|
Infliximab Activity
|
Facility
|
OP
|
$556.00
|
|
|
Service Code
|
CPT 86352
|
| Hospital Charge Code |
3609523
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$100.54 |
| Max. Negotiated Rate |
$543.44 |
| Rate for Payer: Aetna Commercial |
$500.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$478.16
|
| Rate for Payer: Aetna Managed Medicare |
$135.86
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$509.48
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$237.76
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$225.53
|
| Rate for Payer: Anthem Medicaid |
$100.54
|
| Rate for Payer: Anthem Medicare Advantage |
$135.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$294.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$135.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$135.86
|
| Rate for Payer: Cash Price |
$166.80
|
| Rate for Payer: Cash Price |
$166.80
|
| Rate for Payer: Cigna Commercial |
$511.52
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$135.86
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$100.54
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$311.14
|
| Rate for Payer: Dean Health Medicaid |
$100.54
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$135.86
|
| Rate for Payer: Health EOS Commercial |
$494.84
|
| Rate for Payer: HFN Commercial |
$511.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$505.40
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$135.86
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$100.54
|
| Rate for Payer: Independent Care Health Plan Medicare |
$135.86
|
| Rate for Payer: Managed Health Services Medicaid |
$104.56
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$135.86
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$135.86
|
| Rate for Payer: Multiplan Commercial |
$444.80
|
| Rate for Payer: NAPHCARE Commercial |
$203.79
|
| Rate for Payer: Preferred Network Access Commercial |
$511.52
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$100.54
|
| Rate for Payer: Quartz Beloit One Network |
$272.44
|
| Rate for Payer: Quartz Commercial |
$361.40
|
| Rate for Payer: Quartz Medicare Advantage |
$135.86
|
| Rate for Payer: The Alliance Commercial |
$543.44
|
| Rate for Payer: United Healthcare Medicaid |
$100.54
|
| Rate for Payer: United Healthcare Medicare Advantage |
$135.86
|
| Rate for Payer: United Healthcare PPO |
$417.00
|
| Rate for Payer: WEA Trust Commercial |
$305.80
|
| Rate for Payer: Wellcare Medicare |
$135.86
|
| Rate for Payer: WMAP Medicaid |
$100.54
|
| Rate for Payer: WPS Commercial |
$411.83
|
|
|
Infliximab ADA
|
Facility
|
OP
|
$301.00
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
5438972
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.64 |
| Max. Negotiated Rate |
$276.92 |
| Rate for Payer: Aetna Commercial |
$270.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$258.86
|
| Rate for Payer: Aetna Managed Medicare |
$18.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$69.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$32.62
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$30.94
|
| Rate for Payer: Anthem Medicaid |
$19.26
|
| Rate for Payer: Anthem Medicare Advantage |
$18.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$159.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$18.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$18.64
|
| Rate for Payer: Cash Price |
$90.30
|
| Rate for Payer: Cash Price |
$90.30
|
| Rate for Payer: Cigna Commercial |
$276.92
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$18.64
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$19.26
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$168.44
|
| Rate for Payer: Dean Health Medicaid |
$19.26
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$18.64
|
| Rate for Payer: Health EOS Commercial |
$267.89
|
| Rate for Payer: HFN Commercial |
$276.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$69.34
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$18.64
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$19.26
|
| Rate for Payer: Independent Care Health Plan Medicare |
$18.64
|
| Rate for Payer: Managed Health Services Medicaid |
$20.03
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$18.64
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$18.64
|
| Rate for Payer: Multiplan Commercial |
$240.80
|
| Rate for Payer: NAPHCARE Commercial |
$27.96
|
| Rate for Payer: Preferred Network Access Commercial |
$276.92
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$19.26
|
| Rate for Payer: Quartz Beloit One Network |
$147.49
|
| Rate for Payer: Quartz Commercial |
$195.65
|
| Rate for Payer: Quartz Medicare Advantage |
$18.64
|
| Rate for Payer: The Alliance Commercial |
$74.56
|
| Rate for Payer: United Healthcare Medicaid |
$19.26
|
| Rate for Payer: United Healthcare Medicare Advantage |
$18.64
|
| Rate for Payer: United Healthcare PPO |
$225.75
|
| Rate for Payer: WEA Trust Commercial |
$165.55
|
| Rate for Payer: Wellcare Medicare |
$18.64
|
| Rate for Payer: WMAP Medicaid |
$19.26
|
| Rate for Payer: WPS Commercial |
$222.95
|
|
|
Infliximab ADA
|
Professional
|
Both
|
$301.00
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
5438972
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$65.80 |
| Max. Negotiated Rate |
$285.95 |
| Rate for Payer: Aetna Commercial |
$285.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$258.86
|
| Rate for Payer: Cash Price |
$90.30
|
| Rate for Payer: Cash Price |
$90.30
|
| Rate for Payer: Cigna Commercial |
$285.95
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$150.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$180.60
|
| Rate for Payer: Health EOS Commercial |
$273.91
|
| Rate for Payer: HFN Commercial |
$285.95
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$65.80
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$65.80
|
| Rate for Payer: Multiplan Commercial |
$240.80
|
| Rate for Payer: Preferred Network Access Commercial |
$285.95
|
| Rate for Payer: Quartz Beloit One Network |
$132.44
|
| Rate for Payer: Quartz Commercial |
$171.57
|
| Rate for Payer: The Alliance Commercial |
$150.50
|
| Rate for Payer: WEA Trust Commercial |
$165.55
|
| Rate for Payer: WPS Commercial |
$222.95
|
|
|
Infliximab ADA
|
Facility
|
IP
|
$301.00
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
5438972
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$147.49 |
| Max. Negotiated Rate |
$276.92 |
| Rate for Payer: Aetna Commercial |
$270.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$258.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$159.53
|
| Rate for Payer: Cash Price |
$90.30
|
| Rate for Payer: Cigna Commercial |
$276.92
|
| Rate for Payer: Health EOS Commercial |
$267.89
|
| Rate for Payer: HFN Commercial |
$276.92
|
| Rate for Payer: Multiplan Commercial |
$240.80
|
| Rate for Payer: NAPHCARE Commercial |
$180.60
|
| Rate for Payer: Preferred Network Access Commercial |
$276.92
|
| Rate for Payer: Quartz Beloit One Network |
$147.49
|
| Rate for Payer: Quartz Commercial |
$180.60
|
| Rate for Payer: WEA Trust Commercial |
$165.55
|
| Rate for Payer: WPS Commercial |
$222.95
|
|
|
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 |
$31.67 |
| Max. Negotiated Rate |
$330.28 |
| Rate for Payer: Aetna Commercial |
$323.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$308.74
|
| Rate for Payer: Aetna Managed Medicare |
$32.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$31.67
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$31.67
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$31.67
|
| Rate for Payer: Anthem Medicare Advantage |
$32.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$190.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$32.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$32.16
|
| Rate for Payer: Cash Price |
$107.70
|
| Rate for Payer: Cash Price |
$107.70
|
| Rate for Payer: Cigna Commercial |
$330.28
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$32.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$41.90
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$32.16
|
| Rate for Payer: Health EOS Commercial |
$319.51
|
| Rate for Payer: HFN Commercial |
$330.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$119.64
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$32.16
|
| Rate for Payer: Independent Care Health Plan Medicare |
$32.16
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$32.16
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$32.16
|
| Rate for Payer: Multiplan Commercial |
$287.20
|
| Rate for Payer: NAPHCARE Commercial |
$48.24
|
| Rate for Payer: Preferred Network Access Commercial |
$330.28
|
| Rate for Payer: Quartz Beloit One Network |
$175.91
|
| Rate for Payer: Quartz Commercial |
$233.35
|
| Rate for Payer: Quartz Medicare Advantage |
$32.16
|
| Rate for Payer: The Alliance Commercial |
$128.64
|
| Rate for Payer: United Healthcare Medicare Advantage |
$32.16
|
| Rate for Payer: WEA Trust Commercial |
$197.45
|
| Rate for Payer: Wellcare Medicare |
$32.16
|
| Rate for Payer: WPS Commercial |
$79.18
|
|
|
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 |
$31.67 |
| Max. Negotiated Rate |
$341.05 |
| Rate for Payer: Aetna Commercial |
$341.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$308.74
|
| Rate for Payer: Cash Price |
$107.70
|
| Rate for Payer: Cash Price |
$107.70
|
| Rate for Payer: Cigna Commercial |
$341.05
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$31.67
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$31.67
|
| Rate for Payer: Health EOS Commercial |
$326.69
|
| Rate for Payer: HFN Commercial |
$341.05
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$61.25
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$61.25
|
| Rate for Payer: Multiplan Commercial |
$287.20
|
| Rate for Payer: Preferred Network Access Commercial |
$341.05
|
| Rate for Payer: Quartz Beloit One Network |
$157.96
|
| Rate for Payer: Quartz Commercial |
$204.63
|
| Rate for Payer: The Alliance Commercial |
$179.50
|
| Rate for Payer: United Healthcare Medicaid |
$31.67
|
| Rate for Payer: WEA Trust Commercial |
$197.45
|
| Rate for Payer: WPS Commercial |
$79.18
|
|
|
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 |
$175.91 |
| Max. Negotiated Rate |
$330.28 |
| Rate for Payer: Aetna Commercial |
$323.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$308.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$190.27
|
| Rate for Payer: Cash Price |
$107.70
|
| Rate for Payer: Cigna Commercial |
$330.28
|
| Rate for Payer: Health EOS Commercial |
$319.51
|
| Rate for Payer: HFN Commercial |
$330.28
|
| Rate for Payer: Multiplan Commercial |
$287.20
|
| Rate for Payer: NAPHCARE Commercial |
$215.40
|
| Rate for Payer: Preferred Network Access Commercial |
$330.28
|
| Rate for Payer: Quartz Beloit One Network |
$175.91
|
| Rate for Payer: Quartz Commercial |
$215.40
|
| Rate for Payer: WEA Trust Commercial |
$197.45
|
| Rate for Payer: WPS Commercial |
$265.91
|
|
|
Infliximab Level & Anti-Drug Antibody
|
Facility
|
IP
|
$420.00
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
5438797
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$205.80 |
| Max. Negotiated Rate |
$386.40 |
| Rate for Payer: Aetna Commercial |
$378.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$361.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$222.60
|
| Rate for Payer: Cash Price |
$126.00
|
| Rate for Payer: Cigna Commercial |
$386.40
|
| Rate for Payer: Health EOS Commercial |
$373.80
|
| Rate for Payer: HFN Commercial |
$386.40
|
| Rate for Payer: Multiplan Commercial |
$336.00
|
| Rate for Payer: NAPHCARE Commercial |
$252.00
|
| Rate for Payer: Preferred Network Access Commercial |
$386.40
|
| Rate for Payer: Quartz Beloit One Network |
$205.80
|
| Rate for Payer: Quartz Commercial |
$252.00
|
| Rate for Payer: WEA Trust Commercial |
$231.00
|
| Rate for Payer: WPS Commercial |
$311.09
|
|
|
Infliximab Level & Anti-Drug Antibody
|
Professional
|
Both
|
$420.00
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
5438797
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$60.96 |
| Max. Negotiated Rate |
$399.00 |
| Rate for Payer: Aetna Commercial |
$399.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$361.20
|
| Rate for Payer: Cash Price |
$126.00
|
| Rate for Payer: Cash Price |
$126.00
|
| Rate for Payer: Cigna Commercial |
$399.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$210.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$252.00
|
| Rate for Payer: Health EOS Commercial |
$382.20
|
| Rate for Payer: HFN Commercial |
$399.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$60.96
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$60.96
|
| Rate for Payer: Multiplan Commercial |
$336.00
|
| Rate for Payer: Preferred Network Access Commercial |
$399.00
|
| Rate for Payer: Quartz Beloit One Network |
$184.80
|
| Rate for Payer: Quartz Commercial |
$239.40
|
| Rate for Payer: The Alliance Commercial |
$210.00
|
| Rate for Payer: WEA Trust Commercial |
$231.00
|
| Rate for Payer: WPS Commercial |
$311.09
|
|
|
Infliximab Level & Anti-Drug Antibody
|
Facility
|
OP
|
$420.00
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
5438797
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.27 |
| Max. Negotiated Rate |
$386.40 |
| Rate for Payer: Aetna Commercial |
$378.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$361.20
|
| Rate for Payer: Aetna Managed Medicare |
$17.27
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$64.76
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$30.22
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$28.67
|
| Rate for Payer: Anthem Medicaid |
$17.85
|
| Rate for Payer: Anthem Medicare Advantage |
$17.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$222.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$17.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$17.27
|
| Rate for Payer: Cash Price |
$126.00
|
| Rate for Payer: Cash Price |
$126.00
|
| Rate for Payer: Cigna Commercial |
$386.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$17.27
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$17.85
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$235.03
|
| Rate for Payer: Dean Health Medicaid |
$17.85
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$17.27
|
| Rate for Payer: Health EOS Commercial |
$373.80
|
| Rate for Payer: HFN Commercial |
$386.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$64.24
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$17.27
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$17.85
|
| Rate for Payer: Independent Care Health Plan Medicare |
$17.27
|
| Rate for Payer: Managed Health Services Medicaid |
$18.56
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$17.27
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$17.27
|
| Rate for Payer: Multiplan Commercial |
$336.00
|
| Rate for Payer: NAPHCARE Commercial |
$25.90
|
| Rate for Payer: Preferred Network Access Commercial |
$386.40
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$17.85
|
| Rate for Payer: Quartz Beloit One Network |
$205.80
|
| Rate for Payer: Quartz Commercial |
$273.00
|
| Rate for Payer: Quartz Medicare Advantage |
$17.27
|
| Rate for Payer: The Alliance Commercial |
$69.08
|
| Rate for Payer: United Healthcare Medicaid |
$17.85
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17.27
|
| Rate for Payer: United Healthcare PPO |
$315.00
|
| Rate for Payer: WEA Trust Commercial |
$231.00
|
| Rate for Payer: Wellcare Medicare |
$17.27
|
| Rate for Payer: WMAP Medicaid |
$17.85
|
| Rate for Payer: WPS Commercial |
$311.09
|
|
|
***INFLOW TUBE SET TRUCLEAR LEGACY FLUID MANAGEMENT 7209822*** DISC ***
|
Facility
|
OP
|
$901.00
|
|
| Hospital Charge Code |
5797665
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$252.28 |
| Max. Negotiated Rate |
$3,604.00 |
| Rate for Payer: Aetna Commercial |
$810.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$774.86
|
| Rate for Payer: Aetna Managed Medicare |
$252.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$585.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$450.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$432.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$477.53
|
| Rate for Payer: Cash Price |
$270.30
|
| Rate for Payer: Cigna Commercial |
$828.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$504.20
|
| Rate for Payer: Health EOS Commercial |
$801.89
|
| Rate for Payer: HFN Commercial |
$828.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$675.75
|
| Rate for Payer: Multiplan Commercial |
$720.80
|
| Rate for Payer: NAPHCARE Commercial |
$540.60
|
| Rate for Payer: Preferred Network Access Commercial |
$828.92
|
| Rate for Payer: Quartz Beloit One Network |
$441.49
|
| Rate for Payer: Quartz Commercial |
$585.65
|
| Rate for Payer: Quartz Medicare Advantage |
$540.60
|
| Rate for Payer: The Alliance Commercial |
$3,604.00
|
| Rate for Payer: WEA Trust Commercial |
$495.55
|
| Rate for Payer: WPS Commercial |
$667.37
|
|
|
***INFLOW TUBE SET TRUCLEAR LEGACY FLUID MANAGEMENT 7209822*** DISC ***
|
Facility
|
IP
|
$901.00
|
|
| Hospital Charge Code |
5797665
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$441.49 |
| Max. Negotiated Rate |
$828.92 |
| Rate for Payer: Aetna Commercial |
$810.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$774.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$477.53
|
| Rate for Payer: Cash Price |
$270.30
|
| Rate for Payer: Cigna Commercial |
$828.92
|
| Rate for Payer: Health EOS Commercial |
$801.89
|
| Rate for Payer: HFN Commercial |
$828.92
|
| Rate for Payer: Multiplan Commercial |
$720.80
|
| Rate for Payer: NAPHCARE Commercial |
$540.60
|
| Rate for Payer: Preferred Network Access Commercial |
$828.92
|
| Rate for Payer: Quartz Beloit One Network |
$441.49
|
| Rate for Payer: Quartz Commercial |
$540.60
|
| Rate for Payer: WEA Trust Commercial |
$495.55
|
| Rate for Payer: WPS Commercial |
$667.37
|
|
|
Influenza A and B Antibodies
|
Professional
|
Both
|
$100.00
|
|
|
Service Code
|
CPT 86710
|
| Hospital Charge Code |
977995
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$44.00 |
| Max. Negotiated Rate |
$95.00 |
| Rate for Payer: Aetna Commercial |
$95.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$86.00
|
| Rate for Payer: Cash Price |
$30.00
|
| Rate for Payer: Cash Price |
$30.00
|
| Rate for Payer: Cigna Commercial |
$95.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$50.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$60.00
|
| Rate for Payer: Health EOS Commercial |
$91.00
|
| Rate for Payer: HFN Commercial |
$95.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$47.83
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$47.83
|
| Rate for Payer: Multiplan Commercial |
$80.00
|
| Rate for Payer: Preferred Network Access Commercial |
$95.00
|
| Rate for Payer: Quartz Beloit One Network |
$44.00
|
| Rate for Payer: Quartz Commercial |
$57.00
|
| Rate for Payer: The Alliance Commercial |
$50.00
|
| Rate for Payer: WEA Trust Commercial |
$55.00
|
| Rate for Payer: WPS Commercial |
$74.07
|
|
|
Influenza A and B Antibodies
|
Facility
|
OP
|
$100.00
|
|
|
Service Code
|
CPT 86710
|
| Hospital Charge Code |
977995
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.55 |
| Max. Negotiated Rate |
$92.00 |
| Rate for Payer: Quartz Commercial |
$65.00
|
| Rate for Payer: Quartz Medicare Advantage |
$13.55
|
| Rate for Payer: The Alliance Commercial |
$54.20
|
| Rate for Payer: United Healthcare Medicaid |
$14.00
|
| Rate for Payer: Aetna Commercial |
$90.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$86.00
|
| Rate for Payer: Aetna Managed Medicare |
$13.55
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$50.81
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$23.71
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$22.49
|
| Rate for Payer: Anthem Medicaid |
$14.00
|
| Rate for Payer: Anthem Medicare Advantage |
$13.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$53.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$13.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$13.55
|
| Rate for Payer: Cash Price |
$30.00
|
| Rate for Payer: Cash Price |
$30.00
|
| Rate for Payer: Cigna Commercial |
$92.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$13.55
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$14.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$55.96
|
| Rate for Payer: Dean Health Medicaid |
$14.00
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$13.55
|
| Rate for Payer: Health EOS Commercial |
$89.00
|
| Rate for Payer: HFN Commercial |
$92.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$50.41
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$13.55
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$14.00
|
| Rate for Payer: Independent Care Health Plan Medicare |
$13.55
|
| Rate for Payer: Managed Health Services Medicaid |
$14.56
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$13.55
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$13.55
|
| Rate for Payer: Multiplan Commercial |
$80.00
|
| Rate for Payer: NAPHCARE Commercial |
$20.32
|
| Rate for Payer: Preferred Network Access Commercial |
$92.00
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$14.00
|
| Rate for Payer: Quartz Beloit One Network |
$49.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.55
|
| Rate for Payer: United Healthcare PPO |
$75.00
|
| Rate for Payer: WEA Trust Commercial |
$55.00
|
| Rate for Payer: Wellcare Medicare |
$13.55
|
| Rate for Payer: WMAP Medicaid |
$14.00
|
| Rate for Payer: WPS Commercial |
$74.07
|
|
|
Influenza A and B Antibodies
|
Facility
|
IP
|
$100.00
|
|
|
Service Code
|
CPT 86710
|
| Hospital Charge Code |
977995
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$49.00 |
| Max. Negotiated Rate |
$92.00 |
| Rate for Payer: Aetna Commercial |
$90.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$86.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$53.00
|
| Rate for Payer: Cash Price |
$30.00
|
| Rate for Payer: Cigna Commercial |
$92.00
|
| Rate for Payer: Health EOS Commercial |
$89.00
|
| Rate for Payer: HFN Commercial |
$92.00
|
| Rate for Payer: Multiplan Commercial |
$80.00
|
| Rate for Payer: NAPHCARE Commercial |
$60.00
|
| Rate for Payer: Preferred Network Access Commercial |
$92.00
|
| Rate for Payer: Quartz Beloit One Network |
$49.00
|
| Rate for Payer: Quartz Commercial |
$60.00
|
| Rate for Payer: WEA Trust Commercial |
$55.00
|
| Rate for Payer: WPS Commercial |
$74.07
|
|
|
Influenza A Antibody
|
Facility
|
IP
|
$285.00
|
|
|
Service Code
|
CPT 87804
|
| Hospital Charge Code |
982497
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$139.65 |
| Max. Negotiated Rate |
$262.20 |
| Rate for Payer: Multiplan Commercial |
$228.00
|
| Rate for Payer: NAPHCARE Commercial |
$171.00
|
| Rate for Payer: Aetna Commercial |
$256.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$245.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$151.05
|
| Rate for Payer: Cash Price |
$85.50
|
| Rate for Payer: Cigna Commercial |
$262.20
|
| Rate for Payer: Health EOS Commercial |
$253.65
|
| Rate for Payer: HFN Commercial |
$262.20
|
| Rate for Payer: Preferred Network Access Commercial |
$262.20
|
| Rate for Payer: Quartz Beloit One Network |
$139.65
|
| Rate for Payer: Quartz Commercial |
$171.00
|
| Rate for Payer: WEA Trust Commercial |
$156.75
|
| Rate for Payer: WPS Commercial |
$211.10
|
|
|
Influenza A Antibody
|
Professional
|
Both
|
$285.00
|
|
|
Service Code
|
CPT 87804
|
| Hospital Charge Code |
982497
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$58.42 |
| Max. Negotiated Rate |
$270.75 |
| Rate for Payer: Aetna Commercial |
$270.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$245.10
|
| Rate for Payer: Cash Price |
$85.50
|
| Rate for Payer: Cash Price |
$85.50
|
| Rate for Payer: Cigna Commercial |
$270.75
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$142.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$171.00
|
| Rate for Payer: Health EOS Commercial |
$259.35
|
| Rate for Payer: HFN Commercial |
$270.75
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$58.42
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$58.42
|
| Rate for Payer: Multiplan Commercial |
$228.00
|
| Rate for Payer: Preferred Network Access Commercial |
$270.75
|
| Rate for Payer: Quartz Beloit One Network |
$125.40
|
| Rate for Payer: Quartz Commercial |
$162.45
|
| Rate for Payer: The Alliance Commercial |
$142.50
|
| Rate for Payer: WEA Trust Commercial |
$156.75
|
| Rate for Payer: WPS Commercial |
$211.10
|
|
|
Influenza A Antibody
|
Facility
|
OP
|
$285.00
|
|
|
Service Code
|
CPT 87804
|
| Hospital Charge Code |
982497
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$16.55 |
| Max. Negotiated Rate |
$262.20 |
| Rate for Payer: Aetna Commercial |
$256.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$245.10
|
| Rate for Payer: Aetna Managed Medicare |
$16.55
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$62.06
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$28.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$27.47
|
| Rate for Payer: Anthem Medicaid |
$16.86
|
| Rate for Payer: Anthem Medicare Advantage |
$16.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$151.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$16.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$16.55
|
| Rate for Payer: Cash Price |
$85.50
|
| Rate for Payer: Cash Price |
$85.50
|
| Rate for Payer: Cigna Commercial |
$262.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$16.55
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$16.86
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$159.49
|
| Rate for Payer: Dean Health Medicaid |
$16.86
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$16.55
|
| Rate for Payer: Health EOS Commercial |
$253.65
|
| Rate for Payer: HFN Commercial |
$262.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$61.57
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$16.55
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$16.86
|
| Rate for Payer: Independent Care Health Plan Medicare |
$16.55
|
| Rate for Payer: Managed Health Services Medicaid |
$17.53
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$16.55
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$16.55
|
| Rate for Payer: Multiplan Commercial |
$228.00
|
| Rate for Payer: NAPHCARE Commercial |
$24.82
|
| Rate for Payer: Preferred Network Access Commercial |
$262.20
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$16.86
|
| Rate for Payer: Quartz Beloit One Network |
$139.65
|
| Rate for Payer: Quartz Commercial |
$185.25
|
| Rate for Payer: Quartz Medicare Advantage |
$16.55
|
| Rate for Payer: The Alliance Commercial |
$66.20
|
| Rate for Payer: United Healthcare Medicaid |
$16.86
|
| Rate for Payer: United Healthcare Medicare Advantage |
$16.55
|
| Rate for Payer: United Healthcare PPO |
$213.75
|
| Rate for Payer: WEA Trust Commercial |
$156.75
|
| Rate for Payer: Wellcare Medicare |
$16.55
|
| Rate for Payer: WMAP Medicaid |
$16.86
|
| Rate for Payer: WPS Commercial |
$211.10
|
|
|
Influenza A RNA
|
Professional
|
Both
|
$241.00
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
3881390
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$106.04 |
| Max. Negotiated Rate |
$228.95 |
| Rate for Payer: Aetna Commercial |
$228.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$207.26
|
| Rate for Payer: Cash Price |
$72.30
|
| Rate for Payer: Cash Price |
$72.30
|
| Rate for Payer: Cigna Commercial |
$228.95
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$120.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$144.60
|
| Rate for Payer: Health EOS Commercial |
$219.31
|
| Rate for Payer: HFN Commercial |
$228.95
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$123.87
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$123.87
|
| Rate for Payer: Multiplan Commercial |
$192.80
|
| Rate for Payer: Preferred Network Access Commercial |
$228.95
|
| Rate for Payer: Quartz Beloit One Network |
$106.04
|
| Rate for Payer: Quartz Commercial |
$137.37
|
| Rate for Payer: The Alliance Commercial |
$120.50
|
| Rate for Payer: WEA Trust Commercial |
$132.55
|
| Rate for Payer: WPS Commercial |
$178.51
|
|
|
Influenza A RNA
|
Facility
|
IP
|
$241.00
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
3881390
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$118.09 |
| Max. Negotiated Rate |
$221.72 |
| Rate for Payer: Aetna Commercial |
$216.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$207.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$127.73
|
| Rate for Payer: Cash Price |
$72.30
|
| Rate for Payer: Cigna Commercial |
$221.72
|
| Rate for Payer: Health EOS Commercial |
$214.49
|
| Rate for Payer: HFN Commercial |
$221.72
|
| Rate for Payer: Multiplan Commercial |
$192.80
|
| Rate for Payer: NAPHCARE Commercial |
$144.60
|
| Rate for Payer: Preferred Network Access Commercial |
$221.72
|
| Rate for Payer: Quartz Beloit One Network |
$118.09
|
| Rate for Payer: Quartz Commercial |
$144.60
|
| Rate for Payer: WEA Trust Commercial |
$132.55
|
| Rate for Payer: WPS Commercial |
$178.51
|
|
|
Influenza A RNA
|
Facility
|
OP
|
$241.00
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
3881390
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$35.09 |
| Max. Negotiated Rate |
$221.72 |
| Rate for Payer: Aetna Commercial |
$216.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$207.26
|
| Rate for Payer: Aetna Managed Medicare |
$35.09
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$131.59
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$61.41
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$58.25
|
| Rate for Payer: Anthem Medicaid |
$36.26
|
| Rate for Payer: Anthem Medicare Advantage |
$35.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$127.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$35.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$35.09
|
| Rate for Payer: Cash Price |
$72.30
|
| Rate for Payer: Cash Price |
$72.30
|
| Rate for Payer: Cigna Commercial |
$221.72
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$35.09
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$36.26
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$134.86
|
| Rate for Payer: Dean Health Medicaid |
$36.26
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$35.09
|
| Rate for Payer: Health EOS Commercial |
$214.49
|
| Rate for Payer: HFN Commercial |
$221.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$130.53
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$35.09
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$36.26
|
| Rate for Payer: Independent Care Health Plan Medicare |
$35.09
|
| Rate for Payer: Managed Health Services Medicaid |
$37.71
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$35.09
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$35.09
|
| Rate for Payer: Multiplan Commercial |
$192.80
|
| Rate for Payer: NAPHCARE Commercial |
$52.64
|
| Rate for Payer: Preferred Network Access Commercial |
$221.72
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$36.26
|
| Rate for Payer: Quartz Beloit One Network |
$118.09
|
| Rate for Payer: Quartz Commercial |
$156.65
|
| Rate for Payer: Quartz Medicare Advantage |
$35.09
|
| Rate for Payer: The Alliance Commercial |
$140.36
|
| Rate for Payer: United Healthcare Medicaid |
$36.26
|
| Rate for Payer: United Healthcare Medicare Advantage |
$35.09
|
| Rate for Payer: United Healthcare PPO |
$180.75
|
| Rate for Payer: WEA Trust Commercial |
$132.55
|
| Rate for Payer: Wellcare Medicare |
$35.09
|
| Rate for Payer: WMAP Medicaid |
$36.26
|
| Rate for Payer: WPS Commercial |
$178.51
|
|
|
Influenza B Antibody
|
Professional
|
Both
|
$285.00
|
|
|
Service Code
|
CPT 87804
|
| Hospital Charge Code |
982500
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$58.42 |
| Max. Negotiated Rate |
$270.75 |
| Rate for Payer: Aetna Commercial |
$270.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$245.10
|
| Rate for Payer: Cash Price |
$85.50
|
| Rate for Payer: Cash Price |
$85.50
|
| Rate for Payer: Cigna Commercial |
$270.75
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$142.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$171.00
|
| Rate for Payer: Health EOS Commercial |
$259.35
|
| Rate for Payer: HFN Commercial |
$270.75
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$58.42
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$58.42
|
| Rate for Payer: Multiplan Commercial |
$228.00
|
| Rate for Payer: Preferred Network Access Commercial |
$270.75
|
| Rate for Payer: Quartz Beloit One Network |
$125.40
|
| Rate for Payer: Quartz Commercial |
$162.45
|
| Rate for Payer: The Alliance Commercial |
$142.50
|
| Rate for Payer: WEA Trust Commercial |
$156.75
|
| Rate for Payer: WPS Commercial |
$211.10
|
|
|
Influenza B Antibody
|
Facility
|
OP
|
$285.00
|
|
|
Service Code
|
CPT 87804
|
| Hospital Charge Code |
982500
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$16.55 |
| Max. Negotiated Rate |
$262.20 |
| Rate for Payer: Aetna Commercial |
$256.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$245.10
|
| Rate for Payer: Aetna Managed Medicare |
$16.55
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$62.06
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$28.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$27.47
|
| Rate for Payer: Anthem Medicaid |
$16.86
|
| Rate for Payer: Anthem Medicare Advantage |
$16.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$151.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$16.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$16.55
|
| Rate for Payer: Cash Price |
$85.50
|
| Rate for Payer: Cash Price |
$85.50
|
| Rate for Payer: Cigna Commercial |
$262.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$16.55
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$16.86
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$159.49
|
| Rate for Payer: Dean Health Medicaid |
$16.86
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$16.55
|
| Rate for Payer: Health EOS Commercial |
$253.65
|
| Rate for Payer: HFN Commercial |
$262.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$61.57
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$16.55
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$16.86
|
| Rate for Payer: Independent Care Health Plan Medicare |
$16.55
|
| Rate for Payer: Managed Health Services Medicaid |
$17.53
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$16.55
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$16.55
|
| Rate for Payer: Multiplan Commercial |
$228.00
|
| Rate for Payer: NAPHCARE Commercial |
$24.82
|
| Rate for Payer: Preferred Network Access Commercial |
$262.20
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$16.86
|
| Rate for Payer: Quartz Beloit One Network |
$139.65
|
| Rate for Payer: Quartz Commercial |
$185.25
|
| Rate for Payer: Quartz Medicare Advantage |
$16.55
|
| Rate for Payer: The Alliance Commercial |
$66.20
|
| Rate for Payer: United Healthcare Medicaid |
$16.86
|
| Rate for Payer: United Healthcare Medicare Advantage |
$16.55
|
| Rate for Payer: United Healthcare PPO |
$213.75
|
| Rate for Payer: WEA Trust Commercial |
$156.75
|
| Rate for Payer: Wellcare Medicare |
$16.55
|
| Rate for Payer: WMAP Medicaid |
$16.86
|
| Rate for Payer: WPS Commercial |
$211.10
|
|
|
Influenza B Antibody
|
Facility
|
IP
|
$285.00
|
|
|
Service Code
|
CPT 87804
|
| Hospital Charge Code |
982500
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$139.65 |
| Max. Negotiated Rate |
$262.20 |
| Rate for Payer: Aetna Commercial |
$256.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$245.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$151.05
|
| Rate for Payer: Cash Price |
$85.50
|
| Rate for Payer: Cigna Commercial |
$262.20
|
| Rate for Payer: Health EOS Commercial |
$253.65
|
| Rate for Payer: HFN Commercial |
$262.20
|
| Rate for Payer: Multiplan Commercial |
$228.00
|
| Rate for Payer: NAPHCARE Commercial |
$171.00
|
| Rate for Payer: Preferred Network Access Commercial |
$262.20
|
| Rate for Payer: Quartz Beloit One Network |
$139.65
|
| Rate for Payer: Quartz Commercial |
$171.00
|
| Rate for Payer: WEA Trust Commercial |
$156.75
|
| Rate for Payer: WPS Commercial |
$211.10
|
|
|
Influenza B Antibody 86710
|
Facility
|
OP
|
$102.00
|
|
|
Service Code
|
CPT 86710
|
| Hospital Charge Code |
2942929
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.55 |
| Max. Negotiated Rate |
$93.84 |
| Rate for Payer: Aetna Commercial |
$91.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$87.72
|
| Rate for Payer: Aetna Managed Medicare |
$13.55
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$50.81
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$23.71
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$22.49
|
| Rate for Payer: Anthem Medicaid |
$14.00
|
| Rate for Payer: Anthem Medicare Advantage |
$13.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$54.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$13.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$13.55
|
| Rate for Payer: Cash Price |
$30.60
|
| Rate for Payer: Cash Price |
$30.60
|
| Rate for Payer: Cigna Commercial |
$93.84
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$13.55
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$14.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$57.08
|
| Rate for Payer: Dean Health Medicaid |
$14.00
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$13.55
|
| Rate for Payer: Health EOS Commercial |
$90.78
|
| Rate for Payer: HFN Commercial |
$93.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$50.41
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$13.55
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$14.00
|
| Rate for Payer: Independent Care Health Plan Medicare |
$13.55
|
| Rate for Payer: Managed Health Services Medicaid |
$14.56
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$13.55
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$13.55
|
| Rate for Payer: Multiplan Commercial |
$81.60
|
| Rate for Payer: NAPHCARE Commercial |
$20.32
|
| Rate for Payer: Preferred Network Access Commercial |
$93.84
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$14.00
|
| Rate for Payer: Quartz Beloit One Network |
$49.98
|
| Rate for Payer: Quartz Commercial |
$66.30
|
| Rate for Payer: Quartz Medicare Advantage |
$13.55
|
| Rate for Payer: The Alliance Commercial |
$54.20
|
| Rate for Payer: United Healthcare Medicaid |
$14.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.55
|
| Rate for Payer: United Healthcare PPO |
$76.50
|
| Rate for Payer: WEA Trust Commercial |
$56.10
|
| Rate for Payer: Wellcare Medicare |
$13.55
|
| Rate for Payer: WMAP Medicaid |
$14.00
|
| Rate for Payer: WPS Commercial |
$75.55
|
|
