|
AQUACEL AG ADVANTAGE 1X45CM 422301
|
Facility
|
OP
|
$31.00
|
|
|
Service Code
|
HCPCS A6199
|
| Hospital Charge Code |
2963871
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.68 |
| Max. Negotiated Rate |
$124.00 |
| Rate for Payer: Aetna Commercial |
$27.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$26.66
|
| Rate for Payer: Aetna Managed Medicare |
$8.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$20.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$15.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$14.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$16.43
|
| Rate for Payer: Cash Price |
$9.30
|
| Rate for Payer: Cigna Commercial |
$28.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$17.35
|
| Rate for Payer: Health EOS Commercial |
$27.59
|
| Rate for Payer: HFN Commercial |
$28.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$23.25
|
| Rate for Payer: Multiplan Commercial |
$24.80
|
| Rate for Payer: NAPHCARE Commercial |
$18.60
|
| Rate for Payer: Preferred Network Access Commercial |
$28.52
|
| Rate for Payer: Quartz Beloit One Network |
$15.19
|
| Rate for Payer: Quartz Commercial |
$20.15
|
| Rate for Payer: Quartz Medicare Advantage |
$18.60
|
| Rate for Payer: The Alliance Commercial |
$124.00
|
| Rate for Payer: WEA Trust Commercial |
$17.05
|
| Rate for Payer: WPS Commercial |
$22.96
|
|
|
AQUACEL DRESSING 2X2 420671
|
Facility
|
IP
|
$5.00
|
|
|
Service Code
|
HCPCS A6196
|
| Hospital Charge Code |
2973597
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.45 |
| Max. Negotiated Rate |
$4.60 |
| Rate for Payer: Aetna Commercial |
$4.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2.65
|
| Rate for Payer: Cash Price |
$1.50
|
| Rate for Payer: Cigna Commercial |
$4.60
|
| Rate for Payer: Health EOS Commercial |
$4.45
|
| Rate for Payer: HFN Commercial |
$4.60
|
| Rate for Payer: Multiplan Commercial |
$4.00
|
| Rate for Payer: NAPHCARE Commercial |
$3.00
|
| Rate for Payer: Preferred Network Access Commercial |
$4.60
|
| Rate for Payer: Quartz Beloit One Network |
$2.45
|
| Rate for Payer: Quartz Commercial |
$3.00
|
| Rate for Payer: WEA Trust Commercial |
$2.75
|
| Rate for Payer: WPS Commercial |
$3.70
|
|
|
AQUACEL DRESSING 2X2 420671
|
Facility
|
OP
|
$5.00
|
|
|
Service Code
|
HCPCS A6196
|
| Hospital Charge Code |
2973597
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.40 |
| Max. Negotiated Rate |
$20.00 |
| Rate for Payer: Aetna Commercial |
$4.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4.30
|
| Rate for Payer: Aetna Managed Medicare |
$1.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2.65
|
| Rate for Payer: Cash Price |
$1.50
|
| Rate for Payer: Cigna Commercial |
$4.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2.80
|
| Rate for Payer: Health EOS Commercial |
$4.45
|
| Rate for Payer: HFN Commercial |
$4.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3.75
|
| Rate for Payer: Multiplan Commercial |
$4.00
|
| Rate for Payer: NAPHCARE Commercial |
$3.00
|
| Rate for Payer: Preferred Network Access Commercial |
$4.60
|
| Rate for Payer: Quartz Beloit One Network |
$2.45
|
| Rate for Payer: Quartz Commercial |
$3.25
|
| Rate for Payer: Quartz Medicare Advantage |
$3.00
|
| Rate for Payer: The Alliance Commercial |
$20.00
|
| Rate for Payer: WEA Trust Commercial |
$2.75
|
| Rate for Payer: WPS Commercial |
$3.70
|
|
|
AQUACEL EXTRA 10CM X 12CM/4 IN X 5 IN HYDROFIBER 420674
|
Facility
|
OP
|
$131.00
|
|
|
Service Code
|
HCPCS A6197
|
| Hospital Charge Code |
2963585
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$36.68 |
| Max. Negotiated Rate |
$524.00 |
| Rate for Payer: Aetna Commercial |
$117.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$112.66
|
| Rate for Payer: Aetna Managed Medicare |
$36.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$85.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$65.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$62.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$69.43
|
| Rate for Payer: Cash Price |
$39.30
|
| Rate for Payer: Cigna Commercial |
$120.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$73.31
|
| Rate for Payer: Health EOS Commercial |
$116.59
|
| Rate for Payer: HFN Commercial |
$120.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$98.25
|
| Rate for Payer: Multiplan Commercial |
$104.80
|
| Rate for Payer: NAPHCARE Commercial |
$78.60
|
| Rate for Payer: Preferred Network Access Commercial |
$120.52
|
| Rate for Payer: Quartz Beloit One Network |
$64.19
|
| Rate for Payer: Quartz Commercial |
$85.15
|
| Rate for Payer: Quartz Medicare Advantage |
$78.60
|
| Rate for Payer: The Alliance Commercial |
$524.00
|
| Rate for Payer: WEA Trust Commercial |
$72.05
|
| Rate for Payer: WPS Commercial |
$97.03
|
|
|
AQUACEL EXTRA 10CM X 12CM/4 IN X 5 IN HYDROFIBER 420674
|
Facility
|
IP
|
$131.00
|
|
|
Service Code
|
HCPCS A6197
|
| Hospital Charge Code |
2963585
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$64.19 |
| Max. Negotiated Rate |
$120.52 |
| Rate for Payer: Aetna Commercial |
$117.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$112.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$69.43
|
| Rate for Payer: Cash Price |
$39.30
|
| Rate for Payer: Cigna Commercial |
$120.52
|
| Rate for Payer: Health EOS Commercial |
$116.59
|
| Rate for Payer: HFN Commercial |
$120.52
|
| Rate for Payer: Multiplan Commercial |
$104.80
|
| Rate for Payer: NAPHCARE Commercial |
$78.60
|
| Rate for Payer: Preferred Network Access Commercial |
$120.52
|
| Rate for Payer: Quartz Beloit One Network |
$64.19
|
| Rate for Payer: Quartz Commercial |
$78.60
|
| Rate for Payer: WEA Trust Commercial |
$72.05
|
| Rate for Payer: WPS Commercial |
$97.03
|
|
|
AQUAPLAST SPLINTING #A96242104
|
Facility
|
OP
|
$874.00
|
|
| Hospital Charge Code |
2973031
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$244.72 |
| Max. Negotiated Rate |
$3,496.00 |
| Rate for Payer: Aetna Commercial |
$786.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$751.64
|
| Rate for Payer: Aetna Managed Medicare |
$244.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$568.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$437.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$419.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$463.22
|
| Rate for Payer: Cash Price |
$262.20
|
| Rate for Payer: Cigna Commercial |
$804.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$489.09
|
| Rate for Payer: Health EOS Commercial |
$777.86
|
| Rate for Payer: HFN Commercial |
$804.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$655.50
|
| Rate for Payer: Multiplan Commercial |
$699.20
|
| Rate for Payer: NAPHCARE Commercial |
$524.40
|
| Rate for Payer: Preferred Network Access Commercial |
$804.08
|
| Rate for Payer: Quartz Beloit One Network |
$428.26
|
| Rate for Payer: Quartz Commercial |
$568.10
|
| Rate for Payer: Quartz Medicare Advantage |
$524.40
|
| Rate for Payer: The Alliance Commercial |
$3,496.00
|
| Rate for Payer: WEA Trust Commercial |
$480.70
|
| Rate for Payer: WPS Commercial |
$647.37
|
|
|
AQUAPLAST SPLINTING #A96242104
|
Facility
|
IP
|
$874.00
|
|
| Hospital Charge Code |
2973031
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$428.26 |
| Max. Negotiated Rate |
$804.08 |
| Rate for Payer: Aetna Commercial |
$786.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$751.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$463.22
|
| Rate for Payer: Cash Price |
$262.20
|
| Rate for Payer: Cigna Commercial |
$804.08
|
| Rate for Payer: Health EOS Commercial |
$777.86
|
| Rate for Payer: HFN Commercial |
$804.08
|
| Rate for Payer: Multiplan Commercial |
$699.20
|
| Rate for Payer: NAPHCARE Commercial |
$524.40
|
| Rate for Payer: Preferred Network Access Commercial |
$804.08
|
| Rate for Payer: Quartz Beloit One Network |
$428.26
|
| Rate for Payer: Quartz Commercial |
$524.40
|
| Rate for Payer: WEA Trust Commercial |
$480.70
|
| Rate for Payer: WPS Commercial |
$647.37
|
|
|
AQUAPLAST-T WHT A-MICR #551237
|
Facility
|
OP
|
$1,143.00
|
|
| Hospital Charge Code |
2973225
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$320.04 |
| Max. Negotiated Rate |
$4,572.00 |
| Rate for Payer: Aetna Commercial |
$1,028.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$982.98
|
| Rate for Payer: Aetna Managed Medicare |
$320.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$742.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$571.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$548.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$605.79
|
| Rate for Payer: Cash Price |
$342.90
|
| Rate for Payer: Cigna Commercial |
$1,051.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$639.62
|
| Rate for Payer: Health EOS Commercial |
$1,017.27
|
| Rate for Payer: HFN Commercial |
$1,051.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$857.25
|
| Rate for Payer: Multiplan Commercial |
$914.40
|
| Rate for Payer: NAPHCARE Commercial |
$685.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,051.56
|
| Rate for Payer: Quartz Beloit One Network |
$560.07
|
| Rate for Payer: Quartz Commercial |
$742.95
|
| Rate for Payer: Quartz Medicare Advantage |
$685.80
|
| Rate for Payer: The Alliance Commercial |
$4,572.00
|
| Rate for Payer: WEA Trust Commercial |
$628.65
|
| Rate for Payer: WPS Commercial |
$846.62
|
|
|
AQUAPLAST-T WHT A-MICR #551237
|
Facility
|
IP
|
$1,143.00
|
|
| Hospital Charge Code |
2973225
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$560.07 |
| Max. Negotiated Rate |
$1,051.56 |
| Rate for Payer: Aetna Commercial |
$1,028.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$982.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$605.79
|
| Rate for Payer: Cash Price |
$342.90
|
| Rate for Payer: Cigna Commercial |
$1,051.56
|
| Rate for Payer: Health EOS Commercial |
$1,017.27
|
| Rate for Payer: HFN Commercial |
$1,051.56
|
| Rate for Payer: Multiplan Commercial |
$914.40
|
| Rate for Payer: NAPHCARE Commercial |
$685.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,051.56
|
| Rate for Payer: Quartz Beloit One Network |
$560.07
|
| Rate for Payer: Quartz Commercial |
$685.80
|
| Rate for Payer: WEA Trust Commercial |
$628.65
|
| Rate for Payer: WPS Commercial |
$846.62
|
|
|
AQUEOUS SHUNT EXTRAOC EQUAT PLATE RSVR W/GRAFT 66180
|
Professional
|
Both
|
$6,579.00
|
|
|
Service Code
|
CPT 66180
|
| Hospital Charge Code |
6180261
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$919.34 |
| Max. Negotiated Rate |
$6,250.05 |
| Rate for Payer: Aetna Commercial |
$6,250.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,657.94
|
| Rate for Payer: Cash Price |
$1,973.70
|
| Rate for Payer: Cash Price |
$1,973.70
|
| Rate for Payer: Cigna Commercial |
$6,250.05
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$919.34
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,947.40
|
| Rate for Payer: Health EOS Commercial |
$5,986.89
|
| Rate for Payer: HFN Commercial |
$6,250.05
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,833.44
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$3,833.44
|
| Rate for Payer: Multiplan Commercial |
$5,263.20
|
| Rate for Payer: Preferred Network Access Commercial |
$6,250.05
|
| Rate for Payer: Quartz Beloit One Network |
$2,894.76
|
| Rate for Payer: Quartz Commercial |
$3,750.03
|
| Rate for Payer: The Alliance Commercial |
$3,289.50
|
| Rate for Payer: United Healthcare Medicaid |
$919.34
|
| Rate for Payer: WEA Trust Commercial |
$3,618.45
|
| Rate for Payer: WPS Commercial |
$4,873.07
|
|
|
AQUINOX DISPOSABLE #26-P50000
|
Facility
|
OP
|
$642.00
|
|
| Hospital Charge Code |
2973418
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$179.76 |
| Max. Negotiated Rate |
$2,568.00 |
| Rate for Payer: Aetna Commercial |
$577.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$552.12
|
| Rate for Payer: Aetna Managed Medicare |
$179.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$417.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$321.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$308.16
|
| 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: Dean Health DHI/DHP/ASO |
$359.26
|
| Rate for Payer: Health EOS Commercial |
$571.38
|
| Rate for Payer: HFN Commercial |
$590.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$481.50
|
| 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 |
$417.30
|
| Rate for Payer: Quartz Medicare Advantage |
$385.20
|
| Rate for Payer: The Alliance Commercial |
$2,568.00
|
| Rate for Payer: WEA Trust Commercial |
$353.10
|
| Rate for Payer: WPS Commercial |
$475.53
|
|
|
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: Aetna Gatekeeper/Not Gatekeeper |
$552.12
|
| 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: Aetna Gatekeeper/Not Gatekeeper |
$2,641.06
|
| 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: Aetna Gatekeeper/Not Gatekeeper |
$2,641.06
|
| 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
|
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 (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: Aetna Gatekeeper/Not Gatekeeper |
$1,045.76
|
| 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 (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: Aetna Gatekeeper/Not Gatekeeper |
$1,066.40
|
| 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
|
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: Aetna Gatekeeper/Not Gatekeeper |
$1,672.70
|
| 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 (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 (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: Aetna Gatekeeper/Not Gatekeeper |
$1,672.70
|
| 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
|
|
