|
TRUNION 39MM SLOTTED TPS CAP AR-9301-39CPC
|
Facility
IP
|
$15,959.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
6178083
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,819.91 |
| Max. Negotiated Rate |
$14,682.28 |
| Rate for Payer: Aetna Commercial |
$14,363.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$8,458.27
|
| Rate for Payer: Cash Price |
$4,787.70
|
| Rate for Payer: Cigna Commercial |
$14,682.28
|
| Rate for Payer: Health EOS Commercial |
$14,203.51
|
| Rate for Payer: HFN Commercial |
$14,682.28
|
| Rate for Payer: Multiplan Commercial |
$12,767.20
|
| Rate for Payer: NAPHCARE Commercial |
$9,575.40
|
| Rate for Payer: Preferred Network Access Commercial |
$14,682.28
|
| Rate for Payer: Quartz Beloit One Network |
$7,819.91
|
| Rate for Payer: Quartz Commercial |
$9,575.40
|
| Rate for Payer: WEA Trust Commercial |
$8,777.45
|
| Rate for Payer: WPS Commercial |
$11,820.83
|
|
|
TRUNION 39MM SLOTTED TPS CAP AR-9301-39CPC
|
Facility
OP
|
$15,959.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
6178083
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,468.52 |
| Max. Negotiated Rate |
$14,682.28 |
| Rate for Payer: Aetna Commercial |
$14,363.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$13,724.74
|
| Rate for Payer: Aetna Managed Medicare |
$4,468.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$10,373.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$7,979.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7,660.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$8,458.27
|
| Rate for Payer: Cash Price |
$4,787.70
|
| Rate for Payer: Cigna Commercial |
$14,682.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$8,930.66
|
| Rate for Payer: Health EOS Commercial |
$14,203.51
|
| Rate for Payer: HFN Commercial |
$14,682.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$11,969.25
|
| Rate for Payer: Multiplan Commercial |
$12,767.20
|
| Rate for Payer: NAPHCARE Commercial |
$9,575.40
|
| Rate for Payer: Preferred Network Access Commercial |
$14,682.28
|
| Rate for Payer: Quartz Beloit One Network |
$7,819.91
|
| Rate for Payer: Quartz Commercial |
$10,373.35
|
| Rate for Payer: Quartz Medicare Advantage |
$9,575.40
|
| Rate for Payer: WEA Trust Commercial |
$8,777.45
|
| Rate for Payer: WPS Commercial |
$11,820.83
|
|
|
TRUNION 41MM SLOTTED TPS CAP AR-9301-41CPC
|
Facility
IP
|
$17,261.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5885661
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,457.89 |
| Max. Negotiated Rate |
$15,880.12 |
| Rate for Payer: Aetna Commercial |
$15,534.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,148.33
|
| Rate for Payer: Cash Price |
$5,178.30
|
| Rate for Payer: Cigna Commercial |
$15,880.12
|
| Rate for Payer: Health EOS Commercial |
$15,362.29
|
| Rate for Payer: HFN Commercial |
$15,880.12
|
| Rate for Payer: Multiplan Commercial |
$13,808.80
|
| Rate for Payer: NAPHCARE Commercial |
$10,356.60
|
| Rate for Payer: Preferred Network Access Commercial |
$15,880.12
|
| Rate for Payer: Quartz Beloit One Network |
$8,457.89
|
| Rate for Payer: Quartz Commercial |
$10,356.60
|
| Rate for Payer: WEA Trust Commercial |
$9,493.55
|
| Rate for Payer: WPS Commercial |
$12,785.22
|
|
|
TRUNION 41MM SLOTTED TPS CAP AR-9301-41CPC
|
Facility
OP
|
$17,261.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5885661
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,833.08 |
| Max. Negotiated Rate |
$15,880.12 |
| Rate for Payer: Aetna Commercial |
$15,534.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$14,844.46
|
| Rate for Payer: Aetna Managed Medicare |
$4,833.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$11,219.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8,630.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$8,285.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,148.33
|
| Rate for Payer: Cash Price |
$5,178.30
|
| Rate for Payer: Cigna Commercial |
$15,880.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$9,659.26
|
| Rate for Payer: Health EOS Commercial |
$15,362.29
|
| Rate for Payer: HFN Commercial |
$15,880.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$12,945.75
|
| Rate for Payer: Multiplan Commercial |
$13,808.80
|
| Rate for Payer: NAPHCARE Commercial |
$10,356.60
|
| Rate for Payer: Preferred Network Access Commercial |
$15,880.12
|
| Rate for Payer: Quartz Beloit One Network |
$8,457.89
|
| Rate for Payer: Quartz Commercial |
$11,219.65
|
| Rate for Payer: Quartz Medicare Advantage |
$10,356.60
|
| Rate for Payer: WEA Trust Commercial |
$9,493.55
|
| Rate for Payer: WPS Commercial |
$12,785.22
|
|
|
TRUNION 43MM SLOTTED TPS CAP AR-9301-43CPC
|
Facility
IP
|
$17,951.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5603587
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,795.99 |
| Max. Negotiated Rate |
$16,514.92 |
| Rate for Payer: Aetna Commercial |
$16,155.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,514.03
|
| Rate for Payer: Cash Price |
$5,385.30
|
| Rate for Payer: Cigna Commercial |
$16,514.92
|
| Rate for Payer: Health EOS Commercial |
$15,976.39
|
| Rate for Payer: HFN Commercial |
$16,514.92
|
| Rate for Payer: Multiplan Commercial |
$14,360.80
|
| Rate for Payer: NAPHCARE Commercial |
$10,770.60
|
| Rate for Payer: Preferred Network Access Commercial |
$16,514.92
|
| Rate for Payer: Quartz Beloit One Network |
$8,795.99
|
| Rate for Payer: Quartz Commercial |
$10,770.60
|
| Rate for Payer: WEA Trust Commercial |
$9,873.05
|
| Rate for Payer: WPS Commercial |
$13,296.31
|
|
|
TRUNION 43MM SLOTTED TPS CAP AR-9301-43CPC
|
Facility
OP
|
$17,951.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5603587
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,026.28 |
| Max. Negotiated Rate |
$16,514.92 |
| Rate for Payer: Aetna Commercial |
$16,155.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$15,437.86
|
| Rate for Payer: Aetna Managed Medicare |
$5,026.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$11,668.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8,975.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$8,616.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,514.03
|
| Rate for Payer: Cash Price |
$5,385.30
|
| Rate for Payer: Cigna Commercial |
$16,514.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$10,045.38
|
| Rate for Payer: Health EOS Commercial |
$15,976.39
|
| Rate for Payer: HFN Commercial |
$16,514.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$13,463.25
|
| Rate for Payer: Multiplan Commercial |
$14,360.80
|
| Rate for Payer: NAPHCARE Commercial |
$10,770.60
|
| Rate for Payer: Preferred Network Access Commercial |
$16,514.92
|
| Rate for Payer: Quartz Beloit One Network |
$8,795.99
|
| Rate for Payer: Quartz Commercial |
$11,668.15
|
| Rate for Payer: Quartz Medicare Advantage |
$10,770.60
|
| Rate for Payer: WEA Trust Commercial |
$9,873.05
|
| Rate for Payer: WPS Commercial |
$13,296.31
|
|
|
TRUNION 45MM SLOTTED TPS CAP AR-9301-45CPC
|
Facility
OP
|
$17,261.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5729774
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,833.08 |
| Max. Negotiated Rate |
$15,880.12 |
| Rate for Payer: Aetna Commercial |
$15,534.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$14,844.46
|
| Rate for Payer: Aetna Managed Medicare |
$4,833.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$11,219.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8,630.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$8,285.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,148.33
|
| Rate for Payer: Cash Price |
$5,178.30
|
| Rate for Payer: Cigna Commercial |
$15,880.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$9,659.26
|
| Rate for Payer: Health EOS Commercial |
$15,362.29
|
| Rate for Payer: HFN Commercial |
$15,880.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$12,945.75
|
| Rate for Payer: Multiplan Commercial |
$13,808.80
|
| Rate for Payer: NAPHCARE Commercial |
$10,356.60
|
| Rate for Payer: Preferred Network Access Commercial |
$15,880.12
|
| Rate for Payer: Quartz Beloit One Network |
$8,457.89
|
| Rate for Payer: Quartz Commercial |
$11,219.65
|
| Rate for Payer: Quartz Medicare Advantage |
$10,356.60
|
| Rate for Payer: WEA Trust Commercial |
$9,493.55
|
| Rate for Payer: WPS Commercial |
$12,785.22
|
|
|
TRUNION 45MM SLOTTED TPS CAP AR-9301-45CPC
|
Facility
IP
|
$17,261.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5729774
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,457.89 |
| Max. Negotiated Rate |
$15,880.12 |
| Rate for Payer: Aetna Commercial |
$15,534.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,148.33
|
| Rate for Payer: Cash Price |
$5,178.30
|
| Rate for Payer: Cigna Commercial |
$15,880.12
|
| Rate for Payer: Health EOS Commercial |
$15,362.29
|
| Rate for Payer: HFN Commercial |
$15,880.12
|
| Rate for Payer: Multiplan Commercial |
$13,808.80
|
| Rate for Payer: NAPHCARE Commercial |
$10,356.60
|
| Rate for Payer: Preferred Network Access Commercial |
$15,880.12
|
| Rate for Payer: Quartz Beloit One Network |
$8,457.89
|
| Rate for Payer: Quartz Commercial |
$10,356.60
|
| Rate for Payer: WEA Trust Commercial |
$9,493.55
|
| Rate for Payer: WPS Commercial |
$12,785.22
|
|
|
TRUNION 47MM SLOTTED TPS CAP AR-9301-47CPC
|
Facility
OP
|
$17,261.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5617680
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,833.08 |
| Max. Negotiated Rate |
$15,880.12 |
| Rate for Payer: Aetna Commercial |
$15,534.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$14,844.46
|
| Rate for Payer: Aetna Managed Medicare |
$4,833.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$11,219.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8,630.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$8,285.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,148.33
|
| Rate for Payer: Cash Price |
$5,178.30
|
| Rate for Payer: Cigna Commercial |
$15,880.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$9,659.26
|
| Rate for Payer: Health EOS Commercial |
$15,362.29
|
| Rate for Payer: HFN Commercial |
$15,880.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$12,945.75
|
| Rate for Payer: Multiplan Commercial |
$13,808.80
|
| Rate for Payer: NAPHCARE Commercial |
$10,356.60
|
| Rate for Payer: Preferred Network Access Commercial |
$15,880.12
|
| Rate for Payer: Quartz Beloit One Network |
$8,457.89
|
| Rate for Payer: Quartz Commercial |
$11,219.65
|
| Rate for Payer: Quartz Medicare Advantage |
$10,356.60
|
| Rate for Payer: WEA Trust Commercial |
$9,493.55
|
| Rate for Payer: WPS Commercial |
$12,785.22
|
|
|
TRUNION 47MM SLOTTED TPS CAP AR-9301-47CPC
|
Facility
IP
|
$17,261.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5617680
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,457.89 |
| Max. Negotiated Rate |
$15,880.12 |
| Rate for Payer: Aetna Commercial |
$15,534.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,148.33
|
| Rate for Payer: Cash Price |
$5,178.30
|
| Rate for Payer: Cigna Commercial |
$15,880.12
|
| Rate for Payer: Health EOS Commercial |
$15,362.29
|
| Rate for Payer: HFN Commercial |
$15,880.12
|
| Rate for Payer: Multiplan Commercial |
$13,808.80
|
| Rate for Payer: NAPHCARE Commercial |
$10,356.60
|
| Rate for Payer: Preferred Network Access Commercial |
$15,880.12
|
| Rate for Payer: Quartz Beloit One Network |
$8,457.89
|
| Rate for Payer: Quartz Commercial |
$10,356.60
|
| Rate for Payer: WEA Trust Commercial |
$9,493.55
|
| Rate for Payer: WPS Commercial |
$12,785.22
|
|
|
TRUNION 49MM SLOTTED TPS CAP AR-9301-49CPC
|
Facility
IP
|
$17,951.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5563218
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,795.99 |
| Max. Negotiated Rate |
$16,514.92 |
| Rate for Payer: Aetna Commercial |
$16,155.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,514.03
|
| Rate for Payer: Cash Price |
$5,385.30
|
| Rate for Payer: Cigna Commercial |
$16,514.92
|
| Rate for Payer: Health EOS Commercial |
$15,976.39
|
| Rate for Payer: HFN Commercial |
$16,514.92
|
| Rate for Payer: Multiplan Commercial |
$14,360.80
|
| Rate for Payer: NAPHCARE Commercial |
$10,770.60
|
| Rate for Payer: Preferred Network Access Commercial |
$16,514.92
|
| Rate for Payer: Quartz Beloit One Network |
$8,795.99
|
| Rate for Payer: Quartz Commercial |
$10,770.60
|
| Rate for Payer: WEA Trust Commercial |
$9,873.05
|
| Rate for Payer: WPS Commercial |
$13,296.31
|
|
|
TRUNION 49MM SLOTTED TPS CAP AR-9301-49CPC
|
Facility
OP
|
$17,951.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
5563218
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,026.28 |
| Max. Negotiated Rate |
$16,514.92 |
| Rate for Payer: Aetna Commercial |
$16,155.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$15,437.86
|
| Rate for Payer: Aetna Managed Medicare |
$5,026.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$11,668.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8,975.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$8,616.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,514.03
|
| Rate for Payer: Cash Price |
$5,385.30
|
| Rate for Payer: Cigna Commercial |
$16,514.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$10,045.38
|
| Rate for Payer: Health EOS Commercial |
$15,976.39
|
| Rate for Payer: HFN Commercial |
$16,514.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$13,463.25
|
| Rate for Payer: Multiplan Commercial |
$14,360.80
|
| Rate for Payer: NAPHCARE Commercial |
$10,770.60
|
| Rate for Payer: Preferred Network Access Commercial |
$16,514.92
|
| Rate for Payer: Quartz Beloit One Network |
$8,795.99
|
| Rate for Payer: Quartz Commercial |
$11,668.15
|
| Rate for Payer: Quartz Medicare Advantage |
$10,770.60
|
| Rate for Payer: WEA Trust Commercial |
$9,873.05
|
| Rate for Payer: WPS Commercial |
$13,296.31
|
|
|
TRUNION 51MM SLOTTED TPS CAP AR-9301-51CPC
|
Facility
IP
|
$16,597.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
6151660
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,132.53 |
| Max. Negotiated Rate |
$15,269.24 |
| Rate for Payer: Aetna Commercial |
$14,937.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$8,796.41
|
| Rate for Payer: Cash Price |
$4,979.10
|
| Rate for Payer: Cigna Commercial |
$15,269.24
|
| Rate for Payer: Health EOS Commercial |
$14,771.33
|
| Rate for Payer: HFN Commercial |
$15,269.24
|
| Rate for Payer: Multiplan Commercial |
$13,277.60
|
| Rate for Payer: NAPHCARE Commercial |
$9,958.20
|
| Rate for Payer: Preferred Network Access Commercial |
$15,269.24
|
| Rate for Payer: Quartz Beloit One Network |
$8,132.53
|
| Rate for Payer: Quartz Commercial |
$9,958.20
|
| Rate for Payer: WEA Trust Commercial |
$9,128.35
|
| Rate for Payer: WPS Commercial |
$12,293.40
|
|
|
TRUNION 51MM SLOTTED TPS CAP AR-9301-51CPC
|
Facility
OP
|
$16,597.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
6151660
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,647.16 |
| Max. Negotiated Rate |
$15,269.24 |
| Rate for Payer: Aetna Commercial |
$14,937.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$14,273.42
|
| Rate for Payer: Aetna Managed Medicare |
$4,647.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$10,788.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8,298.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7,966.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$8,796.41
|
| Rate for Payer: Cash Price |
$4,979.10
|
| Rate for Payer: Cigna Commercial |
$15,269.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$9,287.68
|
| Rate for Payer: Health EOS Commercial |
$14,771.33
|
| Rate for Payer: HFN Commercial |
$15,269.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$12,447.75
|
| Rate for Payer: Multiplan Commercial |
$13,277.60
|
| Rate for Payer: NAPHCARE Commercial |
$9,958.20
|
| Rate for Payer: Preferred Network Access Commercial |
$15,269.24
|
| Rate for Payer: Quartz Beloit One Network |
$8,132.53
|
| Rate for Payer: Quartz Commercial |
$10,788.05
|
| Rate for Payer: Quartz Medicare Advantage |
$9,958.20
|
| Rate for Payer: WEA Trust Commercial |
$9,128.35
|
| Rate for Payer: WPS Commercial |
$12,293.40
|
|
|
Trypan Blue Ophth Solution 0.06% [Med]
|
Facility
IP
|
$401.00
|
|
| Hospital Charge Code |
2974996
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$196.49 |
| Max. Negotiated Rate |
$368.92 |
| Rate for Payer: Aetna Commercial |
$360.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$212.53
|
| Rate for Payer: Cash Price |
$120.30
|
| Rate for Payer: Cigna Commercial |
$368.92
|
| Rate for Payer: Health EOS Commercial |
$356.89
|
| Rate for Payer: HFN Commercial |
$368.92
|
| Rate for Payer: Multiplan Commercial |
$320.80
|
| Rate for Payer: NAPHCARE Commercial |
$240.60
|
| Rate for Payer: Preferred Network Access Commercial |
$368.92
|
| Rate for Payer: Quartz Beloit One Network |
$196.49
|
| Rate for Payer: Quartz Commercial |
$240.60
|
| Rate for Payer: WEA Trust Commercial |
$220.55
|
| Rate for Payer: WPS Commercial |
$297.02
|
|
|
Trypan Blue Ophth Solution 0.06% [Med]
|
Facility
OP
|
$401.00
|
|
| Hospital Charge Code |
2974996
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$112.28 |
| Max. Negotiated Rate |
$1,604.00 |
| Rate for Payer: Aetna Commercial |
$360.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$344.86
|
| Rate for Payer: Aetna Managed Medicare |
$112.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$260.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$200.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$192.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$212.53
|
| Rate for Payer: Cash Price |
$120.30
|
| Rate for Payer: Cigna Commercial |
$368.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$224.40
|
| Rate for Payer: Health EOS Commercial |
$356.89
|
| Rate for Payer: HFN Commercial |
$368.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$300.75
|
| Rate for Payer: Multiplan Commercial |
$320.80
|
| Rate for Payer: NAPHCARE Commercial |
$240.60
|
| Rate for Payer: Preferred Network Access Commercial |
$368.92
|
| Rate for Payer: Quartz Beloit One Network |
$196.49
|
| Rate for Payer: Quartz Commercial |
$260.65
|
| Rate for Payer: Quartz Medicare Advantage |
$240.60
|
| Rate for Payer: The Alliance Commercial |
$1,604.00
|
| Rate for Payer: WEA Trust Commercial |
$220.55
|
| Rate for Payer: WPS Commercial |
$297.02
|
|
|
Trypanosoma cruzi Antibody, IgG
|
Facility
OP
|
$111.00
|
|
|
Service Code
|
CPT 86753
|
| Hospital Charge Code |
5433346
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.17 |
| Max. Negotiated Rate |
$444.00 |
| Rate for Payer: Aetna Commercial |
$99.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$95.46
|
| Rate for Payer: Aetna Managed Medicare |
$12.39
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$46.46
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$21.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$20.57
|
| Rate for Payer: Anthem Medicaid |
$8.17
|
| Rate for Payer: Anthem Medicare Advantage |
$12.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$58.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$12.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$12.39
|
| Rate for Payer: Cash Price |
$33.30
|
| Rate for Payer: Cash Price |
$33.30
|
| Rate for Payer: Cigna Commercial |
$102.12
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$12.39
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$8.17
|
| Rate for Payer: Dean Health Medicaid |
$8.17
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$12.39
|
| Rate for Payer: Health EOS Commercial |
$98.79
|
| Rate for Payer: HFN Commercial |
$102.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$46.09
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$12.39
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$8.17
|
| Rate for Payer: Independent Care Health Plan Medicare |
$12.39
|
| Rate for Payer: Managed Health Services Medicaid |
$8.50
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$12.39
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$12.39
|
| Rate for Payer: Multiplan Commercial |
$88.80
|
| Rate for Payer: NAPHCARE Commercial |
$18.58
|
| Rate for Payer: Preferred Network Access Commercial |
$102.12
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$8.17
|
| Rate for Payer: Quartz Beloit One Network |
$54.39
|
| Rate for Payer: Quartz Commercial |
$72.15
|
| Rate for Payer: Quartz Medicare Advantage |
$12.39
|
| Rate for Payer: The Alliance Commercial |
$444.00
|
| Rate for Payer: United Healthcare Medicaid |
$8.17
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.39
|
| Rate for Payer: United Healthcare PPO |
$83.25
|
| Rate for Payer: WEA Trust Commercial |
$61.05
|
| Rate for Payer: Wellcare Medicare |
$12.39
|
| Rate for Payer: WMAP Medicaid |
$8.17
|
| Rate for Payer: WPS Commercial |
$82.22
|
|
|
Trypanosoma cruzi Antibody, IgG
|
Professional
|
$111.00
|
|
|
Service Code
|
CPT 86753
|
| Hospital Charge Code |
5433346
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.39 |
| Max. Negotiated Rate |
$105.45 |
| Rate for Payer: Aetna Commercial |
$105.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$95.46
|
| Rate for Payer: Aetna Managed Medicare |
$12.39
|
| Rate for Payer: Anthem Medicare Advantage |
$12.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$12.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$12.39
|
| Rate for Payer: Cash Price |
$33.30
|
| Rate for Payer: Cash Price |
$33.30
|
| Rate for Payer: Cigna Commercial |
$105.45
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$55.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12.39
|
| Rate for Payer: Health EOS Commercial |
$101.01
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$43.74
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$43.74
|
| Rate for Payer: Independent Care Health Plan Medicare |
$12.39
|
| Rate for Payer: Multiplan Commercial |
$88.80
|
| Rate for Payer: Preferred Network Access Commercial |
$105.45
|
| Rate for Payer: Quartz Beloit One Network |
$48.84
|
| Rate for Payer: Quartz Commercial |
$63.27
|
| Rate for Payer: Quartz Medicare Advantage |
$12.39
|
| Rate for Payer: The Alliance Commercial |
$48.94
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.39
|
| Rate for Payer: WEA Trust Commercial |
$61.05
|
| Rate for Payer: WPS Commercial |
$54.52
|
|
|
Trypanosoma cruzi Antibody, IgG
|
Facility
IP
|
$111.00
|
|
|
Service Code
|
CPT 86753
|
| Hospital Charge Code |
5433346
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$54.39 |
| Max. Negotiated Rate |
$102.12 |
| Rate for Payer: Aetna Commercial |
$99.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$58.83
|
| Rate for Payer: Cash Price |
$33.30
|
| Rate for Payer: Cigna Commercial |
$102.12
|
| Rate for Payer: Health EOS Commercial |
$98.79
|
| Rate for Payer: HFN Commercial |
$102.12
|
| Rate for Payer: Multiplan Commercial |
$88.80
|
| Rate for Payer: NAPHCARE Commercial |
$66.60
|
| Rate for Payer: Preferred Network Access Commercial |
$102.12
|
| Rate for Payer: Quartz Beloit One Network |
$54.39
|
| Rate for Payer: Quartz Commercial |
$66.60
|
| Rate for Payer: WEA Trust Commercial |
$61.05
|
| Rate for Payer: WPS Commercial |
$82.22
|
|
|
Trypsinogen (Trypsin)
|
Professional
|
$626.00
|
|
|
Service Code
|
CPT 83519
|
| Hospital Charge Code |
978085
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.40 |
| Max. Negotiated Rate |
$594.70 |
| Rate for Payer: Aetna Commercial |
$594.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$538.36
|
| Rate for Payer: Aetna Managed Medicare |
$18.40
|
| Rate for Payer: Anthem Medicare Advantage |
$18.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$18.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$18.40
|
| Rate for Payer: Cash Price |
$187.80
|
| Rate for Payer: Cash Price |
$187.80
|
| Rate for Payer: Cigna Commercial |
$594.70
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$313.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$18.40
|
| Rate for Payer: Health EOS Commercial |
$569.66
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$64.95
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$64.95
|
| Rate for Payer: Independent Care Health Plan Medicare |
$18.40
|
| Rate for Payer: Multiplan Commercial |
$500.80
|
| Rate for Payer: Preferred Network Access Commercial |
$594.70
|
| Rate for Payer: Quartz Beloit One Network |
$275.44
|
| Rate for Payer: Quartz Commercial |
$356.82
|
| Rate for Payer: Quartz Medicare Advantage |
$18.40
|
| Rate for Payer: The Alliance Commercial |
$72.68
|
| Rate for Payer: United Healthcare Medicare Advantage |
$18.40
|
| Rate for Payer: WEA Trust Commercial |
$344.30
|
| Rate for Payer: WPS Commercial |
$80.96
|
|
|
Trypsinogen (Trypsin)
|
Facility
IP
|
$626.00
|
|
|
Service Code
|
CPT 83519
|
| Hospital Charge Code |
978085
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$306.74 |
| Max. Negotiated Rate |
$575.92 |
| Rate for Payer: Aetna Commercial |
$563.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$331.78
|
| Rate for Payer: Cash Price |
$187.80
|
| Rate for Payer: Cigna Commercial |
$575.92
|
| Rate for Payer: Health EOS Commercial |
$557.14
|
| Rate for Payer: HFN Commercial |
$575.92
|
| Rate for Payer: Multiplan Commercial |
$500.80
|
| Rate for Payer: NAPHCARE Commercial |
$375.60
|
| Rate for Payer: Preferred Network Access Commercial |
$575.92
|
| Rate for Payer: Quartz Beloit One Network |
$306.74
|
| Rate for Payer: Quartz Commercial |
$375.60
|
| Rate for Payer: WEA Trust Commercial |
$344.30
|
| Rate for Payer: WPS Commercial |
$463.68
|
|
|
Trypsinogen (Trypsin)
|
Facility
OP
|
$626.00
|
|
|
Service Code
|
CPT 83519
|
| Hospital Charge Code |
978085
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.40 |
| Max. Negotiated Rate |
$2,504.00 |
| Rate for Payer: Aetna Commercial |
$563.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$538.36
|
| Rate for Payer: Aetna Managed Medicare |
$18.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$69.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$32.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$30.54
|
| Rate for Payer: Anthem Medicaid |
$19.00
|
| Rate for Payer: Anthem Medicare Advantage |
$18.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$331.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$18.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$18.40
|
| Rate for Payer: Cash Price |
$187.80
|
| Rate for Payer: Cash Price |
$187.80
|
| Rate for Payer: Cigna Commercial |
$575.92
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$18.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$19.00
|
| Rate for Payer: Dean Health Medicaid |
$19.00
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$18.40
|
| Rate for Payer: Health EOS Commercial |
$557.14
|
| Rate for Payer: HFN Commercial |
$575.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$68.45
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$18.40
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$19.00
|
| Rate for Payer: Independent Care Health Plan Medicare |
$18.40
|
| Rate for Payer: Managed Health Services Medicaid |
$19.76
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$18.40
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$18.40
|
| Rate for Payer: Multiplan Commercial |
$500.80
|
| Rate for Payer: NAPHCARE Commercial |
$27.60
|
| Rate for Payer: Preferred Network Access Commercial |
$575.92
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$19.00
|
| Rate for Payer: Quartz Beloit One Network |
$306.74
|
| Rate for Payer: Quartz Commercial |
$406.90
|
| Rate for Payer: Quartz Medicare Advantage |
$18.40
|
| Rate for Payer: The Alliance Commercial |
$2,504.00
|
| Rate for Payer: United Healthcare Medicaid |
$19.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$18.40
|
| Rate for Payer: United Healthcare PPO |
$469.50
|
| Rate for Payer: WEA Trust Commercial |
$344.30
|
| Rate for Payer: Wellcare Medicare |
$18.40
|
| Rate for Payer: WMAP Medicaid |
$19.00
|
| Rate for Payer: WPS Commercial |
$463.68
|
|
|
Tryptase Total
|
Facility
IP
|
$330.00
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
978086
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$161.70 |
| Max. Negotiated Rate |
$303.60 |
| Rate for Payer: Aetna Commercial |
$297.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$174.90
|
| Rate for Payer: Cash Price |
$99.00
|
| Rate for Payer: Cigna Commercial |
$303.60
|
| Rate for Payer: Health EOS Commercial |
$293.70
|
| Rate for Payer: HFN Commercial |
$303.60
|
| Rate for Payer: Multiplan Commercial |
$264.00
|
| Rate for Payer: NAPHCARE Commercial |
$198.00
|
| Rate for Payer: Preferred Network Access Commercial |
$303.60
|
| Rate for Payer: Quartz Beloit One Network |
$161.70
|
| Rate for Payer: Quartz Commercial |
$198.00
|
| Rate for Payer: WEA Trust Commercial |
$181.50
|
| Rate for Payer: WPS Commercial |
$244.43
|
|
|
Tryptase Total
|
Professional
|
$330.00
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
978086
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.27 |
| Max. Negotiated Rate |
$313.50 |
| Rate for Payer: Aetna Commercial |
$313.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$283.80
|
| 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 |
$99.00
|
| Rate for Payer: Cash Price |
$99.00
|
| Rate for Payer: Cigna Commercial |
$313.50
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$165.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$17.27
|
| Rate for Payer: Health EOS Commercial |
$300.30
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$60.96
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$60.96
|
| Rate for Payer: Independent Care Health Plan Medicare |
$17.27
|
| Rate for Payer: Multiplan Commercial |
$264.00
|
| Rate for Payer: Preferred Network Access Commercial |
$313.50
|
| Rate for Payer: Quartz Beloit One Network |
$145.20
|
| Rate for Payer: Quartz Commercial |
$188.10
|
| Rate for Payer: Quartz Medicare Advantage |
$17.27
|
| Rate for Payer: The Alliance Commercial |
$68.22
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17.27
|
| Rate for Payer: WEA Trust Commercial |
$181.50
|
| Rate for Payer: WPS Commercial |
$75.99
|
|
|
Tryptase Total
|
Facility
OP
|
$330.00
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
978086
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.27 |
| Max. Negotiated Rate |
$1,320.00 |
| Rate for Payer: Aetna Commercial |
$297.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$283.80
|
| Rate for Payer: Aetna Managed Medicare |
$17.27
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$64.76
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$30.22
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$28.67
|
| Rate for Payer: Anthem Medicaid |
$17.85
|
| Rate for Payer: Anthem Medicare Advantage |
$17.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$174.90
|
| 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 |
$99.00
|
| Rate for Payer: Cash Price |
$99.00
|
| Rate for Payer: Cigna Commercial |
$303.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$17.27
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$17.85
|
| Rate for Payer: Dean Health Medicaid |
$17.85
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$17.27
|
| Rate for Payer: Health EOS Commercial |
$293.70
|
| Rate for Payer: HFN Commercial |
$303.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$64.24
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$17.27
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$17.85
|
| Rate for Payer: Independent Care Health Plan Medicare |
$17.27
|
| Rate for Payer: Managed Health Services Medicaid |
$18.56
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$17.27
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$17.27
|
| Rate for Payer: Multiplan Commercial |
$264.00
|
| Rate for Payer: NAPHCARE Commercial |
$25.90
|
| Rate for Payer: Preferred Network Access Commercial |
$303.60
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$17.85
|
| Rate for Payer: Quartz Beloit One Network |
$161.70
|
| Rate for Payer: Quartz Commercial |
$214.50
|
| Rate for Payer: Quartz Medicare Advantage |
$17.27
|
| Rate for Payer: The Alliance Commercial |
$1,320.00
|
| Rate for Payer: United Healthcare Medicaid |
$17.85
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17.27
|
| Rate for Payer: United Healthcare PPO |
$247.50
|
| Rate for Payer: WEA Trust Commercial |
$181.50
|
| Rate for Payer: Wellcare Medicare |
$17.27
|
| Rate for Payer: WMAP Medicaid |
$17.85
|
| Rate for Payer: WPS Commercial |
$244.43
|
|
