|
Fluvoxamine Level
|
Facility
|
OP
|
$248.00
|
|
|
Service Code
|
CPT 80332
|
| Hospital Charge Code |
5094645
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$69.44 |
| Max. Negotiated Rate |
$992.00 |
| Rate for Payer: Aetna Commercial |
$223.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$213.28
|
| Rate for Payer: Aetna Managed Medicare |
$69.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$161.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$124.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$119.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$131.44
|
| Rate for Payer: Cash Price |
$74.40
|
| Rate for Payer: Cigna Commercial |
$228.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$138.78
|
| Rate for Payer: Health EOS Commercial |
$220.72
|
| Rate for Payer: HFN Commercial |
$228.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$186.00
|
| Rate for Payer: Multiplan Commercial |
$198.40
|
| Rate for Payer: NAPHCARE Commercial |
$148.80
|
| Rate for Payer: Preferred Network Access Commercial |
$228.16
|
| Rate for Payer: Quartz Beloit One Network |
$121.52
|
| Rate for Payer: Quartz Commercial |
$161.20
|
| Rate for Payer: Quartz Medicare Advantage |
$148.80
|
| Rate for Payer: The Alliance Commercial |
$992.00
|
| Rate for Payer: United Healthcare PPO |
$186.00
|
| Rate for Payer: WEA Trust Commercial |
$136.40
|
| Rate for Payer: WPS Commercial |
$183.69
|
|
|
Fluvoxamine Level
|
Professional
|
Both
|
$248.00
|
|
|
Service Code
|
CPT 80332
|
| Hospital Charge Code |
5094645
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$80.06 |
| Max. Negotiated Rate |
$235.60 |
| Rate for Payer: Aetna Commercial |
$235.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$213.28
|
| Rate for Payer: Cash Price |
$74.40
|
| Rate for Payer: Cash Price |
$74.40
|
| Rate for Payer: Cigna Commercial |
$235.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$124.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$148.80
|
| Rate for Payer: Health EOS Commercial |
$225.68
|
| Rate for Payer: HFN Commercial |
$235.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$80.06
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$80.06
|
| Rate for Payer: Multiplan Commercial |
$198.40
|
| Rate for Payer: Preferred Network Access Commercial |
$235.60
|
| Rate for Payer: Quartz Beloit One Network |
$109.12
|
| Rate for Payer: Quartz Commercial |
$141.36
|
| Rate for Payer: The Alliance Commercial |
$124.00
|
| Rate for Payer: WEA Trust Commercial |
$136.40
|
| Rate for Payer: WPS Commercial |
$183.69
|
|
|
Fluvoxamine Level
|
Facility
|
IP
|
$248.00
|
|
|
Service Code
|
CPT 80332
|
| Hospital Charge Code |
5094645
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$121.52 |
| Max. Negotiated Rate |
$228.16 |
| Rate for Payer: Aetna Commercial |
$223.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$213.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$131.44
|
| Rate for Payer: Cash Price |
$74.40
|
| Rate for Payer: Cigna Commercial |
$228.16
|
| Rate for Payer: Health EOS Commercial |
$220.72
|
| Rate for Payer: HFN Commercial |
$228.16
|
| Rate for Payer: Multiplan Commercial |
$198.40
|
| Rate for Payer: NAPHCARE Commercial |
$148.80
|
| Rate for Payer: Preferred Network Access Commercial |
$228.16
|
| Rate for Payer: Quartz Beloit One Network |
$121.52
|
| Rate for Payer: Quartz Commercial |
$148.80
|
| Rate for Payer: WEA Trust Commercial |
$136.40
|
| Rate for Payer: WPS Commercial |
$183.69
|
|
|
Fluzone (0.50 ml dose) 90688
|
Facility
|
OP
|
$17.00
|
|
|
Service Code
|
CPT 90688
|
| Hospital Charge Code |
4356632
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.76 |
| Max. Negotiated Rate |
$68.00 |
| Rate for Payer: Aetna Commercial |
$15.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$14.62
|
| Rate for Payer: Aetna Managed Medicare |
$4.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$11.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$8.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9.01
|
| Rate for Payer: Cash Price |
$5.10
|
| Rate for Payer: Cash Price |
$5.10
|
| Rate for Payer: Cigna Commercial |
$15.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$27.62
|
| Rate for Payer: Health EOS Commercial |
$15.13
|
| Rate for Payer: HFN Commercial |
$15.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$12.75
|
| Rate for Payer: Multiplan Commercial |
$13.60
|
| Rate for Payer: NAPHCARE Commercial |
$10.20
|
| Rate for Payer: Preferred Network Access Commercial |
$15.64
|
| Rate for Payer: Quartz Beloit One Network |
$8.33
|
| Rate for Payer: Quartz Commercial |
$11.05
|
| Rate for Payer: Quartz Medicare Advantage |
$10.20
|
| Rate for Payer: The Alliance Commercial |
$68.00
|
| Rate for Payer: WEA Trust Commercial |
$9.35
|
| Rate for Payer: WPS Commercial |
$52.20
|
|
|
Fluzone (0.50 ml dose) 90688
|
Professional
|
Both
|
$17.00
|
|
|
Service Code
|
CPT 90688
|
| Hospital Charge Code |
4356632
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7.48 |
| Max. Negotiated Rate |
$52.20 |
| Rate for Payer: Aetna Commercial |
$16.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$14.62
|
| Rate for Payer: Cash Price |
$5.10
|
| Rate for Payer: Cash Price |
$5.10
|
| Rate for Payer: Cigna Commercial |
$16.15
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$35.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$20.88
|
| Rate for Payer: Health EOS Commercial |
$15.47
|
| Rate for Payer: HFN Commercial |
$16.15
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$27.99
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$27.99
|
| Rate for Payer: Multiplan Commercial |
$13.60
|
| Rate for Payer: Preferred Network Access Commercial |
$16.15
|
| Rate for Payer: Quartz Beloit One Network |
$7.48
|
| Rate for Payer: Quartz Commercial |
$9.69
|
| Rate for Payer: The Alliance Commercial |
$8.50
|
| Rate for Payer: United Healthcare Medicaid |
$35.88
|
| Rate for Payer: WEA Trust Commercial |
$9.35
|
| Rate for Payer: WPS Commercial |
$52.20
|
|
|
Fluzone (0.50 ml dose) 90688
|
Facility
|
IP
|
$17.00
|
|
|
Service Code
|
CPT 90688
|
| Hospital Charge Code |
4356632
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.33 |
| Max. Negotiated Rate |
$15.64 |
| Rate for Payer: Aetna Commercial |
$15.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$14.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9.01
|
| Rate for Payer: Cash Price |
$5.10
|
| Rate for Payer: Cigna Commercial |
$15.64
|
| Rate for Payer: Health EOS Commercial |
$15.13
|
| Rate for Payer: HFN Commercial |
$15.64
|
| Rate for Payer: Multiplan Commercial |
$13.60
|
| Rate for Payer: NAPHCARE Commercial |
$10.20
|
| Rate for Payer: Preferred Network Access Commercial |
$15.64
|
| Rate for Payer: Quartz Beloit One Network |
$8.33
|
| Rate for Payer: Quartz Commercial |
$10.20
|
| Rate for Payer: WEA Trust Commercial |
$9.35
|
| Rate for Payer: WPS Commercial |
$12.59
|
|
|
Fluzone High Dose (0.7ml) (Dialysis) 90662
|
Facility
|
OP
|
$60.00
|
|
|
Service Code
|
CPT 90662
|
| Hospital Charge Code |
6219916
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$16.80 |
| Max. Negotiated Rate |
$240.00 |
| Rate for Payer: Aetna Commercial |
$54.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$51.60
|
| Rate for Payer: Aetna Managed Medicare |
$16.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$39.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$30.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$28.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$31.80
|
| Rate for Payer: Cash Price |
$18.00
|
| Rate for Payer: Cash Price |
$18.00
|
| Rate for Payer: Cigna Commercial |
$55.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$97.11
|
| Rate for Payer: Health EOS Commercial |
$53.40
|
| Rate for Payer: HFN Commercial |
$55.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$45.00
|
| Rate for Payer: Multiplan Commercial |
$48.00
|
| Rate for Payer: NAPHCARE Commercial |
$36.00
|
| Rate for Payer: Preferred Network Access Commercial |
$55.20
|
| Rate for Payer: Quartz Beloit One Network |
$29.40
|
| Rate for Payer: Quartz Commercial |
$39.00
|
| Rate for Payer: Quartz Medicare Advantage |
$36.00
|
| Rate for Payer: The Alliance Commercial |
$240.00
|
| Rate for Payer: WEA Trust Commercial |
$33.00
|
| Rate for Payer: WPS Commercial |
$183.51
|
|
|
Fluzone High Dose (0.7ml) (Dialysis) 90662
|
Facility
|
IP
|
$60.00
|
|
|
Service Code
|
CPT 90662
|
| Hospital Charge Code |
6219916
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$29.40 |
| Max. Negotiated Rate |
$55.20 |
| Rate for Payer: Aetna Commercial |
$54.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$51.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$31.80
|
| Rate for Payer: Cash Price |
$18.00
|
| Rate for Payer: Cigna Commercial |
$55.20
|
| Rate for Payer: Health EOS Commercial |
$53.40
|
| Rate for Payer: HFN Commercial |
$55.20
|
| Rate for Payer: Multiplan Commercial |
$48.00
|
| Rate for Payer: NAPHCARE Commercial |
$36.00
|
| Rate for Payer: Preferred Network Access Commercial |
$55.20
|
| Rate for Payer: Quartz Beloit One Network |
$29.40
|
| Rate for Payer: Quartz Commercial |
$36.00
|
| Rate for Payer: WEA Trust Commercial |
$33.00
|
| Rate for Payer: WPS Commercial |
$44.44
|
|
|
Fluzone High Dose (0.7ml) - Flu Virus, Inactivated Charge
|
Facility
|
IP
|
$60.00
|
|
|
Service Code
|
CPT 90662
|
| Hospital Charge Code |
5609706
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$29.40 |
| Max. Negotiated Rate |
$55.20 |
| Rate for Payer: Aetna Commercial |
$54.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$51.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$31.80
|
| Rate for Payer: Cash Price |
$18.00
|
| Rate for Payer: Cigna Commercial |
$55.20
|
| Rate for Payer: Health EOS Commercial |
$53.40
|
| Rate for Payer: HFN Commercial |
$55.20
|
| Rate for Payer: Multiplan Commercial |
$48.00
|
| Rate for Payer: NAPHCARE Commercial |
$36.00
|
| Rate for Payer: Preferred Network Access Commercial |
$55.20
|
| Rate for Payer: Quartz Beloit One Network |
$29.40
|
| Rate for Payer: Quartz Commercial |
$36.00
|
| Rate for Payer: WEA Trust Commercial |
$33.00
|
| Rate for Payer: WPS Commercial |
$44.44
|
|
|
Fluzone High Dose (0.7ml) - Flu Virus, Inactivated Charge
|
Facility
|
OP
|
$60.00
|
|
|
Service Code
|
CPT 90662
|
| Hospital Charge Code |
5609706
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$16.80 |
| Max. Negotiated Rate |
$240.00 |
| Rate for Payer: Aetna Commercial |
$54.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$51.60
|
| Rate for Payer: Aetna Managed Medicare |
$16.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$39.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$30.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$28.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$31.80
|
| Rate for Payer: Cash Price |
$18.00
|
| Rate for Payer: Cash Price |
$18.00
|
| Rate for Payer: Cigna Commercial |
$55.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$97.11
|
| Rate for Payer: Health EOS Commercial |
$53.40
|
| Rate for Payer: HFN Commercial |
$55.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$45.00
|
| Rate for Payer: Multiplan Commercial |
$48.00
|
| Rate for Payer: NAPHCARE Commercial |
$36.00
|
| Rate for Payer: Preferred Network Access Commercial |
$55.20
|
| Rate for Payer: Quartz Beloit One Network |
$29.40
|
| Rate for Payer: Quartz Commercial |
$39.00
|
| Rate for Payer: Quartz Medicare Advantage |
$36.00
|
| Rate for Payer: The Alliance Commercial |
$240.00
|
| Rate for Payer: WEA Trust Commercial |
$33.00
|
| Rate for Payer: WPS Commercial |
$183.51
|
|
|
Fluzone High Dose (0.7ml) - Flu Virus, Inactivated Charge
|
Professional
|
Both
|
$60.00
|
|
|
Service Code
|
CPT 90662
|
| Hospital Charge Code |
5609706
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$26.40 |
| Max. Negotiated Rate |
$183.51 |
| Rate for Payer: Aetna Commercial |
$57.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$51.60
|
| Rate for Payer: Cash Price |
$18.00
|
| Rate for Payer: Cash Price |
$18.00
|
| Rate for Payer: Cigna Commercial |
$57.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$88.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$73.40
|
| Rate for Payer: Health EOS Commercial |
$54.60
|
| Rate for Payer: HFN Commercial |
$57.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$89.03
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$89.03
|
| Rate for Payer: Multiplan Commercial |
$48.00
|
| Rate for Payer: Preferred Network Access Commercial |
$57.00
|
| Rate for Payer: Quartz Beloit One Network |
$26.40
|
| Rate for Payer: Quartz Commercial |
$34.20
|
| Rate for Payer: The Alliance Commercial |
$30.00
|
| Rate for Payer: United Healthcare Medicaid |
$88.40
|
| Rate for Payer: WEA Trust Commercial |
$33.00
|
| Rate for Payer: WPS Commercial |
$183.51
|
|
|
Fluzone High Dose (0.7ml) (Peritoneal) 90662
|
Facility
|
OP
|
$60.00
|
|
|
Service Code
|
CPT 90662
|
| Hospital Charge Code |
6219917
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$16.80 |
| Max. Negotiated Rate |
$240.00 |
| Rate for Payer: Aetna Commercial |
$54.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$51.60
|
| Rate for Payer: Aetna Managed Medicare |
$16.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$39.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$30.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$28.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$31.80
|
| Rate for Payer: Cash Price |
$18.00
|
| Rate for Payer: Cash Price |
$18.00
|
| Rate for Payer: Cigna Commercial |
$55.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$97.11
|
| Rate for Payer: Health EOS Commercial |
$53.40
|
| Rate for Payer: HFN Commercial |
$55.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$45.00
|
| Rate for Payer: Multiplan Commercial |
$48.00
|
| Rate for Payer: NAPHCARE Commercial |
$36.00
|
| Rate for Payer: Preferred Network Access Commercial |
$55.20
|
| Rate for Payer: Quartz Beloit One Network |
$29.40
|
| Rate for Payer: Quartz Commercial |
$39.00
|
| Rate for Payer: Quartz Medicare Advantage |
$36.00
|
| Rate for Payer: The Alliance Commercial |
$240.00
|
| Rate for Payer: WEA Trust Commercial |
$33.00
|
| Rate for Payer: WPS Commercial |
$183.51
|
|
|
Fluzone High Dose (0.7ml) (Peritoneal) 90662
|
Facility
|
IP
|
$60.00
|
|
|
Service Code
|
CPT 90662
|
| Hospital Charge Code |
6219917
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$29.40 |
| Max. Negotiated Rate |
$55.20 |
| Rate for Payer: Aetna Commercial |
$54.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$51.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$31.80
|
| Rate for Payer: Cash Price |
$18.00
|
| Rate for Payer: Cigna Commercial |
$55.20
|
| Rate for Payer: Health EOS Commercial |
$53.40
|
| Rate for Payer: HFN Commercial |
$55.20
|
| Rate for Payer: Multiplan Commercial |
$48.00
|
| Rate for Payer: NAPHCARE Commercial |
$36.00
|
| Rate for Payer: Preferred Network Access Commercial |
$55.20
|
| Rate for Payer: Quartz Beloit One Network |
$29.40
|
| Rate for Payer: Quartz Commercial |
$36.00
|
| Rate for Payer: WEA Trust Commercial |
$33.00
|
| Rate for Payer: WPS Commercial |
$44.44
|
|
|
Fluzone high Dose 90662
|
Facility
|
OP
|
$66.00
|
|
|
Service Code
|
CPT 90662
|
| Hospital Charge Code |
3811014
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$18.48 |
| Max. Negotiated Rate |
$264.00 |
| Rate for Payer: Aetna Commercial |
$59.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$56.76
|
| Rate for Payer: Aetna Managed Medicare |
$18.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$42.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$33.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$31.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$34.98
|
| Rate for Payer: Cash Price |
$19.80
|
| Rate for Payer: Cash Price |
$19.80
|
| Rate for Payer: Cigna Commercial |
$60.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$97.11
|
| Rate for Payer: Health EOS Commercial |
$58.74
|
| Rate for Payer: HFN Commercial |
$60.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$49.50
|
| Rate for Payer: Multiplan Commercial |
$52.80
|
| Rate for Payer: NAPHCARE Commercial |
$39.60
|
| Rate for Payer: Preferred Network Access Commercial |
$60.72
|
| Rate for Payer: Quartz Beloit One Network |
$32.34
|
| Rate for Payer: Quartz Commercial |
$42.90
|
| Rate for Payer: Quartz Medicare Advantage |
$39.60
|
| Rate for Payer: The Alliance Commercial |
$264.00
|
| Rate for Payer: WEA Trust Commercial |
$36.30
|
| Rate for Payer: WPS Commercial |
$183.51
|
|
|
Fluzone high Dose 90662
|
Facility
|
IP
|
$66.00
|
|
|
Service Code
|
CPT 90662
|
| Hospital Charge Code |
3811014
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$32.34 |
| Max. Negotiated Rate |
$60.72 |
| Rate for Payer: Aetna Commercial |
$59.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$56.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$34.98
|
| Rate for Payer: Cash Price |
$19.80
|
| Rate for Payer: Cigna Commercial |
$60.72
|
| Rate for Payer: Health EOS Commercial |
$58.74
|
| Rate for Payer: HFN Commercial |
$60.72
|
| Rate for Payer: Multiplan Commercial |
$52.80
|
| Rate for Payer: NAPHCARE Commercial |
$39.60
|
| Rate for Payer: Preferred Network Access Commercial |
$60.72
|
| Rate for Payer: Quartz Beloit One Network |
$32.34
|
| Rate for Payer: Quartz Commercial |
$39.60
|
| Rate for Payer: WEA Trust Commercial |
$36.30
|
| Rate for Payer: WPS Commercial |
$48.89
|
|
|
Fluzone high Dose 90662
|
Professional
|
Both
|
$66.00
|
|
|
Service Code
|
CPT 90662
|
| Hospital Charge Code |
3811014
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$29.04 |
| Max. Negotiated Rate |
$183.51 |
| Rate for Payer: Aetna Commercial |
$62.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$56.76
|
| Rate for Payer: Cash Price |
$19.80
|
| Rate for Payer: Cash Price |
$19.80
|
| Rate for Payer: Cigna Commercial |
$62.70
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$88.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$73.40
|
| Rate for Payer: Health EOS Commercial |
$60.06
|
| Rate for Payer: HFN Commercial |
$62.70
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$89.03
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$89.03
|
| Rate for Payer: Multiplan Commercial |
$52.80
|
| Rate for Payer: Preferred Network Access Commercial |
$62.70
|
| Rate for Payer: Quartz Beloit One Network |
$29.04
|
| Rate for Payer: Quartz Commercial |
$37.62
|
| Rate for Payer: The Alliance Commercial |
$33.00
|
| Rate for Payer: United Healthcare Medicaid |
$88.40
|
| Rate for Payer: WEA Trust Commercial |
$36.30
|
| Rate for Payer: WPS Commercial |
$183.51
|
|
|
Fluzone High Dose 90662 Medicare
|
Facility
|
IP
|
$51.00
|
|
|
Service Code
|
CPT 90662
|
| Hospital Charge Code |
3811015
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$24.99 |
| Max. Negotiated Rate |
$46.92 |
| Rate for Payer: Aetna Commercial |
$45.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$43.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$27.03
|
| Rate for Payer: Cash Price |
$15.30
|
| Rate for Payer: Cigna Commercial |
$46.92
|
| Rate for Payer: Health EOS Commercial |
$45.39
|
| Rate for Payer: HFN Commercial |
$46.92
|
| Rate for Payer: Multiplan Commercial |
$40.80
|
| Rate for Payer: NAPHCARE Commercial |
$30.60
|
| Rate for Payer: Preferred Network Access Commercial |
$46.92
|
| Rate for Payer: Quartz Beloit One Network |
$24.99
|
| Rate for Payer: Quartz Commercial |
$30.60
|
| Rate for Payer: WEA Trust Commercial |
$28.05
|
| Rate for Payer: WPS Commercial |
$37.78
|
|
|
Fluzone High Dose 90662 Medicare
|
Facility
|
OP
|
$51.00
|
|
|
Service Code
|
CPT 90662
|
| Hospital Charge Code |
3811015
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$14.28 |
| Max. Negotiated Rate |
$204.00 |
| Rate for Payer: Aetna Commercial |
$45.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$43.86
|
| Rate for Payer: Aetna Managed Medicare |
$14.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$33.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$25.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$24.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$27.03
|
| Rate for Payer: Cash Price |
$15.30
|
| Rate for Payer: Cash Price |
$15.30
|
| Rate for Payer: Cigna Commercial |
$46.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$97.11
|
| Rate for Payer: Health EOS Commercial |
$45.39
|
| Rate for Payer: HFN Commercial |
$46.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$38.25
|
| Rate for Payer: Multiplan Commercial |
$40.80
|
| Rate for Payer: NAPHCARE Commercial |
$30.60
|
| Rate for Payer: Preferred Network Access Commercial |
$46.92
|
| Rate for Payer: Quartz Beloit One Network |
$24.99
|
| Rate for Payer: Quartz Commercial |
$33.15
|
| Rate for Payer: Quartz Medicare Advantage |
$30.60
|
| Rate for Payer: The Alliance Commercial |
$204.00
|
| Rate for Payer: WEA Trust Commercial |
$28.05
|
| Rate for Payer: WPS Commercial |
$183.51
|
|
|
Fluzone High Dose 90662 Medicare
|
Professional
|
Both
|
$51.00
|
|
|
Service Code
|
CPT 90662
|
| Hospital Charge Code |
3811015
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$22.44 |
| Max. Negotiated Rate |
$183.51 |
| Rate for Payer: Aetna Commercial |
$48.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$43.86
|
| Rate for Payer: Cash Price |
$15.30
|
| Rate for Payer: Cash Price |
$15.30
|
| Rate for Payer: Cigna Commercial |
$48.45
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$88.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$73.40
|
| Rate for Payer: Health EOS Commercial |
$46.41
|
| Rate for Payer: HFN Commercial |
$48.45
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$89.03
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$89.03
|
| Rate for Payer: Multiplan Commercial |
$40.80
|
| Rate for Payer: Preferred Network Access Commercial |
$48.45
|
| Rate for Payer: Quartz Beloit One Network |
$22.44
|
| Rate for Payer: Quartz Commercial |
$29.07
|
| Rate for Payer: The Alliance Commercial |
$25.50
|
| Rate for Payer: United Healthcare Medicaid |
$88.40
|
| Rate for Payer: WEA Trust Commercial |
$28.05
|
| Rate for Payer: WPS Commercial |
$183.51
|
|
|
Fluzone High Dose 90672
|
Facility
|
IP
|
$67.00
|
|
|
Service Code
|
CPT 90672
|
| Hospital Charge Code |
3795877
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$32.83 |
| Max. Negotiated Rate |
$61.64 |
| Rate for Payer: Aetna Commercial |
$60.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$57.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$35.51
|
| Rate for Payer: Cash Price |
$20.10
|
| Rate for Payer: Cigna Commercial |
$61.64
|
| Rate for Payer: Health EOS Commercial |
$59.63
|
| Rate for Payer: HFN Commercial |
$61.64
|
| Rate for Payer: Multiplan Commercial |
$53.60
|
| Rate for Payer: NAPHCARE Commercial |
$40.20
|
| Rate for Payer: Preferred Network Access Commercial |
$61.64
|
| Rate for Payer: Quartz Beloit One Network |
$32.83
|
| Rate for Payer: Quartz Commercial |
$40.20
|
| Rate for Payer: WEA Trust Commercial |
$36.85
|
| Rate for Payer: WPS Commercial |
$49.63
|
|
|
Fluzone High Dose 90672
|
Professional
|
Both
|
$67.00
|
|
|
Service Code
|
CPT 90672
|
| Hospital Charge Code |
3795877
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$27.79 |
| Max. Negotiated Rate |
$69.47 |
| Rate for Payer: Aetna Commercial |
$63.65
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$57.62
|
| Rate for Payer: Cash Price |
$20.10
|
| Rate for Payer: Cash Price |
$20.10
|
| Rate for Payer: Cigna Commercial |
$63.65
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$37.79
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$27.79
|
| Rate for Payer: Health EOS Commercial |
$60.97
|
| Rate for Payer: HFN Commercial |
$63.65
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$39.24
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$39.24
|
| Rate for Payer: Multiplan Commercial |
$53.60
|
| Rate for Payer: Preferred Network Access Commercial |
$63.65
|
| Rate for Payer: Quartz Beloit One Network |
$29.48
|
| Rate for Payer: Quartz Commercial |
$38.19
|
| Rate for Payer: The Alliance Commercial |
$33.50
|
| Rate for Payer: United Healthcare Medicaid |
$37.79
|
| Rate for Payer: WEA Trust Commercial |
$36.85
|
| Rate for Payer: WPS Commercial |
$69.47
|
|
|
Fluzone High Dose 90672
|
Facility
|
OP
|
$67.00
|
|
|
Service Code
|
CPT 90672
|
| Hospital Charge Code |
3795877
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$18.76 |
| Max. Negotiated Rate |
$268.00 |
| Rate for Payer: Aetna Commercial |
$60.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$57.62
|
| Rate for Payer: Aetna Managed Medicare |
$18.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$43.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$33.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$32.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$35.51
|
| Rate for Payer: Cash Price |
$20.10
|
| Rate for Payer: Cash Price |
$20.10
|
| Rate for Payer: Cigna Commercial |
$61.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$36.76
|
| Rate for Payer: Health EOS Commercial |
$59.63
|
| Rate for Payer: HFN Commercial |
$61.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$50.25
|
| Rate for Payer: Multiplan Commercial |
$53.60
|
| Rate for Payer: NAPHCARE Commercial |
$40.20
|
| Rate for Payer: Preferred Network Access Commercial |
$61.64
|
| Rate for Payer: Quartz Beloit One Network |
$32.83
|
| Rate for Payer: Quartz Commercial |
$43.55
|
| Rate for Payer: Quartz Medicare Advantage |
$40.20
|
| Rate for Payer: The Alliance Commercial |
$268.00
|
| Rate for Payer: WEA Trust Commercial |
$36.85
|
| Rate for Payer: WPS Commercial |
$69.47
|
|
|
Fluzone High Dose 90672 Medicare
|
Professional
|
Both
|
$51.00
|
|
|
Service Code
|
CPT 90672
|
| Hospital Charge Code |
3795878
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$22.44 |
| Max. Negotiated Rate |
$69.47 |
| Rate for Payer: Aetna Commercial |
$48.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$43.86
|
| Rate for Payer: Cash Price |
$15.30
|
| Rate for Payer: Cash Price |
$15.30
|
| Rate for Payer: Cigna Commercial |
$48.45
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$37.79
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$27.79
|
| Rate for Payer: Health EOS Commercial |
$46.41
|
| Rate for Payer: HFN Commercial |
$48.45
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$39.24
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$39.24
|
| Rate for Payer: Multiplan Commercial |
$40.80
|
| Rate for Payer: Preferred Network Access Commercial |
$48.45
|
| Rate for Payer: Quartz Beloit One Network |
$22.44
|
| Rate for Payer: Quartz Commercial |
$29.07
|
| Rate for Payer: The Alliance Commercial |
$25.50
|
| Rate for Payer: United Healthcare Medicaid |
$37.79
|
| Rate for Payer: WEA Trust Commercial |
$28.05
|
| Rate for Payer: WPS Commercial |
$69.47
|
|
|
Fluzone High Dose 90672 Medicare
|
Facility
|
IP
|
$51.00
|
|
|
Service Code
|
CPT 90672
|
| Hospital Charge Code |
3795878
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$24.99 |
| Max. Negotiated Rate |
$46.92 |
| Rate for Payer: Aetna Commercial |
$45.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$43.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$27.03
|
| Rate for Payer: Cash Price |
$15.30
|
| Rate for Payer: Cigna Commercial |
$46.92
|
| Rate for Payer: Health EOS Commercial |
$45.39
|
| Rate for Payer: HFN Commercial |
$46.92
|
| Rate for Payer: Multiplan Commercial |
$40.80
|
| Rate for Payer: NAPHCARE Commercial |
$30.60
|
| Rate for Payer: Preferred Network Access Commercial |
$46.92
|
| Rate for Payer: Quartz Beloit One Network |
$24.99
|
| Rate for Payer: Quartz Commercial |
$30.60
|
| Rate for Payer: WEA Trust Commercial |
$28.05
|
| Rate for Payer: WPS Commercial |
$37.78
|
|
|
Fluzone High Dose 90672 Medicare
|
Facility
|
OP
|
$51.00
|
|
|
Service Code
|
CPT 90672
|
| Hospital Charge Code |
3795878
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$14.28 |
| Max. Negotiated Rate |
$204.00 |
| Rate for Payer: Aetna Commercial |
$45.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$43.86
|
| Rate for Payer: Aetna Managed Medicare |
$14.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$33.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$25.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$24.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$27.03
|
| Rate for Payer: Cash Price |
$15.30
|
| Rate for Payer: Cash Price |
$15.30
|
| Rate for Payer: Cigna Commercial |
$46.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$36.76
|
| Rate for Payer: Health EOS Commercial |
$45.39
|
| Rate for Payer: HFN Commercial |
$46.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$38.25
|
| Rate for Payer: Multiplan Commercial |
$40.80
|
| Rate for Payer: NAPHCARE Commercial |
$30.60
|
| Rate for Payer: Preferred Network Access Commercial |
$46.92
|
| Rate for Payer: Quartz Beloit One Network |
$24.99
|
| Rate for Payer: Quartz Commercial |
$33.15
|
| Rate for Payer: Quartz Medicare Advantage |
$30.60
|
| Rate for Payer: The Alliance Commercial |
$204.00
|
| Rate for Payer: WEA Trust Commercial |
$28.05
|
| Rate for Payer: WPS Commercial |
$69.47
|
|
