|
Flow Cytometry - PNH, 1 Marker
|
Facility
|
OP
|
$97.00
|
|
|
Service Code
|
CPT 88184
|
| Hospital Charge Code |
2950377
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$47.53 |
| Max. Negotiated Rate |
$1,421.12 |
| Rate for Payer: Aetna Commercial |
$87.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$83.42
|
| 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 |
$51.41
|
| 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 |
$29.10
|
| Rate for Payer: Cash Price |
$29.10
|
| Rate for Payer: Cigna Commercial |
$89.24
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$355.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$54.28
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$355.28
|
| Rate for Payer: Health EOS Commercial |
$86.33
|
| Rate for Payer: HFN Commercial |
$89.24
|
| 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 |
$77.60
|
| Rate for Payer: NAPHCARE Commercial |
$532.92
|
| Rate for Payer: Preferred Network Access Commercial |
$89.24
|
| Rate for Payer: Quartz Beloit One Network |
$47.53
|
| Rate for Payer: Quartz Commercial |
$63.05
|
| 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 |
$72.75
|
| Rate for Payer: WEA Trust Commercial |
$53.35
|
| Rate for Payer: Wellcare Medicare |
$355.28
|
| Rate for Payer: WPS Commercial |
$71.85
|
|
|
Flow Cytometry - PNH, Read
|
Professional
|
Both
|
$434.00
|
|
|
Service Code
|
CPT 88187
|
| Hospital Charge Code |
2950378
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$68.28 |
| Max. Negotiated Rate |
$412.30 |
| Rate for Payer: Aetna Commercial |
$412.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$373.24
|
| Rate for Payer: Anthem Commercial |
$68.28
|
| Rate for Payer: Cash Price |
$130.20
|
| Rate for Payer: Cash Price |
$130.20
|
| Rate for Payer: Cigna Commercial |
$412.30
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$217.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$260.40
|
| Rate for Payer: Health EOS Commercial |
$394.94
|
| Rate for Payer: HFN Commercial |
$412.30
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$123.94
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$123.94
|
| Rate for Payer: Multiplan Commercial |
$347.20
|
| Rate for Payer: Preferred Network Access Commercial |
$412.30
|
| Rate for Payer: Quartz Beloit One Network |
$190.96
|
| Rate for Payer: Quartz Commercial |
$247.38
|
| Rate for Payer: The Alliance Commercial |
$217.00
|
| Rate for Payer: WEA Trust Commercial |
$238.70
|
| Rate for Payer: WPS Commercial |
$321.46
|
|
|
Flow Cytometry - PNH, Read
|
Facility
|
IP
|
$434.00
|
|
|
Service Code
|
CPT 88187
|
| Hospital Charge Code |
2950378
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$212.66 |
| Max. Negotiated Rate |
$399.28 |
| Rate for Payer: Aetna Commercial |
$390.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$373.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$230.02
|
| Rate for Payer: Cash Price |
$130.20
|
| Rate for Payer: Cigna Commercial |
$399.28
|
| Rate for Payer: Health EOS Commercial |
$386.26
|
| Rate for Payer: HFN Commercial |
$399.28
|
| Rate for Payer: Multiplan Commercial |
$347.20
|
| Rate for Payer: NAPHCARE Commercial |
$260.40
|
| Rate for Payer: Preferred Network Access Commercial |
$399.28
|
| Rate for Payer: Quartz Beloit One Network |
$212.66
|
| Rate for Payer: Quartz Commercial |
$260.40
|
| Rate for Payer: WEA Trust Commercial |
$238.70
|
| Rate for Payer: WPS Commercial |
$321.46
|
|
|
Flow Cytometry - PNH, Read
|
Facility
|
OP
|
$434.00
|
|
|
Service Code
|
CPT 88187
|
| Hospital Charge Code |
2950378
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$121.52 |
| Max. Negotiated Rate |
$1,736.00 |
| Rate for Payer: Aetna Commercial |
$390.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$373.24
|
| Rate for Payer: Aetna Managed Medicare |
$121.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$282.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$217.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$208.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$230.02
|
| Rate for Payer: Cash Price |
$130.20
|
| Rate for Payer: Cigna Commercial |
$399.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$242.87
|
| Rate for Payer: Health EOS Commercial |
$386.26
|
| Rate for Payer: HFN Commercial |
$399.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$325.50
|
| Rate for Payer: Multiplan Commercial |
$347.20
|
| Rate for Payer: NAPHCARE Commercial |
$260.40
|
| Rate for Payer: Preferred Network Access Commercial |
$399.28
|
| Rate for Payer: Quartz Beloit One Network |
$212.66
|
| Rate for Payer: Quartz Commercial |
$282.10
|
| Rate for Payer: Quartz Medicare Advantage |
$260.40
|
| Rate for Payer: The Alliance Commercial |
$1,736.00
|
| Rate for Payer: United Healthcare PPO |
$325.50
|
| Rate for Payer: WEA Trust Commercial |
$238.70
|
| Rate for Payer: WPS Commercial |
$321.46
|
|
|
Flow Volume Loop - Pulmonary Function Test Charge
|
Facility
|
IP
|
$531.00
|
|
|
Service Code
|
CPT 94375
|
| Hospital Charge Code |
3006996
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$260.19 |
| Max. Negotiated Rate |
$488.52 |
| Rate for Payer: Aetna Commercial |
$477.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$456.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$281.43
|
| Rate for Payer: Cash Price |
$159.30
|
| Rate for Payer: Cigna Commercial |
$488.52
|
| Rate for Payer: Health EOS Commercial |
$472.59
|
| Rate for Payer: HFN Commercial |
$488.52
|
| Rate for Payer: Multiplan Commercial |
$424.80
|
| Rate for Payer: NAPHCARE Commercial |
$318.60
|
| Rate for Payer: Preferred Network Access Commercial |
$488.52
|
| Rate for Payer: Quartz Beloit One Network |
$260.19
|
| Rate for Payer: Quartz Commercial |
$318.60
|
| Rate for Payer: WEA Trust Commercial |
$292.05
|
| Rate for Payer: WPS Commercial |
$393.31
|
|
|
Flow Volume Loop - Pulmonary Function Test Charge
|
Facility
|
OP
|
$531.00
|
|
|
Service Code
|
CPT 94375
|
| Hospital Charge Code |
3006996
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$254.88 |
| Max. Negotiated Rate |
$1,240.96 |
| Rate for Payer: Aetna Commercial |
$477.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$456.66
|
| Rate for Payer: Aetna Managed Medicare |
$310.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$345.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$265.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$254.88
|
| Rate for Payer: Anthem Medicare Advantage |
$310.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$281.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$310.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$310.24
|
| Rate for Payer: Cash Price |
$159.30
|
| Rate for Payer: Cash Price |
$159.30
|
| Rate for Payer: Cigna Commercial |
$488.52
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$310.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$297.15
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$310.24
|
| Rate for Payer: Health EOS Commercial |
$472.59
|
| Rate for Payer: HFN Commercial |
$488.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,154.09
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$310.24
|
| Rate for Payer: Independent Care Health Plan Medicare |
$310.24
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$310.24
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$310.24
|
| Rate for Payer: Multiplan Commercial |
$424.80
|
| Rate for Payer: NAPHCARE Commercial |
$465.36
|
| Rate for Payer: Preferred Network Access Commercial |
$488.52
|
| Rate for Payer: Quartz Beloit One Network |
$260.19
|
| Rate for Payer: Quartz Commercial |
$345.15
|
| Rate for Payer: Quartz Medicare Advantage |
$310.24
|
| Rate for Payer: The Alliance Commercial |
$1,240.96
|
| Rate for Payer: United Healthcare Medicare Advantage |
$310.24
|
| Rate for Payer: United Healthcare PPO |
$398.25
|
| Rate for Payer: WEA Trust Commercial |
$292.05
|
| Rate for Payer: Wellcare Medicare |
$310.24
|
| Rate for Payer: WPS Commercial |
$393.31
|
|
|
FLT 3 Gene Analysis
|
Facility
|
IP
|
$412.00
|
|
|
Service Code
|
CPT 81246
|
| Hospital Charge Code |
5484796
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$201.88 |
| Max. Negotiated Rate |
$379.04 |
| Rate for Payer: Aetna Commercial |
$370.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$354.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$218.36
|
| Rate for Payer: Cash Price |
$123.60
|
| Rate for Payer: Cigna Commercial |
$379.04
|
| Rate for Payer: Health EOS Commercial |
$366.68
|
| Rate for Payer: HFN Commercial |
$379.04
|
| Rate for Payer: Multiplan Commercial |
$329.60
|
| Rate for Payer: NAPHCARE Commercial |
$247.20
|
| Rate for Payer: Preferred Network Access Commercial |
$379.04
|
| Rate for Payer: Quartz Beloit One Network |
$201.88
|
| Rate for Payer: Quartz Commercial |
$247.20
|
| Rate for Payer: WEA Trust Commercial |
$226.60
|
| Rate for Payer: WPS Commercial |
$305.17
|
|
|
FLT 3 Gene Analysis
|
Professional
|
Both
|
$412.00
|
|
|
Service Code
|
CPT 81246
|
| Hospital Charge Code |
5484796
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$181.28 |
| Max. Negotiated Rate |
$391.40 |
| Rate for Payer: Aetna Commercial |
$391.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$354.32
|
| Rate for Payer: Cash Price |
$123.60
|
| Rate for Payer: Cash Price |
$123.60
|
| Rate for Payer: Cigna Commercial |
$391.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$206.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$247.20
|
| Rate for Payer: Health EOS Commercial |
$374.92
|
| Rate for Payer: HFN Commercial |
$391.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$292.99
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$292.99
|
| Rate for Payer: Multiplan Commercial |
$329.60
|
| Rate for Payer: Preferred Network Access Commercial |
$391.40
|
| Rate for Payer: Quartz Beloit One Network |
$181.28
|
| Rate for Payer: Quartz Commercial |
$234.84
|
| Rate for Payer: The Alliance Commercial |
$206.00
|
| Rate for Payer: WEA Trust Commercial |
$226.60
|
| Rate for Payer: WPS Commercial |
$305.17
|
|
|
FLT 3 Gene Analysis
|
Facility
|
OP
|
$412.00
|
|
|
Service Code
|
CPT 81246
|
| Hospital Charge Code |
5484796
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$83.00 |
| Max. Negotiated Rate |
$379.04 |
| Rate for Payer: Aetna Commercial |
$370.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$354.32
|
| Rate for Payer: Aetna Managed Medicare |
$83.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$311.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$145.25
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$137.78
|
| Rate for Payer: Anthem Medicaid |
$85.76
|
| Rate for Payer: Anthem Medicare Advantage |
$83.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$218.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$83.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$83.00
|
| Rate for Payer: Cash Price |
$123.60
|
| Rate for Payer: Cash Price |
$123.60
|
| Rate for Payer: Cigna Commercial |
$379.04
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$83.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$85.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$230.56
|
| Rate for Payer: Dean Health Medicaid |
$85.76
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$83.00
|
| Rate for Payer: Health EOS Commercial |
$366.68
|
| Rate for Payer: HFN Commercial |
$379.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$308.76
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$83.00
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$85.76
|
| Rate for Payer: Independent Care Health Plan Medicare |
$83.00
|
| Rate for Payer: Managed Health Services Medicaid |
$89.19
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$83.00
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$83.00
|
| Rate for Payer: Multiplan Commercial |
$329.60
|
| Rate for Payer: NAPHCARE Commercial |
$124.50
|
| Rate for Payer: Preferred Network Access Commercial |
$379.04
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$85.76
|
| Rate for Payer: Quartz Beloit One Network |
$201.88
|
| Rate for Payer: Quartz Commercial |
$267.80
|
| Rate for Payer: Quartz Medicare Advantage |
$83.00
|
| Rate for Payer: The Alliance Commercial |
$332.00
|
| Rate for Payer: United Healthcare Medicaid |
$85.76
|
| Rate for Payer: United Healthcare Medicare Advantage |
$83.00
|
| Rate for Payer: United Healthcare PPO |
$309.00
|
| Rate for Payer: WEA Trust Commercial |
$226.60
|
| Rate for Payer: Wellcare Medicare |
$83.00
|
| Rate for Payer: WMAP Medicaid |
$85.76
|
| Rate for Payer: WPS Commercial |
$305.17
|
|
|
FLT3 Mutation Analysis to Mayo
|
Professional
|
Both
|
$822.00
|
|
|
Service Code
|
CPT 81245
|
| Hospital Charge Code |
5484745
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$361.68 |
| Max. Negotiated Rate |
$780.90 |
| Rate for Payer: Aetna Commercial |
$780.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$706.92
|
| Rate for Payer: Cash Price |
$246.60
|
| Rate for Payer: Cash Price |
$246.60
|
| Rate for Payer: Cigna Commercial |
$780.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$411.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$493.20
|
| Rate for Payer: Health EOS Commercial |
$748.02
|
| Rate for Payer: HFN Commercial |
$780.90
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$584.25
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$584.25
|
| Rate for Payer: Multiplan Commercial |
$657.60
|
| Rate for Payer: Preferred Network Access Commercial |
$780.90
|
| Rate for Payer: Quartz Beloit One Network |
$361.68
|
| Rate for Payer: Quartz Commercial |
$468.54
|
| Rate for Payer: The Alliance Commercial |
$411.00
|
| Rate for Payer: WEA Trust Commercial |
$452.10
|
| Rate for Payer: WPS Commercial |
$608.86
|
|
|
FLT3 Mutation Analysis to Mayo
|
Facility
|
IP
|
$822.00
|
|
|
Service Code
|
CPT 81245
|
| Hospital Charge Code |
5484745
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$402.78 |
| Max. Negotiated Rate |
$756.24 |
| Rate for Payer: Aetna Commercial |
$739.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$706.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$435.66
|
| Rate for Payer: Cash Price |
$246.60
|
| Rate for Payer: Cigna Commercial |
$756.24
|
| Rate for Payer: Health EOS Commercial |
$731.58
|
| Rate for Payer: HFN Commercial |
$756.24
|
| Rate for Payer: Multiplan Commercial |
$657.60
|
| Rate for Payer: NAPHCARE Commercial |
$493.20
|
| Rate for Payer: Preferred Network Access Commercial |
$756.24
|
| Rate for Payer: Quartz Beloit One Network |
$402.78
|
| Rate for Payer: Quartz Commercial |
$493.20
|
| Rate for Payer: WEA Trust Commercial |
$452.10
|
| Rate for Payer: WPS Commercial |
$608.86
|
|
|
FLT3 Mutation Analysis to Mayo
|
Facility
|
OP
|
$822.00
|
|
|
Service Code
|
CPT 81245
|
| Hospital Charge Code |
5484745
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$132.74 |
| Max. Negotiated Rate |
$756.24 |
| Rate for Payer: Aetna Commercial |
$739.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$706.92
|
| Rate for Payer: Aetna Managed Medicare |
$165.51
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$620.66
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$289.64
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$274.75
|
| Rate for Payer: Anthem Medicaid |
$132.74
|
| Rate for Payer: Anthem Medicare Advantage |
$165.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$435.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$165.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$165.51
|
| Rate for Payer: Cash Price |
$246.60
|
| Rate for Payer: Cash Price |
$246.60
|
| Rate for Payer: Cigna Commercial |
$756.24
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$165.51
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$132.74
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$459.99
|
| Rate for Payer: Dean Health Medicaid |
$132.74
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$165.51
|
| Rate for Payer: Health EOS Commercial |
$731.58
|
| Rate for Payer: HFN Commercial |
$756.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$615.70
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$165.51
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$132.74
|
| Rate for Payer: Independent Care Health Plan Medicare |
$165.51
|
| Rate for Payer: Managed Health Services Medicaid |
$138.05
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$165.51
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$165.51
|
| Rate for Payer: Multiplan Commercial |
$657.60
|
| Rate for Payer: NAPHCARE Commercial |
$248.26
|
| Rate for Payer: Preferred Network Access Commercial |
$756.24
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$132.74
|
| Rate for Payer: Quartz Beloit One Network |
$402.78
|
| Rate for Payer: Quartz Commercial |
$534.30
|
| Rate for Payer: Quartz Medicare Advantage |
$165.51
|
| Rate for Payer: The Alliance Commercial |
$662.04
|
| Rate for Payer: United Healthcare Medicaid |
$132.74
|
| Rate for Payer: United Healthcare Medicare Advantage |
$165.51
|
| Rate for Payer: United Healthcare PPO |
$616.50
|
| Rate for Payer: WEA Trust Commercial |
$452.10
|
| Rate for Payer: Wellcare Medicare |
$165.51
|
| Rate for Payer: WMAP Medicaid |
$132.74
|
| Rate for Payer: WPS Commercial |
$608.86
|
|
|
Flu A/B PCR
|
Facility
|
OP
|
$266.00
|
|
|
Service Code
|
CPT 87502
|
| Hospital Charge Code |
4566787
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$95.80 |
| Max. Negotiated Rate |
$383.20 |
| Rate for Payer: Aetna Commercial |
$239.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$228.76
|
| Rate for Payer: Aetna Managed Medicare |
$95.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$359.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$167.65
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$159.03
|
| Rate for Payer: Anthem Medicaid |
$98.99
|
| Rate for Payer: Anthem Medicare Advantage |
$95.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$140.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$95.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$95.80
|
| Rate for Payer: Cash Price |
$79.80
|
| Rate for Payer: Cash Price |
$79.80
|
| Rate for Payer: Cigna Commercial |
$244.72
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$95.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$98.99
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$148.85
|
| Rate for Payer: Dean Health Medicaid |
$98.99
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$95.80
|
| Rate for Payer: Health EOS Commercial |
$236.74
|
| Rate for Payer: HFN Commercial |
$244.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$356.38
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$95.80
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$98.99
|
| Rate for Payer: Independent Care Health Plan Medicare |
$95.80
|
| Rate for Payer: Managed Health Services Medicaid |
$102.95
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$95.80
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$95.80
|
| Rate for Payer: Multiplan Commercial |
$212.80
|
| Rate for Payer: NAPHCARE Commercial |
$143.70
|
| Rate for Payer: Preferred Network Access Commercial |
$244.72
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$98.99
|
| Rate for Payer: Quartz Beloit One Network |
$130.34
|
| Rate for Payer: Quartz Commercial |
$172.90
|
| Rate for Payer: Quartz Medicare Advantage |
$95.80
|
| Rate for Payer: The Alliance Commercial |
$383.20
|
| Rate for Payer: United Healthcare Medicaid |
$98.99
|
| Rate for Payer: United Healthcare Medicare Advantage |
$95.80
|
| Rate for Payer: United Healthcare PPO |
$199.50
|
| Rate for Payer: WEA Trust Commercial |
$146.30
|
| Rate for Payer: Wellcare Medicare |
$95.80
|
| Rate for Payer: WMAP Medicaid |
$98.99
|
| Rate for Payer: WPS Commercial |
$197.03
|
|
|
Flu A/B PCR
|
Facility
|
IP
|
$266.00
|
|
|
Service Code
|
CPT 87502
|
| Hospital Charge Code |
4566787
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$130.34 |
| Max. Negotiated Rate |
$244.72 |
| Rate for Payer: Aetna Commercial |
$239.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$228.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$140.98
|
| Rate for Payer: Cash Price |
$79.80
|
| Rate for Payer: Cigna Commercial |
$244.72
|
| Rate for Payer: Health EOS Commercial |
$236.74
|
| Rate for Payer: HFN Commercial |
$244.72
|
| Rate for Payer: Multiplan Commercial |
$212.80
|
| Rate for Payer: NAPHCARE Commercial |
$159.60
|
| Rate for Payer: Preferred Network Access Commercial |
$244.72
|
| Rate for Payer: Quartz Beloit One Network |
$130.34
|
| Rate for Payer: Quartz Commercial |
$159.60
|
| Rate for Payer: WEA Trust Commercial |
$146.30
|
| Rate for Payer: WPS Commercial |
$197.03
|
|
|
Flu A/B PCR
|
Professional
|
Both
|
$266.00
|
|
|
Service Code
|
CPT 87502
|
| Hospital Charge Code |
4566787
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$117.04 |
| Max. Negotiated Rate |
$338.17 |
| Rate for Payer: Aetna Commercial |
$252.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$228.76
|
| Rate for Payer: Cash Price |
$79.80
|
| Rate for Payer: Cash Price |
$79.80
|
| Rate for Payer: Cigna Commercial |
$252.70
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$133.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$159.60
|
| Rate for Payer: Health EOS Commercial |
$242.06
|
| Rate for Payer: HFN Commercial |
$252.70
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$338.17
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$338.17
|
| Rate for Payer: Multiplan Commercial |
$212.80
|
| Rate for Payer: Preferred Network Access Commercial |
$252.70
|
| Rate for Payer: Quartz Beloit One Network |
$117.04
|
| Rate for Payer: Quartz Commercial |
$151.62
|
| Rate for Payer: The Alliance Commercial |
$133.00
|
| Rate for Payer: WEA Trust Commercial |
$146.30
|
| Rate for Payer: WPS Commercial |
$197.03
|
|
|
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 |
$140.78 |
| Max. Negotiated Rate |
$570.52 |
| Rate for Payer: Aetna Commercial |
$481.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$460.10
|
| Rate for Payer: Aetna Managed Medicare |
$142.63
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$534.86
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$249.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$236.77
|
| Rate for Payer: Anthem Medicaid |
$140.78
|
| Rate for Payer: Anthem Medicare Advantage |
$142.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$283.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$142.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$142.63
|
| Rate for Payer: Cash Price |
$160.50
|
| Rate for Payer: Cash Price |
$160.50
|
| Rate for Payer: Cigna Commercial |
$492.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$142.63
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$140.78
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$299.39
|
| Rate for Payer: Dean Health Medicaid |
$140.78
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$142.63
|
| Rate for Payer: Health EOS Commercial |
$476.15
|
| Rate for Payer: HFN Commercial |
$492.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$530.58
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$142.63
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$140.78
|
| Rate for Payer: Independent Care Health Plan Medicare |
$142.63
|
| Rate for Payer: Managed Health Services Medicaid |
$146.41
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$142.63
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$142.63
|
| Rate for Payer: Multiplan Commercial |
$428.00
|
| Rate for Payer: NAPHCARE Commercial |
$213.94
|
| Rate for Payer: Preferred Network Access Commercial |
$492.20
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$140.78
|
| Rate for Payer: Quartz Beloit One Network |
$262.15
|
| Rate for Payer: Quartz Commercial |
$347.75
|
| Rate for Payer: Quartz Medicare Advantage |
$142.63
|
| Rate for Payer: The Alliance Commercial |
$570.52
|
| Rate for Payer: United Healthcare Medicaid |
$140.78
|
| Rate for Payer: United Healthcare Medicare Advantage |
$142.63
|
| Rate for Payer: United Healthcare PPO |
$401.25
|
| Rate for Payer: WEA Trust Commercial |
$294.25
|
| Rate for Payer: Wellcare Medicare |
$142.63
|
| Rate for Payer: WMAP Medicaid |
$140.78
|
| Rate for Payer: WPS Commercial |
$396.27
|
|
|
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 |
$262.15 |
| Max. Negotiated Rate |
$492.20 |
| Rate for Payer: Aetna Commercial |
$481.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$460.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$283.55
|
| Rate for Payer: Cash Price |
$160.50
|
| Rate for Payer: Cigna Commercial |
$492.20
|
| Rate for Payer: Health EOS Commercial |
$476.15
|
| Rate for Payer: HFN Commercial |
$492.20
|
| Rate for Payer: Multiplan Commercial |
$428.00
|
| Rate for Payer: NAPHCARE Commercial |
$321.00
|
| Rate for Payer: Preferred Network Access Commercial |
$492.20
|
| Rate for Payer: Quartz Beloit One Network |
$262.15
|
| Rate for Payer: Quartz Commercial |
$321.00
|
| Rate for Payer: WEA Trust Commercial |
$294.25
|
| Rate for Payer: WPS Commercial |
$396.27
|
|
|
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 |
$235.40 |
| Max. Negotiated Rate |
$508.25 |
| Rate for Payer: Aetna Commercial |
$508.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$460.10
|
| Rate for Payer: Cash Price |
$160.50
|
| Rate for Payer: Cash Price |
$160.50
|
| Rate for Payer: Cigna Commercial |
$508.25
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$267.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$321.00
|
| Rate for Payer: Health EOS Commercial |
$486.85
|
| Rate for Payer: HFN Commercial |
$508.25
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$503.48
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$503.48
|
| Rate for Payer: Multiplan Commercial |
$428.00
|
| Rate for Payer: Preferred Network Access Commercial |
$508.25
|
| Rate for Payer: Quartz Beloit One Network |
$235.40
|
| Rate for Payer: Quartz Commercial |
$304.95
|
| Rate for Payer: The Alliance Commercial |
$267.50
|
| Rate for Payer: WEA Trust Commercial |
$294.25
|
| Rate for Payer: WPS Commercial |
$396.27
|
|
|
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 |
$8.64 |
| Max. Negotiated Rate |
$278.52 |
| Rate for Payer: Aetna Commercial |
$16.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$15.48
|
| Rate for Payer: Aetna Managed Medicare |
$69.63
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$11.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$9.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$8.64
|
| Rate for Payer: Anthem Medicare Advantage |
$69.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$69.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$69.63
|
| Rate for Payer: Cash Price |
$5.40
|
| Rate for Payer: Cash Price |
$5.40
|
| Rate for Payer: Cigna Commercial |
$16.56
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$69.63
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$10.07
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$69.63
|
| Rate for Payer: Health EOS Commercial |
$16.02
|
| Rate for Payer: HFN Commercial |
$16.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$259.02
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$69.63
|
| Rate for Payer: Independent Care Health Plan Medicare |
$69.63
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$69.63
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$69.63
|
| Rate for Payer: Multiplan Commercial |
$14.40
|
| Rate for Payer: NAPHCARE Commercial |
$104.44
|
| Rate for Payer: Preferred Network Access Commercial |
$16.56
|
| Rate for Payer: Quartz Beloit One Network |
$8.82
|
| Rate for Payer: Quartz Commercial |
$11.70
|
| Rate for Payer: Quartz Medicare Advantage |
$69.63
|
| Rate for Payer: The Alliance Commercial |
$278.52
|
| Rate for Payer: United Healthcare Medicare Advantage |
$69.63
|
| Rate for Payer: United Healthcare PPO |
$13.50
|
| Rate for Payer: WEA Trust Commercial |
$9.90
|
| Rate for Payer: Wellcare Medicare |
$69.63
|
| Rate for Payer: WPS Commercial |
$13.33
|
|
|
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 |
$8.82 |
| Max. Negotiated Rate |
$16.56 |
| Rate for Payer: Aetna Commercial |
$16.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$15.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9.54
|
| Rate for Payer: Cash Price |
$5.40
|
| Rate for Payer: Cigna Commercial |
$16.56
|
| Rate for Payer: Health EOS Commercial |
$16.02
|
| Rate for Payer: HFN Commercial |
$16.56
|
| Rate for Payer: Multiplan Commercial |
$14.40
|
| Rate for Payer: NAPHCARE Commercial |
$10.80
|
| Rate for Payer: Preferred Network Access Commercial |
$16.56
|
| Rate for Payer: Quartz Beloit One Network |
$8.82
|
| Rate for Payer: Quartz Commercial |
$10.80
|
| Rate for Payer: WEA Trust Commercial |
$9.90
|
| Rate for Payer: WPS Commercial |
$13.33
|
|
|
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 |
$8.64 |
| Max. Negotiated Rate |
$278.52 |
| Rate for Payer: Aetna Commercial |
$16.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$15.48
|
| Rate for Payer: Aetna Managed Medicare |
$69.63
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$11.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$9.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$8.64
|
| Rate for Payer: Anthem Medicare Advantage |
$69.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$69.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$69.63
|
| Rate for Payer: Cash Price |
$5.40
|
| Rate for Payer: Cash Price |
$5.40
|
| Rate for Payer: Cigna Commercial |
$16.56
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$69.63
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$10.07
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$69.63
|
| Rate for Payer: Health EOS Commercial |
$16.02
|
| Rate for Payer: HFN Commercial |
$16.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$259.02
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$69.63
|
| Rate for Payer: Independent Care Health Plan Medicare |
$69.63
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$69.63
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$69.63
|
| Rate for Payer: Multiplan Commercial |
$14.40
|
| Rate for Payer: NAPHCARE Commercial |
$104.44
|
| Rate for Payer: Preferred Network Access Commercial |
$16.56
|
| Rate for Payer: Quartz Beloit One Network |
$8.82
|
| Rate for Payer: Quartz Commercial |
$11.70
|
| Rate for Payer: Quartz Medicare Advantage |
$69.63
|
| Rate for Payer: The Alliance Commercial |
$278.52
|
| Rate for Payer: United Healthcare Medicare Advantage |
$69.63
|
| Rate for Payer: United Healthcare PPO |
$13.50
|
| Rate for Payer: WEA Trust Commercial |
$9.90
|
| Rate for Payer: Wellcare Medicare |
$69.63
|
| Rate for Payer: WPS Commercial |
$13.33
|
|
|
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 |
$8.82 |
| Max. Negotiated Rate |
$16.56 |
| Rate for Payer: Aetna Commercial |
$16.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$15.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9.54
|
| Rate for Payer: Cash Price |
$5.40
|
| Rate for Payer: Cigna Commercial |
$16.56
|
| Rate for Payer: Health EOS Commercial |
$16.02
|
| Rate for Payer: HFN Commercial |
$16.56
|
| Rate for Payer: Multiplan Commercial |
$14.40
|
| Rate for Payer: NAPHCARE Commercial |
$10.80
|
| Rate for Payer: Preferred Network Access Commercial |
$16.56
|
| Rate for Payer: Quartz Beloit One Network |
$8.82
|
| Rate for Payer: Quartz Commercial |
$10.80
|
| Rate for Payer: WEA Trust Commercial |
$9.90
|
| Rate for Payer: WPS Commercial |
$13.33
|
|
|
Flublok (0.5ml)
|
Facility
|
IP
|
$42.00
|
|
|
Service Code
|
CPT 90682
|
| Hospital Charge Code |
5657655
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$20.58 |
| Max. Negotiated Rate |
$38.64 |
| Rate for Payer: Aetna Commercial |
$37.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$36.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$22.26
|
| Rate for Payer: Cash Price |
$12.60
|
| Rate for Payer: Cigna Commercial |
$38.64
|
| Rate for Payer: Health EOS Commercial |
$37.38
|
| Rate for Payer: HFN Commercial |
$38.64
|
| Rate for Payer: Multiplan Commercial |
$33.60
|
| Rate for Payer: NAPHCARE Commercial |
$25.20
|
| Rate for Payer: Preferred Network Access Commercial |
$38.64
|
| Rate for Payer: Quartz Beloit One Network |
$20.58
|
| Rate for Payer: Quartz Commercial |
$25.20
|
| Rate for Payer: WEA Trust Commercial |
$23.10
|
| Rate for Payer: WPS Commercial |
$31.11
|
|
|
Flublok (0.5ml)
|
Facility
|
OP
|
$42.00
|
|
|
Service Code
|
CPT 90682
|
| Hospital Charge Code |
5657655
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.76 |
| Max. Negotiated Rate |
$183.51 |
| Rate for Payer: Aetna Commercial |
$37.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$36.12
|
| Rate for Payer: Aetna Managed Medicare |
$11.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$27.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$21.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$20.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$22.26
|
| Rate for Payer: Cash Price |
$12.60
|
| Rate for Payer: Cash Price |
$12.60
|
| Rate for Payer: Cigna Commercial |
$38.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$97.11
|
| Rate for Payer: Health EOS Commercial |
$37.38
|
| Rate for Payer: HFN Commercial |
$38.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$31.50
|
| Rate for Payer: Multiplan Commercial |
$33.60
|
| Rate for Payer: NAPHCARE Commercial |
$25.20
|
| Rate for Payer: Preferred Network Access Commercial |
$38.64
|
| Rate for Payer: Quartz Beloit One Network |
$20.58
|
| Rate for Payer: Quartz Commercial |
$27.30
|
| Rate for Payer: Quartz Medicare Advantage |
$25.20
|
| Rate for Payer: The Alliance Commercial |
$168.00
|
| Rate for Payer: WEA Trust Commercial |
$23.10
|
| Rate for Payer: WPS Commercial |
$183.51
|
|
|
Flublok (0.5 ml) 90682
|
Facility
|
IP
|
$42.00
|
|
|
Service Code
|
CPT 90682
|
| Hospital Charge Code |
5983679
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$20.58 |
| Max. Negotiated Rate |
$38.64 |
| Rate for Payer: Aetna Commercial |
$37.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$36.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$22.26
|
| Rate for Payer: Cash Price |
$12.60
|
| Rate for Payer: Cigna Commercial |
$38.64
|
| Rate for Payer: Health EOS Commercial |
$37.38
|
| Rate for Payer: HFN Commercial |
$38.64
|
| Rate for Payer: Multiplan Commercial |
$33.60
|
| Rate for Payer: NAPHCARE Commercial |
$25.20
|
| Rate for Payer: Preferred Network Access Commercial |
$38.64
|
| Rate for Payer: Quartz Beloit One Network |
$20.58
|
| Rate for Payer: Quartz Commercial |
$25.20
|
| Rate for Payer: WEA Trust Commercial |
$23.10
|
| Rate for Payer: WPS Commercial |
$31.11
|
|
