|
Flucelvax (0.5ml) (Peritoneal) 90674
|
Facility
|
IP
|
$60.00
|
|
|
Service Code
|
CPT 90674
|
| Hospital Charge Code |
6219913
|
|
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
|
|
|
Fludara 50 mg Charge
|
Facility
|
IP
|
$1,497.00
|
|
|
Service Code
|
HCPCS J9185
|
| Hospital Charge Code |
2958952
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$762.87 |
| Max. Negotiated Rate |
$1,432.33 |
| Rate for Payer: Aetna Commercial |
$1,401.19
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,338.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$825.15
|
| Rate for Payer: Cash Price |
$449.10
|
| Rate for Payer: Cigna Commercial |
$1,432.33
|
| Rate for Payer: Health EOS Commercial |
$1,385.62
|
| Rate for Payer: HFN Commercial |
$1,432.33
|
| Rate for Payer: Multiplan Commercial |
$1,245.50
|
| Rate for Payer: Preferred Network Access Commercial |
$1,432.33
|
| Rate for Payer: Quartz Beloit One Network |
$762.87
|
| Rate for Payer: Quartz Commercial |
$934.13
|
| Rate for Payer: WEA Trust Commercial |
$856.28
|
| Rate for Payer: WPS Commercial |
$1,153.14
|
|
|
Fludara 50 mg Charge
|
Professional
|
Both
|
$1,497.00
|
|
|
Service Code
|
HCPCS J9185
|
| Hospital Charge Code |
2958952
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$84.67 |
| Max. Negotiated Rate |
$1,479.04 |
| Rate for Payer: Aetna Commercial |
$1,479.04
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,338.92
|
| Rate for Payer: Aetna Managed Medicare |
$84.67
|
| Rate for Payer: Anthem Medicare Advantage |
$84.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$84.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$84.67
|
| Rate for Payer: Cash Price |
$449.10
|
| Rate for Payer: Cash Price |
$449.10
|
| Rate for Payer: Cigna Commercial |
$1,479.04
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$84.67
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$198.53
|
| Rate for Payer: Health EOS Commercial |
$1,416.76
|
| Rate for Payer: HFN Commercial |
$1,479.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$114.15
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$114.15
|
| Rate for Payer: Independent Care Health Plan Medicare |
$84.67
|
| Rate for Payer: Multiplan Commercial |
$1,245.50
|
| Rate for Payer: NAPHCARE Commercial |
$127.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,479.04
|
| Rate for Payer: Quartz Beloit One Network |
$685.03
|
| Rate for Payer: Quartz Commercial |
$887.42
|
| Rate for Payer: Quartz Medicare Advantage |
$84.67
|
| Rate for Payer: The Alliance Commercial |
$232.83
|
| Rate for Payer: United Healthcare Medicaid |
$84.67
|
| Rate for Payer: United Healthcare Medicare Advantage |
$84.67
|
| Rate for Payer: WEA Trust Commercial |
$856.28
|
| Rate for Payer: WPS Commercial |
$496.33
|
|
|
Fludara 50 mg Charge
|
Facility
|
OP
|
$1,497.00
|
|
|
Service Code
|
HCPCS J9185
|
| Hospital Charge Code |
2958952
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$262.65 |
| Max. Negotiated Rate |
$1,432.33 |
| Rate for Payer: Aetna Commercial |
$1,401.19
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,338.92
|
| Rate for Payer: Aetna Managed Medicare |
$435.93
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,011.97
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$778.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$747.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$825.15
|
| Rate for Payer: Cash Price |
$449.10
|
| Rate for Payer: Cash Price |
$449.10
|
| Rate for Payer: Cigna Commercial |
$1,432.33
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$262.65
|
| Rate for Payer: Health EOS Commercial |
$1,385.62
|
| Rate for Payer: HFN Commercial |
$1,432.33
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,167.66
|
| Rate for Payer: Multiplan Commercial |
$1,245.50
|
| Rate for Payer: NAPHCARE Commercial |
$934.13
|
| Rate for Payer: Preferred Network Access Commercial |
$1,432.33
|
| Rate for Payer: Quartz Beloit One Network |
$762.87
|
| Rate for Payer: Quartz Commercial |
$1,011.97
|
| Rate for Payer: Quartz Medicare Advantage |
$934.13
|
| Rate for Payer: The Alliance Commercial |
$338.67
|
| Rate for Payer: WEA Trust Commercial |
$856.28
|
| Rate for Payer: WPS Commercial |
$496.33
|
|
|
FLUIDAIRE ELITE RENUS062
|
Facility
|
OP
|
$1,571.00
|
|
| Hospital Charge Code |
2964102
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$457.48 |
| Max. Negotiated Rate |
$1,503.13 |
| Rate for Payer: Aetna Commercial |
$1,470.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,405.10
|
| Rate for Payer: Aetna Managed Medicare |
$457.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,062.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$816.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$784.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$865.94
|
| Rate for Payer: Cash Price |
$471.30
|
| Rate for Payer: Cigna Commercial |
$1,503.13
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$914.32
|
| Rate for Payer: Health EOS Commercial |
$1,454.12
|
| Rate for Payer: HFN Commercial |
$1,503.13
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,225.38
|
| Rate for Payer: Multiplan Commercial |
$1,307.07
|
| Rate for Payer: NAPHCARE Commercial |
$980.30
|
| Rate for Payer: Preferred Network Access Commercial |
$1,503.13
|
| Rate for Payer: Quartz Beloit One Network |
$800.58
|
| Rate for Payer: Quartz Commercial |
$1,062.00
|
| Rate for Payer: Quartz Medicare Advantage |
$980.30
|
| Rate for Payer: The Alliance Commercial |
$816.92
|
| Rate for Payer: WEA Trust Commercial |
$898.61
|
| Rate for Payer: WPS Commercial |
$1,210.14
|
|
|
FLUIDAIRE ELITE RENUS062
|
Facility
|
IP
|
$1,571.00
|
|
| Hospital Charge Code |
2964102
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$800.58 |
| Max. Negotiated Rate |
$1,503.13 |
| Rate for Payer: Aetna Commercial |
$1,470.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,405.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$865.94
|
| Rate for Payer: Cash Price |
$471.30
|
| Rate for Payer: Cigna Commercial |
$1,503.13
|
| Rate for Payer: Health EOS Commercial |
$1,454.12
|
| Rate for Payer: HFN Commercial |
$1,503.13
|
| Rate for Payer: Multiplan Commercial |
$1,307.07
|
| Rate for Payer: Preferred Network Access Commercial |
$1,503.13
|
| Rate for Payer: Quartz Beloit One Network |
$800.58
|
| Rate for Payer: Quartz Commercial |
$980.30
|
| Rate for Payer: WEA Trust Commercial |
$898.61
|
| Rate for Payer: WPS Commercial |
$1,210.14
|
|
|
FLUID PRESSURE, MUSCLE 20950
|
Professional
|
Both
|
$874.00
|
|
|
Service Code
|
CPT 20950
|
| Hospital Charge Code |
3013717
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$80.02 |
| Max. Negotiated Rate |
$863.51 |
| Rate for Payer: Aetna Commercial |
$863.51
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$781.71
|
| Rate for Payer: Aetna Managed Medicare |
$80.02
|
| Rate for Payer: Anthem Medicare Advantage |
$80.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$80.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$80.02
|
| Rate for Payer: Cash Price |
$262.20
|
| Rate for Payer: Cash Price |
$262.20
|
| Rate for Payer: Cash Price |
$262.20
|
| Rate for Payer: Cigna Commercial |
$863.51
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$194.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$80.02
|
| Rate for Payer: Health EOS Commercial |
$827.15
|
| Rate for Payer: HFN Commercial |
$863.51
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$301.30
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$301.30
|
| Rate for Payer: Independent Care Health Plan Medicare |
$80.02
|
| Rate for Payer: Multiplan Commercial |
$727.17
|
| Rate for Payer: NAPHCARE Commercial |
$120.03
|
| Rate for Payer: Preferred Network Access Commercial |
$863.51
|
| Rate for Payer: Quartz Beloit One Network |
$399.94
|
| Rate for Payer: Quartz Commercial |
$518.11
|
| Rate for Payer: Quartz Medicare Advantage |
$80.02
|
| Rate for Payer: The Alliance Commercial |
$340.07
|
| Rate for Payer: United Healthcare Medicaid |
$194.28
|
| Rate for Payer: United Healthcare Medicare Advantage |
$80.02
|
| Rate for Payer: WEA Trust Commercial |
$499.93
|
| Rate for Payer: WPS Commercial |
$360.08
|
|
|
Fluid Sheilds
|
Facility
|
IP
|
$1.00
|
|
| Hospital Charge Code |
3040308
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$0.51 |
| Max. Negotiated Rate |
$0.96 |
| Rate for Payer: Aetna Commercial |
$0.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$0.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$0.55
|
| Rate for Payer: Cash Price |
$0.30
|
| Rate for Payer: Cigna Commercial |
$0.96
|
| Rate for Payer: Health EOS Commercial |
$0.93
|
| Rate for Payer: HFN Commercial |
$0.96
|
| Rate for Payer: Multiplan Commercial |
$0.83
|
| Rate for Payer: Preferred Network Access Commercial |
$0.96
|
| Rate for Payer: Quartz Beloit One Network |
$0.51
|
| Rate for Payer: Quartz Commercial |
$0.62
|
| Rate for Payer: WEA Trust Commercial |
$0.57
|
| Rate for Payer: WPS Commercial |
$0.77
|
|
|
Fluid Sheilds
|
Facility
|
OP
|
$1.00
|
|
| Hospital Charge Code |
3040308
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$0.29 |
| Max. Negotiated Rate |
$0.96 |
| Rate for Payer: Aetna Commercial |
$0.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$0.89
|
| Rate for Payer: Aetna Managed Medicare |
$0.29
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$0.68
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$0.52
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$0.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$0.55
|
| Rate for Payer: Cash Price |
$0.30
|
| Rate for Payer: Cigna Commercial |
$0.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$0.58
|
| Rate for Payer: Health EOS Commercial |
$0.93
|
| Rate for Payer: HFN Commercial |
$0.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$0.78
|
| Rate for Payer: Multiplan Commercial |
$0.83
|
| Rate for Payer: NAPHCARE Commercial |
$0.62
|
| Rate for Payer: Preferred Network Access Commercial |
$0.96
|
| Rate for Payer: Quartz Beloit One Network |
$0.51
|
| Rate for Payer: Quartz Commercial |
$0.68
|
| Rate for Payer: Quartz Medicare Advantage |
$0.62
|
| Rate for Payer: The Alliance Commercial |
$0.52
|
| Rate for Payer: WEA Trust Commercial |
$0.57
|
| Rate for Payer: WPS Commercial |
$0.77
|
|
|
FLUID WARMER DISPOSABLE #24250
|
Facility
|
IP
|
$308.00
|
|
| Hospital Charge Code |
2963190
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$156.96 |
| Max. Negotiated Rate |
$294.69 |
| Rate for Payer: Aetna Commercial |
$288.29
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$275.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$169.77
|
| Rate for Payer: Cash Price |
$92.40
|
| Rate for Payer: Cigna Commercial |
$294.69
|
| Rate for Payer: Health EOS Commercial |
$285.08
|
| Rate for Payer: HFN Commercial |
$294.69
|
| Rate for Payer: Multiplan Commercial |
$256.26
|
| Rate for Payer: Preferred Network Access Commercial |
$294.69
|
| Rate for Payer: Quartz Beloit One Network |
$156.96
|
| Rate for Payer: Quartz Commercial |
$192.19
|
| Rate for Payer: WEA Trust Commercial |
$176.18
|
| Rate for Payer: WPS Commercial |
$237.25
|
|
|
FLUID WARMER DISPOSABLE #24250
|
Facility
|
OP
|
$308.00
|
|
| Hospital Charge Code |
2963190
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$89.69 |
| Max. Negotiated Rate |
$294.69 |
| Rate for Payer: Aetna Commercial |
$288.29
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$275.48
|
| Rate for Payer: Aetna Managed Medicare |
$89.69
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$208.21
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$160.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$153.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$169.77
|
| Rate for Payer: Cash Price |
$92.40
|
| Rate for Payer: Cigna Commercial |
$294.69
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$179.26
|
| Rate for Payer: Health EOS Commercial |
$285.08
|
| Rate for Payer: HFN Commercial |
$294.69
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$240.24
|
| Rate for Payer: Multiplan Commercial |
$256.26
|
| Rate for Payer: NAPHCARE Commercial |
$192.19
|
| Rate for Payer: Preferred Network Access Commercial |
$294.69
|
| Rate for Payer: Quartz Beloit One Network |
$156.96
|
| Rate for Payer: Quartz Commercial |
$208.21
|
| Rate for Payer: Quartz Medicare Advantage |
$192.19
|
| Rate for Payer: The Alliance Commercial |
$160.16
|
| Rate for Payer: WEA Trust Commercial |
$176.18
|
| Rate for Payer: WPS Commercial |
$237.25
|
|
|
Flulaval QIV PF syr (0.5ml) 6mo & up (Dialysis) 90686
|
Facility
|
IP
|
$24.00
|
|
|
Service Code
|
CPT 90686
|
| Hospital Charge Code |
6219914
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.23 |
| Max. Negotiated Rate |
$22.96 |
| Rate for Payer: Aetna Commercial |
$22.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$21.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$13.23
|
| Rate for Payer: Cash Price |
$7.20
|
| Rate for Payer: Cigna Commercial |
$22.96
|
| Rate for Payer: Health EOS Commercial |
$22.21
|
| Rate for Payer: HFN Commercial |
$22.96
|
| Rate for Payer: Multiplan Commercial |
$19.97
|
| Rate for Payer: Preferred Network Access Commercial |
$22.96
|
| Rate for Payer: Quartz Beloit One Network |
$12.23
|
| Rate for Payer: Quartz Commercial |
$14.98
|
| Rate for Payer: WEA Trust Commercial |
$13.73
|
| Rate for Payer: WPS Commercial |
$18.49
|
|
|
Flulaval QIV PF syr (0.5ml) 6mo & up (Dialysis) 90686
|
Facility
|
OP
|
$24.00
|
|
|
Service Code
|
CPT 90686
|
| Hospital Charge Code |
6219914
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.99 |
| Max. Negotiated Rate |
$58.11 |
| Rate for Payer: Aetna Commercial |
$22.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$21.47
|
| Rate for Payer: Aetna Managed Medicare |
$6.99
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$16.22
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$12.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$11.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$13.23
|
| Rate for Payer: Cash Price |
$7.20
|
| Rate for Payer: Cash Price |
$7.20
|
| Rate for Payer: Cigna Commercial |
$22.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$30.75
|
| Rate for Payer: Health EOS Commercial |
$22.21
|
| Rate for Payer: HFN Commercial |
$22.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$18.72
|
| Rate for Payer: Multiplan Commercial |
$19.97
|
| Rate for Payer: NAPHCARE Commercial |
$14.98
|
| Rate for Payer: Preferred Network Access Commercial |
$22.96
|
| Rate for Payer: Quartz Beloit One Network |
$12.23
|
| Rate for Payer: Quartz Commercial |
$16.22
|
| Rate for Payer: Quartz Medicare Advantage |
$14.98
|
| Rate for Payer: The Alliance Commercial |
$8.74
|
| Rate for Payer: WEA Trust Commercial |
$13.73
|
| Rate for Payer: WPS Commercial |
$58.11
|
|
|
Flulaval QIV PF syr (0.5ml) 6mo & up - Flu Virus, Inactivated Charge
|
Facility
|
IP
|
$24.00
|
|
|
Service Code
|
CPT 90686
|
| Hospital Charge Code |
5845628
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.23 |
| Max. Negotiated Rate |
$22.96 |
| Rate for Payer: Aetna Commercial |
$22.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$21.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$13.23
|
| Rate for Payer: Cash Price |
$7.20
|
| Rate for Payer: Cigna Commercial |
$22.96
|
| Rate for Payer: Health EOS Commercial |
$22.21
|
| Rate for Payer: HFN Commercial |
$22.96
|
| Rate for Payer: Multiplan Commercial |
$19.97
|
| Rate for Payer: Preferred Network Access Commercial |
$22.96
|
| Rate for Payer: Quartz Beloit One Network |
$12.23
|
| Rate for Payer: Quartz Commercial |
$14.98
|
| Rate for Payer: WEA Trust Commercial |
$13.73
|
| Rate for Payer: WPS Commercial |
$18.49
|
|
|
Flulaval QIV PF syr (0.5ml) 6mo & up - Flu Virus, Inactivated Charge
|
Facility
|
OP
|
$24.00
|
|
|
Service Code
|
CPT 90686
|
| Hospital Charge Code |
5845628
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.99 |
| Max. Negotiated Rate |
$58.11 |
| Rate for Payer: Aetna Commercial |
$22.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$21.47
|
| Rate for Payer: Aetna Managed Medicare |
$6.99
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$16.22
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$12.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$11.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$13.23
|
| Rate for Payer: Cash Price |
$7.20
|
| Rate for Payer: Cash Price |
$7.20
|
| Rate for Payer: Cigna Commercial |
$22.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$30.75
|
| Rate for Payer: Health EOS Commercial |
$22.21
|
| Rate for Payer: HFN Commercial |
$22.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$18.72
|
| Rate for Payer: Multiplan Commercial |
$19.97
|
| Rate for Payer: NAPHCARE Commercial |
$14.98
|
| Rate for Payer: Preferred Network Access Commercial |
$22.96
|
| Rate for Payer: Quartz Beloit One Network |
$12.23
|
| Rate for Payer: Quartz Commercial |
$16.22
|
| Rate for Payer: Quartz Medicare Advantage |
$14.98
|
| Rate for Payer: The Alliance Commercial |
$8.74
|
| Rate for Payer: WEA Trust Commercial |
$13.73
|
| Rate for Payer: WPS Commercial |
$58.11
|
|
|
Flulaval QIV PF syr (0.5ml) 6mo & up - Flu Virus, Inactivated Charge
|
Professional
|
Both
|
$24.00
|
|
|
Service Code
|
CPT 90686
|
| Hospital Charge Code |
5845628
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.98 |
| Max. Negotiated Rate |
$58.11 |
| Rate for Payer: Aetna Commercial |
$23.71
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$21.47
|
| Rate for Payer: Cash Price |
$7.20
|
| Rate for Payer: Cash Price |
$7.20
|
| Rate for Payer: Cigna Commercial |
$23.71
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$12.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$23.24
|
| Rate for Payer: Health EOS Commercial |
$22.71
|
| Rate for Payer: HFN Commercial |
$23.71
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$29.73
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$29.73
|
| Rate for Payer: Multiplan Commercial |
$19.97
|
| Rate for Payer: Preferred Network Access Commercial |
$23.71
|
| Rate for Payer: Quartz Beloit One Network |
$10.98
|
| Rate for Payer: Quartz Commercial |
$14.23
|
| Rate for Payer: The Alliance Commercial |
$12.48
|
| Rate for Payer: WEA Trust Commercial |
$13.73
|
| Rate for Payer: WPS Commercial |
$58.11
|
|
|
Flulaval QIV PF syr (0.5ml) 6mo & up (Peritoneal) 90686
|
Facility
|
OP
|
$24.00
|
|
|
Service Code
|
CPT 90686
|
| Hospital Charge Code |
6219915
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.99 |
| Max. Negotiated Rate |
$58.11 |
| Rate for Payer: Aetna Commercial |
$22.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$21.47
|
| Rate for Payer: Aetna Managed Medicare |
$6.99
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$16.22
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$12.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$11.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$13.23
|
| Rate for Payer: Cash Price |
$7.20
|
| Rate for Payer: Cash Price |
$7.20
|
| Rate for Payer: Cigna Commercial |
$22.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$30.75
|
| Rate for Payer: Health EOS Commercial |
$22.21
|
| Rate for Payer: HFN Commercial |
$22.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$18.72
|
| Rate for Payer: Multiplan Commercial |
$19.97
|
| Rate for Payer: NAPHCARE Commercial |
$14.98
|
| Rate for Payer: Preferred Network Access Commercial |
$22.96
|
| Rate for Payer: Quartz Beloit One Network |
$12.23
|
| Rate for Payer: Quartz Commercial |
$16.22
|
| Rate for Payer: Quartz Medicare Advantage |
$14.98
|
| Rate for Payer: The Alliance Commercial |
$8.74
|
| Rate for Payer: WEA Trust Commercial |
$13.73
|
| Rate for Payer: WPS Commercial |
$58.11
|
|
|
Flulaval QIV PF syr (0.5ml) 6mo & up (Peritoneal) 90686
|
Facility
|
IP
|
$24.00
|
|
|
Service Code
|
CPT 90686
|
| Hospital Charge Code |
6219915
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.23 |
| Max. Negotiated Rate |
$22.96 |
| Rate for Payer: Aetna Commercial |
$22.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$21.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$13.23
|
| Rate for Payer: Cash Price |
$7.20
|
| Rate for Payer: Cigna Commercial |
$22.96
|
| Rate for Payer: Health EOS Commercial |
$22.21
|
| Rate for Payer: HFN Commercial |
$22.96
|
| Rate for Payer: Multiplan Commercial |
$19.97
|
| Rate for Payer: Preferred Network Access Commercial |
$22.96
|
| Rate for Payer: Quartz Beloit One Network |
$12.23
|
| Rate for Payer: Quartz Commercial |
$14.98
|
| Rate for Payer: WEA Trust Commercial |
$13.73
|
| Rate for Payer: WPS Commercial |
$18.49
|
|
|
flumazenil 0.1 mg/mL IV Sol [Med]
|
Facility
|
IP
|
$40.00
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
2983101
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$20.38 |
| Max. Negotiated Rate |
$38.27 |
| Rate for Payer: Aetna Commercial |
$37.44
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$35.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$22.05
|
| Rate for Payer: Cash Price |
$12.00
|
| Rate for Payer: Cigna Commercial |
$38.27
|
| Rate for Payer: Health EOS Commercial |
$37.02
|
| Rate for Payer: HFN Commercial |
$38.27
|
| Rate for Payer: Multiplan Commercial |
$33.28
|
| Rate for Payer: Preferred Network Access Commercial |
$38.27
|
| Rate for Payer: Quartz Beloit One Network |
$20.38
|
| Rate for Payer: Quartz Commercial |
$24.96
|
| Rate for Payer: WEA Trust Commercial |
$22.88
|
| Rate for Payer: WPS Commercial |
$30.81
|
|
|
flumazenil 0.1 mg/mL IV Sol [Med]
|
Facility
|
OP
|
$40.00
|
|
|
Service Code
|
HCPCS J3490
|
| Hospital Charge Code |
2983101
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.65 |
| Max. Negotiated Rate |
$38.27 |
| Rate for Payer: Aetna Commercial |
$37.44
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$35.78
|
| Rate for Payer: Aetna Managed Medicare |
$11.65
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$27.04
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$20.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$19.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$22.05
|
| Rate for Payer: Cash Price |
$12.00
|
| Rate for Payer: Cigna Commercial |
$38.27
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$23.28
|
| Rate for Payer: Health EOS Commercial |
$37.02
|
| Rate for Payer: HFN Commercial |
$38.27
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$31.20
|
| Rate for Payer: Multiplan Commercial |
$33.28
|
| Rate for Payer: NAPHCARE Commercial |
$24.96
|
| Rate for Payer: Preferred Network Access Commercial |
$38.27
|
| Rate for Payer: Quartz Beloit One Network |
$20.38
|
| Rate for Payer: Quartz Commercial |
$27.04
|
| Rate for Payer: Quartz Medicare Advantage |
$24.96
|
| Rate for Payer: The Alliance Commercial |
$20.80
|
| Rate for Payer: WEA Trust Commercial |
$22.88
|
| Rate for Payer: WPS Commercial |
$30.81
|
|
|
Flunitrazepam & Metabolites, Quant
|
Facility
|
OP
|
$191.00
|
|
|
Service Code
|
CPT 80346
|
| Hospital Charge Code |
3907354
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$55.62 |
| Max. Negotiated Rate |
$182.75 |
| Rate for Payer: Aetna Commercial |
$178.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$170.83
|
| Rate for Payer: Aetna Managed Medicare |
$55.62
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$129.12
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$99.32
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$95.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$105.28
|
| Rate for Payer: Cash Price |
$57.30
|
| Rate for Payer: Cigna Commercial |
$182.75
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$111.16
|
| Rate for Payer: Health EOS Commercial |
$176.79
|
| Rate for Payer: HFN Commercial |
$182.75
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$148.98
|
| Rate for Payer: Multiplan Commercial |
$158.91
|
| Rate for Payer: NAPHCARE Commercial |
$119.18
|
| Rate for Payer: Preferred Network Access Commercial |
$182.75
|
| Rate for Payer: Quartz Beloit One Network |
$97.33
|
| Rate for Payer: Quartz Commercial |
$129.12
|
| Rate for Payer: Quartz Medicare Advantage |
$119.18
|
| Rate for Payer: The Alliance Commercial |
$99.32
|
| Rate for Payer: United Healthcare PPO |
$148.98
|
| Rate for Payer: WEA Trust Commercial |
$109.25
|
| Rate for Payer: WPS Commercial |
$147.13
|
|
|
Flunitrazepam & Metabolites, Quant
|
Professional
|
Both
|
$191.00
|
|
|
Service Code
|
CPT 80346
|
| Hospital Charge Code |
3907354
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$83.26 |
| Max. Negotiated Rate |
$188.71 |
| Rate for Payer: Aetna Commercial |
$188.71
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$170.83
|
| Rate for Payer: Cash Price |
$57.30
|
| Rate for Payer: Cash Price |
$57.30
|
| Rate for Payer: Cigna Commercial |
$188.71
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$99.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$119.18
|
| Rate for Payer: Health EOS Commercial |
$180.76
|
| Rate for Payer: HFN Commercial |
$188.71
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$83.26
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$83.26
|
| Rate for Payer: Multiplan Commercial |
$158.91
|
| Rate for Payer: Preferred Network Access Commercial |
$188.71
|
| Rate for Payer: Quartz Beloit One Network |
$87.40
|
| Rate for Payer: Quartz Commercial |
$113.22
|
| Rate for Payer: The Alliance Commercial |
$99.32
|
| Rate for Payer: WEA Trust Commercial |
$109.25
|
| Rate for Payer: WPS Commercial |
$147.13
|
|
|
Flunitrazepam & Metabolites, Quant
|
Facility
|
IP
|
$191.00
|
|
|
Service Code
|
CPT 80346
|
| Hospital Charge Code |
3907354
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$97.33 |
| Max. Negotiated Rate |
$182.75 |
| Rate for Payer: Aetna Commercial |
$178.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$170.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$105.28
|
| Rate for Payer: Cash Price |
$57.30
|
| Rate for Payer: Cigna Commercial |
$182.75
|
| Rate for Payer: Health EOS Commercial |
$176.79
|
| Rate for Payer: HFN Commercial |
$182.75
|
| Rate for Payer: Multiplan Commercial |
$158.91
|
| Rate for Payer: Preferred Network Access Commercial |
$182.75
|
| Rate for Payer: Quartz Beloit One Network |
$97.33
|
| Rate for Payer: Quartz Commercial |
$119.18
|
| Rate for Payer: WEA Trust Commercial |
$109.25
|
| Rate for Payer: WPS Commercial |
$147.13
|
|
|
Flunitrazepam & Metabolites, Quant, Urine
|
Professional
|
Both
|
$320.00
|
|
|
Service Code
|
CPT 80346
|
| Hospital Charge Code |
3907355
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$83.26 |
| Max. Negotiated Rate |
$316.16 |
| Rate for Payer: Aetna Commercial |
$316.16
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$286.21
|
| Rate for Payer: Cash Price |
$96.00
|
| Rate for Payer: Cash Price |
$96.00
|
| Rate for Payer: Cigna Commercial |
$316.16
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$166.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$199.68
|
| Rate for Payer: Health EOS Commercial |
$302.85
|
| Rate for Payer: HFN Commercial |
$316.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$83.26
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$83.26
|
| Rate for Payer: Multiplan Commercial |
$266.24
|
| Rate for Payer: Preferred Network Access Commercial |
$316.16
|
| Rate for Payer: Quartz Beloit One Network |
$146.43
|
| Rate for Payer: Quartz Commercial |
$189.70
|
| Rate for Payer: The Alliance Commercial |
$166.40
|
| Rate for Payer: WEA Trust Commercial |
$183.04
|
| Rate for Payer: WPS Commercial |
$246.50
|
|
|
Flunitrazepam & Metabolites, Quant, Urine
|
Facility
|
IP
|
$320.00
|
|
|
Service Code
|
CPT 80346
|
| Hospital Charge Code |
3907355
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$163.07 |
| Max. Negotiated Rate |
$306.18 |
| Rate for Payer: Aetna Commercial |
$299.52
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$286.21
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$176.38
|
| Rate for Payer: Cash Price |
$96.00
|
| Rate for Payer: Cigna Commercial |
$306.18
|
| Rate for Payer: Health EOS Commercial |
$296.19
|
| Rate for Payer: HFN Commercial |
$306.18
|
| Rate for Payer: Multiplan Commercial |
$266.24
|
| Rate for Payer: Preferred Network Access Commercial |
$306.18
|
| Rate for Payer: Quartz Beloit One Network |
$163.07
|
| Rate for Payer: Quartz Commercial |
$199.68
|
| Rate for Payer: WEA Trust Commercial |
$183.04
|
| Rate for Payer: WPS Commercial |
$246.50
|
|
