|
TREAT THIGH FRACTURE 27246
|
Professional
|
Both
|
$991.00
|
|
|
Service Code
|
CPT 27246
|
| Hospital Charge Code |
3014035
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$301.31 |
| Max. Negotiated Rate |
$1,287.43 |
| Rate for Payer: Aetna Commercial |
$941.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$852.26
|
| Rate for Payer: Cash Price |
$297.30
|
| Rate for Payer: Cash Price |
$297.30
|
| Rate for Payer: Cash Price |
$297.30
|
| Rate for Payer: Cigna Commercial |
$941.45
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$301.31
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$594.60
|
| Rate for Payer: Health EOS Commercial |
$901.81
|
| Rate for Payer: HFN Commercial |
$941.45
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,287.43
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,287.43
|
| Rate for Payer: Multiplan Commercial |
$792.80
|
| Rate for Payer: Preferred Network Access Commercial |
$941.45
|
| Rate for Payer: Quartz Beloit One Network |
$436.04
|
| Rate for Payer: Quartz Commercial |
$564.87
|
| Rate for Payer: The Alliance Commercial |
$495.50
|
| Rate for Payer: United Healthcare Medicaid |
$301.31
|
| Rate for Payer: WEA Trust Commercial |
$545.05
|
| Rate for Payer: WPS Commercial |
$734.03
|
|
|
TREAT THIGH FX GROWTH PLATE 27516
|
Professional
|
Both
|
$2,001.00
|
|
|
Service Code
|
CPT 27516
|
| Hospital Charge Code |
3014091
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$452.00 |
| Max. Negotiated Rate |
$1,900.95 |
| Rate for Payer: Aetna Commercial |
$1,900.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,720.86
|
| Rate for Payer: Cash Price |
$600.30
|
| Rate for Payer: Cash Price |
$600.30
|
| Rate for Payer: Cash Price |
$600.30
|
| Rate for Payer: Cigna Commercial |
$1,900.95
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$452.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,200.60
|
| Rate for Payer: Health EOS Commercial |
$1,820.91
|
| Rate for Payer: HFN Commercial |
$1,900.95
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,613.49
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,613.49
|
| Rate for Payer: Multiplan Commercial |
$1,600.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,900.95
|
| Rate for Payer: Quartz Beloit One Network |
$880.44
|
| Rate for Payer: Quartz Commercial |
$1,140.57
|
| Rate for Payer: The Alliance Commercial |
$1,000.50
|
| Rate for Payer: United Healthcare Medicaid |
$452.00
|
| Rate for Payer: WEA Trust Commercial |
$1,100.55
|
| Rate for Payer: WPS Commercial |
$1,482.14
|
|
|
TREAT TOE DISLOCATION 28635
|
Professional
|
Both
|
$620.00
|
|
|
Service Code
|
CPT 28635
|
| Hospital Charge Code |
3014270
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$105.45 |
| Max. Negotiated Rate |
$589.00 |
| Rate for Payer: Aetna Commercial |
$589.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$533.20
|
| Rate for Payer: Cash Price |
$186.00
|
| Rate for Payer: Cash Price |
$186.00
|
| Rate for Payer: Cash Price |
$186.00
|
| Rate for Payer: Cigna Commercial |
$589.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$105.45
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$372.00
|
| Rate for Payer: Health EOS Commercial |
$564.20
|
| Rate for Payer: HFN Commercial |
$589.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$452.86
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$452.86
|
| Rate for Payer: Multiplan Commercial |
$496.00
|
| Rate for Payer: Preferred Network Access Commercial |
$589.00
|
| Rate for Payer: Quartz Beloit One Network |
$272.80
|
| Rate for Payer: Quartz Commercial |
$353.40
|
| Rate for Payer: The Alliance Commercial |
$310.00
|
| Rate for Payer: United Healthcare Medicaid |
$105.45
|
| Rate for Payer: WEA Trust Commercial |
$341.00
|
| Rate for Payer: WPS Commercial |
$459.23
|
|
|
TREAT TOE DISLOCATION 28636
|
Professional
|
Both
|
$1,132.00
|
|
|
Service Code
|
CPT 28636
|
| Hospital Charge Code |
3014271
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$213.30 |
| Max. Negotiated Rate |
$1,075.40 |
| Rate for Payer: Aetna Commercial |
$1,075.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$973.52
|
| Rate for Payer: Cash Price |
$339.60
|
| Rate for Payer: Cash Price |
$339.60
|
| Rate for Payer: Cash Price |
$339.60
|
| Rate for Payer: Cigna Commercial |
$1,075.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$213.30
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$679.20
|
| Rate for Payer: Health EOS Commercial |
$1,030.12
|
| Rate for Payer: HFN Commercial |
$1,075.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$662.83
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$662.83
|
| Rate for Payer: Multiplan Commercial |
$905.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,075.40
|
| Rate for Payer: Quartz Beloit One Network |
$498.08
|
| Rate for Payer: Quartz Commercial |
$645.24
|
| Rate for Payer: The Alliance Commercial |
$566.00
|
| Rate for Payer: United Healthcare Medicaid |
$213.30
|
| Rate for Payer: WEA Trust Commercial |
$622.60
|
| Rate for Payer: WPS Commercial |
$838.47
|
|
|
TREAT TOE DISLOCATION 28660
|
Professional
|
Both
|
$412.00
|
|
|
Service Code
|
CPT 28660
|
| Hospital Charge Code |
3014273
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$68.02 |
| Max. Negotiated Rate |
$391.40 |
| Rate for Payer: Aetna Commercial |
$391.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$354.32
|
| Rate for Payer: Cash Price |
$123.60
|
| Rate for Payer: Cash Price |
$123.60
|
| Rate for Payer: Cash Price |
$123.60
|
| Rate for Payer: Cigna Commercial |
$391.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$68.02
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$247.20
|
| Rate for Payer: Health EOS Commercial |
$374.92
|
| Rate for Payer: HFN Commercial |
$391.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$306.09
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$306.09
|
| Rate for Payer: Multiplan Commercial |
$329.60
|
| Rate for Payer: Preferred Network Access Commercial |
$391.40
|
| Rate for Payer: Quartz Beloit One Network |
$181.28
|
| Rate for Payer: Quartz Commercial |
$234.84
|
| Rate for Payer: The Alliance Commercial |
$206.00
|
| Rate for Payer: United Healthcare Medicaid |
$68.02
|
| Rate for Payer: WEA Trust Commercial |
$226.60
|
| Rate for Payer: WPS Commercial |
$305.17
|
|
|
TREAT TOE FRACTURE 28525
|
Professional
|
Both
|
$1,953.00
|
|
|
Service Code
|
CPT 28525
|
| Hospital Charge Code |
3014262
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$188.32 |
| Max. Negotiated Rate |
$1,855.35 |
| Rate for Payer: Aetna Commercial |
$1,855.35
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,679.58
|
| Rate for Payer: Cash Price |
$585.90
|
| Rate for Payer: Cash Price |
$585.90
|
| Rate for Payer: Cash Price |
$585.90
|
| Rate for Payer: Cigna Commercial |
$1,855.35
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$188.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,171.80
|
| Rate for Payer: Health EOS Commercial |
$1,777.23
|
| Rate for Payer: HFN Commercial |
$1,855.35
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,358.66
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,358.66
|
| Rate for Payer: Multiplan Commercial |
$1,562.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,855.35
|
| Rate for Payer: Quartz Beloit One Network |
$859.32
|
| Rate for Payer: Quartz Commercial |
$1,113.21
|
| Rate for Payer: The Alliance Commercial |
$976.50
|
| Rate for Payer: United Healthcare Medicaid |
$188.32
|
| Rate for Payer: WEA Trust Commercial |
$1,074.15
|
| Rate for Payer: WPS Commercial |
$1,446.59
|
|
|
TREAT ULNAR FRACTURE 24675
|
Professional
|
Both
|
$1,085.00
|
|
|
Service Code
|
CPT 24675
|
| Hospital Charge Code |
3013853
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$226.00 |
| Max. Negotiated Rate |
$1,392.09 |
| Rate for Payer: Aetna Commercial |
$1,030.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$933.10
|
| Rate for Payer: Cash Price |
$325.50
|
| Rate for Payer: Cash Price |
$325.50
|
| Rate for Payer: Cash Price |
$325.50
|
| Rate for Payer: Cigna Commercial |
$1,030.75
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$226.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$651.00
|
| Rate for Payer: Health EOS Commercial |
$987.35
|
| Rate for Payer: HFN Commercial |
$1,030.75
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,392.09
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,392.09
|
| Rate for Payer: Multiplan Commercial |
$868.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,030.75
|
| Rate for Payer: Quartz Beloit One Network |
$477.40
|
| Rate for Payer: Quartz Commercial |
$618.45
|
| Rate for Payer: The Alliance Commercial |
$542.50
|
| Rate for Payer: United Healthcare Medicaid |
$226.00
|
| Rate for Payer: WEA Trust Commercial |
$596.75
|
| Rate for Payer: WPS Commercial |
$803.66
|
|
|
TREAT VAGINAL BLEEDING 57180
|
Professional
|
Both
|
$943.00
|
|
|
Service Code
|
CPT 57180
|
| Hospital Charge Code |
3015073
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$71.82 |
| Max. Negotiated Rate |
$895.85 |
| Rate for Payer: Aetna Commercial |
$895.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$810.98
|
| Rate for Payer: Cash Price |
$282.90
|
| Rate for Payer: Cash Price |
$282.90
|
| Rate for Payer: Cash Price |
$282.90
|
| Rate for Payer: Cigna Commercial |
$895.85
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$71.82
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$565.80
|
| Rate for Payer: Health EOS Commercial |
$858.13
|
| Rate for Payer: HFN Commercial |
$895.85
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$401.33
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$401.33
|
| Rate for Payer: Multiplan Commercial |
$754.40
|
| Rate for Payer: Preferred Network Access Commercial |
$895.85
|
| Rate for Payer: Quartz Beloit One Network |
$414.92
|
| Rate for Payer: Quartz Commercial |
$537.51
|
| Rate for Payer: The Alliance Commercial |
$471.50
|
| Rate for Payer: United Healthcare Medicaid |
$71.82
|
| Rate for Payer: WEA Trust Commercial |
$518.65
|
| Rate for Payer: WPS Commercial |
$698.48
|
|
|
TREAT WRIST BONE FRACTURE 25624
|
Professional
|
Both
|
$1,430.00
|
|
|
Service Code
|
CPT 25624
|
| Hospital Charge Code |
3013911
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$303.21 |
| Max. Negotiated Rate |
$1,486.59 |
| Rate for Payer: Aetna Commercial |
$1,358.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,229.80
|
| Rate for Payer: Cash Price |
$429.00
|
| Rate for Payer: Cash Price |
$429.00
|
| Rate for Payer: Cash Price |
$429.00
|
| Rate for Payer: Cigna Commercial |
$1,358.50
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$303.21
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$858.00
|
| Rate for Payer: Health EOS Commercial |
$1,301.30
|
| Rate for Payer: HFN Commercial |
$1,358.50
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,486.59
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,486.59
|
| Rate for Payer: Multiplan Commercial |
$1,144.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,358.50
|
| Rate for Payer: Quartz Beloit One Network |
$629.20
|
| Rate for Payer: Quartz Commercial |
$815.10
|
| Rate for Payer: The Alliance Commercial |
$715.00
|
| Rate for Payer: United Healthcare Medicaid |
$303.21
|
| Rate for Payer: WEA Trust Commercial |
$786.50
|
| Rate for Payer: WPS Commercial |
$1,059.20
|
|
|
.Treponema Pallidum Ab
|
Professional
|
Both
|
$75.40
|
|
|
Service Code
|
CPT 86780
|
| Hospital Charge Code |
6222203
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$33.18 |
| Max. Negotiated Rate |
$71.63 |
| Rate for Payer: Aetna Commercial |
$71.63
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$64.84
|
| Rate for Payer: Cash Price |
$22.62
|
| Rate for Payer: Cash Price |
$22.62
|
| Rate for Payer: Cigna Commercial |
$71.63
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$37.70
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$45.24
|
| Rate for Payer: Health EOS Commercial |
$68.61
|
| Rate for Payer: HFN Commercial |
$71.63
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$46.74
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$46.74
|
| Rate for Payer: Multiplan Commercial |
$60.32
|
| Rate for Payer: Preferred Network Access Commercial |
$71.63
|
| Rate for Payer: Quartz Beloit One Network |
$33.18
|
| Rate for Payer: Quartz Commercial |
$42.98
|
| Rate for Payer: The Alliance Commercial |
$37.70
|
| Rate for Payer: WEA Trust Commercial |
$41.47
|
| Rate for Payer: WPS Commercial |
$55.85
|
|
|
.Treponema Pallidum Ab
|
Facility
|
OP
|
$75.40
|
|
|
Service Code
|
CPT 86780
|
| Hospital Charge Code |
6222203
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.13 |
| Max. Negotiated Rate |
$69.37 |
| Rate for Payer: Aetna Commercial |
$67.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$64.84
|
| Rate for Payer: Aetna Managed Medicare |
$13.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$49.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$23.17
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$21.98
|
| Rate for Payer: Anthem Medicaid |
$11.13
|
| Rate for Payer: Anthem Medicare Advantage |
$13.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$39.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$13.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$13.24
|
| Rate for Payer: Cash Price |
$22.62
|
| Rate for Payer: Cash Price |
$22.62
|
| Rate for Payer: Cigna Commercial |
$69.37
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$13.24
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$11.13
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$42.19
|
| Rate for Payer: Dean Health Medicaid |
$11.13
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$13.24
|
| Rate for Payer: Health EOS Commercial |
$67.11
|
| Rate for Payer: HFN Commercial |
$69.37
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$49.25
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$13.24
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$11.13
|
| Rate for Payer: Independent Care Health Plan Medicare |
$13.24
|
| Rate for Payer: Managed Health Services Medicaid |
$11.58
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$13.24
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$13.24
|
| Rate for Payer: Multiplan Commercial |
$60.32
|
| Rate for Payer: NAPHCARE Commercial |
$19.86
|
| Rate for Payer: Preferred Network Access Commercial |
$69.37
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$11.13
|
| Rate for Payer: Quartz Beloit One Network |
$36.95
|
| Rate for Payer: Quartz Commercial |
$49.01
|
| Rate for Payer: Quartz Medicare Advantage |
$13.24
|
| Rate for Payer: The Alliance Commercial |
$52.96
|
| Rate for Payer: United Healthcare Medicaid |
$11.13
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.24
|
| Rate for Payer: United Healthcare PPO |
$56.55
|
| Rate for Payer: WEA Trust Commercial |
$41.47
|
| Rate for Payer: Wellcare Medicare |
$13.24
|
| Rate for Payer: WMAP Medicaid |
$11.13
|
| Rate for Payer: WPS Commercial |
$55.85
|
|
|
.Treponema Pallidum Ab
|
Facility
|
IP
|
$75.40
|
|
|
Service Code
|
CPT 86780
|
| Hospital Charge Code |
6222203
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$36.95 |
| Max. Negotiated Rate |
$69.37 |
| Rate for Payer: Aetna Commercial |
$67.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$64.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$39.96
|
| Rate for Payer: Cash Price |
$22.62
|
| Rate for Payer: Cigna Commercial |
$69.37
|
| Rate for Payer: Health EOS Commercial |
$67.11
|
| Rate for Payer: HFN Commercial |
$69.37
|
| Rate for Payer: Multiplan Commercial |
$60.32
|
| Rate for Payer: NAPHCARE Commercial |
$45.24
|
| Rate for Payer: Preferred Network Access Commercial |
$69.37
|
| Rate for Payer: Quartz Beloit One Network |
$36.95
|
| Rate for Payer: Quartz Commercial |
$45.24
|
| Rate for Payer: WEA Trust Commercial |
$41.47
|
| Rate for Payer: WPS Commercial |
$55.85
|
|
|
Treponema pallidum Ab IgG, IgM
|
Professional
|
Both
|
$81.00
|
|
|
Service Code
|
CPT 86780
|
| Hospital Charge Code |
5278648
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$35.64 |
| Max. Negotiated Rate |
$76.95 |
| Rate for Payer: Aetna Commercial |
$76.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$69.66
|
| Rate for Payer: Cash Price |
$24.30
|
| Rate for Payer: Cash Price |
$24.30
|
| Rate for Payer: Cigna Commercial |
$76.95
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$40.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$48.60
|
| Rate for Payer: Health EOS Commercial |
$73.71
|
| Rate for Payer: HFN Commercial |
$76.95
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$46.74
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$46.74
|
| Rate for Payer: Multiplan Commercial |
$64.80
|
| Rate for Payer: Preferred Network Access Commercial |
$76.95
|
| Rate for Payer: Quartz Beloit One Network |
$35.64
|
| Rate for Payer: Quartz Commercial |
$46.17
|
| Rate for Payer: The Alliance Commercial |
$40.50
|
| Rate for Payer: WEA Trust Commercial |
$44.55
|
| Rate for Payer: WPS Commercial |
$60.00
|
|
|
Treponema pallidum Ab IgG, IgM
|
Facility
|
OP
|
$81.00
|
|
|
Service Code
|
CPT 86780
|
| Hospital Charge Code |
5278648
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.13 |
| Max. Negotiated Rate |
$74.52 |
| Rate for Payer: Aetna Commercial |
$72.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$69.66
|
| Rate for Payer: Aetna Managed Medicare |
$13.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$49.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$23.17
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$21.98
|
| Rate for Payer: Anthem Medicaid |
$11.13
|
| Rate for Payer: Anthem Medicare Advantage |
$13.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$42.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$13.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$13.24
|
| Rate for Payer: Cash Price |
$24.30
|
| Rate for Payer: Cash Price |
$24.30
|
| Rate for Payer: Cigna Commercial |
$74.52
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$13.24
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$11.13
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$45.33
|
| Rate for Payer: Dean Health Medicaid |
$11.13
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$13.24
|
| Rate for Payer: Health EOS Commercial |
$72.09
|
| Rate for Payer: HFN Commercial |
$74.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$49.25
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$13.24
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$11.13
|
| Rate for Payer: Independent Care Health Plan Medicare |
$13.24
|
| Rate for Payer: Managed Health Services Medicaid |
$11.58
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$13.24
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$13.24
|
| Rate for Payer: Multiplan Commercial |
$64.80
|
| Rate for Payer: NAPHCARE Commercial |
$19.86
|
| Rate for Payer: Preferred Network Access Commercial |
$74.52
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$11.13
|
| Rate for Payer: Quartz Beloit One Network |
$39.69
|
| Rate for Payer: Quartz Commercial |
$52.65
|
| Rate for Payer: Quartz Medicare Advantage |
$13.24
|
| Rate for Payer: The Alliance Commercial |
$52.96
|
| Rate for Payer: United Healthcare Medicaid |
$11.13
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.24
|
| Rate for Payer: United Healthcare PPO |
$60.75
|
| Rate for Payer: WEA Trust Commercial |
$44.55
|
| Rate for Payer: Wellcare Medicare |
$13.24
|
| Rate for Payer: WMAP Medicaid |
$11.13
|
| Rate for Payer: WPS Commercial |
$60.00
|
|
|
Treponema pallidum Ab IgG, IgM
|
Facility
|
IP
|
$81.00
|
|
|
Service Code
|
CPT 86780
|
| Hospital Charge Code |
5278648
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$39.69 |
| Max. Negotiated Rate |
$74.52 |
| Rate for Payer: Aetna Commercial |
$72.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$69.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$42.93
|
| Rate for Payer: Cash Price |
$24.30
|
| Rate for Payer: Cigna Commercial |
$74.52
|
| Rate for Payer: Health EOS Commercial |
$72.09
|
| Rate for Payer: HFN Commercial |
$74.52
|
| Rate for Payer: Multiplan Commercial |
$64.80
|
| Rate for Payer: NAPHCARE Commercial |
$48.60
|
| Rate for Payer: Preferred Network Access Commercial |
$74.52
|
| Rate for Payer: Quartz Beloit One Network |
$39.69
|
| Rate for Payer: Quartz Commercial |
$48.60
|
| Rate for Payer: WEA Trust Commercial |
$44.55
|
| Rate for Payer: WPS Commercial |
$60.00
|
|
|
Treponema pallidum Ab IgM
|
Facility
|
OP
|
$54.00
|
|
|
Service Code
|
CPT 86780
|
| Hospital Charge Code |
5278655
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.13 |
| Max. Negotiated Rate |
$52.96 |
| Rate for Payer: Aetna Commercial |
$48.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$46.44
|
| Rate for Payer: Aetna Managed Medicare |
$13.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$49.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$23.17
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$21.98
|
| Rate for Payer: Anthem Medicaid |
$11.13
|
| Rate for Payer: Anthem Medicare Advantage |
$13.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$28.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$13.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$13.24
|
| Rate for Payer: Cash Price |
$16.20
|
| Rate for Payer: Cash Price |
$16.20
|
| Rate for Payer: Cigna Commercial |
$49.68
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$13.24
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$11.13
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$30.22
|
| Rate for Payer: Dean Health Medicaid |
$11.13
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$13.24
|
| Rate for Payer: Health EOS Commercial |
$48.06
|
| Rate for Payer: HFN Commercial |
$49.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$49.25
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$13.24
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$11.13
|
| Rate for Payer: Independent Care Health Plan Medicare |
$13.24
|
| Rate for Payer: Managed Health Services Medicaid |
$11.58
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$13.24
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$13.24
|
| Rate for Payer: Multiplan Commercial |
$43.20
|
| Rate for Payer: NAPHCARE Commercial |
$19.86
|
| Rate for Payer: Preferred Network Access Commercial |
$49.68
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$11.13
|
| Rate for Payer: Quartz Beloit One Network |
$26.46
|
| Rate for Payer: Quartz Commercial |
$35.10
|
| Rate for Payer: Quartz Medicare Advantage |
$13.24
|
| Rate for Payer: The Alliance Commercial |
$52.96
|
| Rate for Payer: United Healthcare Medicaid |
$11.13
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.24
|
| Rate for Payer: United Healthcare PPO |
$40.50
|
| Rate for Payer: WEA Trust Commercial |
$29.70
|
| Rate for Payer: Wellcare Medicare |
$13.24
|
| Rate for Payer: WMAP Medicaid |
$11.13
|
| Rate for Payer: WPS Commercial |
$40.00
|
|
|
Treponema pallidum Ab IgM
|
Facility
|
IP
|
$54.00
|
|
|
Service Code
|
CPT 86780
|
| Hospital Charge Code |
5278655
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$26.46 |
| Max. Negotiated Rate |
$49.68 |
| Rate for Payer: Aetna Commercial |
$48.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$46.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$28.62
|
| Rate for Payer: Cash Price |
$16.20
|
| Rate for Payer: Cigna Commercial |
$49.68
|
| Rate for Payer: Health EOS Commercial |
$48.06
|
| Rate for Payer: HFN Commercial |
$49.68
|
| Rate for Payer: Multiplan Commercial |
$43.20
|
| Rate for Payer: NAPHCARE Commercial |
$32.40
|
| Rate for Payer: Preferred Network Access Commercial |
$49.68
|
| Rate for Payer: Quartz Beloit One Network |
$26.46
|
| Rate for Payer: Quartz Commercial |
$32.40
|
| Rate for Payer: WEA Trust Commercial |
$29.70
|
| Rate for Payer: WPS Commercial |
$40.00
|
|
|
Treponema pallidum Ab IgM
|
Professional
|
Both
|
$54.00
|
|
|
Service Code
|
CPT 86780
|
| Hospital Charge Code |
5278655
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$23.76 |
| Max. Negotiated Rate |
$51.30 |
| Rate for Payer: Aetna Commercial |
$51.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$46.44
|
| Rate for Payer: Cash Price |
$16.20
|
| Rate for Payer: Cash Price |
$16.20
|
| Rate for Payer: Cigna Commercial |
$51.30
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$27.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$32.40
|
| Rate for Payer: Health EOS Commercial |
$49.14
|
| Rate for Payer: HFN Commercial |
$51.30
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$46.74
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$46.74
|
| Rate for Payer: Multiplan Commercial |
$43.20
|
| Rate for Payer: Preferred Network Access Commercial |
$51.30
|
| Rate for Payer: Quartz Beloit One Network |
$23.76
|
| Rate for Payer: Quartz Commercial |
$30.78
|
| Rate for Payer: The Alliance Commercial |
$27.00
|
| Rate for Payer: WEA Trust Commercial |
$29.70
|
| Rate for Payer: WPS Commercial |
$40.00
|
|
|
Treponema pallidum Antibody
|
Facility
|
OP
|
$29.00
|
|
|
Service Code
|
CPT 86780
|
| Hospital Charge Code |
5072628
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.13 |
| Max. Negotiated Rate |
$52.96 |
| Rate for Payer: Aetna Commercial |
$26.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$24.94
|
| Rate for Payer: Aetna Managed Medicare |
$13.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$49.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$23.17
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$21.98
|
| Rate for Payer: Anthem Medicaid |
$11.13
|
| Rate for Payer: Anthem Medicare Advantage |
$13.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$15.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$13.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$13.24
|
| Rate for Payer: Cash Price |
$8.70
|
| Rate for Payer: Cash Price |
$8.70
|
| Rate for Payer: Cigna Commercial |
$26.68
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$13.24
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$11.13
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$16.23
|
| Rate for Payer: Dean Health Medicaid |
$11.13
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$13.24
|
| Rate for Payer: Health EOS Commercial |
$25.81
|
| Rate for Payer: HFN Commercial |
$26.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$49.25
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$13.24
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$11.13
|
| Rate for Payer: Independent Care Health Plan Medicare |
$13.24
|
| Rate for Payer: Managed Health Services Medicaid |
$11.58
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$13.24
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$13.24
|
| Rate for Payer: Multiplan Commercial |
$23.20
|
| Rate for Payer: NAPHCARE Commercial |
$19.86
|
| Rate for Payer: Preferred Network Access Commercial |
$26.68
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$11.13
|
| Rate for Payer: Quartz Beloit One Network |
$14.21
|
| Rate for Payer: Quartz Commercial |
$18.85
|
| Rate for Payer: Quartz Medicare Advantage |
$13.24
|
| Rate for Payer: The Alliance Commercial |
$52.96
|
| Rate for Payer: United Healthcare Medicaid |
$11.13
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.24
|
| Rate for Payer: United Healthcare PPO |
$21.75
|
| Rate for Payer: WEA Trust Commercial |
$15.95
|
| Rate for Payer: Wellcare Medicare |
$13.24
|
| Rate for Payer: WMAP Medicaid |
$11.13
|
| Rate for Payer: WPS Commercial |
$21.48
|
|
|
Treponema pallidum Antibody
|
Facility
|
IP
|
$29.00
|
|
|
Service Code
|
CPT 86780
|
| Hospital Charge Code |
5072628
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.21 |
| Max. Negotiated Rate |
$26.68 |
| Rate for Payer: Aetna Commercial |
$26.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$24.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$15.37
|
| Rate for Payer: Cash Price |
$8.70
|
| Rate for Payer: Cigna Commercial |
$26.68
|
| Rate for Payer: Health EOS Commercial |
$25.81
|
| Rate for Payer: HFN Commercial |
$26.68
|
| Rate for Payer: Multiplan Commercial |
$23.20
|
| Rate for Payer: NAPHCARE Commercial |
$17.40
|
| Rate for Payer: Preferred Network Access Commercial |
$26.68
|
| Rate for Payer: Quartz Beloit One Network |
$14.21
|
| Rate for Payer: Quartz Commercial |
$17.40
|
| Rate for Payer: WEA Trust Commercial |
$15.95
|
| Rate for Payer: WPS Commercial |
$21.48
|
|
|
Treponema pallidum Antibody
|
Professional
|
Both
|
$29.00
|
|
|
Service Code
|
CPT 86780
|
| Hospital Charge Code |
5072628
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.76 |
| Max. Negotiated Rate |
$46.74 |
| Rate for Payer: Aetna Commercial |
$27.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$24.94
|
| Rate for Payer: Cash Price |
$8.70
|
| Rate for Payer: Cash Price |
$8.70
|
| Rate for Payer: Cigna Commercial |
$27.55
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$14.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$17.40
|
| Rate for Payer: Health EOS Commercial |
$26.39
|
| Rate for Payer: HFN Commercial |
$27.55
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$46.74
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$46.74
|
| Rate for Payer: Multiplan Commercial |
$23.20
|
| Rate for Payer: Preferred Network Access Commercial |
$27.55
|
| Rate for Payer: Quartz Beloit One Network |
$12.76
|
| Rate for Payer: Quartz Commercial |
$16.53
|
| Rate for Payer: The Alliance Commercial |
$14.50
|
| Rate for Payer: WEA Trust Commercial |
$15.95
|
| Rate for Payer: WPS Commercial |
$21.48
|
|
|
Treponema pallidum, IFA, CSF
|
Facility
|
OP
|
$31.00
|
|
|
Service Code
|
CPT 86780
|
| Hospital Charge Code |
5364648
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.13 |
| Max. Negotiated Rate |
$52.96 |
| Rate for Payer: Aetna Commercial |
$27.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$26.66
|
| Rate for Payer: Aetna Managed Medicare |
$13.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$49.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$23.17
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$21.98
|
| Rate for Payer: Anthem Medicaid |
$11.13
|
| Rate for Payer: Anthem Medicare Advantage |
$13.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$16.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$13.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$13.24
|
| Rate for Payer: Cash Price |
$9.30
|
| Rate for Payer: Cash Price |
$9.30
|
| Rate for Payer: Cigna Commercial |
$28.52
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$13.24
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$11.13
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$17.35
|
| Rate for Payer: Dean Health Medicaid |
$11.13
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$13.24
|
| Rate for Payer: Health EOS Commercial |
$27.59
|
| Rate for Payer: HFN Commercial |
$28.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$49.25
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$13.24
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$11.13
|
| Rate for Payer: Independent Care Health Plan Medicare |
$13.24
|
| Rate for Payer: Managed Health Services Medicaid |
$11.58
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$13.24
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$13.24
|
| Rate for Payer: Multiplan Commercial |
$24.80
|
| Rate for Payer: NAPHCARE Commercial |
$19.86
|
| Rate for Payer: Preferred Network Access Commercial |
$28.52
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$11.13
|
| Rate for Payer: Quartz Beloit One Network |
$15.19
|
| Rate for Payer: Quartz Commercial |
$20.15
|
| Rate for Payer: Quartz Medicare Advantage |
$13.24
|
| Rate for Payer: The Alliance Commercial |
$52.96
|
| Rate for Payer: United Healthcare Medicaid |
$11.13
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.24
|
| Rate for Payer: United Healthcare PPO |
$23.25
|
| Rate for Payer: WEA Trust Commercial |
$17.05
|
| Rate for Payer: Wellcare Medicare |
$13.24
|
| Rate for Payer: WMAP Medicaid |
$11.13
|
| Rate for Payer: WPS Commercial |
$22.96
|
|
|
Treponema pallidum, IFA, CSF
|
Facility
|
IP
|
$31.00
|
|
|
Service Code
|
CPT 86780
|
| Hospital Charge Code |
5364648
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.19 |
| Max. Negotiated Rate |
$28.52 |
| Rate for Payer: Aetna Commercial |
$27.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$26.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$16.43
|
| Rate for Payer: Cash Price |
$9.30
|
| Rate for Payer: Cigna Commercial |
$28.52
|
| Rate for Payer: Health EOS Commercial |
$27.59
|
| Rate for Payer: HFN Commercial |
$28.52
|
| Rate for Payer: Multiplan Commercial |
$24.80
|
| Rate for Payer: NAPHCARE Commercial |
$18.60
|
| Rate for Payer: Preferred Network Access Commercial |
$28.52
|
| Rate for Payer: Quartz Beloit One Network |
$15.19
|
| Rate for Payer: Quartz Commercial |
$18.60
|
| Rate for Payer: WEA Trust Commercial |
$17.05
|
| Rate for Payer: WPS Commercial |
$22.96
|
|
|
Treponema pallidum, IFA, CSF
|
Professional
|
Both
|
$31.00
|
|
|
Service Code
|
CPT 86780
|
| Hospital Charge Code |
5364648
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.64 |
| Max. Negotiated Rate |
$46.74 |
| Rate for Payer: Aetna Commercial |
$29.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$26.66
|
| Rate for Payer: Cash Price |
$9.30
|
| Rate for Payer: Cash Price |
$9.30
|
| Rate for Payer: Cigna Commercial |
$29.45
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$15.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$18.60
|
| Rate for Payer: Health EOS Commercial |
$28.21
|
| Rate for Payer: HFN Commercial |
$29.45
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$46.74
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$46.74
|
| Rate for Payer: Multiplan Commercial |
$24.80
|
| Rate for Payer: Preferred Network Access Commercial |
$29.45
|
| Rate for Payer: Quartz Beloit One Network |
$13.64
|
| Rate for Payer: Quartz Commercial |
$17.67
|
| Rate for Payer: The Alliance Commercial |
$15.50
|
| Rate for Payer: WEA Trust Commercial |
$17.05
|
| Rate for Payer: WPS Commercial |
$22.96
|
|
|
Triamcinolone 40mg/5ml MDV [Med]
|
Facility
|
IP
|
$630.00
|
|
|
Service Code
|
HCPCS J3301
|
| Hospital Charge Code |
2974993
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$308.70 |
| Max. Negotiated Rate |
$579.60 |
| Rate for Payer: Aetna Commercial |
$567.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$541.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$333.90
|
| Rate for Payer: Cash Price |
$189.00
|
| Rate for Payer: Cigna Commercial |
$579.60
|
| Rate for Payer: Health EOS Commercial |
$560.70
|
| Rate for Payer: HFN Commercial |
$579.60
|
| Rate for Payer: Multiplan Commercial |
$504.00
|
| Rate for Payer: NAPHCARE Commercial |
$378.00
|
| Rate for Payer: Preferred Network Access Commercial |
$579.60
|
| Rate for Payer: Quartz Beloit One Network |
$308.70
|
| Rate for Payer: Quartz Commercial |
$378.00
|
| Rate for Payer: WEA Trust Commercial |
$346.50
|
| Rate for Payer: WPS Commercial |
$466.64
|
|
