|
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
|
|
|
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
|
|
|
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
|
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
|
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
|
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 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 with Reflex Titer, CSF
|
Facility
|
OP
|
$89.00
|
|
|
Service Code
|
CPT 86592
|
| Hospital Charge Code |
5364667
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.44 |
| Max. Negotiated Rate |
$85.16 |
| Rate for Payer: Aetna Commercial |
$83.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$79.60
|
| 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 |
$49.06
|
| 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 |
$26.70
|
| Rate for Payer: Cash Price |
$26.70
|
| Rate for Payer: Cigna Commercial |
$85.16
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$4.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$51.80
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$4.44
|
| Rate for Payer: Health EOS Commercial |
$82.38
|
| Rate for Payer: HFN Commercial |
$85.16
|
| 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 |
$74.05
|
| Rate for Payer: NAPHCARE Commercial |
$6.66
|
| Rate for Payer: Preferred Network Access Commercial |
$85.16
|
| Rate for Payer: Quartz Beloit One Network |
$45.35
|
| Rate for Payer: Quartz Commercial |
$60.16
|
| 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 |
$69.42
|
| Rate for Payer: WEA Trust Commercial |
$50.91
|
| Rate for Payer: Wellcare Medicare |
$4.44
|
| Rate for Payer: WPS Commercial |
$68.56
|
|
|
VDRL with Reflex Titer, CSF
|
Professional
|
Both
|
$89.00
|
|
|
Service Code
|
CPT 86592
|
| Hospital Charge Code |
5364667
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.44 |
| Max. Negotiated Rate |
$87.93 |
| Rate for Payer: Aetna Commercial |
$87.93
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$79.60
|
| 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 |
$26.70
|
| Rate for Payer: Cash Price |
$26.70
|
| Rate for Payer: Cigna Commercial |
$87.93
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$46.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4.44
|
| Rate for Payer: Health EOS Commercial |
$84.23
|
| Rate for Payer: HFN Commercial |
$87.93
|
| 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 |
$74.05
|
| Rate for Payer: NAPHCARE Commercial |
$6.66
|
| Rate for Payer: Preferred Network Access Commercial |
$87.93
|
| Rate for Payer: Quartz Beloit One Network |
$40.73
|
| Rate for Payer: Quartz Commercial |
$52.76
|
| 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 |
$50.91
|
| 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
|
|
|
VE 1st Order
|
Facility
|
OP
|
$1,956.00
|
|
|
Service Code
|
CPT 36215
|
| Hospital Charge Code |
3052559
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$569.59 |
| Max. Negotiated Rate |
$4,386.95 |
| Rate for Payer: Aetna Commercial |
$1,830.82
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,749.45
|
| Rate for Payer: Aetna Managed Medicare |
$569.59
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,322.26
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,017.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$976.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,078.15
|
| Rate for Payer: Cash Price |
$586.80
|
| Rate for Payer: Cash Price |
$586.80
|
| Rate for Payer: Cigna Commercial |
$1,871.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Health EOS Commercial |
$1,810.47
|
| Rate for Payer: HFN Commercial |
$1,871.50
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,525.68
|
| Rate for Payer: Multiplan Commercial |
$1,627.39
|
| Rate for Payer: NAPHCARE Commercial |
$1,220.54
|
| Rate for Payer: Preferred Network Access Commercial |
$1,871.50
|
| Rate for Payer: Quartz Beloit One Network |
$996.78
|
| Rate for Payer: Quartz Commercial |
$1,322.26
|
| Rate for Payer: Quartz Medicare Advantage |
$1,220.54
|
| Rate for Payer: The Alliance Commercial |
$717.18
|
| Rate for Payer: WEA Trust Commercial |
$1,118.83
|
| Rate for Payer: WPS Commercial |
$1,506.71
|
|
|
VE 1st Order
|
Facility
|
IP
|
$1,956.00
|
|
|
Service Code
|
CPT 36215
|
| Hospital Charge Code |
3052559
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$996.78 |
| Max. Negotiated Rate |
$1,871.50 |
| Rate for Payer: Aetna Commercial |
$1,830.82
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,749.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,078.15
|
| Rate for Payer: Cash Price |
$586.80
|
| Rate for Payer: Cigna Commercial |
$1,871.50
|
| Rate for Payer: Health EOS Commercial |
$1,810.47
|
| Rate for Payer: HFN Commercial |
$1,871.50
|
| Rate for Payer: Multiplan Commercial |
$1,627.39
|
| Rate for Payer: Preferred Network Access Commercial |
$1,871.50
|
| Rate for Payer: Quartz Beloit One Network |
$996.78
|
| Rate for Payer: Quartz Commercial |
$1,220.54
|
| Rate for Payer: WEA Trust Commercial |
$1,118.83
|
| Rate for Payer: WPS Commercial |
$1,506.71
|
|
|
VE 2nd Order
|
Facility
|
IP
|
$2,490.00
|
|
|
Service Code
|
CPT 36216
|
| Hospital Charge Code |
3052560
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,268.90 |
| Max. Negotiated Rate |
$2,382.43 |
| Rate for Payer: Aetna Commercial |
$2,330.64
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,227.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,372.49
|
| Rate for Payer: Cash Price |
$747.00
|
| Rate for Payer: Cigna Commercial |
$2,382.43
|
| Rate for Payer: Health EOS Commercial |
$2,304.74
|
| Rate for Payer: HFN Commercial |
$2,382.43
|
| Rate for Payer: Multiplan Commercial |
$2,071.68
|
| Rate for Payer: Preferred Network Access Commercial |
$2,382.43
|
| Rate for Payer: Quartz Beloit One Network |
$1,268.90
|
| Rate for Payer: Quartz Commercial |
$1,553.76
|
| Rate for Payer: WEA Trust Commercial |
$1,424.28
|
| Rate for Payer: WPS Commercial |
$1,918.05
|
|
|
VE 2nd Order
|
Facility
|
OP
|
$2,490.00
|
|
|
Service Code
|
CPT 36216
|
| Hospital Charge Code |
3052560
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$725.09 |
| Max. Negotiated Rate |
$4,386.95 |
| Rate for Payer: Aetna Commercial |
$2,330.64
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,227.06
|
| Rate for Payer: Aetna Managed Medicare |
$725.09
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,683.24
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,294.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,243.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,372.49
|
| Rate for Payer: Cash Price |
$747.00
|
| Rate for Payer: Cash Price |
$747.00
|
| Rate for Payer: Cigna Commercial |
$2,382.43
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Health EOS Commercial |
$2,304.74
|
| Rate for Payer: HFN Commercial |
$2,382.43
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,942.20
|
| Rate for Payer: Multiplan Commercial |
$2,071.68
|
| Rate for Payer: NAPHCARE Commercial |
$1,553.76
|
| Rate for Payer: Preferred Network Access Commercial |
$2,382.43
|
| Rate for Payer: Quartz Beloit One Network |
$1,268.90
|
| Rate for Payer: Quartz Commercial |
$1,683.24
|
| Rate for Payer: Quartz Medicare Advantage |
$1,553.76
|
| Rate for Payer: The Alliance Commercial |
$898.31
|
| Rate for Payer: WEA Trust Commercial |
$1,424.28
|
| Rate for Payer: WPS Commercial |
$1,918.05
|
|
|
VE 3rd Order
|
Facility
|
OP
|
$2,889.00
|
|
|
Service Code
|
CPT 36217
|
| Hospital Charge Code |
3052561
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$841.28 |
| Max. Negotiated Rate |
$4,386.95 |
| Rate for Payer: Aetna Commercial |
$2,704.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,583.92
|
| Rate for Payer: Aetna Managed Medicare |
$841.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,952.96
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,502.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,442.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,592.42
|
| Rate for Payer: Cash Price |
$866.70
|
| Rate for Payer: Cash Price |
$866.70
|
| Rate for Payer: Cigna Commercial |
$2,764.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Health EOS Commercial |
$2,674.06
|
| Rate for Payer: HFN Commercial |
$2,764.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,253.42
|
| Rate for Payer: Multiplan Commercial |
$2,403.65
|
| Rate for Payer: NAPHCARE Commercial |
$1,802.74
|
| Rate for Payer: Preferred Network Access Commercial |
$2,764.20
|
| Rate for Payer: Quartz Beloit One Network |
$1,472.23
|
| Rate for Payer: Quartz Commercial |
$1,952.96
|
| Rate for Payer: Quartz Medicare Advantage |
$1,802.74
|
| Rate for Payer: The Alliance Commercial |
$1,099.57
|
| Rate for Payer: WEA Trust Commercial |
$1,652.51
|
| Rate for Payer: WPS Commercial |
$2,225.40
|
|
|
VE 3rd Order
|
Facility
|
IP
|
$2,889.00
|
|
|
Service Code
|
CPT 36217
|
| Hospital Charge Code |
3052561
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,472.23 |
| Max. Negotiated Rate |
$2,764.20 |
| Rate for Payer: Aetna Commercial |
$2,704.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,583.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,592.42
|
| Rate for Payer: Cash Price |
$866.70
|
| Rate for Payer: Cigna Commercial |
$2,764.20
|
| Rate for Payer: Health EOS Commercial |
$2,674.06
|
| Rate for Payer: HFN Commercial |
$2,764.20
|
| Rate for Payer: Multiplan Commercial |
$2,403.65
|
| Rate for Payer: Preferred Network Access Commercial |
$2,764.20
|
| Rate for Payer: Quartz Beloit One Network |
$1,472.23
|
| Rate for Payer: Quartz Commercial |
$1,802.74
|
| Rate for Payer: WEA Trust Commercial |
$1,652.51
|
| Rate for Payer: WPS Commercial |
$2,225.40
|
|
|
VE Add Vessel +
|
Facility
|
OP
|
$618.00
|
|
|
Service Code
|
CPT 36218
|
| Hospital Charge Code |
4125621
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$171.77 |
| Max. Negotiated Rate |
$4,386.95 |
| Rate for Payer: Aetna Commercial |
$578.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$552.74
|
| Rate for Payer: Aetna Managed Medicare |
$179.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$417.77
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$321.36
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$308.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$340.64
|
| Rate for Payer: Cash Price |
$185.40
|
| Rate for Payer: Cash Price |
$185.40
|
| Rate for Payer: Cigna Commercial |
$591.30
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Health EOS Commercial |
$572.02
|
| Rate for Payer: HFN Commercial |
$591.30
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$482.04
|
| Rate for Payer: Multiplan Commercial |
$514.18
|
| Rate for Payer: NAPHCARE Commercial |
$385.63
|
| Rate for Payer: Preferred Network Access Commercial |
$591.30
|
| Rate for Payer: Quartz Beloit One Network |
$314.93
|
| Rate for Payer: Quartz Commercial |
$417.77
|
| Rate for Payer: Quartz Medicare Advantage |
$385.63
|
| Rate for Payer: The Alliance Commercial |
$171.77
|
| Rate for Payer: WEA Trust Commercial |
$353.50
|
| Rate for Payer: WPS Commercial |
$476.05
|
|
|
VE Add Vessel +
|
Facility
|
IP
|
$618.00
|
|
|
Service Code
|
CPT 36218
|
| Hospital Charge Code |
4125621
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$314.93 |
| Max. Negotiated Rate |
$591.30 |
| Rate for Payer: Aetna Commercial |
$578.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$552.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$340.64
|
| Rate for Payer: Cash Price |
$185.40
|
| Rate for Payer: Cigna Commercial |
$591.30
|
| Rate for Payer: Health EOS Commercial |
$572.02
|
| Rate for Payer: HFN Commercial |
$591.30
|
| Rate for Payer: Multiplan Commercial |
$514.18
|
| Rate for Payer: Preferred Network Access Commercial |
$591.30
|
| Rate for Payer: Quartz Beloit One Network |
$314.93
|
| Rate for Payer: Quartz Commercial |
$385.63
|
| Rate for Payer: WEA Trust Commercial |
$353.50
|
| Rate for Payer: WPS Commercial |
$476.05
|
|
|
Vectibix 5 mg Charge
|
Facility
|
IP
|
$207.00
|
|
|
Service Code
|
HCPCS J9303
|
| Hospital Charge Code |
2958964
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$105.49 |
| Max. Negotiated Rate |
$198.06 |
| Rate for Payer: Aetna Commercial |
$193.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$185.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$114.10
|
| Rate for Payer: Cash Price |
$62.10
|
| Rate for Payer: Cigna Commercial |
$198.06
|
| Rate for Payer: Health EOS Commercial |
$191.60
|
| Rate for Payer: HFN Commercial |
$198.06
|
| Rate for Payer: Multiplan Commercial |
$172.22
|
| Rate for Payer: Preferred Network Access Commercial |
$198.06
|
| Rate for Payer: Quartz Beloit One Network |
$105.49
|
| Rate for Payer: Quartz Commercial |
$129.17
|
| Rate for Payer: WEA Trust Commercial |
$118.40
|
| Rate for Payer: WPS Commercial |
$159.45
|
|
|
Vectibix 5 mg Charge
|
Facility
|
OP
|
$207.00
|
|
|
Service Code
|
HCPCS J9303
|
| Hospital Charge Code |
2958964
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$103.33 |
| Max. Negotiated Rate |
$757.91 |
| Rate for Payer: Aetna Commercial |
$193.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$185.14
|
| Rate for Payer: Aetna Managed Medicare |
$189.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$139.93
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$107.64
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$103.33
|
| Rate for Payer: Anthem Medicare Advantage |
$189.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$114.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$189.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$189.48
|
| Rate for Payer: Cash Price |
$62.10
|
| Rate for Payer: Cash Price |
$62.10
|
| Rate for Payer: Cigna Commercial |
$198.06
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$189.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$208.09
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$189.48
|
| Rate for Payer: Health EOS Commercial |
$191.60
|
| Rate for Payer: HFN Commercial |
$198.06
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$704.86
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$189.48
|
| Rate for Payer: Independent Care Health Plan Medicare |
$189.48
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$189.48
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$189.48
|
| Rate for Payer: Multiplan Commercial |
$172.22
|
| Rate for Payer: NAPHCARE Commercial |
$284.22
|
| Rate for Payer: Preferred Network Access Commercial |
$198.06
|
| Rate for Payer: Quartz Beloit One Network |
$105.49
|
| Rate for Payer: Quartz Commercial |
$139.93
|
| Rate for Payer: Quartz Medicare Advantage |
$189.48
|
| Rate for Payer: The Alliance Commercial |
$757.91
|
| Rate for Payer: United Healthcare Medicare Advantage |
$189.48
|
| Rate for Payer: WEA Trust Commercial |
$118.40
|
| Rate for Payer: Wellcare Medicare |
$189.48
|
| Rate for Payer: WPS Commercial |
$393.22
|
|
|
Vectibix 5 mg Charge
|
Professional
|
Both
|
$207.00
|
|
|
Service Code
|
HCPCS J9303
|
| Hospital Charge Code |
2958964
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$94.72 |
| Max. Negotiated Rate |
$521.06 |
| Rate for Payer: Aetna Commercial |
$204.52
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$185.14
|
| Rate for Payer: Aetna Managed Medicare |
$189.48
|
| Rate for Payer: Anthem Medicare Advantage |
$189.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$189.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$189.48
|
| Rate for Payer: Cash Price |
$62.10
|
| Rate for Payer: Cash Price |
$62.10
|
| Rate for Payer: Cigna Commercial |
$204.52
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$180.62
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$157.29
|
| Rate for Payer: Health EOS Commercial |
$195.90
|
| Rate for Payer: HFN Commercial |
$204.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$188.08
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$188.08
|
| Rate for Payer: Independent Care Health Plan Medicare |
$189.48
|
| Rate for Payer: Multiplan Commercial |
$172.22
|
| Rate for Payer: NAPHCARE Commercial |
$284.22
|
| Rate for Payer: Preferred Network Access Commercial |
$204.52
|
| Rate for Payer: Quartz Beloit One Network |
$94.72
|
| Rate for Payer: Quartz Commercial |
$122.71
|
| Rate for Payer: Quartz Medicare Advantage |
$189.48
|
| Rate for Payer: The Alliance Commercial |
$521.06
|
| Rate for Payer: United Healthcare Medicaid |
$180.62
|
| Rate for Payer: United Healthcare Medicare Advantage |
$189.48
|
| Rate for Payer: WEA Trust Commercial |
$118.40
|
| Rate for Payer: WPS Commercial |
$393.22
|
|
