|
FIDUCIAL MARKER VISICOIL MRI 0.50 X 0.50CM 19G NEEDLE PLATINUM MR-050-005-1920
|
Facility
|
IP
|
$1,834.00
|
|
|
Service Code
|
HCPCS A4648
|
| Hospital Charge Code |
6178760
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$934.61 |
| Max. Negotiated Rate |
$1,754.77 |
| Rate for Payer: Aetna Commercial |
$1,716.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,640.33
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,010.90
|
| Rate for Payer: Cash Price |
$550.20
|
| Rate for Payer: Cigna Commercial |
$1,754.77
|
| Rate for Payer: Health EOS Commercial |
$1,697.55
|
| Rate for Payer: HFN Commercial |
$1,754.77
|
| Rate for Payer: Multiplan Commercial |
$1,525.89
|
| Rate for Payer: Preferred Network Access Commercial |
$1,754.77
|
| Rate for Payer: Quartz Beloit One Network |
$934.61
|
| Rate for Payer: Quartz Commercial |
$1,144.42
|
| Rate for Payer: WEA Trust Commercial |
$1,049.05
|
| Rate for Payer: WPS Commercial |
$1,412.73
|
|
|
FIDUCIAL MARKER VISICOIL MRI 0.50 X 0.50CM 19G NEEDLE PLATINUM MR-050-005-1920
|
Facility
|
OP
|
$1,834.00
|
|
|
Service Code
|
HCPCS A4648
|
| Hospital Charge Code |
6178760
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$534.06 |
| Max. Negotiated Rate |
$1,754.77 |
| Rate for Payer: Aetna Commercial |
$1,716.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,640.33
|
| Rate for Payer: Aetna Managed Medicare |
$534.06
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,239.78
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$953.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$915.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,010.90
|
| Rate for Payer: Cash Price |
$550.20
|
| Rate for Payer: Cigna Commercial |
$1,754.77
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,067.39
|
| Rate for Payer: Health EOS Commercial |
$1,697.55
|
| Rate for Payer: HFN Commercial |
$1,754.77
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,430.52
|
| Rate for Payer: Multiplan Commercial |
$1,525.89
|
| Rate for Payer: NAPHCARE Commercial |
$1,144.42
|
| Rate for Payer: Preferred Network Access Commercial |
$1,754.77
|
| Rate for Payer: Quartz Beloit One Network |
$934.61
|
| Rate for Payer: Quartz Commercial |
$1,239.78
|
| Rate for Payer: Quartz Medicare Advantage |
$1,144.42
|
| Rate for Payer: The Alliance Commercial |
$953.68
|
| Rate for Payer: WEA Trust Commercial |
$1,049.05
|
| Rate for Payer: WPS Commercial |
$1,412.73
|
|
|
Filamentous Hemagglutinin IgA
|
Facility
|
OP
|
$89.00
|
|
|
Service Code
|
CPT 86615
|
| Hospital Charge Code |
3794221
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.72 |
| Max. Negotiated Rate |
$85.16 |
| Rate for Payer: Aetna Commercial |
$83.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$79.60
|
| Rate for Payer: Aetna Managed Medicare |
$13.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$51.44
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$24.01
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$22.77
|
| Rate for Payer: Anthem Medicare Advantage |
$13.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$49.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$13.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$13.72
|
| Rate for Payer: Cash Price |
$26.70
|
| Rate for Payer: Cash Price |
$26.70
|
| Rate for Payer: Cigna Commercial |
$85.16
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$13.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$51.80
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$13.72
|
| Rate for Payer: Health EOS Commercial |
$82.38
|
| Rate for Payer: HFN Commercial |
$85.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$51.03
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$13.72
|
| Rate for Payer: Independent Care Health Plan Medicare |
$13.72
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$13.72
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$13.72
|
| Rate for Payer: Multiplan Commercial |
$74.05
|
| Rate for Payer: NAPHCARE Commercial |
$20.58
|
| Rate for Payer: Preferred Network Access Commercial |
$85.16
|
| Rate for Payer: Quartz Beloit One Network |
$45.35
|
| Rate for Payer: Quartz Commercial |
$60.16
|
| Rate for Payer: Quartz Medicare Advantage |
$13.72
|
| Rate for Payer: The Alliance Commercial |
$54.87
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.72
|
| Rate for Payer: United Healthcare PPO |
$69.42
|
| Rate for Payer: WEA Trust Commercial |
$50.91
|
| Rate for Payer: Wellcare Medicare |
$13.72
|
| Rate for Payer: WPS Commercial |
$68.56
|
|
|
Filamentous Hemagglutinin IgA
|
Professional
|
Both
|
$89.00
|
|
|
Service Code
|
CPT 86615
|
| Hospital Charge Code |
3794221
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.72 |
| Max. Negotiated Rate |
$87.93 |
| Rate for Payer: Aetna Commercial |
$87.93
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$79.60
|
| Rate for Payer: Aetna Managed Medicare |
$13.72
|
| Rate for Payer: Anthem Medicare Advantage |
$13.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$13.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$13.72
|
| Rate for Payer: Cash Price |
$26.70
|
| Rate for Payer: Cash Price |
$26.70
|
| Rate for Payer: Cigna Commercial |
$87.93
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$46.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$13.72
|
| Rate for Payer: Health EOS Commercial |
$84.23
|
| Rate for Payer: HFN Commercial |
$87.93
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$48.42
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$48.42
|
| Rate for Payer: Independent Care Health Plan Medicare |
$13.72
|
| Rate for Payer: Multiplan Commercial |
$74.05
|
| Rate for Payer: NAPHCARE Commercial |
$20.58
|
| Rate for Payer: Preferred Network Access Commercial |
$87.93
|
| Rate for Payer: Quartz Beloit One Network |
$40.73
|
| Rate for Payer: Quartz Commercial |
$52.76
|
| Rate for Payer: Quartz Medicare Advantage |
$13.72
|
| Rate for Payer: The Alliance Commercial |
$54.18
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.72
|
| Rate for Payer: WEA Trust Commercial |
$50.91
|
| Rate for Payer: WPS Commercial |
$60.36
|
|
|
Filamentous Hemagglutinin IgA
|
Facility
|
IP
|
$89.00
|
|
|
Service Code
|
CPT 86615
|
| Hospital Charge Code |
3794221
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$45.35 |
| Max. Negotiated Rate |
$85.16 |
| Rate for Payer: Aetna Commercial |
$83.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$79.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$49.06
|
| Rate for Payer: Cash Price |
$26.70
|
| Rate for Payer: Cigna Commercial |
$85.16
|
| Rate for Payer: Health EOS Commercial |
$82.38
|
| Rate for Payer: HFN Commercial |
$85.16
|
| Rate for Payer: Multiplan Commercial |
$74.05
|
| Rate for Payer: Preferred Network Access Commercial |
$85.16
|
| Rate for Payer: Quartz Beloit One Network |
$45.35
|
| Rate for Payer: Quartz Commercial |
$55.54
|
| Rate for Payer: WEA Trust Commercial |
$50.91
|
| Rate for Payer: WPS Commercial |
$68.56
|
|
|
Filamentous Hemagglutinin IgG
|
Facility
|
IP
|
$89.00
|
|
|
Service Code
|
CPT 86615
|
| Hospital Charge Code |
3794220
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$45.35 |
| Max. Negotiated Rate |
$85.16 |
| Rate for Payer: Aetna Commercial |
$83.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$79.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$49.06
|
| Rate for Payer: Cash Price |
$26.70
|
| Rate for Payer: Cigna Commercial |
$85.16
|
| Rate for Payer: Health EOS Commercial |
$82.38
|
| Rate for Payer: HFN Commercial |
$85.16
|
| Rate for Payer: Multiplan Commercial |
$74.05
|
| Rate for Payer: Preferred Network Access Commercial |
$85.16
|
| Rate for Payer: Quartz Beloit One Network |
$45.35
|
| Rate for Payer: Quartz Commercial |
$55.54
|
| Rate for Payer: WEA Trust Commercial |
$50.91
|
| Rate for Payer: WPS Commercial |
$68.56
|
|
|
Filamentous Hemagglutinin IgG
|
Professional
|
Both
|
$89.00
|
|
|
Service Code
|
CPT 86615
|
| Hospital Charge Code |
3794220
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.72 |
| Max. Negotiated Rate |
$87.93 |
| Rate for Payer: Aetna Commercial |
$87.93
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$79.60
|
| Rate for Payer: Aetna Managed Medicare |
$13.72
|
| Rate for Payer: Anthem Medicare Advantage |
$13.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$13.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$13.72
|
| Rate for Payer: Cash Price |
$26.70
|
| Rate for Payer: Cash Price |
$26.70
|
| Rate for Payer: Cigna Commercial |
$87.93
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$46.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$13.72
|
| Rate for Payer: Health EOS Commercial |
$84.23
|
| Rate for Payer: HFN Commercial |
$87.93
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$48.42
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$48.42
|
| Rate for Payer: Independent Care Health Plan Medicare |
$13.72
|
| Rate for Payer: Multiplan Commercial |
$74.05
|
| Rate for Payer: NAPHCARE Commercial |
$20.58
|
| Rate for Payer: Preferred Network Access Commercial |
$87.93
|
| Rate for Payer: Quartz Beloit One Network |
$40.73
|
| Rate for Payer: Quartz Commercial |
$52.76
|
| Rate for Payer: Quartz Medicare Advantage |
$13.72
|
| Rate for Payer: The Alliance Commercial |
$54.18
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.72
|
| Rate for Payer: WEA Trust Commercial |
$50.91
|
| Rate for Payer: WPS Commercial |
$60.36
|
|
|
Filamentous Hemagglutinin IgG
|
Facility
|
OP
|
$89.00
|
|
|
Service Code
|
CPT 86615
|
| Hospital Charge Code |
3794220
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.72 |
| Max. Negotiated Rate |
$85.16 |
| Rate for Payer: Aetna Commercial |
$83.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$79.60
|
| Rate for Payer: Aetna Managed Medicare |
$13.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$51.44
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$24.01
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$22.77
|
| Rate for Payer: Anthem Medicare Advantage |
$13.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$49.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$13.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$13.72
|
| Rate for Payer: Cash Price |
$26.70
|
| Rate for Payer: Cash Price |
$26.70
|
| Rate for Payer: Cigna Commercial |
$85.16
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$13.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$51.80
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$13.72
|
| Rate for Payer: Health EOS Commercial |
$82.38
|
| Rate for Payer: HFN Commercial |
$85.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$51.03
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$13.72
|
| Rate for Payer: Independent Care Health Plan Medicare |
$13.72
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$13.72
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$13.72
|
| Rate for Payer: Multiplan Commercial |
$74.05
|
| Rate for Payer: NAPHCARE Commercial |
$20.58
|
| Rate for Payer: Preferred Network Access Commercial |
$85.16
|
| Rate for Payer: Quartz Beloit One Network |
$45.35
|
| Rate for Payer: Quartz Commercial |
$60.16
|
| Rate for Payer: Quartz Medicare Advantage |
$13.72
|
| Rate for Payer: The Alliance Commercial |
$54.87
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.72
|
| Rate for Payer: United Healthcare PPO |
$69.42
|
| Rate for Payer: WEA Trust Commercial |
$50.91
|
| Rate for Payer: Wellcare Medicare |
$13.72
|
| Rate for Payer: WPS Commercial |
$68.56
|
|
|
Filgrastim 300 mcg/0.5 ml Syr (Zarxio) Q5101
|
Facility
|
OP
|
$2.00
|
|
|
Service Code
|
HCPCS Q5101
|
| Hospital Charge Code |
4866606
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.36 |
| Max. Negotiated Rate |
$1.91 |
| Rate for Payer: Aetna Commercial |
$1.87
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1.79
|
| Rate for Payer: Aetna Managed Medicare |
$0.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$0.44
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$0.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$0.44
|
| Rate for Payer: Anthem Medicare Advantage |
$0.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$0.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$0.36
|
| Rate for Payer: Cash Price |
$0.60
|
| Rate for Payer: Cash Price |
$0.60
|
| Rate for Payer: Cigna Commercial |
$1.91
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$0.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$0.58
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$0.36
|
| Rate for Payer: Health EOS Commercial |
$1.85
|
| Rate for Payer: HFN Commercial |
$1.91
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1.35
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$0.36
|
| Rate for Payer: Independent Care Health Plan Medicare |
$0.36
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$0.36
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$0.36
|
| Rate for Payer: Multiplan Commercial |
$1.66
|
| Rate for Payer: NAPHCARE Commercial |
$0.55
|
| Rate for Payer: Preferred Network Access Commercial |
$1.91
|
| Rate for Payer: Quartz Beloit One Network |
$1.02
|
| Rate for Payer: Quartz Commercial |
$1.35
|
| Rate for Payer: Quartz Medicare Advantage |
$0.36
|
| Rate for Payer: The Alliance Commercial |
$1.46
|
| Rate for Payer: United Healthcare Medicare Advantage |
$0.36
|
| Rate for Payer: WEA Trust Commercial |
$1.14
|
| Rate for Payer: Wellcare Medicare |
$0.36
|
| Rate for Payer: WPS Commercial |
$1.10
|
|
|
Filgrastim 300 mcg/0.5 ml Syr (Zarxio) Q5101
|
Professional
|
Both
|
$2.00
|
|
|
Service Code
|
HCPCS Q5101
|
| Hospital Charge Code |
4866606
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.36 |
| Max. Negotiated Rate |
$1.98 |
| Rate for Payer: Aetna Commercial |
$1.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1.79
|
| Rate for Payer: Aetna Managed Medicare |
$0.36
|
| Rate for Payer: Anthem Medicare Advantage |
$0.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$0.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$0.36
|
| Rate for Payer: Cash Price |
$0.60
|
| Rate for Payer: Cash Price |
$0.60
|
| Rate for Payer: Cigna Commercial |
$1.98
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$0.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$0.44
|
| Rate for Payer: Health EOS Commercial |
$1.89
|
| Rate for Payer: HFN Commercial |
$1.98
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$0.57
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$0.57
|
| Rate for Payer: Independent Care Health Plan Medicare |
$0.36
|
| Rate for Payer: Multiplan Commercial |
$1.66
|
| Rate for Payer: NAPHCARE Commercial |
$0.55
|
| Rate for Payer: Preferred Network Access Commercial |
$1.98
|
| Rate for Payer: Quartz Beloit One Network |
$0.92
|
| Rate for Payer: Quartz Commercial |
$1.19
|
| Rate for Payer: Quartz Medicare Advantage |
$0.36
|
| Rate for Payer: The Alliance Commercial |
$1.00
|
| Rate for Payer: United Healthcare Medicaid |
$0.36
|
| Rate for Payer: United Healthcare Medicare Advantage |
$0.36
|
| Rate for Payer: WEA Trust Commercial |
$1.14
|
| Rate for Payer: WPS Commercial |
$1.10
|
|
|
Filgrastim 300 mcg/0.5 ml Syr (Zarxio) Q5101
|
Facility
|
IP
|
$2.00
|
|
|
Service Code
|
HCPCS Q5101
|
| Hospital Charge Code |
4866606
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.02 |
| Max. Negotiated Rate |
$1.91 |
| Rate for Payer: Aetna Commercial |
$1.87
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1.79
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1.10
|
| Rate for Payer: Cash Price |
$0.60
|
| Rate for Payer: Cigna Commercial |
$1.91
|
| Rate for Payer: Health EOS Commercial |
$1.85
|
| Rate for Payer: HFN Commercial |
$1.91
|
| Rate for Payer: Multiplan Commercial |
$1.66
|
| Rate for Payer: Preferred Network Access Commercial |
$1.91
|
| Rate for Payer: Quartz Beloit One Network |
$1.02
|
| Rate for Payer: Quartz Commercial |
$1.25
|
| Rate for Payer: WEA Trust Commercial |
$1.14
|
| Rate for Payer: WPS Commercial |
$1.54
|
|
|
Filgrastim 480 mcg/0.8 ml Syr (Zarxio) Q5101
|
Facility
|
IP
|
$2.00
|
|
|
Service Code
|
HCPCS Q5101
|
| Hospital Charge Code |
4866607
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.02 |
| Max. Negotiated Rate |
$1.91 |
| Rate for Payer: Aetna Commercial |
$1.87
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1.79
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1.10
|
| Rate for Payer: Cash Price |
$0.60
|
| Rate for Payer: Cigna Commercial |
$1.91
|
| Rate for Payer: Health EOS Commercial |
$1.85
|
| Rate for Payer: HFN Commercial |
$1.91
|
| Rate for Payer: Multiplan Commercial |
$1.66
|
| Rate for Payer: Preferred Network Access Commercial |
$1.91
|
| Rate for Payer: Quartz Beloit One Network |
$1.02
|
| Rate for Payer: Quartz Commercial |
$1.25
|
| Rate for Payer: WEA Trust Commercial |
$1.14
|
| Rate for Payer: WPS Commercial |
$1.54
|
|
|
Filgrastim 480 mcg/0.8 ml Syr (Zarxio) Q5101
|
Professional
|
Both
|
$2.00
|
|
|
Service Code
|
HCPCS Q5101
|
| Hospital Charge Code |
4866607
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.36 |
| Max. Negotiated Rate |
$1.98 |
| Rate for Payer: Aetna Commercial |
$1.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1.79
|
| Rate for Payer: Aetna Managed Medicare |
$0.36
|
| Rate for Payer: Anthem Medicare Advantage |
$0.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$0.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$0.36
|
| Rate for Payer: Cash Price |
$0.60
|
| Rate for Payer: Cash Price |
$0.60
|
| Rate for Payer: Cigna Commercial |
$1.98
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$0.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$0.44
|
| Rate for Payer: Health EOS Commercial |
$1.89
|
| Rate for Payer: HFN Commercial |
$1.98
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$0.57
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$0.57
|
| Rate for Payer: Independent Care Health Plan Medicare |
$0.36
|
| Rate for Payer: Multiplan Commercial |
$1.66
|
| Rate for Payer: NAPHCARE Commercial |
$0.55
|
| Rate for Payer: Preferred Network Access Commercial |
$1.98
|
| Rate for Payer: Quartz Beloit One Network |
$0.92
|
| Rate for Payer: Quartz Commercial |
$1.19
|
| Rate for Payer: Quartz Medicare Advantage |
$0.36
|
| Rate for Payer: The Alliance Commercial |
$1.00
|
| Rate for Payer: United Healthcare Medicaid |
$0.36
|
| Rate for Payer: United Healthcare Medicare Advantage |
$0.36
|
| Rate for Payer: WEA Trust Commercial |
$1.14
|
| Rate for Payer: WPS Commercial |
$1.10
|
|
|
Filgrastim 480 mcg/0.8 ml Syr (Zarxio) Q5101
|
Facility
|
OP
|
$2.00
|
|
|
Service Code
|
HCPCS Q5101
|
| Hospital Charge Code |
4866607
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.36 |
| Max. Negotiated Rate |
$1.91 |
| Rate for Payer: Aetna Commercial |
$1.87
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1.79
|
| Rate for Payer: Aetna Managed Medicare |
$0.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$0.44
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$0.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$0.44
|
| Rate for Payer: Anthem Medicare Advantage |
$0.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$0.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$0.36
|
| Rate for Payer: Cash Price |
$0.60
|
| Rate for Payer: Cash Price |
$0.60
|
| Rate for Payer: Cigna Commercial |
$1.91
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$0.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$0.58
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$0.36
|
| Rate for Payer: Health EOS Commercial |
$1.85
|
| Rate for Payer: HFN Commercial |
$1.91
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1.35
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$0.36
|
| Rate for Payer: Independent Care Health Plan Medicare |
$0.36
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$0.36
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$0.36
|
| Rate for Payer: Multiplan Commercial |
$1.66
|
| Rate for Payer: NAPHCARE Commercial |
$0.55
|
| Rate for Payer: Preferred Network Access Commercial |
$1.91
|
| Rate for Payer: Quartz Beloit One Network |
$1.02
|
| Rate for Payer: Quartz Commercial |
$1.35
|
| Rate for Payer: Quartz Medicare Advantage |
$0.36
|
| Rate for Payer: The Alliance Commercial |
$1.46
|
| Rate for Payer: United Healthcare Medicare Advantage |
$0.36
|
| Rate for Payer: WEA Trust Commercial |
$1.14
|
| Rate for Payer: Wellcare Medicare |
$0.36
|
| Rate for Payer: WPS Commercial |
$1.10
|
|
|
filgrastim 480 mcg Charge
|
Facility
|
OP
|
$7.00
|
|
|
Service Code
|
HCPCS J1442
|
| Hospital Charge Code |
2958912
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.03 |
| Max. Negotiated Rate |
$6.70 |
| Rate for Payer: Aetna Commercial |
$6.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6.26
|
| Rate for Payer: Aetna Managed Medicare |
$1.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1.03
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1.03
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1.03
|
| Rate for Payer: Anthem Medicare Advantage |
$1.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$1.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$1.04
|
| Rate for Payer: Cash Price |
$2.10
|
| Rate for Payer: Cash Price |
$2.10
|
| Rate for Payer: Cigna Commercial |
$6.70
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$1.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1.37
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$1.04
|
| Rate for Payer: Health EOS Commercial |
$6.48
|
| Rate for Payer: HFN Commercial |
$6.70
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3.87
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1.04
|
| Rate for Payer: Independent Care Health Plan Medicare |
$1.04
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$1.04
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$1.04
|
| Rate for Payer: Multiplan Commercial |
$5.82
|
| Rate for Payer: NAPHCARE Commercial |
$1.56
|
| Rate for Payer: Preferred Network Access Commercial |
$6.70
|
| Rate for Payer: Quartz Beloit One Network |
$3.57
|
| Rate for Payer: Quartz Commercial |
$4.73
|
| Rate for Payer: Quartz Medicare Advantage |
$1.04
|
| Rate for Payer: The Alliance Commercial |
$4.16
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1.04
|
| Rate for Payer: WEA Trust Commercial |
$4.00
|
| Rate for Payer: Wellcare Medicare |
$1.04
|
| Rate for Payer: WPS Commercial |
$2.58
|
|
|
filgrastim 480 mcg Charge
|
Professional
|
Both
|
$7.00
|
|
|
Service Code
|
HCPCS J1442
|
| Hospital Charge Code |
2958912
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.03 |
| Max. Negotiated Rate |
$6.92 |
| Rate for Payer: Aetna Commercial |
$6.92
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6.26
|
| Rate for Payer: Aetna Managed Medicare |
$1.04
|
| Rate for Payer: Anthem Medicare Advantage |
$1.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$1.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$1.04
|
| Rate for Payer: Cash Price |
$2.10
|
| Rate for Payer: Cash Price |
$2.10
|
| Rate for Payer: Cigna Commercial |
$6.92
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1.03
|
| Rate for Payer: Health EOS Commercial |
$6.62
|
| Rate for Payer: HFN Commercial |
$6.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1.45
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1.45
|
| Rate for Payer: Independent Care Health Plan Medicare |
$1.04
|
| Rate for Payer: Multiplan Commercial |
$5.82
|
| Rate for Payer: NAPHCARE Commercial |
$1.56
|
| Rate for Payer: Preferred Network Access Commercial |
$6.92
|
| Rate for Payer: Quartz Beloit One Network |
$3.20
|
| Rate for Payer: Quartz Commercial |
$4.15
|
| Rate for Payer: Quartz Medicare Advantage |
$1.04
|
| Rate for Payer: The Alliance Commercial |
$2.86
|
| Rate for Payer: United Healthcare Medicaid |
$1.04
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1.04
|
| Rate for Payer: WEA Trust Commercial |
$4.00
|
| Rate for Payer: WPS Commercial |
$2.58
|
|
|
filgrastim 480 mcg Charge
|
Facility
|
IP
|
$7.00
|
|
|
Service Code
|
HCPCS J1442
|
| Hospital Charge Code |
2958912
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.57 |
| Max. Negotiated Rate |
$6.70 |
| Rate for Payer: Aetna Commercial |
$6.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3.86
|
| Rate for Payer: Cash Price |
$2.10
|
| Rate for Payer: Cigna Commercial |
$6.70
|
| Rate for Payer: Health EOS Commercial |
$6.48
|
| Rate for Payer: HFN Commercial |
$6.70
|
| Rate for Payer: Multiplan Commercial |
$5.82
|
| Rate for Payer: Preferred Network Access Commercial |
$6.70
|
| Rate for Payer: Quartz Beloit One Network |
$3.57
|
| Rate for Payer: Quartz Commercial |
$4.37
|
| Rate for Payer: WEA Trust Commercial |
$4.00
|
| Rate for Payer: WPS Commercial |
$5.39
|
|
|
filgrastim charge
|
Professional
|
Both
|
$7.00
|
|
|
Service Code
|
HCPCS J1442
|
| Hospital Charge Code |
2958972
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.03 |
| Max. Negotiated Rate |
$6.92 |
| Rate for Payer: Aetna Commercial |
$6.92
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6.26
|
| Rate for Payer: Aetna Managed Medicare |
$1.04
|
| Rate for Payer: Anthem Medicare Advantage |
$1.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$1.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$1.04
|
| Rate for Payer: Cash Price |
$2.10
|
| Rate for Payer: Cash Price |
$2.10
|
| Rate for Payer: Cigna Commercial |
$6.92
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1.03
|
| Rate for Payer: Health EOS Commercial |
$6.62
|
| Rate for Payer: HFN Commercial |
$6.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1.45
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1.45
|
| Rate for Payer: Independent Care Health Plan Medicare |
$1.04
|
| Rate for Payer: Multiplan Commercial |
$5.82
|
| Rate for Payer: NAPHCARE Commercial |
$1.56
|
| Rate for Payer: Preferred Network Access Commercial |
$6.92
|
| Rate for Payer: Quartz Beloit One Network |
$3.20
|
| Rate for Payer: Quartz Commercial |
$4.15
|
| Rate for Payer: Quartz Medicare Advantage |
$1.04
|
| Rate for Payer: The Alliance Commercial |
$2.86
|
| Rate for Payer: United Healthcare Medicaid |
$1.04
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1.04
|
| Rate for Payer: WEA Trust Commercial |
$4.00
|
| Rate for Payer: WPS Commercial |
$2.58
|
|
|
filgrastim charge
|
Facility
|
IP
|
$7.00
|
|
|
Service Code
|
HCPCS J1442
|
| Hospital Charge Code |
2958972
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.57 |
| Max. Negotiated Rate |
$6.70 |
| Rate for Payer: Aetna Commercial |
$6.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3.86
|
| Rate for Payer: Cash Price |
$2.10
|
| Rate for Payer: Cigna Commercial |
$6.70
|
| Rate for Payer: Health EOS Commercial |
$6.48
|
| Rate for Payer: HFN Commercial |
$6.70
|
| Rate for Payer: Multiplan Commercial |
$5.82
|
| Rate for Payer: Preferred Network Access Commercial |
$6.70
|
| Rate for Payer: Quartz Beloit One Network |
$3.57
|
| Rate for Payer: Quartz Commercial |
$4.37
|
| Rate for Payer: WEA Trust Commercial |
$4.00
|
| Rate for Payer: WPS Commercial |
$5.39
|
|
|
filgrastim charge
|
Facility
|
OP
|
$7.00
|
|
|
Service Code
|
HCPCS J1442
|
| Hospital Charge Code |
2958972
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.03 |
| Max. Negotiated Rate |
$6.70 |
| Rate for Payer: Aetna Commercial |
$6.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6.26
|
| Rate for Payer: Aetna Managed Medicare |
$1.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1.03
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1.03
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1.03
|
| Rate for Payer: Anthem Medicare Advantage |
$1.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$1.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$1.04
|
| Rate for Payer: Cash Price |
$2.10
|
| Rate for Payer: Cash Price |
$2.10
|
| Rate for Payer: Cigna Commercial |
$6.70
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$1.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1.37
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$1.04
|
| Rate for Payer: Health EOS Commercial |
$6.48
|
| Rate for Payer: HFN Commercial |
$6.70
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3.87
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1.04
|
| Rate for Payer: Independent Care Health Plan Medicare |
$1.04
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$1.04
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$1.04
|
| Rate for Payer: Multiplan Commercial |
$5.82
|
| Rate for Payer: NAPHCARE Commercial |
$1.56
|
| Rate for Payer: Preferred Network Access Commercial |
$6.70
|
| Rate for Payer: Quartz Beloit One Network |
$3.57
|
| Rate for Payer: Quartz Commercial |
$4.73
|
| Rate for Payer: Quartz Medicare Advantage |
$1.04
|
| Rate for Payer: The Alliance Commercial |
$4.16
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1.04
|
| Rate for Payer: WEA Trust Commercial |
$4.00
|
| Rate for Payer: Wellcare Medicare |
$1.04
|
| Rate for Payer: WPS Commercial |
$2.58
|
|
|
Filgrastim Injection J1442
|
Professional
|
Both
|
$7.00
|
|
|
Service Code
|
HCPCS J1442
|
| Hospital Charge Code |
4062091
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.03 |
| Max. Negotiated Rate |
$6.92 |
| Rate for Payer: Aetna Commercial |
$6.92
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6.26
|
| Rate for Payer: Aetna Managed Medicare |
$1.04
|
| Rate for Payer: Anthem Medicare Advantage |
$1.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$1.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$1.04
|
| Rate for Payer: Cash Price |
$2.10
|
| Rate for Payer: Cash Price |
$2.10
|
| Rate for Payer: Cigna Commercial |
$6.92
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1.03
|
| Rate for Payer: Health EOS Commercial |
$6.62
|
| Rate for Payer: HFN Commercial |
$6.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1.45
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1.45
|
| Rate for Payer: Independent Care Health Plan Medicare |
$1.04
|
| Rate for Payer: Multiplan Commercial |
$5.82
|
| Rate for Payer: NAPHCARE Commercial |
$1.56
|
| Rate for Payer: Preferred Network Access Commercial |
$6.92
|
| Rate for Payer: Quartz Beloit One Network |
$3.20
|
| Rate for Payer: Quartz Commercial |
$4.15
|
| Rate for Payer: Quartz Medicare Advantage |
$1.04
|
| Rate for Payer: The Alliance Commercial |
$2.86
|
| Rate for Payer: United Healthcare Medicaid |
$1.04
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1.04
|
| Rate for Payer: WEA Trust Commercial |
$4.00
|
| Rate for Payer: WPS Commercial |
$2.58
|
|
|
Filgrastim Injection J1442
|
Facility
|
IP
|
$7.00
|
|
|
Service Code
|
HCPCS J1442
|
| Hospital Charge Code |
4062091
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.57 |
| Max. Negotiated Rate |
$6.70 |
| Rate for Payer: Aetna Commercial |
$6.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3.86
|
| Rate for Payer: Cash Price |
$2.10
|
| Rate for Payer: Cigna Commercial |
$6.70
|
| Rate for Payer: Health EOS Commercial |
$6.48
|
| Rate for Payer: HFN Commercial |
$6.70
|
| Rate for Payer: Multiplan Commercial |
$5.82
|
| Rate for Payer: Preferred Network Access Commercial |
$6.70
|
| Rate for Payer: Quartz Beloit One Network |
$3.57
|
| Rate for Payer: Quartz Commercial |
$4.37
|
| Rate for Payer: WEA Trust Commercial |
$4.00
|
| Rate for Payer: WPS Commercial |
$5.39
|
|
|
Filgrastim Injection J1442
|
Facility
|
OP
|
$7.00
|
|
|
Service Code
|
HCPCS J1442
|
| Hospital Charge Code |
4062091
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.03 |
| Max. Negotiated Rate |
$6.70 |
| Rate for Payer: Aetna Commercial |
$6.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6.26
|
| Rate for Payer: Aetna Managed Medicare |
$1.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1.03
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1.03
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1.03
|
| Rate for Payer: Anthem Medicare Advantage |
$1.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$1.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$1.04
|
| Rate for Payer: Cash Price |
$2.10
|
| Rate for Payer: Cash Price |
$2.10
|
| Rate for Payer: Cigna Commercial |
$6.70
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$1.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1.37
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$1.04
|
| Rate for Payer: Health EOS Commercial |
$6.48
|
| Rate for Payer: HFN Commercial |
$6.70
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3.87
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1.04
|
| Rate for Payer: Independent Care Health Plan Medicare |
$1.04
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$1.04
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$1.04
|
| Rate for Payer: Multiplan Commercial |
$5.82
|
| Rate for Payer: NAPHCARE Commercial |
$1.56
|
| Rate for Payer: Preferred Network Access Commercial |
$6.70
|
| Rate for Payer: Quartz Beloit One Network |
$3.57
|
| Rate for Payer: Quartz Commercial |
$4.73
|
| Rate for Payer: Quartz Medicare Advantage |
$1.04
|
| Rate for Payer: The Alliance Commercial |
$4.16
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1.04
|
| Rate for Payer: WEA Trust Commercial |
$4.00
|
| Rate for Payer: Wellcare Medicare |
$1.04
|
| Rate for Payer: WPS Commercial |
$2.58
|
|
|
FILLETED FINGER OR TOE FLAP, INCLUDING PREPARATION OF RECIPIENT SITE
|
Facility
|
OP
|
$8,685.50
|
|
|
Service Code
|
CPT 14350
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,171.37 |
| Max. Negotiated Rate |
$8,685.50 |
| Rate for Payer: Aetna Managed Medicare |
$2,171.37
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,635.84
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,985.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,835.04
|
| Rate for Payer: Anthem Medicare Advantage |
$2,171.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$2,171.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$2,171.37
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$2,171.37
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,807.99
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$2,171.37
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$8,077.51
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$2,171.37
|
| Rate for Payer: Independent Care Health Plan Medicare |
$2,171.37
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$2,171.37
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$2,171.37
|
| Rate for Payer: NAPHCARE Commercial |
$3,257.06
|
| Rate for Payer: Quartz Medicare Advantage |
$2,171.37
|
| Rate for Payer: The Alliance Commercial |
$8,685.50
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,171.37
|
| Rate for Payer: United Healthcare PPO |
$3,726.32
|
| Rate for Payer: Wellcare Medicare |
$2,171.37
|
|
|
FILL KIT IMPLANT 350-8400
|
Facility
|
IP
|
$397.00
|
|
| Hospital Charge Code |
2969473
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$202.31 |
| Max. Negotiated Rate |
$379.85 |
| Rate for Payer: Aetna Commercial |
$371.59
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$355.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$218.83
|
| Rate for Payer: Cash Price |
$119.10
|
| Rate for Payer: Cigna Commercial |
$379.85
|
| Rate for Payer: Health EOS Commercial |
$367.46
|
| Rate for Payer: HFN Commercial |
$379.85
|
| Rate for Payer: Multiplan Commercial |
$330.30
|
| Rate for Payer: Preferred Network Access Commercial |
$379.85
|
| Rate for Payer: Quartz Beloit One Network |
$202.31
|
| Rate for Payer: Quartz Commercial |
$247.73
|
| Rate for Payer: WEA Trust Commercial |
$227.08
|
| Rate for Payer: WPS Commercial |
$305.81
|
|
