|
TACKER RELIATACK 5MM ARTICULATING RELOADABLE FIXATION DEVICE RELTACK4XDPTSW
|
Facility
|
IP
|
$6,267.00
|
|
| Hospital Charge Code |
4640732
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3,193.66 |
| Max. Negotiated Rate |
$5,996.27 |
| Rate for Payer: Aetna Commercial |
$5,865.91
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,605.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,454.37
|
| Rate for Payer: Cash Price |
$1,880.10
|
| Rate for Payer: Cigna Commercial |
$5,996.27
|
| Rate for Payer: Health EOS Commercial |
$5,800.74
|
| Rate for Payer: HFN Commercial |
$5,996.27
|
| Rate for Payer: Multiplan Commercial |
$5,214.14
|
| Rate for Payer: Preferred Network Access Commercial |
$5,996.27
|
| Rate for Payer: Quartz Beloit One Network |
$3,193.66
|
| Rate for Payer: Quartz Commercial |
$3,910.61
|
| Rate for Payer: WEA Trust Commercial |
$3,584.72
|
| Rate for Payer: WPS Commercial |
$4,827.47
|
|
|
TACKER RELIATACK 5MM ARTICULATING RELOADABLE FIXATION DEVICE RELTACK4XDPTSW
|
Facility
|
OP
|
$6,267.00
|
|
| Hospital Charge Code |
4640732
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,824.95 |
| Max. Negotiated Rate |
$5,996.27 |
| Rate for Payer: Aetna Commercial |
$5,865.91
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,605.20
|
| Rate for Payer: Aetna Managed Medicare |
$1,824.95
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,236.49
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,258.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,128.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,454.37
|
| Rate for Payer: Cash Price |
$1,880.10
|
| Rate for Payer: Cigna Commercial |
$5,996.27
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,647.39
|
| Rate for Payer: Health EOS Commercial |
$5,800.74
|
| Rate for Payer: HFN Commercial |
$5,996.27
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,888.26
|
| Rate for Payer: Multiplan Commercial |
$5,214.14
|
| Rate for Payer: NAPHCARE Commercial |
$3,910.61
|
| Rate for Payer: Preferred Network Access Commercial |
$5,996.27
|
| Rate for Payer: Quartz Beloit One Network |
$3,193.66
|
| Rate for Payer: Quartz Commercial |
$4,236.49
|
| Rate for Payer: Quartz Medicare Advantage |
$3,910.61
|
| Rate for Payer: The Alliance Commercial |
$3,258.84
|
| Rate for Payer: WEA Trust Commercial |
$3,584.72
|
| Rate for Payer: WPS Commercial |
$4,827.47
|
|
|
TACKER SYSTEM SORBAFIX 30 ABSORBABLE FIXATION 36CM FASTENER 0113116
|
Facility
|
IP
|
$5,590.00
|
|
| Hospital Charge Code |
4594890
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,848.66 |
| Max. Negotiated Rate |
$5,348.51 |
| Rate for Payer: Aetna Commercial |
$5,232.24
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,999.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,081.21
|
| Rate for Payer: Cash Price |
$1,677.00
|
| Rate for Payer: Cigna Commercial |
$5,348.51
|
| Rate for Payer: Health EOS Commercial |
$5,174.10
|
| Rate for Payer: HFN Commercial |
$5,348.51
|
| Rate for Payer: Multiplan Commercial |
$4,650.88
|
| Rate for Payer: Preferred Network Access Commercial |
$5,348.51
|
| Rate for Payer: Quartz Beloit One Network |
$2,848.66
|
| Rate for Payer: Quartz Commercial |
$3,488.16
|
| Rate for Payer: WEA Trust Commercial |
$3,197.48
|
| Rate for Payer: WPS Commercial |
$4,305.98
|
|
|
TACKER SYSTEM SORBAFIX 30 ABSORBABLE FIXATION 36CM FASTENER 0113116
|
Facility
|
OP
|
$5,590.00
|
|
| Hospital Charge Code |
4594890
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,627.81 |
| Max. Negotiated Rate |
$5,348.51 |
| Rate for Payer: Aetna Commercial |
$5,232.24
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,999.70
|
| Rate for Payer: Aetna Managed Medicare |
$1,627.81
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,778.84
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,906.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,790.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,081.21
|
| Rate for Payer: Cash Price |
$1,677.00
|
| Rate for Payer: Cigna Commercial |
$5,348.51
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,253.38
|
| Rate for Payer: Health EOS Commercial |
$5,174.10
|
| Rate for Payer: HFN Commercial |
$5,348.51
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,360.20
|
| Rate for Payer: Multiplan Commercial |
$4,650.88
|
| Rate for Payer: NAPHCARE Commercial |
$3,488.16
|
| Rate for Payer: Preferred Network Access Commercial |
$5,348.51
|
| Rate for Payer: Quartz Beloit One Network |
$2,848.66
|
| Rate for Payer: Quartz Commercial |
$3,778.84
|
| Rate for Payer: Quartz Medicare Advantage |
$3,488.16
|
| Rate for Payer: The Alliance Commercial |
$2,906.80
|
| Rate for Payer: WEA Trust Commercial |
$3,197.48
|
| Rate for Payer: WPS Commercial |
$4,305.98
|
|
|
TACK SMALL PLATE 80-0248
|
Facility
|
OP
|
$1,244.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5611756
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$362.25 |
| Max. Negotiated Rate |
$1,190.26 |
| Rate for Payer: Aetna Commercial |
$1,164.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,112.63
|
| Rate for Payer: Aetna Managed Medicare |
$362.25
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$840.94
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$646.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$621.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$685.69
|
| Rate for Payer: Cash Price |
$373.20
|
| Rate for Payer: Cigna Commercial |
$1,190.26
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$724.01
|
| Rate for Payer: Health EOS Commercial |
$1,151.45
|
| Rate for Payer: HFN Commercial |
$1,190.26
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$970.32
|
| Rate for Payer: Multiplan Commercial |
$1,035.01
|
| Rate for Payer: NAPHCARE Commercial |
$776.26
|
| Rate for Payer: Preferred Network Access Commercial |
$1,190.26
|
| Rate for Payer: Quartz Beloit One Network |
$633.94
|
| Rate for Payer: Quartz Commercial |
$840.94
|
| Rate for Payer: Quartz Medicare Advantage |
$776.26
|
| Rate for Payer: The Alliance Commercial |
$646.88
|
| Rate for Payer: WEA Trust Commercial |
$711.57
|
| Rate for Payer: WPS Commercial |
$958.25
|
|
|
TACK SMALL PLATE 80-0248
|
Facility
|
IP
|
$1,244.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5611756
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$633.94 |
| Max. Negotiated Rate |
$1,190.26 |
| Rate for Payer: Aetna Commercial |
$1,164.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,112.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$685.69
|
| Rate for Payer: Cash Price |
$373.20
|
| Rate for Payer: Cigna Commercial |
$1,190.26
|
| Rate for Payer: Health EOS Commercial |
$1,151.45
|
| Rate for Payer: HFN Commercial |
$1,190.26
|
| Rate for Payer: Multiplan Commercial |
$1,035.01
|
| Rate for Payer: Preferred Network Access Commercial |
$1,190.26
|
| Rate for Payer: Quartz Beloit One Network |
$633.94
|
| Rate for Payer: Quartz Commercial |
$776.26
|
| Rate for Payer: WEA Trust Commercial |
$711.57
|
| Rate for Payer: WPS Commercial |
$958.25
|
|
|
Tacrolimus Level
|
Facility
|
OP
|
$453.00
|
|
|
Service Code
|
CPT 80197
|
| Hospital Charge Code |
978075
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.28 |
| Max. Negotiated Rate |
$433.43 |
| Rate for Payer: Aetna Commercial |
$424.01
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$405.16
|
| Rate for Payer: Aetna Managed Medicare |
$14.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$53.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$24.99
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$23.70
|
| Rate for Payer: Anthem Medicare Advantage |
$14.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$249.69
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$14.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$14.28
|
| Rate for Payer: Cash Price |
$135.90
|
| Rate for Payer: Cash Price |
$135.90
|
| Rate for Payer: Cigna Commercial |
$433.43
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$14.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$263.65
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$14.28
|
| Rate for Payer: Health EOS Commercial |
$419.30
|
| Rate for Payer: HFN Commercial |
$433.43
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$53.12
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$14.28
|
| Rate for Payer: Independent Care Health Plan Medicare |
$14.28
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$14.28
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$14.28
|
| Rate for Payer: Multiplan Commercial |
$376.90
|
| Rate for Payer: NAPHCARE Commercial |
$21.42
|
| Rate for Payer: Preferred Network Access Commercial |
$433.43
|
| Rate for Payer: Quartz Beloit One Network |
$230.85
|
| Rate for Payer: Quartz Commercial |
$306.23
|
| Rate for Payer: Quartz Medicare Advantage |
$14.28
|
| Rate for Payer: The Alliance Commercial |
$57.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14.28
|
| Rate for Payer: United Healthcare PPO |
$353.34
|
| Rate for Payer: WEA Trust Commercial |
$259.12
|
| Rate for Payer: Wellcare Medicare |
$14.28
|
| Rate for Payer: WPS Commercial |
$348.95
|
|
|
Tacrolimus Level
|
Facility
|
IP
|
$453.00
|
|
|
Service Code
|
CPT 80197
|
| Hospital Charge Code |
978075
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$230.85 |
| Max. Negotiated Rate |
$433.43 |
| Rate for Payer: Aetna Commercial |
$424.01
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$405.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$249.69
|
| Rate for Payer: Cash Price |
$135.90
|
| Rate for Payer: Cigna Commercial |
$433.43
|
| Rate for Payer: Health EOS Commercial |
$419.30
|
| Rate for Payer: HFN Commercial |
$433.43
|
| Rate for Payer: Multiplan Commercial |
$376.90
|
| Rate for Payer: Preferred Network Access Commercial |
$433.43
|
| Rate for Payer: Quartz Beloit One Network |
$230.85
|
| Rate for Payer: Quartz Commercial |
$282.67
|
| Rate for Payer: WEA Trust Commercial |
$259.12
|
| Rate for Payer: WPS Commercial |
$348.95
|
|
|
Tacrolimus Level
|
Professional
|
Both
|
$453.00
|
|
|
Service Code
|
CPT 80197
|
| Hospital Charge Code |
978075
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.28 |
| Max. Negotiated Rate |
$447.56 |
| Rate for Payer: Aetna Commercial |
$447.56
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$405.16
|
| Rate for Payer: Aetna Managed Medicare |
$14.28
|
| Rate for Payer: Anthem Medicare Advantage |
$14.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$14.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$14.28
|
| Rate for Payer: Cash Price |
$135.90
|
| Rate for Payer: Cash Price |
$135.90
|
| Rate for Payer: Cigna Commercial |
$447.56
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$235.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$14.28
|
| Rate for Payer: Health EOS Commercial |
$428.72
|
| Rate for Payer: HFN Commercial |
$447.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$50.41
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$50.41
|
| Rate for Payer: Independent Care Health Plan Medicare |
$14.28
|
| Rate for Payer: Multiplan Commercial |
$376.90
|
| Rate for Payer: NAPHCARE Commercial |
$21.42
|
| Rate for Payer: Preferred Network Access Commercial |
$447.56
|
| Rate for Payer: Quartz Beloit One Network |
$207.29
|
| Rate for Payer: Quartz Commercial |
$268.54
|
| Rate for Payer: Quartz Medicare Advantage |
$14.28
|
| Rate for Payer: The Alliance Commercial |
$56.40
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14.28
|
| Rate for Payer: WEA Trust Commercial |
$259.12
|
| Rate for Payer: WPS Commercial |
$62.83
|
|
|
Tacrolimus to Mayo
|
Facility
|
IP
|
$110.00
|
|
|
Service Code
|
CPT 80197
|
| Hospital Charge Code |
5038606
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$56.06 |
| Max. Negotiated Rate |
$105.25 |
| Rate for Payer: Aetna Commercial |
$102.96
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$98.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$60.63
|
| Rate for Payer: Cash Price |
$33.00
|
| Rate for Payer: Cigna Commercial |
$105.25
|
| Rate for Payer: Health EOS Commercial |
$101.82
|
| Rate for Payer: HFN Commercial |
$105.25
|
| Rate for Payer: Multiplan Commercial |
$91.52
|
| Rate for Payer: Preferred Network Access Commercial |
$105.25
|
| Rate for Payer: Quartz Beloit One Network |
$56.06
|
| Rate for Payer: Quartz Commercial |
$68.64
|
| Rate for Payer: WEA Trust Commercial |
$62.92
|
| Rate for Payer: WPS Commercial |
$84.73
|
|
|
Tacrolimus to Mayo
|
Facility
|
OP
|
$110.00
|
|
|
Service Code
|
CPT 80197
|
| Hospital Charge Code |
5038606
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.28 |
| Max. Negotiated Rate |
$105.25 |
| Rate for Payer: Aetna Commercial |
$102.96
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$98.38
|
| Rate for Payer: Aetna Managed Medicare |
$14.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$53.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$24.99
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$23.70
|
| Rate for Payer: Anthem Medicare Advantage |
$14.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$60.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$14.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$14.28
|
| Rate for Payer: Cash Price |
$33.00
|
| Rate for Payer: Cash Price |
$33.00
|
| Rate for Payer: Cigna Commercial |
$105.25
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$14.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$64.02
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$14.28
|
| Rate for Payer: Health EOS Commercial |
$101.82
|
| Rate for Payer: HFN Commercial |
$105.25
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$53.12
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$14.28
|
| Rate for Payer: Independent Care Health Plan Medicare |
$14.28
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$14.28
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$14.28
|
| Rate for Payer: Multiplan Commercial |
$91.52
|
| Rate for Payer: NAPHCARE Commercial |
$21.42
|
| Rate for Payer: Preferred Network Access Commercial |
$105.25
|
| Rate for Payer: Quartz Beloit One Network |
$56.06
|
| Rate for Payer: Quartz Commercial |
$74.36
|
| Rate for Payer: Quartz Medicare Advantage |
$14.28
|
| Rate for Payer: The Alliance Commercial |
$57.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14.28
|
| Rate for Payer: United Healthcare PPO |
$85.80
|
| Rate for Payer: WEA Trust Commercial |
$62.92
|
| Rate for Payer: Wellcare Medicare |
$14.28
|
| Rate for Payer: WPS Commercial |
$84.73
|
|
|
Tacrolimus to Mayo
|
Professional
|
Both
|
$110.00
|
|
|
Service Code
|
CPT 80197
|
| Hospital Charge Code |
5038606
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.28 |
| Max. Negotiated Rate |
$108.68 |
| Rate for Payer: Aetna Commercial |
$108.68
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$98.38
|
| Rate for Payer: Aetna Managed Medicare |
$14.28
|
| Rate for Payer: Anthem Medicare Advantage |
$14.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$14.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$14.28
|
| Rate for Payer: Cash Price |
$33.00
|
| Rate for Payer: Cash Price |
$33.00
|
| Rate for Payer: Cigna Commercial |
$108.68
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$57.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$14.28
|
| Rate for Payer: Health EOS Commercial |
$104.10
|
| Rate for Payer: HFN Commercial |
$108.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$50.41
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$50.41
|
| Rate for Payer: Independent Care Health Plan Medicare |
$14.28
|
| Rate for Payer: Multiplan Commercial |
$91.52
|
| Rate for Payer: NAPHCARE Commercial |
$21.42
|
| Rate for Payer: Preferred Network Access Commercial |
$108.68
|
| Rate for Payer: Quartz Beloit One Network |
$50.34
|
| Rate for Payer: Quartz Commercial |
$65.21
|
| Rate for Payer: Quartz Medicare Advantage |
$14.28
|
| Rate for Payer: The Alliance Commercial |
$56.40
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14.28
|
| Rate for Payer: WEA Trust Commercial |
$62.92
|
| Rate for Payer: WPS Commercial |
$62.83
|
|
|
TALAR DOME FLAT CUT INFINITY ADAPTIS SZ 1 33680031
|
Facility
|
IP
|
$41,883.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
6175038
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$21,343.58 |
| Max. Negotiated Rate |
$40,073.65 |
| Rate for Payer: Aetna Commercial |
$39,202.49
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$37,460.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$23,085.91
|
| Rate for Payer: Cash Price |
$12,564.90
|
| Rate for Payer: Cigna Commercial |
$40,073.65
|
| Rate for Payer: Health EOS Commercial |
$38,766.90
|
| Rate for Payer: HFN Commercial |
$40,073.65
|
| Rate for Payer: Multiplan Commercial |
$34,846.66
|
| Rate for Payer: Preferred Network Access Commercial |
$40,073.65
|
| Rate for Payer: Quartz Beloit One Network |
$21,343.58
|
| Rate for Payer: Quartz Commercial |
$26,134.99
|
| Rate for Payer: WEA Trust Commercial |
$23,957.08
|
| Rate for Payer: WPS Commercial |
$32,262.47
|
|
|
TALAR DOME FLAT CUT INFINITY ADAPTIS SZ 1 33680031
|
Facility
|
OP
|
$41,883.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
6175038
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$12,196.33 |
| Max. Negotiated Rate |
$40,073.65 |
| Rate for Payer: Aetna Commercial |
$39,202.49
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$37,460.16
|
| Rate for Payer: Aetna Managed Medicare |
$12,196.33
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$28,312.91
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$21,779.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$20,907.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$23,085.91
|
| Rate for Payer: Cash Price |
$12,564.90
|
| Rate for Payer: Cigna Commercial |
$40,073.65
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$24,375.91
|
| Rate for Payer: Health EOS Commercial |
$38,766.90
|
| Rate for Payer: HFN Commercial |
$40,073.65
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$32,668.74
|
| Rate for Payer: Multiplan Commercial |
$34,846.66
|
| Rate for Payer: NAPHCARE Commercial |
$26,134.99
|
| Rate for Payer: Preferred Network Access Commercial |
$40,073.65
|
| Rate for Payer: Quartz Beloit One Network |
$21,343.58
|
| Rate for Payer: Quartz Commercial |
$28,312.91
|
| Rate for Payer: Quartz Medicare Advantage |
$26,134.99
|
| Rate for Payer: The Alliance Commercial |
$21,779.16
|
| Rate for Payer: WEA Trust Commercial |
$23,957.08
|
| Rate for Payer: WPS Commercial |
$32,262.47
|
|
|
TALAR DOME FLAT CUT INFINITY ADAPTIS SZ 2 33680032
|
Facility
|
IP
|
$42,292.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5831725
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$21,552.00 |
| Max. Negotiated Rate |
$40,464.99 |
| Rate for Payer: Aetna Commercial |
$39,585.31
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$37,825.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$23,311.35
|
| Rate for Payer: Cash Price |
$12,687.60
|
| Rate for Payer: Cigna Commercial |
$40,464.99
|
| Rate for Payer: Health EOS Commercial |
$39,145.48
|
| Rate for Payer: HFN Commercial |
$40,464.99
|
| Rate for Payer: Multiplan Commercial |
$35,186.94
|
| Rate for Payer: Preferred Network Access Commercial |
$40,464.99
|
| Rate for Payer: Quartz Beloit One Network |
$21,552.00
|
| Rate for Payer: Quartz Commercial |
$26,390.21
|
| Rate for Payer: WEA Trust Commercial |
$24,191.02
|
| Rate for Payer: WPS Commercial |
$32,577.53
|
|
|
TALAR DOME FLAT CUT INFINITY ADAPTIS SZ 2 33680032
|
Facility
|
OP
|
$42,292.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5831725
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$12,315.43 |
| Max. Negotiated Rate |
$40,464.99 |
| Rate for Payer: Aetna Commercial |
$39,585.31
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$37,825.96
|
| Rate for Payer: Aetna Managed Medicare |
$12,315.43
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$28,589.39
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$21,991.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$21,112.17
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$23,311.35
|
| Rate for Payer: Cash Price |
$12,687.60
|
| Rate for Payer: Cigna Commercial |
$40,464.99
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$24,613.94
|
| Rate for Payer: Health EOS Commercial |
$39,145.48
|
| Rate for Payer: HFN Commercial |
$40,464.99
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$32,987.76
|
| Rate for Payer: Multiplan Commercial |
$35,186.94
|
| Rate for Payer: NAPHCARE Commercial |
$26,390.21
|
| Rate for Payer: Preferred Network Access Commercial |
$40,464.99
|
| Rate for Payer: Quartz Beloit One Network |
$21,552.00
|
| Rate for Payer: Quartz Commercial |
$28,589.39
|
| Rate for Payer: Quartz Medicare Advantage |
$26,390.21
|
| Rate for Payer: The Alliance Commercial |
$21,991.84
|
| Rate for Payer: WEA Trust Commercial |
$24,191.02
|
| Rate for Payer: WPS Commercial |
$32,577.53
|
|
|
TALC POWDER STERILE (MED)
|
Facility
|
IP
|
$564.00
|
|
| Hospital Charge Code |
4519278
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$287.41 |
| Max. Negotiated Rate |
$539.64 |
| Rate for Payer: Aetna Commercial |
$527.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$504.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$310.88
|
| Rate for Payer: Cash Price |
$169.20
|
| Rate for Payer: Cigna Commercial |
$539.64
|
| Rate for Payer: Health EOS Commercial |
$522.04
|
| Rate for Payer: HFN Commercial |
$539.64
|
| Rate for Payer: Multiplan Commercial |
$469.25
|
| Rate for Payer: Preferred Network Access Commercial |
$539.64
|
| Rate for Payer: Quartz Beloit One Network |
$287.41
|
| Rate for Payer: Quartz Commercial |
$351.94
|
| Rate for Payer: WEA Trust Commercial |
$322.61
|
| Rate for Payer: WPS Commercial |
$434.45
|
|
|
TALC POWDER STERILE (MED)
|
Facility
|
OP
|
$564.00
|
|
| Hospital Charge Code |
4519278
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$164.24 |
| Max. Negotiated Rate |
$539.64 |
| Rate for Payer: Aetna Commercial |
$527.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$504.44
|
| Rate for Payer: Aetna Managed Medicare |
$164.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$381.26
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$293.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$281.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$310.88
|
| Rate for Payer: Cash Price |
$169.20
|
| Rate for Payer: Cigna Commercial |
$539.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$328.25
|
| Rate for Payer: Health EOS Commercial |
$522.04
|
| Rate for Payer: HFN Commercial |
$539.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$439.92
|
| Rate for Payer: Multiplan Commercial |
$469.25
|
| Rate for Payer: NAPHCARE Commercial |
$351.94
|
| Rate for Payer: Preferred Network Access Commercial |
$539.64
|
| Rate for Payer: Quartz Beloit One Network |
$287.41
|
| Rate for Payer: Quartz Commercial |
$381.26
|
| Rate for Payer: Quartz Medicare Advantage |
$351.94
|
| Rate for Payer: The Alliance Commercial |
$293.28
|
| Rate for Payer: WEA Trust Commercial |
$322.61
|
| Rate for Payer: WPS Commercial |
$434.45
|
|
|
TALON 3 PRONG 2.4/120 M0063701110
|
Facility
|
IP
|
$2,544.00
|
|
| Hospital Charge Code |
4520076
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,296.42 |
| Max. Negotiated Rate |
$2,434.10 |
| Rate for Payer: Aetna Commercial |
$2,381.18
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,275.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,402.25
|
| Rate for Payer: Cash Price |
$763.20
|
| Rate for Payer: Cigna Commercial |
$2,434.10
|
| Rate for Payer: Health EOS Commercial |
$2,354.73
|
| Rate for Payer: HFN Commercial |
$2,434.10
|
| Rate for Payer: Multiplan Commercial |
$2,116.61
|
| Rate for Payer: Preferred Network Access Commercial |
$2,434.10
|
| Rate for Payer: Quartz Beloit One Network |
$1,296.42
|
| Rate for Payer: Quartz Commercial |
$1,587.46
|
| Rate for Payer: WEA Trust Commercial |
$1,455.17
|
| Rate for Payer: WPS Commercial |
$1,959.64
|
|
|
TALON 3 PRONG 2.4/120 M0063701110
|
Facility
|
OP
|
$2,544.00
|
|
| Hospital Charge Code |
4520076
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$740.81 |
| Max. Negotiated Rate |
$2,434.10 |
| Rate for Payer: Aetna Commercial |
$2,381.18
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,275.35
|
| Rate for Payer: Aetna Managed Medicare |
$740.81
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,719.74
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,322.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,269.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,402.25
|
| Rate for Payer: Cash Price |
$763.20
|
| Rate for Payer: Cigna Commercial |
$2,434.10
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,480.61
|
| Rate for Payer: Health EOS Commercial |
$2,354.73
|
| Rate for Payer: HFN Commercial |
$2,434.10
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,984.32
|
| Rate for Payer: Multiplan Commercial |
$2,116.61
|
| Rate for Payer: NAPHCARE Commercial |
$1,587.46
|
| Rate for Payer: Preferred Network Access Commercial |
$2,434.10
|
| Rate for Payer: Quartz Beloit One Network |
$1,296.42
|
| Rate for Payer: Quartz Commercial |
$1,719.74
|
| Rate for Payer: Quartz Medicare Advantage |
$1,587.46
|
| Rate for Payer: The Alliance Commercial |
$1,322.88
|
| Rate for Payer: WEA Trust Commercial |
$1,455.17
|
| Rate for Payer: WPS Commercial |
$1,959.64
|
|
|
T and B Cells, Total
|
Professional
|
Both
|
$83.00
|
|
|
Service Code
|
CPT 86355
|
| Hospital Charge Code |
4524606
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$37.98 |
| Max. Negotiated Rate |
$172.65 |
| Rate for Payer: Aetna Commercial |
$82.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$74.24
|
| Rate for Payer: Aetna Managed Medicare |
$39.24
|
| Rate for Payer: Anthem Medicare Advantage |
$39.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$39.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$39.24
|
| Rate for Payer: Cash Price |
$24.90
|
| Rate for Payer: Cash Price |
$24.90
|
| Rate for Payer: Cigna Commercial |
$82.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$43.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$39.24
|
| Rate for Payer: Health EOS Commercial |
$78.55
|
| Rate for Payer: HFN Commercial |
$82.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$138.52
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$138.52
|
| Rate for Payer: Independent Care Health Plan Medicare |
$39.24
|
| Rate for Payer: Multiplan Commercial |
$69.06
|
| Rate for Payer: NAPHCARE Commercial |
$58.86
|
| Rate for Payer: Preferred Network Access Commercial |
$82.00
|
| Rate for Payer: Quartz Beloit One Network |
$37.98
|
| Rate for Payer: Quartz Commercial |
$49.20
|
| Rate for Payer: Quartz Medicare Advantage |
$39.24
|
| Rate for Payer: The Alliance Commercial |
$154.99
|
| Rate for Payer: United Healthcare Medicare Advantage |
$39.24
|
| Rate for Payer: WEA Trust Commercial |
$47.48
|
| Rate for Payer: WPS Commercial |
$172.65
|
|
|
T and B Cells, Total
|
Facility
|
IP
|
$83.00
|
|
|
Service Code
|
CPT 86355
|
| Hospital Charge Code |
4524606
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$42.30 |
| Max. Negotiated Rate |
$79.41 |
| Rate for Payer: Aetna Commercial |
$77.69
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$74.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$45.75
|
| Rate for Payer: Cash Price |
$24.90
|
| Rate for Payer: Cigna Commercial |
$79.41
|
| Rate for Payer: Health EOS Commercial |
$76.82
|
| Rate for Payer: HFN Commercial |
$79.41
|
| Rate for Payer: Multiplan Commercial |
$69.06
|
| Rate for Payer: Preferred Network Access Commercial |
$79.41
|
| Rate for Payer: Quartz Beloit One Network |
$42.30
|
| Rate for Payer: Quartz Commercial |
$51.79
|
| Rate for Payer: WEA Trust Commercial |
$47.48
|
| Rate for Payer: WPS Commercial |
$63.93
|
|
|
T and B Cells, Total
|
Facility
|
OP
|
$83.00
|
|
|
Service Code
|
CPT 86355
|
| Hospital Charge Code |
4524606
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$39.24 |
| Max. Negotiated Rate |
$156.96 |
| Rate for Payer: Aetna Commercial |
$77.69
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$74.24
|
| Rate for Payer: Aetna Managed Medicare |
$39.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$147.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$68.67
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$65.14
|
| Rate for Payer: Anthem Medicare Advantage |
$39.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$45.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$39.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$39.24
|
| Rate for Payer: Cash Price |
$24.90
|
| Rate for Payer: Cash Price |
$24.90
|
| Rate for Payer: Cigna Commercial |
$79.41
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$39.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$48.31
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$39.24
|
| Rate for Payer: Health EOS Commercial |
$76.82
|
| Rate for Payer: HFN Commercial |
$79.41
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$145.97
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$39.24
|
| Rate for Payer: Independent Care Health Plan Medicare |
$39.24
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$39.24
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$39.24
|
| Rate for Payer: Multiplan Commercial |
$69.06
|
| Rate for Payer: NAPHCARE Commercial |
$58.86
|
| Rate for Payer: Preferred Network Access Commercial |
$79.41
|
| Rate for Payer: Quartz Beloit One Network |
$42.30
|
| Rate for Payer: Quartz Commercial |
$56.11
|
| Rate for Payer: Quartz Medicare Advantage |
$39.24
|
| Rate for Payer: The Alliance Commercial |
$156.96
|
| Rate for Payer: United Healthcare Medicare Advantage |
$39.24
|
| Rate for Payer: United Healthcare PPO |
$64.74
|
| Rate for Payer: WEA Trust Commercial |
$47.48
|
| Rate for Payer: Wellcare Medicare |
$39.24
|
| Rate for Payer: WPS Commercial |
$63.93
|
|
|
Tangential Biopsy Skin Ea Sep/Add Lesion 11103
|
Professional
|
Both
|
$124.00
|
|
|
Service Code
|
CPT 11103
|
| Hospital Charge Code |
5454806
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$17.27 |
| Max. Negotiated Rate |
$122.51 |
| Rate for Payer: Aetna Commercial |
$122.51
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$110.91
|
| 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 |
$37.20
|
| Rate for Payer: Cash Price |
$37.20
|
| Rate for Payer: Cash Price |
$37.20
|
| Rate for Payer: Cigna Commercial |
$122.51
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$42.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$17.27
|
| Rate for Payer: Health EOS Commercial |
$117.35
|
| Rate for Payer: HFN Commercial |
$122.51
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$76.73
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$76.73
|
| Rate for Payer: Independent Care Health Plan Medicare |
$17.27
|
| Rate for Payer: Multiplan Commercial |
$103.17
|
| Rate for Payer: NAPHCARE Commercial |
$25.91
|
| Rate for Payer: Preferred Network Access Commercial |
$122.51
|
| Rate for Payer: Quartz Beloit One Network |
$56.74
|
| Rate for Payer: Quartz Commercial |
$73.51
|
| Rate for Payer: Quartz Medicare Advantage |
$17.27
|
| Rate for Payer: The Alliance Commercial |
$73.42
|
| Rate for Payer: United Healthcare Medicaid |
$42.92
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17.27
|
| Rate for Payer: WEA Trust Commercial |
$70.93
|
| Rate for Payer: WPS Commercial |
$77.73
|
|
|
Tangential Biopsy Skin Single Lesion 11102
|
Professional
|
Both
|
$400.00
|
|
|
Service Code
|
CPT 11102
|
| Hospital Charge Code |
5454807
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$29.53 |
| Max. Negotiated Rate |
$395.20 |
| Rate for Payer: Aetna Commercial |
$395.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$357.76
|
| Rate for Payer: Aetna Managed Medicare |
$29.53
|
| Rate for Payer: Anthem Medicare Advantage |
$29.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$29.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$29.53
|
| Rate for Payer: Cash Price |
$120.00
|
| Rate for Payer: Cash Price |
$120.00
|
| Rate for Payer: Cash Price |
$120.00
|
| Rate for Payer: Cigna Commercial |
$395.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$79.57
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$29.53
|
| Rate for Payer: Health EOS Commercial |
$378.56
|
| Rate for Payer: HFN Commercial |
$395.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$132.31
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$132.31
|
| Rate for Payer: Independent Care Health Plan Medicare |
$29.53
|
| Rate for Payer: Multiplan Commercial |
$332.80
|
| Rate for Payer: NAPHCARE Commercial |
$44.29
|
| Rate for Payer: Preferred Network Access Commercial |
$395.20
|
| Rate for Payer: Quartz Beloit One Network |
$183.04
|
| Rate for Payer: Quartz Commercial |
$237.12
|
| Rate for Payer: Quartz Medicare Advantage |
$29.53
|
| Rate for Payer: The Alliance Commercial |
$125.48
|
| Rate for Payer: United Healthcare Medicaid |
$79.57
|
| Rate for Payer: United Healthcare Medicare Advantage |
$29.53
|
| Rate for Payer: WEA Trust Commercial |
$228.80
|
| Rate for Payer: WPS Commercial |
$132.87
|
|
