|
THUMB REPAIR, GAMEKEEPER
|
Facility
|
OP
|
$1,242.00
|
|
| Hospital Charge Code |
2960082
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$347.76 |
| Max. Negotiated Rate |
$4,968.00 |
| Rate for Payer: Aetna Commercial |
$1,117.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,068.12
|
| Rate for Payer: Aetna Managed Medicare |
$347.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$807.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$621.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$596.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$658.26
|
| Rate for Payer: Cash Price |
$372.60
|
| Rate for Payer: Cigna Commercial |
$1,142.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$695.02
|
| Rate for Payer: Health EOS Commercial |
$1,105.38
|
| Rate for Payer: HFN Commercial |
$1,142.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$931.50
|
| Rate for Payer: Multiplan Commercial |
$993.60
|
| Rate for Payer: NAPHCARE Commercial |
$745.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,142.64
|
| Rate for Payer: Quartz Beloit One Network |
$608.58
|
| Rate for Payer: Quartz Commercial |
$807.30
|
| Rate for Payer: Quartz Medicare Advantage |
$745.20
|
| Rate for Payer: The Alliance Commercial |
$4,968.00
|
| Rate for Payer: WEA Trust Commercial |
$683.10
|
| Rate for Payer: WPS Commercial |
$919.95
|
|
|
THUMB REPAIR, GAMEKEEPER
|
Facility
|
IP
|
$1,242.00
|
|
| Hospital Charge Code |
2960082
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$608.58 |
| Max. Negotiated Rate |
$1,142.64 |
| Rate for Payer: Aetna Commercial |
$1,117.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,068.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$658.26
|
| Rate for Payer: Cash Price |
$372.60
|
| Rate for Payer: Cigna Commercial |
$1,142.64
|
| Rate for Payer: Health EOS Commercial |
$1,105.38
|
| Rate for Payer: HFN Commercial |
$1,142.64
|
| Rate for Payer: Multiplan Commercial |
$993.60
|
| Rate for Payer: NAPHCARE Commercial |
$745.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,142.64
|
| Rate for Payer: Quartz Beloit One Network |
$608.58
|
| Rate for Payer: Quartz Commercial |
$745.20
|
| Rate for Payer: WEA Trust Commercial |
$683.10
|
| Rate for Payer: WPS Commercial |
$919.95
|
|
|
THUMB SUPPORT LEFT TITAN #5547-66-01
|
Facility
|
OP
|
$468.00
|
|
| Hospital Charge Code |
2969693
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$131.04 |
| Max. Negotiated Rate |
$1,872.00 |
| Rate for Payer: Aetna Commercial |
$421.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$402.48
|
| Rate for Payer: Aetna Managed Medicare |
$131.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$304.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$234.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$224.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$248.04
|
| Rate for Payer: Cash Price |
$140.40
|
| Rate for Payer: Cigna Commercial |
$430.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$261.89
|
| Rate for Payer: Health EOS Commercial |
$416.52
|
| Rate for Payer: HFN Commercial |
$430.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$351.00
|
| Rate for Payer: Multiplan Commercial |
$374.40
|
| Rate for Payer: NAPHCARE Commercial |
$280.80
|
| Rate for Payer: Preferred Network Access Commercial |
$430.56
|
| Rate for Payer: Quartz Beloit One Network |
$229.32
|
| Rate for Payer: Quartz Commercial |
$304.20
|
| Rate for Payer: Quartz Medicare Advantage |
$280.80
|
| Rate for Payer: The Alliance Commercial |
$1,872.00
|
| Rate for Payer: WEA Trust Commercial |
$257.40
|
| Rate for Payer: WPS Commercial |
$346.65
|
|
|
THUMB SUPPORT LEFT TITAN #5547-66-01
|
Facility
|
IP
|
$468.00
|
|
| Hospital Charge Code |
2969693
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$229.32 |
| Max. Negotiated Rate |
$430.56 |
| Rate for Payer: Aetna Commercial |
$421.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$402.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$248.04
|
| Rate for Payer: Cash Price |
$140.40
|
| Rate for Payer: Cigna Commercial |
$430.56
|
| Rate for Payer: Health EOS Commercial |
$416.52
|
| Rate for Payer: HFN Commercial |
$430.56
|
| Rate for Payer: Multiplan Commercial |
$374.40
|
| Rate for Payer: NAPHCARE Commercial |
$280.80
|
| Rate for Payer: Preferred Network Access Commercial |
$430.56
|
| Rate for Payer: Quartz Beloit One Network |
$229.32
|
| Rate for Payer: Quartz Commercial |
$280.80
|
| Rate for Payer: WEA Trust Commercial |
$257.40
|
| Rate for Payer: WPS Commercial |
$346.65
|
|
|
THUMB SUPPORT TITAN (RIGHT) #5547-66-02
|
Facility
|
OP
|
$468.00
|
|
| Hospital Charge Code |
2969692
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$131.04 |
| Max. Negotiated Rate |
$1,872.00 |
| Rate for Payer: Aetna Commercial |
$421.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$402.48
|
| Rate for Payer: Aetna Managed Medicare |
$131.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$304.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$234.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$224.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$248.04
|
| Rate for Payer: Cash Price |
$140.40
|
| Rate for Payer: Cigna Commercial |
$430.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$261.89
|
| Rate for Payer: Health EOS Commercial |
$416.52
|
| Rate for Payer: HFN Commercial |
$430.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$351.00
|
| Rate for Payer: Multiplan Commercial |
$374.40
|
| Rate for Payer: NAPHCARE Commercial |
$280.80
|
| Rate for Payer: Preferred Network Access Commercial |
$430.56
|
| Rate for Payer: Quartz Beloit One Network |
$229.32
|
| Rate for Payer: Quartz Commercial |
$304.20
|
| Rate for Payer: Quartz Medicare Advantage |
$280.80
|
| Rate for Payer: The Alliance Commercial |
$1,872.00
|
| Rate for Payer: WEA Trust Commercial |
$257.40
|
| Rate for Payer: WPS Commercial |
$346.65
|
|
|
THUMB SUPPORT TITAN (RIGHT) #5547-66-02
|
Facility
|
IP
|
$468.00
|
|
| Hospital Charge Code |
2969692
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$229.32 |
| Max. Negotiated Rate |
$430.56 |
| Rate for Payer: Aetna Commercial |
$421.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$402.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$248.04
|
| Rate for Payer: Cash Price |
$140.40
|
| Rate for Payer: Cigna Commercial |
$430.56
|
| Rate for Payer: Health EOS Commercial |
$416.52
|
| Rate for Payer: HFN Commercial |
$430.56
|
| Rate for Payer: Multiplan Commercial |
$374.40
|
| Rate for Payer: NAPHCARE Commercial |
$280.80
|
| Rate for Payer: Preferred Network Access Commercial |
$430.56
|
| Rate for Payer: Quartz Beloit One Network |
$229.32
|
| Rate for Payer: Quartz Commercial |
$280.80
|
| Rate for Payer: WEA Trust Commercial |
$257.40
|
| Rate for Payer: WPS Commercial |
$346.65
|
|
|
Thyroglobulin
|
Facility
|
OP
|
$347.00
|
|
|
Service Code
|
CPT 84432
|
| Hospital Charge Code |
2943016
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$16.06 |
| Max. Negotiated Rate |
$319.24 |
| Rate for Payer: Aetna Commercial |
$312.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$298.42
|
| Rate for Payer: Aetna Managed Medicare |
$16.06
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$60.22
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$28.10
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$26.66
|
| Rate for Payer: Anthem Medicaid |
$16.59
|
| Rate for Payer: Anthem Medicare Advantage |
$16.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$183.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$16.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$16.06
|
| Rate for Payer: Cash Price |
$104.10
|
| Rate for Payer: Cash Price |
$104.10
|
| Rate for Payer: Cigna Commercial |
$319.24
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$16.06
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$16.59
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$194.18
|
| Rate for Payer: Dean Health Medicaid |
$16.59
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$16.06
|
| Rate for Payer: Health EOS Commercial |
$308.83
|
| Rate for Payer: HFN Commercial |
$319.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$59.74
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$16.06
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$16.59
|
| Rate for Payer: Independent Care Health Plan Medicare |
$16.06
|
| Rate for Payer: Managed Health Services Medicaid |
$17.25
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$16.06
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$16.06
|
| Rate for Payer: Multiplan Commercial |
$277.60
|
| Rate for Payer: NAPHCARE Commercial |
$24.09
|
| Rate for Payer: Preferred Network Access Commercial |
$319.24
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$16.59
|
| Rate for Payer: Quartz Beloit One Network |
$170.03
|
| Rate for Payer: Quartz Commercial |
$225.55
|
| Rate for Payer: Quartz Medicare Advantage |
$16.06
|
| Rate for Payer: The Alliance Commercial |
$64.24
|
| Rate for Payer: United Healthcare Medicaid |
$16.59
|
| Rate for Payer: United Healthcare Medicare Advantage |
$16.06
|
| Rate for Payer: United Healthcare PPO |
$260.25
|
| Rate for Payer: WEA Trust Commercial |
$190.85
|
| Rate for Payer: Wellcare Medicare |
$16.06
|
| Rate for Payer: WMAP Medicaid |
$16.59
|
| Rate for Payer: WPS Commercial |
$257.02
|
|
|
Thyroglobulin
|
Facility
|
IP
|
$347.00
|
|
|
Service Code
|
CPT 84432
|
| Hospital Charge Code |
2943016
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$170.03 |
| Max. Negotiated Rate |
$319.24 |
| Rate for Payer: Aetna Commercial |
$312.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$298.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$183.91
|
| Rate for Payer: Cash Price |
$104.10
|
| Rate for Payer: Cigna Commercial |
$319.24
|
| Rate for Payer: Health EOS Commercial |
$308.83
|
| Rate for Payer: HFN Commercial |
$319.24
|
| Rate for Payer: Multiplan Commercial |
$277.60
|
| Rate for Payer: NAPHCARE Commercial |
$208.20
|
| Rate for Payer: Preferred Network Access Commercial |
$319.24
|
| Rate for Payer: Quartz Beloit One Network |
$170.03
|
| Rate for Payer: Quartz Commercial |
$208.20
|
| Rate for Payer: WEA Trust Commercial |
$190.85
|
| Rate for Payer: WPS Commercial |
$257.02
|
|
|
Thyroglobulin
|
Professional
|
Both
|
$347.00
|
|
|
Service Code
|
CPT 84432
|
| Hospital Charge Code |
2943016
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$56.69 |
| Max. Negotiated Rate |
$329.65 |
| Rate for Payer: Aetna Commercial |
$329.65
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$298.42
|
| Rate for Payer: Cash Price |
$104.10
|
| Rate for Payer: Cash Price |
$104.10
|
| Rate for Payer: Cigna Commercial |
$329.65
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$173.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$208.20
|
| Rate for Payer: Health EOS Commercial |
$315.77
|
| Rate for Payer: HFN Commercial |
$329.65
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$56.69
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$56.69
|
| Rate for Payer: Multiplan Commercial |
$277.60
|
| Rate for Payer: Preferred Network Access Commercial |
$329.65
|
| Rate for Payer: Quartz Beloit One Network |
$152.68
|
| Rate for Payer: Quartz Commercial |
$197.79
|
| Rate for Payer: The Alliance Commercial |
$173.50
|
| Rate for Payer: WEA Trust Commercial |
$190.85
|
| Rate for Payer: WPS Commercial |
$257.02
|
|
|
Thyroglobulin Antibody
|
Facility
|
IP
|
$362.00
|
|
|
Service Code
|
CPT 86800
|
| Hospital Charge Code |
633841
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$177.38 |
| Max. Negotiated Rate |
$333.04 |
| Rate for Payer: Aetna Commercial |
$325.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$311.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$191.86
|
| Rate for Payer: Cash Price |
$108.60
|
| Rate for Payer: Cigna Commercial |
$333.04
|
| Rate for Payer: Health EOS Commercial |
$322.18
|
| Rate for Payer: HFN Commercial |
$333.04
|
| Rate for Payer: Multiplan Commercial |
$289.60
|
| Rate for Payer: NAPHCARE Commercial |
$217.20
|
| Rate for Payer: Preferred Network Access Commercial |
$333.04
|
| Rate for Payer: Quartz Beloit One Network |
$177.38
|
| Rate for Payer: Quartz Commercial |
$217.20
|
| Rate for Payer: WEA Trust Commercial |
$199.10
|
| Rate for Payer: WPS Commercial |
$268.13
|
|
|
Thyroglobulin Antibody
|
Facility
|
OP
|
$48.00
|
|
|
Service Code
|
CPT 86800
|
| Hospital Charge Code |
3899561
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.91 |
| Max. Negotiated Rate |
$63.64 |
| Rate for Payer: Aetna Commercial |
$43.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$41.28
|
| Rate for Payer: Aetna Managed Medicare |
$15.91
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$59.66
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$27.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$26.41
|
| Rate for Payer: Anthem Medicaid |
$16.44
|
| Rate for Payer: Anthem Medicare Advantage |
$15.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$25.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$15.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$15.91
|
| Rate for Payer: Cash Price |
$14.40
|
| Rate for Payer: Cash Price |
$14.40
|
| Rate for Payer: Cigna Commercial |
$44.16
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$15.91
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$16.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$26.86
|
| Rate for Payer: Dean Health Medicaid |
$16.44
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$15.91
|
| Rate for Payer: Health EOS Commercial |
$42.72
|
| Rate for Payer: HFN Commercial |
$44.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$59.19
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$15.91
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$16.44
|
| Rate for Payer: Independent Care Health Plan Medicare |
$15.91
|
| Rate for Payer: Managed Health Services Medicaid |
$17.10
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$15.91
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$15.91
|
| Rate for Payer: Multiplan Commercial |
$38.40
|
| Rate for Payer: NAPHCARE Commercial |
$23.86
|
| Rate for Payer: Preferred Network Access Commercial |
$44.16
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$16.44
|
| Rate for Payer: Quartz Beloit One Network |
$23.52
|
| Rate for Payer: Quartz Commercial |
$31.20
|
| Rate for Payer: Quartz Medicare Advantage |
$15.91
|
| Rate for Payer: The Alliance Commercial |
$63.64
|
| Rate for Payer: United Healthcare Medicaid |
$16.44
|
| Rate for Payer: United Healthcare Medicare Advantage |
$15.91
|
| Rate for Payer: United Healthcare PPO |
$36.00
|
| Rate for Payer: WEA Trust Commercial |
$26.40
|
| Rate for Payer: Wellcare Medicare |
$15.91
|
| Rate for Payer: WMAP Medicaid |
$16.44
|
| Rate for Payer: WPS Commercial |
$35.55
|
|
|
Thyroglobulin Antibody
|
Facility
|
OP
|
$362.00
|
|
|
Service Code
|
CPT 86800
|
| Hospital Charge Code |
633841
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.91 |
| Max. Negotiated Rate |
$333.04 |
| Rate for Payer: Aetna Commercial |
$325.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$311.32
|
| Rate for Payer: Aetna Managed Medicare |
$15.91
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$59.66
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$27.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$26.41
|
| Rate for Payer: Anthem Medicaid |
$16.44
|
| Rate for Payer: Anthem Medicare Advantage |
$15.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$191.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$15.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$15.91
|
| Rate for Payer: Cash Price |
$108.60
|
| Rate for Payer: Cash Price |
$108.60
|
| Rate for Payer: Cigna Commercial |
$333.04
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$15.91
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$16.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$202.58
|
| Rate for Payer: Dean Health Medicaid |
$16.44
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$15.91
|
| Rate for Payer: Health EOS Commercial |
$322.18
|
| Rate for Payer: HFN Commercial |
$333.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$59.19
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$15.91
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$16.44
|
| Rate for Payer: Independent Care Health Plan Medicare |
$15.91
|
| Rate for Payer: Managed Health Services Medicaid |
$17.10
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$15.91
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$15.91
|
| Rate for Payer: Multiplan Commercial |
$289.60
|
| Rate for Payer: NAPHCARE Commercial |
$23.86
|
| Rate for Payer: Preferred Network Access Commercial |
$333.04
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$16.44
|
| Rate for Payer: Quartz Beloit One Network |
$177.38
|
| Rate for Payer: Quartz Commercial |
$235.30
|
| Rate for Payer: Quartz Medicare Advantage |
$15.91
|
| Rate for Payer: The Alliance Commercial |
$63.64
|
| Rate for Payer: United Healthcare Medicaid |
$16.44
|
| Rate for Payer: United Healthcare Medicare Advantage |
$15.91
|
| Rate for Payer: United Healthcare PPO |
$271.50
|
| Rate for Payer: WEA Trust Commercial |
$199.10
|
| Rate for Payer: Wellcare Medicare |
$15.91
|
| Rate for Payer: WMAP Medicaid |
$16.44
|
| Rate for Payer: WPS Commercial |
$268.13
|
|
|
Thyroglobulin Antibody
|
Professional
|
Both
|
$362.00
|
|
|
Service Code
|
CPT 86800
|
| Hospital Charge Code |
633841
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$56.16 |
| Max. Negotiated Rate |
$343.90 |
| Rate for Payer: Aetna Commercial |
$343.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$311.32
|
| Rate for Payer: Cash Price |
$108.60
|
| Rate for Payer: Cash Price |
$108.60
|
| Rate for Payer: Cigna Commercial |
$343.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$181.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$217.20
|
| Rate for Payer: Health EOS Commercial |
$329.42
|
| Rate for Payer: HFN Commercial |
$343.90
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$56.16
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$56.16
|
| Rate for Payer: Multiplan Commercial |
$289.60
|
| Rate for Payer: Preferred Network Access Commercial |
$343.90
|
| Rate for Payer: Quartz Beloit One Network |
$159.28
|
| Rate for Payer: Quartz Commercial |
$206.34
|
| Rate for Payer: The Alliance Commercial |
$181.00
|
| Rate for Payer: WEA Trust Commercial |
$199.10
|
| Rate for Payer: WPS Commercial |
$268.13
|
|
|
Thyroglobulin Antibody
|
Facility
|
IP
|
$48.00
|
|
|
Service Code
|
CPT 86800
|
| Hospital Charge Code |
3899561
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$23.52 |
| Max. Negotiated Rate |
$44.16 |
| Rate for Payer: Aetna Commercial |
$43.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$41.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$25.44
|
| Rate for Payer: Cash Price |
$14.40
|
| Rate for Payer: Cigna Commercial |
$44.16
|
| Rate for Payer: Health EOS Commercial |
$42.72
|
| Rate for Payer: HFN Commercial |
$44.16
|
| Rate for Payer: Multiplan Commercial |
$38.40
|
| Rate for Payer: NAPHCARE Commercial |
$28.80
|
| Rate for Payer: Preferred Network Access Commercial |
$44.16
|
| Rate for Payer: Quartz Beloit One Network |
$23.52
|
| Rate for Payer: Quartz Commercial |
$28.80
|
| Rate for Payer: WEA Trust Commercial |
$26.40
|
| Rate for Payer: WPS Commercial |
$35.55
|
|
|
Thyroglobulin Antibody
|
Professional
|
Both
|
$48.00
|
|
|
Service Code
|
CPT 86800
|
| Hospital Charge Code |
3899561
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$21.12 |
| Max. Negotiated Rate |
$56.16 |
| Rate for Payer: Aetna Commercial |
$45.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$41.28
|
| Rate for Payer: Cash Price |
$14.40
|
| Rate for Payer: Cash Price |
$14.40
|
| Rate for Payer: Cigna Commercial |
$45.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$24.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$28.80
|
| Rate for Payer: Health EOS Commercial |
$43.68
|
| Rate for Payer: HFN Commercial |
$45.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$56.16
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$56.16
|
| Rate for Payer: Multiplan Commercial |
$38.40
|
| Rate for Payer: Preferred Network Access Commercial |
$45.60
|
| Rate for Payer: Quartz Beloit One Network |
$21.12
|
| Rate for Payer: Quartz Commercial |
$27.36
|
| Rate for Payer: The Alliance Commercial |
$24.00
|
| Rate for Payer: WEA Trust Commercial |
$26.40
|
| Rate for Payer: WPS Commercial |
$35.55
|
|
|
Thyroglobulin Antibody Screen
|
Facility
|
IP
|
$217.00
|
|
|
Service Code
|
CPT 86800
|
| Hospital Charge Code |
3764168
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$106.33 |
| Max. Negotiated Rate |
$199.64 |
| Rate for Payer: Aetna Commercial |
$195.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$186.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$115.01
|
| Rate for Payer: Cash Price |
$65.10
|
| Rate for Payer: Cigna Commercial |
$199.64
|
| Rate for Payer: Health EOS Commercial |
$193.13
|
| Rate for Payer: HFN Commercial |
$199.64
|
| Rate for Payer: Multiplan Commercial |
$173.60
|
| Rate for Payer: NAPHCARE Commercial |
$130.20
|
| Rate for Payer: Preferred Network Access Commercial |
$199.64
|
| Rate for Payer: Quartz Beloit One Network |
$106.33
|
| Rate for Payer: Quartz Commercial |
$130.20
|
| Rate for Payer: WEA Trust Commercial |
$119.35
|
| Rate for Payer: WPS Commercial |
$160.73
|
|
|
Thyroglobulin Antibody Screen
|
Professional
|
Both
|
$217.00
|
|
|
Service Code
|
CPT 86800
|
| Hospital Charge Code |
3764168
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$56.16 |
| Max. Negotiated Rate |
$206.15 |
| Rate for Payer: Aetna Commercial |
$206.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$186.62
|
| Rate for Payer: Cash Price |
$65.10
|
| Rate for Payer: Cash Price |
$65.10
|
| Rate for Payer: Cigna Commercial |
$206.15
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$108.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$130.20
|
| Rate for Payer: Health EOS Commercial |
$197.47
|
| Rate for Payer: HFN Commercial |
$206.15
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$56.16
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$56.16
|
| Rate for Payer: Multiplan Commercial |
$173.60
|
| Rate for Payer: Preferred Network Access Commercial |
$206.15
|
| Rate for Payer: Quartz Beloit One Network |
$95.48
|
| Rate for Payer: Quartz Commercial |
$123.69
|
| Rate for Payer: The Alliance Commercial |
$108.50
|
| Rate for Payer: WEA Trust Commercial |
$119.35
|
| Rate for Payer: WPS Commercial |
$160.73
|
|
|
Thyroglobulin Antibody Screen
|
Facility
|
OP
|
$217.00
|
|
|
Service Code
|
CPT 86800
|
| Hospital Charge Code |
3764168
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.91 |
| Max. Negotiated Rate |
$199.64 |
| Rate for Payer: Aetna Commercial |
$195.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$186.62
|
| Rate for Payer: Aetna Managed Medicare |
$15.91
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$59.66
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$27.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$26.41
|
| Rate for Payer: Anthem Medicaid |
$16.44
|
| Rate for Payer: Anthem Medicare Advantage |
$15.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$115.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$15.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$15.91
|
| Rate for Payer: Cash Price |
$65.10
|
| Rate for Payer: Cash Price |
$65.10
|
| Rate for Payer: Cigna Commercial |
$199.64
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$15.91
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$16.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$121.43
|
| Rate for Payer: Dean Health Medicaid |
$16.44
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$15.91
|
| Rate for Payer: Health EOS Commercial |
$193.13
|
| Rate for Payer: HFN Commercial |
$199.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$59.19
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$15.91
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$16.44
|
| Rate for Payer: Independent Care Health Plan Medicare |
$15.91
|
| Rate for Payer: Managed Health Services Medicaid |
$17.10
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$15.91
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$15.91
|
| Rate for Payer: Multiplan Commercial |
$173.60
|
| Rate for Payer: NAPHCARE Commercial |
$23.86
|
| Rate for Payer: Preferred Network Access Commercial |
$199.64
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$16.44
|
| Rate for Payer: Quartz Beloit One Network |
$106.33
|
| Rate for Payer: Quartz Commercial |
$141.05
|
| Rate for Payer: Quartz Medicare Advantage |
$15.91
|
| Rate for Payer: The Alliance Commercial |
$63.64
|
| Rate for Payer: United Healthcare Medicaid |
$16.44
|
| Rate for Payer: United Healthcare Medicare Advantage |
$15.91
|
| Rate for Payer: United Healthcare PPO |
$162.75
|
| Rate for Payer: WEA Trust Commercial |
$119.35
|
| Rate for Payer: Wellcare Medicare |
$15.91
|
| Rate for Payer: WMAP Medicaid |
$16.44
|
| Rate for Payer: WPS Commercial |
$160.73
|
|
|
Thyroglobulin, LC/MS/MS
|
Facility
|
OP
|
$290.00
|
|
|
Service Code
|
CPT 84432
|
| Hospital Charge Code |
5162612
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$16.06 |
| Max. Negotiated Rate |
$266.80 |
| Rate for Payer: Aetna Commercial |
$261.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$249.40
|
| Rate for Payer: Aetna Managed Medicare |
$16.06
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$60.22
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$28.10
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$26.66
|
| Rate for Payer: Anthem Medicaid |
$16.59
|
| Rate for Payer: Anthem Medicare Advantage |
$16.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$153.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$16.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$16.06
|
| Rate for Payer: Cash Price |
$87.00
|
| Rate for Payer: Cash Price |
$87.00
|
| Rate for Payer: Cigna Commercial |
$266.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$16.06
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$16.59
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$162.28
|
| Rate for Payer: Dean Health Medicaid |
$16.59
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$16.06
|
| Rate for Payer: Health EOS Commercial |
$258.10
|
| Rate for Payer: HFN Commercial |
$266.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$59.74
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$16.06
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$16.59
|
| Rate for Payer: Independent Care Health Plan Medicare |
$16.06
|
| Rate for Payer: Managed Health Services Medicaid |
$17.25
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$16.06
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$16.06
|
| Rate for Payer: Multiplan Commercial |
$232.00
|
| Rate for Payer: NAPHCARE Commercial |
$24.09
|
| Rate for Payer: Preferred Network Access Commercial |
$266.80
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$16.59
|
| Rate for Payer: Quartz Beloit One Network |
$142.10
|
| Rate for Payer: Quartz Commercial |
$188.50
|
| Rate for Payer: Quartz Medicare Advantage |
$16.06
|
| Rate for Payer: The Alliance Commercial |
$64.24
|
| Rate for Payer: United Healthcare Medicaid |
$16.59
|
| Rate for Payer: United Healthcare Medicare Advantage |
$16.06
|
| Rate for Payer: United Healthcare PPO |
$217.50
|
| Rate for Payer: WEA Trust Commercial |
$159.50
|
| Rate for Payer: Wellcare Medicare |
$16.06
|
| Rate for Payer: WMAP Medicaid |
$16.59
|
| Rate for Payer: WPS Commercial |
$214.80
|
|
|
Thyroglobulin, LC/MS/MS
|
Facility
|
IP
|
$290.00
|
|
|
Service Code
|
CPT 84432
|
| Hospital Charge Code |
5162612
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$142.10 |
| Max. Negotiated Rate |
$266.80 |
| Rate for Payer: Aetna Commercial |
$261.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$249.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$153.70
|
| Rate for Payer: Cash Price |
$87.00
|
| Rate for Payer: Cigna Commercial |
$266.80
|
| Rate for Payer: Health EOS Commercial |
$258.10
|
| Rate for Payer: HFN Commercial |
$266.80
|
| Rate for Payer: Multiplan Commercial |
$232.00
|
| Rate for Payer: NAPHCARE Commercial |
$174.00
|
| Rate for Payer: Preferred Network Access Commercial |
$266.80
|
| Rate for Payer: Quartz Beloit One Network |
$142.10
|
| Rate for Payer: Quartz Commercial |
$174.00
|
| Rate for Payer: WEA Trust Commercial |
$159.50
|
| Rate for Payer: WPS Commercial |
$214.80
|
|
|
Thyroglobulin, LC/MS/MS
|
Professional
|
Both
|
$290.00
|
|
|
Service Code
|
CPT 84432
|
| Hospital Charge Code |
5162612
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$56.69 |
| Max. Negotiated Rate |
$275.50 |
| Rate for Payer: Aetna Commercial |
$275.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$249.40
|
| Rate for Payer: Cash Price |
$87.00
|
| Rate for Payer: Cash Price |
$87.00
|
| Rate for Payer: Cigna Commercial |
$275.50
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$145.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$174.00
|
| Rate for Payer: Health EOS Commercial |
$263.90
|
| Rate for Payer: HFN Commercial |
$275.50
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$56.69
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$56.69
|
| Rate for Payer: Multiplan Commercial |
$232.00
|
| Rate for Payer: Preferred Network Access Commercial |
$275.50
|
| Rate for Payer: Quartz Beloit One Network |
$127.60
|
| Rate for Payer: Quartz Commercial |
$165.30
|
| Rate for Payer: The Alliance Commercial |
$145.00
|
| Rate for Payer: WEA Trust Commercial |
$159.50
|
| Rate for Payer: WPS Commercial |
$214.80
|
|
|
Thyroglobulin Panel
|
Facility
|
OP
|
$362.00
|
|
|
Service Code
|
CPT 86800
|
| Hospital Charge Code |
983423
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.91 |
| Max. Negotiated Rate |
$333.04 |
| Rate for Payer: Aetna Commercial |
$325.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$311.32
|
| Rate for Payer: Aetna Managed Medicare |
$15.91
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$59.66
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$27.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$26.41
|
| Rate for Payer: Anthem Medicaid |
$16.44
|
| Rate for Payer: Anthem Medicare Advantage |
$15.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$191.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$15.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$15.91
|
| Rate for Payer: Cash Price |
$108.60
|
| Rate for Payer: Cash Price |
$108.60
|
| Rate for Payer: Cigna Commercial |
$333.04
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$15.91
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$16.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$202.58
|
| Rate for Payer: Dean Health Medicaid |
$16.44
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$15.91
|
| Rate for Payer: Health EOS Commercial |
$322.18
|
| Rate for Payer: HFN Commercial |
$333.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$59.19
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$15.91
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$16.44
|
| Rate for Payer: Independent Care Health Plan Medicare |
$15.91
|
| Rate for Payer: Managed Health Services Medicaid |
$17.10
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$15.91
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$15.91
|
| Rate for Payer: Multiplan Commercial |
$289.60
|
| Rate for Payer: NAPHCARE Commercial |
$23.86
|
| Rate for Payer: Preferred Network Access Commercial |
$333.04
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$16.44
|
| Rate for Payer: Quartz Beloit One Network |
$177.38
|
| Rate for Payer: Quartz Commercial |
$235.30
|
| Rate for Payer: Quartz Medicare Advantage |
$15.91
|
| Rate for Payer: The Alliance Commercial |
$63.64
|
| Rate for Payer: United Healthcare Medicaid |
$16.44
|
| Rate for Payer: United Healthcare Medicare Advantage |
$15.91
|
| Rate for Payer: United Healthcare PPO |
$271.50
|
| Rate for Payer: WEA Trust Commercial |
$199.10
|
| Rate for Payer: Wellcare Medicare |
$15.91
|
| Rate for Payer: WMAP Medicaid |
$16.44
|
| Rate for Payer: WPS Commercial |
$268.13
|
|
|
Thyroglobulin Panel
|
Professional
|
Both
|
$362.00
|
|
|
Service Code
|
CPT 86800
|
| Hospital Charge Code |
983423
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$56.16 |
| Max. Negotiated Rate |
$343.90 |
| Rate for Payer: Aetna Commercial |
$343.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$311.32
|
| Rate for Payer: Cash Price |
$108.60
|
| Rate for Payer: Cash Price |
$108.60
|
| Rate for Payer: Cigna Commercial |
$343.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$181.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$217.20
|
| Rate for Payer: Health EOS Commercial |
$329.42
|
| Rate for Payer: HFN Commercial |
$343.90
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$56.16
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$56.16
|
| Rate for Payer: Multiplan Commercial |
$289.60
|
| Rate for Payer: Preferred Network Access Commercial |
$343.90
|
| Rate for Payer: Quartz Beloit One Network |
$159.28
|
| Rate for Payer: Quartz Commercial |
$206.34
|
| Rate for Payer: The Alliance Commercial |
$181.00
|
| Rate for Payer: WEA Trust Commercial |
$199.10
|
| Rate for Payer: WPS Commercial |
$268.13
|
|
|
Thyroglobulin Panel
|
Facility
|
IP
|
$362.00
|
|
|
Service Code
|
CPT 86800
|
| Hospital Charge Code |
983423
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$177.38 |
| Max. Negotiated Rate |
$333.04 |
| Rate for Payer: Aetna Commercial |
$325.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$311.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$191.86
|
| Rate for Payer: Cash Price |
$108.60
|
| Rate for Payer: Cigna Commercial |
$333.04
|
| Rate for Payer: Health EOS Commercial |
$322.18
|
| Rate for Payer: HFN Commercial |
$333.04
|
| Rate for Payer: Multiplan Commercial |
$289.60
|
| Rate for Payer: NAPHCARE Commercial |
$217.20
|
| Rate for Payer: Preferred Network Access Commercial |
$333.04
|
| Rate for Payer: Quartz Beloit One Network |
$177.38
|
| Rate for Payer: Quartz Commercial |
$217.20
|
| Rate for Payer: WEA Trust Commercial |
$199.10
|
| Rate for Payer: WPS Commercial |
$268.13
|
|
|
Thyroglobulin Quantitative
|
Professional
|
Both
|
$25.00
|
|
|
Service Code
|
CPT 84432
|
| Hospital Charge Code |
3959986
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.00 |
| Max. Negotiated Rate |
$56.69 |
| Rate for Payer: Aetna Commercial |
$23.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$21.50
|
| Rate for Payer: Cash Price |
$7.50
|
| Rate for Payer: Cash Price |
$7.50
|
| Rate for Payer: Cigna Commercial |
$23.75
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$12.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$15.00
|
| Rate for Payer: Health EOS Commercial |
$22.75
|
| Rate for Payer: HFN Commercial |
$23.75
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$56.69
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$56.69
|
| Rate for Payer: Multiplan Commercial |
$20.00
|
| Rate for Payer: Preferred Network Access Commercial |
$23.75
|
| Rate for Payer: Quartz Beloit One Network |
$11.00
|
| Rate for Payer: Quartz Commercial |
$14.25
|
| Rate for Payer: The Alliance Commercial |
$12.50
|
| Rate for Payer: WEA Trust Commercial |
$13.75
|
| Rate for Payer: WPS Commercial |
$18.52
|
|
