|
Toxoplasma Antibody IgM
|
Professional
|
Both
|
$119.00
|
|
|
Service Code
|
CPT 86778
|
| Hospital Charge Code |
2943021
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$50.87 |
| Max. Negotiated Rate |
$113.05 |
| Rate for Payer: Aetna Commercial |
$113.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$102.34
|
| Rate for Payer: Cash Price |
$35.70
|
| Rate for Payer: Cash Price |
$35.70
|
| Rate for Payer: Cigna Commercial |
$113.05
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$59.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$71.40
|
| Rate for Payer: Health EOS Commercial |
$108.29
|
| Rate for Payer: HFN Commercial |
$113.05
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$50.87
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$50.87
|
| Rate for Payer: Multiplan Commercial |
$95.20
|
| Rate for Payer: Preferred Network Access Commercial |
$113.05
|
| Rate for Payer: Quartz Beloit One Network |
$52.36
|
| Rate for Payer: Quartz Commercial |
$67.83
|
| Rate for Payer: The Alliance Commercial |
$59.50
|
| Rate for Payer: WEA Trust Commercial |
$65.45
|
| Rate for Payer: WPS Commercial |
$88.14
|
|
|
Toxoplasma Antibody IgM
|
Facility
|
IP
|
$119.00
|
|
|
Service Code
|
CPT 86778
|
| Hospital Charge Code |
2943021
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$58.31 |
| Max. Negotiated Rate |
$109.48 |
| Rate for Payer: Aetna Commercial |
$107.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$102.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$63.07
|
| Rate for Payer: Cash Price |
$35.70
|
| Rate for Payer: Cigna Commercial |
$109.48
|
| Rate for Payer: Health EOS Commercial |
$105.91
|
| Rate for Payer: HFN Commercial |
$109.48
|
| Rate for Payer: Multiplan Commercial |
$95.20
|
| Rate for Payer: NAPHCARE Commercial |
$71.40
|
| Rate for Payer: Preferred Network Access Commercial |
$109.48
|
| Rate for Payer: Quartz Beloit One Network |
$58.31
|
| Rate for Payer: Quartz Commercial |
$71.40
|
| Rate for Payer: WEA Trust Commercial |
$65.45
|
| Rate for Payer: WPS Commercial |
$88.14
|
|
|
Toxoplasma Antibody IgM
|
Facility
|
OP
|
$119.00
|
|
|
Service Code
|
CPT 86778
|
| Hospital Charge Code |
2943021
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.41 |
| Max. Negotiated Rate |
$109.48 |
| Rate for Payer: Aetna Commercial |
$107.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$102.34
|
| Rate for Payer: Aetna Managed Medicare |
$14.41
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$54.04
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$25.22
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$23.92
|
| Rate for Payer: Anthem Medicaid |
$14.89
|
| Rate for Payer: Anthem Medicare Advantage |
$14.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$63.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$14.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$14.41
|
| Rate for Payer: Cash Price |
$35.70
|
| Rate for Payer: Cash Price |
$35.70
|
| Rate for Payer: Cigna Commercial |
$109.48
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$14.41
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$14.89
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$66.59
|
| Rate for Payer: Dean Health Medicaid |
$14.89
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$14.41
|
| Rate for Payer: Health EOS Commercial |
$105.91
|
| Rate for Payer: HFN Commercial |
$109.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$53.61
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$14.41
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$14.89
|
| Rate for Payer: Independent Care Health Plan Medicare |
$14.41
|
| Rate for Payer: Managed Health Services Medicaid |
$15.49
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$14.41
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$14.41
|
| Rate for Payer: Multiplan Commercial |
$95.20
|
| Rate for Payer: NAPHCARE Commercial |
$21.62
|
| Rate for Payer: Preferred Network Access Commercial |
$109.48
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$14.89
|
| Rate for Payer: Quartz Beloit One Network |
$58.31
|
| Rate for Payer: Quartz Commercial |
$77.35
|
| Rate for Payer: Quartz Medicare Advantage |
$14.41
|
| Rate for Payer: The Alliance Commercial |
$57.64
|
| Rate for Payer: United Healthcare Medicaid |
$14.89
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14.41
|
| Rate for Payer: United Healthcare PPO |
$89.25
|
| Rate for Payer: WEA Trust Commercial |
$65.45
|
| Rate for Payer: Wellcare Medicare |
$14.41
|
| Rate for Payer: WMAP Medicaid |
$14.89
|
| Rate for Payer: WPS Commercial |
$88.14
|
|
|
Toxoplasma gondii DNA, Qual, PCR
|
Facility
|
OP
|
$1,028.00
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
983428
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$35.09 |
| Max. Negotiated Rate |
$945.76 |
| Rate for Payer: Cigna Commercial |
$945.76
|
| Rate for Payer: Aetna Commercial |
$925.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$884.08
|
| Rate for Payer: Aetna Managed Medicare |
$35.09
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$131.59
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$61.41
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$58.25
|
| Rate for Payer: Anthem Medicaid |
$36.26
|
| Rate for Payer: Anthem Medicare Advantage |
$35.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$544.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$35.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$35.09
|
| Rate for Payer: Cash Price |
$308.40
|
| Rate for Payer: Cash Price |
$308.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$35.09
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$36.26
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$575.27
|
| Rate for Payer: Dean Health Medicaid |
$36.26
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$35.09
|
| Rate for Payer: Health EOS Commercial |
$914.92
|
| Rate for Payer: HFN Commercial |
$945.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$130.53
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$35.09
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$36.26
|
| Rate for Payer: Independent Care Health Plan Medicare |
$35.09
|
| Rate for Payer: Managed Health Services Medicaid |
$37.71
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$35.09
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$35.09
|
| Rate for Payer: Multiplan Commercial |
$822.40
|
| Rate for Payer: NAPHCARE Commercial |
$52.64
|
| Rate for Payer: Preferred Network Access Commercial |
$945.76
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$36.26
|
| Rate for Payer: Quartz Beloit One Network |
$503.72
|
| Rate for Payer: Quartz Commercial |
$668.20
|
| Rate for Payer: Quartz Medicare Advantage |
$35.09
|
| Rate for Payer: The Alliance Commercial |
$140.36
|
| Rate for Payer: United Healthcare Medicaid |
$36.26
|
| Rate for Payer: United Healthcare Medicare Advantage |
$35.09
|
| Rate for Payer: United Healthcare PPO |
$771.00
|
| Rate for Payer: WEA Trust Commercial |
$565.40
|
| Rate for Payer: Wellcare Medicare |
$35.09
|
| Rate for Payer: WMAP Medicaid |
$36.26
|
| Rate for Payer: WPS Commercial |
$761.44
|
|
|
Toxoplasma gondii DNA, Qual, PCR
|
Professional
|
Both
|
$1,028.00
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
983428
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$123.87 |
| Max. Negotiated Rate |
$976.60 |
| Rate for Payer: Aetna Commercial |
$976.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$884.08
|
| Rate for Payer: Cash Price |
$308.40
|
| Rate for Payer: Cash Price |
$308.40
|
| Rate for Payer: Cigna Commercial |
$976.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$514.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$616.80
|
| Rate for Payer: Health EOS Commercial |
$935.48
|
| Rate for Payer: HFN Commercial |
$976.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$123.87
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$123.87
|
| Rate for Payer: Multiplan Commercial |
$822.40
|
| Rate for Payer: Preferred Network Access Commercial |
$976.60
|
| Rate for Payer: Quartz Beloit One Network |
$452.32
|
| Rate for Payer: Quartz Commercial |
$585.96
|
| Rate for Payer: The Alliance Commercial |
$514.00
|
| Rate for Payer: WEA Trust Commercial |
$565.40
|
| Rate for Payer: WPS Commercial |
$761.44
|
|
|
Toxoplasma gondii DNA, Qual, PCR
|
Facility
|
IP
|
$1,028.00
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
983428
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$503.72 |
| Max. Negotiated Rate |
$945.76 |
| Rate for Payer: Aetna Commercial |
$925.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$884.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$544.84
|
| Rate for Payer: Cash Price |
$308.40
|
| Rate for Payer: Cigna Commercial |
$945.76
|
| Rate for Payer: Health EOS Commercial |
$914.92
|
| Rate for Payer: HFN Commercial |
$945.76
|
| Rate for Payer: Multiplan Commercial |
$822.40
|
| Rate for Payer: NAPHCARE Commercial |
$616.80
|
| Rate for Payer: Preferred Network Access Commercial |
$945.76
|
| Rate for Payer: Quartz Beloit One Network |
$503.72
|
| Rate for Payer: Quartz Commercial |
$616.80
|
| Rate for Payer: WEA Trust Commercial |
$565.40
|
| Rate for Payer: WPS Commercial |
$761.44
|
|
|
Tox Scr Serum
|
Professional
|
Both
|
$594.00
|
|
|
Service Code
|
CPT 80329
|
| Hospital Charge Code |
979884
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$80.06 |
| Max. Negotiated Rate |
$564.30 |
| Rate for Payer: Aetna Commercial |
$564.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$510.84
|
| Rate for Payer: Cash Price |
$178.20
|
| Rate for Payer: Cash Price |
$178.20
|
| Rate for Payer: Cigna Commercial |
$564.30
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$297.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$356.40
|
| Rate for Payer: Health EOS Commercial |
$540.54
|
| Rate for Payer: HFN Commercial |
$564.30
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$80.06
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$80.06
|
| Rate for Payer: Multiplan Commercial |
$475.20
|
| Rate for Payer: Preferred Network Access Commercial |
$564.30
|
| Rate for Payer: Quartz Beloit One Network |
$261.36
|
| Rate for Payer: Quartz Commercial |
$338.58
|
| Rate for Payer: The Alliance Commercial |
$297.00
|
| Rate for Payer: WEA Trust Commercial |
$326.70
|
| Rate for Payer: WPS Commercial |
$439.98
|
|
|
Tox Scr Serum
|
Facility
|
IP
|
$594.00
|
|
|
Service Code
|
CPT 80329
|
| Hospital Charge Code |
979884
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$291.06 |
| Max. Negotiated Rate |
$546.48 |
| Rate for Payer: Aetna Commercial |
$534.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$510.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$314.82
|
| Rate for Payer: Cash Price |
$178.20
|
| Rate for Payer: Cigna Commercial |
$546.48
|
| Rate for Payer: Health EOS Commercial |
$528.66
|
| Rate for Payer: HFN Commercial |
$546.48
|
| Rate for Payer: Multiplan Commercial |
$475.20
|
| Rate for Payer: NAPHCARE Commercial |
$356.40
|
| Rate for Payer: Preferred Network Access Commercial |
$546.48
|
| Rate for Payer: Quartz Beloit One Network |
$291.06
|
| Rate for Payer: Quartz Commercial |
$356.40
|
| Rate for Payer: WEA Trust Commercial |
$326.70
|
| Rate for Payer: WPS Commercial |
$439.98
|
|
|
Tox Scr Serum
|
Facility
|
OP
|
$594.00
|
|
|
Service Code
|
CPT 80329
|
| Hospital Charge Code |
979884
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$166.32 |
| Max. Negotiated Rate |
$2,376.00 |
| Rate for Payer: WEA Trust Commercial |
$326.70
|
| Rate for Payer: WPS Commercial |
$439.98
|
| Rate for Payer: Aetna Commercial |
$534.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$510.84
|
| Rate for Payer: Aetna Managed Medicare |
$166.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$386.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$297.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$285.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$314.82
|
| Rate for Payer: Cash Price |
$178.20
|
| Rate for Payer: Cigna Commercial |
$546.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$332.40
|
| Rate for Payer: Health EOS Commercial |
$528.66
|
| Rate for Payer: HFN Commercial |
$546.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$445.50
|
| Rate for Payer: Multiplan Commercial |
$475.20
|
| Rate for Payer: NAPHCARE Commercial |
$356.40
|
| Rate for Payer: Preferred Network Access Commercial |
$546.48
|
| Rate for Payer: Quartz Beloit One Network |
$291.06
|
| Rate for Payer: Quartz Commercial |
$386.10
|
| Rate for Payer: Quartz Medicare Advantage |
$356.40
|
| Rate for Payer: The Alliance Commercial |
$2,376.00
|
| Rate for Payer: United Healthcare PPO |
$445.50
|
|
|
T-PLATE 1.3MM 3H HEAD/8H SHAFT 221.333
|
Facility
|
OP
|
$3,201.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4508594
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$896.28 |
| Max. Negotiated Rate |
$12,804.00 |
| Rate for Payer: Aetna Commercial |
$2,880.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,752.86
|
| Rate for Payer: Aetna Managed Medicare |
$896.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,080.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,600.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,536.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,696.53
|
| Rate for Payer: Cash Price |
$960.30
|
| Rate for Payer: Cigna Commercial |
$2,944.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,791.28
|
| Rate for Payer: Health EOS Commercial |
$2,848.89
|
| Rate for Payer: HFN Commercial |
$2,944.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,400.75
|
| Rate for Payer: Multiplan Commercial |
$2,560.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,920.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,944.92
|
| Rate for Payer: Quartz Beloit One Network |
$1,568.49
|
| Rate for Payer: Quartz Commercial |
$2,080.65
|
| Rate for Payer: Quartz Medicare Advantage |
$1,920.60
|
| Rate for Payer: The Alliance Commercial |
$12,804.00
|
| Rate for Payer: WEA Trust Commercial |
$1,760.55
|
| Rate for Payer: WPS Commercial |
$2,370.98
|
|
|
T-PLATE 1.3MM 3H HEAD/8H SHAFT 221.333
|
Facility
|
IP
|
$3,201.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4508594
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,568.49 |
| Max. Negotiated Rate |
$2,944.92 |
| Rate for Payer: Aetna Commercial |
$2,880.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,752.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,696.53
|
| Rate for Payer: Cash Price |
$960.30
|
| Rate for Payer: Cigna Commercial |
$2,944.92
|
| Rate for Payer: Health EOS Commercial |
$2,848.89
|
| Rate for Payer: HFN Commercial |
$2,944.92
|
| Rate for Payer: Multiplan Commercial |
$2,560.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,920.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,944.92
|
| Rate for Payer: Quartz Beloit One Network |
$1,568.49
|
| Rate for Payer: Quartz Commercial |
$1,920.60
|
| Rate for Payer: WEA Trust Commercial |
$1,760.55
|
| Rate for Payer: WPS Commercial |
$2,370.98
|
|
|
T-PLATE 1.3MM 4H HEAD/8H SHAFT 221.334
|
Facility
|
OP
|
$3,334.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4508597
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$933.52 |
| Max. Negotiated Rate |
$13,336.00 |
| Rate for Payer: Aetna Commercial |
$3,000.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,867.24
|
| Rate for Payer: Aetna Managed Medicare |
$933.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,167.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,667.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,600.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,767.02
|
| Rate for Payer: Cash Price |
$1,000.20
|
| Rate for Payer: Cigna Commercial |
$3,067.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,865.71
|
| Rate for Payer: Health EOS Commercial |
$2,967.26
|
| Rate for Payer: HFN Commercial |
$3,067.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,500.50
|
| Rate for Payer: Multiplan Commercial |
$2,667.20
|
| Rate for Payer: NAPHCARE Commercial |
$2,000.40
|
| Rate for Payer: Preferred Network Access Commercial |
$3,067.28
|
| Rate for Payer: Quartz Beloit One Network |
$1,633.66
|
| Rate for Payer: Quartz Commercial |
$2,167.10
|
| Rate for Payer: Quartz Medicare Advantage |
$2,000.40
|
| Rate for Payer: The Alliance Commercial |
$13,336.00
|
| Rate for Payer: WEA Trust Commercial |
$1,833.70
|
| Rate for Payer: WPS Commercial |
$2,469.49
|
|
|
T-PLATE 1.3MM 4H HEAD/8H SHAFT 221.334
|
Facility
|
IP
|
$3,334.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4508597
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,633.66 |
| Max. Negotiated Rate |
$3,067.28 |
| Rate for Payer: Aetna Commercial |
$3,000.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,867.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,767.02
|
| Rate for Payer: Cash Price |
$1,000.20
|
| Rate for Payer: Cigna Commercial |
$3,067.28
|
| Rate for Payer: Health EOS Commercial |
$2,967.26
|
| Rate for Payer: HFN Commercial |
$3,067.28
|
| Rate for Payer: Multiplan Commercial |
$2,667.20
|
| Rate for Payer: NAPHCARE Commercial |
$2,000.40
|
| Rate for Payer: Preferred Network Access Commercial |
$3,067.28
|
| Rate for Payer: Quartz Beloit One Network |
$1,633.66
|
| Rate for Payer: Quartz Commercial |
$2,000.40
|
| Rate for Payer: WEA Trust Commercial |
$1,833.70
|
| Rate for Payer: WPS Commercial |
$2,469.49
|
|
|
T-PLATE 2.0 2HEAD 7HL 247.351
|
Facility
|
OP
|
$3,944.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5767801
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,104.32 |
| Max. Negotiated Rate |
$15,776.00 |
| Rate for Payer: Aetna Commercial |
$3,549.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,391.84
|
| Rate for Payer: Aetna Managed Medicare |
$1,104.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,563.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,972.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,893.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,090.32
|
| Rate for Payer: Cash Price |
$1,183.20
|
| Rate for Payer: Cigna Commercial |
$3,628.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,207.06
|
| Rate for Payer: Health EOS Commercial |
$3,510.16
|
| Rate for Payer: HFN Commercial |
$3,628.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,958.00
|
| Rate for Payer: Multiplan Commercial |
$3,155.20
|
| Rate for Payer: NAPHCARE Commercial |
$2,366.40
|
| Rate for Payer: Preferred Network Access Commercial |
$3,628.48
|
| Rate for Payer: Quartz Beloit One Network |
$1,932.56
|
| Rate for Payer: Quartz Commercial |
$2,563.60
|
| Rate for Payer: Quartz Medicare Advantage |
$2,366.40
|
| Rate for Payer: The Alliance Commercial |
$15,776.00
|
| Rate for Payer: WEA Trust Commercial |
$2,169.20
|
| Rate for Payer: WPS Commercial |
$2,921.32
|
|
|
T-PLATE 2.0 2HEAD 7HL 247.351
|
Facility
|
IP
|
$3,944.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5767801
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,932.56 |
| Max. Negotiated Rate |
$3,628.48 |
| Rate for Payer: Aetna Commercial |
$3,549.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,391.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,090.32
|
| Rate for Payer: Cash Price |
$1,183.20
|
| Rate for Payer: Cigna Commercial |
$3,628.48
|
| Rate for Payer: Health EOS Commercial |
$3,510.16
|
| Rate for Payer: HFN Commercial |
$3,628.48
|
| Rate for Payer: Multiplan Commercial |
$3,155.20
|
| Rate for Payer: NAPHCARE Commercial |
$2,366.40
|
| Rate for Payer: Preferred Network Access Commercial |
$3,628.48
|
| Rate for Payer: Quartz Beloit One Network |
$1,932.56
|
| Rate for Payer: Quartz Commercial |
$2,366.40
|
| Rate for Payer: WEA Trust Commercial |
$2,169.20
|
| Rate for Payer: WPS Commercial |
$2,921.32
|
|
|
T-PLATE 2.4MM 2HL HEAD/8LH SHAFT 249.913
|
Facility
|
IP
|
$4,354.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4508773
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,133.46 |
| Max. Negotiated Rate |
$4,005.68 |
| Rate for Payer: Aetna Commercial |
$3,918.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,744.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,307.62
|
| Rate for Payer: Cash Price |
$1,306.20
|
| Rate for Payer: Cigna Commercial |
$4,005.68
|
| Rate for Payer: Health EOS Commercial |
$3,875.06
|
| Rate for Payer: HFN Commercial |
$4,005.68
|
| Rate for Payer: Multiplan Commercial |
$3,483.20
|
| Rate for Payer: NAPHCARE Commercial |
$2,612.40
|
| Rate for Payer: Preferred Network Access Commercial |
$4,005.68
|
| Rate for Payer: Quartz Beloit One Network |
$2,133.46
|
| Rate for Payer: Quartz Commercial |
$2,612.40
|
| Rate for Payer: WEA Trust Commercial |
$2,394.70
|
| Rate for Payer: WPS Commercial |
$3,225.01
|
|
|
T-PLATE 2.4MM 2HL HEAD/8LH SHAFT 249.913
|
Facility
|
OP
|
$4,354.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4508773
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,219.12 |
| Max. Negotiated Rate |
$17,416.00 |
| Rate for Payer: Aetna Commercial |
$3,918.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,744.44
|
| Rate for Payer: Aetna Managed Medicare |
$1,219.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,830.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,177.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,089.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,307.62
|
| Rate for Payer: Cash Price |
$1,306.20
|
| Rate for Payer: Cigna Commercial |
$4,005.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,436.50
|
| Rate for Payer: Health EOS Commercial |
$3,875.06
|
| Rate for Payer: HFN Commercial |
$4,005.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,265.50
|
| Rate for Payer: Multiplan Commercial |
$3,483.20
|
| Rate for Payer: NAPHCARE Commercial |
$2,612.40
|
| Rate for Payer: Preferred Network Access Commercial |
$4,005.68
|
| Rate for Payer: Quartz Beloit One Network |
$2,133.46
|
| Rate for Payer: Quartz Commercial |
$2,830.10
|
| Rate for Payer: Quartz Medicare Advantage |
$2,612.40
|
| Rate for Payer: The Alliance Commercial |
$17,416.00
|
| Rate for Payer: WEA Trust Commercial |
$2,394.70
|
| Rate for Payer: WPS Commercial |
$3,225.01
|
|
|
T-PLATE 2.4MM 3HL HEAD/8HL SHAFT 249.914
|
Facility
|
IP
|
$4,633.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4508774
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,270.17 |
| Max. Negotiated Rate |
$4,262.36 |
| Rate for Payer: Aetna Commercial |
$4,169.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,984.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,455.49
|
| Rate for Payer: Cash Price |
$1,389.90
|
| Rate for Payer: Cigna Commercial |
$4,262.36
|
| Rate for Payer: Health EOS Commercial |
$4,123.37
|
| Rate for Payer: HFN Commercial |
$4,262.36
|
| Rate for Payer: Multiplan Commercial |
$3,706.40
|
| Rate for Payer: NAPHCARE Commercial |
$2,779.80
|
| Rate for Payer: Preferred Network Access Commercial |
$4,262.36
|
| Rate for Payer: Quartz Beloit One Network |
$2,270.17
|
| Rate for Payer: Quartz Commercial |
$2,779.80
|
| Rate for Payer: WEA Trust Commercial |
$2,548.15
|
| Rate for Payer: WPS Commercial |
$3,431.66
|
|
|
T-PLATE 2.4MM 3HL HEAD/8HL SHAFT 249.914
|
Facility
|
OP
|
$4,633.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4508774
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,297.24 |
| Max. Negotiated Rate |
$18,532.00 |
| Rate for Payer: Aetna Commercial |
$4,169.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,984.38
|
| Rate for Payer: Aetna Managed Medicare |
$1,297.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,011.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,316.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,223.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,455.49
|
| Rate for Payer: Cash Price |
$1,389.90
|
| Rate for Payer: Cigna Commercial |
$4,262.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,592.63
|
| Rate for Payer: Health EOS Commercial |
$4,123.37
|
| Rate for Payer: HFN Commercial |
$4,262.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,474.75
|
| Rate for Payer: Multiplan Commercial |
$3,706.40
|
| Rate for Payer: NAPHCARE Commercial |
$2,779.80
|
| Rate for Payer: Preferred Network Access Commercial |
$4,262.36
|
| Rate for Payer: Quartz Beloit One Network |
$2,270.17
|
| Rate for Payer: Quartz Commercial |
$3,011.45
|
| Rate for Payer: Quartz Medicare Advantage |
$2,779.80
|
| Rate for Payer: The Alliance Commercial |
$18,532.00
|
| Rate for Payer: WEA Trust Commercial |
$2,548.15
|
| Rate for Payer: WPS Commercial |
$3,431.66
|
|
|
T-PLATE 2.7 3HL SMALL 242.41
|
Facility
|
OP
|
$828.00
|
|
| Hospital Charge Code |
2967327
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$231.84 |
| Max. Negotiated Rate |
$3,312.00 |
| Rate for Payer: Aetna Commercial |
$745.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$712.08
|
| Rate for Payer: Aetna Managed Medicare |
$231.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$538.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$414.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$397.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$438.84
|
| Rate for Payer: Cash Price |
$248.40
|
| Rate for Payer: Cigna Commercial |
$761.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$463.35
|
| Rate for Payer: Health EOS Commercial |
$736.92
|
| Rate for Payer: HFN Commercial |
$761.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$621.00
|
| Rate for Payer: Multiplan Commercial |
$662.40
|
| Rate for Payer: NAPHCARE Commercial |
$496.80
|
| Rate for Payer: Preferred Network Access Commercial |
$761.76
|
| Rate for Payer: Quartz Beloit One Network |
$405.72
|
| Rate for Payer: Quartz Commercial |
$538.20
|
| Rate for Payer: Quartz Medicare Advantage |
$496.80
|
| Rate for Payer: The Alliance Commercial |
$3,312.00
|
| Rate for Payer: WEA Trust Commercial |
$455.40
|
| Rate for Payer: WPS Commercial |
$613.30
|
|
|
T-PLATE 2.7 3HL SMALL 242.41
|
Facility
|
IP
|
$828.00
|
|
| Hospital Charge Code |
2967327
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$405.72 |
| Max. Negotiated Rate |
$761.76 |
| Rate for Payer: Aetna Commercial |
$745.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$712.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$438.84
|
| Rate for Payer: Cash Price |
$248.40
|
| Rate for Payer: Cigna Commercial |
$761.76
|
| Rate for Payer: Health EOS Commercial |
$736.92
|
| Rate for Payer: HFN Commercial |
$761.76
|
| Rate for Payer: Multiplan Commercial |
$662.40
|
| Rate for Payer: NAPHCARE Commercial |
$496.80
|
| Rate for Payer: Preferred Network Access Commercial |
$761.76
|
| Rate for Payer: Quartz Beloit One Network |
$405.72
|
| Rate for Payer: Quartz Commercial |
$496.80
|
| Rate for Payer: WEA Trust Commercial |
$455.40
|
| Rate for Payer: WPS Commercial |
$613.30
|
|
|
T-PLATE 2.7 LCP 2HL HEAD/3HL SHAFT 249.685
|
Facility
|
OP
|
$4,923.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5767804
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,378.44 |
| Max. Negotiated Rate |
$19,692.00 |
| Rate for Payer: Aetna Commercial |
$4,430.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,233.78
|
| Rate for Payer: Aetna Managed Medicare |
$1,378.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,199.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,461.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,363.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,609.19
|
| Rate for Payer: Cash Price |
$1,476.90
|
| Rate for Payer: Cigna Commercial |
$4,529.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,754.91
|
| Rate for Payer: Health EOS Commercial |
$4,381.47
|
| Rate for Payer: HFN Commercial |
$4,529.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,692.25
|
| Rate for Payer: Multiplan Commercial |
$3,938.40
|
| Rate for Payer: NAPHCARE Commercial |
$2,953.80
|
| Rate for Payer: Preferred Network Access Commercial |
$4,529.16
|
| Rate for Payer: Quartz Beloit One Network |
$2,412.27
|
| Rate for Payer: Quartz Commercial |
$3,199.95
|
| Rate for Payer: Quartz Medicare Advantage |
$2,953.80
|
| Rate for Payer: The Alliance Commercial |
$19,692.00
|
| Rate for Payer: WEA Trust Commercial |
$2,707.65
|
| Rate for Payer: WPS Commercial |
$3,646.47
|
|
|
T-PLATE 2.7 LCP 2HL HEAD/3HL SHAFT 249.685
|
Facility
|
IP
|
$4,923.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5767804
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,412.27 |
| Max. Negotiated Rate |
$4,529.16 |
| Rate for Payer: Aetna Commercial |
$4,430.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,233.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,609.19
|
| Rate for Payer: Cash Price |
$1,476.90
|
| Rate for Payer: Cigna Commercial |
$4,529.16
|
| Rate for Payer: Health EOS Commercial |
$4,381.47
|
| Rate for Payer: HFN Commercial |
$4,529.16
|
| Rate for Payer: Multiplan Commercial |
$3,938.40
|
| Rate for Payer: NAPHCARE Commercial |
$2,953.80
|
| Rate for Payer: Preferred Network Access Commercial |
$4,529.16
|
| Rate for Payer: Quartz Beloit One Network |
$2,412.27
|
| Rate for Payer: Quartz Commercial |
$2,953.80
|
| Rate for Payer: WEA Trust Commercial |
$2,707.65
|
| Rate for Payer: WPS Commercial |
$3,646.47
|
|
|
T-PLATE 2.7 LCP 2HL HEAD/4HL SHAFT 249.697
|
Facility
|
OP
|
$4,923.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5767805
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,378.44 |
| Max. Negotiated Rate |
$19,692.00 |
| Rate for Payer: Aetna Commercial |
$4,430.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,233.78
|
| Rate for Payer: Aetna Managed Medicare |
$1,378.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,199.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,461.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,363.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,609.19
|
| Rate for Payer: Cash Price |
$1,476.90
|
| Rate for Payer: Cigna Commercial |
$4,529.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,754.91
|
| Rate for Payer: Health EOS Commercial |
$4,381.47
|
| Rate for Payer: HFN Commercial |
$4,529.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,692.25
|
| Rate for Payer: Multiplan Commercial |
$3,938.40
|
| Rate for Payer: NAPHCARE Commercial |
$2,953.80
|
| Rate for Payer: Preferred Network Access Commercial |
$4,529.16
|
| Rate for Payer: Quartz Beloit One Network |
$2,412.27
|
| Rate for Payer: Quartz Commercial |
$3,199.95
|
| Rate for Payer: Quartz Medicare Advantage |
$2,953.80
|
| Rate for Payer: The Alliance Commercial |
$19,692.00
|
| Rate for Payer: WEA Trust Commercial |
$2,707.65
|
| Rate for Payer: WPS Commercial |
$3,646.47
|
|
|
T-PLATE 2.7 LCP 2HL HEAD/4HL SHAFT 249.697
|
Facility
|
IP
|
$4,923.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5767805
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,412.27 |
| Max. Negotiated Rate |
$4,529.16 |
| Rate for Payer: Aetna Commercial |
$4,430.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,233.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,609.19
|
| Rate for Payer: Cash Price |
$1,476.90
|
| Rate for Payer: Cigna Commercial |
$4,529.16
|
| Rate for Payer: Health EOS Commercial |
$4,381.47
|
| Rate for Payer: HFN Commercial |
$4,529.16
|
| Rate for Payer: Multiplan Commercial |
$3,938.40
|
| Rate for Payer: NAPHCARE Commercial |
$2,953.80
|
| Rate for Payer: Preferred Network Access Commercial |
$4,529.16
|
| Rate for Payer: Quartz Beloit One Network |
$2,412.27
|
| Rate for Payer: Quartz Commercial |
$2,953.80
|
| Rate for Payer: WEA Trust Commercial |
$2,707.65
|
| Rate for Payer: WPS Commercial |
$3,646.47
|
|
