|
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
|
|
|
Arbovirus Antibody Panel IFA (IgG, IgM)
|
Professional
|
$53.00
|
|
|
Service Code
|
CPT 86652
|
| Hospital Charge Code |
5547023
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.19 |
| Max. Negotiated Rate |
$58.04 |
| Rate for Payer: Aetna Commercial |
$50.35
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$45.58
|
| 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 |
$15.90
|
| Rate for Payer: Cash Price |
$15.90
|
| Rate for Payer: Cigna Commercial |
$50.35
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$26.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$13.19
|
| Rate for Payer: Health EOS Commercial |
$48.23
|
| 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 |
$42.40
|
| Rate for Payer: Preferred Network Access Commercial |
$50.35
|
| Rate for Payer: Quartz Beloit One Network |
$23.32
|
| Rate for Payer: Quartz Commercial |
$30.21
|
| 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 |
$29.15
|
| Rate for Payer: WPS Commercial |
$58.04
|
|
|
ARCH BAR
|
Facility
IP
|
$614.00
|
|
| Hospital Charge Code |
2965102
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$300.86 |
| Max. Negotiated Rate |
$564.88 |
| Rate for Payer: Aetna Commercial |
$552.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$325.42
|
| Rate for Payer: Cash Price |
$184.20
|
| Rate for Payer: Cigna Commercial |
$564.88
|
| Rate for Payer: Health EOS Commercial |
$546.46
|
| Rate for Payer: HFN Commercial |
$564.88
|
| Rate for Payer: Multiplan Commercial |
$491.20
|
| Rate for Payer: NAPHCARE Commercial |
$368.40
|
| Rate for Payer: Preferred Network Access Commercial |
$564.88
|
| Rate for Payer: Quartz Beloit One Network |
$300.86
|
| Rate for Payer: Quartz Commercial |
$368.40
|
| Rate for Payer: WEA Trust Commercial |
$337.70
|
| Rate for Payer: WPS Commercial |
$454.79
|
|
|
ARCH BAR
|
Facility
OP
|
$614.00
|
|
| Hospital Charge Code |
2965102
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$171.92 |
| Max. Negotiated Rate |
$2,456.00 |
| Rate for Payer: Aetna Commercial |
$552.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$528.04
|
| Rate for Payer: Aetna Managed Medicare |
$171.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$399.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$307.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$294.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$325.42
|
| Rate for Payer: Cash Price |
$184.20
|
| Rate for Payer: Cigna Commercial |
$564.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$343.59
|
| Rate for Payer: Health EOS Commercial |
$546.46
|
| Rate for Payer: HFN Commercial |
$564.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$460.50
|
| Rate for Payer: Multiplan Commercial |
$491.20
|
| Rate for Payer: NAPHCARE Commercial |
$368.40
|
| Rate for Payer: Preferred Network Access Commercial |
$564.88
|
| Rate for Payer: Quartz Beloit One Network |
$300.86
|
| Rate for Payer: Quartz Commercial |
$399.10
|
| Rate for Payer: Quartz Medicare Advantage |
$368.40
|
| Rate for Payer: The Alliance Commercial |
$2,456.00
|
| Rate for Payer: WEA Trust Commercial |
$337.70
|
| Rate for Payer: WPS Commercial |
$454.79
|
|
|
ARCH BARS REMOVAL/PLACEMENT
|
Facility
IP
|
$1,006.00
|
|
| Hospital Charge Code |
2959814
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$492.94 |
| Max. Negotiated Rate |
$925.52 |
| Rate for Payer: Aetna Commercial |
$905.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$533.18
|
| Rate for Payer: Cash Price |
$301.80
|
| Rate for Payer: Cigna Commercial |
$925.52
|
| Rate for Payer: Health EOS Commercial |
$895.34
|
| Rate for Payer: HFN Commercial |
$925.52
|
| Rate for Payer: Multiplan Commercial |
$804.80
|
| Rate for Payer: NAPHCARE Commercial |
$603.60
|
| Rate for Payer: Preferred Network Access Commercial |
$925.52
|
| Rate for Payer: Quartz Beloit One Network |
$492.94
|
| Rate for Payer: Quartz Commercial |
$603.60
|
| Rate for Payer: WEA Trust Commercial |
$553.30
|
| Rate for Payer: WPS Commercial |
$745.14
|
|
|
ARCH BARS REMOVAL/PLACEMENT
|
Facility
OP
|
$1,006.00
|
|
| Hospital Charge Code |
2959814
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$281.68 |
| Max. Negotiated Rate |
$4,024.00 |
| Rate for Payer: Aetna Commercial |
$905.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$865.16
|
| Rate for Payer: Aetna Managed Medicare |
$281.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$653.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$503.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$482.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$533.18
|
| Rate for Payer: Cash Price |
$301.80
|
| Rate for Payer: Cigna Commercial |
$925.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$562.96
|
| Rate for Payer: Health EOS Commercial |
$895.34
|
| Rate for Payer: HFN Commercial |
$925.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$754.50
|
| Rate for Payer: Multiplan Commercial |
$804.80
|
| Rate for Payer: NAPHCARE Commercial |
$603.60
|
| Rate for Payer: Preferred Network Access Commercial |
$925.52
|
| Rate for Payer: Quartz Beloit One Network |
$492.94
|
| Rate for Payer: Quartz Commercial |
$653.90
|
| Rate for Payer: Quartz Medicare Advantage |
$603.60
|
| Rate for Payer: The Alliance Commercial |
$4,024.00
|
| Rate for Payer: WEA Trust Commercial |
$553.30
|
| Rate for Payer: WPS Commercial |
$745.14
|
|
|
ARCH BARS/WIRES
|
Facility
OP
|
$614.00
|
|
| Hospital Charge Code |
3597491
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$171.92 |
| Max. Negotiated Rate |
$2,456.00 |
| Rate for Payer: Aetna Commercial |
$552.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$528.04
|
| Rate for Payer: Aetna Managed Medicare |
$171.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$399.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$307.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$294.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$325.42
|
| Rate for Payer: Cash Price |
$184.20
|
| Rate for Payer: Cigna Commercial |
$564.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$343.59
|
| Rate for Payer: Health EOS Commercial |
$546.46
|
| Rate for Payer: HFN Commercial |
$564.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$460.50
|
| Rate for Payer: Multiplan Commercial |
$491.20
|
| Rate for Payer: NAPHCARE Commercial |
$368.40
|
| Rate for Payer: Preferred Network Access Commercial |
$564.88
|
| Rate for Payer: Quartz Beloit One Network |
$300.86
|
| Rate for Payer: Quartz Commercial |
$399.10
|
| Rate for Payer: Quartz Medicare Advantage |
$368.40
|
| Rate for Payer: The Alliance Commercial |
$2,456.00
|
| Rate for Payer: WEA Trust Commercial |
$337.70
|
| Rate for Payer: WPS Commercial |
$454.79
|
|
|
ARCH BARS/WIRES
|
Facility
IP
|
$614.00
|
|
| Hospital Charge Code |
3597491
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$300.86 |
| Max. Negotiated Rate |
$564.88 |
| Rate for Payer: Aetna Commercial |
$552.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$325.42
|
| Rate for Payer: Cash Price |
$184.20
|
| Rate for Payer: Cigna Commercial |
$564.88
|
| Rate for Payer: Health EOS Commercial |
$546.46
|
| Rate for Payer: HFN Commercial |
$564.88
|
| Rate for Payer: Multiplan Commercial |
$491.20
|
| Rate for Payer: NAPHCARE Commercial |
$368.40
|
| Rate for Payer: Preferred Network Access Commercial |
$564.88
|
| Rate for Payer: Quartz Beloit One Network |
$300.86
|
| Rate for Payer: Quartz Commercial |
$368.40
|
| Rate for Payer: WEA Trust Commercial |
$337.70
|
| Rate for Payer: WPS Commercial |
$454.79
|
|
|
ARCH BINDER SMALL
|
Facility
OP
|
$233.00
|
|
| Hospital Charge Code |
2969829
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$65.24 |
| Max. Negotiated Rate |
$932.00 |
| Rate for Payer: Aetna Managed Medicare |
$65.24
|
| Rate for Payer: Aetna Commercial |
$209.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$200.38
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$151.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$116.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$111.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$123.49
|
| Rate for Payer: Cash Price |
$69.90
|
| Rate for Payer: Cigna Commercial |
$214.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$130.39
|
| Rate for Payer: Health EOS Commercial |
$207.37
|
| Rate for Payer: HFN Commercial |
$214.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$174.75
|
| Rate for Payer: Multiplan Commercial |
$186.40
|
| Rate for Payer: NAPHCARE Commercial |
$139.80
|
| Rate for Payer: Preferred Network Access Commercial |
$214.36
|
| Rate for Payer: Quartz Beloit One Network |
$114.17
|
| Rate for Payer: Quartz Commercial |
$151.45
|
| Rate for Payer: Quartz Medicare Advantage |
$139.80
|
| Rate for Payer: The Alliance Commercial |
$932.00
|
| Rate for Payer: WEA Trust Commercial |
$128.15
|
| Rate for Payer: WPS Commercial |
$172.58
|
|
|
ARCH BINDER SMALL
|
Facility
IP
|
$233.00
|
|
| Hospital Charge Code |
2969829
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$114.17 |
| Max. Negotiated Rate |
$214.36 |
| Rate for Payer: Aetna Commercial |
$209.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$123.49
|
| Rate for Payer: Cash Price |
$69.90
|
| Rate for Payer: Cigna Commercial |
$214.36
|
| Rate for Payer: Health EOS Commercial |
$207.37
|
| Rate for Payer: HFN Commercial |
$214.36
|
| Rate for Payer: Multiplan Commercial |
$186.40
|
| Rate for Payer: NAPHCARE Commercial |
$139.80
|
| Rate for Payer: Preferred Network Access Commercial |
$214.36
|
| Rate for Payer: Quartz Beloit One Network |
$114.17
|
| Rate for Payer: Quartz Commercial |
$139.80
|
| Rate for Payer: WEA Trust Commercial |
$128.15
|
| Rate for Payer: WPS Commercial |
$172.58
|
|
|
ARCH CARBON FIBER F00T 140MM HOFFMANN LIMB 4934-6-140
|
Facility
OP
|
$7,937.00
|
|
| Hospital Charge Code |
6001642
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,222.36 |
| Max. Negotiated Rate |
$31,748.00 |
| Rate for Payer: Aetna Commercial |
$7,143.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,825.82
|
| Rate for Payer: Aetna Managed Medicare |
$2,222.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,159.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,968.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,809.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,206.61
|
| Rate for Payer: Cash Price |
$2,381.10
|
| Rate for Payer: Cigna Commercial |
$7,302.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,441.55
|
| Rate for Payer: Health EOS Commercial |
$7,063.93
|
| Rate for Payer: HFN Commercial |
$7,302.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,952.75
|
| Rate for Payer: Multiplan Commercial |
$6,349.60
|
| Rate for Payer: NAPHCARE Commercial |
$4,762.20
|
| Rate for Payer: Preferred Network Access Commercial |
$7,302.04
|
| Rate for Payer: Quartz Beloit One Network |
$3,889.13
|
| Rate for Payer: Quartz Commercial |
$5,159.05
|
| Rate for Payer: Quartz Medicare Advantage |
$4,762.20
|
| Rate for Payer: The Alliance Commercial |
$31,748.00
|
| Rate for Payer: WEA Trust Commercial |
$4,365.35
|
| Rate for Payer: WPS Commercial |
$5,878.94
|
|
|
ARCH CARBON FIBER F00T 140MM HOFFMANN LIMB 4934-6-140
|
Facility
IP
|
$7,937.00
|
|
| Hospital Charge Code |
6001642
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3,889.13 |
| Max. Negotiated Rate |
$7,302.04 |
| Rate for Payer: Aetna Commercial |
$7,143.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,206.61
|
| Rate for Payer: Cash Price |
$2,381.10
|
| Rate for Payer: Cigna Commercial |
$7,302.04
|
| Rate for Payer: Health EOS Commercial |
$7,063.93
|
| Rate for Payer: HFN Commercial |
$7,302.04
|
| Rate for Payer: Multiplan Commercial |
$6,349.60
|
| Rate for Payer: NAPHCARE Commercial |
$4,762.20
|
| Rate for Payer: Preferred Network Access Commercial |
$7,302.04
|
| Rate for Payer: Quartz Beloit One Network |
$3,889.13
|
| Rate for Payer: Quartz Commercial |
$4,762.20
|
| Rate for Payer: WEA Trust Commercial |
$4,365.35
|
| Rate for Payer: WPS Commercial |
$5,878.94
|
|
|
ARCH CARBON FIBER F00T 155MM HOFFMANN LIMB 4934-6-155
|
Facility
IP
|
$8,070.00
|
|
| Hospital Charge Code |
6065671
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3,954.30 |
| Max. Negotiated Rate |
$7,424.40 |
| Rate for Payer: Aetna Commercial |
$7,263.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,277.10
|
| Rate for Payer: Cash Price |
$2,421.00
|
| Rate for Payer: Cigna Commercial |
$7,424.40
|
| Rate for Payer: Health EOS Commercial |
$7,182.30
|
| Rate for Payer: HFN Commercial |
$7,424.40
|
| Rate for Payer: Multiplan Commercial |
$6,456.00
|
| Rate for Payer: NAPHCARE Commercial |
$4,842.00
|
| Rate for Payer: Preferred Network Access Commercial |
$7,424.40
|
| Rate for Payer: Quartz Beloit One Network |
$3,954.30
|
| Rate for Payer: Quartz Commercial |
$4,842.00
|
| Rate for Payer: WEA Trust Commercial |
$4,438.50
|
| Rate for Payer: WPS Commercial |
$5,977.45
|
|
|
ARCH CARBON FIBER F00T 155MM HOFFMANN LIMB 4934-6-155
|
Facility
OP
|
$8,070.00
|
|
| Hospital Charge Code |
6065671
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,259.60 |
| Max. Negotiated Rate |
$32,280.00 |
| Rate for Payer: Aetna Managed Medicare |
$2,259.60
|
| Rate for Payer: Aetna Commercial |
$7,263.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,940.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,245.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,035.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,873.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,277.10
|
| Rate for Payer: Cash Price |
$2,421.00
|
| Rate for Payer: Cigna Commercial |
$7,424.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,515.97
|
| Rate for Payer: Health EOS Commercial |
$7,182.30
|
| Rate for Payer: HFN Commercial |
$7,424.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,052.50
|
| Rate for Payer: Multiplan Commercial |
$6,456.00
|
| Rate for Payer: NAPHCARE Commercial |
$4,842.00
|
| Rate for Payer: Preferred Network Access Commercial |
$7,424.40
|
| Rate for Payer: Quartz Beloit One Network |
$3,954.30
|
| Rate for Payer: Quartz Commercial |
$5,245.50
|
| Rate for Payer: Quartz Medicare Advantage |
$4,842.00
|
| Rate for Payer: The Alliance Commercial |
$32,280.00
|
| Rate for Payer: WEA Trust Commercial |
$4,438.50
|
| Rate for Payer: WPS Commercial |
$5,977.45
|
|
|
ARCH CARBON FIBER F00T 180MM HOFFMANN LIMB 4934-6-180
|
Facility
OP
|
$8,584.00
|
|
| Hospital Charge Code |
5599710
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,403.52 |
| Max. Negotiated Rate |
$34,336.00 |
| Rate for Payer: Aetna Commercial |
$7,725.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,382.24
|
| Rate for Payer: Aetna Managed Medicare |
$2,403.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,579.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,292.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,120.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,549.52
|
| Rate for Payer: Cash Price |
$2,575.20
|
| Rate for Payer: Cigna Commercial |
$7,897.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,803.61
|
| Rate for Payer: Health EOS Commercial |
$7,639.76
|
| Rate for Payer: HFN Commercial |
$7,897.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,438.00
|
| Rate for Payer: Multiplan Commercial |
$6,867.20
|
| Rate for Payer: NAPHCARE Commercial |
$5,150.40
|
| Rate for Payer: Preferred Network Access Commercial |
$7,897.28
|
| Rate for Payer: Quartz Beloit One Network |
$4,206.16
|
| Rate for Payer: Quartz Commercial |
$5,579.60
|
| Rate for Payer: Quartz Medicare Advantage |
$5,150.40
|
| Rate for Payer: The Alliance Commercial |
$34,336.00
|
| Rate for Payer: WEA Trust Commercial |
$4,721.20
|
| Rate for Payer: WPS Commercial |
$6,358.17
|
|
|
ARCH CARBON FIBER F00T 180MM HOFFMANN LIMB 4934-6-180
|
Facility
IP
|
$8,584.00
|
|
| Hospital Charge Code |
5599710
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4,206.16 |
| Max. Negotiated Rate |
$7,897.28 |
| Rate for Payer: Aetna Commercial |
$7,725.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,549.52
|
| Rate for Payer: Cash Price |
$2,575.20
|
| Rate for Payer: Cigna Commercial |
$7,897.28
|
| Rate for Payer: Health EOS Commercial |
$7,639.76
|
| Rate for Payer: HFN Commercial |
$7,897.28
|
| Rate for Payer: Multiplan Commercial |
$6,867.20
|
| Rate for Payer: NAPHCARE Commercial |
$5,150.40
|
| Rate for Payer: Preferred Network Access Commercial |
$7,897.28
|
| Rate for Payer: Quartz Beloit One Network |
$4,206.16
|
| Rate for Payer: Quartz Commercial |
$5,150.40
|
| Rate for Payer: WEA Trust Commercial |
$4,721.20
|
| Rate for Payer: WPS Commercial |
$6,358.17
|
|
|
ARCH SWEDE MED RIGHT
|
Facility
IP
|
$799.00
|
|
| Hospital Charge Code |
2971652
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$391.51 |
| Max. Negotiated Rate |
$735.08 |
| Rate for Payer: Aetna Commercial |
$719.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$423.47
|
| Rate for Payer: Cash Price |
$239.70
|
| Rate for Payer: Cigna Commercial |
$735.08
|
| Rate for Payer: Health EOS Commercial |
$711.11
|
| Rate for Payer: HFN Commercial |
$735.08
|
| Rate for Payer: Multiplan Commercial |
$639.20
|
| Rate for Payer: NAPHCARE Commercial |
$479.40
|
| Rate for Payer: Preferred Network Access Commercial |
$735.08
|
| Rate for Payer: Quartz Beloit One Network |
$391.51
|
| Rate for Payer: Quartz Commercial |
$479.40
|
| Rate for Payer: WEA Trust Commercial |
$439.45
|
| Rate for Payer: WPS Commercial |
$591.82
|
|
|
ARCH SWEDE MED RIGHT
|
Facility
OP
|
$799.00
|
|
| Hospital Charge Code |
2971652
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$223.72 |
| Max. Negotiated Rate |
$3,196.00 |
| Rate for Payer: Aetna Commercial |
$719.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$687.14
|
| Rate for Payer: Aetna Managed Medicare |
$223.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$519.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$399.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$383.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$423.47
|
| Rate for Payer: Cash Price |
$239.70
|
| Rate for Payer: Cigna Commercial |
$735.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$447.12
|
| Rate for Payer: Health EOS Commercial |
$711.11
|
| Rate for Payer: HFN Commercial |
$735.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$599.25
|
| Rate for Payer: Multiplan Commercial |
$639.20
|
| Rate for Payer: NAPHCARE Commercial |
$479.40
|
| Rate for Payer: Preferred Network Access Commercial |
$735.08
|
| Rate for Payer: Quartz Beloit One Network |
$391.51
|
| Rate for Payer: Quartz Commercial |
$519.35
|
| Rate for Payer: Quartz Medicare Advantage |
$479.40
|
| Rate for Payer: The Alliance Commercial |
$3,196.00
|
| Rate for Payer: WEA Trust Commercial |
$439.45
|
| Rate for Payer: WPS Commercial |
$591.82
|
|
|
ARCH SWEDE SMALL RIGHT
|
Facility
IP
|
$799.00
|
|
| Hospital Charge Code |
2971651
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$391.51 |
| Max. Negotiated Rate |
$735.08 |
| Rate for Payer: Aetna Commercial |
$719.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$423.47
|
| Rate for Payer: Cash Price |
$239.70
|
| Rate for Payer: Cigna Commercial |
$735.08
|
| Rate for Payer: Health EOS Commercial |
$711.11
|
| Rate for Payer: HFN Commercial |
$735.08
|
| Rate for Payer: Multiplan Commercial |
$639.20
|
| Rate for Payer: NAPHCARE Commercial |
$479.40
|
| Rate for Payer: Preferred Network Access Commercial |
$735.08
|
| Rate for Payer: Quartz Beloit One Network |
$391.51
|
| Rate for Payer: Quartz Commercial |
$479.40
|
| Rate for Payer: WEA Trust Commercial |
$439.45
|
| Rate for Payer: WPS Commercial |
$591.82
|
|
|
ARCH SWEDE SMALL RIGHT
|
Facility
OP
|
$799.00
|
|
| Hospital Charge Code |
2971651
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$223.72 |
| Max. Negotiated Rate |
$3,196.00 |
| Rate for Payer: Aetna Commercial |
$719.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$687.14
|
| Rate for Payer: Aetna Managed Medicare |
$223.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$519.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$399.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$383.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$423.47
|
| Rate for Payer: Cash Price |
$239.70
|
| Rate for Payer: Cigna Commercial |
$735.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$447.12
|
| Rate for Payer: Health EOS Commercial |
$711.11
|
| Rate for Payer: HFN Commercial |
$735.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$599.25
|
| Rate for Payer: Multiplan Commercial |
$639.20
|
| Rate for Payer: NAPHCARE Commercial |
$479.40
|
| Rate for Payer: Preferred Network Access Commercial |
$735.08
|
| Rate for Payer: Quartz Beloit One Network |
$391.51
|
| Rate for Payer: Quartz Commercial |
$519.35
|
| Rate for Payer: Quartz Medicare Advantage |
$479.40
|
| Rate for Payer: The Alliance Commercial |
$3,196.00
|
| Rate for Payer: WEA Trust Commercial |
$439.45
|
| Rate for Payer: WPS Commercial |
$591.82
|
|
|
ARCTIC SUN GEL PAD SET MED #317-07-02
|
Facility
IP
|
$8,740.00
|
|
| Hospital Charge Code |
2973878
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$4,282.60 |
| Max. Negotiated Rate |
$8,040.80 |
| Rate for Payer: Aetna Commercial |
$7,866.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,632.20
|
| Rate for Payer: Cash Price |
$2,622.00
|
| Rate for Payer: Cigna Commercial |
$8,040.80
|
| Rate for Payer: Health EOS Commercial |
$7,778.60
|
| Rate for Payer: HFN Commercial |
$8,040.80
|
| Rate for Payer: Multiplan Commercial |
$6,992.00
|
| Rate for Payer: NAPHCARE Commercial |
$5,244.00
|
| Rate for Payer: Preferred Network Access Commercial |
$8,040.80
|
| Rate for Payer: Quartz Beloit One Network |
$4,282.60
|
| Rate for Payer: Quartz Commercial |
$5,244.00
|
| Rate for Payer: WEA Trust Commercial |
$4,807.00
|
| Rate for Payer: WPS Commercial |
$6,473.72
|
|
|
ARCTIC SUN GEL PAD SET MED #317-07-02
|
Facility
OP
|
$8,740.00
|
|
| Hospital Charge Code |
2973878
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$2,447.20 |
| Max. Negotiated Rate |
$34,960.00 |
| Rate for Payer: Aetna Commercial |
$7,866.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,516.40
|
| Rate for Payer: Aetna Managed Medicare |
$2,447.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,681.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,370.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,195.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,632.20
|
| Rate for Payer: Cash Price |
$2,622.00
|
| Rate for Payer: Cigna Commercial |
$8,040.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,890.90
|
| Rate for Payer: Health EOS Commercial |
$7,778.60
|
| Rate for Payer: HFN Commercial |
$8,040.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,555.00
|
| Rate for Payer: Multiplan Commercial |
$6,992.00
|
| Rate for Payer: NAPHCARE Commercial |
$5,244.00
|
| Rate for Payer: Preferred Network Access Commercial |
$8,040.80
|
| Rate for Payer: Quartz Beloit One Network |
$4,282.60
|
| Rate for Payer: Quartz Commercial |
$5,681.00
|
| Rate for Payer: Quartz Medicare Advantage |
$5,244.00
|
| Rate for Payer: The Alliance Commercial |
$34,960.00
|
| Rate for Payer: WEA Trust Commercial |
$4,807.00
|
| Rate for Payer: WPS Commercial |
$6,473.72
|
|
|
Arexvy RSV 0.5 mL Inj - Arexvy Med Charge
|
Facility
OP
|
$619.00
|
|
|
Service Code
|
CPT 90679
|
| Hospital Charge Code |
6224266
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$173.32 |
| Max. Negotiated Rate |
$2,476.00 |
| Rate for Payer: Aetna Commercial |
$557.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$532.34
|
| Rate for Payer: Aetna Managed Medicare |
$173.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$402.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$309.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$297.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$328.07
|
| Rate for Payer: Cash Price |
$185.70
|
| Rate for Payer: Cigna Commercial |
$569.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$346.39
|
| Rate for Payer: Health EOS Commercial |
$550.91
|
| Rate for Payer: HFN Commercial |
$569.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$464.25
|
| Rate for Payer: Multiplan Commercial |
$495.20
|
| Rate for Payer: NAPHCARE Commercial |
$371.40
|
| Rate for Payer: Preferred Network Access Commercial |
$569.48
|
| Rate for Payer: Quartz Beloit One Network |
$303.31
|
| Rate for Payer: Quartz Commercial |
$402.35
|
| Rate for Payer: Quartz Medicare Advantage |
$371.40
|
| Rate for Payer: The Alliance Commercial |
$2,476.00
|
| Rate for Payer: WEA Trust Commercial |
$340.45
|
| Rate for Payer: WPS Commercial |
$458.49
|
|
|
Arexvy RSV 0.5 mL Inj - Arexvy Med Charge
|
Professional
|
$619.00
|
|
|
Service Code
|
CPT 90679
|
| Hospital Charge Code |
6224266
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$272.36 |
| Max. Negotiated Rate |
$588.05 |
| Rate for Payer: Aetna Commercial |
$588.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$532.34
|
| Rate for Payer: Cash Price |
$185.70
|
| Rate for Payer: Cash Price |
$185.70
|
| Rate for Payer: Cigna Commercial |
$588.05
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$309.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$371.40
|
| Rate for Payer: Health EOS Commercial |
$563.29
|
| Rate for Payer: Multiplan Commercial |
$495.20
|
| Rate for Payer: Preferred Network Access Commercial |
$588.05
|
| Rate for Payer: Quartz Beloit One Network |
$272.36
|
| Rate for Payer: Quartz Commercial |
$352.83
|
| Rate for Payer: The Alliance Commercial |
$309.50
|
| Rate for Payer: United Healthcare Medicaid |
$295.00
|
| Rate for Payer: WEA Trust Commercial |
$340.45
|
| Rate for Payer: WPS Commercial |
$458.49
|
|
|
Arexvy RSV 0.5 mL Inj - Arexvy Med Charge
|
Facility
IP
|
$619.00
|
|
|
Service Code
|
CPT 90679
|
| Hospital Charge Code |
6224266
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$303.31 |
| Max. Negotiated Rate |
$569.48 |
| Rate for Payer: Aetna Commercial |
$557.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$328.07
|
| Rate for Payer: Cash Price |
$185.70
|
| Rate for Payer: Cigna Commercial |
$569.48
|
| Rate for Payer: Health EOS Commercial |
$550.91
|
| Rate for Payer: HFN Commercial |
$569.48
|
| Rate for Payer: Multiplan Commercial |
$495.20
|
| Rate for Payer: NAPHCARE Commercial |
$371.40
|
| Rate for Payer: Preferred Network Access Commercial |
$569.48
|
| Rate for Payer: Quartz Beloit One Network |
$303.31
|
| Rate for Payer: Quartz Commercial |
$371.40
|
| Rate for Payer: WEA Trust Commercial |
$340.45
|
| Rate for Payer: WPS Commercial |
$458.49
|
|
