|
TROCAR NON-BLADED 12X150MM Z-THREAD CTF71
|
Facility
OP
|
$575.00
|
|
| Hospital Charge Code |
5384673
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$161.00 |
| Max. Negotiated Rate |
$2,300.00 |
| Rate for Payer: Aetna Commercial |
$517.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$494.50
|
| Rate for Payer: Aetna Managed Medicare |
$161.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$373.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$287.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$276.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$304.75
|
| Rate for Payer: Cash Price |
$172.50
|
| Rate for Payer: Cigna Commercial |
$529.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$321.77
|
| Rate for Payer: Health EOS Commercial |
$511.75
|
| Rate for Payer: HFN Commercial |
$529.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$431.25
|
| Rate for Payer: Multiplan Commercial |
$460.00
|
| Rate for Payer: NAPHCARE Commercial |
$345.00
|
| Rate for Payer: Preferred Network Access Commercial |
$529.00
|
| Rate for Payer: Quartz Beloit One Network |
$281.75
|
| Rate for Payer: Quartz Commercial |
$373.75
|
| Rate for Payer: Quartz Medicare Advantage |
$345.00
|
| Rate for Payer: The Alliance Commercial |
$2,300.00
|
| Rate for Payer: WEA Trust Commercial |
$316.25
|
| Rate for Payer: WPS Commercial |
$425.90
|
|
|
TROCAR NON-BLADED 12X150MM Z-THREAD CTF71
|
Facility
IP
|
$575.00
|
|
| Hospital Charge Code |
5384673
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$281.75 |
| Max. Negotiated Rate |
$529.00 |
| Rate for Payer: Aetna Commercial |
$517.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$304.75
|
| Rate for Payer: Cash Price |
$172.50
|
| Rate for Payer: Cigna Commercial |
$529.00
|
| Rate for Payer: Health EOS Commercial |
$511.75
|
| Rate for Payer: HFN Commercial |
$529.00
|
| Rate for Payer: Multiplan Commercial |
$460.00
|
| Rate for Payer: NAPHCARE Commercial |
$345.00
|
| Rate for Payer: Preferred Network Access Commercial |
$529.00
|
| Rate for Payer: Quartz Beloit One Network |
$281.75
|
| Rate for Payer: Quartz Commercial |
$345.00
|
| Rate for Payer: WEA Trust Commercial |
$316.25
|
| Rate for Payer: WPS Commercial |
$425.90
|
|
|
TROCAR NON-BLADED 5X100MM BALLOON CFF03
|
Facility
IP
|
$439.00
|
|
| Hospital Charge Code |
5179325
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$215.11 |
| Max. Negotiated Rate |
$403.88 |
| Rate for Payer: Aetna Commercial |
$395.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$232.67
|
| Rate for Payer: Cash Price |
$131.70
|
| Rate for Payer: Cigna Commercial |
$403.88
|
| Rate for Payer: Health EOS Commercial |
$390.71
|
| Rate for Payer: HFN Commercial |
$403.88
|
| Rate for Payer: Multiplan Commercial |
$351.20
|
| Rate for Payer: NAPHCARE Commercial |
$263.40
|
| Rate for Payer: Preferred Network Access Commercial |
$403.88
|
| Rate for Payer: Quartz Beloit One Network |
$215.11
|
| Rate for Payer: Quartz Commercial |
$263.40
|
| Rate for Payer: WEA Trust Commercial |
$241.45
|
| Rate for Payer: WPS Commercial |
$325.17
|
|
|
TROCAR NON-BLADED 5X100MM BALLOON CFF03
|
Facility
OP
|
$439.00
|
|
| Hospital Charge Code |
5179325
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$122.92 |
| Max. Negotiated Rate |
$1,756.00 |
| Rate for Payer: Aetna Commercial |
$395.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$377.54
|
| Rate for Payer: Aetna Managed Medicare |
$122.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$285.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$219.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$210.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$232.67
|
| Rate for Payer: Cash Price |
$131.70
|
| Rate for Payer: Cigna Commercial |
$403.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$245.66
|
| Rate for Payer: Health EOS Commercial |
$390.71
|
| Rate for Payer: HFN Commercial |
$403.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$329.25
|
| Rate for Payer: Multiplan Commercial |
$351.20
|
| Rate for Payer: NAPHCARE Commercial |
$263.40
|
| Rate for Payer: Preferred Network Access Commercial |
$403.88
|
| Rate for Payer: Quartz Beloit One Network |
$215.11
|
| Rate for Payer: Quartz Commercial |
$285.35
|
| Rate for Payer: Quartz Medicare Advantage |
$263.40
|
| Rate for Payer: The Alliance Commercial |
$1,756.00
|
| Rate for Payer: WEA Trust Commercial |
$241.45
|
| Rate for Payer: WPS Commercial |
$325.17
|
|
|
TROCAR NON-BLADED 5X100MM Z-THREAD CTF03
|
Facility
OP
|
$439.00
|
|
| Hospital Charge Code |
5179324
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$122.92 |
| Max. Negotiated Rate |
$1,756.00 |
| Rate for Payer: Aetna Commercial |
$395.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$377.54
|
| Rate for Payer: Aetna Managed Medicare |
$122.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$285.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$219.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$210.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$232.67
|
| Rate for Payer: Cash Price |
$131.70
|
| Rate for Payer: Cigna Commercial |
$403.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$245.66
|
| Rate for Payer: Health EOS Commercial |
$390.71
|
| Rate for Payer: HFN Commercial |
$403.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$329.25
|
| Rate for Payer: Multiplan Commercial |
$351.20
|
| Rate for Payer: NAPHCARE Commercial |
$263.40
|
| Rate for Payer: Preferred Network Access Commercial |
$403.88
|
| Rate for Payer: Quartz Beloit One Network |
$215.11
|
| Rate for Payer: Quartz Commercial |
$285.35
|
| Rate for Payer: Quartz Medicare Advantage |
$263.40
|
| Rate for Payer: The Alliance Commercial |
$1,756.00
|
| Rate for Payer: WEA Trust Commercial |
$241.45
|
| Rate for Payer: WPS Commercial |
$325.17
|
|
|
TROCAR NON-BLADED 5X100MM Z-THREAD CTF03
|
Facility
IP
|
$439.00
|
|
| Hospital Charge Code |
5179324
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$215.11 |
| Max. Negotiated Rate |
$403.88 |
| Rate for Payer: Aetna Commercial |
$395.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$232.67
|
| Rate for Payer: Cash Price |
$131.70
|
| Rate for Payer: Cigna Commercial |
$403.88
|
| Rate for Payer: Health EOS Commercial |
$390.71
|
| Rate for Payer: HFN Commercial |
$403.88
|
| Rate for Payer: Multiplan Commercial |
$351.20
|
| Rate for Payer: NAPHCARE Commercial |
$263.40
|
| Rate for Payer: Preferred Network Access Commercial |
$403.88
|
| Rate for Payer: Quartz Beloit One Network |
$215.11
|
| Rate for Payer: Quartz Commercial |
$263.40
|
| Rate for Payer: WEA Trust Commercial |
$241.45
|
| Rate for Payer: WPS Commercial |
$325.17
|
|
|
TROCAR NON-BLADED 5X150MM Z-THREAD CTF01
|
Facility
OP
|
$439.00
|
|
| Hospital Charge Code |
5384674
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$122.92 |
| Max. Negotiated Rate |
$1,756.00 |
| Rate for Payer: Aetna Commercial |
$395.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$377.54
|
| Rate for Payer: Aetna Managed Medicare |
$122.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$285.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$219.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$210.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$232.67
|
| Rate for Payer: Cash Price |
$131.70
|
| Rate for Payer: Cigna Commercial |
$403.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$245.66
|
| Rate for Payer: Health EOS Commercial |
$390.71
|
| Rate for Payer: HFN Commercial |
$403.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$329.25
|
| Rate for Payer: Multiplan Commercial |
$351.20
|
| Rate for Payer: NAPHCARE Commercial |
$263.40
|
| Rate for Payer: Preferred Network Access Commercial |
$403.88
|
| Rate for Payer: Quartz Beloit One Network |
$215.11
|
| Rate for Payer: Quartz Commercial |
$285.35
|
| Rate for Payer: Quartz Medicare Advantage |
$263.40
|
| Rate for Payer: The Alliance Commercial |
$1,756.00
|
| Rate for Payer: WEA Trust Commercial |
$241.45
|
| Rate for Payer: WPS Commercial |
$325.17
|
|
|
TROCAR NON-BLADED 5X150MM Z-THREAD CTF01
|
Facility
IP
|
$439.00
|
|
| Hospital Charge Code |
5384674
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$215.11 |
| Max. Negotiated Rate |
$403.88 |
| Rate for Payer: Aetna Commercial |
$395.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$232.67
|
| Rate for Payer: Cash Price |
$131.70
|
| Rate for Payer: Cigna Commercial |
$403.88
|
| Rate for Payer: Health EOS Commercial |
$390.71
|
| Rate for Payer: HFN Commercial |
$403.88
|
| Rate for Payer: Multiplan Commercial |
$351.20
|
| Rate for Payer: NAPHCARE Commercial |
$263.40
|
| Rate for Payer: Preferred Network Access Commercial |
$403.88
|
| Rate for Payer: Quartz Beloit One Network |
$215.11
|
| Rate for Payer: Quartz Commercial |
$263.40
|
| Rate for Payer: WEA Trust Commercial |
$241.45
|
| Rate for Payer: WPS Commercial |
$325.17
|
|
|
TROCAR SLEEVE 5X100MM Z-THREAD CTS02
|
Facility
OP
|
$219.00
|
|
| Hospital Charge Code |
5179326
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$61.32 |
| Max. Negotiated Rate |
$876.00 |
| Rate for Payer: Aetna Commercial |
$197.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$188.34
|
| Rate for Payer: Aetna Managed Medicare |
$61.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$142.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$109.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$105.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$116.07
|
| Rate for Payer: Cash Price |
$65.70
|
| Rate for Payer: Cigna Commercial |
$201.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$122.55
|
| Rate for Payer: Health EOS Commercial |
$194.91
|
| Rate for Payer: HFN Commercial |
$201.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$164.25
|
| Rate for Payer: Multiplan Commercial |
$175.20
|
| Rate for Payer: NAPHCARE Commercial |
$131.40
|
| Rate for Payer: Preferred Network Access Commercial |
$201.48
|
| Rate for Payer: Quartz Beloit One Network |
$107.31
|
| Rate for Payer: Quartz Commercial |
$142.35
|
| Rate for Payer: Quartz Medicare Advantage |
$131.40
|
| Rate for Payer: The Alliance Commercial |
$876.00
|
| Rate for Payer: WEA Trust Commercial |
$120.45
|
| Rate for Payer: WPS Commercial |
$162.21
|
|
|
TROCAR SLEEVE 5X100MM Z-THREAD CTS02
|
Facility
IP
|
$219.00
|
|
| Hospital Charge Code |
5179326
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$107.31 |
| Max. Negotiated Rate |
$201.48 |
| Rate for Payer: Aetna Commercial |
$197.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$116.07
|
| Rate for Payer: Cash Price |
$65.70
|
| Rate for Payer: Cigna Commercial |
$201.48
|
| Rate for Payer: Health EOS Commercial |
$194.91
|
| Rate for Payer: HFN Commercial |
$201.48
|
| Rate for Payer: Multiplan Commercial |
$175.20
|
| Rate for Payer: NAPHCARE Commercial |
$131.40
|
| Rate for Payer: Preferred Network Access Commercial |
$201.48
|
| Rate for Payer: Quartz Beloit One Network |
$107.31
|
| Rate for Payer: Quartz Commercial |
$131.40
|
| Rate for Payer: WEA Trust Commercial |
$120.45
|
| Rate for Payer: WPS Commercial |
$162.21
|
|
|
TROCAR THORACOPORT 15MM
|
Facility
IP
|
$518.00
|
|
| Hospital Charge Code |
2963811
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$253.82 |
| Max. Negotiated Rate |
$476.56 |
| Rate for Payer: Aetna Commercial |
$466.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$274.54
|
| Rate for Payer: Cash Price |
$155.40
|
| Rate for Payer: Cigna Commercial |
$476.56
|
| Rate for Payer: Health EOS Commercial |
$461.02
|
| Rate for Payer: HFN Commercial |
$476.56
|
| Rate for Payer: Multiplan Commercial |
$414.40
|
| Rate for Payer: NAPHCARE Commercial |
$310.80
|
| Rate for Payer: Preferred Network Access Commercial |
$476.56
|
| Rate for Payer: Quartz Beloit One Network |
$253.82
|
| Rate for Payer: Quartz Commercial |
$310.80
|
| Rate for Payer: WEA Trust Commercial |
$284.90
|
| Rate for Payer: WPS Commercial |
$383.68
|
|
|
TROCAR THORACOPORT 15MM
|
Facility
OP
|
$518.00
|
|
| Hospital Charge Code |
2963811
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$145.04 |
| Max. Negotiated Rate |
$2,072.00 |
| Rate for Payer: Aetna Commercial |
$466.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$445.48
|
| Rate for Payer: Aetna Managed Medicare |
$145.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$336.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$259.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$248.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$274.54
|
| Rate for Payer: Cash Price |
$155.40
|
| Rate for Payer: Cigna Commercial |
$476.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$289.87
|
| Rate for Payer: Health EOS Commercial |
$461.02
|
| Rate for Payer: HFN Commercial |
$476.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$388.50
|
| Rate for Payer: Multiplan Commercial |
$414.40
|
| Rate for Payer: NAPHCARE Commercial |
$310.80
|
| Rate for Payer: Preferred Network Access Commercial |
$476.56
|
| Rate for Payer: Quartz Beloit One Network |
$253.82
|
| Rate for Payer: Quartz Commercial |
$336.70
|
| Rate for Payer: Quartz Medicare Advantage |
$310.80
|
| Rate for Payer: The Alliance Commercial |
$2,072.00
|
| Rate for Payer: WEA Trust Commercial |
$284.90
|
| Rate for Payer: WPS Commercial |
$383.68
|
|
|
TROCHANTERIC TITANIUM FEMORAL NAILING INSERTION/REMOVAL
|
Facility
OP
|
$5,844.00
|
|
| Hospital Charge Code |
2960428
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,636.32 |
| Max. Negotiated Rate |
$23,376.00 |
| Rate for Payer: Aetna Commercial |
$5,259.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,025.84
|
| Rate for Payer: Aetna Managed Medicare |
$1,636.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,798.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,922.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,805.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,097.32
|
| Rate for Payer: Cash Price |
$1,753.20
|
| Rate for Payer: Cigna Commercial |
$5,376.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,270.30
|
| Rate for Payer: Health EOS Commercial |
$5,201.16
|
| Rate for Payer: HFN Commercial |
$5,376.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,383.00
|
| Rate for Payer: Multiplan Commercial |
$4,675.20
|
| Rate for Payer: NAPHCARE Commercial |
$3,506.40
|
| Rate for Payer: Preferred Network Access Commercial |
$5,376.48
|
| Rate for Payer: Quartz Beloit One Network |
$2,863.56
|
| Rate for Payer: Quartz Commercial |
$3,798.60
|
| Rate for Payer: Quartz Medicare Advantage |
$3,506.40
|
| Rate for Payer: The Alliance Commercial |
$23,376.00
|
| Rate for Payer: WEA Trust Commercial |
$3,214.20
|
| Rate for Payer: WPS Commercial |
$4,328.65
|
|
|
TROCHANTERIC TITANIUM FEMORAL NAILING INSERTION/REMOVAL
|
Facility
IP
|
$5,844.00
|
|
| Hospital Charge Code |
2960428
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,863.56 |
| Max. Negotiated Rate |
$5,376.48 |
| Rate for Payer: Aetna Commercial |
$5,259.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,097.32
|
| Rate for Payer: Cash Price |
$1,753.20
|
| Rate for Payer: Cigna Commercial |
$5,376.48
|
| Rate for Payer: Health EOS Commercial |
$5,201.16
|
| Rate for Payer: HFN Commercial |
$5,376.48
|
| Rate for Payer: Multiplan Commercial |
$4,675.20
|
| Rate for Payer: NAPHCARE Commercial |
$3,506.40
|
| Rate for Payer: Preferred Network Access Commercial |
$5,376.48
|
| Rate for Payer: Quartz Beloit One Network |
$2,863.56
|
| Rate for Payer: Quartz Commercial |
$3,506.40
|
| Rate for Payer: WEA Trust Commercial |
$3,214.20
|
| Rate for Payer: WPS Commercial |
$4,328.65
|
|
|
Tropheryma whipplei DNA, PCR
|
Professional
|
$320.00
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
4808606
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$35.09 |
| Max. Negotiated Rate |
$304.00 |
| Rate for Payer: Aetna Commercial |
$304.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$275.20
|
| Rate for Payer: Aetna Managed Medicare |
$35.09
|
| Rate for Payer: Anthem Medicare Advantage |
$35.09
|
| 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 |
$96.00
|
| Rate for Payer: Cash Price |
$96.00
|
| Rate for Payer: Cigna Commercial |
$304.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$160.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$35.09
|
| Rate for Payer: Health EOS Commercial |
$291.20
|
| 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: Independent Care Health Plan Medicare |
$35.09
|
| Rate for Payer: Multiplan Commercial |
$256.00
|
| Rate for Payer: Preferred Network Access Commercial |
$304.00
|
| Rate for Payer: Quartz Beloit One Network |
$140.80
|
| Rate for Payer: Quartz Commercial |
$182.40
|
| Rate for Payer: Quartz Medicare Advantage |
$35.09
|
| Rate for Payer: The Alliance Commercial |
$138.61
|
| Rate for Payer: United Healthcare Medicare Advantage |
$35.09
|
| Rate for Payer: WEA Trust Commercial |
$176.00
|
| Rate for Payer: WPS Commercial |
$154.40
|
|
|
Tropheryma whipplei DNA, PCR
|
Facility
IP
|
$320.00
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
4808606
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$156.80 |
| Max. Negotiated Rate |
$294.40 |
| Rate for Payer: Aetna Commercial |
$288.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$169.60
|
| Rate for Payer: Cash Price |
$96.00
|
| Rate for Payer: Cigna Commercial |
$294.40
|
| Rate for Payer: Health EOS Commercial |
$284.80
|
| Rate for Payer: HFN Commercial |
$294.40
|
| Rate for Payer: Multiplan Commercial |
$256.00
|
| Rate for Payer: NAPHCARE Commercial |
$192.00
|
| Rate for Payer: Preferred Network Access Commercial |
$294.40
|
| Rate for Payer: Quartz Beloit One Network |
$156.80
|
| Rate for Payer: Quartz Commercial |
$192.00
|
| Rate for Payer: WEA Trust Commercial |
$176.00
|
| Rate for Payer: WPS Commercial |
$237.02
|
|
|
Tropheryma whipplei DNA, PCR
|
Facility
OP
|
$320.00
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
4808606
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$35.09 |
| Max. Negotiated Rate |
$1,280.00 |
| Rate for Payer: Aetna Commercial |
$288.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$275.20
|
| 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 |
$169.60
|
| 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 |
$96.00
|
| Rate for Payer: Cash Price |
$96.00
|
| Rate for Payer: Cigna Commercial |
$294.40
|
| 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 Medicaid |
$36.26
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$35.09
|
| Rate for Payer: Health EOS Commercial |
$284.80
|
| Rate for Payer: HFN Commercial |
$294.40
|
| 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 |
$256.00
|
| Rate for Payer: NAPHCARE Commercial |
$52.64
|
| Rate for Payer: Preferred Network Access Commercial |
$294.40
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$36.26
|
| Rate for Payer: Quartz Beloit One Network |
$156.80
|
| Rate for Payer: Quartz Commercial |
$208.00
|
| Rate for Payer: Quartz Medicare Advantage |
$35.09
|
| Rate for Payer: The Alliance Commercial |
$1,280.00
|
| Rate for Payer: United Healthcare Medicaid |
$36.26
|
| Rate for Payer: United Healthcare Medicare Advantage |
$35.09
|
| Rate for Payer: United Healthcare PPO |
$240.00
|
| Rate for Payer: WEA Trust Commercial |
$176.00
|
| Rate for Payer: Wellcare Medicare |
$35.09
|
| Rate for Payer: WMAP Medicaid |
$36.26
|
| Rate for Payer: WPS Commercial |
$237.02
|
|
|
Tropicamide 1% Ophth Solution 2ml [Med]
|
Facility
IP
|
$112.00
|
|
| Hospital Charge Code |
2974994
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$54.88 |
| Max. Negotiated Rate |
$103.04 |
| Rate for Payer: Aetna Commercial |
$100.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$59.36
|
| Rate for Payer: Cash Price |
$33.60
|
| Rate for Payer: Cigna Commercial |
$103.04
|
| Rate for Payer: Health EOS Commercial |
$99.68
|
| Rate for Payer: HFN Commercial |
$103.04
|
| Rate for Payer: Multiplan Commercial |
$89.60
|
| Rate for Payer: NAPHCARE Commercial |
$67.20
|
| Rate for Payer: Preferred Network Access Commercial |
$103.04
|
| Rate for Payer: Quartz Beloit One Network |
$54.88
|
| Rate for Payer: Quartz Commercial |
$67.20
|
| Rate for Payer: WEA Trust Commercial |
$61.60
|
| Rate for Payer: WPS Commercial |
$82.96
|
|
|
Tropicamide 1% Ophth Solution 2ml [Med]
|
Facility
OP
|
$112.00
|
|
| Hospital Charge Code |
2974994
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$31.36 |
| Max. Negotiated Rate |
$448.00 |
| Rate for Payer: Aetna Commercial |
$100.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$96.32
|
| Rate for Payer: Aetna Managed Medicare |
$31.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$72.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$56.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$53.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$59.36
|
| Rate for Payer: Cash Price |
$33.60
|
| Rate for Payer: Cigna Commercial |
$103.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$62.68
|
| Rate for Payer: Health EOS Commercial |
$99.68
|
| Rate for Payer: HFN Commercial |
$103.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$84.00
|
| Rate for Payer: Multiplan Commercial |
$89.60
|
| Rate for Payer: NAPHCARE Commercial |
$67.20
|
| Rate for Payer: Preferred Network Access Commercial |
$103.04
|
| Rate for Payer: Quartz Beloit One Network |
$54.88
|
| Rate for Payer: Quartz Commercial |
$72.80
|
| Rate for Payer: Quartz Medicare Advantage |
$67.20
|
| Rate for Payer: The Alliance Commercial |
$448.00
|
| Rate for Payer: WEA Trust Commercial |
$61.60
|
| Rate for Payer: WPS Commercial |
$82.96
|
|
|
Troponin-I
|
Facility
IP
|
$227.00
|
|
|
Service Code
|
CPT 84484
|
| Hospital Charge Code |
633854
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$111.23 |
| Max. Negotiated Rate |
$208.84 |
| Rate for Payer: Aetna Commercial |
$204.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$120.31
|
| Rate for Payer: Cash Price |
$68.10
|
| Rate for Payer: Cigna Commercial |
$208.84
|
| Rate for Payer: Health EOS Commercial |
$202.03
|
| Rate for Payer: HFN Commercial |
$208.84
|
| Rate for Payer: Multiplan Commercial |
$181.60
|
| Rate for Payer: NAPHCARE Commercial |
$136.20
|
| Rate for Payer: Preferred Network Access Commercial |
$208.84
|
| Rate for Payer: Quartz Beloit One Network |
$111.23
|
| Rate for Payer: Quartz Commercial |
$136.20
|
| Rate for Payer: WEA Trust Commercial |
$124.85
|
| Rate for Payer: WPS Commercial |
$168.14
|
|
|
Troponin-I
|
Facility
OP
|
$227.00
|
|
|
Service Code
|
CPT 84484
|
| Hospital Charge Code |
633854
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.47 |
| Max. Negotiated Rate |
$908.00 |
| Rate for Payer: Aetna Commercial |
$204.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$195.22
|
| Rate for Payer: Aetna Managed Medicare |
$12.47
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$46.76
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$21.82
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$20.70
|
| Rate for Payer: Anthem Medicaid |
$12.89
|
| Rate for Payer: Anthem Medicare Advantage |
$12.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$120.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$12.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$12.47
|
| Rate for Payer: Cash Price |
$68.10
|
| Rate for Payer: Cash Price |
$68.10
|
| Rate for Payer: Cigna Commercial |
$208.84
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$12.47
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$12.89
|
| Rate for Payer: Dean Health Medicaid |
$12.89
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$12.47
|
| Rate for Payer: Health EOS Commercial |
$202.03
|
| Rate for Payer: HFN Commercial |
$208.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$46.39
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$12.47
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$12.89
|
| Rate for Payer: Independent Care Health Plan Medicare |
$12.47
|
| Rate for Payer: Managed Health Services Medicaid |
$13.41
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$12.47
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$12.47
|
| Rate for Payer: Multiplan Commercial |
$181.60
|
| Rate for Payer: NAPHCARE Commercial |
$18.70
|
| Rate for Payer: Preferred Network Access Commercial |
$208.84
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$12.89
|
| Rate for Payer: Quartz Beloit One Network |
$111.23
|
| Rate for Payer: Quartz Commercial |
$147.55
|
| Rate for Payer: Quartz Medicare Advantage |
$12.47
|
| Rate for Payer: The Alliance Commercial |
$908.00
|
| Rate for Payer: United Healthcare Medicaid |
$12.89
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.47
|
| Rate for Payer: United Healthcare PPO |
$170.25
|
| Rate for Payer: WEA Trust Commercial |
$124.85
|
| Rate for Payer: Wellcare Medicare |
$12.47
|
| Rate for Payer: WMAP Medicaid |
$12.89
|
| Rate for Payer: WPS Commercial |
$168.14
|
|
|
Troponin-I
|
Professional
|
$227.00
|
|
|
Service Code
|
CPT 84484
|
| Hospital Charge Code |
633854
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.47 |
| Max. Negotiated Rate |
$215.65 |
| Rate for Payer: Aetna Commercial |
$215.65
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$195.22
|
| Rate for Payer: Aetna Managed Medicare |
$12.47
|
| Rate for Payer: Anthem Medicare Advantage |
$12.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$12.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$12.47
|
| Rate for Payer: Cash Price |
$68.10
|
| Rate for Payer: Cash Price |
$68.10
|
| Rate for Payer: Cigna Commercial |
$215.65
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$113.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12.47
|
| Rate for Payer: Health EOS Commercial |
$206.57
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$44.02
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$44.02
|
| Rate for Payer: Independent Care Health Plan Medicare |
$12.47
|
| Rate for Payer: Multiplan Commercial |
$181.60
|
| Rate for Payer: Preferred Network Access Commercial |
$215.65
|
| Rate for Payer: Quartz Beloit One Network |
$99.88
|
| Rate for Payer: Quartz Commercial |
$129.39
|
| Rate for Payer: Quartz Medicare Advantage |
$12.47
|
| Rate for Payer: The Alliance Commercial |
$49.26
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.47
|
| Rate for Payer: WEA Trust Commercial |
$124.85
|
| Rate for Payer: WPS Commercial |
$54.87
|
|
|
Troponin T/34483
|
Facility
IP
|
$76.00
|
|
|
Service Code
|
CPT 84484
|
| Hospital Charge Code |
6175389
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$37.24 |
| Max. Negotiated Rate |
$69.92 |
| Rate for Payer: Aetna Commercial |
$68.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$40.28
|
| Rate for Payer: Cash Price |
$22.80
|
| Rate for Payer: Cigna Commercial |
$69.92
|
| Rate for Payer: Health EOS Commercial |
$67.64
|
| Rate for Payer: HFN Commercial |
$69.92
|
| Rate for Payer: Multiplan Commercial |
$60.80
|
| Rate for Payer: NAPHCARE Commercial |
$45.60
|
| Rate for Payer: Preferred Network Access Commercial |
$69.92
|
| Rate for Payer: Quartz Beloit One Network |
$37.24
|
| Rate for Payer: Quartz Commercial |
$45.60
|
| Rate for Payer: WEA Trust Commercial |
$41.80
|
| Rate for Payer: WPS Commercial |
$56.29
|
|
|
Troponin T/34483
|
Professional
|
$76.00
|
|
|
Service Code
|
CPT 84484
|
| Hospital Charge Code |
6175389
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.47 |
| Max. Negotiated Rate |
$72.20 |
| Rate for Payer: Aetna Commercial |
$72.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$65.36
|
| Rate for Payer: Aetna Managed Medicare |
$12.47
|
| Rate for Payer: Anthem Medicare Advantage |
$12.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$12.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$12.47
|
| Rate for Payer: Cash Price |
$22.80
|
| Rate for Payer: Cash Price |
$22.80
|
| Rate for Payer: Cigna Commercial |
$72.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$38.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12.47
|
| Rate for Payer: Health EOS Commercial |
$69.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$44.02
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$44.02
|
| Rate for Payer: Independent Care Health Plan Medicare |
$12.47
|
| Rate for Payer: Multiplan Commercial |
$60.80
|
| Rate for Payer: Preferred Network Access Commercial |
$72.20
|
| Rate for Payer: Quartz Beloit One Network |
$33.44
|
| Rate for Payer: Quartz Commercial |
$43.32
|
| Rate for Payer: Quartz Medicare Advantage |
$12.47
|
| Rate for Payer: The Alliance Commercial |
$49.26
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.47
|
| Rate for Payer: WEA Trust Commercial |
$41.80
|
| Rate for Payer: WPS Commercial |
$54.87
|
|
|
Troponin T/34483
|
Facility
OP
|
$76.00
|
|
|
Service Code
|
CPT 84484
|
| Hospital Charge Code |
6175389
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.47 |
| Max. Negotiated Rate |
$304.00 |
| Rate for Payer: Aetna Commercial |
$68.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$65.36
|
| Rate for Payer: Aetna Managed Medicare |
$12.47
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$46.76
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$21.82
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$20.70
|
| Rate for Payer: Anthem Medicaid |
$12.89
|
| Rate for Payer: Anthem Medicare Advantage |
$12.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$40.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$12.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$12.47
|
| Rate for Payer: Cash Price |
$22.80
|
| Rate for Payer: Cash Price |
$22.80
|
| Rate for Payer: Cigna Commercial |
$69.92
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$12.47
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$12.89
|
| Rate for Payer: Dean Health Medicaid |
$12.89
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$12.47
|
| Rate for Payer: Health EOS Commercial |
$67.64
|
| Rate for Payer: HFN Commercial |
$69.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$46.39
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$12.47
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$12.89
|
| Rate for Payer: Independent Care Health Plan Medicare |
$12.47
|
| Rate for Payer: Managed Health Services Medicaid |
$13.41
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$12.47
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$12.47
|
| Rate for Payer: Multiplan Commercial |
$60.80
|
| Rate for Payer: NAPHCARE Commercial |
$18.70
|
| Rate for Payer: Preferred Network Access Commercial |
$69.92
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$12.89
|
| Rate for Payer: Quartz Beloit One Network |
$37.24
|
| Rate for Payer: Quartz Commercial |
$49.40
|
| Rate for Payer: Quartz Medicare Advantage |
$12.47
|
| Rate for Payer: The Alliance Commercial |
$304.00
|
| Rate for Payer: United Healthcare Medicaid |
$12.89
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.47
|
| Rate for Payer: United Healthcare PPO |
$57.00
|
| Rate for Payer: WEA Trust Commercial |
$41.80
|
| Rate for Payer: Wellcare Medicare |
$12.47
|
| Rate for Payer: WMAP Medicaid |
$12.89
|
| Rate for Payer: WPS Commercial |
$56.29
|
|
