|
Transbronchial - Bronchoscopy Charge
|
Facility
|
OP
|
$4,954.00
|
|
|
Service Code
|
CPT 31628
|
| Hospital Charge Code |
2990186
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,524.56 |
| Max. Negotiated Rate |
$14,596.05 |
| Rate for Payer: Aetna Commercial |
$4,636.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,430.86
|
| Rate for Payer: Aetna Managed Medicare |
$3,923.67
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$10,303.28
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8,364.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7,944.56
|
| Rate for Payer: Anthem Medicare Advantage |
$3,923.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,730.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$3,923.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$3,923.67
|
| Rate for Payer: Cash Price |
$1,486.20
|
| Rate for Payer: Cash Price |
$1,486.20
|
| Rate for Payer: Cash Price |
$1,486.20
|
| Rate for Payer: Cigna Commercial |
$4,739.99
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$3,923.67
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,947.89
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$3,923.67
|
| Rate for Payer: Health EOS Commercial |
$4,585.42
|
| Rate for Payer: HFN Commercial |
$4,739.99
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$14,596.05
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$3,923.67
|
| Rate for Payer: Independent Care Health Plan Medicare |
$3,923.67
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$3,923.67
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$3,923.67
|
| Rate for Payer: Multiplan Commercial |
$4,121.73
|
| Rate for Payer: NAPHCARE Commercial |
$5,885.51
|
| Rate for Payer: Preferred Network Access Commercial |
$4,739.99
|
| Rate for Payer: Quartz Beloit One Network |
$2,524.56
|
| Rate for Payer: Quartz Commercial |
$3,348.90
|
| Rate for Payer: Quartz Medicare Advantage |
$3,923.67
|
| Rate for Payer: The Alliance Commercial |
$6,670.24
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,923.67
|
| Rate for Payer: United Healthcare PPO |
$4,267.12
|
| Rate for Payer: WEA Trust Commercial |
$2,833.69
|
| Rate for Payer: Wellcare Medicare |
$3,923.67
|
| Rate for Payer: WPS Commercial |
$3,816.07
|
|
|
TRANSCATH IV STENT/PERC ADDL 37206
|
Professional
|
Both
|
$3,011.00
|
|
| Hospital Charge Code |
3014548
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$1,377.83 |
| Max. Negotiated Rate |
$2,974.87 |
| Rate for Payer: Aetna Commercial |
$2,974.87
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,693.04
|
| Rate for Payer: Cash Price |
$903.30
|
| Rate for Payer: Cigna Commercial |
$2,974.87
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,565.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,878.86
|
| Rate for Payer: Health EOS Commercial |
$2,849.61
|
| Rate for Payer: HFN Commercial |
$2,974.87
|
| Rate for Payer: Multiplan Commercial |
$2,505.15
|
| Rate for Payer: Preferred Network Access Commercial |
$2,974.87
|
| Rate for Payer: Quartz Beloit One Network |
$1,377.83
|
| Rate for Payer: Quartz Commercial |
$1,784.92
|
| Rate for Payer: The Alliance Commercial |
$1,565.72
|
| Rate for Payer: WEA Trust Commercial |
$1,722.29
|
| Rate for Payer: WPS Commercial |
$2,319.37
|
|
|
Transection or avulsion of other spinal nerve, extradural
|
Facility
|
OP
|
$8,220.12
|
|
|
Service Code
|
CPT 64772
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,055.03 |
| Max. Negotiated Rate |
$8,220.12 |
| Rate for Payer: Aetna Managed Medicare |
$2,055.03
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,635.84
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,985.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,835.04
|
| Rate for Payer: Anthem Medicare Advantage |
$2,055.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$2,055.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$2,055.03
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$2,055.03
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,947.89
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$2,055.03
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7,644.71
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$2,055.03
|
| Rate for Payer: Independent Care Health Plan Medicare |
$2,055.03
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$2,055.03
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$2,055.03
|
| Rate for Payer: NAPHCARE Commercial |
$3,082.54
|
| Rate for Payer: Quartz Medicare Advantage |
$2,055.03
|
| Rate for Payer: The Alliance Commercial |
$8,220.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,055.03
|
| Rate for Payer: United Healthcare PPO |
$3,726.32
|
| Rate for Payer: Wellcare Medicare |
$2,055.03
|
|
|
TRANSESOPHAGEAL ECHOCARDIOGRAPHY (TEE)
|
Facility
|
IP
|
$3,935.00
|
|
| Hospital Charge Code |
2960405
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,005.28 |
| Max. Negotiated Rate |
$3,765.01 |
| Rate for Payer: Aetna Commercial |
$3,683.16
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,519.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,168.97
|
| Rate for Payer: Cash Price |
$1,180.50
|
| Rate for Payer: Cigna Commercial |
$3,765.01
|
| Rate for Payer: Health EOS Commercial |
$3,642.24
|
| Rate for Payer: HFN Commercial |
$3,765.01
|
| Rate for Payer: Multiplan Commercial |
$3,273.92
|
| Rate for Payer: Preferred Network Access Commercial |
$3,765.01
|
| Rate for Payer: Quartz Beloit One Network |
$2,005.28
|
| Rate for Payer: Quartz Commercial |
$2,455.44
|
| Rate for Payer: WEA Trust Commercial |
$2,250.82
|
| Rate for Payer: WPS Commercial |
$3,031.13
|
|
|
TRANSESOPHAGEAL ECHOCARDIOGRAPHY (TEE)
|
Facility
|
OP
|
$3,935.00
|
|
| Hospital Charge Code |
2960405
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,145.87 |
| Max. Negotiated Rate |
$3,765.01 |
| Rate for Payer: Aetna Commercial |
$3,683.16
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,519.46
|
| Rate for Payer: Aetna Managed Medicare |
$1,145.87
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,660.06
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,046.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,964.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,168.97
|
| Rate for Payer: Cash Price |
$1,180.50
|
| Rate for Payer: Cigna Commercial |
$3,765.01
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,290.17
|
| Rate for Payer: Health EOS Commercial |
$3,642.24
|
| Rate for Payer: HFN Commercial |
$3,765.01
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,069.30
|
| Rate for Payer: Multiplan Commercial |
$3,273.92
|
| Rate for Payer: NAPHCARE Commercial |
$2,455.44
|
| Rate for Payer: Preferred Network Access Commercial |
$3,765.01
|
| Rate for Payer: Quartz Beloit One Network |
$2,005.28
|
| Rate for Payer: Quartz Commercial |
$2,660.06
|
| Rate for Payer: Quartz Medicare Advantage |
$2,455.44
|
| Rate for Payer: The Alliance Commercial |
$2,046.20
|
| Rate for Payer: WEA Trust Commercial |
$2,250.82
|
| Rate for Payer: WPS Commercial |
$3,031.13
|
|
|
TRANSFER OR TRANSPLANT OF SINGLE TENDON (WITH MUSCLE REDIRECTION OR REROUTING); DEEP (EG, ANTERIOR TIBIAL OR POSTERIOR TIBIAL THROUGH INTEROSSEOUS SPACE, FLEXOR DIGITORUM LONGUS, FLEXOR HALLUCIS LONGUS, OR PERONEAL TENDON TO MIDFOOT OR HINDFOOT)
|
Facility
|
OP
|
$30,545.47
|
|
|
Service Code
|
CPT 27691
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$7,636.37 |
| Max. Negotiated Rate |
$30,545.47 |
| Rate for Payer: Aetna Managed Medicare |
$7,636.37
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$18,182.32
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$16,724.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$15,889.12
|
| Rate for Payer: Anthem Medicare Advantage |
$7,636.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$7,636.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$7,636.37
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$7,636.37
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$8,107.14
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$7,636.37
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$28,407.28
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$7,636.37
|
| Rate for Payer: Independent Care Health Plan Medicare |
$7,636.37
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$7,636.37
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$7,636.37
|
| Rate for Payer: NAPHCARE Commercial |
$11,454.55
|
| Rate for Payer: Quartz Medicare Advantage |
$7,636.37
|
| Rate for Payer: The Alliance Commercial |
$30,545.47
|
| Rate for Payer: United Healthcare Medicare Advantage |
$7,636.37
|
| Rate for Payer: United Healthcare PPO |
$8,790.08
|
| Rate for Payer: Wellcare Medicare |
$7,636.37
|
|
|
TRANSFER OR TRANSPLANT OF SINGLE TENDON (WITH MUSCLE REDIRECTION OR REROUTING); EACH ADDITIONAL TENDON (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)
|
Facility
|
OP
|
$6,807.99
|
|
|
Service Code
|
CPT 27692
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$335.75 |
| Max. Negotiated Rate |
$6,807.99 |
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,807.99
|
| Rate for Payer: The Alliance Commercial |
$335.75
|
|
|
TRANSFER OR TRANSPLANT OF SINGLE TENDON (WITH MUSCLE REDIRECTION OR REROUTING); SUPERFICIAL (EG, ANTERIOR TIBIAL EXTENSORS INTO MIDFOOT)
|
Facility
|
OP
|
$30,545.47
|
|
|
Service Code
|
CPT 27690
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$7,636.37 |
| Max. Negotiated Rate |
$30,545.47 |
| Rate for Payer: Aetna Managed Medicare |
$7,636.37
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$18,182.32
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$16,724.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$15,889.12
|
| Rate for Payer: Anthem Medicare Advantage |
$7,636.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$7,636.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$7,636.37
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$7,636.37
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$8,107.14
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$7,636.37
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$28,407.28
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$7,636.37
|
| Rate for Payer: Independent Care Health Plan Medicare |
$7,636.37
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$7,636.37
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$7,636.37
|
| Rate for Payer: NAPHCARE Commercial |
$11,454.55
|
| Rate for Payer: Quartz Medicare Advantage |
$7,636.37
|
| Rate for Payer: The Alliance Commercial |
$30,545.47
|
| Rate for Payer: United Healthcare Medicare Advantage |
$7,636.37
|
| Rate for Payer: United Healthcare PPO |
$8,790.08
|
| Rate for Payer: Wellcare Medicare |
$7,636.37
|
|
|
Transferrin
|
Facility
|
IP
|
$179.00
|
|
|
Service Code
|
CPT 84466
|
| Hospital Charge Code |
633851
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$91.22 |
| Max. Negotiated Rate |
$171.27 |
| Rate for Payer: Aetna Commercial |
$167.54
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$160.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$98.66
|
| Rate for Payer: Cash Price |
$53.70
|
| Rate for Payer: Cigna Commercial |
$171.27
|
| Rate for Payer: Health EOS Commercial |
$165.68
|
| Rate for Payer: HFN Commercial |
$171.27
|
| Rate for Payer: Multiplan Commercial |
$148.93
|
| Rate for Payer: Preferred Network Access Commercial |
$171.27
|
| Rate for Payer: Quartz Beloit One Network |
$91.22
|
| Rate for Payer: Quartz Commercial |
$111.70
|
| Rate for Payer: WEA Trust Commercial |
$102.39
|
| Rate for Payer: WPS Commercial |
$137.88
|
|
|
Transferrin
|
Facility
|
OP
|
$179.00
|
|
|
Service Code
|
CPT 84466
|
| Hospital Charge Code |
633851
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.27 |
| Max. Negotiated Rate |
$171.27 |
| Rate for Payer: Aetna Commercial |
$167.54
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$160.10
|
| Rate for Payer: Aetna Managed Medicare |
$13.27
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$49.76
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$23.22
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$22.03
|
| Rate for Payer: Anthem Medicare Advantage |
$13.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$98.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$13.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$13.27
|
| Rate for Payer: Cash Price |
$53.70
|
| Rate for Payer: Cash Price |
$53.70
|
| Rate for Payer: Cigna Commercial |
$171.27
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$13.27
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$104.18
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$13.27
|
| Rate for Payer: Health EOS Commercial |
$165.68
|
| Rate for Payer: HFN Commercial |
$171.27
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$49.37
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$13.27
|
| Rate for Payer: Independent Care Health Plan Medicare |
$13.27
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$13.27
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$13.27
|
| Rate for Payer: Multiplan Commercial |
$148.93
|
| Rate for Payer: NAPHCARE Commercial |
$19.91
|
| Rate for Payer: Preferred Network Access Commercial |
$171.27
|
| Rate for Payer: Quartz Beloit One Network |
$91.22
|
| Rate for Payer: Quartz Commercial |
$121.00
|
| Rate for Payer: Quartz Medicare Advantage |
$13.27
|
| Rate for Payer: The Alliance Commercial |
$53.08
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.27
|
| Rate for Payer: United Healthcare PPO |
$139.62
|
| Rate for Payer: WEA Trust Commercial |
$102.39
|
| Rate for Payer: Wellcare Medicare |
$13.27
|
| Rate for Payer: WPS Commercial |
$137.88
|
|
|
Transferrin
|
Professional
|
Both
|
$179.00
|
|
|
Service Code
|
CPT 84466
|
| Hospital Charge Code |
633851
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.27 |
| Max. Negotiated Rate |
$176.85 |
| Rate for Payer: Aetna Commercial |
$176.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$160.10
|
| Rate for Payer: Aetna Managed Medicare |
$13.27
|
| Rate for Payer: Anthem Medicare Advantage |
$13.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$13.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$13.27
|
| Rate for Payer: Cash Price |
$53.70
|
| Rate for Payer: Cash Price |
$53.70
|
| Rate for Payer: Cigna Commercial |
$176.85
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$93.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$13.27
|
| Rate for Payer: Health EOS Commercial |
$169.41
|
| Rate for Payer: HFN Commercial |
$176.85
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$46.84
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$46.84
|
| Rate for Payer: Independent Care Health Plan Medicare |
$13.27
|
| Rate for Payer: Multiplan Commercial |
$148.93
|
| Rate for Payer: NAPHCARE Commercial |
$19.91
|
| Rate for Payer: Preferred Network Access Commercial |
$176.85
|
| Rate for Payer: Quartz Beloit One Network |
$81.91
|
| Rate for Payer: Quartz Commercial |
$106.11
|
| Rate for Payer: Quartz Medicare Advantage |
$13.27
|
| Rate for Payer: The Alliance Commercial |
$52.42
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.27
|
| Rate for Payer: WEA Trust Commercial |
$102.39
|
| Rate for Payer: WPS Commercial |
$58.39
|
|
|
Transferrin (CDT)
|
Facility
|
OP
|
$76.00
|
|
|
Service Code
|
CPT 84466
|
| Hospital Charge Code |
5528754
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.27 |
| Max. Negotiated Rate |
$72.72 |
| Rate for Payer: Aetna Commercial |
$71.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$67.97
|
| Rate for Payer: Aetna Managed Medicare |
$13.27
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$49.76
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$23.22
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$22.03
|
| Rate for Payer: Anthem Medicare Advantage |
$13.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$41.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$13.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$13.27
|
| Rate for Payer: Cash Price |
$22.80
|
| Rate for Payer: Cash Price |
$22.80
|
| Rate for Payer: Cigna Commercial |
$72.72
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$13.27
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$44.23
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$13.27
|
| Rate for Payer: Health EOS Commercial |
$70.35
|
| Rate for Payer: HFN Commercial |
$72.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$49.37
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$13.27
|
| Rate for Payer: Independent Care Health Plan Medicare |
$13.27
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$13.27
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$13.27
|
| Rate for Payer: Multiplan Commercial |
$63.23
|
| Rate for Payer: NAPHCARE Commercial |
$19.91
|
| Rate for Payer: Preferred Network Access Commercial |
$72.72
|
| Rate for Payer: Quartz Beloit One Network |
$38.73
|
| Rate for Payer: Quartz Commercial |
$51.38
|
| Rate for Payer: Quartz Medicare Advantage |
$13.27
|
| Rate for Payer: The Alliance Commercial |
$53.08
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.27
|
| Rate for Payer: United Healthcare PPO |
$59.28
|
| Rate for Payer: WEA Trust Commercial |
$43.47
|
| Rate for Payer: Wellcare Medicare |
$13.27
|
| Rate for Payer: WPS Commercial |
$58.54
|
|
|
Transferrin (CDT)
|
Facility
|
IP
|
$76.00
|
|
|
Service Code
|
CPT 84466
|
| Hospital Charge Code |
5528754
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$38.73 |
| Max. Negotiated Rate |
$72.72 |
| Rate for Payer: Aetna Commercial |
$71.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$67.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$41.89
|
| Rate for Payer: Cash Price |
$22.80
|
| Rate for Payer: Cigna Commercial |
$72.72
|
| Rate for Payer: Health EOS Commercial |
$70.35
|
| Rate for Payer: HFN Commercial |
$72.72
|
| Rate for Payer: Multiplan Commercial |
$63.23
|
| Rate for Payer: Preferred Network Access Commercial |
$72.72
|
| Rate for Payer: Quartz Beloit One Network |
$38.73
|
| Rate for Payer: Quartz Commercial |
$47.42
|
| Rate for Payer: WEA Trust Commercial |
$43.47
|
| Rate for Payer: WPS Commercial |
$58.54
|
|
|
Transferrin (CDT)
|
Professional
|
Both
|
$76.00
|
|
|
Service Code
|
CPT 84466
|
| Hospital Charge Code |
5528754
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.27 |
| Max. Negotiated Rate |
$75.09 |
| Rate for Payer: Aetna Commercial |
$75.09
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$67.97
|
| Rate for Payer: Aetna Managed Medicare |
$13.27
|
| Rate for Payer: Anthem Medicare Advantage |
$13.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$13.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$13.27
|
| Rate for Payer: Cash Price |
$22.80
|
| Rate for Payer: Cash Price |
$22.80
|
| Rate for Payer: Cigna Commercial |
$75.09
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$39.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$13.27
|
| Rate for Payer: Health EOS Commercial |
$71.93
|
| Rate for Payer: HFN Commercial |
$75.09
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$46.84
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$46.84
|
| Rate for Payer: Independent Care Health Plan Medicare |
$13.27
|
| Rate for Payer: Multiplan Commercial |
$63.23
|
| Rate for Payer: NAPHCARE Commercial |
$19.91
|
| Rate for Payer: Preferred Network Access Commercial |
$75.09
|
| Rate for Payer: Quartz Beloit One Network |
$34.78
|
| Rate for Payer: Quartz Commercial |
$45.05
|
| Rate for Payer: Quartz Medicare Advantage |
$13.27
|
| Rate for Payer: The Alliance Commercial |
$52.42
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.27
|
| Rate for Payer: WEA Trust Commercial |
$43.47
|
| Rate for Payer: WPS Commercial |
$58.39
|
|
|
TRANSFIX 3x50 BONE TENDON BONE
|
Facility
|
IP
|
$5,039.00
|
|
| Hospital Charge Code |
2964707
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,567.87 |
| Max. Negotiated Rate |
$4,821.32 |
| Rate for Payer: Aetna Commercial |
$4,716.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,506.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,777.50
|
| Rate for Payer: Cash Price |
$1,511.70
|
| Rate for Payer: Cigna Commercial |
$4,821.32
|
| Rate for Payer: Health EOS Commercial |
$4,664.10
|
| Rate for Payer: HFN Commercial |
$4,821.32
|
| Rate for Payer: Multiplan Commercial |
$4,192.45
|
| Rate for Payer: Preferred Network Access Commercial |
$4,821.32
|
| Rate for Payer: Quartz Beloit One Network |
$2,567.87
|
| Rate for Payer: Quartz Commercial |
$3,144.34
|
| Rate for Payer: WEA Trust Commercial |
$2,882.31
|
| Rate for Payer: WPS Commercial |
$3,881.54
|
|
|
TRANSFIX 3x50 BONE TENDON BONE
|
Facility
|
OP
|
$5,039.00
|
|
| Hospital Charge Code |
2964707
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,467.36 |
| Max. Negotiated Rate |
$4,821.32 |
| Rate for Payer: Aetna Commercial |
$4,716.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,506.88
|
| Rate for Payer: Aetna Managed Medicare |
$1,467.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,406.36
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,620.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,515.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,777.50
|
| Rate for Payer: Cash Price |
$1,511.70
|
| Rate for Payer: Cigna Commercial |
$4,821.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,932.70
|
| Rate for Payer: Health EOS Commercial |
$4,664.10
|
| Rate for Payer: HFN Commercial |
$4,821.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,930.42
|
| Rate for Payer: Multiplan Commercial |
$4,192.45
|
| Rate for Payer: NAPHCARE Commercial |
$3,144.34
|
| Rate for Payer: Preferred Network Access Commercial |
$4,821.32
|
| Rate for Payer: Quartz Beloit One Network |
$2,567.87
|
| Rate for Payer: Quartz Commercial |
$3,406.36
|
| Rate for Payer: Quartz Medicare Advantage |
$3,144.34
|
| Rate for Payer: The Alliance Commercial |
$2,620.28
|
| Rate for Payer: WEA Trust Commercial |
$2,882.31
|
| Rate for Payer: WPS Commercial |
$3,881.54
|
|
|
TRANSFUSION, BLOOD OR BLOOD COMPONENTS
|
Facility
|
OP
|
$12,349.86
|
|
|
Service Code
|
CPT 36430
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$464.29 |
| Max. Negotiated Rate |
$12,349.86 |
| Rate for Payer: Aetna Managed Medicare |
$464.29
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,030.56
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,388.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,270.32
|
| Rate for Payer: Anthem Medicare Advantage |
$464.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$464.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$464.29
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$464.29
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12,349.86
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$464.29
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,727.15
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$464.29
|
| Rate for Payer: Independent Care Health Plan Medicare |
$464.29
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$464.29
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$464.29
|
| Rate for Payer: NAPHCARE Commercial |
$696.43
|
| Rate for Payer: Quartz Medicare Advantage |
$464.29
|
| Rate for Payer: The Alliance Commercial |
$1,857.15
|
| Rate for Payer: United Healthcare Medicare Advantage |
$464.29
|
| Rate for Payer: United Healthcare PPO |
$2,347.28
|
| Rate for Payer: Wellcare Medicare |
$464.29
|
|
|
Transfusion Reaction Culture
|
Facility
|
OP
|
$275.00
|
|
|
Service Code
|
CPT 87040
|
| Hospital Charge Code |
983498
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.73 |
| Max. Negotiated Rate |
$263.12 |
| Rate for Payer: Aetna Commercial |
$257.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$245.96
|
| Rate for Payer: Aetna Managed Medicare |
$10.73
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$40.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$18.78
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$17.82
|
| Rate for Payer: Anthem Medicare Advantage |
$10.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$151.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$10.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$10.73
|
| Rate for Payer: Cash Price |
$82.50
|
| Rate for Payer: Cash Price |
$82.50
|
| Rate for Payer: Cigna Commercial |
$263.12
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$10.73
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$160.05
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$10.73
|
| Rate for Payer: Health EOS Commercial |
$254.54
|
| Rate for Payer: HFN Commercial |
$263.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$39.93
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$10.73
|
| Rate for Payer: Independent Care Health Plan Medicare |
$10.73
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$10.73
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$10.73
|
| Rate for Payer: Multiplan Commercial |
$228.80
|
| Rate for Payer: NAPHCARE Commercial |
$16.10
|
| Rate for Payer: Preferred Network Access Commercial |
$263.12
|
| Rate for Payer: Quartz Beloit One Network |
$140.14
|
| Rate for Payer: Quartz Commercial |
$185.90
|
| Rate for Payer: Quartz Medicare Advantage |
$10.73
|
| Rate for Payer: The Alliance Commercial |
$42.93
|
| Rate for Payer: United Healthcare Medicare Advantage |
$10.73
|
| Rate for Payer: United Healthcare PPO |
$214.50
|
| Rate for Payer: WEA Trust Commercial |
$157.30
|
| Rate for Payer: Wellcare Medicare |
$10.73
|
| Rate for Payer: WPS Commercial |
$211.83
|
|
|
Transfusion Reaction Culture
|
Facility
|
IP
|
$275.00
|
|
|
Service Code
|
CPT 87040
|
| Hospital Charge Code |
983498
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$140.14 |
| Max. Negotiated Rate |
$263.12 |
| Rate for Payer: Aetna Commercial |
$257.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$245.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$151.58
|
| Rate for Payer: Cash Price |
$82.50
|
| Rate for Payer: Cigna Commercial |
$263.12
|
| Rate for Payer: Health EOS Commercial |
$254.54
|
| Rate for Payer: HFN Commercial |
$263.12
|
| Rate for Payer: Multiplan Commercial |
$228.80
|
| Rate for Payer: Preferred Network Access Commercial |
$263.12
|
| Rate for Payer: Quartz Beloit One Network |
$140.14
|
| Rate for Payer: Quartz Commercial |
$171.60
|
| Rate for Payer: WEA Trust Commercial |
$157.30
|
| Rate for Payer: WPS Commercial |
$211.83
|
|
|
Transfusion Reaction Culture
|
Professional
|
Both
|
$275.00
|
|
|
Service Code
|
CPT 87040
|
| Hospital Charge Code |
983498
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.73 |
| Max. Negotiated Rate |
$271.70 |
| Rate for Payer: Aetna Commercial |
$271.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$245.96
|
| Rate for Payer: Aetna Managed Medicare |
$10.73
|
| Rate for Payer: Anthem Medicare Advantage |
$10.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$10.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$10.73
|
| Rate for Payer: Cash Price |
$82.50
|
| Rate for Payer: Cash Price |
$82.50
|
| Rate for Payer: Cigna Commercial |
$271.70
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$143.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$10.73
|
| Rate for Payer: Health EOS Commercial |
$260.26
|
| Rate for Payer: HFN Commercial |
$271.70
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$37.89
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$37.89
|
| Rate for Payer: Independent Care Health Plan Medicare |
$10.73
|
| Rate for Payer: Multiplan Commercial |
$228.80
|
| Rate for Payer: NAPHCARE Commercial |
$16.10
|
| Rate for Payer: Preferred Network Access Commercial |
$271.70
|
| Rate for Payer: Quartz Beloit One Network |
$125.84
|
| Rate for Payer: Quartz Commercial |
$163.02
|
| Rate for Payer: Quartz Medicare Advantage |
$10.73
|
| Rate for Payer: The Alliance Commercial |
$42.39
|
| Rate for Payer: United Healthcare Medicare Advantage |
$10.73
|
| Rate for Payer: WEA Trust Commercial |
$157.30
|
| Rate for Payer: WPS Commercial |
$47.22
|
|
|
TRANSIENT ISCHEMIA
|
Facility
|
IP
|
$6,488.55
|
|
|
Service Code
|
APR-DRG 0471
|
| Min. Negotiated Rate |
$5,763.53 |
| Max. Negotiated Rate |
$6,488.55 |
| Rate for Payer: Anthem Medicaid |
$6,213.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$6,213.14
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$6,213.14
|
| Rate for Payer: Dean Health Medicaid |
$6,213.14
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$5,763.53
|
| Rate for Payer: Managed Health Services Medicaid |
$6,488.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,213.14
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$6,213.14
|
| Rate for Payer: United Healthcare Medicaid |
$6,213.14
|
|
|
TRANSIENT ISCHEMIA
|
Facility
|
IP
|
$15,081.49
|
|
|
Service Code
|
APR-DRG 0474
|
| Min. Negotiated Rate |
$13,396.32 |
| Max. Negotiated Rate |
$15,081.49 |
| Rate for Payer: Anthem Medicaid |
$14,441.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$14,441.36
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$14,441.36
|
| Rate for Payer: Dean Health Medicaid |
$14,441.36
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$13,396.32
|
| Rate for Payer: Managed Health Services Medicaid |
$15,081.49
|
| Rate for Payer: Molina Healthcare Medicaid |
$14,441.36
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$14,441.36
|
| Rate for Payer: United Healthcare Medicaid |
$14,441.36
|
|
|
TRANSIENT ISCHEMIA
|
Facility
|
OP
|
$56.45
|
|
|
Service Code
|
EAPG 00526
|
| Min. Negotiated Rate |
$54.28 |
| Max. Negotiated Rate |
$56.45 |
| Rate for Payer: Anthem Medicaid |
$54.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$54.28
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$54.28
|
| Rate for Payer: Dean Health Medicaid |
$54.28
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$54.28
|
| Rate for Payer: Managed Health Services Medicaid |
$56.45
|
| Rate for Payer: Molina Healthcare Medicaid |
$54.28
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$54.28
|
| Rate for Payer: United Healthcare Medicaid |
$54.28
|
|
|
TRANSIENT ISCHEMIA
|
Facility
|
IP
|
$9,294.41
|
|
|
Service Code
|
APR-DRG 0473
|
| Min. Negotiated Rate |
$8,255.87 |
| Max. Negotiated Rate |
$9,294.41 |
| Rate for Payer: Anthem Medicaid |
$8,899.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$8,899.91
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$8,899.91
|
| Rate for Payer: Dean Health Medicaid |
$8,899.91
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$8,255.87
|
| Rate for Payer: Managed Health Services Medicaid |
$9,294.41
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,899.91
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$8,899.91
|
| Rate for Payer: United Healthcare Medicaid |
$8,899.91
|
|
|
TRANSIENT ISCHEMIA
|
Facility
|
IP
|
$7,453.06
|
|
|
Service Code
|
APR-DRG 0472
|
| Min. Negotiated Rate |
$6,620.28 |
| Max. Negotiated Rate |
$7,453.06 |
| Rate for Payer: Anthem Medicaid |
$7,136.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$7,136.72
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$7,136.72
|
| Rate for Payer: Dean Health Medicaid |
$7,136.72
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$6,620.28
|
| Rate for Payer: Managed Health Services Medicaid |
$7,453.06
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,136.72
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$7,136.72
|
| Rate for Payer: United Healthcare Medicaid |
$7,136.72
|
|
