|
TAPE WRAP PREM BLACK 2IN #2640-09
|
Facility
IP
|
$902.00
|
|
| Hospital Charge Code |
2974053
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$441.98 |
| Max. Negotiated Rate |
$829.84 |
| Rate for Payer: Aetna Commercial |
$811.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$478.06
|
| Rate for Payer: Cash Price |
$270.60
|
| Rate for Payer: Cigna Commercial |
$829.84
|
| Rate for Payer: Health EOS Commercial |
$802.78
|
| Rate for Payer: HFN Commercial |
$829.84
|
| Rate for Payer: Multiplan Commercial |
$721.60
|
| Rate for Payer: NAPHCARE Commercial |
$541.20
|
| Rate for Payer: Preferred Network Access Commercial |
$829.84
|
| Rate for Payer: Quartz Beloit One Network |
$441.98
|
| Rate for Payer: Quartz Commercial |
$541.20
|
| Rate for Payer: WEA Trust Commercial |
$496.10
|
| Rate for Payer: WPS Commercial |
$668.11
|
|
|
TAP FOR 3.5MM CORT SCREW GOLD/110MM 311.32
|
Facility
IP
|
$1,895.00
|
|
| Hospital Charge Code |
4494462
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$928.55 |
| Max. Negotiated Rate |
$1,743.40 |
| Rate for Payer: Aetna Commercial |
$1,705.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,004.35
|
| Rate for Payer: Cash Price |
$568.50
|
| Rate for Payer: Cigna Commercial |
$1,743.40
|
| Rate for Payer: Health EOS Commercial |
$1,686.55
|
| Rate for Payer: HFN Commercial |
$1,743.40
|
| Rate for Payer: Multiplan Commercial |
$1,516.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,137.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,743.40
|
| Rate for Payer: Quartz Beloit One Network |
$928.55
|
| Rate for Payer: Quartz Commercial |
$1,137.00
|
| Rate for Payer: WEA Trust Commercial |
$1,042.25
|
| Rate for Payer: WPS Commercial |
$1,403.63
|
|
|
TAP FOR 3.5MM CORT SCREW GOLD/110MM 311.32
|
Facility
OP
|
$1,895.00
|
|
| Hospital Charge Code |
4494462
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$530.60 |
| Max. Negotiated Rate |
$7,580.00 |
| Rate for Payer: Aetna Commercial |
$1,705.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,629.70
|
| Rate for Payer: Aetna Managed Medicare |
$530.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,231.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$947.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$909.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,004.35
|
| Rate for Payer: Cash Price |
$568.50
|
| Rate for Payer: Cigna Commercial |
$1,743.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,060.44
|
| Rate for Payer: Health EOS Commercial |
$1,686.55
|
| Rate for Payer: HFN Commercial |
$1,743.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,421.25
|
| Rate for Payer: Multiplan Commercial |
$1,516.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,137.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,743.40
|
| Rate for Payer: Quartz Beloit One Network |
$928.55
|
| Rate for Payer: Quartz Commercial |
$1,231.75
|
| Rate for Payer: Quartz Medicare Advantage |
$1,137.00
|
| Rate for Payer: The Alliance Commercial |
$7,580.00
|
| Rate for Payer: WEA Trust Commercial |
$1,042.25
|
| Rate for Payer: WPS Commercial |
$1,403.63
|
|
|
TAP FOR 4.5MM CORTEX/SHAFT SCREWS 130MM/57MM TAP DEPTH 311.46
|
Facility
IP
|
$1,428.00
|
|
| Hospital Charge Code |
5521034
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$699.72 |
| Max. Negotiated Rate |
$1,313.76 |
| Rate for Payer: Aetna Commercial |
$1,285.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$756.84
|
| Rate for Payer: Cash Price |
$428.40
|
| Rate for Payer: Cigna Commercial |
$1,313.76
|
| Rate for Payer: Health EOS Commercial |
$1,270.92
|
| Rate for Payer: HFN Commercial |
$1,313.76
|
| Rate for Payer: Multiplan Commercial |
$1,142.40
|
| Rate for Payer: NAPHCARE Commercial |
$856.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,313.76
|
| Rate for Payer: Quartz Beloit One Network |
$699.72
|
| Rate for Payer: Quartz Commercial |
$856.80
|
| Rate for Payer: WEA Trust Commercial |
$785.40
|
| Rate for Payer: WPS Commercial |
$1,057.72
|
|
|
TAP FOR 4.5MM CORTEX/SHAFT SCREWS 130MM/57MM TAP DEPTH 311.46
|
Facility
OP
|
$1,428.00
|
|
| Hospital Charge Code |
5521034
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$399.84 |
| Max. Negotiated Rate |
$5,712.00 |
| Rate for Payer: Aetna Commercial |
$1,285.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,228.08
|
| Rate for Payer: Aetna Managed Medicare |
$399.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$928.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$714.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$685.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$756.84
|
| Rate for Payer: Cash Price |
$428.40
|
| Rate for Payer: Cigna Commercial |
$1,313.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$799.11
|
| Rate for Payer: Health EOS Commercial |
$1,270.92
|
| Rate for Payer: HFN Commercial |
$1,313.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,071.00
|
| Rate for Payer: Multiplan Commercial |
$1,142.40
|
| Rate for Payer: NAPHCARE Commercial |
$856.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,313.76
|
| Rate for Payer: Quartz Beloit One Network |
$699.72
|
| Rate for Payer: Quartz Commercial |
$928.20
|
| Rate for Payer: Quartz Medicare Advantage |
$856.80
|
| Rate for Payer: The Alliance Commercial |
$5,712.00
|
| Rate for Payer: WEA Trust Commercial |
$785.40
|
| Rate for Payer: WPS Commercial |
$1,057.72
|
|
|
TARSAL TUNNEL RELEASE
|
Facility
IP
|
$1,337.00
|
|
| Hospital Charge Code |
2960404
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$655.13 |
| Max. Negotiated Rate |
$1,230.04 |
| Rate for Payer: Aetna Commercial |
$1,203.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$708.61
|
| Rate for Payer: Cash Price |
$401.10
|
| Rate for Payer: Cigna Commercial |
$1,230.04
|
| Rate for Payer: Health EOS Commercial |
$1,189.93
|
| Rate for Payer: HFN Commercial |
$1,230.04
|
| Rate for Payer: Multiplan Commercial |
$1,069.60
|
| Rate for Payer: NAPHCARE Commercial |
$802.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,230.04
|
| Rate for Payer: Quartz Beloit One Network |
$655.13
|
| Rate for Payer: Quartz Commercial |
$802.20
|
| Rate for Payer: WEA Trust Commercial |
$735.35
|
| Rate for Payer: WPS Commercial |
$990.32
|
|
|
TARSAL TUNNEL RELEASE
|
Facility
OP
|
$1,337.00
|
|
| Hospital Charge Code |
2960404
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$374.36 |
| Max. Negotiated Rate |
$5,348.00 |
| Rate for Payer: Aetna Commercial |
$1,203.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,149.82
|
| Rate for Payer: Aetna Managed Medicare |
$374.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$869.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$668.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$641.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$708.61
|
| Rate for Payer: Cash Price |
$401.10
|
| Rate for Payer: Cigna Commercial |
$1,230.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$748.19
|
| Rate for Payer: Health EOS Commercial |
$1,189.93
|
| Rate for Payer: HFN Commercial |
$1,230.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,002.75
|
| Rate for Payer: Multiplan Commercial |
$1,069.60
|
| Rate for Payer: NAPHCARE Commercial |
$802.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,230.04
|
| Rate for Payer: Quartz Beloit One Network |
$655.13
|
| Rate for Payer: Quartz Commercial |
$869.05
|
| Rate for Payer: Quartz Medicare Advantage |
$802.20
|
| Rate for Payer: The Alliance Commercial |
$5,348.00
|
| Rate for Payer: WEA Trust Commercial |
$735.35
|
| Rate for Payer: WPS Commercial |
$990.32
|
|
|
Taxotere 1 mg Charge
|
Professional
|
$189.00
|
|
|
Service Code
|
HCPCS J9171
|
| Hospital Charge Code |
2958947
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.87 |
| Max. Negotiated Rate |
$179.55 |
| Rate for Payer: Aetna Commercial |
$179.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$162.54
|
| Rate for Payer: Aetna Managed Medicare |
$0.94
|
| Rate for Payer: Anthem Medicare Advantage |
$0.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$0.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$0.94
|
| Rate for Payer: Cash Price |
$56.70
|
| Rate for Payer: Cash Price |
$56.70
|
| Rate for Payer: Cigna Commercial |
$179.55
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$94.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$0.87
|
| Rate for Payer: Health EOS Commercial |
$171.99
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$0.91
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$0.91
|
| Rate for Payer: Independent Care Health Plan Medicare |
$0.94
|
| Rate for Payer: Multiplan Commercial |
$151.20
|
| Rate for Payer: Preferred Network Access Commercial |
$179.55
|
| Rate for Payer: Quartz Beloit One Network |
$83.16
|
| Rate for Payer: Quartz Commercial |
$107.73
|
| Rate for Payer: Quartz Medicare Advantage |
$0.94
|
| Rate for Payer: The Alliance Commercial |
$2.58
|
| Rate for Payer: United Healthcare Medicaid |
$0.87
|
| Rate for Payer: United Healthcare Medicare Advantage |
$0.94
|
| Rate for Payer: WEA Trust Commercial |
$103.95
|
| Rate for Payer: WPS Commercial |
$2.18
|
|
|
Taxotere 1 mg Charge
|
Facility
OP
|
$189.00
|
|
|
Service Code
|
HCPCS J9171
|
| Hospital Charge Code |
2958947
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.15 |
| Max. Negotiated Rate |
$2,059.96 |
| Rate for Payer: Aetna Commercial |
$170.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$162.54
|
| Rate for Payer: Aetna Managed Medicare |
$52.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$122.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$94.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$90.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$100.17
|
| Rate for Payer: Cash Price |
$56.70
|
| Rate for Payer: Cash Price |
$56.70
|
| Rate for Payer: Cigna Commercial |
$173.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1.15
|
| Rate for Payer: Health EOS Commercial |
$168.21
|
| Rate for Payer: HFN Commercial |
$173.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$141.75
|
| Rate for Payer: Multiplan Commercial |
$151.20
|
| Rate for Payer: NAPHCARE Commercial |
$113.40
|
| Rate for Payer: Preferred Network Access Commercial |
$173.88
|
| Rate for Payer: Quartz Beloit One Network |
$92.61
|
| Rate for Payer: Quartz Commercial |
$122.85
|
| Rate for Payer: Quartz Medicare Advantage |
$113.40
|
| Rate for Payer: The Alliance Commercial |
$2,059.96
|
| Rate for Payer: WEA Trust Commercial |
$103.95
|
| Rate for Payer: WPS Commercial |
$2.18
|
|
|
Taxotere 1 mg Charge
|
Facility
IP
|
$189.00
|
|
|
Service Code
|
HCPCS J9171
|
| Hospital Charge Code |
2958947
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$92.61 |
| Max. Negotiated Rate |
$173.88 |
| Rate for Payer: Aetna Commercial |
$170.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$100.17
|
| Rate for Payer: Cash Price |
$56.70
|
| Rate for Payer: Cigna Commercial |
$173.88
|
| Rate for Payer: Health EOS Commercial |
$168.21
|
| Rate for Payer: HFN Commercial |
$173.88
|
| Rate for Payer: Multiplan Commercial |
$151.20
|
| Rate for Payer: NAPHCARE Commercial |
$113.40
|
| Rate for Payer: Preferred Network Access Commercial |
$173.88
|
| Rate for Payer: Quartz Beloit One Network |
$92.61
|
| Rate for Payer: Quartz Commercial |
$113.40
|
| Rate for Payer: WEA Trust Commercial |
$103.95
|
| Rate for Payer: WPS Commercial |
$139.99
|
|
|
Tay-Sachs Disease Mutation Analysis
|
Facility
OP
|
$592.00
|
|
|
Service Code
|
CPT 81255
|
| Hospital Charge Code |
5619632
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$51.45 |
| Max. Negotiated Rate |
$2,368.00 |
| Rate for Payer: Aetna Commercial |
$532.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$509.12
|
| Rate for Payer: Aetna Managed Medicare |
$51.45
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$192.94
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$90.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$85.41
|
| Rate for Payer: Anthem Medicaid |
$53.16
|
| Rate for Payer: Anthem Medicare Advantage |
$51.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$313.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$51.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$51.45
|
| Rate for Payer: Cash Price |
$177.60
|
| Rate for Payer: Cash Price |
$177.60
|
| Rate for Payer: Cigna Commercial |
$544.64
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$51.45
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$53.16
|
| Rate for Payer: Dean Health Medicaid |
$53.16
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$51.45
|
| Rate for Payer: Health EOS Commercial |
$526.88
|
| Rate for Payer: HFN Commercial |
$544.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$191.39
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$51.45
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$53.16
|
| Rate for Payer: Independent Care Health Plan Medicare |
$51.45
|
| Rate for Payer: Managed Health Services Medicaid |
$55.29
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$51.45
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$51.45
|
| Rate for Payer: Multiplan Commercial |
$473.60
|
| Rate for Payer: NAPHCARE Commercial |
$77.18
|
| Rate for Payer: Preferred Network Access Commercial |
$544.64
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$53.16
|
| Rate for Payer: Quartz Beloit One Network |
$290.08
|
| Rate for Payer: Quartz Commercial |
$384.80
|
| Rate for Payer: Quartz Medicare Advantage |
$51.45
|
| Rate for Payer: The Alliance Commercial |
$2,368.00
|
| Rate for Payer: United Healthcare Medicaid |
$53.16
|
| Rate for Payer: United Healthcare Medicare Advantage |
$51.45
|
| Rate for Payer: United Healthcare PPO |
$444.00
|
| Rate for Payer: WEA Trust Commercial |
$325.60
|
| Rate for Payer: Wellcare Medicare |
$51.45
|
| Rate for Payer: WMAP Medicaid |
$53.16
|
| Rate for Payer: WPS Commercial |
$438.49
|
|
|
Tay-Sachs Disease Mutation Analysis
|
Facility
IP
|
$592.00
|
|
|
Service Code
|
CPT 81255
|
| Hospital Charge Code |
5619632
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$290.08 |
| Max. Negotiated Rate |
$544.64 |
| Rate for Payer: Aetna Commercial |
$532.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$313.76
|
| Rate for Payer: Cash Price |
$177.60
|
| Rate for Payer: Cigna Commercial |
$544.64
|
| Rate for Payer: Health EOS Commercial |
$526.88
|
| Rate for Payer: HFN Commercial |
$544.64
|
| Rate for Payer: Multiplan Commercial |
$473.60
|
| Rate for Payer: NAPHCARE Commercial |
$355.20
|
| Rate for Payer: Preferred Network Access Commercial |
$544.64
|
| Rate for Payer: Quartz Beloit One Network |
$290.08
|
| Rate for Payer: Quartz Commercial |
$355.20
|
| Rate for Payer: WEA Trust Commercial |
$325.60
|
| Rate for Payer: WPS Commercial |
$438.49
|
|
|
Tay-Sachs Disease Mutation Analysis
|
Professional
|
$592.00
|
|
|
Service Code
|
CPT 81255
|
| Hospital Charge Code |
5619632
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$51.45 |
| Max. Negotiated Rate |
$562.40 |
| Rate for Payer: Aetna Commercial |
$562.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$509.12
|
| Rate for Payer: Aetna Managed Medicare |
$51.45
|
| Rate for Payer: Anthem Medicare Advantage |
$51.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$51.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$51.45
|
| Rate for Payer: Cash Price |
$177.60
|
| Rate for Payer: Cash Price |
$177.60
|
| Rate for Payer: Cigna Commercial |
$562.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$296.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$51.45
|
| Rate for Payer: Health EOS Commercial |
$538.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$181.62
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$181.62
|
| Rate for Payer: Independent Care Health Plan Medicare |
$51.45
|
| Rate for Payer: Multiplan Commercial |
$473.60
|
| Rate for Payer: Preferred Network Access Commercial |
$562.40
|
| Rate for Payer: Quartz Beloit One Network |
$260.48
|
| Rate for Payer: Quartz Commercial |
$337.44
|
| Rate for Payer: Quartz Medicare Advantage |
$51.45
|
| Rate for Payer: The Alliance Commercial |
$203.23
|
| Rate for Payer: United Healthcare Medicare Advantage |
$51.45
|
| Rate for Payer: WEA Trust Commercial |
$325.60
|
| Rate for Payer: WPS Commercial |
$226.38
|
|
|
TBII (Thyrotropin-Binding Inhibitory Immunoglobulin)
|
Facility
IP
|
$123.00
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
983418
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$60.27 |
| Max. Negotiated Rate |
$113.16 |
| Rate for Payer: Aetna Commercial |
$110.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$65.19
|
| Rate for Payer: Cash Price |
$36.90
|
| Rate for Payer: Cigna Commercial |
$113.16
|
| Rate for Payer: Health EOS Commercial |
$109.47
|
| Rate for Payer: HFN Commercial |
$113.16
|
| Rate for Payer: Multiplan Commercial |
$98.40
|
| Rate for Payer: NAPHCARE Commercial |
$73.80
|
| Rate for Payer: Preferred Network Access Commercial |
$113.16
|
| Rate for Payer: Quartz Beloit One Network |
$60.27
|
| Rate for Payer: Quartz Commercial |
$73.80
|
| Rate for Payer: WEA Trust Commercial |
$67.65
|
| Rate for Payer: WPS Commercial |
$91.11
|
|
|
TBII (Thyrotropin-Binding Inhibitory Immunoglobulin)
|
Professional
|
$123.00
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
983418
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.27 |
| Max. Negotiated Rate |
$116.85 |
| Rate for Payer: Aetna Commercial |
$116.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$105.78
|
| Rate for Payer: Aetna Managed Medicare |
$17.27
|
| Rate for Payer: Anthem Medicare Advantage |
$17.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$17.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$17.27
|
| Rate for Payer: Cash Price |
$36.90
|
| Rate for Payer: Cash Price |
$36.90
|
| Rate for Payer: Cigna Commercial |
$116.85
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$61.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$17.27
|
| Rate for Payer: Health EOS Commercial |
$111.93
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$60.96
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$60.96
|
| Rate for Payer: Independent Care Health Plan Medicare |
$17.27
|
| Rate for Payer: Multiplan Commercial |
$98.40
|
| Rate for Payer: Preferred Network Access Commercial |
$116.85
|
| Rate for Payer: Quartz Beloit One Network |
$54.12
|
| Rate for Payer: Quartz Commercial |
$70.11
|
| Rate for Payer: Quartz Medicare Advantage |
$17.27
|
| Rate for Payer: The Alliance Commercial |
$68.22
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17.27
|
| Rate for Payer: WEA Trust Commercial |
$67.65
|
| Rate for Payer: WPS Commercial |
$75.99
|
|
|
TBII (Thyrotropin-Binding Inhibitory Immunoglobulin)
|
Facility
OP
|
$123.00
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
983418
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.27 |
| Max. Negotiated Rate |
$492.00 |
| Rate for Payer: Aetna Commercial |
$110.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$105.78
|
| Rate for Payer: Aetna Managed Medicare |
$17.27
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$64.76
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$30.22
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$28.67
|
| Rate for Payer: Anthem Medicaid |
$17.85
|
| Rate for Payer: Anthem Medicare Advantage |
$17.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$65.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$17.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$17.27
|
| Rate for Payer: Cash Price |
$36.90
|
| Rate for Payer: Cash Price |
$36.90
|
| Rate for Payer: Cigna Commercial |
$113.16
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$17.27
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$17.85
|
| Rate for Payer: Dean Health Medicaid |
$17.85
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$17.27
|
| Rate for Payer: Health EOS Commercial |
$109.47
|
| Rate for Payer: HFN Commercial |
$113.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$64.24
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$17.27
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$17.85
|
| Rate for Payer: Independent Care Health Plan Medicare |
$17.27
|
| Rate for Payer: Managed Health Services Medicaid |
$18.56
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$17.27
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$17.27
|
| Rate for Payer: Multiplan Commercial |
$98.40
|
| Rate for Payer: NAPHCARE Commercial |
$25.90
|
| Rate for Payer: Preferred Network Access Commercial |
$113.16
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$17.85
|
| Rate for Payer: Quartz Beloit One Network |
$60.27
|
| Rate for Payer: Quartz Commercial |
$79.95
|
| Rate for Payer: Quartz Medicare Advantage |
$17.27
|
| Rate for Payer: The Alliance Commercial |
$492.00
|
| Rate for Payer: United Healthcare Medicaid |
$17.85
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17.27
|
| Rate for Payer: United Healthcare PPO |
$92.25
|
| Rate for Payer: WEA Trust Commercial |
$67.65
|
| Rate for Payer: Wellcare Medicare |
$17.27
|
| Rate for Payer: WMAP Medicaid |
$17.85
|
| Rate for Payer: WPS Commercial |
$91.11
|
|
|
TBIL (FSURE)
|
Facility
OP
|
$78.00
|
|
|
Service Code
|
CPT 82247
|
| Hospital Charge Code |
4538813
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.24 |
| Max. Negotiated Rate |
$312.00 |
| Rate for Payer: Aetna Commercial |
$70.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$67.08
|
| Rate for Payer: Aetna Managed Medicare |
$5.02
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$18.82
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8.78
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$8.33
|
| Rate for Payer: Anthem Medicaid |
$4.24
|
| Rate for Payer: Anthem Medicare Advantage |
$5.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$41.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5.02
|
| Rate for Payer: Cash Price |
$23.40
|
| Rate for Payer: Cash Price |
$23.40
|
| Rate for Payer: Cigna Commercial |
$71.76
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$5.02
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$4.24
|
| Rate for Payer: Dean Health Medicaid |
$4.24
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$5.02
|
| Rate for Payer: Health EOS Commercial |
$69.42
|
| Rate for Payer: HFN Commercial |
$71.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$18.67
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$5.02
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$4.24
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5.02
|
| Rate for Payer: Managed Health Services Medicaid |
$4.41
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$5.02
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$5.02
|
| Rate for Payer: Multiplan Commercial |
$62.40
|
| Rate for Payer: NAPHCARE Commercial |
$7.53
|
| Rate for Payer: Preferred Network Access Commercial |
$71.76
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$4.24
|
| Rate for Payer: Quartz Beloit One Network |
$38.22
|
| Rate for Payer: Quartz Commercial |
$50.70
|
| Rate for Payer: Quartz Medicare Advantage |
$5.02
|
| Rate for Payer: The Alliance Commercial |
$312.00
|
| Rate for Payer: United Healthcare Medicaid |
$4.24
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.02
|
| Rate for Payer: United Healthcare PPO |
$58.50
|
| Rate for Payer: WEA Trust Commercial |
$42.90
|
| Rate for Payer: Wellcare Medicare |
$5.02
|
| Rate for Payer: WMAP Medicaid |
$4.24
|
| Rate for Payer: WPS Commercial |
$57.77
|
|
|
TBIL (FSURE)
|
Professional
|
$78.00
|
|
|
Service Code
|
CPT 82247
|
| Hospital Charge Code |
4538813
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.02 |
| Max. Negotiated Rate |
$74.10 |
| Rate for Payer: Aetna Commercial |
$74.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$67.08
|
| Rate for Payer: Aetna Managed Medicare |
$5.02
|
| Rate for Payer: Anthem Medicare Advantage |
$5.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5.02
|
| Rate for Payer: Cash Price |
$23.40
|
| Rate for Payer: Cash Price |
$23.40
|
| Rate for Payer: Cigna Commercial |
$74.10
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$39.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5.02
|
| Rate for Payer: Health EOS Commercial |
$70.98
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$17.72
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$17.72
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5.02
|
| Rate for Payer: Multiplan Commercial |
$62.40
|
| Rate for Payer: Preferred Network Access Commercial |
$74.10
|
| Rate for Payer: Quartz Beloit One Network |
$34.32
|
| Rate for Payer: Quartz Commercial |
$44.46
|
| Rate for Payer: Quartz Medicare Advantage |
$5.02
|
| Rate for Payer: The Alliance Commercial |
$19.83
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.02
|
| Rate for Payer: WEA Trust Commercial |
$42.90
|
| Rate for Payer: WPS Commercial |
$22.09
|
|
|
TBIL (FSURE)
|
Facility
IP
|
$78.00
|
|
|
Service Code
|
CPT 82247
|
| Hospital Charge Code |
4538813
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$38.22 |
| Max. Negotiated Rate |
$71.76 |
| Rate for Payer: Aetna Commercial |
$70.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$41.34
|
| Rate for Payer: Cash Price |
$23.40
|
| Rate for Payer: Cigna Commercial |
$71.76
|
| Rate for Payer: Health EOS Commercial |
$69.42
|
| Rate for Payer: HFN Commercial |
$71.76
|
| Rate for Payer: Multiplan Commercial |
$62.40
|
| Rate for Payer: NAPHCARE Commercial |
$46.80
|
| Rate for Payer: Preferred Network Access Commercial |
$71.76
|
| Rate for Payer: Quartz Beloit One Network |
$38.22
|
| Rate for Payer: Quartz Commercial |
$46.80
|
| Rate for Payer: WEA Trust Commercial |
$42.90
|
| Rate for Payer: WPS Commercial |
$57.77
|
|
|
TB Intradermal Test 86580
|
Professional
|
$56.00
|
|
|
Service Code
|
CPT 86580
|
| Hospital Charge Code |
3382901
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.44 |
| Max. Negotiated Rate |
$53.20 |
| Rate for Payer: Aetna Commercial |
$53.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$48.16
|
| Rate for Payer: Aetna Managed Medicare |
$9.44
|
| Rate for Payer: Anthem Medicare Advantage |
$9.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$9.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$9.44
|
| Rate for Payer: Cash Price |
$16.80
|
| Rate for Payer: Cash Price |
$16.80
|
| Rate for Payer: Cigna Commercial |
$53.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$28.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$9.44
|
| Rate for Payer: Health EOS Commercial |
$50.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$32.86
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$32.86
|
| Rate for Payer: Independent Care Health Plan Medicare |
$9.44
|
| Rate for Payer: Multiplan Commercial |
$44.80
|
| Rate for Payer: Preferred Network Access Commercial |
$53.20
|
| Rate for Payer: Quartz Beloit One Network |
$24.64
|
| Rate for Payer: Quartz Commercial |
$31.92
|
| Rate for Payer: Quartz Medicare Advantage |
$9.44
|
| Rate for Payer: The Alliance Commercial |
$37.29
|
| Rate for Payer: United Healthcare Medicare Advantage |
$9.44
|
| Rate for Payer: WEA Trust Commercial |
$30.80
|
| Rate for Payer: WPS Commercial |
$41.54
|
|
|
TB Intradermal Test 86580
|
Facility
OP
|
$56.00
|
|
|
Service Code
|
CPT 86580
|
| Hospital Charge Code |
3382901
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$27.44 |
| Max. Negotiated Rate |
$110.36 |
| Rate for Payer: Aetna Commercial |
$50.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$48.16
|
| Rate for Payer: Aetna Managed Medicare |
$29.43
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$110.36
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$51.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$48.85
|
| Rate for Payer: Anthem Medicare Advantage |
$29.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$29.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$29.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$29.43
|
| Rate for Payer: Cash Price |
$16.80
|
| Rate for Payer: Cash Price |
$16.80
|
| Rate for Payer: Cigna Commercial |
$51.52
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$29.43
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$29.43
|
| Rate for Payer: Health EOS Commercial |
$49.84
|
| Rate for Payer: HFN Commercial |
$51.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$109.48
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$29.43
|
| Rate for Payer: Independent Care Health Plan Medicare |
$29.43
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$29.43
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$29.43
|
| Rate for Payer: Multiplan Commercial |
$44.80
|
| Rate for Payer: NAPHCARE Commercial |
$44.14
|
| Rate for Payer: Preferred Network Access Commercial |
$51.52
|
| Rate for Payer: Quartz Beloit One Network |
$27.44
|
| Rate for Payer: Quartz Commercial |
$36.40
|
| Rate for Payer: Quartz Medicare Advantage |
$29.43
|
| Rate for Payer: United Healthcare Medicare Advantage |
$29.43
|
| Rate for Payer: United Healthcare PPO |
$42.00
|
| Rate for Payer: WEA Trust Commercial |
$30.80
|
| Rate for Payer: Wellcare Medicare |
$29.43
|
| Rate for Payer: WPS Commercial |
$41.48
|
|
|
TB Intradermal Test 86580
|
Facility
IP
|
$56.00
|
|
|
Service Code
|
CPT 86580
|
| Hospital Charge Code |
3382901
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$27.44 |
| Max. Negotiated Rate |
$51.52 |
| Rate for Payer: Aetna Commercial |
$50.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$29.68
|
| Rate for Payer: Cash Price |
$16.80
|
| Rate for Payer: Cigna Commercial |
$51.52
|
| Rate for Payer: Health EOS Commercial |
$49.84
|
| Rate for Payer: HFN Commercial |
$51.52
|
| Rate for Payer: Multiplan Commercial |
$44.80
|
| Rate for Payer: NAPHCARE Commercial |
$33.60
|
| Rate for Payer: Preferred Network Access Commercial |
$51.52
|
| Rate for Payer: Quartz Beloit One Network |
$27.44
|
| Rate for Payer: Quartz Commercial |
$33.60
|
| Rate for Payer: WEA Trust Commercial |
$30.80
|
| Rate for Payer: WPS Commercial |
$41.48
|
|
|
TB Intradermal Test Dialysis
|
Facility
OP
|
$51.00
|
|
|
Service Code
|
CPT 86580
|
| Hospital Charge Code |
3605546
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$24.99 |
| Max. Negotiated Rate |
$110.36 |
| Rate for Payer: Aetna Commercial |
$45.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$43.86
|
| Rate for Payer: Aetna Managed Medicare |
$29.43
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$110.36
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$51.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$48.85
|
| Rate for Payer: Anthem Medicare Advantage |
$29.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$27.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$29.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$29.43
|
| Rate for Payer: Cash Price |
$15.30
|
| Rate for Payer: Cash Price |
$15.30
|
| Rate for Payer: Cigna Commercial |
$46.92
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$29.43
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$29.43
|
| Rate for Payer: Health EOS Commercial |
$45.39
|
| Rate for Payer: HFN Commercial |
$46.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$109.48
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$29.43
|
| Rate for Payer: Independent Care Health Plan Medicare |
$29.43
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$29.43
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$29.43
|
| Rate for Payer: Multiplan Commercial |
$40.80
|
| Rate for Payer: NAPHCARE Commercial |
$44.14
|
| Rate for Payer: Preferred Network Access Commercial |
$46.92
|
| Rate for Payer: Quartz Beloit One Network |
$24.99
|
| Rate for Payer: Quartz Commercial |
$33.15
|
| Rate for Payer: Quartz Medicare Advantage |
$29.43
|
| Rate for Payer: United Healthcare Medicare Advantage |
$29.43
|
| Rate for Payer: United Healthcare PPO |
$38.25
|
| Rate for Payer: WEA Trust Commercial |
$28.05
|
| Rate for Payer: Wellcare Medicare |
$29.43
|
| Rate for Payer: WPS Commercial |
$37.78
|
|
|
TB Intradermal Test Dialysis
|
Facility
IP
|
$51.00
|
|
|
Service Code
|
CPT 86580
|
| Hospital Charge Code |
3605546
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$24.99 |
| Max. Negotiated Rate |
$46.92 |
| Rate for Payer: Aetna Commercial |
$45.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$27.03
|
| Rate for Payer: Cash Price |
$15.30
|
| Rate for Payer: Cigna Commercial |
$46.92
|
| Rate for Payer: Health EOS Commercial |
$45.39
|
| Rate for Payer: HFN Commercial |
$46.92
|
| Rate for Payer: Multiplan Commercial |
$40.80
|
| Rate for Payer: NAPHCARE Commercial |
$30.60
|
| Rate for Payer: Preferred Network Access Commercial |
$46.92
|
| Rate for Payer: Quartz Beloit One Network |
$24.99
|
| Rate for Payer: Quartz Commercial |
$30.60
|
| Rate for Payer: WEA Trust Commercial |
$28.05
|
| Rate for Payer: WPS Commercial |
$37.78
|
|
|
TB Intradermal Test PD
|
Facility
IP
|
$51.00
|
|
|
Service Code
|
CPT 86580
|
| Hospital Charge Code |
3605547
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$24.99 |
| Max. Negotiated Rate |
$46.92 |
| Rate for Payer: Aetna Commercial |
$45.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$27.03
|
| Rate for Payer: Cash Price |
$15.30
|
| Rate for Payer: Cigna Commercial |
$46.92
|
| Rate for Payer: Health EOS Commercial |
$45.39
|
| Rate for Payer: HFN Commercial |
$46.92
|
| Rate for Payer: Multiplan Commercial |
$40.80
|
| Rate for Payer: NAPHCARE Commercial |
$30.60
|
| Rate for Payer: Preferred Network Access Commercial |
$46.92
|
| Rate for Payer: Quartz Beloit One Network |
$24.99
|
| Rate for Payer: Quartz Commercial |
$30.60
|
| Rate for Payer: WEA Trust Commercial |
$28.05
|
| Rate for Payer: WPS Commercial |
$37.78
|
|
