|
Influenza A RNA
|
Facility
|
IP
|
$241.00
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
3881390
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$122.81 |
| Max. Negotiated Rate |
$230.59 |
| Rate for Payer: Aetna Commercial |
$225.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$215.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$132.84
|
| Rate for Payer: Cash Price |
$72.30
|
| Rate for Payer: Cigna Commercial |
$230.59
|
| Rate for Payer: Health EOS Commercial |
$223.07
|
| Rate for Payer: HFN Commercial |
$230.59
|
| Rate for Payer: Multiplan Commercial |
$200.51
|
| Rate for Payer: Preferred Network Access Commercial |
$230.59
|
| Rate for Payer: Quartz Beloit One Network |
$122.81
|
| Rate for Payer: Quartz Commercial |
$150.38
|
| Rate for Payer: WEA Trust Commercial |
$137.85
|
| Rate for Payer: WPS Commercial |
$185.64
|
|
|
Influenza B Antibody
|
Facility
|
OP
|
$285.00
|
|
|
Service Code
|
CPT 87804
|
| Hospital Charge Code |
982500
|
|
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 B Antibody
|
Professional
|
Both
|
$285.00
|
|
|
Service Code
|
CPT 87804
|
| Hospital Charge Code |
982500
|
|
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 B Antibody
|
Facility
|
IP
|
$285.00
|
|
|
Service Code
|
CPT 87804
|
| Hospital Charge Code |
982500
|
|
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 B Antibody 86710
|
Professional
|
Both
|
$102.00
|
|
|
Service Code
|
CPT 86710
|
| Hospital Charge Code |
2942929
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.09 |
| Max. Negotiated Rate |
$100.78 |
| Rate for Payer: Aetna Commercial |
$100.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$91.23
|
| 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 |
$30.60
|
| Rate for Payer: Cash Price |
$30.60
|
| Rate for Payer: Cigna Commercial |
$100.78
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$53.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$14.09
|
| Rate for Payer: Health EOS Commercial |
$96.53
|
| Rate for Payer: HFN Commercial |
$100.78
|
| 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 |
$84.86
|
| Rate for Payer: NAPHCARE Commercial |
$21.14
|
| Rate for Payer: Preferred Network Access Commercial |
$100.78
|
| Rate for Payer: Quartz Beloit One Network |
$46.68
|
| Rate for Payer: Quartz Commercial |
$60.47
|
| 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 |
$58.34
|
| Rate for Payer: WPS Commercial |
$62.00
|
|
|
Influenza B Antibody 86710
|
Facility
|
OP
|
$102.00
|
|
|
Service Code
|
CPT 86710
|
| Hospital Charge Code |
2942929
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.09 |
| Max. Negotiated Rate |
$97.59 |
| Rate for Payer: Aetna Commercial |
$95.47
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$91.23
|
| 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 |
$56.22
|
| 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 |
$30.60
|
| Rate for Payer: Cash Price |
$30.60
|
| Rate for Payer: Cigna Commercial |
$97.59
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$14.09
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$59.36
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$14.09
|
| Rate for Payer: Health EOS Commercial |
$94.41
|
| Rate for Payer: HFN Commercial |
$97.59
|
| 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 |
$84.86
|
| Rate for Payer: NAPHCARE Commercial |
$21.14
|
| Rate for Payer: Preferred Network Access Commercial |
$97.59
|
| Rate for Payer: Quartz Beloit One Network |
$51.98
|
| Rate for Payer: Quartz Commercial |
$68.95
|
| 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 |
$79.56
|
| Rate for Payer: WEA Trust Commercial |
$58.34
|
| Rate for Payer: Wellcare Medicare |
$14.09
|
| Rate for Payer: WPS Commercial |
$78.57
|
|
|
Influenza B Antibody 86710
|
Facility
|
IP
|
$102.00
|
|
|
Service Code
|
CPT 86710
|
| Hospital Charge Code |
2942929
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$51.98 |
| Max. Negotiated Rate |
$97.59 |
| Rate for Payer: Aetna Commercial |
$95.47
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$91.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$56.22
|
| Rate for Payer: Cash Price |
$30.60
|
| Rate for Payer: Cigna Commercial |
$97.59
|
| Rate for Payer: Health EOS Commercial |
$94.41
|
| Rate for Payer: HFN Commercial |
$97.59
|
| Rate for Payer: Multiplan Commercial |
$84.86
|
| Rate for Payer: Preferred Network Access Commercial |
$97.59
|
| Rate for Payer: Quartz Beloit One Network |
$51.98
|
| Rate for Payer: Quartz Commercial |
$63.65
|
| Rate for Payer: WEA Trust Commercial |
$58.34
|
| Rate for Payer: WPS Commercial |
$78.57
|
|
|
Influenza B Antibody 87804
|
Facility
|
IP
|
$233.00
|
|
|
Service Code
|
CPT 87804
|
| Hospital Charge Code |
2942986
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$118.74 |
| Max. Negotiated Rate |
$222.93 |
| Rate for Payer: Aetna Commercial |
$218.09
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$208.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$128.43
|
| Rate for Payer: Cash Price |
$69.90
|
| Rate for Payer: Cigna Commercial |
$222.93
|
| Rate for Payer: Health EOS Commercial |
$215.66
|
| Rate for Payer: HFN Commercial |
$222.93
|
| Rate for Payer: Multiplan Commercial |
$193.86
|
| Rate for Payer: Preferred Network Access Commercial |
$222.93
|
| Rate for Payer: Quartz Beloit One Network |
$118.74
|
| Rate for Payer: Quartz Commercial |
$145.39
|
| Rate for Payer: WEA Trust Commercial |
$133.28
|
| Rate for Payer: WPS Commercial |
$179.48
|
|
|
Influenza B Antibody 87804
|
Professional
|
Both
|
$233.00
|
|
|
Service Code
|
CPT 87804
|
| Hospital Charge Code |
2942986
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.21 |
| Max. Negotiated Rate |
$230.20 |
| Rate for Payer: Aetna Commercial |
$230.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$208.40
|
| 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 |
$69.90
|
| Rate for Payer: Cash Price |
$69.90
|
| Rate for Payer: Cigna Commercial |
$230.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$121.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$17.21
|
| Rate for Payer: Health EOS Commercial |
$220.51
|
| Rate for Payer: HFN Commercial |
$230.20
|
| 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 |
$193.86
|
| Rate for Payer: NAPHCARE Commercial |
$25.82
|
| Rate for Payer: Preferred Network Access Commercial |
$230.20
|
| Rate for Payer: Quartz Beloit One Network |
$106.62
|
| Rate for Payer: Quartz Commercial |
$138.12
|
| 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 |
$133.28
|
| Rate for Payer: WPS Commercial |
$75.73
|
|
|
Influenza B Antibody 87804
|
Facility
|
OP
|
$233.00
|
|
|
Service Code
|
CPT 87804
|
| Hospital Charge Code |
2942986
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.21 |
| Max. Negotiated Rate |
$222.93 |
| Rate for Payer: Aetna Commercial |
$218.09
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$208.40
|
| 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 |
$128.43
|
| 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 |
$69.90
|
| Rate for Payer: Cash Price |
$69.90
|
| Rate for Payer: Cigna Commercial |
$222.93
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$17.21
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$135.61
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$17.21
|
| Rate for Payer: Health EOS Commercial |
$215.66
|
| Rate for Payer: HFN Commercial |
$222.93
|
| 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 |
$193.86
|
| Rate for Payer: NAPHCARE Commercial |
$25.82
|
| Rate for Payer: Preferred Network Access Commercial |
$222.93
|
| Rate for Payer: Quartz Beloit One Network |
$118.74
|
| Rate for Payer: Quartz Commercial |
$157.51
|
| 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 |
$181.74
|
| Rate for Payer: WEA Trust Commercial |
$133.28
|
| Rate for Payer: Wellcare Medicare |
$17.21
|
| Rate for Payer: WPS Commercial |
$179.48
|
|
|
Influenza H1N1 (2009) RNA
|
Facility
|
OP
|
$241.00
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
3881391
|
|
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
|
|
|
Influenza H1N1 (2009) RNA
|
Facility
|
IP
|
$241.00
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
3881391
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$122.81 |
| Max. Negotiated Rate |
$230.59 |
| Rate for Payer: Aetna Commercial |
$225.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$215.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$132.84
|
| Rate for Payer: Cash Price |
$72.30
|
| Rate for Payer: Cigna Commercial |
$230.59
|
| Rate for Payer: Health EOS Commercial |
$223.07
|
| Rate for Payer: HFN Commercial |
$230.59
|
| Rate for Payer: Multiplan Commercial |
$200.51
|
| Rate for Payer: Preferred Network Access Commercial |
$230.59
|
| Rate for Payer: Quartz Beloit One Network |
$122.81
|
| Rate for Payer: Quartz Commercial |
$150.38
|
| Rate for Payer: WEA Trust Commercial |
$137.85
|
| Rate for Payer: WPS Commercial |
$185.64
|
|
|
Influenza H1N1 (2009) RNA
|
Professional
|
Both
|
$241.00
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
3881391
|
|
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
|
|
|
Infusion Cath 10cm
|
Facility
|
OP
|
$2,524.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
2549128
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$734.99 |
| Max. Negotiated Rate |
$2,414.96 |
| Rate for Payer: Aetna Commercial |
$2,362.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,257.47
|
| Rate for Payer: Aetna Managed Medicare |
$734.99
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,706.22
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,312.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,259.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,391.23
|
| Rate for Payer: Cash Price |
$757.20
|
| Rate for Payer: Cigna Commercial |
$2,414.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,468.97
|
| Rate for Payer: Health EOS Commercial |
$2,336.21
|
| Rate for Payer: HFN Commercial |
$2,414.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,968.72
|
| Rate for Payer: Multiplan Commercial |
$2,099.97
|
| Rate for Payer: NAPHCARE Commercial |
$1,574.98
|
| Rate for Payer: Preferred Network Access Commercial |
$2,414.96
|
| Rate for Payer: Quartz Beloit One Network |
$1,286.23
|
| Rate for Payer: Quartz Commercial |
$1,706.22
|
| Rate for Payer: Quartz Medicare Advantage |
$1,574.98
|
| Rate for Payer: The Alliance Commercial |
$1,312.48
|
| Rate for Payer: WEA Trust Commercial |
$1,443.73
|
| Rate for Payer: WPS Commercial |
$1,944.24
|
|
|
Infusion Cath 10cm
|
Facility
|
IP
|
$2,524.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
2549128
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,286.23 |
| Max. Negotiated Rate |
$2,414.96 |
| Rate for Payer: Aetna Commercial |
$2,362.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,257.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,391.23
|
| Rate for Payer: Cash Price |
$757.20
|
| Rate for Payer: Cigna Commercial |
$2,414.96
|
| Rate for Payer: Health EOS Commercial |
$2,336.21
|
| Rate for Payer: HFN Commercial |
$2,414.96
|
| Rate for Payer: Multiplan Commercial |
$2,099.97
|
| Rate for Payer: Preferred Network Access Commercial |
$2,414.96
|
| Rate for Payer: Quartz Beloit One Network |
$1,286.23
|
| Rate for Payer: Quartz Commercial |
$1,574.98
|
| Rate for Payer: WEA Trust Commercial |
$1,443.73
|
| Rate for Payer: WPS Commercial |
$1,944.24
|
|
|
Infusion Cath 10cm
|
Professional
|
Both
|
$2,524.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
2549128
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,154.98 |
| Max. Negotiated Rate |
$2,493.71 |
| Rate for Payer: Aetna Commercial |
$2,493.71
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,257.47
|
| Rate for Payer: Cash Price |
$757.20
|
| Rate for Payer: Cigna Commercial |
$2,493.71
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,312.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,574.98
|
| Rate for Payer: Health EOS Commercial |
$2,388.71
|
| Rate for Payer: HFN Commercial |
$2,493.71
|
| Rate for Payer: Multiplan Commercial |
$2,099.97
|
| Rate for Payer: Preferred Network Access Commercial |
$2,493.71
|
| Rate for Payer: Quartz Beloit One Network |
$1,154.98
|
| Rate for Payer: Quartz Commercial |
$1,496.23
|
| Rate for Payer: The Alliance Commercial |
$1,312.48
|
| Rate for Payer: WEA Trust Commercial |
$1,443.73
|
| Rate for Payer: WPS Commercial |
$1,944.24
|
|
|
Infusion Cath 20cm
|
Facility
|
OP
|
$2,524.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
2549130
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$734.99 |
| Max. Negotiated Rate |
$2,414.96 |
| Rate for Payer: Aetna Commercial |
$2,362.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,257.47
|
| Rate for Payer: Aetna Managed Medicare |
$734.99
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,706.22
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,312.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,259.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,391.23
|
| Rate for Payer: Cash Price |
$757.20
|
| Rate for Payer: Cigna Commercial |
$2,414.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,468.97
|
| Rate for Payer: Health EOS Commercial |
$2,336.21
|
| Rate for Payer: HFN Commercial |
$2,414.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,968.72
|
| Rate for Payer: Multiplan Commercial |
$2,099.97
|
| Rate for Payer: NAPHCARE Commercial |
$1,574.98
|
| Rate for Payer: Preferred Network Access Commercial |
$2,414.96
|
| Rate for Payer: Quartz Beloit One Network |
$1,286.23
|
| Rate for Payer: Quartz Commercial |
$1,706.22
|
| Rate for Payer: Quartz Medicare Advantage |
$1,574.98
|
| Rate for Payer: The Alliance Commercial |
$1,312.48
|
| Rate for Payer: WEA Trust Commercial |
$1,443.73
|
| Rate for Payer: WPS Commercial |
$1,944.24
|
|
|
Infusion Cath 20cm
|
Facility
|
IP
|
$2,524.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
2549130
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,286.23 |
| Max. Negotiated Rate |
$2,414.96 |
| Rate for Payer: Aetna Commercial |
$2,362.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,257.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,391.23
|
| Rate for Payer: Cash Price |
$757.20
|
| Rate for Payer: Cigna Commercial |
$2,414.96
|
| Rate for Payer: Health EOS Commercial |
$2,336.21
|
| Rate for Payer: HFN Commercial |
$2,414.96
|
| Rate for Payer: Multiplan Commercial |
$2,099.97
|
| Rate for Payer: Preferred Network Access Commercial |
$2,414.96
|
| Rate for Payer: Quartz Beloit One Network |
$1,286.23
|
| Rate for Payer: Quartz Commercial |
$1,574.98
|
| Rate for Payer: WEA Trust Commercial |
$1,443.73
|
| Rate for Payer: WPS Commercial |
$1,944.24
|
|
|
Infusion Cath 20cm
|
Professional
|
Both
|
$2,524.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
2549130
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,154.98 |
| Max. Negotiated Rate |
$2,493.71 |
| Rate for Payer: Aetna Commercial |
$2,493.71
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,257.47
|
| Rate for Payer: Cash Price |
$757.20
|
| Rate for Payer: Cigna Commercial |
$2,493.71
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,312.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,574.98
|
| Rate for Payer: Health EOS Commercial |
$2,388.71
|
| Rate for Payer: HFN Commercial |
$2,493.71
|
| Rate for Payer: Multiplan Commercial |
$2,099.97
|
| Rate for Payer: Preferred Network Access Commercial |
$2,493.71
|
| Rate for Payer: Quartz Beloit One Network |
$1,154.98
|
| Rate for Payer: Quartz Commercial |
$1,496.23
|
| Rate for Payer: The Alliance Commercial |
$1,312.48
|
| Rate for Payer: WEA Trust Commercial |
$1,443.73
|
| Rate for Payer: WPS Commercial |
$1,944.24
|
|
|
Infusion Cath 5cm
|
Professional
|
Both
|
$2,524.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
2549126
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,154.98 |
| Max. Negotiated Rate |
$2,493.71 |
| Rate for Payer: Aetna Commercial |
$2,493.71
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,257.47
|
| Rate for Payer: Cash Price |
$757.20
|
| Rate for Payer: Cigna Commercial |
$2,493.71
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,312.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,574.98
|
| Rate for Payer: Health EOS Commercial |
$2,388.71
|
| Rate for Payer: HFN Commercial |
$2,493.71
|
| Rate for Payer: Multiplan Commercial |
$2,099.97
|
| Rate for Payer: Preferred Network Access Commercial |
$2,493.71
|
| Rate for Payer: Quartz Beloit One Network |
$1,154.98
|
| Rate for Payer: Quartz Commercial |
$1,496.23
|
| Rate for Payer: The Alliance Commercial |
$1,312.48
|
| Rate for Payer: WEA Trust Commercial |
$1,443.73
|
| Rate for Payer: WPS Commercial |
$1,944.24
|
|
|
Infusion Cath 5cm
|
Facility
|
IP
|
$2,524.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
2549126
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,286.23 |
| Max. Negotiated Rate |
$2,414.96 |
| Rate for Payer: Aetna Commercial |
$2,362.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,257.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,391.23
|
| Rate for Payer: Cash Price |
$757.20
|
| Rate for Payer: Cigna Commercial |
$2,414.96
|
| Rate for Payer: Health EOS Commercial |
$2,336.21
|
| Rate for Payer: HFN Commercial |
$2,414.96
|
| Rate for Payer: Multiplan Commercial |
$2,099.97
|
| Rate for Payer: Preferred Network Access Commercial |
$2,414.96
|
| Rate for Payer: Quartz Beloit One Network |
$1,286.23
|
| Rate for Payer: Quartz Commercial |
$1,574.98
|
| Rate for Payer: WEA Trust Commercial |
$1,443.73
|
| Rate for Payer: WPS Commercial |
$1,944.24
|
|
|
Infusion Cath 5cm
|
Facility
|
OP
|
$2,524.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
2549126
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$734.99 |
| Max. Negotiated Rate |
$2,414.96 |
| Rate for Payer: Aetna Commercial |
$2,362.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,257.47
|
| Rate for Payer: Aetna Managed Medicare |
$734.99
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,706.22
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,312.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,259.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,391.23
|
| Rate for Payer: Cash Price |
$757.20
|
| Rate for Payer: Cigna Commercial |
$2,414.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,468.97
|
| Rate for Payer: Health EOS Commercial |
$2,336.21
|
| Rate for Payer: HFN Commercial |
$2,414.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,968.72
|
| Rate for Payer: Multiplan Commercial |
$2,099.97
|
| Rate for Payer: NAPHCARE Commercial |
$1,574.98
|
| Rate for Payer: Preferred Network Access Commercial |
$2,414.96
|
| Rate for Payer: Quartz Beloit One Network |
$1,286.23
|
| Rate for Payer: Quartz Commercial |
$1,706.22
|
| Rate for Payer: Quartz Medicare Advantage |
$1,574.98
|
| Rate for Payer: The Alliance Commercial |
$1,312.48
|
| Rate for Payer: WEA Trust Commercial |
$1,443.73
|
| Rate for Payer: WPS Commercial |
$1,944.24
|
|
|
Infusion Catheter-180cm
|
Facility
|
IP
|
$2,748.00
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
4139305
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,400.38 |
| Max. Negotiated Rate |
$2,629.29 |
| Rate for Payer: Aetna Commercial |
$2,572.13
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,457.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,514.70
|
| Rate for Payer: Cash Price |
$824.40
|
| Rate for Payer: Cigna Commercial |
$2,629.29
|
| Rate for Payer: Health EOS Commercial |
$2,543.55
|
| Rate for Payer: HFN Commercial |
$2,629.29
|
| Rate for Payer: Multiplan Commercial |
$2,286.34
|
| Rate for Payer: Preferred Network Access Commercial |
$2,629.29
|
| Rate for Payer: Quartz Beloit One Network |
$1,400.38
|
| Rate for Payer: Quartz Commercial |
$1,714.75
|
| Rate for Payer: WEA Trust Commercial |
$1,571.86
|
| Rate for Payer: WPS Commercial |
$2,116.78
|
|
|
Infusion Catheter-180cm
|
Facility
|
OP
|
$2,748.00
|
|
|
Service Code
|
HCPCS C1751
|
| Hospital Charge Code |
4139305
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$800.22 |
| Max. Negotiated Rate |
$2,629.29 |
| Rate for Payer: Aetna Commercial |
$2,572.13
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,457.81
|
| Rate for Payer: Aetna Managed Medicare |
$800.22
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,857.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,428.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,371.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,514.70
|
| Rate for Payer: Cash Price |
$824.40
|
| Rate for Payer: Cigna Commercial |
$2,629.29
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,599.34
|
| Rate for Payer: Health EOS Commercial |
$2,543.55
|
| Rate for Payer: HFN Commercial |
$2,629.29
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,143.44
|
| Rate for Payer: Multiplan Commercial |
$2,286.34
|
| Rate for Payer: NAPHCARE Commercial |
$1,714.75
|
| Rate for Payer: Preferred Network Access Commercial |
$2,629.29
|
| Rate for Payer: Quartz Beloit One Network |
$1,400.38
|
| Rate for Payer: Quartz Commercial |
$1,857.65
|
| Rate for Payer: Quartz Medicare Advantage |
$1,714.75
|
| Rate for Payer: The Alliance Commercial |
$1,428.96
|
| Rate for Payer: WEA Trust Commercial |
$1,571.86
|
| Rate for Payer: WPS Commercial |
$2,116.78
|
|
|
INFUSION CATHETER 5FR 10CM
|
Facility
|
IP
|
$2,524.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
2972385
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,286.23 |
| Max. Negotiated Rate |
$2,414.96 |
| Rate for Payer: Aetna Commercial |
$2,362.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,257.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,391.23
|
| Rate for Payer: Cash Price |
$757.20
|
| Rate for Payer: Cigna Commercial |
$2,414.96
|
| Rate for Payer: Health EOS Commercial |
$2,336.21
|
| Rate for Payer: HFN Commercial |
$2,414.96
|
| Rate for Payer: Multiplan Commercial |
$2,099.97
|
| Rate for Payer: Preferred Network Access Commercial |
$2,414.96
|
| Rate for Payer: Quartz Beloit One Network |
$1,286.23
|
| Rate for Payer: Quartz Commercial |
$1,574.98
|
| Rate for Payer: WEA Trust Commercial |
$1,443.73
|
| Rate for Payer: WPS Commercial |
$1,944.24
|
|
