|
Rocky Mountain Spotted Fever IgG Titer
|
Facility
|
IP
|
$223.00
|
|
|
Service Code
|
CPT 86757
|
| Hospital Charge Code |
1043037
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$109.27 |
| Max. Negotiated Rate |
$205.16 |
| Rate for Payer: Aetna Commercial |
$200.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$191.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$118.19
|
| Rate for Payer: Cash Price |
$66.90
|
| Rate for Payer: Cigna Commercial |
$205.16
|
| Rate for Payer: Health EOS Commercial |
$198.47
|
| Rate for Payer: HFN Commercial |
$205.16
|
| Rate for Payer: Multiplan Commercial |
$178.40
|
| Rate for Payer: NAPHCARE Commercial |
$133.80
|
| Rate for Payer: Preferred Network Access Commercial |
$205.16
|
| Rate for Payer: Quartz Beloit One Network |
$109.27
|
| Rate for Payer: Quartz Commercial |
$133.80
|
| Rate for Payer: WEA Trust Commercial |
$122.65
|
| Rate for Payer: WPS Commercial |
$165.18
|
|
|
Rocky Mountain Spotted Fever IgG Titer
|
Facility
|
OP
|
$223.00
|
|
|
Service Code
|
CPT 86757
|
| Hospital Charge Code |
1043037
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$19.35 |
| Max. Negotiated Rate |
$205.16 |
| Rate for Payer: Aetna Commercial |
$200.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$191.78
|
| Rate for Payer: Aetna Managed Medicare |
$19.35
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$72.56
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$33.86
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$32.12
|
| Rate for Payer: Anthem Medicaid |
$19.99
|
| Rate for Payer: Anthem Medicare Advantage |
$19.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$118.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$19.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$19.35
|
| Rate for Payer: Cash Price |
$66.90
|
| Rate for Payer: Cash Price |
$66.90
|
| Rate for Payer: Cigna Commercial |
$205.16
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$19.35
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$19.99
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$124.79
|
| Rate for Payer: Dean Health Medicaid |
$19.99
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$19.35
|
| Rate for Payer: Health EOS Commercial |
$198.47
|
| Rate for Payer: HFN Commercial |
$205.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$71.98
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$19.35
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$19.99
|
| Rate for Payer: Independent Care Health Plan Medicare |
$19.35
|
| Rate for Payer: Managed Health Services Medicaid |
$20.79
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$19.35
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$19.35
|
| Rate for Payer: Multiplan Commercial |
$178.40
|
| Rate for Payer: NAPHCARE Commercial |
$29.02
|
| Rate for Payer: Preferred Network Access Commercial |
$205.16
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$19.99
|
| Rate for Payer: Quartz Beloit One Network |
$109.27
|
| Rate for Payer: Quartz Commercial |
$144.95
|
| Rate for Payer: Quartz Medicare Advantage |
$19.35
|
| Rate for Payer: The Alliance Commercial |
$77.40
|
| Rate for Payer: United Healthcare Medicaid |
$19.99
|
| Rate for Payer: United Healthcare Medicare Advantage |
$19.35
|
| Rate for Payer: United Healthcare PPO |
$167.25
|
| Rate for Payer: WEA Trust Commercial |
$122.65
|
| Rate for Payer: Wellcare Medicare |
$19.35
|
| Rate for Payer: WMAP Medicaid |
$19.99
|
| Rate for Payer: WPS Commercial |
$165.18
|
|
|
Rocky Mountain Spotted Fever IgM Titer
|
Professional
|
Both
|
$97.58
|
|
|
Service Code
|
CPT 86757
|
| Hospital Charge Code |
2956797
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$42.94 |
| Max. Negotiated Rate |
$92.70 |
| Rate for Payer: Aetna Commercial |
$92.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$83.92
|
| Rate for Payer: Cash Price |
$29.27
|
| Rate for Payer: Cash Price |
$29.27
|
| Rate for Payer: Cigna Commercial |
$92.70
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$48.79
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$58.55
|
| Rate for Payer: Health EOS Commercial |
$88.80
|
| Rate for Payer: HFN Commercial |
$92.70
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$68.31
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$68.31
|
| Rate for Payer: Multiplan Commercial |
$78.06
|
| Rate for Payer: Preferred Network Access Commercial |
$92.70
|
| Rate for Payer: Quartz Beloit One Network |
$42.94
|
| Rate for Payer: Quartz Commercial |
$55.62
|
| Rate for Payer: The Alliance Commercial |
$48.79
|
| Rate for Payer: WEA Trust Commercial |
$53.67
|
| Rate for Payer: WPS Commercial |
$72.28
|
|
|
Rocky Mountain Spotted Fever IgM Titer
|
Facility
|
IP
|
$97.58
|
|
|
Service Code
|
CPT 86757
|
| Hospital Charge Code |
2956797
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$47.81 |
| Max. Negotiated Rate |
$89.77 |
| Rate for Payer: Aetna Commercial |
$87.82
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$83.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$51.72
|
| Rate for Payer: Cash Price |
$29.27
|
| Rate for Payer: Cigna Commercial |
$89.77
|
| Rate for Payer: Health EOS Commercial |
$86.85
|
| Rate for Payer: HFN Commercial |
$89.77
|
| Rate for Payer: Multiplan Commercial |
$78.06
|
| Rate for Payer: NAPHCARE Commercial |
$58.55
|
| Rate for Payer: Preferred Network Access Commercial |
$89.77
|
| Rate for Payer: Quartz Beloit One Network |
$47.81
|
| Rate for Payer: Quartz Commercial |
$58.55
|
| Rate for Payer: WEA Trust Commercial |
$53.67
|
| Rate for Payer: WPS Commercial |
$72.28
|
|
|
Rocky Mountain Spotted Fever IgM Titer
|
Facility
|
OP
|
$97.58
|
|
|
Service Code
|
CPT 86757
|
| Hospital Charge Code |
2956797
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$19.35 |
| Max. Negotiated Rate |
$89.77 |
| Rate for Payer: Aetna Commercial |
$87.82
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$83.92
|
| Rate for Payer: Aetna Managed Medicare |
$19.35
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$72.56
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$33.86
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$32.12
|
| Rate for Payer: Anthem Medicaid |
$19.99
|
| Rate for Payer: Anthem Medicare Advantage |
$19.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$51.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$19.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$19.35
|
| Rate for Payer: Cash Price |
$29.27
|
| Rate for Payer: Cash Price |
$29.27
|
| Rate for Payer: Cigna Commercial |
$89.77
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$19.35
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$19.99
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$54.61
|
| Rate for Payer: Dean Health Medicaid |
$19.99
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$19.35
|
| Rate for Payer: Health EOS Commercial |
$86.85
|
| Rate for Payer: HFN Commercial |
$89.77
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$71.98
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$19.35
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$19.99
|
| Rate for Payer: Independent Care Health Plan Medicare |
$19.35
|
| Rate for Payer: Managed Health Services Medicaid |
$20.79
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$19.35
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$19.35
|
| Rate for Payer: Multiplan Commercial |
$78.06
|
| Rate for Payer: NAPHCARE Commercial |
$29.02
|
| Rate for Payer: Preferred Network Access Commercial |
$89.77
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$19.99
|
| Rate for Payer: Quartz Beloit One Network |
$47.81
|
| Rate for Payer: Quartz Commercial |
$63.43
|
| Rate for Payer: Quartz Medicare Advantage |
$19.35
|
| Rate for Payer: The Alliance Commercial |
$77.40
|
| Rate for Payer: United Healthcare Medicaid |
$19.99
|
| Rate for Payer: United Healthcare Medicare Advantage |
$19.35
|
| Rate for Payer: United Healthcare PPO |
$73.18
|
| Rate for Payer: WEA Trust Commercial |
$53.67
|
| Rate for Payer: Wellcare Medicare |
$19.35
|
| Rate for Payer: WMAP Medicaid |
$19.99
|
| Rate for Payer: WPS Commercial |
$72.28
|
|
|
ROD ATTACHMENT FOR LARGE MULTI-PIN CLAMP 390.003
|
Facility
|
OP
|
$5,867.00
|
|
| Hospital Charge Code |
2969386
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,642.76 |
| Max. Negotiated Rate |
$23,468.00 |
| Rate for Payer: Aetna Commercial |
$5,280.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,045.62
|
| Rate for Payer: Aetna Managed Medicare |
$1,642.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,813.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,933.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,816.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,109.51
|
| Rate for Payer: Cash Price |
$1,760.10
|
| Rate for Payer: Cigna Commercial |
$5,397.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,283.17
|
| Rate for Payer: Health EOS Commercial |
$5,221.63
|
| Rate for Payer: HFN Commercial |
$5,397.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,400.25
|
| Rate for Payer: Multiplan Commercial |
$4,693.60
|
| Rate for Payer: NAPHCARE Commercial |
$3,520.20
|
| Rate for Payer: Preferred Network Access Commercial |
$5,397.64
|
| Rate for Payer: Quartz Beloit One Network |
$2,874.83
|
| Rate for Payer: Quartz Commercial |
$3,813.55
|
| Rate for Payer: Quartz Medicare Advantage |
$3,520.20
|
| Rate for Payer: The Alliance Commercial |
$23,468.00
|
| Rate for Payer: WEA Trust Commercial |
$3,226.85
|
| Rate for Payer: WPS Commercial |
$4,345.69
|
|
|
ROD ATTACHMENT FOR LARGE MULTI-PIN CLAMP 390.003
|
Facility
|
IP
|
$5,867.00
|
|
| Hospital Charge Code |
2969386
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,874.83 |
| Max. Negotiated Rate |
$5,397.64 |
| Rate for Payer: Aetna Commercial |
$5,280.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,045.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,109.51
|
| Rate for Payer: Cash Price |
$1,760.10
|
| Rate for Payer: Cigna Commercial |
$5,397.64
|
| Rate for Payer: Health EOS Commercial |
$5,221.63
|
| Rate for Payer: HFN Commercial |
$5,397.64
|
| Rate for Payer: Multiplan Commercial |
$4,693.60
|
| Rate for Payer: NAPHCARE Commercial |
$3,520.20
|
| Rate for Payer: Preferred Network Access Commercial |
$5,397.64
|
| Rate for Payer: Quartz Beloit One Network |
$2,874.83
|
| Rate for Payer: Quartz Commercial |
$3,520.20
|
| Rate for Payer: WEA Trust Commercial |
$3,226.85
|
| Rate for Payer: WPS Commercial |
$4,345.69
|
|
|
ROD CARBON FIBER 11.0MM X 100MM 394.80
|
Facility
|
IP
|
$3,132.00
|
|
| Hospital Charge Code |
2966393
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,534.68 |
| Max. Negotiated Rate |
$2,881.44 |
| Rate for Payer: Aetna Commercial |
$2,818.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,693.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,659.96
|
| Rate for Payer: Cash Price |
$939.60
|
| Rate for Payer: Cigna Commercial |
$2,881.44
|
| Rate for Payer: Health EOS Commercial |
$2,787.48
|
| Rate for Payer: HFN Commercial |
$2,881.44
|
| Rate for Payer: Multiplan Commercial |
$2,505.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,879.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,881.44
|
| Rate for Payer: Quartz Beloit One Network |
$1,534.68
|
| Rate for Payer: Quartz Commercial |
$1,879.20
|
| Rate for Payer: WEA Trust Commercial |
$1,722.60
|
| Rate for Payer: WPS Commercial |
$2,319.87
|
|
|
ROD CARBON FIBER 11.0MM X 100MM 394.80
|
Facility
|
OP
|
$3,132.00
|
|
| Hospital Charge Code |
2966393
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$876.96 |
| Max. Negotiated Rate |
$12,528.00 |
| Rate for Payer: Aetna Commercial |
$2,818.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,693.52
|
| Rate for Payer: Aetna Managed Medicare |
$876.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,035.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,566.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,503.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,659.96
|
| Rate for Payer: Cash Price |
$939.60
|
| Rate for Payer: Cigna Commercial |
$2,881.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,752.67
|
| Rate for Payer: Health EOS Commercial |
$2,787.48
|
| Rate for Payer: HFN Commercial |
$2,881.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,349.00
|
| Rate for Payer: Multiplan Commercial |
$2,505.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,879.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,881.44
|
| Rate for Payer: Quartz Beloit One Network |
$1,534.68
|
| Rate for Payer: Quartz Commercial |
$2,035.80
|
| Rate for Payer: Quartz Medicare Advantage |
$1,879.20
|
| Rate for Payer: The Alliance Commercial |
$12,528.00
|
| Rate for Payer: WEA Trust Commercial |
$1,722.60
|
| Rate for Payer: WPS Commercial |
$2,319.87
|
|
|
ROD CARBON FIBER 11.0MM X 150MM 394.82
|
Facility
|
OP
|
$1,950.00
|
|
| Hospital Charge Code |
2966388
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$546.00 |
| Max. Negotiated Rate |
$7,800.00 |
| Rate for Payer: Aetna Commercial |
$1,755.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,677.00
|
| Rate for Payer: Aetna Managed Medicare |
$546.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,267.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$975.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$936.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,033.50
|
| Rate for Payer: Cash Price |
$585.00
|
| Rate for Payer: Cigna Commercial |
$1,794.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,091.22
|
| Rate for Payer: Health EOS Commercial |
$1,735.50
|
| Rate for Payer: HFN Commercial |
$1,794.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,462.50
|
| Rate for Payer: Multiplan Commercial |
$1,560.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,170.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,794.00
|
| Rate for Payer: Quartz Beloit One Network |
$955.50
|
| Rate for Payer: Quartz Commercial |
$1,267.50
|
| Rate for Payer: Quartz Medicare Advantage |
$1,170.00
|
| Rate for Payer: The Alliance Commercial |
$7,800.00
|
| Rate for Payer: WEA Trust Commercial |
$1,072.50
|
| Rate for Payer: WPS Commercial |
$1,444.36
|
|
|
ROD CARBON FIBER 11.0MM X 150MM 394.82
|
Facility
|
IP
|
$1,950.00
|
|
| Hospital Charge Code |
2966388
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$955.50 |
| Max. Negotiated Rate |
$1,794.00 |
| Rate for Payer: Aetna Commercial |
$1,755.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,677.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,033.50
|
| Rate for Payer: Cash Price |
$585.00
|
| Rate for Payer: Cigna Commercial |
$1,794.00
|
| Rate for Payer: Health EOS Commercial |
$1,735.50
|
| Rate for Payer: HFN Commercial |
$1,794.00
|
| Rate for Payer: Multiplan Commercial |
$1,560.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,170.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,794.00
|
| Rate for Payer: Quartz Beloit One Network |
$955.50
|
| Rate for Payer: Quartz Commercial |
$1,170.00
|
| Rate for Payer: WEA Trust Commercial |
$1,072.50
|
| Rate for Payer: WPS Commercial |
$1,444.36
|
|
|
ROD CARBON FIBER 11.0MM X 200MM 394.83
|
Facility
|
OP
|
$3,017.00
|
|
| Hospital Charge Code |
2966389
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$844.76 |
| Max. Negotiated Rate |
$12,068.00 |
| Rate for Payer: Aetna Commercial |
$2,715.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,594.62
|
| Rate for Payer: Aetna Managed Medicare |
$844.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,961.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,508.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,448.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,599.01
|
| Rate for Payer: Cash Price |
$905.10
|
| Rate for Payer: Cigna Commercial |
$2,775.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,688.31
|
| Rate for Payer: Health EOS Commercial |
$2,685.13
|
| Rate for Payer: HFN Commercial |
$2,775.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,262.75
|
| Rate for Payer: Multiplan Commercial |
$2,413.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,810.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,775.64
|
| Rate for Payer: Quartz Beloit One Network |
$1,478.33
|
| Rate for Payer: Quartz Commercial |
$1,961.05
|
| Rate for Payer: Quartz Medicare Advantage |
$1,810.20
|
| Rate for Payer: The Alliance Commercial |
$12,068.00
|
| Rate for Payer: WEA Trust Commercial |
$1,659.35
|
| Rate for Payer: WPS Commercial |
$2,234.69
|
|
|
ROD CARBON FIBER 11.0MM X 200MM 394.83
|
Facility
|
IP
|
$3,017.00
|
|
| Hospital Charge Code |
2966389
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,478.33 |
| Max. Negotiated Rate |
$2,775.64 |
| Rate for Payer: Aetna Commercial |
$2,715.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,594.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,599.01
|
| Rate for Payer: Cash Price |
$905.10
|
| Rate for Payer: Cigna Commercial |
$2,775.64
|
| Rate for Payer: Health EOS Commercial |
$2,685.13
|
| Rate for Payer: HFN Commercial |
$2,775.64
|
| Rate for Payer: Multiplan Commercial |
$2,413.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,810.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,775.64
|
| Rate for Payer: Quartz Beloit One Network |
$1,478.33
|
| Rate for Payer: Quartz Commercial |
$1,810.20
|
| Rate for Payer: WEA Trust Commercial |
$1,659.35
|
| Rate for Payer: WPS Commercial |
$2,234.69
|
|
|
ROD CARBON FIBER 11.0MM X 250MM 394.84
|
Facility
|
IP
|
$2,293.00
|
|
| Hospital Charge Code |
3133483
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,123.57 |
| Max. Negotiated Rate |
$2,109.56 |
| Rate for Payer: Aetna Commercial |
$2,063.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,971.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,215.29
|
| Rate for Payer: Cash Price |
$687.90
|
| Rate for Payer: Cigna Commercial |
$2,109.56
|
| Rate for Payer: Health EOS Commercial |
$2,040.77
|
| Rate for Payer: HFN Commercial |
$2,109.56
|
| Rate for Payer: Multiplan Commercial |
$1,834.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,375.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,109.56
|
| Rate for Payer: Quartz Beloit One Network |
$1,123.57
|
| Rate for Payer: Quartz Commercial |
$1,375.80
|
| Rate for Payer: WEA Trust Commercial |
$1,261.15
|
| Rate for Payer: WPS Commercial |
$1,698.43
|
|
|
ROD CARBON FIBER 11.0MM X 250MM 394.84
|
Facility
|
OP
|
$2,293.00
|
|
| Hospital Charge Code |
3133483
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$642.04 |
| Max. Negotiated Rate |
$9,172.00 |
| Rate for Payer: Aetna Commercial |
$2,063.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,971.98
|
| Rate for Payer: Aetna Managed Medicare |
$642.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,490.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,146.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,100.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,215.29
|
| Rate for Payer: Cash Price |
$687.90
|
| Rate for Payer: Cigna Commercial |
$2,109.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,283.16
|
| Rate for Payer: Health EOS Commercial |
$2,040.77
|
| Rate for Payer: HFN Commercial |
$2,109.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,719.75
|
| Rate for Payer: Multiplan Commercial |
$1,834.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,375.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,109.56
|
| Rate for Payer: Quartz Beloit One Network |
$1,123.57
|
| Rate for Payer: Quartz Commercial |
$1,490.45
|
| Rate for Payer: Quartz Medicare Advantage |
$1,375.80
|
| Rate for Payer: The Alliance Commercial |
$9,172.00
|
| Rate for Payer: WEA Trust Commercial |
$1,261.15
|
| Rate for Payer: WPS Commercial |
$1,698.43
|
|
|
ROD CARBON FIBER 11.0MM X 300MM 394.85
|
Facility
|
OP
|
$3,356.00
|
|
| Hospital Charge Code |
2966390
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$939.68 |
| Max. Negotiated Rate |
$13,424.00 |
| Rate for Payer: Aetna Commercial |
$3,020.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,886.16
|
| Rate for Payer: Aetna Managed Medicare |
$939.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,181.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,678.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,610.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,778.68
|
| Rate for Payer: Cash Price |
$1,006.80
|
| Rate for Payer: Cigna Commercial |
$3,087.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,878.02
|
| Rate for Payer: Health EOS Commercial |
$2,986.84
|
| Rate for Payer: HFN Commercial |
$3,087.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,517.00
|
| Rate for Payer: Multiplan Commercial |
$2,684.80
|
| Rate for Payer: NAPHCARE Commercial |
$2,013.60
|
| Rate for Payer: Preferred Network Access Commercial |
$3,087.52
|
| Rate for Payer: Quartz Beloit One Network |
$1,644.44
|
| Rate for Payer: Quartz Commercial |
$2,181.40
|
| Rate for Payer: Quartz Medicare Advantage |
$2,013.60
|
| Rate for Payer: The Alliance Commercial |
$13,424.00
|
| Rate for Payer: WEA Trust Commercial |
$1,845.80
|
| Rate for Payer: WPS Commercial |
$2,485.79
|
|
|
ROD CARBON FIBER 11.0MM X 300MM 394.85
|
Facility
|
IP
|
$3,356.00
|
|
| Hospital Charge Code |
2966390
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,644.44 |
| Max. Negotiated Rate |
$3,087.52 |
| Rate for Payer: Aetna Commercial |
$3,020.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,886.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,778.68
|
| Rate for Payer: Cash Price |
$1,006.80
|
| Rate for Payer: Cigna Commercial |
$3,087.52
|
| Rate for Payer: Health EOS Commercial |
$2,986.84
|
| Rate for Payer: HFN Commercial |
$3,087.52
|
| Rate for Payer: Multiplan Commercial |
$2,684.80
|
| Rate for Payer: NAPHCARE Commercial |
$2,013.60
|
| Rate for Payer: Preferred Network Access Commercial |
$3,087.52
|
| Rate for Payer: Quartz Beloit One Network |
$1,644.44
|
| Rate for Payer: Quartz Commercial |
$2,013.60
|
| Rate for Payer: WEA Trust Commercial |
$1,845.80
|
| Rate for Payer: WPS Commercial |
$2,485.79
|
|
|
ROD CARBON FIBER 11.0MM X 350MM 394.86
|
Facility
|
OP
|
$3,356.00
|
|
| Hospital Charge Code |
2966391
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$939.68 |
| Max. Negotiated Rate |
$13,424.00 |
| Rate for Payer: Aetna Commercial |
$3,020.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,886.16
|
| Rate for Payer: Aetna Managed Medicare |
$939.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,181.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,678.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,610.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,778.68
|
| Rate for Payer: Cash Price |
$1,006.80
|
| Rate for Payer: Cigna Commercial |
$3,087.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,878.02
|
| Rate for Payer: Health EOS Commercial |
$2,986.84
|
| Rate for Payer: HFN Commercial |
$3,087.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,517.00
|
| Rate for Payer: Multiplan Commercial |
$2,684.80
|
| Rate for Payer: NAPHCARE Commercial |
$2,013.60
|
| Rate for Payer: Preferred Network Access Commercial |
$3,087.52
|
| Rate for Payer: Quartz Beloit One Network |
$1,644.44
|
| Rate for Payer: Quartz Commercial |
$2,181.40
|
| Rate for Payer: Quartz Medicare Advantage |
$2,013.60
|
| Rate for Payer: The Alliance Commercial |
$13,424.00
|
| Rate for Payer: WEA Trust Commercial |
$1,845.80
|
| Rate for Payer: WPS Commercial |
$2,485.79
|
|
|
ROD CARBON FIBER 11.0MM X 350MM 394.86
|
Facility
|
IP
|
$3,356.00
|
|
| Hospital Charge Code |
2966391
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,644.44 |
| Max. Negotiated Rate |
$3,087.52 |
| Rate for Payer: Aetna Commercial |
$3,020.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,886.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,778.68
|
| Rate for Payer: Cash Price |
$1,006.80
|
| Rate for Payer: Cigna Commercial |
$3,087.52
|
| Rate for Payer: Health EOS Commercial |
$2,986.84
|
| Rate for Payer: HFN Commercial |
$3,087.52
|
| Rate for Payer: Multiplan Commercial |
$2,684.80
|
| Rate for Payer: NAPHCARE Commercial |
$2,013.60
|
| Rate for Payer: Preferred Network Access Commercial |
$3,087.52
|
| Rate for Payer: Quartz Beloit One Network |
$1,644.44
|
| Rate for Payer: Quartz Commercial |
$2,013.60
|
| Rate for Payer: WEA Trust Commercial |
$1,845.80
|
| Rate for Payer: WPS Commercial |
$2,485.79
|
|
|
ROD CARBON FIBER 11.0MM X 400MM 394.87
|
Facility
|
OP
|
$3,837.00
|
|
| Hospital Charge Code |
2966392
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,074.36 |
| Max. Negotiated Rate |
$15,348.00 |
| Rate for Payer: Aetna Commercial |
$3,453.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,299.82
|
| Rate for Payer: Aetna Managed Medicare |
$1,074.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,494.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,918.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,841.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,033.61
|
| Rate for Payer: Cash Price |
$1,151.10
|
| Rate for Payer: Cigna Commercial |
$3,530.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,147.19
|
| Rate for Payer: Health EOS Commercial |
$3,414.93
|
| Rate for Payer: HFN Commercial |
$3,530.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,877.75
|
| Rate for Payer: Multiplan Commercial |
$3,069.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,302.20
|
| Rate for Payer: Preferred Network Access Commercial |
$3,530.04
|
| Rate for Payer: Quartz Beloit One Network |
$1,880.13
|
| Rate for Payer: Quartz Commercial |
$2,494.05
|
| Rate for Payer: Quartz Medicare Advantage |
$2,302.20
|
| Rate for Payer: The Alliance Commercial |
$15,348.00
|
| Rate for Payer: WEA Trust Commercial |
$2,110.35
|
| Rate for Payer: WPS Commercial |
$2,842.07
|
|
|
ROD CARBON FIBER 11.0MM X 400MM 394.87
|
Facility
|
IP
|
$3,837.00
|
|
| Hospital Charge Code |
2966392
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,880.13 |
| Max. Negotiated Rate |
$3,530.04 |
| Rate for Payer: Aetna Commercial |
$3,453.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,299.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,033.61
|
| Rate for Payer: Cash Price |
$1,151.10
|
| Rate for Payer: Cigna Commercial |
$3,530.04
|
| Rate for Payer: Health EOS Commercial |
$3,414.93
|
| Rate for Payer: HFN Commercial |
$3,530.04
|
| Rate for Payer: Multiplan Commercial |
$3,069.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,302.20
|
| Rate for Payer: Preferred Network Access Commercial |
$3,530.04
|
| Rate for Payer: Quartz Beloit One Network |
$1,880.13
|
| Rate for Payer: Quartz Commercial |
$2,302.20
|
| Rate for Payer: WEA Trust Commercial |
$2,110.35
|
| Rate for Payer: WPS Commercial |
$2,842.07
|
|
|
ROD CARBON FIBER 11.0MM X 500MM 394.89
|
Facility
|
OP
|
$2,584.00
|
|
| Hospital Charge Code |
4208664
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$723.52 |
| Max. Negotiated Rate |
$10,336.00 |
| Rate for Payer: Aetna Commercial |
$2,325.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,222.24
|
| Rate for Payer: Aetna Managed Medicare |
$723.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,679.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,292.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,240.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,369.52
|
| Rate for Payer: Cash Price |
$775.20
|
| Rate for Payer: Cigna Commercial |
$2,377.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,446.01
|
| Rate for Payer: Health EOS Commercial |
$2,299.76
|
| Rate for Payer: HFN Commercial |
$2,377.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,938.00
|
| Rate for Payer: Multiplan Commercial |
$2,067.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,550.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,377.28
|
| Rate for Payer: Quartz Beloit One Network |
$1,266.16
|
| Rate for Payer: Quartz Commercial |
$1,679.60
|
| Rate for Payer: Quartz Medicare Advantage |
$1,550.40
|
| Rate for Payer: The Alliance Commercial |
$10,336.00
|
| Rate for Payer: WEA Trust Commercial |
$1,421.20
|
| Rate for Payer: WPS Commercial |
$1,913.97
|
|
|
ROD CARBON FIBER 11.0MM X 500MM 394.89
|
Facility
|
IP
|
$2,584.00
|
|
| Hospital Charge Code |
4208664
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,266.16 |
| Max. Negotiated Rate |
$2,377.28 |
| Rate for Payer: Aetna Commercial |
$2,325.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,222.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,369.52
|
| Rate for Payer: Cash Price |
$775.20
|
| Rate for Payer: Cigna Commercial |
$2,377.28
|
| Rate for Payer: Health EOS Commercial |
$2,299.76
|
| Rate for Payer: HFN Commercial |
$2,377.28
|
| Rate for Payer: Multiplan Commercial |
$2,067.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,550.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,377.28
|
| Rate for Payer: Quartz Beloit One Network |
$1,266.16
|
| Rate for Payer: Quartz Commercial |
$1,550.40
|
| Rate for Payer: WEA Trust Commercial |
$1,421.20
|
| Rate for Payer: WPS Commercial |
$1,913.97
|
|
|
ROD CARBON FIBER 11.0 X 650 394.92
|
Facility
|
OP
|
$3,413.00
|
|
| Hospital Charge Code |
4155809
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$955.64 |
| Max. Negotiated Rate |
$13,652.00 |
| Rate for Payer: Aetna Commercial |
$3,071.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,935.18
|
| Rate for Payer: Aetna Managed Medicare |
$955.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,218.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,706.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,638.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,808.89
|
| Rate for Payer: Cash Price |
$1,023.90
|
| Rate for Payer: Cigna Commercial |
$3,139.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,909.91
|
| Rate for Payer: Health EOS Commercial |
$3,037.57
|
| Rate for Payer: HFN Commercial |
$3,139.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,559.75
|
| Rate for Payer: Multiplan Commercial |
$2,730.40
|
| Rate for Payer: NAPHCARE Commercial |
$2,047.80
|
| Rate for Payer: Preferred Network Access Commercial |
$3,139.96
|
| Rate for Payer: Quartz Beloit One Network |
$1,672.37
|
| Rate for Payer: Quartz Commercial |
$2,218.45
|
| Rate for Payer: Quartz Medicare Advantage |
$2,047.80
|
| Rate for Payer: The Alliance Commercial |
$13,652.00
|
| Rate for Payer: WEA Trust Commercial |
$1,877.15
|
| Rate for Payer: WPS Commercial |
$2,528.01
|
|
|
ROD CARBON FIBER 11.0 X 650 394.92
|
Facility
|
IP
|
$3,413.00
|
|
| Hospital Charge Code |
4155809
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,672.37 |
| Max. Negotiated Rate |
$3,139.96 |
| Rate for Payer: Aetna Commercial |
$3,071.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,935.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,808.89
|
| Rate for Payer: Cash Price |
$1,023.90
|
| Rate for Payer: Cigna Commercial |
$3,139.96
|
| Rate for Payer: Health EOS Commercial |
$3,037.57
|
| Rate for Payer: HFN Commercial |
$3,139.96
|
| Rate for Payer: Multiplan Commercial |
$2,730.40
|
| Rate for Payer: NAPHCARE Commercial |
$2,047.80
|
| Rate for Payer: Preferred Network Access Commercial |
$3,139.96
|
| Rate for Payer: Quartz Beloit One Network |
$1,672.37
|
| Rate for Payer: Quartz Commercial |
$2,047.80
|
| Rate for Payer: WEA Trust Commercial |
$1,877.15
|
| Rate for Payer: WPS Commercial |
$2,528.01
|
|
