|
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 |
$16.31 |
| Max. Negotiated Rate |
$30.62 |
| Rate for Payer: Aetna Commercial |
$29.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$28.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$17.64
|
| Rate for Payer: Cash Price |
$9.60
|
| Rate for Payer: Cigna Commercial |
$30.62
|
| Rate for Payer: Health EOS Commercial |
$29.62
|
| Rate for Payer: HFN Commercial |
$30.62
|
| Rate for Payer: Multiplan Commercial |
$26.62
|
| Rate for Payer: Preferred Network Access Commercial |
$30.62
|
| Rate for Payer: Quartz Beloit One Network |
$16.31
|
| Rate for Payer: Quartz Commercial |
$19.97
|
| Rate for Payer: WEA Trust Commercial |
$18.30
|
| Rate for Payer: WPS Commercial |
$24.65
|
|
|
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 |
$7.16 |
| Max. Negotiated Rate |
$31.62 |
| Rate for Payer: Aetna Commercial |
$31.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$28.62
|
| Rate for Payer: Aetna Managed Medicare |
$7.19
|
| Rate for Payer: Anthem Medicare Advantage |
$7.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$7.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$7.19
|
| Rate for Payer: Cash Price |
$9.60
|
| Rate for Payer: Cash Price |
$9.60
|
| Rate for Payer: Cigna Commercial |
$31.62
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$7.19
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$7.16
|
| Rate for Payer: Health EOS Commercial |
$30.28
|
| Rate for Payer: HFN Commercial |
$31.62
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$9.25
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$9.25
|
| Rate for Payer: Independent Care Health Plan Medicare |
$7.19
|
| Rate for Payer: Multiplan Commercial |
$26.62
|
| Rate for Payer: NAPHCARE Commercial |
$10.78
|
| Rate for Payer: Preferred Network Access Commercial |
$31.62
|
| Rate for Payer: Quartz Beloit One Network |
$14.64
|
| Rate for Payer: Quartz Commercial |
$18.97
|
| Rate for Payer: Quartz Medicare Advantage |
$7.19
|
| Rate for Payer: The Alliance Commercial |
$19.76
|
| Rate for Payer: United Healthcare Medicaid |
$7.19
|
| Rate for Payer: United Healthcare Medicare Advantage |
$7.19
|
| Rate for Payer: WEA Trust Commercial |
$18.30
|
| Rate for Payer: WPS Commercial |
$17.90
|
|
|
Bevacizumab Injection C9257
|
Professional
|
Both
|
$73.00
|
|
|
Service Code
|
HCPCS C9257
|
| Hospital Charge Code |
4147650
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$33.40 |
| Max. Negotiated Rate |
$72.12 |
| Rate for Payer: Aetna Commercial |
$72.12
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$65.29
|
| Rate for Payer: Cash Price |
$21.90
|
| Rate for Payer: Cigna Commercial |
$72.12
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$37.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$45.55
|
| Rate for Payer: Health EOS Commercial |
$69.09
|
| Rate for Payer: HFN Commercial |
$72.12
|
| Rate for Payer: Multiplan Commercial |
$60.74
|
| Rate for Payer: Preferred Network Access Commercial |
$72.12
|
| Rate for Payer: Quartz Beloit One Network |
$33.40
|
| Rate for Payer: Quartz Commercial |
$43.27
|
| Rate for Payer: The Alliance Commercial |
$37.96
|
| Rate for Payer: WEA Trust Commercial |
$41.76
|
| Rate for Payer: WPS Commercial |
$56.23
|
|
|
Bevacizumab Injection C9257
|
Facility
|
OP
|
$73.00
|
|
|
Service Code
|
HCPCS C9257
|
| Hospital Charge Code |
4147650
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.91 |
| Max. Negotiated Rate |
$69.85 |
| Rate for Payer: Aetna Commercial |
$68.33
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$65.29
|
| Rate for Payer: Aetna Managed Medicare |
$1.91
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$49.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$37.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$36.44
|
| Rate for Payer: Anthem Medicare Advantage |
$1.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$40.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$1.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$1.91
|
| Rate for Payer: Cash Price |
$21.90
|
| Rate for Payer: Cash Price |
$21.90
|
| Rate for Payer: Cigna Commercial |
$69.85
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$1.91
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$42.49
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$1.91
|
| Rate for Payer: Health EOS Commercial |
$67.57
|
| Rate for Payer: HFN Commercial |
$69.85
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7.12
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1.91
|
| Rate for Payer: Independent Care Health Plan Medicare |
$1.91
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$1.91
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$1.91
|
| Rate for Payer: Multiplan Commercial |
$60.74
|
| Rate for Payer: NAPHCARE Commercial |
$2.87
|
| Rate for Payer: Preferred Network Access Commercial |
$69.85
|
| Rate for Payer: Quartz Beloit One Network |
$37.20
|
| Rate for Payer: Quartz Commercial |
$49.35
|
| Rate for Payer: Quartz Medicare Advantage |
$1.91
|
| Rate for Payer: The Alliance Commercial |
$7.65
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1.91
|
| Rate for Payer: WEA Trust Commercial |
$41.76
|
| Rate for Payer: Wellcare Medicare |
$1.91
|
| Rate for Payer: WPS Commercial |
$56.23
|
|
|
Bevacizumab Injection C9257
|
Facility
|
IP
|
$73.00
|
|
|
Service Code
|
HCPCS C9257
|
| Hospital Charge Code |
4147650
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$37.20 |
| Max. Negotiated Rate |
$69.85 |
| Rate for Payer: Aetna Commercial |
$68.33
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$65.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$40.24
|
| Rate for Payer: Cash Price |
$21.90
|
| Rate for Payer: Cigna Commercial |
$69.85
|
| Rate for Payer: Health EOS Commercial |
$67.57
|
| Rate for Payer: HFN Commercial |
$69.85
|
| Rate for Payer: Multiplan Commercial |
$60.74
|
| Rate for Payer: Preferred Network Access Commercial |
$69.85
|
| Rate for Payer: Quartz Beloit One Network |
$37.20
|
| Rate for Payer: Quartz Commercial |
$45.55
|
| Rate for Payer: WEA Trust Commercial |
$41.76
|
| Rate for Payer: WPS Commercial |
$56.23
|
|
|
Bexsero Charge 90620
|
Professional
|
Both
|
$389.00
|
|
|
Service Code
|
CPT 90620
|
| Hospital Charge Code |
5250694
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$178.01 |
| Max. Negotiated Rate |
$384.33 |
| Rate for Payer: Aetna Commercial |
$384.33
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$347.92
|
| Rate for Payer: Cash Price |
$116.70
|
| Rate for Payer: Cash Price |
$116.70
|
| Rate for Payer: Cigna Commercial |
$384.33
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$246.62
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$242.74
|
| Rate for Payer: Health EOS Commercial |
$368.15
|
| Rate for Payer: HFN Commercial |
$384.33
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$298.43
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$298.43
|
| Rate for Payer: Multiplan Commercial |
$323.65
|
| Rate for Payer: Preferred Network Access Commercial |
$384.33
|
| Rate for Payer: Quartz Beloit One Network |
$178.01
|
| Rate for Payer: Quartz Commercial |
$230.60
|
| Rate for Payer: The Alliance Commercial |
$202.28
|
| Rate for Payer: United Healthcare Medicaid |
$246.62
|
| Rate for Payer: WEA Trust Commercial |
$222.51
|
| Rate for Payer: WPS Commercial |
$299.65
|
|
|
Bexsero Charge 90620
|
Facility
|
OP
|
$389.00
|
|
|
Service Code
|
CPT 90620
|
| Hospital Charge Code |
5250694
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$113.28 |
| Max. Negotiated Rate |
$372.20 |
| Rate for Payer: Aetna Commercial |
$364.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$347.92
|
| Rate for Payer: Aetna Managed Medicare |
$113.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$262.96
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$202.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$194.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$214.42
|
| Rate for Payer: Cash Price |
$116.70
|
| Rate for Payer: Cigna Commercial |
$372.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$226.40
|
| Rate for Payer: Health EOS Commercial |
$360.06
|
| Rate for Payer: HFN Commercial |
$372.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$303.42
|
| Rate for Payer: Multiplan Commercial |
$323.65
|
| Rate for Payer: NAPHCARE Commercial |
$242.74
|
| Rate for Payer: Preferred Network Access Commercial |
$372.20
|
| Rate for Payer: Quartz Beloit One Network |
$198.23
|
| Rate for Payer: Quartz Commercial |
$262.96
|
| Rate for Payer: Quartz Medicare Advantage |
$242.74
|
| Rate for Payer: The Alliance Commercial |
$202.28
|
| Rate for Payer: WEA Trust Commercial |
$222.51
|
| Rate for Payer: WPS Commercial |
$299.65
|
|
|
Bexsero Charge 90620
|
Facility
|
IP
|
$389.00
|
|
|
Service Code
|
CPT 90620
|
| Hospital Charge Code |
5250694
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$198.23 |
| Max. Negotiated Rate |
$372.20 |
| Rate for Payer: Aetna Commercial |
$364.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$347.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$214.42
|
| Rate for Payer: Cash Price |
$116.70
|
| Rate for Payer: Cigna Commercial |
$372.20
|
| Rate for Payer: Health EOS Commercial |
$360.06
|
| Rate for Payer: HFN Commercial |
$372.20
|
| Rate for Payer: Multiplan Commercial |
$323.65
|
| Rate for Payer: Preferred Network Access Commercial |
$372.20
|
| Rate for Payer: Quartz Beloit One Network |
$198.23
|
| Rate for Payer: Quartz Commercial |
$242.74
|
| Rate for Payer: WEA Trust Commercial |
$222.51
|
| Rate for Payer: WPS Commercial |
$299.65
|
|
|
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 |
$912.04 |
| Max. Negotiated Rate |
$2,996.70 |
| Rate for Payer: Aetna Commercial |
$2,931.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,801.26
|
| Rate for Payer: Aetna Managed Medicare |
$912.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,117.23
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,628.64
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,563.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,726.36
|
| Rate for Payer: Cash Price |
$939.60
|
| Rate for Payer: Cigna Commercial |
$2,996.70
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,822.82
|
| Rate for Payer: Health EOS Commercial |
$2,898.98
|
| Rate for Payer: HFN Commercial |
$2,996.70
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,442.96
|
| Rate for Payer: Multiplan Commercial |
$2,605.82
|
| Rate for Payer: NAPHCARE Commercial |
$1,954.37
|
| Rate for Payer: Preferred Network Access Commercial |
$2,996.70
|
| Rate for Payer: Quartz Beloit One Network |
$1,596.07
|
| Rate for Payer: Quartz Commercial |
$2,117.23
|
| Rate for Payer: Quartz Medicare Advantage |
$1,954.37
|
| Rate for Payer: The Alliance Commercial |
$1,628.64
|
| Rate for Payer: WEA Trust Commercial |
$1,791.50
|
| Rate for Payer: WPS Commercial |
$2,412.58
|
|
|
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 |
$1,596.07 |
| Max. Negotiated Rate |
$2,996.70 |
| Rate for Payer: Aetna Commercial |
$2,931.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,801.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,726.36
|
| Rate for Payer: Cash Price |
$939.60
|
| Rate for Payer: Cigna Commercial |
$2,996.70
|
| Rate for Payer: Health EOS Commercial |
$2,898.98
|
| Rate for Payer: HFN Commercial |
$2,996.70
|
| Rate for Payer: Multiplan Commercial |
$2,605.82
|
| Rate for Payer: Preferred Network Access Commercial |
$2,996.70
|
| Rate for Payer: Quartz Beloit One Network |
$1,596.07
|
| Rate for Payer: Quartz Commercial |
$1,954.37
|
| Rate for Payer: WEA Trust Commercial |
$1,791.50
|
| Rate for Payer: WPS Commercial |
$2,412.58
|
|
|
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 |
$578.38 |
| Max. Negotiated Rate |
$3,094.42 |
| Rate for Payer: Aetna Commercial |
$3,094.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,801.26
|
| Rate for Payer: Cash Price |
$939.60
|
| Rate for Payer: Cash Price |
$939.60
|
| Rate for Payer: Cigna Commercial |
$3,094.42
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$578.38
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,954.37
|
| Rate for Payer: Health EOS Commercial |
$2,964.12
|
| Rate for Payer: HFN Commercial |
$3,094.42
|
| Rate for Payer: Multiplan Commercial |
$2,605.82
|
| Rate for Payer: Preferred Network Access Commercial |
$3,094.42
|
| Rate for Payer: Quartz Beloit One Network |
$1,433.20
|
| Rate for Payer: Quartz Commercial |
$1,856.65
|
| Rate for Payer: The Alliance Commercial |
$1,628.64
|
| Rate for Payer: United Healthcare Medicaid |
$578.38
|
| Rate for Payer: WEA Trust Commercial |
$1,791.50
|
| Rate for Payer: WPS Commercial |
$2,412.58
|
|
|
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 |
$578.38 |
| Max. Negotiated Rate |
$3,094.42 |
| Rate for Payer: Aetna Commercial |
$3,094.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,801.26
|
| Rate for Payer: Cash Price |
$939.60
|
| Rate for Payer: Cash Price |
$939.60
|
| Rate for Payer: Cigna Commercial |
$3,094.42
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$578.38
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,954.37
|
| Rate for Payer: Health EOS Commercial |
$2,964.12
|
| Rate for Payer: HFN Commercial |
$3,094.42
|
| Rate for Payer: Multiplan Commercial |
$2,605.82
|
| Rate for Payer: Preferred Network Access Commercial |
$3,094.42
|
| Rate for Payer: Quartz Beloit One Network |
$1,433.20
|
| Rate for Payer: Quartz Commercial |
$1,856.65
|
| Rate for Payer: The Alliance Commercial |
$1,628.64
|
| Rate for Payer: United Healthcare Medicaid |
$578.38
|
| Rate for Payer: WEA Trust Commercial |
$1,791.50
|
| Rate for Payer: WPS Commercial |
$2,412.58
|
|
|
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 |
$1,596.07 |
| Max. Negotiated Rate |
$2,996.70 |
| Rate for Payer: Aetna Commercial |
$2,931.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,801.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,726.36
|
| Rate for Payer: Cash Price |
$939.60
|
| Rate for Payer: Cigna Commercial |
$2,996.70
|
| Rate for Payer: Health EOS Commercial |
$2,898.98
|
| Rate for Payer: HFN Commercial |
$2,996.70
|
| Rate for Payer: Multiplan Commercial |
$2,605.82
|
| Rate for Payer: Preferred Network Access Commercial |
$2,996.70
|
| Rate for Payer: Quartz Beloit One Network |
$1,596.07
|
| Rate for Payer: Quartz Commercial |
$1,954.37
|
| Rate for Payer: WEA Trust Commercial |
$1,791.50
|
| Rate for Payer: WPS Commercial |
$2,412.58
|
|
|
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 |
$912.04 |
| Max. Negotiated Rate |
$2,996.70 |
| Rate for Payer: Aetna Commercial |
$2,931.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,801.26
|
| Rate for Payer: Aetna Managed Medicare |
$912.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,117.23
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,628.64
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,563.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,726.36
|
| Rate for Payer: Cash Price |
$939.60
|
| Rate for Payer: Cigna Commercial |
$2,996.70
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,822.82
|
| Rate for Payer: Health EOS Commercial |
$2,898.98
|
| Rate for Payer: HFN Commercial |
$2,996.70
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,442.96
|
| Rate for Payer: Multiplan Commercial |
$2,605.82
|
| Rate for Payer: NAPHCARE Commercial |
$1,954.37
|
| Rate for Payer: Preferred Network Access Commercial |
$2,996.70
|
| Rate for Payer: Quartz Beloit One Network |
$1,596.07
|
| Rate for Payer: Quartz Commercial |
$2,117.23
|
| Rate for Payer: Quartz Medicare Advantage |
$1,954.37
|
| Rate for Payer: The Alliance Commercial |
$1,628.64
|
| Rate for Payer: WEA Trust Commercial |
$1,791.50
|
| Rate for Payer: WPS Commercial |
$2,412.58
|
|
|
.B. henselae (IgG) Titer
|
Facility
|
OP
|
$48.10
|
|
|
Service Code
|
CPT 86611
|
| Hospital Charge Code |
5390631
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.59 |
| Max. Negotiated Rate |
$46.02 |
| Rate for Payer: Aetna Commercial |
$45.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$43.02
|
| Rate for Payer: Aetna Managed Medicare |
$10.59
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$39.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$18.53
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$17.57
|
| Rate for Payer: Anthem Medicare Advantage |
$10.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$26.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$10.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$10.59
|
| Rate for Payer: Cash Price |
$14.43
|
| Rate for Payer: Cash Price |
$14.43
|
| Rate for Payer: Cigna Commercial |
$46.02
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$10.59
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$27.99
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$10.59
|
| Rate for Payer: Health EOS Commercial |
$44.52
|
| Rate for Payer: HFN Commercial |
$46.02
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$39.38
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$10.59
|
| Rate for Payer: Independent Care Health Plan Medicare |
$10.59
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$10.59
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$10.59
|
| Rate for Payer: Multiplan Commercial |
$40.02
|
| Rate for Payer: NAPHCARE Commercial |
$15.88
|
| Rate for Payer: Preferred Network Access Commercial |
$46.02
|
| Rate for Payer: Quartz Beloit One Network |
$24.51
|
| Rate for Payer: Quartz Commercial |
$32.52
|
| Rate for Payer: Quartz Medicare Advantage |
$10.59
|
| Rate for Payer: The Alliance Commercial |
$42.35
|
| Rate for Payer: United Healthcare Medicare Advantage |
$10.59
|
| Rate for Payer: United Healthcare PPO |
$37.52
|
| Rate for Payer: WEA Trust Commercial |
$27.51
|
| Rate for Payer: Wellcare Medicare |
$10.59
|
| Rate for Payer: WPS Commercial |
$37.05
|
|
|
.B. henselae (IgG) Titer
|
Facility
|
IP
|
$48.10
|
|
|
Service Code
|
CPT 86611
|
| Hospital Charge Code |
5390631
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$24.51 |
| Max. Negotiated Rate |
$46.02 |
| Rate for Payer: Aetna Commercial |
$45.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$43.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$26.51
|
| Rate for Payer: Cash Price |
$14.43
|
| Rate for Payer: Cigna Commercial |
$46.02
|
| Rate for Payer: Health EOS Commercial |
$44.52
|
| Rate for Payer: HFN Commercial |
$46.02
|
| Rate for Payer: Multiplan Commercial |
$40.02
|
| Rate for Payer: Preferred Network Access Commercial |
$46.02
|
| Rate for Payer: Quartz Beloit One Network |
$24.51
|
| Rate for Payer: Quartz Commercial |
$30.01
|
| Rate for Payer: WEA Trust Commercial |
$27.51
|
| Rate for Payer: WPS Commercial |
$37.05
|
|
|
.B. henselae (IgG) Titer
|
Professional
|
Both
|
$48.10
|
|
|
Service Code
|
CPT 86611
|
| Hospital Charge Code |
5390631
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.59 |
| Max. Negotiated Rate |
$47.52 |
| Rate for Payer: Aetna Commercial |
$47.52
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$43.02
|
| Rate for Payer: Aetna Managed Medicare |
$10.59
|
| Rate for Payer: Anthem Medicare Advantage |
$10.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$10.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$10.59
|
| Rate for Payer: Cash Price |
$14.43
|
| Rate for Payer: Cash Price |
$14.43
|
| Rate for Payer: Cigna Commercial |
$47.52
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$25.01
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$10.59
|
| Rate for Payer: Health EOS Commercial |
$45.52
|
| Rate for Payer: HFN Commercial |
$47.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$37.38
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$37.38
|
| Rate for Payer: Independent Care Health Plan Medicare |
$10.59
|
| Rate for Payer: Multiplan Commercial |
$40.02
|
| Rate for Payer: NAPHCARE Commercial |
$15.88
|
| Rate for Payer: Preferred Network Access Commercial |
$47.52
|
| Rate for Payer: Quartz Beloit One Network |
$22.01
|
| Rate for Payer: Quartz Commercial |
$28.51
|
| Rate for Payer: Quartz Medicare Advantage |
$10.59
|
| Rate for Payer: The Alliance Commercial |
$41.82
|
| Rate for Payer: United Healthcare Medicare Advantage |
$10.59
|
| Rate for Payer: WEA Trust Commercial |
$27.51
|
| Rate for Payer: WPS Commercial |
$46.58
|
|
|
.B. henselae (IgM) Titer
|
Facility
|
IP
|
$96.85
|
|
|
Service Code
|
CPT 86611
|
| Hospital Charge Code |
5390632
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$49.35 |
| Max. Negotiated Rate |
$92.67 |
| Rate for Payer: Aetna Commercial |
$90.65
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$86.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$53.38
|
| Rate for Payer: Cash Price |
$29.05
|
| Rate for Payer: Cigna Commercial |
$92.67
|
| Rate for Payer: Health EOS Commercial |
$89.64
|
| Rate for Payer: HFN Commercial |
$92.67
|
| Rate for Payer: Multiplan Commercial |
$80.58
|
| Rate for Payer: Preferred Network Access Commercial |
$92.67
|
| Rate for Payer: Quartz Beloit One Network |
$49.35
|
| Rate for Payer: Quartz Commercial |
$60.43
|
| Rate for Payer: WEA Trust Commercial |
$55.40
|
| Rate for Payer: WPS Commercial |
$74.60
|
|
|
.B. henselae (IgM) Titer
|
Professional
|
Both
|
$96.85
|
|
|
Service Code
|
CPT 86611
|
| Hospital Charge Code |
5390632
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.59 |
| Max. Negotiated Rate |
$95.69 |
| Rate for Payer: Aetna Commercial |
$95.69
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$86.62
|
| Rate for Payer: Aetna Managed Medicare |
$10.59
|
| Rate for Payer: Anthem Medicare Advantage |
$10.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$10.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$10.59
|
| Rate for Payer: Cash Price |
$29.05
|
| Rate for Payer: Cash Price |
$29.05
|
| Rate for Payer: Cigna Commercial |
$95.69
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$50.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$10.59
|
| Rate for Payer: Health EOS Commercial |
$91.66
|
| Rate for Payer: HFN Commercial |
$95.69
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$37.38
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$37.38
|
| Rate for Payer: Independent Care Health Plan Medicare |
$10.59
|
| Rate for Payer: Multiplan Commercial |
$80.58
|
| Rate for Payer: NAPHCARE Commercial |
$15.88
|
| Rate for Payer: Preferred Network Access Commercial |
$95.69
|
| Rate for Payer: Quartz Beloit One Network |
$44.32
|
| Rate for Payer: Quartz Commercial |
$57.41
|
| Rate for Payer: Quartz Medicare Advantage |
$10.59
|
| Rate for Payer: The Alliance Commercial |
$41.82
|
| Rate for Payer: United Healthcare Medicare Advantage |
$10.59
|
| Rate for Payer: WEA Trust Commercial |
$55.40
|
| Rate for Payer: WPS Commercial |
$46.58
|
|
|
.B. henselae (IgM) Titer
|
Facility
|
OP
|
$96.85
|
|
|
Service Code
|
CPT 86611
|
| Hospital Charge Code |
5390632
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.59 |
| Max. Negotiated Rate |
$92.67 |
| Rate for Payer: Aetna Commercial |
$90.65
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$86.62
|
| Rate for Payer: Aetna Managed Medicare |
$10.59
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$39.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$18.53
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$17.57
|
| Rate for Payer: Anthem Medicare Advantage |
$10.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$53.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$10.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$10.59
|
| Rate for Payer: Cash Price |
$29.05
|
| Rate for Payer: Cash Price |
$29.05
|
| Rate for Payer: Cigna Commercial |
$92.67
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$10.59
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$56.37
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$10.59
|
| Rate for Payer: Health EOS Commercial |
$89.64
|
| Rate for Payer: HFN Commercial |
$92.67
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$39.38
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$10.59
|
| Rate for Payer: Independent Care Health Plan Medicare |
$10.59
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$10.59
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$10.59
|
| Rate for Payer: Multiplan Commercial |
$80.58
|
| Rate for Payer: NAPHCARE Commercial |
$15.88
|
| Rate for Payer: Preferred Network Access Commercial |
$92.67
|
| Rate for Payer: Quartz Beloit One Network |
$49.35
|
| Rate for Payer: Quartz Commercial |
$65.47
|
| Rate for Payer: Quartz Medicare Advantage |
$10.59
|
| Rate for Payer: The Alliance Commercial |
$42.35
|
| Rate for Payer: United Healthcare Medicare Advantage |
$10.59
|
| Rate for Payer: United Healthcare PPO |
$75.54
|
| Rate for Payer: WEA Trust Commercial |
$55.40
|
| Rate for Payer: Wellcare Medicare |
$10.59
|
| Rate for Payer: WPS Commercial |
$74.60
|
|
|
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 |
$1,257.11 |
| Max. Negotiated Rate |
$4,130.51 |
| Rate for Payer: Aetna Commercial |
$4,040.71
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,861.12
|
| Rate for Payer: Aetna Managed Medicare |
$1,257.11
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,918.29
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,244.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,155.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,379.53
|
| Rate for Payer: Cash Price |
$1,295.10
|
| Rate for Payer: Cigna Commercial |
$4,130.51
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,512.49
|
| Rate for Payer: Health EOS Commercial |
$3,995.82
|
| Rate for Payer: HFN Commercial |
$4,130.51
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,367.26
|
| Rate for Payer: Multiplan Commercial |
$3,591.74
|
| Rate for Payer: NAPHCARE Commercial |
$2,693.81
|
| Rate for Payer: Preferred Network Access Commercial |
$4,130.51
|
| Rate for Payer: Quartz Beloit One Network |
$2,199.94
|
| Rate for Payer: Quartz Commercial |
$2,918.29
|
| Rate for Payer: Quartz Medicare Advantage |
$2,693.81
|
| Rate for Payer: The Alliance Commercial |
$2,244.84
|
| Rate for Payer: WEA Trust Commercial |
$2,469.32
|
| Rate for Payer: WPS Commercial |
$3,325.39
|
|
|
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 |
$2,199.94 |
| Max. Negotiated Rate |
$4,130.51 |
| Rate for Payer: Aetna Commercial |
$4,040.71
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,861.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,379.53
|
| Rate for Payer: Cash Price |
$1,295.10
|
| Rate for Payer: Cigna Commercial |
$4,130.51
|
| Rate for Payer: Health EOS Commercial |
$3,995.82
|
| Rate for Payer: HFN Commercial |
$4,130.51
|
| Rate for Payer: Multiplan Commercial |
$3,591.74
|
| Rate for Payer: Preferred Network Access Commercial |
$4,130.51
|
| Rate for Payer: Quartz Beloit One Network |
$2,199.94
|
| Rate for Payer: Quartz Commercial |
$2,693.81
|
| Rate for Payer: WEA Trust Commercial |
$2,469.32
|
| Rate for Payer: WPS Commercial |
$3,325.39
|
|
|
BICEPS, TENDON/NERVE REPAIR
|
Facility
|
OP
|
$4,657.00
|
|
| Hospital Charge Code |
2960416
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,356.12 |
| Max. Negotiated Rate |
$4,455.82 |
| Rate for Payer: Aetna Commercial |
$4,358.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,165.22
|
| Rate for Payer: Aetna Managed Medicare |
$1,356.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,148.13
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,421.64
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,324.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,566.94
|
| Rate for Payer: Cash Price |
$1,397.10
|
| Rate for Payer: Cigna Commercial |
$4,455.82
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,710.37
|
| Rate for Payer: Health EOS Commercial |
$4,310.52
|
| Rate for Payer: HFN Commercial |
$4,455.82
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,632.46
|
| Rate for Payer: Multiplan Commercial |
$3,874.62
|
| Rate for Payer: NAPHCARE Commercial |
$2,905.97
|
| Rate for Payer: Preferred Network Access Commercial |
$4,455.82
|
| Rate for Payer: Quartz Beloit One Network |
$2,373.21
|
| Rate for Payer: Quartz Commercial |
$3,148.13
|
| Rate for Payer: Quartz Medicare Advantage |
$2,905.97
|
| Rate for Payer: The Alliance Commercial |
$2,421.64
|
| Rate for Payer: WEA Trust Commercial |
$2,663.80
|
| Rate for Payer: WPS Commercial |
$3,587.29
|
|
|
BICEPS, TENDON/NERVE REPAIR
|
Facility
|
IP
|
$4,657.00
|
|
| Hospital Charge Code |
2960416
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,373.21 |
| Max. Negotiated Rate |
$4,455.82 |
| Rate for Payer: Aetna Commercial |
$4,358.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,165.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,566.94
|
| Rate for Payer: Cash Price |
$1,397.10
|
| Rate for Payer: Cigna Commercial |
$4,455.82
|
| Rate for Payer: Health EOS Commercial |
$4,310.52
|
| Rate for Payer: HFN Commercial |
$4,455.82
|
| Rate for Payer: Multiplan Commercial |
$3,874.62
|
| Rate for Payer: Preferred Network Access Commercial |
$4,455.82
|
| Rate for Payer: Quartz Beloit One Network |
$2,373.21
|
| Rate for Payer: Quartz Commercial |
$2,905.97
|
| Rate for Payer: WEA Trust Commercial |
$2,663.80
|
| Rate for Payer: WPS Commercial |
$3,587.29
|
|
|
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 |
$335.32 |
| Max. Negotiated Rate |
$629.57 |
| Rate for Payer: Aetna Commercial |
$615.89
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$588.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$362.69
|
| Rate for Payer: Cash Price |
$197.40
|
| Rate for Payer: Cigna Commercial |
$629.57
|
| Rate for Payer: Health EOS Commercial |
$609.04
|
| Rate for Payer: HFN Commercial |
$629.57
|
| Rate for Payer: Multiplan Commercial |
$547.46
|
| Rate for Payer: Preferred Network Access Commercial |
$629.57
|
| Rate for Payer: Quartz Beloit One Network |
$335.32
|
| Rate for Payer: Quartz Commercial |
$410.59
|
| Rate for Payer: WEA Trust Commercial |
$376.38
|
| Rate for Payer: WPS Commercial |
$506.86
|
|
