|
ARCH BAR
|
Facility
|
OP
|
$614.00
|
|
| Hospital Charge Code |
2965102
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$178.80 |
| Max. Negotiated Rate |
$587.48 |
| Rate for Payer: Aetna Commercial |
$574.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$549.16
|
| Rate for Payer: Aetna Managed Medicare |
$178.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$415.06
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$319.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$306.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$338.44
|
| Rate for Payer: Cash Price |
$184.20
|
| Rate for Payer: Cigna Commercial |
$587.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$357.35
|
| Rate for Payer: Health EOS Commercial |
$568.32
|
| Rate for Payer: HFN Commercial |
$587.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$478.92
|
| Rate for Payer: Multiplan Commercial |
$510.85
|
| Rate for Payer: NAPHCARE Commercial |
$383.14
|
| Rate for Payer: Preferred Network Access Commercial |
$587.48
|
| Rate for Payer: Quartz Beloit One Network |
$312.89
|
| Rate for Payer: Quartz Commercial |
$415.06
|
| Rate for Payer: Quartz Medicare Advantage |
$383.14
|
| Rate for Payer: The Alliance Commercial |
$319.28
|
| Rate for Payer: WEA Trust Commercial |
$351.21
|
| Rate for Payer: WPS Commercial |
$472.96
|
|
|
ARCH BARS REMOVAL/PLACEMENT
|
Facility
|
IP
|
$1,006.00
|
|
| Hospital Charge Code |
2959814
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$512.66 |
| Max. Negotiated Rate |
$962.54 |
| Rate for Payer: Aetna Commercial |
$941.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$899.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$554.51
|
| Rate for Payer: Cash Price |
$301.80
|
| Rate for Payer: Cigna Commercial |
$962.54
|
| Rate for Payer: Health EOS Commercial |
$931.15
|
| Rate for Payer: HFN Commercial |
$962.54
|
| Rate for Payer: Multiplan Commercial |
$836.99
|
| Rate for Payer: Preferred Network Access Commercial |
$962.54
|
| Rate for Payer: Quartz Beloit One Network |
$512.66
|
| Rate for Payer: Quartz Commercial |
$627.74
|
| Rate for Payer: WEA Trust Commercial |
$575.43
|
| Rate for Payer: WPS Commercial |
$774.92
|
|
|
ARCH BARS REMOVAL/PLACEMENT
|
Facility
|
OP
|
$1,006.00
|
|
| Hospital Charge Code |
2959814
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$292.95 |
| Max. Negotiated Rate |
$962.54 |
| Rate for Payer: Aetna Commercial |
$941.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$899.77
|
| Rate for Payer: Aetna Managed Medicare |
$292.95
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$680.06
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$523.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$502.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$554.51
|
| Rate for Payer: Cash Price |
$301.80
|
| Rate for Payer: Cigna Commercial |
$962.54
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$585.49
|
| Rate for Payer: Health EOS Commercial |
$931.15
|
| Rate for Payer: HFN Commercial |
$962.54
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$784.68
|
| Rate for Payer: Multiplan Commercial |
$836.99
|
| Rate for Payer: NAPHCARE Commercial |
$627.74
|
| Rate for Payer: Preferred Network Access Commercial |
$962.54
|
| Rate for Payer: Quartz Beloit One Network |
$512.66
|
| Rate for Payer: Quartz Commercial |
$680.06
|
| Rate for Payer: Quartz Medicare Advantage |
$627.74
|
| Rate for Payer: The Alliance Commercial |
$523.12
|
| Rate for Payer: WEA Trust Commercial |
$575.43
|
| Rate for Payer: WPS Commercial |
$774.92
|
|
|
ARCH BARS/WIRES
|
Facility
|
OP
|
$614.00
|
|
| Hospital Charge Code |
3597491
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$178.80 |
| Max. Negotiated Rate |
$587.48 |
| Rate for Payer: Aetna Commercial |
$574.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$549.16
|
| Rate for Payer: Aetna Managed Medicare |
$178.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$415.06
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$319.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$306.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$338.44
|
| Rate for Payer: Cash Price |
$184.20
|
| Rate for Payer: Cigna Commercial |
$587.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$357.35
|
| Rate for Payer: Health EOS Commercial |
$568.32
|
| Rate for Payer: HFN Commercial |
$587.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$478.92
|
| Rate for Payer: Multiplan Commercial |
$510.85
|
| Rate for Payer: NAPHCARE Commercial |
$383.14
|
| Rate for Payer: Preferred Network Access Commercial |
$587.48
|
| Rate for Payer: Quartz Beloit One Network |
$312.89
|
| Rate for Payer: Quartz Commercial |
$415.06
|
| Rate for Payer: Quartz Medicare Advantage |
$383.14
|
| Rate for Payer: The Alliance Commercial |
$319.28
|
| Rate for Payer: WEA Trust Commercial |
$351.21
|
| Rate for Payer: WPS Commercial |
$472.96
|
|
|
ARCH BARS/WIRES
|
Facility
|
IP
|
$614.00
|
|
| Hospital Charge Code |
3597491
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$312.89 |
| Max. Negotiated Rate |
$587.48 |
| Rate for Payer: Aetna Commercial |
$574.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$549.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$338.44
|
| Rate for Payer: Cash Price |
$184.20
|
| Rate for Payer: Cigna Commercial |
$587.48
|
| Rate for Payer: Health EOS Commercial |
$568.32
|
| Rate for Payer: HFN Commercial |
$587.48
|
| Rate for Payer: Multiplan Commercial |
$510.85
|
| Rate for Payer: Preferred Network Access Commercial |
$587.48
|
| Rate for Payer: Quartz Beloit One Network |
$312.89
|
| Rate for Payer: Quartz Commercial |
$383.14
|
| Rate for Payer: WEA Trust Commercial |
$351.21
|
| Rate for Payer: WPS Commercial |
$472.96
|
|
|
ARCH BINDER SMALL
|
Facility
|
OP
|
$233.00
|
|
| Hospital Charge Code |
2969829
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$67.85 |
| Max. Negotiated Rate |
$222.93 |
| Rate for Payer: Aetna Commercial |
$218.09
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$208.40
|
| Rate for Payer: Aetna Managed Medicare |
$67.85
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$157.51
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$121.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$116.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$128.43
|
| Rate for Payer: Cash Price |
$69.90
|
| Rate for Payer: Cigna Commercial |
$222.93
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$135.61
|
| Rate for Payer: Health EOS Commercial |
$215.66
|
| Rate for Payer: HFN Commercial |
$222.93
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$181.74
|
| Rate for Payer: Multiplan Commercial |
$193.86
|
| Rate for Payer: NAPHCARE Commercial |
$145.39
|
| Rate for Payer: Preferred Network Access Commercial |
$222.93
|
| Rate for Payer: Quartz Beloit One Network |
$118.74
|
| Rate for Payer: Quartz Commercial |
$157.51
|
| Rate for Payer: Quartz Medicare Advantage |
$145.39
|
| Rate for Payer: The Alliance Commercial |
$121.16
|
| Rate for Payer: WEA Trust Commercial |
$133.28
|
| Rate for Payer: WPS Commercial |
$179.48
|
|
|
ARCH BINDER SMALL
|
Facility
|
IP
|
$233.00
|
|
| Hospital Charge Code |
2969829
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$118.74 |
| Max. Negotiated Rate |
$222.93 |
| Rate for Payer: Aetna Commercial |
$218.09
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$208.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$128.43
|
| Rate for Payer: Cash Price |
$69.90
|
| Rate for Payer: Cigna Commercial |
$222.93
|
| Rate for Payer: Health EOS Commercial |
$215.66
|
| Rate for Payer: HFN Commercial |
$222.93
|
| Rate for Payer: Multiplan Commercial |
$193.86
|
| Rate for Payer: Preferred Network Access Commercial |
$222.93
|
| Rate for Payer: Quartz Beloit One Network |
$118.74
|
| Rate for Payer: Quartz Commercial |
$145.39
|
| Rate for Payer: WEA Trust Commercial |
$133.28
|
| Rate for Payer: WPS Commercial |
$179.48
|
|
|
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 |
$2,311.25 |
| Max. Negotiated Rate |
$7,594.12 |
| Rate for Payer: Aetna Commercial |
$7,429.03
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,098.85
|
| Rate for Payer: Aetna Managed Medicare |
$2,311.25
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,365.41
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,127.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,962.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,374.87
|
| Rate for Payer: Cash Price |
$2,381.10
|
| Rate for Payer: Cigna Commercial |
$7,594.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,619.33
|
| Rate for Payer: Health EOS Commercial |
$7,346.49
|
| Rate for Payer: HFN Commercial |
$7,594.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,190.86
|
| Rate for Payer: Multiplan Commercial |
$6,603.58
|
| Rate for Payer: NAPHCARE Commercial |
$4,952.69
|
| Rate for Payer: Preferred Network Access Commercial |
$7,594.12
|
| Rate for Payer: Quartz Beloit One Network |
$4,044.70
|
| Rate for Payer: Quartz Commercial |
$5,365.41
|
| Rate for Payer: Quartz Medicare Advantage |
$4,952.69
|
| Rate for Payer: The Alliance Commercial |
$4,127.24
|
| Rate for Payer: WEA Trust Commercial |
$4,539.96
|
| Rate for Payer: WPS Commercial |
$6,113.87
|
|
|
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 |
$4,044.70 |
| Max. Negotiated Rate |
$7,594.12 |
| Rate for Payer: Aetna Commercial |
$7,429.03
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,098.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,374.87
|
| Rate for Payer: Cash Price |
$2,381.10
|
| Rate for Payer: Cigna Commercial |
$7,594.12
|
| Rate for Payer: Health EOS Commercial |
$7,346.49
|
| Rate for Payer: HFN Commercial |
$7,594.12
|
| Rate for Payer: Multiplan Commercial |
$6,603.58
|
| Rate for Payer: Preferred Network Access Commercial |
$7,594.12
|
| Rate for Payer: Quartz Beloit One Network |
$4,044.70
|
| Rate for Payer: Quartz Commercial |
$4,952.69
|
| Rate for Payer: WEA Trust Commercial |
$4,539.96
|
| Rate for Payer: WPS Commercial |
$6,113.87
|
|
|
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 |
$4,112.47 |
| Max. Negotiated Rate |
$7,721.38 |
| Rate for Payer: Aetna Commercial |
$7,553.52
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,217.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,448.18
|
| Rate for Payer: Cash Price |
$2,421.00
|
| Rate for Payer: Cigna Commercial |
$7,721.38
|
| Rate for Payer: Health EOS Commercial |
$7,469.59
|
| Rate for Payer: HFN Commercial |
$7,721.38
|
| Rate for Payer: Multiplan Commercial |
$6,714.24
|
| Rate for Payer: Preferred Network Access Commercial |
$7,721.38
|
| Rate for Payer: Quartz Beloit One Network |
$4,112.47
|
| Rate for Payer: Quartz Commercial |
$5,035.68
|
| Rate for Payer: WEA Trust Commercial |
$4,616.04
|
| Rate for Payer: WPS Commercial |
$6,216.32
|
|
|
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 |
$2,349.98 |
| Max. Negotiated Rate |
$7,721.38 |
| Rate for Payer: Aetna Commercial |
$7,553.52
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,217.81
|
| Rate for Payer: Aetna Managed Medicare |
$2,349.98
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,455.32
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,196.40
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,028.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,448.18
|
| Rate for Payer: Cash Price |
$2,421.00
|
| Rate for Payer: Cigna Commercial |
$7,721.38
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,696.74
|
| Rate for Payer: Health EOS Commercial |
$7,469.59
|
| Rate for Payer: HFN Commercial |
$7,721.38
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,294.60
|
| Rate for Payer: Multiplan Commercial |
$6,714.24
|
| Rate for Payer: NAPHCARE Commercial |
$5,035.68
|
| Rate for Payer: Preferred Network Access Commercial |
$7,721.38
|
| Rate for Payer: Quartz Beloit One Network |
$4,112.47
|
| Rate for Payer: Quartz Commercial |
$5,455.32
|
| Rate for Payer: Quartz Medicare Advantage |
$5,035.68
|
| Rate for Payer: The Alliance Commercial |
$4,196.40
|
| Rate for Payer: WEA Trust Commercial |
$4,616.04
|
| Rate for Payer: WPS Commercial |
$6,216.32
|
|
|
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 |
$2,499.66 |
| Max. Negotiated Rate |
$8,213.17 |
| Rate for Payer: Aetna Commercial |
$8,034.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,677.53
|
| Rate for Payer: Aetna Managed Medicare |
$2,499.66
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,802.78
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,463.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,285.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,731.50
|
| Rate for Payer: Cash Price |
$2,575.20
|
| Rate for Payer: Cigna Commercial |
$8,213.17
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,995.89
|
| Rate for Payer: Health EOS Commercial |
$7,945.35
|
| Rate for Payer: HFN Commercial |
$8,213.17
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,695.52
|
| Rate for Payer: Multiplan Commercial |
$7,141.89
|
| Rate for Payer: NAPHCARE Commercial |
$5,356.42
|
| Rate for Payer: Preferred Network Access Commercial |
$8,213.17
|
| Rate for Payer: Quartz Beloit One Network |
$4,374.41
|
| Rate for Payer: Quartz Commercial |
$5,802.78
|
| Rate for Payer: Quartz Medicare Advantage |
$5,356.42
|
| Rate for Payer: The Alliance Commercial |
$4,463.68
|
| Rate for Payer: WEA Trust Commercial |
$4,910.05
|
| Rate for Payer: WPS Commercial |
$6,612.26
|
|
|
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 |
$4,374.41 |
| Max. Negotiated Rate |
$8,213.17 |
| Rate for Payer: Aetna Commercial |
$8,034.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,677.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,731.50
|
| Rate for Payer: Cash Price |
$2,575.20
|
| Rate for Payer: Cigna Commercial |
$8,213.17
|
| Rate for Payer: Health EOS Commercial |
$7,945.35
|
| Rate for Payer: HFN Commercial |
$8,213.17
|
| Rate for Payer: Multiplan Commercial |
$7,141.89
|
| Rate for Payer: Preferred Network Access Commercial |
$8,213.17
|
| Rate for Payer: Quartz Beloit One Network |
$4,374.41
|
| Rate for Payer: Quartz Commercial |
$5,356.42
|
| Rate for Payer: WEA Trust Commercial |
$4,910.05
|
| Rate for Payer: WPS Commercial |
$6,612.26
|
|
|
ARCH SWEDE MED RIGHT
|
Facility
|
IP
|
$799.00
|
|
| Hospital Charge Code |
2971652
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$407.17 |
| Max. Negotiated Rate |
$764.48 |
| Rate for Payer: Aetna Commercial |
$747.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$714.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$440.41
|
| Rate for Payer: Cash Price |
$239.70
|
| Rate for Payer: Cigna Commercial |
$764.48
|
| Rate for Payer: Health EOS Commercial |
$739.55
|
| Rate for Payer: HFN Commercial |
$764.48
|
| Rate for Payer: Multiplan Commercial |
$664.77
|
| Rate for Payer: Preferred Network Access Commercial |
$764.48
|
| Rate for Payer: Quartz Beloit One Network |
$407.17
|
| Rate for Payer: Quartz Commercial |
$498.58
|
| Rate for Payer: WEA Trust Commercial |
$457.03
|
| Rate for Payer: WPS Commercial |
$615.47
|
|
|
ARCH SWEDE MED RIGHT
|
Facility
|
OP
|
$799.00
|
|
| Hospital Charge Code |
2971652
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$232.67 |
| Max. Negotiated Rate |
$764.48 |
| Rate for Payer: Aetna Commercial |
$747.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$714.63
|
| Rate for Payer: Aetna Managed Medicare |
$232.67
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$540.12
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$415.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$398.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$440.41
|
| Rate for Payer: Cash Price |
$239.70
|
| Rate for Payer: Cigna Commercial |
$764.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$465.02
|
| Rate for Payer: Health EOS Commercial |
$739.55
|
| Rate for Payer: HFN Commercial |
$764.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$623.22
|
| Rate for Payer: Multiplan Commercial |
$664.77
|
| Rate for Payer: NAPHCARE Commercial |
$498.58
|
| Rate for Payer: Preferred Network Access Commercial |
$764.48
|
| Rate for Payer: Quartz Beloit One Network |
$407.17
|
| Rate for Payer: Quartz Commercial |
$540.12
|
| Rate for Payer: Quartz Medicare Advantage |
$498.58
|
| Rate for Payer: The Alliance Commercial |
$415.48
|
| Rate for Payer: WEA Trust Commercial |
$457.03
|
| Rate for Payer: WPS Commercial |
$615.47
|
|
|
ARCH SWEDE SMALL RIGHT
|
Facility
|
OP
|
$799.00
|
|
| Hospital Charge Code |
2971651
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$232.67 |
| Max. Negotiated Rate |
$764.48 |
| Rate for Payer: Aetna Commercial |
$747.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$714.63
|
| Rate for Payer: Aetna Managed Medicare |
$232.67
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$540.12
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$415.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$398.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$440.41
|
| Rate for Payer: Cash Price |
$239.70
|
| Rate for Payer: Cigna Commercial |
$764.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$465.02
|
| Rate for Payer: Health EOS Commercial |
$739.55
|
| Rate for Payer: HFN Commercial |
$764.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$623.22
|
| Rate for Payer: Multiplan Commercial |
$664.77
|
| Rate for Payer: NAPHCARE Commercial |
$498.58
|
| Rate for Payer: Preferred Network Access Commercial |
$764.48
|
| Rate for Payer: Quartz Beloit One Network |
$407.17
|
| Rate for Payer: Quartz Commercial |
$540.12
|
| Rate for Payer: Quartz Medicare Advantage |
$498.58
|
| Rate for Payer: The Alliance Commercial |
$415.48
|
| Rate for Payer: WEA Trust Commercial |
$457.03
|
| Rate for Payer: WPS Commercial |
$615.47
|
|
|
ARCH SWEDE SMALL RIGHT
|
Facility
|
IP
|
$799.00
|
|
| Hospital Charge Code |
2971651
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$407.17 |
| Max. Negotiated Rate |
$764.48 |
| Rate for Payer: Aetna Commercial |
$747.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$714.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$440.41
|
| Rate for Payer: Cash Price |
$239.70
|
| Rate for Payer: Cigna Commercial |
$764.48
|
| Rate for Payer: Health EOS Commercial |
$739.55
|
| Rate for Payer: HFN Commercial |
$764.48
|
| Rate for Payer: Multiplan Commercial |
$664.77
|
| Rate for Payer: Preferred Network Access Commercial |
$764.48
|
| Rate for Payer: Quartz Beloit One Network |
$407.17
|
| Rate for Payer: Quartz Commercial |
$498.58
|
| Rate for Payer: WEA Trust Commercial |
$457.03
|
| Rate for Payer: WPS Commercial |
$615.47
|
|
|
ARCTIC PAD SET UNIVERSAL 1/EA #317-00
|
Facility
|
IP
|
$3,843.00
|
|
| Hospital Charge Code |
2973419
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$1,958.39 |
| Max. Negotiated Rate |
$3,676.98 |
| Rate for Payer: Aetna Commercial |
$3,597.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,437.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,118.26
|
| Rate for Payer: Cash Price |
$1,152.90
|
| Rate for Payer: Cigna Commercial |
$3,676.98
|
| Rate for Payer: Health EOS Commercial |
$3,557.08
|
| Rate for Payer: HFN Commercial |
$3,676.98
|
| Rate for Payer: Multiplan Commercial |
$3,197.38
|
| Rate for Payer: Preferred Network Access Commercial |
$3,676.98
|
| Rate for Payer: Quartz Beloit One Network |
$1,958.39
|
| Rate for Payer: Quartz Commercial |
$2,398.03
|
| Rate for Payer: WEA Trust Commercial |
$2,198.20
|
| Rate for Payer: WPS Commercial |
$2,960.26
|
|
|
ARCTIC PAD SET UNIVERSAL 1/EA #317-00
|
Facility
|
OP
|
$3,843.00
|
|
| Hospital Charge Code |
2973419
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$1,119.08 |
| Max. Negotiated Rate |
$3,676.98 |
| Rate for Payer: Aetna Commercial |
$3,597.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,437.18
|
| Rate for Payer: Aetna Managed Medicare |
$1,119.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,597.87
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,998.36
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,918.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,118.26
|
| Rate for Payer: Cash Price |
$1,152.90
|
| Rate for Payer: Cigna Commercial |
$3,676.98
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,236.63
|
| Rate for Payer: Health EOS Commercial |
$3,557.08
|
| Rate for Payer: HFN Commercial |
$3,676.98
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,997.54
|
| Rate for Payer: Multiplan Commercial |
$3,197.38
|
| Rate for Payer: NAPHCARE Commercial |
$2,398.03
|
| Rate for Payer: Preferred Network Access Commercial |
$3,676.98
|
| Rate for Payer: Quartz Beloit One Network |
$1,958.39
|
| Rate for Payer: Quartz Commercial |
$2,597.87
|
| Rate for Payer: Quartz Medicare Advantage |
$2,398.03
|
| Rate for Payer: The Alliance Commercial |
$1,998.36
|
| Rate for Payer: WEA Trust Commercial |
$2,198.20
|
| Rate for Payer: WPS Commercial |
$2,960.26
|
|
|
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 |
$4,453.90 |
| Max. Negotiated Rate |
$8,362.43 |
| Rate for Payer: Aetna Commercial |
$8,180.64
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,817.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,817.49
|
| Rate for Payer: Cash Price |
$2,622.00
|
| Rate for Payer: Cigna Commercial |
$8,362.43
|
| Rate for Payer: Health EOS Commercial |
$8,089.74
|
| Rate for Payer: HFN Commercial |
$8,362.43
|
| Rate for Payer: Multiplan Commercial |
$7,271.68
|
| Rate for Payer: Preferred Network Access Commercial |
$8,362.43
|
| Rate for Payer: Quartz Beloit One Network |
$4,453.90
|
| Rate for Payer: Quartz Commercial |
$5,453.76
|
| Rate for Payer: WEA Trust Commercial |
$4,999.28
|
| Rate for Payer: WPS Commercial |
$6,732.42
|
|
|
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 |
$2,545.09 |
| Max. Negotiated Rate |
$8,362.43 |
| Rate for Payer: Aetna Commercial |
$8,180.64
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,817.06
|
| Rate for Payer: Aetna Managed Medicare |
$2,545.09
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,908.24
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,544.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,363.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,817.49
|
| Rate for Payer: Cash Price |
$2,622.00
|
| Rate for Payer: Cigna Commercial |
$8,362.43
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,086.68
|
| Rate for Payer: Health EOS Commercial |
$8,089.74
|
| Rate for Payer: HFN Commercial |
$8,362.43
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,817.20
|
| Rate for Payer: Multiplan Commercial |
$7,271.68
|
| Rate for Payer: NAPHCARE Commercial |
$5,453.76
|
| Rate for Payer: Preferred Network Access Commercial |
$8,362.43
|
| Rate for Payer: Quartz Beloit One Network |
$4,453.90
|
| Rate for Payer: Quartz Commercial |
$5,908.24
|
| Rate for Payer: Quartz Medicare Advantage |
$5,453.76
|
| Rate for Payer: The Alliance Commercial |
$4,544.80
|
| Rate for Payer: WEA Trust Commercial |
$4,999.28
|
| Rate for Payer: WPS Commercial |
$6,732.42
|
|
|
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 |
$2,545.09 |
| Max. Negotiated Rate |
$8,362.43 |
| Rate for Payer: Aetna Commercial |
$8,180.64
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,817.06
|
| Rate for Payer: Aetna Managed Medicare |
$2,545.09
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,908.24
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,544.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,363.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,817.49
|
| Rate for Payer: Cash Price |
$2,622.00
|
| Rate for Payer: Cigna Commercial |
$8,362.43
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,086.68
|
| Rate for Payer: Health EOS Commercial |
$8,089.74
|
| Rate for Payer: HFN Commercial |
$8,362.43
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,817.20
|
| Rate for Payer: Multiplan Commercial |
$7,271.68
|
| Rate for Payer: NAPHCARE Commercial |
$5,453.76
|
| Rate for Payer: Preferred Network Access Commercial |
$8,362.43
|
| Rate for Payer: Quartz Beloit One Network |
$4,453.90
|
| Rate for Payer: Quartz Commercial |
$5,908.24
|
| Rate for Payer: Quartz Medicare Advantage |
$5,453.76
|
| Rate for Payer: The Alliance Commercial |
$4,544.80
|
| Rate for Payer: WEA Trust Commercial |
$4,999.28
|
| Rate for Payer: WPS Commercial |
$6,732.42
|
|
|
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 |
$4,453.90 |
| Max. Negotiated Rate |
$8,362.43 |
| Rate for Payer: Aetna Commercial |
$8,180.64
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,817.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,817.49
|
| Rate for Payer: Cash Price |
$2,622.00
|
| Rate for Payer: Cigna Commercial |
$8,362.43
|
| Rate for Payer: Health EOS Commercial |
$8,089.74
|
| Rate for Payer: HFN Commercial |
$8,362.43
|
| Rate for Payer: Multiplan Commercial |
$7,271.68
|
| Rate for Payer: Preferred Network Access Commercial |
$8,362.43
|
| Rate for Payer: Quartz Beloit One Network |
$4,453.90
|
| Rate for Payer: Quartz Commercial |
$5,453.76
|
| Rate for Payer: WEA Trust Commercial |
$4,999.28
|
| Rate for Payer: WPS Commercial |
$6,732.42
|
|
|
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 |
$180.25 |
| Max. Negotiated Rate |
$592.26 |
| Rate for Payer: Aetna Commercial |
$579.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$553.63
|
| Rate for Payer: Aetna Managed Medicare |
$180.25
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$418.44
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$321.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$309.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$341.19
|
| Rate for Payer: Cash Price |
$185.70
|
| Rate for Payer: Cigna Commercial |
$592.26
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$360.26
|
| Rate for Payer: Health EOS Commercial |
$572.95
|
| Rate for Payer: HFN Commercial |
$592.26
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$482.82
|
| Rate for Payer: Multiplan Commercial |
$515.01
|
| Rate for Payer: NAPHCARE Commercial |
$386.26
|
| Rate for Payer: Preferred Network Access Commercial |
$592.26
|
| Rate for Payer: Quartz Beloit One Network |
$315.44
|
| Rate for Payer: Quartz Commercial |
$418.44
|
| Rate for Payer: Quartz Medicare Advantage |
$386.26
|
| Rate for Payer: The Alliance Commercial |
$321.88
|
| Rate for Payer: WEA Trust Commercial |
$354.07
|
| Rate for Payer: WPS Commercial |
$476.82
|
|
|
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 |
$283.25 |
| Max. Negotiated Rate |
$611.57 |
| Rate for Payer: Aetna Commercial |
$611.57
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$553.63
|
| Rate for Payer: Cash Price |
$185.70
|
| Rate for Payer: Cash Price |
$185.70
|
| Rate for Payer: Cigna Commercial |
$611.57
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$318.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$386.26
|
| Rate for Payer: Health EOS Commercial |
$585.82
|
| Rate for Payer: HFN Commercial |
$611.57
|
| Rate for Payer: Multiplan Commercial |
$515.01
|
| Rate for Payer: Preferred Network Access Commercial |
$611.57
|
| Rate for Payer: Quartz Beloit One Network |
$283.25
|
| Rate for Payer: Quartz Commercial |
$366.94
|
| Rate for Payer: The Alliance Commercial |
$321.88
|
| Rate for Payer: United Healthcare Medicaid |
$318.60
|
| Rate for Payer: WEA Trust Commercial |
$354.07
|
| Rate for Payer: WPS Commercial |
$476.82
|
|
