|
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 |
$20.12 |
| Max. Negotiated Rate |
$93.36 |
| Rate for Payer: Aetna Commercial |
$91.33
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$87.28
|
| Rate for Payer: Aetna Managed Medicare |
$20.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$75.47
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$35.22
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$33.41
|
| Rate for Payer: Anthem Medicare Advantage |
$20.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$53.79
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$20.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$20.12
|
| Rate for Payer: Cash Price |
$29.27
|
| Rate for Payer: Cash Price |
$29.27
|
| Rate for Payer: Cigna Commercial |
$93.36
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$20.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$56.79
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$20.12
|
| Rate for Payer: Health EOS Commercial |
$90.32
|
| Rate for Payer: HFN Commercial |
$93.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$74.86
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$20.12
|
| Rate for Payer: Independent Care Health Plan Medicare |
$20.12
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$20.12
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$20.12
|
| Rate for Payer: Multiplan Commercial |
$81.19
|
| Rate for Payer: NAPHCARE Commercial |
$30.19
|
| Rate for Payer: Preferred Network Access Commercial |
$93.36
|
| Rate for Payer: Quartz Beloit One Network |
$49.73
|
| Rate for Payer: Quartz Commercial |
$65.96
|
| Rate for Payer: Quartz Medicare Advantage |
$20.12
|
| Rate for Payer: The Alliance Commercial |
$80.50
|
| Rate for Payer: United Healthcare Medicare Advantage |
$20.12
|
| Rate for Payer: United Healthcare PPO |
$76.11
|
| Rate for Payer: WEA Trust Commercial |
$55.82
|
| Rate for Payer: Wellcare Medicare |
$20.12
|
| Rate for Payer: WPS Commercial |
$75.17
|
|
|
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 |
$2,989.82 |
| Max. Negotiated Rate |
$5,613.55 |
| Rate for Payer: Aetna Commercial |
$5,491.51
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,247.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,233.89
|
| Rate for Payer: Cash Price |
$1,760.10
|
| Rate for Payer: Cigna Commercial |
$5,613.55
|
| Rate for Payer: Health EOS Commercial |
$5,430.50
|
| Rate for Payer: HFN Commercial |
$5,613.55
|
| Rate for Payer: Multiplan Commercial |
$4,881.34
|
| Rate for Payer: Preferred Network Access Commercial |
$5,613.55
|
| Rate for Payer: Quartz Beloit One Network |
$2,989.82
|
| Rate for Payer: Quartz Commercial |
$3,661.01
|
| Rate for Payer: WEA Trust Commercial |
$3,355.92
|
| Rate for Payer: WPS Commercial |
$4,519.35
|
|
|
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 |
$1,708.47 |
| Max. Negotiated Rate |
$5,613.55 |
| Rate for Payer: Aetna Commercial |
$5,491.51
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,247.44
|
| Rate for Payer: Aetna Managed Medicare |
$1,708.47
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,966.09
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,050.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,928.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,233.89
|
| Rate for Payer: Cash Price |
$1,760.10
|
| Rate for Payer: Cigna Commercial |
$5,613.55
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,414.59
|
| Rate for Payer: Health EOS Commercial |
$5,430.50
|
| Rate for Payer: HFN Commercial |
$5,613.55
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,576.26
|
| Rate for Payer: Multiplan Commercial |
$4,881.34
|
| Rate for Payer: NAPHCARE Commercial |
$3,661.01
|
| Rate for Payer: Preferred Network Access Commercial |
$5,613.55
|
| Rate for Payer: Quartz Beloit One Network |
$2,989.82
|
| Rate for Payer: Quartz Commercial |
$3,966.09
|
| Rate for Payer: Quartz Medicare Advantage |
$3,661.01
|
| Rate for Payer: The Alliance Commercial |
$3,050.84
|
| Rate for Payer: WEA Trust Commercial |
$3,355.92
|
| Rate for Payer: WPS Commercial |
$4,519.35
|
|
|
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 |
$1,596.07 |
| Max. Negotiated Rate |
$2,996.70 |
| Rate for Payer: Aetna Commercial |
$2,931.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,801.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,726.36
|
| Rate for Payer: Cash Price |
$939.60
|
| Rate for Payer: Cigna Commercial |
$2,996.70
|
| Rate for Payer: Health EOS Commercial |
$2,898.98
|
| Rate for Payer: HFN Commercial |
$2,996.70
|
| Rate for Payer: Multiplan Commercial |
$2,605.82
|
| Rate for Payer: Preferred Network Access Commercial |
$2,996.70
|
| Rate for Payer: Quartz Beloit One Network |
$1,596.07
|
| Rate for Payer: Quartz Commercial |
$1,954.37
|
| Rate for Payer: WEA Trust Commercial |
$1,791.50
|
| Rate for Payer: WPS Commercial |
$2,412.58
|
|
|
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 |
$912.04 |
| Max. Negotiated Rate |
$2,996.70 |
| Rate for Payer: Aetna Commercial |
$2,931.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,801.26
|
| Rate for Payer: Aetna Managed Medicare |
$912.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,117.23
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,628.64
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,563.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,726.36
|
| Rate for Payer: Cash Price |
$939.60
|
| Rate for Payer: Cigna Commercial |
$2,996.70
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,822.82
|
| Rate for Payer: Health EOS Commercial |
$2,898.98
|
| Rate for Payer: HFN Commercial |
$2,996.70
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,442.96
|
| Rate for Payer: Multiplan Commercial |
$2,605.82
|
| Rate for Payer: NAPHCARE Commercial |
$1,954.37
|
| Rate for Payer: Preferred Network Access Commercial |
$2,996.70
|
| Rate for Payer: Quartz Beloit One Network |
$1,596.07
|
| Rate for Payer: Quartz Commercial |
$2,117.23
|
| Rate for Payer: Quartz Medicare Advantage |
$1,954.37
|
| Rate for Payer: The Alliance Commercial |
$1,628.64
|
| Rate for Payer: WEA Trust Commercial |
$1,791.50
|
| Rate for Payer: WPS Commercial |
$2,412.58
|
|
|
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 |
$567.84 |
| Max. Negotiated Rate |
$1,865.76 |
| Rate for Payer: Aetna Commercial |
$1,825.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,744.08
|
| Rate for Payer: Aetna Managed Medicare |
$567.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,318.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,014.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$973.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,074.84
|
| Rate for Payer: Cash Price |
$585.00
|
| Rate for Payer: Cigna Commercial |
$1,865.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,134.90
|
| Rate for Payer: Health EOS Commercial |
$1,804.92
|
| Rate for Payer: HFN Commercial |
$1,865.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,521.00
|
| Rate for Payer: Multiplan Commercial |
$1,622.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,216.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,865.76
|
| Rate for Payer: Quartz Beloit One Network |
$993.72
|
| Rate for Payer: Quartz Commercial |
$1,318.20
|
| Rate for Payer: Quartz Medicare Advantage |
$1,216.80
|
| Rate for Payer: The Alliance Commercial |
$1,014.00
|
| Rate for Payer: WEA Trust Commercial |
$1,115.40
|
| Rate for Payer: WPS Commercial |
$1,502.09
|
|
|
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 |
$993.72 |
| Max. Negotiated Rate |
$1,865.76 |
| Rate for Payer: Aetna Commercial |
$1,825.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,744.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,074.84
|
| Rate for Payer: Cash Price |
$585.00
|
| Rate for Payer: Cigna Commercial |
$1,865.76
|
| Rate for Payer: Health EOS Commercial |
$1,804.92
|
| Rate for Payer: HFN Commercial |
$1,865.76
|
| Rate for Payer: Multiplan Commercial |
$1,622.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,865.76
|
| Rate for Payer: Quartz Beloit One Network |
$993.72
|
| Rate for Payer: Quartz Commercial |
$1,216.80
|
| Rate for Payer: WEA Trust Commercial |
$1,115.40
|
| Rate for Payer: WPS Commercial |
$1,502.09
|
|
|
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 |
$1,537.46 |
| Max. Negotiated Rate |
$2,886.67 |
| Rate for Payer: Aetna Commercial |
$2,823.91
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,698.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,662.97
|
| Rate for Payer: Cash Price |
$905.10
|
| Rate for Payer: Cigna Commercial |
$2,886.67
|
| Rate for Payer: Health EOS Commercial |
$2,792.54
|
| Rate for Payer: HFN Commercial |
$2,886.67
|
| Rate for Payer: Multiplan Commercial |
$2,510.14
|
| Rate for Payer: Preferred Network Access Commercial |
$2,886.67
|
| Rate for Payer: Quartz Beloit One Network |
$1,537.46
|
| Rate for Payer: Quartz Commercial |
$1,882.61
|
| Rate for Payer: WEA Trust Commercial |
$1,725.72
|
| Rate for Payer: WPS Commercial |
$2,324.00
|
|
|
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 |
$878.55 |
| Max. Negotiated Rate |
$2,886.67 |
| Rate for Payer: Aetna Commercial |
$2,823.91
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,698.40
|
| Rate for Payer: Aetna Managed Medicare |
$878.55
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,039.49
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,568.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,506.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,662.97
|
| Rate for Payer: Cash Price |
$905.10
|
| Rate for Payer: Cigna Commercial |
$2,886.67
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,755.89
|
| Rate for Payer: Health EOS Commercial |
$2,792.54
|
| Rate for Payer: HFN Commercial |
$2,886.67
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,353.26
|
| Rate for Payer: Multiplan Commercial |
$2,510.14
|
| Rate for Payer: NAPHCARE Commercial |
$1,882.61
|
| Rate for Payer: Preferred Network Access Commercial |
$2,886.67
|
| Rate for Payer: Quartz Beloit One Network |
$1,537.46
|
| Rate for Payer: Quartz Commercial |
$2,039.49
|
| Rate for Payer: Quartz Medicare Advantage |
$1,882.61
|
| Rate for Payer: The Alliance Commercial |
$1,568.84
|
| Rate for Payer: WEA Trust Commercial |
$1,725.72
|
| Rate for Payer: WPS Commercial |
$2,324.00
|
|
|
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 |
$667.72 |
| Max. Negotiated Rate |
$2,193.94 |
| Rate for Payer: Aetna Commercial |
$2,146.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,050.86
|
| Rate for Payer: Aetna Managed Medicare |
$667.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,550.07
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,192.36
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,144.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,263.90
|
| Rate for Payer: Cash Price |
$687.90
|
| Rate for Payer: Cigna Commercial |
$2,193.94
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,334.53
|
| Rate for Payer: Health EOS Commercial |
$2,122.40
|
| Rate for Payer: HFN Commercial |
$2,193.94
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,788.54
|
| Rate for Payer: Multiplan Commercial |
$1,907.78
|
| Rate for Payer: NAPHCARE Commercial |
$1,430.83
|
| Rate for Payer: Preferred Network Access Commercial |
$2,193.94
|
| Rate for Payer: Quartz Beloit One Network |
$1,168.51
|
| Rate for Payer: Quartz Commercial |
$1,550.07
|
| Rate for Payer: Quartz Medicare Advantage |
$1,430.83
|
| Rate for Payer: The Alliance Commercial |
$1,192.36
|
| Rate for Payer: WEA Trust Commercial |
$1,311.60
|
| Rate for Payer: WPS Commercial |
$1,766.30
|
|
|
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 |
$1,168.51 |
| Max. Negotiated Rate |
$2,193.94 |
| Rate for Payer: Aetna Commercial |
$2,146.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,050.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,263.90
|
| Rate for Payer: Cash Price |
$687.90
|
| Rate for Payer: Cigna Commercial |
$2,193.94
|
| Rate for Payer: Health EOS Commercial |
$2,122.40
|
| Rate for Payer: HFN Commercial |
$2,193.94
|
| Rate for Payer: Multiplan Commercial |
$1,907.78
|
| Rate for Payer: Preferred Network Access Commercial |
$2,193.94
|
| Rate for Payer: Quartz Beloit One Network |
$1,168.51
|
| Rate for Payer: Quartz Commercial |
$1,430.83
|
| Rate for Payer: WEA Trust Commercial |
$1,311.60
|
| Rate for Payer: WPS Commercial |
$1,766.30
|
|
|
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 |
$977.27 |
| Max. Negotiated Rate |
$3,211.02 |
| Rate for Payer: Aetna Commercial |
$3,141.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,001.61
|
| Rate for Payer: Aetna Managed Medicare |
$977.27
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,268.66
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,745.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,675.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,849.83
|
| Rate for Payer: Cash Price |
$1,006.80
|
| Rate for Payer: Cigna Commercial |
$3,211.02
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,953.19
|
| Rate for Payer: Health EOS Commercial |
$3,106.31
|
| Rate for Payer: HFN Commercial |
$3,211.02
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,617.68
|
| Rate for Payer: Multiplan Commercial |
$2,792.19
|
| Rate for Payer: NAPHCARE Commercial |
$2,094.14
|
| Rate for Payer: Preferred Network Access Commercial |
$3,211.02
|
| Rate for Payer: Quartz Beloit One Network |
$1,710.22
|
| Rate for Payer: Quartz Commercial |
$2,268.66
|
| Rate for Payer: Quartz Medicare Advantage |
$2,094.14
|
| Rate for Payer: The Alliance Commercial |
$1,745.12
|
| Rate for Payer: WEA Trust Commercial |
$1,919.63
|
| Rate for Payer: WPS Commercial |
$2,585.13
|
|
|
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 |
$1,710.22 |
| Max. Negotiated Rate |
$3,211.02 |
| Rate for Payer: Aetna Commercial |
$3,141.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,001.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,849.83
|
| Rate for Payer: Cash Price |
$1,006.80
|
| Rate for Payer: Cigna Commercial |
$3,211.02
|
| Rate for Payer: Health EOS Commercial |
$3,106.31
|
| Rate for Payer: HFN Commercial |
$3,211.02
|
| Rate for Payer: Multiplan Commercial |
$2,792.19
|
| Rate for Payer: Preferred Network Access Commercial |
$3,211.02
|
| Rate for Payer: Quartz Beloit One Network |
$1,710.22
|
| Rate for Payer: Quartz Commercial |
$2,094.14
|
| Rate for Payer: WEA Trust Commercial |
$1,919.63
|
| Rate for Payer: WPS Commercial |
$2,585.13
|
|
|
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 |
$977.27 |
| Max. Negotiated Rate |
$3,211.02 |
| Rate for Payer: Aetna Commercial |
$3,141.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,001.61
|
| Rate for Payer: Aetna Managed Medicare |
$977.27
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,268.66
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,745.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,675.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,849.83
|
| Rate for Payer: Cash Price |
$1,006.80
|
| Rate for Payer: Cigna Commercial |
$3,211.02
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,953.19
|
| Rate for Payer: Health EOS Commercial |
$3,106.31
|
| Rate for Payer: HFN Commercial |
$3,211.02
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,617.68
|
| Rate for Payer: Multiplan Commercial |
$2,792.19
|
| Rate for Payer: NAPHCARE Commercial |
$2,094.14
|
| Rate for Payer: Preferred Network Access Commercial |
$3,211.02
|
| Rate for Payer: Quartz Beloit One Network |
$1,710.22
|
| Rate for Payer: Quartz Commercial |
$2,268.66
|
| Rate for Payer: Quartz Medicare Advantage |
$2,094.14
|
| Rate for Payer: The Alliance Commercial |
$1,745.12
|
| Rate for Payer: WEA Trust Commercial |
$1,919.63
|
| Rate for Payer: WPS Commercial |
$2,585.13
|
|
|
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 |
$1,710.22 |
| Max. Negotiated Rate |
$3,211.02 |
| Rate for Payer: Aetna Commercial |
$3,141.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,001.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,849.83
|
| Rate for Payer: Cash Price |
$1,006.80
|
| Rate for Payer: Cigna Commercial |
$3,211.02
|
| Rate for Payer: Health EOS Commercial |
$3,106.31
|
| Rate for Payer: HFN Commercial |
$3,211.02
|
| Rate for Payer: Multiplan Commercial |
$2,792.19
|
| Rate for Payer: Preferred Network Access Commercial |
$3,211.02
|
| Rate for Payer: Quartz Beloit One Network |
$1,710.22
|
| Rate for Payer: Quartz Commercial |
$2,094.14
|
| Rate for Payer: WEA Trust Commercial |
$1,919.63
|
| Rate for Payer: WPS Commercial |
$2,585.13
|
|
|
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 |
$1,955.34 |
| Max. Negotiated Rate |
$3,671.24 |
| Rate for Payer: Aetna Commercial |
$3,591.43
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,431.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,114.95
|
| Rate for Payer: Cash Price |
$1,151.10
|
| Rate for Payer: Cigna Commercial |
$3,671.24
|
| Rate for Payer: Health EOS Commercial |
$3,551.53
|
| Rate for Payer: HFN Commercial |
$3,671.24
|
| Rate for Payer: Multiplan Commercial |
$3,192.38
|
| Rate for Payer: Preferred Network Access Commercial |
$3,671.24
|
| Rate for Payer: Quartz Beloit One Network |
$1,955.34
|
| Rate for Payer: Quartz Commercial |
$2,394.29
|
| Rate for Payer: WEA Trust Commercial |
$2,194.76
|
| Rate for Payer: WPS Commercial |
$2,955.64
|
|
|
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 |
$1,117.33 |
| Max. Negotiated Rate |
$3,671.24 |
| Rate for Payer: Aetna Commercial |
$3,591.43
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,431.81
|
| Rate for Payer: Aetna Managed Medicare |
$1,117.33
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,593.81
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,995.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,915.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,114.95
|
| Rate for Payer: Cash Price |
$1,151.10
|
| Rate for Payer: Cigna Commercial |
$3,671.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,233.13
|
| Rate for Payer: Health EOS Commercial |
$3,551.53
|
| Rate for Payer: HFN Commercial |
$3,671.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,992.86
|
| Rate for Payer: Multiplan Commercial |
$3,192.38
|
| Rate for Payer: NAPHCARE Commercial |
$2,394.29
|
| Rate for Payer: Preferred Network Access Commercial |
$3,671.24
|
| Rate for Payer: Quartz Beloit One Network |
$1,955.34
|
| Rate for Payer: Quartz Commercial |
$2,593.81
|
| Rate for Payer: Quartz Medicare Advantage |
$2,394.29
|
| Rate for Payer: The Alliance Commercial |
$1,995.24
|
| Rate for Payer: WEA Trust Commercial |
$2,194.76
|
| Rate for Payer: WPS Commercial |
$2,955.64
|
|
|
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 |
$752.46 |
| Max. Negotiated Rate |
$2,472.37 |
| Rate for Payer: Aetna Commercial |
$2,418.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,311.13
|
| Rate for Payer: Aetna Managed Medicare |
$752.46
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,746.78
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,343.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,289.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,424.30
|
| Rate for Payer: Cash Price |
$775.20
|
| Rate for Payer: Cigna Commercial |
$2,472.37
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,503.89
|
| Rate for Payer: Health EOS Commercial |
$2,391.75
|
| Rate for Payer: HFN Commercial |
$2,472.37
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,015.52
|
| Rate for Payer: Multiplan Commercial |
$2,149.89
|
| Rate for Payer: NAPHCARE Commercial |
$1,612.42
|
| Rate for Payer: Preferred Network Access Commercial |
$2,472.37
|
| Rate for Payer: Quartz Beloit One Network |
$1,316.81
|
| Rate for Payer: Quartz Commercial |
$1,746.78
|
| Rate for Payer: Quartz Medicare Advantage |
$1,612.42
|
| Rate for Payer: The Alliance Commercial |
$1,343.68
|
| Rate for Payer: WEA Trust Commercial |
$1,478.05
|
| Rate for Payer: WPS Commercial |
$1,990.46
|
|
|
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 |
$1,316.81 |
| Max. Negotiated Rate |
$2,472.37 |
| Rate for Payer: Aetna Commercial |
$2,418.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,311.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,424.30
|
| Rate for Payer: Cash Price |
$775.20
|
| Rate for Payer: Cigna Commercial |
$2,472.37
|
| Rate for Payer: Health EOS Commercial |
$2,391.75
|
| Rate for Payer: HFN Commercial |
$2,472.37
|
| Rate for Payer: Multiplan Commercial |
$2,149.89
|
| Rate for Payer: Preferred Network Access Commercial |
$2,472.37
|
| Rate for Payer: Quartz Beloit One Network |
$1,316.81
|
| Rate for Payer: Quartz Commercial |
$1,612.42
|
| Rate for Payer: WEA Trust Commercial |
$1,478.05
|
| Rate for Payer: WPS Commercial |
$1,990.46
|
|
|
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 |
$993.87 |
| Max. Negotiated Rate |
$3,265.56 |
| Rate for Payer: Aetna Commercial |
$3,194.57
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,052.59
|
| Rate for Payer: Aetna Managed Medicare |
$993.87
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,307.19
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,774.76
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,703.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,881.25
|
| Rate for Payer: Cash Price |
$1,023.90
|
| Rate for Payer: Cigna Commercial |
$3,265.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,986.37
|
| Rate for Payer: Health EOS Commercial |
$3,159.07
|
| Rate for Payer: HFN Commercial |
$3,265.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,662.14
|
| Rate for Payer: Multiplan Commercial |
$2,839.62
|
| Rate for Payer: NAPHCARE Commercial |
$2,129.71
|
| Rate for Payer: Preferred Network Access Commercial |
$3,265.56
|
| Rate for Payer: Quartz Beloit One Network |
$1,739.26
|
| Rate for Payer: Quartz Commercial |
$2,307.19
|
| Rate for Payer: Quartz Medicare Advantage |
$2,129.71
|
| Rate for Payer: The Alliance Commercial |
$1,774.76
|
| Rate for Payer: WEA Trust Commercial |
$1,952.24
|
| Rate for Payer: WPS Commercial |
$2,629.03
|
|
|
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 |
$1,739.26 |
| Max. Negotiated Rate |
$3,265.56 |
| Rate for Payer: Aetna Commercial |
$3,194.57
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,052.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,881.25
|
| Rate for Payer: Cash Price |
$1,023.90
|
| Rate for Payer: Cigna Commercial |
$3,265.56
|
| Rate for Payer: Health EOS Commercial |
$3,159.07
|
| Rate for Payer: HFN Commercial |
$3,265.56
|
| Rate for Payer: Multiplan Commercial |
$2,839.62
|
| Rate for Payer: Preferred Network Access Commercial |
$3,265.56
|
| Rate for Payer: Quartz Beloit One Network |
$1,739.26
|
| Rate for Payer: Quartz Commercial |
$2,129.71
|
| Rate for Payer: WEA Trust Commercial |
$1,952.24
|
| Rate for Payer: WPS Commercial |
$2,629.03
|
|
|
ROD CARBON FIBER 8.0 X 200 395.782
|
Facility
|
OP
|
$2,191.00
|
|
| Hospital Charge Code |
2966394
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$638.02 |
| Max. Negotiated Rate |
$2,096.35 |
| Rate for Payer: Aetna Commercial |
$2,050.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,959.63
|
| Rate for Payer: Aetna Managed Medicare |
$638.02
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,481.12
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,139.32
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,093.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,207.68
|
| Rate for Payer: Cash Price |
$657.30
|
| Rate for Payer: Cigna Commercial |
$2,096.35
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,275.16
|
| Rate for Payer: Health EOS Commercial |
$2,027.99
|
| Rate for Payer: HFN Commercial |
$2,096.35
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,708.98
|
| Rate for Payer: Multiplan Commercial |
$1,822.91
|
| Rate for Payer: NAPHCARE Commercial |
$1,367.18
|
| Rate for Payer: Preferred Network Access Commercial |
$2,096.35
|
| Rate for Payer: Quartz Beloit One Network |
$1,116.53
|
| Rate for Payer: Quartz Commercial |
$1,481.12
|
| Rate for Payer: Quartz Medicare Advantage |
$1,367.18
|
| Rate for Payer: The Alliance Commercial |
$1,139.32
|
| Rate for Payer: WEA Trust Commercial |
$1,253.25
|
| Rate for Payer: WPS Commercial |
$1,687.73
|
|
|
ROD CARBON FIBER 8.0 X 200 395.782
|
Facility
|
IP
|
$2,191.00
|
|
| Hospital Charge Code |
2966394
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,116.53 |
| Max. Negotiated Rate |
$2,096.35 |
| Rate for Payer: Aetna Commercial |
$2,050.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,959.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,207.68
|
| Rate for Payer: Cash Price |
$657.30
|
| Rate for Payer: Cigna Commercial |
$2,096.35
|
| Rate for Payer: Health EOS Commercial |
$2,027.99
|
| Rate for Payer: HFN Commercial |
$2,096.35
|
| Rate for Payer: Multiplan Commercial |
$1,822.91
|
| Rate for Payer: Preferred Network Access Commercial |
$2,096.35
|
| Rate for Payer: Quartz Beloit One Network |
$1,116.53
|
| Rate for Payer: Quartz Commercial |
$1,367.18
|
| Rate for Payer: WEA Trust Commercial |
$1,253.25
|
| Rate for Payer: WPS Commercial |
$1,687.73
|
|
|
ROD CARBON FIBER 8.0 X 220 395.784
|
Facility
|
OP
|
$2,029.00
|
|
| Hospital Charge Code |
2966395
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$590.84 |
| Max. Negotiated Rate |
$1,941.35 |
| Rate for Payer: Aetna Commercial |
$1,899.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,814.74
|
| Rate for Payer: Aetna Managed Medicare |
$590.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,371.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,055.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,012.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,118.38
|
| Rate for Payer: Cash Price |
$608.70
|
| Rate for Payer: Cigna Commercial |
$1,941.35
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,180.88
|
| Rate for Payer: Health EOS Commercial |
$1,878.04
|
| Rate for Payer: HFN Commercial |
$1,941.35
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,582.62
|
| Rate for Payer: Multiplan Commercial |
$1,688.13
|
| Rate for Payer: NAPHCARE Commercial |
$1,266.10
|
| Rate for Payer: Preferred Network Access Commercial |
$1,941.35
|
| Rate for Payer: Quartz Beloit One Network |
$1,033.98
|
| Rate for Payer: Quartz Commercial |
$1,371.60
|
| Rate for Payer: Quartz Medicare Advantage |
$1,266.10
|
| Rate for Payer: The Alliance Commercial |
$1,055.08
|
| Rate for Payer: WEA Trust Commercial |
$1,160.59
|
| Rate for Payer: WPS Commercial |
$1,562.94
|
|
|
ROD CARBON FIBER 8.0 X 220 395.784
|
Facility
|
IP
|
$2,029.00
|
|
| Hospital Charge Code |
2966395
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,033.98 |
| Max. Negotiated Rate |
$1,941.35 |
| Rate for Payer: Aetna Commercial |
$1,899.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,814.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,118.38
|
| Rate for Payer: Cash Price |
$608.70
|
| Rate for Payer: Cigna Commercial |
$1,941.35
|
| Rate for Payer: Health EOS Commercial |
$1,878.04
|
| Rate for Payer: HFN Commercial |
$1,941.35
|
| Rate for Payer: Multiplan Commercial |
$1,688.13
|
| Rate for Payer: Preferred Network Access Commercial |
$1,941.35
|
| Rate for Payer: Quartz Beloit One Network |
$1,033.98
|
| Rate for Payer: Quartz Commercial |
$1,266.10
|
| Rate for Payer: WEA Trust Commercial |
$1,160.59
|
| Rate for Payer: WPS Commercial |
$1,562.94
|
|
