|
TRIGGER POINT INJECTION, PAIN
|
Facility
IP
|
$291.00
|
|
| Hospital Charge Code |
2960454
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$142.59 |
| Max. Negotiated Rate |
$267.72 |
| Rate for Payer: Aetna Commercial |
$261.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$154.23
|
| Rate for Payer: Cash Price |
$87.30
|
| Rate for Payer: Cigna Commercial |
$267.72
|
| Rate for Payer: Health EOS Commercial |
$258.99
|
| Rate for Payer: HFN Commercial |
$267.72
|
| Rate for Payer: Multiplan Commercial |
$232.80
|
| Rate for Payer: NAPHCARE Commercial |
$174.60
|
| Rate for Payer: Preferred Network Access Commercial |
$267.72
|
| Rate for Payer: Quartz Beloit One Network |
$142.59
|
| Rate for Payer: Quartz Commercial |
$174.60
|
| Rate for Payer: WEA Trust Commercial |
$160.05
|
| Rate for Payer: WPS Commercial |
$215.54
|
|
|
Triglycerides
|
Professional
|
$113.00
|
|
|
Service Code
|
CPT 84478
|
| Hospital Charge Code |
633852
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.74 |
| Max. Negotiated Rate |
$107.35 |
| Rate for Payer: Aetna Commercial |
$107.35
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$97.18
|
| Rate for Payer: Aetna Managed Medicare |
$5.74
|
| Rate for Payer: Anthem Medicare Advantage |
$5.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5.74
|
| Rate for Payer: Cash Price |
$33.90
|
| Rate for Payer: Cash Price |
$33.90
|
| Rate for Payer: Cigna Commercial |
$107.35
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$56.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5.74
|
| Rate for Payer: Health EOS Commercial |
$102.83
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$20.26
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$20.26
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5.74
|
| Rate for Payer: Multiplan Commercial |
$90.40
|
| Rate for Payer: Preferred Network Access Commercial |
$107.35
|
| Rate for Payer: Quartz Beloit One Network |
$49.72
|
| Rate for Payer: Quartz Commercial |
$64.41
|
| Rate for Payer: Quartz Medicare Advantage |
$5.74
|
| Rate for Payer: The Alliance Commercial |
$22.67
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.74
|
| Rate for Payer: WEA Trust Commercial |
$62.15
|
| Rate for Payer: WPS Commercial |
$25.26
|
|
|
Triglycerides
|
Facility
OP
|
$113.00
|
|
|
Service Code
|
CPT 84478
|
| Hospital Charge Code |
633852
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.74 |
| Max. Negotiated Rate |
$452.00 |
| Rate for Payer: Aetna Commercial |
$101.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$97.18
|
| Rate for Payer: Aetna Managed Medicare |
$5.74
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$21.52
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$10.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$9.53
|
| Rate for Payer: Anthem Medicaid |
$5.93
|
| Rate for Payer: Anthem Medicare Advantage |
$5.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$59.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5.74
|
| Rate for Payer: Cash Price |
$33.90
|
| Rate for Payer: Cash Price |
$33.90
|
| Rate for Payer: Cigna Commercial |
$103.96
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$5.74
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$5.93
|
| Rate for Payer: Dean Health Medicaid |
$5.93
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$5.74
|
| Rate for Payer: Health EOS Commercial |
$100.57
|
| Rate for Payer: HFN Commercial |
$103.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$21.35
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$5.74
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$5.93
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5.74
|
| Rate for Payer: Managed Health Services Medicaid |
$6.17
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$5.74
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$5.74
|
| Rate for Payer: Multiplan Commercial |
$90.40
|
| Rate for Payer: NAPHCARE Commercial |
$8.61
|
| Rate for Payer: Preferred Network Access Commercial |
$103.96
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$5.93
|
| Rate for Payer: Quartz Beloit One Network |
$55.37
|
| Rate for Payer: Quartz Commercial |
$73.45
|
| Rate for Payer: Quartz Medicare Advantage |
$5.74
|
| Rate for Payer: The Alliance Commercial |
$452.00
|
| Rate for Payer: United Healthcare Medicaid |
$5.93
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.74
|
| Rate for Payer: United Healthcare PPO |
$84.75
|
| Rate for Payer: WEA Trust Commercial |
$62.15
|
| Rate for Payer: Wellcare Medicare |
$5.74
|
| Rate for Payer: WMAP Medicaid |
$5.93
|
| Rate for Payer: WPS Commercial |
$83.70
|
|
|
Triglycerides
|
Facility
IP
|
$113.00
|
|
|
Service Code
|
CPT 84478
|
| Hospital Charge Code |
633852
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$55.37 |
| Max. Negotiated Rate |
$103.96 |
| Rate for Payer: Aetna Commercial |
$101.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$59.89
|
| Rate for Payer: Cash Price |
$33.90
|
| Rate for Payer: Cigna Commercial |
$103.96
|
| Rate for Payer: Health EOS Commercial |
$100.57
|
| Rate for Payer: HFN Commercial |
$103.96
|
| Rate for Payer: Multiplan Commercial |
$90.40
|
| Rate for Payer: NAPHCARE Commercial |
$67.80
|
| Rate for Payer: Preferred Network Access Commercial |
$103.96
|
| Rate for Payer: Quartz Beloit One Network |
$55.37
|
| Rate for Payer: Quartz Commercial |
$67.80
|
| Rate for Payer: WEA Trust Commercial |
$62.15
|
| Rate for Payer: WPS Commercial |
$83.70
|
|
|
Triglycerides (LPE)
|
Facility
IP
|
$114.00
|
|
|
Service Code
|
CPT 84478
|
| Hospital Charge Code |
2942941
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$55.86 |
| Max. Negotiated Rate |
$104.88 |
| Rate for Payer: Aetna Commercial |
$102.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$60.42
|
| Rate for Payer: Cash Price |
$34.20
|
| Rate for Payer: Cigna Commercial |
$104.88
|
| Rate for Payer: Health EOS Commercial |
$101.46
|
| Rate for Payer: HFN Commercial |
$104.88
|
| Rate for Payer: Multiplan Commercial |
$91.20
|
| Rate for Payer: NAPHCARE Commercial |
$68.40
|
| Rate for Payer: Preferred Network Access Commercial |
$104.88
|
| Rate for Payer: Quartz Beloit One Network |
$55.86
|
| Rate for Payer: Quartz Commercial |
$68.40
|
| Rate for Payer: WEA Trust Commercial |
$62.70
|
| Rate for Payer: WPS Commercial |
$84.44
|
|
|
Triglycerides (LPE)
|
Professional
|
$114.00
|
|
|
Service Code
|
CPT 84478
|
| Hospital Charge Code |
2942941
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.74 |
| Max. Negotiated Rate |
$108.30 |
| Rate for Payer: Aetna Commercial |
$108.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$98.04
|
| Rate for Payer: Aetna Managed Medicare |
$5.74
|
| Rate for Payer: Anthem Medicare Advantage |
$5.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5.74
|
| Rate for Payer: Cash Price |
$34.20
|
| Rate for Payer: Cash Price |
$34.20
|
| Rate for Payer: Cigna Commercial |
$108.30
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$57.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5.74
|
| Rate for Payer: Health EOS Commercial |
$103.74
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$20.26
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$20.26
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5.74
|
| Rate for Payer: Multiplan Commercial |
$91.20
|
| Rate for Payer: Preferred Network Access Commercial |
$108.30
|
| Rate for Payer: Quartz Beloit One Network |
$50.16
|
| Rate for Payer: Quartz Commercial |
$64.98
|
| Rate for Payer: Quartz Medicare Advantage |
$5.74
|
| Rate for Payer: The Alliance Commercial |
$22.67
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.74
|
| Rate for Payer: WEA Trust Commercial |
$62.70
|
| Rate for Payer: WPS Commercial |
$25.26
|
|
|
Triglycerides (LPE)
|
Facility
OP
|
$114.00
|
|
|
Service Code
|
CPT 84478
|
| Hospital Charge Code |
2942941
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.74 |
| Max. Negotiated Rate |
$456.00 |
| Rate for Payer: Aetna Commercial |
$102.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$98.04
|
| Rate for Payer: Aetna Managed Medicare |
$5.74
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$21.52
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$10.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$9.53
|
| Rate for Payer: Anthem Medicaid |
$5.93
|
| Rate for Payer: Anthem Medicare Advantage |
$5.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$60.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5.74
|
| Rate for Payer: Cash Price |
$34.20
|
| Rate for Payer: Cash Price |
$34.20
|
| Rate for Payer: Cigna Commercial |
$104.88
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$5.74
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$5.93
|
| Rate for Payer: Dean Health Medicaid |
$5.93
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$5.74
|
| Rate for Payer: Health EOS Commercial |
$101.46
|
| Rate for Payer: HFN Commercial |
$104.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$21.35
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$5.74
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$5.93
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5.74
|
| Rate for Payer: Managed Health Services Medicaid |
$6.17
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$5.74
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$5.74
|
| Rate for Payer: Multiplan Commercial |
$91.20
|
| Rate for Payer: NAPHCARE Commercial |
$8.61
|
| Rate for Payer: Preferred Network Access Commercial |
$104.88
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$5.93
|
| Rate for Payer: Quartz Beloit One Network |
$55.86
|
| Rate for Payer: Quartz Commercial |
$74.10
|
| Rate for Payer: Quartz Medicare Advantage |
$5.74
|
| Rate for Payer: The Alliance Commercial |
$456.00
|
| Rate for Payer: United Healthcare Medicaid |
$5.93
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.74
|
| Rate for Payer: United Healthcare PPO |
$85.50
|
| Rate for Payer: WEA Trust Commercial |
$62.70
|
| Rate for Payer: Wellcare Medicare |
$5.74
|
| Rate for Payer: WMAP Medicaid |
$5.93
|
| Rate for Payer: WPS Commercial |
$84.44
|
|
|
Triglycerides, Peritoneal Fluid
|
Facility
OP
|
$49.00
|
|
|
Service Code
|
CPT 84478
|
| Hospital Charge Code |
3154857
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.74 |
| Max. Negotiated Rate |
$196.00 |
| Rate for Payer: Aetna Commercial |
$44.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$42.14
|
| Rate for Payer: Aetna Managed Medicare |
$5.74
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$21.52
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$10.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$9.53
|
| Rate for Payer: Anthem Medicaid |
$5.93
|
| Rate for Payer: Anthem Medicare Advantage |
$5.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$25.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5.74
|
| Rate for Payer: Cash Price |
$14.70
|
| Rate for Payer: Cash Price |
$14.70
|
| Rate for Payer: Cigna Commercial |
$45.08
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$5.74
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$5.93
|
| Rate for Payer: Dean Health Medicaid |
$5.93
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$5.74
|
| Rate for Payer: Health EOS Commercial |
$43.61
|
| Rate for Payer: HFN Commercial |
$45.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$21.35
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$5.74
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$5.93
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5.74
|
| Rate for Payer: Managed Health Services Medicaid |
$6.17
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$5.74
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$5.74
|
| Rate for Payer: Multiplan Commercial |
$39.20
|
| Rate for Payer: NAPHCARE Commercial |
$8.61
|
| Rate for Payer: Preferred Network Access Commercial |
$45.08
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$5.93
|
| Rate for Payer: Quartz Beloit One Network |
$24.01
|
| Rate for Payer: Quartz Commercial |
$31.85
|
| Rate for Payer: Quartz Medicare Advantage |
$5.74
|
| Rate for Payer: The Alliance Commercial |
$196.00
|
| Rate for Payer: United Healthcare Medicaid |
$5.93
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.74
|
| Rate for Payer: United Healthcare PPO |
$36.75
|
| Rate for Payer: WEA Trust Commercial |
$26.95
|
| Rate for Payer: Wellcare Medicare |
$5.74
|
| Rate for Payer: WMAP Medicaid |
$5.93
|
| Rate for Payer: WPS Commercial |
$36.29
|
|
|
Triglycerides, Peritoneal Fluid
|
Facility
IP
|
$49.00
|
|
|
Service Code
|
CPT 84478
|
| Hospital Charge Code |
3154857
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$24.01 |
| Max. Negotiated Rate |
$45.08 |
| Rate for Payer: Aetna Commercial |
$44.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$25.97
|
| Rate for Payer: Cash Price |
$14.70
|
| Rate for Payer: Cigna Commercial |
$45.08
|
| Rate for Payer: Health EOS Commercial |
$43.61
|
| Rate for Payer: HFN Commercial |
$45.08
|
| Rate for Payer: Multiplan Commercial |
$39.20
|
| Rate for Payer: NAPHCARE Commercial |
$29.40
|
| Rate for Payer: Preferred Network Access Commercial |
$45.08
|
| Rate for Payer: Quartz Beloit One Network |
$24.01
|
| Rate for Payer: Quartz Commercial |
$29.40
|
| Rate for Payer: WEA Trust Commercial |
$26.95
|
| Rate for Payer: WPS Commercial |
$36.29
|
|
|
Triglycerides, Peritoneal Fluid
|
Professional
|
$49.00
|
|
|
Service Code
|
CPT 84478
|
| Hospital Charge Code |
3154857
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.74 |
| Max. Negotiated Rate |
$46.55 |
| Rate for Payer: Aetna Commercial |
$46.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$42.14
|
| Rate for Payer: Aetna Managed Medicare |
$5.74
|
| Rate for Payer: Anthem Medicare Advantage |
$5.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5.74
|
| Rate for Payer: Cash Price |
$14.70
|
| Rate for Payer: Cash Price |
$14.70
|
| Rate for Payer: Cigna Commercial |
$46.55
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$24.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5.74
|
| Rate for Payer: Health EOS Commercial |
$44.59
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$20.26
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$20.26
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5.74
|
| Rate for Payer: Multiplan Commercial |
$39.20
|
| Rate for Payer: Preferred Network Access Commercial |
$46.55
|
| Rate for Payer: Quartz Beloit One Network |
$21.56
|
| Rate for Payer: Quartz Commercial |
$27.93
|
| Rate for Payer: Quartz Medicare Advantage |
$5.74
|
| Rate for Payer: The Alliance Commercial |
$22.67
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.74
|
| Rate for Payer: WEA Trust Commercial |
$26.95
|
| Rate for Payer: WPS Commercial |
$25.26
|
|
|
Triglycerides, Pleural Fluid
|
Professional
|
$49.00
|
|
|
Service Code
|
CPT 84478
|
| Hospital Charge Code |
3154856
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.74 |
| Max. Negotiated Rate |
$46.55 |
| Rate for Payer: Aetna Commercial |
$46.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$42.14
|
| Rate for Payer: Aetna Managed Medicare |
$5.74
|
| Rate for Payer: Anthem Medicare Advantage |
$5.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5.74
|
| Rate for Payer: Cash Price |
$14.70
|
| Rate for Payer: Cash Price |
$14.70
|
| Rate for Payer: Cigna Commercial |
$46.55
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$24.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5.74
|
| Rate for Payer: Health EOS Commercial |
$44.59
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$20.26
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$20.26
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5.74
|
| Rate for Payer: Multiplan Commercial |
$39.20
|
| Rate for Payer: Preferred Network Access Commercial |
$46.55
|
| Rate for Payer: Quartz Beloit One Network |
$21.56
|
| Rate for Payer: Quartz Commercial |
$27.93
|
| Rate for Payer: Quartz Medicare Advantage |
$5.74
|
| Rate for Payer: The Alliance Commercial |
$22.67
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.74
|
| Rate for Payer: WEA Trust Commercial |
$26.95
|
| Rate for Payer: WPS Commercial |
$25.26
|
|
|
Triglycerides, Pleural Fluid
|
Facility
OP
|
$49.00
|
|
|
Service Code
|
CPT 84478
|
| Hospital Charge Code |
3154856
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.74 |
| Max. Negotiated Rate |
$196.00 |
| Rate for Payer: Aetna Commercial |
$44.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$42.14
|
| Rate for Payer: Aetna Managed Medicare |
$5.74
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$21.52
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$10.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$9.53
|
| Rate for Payer: Anthem Medicaid |
$5.93
|
| Rate for Payer: Anthem Medicare Advantage |
$5.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$25.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5.74
|
| Rate for Payer: Cash Price |
$14.70
|
| Rate for Payer: Cash Price |
$14.70
|
| Rate for Payer: Cigna Commercial |
$45.08
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$5.74
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$5.93
|
| Rate for Payer: Dean Health Medicaid |
$5.93
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$5.74
|
| Rate for Payer: Health EOS Commercial |
$43.61
|
| Rate for Payer: HFN Commercial |
$45.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$21.35
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$5.74
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$5.93
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5.74
|
| Rate for Payer: Managed Health Services Medicaid |
$6.17
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$5.74
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$5.74
|
| Rate for Payer: Multiplan Commercial |
$39.20
|
| Rate for Payer: NAPHCARE Commercial |
$8.61
|
| Rate for Payer: Preferred Network Access Commercial |
$45.08
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$5.93
|
| Rate for Payer: Quartz Beloit One Network |
$24.01
|
| Rate for Payer: Quartz Commercial |
$31.85
|
| Rate for Payer: Quartz Medicare Advantage |
$5.74
|
| Rate for Payer: The Alliance Commercial |
$196.00
|
| Rate for Payer: United Healthcare Medicaid |
$5.93
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.74
|
| Rate for Payer: United Healthcare PPO |
$36.75
|
| Rate for Payer: WEA Trust Commercial |
$26.95
|
| Rate for Payer: Wellcare Medicare |
$5.74
|
| Rate for Payer: WMAP Medicaid |
$5.93
|
| Rate for Payer: WPS Commercial |
$36.29
|
|
|
Triglycerides, Pleural Fluid
|
Facility
IP
|
$49.00
|
|
|
Service Code
|
CPT 84478
|
| Hospital Charge Code |
3154856
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$24.01 |
| Max. Negotiated Rate |
$45.08 |
| Rate for Payer: Aetna Commercial |
$44.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$25.97
|
| Rate for Payer: Cash Price |
$14.70
|
| Rate for Payer: Cigna Commercial |
$45.08
|
| Rate for Payer: Health EOS Commercial |
$43.61
|
| Rate for Payer: HFN Commercial |
$45.08
|
| Rate for Payer: Multiplan Commercial |
$39.20
|
| Rate for Payer: NAPHCARE Commercial |
$29.40
|
| Rate for Payer: Preferred Network Access Commercial |
$45.08
|
| Rate for Payer: Quartz Beloit One Network |
$24.01
|
| Rate for Payer: Quartz Commercial |
$29.40
|
| Rate for Payer: WEA Trust Commercial |
$26.95
|
| Rate for Payer: WPS Commercial |
$36.29
|
|
|
Triiodothyronine
|
Facility
IP
|
$233.00
|
|
|
Service Code
|
CPT 84480
|
| Hospital Charge Code |
633833
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$114.17 |
| Max. Negotiated Rate |
$214.36 |
| Rate for Payer: Aetna Commercial |
$209.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$123.49
|
| Rate for Payer: Cash Price |
$69.90
|
| Rate for Payer: Cigna Commercial |
$214.36
|
| Rate for Payer: Health EOS Commercial |
$207.37
|
| Rate for Payer: HFN Commercial |
$214.36
|
| Rate for Payer: Multiplan Commercial |
$186.40
|
| Rate for Payer: NAPHCARE Commercial |
$139.80
|
| Rate for Payer: Preferred Network Access Commercial |
$214.36
|
| Rate for Payer: Quartz Beloit One Network |
$114.17
|
| Rate for Payer: Quartz Commercial |
$139.80
|
| Rate for Payer: WEA Trust Commercial |
$128.15
|
| Rate for Payer: WPS Commercial |
$172.58
|
|
|
Triiodothyronine
|
Facility
OP
|
$233.00
|
|
|
Service Code
|
CPT 84480
|
| Hospital Charge Code |
633833
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.18 |
| Max. Negotiated Rate |
$932.00 |
| Rate for Payer: Aetna Commercial |
$209.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$200.38
|
| Rate for Payer: Aetna Managed Medicare |
$14.18
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$53.18
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$24.82
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$23.54
|
| Rate for Payer: Anthem Medicaid |
$14.65
|
| Rate for Payer: Anthem Medicare Advantage |
$14.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$123.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$14.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$14.18
|
| Rate for Payer: Cash Price |
$69.90
|
| Rate for Payer: Cash Price |
$69.90
|
| Rate for Payer: Cigna Commercial |
$214.36
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$14.18
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$14.65
|
| Rate for Payer: Dean Health Medicaid |
$14.65
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$14.18
|
| Rate for Payer: Health EOS Commercial |
$207.37
|
| Rate for Payer: HFN Commercial |
$214.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$52.75
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$14.18
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$14.65
|
| Rate for Payer: Independent Care Health Plan Medicare |
$14.18
|
| Rate for Payer: Managed Health Services Medicaid |
$15.24
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$14.18
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$14.18
|
| Rate for Payer: Multiplan Commercial |
$186.40
|
| Rate for Payer: NAPHCARE Commercial |
$21.27
|
| Rate for Payer: Preferred Network Access Commercial |
$214.36
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$14.65
|
| Rate for Payer: Quartz Beloit One Network |
$114.17
|
| Rate for Payer: Quartz Commercial |
$151.45
|
| Rate for Payer: Quartz Medicare Advantage |
$14.18
|
| Rate for Payer: The Alliance Commercial |
$932.00
|
| Rate for Payer: United Healthcare Medicaid |
$14.65
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14.18
|
| Rate for Payer: United Healthcare PPO |
$174.75
|
| Rate for Payer: WEA Trust Commercial |
$128.15
|
| Rate for Payer: Wellcare Medicare |
$14.18
|
| Rate for Payer: WMAP Medicaid |
$14.65
|
| Rate for Payer: WPS Commercial |
$172.58
|
|
|
Triiodothyronine
|
Professional
|
$233.00
|
|
|
Service Code
|
CPT 84480
|
| Hospital Charge Code |
633833
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.18 |
| Max. Negotiated Rate |
$221.35 |
| Rate for Payer: Aetna Commercial |
$221.35
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$200.38
|
| Rate for Payer: Aetna Managed Medicare |
$14.18
|
| Rate for Payer: Anthem Medicare Advantage |
$14.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$14.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$14.18
|
| Rate for Payer: Cash Price |
$69.90
|
| Rate for Payer: Cash Price |
$69.90
|
| Rate for Payer: Cigna Commercial |
$221.35
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$116.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$14.18
|
| Rate for Payer: Health EOS Commercial |
$212.03
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$50.06
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$50.06
|
| Rate for Payer: Independent Care Health Plan Medicare |
$14.18
|
| Rate for Payer: Multiplan Commercial |
$186.40
|
| Rate for Payer: Preferred Network Access Commercial |
$221.35
|
| Rate for Payer: Quartz Beloit One Network |
$102.52
|
| Rate for Payer: Quartz Commercial |
$132.81
|
| Rate for Payer: Quartz Medicare Advantage |
$14.18
|
| Rate for Payer: The Alliance Commercial |
$56.01
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14.18
|
| Rate for Payer: WEA Trust Commercial |
$128.15
|
| Rate for Payer: WPS Commercial |
$62.39
|
|
|
Trimming of dystrophic nails, any number G0127
|
Professional
|
$21.00
|
|
|
Service Code
|
HCPCS G0127
|
| Hospital Charge Code |
5468727
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$7.15 |
| Max. Negotiated Rate |
$25.95 |
| Rate for Payer: Aetna Commercial |
$19.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$18.06
|
| Rate for Payer: Aetna Managed Medicare |
$7.15
|
| Rate for Payer: Anthem Medicare Advantage |
$7.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$7.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$7.15
|
| Rate for Payer: Cash Price |
$6.30
|
| Rate for Payer: Cash Price |
$6.30
|
| Rate for Payer: Cigna Commercial |
$19.95
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$10.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$7.15
|
| Rate for Payer: Health EOS Commercial |
$19.11
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$25.95
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$25.95
|
| Rate for Payer: Independent Care Health Plan Medicare |
$7.15
|
| Rate for Payer: Multiplan Commercial |
$16.80
|
| Rate for Payer: Preferred Network Access Commercial |
$19.95
|
| Rate for Payer: Quartz Beloit One Network |
$9.24
|
| Rate for Payer: Quartz Commercial |
$11.97
|
| Rate for Payer: Quartz Medicare Advantage |
$7.15
|
| Rate for Payer: The Alliance Commercial |
$19.66
|
| Rate for Payer: United Healthcare Medicare Advantage |
$7.15
|
| Rate for Payer: WEA Trust Commercial |
$11.55
|
| Rate for Payer: WPS Commercial |
$12.51
|
|
|
Trimming of Nondystrophic Nails 11719
|
Professional
|
$96.00
|
|
|
Service Code
|
CPT 11719
|
| Hospital Charge Code |
2572826
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$7.15 |
| Max. Negotiated Rate |
$91.20 |
| Rate for Payer: Aetna Commercial |
$91.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$82.56
|
| Rate for Payer: Aetna Managed Medicare |
$7.15
|
| Rate for Payer: Anthem Medicare Advantage |
$7.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$7.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$7.15
|
| Rate for Payer: Cash Price |
$28.80
|
| Rate for Payer: Cash Price |
$28.80
|
| Rate for Payer: Cigna Commercial |
$91.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$48.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$7.15
|
| Rate for Payer: Health EOS Commercial |
$87.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$25.95
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$25.95
|
| Rate for Payer: Independent Care Health Plan Medicare |
$7.15
|
| Rate for Payer: Multiplan Commercial |
$76.80
|
| Rate for Payer: Preferred Network Access Commercial |
$91.20
|
| Rate for Payer: Quartz Beloit One Network |
$42.24
|
| Rate for Payer: Quartz Commercial |
$54.72
|
| Rate for Payer: Quartz Medicare Advantage |
$7.15
|
| Rate for Payer: The Alliance Commercial |
$30.39
|
| Rate for Payer: United Healthcare Medicaid |
$16.41
|
| Rate for Payer: United Healthcare Medicare Advantage |
$7.15
|
| Rate for Payer: WEA Trust Commercial |
$52.80
|
| Rate for Payer: WPS Commercial |
$32.18
|
|
|
Trim Nails and Skin Debridement 1171909
|
Professional
|
$21.00
|
|
|
Service Code
|
CPT 11719
|
| Hospital Charge Code |
5468780
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$7.15 |
| Max. Negotiated Rate |
$32.18 |
| Rate for Payer: Aetna Commercial |
$19.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$18.06
|
| Rate for Payer: Aetna Managed Medicare |
$7.15
|
| Rate for Payer: Anthem Medicare Advantage |
$7.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$7.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$7.15
|
| Rate for Payer: Cash Price |
$6.30
|
| Rate for Payer: Cash Price |
$6.30
|
| Rate for Payer: Cigna Commercial |
$19.95
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$10.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$7.15
|
| Rate for Payer: Health EOS Commercial |
$19.11
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$25.95
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$25.95
|
| Rate for Payer: Independent Care Health Plan Medicare |
$7.15
|
| Rate for Payer: Multiplan Commercial |
$16.80
|
| Rate for Payer: Preferred Network Access Commercial |
$19.95
|
| Rate for Payer: Quartz Beloit One Network |
$9.24
|
| Rate for Payer: Quartz Commercial |
$11.97
|
| Rate for Payer: Quartz Medicare Advantage |
$7.15
|
| Rate for Payer: The Alliance Commercial |
$30.39
|
| Rate for Payer: United Healthcare Medicaid |
$16.41
|
| Rate for Payer: United Healthcare Medicare Advantage |
$7.15
|
| Rate for Payer: WEA Trust Commercial |
$11.55
|
| Rate for Payer: WPS Commercial |
$32.18
|
|
|
Trim Nails Only 1171907
|
Professional
|
$16.00
|
|
|
Service Code
|
CPT 11719
|
| Hospital Charge Code |
3147474
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$7.04 |
| Max. Negotiated Rate |
$32.18 |
| Rate for Payer: Aetna Commercial |
$15.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$13.76
|
| Rate for Payer: Aetna Managed Medicare |
$7.15
|
| Rate for Payer: Anthem Medicare Advantage |
$7.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$7.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$7.15
|
| Rate for Payer: Cash Price |
$4.80
|
| Rate for Payer: Cash Price |
$4.80
|
| Rate for Payer: Cigna Commercial |
$15.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$8.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$7.15
|
| Rate for Payer: Health EOS Commercial |
$14.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$25.95
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$25.95
|
| Rate for Payer: Independent Care Health Plan Medicare |
$7.15
|
| Rate for Payer: Multiplan Commercial |
$12.80
|
| Rate for Payer: Preferred Network Access Commercial |
$15.20
|
| Rate for Payer: Quartz Beloit One Network |
$7.04
|
| Rate for Payer: Quartz Commercial |
$9.12
|
| Rate for Payer: Quartz Medicare Advantage |
$7.15
|
| Rate for Payer: The Alliance Commercial |
$30.39
|
| Rate for Payer: United Healthcare Medicaid |
$16.41
|
| Rate for Payer: United Healthcare Medicare Advantage |
$7.15
|
| Rate for Payer: WEA Trust Commercial |
$8.80
|
| Rate for Payer: WPS Commercial |
$32.18
|
|
|
TROCAR 11.5MM THORACOPORT 179303
|
Facility
OP
|
$479.00
|
|
| Hospital Charge Code |
2963613
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$134.12 |
| Max. Negotiated Rate |
$1,916.00 |
| Rate for Payer: Aetna Commercial |
$431.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$411.94
|
| Rate for Payer: Aetna Managed Medicare |
$134.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$311.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$239.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$229.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$253.87
|
| Rate for Payer: Cash Price |
$143.70
|
| Rate for Payer: Cigna Commercial |
$440.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$268.05
|
| Rate for Payer: Health EOS Commercial |
$426.31
|
| Rate for Payer: HFN Commercial |
$440.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$359.25
|
| Rate for Payer: Multiplan Commercial |
$383.20
|
| Rate for Payer: NAPHCARE Commercial |
$287.40
|
| Rate for Payer: Preferred Network Access Commercial |
$440.68
|
| Rate for Payer: Quartz Beloit One Network |
$234.71
|
| Rate for Payer: Quartz Commercial |
$311.35
|
| Rate for Payer: Quartz Medicare Advantage |
$287.40
|
| Rate for Payer: The Alliance Commercial |
$1,916.00
|
| Rate for Payer: WEA Trust Commercial |
$263.45
|
| Rate for Payer: WPS Commercial |
$354.80
|
|
|
TROCAR 11.5MM THORACOPORT 179303
|
Facility
IP
|
$479.00
|
|
| Hospital Charge Code |
2963613
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$234.71 |
| Max. Negotiated Rate |
$440.68 |
| Rate for Payer: Aetna Commercial |
$431.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$253.87
|
| Rate for Payer: Cash Price |
$143.70
|
| Rate for Payer: Cigna Commercial |
$440.68
|
| Rate for Payer: Health EOS Commercial |
$426.31
|
| Rate for Payer: HFN Commercial |
$440.68
|
| Rate for Payer: Multiplan Commercial |
$383.20
|
| Rate for Payer: NAPHCARE Commercial |
$287.40
|
| Rate for Payer: Preferred Network Access Commercial |
$440.68
|
| Rate for Payer: Quartz Beloit One Network |
$234.71
|
| Rate for Payer: Quartz Commercial |
$287.40
|
| Rate for Payer: WEA Trust Commercial |
$263.45
|
| Rate for Payer: WPS Commercial |
$354.80
|
|
|
TROCAR 15MM x100MM SEPARATOR COR37
|
Facility
IP
|
$1,244.00
|
|
| Hospital Charge Code |
2962960
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$609.56 |
| Max. Negotiated Rate |
$1,144.48 |
| Rate for Payer: Aetna Commercial |
$1,119.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$659.32
|
| Rate for Payer: Cash Price |
$373.20
|
| Rate for Payer: Cigna Commercial |
$1,144.48
|
| Rate for Payer: Health EOS Commercial |
$1,107.16
|
| Rate for Payer: HFN Commercial |
$1,144.48
|
| Rate for Payer: Multiplan Commercial |
$995.20
|
| Rate for Payer: NAPHCARE Commercial |
$746.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,144.48
|
| Rate for Payer: Quartz Beloit One Network |
$609.56
|
| Rate for Payer: Quartz Commercial |
$746.40
|
| Rate for Payer: WEA Trust Commercial |
$684.20
|
| Rate for Payer: WPS Commercial |
$921.43
|
|
|
TROCAR 15MM x100MM SEPARATOR COR37
|
Facility
OP
|
$1,244.00
|
|
| Hospital Charge Code |
2962960
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$348.32 |
| Max. Negotiated Rate |
$4,976.00 |
| Rate for Payer: Aetna Commercial |
$1,119.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,069.84
|
| Rate for Payer: Aetna Managed Medicare |
$348.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$808.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$622.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$597.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$659.32
|
| Rate for Payer: Cash Price |
$373.20
|
| Rate for Payer: Cigna Commercial |
$1,144.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$696.14
|
| Rate for Payer: Health EOS Commercial |
$1,107.16
|
| Rate for Payer: HFN Commercial |
$1,144.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$933.00
|
| Rate for Payer: Multiplan Commercial |
$995.20
|
| Rate for Payer: NAPHCARE Commercial |
$746.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,144.48
|
| Rate for Payer: Quartz Beloit One Network |
$609.56
|
| Rate for Payer: Quartz Commercial |
$808.60
|
| Rate for Payer: Quartz Medicare Advantage |
$746.40
|
| Rate for Payer: The Alliance Commercial |
$4,976.00
|
| Rate for Payer: WEA Trust Commercial |
$684.20
|
| Rate for Payer: WPS Commercial |
$921.43
|
|
|
TROCAR 3.2MM 71751136
|
Facility
OP
|
$1,823.00
|
|
| Hospital Charge Code |
2966056
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$510.44 |
| Max. Negotiated Rate |
$7,292.00 |
| Rate for Payer: Aetna Commercial |
$1,640.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,567.78
|
| Rate for Payer: Aetna Managed Medicare |
$510.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,184.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$911.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$875.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$966.19
|
| Rate for Payer: Cash Price |
$546.90
|
| Rate for Payer: Cigna Commercial |
$1,677.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,020.15
|
| Rate for Payer: Health EOS Commercial |
$1,622.47
|
| Rate for Payer: HFN Commercial |
$1,677.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,367.25
|
| Rate for Payer: Multiplan Commercial |
$1,458.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,093.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,677.16
|
| Rate for Payer: Quartz Beloit One Network |
$893.27
|
| Rate for Payer: Quartz Commercial |
$1,184.95
|
| Rate for Payer: Quartz Medicare Advantage |
$1,093.80
|
| Rate for Payer: The Alliance Commercial |
$7,292.00
|
| Rate for Payer: WEA Trust Commercial |
$1,002.65
|
| Rate for Payer: WPS Commercial |
$1,350.30
|
|
