|
INFLATION DEVICE SE ACCLARENT SEID
|
Facility
|
IP
|
$1,314.00
|
|
| Hospital Charge Code |
5178631
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$669.61 |
| Max. Negotiated Rate |
$1,257.24 |
| Rate for Payer: Aetna Commercial |
$1,229.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,175.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$724.28
|
| Rate for Payer: Cash Price |
$394.20
|
| Rate for Payer: Cigna Commercial |
$1,257.24
|
| Rate for Payer: Health EOS Commercial |
$1,216.24
|
| Rate for Payer: HFN Commercial |
$1,257.24
|
| Rate for Payer: Multiplan Commercial |
$1,093.25
|
| Rate for Payer: Preferred Network Access Commercial |
$1,257.24
|
| Rate for Payer: Quartz Beloit One Network |
$669.61
|
| Rate for Payer: Quartz Commercial |
$819.94
|
| Rate for Payer: WEA Trust Commercial |
$751.61
|
| Rate for Payer: WPS Commercial |
$1,012.17
|
|
|
INFLATION SYSTEM TTS BALLOON M00550601
|
Facility
|
IP
|
$667.00
|
|
| Hospital Charge Code |
2972923
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$339.90 |
| Max. Negotiated Rate |
$638.19 |
| Rate for Payer: Aetna Commercial |
$624.31
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$596.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$367.65
|
| Rate for Payer: Cash Price |
$200.10
|
| Rate for Payer: Cigna Commercial |
$638.19
|
| Rate for Payer: Health EOS Commercial |
$617.38
|
| Rate for Payer: HFN Commercial |
$638.19
|
| Rate for Payer: Multiplan Commercial |
$554.94
|
| Rate for Payer: Preferred Network Access Commercial |
$638.19
|
| Rate for Payer: Quartz Beloit One Network |
$339.90
|
| Rate for Payer: Quartz Commercial |
$416.21
|
| Rate for Payer: WEA Trust Commercial |
$381.52
|
| Rate for Payer: WPS Commercial |
$513.79
|
|
|
INFLATION SYSTEM TTS BALLOON M00550601
|
Facility
|
OP
|
$667.00
|
|
| Hospital Charge Code |
2972923
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$194.23 |
| Max. Negotiated Rate |
$638.19 |
| Rate for Payer: Aetna Commercial |
$624.31
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$596.56
|
| Rate for Payer: Aetna Managed Medicare |
$194.23
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$450.89
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$346.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$332.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$367.65
|
| Rate for Payer: Cash Price |
$200.10
|
| Rate for Payer: Cigna Commercial |
$638.19
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$388.19
|
| Rate for Payer: Health EOS Commercial |
$617.38
|
| Rate for Payer: HFN Commercial |
$638.19
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$520.26
|
| Rate for Payer: Multiplan Commercial |
$554.94
|
| Rate for Payer: NAPHCARE Commercial |
$416.21
|
| Rate for Payer: Preferred Network Access Commercial |
$638.19
|
| Rate for Payer: Quartz Beloit One Network |
$339.90
|
| Rate for Payer: Quartz Commercial |
$450.89
|
| Rate for Payer: Quartz Medicare Advantage |
$416.21
|
| Rate for Payer: The Alliance Commercial |
$346.84
|
| Rate for Payer: WEA Trust Commercial |
$381.52
|
| Rate for Payer: WPS Commercial |
$513.79
|
|
|
Infliximab Activity
|
Facility
|
OP
|
$556.00
|
|
|
Service Code
|
CPT 86352
|
| Hospital Charge Code |
3609523
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$141.29 |
| Max. Negotiated Rate |
$565.18 |
| Rate for Payer: Aetna Commercial |
$520.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$497.29
|
| Rate for Payer: Aetna Managed Medicare |
$141.29
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$529.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$247.27
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$234.55
|
| Rate for Payer: Anthem Medicare Advantage |
$141.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$306.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$141.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$141.29
|
| Rate for Payer: Cash Price |
$166.80
|
| Rate for Payer: Cash Price |
$166.80
|
| Rate for Payer: Cigna Commercial |
$531.98
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$141.29
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$323.59
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$141.29
|
| Rate for Payer: Health EOS Commercial |
$514.63
|
| Rate for Payer: HFN Commercial |
$531.98
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$525.62
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$141.29
|
| Rate for Payer: Independent Care Health Plan Medicare |
$141.29
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$141.29
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$141.29
|
| Rate for Payer: Multiplan Commercial |
$462.59
|
| Rate for Payer: NAPHCARE Commercial |
$211.94
|
| Rate for Payer: Preferred Network Access Commercial |
$531.98
|
| Rate for Payer: Quartz Beloit One Network |
$283.34
|
| Rate for Payer: Quartz Commercial |
$375.86
|
| Rate for Payer: Quartz Medicare Advantage |
$141.29
|
| Rate for Payer: The Alliance Commercial |
$565.18
|
| Rate for Payer: United Healthcare Medicare Advantage |
$141.29
|
| Rate for Payer: United Healthcare PPO |
$433.68
|
| Rate for Payer: WEA Trust Commercial |
$318.03
|
| Rate for Payer: Wellcare Medicare |
$141.29
|
| Rate for Payer: WPS Commercial |
$428.29
|
|
|
Infliximab Activity
|
Professional
|
Both
|
$556.00
|
|
|
Service Code
|
CPT 86352
|
| Hospital Charge Code |
3609523
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$141.29 |
| Max. Negotiated Rate |
$621.70 |
| Rate for Payer: Aetna Commercial |
$549.33
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$497.29
|
| Rate for Payer: Aetna Managed Medicare |
$141.29
|
| Rate for Payer: Anthem Medicare Advantage |
$141.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$141.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$141.29
|
| Rate for Payer: Cash Price |
$166.80
|
| Rate for Payer: Cash Price |
$166.80
|
| Rate for Payer: Cigna Commercial |
$549.33
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$289.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$141.29
|
| Rate for Payer: Health EOS Commercial |
$526.20
|
| Rate for Payer: HFN Commercial |
$549.33
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$498.77
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$498.77
|
| Rate for Payer: Independent Care Health Plan Medicare |
$141.29
|
| Rate for Payer: Multiplan Commercial |
$462.59
|
| Rate for Payer: NAPHCARE Commercial |
$211.94
|
| Rate for Payer: Preferred Network Access Commercial |
$549.33
|
| Rate for Payer: Quartz Beloit One Network |
$254.43
|
| Rate for Payer: Quartz Commercial |
$329.60
|
| Rate for Payer: Quartz Medicare Advantage |
$141.29
|
| Rate for Payer: The Alliance Commercial |
$558.11
|
| Rate for Payer: United Healthcare Medicare Advantage |
$141.29
|
| Rate for Payer: WEA Trust Commercial |
$318.03
|
| Rate for Payer: WPS Commercial |
$621.70
|
|
|
Infliximab Activity
|
Facility
|
IP
|
$556.00
|
|
|
Service Code
|
CPT 86352
|
| Hospital Charge Code |
3609523
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$283.34 |
| Max. Negotiated Rate |
$531.98 |
| Rate for Payer: Aetna Commercial |
$520.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$497.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$306.47
|
| Rate for Payer: Cash Price |
$166.80
|
| Rate for Payer: Cigna Commercial |
$531.98
|
| Rate for Payer: Health EOS Commercial |
$514.63
|
| Rate for Payer: HFN Commercial |
$531.98
|
| Rate for Payer: Multiplan Commercial |
$462.59
|
| Rate for Payer: Preferred Network Access Commercial |
$531.98
|
| Rate for Payer: Quartz Beloit One Network |
$283.34
|
| Rate for Payer: Quartz Commercial |
$346.94
|
| Rate for Payer: WEA Trust Commercial |
$318.03
|
| Rate for Payer: WPS Commercial |
$428.29
|
|
|
Infliximab ADA
|
Facility
|
OP
|
$301.00
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
5438972
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$19.39 |
| Max. Negotiated Rate |
$288.00 |
| Rate for Payer: Aetna Commercial |
$281.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$269.21
|
| Rate for Payer: Aetna Managed Medicare |
$19.39
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$72.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$33.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$32.18
|
| Rate for Payer: Anthem Medicare Advantage |
$19.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$165.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$19.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$19.39
|
| Rate for Payer: Cash Price |
$90.30
|
| Rate for Payer: Cash Price |
$90.30
|
| Rate for Payer: Cigna Commercial |
$288.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$19.39
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$175.18
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$19.39
|
| Rate for Payer: Health EOS Commercial |
$278.61
|
| Rate for Payer: HFN Commercial |
$288.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$72.11
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$19.39
|
| Rate for Payer: Independent Care Health Plan Medicare |
$19.39
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$19.39
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$19.39
|
| Rate for Payer: Multiplan Commercial |
$250.43
|
| Rate for Payer: NAPHCARE Commercial |
$29.08
|
| Rate for Payer: Preferred Network Access Commercial |
$288.00
|
| Rate for Payer: Quartz Beloit One Network |
$153.39
|
| Rate for Payer: Quartz Commercial |
$203.48
|
| Rate for Payer: Quartz Medicare Advantage |
$19.39
|
| Rate for Payer: The Alliance Commercial |
$77.54
|
| Rate for Payer: United Healthcare Medicare Advantage |
$19.39
|
| Rate for Payer: United Healthcare PPO |
$234.78
|
| Rate for Payer: WEA Trust Commercial |
$172.17
|
| Rate for Payer: Wellcare Medicare |
$19.39
|
| Rate for Payer: WPS Commercial |
$231.86
|
|
|
Infliximab ADA
|
Facility
|
IP
|
$301.00
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
5438972
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$153.39 |
| Max. Negotiated Rate |
$288.00 |
| Rate for Payer: Aetna Commercial |
$281.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$269.21
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$165.91
|
| Rate for Payer: Cash Price |
$90.30
|
| Rate for Payer: Cigna Commercial |
$288.00
|
| Rate for Payer: Health EOS Commercial |
$278.61
|
| Rate for Payer: HFN Commercial |
$288.00
|
| Rate for Payer: Multiplan Commercial |
$250.43
|
| Rate for Payer: Preferred Network Access Commercial |
$288.00
|
| Rate for Payer: Quartz Beloit One Network |
$153.39
|
| Rate for Payer: Quartz Commercial |
$187.82
|
| Rate for Payer: WEA Trust Commercial |
$172.17
|
| Rate for Payer: WPS Commercial |
$231.86
|
|
|
Infliximab ADA
|
Professional
|
Both
|
$301.00
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
5438972
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$19.39 |
| Max. Negotiated Rate |
$297.39 |
| Rate for Payer: Aetna Commercial |
$297.39
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$269.21
|
| Rate for Payer: Aetna Managed Medicare |
$19.39
|
| Rate for Payer: Anthem Medicare Advantage |
$19.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$19.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$19.39
|
| Rate for Payer: Cash Price |
$90.30
|
| Rate for Payer: Cash Price |
$90.30
|
| Rate for Payer: Cigna Commercial |
$297.39
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$156.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$19.39
|
| Rate for Payer: Health EOS Commercial |
$284.87
|
| Rate for Payer: HFN Commercial |
$297.39
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$68.43
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$68.43
|
| Rate for Payer: Independent Care Health Plan Medicare |
$19.39
|
| Rate for Payer: Multiplan Commercial |
$250.43
|
| Rate for Payer: NAPHCARE Commercial |
$29.08
|
| Rate for Payer: Preferred Network Access Commercial |
$297.39
|
| Rate for Payer: Quartz Beloit One Network |
$137.74
|
| Rate for Payer: Quartz Commercial |
$178.43
|
| Rate for Payer: Quartz Medicare Advantage |
$19.39
|
| Rate for Payer: The Alliance Commercial |
$76.57
|
| Rate for Payer: United Healthcare Medicare Advantage |
$19.39
|
| Rate for Payer: WEA Trust Commercial |
$172.17
|
| Rate for Payer: WPS Commercial |
$85.30
|
|
|
Infliximab inj 10 mg J1745 man
|
Facility
|
OP
|
$359.00
|
|
|
Service Code
|
HCPCS J1745
|
| Hospital Charge Code |
3373593
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$32.94 |
| Max. Negotiated Rate |
$343.49 |
| Rate for Payer: Aetna Commercial |
$336.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$321.09
|
| Rate for Payer: Aetna Managed Medicare |
$33.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$32.94
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$32.94
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$32.94
|
| Rate for Payer: Anthem Medicare Advantage |
$33.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$197.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$33.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$33.72
|
| Rate for Payer: Cash Price |
$107.70
|
| Rate for Payer: Cash Price |
$107.70
|
| Rate for Payer: Cigna Commercial |
$343.49
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$33.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$43.58
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$33.72
|
| Rate for Payer: Health EOS Commercial |
$332.29
|
| Rate for Payer: HFN Commercial |
$343.49
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$125.43
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$33.72
|
| Rate for Payer: Independent Care Health Plan Medicare |
$33.72
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$33.72
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$33.72
|
| Rate for Payer: Multiplan Commercial |
$298.69
|
| Rate for Payer: NAPHCARE Commercial |
$50.58
|
| Rate for Payer: Preferred Network Access Commercial |
$343.49
|
| Rate for Payer: Quartz Beloit One Network |
$182.95
|
| Rate for Payer: Quartz Commercial |
$242.68
|
| Rate for Payer: Quartz Medicare Advantage |
$33.72
|
| Rate for Payer: The Alliance Commercial |
$134.87
|
| Rate for Payer: United Healthcare Medicare Advantage |
$33.72
|
| Rate for Payer: WEA Trust Commercial |
$205.35
|
| Rate for Payer: Wellcare Medicare |
$33.72
|
| Rate for Payer: WPS Commercial |
$82.34
|
|
|
Infliximab inj 10 mg J1745 man
|
Facility
|
IP
|
$359.00
|
|
|
Service Code
|
HCPCS J1745
|
| Hospital Charge Code |
3373593
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$182.95 |
| Max. Negotiated Rate |
$343.49 |
| Rate for Payer: Aetna Commercial |
$336.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$321.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$197.88
|
| Rate for Payer: Cash Price |
$107.70
|
| Rate for Payer: Cigna Commercial |
$343.49
|
| Rate for Payer: Health EOS Commercial |
$332.29
|
| Rate for Payer: HFN Commercial |
$343.49
|
| Rate for Payer: Multiplan Commercial |
$298.69
|
| Rate for Payer: Preferred Network Access Commercial |
$343.49
|
| Rate for Payer: Quartz Beloit One Network |
$182.95
|
| Rate for Payer: Quartz Commercial |
$224.02
|
| Rate for Payer: WEA Trust Commercial |
$205.35
|
| Rate for Payer: WPS Commercial |
$276.54
|
|
|
Infliximab inj 10 mg J1745 man
|
Professional
|
Both
|
$359.00
|
|
|
Service Code
|
HCPCS J1745
|
| Hospital Charge Code |
3373593
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$32.94 |
| Max. Negotiated Rate |
$354.69 |
| Rate for Payer: Aetna Commercial |
$354.69
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$321.09
|
| Rate for Payer: Aetna Managed Medicare |
$33.72
|
| Rate for Payer: Anthem Medicare Advantage |
$33.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$33.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$33.72
|
| Rate for Payer: Cash Price |
$107.70
|
| Rate for Payer: Cash Price |
$107.70
|
| Rate for Payer: Cigna Commercial |
$354.69
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$33.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$32.94
|
| Rate for Payer: Health EOS Commercial |
$339.76
|
| Rate for Payer: HFN Commercial |
$354.69
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$63.70
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$63.70
|
| Rate for Payer: Independent Care Health Plan Medicare |
$33.72
|
| Rate for Payer: Multiplan Commercial |
$298.69
|
| Rate for Payer: NAPHCARE Commercial |
$50.58
|
| Rate for Payer: Preferred Network Access Commercial |
$354.69
|
| Rate for Payer: Quartz Beloit One Network |
$164.28
|
| Rate for Payer: Quartz Commercial |
$212.82
|
| Rate for Payer: Quartz Medicare Advantage |
$33.72
|
| Rate for Payer: The Alliance Commercial |
$92.72
|
| Rate for Payer: United Healthcare Medicaid |
$33.72
|
| Rate for Payer: United Healthcare Medicare Advantage |
$33.72
|
| Rate for Payer: WEA Trust Commercial |
$205.35
|
| Rate for Payer: WPS Commercial |
$82.34
|
|
|
Infliximab Level & Anti-Drug Antibody
|
Professional
|
Both
|
$420.00
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
5438797
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.96 |
| Max. Negotiated Rate |
$414.96 |
| Rate for Payer: Aetna Commercial |
$414.96
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$375.65
|
| Rate for Payer: Aetna Managed Medicare |
$17.96
|
| Rate for Payer: Anthem Medicare Advantage |
$17.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$17.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$17.96
|
| Rate for Payer: Cash Price |
$126.00
|
| Rate for Payer: Cash Price |
$126.00
|
| Rate for Payer: Cigna Commercial |
$414.96
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$218.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$17.96
|
| Rate for Payer: Health EOS Commercial |
$397.49
|
| Rate for Payer: HFN Commercial |
$414.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$63.40
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$63.40
|
| Rate for Payer: Independent Care Health Plan Medicare |
$17.96
|
| Rate for Payer: Multiplan Commercial |
$349.44
|
| Rate for Payer: NAPHCARE Commercial |
$26.94
|
| Rate for Payer: Preferred Network Access Commercial |
$414.96
|
| Rate for Payer: Quartz Beloit One Network |
$192.19
|
| Rate for Payer: Quartz Commercial |
$248.98
|
| Rate for Payer: Quartz Medicare Advantage |
$17.96
|
| Rate for Payer: The Alliance Commercial |
$70.95
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17.96
|
| Rate for Payer: WEA Trust Commercial |
$240.24
|
| Rate for Payer: WPS Commercial |
$79.03
|
|
|
Infliximab Level & Anti-Drug Antibody
|
Facility
|
OP
|
$420.00
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
5438797
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.96 |
| Max. Negotiated Rate |
$401.86 |
| Rate for Payer: Aetna Commercial |
$393.12
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$375.65
|
| Rate for Payer: Aetna Managed Medicare |
$17.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$67.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$31.43
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$29.81
|
| Rate for Payer: Anthem Medicare Advantage |
$17.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$231.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$17.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$17.96
|
| Rate for Payer: Cash Price |
$126.00
|
| Rate for Payer: Cash Price |
$126.00
|
| Rate for Payer: Cigna Commercial |
$401.86
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$17.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$244.44
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$17.96
|
| Rate for Payer: Health EOS Commercial |
$388.75
|
| Rate for Payer: HFN Commercial |
$401.86
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$66.81
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$17.96
|
| Rate for Payer: Independent Care Health Plan Medicare |
$17.96
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$17.96
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$17.96
|
| Rate for Payer: Multiplan Commercial |
$349.44
|
| Rate for Payer: NAPHCARE Commercial |
$26.94
|
| Rate for Payer: Preferred Network Access Commercial |
$401.86
|
| Rate for Payer: Quartz Beloit One Network |
$214.03
|
| Rate for Payer: Quartz Commercial |
$283.92
|
| Rate for Payer: Quartz Medicare Advantage |
$17.96
|
| Rate for Payer: The Alliance Commercial |
$71.84
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17.96
|
| Rate for Payer: United Healthcare PPO |
$327.60
|
| Rate for Payer: WEA Trust Commercial |
$240.24
|
| Rate for Payer: Wellcare Medicare |
$17.96
|
| Rate for Payer: WPS Commercial |
$323.53
|
|
|
Infliximab Level & Anti-Drug Antibody
|
Facility
|
IP
|
$420.00
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
5438797
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$214.03 |
| Max. Negotiated Rate |
$401.86 |
| Rate for Payer: Aetna Commercial |
$393.12
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$375.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$231.50
|
| Rate for Payer: Cash Price |
$126.00
|
| Rate for Payer: Cigna Commercial |
$401.86
|
| Rate for Payer: Health EOS Commercial |
$388.75
|
| Rate for Payer: HFN Commercial |
$401.86
|
| Rate for Payer: Multiplan Commercial |
$349.44
|
| Rate for Payer: Preferred Network Access Commercial |
$401.86
|
| Rate for Payer: Quartz Beloit One Network |
$214.03
|
| Rate for Payer: Quartz Commercial |
$262.08
|
| Rate for Payer: WEA Trust Commercial |
$240.24
|
| Rate for Payer: WPS Commercial |
$323.53
|
|
|
***INFLOW TUBE SET TRUCLEAR LEGACY FLUID MANAGEMENT 7209822*** DISC ***
|
Facility
|
IP
|
$901.00
|
|
| Hospital Charge Code |
5797665
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$459.15 |
| Max. Negotiated Rate |
$862.08 |
| Rate for Payer: Aetna Commercial |
$843.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$805.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$496.63
|
| Rate for Payer: Cash Price |
$270.30
|
| Rate for Payer: Cigna Commercial |
$862.08
|
| Rate for Payer: Health EOS Commercial |
$833.97
|
| Rate for Payer: HFN Commercial |
$862.08
|
| Rate for Payer: Multiplan Commercial |
$749.63
|
| Rate for Payer: Preferred Network Access Commercial |
$862.08
|
| Rate for Payer: Quartz Beloit One Network |
$459.15
|
| Rate for Payer: Quartz Commercial |
$562.22
|
| Rate for Payer: WEA Trust Commercial |
$515.37
|
| Rate for Payer: WPS Commercial |
$694.04
|
|
|
***INFLOW TUBE SET TRUCLEAR LEGACY FLUID MANAGEMENT 7209822*** DISC ***
|
Facility
|
OP
|
$901.00
|
|
| Hospital Charge Code |
5797665
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$262.37 |
| Max. Negotiated Rate |
$862.08 |
| Rate for Payer: Aetna Commercial |
$843.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$805.85
|
| Rate for Payer: Aetna Managed Medicare |
$262.37
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$609.08
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$468.52
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$449.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$496.63
|
| Rate for Payer: Cash Price |
$270.30
|
| Rate for Payer: Cigna Commercial |
$862.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$524.38
|
| Rate for Payer: Health EOS Commercial |
$833.97
|
| Rate for Payer: HFN Commercial |
$862.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$702.78
|
| Rate for Payer: Multiplan Commercial |
$749.63
|
| Rate for Payer: NAPHCARE Commercial |
$562.22
|
| Rate for Payer: Preferred Network Access Commercial |
$862.08
|
| Rate for Payer: Quartz Beloit One Network |
$459.15
|
| Rate for Payer: Quartz Commercial |
$609.08
|
| Rate for Payer: Quartz Medicare Advantage |
$562.22
|
| Rate for Payer: The Alliance Commercial |
$468.52
|
| Rate for Payer: WEA Trust Commercial |
$515.37
|
| Rate for Payer: WPS Commercial |
$694.04
|
|
|
Influenza A and B Antibodies
|
Professional
|
Both
|
$100.00
|
|
|
Service Code
|
CPT 86710
|
| Hospital Charge Code |
977995
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.09 |
| Max. Negotiated Rate |
$98.80 |
| Rate for Payer: Aetna Commercial |
$98.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$89.44
|
| Rate for Payer: Aetna Managed Medicare |
$14.09
|
| Rate for Payer: Anthem Medicare Advantage |
$14.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$14.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$14.09
|
| Rate for Payer: Cash Price |
$30.00
|
| Rate for Payer: Cash Price |
$30.00
|
| Rate for Payer: Cigna Commercial |
$98.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$52.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$14.09
|
| Rate for Payer: Health EOS Commercial |
$94.64
|
| Rate for Payer: HFN Commercial |
$98.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$49.74
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$49.74
|
| Rate for Payer: Independent Care Health Plan Medicare |
$14.09
|
| Rate for Payer: Multiplan Commercial |
$83.20
|
| Rate for Payer: NAPHCARE Commercial |
$21.14
|
| Rate for Payer: Preferred Network Access Commercial |
$98.80
|
| Rate for Payer: Quartz Beloit One Network |
$45.76
|
| Rate for Payer: Quartz Commercial |
$59.28
|
| Rate for Payer: Quartz Medicare Advantage |
$14.09
|
| Rate for Payer: The Alliance Commercial |
$55.66
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14.09
|
| Rate for Payer: WEA Trust Commercial |
$57.20
|
| Rate for Payer: WPS Commercial |
$62.00
|
|
|
Influenza A and B Antibodies
|
Facility
|
OP
|
$100.00
|
|
|
Service Code
|
CPT 86710
|
| Hospital Charge Code |
977995
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.09 |
| Max. Negotiated Rate |
$95.68 |
| Rate for Payer: Aetna Commercial |
$93.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$89.44
|
| Rate for Payer: Aetna Managed Medicare |
$14.09
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$52.84
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$24.66
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$23.39
|
| Rate for Payer: Anthem Medicare Advantage |
$14.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$55.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$14.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$14.09
|
| Rate for Payer: Cash Price |
$30.00
|
| Rate for Payer: Cash Price |
$30.00
|
| Rate for Payer: Cigna Commercial |
$95.68
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$14.09
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$58.20
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$14.09
|
| Rate for Payer: Health EOS Commercial |
$92.56
|
| Rate for Payer: HFN Commercial |
$95.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$52.42
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$14.09
|
| Rate for Payer: Independent Care Health Plan Medicare |
$14.09
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$14.09
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$14.09
|
| Rate for Payer: Multiplan Commercial |
$83.20
|
| Rate for Payer: NAPHCARE Commercial |
$21.14
|
| Rate for Payer: Preferred Network Access Commercial |
$95.68
|
| Rate for Payer: Quartz Beloit One Network |
$50.96
|
| Rate for Payer: Quartz Commercial |
$67.60
|
| Rate for Payer: Quartz Medicare Advantage |
$14.09
|
| Rate for Payer: The Alliance Commercial |
$56.37
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14.09
|
| Rate for Payer: United Healthcare PPO |
$78.00
|
| Rate for Payer: WEA Trust Commercial |
$57.20
|
| Rate for Payer: Wellcare Medicare |
$14.09
|
| Rate for Payer: WPS Commercial |
$77.03
|
|
|
Influenza A and B Antibodies
|
Facility
|
IP
|
$100.00
|
|
|
Service Code
|
CPT 86710
|
| Hospital Charge Code |
977995
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$50.96 |
| Max. Negotiated Rate |
$95.68 |
| Rate for Payer: Aetna Commercial |
$93.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$89.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$55.12
|
| Rate for Payer: Cash Price |
$30.00
|
| Rate for Payer: Cigna Commercial |
$95.68
|
| Rate for Payer: Health EOS Commercial |
$92.56
|
| Rate for Payer: HFN Commercial |
$95.68
|
| Rate for Payer: Multiplan Commercial |
$83.20
|
| Rate for Payer: Preferred Network Access Commercial |
$95.68
|
| Rate for Payer: Quartz Beloit One Network |
$50.96
|
| Rate for Payer: Quartz Commercial |
$62.40
|
| Rate for Payer: WEA Trust Commercial |
$57.20
|
| Rate for Payer: WPS Commercial |
$77.03
|
|
|
Influenza A Antibody
|
Facility
|
IP
|
$285.00
|
|
|
Service Code
|
CPT 87804
|
| Hospital Charge Code |
982497
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$145.24 |
| Max. Negotiated Rate |
$272.69 |
| Rate for Payer: Aetna Commercial |
$266.76
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$254.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$157.09
|
| Rate for Payer: Cash Price |
$85.50
|
| Rate for Payer: Cigna Commercial |
$272.69
|
| Rate for Payer: Health EOS Commercial |
$263.80
|
| Rate for Payer: HFN Commercial |
$272.69
|
| Rate for Payer: Multiplan Commercial |
$237.12
|
| Rate for Payer: Preferred Network Access Commercial |
$272.69
|
| Rate for Payer: Quartz Beloit One Network |
$145.24
|
| Rate for Payer: Quartz Commercial |
$177.84
|
| Rate for Payer: WEA Trust Commercial |
$163.02
|
| Rate for Payer: WPS Commercial |
$219.54
|
|
|
Influenza A Antibody
|
Facility
|
OP
|
$285.00
|
|
|
Service Code
|
CPT 87804
|
| Hospital Charge Code |
982497
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.21 |
| Max. Negotiated Rate |
$272.69 |
| Rate for Payer: Aetna Commercial |
$266.76
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$254.90
|
| Rate for Payer: Aetna Managed Medicare |
$17.21
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$64.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$30.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$28.57
|
| Rate for Payer: Anthem Medicare Advantage |
$17.21
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$157.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$17.21
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$17.21
|
| Rate for Payer: Cash Price |
$85.50
|
| Rate for Payer: Cash Price |
$85.50
|
| Rate for Payer: Cigna Commercial |
$272.69
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$17.21
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$165.87
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$17.21
|
| Rate for Payer: Health EOS Commercial |
$263.80
|
| Rate for Payer: HFN Commercial |
$272.69
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$64.03
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$17.21
|
| Rate for Payer: Independent Care Health Plan Medicare |
$17.21
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$17.21
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$17.21
|
| Rate for Payer: Multiplan Commercial |
$237.12
|
| Rate for Payer: NAPHCARE Commercial |
$25.82
|
| Rate for Payer: Preferred Network Access Commercial |
$272.69
|
| Rate for Payer: Quartz Beloit One Network |
$145.24
|
| Rate for Payer: Quartz Commercial |
$192.66
|
| Rate for Payer: Quartz Medicare Advantage |
$17.21
|
| Rate for Payer: The Alliance Commercial |
$68.85
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17.21
|
| Rate for Payer: United Healthcare PPO |
$222.30
|
| Rate for Payer: WEA Trust Commercial |
$163.02
|
| Rate for Payer: Wellcare Medicare |
$17.21
|
| Rate for Payer: WPS Commercial |
$219.54
|
|
|
Influenza A Antibody
|
Professional
|
Both
|
$285.00
|
|
|
Service Code
|
CPT 87804
|
| Hospital Charge Code |
982497
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.21 |
| Max. Negotiated Rate |
$281.58 |
| Rate for Payer: Aetna Commercial |
$281.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$254.90
|
| Rate for Payer: Aetna Managed Medicare |
$17.21
|
| Rate for Payer: Anthem Medicare Advantage |
$17.21
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$17.21
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$17.21
|
| Rate for Payer: Cash Price |
$85.50
|
| Rate for Payer: Cash Price |
$85.50
|
| Rate for Payer: Cigna Commercial |
$281.58
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$148.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$17.21
|
| Rate for Payer: Health EOS Commercial |
$269.72
|
| Rate for Payer: HFN Commercial |
$281.58
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$60.76
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$60.76
|
| Rate for Payer: Independent Care Health Plan Medicare |
$17.21
|
| Rate for Payer: Multiplan Commercial |
$237.12
|
| Rate for Payer: NAPHCARE Commercial |
$25.82
|
| Rate for Payer: Preferred Network Access Commercial |
$281.58
|
| Rate for Payer: Quartz Beloit One Network |
$130.42
|
| Rate for Payer: Quartz Commercial |
$168.95
|
| Rate for Payer: Quartz Medicare Advantage |
$17.21
|
| Rate for Payer: The Alliance Commercial |
$67.99
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17.21
|
| Rate for Payer: WEA Trust Commercial |
$163.02
|
| Rate for Payer: WPS Commercial |
$75.73
|
|
|
Influenza A RNA
|
Professional
|
Both
|
$241.00
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
3881390
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$36.49 |
| Max. Negotiated Rate |
$238.11 |
| Rate for Payer: Aetna Commercial |
$238.11
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$215.55
|
| Rate for Payer: Aetna Managed Medicare |
$36.49
|
| Rate for Payer: Anthem Medicare Advantage |
$36.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$36.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$36.49
|
| Rate for Payer: Cash Price |
$72.30
|
| Rate for Payer: Cash Price |
$72.30
|
| Rate for Payer: Cigna Commercial |
$238.11
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$125.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$36.49
|
| Rate for Payer: Health EOS Commercial |
$228.08
|
| Rate for Payer: HFN Commercial |
$238.11
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$128.82
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$128.82
|
| Rate for Payer: Independent Care Health Plan Medicare |
$36.49
|
| Rate for Payer: Multiplan Commercial |
$200.51
|
| Rate for Payer: NAPHCARE Commercial |
$54.74
|
| Rate for Payer: Preferred Network Access Commercial |
$238.11
|
| Rate for Payer: Quartz Beloit One Network |
$110.28
|
| Rate for Payer: Quartz Commercial |
$142.86
|
| Rate for Payer: Quartz Medicare Advantage |
$36.49
|
| Rate for Payer: The Alliance Commercial |
$144.15
|
| Rate for Payer: United Healthcare Medicare Advantage |
$36.49
|
| Rate for Payer: WEA Trust Commercial |
$137.85
|
| Rate for Payer: WPS Commercial |
$160.57
|
|
|
Influenza A RNA
|
Facility
|
OP
|
$241.00
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
3881390
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$36.49 |
| Max. Negotiated Rate |
$230.59 |
| Rate for Payer: Aetna Commercial |
$225.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$215.55
|
| Rate for Payer: Aetna Managed Medicare |
$36.49
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$136.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$63.86
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$60.58
|
| Rate for Payer: Anthem Medicare Advantage |
$36.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$132.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$36.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$36.49
|
| Rate for Payer: Cash Price |
$72.30
|
| Rate for Payer: Cash Price |
$72.30
|
| Rate for Payer: Cigna Commercial |
$230.59
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$36.49
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$140.26
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$36.49
|
| Rate for Payer: Health EOS Commercial |
$223.07
|
| Rate for Payer: HFN Commercial |
$230.59
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$135.76
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$36.49
|
| Rate for Payer: Independent Care Health Plan Medicare |
$36.49
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$36.49
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$36.49
|
| Rate for Payer: Multiplan Commercial |
$200.51
|
| Rate for Payer: NAPHCARE Commercial |
$54.74
|
| Rate for Payer: Preferred Network Access Commercial |
$230.59
|
| Rate for Payer: Quartz Beloit One Network |
$122.81
|
| Rate for Payer: Quartz Commercial |
$162.92
|
| Rate for Payer: Quartz Medicare Advantage |
$36.49
|
| Rate for Payer: The Alliance Commercial |
$145.97
|
| Rate for Payer: United Healthcare Medicare Advantage |
$36.49
|
| Rate for Payer: United Healthcare PPO |
$187.98
|
| Rate for Payer: WEA Trust Commercial |
$137.85
|
| Rate for Payer: Wellcare Medicare |
$36.49
|
| Rate for Payer: WPS Commercial |
$185.64
|
|
