|
TROCHANTERIC TITANIUM FEMORAL NAILING INSERTION/REMOVAL
|
Facility
|
OP
|
$5,844.00
|
|
| Hospital Charge Code |
2960428
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,701.77 |
| Max. Negotiated Rate |
$5,591.54 |
| Rate for Payer: Aetna Commercial |
$5,469.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,226.87
|
| Rate for Payer: Aetna Managed Medicare |
$1,701.77
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,950.54
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,038.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,917.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,221.21
|
| Rate for Payer: Cash Price |
$1,753.20
|
| Rate for Payer: Cigna Commercial |
$5,591.54
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,401.21
|
| Rate for Payer: Health EOS Commercial |
$5,409.21
|
| Rate for Payer: HFN Commercial |
$5,591.54
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,558.32
|
| Rate for Payer: Multiplan Commercial |
$4,862.21
|
| Rate for Payer: NAPHCARE Commercial |
$3,646.66
|
| Rate for Payer: Preferred Network Access Commercial |
$5,591.54
|
| Rate for Payer: Quartz Beloit One Network |
$2,978.10
|
| Rate for Payer: Quartz Commercial |
$3,950.54
|
| Rate for Payer: Quartz Medicare Advantage |
$3,646.66
|
| Rate for Payer: The Alliance Commercial |
$3,038.88
|
| Rate for Payer: WEA Trust Commercial |
$3,342.77
|
| Rate for Payer: WPS Commercial |
$4,501.63
|
|
|
Tropheryma whipplei DNA, PCR
|
Facility
|
IP
|
$320.00
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
4808606
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$163.07 |
| Max. Negotiated Rate |
$306.18 |
| Rate for Payer: Aetna Commercial |
$299.52
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$286.21
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$176.38
|
| Rate for Payer: Cash Price |
$96.00
|
| Rate for Payer: Cigna Commercial |
$306.18
|
| Rate for Payer: Health EOS Commercial |
$296.19
|
| Rate for Payer: HFN Commercial |
$306.18
|
| Rate for Payer: Multiplan Commercial |
$266.24
|
| Rate for Payer: Preferred Network Access Commercial |
$306.18
|
| Rate for Payer: Quartz Beloit One Network |
$163.07
|
| Rate for Payer: Quartz Commercial |
$199.68
|
| Rate for Payer: WEA Trust Commercial |
$183.04
|
| Rate for Payer: WPS Commercial |
$246.50
|
|
|
Tropheryma whipplei DNA, PCR
|
Professional
|
Both
|
$320.00
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
4808606
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$36.49 |
| Max. Negotiated Rate |
$316.16 |
| Rate for Payer: Aetna Commercial |
$316.16
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$286.21
|
| 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 |
$96.00
|
| Rate for Payer: Cash Price |
$96.00
|
| Rate for Payer: Cigna Commercial |
$316.16
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$166.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$36.49
|
| Rate for Payer: Health EOS Commercial |
$302.85
|
| Rate for Payer: HFN Commercial |
$316.16
|
| 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 |
$266.24
|
| Rate for Payer: NAPHCARE Commercial |
$54.74
|
| Rate for Payer: Preferred Network Access Commercial |
$316.16
|
| Rate for Payer: Quartz Beloit One Network |
$146.43
|
| Rate for Payer: Quartz Commercial |
$189.70
|
| 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 |
$183.04
|
| Rate for Payer: WPS Commercial |
$160.57
|
|
|
Tropheryma whipplei DNA, PCR
|
Facility
|
OP
|
$320.00
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
4808606
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$36.49 |
| Max. Negotiated Rate |
$306.18 |
| Rate for Payer: Aetna Commercial |
$299.52
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$286.21
|
| 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 |
$176.38
|
| 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 |
$96.00
|
| Rate for Payer: Cash Price |
$96.00
|
| Rate for Payer: Cigna Commercial |
$306.18
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$36.49
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$186.24
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$36.49
|
| Rate for Payer: Health EOS Commercial |
$296.19
|
| Rate for Payer: HFN Commercial |
$306.18
|
| 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 |
$266.24
|
| Rate for Payer: NAPHCARE Commercial |
$54.74
|
| Rate for Payer: Preferred Network Access Commercial |
$306.18
|
| Rate for Payer: Quartz Beloit One Network |
$163.07
|
| Rate for Payer: Quartz Commercial |
$216.32
|
| 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 |
$249.60
|
| Rate for Payer: WEA Trust Commercial |
$183.04
|
| Rate for Payer: Wellcare Medicare |
$36.49
|
| Rate for Payer: WPS Commercial |
$246.50
|
|
|
Tropicamide 1% Ophth Solution 2ml [Med]
|
Facility
|
OP
|
$112.00
|
|
| Hospital Charge Code |
2974994
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$32.61 |
| Max. Negotiated Rate |
$107.16 |
| Rate for Payer: Aetna Commercial |
$104.83
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$100.17
|
| Rate for Payer: Aetna Managed Medicare |
$32.61
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$75.71
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$58.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$55.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$61.73
|
| Rate for Payer: Cash Price |
$33.60
|
| Rate for Payer: Cigna Commercial |
$107.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$65.18
|
| Rate for Payer: Health EOS Commercial |
$103.67
|
| Rate for Payer: HFN Commercial |
$107.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$87.36
|
| Rate for Payer: Multiplan Commercial |
$93.18
|
| Rate for Payer: NAPHCARE Commercial |
$69.89
|
| Rate for Payer: Preferred Network Access Commercial |
$107.16
|
| Rate for Payer: Quartz Beloit One Network |
$57.08
|
| Rate for Payer: Quartz Commercial |
$75.71
|
| Rate for Payer: Quartz Medicare Advantage |
$69.89
|
| Rate for Payer: The Alliance Commercial |
$58.24
|
| Rate for Payer: WEA Trust Commercial |
$64.06
|
| Rate for Payer: WPS Commercial |
$86.27
|
|
|
Tropicamide 1% Ophth Solution 2ml [Med]
|
Facility
|
IP
|
$112.00
|
|
| Hospital Charge Code |
2974994
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$57.08 |
| Max. Negotiated Rate |
$107.16 |
| Rate for Payer: Aetna Commercial |
$104.83
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$100.17
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$61.73
|
| Rate for Payer: Cash Price |
$33.60
|
| Rate for Payer: Cigna Commercial |
$107.16
|
| Rate for Payer: Health EOS Commercial |
$103.67
|
| Rate for Payer: HFN Commercial |
$107.16
|
| Rate for Payer: Multiplan Commercial |
$93.18
|
| Rate for Payer: Preferred Network Access Commercial |
$107.16
|
| Rate for Payer: Quartz Beloit One Network |
$57.08
|
| Rate for Payer: Quartz Commercial |
$69.89
|
| Rate for Payer: WEA Trust Commercial |
$64.06
|
| Rate for Payer: WPS Commercial |
$86.27
|
|
|
Troponin-I
|
Professional
|
Both
|
$227.00
|
|
|
Service Code
|
CPT 84484
|
| Hospital Charge Code |
633854
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.97 |
| Max. Negotiated Rate |
$224.28 |
| Rate for Payer: Aetna Commercial |
$224.28
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$203.03
|
| Rate for Payer: Aetna Managed Medicare |
$12.97
|
| Rate for Payer: Anthem Medicare Advantage |
$12.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$12.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$12.97
|
| Rate for Payer: Cash Price |
$68.10
|
| Rate for Payer: Cash Price |
$68.10
|
| Rate for Payer: Cigna Commercial |
$224.28
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$118.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12.97
|
| Rate for Payer: Health EOS Commercial |
$214.83
|
| Rate for Payer: HFN Commercial |
$224.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$45.78
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$45.78
|
| Rate for Payer: Independent Care Health Plan Medicare |
$12.97
|
| Rate for Payer: Multiplan Commercial |
$188.86
|
| Rate for Payer: NAPHCARE Commercial |
$19.45
|
| Rate for Payer: Preferred Network Access Commercial |
$224.28
|
| Rate for Payer: Quartz Beloit One Network |
$103.88
|
| Rate for Payer: Quartz Commercial |
$134.57
|
| Rate for Payer: Quartz Medicare Advantage |
$12.97
|
| Rate for Payer: The Alliance Commercial |
$51.23
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.97
|
| Rate for Payer: WEA Trust Commercial |
$129.84
|
| Rate for Payer: WPS Commercial |
$57.06
|
|
|
Troponin-I
|
Facility
|
IP
|
$227.00
|
|
|
Service Code
|
CPT 84484
|
| Hospital Charge Code |
633854
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$115.68 |
| Max. Negotiated Rate |
$217.19 |
| Rate for Payer: Aetna Commercial |
$212.47
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$203.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$125.12
|
| Rate for Payer: Cash Price |
$68.10
|
| Rate for Payer: Cigna Commercial |
$217.19
|
| Rate for Payer: Health EOS Commercial |
$210.11
|
| Rate for Payer: HFN Commercial |
$217.19
|
| Rate for Payer: Multiplan Commercial |
$188.86
|
| Rate for Payer: Preferred Network Access Commercial |
$217.19
|
| Rate for Payer: Quartz Beloit One Network |
$115.68
|
| Rate for Payer: Quartz Commercial |
$141.65
|
| Rate for Payer: WEA Trust Commercial |
$129.84
|
| Rate for Payer: WPS Commercial |
$174.86
|
|
|
Troponin-I
|
Facility
|
OP
|
$227.00
|
|
|
Service Code
|
CPT 84484
|
| Hospital Charge Code |
633854
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.97 |
| Max. Negotiated Rate |
$217.19 |
| Rate for Payer: Aetna Commercial |
$212.47
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$203.03
|
| Rate for Payer: Aetna Managed Medicare |
$12.97
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$48.63
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$22.70
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$21.53
|
| Rate for Payer: Anthem Medicare Advantage |
$12.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$125.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$12.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$12.97
|
| Rate for Payer: Cash Price |
$68.10
|
| Rate for Payer: Cash Price |
$68.10
|
| Rate for Payer: Cigna Commercial |
$217.19
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$12.97
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$132.11
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$12.97
|
| Rate for Payer: Health EOS Commercial |
$210.11
|
| Rate for Payer: HFN Commercial |
$217.19
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$48.24
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$12.97
|
| Rate for Payer: Independent Care Health Plan Medicare |
$12.97
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$12.97
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$12.97
|
| Rate for Payer: Multiplan Commercial |
$188.86
|
| Rate for Payer: NAPHCARE Commercial |
$19.45
|
| Rate for Payer: Preferred Network Access Commercial |
$217.19
|
| Rate for Payer: Quartz Beloit One Network |
$115.68
|
| Rate for Payer: Quartz Commercial |
$153.45
|
| Rate for Payer: Quartz Medicare Advantage |
$12.97
|
| Rate for Payer: The Alliance Commercial |
$51.88
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.97
|
| Rate for Payer: United Healthcare PPO |
$177.06
|
| Rate for Payer: WEA Trust Commercial |
$129.84
|
| Rate for Payer: Wellcare Medicare |
$12.97
|
| Rate for Payer: WPS Commercial |
$174.86
|
|
|
Troponin T/34483
|
Facility
|
IP
|
$76.00
|
|
|
Service Code
|
CPT 84484
|
| Hospital Charge Code |
6175389
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$38.73 |
| Max. Negotiated Rate |
$72.72 |
| Rate for Payer: Aetna Commercial |
$71.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$67.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$41.89
|
| Rate for Payer: Cash Price |
$22.80
|
| Rate for Payer: Cigna Commercial |
$72.72
|
| Rate for Payer: Health EOS Commercial |
$70.35
|
| Rate for Payer: HFN Commercial |
$72.72
|
| Rate for Payer: Multiplan Commercial |
$63.23
|
| Rate for Payer: Preferred Network Access Commercial |
$72.72
|
| Rate for Payer: Quartz Beloit One Network |
$38.73
|
| Rate for Payer: Quartz Commercial |
$47.42
|
| Rate for Payer: WEA Trust Commercial |
$43.47
|
| Rate for Payer: WPS Commercial |
$58.54
|
|
|
Troponin T/34483
|
Facility
|
OP
|
$76.00
|
|
|
Service Code
|
CPT 84484
|
| Hospital Charge Code |
6175389
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.97 |
| Max. Negotiated Rate |
$72.72 |
| Rate for Payer: Aetna Commercial |
$71.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$67.97
|
| Rate for Payer: Aetna Managed Medicare |
$12.97
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$48.63
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$22.70
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$21.53
|
| Rate for Payer: Anthem Medicare Advantage |
$12.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$41.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$12.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$12.97
|
| Rate for Payer: Cash Price |
$22.80
|
| Rate for Payer: Cash Price |
$22.80
|
| Rate for Payer: Cigna Commercial |
$72.72
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$12.97
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$44.23
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$12.97
|
| Rate for Payer: Health EOS Commercial |
$70.35
|
| Rate for Payer: HFN Commercial |
$72.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$48.24
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$12.97
|
| Rate for Payer: Independent Care Health Plan Medicare |
$12.97
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$12.97
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$12.97
|
| Rate for Payer: Multiplan Commercial |
$63.23
|
| Rate for Payer: NAPHCARE Commercial |
$19.45
|
| Rate for Payer: Preferred Network Access Commercial |
$72.72
|
| Rate for Payer: Quartz Beloit One Network |
$38.73
|
| Rate for Payer: Quartz Commercial |
$51.38
|
| Rate for Payer: Quartz Medicare Advantage |
$12.97
|
| Rate for Payer: The Alliance Commercial |
$51.88
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.97
|
| Rate for Payer: United Healthcare PPO |
$59.28
|
| Rate for Payer: WEA Trust Commercial |
$43.47
|
| Rate for Payer: Wellcare Medicare |
$12.97
|
| Rate for Payer: WPS Commercial |
$58.54
|
|
|
Troponin T/34483
|
Professional
|
Both
|
$76.00
|
|
|
Service Code
|
CPT 84484
|
| Hospital Charge Code |
6175389
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.97 |
| Max. Negotiated Rate |
$75.09 |
| Rate for Payer: Aetna Commercial |
$75.09
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$67.97
|
| Rate for Payer: Aetna Managed Medicare |
$12.97
|
| Rate for Payer: Anthem Medicare Advantage |
$12.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$12.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$12.97
|
| Rate for Payer: Cash Price |
$22.80
|
| Rate for Payer: Cash Price |
$22.80
|
| Rate for Payer: Cigna Commercial |
$75.09
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$39.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12.97
|
| Rate for Payer: Health EOS Commercial |
$71.93
|
| Rate for Payer: HFN Commercial |
$75.09
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$45.78
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$45.78
|
| Rate for Payer: Independent Care Health Plan Medicare |
$12.97
|
| Rate for Payer: Multiplan Commercial |
$63.23
|
| Rate for Payer: NAPHCARE Commercial |
$19.45
|
| Rate for Payer: Preferred Network Access Commercial |
$75.09
|
| Rate for Payer: Quartz Beloit One Network |
$34.78
|
| Rate for Payer: Quartz Commercial |
$45.05
|
| Rate for Payer: Quartz Medicare Advantage |
$12.97
|
| Rate for Payer: The Alliance Commercial |
$51.23
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.97
|
| Rate for Payer: WEA Trust Commercial |
$43.47
|
| Rate for Payer: WPS Commercial |
$57.06
|
|
|
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 |
$4,647.26 |
| Max. Negotiated Rate |
$15,269.57 |
| Rate for Payer: Aetna Commercial |
$14,937.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$14,273.73
|
| Rate for Payer: Aetna Managed Medicare |
$4,647.26
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$10,788.28
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8,298.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7,966.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$8,796.60
|
| Rate for Payer: Cash Price |
$4,787.70
|
| Rate for Payer: Cigna Commercial |
$15,269.57
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$9,288.14
|
| Rate for Payer: Health EOS Commercial |
$14,771.65
|
| Rate for Payer: HFN Commercial |
$15,269.57
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$12,448.02
|
| Rate for Payer: Multiplan Commercial |
$13,277.89
|
| Rate for Payer: NAPHCARE Commercial |
$9,958.42
|
| Rate for Payer: Preferred Network Access Commercial |
$15,269.57
|
| Rate for Payer: Quartz Beloit One Network |
$8,132.71
|
| Rate for Payer: Quartz Commercial |
$10,788.28
|
| Rate for Payer: Quartz Medicare Advantage |
$9,958.42
|
| Rate for Payer: The Alliance Commercial |
$8,298.68
|
| Rate for Payer: WEA Trust Commercial |
$9,128.55
|
| Rate for Payer: WPS Commercial |
$12,293.22
|
|
|
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 |
$8,132.71 |
| Max. Negotiated Rate |
$15,269.57 |
| Rate for Payer: Aetna Commercial |
$14,937.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$14,273.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$8,796.60
|
| Rate for Payer: Cash Price |
$4,787.70
|
| Rate for Payer: Cigna Commercial |
$15,269.57
|
| Rate for Payer: Health EOS Commercial |
$14,771.65
|
| Rate for Payer: HFN Commercial |
$15,269.57
|
| Rate for Payer: Multiplan Commercial |
$13,277.89
|
| Rate for Payer: Preferred Network Access Commercial |
$15,269.57
|
| Rate for Payer: Quartz Beloit One Network |
$8,132.71
|
| Rate for Payer: Quartz Commercial |
$9,958.42
|
| Rate for Payer: WEA Trust Commercial |
$9,128.55
|
| Rate for Payer: WPS Commercial |
$12,293.22
|
|
|
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 |
$8,796.21 |
| Max. Negotiated Rate |
$16,515.32 |
| Rate for Payer: Aetna Commercial |
$16,156.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$15,438.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,514.26
|
| Rate for Payer: Cash Price |
$5,178.30
|
| Rate for Payer: Cigna Commercial |
$16,515.32
|
| Rate for Payer: Health EOS Commercial |
$15,976.78
|
| Rate for Payer: HFN Commercial |
$16,515.32
|
| Rate for Payer: Multiplan Commercial |
$14,361.15
|
| Rate for Payer: Preferred Network Access Commercial |
$16,515.32
|
| Rate for Payer: Quartz Beloit One Network |
$8,796.21
|
| Rate for Payer: Quartz Commercial |
$10,770.86
|
| Rate for Payer: WEA Trust Commercial |
$9,873.29
|
| Rate for Payer: WPS Commercial |
$13,296.15
|
|
|
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 |
$5,026.40 |
| Max. Negotiated Rate |
$16,515.32 |
| Rate for Payer: Aetna Commercial |
$16,156.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$15,438.24
|
| Rate for Payer: Aetna Managed Medicare |
$5,026.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$11,668.44
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8,975.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$8,616.69
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,514.26
|
| Rate for Payer: Cash Price |
$5,178.30
|
| Rate for Payer: Cigna Commercial |
$16,515.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$10,045.90
|
| Rate for Payer: Health EOS Commercial |
$15,976.78
|
| Rate for Payer: HFN Commercial |
$16,515.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$13,463.58
|
| Rate for Payer: Multiplan Commercial |
$14,361.15
|
| Rate for Payer: NAPHCARE Commercial |
$10,770.86
|
| Rate for Payer: Preferred Network Access Commercial |
$16,515.32
|
| Rate for Payer: Quartz Beloit One Network |
$8,796.21
|
| Rate for Payer: Quartz Commercial |
$11,668.44
|
| Rate for Payer: Quartz Medicare Advantage |
$10,770.86
|
| Rate for Payer: The Alliance Commercial |
$8,975.72
|
| Rate for Payer: WEA Trust Commercial |
$9,873.29
|
| Rate for Payer: WPS Commercial |
$13,296.15
|
|
|
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 |
$5,227.33 |
| Max. Negotiated Rate |
$17,175.52 |
| Rate for Payer: Aetna Commercial |
$16,802.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$16,055.37
|
| Rate for Payer: Aetna Managed Medicare |
$5,227.33
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$12,134.88
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$9,334.52
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$8,961.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,894.59
|
| Rate for Payer: Cash Price |
$5,385.30
|
| Rate for Payer: Cigna Commercial |
$17,175.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$10,447.48
|
| Rate for Payer: Health EOS Commercial |
$16,615.45
|
| Rate for Payer: HFN Commercial |
$17,175.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$14,001.78
|
| Rate for Payer: Multiplan Commercial |
$14,935.23
|
| Rate for Payer: NAPHCARE Commercial |
$11,201.42
|
| Rate for Payer: Preferred Network Access Commercial |
$17,175.52
|
| Rate for Payer: Quartz Beloit One Network |
$9,147.83
|
| Rate for Payer: Quartz Commercial |
$12,134.88
|
| Rate for Payer: Quartz Medicare Advantage |
$11,201.42
|
| Rate for Payer: The Alliance Commercial |
$9,334.52
|
| Rate for Payer: WEA Trust Commercial |
$10,267.97
|
| Rate for Payer: WPS Commercial |
$13,827.66
|
|
|
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 |
$9,147.83 |
| Max. Negotiated Rate |
$17,175.52 |
| Rate for Payer: Aetna Commercial |
$16,802.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$16,055.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,894.59
|
| Rate for Payer: Cash Price |
$5,385.30
|
| Rate for Payer: Cigna Commercial |
$17,175.52
|
| Rate for Payer: Health EOS Commercial |
$16,615.45
|
| Rate for Payer: HFN Commercial |
$17,175.52
|
| Rate for Payer: Multiplan Commercial |
$14,935.23
|
| Rate for Payer: Preferred Network Access Commercial |
$17,175.52
|
| Rate for Payer: Quartz Beloit One Network |
$9,147.83
|
| Rate for Payer: Quartz Commercial |
$11,201.42
|
| Rate for Payer: WEA Trust Commercial |
$10,267.97
|
| Rate for Payer: WPS Commercial |
$13,827.66
|
|
|
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 |
$8,796.21 |
| Max. Negotiated Rate |
$16,515.32 |
| Rate for Payer: Aetna Commercial |
$16,156.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$15,438.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,514.26
|
| Rate for Payer: Cash Price |
$5,178.30
|
| Rate for Payer: Cigna Commercial |
$16,515.32
|
| Rate for Payer: Health EOS Commercial |
$15,976.78
|
| Rate for Payer: HFN Commercial |
$16,515.32
|
| Rate for Payer: Multiplan Commercial |
$14,361.15
|
| Rate for Payer: Preferred Network Access Commercial |
$16,515.32
|
| Rate for Payer: Quartz Beloit One Network |
$8,796.21
|
| Rate for Payer: Quartz Commercial |
$10,770.86
|
| Rate for Payer: WEA Trust Commercial |
$9,873.29
|
| Rate for Payer: WPS Commercial |
$13,296.15
|
|
|
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 |
$5,026.40 |
| Max. Negotiated Rate |
$16,515.32 |
| Rate for Payer: Aetna Commercial |
$16,156.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$15,438.24
|
| Rate for Payer: Aetna Managed Medicare |
$5,026.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$11,668.44
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8,975.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$8,616.69
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,514.26
|
| Rate for Payer: Cash Price |
$5,178.30
|
| Rate for Payer: Cigna Commercial |
$16,515.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$10,045.90
|
| Rate for Payer: Health EOS Commercial |
$15,976.78
|
| Rate for Payer: HFN Commercial |
$16,515.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$13,463.58
|
| Rate for Payer: Multiplan Commercial |
$14,361.15
|
| Rate for Payer: NAPHCARE Commercial |
$10,770.86
|
| Rate for Payer: Preferred Network Access Commercial |
$16,515.32
|
| Rate for Payer: Quartz Beloit One Network |
$8,796.21
|
| Rate for Payer: Quartz Commercial |
$11,668.44
|
| Rate for Payer: Quartz Medicare Advantage |
$10,770.86
|
| Rate for Payer: The Alliance Commercial |
$8,975.72
|
| Rate for Payer: WEA Trust Commercial |
$9,873.29
|
| Rate for Payer: WPS Commercial |
$13,296.15
|
|
|
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 |
$5,026.40 |
| Max. Negotiated Rate |
$16,515.32 |
| Rate for Payer: Aetna Commercial |
$16,156.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$15,438.24
|
| Rate for Payer: Aetna Managed Medicare |
$5,026.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$11,668.44
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8,975.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$8,616.69
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,514.26
|
| Rate for Payer: Cash Price |
$5,178.30
|
| Rate for Payer: Cigna Commercial |
$16,515.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$10,045.90
|
| Rate for Payer: Health EOS Commercial |
$15,976.78
|
| Rate for Payer: HFN Commercial |
$16,515.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$13,463.58
|
| Rate for Payer: Multiplan Commercial |
$14,361.15
|
| Rate for Payer: NAPHCARE Commercial |
$10,770.86
|
| Rate for Payer: Preferred Network Access Commercial |
$16,515.32
|
| Rate for Payer: Quartz Beloit One Network |
$8,796.21
|
| Rate for Payer: Quartz Commercial |
$11,668.44
|
| Rate for Payer: Quartz Medicare Advantage |
$10,770.86
|
| Rate for Payer: The Alliance Commercial |
$8,975.72
|
| Rate for Payer: WEA Trust Commercial |
$9,873.29
|
| Rate for Payer: WPS Commercial |
$13,296.15
|
|
|
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 |
$8,796.21 |
| Max. Negotiated Rate |
$16,515.32 |
| Rate for Payer: Aetna Commercial |
$16,156.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$15,438.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,514.26
|
| Rate for Payer: Cash Price |
$5,178.30
|
| Rate for Payer: Cigna Commercial |
$16,515.32
|
| Rate for Payer: Health EOS Commercial |
$15,976.78
|
| Rate for Payer: HFN Commercial |
$16,515.32
|
| Rate for Payer: Multiplan Commercial |
$14,361.15
|
| Rate for Payer: Preferred Network Access Commercial |
$16,515.32
|
| Rate for Payer: Quartz Beloit One Network |
$8,796.21
|
| Rate for Payer: Quartz Commercial |
$10,770.86
|
| Rate for Payer: WEA Trust Commercial |
$9,873.29
|
| Rate for Payer: WPS Commercial |
$13,296.15
|
|
|
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 |
$9,147.83 |
| Max. Negotiated Rate |
$17,175.52 |
| Rate for Payer: Aetna Commercial |
$16,802.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$16,055.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,894.59
|
| Rate for Payer: Cash Price |
$5,385.30
|
| Rate for Payer: Cigna Commercial |
$17,175.52
|
| Rate for Payer: Health EOS Commercial |
$16,615.45
|
| Rate for Payer: HFN Commercial |
$17,175.52
|
| Rate for Payer: Multiplan Commercial |
$14,935.23
|
| Rate for Payer: Preferred Network Access Commercial |
$17,175.52
|
| Rate for Payer: Quartz Beloit One Network |
$9,147.83
|
| Rate for Payer: Quartz Commercial |
$11,201.42
|
| Rate for Payer: WEA Trust Commercial |
$10,267.97
|
| Rate for Payer: WPS Commercial |
$13,827.66
|
|
|
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 |
$5,227.33 |
| Max. Negotiated Rate |
$17,175.52 |
| Rate for Payer: Aetna Commercial |
$16,802.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$16,055.37
|
| Rate for Payer: Aetna Managed Medicare |
$5,227.33
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$12,134.88
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$9,334.52
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$8,961.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,894.59
|
| Rate for Payer: Cash Price |
$5,385.30
|
| Rate for Payer: Cigna Commercial |
$17,175.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$10,447.48
|
| Rate for Payer: Health EOS Commercial |
$16,615.45
|
| Rate for Payer: HFN Commercial |
$17,175.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$14,001.78
|
| Rate for Payer: Multiplan Commercial |
$14,935.23
|
| Rate for Payer: NAPHCARE Commercial |
$11,201.42
|
| Rate for Payer: Preferred Network Access Commercial |
$17,175.52
|
| Rate for Payer: Quartz Beloit One Network |
$9,147.83
|
| Rate for Payer: Quartz Commercial |
$12,134.88
|
| Rate for Payer: Quartz Medicare Advantage |
$11,201.42
|
| Rate for Payer: The Alliance Commercial |
$9,334.52
|
| Rate for Payer: WEA Trust Commercial |
$10,267.97
|
| Rate for Payer: WPS Commercial |
$13,827.66
|
|
|
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 |
$4,833.05 |
| Max. Negotiated Rate |
$15,880.01 |
| Rate for Payer: Aetna Commercial |
$15,534.79
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$14,844.36
|
| Rate for Payer: Aetna Managed Medicare |
$4,833.05
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$11,219.57
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8,630.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$8,285.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,148.27
|
| Rate for Payer: Cash Price |
$4,979.10
|
| Rate for Payer: Cigna Commercial |
$15,880.01
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$9,659.45
|
| Rate for Payer: Health EOS Commercial |
$15,362.18
|
| Rate for Payer: HFN Commercial |
$15,880.01
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$12,945.66
|
| Rate for Payer: Multiplan Commercial |
$13,808.70
|
| Rate for Payer: NAPHCARE Commercial |
$10,356.53
|
| Rate for Payer: Preferred Network Access Commercial |
$15,880.01
|
| Rate for Payer: Quartz Beloit One Network |
$8,457.83
|
| Rate for Payer: Quartz Commercial |
$11,219.57
|
| Rate for Payer: Quartz Medicare Advantage |
$10,356.53
|
| Rate for Payer: The Alliance Commercial |
$8,630.44
|
| Rate for Payer: WEA Trust Commercial |
$9,493.48
|
| Rate for Payer: WPS Commercial |
$12,784.67
|
|
