|
VASCULAR STUDY 9397926
|
Professional
|
Both
|
$254.00
|
|
|
Service Code
|
CPT 93979 26
|
| Hospital Charge Code |
3015444
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$22.32 |
| Max. Negotiated Rate |
$250.95 |
| Rate for Payer: Aetna Commercial |
$250.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$227.18
|
| Rate for Payer: Aetna Managed Medicare |
$22.32
|
| Rate for Payer: Anthem Medicare Advantage |
$22.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$22.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$22.32
|
| Rate for Payer: Cash Price |
$76.20
|
| Rate for Payer: Cash Price |
$76.20
|
| Rate for Payer: Cash Price |
$76.20
|
| Rate for Payer: Cigna Commercial |
$250.95
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$24.42
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$22.32
|
| Rate for Payer: Health EOS Commercial |
$240.39
|
| Rate for Payer: HFN Commercial |
$250.95
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$82.83
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$82.83
|
| Rate for Payer: Independent Care Health Plan Medicare |
$22.32
|
| Rate for Payer: Multiplan Commercial |
$211.33
|
| Rate for Payer: NAPHCARE Commercial |
$33.48
|
| Rate for Payer: Preferred Network Access Commercial |
$250.95
|
| Rate for Payer: Quartz Beloit One Network |
$116.23
|
| Rate for Payer: Quartz Commercial |
$150.57
|
| Rate for Payer: Quartz Medicare Advantage |
$22.32
|
| Rate for Payer: The Alliance Commercial |
$55.80
|
| Rate for Payer: United Healthcare Medicaid |
$24.42
|
| Rate for Payer: United Healthcare Medicare Advantage |
$22.32
|
| Rate for Payer: WEA Trust Commercial |
$145.29
|
| Rate for Payer: WPS Commercial |
$89.27
|
|
|
VASCULAR STUDY RENAL ARTERIES 9397526
|
Professional
|
Both
|
$760.00
|
|
|
Service Code
|
CPT 93975 26
|
| Hospital Charge Code |
3015448
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$52.53 |
| Max. Negotiated Rate |
$750.88 |
| Rate for Payer: Aetna Commercial |
$750.88
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$679.74
|
| Rate for Payer: Aetna Managed Medicare |
$52.53
|
| Rate for Payer: Anthem Medicare Advantage |
$52.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$52.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$52.53
|
| Rate for Payer: Cash Price |
$228.00
|
| Rate for Payer: Cash Price |
$228.00
|
| Rate for Payer: Cash Price |
$228.00
|
| Rate for Payer: Cigna Commercial |
$750.88
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$91.97
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$52.53
|
| Rate for Payer: Health EOS Commercial |
$719.26
|
| Rate for Payer: HFN Commercial |
$750.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$197.88
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$197.88
|
| Rate for Payer: Independent Care Health Plan Medicare |
$52.53
|
| Rate for Payer: Multiplan Commercial |
$632.32
|
| Rate for Payer: NAPHCARE Commercial |
$78.80
|
| Rate for Payer: Preferred Network Access Commercial |
$750.88
|
| Rate for Payer: Quartz Beloit One Network |
$347.78
|
| Rate for Payer: Quartz Commercial |
$450.53
|
| Rate for Payer: Quartz Medicare Advantage |
$52.53
|
| Rate for Payer: The Alliance Commercial |
$131.33
|
| Rate for Payer: United Healthcare Medicaid |
$91.97
|
| Rate for Payer: United Healthcare Medicare Advantage |
$52.53
|
| Rate for Payer: WEA Trust Commercial |
$434.72
|
| Rate for Payer: WPS Commercial |
$210.12
|
|
|
VASECTOMY
|
Facility
|
OP
|
$1,084.00
|
|
| Hospital Charge Code |
2960496
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$315.66 |
| Max. Negotiated Rate |
$1,037.17 |
| Rate for Payer: Aetna Commercial |
$1,014.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$969.53
|
| Rate for Payer: Aetna Managed Medicare |
$315.66
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$732.78
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$563.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$541.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$597.50
|
| Rate for Payer: Cash Price |
$325.20
|
| Rate for Payer: Cigna Commercial |
$1,037.17
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$630.89
|
| Rate for Payer: Health EOS Commercial |
$1,003.35
|
| Rate for Payer: HFN Commercial |
$1,037.17
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$845.52
|
| Rate for Payer: Multiplan Commercial |
$901.89
|
| Rate for Payer: NAPHCARE Commercial |
$676.42
|
| Rate for Payer: Preferred Network Access Commercial |
$1,037.17
|
| Rate for Payer: Quartz Beloit One Network |
$552.41
|
| Rate for Payer: Quartz Commercial |
$732.78
|
| Rate for Payer: Quartz Medicare Advantage |
$676.42
|
| Rate for Payer: The Alliance Commercial |
$563.68
|
| Rate for Payer: WEA Trust Commercial |
$620.05
|
| Rate for Payer: WPS Commercial |
$835.01
|
|
|
VASECTOMY
|
Facility
|
IP
|
$1,084.00
|
|
| Hospital Charge Code |
2960496
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$552.41 |
| Max. Negotiated Rate |
$1,037.17 |
| Rate for Payer: Aetna Commercial |
$1,014.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$969.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$597.50
|
| Rate for Payer: Cash Price |
$325.20
|
| Rate for Payer: Cigna Commercial |
$1,037.17
|
| Rate for Payer: Health EOS Commercial |
$1,003.35
|
| Rate for Payer: HFN Commercial |
$1,037.17
|
| Rate for Payer: Multiplan Commercial |
$901.89
|
| Rate for Payer: Preferred Network Access Commercial |
$1,037.17
|
| Rate for Payer: Quartz Beloit One Network |
$552.41
|
| Rate for Payer: Quartz Commercial |
$676.42
|
| Rate for Payer: WEA Trust Commercial |
$620.05
|
| Rate for Payer: WPS Commercial |
$835.01
|
|
|
Vasectomy, Unilateral or Bilateral 55250
|
Professional
|
Both
|
$1,546.00
|
|
|
Service Code
|
CPT 55250
|
| Hospital Charge Code |
1188973
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$212.62 |
| Max. Negotiated Rate |
$1,527.45 |
| Rate for Payer: Aetna Commercial |
$1,527.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,382.74
|
| Rate for Payer: Aetna Managed Medicare |
$212.62
|
| Rate for Payer: Anthem Medicare Advantage |
$212.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$212.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$212.62
|
| Rate for Payer: Cash Price |
$463.80
|
| Rate for Payer: Cash Price |
$463.80
|
| Rate for Payer: Cash Price |
$463.80
|
| Rate for Payer: Cigna Commercial |
$1,527.45
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$308.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$212.62
|
| Rate for Payer: Health EOS Commercial |
$1,463.13
|
| Rate for Payer: HFN Commercial |
$1,527.45
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$796.43
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$796.43
|
| Rate for Payer: Independent Care Health Plan Medicare |
$212.62
|
| Rate for Payer: Multiplan Commercial |
$1,286.27
|
| Rate for Payer: NAPHCARE Commercial |
$318.93
|
| Rate for Payer: Preferred Network Access Commercial |
$1,527.45
|
| Rate for Payer: Quartz Beloit One Network |
$707.45
|
| Rate for Payer: Quartz Commercial |
$916.47
|
| Rate for Payer: Quartz Medicare Advantage |
$212.62
|
| Rate for Payer: The Alliance Commercial |
$903.62
|
| Rate for Payer: United Healthcare Medicaid |
$308.96
|
| Rate for Payer: United Healthcare Medicare Advantage |
$212.62
|
| Rate for Payer: WEA Trust Commercial |
$884.31
|
| Rate for Payer: WPS Commercial |
$956.78
|
|
|
VASECTOMY, UNILATERAL OR BILATERAL (SEPARATE PROCEDURE), INCLUDING POSTOPERATIVE SEMEN EXAMINATION(S)
|
Facility
|
OP
|
$8,799.61
|
|
|
Service Code
|
CPT 55250
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,199.90 |
| Max. Negotiated Rate |
$8,799.61 |
| Rate for Payer: Aetna Managed Medicare |
$2,199.90
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,635.84
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,985.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,835.04
|
| Rate for Payer: Anthem Medicare Advantage |
$2,199.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$2,199.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$2,199.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$2,199.90
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,947.89
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$2,199.90
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$8,183.63
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$2,199.90
|
| Rate for Payer: Independent Care Health Plan Medicare |
$2,199.90
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$2,199.90
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$2,199.90
|
| Rate for Payer: NAPHCARE Commercial |
$3,299.85
|
| Rate for Payer: Quartz Medicare Advantage |
$2,199.90
|
| Rate for Payer: The Alliance Commercial |
$8,799.61
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,199.90
|
| Rate for Payer: United Healthcare PPO |
$3,726.32
|
| Rate for Payer: Wellcare Medicare |
$2,199.90
|
|
|
Vasoactive Intestinal Polypeptide
|
Facility
|
IP
|
$817.00
|
|
|
Service Code
|
CPT 84586
|
| Hospital Charge Code |
980577
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$416.34 |
| Max. Negotiated Rate |
$781.71 |
| Rate for Payer: Aetna Commercial |
$764.71
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$730.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$450.33
|
| Rate for Payer: Cash Price |
$245.10
|
| Rate for Payer: Cigna Commercial |
$781.71
|
| Rate for Payer: Health EOS Commercial |
$756.22
|
| Rate for Payer: HFN Commercial |
$781.71
|
| Rate for Payer: Multiplan Commercial |
$679.74
|
| Rate for Payer: Preferred Network Access Commercial |
$781.71
|
| Rate for Payer: Quartz Beloit One Network |
$416.34
|
| Rate for Payer: Quartz Commercial |
$509.81
|
| Rate for Payer: WEA Trust Commercial |
$467.32
|
| Rate for Payer: WPS Commercial |
$629.34
|
|
|
Vasoactive Intestinal Polypeptide
|
Facility
|
OP
|
$817.00
|
|
|
Service Code
|
CPT 84586
|
| Hospital Charge Code |
980577
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$36.74 |
| Max. Negotiated Rate |
$781.71 |
| Rate for Payer: Aetna Commercial |
$764.71
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$730.72
|
| Rate for Payer: Aetna Managed Medicare |
$36.74
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$137.79
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$64.30
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$60.99
|
| Rate for Payer: Anthem Medicare Advantage |
$36.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$450.33
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$36.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$36.74
|
| Rate for Payer: Cash Price |
$245.10
|
| Rate for Payer: Cash Price |
$245.10
|
| Rate for Payer: Cigna Commercial |
$781.71
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$36.74
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$475.49
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$36.74
|
| Rate for Payer: Health EOS Commercial |
$756.22
|
| Rate for Payer: HFN Commercial |
$781.71
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$136.68
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$36.74
|
| Rate for Payer: Independent Care Health Plan Medicare |
$36.74
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$36.74
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$36.74
|
| Rate for Payer: Multiplan Commercial |
$679.74
|
| Rate for Payer: NAPHCARE Commercial |
$55.11
|
| Rate for Payer: Preferred Network Access Commercial |
$781.71
|
| Rate for Payer: Quartz Beloit One Network |
$416.34
|
| Rate for Payer: Quartz Commercial |
$552.29
|
| Rate for Payer: Quartz Medicare Advantage |
$36.74
|
| Rate for Payer: The Alliance Commercial |
$146.97
|
| Rate for Payer: United Healthcare Medicare Advantage |
$36.74
|
| Rate for Payer: United Healthcare PPO |
$637.26
|
| Rate for Payer: WEA Trust Commercial |
$467.32
|
| Rate for Payer: Wellcare Medicare |
$36.74
|
| Rate for Payer: WPS Commercial |
$629.34
|
|
|
Vasoactive Intestinal Polypeptide
|
Professional
|
Both
|
$817.00
|
|
|
Service Code
|
CPT 84586
|
| Hospital Charge Code |
980577
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$36.74 |
| Max. Negotiated Rate |
$807.20 |
| Rate for Payer: Aetna Commercial |
$807.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$730.72
|
| Rate for Payer: Aetna Managed Medicare |
$36.74
|
| Rate for Payer: Anthem Medicare Advantage |
$36.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$36.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$36.74
|
| Rate for Payer: Cash Price |
$245.10
|
| Rate for Payer: Cash Price |
$245.10
|
| Rate for Payer: Cigna Commercial |
$807.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$424.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$36.74
|
| Rate for Payer: Health EOS Commercial |
$773.21
|
| Rate for Payer: HFN Commercial |
$807.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$129.70
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$129.70
|
| Rate for Payer: Independent Care Health Plan Medicare |
$36.74
|
| Rate for Payer: Multiplan Commercial |
$679.74
|
| Rate for Payer: NAPHCARE Commercial |
$55.11
|
| Rate for Payer: Preferred Network Access Commercial |
$807.20
|
| Rate for Payer: Quartz Beloit One Network |
$373.86
|
| Rate for Payer: Quartz Commercial |
$484.32
|
| Rate for Payer: Quartz Medicare Advantage |
$36.74
|
| Rate for Payer: The Alliance Commercial |
$145.14
|
| Rate for Payer: United Healthcare Medicare Advantage |
$36.74
|
| Rate for Payer: WEA Trust Commercial |
$467.32
|
| Rate for Payer: WPS Commercial |
$161.67
|
|
|
Vasopressin 20units/1ml vial [Med]
|
Facility
|
IP
|
$31.00
|
|
| Hospital Charge Code |
2974998
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$15.80 |
| Max. Negotiated Rate |
$29.66 |
| Rate for Payer: Aetna Commercial |
$29.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$27.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$17.09
|
| Rate for Payer: Cash Price |
$9.30
|
| Rate for Payer: Cigna Commercial |
$29.66
|
| Rate for Payer: Health EOS Commercial |
$28.69
|
| Rate for Payer: HFN Commercial |
$29.66
|
| Rate for Payer: Multiplan Commercial |
$25.79
|
| Rate for Payer: Preferred Network Access Commercial |
$29.66
|
| Rate for Payer: Quartz Beloit One Network |
$15.80
|
| Rate for Payer: Quartz Commercial |
$19.34
|
| Rate for Payer: WEA Trust Commercial |
$17.73
|
| Rate for Payer: WPS Commercial |
$23.88
|
|
|
Vasopressin 20units/1ml vial [Med]
|
Facility
|
OP
|
$31.00
|
|
| Hospital Charge Code |
2974998
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.03 |
| Max. Negotiated Rate |
$29.66 |
| Rate for Payer: Aetna Commercial |
$29.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$27.73
|
| Rate for Payer: Aetna Managed Medicare |
$9.03
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$20.96
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$16.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$15.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$17.09
|
| Rate for Payer: Cash Price |
$9.30
|
| Rate for Payer: Cigna Commercial |
$29.66
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$18.04
|
| Rate for Payer: Health EOS Commercial |
$28.69
|
| Rate for Payer: HFN Commercial |
$29.66
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$24.18
|
| Rate for Payer: Multiplan Commercial |
$25.79
|
| Rate for Payer: NAPHCARE Commercial |
$19.34
|
| Rate for Payer: Preferred Network Access Commercial |
$29.66
|
| Rate for Payer: Quartz Beloit One Network |
$15.80
|
| Rate for Payer: Quartz Commercial |
$20.96
|
| Rate for Payer: Quartz Medicare Advantage |
$19.34
|
| Rate for Payer: The Alliance Commercial |
$16.12
|
| Rate for Payer: WEA Trust Commercial |
$17.73
|
| Rate for Payer: WPS Commercial |
$23.88
|
|
|
VASOTOMY FOR VASOGRAM
|
Facility
|
IP
|
$1,084.00
|
|
| Hospital Charge Code |
2960497
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$552.41 |
| Max. Negotiated Rate |
$1,037.17 |
| Rate for Payer: Aetna Commercial |
$1,014.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$969.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$597.50
|
| Rate for Payer: Cash Price |
$325.20
|
| Rate for Payer: Cigna Commercial |
$1,037.17
|
| Rate for Payer: Health EOS Commercial |
$1,003.35
|
| Rate for Payer: HFN Commercial |
$1,037.17
|
| Rate for Payer: Multiplan Commercial |
$901.89
|
| Rate for Payer: Preferred Network Access Commercial |
$1,037.17
|
| Rate for Payer: Quartz Beloit One Network |
$552.41
|
| Rate for Payer: Quartz Commercial |
$676.42
|
| Rate for Payer: WEA Trust Commercial |
$620.05
|
| Rate for Payer: WPS Commercial |
$835.01
|
|
|
VASOTOMY FOR VASOGRAM
|
Facility
|
OP
|
$1,084.00
|
|
| Hospital Charge Code |
2960497
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$315.66 |
| Max. Negotiated Rate |
$1,037.17 |
| Rate for Payer: Aetna Commercial |
$1,014.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$969.53
|
| Rate for Payer: Aetna Managed Medicare |
$315.66
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$732.78
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$563.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$541.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$597.50
|
| Rate for Payer: Cash Price |
$325.20
|
| Rate for Payer: Cigna Commercial |
$1,037.17
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$630.89
|
| Rate for Payer: Health EOS Commercial |
$1,003.35
|
| Rate for Payer: HFN Commercial |
$1,037.17
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$845.52
|
| Rate for Payer: Multiplan Commercial |
$901.89
|
| Rate for Payer: NAPHCARE Commercial |
$676.42
|
| Rate for Payer: Preferred Network Access Commercial |
$1,037.17
|
| Rate for Payer: Quartz Beloit One Network |
$552.41
|
| Rate for Payer: Quartz Commercial |
$732.78
|
| Rate for Payer: Quartz Medicare Advantage |
$676.42
|
| Rate for Payer: The Alliance Commercial |
$563.68
|
| Rate for Payer: WEA Trust Commercial |
$620.05
|
| Rate for Payer: WPS Commercial |
$835.01
|
|
|
VASOVASOTOMY
|
Facility
|
IP
|
$7,430.00
|
|
| Hospital Charge Code |
2960498
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,786.33 |
| Max. Negotiated Rate |
$7,109.02 |
| Rate for Payer: Aetna Commercial |
$6,954.48
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,645.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,095.42
|
| Rate for Payer: Cash Price |
$2,229.00
|
| Rate for Payer: Cigna Commercial |
$7,109.02
|
| Rate for Payer: Health EOS Commercial |
$6,877.21
|
| Rate for Payer: HFN Commercial |
$7,109.02
|
| Rate for Payer: Multiplan Commercial |
$6,181.76
|
| Rate for Payer: Preferred Network Access Commercial |
$7,109.02
|
| Rate for Payer: Quartz Beloit One Network |
$3,786.33
|
| Rate for Payer: Quartz Commercial |
$4,636.32
|
| Rate for Payer: WEA Trust Commercial |
$4,249.96
|
| Rate for Payer: WPS Commercial |
$5,723.33
|
|
|
VASOVASOTOMY
|
Facility
|
OP
|
$7,430.00
|
|
| Hospital Charge Code |
2960498
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,163.62 |
| Max. Negotiated Rate |
$7,109.02 |
| Rate for Payer: Aetna Commercial |
$6,954.48
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,645.39
|
| Rate for Payer: Aetna Managed Medicare |
$2,163.62
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,022.68
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,863.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,709.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,095.42
|
| Rate for Payer: Cash Price |
$2,229.00
|
| Rate for Payer: Cigna Commercial |
$7,109.02
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,324.26
|
| Rate for Payer: Health EOS Commercial |
$6,877.21
|
| Rate for Payer: HFN Commercial |
$7,109.02
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,795.40
|
| Rate for Payer: Multiplan Commercial |
$6,181.76
|
| Rate for Payer: NAPHCARE Commercial |
$4,636.32
|
| Rate for Payer: Preferred Network Access Commercial |
$7,109.02
|
| Rate for Payer: Quartz Beloit One Network |
$3,786.33
|
| Rate for Payer: Quartz Commercial |
$5,022.68
|
| Rate for Payer: Quartz Medicare Advantage |
$4,636.32
|
| Rate for Payer: The Alliance Commercial |
$3,863.60
|
| Rate for Payer: WEA Trust Commercial |
$4,249.96
|
| Rate for Payer: WPS Commercial |
$5,723.33
|
|
|
Vaxelis Charge - Vaxelis Charge
|
Facility
|
IP
|
$274.00
|
|
|
Service Code
|
CPT 90697
|
| Hospital Charge Code |
6178449
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$139.63 |
| Max. Negotiated Rate |
$262.16 |
| Rate for Payer: Aetna Commercial |
$256.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$245.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$151.03
|
| Rate for Payer: Cash Price |
$82.20
|
| Rate for Payer: Cigna Commercial |
$262.16
|
| Rate for Payer: Health EOS Commercial |
$253.61
|
| Rate for Payer: HFN Commercial |
$262.16
|
| Rate for Payer: Multiplan Commercial |
$227.97
|
| Rate for Payer: Preferred Network Access Commercial |
$262.16
|
| Rate for Payer: Quartz Beloit One Network |
$139.63
|
| Rate for Payer: Quartz Commercial |
$170.98
|
| Rate for Payer: WEA Trust Commercial |
$156.73
|
| Rate for Payer: WPS Commercial |
$211.06
|
|
|
Vaxelis Charge - Vaxelis Charge
|
Facility
|
OP
|
$274.00
|
|
|
Service Code
|
CPT 90697
|
| Hospital Charge Code |
6178449
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$79.79 |
| Max. Negotiated Rate |
$262.16 |
| Rate for Payer: Aetna Commercial |
$256.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$245.07
|
| Rate for Payer: Aetna Managed Medicare |
$79.79
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$185.22
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$142.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$136.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$151.03
|
| Rate for Payer: Cash Price |
$82.20
|
| Rate for Payer: Cigna Commercial |
$262.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$159.47
|
| Rate for Payer: Health EOS Commercial |
$253.61
|
| Rate for Payer: HFN Commercial |
$262.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$213.72
|
| Rate for Payer: Multiplan Commercial |
$227.97
|
| Rate for Payer: NAPHCARE Commercial |
$170.98
|
| Rate for Payer: Preferred Network Access Commercial |
$262.16
|
| Rate for Payer: Quartz Beloit One Network |
$139.63
|
| Rate for Payer: Quartz Commercial |
$185.22
|
| Rate for Payer: Quartz Medicare Advantage |
$170.98
|
| Rate for Payer: The Alliance Commercial |
$142.48
|
| Rate for Payer: WEA Trust Commercial |
$156.73
|
| Rate for Payer: WPS Commercial |
$211.06
|
|
|
Vaxelis Charge - Vaxelis Charge
|
Professional
|
Both
|
$274.00
|
|
|
Service Code
|
CPT 90697
|
| Hospital Charge Code |
6178449
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$125.38 |
| Max. Negotiated Rate |
$270.71 |
| Rate for Payer: Aetna Commercial |
$270.71
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$245.07
|
| Rate for Payer: Cash Price |
$82.20
|
| Rate for Payer: Cash Price |
$82.20
|
| Rate for Payer: Cigna Commercial |
$270.71
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$162.97
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$170.98
|
| Rate for Payer: Health EOS Commercial |
$259.31
|
| Rate for Payer: HFN Commercial |
$270.71
|
| Rate for Payer: Multiplan Commercial |
$227.97
|
| Rate for Payer: Preferred Network Access Commercial |
$270.71
|
| Rate for Payer: Quartz Beloit One Network |
$125.38
|
| Rate for Payer: Quartz Commercial |
$162.43
|
| Rate for Payer: The Alliance Commercial |
$142.48
|
| Rate for Payer: United Healthcare Medicaid |
$162.97
|
| Rate for Payer: WEA Trust Commercial |
$156.73
|
| Rate for Payer: WPS Commercial |
$211.06
|
|
|
Vaxelis (Dtap-IPV-HibHepB) Vaccine 90697
|
Professional
|
Both
|
$285.00
|
|
|
Service Code
|
CPT 90697
|
| Hospital Charge Code |
6178254
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$130.42 |
| Max. Negotiated Rate |
$281.58 |
| Rate for Payer: Aetna Commercial |
$281.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$254.90
|
| Rate for Payer: Cash Price |
$85.50
|
| Rate for Payer: Cash Price |
$85.50
|
| Rate for Payer: Cigna Commercial |
$281.58
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$162.97
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$177.84
|
| Rate for Payer: Health EOS Commercial |
$269.72
|
| Rate for Payer: HFN Commercial |
$281.58
|
| Rate for Payer: Multiplan Commercial |
$237.12
|
| Rate for Payer: Preferred Network Access Commercial |
$281.58
|
| Rate for Payer: Quartz Beloit One Network |
$130.42
|
| Rate for Payer: Quartz Commercial |
$168.95
|
| Rate for Payer: The Alliance Commercial |
$148.20
|
| Rate for Payer: United Healthcare Medicaid |
$162.97
|
| Rate for Payer: WEA Trust Commercial |
$163.02
|
| Rate for Payer: WPS Commercial |
$219.54
|
|
|
Vaxelis (Dtap-IPV-HibHepB) Vaccine 90697
|
Facility
|
IP
|
$285.00
|
|
|
Service Code
|
CPT 90697
|
| Hospital Charge Code |
6178254
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$145.24 |
| Max. Negotiated Rate |
$272.69 |
| Rate for Payer: Aetna Commercial |
$266.76
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$254.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$157.09
|
| Rate for Payer: Cash Price |
$85.50
|
| Rate for Payer: Cigna Commercial |
$272.69
|
| Rate for Payer: Health EOS Commercial |
$263.80
|
| Rate for Payer: HFN Commercial |
$272.69
|
| Rate for Payer: Multiplan Commercial |
$237.12
|
| Rate for Payer: Preferred Network Access Commercial |
$272.69
|
| Rate for Payer: Quartz Beloit One Network |
$145.24
|
| Rate for Payer: Quartz Commercial |
$177.84
|
| Rate for Payer: WEA Trust Commercial |
$163.02
|
| Rate for Payer: WPS Commercial |
$219.54
|
|
|
Vaxelis (Dtap-IPV-HibHepB) Vaccine 90697
|
Facility
|
OP
|
$285.00
|
|
|
Service Code
|
CPT 90697
|
| Hospital Charge Code |
6178254
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$82.99 |
| Max. Negotiated Rate |
$272.69 |
| Rate for Payer: Aetna Commercial |
$266.76
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$254.90
|
| Rate for Payer: Aetna Managed Medicare |
$82.99
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$192.66
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$148.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$142.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$157.09
|
| Rate for Payer: Cash Price |
$85.50
|
| Rate for Payer: Cigna Commercial |
$272.69
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$165.87
|
| Rate for Payer: Health EOS Commercial |
$263.80
|
| Rate for Payer: HFN Commercial |
$272.69
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$222.30
|
| Rate for Payer: Multiplan Commercial |
$237.12
|
| Rate for Payer: NAPHCARE Commercial |
$177.84
|
| Rate for Payer: Preferred Network Access Commercial |
$272.69
|
| Rate for Payer: Quartz Beloit One Network |
$145.24
|
| Rate for Payer: Quartz Commercial |
$192.66
|
| Rate for Payer: Quartz Medicare Advantage |
$177.84
|
| Rate for Payer: The Alliance Commercial |
$148.20
|
| Rate for Payer: WEA Trust Commercial |
$163.02
|
| Rate for Payer: WPS Commercial |
$219.54
|
|
|
VDRL Screen Cerebrospinal Fluid
|
Facility
|
IP
|
$302.00
|
|
|
Service Code
|
CPT 86592
|
| Hospital Charge Code |
978088
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$153.90 |
| Max. Negotiated Rate |
$288.95 |
| Rate for Payer: Aetna Commercial |
$282.67
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$270.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$166.46
|
| Rate for Payer: Cash Price |
$90.60
|
| Rate for Payer: Cigna Commercial |
$288.95
|
| Rate for Payer: Health EOS Commercial |
$279.53
|
| Rate for Payer: HFN Commercial |
$288.95
|
| Rate for Payer: Multiplan Commercial |
$251.26
|
| Rate for Payer: Preferred Network Access Commercial |
$288.95
|
| Rate for Payer: Quartz Beloit One Network |
$153.90
|
| Rate for Payer: Quartz Commercial |
$188.45
|
| Rate for Payer: WEA Trust Commercial |
$172.74
|
| Rate for Payer: WPS Commercial |
$232.63
|
|
|
VDRL Screen Cerebrospinal Fluid
|
Facility
|
OP
|
$302.00
|
|
|
Service Code
|
CPT 86592
|
| Hospital Charge Code |
978088
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.44 |
| Max. Negotiated Rate |
$288.95 |
| Rate for Payer: Aetna Commercial |
$282.67
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$270.11
|
| Rate for Payer: Aetna Managed Medicare |
$4.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$16.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$7.77
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7.37
|
| Rate for Payer: Anthem Medicare Advantage |
$4.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$166.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$4.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$4.44
|
| Rate for Payer: Cash Price |
$90.60
|
| Rate for Payer: Cash Price |
$90.60
|
| Rate for Payer: Cigna Commercial |
$288.95
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$4.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$175.76
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$4.44
|
| Rate for Payer: Health EOS Commercial |
$279.53
|
| Rate for Payer: HFN Commercial |
$288.95
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$16.52
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$4.44
|
| Rate for Payer: Independent Care Health Plan Medicare |
$4.44
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$4.44
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$4.44
|
| Rate for Payer: Multiplan Commercial |
$251.26
|
| Rate for Payer: NAPHCARE Commercial |
$6.66
|
| Rate for Payer: Preferred Network Access Commercial |
$288.95
|
| Rate for Payer: Quartz Beloit One Network |
$153.90
|
| Rate for Payer: Quartz Commercial |
$204.15
|
| Rate for Payer: Quartz Medicare Advantage |
$4.44
|
| Rate for Payer: The Alliance Commercial |
$17.76
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4.44
|
| Rate for Payer: United Healthcare PPO |
$235.56
|
| Rate for Payer: WEA Trust Commercial |
$172.74
|
| Rate for Payer: Wellcare Medicare |
$4.44
|
| Rate for Payer: WPS Commercial |
$232.63
|
|
|
VDRL Screen Cerebrospinal Fluid
|
Professional
|
Both
|
$302.00
|
|
|
Service Code
|
CPT 86592
|
| Hospital Charge Code |
978088
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.44 |
| Max. Negotiated Rate |
$298.38 |
| Rate for Payer: Aetna Commercial |
$298.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$270.11
|
| Rate for Payer: Aetna Managed Medicare |
$4.44
|
| Rate for Payer: Anthem Medicare Advantage |
$4.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$4.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$4.44
|
| Rate for Payer: Cash Price |
$90.60
|
| Rate for Payer: Cash Price |
$90.60
|
| Rate for Payer: Cigna Commercial |
$298.38
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$157.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4.44
|
| Rate for Payer: Health EOS Commercial |
$285.81
|
| Rate for Payer: HFN Commercial |
$298.38
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$15.67
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$15.67
|
| Rate for Payer: Independent Care Health Plan Medicare |
$4.44
|
| Rate for Payer: Multiplan Commercial |
$251.26
|
| Rate for Payer: NAPHCARE Commercial |
$6.66
|
| Rate for Payer: Preferred Network Access Commercial |
$298.38
|
| Rate for Payer: Quartz Beloit One Network |
$138.20
|
| Rate for Payer: Quartz Commercial |
$179.03
|
| Rate for Payer: Quartz Medicare Advantage |
$4.44
|
| Rate for Payer: The Alliance Commercial |
$17.54
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4.44
|
| Rate for Payer: WEA Trust Commercial |
$172.74
|
| Rate for Payer: WPS Commercial |
$19.54
|
|
|
VDRL with Reflex Titer, CSF
|
Facility
|
IP
|
$89.00
|
|
|
Service Code
|
CPT 86592
|
| Hospital Charge Code |
5364667
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$45.35 |
| Max. Negotiated Rate |
$85.16 |
| Rate for Payer: Aetna Commercial |
$83.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$79.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$49.06
|
| Rate for Payer: Cash Price |
$26.70
|
| Rate for Payer: Cigna Commercial |
$85.16
|
| Rate for Payer: Health EOS Commercial |
$82.38
|
| Rate for Payer: HFN Commercial |
$85.16
|
| Rate for Payer: Multiplan Commercial |
$74.05
|
| Rate for Payer: Preferred Network Access Commercial |
$85.16
|
| Rate for Payer: Quartz Beloit One Network |
$45.35
|
| Rate for Payer: Quartz Commercial |
$55.54
|
| Rate for Payer: WEA Trust Commercial |
$50.91
|
| Rate for Payer: WPS Commercial |
$68.56
|
|
