|
T-PLATE NARROW LOCK 2.7MM 3 X 10 HOLE 629785
|
Facility
|
IP
|
$5,657.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5685716
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,771.93 |
| Max. Negotiated Rate |
$5,204.44 |
| Rate for Payer: Aetna Commercial |
$5,091.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,865.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,998.21
|
| Rate for Payer: Cash Price |
$1,697.10
|
| Rate for Payer: Cigna Commercial |
$5,204.44
|
| Rate for Payer: Health EOS Commercial |
$5,034.73
|
| Rate for Payer: HFN Commercial |
$5,204.44
|
| Rate for Payer: Multiplan Commercial |
$4,525.60
|
| Rate for Payer: NAPHCARE Commercial |
$3,394.20
|
| Rate for Payer: Preferred Network Access Commercial |
$5,204.44
|
| Rate for Payer: Quartz Beloit One Network |
$2,771.93
|
| Rate for Payer: Quartz Commercial |
$3,394.20
|
| Rate for Payer: WEA Trust Commercial |
$3,111.35
|
| Rate for Payer: WPS Commercial |
$4,190.14
|
|
|
T-PLATE NARROW LOCK 2.7MM 3 X 10 HOLE 629785
|
Facility
|
OP
|
$5,657.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5685716
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,583.96 |
| Max. Negotiated Rate |
$22,628.00 |
| Rate for Payer: Aetna Commercial |
$5,091.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,865.02
|
| Rate for Payer: Aetna Managed Medicare |
$1,583.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,677.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,828.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,715.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,998.21
|
| Rate for Payer: Cash Price |
$1,697.10
|
| Rate for Payer: Cigna Commercial |
$5,204.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,165.66
|
| Rate for Payer: Health EOS Commercial |
$5,034.73
|
| Rate for Payer: HFN Commercial |
$5,204.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,242.75
|
| Rate for Payer: Multiplan Commercial |
$4,525.60
|
| Rate for Payer: NAPHCARE Commercial |
$3,394.20
|
| Rate for Payer: Preferred Network Access Commercial |
$5,204.44
|
| Rate for Payer: Quartz Beloit One Network |
$2,771.93
|
| Rate for Payer: Quartz Commercial |
$3,677.05
|
| Rate for Payer: Quartz Medicare Advantage |
$3,394.20
|
| Rate for Payer: The Alliance Commercial |
$22,628.00
|
| Rate for Payer: WEA Trust Commercial |
$3,111.35
|
| Rate for Payer: WPS Commercial |
$4,190.14
|
|
|
T-PLATE OBLIQUE 3HL 241.23
|
Facility
|
IP
|
$799.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2967331
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$391.51 |
| Max. Negotiated Rate |
$735.08 |
| Rate for Payer: Aetna Commercial |
$719.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$687.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$423.47
|
| Rate for Payer: Cash Price |
$239.70
|
| Rate for Payer: Cigna Commercial |
$735.08
|
| Rate for Payer: Health EOS Commercial |
$711.11
|
| Rate for Payer: HFN Commercial |
$735.08
|
| Rate for Payer: Multiplan Commercial |
$639.20
|
| Rate for Payer: NAPHCARE Commercial |
$479.40
|
| Rate for Payer: Preferred Network Access Commercial |
$735.08
|
| Rate for Payer: Quartz Beloit One Network |
$391.51
|
| Rate for Payer: Quartz Commercial |
$479.40
|
| Rate for Payer: WEA Trust Commercial |
$439.45
|
| Rate for Payer: WPS Commercial |
$591.82
|
|
|
T-PLATE OBLIQUE 3HL 241.23
|
Facility
|
OP
|
$799.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2967331
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$223.72 |
| Max. Negotiated Rate |
$3,196.00 |
| Rate for Payer: Aetna Commercial |
$719.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$687.14
|
| Rate for Payer: Aetna Managed Medicare |
$223.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$519.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$399.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$383.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$423.47
|
| Rate for Payer: Cash Price |
$239.70
|
| Rate for Payer: Cigna Commercial |
$735.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$447.12
|
| Rate for Payer: Health EOS Commercial |
$711.11
|
| Rate for Payer: HFN Commercial |
$735.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$599.25
|
| Rate for Payer: Multiplan Commercial |
$639.20
|
| Rate for Payer: NAPHCARE Commercial |
$479.40
|
| Rate for Payer: Preferred Network Access Commercial |
$735.08
|
| Rate for Payer: Quartz Beloit One Network |
$391.51
|
| Rate for Payer: Quartz Commercial |
$519.35
|
| Rate for Payer: Quartz Medicare Advantage |
$479.40
|
| Rate for Payer: The Alliance Commercial |
$3,196.00
|
| Rate for Payer: WEA Trust Commercial |
$439.45
|
| Rate for Payer: WPS Commercial |
$591.82
|
|
|
T-PLATE OBLIQUE 5HL 241.25
|
Facility
|
IP
|
$730.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2967332
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$357.70 |
| Max. Negotiated Rate |
$671.60 |
| Rate for Payer: Aetna Commercial |
$657.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$627.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$386.90
|
| Rate for Payer: Cash Price |
$219.00
|
| Rate for Payer: Cigna Commercial |
$671.60
|
| Rate for Payer: Health EOS Commercial |
$649.70
|
| Rate for Payer: HFN Commercial |
$671.60
|
| Rate for Payer: Multiplan Commercial |
$584.00
|
| Rate for Payer: NAPHCARE Commercial |
$438.00
|
| Rate for Payer: Preferred Network Access Commercial |
$671.60
|
| Rate for Payer: Quartz Beloit One Network |
$357.70
|
| Rate for Payer: Quartz Commercial |
$438.00
|
| Rate for Payer: WEA Trust Commercial |
$401.50
|
| Rate for Payer: WPS Commercial |
$540.71
|
|
|
T-PLATE OBLIQUE 5HL 241.25
|
Facility
|
OP
|
$730.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2967332
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$204.40 |
| Max. Negotiated Rate |
$2,920.00 |
| Rate for Payer: Aetna Commercial |
$657.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$627.80
|
| Rate for Payer: Aetna Managed Medicare |
$204.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$474.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$365.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$350.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$386.90
|
| Rate for Payer: Cash Price |
$219.00
|
| Rate for Payer: Cigna Commercial |
$671.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$408.51
|
| Rate for Payer: Health EOS Commercial |
$649.70
|
| Rate for Payer: HFN Commercial |
$671.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$547.50
|
| Rate for Payer: Multiplan Commercial |
$584.00
|
| Rate for Payer: NAPHCARE Commercial |
$438.00
|
| Rate for Payer: Preferred Network Access Commercial |
$671.60
|
| Rate for Payer: Quartz Beloit One Network |
$357.70
|
| Rate for Payer: Quartz Commercial |
$474.50
|
| Rate for Payer: Quartz Medicare Advantage |
$438.00
|
| Rate for Payer: The Alliance Commercial |
$2,920.00
|
| Rate for Payer: WEA Trust Commercial |
$401.50
|
| Rate for Payer: WPS Commercial |
$540.71
|
|
|
TPMT Activity
|
Facility
|
IP
|
$564.00
|
|
|
Service Code
|
CPT 82657
|
| Hospital Charge Code |
5438799
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$276.36 |
| Max. Negotiated Rate |
$518.88 |
| Rate for Payer: Aetna Commercial |
$507.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$485.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$298.92
|
| Rate for Payer: Cash Price |
$169.20
|
| Rate for Payer: Cigna Commercial |
$518.88
|
| Rate for Payer: Health EOS Commercial |
$501.96
|
| Rate for Payer: HFN Commercial |
$518.88
|
| Rate for Payer: Multiplan Commercial |
$451.20
|
| Rate for Payer: NAPHCARE Commercial |
$338.40
|
| Rate for Payer: Preferred Network Access Commercial |
$518.88
|
| Rate for Payer: Quartz Beloit One Network |
$276.36
|
| Rate for Payer: Quartz Commercial |
$338.40
|
| Rate for Payer: WEA Trust Commercial |
$310.20
|
| Rate for Payer: WPS Commercial |
$417.75
|
|
|
TPMT Activity
|
Facility
|
OP
|
$564.00
|
|
|
Service Code
|
CPT 82657
|
| Hospital Charge Code |
5438799
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$22.17 |
| Max. Negotiated Rate |
$518.88 |
| Rate for Payer: Aetna Commercial |
$507.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$485.04
|
| Rate for Payer: Aetna Managed Medicare |
$22.17
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$83.14
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$38.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$36.80
|
| Rate for Payer: Anthem Medicaid |
$22.91
|
| Rate for Payer: Anthem Medicare Advantage |
$22.17
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$298.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$22.17
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$22.17
|
| Rate for Payer: Cash Price |
$169.20
|
| Rate for Payer: Cash Price |
$169.20
|
| Rate for Payer: Cigna Commercial |
$518.88
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$22.17
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$22.91
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$315.61
|
| Rate for Payer: Dean Health Medicaid |
$22.91
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$22.17
|
| Rate for Payer: Health EOS Commercial |
$501.96
|
| Rate for Payer: HFN Commercial |
$518.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$82.47
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$22.17
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$22.91
|
| Rate for Payer: Independent Care Health Plan Medicare |
$22.17
|
| Rate for Payer: Managed Health Services Medicaid |
$23.83
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$22.17
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$22.17
|
| Rate for Payer: Multiplan Commercial |
$451.20
|
| Rate for Payer: NAPHCARE Commercial |
$33.26
|
| Rate for Payer: Preferred Network Access Commercial |
$518.88
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$22.91
|
| Rate for Payer: Quartz Beloit One Network |
$276.36
|
| Rate for Payer: Quartz Commercial |
$366.60
|
| Rate for Payer: Quartz Medicare Advantage |
$22.17
|
| Rate for Payer: The Alliance Commercial |
$88.68
|
| Rate for Payer: United Healthcare Medicaid |
$22.91
|
| Rate for Payer: United Healthcare Medicare Advantage |
$22.17
|
| Rate for Payer: United Healthcare PPO |
$423.00
|
| Rate for Payer: WEA Trust Commercial |
$310.20
|
| Rate for Payer: Wellcare Medicare |
$22.17
|
| Rate for Payer: WMAP Medicaid |
$22.91
|
| Rate for Payer: WPS Commercial |
$417.75
|
|
|
TPMT Activity
|
Professional
|
Both
|
$564.00
|
|
|
Service Code
|
CPT 82657
|
| Hospital Charge Code |
5438799
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$78.26 |
| Max. Negotiated Rate |
$535.80 |
| Rate for Payer: Aetna Commercial |
$535.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$485.04
|
| Rate for Payer: Cash Price |
$169.20
|
| Rate for Payer: Cash Price |
$169.20
|
| Rate for Payer: Cigna Commercial |
$535.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$282.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$338.40
|
| Rate for Payer: Health EOS Commercial |
$513.24
|
| Rate for Payer: HFN Commercial |
$535.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$78.26
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$78.26
|
| Rate for Payer: Multiplan Commercial |
$451.20
|
| Rate for Payer: Preferred Network Access Commercial |
$535.80
|
| Rate for Payer: Quartz Beloit One Network |
$248.16
|
| Rate for Payer: Quartz Commercial |
$321.48
|
| Rate for Payer: The Alliance Commercial |
$282.00
|
| Rate for Payer: WEA Trust Commercial |
$310.20
|
| Rate for Payer: WPS Commercial |
$417.75
|
|
|
TPMT Amplification
|
Professional
|
Both
|
$181.00
|
|
| Hospital Charge Code |
2778838
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$79.64 |
| Max. Negotiated Rate |
$171.95 |
| Rate for Payer: Aetna Commercial |
$171.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$155.66
|
| Rate for Payer: Cash Price |
$54.30
|
| Rate for Payer: Cigna Commercial |
$171.95
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$90.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$108.60
|
| Rate for Payer: Health EOS Commercial |
$164.71
|
| Rate for Payer: HFN Commercial |
$171.95
|
| Rate for Payer: Multiplan Commercial |
$144.80
|
| Rate for Payer: Preferred Network Access Commercial |
$171.95
|
| Rate for Payer: Quartz Beloit One Network |
$79.64
|
| Rate for Payer: Quartz Commercial |
$103.17
|
| Rate for Payer: The Alliance Commercial |
$90.50
|
| Rate for Payer: WEA Trust Commercial |
$99.55
|
| Rate for Payer: WPS Commercial |
$134.07
|
|
|
TPMT Amplification
|
Facility
|
IP
|
$181.00
|
|
| Hospital Charge Code |
2778838
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$88.69 |
| Max. Negotiated Rate |
$166.52 |
| Rate for Payer: Aetna Commercial |
$162.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$155.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$95.93
|
| Rate for Payer: Cash Price |
$54.30
|
| Rate for Payer: Cigna Commercial |
$166.52
|
| Rate for Payer: Health EOS Commercial |
$161.09
|
| Rate for Payer: HFN Commercial |
$166.52
|
| Rate for Payer: Multiplan Commercial |
$144.80
|
| Rate for Payer: NAPHCARE Commercial |
$108.60
|
| Rate for Payer: Preferred Network Access Commercial |
$166.52
|
| Rate for Payer: Quartz Beloit One Network |
$88.69
|
| Rate for Payer: Quartz Commercial |
$108.60
|
| Rate for Payer: WEA Trust Commercial |
$99.55
|
| Rate for Payer: WPS Commercial |
$134.07
|
|
|
TPMT Amplification
|
Facility
|
OP
|
$181.00
|
|
| Hospital Charge Code |
2778838
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$50.68 |
| Max. Negotiated Rate |
$724.00 |
| Rate for Payer: Aetna Commercial |
$162.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$155.66
|
| Rate for Payer: Aetna Managed Medicare |
$50.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$117.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$90.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$86.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$95.93
|
| Rate for Payer: Cash Price |
$54.30
|
| Rate for Payer: Cigna Commercial |
$166.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$101.29
|
| Rate for Payer: Health EOS Commercial |
$161.09
|
| Rate for Payer: HFN Commercial |
$166.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$135.75
|
| Rate for Payer: Multiplan Commercial |
$144.80
|
| Rate for Payer: NAPHCARE Commercial |
$108.60
|
| Rate for Payer: Preferred Network Access Commercial |
$166.52
|
| Rate for Payer: Quartz Beloit One Network |
$88.69
|
| Rate for Payer: Quartz Commercial |
$117.65
|
| Rate for Payer: Quartz Medicare Advantage |
$108.60
|
| Rate for Payer: The Alliance Commercial |
$724.00
|
| Rate for Payer: United Healthcare PPO |
$135.75
|
| Rate for Payer: WEA Trust Commercial |
$99.55
|
| Rate for Payer: WPS Commercial |
$134.07
|
|
|
TPMT Chromatography
|
Facility
|
IP
|
$313.00
|
|
|
Service Code
|
CPT 82542
|
| Hospital Charge Code |
2778839
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$153.37 |
| Max. Negotiated Rate |
$287.96 |
| Rate for Payer: Aetna Commercial |
$281.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$269.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$165.89
|
| Rate for Payer: Cash Price |
$93.90
|
| Rate for Payer: Cigna Commercial |
$287.96
|
| Rate for Payer: Health EOS Commercial |
$278.57
|
| Rate for Payer: HFN Commercial |
$287.96
|
| Rate for Payer: Multiplan Commercial |
$250.40
|
| Rate for Payer: NAPHCARE Commercial |
$187.80
|
| Rate for Payer: Preferred Network Access Commercial |
$287.96
|
| Rate for Payer: Quartz Beloit One Network |
$153.37
|
| Rate for Payer: Quartz Commercial |
$187.80
|
| Rate for Payer: WEA Trust Commercial |
$172.15
|
| Rate for Payer: WPS Commercial |
$231.84
|
|
|
TPMT Chromatography
|
Facility
|
OP
|
$313.00
|
|
|
Service Code
|
CPT 82542
|
| Hospital Charge Code |
2778839
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$24.09 |
| Max. Negotiated Rate |
$287.96 |
| Rate for Payer: Aetna Commercial |
$281.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$269.18
|
| Rate for Payer: Aetna Managed Medicare |
$24.09
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$90.34
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$42.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$39.99
|
| Rate for Payer: Anthem Medicaid |
$24.89
|
| Rate for Payer: Anthem Medicare Advantage |
$24.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$165.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$24.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$24.09
|
| Rate for Payer: Cash Price |
$93.90
|
| Rate for Payer: Cash Price |
$93.90
|
| Rate for Payer: Cigna Commercial |
$287.96
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$24.09
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$24.89
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$175.15
|
| Rate for Payer: Dean Health Medicaid |
$24.89
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$24.09
|
| Rate for Payer: Health EOS Commercial |
$278.57
|
| Rate for Payer: HFN Commercial |
$287.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$89.61
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$24.09
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$24.89
|
| Rate for Payer: Independent Care Health Plan Medicare |
$24.09
|
| Rate for Payer: Managed Health Services Medicaid |
$25.89
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$24.09
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$24.09
|
| Rate for Payer: Multiplan Commercial |
$250.40
|
| Rate for Payer: NAPHCARE Commercial |
$36.14
|
| Rate for Payer: Preferred Network Access Commercial |
$287.96
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$24.89
|
| Rate for Payer: Quartz Beloit One Network |
$153.37
|
| Rate for Payer: Quartz Commercial |
$203.45
|
| Rate for Payer: Quartz Medicare Advantage |
$24.09
|
| Rate for Payer: The Alliance Commercial |
$96.36
|
| Rate for Payer: United Healthcare Medicaid |
$24.89
|
| Rate for Payer: United Healthcare Medicare Advantage |
$24.09
|
| Rate for Payer: United Healthcare PPO |
$234.75
|
| Rate for Payer: WEA Trust Commercial |
$172.15
|
| Rate for Payer: Wellcare Medicare |
$24.09
|
| Rate for Payer: WMAP Medicaid |
$24.89
|
| Rate for Payer: WPS Commercial |
$231.84
|
|
|
TPMT Chromatography
|
Professional
|
Both
|
$313.00
|
|
|
Service Code
|
CPT 82542
|
| Hospital Charge Code |
2778839
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$85.04 |
| Max. Negotiated Rate |
$297.35 |
| Rate for Payer: Aetna Commercial |
$297.35
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$269.18
|
| Rate for Payer: Cash Price |
$93.90
|
| Rate for Payer: Cash Price |
$93.90
|
| Rate for Payer: Cigna Commercial |
$297.35
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$156.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$187.80
|
| Rate for Payer: Health EOS Commercial |
$284.83
|
| Rate for Payer: HFN Commercial |
$297.35
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$85.04
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$85.04
|
| Rate for Payer: Multiplan Commercial |
$250.40
|
| Rate for Payer: Preferred Network Access Commercial |
$297.35
|
| Rate for Payer: Quartz Beloit One Network |
$137.72
|
| Rate for Payer: Quartz Commercial |
$178.41
|
| Rate for Payer: The Alliance Commercial |
$156.50
|
| Rate for Payer: WEA Trust Commercial |
$172.15
|
| Rate for Payer: WPS Commercial |
$231.84
|
|
|
TPMT Enzyme Activity
|
Professional
|
Both
|
$313.00
|
|
|
Service Code
|
CPT 82657
|
| Hospital Charge Code |
2778840
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$78.26 |
| Max. Negotiated Rate |
$297.35 |
| Rate for Payer: Aetna Commercial |
$297.35
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$269.18
|
| Rate for Payer: Cash Price |
$93.90
|
| Rate for Payer: Cash Price |
$93.90
|
| Rate for Payer: Cigna Commercial |
$297.35
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$156.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$187.80
|
| Rate for Payer: Health EOS Commercial |
$284.83
|
| Rate for Payer: HFN Commercial |
$297.35
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$78.26
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$78.26
|
| Rate for Payer: Multiplan Commercial |
$250.40
|
| Rate for Payer: Preferred Network Access Commercial |
$297.35
|
| Rate for Payer: Quartz Beloit One Network |
$137.72
|
| Rate for Payer: Quartz Commercial |
$178.41
|
| Rate for Payer: The Alliance Commercial |
$156.50
|
| Rate for Payer: WEA Trust Commercial |
$172.15
|
| Rate for Payer: WPS Commercial |
$231.84
|
|
|
TPMT Enzyme Activity
|
Facility
|
OP
|
$313.00
|
|
|
Service Code
|
CPT 82657
|
| Hospital Charge Code |
2778840
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$22.17 |
| Max. Negotiated Rate |
$287.96 |
| Rate for Payer: Aetna Commercial |
$281.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$269.18
|
| Rate for Payer: Aetna Managed Medicare |
$22.17
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$83.14
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$38.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$36.80
|
| Rate for Payer: Anthem Medicaid |
$22.91
|
| Rate for Payer: Anthem Medicare Advantage |
$22.17
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$165.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$22.17
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$22.17
|
| Rate for Payer: Cash Price |
$93.90
|
| Rate for Payer: Cash Price |
$93.90
|
| Rate for Payer: Cigna Commercial |
$287.96
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$22.17
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$22.91
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$175.15
|
| Rate for Payer: Dean Health Medicaid |
$22.91
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$22.17
|
| Rate for Payer: Health EOS Commercial |
$278.57
|
| Rate for Payer: HFN Commercial |
$287.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$82.47
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$22.17
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$22.91
|
| Rate for Payer: Independent Care Health Plan Medicare |
$22.17
|
| Rate for Payer: Managed Health Services Medicaid |
$23.83
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$22.17
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$22.17
|
| Rate for Payer: Multiplan Commercial |
$250.40
|
| Rate for Payer: NAPHCARE Commercial |
$33.26
|
| Rate for Payer: Preferred Network Access Commercial |
$287.96
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$22.91
|
| Rate for Payer: Quartz Beloit One Network |
$153.37
|
| Rate for Payer: Quartz Commercial |
$203.45
|
| Rate for Payer: Quartz Medicare Advantage |
$22.17
|
| Rate for Payer: The Alliance Commercial |
$88.68
|
| Rate for Payer: United Healthcare Medicaid |
$22.91
|
| Rate for Payer: United Healthcare Medicare Advantage |
$22.17
|
| Rate for Payer: United Healthcare PPO |
$234.75
|
| Rate for Payer: WEA Trust Commercial |
$172.15
|
| Rate for Payer: Wellcare Medicare |
$22.17
|
| Rate for Payer: WMAP Medicaid |
$22.91
|
| Rate for Payer: WPS Commercial |
$231.84
|
|
|
TPMT Enzyme Activity
|
Facility
|
IP
|
$313.00
|
|
|
Service Code
|
CPT 82657
|
| Hospital Charge Code |
2778840
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$153.37 |
| Max. Negotiated Rate |
$287.96 |
| Rate for Payer: Aetna Commercial |
$281.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$269.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$165.89
|
| Rate for Payer: Cash Price |
$93.90
|
| Rate for Payer: Cigna Commercial |
$287.96
|
| Rate for Payer: Health EOS Commercial |
$278.57
|
| Rate for Payer: HFN Commercial |
$287.96
|
| Rate for Payer: Multiplan Commercial |
$250.40
|
| Rate for Payer: NAPHCARE Commercial |
$187.80
|
| Rate for Payer: Preferred Network Access Commercial |
$287.96
|
| Rate for Payer: Quartz Beloit One Network |
$153.37
|
| Rate for Payer: Quartz Commercial |
$187.80
|
| Rate for Payer: WEA Trust Commercial |
$172.15
|
| Rate for Payer: WPS Commercial |
$231.84
|
|
|
TPMT Interp & Report
|
Facility
|
IP
|
$44.00
|
|
| Hospital Charge Code |
2778843
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$21.56 |
| Max. Negotiated Rate |
$40.48 |
| Rate for Payer: Aetna Commercial |
$39.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$37.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$23.32
|
| Rate for Payer: Cash Price |
$13.20
|
| Rate for Payer: Cigna Commercial |
$40.48
|
| Rate for Payer: Health EOS Commercial |
$39.16
|
| Rate for Payer: HFN Commercial |
$40.48
|
| Rate for Payer: Multiplan Commercial |
$35.20
|
| Rate for Payer: NAPHCARE Commercial |
$26.40
|
| Rate for Payer: Preferred Network Access Commercial |
$40.48
|
| Rate for Payer: Quartz Beloit One Network |
$21.56
|
| Rate for Payer: Quartz Commercial |
$26.40
|
| Rate for Payer: WEA Trust Commercial |
$24.20
|
| Rate for Payer: WPS Commercial |
$32.59
|
|
|
TPMT Interp & Report
|
Professional
|
Both
|
$44.00
|
|
| Hospital Charge Code |
2778843
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$19.36 |
| Max. Negotiated Rate |
$41.80 |
| Rate for Payer: Aetna Commercial |
$41.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$37.84
|
| Rate for Payer: Cash Price |
$13.20
|
| Rate for Payer: Cigna Commercial |
$41.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$22.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$26.40
|
| Rate for Payer: Health EOS Commercial |
$40.04
|
| Rate for Payer: HFN Commercial |
$41.80
|
| Rate for Payer: Multiplan Commercial |
$35.20
|
| Rate for Payer: Preferred Network Access Commercial |
$41.80
|
| Rate for Payer: Quartz Beloit One Network |
$19.36
|
| Rate for Payer: Quartz Commercial |
$25.08
|
| Rate for Payer: The Alliance Commercial |
$22.00
|
| Rate for Payer: WEA Trust Commercial |
$24.20
|
| Rate for Payer: WPS Commercial |
$32.59
|
|
|
TPMT Interp & Report
|
Facility
|
OP
|
$44.00
|
|
| Hospital Charge Code |
2778843
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.32 |
| Max. Negotiated Rate |
$176.00 |
| Rate for Payer: Aetna Commercial |
$39.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$37.84
|
| Rate for Payer: Aetna Managed Medicare |
$12.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$28.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$22.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$21.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$23.32
|
| Rate for Payer: Cash Price |
$13.20
|
| Rate for Payer: Cigna Commercial |
$40.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$24.62
|
| Rate for Payer: Health EOS Commercial |
$39.16
|
| Rate for Payer: HFN Commercial |
$40.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$33.00
|
| Rate for Payer: Multiplan Commercial |
$35.20
|
| Rate for Payer: NAPHCARE Commercial |
$26.40
|
| Rate for Payer: Preferred Network Access Commercial |
$40.48
|
| Rate for Payer: Quartz Beloit One Network |
$21.56
|
| Rate for Payer: Quartz Commercial |
$28.60
|
| Rate for Payer: Quartz Medicare Advantage |
$26.40
|
| Rate for Payer: The Alliance Commercial |
$176.00
|
| Rate for Payer: United Healthcare PPO |
$33.00
|
| Rate for Payer: WEA Trust Commercial |
$24.20
|
| Rate for Payer: WPS Commercial |
$32.59
|
|
|
TPMT Lysis
|
Facility
|
OP
|
$61.00
|
|
| Hospital Charge Code |
2778844
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.08 |
| Max. Negotiated Rate |
$244.00 |
| Rate for Payer: Aetna Commercial |
$54.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$52.46
|
| Rate for Payer: Aetna Managed Medicare |
$17.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$39.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$30.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$29.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$32.33
|
| Rate for Payer: Cash Price |
$18.30
|
| Rate for Payer: Cigna Commercial |
$56.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$34.14
|
| Rate for Payer: Health EOS Commercial |
$54.29
|
| Rate for Payer: HFN Commercial |
$56.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$45.75
|
| Rate for Payer: Multiplan Commercial |
$48.80
|
| Rate for Payer: NAPHCARE Commercial |
$36.60
|
| Rate for Payer: Preferred Network Access Commercial |
$56.12
|
| Rate for Payer: Quartz Beloit One Network |
$29.89
|
| Rate for Payer: Quartz Commercial |
$39.65
|
| Rate for Payer: Quartz Medicare Advantage |
$36.60
|
| Rate for Payer: The Alliance Commercial |
$244.00
|
| Rate for Payer: United Healthcare PPO |
$45.75
|
| Rate for Payer: WEA Trust Commercial |
$33.55
|
| Rate for Payer: WPS Commercial |
$45.18
|
|
|
TPMT Lysis
|
Professional
|
Both
|
$61.00
|
|
| Hospital Charge Code |
2778844
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$26.84 |
| Max. Negotiated Rate |
$57.95 |
| Rate for Payer: Aetna Commercial |
$57.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$52.46
|
| Rate for Payer: Cash Price |
$18.30
|
| Rate for Payer: Cigna Commercial |
$57.95
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$30.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$36.60
|
| Rate for Payer: Health EOS Commercial |
$55.51
|
| Rate for Payer: HFN Commercial |
$57.95
|
| Rate for Payer: Multiplan Commercial |
$48.80
|
| Rate for Payer: Preferred Network Access Commercial |
$57.95
|
| Rate for Payer: Quartz Beloit One Network |
$26.84
|
| Rate for Payer: Quartz Commercial |
$34.77
|
| Rate for Payer: The Alliance Commercial |
$30.50
|
| Rate for Payer: WEA Trust Commercial |
$33.55
|
| Rate for Payer: WPS Commercial |
$45.18
|
|
|
TPMT Lysis
|
Facility
|
IP
|
$61.00
|
|
| Hospital Charge Code |
2778844
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$29.89 |
| Max. Negotiated Rate |
$56.12 |
| Rate for Payer: Aetna Commercial |
$54.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$52.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$32.33
|
| Rate for Payer: Cash Price |
$18.30
|
| Rate for Payer: Cigna Commercial |
$56.12
|
| Rate for Payer: Health EOS Commercial |
$54.29
|
| Rate for Payer: HFN Commercial |
$56.12
|
| Rate for Payer: Multiplan Commercial |
$48.80
|
| Rate for Payer: NAPHCARE Commercial |
$36.60
|
| Rate for Payer: Preferred Network Access Commercial |
$56.12
|
| Rate for Payer: Quartz Beloit One Network |
$29.89
|
| Rate for Payer: Quartz Commercial |
$36.60
|
| Rate for Payer: WEA Trust Commercial |
$33.55
|
| Rate for Payer: WPS Commercial |
$45.18
|
|
|
TPMT Nucleic Acid Probe
|
Facility
|
OP
|
$44.00
|
|
| Hospital Charge Code |
2778848
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.32 |
| Max. Negotiated Rate |
$176.00 |
| Rate for Payer: Aetna Commercial |
$39.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$37.84
|
| Rate for Payer: Aetna Managed Medicare |
$12.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$28.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$22.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$21.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$23.32
|
| Rate for Payer: Cash Price |
$13.20
|
| Rate for Payer: Cigna Commercial |
$40.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$24.62
|
| Rate for Payer: Health EOS Commercial |
$39.16
|
| Rate for Payer: HFN Commercial |
$40.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$33.00
|
| Rate for Payer: Multiplan Commercial |
$35.20
|
| Rate for Payer: NAPHCARE Commercial |
$26.40
|
| Rate for Payer: Preferred Network Access Commercial |
$40.48
|
| Rate for Payer: Quartz Beloit One Network |
$21.56
|
| Rate for Payer: Quartz Commercial |
$28.60
|
| Rate for Payer: Quartz Medicare Advantage |
$26.40
|
| Rate for Payer: The Alliance Commercial |
$176.00
|
| Rate for Payer: United Healthcare PPO |
$33.00
|
| Rate for Payer: WEA Trust Commercial |
$24.20
|
| Rate for Payer: WPS Commercial |
$32.59
|
|
