|
FLIP CUTTER II 9.5MM SHORT AR-1204AS-95
|
Facility
|
IP
|
$4,947.00
|
|
| Hospital Charge Code |
5459090
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,520.99 |
| Max. Negotiated Rate |
$4,733.29 |
| Rate for Payer: Aetna Commercial |
$4,630.39
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,424.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,726.79
|
| Rate for Payer: Cash Price |
$1,484.10
|
| Rate for Payer: Cigna Commercial |
$4,733.29
|
| Rate for Payer: Health EOS Commercial |
$4,578.94
|
| Rate for Payer: HFN Commercial |
$4,733.29
|
| Rate for Payer: Multiplan Commercial |
$4,115.90
|
| Rate for Payer: Preferred Network Access Commercial |
$4,733.29
|
| Rate for Payer: Quartz Beloit One Network |
$2,520.99
|
| Rate for Payer: Quartz Commercial |
$3,086.93
|
| Rate for Payer: WEA Trust Commercial |
$2,829.68
|
| Rate for Payer: WPS Commercial |
$3,810.67
|
|
|
FLIP CUTTER II 9.5MM SHORT AR-1204AS-95
|
Facility
|
OP
|
$4,947.00
|
|
| Hospital Charge Code |
5459090
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,440.57 |
| Max. Negotiated Rate |
$4,733.29 |
| Rate for Payer: Aetna Commercial |
$4,630.39
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,424.60
|
| Rate for Payer: Aetna Managed Medicare |
$1,440.57
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,344.17
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,572.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,469.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,726.79
|
| Rate for Payer: Cash Price |
$1,484.10
|
| Rate for Payer: Cigna Commercial |
$4,733.29
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,879.15
|
| Rate for Payer: Health EOS Commercial |
$4,578.94
|
| Rate for Payer: HFN Commercial |
$4,733.29
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,858.66
|
| Rate for Payer: Multiplan Commercial |
$4,115.90
|
| Rate for Payer: NAPHCARE Commercial |
$3,086.93
|
| Rate for Payer: Preferred Network Access Commercial |
$4,733.29
|
| Rate for Payer: Quartz Beloit One Network |
$2,520.99
|
| Rate for Payer: Quartz Commercial |
$3,344.17
|
| Rate for Payer: Quartz Medicare Advantage |
$3,086.93
|
| Rate for Payer: The Alliance Commercial |
$2,572.44
|
| Rate for Payer: WEA Trust Commercial |
$2,829.68
|
| Rate for Payer: WPS Commercial |
$3,810.67
|
|
|
Floseal 10ml [Med]
|
Facility
|
IP
|
$927.00
|
|
| Hospital Charge Code |
2974936
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$472.40 |
| Max. Negotiated Rate |
$886.95 |
| Rate for Payer: Aetna Commercial |
$867.67
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$829.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$510.96
|
| Rate for Payer: Cash Price |
$278.10
|
| Rate for Payer: Cigna Commercial |
$886.95
|
| Rate for Payer: Health EOS Commercial |
$858.03
|
| Rate for Payer: HFN Commercial |
$886.95
|
| Rate for Payer: Multiplan Commercial |
$771.26
|
| Rate for Payer: Preferred Network Access Commercial |
$886.95
|
| Rate for Payer: Quartz Beloit One Network |
$472.40
|
| Rate for Payer: Quartz Commercial |
$578.45
|
| Rate for Payer: WEA Trust Commercial |
$530.24
|
| Rate for Payer: WPS Commercial |
$714.07
|
|
|
Floseal 10ml [Med]
|
Facility
|
OP
|
$927.00
|
|
| Hospital Charge Code |
2974936
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$269.94 |
| Max. Negotiated Rate |
$886.95 |
| Rate for Payer: Aetna Commercial |
$867.67
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$829.11
|
| Rate for Payer: Aetna Managed Medicare |
$269.94
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$626.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$482.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$462.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$510.96
|
| Rate for Payer: Cash Price |
$278.10
|
| Rate for Payer: Cigna Commercial |
$886.95
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$539.51
|
| Rate for Payer: Health EOS Commercial |
$858.03
|
| Rate for Payer: HFN Commercial |
$886.95
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$723.06
|
| Rate for Payer: Multiplan Commercial |
$771.26
|
| Rate for Payer: NAPHCARE Commercial |
$578.45
|
| Rate for Payer: Preferred Network Access Commercial |
$886.95
|
| Rate for Payer: Quartz Beloit One Network |
$472.40
|
| Rate for Payer: Quartz Commercial |
$626.65
|
| Rate for Payer: Quartz Medicare Advantage |
$578.45
|
| Rate for Payer: The Alliance Commercial |
$482.04
|
| Rate for Payer: WEA Trust Commercial |
$530.24
|
| Rate for Payer: WPS Commercial |
$714.07
|
|
|
Floseal 5ml [Med]
|
Facility
|
IP
|
$745.00
|
|
| Hospital Charge Code |
2974937
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$379.65 |
| Max. Negotiated Rate |
$712.82 |
| Rate for Payer: Aetna Commercial |
$697.32
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$666.33
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$410.64
|
| Rate for Payer: Cash Price |
$223.50
|
| Rate for Payer: Cigna Commercial |
$712.82
|
| Rate for Payer: Health EOS Commercial |
$689.57
|
| Rate for Payer: HFN Commercial |
$712.82
|
| Rate for Payer: Multiplan Commercial |
$619.84
|
| Rate for Payer: Preferred Network Access Commercial |
$712.82
|
| Rate for Payer: Quartz Beloit One Network |
$379.65
|
| Rate for Payer: Quartz Commercial |
$464.88
|
| Rate for Payer: WEA Trust Commercial |
$426.14
|
| Rate for Payer: WPS Commercial |
$573.87
|
|
|
Floseal 5ml [Med]
|
Facility
|
OP
|
$745.00
|
|
| Hospital Charge Code |
2974937
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$216.94 |
| Max. Negotiated Rate |
$712.82 |
| Rate for Payer: Aetna Commercial |
$697.32
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$666.33
|
| Rate for Payer: Aetna Managed Medicare |
$216.94
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$503.62
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$387.40
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$371.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$410.64
|
| Rate for Payer: Cash Price |
$223.50
|
| Rate for Payer: Cigna Commercial |
$712.82
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$433.59
|
| Rate for Payer: Health EOS Commercial |
$689.57
|
| Rate for Payer: HFN Commercial |
$712.82
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$581.10
|
| Rate for Payer: Multiplan Commercial |
$619.84
|
| Rate for Payer: NAPHCARE Commercial |
$464.88
|
| Rate for Payer: Preferred Network Access Commercial |
$712.82
|
| Rate for Payer: Quartz Beloit One Network |
$379.65
|
| Rate for Payer: Quartz Commercial |
$503.62
|
| Rate for Payer: Quartz Medicare Advantage |
$464.88
|
| Rate for Payer: The Alliance Commercial |
$387.40
|
| Rate for Payer: WEA Trust Commercial |
$426.14
|
| Rate for Payer: WPS Commercial |
$573.87
|
|
|
Floseal Endoscopic Applicator 0600125 [Med]
|
Facility
|
OP
|
$378.00
|
|
| Hospital Charge Code |
2974938
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$110.07 |
| Max. Negotiated Rate |
$361.67 |
| Rate for Payer: Aetna Commercial |
$353.81
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$338.08
|
| Rate for Payer: Aetna Managed Medicare |
$110.07
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$255.53
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$196.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$188.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$208.35
|
| Rate for Payer: Cash Price |
$113.40
|
| Rate for Payer: Cigna Commercial |
$361.67
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$220.00
|
| Rate for Payer: Health EOS Commercial |
$349.88
|
| Rate for Payer: HFN Commercial |
$361.67
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$294.84
|
| Rate for Payer: Multiplan Commercial |
$314.50
|
| Rate for Payer: NAPHCARE Commercial |
$235.87
|
| Rate for Payer: Preferred Network Access Commercial |
$361.67
|
| Rate for Payer: Quartz Beloit One Network |
$192.63
|
| Rate for Payer: Quartz Commercial |
$255.53
|
| Rate for Payer: Quartz Medicare Advantage |
$235.87
|
| Rate for Payer: The Alliance Commercial |
$196.56
|
| Rate for Payer: WEA Trust Commercial |
$216.22
|
| Rate for Payer: WPS Commercial |
$291.17
|
|
|
Floseal Endoscopic Applicator 0600125 [Med]
|
Facility
|
IP
|
$378.00
|
|
| Hospital Charge Code |
2974938
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$192.63 |
| Max. Negotiated Rate |
$361.67 |
| Rate for Payer: Aetna Commercial |
$353.81
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$338.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$208.35
|
| Rate for Payer: Cash Price |
$113.40
|
| Rate for Payer: Cigna Commercial |
$361.67
|
| Rate for Payer: Health EOS Commercial |
$349.88
|
| Rate for Payer: HFN Commercial |
$361.67
|
| Rate for Payer: Multiplan Commercial |
$314.50
|
| Rate for Payer: Preferred Network Access Commercial |
$361.67
|
| Rate for Payer: Quartz Beloit One Network |
$192.63
|
| Rate for Payer: Quartz Commercial |
$235.87
|
| Rate for Payer: WEA Trust Commercial |
$216.22
|
| Rate for Payer: WPS Commercial |
$291.17
|
|
|
Flow Cytometry, 1 Marker
|
Professional
|
Both
|
$84.00
|
|
|
Service Code
|
CPT 88184
|
| Hospital Charge Code |
2802799
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$38.44 |
| Max. Negotiated Rate |
$353.82 |
| Rate for Payer: Aetna Commercial |
$82.99
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$75.13
|
| Rate for Payer: Aetna Managed Medicare |
$80.41
|
| Rate for Payer: Anthem Medicare Advantage |
$80.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$80.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$80.41
|
| Rate for Payer: Cash Price |
$25.20
|
| Rate for Payer: Cash Price |
$25.20
|
| Rate for Payer: Cigna Commercial |
$82.99
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$43.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$80.41
|
| Rate for Payer: Health EOS Commercial |
$79.50
|
| Rate for Payer: HFN Commercial |
$82.99
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$239.69
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$239.69
|
| Rate for Payer: Independent Care Health Plan Medicare |
$80.41
|
| Rate for Payer: Multiplan Commercial |
$69.89
|
| Rate for Payer: NAPHCARE Commercial |
$120.62
|
| Rate for Payer: Preferred Network Access Commercial |
$82.99
|
| Rate for Payer: Quartz Beloit One Network |
$38.44
|
| Rate for Payer: Quartz Commercial |
$49.80
|
| Rate for Payer: Quartz Medicare Advantage |
$80.41
|
| Rate for Payer: The Alliance Commercial |
$317.63
|
| Rate for Payer: United Healthcare Medicare Advantage |
$80.41
|
| Rate for Payer: WEA Trust Commercial |
$48.05
|
| Rate for Payer: WPS Commercial |
$353.82
|
|
|
Flow Cytometry, 1 Marker
|
Facility
|
IP
|
$84.00
|
|
|
Service Code
|
CPT 88184
|
| Hospital Charge Code |
2802799
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$42.81 |
| Max. Negotiated Rate |
$80.37 |
| Rate for Payer: Aetna Commercial |
$78.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$75.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$46.30
|
| Rate for Payer: Cash Price |
$25.20
|
| Rate for Payer: Cigna Commercial |
$80.37
|
| Rate for Payer: Health EOS Commercial |
$77.75
|
| Rate for Payer: HFN Commercial |
$80.37
|
| Rate for Payer: Multiplan Commercial |
$69.89
|
| Rate for Payer: Preferred Network Access Commercial |
$80.37
|
| Rate for Payer: Quartz Beloit One Network |
$42.81
|
| Rate for Payer: Quartz Commercial |
$52.42
|
| Rate for Payer: WEA Trust Commercial |
$48.05
|
| Rate for Payer: WPS Commercial |
$64.71
|
|
|
Flow Cytometry, 1 Marker
|
Facility
|
OP
|
$84.00
|
|
|
Service Code
|
CPT 88184
|
| Hospital Charge Code |
2802799
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$42.81 |
| Max. Negotiated Rate |
$1,508.92 |
| Rate for Payer: Aetna Commercial |
$78.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$75.13
|
| Rate for Payer: Aetna Managed Medicare |
$377.23
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,385.59
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$646.61
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$613.36
|
| Rate for Payer: Anthem Medicare Advantage |
$377.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$46.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$377.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$377.23
|
| Rate for Payer: Cash Price |
$25.20
|
| Rate for Payer: Cash Price |
$25.20
|
| Rate for Payer: Cigna Commercial |
$80.37
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$377.23
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$48.89
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$377.23
|
| Rate for Payer: Health EOS Commercial |
$77.75
|
| Rate for Payer: HFN Commercial |
$80.37
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,403.29
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$377.23
|
| Rate for Payer: Independent Care Health Plan Medicare |
$377.23
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$377.23
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$377.23
|
| Rate for Payer: Multiplan Commercial |
$69.89
|
| Rate for Payer: NAPHCARE Commercial |
$565.84
|
| Rate for Payer: Preferred Network Access Commercial |
$80.37
|
| Rate for Payer: Quartz Beloit One Network |
$42.81
|
| Rate for Payer: Quartz Commercial |
$56.78
|
| Rate for Payer: Quartz Medicare Advantage |
$377.23
|
| Rate for Payer: The Alliance Commercial |
$1,508.92
|
| Rate for Payer: United Healthcare Medicare Advantage |
$377.23
|
| Rate for Payer: United Healthcare PPO |
$65.52
|
| Rate for Payer: WEA Trust Commercial |
$48.05
|
| Rate for Payer: Wellcare Medicare |
$377.23
|
| Rate for Payer: WPS Commercial |
$64.71
|
|
|
Flow Cytometry, Add Marker
|
Facility
|
IP
|
$84.00
|
|
|
Service Code
|
CPT 88185
|
| Hospital Charge Code |
2802800
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$42.81 |
| Max. Negotiated Rate |
$80.37 |
| Rate for Payer: Aetna Commercial |
$78.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$75.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$46.30
|
| Rate for Payer: Cash Price |
$25.20
|
| Rate for Payer: Cigna Commercial |
$80.37
|
| Rate for Payer: Health EOS Commercial |
$77.75
|
| Rate for Payer: HFN Commercial |
$80.37
|
| Rate for Payer: Multiplan Commercial |
$69.89
|
| Rate for Payer: Preferred Network Access Commercial |
$80.37
|
| Rate for Payer: Quartz Beloit One Network |
$42.81
|
| Rate for Payer: Quartz Commercial |
$52.42
|
| Rate for Payer: WEA Trust Commercial |
$48.05
|
| Rate for Payer: WPS Commercial |
$64.71
|
|
|
Flow Cytometry, Add Marker
|
Facility
|
OP
|
$84.00
|
|
|
Service Code
|
CPT 88185
|
| Hospital Charge Code |
2802800
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$24.46 |
| Max. Negotiated Rate |
$91.85 |
| Rate for Payer: Aetna Commercial |
$78.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$75.13
|
| Rate for Payer: Aetna Managed Medicare |
$24.46
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$56.78
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$43.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$41.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$46.30
|
| Rate for Payer: Cash Price |
$25.20
|
| Rate for Payer: Cash Price |
$25.20
|
| Rate for Payer: Cigna Commercial |
$80.37
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$48.89
|
| Rate for Payer: Health EOS Commercial |
$77.75
|
| Rate for Payer: HFN Commercial |
$80.37
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$65.52
|
| Rate for Payer: Multiplan Commercial |
$69.89
|
| Rate for Payer: NAPHCARE Commercial |
$52.42
|
| Rate for Payer: Preferred Network Access Commercial |
$80.37
|
| Rate for Payer: Quartz Beloit One Network |
$42.81
|
| Rate for Payer: Quartz Commercial |
$56.78
|
| Rate for Payer: Quartz Medicare Advantage |
$52.42
|
| Rate for Payer: The Alliance Commercial |
$91.85
|
| Rate for Payer: United Healthcare PPO |
$65.52
|
| Rate for Payer: WEA Trust Commercial |
$48.05
|
| Rate for Payer: WPS Commercial |
$64.71
|
|
|
Flow Cytometry, Add Marker
|
Professional
|
Both
|
$84.00
|
|
|
Service Code
|
CPT 88185
|
| Hospital Charge Code |
2802800
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$22.96 |
| Max. Negotiated Rate |
$101.04 |
| Rate for Payer: Aetna Commercial |
$82.99
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$75.13
|
| Rate for Payer: Aetna Managed Medicare |
$22.96
|
| Rate for Payer: Anthem Medicare Advantage |
$22.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$22.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$22.96
|
| Rate for Payer: Cash Price |
$25.20
|
| Rate for Payer: Cash Price |
$25.20
|
| Rate for Payer: Cigna Commercial |
$82.99
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$43.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$22.96
|
| Rate for Payer: Health EOS Commercial |
$79.50
|
| Rate for Payer: HFN Commercial |
$82.99
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$79.63
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$79.63
|
| Rate for Payer: Independent Care Health Plan Medicare |
$22.96
|
| Rate for Payer: Multiplan Commercial |
$69.89
|
| Rate for Payer: NAPHCARE Commercial |
$34.44
|
| Rate for Payer: Preferred Network Access Commercial |
$82.99
|
| Rate for Payer: Quartz Beloit One Network |
$38.44
|
| Rate for Payer: Quartz Commercial |
$49.80
|
| Rate for Payer: Quartz Medicare Advantage |
$22.96
|
| Rate for Payer: The Alliance Commercial |
$90.70
|
| Rate for Payer: United Healthcare Medicare Advantage |
$22.96
|
| Rate for Payer: WEA Trust Commercial |
$48.05
|
| Rate for Payer: WPS Commercial |
$101.04
|
|
|
Flow Cytometry CD19+
|
Professional
|
Both
|
$656.00
|
|
|
Service Code
|
CPT 88185
|
| Hospital Charge Code |
2798807
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$22.96 |
| Max. Negotiated Rate |
$648.13 |
| Rate for Payer: Aetna Commercial |
$648.13
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$586.73
|
| Rate for Payer: Aetna Managed Medicare |
$22.96
|
| Rate for Payer: Anthem Medicare Advantage |
$22.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$22.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$22.96
|
| Rate for Payer: Cash Price |
$196.80
|
| Rate for Payer: Cash Price |
$196.80
|
| Rate for Payer: Cigna Commercial |
$648.13
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$341.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$22.96
|
| Rate for Payer: Health EOS Commercial |
$620.84
|
| Rate for Payer: HFN Commercial |
$648.13
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$79.63
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$79.63
|
| Rate for Payer: Independent Care Health Plan Medicare |
$22.96
|
| Rate for Payer: Multiplan Commercial |
$545.79
|
| Rate for Payer: NAPHCARE Commercial |
$34.44
|
| Rate for Payer: Preferred Network Access Commercial |
$648.13
|
| Rate for Payer: Quartz Beloit One Network |
$300.19
|
| Rate for Payer: Quartz Commercial |
$388.88
|
| Rate for Payer: Quartz Medicare Advantage |
$22.96
|
| Rate for Payer: The Alliance Commercial |
$90.70
|
| Rate for Payer: United Healthcare Medicare Advantage |
$22.96
|
| Rate for Payer: WEA Trust Commercial |
$375.23
|
| Rate for Payer: WPS Commercial |
$101.04
|
|
|
Flow Cytometry CD19+
|
Facility
|
IP
|
$656.00
|
|
|
Service Code
|
CPT 88185
|
| Hospital Charge Code |
2798807
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$334.30 |
| Max. Negotiated Rate |
$627.66 |
| Rate for Payer: Aetna Commercial |
$614.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$586.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$361.59
|
| Rate for Payer: Cash Price |
$196.80
|
| Rate for Payer: Cigna Commercial |
$627.66
|
| Rate for Payer: Health EOS Commercial |
$607.19
|
| Rate for Payer: HFN Commercial |
$627.66
|
| Rate for Payer: Multiplan Commercial |
$545.79
|
| Rate for Payer: Preferred Network Access Commercial |
$627.66
|
| Rate for Payer: Quartz Beloit One Network |
$334.30
|
| Rate for Payer: Quartz Commercial |
$409.34
|
| Rate for Payer: WEA Trust Commercial |
$375.23
|
| Rate for Payer: WPS Commercial |
$505.32
|
|
|
Flow Cytometry CD19+
|
Facility
|
OP
|
$656.00
|
|
|
Service Code
|
CPT 88185
|
| Hospital Charge Code |
2798807
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$91.85 |
| Max. Negotiated Rate |
$627.66 |
| Rate for Payer: Aetna Commercial |
$614.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$586.73
|
| Rate for Payer: Aetna Managed Medicare |
$191.03
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$443.46
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$341.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$327.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$361.59
|
| Rate for Payer: Cash Price |
$196.80
|
| Rate for Payer: Cash Price |
$196.80
|
| Rate for Payer: Cigna Commercial |
$627.66
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$381.79
|
| Rate for Payer: Health EOS Commercial |
$607.19
|
| Rate for Payer: HFN Commercial |
$627.66
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$511.68
|
| Rate for Payer: Multiplan Commercial |
$545.79
|
| Rate for Payer: NAPHCARE Commercial |
$409.34
|
| Rate for Payer: Preferred Network Access Commercial |
$627.66
|
| Rate for Payer: Quartz Beloit One Network |
$334.30
|
| Rate for Payer: Quartz Commercial |
$443.46
|
| Rate for Payer: Quartz Medicare Advantage |
$409.34
|
| Rate for Payer: The Alliance Commercial |
$91.85
|
| Rate for Payer: United Healthcare PPO |
$511.68
|
| Rate for Payer: WEA Trust Commercial |
$375.23
|
| Rate for Payer: WPS Commercial |
$505.32
|
|
|
Flow Cytometry CD5+
|
Facility
|
IP
|
$545.00
|
|
|
Service Code
|
CPT 88184
|
| Hospital Charge Code |
2800799
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$277.73 |
| Max. Negotiated Rate |
$521.46 |
| Rate for Payer: Aetna Commercial |
$510.12
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$487.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$300.40
|
| Rate for Payer: Cash Price |
$163.50
|
| Rate for Payer: Cigna Commercial |
$521.46
|
| Rate for Payer: Health EOS Commercial |
$504.45
|
| Rate for Payer: HFN Commercial |
$521.46
|
| Rate for Payer: Multiplan Commercial |
$453.44
|
| Rate for Payer: Preferred Network Access Commercial |
$521.46
|
| Rate for Payer: Quartz Beloit One Network |
$277.73
|
| Rate for Payer: Quartz Commercial |
$340.08
|
| Rate for Payer: WEA Trust Commercial |
$311.74
|
| Rate for Payer: WPS Commercial |
$419.81
|
|
|
Flow Cytometry CD5+
|
Professional
|
Both
|
$545.00
|
|
|
Service Code
|
CPT 88184
|
| Hospital Charge Code |
2800799
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$80.41 |
| Max. Negotiated Rate |
$538.46 |
| Rate for Payer: Aetna Commercial |
$538.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$487.45
|
| Rate for Payer: Aetna Managed Medicare |
$80.41
|
| Rate for Payer: Anthem Medicare Advantage |
$80.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$80.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$80.41
|
| Rate for Payer: Cash Price |
$163.50
|
| Rate for Payer: Cash Price |
$163.50
|
| Rate for Payer: Cigna Commercial |
$538.46
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$283.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$80.41
|
| Rate for Payer: Health EOS Commercial |
$515.79
|
| Rate for Payer: HFN Commercial |
$538.46
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$239.69
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$239.69
|
| Rate for Payer: Independent Care Health Plan Medicare |
$80.41
|
| Rate for Payer: Multiplan Commercial |
$453.44
|
| Rate for Payer: NAPHCARE Commercial |
$120.62
|
| Rate for Payer: Preferred Network Access Commercial |
$538.46
|
| Rate for Payer: Quartz Beloit One Network |
$249.39
|
| Rate for Payer: Quartz Commercial |
$323.08
|
| Rate for Payer: Quartz Medicare Advantage |
$80.41
|
| Rate for Payer: The Alliance Commercial |
$317.63
|
| Rate for Payer: United Healthcare Medicare Advantage |
$80.41
|
| Rate for Payer: WEA Trust Commercial |
$311.74
|
| Rate for Payer: WPS Commercial |
$353.82
|
|
|
Flow Cytometry CD5+
|
Facility
|
OP
|
$545.00
|
|
|
Service Code
|
CPT 88184
|
| Hospital Charge Code |
2800799
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$277.73 |
| Max. Negotiated Rate |
$1,508.92 |
| Rate for Payer: Aetna Commercial |
$510.12
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$487.45
|
| Rate for Payer: Aetna Managed Medicare |
$377.23
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,385.59
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$646.61
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$613.36
|
| Rate for Payer: Anthem Medicare Advantage |
$377.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$300.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$377.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$377.23
|
| Rate for Payer: Cash Price |
$163.50
|
| Rate for Payer: Cash Price |
$163.50
|
| Rate for Payer: Cigna Commercial |
$521.46
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$377.23
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$317.19
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$377.23
|
| Rate for Payer: Health EOS Commercial |
$504.45
|
| Rate for Payer: HFN Commercial |
$521.46
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,403.29
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$377.23
|
| Rate for Payer: Independent Care Health Plan Medicare |
$377.23
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$377.23
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$377.23
|
| Rate for Payer: Multiplan Commercial |
$453.44
|
| Rate for Payer: NAPHCARE Commercial |
$565.84
|
| Rate for Payer: Preferred Network Access Commercial |
$521.46
|
| Rate for Payer: Quartz Beloit One Network |
$277.73
|
| Rate for Payer: Quartz Commercial |
$368.42
|
| Rate for Payer: Quartz Medicare Advantage |
$377.23
|
| Rate for Payer: The Alliance Commercial |
$1,508.92
|
| Rate for Payer: United Healthcare Medicare Advantage |
$377.23
|
| Rate for Payer: United Healthcare PPO |
$425.10
|
| Rate for Payer: WEA Trust Commercial |
$311.74
|
| Rate for Payer: Wellcare Medicare |
$377.23
|
| Rate for Payer: WPS Commercial |
$419.81
|
|
|
Flow Cytometry, DNA Analysis
|
Facility
|
IP
|
$716.00
|
|
|
Service Code
|
CPT 88182
|
| Hospital Charge Code |
2802801
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$364.87 |
| Max. Negotiated Rate |
$685.07 |
| Rate for Payer: Aetna Commercial |
$670.18
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$640.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$394.66
|
| Rate for Payer: Cash Price |
$214.80
|
| Rate for Payer: Cigna Commercial |
$685.07
|
| Rate for Payer: Health EOS Commercial |
$662.73
|
| Rate for Payer: HFN Commercial |
$685.07
|
| Rate for Payer: Multiplan Commercial |
$595.71
|
| Rate for Payer: Preferred Network Access Commercial |
$685.07
|
| Rate for Payer: Quartz Beloit One Network |
$364.87
|
| Rate for Payer: Quartz Commercial |
$446.78
|
| Rate for Payer: WEA Trust Commercial |
$409.55
|
| Rate for Payer: WPS Commercial |
$551.53
|
|
|
Flow Cytometry, DNA Analysis
|
Professional
|
Both
|
$716.00
|
|
|
Service Code
|
CPT 88182
|
| Hospital Charge Code |
2802801
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$34.63 |
| Max. Negotiated Rate |
$707.41 |
| Rate for Payer: Aetna Commercial |
$707.41
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$640.39
|
| Rate for Payer: Aetna Managed Medicare |
$148.16
|
| Rate for Payer: Anthem Commercial |
$34.63
|
| Rate for Payer: Anthem Medicare Advantage |
$148.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$148.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$148.16
|
| Rate for Payer: Cash Price |
$214.80
|
| Rate for Payer: Cash Price |
$214.80
|
| Rate for Payer: Cigna Commercial |
$707.41
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$372.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$148.16
|
| Rate for Payer: Health EOS Commercial |
$677.62
|
| Rate for Payer: HFN Commercial |
$707.41
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$487.86
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$487.86
|
| Rate for Payer: Independent Care Health Plan Medicare |
$148.16
|
| Rate for Payer: Multiplan Commercial |
$595.71
|
| Rate for Payer: NAPHCARE Commercial |
$222.24
|
| Rate for Payer: Preferred Network Access Commercial |
$707.41
|
| Rate for Payer: Quartz Beloit One Network |
$327.64
|
| Rate for Payer: Quartz Commercial |
$424.44
|
| Rate for Payer: Quartz Medicare Advantage |
$148.16
|
| Rate for Payer: The Alliance Commercial |
$585.23
|
| Rate for Payer: United Healthcare Medicare Advantage |
$148.16
|
| Rate for Payer: WEA Trust Commercial |
$409.55
|
| Rate for Payer: WPS Commercial |
$651.90
|
|
|
Flow Cytometry, DNA Analysis
|
Facility
|
OP
|
$716.00
|
|
|
Service Code
|
CPT 88182
|
| Hospital Charge Code |
2802801
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$54.84 |
| Max. Negotiated Rate |
$685.07 |
| Rate for Payer: Aetna Commercial |
$670.18
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$640.39
|
| Rate for Payer: Aetna Managed Medicare |
$54.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$208.88
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$97.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$92.47
|
| Rate for Payer: Anthem Medicare Advantage |
$54.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$394.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$54.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$54.84
|
| Rate for Payer: Cash Price |
$214.80
|
| Rate for Payer: Cash Price |
$214.80
|
| Rate for Payer: Cigna Commercial |
$685.07
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$54.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$416.71
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$54.84
|
| Rate for Payer: Health EOS Commercial |
$662.73
|
| Rate for Payer: HFN Commercial |
$685.07
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$204.00
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$54.84
|
| Rate for Payer: Independent Care Health Plan Medicare |
$54.84
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$54.84
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$54.84
|
| Rate for Payer: Multiplan Commercial |
$595.71
|
| Rate for Payer: NAPHCARE Commercial |
$82.26
|
| Rate for Payer: Preferred Network Access Commercial |
$685.07
|
| Rate for Payer: Quartz Beloit One Network |
$364.87
|
| Rate for Payer: Quartz Commercial |
$484.02
|
| Rate for Payer: Quartz Medicare Advantage |
$54.84
|
| Rate for Payer: The Alliance Commercial |
$219.36
|
| Rate for Payer: United Healthcare Medicare Advantage |
$54.84
|
| Rate for Payer: United Healthcare PPO |
$558.48
|
| Rate for Payer: WEA Trust Commercial |
$409.55
|
| Rate for Payer: Wellcare Medicare |
$54.84
|
| Rate for Payer: WPS Commercial |
$551.53
|
|
|
Flow Cytometry - Ea. Addtnl Marker
|
Professional
|
Both
|
$87.00
|
|
|
Service Code
|
CPT 88185
|
| Hospital Charge Code |
2956820
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$22.96 |
| Max. Negotiated Rate |
$101.04 |
| Rate for Payer: Aetna Commercial |
$85.96
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$77.81
|
| Rate for Payer: Aetna Managed Medicare |
$22.96
|
| Rate for Payer: Anthem Medicare Advantage |
$22.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$22.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$22.96
|
| Rate for Payer: Cash Price |
$26.10
|
| Rate for Payer: Cash Price |
$26.10
|
| Rate for Payer: Cigna Commercial |
$85.96
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$45.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$22.96
|
| Rate for Payer: Health EOS Commercial |
$82.34
|
| Rate for Payer: HFN Commercial |
$85.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$79.63
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$79.63
|
| Rate for Payer: Independent Care Health Plan Medicare |
$22.96
|
| Rate for Payer: Multiplan Commercial |
$72.38
|
| Rate for Payer: NAPHCARE Commercial |
$34.44
|
| Rate for Payer: Preferred Network Access Commercial |
$85.96
|
| Rate for Payer: Quartz Beloit One Network |
$39.81
|
| Rate for Payer: Quartz Commercial |
$51.57
|
| Rate for Payer: Quartz Medicare Advantage |
$22.96
|
| Rate for Payer: The Alliance Commercial |
$90.70
|
| Rate for Payer: United Healthcare Medicare Advantage |
$22.96
|
| Rate for Payer: WEA Trust Commercial |
$49.76
|
| Rate for Payer: WPS Commercial |
$101.04
|
|
|
Flow Cytometry - Ea. Addtnl Marker
|
Facility
|
OP
|
$87.00
|
|
|
Service Code
|
CPT 88185
|
| Hospital Charge Code |
2956820
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$25.33 |
| Max. Negotiated Rate |
$91.85 |
| Rate for Payer: Aetna Commercial |
$81.43
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$77.81
|
| Rate for Payer: Aetna Managed Medicare |
$25.33
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$58.81
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$45.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$43.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$47.95
|
| Rate for Payer: Cash Price |
$26.10
|
| Rate for Payer: Cash Price |
$26.10
|
| Rate for Payer: Cigna Commercial |
$83.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$50.63
|
| Rate for Payer: Health EOS Commercial |
$80.53
|
| Rate for Payer: HFN Commercial |
$83.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$67.86
|
| Rate for Payer: Multiplan Commercial |
$72.38
|
| Rate for Payer: NAPHCARE Commercial |
$54.29
|
| Rate for Payer: Preferred Network Access Commercial |
$83.24
|
| Rate for Payer: Quartz Beloit One Network |
$44.34
|
| Rate for Payer: Quartz Commercial |
$58.81
|
| Rate for Payer: Quartz Medicare Advantage |
$54.29
|
| Rate for Payer: The Alliance Commercial |
$91.85
|
| Rate for Payer: United Healthcare PPO |
$67.86
|
| Rate for Payer: WEA Trust Commercial |
$49.76
|
| Rate for Payer: WPS Commercial |
$67.02
|
|
