|
Citrate Level 24 Hour Urine
|
Facility
|
IP
|
$354.00
|
|
|
Service Code
|
CPT 82507
|
| Hospital Charge Code |
978110
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$180.40 |
| Max. Negotiated Rate |
$338.71 |
| Rate for Payer: Aetna Commercial |
$331.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$316.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$195.12
|
| Rate for Payer: Cash Price |
$106.20
|
| Rate for Payer: Cigna Commercial |
$338.71
|
| Rate for Payer: Health EOS Commercial |
$327.66
|
| Rate for Payer: HFN Commercial |
$338.71
|
| Rate for Payer: Multiplan Commercial |
$294.53
|
| Rate for Payer: Preferred Network Access Commercial |
$338.71
|
| Rate for Payer: Quartz Beloit One Network |
$180.40
|
| Rate for Payer: Quartz Commercial |
$220.90
|
| Rate for Payer: WEA Trust Commercial |
$202.49
|
| Rate for Payer: WPS Commercial |
$272.69
|
|
|
Citrate Level 24 Hour Urine
|
Facility
|
OP
|
$354.00
|
|
|
Service Code
|
CPT 82507
|
| Hospital Charge Code |
978110
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$28.91 |
| Max. Negotiated Rate |
$338.71 |
| Rate for Payer: Aetna Commercial |
$331.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$316.62
|
| Rate for Payer: Aetna Managed Medicare |
$28.91
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$108.42
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$50.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$47.99
|
| Rate for Payer: Anthem Medicare Advantage |
$28.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$195.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$28.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$28.91
|
| Rate for Payer: Cash Price |
$106.20
|
| Rate for Payer: Cash Price |
$106.20
|
| Rate for Payer: Cigna Commercial |
$338.71
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$28.91
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$206.03
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$28.91
|
| Rate for Payer: Health EOS Commercial |
$327.66
|
| Rate for Payer: HFN Commercial |
$338.71
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$107.55
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$28.91
|
| Rate for Payer: Independent Care Health Plan Medicare |
$28.91
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$28.91
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$28.91
|
| Rate for Payer: Multiplan Commercial |
$294.53
|
| Rate for Payer: NAPHCARE Commercial |
$43.37
|
| Rate for Payer: Preferred Network Access Commercial |
$338.71
|
| Rate for Payer: Quartz Beloit One Network |
$180.40
|
| Rate for Payer: Quartz Commercial |
$239.30
|
| Rate for Payer: Quartz Medicare Advantage |
$28.91
|
| Rate for Payer: The Alliance Commercial |
$115.65
|
| Rate for Payer: United Healthcare Medicare Advantage |
$28.91
|
| Rate for Payer: United Healthcare PPO |
$276.12
|
| Rate for Payer: WEA Trust Commercial |
$202.49
|
| Rate for Payer: Wellcare Medicare |
$28.91
|
| Rate for Payer: WPS Commercial |
$272.69
|
|
|
Citrate Level Urine
|
Professional
|
Both
|
$528.00
|
|
|
Service Code
|
CPT 82507
|
| Hospital Charge Code |
978111
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$28.91 |
| Max. Negotiated Rate |
$521.66 |
| Rate for Payer: Aetna Commercial |
$521.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$472.24
|
| Rate for Payer: Aetna Managed Medicare |
$28.91
|
| Rate for Payer: Anthem Medicare Advantage |
$28.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$28.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$28.91
|
| Rate for Payer: Cash Price |
$158.40
|
| Rate for Payer: Cash Price |
$158.40
|
| Rate for Payer: Cigna Commercial |
$521.66
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$274.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$28.91
|
| Rate for Payer: Health EOS Commercial |
$499.70
|
| Rate for Payer: HFN Commercial |
$521.66
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$102.06
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$102.06
|
| Rate for Payer: Independent Care Health Plan Medicare |
$28.91
|
| Rate for Payer: Multiplan Commercial |
$439.30
|
| Rate for Payer: NAPHCARE Commercial |
$43.37
|
| Rate for Payer: Preferred Network Access Commercial |
$521.66
|
| Rate for Payer: Quartz Beloit One Network |
$241.61
|
| Rate for Payer: Quartz Commercial |
$313.00
|
| Rate for Payer: Quartz Medicare Advantage |
$28.91
|
| Rate for Payer: The Alliance Commercial |
$114.20
|
| Rate for Payer: United Healthcare Medicare Advantage |
$28.91
|
| Rate for Payer: WEA Trust Commercial |
$302.02
|
| Rate for Payer: WPS Commercial |
$127.21
|
|
|
Citrate Level Urine
|
Facility
|
OP
|
$528.00
|
|
|
Service Code
|
CPT 82507
|
| Hospital Charge Code |
978111
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$28.91 |
| Max. Negotiated Rate |
$505.19 |
| Rate for Payer: Aetna Commercial |
$494.21
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$472.24
|
| Rate for Payer: Aetna Managed Medicare |
$28.91
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$108.42
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$50.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$47.99
|
| Rate for Payer: Anthem Medicare Advantage |
$28.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$291.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$28.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$28.91
|
| Rate for Payer: Cash Price |
$158.40
|
| Rate for Payer: Cash Price |
$158.40
|
| Rate for Payer: Cigna Commercial |
$505.19
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$28.91
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$307.30
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$28.91
|
| Rate for Payer: Health EOS Commercial |
$488.72
|
| Rate for Payer: HFN Commercial |
$505.19
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$107.55
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$28.91
|
| Rate for Payer: Independent Care Health Plan Medicare |
$28.91
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$28.91
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$28.91
|
| Rate for Payer: Multiplan Commercial |
$439.30
|
| Rate for Payer: NAPHCARE Commercial |
$43.37
|
| Rate for Payer: Preferred Network Access Commercial |
$505.19
|
| Rate for Payer: Quartz Beloit One Network |
$269.07
|
| Rate for Payer: Quartz Commercial |
$356.93
|
| Rate for Payer: Quartz Medicare Advantage |
$28.91
|
| Rate for Payer: The Alliance Commercial |
$115.65
|
| Rate for Payer: United Healthcare Medicare Advantage |
$28.91
|
| Rate for Payer: United Healthcare PPO |
$411.84
|
| Rate for Payer: WEA Trust Commercial |
$302.02
|
| Rate for Payer: Wellcare Medicare |
$28.91
|
| Rate for Payer: WPS Commercial |
$406.72
|
|
|
Citrate Level Urine
|
Facility
|
IP
|
$528.00
|
|
|
Service Code
|
CPT 82507
|
| Hospital Charge Code |
978111
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$269.07 |
| Max. Negotiated Rate |
$505.19 |
| Rate for Payer: Aetna Commercial |
$494.21
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$472.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$291.03
|
| Rate for Payer: Cash Price |
$158.40
|
| Rate for Payer: Cigna Commercial |
$505.19
|
| Rate for Payer: Health EOS Commercial |
$488.72
|
| Rate for Payer: HFN Commercial |
$505.19
|
| Rate for Payer: Multiplan Commercial |
$439.30
|
| Rate for Payer: Preferred Network Access Commercial |
$505.19
|
| Rate for Payer: Quartz Beloit One Network |
$269.07
|
| Rate for Payer: Quartz Commercial |
$329.47
|
| Rate for Payer: WEA Trust Commercial |
$302.02
|
| Rate for Payer: WPS Commercial |
$406.72
|
|
|
CK-MB Isoenzyme
|
Facility
|
OP
|
$237.00
|
|
|
Service Code
|
CPT 82553
|
| Hospital Charge Code |
633713
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.01 |
| Max. Negotiated Rate |
$226.76 |
| Rate for Payer: Aetna Commercial |
$221.83
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$211.97
|
| Rate for Payer: Aetna Managed Medicare |
$12.01
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$45.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$21.02
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$19.94
|
| Rate for Payer: Anthem Medicare Advantage |
$12.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$130.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$12.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$12.01
|
| Rate for Payer: Cash Price |
$71.10
|
| Rate for Payer: Cash Price |
$71.10
|
| Rate for Payer: Cigna Commercial |
$226.76
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$12.01
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$137.93
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$12.01
|
| Rate for Payer: Health EOS Commercial |
$219.37
|
| Rate for Payer: HFN Commercial |
$226.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$44.68
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$12.01
|
| Rate for Payer: Independent Care Health Plan Medicare |
$12.01
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$12.01
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$12.01
|
| Rate for Payer: Multiplan Commercial |
$197.18
|
| Rate for Payer: NAPHCARE Commercial |
$18.02
|
| Rate for Payer: Preferred Network Access Commercial |
$226.76
|
| Rate for Payer: Quartz Beloit One Network |
$120.78
|
| Rate for Payer: Quartz Commercial |
$160.21
|
| Rate for Payer: Quartz Medicare Advantage |
$12.01
|
| Rate for Payer: The Alliance Commercial |
$48.05
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.01
|
| Rate for Payer: United Healthcare PPO |
$184.86
|
| Rate for Payer: WEA Trust Commercial |
$135.56
|
| Rate for Payer: Wellcare Medicare |
$12.01
|
| Rate for Payer: WPS Commercial |
$182.56
|
|
|
CK-MB Isoenzyme
|
Facility
|
IP
|
$237.00
|
|
|
Service Code
|
CPT 82553
|
| Hospital Charge Code |
633713
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$120.78 |
| Max. Negotiated Rate |
$226.76 |
| Rate for Payer: Aetna Commercial |
$221.83
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$211.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$130.63
|
| Rate for Payer: Cash Price |
$71.10
|
| Rate for Payer: Cigna Commercial |
$226.76
|
| Rate for Payer: Health EOS Commercial |
$219.37
|
| Rate for Payer: HFN Commercial |
$226.76
|
| Rate for Payer: Multiplan Commercial |
$197.18
|
| Rate for Payer: Preferred Network Access Commercial |
$226.76
|
| Rate for Payer: Quartz Beloit One Network |
$120.78
|
| Rate for Payer: Quartz Commercial |
$147.89
|
| Rate for Payer: WEA Trust Commercial |
$135.56
|
| Rate for Payer: WPS Commercial |
$182.56
|
|
|
CK-MB Isoenzyme
|
Professional
|
Both
|
$237.00
|
|
|
Service Code
|
CPT 82553
|
| Hospital Charge Code |
633713
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.01 |
| Max. Negotiated Rate |
$234.16 |
| Rate for Payer: Aetna Commercial |
$234.16
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$211.97
|
| Rate for Payer: Aetna Managed Medicare |
$12.01
|
| Rate for Payer: Anthem Medicare Advantage |
$12.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$12.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$12.01
|
| Rate for Payer: Cash Price |
$71.10
|
| Rate for Payer: Cash Price |
$71.10
|
| Rate for Payer: Cigna Commercial |
$234.16
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$123.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12.01
|
| Rate for Payer: Health EOS Commercial |
$224.30
|
| Rate for Payer: HFN Commercial |
$234.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$42.40
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$42.40
|
| Rate for Payer: Independent Care Health Plan Medicare |
$12.01
|
| Rate for Payer: Multiplan Commercial |
$197.18
|
| Rate for Payer: NAPHCARE Commercial |
$18.02
|
| Rate for Payer: Preferred Network Access Commercial |
$234.16
|
| Rate for Payer: Quartz Beloit One Network |
$108.45
|
| Rate for Payer: Quartz Commercial |
$140.49
|
| Rate for Payer: Quartz Medicare Advantage |
$12.01
|
| Rate for Payer: The Alliance Commercial |
$47.45
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.01
|
| Rate for Payer: WEA Trust Commercial |
$135.56
|
| Rate for Payer: WPS Commercial |
$52.85
|
|
|
Cladosporium hormodendrum IgG4
|
Facility
|
IP
|
$122.00
|
|
|
Service Code
|
CPT 86001
|
| Hospital Charge Code |
6196560
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$62.17 |
| Max. Negotiated Rate |
$116.73 |
| Rate for Payer: Aetna Commercial |
$114.19
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$109.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$67.25
|
| Rate for Payer: Cash Price |
$36.60
|
| Rate for Payer: Cigna Commercial |
$116.73
|
| Rate for Payer: Health EOS Commercial |
$112.92
|
| Rate for Payer: HFN Commercial |
$116.73
|
| Rate for Payer: Multiplan Commercial |
$101.50
|
| Rate for Payer: Preferred Network Access Commercial |
$116.73
|
| Rate for Payer: Quartz Beloit One Network |
$62.17
|
| Rate for Payer: Quartz Commercial |
$76.13
|
| Rate for Payer: WEA Trust Commercial |
$69.78
|
| Rate for Payer: WPS Commercial |
$93.98
|
|
|
Cladosporium hormodendrum IgG4
|
Professional
|
Both
|
$122.00
|
|
|
Service Code
|
CPT 86001
|
| Hospital Charge Code |
6196560
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.13 |
| Max. Negotiated Rate |
$120.54 |
| Rate for Payer: Aetna Commercial |
$120.54
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$109.12
|
| Rate for Payer: Aetna Managed Medicare |
$8.13
|
| Rate for Payer: Anthem Medicare Advantage |
$8.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$8.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$8.13
|
| Rate for Payer: Cash Price |
$36.60
|
| Rate for Payer: Cash Price |
$36.60
|
| Rate for Payer: Cigna Commercial |
$120.54
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$63.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$8.13
|
| Rate for Payer: Health EOS Commercial |
$115.46
|
| Rate for Payer: HFN Commercial |
$120.54
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$28.70
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$28.70
|
| Rate for Payer: Independent Care Health Plan Medicare |
$8.13
|
| Rate for Payer: Multiplan Commercial |
$101.50
|
| Rate for Payer: NAPHCARE Commercial |
$12.20
|
| Rate for Payer: Preferred Network Access Commercial |
$120.54
|
| Rate for Payer: Quartz Beloit One Network |
$55.83
|
| Rate for Payer: Quartz Commercial |
$72.32
|
| Rate for Payer: Quartz Medicare Advantage |
$8.13
|
| Rate for Payer: The Alliance Commercial |
$32.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8.13
|
| Rate for Payer: WEA Trust Commercial |
$69.78
|
| Rate for Payer: WPS Commercial |
$35.78
|
|
|
Cladosporium hormodendrum IgG4
|
Facility
|
OP
|
$122.00
|
|
|
Service Code
|
CPT 86001
|
| Hospital Charge Code |
6196560
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.13 |
| Max. Negotiated Rate |
$116.73 |
| Rate for Payer: Aetna Commercial |
$114.19
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$109.12
|
| Rate for Payer: Aetna Managed Medicare |
$8.13
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$30.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$14.23
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$13.50
|
| Rate for Payer: Anthem Medicare Advantage |
$8.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$67.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$8.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$8.13
|
| Rate for Payer: Cash Price |
$36.60
|
| Rate for Payer: Cash Price |
$36.60
|
| Rate for Payer: Cigna Commercial |
$116.73
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$8.13
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$71.00
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$8.13
|
| Rate for Payer: Health EOS Commercial |
$112.92
|
| Rate for Payer: HFN Commercial |
$116.73
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$30.25
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$8.13
|
| Rate for Payer: Independent Care Health Plan Medicare |
$8.13
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$8.13
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$8.13
|
| Rate for Payer: Multiplan Commercial |
$101.50
|
| Rate for Payer: NAPHCARE Commercial |
$12.20
|
| Rate for Payer: Preferred Network Access Commercial |
$116.73
|
| Rate for Payer: Quartz Beloit One Network |
$62.17
|
| Rate for Payer: Quartz Commercial |
$82.47
|
| Rate for Payer: Quartz Medicare Advantage |
$8.13
|
| Rate for Payer: The Alliance Commercial |
$32.53
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8.13
|
| Rate for Payer: United Healthcare PPO |
$95.16
|
| Rate for Payer: WEA Trust Commercial |
$69.78
|
| Rate for Payer: Wellcare Medicare |
$8.13
|
| Rate for Payer: WPS Commercial |
$93.98
|
|
|
CLAMP 4.O ADJUSTABLE 390.051
|
Facility
|
IP
|
$7,837.00
|
|
| Hospital Charge Code |
2966162
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3,993.74 |
| Max. Negotiated Rate |
$7,498.44 |
| Rate for Payer: Aetna Commercial |
$7,335.43
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,009.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,319.75
|
| Rate for Payer: Cash Price |
$2,351.10
|
| Rate for Payer: Cigna Commercial |
$7,498.44
|
| Rate for Payer: Health EOS Commercial |
$7,253.93
|
| Rate for Payer: HFN Commercial |
$7,498.44
|
| Rate for Payer: Multiplan Commercial |
$6,520.38
|
| Rate for Payer: Preferred Network Access Commercial |
$7,498.44
|
| Rate for Payer: Quartz Beloit One Network |
$3,993.74
|
| Rate for Payer: Quartz Commercial |
$4,890.29
|
| Rate for Payer: WEA Trust Commercial |
$4,482.76
|
| Rate for Payer: WPS Commercial |
$6,036.84
|
|
|
CLAMP 4.O ADJUSTABLE 390.051
|
Facility
|
OP
|
$7,837.00
|
|
| Hospital Charge Code |
2966162
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,282.13 |
| Max. Negotiated Rate |
$7,498.44 |
| Rate for Payer: Aetna Commercial |
$7,335.43
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,009.41
|
| Rate for Payer: Aetna Managed Medicare |
$2,282.13
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,297.81
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,075.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,912.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,319.75
|
| Rate for Payer: Cash Price |
$2,351.10
|
| Rate for Payer: Cigna Commercial |
$7,498.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,561.13
|
| Rate for Payer: Health EOS Commercial |
$7,253.93
|
| Rate for Payer: HFN Commercial |
$7,498.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,112.86
|
| Rate for Payer: Multiplan Commercial |
$6,520.38
|
| Rate for Payer: NAPHCARE Commercial |
$4,890.29
|
| Rate for Payer: Preferred Network Access Commercial |
$7,498.44
|
| Rate for Payer: Quartz Beloit One Network |
$3,993.74
|
| Rate for Payer: Quartz Commercial |
$5,297.81
|
| Rate for Payer: Quartz Medicare Advantage |
$4,890.29
|
| Rate for Payer: The Alliance Commercial |
$4,075.24
|
| Rate for Payer: WEA Trust Commercial |
$4,482.76
|
| Rate for Payer: WPS Commercial |
$6,036.84
|
|
|
CLAMP ADJUSTABLE 393.64
|
Facility
|
OP
|
$2,968.00
|
|
| Hospital Charge Code |
5811625
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$864.28 |
| Max. Negotiated Rate |
$2,839.78 |
| Rate for Payer: Aetna Commercial |
$2,778.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,654.58
|
| Rate for Payer: Aetna Managed Medicare |
$864.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,006.37
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,543.36
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,481.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,635.96
|
| Rate for Payer: Cash Price |
$890.40
|
| Rate for Payer: Cigna Commercial |
$2,839.78
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,727.38
|
| Rate for Payer: Health EOS Commercial |
$2,747.18
|
| Rate for Payer: HFN Commercial |
$2,839.78
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,315.04
|
| Rate for Payer: Multiplan Commercial |
$2,469.38
|
| Rate for Payer: NAPHCARE Commercial |
$1,852.03
|
| Rate for Payer: Preferred Network Access Commercial |
$2,839.78
|
| Rate for Payer: Quartz Beloit One Network |
$1,512.49
|
| Rate for Payer: Quartz Commercial |
$2,006.37
|
| Rate for Payer: Quartz Medicare Advantage |
$1,852.03
|
| Rate for Payer: The Alliance Commercial |
$1,543.36
|
| Rate for Payer: WEA Trust Commercial |
$1,697.70
|
| Rate for Payer: WPS Commercial |
$2,286.25
|
|
|
CLAMP ADJUSTABLE 393.64
|
Facility
|
IP
|
$2,968.00
|
|
| Hospital Charge Code |
5811625
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,512.49 |
| Max. Negotiated Rate |
$2,839.78 |
| Rate for Payer: Aetna Commercial |
$2,778.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,654.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,635.96
|
| Rate for Payer: Cash Price |
$890.40
|
| Rate for Payer: Cigna Commercial |
$2,839.78
|
| Rate for Payer: Health EOS Commercial |
$2,747.18
|
| Rate for Payer: HFN Commercial |
$2,839.78
|
| Rate for Payer: Multiplan Commercial |
$2,469.38
|
| Rate for Payer: Preferred Network Access Commercial |
$2,839.78
|
| Rate for Payer: Quartz Beloit One Network |
$1,512.49
|
| Rate for Payer: Quartz Commercial |
$1,852.03
|
| Rate for Payer: WEA Trust Commercial |
$1,697.70
|
| Rate for Payer: WPS Commercial |
$2,286.25
|
|
|
CLAMP ADJUSTABLE WIRE PIN
|
Facility
|
OP
|
$8,681.00
|
|
| Hospital Charge Code |
2966163
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,527.91 |
| Max. Negotiated Rate |
$8,305.98 |
| Rate for Payer: Aetna Commercial |
$8,125.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,764.29
|
| Rate for Payer: Aetna Managed Medicare |
$2,527.91
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,868.36
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,514.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,333.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,784.97
|
| Rate for Payer: Cash Price |
$2,604.30
|
| Rate for Payer: Cigna Commercial |
$8,305.98
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,052.34
|
| Rate for Payer: Health EOS Commercial |
$8,035.13
|
| Rate for Payer: HFN Commercial |
$8,305.98
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,771.18
|
| Rate for Payer: Multiplan Commercial |
$7,222.59
|
| Rate for Payer: NAPHCARE Commercial |
$5,416.94
|
| Rate for Payer: Preferred Network Access Commercial |
$8,305.98
|
| Rate for Payer: Quartz Beloit One Network |
$4,423.84
|
| Rate for Payer: Quartz Commercial |
$5,868.36
|
| Rate for Payer: Quartz Medicare Advantage |
$5,416.94
|
| Rate for Payer: The Alliance Commercial |
$4,514.12
|
| Rate for Payer: WEA Trust Commercial |
$4,965.53
|
| Rate for Payer: WPS Commercial |
$6,686.97
|
|
|
CLAMP ADJUSTABLE WIRE PIN
|
Facility
|
IP
|
$8,681.00
|
|
| Hospital Charge Code |
2966163
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4,423.84 |
| Max. Negotiated Rate |
$8,305.98 |
| Rate for Payer: Aetna Commercial |
$8,125.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,764.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,784.97
|
| Rate for Payer: Cash Price |
$2,604.30
|
| Rate for Payer: Cigna Commercial |
$8,305.98
|
| Rate for Payer: Health EOS Commercial |
$8,035.13
|
| Rate for Payer: HFN Commercial |
$8,305.98
|
| Rate for Payer: Multiplan Commercial |
$7,222.59
|
| Rate for Payer: Preferred Network Access Commercial |
$8,305.98
|
| Rate for Payer: Quartz Beloit One Network |
$4,423.84
|
| Rate for Payer: Quartz Commercial |
$5,416.94
|
| Rate for Payer: WEA Trust Commercial |
$4,965.53
|
| Rate for Payer: WPS Commercial |
$6,686.97
|
|
|
CLAMP COVER RED 061011PBX
|
Facility
|
OP
|
$62.00
|
|
| Hospital Charge Code |
2965506
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$18.05 |
| Max. Negotiated Rate |
$59.32 |
| Rate for Payer: Aetna Commercial |
$58.03
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$55.45
|
| Rate for Payer: Aetna Managed Medicare |
$18.05
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$41.91
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$32.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$30.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$34.17
|
| Rate for Payer: Cash Price |
$18.60
|
| Rate for Payer: Cigna Commercial |
$59.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$36.08
|
| Rate for Payer: Health EOS Commercial |
$57.39
|
| Rate for Payer: HFN Commercial |
$59.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$48.36
|
| Rate for Payer: Multiplan Commercial |
$51.58
|
| Rate for Payer: NAPHCARE Commercial |
$38.69
|
| Rate for Payer: Preferred Network Access Commercial |
$59.32
|
| Rate for Payer: Quartz Beloit One Network |
$31.60
|
| Rate for Payer: Quartz Commercial |
$41.91
|
| Rate for Payer: Quartz Medicare Advantage |
$38.69
|
| Rate for Payer: The Alliance Commercial |
$32.24
|
| Rate for Payer: WEA Trust Commercial |
$35.46
|
| Rate for Payer: WPS Commercial |
$47.76
|
|
|
CLAMP COVER RED 061011PBX
|
Facility
|
IP
|
$62.00
|
|
| Hospital Charge Code |
2965506
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$31.60 |
| Max. Negotiated Rate |
$59.32 |
| Rate for Payer: Aetna Commercial |
$58.03
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$55.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$34.17
|
| Rate for Payer: Cash Price |
$18.60
|
| Rate for Payer: Cigna Commercial |
$59.32
|
| Rate for Payer: Health EOS Commercial |
$57.39
|
| Rate for Payer: HFN Commercial |
$59.32
|
| Rate for Payer: Multiplan Commercial |
$51.58
|
| Rate for Payer: Preferred Network Access Commercial |
$59.32
|
| Rate for Payer: Quartz Beloit One Network |
$31.60
|
| Rate for Payer: Quartz Commercial |
$38.69
|
| Rate for Payer: WEA Trust Commercial |
$35.46
|
| Rate for Payer: WPS Commercial |
$47.76
|
|
|
CLAMP DISPOSABLE PLASTIC
|
Facility
|
IP
|
$36.00
|
|
| Hospital Charge Code |
2972252
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$18.35 |
| Max. Negotiated Rate |
$34.44 |
| Rate for Payer: Aetna Commercial |
$33.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$32.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$19.84
|
| Rate for Payer: Cash Price |
$10.80
|
| Rate for Payer: Cigna Commercial |
$34.44
|
| Rate for Payer: Health EOS Commercial |
$33.32
|
| Rate for Payer: HFN Commercial |
$34.44
|
| Rate for Payer: Multiplan Commercial |
$29.95
|
| Rate for Payer: Preferred Network Access Commercial |
$34.44
|
| Rate for Payer: Quartz Beloit One Network |
$18.35
|
| Rate for Payer: Quartz Commercial |
$22.46
|
| Rate for Payer: WEA Trust Commercial |
$20.59
|
| Rate for Payer: WPS Commercial |
$27.73
|
|
|
CLAMP DISPOSABLE PLASTIC
|
Facility
|
OP
|
$36.00
|
|
| Hospital Charge Code |
2972252
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$10.48 |
| Max. Negotiated Rate |
$34.44 |
| Rate for Payer: Aetna Commercial |
$33.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$32.20
|
| Rate for Payer: Aetna Managed Medicare |
$10.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$24.34
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$18.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$17.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$19.84
|
| Rate for Payer: Cash Price |
$10.80
|
| Rate for Payer: Cigna Commercial |
$34.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$20.95
|
| Rate for Payer: Health EOS Commercial |
$33.32
|
| Rate for Payer: HFN Commercial |
$34.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$28.08
|
| Rate for Payer: Multiplan Commercial |
$29.95
|
| Rate for Payer: NAPHCARE Commercial |
$22.46
|
| Rate for Payer: Preferred Network Access Commercial |
$34.44
|
| Rate for Payer: Quartz Beloit One Network |
$18.35
|
| Rate for Payer: Quartz Commercial |
$24.34
|
| Rate for Payer: Quartz Medicare Advantage |
$22.46
|
| Rate for Payer: The Alliance Commercial |
$18.72
|
| Rate for Payer: WEA Trust Commercial |
$20.59
|
| Rate for Payer: WPS Commercial |
$27.73
|
|
|
CLAMP HOFFMANN 3 10 HOLE 4921-2-060
|
Facility
|
IP
|
$4,575.00
|
|
| Hospital Charge Code |
5685709
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,331.42 |
| Max. Negotiated Rate |
$4,377.36 |
| Rate for Payer: Aetna Commercial |
$4,282.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,091.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,521.74
|
| Rate for Payer: Cash Price |
$1,372.50
|
| Rate for Payer: Cigna Commercial |
$4,377.36
|
| Rate for Payer: Health EOS Commercial |
$4,234.62
|
| Rate for Payer: HFN Commercial |
$4,377.36
|
| Rate for Payer: Multiplan Commercial |
$3,806.40
|
| Rate for Payer: Preferred Network Access Commercial |
$4,377.36
|
| Rate for Payer: Quartz Beloit One Network |
$2,331.42
|
| Rate for Payer: Quartz Commercial |
$2,854.80
|
| Rate for Payer: WEA Trust Commercial |
$2,616.90
|
| Rate for Payer: WPS Commercial |
$3,524.12
|
|
|
CLAMP HOFFMANN 3 10 HOLE 4921-2-060
|
Facility
|
OP
|
$4,575.00
|
|
| Hospital Charge Code |
5685709
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,332.24 |
| Max. Negotiated Rate |
$4,377.36 |
| Rate for Payer: Aetna Commercial |
$4,282.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,091.88
|
| Rate for Payer: Aetna Managed Medicare |
$1,332.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,092.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,379.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,283.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,521.74
|
| Rate for Payer: Cash Price |
$1,372.50
|
| Rate for Payer: Cigna Commercial |
$4,377.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,662.65
|
| Rate for Payer: Health EOS Commercial |
$4,234.62
|
| Rate for Payer: HFN Commercial |
$4,377.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,568.50
|
| Rate for Payer: Multiplan Commercial |
$3,806.40
|
| Rate for Payer: NAPHCARE Commercial |
$2,854.80
|
| Rate for Payer: Preferred Network Access Commercial |
$4,377.36
|
| Rate for Payer: Quartz Beloit One Network |
$2,331.42
|
| Rate for Payer: Quartz Commercial |
$3,092.70
|
| Rate for Payer: Quartz Medicare Advantage |
$2,854.80
|
| Rate for Payer: The Alliance Commercial |
$2,379.00
|
| Rate for Payer: WEA Trust Commercial |
$2,616.90
|
| Rate for Payer: WPS Commercial |
$3,524.12
|
|
|
CLAMP HOLDING 1.25MM 395.125
|
Facility
|
IP
|
$4,063.00
|
|
| Hospital Charge Code |
5771655
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,070.50 |
| Max. Negotiated Rate |
$3,887.48 |
| Rate for Payer: Aetna Commercial |
$3,802.97
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,633.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,239.53
|
| Rate for Payer: Cash Price |
$1,218.90
|
| Rate for Payer: Cigna Commercial |
$3,887.48
|
| Rate for Payer: Health EOS Commercial |
$3,760.71
|
| Rate for Payer: HFN Commercial |
$3,887.48
|
| Rate for Payer: Multiplan Commercial |
$3,380.42
|
| Rate for Payer: Preferred Network Access Commercial |
$3,887.48
|
| Rate for Payer: Quartz Beloit One Network |
$2,070.50
|
| Rate for Payer: Quartz Commercial |
$2,535.31
|
| Rate for Payer: WEA Trust Commercial |
$2,324.04
|
| Rate for Payer: WPS Commercial |
$3,129.73
|
|
|
CLAMP HOLDING 1.25MM 395.125
|
Facility
|
OP
|
$4,063.00
|
|
| Hospital Charge Code |
5771655
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,183.15 |
| Max. Negotiated Rate |
$3,887.48 |
| Rate for Payer: Aetna Commercial |
$3,802.97
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,633.95
|
| Rate for Payer: Aetna Managed Medicare |
$1,183.15
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,746.59
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,112.76
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,028.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,239.53
|
| Rate for Payer: Cash Price |
$1,218.90
|
| Rate for Payer: Cigna Commercial |
$3,887.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,364.67
|
| Rate for Payer: Health EOS Commercial |
$3,760.71
|
| Rate for Payer: HFN Commercial |
$3,887.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,169.14
|
| Rate for Payer: Multiplan Commercial |
$3,380.42
|
| Rate for Payer: NAPHCARE Commercial |
$2,535.31
|
| Rate for Payer: Preferred Network Access Commercial |
$3,887.48
|
| Rate for Payer: Quartz Beloit One Network |
$2,070.50
|
| Rate for Payer: Quartz Commercial |
$2,746.59
|
| Rate for Payer: Quartz Medicare Advantage |
$2,535.31
|
| Rate for Payer: The Alliance Commercial |
$2,112.76
|
| Rate for Payer: WEA Trust Commercial |
$2,324.04
|
| Rate for Payer: WPS Commercial |
$3,129.73
|
|
