multiplan Commercial |
$374.40
|
| Rate for Payer: NAPHCARE Commercial |
$24.18
|
| Rate for Payer: Preferred Network Access Commercial |
$430.56
|
| Rate for Payer: Quartz Beloit One Network |
$229.32
|
| Rate for Payer: Quartz Commercial |
$304.20
|
| Rate for Payer: Quartz Medicare Advantage |
$16.12
|
| Rate for Payer: The Alliance Commercial |
$64.48
|
| Rate for Payer: United Healthcare Medicare Advantage |
$16.12
|
| Rate for Payer: United Healthcare PPO |
$351.00
|
| Rate for Payer: WEA Trust Commercial |
$257.40
|
| Rate for Payer: Wellcare Medicare |
$16.12
|
| Rate for Payer: WPS Commercial |
$346.63
|
|
|
Vanillylmandelic Acid, Random Urine
|
Facility
|
OP
|
$30.19
|
|
|
Service Code
|
CPT 82570
|
| Hospital Charge Code |
4076077
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.39 |
| Max. Negotiated Rate |
$28.89 |
| Rate for Payer: Aetna Commercial |
$28.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$27.00
|
| Rate for Payer: Aetna Managed Medicare |
$5.39
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$20.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$9.43
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$8.94
|
| Rate for Payer: Anthem Medicare Advantage |
$5.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$16.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5.39
|
| Rate for Payer: Cash Price |
$9.06
|
| Rate for Payer: Cash Price |
$9.06
|
| Rate for Payer: Cigna Commercial |
$28.89
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$5.39
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$17.57
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$5.39
|
| Rate for Payer: Health EOS Commercial |
$27.94
|
| Rate for Payer: HFN Commercial |
$28.89
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$20.04
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$5.39
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5.39
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$5.39
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$5.39
|
| Rate for Payer: Multiplan Commercial |
$25.12
|
| Rate for Payer: NAPHCARE Commercial |
$8.08
|
| Rate for Payer: Preferred Network Access Commercial |
$28.89
|
| Rate for Payer: Quartz Beloit One Network |
$15.38
|
| Rate for Payer: Quartz Commercial |
$20.41
|
| Rate for Payer: Quartz Medicare Advantage |
$5.39
|
| Rate for Payer: The Alliance Commercial |
$21.55
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.39
|
| Rate for Payer: United Healthcare PPO |
$23.55
|
| Rate for Payer: WEA Trust Commercial |
$17.27
|
| Rate for Payer: Wellcare Medicare |
$5.39
|
| Rate for Payer: WPS Commercial |
$23.26
|
|
|
Vanillylmandelic Acid, Random Urine
|
Facility
|
IP
|
$30.19
|
|
|
Service Code
|
CPT 82570
|
| Hospital Charge Code |
4076077
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.38 |
| Max. Negotiated Rate |
$28.89 |
| Rate for Payer: Aetna Commercial |
$28.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$27.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$16.64
|
| Rate for Payer: Cash Price |
$9.06
|
| Rate for Payer: Cigna Commercial |
$28.89
|
| Rate for Payer: Health EOS Commercial |
$27.94
|
| Rate for Payer: HFN Commercial |
$28.89
|
| Rate for Payer: Multiplan Commercial |
$25.12
|
| Rate for Payer: Preferred Network Access Commercial |
$28.89
|
| Rate for Payer: Quartz Beloit One Network |
$15.38
|
| Rate for Payer: Quartz Commercial |
$18.84
|
| Rate for Payer: WEA Trust Commercial |
$17.27
|
| Rate for Payer: WPS Commercial |
$23.26
|
|
|
Vanillylmandelic Acid, Random Urine
|
Professional
|
Both
|
$30.19
|
|
|
Service Code
|
CPT 82570
|
| Hospital Charge Code |
4076077
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.39 |
| Max. Negotiated Rate |
$29.83 |
| Rate for Payer: Aetna Commercial |
$29.83
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$27.00
|
| Rate for Payer: Aetna Managed Medicare |
$5.39
|
| Rate for Payer: Anthem Medicare Advantage |
$5.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5.39
|
| Rate for Payer: Cash Price |
$9.06
|
| Rate for Payer: Cash Price |
$9.06
|
| Rate for Payer: Cigna Commercial |
$29.83
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$15.70
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5.39
|
| Rate for Payer: Health EOS Commercial |
$28.57
|
| Rate for Payer: HFN Commercial |
$29.83
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$19.02
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$19.02
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5.39
|
| Rate for Payer: Multiplan Commercial |
$25.12
|
| Rate for Payer: NAPHCARE Commercial |
$8.08
|
| Rate for Payer: Preferred Network Access Commercial |
$29.83
|
| Rate for Payer: Quartz Beloit One Network |
$13.81
|
| Rate for Payer: Quartz Commercial |
$17.90
|
| Rate for Payer: Quartz Medicare Advantage |
$5.39
|
| Rate for Payer: The Alliance Commercial |
$21.28
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.39
|
| Rate for Payer: WEA Trust Commercial |
$17.27
|
| Rate for Payer: WPS Commercial |
$23.70
|
|
|
Varicella Zoster Antibody IgG
|
Facility
|
OP
|
$244.00
|
|
|
Service Code
|
CPT 86787
|
| Hospital Charge Code |
980591
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.40 |
| Max. Negotiated Rate |
$233.46 |
| Rate for Payer: Aetna Commercial |
$228.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$218.23
|
| 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 |
$134.49
|
| 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 |
$73.20
|
| Rate for Payer: Cash Price |
$73.20
|
| Rate for Payer: Cigna Commercial |
$233.46
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$13.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$142.01
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$13.40
|
| Rate for Payer: Health EOS Commercial |
$225.85
|
| Rate for Payer: HFN Commercial |
$233.46
|
| 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 |
$203.01
|
| Rate for Payer: NAPHCARE Commercial |
$20.09
|
| Rate for Payer: Preferred Network Access Commercial |
$233.46
|
| Rate for Payer: Quartz Beloit One Network |
$124.34
|
| Rate for Payer: Quartz Commercial |
$164.94
|
| 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 |
$190.32
|
| Rate for Payer: WEA Trust Commercial |
$139.57
|
| Rate for Payer: Wellcare Medicare |
$13.40
|
| Rate for Payer: WPS Commercial |
$187.95
|
|
|
Varicella Zoster Antibody IgG
|
Professional
|
Both
|
$244.00
|
|
|
Service Code
|
CPT 86787
|
| Hospital Charge Code |
980591
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.40 |
| Max. Negotiated Rate |
$241.07 |
| Rate for Payer: Aetna Commercial |
$241.07
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$218.23
|
| 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 |
$73.20
|
| Rate for Payer: Cash Price |
$73.20
|
| Rate for Payer: Cigna Commercial |
$241.07
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$126.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$13.40
|
| Rate for Payer: Health EOS Commercial |
$230.92
|
| Rate for Payer: HFN Commercial |
$241.07
|
| 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 |
$203.01
|
| Rate for Payer: NAPHCARE Commercial |
$20.09
|
| Rate for Payer: Preferred Network Access Commercial |
$241.07
|
| Rate for Payer: Quartz Beloit One Network |
$111.65
|
| Rate for Payer: Quartz Commercial |
$144.64
|
| 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 |
$139.57
|
| Rate for Payer: WPS Commercial |
$58.94
|
|
