|
Thrombectomy Xpeedior
|
Facility
|
IP
|
$11,504.00
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
4139315
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$5,636.96 |
| Max. Negotiated Rate |
$10,583.68 |
| Rate for Payer: Aetna Commercial |
$10,353.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,893.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,097.12
|
| Rate for Payer: Cash Price |
$3,451.20
|
| Rate for Payer: Cigna Commercial |
$10,583.68
|
| Rate for Payer: Health EOS Commercial |
$10,238.56
|
| Rate for Payer: HFN Commercial |
$10,583.68
|
| Rate for Payer: Multiplan Commercial |
$9,203.20
|
| Rate for Payer: NAPHCARE Commercial |
$6,902.40
|
| Rate for Payer: Preferred Network Access Commercial |
$10,583.68
|
| Rate for Payer: Quartz Beloit One Network |
$5,636.96
|
| Rate for Payer: Quartz Commercial |
$6,902.40
|
| Rate for Payer: WEA Trust Commercial |
$6,327.20
|
| Rate for Payer: WPS Commercial |
$8,521.01
|
|
|
Thrombectomy Xpeedior
|
Facility
|
OP
|
$11,504.00
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
4139315
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$3,221.12 |
| Max. Negotiated Rate |
$46,016.00 |
| Rate for Payer: Aetna Commercial |
$10,353.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,893.44
|
| Rate for Payer: Aetna Managed Medicare |
$3,221.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$7,477.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5,752.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5,521.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,097.12
|
| Rate for Payer: Cash Price |
$3,451.20
|
| Rate for Payer: Cigna Commercial |
$10,583.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,437.64
|
| Rate for Payer: Health EOS Commercial |
$10,238.56
|
| Rate for Payer: HFN Commercial |
$10,583.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$8,628.00
|
| Rate for Payer: Multiplan Commercial |
$9,203.20
|
| Rate for Payer: NAPHCARE Commercial |
$6,902.40
|
| Rate for Payer: Preferred Network Access Commercial |
$10,583.68
|
| Rate for Payer: Quartz Beloit One Network |
$5,636.96
|
| Rate for Payer: Quartz Commercial |
$7,477.60
|
| Rate for Payer: Quartz Medicare Advantage |
$6,902.40
|
| Rate for Payer: The Alliance Commercial |
$46,016.00
|
| Rate for Payer: WEA Trust Commercial |
$6,327.20
|
| Rate for Payer: WPS Commercial |
$8,521.01
|
|
|
THROMBETOMY SET SPIROFLEX 106553-001
|
Facility
|
OP
|
$10,949.00
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
2973897
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3,065.72 |
| Max. Negotiated Rate |
$43,796.00 |
| Rate for Payer: Aetna Commercial |
$9,854.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,416.14
|
| Rate for Payer: Aetna Managed Medicare |
$3,065.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$7,116.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5,474.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5,255.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,802.97
|
| Rate for Payer: Cash Price |
$3,284.70
|
| Rate for Payer: Cigna Commercial |
$10,073.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,127.06
|
| Rate for Payer: Health EOS Commercial |
$9,744.61
|
| Rate for Payer: HFN Commercial |
$10,073.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$8,211.75
|
| Rate for Payer: Multiplan Commercial |
$8,759.20
|
| Rate for Payer: NAPHCARE Commercial |
$6,569.40
|
| Rate for Payer: Preferred Network Access Commercial |
$10,073.08
|
| Rate for Payer: Quartz Beloit One Network |
$5,365.01
|
| Rate for Payer: Quartz Commercial |
$7,116.85
|
| Rate for Payer: Quartz Medicare Advantage |
$6,569.40
|
| Rate for Payer: The Alliance Commercial |
$43,796.00
|
| Rate for Payer: WEA Trust Commercial |
$6,021.95
|
| Rate for Payer: WPS Commercial |
$8,109.92
|
|
|
THROMBETOMY SET SPIROFLEX 106553-001
|
Facility
|
IP
|
$10,949.00
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
2973897
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5,365.01 |
| Max. Negotiated Rate |
$10,073.08 |
| Rate for Payer: Aetna Commercial |
$9,854.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,416.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,802.97
|
| Rate for Payer: Cash Price |
$3,284.70
|
| Rate for Payer: Cigna Commercial |
$10,073.08
|
| Rate for Payer: Health EOS Commercial |
$9,744.61
|
| Rate for Payer: HFN Commercial |
$10,073.08
|
| Rate for Payer: Multiplan Commercial |
$8,759.20
|
| Rate for Payer: NAPHCARE Commercial |
$6,569.40
|
| Rate for Payer: Preferred Network Access Commercial |
$10,073.08
|
| Rate for Payer: Quartz Beloit One Network |
$5,365.01
|
| Rate for Payer: Quartz Commercial |
$6,569.40
|
| Rate for Payer: WEA Trust Commercial |
$6,021.95
|
| Rate for Payer: WPS Commercial |
$8,109.92
|
|
|
Thrombin 20,000 units vial [Med]
|
Facility
|
IP
|
$1,725.00
|
|
| Hospital Charge Code |
2974987
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$845.25 |
| Max. Negotiated Rate |
$1,587.00 |
| Rate for Payer: Aetna Commercial |
$1,552.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,483.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$914.25
|
| Rate for Payer: Cash Price |
$517.50
|
| Rate for Payer: Cigna Commercial |
$1,587.00
|
| Rate for Payer: Health EOS Commercial |
$1,535.25
|
| Rate for Payer: HFN Commercial |
$1,587.00
|
| Rate for Payer: Multiplan Commercial |
$1,380.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,035.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,587.00
|
| Rate for Payer: Quartz Beloit One Network |
$845.25
|
| Rate for Payer: Quartz Commercial |
$1,035.00
|
| Rate for Payer: WEA Trust Commercial |
$948.75
|
| Rate for Payer: WPS Commercial |
$1,277.71
|
|
|
Thrombin 20,000 units vial [Med]
|
Facility
|
OP
|
$1,725.00
|
|
| Hospital Charge Code |
2974987
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$483.00 |
| Max. Negotiated Rate |
$6,900.00 |
| Rate for Payer: Aetna Commercial |
$1,552.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,483.50
|
| Rate for Payer: Aetna Managed Medicare |
$483.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,121.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$862.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$828.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$914.25
|
| Rate for Payer: Cash Price |
$517.50
|
| Rate for Payer: Cigna Commercial |
$1,587.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$965.31
|
| Rate for Payer: Health EOS Commercial |
$1,535.25
|
| Rate for Payer: HFN Commercial |
$1,587.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,293.75
|
| Rate for Payer: Multiplan Commercial |
$1,380.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,035.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,587.00
|
| Rate for Payer: Quartz Beloit One Network |
$845.25
|
| Rate for Payer: Quartz Commercial |
$1,121.25
|
| Rate for Payer: Quartz Medicare Advantage |
$1,035.00
|
| Rate for Payer: The Alliance Commercial |
$6,900.00
|
| Rate for Payer: WEA Trust Commercial |
$948.75
|
| Rate for Payer: WPS Commercial |
$1,277.71
|
|
|
Thrombin Time
|
Professional
|
Both
|
$276.00
|
|
|
Service Code
|
CPT 85670
|
| Hospital Charge Code |
978134
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$20.37 |
| Max. Negotiated Rate |
$262.20 |
| Rate for Payer: Aetna Commercial |
$262.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$237.36
|
| Rate for Payer: Cash Price |
$82.80
|
| Rate for Payer: Cash Price |
$82.80
|
| Rate for Payer: Cigna Commercial |
$262.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$138.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$165.60
|
| Rate for Payer: Health EOS Commercial |
$251.16
|
| Rate for Payer: HFN Commercial |
$262.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$20.37
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$20.37
|
| Rate for Payer: Multiplan Commercial |
$220.80
|
| Rate for Payer: Preferred Network Access Commercial |
$262.20
|
| Rate for Payer: Quartz Beloit One Network |
$121.44
|
| Rate for Payer: Quartz Commercial |
$157.32
|
| Rate for Payer: The Alliance Commercial |
$138.00
|
| Rate for Payer: WEA Trust Commercial |
$151.80
|
| Rate for Payer: WPS Commercial |
$204.43
|
|
|
Thrombin Time
|
Facility
|
OP
|
$276.00
|
|
|
Service Code
|
CPT 85670
|
| Hospital Charge Code |
978134
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.77 |
| Max. Negotiated Rate |
$253.92 |
| Rate for Payer: Aetna Commercial |
$248.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$237.36
|
| Rate for Payer: Aetna Managed Medicare |
$5.77
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$21.64
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$10.10
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$9.58
|
| Rate for Payer: Anthem Medicare Advantage |
$5.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$146.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5.77
|
| Rate for Payer: Cash Price |
$82.80
|
| Rate for Payer: Cash Price |
$82.80
|
| Rate for Payer: Cigna Commercial |
$253.92
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$5.77
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$154.45
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$5.77
|
| Rate for Payer: Health EOS Commercial |
$245.64
|
| Rate for Payer: HFN Commercial |
$253.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$21.46
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$5.77
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5.77
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$5.77
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$5.77
|
| Rate for Payer: Multiplan Commercial |
$220.80
|
| Rate for Payer: NAPHCARE Commercial |
$8.66
|
| Rate for Payer: Preferred Network Access Commercial |
$253.92
|
| Rate for Payer: Quartz Beloit One Network |
$135.24
|
| Rate for Payer: Quartz Commercial |
$179.40
|
| Rate for Payer: Quartz Medicare Advantage |
$5.77
|
| Rate for Payer: The Alliance Commercial |
$23.08
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.77
|
| Rate for Payer: United Healthcare PPO |
$207.00
|
| Rate for Payer: WEA Trust Commercial |
$151.80
|
| Rate for Payer: Wellcare Medicare |
$5.77
|
| Rate for Payer: WPS Commercial |
$204.43
|
|
|
Thrombin Time
|
Facility
|
IP
|
$276.00
|
|
|
Service Code
|
CPT 85670
|
| Hospital Charge Code |
978134
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$135.24 |
| Max. Negotiated Rate |
$253.92 |
| Rate for Payer: Aetna Commercial |
$248.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$237.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$146.28
|
| Rate for Payer: Cash Price |
$82.80
|
| Rate for Payer: Cigna Commercial |
$253.92
|
| Rate for Payer: Health EOS Commercial |
$245.64
|
| Rate for Payer: HFN Commercial |
$253.92
|
| Rate for Payer: Multiplan Commercial |
$220.80
|
| Rate for Payer: NAPHCARE Commercial |
$165.60
|
| Rate for Payer: Preferred Network Access Commercial |
$253.92
|
| Rate for Payer: Quartz Beloit One Network |
$135.24
|
| Rate for Payer: Quartz Commercial |
$165.60
|
| Rate for Payer: WEA Trust Commercial |
$151.80
|
| Rate for Payer: WPS Commercial |
$204.43
|
|
|
Thrombolysis (IC) Coronary
|
Facility
|
IP
|
$2,592.00
|
|
|
Service Code
|
CPT 92975
|
| Hospital Charge Code |
5238883
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,270.08 |
| Max. Negotiated Rate |
$2,384.64 |
| Rate for Payer: Aetna Commercial |
$2,332.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,229.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,373.76
|
| Rate for Payer: Cash Price |
$777.60
|
| Rate for Payer: Cigna Commercial |
$2,384.64
|
| Rate for Payer: Health EOS Commercial |
$2,306.88
|
| Rate for Payer: HFN Commercial |
$2,384.64
|
| Rate for Payer: Multiplan Commercial |
$2,073.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,555.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,384.64
|
| Rate for Payer: Quartz Beloit One Network |
$1,270.08
|
| Rate for Payer: Quartz Commercial |
$1,555.20
|
| Rate for Payer: WEA Trust Commercial |
$1,425.60
|
| Rate for Payer: WPS Commercial |
$1,919.89
|
|
|
Thrombolysis (IC) Coronary
|
Facility
|
OP
|
$2,592.00
|
|
|
Service Code
|
CPT 92975
|
| Hospital Charge Code |
5238883
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$725.76 |
| Max. Negotiated Rate |
$10,368.00 |
| Rate for Payer: Aetna Commercial |
$2,332.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,229.12
|
| Rate for Payer: Aetna Managed Medicare |
$725.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,914.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,297.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,183.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,373.76
|
| 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 |
$2,384.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,450.48
|
| Rate for Payer: Health EOS Commercial |
$2,306.88
|
| Rate for Payer: HFN Commercial |
$2,384.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,944.00
|
| Rate for Payer: Multiplan Commercial |
$2,073.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,555.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,384.64
|
| Rate for Payer: Quartz Beloit One Network |
$1,270.08
|
| Rate for Payer: Quartz Commercial |
$1,684.80
|
| Rate for Payer: Quartz Medicare Advantage |
$1,555.20
|
| Rate for Payer: The Alliance Commercial |
$10,368.00
|
| Rate for Payer: United Healthcare PPO |
$2,257.00
|
| Rate for Payer: WEA Trust Commercial |
$1,425.60
|
| Rate for Payer: WPS Commercial |
$1,919.89
|
|
|
Thrombolytic Therapy Arterial, Initial
|
Facility
|
OP
|
$15,109.00
|
|
|
Service Code
|
CPT 37211
|
| Hospital Charge Code |
3052437
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$4,240.00 |
| Max. Negotiated Rate |
$21,726.56 |
| Rate for Payer: Aetna Commercial |
$13,598.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$12,993.74
|
| Rate for Payer: Aetna Managed Medicare |
$5,431.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$12,238.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$10,914.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$10,367.00
|
| Rate for Payer: Anthem Medicare Advantage |
$5,431.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$8,007.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5,431.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5,431.64
|
| 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 |
$13,900.28
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$5,431.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$11,874.87
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$5,431.64
|
| Rate for Payer: Health EOS Commercial |
$13,447.01
|
| Rate for Payer: HFN Commercial |
$13,900.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$20,205.70
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$5,431.64
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5,431.64
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$5,431.64
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$5,431.64
|
| Rate for Payer: Multiplan Commercial |
$12,087.20
|
| Rate for Payer: NAPHCARE Commercial |
$8,147.46
|
| Rate for Payer: Preferred Network Access Commercial |
$13,900.28
|
| Rate for Payer: Quartz Beloit One Network |
$7,403.41
|
| Rate for Payer: Quartz Commercial |
$9,820.85
|
| Rate for Payer: Quartz Medicare Advantage |
$5,431.64
|
| Rate for Payer: The Alliance Commercial |
$21,726.56
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5,431.64
|
| Rate for Payer: United Healthcare PPO |
$4,240.00
|
| Rate for Payer: WEA Trust Commercial |
$8,309.95
|
| Rate for Payer: Wellcare Medicare |
$5,431.64
|
| Rate for Payer: WPS Commercial |
$11,191.24
|
|
|
Thrombolytic Therapy Arterial, Initial
|
Facility
|
IP
|
$15,109.00
|
|
|
Service Code
|
CPT 37211
|
| Hospital Charge Code |
3052437
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$7,403.41 |
| Max. Negotiated Rate |
$13,900.28 |
| Rate for Payer: Aetna Commercial |
$13,598.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$12,993.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$8,007.77
|
| Rate for Payer: Cash Price |
$4,532.70
|
| Rate for Payer: Cigna Commercial |
$13,900.28
|
| Rate for Payer: Health EOS Commercial |
$13,447.01
|
| Rate for Payer: HFN Commercial |
$13,900.28
|
| Rate for Payer: Multiplan Commercial |
$12,087.20
|
| Rate for Payer: NAPHCARE Commercial |
$9,065.40
|
| Rate for Payer: Preferred Network Access Commercial |
$13,900.28
|
| Rate for Payer: Quartz Beloit One Network |
$7,403.41
|
| Rate for Payer: Quartz Commercial |
$9,065.40
|
| Rate for Payer: WEA Trust Commercial |
$8,309.95
|
| Rate for Payer: WPS Commercial |
$11,191.24
|
|
|
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 |
$3,576.51 |
| Max. Negotiated Rate |
$6,715.08 |
| Rate for Payer: Aetna Commercial |
$6,569.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,277.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,868.47
|
| Rate for Payer: Cash Price |
$2,189.70
|
| Rate for Payer: Cigna Commercial |
$6,715.08
|
| Rate for Payer: Health EOS Commercial |
$6,496.11
|
| Rate for Payer: HFN Commercial |
$6,715.08
|
| Rate for Payer: Multiplan Commercial |
$5,839.20
|
| Rate for Payer: NAPHCARE Commercial |
$4,379.40
|
| Rate for Payer: Preferred Network Access Commercial |
$6,715.08
|
| Rate for Payer: Quartz Beloit One Network |
$3,576.51
|
| Rate for Payer: Quartz Commercial |
$4,379.40
|
| Rate for Payer: WEA Trust Commercial |
$4,014.45
|
| Rate for Payer: WPS Commercial |
$5,406.37
|
|
|
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 |
$2,726.00 |
| Max. Negotiated Rate |
$12,602.12 |
| Rate for Payer: Aetna Commercial |
$6,569.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,277.14
|
| Rate for Payer: Aetna Managed Medicare |
$3,150.53
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,496.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,871.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,726.00
|
| Rate for Payer: Anthem Medicare Advantage |
$3,150.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,868.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$3,150.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$3,150.53
|
| 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 |
$6,715.08
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$3,150.53
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$11,874.87
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$3,150.53
|
| Rate for Payer: Health EOS Commercial |
$6,496.11
|
| Rate for Payer: HFN Commercial |
$6,715.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$11,719.97
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$3,150.53
|
| Rate for Payer: Independent Care Health Plan Medicare |
$3,150.53
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$3,150.53
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$3,150.53
|
| Rate for Payer: Multiplan Commercial |
$5,839.20
|
| Rate for Payer: NAPHCARE Commercial |
$4,725.80
|
| Rate for Payer: Preferred Network Access Commercial |
$6,715.08
|
| Rate for Payer: Quartz Beloit One Network |
$3,576.51
|
| Rate for Payer: Quartz Commercial |
$4,744.35
|
| Rate for Payer: Quartz Medicare Advantage |
$3,150.53
|
| Rate for Payer: The Alliance Commercial |
$12,602.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,150.53
|
| Rate for Payer: United Healthcare PPO |
$3,583.00
|
| Rate for Payer: WEA Trust Commercial |
$4,014.45
|
| Rate for Payer: Wellcare Medicare |
$3,150.53
|
| Rate for Payer: WPS Commercial |
$5,406.37
|
|
|
Thrombolytic Therapy Cessation
|
Facility
|
IP
|
$1,708.00
|
|
|
Service Code
|
CPT 37214
|
| Hospital Charge Code |
3052440
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$836.92 |
| Max. Negotiated Rate |
$1,571.36 |
| Rate for Payer: Aetna Commercial |
$1,537.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,468.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$905.24
|
| Rate for Payer: Cash Price |
$512.40
|
| Rate for Payer: Cigna Commercial |
$1,571.36
|
| Rate for Payer: Health EOS Commercial |
$1,520.12
|
| Rate for Payer: HFN Commercial |
$1,571.36
|
| Rate for Payer: Multiplan Commercial |
$1,366.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,024.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,571.36
|
| Rate for Payer: Quartz Beloit One Network |
$836.92
|
| Rate for Payer: Quartz Commercial |
$1,024.80
|
| Rate for Payer: WEA Trust Commercial |
$939.40
|
| Rate for Payer: WPS Commercial |
$1,265.12
|
|
|
Thrombolytic Therapy Cessation
|
Facility
|
OP
|
$1,708.00
|
|
|
Service Code
|
CPT 37214
|
| Hospital Charge Code |
3052440
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$836.92 |
| Max. Negotiated Rate |
$12,602.12 |
| Rate for Payer: Aetna Commercial |
$1,537.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,468.88
|
| Rate for Payer: Aetna Managed Medicare |
$3,150.53
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,496.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,871.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,726.00
|
| Rate for Payer: Anthem Medicare Advantage |
$3,150.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$905.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$3,150.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$3,150.53
|
| 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 |
$1,571.36
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$3,150.53
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$11,874.87
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$3,150.53
|
| Rate for Payer: Health EOS Commercial |
$1,520.12
|
| Rate for Payer: HFN Commercial |
$1,571.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$11,719.97
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$3,150.53
|
| Rate for Payer: Independent Care Health Plan Medicare |
$3,150.53
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$3,150.53
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$3,150.53
|
| Rate for Payer: Multiplan Commercial |
$1,366.40
|
| Rate for Payer: NAPHCARE Commercial |
$4,725.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,571.36
|
| Rate for Payer: Quartz Beloit One Network |
$836.92
|
| Rate for Payer: Quartz Commercial |
$1,110.20
|
| Rate for Payer: Quartz Medicare Advantage |
$3,150.53
|
| Rate for Payer: The Alliance Commercial |
$12,602.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,150.53
|
| Rate for Payer: United Healthcare PPO |
$3,583.00
|
| Rate for Payer: WEA Trust Commercial |
$939.40
|
| Rate for Payer: Wellcare Medicare |
$3,150.53
|
| Rate for Payer: WPS Commercial |
$1,265.12
|
|
|
Thrombolytic Therapy Venous Initial
|
Facility
|
OP
|
$6,812.00
|
|
|
Service Code
|
CPT 37212
|
| Hospital Charge Code |
3052438
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$3,150.53 |
| Max. Negotiated Rate |
$12,602.12 |
| Rate for Payer: Aetna Commercial |
$6,130.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,858.32
|
| Rate for Payer: Aetna Managed Medicare |
$3,150.53
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$9,907.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8,043.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7,639.00
|
| Rate for Payer: Anthem Medicare Advantage |
$3,150.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,610.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$3,150.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$3,150.53
|
| 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 |
$6,267.04
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$3,150.53
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$11,874.87
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$3,150.53
|
| Rate for Payer: Health EOS Commercial |
$6,062.68
|
| Rate for Payer: HFN Commercial |
$6,267.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$11,719.97
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$3,150.53
|
| Rate for Payer: Independent Care Health Plan Medicare |
$3,150.53
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$3,150.53
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$3,150.53
|
| Rate for Payer: Multiplan Commercial |
$5,449.60
|
| Rate for Payer: NAPHCARE Commercial |
$4,725.80
|
| Rate for Payer: Preferred Network Access Commercial |
$6,267.04
|
| Rate for Payer: Quartz Beloit One Network |
$3,337.88
|
| Rate for Payer: Quartz Commercial |
$4,427.80
|
| Rate for Payer: Quartz Medicare Advantage |
$3,150.53
|
| Rate for Payer: The Alliance Commercial |
$12,602.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,150.53
|
| Rate for Payer: United Healthcare PPO |
$4,103.00
|
| Rate for Payer: WEA Trust Commercial |
$3,746.60
|
| Rate for Payer: Wellcare Medicare |
$3,150.53
|
| Rate for Payer: WPS Commercial |
$5,045.65
|
|
|
Thrombolytic Therapy Venous Initial
|
Facility
|
IP
|
$6,812.00
|
|
|
Service Code
|
CPT 37212
|
| Hospital Charge Code |
3052438
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$3,337.88 |
| Max. Negotiated Rate |
$6,267.04 |
| Rate for Payer: Aetna Commercial |
$6,130.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,858.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,610.36
|
| Rate for Payer: Cash Price |
$2,043.60
|
| Rate for Payer: Cigna Commercial |
$6,267.04
|
| Rate for Payer: Health EOS Commercial |
$6,062.68
|
| Rate for Payer: HFN Commercial |
$6,267.04
|
| Rate for Payer: Multiplan Commercial |
$5,449.60
|
| Rate for Payer: NAPHCARE Commercial |
$4,087.20
|
| Rate for Payer: Preferred Network Access Commercial |
$6,267.04
|
| Rate for Payer: Quartz Beloit One Network |
$3,337.88
|
| Rate for Payer: Quartz Commercial |
$4,087.20
|
| Rate for Payer: WEA Trust Commercial |
$3,746.60
|
| Rate for Payer: WPS Commercial |
$5,045.65
|
|
|
Thrombosis Hypercoagulability Panel
|
Professional
|
Both
|
$323.00
|
|
|
Service Code
|
CPT 85730
|
| Hospital Charge Code |
5486694
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$21.22 |
| Max. Negotiated Rate |
$306.85 |
| Rate for Payer: Aetna Commercial |
$306.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$277.78
|
| Rate for Payer: Cash Price |
$96.90
|
| Rate for Payer: Cash Price |
$96.90
|
| Rate for Payer: Cigna Commercial |
$306.85
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$161.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$193.80
|
| Rate for Payer: Health EOS Commercial |
$293.93
|
| Rate for Payer: HFN Commercial |
$306.85
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$21.22
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$21.22
|
| Rate for Payer: Multiplan Commercial |
$258.40
|
| Rate for Payer: Preferred Network Access Commercial |
$306.85
|
| Rate for Payer: Quartz Beloit One Network |
$142.12
|
| Rate for Payer: Quartz Commercial |
$184.11
|
| Rate for Payer: The Alliance Commercial |
$161.50
|
| Rate for Payer: WEA Trust Commercial |
$177.65
|
| Rate for Payer: WPS Commercial |
$239.25
|
|
|
Thrombosis Hypercoagulability Panel
|
Facility
|
OP
|
$323.00
|
|
|
Service Code
|
CPT 85730
|
| Hospital Charge Code |
5486694
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.01 |
| Max. Negotiated Rate |
$297.16 |
| Rate for Payer: Aetna Commercial |
$290.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$277.78
|
| Rate for Payer: Aetna Managed Medicare |
$6.01
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$22.54
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$10.52
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$9.98
|
| Rate for Payer: Anthem Medicaid |
$6.21
|
| Rate for Payer: Anthem Medicare Advantage |
$6.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$171.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$6.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$6.01
|
| Rate for Payer: Cash Price |
$96.90
|
| Rate for Payer: Cash Price |
$96.90
|
| Rate for Payer: Cigna Commercial |
$297.16
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$6.01
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$6.21
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$180.75
|
| Rate for Payer: Dean Health Medicaid |
$6.21
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$6.01
|
| Rate for Payer: Health EOS Commercial |
$287.47
|
| Rate for Payer: HFN Commercial |
$297.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$22.36
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$6.01
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$6.21
|
| Rate for Payer: Independent Care Health Plan Medicare |
$6.01
|
| Rate for Payer: Managed Health Services Medicaid |
$6.46
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$6.01
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$6.01
|
| Rate for Payer: Multiplan Commercial |
$258.40
|
| Rate for Payer: NAPHCARE Commercial |
$9.02
|
| Rate for Payer: Preferred Network Access Commercial |
$297.16
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$6.21
|
| Rate for Payer: Quartz Beloit One Network |
$158.27
|
| Rate for Payer: Quartz Commercial |
$209.95
|
| Rate for Payer: Quartz Medicare Advantage |
$6.01
|
| Rate for Payer: The Alliance Commercial |
$24.04
|
| Rate for Payer: United Healthcare Medicaid |
$6.21
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6.01
|
| Rate for Payer: United Healthcare PPO |
$242.25
|
| Rate for Payer: WEA Trust Commercial |
$177.65
|
| Rate for Payer: Wellcare Medicare |
$6.01
|
| Rate for Payer: WMAP Medicaid |
$6.21
|
| Rate for Payer: WPS Commercial |
$239.25
|
|
|
Thrombosis Hypercoagulability Panel
|
Facility
|
IP
|
$323.00
|
|
|
Service Code
|
CPT 85730
|
| Hospital Charge Code |
5486694
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$158.27 |
| Max. Negotiated Rate |
$297.16 |
| Rate for Payer: Aetna Commercial |
$290.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$277.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$171.19
|
| Rate for Payer: Cash Price |
$96.90
|
| Rate for Payer: Cigna Commercial |
$297.16
|
| Rate for Payer: Health EOS Commercial |
$287.47
|
| Rate for Payer: HFN Commercial |
$297.16
|
| Rate for Payer: Multiplan Commercial |
$258.40
|
| Rate for Payer: NAPHCARE Commercial |
$193.80
|
| Rate for Payer: Preferred Network Access Commercial |
$297.16
|
| Rate for Payer: Quartz Beloit One Network |
$158.27
|
| Rate for Payer: Quartz Commercial |
$193.80
|
| Rate for Payer: WEA Trust Commercial |
$177.65
|
| Rate for Payer: WPS Commercial |
$239.25
|
|
|
Thrombospondin Type 1 7A Antibodies
|
Facility
|
OP
|
$350.00
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
5613547
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.05 |
| Max. Negotiated Rate |
$322.00 |
| Rate for Payer: Aetna Commercial |
$315.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$301.00
|
| Rate for Payer: Aetna Managed Medicare |
$12.05
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$45.19
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$21.09
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$20.00
|
| Rate for Payer: Anthem Medicaid |
$12.45
|
| Rate for Payer: Anthem Medicare Advantage |
$12.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$185.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$12.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$12.05
|
| Rate for Payer: Cash Price |
$105.00
|
| Rate for Payer: Cash Price |
$105.00
|
| Rate for Payer: Cigna Commercial |
$322.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$12.05
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$12.45
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$195.86
|
| Rate for Payer: Dean Health Medicaid |
$12.45
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$12.05
|
| Rate for Payer: Health EOS Commercial |
$311.50
|
| Rate for Payer: HFN Commercial |
$322.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$44.83
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$12.05
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$12.45
|
| Rate for Payer: Independent Care Health Plan Medicare |
$12.05
|
| Rate for Payer: Managed Health Services Medicaid |
$12.95
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$12.05
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$12.05
|
| Rate for Payer: Multiplan Commercial |
$280.00
|
| Rate for Payer: NAPHCARE Commercial |
$18.08
|
| Rate for Payer: Preferred Network Access Commercial |
$322.00
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$12.45
|
| Rate for Payer: Quartz Beloit One Network |
$171.50
|
| Rate for Payer: Quartz Commercial |
$227.50
|
| Rate for Payer: Quartz Medicare Advantage |
$12.05
|
| Rate for Payer: The Alliance Commercial |
$48.20
|
| Rate for Payer: United Healthcare Medicaid |
$12.45
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.05
|
| Rate for Payer: United Healthcare PPO |
$262.50
|
| Rate for Payer: WEA Trust Commercial |
$192.50
|
| Rate for Payer: Wellcare Medicare |
$12.05
|
| Rate for Payer: WMAP Medicaid |
$12.45
|
| Rate for Payer: WPS Commercial |
$259.24
|
|
|
Thrombospondin Type 1 7A Antibodies
|
Professional
|
Both
|
$350.00
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
5613547
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$16.61 |
| Max. Negotiated Rate |
$332.50 |
| Rate for Payer: Aetna Commercial |
$332.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$301.00
|
| Rate for Payer: Anthem Commercial |
$16.61
|
| Rate for Payer: Cash Price |
$105.00
|
| Rate for Payer: Cash Price |
$105.00
|
| Rate for Payer: Cigna Commercial |
$332.50
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$175.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$210.00
|
| Rate for Payer: Health EOS Commercial |
$318.50
|
| Rate for Payer: HFN Commercial |
$332.50
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$42.54
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$42.54
|
| Rate for Payer: Multiplan Commercial |
$280.00
|
| Rate for Payer: Preferred Network Access Commercial |
$332.50
|
| Rate for Payer: Quartz Beloit One Network |
$154.00
|
| Rate for Payer: Quartz Commercial |
$199.50
|
| Rate for Payer: The Alliance Commercial |
$175.00
|
| Rate for Payer: WEA Trust Commercial |
$192.50
|
| Rate for Payer: WPS Commercial |
$259.24
|
|
|
Thrombospondin Type 1 7A Antibodies
|
Facility
|
IP
|
$350.00
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
5613547
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$171.50 |
| Max. Negotiated Rate |
$322.00 |
| Rate for Payer: Aetna Commercial |
$315.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$301.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$185.50
|
| Rate for Payer: Cash Price |
$105.00
|
| Rate for Payer: Cigna Commercial |
$322.00
|
| Rate for Payer: Health EOS Commercial |
$311.50
|
| Rate for Payer: HFN Commercial |
$322.00
|
| Rate for Payer: Multiplan Commercial |
$280.00
|
| Rate for Payer: NAPHCARE Commercial |
$210.00
|
| Rate for Payer: Preferred Network Access Commercial |
$322.00
|
| Rate for Payer: Quartz Beloit One Network |
$171.50
|
| Rate for Payer: Quartz Commercial |
$210.00
|
| Rate for Payer: WEA Trust Commercial |
$192.50
|
| Rate for Payer: WPS Commercial |
$259.24
|
|
