|
Ranibizumab Injection J2778
|
Facility
|
OP
|
$1,124.00
|
|
|
Service Code
|
HCPCS J2778
|
| Hospital Charge Code |
5246757
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$187.55 |
| Max. Negotiated Rate |
$1,034.08 |
| Rate for Payer: Aetna Commercial |
$1,011.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$966.64
|
| Rate for Payer: Aetna Managed Medicare |
$187.55
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$730.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$562.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$539.52
|
| Rate for Payer: Anthem Medicare Advantage |
$187.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$595.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$187.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$187.55
|
| Rate for Payer: Cash Price |
$337.20
|
| Rate for Payer: Cash Price |
$337.20
|
| Rate for Payer: Cigna Commercial |
$1,034.08
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$187.55
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$229.38
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$187.55
|
| Rate for Payer: Health EOS Commercial |
$1,000.36
|
| Rate for Payer: HFN Commercial |
$1,034.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$697.70
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$187.55
|
| Rate for Payer: Independent Care Health Plan Medicare |
$187.55
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$187.55
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$187.55
|
| Rate for Payer: Multiplan Commercial |
$899.20
|
| Rate for Payer: NAPHCARE Commercial |
$281.33
|
| Rate for Payer: Preferred Network Access Commercial |
$1,034.08
|
| Rate for Payer: Quartz Beloit One Network |
$550.76
|
| Rate for Payer: Quartz Commercial |
$730.60
|
| Rate for Payer: Quartz Medicare Advantage |
$187.55
|
| Rate for Payer: The Alliance Commercial |
$750.21
|
| Rate for Payer: United Healthcare Medicare Advantage |
$187.55
|
| Rate for Payer: WEA Trust Commercial |
$618.20
|
| Rate for Payer: Wellcare Medicare |
$187.55
|
| Rate for Payer: WPS Commercial |
$433.44
|
|
|
Ranibizumab Injection J2778
|
Professional
|
Both
|
$1,124.00
|
|
|
Service Code
|
HCPCS J2778
|
| Hospital Charge Code |
5246757
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$173.38 |
| Max. Negotiated Rate |
$1,067.80 |
| Rate for Payer: Aetna Commercial |
$1,067.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$966.64
|
| Rate for Payer: Cash Price |
$337.20
|
| Rate for Payer: Cash Price |
$337.20
|
| Rate for Payer: Cigna Commercial |
$1,067.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$173.38
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$173.38
|
| Rate for Payer: Health EOS Commercial |
$1,022.84
|
| Rate for Payer: HFN Commercial |
$1,067.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$455.90
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$455.90
|
| Rate for Payer: Multiplan Commercial |
$899.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,067.80
|
| Rate for Payer: Quartz Beloit One Network |
$494.56
|
| Rate for Payer: Quartz Commercial |
$640.68
|
| Rate for Payer: The Alliance Commercial |
$562.00
|
| Rate for Payer: United Healthcare Medicaid |
$173.38
|
| Rate for Payer: WEA Trust Commercial |
$618.20
|
| Rate for Payer: WPS Commercial |
$433.44
|
|
|
Rapamycin (Sirolimus)
|
Professional
|
Both
|
$266.00
|
|
|
Service Code
|
CPT 80195
|
| Hospital Charge Code |
983385
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$48.47 |
| Max. Negotiated Rate |
$252.70 |
| Rate for Payer: Aetna Commercial |
$252.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$228.76
|
| Rate for Payer: Cash Price |
$79.80
|
| Rate for Payer: Cash Price |
$79.80
|
| Rate for Payer: Cigna Commercial |
$252.70
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$133.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$159.60
|
| Rate for Payer: Health EOS Commercial |
$242.06
|
| Rate for Payer: HFN Commercial |
$252.70
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$48.47
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$48.47
|
| Rate for Payer: Multiplan Commercial |
$212.80
|
| Rate for Payer: Preferred Network Access Commercial |
$252.70
|
| Rate for Payer: Quartz Beloit One Network |
$117.04
|
| Rate for Payer: Quartz Commercial |
$151.62
|
| Rate for Payer: The Alliance Commercial |
$133.00
|
| Rate for Payer: WEA Trust Commercial |
$146.30
|
| Rate for Payer: WPS Commercial |
$197.03
|
|
|
Rapamycin (Sirolimus)
|
Facility
|
IP
|
$266.00
|
|
|
Service Code
|
CPT 80195
|
| Hospital Charge Code |
983385
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$130.34 |
| Max. Negotiated Rate |
$244.72 |
| Rate for Payer: Aetna Commercial |
$239.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$228.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$140.98
|
| Rate for Payer: Cash Price |
$79.80
|
| Rate for Payer: Cigna Commercial |
$244.72
|
| Rate for Payer: Health EOS Commercial |
$236.74
|
| Rate for Payer: HFN Commercial |
$244.72
|
| Rate for Payer: Multiplan Commercial |
$212.80
|
| Rate for Payer: NAPHCARE Commercial |
$159.60
|
| Rate for Payer: Preferred Network Access Commercial |
$244.72
|
| Rate for Payer: Quartz Beloit One Network |
$130.34
|
| Rate for Payer: Quartz Commercial |
$159.60
|
| Rate for Payer: WEA Trust Commercial |
$146.30
|
| Rate for Payer: WPS Commercial |
$197.03
|
|
|
Rapamycin (Sirolimus)
|
Facility
|
OP
|
$266.00
|
|
|
Service Code
|
CPT 80195
|
| Hospital Charge Code |
983385
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.73 |
| Max. Negotiated Rate |
$244.72 |
| Rate for Payer: Aetna Commercial |
$239.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$228.76
|
| Rate for Payer: Aetna Managed Medicare |
$13.73
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$51.49
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$24.03
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$22.79
|
| Rate for Payer: Anthem Medicaid |
$14.19
|
| Rate for Payer: Anthem Medicare Advantage |
$13.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$140.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$13.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$13.73
|
| Rate for Payer: Cash Price |
$79.80
|
| Rate for Payer: Cash Price |
$79.80
|
| Rate for Payer: Cigna Commercial |
$244.72
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$13.73
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$14.19
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$148.85
|
| Rate for Payer: Dean Health Medicaid |
$14.19
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$13.73
|
| Rate for Payer: Health EOS Commercial |
$236.74
|
| Rate for Payer: HFN Commercial |
$244.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$51.08
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$13.73
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$14.19
|
| Rate for Payer: Independent Care Health Plan Medicare |
$13.73
|
| Rate for Payer: Managed Health Services Medicaid |
$14.76
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$13.73
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$13.73
|
| Rate for Payer: Multiplan Commercial |
$212.80
|
| Rate for Payer: NAPHCARE Commercial |
$20.60
|
| Rate for Payer: Preferred Network Access Commercial |
$244.72
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$14.19
|
| Rate for Payer: Quartz Beloit One Network |
$130.34
|
| Rate for Payer: Quartz Commercial |
$172.90
|
| Rate for Payer: Quartz Medicare Advantage |
$13.73
|
| Rate for Payer: The Alliance Commercial |
$54.92
|
| Rate for Payer: United Healthcare Medicaid |
$14.19
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.73
|
| Rate for Payer: United Healthcare PPO |
$199.50
|
| Rate for Payer: WEA Trust Commercial |
$146.30
|
| Rate for Payer: Wellcare Medicare |
$13.73
|
| Rate for Payer: WMAP Medicaid |
$14.19
|
| Rate for Payer: WPS Commercial |
$197.03
|
|
|
Rapid Anaerobe ID
|
Facility
|
OP
|
$205.00
|
|
|
Service Code
|
CPT 87076
|
| Hospital Charge Code |
1942802
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.08 |
| Max. Negotiated Rate |
$188.60 |
| Rate for Payer: Aetna Commercial |
$184.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$176.30
|
| Rate for Payer: Aetna Managed Medicare |
$8.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$30.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$14.14
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$13.41
|
| Rate for Payer: Anthem Medicaid |
$8.35
|
| Rate for Payer: Anthem Medicare Advantage |
$8.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$108.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$8.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$8.08
|
| Rate for Payer: Cash Price |
$61.50
|
| Rate for Payer: Cash Price |
$61.50
|
| Rate for Payer: Cigna Commercial |
$188.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$8.08
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$8.35
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$114.72
|
| Rate for Payer: Dean Health Medicaid |
$8.35
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$8.08
|
| Rate for Payer: Health EOS Commercial |
$182.45
|
| Rate for Payer: HFN Commercial |
$188.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$30.06
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$8.08
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$8.35
|
| Rate for Payer: Independent Care Health Plan Medicare |
$8.08
|
| Rate for Payer: Managed Health Services Medicaid |
$8.68
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$8.08
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$8.08
|
| Rate for Payer: Multiplan Commercial |
$164.00
|
| Rate for Payer: NAPHCARE Commercial |
$12.12
|
| Rate for Payer: Preferred Network Access Commercial |
$188.60
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$8.35
|
| Rate for Payer: Quartz Beloit One Network |
$100.45
|
| Rate for Payer: Quartz Commercial |
$133.25
|
| Rate for Payer: Quartz Medicare Advantage |
$8.08
|
| Rate for Payer: The Alliance Commercial |
$32.32
|
| Rate for Payer: United Healthcare Medicaid |
$8.35
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8.08
|
| Rate for Payer: United Healthcare PPO |
$153.75
|
| Rate for Payer: WEA Trust Commercial |
$112.75
|
| Rate for Payer: Wellcare Medicare |
$8.08
|
| Rate for Payer: WMAP Medicaid |
$8.35
|
| Rate for Payer: WPS Commercial |
$151.84
|
|
|
Rapid Anaerobe ID
|
Facility
|
IP
|
$205.00
|
|
|
Service Code
|
CPT 87076
|
| Hospital Charge Code |
1942802
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$100.45 |
| Max. Negotiated Rate |
$188.60 |
| Rate for Payer: Aetna Commercial |
$184.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$176.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$108.65
|
| Rate for Payer: Cash Price |
$61.50
|
| Rate for Payer: Cigna Commercial |
$188.60
|
| Rate for Payer: Health EOS Commercial |
$182.45
|
| Rate for Payer: HFN Commercial |
$188.60
|
| Rate for Payer: Multiplan Commercial |
$164.00
|
| Rate for Payer: NAPHCARE Commercial |
$123.00
|
| Rate for Payer: Preferred Network Access Commercial |
$188.60
|
| Rate for Payer: Quartz Beloit One Network |
$100.45
|
| Rate for Payer: Quartz Commercial |
$123.00
|
| Rate for Payer: WEA Trust Commercial |
$112.75
|
| Rate for Payer: WPS Commercial |
$151.84
|
|
|
Rapid Anaerobe ID
|
Professional
|
Both
|
$205.00
|
|
|
Service Code
|
CPT 87076
|
| Hospital Charge Code |
1942802
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$28.52 |
| Max. Negotiated Rate |
$194.75 |
| Rate for Payer: Aetna Commercial |
$194.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$176.30
|
| Rate for Payer: Cash Price |
$61.50
|
| Rate for Payer: Cash Price |
$61.50
|
| Rate for Payer: Cigna Commercial |
$194.75
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$102.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$123.00
|
| Rate for Payer: Health EOS Commercial |
$186.55
|
| Rate for Payer: HFN Commercial |
$194.75
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$28.52
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$28.52
|
| Rate for Payer: Multiplan Commercial |
$164.00
|
| Rate for Payer: Preferred Network Access Commercial |
$194.75
|
| Rate for Payer: Quartz Beloit One Network |
$90.20
|
| Rate for Payer: Quartz Commercial |
$116.85
|
| Rate for Payer: The Alliance Commercial |
$102.50
|
| Rate for Payer: WEA Trust Commercial |
$112.75
|
| Rate for Payer: WPS Commercial |
$151.84
|
|
|
Rapid Desensitization 95180
|
Professional
|
Both
|
$353.00
|
|
|
Service Code
|
CPT 95180
|
| Hospital Charge Code |
4586645
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$74.72 |
| Max. Negotiated Rate |
$465.50 |
| Rate for Payer: Aetna Commercial |
$335.35
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$303.58
|
| 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 |
$74.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$211.80
|
| Rate for Payer: Health EOS Commercial |
$321.23
|
| Rate for Payer: HFN Commercial |
$335.35
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$465.50
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$465.50
|
| 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: The Alliance Commercial |
$176.50
|
| Rate for Payer: United Healthcare Medicaid |
$74.72
|
| Rate for Payer: WEA Trust Commercial |
$194.15
|
| Rate for Payer: WPS Commercial |
$261.47
|
|
|
Rapid Neg Urine Combo Panel 1
|
Facility
|
OP
|
$187.00
|
|
|
Service Code
|
CPT 87186
|
| Hospital Charge Code |
1562877
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.65 |
| Max. Negotiated Rate |
$172.04 |
| Rate for Payer: Aetna Commercial |
$168.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$160.82
|
| Rate for Payer: Aetna Managed Medicare |
$8.65
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$32.44
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$15.14
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$14.36
|
| Rate for Payer: Anthem Medicaid |
$8.94
|
| Rate for Payer: Anthem Medicare Advantage |
$8.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$99.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$8.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$8.65
|
| Rate for Payer: Cash Price |
$56.10
|
| Rate for Payer: Cash Price |
$56.10
|
| Rate for Payer: Cigna Commercial |
$172.04
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$8.65
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$8.94
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$104.65
|
| Rate for Payer: Dean Health Medicaid |
$8.94
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$8.65
|
| Rate for Payer: Health EOS Commercial |
$166.43
|
| Rate for Payer: HFN Commercial |
$172.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$32.18
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$8.65
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$8.94
|
| Rate for Payer: Independent Care Health Plan Medicare |
$8.65
|
| Rate for Payer: Managed Health Services Medicaid |
$9.30
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$8.65
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$8.65
|
| Rate for Payer: Multiplan Commercial |
$149.60
|
| Rate for Payer: NAPHCARE Commercial |
$12.98
|
| Rate for Payer: Preferred Network Access Commercial |
$172.04
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$8.94
|
| Rate for Payer: Quartz Beloit One Network |
$91.63
|
| Rate for Payer: Quartz Commercial |
$121.55
|
| Rate for Payer: Quartz Medicare Advantage |
$8.65
|
| Rate for Payer: The Alliance Commercial |
$34.60
|
| Rate for Payer: United Healthcare Medicaid |
$8.94
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8.65
|
| Rate for Payer: United Healthcare PPO |
$140.25
|
| Rate for Payer: WEA Trust Commercial |
$102.85
|
| Rate for Payer: Wellcare Medicare |
$8.65
|
| Rate for Payer: WMAP Medicaid |
$8.94
|
| Rate for Payer: WPS Commercial |
$138.51
|
|
|
Rapid Neg Urine Combo Panel 1
|
Facility
|
IP
|
$187.00
|
|
|
Service Code
|
CPT 87186
|
| Hospital Charge Code |
1562877
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$91.63 |
| Max. Negotiated Rate |
$172.04 |
| Rate for Payer: Aetna Commercial |
$168.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$160.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$99.11
|
| Rate for Payer: Cash Price |
$56.10
|
| Rate for Payer: Cigna Commercial |
$172.04
|
| Rate for Payer: Health EOS Commercial |
$166.43
|
| Rate for Payer: HFN Commercial |
$172.04
|
| Rate for Payer: Multiplan Commercial |
$149.60
|
| Rate for Payer: NAPHCARE Commercial |
$112.20
|
| Rate for Payer: Preferred Network Access Commercial |
$172.04
|
| Rate for Payer: Quartz Beloit One Network |
$91.63
|
| Rate for Payer: Quartz Commercial |
$112.20
|
| Rate for Payer: WEA Trust Commercial |
$102.85
|
| Rate for Payer: WPS Commercial |
$138.51
|
|
|
Rapid Neg Urine Combo Panel 1
|
Professional
|
Both
|
$187.00
|
|
|
Service Code
|
CPT 87186
|
| Hospital Charge Code |
1562877
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$30.53 |
| Max. Negotiated Rate |
$177.65 |
| Rate for Payer: Aetna Commercial |
$177.65
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$160.82
|
| Rate for Payer: Cash Price |
$56.10
|
| Rate for Payer: Cash Price |
$56.10
|
| Rate for Payer: Cigna Commercial |
$177.65
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$93.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$112.20
|
| Rate for Payer: Health EOS Commercial |
$170.17
|
| Rate for Payer: HFN Commercial |
$177.65
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$30.53
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$30.53
|
| Rate for Payer: Multiplan Commercial |
$149.60
|
| Rate for Payer: Preferred Network Access Commercial |
$177.65
|
| Rate for Payer: Quartz Beloit One Network |
$82.28
|
| Rate for Payer: Quartz Commercial |
$106.59
|
| Rate for Payer: The Alliance Commercial |
$93.50
|
| Rate for Payer: WEA Trust Commercial |
$102.85
|
| Rate for Payer: WPS Commercial |
$138.51
|
|
|
Rapid Plasma Reagin Test
|
Facility
|
IP
|
$82.00
|
|
|
Service Code
|
CPT 86592
|
| Hospital Charge Code |
633820
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$40.18 |
| Max. Negotiated Rate |
$75.44 |
| Rate for Payer: Aetna Commercial |
$73.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$70.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$43.46
|
| Rate for Payer: Cash Price |
$24.60
|
| Rate for Payer: Cigna Commercial |
$75.44
|
| Rate for Payer: Health EOS Commercial |
$72.98
|
| Rate for Payer: HFN Commercial |
$75.44
|
| Rate for Payer: Multiplan Commercial |
$65.60
|
| Rate for Payer: NAPHCARE Commercial |
$49.20
|
| Rate for Payer: Preferred Network Access Commercial |
$75.44
|
| Rate for Payer: Quartz Beloit One Network |
$40.18
|
| Rate for Payer: Quartz Commercial |
$49.20
|
| Rate for Payer: WEA Trust Commercial |
$45.10
|
| Rate for Payer: WPS Commercial |
$60.74
|
|
|
Rapid Plasma Reagin Test
|
Professional
|
Both
|
$82.00
|
|
|
Service Code
|
CPT 86592
|
| Hospital Charge Code |
633820
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.07 |
| Max. Negotiated Rate |
$77.90 |
| Rate for Payer: Aetna Commercial |
$77.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$70.52
|
| Rate for Payer: Cash Price |
$24.60
|
| Rate for Payer: Cash Price |
$24.60
|
| Rate for Payer: Cigna Commercial |
$77.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$41.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$49.20
|
| Rate for Payer: Health EOS Commercial |
$74.62
|
| Rate for Payer: HFN Commercial |
$77.90
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$15.07
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$15.07
|
| Rate for Payer: Multiplan Commercial |
$65.60
|
| Rate for Payer: Preferred Network Access Commercial |
$77.90
|
| Rate for Payer: Quartz Beloit One Network |
$36.08
|
| Rate for Payer: Quartz Commercial |
$46.74
|
| Rate for Payer: The Alliance Commercial |
$41.00
|
| Rate for Payer: WEA Trust Commercial |
$45.10
|
| Rate for Payer: WPS Commercial |
$60.74
|
|
|
Rapid Plasma Reagin Test
|
Facility
|
OP
|
$82.00
|
|
|
Service Code
|
CPT 86592
|
| Hospital Charge Code |
633820
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.27 |
| Max. Negotiated Rate |
$75.44 |
| Rate for Payer: Aetna Commercial |
$73.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$70.52
|
| Rate for Payer: Aetna Managed Medicare |
$4.27
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$16.01
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$7.47
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7.09
|
| Rate for Payer: Anthem Medicaid |
$4.41
|
| Rate for Payer: Anthem Medicare Advantage |
$4.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$43.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$4.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$4.27
|
| Rate for Payer: Cash Price |
$24.60
|
| Rate for Payer: Cash Price |
$24.60
|
| Rate for Payer: Cigna Commercial |
$75.44
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$4.27
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$4.41
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$45.89
|
| Rate for Payer: Dean Health Medicaid |
$4.41
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$4.27
|
| Rate for Payer: Health EOS Commercial |
$72.98
|
| Rate for Payer: HFN Commercial |
$75.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$15.88
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$4.27
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$4.41
|
| Rate for Payer: Independent Care Health Plan Medicare |
$4.27
|
| Rate for Payer: Managed Health Services Medicaid |
$4.59
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$4.27
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$4.27
|
| Rate for Payer: Multiplan Commercial |
$65.60
|
| Rate for Payer: NAPHCARE Commercial |
$6.40
|
| Rate for Payer: Preferred Network Access Commercial |
$75.44
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$4.41
|
| Rate for Payer: Quartz Beloit One Network |
$40.18
|
| Rate for Payer: Quartz Commercial |
$53.30
|
| Rate for Payer: Quartz Medicare Advantage |
$4.27
|
| Rate for Payer: The Alliance Commercial |
$17.08
|
| Rate for Payer: United Healthcare Medicaid |
$4.41
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4.27
|
| Rate for Payer: United Healthcare PPO |
$61.50
|
| Rate for Payer: WEA Trust Commercial |
$45.10
|
| Rate for Payer: Wellcare Medicare |
$4.27
|
| Rate for Payer: WMAP Medicaid |
$4.41
|
| Rate for Payer: WPS Commercial |
$60.74
|
|
|
RAPID REFILL CONTINUOUS 6600
|
Facility
|
OP
|
$480.00
|
|
| Hospital Charge Code |
2973232
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$134.40 |
| Max. Negotiated Rate |
$1,920.00 |
| Rate for Payer: Aetna Commercial |
$432.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$412.80
|
| Rate for Payer: Aetna Managed Medicare |
$134.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$312.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$240.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$230.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$254.40
|
| Rate for Payer: Cash Price |
$144.00
|
| Rate for Payer: Cigna Commercial |
$441.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$268.61
|
| Rate for Payer: Health EOS Commercial |
$427.20
|
| Rate for Payer: HFN Commercial |
$441.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$360.00
|
| Rate for Payer: Multiplan Commercial |
$384.00
|
| Rate for Payer: NAPHCARE Commercial |
$288.00
|
| Rate for Payer: Preferred Network Access Commercial |
$441.60
|
| Rate for Payer: Quartz Beloit One Network |
$235.20
|
| Rate for Payer: Quartz Commercial |
$312.00
|
| Rate for Payer: Quartz Medicare Advantage |
$288.00
|
| Rate for Payer: The Alliance Commercial |
$1,920.00
|
| Rate for Payer: WEA Trust Commercial |
$264.00
|
| Rate for Payer: WPS Commercial |
$355.54
|
|
|
RAPID REFILL CONTINUOUS 6600
|
Facility
|
IP
|
$480.00
|
|
| Hospital Charge Code |
2973232
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$235.20 |
| Max. Negotiated Rate |
$441.60 |
| Rate for Payer: Aetna Commercial |
$432.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$412.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$254.40
|
| Rate for Payer: Cash Price |
$144.00
|
| Rate for Payer: Cigna Commercial |
$441.60
|
| Rate for Payer: Health EOS Commercial |
$427.20
|
| Rate for Payer: HFN Commercial |
$441.60
|
| Rate for Payer: Multiplan Commercial |
$384.00
|
| Rate for Payer: NAPHCARE Commercial |
$288.00
|
| Rate for Payer: Preferred Network Access Commercial |
$441.60
|
| Rate for Payer: Quartz Beloit One Network |
$235.20
|
| Rate for Payer: Quartz Commercial |
$288.00
|
| Rate for Payer: WEA Trust Commercial |
$264.00
|
| Rate for Payer: WPS Commercial |
$355.54
|
|
|
Rapid Strep POC (Clinics.)
|
Professional
|
Both
|
$191.00
|
|
|
Service Code
|
CPT 87880
|
| Hospital Charge Code |
3991999
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$58.35 |
| Max. Negotiated Rate |
$181.45 |
| Rate for Payer: Aetna Commercial |
$181.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$164.26
|
| Rate for Payer: Cash Price |
$57.30
|
| Rate for Payer: Cash Price |
$57.30
|
| Rate for Payer: Cigna Commercial |
$181.45
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$95.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$114.60
|
| Rate for Payer: Health EOS Commercial |
$173.81
|
| Rate for Payer: HFN Commercial |
$181.45
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$58.35
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$58.35
|
| Rate for Payer: Multiplan Commercial |
$152.80
|
| Rate for Payer: Preferred Network Access Commercial |
$181.45
|
| Rate for Payer: Quartz Beloit One Network |
$84.04
|
| Rate for Payer: Quartz Commercial |
$108.87
|
| Rate for Payer: The Alliance Commercial |
$95.50
|
| Rate for Payer: WEA Trust Commercial |
$105.05
|
| Rate for Payer: WPS Commercial |
$141.47
|
|
|
Rapid Strep POC (Clinics.)
|
Facility
|
IP
|
$191.00
|
|
|
Service Code
|
CPT 87880
|
| Hospital Charge Code |
3991999
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$93.59 |
| Max. Negotiated Rate |
$175.72 |
| Rate for Payer: Aetna Commercial |
$171.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$164.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$101.23
|
| Rate for Payer: Cash Price |
$57.30
|
| Rate for Payer: Cigna Commercial |
$175.72
|
| Rate for Payer: Health EOS Commercial |
$169.99
|
| Rate for Payer: HFN Commercial |
$175.72
|
| Rate for Payer: Multiplan Commercial |
$152.80
|
| Rate for Payer: NAPHCARE Commercial |
$114.60
|
| Rate for Payer: Preferred Network Access Commercial |
$175.72
|
| Rate for Payer: Quartz Beloit One Network |
$93.59
|
| Rate for Payer: Quartz Commercial |
$114.60
|
| Rate for Payer: WEA Trust Commercial |
$105.05
|
| Rate for Payer: WPS Commercial |
$141.47
|
|
|
Rapid Strep POC (Clinics.)
|
Facility
|
OP
|
$191.00
|
|
|
Service Code
|
CPT 87880
|
| Hospital Charge Code |
3991999
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$16.53 |
| Max. Negotiated Rate |
$175.72 |
| Rate for Payer: Aetna Commercial |
$171.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$164.26
|
| Rate for Payer: Aetna Managed Medicare |
$16.53
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$61.99
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$28.93
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$27.44
|
| Rate for Payer: Anthem Medicaid |
$16.86
|
| Rate for Payer: Anthem Medicare Advantage |
$16.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$101.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$16.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$16.53
|
| Rate for Payer: Cash Price |
$57.30
|
| Rate for Payer: Cash Price |
$57.30
|
| Rate for Payer: Cigna Commercial |
$175.72
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$16.53
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$16.86
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$106.88
|
| Rate for Payer: Dean Health Medicaid |
$16.86
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$16.53
|
| Rate for Payer: Health EOS Commercial |
$169.99
|
| Rate for Payer: HFN Commercial |
$175.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$61.49
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$16.53
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$16.86
|
| Rate for Payer: Independent Care Health Plan Medicare |
$16.53
|
| Rate for Payer: Managed Health Services Medicaid |
$17.53
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$16.53
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$16.53
|
| Rate for Payer: Multiplan Commercial |
$152.80
|
| Rate for Payer: NAPHCARE Commercial |
$24.80
|
| Rate for Payer: Preferred Network Access Commercial |
$175.72
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$16.86
|
| Rate for Payer: Quartz Beloit One Network |
$93.59
|
| Rate for Payer: Quartz Commercial |
$124.15
|
| Rate for Payer: Quartz Medicare Advantage |
$16.53
|
| Rate for Payer: The Alliance Commercial |
$66.12
|
| Rate for Payer: United Healthcare Medicaid |
$16.86
|
| Rate for Payer: United Healthcare Medicare Advantage |
$16.53
|
| Rate for Payer: United Healthcare PPO |
$143.25
|
| Rate for Payer: WEA Trust Commercial |
$105.05
|
| Rate for Payer: Wellcare Medicare |
$16.53
|
| Rate for Payer: WMAP Medicaid |
$16.86
|
| Rate for Payer: WPS Commercial |
$141.47
|
|
|
Rapid Yeast ID
|
Professional
|
Both
|
$151.00
|
|
|
Service Code
|
CPT 87106
|
| Hospital Charge Code |
1942804
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$36.43 |
| Max. Negotiated Rate |
$143.45 |
| 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 |
$75.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$90.60
|
| Rate for Payer: Health EOS Commercial |
$137.41
|
| Rate for Payer: HFN Commercial |
$143.45
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$36.43
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$36.43
|
| 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: WEA Trust Commercial |
$83.05
|
| Rate for Payer: WPS Commercial |
$111.85
|
|
|
Rapid Yeast ID
|
Facility
|
OP
|
$151.00
|
|
|
Service Code
|
CPT 87106
|
| Hospital Charge Code |
1942804
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.32 |
| Max. Negotiated Rate |
$138.92 |
| Rate for Payer: Aetna Commercial |
$135.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$129.86
|
| Rate for Payer: Aetna Managed Medicare |
$10.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$38.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$18.06
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$17.13
|
| Rate for Payer: Anthem Medicaid |
$10.66
|
| Rate for Payer: Anthem Medicare Advantage |
$10.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$80.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$10.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$10.32
|
| Rate for Payer: Cash Price |
$45.30
|
| Rate for Payer: Cash Price |
$45.30
|
| Rate for Payer: Cigna Commercial |
$138.92
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$10.32
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$10.66
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$84.50
|
| Rate for Payer: Dean Health Medicaid |
$10.66
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$10.32
|
| Rate for Payer: Health EOS Commercial |
$134.39
|
| Rate for Payer: HFN Commercial |
$138.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$38.39
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$10.32
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$10.66
|
| Rate for Payer: Independent Care Health Plan Medicare |
$10.32
|
| Rate for Payer: Managed Health Services Medicaid |
$11.09
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$10.32
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$10.32
|
| Rate for Payer: Multiplan Commercial |
$120.80
|
| Rate for Payer: NAPHCARE Commercial |
$15.48
|
| Rate for Payer: Preferred Network Access Commercial |
$138.92
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$10.66
|
| Rate for Payer: Quartz Beloit One Network |
$73.99
|
| Rate for Payer: Quartz Commercial |
$98.15
|
| Rate for Payer: Quartz Medicare Advantage |
$10.32
|
| Rate for Payer: The Alliance Commercial |
$41.28
|
| Rate for Payer: United Healthcare Medicaid |
$10.66
|
| Rate for Payer: United Healthcare Medicare Advantage |
$10.32
|
| Rate for Payer: United Healthcare PPO |
$113.25
|
| Rate for Payer: WEA Trust Commercial |
$83.05
|
| Rate for Payer: Wellcare Medicare |
$10.32
|
| Rate for Payer: WMAP Medicaid |
$10.66
|
| Rate for Payer: WPS Commercial |
$111.85
|
|
|
Rapid Yeast ID
|
Facility
|
IP
|
$151.00
|
|
|
Service Code
|
CPT 87106
|
| Hospital Charge Code |
1942804
|
|
Hospital Revenue Code
|
300
|
| 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
|
|
|
RAPTOR GRASPING DEVICE BX00711177
|
Facility
|
IP
|
$2,078.00
|
|
| Hospital Charge Code |
3065506
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,018.22 |
| Max. Negotiated Rate |
$1,911.76 |
| Rate for Payer: Aetna Commercial |
$1,870.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,787.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,101.34
|
| Rate for Payer: Cash Price |
$623.40
|
| Rate for Payer: Cigna Commercial |
$1,911.76
|
| Rate for Payer: Health EOS Commercial |
$1,849.42
|
| Rate for Payer: HFN Commercial |
$1,911.76
|
| Rate for Payer: Multiplan Commercial |
$1,662.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,246.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,911.76
|
| Rate for Payer: Quartz Beloit One Network |
$1,018.22
|
| Rate for Payer: Quartz Commercial |
$1,246.80
|
| Rate for Payer: WEA Trust Commercial |
$1,142.90
|
| Rate for Payer: WPS Commercial |
$1,539.17
|
|
|
RAPTOR GRASPING DEVICE BX00711177
|
Facility
|
OP
|
$2,078.00
|
|
| Hospital Charge Code |
3065506
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$581.84 |
| Max. Negotiated Rate |
$8,312.00 |
| Rate for Payer: Aetna Commercial |
$1,870.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,787.08
|
| Rate for Payer: Aetna Managed Medicare |
$581.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,350.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,039.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$997.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,101.34
|
| Rate for Payer: Cash Price |
$623.40
|
| Rate for Payer: Cigna Commercial |
$1,911.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,162.85
|
| Rate for Payer: Health EOS Commercial |
$1,849.42
|
| Rate for Payer: HFN Commercial |
$1,911.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,558.50
|
| Rate for Payer: Multiplan Commercial |
$1,662.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,246.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,911.76
|
| Rate for Payer: Quartz Beloit One Network |
$1,018.22
|
| Rate for Payer: Quartz Commercial |
$1,350.70
|
| Rate for Payer: Quartz Medicare Advantage |
$1,246.80
|
| Rate for Payer: The Alliance Commercial |
$8,312.00
|
| Rate for Payer: WEA Trust Commercial |
$1,142.90
|
| Rate for Payer: WPS Commercial |
$1,539.17
|
|
