|
Triamcinolone 40mg/5ml MDV [Med]
|
Facility
|
OP
|
$630.00
|
|
|
Service Code
|
HCPCS J3301
|
| Hospital Charge Code |
2974993
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.43 |
| Max. Negotiated Rate |
$2,520.00 |
| Rate for Payer: Aetna Commercial |
$567.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$541.80
|
| Rate for Payer: Aetna Managed Medicare |
$176.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$409.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$315.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$302.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$333.90
|
| Rate for Payer: Cash Price |
$189.00
|
| Rate for Payer: Cash Price |
$189.00
|
| Rate for Payer: Cigna Commercial |
$579.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1.43
|
| Rate for Payer: Health EOS Commercial |
$560.70
|
| Rate for Payer: HFN Commercial |
$579.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$472.50
|
| 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 |
$409.50
|
| Rate for Payer: Quartz Medicare Advantage |
$378.00
|
| Rate for Payer: The Alliance Commercial |
$2,520.00
|
| Rate for Payer: WEA Trust Commercial |
$346.50
|
| Rate for Payer: WPS Commercial |
$2.71
|
|
|
Triamcinolone acetonide 40mg/mL Inj 1ml [MED]
|
Facility
|
IP
|
$10.00
|
|
|
Service Code
|
HCPCS J3301
|
| Hospital Charge Code |
3538818
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.90 |
| Max. Negotiated Rate |
$9.20 |
| Rate for Payer: Aetna Commercial |
$9.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5.30
|
| Rate for Payer: Cash Price |
$3.00
|
| Rate for Payer: Cigna Commercial |
$9.20
|
| Rate for Payer: Health EOS Commercial |
$8.90
|
| Rate for Payer: HFN Commercial |
$9.20
|
| Rate for Payer: Multiplan Commercial |
$8.00
|
| Rate for Payer: NAPHCARE Commercial |
$6.00
|
| Rate for Payer: Preferred Network Access Commercial |
$9.20
|
| Rate for Payer: Quartz Beloit One Network |
$4.90
|
| Rate for Payer: Quartz Commercial |
$6.00
|
| Rate for Payer: WEA Trust Commercial |
$5.50
|
| Rate for Payer: WPS Commercial |
$7.41
|
|
|
Triamcinolone acetonide 40mg/mL Inj 1ml [MED]
|
Facility
|
OP
|
$10.00
|
|
|
Service Code
|
HCPCS J3301
|
| Hospital Charge Code |
3538818
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.43 |
| Max. Negotiated Rate |
$40.00 |
| Rate for Payer: Aetna Commercial |
$9.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8.60
|
| Rate for Payer: Aetna Managed Medicare |
$2.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5.30
|
| Rate for Payer: Cash Price |
$3.00
|
| Rate for Payer: Cash Price |
$3.00
|
| Rate for Payer: Cigna Commercial |
$9.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1.43
|
| Rate for Payer: Health EOS Commercial |
$8.90
|
| Rate for Payer: HFN Commercial |
$9.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7.50
|
| Rate for Payer: Multiplan Commercial |
$8.00
|
| Rate for Payer: NAPHCARE Commercial |
$6.00
|
| Rate for Payer: Preferred Network Access Commercial |
$9.20
|
| Rate for Payer: Quartz Beloit One Network |
$4.90
|
| Rate for Payer: Quartz Commercial |
$6.50
|
| Rate for Payer: Quartz Medicare Advantage |
$6.00
|
| Rate for Payer: The Alliance Commercial |
$40.00
|
| Rate for Payer: WEA Trust Commercial |
$5.50
|
| Rate for Payer: WPS Commercial |
$2.71
|
|
|
Triamcinolone acetoride inj 10 mg J3301 man
|
Professional
|
Both
|
$30.00
|
|
|
Service Code
|
HCPCS J3301
|
| Hospital Charge Code |
3373638
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.95 |
| Max. Negotiated Rate |
$28.50 |
| Rate for Payer: Aetna Commercial |
$28.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$25.80
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Cigna Commercial |
$28.50
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$0.95
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1.08
|
| Rate for Payer: Health EOS Commercial |
$27.30
|
| Rate for Payer: HFN Commercial |
$28.50
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1.88
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1.88
|
| Rate for Payer: Multiplan Commercial |
$24.00
|
| Rate for Payer: Preferred Network Access Commercial |
$28.50
|
| Rate for Payer: Quartz Beloit One Network |
$13.20
|
| Rate for Payer: Quartz Commercial |
$17.10
|
| Rate for Payer: The Alliance Commercial |
$15.00
|
| Rate for Payer: United Healthcare Medicaid |
$0.95
|
| Rate for Payer: WEA Trust Commercial |
$16.50
|
| Rate for Payer: WPS Commercial |
$2.71
|
|
|
Triamcinolone acetoride inj 10 mg J3301 man
|
Facility
|
IP
|
$30.00
|
|
|
Service Code
|
HCPCS J3301
|
| Hospital Charge Code |
3373638
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$14.70 |
| Max. Negotiated Rate |
$27.60 |
| Rate for Payer: Aetna Commercial |
$27.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$25.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$15.90
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Cigna Commercial |
$27.60
|
| Rate for Payer: Health EOS Commercial |
$26.70
|
| Rate for Payer: HFN Commercial |
$27.60
|
| Rate for Payer: Multiplan Commercial |
$24.00
|
| Rate for Payer: NAPHCARE Commercial |
$18.00
|
| Rate for Payer: Preferred Network Access Commercial |
$27.60
|
| Rate for Payer: Quartz Beloit One Network |
$14.70
|
| Rate for Payer: Quartz Commercial |
$18.00
|
| Rate for Payer: WEA Trust Commercial |
$16.50
|
| Rate for Payer: WPS Commercial |
$22.22
|
|
|
Triamcinolone acetoride inj 10 mg J3301 man
|
Facility
|
OP
|
$30.00
|
|
|
Service Code
|
HCPCS J3301
|
| Hospital Charge Code |
3373638
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.43 |
| Max. Negotiated Rate |
$120.00 |
| Rate for Payer: Aetna Commercial |
$27.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$25.80
|
| Rate for Payer: Aetna Managed Medicare |
$8.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$19.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$15.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$14.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$15.90
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Cigna Commercial |
$27.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1.43
|
| Rate for Payer: Health EOS Commercial |
$26.70
|
| Rate for Payer: HFN Commercial |
$27.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$22.50
|
| Rate for Payer: Multiplan Commercial |
$24.00
|
| Rate for Payer: NAPHCARE Commercial |
$18.00
|
| Rate for Payer: Preferred Network Access Commercial |
$27.60
|
| Rate for Payer: Quartz Beloit One Network |
$14.70
|
| Rate for Payer: Quartz Commercial |
$19.50
|
| Rate for Payer: Quartz Medicare Advantage |
$18.00
|
| Rate for Payer: The Alliance Commercial |
$120.00
|
| Rate for Payer: WEA Trust Commercial |
$16.50
|
| Rate for Payer: WPS Commercial |
$2.71
|
|
|
Triamcinolone A Inj prs free J3300
|
Facility
|
IP
|
$18.00
|
|
|
Service Code
|
HCPCS J3300
|
| Hospital Charge Code |
4560609
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.82 |
| Max. Negotiated Rate |
$16.56 |
| Rate for Payer: Aetna Commercial |
$16.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$15.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9.54
|
| Rate for Payer: Cash Price |
$5.40
|
| Rate for Payer: Cigna Commercial |
$16.56
|
| Rate for Payer: Health EOS Commercial |
$16.02
|
| Rate for Payer: HFN Commercial |
$16.56
|
| Rate for Payer: Multiplan Commercial |
$14.40
|
| Rate for Payer: NAPHCARE Commercial |
$10.80
|
| Rate for Payer: Preferred Network Access Commercial |
$16.56
|
| Rate for Payer: Quartz Beloit One Network |
$8.82
|
| Rate for Payer: Quartz Commercial |
$10.80
|
| Rate for Payer: WEA Trust Commercial |
$9.90
|
| Rate for Payer: WPS Commercial |
$13.33
|
|
|
Triamcinolone A Inj prs free J3300
|
Professional
|
Both
|
$18.00
|
|
|
Service Code
|
HCPCS J3300
|
| Hospital Charge Code |
4560609
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.27 |
| Max. Negotiated Rate |
$17.10 |
| Rate for Payer: Aetna Commercial |
$17.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$15.48
|
| Rate for Payer: Cash Price |
$5.40
|
| Rate for Payer: Cash Price |
$5.40
|
| Rate for Payer: Cigna Commercial |
$17.10
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$4.27
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$10.80
|
| Rate for Payer: Health EOS Commercial |
$16.38
|
| Rate for Payer: HFN Commercial |
$17.10
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5.65
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$5.65
|
| Rate for Payer: Multiplan Commercial |
$14.40
|
| Rate for Payer: Preferred Network Access Commercial |
$17.10
|
| Rate for Payer: Quartz Beloit One Network |
$7.92
|
| Rate for Payer: Quartz Commercial |
$10.26
|
| Rate for Payer: The Alliance Commercial |
$9.00
|
| Rate for Payer: United Healthcare Medicaid |
$4.27
|
| Rate for Payer: WEA Trust Commercial |
$9.90
|
| Rate for Payer: WPS Commercial |
$13.33
|
|
|
Triamcinolone A Inj prs free J3300
|
Facility
|
OP
|
$18.00
|
|
|
Service Code
|
HCPCS J3300
|
| Hospital Charge Code |
4560609
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.04 |
| Max. Negotiated Rate |
$72.00 |
| Rate for Payer: Aetna Commercial |
$16.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$15.48
|
| Rate for Payer: Aetna Managed Medicare |
$5.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$11.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$9.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$8.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9.54
|
| Rate for Payer: Cash Price |
$5.40
|
| Rate for Payer: Cigna Commercial |
$16.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$10.07
|
| Rate for Payer: Health EOS Commercial |
$16.02
|
| Rate for Payer: HFN Commercial |
$16.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$13.50
|
| Rate for Payer: Multiplan Commercial |
$14.40
|
| Rate for Payer: NAPHCARE Commercial |
$10.80
|
| Rate for Payer: Preferred Network Access Commercial |
$16.56
|
| Rate for Payer: Quartz Beloit One Network |
$8.82
|
| Rate for Payer: Quartz Commercial |
$11.70
|
| Rate for Payer: Quartz Medicare Advantage |
$10.80
|
| Rate for Payer: The Alliance Commercial |
$72.00
|
| Rate for Payer: WEA Trust Commercial |
$9.90
|
| Rate for Payer: WPS Commercial |
$13.33
|
|
|
Triamcinolone hexacetoni inj Per 5 mg J3303
|
Facility
|
OP
|
$8.00
|
|
|
Service Code
|
HCPCS J3303
|
| Hospital Charge Code |
3431511
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.24 |
| Max. Negotiated Rate |
$32.00 |
| Rate for Payer: Aetna Commercial |
$7.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6.88
|
| Rate for Payer: Aetna Managed Medicare |
$2.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4.24
|
| Rate for Payer: Cash Price |
$2.40
|
| Rate for Payer: Cigna Commercial |
$7.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4.48
|
| Rate for Payer: Health EOS Commercial |
$7.12
|
| Rate for Payer: HFN Commercial |
$7.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6.00
|
| Rate for Payer: Multiplan Commercial |
$6.40
|
| Rate for Payer: NAPHCARE Commercial |
$4.80
|
| Rate for Payer: Preferred Network Access Commercial |
$7.36
|
| Rate for Payer: Quartz Beloit One Network |
$3.92
|
| Rate for Payer: Quartz Commercial |
$5.20
|
| Rate for Payer: Quartz Medicare Advantage |
$4.80
|
| Rate for Payer: The Alliance Commercial |
$32.00
|
| Rate for Payer: WEA Trust Commercial |
$4.40
|
| Rate for Payer: WPS Commercial |
$5.93
|
|
|
Triamcinolone hexacetoni inj Per 5 mg J3303
|
Facility
|
IP
|
$8.00
|
|
|
Service Code
|
HCPCS J3303
|
| Hospital Charge Code |
3431511
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.92 |
| Max. Negotiated Rate |
$7.36 |
| Rate for Payer: Aetna Commercial |
$7.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4.24
|
| Rate for Payer: Cash Price |
$2.40
|
| Rate for Payer: Cigna Commercial |
$7.36
|
| Rate for Payer: Health EOS Commercial |
$7.12
|
| Rate for Payer: HFN Commercial |
$7.36
|
| Rate for Payer: Multiplan Commercial |
$6.40
|
| Rate for Payer: NAPHCARE Commercial |
$4.80
|
| Rate for Payer: Preferred Network Access Commercial |
$7.36
|
| Rate for Payer: Quartz Beloit One Network |
$3.92
|
| Rate for Payer: Quartz Commercial |
$4.80
|
| Rate for Payer: WEA Trust Commercial |
$4.40
|
| Rate for Payer: WPS Commercial |
$5.93
|
|
|
Triamcinolone hexacetoni inj Per 5 mg J3303
|
Professional
|
Both
|
$8.00
|
|
|
Service Code
|
HCPCS J3303
|
| Hospital Charge Code |
3431511
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.52 |
| Max. Negotiated Rate |
$7.60 |
| Rate for Payer: Aetna Commercial |
$7.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6.88
|
| Rate for Payer: Cash Price |
$2.40
|
| Rate for Payer: Cash Price |
$2.40
|
| Rate for Payer: Cigna Commercial |
$7.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$3.61
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4.80
|
| Rate for Payer: Health EOS Commercial |
$7.28
|
| Rate for Payer: HFN Commercial |
$7.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5.27
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$5.27
|
| Rate for Payer: Multiplan Commercial |
$6.40
|
| Rate for Payer: Preferred Network Access Commercial |
$7.60
|
| Rate for Payer: Quartz Beloit One Network |
$3.52
|
| Rate for Payer: Quartz Commercial |
$4.56
|
| Rate for Payer: The Alliance Commercial |
$4.00
|
| Rate for Payer: United Healthcare Medicaid |
$3.61
|
| Rate for Payer: WEA Trust Commercial |
$4.40
|
| Rate for Payer: WPS Commercial |
$5.93
|
|
|
Trichomonas vaginalis RNA Ql, Males
|
Facility
|
IP
|
$238.00
|
|
|
Service Code
|
CPT 87661
|
| Hospital Charge Code |
5184660
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$116.62 |
| Max. Negotiated Rate |
$218.96 |
| Rate for Payer: Aetna Commercial |
$214.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$204.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$126.14
|
| Rate for Payer: Cash Price |
$71.40
|
| Rate for Payer: Cigna Commercial |
$218.96
|
| Rate for Payer: Health EOS Commercial |
$211.82
|
| Rate for Payer: HFN Commercial |
$218.96
|
| Rate for Payer: Multiplan Commercial |
$190.40
|
| Rate for Payer: NAPHCARE Commercial |
$142.80
|
| Rate for Payer: Preferred Network Access Commercial |
$218.96
|
| Rate for Payer: Quartz Beloit One Network |
$116.62
|
| Rate for Payer: Quartz Commercial |
$142.80
|
| Rate for Payer: WEA Trust Commercial |
$130.90
|
| Rate for Payer: WPS Commercial |
$176.29
|
|
|
Trichomonas vaginalis RNA Ql, Males
|
Facility
|
OP
|
$238.00
|
|
|
Service Code
|
CPT 87661
|
| Hospital Charge Code |
5184660
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$35.09 |
| Max. Negotiated Rate |
$218.96 |
| Rate for Payer: Aetna Commercial |
$214.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$204.68
|
| Rate for Payer: Aetna Managed Medicare |
$35.09
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$131.59
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$61.41
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$58.25
|
| Rate for Payer: Anthem Medicaid |
$36.26
|
| Rate for Payer: Anthem Medicare Advantage |
$35.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$126.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$35.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$35.09
|
| Rate for Payer: Cash Price |
$71.40
|
| Rate for Payer: Cash Price |
$71.40
|
| Rate for Payer: Cigna Commercial |
$218.96
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$35.09
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$36.26
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$133.18
|
| Rate for Payer: Dean Health Medicaid |
$36.26
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$35.09
|
| Rate for Payer: Health EOS Commercial |
$211.82
|
| Rate for Payer: HFN Commercial |
$218.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$130.53
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$35.09
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$36.26
|
| Rate for Payer: Independent Care Health Plan Medicare |
$35.09
|
| Rate for Payer: Managed Health Services Medicaid |
$37.71
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$35.09
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$35.09
|
| Rate for Payer: Multiplan Commercial |
$190.40
|
| Rate for Payer: NAPHCARE Commercial |
$52.64
|
| Rate for Payer: Preferred Network Access Commercial |
$218.96
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$36.26
|
| Rate for Payer: Quartz Beloit One Network |
$116.62
|
| Rate for Payer: Quartz Commercial |
$154.70
|
| Rate for Payer: Quartz Medicare Advantage |
$35.09
|
| Rate for Payer: The Alliance Commercial |
$140.36
|
| Rate for Payer: United Healthcare Medicaid |
$36.26
|
| Rate for Payer: United Healthcare Medicare Advantage |
$35.09
|
| Rate for Payer: United Healthcare PPO |
$178.50
|
| Rate for Payer: WEA Trust Commercial |
$130.90
|
| Rate for Payer: Wellcare Medicare |
$35.09
|
| Rate for Payer: WMAP Medicaid |
$36.26
|
| Rate for Payer: WPS Commercial |
$176.29
|
|
|
Trichomonas vaginalis RNA Ql, Males
|
Professional
|
Both
|
$238.00
|
|
|
Service Code
|
CPT 87661
|
| Hospital Charge Code |
5184660
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$104.72 |
| Max. Negotiated Rate |
$226.10 |
| Rate for Payer: Aetna Commercial |
$226.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$204.68
|
| Rate for Payer: Cash Price |
$71.40
|
| Rate for Payer: Cash Price |
$71.40
|
| Rate for Payer: Cigna Commercial |
$226.10
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$119.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$142.80
|
| Rate for Payer: Health EOS Commercial |
$216.58
|
| Rate for Payer: HFN Commercial |
$226.10
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$123.87
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$123.87
|
| Rate for Payer: Multiplan Commercial |
$190.40
|
| Rate for Payer: Preferred Network Access Commercial |
$226.10
|
| Rate for Payer: Quartz Beloit One Network |
$104.72
|
| Rate for Payer: Quartz Commercial |
$135.66
|
| Rate for Payer: The Alliance Commercial |
$119.00
|
| Rate for Payer: WEA Trust Commercial |
$130.90
|
| Rate for Payer: WPS Commercial |
$176.29
|
|
|
Trichomonas vaginalis RNA, Ql TMA
|
Professional
|
Both
|
$220.00
|
|
|
Service Code
|
CPT 87661
|
| Hospital Charge Code |
5296693
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$96.80 |
| Max. Negotiated Rate |
$209.00 |
| Rate for Payer: Aetna Commercial |
$209.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$189.20
|
| Rate for Payer: Cash Price |
$66.00
|
| Rate for Payer: Cash Price |
$66.00
|
| Rate for Payer: Cigna Commercial |
$209.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$110.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$132.00
|
| Rate for Payer: Health EOS Commercial |
$200.20
|
| Rate for Payer: HFN Commercial |
$209.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$123.87
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$123.87
|
| Rate for Payer: Multiplan Commercial |
$176.00
|
| Rate for Payer: Preferred Network Access Commercial |
$209.00
|
| Rate for Payer: Quartz Beloit One Network |
$96.80
|
| Rate for Payer: Quartz Commercial |
$125.40
|
| Rate for Payer: The Alliance Commercial |
$110.00
|
| Rate for Payer: WEA Trust Commercial |
$121.00
|
| Rate for Payer: WPS Commercial |
$162.95
|
|
|
Trichomonas vaginalis RNA, Ql TMA
|
Facility
|
IP
|
$220.00
|
|
|
Service Code
|
CPT 87661
|
| Hospital Charge Code |
5296693
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$107.80 |
| Max. Negotiated Rate |
$202.40 |
| Rate for Payer: Aetna Commercial |
$198.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$189.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$116.60
|
| Rate for Payer: Cash Price |
$66.00
|
| Rate for Payer: Cigna Commercial |
$202.40
|
| Rate for Payer: Health EOS Commercial |
$195.80
|
| Rate for Payer: HFN Commercial |
$202.40
|
| Rate for Payer: Multiplan Commercial |
$176.00
|
| Rate for Payer: NAPHCARE Commercial |
$132.00
|
| Rate for Payer: Preferred Network Access Commercial |
$202.40
|
| Rate for Payer: Quartz Beloit One Network |
$107.80
|
| Rate for Payer: Quartz Commercial |
$132.00
|
| Rate for Payer: WEA Trust Commercial |
$121.00
|
| Rate for Payer: WPS Commercial |
$162.95
|
|
|
Trichomonas vaginalis RNA, Ql TMA
|
Facility
|
OP
|
$220.00
|
|
|
Service Code
|
CPT 87661
|
| Hospital Charge Code |
5296693
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$35.09 |
| Max. Negotiated Rate |
$202.40 |
| Rate for Payer: Aetna Commercial |
$198.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$189.20
|
| Rate for Payer: Aetna Managed Medicare |
$35.09
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$131.59
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$61.41
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$58.25
|
| Rate for Payer: Anthem Medicaid |
$36.26
|
| Rate for Payer: Anthem Medicare Advantage |
$35.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$116.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$35.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$35.09
|
| Rate for Payer: Cash Price |
$66.00
|
| Rate for Payer: Cash Price |
$66.00
|
| Rate for Payer: Cigna Commercial |
$202.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$35.09
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$36.26
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$123.11
|
| Rate for Payer: Dean Health Medicaid |
$36.26
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$35.09
|
| Rate for Payer: Health EOS Commercial |
$195.80
|
| Rate for Payer: HFN Commercial |
$202.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$130.53
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$35.09
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$36.26
|
| Rate for Payer: Independent Care Health Plan Medicare |
$35.09
|
| Rate for Payer: Managed Health Services Medicaid |
$37.71
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$35.09
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$35.09
|
| Rate for Payer: Multiplan Commercial |
$176.00
|
| Rate for Payer: NAPHCARE Commercial |
$52.64
|
| Rate for Payer: Preferred Network Access Commercial |
$202.40
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$36.26
|
| Rate for Payer: Quartz Beloit One Network |
$107.80
|
| Rate for Payer: Quartz Commercial |
$143.00
|
| Rate for Payer: Quartz Medicare Advantage |
$35.09
|
| Rate for Payer: The Alliance Commercial |
$140.36
|
| Rate for Payer: United Healthcare Medicaid |
$36.26
|
| Rate for Payer: United Healthcare Medicare Advantage |
$35.09
|
| Rate for Payer: United Healthcare PPO |
$165.00
|
| Rate for Payer: WEA Trust Commercial |
$121.00
|
| Rate for Payer: Wellcare Medicare |
$35.09
|
| Rate for Payer: WMAP Medicaid |
$36.26
|
| Rate for Payer: WPS Commercial |
$162.95
|
|
|
Trichrome Stain Report
|
Facility
|
IP
|
$135.00
|
|
|
Service Code
|
CPT 87209
|
| Hospital Charge Code |
634215
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$66.15 |
| Max. Negotiated Rate |
$124.20 |
| Rate for Payer: Aetna Commercial |
$121.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$116.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$71.55
|
| Rate for Payer: Cash Price |
$40.50
|
| Rate for Payer: Cigna Commercial |
$124.20
|
| Rate for Payer: Health EOS Commercial |
$120.15
|
| Rate for Payer: HFN Commercial |
$124.20
|
| Rate for Payer: Multiplan Commercial |
$108.00
|
| Rate for Payer: NAPHCARE Commercial |
$81.00
|
| Rate for Payer: Preferred Network Access Commercial |
$124.20
|
| Rate for Payer: Quartz Beloit One Network |
$66.15
|
| Rate for Payer: Quartz Commercial |
$81.00
|
| Rate for Payer: WEA Trust Commercial |
$74.25
|
| Rate for Payer: WPS Commercial |
$99.99
|
|
|
Trichrome Stain Report
|
Facility
|
OP
|
$135.00
|
|
|
Service Code
|
CPT 87209
|
| Hospital Charge Code |
634215
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$17.98 |
| Max. Negotiated Rate |
$124.20 |
| Rate for Payer: Aetna Commercial |
$121.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$116.10
|
| Rate for Payer: Aetna Managed Medicare |
$17.98
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$67.42
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$31.46
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$29.85
|
| Rate for Payer: Anthem Medicaid |
$18.58
|
| Rate for Payer: Anthem Medicare Advantage |
$17.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$71.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$17.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$17.98
|
| Rate for Payer: Cash Price |
$40.50
|
| Rate for Payer: Cash Price |
$40.50
|
| Rate for Payer: Cigna Commercial |
$124.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$17.98
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$18.58
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$75.55
|
| Rate for Payer: Dean Health Medicaid |
$18.58
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$17.98
|
| Rate for Payer: Health EOS Commercial |
$120.15
|
| Rate for Payer: HFN Commercial |
$124.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$66.89
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$17.98
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$18.58
|
| Rate for Payer: Independent Care Health Plan Medicare |
$17.98
|
| Rate for Payer: Managed Health Services Medicaid |
$19.32
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$17.98
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$17.98
|
| Rate for Payer: Multiplan Commercial |
$108.00
|
| Rate for Payer: NAPHCARE Commercial |
$26.97
|
| Rate for Payer: Preferred Network Access Commercial |
$124.20
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$18.58
|
| Rate for Payer: Quartz Beloit One Network |
$66.15
|
| Rate for Payer: Quartz Commercial |
$87.75
|
| Rate for Payer: Quartz Medicare Advantage |
$17.98
|
| Rate for Payer: The Alliance Commercial |
$71.92
|
| Rate for Payer: United Healthcare Medicaid |
$18.58
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17.98
|
| Rate for Payer: United Healthcare PPO |
$101.25
|
| Rate for Payer: WEA Trust Commercial |
$74.25
|
| Rate for Payer: Wellcare Medicare |
$17.98
|
| Rate for Payer: WMAP Medicaid |
$18.58
|
| Rate for Payer: WPS Commercial |
$99.99
|
|
|
Trichrome Stain Report
|
Professional
|
Both
|
$135.00
|
|
|
Service Code
|
CPT 87209
|
| Hospital Charge Code |
634215
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$59.40 |
| Max. Negotiated Rate |
$128.25 |
| Rate for Payer: Aetna Commercial |
$128.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$116.10
|
| Rate for Payer: Cash Price |
$40.50
|
| Rate for Payer: Cash Price |
$40.50
|
| Rate for Payer: Cigna Commercial |
$128.25
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$67.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$81.00
|
| Rate for Payer: Health EOS Commercial |
$122.85
|
| Rate for Payer: HFN Commercial |
$128.25
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$63.47
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$63.47
|
| Rate for Payer: Multiplan Commercial |
$108.00
|
| Rate for Payer: Preferred Network Access Commercial |
$128.25
|
| Rate for Payer: Quartz Beloit One Network |
$59.40
|
| Rate for Payer: Quartz Commercial |
$76.95
|
| Rate for Payer: The Alliance Commercial |
$67.50
|
| Rate for Payer: WEA Trust Commercial |
$74.25
|
| Rate for Payer: WPS Commercial |
$99.99
|
|
|
TRICUSPID RING 26MM TRI-AD #900SFC-26
|
Facility
|
OP
|
$15,864.00
|
|
| Hospital Charge Code |
2973913
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,441.92 |
| Max. Negotiated Rate |
$63,456.00 |
| Rate for Payer: Aetna Commercial |
$14,277.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$13,643.04
|
| Rate for Payer: Aetna Managed Medicare |
$4,441.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$10,311.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$7,932.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7,614.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$8,407.92
|
| Rate for Payer: Cash Price |
$4,759.20
|
| Rate for Payer: Cigna Commercial |
$14,594.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$8,877.49
|
| Rate for Payer: Health EOS Commercial |
$14,118.96
|
| Rate for Payer: HFN Commercial |
$14,594.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$11,898.00
|
| Rate for Payer: Multiplan Commercial |
$12,691.20
|
| Rate for Payer: NAPHCARE Commercial |
$9,518.40
|
| Rate for Payer: Preferred Network Access Commercial |
$14,594.88
|
| Rate for Payer: Quartz Beloit One Network |
$7,773.36
|
| Rate for Payer: Quartz Commercial |
$10,311.60
|
| Rate for Payer: Quartz Medicare Advantage |
$9,518.40
|
| Rate for Payer: The Alliance Commercial |
$63,456.00
|
| Rate for Payer: WEA Trust Commercial |
$8,725.20
|
| Rate for Payer: WPS Commercial |
$11,750.46
|
|
|
TRICUSPID RING 26MM TRI-AD #900SFC-26
|
Facility
|
IP
|
$15,864.00
|
|
| Hospital Charge Code |
2973913
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,773.36 |
| Max. Negotiated Rate |
$14,594.88 |
| Rate for Payer: Aetna Commercial |
$14,277.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$13,643.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$8,407.92
|
| Rate for Payer: Cash Price |
$4,759.20
|
| Rate for Payer: Cigna Commercial |
$14,594.88
|
| Rate for Payer: Health EOS Commercial |
$14,118.96
|
| Rate for Payer: HFN Commercial |
$14,594.88
|
| Rate for Payer: Multiplan Commercial |
$12,691.20
|
| Rate for Payer: NAPHCARE Commercial |
$9,518.40
|
| Rate for Payer: Preferred Network Access Commercial |
$14,594.88
|
| Rate for Payer: Quartz Beloit One Network |
$7,773.36
|
| Rate for Payer: Quartz Commercial |
$9,518.40
|
| Rate for Payer: WEA Trust Commercial |
$8,725.20
|
| Rate for Payer: WPS Commercial |
$11,750.46
|
|
|
TRICUSPID RING 28MM TRI-AD 900SFC-28
|
Facility
|
IP
|
$15,864.00
|
|
| Hospital Charge Code |
2973914
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,773.36 |
| Max. Negotiated Rate |
$14,594.88 |
| Rate for Payer: Aetna Commercial |
$14,277.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$13,643.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$8,407.92
|
| Rate for Payer: Cash Price |
$4,759.20
|
| Rate for Payer: Cigna Commercial |
$14,594.88
|
| Rate for Payer: Health EOS Commercial |
$14,118.96
|
| Rate for Payer: HFN Commercial |
$14,594.88
|
| Rate for Payer: Multiplan Commercial |
$12,691.20
|
| Rate for Payer: NAPHCARE Commercial |
$9,518.40
|
| Rate for Payer: Preferred Network Access Commercial |
$14,594.88
|
| Rate for Payer: Quartz Beloit One Network |
$7,773.36
|
| Rate for Payer: Quartz Commercial |
$9,518.40
|
| Rate for Payer: WEA Trust Commercial |
$8,725.20
|
| Rate for Payer: WPS Commercial |
$11,750.46
|
|
|
TRICUSPID RING 28MM TRI-AD 900SFC-28
|
Facility
|
OP
|
$15,864.00
|
|
| Hospital Charge Code |
2973914
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,441.92 |
| Max. Negotiated Rate |
$63,456.00 |
| Rate for Payer: Aetna Commercial |
$14,277.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$13,643.04
|
| Rate for Payer: Aetna Managed Medicare |
$4,441.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$10,311.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$7,932.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7,614.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$8,407.92
|
| Rate for Payer: Cash Price |
$4,759.20
|
| Rate for Payer: Cigna Commercial |
$14,594.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$8,877.49
|
| Rate for Payer: Health EOS Commercial |
$14,118.96
|
| Rate for Payer: HFN Commercial |
$14,594.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$11,898.00
|
| Rate for Payer: Multiplan Commercial |
$12,691.20
|
| Rate for Payer: NAPHCARE Commercial |
$9,518.40
|
| Rate for Payer: Preferred Network Access Commercial |
$14,594.88
|
| Rate for Payer: Quartz Beloit One Network |
$7,773.36
|
| Rate for Payer: Quartz Commercial |
$10,311.60
|
| Rate for Payer: Quartz Medicare Advantage |
$9,518.40
|
| Rate for Payer: The Alliance Commercial |
$63,456.00
|
| Rate for Payer: WEA Trust Commercial |
$8,725.20
|
| Rate for Payer: WPS Commercial |
$11,750.46
|
|
