|
Veriflex 4.0mm x 8mm
|
Facility
IP
|
$17,408.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
1162982
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,529.92 |
| Max. Negotiated Rate |
$16,015.36 |
| Rate for Payer: Aetna Commercial |
$15,667.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,226.24
|
| Rate for Payer: Cash Price |
$5,222.40
|
| Rate for Payer: Cigna Commercial |
$16,015.36
|
| Rate for Payer: Health EOS Commercial |
$15,493.12
|
| Rate for Payer: HFN Commercial |
$16,015.36
|
| Rate for Payer: Multiplan Commercial |
$13,926.40
|
| Rate for Payer: NAPHCARE Commercial |
$10,444.80
|
| Rate for Payer: Preferred Network Access Commercial |
$16,015.36
|
| Rate for Payer: Quartz Beloit One Network |
$8,529.92
|
| Rate for Payer: Quartz Commercial |
$10,444.80
|
| Rate for Payer: WEA Trust Commercial |
$9,574.40
|
| Rate for Payer: WPS Commercial |
$12,894.11
|
|
|
Veriflex 4.0mm x 8mm
|
Professional
|
$17,408.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
1162982
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,659.52 |
| Max. Negotiated Rate |
$16,537.60 |
| Rate for Payer: Aetna Commercial |
$16,537.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$14,970.88
|
| Rate for Payer: Cash Price |
$5,222.40
|
| Rate for Payer: Cigna Commercial |
$16,537.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$8,704.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$10,444.80
|
| Rate for Payer: Health EOS Commercial |
$15,841.28
|
| Rate for Payer: Multiplan Commercial |
$13,926.40
|
| Rate for Payer: Preferred Network Access Commercial |
$16,537.60
|
| Rate for Payer: Quartz Beloit One Network |
$7,659.52
|
| Rate for Payer: Quartz Commercial |
$9,922.56
|
| Rate for Payer: The Alliance Commercial |
$8,704.00
|
| Rate for Payer: WEA Trust Commercial |
$9,574.40
|
| Rate for Payer: WPS Commercial |
$12,894.11
|
|
|
Veriflex 4.5mm x 12mm
|
Facility
IP
|
$17,408.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
1162988
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,529.92 |
| Max. Negotiated Rate |
$16,015.36 |
| Rate for Payer: Aetna Commercial |
$15,667.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,226.24
|
| Rate for Payer: Cash Price |
$5,222.40
|
| Rate for Payer: Cigna Commercial |
$16,015.36
|
| Rate for Payer: Health EOS Commercial |
$15,493.12
|
| Rate for Payer: HFN Commercial |
$16,015.36
|
| Rate for Payer: Multiplan Commercial |
$13,926.40
|
| Rate for Payer: NAPHCARE Commercial |
$10,444.80
|
| Rate for Payer: Preferred Network Access Commercial |
$16,015.36
|
| Rate for Payer: Quartz Beloit One Network |
$8,529.92
|
| Rate for Payer: Quartz Commercial |
$10,444.80
|
| Rate for Payer: WEA Trust Commercial |
$9,574.40
|
| Rate for Payer: WPS Commercial |
$12,894.11
|
|
|
Veriflex 4.5mm x 12mm
|
Professional
|
$17,408.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
1162988
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,659.52 |
| Max. Negotiated Rate |
$16,537.60 |
| Rate for Payer: Aetna Commercial |
$16,537.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$14,970.88
|
| Rate for Payer: Cash Price |
$5,222.40
|
| Rate for Payer: Cigna Commercial |
$16,537.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$8,704.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$10,444.80
|
| Rate for Payer: Health EOS Commercial |
$15,841.28
|
| Rate for Payer: Multiplan Commercial |
$13,926.40
|
| Rate for Payer: Preferred Network Access Commercial |
$16,537.60
|
| Rate for Payer: Quartz Beloit One Network |
$7,659.52
|
| Rate for Payer: Quartz Commercial |
$9,922.56
|
| Rate for Payer: The Alliance Commercial |
$8,704.00
|
| Rate for Payer: WEA Trust Commercial |
$9,574.40
|
| Rate for Payer: WPS Commercial |
$12,894.11
|
|
|
Veriflex 4.5mm x 12mm
|
Facility
OP
|
$17,408.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
1162988
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,874.24 |
| Max. Negotiated Rate |
$16,015.36 |
| Rate for Payer: Aetna Commercial |
$15,667.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$14,970.88
|
| Rate for Payer: Aetna Managed Medicare |
$4,874.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$11,315.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8,704.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$8,355.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,226.24
|
| Rate for Payer: Cash Price |
$5,222.40
|
| Rate for Payer: Cigna Commercial |
$16,015.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$9,741.52
|
| Rate for Payer: Health EOS Commercial |
$15,493.12
|
| Rate for Payer: HFN Commercial |
$16,015.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$13,056.00
|
| Rate for Payer: Multiplan Commercial |
$13,926.40
|
| Rate for Payer: NAPHCARE Commercial |
$10,444.80
|
| Rate for Payer: Preferred Network Access Commercial |
$16,015.36
|
| Rate for Payer: Quartz Beloit One Network |
$8,529.92
|
| Rate for Payer: Quartz Commercial |
$11,315.20
|
| Rate for Payer: Quartz Medicare Advantage |
$10,444.80
|
| Rate for Payer: WEA Trust Commercial |
$9,574.40
|
| Rate for Payer: WPS Commercial |
$12,894.11
|
|
|
Veriflex 4.5mm x 16mm
|
Professional
|
$17,408.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
1162990
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,659.52 |
| Max. Negotiated Rate |
$16,537.60 |
| Rate for Payer: Aetna Commercial |
$16,537.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$14,970.88
|
| Rate for Payer: Cash Price |
$5,222.40
|
| Rate for Payer: Cigna Commercial |
$16,537.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$8,704.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$10,444.80
|
| Rate for Payer: Health EOS Commercial |
$15,841.28
|
| Rate for Payer: Multiplan Commercial |
$13,926.40
|
| Rate for Payer: Preferred Network Access Commercial |
$16,537.60
|
| Rate for Payer: Quartz Beloit One Network |
$7,659.52
|
| Rate for Payer: Quartz Commercial |
$9,922.56
|
| Rate for Payer: The Alliance Commercial |
$8,704.00
|
| Rate for Payer: WEA Trust Commercial |
$9,574.40
|
| Rate for Payer: WPS Commercial |
$12,894.11
|
|
|
Veriflex 4.5mm x 16mm
|
Facility
OP
|
$17,408.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
1162990
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,874.24 |
| Max. Negotiated Rate |
$16,015.36 |
| Rate for Payer: Aetna Commercial |
$15,667.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$14,970.88
|
| Rate for Payer: Aetna Managed Medicare |
$4,874.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$11,315.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8,704.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$8,355.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,226.24
|
| Rate for Payer: Cash Price |
$5,222.40
|
| Rate for Payer: Cigna Commercial |
$16,015.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$9,741.52
|
| Rate for Payer: Health EOS Commercial |
$15,493.12
|
| Rate for Payer: HFN Commercial |
$16,015.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$13,056.00
|
| Rate for Payer: Multiplan Commercial |
$13,926.40
|
| Rate for Payer: NAPHCARE Commercial |
$10,444.80
|
| Rate for Payer: Preferred Network Access Commercial |
$16,015.36
|
| Rate for Payer: Quartz Beloit One Network |
$8,529.92
|
| Rate for Payer: Quartz Commercial |
$11,315.20
|
| Rate for Payer: Quartz Medicare Advantage |
$10,444.80
|
| Rate for Payer: WEA Trust Commercial |
$9,574.40
|
| Rate for Payer: WPS Commercial |
$12,894.11
|
|
|
Veriflex 4.5mm x 16mm
|
Facility
IP
|
$17,408.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
1162990
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,529.92 |
| Max. Negotiated Rate |
$16,015.36 |
| Rate for Payer: Aetna Commercial |
$15,667.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,226.24
|
| Rate for Payer: Cash Price |
$5,222.40
|
| Rate for Payer: Cigna Commercial |
$16,015.36
|
| Rate for Payer: Health EOS Commercial |
$15,493.12
|
| Rate for Payer: HFN Commercial |
$16,015.36
|
| Rate for Payer: Multiplan Commercial |
$13,926.40
|
| Rate for Payer: NAPHCARE Commercial |
$10,444.80
|
| Rate for Payer: Preferred Network Access Commercial |
$16,015.36
|
| Rate for Payer: Quartz Beloit One Network |
$8,529.92
|
| Rate for Payer: Quartz Commercial |
$10,444.80
|
| Rate for Payer: WEA Trust Commercial |
$9,574.40
|
| Rate for Payer: WPS Commercial |
$12,894.11
|
|
|
Veriflex 5.0mm x 12mm
|
Professional
|
$17,408.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
1162992
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,659.52 |
| Max. Negotiated Rate |
$16,537.60 |
| Rate for Payer: Aetna Commercial |
$16,537.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$14,970.88
|
| Rate for Payer: Cash Price |
$5,222.40
|
| Rate for Payer: Cigna Commercial |
$16,537.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$8,704.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$10,444.80
|
| Rate for Payer: Health EOS Commercial |
$15,841.28
|
| Rate for Payer: Multiplan Commercial |
$13,926.40
|
| Rate for Payer: Preferred Network Access Commercial |
$16,537.60
|
| Rate for Payer: Quartz Beloit One Network |
$7,659.52
|
| Rate for Payer: Quartz Commercial |
$9,922.56
|
| Rate for Payer: The Alliance Commercial |
$8,704.00
|
| Rate for Payer: WEA Trust Commercial |
$9,574.40
|
| Rate for Payer: WPS Commercial |
$12,894.11
|
|
|
Veriflex 5.0mm x 12mm
|
Facility
OP
|
$17,408.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
1162992
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,874.24 |
| Max. Negotiated Rate |
$16,015.36 |
| Rate for Payer: Aetna Commercial |
$15,667.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$14,970.88
|
| Rate for Payer: Aetna Managed Medicare |
$4,874.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$11,315.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8,704.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$8,355.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,226.24
|
| Rate for Payer: Cash Price |
$5,222.40
|
| Rate for Payer: Cigna Commercial |
$16,015.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$9,741.52
|
| Rate for Payer: Health EOS Commercial |
$15,493.12
|
| Rate for Payer: HFN Commercial |
$16,015.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$13,056.00
|
| Rate for Payer: Multiplan Commercial |
$13,926.40
|
| Rate for Payer: NAPHCARE Commercial |
$10,444.80
|
| Rate for Payer: Preferred Network Access Commercial |
$16,015.36
|
| Rate for Payer: Quartz Beloit One Network |
$8,529.92
|
| Rate for Payer: Quartz Commercial |
$11,315.20
|
| Rate for Payer: Quartz Medicare Advantage |
$10,444.80
|
| Rate for Payer: WEA Trust Commercial |
$9,574.40
|
| Rate for Payer: WPS Commercial |
$12,894.11
|
|
|
Veriflex 5.0mm x 12mm
|
Facility
IP
|
$17,408.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
1162992
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,529.92 |
| Max. Negotiated Rate |
$16,015.36 |
| Rate for Payer: Aetna Commercial |
$15,667.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,226.24
|
| Rate for Payer: Cash Price |
$5,222.40
|
| Rate for Payer: Cigna Commercial |
$16,015.36
|
| Rate for Payer: Health EOS Commercial |
$15,493.12
|
| Rate for Payer: HFN Commercial |
$16,015.36
|
| Rate for Payer: Multiplan Commercial |
$13,926.40
|
| Rate for Payer: NAPHCARE Commercial |
$10,444.80
|
| Rate for Payer: Preferred Network Access Commercial |
$16,015.36
|
| Rate for Payer: Quartz Beloit One Network |
$8,529.92
|
| Rate for Payer: Quartz Commercial |
$10,444.80
|
| Rate for Payer: WEA Trust Commercial |
$9,574.40
|
| Rate for Payer: WPS Commercial |
$12,894.11
|
|
|
Veriflex 5.0mm x 16mm
|
Facility
OP
|
$17,408.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
1162994
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,874.24 |
| Max. Negotiated Rate |
$16,015.36 |
| Rate for Payer: Aetna Commercial |
$15,667.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$14,970.88
|
| Rate for Payer: Aetna Managed Medicare |
$4,874.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$11,315.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8,704.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$8,355.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,226.24
|
| Rate for Payer: Cash Price |
$5,222.40
|
| Rate for Payer: Cigna Commercial |
$16,015.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$9,741.52
|
| Rate for Payer: Health EOS Commercial |
$15,493.12
|
| Rate for Payer: HFN Commercial |
$16,015.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$13,056.00
|
| Rate for Payer: Multiplan Commercial |
$13,926.40
|
| Rate for Payer: NAPHCARE Commercial |
$10,444.80
|
| Rate for Payer: Preferred Network Access Commercial |
$16,015.36
|
| Rate for Payer: Quartz Beloit One Network |
$8,529.92
|
| Rate for Payer: Quartz Commercial |
$11,315.20
|
| Rate for Payer: Quartz Medicare Advantage |
$10,444.80
|
| Rate for Payer: WEA Trust Commercial |
$9,574.40
|
| Rate for Payer: WPS Commercial |
$12,894.11
|
|
|
Veriflex 5.0mm x 16mm
|
Facility
IP
|
$17,408.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
1162994
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,529.92 |
| Max. Negotiated Rate |
$16,015.36 |
| Rate for Payer: Aetna Commercial |
$15,667.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,226.24
|
| Rate for Payer: Cash Price |
$5,222.40
|
| Rate for Payer: Cigna Commercial |
$16,015.36
|
| Rate for Payer: Health EOS Commercial |
$15,493.12
|
| Rate for Payer: HFN Commercial |
$16,015.36
|
| Rate for Payer: Multiplan Commercial |
$13,926.40
|
| Rate for Payer: NAPHCARE Commercial |
$10,444.80
|
| Rate for Payer: Preferred Network Access Commercial |
$16,015.36
|
| Rate for Payer: Quartz Beloit One Network |
$8,529.92
|
| Rate for Payer: Quartz Commercial |
$10,444.80
|
| Rate for Payer: WEA Trust Commercial |
$9,574.40
|
| Rate for Payer: WPS Commercial |
$12,894.11
|
|
|
Veriflex 5.0mm x 16mm
|
Professional
|
$17,408.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
1162994
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,659.52 |
| Max. Negotiated Rate |
$16,537.60 |
| Rate for Payer: Aetna Commercial |
$16,537.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$14,970.88
|
| Rate for Payer: Cash Price |
$5,222.40
|
| Rate for Payer: Cigna Commercial |
$16,537.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$8,704.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$10,444.80
|
| Rate for Payer: Health EOS Commercial |
$15,841.28
|
| Rate for Payer: Multiplan Commercial |
$13,926.40
|
| Rate for Payer: Preferred Network Access Commercial |
$16,537.60
|
| Rate for Payer: Quartz Beloit One Network |
$7,659.52
|
| Rate for Payer: Quartz Commercial |
$9,922.56
|
| Rate for Payer: The Alliance Commercial |
$8,704.00
|
| Rate for Payer: WEA Trust Commercial |
$9,574.40
|
| Rate for Payer: WPS Commercial |
$12,894.11
|
|
|
Verigene Gram Negative PCR Report
|
Facility
OP
|
$212.00
|
|
|
Service Code
|
CPT 87149
|
| Hospital Charge Code |
5466692
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$20.05 |
| Max. Negotiated Rate |
$848.00 |
| Rate for Payer: Aetna Commercial |
$190.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$182.32
|
| Rate for Payer: Aetna Managed Medicare |
$20.05
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$75.19
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$35.09
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$33.28
|
| Rate for Payer: Anthem Medicaid |
$20.72
|
| Rate for Payer: Anthem Medicare Advantage |
$20.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$112.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$20.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$20.05
|
| Rate for Payer: Cash Price |
$63.60
|
| Rate for Payer: Cash Price |
$63.60
|
| Rate for Payer: Cigna Commercial |
$195.04
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$20.05
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$20.72
|
| Rate for Payer: Dean Health Medicaid |
$20.72
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$20.05
|
| Rate for Payer: Health EOS Commercial |
$188.68
|
| Rate for Payer: HFN Commercial |
$195.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$74.59
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$20.05
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$20.72
|
| Rate for Payer: Independent Care Health Plan Medicare |
$20.05
|
| Rate for Payer: Managed Health Services Medicaid |
$21.55
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$20.05
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$20.05
|
| Rate for Payer: Multiplan Commercial |
$169.60
|
| Rate for Payer: NAPHCARE Commercial |
$30.08
|
| Rate for Payer: Preferred Network Access Commercial |
$195.04
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$20.72
|
| Rate for Payer: Quartz Beloit One Network |
$103.88
|
| Rate for Payer: Quartz Commercial |
$137.80
|
| Rate for Payer: Quartz Medicare Advantage |
$20.05
|
| Rate for Payer: The Alliance Commercial |
$848.00
|
| Rate for Payer: United Healthcare Medicaid |
$20.72
|
| Rate for Payer: United Healthcare Medicare Advantage |
$20.05
|
| Rate for Payer: United Healthcare PPO |
$159.00
|
| Rate for Payer: WEA Trust Commercial |
$116.60
|
| Rate for Payer: Wellcare Medicare |
$20.05
|
| Rate for Payer: WMAP Medicaid |
$20.72
|
| Rate for Payer: WPS Commercial |
$157.03
|
|
|
Verigene Gram Negative PCR Report
|
Facility
OP
|
$212.00
|
|
|
Service Code
|
CPT 87149
|
| Hospital Charge Code |
5454662
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$20.05 |
| Max. Negotiated Rate |
$848.00 |
| Rate for Payer: Aetna Commercial |
$190.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$182.32
|
| Rate for Payer: Aetna Managed Medicare |
$20.05
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$75.19
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$35.09
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$33.28
|
| Rate for Payer: Anthem Medicaid |
$20.72
|
| Rate for Payer: Anthem Medicare Advantage |
$20.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$112.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$20.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$20.05
|
| Rate for Payer: Cash Price |
$63.60
|
| Rate for Payer: Cash Price |
$63.60
|
| Rate for Payer: Cigna Commercial |
$195.04
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$20.05
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$20.72
|
| Rate for Payer: Dean Health Medicaid |
$20.72
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$20.05
|
| Rate for Payer: Health EOS Commercial |
$188.68
|
| Rate for Payer: HFN Commercial |
$195.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$74.59
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$20.05
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$20.72
|
| Rate for Payer: Independent Care Health Plan Medicare |
$20.05
|
| Rate for Payer: Managed Health Services Medicaid |
$21.55
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$20.05
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$20.05
|
| Rate for Payer: Multiplan Commercial |
$169.60
|
| Rate for Payer: NAPHCARE Commercial |
$30.08
|
| Rate for Payer: Preferred Network Access Commercial |
$195.04
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$20.72
|
| Rate for Payer: Quartz Beloit One Network |
$103.88
|
| Rate for Payer: Quartz Commercial |
$137.80
|
| Rate for Payer: Quartz Medicare Advantage |
$20.05
|
| Rate for Payer: The Alliance Commercial |
$848.00
|
| Rate for Payer: United Healthcare Medicaid |
$20.72
|
| Rate for Payer: United Healthcare Medicare Advantage |
$20.05
|
| Rate for Payer: United Healthcare PPO |
$159.00
|
| Rate for Payer: WEA Trust Commercial |
$116.60
|
| Rate for Payer: Wellcare Medicare |
$20.05
|
| Rate for Payer: WMAP Medicaid |
$20.72
|
| Rate for Payer: WPS Commercial |
$157.03
|
|
|
Verigene Gram Negative PCR Report
|
Professional
|
$212.00
|
|
|
Service Code
|
CPT 87149
|
| Hospital Charge Code |
5466692
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$20.05 |
| Max. Negotiated Rate |
$201.40 |
| Rate for Payer: Aetna Commercial |
$201.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$182.32
|
| Rate for Payer: Aetna Managed Medicare |
$20.05
|
| Rate for Payer: Anthem Medicare Advantage |
$20.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$20.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$20.05
|
| Rate for Payer: Cash Price |
$63.60
|
| Rate for Payer: Cash Price |
$63.60
|
| Rate for Payer: Cigna Commercial |
$201.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$106.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$20.05
|
| Rate for Payer: Health EOS Commercial |
$192.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$70.78
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$70.78
|
| Rate for Payer: Independent Care Health Plan Medicare |
$20.05
|
| Rate for Payer: Multiplan Commercial |
$169.60
|
| Rate for Payer: Preferred Network Access Commercial |
$201.40
|
| Rate for Payer: Quartz Beloit One Network |
$93.28
|
| Rate for Payer: Quartz Commercial |
$120.84
|
| Rate for Payer: Quartz Medicare Advantage |
$20.05
|
| Rate for Payer: The Alliance Commercial |
$79.20
|
| Rate for Payer: United Healthcare Medicare Advantage |
$20.05
|
| Rate for Payer: WEA Trust Commercial |
$116.60
|
| Rate for Payer: WPS Commercial |
$88.22
|
|
|
Verigene Gram Negative PCR Report
|
Professional
|
$212.00
|
|
|
Service Code
|
CPT 87149
|
| Hospital Charge Code |
5454662
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$20.05 |
| Max. Negotiated Rate |
$201.40 |
| Rate for Payer: Aetna Commercial |
$201.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$182.32
|
| Rate for Payer: Aetna Managed Medicare |
$20.05
|
| Rate for Payer: Anthem Medicare Advantage |
$20.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$20.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$20.05
|
| Rate for Payer: Cash Price |
$63.60
|
| Rate for Payer: Cash Price |
$63.60
|
| Rate for Payer: Cigna Commercial |
$201.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$106.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$20.05
|
| Rate for Payer: Health EOS Commercial |
$192.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$70.78
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$70.78
|
| Rate for Payer: Independent Care Health Plan Medicare |
$20.05
|
| Rate for Payer: Multiplan Commercial |
$169.60
|
| Rate for Payer: Preferred Network Access Commercial |
$201.40
|
| Rate for Payer: Quartz Beloit One Network |
$93.28
|
| Rate for Payer: Quartz Commercial |
$120.84
|
| Rate for Payer: Quartz Medicare Advantage |
$20.05
|
| Rate for Payer: The Alliance Commercial |
$79.20
|
| Rate for Payer: United Healthcare Medicare Advantage |
$20.05
|
| Rate for Payer: WEA Trust Commercial |
$116.60
|
| Rate for Payer: WPS Commercial |
$88.22
|
|
|
Verigene Gram Negative PCR Report
|
Facility
IP
|
$212.00
|
|
|
Service Code
|
CPT 87149
|
| Hospital Charge Code |
5454662
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$103.88 |
| Max. Negotiated Rate |
$195.04 |
| Rate for Payer: Aetna Commercial |
$190.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$112.36
|
| Rate for Payer: Cash Price |
$63.60
|
| Rate for Payer: Cigna Commercial |
$195.04
|
| Rate for Payer: Health EOS Commercial |
$188.68
|
| Rate for Payer: HFN Commercial |
$195.04
|
| Rate for Payer: Multiplan Commercial |
$169.60
|
| Rate for Payer: NAPHCARE Commercial |
$127.20
|
| Rate for Payer: Preferred Network Access Commercial |
$195.04
|
| Rate for Payer: Quartz Beloit One Network |
$103.88
|
| Rate for Payer: Quartz Commercial |
$127.20
|
| Rate for Payer: WEA Trust Commercial |
$116.60
|
| Rate for Payer: WPS Commercial |
$157.03
|
|
|
Verigene Gram Negative PCR Report
|
Facility
IP
|
$212.00
|
|
|
Service Code
|
CPT 87149
|
| Hospital Charge Code |
5466692
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$103.88 |
| Max. Negotiated Rate |
$195.04 |
| Rate for Payer: Aetna Commercial |
$190.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$112.36
|
| Rate for Payer: Cash Price |
$63.60
|
| Rate for Payer: Cigna Commercial |
$195.04
|
| Rate for Payer: Health EOS Commercial |
$188.68
|
| Rate for Payer: HFN Commercial |
$195.04
|
| Rate for Payer: Multiplan Commercial |
$169.60
|
| Rate for Payer: NAPHCARE Commercial |
$127.20
|
| Rate for Payer: Preferred Network Access Commercial |
$195.04
|
| Rate for Payer: Quartz Beloit One Network |
$103.88
|
| Rate for Payer: Quartz Commercial |
$127.20
|
| Rate for Payer: WEA Trust Commercial |
$116.60
|
| Rate for Payer: WPS Commercial |
$157.03
|
|
|
Verigene Gram Positive PCR Report
|
Professional
|
$212.00
|
|
|
Service Code
|
CPT 87149
|
| Hospital Charge Code |
5466693
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$20.05 |
| Max. Negotiated Rate |
$201.40 |
| Rate for Payer: Aetna Commercial |
$201.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$182.32
|
| Rate for Payer: Aetna Managed Medicare |
$20.05
|
| Rate for Payer: Anthem Medicare Advantage |
$20.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$20.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$20.05
|
| Rate for Payer: Cash Price |
$63.60
|
| Rate for Payer: Cash Price |
$63.60
|
| Rate for Payer: Cigna Commercial |
$201.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$106.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$20.05
|
| Rate for Payer: Health EOS Commercial |
$192.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$70.78
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$70.78
|
| Rate for Payer: Independent Care Health Plan Medicare |
$20.05
|
| Rate for Payer: Multiplan Commercial |
$169.60
|
| Rate for Payer: Preferred Network Access Commercial |
$201.40
|
| Rate for Payer: Quartz Beloit One Network |
$93.28
|
| Rate for Payer: Quartz Commercial |
$120.84
|
| Rate for Payer: Quartz Medicare Advantage |
$20.05
|
| Rate for Payer: The Alliance Commercial |
$79.20
|
| Rate for Payer: United Healthcare Medicare Advantage |
$20.05
|
| Rate for Payer: WEA Trust Commercial |
$116.60
|
| Rate for Payer: WPS Commercial |
$88.22
|
|
|
Verigene Gram Positive PCR Report
|
Facility
OP
|
$212.00
|
|
|
Service Code
|
CPT 87149
|
| Hospital Charge Code |
5466693
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$20.05 |
| Max. Negotiated Rate |
$848.00 |
| Rate for Payer: Aetna Commercial |
$190.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$182.32
|
| Rate for Payer: Aetna Managed Medicare |
$20.05
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$75.19
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$35.09
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$33.28
|
| Rate for Payer: Anthem Medicaid |
$20.72
|
| Rate for Payer: Anthem Medicare Advantage |
$20.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$112.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$20.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$20.05
|
| Rate for Payer: Cash Price |
$63.60
|
| Rate for Payer: Cash Price |
$63.60
|
| Rate for Payer: Cigna Commercial |
$195.04
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$20.05
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$20.72
|
| Rate for Payer: Dean Health Medicaid |
$20.72
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$20.05
|
| Rate for Payer: Health EOS Commercial |
$188.68
|
| Rate for Payer: HFN Commercial |
$195.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$74.59
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$20.05
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$20.72
|
| Rate for Payer: Independent Care Health Plan Medicare |
$20.05
|
| Rate for Payer: Managed Health Services Medicaid |
$21.55
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$20.05
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$20.05
|
| Rate for Payer: Multiplan Commercial |
$169.60
|
| Rate for Payer: NAPHCARE Commercial |
$30.08
|
| Rate for Payer: Preferred Network Access Commercial |
$195.04
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$20.72
|
| Rate for Payer: Quartz Beloit One Network |
$103.88
|
| Rate for Payer: Quartz Commercial |
$137.80
|
| Rate for Payer: Quartz Medicare Advantage |
$20.05
|
| Rate for Payer: The Alliance Commercial |
$848.00
|
| Rate for Payer: United Healthcare Medicaid |
$20.72
|
| Rate for Payer: United Healthcare Medicare Advantage |
$20.05
|
| Rate for Payer: United Healthcare PPO |
$159.00
|
| Rate for Payer: WEA Trust Commercial |
$116.60
|
| Rate for Payer: Wellcare Medicare |
$20.05
|
| Rate for Payer: WMAP Medicaid |
$20.72
|
| Rate for Payer: WPS Commercial |
$157.03
|
|
|
Verigene Gram Positive PCR Report
|
Professional
|
$212.00
|
|
|
Service Code
|
CPT 87149
|
| Hospital Charge Code |
5454661
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$20.05 |
| Max. Negotiated Rate |
$201.40 |
| Rate for Payer: Aetna Commercial |
$201.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$182.32
|
| Rate for Payer: Aetna Managed Medicare |
$20.05
|
| Rate for Payer: Anthem Medicare Advantage |
$20.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$20.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$20.05
|
| Rate for Payer: Cash Price |
$63.60
|
| Rate for Payer: Cash Price |
$63.60
|
| Rate for Payer: Cigna Commercial |
$201.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$106.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$20.05
|
| Rate for Payer: Health EOS Commercial |
$192.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$70.78
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$70.78
|
| Rate for Payer: Independent Care Health Plan Medicare |
$20.05
|
| Rate for Payer: Multiplan Commercial |
$169.60
|
| Rate for Payer: Preferred Network Access Commercial |
$201.40
|
| Rate for Payer: Quartz Beloit One Network |
$93.28
|
| Rate for Payer: Quartz Commercial |
$120.84
|
| Rate for Payer: Quartz Medicare Advantage |
$20.05
|
| Rate for Payer: The Alliance Commercial |
$79.20
|
| Rate for Payer: United Healthcare Medicare Advantage |
$20.05
|
| Rate for Payer: WEA Trust Commercial |
$116.60
|
| Rate for Payer: WPS Commercial |
$88.22
|
|
|
Verigene Gram Positive PCR Report
|
Facility
OP
|
$212.00
|
|
|
Service Code
|
CPT 87149
|
| Hospital Charge Code |
5454661
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$20.05 |
| Max. Negotiated Rate |
$848.00 |
| Rate for Payer: Aetna Commercial |
$190.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$182.32
|
| Rate for Payer: Aetna Managed Medicare |
$20.05
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$75.19
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$35.09
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$33.28
|
| Rate for Payer: Anthem Medicaid |
$20.72
|
| Rate for Payer: Anthem Medicare Advantage |
$20.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$112.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$20.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$20.05
|
| Rate for Payer: Cash Price |
$63.60
|
| Rate for Payer: Cash Price |
$63.60
|
| Rate for Payer: Cigna Commercial |
$195.04
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$20.05
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$20.72
|
| Rate for Payer: Dean Health Medicaid |
$20.72
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$20.05
|
| Rate for Payer: Health EOS Commercial |
$188.68
|
| Rate for Payer: HFN Commercial |
$195.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$74.59
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$20.05
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$20.72
|
| Rate for Payer: Independent Care Health Plan Medicare |
$20.05
|
| Rate for Payer: Managed Health Services Medicaid |
$21.55
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$20.05
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$20.05
|
| Rate for Payer: Multiplan Commercial |
$169.60
|
| Rate for Payer: NAPHCARE Commercial |
$30.08
|
| Rate for Payer: Preferred Network Access Commercial |
$195.04
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$20.72
|
| Rate for Payer: Quartz Beloit One Network |
$103.88
|
| Rate for Payer: Quartz Commercial |
$137.80
|
| Rate for Payer: Quartz Medicare Advantage |
$20.05
|
| Rate for Payer: The Alliance Commercial |
$848.00
|
| Rate for Payer: United Healthcare Medicaid |
$20.72
|
| Rate for Payer: United Healthcare Medicare Advantage |
$20.05
|
| Rate for Payer: United Healthcare PPO |
$159.00
|
| Rate for Payer: WEA Trust Commercial |
$116.60
|
| Rate for Payer: Wellcare Medicare |
$20.05
|
| Rate for Payer: WMAP Medicaid |
$20.72
|
| Rate for Payer: WPS Commercial |
$157.03
|
|
|
Verigene Gram Positive PCR Report
|
Facility
IP
|
$212.00
|
|
|
Service Code
|
CPT 87149
|
| Hospital Charge Code |
5454661
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$103.88 |
| Max. Negotiated Rate |
$195.04 |
| Rate for Payer: Aetna Commercial |
$190.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$112.36
|
| Rate for Payer: Cash Price |
$63.60
|
| Rate for Payer: Cigna Commercial |
$195.04
|
| Rate for Payer: Health EOS Commercial |
$188.68
|
| Rate for Payer: HFN Commercial |
$195.04
|
| Rate for Payer: Multiplan Commercial |
$169.60
|
| Rate for Payer: NAPHCARE Commercial |
$127.20
|
| Rate for Payer: Preferred Network Access Commercial |
$195.04
|
| Rate for Payer: Quartz Beloit One Network |
$103.88
|
| Rate for Payer: Quartz Commercial |
$127.20
|
| Rate for Payer: WEA Trust Commercial |
$116.60
|
| Rate for Payer: WPS Commercial |
$157.03
|
|
