|
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
|
|
|
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 |
$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
|
|
|
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 |
$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 vaccine preF3, recombinant 90679
|
Facility
|
IP
|
$619.00
|
|
|
Service Code
|
CPT 90679
|
| Hospital Charge Code |
6224162
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$315.44 |
| Max. Negotiated Rate |
$592.26 |
| Rate for Payer: Aetna Commercial |
$579.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$553.63
|
| 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: Health EOS Commercial |
$572.95
|
| Rate for Payer: HFN Commercial |
$592.26
|
| Rate for Payer: Multiplan Commercial |
$515.01
|
| Rate for Payer: Preferred Network Access Commercial |
$592.26
|
| Rate for Payer: Quartz Beloit One Network |
$315.44
|
| Rate for Payer: Quartz Commercial |
$386.26
|
| Rate for Payer: WEA Trust Commercial |
$354.07
|
| Rate for Payer: WPS Commercial |
$476.82
|
|
|
Argenine Vasopressin (ADH)
|
Facility
|
IP
|
$1,212.00
|
|
|
Service Code
|
CPT 84588
|
| Hospital Charge Code |
980028
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$617.64 |
| Max. Negotiated Rate |
$1,159.64 |
| Rate for Payer: Aetna Commercial |
$1,134.43
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,084.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$668.05
|
| Rate for Payer: Cash Price |
$363.60
|
| Rate for Payer: Cigna Commercial |
$1,159.64
|
| Rate for Payer: Health EOS Commercial |
$1,121.83
|
| Rate for Payer: HFN Commercial |
$1,159.64
|
| Rate for Payer: Multiplan Commercial |
$1,008.38
|
| Rate for Payer: Preferred Network Access Commercial |
$1,159.64
|
| Rate for Payer: Quartz Beloit One Network |
$617.64
|
| Rate for Payer: Quartz Commercial |
$756.29
|
| Rate for Payer: WEA Trust Commercial |
$693.26
|
| Rate for Payer: WPS Commercial |
$933.60
|
|
|
Argenine Vasopressin (ADH)
|
Professional
|
Both
|
$1,212.00
|
|
|
Service Code
|
CPT 84588
|
| Hospital Charge Code |
980028
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$35.30 |
| Max. Negotiated Rate |
$1,197.46 |
| Rate for Payer: Aetna Commercial |
$1,197.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,084.01
|
| Rate for Payer: Aetna Managed Medicare |
$35.30
|
| Rate for Payer: Anthem Medicare Advantage |
$35.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$35.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$35.30
|
| Rate for Payer: Cash Price |
$363.60
|
| Rate for Payer: Cash Price |
$363.60
|
| Rate for Payer: Cigna Commercial |
$1,197.46
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$630.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$35.30
|
| Rate for Payer: Health EOS Commercial |
$1,147.04
|
| Rate for Payer: HFN Commercial |
$1,197.46
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$124.60
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$124.60
|
| Rate for Payer: Independent Care Health Plan Medicare |
$35.30
|
| Rate for Payer: Multiplan Commercial |
$1,008.38
|
| Rate for Payer: NAPHCARE Commercial |
$52.95
|
| Rate for Payer: Preferred Network Access Commercial |
$1,197.46
|
| Rate for Payer: Quartz Beloit One Network |
$554.61
|
| Rate for Payer: Quartz Commercial |
$718.47
|
| Rate for Payer: Quartz Medicare Advantage |
$35.30
|
| Rate for Payer: The Alliance Commercial |
$139.43
|
| Rate for Payer: United Healthcare Medicare Advantage |
$35.30
|
| Rate for Payer: WEA Trust Commercial |
$693.26
|
| Rate for Payer: WPS Commercial |
$155.31
|
|
|
Argenine Vasopressin (ADH)
|
Facility
|
OP
|
$1,212.00
|
|
|
Service Code
|
CPT 84588
|
| Hospital Charge Code |
980028
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$35.30 |
| Max. Negotiated Rate |
$1,159.64 |
| Rate for Payer: Aetna Commercial |
$1,134.43
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,084.01
|
| Rate for Payer: Aetna Managed Medicare |
$35.30
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$132.37
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$61.77
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$58.59
|
| Rate for Payer: Anthem Medicare Advantage |
$35.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$668.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$35.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$35.30
|
| Rate for Payer: Cash Price |
$363.60
|
| Rate for Payer: Cash Price |
$363.60
|
| Rate for Payer: Cigna Commercial |
$1,159.64
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$35.30
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$705.38
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$35.30
|
| Rate for Payer: Health EOS Commercial |
$1,121.83
|
| Rate for Payer: HFN Commercial |
$1,159.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$131.31
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$35.30
|
| Rate for Payer: Independent Care Health Plan Medicare |
$35.30
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$35.30
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$35.30
|
| Rate for Payer: Multiplan Commercial |
$1,008.38
|
| Rate for Payer: NAPHCARE Commercial |
$52.95
|
| Rate for Payer: Preferred Network Access Commercial |
$1,159.64
|
| Rate for Payer: Quartz Beloit One Network |
$617.64
|
| Rate for Payer: Quartz Commercial |
$819.31
|
| Rate for Payer: Quartz Medicare Advantage |
$35.30
|
| Rate for Payer: The Alliance Commercial |
$141.19
|
| Rate for Payer: United Healthcare Medicare Advantage |
$35.30
|
| Rate for Payer: United Healthcare PPO |
$945.36
|
| Rate for Payer: WEA Trust Commercial |
$693.26
|
| Rate for Payer: Wellcare Medicare |
$35.30
|
| Rate for Payer: WPS Commercial |
$933.60
|
|
|
ARGON BEAM COAGULATION
|
Facility
|
IP
|
$6,563.00
|
|
|
Service Code
|
CPT 53899
|
| Hospital Charge Code |
5432917
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,344.50 |
| Max. Negotiated Rate |
$6,279.48 |
| Rate for Payer: Aetna Commercial |
$6,142.97
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,869.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,617.53
|
| Rate for Payer: Cash Price |
$1,968.90
|
| Rate for Payer: Cigna Commercial |
$6,279.48
|
| Rate for Payer: Health EOS Commercial |
$6,074.71
|
| Rate for Payer: HFN Commercial |
$6,279.48
|
| Rate for Payer: Multiplan Commercial |
$5,460.42
|
| Rate for Payer: Preferred Network Access Commercial |
$6,279.48
|
| Rate for Payer: Quartz Beloit One Network |
$3,344.50
|
| Rate for Payer: Quartz Commercial |
$4,095.31
|
| Rate for Payer: WEA Trust Commercial |
$3,754.04
|
| Rate for Payer: WPS Commercial |
$5,055.48
|
|
|
ARGON BEAM COAGULATION
|
Facility
|
OP
|
$6,563.00
|
|
|
Service Code
|
CPT 53899
|
| Hospital Charge Code |
5432917
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$262.93 |
| Max. Negotiated Rate |
$29,092.96 |
| Rate for Payer: Aetna Commercial |
$6,142.97
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,869.95
|
| Rate for Payer: Aetna Managed Medicare |
$262.93
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$29,092.96
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$26,282.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$24,968.32
|
| Rate for Payer: Anthem Medicare Advantage |
$262.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,617.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$262.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$262.93
|
| 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: Cash Price |
$1,968.90
|
| Rate for Payer: Cigna Commercial |
$6,279.48
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$262.93
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$262.93
|
| Rate for Payer: Health EOS Commercial |
$6,074.71
|
| Rate for Payer: HFN Commercial |
$6,279.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$978.11
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$262.93
|
| Rate for Payer: Independent Care Health Plan Medicare |
$262.93
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$262.93
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$262.93
|
| Rate for Payer: Multiplan Commercial |
$5,460.42
|
| Rate for Payer: NAPHCARE Commercial |
$394.40
|
| Rate for Payer: Preferred Network Access Commercial |
$6,279.48
|
| Rate for Payer: Quartz Beloit One Network |
$3,344.50
|
| Rate for Payer: Quartz Commercial |
$4,436.59
|
| Rate for Payer: Quartz Medicare Advantage |
$262.93
|
| Rate for Payer: The Alliance Commercial |
$1,051.73
|
| Rate for Payer: United Healthcare Medicare Advantage |
$262.93
|
| Rate for Payer: United Healthcare PPO |
$14,223.04
|
| Rate for Payer: WEA Trust Commercial |
$3,754.04
|
| Rate for Payer: Wellcare Medicare |
$262.93
|
| Rate for Payer: WPS Commercial |
$5,055.48
|
|
|
ARGON PLASMA COAGULATOR
|
Facility
|
IP
|
$2,003.00
|
|
| Hospital Charge Code |
4075907
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,020.73 |
| Max. Negotiated Rate |
$1,916.47 |
| Rate for Payer: Aetna Commercial |
$1,874.81
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,791.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,104.05
|
| Rate for Payer: Cash Price |
$600.90
|
| Rate for Payer: Cigna Commercial |
$1,916.47
|
| Rate for Payer: Health EOS Commercial |
$1,853.98
|
| Rate for Payer: HFN Commercial |
$1,916.47
|
| Rate for Payer: Multiplan Commercial |
$1,666.50
|
| Rate for Payer: Preferred Network Access Commercial |
$1,916.47
|
| Rate for Payer: Quartz Beloit One Network |
$1,020.73
|
| Rate for Payer: Quartz Commercial |
$1,249.87
|
| Rate for Payer: WEA Trust Commercial |
$1,145.72
|
| Rate for Payer: WPS Commercial |
$1,542.91
|
|
|
ARGON PLASMA COAGULATOR
|
Facility
|
OP
|
$2,003.00
|
|
| Hospital Charge Code |
4075907
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$583.27 |
| Max. Negotiated Rate |
$1,916.47 |
| Rate for Payer: Aetna Commercial |
$1,874.81
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,791.48
|
| Rate for Payer: Aetna Managed Medicare |
$583.27
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,354.03
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,041.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$999.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,104.05
|
| Rate for Payer: Cash Price |
$600.90
|
| Rate for Payer: Cigna Commercial |
$1,916.47
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,165.75
|
| Rate for Payer: Health EOS Commercial |
$1,853.98
|
| Rate for Payer: HFN Commercial |
$1,916.47
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,562.34
|
| Rate for Payer: Multiplan Commercial |
$1,666.50
|
| Rate for Payer: NAPHCARE Commercial |
$1,249.87
|
| Rate for Payer: Preferred Network Access Commercial |
$1,916.47
|
| Rate for Payer: Quartz Beloit One Network |
$1,020.73
|
| Rate for Payer: Quartz Commercial |
$1,354.03
|
| Rate for Payer: Quartz Medicare Advantage |
$1,249.87
|
| Rate for Payer: The Alliance Commercial |
$1,041.56
|
| Rate for Payer: WEA Trust Commercial |
$1,145.72
|
| Rate for Payer: WPS Commercial |
$1,542.91
|
|
|
ARGON PLASMA COAGULATORY
|
Facility
|
IP
|
$1,643.00
|
|
| Hospital Charge Code |
2969255
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$837.27 |
| Max. Negotiated Rate |
$1,572.02 |
| Rate for Payer: Aetna Commercial |
$1,537.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,469.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$905.62
|
| Rate for Payer: Cash Price |
$492.90
|
| Rate for Payer: Cigna Commercial |
$1,572.02
|
| Rate for Payer: Health EOS Commercial |
$1,520.76
|
| Rate for Payer: HFN Commercial |
$1,572.02
|
| Rate for Payer: Multiplan Commercial |
$1,366.98
|
| Rate for Payer: Preferred Network Access Commercial |
$1,572.02
|
| Rate for Payer: Quartz Beloit One Network |
$837.27
|
| Rate for Payer: Quartz Commercial |
$1,025.23
|
| Rate for Payer: WEA Trust Commercial |
$939.80
|
| Rate for Payer: WPS Commercial |
$1,265.60
|
|
|
ARGON PLASMA COAGULATORY
|
Facility
|
OP
|
$1,643.00
|
|
| Hospital Charge Code |
2969255
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$478.44 |
| Max. Negotiated Rate |
$1,572.02 |
| Rate for Payer: Aetna Commercial |
$1,537.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,469.50
|
| Rate for Payer: Aetna Managed Medicare |
$478.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,110.67
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$854.36
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$820.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$905.62
|
| Rate for Payer: Cash Price |
$492.90
|
| Rate for Payer: Cigna Commercial |
$1,572.02
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$956.23
|
| Rate for Payer: Health EOS Commercial |
$1,520.76
|
| Rate for Payer: HFN Commercial |
$1,572.02
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,281.54
|
| Rate for Payer: Multiplan Commercial |
$1,366.98
|
| Rate for Payer: NAPHCARE Commercial |
$1,025.23
|
| Rate for Payer: Preferred Network Access Commercial |
$1,572.02
|
| Rate for Payer: Quartz Beloit One Network |
$837.27
|
| Rate for Payer: Quartz Commercial |
$1,110.67
|
| Rate for Payer: Quartz Medicare Advantage |
$1,025.23
|
| Rate for Payer: The Alliance Commercial |
$854.36
|
| Rate for Payer: WEA Trust Commercial |
$939.80
|
| Rate for Payer: WPS Commercial |
$1,265.60
|
|
|
Aripiprazole (Abilify)
|
Facility
|
IP
|
$234.00
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
3256219
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$119.25 |
| Max. Negotiated Rate |
$223.89 |
| Rate for Payer: Aetna Commercial |
$219.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$209.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$128.98
|
| Rate for Payer: Cash Price |
$70.20
|
| Rate for Payer: Cigna Commercial |
$223.89
|
| Rate for Payer: Health EOS Commercial |
$216.59
|
| Rate for Payer: HFN Commercial |
$223.89
|
| Rate for Payer: Multiplan Commercial |
$194.69
|
| Rate for Payer: Preferred Network Access Commercial |
$223.89
|
| Rate for Payer: Quartz Beloit One Network |
$119.25
|
| Rate for Payer: Quartz Commercial |
$146.02
|
| Rate for Payer: WEA Trust Commercial |
$133.85
|
| Rate for Payer: WPS Commercial |
$180.25
|
|
|
Aripiprazole (Abilify)
|
Professional
|
Both
|
$234.00
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
3256219
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$19.39 |
| Max. Negotiated Rate |
$231.19 |
| Rate for Payer: Aetna Commercial |
$231.19
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$209.29
|
| Rate for Payer: Aetna Managed Medicare |
$19.39
|
| Rate for Payer: Anthem Medicare Advantage |
$19.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$19.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$19.39
|
| Rate for Payer: Cash Price |
$70.20
|
| Rate for Payer: Cash Price |
$70.20
|
| Rate for Payer: Cigna Commercial |
$231.19
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$121.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$19.39
|
| Rate for Payer: Health EOS Commercial |
$221.46
|
| Rate for Payer: HFN Commercial |
$231.19
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$68.43
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$68.43
|
| Rate for Payer: Independent Care Health Plan Medicare |
$19.39
|
| Rate for Payer: Multiplan Commercial |
$194.69
|
| Rate for Payer: NAPHCARE Commercial |
$29.08
|
| Rate for Payer: Preferred Network Access Commercial |
$231.19
|
| Rate for Payer: Quartz Beloit One Network |
$107.08
|
| Rate for Payer: Quartz Commercial |
$138.72
|
| Rate for Payer: Quartz Medicare Advantage |
$19.39
|
| Rate for Payer: The Alliance Commercial |
$76.57
|
| Rate for Payer: United Healthcare Medicare Advantage |
$19.39
|
| Rate for Payer: WEA Trust Commercial |
$133.85
|
| Rate for Payer: WPS Commercial |
$85.30
|
|
|
Aripiprazole (Abilify)
|
Facility
|
OP
|
$234.00
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
3256219
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$19.39 |
| Max. Negotiated Rate |
$223.89 |
| Rate for Payer: Aetna Commercial |
$219.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$209.29
|
| Rate for Payer: Aetna Managed Medicare |
$19.39
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$72.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$33.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$32.18
|
| Rate for Payer: Anthem Medicare Advantage |
$19.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$128.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$19.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$19.39
|
| Rate for Payer: Cash Price |
$70.20
|
| Rate for Payer: Cash Price |
$70.20
|
| Rate for Payer: Cigna Commercial |
$223.89
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$19.39
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$136.19
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$19.39
|
| Rate for Payer: Health EOS Commercial |
$216.59
|
| Rate for Payer: HFN Commercial |
$223.89
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$72.11
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$19.39
|
| Rate for Payer: Independent Care Health Plan Medicare |
$19.39
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$19.39
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$19.39
|
| Rate for Payer: Multiplan Commercial |
$194.69
|
| Rate for Payer: NAPHCARE Commercial |
$29.08
|
| Rate for Payer: Preferred Network Access Commercial |
$223.89
|
| Rate for Payer: Quartz Beloit One Network |
$119.25
|
| Rate for Payer: Quartz Commercial |
$158.18
|
| Rate for Payer: Quartz Medicare Advantage |
$19.39
|
| Rate for Payer: The Alliance Commercial |
$77.54
|
| Rate for Payer: United Healthcare Medicare Advantage |
$19.39
|
| Rate for Payer: United Healthcare PPO |
$182.52
|
| Rate for Payer: WEA Trust Commercial |
$133.85
|
| Rate for Payer: Wellcare Medicare |
$19.39
|
| Rate for Payer: WPS Commercial |
$180.25
|
|
|
ARISTA AH ABSORBABLE HEMASTATIC PARTICLES 3G SM0002-USA
|
Facility
|
OP
|
$2,551.00
|
|
| Hospital Charge Code |
4594721
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$742.85 |
| Max. Negotiated Rate |
$2,440.80 |
| Rate for Payer: Aetna Commercial |
$2,387.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,281.61
|
| Rate for Payer: Aetna Managed Medicare |
$742.85
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,724.48
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,326.52
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,273.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,406.11
|
| Rate for Payer: Cash Price |
$765.30
|
| Rate for Payer: Cigna Commercial |
$2,440.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,484.68
|
| Rate for Payer: Health EOS Commercial |
$2,361.21
|
| Rate for Payer: HFN Commercial |
$2,440.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,989.78
|
| Rate for Payer: Multiplan Commercial |
$2,122.43
|
| Rate for Payer: NAPHCARE Commercial |
$1,591.82
|
| Rate for Payer: Preferred Network Access Commercial |
$2,440.80
|
| Rate for Payer: Quartz Beloit One Network |
$1,299.99
|
| Rate for Payer: Quartz Commercial |
$1,724.48
|
| Rate for Payer: Quartz Medicare Advantage |
$1,591.82
|
| Rate for Payer: The Alliance Commercial |
$1,326.52
|
| Rate for Payer: WEA Trust Commercial |
$1,459.17
|
| Rate for Payer: WPS Commercial |
$1,965.04
|
|
|
ARISTA AH ABSORBABLE HEMASTATIC PARTICLES 3G SM0002-USA
|
Facility
|
IP
|
$2,551.00
|
|
| Hospital Charge Code |
4594721
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,299.99 |
| Max. Negotiated Rate |
$2,440.80 |
| Rate for Payer: Aetna Commercial |
$2,387.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,281.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,406.11
|
| Rate for Payer: Cash Price |
$765.30
|
| Rate for Payer: Cigna Commercial |
$2,440.80
|
| Rate for Payer: Health EOS Commercial |
$2,361.21
|
| Rate for Payer: HFN Commercial |
$2,440.80
|
| Rate for Payer: Multiplan Commercial |
$2,122.43
|
| Rate for Payer: Preferred Network Access Commercial |
$2,440.80
|
| Rate for Payer: Quartz Beloit One Network |
$1,299.99
|
| Rate for Payer: Quartz Commercial |
$1,591.82
|
| Rate for Payer: WEA Trust Commercial |
$1,459.17
|
| Rate for Payer: WPS Commercial |
$1,965.04
|
|
|
ARM CRADLE POSITIONER NON081344
|
Facility
|
OP
|
$303.00
|
|
| Hospital Charge Code |
2965825
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$88.23 |
| Max. Negotiated Rate |
$289.91 |
| Rate for Payer: Aetna Commercial |
$283.61
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$271.00
|
| Rate for Payer: Aetna Managed Medicare |
$88.23
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$204.83
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$157.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$151.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$167.01
|
| Rate for Payer: Cash Price |
$90.90
|
| Rate for Payer: Cigna Commercial |
$289.91
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$176.35
|
| Rate for Payer: Health EOS Commercial |
$280.46
|
| Rate for Payer: HFN Commercial |
$289.91
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$236.34
|
| Rate for Payer: Multiplan Commercial |
$252.10
|
| Rate for Payer: NAPHCARE Commercial |
$189.07
|
| Rate for Payer: Preferred Network Access Commercial |
$289.91
|
| Rate for Payer: Quartz Beloit One Network |
$154.41
|
| Rate for Payer: Quartz Commercial |
$204.83
|
| Rate for Payer: Quartz Medicare Advantage |
$189.07
|
| Rate for Payer: The Alliance Commercial |
$157.56
|
| Rate for Payer: WEA Trust Commercial |
$173.32
|
| Rate for Payer: WPS Commercial |
$233.40
|
|
|
ARM CRADLE POSITIONER NON081344
|
Facility
|
IP
|
$303.00
|
|
| Hospital Charge Code |
2965825
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$154.41 |
| Max. Negotiated Rate |
$289.91 |
| Rate for Payer: Aetna Commercial |
$283.61
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$271.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$167.01
|
| Rate for Payer: Cash Price |
$90.90
|
| Rate for Payer: Cigna Commercial |
$289.91
|
| Rate for Payer: Health EOS Commercial |
$280.46
|
| Rate for Payer: HFN Commercial |
$289.91
|
| Rate for Payer: Multiplan Commercial |
$252.10
|
| Rate for Payer: Preferred Network Access Commercial |
$289.91
|
| Rate for Payer: Quartz Beloit One Network |
$154.41
|
| Rate for Payer: Quartz Commercial |
$189.07
|
| Rate for Payer: WEA Trust Commercial |
$173.32
|
| Rate for Payer: WPS Commercial |
$233.40
|
|
|
ARM SLEEVE LATERAL TRACTION AR-1635
|
Facility
|
OP
|
$861.00
|
|
| Hospital Charge Code |
5685637
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$250.72 |
| Max. Negotiated Rate |
$823.80 |
| Rate for Payer: Aetna Commercial |
$805.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$770.08
|
| Rate for Payer: Aetna Managed Medicare |
$250.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$582.04
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$447.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$429.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$474.58
|
| Rate for Payer: Cash Price |
$258.30
|
| Rate for Payer: Cigna Commercial |
$823.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$501.10
|
| Rate for Payer: Health EOS Commercial |
$796.94
|
| Rate for Payer: HFN Commercial |
$823.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$671.58
|
| Rate for Payer: Multiplan Commercial |
$716.35
|
| Rate for Payer: NAPHCARE Commercial |
$537.26
|
| Rate for Payer: Preferred Network Access Commercial |
$823.80
|
| Rate for Payer: Quartz Beloit One Network |
$438.77
|
| Rate for Payer: Quartz Commercial |
$582.04
|
| Rate for Payer: Quartz Medicare Advantage |
$537.26
|
| Rate for Payer: The Alliance Commercial |
$447.72
|
| Rate for Payer: WEA Trust Commercial |
$492.49
|
| Rate for Payer: WPS Commercial |
$663.23
|
|
|
ARM SLEEVE LATERAL TRACTION AR-1635
|
Facility
|
IP
|
$861.00
|
|
| Hospital Charge Code |
5685637
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$438.77 |
| Max. Negotiated Rate |
$823.80 |
| Rate for Payer: Aetna Commercial |
$805.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$770.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$474.58
|
| Rate for Payer: Cash Price |
$258.30
|
| Rate for Payer: Cigna Commercial |
$823.80
|
| Rate for Payer: Health EOS Commercial |
$796.94
|
| Rate for Payer: HFN Commercial |
$823.80
|
| Rate for Payer: Multiplan Commercial |
$716.35
|
| Rate for Payer: Preferred Network Access Commercial |
$823.80
|
| Rate for Payer: Quartz Beloit One Network |
$438.77
|
| Rate for Payer: Quartz Commercial |
$537.26
|
| Rate for Payer: WEA Trust Commercial |
$492.49
|
| Rate for Payer: WPS Commercial |
$663.23
|
|
|
ARM SLING LARGE TX990205
|
Facility
|
OP
|
$109.00
|
|
|
Service Code
|
HCPCS A4565
|
| Hospital Charge Code |
2974223
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$31.74 |
| Max. Negotiated Rate |
$104.29 |
| Rate for Payer: Aetna Commercial |
$102.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$97.49
|
| Rate for Payer: Aetna Managed Medicare |
$31.74
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$73.68
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$56.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$54.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$60.08
|
| Rate for Payer: Cash Price |
$32.70
|
| Rate for Payer: Cash Price |
$32.70
|
| Rate for Payer: Cigna Commercial |
$104.29
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$63.44
|
| Rate for Payer: Health EOS Commercial |
$100.89
|
| Rate for Payer: HFN Commercial |
$104.29
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$85.02
|
| Rate for Payer: Multiplan Commercial |
$90.69
|
| Rate for Payer: NAPHCARE Commercial |
$68.02
|
| Rate for Payer: Preferred Network Access Commercial |
$104.29
|
| Rate for Payer: Quartz Beloit One Network |
$55.55
|
| Rate for Payer: Quartz Commercial |
$73.68
|
| Rate for Payer: Quartz Medicare Advantage |
$68.02
|
| Rate for Payer: The Alliance Commercial |
$45.68
|
| Rate for Payer: WEA Trust Commercial |
$62.35
|
| Rate for Payer: WPS Commercial |
$83.96
|
|
|
ARM SLING LARGE TX990205
|
Facility
|
IP
|
$109.00
|
|
|
Service Code
|
HCPCS A4565
|
| Hospital Charge Code |
2974223
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$55.55 |
| Max. Negotiated Rate |
$104.29 |
| Rate for Payer: Aetna Commercial |
$102.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$97.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$60.08
|
| Rate for Payer: Cash Price |
$32.70
|
| Rate for Payer: Cigna Commercial |
$104.29
|
| Rate for Payer: Health EOS Commercial |
$100.89
|
| Rate for Payer: HFN Commercial |
$104.29
|
| Rate for Payer: Multiplan Commercial |
$90.69
|
| Rate for Payer: Preferred Network Access Commercial |
$104.29
|
| Rate for Payer: Quartz Beloit One Network |
$55.55
|
| Rate for Payer: Quartz Commercial |
$68.02
|
| Rate for Payer: WEA Trust Commercial |
$62.35
|
| Rate for Payer: WPS Commercial |
$83.96
|
|
|
ARM SLING MEDIUM TX990204
|
Facility
|
OP
|
$109.00
|
|
|
Service Code
|
HCPCS A4565
|
| Hospital Charge Code |
2974222
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$31.74 |
| Max. Negotiated Rate |
$104.29 |
| Rate for Payer: Aetna Commercial |
$102.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$97.49
|
| Rate for Payer: Aetna Managed Medicare |
$31.74
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$73.68
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$56.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$54.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$60.08
|
| Rate for Payer: Cash Price |
$32.70
|
| Rate for Payer: Cash Price |
$32.70
|
| Rate for Payer: Cigna Commercial |
$104.29
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$63.44
|
| Rate for Payer: Health EOS Commercial |
$100.89
|
| Rate for Payer: HFN Commercial |
$104.29
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$85.02
|
| Rate for Payer: Multiplan Commercial |
$90.69
|
| Rate for Payer: NAPHCARE Commercial |
$68.02
|
| Rate for Payer: Preferred Network Access Commercial |
$104.29
|
| Rate for Payer: Quartz Beloit One Network |
$55.55
|
| Rate for Payer: Quartz Commercial |
$73.68
|
| Rate for Payer: Quartz Medicare Advantage |
$68.02
|
| Rate for Payer: The Alliance Commercial |
$45.68
|
| Rate for Payer: WEA Trust Commercial |
$62.35
|
| Rate for Payer: WPS Commercial |
$83.96
|
|
