|
Beta-2 Transferrin
|
Facility
|
IP
|
$417.00
|
|
|
Service Code
|
CPT 86335
|
| Hospital Charge Code |
980036
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$204.33 |
| Max. Negotiated Rate |
$383.64 |
| Rate for Payer: Aetna Commercial |
$375.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$358.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$221.01
|
| Rate for Payer: Cash Price |
$125.10
|
| Rate for Payer: Cigna Commercial |
$383.64
|
| Rate for Payer: Health EOS Commercial |
$371.13
|
| Rate for Payer: HFN Commercial |
$383.64
|
| Rate for Payer: Multiplan Commercial |
$333.60
|
| Rate for Payer: NAPHCARE Commercial |
$250.20
|
| Rate for Payer: Preferred Network Access Commercial |
$383.64
|
| Rate for Payer: Quartz Beloit One Network |
$204.33
|
| Rate for Payer: Quartz Commercial |
$250.20
|
| Rate for Payer: WEA Trust Commercial |
$229.35
|
| Rate for Payer: WPS Commercial |
$308.87
|
|
|
Beta-2 Transferrin
|
Facility
|
OP
|
$417.00
|
|
|
Service Code
|
CPT 86335
|
| Hospital Charge Code |
980036
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$29.35 |
| Max. Negotiated Rate |
$383.64 |
| Rate for Payer: Aetna Commercial |
$375.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$358.62
|
| Rate for Payer: Aetna Managed Medicare |
$29.35
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$110.06
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$51.36
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$48.72
|
| Rate for Payer: Anthem Medicaid |
$30.33
|
| Rate for Payer: Anthem Medicare Advantage |
$29.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$221.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$29.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$29.35
|
| Rate for Payer: Cash Price |
$125.10
|
| Rate for Payer: Cash Price |
$125.10
|
| Rate for Payer: Cigna Commercial |
$383.64
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$29.35
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$30.33
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$233.35
|
| Rate for Payer: Dean Health Medicaid |
$30.33
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$29.35
|
| Rate for Payer: Health EOS Commercial |
$371.13
|
| Rate for Payer: HFN Commercial |
$383.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$109.18
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$29.35
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$30.33
|
| Rate for Payer: Independent Care Health Plan Medicare |
$29.35
|
| Rate for Payer: Managed Health Services Medicaid |
$31.54
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$29.35
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$29.35
|
| Rate for Payer: Multiplan Commercial |
$333.60
|
| Rate for Payer: NAPHCARE Commercial |
$44.02
|
| Rate for Payer: Preferred Network Access Commercial |
$383.64
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$30.33
|
| Rate for Payer: Quartz Beloit One Network |
$204.33
|
| Rate for Payer: Quartz Commercial |
$271.05
|
| Rate for Payer: Quartz Medicare Advantage |
$29.35
|
| Rate for Payer: The Alliance Commercial |
$117.40
|
| Rate for Payer: United Healthcare Medicaid |
$30.33
|
| Rate for Payer: United Healthcare Medicare Advantage |
$29.35
|
| Rate for Payer: United Healthcare PPO |
$312.75
|
| Rate for Payer: WEA Trust Commercial |
$229.35
|
| Rate for Payer: Wellcare Medicare |
$29.35
|
| Rate for Payer: WMAP Medicaid |
$30.33
|
| Rate for Payer: WPS Commercial |
$308.87
|
|
|
Beta-2 Transferrin
|
Professional
|
Both
|
$417.00
|
|
|
Service Code
|
CPT 86335
|
| Hospital Charge Code |
980036
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$16.61 |
| Max. Negotiated Rate |
$396.15 |
| Rate for Payer: Aetna Commercial |
$396.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$358.62
|
| Rate for Payer: Anthem Commercial |
$16.61
|
| Rate for Payer: Cash Price |
$125.10
|
| Rate for Payer: Cash Price |
$125.10
|
| Rate for Payer: Cigna Commercial |
$396.15
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$208.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$250.20
|
| Rate for Payer: Health EOS Commercial |
$379.47
|
| Rate for Payer: HFN Commercial |
$396.15
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$103.61
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$103.61
|
| Rate for Payer: Multiplan Commercial |
$333.60
|
| Rate for Payer: Preferred Network Access Commercial |
$396.15
|
| Rate for Payer: Quartz Beloit One Network |
$183.48
|
| Rate for Payer: Quartz Commercial |
$237.69
|
| Rate for Payer: The Alliance Commercial |
$208.50
|
| Rate for Payer: WEA Trust Commercial |
$229.35
|
| Rate for Payer: WPS Commercial |
$308.87
|
|
|
Beta-Amloid 42/40 Ratio, CSF
|
Facility
|
OP
|
$1,147.00
|
|
|
Service Code
|
CPT 82542
|
| Hospital Charge Code |
5613541
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$24.09 |
| Max. Negotiated Rate |
$1,055.24 |
| Rate for Payer: Aetna Commercial |
$1,032.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$986.42
|
| Rate for Payer: Aetna Managed Medicare |
$24.09
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$90.34
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$42.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$39.99
|
| Rate for Payer: Anthem Medicaid |
$24.89
|
| Rate for Payer: Anthem Medicare Advantage |
$24.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$607.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$24.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$24.09
|
| Rate for Payer: Cash Price |
$344.10
|
| Rate for Payer: Cash Price |
$344.10
|
| Rate for Payer: Cigna Commercial |
$1,055.24
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$24.09
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$24.89
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$641.86
|
| Rate for Payer: Dean Health Medicaid |
$24.89
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$24.09
|
| Rate for Payer: Health EOS Commercial |
$1,020.83
|
| Rate for Payer: HFN Commercial |
$1,055.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$89.61
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$24.09
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$24.89
|
| Rate for Payer: Independent Care Health Plan Medicare |
$24.09
|
| Rate for Payer: Managed Health Services Medicaid |
$25.89
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$24.09
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$24.09
|
| Rate for Payer: Multiplan Commercial |
$917.60
|
| Rate for Payer: NAPHCARE Commercial |
$36.14
|
| Rate for Payer: Preferred Network Access Commercial |
$1,055.24
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$24.89
|
| Rate for Payer: Quartz Beloit One Network |
$562.03
|
| Rate for Payer: Quartz Commercial |
$745.55
|
| Rate for Payer: Quartz Medicare Advantage |
$24.09
|
| Rate for Payer: The Alliance Commercial |
$96.36
|
| Rate for Payer: United Healthcare Medicaid |
$24.89
|
| Rate for Payer: United Healthcare Medicare Advantage |
$24.09
|
| Rate for Payer: United Healthcare PPO |
$860.25
|
| Rate for Payer: WEA Trust Commercial |
$630.85
|
| Rate for Payer: Wellcare Medicare |
$24.09
|
| Rate for Payer: WMAP Medicaid |
$24.89
|
| Rate for Payer: WPS Commercial |
$849.58
|
|
|
Beta-Amloid 42/40 Ratio, CSF
|
Facility
|
IP
|
$1,147.00
|
|
|
Service Code
|
CPT 82542
|
| Hospital Charge Code |
5613541
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$562.03 |
| Max. Negotiated Rate |
$1,055.24 |
| Rate for Payer: Aetna Commercial |
$1,032.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$986.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$607.91
|
| Rate for Payer: Cash Price |
$344.10
|
| Rate for Payer: Cigna Commercial |
$1,055.24
|
| Rate for Payer: Health EOS Commercial |
$1,020.83
|
| Rate for Payer: HFN Commercial |
$1,055.24
|
| Rate for Payer: Multiplan Commercial |
$917.60
|
| Rate for Payer: NAPHCARE Commercial |
$688.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,055.24
|
| Rate for Payer: Quartz Beloit One Network |
$562.03
|
| Rate for Payer: Quartz Commercial |
$688.20
|
| Rate for Payer: WEA Trust Commercial |
$630.85
|
| Rate for Payer: WPS Commercial |
$849.58
|
|
|
Beta-Amloid 42/40 Ratio, CSF
|
Professional
|
Both
|
$1,147.00
|
|
|
Service Code
|
CPT 82542
|
| Hospital Charge Code |
5613541
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$85.04 |
| Max. Negotiated Rate |
$1,089.65 |
| Rate for Payer: Aetna Commercial |
$1,089.65
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$986.42
|
| Rate for Payer: Cash Price |
$344.10
|
| Rate for Payer: Cash Price |
$344.10
|
| Rate for Payer: Cigna Commercial |
$1,089.65
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$573.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$688.20
|
| Rate for Payer: Health EOS Commercial |
$1,043.77
|
| Rate for Payer: HFN Commercial |
$1,089.65
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$85.04
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$85.04
|
| Rate for Payer: Multiplan Commercial |
$917.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,089.65
|
| Rate for Payer: Quartz Beloit One Network |
$504.68
|
| Rate for Payer: Quartz Commercial |
$653.79
|
| Rate for Payer: The Alliance Commercial |
$573.50
|
| Rate for Payer: WEA Trust Commercial |
$630.85
|
| Rate for Payer: WPS Commercial |
$849.58
|
|
|
Beta-Globin Complete
|
Facility
|
IP
|
$1,344.00
|
|
|
Service Code
|
CPT 81364
|
| Hospital Charge Code |
4253861
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$658.56 |
| Max. Negotiated Rate |
$1,236.48 |
| Rate for Payer: Aetna Commercial |
$1,209.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,155.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$712.32
|
| Rate for Payer: Cash Price |
$403.20
|
| Rate for Payer: Cigna Commercial |
$1,236.48
|
| Rate for Payer: Health EOS Commercial |
$1,196.16
|
| Rate for Payer: HFN Commercial |
$1,236.48
|
| Rate for Payer: Multiplan Commercial |
$1,075.20
|
| Rate for Payer: NAPHCARE Commercial |
$806.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,236.48
|
| Rate for Payer: Quartz Beloit One Network |
$658.56
|
| Rate for Payer: Quartz Commercial |
$806.40
|
| Rate for Payer: WEA Trust Commercial |
$739.20
|
| Rate for Payer: WPS Commercial |
$995.50
|
|
|
Beta-Globin Complete
|
Professional
|
Both
|
$1,344.00
|
|
|
Service Code
|
CPT 81364
|
| Hospital Charge Code |
4253861
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$591.36 |
| Max. Negotiated Rate |
$1,276.80 |
| Rate for Payer: Aetna Commercial |
$1,276.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,155.84
|
| Rate for Payer: Cash Price |
$403.20
|
| Rate for Payer: Cash Price |
$403.20
|
| Rate for Payer: Cigna Commercial |
$1,276.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$672.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$806.40
|
| Rate for Payer: Health EOS Commercial |
$1,223.04
|
| Rate for Payer: HFN Commercial |
$1,276.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,145.77
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,145.77
|
| Rate for Payer: Multiplan Commercial |
$1,075.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,276.80
|
| Rate for Payer: Quartz Beloit One Network |
$591.36
|
| Rate for Payer: Quartz Commercial |
$766.08
|
| Rate for Payer: The Alliance Commercial |
$672.00
|
| Rate for Payer: WEA Trust Commercial |
$739.20
|
| Rate for Payer: WPS Commercial |
$995.50
|
|
|
Beta-Globin Complete
|
Facility
|
OP
|
$1,344.00
|
|
|
Service Code
|
CPT 81364
|
| Hospital Charge Code |
4253861
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$259.66 |
| Max. Negotiated Rate |
$1,298.32 |
| Rate for Payer: Aetna Commercial |
$1,209.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,155.84
|
| Rate for Payer: Aetna Managed Medicare |
$324.58
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,217.18
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$568.02
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$538.80
|
| Rate for Payer: Anthem Medicaid |
$259.66
|
| Rate for Payer: Anthem Medicare Advantage |
$324.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$712.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$324.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$324.58
|
| Rate for Payer: Cash Price |
$403.20
|
| Rate for Payer: Cash Price |
$403.20
|
| Rate for Payer: Cigna Commercial |
$1,236.48
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$324.58
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$259.66
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$752.10
|
| Rate for Payer: Dean Health Medicaid |
$259.66
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$324.58
|
| Rate for Payer: Health EOS Commercial |
$1,196.16
|
| Rate for Payer: HFN Commercial |
$1,236.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,207.44
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$324.58
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$259.66
|
| Rate for Payer: Independent Care Health Plan Medicare |
$324.58
|
| Rate for Payer: Managed Health Services Medicaid |
$270.05
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$324.58
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$324.58
|
| Rate for Payer: Multiplan Commercial |
$1,075.20
|
| Rate for Payer: NAPHCARE Commercial |
$486.87
|
| Rate for Payer: Preferred Network Access Commercial |
$1,236.48
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$259.66
|
| Rate for Payer: Quartz Beloit One Network |
$658.56
|
| Rate for Payer: Quartz Commercial |
$873.60
|
| Rate for Payer: Quartz Medicare Advantage |
$324.58
|
| Rate for Payer: The Alliance Commercial |
$1,298.32
|
| Rate for Payer: United Healthcare Medicaid |
$259.66
|
| Rate for Payer: United Healthcare Medicare Advantage |
$324.58
|
| Rate for Payer: United Healthcare PPO |
$1,008.00
|
| Rate for Payer: WEA Trust Commercial |
$739.20
|
| Rate for Payer: Wellcare Medicare |
$324.58
|
| Rate for Payer: WMAP Medicaid |
$259.66
|
| Rate for Payer: WPS Commercial |
$995.50
|
|
|
Beta Human Chorionic Gonadotropin Quantitative
|
Facility
|
OP
|
$259.00
|
|
|
Service Code
|
CPT 84702
|
| Hospital Charge Code |
633665
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.05 |
| Max. Negotiated Rate |
$238.28 |
| Rate for Payer: Aetna Commercial |
$233.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$222.74
|
| Rate for Payer: Aetna Managed Medicare |
$15.05
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$56.44
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$26.34
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$24.98
|
| Rate for Payer: Anthem Medicaid |
$15.55
|
| Rate for Payer: Anthem Medicare Advantage |
$15.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$137.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$15.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$15.05
|
| Rate for Payer: Cash Price |
$77.70
|
| Rate for Payer: Cash Price |
$77.70
|
| Rate for Payer: Cigna Commercial |
$238.28
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$15.05
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$15.55
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$144.94
|
| Rate for Payer: Dean Health Medicaid |
$15.55
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$15.05
|
| Rate for Payer: Health EOS Commercial |
$230.51
|
| Rate for Payer: HFN Commercial |
$238.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$55.99
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$15.05
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$15.55
|
| Rate for Payer: Independent Care Health Plan Medicare |
$15.05
|
| Rate for Payer: Managed Health Services Medicaid |
$16.17
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$15.05
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$15.05
|
| Rate for Payer: Multiplan Commercial |
$207.20
|
| Rate for Payer: NAPHCARE Commercial |
$22.58
|
| Rate for Payer: Preferred Network Access Commercial |
$238.28
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$15.55
|
| Rate for Payer: Quartz Beloit One Network |
$126.91
|
| Rate for Payer: Quartz Commercial |
$168.35
|
| Rate for Payer: Quartz Medicare Advantage |
$15.05
|
| Rate for Payer: The Alliance Commercial |
$60.20
|
| Rate for Payer: United Healthcare Medicaid |
$15.55
|
| Rate for Payer: United Healthcare Medicare Advantage |
$15.05
|
| Rate for Payer: United Healthcare PPO |
$194.25
|
| Rate for Payer: WEA Trust Commercial |
$142.45
|
| Rate for Payer: Wellcare Medicare |
$15.05
|
| Rate for Payer: WMAP Medicaid |
$15.55
|
| Rate for Payer: WPS Commercial |
$191.84
|
|
|
Beta Human Chorionic Gonadotropin Quantitative
|
Facility
|
IP
|
$259.00
|
|
|
Service Code
|
CPT 84702
|
| Hospital Charge Code |
633665
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$126.91 |
| Max. Negotiated Rate |
$238.28 |
| Rate for Payer: Aetna Commercial |
$233.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$222.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$137.27
|
| Rate for Payer: Cash Price |
$77.70
|
| Rate for Payer: Cigna Commercial |
$238.28
|
| Rate for Payer: Health EOS Commercial |
$230.51
|
| Rate for Payer: HFN Commercial |
$238.28
|
| Rate for Payer: Multiplan Commercial |
$207.20
|
| Rate for Payer: NAPHCARE Commercial |
$155.40
|
| Rate for Payer: Preferred Network Access Commercial |
$238.28
|
| Rate for Payer: Quartz Beloit One Network |
$126.91
|
| Rate for Payer: Quartz Commercial |
$155.40
|
| Rate for Payer: WEA Trust Commercial |
$142.45
|
| Rate for Payer: WPS Commercial |
$191.84
|
|
|
Beta Human Chorionic Gonadotropin Quantitative
|
Professional
|
Both
|
$259.00
|
|
|
Service Code
|
CPT 84702
|
| Hospital Charge Code |
633665
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$53.13 |
| Max. Negotiated Rate |
$246.05 |
| Rate for Payer: Aetna Commercial |
$246.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$222.74
|
| Rate for Payer: Cash Price |
$77.70
|
| Rate for Payer: Cash Price |
$77.70
|
| Rate for Payer: Cigna Commercial |
$246.05
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$129.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$155.40
|
| Rate for Payer: Health EOS Commercial |
$235.69
|
| Rate for Payer: HFN Commercial |
$246.05
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$53.13
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$53.13
|
| Rate for Payer: Multiplan Commercial |
$207.20
|
| Rate for Payer: Preferred Network Access Commercial |
$246.05
|
| Rate for Payer: Quartz Beloit One Network |
$113.96
|
| Rate for Payer: Quartz Commercial |
$147.63
|
| Rate for Payer: The Alliance Commercial |
$129.50
|
| Rate for Payer: WEA Trust Commercial |
$142.45
|
| Rate for Payer: WPS Commercial |
$191.84
|
|
|
Beta Human Chorionic Gonadotropin Tumor Marker
|
Professional
|
Both
|
$44.00
|
|
|
Service Code
|
CPT 84702
|
| Hospital Charge Code |
3473533
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$19.36 |
| Max. Negotiated Rate |
$53.13 |
| Rate for Payer: Aetna Commercial |
$41.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$37.84
|
| Rate for Payer: Cash Price |
$13.20
|
| Rate for Payer: Cash Price |
$13.20
|
| Rate for Payer: Cigna Commercial |
$41.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$22.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$26.40
|
| Rate for Payer: Health EOS Commercial |
$40.04
|
| Rate for Payer: HFN Commercial |
$41.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$53.13
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$53.13
|
| Rate for Payer: Multiplan Commercial |
$35.20
|
| Rate for Payer: Preferred Network Access Commercial |
$41.80
|
| Rate for Payer: Quartz Beloit One Network |
$19.36
|
| Rate for Payer: Quartz Commercial |
$25.08
|
| Rate for Payer: The Alliance Commercial |
$22.00
|
| Rate for Payer: WEA Trust Commercial |
$24.20
|
| Rate for Payer: WPS Commercial |
$32.59
|
|
|
Beta Human Chorionic Gonadotropin Tumor Marker
|
Facility
|
OP
|
$44.00
|
|
|
Service Code
|
CPT 84702
|
| Hospital Charge Code |
3473533
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.05 |
| Max. Negotiated Rate |
$60.20 |
| Rate for Payer: Aetna Commercial |
$39.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$37.84
|
| Rate for Payer: Aetna Managed Medicare |
$15.05
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$56.44
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$26.34
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$24.98
|
| Rate for Payer: Anthem Medicaid |
$15.55
|
| Rate for Payer: Anthem Medicare Advantage |
$15.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$23.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$15.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$15.05
|
| Rate for Payer: Cash Price |
$13.20
|
| Rate for Payer: Cash Price |
$13.20
|
| Rate for Payer: Cigna Commercial |
$40.48
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$15.05
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$15.55
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$24.62
|
| Rate for Payer: Dean Health Medicaid |
$15.55
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$15.05
|
| Rate for Payer: Health EOS Commercial |
$39.16
|
| Rate for Payer: HFN Commercial |
$40.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$55.99
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$15.05
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$15.55
|
| Rate for Payer: Independent Care Health Plan Medicare |
$15.05
|
| Rate for Payer: Managed Health Services Medicaid |
$16.17
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$15.05
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$15.05
|
| Rate for Payer: Multiplan Commercial |
$35.20
|
| Rate for Payer: NAPHCARE Commercial |
$22.58
|
| Rate for Payer: Preferred Network Access Commercial |
$40.48
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$15.55
|
| Rate for Payer: Quartz Beloit One Network |
$21.56
|
| Rate for Payer: Quartz Commercial |
$28.60
|
| Rate for Payer: Quartz Medicare Advantage |
$15.05
|
| Rate for Payer: The Alliance Commercial |
$60.20
|
| Rate for Payer: United Healthcare Medicaid |
$15.55
|
| Rate for Payer: United Healthcare Medicare Advantage |
$15.05
|
| Rate for Payer: United Healthcare PPO |
$33.00
|
| Rate for Payer: WEA Trust Commercial |
$24.20
|
| Rate for Payer: Wellcare Medicare |
$15.05
|
| Rate for Payer: WMAP Medicaid |
$15.55
|
| Rate for Payer: WPS Commercial |
$32.59
|
|
|
Beta Human Chorionic Gonadotropin Tumor Marker
|
Facility
|
IP
|
$44.00
|
|
|
Service Code
|
CPT 84702
|
| Hospital Charge Code |
3473533
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$21.56 |
| Max. Negotiated Rate |
$40.48 |
| Rate for Payer: Aetna Commercial |
$39.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$37.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$23.32
|
| Rate for Payer: Cash Price |
$13.20
|
| Rate for Payer: Cigna Commercial |
$40.48
|
| Rate for Payer: Health EOS Commercial |
$39.16
|
| Rate for Payer: HFN Commercial |
$40.48
|
| Rate for Payer: Multiplan Commercial |
$35.20
|
| Rate for Payer: NAPHCARE Commercial |
$26.40
|
| Rate for Payer: Preferred Network Access Commercial |
$40.48
|
| Rate for Payer: Quartz Beloit One Network |
$21.56
|
| Rate for Payer: Quartz Commercial |
$26.40
|
| Rate for Payer: WEA Trust Commercial |
$24.20
|
| Rate for Payer: WPS Commercial |
$32.59
|
|
|
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 |
$98.44 |
| 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 DHI/DHP/ASO |
$59.88
|
| 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 |
$32.68
|
| Rate for Payer: United Healthcare Medicaid |
$8.44
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8.17
|
| Rate for Payer: United Healthcare PPO |
$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
|
Professional
|
Both
|
$107.00
|
|
|
Service Code
|
CPT 82010
|
| Hospital Charge Code |
4676607
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$28.84 |
| Max. Negotiated Rate |
$101.65 |
| Rate for Payer: Aetna Commercial |
$101.65
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$92.02
|
| Rate for Payer: Cash Price |
$32.10
|
| Rate for Payer: Cash Price |
$32.10
|
| Rate for Payer: Cigna Commercial |
$101.65
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$53.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$64.20
|
| Rate for Payer: Health EOS Commercial |
$97.37
|
| Rate for Payer: HFN Commercial |
$101.65
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$28.84
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$28.84
|
| Rate for Payer: Multiplan Commercial |
$85.60
|
| Rate for Payer: Preferred Network Access Commercial |
$101.65
|
| Rate for Payer: Quartz Beloit One Network |
$47.08
|
| Rate for Payer: Quartz Commercial |
$60.99
|
| Rate for Payer: The Alliance Commercial |
$53.50
|
| Rate for Payer: WEA Trust Commercial |
$58.85
|
| 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: Aetna Gatekeeper/Not Gatekeeper |
$92.02
|
| 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
|
Both
|
$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: 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 |
$6.82
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6.88
|
| Rate for Payer: Health EOS Commercial |
$29.12
|
| Rate for Payer: HFN Commercial |
$30.40
|
| 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: 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: The Alliance Commercial |
$16.00
|
| Rate for Payer: United Healthcare Medicaid |
$6.82
|
| 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 |
$128.00 |
| 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 |
$128.00
|
| 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: Aetna Gatekeeper/Not Gatekeeper |
$27.52
|
| 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
|
Both
|
$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: HFN Commercial |
$69.35
|
| 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: Aetna Gatekeeper/Not Gatekeeper |
$62.78
|
| 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: The Alliance Commercial |
$7.41
|
| 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
|
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: Aetna Gatekeeper/Not Gatekeeper |
$334.54
|
| 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
|
|
