|
Toxoplasma Antibody IgM
|
Professional
|
Both
|
$119.00
|
|
|
Service Code
|
CPT 86778
|
| Hospital Charge Code |
2943021
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.99 |
| Max. Negotiated Rate |
$117.57 |
| Rate for Payer: Aetna Commercial |
$117.57
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$106.43
|
| Rate for Payer: Aetna Managed Medicare |
$14.99
|
| Rate for Payer: Anthem Medicare Advantage |
$14.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$14.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$14.99
|
| Rate for Payer: Cash Price |
$35.70
|
| Rate for Payer: Cash Price |
$35.70
|
| Rate for Payer: Cigna Commercial |
$117.57
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$61.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$14.99
|
| Rate for Payer: Health EOS Commercial |
$112.62
|
| Rate for Payer: HFN Commercial |
$117.57
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$52.90
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$52.90
|
| Rate for Payer: Independent Care Health Plan Medicare |
$14.99
|
| Rate for Payer: Multiplan Commercial |
$99.01
|
| Rate for Payer: NAPHCARE Commercial |
$22.48
|
| Rate for Payer: Preferred Network Access Commercial |
$117.57
|
| Rate for Payer: Quartz Beloit One Network |
$54.45
|
| Rate for Payer: Quartz Commercial |
$70.54
|
| Rate for Payer: Quartz Medicare Advantage |
$14.99
|
| Rate for Payer: The Alliance Commercial |
$59.20
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14.99
|
| Rate for Payer: WEA Trust Commercial |
$68.07
|
| Rate for Payer: WPS Commercial |
$65.94
|
|
|
Toxoplasma gondii DNA, Qual, PCR
|
Professional
|
Both
|
$1,028.00
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
983428
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$36.49 |
| Max. Negotiated Rate |
$1,015.66 |
| Rate for Payer: Aetna Commercial |
$1,015.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$919.44
|
| Rate for Payer: Aetna Managed Medicare |
$36.49
|
| Rate for Payer: Anthem Medicare Advantage |
$36.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$36.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$36.49
|
| Rate for Payer: Cash Price |
$308.40
|
| Rate for Payer: Cash Price |
$308.40
|
| Rate for Payer: Cigna Commercial |
$1,015.66
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$534.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$36.49
|
| Rate for Payer: Health EOS Commercial |
$972.90
|
| Rate for Payer: HFN Commercial |
$1,015.66
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$128.82
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$128.82
|
| Rate for Payer: Independent Care Health Plan Medicare |
$36.49
|
| Rate for Payer: Multiplan Commercial |
$855.30
|
| Rate for Payer: NAPHCARE Commercial |
$54.74
|
| Rate for Payer: Preferred Network Access Commercial |
$1,015.66
|
| Rate for Payer: Quartz Beloit One Network |
$470.41
|
| Rate for Payer: Quartz Commercial |
$609.40
|
| Rate for Payer: Quartz Medicare Advantage |
$36.49
|
| Rate for Payer: The Alliance Commercial |
$144.15
|
| Rate for Payer: United Healthcare Medicare Advantage |
$36.49
|
| Rate for Payer: WEA Trust Commercial |
$588.02
|
| Rate for Payer: WPS Commercial |
$160.57
|
|
|
Toxoplasma gondii DNA, Qual, PCR
|
Facility
|
IP
|
$1,028.00
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
983428
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$523.87 |
| Max. Negotiated Rate |
$983.59 |
| Rate for Payer: Aetna Commercial |
$962.21
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$919.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$566.63
|
| Rate for Payer: Cash Price |
$308.40
|
| Rate for Payer: Cigna Commercial |
$983.59
|
| Rate for Payer: Health EOS Commercial |
$951.52
|
| Rate for Payer: HFN Commercial |
$983.59
|
| Rate for Payer: Multiplan Commercial |
$855.30
|
| Rate for Payer: Preferred Network Access Commercial |
$983.59
|
| Rate for Payer: Quartz Beloit One Network |
$523.87
|
| Rate for Payer: Quartz Commercial |
$641.47
|
| Rate for Payer: WEA Trust Commercial |
$588.02
|
| Rate for Payer: WPS Commercial |
$791.87
|
|
|
Toxoplasma gondii DNA, Qual, PCR
|
Facility
|
OP
|
$1,028.00
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
983428
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$36.49 |
| Max. Negotiated Rate |
$983.59 |
| Rate for Payer: Aetna Commercial |
$962.21
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$919.44
|
| Rate for Payer: Aetna Managed Medicare |
$36.49
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$136.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$63.86
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$60.58
|
| Rate for Payer: Anthem Medicare Advantage |
$36.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$566.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$36.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$36.49
|
| Rate for Payer: Cash Price |
$308.40
|
| Rate for Payer: Cash Price |
$308.40
|
| Rate for Payer: Cigna Commercial |
$983.59
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$36.49
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$598.30
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$36.49
|
| Rate for Payer: Health EOS Commercial |
$951.52
|
| Rate for Payer: HFN Commercial |
$983.59
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$135.76
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$36.49
|
| Rate for Payer: Independent Care Health Plan Medicare |
$36.49
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$36.49
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$36.49
|
| Rate for Payer: Multiplan Commercial |
$855.30
|
| Rate for Payer: NAPHCARE Commercial |
$54.74
|
| Rate for Payer: Preferred Network Access Commercial |
$983.59
|
| Rate for Payer: Quartz Beloit One Network |
$523.87
|
| Rate for Payer: Quartz Commercial |
$694.93
|
| Rate for Payer: Quartz Medicare Advantage |
$36.49
|
| Rate for Payer: The Alliance Commercial |
$145.97
|
| Rate for Payer: United Healthcare Medicare Advantage |
$36.49
|
| Rate for Payer: United Healthcare PPO |
$801.84
|
| Rate for Payer: WEA Trust Commercial |
$588.02
|
| Rate for Payer: Wellcare Medicare |
$36.49
|
| Rate for Payer: WPS Commercial |
$791.87
|
|
|
Tox Scr Serum
|
Facility
|
IP
|
$594.00
|
|
|
Service Code
|
CPT 80329
|
| Hospital Charge Code |
979884
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$302.70 |
| Max. Negotiated Rate |
$568.34 |
| Rate for Payer: Aetna Commercial |
$555.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$531.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$327.41
|
| Rate for Payer: Cash Price |
$178.20
|
| Rate for Payer: Cigna Commercial |
$568.34
|
| Rate for Payer: Health EOS Commercial |
$549.81
|
| Rate for Payer: HFN Commercial |
$568.34
|
| Rate for Payer: Multiplan Commercial |
$494.21
|
| Rate for Payer: Preferred Network Access Commercial |
$568.34
|
| Rate for Payer: Quartz Beloit One Network |
$302.70
|
| Rate for Payer: Quartz Commercial |
$370.66
|
| Rate for Payer: WEA Trust Commercial |
$339.77
|
| Rate for Payer: WPS Commercial |
$457.56
|
|
|
Tox Scr Serum
|
Professional
|
Both
|
$594.00
|
|
|
Service Code
|
CPT 80329
|
| Hospital Charge Code |
979884
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$83.26 |
| Max. Negotiated Rate |
$586.87 |
| Rate for Payer: Aetna Commercial |
$586.87
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$531.27
|
| Rate for Payer: Cash Price |
$178.20
|
| Rate for Payer: Cash Price |
$178.20
|
| Rate for Payer: Cigna Commercial |
$586.87
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$308.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$370.66
|
| Rate for Payer: Health EOS Commercial |
$562.16
|
| Rate for Payer: HFN Commercial |
$586.87
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$83.26
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$83.26
|
| Rate for Payer: Multiplan Commercial |
$494.21
|
| Rate for Payer: Preferred Network Access Commercial |
$586.87
|
| Rate for Payer: Quartz Beloit One Network |
$271.81
|
| Rate for Payer: Quartz Commercial |
$352.12
|
| Rate for Payer: The Alliance Commercial |
$308.88
|
| Rate for Payer: WEA Trust Commercial |
$339.77
|
| Rate for Payer: WPS Commercial |
$457.56
|
|
|
Tox Scr Serum
|
Facility
|
OP
|
$594.00
|
|
|
Service Code
|
CPT 80329
|
| Hospital Charge Code |
979884
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$172.97 |
| Max. Negotiated Rate |
$568.34 |
| Rate for Payer: Aetna Commercial |
$555.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$531.27
|
| Rate for Payer: Aetna Managed Medicare |
$172.97
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$401.54
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$308.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$296.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$327.41
|
| Rate for Payer: Cash Price |
$178.20
|
| Rate for Payer: Cigna Commercial |
$568.34
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$345.71
|
| Rate for Payer: Health EOS Commercial |
$549.81
|
| Rate for Payer: HFN Commercial |
$568.34
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$463.32
|
| Rate for Payer: Multiplan Commercial |
$494.21
|
| Rate for Payer: NAPHCARE Commercial |
$370.66
|
| Rate for Payer: Preferred Network Access Commercial |
$568.34
|
| Rate for Payer: Quartz Beloit One Network |
$302.70
|
| Rate for Payer: Quartz Commercial |
$401.54
|
| Rate for Payer: Quartz Medicare Advantage |
$370.66
|
| Rate for Payer: The Alliance Commercial |
$308.88
|
| Rate for Payer: United Healthcare PPO |
$463.32
|
| Rate for Payer: WEA Trust Commercial |
$339.77
|
| Rate for Payer: WPS Commercial |
$457.56
|
|
|
T-PLATE 1.3MM 3H HEAD/8H SHAFT 221.333
|
Facility
|
IP
|
$3,201.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4508594
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,631.23 |
| Max. Negotiated Rate |
$3,062.72 |
| Rate for Payer: Aetna Commercial |
$2,996.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,862.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,764.39
|
| Rate for Payer: Cash Price |
$960.30
|
| Rate for Payer: Cigna Commercial |
$3,062.72
|
| Rate for Payer: Health EOS Commercial |
$2,962.85
|
| Rate for Payer: HFN Commercial |
$3,062.72
|
| Rate for Payer: Multiplan Commercial |
$2,663.23
|
| Rate for Payer: Preferred Network Access Commercial |
$3,062.72
|
| Rate for Payer: Quartz Beloit One Network |
$1,631.23
|
| Rate for Payer: Quartz Commercial |
$1,997.42
|
| Rate for Payer: WEA Trust Commercial |
$1,830.97
|
| Rate for Payer: WPS Commercial |
$2,465.73
|
|
|
T-PLATE 1.3MM 3H HEAD/8H SHAFT 221.333
|
Facility
|
OP
|
$3,201.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4508594
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$932.13 |
| Max. Negotiated Rate |
$3,062.72 |
| Rate for Payer: Aetna Commercial |
$2,996.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,862.97
|
| Rate for Payer: Aetna Managed Medicare |
$932.13
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,163.88
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,664.52
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,597.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,764.39
|
| Rate for Payer: Cash Price |
$960.30
|
| Rate for Payer: Cigna Commercial |
$3,062.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,862.98
|
| Rate for Payer: Health EOS Commercial |
$2,962.85
|
| Rate for Payer: HFN Commercial |
$3,062.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,496.78
|
| Rate for Payer: Multiplan Commercial |
$2,663.23
|
| Rate for Payer: NAPHCARE Commercial |
$1,997.42
|
| Rate for Payer: Preferred Network Access Commercial |
$3,062.72
|
| Rate for Payer: Quartz Beloit One Network |
$1,631.23
|
| Rate for Payer: Quartz Commercial |
$2,163.88
|
| Rate for Payer: Quartz Medicare Advantage |
$1,997.42
|
| Rate for Payer: The Alliance Commercial |
$1,664.52
|
| Rate for Payer: WEA Trust Commercial |
$1,830.97
|
| Rate for Payer: WPS Commercial |
$2,465.73
|
|
|
T-PLATE 1.3MM 4H HEAD/8H SHAFT 221.334
|
Facility
|
IP
|
$3,334.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4508597
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,699.01 |
| Max. Negotiated Rate |
$3,189.97 |
| Rate for Payer: Aetna Commercial |
$3,120.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,981.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,837.70
|
| Rate for Payer: Cash Price |
$1,000.20
|
| Rate for Payer: Cigna Commercial |
$3,189.97
|
| Rate for Payer: Health EOS Commercial |
$3,085.95
|
| Rate for Payer: HFN Commercial |
$3,189.97
|
| Rate for Payer: Multiplan Commercial |
$2,773.89
|
| Rate for Payer: Preferred Network Access Commercial |
$3,189.97
|
| Rate for Payer: Quartz Beloit One Network |
$1,699.01
|
| Rate for Payer: Quartz Commercial |
$2,080.42
|
| Rate for Payer: WEA Trust Commercial |
$1,907.05
|
| Rate for Payer: WPS Commercial |
$2,568.18
|
|
|
T-PLATE 1.3MM 4H HEAD/8H SHAFT 221.334
|
Facility
|
OP
|
$3,334.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4508597
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$970.86 |
| Max. Negotiated Rate |
$3,189.97 |
| Rate for Payer: Aetna Commercial |
$3,120.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,981.93
|
| Rate for Payer: Aetna Managed Medicare |
$970.86
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,253.78
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,733.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,664.33
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,837.70
|
| Rate for Payer: Cash Price |
$1,000.20
|
| Rate for Payer: Cigna Commercial |
$3,189.97
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,940.39
|
| Rate for Payer: Health EOS Commercial |
$3,085.95
|
| Rate for Payer: HFN Commercial |
$3,189.97
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,600.52
|
| Rate for Payer: Multiplan Commercial |
$2,773.89
|
| Rate for Payer: NAPHCARE Commercial |
$2,080.42
|
| Rate for Payer: Preferred Network Access Commercial |
$3,189.97
|
| Rate for Payer: Quartz Beloit One Network |
$1,699.01
|
| Rate for Payer: Quartz Commercial |
$2,253.78
|
| Rate for Payer: Quartz Medicare Advantage |
$2,080.42
|
| Rate for Payer: The Alliance Commercial |
$1,733.68
|
| Rate for Payer: WEA Trust Commercial |
$1,907.05
|
| Rate for Payer: WPS Commercial |
$2,568.18
|
|
|
T-PLATE 2.0 2HEAD 7HL 247.351
|
Facility
|
OP
|
$3,944.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5767801
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,148.49 |
| Max. Negotiated Rate |
$3,773.62 |
| Rate for Payer: Aetna Commercial |
$3,691.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,527.51
|
| Rate for Payer: Aetna Managed Medicare |
$1,148.49
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,666.14
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,050.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,968.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,173.93
|
| Rate for Payer: Cash Price |
$1,183.20
|
| Rate for Payer: Cigna Commercial |
$3,773.62
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,295.41
|
| Rate for Payer: Health EOS Commercial |
$3,650.57
|
| Rate for Payer: HFN Commercial |
$3,773.62
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,076.32
|
| Rate for Payer: Multiplan Commercial |
$3,281.41
|
| Rate for Payer: NAPHCARE Commercial |
$2,461.06
|
| Rate for Payer: Preferred Network Access Commercial |
$3,773.62
|
| Rate for Payer: Quartz Beloit One Network |
$2,009.86
|
| Rate for Payer: Quartz Commercial |
$2,666.14
|
| Rate for Payer: Quartz Medicare Advantage |
$2,461.06
|
| Rate for Payer: The Alliance Commercial |
$2,050.88
|
| Rate for Payer: WEA Trust Commercial |
$2,255.97
|
| Rate for Payer: WPS Commercial |
$3,038.06
|
|
|
T-PLATE 2.0 2HEAD 7HL 247.351
|
Facility
|
IP
|
$3,944.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5767801
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,009.86 |
| Max. Negotiated Rate |
$3,773.62 |
| Rate for Payer: Aetna Commercial |
$3,691.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,527.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,173.93
|
| Rate for Payer: Cash Price |
$1,183.20
|
| Rate for Payer: Cigna Commercial |
$3,773.62
|
| Rate for Payer: Health EOS Commercial |
$3,650.57
|
| Rate for Payer: HFN Commercial |
$3,773.62
|
| Rate for Payer: Multiplan Commercial |
$3,281.41
|
| Rate for Payer: Preferred Network Access Commercial |
$3,773.62
|
| Rate for Payer: Quartz Beloit One Network |
$2,009.86
|
| Rate for Payer: Quartz Commercial |
$2,461.06
|
| Rate for Payer: WEA Trust Commercial |
$2,255.97
|
| Rate for Payer: WPS Commercial |
$3,038.06
|
|
|
T-PLATE 2.4MM 2HL HEAD/8LH SHAFT 249.913
|
Facility
|
OP
|
$4,354.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4508773
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,267.88 |
| Max. Negotiated Rate |
$4,165.91 |
| Rate for Payer: Aetna Commercial |
$4,075.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,894.22
|
| Rate for Payer: Aetna Managed Medicare |
$1,267.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,943.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,264.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,173.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,399.92
|
| Rate for Payer: Cash Price |
$1,306.20
|
| Rate for Payer: Cigna Commercial |
$4,165.91
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,534.03
|
| Rate for Payer: Health EOS Commercial |
$4,030.06
|
| Rate for Payer: HFN Commercial |
$4,165.91
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,396.12
|
| Rate for Payer: Multiplan Commercial |
$3,622.53
|
| Rate for Payer: NAPHCARE Commercial |
$2,716.90
|
| Rate for Payer: Preferred Network Access Commercial |
$4,165.91
|
| Rate for Payer: Quartz Beloit One Network |
$2,218.80
|
| Rate for Payer: Quartz Commercial |
$2,943.30
|
| Rate for Payer: Quartz Medicare Advantage |
$2,716.90
|
| Rate for Payer: The Alliance Commercial |
$2,264.08
|
| Rate for Payer: WEA Trust Commercial |
$2,490.49
|
| Rate for Payer: WPS Commercial |
$3,353.89
|
|
|
T-PLATE 2.4MM 2HL HEAD/8LH SHAFT 249.913
|
Facility
|
IP
|
$4,354.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4508773
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,218.80 |
| Max. Negotiated Rate |
$4,165.91 |
| Rate for Payer: Aetna Commercial |
$4,075.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,894.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,399.92
|
| Rate for Payer: Cash Price |
$1,306.20
|
| Rate for Payer: Cigna Commercial |
$4,165.91
|
| Rate for Payer: Health EOS Commercial |
$4,030.06
|
| Rate for Payer: HFN Commercial |
$4,165.91
|
| Rate for Payer: Multiplan Commercial |
$3,622.53
|
| Rate for Payer: Preferred Network Access Commercial |
$4,165.91
|
| Rate for Payer: Quartz Beloit One Network |
$2,218.80
|
| Rate for Payer: Quartz Commercial |
$2,716.90
|
| Rate for Payer: WEA Trust Commercial |
$2,490.49
|
| Rate for Payer: WPS Commercial |
$3,353.89
|
|
|
T-PLATE 2.4MM 3HL HEAD/8HL SHAFT 249.914
|
Facility
|
OP
|
$4,633.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4508774
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,349.13 |
| Max. Negotiated Rate |
$4,432.85 |
| Rate for Payer: Aetna Commercial |
$4,336.49
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,143.76
|
| Rate for Payer: Aetna Managed Medicare |
$1,349.13
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,131.91
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,409.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,312.79
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,553.71
|
| Rate for Payer: Cash Price |
$1,389.90
|
| Rate for Payer: Cigna Commercial |
$4,432.85
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,696.41
|
| Rate for Payer: Health EOS Commercial |
$4,288.30
|
| Rate for Payer: HFN Commercial |
$4,432.85
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,613.74
|
| Rate for Payer: Multiplan Commercial |
$3,854.66
|
| Rate for Payer: NAPHCARE Commercial |
$2,890.99
|
| Rate for Payer: Preferred Network Access Commercial |
$4,432.85
|
| Rate for Payer: Quartz Beloit One Network |
$2,360.98
|
| Rate for Payer: Quartz Commercial |
$3,131.91
|
| Rate for Payer: Quartz Medicare Advantage |
$2,890.99
|
| Rate for Payer: The Alliance Commercial |
$2,409.16
|
| Rate for Payer: WEA Trust Commercial |
$2,650.08
|
| Rate for Payer: WPS Commercial |
$3,568.80
|
|
|
T-PLATE 2.4MM 3HL HEAD/8HL SHAFT 249.914
|
Facility
|
IP
|
$4,633.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4508774
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,360.98 |
| Max. Negotiated Rate |
$4,432.85 |
| Rate for Payer: Aetna Commercial |
$4,336.49
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,143.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,553.71
|
| Rate for Payer: Cash Price |
$1,389.90
|
| Rate for Payer: Cigna Commercial |
$4,432.85
|
| Rate for Payer: Health EOS Commercial |
$4,288.30
|
| Rate for Payer: HFN Commercial |
$4,432.85
|
| Rate for Payer: Multiplan Commercial |
$3,854.66
|
| Rate for Payer: Preferred Network Access Commercial |
$4,432.85
|
| Rate for Payer: Quartz Beloit One Network |
$2,360.98
|
| Rate for Payer: Quartz Commercial |
$2,890.99
|
| Rate for Payer: WEA Trust Commercial |
$2,650.08
|
| Rate for Payer: WPS Commercial |
$3,568.80
|
|
|
T-PLATE 2.7 3HL SMALL 242.41
|
Facility
|
OP
|
$828.00
|
|
| Hospital Charge Code |
2967327
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$241.11 |
| Max. Negotiated Rate |
$792.23 |
| Rate for Payer: Aetna Commercial |
$775.01
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$740.56
|
| Rate for Payer: Aetna Managed Medicare |
$241.11
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$559.73
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$430.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$413.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$456.39
|
| Rate for Payer: Cash Price |
$248.40
|
| Rate for Payer: Cigna Commercial |
$792.23
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$481.90
|
| Rate for Payer: Health EOS Commercial |
$766.40
|
| Rate for Payer: HFN Commercial |
$792.23
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$645.84
|
| Rate for Payer: Multiplan Commercial |
$688.90
|
| Rate for Payer: NAPHCARE Commercial |
$516.67
|
| Rate for Payer: Preferred Network Access Commercial |
$792.23
|
| Rate for Payer: Quartz Beloit One Network |
$421.95
|
| Rate for Payer: Quartz Commercial |
$559.73
|
| Rate for Payer: Quartz Medicare Advantage |
$516.67
|
| Rate for Payer: The Alliance Commercial |
$430.56
|
| Rate for Payer: WEA Trust Commercial |
$473.62
|
| Rate for Payer: WPS Commercial |
$637.81
|
|
|
T-PLATE 2.7 3HL SMALL 242.41
|
Facility
|
IP
|
$828.00
|
|
| Hospital Charge Code |
2967327
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$421.95 |
| Max. Negotiated Rate |
$792.23 |
| Rate for Payer: Aetna Commercial |
$775.01
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$740.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$456.39
|
| Rate for Payer: Cash Price |
$248.40
|
| Rate for Payer: Cigna Commercial |
$792.23
|
| Rate for Payer: Health EOS Commercial |
$766.40
|
| Rate for Payer: HFN Commercial |
$792.23
|
| Rate for Payer: Multiplan Commercial |
$688.90
|
| Rate for Payer: Preferred Network Access Commercial |
$792.23
|
| Rate for Payer: Quartz Beloit One Network |
$421.95
|
| Rate for Payer: Quartz Commercial |
$516.67
|
| Rate for Payer: WEA Trust Commercial |
$473.62
|
| Rate for Payer: WPS Commercial |
$637.81
|
|
|
T-PLATE 2.7 LCP 2HL HEAD/3HL SHAFT 249.685
|
Facility
|
OP
|
$4,923.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5767804
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,433.58 |
| Max. Negotiated Rate |
$4,710.33 |
| Rate for Payer: Aetna Commercial |
$4,607.93
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,403.13
|
| Rate for Payer: Aetna Managed Medicare |
$1,433.58
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,327.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,559.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,457.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,713.56
|
| Rate for Payer: Cash Price |
$1,476.90
|
| Rate for Payer: Cigna Commercial |
$4,710.33
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,865.19
|
| Rate for Payer: Health EOS Commercial |
$4,556.73
|
| Rate for Payer: HFN Commercial |
$4,710.33
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,839.94
|
| Rate for Payer: Multiplan Commercial |
$4,095.94
|
| Rate for Payer: NAPHCARE Commercial |
$3,071.95
|
| Rate for Payer: Preferred Network Access Commercial |
$4,710.33
|
| Rate for Payer: Quartz Beloit One Network |
$2,508.76
|
| Rate for Payer: Quartz Commercial |
$3,327.95
|
| Rate for Payer: Quartz Medicare Advantage |
$3,071.95
|
| Rate for Payer: The Alliance Commercial |
$2,559.96
|
| Rate for Payer: WEA Trust Commercial |
$2,815.96
|
| Rate for Payer: WPS Commercial |
$3,792.19
|
|
|
T-PLATE 2.7 LCP 2HL HEAD/3HL SHAFT 249.685
|
Facility
|
IP
|
$4,923.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5767804
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,508.76 |
| Max. Negotiated Rate |
$4,710.33 |
| Rate for Payer: Aetna Commercial |
$4,607.93
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,403.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,713.56
|
| Rate for Payer: Cash Price |
$1,476.90
|
| Rate for Payer: Cigna Commercial |
$4,710.33
|
| Rate for Payer: Health EOS Commercial |
$4,556.73
|
| Rate for Payer: HFN Commercial |
$4,710.33
|
| Rate for Payer: Multiplan Commercial |
$4,095.94
|
| Rate for Payer: Preferred Network Access Commercial |
$4,710.33
|
| Rate for Payer: Quartz Beloit One Network |
$2,508.76
|
| Rate for Payer: Quartz Commercial |
$3,071.95
|
| Rate for Payer: WEA Trust Commercial |
$2,815.96
|
| Rate for Payer: WPS Commercial |
$3,792.19
|
|
|
T-PLATE 2.7 LCP 2HL HEAD/4HL SHAFT 249.697
|
Facility
|
IP
|
$4,923.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5767805
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,508.76 |
| Max. Negotiated Rate |
$4,710.33 |
| Rate for Payer: Aetna Commercial |
$4,607.93
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,403.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,713.56
|
| Rate for Payer: Cash Price |
$1,476.90
|
| Rate for Payer: Cigna Commercial |
$4,710.33
|
| Rate for Payer: Health EOS Commercial |
$4,556.73
|
| Rate for Payer: HFN Commercial |
$4,710.33
|
| Rate for Payer: Multiplan Commercial |
$4,095.94
|
| Rate for Payer: Preferred Network Access Commercial |
$4,710.33
|
| Rate for Payer: Quartz Beloit One Network |
$2,508.76
|
| Rate for Payer: Quartz Commercial |
$3,071.95
|
| Rate for Payer: WEA Trust Commercial |
$2,815.96
|
| Rate for Payer: WPS Commercial |
$3,792.19
|
|
|
T-PLATE 2.7 LCP 2HL HEAD/4HL SHAFT 249.697
|
Facility
|
OP
|
$4,923.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5767805
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,433.58 |
| Max. Negotiated Rate |
$4,710.33 |
| Rate for Payer: Aetna Commercial |
$4,607.93
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,403.13
|
| Rate for Payer: Aetna Managed Medicare |
$1,433.58
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,327.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,559.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,457.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,713.56
|
| Rate for Payer: Cash Price |
$1,476.90
|
| Rate for Payer: Cigna Commercial |
$4,710.33
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,865.19
|
| Rate for Payer: Health EOS Commercial |
$4,556.73
|
| Rate for Payer: HFN Commercial |
$4,710.33
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,839.94
|
| Rate for Payer: Multiplan Commercial |
$4,095.94
|
| Rate for Payer: NAPHCARE Commercial |
$3,071.95
|
| Rate for Payer: Preferred Network Access Commercial |
$4,710.33
|
| Rate for Payer: Quartz Beloit One Network |
$2,508.76
|
| Rate for Payer: Quartz Commercial |
$3,327.95
|
| Rate for Payer: Quartz Medicare Advantage |
$3,071.95
|
| Rate for Payer: The Alliance Commercial |
$2,559.96
|
| Rate for Payer: WEA Trust Commercial |
$2,815.96
|
| Rate for Payer: WPS Commercial |
$3,792.19
|
|
|
T-PLATE 3HL HEAD/7HL SHAFT 2.0
|
Facility
|
OP
|
$5,608.00
|
|
| Hospital Charge Code |
2966589
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,633.05 |
| Max. Negotiated Rate |
$5,365.73 |
| Rate for Payer: Aetna Commercial |
$5,249.09
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,015.80
|
| Rate for Payer: Aetna Managed Medicare |
$1,633.05
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,791.01
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,916.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,799.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,091.13
|
| Rate for Payer: Cash Price |
$1,682.40
|
| Rate for Payer: Cigna Commercial |
$5,365.73
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,263.86
|
| Rate for Payer: Health EOS Commercial |
$5,190.76
|
| Rate for Payer: HFN Commercial |
$5,365.73
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,374.24
|
| Rate for Payer: Multiplan Commercial |
$4,665.86
|
| Rate for Payer: NAPHCARE Commercial |
$3,499.39
|
| Rate for Payer: Preferred Network Access Commercial |
$5,365.73
|
| Rate for Payer: Quartz Beloit One Network |
$2,857.84
|
| Rate for Payer: Quartz Commercial |
$3,791.01
|
| Rate for Payer: Quartz Medicare Advantage |
$3,499.39
|
| Rate for Payer: The Alliance Commercial |
$2,916.16
|
| Rate for Payer: WEA Trust Commercial |
$3,207.78
|
| Rate for Payer: WPS Commercial |
$4,319.84
|
|
|
T-PLATE 3HL HEAD/7HL SHAFT 2.0
|
Facility
|
IP
|
$5,608.00
|
|
| Hospital Charge Code |
2966589
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,857.84 |
| Max. Negotiated Rate |
$5,365.73 |
| Rate for Payer: Aetna Commercial |
$5,249.09
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,015.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,091.13
|
| Rate for Payer: Cash Price |
$1,682.40
|
| Rate for Payer: Cigna Commercial |
$5,365.73
|
| Rate for Payer: Health EOS Commercial |
$5,190.76
|
| Rate for Payer: HFN Commercial |
$5,365.73
|
| Rate for Payer: Multiplan Commercial |
$4,665.86
|
| Rate for Payer: Preferred Network Access Commercial |
$5,365.73
|
| Rate for Payer: Quartz Beloit One Network |
$2,857.84
|
| Rate for Payer: Quartz Commercial |
$3,499.39
|
| Rate for Payer: WEA Trust Commercial |
$3,207.78
|
| Rate for Payer: WPS Commercial |
$4,319.84
|
|
