|
FLIP CUTTER II 10.0MM AR-1204AF-100
|
Facility
|
IP
|
$5,894.00
|
|
| Hospital Charge Code |
2964677
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,888.06 |
| Max. Negotiated Rate |
$5,422.48 |
| Rate for Payer: Aetna Commercial |
$5,304.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,068.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,123.82
|
| Rate for Payer: Cash Price |
$1,768.20
|
| Rate for Payer: Cigna Commercial |
$5,422.48
|
| Rate for Payer: Health EOS Commercial |
$5,245.66
|
| Rate for Payer: HFN Commercial |
$5,422.48
|
| Rate for Payer: Multiplan Commercial |
$4,715.20
|
| Rate for Payer: NAPHCARE Commercial |
$3,536.40
|
| Rate for Payer: Preferred Network Access Commercial |
$5,422.48
|
| Rate for Payer: Quartz Beloit One Network |
$2,888.06
|
| Rate for Payer: Quartz Commercial |
$3,536.40
|
| Rate for Payer: WEA Trust Commercial |
$3,241.70
|
| Rate for Payer: WPS Commercial |
$4,365.69
|
|
|
FLIP CUTTER II 10.0MM SHORT AR-1204AS-100
|
Facility
|
IP
|
$3,458.00
|
|
| Hospital Charge Code |
5200643
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,694.42 |
| Max. Negotiated Rate |
$3,181.36 |
| Rate for Payer: Aetna Commercial |
$3,112.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,973.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,832.74
|
| Rate for Payer: Cash Price |
$1,037.40
|
| Rate for Payer: Cigna Commercial |
$3,181.36
|
| Rate for Payer: Health EOS Commercial |
$3,077.62
|
| Rate for Payer: HFN Commercial |
$3,181.36
|
| Rate for Payer: Multiplan Commercial |
$2,766.40
|
| Rate for Payer: NAPHCARE Commercial |
$2,074.80
|
| Rate for Payer: Preferred Network Access Commercial |
$3,181.36
|
| Rate for Payer: Quartz Beloit One Network |
$1,694.42
|
| Rate for Payer: Quartz Commercial |
$2,074.80
|
| Rate for Payer: WEA Trust Commercial |
$1,901.90
|
| Rate for Payer: WPS Commercial |
$2,561.34
|
|
|
FLIP CUTTER II 10.0MM SHORT AR-1204AS-100
|
Facility
|
OP
|
$3,458.00
|
|
| Hospital Charge Code |
5200643
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$968.24 |
| Max. Negotiated Rate |
$13,832.00 |
| Rate for Payer: Aetna Commercial |
$3,112.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,973.88
|
| Rate for Payer: Aetna Managed Medicare |
$968.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,247.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,729.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,659.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,832.74
|
| Rate for Payer: Cash Price |
$1,037.40
|
| Rate for Payer: Cigna Commercial |
$3,181.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,935.10
|
| Rate for Payer: Health EOS Commercial |
$3,077.62
|
| Rate for Payer: HFN Commercial |
$3,181.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,593.50
|
| Rate for Payer: Multiplan Commercial |
$2,766.40
|
| Rate for Payer: NAPHCARE Commercial |
$2,074.80
|
| Rate for Payer: Preferred Network Access Commercial |
$3,181.36
|
| Rate for Payer: Quartz Beloit One Network |
$1,694.42
|
| Rate for Payer: Quartz Commercial |
$2,247.70
|
| Rate for Payer: Quartz Medicare Advantage |
$2,074.80
|
| Rate for Payer: The Alliance Commercial |
$13,832.00
|
| Rate for Payer: WEA Trust Commercial |
$1,901.90
|
| Rate for Payer: WPS Commercial |
$2,561.34
|
|
|
FLIP CUTTER II 11.0MM AR-1204AF-110
|
Facility
|
IP
|
$5,145.00
|
|
| Hospital Charge Code |
3901342
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,521.05 |
| Max. Negotiated Rate |
$4,733.40 |
| Rate for Payer: Aetna Commercial |
$4,630.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,424.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,726.85
|
| Rate for Payer: Cash Price |
$1,543.50
|
| Rate for Payer: Cigna Commercial |
$4,733.40
|
| Rate for Payer: Health EOS Commercial |
$4,579.05
|
| Rate for Payer: HFN Commercial |
$4,733.40
|
| Rate for Payer: Multiplan Commercial |
$4,116.00
|
| Rate for Payer: NAPHCARE Commercial |
$3,087.00
|
| Rate for Payer: Preferred Network Access Commercial |
$4,733.40
|
| Rate for Payer: Quartz Beloit One Network |
$2,521.05
|
| Rate for Payer: Quartz Commercial |
$3,087.00
|
| Rate for Payer: WEA Trust Commercial |
$2,829.75
|
| Rate for Payer: WPS Commercial |
$3,810.90
|
|
|
FLIP CUTTER II 11.0MM AR-1204AF-110
|
Facility
|
OP
|
$5,145.00
|
|
| Hospital Charge Code |
3901342
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,440.60 |
| Max. Negotiated Rate |
$20,580.00 |
| Rate for Payer: Aetna Commercial |
$4,630.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,424.70
|
| Rate for Payer: Aetna Managed Medicare |
$1,440.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,344.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,572.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,469.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,726.85
|
| Rate for Payer: Cash Price |
$1,543.50
|
| Rate for Payer: Cigna Commercial |
$4,733.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,879.14
|
| Rate for Payer: Health EOS Commercial |
$4,579.05
|
| Rate for Payer: HFN Commercial |
$4,733.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,858.75
|
| Rate for Payer: Multiplan Commercial |
$4,116.00
|
| Rate for Payer: NAPHCARE Commercial |
$3,087.00
|
| Rate for Payer: Preferred Network Access Commercial |
$4,733.40
|
| Rate for Payer: Quartz Beloit One Network |
$2,521.05
|
| Rate for Payer: Quartz Commercial |
$3,344.25
|
| Rate for Payer: Quartz Medicare Advantage |
$3,087.00
|
| Rate for Payer: The Alliance Commercial |
$20,580.00
|
| Rate for Payer: WEA Trust Commercial |
$2,829.75
|
| Rate for Payer: WPS Commercial |
$3,810.90
|
|
|
FLIP CUTTER II 9.5MM AR-1204AF-95
|
Facility
|
IP
|
$5,453.00
|
|
| Hospital Charge Code |
5306773
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,671.97 |
| Max. Negotiated Rate |
$5,016.76 |
| Rate for Payer: Aetna Commercial |
$4,907.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,689.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,890.09
|
| Rate for Payer: Cash Price |
$1,635.90
|
| Rate for Payer: Cigna Commercial |
$5,016.76
|
| Rate for Payer: Health EOS Commercial |
$4,853.17
|
| Rate for Payer: HFN Commercial |
$5,016.76
|
| Rate for Payer: Multiplan Commercial |
$4,362.40
|
| Rate for Payer: NAPHCARE Commercial |
$3,271.80
|
| Rate for Payer: Preferred Network Access Commercial |
$5,016.76
|
| Rate for Payer: Quartz Beloit One Network |
$2,671.97
|
| Rate for Payer: Quartz Commercial |
$3,271.80
|
| Rate for Payer: WEA Trust Commercial |
$2,999.15
|
| Rate for Payer: WPS Commercial |
$4,039.04
|
|
|
FLIP CUTTER II 9.5MM AR-1204AF-95
|
Facility
|
OP
|
$5,453.00
|
|
| Hospital Charge Code |
5306773
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,526.84 |
| Max. Negotiated Rate |
$21,812.00 |
| Rate for Payer: Aetna Commercial |
$4,907.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,689.58
|
| Rate for Payer: Aetna Managed Medicare |
$1,526.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,544.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,726.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,617.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,890.09
|
| Rate for Payer: Cash Price |
$1,635.90
|
| Rate for Payer: Cigna Commercial |
$5,016.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,051.50
|
| Rate for Payer: Health EOS Commercial |
$4,853.17
|
| Rate for Payer: HFN Commercial |
$5,016.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,089.75
|
| Rate for Payer: Multiplan Commercial |
$4,362.40
|
| Rate for Payer: NAPHCARE Commercial |
$3,271.80
|
| Rate for Payer: Preferred Network Access Commercial |
$5,016.76
|
| Rate for Payer: Quartz Beloit One Network |
$2,671.97
|
| Rate for Payer: Quartz Commercial |
$3,544.45
|
| Rate for Payer: Quartz Medicare Advantage |
$3,271.80
|
| Rate for Payer: The Alliance Commercial |
$21,812.00
|
| Rate for Payer: WEA Trust Commercial |
$2,999.15
|
| Rate for Payer: WPS Commercial |
$4,039.04
|
|
|
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 |
$1,385.16 |
| Max. Negotiated Rate |
$19,788.00 |
| Rate for Payer: Aetna Commercial |
$4,452.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,254.42
|
| Rate for Payer: Aetna Managed Medicare |
$1,385.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,215.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,473.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,374.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,621.91
|
| Rate for Payer: Cash Price |
$1,484.10
|
| Rate for Payer: Cigna Commercial |
$4,551.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,768.34
|
| Rate for Payer: Health EOS Commercial |
$4,402.83
|
| Rate for Payer: HFN Commercial |
$4,551.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,710.25
|
| Rate for Payer: Multiplan Commercial |
$3,957.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,968.20
|
| Rate for Payer: Preferred Network Access Commercial |
$4,551.24
|
| Rate for Payer: Quartz Beloit One Network |
$2,424.03
|
| Rate for Payer: Quartz Commercial |
$3,215.55
|
| Rate for Payer: Quartz Medicare Advantage |
$2,968.20
|
| Rate for Payer: The Alliance Commercial |
$19,788.00
|
| Rate for Payer: WEA Trust Commercial |
$2,720.85
|
| Rate for Payer: WPS Commercial |
$3,664.24
|
|
|
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 |
$2,424.03 |
| Max. Negotiated Rate |
$4,551.24 |
| Rate for Payer: Aetna Commercial |
$4,452.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,254.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,621.91
|
| Rate for Payer: Cash Price |
$1,484.10
|
| Rate for Payer: Cigna Commercial |
$4,551.24
|
| Rate for Payer: Health EOS Commercial |
$4,402.83
|
| Rate for Payer: HFN Commercial |
$4,551.24
|
| Rate for Payer: Multiplan Commercial |
$3,957.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,968.20
|
| Rate for Payer: Preferred Network Access Commercial |
$4,551.24
|
| Rate for Payer: Quartz Beloit One Network |
$2,424.03
|
| Rate for Payer: Quartz Commercial |
$2,968.20
|
| Rate for Payer: WEA Trust Commercial |
$2,720.85
|
| Rate for Payer: WPS Commercial |
$3,664.24
|
|
|
Floseal 10ml [Med]
|
Facility
|
OP
|
$927.00
|
|
| Hospital Charge Code |
2974936
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$259.56 |
| Max. Negotiated Rate |
$3,708.00 |
| Rate for Payer: Aetna Commercial |
$834.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$797.22
|
| Rate for Payer: Aetna Managed Medicare |
$259.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$602.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$463.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$444.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$491.31
|
| Rate for Payer: Cash Price |
$278.10
|
| Rate for Payer: Cigna Commercial |
$852.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$518.75
|
| Rate for Payer: Health EOS Commercial |
$825.03
|
| Rate for Payer: HFN Commercial |
$852.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$695.25
|
| Rate for Payer: Multiplan Commercial |
$741.60
|
| Rate for Payer: NAPHCARE Commercial |
$556.20
|
| Rate for Payer: Preferred Network Access Commercial |
$852.84
|
| Rate for Payer: Quartz Beloit One Network |
$454.23
|
| Rate for Payer: Quartz Commercial |
$602.55
|
| Rate for Payer: Quartz Medicare Advantage |
$556.20
|
| Rate for Payer: The Alliance Commercial |
$3,708.00
|
| Rate for Payer: WEA Trust Commercial |
$509.85
|
| Rate for Payer: WPS Commercial |
$686.63
|
|
|
Floseal 10ml [Med]
|
Facility
|
IP
|
$927.00
|
|
| Hospital Charge Code |
2974936
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$454.23 |
| Max. Negotiated Rate |
$852.84 |
| Rate for Payer: Aetna Commercial |
$834.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$797.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$491.31
|
| Rate for Payer: Cash Price |
$278.10
|
| Rate for Payer: Cigna Commercial |
$852.84
|
| Rate for Payer: Health EOS Commercial |
$825.03
|
| Rate for Payer: HFN Commercial |
$852.84
|
| Rate for Payer: Multiplan Commercial |
$741.60
|
| Rate for Payer: NAPHCARE Commercial |
$556.20
|
| Rate for Payer: Preferred Network Access Commercial |
$852.84
|
| Rate for Payer: Quartz Beloit One Network |
$454.23
|
| Rate for Payer: Quartz Commercial |
$556.20
|
| Rate for Payer: WEA Trust Commercial |
$509.85
|
| Rate for Payer: WPS Commercial |
$686.63
|
|
|
Floseal 5ml [Med]
|
Facility
|
OP
|
$745.00
|
|
| Hospital Charge Code |
2974937
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$208.60 |
| Max. Negotiated Rate |
$2,980.00 |
| Rate for Payer: Aetna Commercial |
$670.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$640.70
|
| Rate for Payer: Aetna Managed Medicare |
$208.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$484.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$372.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$357.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$394.85
|
| Rate for Payer: Cash Price |
$223.50
|
| Rate for Payer: Cigna Commercial |
$685.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$416.90
|
| Rate for Payer: Health EOS Commercial |
$663.05
|
| Rate for Payer: HFN Commercial |
$685.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$558.75
|
| Rate for Payer: Multiplan Commercial |
$596.00
|
| Rate for Payer: NAPHCARE Commercial |
$447.00
|
| Rate for Payer: Preferred Network Access Commercial |
$685.40
|
| Rate for Payer: Quartz Beloit One Network |
$365.05
|
| Rate for Payer: Quartz Commercial |
$484.25
|
| Rate for Payer: Quartz Medicare Advantage |
$447.00
|
| Rate for Payer: The Alliance Commercial |
$2,980.00
|
| Rate for Payer: WEA Trust Commercial |
$409.75
|
| Rate for Payer: WPS Commercial |
$551.82
|
|
|
Floseal 5ml [Med]
|
Facility
|
IP
|
$745.00
|
|
| Hospital Charge Code |
2974937
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$365.05 |
| Max. Negotiated Rate |
$685.40 |
| Rate for Payer: Aetna Commercial |
$670.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$640.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$394.85
|
| Rate for Payer: Cash Price |
$223.50
|
| Rate for Payer: Cigna Commercial |
$685.40
|
| Rate for Payer: Health EOS Commercial |
$663.05
|
| Rate for Payer: HFN Commercial |
$685.40
|
| Rate for Payer: Multiplan Commercial |
$596.00
|
| Rate for Payer: NAPHCARE Commercial |
$447.00
|
| Rate for Payer: Preferred Network Access Commercial |
$685.40
|
| Rate for Payer: Quartz Beloit One Network |
$365.05
|
| Rate for Payer: Quartz Commercial |
$447.00
|
| Rate for Payer: WEA Trust Commercial |
$409.75
|
| Rate for Payer: WPS Commercial |
$551.82
|
|
|
Floseal Endoscopic Applicator 0600125 [Med]
|
Facility
|
IP
|
$378.00
|
|
| Hospital Charge Code |
2974938
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$185.22 |
| Max. Negotiated Rate |
$347.76 |
| Rate for Payer: Aetna Commercial |
$340.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$325.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$200.34
|
| Rate for Payer: Cash Price |
$113.40
|
| Rate for Payer: Cigna Commercial |
$347.76
|
| Rate for Payer: Health EOS Commercial |
$336.42
|
| Rate for Payer: HFN Commercial |
$347.76
|
| Rate for Payer: Multiplan Commercial |
$302.40
|
| Rate for Payer: NAPHCARE Commercial |
$226.80
|
| Rate for Payer: Preferred Network Access Commercial |
$347.76
|
| Rate for Payer: Quartz Beloit One Network |
$185.22
|
| Rate for Payer: Quartz Commercial |
$226.80
|
| Rate for Payer: WEA Trust Commercial |
$207.90
|
| Rate for Payer: WPS Commercial |
$279.98
|
|
|
Floseal Endoscopic Applicator 0600125 [Med]
|
Facility
|
OP
|
$378.00
|
|
| Hospital Charge Code |
2974938
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$105.84 |
| Max. Negotiated Rate |
$1,512.00 |
| Rate for Payer: Aetna Commercial |
$340.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$325.08
|
| Rate for Payer: Aetna Managed Medicare |
$105.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$245.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$189.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$181.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$200.34
|
| Rate for Payer: Cash Price |
$113.40
|
| Rate for Payer: Cigna Commercial |
$347.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$211.53
|
| Rate for Payer: Health EOS Commercial |
$336.42
|
| Rate for Payer: HFN Commercial |
$347.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$283.50
|
| Rate for Payer: Multiplan Commercial |
$302.40
|
| Rate for Payer: NAPHCARE Commercial |
$226.80
|
| Rate for Payer: Preferred Network Access Commercial |
$347.76
|
| Rate for Payer: Quartz Beloit One Network |
$185.22
|
| Rate for Payer: Quartz Commercial |
$245.70
|
| Rate for Payer: Quartz Medicare Advantage |
$226.80
|
| Rate for Payer: The Alliance Commercial |
$1,512.00
|
| Rate for Payer: WEA Trust Commercial |
$207.90
|
| Rate for Payer: WPS Commercial |
$279.98
|
|
|
Flow Cytometry, 1 Marker
|
Facility
|
IP
|
$84.00
|
|
|
Service Code
|
CPT 88184
|
| Hospital Charge Code |
2802799
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$41.16 |
| Max. Negotiated Rate |
$77.28 |
| Rate for Payer: Aetna Commercial |
$75.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$72.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$44.52
|
| Rate for Payer: Cash Price |
$25.20
|
| Rate for Payer: Cigna Commercial |
$77.28
|
| Rate for Payer: Health EOS Commercial |
$74.76
|
| Rate for Payer: HFN Commercial |
$77.28
|
| Rate for Payer: Multiplan Commercial |
$67.20
|
| Rate for Payer: NAPHCARE Commercial |
$50.40
|
| Rate for Payer: Preferred Network Access Commercial |
$77.28
|
| Rate for Payer: Quartz Beloit One Network |
$41.16
|
| Rate for Payer: Quartz Commercial |
$50.40
|
| Rate for Payer: WEA Trust Commercial |
$46.20
|
| Rate for Payer: WPS Commercial |
$62.22
|
|
|
Flow Cytometry, 1 Marker
|
Facility
|
OP
|
$84.00
|
|
|
Service Code
|
CPT 88184
|
| Hospital Charge Code |
2802799
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$41.16 |
| Max. Negotiated Rate |
$1,421.12 |
| Rate for Payer: Aetna Commercial |
$75.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$72.24
|
| Rate for Payer: Aetna Managed Medicare |
$355.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,332.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$621.74
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$589.76
|
| Rate for Payer: Anthem Medicare Advantage |
$355.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$44.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$355.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$355.28
|
| Rate for Payer: Cash Price |
$25.20
|
| Rate for Payer: Cash Price |
$25.20
|
| Rate for Payer: Cigna Commercial |
$77.28
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$355.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$47.01
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$355.28
|
| Rate for Payer: Health EOS Commercial |
$74.76
|
| Rate for Payer: HFN Commercial |
$77.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,321.64
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$355.28
|
| Rate for Payer: Independent Care Health Plan Medicare |
$355.28
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$355.28
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$355.28
|
| Rate for Payer: Multiplan Commercial |
$67.20
|
| Rate for Payer: NAPHCARE Commercial |
$532.92
|
| Rate for Payer: Preferred Network Access Commercial |
$77.28
|
| Rate for Payer: Quartz Beloit One Network |
$41.16
|
| Rate for Payer: Quartz Commercial |
$54.60
|
| Rate for Payer: Quartz Medicare Advantage |
$355.28
|
| Rate for Payer: The Alliance Commercial |
$1,421.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$355.28
|
| Rate for Payer: United Healthcare PPO |
$63.00
|
| Rate for Payer: WEA Trust Commercial |
$46.20
|
| Rate for Payer: Wellcare Medicare |
$355.28
|
| Rate for Payer: WPS Commercial |
$62.22
|
|
|
Flow Cytometry, 1 Marker
|
Professional
|
Both
|
$84.00
|
|
|
Service Code
|
CPT 88184
|
| Hospital Charge Code |
2802799
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$36.96 |
| Max. Negotiated Rate |
$230.47 |
| Rate for Payer: Aetna Commercial |
$79.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$72.24
|
| Rate for Payer: Cash Price |
$25.20
|
| Rate for Payer: Cash Price |
$25.20
|
| Rate for Payer: Cigna Commercial |
$79.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$42.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$50.40
|
| Rate for Payer: Health EOS Commercial |
$76.44
|
| Rate for Payer: HFN Commercial |
$79.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$230.47
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$230.47
|
| Rate for Payer: Multiplan Commercial |
$67.20
|
| Rate for Payer: Preferred Network Access Commercial |
$79.80
|
| Rate for Payer: Quartz Beloit One Network |
$36.96
|
| Rate for Payer: Quartz Commercial |
$47.88
|
| Rate for Payer: The Alliance Commercial |
$42.00
|
| Rate for Payer: WEA Trust Commercial |
$46.20
|
| Rate for Payer: WPS Commercial |
$62.22
|
|
|
Flow Cytometry, Add Marker
|
Professional
|
Both
|
$84.00
|
|
|
Service Code
|
CPT 88185
|
| Hospital Charge Code |
2802800
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$36.96 |
| Max. Negotiated Rate |
$79.80 |
| Rate for Payer: Aetna Commercial |
$79.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$72.24
|
| Rate for Payer: Cash Price |
$25.20
|
| Rate for Payer: Cash Price |
$25.20
|
| Rate for Payer: Cigna Commercial |
$79.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$42.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$50.40
|
| Rate for Payer: Health EOS Commercial |
$76.44
|
| Rate for Payer: HFN Commercial |
$79.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$76.57
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$76.57
|
| Rate for Payer: Multiplan Commercial |
$67.20
|
| Rate for Payer: Preferred Network Access Commercial |
$79.80
|
| Rate for Payer: Quartz Beloit One Network |
$36.96
|
| Rate for Payer: Quartz Commercial |
$47.88
|
| Rate for Payer: The Alliance Commercial |
$42.00
|
| Rate for Payer: WEA Trust Commercial |
$46.20
|
| Rate for Payer: WPS Commercial |
$62.22
|
|
|
Flow Cytometry, Add Marker
|
Facility
|
OP
|
$84.00
|
|
|
Service Code
|
CPT 88185
|
| Hospital Charge Code |
2802800
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$23.52 |
| Max. Negotiated Rate |
$336.00 |
| Rate for Payer: Aetna Commercial |
$75.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$72.24
|
| Rate for Payer: Aetna Managed Medicare |
$23.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$54.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$42.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$40.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$44.52
|
| Rate for Payer: Cash Price |
$25.20
|
| Rate for Payer: Cigna Commercial |
$77.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$47.01
|
| Rate for Payer: Health EOS Commercial |
$74.76
|
| Rate for Payer: HFN Commercial |
$77.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$63.00
|
| Rate for Payer: Multiplan Commercial |
$67.20
|
| Rate for Payer: NAPHCARE Commercial |
$50.40
|
| Rate for Payer: Preferred Network Access Commercial |
$77.28
|
| Rate for Payer: Quartz Beloit One Network |
$41.16
|
| Rate for Payer: Quartz Commercial |
$54.60
|
| Rate for Payer: Quartz Medicare Advantage |
$50.40
|
| Rate for Payer: The Alliance Commercial |
$336.00
|
| Rate for Payer: United Healthcare PPO |
$63.00
|
| Rate for Payer: WEA Trust Commercial |
$46.20
|
| Rate for Payer: WPS Commercial |
$62.22
|
|
|
Flow Cytometry, Add Marker
|
Facility
|
IP
|
$84.00
|
|
|
Service Code
|
CPT 88185
|
| Hospital Charge Code |
2802800
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$41.16 |
| Max. Negotiated Rate |
$77.28 |
| Rate for Payer: Aetna Commercial |
$75.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$72.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$44.52
|
| Rate for Payer: Cash Price |
$25.20
|
| Rate for Payer: Cigna Commercial |
$77.28
|
| Rate for Payer: Health EOS Commercial |
$74.76
|
| Rate for Payer: HFN Commercial |
$77.28
|
| Rate for Payer: Multiplan Commercial |
$67.20
|
| Rate for Payer: NAPHCARE Commercial |
$50.40
|
| Rate for Payer: Preferred Network Access Commercial |
$77.28
|
| Rate for Payer: Quartz Beloit One Network |
$41.16
|
| Rate for Payer: Quartz Commercial |
$50.40
|
| Rate for Payer: WEA Trust Commercial |
$46.20
|
| Rate for Payer: WPS Commercial |
$62.22
|
|
|
Flow Cytometry CD19+
|
Professional
|
Both
|
$656.00
|
|
|
Service Code
|
CPT 88185
|
| Hospital Charge Code |
2798807
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$76.57 |
| Max. Negotiated Rate |
$623.20 |
| Rate for Payer: Aetna Commercial |
$623.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$564.16
|
| Rate for Payer: Cash Price |
$196.80
|
| Rate for Payer: Cash Price |
$196.80
|
| Rate for Payer: Cigna Commercial |
$623.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$328.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$393.60
|
| Rate for Payer: Health EOS Commercial |
$596.96
|
| Rate for Payer: HFN Commercial |
$623.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$76.57
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$76.57
|
| Rate for Payer: Multiplan Commercial |
$524.80
|
| Rate for Payer: Preferred Network Access Commercial |
$623.20
|
| Rate for Payer: Quartz Beloit One Network |
$288.64
|
| Rate for Payer: Quartz Commercial |
$373.92
|
| Rate for Payer: The Alliance Commercial |
$328.00
|
| Rate for Payer: WEA Trust Commercial |
$360.80
|
| Rate for Payer: WPS Commercial |
$485.90
|
|
|
Flow Cytometry CD19+
|
Facility
|
OP
|
$656.00
|
|
|
Service Code
|
CPT 88185
|
| Hospital Charge Code |
2798807
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$183.68 |
| Max. Negotiated Rate |
$2,624.00 |
| Rate for Payer: Aetna Commercial |
$590.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$564.16
|
| Rate for Payer: Aetna Managed Medicare |
$183.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$426.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$328.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$314.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$347.68
|
| Rate for Payer: Cash Price |
$196.80
|
| Rate for Payer: Cigna Commercial |
$603.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$367.10
|
| Rate for Payer: Health EOS Commercial |
$583.84
|
| Rate for Payer: HFN Commercial |
$603.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$492.00
|
| Rate for Payer: Multiplan Commercial |
$524.80
|
| Rate for Payer: NAPHCARE Commercial |
$393.60
|
| Rate for Payer: Preferred Network Access Commercial |
$603.52
|
| Rate for Payer: Quartz Beloit One Network |
$321.44
|
| Rate for Payer: Quartz Commercial |
$426.40
|
| Rate for Payer: Quartz Medicare Advantage |
$393.60
|
| Rate for Payer: The Alliance Commercial |
$2,624.00
|
| Rate for Payer: United Healthcare PPO |
$492.00
|
| Rate for Payer: WEA Trust Commercial |
$360.80
|
| Rate for Payer: WPS Commercial |
$485.90
|
|
|
Flow Cytometry CD19+
|
Facility
|
IP
|
$656.00
|
|
|
Service Code
|
CPT 88185
|
| Hospital Charge Code |
2798807
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$321.44 |
| Max. Negotiated Rate |
$603.52 |
| Rate for Payer: Aetna Commercial |
$590.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$564.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$347.68
|
| Rate for Payer: Cash Price |
$196.80
|
| Rate for Payer: Cigna Commercial |
$603.52
|
| Rate for Payer: Health EOS Commercial |
$583.84
|
| Rate for Payer: HFN Commercial |
$603.52
|
| Rate for Payer: Multiplan Commercial |
$524.80
|
| Rate for Payer: NAPHCARE Commercial |
$393.60
|
| Rate for Payer: Preferred Network Access Commercial |
$603.52
|
| Rate for Payer: Quartz Beloit One Network |
$321.44
|
| Rate for Payer: Quartz Commercial |
$393.60
|
| Rate for Payer: WEA Trust Commercial |
$360.80
|
| Rate for Payer: WPS Commercial |
$485.90
|
|
|
Flow Cytometry CD5+
|
Facility
|
OP
|
$545.00
|
|
|
Service Code
|
CPT 88184
|
| Hospital Charge Code |
2800799
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$267.05 |
| Max. Negotiated Rate |
$1,421.12 |
| Rate for Payer: Aetna Commercial |
$490.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$468.70
|
| Rate for Payer: Aetna Managed Medicare |
$355.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,332.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$621.74
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$589.76
|
| Rate for Payer: Anthem Medicare Advantage |
$355.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$288.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$355.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$355.28
|
| Rate for Payer: Cash Price |
$163.50
|
| Rate for Payer: Cash Price |
$163.50
|
| Rate for Payer: Cigna Commercial |
$501.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$355.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$304.98
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$355.28
|
| Rate for Payer: Health EOS Commercial |
$485.05
|
| Rate for Payer: HFN Commercial |
$501.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,321.64
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$355.28
|
| Rate for Payer: Independent Care Health Plan Medicare |
$355.28
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$355.28
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$355.28
|
| Rate for Payer: Multiplan Commercial |
$436.00
|
| Rate for Payer: NAPHCARE Commercial |
$532.92
|
| Rate for Payer: Preferred Network Access Commercial |
$501.40
|
| Rate for Payer: Quartz Beloit One Network |
$267.05
|
| Rate for Payer: Quartz Commercial |
$354.25
|
| Rate for Payer: Quartz Medicare Advantage |
$355.28
|
| Rate for Payer: The Alliance Commercial |
$1,421.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$355.28
|
| Rate for Payer: United Healthcare PPO |
$408.75
|
| Rate for Payer: WEA Trust Commercial |
$299.75
|
| Rate for Payer: Wellcare Medicare |
$355.28
|
| Rate for Payer: WPS Commercial |
$403.68
|
|
