|
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 |
$297.08 |
| Max. Negotiated Rate |
$1,468.70 |
| Rate for Payer: Aetna Commercial |
$1,468.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,329.56
|
| Rate for Payer: Cash Price |
$463.80
|
| Rate for Payer: Cash Price |
$463.80
|
| Rate for Payer: Cigna Commercial |
$1,468.70
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$297.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$927.60
|
| Rate for Payer: Health EOS Commercial |
$1,406.86
|
| Rate for Payer: HFN Commercial |
$1,468.70
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$765.80
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$765.80
|
| Rate for Payer: Multiplan Commercial |
$1,236.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,468.70
|
| Rate for Payer: Quartz Beloit One Network |
$680.24
|
| Rate for Payer: Quartz Commercial |
$881.22
|
| Rate for Payer: The Alliance Commercial |
$773.00
|
| Rate for Payer: United Healthcare Medicaid |
$297.08
|
| Rate for Payer: WEA Trust Commercial |
$850.30
|
| Rate for Payer: WPS Commercial |
$1,145.12
|
|
|
VASECTOMY, UNILATERAL OR BILATERAL (SEPARATE PROCEDURE), INCLUDING POSTOPERATIVE SEMEN EXAMINATION(S)
|
Facility
|
OP
|
$8,052.80
|
|
|
Service Code
|
CPT 55250
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,013.20 |
| Max. Negotiated Rate |
$8,052.80 |
| Rate for Payer: Aetna Managed Medicare |
$2,013.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,496.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,871.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,726.00
|
| Rate for Payer: Anthem Medicare Advantage |
$2,013.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$2,013.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$2,013.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$2,013.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,757.59
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$2,013.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7,489.10
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$2,013.20
|
| Rate for Payer: Independent Care Health Plan Medicare |
$2,013.20
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$2,013.20
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$2,013.20
|
| Rate for Payer: NAPHCARE Commercial |
$3,019.80
|
| Rate for Payer: Quartz Medicare Advantage |
$2,013.20
|
| Rate for Payer: The Alliance Commercial |
$8,052.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,013.20
|
| Rate for Payer: United Healthcare PPO |
$3,583.00
|
| Rate for Payer: Wellcare Medicare |
$2,013.20
|
|
|
Vasoactive Intestinal Polypeptide
|
Professional
|
Both
|
$817.00
|
|
|
Service Code
|
CPT 84586
|
| Hospital Charge Code |
980577
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$124.71 |
| Max. Negotiated Rate |
$776.15 |
| Rate for Payer: Aetna Commercial |
$776.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$702.62
|
| Rate for Payer: Cash Price |
$245.10
|
| Rate for Payer: Cash Price |
$245.10
|
| Rate for Payer: Cigna Commercial |
$776.15
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$408.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$490.20
|
| Rate for Payer: Health EOS Commercial |
$743.47
|
| Rate for Payer: HFN Commercial |
$776.15
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$124.71
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$124.71
|
| Rate for Payer: Multiplan Commercial |
$653.60
|
| Rate for Payer: Preferred Network Access Commercial |
$776.15
|
| Rate for Payer: Quartz Beloit One Network |
$359.48
|
| Rate for Payer: Quartz Commercial |
$465.69
|
| Rate for Payer: The Alliance Commercial |
$408.50
|
| Rate for Payer: WEA Trust Commercial |
$449.35
|
| Rate for Payer: WPS Commercial |
$605.15
|
|
|
Vasoactive Intestinal Polypeptide
|
Facility
|
IP
|
$817.00
|
|
|
Service Code
|
CPT 84586
|
| Hospital Charge Code |
980577
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$400.33 |
| Max. Negotiated Rate |
$751.64 |
| Rate for Payer: Aetna Commercial |
$735.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$702.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$433.01
|
| Rate for Payer: Cash Price |
$245.10
|
| Rate for Payer: Cigna Commercial |
$751.64
|
| Rate for Payer: Health EOS Commercial |
$727.13
|
| Rate for Payer: HFN Commercial |
$751.64
|
| Rate for Payer: Multiplan Commercial |
$653.60
|
| Rate for Payer: NAPHCARE Commercial |
$490.20
|
| Rate for Payer: Preferred Network Access Commercial |
$751.64
|
| Rate for Payer: Quartz Beloit One Network |
$400.33
|
| Rate for Payer: Quartz Commercial |
$490.20
|
| Rate for Payer: WEA Trust Commercial |
$449.35
|
| Rate for Payer: WPS Commercial |
$605.15
|
|
|
Vasoactive Intestinal Polypeptide
|
Facility
|
OP
|
$817.00
|
|
|
Service Code
|
CPT 84586
|
| Hospital Charge Code |
980577
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.93 |
| Max. Negotiated Rate |
$751.64 |
| Rate for Payer: Aetna Commercial |
$735.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$702.62
|
| Rate for Payer: Aetna Managed Medicare |
$35.33
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$132.49
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$61.83
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$58.65
|
| Rate for Payer: Anthem Medicaid |
$17.93
|
| Rate for Payer: Anthem Medicare Advantage |
$35.33
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$433.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$35.33
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$35.33
|
| Rate for Payer: Cash Price |
$245.10
|
| Rate for Payer: Cash Price |
$245.10
|
| Rate for Payer: Cigna Commercial |
$751.64
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$35.33
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$17.93
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$457.19
|
| Rate for Payer: Dean Health Medicaid |
$17.93
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$35.33
|
| Rate for Payer: Health EOS Commercial |
$727.13
|
| Rate for Payer: HFN Commercial |
$751.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$131.43
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$35.33
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$17.93
|
| Rate for Payer: Independent Care Health Plan Medicare |
$35.33
|
| Rate for Payer: Managed Health Services Medicaid |
$18.65
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$35.33
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$35.33
|
| Rate for Payer: Multiplan Commercial |
$653.60
|
| Rate for Payer: NAPHCARE Commercial |
$53.00
|
| Rate for Payer: Preferred Network Access Commercial |
$751.64
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$17.93
|
| Rate for Payer: Quartz Beloit One Network |
$400.33
|
| Rate for Payer: Quartz Commercial |
$531.05
|
| Rate for Payer: Quartz Medicare Advantage |
$35.33
|
| Rate for Payer: The Alliance Commercial |
$141.32
|
| Rate for Payer: United Healthcare Medicaid |
$17.93
|
| Rate for Payer: United Healthcare Medicare Advantage |
$35.33
|
| Rate for Payer: United Healthcare PPO |
$612.75
|
| Rate for Payer: WEA Trust Commercial |
$449.35
|
| Rate for Payer: Wellcare Medicare |
$35.33
|
| Rate for Payer: WMAP Medicaid |
$17.93
|
| Rate for Payer: WPS Commercial |
$605.15
|
|
|
Vasopressin 20units/1ml vial [Med]
|
Facility
|
OP
|
$31.00
|
|
| Hospital Charge Code |
2974998
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$8.68 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: Aetna Commercial |
$27.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$26.66
|
| Rate for Payer: Aetna Managed Medicare |
$8.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$20.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$15.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$14.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$16.43
|
| Rate for Payer: Cash Price |
$9.30
|
| Rate for Payer: Cigna Commercial |
$28.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$17.35
|
| Rate for Payer: Health EOS Commercial |
$27.59
|
| Rate for Payer: HFN Commercial |
$28.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$23.25
|
| Rate for Payer: Multiplan Commercial |
$24.80
|
| Rate for Payer: NAPHCARE Commercial |
$18.60
|
| Rate for Payer: Preferred Network Access Commercial |
$28.52
|
| Rate for Payer: Quartz Beloit One Network |
$15.19
|
| Rate for Payer: Quartz Commercial |
$20.15
|
| Rate for Payer: Quartz Medicare Advantage |
$18.60
|
| Rate for Payer: The Alliance Commercial |
$124.00
|
| Rate for Payer: WEA Trust Commercial |
$17.05
|
| Rate for Payer: WPS Commercial |
$22.96
|
|
|
Vasopressin 20units/1ml vial [Med]
|
Facility
|
IP
|
$31.00
|
|
| Hospital Charge Code |
2974998
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$15.19 |
| Max. Negotiated Rate |
$28.52 |
| Rate for Payer: Aetna Commercial |
$27.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$26.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$16.43
|
| Rate for Payer: Cash Price |
$9.30
|
| Rate for Payer: Cigna Commercial |
$28.52
|
| Rate for Payer: Health EOS Commercial |
$27.59
|
| Rate for Payer: HFN Commercial |
$28.52
|
| Rate for Payer: Multiplan Commercial |
$24.80
|
| Rate for Payer: NAPHCARE Commercial |
$18.60
|
| Rate for Payer: Preferred Network Access Commercial |
$28.52
|
| Rate for Payer: Quartz Beloit One Network |
$15.19
|
| Rate for Payer: Quartz Commercial |
$18.60
|
| Rate for Payer: WEA Trust Commercial |
$17.05
|
| Rate for Payer: WPS Commercial |
$22.96
|
|
|
VASOTOMY FOR VASOGRAM
|
Facility
|
OP
|
$1,084.00
|
|
| Hospital Charge Code |
2960497
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$303.52 |
| Max. Negotiated Rate |
$4,336.00 |
| Rate for Payer: Aetna Commercial |
$975.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$932.24
|
| Rate for Payer: Aetna Managed Medicare |
$303.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$704.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$542.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$520.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$574.52
|
| Rate for Payer: Cash Price |
$325.20
|
| Rate for Payer: Cigna Commercial |
$997.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$606.61
|
| Rate for Payer: Health EOS Commercial |
$964.76
|
| Rate for Payer: HFN Commercial |
$997.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$813.00
|
| Rate for Payer: Multiplan Commercial |
$867.20
|
| Rate for Payer: NAPHCARE Commercial |
$650.40
|
| Rate for Payer: Preferred Network Access Commercial |
$997.28
|
| Rate for Payer: Quartz Beloit One Network |
$531.16
|
| Rate for Payer: Quartz Commercial |
$704.60
|
| Rate for Payer: Quartz Medicare Advantage |
$650.40
|
| Rate for Payer: The Alliance Commercial |
$4,336.00
|
| Rate for Payer: WEA Trust Commercial |
$596.20
|
| Rate for Payer: WPS Commercial |
$802.92
|
|
|
VASOTOMY FOR VASOGRAM
|
Facility
|
IP
|
$1,084.00
|
|
| Hospital Charge Code |
2960497
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$531.16 |
| Max. Negotiated Rate |
$997.28 |
| Rate for Payer: Aetna Commercial |
$975.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$932.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$574.52
|
| Rate for Payer: Cash Price |
$325.20
|
| Rate for Payer: Cigna Commercial |
$997.28
|
| Rate for Payer: Health EOS Commercial |
$964.76
|
| Rate for Payer: HFN Commercial |
$997.28
|
| Rate for Payer: Multiplan Commercial |
$867.20
|
| Rate for Payer: NAPHCARE Commercial |
$650.40
|
| Rate for Payer: Preferred Network Access Commercial |
$997.28
|
| Rate for Payer: Quartz Beloit One Network |
$531.16
|
| Rate for Payer: Quartz Commercial |
$650.40
|
| Rate for Payer: WEA Trust Commercial |
$596.20
|
| Rate for Payer: WPS Commercial |
$802.92
|
|
|
VASOVASOTOMY
|
Facility
|
OP
|
$7,430.00
|
|
| Hospital Charge Code |
2960498
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,080.40 |
| Max. Negotiated Rate |
$29,720.00 |
| Rate for Payer: Aetna Commercial |
$6,687.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,389.80
|
| Rate for Payer: Aetna Managed Medicare |
$2,080.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,829.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,715.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,566.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,937.90
|
| Rate for Payer: Cash Price |
$2,229.00
|
| Rate for Payer: Cigna Commercial |
$6,835.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,157.83
|
| Rate for Payer: Health EOS Commercial |
$6,612.70
|
| Rate for Payer: HFN Commercial |
$6,835.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,572.50
|
| Rate for Payer: Multiplan Commercial |
$5,944.00
|
| Rate for Payer: NAPHCARE Commercial |
$4,458.00
|
| Rate for Payer: Preferred Network Access Commercial |
$6,835.60
|
| Rate for Payer: Quartz Beloit One Network |
$3,640.70
|
| Rate for Payer: Quartz Commercial |
$4,829.50
|
| Rate for Payer: Quartz Medicare Advantage |
$4,458.00
|
| Rate for Payer: The Alliance Commercial |
$29,720.00
|
| Rate for Payer: WEA Trust Commercial |
$4,086.50
|
| Rate for Payer: WPS Commercial |
$5,503.40
|
|
|
VASOVASOTOMY
|
Facility
|
IP
|
$7,430.00
|
|
| Hospital Charge Code |
2960498
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,640.70 |
| Max. Negotiated Rate |
$6,835.60 |
| Rate for Payer: Aetna Commercial |
$6,687.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,389.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,937.90
|
| Rate for Payer: Cash Price |
$2,229.00
|
| Rate for Payer: Cigna Commercial |
$6,835.60
|
| Rate for Payer: Health EOS Commercial |
$6,612.70
|
| Rate for Payer: HFN Commercial |
$6,835.60
|
| Rate for Payer: Multiplan Commercial |
$5,944.00
|
| Rate for Payer: NAPHCARE Commercial |
$4,458.00
|
| Rate for Payer: Preferred Network Access Commercial |
$6,835.60
|
| Rate for Payer: Quartz Beloit One Network |
$3,640.70
|
| Rate for Payer: Quartz Commercial |
$4,458.00
|
| Rate for Payer: WEA Trust Commercial |
$4,086.50
|
| Rate for Payer: WPS Commercial |
$5,503.40
|
|
|
Vaxelis Charge - Vaxelis Charge
|
Facility
|
OP
|
$274.00
|
|
|
Service Code
|
CPT 90697
|
| Hospital Charge Code |
6178449
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$76.72 |
| Max. Negotiated Rate |
$1,096.00 |
| Rate for Payer: Aetna Commercial |
$246.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$235.64
|
| Rate for Payer: Aetna Managed Medicare |
$76.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$178.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$137.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$131.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$145.22
|
| Rate for Payer: Cash Price |
$82.20
|
| Rate for Payer: Cigna Commercial |
$252.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$153.33
|
| Rate for Payer: Health EOS Commercial |
$243.86
|
| Rate for Payer: HFN Commercial |
$252.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$205.50
|
| Rate for Payer: Multiplan Commercial |
$219.20
|
| Rate for Payer: NAPHCARE Commercial |
$164.40
|
| Rate for Payer: Preferred Network Access Commercial |
$252.08
|
| Rate for Payer: Quartz Beloit One Network |
$134.26
|
| Rate for Payer: Quartz Commercial |
$178.10
|
| Rate for Payer: Quartz Medicare Advantage |
$164.40
|
| Rate for Payer: The Alliance Commercial |
$1,096.00
|
| Rate for Payer: WEA Trust Commercial |
$150.70
|
| Rate for Payer: WPS Commercial |
$202.95
|
|
|
Vaxelis Charge - Vaxelis Charge
|
Professional
|
Both
|
$274.00
|
|
|
Service Code
|
CPT 90697
|
| Hospital Charge Code |
6178449
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.00 |
| Max. Negotiated Rate |
$260.30 |
| Rate for Payer: Aetna Commercial |
$260.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$235.64
|
| Rate for Payer: Cash Price |
$82.20
|
| Rate for Payer: Cash Price |
$82.20
|
| Rate for Payer: Cigna Commercial |
$260.30
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$15.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$164.40
|
| Rate for Payer: Health EOS Commercial |
$249.34
|
| Rate for Payer: HFN Commercial |
$260.30
|
| Rate for Payer: Multiplan Commercial |
$219.20
|
| Rate for Payer: Preferred Network Access Commercial |
$260.30
|
| Rate for Payer: Quartz Beloit One Network |
$120.56
|
| Rate for Payer: Quartz Commercial |
$156.18
|
| Rate for Payer: The Alliance Commercial |
$137.00
|
| Rate for Payer: United Healthcare Medicaid |
$15.00
|
| Rate for Payer: WEA Trust Commercial |
$150.70
|
| Rate for Payer: WPS Commercial |
$202.95
|
|
|
Vaxelis Charge - Vaxelis Charge
|
Facility
|
IP
|
$274.00
|
|
|
Service Code
|
CPT 90697
|
| Hospital Charge Code |
6178449
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$134.26 |
| Max. Negotiated Rate |
$252.08 |
| Rate for Payer: Aetna Commercial |
$246.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$235.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$145.22
|
| Rate for Payer: Cash Price |
$82.20
|
| Rate for Payer: Cigna Commercial |
$252.08
|
| Rate for Payer: Health EOS Commercial |
$243.86
|
| Rate for Payer: HFN Commercial |
$252.08
|
| Rate for Payer: Multiplan Commercial |
$219.20
|
| Rate for Payer: NAPHCARE Commercial |
$164.40
|
| Rate for Payer: Preferred Network Access Commercial |
$252.08
|
| Rate for Payer: Quartz Beloit One Network |
$134.26
|
| Rate for Payer: Quartz Commercial |
$164.40
|
| Rate for Payer: WEA Trust Commercial |
$150.70
|
| Rate for Payer: WPS Commercial |
$202.95
|
|
|
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 |
$15.00 |
| Max. Negotiated Rate |
$270.75 |
| Rate for Payer: Aetna Commercial |
$270.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$245.10
|
| Rate for Payer: Cash Price |
$85.50
|
| Rate for Payer: Cash Price |
$85.50
|
| Rate for Payer: Cigna Commercial |
$270.75
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$15.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$171.00
|
| Rate for Payer: Health EOS Commercial |
$259.35
|
| Rate for Payer: HFN Commercial |
$270.75
|
| Rate for Payer: Multiplan Commercial |
$228.00
|
| Rate for Payer: Preferred Network Access Commercial |
$270.75
|
| Rate for Payer: Quartz Beloit One Network |
$125.40
|
| Rate for Payer: Quartz Commercial |
$162.45
|
| Rate for Payer: The Alliance Commercial |
$142.50
|
| Rate for Payer: United Healthcare Medicaid |
$15.00
|
| Rate for Payer: WEA Trust Commercial |
$156.75
|
| Rate for Payer: WPS Commercial |
$211.10
|
|
|
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 |
$79.80 |
| Max. Negotiated Rate |
$1,140.00 |
| Rate for Payer: Aetna Commercial |
$256.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$245.10
|
| Rate for Payer: Aetna Managed Medicare |
$79.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$185.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$142.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$136.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$151.05
|
| Rate for Payer: Cash Price |
$85.50
|
| Rate for Payer: Cigna Commercial |
$262.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$159.49
|
| Rate for Payer: Health EOS Commercial |
$253.65
|
| Rate for Payer: HFN Commercial |
$262.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$213.75
|
| Rate for Payer: Multiplan Commercial |
$228.00
|
| Rate for Payer: NAPHCARE Commercial |
$171.00
|
| Rate for Payer: Preferred Network Access Commercial |
$262.20
|
| Rate for Payer: Quartz Beloit One Network |
$139.65
|
| Rate for Payer: Quartz Commercial |
$185.25
|
| Rate for Payer: Quartz Medicare Advantage |
$171.00
|
| Rate for Payer: The Alliance Commercial |
$1,140.00
|
| Rate for Payer: WEA Trust Commercial |
$156.75
|
| Rate for Payer: WPS Commercial |
$211.10
|
|
|
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 |
$139.65 |
| Max. Negotiated Rate |
$262.20 |
| Rate for Payer: Aetna Commercial |
$256.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$245.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$151.05
|
| Rate for Payer: Cash Price |
$85.50
|
| Rate for Payer: Cigna Commercial |
$262.20
|
| Rate for Payer: Health EOS Commercial |
$253.65
|
| Rate for Payer: HFN Commercial |
$262.20
|
| Rate for Payer: Multiplan Commercial |
$228.00
|
| Rate for Payer: NAPHCARE Commercial |
$171.00
|
| Rate for Payer: Preferred Network Access Commercial |
$262.20
|
| Rate for Payer: Quartz Beloit One Network |
$139.65
|
| Rate for Payer: Quartz Commercial |
$171.00
|
| Rate for Payer: WEA Trust Commercial |
$156.75
|
| Rate for Payer: WPS Commercial |
$211.10
|
|
|
VDRL Screen Cerebrospinal Fluid
|
Professional
|
Both
|
$302.00
|
|
|
Service Code
|
CPT 86592
|
| Hospital Charge Code |
978088
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.07 |
| Max. Negotiated Rate |
$286.90 |
| Rate for Payer: Aetna Commercial |
$286.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$259.72
|
| Rate for Payer: Cash Price |
$90.60
|
| Rate for Payer: Cash Price |
$90.60
|
| Rate for Payer: Cigna Commercial |
$286.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$151.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$181.20
|
| Rate for Payer: Health EOS Commercial |
$274.82
|
| Rate for Payer: HFN Commercial |
$286.90
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$15.07
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$15.07
|
| Rate for Payer: Multiplan Commercial |
$241.60
|
| Rate for Payer: Preferred Network Access Commercial |
$286.90
|
| Rate for Payer: Quartz Beloit One Network |
$132.88
|
| Rate for Payer: Quartz Commercial |
$172.14
|
| Rate for Payer: The Alliance Commercial |
$151.00
|
| Rate for Payer: WEA Trust Commercial |
$166.10
|
| Rate for Payer: WPS Commercial |
$223.69
|
|
|
VDRL Screen Cerebrospinal Fluid
|
Facility
|
OP
|
$302.00
|
|
|
Service Code
|
CPT 86592
|
| Hospital Charge Code |
978088
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.27 |
| Max. Negotiated Rate |
$277.84 |
| Rate for Payer: Aetna Commercial |
$271.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$259.72
|
| Rate for Payer: Aetna Managed Medicare |
$4.27
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$16.01
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$7.47
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7.09
|
| Rate for Payer: Anthem Medicaid |
$4.41
|
| Rate for Payer: Anthem Medicare Advantage |
$4.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$160.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$4.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$4.27
|
| Rate for Payer: Cash Price |
$90.60
|
| Rate for Payer: Cash Price |
$90.60
|
| Rate for Payer: Cigna Commercial |
$277.84
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$4.27
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$4.41
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$169.00
|
| Rate for Payer: Dean Health Medicaid |
$4.41
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$4.27
|
| Rate for Payer: Health EOS Commercial |
$268.78
|
| Rate for Payer: HFN Commercial |
$277.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$15.88
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$4.27
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$4.41
|
| Rate for Payer: Independent Care Health Plan Medicare |
$4.27
|
| Rate for Payer: Managed Health Services Medicaid |
$4.59
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$4.27
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$4.27
|
| Rate for Payer: Multiplan Commercial |
$241.60
|
| Rate for Payer: NAPHCARE Commercial |
$6.40
|
| Rate for Payer: Preferred Network Access Commercial |
$277.84
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$4.41
|
| Rate for Payer: Quartz Beloit One Network |
$147.98
|
| Rate for Payer: Quartz Commercial |
$196.30
|
| Rate for Payer: Quartz Medicare Advantage |
$4.27
|
| Rate for Payer: The Alliance Commercial |
$17.08
|
| Rate for Payer: United Healthcare Medicaid |
$4.41
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4.27
|
| Rate for Payer: United Healthcare PPO |
$226.50
|
| Rate for Payer: WEA Trust Commercial |
$166.10
|
| Rate for Payer: Wellcare Medicare |
$4.27
|
| Rate for Payer: WMAP Medicaid |
$4.41
|
| Rate for Payer: WPS Commercial |
$223.69
|
|
|
VDRL Screen Cerebrospinal Fluid
|
Facility
|
IP
|
$302.00
|
|
|
Service Code
|
CPT 86592
|
| Hospital Charge Code |
978088
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$147.98 |
| Max. Negotiated Rate |
$277.84 |
| Rate for Payer: Aetna Commercial |
$271.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$259.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$160.06
|
| Rate for Payer: Cash Price |
$90.60
|
| Rate for Payer: Cigna Commercial |
$277.84
|
| Rate for Payer: Health EOS Commercial |
$268.78
|
| Rate for Payer: HFN Commercial |
$277.84
|
| Rate for Payer: Multiplan Commercial |
$241.60
|
| Rate for Payer: NAPHCARE Commercial |
$181.20
|
| Rate for Payer: Preferred Network Access Commercial |
$277.84
|
| Rate for Payer: Quartz Beloit One Network |
$147.98
|
| Rate for Payer: Quartz Commercial |
$181.20
|
| Rate for Payer: WEA Trust Commercial |
$166.10
|
| Rate for Payer: WPS Commercial |
$223.69
|
|
|
VDRL with Reflex Titer, CSF
|
Professional
|
Both
|
$89.00
|
|
|
Service Code
|
CPT 86592
|
| Hospital Charge Code |
5364667
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.07 |
| Max. Negotiated Rate |
$84.55 |
| Rate for Payer: Aetna Commercial |
$84.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$76.54
|
| Rate for Payer: Cash Price |
$26.70
|
| Rate for Payer: Cash Price |
$26.70
|
| Rate for Payer: Cigna Commercial |
$84.55
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$44.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$53.40
|
| Rate for Payer: Health EOS Commercial |
$80.99
|
| Rate for Payer: HFN Commercial |
$84.55
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$15.07
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$15.07
|
| Rate for Payer: Multiplan Commercial |
$71.20
|
| Rate for Payer: Preferred Network Access Commercial |
$84.55
|
| Rate for Payer: Quartz Beloit One Network |
$39.16
|
| Rate for Payer: Quartz Commercial |
$50.73
|
| Rate for Payer: The Alliance Commercial |
$44.50
|
| Rate for Payer: WEA Trust Commercial |
$48.95
|
| Rate for Payer: WPS Commercial |
$65.92
|
|
|
VDRL with Reflex Titer, CSF
|
Facility
|
OP
|
$89.00
|
|
|
Service Code
|
CPT 86592
|
| Hospital Charge Code |
5364667
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.27 |
| Max. Negotiated Rate |
$81.88 |
| Rate for Payer: Aetna Commercial |
$80.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$76.54
|
| Rate for Payer: Aetna Managed Medicare |
$4.27
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$16.01
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$7.47
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7.09
|
| Rate for Payer: Anthem Medicaid |
$4.41
|
| Rate for Payer: Anthem Medicare Advantage |
$4.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$47.17
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$4.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$4.27
|
| Rate for Payer: Cash Price |
$26.70
|
| Rate for Payer: Cash Price |
$26.70
|
| Rate for Payer: Cigna Commercial |
$81.88
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$4.27
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$4.41
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$49.80
|
| Rate for Payer: Dean Health Medicaid |
$4.41
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$4.27
|
| Rate for Payer: Health EOS Commercial |
$79.21
|
| Rate for Payer: HFN Commercial |
$81.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$15.88
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$4.27
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$4.41
|
| Rate for Payer: Independent Care Health Plan Medicare |
$4.27
|
| Rate for Payer: Managed Health Services Medicaid |
$4.59
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$4.27
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$4.27
|
| Rate for Payer: Multiplan Commercial |
$71.20
|
| Rate for Payer: NAPHCARE Commercial |
$6.40
|
| Rate for Payer: Preferred Network Access Commercial |
$81.88
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$4.41
|
| Rate for Payer: Quartz Beloit One Network |
$43.61
|
| Rate for Payer: Quartz Commercial |
$57.85
|
| Rate for Payer: Quartz Medicare Advantage |
$4.27
|
| Rate for Payer: The Alliance Commercial |
$17.08
|
| Rate for Payer: United Healthcare Medicaid |
$4.41
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4.27
|
| Rate for Payer: United Healthcare PPO |
$66.75
|
| Rate for Payer: WEA Trust Commercial |
$48.95
|
| Rate for Payer: Wellcare Medicare |
$4.27
|
| Rate for Payer: WMAP Medicaid |
$4.41
|
| Rate for Payer: WPS Commercial |
$65.92
|
|
|
VDRL with Reflex Titer, CSF
|
Facility
|
IP
|
$89.00
|
|
|
Service Code
|
CPT 86592
|
| Hospital Charge Code |
5364667
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$43.61 |
| Max. Negotiated Rate |
$81.88 |
| Rate for Payer: Aetna Commercial |
$80.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$76.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$47.17
|
| Rate for Payer: Cash Price |
$26.70
|
| Rate for Payer: Cigna Commercial |
$81.88
|
| Rate for Payer: Health EOS Commercial |
$79.21
|
| Rate for Payer: HFN Commercial |
$81.88
|
| Rate for Payer: Multiplan Commercial |
$71.20
|
| Rate for Payer: NAPHCARE Commercial |
$53.40
|
| Rate for Payer: Preferred Network Access Commercial |
$81.88
|
| Rate for Payer: Quartz Beloit One Network |
$43.61
|
| Rate for Payer: Quartz Commercial |
$53.40
|
| Rate for Payer: WEA Trust Commercial |
$48.95
|
| Rate for Payer: WPS Commercial |
$65.92
|
|
|
VE 1st Order
|
Facility
|
OP
|
$1,956.00
|
|
|
Service Code
|
CPT 36215
|
| Hospital Charge Code |
3052559
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$547.68 |
| Max. Negotiated Rate |
$7,824.00 |
| Rate for Payer: Aetna Commercial |
$1,760.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,682.16
|
| Rate for Payer: Aetna Managed Medicare |
$547.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,271.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$978.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$938.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,036.68
|
| Rate for Payer: Cash Price |
$586.80
|
| Rate for Payer: Cash Price |
$586.80
|
| Rate for Payer: Cigna Commercial |
$1,799.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,218.22
|
| Rate for Payer: Health EOS Commercial |
$1,740.84
|
| Rate for Payer: HFN Commercial |
$1,799.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,467.00
|
| Rate for Payer: Multiplan Commercial |
$1,564.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,173.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,799.52
|
| Rate for Payer: Quartz Beloit One Network |
$958.44
|
| Rate for Payer: Quartz Commercial |
$1,271.40
|
| Rate for Payer: Quartz Medicare Advantage |
$1,173.60
|
| Rate for Payer: The Alliance Commercial |
$7,824.00
|
| Rate for Payer: WEA Trust Commercial |
$1,075.80
|
| Rate for Payer: WPS Commercial |
$1,448.81
|
|
|
VE 1st Order
|
Facility
|
IP
|
$1,956.00
|
|
|
Service Code
|
CPT 36215
|
| Hospital Charge Code |
3052559
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$958.44 |
| Max. Negotiated Rate |
$1,799.52 |
| Rate for Payer: Aetna Commercial |
$1,760.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,682.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,036.68
|
| Rate for Payer: Cash Price |
$586.80
|
| Rate for Payer: Cigna Commercial |
$1,799.52
|
| Rate for Payer: Health EOS Commercial |
$1,740.84
|
| Rate for Payer: HFN Commercial |
$1,799.52
|
| Rate for Payer: Multiplan Commercial |
$1,564.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,173.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,799.52
|
| Rate for Payer: Quartz Beloit One Network |
$958.44
|
| Rate for Payer: Quartz Commercial |
$1,173.60
|
| Rate for Payer: WEA Trust Commercial |
$1,075.80
|
| Rate for Payer: WPS Commercial |
$1,448.81
|
|
