|
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: Aetna Gatekeeper/Not Gatekeeper |
$7,382.24
|
| 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: Aetna Gatekeeper/Not Gatekeeper |
$687.14
|
| 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: Aetna Gatekeeper/Not Gatekeeper |
$687.14
|
| 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 PAD SET UNIVERSAL 1/EA #317-00
|
Facility
|
OP
|
$3,843.00
|
|
| Hospital Charge Code |
2973419
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$1,076.04 |
| Max. Negotiated Rate |
$15,372.00 |
| Rate for Payer: Aetna Commercial |
$3,458.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,304.98
|
| Rate for Payer: Aetna Managed Medicare |
$1,076.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,497.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,921.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,844.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,036.79
|
| Rate for Payer: Cash Price |
$1,152.90
|
| Rate for Payer: Cigna Commercial |
$3,535.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,150.54
|
| Rate for Payer: Health EOS Commercial |
$3,420.27
|
| Rate for Payer: HFN Commercial |
$3,535.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,882.25
|
| Rate for Payer: Multiplan Commercial |
$3,074.40
|
| Rate for Payer: NAPHCARE Commercial |
$2,305.80
|
| Rate for Payer: Preferred Network Access Commercial |
$3,535.56
|
| Rate for Payer: Quartz Beloit One Network |
$1,883.07
|
| Rate for Payer: Quartz Commercial |
$2,497.95
|
| Rate for Payer: Quartz Medicare Advantage |
$2,305.80
|
| Rate for Payer: The Alliance Commercial |
$15,372.00
|
| Rate for Payer: WEA Trust Commercial |
$2,113.65
|
| Rate for Payer: WPS Commercial |
$2,846.51
|
|
|
ARCTIC PAD SET UNIVERSAL 1/EA #317-00
|
Facility
|
IP
|
$3,843.00
|
|
| Hospital Charge Code |
2973419
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$1,883.07 |
| Max. Negotiated Rate |
$3,535.56 |
| Rate for Payer: Aetna Commercial |
$3,458.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,304.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,036.79
|
| Rate for Payer: Cash Price |
$1,152.90
|
| Rate for Payer: Cigna Commercial |
$3,535.56
|
| Rate for Payer: Health EOS Commercial |
$3,420.27
|
| Rate for Payer: HFN Commercial |
$3,535.56
|
| Rate for Payer: Multiplan Commercial |
$3,074.40
|
| Rate for Payer: NAPHCARE Commercial |
$2,305.80
|
| Rate for Payer: Preferred Network Access Commercial |
$3,535.56
|
| Rate for Payer: Quartz Beloit One Network |
$1,883.07
|
| Rate for Payer: Quartz Commercial |
$2,305.80
|
| Rate for Payer: WEA Trust Commercial |
$2,113.65
|
| Rate for Payer: WPS Commercial |
$2,846.51
|
|
|
ARCTIC SUN GEL PAD SET LRG #317-09-02
|
Facility
|
IP
|
$8,740.00
|
|
| Hospital Charge Code |
2973879
|
|
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: Aetna Gatekeeper/Not Gatekeeper |
$7,516.40
|
| 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 LRG #317-09-02
|
Facility
|
OP
|
$8,740.00
|
|
| Hospital Charge Code |
2973879
|
|
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
|
|
|
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
|
|
|
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: Aetna Gatekeeper/Not Gatekeeper |
$7,516.40
|
| 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
|
|
|
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: Aetna Gatekeeper/Not Gatekeeper |
$532.34
|
| 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
|
|
|
Arexvy RSV 0.5 mL Inj - Arexvy Med Charge
|
Professional
|
Both
|
$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 |
$295.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$371.40
|
| Rate for Payer: Health EOS Commercial |
$563.29
|
| Rate for Payer: HFN Commercial |
$588.05
|
| 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
|
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 vaccine preF3, recombinant 90679
|
Facility
|
OP
|
$619.00
|
|
|
Service Code
|
CPT 90679
|
| Hospital Charge Code |
6224162
|
|
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 vaccine preF3, recombinant 90679
|
Professional
|
Both
|
$619.00
|
|
|
Service Code
|
CPT 90679
|
| Hospital Charge Code |
6224162
|
|
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 |
$295.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$371.40
|
| Rate for Payer: Health EOS Commercial |
$563.29
|
| Rate for Payer: HFN Commercial |
$588.05
|
| 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 vaccine preF3, recombinant 90679
|
Facility
|
IP
|
$619.00
|
|
|
Service Code
|
CPT 90679
|
| Hospital Charge Code |
6224162
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$303.31 |
| Max. Negotiated Rate |
$569.48 |
| Rate for Payer: Aetna Commercial |
$557.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$532.34
|
| 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
|
|
|
Argenine Vasopressin (ADH)
|
Facility
|
IP
|
$1,212.00
|
|
|
Service Code
|
CPT 84588
|
| Hospital Charge Code |
980028
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$593.88 |
| Max. Negotiated Rate |
$1,115.04 |
| Rate for Payer: Aetna Commercial |
$1,090.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,042.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$642.36
|
| Rate for Payer: Cash Price |
$363.60
|
| Rate for Payer: Cigna Commercial |
$1,115.04
|
| Rate for Payer: Health EOS Commercial |
$1,078.68
|
| Rate for Payer: HFN Commercial |
$1,115.04
|
| Rate for Payer: Multiplan Commercial |
$969.60
|
| Rate for Payer: NAPHCARE Commercial |
$727.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,115.04
|
| Rate for Payer: Quartz Beloit One Network |
$593.88
|
| Rate for Payer: Quartz Commercial |
$727.20
|
| Rate for Payer: WEA Trust Commercial |
$666.60
|
| Rate for Payer: WPS Commercial |
$897.73
|
|
|
Argenine Vasopressin (ADH)
|
Professional
|
Both
|
$1,212.00
|
|
|
Service Code
|
CPT 84588
|
| Hospital Charge Code |
980028
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$119.81 |
| Max. Negotiated Rate |
$1,151.40 |
| Rate for Payer: Aetna Commercial |
$1,151.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,042.32
|
| Rate for Payer: Cash Price |
$363.60
|
| Rate for Payer: Cash Price |
$363.60
|
| Rate for Payer: Cigna Commercial |
$1,151.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$606.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$727.20
|
| Rate for Payer: Health EOS Commercial |
$1,102.92
|
| Rate for Payer: HFN Commercial |
$1,151.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$119.81
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$119.81
|
| Rate for Payer: Multiplan Commercial |
$969.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,151.40
|
| Rate for Payer: Quartz Beloit One Network |
$533.28
|
| Rate for Payer: Quartz Commercial |
$690.84
|
| Rate for Payer: The Alliance Commercial |
$606.00
|
| Rate for Payer: WEA Trust Commercial |
$666.60
|
| Rate for Payer: WPS Commercial |
$897.73
|
|
|
Argenine Vasopressin (ADH)
|
Facility
|
OP
|
$1,212.00
|
|
|
Service Code
|
CPT 84588
|
| Hospital Charge Code |
980028
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$33.94 |
| Max. Negotiated Rate |
$1,115.04 |
| Rate for Payer: Aetna Commercial |
$1,090.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,042.32
|
| Rate for Payer: Aetna Managed Medicare |
$33.94
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$127.28
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$59.40
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$56.34
|
| Rate for Payer: Anthem Medicaid |
$35.07
|
| Rate for Payer: Anthem Medicare Advantage |
$33.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$642.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$33.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$33.94
|
| Rate for Payer: Cash Price |
$363.60
|
| Rate for Payer: Cash Price |
$363.60
|
| Rate for Payer: Cigna Commercial |
$1,115.04
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$33.94
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$35.07
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$678.24
|
| Rate for Payer: Dean Health Medicaid |
$35.07
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$33.94
|
| Rate for Payer: Health EOS Commercial |
$1,078.68
|
| Rate for Payer: HFN Commercial |
$1,115.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$126.26
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$33.94
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$35.07
|
| Rate for Payer: Independent Care Health Plan Medicare |
$33.94
|
| Rate for Payer: Managed Health Services Medicaid |
$36.47
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$33.94
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$33.94
|
| Rate for Payer: Multiplan Commercial |
$969.60
|
| Rate for Payer: NAPHCARE Commercial |
$50.91
|
| Rate for Payer: Preferred Network Access Commercial |
$1,115.04
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$35.07
|
| Rate for Payer: Quartz Beloit One Network |
$593.88
|
| Rate for Payer: Quartz Commercial |
$787.80
|
| Rate for Payer: Quartz Medicare Advantage |
$33.94
|
| Rate for Payer: The Alliance Commercial |
$135.76
|
| Rate for Payer: United Healthcare Medicaid |
$35.07
|
| Rate for Payer: United Healthcare Medicare Advantage |
$33.94
|
| Rate for Payer: United Healthcare PPO |
$909.00
|
| Rate for Payer: WEA Trust Commercial |
$666.60
|
| Rate for Payer: Wellcare Medicare |
$33.94
|
| Rate for Payer: WMAP Medicaid |
$35.07
|
| Rate for Payer: WPS Commercial |
$897.73
|
|
|
ARGON BEAM COAGULATION
|
Facility
|
OP
|
$6,563.00
|
|
|
Service Code
|
CPT 53899
|
| Hospital Charge Code |
5432917
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$244.28 |
| Max. Negotiated Rate |
$27,974.00 |
| Rate for Payer: Aetna Commercial |
$5,906.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,644.18
|
| Rate for Payer: Aetna Managed Medicare |
$244.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$27,974.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$25,272.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$24,008.00
|
| Rate for Payer: Anthem Medicare Advantage |
$244.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,478.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$244.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$244.28
|
| Rate for Payer: Cash Price |
$1,968.90
|
| Rate for Payer: Cash Price |
$1,968.90
|
| Rate for Payer: Cash Price |
$1,968.90
|
| Rate for Payer: Cigna Commercial |
$6,037.96
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$244.28
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$244.28
|
| Rate for Payer: Health EOS Commercial |
$5,841.07
|
| Rate for Payer: HFN Commercial |
$6,037.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$908.72
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$244.28
|
| Rate for Payer: Independent Care Health Plan Medicare |
$244.28
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$244.28
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$244.28
|
| Rate for Payer: Multiplan Commercial |
$5,250.40
|
| Rate for Payer: NAPHCARE Commercial |
$366.42
|
| Rate for Payer: Preferred Network Access Commercial |
$6,037.96
|
| Rate for Payer: Quartz Beloit One Network |
$3,215.87
|
| Rate for Payer: Quartz Commercial |
$4,265.95
|
| Rate for Payer: Quartz Medicare Advantage |
$244.28
|
| Rate for Payer: The Alliance Commercial |
$977.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$244.28
|
| Rate for Payer: United Healthcare PPO |
$13,676.00
|
| Rate for Payer: WEA Trust Commercial |
$3,609.65
|
| Rate for Payer: Wellcare Medicare |
$244.28
|
| Rate for Payer: WPS Commercial |
$4,861.21
|
|
|
ARGON BEAM COAGULATION
|
Facility
|
IP
|
$6,563.00
|
|
|
Service Code
|
CPT 53899
|
| Hospital Charge Code |
5432917
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,215.87 |
| Max. Negotiated Rate |
$6,037.96 |
| Rate for Payer: Aetna Commercial |
$5,906.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,644.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,478.39
|
| Rate for Payer: Cash Price |
$1,968.90
|
| Rate for Payer: Cigna Commercial |
$6,037.96
|
| Rate for Payer: Health EOS Commercial |
$5,841.07
|
| Rate for Payer: HFN Commercial |
$6,037.96
|
| Rate for Payer: Multiplan Commercial |
$5,250.40
|
| Rate for Payer: NAPHCARE Commercial |
$3,937.80
|
| Rate for Payer: Preferred Network Access Commercial |
$6,037.96
|
| Rate for Payer: Quartz Beloit One Network |
$3,215.87
|
| Rate for Payer: Quartz Commercial |
$3,937.80
|
| Rate for Payer: WEA Trust Commercial |
$3,609.65
|
| Rate for Payer: WPS Commercial |
$4,861.21
|
|
|
ARGON PLASMA COAGULATOR
|
Facility
|
OP
|
$2,003.00
|
|
| Hospital Charge Code |
4075907
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$560.84 |
| Max. Negotiated Rate |
$8,012.00 |
| Rate for Payer: Aetna Commercial |
$1,802.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,722.58
|
| Rate for Payer: Aetna Managed Medicare |
$560.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,301.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,001.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$961.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,061.59
|
| Rate for Payer: Cash Price |
$600.90
|
| Rate for Payer: Cigna Commercial |
$1,842.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,120.88
|
| Rate for Payer: Health EOS Commercial |
$1,782.67
|
| Rate for Payer: HFN Commercial |
$1,842.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,502.25
|
| Rate for Payer: Multiplan Commercial |
$1,602.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,201.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,842.76
|
| Rate for Payer: Quartz Beloit One Network |
$981.47
|
| Rate for Payer: Quartz Commercial |
$1,301.95
|
| Rate for Payer: Quartz Medicare Advantage |
$1,201.80
|
| Rate for Payer: The Alliance Commercial |
$8,012.00
|
| Rate for Payer: WEA Trust Commercial |
$1,101.65
|
| Rate for Payer: WPS Commercial |
$1,483.62
|
|
|
ARGON PLASMA COAGULATOR
|
Facility
|
IP
|
$2,003.00
|
|
| Hospital Charge Code |
4075907
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$981.47 |
| Max. Negotiated Rate |
$1,842.76 |
| Rate for Payer: Aetna Commercial |
$1,802.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,722.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,061.59
|
| Rate for Payer: Cash Price |
$600.90
|
| Rate for Payer: Cigna Commercial |
$1,842.76
|
| Rate for Payer: Health EOS Commercial |
$1,782.67
|
| Rate for Payer: HFN Commercial |
$1,842.76
|
| Rate for Payer: Multiplan Commercial |
$1,602.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,201.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,842.76
|
| Rate for Payer: Quartz Beloit One Network |
$981.47
|
| Rate for Payer: Quartz Commercial |
$1,201.80
|
| Rate for Payer: WEA Trust Commercial |
$1,101.65
|
| Rate for Payer: WPS Commercial |
$1,483.62
|
|
