|
FLT 3 Gene Analysis
|
Professional
|
Both
|
$412.00
|
|
|
Service Code
|
CPT 81246
|
| Hospital Charge Code |
5484796
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$86.32 |
| Max. Negotiated Rate |
$407.06 |
| Rate for Payer: Aetna Commercial |
$407.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$368.49
|
| Rate for Payer: Aetna Managed Medicare |
$86.32
|
| Rate for Payer: Anthem Medicare Advantage |
$86.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$86.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$86.32
|
| Rate for Payer: Cash Price |
$123.60
|
| Rate for Payer: Cash Price |
$123.60
|
| Rate for Payer: Cigna Commercial |
$407.06
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$214.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$86.32
|
| Rate for Payer: Health EOS Commercial |
$389.92
|
| Rate for Payer: HFN Commercial |
$407.06
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$304.71
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$304.71
|
| Rate for Payer: Independent Care Health Plan Medicare |
$86.32
|
| Rate for Payer: Multiplan Commercial |
$342.78
|
| Rate for Payer: NAPHCARE Commercial |
$129.48
|
| Rate for Payer: Preferred Network Access Commercial |
$407.06
|
| Rate for Payer: Quartz Beloit One Network |
$188.53
|
| Rate for Payer: Quartz Commercial |
$244.23
|
| Rate for Payer: Quartz Medicare Advantage |
$86.32
|
| Rate for Payer: The Alliance Commercial |
$340.96
|
| Rate for Payer: United Healthcare Medicare Advantage |
$86.32
|
| Rate for Payer: WEA Trust Commercial |
$235.66
|
| Rate for Payer: WPS Commercial |
$379.81
|
|
|
FLT 3 Gene Analysis
|
Facility
|
IP
|
$412.00
|
|
|
Service Code
|
CPT 81246
|
| Hospital Charge Code |
5484796
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$209.96 |
| Max. Negotiated Rate |
$394.20 |
| Rate for Payer: Aetna Commercial |
$385.63
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$368.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$227.09
|
| Rate for Payer: Cash Price |
$123.60
|
| Rate for Payer: Cigna Commercial |
$394.20
|
| Rate for Payer: Health EOS Commercial |
$381.35
|
| Rate for Payer: HFN Commercial |
$394.20
|
| Rate for Payer: Multiplan Commercial |
$342.78
|
| Rate for Payer: Preferred Network Access Commercial |
$394.20
|
| Rate for Payer: Quartz Beloit One Network |
$209.96
|
| Rate for Payer: Quartz Commercial |
$257.09
|
| Rate for Payer: WEA Trust Commercial |
$235.66
|
| Rate for Payer: WPS Commercial |
$317.36
|
|
|
FLT3 Mutation Analysis to Mayo
|
Facility
|
OP
|
$822.00
|
|
|
Service Code
|
CPT 81245
|
| Hospital Charge Code |
5484745
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$172.13 |
| Max. Negotiated Rate |
$786.49 |
| Rate for Payer: Aetna Commercial |
$769.39
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$735.20
|
| Rate for Payer: Aetna Managed Medicare |
$172.13
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$645.49
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$301.23
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$285.74
|
| Rate for Payer: Anthem Medicare Advantage |
$172.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$453.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$172.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$172.13
|
| Rate for Payer: Cash Price |
$246.60
|
| Rate for Payer: Cash Price |
$246.60
|
| Rate for Payer: Cigna Commercial |
$786.49
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$172.13
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$478.40
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$172.13
|
| Rate for Payer: Health EOS Commercial |
$760.84
|
| Rate for Payer: HFN Commercial |
$786.49
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$640.33
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$172.13
|
| Rate for Payer: Independent Care Health Plan Medicare |
$172.13
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$172.13
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$172.13
|
| Rate for Payer: Multiplan Commercial |
$683.90
|
| Rate for Payer: NAPHCARE Commercial |
$258.20
|
| Rate for Payer: Preferred Network Access Commercial |
$786.49
|
| Rate for Payer: Quartz Beloit One Network |
$418.89
|
| Rate for Payer: Quartz Commercial |
$555.67
|
| Rate for Payer: Quartz Medicare Advantage |
$172.13
|
| Rate for Payer: The Alliance Commercial |
$688.52
|
| Rate for Payer: United Healthcare Medicare Advantage |
$172.13
|
| Rate for Payer: United Healthcare PPO |
$641.16
|
| Rate for Payer: WEA Trust Commercial |
$470.18
|
| Rate for Payer: Wellcare Medicare |
$172.13
|
| Rate for Payer: WPS Commercial |
$633.19
|
|
|
FLT3 Mutation Analysis to Mayo
|
Professional
|
Both
|
$822.00
|
|
|
Service Code
|
CPT 81245
|
| Hospital Charge Code |
5484745
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$172.13 |
| Max. Negotiated Rate |
$812.14 |
| Rate for Payer: Aetna Commercial |
$812.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$735.20
|
| Rate for Payer: Aetna Managed Medicare |
$172.13
|
| Rate for Payer: Anthem Medicare Advantage |
$172.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$172.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$172.13
|
| Rate for Payer: Cash Price |
$246.60
|
| Rate for Payer: Cash Price |
$246.60
|
| Rate for Payer: Cigna Commercial |
$812.14
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$427.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$172.13
|
| Rate for Payer: Health EOS Commercial |
$777.94
|
| Rate for Payer: HFN Commercial |
$812.14
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$607.62
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$607.62
|
| Rate for Payer: Independent Care Health Plan Medicare |
$172.13
|
| Rate for Payer: Multiplan Commercial |
$683.90
|
| Rate for Payer: NAPHCARE Commercial |
$258.20
|
| Rate for Payer: Preferred Network Access Commercial |
$812.14
|
| Rate for Payer: Quartz Beloit One Network |
$376.15
|
| Rate for Payer: Quartz Commercial |
$487.28
|
| Rate for Payer: Quartz Medicare Advantage |
$172.13
|
| Rate for Payer: The Alliance Commercial |
$679.92
|
| Rate for Payer: United Healthcare Medicare Advantage |
$172.13
|
| Rate for Payer: WEA Trust Commercial |
$470.18
|
| Rate for Payer: WPS Commercial |
$757.37
|
|
|
FLT3 Mutation Analysis to Mayo
|
Facility
|
IP
|
$822.00
|
|
|
Service Code
|
CPT 81245
|
| Hospital Charge Code |
5484745
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$418.89 |
| Max. Negotiated Rate |
$786.49 |
| Rate for Payer: Aetna Commercial |
$769.39
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$735.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$453.09
|
| Rate for Payer: Cash Price |
$246.60
|
| Rate for Payer: Cigna Commercial |
$786.49
|
| Rate for Payer: Health EOS Commercial |
$760.84
|
| Rate for Payer: HFN Commercial |
$786.49
|
| Rate for Payer: Multiplan Commercial |
$683.90
|
| Rate for Payer: Preferred Network Access Commercial |
$786.49
|
| Rate for Payer: Quartz Beloit One Network |
$418.89
|
| Rate for Payer: Quartz Commercial |
$512.93
|
| Rate for Payer: WEA Trust Commercial |
$470.18
|
| Rate for Payer: WPS Commercial |
$633.19
|
|
|
Flu A/B PCR
|
Facility
|
OP
|
$266.00
|
|
|
Service Code
|
CPT 87502
|
| Hospital Charge Code |
4566787
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$99.63 |
| Max. Negotiated Rate |
$398.53 |
| Rate for Payer: Aetna Commercial |
$248.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$237.91
|
| Rate for Payer: Aetna Managed Medicare |
$99.63
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$373.62
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$174.36
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$165.39
|
| Rate for Payer: Anthem Medicare Advantage |
$99.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$146.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$99.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$99.63
|
| Rate for Payer: Cash Price |
$79.80
|
| Rate for Payer: Cash Price |
$79.80
|
| Rate for Payer: Cigna Commercial |
$254.51
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$99.63
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$154.81
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$99.63
|
| Rate for Payer: Health EOS Commercial |
$246.21
|
| Rate for Payer: HFN Commercial |
$254.51
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$370.63
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$99.63
|
| Rate for Payer: Independent Care Health Plan Medicare |
$99.63
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$99.63
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$99.63
|
| Rate for Payer: Multiplan Commercial |
$221.31
|
| Rate for Payer: NAPHCARE Commercial |
$149.45
|
| Rate for Payer: Preferred Network Access Commercial |
$254.51
|
| Rate for Payer: Quartz Beloit One Network |
$135.55
|
| Rate for Payer: Quartz Commercial |
$179.82
|
| Rate for Payer: Quartz Medicare Advantage |
$99.63
|
| Rate for Payer: The Alliance Commercial |
$398.53
|
| Rate for Payer: United Healthcare Medicare Advantage |
$99.63
|
| Rate for Payer: United Healthcare PPO |
$207.48
|
| Rate for Payer: WEA Trust Commercial |
$152.15
|
| Rate for Payer: Wellcare Medicare |
$99.63
|
| Rate for Payer: WPS Commercial |
$204.90
|
|
|
Flu A/B PCR
|
Professional
|
Both
|
$266.00
|
|
|
Service Code
|
CPT 87502
|
| Hospital Charge Code |
4566787
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$99.63 |
| Max. Negotiated Rate |
$438.38 |
| Rate for Payer: Aetna Commercial |
$262.81
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$237.91
|
| Rate for Payer: Aetna Managed Medicare |
$99.63
|
| Rate for Payer: Anthem Medicare Advantage |
$99.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$99.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$99.63
|
| Rate for Payer: Cash Price |
$79.80
|
| Rate for Payer: Cash Price |
$79.80
|
| Rate for Payer: Cigna Commercial |
$262.81
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$138.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$99.63
|
| Rate for Payer: Health EOS Commercial |
$251.74
|
| Rate for Payer: HFN Commercial |
$262.81
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$351.70
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$351.70
|
| Rate for Payer: Independent Care Health Plan Medicare |
$99.63
|
| Rate for Payer: Multiplan Commercial |
$221.31
|
| Rate for Payer: NAPHCARE Commercial |
$149.45
|
| Rate for Payer: Preferred Network Access Commercial |
$262.81
|
| Rate for Payer: Quartz Beloit One Network |
$121.72
|
| Rate for Payer: Quartz Commercial |
$157.68
|
| Rate for Payer: Quartz Medicare Advantage |
$99.63
|
| Rate for Payer: The Alliance Commercial |
$393.55
|
| Rate for Payer: United Healthcare Medicare Advantage |
$99.63
|
| Rate for Payer: WEA Trust Commercial |
$152.15
|
| Rate for Payer: WPS Commercial |
$438.38
|
|
|
Flu A/B PCR
|
Facility
|
IP
|
$266.00
|
|
|
Service Code
|
CPT 87502
|
| Hospital Charge Code |
4566787
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$135.55 |
| Max. Negotiated Rate |
$254.51 |
| Rate for Payer: Aetna Commercial |
$248.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$237.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$146.62
|
| Rate for Payer: Cash Price |
$79.80
|
| Rate for Payer: Cigna Commercial |
$254.51
|
| Rate for Payer: Health EOS Commercial |
$246.21
|
| Rate for Payer: HFN Commercial |
$254.51
|
| Rate for Payer: Multiplan Commercial |
$221.31
|
| Rate for Payer: Preferred Network Access Commercial |
$254.51
|
| Rate for Payer: Quartz Beloit One Network |
$135.55
|
| Rate for Payer: Quartz Commercial |
$165.98
|
| Rate for Payer: WEA Trust Commercial |
$152.15
|
| Rate for Payer: WPS Commercial |
$204.90
|
|
|
Flu A/B with RSV PCR
|
Professional
|
Both
|
$535.00
|
|
|
Service Code
|
CPT 87631
|
| Hospital Charge Code |
5372812
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$148.34 |
| Max. Negotiated Rate |
$652.67 |
| Rate for Payer: Aetna Commercial |
$528.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$478.50
|
| Rate for Payer: Aetna Managed Medicare |
$148.34
|
| Rate for Payer: Anthem Medicare Advantage |
$148.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$148.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$148.34
|
| Rate for Payer: Cash Price |
$160.50
|
| Rate for Payer: Cash Price |
$160.50
|
| Rate for Payer: Cigna Commercial |
$528.58
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$278.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$148.34
|
| Rate for Payer: Health EOS Commercial |
$506.32
|
| Rate for Payer: HFN Commercial |
$528.58
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$523.62
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$523.62
|
| Rate for Payer: Independent Care Health Plan Medicare |
$148.34
|
| Rate for Payer: Multiplan Commercial |
$445.12
|
| Rate for Payer: NAPHCARE Commercial |
$222.50
|
| Rate for Payer: Preferred Network Access Commercial |
$528.58
|
| Rate for Payer: Quartz Beloit One Network |
$244.82
|
| Rate for Payer: Quartz Commercial |
$317.15
|
| Rate for Payer: Quartz Medicare Advantage |
$148.34
|
| Rate for Payer: The Alliance Commercial |
$585.92
|
| Rate for Payer: United Healthcare Medicare Advantage |
$148.34
|
| Rate for Payer: WEA Trust Commercial |
$306.02
|
| Rate for Payer: WPS Commercial |
$652.67
|
|
|
Flu A/B with RSV PCR
|
Facility
|
IP
|
$535.00
|
|
|
Service Code
|
CPT 87631
|
| Hospital Charge Code |
5372812
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$272.64 |
| Max. Negotiated Rate |
$511.89 |
| Rate for Payer: Aetna Commercial |
$500.76
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$478.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$294.89
|
| Rate for Payer: Cash Price |
$160.50
|
| Rate for Payer: Cigna Commercial |
$511.89
|
| Rate for Payer: Health EOS Commercial |
$495.20
|
| Rate for Payer: HFN Commercial |
$511.89
|
| Rate for Payer: Multiplan Commercial |
$445.12
|
| Rate for Payer: Preferred Network Access Commercial |
$511.89
|
| Rate for Payer: Quartz Beloit One Network |
$272.64
|
| Rate for Payer: Quartz Commercial |
$333.84
|
| Rate for Payer: WEA Trust Commercial |
$306.02
|
| Rate for Payer: WPS Commercial |
$412.11
|
|
|
Flu A/B with RSV PCR
|
Facility
|
OP
|
$535.00
|
|
|
Service Code
|
CPT 87631
|
| Hospital Charge Code |
5372812
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$148.34 |
| Max. Negotiated Rate |
$593.34 |
| Rate for Payer: Aetna Commercial |
$500.76
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$478.50
|
| Rate for Payer: Aetna Managed Medicare |
$148.34
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$556.26
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$259.59
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$246.24
|
| Rate for Payer: Anthem Medicare Advantage |
$148.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$294.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$148.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$148.34
|
| Rate for Payer: Cash Price |
$160.50
|
| Rate for Payer: Cash Price |
$160.50
|
| Rate for Payer: Cigna Commercial |
$511.89
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$148.34
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$311.37
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$148.34
|
| Rate for Payer: Health EOS Commercial |
$495.20
|
| Rate for Payer: HFN Commercial |
$511.89
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$551.81
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$148.34
|
| Rate for Payer: Independent Care Health Plan Medicare |
$148.34
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$148.34
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$148.34
|
| Rate for Payer: Multiplan Commercial |
$445.12
|
| Rate for Payer: NAPHCARE Commercial |
$222.50
|
| Rate for Payer: Preferred Network Access Commercial |
$511.89
|
| Rate for Payer: Quartz Beloit One Network |
$272.64
|
| Rate for Payer: Quartz Commercial |
$361.66
|
| Rate for Payer: Quartz Medicare Advantage |
$148.34
|
| Rate for Payer: The Alliance Commercial |
$593.34
|
| Rate for Payer: United Healthcare Medicare Advantage |
$148.34
|
| Rate for Payer: United Healthcare PPO |
$417.30
|
| Rate for Payer: WEA Trust Commercial |
$306.02
|
| Rate for Payer: Wellcare Medicare |
$148.34
|
| Rate for Payer: WPS Commercial |
$412.11
|
|
|
Flu Admin All Other (Dialysis) 90471
|
Facility
|
OP
|
$18.00
|
|
|
Service Code
|
CPT 90471
|
| Hospital Charge Code |
6219908
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$8.99 |
| Max. Negotiated Rate |
$303.10 |
| Rate for Payer: Aetna Commercial |
$16.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$16.10
|
| Rate for Payer: Aetna Managed Medicare |
$75.77
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$12.17
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$9.36
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$8.99
|
| Rate for Payer: Anthem Medicare Advantage |
$75.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$75.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$75.77
|
| Rate for Payer: Cash Price |
$5.40
|
| Rate for Payer: Cash Price |
$5.40
|
| Rate for Payer: Cigna Commercial |
$17.22
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$75.77
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$10.48
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$75.77
|
| Rate for Payer: Health EOS Commercial |
$16.66
|
| Rate for Payer: HFN Commercial |
$17.22
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$281.88
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$75.77
|
| Rate for Payer: Independent Care Health Plan Medicare |
$75.77
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$75.77
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$75.77
|
| Rate for Payer: Multiplan Commercial |
$14.98
|
| Rate for Payer: NAPHCARE Commercial |
$113.66
|
| Rate for Payer: Preferred Network Access Commercial |
$17.22
|
| Rate for Payer: Quartz Beloit One Network |
$9.17
|
| Rate for Payer: Quartz Commercial |
$12.17
|
| Rate for Payer: Quartz Medicare Advantage |
$75.77
|
| Rate for Payer: The Alliance Commercial |
$303.10
|
| Rate for Payer: United Healthcare Medicare Advantage |
$75.77
|
| Rate for Payer: United Healthcare PPO |
$14.04
|
| Rate for Payer: WEA Trust Commercial |
$10.30
|
| Rate for Payer: Wellcare Medicare |
$75.77
|
| Rate for Payer: WPS Commercial |
$13.87
|
|
|
Flu Admin All Other (Dialysis) 90471
|
Facility
|
IP
|
$18.00
|
|
|
Service Code
|
CPT 90471
|
| Hospital Charge Code |
6219908
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$9.17 |
| Max. Negotiated Rate |
$17.22 |
| Rate for Payer: Aetna Commercial |
$16.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$16.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9.92
|
| Rate for Payer: Cash Price |
$5.40
|
| Rate for Payer: Cigna Commercial |
$17.22
|
| Rate for Payer: Health EOS Commercial |
$16.66
|
| Rate for Payer: HFN Commercial |
$17.22
|
| Rate for Payer: Multiplan Commercial |
$14.98
|
| Rate for Payer: Preferred Network Access Commercial |
$17.22
|
| Rate for Payer: Quartz Beloit One Network |
$9.17
|
| Rate for Payer: Quartz Commercial |
$11.23
|
| Rate for Payer: WEA Trust Commercial |
$10.30
|
| Rate for Payer: WPS Commercial |
$13.87
|
|
|
Flu Admin All Other (Peritoneal) 90471
|
Facility
|
OP
|
$18.00
|
|
|
Service Code
|
CPT 90471
|
| Hospital Charge Code |
6219911
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$8.99 |
| Max. Negotiated Rate |
$303.10 |
| Rate for Payer: Aetna Commercial |
$16.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$16.10
|
| Rate for Payer: Aetna Managed Medicare |
$75.77
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$12.17
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$9.36
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$8.99
|
| Rate for Payer: Anthem Medicare Advantage |
$75.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$75.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$75.77
|
| Rate for Payer: Cash Price |
$5.40
|
| Rate for Payer: Cash Price |
$5.40
|
| Rate for Payer: Cigna Commercial |
$17.22
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$75.77
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$10.48
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$75.77
|
| Rate for Payer: Health EOS Commercial |
$16.66
|
| Rate for Payer: HFN Commercial |
$17.22
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$281.88
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$75.77
|
| Rate for Payer: Independent Care Health Plan Medicare |
$75.77
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$75.77
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$75.77
|
| Rate for Payer: Multiplan Commercial |
$14.98
|
| Rate for Payer: NAPHCARE Commercial |
$113.66
|
| Rate for Payer: Preferred Network Access Commercial |
$17.22
|
| Rate for Payer: Quartz Beloit One Network |
$9.17
|
| Rate for Payer: Quartz Commercial |
$12.17
|
| Rate for Payer: Quartz Medicare Advantage |
$75.77
|
| Rate for Payer: The Alliance Commercial |
$303.10
|
| Rate for Payer: United Healthcare Medicare Advantage |
$75.77
|
| Rate for Payer: United Healthcare PPO |
$14.04
|
| Rate for Payer: WEA Trust Commercial |
$10.30
|
| Rate for Payer: Wellcare Medicare |
$75.77
|
| Rate for Payer: WPS Commercial |
$13.87
|
|
|
Flu Admin All Other (Peritoneal) 90471
|
Facility
|
IP
|
$18.00
|
|
|
Service Code
|
CPT 90471
|
| Hospital Charge Code |
6219911
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$9.17 |
| Max. Negotiated Rate |
$17.22 |
| Rate for Payer: Aetna Commercial |
$16.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$16.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9.92
|
| Rate for Payer: Cash Price |
$5.40
|
| Rate for Payer: Cigna Commercial |
$17.22
|
| Rate for Payer: Health EOS Commercial |
$16.66
|
| Rate for Payer: HFN Commercial |
$17.22
|
| Rate for Payer: Multiplan Commercial |
$14.98
|
| Rate for Payer: Preferred Network Access Commercial |
$17.22
|
| Rate for Payer: Quartz Beloit One Network |
$9.17
|
| Rate for Payer: Quartz Commercial |
$11.23
|
| Rate for Payer: WEA Trust Commercial |
$10.30
|
| Rate for Payer: WPS Commercial |
$13.87
|
|
|
Flublok (0.5ml)
|
Facility
|
IP
|
$42.00
|
|
|
Service Code
|
CPT 90682
|
| Hospital Charge Code |
5657655
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$21.40 |
| Max. Negotiated Rate |
$40.19 |
| Rate for Payer: Aetna Commercial |
$39.31
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$37.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$23.15
|
| Rate for Payer: Cash Price |
$12.60
|
| Rate for Payer: Cigna Commercial |
$40.19
|
| Rate for Payer: Health EOS Commercial |
$38.88
|
| Rate for Payer: HFN Commercial |
$40.19
|
| Rate for Payer: Multiplan Commercial |
$34.94
|
| Rate for Payer: Preferred Network Access Commercial |
$40.19
|
| Rate for Payer: Quartz Beloit One Network |
$21.40
|
| Rate for Payer: Quartz Commercial |
$26.21
|
| Rate for Payer: WEA Trust Commercial |
$24.02
|
| Rate for Payer: WPS Commercial |
$32.35
|
|
|
Flublok (0.5ml)
|
Facility
|
OP
|
$42.00
|
|
|
Service Code
|
CPT 90682
|
| Hospital Charge Code |
5657655
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.23 |
| Max. Negotiated Rate |
$190.85 |
| Rate for Payer: Aetna Commercial |
$39.31
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$37.56
|
| Rate for Payer: Aetna Managed Medicare |
$12.23
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$28.39
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$21.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$20.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$23.15
|
| Rate for Payer: Cash Price |
$12.60
|
| Rate for Payer: Cash Price |
$12.60
|
| Rate for Payer: Cigna Commercial |
$40.19
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$101.00
|
| Rate for Payer: Health EOS Commercial |
$38.88
|
| Rate for Payer: HFN Commercial |
$40.19
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$32.76
|
| Rate for Payer: Multiplan Commercial |
$34.94
|
| Rate for Payer: NAPHCARE Commercial |
$26.21
|
| Rate for Payer: Preferred Network Access Commercial |
$40.19
|
| Rate for Payer: Quartz Beloit One Network |
$21.40
|
| Rate for Payer: Quartz Commercial |
$28.39
|
| Rate for Payer: Quartz Medicare Advantage |
$26.21
|
| Rate for Payer: The Alliance Commercial |
$15.29
|
| Rate for Payer: WEA Trust Commercial |
$24.02
|
| Rate for Payer: WPS Commercial |
$190.85
|
|
|
Flublok (0.5 ml) 90682
|
Facility
|
OP
|
$42.00
|
|
|
Service Code
|
CPT 90682
|
| Hospital Charge Code |
5983679
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.23 |
| Max. Negotiated Rate |
$190.85 |
| Rate for Payer: Aetna Commercial |
$39.31
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$37.56
|
| Rate for Payer: Aetna Managed Medicare |
$12.23
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$28.39
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$21.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$20.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$23.15
|
| Rate for Payer: Cash Price |
$12.60
|
| Rate for Payer: Cash Price |
$12.60
|
| Rate for Payer: Cigna Commercial |
$40.19
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$101.00
|
| Rate for Payer: Health EOS Commercial |
$38.88
|
| Rate for Payer: HFN Commercial |
$40.19
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$32.76
|
| Rate for Payer: Multiplan Commercial |
$34.94
|
| Rate for Payer: NAPHCARE Commercial |
$26.21
|
| Rate for Payer: Preferred Network Access Commercial |
$40.19
|
| Rate for Payer: Quartz Beloit One Network |
$21.40
|
| Rate for Payer: Quartz Commercial |
$28.39
|
| Rate for Payer: Quartz Medicare Advantage |
$26.21
|
| Rate for Payer: The Alliance Commercial |
$15.29
|
| Rate for Payer: WEA Trust Commercial |
$24.02
|
| Rate for Payer: WPS Commercial |
$190.85
|
|
|
Flublok (0.5 ml) 90682
|
Facility
|
IP
|
$42.00
|
|
|
Service Code
|
CPT 90682
|
| Hospital Charge Code |
5983679
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$21.40 |
| Max. Negotiated Rate |
$40.19 |
| Rate for Payer: Aetna Commercial |
$39.31
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$37.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$23.15
|
| Rate for Payer: Cash Price |
$12.60
|
| Rate for Payer: Cigna Commercial |
$40.19
|
| Rate for Payer: Health EOS Commercial |
$38.88
|
| Rate for Payer: HFN Commercial |
$40.19
|
| Rate for Payer: Multiplan Commercial |
$34.94
|
| Rate for Payer: Preferred Network Access Commercial |
$40.19
|
| Rate for Payer: Quartz Beloit One Network |
$21.40
|
| Rate for Payer: Quartz Commercial |
$26.21
|
| Rate for Payer: WEA Trust Commercial |
$24.02
|
| Rate for Payer: WPS Commercial |
$32.35
|
|
|
Flucelvax (0.5ml) (Dialysis) 90674
|
Facility
|
OP
|
$60.00
|
|
|
Service Code
|
CPT 90674
|
| Hospital Charge Code |
6219912
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$17.47 |
| Max. Negotiated Rate |
$88.85 |
| Rate for Payer: Aetna Commercial |
$56.16
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$53.66
|
| Rate for Payer: Aetna Managed Medicare |
$17.47
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$40.56
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$31.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$29.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$33.07
|
| Rate for Payer: Cash Price |
$18.00
|
| Rate for Payer: Cash Price |
$18.00
|
| Rate for Payer: Cigna Commercial |
$57.41
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$47.02
|
| Rate for Payer: Health EOS Commercial |
$55.54
|
| Rate for Payer: HFN Commercial |
$57.41
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$46.80
|
| Rate for Payer: Multiplan Commercial |
$49.92
|
| Rate for Payer: NAPHCARE Commercial |
$37.44
|
| Rate for Payer: Preferred Network Access Commercial |
$57.41
|
| Rate for Payer: Quartz Beloit One Network |
$30.58
|
| Rate for Payer: Quartz Commercial |
$40.56
|
| Rate for Payer: Quartz Medicare Advantage |
$37.44
|
| Rate for Payer: The Alliance Commercial |
$21.84
|
| Rate for Payer: WEA Trust Commercial |
$34.32
|
| Rate for Payer: WPS Commercial |
$88.85
|
|
|
Flucelvax (0.5ml) (Dialysis) 90674
|
Facility
|
IP
|
$60.00
|
|
|
Service Code
|
CPT 90674
|
| Hospital Charge Code |
6219912
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$30.58 |
| Max. Negotiated Rate |
$57.41 |
| Rate for Payer: Aetna Commercial |
$56.16
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$53.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$33.07
|
| Rate for Payer: Cash Price |
$18.00
|
| Rate for Payer: Cigna Commercial |
$57.41
|
| Rate for Payer: Health EOS Commercial |
$55.54
|
| Rate for Payer: HFN Commercial |
$57.41
|
| Rate for Payer: Multiplan Commercial |
$49.92
|
| Rate for Payer: Preferred Network Access Commercial |
$57.41
|
| Rate for Payer: Quartz Beloit One Network |
$30.58
|
| Rate for Payer: Quartz Commercial |
$37.44
|
| Rate for Payer: WEA Trust Commercial |
$34.32
|
| Rate for Payer: WPS Commercial |
$46.22
|
|
|
Flucelvax (0.5ml) - Flu Virus, Inactivated Charge
|
Facility
|
IP
|
$60.00
|
|
|
Service Code
|
CPT 90674
|
| Hospital Charge Code |
6210852
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$30.58 |
| Max. Negotiated Rate |
$57.41 |
| Rate for Payer: Aetna Commercial |
$56.16
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$53.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$33.07
|
| Rate for Payer: Cash Price |
$18.00
|
| Rate for Payer: Cigna Commercial |
$57.41
|
| Rate for Payer: Health EOS Commercial |
$55.54
|
| Rate for Payer: HFN Commercial |
$57.41
|
| Rate for Payer: Multiplan Commercial |
$49.92
|
| Rate for Payer: Preferred Network Access Commercial |
$57.41
|
| Rate for Payer: Quartz Beloit One Network |
$30.58
|
| Rate for Payer: Quartz Commercial |
$37.44
|
| Rate for Payer: WEA Trust Commercial |
$34.32
|
| Rate for Payer: WPS Commercial |
$46.22
|
|
|
Flucelvax (0.5ml) - Flu Virus, Inactivated Charge
|
Professional
|
Both
|
$60.00
|
|
|
Service Code
|
CPT 90674
|
| Hospital Charge Code |
6210852
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$27.46 |
| Max. Negotiated Rate |
$88.85 |
| Rate for Payer: Aetna Commercial |
$59.28
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$53.66
|
| Rate for Payer: Cash Price |
$18.00
|
| Rate for Payer: Cash Price |
$18.00
|
| Rate for Payer: Cigna Commercial |
$59.28
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$31.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$35.54
|
| Rate for Payer: Health EOS Commercial |
$56.78
|
| Rate for Payer: HFN Commercial |
$59.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$44.39
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$44.39
|
| Rate for Payer: Multiplan Commercial |
$49.92
|
| Rate for Payer: Preferred Network Access Commercial |
$59.28
|
| Rate for Payer: Quartz Beloit One Network |
$27.46
|
| Rate for Payer: Quartz Commercial |
$35.57
|
| Rate for Payer: The Alliance Commercial |
$31.20
|
| Rate for Payer: WEA Trust Commercial |
$34.32
|
| Rate for Payer: WPS Commercial |
$88.85
|
|
|
Flucelvax (0.5ml) - Flu Virus, Inactivated Charge
|
Facility
|
OP
|
$60.00
|
|
|
Service Code
|
CPT 90674
|
| Hospital Charge Code |
6210852
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$17.47 |
| Max. Negotiated Rate |
$88.85 |
| Rate for Payer: Aetna Commercial |
$56.16
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$53.66
|
| Rate for Payer: Aetna Managed Medicare |
$17.47
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$40.56
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$31.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$29.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$33.07
|
| Rate for Payer: Cash Price |
$18.00
|
| Rate for Payer: Cash Price |
$18.00
|
| Rate for Payer: Cigna Commercial |
$57.41
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$47.02
|
| Rate for Payer: Health EOS Commercial |
$55.54
|
| Rate for Payer: HFN Commercial |
$57.41
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$46.80
|
| Rate for Payer: Multiplan Commercial |
$49.92
|
| Rate for Payer: NAPHCARE Commercial |
$37.44
|
| Rate for Payer: Preferred Network Access Commercial |
$57.41
|
| Rate for Payer: Quartz Beloit One Network |
$30.58
|
| Rate for Payer: Quartz Commercial |
$40.56
|
| Rate for Payer: Quartz Medicare Advantage |
$37.44
|
| Rate for Payer: The Alliance Commercial |
$21.84
|
| Rate for Payer: WEA Trust Commercial |
$34.32
|
| Rate for Payer: WPS Commercial |
$88.85
|
|
|
Flucelvax (0.5ml) (Peritoneal) 90674
|
Facility
|
OP
|
$60.00
|
|
|
Service Code
|
CPT 90674
|
| Hospital Charge Code |
6219913
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$17.47 |
| Max. Negotiated Rate |
$88.85 |
| Rate for Payer: Aetna Commercial |
$56.16
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$53.66
|
| Rate for Payer: Aetna Managed Medicare |
$17.47
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$40.56
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$31.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$29.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$33.07
|
| Rate for Payer: Cash Price |
$18.00
|
| Rate for Payer: Cash Price |
$18.00
|
| Rate for Payer: Cigna Commercial |
$57.41
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$47.02
|
| Rate for Payer: Health EOS Commercial |
$55.54
|
| Rate for Payer: HFN Commercial |
$57.41
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$46.80
|
| Rate for Payer: Multiplan Commercial |
$49.92
|
| Rate for Payer: NAPHCARE Commercial |
$37.44
|
| Rate for Payer: Preferred Network Access Commercial |
$57.41
|
| Rate for Payer: Quartz Beloit One Network |
$30.58
|
| Rate for Payer: Quartz Commercial |
$40.56
|
| Rate for Payer: Quartz Medicare Advantage |
$37.44
|
| Rate for Payer: The Alliance Commercial |
$21.84
|
| Rate for Payer: WEA Trust Commercial |
$34.32
|
| Rate for Payer: WPS Commercial |
$88.85
|
|
