|
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: Aetna Gatekeeper/Not Gatekeeper |
$1,584.98
|
| 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: Aetna Gatekeeper/Not Gatekeeper |
$1,584.98
|
| 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
|
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: Aetna Gatekeeper/Not Gatekeeper |
$374.10
|
| 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 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 |
$566.44 |
| 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 |
$566.44
|
| 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 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: Aetna Gatekeeper/Not Gatekeeper |
$374.10
|
| 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 |
$566.44 |
| 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 |
$566.44
|
| 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
|
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: Aetna Gatekeeper/Not Gatekeeper |
$376.70
|
| 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 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 |
$402.98 |
| 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 DHI/DHP/ASO |
$245.12
|
| 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 |
$52.76
|
| 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
|
Professional
|
Both
|
$438.03
|
|
|
Service Code
|
CPT 86651
|
| Hospital Charge Code |
4916625
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$46.56 |
| Max. Negotiated Rate |
$416.13 |
| Rate for Payer: Aetna Commercial |
$416.13
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$376.71
|
| 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 |
$262.82
|
| Rate for Payer: Health EOS Commercial |
$398.61
|
| Rate for Payer: HFN Commercial |
$416.13
|
| 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: 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: The Alliance Commercial |
$219.02
|
| Rate for Payer: WEA Trust Commercial |
$240.92
|
| Rate for Payer: WPS Commercial |
$324.45
|
|
|
Arbovirus Antibody Panel IFA (IgG, IgM)
|
Facility
|
OP
|
$53.00
|
|
|
Service Code
|
CPT 86652
|
| Hospital Charge Code |
5547023
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.17 |
| Max. Negotiated Rate |
$52.76 |
| Rate for Payer: Aetna Commercial |
$47.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$45.58
|
| 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 |
$28.09
|
| 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 |
$48.76
|
| 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 DHI/DHP/ASO |
$29.66
|
| 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 |
$47.17
|
| Rate for Payer: HFN Commercial |
$48.76
|
| 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 |
$42.40
|
| Rate for Payer: NAPHCARE Commercial |
$19.78
|
| Rate for Payer: Preferred Network Access Commercial |
$48.76
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$8.17
|
| Rate for Payer: Quartz Beloit One Network |
$25.97
|
| Rate for Payer: Quartz Commercial |
$34.45
|
| Rate for Payer: Quartz Medicare Advantage |
$13.19
|
| Rate for Payer: The Alliance Commercial |
$52.76
|
| Rate for Payer: United Healthcare Medicaid |
$8.17
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.19
|
| Rate for Payer: United Healthcare PPO |
$39.75
|
| Rate for Payer: WEA Trust Commercial |
$29.15
|
| Rate for Payer: Wellcare Medicare |
$13.19
|
| Rate for Payer: WMAP Medicaid |
$8.17
|
| Rate for Payer: WPS Commercial |
$39.26
|
|
|
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: Aetna Gatekeeper/Not Gatekeeper |
$45.58
|
| 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
|
Both
|
$53.00
|
|
|
Service Code
|
CPT 86652
|
| Hospital Charge Code |
5547023
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$23.32 |
| Max. Negotiated Rate |
$50.35 |
| Rate for Payer: Aetna Commercial |
$50.35
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$45.58
|
| 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 |
$31.80
|
| Rate for Payer: Health EOS Commercial |
$48.23
|
| Rate for Payer: HFN Commercial |
$50.35
|
| 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: 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: The Alliance Commercial |
$26.50
|
| Rate for Payer: WEA Trust Commercial |
$29.15
|
| Rate for Payer: WPS Commercial |
$39.26
|
|
|
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: Aetna Gatekeeper/Not Gatekeeper |
$528.04
|
| 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
|
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 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: Aetna Gatekeeper/Not Gatekeeper |
$865.16
|
| 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/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: Aetna Gatekeeper/Not Gatekeeper |
$528.04
|
| 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 Commercial |
$209.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$200.38
|
| Rate for Payer: Aetna Managed Medicare |
$65.24
|
| 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: Aetna Gatekeeper/Not Gatekeeper |
$200.38
|
| 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
|
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: Aetna Gatekeeper/Not Gatekeeper |
$6,825.82
|
| 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 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 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 Commercial |
$7,263.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,940.20
|
| Rate for Payer: Aetna Managed Medicare |
$2,259.60
|
| 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 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: Aetna Gatekeeper/Not Gatekeeper |
$6,940.20
|
| 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
|
|
