|
Bexsero Charge 90620
|
Professional
|
Both
|
$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 |
$226.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$233.40
|
| Rate for Payer: Health EOS Commercial |
$353.99
|
| Rate for Payer: HFN Commercial |
$369.55
|
| 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: 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
|
|
|
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
|
Professional
|
Both
|
$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: Dean Health DHI/DHP/ASO |
$1,879.20
|
| Rate for Payer: Health EOS Commercial |
$2,850.12
|
| Rate for Payer: HFN Commercial |
$2,975.40
|
| 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
|
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: Aetna Gatekeeper/Not Gatekeeper |
$2,693.52
|
| 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
|
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
|
Professional
|
Both
|
$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: Dean Health DHI/DHP/ASO |
$1,879.20
|
| Rate for Payer: Health EOS Commercial |
$2,850.12
|
| Rate for Payer: HFN Commercial |
$2,975.40
|
| 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
|
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: Aetna Gatekeeper/Not Gatekeeper |
$2,693.52
|
| 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
|
Both
|
$48.10
|
|
|
Service Code
|
CPT 86611
|
| Hospital Charge Code |
5390631
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$21.16 |
| Max. Negotiated Rate |
$45.70 |
| Rate for Payer: Aetna Commercial |
$45.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$41.37
|
| 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 |
$28.86
|
| Rate for Payer: Health EOS Commercial |
$43.77
|
| Rate for Payer: HFN Commercial |
$45.70
|
| 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: 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: The Alliance Commercial |
$24.05
|
| 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 |
$44.25 |
| 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 DHI/DHP/ASO |
$26.92
|
| 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 |
$40.72
|
| 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 (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: Aetna Gatekeeper/Not Gatekeeper |
$41.37
|
| 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 (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 |
$89.10 |
| 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 DHI/DHP/ASO |
$54.20
|
| 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 |
$40.72
|
| 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
|
Both
|
$96.85
|
|
|
Service Code
|
CPT 86611
|
| Hospital Charge Code |
5390632
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$35.94 |
| Max. Negotiated Rate |
$92.01 |
| Rate for Payer: Aetna Commercial |
$92.01
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$83.29
|
| 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 |
$58.11
|
| Rate for Payer: Health EOS Commercial |
$88.13
|
| Rate for Payer: HFN Commercial |
$92.01
|
| 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: 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: The Alliance Commercial |
$48.42
|
| Rate for Payer: WEA Trust Commercial |
$53.27
|
| Rate for Payer: WPS Commercial |
$71.74
|
|
|
.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: Aetna Gatekeeper/Not Gatekeeper |
$83.29
|
| 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
|
|
|
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: Aetna Gatekeeper/Not Gatekeeper |
$3,712.62
|
| 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 |
$17,268.00 |
| 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: The Alliance Commercial |
$17,268.00
|
| Rate for Payer: WEA Trust Commercial |
$2,374.35
|
| Rate for Payer: WPS Commercial |
$3,197.60
|
|
|
BICEPS, TENDON/NERVE REPAIR
|
Facility
|
OP
|
$4,657.00
|
|
| Hospital Charge Code |
2960416
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,303.96 |
| Max. Negotiated Rate |
$18,628.00 |
| Rate for Payer: Aetna Commercial |
$4,191.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,005.02
|
| Rate for Payer: Aetna Managed Medicare |
$1,303.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,027.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,328.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,235.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,468.21
|
| Rate for Payer: Cash Price |
$1,397.10
|
| Rate for Payer: Cigna Commercial |
$4,284.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,606.06
|
| Rate for Payer: Health EOS Commercial |
$4,144.73
|
| Rate for Payer: HFN Commercial |
$4,284.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,492.75
|
| Rate for Payer: Multiplan Commercial |
$3,725.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,794.20
|
| Rate for Payer: Preferred Network Access Commercial |
$4,284.44
|
| Rate for Payer: Quartz Beloit One Network |
$2,281.93
|
| Rate for Payer: Quartz Commercial |
$3,027.05
|
| Rate for Payer: Quartz Medicare Advantage |
$2,794.20
|
| Rate for Payer: The Alliance Commercial |
$18,628.00
|
| Rate for Payer: WEA Trust Commercial |
$2,561.35
|
| Rate for Payer: WPS Commercial |
$3,449.44
|
|
|
BICEPS, TENDON/NERVE REPAIR
|
Facility
|
IP
|
$4,657.00
|
|
| Hospital Charge Code |
2960416
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,281.93 |
| Max. Negotiated Rate |
$4,284.44 |
| Rate for Payer: Aetna Commercial |
$4,191.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,005.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,468.21
|
| Rate for Payer: Cash Price |
$1,397.10
|
| Rate for Payer: Cigna Commercial |
$4,284.44
|
| Rate for Payer: Health EOS Commercial |
$4,144.73
|
| Rate for Payer: HFN Commercial |
$4,284.44
|
| Rate for Payer: Multiplan Commercial |
$3,725.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,794.20
|
| Rate for Payer: Preferred Network Access Commercial |
$4,284.44
|
| Rate for Payer: Quartz Beloit One Network |
$2,281.93
|
| Rate for Payer: Quartz Commercial |
$2,794.20
|
| Rate for Payer: WEA Trust Commercial |
$2,561.35
|
| Rate for Payer: WPS Commercial |
$3,449.44
|
|
|
Bicillin LA 1.2mu syringe [Med]
|
Facility
|
OP
|
$658.00
|
|
|
Service Code
|
HCPCS J0561
|
| Hospital Charge Code |
2974914
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$21.73 |
| Max. Negotiated Rate |
$605.36 |
| Rate for Payer: Aetna Commercial |
$592.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$565.88
|
| Rate for Payer: Aetna Managed Medicare |
$21.73
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$427.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$329.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$315.84
|
| Rate for Payer: Anthem Medicare Advantage |
$21.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$348.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$21.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$21.73
|
| Rate for Payer: Cash Price |
$197.40
|
| Rate for Payer: Cash Price |
$197.40
|
| Rate for Payer: Cigna Commercial |
$605.36
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$21.73
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$29.10
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$21.73
|
| Rate for Payer: Health EOS Commercial |
$585.62
|
| Rate for Payer: HFN Commercial |
$605.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$80.84
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$21.73
|
| Rate for Payer: Independent Care Health Plan Medicare |
$21.73
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$21.73
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$21.73
|
| Rate for Payer: Multiplan Commercial |
$526.40
|
| Rate for Payer: NAPHCARE Commercial |
$32.60
|
| Rate for Payer: Preferred Network Access Commercial |
$605.36
|
| Rate for Payer: Quartz Beloit One Network |
$322.42
|
| Rate for Payer: Quartz Commercial |
$427.70
|
| Rate for Payer: Quartz Medicare Advantage |
$21.73
|
| Rate for Payer: The Alliance Commercial |
$86.92
|
| Rate for Payer: United Healthcare Medicare Advantage |
$21.73
|
| Rate for Payer: WEA Trust Commercial |
$361.90
|
| Rate for Payer: Wellcare Medicare |
$21.73
|
| Rate for Payer: WPS Commercial |
$55.00
|
|
|
Bicillin LA 1.2mu syringe [Med]
|
Facility
|
IP
|
$658.00
|
|
|
Service Code
|
HCPCS J0561
|
| Hospital Charge Code |
2974914
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$322.42 |
| Max. Negotiated Rate |
$605.36 |
| Rate for Payer: Aetna Commercial |
$592.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$565.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$348.74
|
| Rate for Payer: Cash Price |
$197.40
|
| Rate for Payer: Cigna Commercial |
$605.36
|
| Rate for Payer: Health EOS Commercial |
$585.62
|
| Rate for Payer: HFN Commercial |
$605.36
|
| Rate for Payer: Multiplan Commercial |
$526.40
|
| Rate for Payer: NAPHCARE Commercial |
$394.80
|
| Rate for Payer: Preferred Network Access Commercial |
$605.36
|
| Rate for Payer: Quartz Beloit One Network |
$322.42
|
| Rate for Payer: Quartz Commercial |
$394.80
|
| Rate for Payer: WEA Trust Commercial |
$361.90
|
| Rate for Payer: WPS Commercial |
$487.38
|
|
|
Bicitra 30ml UD cup [Med]
|
Facility
|
OP
|
$18.00
|
|
| Hospital Charge Code |
2974915
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$5.04 |
| Max. Negotiated Rate |
$72.00 |
| Rate for Payer: Aetna Commercial |
$16.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$15.48
|
| Rate for Payer: Aetna Managed Medicare |
$5.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$11.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$9.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$8.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9.54
|
| Rate for Payer: Cash Price |
$5.40
|
| Rate for Payer: Cigna Commercial |
$16.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$10.07
|
| Rate for Payer: Health EOS Commercial |
$16.02
|
| Rate for Payer: HFN Commercial |
$16.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$13.50
|
| Rate for Payer: Multiplan Commercial |
$14.40
|
| Rate for Payer: NAPHCARE Commercial |
$10.80
|
| Rate for Payer: Preferred Network Access Commercial |
$16.56
|
| Rate for Payer: Quartz Beloit One Network |
$8.82
|
| Rate for Payer: Quartz Commercial |
$11.70
|
| Rate for Payer: Quartz Medicare Advantage |
$10.80
|
| Rate for Payer: The Alliance Commercial |
$72.00
|
| Rate for Payer: WEA Trust Commercial |
$9.90
|
| Rate for Payer: WPS Commercial |
$13.33
|
|
|
Bicitra 30ml UD cup [Med]
|
Facility
|
IP
|
$18.00
|
|
| Hospital Charge Code |
2974915
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$8.82 |
| Max. Negotiated Rate |
$16.56 |
| Rate for Payer: Aetna Commercial |
$16.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$15.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9.54
|
| Rate for Payer: Cash Price |
$5.40
|
| Rate for Payer: Cigna Commercial |
$16.56
|
| Rate for Payer: Health EOS Commercial |
$16.02
|
| Rate for Payer: HFN Commercial |
$16.56
|
| Rate for Payer: Multiplan Commercial |
$14.40
|
| Rate for Payer: NAPHCARE Commercial |
$10.80
|
| Rate for Payer: Preferred Network Access Commercial |
$16.56
|
| Rate for Payer: Quartz Beloit One Network |
$8.82
|
| Rate for Payer: Quartz Commercial |
$10.80
|
| Rate for Payer: WEA Trust Commercial |
$9.90
|
| Rate for Payer: WPS Commercial |
$13.33
|
|
|
BIER BLOCK - SET-UP CHARGE
|
Facility
|
OP
|
$102.00
|
|
| Hospital Charge Code |
4519593
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$28.56 |
| Max. Negotiated Rate |
$408.00 |
| Rate for Payer: Aetna Commercial |
$91.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$87.72
|
| Rate for Payer: Aetna Managed Medicare |
$28.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$66.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$51.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$48.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$54.06
|
| Rate for Payer: Cash Price |
$30.60
|
| Rate for Payer: Cigna Commercial |
$93.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$57.08
|
| Rate for Payer: Health EOS Commercial |
$90.78
|
| Rate for Payer: HFN Commercial |
$93.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$76.50
|
| Rate for Payer: Multiplan Commercial |
$81.60
|
| Rate for Payer: NAPHCARE Commercial |
$61.20
|
| Rate for Payer: Preferred Network Access Commercial |
$93.84
|
| Rate for Payer: Quartz Beloit One Network |
$49.98
|
| Rate for Payer: Quartz Commercial |
$66.30
|
| Rate for Payer: Quartz Medicare Advantage |
$61.20
|
| Rate for Payer: The Alliance Commercial |
$408.00
|
| Rate for Payer: WEA Trust Commercial |
$56.10
|
| Rate for Payer: WPS Commercial |
$75.55
|
|
|
BIER BLOCK - SET-UP CHARGE
|
Facility
|
IP
|
$102.00
|
|
| Hospital Charge Code |
4519593
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$49.98 |
| Max. Negotiated Rate |
$93.84 |
| Rate for Payer: Aetna Commercial |
$91.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$87.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$54.06
|
| Rate for Payer: Cash Price |
$30.60
|
| Rate for Payer: Cigna Commercial |
$93.84
|
| Rate for Payer: Health EOS Commercial |
$90.78
|
| Rate for Payer: HFN Commercial |
$93.84
|
| Rate for Payer: Multiplan Commercial |
$81.60
|
| Rate for Payer: NAPHCARE Commercial |
$61.20
|
| Rate for Payer: Preferred Network Access Commercial |
$93.84
|
| Rate for Payer: Quartz Beloit One Network |
$49.98
|
| Rate for Payer: Quartz Commercial |
$61.20
|
| Rate for Payer: WEA Trust Commercial |
$56.10
|
| Rate for Payer: WPS Commercial |
$75.55
|
|
|
Bilateral - Ear, impacted cerumen removal
|
Facility
|
OP
|
$223.00
|
|
|
Service Code
|
CPT 69209
|
| Hospital Charge Code |
4612686
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$60.46 |
| Max. Negotiated Rate |
$4,218.22 |
| Rate for Payer: Aetna Commercial |
$200.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$191.78
|
| Rate for Payer: Aetna Managed Medicare |
$60.46
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$144.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$111.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$107.04
|
| Rate for Payer: Anthem Medicare Advantage |
$60.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$118.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$60.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$60.46
|
| Rate for Payer: Cash Price |
$66.90
|
| Rate for Payer: Cash Price |
$66.90
|
| Rate for Payer: Cash Price |
$66.90
|
| Rate for Payer: Cigna Commercial |
$205.16
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$60.46
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,218.22
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$60.46
|
| Rate for Payer: Health EOS Commercial |
$198.47
|
| Rate for Payer: HFN Commercial |
$205.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$224.91
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$60.46
|
| Rate for Payer: Independent Care Health Plan Medicare |
$60.46
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$60.46
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$60.46
|
| Rate for Payer: Multiplan Commercial |
$178.40
|
| Rate for Payer: NAPHCARE Commercial |
$90.69
|
| Rate for Payer: Preferred Network Access Commercial |
$205.16
|
| Rate for Payer: Quartz Beloit One Network |
$109.27
|
| Rate for Payer: Quartz Commercial |
$144.95
|
| Rate for Payer: Quartz Medicare Advantage |
$60.46
|
| Rate for Payer: The Alliance Commercial |
$241.84
|
| Rate for Payer: United Healthcare Medicare Advantage |
$60.46
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$122.65
|
| Rate for Payer: Wellcare Medicare |
$60.46
|
| Rate for Payer: WPS Commercial |
$165.18
|
|
