|
VALVULOTOME TRU-INCISE TIVK2030
|
Facility
|
OP
|
$4,805.00
|
|
| Hospital Charge Code |
2973635
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,345.40 |
| Max. Negotiated Rate |
$19,220.00 |
| Rate for Payer: Aetna Commercial |
$4,324.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,132.30
|
| Rate for Payer: Aetna Managed Medicare |
$1,345.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,123.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,402.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,306.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,546.65
|
| Rate for Payer: Cash Price |
$1,441.50
|
| Rate for Payer: Cigna Commercial |
$4,420.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,688.88
|
| Rate for Payer: Health EOS Commercial |
$4,276.45
|
| Rate for Payer: HFN Commercial |
$4,420.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,603.75
|
| Rate for Payer: Multiplan Commercial |
$3,844.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,883.00
|
| Rate for Payer: Preferred Network Access Commercial |
$4,420.60
|
| Rate for Payer: Quartz Beloit One Network |
$2,354.45
|
| Rate for Payer: Quartz Commercial |
$3,123.25
|
| Rate for Payer: Quartz Medicare Advantage |
$2,883.00
|
| Rate for Payer: The Alliance Commercial |
$19,220.00
|
| Rate for Payer: WEA Trust Commercial |
$2,642.75
|
| Rate for Payer: WPS Commercial |
$3,559.06
|
|
|
Vancomycin
|
Facility
|
IP
|
$32.00
|
|
|
Service Code
|
HCPCS J3370
|
| Hospital Charge Code |
4075402
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.68 |
| Max. Negotiated Rate |
$29.44 |
| Rate for Payer: Aetna Commercial |
$28.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$27.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$16.96
|
| Rate for Payer: Cash Price |
$9.60
|
| Rate for Payer: Cigna Commercial |
$29.44
|
| Rate for Payer: Health EOS Commercial |
$28.48
|
| Rate for Payer: HFN Commercial |
$29.44
|
| Rate for Payer: Multiplan Commercial |
$25.60
|
| Rate for Payer: NAPHCARE Commercial |
$19.20
|
| Rate for Payer: Preferred Network Access Commercial |
$29.44
|
| Rate for Payer: Quartz Beloit One Network |
$15.68
|
| Rate for Payer: Quartz Commercial |
$19.20
|
| Rate for Payer: WEA Trust Commercial |
$17.60
|
| Rate for Payer: WPS Commercial |
$23.70
|
|
|
Vancomycin
|
Facility
|
OP
|
$32.00
|
|
|
Service Code
|
HCPCS J3370
|
| Hospital Charge Code |
4075402
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.41 |
| Max. Negotiated Rate |
$128.00 |
| Rate for Payer: Aetna Commercial |
$28.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$27.52
|
| Rate for Payer: Aetna Managed Medicare |
$8.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$20.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$16.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$15.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$16.96
|
| Rate for Payer: Cash Price |
$9.60
|
| Rate for Payer: Cash Price |
$9.60
|
| Rate for Payer: Cigna Commercial |
$29.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3.41
|
| Rate for Payer: Health EOS Commercial |
$28.48
|
| Rate for Payer: HFN Commercial |
$29.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$24.00
|
| Rate for Payer: Multiplan Commercial |
$25.60
|
| Rate for Payer: NAPHCARE Commercial |
$19.20
|
| Rate for Payer: Preferred Network Access Commercial |
$29.44
|
| Rate for Payer: Quartz Beloit One Network |
$15.68
|
| Rate for Payer: Quartz Commercial |
$20.80
|
| Rate for Payer: Quartz Medicare Advantage |
$19.20
|
| Rate for Payer: The Alliance Commercial |
$128.00
|
| Rate for Payer: WEA Trust Commercial |
$17.60
|
| Rate for Payer: WPS Commercial |
$6.44
|
|
|
Vancomycin, Kinetics
|
Facility
|
OP
|
$279.00
|
|
|
Service Code
|
CPT 80202
|
| Hospital Charge Code |
979882
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.54 |
| Max. Negotiated Rate |
$256.68 |
| Rate for Payer: Aetna Commercial |
$251.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$239.94
|
| Rate for Payer: Aetna Managed Medicare |
$13.54
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$50.78
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$23.70
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$22.48
|
| Rate for Payer: Anthem Medicaid |
$13.99
|
| Rate for Payer: Anthem Medicare Advantage |
$13.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$147.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$13.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$13.54
|
| Rate for Payer: Cash Price |
$83.70
|
| Rate for Payer: Cash Price |
$83.70
|
| Rate for Payer: Cigna Commercial |
$256.68
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$13.54
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$13.99
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$156.13
|
| Rate for Payer: Dean Health Medicaid |
$13.99
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$13.54
|
| Rate for Payer: Health EOS Commercial |
$248.31
|
| Rate for Payer: HFN Commercial |
$256.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$50.37
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$13.54
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$13.99
|
| Rate for Payer: Independent Care Health Plan Medicare |
$13.54
|
| Rate for Payer: Managed Health Services Medicaid |
$14.55
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$13.54
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$13.54
|
| Rate for Payer: Multiplan Commercial |
$223.20
|
| Rate for Payer: NAPHCARE Commercial |
$20.31
|
| Rate for Payer: Preferred Network Access Commercial |
$256.68
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$13.99
|
| Rate for Payer: Quartz Beloit One Network |
$136.71
|
| Rate for Payer: Quartz Commercial |
$181.35
|
| Rate for Payer: Quartz Medicare Advantage |
$13.54
|
| Rate for Payer: The Alliance Commercial |
$54.16
|
| Rate for Payer: United Healthcare Medicaid |
$13.99
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.54
|
| Rate for Payer: United Healthcare PPO |
$209.25
|
| Rate for Payer: WEA Trust Commercial |
$153.45
|
| Rate for Payer: Wellcare Medicare |
$13.54
|
| Rate for Payer: WMAP Medicaid |
$13.99
|
| Rate for Payer: WPS Commercial |
$206.66
|
|
|
Vancomycin, Kinetics
|
Facility
|
IP
|
$279.00
|
|
|
Service Code
|
CPT 80202
|
| Hospital Charge Code |
979882
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$136.71 |
| Max. Negotiated Rate |
$256.68 |
| Rate for Payer: Aetna Commercial |
$251.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$239.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$147.87
|
| Rate for Payer: Cash Price |
$83.70
|
| Rate for Payer: Cigna Commercial |
$256.68
|
| Rate for Payer: Health EOS Commercial |
$248.31
|
| Rate for Payer: HFN Commercial |
$256.68
|
| Rate for Payer: Multiplan Commercial |
$223.20
|
| Rate for Payer: NAPHCARE Commercial |
$167.40
|
| Rate for Payer: Preferred Network Access Commercial |
$256.68
|
| Rate for Payer: Quartz Beloit One Network |
$136.71
|
| Rate for Payer: Quartz Commercial |
$167.40
|
| Rate for Payer: WEA Trust Commercial |
$153.45
|
| Rate for Payer: WPS Commercial |
$206.66
|
|
|
Vancomycin, Kinetics
|
Professional
|
Both
|
$279.00
|
|
|
Service Code
|
CPT 80202
|
| Hospital Charge Code |
979882
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$47.80 |
| Max. Negotiated Rate |
$265.05 |
| Rate for Payer: Aetna Commercial |
$265.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$239.94
|
| Rate for Payer: Cash Price |
$83.70
|
| Rate for Payer: Cash Price |
$83.70
|
| Rate for Payer: Cigna Commercial |
$265.05
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$139.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$167.40
|
| Rate for Payer: Health EOS Commercial |
$253.89
|
| Rate for Payer: HFN Commercial |
$265.05
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$47.80
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$47.80
|
| Rate for Payer: Multiplan Commercial |
$223.20
|
| Rate for Payer: Preferred Network Access Commercial |
$265.05
|
| Rate for Payer: Quartz Beloit One Network |
$122.76
|
| Rate for Payer: Quartz Commercial |
$159.03
|
| Rate for Payer: The Alliance Commercial |
$139.50
|
| Rate for Payer: WEA Trust Commercial |
$153.45
|
| Rate for Payer: WPS Commercial |
$206.66
|
|
|
Vancomycin Level Peak
|
Professional
|
Both
|
$262.00
|
|
|
Service Code
|
CPT 80202
|
| Hospital Charge Code |
633869
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$47.80 |
| Max. Negotiated Rate |
$248.90 |
| Rate for Payer: Aetna Commercial |
$248.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$225.32
|
| Rate for Payer: Cash Price |
$78.60
|
| Rate for Payer: Cash Price |
$78.60
|
| Rate for Payer: Cigna Commercial |
$248.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$131.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$157.20
|
| Rate for Payer: Health EOS Commercial |
$238.42
|
| Rate for Payer: HFN Commercial |
$248.90
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$47.80
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$47.80
|
| Rate for Payer: Multiplan Commercial |
$209.60
|
| Rate for Payer: Preferred Network Access Commercial |
$248.90
|
| Rate for Payer: Quartz Beloit One Network |
$115.28
|
| Rate for Payer: Quartz Commercial |
$149.34
|
| Rate for Payer: The Alliance Commercial |
$131.00
|
| Rate for Payer: WEA Trust Commercial |
$144.10
|
| Rate for Payer: WPS Commercial |
$194.06
|
|
|
Vancomycin Level Peak
|
Facility
|
IP
|
$262.00
|
|
|
Service Code
|
CPT 80202
|
| Hospital Charge Code |
633869
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$128.38 |
| Max. Negotiated Rate |
$241.04 |
| Rate for Payer: Aetna Commercial |
$235.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$225.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$138.86
|
| Rate for Payer: Cash Price |
$78.60
|
| Rate for Payer: Cigna Commercial |
$241.04
|
| Rate for Payer: Health EOS Commercial |
$233.18
|
| Rate for Payer: HFN Commercial |
$241.04
|
| Rate for Payer: Multiplan Commercial |
$209.60
|
| Rate for Payer: NAPHCARE Commercial |
$157.20
|
| Rate for Payer: Preferred Network Access Commercial |
$241.04
|
| Rate for Payer: Quartz Beloit One Network |
$128.38
|
| Rate for Payer: Quartz Commercial |
$157.20
|
| Rate for Payer: WEA Trust Commercial |
$144.10
|
| Rate for Payer: WPS Commercial |
$194.06
|
|
|
Vancomycin Level Peak
|
Facility
|
OP
|
$262.00
|
|
|
Service Code
|
CPT 80202
|
| Hospital Charge Code |
633869
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.54 |
| Max. Negotiated Rate |
$241.04 |
| Rate for Payer: Aetna Commercial |
$235.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$225.32
|
| Rate for Payer: Aetna Managed Medicare |
$13.54
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$50.78
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$23.70
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$22.48
|
| Rate for Payer: Anthem Medicaid |
$13.99
|
| Rate for Payer: Anthem Medicare Advantage |
$13.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$138.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$13.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$13.54
|
| Rate for Payer: Cash Price |
$78.60
|
| Rate for Payer: Cash Price |
$78.60
|
| Rate for Payer: Cigna Commercial |
$241.04
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$13.54
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$13.99
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$146.62
|
| Rate for Payer: Dean Health Medicaid |
$13.99
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$13.54
|
| Rate for Payer: Health EOS Commercial |
$233.18
|
| Rate for Payer: HFN Commercial |
$241.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$50.37
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$13.54
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$13.99
|
| Rate for Payer: Independent Care Health Plan Medicare |
$13.54
|
| Rate for Payer: Managed Health Services Medicaid |
$14.55
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$13.54
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$13.54
|
| Rate for Payer: Multiplan Commercial |
$209.60
|
| Rate for Payer: NAPHCARE Commercial |
$20.31
|
| Rate for Payer: Preferred Network Access Commercial |
$241.04
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$13.99
|
| Rate for Payer: Quartz Beloit One Network |
$128.38
|
| Rate for Payer: Quartz Commercial |
$170.30
|
| Rate for Payer: Quartz Medicare Advantage |
$13.54
|
| Rate for Payer: The Alliance Commercial |
$54.16
|
| Rate for Payer: United Healthcare Medicaid |
$13.99
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.54
|
| Rate for Payer: United Healthcare PPO |
$196.50
|
| Rate for Payer: WEA Trust Commercial |
$144.10
|
| Rate for Payer: Wellcare Medicare |
$13.54
|
| Rate for Payer: WMAP Medicaid |
$13.99
|
| Rate for Payer: WPS Commercial |
$194.06
|
|
|
Vancomycin Level Trough
|
Facility
|
OP
|
$279.00
|
|
|
Service Code
|
CPT 80202
|
| Hospital Charge Code |
633870
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.54 |
| Max. Negotiated Rate |
$256.68 |
| Rate for Payer: Aetna Commercial |
$251.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$239.94
|
| Rate for Payer: Aetna Managed Medicare |
$13.54
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$50.78
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$23.70
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$22.48
|
| Rate for Payer: Anthem Medicaid |
$13.99
|
| Rate for Payer: Anthem Medicare Advantage |
$13.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$147.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$13.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$13.54
|
| Rate for Payer: Cash Price |
$83.70
|
| Rate for Payer: Cash Price |
$83.70
|
| Rate for Payer: Cigna Commercial |
$256.68
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$13.54
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$13.99
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$156.13
|
| Rate for Payer: Dean Health Medicaid |
$13.99
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$13.54
|
| Rate for Payer: Health EOS Commercial |
$248.31
|
| Rate for Payer: HFN Commercial |
$256.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$50.37
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$13.54
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$13.99
|
| Rate for Payer: Independent Care Health Plan Medicare |
$13.54
|
| Rate for Payer: Managed Health Services Medicaid |
$14.55
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$13.54
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$13.54
|
| Rate for Payer: Multiplan Commercial |
$223.20
|
| Rate for Payer: NAPHCARE Commercial |
$20.31
|
| Rate for Payer: Preferred Network Access Commercial |
$256.68
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$13.99
|
| Rate for Payer: Quartz Beloit One Network |
$136.71
|
| Rate for Payer: Quartz Commercial |
$181.35
|
| Rate for Payer: Quartz Medicare Advantage |
$13.54
|
| Rate for Payer: The Alliance Commercial |
$54.16
|
| Rate for Payer: United Healthcare Medicaid |
$13.99
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.54
|
| Rate for Payer: United Healthcare PPO |
$209.25
|
| Rate for Payer: WEA Trust Commercial |
$153.45
|
| Rate for Payer: Wellcare Medicare |
$13.54
|
| Rate for Payer: WMAP Medicaid |
$13.99
|
| Rate for Payer: WPS Commercial |
$206.66
|
|
|
Vancomycin Level Trough
|
Professional
|
Both
|
$279.00
|
|
|
Service Code
|
CPT 80202
|
| Hospital Charge Code |
633870
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$47.80 |
| Max. Negotiated Rate |
$265.05 |
| Rate for Payer: Aetna Commercial |
$265.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$239.94
|
| Rate for Payer: Cash Price |
$83.70
|
| Rate for Payer: Cash Price |
$83.70
|
| Rate for Payer: Cigna Commercial |
$265.05
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$139.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$167.40
|
| Rate for Payer: Health EOS Commercial |
$253.89
|
| Rate for Payer: HFN Commercial |
$265.05
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$47.80
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$47.80
|
| Rate for Payer: Multiplan Commercial |
$223.20
|
| Rate for Payer: Preferred Network Access Commercial |
$265.05
|
| Rate for Payer: Quartz Beloit One Network |
$122.76
|
| Rate for Payer: Quartz Commercial |
$159.03
|
| Rate for Payer: The Alliance Commercial |
$139.50
|
| Rate for Payer: WEA Trust Commercial |
$153.45
|
| Rate for Payer: WPS Commercial |
$206.66
|
|
|
Vancomycin Level Trough
|
Facility
|
IP
|
$279.00
|
|
|
Service Code
|
CPT 80202
|
| Hospital Charge Code |
633870
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$136.71 |
| Max. Negotiated Rate |
$256.68 |
| Rate for Payer: Aetna Commercial |
$251.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$239.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$147.87
|
| Rate for Payer: Cash Price |
$83.70
|
| Rate for Payer: Cigna Commercial |
$256.68
|
| Rate for Payer: Health EOS Commercial |
$248.31
|
| Rate for Payer: HFN Commercial |
$256.68
|
| Rate for Payer: Multiplan Commercial |
$223.20
|
| Rate for Payer: NAPHCARE Commercial |
$167.40
|
| Rate for Payer: Preferred Network Access Commercial |
$256.68
|
| Rate for Payer: Quartz Beloit One Network |
$136.71
|
| Rate for Payer: Quartz Commercial |
$167.40
|
| Rate for Payer: WEA Trust Commercial |
$153.45
|
| Rate for Payer: WPS Commercial |
$206.66
|
|
|
Vancomycin Powder 1gm Vial (MED)
|
Facility
|
OP
|
$185.00
|
|
|
Service Code
|
HCPCS J3370
|
| Hospital Charge Code |
5298713
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.41 |
| Max. Negotiated Rate |
$740.00 |
| Rate for Payer: Aetna Commercial |
$166.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$159.10
|
| Rate for Payer: Aetna Managed Medicare |
$51.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$120.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$92.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$88.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$98.05
|
| Rate for Payer: Cash Price |
$55.50
|
| Rate for Payer: Cash Price |
$55.50
|
| Rate for Payer: Cigna Commercial |
$170.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3.41
|
| Rate for Payer: Health EOS Commercial |
$164.65
|
| Rate for Payer: HFN Commercial |
$170.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$138.75
|
| Rate for Payer: Multiplan Commercial |
$148.00
|
| Rate for Payer: NAPHCARE Commercial |
$111.00
|
| Rate for Payer: Preferred Network Access Commercial |
$170.20
|
| Rate for Payer: Quartz Beloit One Network |
$90.65
|
| Rate for Payer: Quartz Commercial |
$120.25
|
| Rate for Payer: Quartz Medicare Advantage |
$111.00
|
| Rate for Payer: The Alliance Commercial |
$740.00
|
| Rate for Payer: WEA Trust Commercial |
$101.75
|
| Rate for Payer: WPS Commercial |
$6.44
|
|
|
Vancomycin Powder 1gm Vial (MED)
|
Facility
|
IP
|
$185.00
|
|
|
Service Code
|
HCPCS J3370
|
| Hospital Charge Code |
5298713
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$90.65 |
| Max. Negotiated Rate |
$170.20 |
| Rate for Payer: Aetna Commercial |
$166.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$159.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$98.05
|
| Rate for Payer: Cash Price |
$55.50
|
| Rate for Payer: Cigna Commercial |
$170.20
|
| Rate for Payer: Health EOS Commercial |
$164.65
|
| Rate for Payer: HFN Commercial |
$170.20
|
| Rate for Payer: Multiplan Commercial |
$148.00
|
| Rate for Payer: NAPHCARE Commercial |
$111.00
|
| Rate for Payer: Preferred Network Access Commercial |
$170.20
|
| Rate for Payer: Quartz Beloit One Network |
$90.65
|
| Rate for Payer: Quartz Commercial |
$111.00
|
| Rate for Payer: WEA Trust Commercial |
$101.75
|
| Rate for Payer: WPS Commercial |
$137.03
|
|
|
Vanillylmandelic Acid 24 Hour Urine
|
Facility
|
OP
|
$450.00
|
|
|
Service Code
|
CPT 84585
|
| Hospital Charge Code |
978095
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.50 |
| Max. Negotiated Rate |
$414.00 |
| Rate for Payer: Aetna Commercial |
$405.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$387.00
|
| Rate for Payer: Aetna Managed Medicare |
$15.50
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$58.12
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$27.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$25.73
|
| Rate for Payer: Anthem Medicaid |
$16.02
|
| Rate for Payer: Anthem Medicare Advantage |
$15.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$238.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$15.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$15.50
|
| Rate for Payer: Cash Price |
$135.00
|
| Rate for Payer: Cash Price |
$135.00
|
| Rate for Payer: Cigna Commercial |
$414.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$15.50
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$16.02
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$251.82
|
| Rate for Payer: Dean Health Medicaid |
$16.02
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$15.50
|
| Rate for Payer: Health EOS Commercial |
$400.50
|
| Rate for Payer: HFN Commercial |
$414.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$57.66
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$15.50
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$16.02
|
| Rate for Payer: Independent Care Health Plan Medicare |
$15.50
|
| Rate for Payer: Managed Health Services Medicaid |
$16.66
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$15.50
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$15.50
|
| Rate for Payer: Multiplan Commercial |
$360.00
|
| Rate for Payer: NAPHCARE Commercial |
$23.25
|
| Rate for Payer: Preferred Network Access Commercial |
$414.00
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$16.02
|
| Rate for Payer: Quartz Beloit One Network |
$220.50
|
| Rate for Payer: Quartz Commercial |
$292.50
|
| Rate for Payer: Quartz Medicare Advantage |
$15.50
|
| Rate for Payer: The Alliance Commercial |
$62.00
|
| Rate for Payer: United Healthcare Medicaid |
$16.02
|
| Rate for Payer: United Healthcare Medicare Advantage |
$15.50
|
| Rate for Payer: United Healthcare PPO |
$337.50
|
| Rate for Payer: WEA Trust Commercial |
$247.50
|
| Rate for Payer: Wellcare Medicare |
$15.50
|
| Rate for Payer: WMAP Medicaid |
$16.02
|
| Rate for Payer: WPS Commercial |
$333.32
|
|
|
Vanillylmandelic Acid 24 Hour Urine
|
Professional
|
Both
|
$450.00
|
|
|
Service Code
|
CPT 84585
|
| Hospital Charge Code |
978095
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$54.72 |
| Max. Negotiated Rate |
$427.50 |
| Rate for Payer: Aetna Commercial |
$427.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$387.00
|
| Rate for Payer: Cash Price |
$135.00
|
| Rate for Payer: Cash Price |
$135.00
|
| Rate for Payer: Cigna Commercial |
$427.50
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$225.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$270.00
|
| Rate for Payer: Health EOS Commercial |
$409.50
|
| Rate for Payer: HFN Commercial |
$427.50
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$54.72
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$54.72
|
| Rate for Payer: Multiplan Commercial |
$360.00
|
| Rate for Payer: Preferred Network Access Commercial |
$427.50
|
| Rate for Payer: Quartz Beloit One Network |
$198.00
|
| Rate for Payer: Quartz Commercial |
$256.50
|
| Rate for Payer: The Alliance Commercial |
$225.00
|
| Rate for Payer: WEA Trust Commercial |
$247.50
|
| Rate for Payer: WPS Commercial |
$333.32
|
|
|
Vanillylmandelic Acid 24 Hour Urine
|
Facility
|
IP
|
$450.00
|
|
|
Service Code
|
CPT 84585
|
| Hospital Charge Code |
978095
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$220.50 |
| Max. Negotiated Rate |
$414.00 |
| Rate for Payer: Aetna Commercial |
$405.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$387.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$238.50
|
| Rate for Payer: Cash Price |
$135.00
|
| Rate for Payer: Cigna Commercial |
$414.00
|
| Rate for Payer: Health EOS Commercial |
$400.50
|
| Rate for Payer: HFN Commercial |
$414.00
|
| Rate for Payer: Multiplan Commercial |
$360.00
|
| Rate for Payer: NAPHCARE Commercial |
$270.00
|
| Rate for Payer: Preferred Network Access Commercial |
$414.00
|
| Rate for Payer: Quartz Beloit One Network |
$220.50
|
| Rate for Payer: Quartz Commercial |
$270.00
|
| Rate for Payer: WEA Trust Commercial |
$247.50
|
| Rate for Payer: WPS Commercial |
$333.32
|
|
|
Vanillylmandelic Acid, Random Urine
|
Facility
|
IP
|
$30.19
|
|
|
Service Code
|
CPT 82570
|
| Hospital Charge Code |
4076077
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.79 |
| Max. Negotiated Rate |
$27.77 |
| Rate for Payer: Aetna Commercial |
$27.17
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$25.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$16.00
|
| Rate for Payer: Cash Price |
$9.06
|
| Rate for Payer: Cigna Commercial |
$27.77
|
| Rate for Payer: Health EOS Commercial |
$26.87
|
| Rate for Payer: HFN Commercial |
$27.77
|
| Rate for Payer: Multiplan Commercial |
$24.15
|
| Rate for Payer: NAPHCARE Commercial |
$18.11
|
| Rate for Payer: Preferred Network Access Commercial |
$27.77
|
| Rate for Payer: Quartz Beloit One Network |
$14.79
|
| Rate for Payer: Quartz Commercial |
$18.11
|
| Rate for Payer: WEA Trust Commercial |
$16.60
|
| Rate for Payer: WPS Commercial |
$22.36
|
|
|
Vanillylmandelic Acid, Random Urine
|
Facility
|
OP
|
$30.19
|
|
|
Service Code
|
CPT 82570
|
| Hospital Charge Code |
4076077
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.18 |
| Max. Negotiated Rate |
$27.77 |
| Rate for Payer: Aetna Commercial |
$27.17
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$25.96
|
| Rate for Payer: Aetna Managed Medicare |
$5.18
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$19.42
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$9.06
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$8.60
|
| Rate for Payer: Anthem Medicaid |
$5.35
|
| Rate for Payer: Anthem Medicare Advantage |
$5.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$16.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5.18
|
| Rate for Payer: Cash Price |
$9.06
|
| Rate for Payer: Cash Price |
$9.06
|
| Rate for Payer: Cigna Commercial |
$27.77
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$5.18
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$5.35
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$16.89
|
| Rate for Payer: Dean Health Medicaid |
$5.35
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$5.18
|
| Rate for Payer: Health EOS Commercial |
$26.87
|
| Rate for Payer: HFN Commercial |
$27.77
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$19.27
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$5.18
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$5.35
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5.18
|
| Rate for Payer: Managed Health Services Medicaid |
$5.56
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$5.18
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$5.18
|
| Rate for Payer: Multiplan Commercial |
$24.15
|
| Rate for Payer: NAPHCARE Commercial |
$7.77
|
| Rate for Payer: Preferred Network Access Commercial |
$27.77
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$5.35
|
| Rate for Payer: Quartz Beloit One Network |
$14.79
|
| Rate for Payer: Quartz Commercial |
$19.62
|
| Rate for Payer: Quartz Medicare Advantage |
$5.18
|
| Rate for Payer: The Alliance Commercial |
$20.72
|
| Rate for Payer: United Healthcare Medicaid |
$5.35
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.18
|
| Rate for Payer: United Healthcare PPO |
$22.64
|
| Rate for Payer: WEA Trust Commercial |
$16.60
|
| Rate for Payer: Wellcare Medicare |
$5.18
|
| Rate for Payer: WMAP Medicaid |
$5.35
|
| Rate for Payer: WPS Commercial |
$22.36
|
|
|
Vanillylmandelic Acid, Random Urine
|
Professional
|
Both
|
$30.19
|
|
|
Service Code
|
CPT 82570
|
| Hospital Charge Code |
4076077
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.28 |
| Max. Negotiated Rate |
$28.68 |
| Rate for Payer: Aetna Commercial |
$28.68
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$25.96
|
| Rate for Payer: Cash Price |
$9.06
|
| Rate for Payer: Cash Price |
$9.06
|
| Rate for Payer: Cigna Commercial |
$28.68
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$15.10
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$18.11
|
| Rate for Payer: Health EOS Commercial |
$27.47
|
| Rate for Payer: HFN Commercial |
$28.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$18.29
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$18.29
|
| Rate for Payer: Multiplan Commercial |
$24.15
|
| Rate for Payer: Preferred Network Access Commercial |
$28.68
|
| Rate for Payer: Quartz Beloit One Network |
$13.28
|
| Rate for Payer: Quartz Commercial |
$17.21
|
| Rate for Payer: The Alliance Commercial |
$15.10
|
| Rate for Payer: WEA Trust Commercial |
$16.60
|
| Rate for Payer: WPS Commercial |
$22.36
|
|
|
Varicella Zoster Antibody IgG
|
Professional
|
Both
|
$244.00
|
|
|
Service Code
|
CPT 86787
|
| Hospital Charge Code |
980591
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$45.47 |
| Max. Negotiated Rate |
$231.80 |
| Rate for Payer: Aetna Commercial |
$231.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$209.84
|
| Rate for Payer: Cash Price |
$73.20
|
| Rate for Payer: Cash Price |
$73.20
|
| Rate for Payer: Cigna Commercial |
$231.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$122.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$146.40
|
| Rate for Payer: Health EOS Commercial |
$222.04
|
| Rate for Payer: HFN Commercial |
$231.80
|
| 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 |
$195.20
|
| Rate for Payer: Preferred Network Access Commercial |
$231.80
|
| Rate for Payer: Quartz Beloit One Network |
$107.36
|
| Rate for Payer: Quartz Commercial |
$139.08
|
| Rate for Payer: The Alliance Commercial |
$122.00
|
| Rate for Payer: WEA Trust Commercial |
$134.20
|
| Rate for Payer: WPS Commercial |
$180.73
|
|
|
Varicella Zoster Antibody IgG
|
Facility
|
OP
|
$244.00
|
|
|
Service Code
|
CPT 86787
|
| Hospital Charge Code |
980591
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.17 |
| Max. Negotiated Rate |
$224.48 |
| Rate for Payer: Aetna Commercial |
$219.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$209.84
|
| 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 |
$129.32
|
| 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 |
$73.20
|
| Rate for Payer: Cash Price |
$73.20
|
| Rate for Payer: Cigna Commercial |
$224.48
|
| 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 |
$136.54
|
| 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 |
$217.16
|
| Rate for Payer: HFN Commercial |
$224.48
|
| 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 |
$195.20
|
| Rate for Payer: NAPHCARE Commercial |
$19.32
|
| Rate for Payer: Preferred Network Access Commercial |
$224.48
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$8.17
|
| Rate for Payer: Quartz Beloit One Network |
$119.56
|
| Rate for Payer: Quartz Commercial |
$158.60
|
| 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 |
$183.00
|
| Rate for Payer: WEA Trust Commercial |
$134.20
|
| Rate for Payer: Wellcare Medicare |
$12.88
|
| Rate for Payer: WMAP Medicaid |
$8.17
|
| Rate for Payer: WPS Commercial |
$180.73
|
|
|
Varicella Zoster Antibody IgG
|
Facility
|
IP
|
$244.00
|
|
|
Service Code
|
CPT 86787
|
| Hospital Charge Code |
980591
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$119.56 |
| Max. Negotiated Rate |
$224.48 |
| Rate for Payer: Aetna Commercial |
$219.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$209.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$129.32
|
| Rate for Payer: Cash Price |
$73.20
|
| Rate for Payer: Cigna Commercial |
$224.48
|
| Rate for Payer: Health EOS Commercial |
$217.16
|
| Rate for Payer: HFN Commercial |
$224.48
|
| Rate for Payer: Multiplan Commercial |
$195.20
|
| Rate for Payer: NAPHCARE Commercial |
$146.40
|
| Rate for Payer: Preferred Network Access Commercial |
$224.48
|
| Rate for Payer: Quartz Beloit One Network |
$119.56
|
| Rate for Payer: Quartz Commercial |
$146.40
|
| Rate for Payer: WEA Trust Commercial |
$134.20
|
| Rate for Payer: WPS Commercial |
$180.73
|
|
|
Varicella Zoster Antibody IgM
|
Facility
|
OP
|
$34.00
|
|
|
Service Code
|
CPT 86787
|
| Hospital Charge Code |
3403606
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.17 |
| Max. Negotiated Rate |
$51.52 |
| Rate for Payer: Aetna Commercial |
$30.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$29.24
|
| 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 |
$18.02
|
| 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 |
$10.20
|
| Rate for Payer: Cash Price |
$10.20
|
| Rate for Payer: Cigna Commercial |
$31.28
|
| 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 |
$19.03
|
| 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 |
$30.26
|
| Rate for Payer: HFN Commercial |
$31.28
|
| 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 |
$27.20
|
| Rate for Payer: NAPHCARE Commercial |
$19.32
|
| Rate for Payer: Preferred Network Access Commercial |
$31.28
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$8.17
|
| Rate for Payer: Quartz Beloit One Network |
$16.66
|
| Rate for Payer: Quartz Commercial |
$22.10
|
| 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 |
$25.50
|
| Rate for Payer: WEA Trust Commercial |
$18.70
|
| Rate for Payer: Wellcare Medicare |
$12.88
|
| Rate for Payer: WMAP Medicaid |
$8.17
|
| Rate for Payer: WPS Commercial |
$25.18
|
|
|
Varicella Zoster Antibody IgM
|
Facility
|
IP
|
$34.00
|
|
|
Service Code
|
CPT 86787
|
| Hospital Charge Code |
3403606
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$16.66 |
| Max. Negotiated Rate |
$31.28 |
| Rate for Payer: Aetna Commercial |
$30.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$29.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$18.02
|
| Rate for Payer: Cash Price |
$10.20
|
| Rate for Payer: Cigna Commercial |
$31.28
|
| Rate for Payer: Health EOS Commercial |
$30.26
|
| Rate for Payer: HFN Commercial |
$31.28
|
| Rate for Payer: Multiplan Commercial |
$27.20
|
| Rate for Payer: NAPHCARE Commercial |
$20.40
|
| Rate for Payer: Preferred Network Access Commercial |
$31.28
|
| Rate for Payer: Quartz Beloit One Network |
$16.66
|
| Rate for Payer: Quartz Commercial |
$20.40
|
| Rate for Payer: WEA Trust Commercial |
$18.70
|
| Rate for Payer: WPS Commercial |
$25.18
|
|
