|
Beta Hydroxybutyrate
|
Facility
OP
|
$107.00
|
|
|
Service Code
|
CPT 82010
|
| Hospital Charge Code |
4676607
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.17 |
| Max. Negotiated Rate |
$428.00 |
| Rate for Payer: Aetna Commercial |
$96.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$92.02
|
| 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 |
$56.71
|
| 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 |
$32.10
|
| Rate for Payer: Cash Price |
$32.10
|
| Rate for Payer: Cigna Commercial |
$98.44
|
| 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 Medicaid |
$8.44
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$8.17
|
| Rate for Payer: Health EOS Commercial |
$95.23
|
| Rate for Payer: HFN Commercial |
$98.44
|
| 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 |
$85.60
|
| Rate for Payer: NAPHCARE Commercial |
$12.26
|
| Rate for Payer: Preferred Network Access Commercial |
$98.44
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$8.44
|
| Rate for Payer: Quartz Beloit One Network |
$52.43
|
| Rate for Payer: Quartz Commercial |
$69.55
|
| Rate for Payer: Quartz Medicare Advantage |
$8.17
|
| Rate for Payer: The Alliance Commercial |
$428.00
|
| Rate for Payer: United Healthcare Medicaid |
$8.44
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8.17
|
| Rate for Payer: United Healthcare PPO |
$80.25
|
| Rate for Payer: WEA Trust Commercial |
$58.85
|
| Rate for Payer: Wellcare Medicare |
$8.17
|
| Rate for Payer: WMAP Medicaid |
$8.44
|
| Rate for Payer: WPS Commercial |
$79.25
|
|
|
Beta Hydroxybutyrate
|
Facility
IP
|
$107.00
|
|
|
Service Code
|
CPT 82010
|
| Hospital Charge Code |
4676607
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$52.43 |
| Max. Negotiated Rate |
$98.44 |
| Rate for Payer: Aetna Commercial |
$96.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$56.71
|
| Rate for Payer: Cash Price |
$32.10
|
| Rate for Payer: Cigna Commercial |
$98.44
|
| Rate for Payer: Health EOS Commercial |
$95.23
|
| Rate for Payer: HFN Commercial |
$98.44
|
| Rate for Payer: Multiplan Commercial |
$85.60
|
| Rate for Payer: NAPHCARE Commercial |
$64.20
|
| Rate for Payer: Preferred Network Access Commercial |
$98.44
|
| Rate for Payer: Quartz Beloit One Network |
$52.43
|
| Rate for Payer: Quartz Commercial |
$64.20
|
| Rate for Payer: WEA Trust Commercial |
$58.85
|
| Rate for Payer: WPS Commercial |
$79.25
|
|
|
Betamethasone acet&sod phosp 3Mg/3Mg J0702
|
Professional
|
$32.00
|
|
|
Service Code
|
HCPCS J0702
|
| Hospital Charge Code |
3376942
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.82 |
| Max. Negotiated Rate |
$30.40 |
| Rate for Payer: Aetna Commercial |
$30.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$27.52
|
| Rate for Payer: Aetna Managed Medicare |
$6.96
|
| Rate for Payer: Anthem Medicare Advantage |
$6.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$6.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$6.96
|
| Rate for Payer: Cash Price |
$9.60
|
| Rate for Payer: Cash Price |
$9.60
|
| Rate for Payer: Cigna Commercial |
$30.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$16.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6.88
|
| Rate for Payer: Health EOS Commercial |
$29.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$8.89
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$8.89
|
| Rate for Payer: Independent Care Health Plan Medicare |
$6.96
|
| Rate for Payer: Multiplan Commercial |
$25.60
|
| Rate for Payer: Preferred Network Access Commercial |
$30.40
|
| Rate for Payer: Quartz Beloit One Network |
$14.08
|
| Rate for Payer: Quartz Commercial |
$18.24
|
| Rate for Payer: Quartz Medicare Advantage |
$6.96
|
| Rate for Payer: The Alliance Commercial |
$19.13
|
| Rate for Payer: United Healthcare Medicaid |
$6.82
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6.96
|
| Rate for Payer: WEA Trust Commercial |
$17.60
|
| Rate for Payer: WPS Commercial |
$17.21
|
|
|
Betamethasone acet&sod phosp 3Mg/3Mg J0702
|
Facility
OP
|
$32.00
|
|
|
Service Code
|
HCPCS J0702
|
| Hospital Charge Code |
3376942
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.96 |
| Max. Negotiated Rate |
$933.88 |
| Rate for Payer: Aetna Commercial |
$28.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$27.52
|
| Rate for Payer: Aetna Managed Medicare |
$8.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$20.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$16.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$15.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$16.96
|
| Rate for Payer: Cash Price |
$9.60
|
| Rate for Payer: Cash Price |
$9.60
|
| Rate for Payer: Cigna Commercial |
$29.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$9.11
|
| Rate for Payer: Health EOS Commercial |
$28.48
|
| Rate for Payer: HFN Commercial |
$29.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$24.00
|
| Rate for Payer: Multiplan Commercial |
$25.60
|
| Rate for Payer: NAPHCARE Commercial |
$19.20
|
| Rate for Payer: Preferred Network Access Commercial |
$29.44
|
| Rate for Payer: Quartz Beloit One Network |
$15.68
|
| Rate for Payer: Quartz Commercial |
$20.80
|
| Rate for Payer: Quartz Medicare Advantage |
$19.20
|
| Rate for Payer: The Alliance Commercial |
$933.88
|
| Rate for Payer: WEA Trust Commercial |
$17.60
|
| Rate for Payer: WPS Commercial |
$17.21
|
|
|
Betamethasone acet&sod phosp 3Mg/3Mg J0702
|
Facility
IP
|
$32.00
|
|
|
Service Code
|
HCPCS J0702
|
| Hospital Charge Code |
3376942
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.68 |
| Max. Negotiated Rate |
$29.44 |
| Rate for Payer: Aetna Commercial |
$28.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$16.96
|
| Rate for Payer: Cash Price |
$9.60
|
| Rate for Payer: Cigna Commercial |
$29.44
|
| Rate for Payer: Health EOS Commercial |
$28.48
|
| Rate for Payer: HFN Commercial |
$29.44
|
| Rate for Payer: Multiplan Commercial |
$25.60
|
| Rate for Payer: NAPHCARE Commercial |
$19.20
|
| Rate for Payer: Preferred Network Access Commercial |
$29.44
|
| Rate for Payer: Quartz Beloit One Network |
$15.68
|
| Rate for Payer: Quartz Commercial |
$19.20
|
| Rate for Payer: WEA Trust Commercial |
$17.60
|
| Rate for Payer: WPS Commercial |
$23.70
|
|
|
Bevacizumab Injection C9257
|
Professional
|
$73.00
|
|
|
Service Code
|
HCPCS C9257
|
| Hospital Charge Code |
4147650
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$32.12 |
| Max. Negotiated Rate |
$69.35 |
| Rate for Payer: Aetna Commercial |
$69.35
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$62.78
|
| Rate for Payer: Cash Price |
$21.90
|
| Rate for Payer: Cigna Commercial |
$69.35
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$36.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$43.80
|
| Rate for Payer: Health EOS Commercial |
$66.43
|
| Rate for Payer: Multiplan Commercial |
$58.40
|
| Rate for Payer: Preferred Network Access Commercial |
$69.35
|
| Rate for Payer: Quartz Beloit One Network |
$32.12
|
| Rate for Payer: Quartz Commercial |
$41.61
|
| Rate for Payer: The Alliance Commercial |
$36.50
|
| Rate for Payer: WEA Trust Commercial |
$40.15
|
| Rate for Payer: WPS Commercial |
$54.07
|
|
|
Bevacizumab Injection C9257
|
Facility
IP
|
$73.00
|
|
|
Service Code
|
HCPCS C9257
|
| Hospital Charge Code |
4147650
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$35.77 |
| Max. Negotiated Rate |
$67.16 |
| Rate for Payer: Aetna Commercial |
$65.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$38.69
|
| Rate for Payer: Cash Price |
$21.90
|
| Rate for Payer: Cigna Commercial |
$67.16
|
| Rate for Payer: Health EOS Commercial |
$64.97
|
| Rate for Payer: HFN Commercial |
$67.16
|
| Rate for Payer: Multiplan Commercial |
$58.40
|
| Rate for Payer: NAPHCARE Commercial |
$43.80
|
| Rate for Payer: Preferred Network Access Commercial |
$67.16
|
| Rate for Payer: Quartz Beloit One Network |
$35.77
|
| Rate for Payer: Quartz Commercial |
$43.80
|
| Rate for Payer: WEA Trust Commercial |
$40.15
|
| Rate for Payer: WPS Commercial |
$54.07
|
|
|
Bevacizumab Injection C9257
|
Facility
OP
|
$73.00
|
|
|
Service Code
|
HCPCS C9257
|
| Hospital Charge Code |
4147650
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.85 |
| Max. Negotiated Rate |
$67.16 |
| Rate for Payer: Aetna Commercial |
$65.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$62.78
|
| Rate for Payer: Aetna Managed Medicare |
$1.85
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$47.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$36.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$35.04
|
| Rate for Payer: Anthem Medicare Advantage |
$1.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$38.69
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$1.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$1.85
|
| Rate for Payer: Cash Price |
$21.90
|
| Rate for Payer: Cash Price |
$21.90
|
| Rate for Payer: Cigna Commercial |
$67.16
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$1.85
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$40.85
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$1.85
|
| Rate for Payer: Health EOS Commercial |
$64.97
|
| Rate for Payer: HFN Commercial |
$67.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6.89
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1.85
|
| Rate for Payer: Independent Care Health Plan Medicare |
$1.85
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$1.85
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$1.85
|
| Rate for Payer: Multiplan Commercial |
$58.40
|
| Rate for Payer: NAPHCARE Commercial |
$2.78
|
| Rate for Payer: Preferred Network Access Commercial |
$67.16
|
| Rate for Payer: Quartz Beloit One Network |
$35.77
|
| Rate for Payer: Quartz Commercial |
$47.45
|
| Rate for Payer: Quartz Medicare Advantage |
$1.85
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1.85
|
| Rate for Payer: WEA Trust Commercial |
$40.15
|
| Rate for Payer: Wellcare Medicare |
$1.85
|
| Rate for Payer: WPS Commercial |
$54.07
|
|
|
Bexsero Charge 90620
|
Facility
OP
|
$389.00
|
|
|
Service Code
|
CPT 90620
|
| Hospital Charge Code |
5250694
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$108.92 |
| Max. Negotiated Rate |
$1,556.00 |
| Rate for Payer: Aetna Commercial |
$350.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$334.54
|
| Rate for Payer: Aetna Managed Medicare |
$108.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$252.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$194.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$186.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$206.17
|
| Rate for Payer: Cash Price |
$116.70
|
| Rate for Payer: Cigna Commercial |
$357.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$217.68
|
| Rate for Payer: Health EOS Commercial |
$346.21
|
| Rate for Payer: HFN Commercial |
$357.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$291.75
|
| Rate for Payer: Multiplan Commercial |
$311.20
|
| Rate for Payer: NAPHCARE Commercial |
$233.40
|
| Rate for Payer: Preferred Network Access Commercial |
$357.88
|
| Rate for Payer: Quartz Beloit One Network |
$190.61
|
| Rate for Payer: Quartz Commercial |
$252.85
|
| Rate for Payer: Quartz Medicare Advantage |
$233.40
|
| Rate for Payer: The Alliance Commercial |
$1,556.00
|
| Rate for Payer: WEA Trust Commercial |
$213.95
|
| Rate for Payer: WPS Commercial |
$288.13
|
|
|
Bexsero Charge 90620
|
Professional
|
$389.00
|
|
|
Service Code
|
CPT 90620
|
| Hospital Charge Code |
5250694
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$171.16 |
| Max. Negotiated Rate |
$369.55 |
| Rate for Payer: Aetna Commercial |
$369.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$334.54
|
| Rate for Payer: Cash Price |
$116.70
|
| Rate for Payer: Cash Price |
$116.70
|
| Rate for Payer: Cigna Commercial |
$369.55
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$194.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$233.40
|
| Rate for Payer: Health EOS Commercial |
$353.99
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$286.95
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$286.95
|
| Rate for Payer: Multiplan Commercial |
$311.20
|
| Rate for Payer: Preferred Network Access Commercial |
$369.55
|
| Rate for Payer: Quartz Beloit One Network |
$171.16
|
| Rate for Payer: Quartz Commercial |
$221.73
|
| Rate for Payer: The Alliance Commercial |
$194.50
|
| Rate for Payer: United Healthcare Medicaid |
$226.32
|
| Rate for Payer: WEA Trust Commercial |
$213.95
|
| Rate for Payer: WPS Commercial |
$288.13
|
|
|
Bexsero Charge 90620
|
Facility
IP
|
$389.00
|
|
|
Service Code
|
CPT 90620
|
| Hospital Charge Code |
5250694
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$190.61 |
| Max. Negotiated Rate |
$357.88 |
| Rate for Payer: Aetna Commercial |
$350.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$206.17
|
| Rate for Payer: Cash Price |
$116.70
|
| Rate for Payer: Cigna Commercial |
$357.88
|
| Rate for Payer: Health EOS Commercial |
$346.21
|
| Rate for Payer: HFN Commercial |
$357.88
|
| Rate for Payer: Multiplan Commercial |
$311.20
|
| Rate for Payer: NAPHCARE Commercial |
$233.40
|
| Rate for Payer: Preferred Network Access Commercial |
$357.88
|
| Rate for Payer: Quartz Beloit One Network |
$190.61
|
| Rate for Payer: Quartz Commercial |
$233.40
|
| Rate for Payer: WEA Trust Commercial |
$213.95
|
| Rate for Payer: WPS Commercial |
$288.13
|
|
|
Beyfortus 100mg/mL - Beyfortus Charge
|
Professional
|
$3,132.00
|
|
|
Service Code
|
CPT 90381
|
| Hospital Charge Code |
6220014
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,378.08 |
| Max. Negotiated Rate |
$2,975.40 |
| Rate for Payer: Aetna Commercial |
$2,975.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,693.52
|
| Rate for Payer: Cash Price |
$939.60
|
| Rate for Payer: Cigna Commercial |
$2,975.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,566.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,879.20
|
| Rate for Payer: Health EOS Commercial |
$2,850.12
|
| Rate for Payer: Multiplan Commercial |
$2,505.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,975.40
|
| Rate for Payer: Quartz Beloit One Network |
$1,378.08
|
| Rate for Payer: Quartz Commercial |
$1,785.24
|
| Rate for Payer: The Alliance Commercial |
$1,566.00
|
| Rate for Payer: WEA Trust Commercial |
$1,722.60
|
| Rate for Payer: WPS Commercial |
$2,319.87
|
|
|
Beyfortus 100mg/mL - Beyfortus Charge
|
Facility
OP
|
$3,132.00
|
|
|
Service Code
|
CPT 90381
|
| Hospital Charge Code |
6220014
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$876.96 |
| Max. Negotiated Rate |
$12,528.00 |
| Rate for Payer: Aetna Commercial |
$2,818.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,693.52
|
| Rate for Payer: Aetna Managed Medicare |
$876.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,035.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,566.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,503.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,659.96
|
| Rate for Payer: Cash Price |
$939.60
|
| Rate for Payer: Cigna Commercial |
$2,881.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,752.67
|
| Rate for Payer: Health EOS Commercial |
$2,787.48
|
| Rate for Payer: HFN Commercial |
$2,881.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,349.00
|
| Rate for Payer: Multiplan Commercial |
$2,505.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,879.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,881.44
|
| Rate for Payer: Quartz Beloit One Network |
$1,534.68
|
| Rate for Payer: Quartz Commercial |
$2,035.80
|
| Rate for Payer: Quartz Medicare Advantage |
$1,879.20
|
| Rate for Payer: The Alliance Commercial |
$12,528.00
|
| Rate for Payer: WEA Trust Commercial |
$1,722.60
|
| Rate for Payer: WPS Commercial |
$2,319.87
|
|
|
Beyfortus 100mg/mL - Beyfortus Charge
|
Facility
IP
|
$3,132.00
|
|
|
Service Code
|
CPT 90381
|
| Hospital Charge Code |
6220014
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,534.68 |
| Max. Negotiated Rate |
$2,881.44 |
| Rate for Payer: Aetna Commercial |
$2,818.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,659.96
|
| Rate for Payer: Cash Price |
$939.60
|
| Rate for Payer: Cigna Commercial |
$2,881.44
|
| Rate for Payer: Health EOS Commercial |
$2,787.48
|
| Rate for Payer: HFN Commercial |
$2,881.44
|
| Rate for Payer: Multiplan Commercial |
$2,505.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,879.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,881.44
|
| Rate for Payer: Quartz Beloit One Network |
$1,534.68
|
| Rate for Payer: Quartz Commercial |
$1,879.20
|
| Rate for Payer: WEA Trust Commercial |
$1,722.60
|
| Rate for Payer: WPS Commercial |
$2,319.87
|
|
|
Beyfortus 50mg/0.5mL - Beyfortus Charge
|
Professional
|
$3,132.00
|
|
|
Service Code
|
CPT 90380
|
| Hospital Charge Code |
6220015
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,378.08 |
| Max. Negotiated Rate |
$2,975.40 |
| Rate for Payer: Aetna Commercial |
$2,975.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,693.52
|
| Rate for Payer: Cash Price |
$939.60
|
| Rate for Payer: Cigna Commercial |
$2,975.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,566.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,879.20
|
| Rate for Payer: Health EOS Commercial |
$2,850.12
|
| Rate for Payer: Multiplan Commercial |
$2,505.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,975.40
|
| Rate for Payer: Quartz Beloit One Network |
$1,378.08
|
| Rate for Payer: Quartz Commercial |
$1,785.24
|
| Rate for Payer: The Alliance Commercial |
$1,566.00
|
| Rate for Payer: WEA Trust Commercial |
$1,722.60
|
| Rate for Payer: WPS Commercial |
$2,319.87
|
|
|
Beyfortus 50mg/0.5mL - Beyfortus Charge
|
Facility
OP
|
$3,132.00
|
|
|
Service Code
|
CPT 90380
|
| Hospital Charge Code |
6220015
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$876.96 |
| Max. Negotiated Rate |
$12,528.00 |
| Rate for Payer: Aetna Commercial |
$2,818.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,693.52
|
| Rate for Payer: Aetna Managed Medicare |
$876.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,035.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,566.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,503.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,659.96
|
| Rate for Payer: Cash Price |
$939.60
|
| Rate for Payer: Cigna Commercial |
$2,881.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,752.67
|
| Rate for Payer: Health EOS Commercial |
$2,787.48
|
| Rate for Payer: HFN Commercial |
$2,881.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,349.00
|
| Rate for Payer: Multiplan Commercial |
$2,505.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,879.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,881.44
|
| Rate for Payer: Quartz Beloit One Network |
$1,534.68
|
| Rate for Payer: Quartz Commercial |
$2,035.80
|
| Rate for Payer: Quartz Medicare Advantage |
$1,879.20
|
| Rate for Payer: The Alliance Commercial |
$12,528.00
|
| Rate for Payer: WEA Trust Commercial |
$1,722.60
|
| Rate for Payer: WPS Commercial |
$2,319.87
|
|
|
Beyfortus 50mg/0.5mL - Beyfortus Charge
|
Facility
IP
|
$3,132.00
|
|
|
Service Code
|
CPT 90380
|
| Hospital Charge Code |
6220015
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,534.68 |
| Max. Negotiated Rate |
$2,881.44 |
| Rate for Payer: Aetna Commercial |
$2,818.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,659.96
|
| Rate for Payer: Cash Price |
$939.60
|
| Rate for Payer: Cigna Commercial |
$2,881.44
|
| Rate for Payer: Health EOS Commercial |
$2,787.48
|
| Rate for Payer: HFN Commercial |
$2,881.44
|
| Rate for Payer: Multiplan Commercial |
$2,505.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,879.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,881.44
|
| Rate for Payer: Quartz Beloit One Network |
$1,534.68
|
| Rate for Payer: Quartz Commercial |
$1,879.20
|
| Rate for Payer: WEA Trust Commercial |
$1,722.60
|
| Rate for Payer: WPS Commercial |
$2,319.87
|
|
|
.B. henselae (IgG) Titer
|
Professional
|
$48.10
|
|
|
Service Code
|
CPT 86611
|
| Hospital Charge Code |
5390631
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.18 |
| Max. Negotiated Rate |
$45.70 |
| Rate for Payer: Aetna Commercial |
$45.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$41.37
|
| Rate for Payer: Aetna Managed Medicare |
$10.18
|
| Rate for Payer: Anthem Medicare Advantage |
$10.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$10.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$10.18
|
| Rate for Payer: Cash Price |
$14.43
|
| Rate for Payer: Cash Price |
$14.43
|
| Rate for Payer: Cigna Commercial |
$45.70
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$24.05
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$10.18
|
| Rate for Payer: Health EOS Commercial |
$43.77
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$35.94
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$35.94
|
| Rate for Payer: Independent Care Health Plan Medicare |
$10.18
|
| Rate for Payer: Multiplan Commercial |
$38.48
|
| Rate for Payer: Preferred Network Access Commercial |
$45.70
|
| Rate for Payer: Quartz Beloit One Network |
$21.16
|
| Rate for Payer: Quartz Commercial |
$27.42
|
| Rate for Payer: Quartz Medicare Advantage |
$10.18
|
| Rate for Payer: The Alliance Commercial |
$40.21
|
| Rate for Payer: United Healthcare Medicare Advantage |
$10.18
|
| Rate for Payer: WEA Trust Commercial |
$26.46
|
| Rate for Payer: WPS Commercial |
$44.79
|
|
|
.B. henselae (IgG) Titer
|
Facility
IP
|
$48.10
|
|
|
Service Code
|
CPT 86611
|
| Hospital Charge Code |
5390631
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$23.57 |
| Max. Negotiated Rate |
$44.25 |
| Rate for Payer: Aetna Commercial |
$43.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$25.49
|
| Rate for Payer: Cash Price |
$14.43
|
| Rate for Payer: Cigna Commercial |
$44.25
|
| Rate for Payer: Health EOS Commercial |
$42.81
|
| Rate for Payer: HFN Commercial |
$44.25
|
| Rate for Payer: Multiplan Commercial |
$38.48
|
| Rate for Payer: NAPHCARE Commercial |
$28.86
|
| Rate for Payer: Preferred Network Access Commercial |
$44.25
|
| Rate for Payer: Quartz Beloit One Network |
$23.57
|
| Rate for Payer: Quartz Commercial |
$28.86
|
| Rate for Payer: WEA Trust Commercial |
$26.46
|
| Rate for Payer: WPS Commercial |
$35.63
|
|
|
.B. henselae (IgG) Titer
|
Facility
OP
|
$48.10
|
|
|
Service Code
|
CPT 86611
|
| Hospital Charge Code |
5390631
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.17 |
| Max. Negotiated Rate |
$192.40 |
| Rate for Payer: Aetna Commercial |
$43.29
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$41.37
|
| Rate for Payer: Aetna Managed Medicare |
$10.18
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$38.18
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$17.82
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$16.90
|
| Rate for Payer: Anthem Medicaid |
$8.17
|
| Rate for Payer: Anthem Medicare Advantage |
$10.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$25.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$10.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$10.18
|
| Rate for Payer: Cash Price |
$14.43
|
| Rate for Payer: Cash Price |
$14.43
|
| Rate for Payer: Cigna Commercial |
$44.25
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$10.18
|
| 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 |
$10.18
|
| Rate for Payer: Health EOS Commercial |
$42.81
|
| Rate for Payer: HFN Commercial |
$44.25
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$37.87
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$10.18
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$8.17
|
| Rate for Payer: Independent Care Health Plan Medicare |
$10.18
|
| Rate for Payer: Managed Health Services Medicaid |
$8.50
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$10.18
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$10.18
|
| Rate for Payer: Multiplan Commercial |
$38.48
|
| Rate for Payer: NAPHCARE Commercial |
$15.27
|
| Rate for Payer: Preferred Network Access Commercial |
$44.25
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$8.17
|
| Rate for Payer: Quartz Beloit One Network |
$23.57
|
| Rate for Payer: Quartz Commercial |
$31.26
|
| Rate for Payer: Quartz Medicare Advantage |
$10.18
|
| Rate for Payer: The Alliance Commercial |
$192.40
|
| Rate for Payer: United Healthcare Medicaid |
$8.17
|
| Rate for Payer: United Healthcare Medicare Advantage |
$10.18
|
| Rate for Payer: United Healthcare PPO |
$36.08
|
| Rate for Payer: WEA Trust Commercial |
$26.46
|
| Rate for Payer: Wellcare Medicare |
$10.18
|
| Rate for Payer: WMAP Medicaid |
$8.17
|
| Rate for Payer: WPS Commercial |
$35.63
|
|
|
.B. henselae (IgM) Titer
|
Facility
IP
|
$96.85
|
|
|
Service Code
|
CPT 86611
|
| Hospital Charge Code |
5390632
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$47.46 |
| Max. Negotiated Rate |
$89.10 |
| Rate for Payer: Aetna Commercial |
$87.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$51.33
|
| Rate for Payer: Cash Price |
$29.05
|
| Rate for Payer: Cigna Commercial |
$89.10
|
| Rate for Payer: Health EOS Commercial |
$86.20
|
| Rate for Payer: HFN Commercial |
$89.10
|
| Rate for Payer: Multiplan Commercial |
$77.48
|
| Rate for Payer: NAPHCARE Commercial |
$58.11
|
| Rate for Payer: Preferred Network Access Commercial |
$89.10
|
| Rate for Payer: Quartz Beloit One Network |
$47.46
|
| Rate for Payer: Quartz Commercial |
$58.11
|
| Rate for Payer: WEA Trust Commercial |
$53.27
|
| Rate for Payer: WPS Commercial |
$71.74
|
|
|
.B. henselae (IgM) Titer
|
Facility
OP
|
$96.85
|
|
|
Service Code
|
CPT 86611
|
| Hospital Charge Code |
5390632
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.17 |
| Max. Negotiated Rate |
$387.40 |
| Rate for Payer: Aetna Commercial |
$87.16
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$83.29
|
| Rate for Payer: Aetna Managed Medicare |
$10.18
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$38.18
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$17.82
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$16.90
|
| Rate for Payer: Anthem Medicaid |
$8.17
|
| Rate for Payer: Anthem Medicare Advantage |
$10.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$51.33
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$10.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$10.18
|
| Rate for Payer: Cash Price |
$29.05
|
| Rate for Payer: Cash Price |
$29.05
|
| Rate for Payer: Cigna Commercial |
$89.10
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$10.18
|
| 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 |
$10.18
|
| Rate for Payer: Health EOS Commercial |
$86.20
|
| Rate for Payer: HFN Commercial |
$89.10
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$37.87
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$10.18
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$8.17
|
| Rate for Payer: Independent Care Health Plan Medicare |
$10.18
|
| Rate for Payer: Managed Health Services Medicaid |
$8.50
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$10.18
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$10.18
|
| Rate for Payer: Multiplan Commercial |
$77.48
|
| Rate for Payer: NAPHCARE Commercial |
$15.27
|
| Rate for Payer: Preferred Network Access Commercial |
$89.10
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$8.17
|
| Rate for Payer: Quartz Beloit One Network |
$47.46
|
| Rate for Payer: Quartz Commercial |
$62.95
|
| Rate for Payer: Quartz Medicare Advantage |
$10.18
|
| Rate for Payer: The Alliance Commercial |
$387.40
|
| Rate for Payer: United Healthcare Medicaid |
$8.17
|
| Rate for Payer: United Healthcare Medicare Advantage |
$10.18
|
| Rate for Payer: United Healthcare PPO |
$72.64
|
| Rate for Payer: WEA Trust Commercial |
$53.27
|
| Rate for Payer: Wellcare Medicare |
$10.18
|
| Rate for Payer: WMAP Medicaid |
$8.17
|
| Rate for Payer: WPS Commercial |
$71.74
|
|
|
.B. henselae (IgM) Titer
|
Professional
|
$96.85
|
|
|
Service Code
|
CPT 86611
|
| Hospital Charge Code |
5390632
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.18 |
| Max. Negotiated Rate |
$92.01 |
| Rate for Payer: Aetna Commercial |
$92.01
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$83.29
|
| Rate for Payer: Aetna Managed Medicare |
$10.18
|
| Rate for Payer: Anthem Medicare Advantage |
$10.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$10.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$10.18
|
| Rate for Payer: Cash Price |
$29.05
|
| Rate for Payer: Cash Price |
$29.05
|
| Rate for Payer: Cigna Commercial |
$92.01
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$48.42
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$10.18
|
| Rate for Payer: Health EOS Commercial |
$88.13
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$35.94
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$35.94
|
| Rate for Payer: Independent Care Health Plan Medicare |
$10.18
|
| Rate for Payer: Multiplan Commercial |
$77.48
|
| Rate for Payer: Preferred Network Access Commercial |
$92.01
|
| Rate for Payer: Quartz Beloit One Network |
$42.61
|
| Rate for Payer: Quartz Commercial |
$55.20
|
| Rate for Payer: Quartz Medicare Advantage |
$10.18
|
| Rate for Payer: The Alliance Commercial |
$40.21
|
| Rate for Payer: United Healthcare Medicare Advantage |
$10.18
|
| Rate for Payer: WEA Trust Commercial |
$53.27
|
| Rate for Payer: WPS Commercial |
$44.79
|
|
|
BICEPS BUTTON 2.6 X 12MM AR-2261
|
Facility
IP
|
$4,317.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5617624
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,115.33 |
| Max. Negotiated Rate |
$3,971.64 |
| Rate for Payer: Aetna Commercial |
$3,885.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,288.01
|
| Rate for Payer: Cash Price |
$1,295.10
|
| Rate for Payer: Cigna Commercial |
$3,971.64
|
| Rate for Payer: Health EOS Commercial |
$3,842.13
|
| Rate for Payer: HFN Commercial |
$3,971.64
|
| Rate for Payer: Multiplan Commercial |
$3,453.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,590.20
|
| Rate for Payer: Preferred Network Access Commercial |
$3,971.64
|
| Rate for Payer: Quartz Beloit One Network |
$2,115.33
|
| Rate for Payer: Quartz Commercial |
$2,590.20
|
| Rate for Payer: WEA Trust Commercial |
$2,374.35
|
| Rate for Payer: WPS Commercial |
$3,197.60
|
|
|
BICEPS BUTTON 2.6 X 12MM AR-2261
|
Facility
OP
|
$4,317.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5617624
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,208.76 |
| Max. Negotiated Rate |
$3,971.64 |
| Rate for Payer: Aetna Commercial |
$3,885.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,712.62
|
| Rate for Payer: Aetna Managed Medicare |
$1,208.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,806.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,158.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,072.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,288.01
|
| Rate for Payer: Cash Price |
$1,295.10
|
| Rate for Payer: Cigna Commercial |
$3,971.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,415.79
|
| Rate for Payer: Health EOS Commercial |
$3,842.13
|
| Rate for Payer: HFN Commercial |
$3,971.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,237.75
|
| Rate for Payer: Multiplan Commercial |
$3,453.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,590.20
|
| Rate for Payer: Preferred Network Access Commercial |
$3,971.64
|
| Rate for Payer: Quartz Beloit One Network |
$2,115.33
|
| Rate for Payer: Quartz Commercial |
$2,806.05
|
| Rate for Payer: Quartz Medicare Advantage |
$2,590.20
|
| Rate for Payer: WEA Trust Commercial |
$2,374.35
|
| Rate for Payer: WPS Commercial |
$3,197.60
|
|
