|
Vancomycin Level Trough
|
Facility
|
OP
|
$279.00
|
|
|
Service Code
|
CPT 80202
|
| Hospital Charge Code |
633870
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.08 |
| Max. Negotiated Rate |
$266.95 |
| Rate for Payer: Aetna Commercial |
$261.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$249.54
|
| Rate for Payer: Aetna Managed Medicare |
$14.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$52.81
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$24.64
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$23.38
|
| Rate for Payer: Anthem Medicare Advantage |
$14.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$153.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$14.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$14.08
|
| Rate for Payer: Cash Price |
$83.70
|
| Rate for Payer: Cash Price |
$83.70
|
| Rate for Payer: Cigna Commercial |
$266.95
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$14.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$162.38
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$14.08
|
| Rate for Payer: Health EOS Commercial |
$258.24
|
| Rate for Payer: HFN Commercial |
$266.95
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$52.38
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$14.08
|
| Rate for Payer: Independent Care Health Plan Medicare |
$14.08
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$14.08
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$14.08
|
| Rate for Payer: Multiplan Commercial |
$232.13
|
| Rate for Payer: NAPHCARE Commercial |
$21.12
|
| Rate for Payer: Preferred Network Access Commercial |
$266.95
|
| Rate for Payer: Quartz Beloit One Network |
$142.18
|
| Rate for Payer: Quartz Commercial |
$188.60
|
| Rate for Payer: Quartz Medicare Advantage |
$14.08
|
| Rate for Payer: The Alliance Commercial |
$56.33
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14.08
|
| Rate for Payer: United Healthcare PPO |
$217.62
|
| Rate for Payer: WEA Trust Commercial |
$159.59
|
| Rate for Payer: Wellcare Medicare |
$14.08
|
| Rate for Payer: WPS Commercial |
$214.91
|
|
|
Vancomycin Level Trough
|
Professional
|
Both
|
$279.00
|
|
|
Service Code
|
CPT 80202
|
| Hospital Charge Code |
633870
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.08 |
| Max. Negotiated Rate |
$275.65 |
| Rate for Payer: Aetna Commercial |
$275.65
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$249.54
|
| Rate for Payer: Aetna Managed Medicare |
$14.08
|
| Rate for Payer: Anthem Medicare Advantage |
$14.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$14.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$14.08
|
| Rate for Payer: Cash Price |
$83.70
|
| Rate for Payer: Cash Price |
$83.70
|
| Rate for Payer: Cigna Commercial |
$275.65
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$145.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$14.08
|
| Rate for Payer: Health EOS Commercial |
$264.05
|
| Rate for Payer: HFN Commercial |
$275.65
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$49.71
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$49.71
|
| Rate for Payer: Independent Care Health Plan Medicare |
$14.08
|
| Rate for Payer: Multiplan Commercial |
$232.13
|
| Rate for Payer: NAPHCARE Commercial |
$21.12
|
| Rate for Payer: Preferred Network Access Commercial |
$275.65
|
| Rate for Payer: Quartz Beloit One Network |
$127.67
|
| Rate for Payer: Quartz Commercial |
$165.39
|
| Rate for Payer: Quartz Medicare Advantage |
$14.08
|
| Rate for Payer: The Alliance Commercial |
$55.62
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14.08
|
| Rate for Payer: WEA Trust Commercial |
$159.59
|
| Rate for Payer: WPS Commercial |
$61.96
|
|
|
Vancomycin Powder 1gm Vial (MED)
|
Facility
|
IP
|
$185.00
|
|
|
Service Code
|
HCPCS J3370
|
| Hospital Charge Code |
5298713
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$94.28 |
| Max. Negotiated Rate |
$177.01 |
| Rate for Payer: Aetna Commercial |
$173.16
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$165.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$101.97
|
| Rate for Payer: Cash Price |
$55.50
|
| Rate for Payer: Cigna Commercial |
$177.01
|
| Rate for Payer: Health EOS Commercial |
$171.24
|
| Rate for Payer: HFN Commercial |
$177.01
|
| Rate for Payer: Multiplan Commercial |
$153.92
|
| Rate for Payer: Preferred Network Access Commercial |
$177.01
|
| Rate for Payer: Quartz Beloit One Network |
$94.28
|
| Rate for Payer: Quartz Commercial |
$115.44
|
| Rate for Payer: WEA Trust Commercial |
$105.82
|
| Rate for Payer: WPS Commercial |
$142.51
|
|
|
Vancomycin Powder 1gm Vial (MED)
|
Facility
|
OP
|
$185.00
|
|
|
Service Code
|
HCPCS J3370
|
| Hospital Charge Code |
5298713
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.55 |
| Max. Negotiated Rate |
$177.01 |
| Rate for Payer: Aetna Commercial |
$173.16
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$165.46
|
| Rate for Payer: Aetna Managed Medicare |
$53.87
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$125.06
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$96.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$92.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$101.97
|
| Rate for Payer: Cash Price |
$55.50
|
| Rate for Payer: Cash Price |
$55.50
|
| Rate for Payer: Cigna Commercial |
$177.01
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3.55
|
| Rate for Payer: Health EOS Commercial |
$171.24
|
| Rate for Payer: HFN Commercial |
$177.01
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$144.30
|
| Rate for Payer: Multiplan Commercial |
$153.92
|
| Rate for Payer: NAPHCARE Commercial |
$115.44
|
| Rate for Payer: Preferred Network Access Commercial |
$177.01
|
| Rate for Payer: Quartz Beloit One Network |
$94.28
|
| Rate for Payer: Quartz Commercial |
$125.06
|
| Rate for Payer: Quartz Medicare Advantage |
$115.44
|
| Rate for Payer: The Alliance Commercial |
$96.20
|
| Rate for Payer: WEA Trust Commercial |
$105.82
|
| Rate for Payer: WPS Commercial |
$6.70
|
|
|
Vanillylmandelic Acid 24 Hour Urine
|
Facility
|
OP
|
$450.00
|
|
|
Service Code
|
CPT 84585
|
| Hospital Charge Code |
978095
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$16.12 |
| Max. Negotiated Rate |
$430.56 |
| Rate for Payer: Aetna Commercial |
$421.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$402.48
|
| Rate for Payer: Aetna Managed Medicare |
$16.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$60.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$28.21
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$26.76
|
| Rate for Payer: Anthem Medicare Advantage |
$16.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$248.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$16.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$16.12
|
| Rate for Payer: Cash Price |
$135.00
|
| Rate for Payer: Cash Price |
$135.00
|
| Rate for Payer: Cigna Commercial |
$430.56
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$16.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$261.90
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$16.12
|
| Rate for Payer: Health EOS Commercial |
$416.52
|
| Rate for Payer: HFN Commercial |
$430.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$59.97
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$16.12
|
| Rate for Payer: Independent Care Health Plan Medicare |
$16.12
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$16.12
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$16.12
|
| Rate for Payer: Multiplan Commercial |
$374.40
|
| Rate for Payer: NAPHCARE Commercial |
$24.18
|
| Rate for Payer: Preferred Network Access Commercial |
$430.56
|
| Rate for Payer: Quartz Beloit One Network |
$229.32
|
| Rate for Payer: Quartz Commercial |
$304.20
|
| Rate for Payer: Quartz Medicare Advantage |
$16.12
|
| Rate for Payer: The Alliance Commercial |
$64.48
|
| Rate for Payer: United Healthcare Medicare Advantage |
$16.12
|
| Rate for Payer: United Healthcare PPO |
$351.00
|
| Rate for Payer: WEA Trust Commercial |
$257.40
|
| Rate for Payer: Wellcare Medicare |
$16.12
|
| Rate for Payer: WPS Commercial |
$346.63
|
|
|
Vanillylmandelic Acid 24 Hour Urine
|
Facility
|
IP
|
$450.00
|
|
|
Service Code
|
CPT 84585
|
| Hospital Charge Code |
978095
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$229.32 |
| Max. Negotiated Rate |
$430.56 |
| Rate for Payer: Aetna Commercial |
$421.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$402.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$248.04
|
| Rate for Payer: Cash Price |
$135.00
|
| Rate for Payer: Cigna Commercial |
$430.56
|
| Rate for Payer: Health EOS Commercial |
$416.52
|
| Rate for Payer: HFN Commercial |
$430.56
|
| Rate for Payer: Multiplan Commercial |
$374.40
|
| Rate for Payer: Preferred Network Access Commercial |
$430.56
|
| Rate for Payer: Quartz Beloit One Network |
$229.32
|
| Rate for Payer: Quartz Commercial |
$280.80
|
| Rate for Payer: WEA Trust Commercial |
$257.40
|
| Rate for Payer: WPS Commercial |
$346.63
|
|
|
Vanillylmandelic Acid 24 Hour Urine
|
Professional
|
Both
|
$450.00
|
|
|
Service Code
|
CPT 84585
|
| Hospital Charge Code |
978095
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$16.12 |
| Max. Negotiated Rate |
$444.60 |
| Rate for Payer: Aetna Commercial |
$444.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$402.48
|
| Rate for Payer: Aetna Managed Medicare |
$16.12
|
| Rate for Payer: Anthem Medicare Advantage |
$16.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$16.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$16.12
|
| Rate for Payer: Cash Price |
$135.00
|
| Rate for Payer: Cash Price |
$135.00
|
| Rate for Payer: Cigna Commercial |
$444.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$234.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$16.12
|
| Rate for Payer: Health EOS Commercial |
$425.88
|
| Rate for Payer: HFN Commercial |
$444.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$56.91
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$56.91
|
| Rate for Payer: Independent Care Health Plan Medicare |
$16.12
|
| Rate for Payer: Multiplan Commercial |
$374.40
|
| Rate for Payer: NAPHCARE Commercial |
$24.18
|
| Rate for Payer: Preferred Network Access Commercial |
$444.60
|
| Rate for Payer: Quartz Beloit One Network |
$205.92
|
| Rate for Payer: Quartz Commercial |
$266.76
|
| Rate for Payer: Quartz Medicare Advantage |
$16.12
|
| Rate for Payer: The Alliance Commercial |
$63.67
|
| Rate for Payer: United Healthcare Medicare Advantage |
$16.12
|
| Rate for Payer: WEA Trust Commercial |
$257.40
|
| Rate for Payer: WPS Commercial |
$70.93
|
|
|
Vanillylmandelic Acid, Random Urine
|
Professional
|
Both
|
$30.19
|
|
|
Service Code
|
CPT 82570
|
| Hospital Charge Code |
4076077
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.39 |
| Max. Negotiated Rate |
$29.83 |
| Rate for Payer: Aetna Commercial |
$29.83
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$27.00
|
| Rate for Payer: Aetna Managed Medicare |
$5.39
|
| Rate for Payer: Anthem Medicare Advantage |
$5.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5.39
|
| Rate for Payer: Cash Price |
$9.06
|
| Rate for Payer: Cash Price |
$9.06
|
| Rate for Payer: Cigna Commercial |
$29.83
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$15.70
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5.39
|
| Rate for Payer: Health EOS Commercial |
$28.57
|
| Rate for Payer: HFN Commercial |
$29.83
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$19.02
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$19.02
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5.39
|
| Rate for Payer: Multiplan Commercial |
$25.12
|
| Rate for Payer: NAPHCARE Commercial |
$8.08
|
| Rate for Payer: Preferred Network Access Commercial |
$29.83
|
| Rate for Payer: Quartz Beloit One Network |
$13.81
|
| Rate for Payer: Quartz Commercial |
$17.90
|
| Rate for Payer: Quartz Medicare Advantage |
$5.39
|
| Rate for Payer: The Alliance Commercial |
$21.28
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.39
|
| Rate for Payer: WEA Trust Commercial |
$17.27
|
| Rate for Payer: WPS Commercial |
$23.70
|
|
|
Vanillylmandelic Acid, Random Urine
|
Facility
|
IP
|
$30.19
|
|
|
Service Code
|
CPT 82570
|
| Hospital Charge Code |
4076077
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.38 |
| Max. Negotiated Rate |
$28.89 |
| Rate for Payer: Aetna Commercial |
$28.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$27.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$16.64
|
| Rate for Payer: Cash Price |
$9.06
|
| Rate for Payer: Cigna Commercial |
$28.89
|
| Rate for Payer: Health EOS Commercial |
$27.94
|
| Rate for Payer: HFN Commercial |
$28.89
|
| Rate for Payer: Multiplan Commercial |
$25.12
|
| Rate for Payer: Preferred Network Access Commercial |
$28.89
|
| Rate for Payer: Quartz Beloit One Network |
$15.38
|
| Rate for Payer: Quartz Commercial |
$18.84
|
| Rate for Payer: WEA Trust Commercial |
$17.27
|
| Rate for Payer: WPS Commercial |
$23.26
|
|
|
Vanillylmandelic Acid, Random Urine
|
Facility
|
OP
|
$30.19
|
|
|
Service Code
|
CPT 82570
|
| Hospital Charge Code |
4076077
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.39 |
| Max. Negotiated Rate |
$28.89 |
| Rate for Payer: Aetna Commercial |
$28.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$27.00
|
| Rate for Payer: Aetna Managed Medicare |
$5.39
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$20.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$9.43
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$8.94
|
| Rate for Payer: Anthem Medicare Advantage |
$5.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$16.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5.39
|
| Rate for Payer: Cash Price |
$9.06
|
| Rate for Payer: Cash Price |
$9.06
|
| Rate for Payer: Cigna Commercial |
$28.89
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$5.39
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$17.57
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$5.39
|
| Rate for Payer: Health EOS Commercial |
$27.94
|
| Rate for Payer: HFN Commercial |
$28.89
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$20.04
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$5.39
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5.39
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$5.39
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$5.39
|
| Rate for Payer: Multiplan Commercial |
$25.12
|
| Rate for Payer: NAPHCARE Commercial |
$8.08
|
| Rate for Payer: Preferred Network Access Commercial |
$28.89
|
| Rate for Payer: Quartz Beloit One Network |
$15.38
|
| Rate for Payer: Quartz Commercial |
$20.41
|
| Rate for Payer: Quartz Medicare Advantage |
$5.39
|
| Rate for Payer: The Alliance Commercial |
$21.55
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.39
|
| Rate for Payer: United Healthcare PPO |
$23.55
|
| Rate for Payer: WEA Trust Commercial |
$17.27
|
| Rate for Payer: Wellcare Medicare |
$5.39
|
| Rate for Payer: WPS Commercial |
$23.26
|
|
|
Varicella Zoster Antibody IgG
|
Facility
|
IP
|
$244.00
|
|
|
Service Code
|
CPT 86787
|
| Hospital Charge Code |
980591
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$124.34 |
| Max. Negotiated Rate |
$233.46 |
| Rate for Payer: Aetna Commercial |
$228.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$218.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$134.49
|
| Rate for Payer: Cash Price |
$73.20
|
| Rate for Payer: Cigna Commercial |
$233.46
|
| Rate for Payer: Health EOS Commercial |
$225.85
|
| Rate for Payer: HFN Commercial |
$233.46
|
| Rate for Payer: Multiplan Commercial |
$203.01
|
| Rate for Payer: Preferred Network Access Commercial |
$233.46
|
| Rate for Payer: Quartz Beloit One Network |
$124.34
|
| Rate for Payer: Quartz Commercial |
$152.26
|
| Rate for Payer: WEA Trust Commercial |
$139.57
|
| Rate for Payer: WPS Commercial |
$187.95
|
|
|
Varicella Zoster Antibody IgG
|
Facility
|
OP
|
$244.00
|
|
|
Service Code
|
CPT 86787
|
| Hospital Charge Code |
980591
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.40 |
| Max. Negotiated Rate |
$233.46 |
| Rate for Payer: Aetna Commercial |
$228.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$218.23
|
| Rate for Payer: Aetna Managed Medicare |
$13.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$50.23
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$23.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$22.24
|
| Rate for Payer: Anthem Medicare Advantage |
$13.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$134.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$13.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$13.40
|
| Rate for Payer: Cash Price |
$73.20
|
| Rate for Payer: Cash Price |
$73.20
|
| Rate for Payer: Cigna Commercial |
$233.46
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$13.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$142.01
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$13.40
|
| Rate for Payer: Health EOS Commercial |
$225.85
|
| Rate for Payer: HFN Commercial |
$233.46
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$49.83
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$13.40
|
| Rate for Payer: Independent Care Health Plan Medicare |
$13.40
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$13.40
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$13.40
|
| Rate for Payer: Multiplan Commercial |
$203.01
|
| Rate for Payer: NAPHCARE Commercial |
$20.09
|
| Rate for Payer: Preferred Network Access Commercial |
$233.46
|
| Rate for Payer: Quartz Beloit One Network |
$124.34
|
| Rate for Payer: Quartz Commercial |
$164.94
|
| Rate for Payer: Quartz Medicare Advantage |
$13.40
|
| Rate for Payer: The Alliance Commercial |
$53.58
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.40
|
| Rate for Payer: United Healthcare PPO |
$190.32
|
| Rate for Payer: WEA Trust Commercial |
$139.57
|
| Rate for Payer: Wellcare Medicare |
$13.40
|
| Rate for Payer: WPS Commercial |
$187.95
|
|
|
Varicella Zoster Antibody IgG
|
Professional
|
Both
|
$244.00
|
|
|
Service Code
|
CPT 86787
|
| Hospital Charge Code |
980591
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.40 |
| Max. Negotiated Rate |
$241.07 |
| Rate for Payer: Aetna Commercial |
$241.07
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$218.23
|
| Rate for Payer: Aetna Managed Medicare |
$13.40
|
| Rate for Payer: Anthem Medicare Advantage |
$13.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$13.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$13.40
|
| Rate for Payer: Cash Price |
$73.20
|
| Rate for Payer: Cash Price |
$73.20
|
| Rate for Payer: Cigna Commercial |
$241.07
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$126.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$13.40
|
| Rate for Payer: Health EOS Commercial |
$230.92
|
| Rate for Payer: HFN Commercial |
$241.07
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$47.29
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$47.29
|
| Rate for Payer: Independent Care Health Plan Medicare |
$13.40
|
| Rate for Payer: Multiplan Commercial |
$203.01
|
| Rate for Payer: NAPHCARE Commercial |
$20.09
|
| Rate for Payer: Preferred Network Access Commercial |
$241.07
|
| Rate for Payer: Quartz Beloit One Network |
$111.65
|
| Rate for Payer: Quartz Commercial |
$144.64
|
| Rate for Payer: Quartz Medicare Advantage |
$13.40
|
| Rate for Payer: The Alliance Commercial |
$52.91
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.40
|
| Rate for Payer: WEA Trust Commercial |
$139.57
|
| Rate for Payer: WPS Commercial |
$58.94
|
|
|
Varicella Zoster Antibody IgM
|
Professional
|
Both
|
$34.00
|
|
|
Service Code
|
CPT 86787
|
| Hospital Charge Code |
3403606
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.40 |
| Max. Negotiated Rate |
$58.94 |
| Rate for Payer: Aetna Commercial |
$33.59
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$30.41
|
| Rate for Payer: Aetna Managed Medicare |
$13.40
|
| Rate for Payer: Anthem Medicare Advantage |
$13.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$13.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$13.40
|
| Rate for Payer: Cash Price |
$10.20
|
| Rate for Payer: Cash Price |
$10.20
|
| Rate for Payer: Cigna Commercial |
$33.59
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$17.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$13.40
|
| Rate for Payer: Health EOS Commercial |
$32.18
|
| Rate for Payer: HFN Commercial |
$33.59
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$47.29
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$47.29
|
| Rate for Payer: Independent Care Health Plan Medicare |
$13.40
|
| Rate for Payer: Multiplan Commercial |
$28.29
|
| Rate for Payer: NAPHCARE Commercial |
$20.09
|
| Rate for Payer: Preferred Network Access Commercial |
$33.59
|
| Rate for Payer: Quartz Beloit One Network |
$15.56
|
| Rate for Payer: Quartz Commercial |
$20.16
|
| Rate for Payer: Quartz Medicare Advantage |
$13.40
|
| Rate for Payer: The Alliance Commercial |
$52.91
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.40
|
| Rate for Payer: WEA Trust Commercial |
$19.45
|
| Rate for Payer: WPS Commercial |
$58.94
|
|
|
Varicella Zoster Antibody IgM
|
Facility
|
IP
|
$34.00
|
|
|
Service Code
|
CPT 86787
|
| Hospital Charge Code |
3403606
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.33 |
| Max. Negotiated Rate |
$32.53 |
| Rate for Payer: Aetna Commercial |
$31.82
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$30.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$18.74
|
| Rate for Payer: Cash Price |
$10.20
|
| Rate for Payer: Cigna Commercial |
$32.53
|
| Rate for Payer: Health EOS Commercial |
$31.47
|
| Rate for Payer: HFN Commercial |
$32.53
|
| Rate for Payer: Multiplan Commercial |
$28.29
|
| Rate for Payer: Preferred Network Access Commercial |
$32.53
|
| Rate for Payer: Quartz Beloit One Network |
$17.33
|
| Rate for Payer: Quartz Commercial |
$21.22
|
| Rate for Payer: WEA Trust Commercial |
$19.45
|
| Rate for Payer: WPS Commercial |
$26.19
|
|
|
Varicella Zoster Antibody IgM
|
Facility
|
OP
|
$34.00
|
|
|
Service Code
|
CPT 86787
|
| Hospital Charge Code |
3403606
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.40 |
| Max. Negotiated Rate |
$53.58 |
| Rate for Payer: Aetna Commercial |
$31.82
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$30.41
|
| Rate for Payer: Aetna Managed Medicare |
$13.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$50.23
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$23.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$22.24
|
| Rate for Payer: Anthem Medicare Advantage |
$13.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$18.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$13.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$13.40
|
| Rate for Payer: Cash Price |
$10.20
|
| Rate for Payer: Cash Price |
$10.20
|
| Rate for Payer: Cigna Commercial |
$32.53
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$13.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$19.79
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$13.40
|
| Rate for Payer: Health EOS Commercial |
$31.47
|
| Rate for Payer: HFN Commercial |
$32.53
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$49.83
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$13.40
|
| Rate for Payer: Independent Care Health Plan Medicare |
$13.40
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$13.40
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$13.40
|
| Rate for Payer: Multiplan Commercial |
$28.29
|
| Rate for Payer: NAPHCARE Commercial |
$20.09
|
| Rate for Payer: Preferred Network Access Commercial |
$32.53
|
| Rate for Payer: Quartz Beloit One Network |
$17.33
|
| Rate for Payer: Quartz Commercial |
$22.98
|
| Rate for Payer: Quartz Medicare Advantage |
$13.40
|
| Rate for Payer: The Alliance Commercial |
$53.58
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.40
|
| Rate for Payer: United Healthcare PPO |
$26.52
|
| Rate for Payer: WEA Trust Commercial |
$19.45
|
| Rate for Payer: Wellcare Medicare |
$13.40
|
| Rate for Payer: WPS Commercial |
$26.19
|
|
|
Varicella Zoster Culture
|
Facility
|
IP
|
$297.00
|
|
|
Service Code
|
CPT 87254
|
| Hospital Charge Code |
2942916
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$151.35 |
| Max. Negotiated Rate |
$284.17 |
| Rate for Payer: Aetna Commercial |
$277.99
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$265.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$163.71
|
| Rate for Payer: Cash Price |
$89.10
|
| Rate for Payer: Cigna Commercial |
$284.17
|
| Rate for Payer: Health EOS Commercial |
$274.90
|
| Rate for Payer: HFN Commercial |
$284.17
|
| Rate for Payer: Multiplan Commercial |
$247.10
|
| Rate for Payer: Preferred Network Access Commercial |
$284.17
|
| Rate for Payer: Quartz Beloit One Network |
$151.35
|
| Rate for Payer: Quartz Commercial |
$185.33
|
| Rate for Payer: WEA Trust Commercial |
$169.88
|
| Rate for Payer: WPS Commercial |
$228.78
|
|
|
Varicella Zoster Culture
|
Facility
|
OP
|
$297.00
|
|
|
Service Code
|
CPT 87254
|
| Hospital Charge Code |
2942916
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$20.34 |
| Max. Negotiated Rate |
$284.17 |
| Rate for Payer: Aetna Commercial |
$277.99
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$265.64
|
| Rate for Payer: Aetna Managed Medicare |
$20.34
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$76.28
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$35.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$33.77
|
| Rate for Payer: Anthem Medicare Advantage |
$20.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$163.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$20.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$20.34
|
| Rate for Payer: Cash Price |
$89.10
|
| Rate for Payer: Cash Price |
$89.10
|
| Rate for Payer: Cigna Commercial |
$284.17
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$20.34
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$172.85
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$20.34
|
| Rate for Payer: Health EOS Commercial |
$274.90
|
| Rate for Payer: HFN Commercial |
$284.17
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$75.67
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$20.34
|
| Rate for Payer: Independent Care Health Plan Medicare |
$20.34
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$20.34
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$20.34
|
| Rate for Payer: Multiplan Commercial |
$247.10
|
| Rate for Payer: NAPHCARE Commercial |
$30.51
|
| Rate for Payer: Preferred Network Access Commercial |
$284.17
|
| Rate for Payer: Quartz Beloit One Network |
$151.35
|
| Rate for Payer: Quartz Commercial |
$200.77
|
| Rate for Payer: Quartz Medicare Advantage |
$20.34
|
| Rate for Payer: The Alliance Commercial |
$81.37
|
| Rate for Payer: United Healthcare Medicare Advantage |
$20.34
|
| Rate for Payer: United Healthcare PPO |
$231.66
|
| Rate for Payer: WEA Trust Commercial |
$169.88
|
| Rate for Payer: Wellcare Medicare |
$20.34
|
| Rate for Payer: WPS Commercial |
$228.78
|
|
|
Varicella Zoster Culture
|
Professional
|
Both
|
$297.00
|
|
|
Service Code
|
CPT 87254
|
| Hospital Charge Code |
2942916
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$20.34 |
| Max. Negotiated Rate |
$293.44 |
| Rate for Payer: Aetna Commercial |
$293.44
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$265.64
|
| Rate for Payer: Aetna Managed Medicare |
$20.34
|
| Rate for Payer: Anthem Medicare Advantage |
$20.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$20.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$20.34
|
| Rate for Payer: Cash Price |
$89.10
|
| Rate for Payer: Cash Price |
$89.10
|
| Rate for Payer: Cigna Commercial |
$293.44
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$154.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$20.34
|
| Rate for Payer: Health EOS Commercial |
$281.08
|
| Rate for Payer: HFN Commercial |
$293.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$71.81
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$71.81
|
| Rate for Payer: Independent Care Health Plan Medicare |
$20.34
|
| Rate for Payer: Multiplan Commercial |
$247.10
|
| Rate for Payer: NAPHCARE Commercial |
$30.51
|
| Rate for Payer: Preferred Network Access Commercial |
$293.44
|
| Rate for Payer: Quartz Beloit One Network |
$135.91
|
| Rate for Payer: Quartz Commercial |
$176.06
|
| Rate for Payer: Quartz Medicare Advantage |
$20.34
|
| Rate for Payer: The Alliance Commercial |
$80.35
|
| Rate for Payer: United Healthcare Medicare Advantage |
$20.34
|
| Rate for Payer: WEA Trust Commercial |
$169.88
|
| Rate for Payer: WPS Commercial |
$89.51
|
|
|
Varicella-Zoster DNA, Qual, RT PCR
|
Professional
|
Both
|
$311.00
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
6167795
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$36.49 |
| Max. Negotiated Rate |
$307.27 |
| Rate for Payer: Aetna Commercial |
$307.27
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$278.16
|
| Rate for Payer: Aetna Managed Medicare |
$36.49
|
| Rate for Payer: Anthem Medicare Advantage |
$36.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$36.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$36.49
|
| Rate for Payer: Cash Price |
$93.30
|
| Rate for Payer: Cash Price |
$93.30
|
| Rate for Payer: Cigna Commercial |
$307.27
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$161.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$36.49
|
| Rate for Payer: Health EOS Commercial |
$294.33
|
| Rate for Payer: HFN Commercial |
$307.27
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$128.82
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$128.82
|
| Rate for Payer: Independent Care Health Plan Medicare |
$36.49
|
| Rate for Payer: Multiplan Commercial |
$258.75
|
| Rate for Payer: NAPHCARE Commercial |
$54.74
|
| Rate for Payer: Preferred Network Access Commercial |
$307.27
|
| Rate for Payer: Quartz Beloit One Network |
$142.31
|
| Rate for Payer: Quartz Commercial |
$184.36
|
| Rate for Payer: Quartz Medicare Advantage |
$36.49
|
| Rate for Payer: The Alliance Commercial |
$144.15
|
| Rate for Payer: United Healthcare Medicare Advantage |
$36.49
|
| Rate for Payer: WEA Trust Commercial |
$177.89
|
| Rate for Payer: WPS Commercial |
$160.57
|
|
|
Varicella-Zoster DNA, Qual, RT PCR
|
Facility
|
IP
|
$311.00
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
6167795
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$158.49 |
| Max. Negotiated Rate |
$297.56 |
| Rate for Payer: Aetna Commercial |
$291.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$278.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$171.42
|
| Rate for Payer: Cash Price |
$93.30
|
| Rate for Payer: Cigna Commercial |
$297.56
|
| Rate for Payer: Health EOS Commercial |
$287.86
|
| Rate for Payer: HFN Commercial |
$297.56
|
| Rate for Payer: Multiplan Commercial |
$258.75
|
| Rate for Payer: Preferred Network Access Commercial |
$297.56
|
| Rate for Payer: Quartz Beloit One Network |
$158.49
|
| Rate for Payer: Quartz Commercial |
$194.06
|
| Rate for Payer: WEA Trust Commercial |
$177.89
|
| Rate for Payer: WPS Commercial |
$239.56
|
|
|
Varicella-Zoster DNA, Qual, RT PCR
|
Facility
|
OP
|
$311.00
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
6167795
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$36.49 |
| Max. Negotiated Rate |
$297.56 |
| Rate for Payer: Aetna Commercial |
$291.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$278.16
|
| Rate for Payer: Aetna Managed Medicare |
$36.49
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$136.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$63.86
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$60.58
|
| Rate for Payer: Anthem Medicare Advantage |
$36.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$171.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$36.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$36.49
|
| Rate for Payer: Cash Price |
$93.30
|
| Rate for Payer: Cash Price |
$93.30
|
| Rate for Payer: Cigna Commercial |
$297.56
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$36.49
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$181.00
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$36.49
|
| Rate for Payer: Health EOS Commercial |
$287.86
|
| Rate for Payer: HFN Commercial |
$297.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$135.76
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$36.49
|
| Rate for Payer: Independent Care Health Plan Medicare |
$36.49
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$36.49
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$36.49
|
| Rate for Payer: Multiplan Commercial |
$258.75
|
| Rate for Payer: NAPHCARE Commercial |
$54.74
|
| Rate for Payer: Preferred Network Access Commercial |
$297.56
|
| Rate for Payer: Quartz Beloit One Network |
$158.49
|
| Rate for Payer: Quartz Commercial |
$210.24
|
| Rate for Payer: Quartz Medicare Advantage |
$36.49
|
| Rate for Payer: The Alliance Commercial |
$145.97
|
| Rate for Payer: United Healthcare Medicare Advantage |
$36.49
|
| Rate for Payer: United Healthcare PPO |
$242.58
|
| Rate for Payer: WEA Trust Commercial |
$177.89
|
| Rate for Payer: Wellcare Medicare |
$36.49
|
| Rate for Payer: WPS Commercial |
$239.56
|
|
|
Varicella-Zoster PCR Occular
|
Facility
|
IP
|
$370.00
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
6196143
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$188.55 |
| Max. Negotiated Rate |
$354.02 |
| Rate for Payer: Aetna Commercial |
$346.32
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$330.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$203.94
|
| Rate for Payer: Cash Price |
$111.00
|
| Rate for Payer: Cigna Commercial |
$354.02
|
| Rate for Payer: Health EOS Commercial |
$342.47
|
| Rate for Payer: HFN Commercial |
$354.02
|
| Rate for Payer: Multiplan Commercial |
$307.84
|
| Rate for Payer: Preferred Network Access Commercial |
$354.02
|
| Rate for Payer: Quartz Beloit One Network |
$188.55
|
| Rate for Payer: Quartz Commercial |
$230.88
|
| Rate for Payer: WEA Trust Commercial |
$211.64
|
| Rate for Payer: WPS Commercial |
$285.01
|
|
|
Varicella-Zoster PCR Occular
|
Professional
|
Both
|
$370.00
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
6196143
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$36.49 |
| Max. Negotiated Rate |
$365.56 |
| Rate for Payer: Aetna Commercial |
$365.56
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$330.93
|
| Rate for Payer: Aetna Managed Medicare |
$36.49
|
| Rate for Payer: Anthem Medicare Advantage |
$36.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$36.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$36.49
|
| Rate for Payer: Cash Price |
$111.00
|
| Rate for Payer: Cash Price |
$111.00
|
| Rate for Payer: Cigna Commercial |
$365.56
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$192.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$36.49
|
| Rate for Payer: Health EOS Commercial |
$350.17
|
| Rate for Payer: HFN Commercial |
$365.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$128.82
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$128.82
|
| Rate for Payer: Independent Care Health Plan Medicare |
$36.49
|
| Rate for Payer: Multiplan Commercial |
$307.84
|
| Rate for Payer: NAPHCARE Commercial |
$54.74
|
| Rate for Payer: Preferred Network Access Commercial |
$365.56
|
| Rate for Payer: Quartz Beloit One Network |
$169.31
|
| Rate for Payer: Quartz Commercial |
$219.34
|
| Rate for Payer: Quartz Medicare Advantage |
$36.49
|
| Rate for Payer: The Alliance Commercial |
$144.15
|
| Rate for Payer: United Healthcare Medicare Advantage |
$36.49
|
| Rate for Payer: WEA Trust Commercial |
$211.64
|
| Rate for Payer: WPS Commercial |
$160.57
|
|
|
Varicella-Zoster PCR Occular
|
Facility
|
OP
|
$370.00
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
6196143
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$36.49 |
| Max. Negotiated Rate |
$354.02 |
| Rate for Payer: Aetna Commercial |
$346.32
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$330.93
|
| Rate for Payer: Aetna Managed Medicare |
$36.49
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$136.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$63.86
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$60.58
|
| Rate for Payer: Anthem Medicare Advantage |
$36.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$203.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$36.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$36.49
|
| Rate for Payer: Cash Price |
$111.00
|
| Rate for Payer: Cash Price |
$111.00
|
| Rate for Payer: Cigna Commercial |
$354.02
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$36.49
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$215.34
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$36.49
|
| Rate for Payer: Health EOS Commercial |
$342.47
|
| Rate for Payer: HFN Commercial |
$354.02
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$135.76
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$36.49
|
| Rate for Payer: Independent Care Health Plan Medicare |
$36.49
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$36.49
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$36.49
|
| Rate for Payer: Multiplan Commercial |
$307.84
|
| Rate for Payer: NAPHCARE Commercial |
$54.74
|
| Rate for Payer: Preferred Network Access Commercial |
$354.02
|
| Rate for Payer: Quartz Beloit One Network |
$188.55
|
| Rate for Payer: Quartz Commercial |
$250.12
|
| Rate for Payer: Quartz Medicare Advantage |
$36.49
|
| Rate for Payer: The Alliance Commercial |
$145.97
|
| Rate for Payer: United Healthcare Medicare Advantage |
$36.49
|
| Rate for Payer: United Healthcare PPO |
$288.60
|
| Rate for Payer: WEA Trust Commercial |
$211.64
|
| Rate for Payer: Wellcare Medicare |
$36.49
|
| Rate for Payer: WPS Commercial |
$285.01
|
|
