|
Thrombin Time
|
Professional
|
Both
|
$276.00
|
|
|
Service Code
|
CPT 85670
|
| Hospital Charge Code |
978134
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.00 |
| Max. Negotiated Rate |
$272.69 |
| Rate for Payer: Aetna Commercial |
$272.69
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$246.85
|
| Rate for Payer: Aetna Managed Medicare |
$6.00
|
| Rate for Payer: Anthem Medicare Advantage |
$6.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$6.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$6.00
|
| Rate for Payer: Cash Price |
$82.80
|
| Rate for Payer: Cash Price |
$82.80
|
| Rate for Payer: Cigna Commercial |
$272.69
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$143.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6.00
|
| Rate for Payer: Health EOS Commercial |
$261.21
|
| Rate for Payer: HFN Commercial |
$272.69
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$21.18
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$21.18
|
| Rate for Payer: Independent Care Health Plan Medicare |
$6.00
|
| Rate for Payer: Multiplan Commercial |
$229.63
|
| Rate for Payer: NAPHCARE Commercial |
$9.00
|
| Rate for Payer: Preferred Network Access Commercial |
$272.69
|
| Rate for Payer: Quartz Beloit One Network |
$126.30
|
| Rate for Payer: Quartz Commercial |
$163.61
|
| Rate for Payer: Quartz Medicare Advantage |
$6.00
|
| Rate for Payer: The Alliance Commercial |
$23.70
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6.00
|
| Rate for Payer: WEA Trust Commercial |
$157.87
|
| Rate for Payer: WPS Commercial |
$26.40
|
|
|
Thrombin Time
|
Facility
|
OP
|
$276.00
|
|
|
Service Code
|
CPT 85670
|
| Hospital Charge Code |
978134
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.00 |
| Max. Negotiated Rate |
$264.08 |
| Rate for Payer: Aetna Commercial |
$258.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$246.85
|
| Rate for Payer: Aetna Managed Medicare |
$6.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$22.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$10.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$9.96
|
| Rate for Payer: Anthem Medicare Advantage |
$6.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$152.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$6.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$6.00
|
| Rate for Payer: Cash Price |
$82.80
|
| Rate for Payer: Cash Price |
$82.80
|
| Rate for Payer: Cigna Commercial |
$264.08
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$6.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$160.63
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$6.00
|
| Rate for Payer: Health EOS Commercial |
$255.47
|
| Rate for Payer: HFN Commercial |
$264.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$22.32
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$6.00
|
| Rate for Payer: Independent Care Health Plan Medicare |
$6.00
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$6.00
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$6.00
|
| Rate for Payer: Multiplan Commercial |
$229.63
|
| Rate for Payer: NAPHCARE Commercial |
$9.00
|
| Rate for Payer: Preferred Network Access Commercial |
$264.08
|
| Rate for Payer: Quartz Beloit One Network |
$140.65
|
| Rate for Payer: Quartz Commercial |
$186.58
|
| Rate for Payer: Quartz Medicare Advantage |
$6.00
|
| Rate for Payer: The Alliance Commercial |
$24.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6.00
|
| Rate for Payer: United Healthcare PPO |
$215.28
|
| Rate for Payer: WEA Trust Commercial |
$157.87
|
| Rate for Payer: Wellcare Medicare |
$6.00
|
| Rate for Payer: WPS Commercial |
$212.60
|
|
|
Thrombin Time
|
Facility
|
IP
|
$276.00
|
|
|
Service Code
|
CPT 85670
|
| Hospital Charge Code |
978134
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$140.65 |
| Max. Negotiated Rate |
$264.08 |
| Rate for Payer: Aetna Commercial |
$258.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$246.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$152.13
|
| Rate for Payer: Cash Price |
$82.80
|
| Rate for Payer: Cigna Commercial |
$264.08
|
| Rate for Payer: Health EOS Commercial |
$255.47
|
| Rate for Payer: HFN Commercial |
$264.08
|
| Rate for Payer: Multiplan Commercial |
$229.63
|
| Rate for Payer: Preferred Network Access Commercial |
$264.08
|
| Rate for Payer: Quartz Beloit One Network |
$140.65
|
| Rate for Payer: Quartz Commercial |
$172.22
|
| Rate for Payer: WEA Trust Commercial |
$157.87
|
| Rate for Payer: WPS Commercial |
$212.60
|
|
|
THROMBOLYSIS
|
Facility
|
OP
|
$150.68
|
|
|
Service Code
|
EAPG 00095
|
| Min. Negotiated Rate |
$144.89 |
| Max. Negotiated Rate |
$150.68 |
| Rate for Payer: Anthem Medicaid |
$144.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$144.89
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$144.89
|
| Rate for Payer: Dean Health Medicaid |
$144.89
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$144.89
|
| Rate for Payer: Managed Health Services Medicaid |
$150.68
|
| Rate for Payer: Molina Healthcare Medicaid |
$144.89
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$144.89
|
| Rate for Payer: United Healthcare Medicaid |
$144.89
|
|
|
Thrombolysis (IC) Coronary
|
Facility
|
OP
|
$2,592.00
|
|
|
Service Code
|
CPT 92975
|
| Hospital Charge Code |
5238883
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$754.79 |
| Max. Negotiated Rate |
$3,030.56 |
| Rate for Payer: Aetna Commercial |
$2,426.11
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,318.28
|
| Rate for Payer: Aetna Managed Medicare |
$754.79
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,030.56
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,388.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,270.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,428.71
|
| Rate for Payer: Cash Price |
$777.60
|
| Rate for Payer: Cash Price |
$777.60
|
| Rate for Payer: Cash Price |
$777.60
|
| Rate for Payer: Cigna Commercial |
$2,480.03
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,508.54
|
| Rate for Payer: Health EOS Commercial |
$2,399.16
|
| Rate for Payer: HFN Commercial |
$2,480.03
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,021.76
|
| Rate for Payer: Multiplan Commercial |
$2,156.54
|
| Rate for Payer: NAPHCARE Commercial |
$1,617.41
|
| Rate for Payer: Preferred Network Access Commercial |
$2,480.03
|
| Rate for Payer: Quartz Beloit One Network |
$1,320.88
|
| Rate for Payer: Quartz Commercial |
$1,752.19
|
| Rate for Payer: Quartz Medicare Advantage |
$1,617.41
|
| Rate for Payer: The Alliance Commercial |
$1,347.84
|
| Rate for Payer: United Healthcare PPO |
$2,347.28
|
| Rate for Payer: WEA Trust Commercial |
$1,482.62
|
| Rate for Payer: WPS Commercial |
$1,996.62
|
|
|
Thrombolysis (IC) Coronary
|
Facility
|
IP
|
$2,592.00
|
|
|
Service Code
|
CPT 92975
|
| Hospital Charge Code |
5238883
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,320.88 |
| Max. Negotiated Rate |
$2,480.03 |
| Rate for Payer: Aetna Commercial |
$2,426.11
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,318.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,428.71
|
| Rate for Payer: Cash Price |
$777.60
|
| Rate for Payer: Cigna Commercial |
$2,480.03
|
| Rate for Payer: Health EOS Commercial |
$2,399.16
|
| Rate for Payer: HFN Commercial |
$2,480.03
|
| Rate for Payer: Multiplan Commercial |
$2,156.54
|
| Rate for Payer: Preferred Network Access Commercial |
$2,480.03
|
| Rate for Payer: Quartz Beloit One Network |
$1,320.88
|
| Rate for Payer: Quartz Commercial |
$1,617.41
|
| Rate for Payer: WEA Trust Commercial |
$1,482.62
|
| Rate for Payer: WPS Commercial |
$1,996.62
|
|
|
Thrombolytic Therapy Arterial, Initial
|
Facility
|
OP
|
$15,109.00
|
|
|
Service Code
|
CPT 37211
|
| Hospital Charge Code |
3052437
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$4,409.60 |
| Max. Negotiated Rate |
$23,424.04 |
| Rate for Payer: Aetna Commercial |
$14,142.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$13,513.49
|
| Rate for Payer: Aetna Managed Medicare |
$5,856.01
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$12,727.52
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$11,350.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$10,781.68
|
| Rate for Payer: Anthem Medicare Advantage |
$5,856.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$8,328.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5,856.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5,856.01
|
| Rate for Payer: Cash Price |
$4,532.70
|
| Rate for Payer: Cash Price |
$4,532.70
|
| Rate for Payer: Cash Price |
$4,532.70
|
| Rate for Payer: Cigna Commercial |
$14,456.29
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$5,856.01
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12,349.86
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$5,856.01
|
| Rate for Payer: Health EOS Commercial |
$13,984.89
|
| Rate for Payer: HFN Commercial |
$14,456.29
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$21,784.36
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$5,856.01
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5,856.01
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$5,856.01
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$5,856.01
|
| Rate for Payer: Multiplan Commercial |
$12,570.69
|
| Rate for Payer: NAPHCARE Commercial |
$8,784.02
|
| Rate for Payer: Preferred Network Access Commercial |
$14,456.29
|
| Rate for Payer: Quartz Beloit One Network |
$7,699.55
|
| Rate for Payer: Quartz Commercial |
$10,213.68
|
| Rate for Payer: Quartz Medicare Advantage |
$5,856.01
|
| Rate for Payer: The Alliance Commercial |
$23,424.04
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5,856.01
|
| Rate for Payer: United Healthcare PPO |
$4,409.60
|
| Rate for Payer: WEA Trust Commercial |
$8,642.35
|
| Rate for Payer: Wellcare Medicare |
$5,856.01
|
| Rate for Payer: WPS Commercial |
$11,638.46
|
|
|
Thrombolytic Therapy Arterial, Initial
|
Facility
|
IP
|
$15,109.00
|
|
|
Service Code
|
CPT 37211
|
| Hospital Charge Code |
3052437
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$7,699.55 |
| Max. Negotiated Rate |
$14,456.29 |
| Rate for Payer: Aetna Commercial |
$14,142.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$13,513.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$8,328.08
|
| Rate for Payer: Cash Price |
$4,532.70
|
| Rate for Payer: Cigna Commercial |
$14,456.29
|
| Rate for Payer: Health EOS Commercial |
$13,984.89
|
| Rate for Payer: HFN Commercial |
$14,456.29
|
| Rate for Payer: Multiplan Commercial |
$12,570.69
|
| Rate for Payer: Preferred Network Access Commercial |
$14,456.29
|
| Rate for Payer: Quartz Beloit One Network |
$7,699.55
|
| Rate for Payer: Quartz Commercial |
$9,428.02
|
| Rate for Payer: WEA Trust Commercial |
$8,642.35
|
| Rate for Payer: WPS Commercial |
$11,638.46
|
|
|
Thrombolytic Therapy Art/Vein F/U
|
Facility
|
OP
|
$7,299.00
|
|
|
Service Code
|
CPT 37213
|
| Hospital Charge Code |
3052439
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,835.04 |
| Max. Negotiated Rate |
$13,291.62 |
| Rate for Payer: Aetna Commercial |
$6,831.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,528.23
|
| Rate for Payer: Aetna Managed Medicare |
$3,322.90
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,635.84
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,985.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,835.04
|
| Rate for Payer: Anthem Medicare Advantage |
$3,322.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,023.21
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$3,322.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$3,322.90
|
| Rate for Payer: Cash Price |
$2,189.70
|
| Rate for Payer: Cash Price |
$2,189.70
|
| Rate for Payer: Cash Price |
$2,189.70
|
| Rate for Payer: Cigna Commercial |
$6,983.68
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$3,322.90
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12,349.86
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$3,322.90
|
| Rate for Payer: Health EOS Commercial |
$6,755.95
|
| Rate for Payer: HFN Commercial |
$6,983.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$12,361.20
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$3,322.90
|
| Rate for Payer: Independent Care Health Plan Medicare |
$3,322.90
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$3,322.90
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$3,322.90
|
| Rate for Payer: Multiplan Commercial |
$6,072.77
|
| Rate for Payer: NAPHCARE Commercial |
$4,984.36
|
| Rate for Payer: Preferred Network Access Commercial |
$6,983.68
|
| Rate for Payer: Quartz Beloit One Network |
$3,719.57
|
| Rate for Payer: Quartz Commercial |
$4,934.12
|
| Rate for Payer: Quartz Medicare Advantage |
$3,322.90
|
| Rate for Payer: The Alliance Commercial |
$13,291.62
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,322.90
|
| Rate for Payer: United Healthcare PPO |
$3,726.32
|
| Rate for Payer: WEA Trust Commercial |
$4,175.03
|
| Rate for Payer: Wellcare Medicare |
$3,322.90
|
| Rate for Payer: WPS Commercial |
$5,622.42
|
|
|
Thrombolytic Therapy Art/Vein F/U
|
Facility
|
IP
|
$7,299.00
|
|
|
Service Code
|
CPT 37213
|
| Hospital Charge Code |
3052439
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$3,719.57 |
| Max. Negotiated Rate |
$6,983.68 |
| Rate for Payer: Aetna Commercial |
$6,831.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,528.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,023.21
|
| Rate for Payer: Cash Price |
$2,189.70
|
| Rate for Payer: Cigna Commercial |
$6,983.68
|
| Rate for Payer: Health EOS Commercial |
$6,755.95
|
| Rate for Payer: HFN Commercial |
$6,983.68
|
| Rate for Payer: Multiplan Commercial |
$6,072.77
|
| Rate for Payer: Preferred Network Access Commercial |
$6,983.68
|
| Rate for Payer: Quartz Beloit One Network |
$3,719.57
|
| Rate for Payer: Quartz Commercial |
$4,554.58
|
| Rate for Payer: WEA Trust Commercial |
$4,175.03
|
| Rate for Payer: WPS Commercial |
$5,622.42
|
|
|
Thrombolytic Therapy Cessation
|
Facility
|
OP
|
$1,708.00
|
|
|
Service Code
|
CPT 37214
|
| Hospital Charge Code |
3052440
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$870.40 |
| Max. Negotiated Rate |
$13,291.62 |
| Rate for Payer: Aetna Commercial |
$1,598.69
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,527.64
|
| Rate for Payer: Aetna Managed Medicare |
$3,322.90
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,635.84
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,985.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,835.04
|
| Rate for Payer: Anthem Medicare Advantage |
$3,322.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$941.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$3,322.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$3,322.90
|
| Rate for Payer: Cash Price |
$512.40
|
| Rate for Payer: Cash Price |
$512.40
|
| Rate for Payer: Cash Price |
$512.40
|
| Rate for Payer: Cigna Commercial |
$1,634.21
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$3,322.90
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12,349.86
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$3,322.90
|
| Rate for Payer: Health EOS Commercial |
$1,580.92
|
| Rate for Payer: HFN Commercial |
$1,634.21
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$12,361.20
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$3,322.90
|
| Rate for Payer: Independent Care Health Plan Medicare |
$3,322.90
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$3,322.90
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$3,322.90
|
| Rate for Payer: Multiplan Commercial |
$1,421.06
|
| Rate for Payer: NAPHCARE Commercial |
$4,984.36
|
| Rate for Payer: Preferred Network Access Commercial |
$1,634.21
|
| Rate for Payer: Quartz Beloit One Network |
$870.40
|
| Rate for Payer: Quartz Commercial |
$1,154.61
|
| Rate for Payer: Quartz Medicare Advantage |
$3,322.90
|
| Rate for Payer: The Alliance Commercial |
$13,291.62
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,322.90
|
| Rate for Payer: United Healthcare PPO |
$3,726.32
|
| Rate for Payer: WEA Trust Commercial |
$976.98
|
| Rate for Payer: Wellcare Medicare |
$3,322.90
|
| Rate for Payer: WPS Commercial |
$1,315.67
|
|
|
Thrombolytic Therapy Cessation
|
Facility
|
IP
|
$1,708.00
|
|
|
Service Code
|
CPT 37214
|
| Hospital Charge Code |
3052440
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$870.40 |
| Max. Negotiated Rate |
$1,634.21 |
| Rate for Payer: Aetna Commercial |
$1,598.69
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,527.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$941.45
|
| Rate for Payer: Cash Price |
$512.40
|
| Rate for Payer: Cigna Commercial |
$1,634.21
|
| Rate for Payer: Health EOS Commercial |
$1,580.92
|
| Rate for Payer: HFN Commercial |
$1,634.21
|
| Rate for Payer: Multiplan Commercial |
$1,421.06
|
| Rate for Payer: Preferred Network Access Commercial |
$1,634.21
|
| Rate for Payer: Quartz Beloit One Network |
$870.40
|
| Rate for Payer: Quartz Commercial |
$1,065.79
|
| Rate for Payer: WEA Trust Commercial |
$976.98
|
| Rate for Payer: WPS Commercial |
$1,315.67
|
|
|
Thrombolytic Therapy Venous Initial
|
Facility
|
OP
|
$6,812.00
|
|
|
Service Code
|
CPT 37212
|
| Hospital Charge Code |
3052438
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$3,322.90 |
| Max. Negotiated Rate |
$13,291.62 |
| Rate for Payer: Aetna Commercial |
$6,376.03
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,092.65
|
| Rate for Payer: Aetna Managed Medicare |
$3,322.90
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$10,303.28
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8,364.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7,944.56
|
| Rate for Payer: Anthem Medicare Advantage |
$3,322.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,754.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$3,322.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$3,322.90
|
| Rate for Payer: Cash Price |
$2,043.60
|
| Rate for Payer: Cash Price |
$2,043.60
|
| Rate for Payer: Cash Price |
$2,043.60
|
| Rate for Payer: Cigna Commercial |
$6,517.72
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$3,322.90
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12,349.86
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$3,322.90
|
| Rate for Payer: Health EOS Commercial |
$6,305.19
|
| Rate for Payer: HFN Commercial |
$6,517.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$12,361.20
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$3,322.90
|
| Rate for Payer: Independent Care Health Plan Medicare |
$3,322.90
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$3,322.90
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$3,322.90
|
| Rate for Payer: Multiplan Commercial |
$5,667.58
|
| Rate for Payer: NAPHCARE Commercial |
$4,984.36
|
| Rate for Payer: Preferred Network Access Commercial |
$6,517.72
|
| Rate for Payer: Quartz Beloit One Network |
$3,471.40
|
| Rate for Payer: Quartz Commercial |
$4,604.91
|
| Rate for Payer: Quartz Medicare Advantage |
$3,322.90
|
| Rate for Payer: The Alliance Commercial |
$13,291.62
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,322.90
|
| Rate for Payer: United Healthcare PPO |
$4,267.12
|
| Rate for Payer: WEA Trust Commercial |
$3,896.46
|
| Rate for Payer: Wellcare Medicare |
$3,322.90
|
| Rate for Payer: WPS Commercial |
$5,247.28
|
|
|
Thrombolytic Therapy Venous Initial
|
Facility
|
IP
|
$6,812.00
|
|
|
Service Code
|
CPT 37212
|
| Hospital Charge Code |
3052438
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$3,471.40 |
| Max. Negotiated Rate |
$6,517.72 |
| Rate for Payer: Aetna Commercial |
$6,376.03
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,092.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,754.77
|
| Rate for Payer: Cash Price |
$2,043.60
|
| Rate for Payer: Cigna Commercial |
$6,517.72
|
| Rate for Payer: Health EOS Commercial |
$6,305.19
|
| Rate for Payer: HFN Commercial |
$6,517.72
|
| Rate for Payer: Multiplan Commercial |
$5,667.58
|
| Rate for Payer: Preferred Network Access Commercial |
$6,517.72
|
| Rate for Payer: Quartz Beloit One Network |
$3,471.40
|
| Rate for Payer: Quartz Commercial |
$4,250.69
|
| Rate for Payer: WEA Trust Commercial |
$3,896.46
|
| Rate for Payer: WPS Commercial |
$5,247.28
|
|
|
Thrombosis Hypercoagulability Panel
|
Facility
|
OP
|
$323.00
|
|
|
Service Code
|
CPT 85730
|
| Hospital Charge Code |
5486694
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.25 |
| Max. Negotiated Rate |
$309.05 |
| Rate for Payer: Aetna Commercial |
$302.33
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$288.89
|
| Rate for Payer: Aetna Managed Medicare |
$6.25
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$23.44
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$10.94
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$10.38
|
| Rate for Payer: Anthem Medicare Advantage |
$6.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$178.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$6.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$6.25
|
| Rate for Payer: Cash Price |
$96.90
|
| Rate for Payer: Cash Price |
$96.90
|
| Rate for Payer: Cigna Commercial |
$309.05
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$6.25
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$187.99
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$6.25
|
| Rate for Payer: Health EOS Commercial |
$298.97
|
| Rate for Payer: HFN Commercial |
$309.05
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$23.25
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$6.25
|
| Rate for Payer: Independent Care Health Plan Medicare |
$6.25
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$6.25
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$6.25
|
| Rate for Payer: Multiplan Commercial |
$268.74
|
| Rate for Payer: NAPHCARE Commercial |
$9.38
|
| Rate for Payer: Preferred Network Access Commercial |
$309.05
|
| Rate for Payer: Quartz Beloit One Network |
$164.60
|
| Rate for Payer: Quartz Commercial |
$218.35
|
| Rate for Payer: Quartz Medicare Advantage |
$6.25
|
| Rate for Payer: The Alliance Commercial |
$25.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6.25
|
| Rate for Payer: United Healthcare PPO |
$251.94
|
| Rate for Payer: WEA Trust Commercial |
$184.76
|
| Rate for Payer: Wellcare Medicare |
$6.25
|
| Rate for Payer: WPS Commercial |
$248.81
|
|
|
Thrombosis Hypercoagulability Panel
|
Professional
|
Both
|
$323.00
|
|
|
Service Code
|
CPT 85730
|
| Hospital Charge Code |
5486694
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.25 |
| Max. Negotiated Rate |
$319.12 |
| Rate for Payer: Aetna Commercial |
$319.12
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$288.89
|
| Rate for Payer: Aetna Managed Medicare |
$6.25
|
| Rate for Payer: Anthem Medicare Advantage |
$6.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$6.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$6.25
|
| Rate for Payer: Cash Price |
$96.90
|
| Rate for Payer: Cash Price |
$96.90
|
| Rate for Payer: Cigna Commercial |
$319.12
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$167.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6.25
|
| Rate for Payer: Health EOS Commercial |
$305.69
|
| Rate for Payer: HFN Commercial |
$319.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$22.07
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$22.07
|
| Rate for Payer: Independent Care Health Plan Medicare |
$6.25
|
| Rate for Payer: Multiplan Commercial |
$268.74
|
| Rate for Payer: NAPHCARE Commercial |
$9.38
|
| Rate for Payer: Preferred Network Access Commercial |
$319.12
|
| Rate for Payer: Quartz Beloit One Network |
$147.80
|
| Rate for Payer: Quartz Commercial |
$191.47
|
| Rate for Payer: Quartz Medicare Advantage |
$6.25
|
| Rate for Payer: The Alliance Commercial |
$24.69
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6.25
|
| Rate for Payer: WEA Trust Commercial |
$184.76
|
| Rate for Payer: WPS Commercial |
$27.50
|
|
|
Thrombosis Hypercoagulability Panel
|
Facility
|
IP
|
$323.00
|
|
|
Service Code
|
CPT 85730
|
| Hospital Charge Code |
5486694
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$164.60 |
| Max. Negotiated Rate |
$309.05 |
| Rate for Payer: Aetna Commercial |
$302.33
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$288.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$178.04
|
| Rate for Payer: Cash Price |
$96.90
|
| Rate for Payer: Cigna Commercial |
$309.05
|
| Rate for Payer: Health EOS Commercial |
$298.97
|
| Rate for Payer: HFN Commercial |
$309.05
|
| Rate for Payer: Multiplan Commercial |
$268.74
|
| Rate for Payer: Preferred Network Access Commercial |
$309.05
|
| Rate for Payer: Quartz Beloit One Network |
$164.60
|
| Rate for Payer: Quartz Commercial |
$201.55
|
| Rate for Payer: WEA Trust Commercial |
$184.76
|
| Rate for Payer: WPS Commercial |
$248.81
|
|
|
Thrombospondin Type 1 7A Antibodies
|
Professional
|
Both
|
$350.00
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
5613547
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.53 |
| Max. Negotiated Rate |
$345.80 |
| Rate for Payer: Aetna Commercial |
$345.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$313.04
|
| Rate for Payer: Aetna Managed Medicare |
$12.53
|
| Rate for Payer: Anthem Commercial |
$17.27
|
| Rate for Payer: Anthem Medicare Advantage |
$12.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$12.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$12.53
|
| Rate for Payer: Cash Price |
$105.00
|
| Rate for Payer: Cash Price |
$105.00
|
| Rate for Payer: Cigna Commercial |
$345.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$182.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12.53
|
| Rate for Payer: Health EOS Commercial |
$331.24
|
| Rate for Payer: HFN Commercial |
$345.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$44.24
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$44.24
|
| Rate for Payer: Independent Care Health Plan Medicare |
$12.53
|
| Rate for Payer: Multiplan Commercial |
$291.20
|
| Rate for Payer: NAPHCARE Commercial |
$18.80
|
| Rate for Payer: Preferred Network Access Commercial |
$345.80
|
| Rate for Payer: Quartz Beloit One Network |
$160.16
|
| Rate for Payer: Quartz Commercial |
$207.48
|
| Rate for Payer: Quartz Medicare Advantage |
$12.53
|
| Rate for Payer: The Alliance Commercial |
$49.50
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.53
|
| Rate for Payer: WEA Trust Commercial |
$200.20
|
| Rate for Payer: WPS Commercial |
$55.14
|
|
|
Thrombospondin Type 1 7A Antibodies
|
Facility
|
IP
|
$350.00
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
5613547
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$178.36 |
| Max. Negotiated Rate |
$334.88 |
| Rate for Payer: Aetna Commercial |
$327.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$313.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$192.92
|
| Rate for Payer: Cash Price |
$105.00
|
| Rate for Payer: Cigna Commercial |
$334.88
|
| Rate for Payer: Health EOS Commercial |
$323.96
|
| Rate for Payer: HFN Commercial |
$334.88
|
| Rate for Payer: Multiplan Commercial |
$291.20
|
| Rate for Payer: Preferred Network Access Commercial |
$334.88
|
| Rate for Payer: Quartz Beloit One Network |
$178.36
|
| Rate for Payer: Quartz Commercial |
$218.40
|
| Rate for Payer: WEA Trust Commercial |
$200.20
|
| Rate for Payer: WPS Commercial |
$269.61
|
|
|
Thrombospondin Type 1 7A Antibodies
|
Facility
|
OP
|
$350.00
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
5613547
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.53 |
| Max. Negotiated Rate |
$334.88 |
| Rate for Payer: Aetna Commercial |
$327.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$313.04
|
| Rate for Payer: Aetna Managed Medicare |
$12.53
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$46.99
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$21.93
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$20.80
|
| Rate for Payer: Anthem Medicare Advantage |
$12.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$192.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$12.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$12.53
|
| Rate for Payer: Cash Price |
$105.00
|
| Rate for Payer: Cash Price |
$105.00
|
| Rate for Payer: Cigna Commercial |
$334.88
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$12.53
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$203.70
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$12.53
|
| Rate for Payer: Health EOS Commercial |
$323.96
|
| Rate for Payer: HFN Commercial |
$334.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$46.62
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$12.53
|
| Rate for Payer: Independent Care Health Plan Medicare |
$12.53
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$12.53
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$12.53
|
| Rate for Payer: Multiplan Commercial |
$291.20
|
| Rate for Payer: NAPHCARE Commercial |
$18.80
|
| Rate for Payer: Preferred Network Access Commercial |
$334.88
|
| Rate for Payer: Quartz Beloit One Network |
$178.36
|
| Rate for Payer: Quartz Commercial |
$236.60
|
| Rate for Payer: Quartz Medicare Advantage |
$12.53
|
| Rate for Payer: The Alliance Commercial |
$50.13
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.53
|
| Rate for Payer: United Healthcare PPO |
$273.00
|
| Rate for Payer: WEA Trust Commercial |
$200.20
|
| Rate for Payer: Wellcare Medicare |
$12.53
|
| Rate for Payer: WPS Commercial |
$269.61
|
|
|
THUMB REPAIR, GAMEKEEPER
|
Facility
|
IP
|
$1,242.00
|
|
| Hospital Charge Code |
2960082
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$632.92 |
| Max. Negotiated Rate |
$1,188.35 |
| Rate for Payer: Aetna Commercial |
$1,162.51
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,110.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$684.59
|
| Rate for Payer: Cash Price |
$372.60
|
| Rate for Payer: Cigna Commercial |
$1,188.35
|
| Rate for Payer: Health EOS Commercial |
$1,149.60
|
| Rate for Payer: HFN Commercial |
$1,188.35
|
| Rate for Payer: Multiplan Commercial |
$1,033.34
|
| Rate for Payer: Preferred Network Access Commercial |
$1,188.35
|
| Rate for Payer: Quartz Beloit One Network |
$632.92
|
| Rate for Payer: Quartz Commercial |
$775.01
|
| Rate for Payer: WEA Trust Commercial |
$710.42
|
| Rate for Payer: WPS Commercial |
$956.71
|
|
|
THUMB REPAIR, GAMEKEEPER
|
Facility
|
OP
|
$1,242.00
|
|
| Hospital Charge Code |
2960082
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$361.67 |
| Max. Negotiated Rate |
$1,188.35 |
| Rate for Payer: Aetna Commercial |
$1,162.51
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,110.84
|
| Rate for Payer: Aetna Managed Medicare |
$361.67
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$839.59
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$645.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$620.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$684.59
|
| Rate for Payer: Cash Price |
$372.60
|
| Rate for Payer: Cigna Commercial |
$1,188.35
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$722.84
|
| Rate for Payer: Health EOS Commercial |
$1,149.60
|
| Rate for Payer: HFN Commercial |
$1,188.35
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$968.76
|
| Rate for Payer: Multiplan Commercial |
$1,033.34
|
| Rate for Payer: NAPHCARE Commercial |
$775.01
|
| Rate for Payer: Preferred Network Access Commercial |
$1,188.35
|
| Rate for Payer: Quartz Beloit One Network |
$632.92
|
| Rate for Payer: Quartz Commercial |
$839.59
|
| Rate for Payer: Quartz Medicare Advantage |
$775.01
|
| Rate for Payer: The Alliance Commercial |
$645.84
|
| Rate for Payer: WEA Trust Commercial |
$710.42
|
| Rate for Payer: WPS Commercial |
$956.71
|
|
|
THUMB SUPPORT LEFT TITAN #5547-66-01
|
Facility
|
IP
|
$468.00
|
|
| Hospital Charge Code |
2969693
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$238.49 |
| Max. Negotiated Rate |
$447.78 |
| Rate for Payer: Aetna Commercial |
$438.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$418.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$257.96
|
| Rate for Payer: Cash Price |
$140.40
|
| Rate for Payer: Cigna Commercial |
$447.78
|
| Rate for Payer: Health EOS Commercial |
$433.18
|
| Rate for Payer: HFN Commercial |
$447.78
|
| Rate for Payer: Multiplan Commercial |
$389.38
|
| Rate for Payer: Preferred Network Access Commercial |
$447.78
|
| Rate for Payer: Quartz Beloit One Network |
$238.49
|
| Rate for Payer: Quartz Commercial |
$292.03
|
| Rate for Payer: WEA Trust Commercial |
$267.70
|
| Rate for Payer: WPS Commercial |
$360.50
|
|
|
THUMB SUPPORT LEFT TITAN #5547-66-01
|
Facility
|
OP
|
$468.00
|
|
| Hospital Charge Code |
2969693
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$136.28 |
| Max. Negotiated Rate |
$447.78 |
| Rate for Payer: Aetna Commercial |
$438.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$418.58
|
| Rate for Payer: Aetna Managed Medicare |
$136.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$316.37
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$243.36
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$233.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$257.96
|
| Rate for Payer: Cash Price |
$140.40
|
| Rate for Payer: Cigna Commercial |
$447.78
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$272.38
|
| Rate for Payer: Health EOS Commercial |
$433.18
|
| Rate for Payer: HFN Commercial |
$447.78
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$365.04
|
| Rate for Payer: Multiplan Commercial |
$389.38
|
| Rate for Payer: NAPHCARE Commercial |
$292.03
|
| Rate for Payer: Preferred Network Access Commercial |
$447.78
|
| Rate for Payer: Quartz Beloit One Network |
$238.49
|
| Rate for Payer: Quartz Commercial |
$316.37
|
| Rate for Payer: Quartz Medicare Advantage |
$292.03
|
| Rate for Payer: The Alliance Commercial |
$243.36
|
| Rate for Payer: WEA Trust Commercial |
$267.70
|
| Rate for Payer: WPS Commercial |
$360.50
|
|
|
THUMB SUPPORT TITAN (RIGHT) #5547-66-02
|
Facility
|
OP
|
$468.00
|
|
| Hospital Charge Code |
2969692
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$136.28 |
| Max. Negotiated Rate |
$447.78 |
| Rate for Payer: Aetna Commercial |
$438.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$418.58
|
| Rate for Payer: Aetna Managed Medicare |
$136.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$316.37
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$243.36
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$233.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$257.96
|
| Rate for Payer: Cash Price |
$140.40
|
| Rate for Payer: Cigna Commercial |
$447.78
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$272.38
|
| Rate for Payer: Health EOS Commercial |
$433.18
|
| Rate for Payer: HFN Commercial |
$447.78
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$365.04
|
| Rate for Payer: Multiplan Commercial |
$389.38
|
| Rate for Payer: NAPHCARE Commercial |
$292.03
|
| Rate for Payer: Preferred Network Access Commercial |
$447.78
|
| Rate for Payer: Quartz Beloit One Network |
$238.49
|
| Rate for Payer: Quartz Commercial |
$316.37
|
| Rate for Payer: Quartz Medicare Advantage |
$292.03
|
| Rate for Payer: The Alliance Commercial |
$243.36
|
| Rate for Payer: WEA Trust Commercial |
$267.70
|
| Rate for Payer: WPS Commercial |
$360.50
|
|
