|
Chicken Pox Vaccine, SC 90716
|
Facility
|
OP
|
$306.00
|
|
|
Service Code
|
CPT 90716
|
| Hospital Charge Code |
3455568
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$89.11 |
| Max. Negotiated Rate |
$292.78 |
| Rate for Payer: Aetna Commercial |
$286.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$273.69
|
| Rate for Payer: Aetna Managed Medicare |
$89.11
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$206.86
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$159.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$152.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$168.67
|
| Rate for Payer: Cash Price |
$91.80
|
| Rate for Payer: Cigna Commercial |
$292.78
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$178.09
|
| Rate for Payer: Health EOS Commercial |
$283.23
|
| Rate for Payer: HFN Commercial |
$292.78
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$238.68
|
| Rate for Payer: Multiplan Commercial |
$254.59
|
| Rate for Payer: NAPHCARE Commercial |
$190.94
|
| Rate for Payer: Preferred Network Access Commercial |
$292.78
|
| Rate for Payer: Quartz Beloit One Network |
$155.94
|
| Rate for Payer: Quartz Commercial |
$206.86
|
| Rate for Payer: Quartz Medicare Advantage |
$190.94
|
| Rate for Payer: The Alliance Commercial |
$159.12
|
| Rate for Payer: WEA Trust Commercial |
$175.03
|
| Rate for Payer: WPS Commercial |
$235.71
|
|
|
Chicken Pox Vaccine, SC 90716
|
Professional
|
Both
|
$306.00
|
|
|
Service Code
|
CPT 90716
|
| Hospital Charge Code |
3455568
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$140.03 |
| Max. Negotiated Rate |
$302.33 |
| Rate for Payer: Aetna Commercial |
$302.33
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$273.69
|
| Rate for Payer: Cash Price |
$91.80
|
| Rate for Payer: Cash Price |
$91.80
|
| Rate for Payer: Cigna Commercial |
$302.33
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$159.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$190.94
|
| Rate for Payer: Health EOS Commercial |
$289.60
|
| Rate for Payer: HFN Commercial |
$302.33
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$246.41
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$246.41
|
| Rate for Payer: Multiplan Commercial |
$254.59
|
| Rate for Payer: Preferred Network Access Commercial |
$302.33
|
| Rate for Payer: Quartz Beloit One Network |
$140.03
|
| Rate for Payer: Quartz Commercial |
$181.40
|
| Rate for Payer: The Alliance Commercial |
$159.12
|
| Rate for Payer: WEA Trust Commercial |
$175.03
|
| Rate for Payer: WPS Commercial |
$235.71
|
|
|
Chicken Pox Vaccine, SC 90716
|
Facility
|
IP
|
$306.00
|
|
|
Service Code
|
CPT 90716
|
| Hospital Charge Code |
3455568
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$155.94 |
| Max. Negotiated Rate |
$292.78 |
| Rate for Payer: Aetna Commercial |
$286.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$273.69
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$168.67
|
| Rate for Payer: Cash Price |
$91.80
|
| Rate for Payer: Cigna Commercial |
$292.78
|
| Rate for Payer: Health EOS Commercial |
$283.23
|
| Rate for Payer: HFN Commercial |
$292.78
|
| Rate for Payer: Multiplan Commercial |
$254.59
|
| Rate for Payer: Preferred Network Access Commercial |
$292.78
|
| Rate for Payer: Quartz Beloit One Network |
$155.94
|
| Rate for Payer: Quartz Commercial |
$190.94
|
| Rate for Payer: WEA Trust Commercial |
$175.03
|
| Rate for Payer: WPS Commercial |
$235.71
|
|
|
Chicken Pox Vaccine, SC 90716VFC
|
Facility
|
IP
|
$20.83
|
|
|
Service Code
|
CPT 90716
|
| Hospital Charge Code |
5100630
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.61 |
| Max. Negotiated Rate |
$19.93 |
| Rate for Payer: Aetna Commercial |
$19.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$18.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$11.48
|
| Rate for Payer: Cash Price |
$6.25
|
| Rate for Payer: Cigna Commercial |
$19.93
|
| Rate for Payer: Health EOS Commercial |
$19.28
|
| Rate for Payer: HFN Commercial |
$19.93
|
| Rate for Payer: Multiplan Commercial |
$17.33
|
| Rate for Payer: Preferred Network Access Commercial |
$19.93
|
| Rate for Payer: Quartz Beloit One Network |
$10.61
|
| Rate for Payer: Quartz Commercial |
$13.00
|
| Rate for Payer: WEA Trust Commercial |
$11.91
|
| Rate for Payer: WPS Commercial |
$16.05
|
|
|
Chicken Pox Vaccine, SC 90716VFC
|
Facility
|
OP
|
$20.83
|
|
|
Service Code
|
CPT 90716
|
| Hospital Charge Code |
5100630
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.07 |
| Max. Negotiated Rate |
$19.93 |
| Rate for Payer: Aetna Commercial |
$19.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$18.63
|
| Rate for Payer: Aetna Managed Medicare |
$6.07
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$14.08
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$10.83
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$10.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$11.48
|
| Rate for Payer: Cash Price |
$6.25
|
| Rate for Payer: Cigna Commercial |
$19.93
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12.12
|
| Rate for Payer: Health EOS Commercial |
$19.28
|
| Rate for Payer: HFN Commercial |
$19.93
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$16.25
|
| Rate for Payer: Multiplan Commercial |
$17.33
|
| Rate for Payer: NAPHCARE Commercial |
$13.00
|
| Rate for Payer: Preferred Network Access Commercial |
$19.93
|
| Rate for Payer: Quartz Beloit One Network |
$10.61
|
| Rate for Payer: Quartz Commercial |
$14.08
|
| Rate for Payer: Quartz Medicare Advantage |
$13.00
|
| Rate for Payer: The Alliance Commercial |
$10.83
|
| Rate for Payer: WEA Trust Commercial |
$11.91
|
| Rate for Payer: WPS Commercial |
$16.05
|
|
|
Chicken Pox Vaccine, SC 90716VFC
|
Professional
|
Both
|
$20.83
|
|
|
Service Code
|
CPT 90716
|
| Hospital Charge Code |
5100630
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.53 |
| Max. Negotiated Rate |
$246.41 |
| Rate for Payer: Aetna Commercial |
$20.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$18.63
|
| Rate for Payer: Cash Price |
$6.25
|
| Rate for Payer: Cash Price |
$6.25
|
| Rate for Payer: Cigna Commercial |
$20.58
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$10.83
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$13.00
|
| Rate for Payer: Health EOS Commercial |
$19.71
|
| Rate for Payer: HFN Commercial |
$20.58
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$246.41
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$246.41
|
| Rate for Payer: Multiplan Commercial |
$17.33
|
| Rate for Payer: Preferred Network Access Commercial |
$20.58
|
| Rate for Payer: Quartz Beloit One Network |
$9.53
|
| Rate for Payer: Quartz Commercial |
$12.35
|
| Rate for Payer: The Alliance Commercial |
$10.83
|
| Rate for Payer: WEA Trust Commercial |
$11.91
|
| Rate for Payer: WPS Commercial |
$16.05
|
|
|
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 |
$16.85 |
| Max. Negotiated Rate |
$86.11 |
| Rate for Payer: Aetna Commercial |
$84.24
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$80.50
|
| Rate for Payer: Aetna Managed Medicare |
$16.85
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$63.18
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$29.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$27.97
|
| Rate for Payer: Anthem Medicare Advantage |
$16.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$49.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$16.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$16.85
|
| Rate for Payer: Cash Price |
$27.00
|
| Rate for Payer: Cash Price |
$27.00
|
| Rate for Payer: Cigna Commercial |
$86.11
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$16.85
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$52.38
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$16.85
|
| Rate for Payer: Health EOS Commercial |
$83.30
|
| Rate for Payer: HFN Commercial |
$86.11
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$62.67
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$16.85
|
| Rate for Payer: Independent Care Health Plan Medicare |
$16.85
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$16.85
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$16.85
|
| Rate for Payer: Multiplan Commercial |
$74.88
|
| Rate for Payer: NAPHCARE Commercial |
$25.27
|
| Rate for Payer: Preferred Network Access Commercial |
$86.11
|
| Rate for Payer: Quartz Beloit One Network |
$45.86
|
| Rate for Payer: Quartz Commercial |
$60.84
|
| Rate for Payer: Quartz Medicare Advantage |
$16.85
|
| Rate for Payer: The Alliance Commercial |
$67.39
|
| Rate for Payer: United Healthcare Medicare Advantage |
$16.85
|
| Rate for Payer: United Healthcare PPO |
$70.20
|
| Rate for Payer: WEA Trust Commercial |
$51.48
|
| Rate for Payer: Wellcare Medicare |
$16.85
|
| Rate for Payer: WPS Commercial |
$69.33
|
|
|
Chikungunya Antibodies Panel w/Rfx Titer
|
Professional
|
Both
|
$90.00
|
|
|
Service Code
|
CPT 86720
|
| Hospital Charge Code |
4392638
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$16.85 |
| Max. Negotiated Rate |
$88.92 |
| Rate for Payer: Aetna Commercial |
$88.92
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$80.50
|
| Rate for Payer: Aetna Managed Medicare |
$16.85
|
| Rate for Payer: Anthem Medicare Advantage |
$16.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$16.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$16.85
|
| Rate for Payer: Cash Price |
$27.00
|
| Rate for Payer: Cash Price |
$27.00
|
| Rate for Payer: Cigna Commercial |
$88.92
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$46.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$16.85
|
| Rate for Payer: Health EOS Commercial |
$85.18
|
| Rate for Payer: HFN Commercial |
$88.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$59.48
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$59.48
|
| Rate for Payer: Independent Care Health Plan Medicare |
$16.85
|
| Rate for Payer: Multiplan Commercial |
$74.88
|
| Rate for Payer: NAPHCARE Commercial |
$25.27
|
| Rate for Payer: Preferred Network Access Commercial |
$88.92
|
| Rate for Payer: Quartz Beloit One Network |
$41.18
|
| Rate for Payer: Quartz Commercial |
$53.35
|
| Rate for Payer: Quartz Medicare Advantage |
$16.85
|
| Rate for Payer: The Alliance Commercial |
$66.55
|
| Rate for Payer: United Healthcare Medicare Advantage |
$16.85
|
| Rate for Payer: WEA Trust Commercial |
$51.48
|
| Rate for Payer: WPS Commercial |
$74.13
|
|
|
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 |
$45.86 |
| Max. Negotiated Rate |
$86.11 |
| Rate for Payer: Aetna Commercial |
$84.24
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$80.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$49.61
|
| Rate for Payer: Cash Price |
$27.00
|
| Rate for Payer: Cigna Commercial |
$86.11
|
| Rate for Payer: Health EOS Commercial |
$83.30
|
| Rate for Payer: HFN Commercial |
$86.11
|
| Rate for Payer: Multiplan Commercial |
$74.88
|
| Rate for Payer: Preferred Network Access Commercial |
$86.11
|
| Rate for Payer: Quartz Beloit One Network |
$45.86
|
| Rate for Payer: Quartz Commercial |
$56.16
|
| Rate for Payer: WEA Trust Commercial |
$51.48
|
| Rate for Payer: WPS Commercial |
$69.33
|
|
|
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 |
$16.85 |
| Max. Negotiated Rate |
$88.98 |
| Rate for Payer: Aetna Commercial |
$87.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$83.18
|
| Rate for Payer: Aetna Managed Medicare |
$16.85
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$63.18
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$29.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$27.97
|
| Rate for Payer: Anthem Medicare Advantage |
$16.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$51.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$16.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$16.85
|
| Rate for Payer: Cash Price |
$27.90
|
| Rate for Payer: Cash Price |
$27.90
|
| Rate for Payer: Cigna Commercial |
$88.98
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$16.85
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$54.13
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$16.85
|
| Rate for Payer: Health EOS Commercial |
$86.08
|
| Rate for Payer: HFN Commercial |
$88.98
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$62.67
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$16.85
|
| Rate for Payer: Independent Care Health Plan Medicare |
$16.85
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$16.85
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$16.85
|
| Rate for Payer: Multiplan Commercial |
$77.38
|
| Rate for Payer: NAPHCARE Commercial |
$25.27
|
| Rate for Payer: Preferred Network Access Commercial |
$88.98
|
| Rate for Payer: Quartz Beloit One Network |
$47.39
|
| Rate for Payer: Quartz Commercial |
$62.87
|
| Rate for Payer: Quartz Medicare Advantage |
$16.85
|
| Rate for Payer: The Alliance Commercial |
$67.39
|
| Rate for Payer: United Healthcare Medicare Advantage |
$16.85
|
| Rate for Payer: United Healthcare PPO |
$72.54
|
| Rate for Payer: WEA Trust Commercial |
$53.20
|
| Rate for Payer: Wellcare Medicare |
$16.85
|
| Rate for Payer: WPS Commercial |
$71.64
|
|
|
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 |
$47.39 |
| Max. Negotiated Rate |
$88.98 |
| Rate for Payer: Aetna Commercial |
$87.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$83.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$51.26
|
| Rate for Payer: Cash Price |
$27.90
|
| Rate for Payer: Cigna Commercial |
$88.98
|
| Rate for Payer: Health EOS Commercial |
$86.08
|
| Rate for Payer: HFN Commercial |
$88.98
|
| Rate for Payer: Multiplan Commercial |
$77.38
|
| Rate for Payer: Preferred Network Access Commercial |
$88.98
|
| Rate for Payer: Quartz Beloit One Network |
$47.39
|
| Rate for Payer: Quartz Commercial |
$58.03
|
| Rate for Payer: WEA Trust Commercial |
$53.20
|
| Rate for Payer: WPS Commercial |
$71.64
|
|
|
Chikungunya Antibodies Panel w/ Rfx Titier
|
Professional
|
Both
|
$93.00
|
|
|
Service Code
|
CPT 86720
|
| Hospital Charge Code |
4392803
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$16.85 |
| Max. Negotiated Rate |
$91.88 |
| Rate for Payer: Aetna Commercial |
$91.88
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$83.18
|
| Rate for Payer: Aetna Managed Medicare |
$16.85
|
| Rate for Payer: Anthem Medicare Advantage |
$16.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$16.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$16.85
|
| Rate for Payer: Cash Price |
$27.90
|
| Rate for Payer: Cash Price |
$27.90
|
| Rate for Payer: Cigna Commercial |
$91.88
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$48.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$16.85
|
| Rate for Payer: Health EOS Commercial |
$88.02
|
| Rate for Payer: HFN Commercial |
$91.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$59.48
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$59.48
|
| Rate for Payer: Independent Care Health Plan Medicare |
$16.85
|
| Rate for Payer: Multiplan Commercial |
$77.38
|
| Rate for Payer: NAPHCARE Commercial |
$25.27
|
| Rate for Payer: Preferred Network Access Commercial |
$91.88
|
| Rate for Payer: Quartz Beloit One Network |
$42.56
|
| Rate for Payer: Quartz Commercial |
$55.13
|
| Rate for Payer: Quartz Medicare Advantage |
$16.85
|
| Rate for Payer: The Alliance Commercial |
$66.55
|
| Rate for Payer: United Healthcare Medicare Advantage |
$16.85
|
| Rate for Payer: WEA Trust Commercial |
$53.20
|
| Rate for Payer: WPS Commercial |
$74.13
|
|
|
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 |
$292.00 |
| Max. Negotiated Rate |
$548.25 |
| Rate for Payer: Aetna Commercial |
$536.33
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$512.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$315.84
|
| Rate for Payer: Cash Price |
$171.90
|
| Rate for Payer: Cigna Commercial |
$548.25
|
| Rate for Payer: Health EOS Commercial |
$530.37
|
| Rate for Payer: HFN Commercial |
$548.25
|
| Rate for Payer: Multiplan Commercial |
$476.74
|
| Rate for Payer: Preferred Network Access Commercial |
$548.25
|
| Rate for Payer: Quartz Beloit One Network |
$292.00
|
| Rate for Payer: Quartz Commercial |
$357.55
|
| Rate for Payer: WEA Trust Commercial |
$327.76
|
| Rate for Payer: WPS Commercial |
$441.38
|
|
|
Chikungunya Virus RNA, Qualitative, Real-Time PCR
|
Professional
|
Both
|
$573.00
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
4392634
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$36.49 |
| Max. Negotiated Rate |
$566.12 |
| Rate for Payer: Aetna Commercial |
$566.12
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$512.49
|
| 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 |
$171.90
|
| Rate for Payer: Cash Price |
$171.90
|
| Rate for Payer: Cigna Commercial |
$566.12
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$297.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$36.49
|
| Rate for Payer: Health EOS Commercial |
$542.29
|
| Rate for Payer: HFN Commercial |
$566.12
|
| 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 |
$476.74
|
| Rate for Payer: NAPHCARE Commercial |
$54.74
|
| Rate for Payer: Preferred Network Access Commercial |
$566.12
|
| Rate for Payer: Quartz Beloit One Network |
$262.20
|
| Rate for Payer: Quartz Commercial |
$339.67
|
| 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 |
$327.76
|
| Rate for Payer: WPS Commercial |
$160.57
|
|
|
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 |
$36.49 |
| Max. Negotiated Rate |
$548.25 |
| Rate for Payer: Aetna Commercial |
$536.33
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$512.49
|
| 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 |
$315.84
|
| 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 |
$171.90
|
| Rate for Payer: Cash Price |
$171.90
|
| Rate for Payer: Cigna Commercial |
$548.25
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$36.49
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$333.49
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$36.49
|
| Rate for Payer: Health EOS Commercial |
$530.37
|
| Rate for Payer: HFN Commercial |
$548.25
|
| 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 |
$476.74
|
| Rate for Payer: NAPHCARE Commercial |
$54.74
|
| Rate for Payer: Preferred Network Access Commercial |
$548.25
|
| Rate for Payer: Quartz Beloit One Network |
$292.00
|
| Rate for Payer: Quartz Commercial |
$387.35
|
| 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 |
$446.94
|
| Rate for Payer: WEA Trust Commercial |
$327.76
|
| Rate for Payer: Wellcare Medicare |
$36.49
|
| Rate for Payer: WPS Commercial |
$441.38
|
|
|
CHILDHOOD BEHAVIORAL DIAGNOSES
|
Facility
|
OP
|
$89.10
|
|
|
Service Code
|
EAPG 00829
|
| Min. Negotiated Rate |
$85.67 |
| Max. Negotiated Rate |
$89.10 |
| Rate for Payer: Anthem Medicaid |
$85.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$85.67
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$85.67
|
| Rate for Payer: Dean Health Medicaid |
$85.67
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$85.67
|
| Rate for Payer: Managed Health Services Medicaid |
$89.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$85.67
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$85.67
|
| Rate for Payer: United Healthcare Medicaid |
$85.67
|
|
|
CHILD PREVENTIVE MEDICINE
|
Facility
|
OP
|
$91.72
|
|
|
Service Code
|
EAPG 00877
|
| Min. Negotiated Rate |
$88.19 |
| Max. Negotiated Rate |
$91.72 |
| Rate for Payer: Anthem Medicaid |
$88.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$88.19
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$88.19
|
| Rate for Payer: Dean Health Medicaid |
$88.19
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$88.19
|
| Rate for Payer: Managed Health Services Medicaid |
$91.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$88.19
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$88.19
|
| Rate for Payer: United Healthcare Medicaid |
$88.19
|
|
|
CHIMERIC ANTIGEN RECEPTOR (CAR) T-CELL AND OTHER IMMUNOTHERAPIES
|
Facility
|
IP
|
$206,493.70
|
|
|
Service Code
|
APR-DRG 0113
|
| Min. Negotiated Rate |
$183,420.59 |
| Max. Negotiated Rate |
$206,493.70 |
| Rate for Payer: Anthem Medicaid |
$197,729.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$197,729.10
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$197,729.10
|
| Rate for Payer: Dean Health Medicaid |
$197,729.10
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$183,420.59
|
| Rate for Payer: Managed Health Services Medicaid |
$206,493.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$197,729.10
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$197,729.10
|
| Rate for Payer: United Healthcare Medicaid |
$197,729.10
|
|
|
CHIMERIC ANTIGEN RECEPTOR (CAR) T-CELL AND OTHER IMMUNOTHERAPIES
|
Facility
|
IP
|
$80,843.82
|
|
|
Service Code
|
APR-DRG 0111
|
| Min. Negotiated Rate |
$71,810.52 |
| Max. Negotiated Rate |
$80,843.82 |
| Rate for Payer: Anthem Medicaid |
$77,412.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$77,412.41
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$77,412.41
|
| Rate for Payer: Dean Health Medicaid |
$77,412.41
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$71,810.52
|
| Rate for Payer: Managed Health Services Medicaid |
$80,843.82
|
| Rate for Payer: Molina Healthcare Medicaid |
$77,412.41
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$77,412.41
|
| Rate for Payer: United Healthcare Medicaid |
$77,412.41
|
|
|
CHIMERIC ANTIGEN RECEPTOR (CAR) T-CELL AND OTHER IMMUNOTHERAPIES
|
Facility
|
IP
|
$164,142.76
|
|
|
Service Code
|
APR-DRG 0112
|
| Min. Negotiated Rate |
$145,801.84 |
| Max. Negotiated Rate |
$164,142.76 |
| Rate for Payer: Anthem Medicaid |
$157,175.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$157,175.74
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$157,175.74
|
| Rate for Payer: Dean Health Medicaid |
$157,175.74
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$145,801.84
|
| Rate for Payer: Managed Health Services Medicaid |
$164,142.76
|
| Rate for Payer: Molina Healthcare Medicaid |
$157,175.74
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$157,175.74
|
| Rate for Payer: United Healthcare Medicaid |
$157,175.74
|
|
|
CHIMERIC ANTIGEN RECEPTOR (CAR) T-CELL AND OTHER IMMUNOTHERAPIES
|
Facility
|
IP
|
$277,429.33
|
|
|
Service Code
|
APR-DRG 0114
|
| Min. Negotiated Rate |
$246,430.04 |
| Max. Negotiated Rate |
$277,429.33 |
| Rate for Payer: Anthem Medicaid |
$265,653.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$265,653.87
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$265,653.87
|
| Rate for Payer: Dean Health Medicaid |
$265,653.87
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$246,430.04
|
| Rate for Payer: Managed Health Services Medicaid |
$277,429.33
|
| Rate for Payer: Molina Healthcare Medicaid |
$265,653.87
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$265,653.87
|
| Rate for Payer: United Healthcare Medicaid |
$265,653.87
|
|
|
CHIMERIC ANTIGEN RECEPTOR (CAR) T-CELL AND OTHER IMMUNOTHERAPIES
|
Facility
|
IP
|
$1,019,011.76
|
|
|
Service Code
|
MSDRG 018
|
| Min. Negotiated Rate |
$331,209.14 |
| Max. Negotiated Rate |
$1,019,011.76 |
| Rate for Payer: Aetna Managed Medicare |
$331,209.14
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$942,214.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$722,199.51
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$686,136.69
|
| Rate for Payer: Anthem Medicare Advantage |
$331,209.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$331,209.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$331,209.14
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$331,209.14
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$761,674.64
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$331,209.14
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$747,170.01
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$331,209.14
|
| Rate for Payer: Independent Care Health Plan Medicare |
$331,209.14
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$331,209.14
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$331,209.14
|
| Rate for Payer: NAPHCARE Commercial |
$496,813.71
|
| Rate for Payer: Quartz Medicare Advantage |
$331,209.14
|
| Rate for Payer: The Alliance Commercial |
$1,019,011.76
|
| Rate for Payer: United Healthcare Medicare Advantage |
$331,209.14
|
| Rate for Payer: United Healthcare PPO |
$581,681.39
|
| Rate for Payer: Wellcare Medicare |
$331,209.14
|
|
|
CHIN IMPLANT/FACIAL AUGMENTATION
|
Facility
|
OP
|
$3,935.00
|
|
| Hospital Charge Code |
2960046
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,145.87 |
| Max. Negotiated Rate |
$3,765.01 |
| Rate for Payer: Aetna Commercial |
$3,683.16
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,519.46
|
| Rate for Payer: Aetna Managed Medicare |
$1,145.87
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,660.06
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,046.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,964.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,168.97
|
| Rate for Payer: Cash Price |
$1,180.50
|
| Rate for Payer: Cigna Commercial |
$3,765.01
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,290.17
|
| Rate for Payer: Health EOS Commercial |
$3,642.24
|
| Rate for Payer: HFN Commercial |
$3,765.01
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,069.30
|
| Rate for Payer: Multiplan Commercial |
$3,273.92
|
| Rate for Payer: NAPHCARE Commercial |
$2,455.44
|
| Rate for Payer: Preferred Network Access Commercial |
$3,765.01
|
| Rate for Payer: Quartz Beloit One Network |
$2,005.28
|
| Rate for Payer: Quartz Commercial |
$2,660.06
|
| Rate for Payer: Quartz Medicare Advantage |
$2,455.44
|
| Rate for Payer: The Alliance Commercial |
$2,046.20
|
| Rate for Payer: WEA Trust Commercial |
$2,250.82
|
| Rate for Payer: WPS Commercial |
$3,031.13
|
|
|
CHIN IMPLANT/FACIAL AUGMENTATION
|
Facility
|
IP
|
$3,935.00
|
|
| Hospital Charge Code |
2960046
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,005.28 |
| Max. Negotiated Rate |
$3,765.01 |
| Rate for Payer: Aetna Commercial |
$3,683.16
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,519.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,168.97
|
| Rate for Payer: Cash Price |
$1,180.50
|
| Rate for Payer: Cigna Commercial |
$3,765.01
|
| Rate for Payer: Health EOS Commercial |
$3,642.24
|
| Rate for Payer: HFN Commercial |
$3,765.01
|
| Rate for Payer: Multiplan Commercial |
$3,273.92
|
| Rate for Payer: Preferred Network Access Commercial |
$3,765.01
|
| Rate for Payer: Quartz Beloit One Network |
$2,005.28
|
| Rate for Payer: Quartz Commercial |
$2,455.44
|
| Rate for Payer: WEA Trust Commercial |
$2,250.82
|
| Rate for Payer: WPS Commercial |
$3,031.13
|
|
|
Chlamydia
|
Facility
|
IP
|
$10.00
|
|
|
Service Code
|
CPT 86631
|
| Hospital Charge Code |
4772606
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.10 |
| Max. Negotiated Rate |
$9.57 |
| Rate for Payer: Aetna Commercial |
$9.36
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5.51
|
| Rate for Payer: Cash Price |
$3.00
|
| Rate for Payer: Cigna Commercial |
$9.57
|
| Rate for Payer: Health EOS Commercial |
$9.26
|
| Rate for Payer: HFN Commercial |
$9.57
|
| Rate for Payer: Multiplan Commercial |
$8.32
|
| Rate for Payer: Preferred Network Access Commercial |
$9.57
|
| Rate for Payer: Quartz Beloit One Network |
$5.10
|
| Rate for Payer: Quartz Commercial |
$6.24
|
| Rate for Payer: WEA Trust Commercial |
$5.72
|
| Rate for Payer: WPS Commercial |
$7.70
|
|
