|
Chicken Pox Vaccine, SC 90716VFC
|
Facility
IP
|
$20.83
|
|
|
Service Code
|
CPT 90716
|
| Hospital Charge Code |
5100630
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.21 |
| Max. Negotiated Rate |
$19.16 |
| Rate for Payer: Aetna Commercial |
$18.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$11.04
|
| Rate for Payer: Cash Price |
$6.25
|
| Rate for Payer: Cigna Commercial |
$19.16
|
| Rate for Payer: Health EOS Commercial |
$18.54
|
| Rate for Payer: HFN Commercial |
$19.16
|
| Rate for Payer: Multiplan Commercial |
$16.66
|
| Rate for Payer: NAPHCARE Commercial |
$12.50
|
| Rate for Payer: Preferred Network Access Commercial |
$19.16
|
| Rate for Payer: Quartz Beloit One Network |
$10.21
|
| Rate for Payer: Quartz Commercial |
$12.50
|
| Rate for Payer: WEA Trust Commercial |
$11.46
|
| Rate for Payer: WPS Commercial |
$15.43
|
|
|
Chikungunya Antibodies Panel w/Rfx Titer
|
Facility
OP
|
$90.00
|
|
|
Service Code
|
CPT 86720
|
| Hospital Charge Code |
4392638
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.17 |
| Max. Negotiated Rate |
$360.00 |
| Rate for Payer: Aetna Commercial |
$81.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$77.40
|
| Rate for Payer: Aetna Managed Medicare |
$16.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$60.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$28.35
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$26.89
|
| Rate for Payer: Anthem Medicaid |
$8.17
|
| Rate for Payer: Anthem Medicare Advantage |
$16.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$47.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$16.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$16.20
|
| Rate for Payer: Cash Price |
$27.00
|
| Rate for Payer: Cash Price |
$27.00
|
| Rate for Payer: Cigna Commercial |
$82.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$16.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$8.17
|
| Rate for Payer: Dean Health Medicaid |
$8.17
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$16.20
|
| Rate for Payer: Health EOS Commercial |
$80.10
|
| Rate for Payer: HFN Commercial |
$82.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$60.26
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$16.20
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$8.17
|
| Rate for Payer: Independent Care Health Plan Medicare |
$16.20
|
| Rate for Payer: Managed Health Services Medicaid |
$8.50
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$16.20
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$16.20
|
| Rate for Payer: Multiplan Commercial |
$72.00
|
| Rate for Payer: NAPHCARE Commercial |
$24.30
|
| Rate for Payer: Preferred Network Access Commercial |
$82.80
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$8.17
|
| Rate for Payer: Quartz Beloit One Network |
$44.10
|
| Rate for Payer: Quartz Commercial |
$58.50
|
| Rate for Payer: Quartz Medicare Advantage |
$16.20
|
| Rate for Payer: The Alliance Commercial |
$360.00
|
| Rate for Payer: United Healthcare Medicaid |
$8.17
|
| Rate for Payer: United Healthcare Medicare Advantage |
$16.20
|
| Rate for Payer: United Healthcare PPO |
$67.50
|
| Rate for Payer: WEA Trust Commercial |
$49.50
|
| Rate for Payer: Wellcare Medicare |
$16.20
|
| Rate for Payer: WMAP Medicaid |
$8.17
|
| Rate for Payer: WPS Commercial |
$66.66
|
|
|
Chikungunya Antibodies Panel w/Rfx Titer
|
Professional
|
$90.00
|
|
|
Service Code
|
CPT 86720
|
| Hospital Charge Code |
4392638
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$16.20 |
| Max. Negotiated Rate |
$85.50 |
| Rate for Payer: Aetna Commercial |
$85.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$77.40
|
| Rate for Payer: Aetna Managed Medicare |
$16.20
|
| Rate for Payer: Anthem Medicare Advantage |
$16.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$16.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$16.20
|
| Rate for Payer: Cash Price |
$27.00
|
| Rate for Payer: Cash Price |
$27.00
|
| Rate for Payer: Cigna Commercial |
$85.50
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$45.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$16.20
|
| Rate for Payer: Health EOS Commercial |
$81.90
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$57.19
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$57.19
|
| Rate for Payer: Independent Care Health Plan Medicare |
$16.20
|
| Rate for Payer: Multiplan Commercial |
$72.00
|
| Rate for Payer: Preferred Network Access Commercial |
$85.50
|
| Rate for Payer: Quartz Beloit One Network |
$39.60
|
| Rate for Payer: Quartz Commercial |
$51.30
|
| Rate for Payer: Quartz Medicare Advantage |
$16.20
|
| Rate for Payer: The Alliance Commercial |
$63.99
|
| Rate for Payer: United Healthcare Medicare Advantage |
$16.20
|
| Rate for Payer: WEA Trust Commercial |
$49.50
|
| Rate for Payer: WPS Commercial |
$71.28
|
|
|
Chikungunya Antibodies Panel w/Rfx Titer
|
Facility
IP
|
$90.00
|
|
|
Service Code
|
CPT 86720
|
| Hospital Charge Code |
4392638
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$44.10 |
| Max. Negotiated Rate |
$82.80 |
| Rate for Payer: Aetna Commercial |
$81.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$47.70
|
| Rate for Payer: Cash Price |
$27.00
|
| Rate for Payer: Cigna Commercial |
$82.80
|
| Rate for Payer: Health EOS Commercial |
$80.10
|
| Rate for Payer: HFN Commercial |
$82.80
|
| Rate for Payer: Multiplan Commercial |
$72.00
|
| Rate for Payer: NAPHCARE Commercial |
$54.00
|
| Rate for Payer: Preferred Network Access Commercial |
$82.80
|
| Rate for Payer: Quartz Beloit One Network |
$44.10
|
| Rate for Payer: Quartz Commercial |
$54.00
|
| Rate for Payer: WEA Trust Commercial |
$49.50
|
| Rate for Payer: WPS Commercial |
$66.66
|
|
|
Chikungunya Antibodies Panel w/ Rfx Titier
|
Facility
IP
|
$93.00
|
|
|
Service Code
|
CPT 86720
|
| Hospital Charge Code |
4392803
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$45.57 |
| Max. Negotiated Rate |
$85.56 |
| Rate for Payer: Aetna Commercial |
$83.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$49.29
|
| Rate for Payer: Cash Price |
$27.90
|
| Rate for Payer: Cigna Commercial |
$85.56
|
| Rate for Payer: Health EOS Commercial |
$82.77
|
| Rate for Payer: HFN Commercial |
$85.56
|
| Rate for Payer: Multiplan Commercial |
$74.40
|
| Rate for Payer: NAPHCARE Commercial |
$55.80
|
| Rate for Payer: Preferred Network Access Commercial |
$85.56
|
| Rate for Payer: Quartz Beloit One Network |
$45.57
|
| Rate for Payer: Quartz Commercial |
$55.80
|
| Rate for Payer: WEA Trust Commercial |
$51.15
|
| Rate for Payer: WPS Commercial |
$68.89
|
|
|
Chikungunya Antibodies Panel w/ Rfx Titier
|
Professional
|
$93.00
|
|
|
Service Code
|
CPT 86720
|
| Hospital Charge Code |
4392803
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$16.20 |
| Max. Negotiated Rate |
$88.35 |
| Rate for Payer: Aetna Commercial |
$88.35
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$79.98
|
| Rate for Payer: Aetna Managed Medicare |
$16.20
|
| Rate for Payer: Anthem Medicare Advantage |
$16.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$16.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$16.20
|
| Rate for Payer: Cash Price |
$27.90
|
| Rate for Payer: Cash Price |
$27.90
|
| Rate for Payer: Cigna Commercial |
$88.35
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$46.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$16.20
|
| Rate for Payer: Health EOS Commercial |
$84.63
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$57.19
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$57.19
|
| Rate for Payer: Independent Care Health Plan Medicare |
$16.20
|
| Rate for Payer: Multiplan Commercial |
$74.40
|
| Rate for Payer: Preferred Network Access Commercial |
$88.35
|
| Rate for Payer: Quartz Beloit One Network |
$40.92
|
| Rate for Payer: Quartz Commercial |
$53.01
|
| Rate for Payer: Quartz Medicare Advantage |
$16.20
|
| Rate for Payer: The Alliance Commercial |
$63.99
|
| Rate for Payer: United Healthcare Medicare Advantage |
$16.20
|
| Rate for Payer: WEA Trust Commercial |
$51.15
|
| Rate for Payer: WPS Commercial |
$71.28
|
|
|
Chikungunya Antibodies Panel w/ Rfx Titier
|
Facility
OP
|
$93.00
|
|
|
Service Code
|
CPT 86720
|
| Hospital Charge Code |
4392803
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.17 |
| Max. Negotiated Rate |
$372.00 |
| Rate for Payer: Aetna Commercial |
$83.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$79.98
|
| Rate for Payer: Aetna Managed Medicare |
$16.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$60.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$28.35
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$26.89
|
| Rate for Payer: Anthem Medicaid |
$8.17
|
| Rate for Payer: Anthem Medicare Advantage |
$16.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$49.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$16.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$16.20
|
| Rate for Payer: Cash Price |
$27.90
|
| Rate for Payer: Cash Price |
$27.90
|
| Rate for Payer: Cigna Commercial |
$85.56
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$16.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$8.17
|
| Rate for Payer: Dean Health Medicaid |
$8.17
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$16.20
|
| Rate for Payer: Health EOS Commercial |
$82.77
|
| Rate for Payer: HFN Commercial |
$85.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$60.26
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$16.20
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$8.17
|
| Rate for Payer: Independent Care Health Plan Medicare |
$16.20
|
| Rate for Payer: Managed Health Services Medicaid |
$8.50
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$16.20
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$16.20
|
| Rate for Payer: Multiplan Commercial |
$74.40
|
| Rate for Payer: NAPHCARE Commercial |
$24.30
|
| Rate for Payer: Preferred Network Access Commercial |
$85.56
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$8.17
|
| Rate for Payer: Quartz Beloit One Network |
$45.57
|
| Rate for Payer: Quartz Commercial |
$60.45
|
| Rate for Payer: Quartz Medicare Advantage |
$16.20
|
| Rate for Payer: The Alliance Commercial |
$372.00
|
| Rate for Payer: United Healthcare Medicaid |
$8.17
|
| Rate for Payer: United Healthcare Medicare Advantage |
$16.20
|
| Rate for Payer: United Healthcare PPO |
$69.75
|
| Rate for Payer: WEA Trust Commercial |
$51.15
|
| Rate for Payer: Wellcare Medicare |
$16.20
|
| Rate for Payer: WMAP Medicaid |
$8.17
|
| Rate for Payer: WPS Commercial |
$68.89
|
|
|
Chikungunya Virus RNA, Qualitative, Real-Time PCR
|
Professional
|
$573.00
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
4392634
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$35.09 |
| Max. Negotiated Rate |
$544.35 |
| Rate for Payer: Aetna Commercial |
$544.35
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$492.78
|
| Rate for Payer: Aetna Managed Medicare |
$35.09
|
| Rate for Payer: Anthem Medicare Advantage |
$35.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$35.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$35.09
|
| Rate for Payer: Cash Price |
$171.90
|
| Rate for Payer: Cash Price |
$171.90
|
| Rate for Payer: Cigna Commercial |
$544.35
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$286.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$35.09
|
| Rate for Payer: Health EOS Commercial |
$521.43
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$123.87
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$123.87
|
| Rate for Payer: Independent Care Health Plan Medicare |
$35.09
|
| Rate for Payer: Multiplan Commercial |
$458.40
|
| Rate for Payer: Preferred Network Access Commercial |
$544.35
|
| Rate for Payer: Quartz Beloit One Network |
$252.12
|
| Rate for Payer: Quartz Commercial |
$326.61
|
| Rate for Payer: Quartz Medicare Advantage |
$35.09
|
| Rate for Payer: The Alliance Commercial |
$138.61
|
| Rate for Payer: United Healthcare Medicare Advantage |
$35.09
|
| Rate for Payer: WEA Trust Commercial |
$315.15
|
| Rate for Payer: WPS Commercial |
$154.40
|
|
|
Chikungunya Virus RNA, Qualitative, Real-Time PCR
|
Facility
OP
|
$573.00
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
4392634
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$35.09 |
| Max. Negotiated Rate |
$2,292.00 |
| Rate for Payer: Aetna Commercial |
$515.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$492.78
|
| Rate for Payer: Aetna Managed Medicare |
$35.09
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$131.59
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$61.41
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$58.25
|
| Rate for Payer: Anthem Medicaid |
$36.26
|
| Rate for Payer: Anthem Medicare Advantage |
$35.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$303.69
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$35.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$35.09
|
| Rate for Payer: Cash Price |
$171.90
|
| Rate for Payer: Cash Price |
$171.90
|
| Rate for Payer: Cigna Commercial |
$527.16
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$35.09
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$36.26
|
| Rate for Payer: Dean Health Medicaid |
$36.26
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$35.09
|
| Rate for Payer: Health EOS Commercial |
$509.97
|
| Rate for Payer: HFN Commercial |
$527.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$130.53
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$35.09
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$36.26
|
| Rate for Payer: Independent Care Health Plan Medicare |
$35.09
|
| Rate for Payer: Managed Health Services Medicaid |
$37.71
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$35.09
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$35.09
|
| Rate for Payer: Multiplan Commercial |
$458.40
|
| Rate for Payer: NAPHCARE Commercial |
$52.64
|
| Rate for Payer: Preferred Network Access Commercial |
$527.16
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$36.26
|
| Rate for Payer: Quartz Beloit One Network |
$280.77
|
| Rate for Payer: Quartz Commercial |
$372.45
|
| Rate for Payer: Quartz Medicare Advantage |
$35.09
|
| Rate for Payer: The Alliance Commercial |
$2,292.00
|
| Rate for Payer: United Healthcare Medicaid |
$36.26
|
| Rate for Payer: United Healthcare Medicare Advantage |
$35.09
|
| Rate for Payer: United Healthcare PPO |
$429.75
|
| Rate for Payer: WEA Trust Commercial |
$315.15
|
| Rate for Payer: Wellcare Medicare |
$35.09
|
| Rate for Payer: WMAP Medicaid |
$36.26
|
| Rate for Payer: WPS Commercial |
$424.42
|
|
|
Chikungunya Virus RNA, Qualitative, Real-Time PCR
|
Facility
IP
|
$573.00
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
4392634
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$280.77 |
| Max. Negotiated Rate |
$527.16 |
| Rate for Payer: Aetna Commercial |
$515.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$303.69
|
| Rate for Payer: Cash Price |
$171.90
|
| Rate for Payer: Cigna Commercial |
$527.16
|
| Rate for Payer: Health EOS Commercial |
$509.97
|
| Rate for Payer: HFN Commercial |
$527.16
|
| Rate for Payer: Multiplan Commercial |
$458.40
|
| Rate for Payer: NAPHCARE Commercial |
$343.80
|
| Rate for Payer: Preferred Network Access Commercial |
$527.16
|
| Rate for Payer: Quartz Beloit One Network |
$280.77
|
| Rate for Payer: Quartz Commercial |
$343.80
|
| Rate for Payer: WEA Trust Commercial |
$315.15
|
| Rate for Payer: WPS Commercial |
$424.42
|
|
|
CHIMERIC ANTIGEN RECEPTOR (CAR) T-CELL AND OTHER IMMUNOTHERAPIES
|
Facility
IP
|
$979,819.00
|
|
|
Service Code
|
MS-DRG 018
|
| Min. Negotiated Rate |
$352,452.84 |
| Max. Negotiated Rate |
$979,819.00 |
| Rate for Payer: Aetna Managed Medicare |
$352,452.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$772,903.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$592,424.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$562,841.52
|
| Rate for Payer: Anthem Medicare Advantage |
$352,452.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$352,452.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$352,452.84
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$352,452.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$624,805.66
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$352,452.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$718,432.70
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$352,452.84
|
| Rate for Payer: Independent Care Health Plan Medicare |
$352,452.84
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$352,452.84
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$352,452.84
|
| Rate for Payer: NAPHCARE Commercial |
$528,679.26
|
| Rate for Payer: Quartz Medicare Advantage |
$352,452.84
|
| Rate for Payer: The Alliance Commercial |
$979,819.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$352,452.84
|
| Rate for Payer: United Healthcare PPO |
$559,309.03
|
| Rate for Payer: Wellcare Medicare |
$352,452.84
|
|
|
CHIN IMPLANT/FACIAL AUGMENTATION
|
Facility
OP
|
$3,935.00
|
|
| Hospital Charge Code |
2960046
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,101.80 |
| Max. Negotiated Rate |
$15,740.00 |
| Rate for Payer: Aetna Commercial |
$3,541.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,384.10
|
| Rate for Payer: Aetna Managed Medicare |
$1,101.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,557.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,967.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,888.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,085.55
|
| Rate for Payer: Cash Price |
$1,180.50
|
| Rate for Payer: Cigna Commercial |
$3,620.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,202.03
|
| Rate for Payer: Health EOS Commercial |
$3,502.15
|
| Rate for Payer: HFN Commercial |
$3,620.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,951.25
|
| Rate for Payer: Multiplan Commercial |
$3,148.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,361.00
|
| Rate for Payer: Preferred Network Access Commercial |
$3,620.20
|
| Rate for Payer: Quartz Beloit One Network |
$1,928.15
|
| Rate for Payer: Quartz Commercial |
$2,557.75
|
| Rate for Payer: Quartz Medicare Advantage |
$2,361.00
|
| Rate for Payer: The Alliance Commercial |
$15,740.00
|
| Rate for Payer: WEA Trust Commercial |
$2,164.25
|
| Rate for Payer: WPS Commercial |
$2,914.65
|
|
|
CHIN IMPLANT/FACIAL AUGMENTATION
|
Facility
IP
|
$3,935.00
|
|
| Hospital Charge Code |
2960046
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,928.15 |
| Max. Negotiated Rate |
$3,620.20 |
| Rate for Payer: Aetna Commercial |
$3,541.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,085.55
|
| Rate for Payer: Cash Price |
$1,180.50
|
| Rate for Payer: Cigna Commercial |
$3,620.20
|
| Rate for Payer: Health EOS Commercial |
$3,502.15
|
| Rate for Payer: HFN Commercial |
$3,620.20
|
| Rate for Payer: Multiplan Commercial |
$3,148.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,361.00
|
| Rate for Payer: Preferred Network Access Commercial |
$3,620.20
|
| Rate for Payer: Quartz Beloit One Network |
$1,928.15
|
| Rate for Payer: Quartz Commercial |
$2,361.00
|
| Rate for Payer: WEA Trust Commercial |
$2,164.25
|
| Rate for Payer: WPS Commercial |
$2,914.65
|
|
|
Chlamydia
|
Professional
|
$10.00
|
|
|
Service Code
|
CPT 86631
|
| Hospital Charge Code |
4772606
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.40 |
| Max. Negotiated Rate |
$52.01 |
| Rate for Payer: Aetna Commercial |
$9.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8.60
|
| Rate for Payer: Aetna Managed Medicare |
$11.82
|
| Rate for Payer: Anthem Medicare Advantage |
$11.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$11.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$11.82
|
| Rate for Payer: Cash Price |
$3.00
|
| Rate for Payer: Cash Price |
$3.00
|
| Rate for Payer: Cigna Commercial |
$9.50
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$5.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$11.82
|
| Rate for Payer: Health EOS Commercial |
$9.10
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$41.72
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$41.72
|
| Rate for Payer: Independent Care Health Plan Medicare |
$11.82
|
| Rate for Payer: Multiplan Commercial |
$8.00
|
| Rate for Payer: Preferred Network Access Commercial |
$9.50
|
| Rate for Payer: Quartz Beloit One Network |
$4.40
|
| Rate for Payer: Quartz Commercial |
$5.70
|
| Rate for Payer: Quartz Medicare Advantage |
$11.82
|
| Rate for Payer: The Alliance Commercial |
$46.69
|
| Rate for Payer: United Healthcare Medicare Advantage |
$11.82
|
| Rate for Payer: WEA Trust Commercial |
$5.50
|
| Rate for Payer: WPS Commercial |
$52.01
|
|
|
Chlamydia
|
Facility
IP
|
$10.00
|
|
|
Service Code
|
CPT 86631
|
| Hospital Charge Code |
4772606
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.90 |
| Max. Negotiated Rate |
$9.20 |
| Rate for Payer: Aetna Commercial |
$9.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5.30
|
| Rate for Payer: Cash Price |
$3.00
|
| Rate for Payer: Cigna Commercial |
$9.20
|
| Rate for Payer: Health EOS Commercial |
$8.90
|
| Rate for Payer: HFN Commercial |
$9.20
|
| Rate for Payer: Multiplan Commercial |
$8.00
|
| Rate for Payer: NAPHCARE Commercial |
$6.00
|
| Rate for Payer: Preferred Network Access Commercial |
$9.20
|
| Rate for Payer: Quartz Beloit One Network |
$4.90
|
| Rate for Payer: Quartz Commercial |
$6.00
|
| Rate for Payer: WEA Trust Commercial |
$5.50
|
| Rate for Payer: WPS Commercial |
$7.41
|
|
|
Chlamydia
|
Facility
OP
|
$10.00
|
|
|
Service Code
|
CPT 86631
|
| Hospital Charge Code |
4772606
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.90 |
| Max. Negotiated Rate |
$44.32 |
| Rate for Payer: Aetna Commercial |
$9.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8.60
|
| Rate for Payer: Aetna Managed Medicare |
$11.82
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$44.32
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$20.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$19.62
|
| Rate for Payer: Anthem Medicaid |
$8.17
|
| Rate for Payer: Anthem Medicare Advantage |
$11.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$11.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$11.82
|
| Rate for Payer: Cash Price |
$3.00
|
| Rate for Payer: Cash Price |
$3.00
|
| Rate for Payer: Cigna Commercial |
$9.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$11.82
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$8.17
|
| Rate for Payer: Dean Health Medicaid |
$8.17
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$11.82
|
| Rate for Payer: Health EOS Commercial |
$8.90
|
| Rate for Payer: HFN Commercial |
$9.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$43.97
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$11.82
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$8.17
|
| Rate for Payer: Independent Care Health Plan Medicare |
$11.82
|
| Rate for Payer: Managed Health Services Medicaid |
$8.50
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$11.82
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$11.82
|
| Rate for Payer: Multiplan Commercial |
$8.00
|
| Rate for Payer: NAPHCARE Commercial |
$17.73
|
| Rate for Payer: Preferred Network Access Commercial |
$9.20
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$8.17
|
| Rate for Payer: Quartz Beloit One Network |
$4.90
|
| Rate for Payer: Quartz Commercial |
$6.50
|
| Rate for Payer: Quartz Medicare Advantage |
$11.82
|
| Rate for Payer: The Alliance Commercial |
$40.00
|
| Rate for Payer: United Healthcare Medicaid |
$8.17
|
| Rate for Payer: United Healthcare Medicare Advantage |
$11.82
|
| Rate for Payer: United Healthcare PPO |
$7.50
|
| Rate for Payer: WEA Trust Commercial |
$5.50
|
| Rate for Payer: Wellcare Medicare |
$11.82
|
| Rate for Payer: WMAP Medicaid |
$8.17
|
| Rate for Payer: WPS Commercial |
$7.41
|
|
|
Chlamydia Cx / 690
|
Professional
|
$215.00
|
|
|
Service Code
|
CPT 87110
|
| Hospital Charge Code |
1038856
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$19.60 |
| Max. Negotiated Rate |
$204.25 |
| Rate for Payer: Aetna Commercial |
$204.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$184.90
|
| Rate for Payer: Aetna Managed Medicare |
$19.60
|
| Rate for Payer: Anthem Medicare Advantage |
$19.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$19.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$19.60
|
| Rate for Payer: Cash Price |
$64.50
|
| Rate for Payer: Cash Price |
$64.50
|
| Rate for Payer: Cigna Commercial |
$204.25
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$107.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$19.60
|
| Rate for Payer: Health EOS Commercial |
$195.65
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$69.19
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$69.19
|
| Rate for Payer: Independent Care Health Plan Medicare |
$19.60
|
| Rate for Payer: Multiplan Commercial |
$172.00
|
| Rate for Payer: Preferred Network Access Commercial |
$204.25
|
| Rate for Payer: Quartz Beloit One Network |
$94.60
|
| Rate for Payer: Quartz Commercial |
$122.55
|
| Rate for Payer: Quartz Medicare Advantage |
$19.60
|
| Rate for Payer: The Alliance Commercial |
$77.42
|
| Rate for Payer: United Healthcare Medicare Advantage |
$19.60
|
| Rate for Payer: WEA Trust Commercial |
$118.25
|
| Rate for Payer: WPS Commercial |
$86.24
|
|
|
Chlamydia Cx / 690
|
Facility
IP
|
$215.00
|
|
|
Service Code
|
CPT 87110
|
| Hospital Charge Code |
1038856
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$105.35 |
| Max. Negotiated Rate |
$197.80 |
| Rate for Payer: Aetna Commercial |
$193.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$113.95
|
| Rate for Payer: Cash Price |
$64.50
|
| Rate for Payer: Cigna Commercial |
$197.80
|
| Rate for Payer: Health EOS Commercial |
$191.35
|
| Rate for Payer: HFN Commercial |
$197.80
|
| Rate for Payer: Multiplan Commercial |
$172.00
|
| Rate for Payer: NAPHCARE Commercial |
$129.00
|
| Rate for Payer: Preferred Network Access Commercial |
$197.80
|
| Rate for Payer: Quartz Beloit One Network |
$105.35
|
| Rate for Payer: Quartz Commercial |
$129.00
|
| Rate for Payer: WEA Trust Commercial |
$118.25
|
| Rate for Payer: WPS Commercial |
$159.25
|
|
|
Chlamydia Cx / 690
|
Facility
OP
|
$215.00
|
|
|
Service Code
|
CPT 87110
|
| Hospital Charge Code |
1038856
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$19.60 |
| Max. Negotiated Rate |
$860.00 |
| Rate for Payer: Aetna Commercial |
$193.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$184.90
|
| Rate for Payer: Aetna Managed Medicare |
$19.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$73.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$34.30
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$32.54
|
| Rate for Payer: Anthem Medicaid |
$20.25
|
| Rate for Payer: Anthem Medicare Advantage |
$19.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$113.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$19.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$19.60
|
| Rate for Payer: Cash Price |
$64.50
|
| Rate for Payer: Cash Price |
$64.50
|
| Rate for Payer: Cigna Commercial |
$197.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$19.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$20.25
|
| Rate for Payer: Dean Health Medicaid |
$20.25
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$19.60
|
| Rate for Payer: Health EOS Commercial |
$191.35
|
| Rate for Payer: HFN Commercial |
$197.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$72.91
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$19.60
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$20.25
|
| Rate for Payer: Independent Care Health Plan Medicare |
$19.60
|
| Rate for Payer: Managed Health Services Medicaid |
$21.06
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$19.60
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$19.60
|
| Rate for Payer: Multiplan Commercial |
$172.00
|
| Rate for Payer: NAPHCARE Commercial |
$29.40
|
| Rate for Payer: Preferred Network Access Commercial |
$197.80
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$20.25
|
| Rate for Payer: Quartz Beloit One Network |
$105.35
|
| Rate for Payer: Quartz Commercial |
$139.75
|
| Rate for Payer: Quartz Medicare Advantage |
$19.60
|
| Rate for Payer: The Alliance Commercial |
$860.00
|
| Rate for Payer: United Healthcare Medicaid |
$20.25
|
| Rate for Payer: United Healthcare Medicare Advantage |
$19.60
|
| Rate for Payer: United Healthcare PPO |
$161.25
|
| Rate for Payer: WEA Trust Commercial |
$118.25
|
| Rate for Payer: Wellcare Medicare |
$19.60
|
| Rate for Payer: WMAP Medicaid |
$20.25
|
| Rate for Payer: WPS Commercial |
$159.25
|
|
|
Chlamydia DNA Probe
|
Professional
|
$344.00
|
|
|
Service Code
|
CPT 87491
|
| Hospital Charge Code |
3328234
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$35.09 |
| Max. Negotiated Rate |
$326.80 |
| Rate for Payer: Aetna Commercial |
$326.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$295.84
|
| Rate for Payer: Aetna Managed Medicare |
$35.09
|
| Rate for Payer: Anthem Medicare Advantage |
$35.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$35.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$35.09
|
| Rate for Payer: Cash Price |
$103.20
|
| Rate for Payer: Cash Price |
$103.20
|
| Rate for Payer: Cigna Commercial |
$326.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$172.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$35.09
|
| Rate for Payer: Health EOS Commercial |
$313.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$123.87
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$123.87
|
| Rate for Payer: Independent Care Health Plan Medicare |
$35.09
|
| Rate for Payer: Multiplan Commercial |
$275.20
|
| Rate for Payer: Preferred Network Access Commercial |
$326.80
|
| Rate for Payer: Quartz Beloit One Network |
$151.36
|
| Rate for Payer: Quartz Commercial |
$196.08
|
| Rate for Payer: Quartz Medicare Advantage |
$35.09
|
| Rate for Payer: The Alliance Commercial |
$138.61
|
| Rate for Payer: United Healthcare Medicare Advantage |
$35.09
|
| Rate for Payer: WEA Trust Commercial |
$189.20
|
| Rate for Payer: WPS Commercial |
$154.40
|
|
|
Chlamydia DNA Probe
|
Facility
IP
|
$344.00
|
|
|
Service Code
|
CPT 87491
|
| Hospital Charge Code |
3328234
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$168.56 |
| Max. Negotiated Rate |
$316.48 |
| Rate for Payer: Aetna Commercial |
$309.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$182.32
|
| Rate for Payer: Cash Price |
$103.20
|
| Rate for Payer: Cigna Commercial |
$316.48
|
| Rate for Payer: Health EOS Commercial |
$306.16
|
| Rate for Payer: HFN Commercial |
$316.48
|
| Rate for Payer: Multiplan Commercial |
$275.20
|
| Rate for Payer: NAPHCARE Commercial |
$206.40
|
| Rate for Payer: Preferred Network Access Commercial |
$316.48
|
| Rate for Payer: Quartz Beloit One Network |
$168.56
|
| Rate for Payer: Quartz Commercial |
$206.40
|
| Rate for Payer: WEA Trust Commercial |
$189.20
|
| Rate for Payer: WPS Commercial |
$254.80
|
|
|
Chlamydia DNA Probe
|
Facility
OP
|
$344.00
|
|
|
Service Code
|
CPT 87491
|
| Hospital Charge Code |
3328234
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$35.09 |
| Max. Negotiated Rate |
$1,376.00 |
| Rate for Payer: Aetna Commercial |
$309.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$295.84
|
| Rate for Payer: Aetna Managed Medicare |
$35.09
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$131.59
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$61.41
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$58.25
|
| Rate for Payer: Anthem Medicaid |
$36.26
|
| Rate for Payer: Anthem Medicare Advantage |
$35.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$182.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$35.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$35.09
|
| Rate for Payer: Cash Price |
$103.20
|
| Rate for Payer: Cash Price |
$103.20
|
| Rate for Payer: Cigna Commercial |
$316.48
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$35.09
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$36.26
|
| Rate for Payer: Dean Health Medicaid |
$36.26
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$35.09
|
| Rate for Payer: Health EOS Commercial |
$306.16
|
| Rate for Payer: HFN Commercial |
$316.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$130.53
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$35.09
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$36.26
|
| Rate for Payer: Independent Care Health Plan Medicare |
$35.09
|
| Rate for Payer: Managed Health Services Medicaid |
$37.71
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$35.09
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$35.09
|
| Rate for Payer: Multiplan Commercial |
$275.20
|
| Rate for Payer: NAPHCARE Commercial |
$52.64
|
| Rate for Payer: Preferred Network Access Commercial |
$316.48
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$36.26
|
| Rate for Payer: Quartz Beloit One Network |
$168.56
|
| Rate for Payer: Quartz Commercial |
$223.60
|
| Rate for Payer: Quartz Medicare Advantage |
$35.09
|
| Rate for Payer: The Alliance Commercial |
$1,376.00
|
| Rate for Payer: United Healthcare Medicaid |
$36.26
|
| Rate for Payer: United Healthcare Medicare Advantage |
$35.09
|
| Rate for Payer: United Healthcare PPO |
$258.00
|
| Rate for Payer: WEA Trust Commercial |
$189.20
|
| Rate for Payer: Wellcare Medicare |
$35.09
|
| Rate for Payer: WMAP Medicaid |
$36.26
|
| Rate for Payer: WPS Commercial |
$254.80
|
|
|
Chlamydia & GC PCR, Genital
|
Facility
OP
|
$353.00
|
|
|
Service Code
|
CPT 87491
|
| Hospital Charge Code |
3322179
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$35.09 |
| Max. Negotiated Rate |
$1,412.00 |
| Rate for Payer: Aetna Commercial |
$317.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$303.58
|
| Rate for Payer: Aetna Managed Medicare |
$35.09
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$131.59
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$61.41
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$58.25
|
| Rate for Payer: Anthem Medicaid |
$36.26
|
| Rate for Payer: Anthem Medicare Advantage |
$35.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$187.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$35.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$35.09
|
| Rate for Payer: Cash Price |
$105.90
|
| Rate for Payer: Cash Price |
$105.90
|
| Rate for Payer: Cigna Commercial |
$324.76
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$35.09
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$36.26
|
| Rate for Payer: Dean Health Medicaid |
$36.26
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$35.09
|
| Rate for Payer: Health EOS Commercial |
$314.17
|
| Rate for Payer: HFN Commercial |
$324.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$130.53
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$35.09
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$36.26
|
| Rate for Payer: Independent Care Health Plan Medicare |
$35.09
|
| Rate for Payer: Managed Health Services Medicaid |
$37.71
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$35.09
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$35.09
|
| Rate for Payer: Multiplan Commercial |
$282.40
|
| Rate for Payer: NAPHCARE Commercial |
$52.64
|
| Rate for Payer: Preferred Network Access Commercial |
$324.76
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$36.26
|
| Rate for Payer: Quartz Beloit One Network |
$172.97
|
| Rate for Payer: Quartz Commercial |
$229.45
|
| Rate for Payer: Quartz Medicare Advantage |
$35.09
|
| Rate for Payer: The Alliance Commercial |
$1,412.00
|
| Rate for Payer: United Healthcare Medicaid |
$36.26
|
| Rate for Payer: United Healthcare Medicare Advantage |
$35.09
|
| Rate for Payer: United Healthcare PPO |
$264.75
|
| Rate for Payer: WEA Trust Commercial |
$194.15
|
| Rate for Payer: Wellcare Medicare |
$35.09
|
| Rate for Payer: WMAP Medicaid |
$36.26
|
| Rate for Payer: WPS Commercial |
$261.47
|
|
|
Chlamydia & GC PCR, Genital
|
Facility
IP
|
$353.00
|
|
|
Service Code
|
CPT 87491
|
| Hospital Charge Code |
3322179
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$172.97 |
| Max. Negotiated Rate |
$324.76 |
| Rate for Payer: Aetna Commercial |
$317.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$187.09
|
| Rate for Payer: Cash Price |
$105.90
|
| Rate for Payer: Cigna Commercial |
$324.76
|
| Rate for Payer: Health EOS Commercial |
$314.17
|
| Rate for Payer: HFN Commercial |
$324.76
|
| Rate for Payer: Multiplan Commercial |
$282.40
|
| Rate for Payer: NAPHCARE Commercial |
$211.80
|
| Rate for Payer: Preferred Network Access Commercial |
$324.76
|
| Rate for Payer: Quartz Beloit One Network |
$172.97
|
| Rate for Payer: Quartz Commercial |
$211.80
|
| Rate for Payer: WEA Trust Commercial |
$194.15
|
| Rate for Payer: WPS Commercial |
$261.47
|
|
|
Chlamydia & GC PCR, Genital
|
Professional
|
$353.00
|
|
|
Service Code
|
CPT 87491
|
| Hospital Charge Code |
3322179
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$35.09 |
| Max. Negotiated Rate |
$335.35 |
| Rate for Payer: Aetna Commercial |
$335.35
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$303.58
|
| Rate for Payer: Aetna Managed Medicare |
$35.09
|
| Rate for Payer: Anthem Medicare Advantage |
$35.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$35.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$35.09
|
| Rate for Payer: Cash Price |
$105.90
|
| Rate for Payer: Cash Price |
$105.90
|
| Rate for Payer: Cigna Commercial |
$335.35
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$176.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$35.09
|
| Rate for Payer: Health EOS Commercial |
$321.23
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$123.87
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$123.87
|
| Rate for Payer: Independent Care Health Plan Medicare |
$35.09
|
| Rate for Payer: Multiplan Commercial |
$282.40
|
| Rate for Payer: Preferred Network Access Commercial |
$335.35
|
| Rate for Payer: Quartz Beloit One Network |
$155.32
|
| Rate for Payer: Quartz Commercial |
$201.21
|
| Rate for Payer: Quartz Medicare Advantage |
$35.09
|
| Rate for Payer: The Alliance Commercial |
$138.61
|
| Rate for Payer: United Healthcare Medicare Advantage |
$35.09
|
| Rate for Payer: WEA Trust Commercial |
$194.15
|
| Rate for Payer: WPS Commercial |
$154.40
|
|
