|
Hep A Vacc, Ped/Addl, 2 Doses 90633 VFC
|
Facility
|
OP
|
$20.83
|
|
|
Service Code
|
CPT 90633
|
| Hospital Charge Code |
5076608
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.83 |
| Max. Negotiated Rate |
$83.32 |
| Rate for Payer: Aetna Commercial |
$18.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$17.91
|
| Rate for Payer: Aetna Managed Medicare |
$5.83
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$13.54
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$10.42
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$10.00
|
| 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: Dean Health DHI/DHP/ASO |
$11.66
|
| Rate for Payer: Health EOS Commercial |
$18.54
|
| Rate for Payer: HFN Commercial |
$19.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$15.62
|
| 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 |
$13.54
|
| Rate for Payer: Quartz Medicare Advantage |
$12.50
|
| Rate for Payer: The Alliance Commercial |
$83.32
|
| Rate for Payer: WEA Trust Commercial |
$11.46
|
| Rate for Payer: WPS Commercial |
$15.43
|
|
|
Hep A Vacc, Ped/Addl, 2 Doses 90633 VFC
|
Professional
|
Both
|
$20.83
|
|
|
Service Code
|
CPT 90633
|
| Hospital Charge Code |
5076608
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.17 |
| Max. Negotiated Rate |
$57.38 |
| Rate for Payer: Aetna Commercial |
$19.79
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$17.91
|
| Rate for Payer: Cash Price |
$6.25
|
| Rate for Payer: Cash Price |
$6.25
|
| Rate for Payer: Cigna Commercial |
$19.79
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$15.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12.50
|
| Rate for Payer: Health EOS Commercial |
$18.96
|
| Rate for Payer: HFN Commercial |
$19.79
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$57.38
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$57.38
|
| Rate for Payer: Multiplan Commercial |
$16.66
|
| Rate for Payer: Preferred Network Access Commercial |
$19.79
|
| Rate for Payer: Quartz Beloit One Network |
$9.17
|
| Rate for Payer: Quartz Commercial |
$11.87
|
| Rate for Payer: The Alliance Commercial |
$10.42
|
| Rate for Payer: United Healthcare Medicaid |
$15.00
|
| Rate for Payer: WEA Trust Commercial |
$11.46
|
| Rate for Payer: WPS Commercial |
$15.43
|
|
|
Hep A Vacc, Ped/Addl, 2 Doses 90633 VFC
|
Facility
|
IP
|
$20.83
|
|
|
Service Code
|
CPT 90633
|
| Hospital Charge Code |
5076608
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.21 |
| Max. Negotiated Rate |
$19.16 |
| Rate for Payer: Aetna Commercial |
$18.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$17.91
|
| 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
|
|
|
Hep B Vaccine, Adult, IM 90746
|
Facility
|
IP
|
$151.00
|
|
|
Service Code
|
CPT 90746
|
| Hospital Charge Code |
3382859
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$73.99 |
| Max. Negotiated Rate |
$138.92 |
| Rate for Payer: Aetna Commercial |
$135.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$129.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$80.03
|
| Rate for Payer: Cash Price |
$45.30
|
| Rate for Payer: Cigna Commercial |
$138.92
|
| Rate for Payer: Health EOS Commercial |
$134.39
|
| Rate for Payer: HFN Commercial |
$138.92
|
| Rate for Payer: Multiplan Commercial |
$120.80
|
| Rate for Payer: NAPHCARE Commercial |
$90.60
|
| Rate for Payer: Preferred Network Access Commercial |
$138.92
|
| Rate for Payer: Quartz Beloit One Network |
$73.99
|
| Rate for Payer: Quartz Commercial |
$90.60
|
| Rate for Payer: WEA Trust Commercial |
$83.05
|
| Rate for Payer: WPS Commercial |
$111.85
|
|
|
Hep B Vaccine, Adult, IM 90746
|
Facility
|
OP
|
$151.00
|
|
|
Service Code
|
CPT 90746
|
| Hospital Charge Code |
3382859
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$42.28 |
| Max. Negotiated Rate |
$604.00 |
| Rate for Payer: Aetna Commercial |
$135.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$129.86
|
| Rate for Payer: Aetna Managed Medicare |
$42.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$98.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$75.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$72.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$80.03
|
| Rate for Payer: Cash Price |
$45.30
|
| Rate for Payer: Cash Price |
$45.30
|
| Rate for Payer: Cigna Commercial |
$138.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$93.11
|
| Rate for Payer: Health EOS Commercial |
$134.39
|
| Rate for Payer: HFN Commercial |
$138.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$113.25
|
| Rate for Payer: Multiplan Commercial |
$120.80
|
| Rate for Payer: NAPHCARE Commercial |
$90.60
|
| Rate for Payer: Preferred Network Access Commercial |
$138.92
|
| Rate for Payer: Quartz Beloit One Network |
$73.99
|
| Rate for Payer: Quartz Commercial |
$98.15
|
| Rate for Payer: Quartz Medicare Advantage |
$90.60
|
| Rate for Payer: The Alliance Commercial |
$604.00
|
| Rate for Payer: WEA Trust Commercial |
$83.05
|
| Rate for Payer: WPS Commercial |
$175.94
|
|
|
Hep B Vaccine, Adult, IM 90746
|
Professional
|
Both
|
$151.00
|
|
|
Service Code
|
CPT 90746
|
| Hospital Charge Code |
3382859
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$66.44 |
| Max. Negotiated Rate |
$175.94 |
| Rate for Payer: Aetna Commercial |
$143.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$129.86
|
| Rate for Payer: Cash Price |
$45.30
|
| Rate for Payer: Cash Price |
$45.30
|
| Rate for Payer: Cigna Commercial |
$143.45
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$81.85
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$70.38
|
| Rate for Payer: Health EOS Commercial |
$137.41
|
| Rate for Payer: HFN Commercial |
$143.45
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$101.69
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$101.69
|
| Rate for Payer: Multiplan Commercial |
$120.80
|
| Rate for Payer: Preferred Network Access Commercial |
$143.45
|
| Rate for Payer: Quartz Beloit One Network |
$66.44
|
| Rate for Payer: Quartz Commercial |
$86.07
|
| Rate for Payer: The Alliance Commercial |
$75.50
|
| Rate for Payer: United Healthcare Medicaid |
$81.85
|
| Rate for Payer: WEA Trust Commercial |
$83.05
|
| Rate for Payer: WPS Commercial |
$175.94
|
|
|
Hep B Vaccine, Adult,IM 90746VFC
|
Professional
|
Both
|
$20.83
|
|
|
Service Code
|
CPT 90746
|
| Hospital Charge Code |
5100629
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.17 |
| Max. Negotiated Rate |
$175.94 |
| Rate for Payer: Aetna Commercial |
$19.79
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$17.91
|
| Rate for Payer: Cash Price |
$6.25
|
| Rate for Payer: Cash Price |
$6.25
|
| Rate for Payer: Cigna Commercial |
$19.79
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$81.85
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$70.38
|
| Rate for Payer: Health EOS Commercial |
$18.96
|
| Rate for Payer: HFN Commercial |
$19.79
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$101.69
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$101.69
|
| Rate for Payer: Multiplan Commercial |
$16.66
|
| Rate for Payer: Preferred Network Access Commercial |
$19.79
|
| Rate for Payer: Quartz Beloit One Network |
$9.17
|
| Rate for Payer: Quartz Commercial |
$11.87
|
| Rate for Payer: The Alliance Commercial |
$10.42
|
| Rate for Payer: United Healthcare Medicaid |
$81.85
|
| Rate for Payer: WEA Trust Commercial |
$11.46
|
| Rate for Payer: WPS Commercial |
$175.94
|
|
|
Hep B Vaccine, Adult,IM 90746VFC
|
Facility
|
OP
|
$20.83
|
|
|
Service Code
|
CPT 90746
|
| Hospital Charge Code |
5100629
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.83 |
| Max. Negotiated Rate |
$175.94 |
| Rate for Payer: Aetna Commercial |
$18.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$17.91
|
| Rate for Payer: Aetna Managed Medicare |
$5.83
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$13.54
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$10.42
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$10.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$11.04
|
| Rate for Payer: Cash Price |
$6.25
|
| Rate for Payer: Cash Price |
$6.25
|
| Rate for Payer: Cigna Commercial |
$19.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$93.11
|
| Rate for Payer: Health EOS Commercial |
$18.54
|
| Rate for Payer: HFN Commercial |
$19.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$15.62
|
| 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 |
$13.54
|
| Rate for Payer: Quartz Medicare Advantage |
$12.50
|
| Rate for Payer: The Alliance Commercial |
$83.32
|
| Rate for Payer: WEA Trust Commercial |
$11.46
|
| Rate for Payer: WPS Commercial |
$175.94
|
|
|
Hep B Vaccine, Adult,IM 90746VFC
|
Facility
|
IP
|
$20.83
|
|
|
Service Code
|
CPT 90746
|
| Hospital Charge Code |
5100629
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.21 |
| Max. Negotiated Rate |
$19.16 |
| Rate for Payer: Aetna Commercial |
$18.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$17.91
|
| 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
|
|
|
HEPB Vacc Ped/Adol 3 Dose IM 90744
|
Facility
|
OP
|
$146.00
|
|
|
Service Code
|
CPT 90744
|
| Hospital Charge Code |
3455575
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$40.71 |
| Max. Negotiated Rate |
$584.00 |
| Rate for Payer: Aetna Commercial |
$131.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$125.56
|
| Rate for Payer: Aetna Managed Medicare |
$40.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$94.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$73.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$70.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$77.38
|
| Rate for Payer: Cash Price |
$43.80
|
| Rate for Payer: Cash Price |
$43.80
|
| Rate for Payer: Cigna Commercial |
$134.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$40.71
|
| Rate for Payer: Health EOS Commercial |
$129.94
|
| Rate for Payer: HFN Commercial |
$134.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$109.50
|
| Rate for Payer: Multiplan Commercial |
$116.80
|
| Rate for Payer: NAPHCARE Commercial |
$87.60
|
| Rate for Payer: Preferred Network Access Commercial |
$134.32
|
| Rate for Payer: Quartz Beloit One Network |
$71.54
|
| Rate for Payer: Quartz Commercial |
$94.90
|
| Rate for Payer: Quartz Medicare Advantage |
$87.60
|
| Rate for Payer: The Alliance Commercial |
$584.00
|
| Rate for Payer: WEA Trust Commercial |
$80.30
|
| Rate for Payer: WPS Commercial |
$76.92
|
|
|
HEPB Vacc Ped/Adol 3 Dose IM 90744
|
Facility
|
IP
|
$146.00
|
|
|
Service Code
|
CPT 90744
|
| Hospital Charge Code |
3455575
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$71.54 |
| Max. Negotiated Rate |
$134.32 |
| Rate for Payer: Aetna Commercial |
$131.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$125.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$77.38
|
| Rate for Payer: Cash Price |
$43.80
|
| Rate for Payer: Cigna Commercial |
$134.32
|
| Rate for Payer: Health EOS Commercial |
$129.94
|
| Rate for Payer: HFN Commercial |
$134.32
|
| Rate for Payer: Multiplan Commercial |
$116.80
|
| Rate for Payer: NAPHCARE Commercial |
$87.60
|
| Rate for Payer: Preferred Network Access Commercial |
$134.32
|
| Rate for Payer: Quartz Beloit One Network |
$71.54
|
| Rate for Payer: Quartz Commercial |
$87.60
|
| Rate for Payer: WEA Trust Commercial |
$80.30
|
| Rate for Payer: WPS Commercial |
$108.14
|
|
|
HEPB Vacc Ped/Adol 3 Dose IM 90744
|
Professional
|
Both
|
$146.00
|
|
|
Service Code
|
CPT 90744
|
| Hospital Charge Code |
3455575
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$30.77 |
| Max. Negotiated Rate |
$138.70 |
| Rate for Payer: Aetna Commercial |
$138.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$125.56
|
| Rate for Payer: Cash Price |
$43.80
|
| Rate for Payer: Cash Price |
$43.80
|
| Rate for Payer: Cigna Commercial |
$138.70
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$81.85
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$30.77
|
| Rate for Payer: Health EOS Commercial |
$132.86
|
| Rate for Payer: HFN Commercial |
$138.70
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$41.20
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$41.20
|
| Rate for Payer: Multiplan Commercial |
$116.80
|
| Rate for Payer: Preferred Network Access Commercial |
$138.70
|
| Rate for Payer: Quartz Beloit One Network |
$64.24
|
| Rate for Payer: Quartz Commercial |
$83.22
|
| Rate for Payer: The Alliance Commercial |
$73.00
|
| Rate for Payer: United Healthcare Medicaid |
$81.85
|
| Rate for Payer: WEA Trust Commercial |
$80.30
|
| Rate for Payer: WPS Commercial |
$76.92
|
|
|
Hep B Vacc Ped/Adol 90744VFC
|
Facility
|
OP
|
$20.83
|
|
|
Service Code
|
CPT 90744
|
| Hospital Charge Code |
5096655
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.83 |
| Max. Negotiated Rate |
$83.32 |
| Rate for Payer: Aetna Commercial |
$18.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$17.91
|
| Rate for Payer: Aetna Managed Medicare |
$5.83
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$13.54
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$10.42
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$10.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$11.04
|
| Rate for Payer: Cash Price |
$6.25
|
| Rate for Payer: Cash Price |
$6.25
|
| Rate for Payer: Cigna Commercial |
$19.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$40.71
|
| Rate for Payer: Health EOS Commercial |
$18.54
|
| Rate for Payer: HFN Commercial |
$19.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$15.62
|
| 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 |
$13.54
|
| Rate for Payer: Quartz Medicare Advantage |
$12.50
|
| Rate for Payer: The Alliance Commercial |
$83.32
|
| Rate for Payer: WEA Trust Commercial |
$11.46
|
| Rate for Payer: WPS Commercial |
$76.92
|
|
|
Hep B Vacc Ped/Adol 90744VFC
|
Professional
|
Both
|
$20.83
|
|
|
Service Code
|
CPT 90744
|
| Hospital Charge Code |
5096655
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$9.17 |
| Max. Negotiated Rate |
$81.85 |
| Rate for Payer: Aetna Commercial |
$19.79
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$17.91
|
| Rate for Payer: Cash Price |
$6.25
|
| Rate for Payer: Cash Price |
$6.25
|
| Rate for Payer: Cigna Commercial |
$19.79
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$81.85
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$30.77
|
| Rate for Payer: Health EOS Commercial |
$18.96
|
| Rate for Payer: HFN Commercial |
$19.79
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$41.20
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$41.20
|
| Rate for Payer: Multiplan Commercial |
$16.66
|
| Rate for Payer: Preferred Network Access Commercial |
$19.79
|
| Rate for Payer: Quartz Beloit One Network |
$9.17
|
| Rate for Payer: Quartz Commercial |
$11.87
|
| Rate for Payer: The Alliance Commercial |
$10.42
|
| Rate for Payer: United Healthcare Medicaid |
$81.85
|
| Rate for Payer: WEA Trust Commercial |
$11.46
|
| Rate for Payer: WPS Commercial |
$76.92
|
|
|
Hep B Vacc Ped/Adol 90744VFC
|
Facility
|
IP
|
$20.83
|
|
|
Service Code
|
CPT 90744
|
| Hospital Charge Code |
5096655
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.21 |
| Max. Negotiated Rate |
$19.16 |
| Rate for Payer: Aetna Commercial |
$18.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$17.91
|
| 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
|
|
|
Heper (CD4)/Supressor (CD8) Ratio
|
Facility
|
OP
|
$517.00
|
|
|
Service Code
|
CPT 86360
|
| Hospital Charge Code |
2942945
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$46.98 |
| Max. Negotiated Rate |
$475.64 |
| Rate for Payer: Aetna Commercial |
$465.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$444.62
|
| Rate for Payer: Aetna Managed Medicare |
$46.98
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$176.18
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$82.22
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$77.99
|
| Rate for Payer: Anthem Medicaid |
$48.54
|
| Rate for Payer: Anthem Medicare Advantage |
$46.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$274.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$46.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$46.98
|
| Rate for Payer: Cash Price |
$155.10
|
| Rate for Payer: Cash Price |
$155.10
|
| Rate for Payer: Cigna Commercial |
$475.64
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$46.98
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$48.54
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$289.31
|
| Rate for Payer: Dean Health Medicaid |
$48.54
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$46.98
|
| Rate for Payer: Health EOS Commercial |
$460.13
|
| Rate for Payer: HFN Commercial |
$475.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$174.77
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$46.98
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$48.54
|
| Rate for Payer: Independent Care Health Plan Medicare |
$46.98
|
| Rate for Payer: Managed Health Services Medicaid |
$50.48
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$46.98
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$46.98
|
| Rate for Payer: Multiplan Commercial |
$413.60
|
| Rate for Payer: NAPHCARE Commercial |
$70.47
|
| Rate for Payer: Preferred Network Access Commercial |
$475.64
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$48.54
|
| Rate for Payer: Quartz Beloit One Network |
$253.33
|
| Rate for Payer: Quartz Commercial |
$336.05
|
| Rate for Payer: Quartz Medicare Advantage |
$46.98
|
| Rate for Payer: The Alliance Commercial |
$187.92
|
| Rate for Payer: United Healthcare Medicaid |
$48.54
|
| Rate for Payer: United Healthcare Medicare Advantage |
$46.98
|
| Rate for Payer: United Healthcare PPO |
$387.75
|
| Rate for Payer: WEA Trust Commercial |
$284.35
|
| Rate for Payer: Wellcare Medicare |
$46.98
|
| Rate for Payer: WMAP Medicaid |
$48.54
|
| Rate for Payer: WPS Commercial |
$382.94
|
|
|
Heper (CD4)/Supressor (CD8) Ratio
|
Professional
|
Both
|
$517.00
|
|
|
Service Code
|
CPT 86360
|
| Hospital Charge Code |
2942945
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$165.84 |
| Max. Negotiated Rate |
$491.15 |
| Rate for Payer: Aetna Commercial |
$491.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$444.62
|
| Rate for Payer: Cash Price |
$155.10
|
| Rate for Payer: Cash Price |
$155.10
|
| Rate for Payer: Cigna Commercial |
$491.15
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$258.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$310.20
|
| Rate for Payer: Health EOS Commercial |
$470.47
|
| Rate for Payer: HFN Commercial |
$491.15
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$165.84
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$165.84
|
| Rate for Payer: Multiplan Commercial |
$413.60
|
| Rate for Payer: Preferred Network Access Commercial |
$491.15
|
| Rate for Payer: Quartz Beloit One Network |
$227.48
|
| Rate for Payer: Quartz Commercial |
$294.69
|
| Rate for Payer: The Alliance Commercial |
$258.50
|
| Rate for Payer: WEA Trust Commercial |
$284.35
|
| Rate for Payer: WPS Commercial |
$382.94
|
|
|
Heper (CD4)/Supressor (CD8) Ratio
|
Facility
|
IP
|
$517.00
|
|
|
Service Code
|
CPT 86360
|
| Hospital Charge Code |
2942945
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$253.33 |
| Max. Negotiated Rate |
$475.64 |
| Rate for Payer: Aetna Commercial |
$465.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$444.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$274.01
|
| Rate for Payer: Cash Price |
$155.10
|
| Rate for Payer: Cigna Commercial |
$475.64
|
| Rate for Payer: Health EOS Commercial |
$460.13
|
| Rate for Payer: HFN Commercial |
$475.64
|
| Rate for Payer: Multiplan Commercial |
$413.60
|
| Rate for Payer: NAPHCARE Commercial |
$310.20
|
| Rate for Payer: Preferred Network Access Commercial |
$475.64
|
| Rate for Payer: Quartz Beloit One Network |
$253.33
|
| Rate for Payer: Quartz Commercial |
$310.20
|
| Rate for Payer: WEA Trust Commercial |
$284.35
|
| Rate for Payer: WPS Commercial |
$382.94
|
|
|
Hep Func Panel
|
Professional
|
Both
|
$281.00
|
|
|
Service Code
|
CPT 80076
|
| Hospital Charge Code |
633744
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$28.84 |
| Max. Negotiated Rate |
$266.95 |
| Rate for Payer: Aetna Commercial |
$266.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$241.66
|
| Rate for Payer: Cash Price |
$84.30
|
| Rate for Payer: Cash Price |
$84.30
|
| Rate for Payer: Cigna Commercial |
$266.95
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$140.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$168.60
|
| Rate for Payer: Health EOS Commercial |
$255.71
|
| Rate for Payer: HFN Commercial |
$266.95
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$28.84
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$28.84
|
| Rate for Payer: Multiplan Commercial |
$224.80
|
| Rate for Payer: Preferred Network Access Commercial |
$266.95
|
| Rate for Payer: Quartz Beloit One Network |
$123.64
|
| Rate for Payer: Quartz Commercial |
$160.17
|
| Rate for Payer: The Alliance Commercial |
$140.50
|
| Rate for Payer: WEA Trust Commercial |
$154.55
|
| Rate for Payer: WPS Commercial |
$208.14
|
|
|
Hep Func Panel
|
Facility
|
IP
|
$281.00
|
|
|
Service Code
|
CPT 80076
|
| Hospital Charge Code |
633744
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$137.69 |
| Max. Negotiated Rate |
$258.52 |
| Rate for Payer: Aetna Commercial |
$252.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$241.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$148.93
|
| Rate for Payer: Cash Price |
$84.30
|
| Rate for Payer: Cigna Commercial |
$258.52
|
| Rate for Payer: Health EOS Commercial |
$250.09
|
| Rate for Payer: HFN Commercial |
$258.52
|
| Rate for Payer: Multiplan Commercial |
$224.80
|
| Rate for Payer: NAPHCARE Commercial |
$168.60
|
| Rate for Payer: Preferred Network Access Commercial |
$258.52
|
| Rate for Payer: Quartz Beloit One Network |
$137.69
|
| Rate for Payer: Quartz Commercial |
$168.60
|
| Rate for Payer: WEA Trust Commercial |
$154.55
|
| Rate for Payer: WPS Commercial |
$208.14
|
|
|
Hep Func Panel
|
Facility
|
OP
|
$281.00
|
|
|
Service Code
|
CPT 80076
|
| Hospital Charge Code |
633744
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.17 |
| Max. Negotiated Rate |
$258.52 |
| Rate for Payer: Aetna Commercial |
$252.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$241.66
|
| Rate for Payer: Aetna Managed Medicare |
$8.17
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$30.64
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$14.30
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$13.56
|
| Rate for Payer: Anthem Medicaid |
$8.44
|
| Rate for Payer: Anthem Medicare Advantage |
$8.17
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$148.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$8.17
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$8.17
|
| Rate for Payer: Cash Price |
$84.30
|
| Rate for Payer: Cash Price |
$84.30
|
| Rate for Payer: Cigna Commercial |
$258.52
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$8.17
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$8.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$157.25
|
| Rate for Payer: Dean Health Medicaid |
$8.44
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$8.17
|
| Rate for Payer: Health EOS Commercial |
$250.09
|
| Rate for Payer: HFN Commercial |
$258.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$30.39
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$8.17
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$8.44
|
| Rate for Payer: Independent Care Health Plan Medicare |
$8.17
|
| Rate for Payer: Managed Health Services Medicaid |
$8.78
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$8.17
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$8.17
|
| Rate for Payer: Multiplan Commercial |
$224.80
|
| Rate for Payer: NAPHCARE Commercial |
$12.26
|
| Rate for Payer: Preferred Network Access Commercial |
$258.52
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$8.44
|
| Rate for Payer: Quartz Beloit One Network |
$137.69
|
| Rate for Payer: Quartz Commercial |
$182.65
|
| Rate for Payer: Quartz Medicare Advantage |
$8.17
|
| Rate for Payer: The Alliance Commercial |
$32.68
|
| Rate for Payer: United Healthcare Medicaid |
$8.44
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8.17
|
| Rate for Payer: United Healthcare PPO |
$210.75
|
| Rate for Payer: WEA Trust Commercial |
$154.55
|
| Rate for Payer: Wellcare Medicare |
$8.17
|
| Rate for Payer: WMAP Medicaid |
$8.44
|
| Rate for Payer: WPS Commercial |
$208.14
|
|
|
Herceptin 10 mg Charge
|
Facility
|
IP
|
$310.00
|
|
|
Service Code
|
HCPCS J9355
|
| Hospital Charge Code |
2958862
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$151.90 |
| Max. Negotiated Rate |
$285.20 |
| Rate for Payer: Aetna Commercial |
$279.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$266.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$164.30
|
| Rate for Payer: Cash Price |
$93.00
|
| Rate for Payer: Cigna Commercial |
$285.20
|
| Rate for Payer: Health EOS Commercial |
$275.90
|
| Rate for Payer: HFN Commercial |
$285.20
|
| Rate for Payer: Multiplan Commercial |
$248.00
|
| Rate for Payer: NAPHCARE Commercial |
$186.00
|
| Rate for Payer: Preferred Network Access Commercial |
$285.20
|
| Rate for Payer: Quartz Beloit One Network |
$151.90
|
| Rate for Payer: Quartz Commercial |
$186.00
|
| Rate for Payer: WEA Trust Commercial |
$170.50
|
| Rate for Payer: WPS Commercial |
$229.62
|
|
|
Herceptin 10 mg Charge
|
Professional
|
Both
|
$310.00
|
|
|
Service Code
|
HCPCS J9355
|
| Hospital Charge Code |
2958862
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$80.05 |
| Max. Negotiated Rate |
$294.50 |
| Rate for Payer: Aetna Commercial |
$294.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$266.60
|
| Rate for Payer: Cash Price |
$93.00
|
| Rate for Payer: Cash Price |
$93.00
|
| Rate for Payer: Cigna Commercial |
$294.50
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$80.05
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$80.05
|
| Rate for Payer: Health EOS Commercial |
$282.10
|
| Rate for Payer: HFN Commercial |
$294.50
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$136.77
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$136.77
|
| Rate for Payer: Multiplan Commercial |
$248.00
|
| Rate for Payer: Preferred Network Access Commercial |
$294.50
|
| Rate for Payer: Quartz Beloit One Network |
$136.40
|
| Rate for Payer: Quartz Commercial |
$176.70
|
| Rate for Payer: The Alliance Commercial |
$155.00
|
| Rate for Payer: United Healthcare Medicaid |
$80.05
|
| Rate for Payer: WEA Trust Commercial |
$170.50
|
| Rate for Payer: WPS Commercial |
$200.12
|
|
|
Herceptin 10 mg Charge
|
Facility
|
OP
|
$310.00
|
|
|
Service Code
|
HCPCS J9355
|
| Hospital Charge Code |
2958862
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$80.46 |
| Max. Negotiated Rate |
$321.86 |
| Rate for Payer: Aetna Commercial |
$279.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$266.60
|
| Rate for Payer: Aetna Managed Medicare |
$80.46
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$201.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$155.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$148.80
|
| Rate for Payer: Anthem Medicare Advantage |
$80.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$164.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$80.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$80.46
|
| Rate for Payer: Cash Price |
$93.00
|
| Rate for Payer: Cash Price |
$93.00
|
| Rate for Payer: Cigna Commercial |
$285.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$80.46
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$105.90
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$80.46
|
| Rate for Payer: Health EOS Commercial |
$275.90
|
| Rate for Payer: HFN Commercial |
$285.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$299.33
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$80.46
|
| Rate for Payer: Independent Care Health Plan Medicare |
$80.46
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$80.46
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$80.46
|
| Rate for Payer: Multiplan Commercial |
$248.00
|
| Rate for Payer: NAPHCARE Commercial |
$120.70
|
| Rate for Payer: Preferred Network Access Commercial |
$285.20
|
| Rate for Payer: Quartz Beloit One Network |
$151.90
|
| Rate for Payer: Quartz Commercial |
$201.50
|
| Rate for Payer: Quartz Medicare Advantage |
$80.46
|
| Rate for Payer: The Alliance Commercial |
$321.86
|
| Rate for Payer: United Healthcare Medicare Advantage |
$80.46
|
| Rate for Payer: WEA Trust Commercial |
$170.50
|
| Rate for Payer: Wellcare Medicare |
$80.46
|
| Rate for Payer: WPS Commercial |
$200.12
|
|
|
Hereditary Erythrocytosis Mutations
|
Facility
|
IP
|
$1,282.00
|
|
|
Service Code
|
CPT 81479
|
| Hospital Charge Code |
4606696
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$628.18 |
| Max. Negotiated Rate |
$1,179.44 |
| Rate for Payer: Aetna Commercial |
$1,153.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,102.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$679.46
|
| Rate for Payer: Cash Price |
$384.60
|
| Rate for Payer: Cigna Commercial |
$1,179.44
|
| Rate for Payer: Health EOS Commercial |
$1,140.98
|
| Rate for Payer: HFN Commercial |
$1,179.44
|
| Rate for Payer: Multiplan Commercial |
$1,025.60
|
| Rate for Payer: NAPHCARE Commercial |
$769.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,179.44
|
| Rate for Payer: Quartz Beloit One Network |
$628.18
|
| Rate for Payer: Quartz Commercial |
$769.20
|
| Rate for Payer: WEA Trust Commercial |
$705.10
|
| Rate for Payer: WPS Commercial |
$949.58
|
|
