|
B2 Glycoprotein 1 Antibody IgM
|
Facility
OP
|
$213.00
|
|
|
Service Code
|
CPT 86146
|
| Hospital Charge Code |
2942865
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.17 |
| Max. Negotiated Rate |
$852.00 |
| Rate for Payer: Aetna Commercial |
$191.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$183.18
|
| Rate for Payer: Aetna Managed Medicare |
$25.45
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$95.44
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$44.54
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$42.25
|
| Rate for Payer: Anthem Medicaid |
$8.17
|
| Rate for Payer: Anthem Medicare Advantage |
$25.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$112.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$25.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$25.45
|
| Rate for Payer: Cash Price |
$63.90
|
| Rate for Payer: Cash Price |
$63.90
|
| Rate for Payer: Cigna Commercial |
$195.96
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$25.45
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$8.17
|
| Rate for Payer: Dean Health Medicaid |
$8.17
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$25.45
|
| Rate for Payer: Health EOS Commercial |
$189.57
|
| Rate for Payer: HFN Commercial |
$195.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$94.67
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$25.45
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$8.17
|
| Rate for Payer: Independent Care Health Plan Medicare |
$25.45
|
| Rate for Payer: Managed Health Services Medicaid |
$8.50
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$25.45
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$25.45
|
| Rate for Payer: Multiplan Commercial |
$170.40
|
| Rate for Payer: NAPHCARE Commercial |
$38.18
|
| Rate for Payer: Preferred Network Access Commercial |
$195.96
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$8.17
|
| Rate for Payer: Quartz Beloit One Network |
$104.37
|
| Rate for Payer: Quartz Commercial |
$138.45
|
| Rate for Payer: Quartz Medicare Advantage |
$25.45
|
| Rate for Payer: The Alliance Commercial |
$852.00
|
| Rate for Payer: United Healthcare Medicaid |
$8.17
|
| Rate for Payer: United Healthcare Medicare Advantage |
$25.45
|
| Rate for Payer: United Healthcare PPO |
$159.75
|
| Rate for Payer: WEA Trust Commercial |
$117.15
|
| Rate for Payer: Wellcare Medicare |
$25.45
|
| Rate for Payer: WMAP Medicaid |
$8.17
|
| Rate for Payer: WPS Commercial |
$157.77
|
|
|
BABCOCK ENDO 10MM 10BB
|
Facility
OP
|
$1,296.00
|
|
| Hospital Charge Code |
3633522
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$362.88 |
| Max. Negotiated Rate |
$5,184.00 |
| Rate for Payer: Aetna Commercial |
$1,166.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,114.56
|
| Rate for Payer: Aetna Managed Medicare |
$362.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$842.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$648.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$622.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$686.88
|
| Rate for Payer: Cash Price |
$388.80
|
| Rate for Payer: Cigna Commercial |
$1,192.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$725.24
|
| Rate for Payer: Health EOS Commercial |
$1,153.44
|
| Rate for Payer: HFN Commercial |
$1,192.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$972.00
|
| Rate for Payer: Multiplan Commercial |
$1,036.80
|
| Rate for Payer: NAPHCARE Commercial |
$777.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,192.32
|
| Rate for Payer: Quartz Beloit One Network |
$635.04
|
| Rate for Payer: Quartz Commercial |
$842.40
|
| Rate for Payer: Quartz Medicare Advantage |
$777.60
|
| Rate for Payer: The Alliance Commercial |
$5,184.00
|
| Rate for Payer: WEA Trust Commercial |
$712.80
|
| Rate for Payer: WPS Commercial |
$959.95
|
|
|
BABCOCK ENDO 10MM 10BB
|
Facility
IP
|
$1,296.00
|
|
| Hospital Charge Code |
3633522
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$635.04 |
| Max. Negotiated Rate |
$1,192.32 |
| Rate for Payer: Aetna Commercial |
$1,166.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$686.88
|
| Rate for Payer: Cash Price |
$388.80
|
| Rate for Payer: Cigna Commercial |
$1,192.32
|
| Rate for Payer: Health EOS Commercial |
$1,153.44
|
| Rate for Payer: HFN Commercial |
$1,192.32
|
| Rate for Payer: Multiplan Commercial |
$1,036.80
|
| Rate for Payer: NAPHCARE Commercial |
$777.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,192.32
|
| Rate for Payer: Quartz Beloit One Network |
$635.04
|
| Rate for Payer: Quartz Commercial |
$777.60
|
| Rate for Payer: WEA Trust Commercial |
$712.80
|
| Rate for Payer: WPS Commercial |
$959.95
|
|
|
BABCOCK ENDO 10MM CLAMP 174001
|
Facility
OP
|
$1,762.00
|
|
| Hospital Charge Code |
2962917
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$493.36 |
| Max. Negotiated Rate |
$7,048.00 |
| Rate for Payer: Aetna Commercial |
$1,585.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,515.32
|
| Rate for Payer: Aetna Managed Medicare |
$493.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,145.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$881.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$845.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$933.86
|
| Rate for Payer: Cash Price |
$528.60
|
| Rate for Payer: Cigna Commercial |
$1,621.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$986.02
|
| Rate for Payer: Health EOS Commercial |
$1,568.18
|
| Rate for Payer: HFN Commercial |
$1,621.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,321.50
|
| Rate for Payer: Multiplan Commercial |
$1,409.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,057.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,621.04
|
| Rate for Payer: Quartz Beloit One Network |
$863.38
|
| Rate for Payer: Quartz Commercial |
$1,145.30
|
| Rate for Payer: Quartz Medicare Advantage |
$1,057.20
|
| Rate for Payer: The Alliance Commercial |
$7,048.00
|
| Rate for Payer: WEA Trust Commercial |
$969.10
|
| Rate for Payer: WPS Commercial |
$1,305.11
|
|
|
BABCOCK ENDO 10MM CLAMP 174001
|
Facility
IP
|
$1,762.00
|
|
| Hospital Charge Code |
2962917
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$863.38 |
| Max. Negotiated Rate |
$1,621.04 |
| Rate for Payer: Aetna Commercial |
$1,585.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$933.86
|
| Rate for Payer: Cash Price |
$528.60
|
| Rate for Payer: Cigna Commercial |
$1,621.04
|
| Rate for Payer: Health EOS Commercial |
$1,568.18
|
| Rate for Payer: HFN Commercial |
$1,621.04
|
| Rate for Payer: Multiplan Commercial |
$1,409.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,057.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,621.04
|
| Rate for Payer: Quartz Beloit One Network |
$863.38
|
| Rate for Payer: Quartz Commercial |
$1,057.20
|
| Rate for Payer: WEA Trust Commercial |
$969.10
|
| Rate for Payer: WPS Commercial |
$1,305.11
|
|
|
Babesia microti Antibodies, IgG & IgM
|
Facility
IP
|
$70.00
|
|
|
Service Code
|
CPT 86753
|
| Hospital Charge Code |
980032
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$34.30 |
| Max. Negotiated Rate |
$64.40 |
| Rate for Payer: Aetna Commercial |
$63.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$37.10
|
| Rate for Payer: Cash Price |
$21.00
|
| Rate for Payer: Cigna Commercial |
$64.40
|
| Rate for Payer: Health EOS Commercial |
$62.30
|
| Rate for Payer: HFN Commercial |
$64.40
|
| Rate for Payer: Multiplan Commercial |
$56.00
|
| Rate for Payer: NAPHCARE Commercial |
$42.00
|
| Rate for Payer: Preferred Network Access Commercial |
$64.40
|
| Rate for Payer: Quartz Beloit One Network |
$34.30
|
| Rate for Payer: Quartz Commercial |
$42.00
|
| Rate for Payer: WEA Trust Commercial |
$38.50
|
| Rate for Payer: WPS Commercial |
$51.85
|
|
|
Babesia microti Antibodies, IgG & IgM
|
Professional
|
$70.00
|
|
|
Service Code
|
CPT 86753
|
| Hospital Charge Code |
980032
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.39 |
| Max. Negotiated Rate |
$66.50 |
| Rate for Payer: Aetna Commercial |
$66.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$60.20
|
| Rate for Payer: Aetna Managed Medicare |
$12.39
|
| Rate for Payer: Anthem Medicare Advantage |
$12.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$12.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$12.39
|
| Rate for Payer: Cash Price |
$21.00
|
| Rate for Payer: Cash Price |
$21.00
|
| Rate for Payer: Cigna Commercial |
$66.50
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$35.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12.39
|
| Rate for Payer: Health EOS Commercial |
$63.70
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$43.74
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$43.74
|
| Rate for Payer: Independent Care Health Plan Medicare |
$12.39
|
| Rate for Payer: Multiplan Commercial |
$56.00
|
| Rate for Payer: Preferred Network Access Commercial |
$66.50
|
| Rate for Payer: Quartz Beloit One Network |
$30.80
|
| Rate for Payer: Quartz Commercial |
$39.90
|
| Rate for Payer: Quartz Medicare Advantage |
$12.39
|
| Rate for Payer: The Alliance Commercial |
$48.94
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.39
|
| Rate for Payer: WEA Trust Commercial |
$38.50
|
| Rate for Payer: WPS Commercial |
$54.52
|
|
|
Babesia microti Antibodies, IgG & IgM
|
Facility
OP
|
$70.00
|
|
|
Service Code
|
CPT 86753
|
| Hospital Charge Code |
980032
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.17 |
| Max. Negotiated Rate |
$280.00 |
| Rate for Payer: Aetna Commercial |
$63.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$60.20
|
| Rate for Payer: Aetna Managed Medicare |
$12.39
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$46.46
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$21.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$20.57
|
| Rate for Payer: Anthem Medicaid |
$8.17
|
| Rate for Payer: Anthem Medicare Advantage |
$12.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$37.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$12.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$12.39
|
| Rate for Payer: Cash Price |
$21.00
|
| Rate for Payer: Cash Price |
$21.00
|
| Rate for Payer: Cigna Commercial |
$64.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$12.39
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$8.17
|
| Rate for Payer: Dean Health Medicaid |
$8.17
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$12.39
|
| Rate for Payer: Health EOS Commercial |
$62.30
|
| Rate for Payer: HFN Commercial |
$64.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$46.09
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$12.39
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$8.17
|
| Rate for Payer: Independent Care Health Plan Medicare |
$12.39
|
| Rate for Payer: Managed Health Services Medicaid |
$8.50
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$12.39
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$12.39
|
| Rate for Payer: Multiplan Commercial |
$56.00
|
| Rate for Payer: NAPHCARE Commercial |
$18.58
|
| Rate for Payer: Preferred Network Access Commercial |
$64.40
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$8.17
|
| Rate for Payer: Quartz Beloit One Network |
$34.30
|
| Rate for Payer: Quartz Commercial |
$45.50
|
| Rate for Payer: Quartz Medicare Advantage |
$12.39
|
| Rate for Payer: The Alliance Commercial |
$280.00
|
| Rate for Payer: United Healthcare Medicaid |
$8.17
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.39
|
| Rate for Payer: United Healthcare PPO |
$52.50
|
| Rate for Payer: WEA Trust Commercial |
$38.50
|
| Rate for Payer: Wellcare Medicare |
$12.39
|
| Rate for Payer: WMAP Medicaid |
$8.17
|
| Rate for Payer: WPS Commercial |
$51.85
|
|
|
Babesia microti Antibody IgG
|
Professional
|
$414.00
|
|
|
Service Code
|
CPT 86753
|
| Hospital Charge Code |
5679633
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.39 |
| Max. Negotiated Rate |
$393.30 |
| Rate for Payer: Aetna Commercial |
$393.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$356.04
|
| Rate for Payer: Aetna Managed Medicare |
$12.39
|
| Rate for Payer: Anthem Medicare Advantage |
$12.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$12.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$12.39
|
| Rate for Payer: Cash Price |
$124.20
|
| Rate for Payer: Cash Price |
$124.20
|
| Rate for Payer: Cigna Commercial |
$393.30
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$207.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12.39
|
| Rate for Payer: Health EOS Commercial |
$376.74
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$43.74
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$43.74
|
| Rate for Payer: Independent Care Health Plan Medicare |
$12.39
|
| Rate for Payer: Multiplan Commercial |
$331.20
|
| Rate for Payer: Preferred Network Access Commercial |
$393.30
|
| Rate for Payer: Quartz Beloit One Network |
$182.16
|
| Rate for Payer: Quartz Commercial |
$235.98
|
| Rate for Payer: Quartz Medicare Advantage |
$12.39
|
| Rate for Payer: The Alliance Commercial |
$48.94
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.39
|
| Rate for Payer: WEA Trust Commercial |
$227.70
|
| Rate for Payer: WPS Commercial |
$54.52
|
|
|
Babesia microti Antibody IgG
|
Facility
OP
|
$414.00
|
|
|
Service Code
|
CPT 86753
|
| Hospital Charge Code |
5679633
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.17 |
| Max. Negotiated Rate |
$1,656.00 |
| Rate for Payer: Aetna Commercial |
$372.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$356.04
|
| Rate for Payer: Aetna Managed Medicare |
$12.39
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$46.46
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$21.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$20.57
|
| Rate for Payer: Anthem Medicaid |
$8.17
|
| Rate for Payer: Anthem Medicare Advantage |
$12.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$219.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$12.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$12.39
|
| Rate for Payer: Cash Price |
$124.20
|
| Rate for Payer: Cash Price |
$124.20
|
| Rate for Payer: Cigna Commercial |
$380.88
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$12.39
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$8.17
|
| Rate for Payer: Dean Health Medicaid |
$8.17
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$12.39
|
| Rate for Payer: Health EOS Commercial |
$368.46
|
| Rate for Payer: HFN Commercial |
$380.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$46.09
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$12.39
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$8.17
|
| Rate for Payer: Independent Care Health Plan Medicare |
$12.39
|
| Rate for Payer: Managed Health Services Medicaid |
$8.50
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$12.39
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$12.39
|
| Rate for Payer: Multiplan Commercial |
$331.20
|
| Rate for Payer: NAPHCARE Commercial |
$18.58
|
| Rate for Payer: Preferred Network Access Commercial |
$380.88
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$8.17
|
| Rate for Payer: Quartz Beloit One Network |
$202.86
|
| Rate for Payer: Quartz Commercial |
$269.10
|
| Rate for Payer: Quartz Medicare Advantage |
$12.39
|
| Rate for Payer: The Alliance Commercial |
$1,656.00
|
| Rate for Payer: United Healthcare Medicaid |
$8.17
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.39
|
| Rate for Payer: United Healthcare PPO |
$310.50
|
| Rate for Payer: WEA Trust Commercial |
$227.70
|
| Rate for Payer: Wellcare Medicare |
$12.39
|
| Rate for Payer: WMAP Medicaid |
$8.17
|
| Rate for Payer: WPS Commercial |
$306.65
|
|
|
Babesia microti Antibody IgG
|
Facility
IP
|
$414.00
|
|
|
Service Code
|
CPT 86753
|
| Hospital Charge Code |
5679633
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$202.86 |
| Max. Negotiated Rate |
$380.88 |
| Rate for Payer: Aetna Commercial |
$372.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$219.42
|
| Rate for Payer: Cash Price |
$124.20
|
| Rate for Payer: Cigna Commercial |
$380.88
|
| Rate for Payer: Health EOS Commercial |
$368.46
|
| Rate for Payer: HFN Commercial |
$380.88
|
| Rate for Payer: Multiplan Commercial |
$331.20
|
| Rate for Payer: NAPHCARE Commercial |
$248.40
|
| Rate for Payer: Preferred Network Access Commercial |
$380.88
|
| Rate for Payer: Quartz Beloit One Network |
$202.86
|
| Rate for Payer: Quartz Commercial |
$248.40
|
| Rate for Payer: WEA Trust Commercial |
$227.70
|
| Rate for Payer: WPS Commercial |
$306.65
|
|
|
Babesia microti Antibody IgM
|
Facility
OP
|
$414.00
|
|
|
Service Code
|
CPT 86753
|
| Hospital Charge Code |
5679634
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.17 |
| Max. Negotiated Rate |
$1,656.00 |
| Rate for Payer: Aetna Commercial |
$372.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$356.04
|
| Rate for Payer: Aetna Managed Medicare |
$12.39
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$46.46
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$21.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$20.57
|
| Rate for Payer: Anthem Medicaid |
$8.17
|
| Rate for Payer: Anthem Medicare Advantage |
$12.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$219.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$12.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$12.39
|
| Rate for Payer: Cash Price |
$124.20
|
| Rate for Payer: Cash Price |
$124.20
|
| Rate for Payer: Cigna Commercial |
$380.88
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$12.39
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$8.17
|
| Rate for Payer: Dean Health Medicaid |
$8.17
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$12.39
|
| Rate for Payer: Health EOS Commercial |
$368.46
|
| Rate for Payer: HFN Commercial |
$380.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$46.09
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$12.39
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$8.17
|
| Rate for Payer: Independent Care Health Plan Medicare |
$12.39
|
| Rate for Payer: Managed Health Services Medicaid |
$8.50
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$12.39
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$12.39
|
| Rate for Payer: Multiplan Commercial |
$331.20
|
| Rate for Payer: NAPHCARE Commercial |
$18.58
|
| Rate for Payer: Preferred Network Access Commercial |
$380.88
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$8.17
|
| Rate for Payer: Quartz Beloit One Network |
$202.86
|
| Rate for Payer: Quartz Commercial |
$269.10
|
| Rate for Payer: Quartz Medicare Advantage |
$12.39
|
| Rate for Payer: The Alliance Commercial |
$1,656.00
|
| Rate for Payer: United Healthcare Medicaid |
$8.17
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.39
|
| Rate for Payer: United Healthcare PPO |
$310.50
|
| Rate for Payer: WEA Trust Commercial |
$227.70
|
| Rate for Payer: Wellcare Medicare |
$12.39
|
| Rate for Payer: WMAP Medicaid |
$8.17
|
| Rate for Payer: WPS Commercial |
$306.65
|
|
|
Babesia microti Antibody IgM
|
Facility
IP
|
$414.00
|
|
|
Service Code
|
CPT 86753
|
| Hospital Charge Code |
5679634
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$202.86 |
| Max. Negotiated Rate |
$380.88 |
| Rate for Payer: Aetna Commercial |
$372.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$219.42
|
| Rate for Payer: Cash Price |
$124.20
|
| Rate for Payer: Cigna Commercial |
$380.88
|
| Rate for Payer: Health EOS Commercial |
$368.46
|
| Rate for Payer: HFN Commercial |
$380.88
|
| Rate for Payer: Multiplan Commercial |
$331.20
|
| Rate for Payer: NAPHCARE Commercial |
$248.40
|
| Rate for Payer: Preferred Network Access Commercial |
$380.88
|
| Rate for Payer: Quartz Beloit One Network |
$202.86
|
| Rate for Payer: Quartz Commercial |
$248.40
|
| Rate for Payer: WEA Trust Commercial |
$227.70
|
| Rate for Payer: WPS Commercial |
$306.65
|
|
|
Babesia microti Antibody IgM
|
Professional
|
$414.00
|
|
|
Service Code
|
CPT 86753
|
| Hospital Charge Code |
5679634
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.39 |
| Max. Negotiated Rate |
$393.30 |
| Rate for Payer: Aetna Commercial |
$393.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$356.04
|
| Rate for Payer: Aetna Managed Medicare |
$12.39
|
| Rate for Payer: Anthem Medicare Advantage |
$12.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$12.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$12.39
|
| Rate for Payer: Cash Price |
$124.20
|
| Rate for Payer: Cash Price |
$124.20
|
| Rate for Payer: Cigna Commercial |
$393.30
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$207.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12.39
|
| Rate for Payer: Health EOS Commercial |
$376.74
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$43.74
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$43.74
|
| Rate for Payer: Independent Care Health Plan Medicare |
$12.39
|
| Rate for Payer: Multiplan Commercial |
$331.20
|
| Rate for Payer: Preferred Network Access Commercial |
$393.30
|
| Rate for Payer: Quartz Beloit One Network |
$182.16
|
| Rate for Payer: Quartz Commercial |
$235.98
|
| Rate for Payer: Quartz Medicare Advantage |
$12.39
|
| Rate for Payer: The Alliance Commercial |
$48.94
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.39
|
| Rate for Payer: WEA Trust Commercial |
$227.70
|
| Rate for Payer: WPS Commercial |
$54.52
|
|
|
Babesia microti DNA, PCR
|
Facility
IP
|
$650.00
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
980033
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$318.50 |
| Max. Negotiated Rate |
$598.00 |
| Rate for Payer: Aetna Commercial |
$585.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$344.50
|
| Rate for Payer: Cash Price |
$195.00
|
| Rate for Payer: Cigna Commercial |
$598.00
|
| Rate for Payer: Health EOS Commercial |
$578.50
|
| Rate for Payer: HFN Commercial |
$598.00
|
| Rate for Payer: Multiplan Commercial |
$520.00
|
| Rate for Payer: NAPHCARE Commercial |
$390.00
|
| Rate for Payer: Preferred Network Access Commercial |
$598.00
|
| Rate for Payer: Quartz Beloit One Network |
$318.50
|
| Rate for Payer: Quartz Commercial |
$390.00
|
| Rate for Payer: WEA Trust Commercial |
$357.50
|
| Rate for Payer: WPS Commercial |
$481.46
|
|
|
Babesia microti DNA, PCR
|
Professional
|
$650.00
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
980033
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$35.09 |
| Max. Negotiated Rate |
$617.50 |
| Rate for Payer: Aetna Commercial |
$617.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$559.00
|
| Rate for Payer: Aetna Managed Medicare |
$35.09
|
| Rate for Payer: Anthem Medicare Advantage |
$35.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$35.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$35.09
|
| Rate for Payer: Cash Price |
$195.00
|
| Rate for Payer: Cash Price |
$195.00
|
| Rate for Payer: Cigna Commercial |
$617.50
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$325.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$35.09
|
| Rate for Payer: Health EOS Commercial |
$591.50
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$123.87
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$123.87
|
| Rate for Payer: Independent Care Health Plan Medicare |
$35.09
|
| Rate for Payer: Multiplan Commercial |
$520.00
|
| Rate for Payer: Preferred Network Access Commercial |
$617.50
|
| Rate for Payer: Quartz Beloit One Network |
$286.00
|
| Rate for Payer: Quartz Commercial |
$370.50
|
| Rate for Payer: Quartz Medicare Advantage |
$35.09
|
| Rate for Payer: The Alliance Commercial |
$138.61
|
| Rate for Payer: United Healthcare Medicare Advantage |
$35.09
|
| Rate for Payer: WEA Trust Commercial |
$357.50
|
| Rate for Payer: WPS Commercial |
$154.40
|
|
|
Babesia microti DNA, PCR
|
Facility
OP
|
$650.00
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
980033
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$35.09 |
| Max. Negotiated Rate |
$2,600.00 |
| Rate for Payer: Aetna Commercial |
$585.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$559.00
|
| Rate for Payer: Aetna Managed Medicare |
$35.09
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$131.59
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$61.41
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$58.25
|
| Rate for Payer: Anthem Medicaid |
$36.26
|
| Rate for Payer: Anthem Medicare Advantage |
$35.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$344.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$35.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$35.09
|
| Rate for Payer: Cash Price |
$195.00
|
| Rate for Payer: Cash Price |
$195.00
|
| Rate for Payer: Cigna Commercial |
$598.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$35.09
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$36.26
|
| Rate for Payer: Dean Health Medicaid |
$36.26
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$35.09
|
| Rate for Payer: Health EOS Commercial |
$578.50
|
| Rate for Payer: HFN Commercial |
$598.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$130.53
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$35.09
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$36.26
|
| Rate for Payer: Independent Care Health Plan Medicare |
$35.09
|
| Rate for Payer: Managed Health Services Medicaid |
$37.71
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$35.09
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$35.09
|
| Rate for Payer: Multiplan Commercial |
$520.00
|
| Rate for Payer: NAPHCARE Commercial |
$52.64
|
| Rate for Payer: Preferred Network Access Commercial |
$598.00
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$36.26
|
| Rate for Payer: Quartz Beloit One Network |
$318.50
|
| Rate for Payer: Quartz Commercial |
$422.50
|
| Rate for Payer: Quartz Medicare Advantage |
$35.09
|
| Rate for Payer: The Alliance Commercial |
$2,600.00
|
| Rate for Payer: United Healthcare Medicaid |
$36.26
|
| Rate for Payer: United Healthcare Medicare Advantage |
$35.09
|
| Rate for Payer: United Healthcare PPO |
$487.50
|
| Rate for Payer: WEA Trust Commercial |
$357.50
|
| Rate for Payer: Wellcare Medicare |
$35.09
|
| Rate for Payer: WMAP Medicaid |
$36.26
|
| Rate for Payer: WPS Commercial |
$481.46
|
|
|
Babesia microti IgM
|
Facility
OP
|
$66.00
|
|
|
Service Code
|
CPT 86753
|
| Hospital Charge Code |
2942871
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.17 |
| Max. Negotiated Rate |
$264.00 |
| Rate for Payer: Aetna Commercial |
$59.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$56.76
|
| Rate for Payer: Aetna Managed Medicare |
$12.39
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$46.46
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$21.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$20.57
|
| Rate for Payer: Anthem Medicaid |
$8.17
|
| Rate for Payer: Anthem Medicare Advantage |
$12.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$34.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$12.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$12.39
|
| Rate for Payer: Cash Price |
$19.80
|
| Rate for Payer: Cash Price |
$19.80
|
| Rate for Payer: Cigna Commercial |
$60.72
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$12.39
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$8.17
|
| Rate for Payer: Dean Health Medicaid |
$8.17
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$12.39
|
| Rate for Payer: Health EOS Commercial |
$58.74
|
| Rate for Payer: HFN Commercial |
$60.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$46.09
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$12.39
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$8.17
|
| Rate for Payer: Independent Care Health Plan Medicare |
$12.39
|
| Rate for Payer: Managed Health Services Medicaid |
$8.50
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$12.39
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$12.39
|
| Rate for Payer: Multiplan Commercial |
$52.80
|
| Rate for Payer: NAPHCARE Commercial |
$18.58
|
| Rate for Payer: Preferred Network Access Commercial |
$60.72
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$8.17
|
| Rate for Payer: Quartz Beloit One Network |
$32.34
|
| Rate for Payer: Quartz Commercial |
$42.90
|
| Rate for Payer: Quartz Medicare Advantage |
$12.39
|
| Rate for Payer: The Alliance Commercial |
$264.00
|
| Rate for Payer: United Healthcare Medicaid |
$8.17
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.39
|
| Rate for Payer: United Healthcare PPO |
$49.50
|
| Rate for Payer: WEA Trust Commercial |
$36.30
|
| Rate for Payer: Wellcare Medicare |
$12.39
|
| Rate for Payer: WMAP Medicaid |
$8.17
|
| Rate for Payer: WPS Commercial |
$48.89
|
|
|
Babesia microti IgM
|
Facility
IP
|
$66.00
|
|
|
Service Code
|
CPT 86753
|
| Hospital Charge Code |
2942871
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$32.34 |
| Max. Negotiated Rate |
$60.72 |
| Rate for Payer: Aetna Commercial |
$59.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$34.98
|
| Rate for Payer: Cash Price |
$19.80
|
| Rate for Payer: Cigna Commercial |
$60.72
|
| Rate for Payer: Health EOS Commercial |
$58.74
|
| Rate for Payer: HFN Commercial |
$60.72
|
| Rate for Payer: Multiplan Commercial |
$52.80
|
| Rate for Payer: NAPHCARE Commercial |
$39.60
|
| Rate for Payer: Preferred Network Access Commercial |
$60.72
|
| Rate for Payer: Quartz Beloit One Network |
$32.34
|
| Rate for Payer: Quartz Commercial |
$39.60
|
| Rate for Payer: WEA Trust Commercial |
$36.30
|
| Rate for Payer: WPS Commercial |
$48.89
|
|
|
Babesia microti IgM
|
Professional
|
$66.00
|
|
|
Service Code
|
CPT 86753
|
| Hospital Charge Code |
2942871
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.39 |
| Max. Negotiated Rate |
$62.70 |
| Rate for Payer: Aetna Commercial |
$62.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$56.76
|
| Rate for Payer: Aetna Managed Medicare |
$12.39
|
| Rate for Payer: Anthem Medicare Advantage |
$12.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$12.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$12.39
|
| Rate for Payer: Cash Price |
$19.80
|
| Rate for Payer: Cash Price |
$19.80
|
| Rate for Payer: Cigna Commercial |
$62.70
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$33.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12.39
|
| Rate for Payer: Health EOS Commercial |
$60.06
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$43.74
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$43.74
|
| Rate for Payer: Independent Care Health Plan Medicare |
$12.39
|
| Rate for Payer: Multiplan Commercial |
$52.80
|
| Rate for Payer: Preferred Network Access Commercial |
$62.70
|
| Rate for Payer: Quartz Beloit One Network |
$29.04
|
| Rate for Payer: Quartz Commercial |
$37.62
|
| Rate for Payer: Quartz Medicare Advantage |
$12.39
|
| Rate for Payer: The Alliance Commercial |
$48.94
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.39
|
| Rate for Payer: WEA Trust Commercial |
$36.30
|
| Rate for Payer: WPS Commercial |
$54.52
|
|
|
Bacitracin 50,000units vial [Med]
|
Facility
OP
|
$124.00
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
2974911
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$34.72 |
| Max. Negotiated Rate |
$700.24 |
| Rate for Payer: Aetna Commercial |
$111.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$106.64
|
| Rate for Payer: Aetna Managed Medicare |
$34.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$80.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$62.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$59.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$65.72
|
| Rate for Payer: Cash Price |
$37.20
|
| Rate for Payer: Cash Price |
$37.20
|
| Rate for Payer: Cigna Commercial |
$114.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$69.39
|
| Rate for Payer: Health EOS Commercial |
$110.36
|
| Rate for Payer: HFN Commercial |
$114.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$93.00
|
| Rate for Payer: Multiplan Commercial |
$99.20
|
| Rate for Payer: NAPHCARE Commercial |
$74.40
|
| Rate for Payer: Preferred Network Access Commercial |
$114.08
|
| Rate for Payer: Quartz Beloit One Network |
$60.76
|
| Rate for Payer: Quartz Commercial |
$80.60
|
| Rate for Payer: Quartz Medicare Advantage |
$74.40
|
| Rate for Payer: The Alliance Commercial |
$700.24
|
| Rate for Payer: WEA Trust Commercial |
$68.20
|
| Rate for Payer: WPS Commercial |
$91.85
|
|
|
Bacitracin 50,000units vial [Med]
|
Facility
IP
|
$124.00
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
2974911
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$60.76 |
| Max. Negotiated Rate |
$114.08 |
| Rate for Payer: Aetna Commercial |
$111.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$65.72
|
| Rate for Payer: Cash Price |
$37.20
|
| Rate for Payer: Cigna Commercial |
$114.08
|
| Rate for Payer: Health EOS Commercial |
$110.36
|
| Rate for Payer: HFN Commercial |
$114.08
|
| Rate for Payer: Multiplan Commercial |
$99.20
|
| Rate for Payer: NAPHCARE Commercial |
$74.40
|
| Rate for Payer: Preferred Network Access Commercial |
$114.08
|
| Rate for Payer: Quartz Beloit One Network |
$60.76
|
| Rate for Payer: Quartz Commercial |
$74.40
|
| Rate for Payer: WEA Trust Commercial |
$68.20
|
| Rate for Payer: WPS Commercial |
$91.85
|
|
|
Bacitracin Ointment 1oz [Med]
|
Facility
IP
|
$27.00
|
|
| Hospital Charge Code |
2974912
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$13.23 |
| Max. Negotiated Rate |
$24.84 |
| Rate for Payer: Aetna Commercial |
$24.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$14.31
|
| Rate for Payer: Cash Price |
$8.10
|
| Rate for Payer: Cigna Commercial |
$24.84
|
| Rate for Payer: Health EOS Commercial |
$24.03
|
| Rate for Payer: HFN Commercial |
$24.84
|
| Rate for Payer: Multiplan Commercial |
$21.60
|
| Rate for Payer: NAPHCARE Commercial |
$16.20
|
| Rate for Payer: Preferred Network Access Commercial |
$24.84
|
| Rate for Payer: Quartz Beloit One Network |
$13.23
|
| Rate for Payer: Quartz Commercial |
$16.20
|
| Rate for Payer: WEA Trust Commercial |
$14.85
|
| Rate for Payer: WPS Commercial |
$20.00
|
|
|
Bacitracin Ointment 1oz [Med]
|
Facility
OP
|
$27.00
|
|
| Hospital Charge Code |
2974912
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$7.56 |
| Max. Negotiated Rate |
$108.00 |
| Rate for Payer: Aetna Commercial |
$24.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$23.22
|
| Rate for Payer: Aetna Managed Medicare |
$7.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$17.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$13.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$12.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$14.31
|
| Rate for Payer: Cash Price |
$8.10
|
| Rate for Payer: Cigna Commercial |
$24.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$15.11
|
| Rate for Payer: Health EOS Commercial |
$24.03
|
| Rate for Payer: HFN Commercial |
$24.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$20.25
|
| Rate for Payer: Multiplan Commercial |
$21.60
|
| Rate for Payer: NAPHCARE Commercial |
$16.20
|
| Rate for Payer: Preferred Network Access Commercial |
$24.84
|
| Rate for Payer: Quartz Beloit One Network |
$13.23
|
| Rate for Payer: Quartz Commercial |
$17.55
|
| Rate for Payer: Quartz Medicare Advantage |
$16.20
|
| Rate for Payer: The Alliance Commercial |
$108.00
|
| Rate for Payer: WEA Trust Commercial |
$14.85
|
| Rate for Payer: WPS Commercial |
$20.00
|
|
|
Bacitracin/Polymyxin B Ophth Oiintment 3.5gm [Med]
|
Facility
OP
|
$35.00
|
|
| Hospital Charge Code |
2974972
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$9.80 |
| Max. Negotiated Rate |
$140.00 |
| Rate for Payer: Aetna Commercial |
$31.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$30.10
|
| Rate for Payer: Aetna Managed Medicare |
$9.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$22.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$17.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$16.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$18.55
|
| Rate for Payer: Cash Price |
$10.50
|
| Rate for Payer: Cigna Commercial |
$32.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$19.59
|
| Rate for Payer: Health EOS Commercial |
$31.15
|
| Rate for Payer: HFN Commercial |
$32.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$26.25
|
| Rate for Payer: Multiplan Commercial |
$28.00
|
| Rate for Payer: NAPHCARE Commercial |
$21.00
|
| Rate for Payer: Preferred Network Access Commercial |
$32.20
|
| Rate for Payer: Quartz Beloit One Network |
$17.15
|
| Rate for Payer: Quartz Commercial |
$22.75
|
| Rate for Payer: Quartz Medicare Advantage |
$21.00
|
| Rate for Payer: The Alliance Commercial |
$140.00
|
| Rate for Payer: WEA Trust Commercial |
$19.25
|
| Rate for Payer: WPS Commercial |
$25.92
|
|
