|
THERAPY SYSTEM V.A.C.VIA WOUND VAC VIAKIT077D01/US
|
Facility
|
IP
|
$4,806.00
|
|
| Hospital Charge Code |
5415563
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,449.14 |
| Max. Negotiated Rate |
$4,598.38 |
| Rate for Payer: Aetna Commercial |
$4,498.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,298.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,649.07
|
| Rate for Payer: Cash Price |
$1,441.80
|
| Rate for Payer: Cigna Commercial |
$4,598.38
|
| Rate for Payer: Health EOS Commercial |
$4,448.43
|
| Rate for Payer: HFN Commercial |
$4,598.38
|
| Rate for Payer: Multiplan Commercial |
$3,998.59
|
| Rate for Payer: Preferred Network Access Commercial |
$4,598.38
|
| Rate for Payer: Quartz Beloit One Network |
$2,449.14
|
| Rate for Payer: Quartz Commercial |
$2,998.94
|
| Rate for Payer: WEA Trust Commercial |
$2,749.03
|
| Rate for Payer: WPS Commercial |
$3,702.06
|
|
|
THERAPY SYSTEM V.A.C.VIA WOUND VAC VIAKIT077D01/US
|
Facility
|
OP
|
$4,806.00
|
|
| Hospital Charge Code |
5415563
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,399.51 |
| Max. Negotiated Rate |
$4,598.38 |
| Rate for Payer: Aetna Commercial |
$4,498.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,298.49
|
| Rate for Payer: Aetna Managed Medicare |
$1,399.51
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,248.86
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,499.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,399.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,649.07
|
| Rate for Payer: Cash Price |
$1,441.80
|
| Rate for Payer: Cigna Commercial |
$4,598.38
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,797.09
|
| Rate for Payer: Health EOS Commercial |
$4,448.43
|
| Rate for Payer: HFN Commercial |
$4,598.38
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,748.68
|
| Rate for Payer: Multiplan Commercial |
$3,998.59
|
| Rate for Payer: NAPHCARE Commercial |
$2,998.94
|
| Rate for Payer: Preferred Network Access Commercial |
$4,598.38
|
| Rate for Payer: Quartz Beloit One Network |
$2,449.14
|
| Rate for Payer: Quartz Commercial |
$3,248.86
|
| Rate for Payer: Quartz Medicare Advantage |
$2,998.94
|
| Rate for Payer: The Alliance Commercial |
$2,499.12
|
| Rate for Payer: WEA Trust Commercial |
$2,749.03
|
| Rate for Payer: WPS Commercial |
$3,702.06
|
|
|
Therapy vest
|
Facility
|
OP
|
$134.00
|
|
|
Service Code
|
CPT 94667
|
| Hospital Charge Code |
2989709
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$66.89 |
| Max. Negotiated Rate |
$560.06 |
| Rate for Payer: Aetna Commercial |
$125.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$119.85
|
| Rate for Payer: Aetna Managed Medicare |
$140.02
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$90.58
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$69.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$66.89
|
| Rate for Payer: Anthem Medicare Advantage |
$140.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$73.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$140.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$140.02
|
| Rate for Payer: Cash Price |
$40.20
|
| Rate for Payer: Cash Price |
$40.20
|
| Rate for Payer: Cigna Commercial |
$128.21
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$140.02
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$77.99
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$140.02
|
| Rate for Payer: Health EOS Commercial |
$124.03
|
| Rate for Payer: HFN Commercial |
$128.21
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$520.86
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$140.02
|
| Rate for Payer: Independent Care Health Plan Medicare |
$140.02
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$140.02
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$140.02
|
| Rate for Payer: Multiplan Commercial |
$111.49
|
| Rate for Payer: NAPHCARE Commercial |
$210.02
|
| Rate for Payer: Preferred Network Access Commercial |
$128.21
|
| Rate for Payer: Quartz Beloit One Network |
$68.29
|
| Rate for Payer: Quartz Commercial |
$90.58
|
| Rate for Payer: Quartz Medicare Advantage |
$140.02
|
| Rate for Payer: The Alliance Commercial |
$560.06
|
| Rate for Payer: United Healthcare Medicare Advantage |
$140.02
|
| Rate for Payer: United Healthcare PPO |
$104.52
|
| Rate for Payer: WEA Trust Commercial |
$76.65
|
| Rate for Payer: Wellcare Medicare |
$140.02
|
| Rate for Payer: WPS Commercial |
$103.22
|
|
|
Therapy vest
|
Facility
|
IP
|
$134.00
|
|
|
Service Code
|
CPT 94667
|
| Hospital Charge Code |
2989709
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$68.29 |
| Max. Negotiated Rate |
$128.21 |
| Rate for Payer: Aetna Commercial |
$125.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$119.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$73.86
|
| Rate for Payer: Cash Price |
$40.20
|
| Rate for Payer: Cigna Commercial |
$128.21
|
| Rate for Payer: Health EOS Commercial |
$124.03
|
| Rate for Payer: HFN Commercial |
$128.21
|
| Rate for Payer: Multiplan Commercial |
$111.49
|
| Rate for Payer: Preferred Network Access Commercial |
$128.21
|
| Rate for Payer: Quartz Beloit One Network |
$68.29
|
| Rate for Payer: Quartz Commercial |
$83.62
|
| Rate for Payer: WEA Trust Commercial |
$76.65
|
| Rate for Payer: WPS Commercial |
$103.22
|
|
|
Ther Injection, Carp Tunnel 2052650
|
Professional
|
Both
|
$509.00
|
|
|
Service Code
|
CPT 20526 50
|
| Hospital Charge Code |
3190198
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$26.93 |
| Max. Negotiated Rate |
$502.89 |
| Rate for Payer: Aetna Commercial |
$502.89
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$455.25
|
| Rate for Payer: Cash Price |
$152.70
|
| Rate for Payer: Cash Price |
$152.70
|
| Rate for Payer: Cash Price |
$152.70
|
| Rate for Payer: Cigna Commercial |
$502.89
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$26.93
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$317.62
|
| Rate for Payer: Health EOS Commercial |
$481.72
|
| Rate for Payer: HFN Commercial |
$502.89
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$195.27
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$195.27
|
| Rate for Payer: Multiplan Commercial |
$423.49
|
| Rate for Payer: Preferred Network Access Commercial |
$502.89
|
| Rate for Payer: Quartz Beloit One Network |
$232.92
|
| Rate for Payer: Quartz Commercial |
$301.74
|
| Rate for Payer: The Alliance Commercial |
$264.68
|
| Rate for Payer: United Healthcare Medicaid |
$26.93
|
| Rate for Payer: WEA Trust Commercial |
$291.15
|
| Rate for Payer: WPS Commercial |
$392.08
|
|
|
THERMAL DESTRUCTION OF INTRAOSSEOUS BASIVERTEBRAL NERVE, INCLUDING ALL IMAGING GUIDANCE; EACH ADDITIONAL VERTEBRAL BODY, LUMBAR OR SACRAL (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)
|
Facility
|
OP
|
$653.16
|
|
|
Service Code
|
CPT 64629
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$653.16 |
| Max. Negotiated Rate |
$653.16 |
| Rate for Payer: The Alliance Commercial |
$653.16
|
|
|
THERMAL DESTRUCTION OF INTRAOSSEOUS BASIVERTEBRAL NERVE, INCLUDING ALL IMAGING GUIDANCE; FIRST 2 VERTEBRAL BODIES, LUMBAR OR SACRAL
|
Facility
|
OP
|
$54,045.18
|
|
|
Service Code
|
CPT 64628
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$13,511.30 |
| Max. Negotiated Rate |
$54,045.18 |
| Rate for Payer: Aetna Managed Medicare |
$13,511.30
|
| Rate for Payer: Anthem Medicare Advantage |
$13,511.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$13,511.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$13,511.30
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$13,511.30
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$13,511.30
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$50,262.02
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$13,511.30
|
| Rate for Payer: Independent Care Health Plan Medicare |
$13,511.30
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$13,511.30
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$13,511.30
|
| Rate for Payer: NAPHCARE Commercial |
$20,266.94
|
| Rate for Payer: Quartz Medicare Advantage |
$13,511.30
|
| Rate for Payer: The Alliance Commercial |
$54,045.18
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13,511.30
|
| Rate for Payer: Wellcare Medicare |
$13,511.30
|
|
|
THERMASHELL CHARGE REFILL PACK
|
Facility
|
IP
|
$1,099.00
|
|
| Hospital Charge Code |
2972013
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$560.05 |
| Max. Negotiated Rate |
$1,051.52 |
| Rate for Payer: Aetna Commercial |
$1,028.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$982.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$605.77
|
| Rate for Payer: Cash Price |
$329.70
|
| Rate for Payer: Cigna Commercial |
$1,051.52
|
| Rate for Payer: Health EOS Commercial |
$1,017.23
|
| Rate for Payer: HFN Commercial |
$1,051.52
|
| Rate for Payer: Multiplan Commercial |
$914.37
|
| Rate for Payer: Preferred Network Access Commercial |
$1,051.52
|
| Rate for Payer: Quartz Beloit One Network |
$560.05
|
| Rate for Payer: Quartz Commercial |
$685.78
|
| Rate for Payer: WEA Trust Commercial |
$628.63
|
| Rate for Payer: WPS Commercial |
$846.56
|
|
|
THERMASHELL CHARGE REFILL PACK
|
Facility
|
OP
|
$1,099.00
|
|
| Hospital Charge Code |
2972013
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$320.03 |
| Max. Negotiated Rate |
$1,051.52 |
| Rate for Payer: Aetna Commercial |
$1,028.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$982.95
|
| Rate for Payer: Aetna Managed Medicare |
$320.03
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$742.92
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$571.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$548.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$605.77
|
| Rate for Payer: Cash Price |
$329.70
|
| Rate for Payer: Cigna Commercial |
$1,051.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$639.62
|
| Rate for Payer: Health EOS Commercial |
$1,017.23
|
| Rate for Payer: HFN Commercial |
$1,051.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$857.22
|
| Rate for Payer: Multiplan Commercial |
$914.37
|
| Rate for Payer: NAPHCARE Commercial |
$685.78
|
| Rate for Payer: Preferred Network Access Commercial |
$1,051.52
|
| Rate for Payer: Quartz Beloit One Network |
$560.05
|
| Rate for Payer: Quartz Commercial |
$742.92
|
| Rate for Payer: Quartz Medicare Advantage |
$685.78
|
| Rate for Payer: The Alliance Commercial |
$571.48
|
| Rate for Payer: WEA Trust Commercial |
$628.63
|
| Rate for Payer: WPS Commercial |
$846.56
|
|
|
THERMOMETER RECTAL & ESOPH 9FR
|
Facility
|
IP
|
$94.00
|
|
| Hospital Charge Code |
2964052
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$47.90 |
| Max. Negotiated Rate |
$89.94 |
| Rate for Payer: Aetna Commercial |
$87.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$84.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$51.81
|
| Rate for Payer: Cash Price |
$28.20
|
| Rate for Payer: Cigna Commercial |
$89.94
|
| Rate for Payer: Health EOS Commercial |
$87.01
|
| Rate for Payer: HFN Commercial |
$89.94
|
| Rate for Payer: Multiplan Commercial |
$78.21
|
| Rate for Payer: Preferred Network Access Commercial |
$89.94
|
| Rate for Payer: Quartz Beloit One Network |
$47.90
|
| Rate for Payer: Quartz Commercial |
$58.66
|
| Rate for Payer: WEA Trust Commercial |
$53.77
|
| Rate for Payer: WPS Commercial |
$72.41
|
|
|
THERMOMETER RECTAL & ESOPH 9FR
|
Facility
|
OP
|
$94.00
|
|
| Hospital Charge Code |
2964052
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$27.37 |
| Max. Negotiated Rate |
$89.94 |
| Rate for Payer: Aetna Commercial |
$87.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$84.07
|
| Rate for Payer: Aetna Managed Medicare |
$27.37
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$63.54
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$48.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$46.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$51.81
|
| Rate for Payer: Cash Price |
$28.20
|
| Rate for Payer: Cigna Commercial |
$89.94
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$54.71
|
| Rate for Payer: Health EOS Commercial |
$87.01
|
| Rate for Payer: HFN Commercial |
$89.94
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$73.32
|
| Rate for Payer: Multiplan Commercial |
$78.21
|
| Rate for Payer: NAPHCARE Commercial |
$58.66
|
| Rate for Payer: Preferred Network Access Commercial |
$89.94
|
| Rate for Payer: Quartz Beloit One Network |
$47.90
|
| Rate for Payer: Quartz Commercial |
$63.54
|
| Rate for Payer: Quartz Medicare Advantage |
$58.66
|
| Rate for Payer: The Alliance Commercial |
$48.88
|
| Rate for Payer: WEA Trust Commercial |
$53.77
|
| Rate for Payer: WPS Commercial |
$72.41
|
|
|
THERMOSET #414240403
|
Facility
|
IP
|
$344.00
|
|
| Hospital Charge Code |
2963892
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$175.30 |
| Max. Negotiated Rate |
$329.14 |
| Rate for Payer: Aetna Commercial |
$321.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$307.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$189.61
|
| Rate for Payer: Cash Price |
$103.20
|
| Rate for Payer: Cigna Commercial |
$329.14
|
| Rate for Payer: Health EOS Commercial |
$318.41
|
| Rate for Payer: HFN Commercial |
$329.14
|
| Rate for Payer: Multiplan Commercial |
$286.21
|
| Rate for Payer: Preferred Network Access Commercial |
$329.14
|
| Rate for Payer: Quartz Beloit One Network |
$175.30
|
| Rate for Payer: Quartz Commercial |
$214.66
|
| Rate for Payer: WEA Trust Commercial |
$196.77
|
| Rate for Payer: WPS Commercial |
$264.98
|
|
|
THERMOSET #414240403
|
Facility
|
OP
|
$344.00
|
|
| Hospital Charge Code |
2963892
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$100.17 |
| Max. Negotiated Rate |
$329.14 |
| Rate for Payer: Aetna Commercial |
$321.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$307.67
|
| Rate for Payer: Aetna Managed Medicare |
$100.17
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$232.54
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$178.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$171.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$189.61
|
| Rate for Payer: Cash Price |
$103.20
|
| Rate for Payer: Cigna Commercial |
$329.14
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$200.21
|
| Rate for Payer: Health EOS Commercial |
$318.41
|
| Rate for Payer: HFN Commercial |
$329.14
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$268.32
|
| Rate for Payer: Multiplan Commercial |
$286.21
|
| Rate for Payer: NAPHCARE Commercial |
$214.66
|
| Rate for Payer: Preferred Network Access Commercial |
$329.14
|
| Rate for Payer: Quartz Beloit One Network |
$175.30
|
| Rate for Payer: Quartz Commercial |
$232.54
|
| Rate for Payer: Quartz Medicare Advantage |
$214.66
|
| Rate for Payer: The Alliance Commercial |
$178.88
|
| Rate for Payer: WEA Trust Commercial |
$196.77
|
| Rate for Payer: WPS Commercial |
$264.98
|
|
|
Ther spi pnxr drg csf 62272
|
Professional
|
Both
|
$1,030.00
|
|
|
Service Code
|
CPT 62272
|
| Hospital Charge Code |
6178533
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$76.16 |
| Max. Negotiated Rate |
$1,017.64 |
| Rate for Payer: Aetna Commercial |
$1,017.64
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$921.23
|
| Rate for Payer: Aetna Managed Medicare |
$76.16
|
| Rate for Payer: Anthem Medicare Advantage |
$76.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$76.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$76.16
|
| Rate for Payer: Cash Price |
$309.00
|
| Rate for Payer: Cash Price |
$309.00
|
| Rate for Payer: Cash Price |
$309.00
|
| Rate for Payer: Cigna Commercial |
$1,017.64
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$90.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$76.16
|
| Rate for Payer: Health EOS Commercial |
$974.79
|
| Rate for Payer: HFN Commercial |
$1,017.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$293.74
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$293.74
|
| Rate for Payer: Independent Care Health Plan Medicare |
$76.16
|
| Rate for Payer: Multiplan Commercial |
$856.96
|
| Rate for Payer: NAPHCARE Commercial |
$114.24
|
| Rate for Payer: Preferred Network Access Commercial |
$1,017.64
|
| Rate for Payer: Quartz Beloit One Network |
$471.33
|
| Rate for Payer: Quartz Commercial |
$610.58
|
| Rate for Payer: Quartz Medicare Advantage |
$76.16
|
| Rate for Payer: The Alliance Commercial |
$323.68
|
| Rate for Payer: United Healthcare Medicaid |
$90.96
|
| Rate for Payer: United Healthcare Medicare Advantage |
$76.16
|
| Rate for Payer: WEA Trust Commercial |
$589.16
|
| Rate for Payer: WPS Commercial |
$342.72
|
|
|
Thiamine hcl 100 MG J3411
|
Professional
|
Both
|
$7.00
|
|
|
Service Code
|
HCPCS J3411
|
| Hospital Charge Code |
3407537
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.66 |
| Max. Negotiated Rate |
$6.92 |
| Rate for Payer: Aetna Managed Medicare |
$1.66
|
| Rate for Payer: Aetna Commercial |
$6.92
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6.26
|
| Rate for Payer: Anthem Medicare Advantage |
$1.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$1.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$1.66
|
| Rate for Payer: Cash Price |
$2.10
|
| Rate for Payer: Cash Price |
$2.10
|
| Rate for Payer: Cigna Commercial |
$6.92
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2.35
|
| Rate for Payer: Health EOS Commercial |
$6.62
|
| Rate for Payer: HFN Commercial |
$6.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4.52
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$4.52
|
| Rate for Payer: Independent Care Health Plan Medicare |
$1.66
|
| Rate for Payer: Multiplan Commercial |
$5.82
|
| Rate for Payer: NAPHCARE Commercial |
$2.50
|
| Rate for Payer: Preferred Network Access Commercial |
$6.92
|
| Rate for Payer: Quartz Beloit One Network |
$3.20
|
| Rate for Payer: Quartz Commercial |
$4.15
|
| Rate for Payer: Quartz Medicare Advantage |
$1.66
|
| Rate for Payer: The Alliance Commercial |
$4.58
|
| Rate for Payer: United Healthcare Medicaid |
$1.88
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1.66
|
| Rate for Payer: WEA Trust Commercial |
$4.00
|
| Rate for Payer: WPS Commercial |
$5.88
|
|
|
Thiamine hcl 100 MG J3411
|
Facility
|
OP
|
$7.00
|
|
|
Service Code
|
HCPCS J3411
|
| Hospital Charge Code |
3407537
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.04 |
| Max. Negotiated Rate |
$6.70 |
| Rate for Payer: Aetna Commercial |
$6.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6.26
|
| Rate for Payer: Aetna Managed Medicare |
$2.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4.73
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3.64
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3.86
|
| Rate for Payer: Cash Price |
$2.10
|
| Rate for Payer: Cash Price |
$2.10
|
| Rate for Payer: Cigna Commercial |
$6.70
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3.11
|
| Rate for Payer: Health EOS Commercial |
$6.48
|
| Rate for Payer: HFN Commercial |
$6.70
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5.46
|
| Rate for Payer: Multiplan Commercial |
$5.82
|
| Rate for Payer: NAPHCARE Commercial |
$4.37
|
| Rate for Payer: Preferred Network Access Commercial |
$6.70
|
| Rate for Payer: Quartz Beloit One Network |
$3.57
|
| Rate for Payer: Quartz Commercial |
$4.73
|
| Rate for Payer: Quartz Medicare Advantage |
$4.37
|
| Rate for Payer: The Alliance Commercial |
$6.66
|
| Rate for Payer: WEA Trust Commercial |
$4.00
|
| Rate for Payer: WPS Commercial |
$5.88
|
|
|
Thiamine hcl 100 MG J3411
|
Facility
|
IP
|
$7.00
|
|
|
Service Code
|
HCPCS J3411
|
| Hospital Charge Code |
3407537
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.57 |
| Max. Negotiated Rate |
$6.70 |
| Rate for Payer: Aetna Commercial |
$6.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3.86
|
| Rate for Payer: Cash Price |
$2.10
|
| Rate for Payer: Cigna Commercial |
$6.70
|
| Rate for Payer: Health EOS Commercial |
$6.48
|
| Rate for Payer: HFN Commercial |
$6.70
|
| Rate for Payer: Multiplan Commercial |
$5.82
|
| Rate for Payer: Preferred Network Access Commercial |
$6.70
|
| Rate for Payer: Quartz Beloit One Network |
$3.57
|
| Rate for Payer: Quartz Commercial |
$4.37
|
| Rate for Payer: WEA Trust Commercial |
$4.00
|
| Rate for Payer: WPS Commercial |
$5.39
|
|
|
ThinPrep Pap #58315
|
Facility
|
IP
|
$147.00
|
|
|
Service Code
|
CPT 88175
|
| Hospital Charge Code |
5460754
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$74.91 |
| Max. Negotiated Rate |
$140.65 |
| Rate for Payer: Aetna Commercial |
$137.59
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$131.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$81.03
|
| Rate for Payer: Cash Price |
$44.10
|
| Rate for Payer: Cigna Commercial |
$140.65
|
| Rate for Payer: Health EOS Commercial |
$136.06
|
| Rate for Payer: HFN Commercial |
$140.65
|
| Rate for Payer: Multiplan Commercial |
$122.30
|
| Rate for Payer: Preferred Network Access Commercial |
$140.65
|
| Rate for Payer: Quartz Beloit One Network |
$74.91
|
| Rate for Payer: Quartz Commercial |
$91.73
|
| Rate for Payer: WEA Trust Commercial |
$84.08
|
| Rate for Payer: WPS Commercial |
$113.23
|
|
|
ThinPrep Pap #58315
|
Facility
|
OP
|
$147.00
|
|
|
Service Code
|
CPT 88175
|
| Hospital Charge Code |
5460754
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$27.67 |
| Max. Negotiated Rate |
$140.65 |
| Rate for Payer: Aetna Commercial |
$137.59
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$131.48
|
| Rate for Payer: Aetna Managed Medicare |
$27.67
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$103.78
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$48.43
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$45.94
|
| Rate for Payer: Anthem Medicare Advantage |
$27.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$81.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$27.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$27.67
|
| Rate for Payer: Cash Price |
$44.10
|
| Rate for Payer: Cash Price |
$44.10
|
| Rate for Payer: Cigna Commercial |
$140.65
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$27.67
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$85.55
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$27.67
|
| Rate for Payer: Health EOS Commercial |
$136.06
|
| Rate for Payer: HFN Commercial |
$140.65
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$102.95
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$27.67
|
| Rate for Payer: Independent Care Health Plan Medicare |
$27.67
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$27.67
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$27.67
|
| Rate for Payer: Multiplan Commercial |
$122.30
|
| Rate for Payer: NAPHCARE Commercial |
$41.51
|
| Rate for Payer: Preferred Network Access Commercial |
$140.65
|
| Rate for Payer: Quartz Beloit One Network |
$74.91
|
| Rate for Payer: Quartz Commercial |
$99.37
|
| Rate for Payer: Quartz Medicare Advantage |
$27.67
|
| Rate for Payer: The Alliance Commercial |
$110.70
|
| Rate for Payer: United Healthcare Medicare Advantage |
$27.67
|
| Rate for Payer: United Healthcare PPO |
$114.66
|
| Rate for Payer: WEA Trust Commercial |
$84.08
|
| Rate for Payer: Wellcare Medicare |
$27.67
|
| Rate for Payer: WPS Commercial |
$113.23
|
|
|
ThinPrep Pap #58315
|
Professional
|
Both
|
$147.00
|
|
|
Service Code
|
CPT 88175
|
| Hospital Charge Code |
5460754
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$27.67 |
| Max. Negotiated Rate |
$145.24 |
| Rate for Payer: Aetna Commercial |
$145.24
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$131.48
|
| Rate for Payer: Aetna Managed Medicare |
$27.67
|
| Rate for Payer: Anthem Medicare Advantage |
$27.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$27.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$27.67
|
| Rate for Payer: Cash Price |
$44.10
|
| Rate for Payer: Cash Price |
$44.10
|
| Rate for Payer: Cigna Commercial |
$145.24
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$76.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$27.67
|
| Rate for Payer: Health EOS Commercial |
$139.12
|
| Rate for Payer: HFN Commercial |
$145.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$97.69
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$97.69
|
| Rate for Payer: Independent Care Health Plan Medicare |
$27.67
|
| Rate for Payer: Multiplan Commercial |
$122.30
|
| Rate for Payer: NAPHCARE Commercial |
$41.51
|
| Rate for Payer: Preferred Network Access Commercial |
$145.24
|
| Rate for Payer: Quartz Beloit One Network |
$67.27
|
| Rate for Payer: Quartz Commercial |
$87.14
|
| Rate for Payer: Quartz Medicare Advantage |
$27.67
|
| Rate for Payer: The Alliance Commercial |
$109.31
|
| Rate for Payer: United Healthcare Medicare Advantage |
$27.67
|
| Rate for Payer: WEA Trust Commercial |
$84.08
|
| Rate for Payer: WPS Commercial |
$121.77
|
|
|
ThinPrep Pap & HPV mRNA E6/E7 #90933
|
Professional
|
Both
|
$147.00
|
|
|
Service Code
|
CPT 88175
|
| Hospital Charge Code |
5460756
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$27.67 |
| Max. Negotiated Rate |
$145.24 |
| Rate for Payer: Aetna Commercial |
$145.24
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$131.48
|
| Rate for Payer: Aetna Managed Medicare |
$27.67
|
| Rate for Payer: Anthem Medicare Advantage |
$27.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$27.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$27.67
|
| Rate for Payer: Cash Price |
$44.10
|
| Rate for Payer: Cash Price |
$44.10
|
| Rate for Payer: Cigna Commercial |
$145.24
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$76.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$27.67
|
| Rate for Payer: Health EOS Commercial |
$139.12
|
| Rate for Payer: HFN Commercial |
$145.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$97.69
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$97.69
|
| Rate for Payer: Independent Care Health Plan Medicare |
$27.67
|
| Rate for Payer: Multiplan Commercial |
$122.30
|
| Rate for Payer: NAPHCARE Commercial |
$41.51
|
| Rate for Payer: Preferred Network Access Commercial |
$145.24
|
| Rate for Payer: Quartz Beloit One Network |
$67.27
|
| Rate for Payer: Quartz Commercial |
$87.14
|
| Rate for Payer: Quartz Medicare Advantage |
$27.67
|
| Rate for Payer: The Alliance Commercial |
$109.31
|
| Rate for Payer: United Healthcare Medicare Advantage |
$27.67
|
| Rate for Payer: WEA Trust Commercial |
$84.08
|
| Rate for Payer: WPS Commercial |
$121.77
|
|
|
ThinPrep Pap & HPV mRNA E6/E7 #90933
|
Facility
|
IP
|
$147.00
|
|
|
Service Code
|
CPT 88175
|
| Hospital Charge Code |
5460756
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$74.91 |
| Max. Negotiated Rate |
$140.65 |
| Rate for Payer: Aetna Commercial |
$137.59
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$131.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$81.03
|
| Rate for Payer: Cash Price |
$44.10
|
| Rate for Payer: Cigna Commercial |
$140.65
|
| Rate for Payer: Health EOS Commercial |
$136.06
|
| Rate for Payer: HFN Commercial |
$140.65
|
| Rate for Payer: Multiplan Commercial |
$122.30
|
| Rate for Payer: Preferred Network Access Commercial |
$140.65
|
| Rate for Payer: Quartz Beloit One Network |
$74.91
|
| Rate for Payer: Quartz Commercial |
$91.73
|
| Rate for Payer: WEA Trust Commercial |
$84.08
|
| Rate for Payer: WPS Commercial |
$113.23
|
|
|
ThinPrep Pap & HPV mRNA E6/E7 #90933
|
Facility
|
OP
|
$147.00
|
|
|
Service Code
|
CPT 88175
|
| Hospital Charge Code |
5460756
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$27.67 |
| Max. Negotiated Rate |
$140.65 |
| Rate for Payer: Aetna Commercial |
$137.59
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$131.48
|
| Rate for Payer: Aetna Managed Medicare |
$27.67
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$103.78
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$48.43
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$45.94
|
| Rate for Payer: Anthem Medicare Advantage |
$27.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$81.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$27.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$27.67
|
| Rate for Payer: Cash Price |
$44.10
|
| Rate for Payer: Cash Price |
$44.10
|
| Rate for Payer: Cigna Commercial |
$140.65
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$27.67
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$85.55
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$27.67
|
| Rate for Payer: Health EOS Commercial |
$136.06
|
| Rate for Payer: HFN Commercial |
$140.65
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$102.95
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$27.67
|
| Rate for Payer: Independent Care Health Plan Medicare |
$27.67
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$27.67
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$27.67
|
| Rate for Payer: Multiplan Commercial |
$122.30
|
| Rate for Payer: NAPHCARE Commercial |
$41.51
|
| Rate for Payer: Preferred Network Access Commercial |
$140.65
|
| Rate for Payer: Quartz Beloit One Network |
$74.91
|
| Rate for Payer: Quartz Commercial |
$99.37
|
| Rate for Payer: Quartz Medicare Advantage |
$27.67
|
| Rate for Payer: The Alliance Commercial |
$110.70
|
| Rate for Payer: United Healthcare Medicare Advantage |
$27.67
|
| Rate for Payer: United Healthcare PPO |
$114.66
|
| Rate for Payer: WEA Trust Commercial |
$84.08
|
| Rate for Payer: Wellcare Medicare |
$27.67
|
| Rate for Payer: WPS Commercial |
$113.23
|
|
|
ThinPrep Pap & HPV mRNA w/Rfx HPV 16,18/45 #91414
|
Facility
|
IP
|
$147.00
|
|
|
Service Code
|
CPT 88175
|
| Hospital Charge Code |
5460757
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$74.91 |
| Max. Negotiated Rate |
$140.65 |
| Rate for Payer: Aetna Commercial |
$137.59
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$131.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$81.03
|
| Rate for Payer: Cash Price |
$44.10
|
| Rate for Payer: Cigna Commercial |
$140.65
|
| Rate for Payer: Health EOS Commercial |
$136.06
|
| Rate for Payer: HFN Commercial |
$140.65
|
| Rate for Payer: Multiplan Commercial |
$122.30
|
| Rate for Payer: Preferred Network Access Commercial |
$140.65
|
| Rate for Payer: Quartz Beloit One Network |
$74.91
|
| Rate for Payer: Quartz Commercial |
$91.73
|
| Rate for Payer: WEA Trust Commercial |
$84.08
|
| Rate for Payer: WPS Commercial |
$113.23
|
|
|
ThinPrep Pap & HPV mRNA w/Rfx HPV 16,18/45 #91414
|
Facility
|
OP
|
$147.00
|
|
|
Service Code
|
CPT 88175
|
| Hospital Charge Code |
5460757
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$27.67 |
| Max. Negotiated Rate |
$140.65 |
| Rate for Payer: Aetna Commercial |
$137.59
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$131.48
|
| Rate for Payer: Aetna Managed Medicare |
$27.67
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$103.78
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$48.43
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$45.94
|
| Rate for Payer: Anthem Medicare Advantage |
$27.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$81.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$27.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$27.67
|
| Rate for Payer: Cash Price |
$44.10
|
| Rate for Payer: Cash Price |
$44.10
|
| Rate for Payer: Cigna Commercial |
$140.65
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$27.67
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$85.55
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$27.67
|
| Rate for Payer: Health EOS Commercial |
$136.06
|
| Rate for Payer: HFN Commercial |
$140.65
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$102.95
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$27.67
|
| Rate for Payer: Independent Care Health Plan Medicare |
$27.67
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$27.67
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$27.67
|
| Rate for Payer: Multiplan Commercial |
$122.30
|
| Rate for Payer: NAPHCARE Commercial |
$41.51
|
| Rate for Payer: Preferred Network Access Commercial |
$140.65
|
| Rate for Payer: Quartz Beloit One Network |
$74.91
|
| Rate for Payer: Quartz Commercial |
$99.37
|
| Rate for Payer: Quartz Medicare Advantage |
$27.67
|
| Rate for Payer: The Alliance Commercial |
$110.70
|
| Rate for Payer: United Healthcare Medicare Advantage |
$27.67
|
| Rate for Payer: United Healthcare PPO |
$114.66
|
| Rate for Payer: WEA Trust Commercial |
$84.08
|
| Rate for Payer: Wellcare Medicare |
$27.67
|
| Rate for Payer: WPS Commercial |
$113.23
|
|
