|
WASHER STRYKER 619905
|
Facility
|
IP
|
$453.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4006556
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$230.85 |
| Max. Negotiated Rate |
$433.43 |
| Rate for Payer: Aetna Commercial |
$424.01
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$405.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$249.69
|
| Rate for Payer: Cash Price |
$135.90
|
| Rate for Payer: Cigna Commercial |
$433.43
|
| Rate for Payer: Health EOS Commercial |
$419.30
|
| Rate for Payer: HFN Commercial |
$433.43
|
| Rate for Payer: Multiplan Commercial |
$376.90
|
| Rate for Payer: Preferred Network Access Commercial |
$433.43
|
| Rate for Payer: Quartz Beloit One Network |
$230.85
|
| Rate for Payer: Quartz Commercial |
$282.67
|
| Rate for Payer: WEA Trust Commercial |
$259.12
|
| Rate for Payer: WPS Commercial |
$348.95
|
|
|
WASHER T8 STRYKER 619920
|
Facility
|
OP
|
$610.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5685723
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$177.63 |
| Max. Negotiated Rate |
$583.65 |
| Rate for Payer: Aetna Commercial |
$570.96
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$545.58
|
| Rate for Payer: Aetna Managed Medicare |
$177.63
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$412.36
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$317.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$304.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$336.23
|
| Rate for Payer: Cash Price |
$183.00
|
| Rate for Payer: Cigna Commercial |
$583.65
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$355.02
|
| Rate for Payer: Health EOS Commercial |
$564.62
|
| Rate for Payer: HFN Commercial |
$583.65
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$475.80
|
| Rate for Payer: Multiplan Commercial |
$507.52
|
| Rate for Payer: NAPHCARE Commercial |
$380.64
|
| Rate for Payer: Preferred Network Access Commercial |
$583.65
|
| Rate for Payer: Quartz Beloit One Network |
$310.86
|
| Rate for Payer: Quartz Commercial |
$412.36
|
| Rate for Payer: Quartz Medicare Advantage |
$380.64
|
| Rate for Payer: The Alliance Commercial |
$317.20
|
| Rate for Payer: WEA Trust Commercial |
$348.92
|
| Rate for Payer: WPS Commercial |
$469.88
|
|
|
WASHER T8 STRYKER 619920
|
Facility
|
IP
|
$610.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5685723
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$310.86 |
| Max. Negotiated Rate |
$583.65 |
| Rate for Payer: Aetna Commercial |
$570.96
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$545.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$336.23
|
| Rate for Payer: Cash Price |
$183.00
|
| Rate for Payer: Cigna Commercial |
$583.65
|
| Rate for Payer: Health EOS Commercial |
$564.62
|
| Rate for Payer: HFN Commercial |
$583.65
|
| Rate for Payer: Multiplan Commercial |
$507.52
|
| Rate for Payer: Preferred Network Access Commercial |
$583.65
|
| Rate for Payer: Quartz Beloit One Network |
$310.86
|
| Rate for Payer: Quartz Commercial |
$380.64
|
| Rate for Payer: WEA Trust Commercial |
$348.92
|
| Rate for Payer: WPS Commercial |
$469.88
|
|
|
WASHER THREADED 219.89
|
Facility
|
IP
|
$791.00
|
|
| Hospital Charge Code |
2967338
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$403.09 |
| Max. Negotiated Rate |
$756.83 |
| Rate for Payer: Aetna Commercial |
$740.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$707.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$436.00
|
| Rate for Payer: Cash Price |
$237.30
|
| Rate for Payer: Cigna Commercial |
$756.83
|
| Rate for Payer: Health EOS Commercial |
$732.15
|
| Rate for Payer: HFN Commercial |
$756.83
|
| Rate for Payer: Multiplan Commercial |
$658.11
|
| Rate for Payer: Preferred Network Access Commercial |
$756.83
|
| Rate for Payer: Quartz Beloit One Network |
$403.09
|
| Rate for Payer: Quartz Commercial |
$493.58
|
| Rate for Payer: WEA Trust Commercial |
$452.45
|
| Rate for Payer: WPS Commercial |
$609.31
|
|
|
WASHER THREADED 219.89
|
Facility
|
OP
|
$791.00
|
|
| Hospital Charge Code |
2967338
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$230.34 |
| Max. Negotiated Rate |
$756.83 |
| Rate for Payer: Aetna Commercial |
$740.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$707.47
|
| Rate for Payer: Aetna Managed Medicare |
$230.34
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$534.72
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$411.32
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$394.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$436.00
|
| Rate for Payer: Cash Price |
$237.30
|
| Rate for Payer: Cigna Commercial |
$756.83
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$460.36
|
| Rate for Payer: Health EOS Commercial |
$732.15
|
| Rate for Payer: HFN Commercial |
$756.83
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$616.98
|
| Rate for Payer: Multiplan Commercial |
$658.11
|
| Rate for Payer: NAPHCARE Commercial |
$493.58
|
| Rate for Payer: Preferred Network Access Commercial |
$756.83
|
| Rate for Payer: Quartz Beloit One Network |
$403.09
|
| Rate for Payer: Quartz Commercial |
$534.72
|
| Rate for Payer: Quartz Medicare Advantage |
$493.58
|
| Rate for Payer: The Alliance Commercial |
$411.32
|
| Rate for Payer: WEA Trust Commercial |
$452.45
|
| Rate for Payer: WPS Commercial |
$609.31
|
|
|
WASTE BAG 10 L CELL SAVER CSE-B-1000
|
Facility
|
OP
|
$59.00
|
|
| Hospital Charge Code |
5810149
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$17.18 |
| Max. Negotiated Rate |
$56.45 |
| Rate for Payer: Aetna Commercial |
$55.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$52.77
|
| Rate for Payer: Aetna Managed Medicare |
$17.18
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$39.88
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$30.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$29.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$32.52
|
| Rate for Payer: Cash Price |
$17.70
|
| Rate for Payer: Cigna Commercial |
$56.45
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$34.34
|
| Rate for Payer: Health EOS Commercial |
$54.61
|
| Rate for Payer: HFN Commercial |
$56.45
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$46.02
|
| Rate for Payer: Multiplan Commercial |
$49.09
|
| Rate for Payer: NAPHCARE Commercial |
$36.82
|
| Rate for Payer: Preferred Network Access Commercial |
$56.45
|
| Rate for Payer: Quartz Beloit One Network |
$30.07
|
| Rate for Payer: Quartz Commercial |
$39.88
|
| Rate for Payer: Quartz Medicare Advantage |
$36.82
|
| Rate for Payer: The Alliance Commercial |
$30.68
|
| Rate for Payer: WEA Trust Commercial |
$33.75
|
| Rate for Payer: WPS Commercial |
$45.45
|
|
|
WASTE BAG 10 L CELL SAVER CSE-B-1000
|
Facility
|
IP
|
$59.00
|
|
| Hospital Charge Code |
5810149
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$30.07 |
| Max. Negotiated Rate |
$56.45 |
| Rate for Payer: Aetna Commercial |
$55.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$52.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$32.52
|
| Rate for Payer: Cash Price |
$17.70
|
| Rate for Payer: Cigna Commercial |
$56.45
|
| Rate for Payer: Health EOS Commercial |
$54.61
|
| Rate for Payer: HFN Commercial |
$56.45
|
| Rate for Payer: Multiplan Commercial |
$49.09
|
| Rate for Payer: Preferred Network Access Commercial |
$56.45
|
| Rate for Payer: Quartz Beloit One Network |
$30.07
|
| Rate for Payer: Quartz Commercial |
$36.82
|
| Rate for Payer: WEA Trust Commercial |
$33.75
|
| Rate for Payer: WPS Commercial |
$45.45
|
|
|
WEARABLE DEFIBRILLATOR SYSTEM 93292
|
Professional
|
Both
|
$320.00
|
|
|
Service Code
|
CPT 93292
|
| Hospital Charge Code |
3015364
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$36.24 |
| Max. Negotiated Rate |
$316.16 |
| Rate for Payer: Aetna Commercial |
$316.16
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$286.21
|
| Rate for Payer: Aetna Managed Medicare |
$51.41
|
| Rate for Payer: Anthem Medicare Advantage |
$51.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$51.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$51.41
|
| Rate for Payer: Cash Price |
$96.00
|
| Rate for Payer: Cash Price |
$96.00
|
| Rate for Payer: Cash Price |
$96.00
|
| Rate for Payer: Cigna Commercial |
$316.16
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$36.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$51.41
|
| Rate for Payer: Health EOS Commercial |
$302.85
|
| Rate for Payer: HFN Commercial |
$316.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$174.49
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$174.49
|
| Rate for Payer: Independent Care Health Plan Medicare |
$51.41
|
| Rate for Payer: Multiplan Commercial |
$266.24
|
| Rate for Payer: NAPHCARE Commercial |
$77.11
|
| Rate for Payer: Preferred Network Access Commercial |
$316.16
|
| Rate for Payer: Quartz Beloit One Network |
$146.43
|
| Rate for Payer: Quartz Commercial |
$189.70
|
| Rate for Payer: Quartz Medicare Advantage |
$51.41
|
| Rate for Payer: The Alliance Commercial |
$195.35
|
| Rate for Payer: United Healthcare Medicaid |
$36.24
|
| Rate for Payer: United Healthcare Medicare Advantage |
$51.41
|
| Rate for Payer: WEA Trust Commercial |
$183.04
|
| Rate for Payer: WPS Commercial |
$205.63
|
|
|
Wearable ECG Monitor/Report,24Hrs,W/ Superimp Scan Interp;Phys
|
Professional
|
Both
|
$846.00
|
|
|
Service Code
|
CPT 93227
|
| Hospital Charge Code |
1188827
|
|
Hospital Revenue Code
|
730
|
| Min. Negotiated Rate |
$17.96 |
| Max. Negotiated Rate |
$835.85 |
| Rate for Payer: Aetna Commercial |
$835.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$756.66
|
| Rate for Payer: Aetna Managed Medicare |
$17.96
|
| Rate for Payer: Anthem Medicare Advantage |
$17.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$17.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$17.96
|
| Rate for Payer: Cash Price |
$253.80
|
| Rate for Payer: Cash Price |
$253.80
|
| Rate for Payer: Cash Price |
$253.80
|
| Rate for Payer: Cigna Commercial |
$835.85
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$28.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$17.96
|
| Rate for Payer: Health EOS Commercial |
$800.65
|
| Rate for Payer: HFN Commercial |
$835.85
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$67.22
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$67.22
|
| Rate for Payer: Independent Care Health Plan Medicare |
$17.96
|
| Rate for Payer: Multiplan Commercial |
$703.87
|
| Rate for Payer: NAPHCARE Commercial |
$26.94
|
| Rate for Payer: Preferred Network Access Commercial |
$835.85
|
| Rate for Payer: Quartz Beloit One Network |
$387.13
|
| Rate for Payer: Quartz Commercial |
$501.51
|
| Rate for Payer: Quartz Medicare Advantage |
$17.96
|
| Rate for Payer: The Alliance Commercial |
$68.25
|
| Rate for Payer: United Healthcare Medicaid |
$28.36
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17.96
|
| Rate for Payer: WEA Trust Commercial |
$483.91
|
| Rate for Payer: WPS Commercial |
$71.84
|
|
|
WEAVER DUNN PROCEDURE
|
Facility
|
OP
|
$4,324.00
|
|
| Hospital Charge Code |
2960508
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,259.15 |
| Max. Negotiated Rate |
$4,137.20 |
| Rate for Payer: Aetna Commercial |
$4,047.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,867.39
|
| Rate for Payer: Aetna Managed Medicare |
$1,259.15
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,923.02
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,248.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,158.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,383.39
|
| Rate for Payer: Cash Price |
$1,297.20
|
| Rate for Payer: Cigna Commercial |
$4,137.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,516.57
|
| Rate for Payer: Health EOS Commercial |
$4,002.29
|
| Rate for Payer: HFN Commercial |
$4,137.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,372.72
|
| Rate for Payer: Multiplan Commercial |
$3,597.57
|
| Rate for Payer: NAPHCARE Commercial |
$2,698.18
|
| Rate for Payer: Preferred Network Access Commercial |
$4,137.20
|
| Rate for Payer: Quartz Beloit One Network |
$2,203.51
|
| Rate for Payer: Quartz Commercial |
$2,923.02
|
| Rate for Payer: Quartz Medicare Advantage |
$2,698.18
|
| Rate for Payer: The Alliance Commercial |
$2,248.48
|
| Rate for Payer: WEA Trust Commercial |
$2,473.33
|
| Rate for Payer: WPS Commercial |
$3,330.78
|
|
|
WEAVER DUNN PROCEDURE
|
Facility
|
IP
|
$4,324.00
|
|
| Hospital Charge Code |
2960508
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,203.51 |
| Max. Negotiated Rate |
$4,137.20 |
| Rate for Payer: Aetna Commercial |
$4,047.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,867.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,383.39
|
| Rate for Payer: Cash Price |
$1,297.20
|
| Rate for Payer: Cigna Commercial |
$4,137.20
|
| Rate for Payer: Health EOS Commercial |
$4,002.29
|
| Rate for Payer: HFN Commercial |
$4,137.20
|
| Rate for Payer: Multiplan Commercial |
$3,597.57
|
| Rate for Payer: Preferred Network Access Commercial |
$4,137.20
|
| Rate for Payer: Quartz Beloit One Network |
$2,203.51
|
| Rate for Payer: Quartz Commercial |
$2,698.18
|
| Rate for Payer: WEA Trust Commercial |
$2,473.33
|
| Rate for Payer: WPS Commercial |
$3,330.78
|
|
|
WEDGE CHRONOS BETA-TCP
|
Facility
|
OP
|
$8,191.00
|
|
| Hospital Charge Code |
2966591
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,385.22 |
| Max. Negotiated Rate |
$7,837.15 |
| Rate for Payer: Aetna Commercial |
$7,666.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,326.03
|
| Rate for Payer: Aetna Managed Medicare |
$2,385.22
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,537.12
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,259.32
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,088.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,514.88
|
| Rate for Payer: Cash Price |
$2,457.30
|
| Rate for Payer: Cigna Commercial |
$7,837.15
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,767.16
|
| Rate for Payer: Health EOS Commercial |
$7,581.59
|
| Rate for Payer: HFN Commercial |
$7,837.15
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,388.98
|
| Rate for Payer: Multiplan Commercial |
$6,814.91
|
| Rate for Payer: NAPHCARE Commercial |
$5,111.18
|
| Rate for Payer: Preferred Network Access Commercial |
$7,837.15
|
| Rate for Payer: Quartz Beloit One Network |
$4,174.13
|
| Rate for Payer: Quartz Commercial |
$5,537.12
|
| Rate for Payer: Quartz Medicare Advantage |
$5,111.18
|
| Rate for Payer: The Alliance Commercial |
$4,259.32
|
| Rate for Payer: WEA Trust Commercial |
$4,685.25
|
| Rate for Payer: WPS Commercial |
$6,309.53
|
|
|
WEDGE CHRONOS BETA-TCP
|
Facility
|
IP
|
$8,191.00
|
|
| Hospital Charge Code |
2966591
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,174.13 |
| Max. Negotiated Rate |
$7,837.15 |
| Rate for Payer: Aetna Commercial |
$7,666.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,326.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,514.88
|
| Rate for Payer: Cash Price |
$2,457.30
|
| Rate for Payer: Cigna Commercial |
$7,837.15
|
| Rate for Payer: Health EOS Commercial |
$7,581.59
|
| Rate for Payer: HFN Commercial |
$7,837.15
|
| Rate for Payer: Multiplan Commercial |
$6,814.91
|
| Rate for Payer: Preferred Network Access Commercial |
$7,837.15
|
| Rate for Payer: Quartz Beloit One Network |
$4,174.13
|
| Rate for Payer: Quartz Commercial |
$5,111.18
|
| Rate for Payer: WEA Trust Commercial |
$4,685.25
|
| Rate for Payer: WPS Commercial |
$6,309.53
|
|
|
WEDGES MAKE UP LATEX
|
Facility
|
IP
|
$3.00
|
|
| Hospital Charge Code |
2970457
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$1.53 |
| Max. Negotiated Rate |
$2.87 |
| Rate for Payer: Aetna Commercial |
$2.81
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1.65
|
| Rate for Payer: Cash Price |
$0.90
|
| Rate for Payer: Cigna Commercial |
$2.87
|
| Rate for Payer: Health EOS Commercial |
$2.78
|
| Rate for Payer: HFN Commercial |
$2.87
|
| Rate for Payer: Multiplan Commercial |
$2.50
|
| Rate for Payer: Preferred Network Access Commercial |
$2.87
|
| Rate for Payer: Quartz Beloit One Network |
$1.53
|
| Rate for Payer: Quartz Commercial |
$1.87
|
| Rate for Payer: WEA Trust Commercial |
$1.72
|
| Rate for Payer: WPS Commercial |
$2.31
|
|
|
WEDGES MAKE UP LATEX
|
Facility
|
OP
|
$3.00
|
|
| Hospital Charge Code |
2970457
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$0.87 |
| Max. Negotiated Rate |
$2.87 |
| Rate for Payer: Aetna Commercial |
$2.81
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2.68
|
| Rate for Payer: Aetna Managed Medicare |
$0.87
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2.03
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1.65
|
| Rate for Payer: Cash Price |
$0.90
|
| Rate for Payer: Cigna Commercial |
$2.87
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1.75
|
| Rate for Payer: Health EOS Commercial |
$2.78
|
| Rate for Payer: HFN Commercial |
$2.87
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2.34
|
| Rate for Payer: Multiplan Commercial |
$2.50
|
| Rate for Payer: NAPHCARE Commercial |
$1.87
|
| Rate for Payer: Preferred Network Access Commercial |
$2.87
|
| Rate for Payer: Quartz Beloit One Network |
$1.53
|
| Rate for Payer: Quartz Commercial |
$2.03
|
| Rate for Payer: Quartz Medicare Advantage |
$1.87
|
| Rate for Payer: The Alliance Commercial |
$1.56
|
| Rate for Payer: WEA Trust Commercial |
$1.72
|
| Rate for Payer: WPS Commercial |
$2.31
|
|
|
Welcome To Medicare Visit
|
Professional
|
Both
|
$272.00
|
|
|
Service Code
|
HCPCS G0402
|
| Hospital Charge Code |
1122840
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$113.77 |
| Max. Negotiated Rate |
$476.30 |
| Rate for Payer: Aetna Commercial |
$268.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$243.28
|
| Rate for Payer: Aetna Managed Medicare |
$113.77
|
| Rate for Payer: Anthem Medicare Advantage |
$113.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$113.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$113.77
|
| Rate for Payer: Cash Price |
$81.60
|
| Rate for Payer: Cash Price |
$81.60
|
| Rate for Payer: Cigna Commercial |
$268.74
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$141.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$113.77
|
| Rate for Payer: Health EOS Commercial |
$257.42
|
| Rate for Payer: HFN Commercial |
$268.74
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$476.30
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$476.30
|
| Rate for Payer: Independent Care Health Plan Medicare |
$113.77
|
| Rate for Payer: Multiplan Commercial |
$226.30
|
| Rate for Payer: NAPHCARE Commercial |
$170.65
|
| Rate for Payer: Preferred Network Access Commercial |
$268.74
|
| Rate for Payer: Quartz Beloit One Network |
$124.47
|
| Rate for Payer: Quartz Commercial |
$161.24
|
| Rate for Payer: Quartz Medicare Advantage |
$113.77
|
| Rate for Payer: The Alliance Commercial |
$312.86
|
| Rate for Payer: United Healthcare Medicare Advantage |
$113.77
|
| Rate for Payer: WEA Trust Commercial |
$155.58
|
| Rate for Payer: WPS Commercial |
$199.09
|
|
|
W. equine encephalitis virus IgG
|
Facility
|
IP
|
$53.00
|
|
|
Service Code
|
CPT 86654
|
| Hospital Charge Code |
5547104
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$27.01 |
| Max. Negotiated Rate |
$50.71 |
| Rate for Payer: Aetna Commercial |
$49.61
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$47.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$29.21
|
| Rate for Payer: Cash Price |
$15.90
|
| Rate for Payer: Cigna Commercial |
$50.71
|
| Rate for Payer: Health EOS Commercial |
$49.06
|
| Rate for Payer: HFN Commercial |
$50.71
|
| Rate for Payer: Multiplan Commercial |
$44.10
|
| Rate for Payer: Preferred Network Access Commercial |
$50.71
|
| Rate for Payer: Quartz Beloit One Network |
$27.01
|
| Rate for Payer: Quartz Commercial |
$33.07
|
| Rate for Payer: WEA Trust Commercial |
$30.32
|
| Rate for Payer: WPS Commercial |
$40.83
|
|
|
W. equine encephalitis virus IgG
|
Facility
|
OP
|
$53.00
|
|
|
Service Code
|
CPT 86654
|
| Hospital Charge Code |
5547104
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.72 |
| Max. Negotiated Rate |
$54.87 |
| Rate for Payer: Aetna Commercial |
$49.61
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$47.40
|
| Rate for Payer: Aetna Managed Medicare |
$13.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$51.44
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$24.01
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$22.77
|
| Rate for Payer: Anthem Medicare Advantage |
$13.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$29.21
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$13.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$13.72
|
| Rate for Payer: Cash Price |
$15.90
|
| Rate for Payer: Cash Price |
$15.90
|
| Rate for Payer: Cigna Commercial |
$50.71
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$13.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$30.85
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$13.72
|
| Rate for Payer: Health EOS Commercial |
$49.06
|
| Rate for Payer: HFN Commercial |
$50.71
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$51.03
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$13.72
|
| Rate for Payer: Independent Care Health Plan Medicare |
$13.72
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$13.72
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$13.72
|
| Rate for Payer: Multiplan Commercial |
$44.10
|
| Rate for Payer: NAPHCARE Commercial |
$20.58
|
| Rate for Payer: Preferred Network Access Commercial |
$50.71
|
| Rate for Payer: Quartz Beloit One Network |
$27.01
|
| Rate for Payer: Quartz Commercial |
$35.83
|
| Rate for Payer: Quartz Medicare Advantage |
$13.72
|
| Rate for Payer: The Alliance Commercial |
$54.87
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.72
|
| Rate for Payer: United Healthcare PPO |
$41.34
|
| Rate for Payer: WEA Trust Commercial |
$30.32
|
| Rate for Payer: Wellcare Medicare |
$13.72
|
| Rate for Payer: WPS Commercial |
$40.83
|
|
|
W. equine encephalitis virus IgG
|
Professional
|
Both
|
$53.00
|
|
|
Service Code
|
CPT 86654
|
| Hospital Charge Code |
5547104
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.72 |
| Max. Negotiated Rate |
$60.36 |
| Rate for Payer: Aetna Commercial |
$52.36
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$47.40
|
| Rate for Payer: Aetna Managed Medicare |
$13.72
|
| Rate for Payer: Anthem Medicare Advantage |
$13.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$13.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$13.72
|
| Rate for Payer: Cash Price |
$15.90
|
| Rate for Payer: Cash Price |
$15.90
|
| Rate for Payer: Cigna Commercial |
$52.36
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$27.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$13.72
|
| Rate for Payer: Health EOS Commercial |
$50.16
|
| Rate for Payer: HFN Commercial |
$52.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$48.42
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$48.42
|
| Rate for Payer: Independent Care Health Plan Medicare |
$13.72
|
| Rate for Payer: Multiplan Commercial |
$44.10
|
| Rate for Payer: NAPHCARE Commercial |
$20.58
|
| Rate for Payer: Preferred Network Access Commercial |
$52.36
|
| Rate for Payer: Quartz Beloit One Network |
$24.25
|
| Rate for Payer: Quartz Commercial |
$31.42
|
| Rate for Payer: Quartz Medicare Advantage |
$13.72
|
| Rate for Payer: The Alliance Commercial |
$54.18
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.72
|
| Rate for Payer: WEA Trust Commercial |
$30.32
|
| Rate for Payer: WPS Commercial |
$60.36
|
|
|
W. equine encephalitis virus IgM
|
Facility
|
IP
|
$53.00
|
|
|
Service Code
|
CPT 86654
|
| Hospital Charge Code |
5547105
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$27.01 |
| Max. Negotiated Rate |
$50.71 |
| Rate for Payer: Aetna Commercial |
$49.61
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$47.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$29.21
|
| Rate for Payer: Cash Price |
$15.90
|
| Rate for Payer: Cigna Commercial |
$50.71
|
| Rate for Payer: Health EOS Commercial |
$49.06
|
| Rate for Payer: HFN Commercial |
$50.71
|
| Rate for Payer: Multiplan Commercial |
$44.10
|
| Rate for Payer: Preferred Network Access Commercial |
$50.71
|
| Rate for Payer: Quartz Beloit One Network |
$27.01
|
| Rate for Payer: Quartz Commercial |
$33.07
|
| Rate for Payer: WEA Trust Commercial |
$30.32
|
| Rate for Payer: WPS Commercial |
$40.83
|
|
|
W. equine encephalitis virus IgM
|
Facility
|
OP
|
$53.00
|
|
|
Service Code
|
CPT 86654
|
| Hospital Charge Code |
5547105
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.72 |
| Max. Negotiated Rate |
$54.87 |
| Rate for Payer: Aetna Commercial |
$49.61
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$47.40
|
| Rate for Payer: Aetna Managed Medicare |
$13.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$51.44
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$24.01
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$22.77
|
| Rate for Payer: Anthem Medicare Advantage |
$13.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$29.21
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$13.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$13.72
|
| Rate for Payer: Cash Price |
$15.90
|
| Rate for Payer: Cash Price |
$15.90
|
| Rate for Payer: Cigna Commercial |
$50.71
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$13.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$30.85
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$13.72
|
| Rate for Payer: Health EOS Commercial |
$49.06
|
| Rate for Payer: HFN Commercial |
$50.71
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$51.03
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$13.72
|
| Rate for Payer: Independent Care Health Plan Medicare |
$13.72
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$13.72
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$13.72
|
| Rate for Payer: Multiplan Commercial |
$44.10
|
| Rate for Payer: NAPHCARE Commercial |
$20.58
|
| Rate for Payer: Preferred Network Access Commercial |
$50.71
|
| Rate for Payer: Quartz Beloit One Network |
$27.01
|
| Rate for Payer: Quartz Commercial |
$35.83
|
| Rate for Payer: Quartz Medicare Advantage |
$13.72
|
| Rate for Payer: The Alliance Commercial |
$54.87
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.72
|
| Rate for Payer: United Healthcare PPO |
$41.34
|
| Rate for Payer: WEA Trust Commercial |
$30.32
|
| Rate for Payer: Wellcare Medicare |
$13.72
|
| Rate for Payer: WPS Commercial |
$40.83
|
|
|
W. equine encephalitis virus IgM
|
Professional
|
Both
|
$53.00
|
|
|
Service Code
|
CPT 86654
|
| Hospital Charge Code |
5547105
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.72 |
| Max. Negotiated Rate |
$60.36 |
| Rate for Payer: Aetna Commercial |
$52.36
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$47.40
|
| Rate for Payer: Aetna Managed Medicare |
$13.72
|
| Rate for Payer: Anthem Medicare Advantage |
$13.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$13.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$13.72
|
| Rate for Payer: Cash Price |
$15.90
|
| Rate for Payer: Cash Price |
$15.90
|
| Rate for Payer: Cigna Commercial |
$52.36
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$27.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$13.72
|
| Rate for Payer: Health EOS Commercial |
$50.16
|
| Rate for Payer: HFN Commercial |
$52.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$48.42
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$48.42
|
| Rate for Payer: Independent Care Health Plan Medicare |
$13.72
|
| Rate for Payer: Multiplan Commercial |
$44.10
|
| Rate for Payer: NAPHCARE Commercial |
$20.58
|
| Rate for Payer: Preferred Network Access Commercial |
$52.36
|
| Rate for Payer: Quartz Beloit One Network |
$24.25
|
| Rate for Payer: Quartz Commercial |
$31.42
|
| Rate for Payer: Quartz Medicare Advantage |
$13.72
|
| Rate for Payer: The Alliance Commercial |
$54.18
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.72
|
| Rate for Payer: WEA Trust Commercial |
$30.32
|
| Rate for Payer: WPS Commercial |
$60.36
|
|
|
West Equine IgG
|
Facility
|
IP
|
$87.00
|
|
|
Service Code
|
CPT 86654
|
| Hospital Charge Code |
4916659
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$44.34 |
| Max. Negotiated Rate |
$83.24 |
| Rate for Payer: Aetna Commercial |
$81.43
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$77.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$47.95
|
| Rate for Payer: Cash Price |
$26.10
|
| Rate for Payer: Cigna Commercial |
$83.24
|
| Rate for Payer: Health EOS Commercial |
$80.53
|
| Rate for Payer: HFN Commercial |
$83.24
|
| Rate for Payer: Multiplan Commercial |
$72.38
|
| Rate for Payer: Preferred Network Access Commercial |
$83.24
|
| Rate for Payer: Quartz Beloit One Network |
$44.34
|
| Rate for Payer: Quartz Commercial |
$54.29
|
| Rate for Payer: WEA Trust Commercial |
$49.76
|
| Rate for Payer: WPS Commercial |
$67.02
|
|
|
West Equine IgG
|
Facility
|
OP
|
$87.00
|
|
|
Service Code
|
CPT 86654
|
| Hospital Charge Code |
4916659
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.72 |
| Max. Negotiated Rate |
$83.24 |
| Rate for Payer: Aetna Commercial |
$81.43
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$77.81
|
| Rate for Payer: Aetna Managed Medicare |
$13.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$51.44
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$24.01
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$22.77
|
| Rate for Payer: Anthem Medicare Advantage |
$13.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$47.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$13.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$13.72
|
| Rate for Payer: Cash Price |
$26.10
|
| Rate for Payer: Cash Price |
$26.10
|
| Rate for Payer: Cigna Commercial |
$83.24
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$13.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$50.63
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$13.72
|
| Rate for Payer: Health EOS Commercial |
$80.53
|
| Rate for Payer: HFN Commercial |
$83.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$51.03
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$13.72
|
| Rate for Payer: Independent Care Health Plan Medicare |
$13.72
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$13.72
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$13.72
|
| Rate for Payer: Multiplan Commercial |
$72.38
|
| Rate for Payer: NAPHCARE Commercial |
$20.58
|
| Rate for Payer: Preferred Network Access Commercial |
$83.24
|
| Rate for Payer: Quartz Beloit One Network |
$44.34
|
| Rate for Payer: Quartz Commercial |
$58.81
|
| Rate for Payer: Quartz Medicare Advantage |
$13.72
|
| Rate for Payer: The Alliance Commercial |
$54.87
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.72
|
| Rate for Payer: United Healthcare PPO |
$67.86
|
| Rate for Payer: WEA Trust Commercial |
$49.76
|
| Rate for Payer: Wellcare Medicare |
$13.72
|
| Rate for Payer: WPS Commercial |
$67.02
|
|
|
West Equine IgG
|
Professional
|
Both
|
$87.00
|
|
|
Service Code
|
CPT 86654
|
| Hospital Charge Code |
4916659
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.72 |
| Max. Negotiated Rate |
$85.96 |
| Rate for Payer: Aetna Commercial |
$85.96
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$77.81
|
| Rate for Payer: Aetna Managed Medicare |
$13.72
|
| Rate for Payer: Anthem Medicare Advantage |
$13.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$13.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$13.72
|
| Rate for Payer: Cash Price |
$26.10
|
| Rate for Payer: Cash Price |
$26.10
|
| Rate for Payer: Cigna Commercial |
$85.96
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$45.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$13.72
|
| Rate for Payer: Health EOS Commercial |
$82.34
|
| Rate for Payer: HFN Commercial |
$85.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$48.42
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$48.42
|
| Rate for Payer: Independent Care Health Plan Medicare |
$13.72
|
| Rate for Payer: Multiplan Commercial |
$72.38
|
| Rate for Payer: NAPHCARE Commercial |
$20.58
|
| Rate for Payer: Preferred Network Access Commercial |
$85.96
|
| Rate for Payer: Quartz Beloit One Network |
$39.81
|
| Rate for Payer: Quartz Commercial |
$51.57
|
| Rate for Payer: Quartz Medicare Advantage |
$13.72
|
| Rate for Payer: The Alliance Commercial |
$54.18
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.72
|
| Rate for Payer: WEA Trust Commercial |
$49.76
|
| Rate for Payer: WPS Commercial |
$60.36
|
|
