|
TE voice prosthesis indwelling - Equipment/Device Used
|
Facility
|
OP
|
$818.00
|
|
|
Service Code
|
HCPCS L8509
|
| Hospital Charge Code |
3008017
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$108.93 |
| Max. Negotiated Rate |
$782.66 |
| Rate for Payer: Aetna Commercial |
$765.65
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$731.62
|
| Rate for Payer: Aetna Managed Medicare |
$238.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$108.93
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$108.93
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$108.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$450.88
|
| Rate for Payer: Cash Price |
$245.40
|
| Rate for Payer: Cash Price |
$245.40
|
| Rate for Payer: Cigna Commercial |
$782.66
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$476.08
|
| Rate for Payer: Health EOS Commercial |
$757.14
|
| Rate for Payer: HFN Commercial |
$782.66
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$638.04
|
| Rate for Payer: Multiplan Commercial |
$680.58
|
| Rate for Payer: NAPHCARE Commercial |
$510.43
|
| Rate for Payer: Preferred Network Access Commercial |
$782.66
|
| Rate for Payer: Quartz Beloit One Network |
$416.85
|
| Rate for Payer: Quartz Commercial |
$552.97
|
| Rate for Payer: Quartz Medicare Advantage |
$510.43
|
| Rate for Payer: The Alliance Commercial |
$559.44
|
| Rate for Payer: WEA Trust Commercial |
$467.90
|
| Rate for Payer: WPS Commercial |
$630.11
|
|
|
TE voice prosthesis PT insert - Equipment/Device Used
|
Facility
|
IP
|
$310.00
|
|
|
Service Code
|
HCPCS L8507
|
| Hospital Charge Code |
3008018
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$157.98 |
| Max. Negotiated Rate |
$296.61 |
| Rate for Payer: Aetna Commercial |
$290.16
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$277.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$170.87
|
| Rate for Payer: Cash Price |
$93.00
|
| Rate for Payer: Cigna Commercial |
$296.61
|
| Rate for Payer: Health EOS Commercial |
$286.94
|
| Rate for Payer: HFN Commercial |
$296.61
|
| Rate for Payer: Multiplan Commercial |
$257.92
|
| Rate for Payer: Preferred Network Access Commercial |
$296.61
|
| Rate for Payer: Quartz Beloit One Network |
$157.98
|
| Rate for Payer: Quartz Commercial |
$193.44
|
| Rate for Payer: WEA Trust Commercial |
$177.32
|
| Rate for Payer: WPS Commercial |
$238.79
|
|
|
TE voice prosthesis PT insert - Equipment/Device Used
|
Facility
|
OP
|
$310.00
|
|
|
Service Code
|
HCPCS L8507
|
| Hospital Charge Code |
3008018
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$41.77 |
| Max. Negotiated Rate |
$296.61 |
| Rate for Payer: Aetna Commercial |
$290.16
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$277.26
|
| Rate for Payer: Aetna Managed Medicare |
$90.27
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$41.77
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$41.77
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$41.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$170.87
|
| Rate for Payer: Cash Price |
$93.00
|
| Rate for Payer: Cash Price |
$93.00
|
| Rate for Payer: Cigna Commercial |
$296.61
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$180.42
|
| Rate for Payer: Health EOS Commercial |
$286.94
|
| Rate for Payer: HFN Commercial |
$296.61
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$241.80
|
| Rate for Payer: Multiplan Commercial |
$257.92
|
| Rate for Payer: NAPHCARE Commercial |
$193.44
|
| Rate for Payer: Preferred Network Access Commercial |
$296.61
|
| Rate for Payer: Quartz Beloit One Network |
$157.98
|
| Rate for Payer: Quartz Commercial |
$209.56
|
| Rate for Payer: Quartz Medicare Advantage |
$193.44
|
| Rate for Payer: The Alliance Commercial |
$214.45
|
| Rate for Payer: WEA Trust Commercial |
$177.32
|
| Rate for Payer: WPS Commercial |
$238.79
|
|
|
tezepelumab (Tezspire) 210 mg/1.9 mL J2356
|
Facility
|
OP
|
$8,003.00
|
|
|
Service Code
|
HCPCS J2356
|
| Hospital Charge Code |
6180528
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$18.64 |
| Max. Negotiated Rate |
$7,657.27 |
| Rate for Payer: Aetna Commercial |
$7,490.81
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,157.88
|
| Rate for Payer: Aetna Managed Medicare |
$18.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,410.03
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,161.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,995.10
|
| Rate for Payer: Anthem Medicare Advantage |
$18.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,411.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$18.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$18.64
|
| Rate for Payer: Cash Price |
$2,400.90
|
| Rate for Payer: Cash Price |
$2,400.90
|
| Rate for Payer: Cigna Commercial |
$7,657.27
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$18.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$24.49
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$18.64
|
| Rate for Payer: Health EOS Commercial |
$7,407.58
|
| Rate for Payer: HFN Commercial |
$7,657.27
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$69.33
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$18.64
|
| Rate for Payer: Independent Care Health Plan Medicare |
$18.64
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$18.64
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$18.64
|
| Rate for Payer: Multiplan Commercial |
$6,658.50
|
| Rate for Payer: NAPHCARE Commercial |
$27.96
|
| Rate for Payer: Preferred Network Access Commercial |
$7,657.27
|
| Rate for Payer: Quartz Beloit One Network |
$4,078.33
|
| Rate for Payer: Quartz Commercial |
$5,410.03
|
| Rate for Payer: Quartz Medicare Advantage |
$18.64
|
| Rate for Payer: The Alliance Commercial |
$74.55
|
| Rate for Payer: United Healthcare Medicare Advantage |
$18.64
|
| Rate for Payer: WEA Trust Commercial |
$4,577.72
|
| Rate for Payer: Wellcare Medicare |
$18.64
|
| Rate for Payer: WPS Commercial |
$46.28
|
|
|
tezepelumab (Tezspire) 210 mg/1.9 mL J2356
|
Professional
|
Both
|
$8,003.00
|
|
|
Service Code
|
HCPCS J2356
|
| Hospital Charge Code |
6180528
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$18.51 |
| Max. Negotiated Rate |
$7,906.96 |
| Rate for Payer: Aetna Commercial |
$7,906.96
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,157.88
|
| Rate for Payer: Aetna Managed Medicare |
$18.64
|
| Rate for Payer: Anthem Medicare Advantage |
$18.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$18.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$18.64
|
| Rate for Payer: Cash Price |
$2,400.90
|
| Rate for Payer: Cash Price |
$2,400.90
|
| Rate for Payer: Cigna Commercial |
$7,906.96
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$18.53
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$18.51
|
| Rate for Payer: Health EOS Commercial |
$7,574.04
|
| Rate for Payer: HFN Commercial |
$7,906.96
|
| Rate for Payer: Independent Care Health Plan Medicare |
$18.64
|
| Rate for Payer: Multiplan Commercial |
$6,658.50
|
| Rate for Payer: NAPHCARE Commercial |
$27.96
|
| Rate for Payer: Preferred Network Access Commercial |
$7,906.96
|
| Rate for Payer: Quartz Beloit One Network |
$3,662.17
|
| Rate for Payer: Quartz Commercial |
$4,744.18
|
| Rate for Payer: Quartz Medicare Advantage |
$18.64
|
| Rate for Payer: The Alliance Commercial |
$51.25
|
| Rate for Payer: United Healthcare Medicaid |
$18.53
|
| Rate for Payer: United Healthcare Medicare Advantage |
$18.64
|
| Rate for Payer: WEA Trust Commercial |
$4,577.72
|
| Rate for Payer: WPS Commercial |
$46.28
|
|
|
tezepelumab (Tezspire) 210 mg/1.9 mL J2356
|
Facility
|
IP
|
$8,003.00
|
|
|
Service Code
|
HCPCS J2356
|
| Hospital Charge Code |
6180528
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4,078.33 |
| Max. Negotiated Rate |
$7,657.27 |
| Rate for Payer: Aetna Commercial |
$7,490.81
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,157.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,411.25
|
| Rate for Payer: Cash Price |
$2,400.90
|
| Rate for Payer: Cigna Commercial |
$7,657.27
|
| Rate for Payer: Health EOS Commercial |
$7,407.58
|
| Rate for Payer: HFN Commercial |
$7,657.27
|
| Rate for Payer: Multiplan Commercial |
$6,658.50
|
| Rate for Payer: Preferred Network Access Commercial |
$7,657.27
|
| Rate for Payer: Quartz Beloit One Network |
$4,078.33
|
| Rate for Payer: Quartz Commercial |
$4,993.87
|
| Rate for Payer: WEA Trust Commercial |
$4,577.72
|
| Rate for Payer: WPS Commercial |
$6,164.71
|
|
|
Tezspire Charge
|
Facility
|
OP
|
$8,003.00
|
|
|
Service Code
|
HCPCS J2356
|
| Hospital Charge Code |
6181580
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$18.64 |
| Max. Negotiated Rate |
$7,657.27 |
| Rate for Payer: Aetna Commercial |
$7,490.81
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,157.88
|
| Rate for Payer: Aetna Managed Medicare |
$18.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,410.03
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,161.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,995.10
|
| Rate for Payer: Anthem Medicare Advantage |
$18.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,411.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$18.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$18.64
|
| Rate for Payer: Cash Price |
$2,400.90
|
| Rate for Payer: Cash Price |
$2,400.90
|
| Rate for Payer: Cigna Commercial |
$7,657.27
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$18.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$24.49
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$18.64
|
| Rate for Payer: Health EOS Commercial |
$7,407.58
|
| Rate for Payer: HFN Commercial |
$7,657.27
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$69.33
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$18.64
|
| Rate for Payer: Independent Care Health Plan Medicare |
$18.64
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$18.64
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$18.64
|
| Rate for Payer: Multiplan Commercial |
$6,658.50
|
| Rate for Payer: NAPHCARE Commercial |
$27.96
|
| Rate for Payer: Preferred Network Access Commercial |
$7,657.27
|
| Rate for Payer: Quartz Beloit One Network |
$4,078.33
|
| Rate for Payer: Quartz Commercial |
$5,410.03
|
| Rate for Payer: Quartz Medicare Advantage |
$18.64
|
| Rate for Payer: The Alliance Commercial |
$74.55
|
| Rate for Payer: United Healthcare Medicare Advantage |
$18.64
|
| Rate for Payer: WEA Trust Commercial |
$4,577.72
|
| Rate for Payer: Wellcare Medicare |
$18.64
|
| Rate for Payer: WPS Commercial |
$46.28
|
|
|
Tezspire Charge
|
Professional
|
Both
|
$8,003.00
|
|
|
Service Code
|
HCPCS J2356
|
| Hospital Charge Code |
6181580
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$18.51 |
| Max. Negotiated Rate |
$7,906.96 |
| Rate for Payer: Aetna Commercial |
$7,906.96
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,157.88
|
| Rate for Payer: Aetna Managed Medicare |
$18.64
|
| Rate for Payer: Anthem Medicare Advantage |
$18.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$18.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$18.64
|
| Rate for Payer: Cash Price |
$2,400.90
|
| Rate for Payer: Cash Price |
$2,400.90
|
| Rate for Payer: Cigna Commercial |
$7,906.96
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$18.53
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$18.51
|
| Rate for Payer: Health EOS Commercial |
$7,574.04
|
| Rate for Payer: HFN Commercial |
$7,906.96
|
| Rate for Payer: Independent Care Health Plan Medicare |
$18.64
|
| Rate for Payer: Multiplan Commercial |
$6,658.50
|
| Rate for Payer: NAPHCARE Commercial |
$27.96
|
| Rate for Payer: Preferred Network Access Commercial |
$7,906.96
|
| Rate for Payer: Quartz Beloit One Network |
$3,662.17
|
| Rate for Payer: Quartz Commercial |
$4,744.18
|
| Rate for Payer: Quartz Medicare Advantage |
$18.64
|
| Rate for Payer: The Alliance Commercial |
$51.25
|
| Rate for Payer: United Healthcare Medicaid |
$18.53
|
| Rate for Payer: United Healthcare Medicare Advantage |
$18.64
|
| Rate for Payer: WEA Trust Commercial |
$4,577.72
|
| Rate for Payer: WPS Commercial |
$46.28
|
|
|
Tezspire Charge
|
Facility
|
IP
|
$8,003.00
|
|
|
Service Code
|
HCPCS J2356
|
| Hospital Charge Code |
6181580
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4,078.33 |
| Max. Negotiated Rate |
$7,657.27 |
| Rate for Payer: Aetna Commercial |
$7,490.81
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,157.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,411.25
|
| Rate for Payer: Cash Price |
$2,400.90
|
| Rate for Payer: Cigna Commercial |
$7,657.27
|
| Rate for Payer: Health EOS Commercial |
$7,407.58
|
| Rate for Payer: HFN Commercial |
$7,657.27
|
| Rate for Payer: Multiplan Commercial |
$6,658.50
|
| Rate for Payer: Preferred Network Access Commercial |
$7,657.27
|
| Rate for Payer: Quartz Beloit One Network |
$4,078.33
|
| Rate for Payer: Quartz Commercial |
$4,993.87
|
| Rate for Payer: WEA Trust Commercial |
$4,577.72
|
| Rate for Payer: WPS Commercial |
$6,164.71
|
|
|
Thalassemia & Hemoglobinopathy Comprehensive
|
Facility
|
IP
|
$99.27
|
|
|
Service Code
|
CPT 82728
|
| Hospital Charge Code |
4254047
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$50.59 |
| Max. Negotiated Rate |
$94.98 |
| Rate for Payer: Aetna Commercial |
$92.92
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$88.79
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$54.72
|
| Rate for Payer: Cash Price |
$29.78
|
| Rate for Payer: Cigna Commercial |
$94.98
|
| Rate for Payer: Health EOS Commercial |
$91.88
|
| Rate for Payer: HFN Commercial |
$94.98
|
| Rate for Payer: Multiplan Commercial |
$82.59
|
| Rate for Payer: Preferred Network Access Commercial |
$94.98
|
| Rate for Payer: Quartz Beloit One Network |
$50.59
|
| Rate for Payer: Quartz Commercial |
$61.94
|
| Rate for Payer: WEA Trust Commercial |
$56.78
|
| Rate for Payer: WPS Commercial |
$76.47
|
|
|
Thalassemia & Hemoglobinopathy Comprehensive
|
Professional
|
Both
|
$99.27
|
|
|
Service Code
|
CPT 82728
|
| Hospital Charge Code |
4254047
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.18 |
| Max. Negotiated Rate |
$98.08 |
| Rate for Payer: Aetna Commercial |
$98.08
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$88.79
|
| Rate for Payer: Aetna Managed Medicare |
$14.18
|
| Rate for Payer: Anthem Medicare Advantage |
$14.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$14.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$14.18
|
| Rate for Payer: Cash Price |
$29.78
|
| Rate for Payer: Cash Price |
$29.78
|
| Rate for Payer: Cigna Commercial |
$98.08
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$51.62
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$14.18
|
| Rate for Payer: Health EOS Commercial |
$93.95
|
| Rate for Payer: HFN Commercial |
$98.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$50.03
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$50.03
|
| Rate for Payer: Independent Care Health Plan Medicare |
$14.18
|
| Rate for Payer: Multiplan Commercial |
$82.59
|
| Rate for Payer: NAPHCARE Commercial |
$21.26
|
| Rate for Payer: Preferred Network Access Commercial |
$98.08
|
| Rate for Payer: Quartz Beloit One Network |
$45.43
|
| Rate for Payer: Quartz Commercial |
$58.85
|
| Rate for Payer: Quartz Medicare Advantage |
$14.18
|
| Rate for Payer: The Alliance Commercial |
$55.99
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14.18
|
| Rate for Payer: WEA Trust Commercial |
$56.78
|
| Rate for Payer: WPS Commercial |
$62.37
|
|
|
Thalassemia & Hemoglobinopathy Comprehensive
|
Facility
|
OP
|
$99.27
|
|
|
Service Code
|
CPT 82728
|
| Hospital Charge Code |
4254047
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.18 |
| Max. Negotiated Rate |
$94.98 |
| Rate for Payer: Aetna Commercial |
$92.92
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$88.79
|
| Rate for Payer: Aetna Managed Medicare |
$14.18
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$53.16
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$24.81
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$23.53
|
| Rate for Payer: Anthem Medicare Advantage |
$14.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$54.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$14.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$14.18
|
| Rate for Payer: Cash Price |
$29.78
|
| Rate for Payer: Cash Price |
$29.78
|
| Rate for Payer: Cigna Commercial |
$94.98
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$14.18
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$57.78
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$14.18
|
| Rate for Payer: Health EOS Commercial |
$91.88
|
| Rate for Payer: HFN Commercial |
$94.98
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$52.73
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$14.18
|
| Rate for Payer: Independent Care Health Plan Medicare |
$14.18
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$14.18
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$14.18
|
| Rate for Payer: Multiplan Commercial |
$82.59
|
| Rate for Payer: NAPHCARE Commercial |
$21.26
|
| Rate for Payer: Preferred Network Access Commercial |
$94.98
|
| Rate for Payer: Quartz Beloit One Network |
$50.59
|
| Rate for Payer: Quartz Commercial |
$67.11
|
| Rate for Payer: Quartz Medicare Advantage |
$14.18
|
| Rate for Payer: The Alliance Commercial |
$56.70
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14.18
|
| Rate for Payer: United Healthcare PPO |
$77.43
|
| Rate for Payer: WEA Trust Commercial |
$56.78
|
| Rate for Payer: Wellcare Medicare |
$14.18
|
| Rate for Payer: WPS Commercial |
$76.47
|
|
|
Thalass Interp
|
Facility
|
IP
|
$129.00
|
|
|
Service Code
|
CPT 83021
|
| Hospital Charge Code |
4254086
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$65.74 |
| Max. Negotiated Rate |
$123.43 |
| Rate for Payer: Aetna Commercial |
$120.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$115.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$71.10
|
| Rate for Payer: Cash Price |
$38.70
|
| Rate for Payer: Cigna Commercial |
$123.43
|
| Rate for Payer: Health EOS Commercial |
$119.40
|
| Rate for Payer: HFN Commercial |
$123.43
|
| Rate for Payer: Multiplan Commercial |
$107.33
|
| Rate for Payer: Preferred Network Access Commercial |
$123.43
|
| Rate for Payer: Quartz Beloit One Network |
$65.74
|
| Rate for Payer: Quartz Commercial |
$80.50
|
| Rate for Payer: WEA Trust Commercial |
$73.79
|
| Rate for Payer: WPS Commercial |
$99.37
|
|
|
Thalass Interp
|
Facility
|
OP
|
$129.00
|
|
|
Service Code
|
CPT 83021
|
| Hospital Charge Code |
4254086
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.78 |
| Max. Negotiated Rate |
$123.43 |
| Rate for Payer: Aetna Commercial |
$120.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$115.38
|
| Rate for Payer: Aetna Managed Medicare |
$18.78
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$70.43
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$32.87
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$31.18
|
| Rate for Payer: Anthem Medicare Advantage |
$18.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$71.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$18.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$18.78
|
| Rate for Payer: Cash Price |
$38.70
|
| Rate for Payer: Cash Price |
$38.70
|
| Rate for Payer: Cigna Commercial |
$123.43
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$18.78
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$75.08
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$18.78
|
| Rate for Payer: Health EOS Commercial |
$119.40
|
| Rate for Payer: HFN Commercial |
$123.43
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$69.87
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$18.78
|
| Rate for Payer: Independent Care Health Plan Medicare |
$18.78
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$18.78
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$18.78
|
| Rate for Payer: Multiplan Commercial |
$107.33
|
| Rate for Payer: NAPHCARE Commercial |
$28.17
|
| Rate for Payer: Preferred Network Access Commercial |
$123.43
|
| Rate for Payer: Quartz Beloit One Network |
$65.74
|
| Rate for Payer: Quartz Commercial |
$87.20
|
| Rate for Payer: Quartz Medicare Advantage |
$18.78
|
| Rate for Payer: The Alliance Commercial |
$75.13
|
| Rate for Payer: United Healthcare Medicare Advantage |
$18.78
|
| Rate for Payer: United Healthcare PPO |
$100.62
|
| Rate for Payer: WEA Trust Commercial |
$73.79
|
| Rate for Payer: Wellcare Medicare |
$18.78
|
| Rate for Payer: WPS Commercial |
$99.37
|
|
|
Thalass Interp
|
Professional
|
Both
|
$129.00
|
|
|
Service Code
|
CPT 83021
|
| Hospital Charge Code |
4254086
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.78 |
| Max. Negotiated Rate |
$127.45 |
| Rate for Payer: Aetna Commercial |
$127.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$115.38
|
| Rate for Payer: Aetna Managed Medicare |
$18.78
|
| Rate for Payer: Anthem Medicare Advantage |
$18.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$18.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$18.78
|
| Rate for Payer: Cash Price |
$38.70
|
| Rate for Payer: Cash Price |
$38.70
|
| Rate for Payer: Cigna Commercial |
$127.45
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$67.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$18.78
|
| Rate for Payer: Health EOS Commercial |
$122.09
|
| Rate for Payer: HFN Commercial |
$127.45
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$66.30
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$66.30
|
| Rate for Payer: Independent Care Health Plan Medicare |
$18.78
|
| Rate for Payer: Multiplan Commercial |
$107.33
|
| Rate for Payer: NAPHCARE Commercial |
$28.17
|
| Rate for Payer: Preferred Network Access Commercial |
$127.45
|
| Rate for Payer: Quartz Beloit One Network |
$59.03
|
| Rate for Payer: Quartz Commercial |
$76.47
|
| Rate for Payer: Quartz Medicare Advantage |
$18.78
|
| Rate for Payer: The Alliance Commercial |
$74.19
|
| Rate for Payer: United Healthcare Medicare Advantage |
$18.78
|
| Rate for Payer: WEA Trust Commercial |
$73.79
|
| Rate for Payer: WPS Commercial |
$82.64
|
|
|
Thallium-201(per mCi)
|
Facility
|
IP
|
$120.00
|
|
|
Service Code
|
HCPCS A9505
|
| Hospital Charge Code |
5381842
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$61.15 |
| Max. Negotiated Rate |
$114.82 |
| Rate for Payer: Aetna Commercial |
$112.32
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$107.33
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$66.14
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Cigna Commercial |
$114.82
|
| Rate for Payer: Health EOS Commercial |
$111.07
|
| Rate for Payer: HFN Commercial |
$114.82
|
| Rate for Payer: Multiplan Commercial |
$99.84
|
| Rate for Payer: Preferred Network Access Commercial |
$114.82
|
| Rate for Payer: Quartz Beloit One Network |
$61.15
|
| Rate for Payer: Quartz Commercial |
$74.88
|
| Rate for Payer: WEA Trust Commercial |
$68.64
|
| Rate for Payer: WPS Commercial |
$92.44
|
|
|
Thallium-201(per mCi)
|
Professional
|
Both
|
$120.00
|
|
|
Service Code
|
HCPCS A9505
|
| Hospital Charge Code |
5381842
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$34.12 |
| Max. Negotiated Rate |
$118.56 |
| Rate for Payer: Aetna Commercial |
$118.56
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$107.33
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Cigna Commercial |
$118.56
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$34.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$74.88
|
| Rate for Payer: Health EOS Commercial |
$113.57
|
| Rate for Payer: HFN Commercial |
$118.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$55.36
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$55.36
|
| Rate for Payer: Multiplan Commercial |
$99.84
|
| Rate for Payer: Preferred Network Access Commercial |
$118.56
|
| Rate for Payer: Quartz Beloit One Network |
$54.91
|
| Rate for Payer: Quartz Commercial |
$71.14
|
| Rate for Payer: The Alliance Commercial |
$62.40
|
| Rate for Payer: United Healthcare Medicaid |
$34.12
|
| Rate for Payer: WEA Trust Commercial |
$68.64
|
| Rate for Payer: WPS Commercial |
$92.44
|
|
|
Thallium-201(per mCi)
|
Facility
|
OP
|
$128.00
|
|
|
Service Code
|
HCPCS A9505
|
| Hospital Charge Code |
1486854
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$37.27 |
| Max. Negotiated Rate |
$122.47 |
| Rate for Payer: Aetna Commercial |
$119.81
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$114.48
|
| Rate for Payer: Aetna Managed Medicare |
$37.27
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$86.53
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$66.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$63.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$70.55
|
| Rate for Payer: Cash Price |
$38.40
|
| Rate for Payer: Cigna Commercial |
$122.47
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$74.50
|
| Rate for Payer: Health EOS Commercial |
$118.48
|
| Rate for Payer: HFN Commercial |
$122.47
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$99.84
|
| Rate for Payer: Multiplan Commercial |
$106.50
|
| Rate for Payer: NAPHCARE Commercial |
$79.87
|
| Rate for Payer: Preferred Network Access Commercial |
$122.47
|
| Rate for Payer: Quartz Beloit One Network |
$65.23
|
| Rate for Payer: Quartz Commercial |
$86.53
|
| Rate for Payer: Quartz Medicare Advantage |
$79.87
|
| Rate for Payer: The Alliance Commercial |
$66.56
|
| Rate for Payer: WEA Trust Commercial |
$73.22
|
| Rate for Payer: WPS Commercial |
$98.60
|
|
|
Thallium-201(per mCi)
|
Professional
|
Both
|
$128.00
|
|
|
Service Code
|
HCPCS A9505
|
| Hospital Charge Code |
1486854
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$34.12 |
| Max. Negotiated Rate |
$126.46 |
| Rate for Payer: Aetna Commercial |
$126.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$114.48
|
| Rate for Payer: Cash Price |
$38.40
|
| Rate for Payer: Cash Price |
$38.40
|
| Rate for Payer: Cigna Commercial |
$126.46
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$34.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$79.87
|
| Rate for Payer: Health EOS Commercial |
$121.14
|
| Rate for Payer: HFN Commercial |
$126.46
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$55.36
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$55.36
|
| Rate for Payer: Multiplan Commercial |
$106.50
|
| Rate for Payer: Preferred Network Access Commercial |
$126.46
|
| Rate for Payer: Quartz Beloit One Network |
$58.57
|
| Rate for Payer: Quartz Commercial |
$75.88
|
| Rate for Payer: The Alliance Commercial |
$66.56
|
| Rate for Payer: United Healthcare Medicaid |
$34.12
|
| Rate for Payer: WEA Trust Commercial |
$73.22
|
| Rate for Payer: WPS Commercial |
$98.60
|
|
|
Thallium-201(per mCi)
|
Facility
|
OP
|
$120.00
|
|
|
Service Code
|
HCPCS A9505
|
| Hospital Charge Code |
5381842
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$34.94 |
| Max. Negotiated Rate |
$114.82 |
| Rate for Payer: Aetna Commercial |
$112.32
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$107.33
|
| Rate for Payer: Aetna Managed Medicare |
$34.94
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$81.12
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$62.40
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$59.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$66.14
|
| Rate for Payer: Cash Price |
$36.00
|
| Rate for Payer: Cigna Commercial |
$114.82
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$69.84
|
| Rate for Payer: Health EOS Commercial |
$111.07
|
| Rate for Payer: HFN Commercial |
$114.82
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$93.60
|
| Rate for Payer: Multiplan Commercial |
$99.84
|
| Rate for Payer: NAPHCARE Commercial |
$74.88
|
| Rate for Payer: Preferred Network Access Commercial |
$114.82
|
| Rate for Payer: Quartz Beloit One Network |
$61.15
|
| Rate for Payer: Quartz Commercial |
$81.12
|
| Rate for Payer: Quartz Medicare Advantage |
$74.88
|
| Rate for Payer: The Alliance Commercial |
$62.40
|
| Rate for Payer: WEA Trust Commercial |
$68.64
|
| Rate for Payer: WPS Commercial |
$92.44
|
|
|
Thallium-201(per mCi)
|
Facility
|
IP
|
$128.00
|
|
|
Service Code
|
HCPCS A9505
|
| Hospital Charge Code |
1486854
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$65.23 |
| Max. Negotiated Rate |
$122.47 |
| Rate for Payer: Aetna Commercial |
$119.81
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$114.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$70.55
|
| Rate for Payer: Cash Price |
$38.40
|
| Rate for Payer: Cigna Commercial |
$122.47
|
| Rate for Payer: Health EOS Commercial |
$118.48
|
| Rate for Payer: HFN Commercial |
$122.47
|
| Rate for Payer: Multiplan Commercial |
$106.50
|
| Rate for Payer: Preferred Network Access Commercial |
$122.47
|
| Rate for Payer: Quartz Beloit One Network |
$65.23
|
| Rate for Payer: Quartz Commercial |
$79.87
|
| Rate for Payer: WEA Trust Commercial |
$73.22
|
| Rate for Payer: WPS Commercial |
$98.60
|
|
|
Thawing Fee
|
Professional
|
Both
|
$49.00
|
|
|
Service Code
|
CPT 86927
|
| Hospital Charge Code |
2949311
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$22.42 |
| Max. Negotiated Rate |
$71.19 |
| Rate for Payer: Aetna Commercial |
$48.41
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$43.83
|
| Rate for Payer: Cash Price |
$14.70
|
| Rate for Payer: Cash Price |
$14.70
|
| Rate for Payer: Cigna Commercial |
$48.41
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$25.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$30.58
|
| Rate for Payer: Health EOS Commercial |
$46.37
|
| Rate for Payer: HFN Commercial |
$48.41
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$71.19
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$71.19
|
| Rate for Payer: Multiplan Commercial |
$40.77
|
| Rate for Payer: Preferred Network Access Commercial |
$48.41
|
| Rate for Payer: Quartz Beloit One Network |
$22.42
|
| Rate for Payer: Quartz Commercial |
$29.05
|
| Rate for Payer: The Alliance Commercial |
$25.48
|
| Rate for Payer: WEA Trust Commercial |
$28.03
|
| Rate for Payer: WPS Commercial |
$37.74
|
|
|
Thawing Fee
|
Facility
|
OP
|
$49.00
|
|
|
Service Code
|
CPT 86927
|
| Hospital Charge Code |
2949311
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$24.46 |
| Max. Negotiated Rate |
$717.18 |
| Rate for Payer: Aetna Commercial |
$45.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$43.83
|
| Rate for Payer: Aetna Managed Medicare |
$179.30
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$33.12
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$25.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$24.46
|
| Rate for Payer: Anthem Medicare Advantage |
$179.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$27.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$179.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$179.30
|
| Rate for Payer: Cash Price |
$14.70
|
| Rate for Payer: Cash Price |
$14.70
|
| Rate for Payer: Cigna Commercial |
$46.88
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$179.30
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$28.52
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$179.30
|
| Rate for Payer: Health EOS Commercial |
$45.35
|
| Rate for Payer: HFN Commercial |
$46.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$666.98
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$179.30
|
| Rate for Payer: Independent Care Health Plan Medicare |
$179.30
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$179.30
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$179.30
|
| Rate for Payer: Multiplan Commercial |
$40.77
|
| Rate for Payer: NAPHCARE Commercial |
$268.94
|
| Rate for Payer: Preferred Network Access Commercial |
$46.88
|
| Rate for Payer: Quartz Beloit One Network |
$24.97
|
| Rate for Payer: Quartz Commercial |
$33.12
|
| Rate for Payer: Quartz Medicare Advantage |
$179.30
|
| Rate for Payer: The Alliance Commercial |
$717.18
|
| Rate for Payer: United Healthcare Medicare Advantage |
$179.30
|
| Rate for Payer: United Healthcare PPO |
$38.22
|
| Rate for Payer: WEA Trust Commercial |
$28.03
|
| Rate for Payer: Wellcare Medicare |
$179.30
|
| Rate for Payer: WPS Commercial |
$37.74
|
|
|
Thawing Fee
|
Facility
|
IP
|
$49.00
|
|
|
Service Code
|
CPT 86927
|
| Hospital Charge Code |
2949311
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$24.97 |
| Max. Negotiated Rate |
$46.88 |
| Rate for Payer: Aetna Commercial |
$45.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$43.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$27.01
|
| Rate for Payer: Cash Price |
$14.70
|
| Rate for Payer: Cigna Commercial |
$46.88
|
| Rate for Payer: Health EOS Commercial |
$45.35
|
| Rate for Payer: HFN Commercial |
$46.88
|
| Rate for Payer: Multiplan Commercial |
$40.77
|
| Rate for Payer: Preferred Network Access Commercial |
$46.88
|
| Rate for Payer: Quartz Beloit One Network |
$24.97
|
| Rate for Payer: Quartz Commercial |
$30.58
|
| Rate for Payer: WEA Trust Commercial |
$28.03
|
| Rate for Payer: WPS Commercial |
$37.74
|
|
|
Theophylline Level
|
Facility
|
IP
|
$350.00
|
|
|
Service Code
|
CPT 80198
|
| Hospital Charge Code |
633839
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$178.36 |
| Max. Negotiated Rate |
$334.88 |
| Rate for Payer: Aetna Commercial |
$327.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$313.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$192.92
|
| Rate for Payer: Cash Price |
$105.00
|
| Rate for Payer: Cigna Commercial |
$334.88
|
| Rate for Payer: Health EOS Commercial |
$323.96
|
| Rate for Payer: HFN Commercial |
$334.88
|
| Rate for Payer: Multiplan Commercial |
$291.20
|
| Rate for Payer: Preferred Network Access Commercial |
$334.88
|
| Rate for Payer: Quartz Beloit One Network |
$178.36
|
| Rate for Payer: Quartz Commercial |
$218.40
|
| Rate for Payer: WEA Trust Commercial |
$200.20
|
| Rate for Payer: WPS Commercial |
$269.61
|
|
