|
Thyroid Peroxidase Antibody
|
Professional
|
Both
|
$192.00
|
|
|
Service Code
|
CPT 86376
|
| Hospital Charge Code |
983424
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.13 |
| Max. Negotiated Rate |
$189.70 |
| Rate for Payer: Aetna Commercial |
$189.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$171.72
|
| Rate for Payer: Aetna Managed Medicare |
$15.13
|
| Rate for Payer: Anthem Medicare Advantage |
$15.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$15.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$15.13
|
| Rate for Payer: Cash Price |
$57.60
|
| Rate for Payer: Cash Price |
$57.60
|
| Rate for Payer: Cigna Commercial |
$189.70
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$99.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$15.13
|
| Rate for Payer: Health EOS Commercial |
$181.71
|
| Rate for Payer: HFN Commercial |
$189.70
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$53.41
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$53.41
|
| Rate for Payer: Independent Care Health Plan Medicare |
$15.13
|
| Rate for Payer: Multiplan Commercial |
$159.74
|
| Rate for Payer: NAPHCARE Commercial |
$22.70
|
| Rate for Payer: Preferred Network Access Commercial |
$189.70
|
| Rate for Payer: Quartz Beloit One Network |
$87.86
|
| Rate for Payer: Quartz Commercial |
$113.82
|
| Rate for Payer: Quartz Medicare Advantage |
$15.13
|
| Rate for Payer: The Alliance Commercial |
$59.77
|
| Rate for Payer: United Healthcare Medicare Advantage |
$15.13
|
| Rate for Payer: WEA Trust Commercial |
$109.82
|
| Rate for Payer: WPS Commercial |
$66.58
|
|
|
Thyroid Peroxidase & Thyroglobulin Antibodies
|
Professional
|
Both
|
$49.61
|
|
|
Service Code
|
CPT 76376
|
| Hospital Charge Code |
3899560
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$22.70 |
| Max. Negotiated Rate |
$125.63 |
| Rate for Payer: Aetna Commercial |
$49.01
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$44.37
|
| Rate for Payer: Aetna Managed Medicare |
$25.13
|
| Rate for Payer: Anthem Medicare Advantage |
$25.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$25.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$25.13
|
| Rate for Payer: Cash Price |
$14.88
|
| Rate for Payer: Cash Price |
$14.88
|
| Rate for Payer: Cash Price |
$14.88
|
| Rate for Payer: Cigna Commercial |
$49.01
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$25.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$25.13
|
| Rate for Payer: Health EOS Commercial |
$46.95
|
| Rate for Payer: HFN Commercial |
$49.01
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$79.48
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$79.48
|
| Rate for Payer: Independent Care Health Plan Medicare |
$25.13
|
| Rate for Payer: Multiplan Commercial |
$41.28
|
| Rate for Payer: NAPHCARE Commercial |
$37.69
|
| Rate for Payer: Preferred Network Access Commercial |
$49.01
|
| Rate for Payer: Quartz Beloit One Network |
$22.70
|
| Rate for Payer: Quartz Commercial |
$29.41
|
| Rate for Payer: Quartz Medicare Advantage |
$25.13
|
| Rate for Payer: The Alliance Commercial |
$95.48
|
| Rate for Payer: United Healthcare Medicare Advantage |
$25.13
|
| Rate for Payer: WEA Trust Commercial |
$28.38
|
| Rate for Payer: WPS Commercial |
$125.63
|
|
|
Thyroid Peroxidase & Thyroglobulin Antibodies
|
Facility
|
OP
|
$49.61
|
|
|
Service Code
|
CPT 76376
|
| Hospital Charge Code |
3899560
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.45 |
| Max. Negotiated Rate |
$100.51 |
| Rate for Payer: Aetna Commercial |
$46.43
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$44.37
|
| Rate for Payer: Aetna Managed Medicare |
$14.45
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$33.54
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$25.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$24.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$27.35
|
| Rate for Payer: Cash Price |
$14.88
|
| Rate for Payer: Cash Price |
$14.88
|
| Rate for Payer: Cigna Commercial |
$47.47
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$28.87
|
| Rate for Payer: Health EOS Commercial |
$45.92
|
| Rate for Payer: HFN Commercial |
$47.47
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$38.70
|
| Rate for Payer: Multiplan Commercial |
$41.28
|
| Rate for Payer: NAPHCARE Commercial |
$30.96
|
| Rate for Payer: Preferred Network Access Commercial |
$47.47
|
| Rate for Payer: Quartz Beloit One Network |
$25.28
|
| Rate for Payer: Quartz Commercial |
$33.54
|
| Rate for Payer: Quartz Medicare Advantage |
$30.96
|
| Rate for Payer: The Alliance Commercial |
$100.51
|
| Rate for Payer: United Healthcare PPO |
$38.70
|
| Rate for Payer: WEA Trust Commercial |
$28.38
|
| Rate for Payer: WPS Commercial |
$38.21
|
|
|
Thyroid Peroxidase & Thyroglobulin Antibodies
|
Facility
|
IP
|
$49.61
|
|
|
Service Code
|
CPT 76376
|
| Hospital Charge Code |
3899560
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$25.28 |
| Max. Negotiated Rate |
$47.47 |
| Rate for Payer: Aetna Commercial |
$46.43
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$44.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$27.35
|
| Rate for Payer: Cash Price |
$14.88
|
| Rate for Payer: Cigna Commercial |
$47.47
|
| Rate for Payer: Health EOS Commercial |
$45.92
|
| Rate for Payer: HFN Commercial |
$47.47
|
| Rate for Payer: Multiplan Commercial |
$41.28
|
| Rate for Payer: Preferred Network Access Commercial |
$47.47
|
| Rate for Payer: Quartz Beloit One Network |
$25.28
|
| Rate for Payer: Quartz Commercial |
$30.96
|
| Rate for Payer: WEA Trust Commercial |
$28.38
|
| Rate for Payer: WPS Commercial |
$38.21
|
|
|
Thyroid Stimulating Hormone
|
Facility
|
IP
|
$298.00
|
|
|
Service Code
|
CPT 84443
|
| Hospital Charge Code |
633844
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$151.86 |
| Max. Negotiated Rate |
$285.13 |
| Rate for Payer: Aetna Commercial |
$278.93
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$266.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$164.26
|
| Rate for Payer: Cash Price |
$89.40
|
| Rate for Payer: Cigna Commercial |
$285.13
|
| Rate for Payer: Health EOS Commercial |
$275.83
|
| Rate for Payer: HFN Commercial |
$285.13
|
| Rate for Payer: Multiplan Commercial |
$247.94
|
| Rate for Payer: Preferred Network Access Commercial |
$285.13
|
| Rate for Payer: Quartz Beloit One Network |
$151.86
|
| Rate for Payer: Quartz Commercial |
$185.95
|
| Rate for Payer: WEA Trust Commercial |
$170.46
|
| Rate for Payer: WPS Commercial |
$229.55
|
|
|
Thyroid Stimulating Hormone
|
Facility
|
OP
|
$298.00
|
|
|
Service Code
|
CPT 84443
|
| Hospital Charge Code |
633844
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.47 |
| Max. Negotiated Rate |
$285.13 |
| Rate for Payer: Aetna Commercial |
$278.93
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$266.53
|
| Rate for Payer: Aetna Managed Medicare |
$17.47
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$65.52
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$30.58
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$29.00
|
| Rate for Payer: Anthem Medicare Advantage |
$17.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$164.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$17.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$17.47
|
| Rate for Payer: Cash Price |
$89.40
|
| Rate for Payer: Cash Price |
$89.40
|
| Rate for Payer: Cigna Commercial |
$285.13
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$17.47
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$173.44
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$17.47
|
| Rate for Payer: Health EOS Commercial |
$275.83
|
| Rate for Payer: HFN Commercial |
$285.13
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$65.00
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$17.47
|
| Rate for Payer: Independent Care Health Plan Medicare |
$17.47
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$17.47
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$17.47
|
| Rate for Payer: Multiplan Commercial |
$247.94
|
| Rate for Payer: NAPHCARE Commercial |
$26.21
|
| Rate for Payer: Preferred Network Access Commercial |
$285.13
|
| Rate for Payer: Quartz Beloit One Network |
$151.86
|
| Rate for Payer: Quartz Commercial |
$201.45
|
| Rate for Payer: Quartz Medicare Advantage |
$17.47
|
| Rate for Payer: The Alliance Commercial |
$69.89
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17.47
|
| Rate for Payer: United Healthcare PPO |
$232.44
|
| Rate for Payer: WEA Trust Commercial |
$170.46
|
| Rate for Payer: Wellcare Medicare |
$17.47
|
| Rate for Payer: WPS Commercial |
$229.55
|
|
|
Thyroid Stimulating Hormone
|
Professional
|
Both
|
$298.00
|
|
|
Service Code
|
CPT 84443
|
| Hospital Charge Code |
633844
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.47 |
| Max. Negotiated Rate |
$294.42 |
| Rate for Payer: Aetna Commercial |
$294.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$266.53
|
| Rate for Payer: Aetna Managed Medicare |
$17.47
|
| Rate for Payer: Anthem Medicare Advantage |
$17.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$17.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$17.47
|
| Rate for Payer: Cash Price |
$89.40
|
| Rate for Payer: Cash Price |
$89.40
|
| Rate for Payer: Cigna Commercial |
$294.42
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$154.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$17.47
|
| Rate for Payer: Health EOS Commercial |
$282.03
|
| Rate for Payer: HFN Commercial |
$294.42
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$61.67
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$61.67
|
| Rate for Payer: Independent Care Health Plan Medicare |
$17.47
|
| Rate for Payer: Multiplan Commercial |
$247.94
|
| Rate for Payer: NAPHCARE Commercial |
$26.21
|
| Rate for Payer: Preferred Network Access Commercial |
$294.42
|
| Rate for Payer: Quartz Beloit One Network |
$136.36
|
| Rate for Payer: Quartz Commercial |
$176.65
|
| Rate for Payer: Quartz Medicare Advantage |
$17.47
|
| Rate for Payer: The Alliance Commercial |
$69.01
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17.47
|
| Rate for Payer: WEA Trust Commercial |
$170.46
|
| Rate for Payer: WPS Commercial |
$76.88
|
|
|
Thyroid Stimulating Immunoglobulins
|
Professional
|
Both
|
$444.00
|
|
|
Service Code
|
CPT 84445
|
| Hospital Charge Code |
978077
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$52.89 |
| Max. Negotiated Rate |
$438.67 |
| Rate for Payer: Aetna Commercial |
$438.67
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$397.11
|
| Rate for Payer: Aetna Managed Medicare |
$52.89
|
| Rate for Payer: Anthem Medicare Advantage |
$52.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$52.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$52.89
|
| Rate for Payer: Cash Price |
$133.20
|
| Rate for Payer: Cash Price |
$133.20
|
| Rate for Payer: Cigna Commercial |
$438.67
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$230.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$52.89
|
| Rate for Payer: Health EOS Commercial |
$420.20
|
| Rate for Payer: HFN Commercial |
$438.67
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$186.72
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$186.72
|
| Rate for Payer: Independent Care Health Plan Medicare |
$52.89
|
| Rate for Payer: Multiplan Commercial |
$369.41
|
| Rate for Payer: NAPHCARE Commercial |
$79.34
|
| Rate for Payer: Preferred Network Access Commercial |
$438.67
|
| Rate for Payer: Quartz Beloit One Network |
$203.17
|
| Rate for Payer: Quartz Commercial |
$263.20
|
| Rate for Payer: Quartz Medicare Advantage |
$52.89
|
| Rate for Payer: The Alliance Commercial |
$208.93
|
| Rate for Payer: United Healthcare Medicare Advantage |
$52.89
|
| Rate for Payer: WEA Trust Commercial |
$253.97
|
| Rate for Payer: WPS Commercial |
$232.74
|
|
|
Thyroid Stimulating Immunoglobulins
|
Facility
|
OP
|
$444.00
|
|
|
Service Code
|
CPT 84445
|
| Hospital Charge Code |
978077
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$52.89 |
| Max. Negotiated Rate |
$424.82 |
| Rate for Payer: Aetna Commercial |
$415.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$397.11
|
| Rate for Payer: Aetna Managed Medicare |
$52.89
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$198.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$92.57
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$87.80
|
| Rate for Payer: Anthem Medicare Advantage |
$52.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$244.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$52.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$52.89
|
| Rate for Payer: Cash Price |
$133.20
|
| Rate for Payer: Cash Price |
$133.20
|
| Rate for Payer: Cigna Commercial |
$424.82
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$52.89
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$258.41
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$52.89
|
| Rate for Payer: Health EOS Commercial |
$410.97
|
| Rate for Payer: HFN Commercial |
$424.82
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$196.77
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$52.89
|
| Rate for Payer: Independent Care Health Plan Medicare |
$52.89
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$52.89
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$52.89
|
| Rate for Payer: Multiplan Commercial |
$369.41
|
| Rate for Payer: NAPHCARE Commercial |
$79.34
|
| Rate for Payer: Preferred Network Access Commercial |
$424.82
|
| Rate for Payer: Quartz Beloit One Network |
$226.26
|
| Rate for Payer: Quartz Commercial |
$300.14
|
| Rate for Payer: Quartz Medicare Advantage |
$52.89
|
| Rate for Payer: The Alliance Commercial |
$211.58
|
| Rate for Payer: United Healthcare Medicare Advantage |
$52.89
|
| Rate for Payer: United Healthcare PPO |
$346.32
|
| Rate for Payer: WEA Trust Commercial |
$253.97
|
| Rate for Payer: Wellcare Medicare |
$52.89
|
| Rate for Payer: WPS Commercial |
$342.01
|
|
|
Thyroid Stimulating Immunoglobulins
|
Facility
|
IP
|
$444.00
|
|
|
Service Code
|
CPT 84445
|
| Hospital Charge Code |
978077
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$226.26 |
| Max. Negotiated Rate |
$424.82 |
| Rate for Payer: Aetna Commercial |
$415.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$397.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$244.73
|
| Rate for Payer: Cash Price |
$133.20
|
| Rate for Payer: Cigna Commercial |
$424.82
|
| Rate for Payer: Health EOS Commercial |
$410.97
|
| Rate for Payer: HFN Commercial |
$424.82
|
| Rate for Payer: Multiplan Commercial |
$369.41
|
| Rate for Payer: Preferred Network Access Commercial |
$424.82
|
| Rate for Payer: Quartz Beloit One Network |
$226.26
|
| Rate for Payer: Quartz Commercial |
$277.06
|
| Rate for Payer: WEA Trust Commercial |
$253.97
|
| Rate for Payer: WPS Commercial |
$342.01
|
|
|
Thyrotropin injection 0.9 Mg J3240
|
Professional
|
Both
|
$3,397.00
|
|
|
Service Code
|
HCPCS J3240
|
| Hospital Charge Code |
3382882
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,554.47 |
| Max. Negotiated Rate |
$6,079.33 |
| Rate for Payer: Aetna Commercial |
$3,356.24
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,038.28
|
| Rate for Payer: Aetna Managed Medicare |
$2,210.67
|
| Rate for Payer: Anthem Medicare Advantage |
$2,210.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$2,210.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$2,210.67
|
| Rate for Payer: Cash Price |
$1,019.10
|
| Rate for Payer: Cash Price |
$1,019.10
|
| Rate for Payer: Cigna Commercial |
$3,356.24
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,210.67
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,103.26
|
| Rate for Payer: Health EOS Commercial |
$3,214.92
|
| Rate for Payer: HFN Commercial |
$3,356.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,694.14
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$2,694.14
|
| Rate for Payer: Independent Care Health Plan Medicare |
$2,210.67
|
| Rate for Payer: Multiplan Commercial |
$2,826.30
|
| Rate for Payer: NAPHCARE Commercial |
$3,316.00
|
| Rate for Payer: Preferred Network Access Commercial |
$3,356.24
|
| Rate for Payer: Quartz Beloit One Network |
$1,554.47
|
| Rate for Payer: Quartz Commercial |
$2,013.74
|
| Rate for Payer: Quartz Medicare Advantage |
$2,210.67
|
| Rate for Payer: The Alliance Commercial |
$6,079.33
|
| Rate for Payer: United Healthcare Medicaid |
$2,210.67
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,210.67
|
| Rate for Payer: WEA Trust Commercial |
$1,943.08
|
| Rate for Payer: WPS Commercial |
$5,258.15
|
|
|
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 |
$1,695.78 |
| Max. Negotiated Rate |
$8,842.66 |
| Rate for Payer: Aetna Commercial |
$3,179.59
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,038.28
|
| Rate for Payer: Aetna Managed Medicare |
$2,210.67
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,296.37
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,766.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,695.78
|
| Rate for Payer: Anthem Medicare Advantage |
$2,210.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,872.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$2,210.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$2,210.67
|
| Rate for Payer: Cash Price |
$1,019.10
|
| Rate for Payer: Cash Price |
$1,019.10
|
| Rate for Payer: Cigna Commercial |
$3,250.25
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$2,210.67
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,782.57
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$2,210.67
|
| Rate for Payer: Health EOS Commercial |
$3,144.26
|
| Rate for Payer: HFN Commercial |
$3,250.25
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$8,223.68
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$2,210.67
|
| Rate for Payer: Independent Care Health Plan Medicare |
$2,210.67
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$2,210.67
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$2,210.67
|
| Rate for Payer: Multiplan Commercial |
$2,826.30
|
| Rate for Payer: NAPHCARE Commercial |
$3,316.00
|
| Rate for Payer: Preferred Network Access Commercial |
$3,250.25
|
| Rate for Payer: Quartz Beloit One Network |
$1,731.11
|
| Rate for Payer: Quartz Commercial |
$2,296.37
|
| Rate for Payer: Quartz Medicare Advantage |
$2,210.67
|
| Rate for Payer: The Alliance Commercial |
$8,842.66
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,210.67
|
| Rate for Payer: WEA Trust Commercial |
$1,943.08
|
| Rate for Payer: Wellcare Medicare |
$2,210.67
|
| Rate for Payer: WPS Commercial |
$5,258.15
|
|
|
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 |
$1,731.11 |
| Max. Negotiated Rate |
$3,250.25 |
| Rate for Payer: Aetna Commercial |
$3,179.59
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,038.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,872.43
|
| Rate for Payer: Cash Price |
$1,019.10
|
| Rate for Payer: Cigna Commercial |
$3,250.25
|
| Rate for Payer: Health EOS Commercial |
$3,144.26
|
| Rate for Payer: HFN Commercial |
$3,250.25
|
| Rate for Payer: Multiplan Commercial |
$2,826.30
|
| Rate for Payer: Preferred Network Access Commercial |
$3,250.25
|
| Rate for Payer: Quartz Beloit One Network |
$1,731.11
|
| Rate for Payer: Quartz Commercial |
$2,119.73
|
| Rate for Payer: WEA Trust Commercial |
$1,943.08
|
| Rate for Payer: WPS Commercial |
$2,616.71
|
|
|
Thyroxine
|
Facility
|
IP
|
$140.00
|
|
|
Service Code
|
CPT 84436
|
| Hospital Charge Code |
633845
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$71.34 |
| Max. Negotiated Rate |
$133.95 |
| Rate for Payer: Aetna Commercial |
$131.04
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$125.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$77.17
|
| Rate for Payer: Cash Price |
$42.00
|
| Rate for Payer: Cigna Commercial |
$133.95
|
| Rate for Payer: Health EOS Commercial |
$129.58
|
| Rate for Payer: HFN Commercial |
$133.95
|
| Rate for Payer: Multiplan Commercial |
$116.48
|
| Rate for Payer: Preferred Network Access Commercial |
$133.95
|
| Rate for Payer: Quartz Beloit One Network |
$71.34
|
| Rate for Payer: Quartz Commercial |
$87.36
|
| Rate for Payer: WEA Trust Commercial |
$80.08
|
| Rate for Payer: WPS Commercial |
$107.84
|
|
|
Thyroxine
|
Professional
|
Both
|
$140.00
|
|
|
Service Code
|
CPT 84436
|
| Hospital Charge Code |
633845
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$7.14 |
| Max. Negotiated Rate |
$138.32 |
| Rate for Payer: Aetna Commercial |
$138.32
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$125.22
|
| Rate for Payer: Aetna Managed Medicare |
$7.14
|
| Rate for Payer: Anthem Medicare Advantage |
$7.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$7.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$7.14
|
| Rate for Payer: Cash Price |
$42.00
|
| Rate for Payer: Cash Price |
$42.00
|
| Rate for Payer: Cigna Commercial |
$138.32
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$72.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$7.14
|
| Rate for Payer: Health EOS Commercial |
$132.50
|
| Rate for Payer: HFN Commercial |
$138.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$25.22
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$25.22
|
| Rate for Payer: Independent Care Health Plan Medicare |
$7.14
|
| Rate for Payer: Multiplan Commercial |
$116.48
|
| Rate for Payer: NAPHCARE Commercial |
$10.72
|
| Rate for Payer: Preferred Network Access Commercial |
$138.32
|
| Rate for Payer: Quartz Beloit One Network |
$64.06
|
| Rate for Payer: Quartz Commercial |
$82.99
|
| Rate for Payer: Quartz Medicare Advantage |
$7.14
|
| Rate for Payer: The Alliance Commercial |
$28.22
|
| Rate for Payer: United Healthcare Medicare Advantage |
$7.14
|
| Rate for Payer: WEA Trust Commercial |
$80.08
|
| Rate for Payer: WPS Commercial |
$31.44
|
|
|
Thyroxine
|
Facility
|
OP
|
$140.00
|
|
|
Service Code
|
CPT 84436
|
| Hospital Charge Code |
633845
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$7.14 |
| Max. Negotiated Rate |
$133.95 |
| Rate for Payer: Aetna Commercial |
$131.04
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$125.22
|
| Rate for Payer: Aetna Managed Medicare |
$7.14
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$26.79
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$12.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$11.86
|
| Rate for Payer: Anthem Medicare Advantage |
$7.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$77.17
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$7.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$7.14
|
| Rate for Payer: Cash Price |
$42.00
|
| Rate for Payer: Cash Price |
$42.00
|
| Rate for Payer: Cigna Commercial |
$133.95
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$7.14
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$81.48
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$7.14
|
| Rate for Payer: Health EOS Commercial |
$129.58
|
| Rate for Payer: HFN Commercial |
$133.95
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$26.58
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$7.14
|
| Rate for Payer: Independent Care Health Plan Medicare |
$7.14
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$7.14
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$7.14
|
| Rate for Payer: Multiplan Commercial |
$116.48
|
| Rate for Payer: NAPHCARE Commercial |
$10.72
|
| Rate for Payer: Preferred Network Access Commercial |
$133.95
|
| Rate for Payer: Quartz Beloit One Network |
$71.34
|
| Rate for Payer: Quartz Commercial |
$94.64
|
| Rate for Payer: Quartz Medicare Advantage |
$7.14
|
| Rate for Payer: The Alliance Commercial |
$28.58
|
| Rate for Payer: United Healthcare Medicare Advantage |
$7.14
|
| Rate for Payer: United Healthcare PPO |
$109.20
|
| Rate for Payer: WEA Trust Commercial |
$80.08
|
| Rate for Payer: Wellcare Medicare |
$7.14
|
| Rate for Payer: WPS Commercial |
$107.84
|
|
|
Thyroxine Binding Globulin (TBG)
|
Facility
|
OP
|
$111.00
|
|
|
Service Code
|
CPT 84442
|
| Hospital Charge Code |
6087633
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.37 |
| Max. Negotiated Rate |
$106.20 |
| Rate for Payer: Aetna Commercial |
$103.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$99.28
|
| Rate for Payer: Aetna Managed Medicare |
$15.37
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$57.64
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$26.90
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$25.52
|
| Rate for Payer: Anthem Medicare Advantage |
$15.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$61.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$15.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$15.37
|
| Rate for Payer: Cash Price |
$33.30
|
| Rate for Payer: Cash Price |
$33.30
|
| Rate for Payer: Cigna Commercial |
$106.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$15.37
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$64.60
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$15.37
|
| Rate for Payer: Health EOS Commercial |
$102.74
|
| Rate for Payer: HFN Commercial |
$106.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$57.18
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$15.37
|
| Rate for Payer: Independent Care Health Plan Medicare |
$15.37
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$15.37
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$15.37
|
| Rate for Payer: Multiplan Commercial |
$92.35
|
| Rate for Payer: NAPHCARE Commercial |
$23.06
|
| Rate for Payer: Preferred Network Access Commercial |
$106.20
|
| Rate for Payer: Quartz Beloit One Network |
$56.57
|
| Rate for Payer: Quartz Commercial |
$75.04
|
| Rate for Payer: Quartz Medicare Advantage |
$15.37
|
| Rate for Payer: The Alliance Commercial |
$61.48
|
| Rate for Payer: United Healthcare Medicare Advantage |
$15.37
|
| Rate for Payer: United Healthcare PPO |
$86.58
|
| Rate for Payer: WEA Trust Commercial |
$63.49
|
| Rate for Payer: Wellcare Medicare |
$15.37
|
| Rate for Payer: WPS Commercial |
$85.50
|
|
|
Thyroxine Binding Globulin (TBG)
|
Professional
|
Both
|
$111.00
|
|
|
Service Code
|
CPT 84442
|
| Hospital Charge Code |
6087633
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.37 |
| Max. Negotiated Rate |
$109.67 |
| Rate for Payer: Aetna Commercial |
$109.67
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$99.28
|
| Rate for Payer: Aetna Managed Medicare |
$15.37
|
| Rate for Payer: Anthem Medicare Advantage |
$15.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$15.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$15.37
|
| Rate for Payer: Cash Price |
$33.30
|
| Rate for Payer: Cash Price |
$33.30
|
| Rate for Payer: Cigna Commercial |
$109.67
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$57.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$15.37
|
| Rate for Payer: Health EOS Commercial |
$105.05
|
| Rate for Payer: HFN Commercial |
$109.67
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$54.26
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$54.26
|
| Rate for Payer: Independent Care Health Plan Medicare |
$15.37
|
| Rate for Payer: Multiplan Commercial |
$92.35
|
| Rate for Payer: NAPHCARE Commercial |
$23.06
|
| Rate for Payer: Preferred Network Access Commercial |
$109.67
|
| Rate for Payer: Quartz Beloit One Network |
$50.79
|
| Rate for Payer: Quartz Commercial |
$65.80
|
| Rate for Payer: Quartz Medicare Advantage |
$15.37
|
| Rate for Payer: The Alliance Commercial |
$60.72
|
| Rate for Payer: United Healthcare Medicare Advantage |
$15.37
|
| Rate for Payer: WEA Trust Commercial |
$63.49
|
| Rate for Payer: WPS Commercial |
$67.63
|
|
|
Thyroxine Binding Globulin (TBG)
|
Facility
|
IP
|
$111.00
|
|
|
Service Code
|
CPT 84442
|
| Hospital Charge Code |
6087633
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$56.57 |
| Max. Negotiated Rate |
$106.20 |
| Rate for Payer: Aetna Commercial |
$103.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$99.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$61.18
|
| Rate for Payer: Cash Price |
$33.30
|
| Rate for Payer: Cigna Commercial |
$106.20
|
| Rate for Payer: Health EOS Commercial |
$102.74
|
| Rate for Payer: HFN Commercial |
$106.20
|
| Rate for Payer: Multiplan Commercial |
$92.35
|
| Rate for Payer: Preferred Network Access Commercial |
$106.20
|
| Rate for Payer: Quartz Beloit One Network |
$56.57
|
| Rate for Payer: Quartz Commercial |
$69.26
|
| Rate for Payer: WEA Trust Commercial |
$63.49
|
| Rate for Payer: WPS Commercial |
$85.50
|
|
|
Thyroxine Free
|
Professional
|
Both
|
$296.00
|
|
|
Service Code
|
CPT 84439
|
| Hospital Charge Code |
633846
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.38 |
| Max. Negotiated Rate |
$292.45 |
| Rate for Payer: Aetna Commercial |
$292.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$264.74
|
| Rate for Payer: Aetna Managed Medicare |
$9.38
|
| Rate for Payer: Anthem Medicare Advantage |
$9.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$9.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$9.38
|
| Rate for Payer: Cash Price |
$88.80
|
| Rate for Payer: Cash Price |
$88.80
|
| Rate for Payer: Cigna Commercial |
$292.45
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$153.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$9.38
|
| Rate for Payer: Health EOS Commercial |
$280.13
|
| Rate for Payer: HFN Commercial |
$292.45
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$33.11
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$33.11
|
| Rate for Payer: Independent Care Health Plan Medicare |
$9.38
|
| Rate for Payer: Multiplan Commercial |
$246.27
|
| Rate for Payer: NAPHCARE Commercial |
$14.07
|
| Rate for Payer: Preferred Network Access Commercial |
$292.45
|
| Rate for Payer: Quartz Beloit One Network |
$135.45
|
| Rate for Payer: Quartz Commercial |
$175.47
|
| Rate for Payer: Quartz Medicare Advantage |
$9.38
|
| Rate for Payer: The Alliance Commercial |
$37.05
|
| Rate for Payer: United Healthcare Medicare Advantage |
$9.38
|
| Rate for Payer: WEA Trust Commercial |
$169.31
|
| Rate for Payer: WPS Commercial |
$41.28
|
|
|
Thyroxine Free
|
Facility
|
OP
|
$296.00
|
|
|
Service Code
|
CPT 84439
|
| Hospital Charge Code |
633846
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.38 |
| Max. Negotiated Rate |
$283.21 |
| Rate for Payer: Aetna Commercial |
$277.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$264.74
|
| Rate for Payer: Aetna Managed Medicare |
$9.38
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$35.18
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$16.42
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$15.57
|
| Rate for Payer: Anthem Medicare Advantage |
$9.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$163.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$9.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$9.38
|
| Rate for Payer: Cash Price |
$88.80
|
| Rate for Payer: Cash Price |
$88.80
|
| Rate for Payer: Cigna Commercial |
$283.21
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$9.38
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$172.27
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$9.38
|
| Rate for Payer: Health EOS Commercial |
$273.98
|
| Rate for Payer: HFN Commercial |
$283.21
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$34.90
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$9.38
|
| Rate for Payer: Independent Care Health Plan Medicare |
$9.38
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$9.38
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$9.38
|
| Rate for Payer: Multiplan Commercial |
$246.27
|
| Rate for Payer: NAPHCARE Commercial |
$14.07
|
| Rate for Payer: Preferred Network Access Commercial |
$283.21
|
| Rate for Payer: Quartz Beloit One Network |
$150.84
|
| Rate for Payer: Quartz Commercial |
$200.10
|
| Rate for Payer: Quartz Medicare Advantage |
$9.38
|
| Rate for Payer: The Alliance Commercial |
$37.52
|
| Rate for Payer: United Healthcare Medicare Advantage |
$9.38
|
| Rate for Payer: United Healthcare PPO |
$230.88
|
| Rate for Payer: WEA Trust Commercial |
$169.31
|
| Rate for Payer: Wellcare Medicare |
$9.38
|
| Rate for Payer: WPS Commercial |
$228.01
|
|
|
Thyroxine Free
|
Facility
|
IP
|
$296.00
|
|
|
Service Code
|
CPT 84439
|
| Hospital Charge Code |
633846
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$150.84 |
| Max. Negotiated Rate |
$283.21 |
| Rate for Payer: Aetna Commercial |
$277.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$264.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$163.16
|
| Rate for Payer: Cash Price |
$88.80
|
| Rate for Payer: Cigna Commercial |
$283.21
|
| Rate for Payer: Health EOS Commercial |
$273.98
|
| Rate for Payer: HFN Commercial |
$283.21
|
| Rate for Payer: Multiplan Commercial |
$246.27
|
| Rate for Payer: Preferred Network Access Commercial |
$283.21
|
| Rate for Payer: Quartz Beloit One Network |
$150.84
|
| Rate for Payer: Quartz Commercial |
$184.70
|
| Rate for Payer: WEA Trust Commercial |
$169.31
|
| Rate for Payer: WPS Commercial |
$228.01
|
|
|
Tiagabine (Gabitril)
|
Facility
|
IP
|
$234.00
|
|
|
Service Code
|
CPT 80199
|
| Hospital Charge Code |
983425
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$119.25 |
| Max. Negotiated Rate |
$223.89 |
| Rate for Payer: Aetna Commercial |
$219.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$209.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$128.98
|
| Rate for Payer: Cash Price |
$70.20
|
| Rate for Payer: Cigna Commercial |
$223.89
|
| Rate for Payer: Health EOS Commercial |
$216.59
|
| Rate for Payer: HFN Commercial |
$223.89
|
| Rate for Payer: Multiplan Commercial |
$194.69
|
| Rate for Payer: Preferred Network Access Commercial |
$223.89
|
| Rate for Payer: Quartz Beloit One Network |
$119.25
|
| Rate for Payer: Quartz Commercial |
$146.02
|
| Rate for Payer: WEA Trust Commercial |
$133.85
|
| Rate for Payer: WPS Commercial |
$180.25
|
|
|
Tiagabine (Gabitril)
|
Professional
|
Both
|
$234.00
|
|
|
Service Code
|
CPT 80199
|
| Hospital Charge Code |
983425
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$28.19 |
| Max. Negotiated Rate |
$231.19 |
| Rate for Payer: Aetna Commercial |
$231.19
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$209.29
|
| Rate for Payer: Aetna Managed Medicare |
$28.19
|
| Rate for Payer: Anthem Medicare Advantage |
$28.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$28.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$28.19
|
| Rate for Payer: Cash Price |
$70.20
|
| Rate for Payer: Cash Price |
$70.20
|
| Rate for Payer: Cigna Commercial |
$231.19
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$121.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$28.19
|
| Rate for Payer: Health EOS Commercial |
$221.46
|
| Rate for Payer: HFN Commercial |
$231.19
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$99.53
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$99.53
|
| Rate for Payer: Independent Care Health Plan Medicare |
$28.19
|
| Rate for Payer: Multiplan Commercial |
$194.69
|
| Rate for Payer: NAPHCARE Commercial |
$42.29
|
| Rate for Payer: Preferred Network Access Commercial |
$231.19
|
| Rate for Payer: Quartz Beloit One Network |
$107.08
|
| Rate for Payer: Quartz Commercial |
$138.72
|
| Rate for Payer: Quartz Medicare Advantage |
$28.19
|
| Rate for Payer: The Alliance Commercial |
$111.37
|
| Rate for Payer: United Healthcare Medicare Advantage |
$28.19
|
| Rate for Payer: WEA Trust Commercial |
$133.85
|
| Rate for Payer: WPS Commercial |
$124.06
|
|
|
Tiagabine (Gabitril)
|
Facility
|
OP
|
$234.00
|
|
|
Service Code
|
CPT 80199
|
| Hospital Charge Code |
983425
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$28.19 |
| Max. Negotiated Rate |
$223.89 |
| Rate for Payer: Aetna Commercial |
$219.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$209.29
|
| Rate for Payer: Aetna Managed Medicare |
$28.19
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$105.73
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$49.34
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$46.80
|
| Rate for Payer: Anthem Medicare Advantage |
$28.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$128.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$28.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$28.19
|
| Rate for Payer: Cash Price |
$70.20
|
| Rate for Payer: Cash Price |
$70.20
|
| Rate for Payer: Cigna Commercial |
$223.89
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$28.19
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$136.19
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$28.19
|
| Rate for Payer: Health EOS Commercial |
$216.59
|
| Rate for Payer: HFN Commercial |
$223.89
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$104.88
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$28.19
|
| Rate for Payer: Independent Care Health Plan Medicare |
$28.19
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$28.19
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$28.19
|
| Rate for Payer: Multiplan Commercial |
$194.69
|
| Rate for Payer: NAPHCARE Commercial |
$42.29
|
| Rate for Payer: Preferred Network Access Commercial |
$223.89
|
| Rate for Payer: Quartz Beloit One Network |
$119.25
|
| Rate for Payer: Quartz Commercial |
$158.18
|
| Rate for Payer: Quartz Medicare Advantage |
$28.19
|
| Rate for Payer: The Alliance Commercial |
$112.78
|
| Rate for Payer: United Healthcare Medicare Advantage |
$28.19
|
| Rate for Payer: United Healthcare PPO |
$182.52
|
| Rate for Payer: WEA Trust Commercial |
$133.85
|
| Rate for Payer: Wellcare Medicare |
$28.19
|
| Rate for Payer: WPS Commercial |
$180.25
|
|
