|
Thyroid Peroxidase Antibody
|
Facility
OP
|
$30.00
|
|
|
Service Code
|
CPT 86376
|
| Hospital Charge Code |
3899562
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.55 |
| Max. Negotiated Rate |
$120.00 |
| Rate for Payer: Aetna Commercial |
$27.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$25.80
|
| Rate for Payer: Aetna Managed Medicare |
$14.55
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$54.56
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$25.46
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$24.15
|
| Rate for Payer: Anthem Medicaid |
$15.03
|
| Rate for Payer: Anthem Medicare Advantage |
$14.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$15.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$14.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$14.55
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Cigna Commercial |
$27.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$14.55
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$15.03
|
| Rate for Payer: Dean Health Medicaid |
$15.03
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$14.55
|
| Rate for Payer: Health EOS Commercial |
$26.70
|
| Rate for Payer: HFN Commercial |
$27.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$54.13
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$14.55
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$15.03
|
| Rate for Payer: Independent Care Health Plan Medicare |
$14.55
|
| Rate for Payer: Managed Health Services Medicaid |
$15.63
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$14.55
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$14.55
|
| Rate for Payer: Multiplan Commercial |
$24.00
|
| Rate for Payer: NAPHCARE Commercial |
$21.82
|
| Rate for Payer: Preferred Network Access Commercial |
$27.60
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$15.03
|
| Rate for Payer: Quartz Beloit One Network |
$14.70
|
| Rate for Payer: Quartz Commercial |
$19.50
|
| Rate for Payer: Quartz Medicare Advantage |
$14.55
|
| Rate for Payer: The Alliance Commercial |
$120.00
|
| Rate for Payer: United Healthcare Medicaid |
$15.03
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14.55
|
| Rate for Payer: United Healthcare PPO |
$22.50
|
| Rate for Payer: WEA Trust Commercial |
$16.50
|
| Rate for Payer: Wellcare Medicare |
$14.55
|
| Rate for Payer: WMAP Medicaid |
$15.03
|
| Rate for Payer: WPS Commercial |
$22.22
|
|
|
Thyroid Peroxidase Antibody
|
Facility
OP
|
$192.00
|
|
|
Service Code
|
CPT 86376
|
| Hospital Charge Code |
983424
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.55 |
| Max. Negotiated Rate |
$768.00 |
| Rate for Payer: Aetna Commercial |
$172.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$165.12
|
| Rate for Payer: Aetna Managed Medicare |
$14.55
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$54.56
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$25.46
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$24.15
|
| Rate for Payer: Anthem Medicaid |
$15.03
|
| Rate for Payer: Anthem Medicare Advantage |
$14.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$101.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$14.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$14.55
|
| Rate for Payer: Cash Price |
$57.60
|
| Rate for Payer: Cash Price |
$57.60
|
| Rate for Payer: Cigna Commercial |
$176.64
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$14.55
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$15.03
|
| Rate for Payer: Dean Health Medicaid |
$15.03
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$14.55
|
| Rate for Payer: Health EOS Commercial |
$170.88
|
| Rate for Payer: HFN Commercial |
$176.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$54.13
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$14.55
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$15.03
|
| Rate for Payer: Independent Care Health Plan Medicare |
$14.55
|
| Rate for Payer: Managed Health Services Medicaid |
$15.63
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$14.55
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$14.55
|
| Rate for Payer: Multiplan Commercial |
$153.60
|
| Rate for Payer: NAPHCARE Commercial |
$21.82
|
| Rate for Payer: Preferred Network Access Commercial |
$176.64
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$15.03
|
| Rate for Payer: Quartz Beloit One Network |
$94.08
|
| Rate for Payer: Quartz Commercial |
$124.80
|
| Rate for Payer: Quartz Medicare Advantage |
$14.55
|
| Rate for Payer: The Alliance Commercial |
$768.00
|
| Rate for Payer: United Healthcare Medicaid |
$15.03
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14.55
|
| Rate for Payer: United Healthcare PPO |
$144.00
|
| Rate for Payer: WEA Trust Commercial |
$105.60
|
| Rate for Payer: Wellcare Medicare |
$14.55
|
| Rate for Payer: WMAP Medicaid |
$15.03
|
| Rate for Payer: WPS Commercial |
$142.21
|
|
|
Thyroid Peroxidase Antibody
|
Facility
IP
|
$192.00
|
|
|
Service Code
|
CPT 86376
|
| Hospital Charge Code |
983424
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$94.08 |
| Max. Negotiated Rate |
$176.64 |
| Rate for Payer: Aetna Commercial |
$172.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$101.76
|
| Rate for Payer: Cash Price |
$57.60
|
| Rate for Payer: Cigna Commercial |
$176.64
|
| Rate for Payer: Health EOS Commercial |
$170.88
|
| Rate for Payer: HFN Commercial |
$176.64
|
| Rate for Payer: Multiplan Commercial |
$153.60
|
| Rate for Payer: NAPHCARE Commercial |
$115.20
|
| Rate for Payer: Preferred Network Access Commercial |
$176.64
|
| Rate for Payer: Quartz Beloit One Network |
$94.08
|
| Rate for Payer: Quartz Commercial |
$115.20
|
| Rate for Payer: WEA Trust Commercial |
$105.60
|
| Rate for Payer: WPS Commercial |
$142.21
|
|
|
Thyroid Peroxidase & Thyroglobulin Antibodies
|
Facility
OP
|
$49.61
|
|
|
Service Code
|
CPT 76376
|
| Hospital Charge Code |
3899560
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.84 |
| Max. Negotiated Rate |
$45.64 |
| Rate for Payer: Aetna Commercial |
$44.65
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$42.66
|
| Rate for Payer: Aetna Managed Medicare |
$13.89
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$32.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$24.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$23.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$26.29
|
| Rate for Payer: Cash Price |
$14.88
|
| Rate for Payer: Cash Price |
$14.88
|
| Rate for Payer: Cigna Commercial |
$45.64
|
| Rate for Payer: Health EOS Commercial |
$44.15
|
| Rate for Payer: HFN Commercial |
$45.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$37.21
|
| Rate for Payer: Multiplan Commercial |
$39.69
|
| Rate for Payer: NAPHCARE Commercial |
$29.77
|
| Rate for Payer: Preferred Network Access Commercial |
$45.64
|
| Rate for Payer: Quartz Beloit One Network |
$24.31
|
| Rate for Payer: Quartz Commercial |
$32.25
|
| Rate for Payer: Quartz Medicare Advantage |
$29.77
|
| Rate for Payer: The Alliance Commercial |
$8.84
|
| Rate for Payer: United Healthcare PPO |
$37.21
|
| Rate for Payer: WEA Trust Commercial |
$27.29
|
| Rate for Payer: WPS Commercial |
$36.75
|
|
|
Thyroid Peroxidase & Thyroglobulin Antibodies
|
Facility
IP
|
$49.61
|
|
|
Service Code
|
CPT 76376
|
| Hospital Charge Code |
3899560
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$24.31 |
| Max. Negotiated Rate |
$45.64 |
| Rate for Payer: Aetna Commercial |
$44.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$26.29
|
| Rate for Payer: Cash Price |
$14.88
|
| Rate for Payer: Cigna Commercial |
$45.64
|
| Rate for Payer: Health EOS Commercial |
$44.15
|
| Rate for Payer: HFN Commercial |
$45.64
|
| Rate for Payer: Multiplan Commercial |
$39.69
|
| Rate for Payer: NAPHCARE Commercial |
$29.77
|
| Rate for Payer: Preferred Network Access Commercial |
$45.64
|
| Rate for Payer: Quartz Beloit One Network |
$24.31
|
| Rate for Payer: Quartz Commercial |
$29.77
|
| Rate for Payer: WEA Trust Commercial |
$27.29
|
| Rate for Payer: WPS Commercial |
$36.75
|
|
|
Thyroid Peroxidase & Thyroglobulin Antibodies
|
Professional
|
$49.61
|
|
|
Service Code
|
CPT 76376
|
| Hospital Charge Code |
3899560
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$21.83 |
| Max. Negotiated Rate |
$115.45 |
| Rate for Payer: Aetna Commercial |
$47.13
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$42.66
|
| Rate for Payer: Aetna Managed Medicare |
$23.09
|
| Rate for Payer: Anthem Medicare Advantage |
$23.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$23.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$23.09
|
| Rate for Payer: Cash Price |
$14.88
|
| Rate for Payer: Cash Price |
$14.88
|
| Rate for Payer: Cigna Commercial |
$47.13
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$24.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$23.09
|
| Rate for Payer: Health EOS Commercial |
$45.15
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$76.42
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$76.42
|
| Rate for Payer: Independent Care Health Plan Medicare |
$23.09
|
| Rate for Payer: Multiplan Commercial |
$39.69
|
| Rate for Payer: Preferred Network Access Commercial |
$47.13
|
| Rate for Payer: Quartz Beloit One Network |
$21.83
|
| Rate for Payer: Quartz Commercial |
$28.28
|
| Rate for Payer: Quartz Medicare Advantage |
$23.09
|
| Rate for Payer: The Alliance Commercial |
$87.74
|
| Rate for Payer: United Healthcare Medicare Advantage |
$23.09
|
| Rate for Payer: WEA Trust Commercial |
$27.29
|
| Rate for Payer: WPS Commercial |
$115.45
|
|
|
Thyroid Stimulating Hormone
|
Professional
|
$298.00
|
|
|
Service Code
|
CPT 84443
|
| Hospital Charge Code |
633844
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$16.80 |
| Max. Negotiated Rate |
$283.10 |
| Rate for Payer: Aetna Commercial |
$283.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$256.28
|
| Rate for Payer: Aetna Managed Medicare |
$16.80
|
| Rate for Payer: Anthem Medicare Advantage |
$16.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$16.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$16.80
|
| Rate for Payer: Cash Price |
$89.40
|
| Rate for Payer: Cash Price |
$89.40
|
| Rate for Payer: Cigna Commercial |
$283.10
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$149.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$16.80
|
| Rate for Payer: Health EOS Commercial |
$271.18
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$59.30
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$59.30
|
| Rate for Payer: Independent Care Health Plan Medicare |
$16.80
|
| Rate for Payer: Multiplan Commercial |
$238.40
|
| Rate for Payer: Preferred Network Access Commercial |
$283.10
|
| Rate for Payer: Quartz Beloit One Network |
$131.12
|
| Rate for Payer: Quartz Commercial |
$169.86
|
| Rate for Payer: Quartz Medicare Advantage |
$16.80
|
| Rate for Payer: The Alliance Commercial |
$66.36
|
| Rate for Payer: United Healthcare Medicare Advantage |
$16.80
|
| Rate for Payer: WEA Trust Commercial |
$163.90
|
| Rate for Payer: WPS Commercial |
$73.92
|
|
|
Thyroid Stimulating Hormone
|
Facility
OP
|
$298.00
|
|
|
Service Code
|
CPT 84443
|
| Hospital Charge Code |
633844
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$16.80 |
| Max. Negotiated Rate |
$1,192.00 |
| Rate for Payer: Aetna Commercial |
$268.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$256.28
|
| Rate for Payer: Aetna Managed Medicare |
$16.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$63.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$29.40
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$27.89
|
| Rate for Payer: Anthem Medicaid |
$17.36
|
| Rate for Payer: Anthem Medicare Advantage |
$16.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$157.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$16.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$16.80
|
| Rate for Payer: Cash Price |
$89.40
|
| Rate for Payer: Cash Price |
$89.40
|
| Rate for Payer: Cigna Commercial |
$274.16
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$16.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$17.36
|
| Rate for Payer: Dean Health Medicaid |
$17.36
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$16.80
|
| Rate for Payer: Health EOS Commercial |
$265.22
|
| Rate for Payer: HFN Commercial |
$274.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$62.50
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$16.80
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$17.36
|
| Rate for Payer: Independent Care Health Plan Medicare |
$16.80
|
| Rate for Payer: Managed Health Services Medicaid |
$18.05
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$16.80
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$16.80
|
| Rate for Payer: Multiplan Commercial |
$238.40
|
| Rate for Payer: NAPHCARE Commercial |
$25.20
|
| Rate for Payer: Preferred Network Access Commercial |
$274.16
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$17.36
|
| Rate for Payer: Quartz Beloit One Network |
$146.02
|
| Rate for Payer: Quartz Commercial |
$193.70
|
| Rate for Payer: Quartz Medicare Advantage |
$16.80
|
| Rate for Payer: The Alliance Commercial |
$1,192.00
|
| Rate for Payer: United Healthcare Medicaid |
$17.36
|
| Rate for Payer: United Healthcare Medicare Advantage |
$16.80
|
| Rate for Payer: United Healthcare PPO |
$223.50
|
| Rate for Payer: WEA Trust Commercial |
$163.90
|
| Rate for Payer: Wellcare Medicare |
$16.80
|
| Rate for Payer: WMAP Medicaid |
$17.36
|
| Rate for Payer: WPS Commercial |
$220.73
|
|
|
Thyroid Stimulating Hormone
|
Facility
IP
|
$298.00
|
|
|
Service Code
|
CPT 84443
|
| Hospital Charge Code |
633844
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$146.02 |
| Max. Negotiated Rate |
$274.16 |
| Rate for Payer: Aetna Commercial |
$268.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$157.94
|
| Rate for Payer: Cash Price |
$89.40
|
| Rate for Payer: Cigna Commercial |
$274.16
|
| Rate for Payer: Health EOS Commercial |
$265.22
|
| Rate for Payer: HFN Commercial |
$274.16
|
| Rate for Payer: Multiplan Commercial |
$238.40
|
| Rate for Payer: NAPHCARE Commercial |
$178.80
|
| Rate for Payer: Preferred Network Access Commercial |
$274.16
|
| Rate for Payer: Quartz Beloit One Network |
$146.02
|
| Rate for Payer: Quartz Commercial |
$178.80
|
| Rate for Payer: WEA Trust Commercial |
$163.90
|
| Rate for Payer: WPS Commercial |
$220.73
|
|
|
Thyroid Stimulating Immunoglobulins
|
Facility
IP
|
$444.00
|
|
|
Service Code
|
CPT 84445
|
| Hospital Charge Code |
978077
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$217.56 |
| Max. Negotiated Rate |
$408.48 |
| Rate for Payer: Aetna Commercial |
$399.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$235.32
|
| Rate for Payer: Cash Price |
$133.20
|
| Rate for Payer: Cigna Commercial |
$408.48
|
| Rate for Payer: Health EOS Commercial |
$395.16
|
| Rate for Payer: HFN Commercial |
$408.48
|
| Rate for Payer: Multiplan Commercial |
$355.20
|
| Rate for Payer: NAPHCARE Commercial |
$266.40
|
| Rate for Payer: Preferred Network Access Commercial |
$408.48
|
| Rate for Payer: Quartz Beloit One Network |
$217.56
|
| Rate for Payer: Quartz Commercial |
$266.40
|
| Rate for Payer: WEA Trust Commercial |
$244.20
|
| Rate for Payer: WPS Commercial |
$328.87
|
|
|
Thyroid Stimulating Immunoglobulins
|
Facility
OP
|
$444.00
|
|
|
Service Code
|
CPT 84445
|
| Hospital Charge Code |
978077
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$32.70 |
| Max. Negotiated Rate |
$1,776.00 |
| Rate for Payer: Aetna Commercial |
$399.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$381.84
|
| Rate for Payer: Aetna Managed Medicare |
$50.86
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$190.72
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$89.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$84.43
|
| Rate for Payer: Anthem Medicaid |
$32.70
|
| Rate for Payer: Anthem Medicare Advantage |
$50.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$235.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$50.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$50.86
|
| Rate for Payer: Cash Price |
$133.20
|
| Rate for Payer: Cash Price |
$133.20
|
| Rate for Payer: Cigna Commercial |
$408.48
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$50.86
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$32.70
|
| Rate for Payer: Dean Health Medicaid |
$32.70
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$50.86
|
| Rate for Payer: Health EOS Commercial |
$395.16
|
| Rate for Payer: HFN Commercial |
$408.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$189.20
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$50.86
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$32.70
|
| Rate for Payer: Independent Care Health Plan Medicare |
$50.86
|
| Rate for Payer: Managed Health Services Medicaid |
$34.01
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$50.86
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$50.86
|
| Rate for Payer: Multiplan Commercial |
$355.20
|
| Rate for Payer: NAPHCARE Commercial |
$76.29
|
| Rate for Payer: Preferred Network Access Commercial |
$408.48
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$32.70
|
| Rate for Payer: Quartz Beloit One Network |
$217.56
|
| Rate for Payer: Quartz Commercial |
$288.60
|
| Rate for Payer: Quartz Medicare Advantage |
$50.86
|
| Rate for Payer: The Alliance Commercial |
$1,776.00
|
| Rate for Payer: United Healthcare Medicaid |
$32.70
|
| Rate for Payer: United Healthcare Medicare Advantage |
$50.86
|
| Rate for Payer: United Healthcare PPO |
$333.00
|
| Rate for Payer: WEA Trust Commercial |
$244.20
|
| Rate for Payer: Wellcare Medicare |
$50.86
|
| Rate for Payer: WMAP Medicaid |
$32.70
|
| Rate for Payer: WPS Commercial |
$328.87
|
|
|
Thyroid Stimulating Immunoglobulins
|
Professional
|
$444.00
|
|
|
Service Code
|
CPT 84445
|
| Hospital Charge Code |
978077
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$50.86 |
| Max. Negotiated Rate |
$421.80 |
| Rate for Payer: Aetna Commercial |
$421.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$381.84
|
| Rate for Payer: Aetna Managed Medicare |
$50.86
|
| Rate for Payer: Anthem Medicare Advantage |
$50.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$50.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$50.86
|
| Rate for Payer: Cash Price |
$133.20
|
| Rate for Payer: Cash Price |
$133.20
|
| Rate for Payer: Cigna Commercial |
$421.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$222.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$50.86
|
| Rate for Payer: Health EOS Commercial |
$404.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$179.54
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$179.54
|
| Rate for Payer: Independent Care Health Plan Medicare |
$50.86
|
| Rate for Payer: Multiplan Commercial |
$355.20
|
| Rate for Payer: Preferred Network Access Commercial |
$421.80
|
| Rate for Payer: Quartz Beloit One Network |
$195.36
|
| Rate for Payer: Quartz Commercial |
$253.08
|
| Rate for Payer: Quartz Medicare Advantage |
$50.86
|
| Rate for Payer: The Alliance Commercial |
$200.90
|
| Rate for Payer: United Healthcare Medicare Advantage |
$50.86
|
| Rate for Payer: WEA Trust Commercial |
$244.20
|
| Rate for Payer: WPS Commercial |
$223.78
|
|
|
Thyrotropin injection 0.9 Mg J3240
|
Professional
|
$3,397.00
|
|
|
Service Code
|
HCPCS J3240
|
| Hospital Charge Code |
3382882
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,494.68 |
| Max. Negotiated Rate |
$5,504.08 |
| Rate for Payer: Aetna Commercial |
$3,227.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,921.42
|
| Rate for Payer: Aetna Managed Medicare |
$2,001.48
|
| Rate for Payer: Anthem Medicare Advantage |
$2,001.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$2,001.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$2,001.48
|
| Rate for Payer: Cash Price |
$1,019.10
|
| Rate for Payer: Cash Price |
$1,019.10
|
| Rate for Payer: Cigna Commercial |
$3,227.15
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,698.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,022.37
|
| Rate for Payer: Health EOS Commercial |
$3,091.27
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,590.52
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$2,590.52
|
| Rate for Payer: Independent Care Health Plan Medicare |
$2,001.48
|
| Rate for Payer: Multiplan Commercial |
$2,717.60
|
| Rate for Payer: Preferred Network Access Commercial |
$3,227.15
|
| Rate for Payer: Quartz Beloit One Network |
$1,494.68
|
| Rate for Payer: Quartz Commercial |
$1,936.29
|
| Rate for Payer: Quartz Medicare Advantage |
$2,001.48
|
| Rate for Payer: The Alliance Commercial |
$5,504.08
|
| Rate for Payer: United Healthcare Medicaid |
$2,021.17
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,001.48
|
| Rate for Payer: WEA Trust Commercial |
$1,868.35
|
| Rate for Payer: WPS Commercial |
$5,055.92
|
|
|
Thyrotropin injection 0.9 Mg J3240
|
Facility
IP
|
$3,397.00
|
|
|
Service Code
|
HCPCS J3240
|
| Hospital Charge Code |
3382882
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,664.53 |
| Max. Negotiated Rate |
$3,125.24 |
| Rate for Payer: Aetna Commercial |
$3,057.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,800.41
|
| Rate for Payer: Cash Price |
$1,019.10
|
| Rate for Payer: Cigna Commercial |
$3,125.24
|
| Rate for Payer: Health EOS Commercial |
$3,023.33
|
| Rate for Payer: HFN Commercial |
$3,125.24
|
| Rate for Payer: Multiplan Commercial |
$2,717.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,038.20
|
| Rate for Payer: Preferred Network Access Commercial |
$3,125.24
|
| Rate for Payer: Quartz Beloit One Network |
$1,664.53
|
| Rate for Payer: Quartz Commercial |
$2,038.20
|
| Rate for Payer: WEA Trust Commercial |
$1,868.35
|
| Rate for Payer: WPS Commercial |
$2,516.16
|
|
|
Thyrotropin injection 0.9 Mg J3240
|
Facility
OP
|
$3,397.00
|
|
|
Service Code
|
HCPCS J3240
|
| Hospital Charge Code |
3382882
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,630.56 |
| Max. Negotiated Rate |
$7,518.75 |
| Rate for Payer: Quartz Beloit One Network |
$1,664.53
|
| Rate for Payer: Aetna Commercial |
$3,057.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,921.42
|
| Rate for Payer: Aetna Managed Medicare |
$2,021.17
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,208.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,698.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,630.56
|
| Rate for Payer: Anthem Medicare Advantage |
$2,021.17
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,800.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$2,021.17
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$2,021.17
|
| Rate for Payer: Cash Price |
$1,019.10
|
| Rate for Payer: Cash Price |
$1,019.10
|
| Rate for Payer: Cigna Commercial |
$3,125.24
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$2,021.17
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,675.59
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$2,021.17
|
| Rate for Payer: Health EOS Commercial |
$3,023.33
|
| Rate for Payer: HFN Commercial |
$3,125.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7,518.75
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$2,021.17
|
| Rate for Payer: Independent Care Health Plan Medicare |
$2,021.17
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$2,021.17
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$2,021.17
|
| Rate for Payer: Multiplan Commercial |
$2,717.60
|
| Rate for Payer: NAPHCARE Commercial |
$3,031.76
|
| Rate for Payer: Preferred Network Access Commercial |
$3,125.24
|
| Rate for Payer: Quartz Commercial |
$2,208.05
|
| Rate for Payer: Quartz Medicare Advantage |
$2,021.17
|
| Rate for Payer: The Alliance Commercial |
$1,654.44
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,021.17
|
| Rate for Payer: WEA Trust Commercial |
$1,868.35
|
| Rate for Payer: Wellcare Medicare |
$2,021.17
|
| Rate for Payer: WPS Commercial |
$5,055.92
|
|
|
Thyroxine
|
Facility
IP
|
$140.00
|
|
|
Service Code
|
CPT 84436
|
| Hospital Charge Code |
633845
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$68.60 |
| Max. Negotiated Rate |
$128.80 |
| Rate for Payer: Aetna Commercial |
$126.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$74.20
|
| Rate for Payer: Cash Price |
$42.00
|
| Rate for Payer: Cigna Commercial |
$128.80
|
| Rate for Payer: Health EOS Commercial |
$124.60
|
| Rate for Payer: HFN Commercial |
$128.80
|
| Rate for Payer: Multiplan Commercial |
$112.00
|
| Rate for Payer: NAPHCARE Commercial |
$84.00
|
| Rate for Payer: Preferred Network Access Commercial |
$128.80
|
| Rate for Payer: Quartz Beloit One Network |
$68.60
|
| Rate for Payer: Quartz Commercial |
$84.00
|
| Rate for Payer: WEA Trust Commercial |
$77.00
|
| Rate for Payer: WPS Commercial |
$103.70
|
|
|
Thyroxine
|
Professional
|
$140.00
|
|
|
Service Code
|
CPT 84436
|
| Hospital Charge Code |
633845
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.87 |
| Max. Negotiated Rate |
$133.00 |
| Rate for Payer: Aetna Commercial |
$133.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$120.40
|
| Rate for Payer: Aetna Managed Medicare |
$6.87
|
| Rate for Payer: Anthem Medicare Advantage |
$6.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$6.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$6.87
|
| Rate for Payer: Cash Price |
$42.00
|
| Rate for Payer: Cash Price |
$42.00
|
| Rate for Payer: Cigna Commercial |
$133.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$70.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6.87
|
| Rate for Payer: Health EOS Commercial |
$127.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$24.25
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$24.25
|
| Rate for Payer: Independent Care Health Plan Medicare |
$6.87
|
| Rate for Payer: Multiplan Commercial |
$112.00
|
| Rate for Payer: Preferred Network Access Commercial |
$133.00
|
| Rate for Payer: Quartz Beloit One Network |
$61.60
|
| Rate for Payer: Quartz Commercial |
$79.80
|
| Rate for Payer: Quartz Medicare Advantage |
$6.87
|
| Rate for Payer: The Alliance Commercial |
$27.14
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6.87
|
| Rate for Payer: WEA Trust Commercial |
$77.00
|
| Rate for Payer: WPS Commercial |
$30.23
|
|
|
Thyroxine
|
Facility
OP
|
$140.00
|
|
|
Service Code
|
CPT 84436
|
| Hospital Charge Code |
633845
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.87 |
| Max. Negotiated Rate |
$560.00 |
| Rate for Payer: Aetna Commercial |
$126.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$120.40
|
| Rate for Payer: Aetna Managed Medicare |
$6.87
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$25.76
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$12.02
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$11.40
|
| Rate for Payer: Anthem Medicaid |
$7.10
|
| Rate for Payer: Anthem Medicare Advantage |
$6.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$74.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$6.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$6.87
|
| Rate for Payer: Cash Price |
$42.00
|
| Rate for Payer: Cash Price |
$42.00
|
| Rate for Payer: Cigna Commercial |
$128.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$6.87
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$7.10
|
| Rate for Payer: Dean Health Medicaid |
$7.10
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$6.87
|
| Rate for Payer: Health EOS Commercial |
$124.60
|
| Rate for Payer: HFN Commercial |
$128.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$25.56
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$6.87
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$7.10
|
| Rate for Payer: Independent Care Health Plan Medicare |
$6.87
|
| Rate for Payer: Managed Health Services Medicaid |
$7.38
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$6.87
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$6.87
|
| Rate for Payer: Multiplan Commercial |
$112.00
|
| Rate for Payer: NAPHCARE Commercial |
$10.30
|
| Rate for Payer: Preferred Network Access Commercial |
$128.80
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$7.10
|
| Rate for Payer: Quartz Beloit One Network |
$68.60
|
| Rate for Payer: Quartz Commercial |
$91.00
|
| Rate for Payer: Quartz Medicare Advantage |
$6.87
|
| Rate for Payer: The Alliance Commercial |
$560.00
|
| Rate for Payer: United Healthcare Medicaid |
$7.10
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6.87
|
| Rate for Payer: United Healthcare PPO |
$105.00
|
| Rate for Payer: WEA Trust Commercial |
$77.00
|
| Rate for Payer: Wellcare Medicare |
$6.87
|
| Rate for Payer: WMAP Medicaid |
$7.10
|
| Rate for Payer: WPS Commercial |
$103.70
|
|
|
Thyroxine Binding Globulin (TBG)
|
Professional
|
$111.00
|
|
|
Service Code
|
CPT 84442
|
| Hospital Charge Code |
6087633
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.78 |
| Max. Negotiated Rate |
$105.45 |
| Rate for Payer: Aetna Commercial |
$105.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$95.46
|
| Rate for Payer: Aetna Managed Medicare |
$14.78
|
| Rate for Payer: Anthem Medicare Advantage |
$14.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$14.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$14.78
|
| Rate for Payer: Cash Price |
$33.30
|
| Rate for Payer: Cash Price |
$33.30
|
| Rate for Payer: Cigna Commercial |
$105.45
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$55.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$14.78
|
| Rate for Payer: Health EOS Commercial |
$101.01
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$52.17
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$52.17
|
| Rate for Payer: Independent Care Health Plan Medicare |
$14.78
|
| Rate for Payer: Multiplan Commercial |
$88.80
|
| Rate for Payer: Preferred Network Access Commercial |
$105.45
|
| Rate for Payer: Quartz Beloit One Network |
$48.84
|
| Rate for Payer: Quartz Commercial |
$63.27
|
| Rate for Payer: Quartz Medicare Advantage |
$14.78
|
| Rate for Payer: The Alliance Commercial |
$58.38
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14.78
|
| Rate for Payer: WEA Trust Commercial |
$61.05
|
| Rate for Payer: WPS Commercial |
$65.03
|
|
|
Thyroxine Binding Globulin (TBG)
|
Facility
OP
|
$111.00
|
|
|
Service Code
|
CPT 84442
|
| Hospital Charge Code |
6087633
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.78 |
| Max. Negotiated Rate |
$444.00 |
| Rate for Payer: Aetna Commercial |
$99.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$95.46
|
| Rate for Payer: Aetna Managed Medicare |
$14.78
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$55.42
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$25.86
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$24.53
|
| Rate for Payer: Anthem Medicaid |
$15.27
|
| Rate for Payer: Anthem Medicare Advantage |
$14.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$58.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$14.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$14.78
|
| Rate for Payer: Cash Price |
$33.30
|
| Rate for Payer: Cash Price |
$33.30
|
| Rate for Payer: Cigna Commercial |
$102.12
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$14.78
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$15.27
|
| Rate for Payer: Dean Health Medicaid |
$15.27
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$14.78
|
| Rate for Payer: Health EOS Commercial |
$98.79
|
| Rate for Payer: HFN Commercial |
$102.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$54.98
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$14.78
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$15.27
|
| Rate for Payer: Independent Care Health Plan Medicare |
$14.78
|
| Rate for Payer: Managed Health Services Medicaid |
$15.88
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$14.78
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$14.78
|
| Rate for Payer: Multiplan Commercial |
$88.80
|
| Rate for Payer: NAPHCARE Commercial |
$22.17
|
| Rate for Payer: Preferred Network Access Commercial |
$102.12
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$15.27
|
| Rate for Payer: Quartz Beloit One Network |
$54.39
|
| Rate for Payer: Quartz Commercial |
$72.15
|
| Rate for Payer: Quartz Medicare Advantage |
$14.78
|
| Rate for Payer: The Alliance Commercial |
$444.00
|
| Rate for Payer: United Healthcare Medicaid |
$15.27
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14.78
|
| Rate for Payer: United Healthcare PPO |
$83.25
|
| Rate for Payer: WEA Trust Commercial |
$61.05
|
| Rate for Payer: Wellcare Medicare |
$14.78
|
| Rate for Payer: WMAP Medicaid |
$15.27
|
| Rate for Payer: WPS Commercial |
$82.22
|
|
|
Thyroxine Binding Globulin (TBG)
|
Facility
IP
|
$111.00
|
|
|
Service Code
|
CPT 84442
|
| Hospital Charge Code |
6087633
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$54.39 |
| Max. Negotiated Rate |
$102.12 |
| Rate for Payer: Aetna Commercial |
$99.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$58.83
|
| Rate for Payer: Cash Price |
$33.30
|
| Rate for Payer: Cigna Commercial |
$102.12
|
| Rate for Payer: Health EOS Commercial |
$98.79
|
| Rate for Payer: HFN Commercial |
$102.12
|
| Rate for Payer: Multiplan Commercial |
$88.80
|
| Rate for Payer: NAPHCARE Commercial |
$66.60
|
| Rate for Payer: Preferred Network Access Commercial |
$102.12
|
| Rate for Payer: Quartz Beloit One Network |
$54.39
|
| Rate for Payer: Quartz Commercial |
$66.60
|
| Rate for Payer: WEA Trust Commercial |
$61.05
|
| Rate for Payer: WPS Commercial |
$82.22
|
|
|
Thyroxine Free
|
Facility
IP
|
$296.00
|
|
|
Service Code
|
CPT 84439
|
| Hospital Charge Code |
633846
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$145.04 |
| Max. Negotiated Rate |
$272.32 |
| Rate for Payer: Aetna Commercial |
$266.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$156.88
|
| Rate for Payer: Cash Price |
$88.80
|
| Rate for Payer: Cigna Commercial |
$272.32
|
| Rate for Payer: Health EOS Commercial |
$263.44
|
| Rate for Payer: HFN Commercial |
$272.32
|
| Rate for Payer: Multiplan Commercial |
$236.80
|
| Rate for Payer: NAPHCARE Commercial |
$177.60
|
| Rate for Payer: Preferred Network Access Commercial |
$272.32
|
| Rate for Payer: Quartz Beloit One Network |
$145.04
|
| Rate for Payer: Quartz Commercial |
$177.60
|
| Rate for Payer: WEA Trust Commercial |
$162.80
|
| Rate for Payer: WPS Commercial |
$219.25
|
|
|
Thyroxine Free
|
Professional
|
$296.00
|
|
|
Service Code
|
CPT 84439
|
| Hospital Charge Code |
633846
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.02 |
| Max. Negotiated Rate |
$281.20 |
| Rate for Payer: Aetna Commercial |
$281.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$254.56
|
| Rate for Payer: Aetna Managed Medicare |
$9.02
|
| Rate for Payer: Anthem Medicare Advantage |
$9.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$9.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$9.02
|
| Rate for Payer: Cash Price |
$88.80
|
| Rate for Payer: Cash Price |
$88.80
|
| Rate for Payer: Cigna Commercial |
$281.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$148.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$9.02
|
| Rate for Payer: Health EOS Commercial |
$269.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$31.84
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$31.84
|
| Rate for Payer: Independent Care Health Plan Medicare |
$9.02
|
| Rate for Payer: Multiplan Commercial |
$236.80
|
| Rate for Payer: Preferred Network Access Commercial |
$281.20
|
| Rate for Payer: Quartz Beloit One Network |
$130.24
|
| Rate for Payer: Quartz Commercial |
$168.72
|
| Rate for Payer: Quartz Medicare Advantage |
$9.02
|
| Rate for Payer: The Alliance Commercial |
$35.63
|
| Rate for Payer: United Healthcare Medicare Advantage |
$9.02
|
| Rate for Payer: WEA Trust Commercial |
$162.80
|
| Rate for Payer: WPS Commercial |
$39.69
|
|
|
Thyroxine Free
|
Facility
OP
|
$296.00
|
|
|
Service Code
|
CPT 84439
|
| Hospital Charge Code |
633846
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.02 |
| Max. Negotiated Rate |
$1,184.00 |
| Rate for Payer: Aetna Commercial |
$266.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$254.56
|
| Rate for Payer: Aetna Managed Medicare |
$9.02
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$33.82
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$15.78
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$14.97
|
| Rate for Payer: Anthem Medicaid |
$9.32
|
| Rate for Payer: Anthem Medicare Advantage |
$9.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$156.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$9.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$9.02
|
| Rate for Payer: Cash Price |
$88.80
|
| Rate for Payer: Cash Price |
$88.80
|
| Rate for Payer: Cigna Commercial |
$272.32
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$9.02
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$9.32
|
| Rate for Payer: Dean Health Medicaid |
$9.32
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$9.02
|
| Rate for Payer: Health EOS Commercial |
$263.44
|
| Rate for Payer: HFN Commercial |
$272.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$33.55
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$9.02
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$9.32
|
| Rate for Payer: Independent Care Health Plan Medicare |
$9.02
|
| Rate for Payer: Managed Health Services Medicaid |
$9.69
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$9.02
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$9.02
|
| Rate for Payer: Multiplan Commercial |
$236.80
|
| Rate for Payer: NAPHCARE Commercial |
$13.53
|
| Rate for Payer: Preferred Network Access Commercial |
$272.32
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$9.32
|
| Rate for Payer: Quartz Beloit One Network |
$145.04
|
| Rate for Payer: Quartz Commercial |
$192.40
|
| Rate for Payer: Quartz Medicare Advantage |
$9.02
|
| Rate for Payer: The Alliance Commercial |
$1,184.00
|
| Rate for Payer: United Healthcare Medicaid |
$9.32
|
| Rate for Payer: United Healthcare Medicare Advantage |
$9.02
|
| Rate for Payer: United Healthcare PPO |
$222.00
|
| Rate for Payer: WEA Trust Commercial |
$162.80
|
| Rate for Payer: Wellcare Medicare |
$9.02
|
| Rate for Payer: WMAP Medicaid |
$9.32
|
| Rate for Payer: WPS Commercial |
$219.25
|
|
|
Tiagabine (Gabitril)
|
Facility
OP
|
$234.00
|
|
|
Service Code
|
CPT 80199
|
| Hospital Charge Code |
983425
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$19.70 |
| Max. Negotiated Rate |
$936.00 |
| Rate for Payer: Aetna Commercial |
$210.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$201.24
|
| Rate for Payer: Aetna Managed Medicare |
$27.11
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$101.66
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$47.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$45.00
|
| Rate for Payer: Anthem Medicaid |
$19.70
|
| Rate for Payer: Anthem Medicare Advantage |
$27.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$124.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$27.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$27.11
|
| Rate for Payer: Cash Price |
$70.20
|
| Rate for Payer: Cash Price |
$70.20
|
| Rate for Payer: Cigna Commercial |
$215.28
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$27.11
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$19.70
|
| Rate for Payer: Dean Health Medicaid |
$19.70
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$27.11
|
| Rate for Payer: Health EOS Commercial |
$208.26
|
| Rate for Payer: HFN Commercial |
$215.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$100.85
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$27.11
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$19.70
|
| Rate for Payer: Independent Care Health Plan Medicare |
$27.11
|
| Rate for Payer: Managed Health Services Medicaid |
$20.49
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$27.11
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$27.11
|
| Rate for Payer: Multiplan Commercial |
$187.20
|
| Rate for Payer: NAPHCARE Commercial |
$40.66
|
| Rate for Payer: Preferred Network Access Commercial |
$215.28
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$19.70
|
| Rate for Payer: Quartz Beloit One Network |
$114.66
|
| Rate for Payer: Quartz Commercial |
$152.10
|
| Rate for Payer: Quartz Medicare Advantage |
$27.11
|
| Rate for Payer: The Alliance Commercial |
$936.00
|
| Rate for Payer: United Healthcare Medicaid |
$19.70
|
| Rate for Payer: United Healthcare Medicare Advantage |
$27.11
|
| Rate for Payer: United Healthcare PPO |
$175.50
|
| Rate for Payer: WEA Trust Commercial |
$128.70
|
| Rate for Payer: Wellcare Medicare |
$27.11
|
| Rate for Payer: WMAP Medicaid |
$19.70
|
| Rate for Payer: WPS Commercial |
$173.32
|
|
