|
TUBING SET AR-200 IRRIGATION OEM04364100
|
Facility
|
IP
|
$583.00
|
|
| Hospital Charge Code |
5787770
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$297.10 |
| Max. Negotiated Rate |
$557.81 |
| Rate for Payer: Aetna Commercial |
$545.69
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$521.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$321.35
|
| Rate for Payer: Cash Price |
$174.90
|
| Rate for Payer: Cigna Commercial |
$557.81
|
| Rate for Payer: Health EOS Commercial |
$539.62
|
| Rate for Payer: HFN Commercial |
$557.81
|
| Rate for Payer: Multiplan Commercial |
$485.06
|
| Rate for Payer: Preferred Network Access Commercial |
$557.81
|
| Rate for Payer: Quartz Beloit One Network |
$297.10
|
| Rate for Payer: Quartz Commercial |
$363.79
|
| Rate for Payer: WEA Trust Commercial |
$333.48
|
| Rate for Payer: WPS Commercial |
$449.08
|
|
|
TUBING SET AR-200 IRRIGATION OEM04364100
|
Facility
|
OP
|
$583.00
|
|
| Hospital Charge Code |
5787770
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$169.77 |
| Max. Negotiated Rate |
$557.81 |
| Rate for Payer: Aetna Commercial |
$545.69
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$521.44
|
| Rate for Payer: Aetna Managed Medicare |
$169.77
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$394.11
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$303.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$291.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$321.35
|
| Rate for Payer: Cash Price |
$174.90
|
| Rate for Payer: Cigna Commercial |
$557.81
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$339.31
|
| Rate for Payer: Health EOS Commercial |
$539.62
|
| Rate for Payer: HFN Commercial |
$557.81
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$454.74
|
| Rate for Payer: Multiplan Commercial |
$485.06
|
| Rate for Payer: NAPHCARE Commercial |
$363.79
|
| Rate for Payer: Preferred Network Access Commercial |
$557.81
|
| Rate for Payer: Quartz Beloit One Network |
$297.10
|
| Rate for Payer: Quartz Commercial |
$394.11
|
| Rate for Payer: Quartz Medicare Advantage |
$363.79
|
| Rate for Payer: The Alliance Commercial |
$303.16
|
| Rate for Payer: WEA Trust Commercial |
$333.48
|
| Rate for Payer: WPS Commercial |
$449.08
|
|
|
TUBING SMALL JOINT #9350
|
Facility
|
IP
|
$1,446.00
|
|
| Hospital Charge Code |
2964967
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$736.88 |
| Max. Negotiated Rate |
$1,383.53 |
| Rate for Payer: Aetna Commercial |
$1,353.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,293.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$797.04
|
| Rate for Payer: Cash Price |
$433.80
|
| Rate for Payer: Cigna Commercial |
$1,383.53
|
| Rate for Payer: Health EOS Commercial |
$1,338.42
|
| Rate for Payer: HFN Commercial |
$1,383.53
|
| Rate for Payer: Multiplan Commercial |
$1,203.07
|
| Rate for Payer: Preferred Network Access Commercial |
$1,383.53
|
| Rate for Payer: Quartz Beloit One Network |
$736.88
|
| Rate for Payer: Quartz Commercial |
$902.30
|
| Rate for Payer: WEA Trust Commercial |
$827.11
|
| Rate for Payer: WPS Commercial |
$1,113.85
|
|
|
TUBING SMALL JOINT #9350
|
Facility
|
OP
|
$1,446.00
|
|
| Hospital Charge Code |
2964967
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$421.08 |
| Max. Negotiated Rate |
$1,383.53 |
| Rate for Payer: Aetna Commercial |
$1,353.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,293.30
|
| Rate for Payer: Aetna Managed Medicare |
$421.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$977.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$751.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$721.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$797.04
|
| Rate for Payer: Cash Price |
$433.80
|
| Rate for Payer: Cigna Commercial |
$1,383.53
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$841.57
|
| Rate for Payer: Health EOS Commercial |
$1,338.42
|
| Rate for Payer: HFN Commercial |
$1,383.53
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,127.88
|
| Rate for Payer: Multiplan Commercial |
$1,203.07
|
| Rate for Payer: NAPHCARE Commercial |
$902.30
|
| Rate for Payer: Preferred Network Access Commercial |
$1,383.53
|
| Rate for Payer: Quartz Beloit One Network |
$736.88
|
| Rate for Payer: Quartz Commercial |
$977.50
|
| Rate for Payer: Quartz Medicare Advantage |
$902.30
|
| Rate for Payer: The Alliance Commercial |
$751.92
|
| Rate for Payer: WEA Trust Commercial |
$827.11
|
| Rate for Payer: WPS Commercial |
$1,113.85
|
|
|
TUBING SMOKE EVAC SM-BLAP100
|
Facility
|
IP
|
$131.00
|
|
| Hospital Charge Code |
2967383
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$66.76 |
| Max. Negotiated Rate |
$125.34 |
| Rate for Payer: Aetna Commercial |
$122.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$117.17
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$72.21
|
| Rate for Payer: Cash Price |
$39.30
|
| Rate for Payer: Cigna Commercial |
$125.34
|
| Rate for Payer: Health EOS Commercial |
$121.25
|
| Rate for Payer: HFN Commercial |
$125.34
|
| Rate for Payer: Multiplan Commercial |
$108.99
|
| Rate for Payer: Preferred Network Access Commercial |
$125.34
|
| Rate for Payer: Quartz Beloit One Network |
$66.76
|
| Rate for Payer: Quartz Commercial |
$81.74
|
| Rate for Payer: WEA Trust Commercial |
$74.93
|
| Rate for Payer: WPS Commercial |
$100.91
|
|
|
TUBING SMOKE EVAC SM-BLAP100
|
Facility
|
OP
|
$131.00
|
|
| Hospital Charge Code |
2967383
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$38.15 |
| Max. Negotiated Rate |
$125.34 |
| Rate for Payer: Aetna Commercial |
$122.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$117.17
|
| Rate for Payer: Aetna Managed Medicare |
$38.15
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$88.56
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$68.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$65.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$72.21
|
| Rate for Payer: Cash Price |
$39.30
|
| Rate for Payer: Cigna Commercial |
$125.34
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$76.24
|
| Rate for Payer: Health EOS Commercial |
$121.25
|
| Rate for Payer: HFN Commercial |
$125.34
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$102.18
|
| Rate for Payer: Multiplan Commercial |
$108.99
|
| Rate for Payer: NAPHCARE Commercial |
$81.74
|
| Rate for Payer: Preferred Network Access Commercial |
$125.34
|
| Rate for Payer: Quartz Beloit One Network |
$66.76
|
| Rate for Payer: Quartz Commercial |
$88.56
|
| Rate for Payer: Quartz Medicare Advantage |
$81.74
|
| Rate for Payer: The Alliance Commercial |
$68.12
|
| Rate for Payer: WEA Trust Commercial |
$74.93
|
| Rate for Payer: WPS Commercial |
$100.91
|
|
|
TUBING STRAIGHTSHOT XPS 1895522
|
Facility
|
OP
|
$680.00
|
|
| Hospital Charge Code |
3259480
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$198.02 |
| Max. Negotiated Rate |
$650.62 |
| Rate for Payer: Aetna Commercial |
$636.48
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$608.19
|
| Rate for Payer: Aetna Managed Medicare |
$198.02
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$459.68
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$353.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$339.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$374.82
|
| Rate for Payer: Cash Price |
$204.00
|
| Rate for Payer: Cigna Commercial |
$650.62
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$395.76
|
| Rate for Payer: Health EOS Commercial |
$629.41
|
| Rate for Payer: HFN Commercial |
$650.62
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$530.40
|
| Rate for Payer: Multiplan Commercial |
$565.76
|
| Rate for Payer: NAPHCARE Commercial |
$424.32
|
| Rate for Payer: Preferred Network Access Commercial |
$650.62
|
| Rate for Payer: Quartz Beloit One Network |
$346.53
|
| Rate for Payer: Quartz Commercial |
$459.68
|
| Rate for Payer: Quartz Medicare Advantage |
$424.32
|
| Rate for Payer: The Alliance Commercial |
$353.60
|
| Rate for Payer: WEA Trust Commercial |
$388.96
|
| Rate for Payer: WPS Commercial |
$523.80
|
|
|
TUBING STRAIGHTSHOT XPS 1895522
|
Facility
|
IP
|
$680.00
|
|
| Hospital Charge Code |
3259480
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$346.53 |
| Max. Negotiated Rate |
$650.62 |
| Rate for Payer: Aetna Commercial |
$636.48
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$608.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$374.82
|
| Rate for Payer: Cash Price |
$204.00
|
| Rate for Payer: Cigna Commercial |
$650.62
|
| Rate for Payer: Health EOS Commercial |
$629.41
|
| Rate for Payer: HFN Commercial |
$650.62
|
| Rate for Payer: Multiplan Commercial |
$565.76
|
| Rate for Payer: Preferred Network Access Commercial |
$650.62
|
| Rate for Payer: Quartz Beloit One Network |
$346.53
|
| Rate for Payer: Quartz Commercial |
$424.32
|
| Rate for Payer: WEA Trust Commercial |
$388.96
|
| Rate for Payer: WPS Commercial |
$523.80
|
|
|
TUBING SUCTION CONNECTING 6FT N56A
|
Facility
|
OP
|
$22.00
|
|
| Hospital Charge Code |
2963771
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.41 |
| Max. Negotiated Rate |
$21.05 |
| Rate for Payer: Aetna Commercial |
$20.59
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$19.68
|
| Rate for Payer: Aetna Managed Medicare |
$6.41
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$14.87
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$11.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$10.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$12.13
|
| Rate for Payer: Cash Price |
$6.60
|
| Rate for Payer: Cigna Commercial |
$21.05
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12.80
|
| Rate for Payer: Health EOS Commercial |
$20.36
|
| Rate for Payer: HFN Commercial |
$21.05
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$17.16
|
| Rate for Payer: Multiplan Commercial |
$18.30
|
| Rate for Payer: NAPHCARE Commercial |
$13.73
|
| Rate for Payer: Preferred Network Access Commercial |
$21.05
|
| Rate for Payer: Quartz Beloit One Network |
$11.21
|
| Rate for Payer: Quartz Commercial |
$14.87
|
| Rate for Payer: Quartz Medicare Advantage |
$13.73
|
| Rate for Payer: The Alliance Commercial |
$11.44
|
| Rate for Payer: WEA Trust Commercial |
$12.58
|
| Rate for Payer: WPS Commercial |
$16.95
|
|
|
TUBING SUCTION CONNECTING 6FT N56A
|
Facility
|
IP
|
$22.00
|
|
| Hospital Charge Code |
2963771
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$11.21 |
| Max. Negotiated Rate |
$21.05 |
| Rate for Payer: Aetna Commercial |
$20.59
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$19.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$12.13
|
| Rate for Payer: Cash Price |
$6.60
|
| Rate for Payer: Cigna Commercial |
$21.05
|
| Rate for Payer: Health EOS Commercial |
$20.36
|
| Rate for Payer: HFN Commercial |
$21.05
|
| Rate for Payer: Multiplan Commercial |
$18.30
|
| Rate for Payer: Preferred Network Access Commercial |
$21.05
|
| Rate for Payer: Quartz Beloit One Network |
$11.21
|
| Rate for Payer: Quartz Commercial |
$13.73
|
| Rate for Payer: WEA Trust Commercial |
$12.58
|
| Rate for Payer: WPS Commercial |
$16.95
|
|
|
TUBING SYRINGE PUMP MICROBORE W/FILTER 10014916
|
Facility
|
OP
|
$87.00
|
|
| Hospital Charge Code |
4595038
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$25.33 |
| Max. Negotiated Rate |
$83.24 |
| Rate for Payer: Aetna Commercial |
$81.43
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$77.81
|
| Rate for Payer: Aetna Managed Medicare |
$25.33
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$58.81
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$45.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$43.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$47.95
|
| Rate for Payer: Cash Price |
$26.10
|
| Rate for Payer: Cigna Commercial |
$83.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$50.63
|
| Rate for Payer: Health EOS Commercial |
$80.53
|
| Rate for Payer: HFN Commercial |
$83.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$67.86
|
| Rate for Payer: Multiplan Commercial |
$72.38
|
| Rate for Payer: NAPHCARE Commercial |
$54.29
|
| Rate for Payer: Preferred Network Access Commercial |
$83.24
|
| Rate for Payer: Quartz Beloit One Network |
$44.34
|
| Rate for Payer: Quartz Commercial |
$58.81
|
| Rate for Payer: Quartz Medicare Advantage |
$54.29
|
| Rate for Payer: The Alliance Commercial |
$45.24
|
| Rate for Payer: WEA Trust Commercial |
$49.76
|
| Rate for Payer: WPS Commercial |
$67.02
|
|
|
TUBING SYRINGE PUMP MICROBORE W/FILTER 10014916
|
Facility
|
IP
|
$87.00
|
|
| Hospital Charge Code |
4595038
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$44.34 |
| Max. Negotiated Rate |
$83.24 |
| Rate for Payer: Aetna Commercial |
$81.43
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$77.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$47.95
|
| Rate for Payer: Cash Price |
$26.10
|
| Rate for Payer: Cigna Commercial |
$83.24
|
| Rate for Payer: Health EOS Commercial |
$80.53
|
| Rate for Payer: HFN Commercial |
$83.24
|
| Rate for Payer: Multiplan Commercial |
$72.38
|
| Rate for Payer: Preferred Network Access Commercial |
$83.24
|
| Rate for Payer: Quartz Beloit One Network |
$44.34
|
| Rate for Payer: Quartz Commercial |
$54.29
|
| Rate for Payer: WEA Trust Commercial |
$49.76
|
| Rate for Payer: WPS Commercial |
$67.02
|
|
|
TUBING SYRINGE PUMP MICROBORE W/O FILTER 10014914
|
Facility
|
IP
|
$93.00
|
|
| Hospital Charge Code |
4595049
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$47.39 |
| Max. Negotiated Rate |
$88.98 |
| Rate for Payer: Aetna Commercial |
$87.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$83.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$51.26
|
| Rate for Payer: Cash Price |
$27.90
|
| Rate for Payer: Cigna Commercial |
$88.98
|
| Rate for Payer: Health EOS Commercial |
$86.08
|
| Rate for Payer: HFN Commercial |
$88.98
|
| Rate for Payer: Multiplan Commercial |
$77.38
|
| Rate for Payer: Preferred Network Access Commercial |
$88.98
|
| Rate for Payer: Quartz Beloit One Network |
$47.39
|
| Rate for Payer: Quartz Commercial |
$58.03
|
| Rate for Payer: WEA Trust Commercial |
$53.20
|
| Rate for Payer: WPS Commercial |
$71.64
|
|
|
TUBING SYRINGE PUMP MICROBORE W/O FILTER 10014914
|
Facility
|
OP
|
$93.00
|
|
| Hospital Charge Code |
4595049
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$27.08 |
| Max. Negotiated Rate |
$88.98 |
| Rate for Payer: Aetna Commercial |
$87.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$83.18
|
| Rate for Payer: Aetna Managed Medicare |
$27.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$62.87
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$48.36
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$46.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$51.26
|
| Rate for Payer: Cash Price |
$27.90
|
| Rate for Payer: Cigna Commercial |
$88.98
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$54.13
|
| Rate for Payer: Health EOS Commercial |
$86.08
|
| Rate for Payer: HFN Commercial |
$88.98
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$72.54
|
| Rate for Payer: Multiplan Commercial |
$77.38
|
| Rate for Payer: NAPHCARE Commercial |
$58.03
|
| Rate for Payer: Preferred Network Access Commercial |
$88.98
|
| Rate for Payer: Quartz Beloit One Network |
$47.39
|
| Rate for Payer: Quartz Commercial |
$62.87
|
| Rate for Payer: Quartz Medicare Advantage |
$58.03
|
| Rate for Payer: The Alliance Commercial |
$48.36
|
| Rate for Payer: WEA Trust Commercial |
$53.20
|
| Rate for Payer: WPS Commercial |
$71.64
|
|
|
TUMESCENT INFILTRATION KIT TIK-01
|
Facility
|
OP
|
$410.00
|
|
| Hospital Charge Code |
4069312
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$119.39 |
| Max. Negotiated Rate |
$392.29 |
| Rate for Payer: Aetna Commercial |
$383.76
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$366.70
|
| Rate for Payer: Aetna Managed Medicare |
$119.39
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$277.16
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$213.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$204.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$225.99
|
| Rate for Payer: Cash Price |
$123.00
|
| Rate for Payer: Cigna Commercial |
$392.29
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$238.62
|
| Rate for Payer: Health EOS Commercial |
$379.50
|
| Rate for Payer: HFN Commercial |
$392.29
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$319.80
|
| Rate for Payer: Multiplan Commercial |
$341.12
|
| Rate for Payer: NAPHCARE Commercial |
$255.84
|
| Rate for Payer: Preferred Network Access Commercial |
$392.29
|
| Rate for Payer: Quartz Beloit One Network |
$208.94
|
| Rate for Payer: Quartz Commercial |
$277.16
|
| Rate for Payer: Quartz Medicare Advantage |
$255.84
|
| Rate for Payer: The Alliance Commercial |
$213.20
|
| Rate for Payer: WEA Trust Commercial |
$234.52
|
| Rate for Payer: WPS Commercial |
$315.82
|
|
|
TUMESCENT INFILTRATION KIT TIK-01
|
Facility
|
IP
|
$410.00
|
|
| Hospital Charge Code |
4069312
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$208.94 |
| Max. Negotiated Rate |
$392.29 |
| Rate for Payer: Aetna Commercial |
$383.76
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$366.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$225.99
|
| Rate for Payer: Cash Price |
$123.00
|
| Rate for Payer: Cigna Commercial |
$392.29
|
| Rate for Payer: Health EOS Commercial |
$379.50
|
| Rate for Payer: HFN Commercial |
$392.29
|
| Rate for Payer: Multiplan Commercial |
$341.12
|
| Rate for Payer: Preferred Network Access Commercial |
$392.29
|
| Rate for Payer: Quartz Beloit One Network |
$208.94
|
| Rate for Payer: Quartz Commercial |
$255.84
|
| Rate for Payer: WEA Trust Commercial |
$234.52
|
| Rate for Payer: WPS Commercial |
$315.82
|
|
|
Tumor Immunohisto/Comp
|
Professional
|
Both
|
$324.00
|
|
|
Service Code
|
CPT 88361
|
| Hospital Charge Code |
2780799
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$55.87 |
| Max. Negotiated Rate |
$506.20 |
| Rate for Payer: Aetna Commercial |
$320.11
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$289.79
|
| Rate for Payer: Aetna Managed Medicare |
$115.04
|
| Rate for Payer: Anthem Commercial |
$55.87
|
| Rate for Payer: Anthem Medicare Advantage |
$115.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$115.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$115.04
|
| Rate for Payer: Cash Price |
$97.20
|
| Rate for Payer: Cash Price |
$97.20
|
| Rate for Payer: Cigna Commercial |
$320.11
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$168.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$115.04
|
| Rate for Payer: Health EOS Commercial |
$306.63
|
| Rate for Payer: HFN Commercial |
$320.11
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$435.00
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$435.00
|
| Rate for Payer: Independent Care Health Plan Medicare |
$115.04
|
| Rate for Payer: Multiplan Commercial |
$269.57
|
| Rate for Payer: NAPHCARE Commercial |
$172.57
|
| Rate for Payer: Preferred Network Access Commercial |
$320.11
|
| Rate for Payer: Quartz Beloit One Network |
$148.26
|
| Rate for Payer: Quartz Commercial |
$192.07
|
| Rate for Payer: Quartz Medicare Advantage |
$115.04
|
| Rate for Payer: The Alliance Commercial |
$454.43
|
| Rate for Payer: United Healthcare Medicare Advantage |
$115.04
|
| Rate for Payer: WEA Trust Commercial |
$185.33
|
| Rate for Payer: WPS Commercial |
$506.20
|
|
|
Tumor Immunohisto/Comp
|
Facility
|
OP
|
$324.00
|
|
|
Service Code
|
CPT 88361
|
| Hospital Charge Code |
2780799
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$165.11 |
| Max. Negotiated Rate |
$1,508.92 |
| Rate for Payer: Aetna Commercial |
$303.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$289.79
|
| Rate for Payer: Aetna Managed Medicare |
$377.23
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,385.59
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$646.61
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$613.36
|
| Rate for Payer: Anthem Medicare Advantage |
$377.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$178.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$377.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$377.23
|
| Rate for Payer: Cash Price |
$97.20
|
| Rate for Payer: Cash Price |
$97.20
|
| Rate for Payer: Cigna Commercial |
$310.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$377.23
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$188.57
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$377.23
|
| Rate for Payer: Health EOS Commercial |
$299.89
|
| Rate for Payer: HFN Commercial |
$310.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,403.29
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$377.23
|
| Rate for Payer: Independent Care Health Plan Medicare |
$377.23
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$377.23
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$377.23
|
| Rate for Payer: Multiplan Commercial |
$269.57
|
| Rate for Payer: NAPHCARE Commercial |
$565.84
|
| Rate for Payer: Preferred Network Access Commercial |
$310.00
|
| Rate for Payer: Quartz Beloit One Network |
$165.11
|
| Rate for Payer: Quartz Commercial |
$219.02
|
| Rate for Payer: Quartz Medicare Advantage |
$377.23
|
| Rate for Payer: The Alliance Commercial |
$1,508.92
|
| Rate for Payer: United Healthcare Medicare Advantage |
$377.23
|
| Rate for Payer: United Healthcare PPO |
$252.72
|
| Rate for Payer: WEA Trust Commercial |
$185.33
|
| Rate for Payer: Wellcare Medicare |
$377.23
|
| Rate for Payer: WPS Commercial |
$249.58
|
|
|
Tumor Immunohisto/Comp
|
Facility
|
IP
|
$324.00
|
|
|
Service Code
|
CPT 88361
|
| Hospital Charge Code |
2780799
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$165.11 |
| Max. Negotiated Rate |
$310.00 |
| Rate for Payer: Aetna Commercial |
$303.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$289.79
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$178.59
|
| Rate for Payer: Cash Price |
$97.20
|
| Rate for Payer: Cigna Commercial |
$310.00
|
| Rate for Payer: Health EOS Commercial |
$299.89
|
| Rate for Payer: HFN Commercial |
$310.00
|
| Rate for Payer: Multiplan Commercial |
$269.57
|
| Rate for Payer: Preferred Network Access Commercial |
$310.00
|
| Rate for Payer: Quartz Beloit One Network |
$165.11
|
| Rate for Payer: Quartz Commercial |
$202.18
|
| Rate for Payer: WEA Trust Commercial |
$185.33
|
| Rate for Payer: WPS Commercial |
$249.58
|
|
|
Tumor Necrosis Factor-Alpha, Highly Sensitive
|
Professional
|
Both
|
$277.00
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
4464672
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.96 |
| Max. Negotiated Rate |
$273.68 |
| Rate for Payer: Aetna Commercial |
$273.68
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$247.75
|
| Rate for Payer: Aetna Managed Medicare |
$17.96
|
| Rate for Payer: Anthem Medicare Advantage |
$17.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$17.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$17.96
|
| Rate for Payer: Cash Price |
$83.10
|
| Rate for Payer: Cash Price |
$83.10
|
| Rate for Payer: Cigna Commercial |
$273.68
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$144.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$17.96
|
| Rate for Payer: Health EOS Commercial |
$262.15
|
| Rate for Payer: HFN Commercial |
$273.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$63.40
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$63.40
|
| Rate for Payer: Independent Care Health Plan Medicare |
$17.96
|
| Rate for Payer: Multiplan Commercial |
$230.46
|
| Rate for Payer: NAPHCARE Commercial |
$26.94
|
| Rate for Payer: Preferred Network Access Commercial |
$273.68
|
| Rate for Payer: Quartz Beloit One Network |
$126.76
|
| Rate for Payer: Quartz Commercial |
$164.21
|
| Rate for Payer: Quartz Medicare Advantage |
$17.96
|
| Rate for Payer: The Alliance Commercial |
$70.95
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17.96
|
| Rate for Payer: WEA Trust Commercial |
$158.44
|
| Rate for Payer: WPS Commercial |
$79.03
|
|
|
Tumor Necrosis Factor-Alpha, Highly Sensitive
|
Facility
|
OP
|
$277.00
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
4464672
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.96 |
| Max. Negotiated Rate |
$265.03 |
| Rate for Payer: Aetna Commercial |
$259.27
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$247.75
|
| Rate for Payer: Aetna Managed Medicare |
$17.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$67.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$31.43
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$29.81
|
| Rate for Payer: Anthem Medicare Advantage |
$17.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$152.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$17.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$17.96
|
| Rate for Payer: Cash Price |
$83.10
|
| Rate for Payer: Cash Price |
$83.10
|
| Rate for Payer: Cigna Commercial |
$265.03
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$17.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$161.21
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$17.96
|
| Rate for Payer: Health EOS Commercial |
$256.39
|
| Rate for Payer: HFN Commercial |
$265.03
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$66.81
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$17.96
|
| Rate for Payer: Independent Care Health Plan Medicare |
$17.96
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$17.96
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$17.96
|
| Rate for Payer: Multiplan Commercial |
$230.46
|
| Rate for Payer: NAPHCARE Commercial |
$26.94
|
| Rate for Payer: Preferred Network Access Commercial |
$265.03
|
| Rate for Payer: Quartz Beloit One Network |
$141.16
|
| Rate for Payer: Quartz Commercial |
$187.25
|
| Rate for Payer: Quartz Medicare Advantage |
$17.96
|
| Rate for Payer: The Alliance Commercial |
$71.84
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17.96
|
| Rate for Payer: United Healthcare PPO |
$216.06
|
| Rate for Payer: WEA Trust Commercial |
$158.44
|
| Rate for Payer: Wellcare Medicare |
$17.96
|
| Rate for Payer: WPS Commercial |
$213.37
|
|
|
Tumor Necrosis Factor-Alpha, Highly Sensitive
|
Facility
|
IP
|
$277.00
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
4464672
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$141.16 |
| Max. Negotiated Rate |
$265.03 |
| Rate for Payer: Aetna Commercial |
$259.27
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$247.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$152.68
|
| Rate for Payer: Cash Price |
$83.10
|
| Rate for Payer: Cigna Commercial |
$265.03
|
| Rate for Payer: Health EOS Commercial |
$256.39
|
| Rate for Payer: HFN Commercial |
$265.03
|
| Rate for Payer: Multiplan Commercial |
$230.46
|
| Rate for Payer: Preferred Network Access Commercial |
$265.03
|
| Rate for Payer: Quartz Beloit One Network |
$141.16
|
| Rate for Payer: Quartz Commercial |
$172.85
|
| Rate for Payer: WEA Trust Commercial |
$158.44
|
| Rate for Payer: WPS Commercial |
$213.37
|
|
|
TUMOR RESECTION, ORTHO
|
Facility
|
OP
|
$4,170.00
|
|
| Hospital Charge Code |
2950497
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,214.30 |
| Max. Negotiated Rate |
$3,989.86 |
| Rate for Payer: Aetna Commercial |
$3,903.12
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,729.65
|
| Rate for Payer: Aetna Managed Medicare |
$1,214.30
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,818.92
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,168.40
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,081.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,298.50
|
| Rate for Payer: Cash Price |
$1,251.00
|
| Rate for Payer: Cigna Commercial |
$3,989.86
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,426.94
|
| Rate for Payer: Health EOS Commercial |
$3,859.75
|
| Rate for Payer: HFN Commercial |
$3,989.86
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,252.60
|
| Rate for Payer: Multiplan Commercial |
$3,469.44
|
| Rate for Payer: NAPHCARE Commercial |
$2,602.08
|
| Rate for Payer: Preferred Network Access Commercial |
$3,989.86
|
| Rate for Payer: Quartz Beloit One Network |
$2,125.03
|
| Rate for Payer: Quartz Commercial |
$2,818.92
|
| Rate for Payer: Quartz Medicare Advantage |
$2,602.08
|
| Rate for Payer: The Alliance Commercial |
$2,168.40
|
| Rate for Payer: WEA Trust Commercial |
$2,385.24
|
| Rate for Payer: WPS Commercial |
$3,212.15
|
|
|
TUMOR RESECTION, ORTHO
|
Facility
|
IP
|
$4,170.00
|
|
| Hospital Charge Code |
2950497
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,125.03 |
| Max. Negotiated Rate |
$3,989.86 |
| Rate for Payer: Aetna Commercial |
$3,903.12
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,729.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,298.50
|
| Rate for Payer: Cash Price |
$1,251.00
|
| Rate for Payer: Cigna Commercial |
$3,989.86
|
| Rate for Payer: Health EOS Commercial |
$3,859.75
|
| Rate for Payer: HFN Commercial |
$3,989.86
|
| Rate for Payer: Multiplan Commercial |
$3,469.44
|
| Rate for Payer: Preferred Network Access Commercial |
$3,989.86
|
| Rate for Payer: Quartz Beloit One Network |
$2,125.03
|
| Rate for Payer: Quartz Commercial |
$2,602.08
|
| Rate for Payer: WEA Trust Commercial |
$2,385.24
|
| Rate for Payer: WPS Commercial |
$3,212.15
|
|
|
TUNNELER #402
|
Facility
|
IP
|
$4,600.00
|
|
| Hospital Charge Code |
2965003
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,344.16 |
| Max. Negotiated Rate |
$4,401.28 |
| Rate for Payer: Aetna Commercial |
$4,305.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,114.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,535.52
|
| Rate for Payer: Cash Price |
$1,380.00
|
| Rate for Payer: Cigna Commercial |
$4,401.28
|
| Rate for Payer: Health EOS Commercial |
$4,257.76
|
| Rate for Payer: HFN Commercial |
$4,401.28
|
| Rate for Payer: Multiplan Commercial |
$3,827.20
|
| Rate for Payer: Preferred Network Access Commercial |
$4,401.28
|
| Rate for Payer: Quartz Beloit One Network |
$2,344.16
|
| Rate for Payer: Quartz Commercial |
$2,870.40
|
| Rate for Payer: WEA Trust Commercial |
$2,631.20
|
| Rate for Payer: WPS Commercial |
$3,543.38
|
|
