|
TRUNION 51MM SLOTTED TPS CAP AR-9301-51CPC
|
Facility
|
IP
|
$16,597.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
6151660
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,457.83 |
| Max. Negotiated Rate |
$15,880.01 |
| Rate for Payer: Aetna Commercial |
$15,534.79
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$14,844.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,148.27
|
| Rate for Payer: Cash Price |
$4,979.10
|
| Rate for Payer: Cigna Commercial |
$15,880.01
|
| Rate for Payer: Health EOS Commercial |
$15,362.18
|
| Rate for Payer: HFN Commercial |
$15,880.01
|
| Rate for Payer: Multiplan Commercial |
$13,808.70
|
| Rate for Payer: Preferred Network Access Commercial |
$15,880.01
|
| Rate for Payer: Quartz Beloit One Network |
$8,457.83
|
| Rate for Payer: Quartz Commercial |
$10,356.53
|
| Rate for Payer: WEA Trust Commercial |
$9,493.48
|
| Rate for Payer: WPS Commercial |
$12,784.67
|
|
|
Trypan Blue Ophth Solution 0.06% [Med]
|
Facility
|
OP
|
$401.00
|
|
| Hospital Charge Code |
2974996
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$116.77 |
| Max. Negotiated Rate |
$383.68 |
| Rate for Payer: Aetna Commercial |
$375.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$358.65
|
| Rate for Payer: Aetna Managed Medicare |
$116.77
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$271.08
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$208.52
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$200.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$221.03
|
| Rate for Payer: Cash Price |
$120.30
|
| Rate for Payer: Cigna Commercial |
$383.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$233.38
|
| Rate for Payer: Health EOS Commercial |
$371.17
|
| Rate for Payer: HFN Commercial |
$383.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$312.78
|
| Rate for Payer: Multiplan Commercial |
$333.63
|
| Rate for Payer: NAPHCARE Commercial |
$250.22
|
| Rate for Payer: Preferred Network Access Commercial |
$383.68
|
| Rate for Payer: Quartz Beloit One Network |
$204.35
|
| Rate for Payer: Quartz Commercial |
$271.08
|
| Rate for Payer: Quartz Medicare Advantage |
$250.22
|
| Rate for Payer: The Alliance Commercial |
$208.52
|
| Rate for Payer: WEA Trust Commercial |
$229.37
|
| Rate for Payer: WPS Commercial |
$308.89
|
|
|
Trypan Blue Ophth Solution 0.06% [Med]
|
Facility
|
IP
|
$401.00
|
|
| Hospital Charge Code |
2974996
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$204.35 |
| Max. Negotiated Rate |
$383.68 |
| Rate for Payer: Aetna Commercial |
$375.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$358.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$221.03
|
| Rate for Payer: Cash Price |
$120.30
|
| Rate for Payer: Cigna Commercial |
$383.68
|
| Rate for Payer: Health EOS Commercial |
$371.17
|
| Rate for Payer: HFN Commercial |
$383.68
|
| Rate for Payer: Multiplan Commercial |
$333.63
|
| Rate for Payer: Preferred Network Access Commercial |
$383.68
|
| Rate for Payer: Quartz Beloit One Network |
$204.35
|
| Rate for Payer: Quartz Commercial |
$250.22
|
| Rate for Payer: WEA Trust Commercial |
$229.37
|
| Rate for Payer: WPS Commercial |
$308.89
|
|
|
Trypanosoma cruzi Antibody, IgG
|
Facility
|
OP
|
$111.00
|
|
|
Service Code
|
CPT 86753
|
| Hospital Charge Code |
5433346
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.89 |
| Max. Negotiated Rate |
$106.20 |
| Rate for Payer: Aetna Commercial |
$103.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$99.28
|
| Rate for Payer: Aetna Managed Medicare |
$12.89
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$48.32
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$22.55
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$21.39
|
| Rate for Payer: Anthem Medicare Advantage |
$12.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$61.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$12.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$12.89
|
| Rate for Payer: Cash Price |
$33.30
|
| Rate for Payer: Cash Price |
$33.30
|
| Rate for Payer: Cigna Commercial |
$106.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$12.89
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$64.60
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$12.89
|
| Rate for Payer: Health EOS Commercial |
$102.74
|
| Rate for Payer: HFN Commercial |
$106.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$47.93
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$12.89
|
| Rate for Payer: Independent Care Health Plan Medicare |
$12.89
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$12.89
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$12.89
|
| Rate for Payer: Multiplan Commercial |
$92.35
|
| Rate for Payer: NAPHCARE Commercial |
$19.33
|
| Rate for Payer: Preferred Network Access Commercial |
$106.20
|
| Rate for Payer: Quartz Beloit One Network |
$56.57
|
| Rate for Payer: Quartz Commercial |
$75.04
|
| Rate for Payer: Quartz Medicare Advantage |
$12.89
|
| Rate for Payer: The Alliance Commercial |
$51.54
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.89
|
| Rate for Payer: United Healthcare PPO |
$86.58
|
| Rate for Payer: WEA Trust Commercial |
$63.49
|
| Rate for Payer: Wellcare Medicare |
$12.89
|
| Rate for Payer: WPS Commercial |
$85.50
|
|
|
Trypanosoma cruzi Antibody, IgG
|
Professional
|
Both
|
$111.00
|
|
|
Service Code
|
CPT 86753
|
| Hospital Charge Code |
5433346
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.89 |
| Max. Negotiated Rate |
$109.67 |
| Rate for Payer: Aetna Commercial |
$109.67
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$99.28
|
| Rate for Payer: Aetna Managed Medicare |
$12.89
|
| Rate for Payer: Anthem Medicare Advantage |
$12.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$12.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$12.89
|
| Rate for Payer: Cash Price |
$33.30
|
| Rate for Payer: Cash Price |
$33.30
|
| Rate for Payer: Cigna Commercial |
$109.67
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$57.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12.89
|
| Rate for Payer: Health EOS Commercial |
$105.05
|
| Rate for Payer: HFN Commercial |
$109.67
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$45.49
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$45.49
|
| Rate for Payer: Independent Care Health Plan Medicare |
$12.89
|
| Rate for Payer: Multiplan Commercial |
$92.35
|
| Rate for Payer: NAPHCARE Commercial |
$19.33
|
| Rate for Payer: Preferred Network Access Commercial |
$109.67
|
| Rate for Payer: Quartz Beloit One Network |
$50.79
|
| Rate for Payer: Quartz Commercial |
$65.80
|
| Rate for Payer: Quartz Medicare Advantage |
$12.89
|
| Rate for Payer: The Alliance Commercial |
$50.90
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.89
|
| Rate for Payer: WEA Trust Commercial |
$63.49
|
| Rate for Payer: WPS Commercial |
$56.70
|
|
|
Trypanosoma cruzi Antibody, IgG
|
Facility
|
IP
|
$111.00
|
|
|
Service Code
|
CPT 86753
|
| Hospital Charge Code |
5433346
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$56.57 |
| Max. Negotiated Rate |
$106.20 |
| Rate for Payer: Aetna Commercial |
$103.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$99.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$61.18
|
| Rate for Payer: Cash Price |
$33.30
|
| Rate for Payer: Cigna Commercial |
$106.20
|
| Rate for Payer: Health EOS Commercial |
$102.74
|
| Rate for Payer: HFN Commercial |
$106.20
|
| Rate for Payer: Multiplan Commercial |
$92.35
|
| Rate for Payer: Preferred Network Access Commercial |
$106.20
|
| Rate for Payer: Quartz Beloit One Network |
$56.57
|
| Rate for Payer: Quartz Commercial |
$69.26
|
| Rate for Payer: WEA Trust Commercial |
$63.49
|
| Rate for Payer: WPS Commercial |
$85.50
|
|
|
Trypsinogen (Trypsin)
|
Professional
|
Both
|
$626.00
|
|
|
Service Code
|
CPT 83519
|
| Hospital Charge Code |
978085
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$19.14 |
| Max. Negotiated Rate |
$618.49 |
| Rate for Payer: Aetna Commercial |
$618.49
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$559.89
|
| Rate for Payer: Aetna Managed Medicare |
$19.14
|
| Rate for Payer: Anthem Medicare Advantage |
$19.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$19.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$19.14
|
| Rate for Payer: Cash Price |
$187.80
|
| Rate for Payer: Cash Price |
$187.80
|
| Rate for Payer: Cigna Commercial |
$618.49
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$325.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$19.14
|
| Rate for Payer: Health EOS Commercial |
$592.45
|
| Rate for Payer: HFN Commercial |
$618.49
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$67.55
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$67.55
|
| Rate for Payer: Independent Care Health Plan Medicare |
$19.14
|
| Rate for Payer: Multiplan Commercial |
$520.83
|
| Rate for Payer: NAPHCARE Commercial |
$28.70
|
| Rate for Payer: Preferred Network Access Commercial |
$618.49
|
| Rate for Payer: Quartz Beloit One Network |
$286.46
|
| Rate for Payer: Quartz Commercial |
$371.09
|
| Rate for Payer: Quartz Medicare Advantage |
$19.14
|
| Rate for Payer: The Alliance Commercial |
$75.59
|
| Rate for Payer: United Healthcare Medicare Advantage |
$19.14
|
| Rate for Payer: WEA Trust Commercial |
$358.07
|
| Rate for Payer: WPS Commercial |
$84.20
|
|
|
Trypsinogen (Trypsin)
|
Facility
|
OP
|
$626.00
|
|
|
Service Code
|
CPT 83519
|
| Hospital Charge Code |
978085
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$19.14 |
| Max. Negotiated Rate |
$598.96 |
| Rate for Payer: Aetna Commercial |
$585.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$559.89
|
| Rate for Payer: Aetna Managed Medicare |
$19.14
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$71.76
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$33.49
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$31.77
|
| Rate for Payer: Anthem Medicare Advantage |
$19.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$345.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$19.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$19.14
|
| Rate for Payer: Cash Price |
$187.80
|
| Rate for Payer: Cash Price |
$187.80
|
| Rate for Payer: Cigna Commercial |
$598.96
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$19.14
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$364.33
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$19.14
|
| Rate for Payer: Health EOS Commercial |
$579.43
|
| Rate for Payer: HFN Commercial |
$598.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$71.19
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$19.14
|
| Rate for Payer: Independent Care Health Plan Medicare |
$19.14
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$19.14
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$19.14
|
| Rate for Payer: Multiplan Commercial |
$520.83
|
| Rate for Payer: NAPHCARE Commercial |
$28.70
|
| Rate for Payer: Preferred Network Access Commercial |
$598.96
|
| Rate for Payer: Quartz Beloit One Network |
$319.01
|
| Rate for Payer: Quartz Commercial |
$423.18
|
| Rate for Payer: Quartz Medicare Advantage |
$19.14
|
| Rate for Payer: The Alliance Commercial |
$76.54
|
| Rate for Payer: United Healthcare Medicare Advantage |
$19.14
|
| Rate for Payer: United Healthcare PPO |
$488.28
|
| Rate for Payer: WEA Trust Commercial |
$358.07
|
| Rate for Payer: Wellcare Medicare |
$19.14
|
| Rate for Payer: WPS Commercial |
$482.21
|
|
|
Trypsinogen (Trypsin)
|
Facility
|
IP
|
$626.00
|
|
|
Service Code
|
CPT 83519
|
| Hospital Charge Code |
978085
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$319.01 |
| Max. Negotiated Rate |
$598.96 |
| Rate for Payer: Aetna Commercial |
$585.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$559.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$345.05
|
| Rate for Payer: Cash Price |
$187.80
|
| Rate for Payer: Cigna Commercial |
$598.96
|
| Rate for Payer: Health EOS Commercial |
$579.43
|
| Rate for Payer: HFN Commercial |
$598.96
|
| Rate for Payer: Multiplan Commercial |
$520.83
|
| Rate for Payer: Preferred Network Access Commercial |
$598.96
|
| Rate for Payer: Quartz Beloit One Network |
$319.01
|
| Rate for Payer: Quartz Commercial |
$390.62
|
| Rate for Payer: WEA Trust Commercial |
$358.07
|
| Rate for Payer: WPS Commercial |
$482.21
|
|
|
Tryptase Total
|
Facility
|
IP
|
$330.00
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
978086
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$168.17 |
| Max. Negotiated Rate |
$315.74 |
| Rate for Payer: Aetna Commercial |
$308.88
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$295.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$181.90
|
| Rate for Payer: Cash Price |
$99.00
|
| Rate for Payer: Cigna Commercial |
$315.74
|
| Rate for Payer: Health EOS Commercial |
$305.45
|
| Rate for Payer: HFN Commercial |
$315.74
|
| Rate for Payer: Multiplan Commercial |
$274.56
|
| Rate for Payer: Preferred Network Access Commercial |
$315.74
|
| Rate for Payer: Quartz Beloit One Network |
$168.17
|
| Rate for Payer: Quartz Commercial |
$205.92
|
| Rate for Payer: WEA Trust Commercial |
$188.76
|
| Rate for Payer: WPS Commercial |
$254.20
|
|
|
Tryptase Total
|
Facility
|
OP
|
$330.00
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
978086
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.96 |
| Max. Negotiated Rate |
$315.74 |
| Rate for Payer: Aetna Commercial |
$308.88
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$295.15
|
| Rate for Payer: Aetna Managed Medicare |
$17.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$67.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$31.43
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$29.81
|
| Rate for Payer: Anthem Medicare Advantage |
$17.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$181.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$17.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$17.96
|
| Rate for Payer: Cash Price |
$99.00
|
| Rate for Payer: Cash Price |
$99.00
|
| Rate for Payer: Cigna Commercial |
$315.74
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$17.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$192.06
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$17.96
|
| Rate for Payer: Health EOS Commercial |
$305.45
|
| Rate for Payer: HFN Commercial |
$315.74
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$66.81
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$17.96
|
| Rate for Payer: Independent Care Health Plan Medicare |
$17.96
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$17.96
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$17.96
|
| Rate for Payer: Multiplan Commercial |
$274.56
|
| Rate for Payer: NAPHCARE Commercial |
$26.94
|
| Rate for Payer: Preferred Network Access Commercial |
$315.74
|
| Rate for Payer: Quartz Beloit One Network |
$168.17
|
| Rate for Payer: Quartz Commercial |
$223.08
|
| Rate for Payer: Quartz Medicare Advantage |
$17.96
|
| Rate for Payer: The Alliance Commercial |
$71.84
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17.96
|
| Rate for Payer: United Healthcare PPO |
$257.40
|
| Rate for Payer: WEA Trust Commercial |
$188.76
|
| Rate for Payer: Wellcare Medicare |
$17.96
|
| Rate for Payer: WPS Commercial |
$254.20
|
|
|
Tryptase Total
|
Professional
|
Both
|
$330.00
|
|
|
Service Code
|
CPT 83520
|
| Hospital Charge Code |
978086
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.96 |
| Max. Negotiated Rate |
$326.04 |
| Rate for Payer: Aetna Commercial |
$326.04
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$295.15
|
| Rate for Payer: Aetna Managed Medicare |
$17.96
|
| Rate for Payer: Anthem Medicare Advantage |
$17.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$17.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$17.96
|
| Rate for Payer: Cash Price |
$99.00
|
| Rate for Payer: Cash Price |
$99.00
|
| Rate for Payer: Cigna Commercial |
$326.04
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$171.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$17.96
|
| Rate for Payer: Health EOS Commercial |
$312.31
|
| Rate for Payer: HFN Commercial |
$326.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$63.40
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$63.40
|
| Rate for Payer: Independent Care Health Plan Medicare |
$17.96
|
| Rate for Payer: Multiplan Commercial |
$274.56
|
| Rate for Payer: NAPHCARE Commercial |
$26.94
|
| Rate for Payer: Preferred Network Access Commercial |
$326.04
|
| Rate for Payer: Quartz Beloit One Network |
$151.01
|
| Rate for Payer: Quartz Commercial |
$195.62
|
| Rate for Payer: Quartz Medicare Advantage |
$17.96
|
| Rate for Payer: The Alliance Commercial |
$70.95
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17.96
|
| Rate for Payer: WEA Trust Commercial |
$188.76
|
| Rate for Payer: WPS Commercial |
$79.03
|
|
|
TSH, Sensitive to Mayo
|
Facility
|
IP
|
$61.00
|
|
|
Service Code
|
CPT 84443
|
| Hospital Charge Code |
5426965
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$31.09 |
| Max. Negotiated Rate |
$58.36 |
| Rate for Payer: Aetna Commercial |
$57.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$54.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$33.62
|
| Rate for Payer: Cash Price |
$18.30
|
| Rate for Payer: Cigna Commercial |
$58.36
|
| Rate for Payer: Health EOS Commercial |
$56.46
|
| Rate for Payer: HFN Commercial |
$58.36
|
| Rate for Payer: Multiplan Commercial |
$50.75
|
| Rate for Payer: Preferred Network Access Commercial |
$58.36
|
| Rate for Payer: Quartz Beloit One Network |
$31.09
|
| Rate for Payer: Quartz Commercial |
$38.06
|
| Rate for Payer: WEA Trust Commercial |
$34.89
|
| Rate for Payer: WPS Commercial |
$46.99
|
|
|
TSH, Sensitive to Mayo
|
Facility
|
OP
|
$61.00
|
|
|
Service Code
|
CPT 84443
|
| Hospital Charge Code |
5426965
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.47 |
| Max. Negotiated Rate |
$69.89 |
| Rate for Payer: Aetna Commercial |
$57.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$54.56
|
| Rate for Payer: Aetna Managed Medicare |
$17.47
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$65.52
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$30.58
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$29.00
|
| Rate for Payer: Anthem Medicare Advantage |
$17.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$33.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$17.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$17.47
|
| Rate for Payer: Cash Price |
$18.30
|
| Rate for Payer: Cash Price |
$18.30
|
| Rate for Payer: Cigna Commercial |
$58.36
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$17.47
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$35.50
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$17.47
|
| Rate for Payer: Health EOS Commercial |
$56.46
|
| Rate for Payer: HFN Commercial |
$58.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$65.00
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$17.47
|
| Rate for Payer: Independent Care Health Plan Medicare |
$17.47
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$17.47
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$17.47
|
| Rate for Payer: Multiplan Commercial |
$50.75
|
| Rate for Payer: NAPHCARE Commercial |
$26.21
|
| Rate for Payer: Preferred Network Access Commercial |
$58.36
|
| Rate for Payer: Quartz Beloit One Network |
$31.09
|
| Rate for Payer: Quartz Commercial |
$41.24
|
| Rate for Payer: Quartz Medicare Advantage |
$17.47
|
| Rate for Payer: The Alliance Commercial |
$69.89
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17.47
|
| Rate for Payer: United Healthcare PPO |
$47.58
|
| Rate for Payer: WEA Trust Commercial |
$34.89
|
| Rate for Payer: Wellcare Medicare |
$17.47
|
| Rate for Payer: WPS Commercial |
$46.99
|
|
|
TSH, Sensitive to Mayo
|
Professional
|
Both
|
$61.00
|
|
|
Service Code
|
CPT 84443
|
| Hospital Charge Code |
5426965
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.47 |
| Max. Negotiated Rate |
$76.88 |
| Rate for Payer: Aetna Commercial |
$60.27
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$54.56
|
| Rate for Payer: Aetna Managed Medicare |
$17.47
|
| Rate for Payer: Anthem Medicare Advantage |
$17.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$17.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$17.47
|
| Rate for Payer: Cash Price |
$18.30
|
| Rate for Payer: Cash Price |
$18.30
|
| Rate for Payer: Cigna Commercial |
$60.27
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$31.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$17.47
|
| Rate for Payer: Health EOS Commercial |
$57.73
|
| Rate for Payer: HFN Commercial |
$60.27
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$61.67
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$61.67
|
| Rate for Payer: Independent Care Health Plan Medicare |
$17.47
|
| Rate for Payer: Multiplan Commercial |
$50.75
|
| Rate for Payer: NAPHCARE Commercial |
$26.21
|
| Rate for Payer: Preferred Network Access Commercial |
$60.27
|
| Rate for Payer: Quartz Beloit One Network |
$27.91
|
| Rate for Payer: Quartz Commercial |
$36.16
|
| Rate for Payer: Quartz Medicare Advantage |
$17.47
|
| Rate for Payer: The Alliance Commercial |
$69.01
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17.47
|
| Rate for Payer: WEA Trust Commercial |
$34.89
|
| Rate for Payer: WPS Commercial |
$76.88
|
|
|
TSII-Antithrombin III Activity
|
Facility
|
OP
|
$184.00
|
|
|
Service Code
|
CPT 85300
|
| Hospital Charge Code |
4066516
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.32 |
| Max. Negotiated Rate |
$176.05 |
| Rate for Payer: Aetna Commercial |
$172.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$164.57
|
| Rate for Payer: Aetna Managed Medicare |
$12.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$46.22
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$21.57
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$20.46
|
| Rate for Payer: Anthem Medicare Advantage |
$12.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$101.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$12.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$12.32
|
| Rate for Payer: Cash Price |
$55.20
|
| Rate for Payer: Cash Price |
$55.20
|
| Rate for Payer: Cigna Commercial |
$176.05
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$12.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$107.09
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$12.32
|
| Rate for Payer: Health EOS Commercial |
$170.31
|
| Rate for Payer: HFN Commercial |
$176.05
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$45.85
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$12.32
|
| Rate for Payer: Independent Care Health Plan Medicare |
$12.32
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$12.32
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$12.32
|
| Rate for Payer: Multiplan Commercial |
$153.09
|
| Rate for Payer: NAPHCARE Commercial |
$18.49
|
| Rate for Payer: Preferred Network Access Commercial |
$176.05
|
| Rate for Payer: Quartz Beloit One Network |
$93.77
|
| Rate for Payer: Quartz Commercial |
$124.38
|
| Rate for Payer: Quartz Medicare Advantage |
$12.32
|
| Rate for Payer: The Alliance Commercial |
$49.30
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.32
|
| Rate for Payer: United Healthcare PPO |
$143.52
|
| Rate for Payer: WEA Trust Commercial |
$105.25
|
| Rate for Payer: Wellcare Medicare |
$12.32
|
| Rate for Payer: WPS Commercial |
$141.74
|
|
|
TSII-Antithrombin III Activity
|
Professional
|
Both
|
$184.00
|
|
|
Service Code
|
CPT 85300
|
| Hospital Charge Code |
4066516
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.32 |
| Max. Negotiated Rate |
$181.79 |
| Rate for Payer: Aetna Commercial |
$181.79
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$164.57
|
| Rate for Payer: Aetna Managed Medicare |
$12.32
|
| Rate for Payer: Anthem Medicare Advantage |
$12.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$12.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$12.32
|
| Rate for Payer: Cash Price |
$55.20
|
| Rate for Payer: Cash Price |
$55.20
|
| Rate for Payer: Cigna Commercial |
$181.79
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$95.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12.32
|
| Rate for Payer: Health EOS Commercial |
$174.14
|
| Rate for Payer: HFN Commercial |
$181.79
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$43.50
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$43.50
|
| Rate for Payer: Independent Care Health Plan Medicare |
$12.32
|
| Rate for Payer: Multiplan Commercial |
$153.09
|
| Rate for Payer: NAPHCARE Commercial |
$18.49
|
| Rate for Payer: Preferred Network Access Commercial |
$181.79
|
| Rate for Payer: Quartz Beloit One Network |
$84.20
|
| Rate for Payer: Quartz Commercial |
$109.08
|
| Rate for Payer: Quartz Medicare Advantage |
$12.32
|
| Rate for Payer: The Alliance Commercial |
$48.68
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.32
|
| Rate for Payer: WEA Trust Commercial |
$105.25
|
| Rate for Payer: WPS Commercial |
$54.23
|
|
|
TSII-Antithrombin III Activity
|
Facility
|
IP
|
$184.00
|
|
|
Service Code
|
CPT 85300
|
| Hospital Charge Code |
4066516
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$93.77 |
| Max. Negotiated Rate |
$176.05 |
| Rate for Payer: Aetna Commercial |
$172.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$164.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$101.42
|
| Rate for Payer: Cash Price |
$55.20
|
| Rate for Payer: Cigna Commercial |
$176.05
|
| Rate for Payer: Health EOS Commercial |
$170.31
|
| Rate for Payer: HFN Commercial |
$176.05
|
| Rate for Payer: Multiplan Commercial |
$153.09
|
| Rate for Payer: Preferred Network Access Commercial |
$176.05
|
| Rate for Payer: Quartz Beloit One Network |
$93.77
|
| Rate for Payer: Quartz Commercial |
$114.82
|
| Rate for Payer: WEA Trust Commercial |
$105.25
|
| Rate for Payer: WPS Commercial |
$141.74
|
|
|
TSII-Factor V (Leiden) Mutation
|
Professional
|
Both
|
$359.00
|
|
|
Service Code
|
CPT 81241
|
| Hospital Charge Code |
4066514
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$76.30 |
| Max. Negotiated Rate |
$354.69 |
| Rate for Payer: Aetna Commercial |
$354.69
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$321.09
|
| Rate for Payer: Aetna Managed Medicare |
$76.30
|
| Rate for Payer: Anthem Medicare Advantage |
$76.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$76.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$76.30
|
| Rate for Payer: Cash Price |
$107.70
|
| Rate for Payer: Cash Price |
$107.70
|
| Rate for Payer: Cigna Commercial |
$354.69
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$186.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$76.30
|
| Rate for Payer: Health EOS Commercial |
$339.76
|
| Rate for Payer: HFN Commercial |
$354.69
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$269.36
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$269.36
|
| Rate for Payer: Independent Care Health Plan Medicare |
$76.30
|
| Rate for Payer: Multiplan Commercial |
$298.69
|
| Rate for Payer: NAPHCARE Commercial |
$114.46
|
| Rate for Payer: Preferred Network Access Commercial |
$354.69
|
| Rate for Payer: Quartz Beloit One Network |
$164.28
|
| Rate for Payer: Quartz Commercial |
$212.82
|
| Rate for Payer: Quartz Medicare Advantage |
$76.30
|
| Rate for Payer: The Alliance Commercial |
$301.40
|
| Rate for Payer: United Healthcare Medicare Advantage |
$76.30
|
| Rate for Payer: WEA Trust Commercial |
$205.35
|
| Rate for Payer: WPS Commercial |
$335.74
|
|
|
TSII-Factor V (Leiden) Mutation
|
Facility
|
OP
|
$359.00
|
|
|
Service Code
|
CPT 81241
|
| Hospital Charge Code |
4066514
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$76.30 |
| Max. Negotiated Rate |
$343.49 |
| Rate for Payer: Aetna Commercial |
$336.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$321.09
|
| Rate for Payer: Aetna Managed Medicare |
$76.30
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$286.14
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$133.53
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$126.67
|
| Rate for Payer: Anthem Medicare Advantage |
$76.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$197.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$76.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$76.30
|
| Rate for Payer: Cash Price |
$107.70
|
| Rate for Payer: Cash Price |
$107.70
|
| Rate for Payer: Cigna Commercial |
$343.49
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$76.30
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$208.94
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$76.30
|
| Rate for Payer: Health EOS Commercial |
$332.29
|
| Rate for Payer: HFN Commercial |
$343.49
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$283.85
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$76.30
|
| Rate for Payer: Independent Care Health Plan Medicare |
$76.30
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$76.30
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$76.30
|
| Rate for Payer: Multiplan Commercial |
$298.69
|
| Rate for Payer: NAPHCARE Commercial |
$114.46
|
| Rate for Payer: Preferred Network Access Commercial |
$343.49
|
| Rate for Payer: Quartz Beloit One Network |
$182.95
|
| Rate for Payer: Quartz Commercial |
$242.68
|
| Rate for Payer: Quartz Medicare Advantage |
$76.30
|
| Rate for Payer: The Alliance Commercial |
$305.22
|
| Rate for Payer: United Healthcare Medicare Advantage |
$76.30
|
| Rate for Payer: United Healthcare PPO |
$280.02
|
| Rate for Payer: WEA Trust Commercial |
$205.35
|
| Rate for Payer: Wellcare Medicare |
$76.30
|
| Rate for Payer: WPS Commercial |
$276.54
|
|
|
TSII-Factor V (Leiden) Mutation
|
Facility
|
IP
|
$359.00
|
|
|
Service Code
|
CPT 81241
|
| Hospital Charge Code |
4066514
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$182.95 |
| Max. Negotiated Rate |
$343.49 |
| Rate for Payer: Aetna Commercial |
$336.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$321.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$197.88
|
| Rate for Payer: Cash Price |
$107.70
|
| Rate for Payer: Cigna Commercial |
$343.49
|
| Rate for Payer: Health EOS Commercial |
$332.29
|
| Rate for Payer: HFN Commercial |
$343.49
|
| Rate for Payer: Multiplan Commercial |
$298.69
|
| Rate for Payer: Preferred Network Access Commercial |
$343.49
|
| Rate for Payer: Quartz Beloit One Network |
$182.95
|
| Rate for Payer: Quartz Commercial |
$224.02
|
| Rate for Payer: WEA Trust Commercial |
$205.35
|
| Rate for Payer: WPS Commercial |
$276.54
|
|
|
TSII-PGA Mutation
|
Professional
|
Both
|
$430.00
|
|
|
Service Code
|
CPT 81240
|
| Hospital Charge Code |
4066515
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$68.32 |
| Max. Negotiated Rate |
$424.84 |
| Rate for Payer: Aetna Commercial |
$424.84
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$384.59
|
| Rate for Payer: Aetna Managed Medicare |
$68.32
|
| Rate for Payer: Anthem Medicare Advantage |
$68.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$68.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$68.32
|
| Rate for Payer: Cash Price |
$129.00
|
| Rate for Payer: Cash Price |
$129.00
|
| Rate for Payer: Cigna Commercial |
$424.84
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$223.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$68.32
|
| Rate for Payer: Health EOS Commercial |
$406.95
|
| Rate for Payer: HFN Commercial |
$424.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$241.17
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$241.17
|
| Rate for Payer: Independent Care Health Plan Medicare |
$68.32
|
| Rate for Payer: Multiplan Commercial |
$357.76
|
| Rate for Payer: NAPHCARE Commercial |
$102.48
|
| Rate for Payer: Preferred Network Access Commercial |
$424.84
|
| Rate for Payer: Quartz Beloit One Network |
$196.77
|
| Rate for Payer: Quartz Commercial |
$254.90
|
| Rate for Payer: Quartz Medicare Advantage |
$68.32
|
| Rate for Payer: The Alliance Commercial |
$269.85
|
| Rate for Payer: United Healthcare Medicare Advantage |
$68.32
|
| Rate for Payer: WEA Trust Commercial |
$245.96
|
| Rate for Payer: WPS Commercial |
$300.60
|
|
|
TSII-PGA Mutation
|
Facility
|
OP
|
$430.00
|
|
|
Service Code
|
CPT 81240
|
| Hospital Charge Code |
4066515
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$68.32 |
| Max. Negotiated Rate |
$411.42 |
| Rate for Payer: Aetna Commercial |
$402.48
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$384.59
|
| Rate for Payer: Aetna Managed Medicare |
$68.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$256.19
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$119.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$113.41
|
| Rate for Payer: Anthem Medicare Advantage |
$68.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$237.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$68.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$68.32
|
| Rate for Payer: Cash Price |
$129.00
|
| Rate for Payer: Cash Price |
$129.00
|
| Rate for Payer: Cigna Commercial |
$411.42
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$68.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$250.26
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$68.32
|
| Rate for Payer: Health EOS Commercial |
$398.01
|
| Rate for Payer: HFN Commercial |
$411.42
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$254.14
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$68.32
|
| Rate for Payer: Independent Care Health Plan Medicare |
$68.32
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$68.32
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$68.32
|
| Rate for Payer: Multiplan Commercial |
$357.76
|
| Rate for Payer: NAPHCARE Commercial |
$102.48
|
| Rate for Payer: Preferred Network Access Commercial |
$411.42
|
| Rate for Payer: Quartz Beloit One Network |
$219.13
|
| Rate for Payer: Quartz Commercial |
$290.68
|
| Rate for Payer: Quartz Medicare Advantage |
$68.32
|
| Rate for Payer: The Alliance Commercial |
$273.27
|
| Rate for Payer: United Healthcare Medicare Advantage |
$68.32
|
| Rate for Payer: United Healthcare PPO |
$335.40
|
| Rate for Payer: WEA Trust Commercial |
$245.96
|
| Rate for Payer: Wellcare Medicare |
$68.32
|
| Rate for Payer: WPS Commercial |
$331.23
|
|
|
TSII-PGA Mutation
|
Facility
|
IP
|
$430.00
|
|
|
Service Code
|
CPT 81240
|
| Hospital Charge Code |
4066515
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$219.13 |
| Max. Negotiated Rate |
$411.42 |
| Rate for Payer: Aetna Commercial |
$402.48
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$384.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$237.02
|
| Rate for Payer: Cash Price |
$129.00
|
| Rate for Payer: Cigna Commercial |
$411.42
|
| Rate for Payer: Health EOS Commercial |
$398.01
|
| Rate for Payer: HFN Commercial |
$411.42
|
| Rate for Payer: Multiplan Commercial |
$357.76
|
| Rate for Payer: Preferred Network Access Commercial |
$411.42
|
| Rate for Payer: Quartz Beloit One Network |
$219.13
|
| Rate for Payer: Quartz Commercial |
$268.32
|
| Rate for Payer: WEA Trust Commercial |
$245.96
|
| Rate for Payer: WPS Commercial |
$331.23
|
|
|
TSII-Protein C Activity
|
Facility
|
IP
|
$283.00
|
|
|
Service Code
|
CPT 85303
|
| Hospital Charge Code |
4066517
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$144.22 |
| Max. Negotiated Rate |
$270.77 |
| Rate for Payer: Aetna Commercial |
$264.89
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$253.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$155.99
|
| Rate for Payer: Cash Price |
$84.90
|
| Rate for Payer: Cigna Commercial |
$270.77
|
| Rate for Payer: Health EOS Commercial |
$261.94
|
| Rate for Payer: HFN Commercial |
$270.77
|
| Rate for Payer: Multiplan Commercial |
$235.46
|
| Rate for Payer: Preferred Network Access Commercial |
$270.77
|
| Rate for Payer: Quartz Beloit One Network |
$144.22
|
| Rate for Payer: Quartz Commercial |
$176.59
|
| Rate for Payer: WEA Trust Commercial |
$161.88
|
| Rate for Payer: WPS Commercial |
$217.99
|
|
