|
TSH, Sensitive to Mayo
|
Facility
OP
|
$61.00
|
|
|
Service Code
|
CPT 84443
|
| Hospital Charge Code |
5426965
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$16.80 |
| Max. Negotiated Rate |
$244.00 |
| Rate for Payer: Aetna Commercial |
$54.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$52.46
|
| Rate for Payer: Aetna Managed Medicare |
$16.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$63.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$29.40
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$27.89
|
| Rate for Payer: Anthem Medicaid |
$17.36
|
| Rate for Payer: Anthem Medicare Advantage |
$16.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$32.33
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$16.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$16.80
|
| Rate for Payer: Cash Price |
$18.30
|
| Rate for Payer: Cash Price |
$18.30
|
| Rate for Payer: Cigna Commercial |
$56.12
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$16.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$17.36
|
| Rate for Payer: Dean Health Medicaid |
$17.36
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$16.80
|
| Rate for Payer: Health EOS Commercial |
$54.29
|
| Rate for Payer: HFN Commercial |
$56.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$62.50
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$16.80
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$17.36
|
| Rate for Payer: Independent Care Health Plan Medicare |
$16.80
|
| Rate for Payer: Managed Health Services Medicaid |
$18.05
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$16.80
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$16.80
|
| Rate for Payer: Multiplan Commercial |
$48.80
|
| Rate for Payer: NAPHCARE Commercial |
$25.20
|
| Rate for Payer: Preferred Network Access Commercial |
$56.12
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$17.36
|
| Rate for Payer: Quartz Beloit One Network |
$29.89
|
| Rate for Payer: Quartz Commercial |
$39.65
|
| Rate for Payer: Quartz Medicare Advantage |
$16.80
|
| Rate for Payer: The Alliance Commercial |
$244.00
|
| Rate for Payer: United Healthcare Medicaid |
$17.36
|
| Rate for Payer: United Healthcare Medicare Advantage |
$16.80
|
| Rate for Payer: United Healthcare PPO |
$45.75
|
| Rate for Payer: WEA Trust Commercial |
$33.55
|
| Rate for Payer: Wellcare Medicare |
$16.80
|
| Rate for Payer: WMAP Medicaid |
$17.36
|
| Rate for Payer: WPS Commercial |
$45.18
|
|
|
TSH, Sensitive to Mayo
|
Professional
|
$61.00
|
|
|
Service Code
|
CPT 84443
|
| Hospital Charge Code |
5426965
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$16.80 |
| Max. Negotiated Rate |
$73.92 |
| Rate for Payer: Aetna Commercial |
$57.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$52.46
|
| Rate for Payer: Aetna Managed Medicare |
$16.80
|
| Rate for Payer: Anthem Medicare Advantage |
$16.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$16.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$16.80
|
| Rate for Payer: Cash Price |
$18.30
|
| Rate for Payer: Cash Price |
$18.30
|
| Rate for Payer: Cigna Commercial |
$57.95
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$30.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$16.80
|
| Rate for Payer: Health EOS Commercial |
$55.51
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$59.30
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$59.30
|
| Rate for Payer: Independent Care Health Plan Medicare |
$16.80
|
| Rate for Payer: Multiplan Commercial |
$48.80
|
| Rate for Payer: Preferred Network Access Commercial |
$57.95
|
| Rate for Payer: Quartz Beloit One Network |
$26.84
|
| Rate for Payer: Quartz Commercial |
$34.77
|
| Rate for Payer: Quartz Medicare Advantage |
$16.80
|
| Rate for Payer: The Alliance Commercial |
$66.36
|
| Rate for Payer: United Healthcare Medicare Advantage |
$16.80
|
| Rate for Payer: WEA Trust Commercial |
$33.55
|
| Rate for Payer: WPS Commercial |
$73.92
|
|
|
TSH, Sensitive to Mayo
|
Facility
IP
|
$61.00
|
|
|
Service Code
|
CPT 84443
|
| Hospital Charge Code |
5426965
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$29.89 |
| Max. Negotiated Rate |
$56.12 |
| Rate for Payer: Aetna Commercial |
$54.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$32.33
|
| Rate for Payer: Cash Price |
$18.30
|
| Rate for Payer: Cigna Commercial |
$56.12
|
| Rate for Payer: Health EOS Commercial |
$54.29
|
| Rate for Payer: HFN Commercial |
$56.12
|
| Rate for Payer: Multiplan Commercial |
$48.80
|
| Rate for Payer: NAPHCARE Commercial |
$36.60
|
| Rate for Payer: Preferred Network Access Commercial |
$56.12
|
| Rate for Payer: Quartz Beloit One Network |
$29.89
|
| Rate for Payer: Quartz Commercial |
$36.60
|
| Rate for Payer: WEA Trust Commercial |
$33.55
|
| Rate for Payer: WPS Commercial |
$45.18
|
|
|
TSII-Antithrombin III Activity
|
Facility
IP
|
$184.00
|
|
|
Service Code
|
CPT 85300
|
| Hospital Charge Code |
4066516
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$90.16 |
| Max. Negotiated Rate |
$169.28 |
| Rate for Payer: Aetna Commercial |
$165.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$97.52
|
| Rate for Payer: Cash Price |
$55.20
|
| Rate for Payer: Cigna Commercial |
$169.28
|
| Rate for Payer: Health EOS Commercial |
$163.76
|
| Rate for Payer: HFN Commercial |
$169.28
|
| Rate for Payer: Multiplan Commercial |
$147.20
|
| Rate for Payer: NAPHCARE Commercial |
$110.40
|
| Rate for Payer: Preferred Network Access Commercial |
$169.28
|
| Rate for Payer: Quartz Beloit One Network |
$90.16
|
| Rate for Payer: Quartz Commercial |
$110.40
|
| Rate for Payer: WEA Trust Commercial |
$101.20
|
| Rate for Payer: WPS Commercial |
$136.29
|
|
|
TSII-Antithrombin III Activity
|
Professional
|
$184.00
|
|
|
Service Code
|
CPT 85300
|
| Hospital Charge Code |
4066516
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.85 |
| Max. Negotiated Rate |
$174.80 |
| Rate for Payer: Aetna Commercial |
$174.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$158.24
|
| Rate for Payer: Aetna Managed Medicare |
$11.85
|
| Rate for Payer: Anthem Medicare Advantage |
$11.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$11.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$11.85
|
| Rate for Payer: Cash Price |
$55.20
|
| Rate for Payer: Cash Price |
$55.20
|
| Rate for Payer: Cigna Commercial |
$174.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$92.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$11.85
|
| Rate for Payer: Health EOS Commercial |
$167.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$41.83
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$41.83
|
| Rate for Payer: Independent Care Health Plan Medicare |
$11.85
|
| Rate for Payer: Multiplan Commercial |
$147.20
|
| Rate for Payer: Preferred Network Access Commercial |
$174.80
|
| Rate for Payer: Quartz Beloit One Network |
$80.96
|
| Rate for Payer: Quartz Commercial |
$104.88
|
| Rate for Payer: Quartz Medicare Advantage |
$11.85
|
| Rate for Payer: The Alliance Commercial |
$46.81
|
| Rate for Payer: United Healthcare Medicare Advantage |
$11.85
|
| Rate for Payer: WEA Trust Commercial |
$101.20
|
| Rate for Payer: WPS Commercial |
$52.14
|
|
|
TSII-Antithrombin III Activity
|
Facility
OP
|
$184.00
|
|
|
Service Code
|
CPT 85300
|
| Hospital Charge Code |
4066516
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.85 |
| Max. Negotiated Rate |
$736.00 |
| Rate for Payer: Aetna Commercial |
$165.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$158.24
|
| Rate for Payer: Aetna Managed Medicare |
$11.85
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$44.44
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$20.74
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$19.67
|
| Rate for Payer: Anthem Medicaid |
$12.24
|
| Rate for Payer: Anthem Medicare Advantage |
$11.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$97.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$11.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$11.85
|
| Rate for Payer: Cash Price |
$55.20
|
| Rate for Payer: Cash Price |
$55.20
|
| Rate for Payer: Cigna Commercial |
$169.28
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$11.85
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$12.24
|
| Rate for Payer: Dean Health Medicaid |
$12.24
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$11.85
|
| Rate for Payer: Health EOS Commercial |
$163.76
|
| Rate for Payer: HFN Commercial |
$169.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$44.08
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$11.85
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$12.24
|
| Rate for Payer: Independent Care Health Plan Medicare |
$11.85
|
| Rate for Payer: Managed Health Services Medicaid |
$12.73
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$11.85
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$11.85
|
| Rate for Payer: Multiplan Commercial |
$147.20
|
| Rate for Payer: NAPHCARE Commercial |
$17.78
|
| Rate for Payer: Preferred Network Access Commercial |
$169.28
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$12.24
|
| Rate for Payer: Quartz Beloit One Network |
$90.16
|
| Rate for Payer: Quartz Commercial |
$119.60
|
| Rate for Payer: Quartz Medicare Advantage |
$11.85
|
| Rate for Payer: The Alliance Commercial |
$736.00
|
| Rate for Payer: United Healthcare Medicaid |
$12.24
|
| Rate for Payer: United Healthcare Medicare Advantage |
$11.85
|
| Rate for Payer: United Healthcare PPO |
$138.00
|
| Rate for Payer: WEA Trust Commercial |
$101.20
|
| Rate for Payer: Wellcare Medicare |
$11.85
|
| Rate for Payer: WMAP Medicaid |
$12.24
|
| Rate for Payer: WPS Commercial |
$136.29
|
|
|
TSII-Factor V (Leiden) Mutation
|
Facility
OP
|
$359.00
|
|
|
Service Code
|
CPT 81241
|
| Hospital Charge Code |
4066514
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$66.70 |
| Max. Negotiated Rate |
$1,436.00 |
| Rate for Payer: Aetna Commercial |
$323.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$308.74
|
| Rate for Payer: Aetna Managed Medicare |
$73.37
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$275.14
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$128.40
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$121.79
|
| Rate for Payer: Anthem Medicaid |
$66.70
|
| Rate for Payer: Anthem Medicare Advantage |
$73.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$190.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$73.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$73.37
|
| Rate for Payer: Cash Price |
$107.70
|
| Rate for Payer: Cash Price |
$107.70
|
| Rate for Payer: Cigna Commercial |
$330.28
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$73.37
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$66.70
|
| Rate for Payer: Dean Health Medicaid |
$66.70
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$73.37
|
| Rate for Payer: Health EOS Commercial |
$319.51
|
| Rate for Payer: HFN Commercial |
$330.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$272.94
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$73.37
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$66.70
|
| Rate for Payer: Independent Care Health Plan Medicare |
$73.37
|
| Rate for Payer: Managed Health Services Medicaid |
$69.37
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$73.37
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$73.37
|
| Rate for Payer: Multiplan Commercial |
$287.20
|
| Rate for Payer: NAPHCARE Commercial |
$110.06
|
| Rate for Payer: Preferred Network Access Commercial |
$330.28
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$66.70
|
| Rate for Payer: Quartz Beloit One Network |
$175.91
|
| Rate for Payer: Quartz Commercial |
$233.35
|
| Rate for Payer: Quartz Medicare Advantage |
$73.37
|
| Rate for Payer: The Alliance Commercial |
$1,436.00
|
| Rate for Payer: United Healthcare Medicaid |
$66.70
|
| Rate for Payer: United Healthcare Medicare Advantage |
$73.37
|
| Rate for Payer: United Healthcare PPO |
$269.25
|
| Rate for Payer: WEA Trust Commercial |
$197.45
|
| Rate for Payer: Wellcare Medicare |
$73.37
|
| Rate for Payer: WMAP Medicaid |
$66.70
|
| Rate for Payer: WPS Commercial |
$265.91
|
|
|
TSII-Factor V (Leiden) Mutation
|
Facility
IP
|
$359.00
|
|
|
Service Code
|
CPT 81241
|
| Hospital Charge Code |
4066514
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$175.91 |
| Max. Negotiated Rate |
$330.28 |
| Rate for Payer: Aetna Commercial |
$323.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$190.27
|
| Rate for Payer: Cash Price |
$107.70
|
| Rate for Payer: Cigna Commercial |
$330.28
|
| Rate for Payer: Health EOS Commercial |
$319.51
|
| Rate for Payer: HFN Commercial |
$330.28
|
| Rate for Payer: Multiplan Commercial |
$287.20
|
| Rate for Payer: NAPHCARE Commercial |
$215.40
|
| Rate for Payer: Preferred Network Access Commercial |
$330.28
|
| Rate for Payer: Quartz Beloit One Network |
$175.91
|
| Rate for Payer: Quartz Commercial |
$215.40
|
| Rate for Payer: WEA Trust Commercial |
$197.45
|
| Rate for Payer: WPS Commercial |
$265.91
|
|
|
TSII-Factor V (Leiden) Mutation
|
Professional
|
$359.00
|
|
|
Service Code
|
CPT 81241
|
| Hospital Charge Code |
4066514
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$73.37 |
| Max. Negotiated Rate |
$341.05 |
| Rate for Payer: Aetna Commercial |
$341.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$308.74
|
| Rate for Payer: Aetna Managed Medicare |
$73.37
|
| Rate for Payer: Anthem Medicare Advantage |
$73.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$73.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$73.37
|
| Rate for Payer: Cash Price |
$107.70
|
| Rate for Payer: Cash Price |
$107.70
|
| Rate for Payer: Cigna Commercial |
$341.05
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$179.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$73.37
|
| Rate for Payer: Health EOS Commercial |
$326.69
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$259.00
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$259.00
|
| Rate for Payer: Independent Care Health Plan Medicare |
$73.37
|
| Rate for Payer: Multiplan Commercial |
$287.20
|
| Rate for Payer: Preferred Network Access Commercial |
$341.05
|
| Rate for Payer: Quartz Beloit One Network |
$157.96
|
| Rate for Payer: Quartz Commercial |
$204.63
|
| Rate for Payer: Quartz Medicare Advantage |
$73.37
|
| Rate for Payer: The Alliance Commercial |
$289.81
|
| Rate for Payer: United Healthcare Medicare Advantage |
$73.37
|
| Rate for Payer: WEA Trust Commercial |
$197.45
|
| Rate for Payer: WPS Commercial |
$322.83
|
|
|
TSII-PGA Mutation
|
Facility
OP
|
$430.00
|
|
|
Service Code
|
CPT 81240
|
| Hospital Charge Code |
4066515
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$53.70 |
| Max. Negotiated Rate |
$1,720.00 |
| Rate for Payer: Aetna Commercial |
$387.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$369.80
|
| Rate for Payer: Aetna Managed Medicare |
$65.69
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$246.34
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$114.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$109.05
|
| Rate for Payer: Anthem Medicaid |
$53.70
|
| Rate for Payer: Anthem Medicare Advantage |
$65.69
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$227.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$65.69
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$65.69
|
| Rate for Payer: Cash Price |
$129.00
|
| Rate for Payer: Cash Price |
$129.00
|
| Rate for Payer: Cigna Commercial |
$395.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$65.69
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$53.70
|
| Rate for Payer: Dean Health Medicaid |
$53.70
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$65.69
|
| Rate for Payer: Health EOS Commercial |
$382.70
|
| Rate for Payer: HFN Commercial |
$395.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$244.37
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$65.69
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$53.70
|
| Rate for Payer: Independent Care Health Plan Medicare |
$65.69
|
| Rate for Payer: Managed Health Services Medicaid |
$55.85
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$65.69
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$65.69
|
| Rate for Payer: Multiplan Commercial |
$344.00
|
| Rate for Payer: NAPHCARE Commercial |
$98.54
|
| Rate for Payer: Preferred Network Access Commercial |
$395.60
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$53.70
|
| Rate for Payer: Quartz Beloit One Network |
$210.70
|
| Rate for Payer: Quartz Commercial |
$279.50
|
| Rate for Payer: Quartz Medicare Advantage |
$65.69
|
| Rate for Payer: The Alliance Commercial |
$1,720.00
|
| Rate for Payer: United Healthcare Medicaid |
$53.70
|
| Rate for Payer: United Healthcare Medicare Advantage |
$65.69
|
| Rate for Payer: United Healthcare PPO |
$322.50
|
| Rate for Payer: WEA Trust Commercial |
$236.50
|
| Rate for Payer: Wellcare Medicare |
$65.69
|
| Rate for Payer: WMAP Medicaid |
$53.70
|
| Rate for Payer: WPS Commercial |
$318.50
|
|
|
TSII-PGA Mutation
|
Professional
|
$430.00
|
|
|
Service Code
|
CPT 81240
|
| Hospital Charge Code |
4066515
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$65.69 |
| Max. Negotiated Rate |
$408.50 |
| Rate for Payer: Aetna Commercial |
$408.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$369.80
|
| Rate for Payer: Aetna Managed Medicare |
$65.69
|
| Rate for Payer: Anthem Medicare Advantage |
$65.69
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$65.69
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$65.69
|
| Rate for Payer: Cash Price |
$129.00
|
| Rate for Payer: Cash Price |
$129.00
|
| Rate for Payer: Cigna Commercial |
$408.50
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$215.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$65.69
|
| Rate for Payer: Health EOS Commercial |
$391.30
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$231.89
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$231.89
|
| Rate for Payer: Independent Care Health Plan Medicare |
$65.69
|
| Rate for Payer: Multiplan Commercial |
$344.00
|
| Rate for Payer: Preferred Network Access Commercial |
$408.50
|
| Rate for Payer: Quartz Beloit One Network |
$189.20
|
| Rate for Payer: Quartz Commercial |
$245.10
|
| Rate for Payer: Quartz Medicare Advantage |
$65.69
|
| Rate for Payer: The Alliance Commercial |
$259.48
|
| Rate for Payer: United Healthcare Medicare Advantage |
$65.69
|
| Rate for Payer: WEA Trust Commercial |
$236.50
|
| Rate for Payer: WPS Commercial |
$289.04
|
|
|
TSII-PGA Mutation
|
Facility
IP
|
$430.00
|
|
|
Service Code
|
CPT 81240
|
| Hospital Charge Code |
4066515
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$210.70 |
| Max. Negotiated Rate |
$395.60 |
| Rate for Payer: Aetna Commercial |
$387.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$227.90
|
| Rate for Payer: Cash Price |
$129.00
|
| Rate for Payer: Cigna Commercial |
$395.60
|
| Rate for Payer: Health EOS Commercial |
$382.70
|
| Rate for Payer: HFN Commercial |
$395.60
|
| Rate for Payer: Multiplan Commercial |
$344.00
|
| Rate for Payer: NAPHCARE Commercial |
$258.00
|
| Rate for Payer: Preferred Network Access Commercial |
$395.60
|
| Rate for Payer: Quartz Beloit One Network |
$210.70
|
| Rate for Payer: Quartz Commercial |
$258.00
|
| Rate for Payer: WEA Trust Commercial |
$236.50
|
| Rate for Payer: WPS Commercial |
$318.50
|
|
|
TSII-Protein C Activity
|
Facility
OP
|
$283.00
|
|
|
Service Code
|
CPT 85303
|
| Hospital Charge Code |
4066517
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.84 |
| Max. Negotiated Rate |
$1,132.00 |
| Rate for Payer: Aetna Commercial |
$254.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$243.38
|
| Rate for Payer: Aetna Managed Medicare |
$13.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$51.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$24.22
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$22.97
|
| Rate for Payer: Anthem Medicaid |
$14.30
|
| Rate for Payer: Anthem Medicare Advantage |
$13.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$149.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$13.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$13.84
|
| Rate for Payer: Cash Price |
$84.90
|
| Rate for Payer: Cash Price |
$84.90
|
| Rate for Payer: Cigna Commercial |
$260.36
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$13.84
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$14.30
|
| Rate for Payer: Dean Health Medicaid |
$14.30
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$13.84
|
| Rate for Payer: Health EOS Commercial |
$251.87
|
| Rate for Payer: HFN Commercial |
$260.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$51.48
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$13.84
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$14.30
|
| Rate for Payer: Independent Care Health Plan Medicare |
$13.84
|
| Rate for Payer: Managed Health Services Medicaid |
$14.87
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$13.84
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$13.84
|
| Rate for Payer: Multiplan Commercial |
$226.40
|
| Rate for Payer: NAPHCARE Commercial |
$20.76
|
| Rate for Payer: Preferred Network Access Commercial |
$260.36
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$14.30
|
| Rate for Payer: Quartz Beloit One Network |
$138.67
|
| Rate for Payer: Quartz Commercial |
$183.95
|
| Rate for Payer: Quartz Medicare Advantage |
$13.84
|
| Rate for Payer: The Alliance Commercial |
$1,132.00
|
| Rate for Payer: United Healthcare Medicaid |
$14.30
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.84
|
| Rate for Payer: United Healthcare PPO |
$212.25
|
| Rate for Payer: WEA Trust Commercial |
$155.65
|
| Rate for Payer: Wellcare Medicare |
$13.84
|
| Rate for Payer: WMAP Medicaid |
$14.30
|
| Rate for Payer: WPS Commercial |
$209.62
|
|
|
TSII-Protein C Activity
|
Professional
|
$283.00
|
|
|
Service Code
|
CPT 85303
|
| Hospital Charge Code |
4066517
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.84 |
| Max. Negotiated Rate |
$268.85 |
| Rate for Payer: Aetna Commercial |
$268.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$243.38
|
| Rate for Payer: Aetna Managed Medicare |
$13.84
|
| Rate for Payer: Anthem Medicare Advantage |
$13.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$13.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$13.84
|
| Rate for Payer: Cash Price |
$84.90
|
| Rate for Payer: Cash Price |
$84.90
|
| Rate for Payer: Cigna Commercial |
$268.85
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$141.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$13.84
|
| Rate for Payer: Health EOS Commercial |
$257.53
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$48.86
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$48.86
|
| Rate for Payer: Independent Care Health Plan Medicare |
$13.84
|
| Rate for Payer: Multiplan Commercial |
$226.40
|
| Rate for Payer: Preferred Network Access Commercial |
$268.85
|
| Rate for Payer: Quartz Beloit One Network |
$124.52
|
| Rate for Payer: Quartz Commercial |
$161.31
|
| Rate for Payer: Quartz Medicare Advantage |
$13.84
|
| Rate for Payer: The Alliance Commercial |
$54.67
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.84
|
| Rate for Payer: WEA Trust Commercial |
$155.65
|
| Rate for Payer: WPS Commercial |
$60.90
|
|
|
TSII-Protein C Activity
|
Facility
IP
|
$283.00
|
|
|
Service Code
|
CPT 85303
|
| Hospital Charge Code |
4066517
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$138.67 |
| Max. Negotiated Rate |
$260.36 |
| Rate for Payer: Aetna Commercial |
$254.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$149.99
|
| Rate for Payer: Cash Price |
$84.90
|
| Rate for Payer: Cigna Commercial |
$260.36
|
| Rate for Payer: Health EOS Commercial |
$251.87
|
| Rate for Payer: HFN Commercial |
$260.36
|
| Rate for Payer: Multiplan Commercial |
$226.40
|
| Rate for Payer: NAPHCARE Commercial |
$169.80
|
| Rate for Payer: Preferred Network Access Commercial |
$260.36
|
| Rate for Payer: Quartz Beloit One Network |
$138.67
|
| Rate for Payer: Quartz Commercial |
$169.80
|
| Rate for Payer: WEA Trust Commercial |
$155.65
|
| Rate for Payer: WPS Commercial |
$209.62
|
|
|
TSII-Protein S Antigen, Free
|
Professional
|
$201.00
|
|
|
Service Code
|
CPT 85306
|
| Hospital Charge Code |
4066518
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.32 |
| Max. Negotiated Rate |
$190.95 |
| Rate for Payer: Aetna Commercial |
$190.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$172.86
|
| Rate for Payer: Aetna Managed Medicare |
$15.32
|
| Rate for Payer: Anthem Medicare Advantage |
$15.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$15.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$15.32
|
| Rate for Payer: Cash Price |
$60.30
|
| Rate for Payer: Cash Price |
$60.30
|
| Rate for Payer: Cigna Commercial |
$190.95
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$100.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$15.32
|
| Rate for Payer: Health EOS Commercial |
$182.91
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$54.08
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$54.08
|
| Rate for Payer: Independent Care Health Plan Medicare |
$15.32
|
| Rate for Payer: Multiplan Commercial |
$160.80
|
| Rate for Payer: Preferred Network Access Commercial |
$190.95
|
| Rate for Payer: Quartz Beloit One Network |
$88.44
|
| Rate for Payer: Quartz Commercial |
$114.57
|
| Rate for Payer: Quartz Medicare Advantage |
$15.32
|
| Rate for Payer: The Alliance Commercial |
$60.51
|
| Rate for Payer: United Healthcare Medicare Advantage |
$15.32
|
| Rate for Payer: WEA Trust Commercial |
$110.55
|
| Rate for Payer: WPS Commercial |
$67.41
|
|
|
TSII-Protein S Antigen, Free
|
Facility
OP
|
$201.00
|
|
|
Service Code
|
CPT 85306
|
| Hospital Charge Code |
4066518
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.32 |
| Max. Negotiated Rate |
$804.00 |
| Rate for Payer: Aetna Commercial |
$180.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$172.86
|
| Rate for Payer: Aetna Managed Medicare |
$15.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$57.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$26.81
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$25.43
|
| Rate for Payer: Anthem Medicaid |
$15.83
|
| Rate for Payer: Anthem Medicare Advantage |
$15.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$106.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$15.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$15.32
|
| Rate for Payer: Cash Price |
$60.30
|
| Rate for Payer: Cash Price |
$60.30
|
| Rate for Payer: Cigna Commercial |
$184.92
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$15.32
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$15.83
|
| Rate for Payer: Dean Health Medicaid |
$15.83
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$15.32
|
| Rate for Payer: Health EOS Commercial |
$178.89
|
| Rate for Payer: HFN Commercial |
$184.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$56.99
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$15.32
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$15.83
|
| Rate for Payer: Independent Care Health Plan Medicare |
$15.32
|
| Rate for Payer: Managed Health Services Medicaid |
$16.46
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$15.32
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$15.32
|
| Rate for Payer: Multiplan Commercial |
$160.80
|
| Rate for Payer: NAPHCARE Commercial |
$22.98
|
| Rate for Payer: Preferred Network Access Commercial |
$184.92
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$15.83
|
| Rate for Payer: Quartz Beloit One Network |
$98.49
|
| Rate for Payer: Quartz Commercial |
$130.65
|
| Rate for Payer: Quartz Medicare Advantage |
$15.32
|
| Rate for Payer: The Alliance Commercial |
$804.00
|
| Rate for Payer: United Healthcare Medicaid |
$15.83
|
| Rate for Payer: United Healthcare Medicare Advantage |
$15.32
|
| Rate for Payer: United Healthcare PPO |
$150.75
|
| Rate for Payer: WEA Trust Commercial |
$110.55
|
| Rate for Payer: Wellcare Medicare |
$15.32
|
| Rate for Payer: WMAP Medicaid |
$15.83
|
| Rate for Payer: WPS Commercial |
$148.88
|
|
|
TSII-Protein S Antigen, Free
|
Facility
IP
|
$201.00
|
|
|
Service Code
|
CPT 85306
|
| Hospital Charge Code |
4066518
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$98.49 |
| Max. Negotiated Rate |
$184.92 |
| Rate for Payer: Aetna Commercial |
$180.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$106.53
|
| Rate for Payer: Cash Price |
$60.30
|
| Rate for Payer: Cigna Commercial |
$184.92
|
| Rate for Payer: Health EOS Commercial |
$178.89
|
| Rate for Payer: HFN Commercial |
$184.92
|
| Rate for Payer: Multiplan Commercial |
$160.80
|
| Rate for Payer: NAPHCARE Commercial |
$120.60
|
| Rate for Payer: Preferred Network Access Commercial |
$184.92
|
| Rate for Payer: Quartz Beloit One Network |
$98.49
|
| Rate for Payer: Quartz Commercial |
$120.60
|
| Rate for Payer: WEA Trust Commercial |
$110.55
|
| Rate for Payer: WPS Commercial |
$148.88
|
|
|
T-TUBE 10 FRENCH
|
Facility
OP
|
$196.00
|
|
| Hospital Charge Code |
2975043
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$54.88 |
| Max. Negotiated Rate |
$784.00 |
| Rate for Payer: Aetna Commercial |
$176.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$168.56
|
| Rate for Payer: Aetna Managed Medicare |
$54.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$127.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$98.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$94.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$103.88
|
| Rate for Payer: Cash Price |
$58.80
|
| Rate for Payer: Cigna Commercial |
$180.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$109.68
|
| Rate for Payer: Health EOS Commercial |
$174.44
|
| Rate for Payer: HFN Commercial |
$180.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$147.00
|
| Rate for Payer: Multiplan Commercial |
$156.80
|
| Rate for Payer: NAPHCARE Commercial |
$117.60
|
| Rate for Payer: Preferred Network Access Commercial |
$180.32
|
| Rate for Payer: Quartz Beloit One Network |
$96.04
|
| Rate for Payer: Quartz Commercial |
$127.40
|
| Rate for Payer: Quartz Medicare Advantage |
$117.60
|
| Rate for Payer: The Alliance Commercial |
$784.00
|
| Rate for Payer: WEA Trust Commercial |
$107.80
|
| Rate for Payer: WPS Commercial |
$145.18
|
|
|
T-TUBE 10 FRENCH
|
Facility
IP
|
$196.00
|
|
| Hospital Charge Code |
2975043
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$96.04 |
| Max. Negotiated Rate |
$180.32 |
| Rate for Payer: Aetna Commercial |
$176.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$103.88
|
| Rate for Payer: Cash Price |
$58.80
|
| Rate for Payer: Cigna Commercial |
$180.32
|
| Rate for Payer: Health EOS Commercial |
$174.44
|
| Rate for Payer: HFN Commercial |
$180.32
|
| Rate for Payer: Multiplan Commercial |
$156.80
|
| Rate for Payer: NAPHCARE Commercial |
$117.60
|
| Rate for Payer: Preferred Network Access Commercial |
$180.32
|
| Rate for Payer: Quartz Beloit One Network |
$96.04
|
| Rate for Payer: Quartz Commercial |
$117.60
|
| Rate for Payer: WEA Trust Commercial |
$107.80
|
| Rate for Payer: WPS Commercial |
$145.18
|
|
|
T-TUBE 12 FRENCH SU130-1238
|
Facility
IP
|
$196.00
|
|
| Hospital Charge Code |
2975042
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$96.04 |
| Max. Negotiated Rate |
$180.32 |
| Rate for Payer: Aetna Commercial |
$176.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$103.88
|
| Rate for Payer: Cash Price |
$58.80
|
| Rate for Payer: Cigna Commercial |
$180.32
|
| Rate for Payer: Health EOS Commercial |
$174.44
|
| Rate for Payer: HFN Commercial |
$180.32
|
| Rate for Payer: Multiplan Commercial |
$156.80
|
| Rate for Payer: NAPHCARE Commercial |
$117.60
|
| Rate for Payer: Preferred Network Access Commercial |
$180.32
|
| Rate for Payer: Quartz Beloit One Network |
$96.04
|
| Rate for Payer: Quartz Commercial |
$117.60
|
| Rate for Payer: WEA Trust Commercial |
$107.80
|
| Rate for Payer: WPS Commercial |
$145.18
|
|
|
T-TUBE 12 FRENCH SU130-1238
|
Facility
OP
|
$196.00
|
|
| Hospital Charge Code |
2975042
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$54.88 |
| Max. Negotiated Rate |
$784.00 |
| Rate for Payer: Aetna Commercial |
$176.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$168.56
|
| Rate for Payer: Aetna Managed Medicare |
$54.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$127.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$98.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$94.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$103.88
|
| Rate for Payer: Cash Price |
$58.80
|
| Rate for Payer: Cigna Commercial |
$180.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$109.68
|
| Rate for Payer: Health EOS Commercial |
$174.44
|
| Rate for Payer: HFN Commercial |
$180.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$147.00
|
| Rate for Payer: Multiplan Commercial |
$156.80
|
| Rate for Payer: NAPHCARE Commercial |
$117.60
|
| Rate for Payer: Preferred Network Access Commercial |
$180.32
|
| Rate for Payer: Quartz Beloit One Network |
$96.04
|
| Rate for Payer: Quartz Commercial |
$127.40
|
| Rate for Payer: Quartz Medicare Advantage |
$117.60
|
| Rate for Payer: The Alliance Commercial |
$784.00
|
| Rate for Payer: WEA Trust Commercial |
$107.80
|
| Rate for Payer: WPS Commercial |
$145.18
|
|
|
T-TUBE 14 FRENCH
|
Facility
OP
|
$196.00
|
|
| Hospital Charge Code |
2963378
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$54.88 |
| Max. Negotiated Rate |
$784.00 |
| Rate for Payer: Aetna Commercial |
$176.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$168.56
|
| Rate for Payer: Aetna Managed Medicare |
$54.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$127.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$98.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$94.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$103.88
|
| Rate for Payer: Cash Price |
$58.80
|
| Rate for Payer: Cigna Commercial |
$180.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$109.68
|
| Rate for Payer: Health EOS Commercial |
$174.44
|
| Rate for Payer: HFN Commercial |
$180.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$147.00
|
| Rate for Payer: Multiplan Commercial |
$156.80
|
| Rate for Payer: NAPHCARE Commercial |
$117.60
|
| Rate for Payer: Preferred Network Access Commercial |
$180.32
|
| Rate for Payer: Quartz Beloit One Network |
$96.04
|
| Rate for Payer: Quartz Commercial |
$127.40
|
| Rate for Payer: Quartz Medicare Advantage |
$117.60
|
| Rate for Payer: The Alliance Commercial |
$784.00
|
| Rate for Payer: WEA Trust Commercial |
$107.80
|
| Rate for Payer: WPS Commercial |
$145.18
|
|
|
T-TUBE 14 FRENCH
|
Facility
IP
|
$196.00
|
|
| Hospital Charge Code |
2963378
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$96.04 |
| Max. Negotiated Rate |
$180.32 |
| Rate for Payer: Aetna Commercial |
$176.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$103.88
|
| Rate for Payer: Cash Price |
$58.80
|
| Rate for Payer: Cigna Commercial |
$180.32
|
| Rate for Payer: Health EOS Commercial |
$174.44
|
| Rate for Payer: HFN Commercial |
$180.32
|
| Rate for Payer: Multiplan Commercial |
$156.80
|
| Rate for Payer: NAPHCARE Commercial |
$117.60
|
| Rate for Payer: Preferred Network Access Commercial |
$180.32
|
| Rate for Payer: Quartz Beloit One Network |
$96.04
|
| Rate for Payer: Quartz Commercial |
$117.60
|
| Rate for Payer: WEA Trust Commercial |
$107.80
|
| Rate for Payer: WPS Commercial |
$145.18
|
|
|
T-TUBE 16 FRENCH SU130-1240
|
Facility
IP
|
$196.00
|
|
| Hospital Charge Code |
2963377
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$96.04 |
| Max. Negotiated Rate |
$180.32 |
| Rate for Payer: Aetna Commercial |
$176.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$103.88
|
| Rate for Payer: Cash Price |
$58.80
|
| Rate for Payer: Cigna Commercial |
$180.32
|
| Rate for Payer: Health EOS Commercial |
$174.44
|
| Rate for Payer: HFN Commercial |
$180.32
|
| Rate for Payer: Multiplan Commercial |
$156.80
|
| Rate for Payer: NAPHCARE Commercial |
$117.60
|
| Rate for Payer: Preferred Network Access Commercial |
$180.32
|
| Rate for Payer: Quartz Beloit One Network |
$96.04
|
| Rate for Payer: Quartz Commercial |
$117.60
|
| Rate for Payer: WEA Trust Commercial |
$107.80
|
| Rate for Payer: WPS Commercial |
$145.18
|
|
