|
Thyroglobulin Quantitative
|
Facility
|
OP
|
$25.00
|
|
|
Service Code
|
CPT 84432
|
| Hospital Charge Code |
3959986
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.25 |
| Max. Negotiated Rate |
$64.24 |
| Rate for Payer: Aetna Commercial |
$22.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$21.50
|
| 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 |
$13.25
|
| 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 |
$7.50
|
| Rate for Payer: Cash Price |
$7.50
|
| Rate for Payer: Cigna Commercial |
$23.00
|
| 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 |
$13.99
|
| 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 |
$22.25
|
| Rate for Payer: HFN Commercial |
$23.00
|
| 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 |
$20.00
|
| Rate for Payer: NAPHCARE Commercial |
$24.09
|
| Rate for Payer: Preferred Network Access Commercial |
$23.00
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$16.59
|
| Rate for Payer: Quartz Beloit One Network |
$12.25
|
| Rate for Payer: Quartz Commercial |
$16.25
|
| 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 |
$18.75
|
| Rate for Payer: WEA Trust Commercial |
$13.75
|
| Rate for Payer: Wellcare Medicare |
$16.06
|
| Rate for Payer: WMAP Medicaid |
$16.59
|
| Rate for Payer: WPS Commercial |
$18.52
|
|
|
Thyroglobulin Quantitative
|
Facility
|
IP
|
$25.00
|
|
|
Service Code
|
CPT 84432
|
| Hospital Charge Code |
3959986
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.25 |
| Max. Negotiated Rate |
$23.00 |
| Rate for Payer: Aetna Commercial |
$22.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$21.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$13.25
|
| Rate for Payer: Cash Price |
$7.50
|
| Rate for Payer: Cigna Commercial |
$23.00
|
| Rate for Payer: Health EOS Commercial |
$22.25
|
| Rate for Payer: HFN Commercial |
$23.00
|
| Rate for Payer: Multiplan Commercial |
$20.00
|
| Rate for Payer: NAPHCARE Commercial |
$15.00
|
| Rate for Payer: Preferred Network Access Commercial |
$23.00
|
| Rate for Payer: Quartz Beloit One Network |
$12.25
|
| Rate for Payer: Quartz Commercial |
$15.00
|
| Rate for Payer: WEA Trust Commercial |
$13.75
|
| Rate for Payer: WPS Commercial |
$18.52
|
|
|
Thyroglobulin, Tumor Marker, Serum to Mayo
|
Facility
|
OP
|
$320.00
|
|
|
Service Code
|
CPT 84432
|
| Hospital Charge Code |
3756168
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$16.06 |
| Max. Negotiated Rate |
$294.40 |
| Rate for Payer: Aetna Commercial |
$288.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$275.20
|
| 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 |
$169.60
|
| 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 |
$96.00
|
| Rate for Payer: Cash Price |
$96.00
|
| Rate for Payer: Cigna Commercial |
$294.40
|
| 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 |
$179.07
|
| 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 |
$284.80
|
| Rate for Payer: HFN Commercial |
$294.40
|
| 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 |
$256.00
|
| Rate for Payer: NAPHCARE Commercial |
$24.09
|
| Rate for Payer: Preferred Network Access Commercial |
$294.40
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$16.59
|
| Rate for Payer: Quartz Beloit One Network |
$156.80
|
| Rate for Payer: Quartz Commercial |
$208.00
|
| 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 |
$240.00
|
| Rate for Payer: WEA Trust Commercial |
$176.00
|
| Rate for Payer: Wellcare Medicare |
$16.06
|
| Rate for Payer: WMAP Medicaid |
$16.59
|
| Rate for Payer: WPS Commercial |
$237.02
|
|
|
Thyroglobulin, Tumor Marker, Serum to Mayo
|
Facility
|
IP
|
$320.00
|
|
|
Service Code
|
CPT 84432
|
| Hospital Charge Code |
3756168
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$156.80 |
| Max. Negotiated Rate |
$294.40 |
| Rate for Payer: Aetna Commercial |
$288.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$275.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$169.60
|
| Rate for Payer: Cash Price |
$96.00
|
| Rate for Payer: Cigna Commercial |
$294.40
|
| Rate for Payer: Health EOS Commercial |
$284.80
|
| Rate for Payer: HFN Commercial |
$294.40
|
| Rate for Payer: Multiplan Commercial |
$256.00
|
| Rate for Payer: NAPHCARE Commercial |
$192.00
|
| Rate for Payer: Preferred Network Access Commercial |
$294.40
|
| Rate for Payer: Quartz Beloit One Network |
$156.80
|
| Rate for Payer: Quartz Commercial |
$192.00
|
| Rate for Payer: WEA Trust Commercial |
$176.00
|
| Rate for Payer: WPS Commercial |
$237.02
|
|
|
Thyroglobulin, Tumor Marker, Serum to Mayo
|
Professional
|
Both
|
$320.00
|
|
|
Service Code
|
CPT 84432
|
| Hospital Charge Code |
3756168
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$56.69 |
| Max. Negotiated Rate |
$304.00 |
| Rate for Payer: Aetna Commercial |
$304.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$275.20
|
| Rate for Payer: Cash Price |
$96.00
|
| Rate for Payer: Cash Price |
$96.00
|
| Rate for Payer: Cigna Commercial |
$304.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$160.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$192.00
|
| Rate for Payer: Health EOS Commercial |
$291.20
|
| Rate for Payer: HFN Commercial |
$304.00
|
| 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 |
$256.00
|
| Rate for Payer: Preferred Network Access Commercial |
$304.00
|
| Rate for Payer: Quartz Beloit One Network |
$140.80
|
| Rate for Payer: Quartz Commercial |
$182.40
|
| Rate for Payer: The Alliance Commercial |
$160.00
|
| Rate for Payer: WEA Trust Commercial |
$176.00
|
| Rate for Payer: WPS Commercial |
$237.02
|
|
|
THYROGLOSSAL DUCT EXCISION
|
Facility
|
OP
|
$3,935.00
|
|
| Hospital Charge Code |
2960434
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,101.80 |
| Max. Negotiated Rate |
$15,740.00 |
| Rate for Payer: Aetna Commercial |
$3,541.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,384.10
|
| Rate for Payer: Aetna Managed Medicare |
$1,101.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,557.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,967.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,888.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,085.55
|
| Rate for Payer: Cash Price |
$1,180.50
|
| Rate for Payer: Cigna Commercial |
$3,620.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,202.03
|
| Rate for Payer: Health EOS Commercial |
$3,502.15
|
| Rate for Payer: HFN Commercial |
$3,620.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,951.25
|
| Rate for Payer: Multiplan Commercial |
$3,148.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,361.00
|
| Rate for Payer: Preferred Network Access Commercial |
$3,620.20
|
| Rate for Payer: Quartz Beloit One Network |
$1,928.15
|
| Rate for Payer: Quartz Commercial |
$2,557.75
|
| Rate for Payer: Quartz Medicare Advantage |
$2,361.00
|
| Rate for Payer: The Alliance Commercial |
$15,740.00
|
| Rate for Payer: WEA Trust Commercial |
$2,164.25
|
| Rate for Payer: WPS Commercial |
$2,914.65
|
|
|
THYROGLOSSAL DUCT EXCISION
|
Facility
|
IP
|
$3,935.00
|
|
| Hospital Charge Code |
2960434
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,928.15 |
| Max. Negotiated Rate |
$3,620.20 |
| Rate for Payer: Aetna Commercial |
$3,541.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,384.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,085.55
|
| Rate for Payer: Cash Price |
$1,180.50
|
| Rate for Payer: Cigna Commercial |
$3,620.20
|
| Rate for Payer: Health EOS Commercial |
$3,502.15
|
| Rate for Payer: HFN Commercial |
$3,620.20
|
| Rate for Payer: Multiplan Commercial |
$3,148.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,361.00
|
| Rate for Payer: Preferred Network Access Commercial |
$3,620.20
|
| Rate for Payer: Quartz Beloit One Network |
$1,928.15
|
| Rate for Payer: Quartz Commercial |
$2,361.00
|
| Rate for Payer: WEA Trust Commercial |
$2,164.25
|
| Rate for Payer: WPS Commercial |
$2,914.65
|
|
|
Thyroid Cancer Mut Pnl
|
Professional
|
Both
|
$2,945.80
|
|
|
Service Code
|
CPT 81445
|
| Hospital Charge Code |
6243967
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$1,296.15 |
| Max. Negotiated Rate |
$2,798.51 |
| Rate for Payer: Aetna Commercial |
$2,798.51
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,533.39
|
| Rate for Payer: Cash Price |
$883.74
|
| Rate for Payer: Cash Price |
$883.74
|
| Rate for Payer: Cigna Commercial |
$2,798.51
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,472.90
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,767.48
|
| Rate for Payer: Health EOS Commercial |
$2,680.68
|
| Rate for Payer: HFN Commercial |
$2,798.51
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,110.62
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$2,110.62
|
| Rate for Payer: Multiplan Commercial |
$2,356.64
|
| Rate for Payer: Preferred Network Access Commercial |
$2,798.51
|
| Rate for Payer: Quartz Beloit One Network |
$1,296.15
|
| Rate for Payer: Quartz Commercial |
$1,679.11
|
| Rate for Payer: The Alliance Commercial |
$1,472.90
|
| Rate for Payer: WEA Trust Commercial |
$1,620.19
|
| Rate for Payer: WPS Commercial |
$2,181.95
|
|
|
Thyroid Cancer Mut Pnl
|
Facility
|
IP
|
$2,945.80
|
|
|
Service Code
|
CPT 81445
|
| Hospital Charge Code |
6243967
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$1,443.44 |
| Max. Negotiated Rate |
$2,710.14 |
| Rate for Payer: Aetna Commercial |
$2,651.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,533.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,561.27
|
| Rate for Payer: Cash Price |
$883.74
|
| Rate for Payer: Cigna Commercial |
$2,710.14
|
| Rate for Payer: Health EOS Commercial |
$2,621.76
|
| Rate for Payer: HFN Commercial |
$2,710.14
|
| Rate for Payer: Multiplan Commercial |
$2,356.64
|
| Rate for Payer: NAPHCARE Commercial |
$1,767.48
|
| Rate for Payer: Preferred Network Access Commercial |
$2,710.14
|
| Rate for Payer: Quartz Beloit One Network |
$1,443.44
|
| Rate for Payer: Quartz Commercial |
$1,767.48
|
| Rate for Payer: WEA Trust Commercial |
$1,620.19
|
| Rate for Payer: WPS Commercial |
$2,181.95
|
|
|
Thyroid Cancer Mut Pnl
|
Facility
|
OP
|
$2,945.80
|
|
|
Service Code
|
CPT 81445
|
| Hospital Charge Code |
6243967
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$597.91 |
| Max. Negotiated Rate |
$2,710.14 |
| Rate for Payer: Aetna Commercial |
$2,651.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,533.39
|
| Rate for Payer: Aetna Managed Medicare |
$597.91
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,242.16
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,046.34
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$992.53
|
| Rate for Payer: Anthem Medicaid |
$597.91
|
| Rate for Payer: Anthem Medicare Advantage |
$597.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,561.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$597.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$597.91
|
| Rate for Payer: Cash Price |
$883.74
|
| Rate for Payer: Cash Price |
$883.74
|
| Rate for Payer: Cigna Commercial |
$2,710.14
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$597.91
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$597.91
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,648.47
|
| Rate for Payer: Dean Health Medicaid |
$597.91
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$597.91
|
| Rate for Payer: Health EOS Commercial |
$2,621.76
|
| Rate for Payer: HFN Commercial |
$2,710.14
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,224.23
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$597.91
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$597.91
|
| Rate for Payer: Independent Care Health Plan Medicare |
$597.91
|
| Rate for Payer: Managed Health Services Medicaid |
$621.83
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$597.91
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$597.91
|
| Rate for Payer: Multiplan Commercial |
$2,356.64
|
| Rate for Payer: NAPHCARE Commercial |
$896.86
|
| Rate for Payer: Preferred Network Access Commercial |
$2,710.14
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$597.91
|
| Rate for Payer: Quartz Beloit One Network |
$1,443.44
|
| Rate for Payer: Quartz Commercial |
$1,914.77
|
| Rate for Payer: Quartz Medicare Advantage |
$597.91
|
| Rate for Payer: The Alliance Commercial |
$2,391.64
|
| Rate for Payer: United Healthcare Medicaid |
$597.91
|
| Rate for Payer: United Healthcare Medicare Advantage |
$597.91
|
| Rate for Payer: United Healthcare PPO |
$2,209.35
|
| Rate for Payer: WEA Trust Commercial |
$1,620.19
|
| Rate for Payer: Wellcare Medicare |
$597.91
|
| Rate for Payer: WMAP Medicaid |
$597.91
|
| Rate for Payer: WPS Commercial |
$2,181.95
|
|
|
THYROIDECTOMY/PARATHRYOIDECTOMY/THYROIDOPLASTY
|
Facility
|
IP
|
$4,238.00
|
|
| Hospital Charge Code |
2960435
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,076.62 |
| Max. Negotiated Rate |
$3,898.96 |
| Rate for Payer: Aetna Commercial |
$3,814.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,644.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,246.14
|
| Rate for Payer: Cash Price |
$1,271.40
|
| Rate for Payer: Cigna Commercial |
$3,898.96
|
| Rate for Payer: Health EOS Commercial |
$3,771.82
|
| Rate for Payer: HFN Commercial |
$3,898.96
|
| Rate for Payer: Multiplan Commercial |
$3,390.40
|
| Rate for Payer: NAPHCARE Commercial |
$2,542.80
|
| Rate for Payer: Preferred Network Access Commercial |
$3,898.96
|
| Rate for Payer: Quartz Beloit One Network |
$2,076.62
|
| Rate for Payer: Quartz Commercial |
$2,542.80
|
| Rate for Payer: WEA Trust Commercial |
$2,330.90
|
| Rate for Payer: WPS Commercial |
$3,139.09
|
|
|
THYROIDECTOMY/PARATHRYOIDECTOMY/THYROIDOPLASTY
|
Facility
|
OP
|
$4,238.00
|
|
| Hospital Charge Code |
2960435
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,186.64 |
| Max. Negotiated Rate |
$16,952.00 |
| Rate for Payer: Aetna Commercial |
$3,814.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,644.68
|
| Rate for Payer: Aetna Managed Medicare |
$1,186.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,754.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,119.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,034.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,246.14
|
| Rate for Payer: Cash Price |
$1,271.40
|
| Rate for Payer: Cigna Commercial |
$3,898.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,371.58
|
| Rate for Payer: Health EOS Commercial |
$3,771.82
|
| Rate for Payer: HFN Commercial |
$3,898.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,178.50
|
| Rate for Payer: Multiplan Commercial |
$3,390.40
|
| Rate for Payer: NAPHCARE Commercial |
$2,542.80
|
| Rate for Payer: Preferred Network Access Commercial |
$3,898.96
|
| Rate for Payer: Quartz Beloit One Network |
$2,076.62
|
| Rate for Payer: Quartz Commercial |
$2,754.70
|
| Rate for Payer: Quartz Medicare Advantage |
$2,542.80
|
| Rate for Payer: The Alliance Commercial |
$16,952.00
|
| Rate for Payer: WEA Trust Commercial |
$2,330.90
|
| Rate for Payer: WPS Commercial |
$3,139.09
|
|
|
THYROID, PARATHYROID AND THYROGLOSSAL PROCEDURES WITH CC
|
Facility
|
IP
|
$39,984.00
|
|
|
Service Code
|
MSDRG 626
|
| Min. Negotiated Rate |
$14,382.74 |
| Max. Negotiated Rate |
$39,984.00 |
| Rate for Payer: Aetna Managed Medicare |
$14,382.74
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$31,260.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$23,960.69
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$22,764.22
|
| Rate for Payer: Anthem Medicare Advantage |
$14,382.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$14,382.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$14,382.74
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$14,382.74
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$25,270.37
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$14,382.74
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$29,092.05
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$14,382.74
|
| Rate for Payer: Independent Care Health Plan Medicare |
$14,382.74
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$14,382.74
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$14,382.74
|
| Rate for Payer: NAPHCARE Commercial |
$21,574.11
|
| Rate for Payer: Quartz Medicare Advantage |
$14,382.74
|
| Rate for Payer: The Alliance Commercial |
$39,984.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14,382.74
|
| Rate for Payer: United Healthcare PPO |
$22,648.53
|
| Rate for Payer: Wellcare Medicare |
$14,382.74
|
|
|
THYROID, PARATHYROID AND THYROGLOSSAL PROCEDURES WITH MCC
|
Facility
|
IP
|
$77,983.00
|
|
|
Service Code
|
MSDRG 625
|
| Min. Negotiated Rate |
$28,051.57 |
| Max. Negotiated Rate |
$77,983.00 |
| Rate for Payer: Aetna Managed Medicare |
$28,051.57
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$61,261.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$46,956.52
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$44,611.76
|
| Rate for Payer: Anthem Medicare Advantage |
$28,051.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$28,051.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$28,051.57
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$28,051.57
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$49,523.14
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$28,051.57
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$56,963.40
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$28,051.57
|
| Rate for Payer: Independent Care Health Plan Medicare |
$28,051.57
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$28,051.57
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$28,051.57
|
| Rate for Payer: NAPHCARE Commercial |
$42,077.36
|
| Rate for Payer: Quartz Medicare Advantage |
$28,051.57
|
| Rate for Payer: The Alliance Commercial |
$77,983.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$28,051.57
|
| Rate for Payer: United Healthcare PPO |
$44,346.74
|
| Rate for Payer: Wellcare Medicare |
$28,051.57
|
|
|
THYROID, PARATHYROID AND THYROGLOSSAL PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$33,181.00
|
|
|
Service Code
|
MSDRG 627
|
| Min. Negotiated Rate |
$11,935.50 |
| Max. Negotiated Rate |
$33,181.00 |
| Rate for Payer: Aetna Managed Medicare |
$11,935.50
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$26,015.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$19,940.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$18,944.72
|
| Rate for Payer: Anthem Medicare Advantage |
$11,935.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$11,935.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$11,935.50
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$11,935.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$21,030.38
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$11,935.50
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$24,102.00
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$11,935.50
|
| Rate for Payer: Independent Care Health Plan Medicare |
$11,935.50
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$11,935.50
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$11,935.50
|
| Rate for Payer: NAPHCARE Commercial |
$17,903.25
|
| Rate for Payer: Quartz Medicare Advantage |
$11,935.50
|
| Rate for Payer: The Alliance Commercial |
$33,181.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$11,935.50
|
| Rate for Payer: United Healthcare PPO |
$18,763.72
|
| Rate for Payer: Wellcare Medicare |
$11,935.50
|
|
|
Thyroid Peroxidase Antibody
|
Professional
|
Both
|
$30.00
|
|
|
Service Code
|
CPT 86376
|
| Hospital Charge Code |
3899562
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.20 |
| Max. Negotiated Rate |
$51.36 |
| Rate for Payer: Aetna Commercial |
$28.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$25.80
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Cigna Commercial |
$28.50
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$15.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$18.00
|
| Rate for Payer: Health EOS Commercial |
$27.30
|
| Rate for Payer: HFN Commercial |
$28.50
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$51.36
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$51.36
|
| Rate for Payer: Multiplan Commercial |
$24.00
|
| Rate for Payer: Preferred Network Access Commercial |
$28.50
|
| Rate for Payer: Quartz Beloit One Network |
$13.20
|
| Rate for Payer: Quartz Commercial |
$17.10
|
| Rate for Payer: The Alliance Commercial |
$15.00
|
| Rate for Payer: WEA Trust Commercial |
$16.50
|
| Rate for Payer: WPS Commercial |
$22.22
|
|
|
Thyroid Peroxidase Antibody
|
Facility
|
IP
|
$30.00
|
|
|
Service Code
|
CPT 86376
|
| Hospital Charge Code |
3899562
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.70 |
| Max. Negotiated Rate |
$27.60 |
| Rate for Payer: Aetna Commercial |
$27.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$25.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$15.90
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Cigna Commercial |
$27.60
|
| Rate for Payer: Health EOS Commercial |
$26.70
|
| Rate for Payer: HFN Commercial |
$27.60
|
| Rate for Payer: Multiplan Commercial |
$24.00
|
| Rate for Payer: NAPHCARE Commercial |
$18.00
|
| Rate for Payer: Preferred Network Access Commercial |
$27.60
|
| Rate for Payer: Quartz Beloit One Network |
$14.70
|
| Rate for Payer: Quartz Commercial |
$18.00
|
| Rate for Payer: WEA Trust Commercial |
$16.50
|
| Rate for Payer: WPS Commercial |
$22.22
|
|
|
Thyroid Peroxidase Antibody
|
Professional
|
Both
|
$192.00
|
|
|
Service Code
|
CPT 86376
|
| Hospital Charge Code |
983424
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$51.36 |
| Max. Negotiated Rate |
$182.40 |
| Rate for Payer: Aetna Commercial |
$182.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$165.12
|
| Rate for Payer: Cash Price |
$57.60
|
| Rate for Payer: Cash Price |
$57.60
|
| Rate for Payer: Cigna Commercial |
$182.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$96.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$115.20
|
| Rate for Payer: Health EOS Commercial |
$174.72
|
| Rate for Payer: HFN Commercial |
$182.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$51.36
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$51.36
|
| Rate for Payer: Multiplan Commercial |
$153.60
|
| Rate for Payer: Preferred Network Access Commercial |
$182.40
|
| Rate for Payer: Quartz Beloit One Network |
$84.48
|
| Rate for Payer: Quartz Commercial |
$109.44
|
| Rate for Payer: The Alliance Commercial |
$96.00
|
| Rate for Payer: WEA Trust Commercial |
$105.60
|
| Rate for Payer: WPS Commercial |
$142.21
|
|
|
Thyroid Peroxidase Antibody
|
Facility
|
OP
|
$192.00
|
|
|
Service Code
|
CPT 86376
|
| Hospital Charge Code |
983424
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.55 |
| Max. Negotiated Rate |
$176.64 |
| Rate for Payer: Aetna Commercial |
$172.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$165.12
|
| Rate for Payer: Aetna Managed Medicare |
$14.55
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$54.56
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$25.46
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$24.15
|
| Rate for Payer: Anthem Medicaid |
$15.03
|
| Rate for Payer: Anthem Medicare Advantage |
$14.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$101.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$14.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$14.55
|
| Rate for Payer: Cash Price |
$57.60
|
| Rate for Payer: Cash Price |
$57.60
|
| Rate for Payer: Cigna Commercial |
$176.64
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$14.55
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$15.03
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$107.44
|
| Rate for Payer: Dean Health Medicaid |
$15.03
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$14.55
|
| Rate for Payer: Health EOS Commercial |
$170.88
|
| Rate for Payer: HFN Commercial |
$176.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$54.13
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$14.55
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$15.03
|
| Rate for Payer: Independent Care Health Plan Medicare |
$14.55
|
| Rate for Payer: Managed Health Services Medicaid |
$15.63
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$14.55
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$14.55
|
| Rate for Payer: Multiplan Commercial |
$153.60
|
| Rate for Payer: NAPHCARE Commercial |
$21.82
|
| Rate for Payer: Preferred Network Access Commercial |
$176.64
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$15.03
|
| Rate for Payer: Quartz Beloit One Network |
$94.08
|
| Rate for Payer: Quartz Commercial |
$124.80
|
| Rate for Payer: Quartz Medicare Advantage |
$14.55
|
| Rate for Payer: The Alliance Commercial |
$58.20
|
| Rate for Payer: United Healthcare Medicaid |
$15.03
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14.55
|
| Rate for Payer: United Healthcare PPO |
$144.00
|
| Rate for Payer: WEA Trust Commercial |
$105.60
|
| Rate for Payer: Wellcare Medicare |
$14.55
|
| Rate for Payer: WMAP Medicaid |
$15.03
|
| Rate for Payer: WPS Commercial |
$142.21
|
|
|
Thyroid Peroxidase Antibody
|
Facility
|
IP
|
$192.00
|
|
|
Service Code
|
CPT 86376
|
| Hospital Charge Code |
983424
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$94.08 |
| Max. Negotiated Rate |
$176.64 |
| Rate for Payer: Aetna Commercial |
$172.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$165.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$101.76
|
| Rate for Payer: Cash Price |
$57.60
|
| Rate for Payer: Cigna Commercial |
$176.64
|
| Rate for Payer: Health EOS Commercial |
$170.88
|
| Rate for Payer: HFN Commercial |
$176.64
|
| Rate for Payer: Multiplan Commercial |
$153.60
|
| Rate for Payer: NAPHCARE Commercial |
$115.20
|
| Rate for Payer: Preferred Network Access Commercial |
$176.64
|
| Rate for Payer: Quartz Beloit One Network |
$94.08
|
| Rate for Payer: Quartz Commercial |
$115.20
|
| Rate for Payer: WEA Trust Commercial |
$105.60
|
| Rate for Payer: WPS Commercial |
$142.21
|
|
|
Thyroid Peroxidase Antibody
|
Facility
|
OP
|
$30.00
|
|
|
Service Code
|
CPT 86376
|
| Hospital Charge Code |
3899562
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.55 |
| Max. Negotiated Rate |
$58.20 |
| Rate for Payer: Aetna Commercial |
$27.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$25.80
|
| Rate for Payer: Aetna Managed Medicare |
$14.55
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$54.56
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$25.46
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$24.15
|
| Rate for Payer: Anthem Medicaid |
$15.03
|
| Rate for Payer: Anthem Medicare Advantage |
$14.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$15.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$14.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$14.55
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Cigna Commercial |
$27.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$14.55
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$15.03
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$16.79
|
| Rate for Payer: Dean Health Medicaid |
$15.03
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$14.55
|
| Rate for Payer: Health EOS Commercial |
$26.70
|
| Rate for Payer: HFN Commercial |
$27.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$54.13
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$14.55
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$15.03
|
| Rate for Payer: Independent Care Health Plan Medicare |
$14.55
|
| Rate for Payer: Managed Health Services Medicaid |
$15.63
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$14.55
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$14.55
|
| Rate for Payer: Multiplan Commercial |
$24.00
|
| Rate for Payer: NAPHCARE Commercial |
$21.82
|
| Rate for Payer: Preferred Network Access Commercial |
$27.60
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$15.03
|
| Rate for Payer: Quartz Beloit One Network |
$14.70
|
| Rate for Payer: Quartz Commercial |
$19.50
|
| Rate for Payer: Quartz Medicare Advantage |
$14.55
|
| Rate for Payer: The Alliance Commercial |
$58.20
|
| Rate for Payer: United Healthcare Medicaid |
$15.03
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14.55
|
| Rate for Payer: United Healthcare PPO |
$22.50
|
| Rate for Payer: WEA Trust Commercial |
$16.50
|
| Rate for Payer: Wellcare Medicare |
$14.55
|
| Rate for Payer: WMAP Medicaid |
$15.03
|
| Rate for Payer: WPS Commercial |
$22.22
|
|
|
Thyroid Peroxidase & Thyroglobulin Antibodies
|
Facility
|
OP
|
$49.61
|
|
|
Service Code
|
CPT 76376
|
| Hospital Charge Code |
3899560
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.89 |
| Max. Negotiated Rate |
$198.44 |
| Rate for Payer: Aetna Commercial |
$44.65
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$42.66
|
| Rate for Payer: Aetna Managed Medicare |
$13.89
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$32.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$24.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$23.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$26.29
|
| Rate for Payer: Cash Price |
$14.88
|
| Rate for Payer: Cigna Commercial |
$45.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$27.76
|
| Rate for Payer: Health EOS Commercial |
$44.15
|
| Rate for Payer: HFN Commercial |
$45.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$37.21
|
| Rate for Payer: Multiplan Commercial |
$39.69
|
| Rate for Payer: NAPHCARE Commercial |
$29.77
|
| Rate for Payer: Preferred Network Access Commercial |
$45.64
|
| Rate for Payer: Quartz Beloit One Network |
$24.31
|
| Rate for Payer: Quartz Commercial |
$32.25
|
| Rate for Payer: Quartz Medicare Advantage |
$29.77
|
| Rate for Payer: The Alliance Commercial |
$198.44
|
| Rate for Payer: United Healthcare PPO |
$37.21
|
| Rate for Payer: WEA Trust Commercial |
$27.29
|
| Rate for Payer: WPS Commercial |
$36.75
|
|
|
Thyroid Peroxidase & Thyroglobulin Antibodies
|
Professional
|
Both
|
$49.61
|
|
|
Service Code
|
CPT 76376
|
| Hospital Charge Code |
3899560
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$21.83 |
| Max. Negotiated Rate |
$76.42 |
| Rate for Payer: Aetna Commercial |
$47.13
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$42.66
|
| Rate for Payer: Cash Price |
$14.88
|
| Rate for Payer: Cash Price |
$14.88
|
| Rate for Payer: Cigna Commercial |
$47.13
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$24.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$29.77
|
| Rate for Payer: Health EOS Commercial |
$45.15
|
| Rate for Payer: HFN Commercial |
$47.13
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$76.42
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$76.42
|
| Rate for Payer: Multiplan Commercial |
$39.69
|
| Rate for Payer: Preferred Network Access Commercial |
$47.13
|
| Rate for Payer: Quartz Beloit One Network |
$21.83
|
| Rate for Payer: Quartz Commercial |
$28.28
|
| Rate for Payer: The Alliance Commercial |
$24.80
|
| Rate for Payer: WEA Trust Commercial |
$27.29
|
| Rate for Payer: WPS Commercial |
$36.75
|
|
|
Thyroid Peroxidase & Thyroglobulin Antibodies
|
Facility
|
IP
|
$49.61
|
|
|
Service Code
|
CPT 76376
|
| Hospital Charge Code |
3899560
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$24.31 |
| Max. Negotiated Rate |
$45.64 |
| Rate for Payer: Aetna Commercial |
$44.65
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$42.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$26.29
|
| Rate for Payer: Cash Price |
$14.88
|
| Rate for Payer: Cigna Commercial |
$45.64
|
| Rate for Payer: Health EOS Commercial |
$44.15
|
| Rate for Payer: HFN Commercial |
$45.64
|
| Rate for Payer: Multiplan Commercial |
$39.69
|
| Rate for Payer: NAPHCARE Commercial |
$29.77
|
| Rate for Payer: Preferred Network Access Commercial |
$45.64
|
| Rate for Payer: Quartz Beloit One Network |
$24.31
|
| Rate for Payer: Quartz Commercial |
$29.77
|
| Rate for Payer: WEA Trust Commercial |
$27.29
|
| Rate for Payer: WPS Commercial |
$36.75
|
|
|
Thyroid Stimulating Hormone
|
Facility
|
IP
|
$298.00
|
|
|
Service Code
|
CPT 84443
|
| Hospital Charge Code |
633844
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$146.02 |
| Max. Negotiated Rate |
$274.16 |
| Rate for Payer: Aetna Commercial |
$268.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$256.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$157.94
|
| Rate for Payer: Cash Price |
$89.40
|
| Rate for Payer: Cigna Commercial |
$274.16
|
| Rate for Payer: Health EOS Commercial |
$265.22
|
| Rate for Payer: HFN Commercial |
$274.16
|
| Rate for Payer: Multiplan Commercial |
$238.40
|
| Rate for Payer: NAPHCARE Commercial |
$178.80
|
| Rate for Payer: Preferred Network Access Commercial |
$274.16
|
| Rate for Payer: Quartz Beloit One Network |
$146.02
|
| Rate for Payer: Quartz Commercial |
$178.80
|
| Rate for Payer: WEA Trust Commercial |
$163.90
|
| Rate for Payer: WPS Commercial |
$220.73
|
|
