|
AQUINOX DISPOSABLE #26-P50000
|
Facility
IP
|
$642.00
|
|
| Hospital Charge Code |
2973418
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$314.58 |
| Max. Negotiated Rate |
$590.64 |
| Rate for Payer: Aetna Commercial |
$577.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$340.26
|
| Rate for Payer: Cash Price |
$192.60
|
| Rate for Payer: Cigna Commercial |
$590.64
|
| Rate for Payer: Health EOS Commercial |
$571.38
|
| Rate for Payer: HFN Commercial |
$590.64
|
| Rate for Payer: Multiplan Commercial |
$513.60
|
| Rate for Payer: NAPHCARE Commercial |
$385.20
|
| Rate for Payer: Preferred Network Access Commercial |
$590.64
|
| Rate for Payer: Quartz Beloit One Network |
$314.58
|
| Rate for Payer: Quartz Commercial |
$385.20
|
| Rate for Payer: WEA Trust Commercial |
$353.10
|
| Rate for Payer: WPS Commercial |
$475.53
|
|
|
Aranesp Administration 100mcg (Dialysis)
|
Facility
IP
|
$3,071.00
|
|
|
Service Code
|
HCPCS J0882 JA
|
| Hospital Charge Code |
3005566
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,504.79 |
| Max. Negotiated Rate |
$2,825.32 |
| Rate for Payer: Aetna Commercial |
$2,763.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,627.63
|
| Rate for Payer: Cash Price |
$921.30
|
| Rate for Payer: Cigna Commercial |
$2,825.32
|
| Rate for Payer: Health EOS Commercial |
$2,733.19
|
| Rate for Payer: HFN Commercial |
$2,825.32
|
| Rate for Payer: Multiplan Commercial |
$2,456.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,842.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,825.32
|
| Rate for Payer: Quartz Beloit One Network |
$1,504.79
|
| Rate for Payer: Quartz Commercial |
$1,842.60
|
| Rate for Payer: WEA Trust Commercial |
$1,689.05
|
| Rate for Payer: WPS Commercial |
$2,274.69
|
|
|
Aranesp Administration 100mcg (Dialysis)
|
Facility
OP
|
$3,071.00
|
|
|
Service Code
|
HCPCS J0882 JA
|
| Hospital Charge Code |
3005566
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$859.88 |
| Max. Negotiated Rate |
$12,284.00 |
| Rate for Payer: Aetna Commercial |
$2,763.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,641.06
|
| Rate for Payer: Aetna Managed Medicare |
$859.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,996.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,535.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,474.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,627.63
|
| Rate for Payer: Cash Price |
$921.30
|
| Rate for Payer: Cigna Commercial |
$2,825.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,718.53
|
| Rate for Payer: Health EOS Commercial |
$2,733.19
|
| Rate for Payer: HFN Commercial |
$2,825.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,303.25
|
| Rate for Payer: Multiplan Commercial |
$2,456.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,842.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,825.32
|
| Rate for Payer: Quartz Beloit One Network |
$1,504.79
|
| Rate for Payer: Quartz Commercial |
$1,996.15
|
| Rate for Payer: Quartz Medicare Advantage |
$1,842.60
|
| Rate for Payer: The Alliance Commercial |
$12,284.00
|
| Rate for Payer: WEA Trust Commercial |
$1,689.05
|
| Rate for Payer: WPS Commercial |
$2,274.69
|
|
|
Aranesp Administration 100mcg (Peritoneal Dialysis)
|
Facility
IP
|
$3,071.00
|
|
|
Service Code
|
HCPCS J0882 JB
|
| Hospital Charge Code |
3026465
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,504.79 |
| Max. Negotiated Rate |
$2,825.32 |
| Rate for Payer: Aetna Commercial |
$2,763.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,627.63
|
| Rate for Payer: Cash Price |
$921.30
|
| Rate for Payer: Cigna Commercial |
$2,825.32
|
| Rate for Payer: Health EOS Commercial |
$2,733.19
|
| Rate for Payer: HFN Commercial |
$2,825.32
|
| Rate for Payer: Multiplan Commercial |
$2,456.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,842.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,825.32
|
| Rate for Payer: Quartz Beloit One Network |
$1,504.79
|
| Rate for Payer: Quartz Commercial |
$1,842.60
|
| Rate for Payer: WEA Trust Commercial |
$1,689.05
|
| Rate for Payer: WPS Commercial |
$2,274.69
|
|
|
Aranesp Administration 100mcg (Peritoneal Dialysis)
|
Facility
OP
|
$3,071.00
|
|
|
Service Code
|
HCPCS J0882 JB
|
| Hospital Charge Code |
3026465
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$859.88 |
| Max. Negotiated Rate |
$12,284.00 |
| Rate for Payer: Aetna Commercial |
$2,763.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,641.06
|
| Rate for Payer: Aetna Managed Medicare |
$859.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,996.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,535.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,474.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,627.63
|
| Rate for Payer: Cash Price |
$921.30
|
| Rate for Payer: Cigna Commercial |
$2,825.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,718.53
|
| Rate for Payer: Health EOS Commercial |
$2,733.19
|
| Rate for Payer: HFN Commercial |
$2,825.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,303.25
|
| Rate for Payer: Multiplan Commercial |
$2,456.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,842.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,825.32
|
| Rate for Payer: Quartz Beloit One Network |
$1,504.79
|
| Rate for Payer: Quartz Commercial |
$1,996.15
|
| Rate for Payer: Quartz Medicare Advantage |
$1,842.60
|
| Rate for Payer: The Alliance Commercial |
$12,284.00
|
| Rate for Payer: WEA Trust Commercial |
$1,689.05
|
| Rate for Payer: WPS Commercial |
$2,274.69
|
|
|
Aranesp Administration 25mcq (Dialysis)
|
Facility
IP
|
$1,216.00
|
|
|
Service Code
|
HCPCS J0882 JA
|
| Hospital Charge Code |
3005568
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$595.84 |
| Max. Negotiated Rate |
$1,118.72 |
| Rate for Payer: Aetna Commercial |
$1,094.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$644.48
|
| Rate for Payer: Cash Price |
$364.80
|
| Rate for Payer: Cigna Commercial |
$1,118.72
|
| Rate for Payer: Health EOS Commercial |
$1,082.24
|
| Rate for Payer: HFN Commercial |
$1,118.72
|
| Rate for Payer: Multiplan Commercial |
$972.80
|
| Rate for Payer: NAPHCARE Commercial |
$729.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,118.72
|
| Rate for Payer: Quartz Beloit One Network |
$595.84
|
| Rate for Payer: Quartz Commercial |
$729.60
|
| Rate for Payer: WEA Trust Commercial |
$668.80
|
| Rate for Payer: WPS Commercial |
$900.69
|
|
|
Aranesp Administration 25mcq (Dialysis)
|
Facility
OP
|
$1,216.00
|
|
|
Service Code
|
HCPCS J0882 JA
|
| Hospital Charge Code |
3005568
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$340.48 |
| Max. Negotiated Rate |
$4,864.00 |
| Rate for Payer: Aetna Commercial |
$1,094.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,045.76
|
| Rate for Payer: Aetna Managed Medicare |
$340.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$790.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$608.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$583.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$644.48
|
| Rate for Payer: Cash Price |
$364.80
|
| Rate for Payer: Cigna Commercial |
$1,118.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$680.47
|
| Rate for Payer: Health EOS Commercial |
$1,082.24
|
| Rate for Payer: HFN Commercial |
$1,118.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$912.00
|
| Rate for Payer: Multiplan Commercial |
$972.80
|
| Rate for Payer: NAPHCARE Commercial |
$729.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,118.72
|
| Rate for Payer: Quartz Beloit One Network |
$595.84
|
| Rate for Payer: Quartz Commercial |
$790.40
|
| Rate for Payer: Quartz Medicare Advantage |
$729.60
|
| Rate for Payer: The Alliance Commercial |
$4,864.00
|
| Rate for Payer: WEA Trust Commercial |
$668.80
|
| Rate for Payer: WPS Commercial |
$900.69
|
|
|
Aranesp Administration 25mcq (Peritoneal Dialysis)
|
Facility
OP
|
$1,240.00
|
|
|
Service Code
|
HCPCS J0882 JB
|
| Hospital Charge Code |
3026467
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$347.20 |
| Max. Negotiated Rate |
$4,960.00 |
| Rate for Payer: Aetna Commercial |
$1,116.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,066.40
|
| Rate for Payer: Aetna Managed Medicare |
$347.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$806.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$620.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$595.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$657.20
|
| Rate for Payer: Cash Price |
$372.00
|
| Rate for Payer: Cigna Commercial |
$1,140.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$693.90
|
| Rate for Payer: Health EOS Commercial |
$1,103.60
|
| Rate for Payer: HFN Commercial |
$1,140.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$930.00
|
| Rate for Payer: Multiplan Commercial |
$992.00
|
| Rate for Payer: NAPHCARE Commercial |
$744.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,140.80
|
| Rate for Payer: Quartz Beloit One Network |
$607.60
|
| Rate for Payer: Quartz Commercial |
$806.00
|
| Rate for Payer: Quartz Medicare Advantage |
$744.00
|
| Rate for Payer: The Alliance Commercial |
$4,960.00
|
| Rate for Payer: WEA Trust Commercial |
$682.00
|
| Rate for Payer: WPS Commercial |
$918.47
|
|
|
Aranesp Administration 25mcq (Peritoneal Dialysis)
|
Facility
IP
|
$1,240.00
|
|
|
Service Code
|
HCPCS J0882 JB
|
| Hospital Charge Code |
3026467
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$607.60 |
| Max. Negotiated Rate |
$1,140.80 |
| Rate for Payer: Aetna Commercial |
$1,116.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$657.20
|
| Rate for Payer: Cash Price |
$372.00
|
| Rate for Payer: Cigna Commercial |
$1,140.80
|
| Rate for Payer: Health EOS Commercial |
$1,103.60
|
| Rate for Payer: HFN Commercial |
$1,140.80
|
| Rate for Payer: Multiplan Commercial |
$992.00
|
| Rate for Payer: NAPHCARE Commercial |
$744.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,140.80
|
| Rate for Payer: Quartz Beloit One Network |
$607.60
|
| Rate for Payer: Quartz Commercial |
$744.00
|
| Rate for Payer: WEA Trust Commercial |
$682.00
|
| Rate for Payer: WPS Commercial |
$918.47
|
|
|
Aranesp Administration 40mcq (Dialysis)
|
Facility
OP
|
$1,945.00
|
|
|
Service Code
|
HCPCS J0882 JA
|
| Hospital Charge Code |
3005569
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$544.60 |
| Max. Negotiated Rate |
$7,780.00 |
| Rate for Payer: Aetna Commercial |
$1,750.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,672.70
|
| Rate for Payer: Aetna Managed Medicare |
$544.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,264.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$972.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$933.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,030.85
|
| Rate for Payer: Cash Price |
$583.50
|
| Rate for Payer: Cigna Commercial |
$1,789.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,088.42
|
| Rate for Payer: Health EOS Commercial |
$1,731.05
|
| Rate for Payer: HFN Commercial |
$1,789.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,458.75
|
| Rate for Payer: Multiplan Commercial |
$1,556.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,167.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,789.40
|
| Rate for Payer: Quartz Beloit One Network |
$953.05
|
| Rate for Payer: Quartz Commercial |
$1,264.25
|
| Rate for Payer: Quartz Medicare Advantage |
$1,167.00
|
| Rate for Payer: The Alliance Commercial |
$7,780.00
|
| Rate for Payer: WEA Trust Commercial |
$1,069.75
|
| Rate for Payer: WPS Commercial |
$1,440.66
|
|
|
Aranesp Administration 40mcq (Dialysis)
|
Facility
IP
|
$1,945.00
|
|
|
Service Code
|
HCPCS J0882 JA
|
| Hospital Charge Code |
3005569
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$953.05 |
| Max. Negotiated Rate |
$1,789.40 |
| Rate for Payer: Aetna Commercial |
$1,750.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,030.85
|
| Rate for Payer: Cash Price |
$583.50
|
| Rate for Payer: Cigna Commercial |
$1,789.40
|
| Rate for Payer: Health EOS Commercial |
$1,731.05
|
| Rate for Payer: HFN Commercial |
$1,789.40
|
| Rate for Payer: Multiplan Commercial |
$1,556.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,167.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,789.40
|
| Rate for Payer: Quartz Beloit One Network |
$953.05
|
| Rate for Payer: Quartz Commercial |
$1,167.00
|
| Rate for Payer: WEA Trust Commercial |
$1,069.75
|
| Rate for Payer: WPS Commercial |
$1,440.66
|
|
|
Aranesp Administration 40mcq (Peritoneal Dialysis)
|
Facility
IP
|
$1,945.00
|
|
|
Service Code
|
HCPCS J0882 JB
|
| Hospital Charge Code |
3026468
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$953.05 |
| Max. Negotiated Rate |
$1,789.40 |
| Rate for Payer: Aetna Commercial |
$1,750.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,030.85
|
| Rate for Payer: Cash Price |
$583.50
|
| Rate for Payer: Cigna Commercial |
$1,789.40
|
| Rate for Payer: Health EOS Commercial |
$1,731.05
|
| Rate for Payer: HFN Commercial |
$1,789.40
|
| Rate for Payer: Multiplan Commercial |
$1,556.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,167.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,789.40
|
| Rate for Payer: Quartz Beloit One Network |
$953.05
|
| Rate for Payer: Quartz Commercial |
$1,167.00
|
| Rate for Payer: WEA Trust Commercial |
$1,069.75
|
| Rate for Payer: WPS Commercial |
$1,440.66
|
|
|
Aranesp Administration 40mcq (Peritoneal Dialysis)
|
Facility
OP
|
$1,945.00
|
|
|
Service Code
|
HCPCS J0882 JB
|
| Hospital Charge Code |
3026468
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$544.60 |
| Max. Negotiated Rate |
$7,780.00 |
| Rate for Payer: Aetna Commercial |
$1,750.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,672.70
|
| Rate for Payer: Aetna Managed Medicare |
$544.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,264.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$972.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$933.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,030.85
|
| Rate for Payer: Cash Price |
$583.50
|
| Rate for Payer: Cigna Commercial |
$1,789.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,088.42
|
| Rate for Payer: Health EOS Commercial |
$1,731.05
|
| Rate for Payer: HFN Commercial |
$1,789.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,458.75
|
| Rate for Payer: Multiplan Commercial |
$1,556.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,167.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,789.40
|
| Rate for Payer: Quartz Beloit One Network |
$953.05
|
| Rate for Payer: Quartz Commercial |
$1,264.25
|
| Rate for Payer: Quartz Medicare Advantage |
$1,167.00
|
| Rate for Payer: The Alliance Commercial |
$7,780.00
|
| Rate for Payer: WEA Trust Commercial |
$1,069.75
|
| Rate for Payer: WPS Commercial |
$1,440.66
|
|
|
Aranesp Administration 60mcq (Dialysis)
|
Facility
OP
|
$1,843.00
|
|
|
Service Code
|
HCPCS J0882 JA
|
| Hospital Charge Code |
3005567
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$516.04 |
| Max. Negotiated Rate |
$7,372.00 |
| Rate for Payer: Aetna Commercial |
$1,658.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,584.98
|
| Rate for Payer: Aetna Managed Medicare |
$516.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,197.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$921.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$884.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$976.79
|
| Rate for Payer: Cash Price |
$552.90
|
| Rate for Payer: Cigna Commercial |
$1,695.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,031.34
|
| Rate for Payer: Health EOS Commercial |
$1,640.27
|
| Rate for Payer: HFN Commercial |
$1,695.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,382.25
|
| Rate for Payer: Multiplan Commercial |
$1,474.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,105.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,695.56
|
| Rate for Payer: Quartz Beloit One Network |
$903.07
|
| Rate for Payer: Quartz Commercial |
$1,197.95
|
| Rate for Payer: Quartz Medicare Advantage |
$1,105.80
|
| Rate for Payer: The Alliance Commercial |
$7,372.00
|
| Rate for Payer: WEA Trust Commercial |
$1,013.65
|
| Rate for Payer: WPS Commercial |
$1,365.11
|
|
|
Aranesp Administration 60mcq (Dialysis)
|
Facility
IP
|
$1,843.00
|
|
|
Service Code
|
HCPCS J0882 JA
|
| Hospital Charge Code |
3005567
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$903.07 |
| Max. Negotiated Rate |
$1,695.56 |
| Rate for Payer: Aetna Commercial |
$1,658.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$976.79
|
| Rate for Payer: Cash Price |
$552.90
|
| Rate for Payer: Cigna Commercial |
$1,695.56
|
| Rate for Payer: Health EOS Commercial |
$1,640.27
|
| Rate for Payer: HFN Commercial |
$1,695.56
|
| Rate for Payer: Multiplan Commercial |
$1,474.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,105.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,695.56
|
| Rate for Payer: Quartz Beloit One Network |
$903.07
|
| Rate for Payer: Quartz Commercial |
$1,105.80
|
| Rate for Payer: WEA Trust Commercial |
$1,013.65
|
| Rate for Payer: WPS Commercial |
$1,365.11
|
|
|
Aranesp Administration 60mcq (Peritoneal Dialysis)
|
Facility
OP
|
$1,843.00
|
|
|
Service Code
|
HCPCS J0882 JB
|
| Hospital Charge Code |
3026466
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$516.04 |
| Max. Negotiated Rate |
$7,372.00 |
| Rate for Payer: Aetna Commercial |
$1,658.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,584.98
|
| Rate for Payer: Aetna Managed Medicare |
$516.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,197.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$921.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$884.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$976.79
|
| Rate for Payer: Cash Price |
$552.90
|
| Rate for Payer: Cigna Commercial |
$1,695.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,031.34
|
| Rate for Payer: Health EOS Commercial |
$1,640.27
|
| Rate for Payer: HFN Commercial |
$1,695.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,382.25
|
| Rate for Payer: Multiplan Commercial |
$1,474.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,105.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,695.56
|
| Rate for Payer: Quartz Beloit One Network |
$903.07
|
| Rate for Payer: Quartz Commercial |
$1,197.95
|
| Rate for Payer: Quartz Medicare Advantage |
$1,105.80
|
| Rate for Payer: The Alliance Commercial |
$7,372.00
|
| Rate for Payer: WEA Trust Commercial |
$1,013.65
|
| Rate for Payer: WPS Commercial |
$1,365.11
|
|
|
Aranesp Administration 60mcq (Peritoneal Dialysis)
|
Facility
IP
|
$1,843.00
|
|
|
Service Code
|
HCPCS J0882 JB
|
| Hospital Charge Code |
3026466
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$903.07 |
| Max. Negotiated Rate |
$1,695.56 |
| Rate for Payer: Aetna Commercial |
$1,658.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$976.79
|
| Rate for Payer: Cash Price |
$552.90
|
| Rate for Payer: Cigna Commercial |
$1,695.56
|
| Rate for Payer: Health EOS Commercial |
$1,640.27
|
| Rate for Payer: HFN Commercial |
$1,695.56
|
| Rate for Payer: Multiplan Commercial |
$1,474.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,105.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,695.56
|
| Rate for Payer: Quartz Beloit One Network |
$903.07
|
| Rate for Payer: Quartz Commercial |
$1,105.80
|
| Rate for Payer: WEA Trust Commercial |
$1,013.65
|
| Rate for Payer: WPS Commercial |
$1,365.11
|
|
|
ARBC CPD AS5 500
|
Facility
OP
|
$435.00
|
|
|
Service Code
|
HCPCS P9021
|
| Hospital Charge Code |
1052863
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$141.61 |
| Max. Negotiated Rate |
$2,042.72 |
| Rate for Payer: Aetna Commercial |
$391.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$374.10
|
| Rate for Payer: Aetna Managed Medicare |
$141.61
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$282.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$217.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$208.80
|
| Rate for Payer: Anthem Medicare Advantage |
$141.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$230.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$141.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$141.61
|
| Rate for Payer: Cash Price |
$130.50
|
| Rate for Payer: Cash Price |
$130.50
|
| Rate for Payer: Cigna Commercial |
$400.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$141.61
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$243.43
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$141.61
|
| Rate for Payer: Health EOS Commercial |
$387.15
|
| Rate for Payer: HFN Commercial |
$400.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$526.79
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$141.61
|
| Rate for Payer: Independent Care Health Plan Medicare |
$141.61
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$141.61
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$141.61
|
| Rate for Payer: Multiplan Commercial |
$348.00
|
| Rate for Payer: NAPHCARE Commercial |
$212.42
|
| Rate for Payer: Preferred Network Access Commercial |
$400.20
|
| Rate for Payer: Quartz Beloit One Network |
$213.15
|
| Rate for Payer: Quartz Commercial |
$282.75
|
| Rate for Payer: Quartz Medicare Advantage |
$141.61
|
| Rate for Payer: The Alliance Commercial |
$2,042.72
|
| Rate for Payer: United Healthcare Medicare Advantage |
$141.61
|
| Rate for Payer: United Healthcare PPO |
$326.25
|
| Rate for Payer: WEA Trust Commercial |
$239.25
|
| Rate for Payer: Wellcare Medicare |
$141.61
|
| Rate for Payer: WPS Commercial |
$322.20
|
|
|
ARBC CPD AS5 500
|
Facility
IP
|
$435.00
|
|
|
Service Code
|
HCPCS P9021
|
| Hospital Charge Code |
1052863
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$213.15 |
| Max. Negotiated Rate |
$400.20 |
| Rate for Payer: Aetna Commercial |
$391.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$230.55
|
| Rate for Payer: Cash Price |
$130.50
|
| Rate for Payer: Cigna Commercial |
$400.20
|
| Rate for Payer: Health EOS Commercial |
$387.15
|
| Rate for Payer: HFN Commercial |
$400.20
|
| Rate for Payer: Multiplan Commercial |
$348.00
|
| Rate for Payer: NAPHCARE Commercial |
$261.00
|
| Rate for Payer: Preferred Network Access Commercial |
$400.20
|
| Rate for Payer: Quartz Beloit One Network |
$213.15
|
| Rate for Payer: Quartz Commercial |
$261.00
|
| Rate for Payer: WEA Trust Commercial |
$239.25
|
| Rate for Payer: WPS Commercial |
$322.20
|
|
|
ARBC CPD AS5 LV
|
Facility
IP
|
$435.00
|
|
|
Service Code
|
HCPCS P9021
|
| Hospital Charge Code |
1052820
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$213.15 |
| Max. Negotiated Rate |
$400.20 |
| Rate for Payer: Aetna Commercial |
$391.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$230.55
|
| Rate for Payer: Cash Price |
$130.50
|
| Rate for Payer: Cigna Commercial |
$400.20
|
| Rate for Payer: Health EOS Commercial |
$387.15
|
| Rate for Payer: HFN Commercial |
$400.20
|
| Rate for Payer: Multiplan Commercial |
$348.00
|
| Rate for Payer: NAPHCARE Commercial |
$261.00
|
| Rate for Payer: Preferred Network Access Commercial |
$400.20
|
| Rate for Payer: Quartz Beloit One Network |
$213.15
|
| Rate for Payer: Quartz Commercial |
$261.00
|
| Rate for Payer: WEA Trust Commercial |
$239.25
|
| Rate for Payer: WPS Commercial |
$322.20
|
|
|
ARBC CPD AS5 LV
|
Facility
OP
|
$435.00
|
|
|
Service Code
|
HCPCS P9021
|
| Hospital Charge Code |
1052820
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$141.61 |
| Max. Negotiated Rate |
$2,042.72 |
| Rate for Payer: Aetna Commercial |
$391.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$374.10
|
| Rate for Payer: Aetna Managed Medicare |
$141.61
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$282.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$217.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$208.80
|
| Rate for Payer: Anthem Medicare Advantage |
$141.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$230.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$141.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$141.61
|
| Rate for Payer: Cash Price |
$130.50
|
| Rate for Payer: Cash Price |
$130.50
|
| Rate for Payer: Cigna Commercial |
$400.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$141.61
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$243.43
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$141.61
|
| Rate for Payer: Health EOS Commercial |
$387.15
|
| Rate for Payer: HFN Commercial |
$400.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$526.79
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$141.61
|
| Rate for Payer: Independent Care Health Plan Medicare |
$141.61
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$141.61
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$141.61
|
| Rate for Payer: Multiplan Commercial |
$348.00
|
| Rate for Payer: NAPHCARE Commercial |
$212.42
|
| Rate for Payer: Preferred Network Access Commercial |
$400.20
|
| Rate for Payer: Quartz Beloit One Network |
$213.15
|
| Rate for Payer: Quartz Commercial |
$282.75
|
| Rate for Payer: Quartz Medicare Advantage |
$141.61
|
| Rate for Payer: The Alliance Commercial |
$2,042.72
|
| Rate for Payer: United Healthcare Medicare Advantage |
$141.61
|
| Rate for Payer: United Healthcare PPO |
$326.25
|
| Rate for Payer: WEA Trust Commercial |
$239.25
|
| Rate for Payer: Wellcare Medicare |
$141.61
|
| Rate for Payer: WPS Commercial |
$322.20
|
|
|
Arbovirus Ab Panel, IFA, CSF
|
Professional
|
$438.03
|
|
|
Service Code
|
CPT 86651
|
| Hospital Charge Code |
4916625
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.19 |
| Max. Negotiated Rate |
$416.13 |
| Rate for Payer: Aetna Commercial |
$416.13
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$376.71
|
| Rate for Payer: Aetna Managed Medicare |
$13.19
|
| Rate for Payer: Anthem Medicare Advantage |
$13.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$13.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$13.19
|
| Rate for Payer: Cash Price |
$131.41
|
| Rate for Payer: Cash Price |
$131.41
|
| Rate for Payer: Cigna Commercial |
$416.13
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$219.02
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$13.19
|
| Rate for Payer: Health EOS Commercial |
$398.61
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$46.56
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$46.56
|
| Rate for Payer: Independent Care Health Plan Medicare |
$13.19
|
| Rate for Payer: Multiplan Commercial |
$350.42
|
| Rate for Payer: Preferred Network Access Commercial |
$416.13
|
| Rate for Payer: Quartz Beloit One Network |
$192.73
|
| Rate for Payer: Quartz Commercial |
$249.68
|
| Rate for Payer: Quartz Medicare Advantage |
$13.19
|
| Rate for Payer: The Alliance Commercial |
$52.10
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.19
|
| Rate for Payer: WEA Trust Commercial |
$240.92
|
| Rate for Payer: WPS Commercial |
$58.04
|
|
|
Arbovirus Ab Panel, IFA, CSF
|
Facility
OP
|
$438.02
|
|
|
Service Code
|
CPT 86651
|
| Hospital Charge Code |
4916625
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.17 |
| Max. Negotiated Rate |
$1,752.08 |
| Rate for Payer: Aetna Commercial |
$394.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$376.70
|
| Rate for Payer: Aetna Managed Medicare |
$13.19
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$49.46
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$23.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$21.90
|
| Rate for Payer: Anthem Medicaid |
$8.17
|
| Rate for Payer: Anthem Medicare Advantage |
$13.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$232.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$13.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$13.19
|
| Rate for Payer: Cash Price |
$131.41
|
| Rate for Payer: Cash Price |
$131.41
|
| Rate for Payer: Cigna Commercial |
$402.98
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$13.19
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$8.17
|
| Rate for Payer: Dean Health Medicaid |
$8.17
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$13.19
|
| Rate for Payer: Health EOS Commercial |
$389.84
|
| Rate for Payer: HFN Commercial |
$402.98
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$49.07
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$13.19
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$8.17
|
| Rate for Payer: Independent Care Health Plan Medicare |
$13.19
|
| Rate for Payer: Managed Health Services Medicaid |
$8.50
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$13.19
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$13.19
|
| Rate for Payer: Multiplan Commercial |
$350.42
|
| Rate for Payer: NAPHCARE Commercial |
$19.78
|
| Rate for Payer: Preferred Network Access Commercial |
$402.98
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$8.17
|
| Rate for Payer: Quartz Beloit One Network |
$214.63
|
| Rate for Payer: Quartz Commercial |
$284.71
|
| Rate for Payer: Quartz Medicare Advantage |
$13.19
|
| Rate for Payer: The Alliance Commercial |
$1,752.08
|
| Rate for Payer: United Healthcare Medicaid |
$8.17
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.19
|
| Rate for Payer: United Healthcare PPO |
$328.52
|
| Rate for Payer: WEA Trust Commercial |
$240.91
|
| Rate for Payer: Wellcare Medicare |
$13.19
|
| Rate for Payer: WMAP Medicaid |
$8.17
|
| Rate for Payer: WPS Commercial |
$324.44
|
|
|
Arbovirus Ab Panel, IFA, CSF
|
Facility
IP
|
$438.02
|
|
|
Service Code
|
CPT 86651
|
| Hospital Charge Code |
4916625
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$214.63 |
| Max. Negotiated Rate |
$402.98 |
| Rate for Payer: Aetna Commercial |
$394.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$232.15
|
| Rate for Payer: Cash Price |
$131.41
|
| Rate for Payer: Cigna Commercial |
$402.98
|
| Rate for Payer: Health EOS Commercial |
$389.84
|
| Rate for Payer: HFN Commercial |
$402.98
|
| Rate for Payer: Multiplan Commercial |
$350.42
|
| Rate for Payer: NAPHCARE Commercial |
$262.81
|
| Rate for Payer: Preferred Network Access Commercial |
$402.98
|
| Rate for Payer: Quartz Beloit One Network |
$214.63
|
| Rate for Payer: Quartz Commercial |
$262.81
|
| Rate for Payer: WEA Trust Commercial |
$240.91
|
| Rate for Payer: WPS Commercial |
$324.44
|
|
|
Arbovirus Antibody Panel IFA (IgG, IgM)
|
Facility
IP
|
$53.00
|
|
|
Service Code
|
CPT 86652
|
| Hospital Charge Code |
5547023
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$25.97 |
| Max. Negotiated Rate |
$48.76 |
| Rate for Payer: Aetna Commercial |
$47.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$28.09
|
| Rate for Payer: Cash Price |
$15.90
|
| Rate for Payer: Cigna Commercial |
$48.76
|
| Rate for Payer: Health EOS Commercial |
$47.17
|
| Rate for Payer: HFN Commercial |
$48.76
|
| Rate for Payer: Multiplan Commercial |
$42.40
|
| Rate for Payer: NAPHCARE Commercial |
$31.80
|
| Rate for Payer: Preferred Network Access Commercial |
$48.76
|
| Rate for Payer: Quartz Beloit One Network |
$25.97
|
| Rate for Payer: Quartz Commercial |
$31.80
|
| Rate for Payer: WEA Trust Commercial |
$29.15
|
| Rate for Payer: WPS Commercial |
$39.26
|
|
