|
THERMASHELL CHARGE REFILL PACK
|
Facility
|
IP
|
$1,099.00
|
|
| Hospital Charge Code |
2972013
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$538.51 |
| Max. Negotiated Rate |
$1,011.08 |
| Rate for Payer: Aetna Commercial |
$989.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$945.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$582.47
|
| Rate for Payer: Cash Price |
$329.70
|
| Rate for Payer: Cigna Commercial |
$1,011.08
|
| Rate for Payer: Health EOS Commercial |
$978.11
|
| Rate for Payer: HFN Commercial |
$1,011.08
|
| Rate for Payer: Multiplan Commercial |
$879.20
|
| Rate for Payer: NAPHCARE Commercial |
$659.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,011.08
|
| Rate for Payer: Quartz Beloit One Network |
$538.51
|
| Rate for Payer: Quartz Commercial |
$659.40
|
| Rate for Payer: WEA Trust Commercial |
$604.45
|
| Rate for Payer: WPS Commercial |
$814.03
|
|
|
THERMOMETER RECTAL & ESOPH 9FR
|
Facility
|
IP
|
$94.00
|
|
| Hospital Charge Code |
2964052
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$46.06 |
| Max. Negotiated Rate |
$86.48 |
| Rate for Payer: Aetna Commercial |
$84.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$80.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$49.82
|
| Rate for Payer: Cash Price |
$28.20
|
| Rate for Payer: Cigna Commercial |
$86.48
|
| Rate for Payer: Health EOS Commercial |
$83.66
|
| Rate for Payer: HFN Commercial |
$86.48
|
| Rate for Payer: Multiplan Commercial |
$75.20
|
| Rate for Payer: NAPHCARE Commercial |
$56.40
|
| Rate for Payer: Preferred Network Access Commercial |
$86.48
|
| Rate for Payer: Quartz Beloit One Network |
$46.06
|
| Rate for Payer: Quartz Commercial |
$56.40
|
| Rate for Payer: WEA Trust Commercial |
$51.70
|
| Rate for Payer: WPS Commercial |
$69.63
|
|
|
THERMOMETER RECTAL & ESOPH 9FR
|
Facility
|
OP
|
$94.00
|
|
| Hospital Charge Code |
2964052
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$26.32 |
| Max. Negotiated Rate |
$376.00 |
| Rate for Payer: Aetna Commercial |
$84.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$80.84
|
| Rate for Payer: Aetna Managed Medicare |
$26.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$61.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$47.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$45.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$49.82
|
| Rate for Payer: Cash Price |
$28.20
|
| Rate for Payer: Cigna Commercial |
$86.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$52.60
|
| Rate for Payer: Health EOS Commercial |
$83.66
|
| Rate for Payer: HFN Commercial |
$86.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$70.50
|
| Rate for Payer: Multiplan Commercial |
$75.20
|
| Rate for Payer: NAPHCARE Commercial |
$56.40
|
| Rate for Payer: Preferred Network Access Commercial |
$86.48
|
| Rate for Payer: Quartz Beloit One Network |
$46.06
|
| Rate for Payer: Quartz Commercial |
$61.10
|
| Rate for Payer: Quartz Medicare Advantage |
$56.40
|
| Rate for Payer: The Alliance Commercial |
$376.00
|
| Rate for Payer: WEA Trust Commercial |
$51.70
|
| Rate for Payer: WPS Commercial |
$69.63
|
|
|
THERMOSET #414240403
|
Facility
|
IP
|
$344.00
|
|
| Hospital Charge Code |
2963892
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$168.56 |
| Max. Negotiated Rate |
$316.48 |
| Rate for Payer: Aetna Commercial |
$309.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$295.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$182.32
|
| Rate for Payer: Cash Price |
$103.20
|
| Rate for Payer: Cigna Commercial |
$316.48
|
| Rate for Payer: Health EOS Commercial |
$306.16
|
| Rate for Payer: HFN Commercial |
$316.48
|
| Rate for Payer: Multiplan Commercial |
$275.20
|
| Rate for Payer: NAPHCARE Commercial |
$206.40
|
| Rate for Payer: Preferred Network Access Commercial |
$316.48
|
| Rate for Payer: Quartz Beloit One Network |
$168.56
|
| Rate for Payer: Quartz Commercial |
$206.40
|
| Rate for Payer: WEA Trust Commercial |
$189.20
|
| Rate for Payer: WPS Commercial |
$254.80
|
|
|
THERMOSET #414240403
|
Facility
|
OP
|
$344.00
|
|
| Hospital Charge Code |
2963892
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$96.32 |
| Max. Negotiated Rate |
$1,376.00 |
| Rate for Payer: Aetna Commercial |
$309.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$295.84
|
| Rate for Payer: Aetna Managed Medicare |
$96.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$223.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$172.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$165.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$182.32
|
| Rate for Payer: Cash Price |
$103.20
|
| Rate for Payer: Cigna Commercial |
$316.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$192.50
|
| Rate for Payer: Health EOS Commercial |
$306.16
|
| Rate for Payer: HFN Commercial |
$316.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$258.00
|
| Rate for Payer: Multiplan Commercial |
$275.20
|
| Rate for Payer: NAPHCARE Commercial |
$206.40
|
| Rate for Payer: Preferred Network Access Commercial |
$316.48
|
| Rate for Payer: Quartz Beloit One Network |
$168.56
|
| Rate for Payer: Quartz Commercial |
$223.60
|
| Rate for Payer: Quartz Medicare Advantage |
$206.40
|
| Rate for Payer: The Alliance Commercial |
$1,376.00
|
| Rate for Payer: WEA Trust Commercial |
$189.20
|
| Rate for Payer: WPS Commercial |
$254.80
|
|
|
Ther spi pnxr drg csf 62272
|
Professional
|
Both
|
$1,030.00
|
|
|
Service Code
|
CPT 62272
|
| Hospital Charge Code |
6178533
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$87.46 |
| Max. Negotiated Rate |
$978.50 |
| Rate for Payer: Aetna Commercial |
$978.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$885.80
|
| Rate for Payer: Cash Price |
$309.00
|
| Rate for Payer: Cash Price |
$309.00
|
| Rate for Payer: Cigna Commercial |
$978.50
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$87.46
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$618.00
|
| Rate for Payer: Health EOS Commercial |
$937.30
|
| Rate for Payer: HFN Commercial |
$978.50
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$282.44
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$282.44
|
| Rate for Payer: Multiplan Commercial |
$824.00
|
| Rate for Payer: Preferred Network Access Commercial |
$978.50
|
| Rate for Payer: Quartz Beloit One Network |
$453.20
|
| Rate for Payer: Quartz Commercial |
$587.10
|
| Rate for Payer: The Alliance Commercial |
$515.00
|
| Rate for Payer: United Healthcare Medicaid |
$87.46
|
| Rate for Payer: WEA Trust Commercial |
$566.50
|
| Rate for Payer: WPS Commercial |
$762.92
|
|
|
Thiamine hcl 100 MG J3411
|
Facility
|
OP
|
$7.00
|
|
|
Service Code
|
HCPCS J3411
|
| Hospital Charge Code |
3407537
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.96 |
| Max. Negotiated Rate |
$28.00 |
| Rate for Payer: Aetna Commercial |
$6.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6.02
|
| Rate for Payer: Aetna Managed Medicare |
$1.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3.71
|
| Rate for Payer: Cash Price |
$2.10
|
| Rate for Payer: Cash Price |
$2.10
|
| Rate for Payer: Cigna Commercial |
$6.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2.99
|
| Rate for Payer: Health EOS Commercial |
$6.23
|
| Rate for Payer: HFN Commercial |
$6.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5.25
|
| Rate for Payer: Multiplan Commercial |
$5.60
|
| Rate for Payer: NAPHCARE Commercial |
$4.20
|
| Rate for Payer: Preferred Network Access Commercial |
$6.44
|
| Rate for Payer: Quartz Beloit One Network |
$3.43
|
| Rate for Payer: Quartz Commercial |
$4.55
|
| Rate for Payer: Quartz Medicare Advantage |
$4.20
|
| Rate for Payer: The Alliance Commercial |
$28.00
|
| Rate for Payer: WEA Trust Commercial |
$3.85
|
| Rate for Payer: WPS Commercial |
$5.65
|
|
|
Thiamine hcl 100 MG J3411
|
Professional
|
Both
|
$7.00
|
|
|
Service Code
|
HCPCS J3411
|
| Hospital Charge Code |
3407537
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.26 |
| Max. Negotiated Rate |
$6.65 |
| Rate for Payer: Aetna Commercial |
$6.65
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6.02
|
| Rate for Payer: Cash Price |
$2.10
|
| Rate for Payer: Cash Price |
$2.10
|
| Rate for Payer: Cigna Commercial |
$6.65
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2.26
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2.26
|
| Rate for Payer: Health EOS Commercial |
$6.37
|
| Rate for Payer: HFN Commercial |
$6.65
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4.35
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$4.35
|
| Rate for Payer: Multiplan Commercial |
$5.60
|
| Rate for Payer: Preferred Network Access Commercial |
$6.65
|
| Rate for Payer: Quartz Beloit One Network |
$3.08
|
| Rate for Payer: Quartz Commercial |
$3.99
|
| Rate for Payer: The Alliance Commercial |
$3.50
|
| Rate for Payer: United Healthcare Medicaid |
$2.26
|
| Rate for Payer: WEA Trust Commercial |
$3.85
|
| Rate for Payer: WPS Commercial |
$5.65
|
|
|
Thiamine hcl 100 MG J3411
|
Facility
|
IP
|
$7.00
|
|
|
Service Code
|
HCPCS J3411
|
| Hospital Charge Code |
3407537
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.43 |
| Max. Negotiated Rate |
$6.44 |
| Rate for Payer: Aetna Commercial |
$6.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3.71
|
| Rate for Payer: Cash Price |
$2.10
|
| Rate for Payer: Cigna Commercial |
$6.44
|
| Rate for Payer: Health EOS Commercial |
$6.23
|
| Rate for Payer: HFN Commercial |
$6.44
|
| Rate for Payer: Multiplan Commercial |
$5.60
|
| Rate for Payer: NAPHCARE Commercial |
$4.20
|
| Rate for Payer: Preferred Network Access Commercial |
$6.44
|
| Rate for Payer: Quartz Beloit One Network |
$3.43
|
| Rate for Payer: Quartz Commercial |
$4.20
|
| Rate for Payer: WEA Trust Commercial |
$3.85
|
| Rate for Payer: WPS Commercial |
$5.18
|
|
|
ThinPrep Pap #58315
|
Facility
|
IP
|
$147.00
|
|
|
Service Code
|
CPT 88175
|
| Hospital Charge Code |
5460754
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$72.03 |
| Max. Negotiated Rate |
$135.24 |
| Rate for Payer: Aetna Commercial |
$132.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$126.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$77.91
|
| Rate for Payer: Cash Price |
$44.10
|
| Rate for Payer: Cigna Commercial |
$135.24
|
| Rate for Payer: Health EOS Commercial |
$130.83
|
| Rate for Payer: HFN Commercial |
$135.24
|
| Rate for Payer: Multiplan Commercial |
$117.60
|
| Rate for Payer: NAPHCARE Commercial |
$88.20
|
| Rate for Payer: Preferred Network Access Commercial |
$135.24
|
| Rate for Payer: Quartz Beloit One Network |
$72.03
|
| Rate for Payer: Quartz Commercial |
$88.20
|
| Rate for Payer: WEA Trust Commercial |
$80.85
|
| Rate for Payer: WPS Commercial |
$108.88
|
|
|
ThinPrep Pap #58315
|
Professional
|
Both
|
$147.00
|
|
|
Service Code
|
CPT 88175
|
| Hospital Charge Code |
5460754
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$64.68 |
| Max. Negotiated Rate |
$139.65 |
| Rate for Payer: Aetna Commercial |
$139.65
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$126.42
|
| Rate for Payer: Cash Price |
$44.10
|
| Rate for Payer: Cash Price |
$44.10
|
| Rate for Payer: Cigna Commercial |
$139.65
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$73.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$88.20
|
| Rate for Payer: Health EOS Commercial |
$133.77
|
| Rate for Payer: HFN Commercial |
$139.65
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$93.93
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$93.93
|
| Rate for Payer: Multiplan Commercial |
$117.60
|
| Rate for Payer: Preferred Network Access Commercial |
$139.65
|
| Rate for Payer: Quartz Beloit One Network |
$64.68
|
| Rate for Payer: Quartz Commercial |
$83.79
|
| Rate for Payer: The Alliance Commercial |
$73.50
|
| Rate for Payer: WEA Trust Commercial |
$80.85
|
| Rate for Payer: WPS Commercial |
$108.88
|
|
|
ThinPrep Pap #58315
|
Facility
|
OP
|
$147.00
|
|
|
Service Code
|
CPT 88175
|
| Hospital Charge Code |
5460754
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$26.61 |
| Max. Negotiated Rate |
$135.24 |
| Rate for Payer: Aetna Commercial |
$132.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$126.42
|
| Rate for Payer: Aetna Managed Medicare |
$26.61
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$99.79
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$46.57
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$44.17
|
| Rate for Payer: Anthem Medicaid |
$27.50
|
| Rate for Payer: Anthem Medicare Advantage |
$26.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$77.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$26.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$26.61
|
| Rate for Payer: Cash Price |
$44.10
|
| Rate for Payer: Cash Price |
$44.10
|
| Rate for Payer: Cigna Commercial |
$135.24
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$26.61
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$27.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$82.26
|
| Rate for Payer: Dean Health Medicaid |
$27.50
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$26.61
|
| Rate for Payer: Health EOS Commercial |
$130.83
|
| Rate for Payer: HFN Commercial |
$135.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$98.99
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$26.61
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$27.50
|
| Rate for Payer: Independent Care Health Plan Medicare |
$26.61
|
| Rate for Payer: Managed Health Services Medicaid |
$28.60
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$26.61
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$26.61
|
| Rate for Payer: Multiplan Commercial |
$117.60
|
| Rate for Payer: NAPHCARE Commercial |
$39.92
|
| Rate for Payer: Preferred Network Access Commercial |
$135.24
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$27.50
|
| Rate for Payer: Quartz Beloit One Network |
$72.03
|
| Rate for Payer: Quartz Commercial |
$95.55
|
| Rate for Payer: Quartz Medicare Advantage |
$26.61
|
| Rate for Payer: The Alliance Commercial |
$106.44
|
| Rate for Payer: United Healthcare Medicaid |
$27.50
|
| Rate for Payer: United Healthcare Medicare Advantage |
$26.61
|
| Rate for Payer: United Healthcare PPO |
$110.25
|
| Rate for Payer: WEA Trust Commercial |
$80.85
|
| Rate for Payer: Wellcare Medicare |
$26.61
|
| Rate for Payer: WMAP Medicaid |
$27.50
|
| Rate for Payer: WPS Commercial |
$108.88
|
|
|
ThinPrep Pap & HPV mRNA E6/E7 #90933
|
Facility
|
IP
|
$147.00
|
|
|
Service Code
|
CPT 88175
|
| Hospital Charge Code |
5460756
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$72.03 |
| Max. Negotiated Rate |
$135.24 |
| Rate for Payer: Aetna Commercial |
$132.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$126.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$77.91
|
| Rate for Payer: Cash Price |
$44.10
|
| Rate for Payer: Cigna Commercial |
$135.24
|
| Rate for Payer: Health EOS Commercial |
$130.83
|
| Rate for Payer: HFN Commercial |
$135.24
|
| Rate for Payer: Multiplan Commercial |
$117.60
|
| Rate for Payer: NAPHCARE Commercial |
$88.20
|
| Rate for Payer: Preferred Network Access Commercial |
$135.24
|
| Rate for Payer: Quartz Beloit One Network |
$72.03
|
| Rate for Payer: Quartz Commercial |
$88.20
|
| Rate for Payer: WEA Trust Commercial |
$80.85
|
| Rate for Payer: WPS Commercial |
$108.88
|
|
|
ThinPrep Pap & HPV mRNA E6/E7 #90933
|
Facility
|
OP
|
$147.00
|
|
|
Service Code
|
CPT 88175
|
| Hospital Charge Code |
5460756
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$26.61 |
| Max. Negotiated Rate |
$135.24 |
| Rate for Payer: Aetna Commercial |
$132.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$126.42
|
| Rate for Payer: Aetna Managed Medicare |
$26.61
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$99.79
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$46.57
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$44.17
|
| Rate for Payer: Anthem Medicaid |
$27.50
|
| Rate for Payer: Anthem Medicare Advantage |
$26.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$77.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$26.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$26.61
|
| Rate for Payer: Cash Price |
$44.10
|
| Rate for Payer: Cash Price |
$44.10
|
| Rate for Payer: Cigna Commercial |
$135.24
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$26.61
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$27.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$82.26
|
| Rate for Payer: Dean Health Medicaid |
$27.50
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$26.61
|
| Rate for Payer: Health EOS Commercial |
$130.83
|
| Rate for Payer: HFN Commercial |
$135.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$98.99
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$26.61
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$27.50
|
| Rate for Payer: Independent Care Health Plan Medicare |
$26.61
|
| Rate for Payer: Managed Health Services Medicaid |
$28.60
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$26.61
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$26.61
|
| Rate for Payer: Multiplan Commercial |
$117.60
|
| Rate for Payer: NAPHCARE Commercial |
$39.92
|
| Rate for Payer: Preferred Network Access Commercial |
$135.24
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$27.50
|
| Rate for Payer: Quartz Beloit One Network |
$72.03
|
| Rate for Payer: Quartz Commercial |
$95.55
|
| Rate for Payer: Quartz Medicare Advantage |
$26.61
|
| Rate for Payer: The Alliance Commercial |
$106.44
|
| Rate for Payer: United Healthcare Medicaid |
$27.50
|
| Rate for Payer: United Healthcare Medicare Advantage |
$26.61
|
| Rate for Payer: United Healthcare PPO |
$110.25
|
| Rate for Payer: WEA Trust Commercial |
$80.85
|
| Rate for Payer: Wellcare Medicare |
$26.61
|
| Rate for Payer: WMAP Medicaid |
$27.50
|
| Rate for Payer: WPS Commercial |
$108.88
|
|
|
ThinPrep Pap & HPV mRNA E6/E7 #90933
|
Professional
|
Both
|
$147.00
|
|
|
Service Code
|
CPT 88175
|
| Hospital Charge Code |
5460756
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$64.68 |
| Max. Negotiated Rate |
$139.65 |
| Rate for Payer: Aetna Commercial |
$139.65
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$126.42
|
| Rate for Payer: Cash Price |
$44.10
|
| Rate for Payer: Cash Price |
$44.10
|
| Rate for Payer: Cigna Commercial |
$139.65
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$73.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$88.20
|
| Rate for Payer: Health EOS Commercial |
$133.77
|
| Rate for Payer: HFN Commercial |
$139.65
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$93.93
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$93.93
|
| Rate for Payer: Multiplan Commercial |
$117.60
|
| Rate for Payer: Preferred Network Access Commercial |
$139.65
|
| Rate for Payer: Quartz Beloit One Network |
$64.68
|
| Rate for Payer: Quartz Commercial |
$83.79
|
| Rate for Payer: The Alliance Commercial |
$73.50
|
| Rate for Payer: WEA Trust Commercial |
$80.85
|
| Rate for Payer: WPS Commercial |
$108.88
|
|
|
ThinPrep Pap & HPV mRNA w/Rfx HPV 16,18/45 #91414
|
Professional
|
Both
|
$147.00
|
|
|
Service Code
|
CPT 88175
|
| Hospital Charge Code |
5460757
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$64.68 |
| Max. Negotiated Rate |
$139.65 |
| Rate for Payer: Aetna Commercial |
$139.65
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$126.42
|
| Rate for Payer: Cash Price |
$44.10
|
| Rate for Payer: Cash Price |
$44.10
|
| Rate for Payer: Cigna Commercial |
$139.65
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$73.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$88.20
|
| Rate for Payer: Health EOS Commercial |
$133.77
|
| Rate for Payer: HFN Commercial |
$139.65
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$93.93
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$93.93
|
| Rate for Payer: Multiplan Commercial |
$117.60
|
| Rate for Payer: Preferred Network Access Commercial |
$139.65
|
| Rate for Payer: Quartz Beloit One Network |
$64.68
|
| Rate for Payer: Quartz Commercial |
$83.79
|
| Rate for Payer: The Alliance Commercial |
$73.50
|
| Rate for Payer: WEA Trust Commercial |
$80.85
|
| Rate for Payer: WPS Commercial |
$108.88
|
|
|
ThinPrep Pap & HPV mRNA w/Rfx HPV 16,18/45 #91414
|
Facility
|
IP
|
$147.00
|
|
|
Service Code
|
CPT 88175
|
| Hospital Charge Code |
5460757
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$72.03 |
| Max. Negotiated Rate |
$135.24 |
| Rate for Payer: Aetna Commercial |
$132.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$126.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$77.91
|
| Rate for Payer: Cash Price |
$44.10
|
| Rate for Payer: Cigna Commercial |
$135.24
|
| Rate for Payer: Health EOS Commercial |
$130.83
|
| Rate for Payer: HFN Commercial |
$135.24
|
| Rate for Payer: Multiplan Commercial |
$117.60
|
| Rate for Payer: NAPHCARE Commercial |
$88.20
|
| Rate for Payer: Preferred Network Access Commercial |
$135.24
|
| Rate for Payer: Quartz Beloit One Network |
$72.03
|
| Rate for Payer: Quartz Commercial |
$88.20
|
| Rate for Payer: WEA Trust Commercial |
$80.85
|
| Rate for Payer: WPS Commercial |
$108.88
|
|
|
ThinPrep Pap & HPV mRNA w/Rfx HPV 16,18/45 #91414
|
Facility
|
OP
|
$147.00
|
|
|
Service Code
|
CPT 88175
|
| Hospital Charge Code |
5460757
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$26.61 |
| Max. Negotiated Rate |
$135.24 |
| Rate for Payer: Aetna Commercial |
$132.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$126.42
|
| Rate for Payer: Aetna Managed Medicare |
$26.61
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$99.79
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$46.57
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$44.17
|
| Rate for Payer: Anthem Medicaid |
$27.50
|
| Rate for Payer: Anthem Medicare Advantage |
$26.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$77.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$26.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$26.61
|
| Rate for Payer: Cash Price |
$44.10
|
| Rate for Payer: Cash Price |
$44.10
|
| Rate for Payer: Cigna Commercial |
$135.24
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$26.61
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$27.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$82.26
|
| Rate for Payer: Dean Health Medicaid |
$27.50
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$26.61
|
| Rate for Payer: Health EOS Commercial |
$130.83
|
| Rate for Payer: HFN Commercial |
$135.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$98.99
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$26.61
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$27.50
|
| Rate for Payer: Independent Care Health Plan Medicare |
$26.61
|
| Rate for Payer: Managed Health Services Medicaid |
$28.60
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$26.61
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$26.61
|
| Rate for Payer: Multiplan Commercial |
$117.60
|
| Rate for Payer: NAPHCARE Commercial |
$39.92
|
| Rate for Payer: Preferred Network Access Commercial |
$135.24
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$27.50
|
| Rate for Payer: Quartz Beloit One Network |
$72.03
|
| Rate for Payer: Quartz Commercial |
$95.55
|
| Rate for Payer: Quartz Medicare Advantage |
$26.61
|
| Rate for Payer: The Alliance Commercial |
$106.44
|
| Rate for Payer: United Healthcare Medicaid |
$27.50
|
| Rate for Payer: United Healthcare Medicare Advantage |
$26.61
|
| Rate for Payer: United Healthcare PPO |
$110.25
|
| Rate for Payer: WEA Trust Commercial |
$80.85
|
| Rate for Payer: Wellcare Medicare |
$26.61
|
| Rate for Payer: WMAP Medicaid |
$27.50
|
| Rate for Payer: WPS Commercial |
$108.88
|
|
|
ThinPrep Pap w/Rfx HPV mRNA E6/E7 #90934
|
Facility
|
OP
|
$147.00
|
|
|
Service Code
|
CPT 88175
|
| Hospital Charge Code |
5460755
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$26.61 |
| Max. Negotiated Rate |
$135.24 |
| Rate for Payer: Aetna Commercial |
$132.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$126.42
|
| Rate for Payer: Aetna Managed Medicare |
$26.61
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$99.79
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$46.57
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$44.17
|
| Rate for Payer: Anthem Medicaid |
$27.50
|
| Rate for Payer: Anthem Medicare Advantage |
$26.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$77.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$26.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$26.61
|
| Rate for Payer: Cash Price |
$44.10
|
| Rate for Payer: Cash Price |
$44.10
|
| Rate for Payer: Cigna Commercial |
$135.24
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$26.61
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$27.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$82.26
|
| Rate for Payer: Dean Health Medicaid |
$27.50
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$26.61
|
| Rate for Payer: Health EOS Commercial |
$130.83
|
| Rate for Payer: HFN Commercial |
$135.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$98.99
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$26.61
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$27.50
|
| Rate for Payer: Independent Care Health Plan Medicare |
$26.61
|
| Rate for Payer: Managed Health Services Medicaid |
$28.60
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$26.61
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$26.61
|
| Rate for Payer: Multiplan Commercial |
$117.60
|
| Rate for Payer: NAPHCARE Commercial |
$39.92
|
| Rate for Payer: Preferred Network Access Commercial |
$135.24
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$27.50
|
| Rate for Payer: Quartz Beloit One Network |
$72.03
|
| Rate for Payer: Quartz Commercial |
$95.55
|
| Rate for Payer: Quartz Medicare Advantage |
$26.61
|
| Rate for Payer: The Alliance Commercial |
$106.44
|
| Rate for Payer: United Healthcare Medicaid |
$27.50
|
| Rate for Payer: United Healthcare Medicare Advantage |
$26.61
|
| Rate for Payer: United Healthcare PPO |
$110.25
|
| Rate for Payer: WEA Trust Commercial |
$80.85
|
| Rate for Payer: Wellcare Medicare |
$26.61
|
| Rate for Payer: WMAP Medicaid |
$27.50
|
| Rate for Payer: WPS Commercial |
$108.88
|
|
|
ThinPrep Pap w/Rfx HPV mRNA E6/E7 #90934
|
Facility
|
IP
|
$147.00
|
|
|
Service Code
|
CPT 88175
|
| Hospital Charge Code |
5460755
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$72.03 |
| Max. Negotiated Rate |
$135.24 |
| Rate for Payer: Aetna Commercial |
$132.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$126.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$77.91
|
| Rate for Payer: Cash Price |
$44.10
|
| Rate for Payer: Cigna Commercial |
$135.24
|
| Rate for Payer: Health EOS Commercial |
$130.83
|
| Rate for Payer: HFN Commercial |
$135.24
|
| Rate for Payer: Multiplan Commercial |
$117.60
|
| Rate for Payer: NAPHCARE Commercial |
$88.20
|
| Rate for Payer: Preferred Network Access Commercial |
$135.24
|
| Rate for Payer: Quartz Beloit One Network |
$72.03
|
| Rate for Payer: Quartz Commercial |
$88.20
|
| Rate for Payer: WEA Trust Commercial |
$80.85
|
| Rate for Payer: WPS Commercial |
$108.88
|
|
|
ThinPrep Pap w/Rfx HPV mRNA E6/E7 #90934
|
Professional
|
Both
|
$147.00
|
|
|
Service Code
|
CPT 88175
|
| Hospital Charge Code |
5460755
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$64.68 |
| Max. Negotiated Rate |
$139.65 |
| Rate for Payer: Aetna Commercial |
$139.65
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$126.42
|
| Rate for Payer: Cash Price |
$44.10
|
| Rate for Payer: Cash Price |
$44.10
|
| Rate for Payer: Cigna Commercial |
$139.65
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$73.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$88.20
|
| Rate for Payer: Health EOS Commercial |
$133.77
|
| Rate for Payer: HFN Commercial |
$139.65
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$93.93
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$93.93
|
| Rate for Payer: Multiplan Commercial |
$117.60
|
| Rate for Payer: Preferred Network Access Commercial |
$139.65
|
| Rate for Payer: Quartz Beloit One Network |
$64.68
|
| Rate for Payer: Quartz Commercial |
$83.79
|
| Rate for Payer: The Alliance Commercial |
$73.50
|
| Rate for Payer: WEA Trust Commercial |
$80.85
|
| Rate for Payer: WPS Commercial |
$108.88
|
|
|
Thiopurine Metabolites
|
Professional
|
Both
|
$130.00
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
5438798
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$57.20 |
| Max. Negotiated Rate |
$123.50 |
| Rate for Payer: Aetna Commercial |
$123.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$111.80
|
| Rate for Payer: Cash Price |
$39.00
|
| Rate for Payer: Cash Price |
$39.00
|
| Rate for Payer: Cigna Commercial |
$123.50
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$65.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$78.00
|
| Rate for Payer: Health EOS Commercial |
$118.30
|
| Rate for Payer: HFN Commercial |
$123.50
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$65.80
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$65.80
|
| Rate for Payer: Multiplan Commercial |
$104.00
|
| Rate for Payer: Preferred Network Access Commercial |
$123.50
|
| Rate for Payer: Quartz Beloit One Network |
$57.20
|
| Rate for Payer: Quartz Commercial |
$74.10
|
| Rate for Payer: The Alliance Commercial |
$65.00
|
| Rate for Payer: WEA Trust Commercial |
$71.50
|
| Rate for Payer: WPS Commercial |
$96.29
|
|
|
Thiopurine Metabolites
|
Facility
|
OP
|
$130.00
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
5438798
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.64 |
| Max. Negotiated Rate |
$119.60 |
| Rate for Payer: Aetna Commercial |
$117.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$111.80
|
| Rate for Payer: Aetna Managed Medicare |
$18.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$69.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$32.62
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$30.94
|
| Rate for Payer: Anthem Medicaid |
$19.26
|
| Rate for Payer: Anthem Medicare Advantage |
$18.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$68.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$18.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$18.64
|
| Rate for Payer: Cash Price |
$39.00
|
| Rate for Payer: Cash Price |
$39.00
|
| Rate for Payer: Cigna Commercial |
$119.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$18.64
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$19.26
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$72.75
|
| Rate for Payer: Dean Health Medicaid |
$19.26
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$18.64
|
| Rate for Payer: Health EOS Commercial |
$115.70
|
| Rate for Payer: HFN Commercial |
$119.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$69.34
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$18.64
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$19.26
|
| Rate for Payer: Independent Care Health Plan Medicare |
$18.64
|
| Rate for Payer: Managed Health Services Medicaid |
$20.03
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$18.64
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$18.64
|
| Rate for Payer: Multiplan Commercial |
$104.00
|
| Rate for Payer: NAPHCARE Commercial |
$27.96
|
| Rate for Payer: Preferred Network Access Commercial |
$119.60
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$19.26
|
| Rate for Payer: Quartz Beloit One Network |
$63.70
|
| Rate for Payer: Quartz Commercial |
$84.50
|
| Rate for Payer: Quartz Medicare Advantage |
$18.64
|
| Rate for Payer: The Alliance Commercial |
$74.56
|
| Rate for Payer: United Healthcare Medicaid |
$19.26
|
| Rate for Payer: United Healthcare Medicare Advantage |
$18.64
|
| Rate for Payer: United Healthcare PPO |
$97.50
|
| Rate for Payer: WEA Trust Commercial |
$71.50
|
| Rate for Payer: Wellcare Medicare |
$18.64
|
| Rate for Payer: WMAP Medicaid |
$19.26
|
| Rate for Payer: WPS Commercial |
$96.29
|
|
|
Thiopurine Metabolites
|
Facility
|
IP
|
$130.00
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
5438798
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$63.70 |
| Max. Negotiated Rate |
$119.60 |
| Rate for Payer: Aetna Commercial |
$117.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$111.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$68.90
|
| Rate for Payer: Cash Price |
$39.00
|
| Rate for Payer: Cigna Commercial |
$119.60
|
| Rate for Payer: Health EOS Commercial |
$115.70
|
| Rate for Payer: HFN Commercial |
$119.60
|
| Rate for Payer: Multiplan Commercial |
$104.00
|
| Rate for Payer: NAPHCARE Commercial |
$78.00
|
| Rate for Payer: Preferred Network Access Commercial |
$119.60
|
| Rate for Payer: Quartz Beloit One Network |
$63.70
|
| Rate for Payer: Quartz Commercial |
$78.00
|
| Rate for Payer: WEA Trust Commercial |
$71.50
|
| Rate for Payer: WPS Commercial |
$96.29
|
|
|
Thiopurine Metabolites to Prometheus
|
Facility
|
IP
|
$301.00
|
|
| Hospital Charge Code |
2778835
|
| Min. Negotiated Rate |
$147.49 |
| Max. Negotiated Rate |
$276.92 |
| Rate for Payer: Aetna Commercial |
$270.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$258.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$159.53
|
| Rate for Payer: Cash Price |
$90.30
|
| Rate for Payer: Cigna Commercial |
$276.92
|
| Rate for Payer: Health EOS Commercial |
$267.89
|
| Rate for Payer: HFN Commercial |
$276.92
|
| Rate for Payer: Multiplan Commercial |
$240.80
|
| Rate for Payer: NAPHCARE Commercial |
$180.60
|
| Rate for Payer: Preferred Network Access Commercial |
$276.92
|
| Rate for Payer: Quartz Beloit One Network |
$147.49
|
| Rate for Payer: Quartz Commercial |
$180.60
|
| Rate for Payer: WEA Trust Commercial |
$165.55
|
| Rate for Payer: WPS Commercial |
$222.95
|
|
