|
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 |
$315.34 |
| Max. Negotiated Rate |
$1,929.61 |
| Rate for Payer: Aetna Commercial |
$1,412.84
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,278.99
|
| Rate for Payer: Aetna Managed Medicare |
$428.80
|
| Rate for Payer: Anthem Medicare Advantage |
$428.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$428.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$428.80
|
| 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 |
$1,412.84
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$315.34
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$428.80
|
| Rate for Payer: Health EOS Commercial |
$1,353.35
|
| Rate for Payer: HFN Commercial |
$1,412.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,546.05
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,546.05
|
| Rate for Payer: Independent Care Health Plan Medicare |
$428.80
|
| Rate for Payer: Multiplan Commercial |
$1,189.76
|
| Rate for Payer: NAPHCARE Commercial |
$643.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,412.84
|
| Rate for Payer: Quartz Beloit One Network |
$654.37
|
| Rate for Payer: Quartz Commercial |
$847.70
|
| Rate for Payer: Quartz Medicare Advantage |
$428.80
|
| Rate for Payer: The Alliance Commercial |
$1,822.41
|
| Rate for Payer: United Healthcare Medicaid |
$315.34
|
| Rate for Payer: United Healthcare Medicare Advantage |
$428.80
|
| Rate for Payer: WEA Trust Commercial |
$817.96
|
| Rate for Payer: WPS Commercial |
$1,929.61
|
|
|
.Treponema Pallidum Ab
|
Professional
|
Both
|
$75.40
|
|
|
Service Code
|
CPT 86780
|
| Hospital Charge Code |
6222203
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.77 |
| Max. Negotiated Rate |
$74.50 |
| Rate for Payer: Aetna Commercial |
$74.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$67.44
|
| Rate for Payer: Aetna Managed Medicare |
$13.77
|
| Rate for Payer: Anthem Medicare Advantage |
$13.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$13.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$13.77
|
| Rate for Payer: Cash Price |
$22.62
|
| Rate for Payer: Cash Price |
$22.62
|
| Rate for Payer: Cigna Commercial |
$74.50
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$39.21
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$13.77
|
| Rate for Payer: Health EOS Commercial |
$71.36
|
| Rate for Payer: HFN Commercial |
$74.50
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$48.61
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$48.61
|
| Rate for Payer: Independent Care Health Plan Medicare |
$13.77
|
| Rate for Payer: Multiplan Commercial |
$62.73
|
| Rate for Payer: NAPHCARE Commercial |
$20.65
|
| Rate for Payer: Preferred Network Access Commercial |
$74.50
|
| Rate for Payer: Quartz Beloit One Network |
$34.50
|
| Rate for Payer: Quartz Commercial |
$44.70
|
| Rate for Payer: Quartz Medicare Advantage |
$13.77
|
| Rate for Payer: The Alliance Commercial |
$54.39
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.77
|
| Rate for Payer: WEA Trust Commercial |
$43.13
|
| Rate for Payer: WPS Commercial |
$60.59
|
|
|
.Treponema Pallidum Ab
|
Facility
|
OP
|
$75.40
|
|
|
Service Code
|
CPT 86780
|
| Hospital Charge Code |
6222203
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.77 |
| Max. Negotiated Rate |
$72.14 |
| Rate for Payer: Aetna Commercial |
$70.57
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$67.44
|
| Rate for Payer: Aetna Managed Medicare |
$13.77
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$51.64
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$24.10
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$22.86
|
| Rate for Payer: Anthem Medicare Advantage |
$13.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$41.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$13.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$13.77
|
| Rate for Payer: Cash Price |
$22.62
|
| Rate for Payer: Cash Price |
$22.62
|
| Rate for Payer: Cigna Commercial |
$72.14
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$13.77
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$43.88
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$13.77
|
| Rate for Payer: Health EOS Commercial |
$69.79
|
| Rate for Payer: HFN Commercial |
$72.14
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$51.22
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$13.77
|
| Rate for Payer: Independent Care Health Plan Medicare |
$13.77
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$13.77
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$13.77
|
| Rate for Payer: Multiplan Commercial |
$62.73
|
| Rate for Payer: NAPHCARE Commercial |
$20.65
|
| Rate for Payer: Preferred Network Access Commercial |
$72.14
|
| Rate for Payer: Quartz Beloit One Network |
$38.42
|
| Rate for Payer: Quartz Commercial |
$50.97
|
| Rate for Payer: Quartz Medicare Advantage |
$13.77
|
| Rate for Payer: The Alliance Commercial |
$55.08
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.77
|
| Rate for Payer: United Healthcare PPO |
$58.81
|
| Rate for Payer: WEA Trust Commercial |
$43.13
|
| Rate for Payer: Wellcare Medicare |
$13.77
|
| Rate for Payer: WPS Commercial |
$58.08
|
|
|
.Treponema Pallidum Ab
|
Facility
|
IP
|
$75.40
|
|
|
Service Code
|
CPT 86780
|
| Hospital Charge Code |
6222203
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$38.42 |
| Max. Negotiated Rate |
$72.14 |
| Rate for Payer: Aetna Commercial |
$70.57
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$67.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$41.56
|
| Rate for Payer: Cash Price |
$22.62
|
| Rate for Payer: Cigna Commercial |
$72.14
|
| Rate for Payer: Health EOS Commercial |
$69.79
|
| Rate for Payer: HFN Commercial |
$72.14
|
| Rate for Payer: Multiplan Commercial |
$62.73
|
| Rate for Payer: Preferred Network Access Commercial |
$72.14
|
| Rate for Payer: Quartz Beloit One Network |
$38.42
|
| Rate for Payer: Quartz Commercial |
$47.05
|
| Rate for Payer: WEA Trust Commercial |
$43.13
|
| Rate for Payer: WPS Commercial |
$58.08
|
|
|
Treponema pallidum Ab IgG, IgM
|
Facility
|
IP
|
$81.00
|
|
|
Service Code
|
CPT 86780
|
| Hospital Charge Code |
5278648
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$41.28 |
| Max. Negotiated Rate |
$77.50 |
| Rate for Payer: Aetna Commercial |
$75.82
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$72.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$44.65
|
| Rate for Payer: Cash Price |
$24.30
|
| Rate for Payer: Cigna Commercial |
$77.50
|
| Rate for Payer: Health EOS Commercial |
$74.97
|
| Rate for Payer: HFN Commercial |
$77.50
|
| Rate for Payer: Multiplan Commercial |
$67.39
|
| Rate for Payer: Preferred Network Access Commercial |
$77.50
|
| Rate for Payer: Quartz Beloit One Network |
$41.28
|
| Rate for Payer: Quartz Commercial |
$50.54
|
| Rate for Payer: WEA Trust Commercial |
$46.33
|
| Rate for Payer: WPS Commercial |
$62.39
|
|
|
Treponema pallidum Ab IgG, IgM
|
Professional
|
Both
|
$81.00
|
|
|
Service Code
|
CPT 86780
|
| Hospital Charge Code |
5278648
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.77 |
| Max. Negotiated Rate |
$80.03 |
| Rate for Payer: Aetna Commercial |
$80.03
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$72.45
|
| Rate for Payer: Aetna Managed Medicare |
$13.77
|
| Rate for Payer: Anthem Medicare Advantage |
$13.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$13.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$13.77
|
| Rate for Payer: Cash Price |
$24.30
|
| Rate for Payer: Cash Price |
$24.30
|
| Rate for Payer: Cigna Commercial |
$80.03
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$42.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$13.77
|
| Rate for Payer: Health EOS Commercial |
$76.66
|
| Rate for Payer: HFN Commercial |
$80.03
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$48.61
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$48.61
|
| Rate for Payer: Independent Care Health Plan Medicare |
$13.77
|
| Rate for Payer: Multiplan Commercial |
$67.39
|
| Rate for Payer: NAPHCARE Commercial |
$20.65
|
| Rate for Payer: Preferred Network Access Commercial |
$80.03
|
| Rate for Payer: Quartz Beloit One Network |
$37.07
|
| Rate for Payer: Quartz Commercial |
$48.02
|
| Rate for Payer: Quartz Medicare Advantage |
$13.77
|
| Rate for Payer: The Alliance Commercial |
$54.39
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.77
|
| Rate for Payer: WEA Trust Commercial |
$46.33
|
| Rate for Payer: WPS Commercial |
$60.59
|
|
|
Treponema pallidum Ab IgG, IgM
|
Facility
|
OP
|
$81.00
|
|
|
Service Code
|
CPT 86780
|
| Hospital Charge Code |
5278648
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.77 |
| Max. Negotiated Rate |
$77.50 |
| Rate for Payer: Aetna Commercial |
$75.82
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$72.45
|
| Rate for Payer: Aetna Managed Medicare |
$13.77
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$51.64
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$24.10
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$22.86
|
| Rate for Payer: Anthem Medicare Advantage |
$13.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$44.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$13.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$13.77
|
| Rate for Payer: Cash Price |
$24.30
|
| Rate for Payer: Cash Price |
$24.30
|
| Rate for Payer: Cigna Commercial |
$77.50
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$13.77
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$47.14
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$13.77
|
| Rate for Payer: Health EOS Commercial |
$74.97
|
| Rate for Payer: HFN Commercial |
$77.50
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$51.22
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$13.77
|
| Rate for Payer: Independent Care Health Plan Medicare |
$13.77
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$13.77
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$13.77
|
| Rate for Payer: Multiplan Commercial |
$67.39
|
| Rate for Payer: NAPHCARE Commercial |
$20.65
|
| Rate for Payer: Preferred Network Access Commercial |
$77.50
|
| Rate for Payer: Quartz Beloit One Network |
$41.28
|
| Rate for Payer: Quartz Commercial |
$54.76
|
| Rate for Payer: Quartz Medicare Advantage |
$13.77
|
| Rate for Payer: The Alliance Commercial |
$55.08
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.77
|
| Rate for Payer: United Healthcare PPO |
$63.18
|
| Rate for Payer: WEA Trust Commercial |
$46.33
|
| Rate for Payer: Wellcare Medicare |
$13.77
|
| Rate for Payer: WPS Commercial |
$62.39
|
|
|
Treponema pallidum Ab IgM
|
Facility
|
IP
|
$54.00
|
|
|
Service Code
|
CPT 86780
|
| Hospital Charge Code |
5278655
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$27.52 |
| Max. Negotiated Rate |
$51.67 |
| Rate for Payer: Aetna Commercial |
$50.54
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$48.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$29.76
|
| Rate for Payer: Cash Price |
$16.20
|
| Rate for Payer: Cigna Commercial |
$51.67
|
| Rate for Payer: Health EOS Commercial |
$49.98
|
| Rate for Payer: HFN Commercial |
$51.67
|
| Rate for Payer: Multiplan Commercial |
$44.93
|
| Rate for Payer: Preferred Network Access Commercial |
$51.67
|
| Rate for Payer: Quartz Beloit One Network |
$27.52
|
| Rate for Payer: Quartz Commercial |
$33.70
|
| Rate for Payer: WEA Trust Commercial |
$30.89
|
| Rate for Payer: WPS Commercial |
$41.60
|
|
|
Treponema pallidum Ab IgM
|
Professional
|
Both
|
$54.00
|
|
|
Service Code
|
CPT 86780
|
| Hospital Charge Code |
5278655
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.77 |
| Max. Negotiated Rate |
$60.59 |
| Rate for Payer: Aetna Commercial |
$53.35
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$48.30
|
| Rate for Payer: Aetna Managed Medicare |
$13.77
|
| Rate for Payer: Anthem Medicare Advantage |
$13.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$13.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$13.77
|
| Rate for Payer: Cash Price |
$16.20
|
| Rate for Payer: Cash Price |
$16.20
|
| Rate for Payer: Cigna Commercial |
$53.35
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$28.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$13.77
|
| Rate for Payer: Health EOS Commercial |
$51.11
|
| Rate for Payer: HFN Commercial |
$53.35
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$48.61
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$48.61
|
| Rate for Payer: Independent Care Health Plan Medicare |
$13.77
|
| Rate for Payer: Multiplan Commercial |
$44.93
|
| Rate for Payer: NAPHCARE Commercial |
$20.65
|
| Rate for Payer: Preferred Network Access Commercial |
$53.35
|
| Rate for Payer: Quartz Beloit One Network |
$24.71
|
| Rate for Payer: Quartz Commercial |
$32.01
|
| Rate for Payer: Quartz Medicare Advantage |
$13.77
|
| Rate for Payer: The Alliance Commercial |
$54.39
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.77
|
| Rate for Payer: WEA Trust Commercial |
$30.89
|
| Rate for Payer: WPS Commercial |
$60.59
|
|
|
Treponema pallidum Ab IgM
|
Facility
|
OP
|
$54.00
|
|
|
Service Code
|
CPT 86780
|
| Hospital Charge Code |
5278655
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.77 |
| Max. Negotiated Rate |
$55.08 |
| Rate for Payer: Aetna Commercial |
$50.54
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$48.30
|
| Rate for Payer: Aetna Managed Medicare |
$13.77
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$51.64
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$24.10
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$22.86
|
| Rate for Payer: Anthem Medicare Advantage |
$13.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$29.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$13.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$13.77
|
| Rate for Payer: Cash Price |
$16.20
|
| Rate for Payer: Cash Price |
$16.20
|
| Rate for Payer: Cigna Commercial |
$51.67
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$13.77
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$31.43
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$13.77
|
| Rate for Payer: Health EOS Commercial |
$49.98
|
| Rate for Payer: HFN Commercial |
$51.67
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$51.22
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$13.77
|
| Rate for Payer: Independent Care Health Plan Medicare |
$13.77
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$13.77
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$13.77
|
| Rate for Payer: Multiplan Commercial |
$44.93
|
| Rate for Payer: NAPHCARE Commercial |
$20.65
|
| Rate for Payer: Preferred Network Access Commercial |
$51.67
|
| Rate for Payer: Quartz Beloit One Network |
$27.52
|
| Rate for Payer: Quartz Commercial |
$36.50
|
| Rate for Payer: Quartz Medicare Advantage |
$13.77
|
| Rate for Payer: The Alliance Commercial |
$55.08
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.77
|
| Rate for Payer: United Healthcare PPO |
$42.12
|
| Rate for Payer: WEA Trust Commercial |
$30.89
|
| Rate for Payer: Wellcare Medicare |
$13.77
|
| Rate for Payer: WPS Commercial |
$41.60
|
|
|
Treponema pallidum Antibody
|
Facility
|
IP
|
$29.00
|
|
|
Service Code
|
CPT 86780
|
| Hospital Charge Code |
5072628
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.78 |
| Max. Negotiated Rate |
$27.75 |
| Rate for Payer: Aetna Commercial |
$27.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$25.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$15.98
|
| Rate for Payer: Cash Price |
$8.70
|
| Rate for Payer: Cigna Commercial |
$27.75
|
| Rate for Payer: Health EOS Commercial |
$26.84
|
| Rate for Payer: HFN Commercial |
$27.75
|
| Rate for Payer: Multiplan Commercial |
$24.13
|
| Rate for Payer: Preferred Network Access Commercial |
$27.75
|
| Rate for Payer: Quartz Beloit One Network |
$14.78
|
| Rate for Payer: Quartz Commercial |
$18.10
|
| Rate for Payer: WEA Trust Commercial |
$16.59
|
| Rate for Payer: WPS Commercial |
$22.34
|
|
|
Treponema pallidum Antibody
|
Facility
|
OP
|
$29.00
|
|
|
Service Code
|
CPT 86780
|
| Hospital Charge Code |
5072628
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.77 |
| Max. Negotiated Rate |
$55.08 |
| Rate for Payer: Aetna Commercial |
$27.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$25.94
|
| Rate for Payer: Aetna Managed Medicare |
$13.77
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$51.64
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$24.10
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$22.86
|
| Rate for Payer: Anthem Medicare Advantage |
$13.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$15.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$13.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$13.77
|
| Rate for Payer: Cash Price |
$8.70
|
| Rate for Payer: Cash Price |
$8.70
|
| Rate for Payer: Cigna Commercial |
$27.75
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$13.77
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$16.88
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$13.77
|
| Rate for Payer: Health EOS Commercial |
$26.84
|
| Rate for Payer: HFN Commercial |
$27.75
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$51.22
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$13.77
|
| Rate for Payer: Independent Care Health Plan Medicare |
$13.77
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$13.77
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$13.77
|
| Rate for Payer: Multiplan Commercial |
$24.13
|
| Rate for Payer: NAPHCARE Commercial |
$20.65
|
| Rate for Payer: Preferred Network Access Commercial |
$27.75
|
| Rate for Payer: Quartz Beloit One Network |
$14.78
|
| Rate for Payer: Quartz Commercial |
$19.60
|
| Rate for Payer: Quartz Medicare Advantage |
$13.77
|
| Rate for Payer: The Alliance Commercial |
$55.08
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.77
|
| Rate for Payer: United Healthcare PPO |
$22.62
|
| Rate for Payer: WEA Trust Commercial |
$16.59
|
| Rate for Payer: Wellcare Medicare |
$13.77
|
| Rate for Payer: WPS Commercial |
$22.34
|
|
|
Treponema pallidum Antibody
|
Professional
|
Both
|
$29.00
|
|
|
Service Code
|
CPT 86780
|
| Hospital Charge Code |
5072628
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.27 |
| Max. Negotiated Rate |
$60.59 |
| Rate for Payer: Aetna Commercial |
$28.65
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$25.94
|
| Rate for Payer: Aetna Managed Medicare |
$13.77
|
| Rate for Payer: Anthem Medicare Advantage |
$13.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$13.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$13.77
|
| Rate for Payer: Cash Price |
$8.70
|
| Rate for Payer: Cash Price |
$8.70
|
| Rate for Payer: Cigna Commercial |
$28.65
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$15.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$13.77
|
| Rate for Payer: Health EOS Commercial |
$27.45
|
| Rate for Payer: HFN Commercial |
$28.65
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$48.61
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$48.61
|
| Rate for Payer: Independent Care Health Plan Medicare |
$13.77
|
| Rate for Payer: Multiplan Commercial |
$24.13
|
| Rate for Payer: NAPHCARE Commercial |
$20.65
|
| Rate for Payer: Preferred Network Access Commercial |
$28.65
|
| Rate for Payer: Quartz Beloit One Network |
$13.27
|
| Rate for Payer: Quartz Commercial |
$17.19
|
| Rate for Payer: Quartz Medicare Advantage |
$13.77
|
| Rate for Payer: The Alliance Commercial |
$54.39
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.77
|
| Rate for Payer: WEA Trust Commercial |
$16.59
|
| Rate for Payer: WPS Commercial |
$60.59
|
|
|
Treponema pallidum, IFA, CSF
|
Facility
|
OP
|
$31.00
|
|
|
Service Code
|
CPT 86780
|
| Hospital Charge Code |
5364648
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.77 |
| Max. Negotiated Rate |
$55.08 |
| Rate for Payer: Aetna Commercial |
$29.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$27.73
|
| Rate for Payer: Aetna Managed Medicare |
$13.77
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$51.64
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$24.10
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$22.86
|
| Rate for Payer: Anthem Medicare Advantage |
$13.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$17.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$13.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$13.77
|
| Rate for Payer: Cash Price |
$9.30
|
| Rate for Payer: Cash Price |
$9.30
|
| Rate for Payer: Cigna Commercial |
$29.66
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$13.77
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$18.04
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$13.77
|
| Rate for Payer: Health EOS Commercial |
$28.69
|
| Rate for Payer: HFN Commercial |
$29.66
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$51.22
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$13.77
|
| Rate for Payer: Independent Care Health Plan Medicare |
$13.77
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$13.77
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$13.77
|
| Rate for Payer: Multiplan Commercial |
$25.79
|
| Rate for Payer: NAPHCARE Commercial |
$20.65
|
| Rate for Payer: Preferred Network Access Commercial |
$29.66
|
| Rate for Payer: Quartz Beloit One Network |
$15.80
|
| Rate for Payer: Quartz Commercial |
$20.96
|
| Rate for Payer: Quartz Medicare Advantage |
$13.77
|
| Rate for Payer: The Alliance Commercial |
$55.08
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.77
|
| Rate for Payer: United Healthcare PPO |
$24.18
|
| Rate for Payer: WEA Trust Commercial |
$17.73
|
| Rate for Payer: Wellcare Medicare |
$13.77
|
| Rate for Payer: WPS Commercial |
$23.88
|
|
|
Treponema pallidum, IFA, CSF
|
Facility
|
IP
|
$31.00
|
|
|
Service Code
|
CPT 86780
|
| Hospital Charge Code |
5364648
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.80 |
| Max. Negotiated Rate |
$29.66 |
| Rate for Payer: Aetna Commercial |
$29.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$27.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$17.09
|
| Rate for Payer: Cash Price |
$9.30
|
| Rate for Payer: Cigna Commercial |
$29.66
|
| Rate for Payer: Health EOS Commercial |
$28.69
|
| Rate for Payer: HFN Commercial |
$29.66
|
| Rate for Payer: Multiplan Commercial |
$25.79
|
| Rate for Payer: Preferred Network Access Commercial |
$29.66
|
| Rate for Payer: Quartz Beloit One Network |
$15.80
|
| Rate for Payer: Quartz Commercial |
$19.34
|
| Rate for Payer: WEA Trust Commercial |
$17.73
|
| Rate for Payer: WPS Commercial |
$23.88
|
|
|
Treponema pallidum, IFA, CSF
|
Professional
|
Both
|
$31.00
|
|
|
Service Code
|
CPT 86780
|
| Hospital Charge Code |
5364648
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.77 |
| Max. Negotiated Rate |
$60.59 |
| Rate for Payer: Aetna Commercial |
$30.63
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$27.73
|
| Rate for Payer: Aetna Managed Medicare |
$13.77
|
| Rate for Payer: Anthem Medicare Advantage |
$13.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$13.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$13.77
|
| Rate for Payer: Cash Price |
$9.30
|
| Rate for Payer: Cash Price |
$9.30
|
| Rate for Payer: Cigna Commercial |
$30.63
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$16.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$13.77
|
| Rate for Payer: Health EOS Commercial |
$29.34
|
| Rate for Payer: HFN Commercial |
$30.63
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$48.61
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$48.61
|
| Rate for Payer: Independent Care Health Plan Medicare |
$13.77
|
| Rate for Payer: Multiplan Commercial |
$25.79
|
| Rate for Payer: NAPHCARE Commercial |
$20.65
|
| Rate for Payer: Preferred Network Access Commercial |
$30.63
|
| Rate for Payer: Quartz Beloit One Network |
$14.19
|
| Rate for Payer: Quartz Commercial |
$18.38
|
| Rate for Payer: Quartz Medicare Advantage |
$13.77
|
| Rate for Payer: The Alliance Commercial |
$54.39
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.77
|
| Rate for Payer: WEA Trust Commercial |
$17.73
|
| Rate for Payer: WPS Commercial |
$60.59
|
|
|
Triamcinolone 40mg/5ml MDV [Med]
|
Facility
|
IP
|
$630.00
|
|
|
Service Code
|
HCPCS J3301
|
| Hospital Charge Code |
2974993
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$321.05 |
| Max. Negotiated Rate |
$602.78 |
| Rate for Payer: Aetna Commercial |
$589.68
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$563.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$347.26
|
| Rate for Payer: Cash Price |
$189.00
|
| Rate for Payer: Cigna Commercial |
$602.78
|
| Rate for Payer: Health EOS Commercial |
$583.13
|
| Rate for Payer: HFN Commercial |
$602.78
|
| Rate for Payer: Multiplan Commercial |
$524.16
|
| Rate for Payer: Preferred Network Access Commercial |
$602.78
|
| Rate for Payer: Quartz Beloit One Network |
$321.05
|
| Rate for Payer: Quartz Commercial |
$393.12
|
| Rate for Payer: WEA Trust Commercial |
$360.36
|
| Rate for Payer: WPS Commercial |
$485.29
|
|
|
Triamcinolone 40mg/5ml MDV [Med]
|
Facility
|
OP
|
$630.00
|
|
|
Service Code
|
HCPCS J3301
|
| Hospital Charge Code |
2974993
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.49 |
| Max. Negotiated Rate |
$602.78 |
| Rate for Payer: Aetna Commercial |
$589.68
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$563.47
|
| Rate for Payer: Aetna Managed Medicare |
$183.46
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$425.88
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$327.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$314.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$347.26
|
| Rate for Payer: Cash Price |
$189.00
|
| Rate for Payer: Cash Price |
$189.00
|
| Rate for Payer: Cigna Commercial |
$602.78
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1.49
|
| Rate for Payer: Health EOS Commercial |
$583.13
|
| Rate for Payer: HFN Commercial |
$602.78
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$491.40
|
| Rate for Payer: Multiplan Commercial |
$524.16
|
| Rate for Payer: NAPHCARE Commercial |
$393.12
|
| Rate for Payer: Preferred Network Access Commercial |
$602.78
|
| Rate for Payer: Quartz Beloit One Network |
$321.05
|
| Rate for Payer: Quartz Commercial |
$425.88
|
| Rate for Payer: Quartz Medicare Advantage |
$393.12
|
| Rate for Payer: The Alliance Commercial |
$3.08
|
| Rate for Payer: WEA Trust Commercial |
$360.36
|
| Rate for Payer: WPS Commercial |
$2.82
|
|
|
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 |
$5.10 |
| Max. Negotiated Rate |
$9.57 |
| Rate for Payer: Aetna Commercial |
$9.36
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5.51
|
| Rate for Payer: Cash Price |
$3.00
|
| Rate for Payer: Cigna Commercial |
$9.57
|
| Rate for Payer: Health EOS Commercial |
$9.26
|
| Rate for Payer: HFN Commercial |
$9.57
|
| Rate for Payer: Multiplan Commercial |
$8.32
|
| Rate for Payer: Preferred Network Access Commercial |
$9.57
|
| Rate for Payer: Quartz Beloit One Network |
$5.10
|
| Rate for Payer: Quartz Commercial |
$6.24
|
| Rate for Payer: WEA Trust Commercial |
$5.72
|
| Rate for Payer: WPS Commercial |
$7.70
|
|
|
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 |
$1.49 |
| Max. Negotiated Rate |
$9.57 |
| Rate for Payer: Aetna Commercial |
$9.36
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8.94
|
| Rate for Payer: Aetna Managed Medicare |
$2.91
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6.76
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5.51
|
| Rate for Payer: Cash Price |
$3.00
|
| Rate for Payer: Cash Price |
$3.00
|
| Rate for Payer: Cigna Commercial |
$9.57
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1.49
|
| Rate for Payer: Health EOS Commercial |
$9.26
|
| Rate for Payer: HFN Commercial |
$9.57
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7.80
|
| Rate for Payer: Multiplan Commercial |
$8.32
|
| Rate for Payer: NAPHCARE Commercial |
$6.24
|
| Rate for Payer: Preferred Network Access Commercial |
$9.57
|
| Rate for Payer: Quartz Beloit One Network |
$5.10
|
| Rate for Payer: Quartz Commercial |
$6.76
|
| Rate for Payer: Quartz Medicare Advantage |
$6.24
|
| Rate for Payer: The Alliance Commercial |
$3.08
|
| Rate for Payer: WEA Trust Commercial |
$5.72
|
| Rate for Payer: WPS Commercial |
$2.82
|
|
|
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 |
$1.49 |
| Max. Negotiated Rate |
$28.70 |
| Rate for Payer: Aetna Commercial |
$28.08
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$26.83
|
| Rate for Payer: Aetna Managed Medicare |
$8.74
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$20.28
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$15.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$14.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$16.54
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Cigna Commercial |
$28.70
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1.49
|
| Rate for Payer: Health EOS Commercial |
$27.77
|
| Rate for Payer: HFN Commercial |
$28.70
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$23.40
|
| Rate for Payer: Multiplan Commercial |
$24.96
|
| Rate for Payer: NAPHCARE Commercial |
$18.72
|
| Rate for Payer: Preferred Network Access Commercial |
$28.70
|
| Rate for Payer: Quartz Beloit One Network |
$15.29
|
| Rate for Payer: Quartz Commercial |
$20.28
|
| Rate for Payer: Quartz Medicare Advantage |
$18.72
|
| Rate for Payer: The Alliance Commercial |
$3.08
|
| Rate for Payer: WEA Trust Commercial |
$17.16
|
| Rate for Payer: WPS Commercial |
$2.82
|
|
|
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 |
$0.77 |
| Max. Negotiated Rate |
$29.64 |
| Rate for Payer: Aetna Commercial |
$29.64
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$26.83
|
| Rate for Payer: Aetna Managed Medicare |
$0.77
|
| Rate for Payer: Anthem Medicare Advantage |
$0.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$0.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$0.77
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Cigna Commercial |
$29.64
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$0.77
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1.13
|
| Rate for Payer: Health EOS Commercial |
$28.39
|
| Rate for Payer: HFN Commercial |
$29.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1.96
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1.96
|
| Rate for Payer: Independent Care Health Plan Medicare |
$0.77
|
| Rate for Payer: Multiplan Commercial |
$24.96
|
| Rate for Payer: NAPHCARE Commercial |
$1.15
|
| Rate for Payer: Preferred Network Access Commercial |
$29.64
|
| Rate for Payer: Quartz Beloit One Network |
$13.73
|
| Rate for Payer: Quartz Commercial |
$17.78
|
| Rate for Payer: Quartz Medicare Advantage |
$0.77
|
| Rate for Payer: The Alliance Commercial |
$2.12
|
| Rate for Payer: United Healthcare Medicaid |
$0.77
|
| Rate for Payer: United Healthcare Medicare Advantage |
$0.77
|
| Rate for Payer: WEA Trust Commercial |
$17.16
|
| Rate for Payer: WPS Commercial |
$2.82
|
|
|
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 |
$15.29 |
| Max. Negotiated Rate |
$28.70 |
| Rate for Payer: Aetna Commercial |
$28.08
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$26.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$16.54
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Cigna Commercial |
$28.70
|
| Rate for Payer: Health EOS Commercial |
$27.77
|
| Rate for Payer: HFN Commercial |
$28.70
|
| Rate for Payer: Multiplan Commercial |
$24.96
|
| Rate for Payer: Preferred Network Access Commercial |
$28.70
|
| Rate for Payer: Quartz Beloit One Network |
$15.29
|
| Rate for Payer: Quartz Commercial |
$18.72
|
| Rate for Payer: WEA Trust Commercial |
$17.16
|
| Rate for Payer: WPS Commercial |
$23.11
|
|
|
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 |
$8.99 |
| Max. Negotiated Rate |
$101.88 |
| Rate for Payer: Aetna Commercial |
$16.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$16.10
|
| Rate for Payer: Aetna Managed Medicare |
$25.47
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$12.17
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$9.36
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$8.99
|
| Rate for Payer: Anthem Medicare Advantage |
$25.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$25.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$25.47
|
| Rate for Payer: Cash Price |
$5.40
|
| Rate for Payer: Cash Price |
$5.40
|
| Rate for Payer: Cigna Commercial |
$17.22
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$25.47
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$10.48
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$25.47
|
| Rate for Payer: Health EOS Commercial |
$16.66
|
| Rate for Payer: HFN Commercial |
$17.22
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$94.75
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$25.47
|
| Rate for Payer: Independent Care Health Plan Medicare |
$25.47
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$25.47
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$25.47
|
| Rate for Payer: Multiplan Commercial |
$14.98
|
| Rate for Payer: NAPHCARE Commercial |
$38.20
|
| Rate for Payer: Preferred Network Access Commercial |
$17.22
|
| Rate for Payer: Quartz Beloit One Network |
$9.17
|
| Rate for Payer: Quartz Commercial |
$12.17
|
| Rate for Payer: Quartz Medicare Advantage |
$25.47
|
| Rate for Payer: The Alliance Commercial |
$101.88
|
| Rate for Payer: United Healthcare Medicare Advantage |
$25.47
|
| Rate for Payer: WEA Trust Commercial |
$10.30
|
| Rate for Payer: Wellcare Medicare |
$25.47
|
| Rate for Payer: WPS Commercial |
$13.87
|
|
|
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 |
$5.88 |
| Max. Negotiated Rate |
$70.04 |
| Rate for Payer: Aetna Commercial |
$17.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$16.10
|
| Rate for Payer: Aetna Managed Medicare |
$25.47
|
| Rate for Payer: Anthem Medicare Advantage |
$25.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$25.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$25.47
|
| Rate for Payer: Cash Price |
$5.40
|
| Rate for Payer: Cash Price |
$5.40
|
| Rate for Payer: Cigna Commercial |
$17.78
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$25.47
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$25.47
|
| Rate for Payer: Health EOS Commercial |
$17.04
|
| Rate for Payer: HFN Commercial |
$17.78
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5.88
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$5.88
|
| Rate for Payer: Independent Care Health Plan Medicare |
$25.47
|
| Rate for Payer: Multiplan Commercial |
$14.98
|
| Rate for Payer: NAPHCARE Commercial |
$38.20
|
| Rate for Payer: Preferred Network Access Commercial |
$17.78
|
| Rate for Payer: Quartz Beloit One Network |
$8.24
|
| Rate for Payer: Quartz Commercial |
$10.67
|
| Rate for Payer: Quartz Medicare Advantage |
$25.47
|
| Rate for Payer: The Alliance Commercial |
$70.04
|
| Rate for Payer: United Healthcare Medicaid |
$25.47
|
| Rate for Payer: United Healthcare Medicare Advantage |
$25.47
|
| Rate for Payer: WEA Trust Commercial |
$10.30
|
| Rate for Payer: WPS Commercial |
$44.57
|
|
