|
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 |
$9.17 |
| Max. Negotiated Rate |
$17.22 |
| Rate for Payer: Aetna Commercial |
$16.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$16.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9.92
|
| Rate for Payer: Cash Price |
$5.40
|
| Rate for Payer: Cigna Commercial |
$17.22
|
| Rate for Payer: Health EOS Commercial |
$16.66
|
| Rate for Payer: HFN Commercial |
$17.22
|
| Rate for Payer: Multiplan Commercial |
$14.98
|
| Rate for Payer: Preferred Network Access Commercial |
$17.22
|
| Rate for Payer: Quartz Beloit One Network |
$9.17
|
| Rate for Payer: Quartz Commercial |
$11.23
|
| Rate for Payer: WEA Trust Commercial |
$10.30
|
| Rate for Payer: WPS Commercial |
$13.87
|
|
|
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 |
$2.33 |
| Max. Negotiated Rate |
$7.65 |
| Rate for Payer: Aetna Commercial |
$7.49
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7.16
|
| Rate for Payer: Aetna Managed Medicare |
$2.33
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5.41
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4.41
|
| Rate for Payer: Cash Price |
$2.40
|
| Rate for Payer: Cigna Commercial |
$7.65
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4.66
|
| Rate for Payer: Health EOS Commercial |
$7.40
|
| Rate for Payer: HFN Commercial |
$7.65
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6.24
|
| Rate for Payer: Multiplan Commercial |
$6.66
|
| Rate for Payer: NAPHCARE Commercial |
$4.99
|
| Rate for Payer: Preferred Network Access Commercial |
$7.65
|
| Rate for Payer: Quartz Beloit One Network |
$4.08
|
| Rate for Payer: Quartz Commercial |
$5.41
|
| Rate for Payer: Quartz Medicare Advantage |
$4.99
|
| Rate for Payer: The Alliance Commercial |
$4.16
|
| Rate for Payer: WEA Trust Commercial |
$4.58
|
| Rate for Payer: WPS Commercial |
$6.16
|
|
|
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 |
$3.66 |
| Max. Negotiated Rate |
$7.90 |
| Rate for Payer: Aetna Commercial |
$7.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7.16
|
| Rate for Payer: Cash Price |
$2.40
|
| Rate for Payer: Cash Price |
$2.40
|
| Rate for Payer: Cigna Commercial |
$7.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$3.75
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4.99
|
| Rate for Payer: Health EOS Commercial |
$7.57
|
| Rate for Payer: HFN Commercial |
$7.90
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5.48
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$5.48
|
| Rate for Payer: Multiplan Commercial |
$6.66
|
| Rate for Payer: Preferred Network Access Commercial |
$7.90
|
| Rate for Payer: Quartz Beloit One Network |
$3.66
|
| Rate for Payer: Quartz Commercial |
$4.74
|
| Rate for Payer: The Alliance Commercial |
$4.16
|
| Rate for Payer: United Healthcare Medicaid |
$3.75
|
| Rate for Payer: WEA Trust Commercial |
$4.58
|
| Rate for Payer: WPS Commercial |
$6.16
|
|
|
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 |
$4.08 |
| Max. Negotiated Rate |
$7.65 |
| Rate for Payer: Aetna Commercial |
$7.49
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4.41
|
| Rate for Payer: Cash Price |
$2.40
|
| Rate for Payer: Cigna Commercial |
$7.65
|
| Rate for Payer: Health EOS Commercial |
$7.40
|
| Rate for Payer: HFN Commercial |
$7.65
|
| Rate for Payer: Multiplan Commercial |
$6.66
|
| Rate for Payer: Preferred Network Access Commercial |
$7.65
|
| Rate for Payer: Quartz Beloit One Network |
$4.08
|
| Rate for Payer: Quartz Commercial |
$4.99
|
| Rate for Payer: WEA Trust Commercial |
$4.58
|
| Rate for Payer: WPS Commercial |
$6.16
|
|
|
Trichomonas vaginalis RNA Ql, Males
|
Facility
|
OP
|
$238.00
|
|
|
Service Code
|
CPT 87661
|
| Hospital Charge Code |
5184660
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$36.49 |
| Max. Negotiated Rate |
$227.72 |
| Rate for Payer: Aetna Commercial |
$222.77
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$212.87
|
| Rate for Payer: Aetna Managed Medicare |
$36.49
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$136.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$63.86
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$60.58
|
| Rate for Payer: Anthem Medicare Advantage |
$36.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$131.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$36.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$36.49
|
| Rate for Payer: Cash Price |
$71.40
|
| Rate for Payer: Cash Price |
$71.40
|
| Rate for Payer: Cigna Commercial |
$227.72
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$36.49
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$138.52
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$36.49
|
| Rate for Payer: Health EOS Commercial |
$220.29
|
| Rate for Payer: HFN Commercial |
$227.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$135.76
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$36.49
|
| Rate for Payer: Independent Care Health Plan Medicare |
$36.49
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$36.49
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$36.49
|
| Rate for Payer: Multiplan Commercial |
$198.02
|
| Rate for Payer: NAPHCARE Commercial |
$54.74
|
| Rate for Payer: Preferred Network Access Commercial |
$227.72
|
| Rate for Payer: Quartz Beloit One Network |
$121.28
|
| Rate for Payer: Quartz Commercial |
$160.89
|
| Rate for Payer: Quartz Medicare Advantage |
$36.49
|
| Rate for Payer: The Alliance Commercial |
$145.97
|
| Rate for Payer: United Healthcare Medicare Advantage |
$36.49
|
| Rate for Payer: United Healthcare PPO |
$185.64
|
| Rate for Payer: WEA Trust Commercial |
$136.14
|
| Rate for Payer: Wellcare Medicare |
$36.49
|
| Rate for Payer: WPS Commercial |
$183.33
|
|
|
Trichomonas vaginalis RNA Ql, Males
|
Facility
|
IP
|
$238.00
|
|
|
Service Code
|
CPT 87661
|
| Hospital Charge Code |
5184660
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$121.28 |
| Max. Negotiated Rate |
$227.72 |
| Rate for Payer: Aetna Commercial |
$222.77
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$212.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$131.19
|
| Rate for Payer: Cash Price |
$71.40
|
| Rate for Payer: Cigna Commercial |
$227.72
|
| Rate for Payer: Health EOS Commercial |
$220.29
|
| Rate for Payer: HFN Commercial |
$227.72
|
| Rate for Payer: Multiplan Commercial |
$198.02
|
| Rate for Payer: Preferred Network Access Commercial |
$227.72
|
| Rate for Payer: Quartz Beloit One Network |
$121.28
|
| Rate for Payer: Quartz Commercial |
$148.51
|
| Rate for Payer: WEA Trust Commercial |
$136.14
|
| Rate for Payer: WPS Commercial |
$183.33
|
|
|
Trichomonas vaginalis RNA Ql, Males
|
Professional
|
Both
|
$238.00
|
|
|
Service Code
|
CPT 87661
|
| Hospital Charge Code |
5184660
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$36.49 |
| Max. Negotiated Rate |
$235.14 |
| Rate for Payer: Aetna Commercial |
$235.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$212.87
|
| Rate for Payer: Aetna Managed Medicare |
$36.49
|
| Rate for Payer: Anthem Medicare Advantage |
$36.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$36.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$36.49
|
| Rate for Payer: Cash Price |
$71.40
|
| Rate for Payer: Cash Price |
$71.40
|
| Rate for Payer: Cigna Commercial |
$235.14
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$123.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$36.49
|
| Rate for Payer: Health EOS Commercial |
$225.24
|
| Rate for Payer: HFN Commercial |
$235.14
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$128.82
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$128.82
|
| Rate for Payer: Independent Care Health Plan Medicare |
$36.49
|
| Rate for Payer: Multiplan Commercial |
$198.02
|
| Rate for Payer: NAPHCARE Commercial |
$54.74
|
| Rate for Payer: Preferred Network Access Commercial |
$235.14
|
| Rate for Payer: Quartz Beloit One Network |
$108.91
|
| Rate for Payer: Quartz Commercial |
$141.09
|
| Rate for Payer: Quartz Medicare Advantage |
$36.49
|
| Rate for Payer: The Alliance Commercial |
$144.15
|
| Rate for Payer: United Healthcare Medicare Advantage |
$36.49
|
| Rate for Payer: WEA Trust Commercial |
$136.14
|
| Rate for Payer: WPS Commercial |
$160.57
|
|
|
Trichomonas vaginalis RNA, Ql TMA
|
Facility
|
OP
|
$220.00
|
|
|
Service Code
|
CPT 87661
|
| Hospital Charge Code |
5296693
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$36.49 |
| Max. Negotiated Rate |
$210.50 |
| Rate for Payer: Aetna Commercial |
$205.92
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$196.77
|
| Rate for Payer: Aetna Managed Medicare |
$36.49
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$136.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$63.86
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$60.58
|
| Rate for Payer: Anthem Medicare Advantage |
$36.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$121.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$36.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$36.49
|
| Rate for Payer: Cash Price |
$66.00
|
| Rate for Payer: Cash Price |
$66.00
|
| Rate for Payer: Cigna Commercial |
$210.50
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$36.49
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$128.04
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$36.49
|
| Rate for Payer: Health EOS Commercial |
$203.63
|
| Rate for Payer: HFN Commercial |
$210.50
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$135.76
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$36.49
|
| Rate for Payer: Independent Care Health Plan Medicare |
$36.49
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$36.49
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$36.49
|
| Rate for Payer: Multiplan Commercial |
$183.04
|
| Rate for Payer: NAPHCARE Commercial |
$54.74
|
| Rate for Payer: Preferred Network Access Commercial |
$210.50
|
| Rate for Payer: Quartz Beloit One Network |
$112.11
|
| Rate for Payer: Quartz Commercial |
$148.72
|
| Rate for Payer: Quartz Medicare Advantage |
$36.49
|
| Rate for Payer: The Alliance Commercial |
$145.97
|
| Rate for Payer: United Healthcare Medicare Advantage |
$36.49
|
| Rate for Payer: United Healthcare PPO |
$171.60
|
| Rate for Payer: WEA Trust Commercial |
$125.84
|
| Rate for Payer: Wellcare Medicare |
$36.49
|
| Rate for Payer: WPS Commercial |
$169.47
|
|
|
Trichomonas vaginalis RNA, Ql TMA
|
Facility
|
IP
|
$220.00
|
|
|
Service Code
|
CPT 87661
|
| Hospital Charge Code |
5296693
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$112.11 |
| Max. Negotiated Rate |
$210.50 |
| Rate for Payer: Aetna Commercial |
$205.92
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$196.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$121.26
|
| Rate for Payer: Cash Price |
$66.00
|
| Rate for Payer: Cigna Commercial |
$210.50
|
| Rate for Payer: Health EOS Commercial |
$203.63
|
| Rate for Payer: HFN Commercial |
$210.50
|
| Rate for Payer: Multiplan Commercial |
$183.04
|
| Rate for Payer: Preferred Network Access Commercial |
$210.50
|
| Rate for Payer: Quartz Beloit One Network |
$112.11
|
| Rate for Payer: Quartz Commercial |
$137.28
|
| Rate for Payer: WEA Trust Commercial |
$125.84
|
| Rate for Payer: WPS Commercial |
$169.47
|
|
|
Trichomonas vaginalis RNA, Ql TMA
|
Professional
|
Both
|
$220.00
|
|
|
Service Code
|
CPT 87661
|
| Hospital Charge Code |
5296693
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$36.49 |
| Max. Negotiated Rate |
$217.36 |
| Rate for Payer: Aetna Commercial |
$217.36
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$196.77
|
| Rate for Payer: Aetna Managed Medicare |
$36.49
|
| Rate for Payer: Anthem Medicare Advantage |
$36.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$36.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$36.49
|
| Rate for Payer: Cash Price |
$66.00
|
| Rate for Payer: Cash Price |
$66.00
|
| Rate for Payer: Cigna Commercial |
$217.36
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$114.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$36.49
|
| Rate for Payer: Health EOS Commercial |
$208.21
|
| Rate for Payer: HFN Commercial |
$217.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$128.82
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$128.82
|
| Rate for Payer: Independent Care Health Plan Medicare |
$36.49
|
| Rate for Payer: Multiplan Commercial |
$183.04
|
| Rate for Payer: NAPHCARE Commercial |
$54.74
|
| Rate for Payer: Preferred Network Access Commercial |
$217.36
|
| Rate for Payer: Quartz Beloit One Network |
$100.67
|
| Rate for Payer: Quartz Commercial |
$130.42
|
| Rate for Payer: Quartz Medicare Advantage |
$36.49
|
| Rate for Payer: The Alliance Commercial |
$144.15
|
| Rate for Payer: United Healthcare Medicare Advantage |
$36.49
|
| Rate for Payer: WEA Trust Commercial |
$125.84
|
| Rate for Payer: WPS Commercial |
$160.57
|
|
|
Trichrome Stain Report
|
Facility
|
OP
|
$135.00
|
|
|
Service Code
|
CPT 87209
|
| Hospital Charge Code |
634215
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$18.70 |
| Max. Negotiated Rate |
$129.17 |
| Rate for Payer: Aetna Commercial |
$126.36
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$120.74
|
| Rate for Payer: Aetna Managed Medicare |
$18.70
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$70.12
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$32.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$31.04
|
| Rate for Payer: Anthem Medicare Advantage |
$18.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$74.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$18.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$18.70
|
| Rate for Payer: Cash Price |
$40.50
|
| Rate for Payer: Cash Price |
$40.50
|
| Rate for Payer: Cigna Commercial |
$129.17
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$18.70
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$78.57
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$18.70
|
| Rate for Payer: Health EOS Commercial |
$124.96
|
| Rate for Payer: HFN Commercial |
$129.17
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$69.56
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$18.70
|
| Rate for Payer: Independent Care Health Plan Medicare |
$18.70
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$18.70
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$18.70
|
| Rate for Payer: Multiplan Commercial |
$112.32
|
| Rate for Payer: NAPHCARE Commercial |
$28.05
|
| Rate for Payer: Preferred Network Access Commercial |
$129.17
|
| Rate for Payer: Quartz Beloit One Network |
$68.80
|
| Rate for Payer: Quartz Commercial |
$91.26
|
| Rate for Payer: Quartz Medicare Advantage |
$18.70
|
| Rate for Payer: The Alliance Commercial |
$74.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$18.70
|
| Rate for Payer: United Healthcare PPO |
$105.30
|
| Rate for Payer: WEA Trust Commercial |
$77.22
|
| Rate for Payer: Wellcare Medicare |
$18.70
|
| Rate for Payer: WPS Commercial |
$103.99
|
|
|
Trichrome Stain Report
|
Professional
|
Both
|
$135.00
|
|
|
Service Code
|
CPT 87209
|
| Hospital Charge Code |
634215
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$18.70 |
| Max. Negotiated Rate |
$133.38 |
| Rate for Payer: Aetna Commercial |
$133.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$120.74
|
| Rate for Payer: Aetna Managed Medicare |
$18.70
|
| Rate for Payer: Anthem Medicare Advantage |
$18.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$18.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$18.70
|
| Rate for Payer: Cash Price |
$40.50
|
| Rate for Payer: Cash Price |
$40.50
|
| Rate for Payer: Cigna Commercial |
$133.38
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$70.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$18.70
|
| Rate for Payer: Health EOS Commercial |
$127.76
|
| Rate for Payer: HFN Commercial |
$133.38
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$66.01
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$66.01
|
| Rate for Payer: Independent Care Health Plan Medicare |
$18.70
|
| Rate for Payer: Multiplan Commercial |
$112.32
|
| Rate for Payer: NAPHCARE Commercial |
$28.05
|
| Rate for Payer: Preferred Network Access Commercial |
$133.38
|
| Rate for Payer: Quartz Beloit One Network |
$61.78
|
| Rate for Payer: Quartz Commercial |
$80.03
|
| Rate for Payer: Quartz Medicare Advantage |
$18.70
|
| Rate for Payer: The Alliance Commercial |
$73.86
|
| Rate for Payer: United Healthcare Medicare Advantage |
$18.70
|
| Rate for Payer: WEA Trust Commercial |
$77.22
|
| Rate for Payer: WPS Commercial |
$82.28
|
|
|
Trichrome Stain Report
|
Facility
|
IP
|
$135.00
|
|
|
Service Code
|
CPT 87209
|
| Hospital Charge Code |
634215
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$68.80 |
| Max. Negotiated Rate |
$129.17 |
| Rate for Payer: Aetna Commercial |
$126.36
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$120.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$74.41
|
| Rate for Payer: Cash Price |
$40.50
|
| Rate for Payer: Cigna Commercial |
$129.17
|
| Rate for Payer: Health EOS Commercial |
$124.96
|
| Rate for Payer: HFN Commercial |
$129.17
|
| Rate for Payer: Multiplan Commercial |
$112.32
|
| Rate for Payer: Preferred Network Access Commercial |
$129.17
|
| Rate for Payer: Quartz Beloit One Network |
$68.80
|
| Rate for Payer: Quartz Commercial |
$84.24
|
| Rate for Payer: WEA Trust Commercial |
$77.22
|
| Rate for Payer: WPS Commercial |
$103.99
|
|
|
TRICUSPID RING 26MM TRI-AD #900SFC-26
|
Facility
|
OP
|
$15,864.00
|
|
| Hospital Charge Code |
2973913
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,619.60 |
| Max. Negotiated Rate |
$15,178.68 |
| Rate for Payer: Aetna Commercial |
$14,848.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$14,188.76
|
| Rate for Payer: Aetna Managed Medicare |
$4,619.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$10,724.06
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8,249.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7,919.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$8,744.24
|
| Rate for Payer: Cash Price |
$4,759.20
|
| Rate for Payer: Cigna Commercial |
$15,178.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$9,232.85
|
| Rate for Payer: Health EOS Commercial |
$14,683.72
|
| Rate for Payer: HFN Commercial |
$15,178.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$12,373.92
|
| Rate for Payer: Multiplan Commercial |
$13,198.85
|
| Rate for Payer: NAPHCARE Commercial |
$9,899.14
|
| Rate for Payer: Preferred Network Access Commercial |
$15,178.68
|
| Rate for Payer: Quartz Beloit One Network |
$8,084.29
|
| Rate for Payer: Quartz Commercial |
$10,724.06
|
| Rate for Payer: Quartz Medicare Advantage |
$9,899.14
|
| Rate for Payer: The Alliance Commercial |
$8,249.28
|
| Rate for Payer: WEA Trust Commercial |
$9,074.21
|
| Rate for Payer: WPS Commercial |
$12,220.04
|
|
|
TRICUSPID RING 26MM TRI-AD #900SFC-26
|
Facility
|
IP
|
$15,864.00
|
|
| Hospital Charge Code |
2973913
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,084.29 |
| Max. Negotiated Rate |
$15,178.68 |
| Rate for Payer: Aetna Commercial |
$14,848.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$14,188.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$8,744.24
|
| Rate for Payer: Cash Price |
$4,759.20
|
| Rate for Payer: Cigna Commercial |
$15,178.68
|
| Rate for Payer: Health EOS Commercial |
$14,683.72
|
| Rate for Payer: HFN Commercial |
$15,178.68
|
| Rate for Payer: Multiplan Commercial |
$13,198.85
|
| Rate for Payer: Preferred Network Access Commercial |
$15,178.68
|
| Rate for Payer: Quartz Beloit One Network |
$8,084.29
|
| Rate for Payer: Quartz Commercial |
$9,899.14
|
| Rate for Payer: WEA Trust Commercial |
$9,074.21
|
| Rate for Payer: WPS Commercial |
$12,220.04
|
|
|
TRICUSPID RING 28MM TRI-AD 900SFC-28
|
Facility
|
IP
|
$15,864.00
|
|
| Hospital Charge Code |
2973914
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,084.29 |
| Max. Negotiated Rate |
$15,178.68 |
| Rate for Payer: Aetna Commercial |
$14,848.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$14,188.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$8,744.24
|
| Rate for Payer: Cash Price |
$4,759.20
|
| Rate for Payer: Cigna Commercial |
$15,178.68
|
| Rate for Payer: Health EOS Commercial |
$14,683.72
|
| Rate for Payer: HFN Commercial |
$15,178.68
|
| Rate for Payer: Multiplan Commercial |
$13,198.85
|
| Rate for Payer: Preferred Network Access Commercial |
$15,178.68
|
| Rate for Payer: Quartz Beloit One Network |
$8,084.29
|
| Rate for Payer: Quartz Commercial |
$9,899.14
|
| Rate for Payer: WEA Trust Commercial |
$9,074.21
|
| Rate for Payer: WPS Commercial |
$12,220.04
|
|
|
TRICUSPID RING 28MM TRI-AD 900SFC-28
|
Facility
|
OP
|
$15,864.00
|
|
| Hospital Charge Code |
2973914
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,619.60 |
| Max. Negotiated Rate |
$15,178.68 |
| Rate for Payer: Aetna Commercial |
$14,848.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$14,188.76
|
| Rate for Payer: Aetna Managed Medicare |
$4,619.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$10,724.06
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8,249.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7,919.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$8,744.24
|
| Rate for Payer: Cash Price |
$4,759.20
|
| Rate for Payer: Cigna Commercial |
$15,178.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$9,232.85
|
| Rate for Payer: Health EOS Commercial |
$14,683.72
|
| Rate for Payer: HFN Commercial |
$15,178.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$12,373.92
|
| Rate for Payer: Multiplan Commercial |
$13,198.85
|
| Rate for Payer: NAPHCARE Commercial |
$9,899.14
|
| Rate for Payer: Preferred Network Access Commercial |
$15,178.68
|
| Rate for Payer: Quartz Beloit One Network |
$8,084.29
|
| Rate for Payer: Quartz Commercial |
$10,724.06
|
| Rate for Payer: Quartz Medicare Advantage |
$9,899.14
|
| Rate for Payer: The Alliance Commercial |
$8,249.28
|
| Rate for Payer: WEA Trust Commercial |
$9,074.21
|
| Rate for Payer: WPS Commercial |
$12,220.04
|
|
|
TRICUSPID RING 30MM TRI-AD #900SFC-30
|
Facility
|
OP
|
$15,864.00
|
|
| Hospital Charge Code |
2973915
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,619.60 |
| Max. Negotiated Rate |
$15,178.68 |
| Rate for Payer: Aetna Commercial |
$14,848.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$14,188.76
|
| Rate for Payer: Aetna Managed Medicare |
$4,619.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$10,724.06
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8,249.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7,919.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$8,744.24
|
| Rate for Payer: Cash Price |
$4,759.20
|
| Rate for Payer: Cigna Commercial |
$15,178.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$9,232.85
|
| Rate for Payer: Health EOS Commercial |
$14,683.72
|
| Rate for Payer: HFN Commercial |
$15,178.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$12,373.92
|
| Rate for Payer: Multiplan Commercial |
$13,198.85
|
| Rate for Payer: NAPHCARE Commercial |
$9,899.14
|
| Rate for Payer: Preferred Network Access Commercial |
$15,178.68
|
| Rate for Payer: Quartz Beloit One Network |
$8,084.29
|
| Rate for Payer: Quartz Commercial |
$10,724.06
|
| Rate for Payer: Quartz Medicare Advantage |
$9,899.14
|
| Rate for Payer: The Alliance Commercial |
$8,249.28
|
| Rate for Payer: WEA Trust Commercial |
$9,074.21
|
| Rate for Payer: WPS Commercial |
$12,220.04
|
|
|
TRICUSPID RING 30MM TRI-AD #900SFC-30
|
Facility
|
IP
|
$15,864.00
|
|
| Hospital Charge Code |
2973915
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,084.29 |
| Max. Negotiated Rate |
$15,178.68 |
| Rate for Payer: Aetna Commercial |
$14,848.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$14,188.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$8,744.24
|
| Rate for Payer: Cash Price |
$4,759.20
|
| Rate for Payer: Cigna Commercial |
$15,178.68
|
| Rate for Payer: Health EOS Commercial |
$14,683.72
|
| Rate for Payer: HFN Commercial |
$15,178.68
|
| Rate for Payer: Multiplan Commercial |
$13,198.85
|
| Rate for Payer: Preferred Network Access Commercial |
$15,178.68
|
| Rate for Payer: Quartz Beloit One Network |
$8,084.29
|
| Rate for Payer: Quartz Commercial |
$9,899.14
|
| Rate for Payer: WEA Trust Commercial |
$9,074.21
|
| Rate for Payer: WPS Commercial |
$12,220.04
|
|
|
TRICUSPID RING 32MM TRI-AD #900SFC-32
|
Facility
|
IP
|
$15,864.00
|
|
| Hospital Charge Code |
2973916
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,084.29 |
| Max. Negotiated Rate |
$15,178.68 |
| Rate for Payer: Aetna Commercial |
$14,848.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$14,188.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$8,744.24
|
| Rate for Payer: Cash Price |
$4,759.20
|
| Rate for Payer: Cigna Commercial |
$15,178.68
|
| Rate for Payer: Health EOS Commercial |
$14,683.72
|
| Rate for Payer: HFN Commercial |
$15,178.68
|
| Rate for Payer: Multiplan Commercial |
$13,198.85
|
| Rate for Payer: Preferred Network Access Commercial |
$15,178.68
|
| Rate for Payer: Quartz Beloit One Network |
$8,084.29
|
| Rate for Payer: Quartz Commercial |
$9,899.14
|
| Rate for Payer: WEA Trust Commercial |
$9,074.21
|
| Rate for Payer: WPS Commercial |
$12,220.04
|
|
|
TRICUSPID RING 32MM TRI-AD #900SFC-32
|
Facility
|
OP
|
$15,864.00
|
|
| Hospital Charge Code |
2973916
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,619.60 |
| Max. Negotiated Rate |
$15,178.68 |
| Rate for Payer: Aetna Commercial |
$14,848.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$14,188.76
|
| Rate for Payer: Aetna Managed Medicare |
$4,619.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$10,724.06
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8,249.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7,919.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$8,744.24
|
| Rate for Payer: Cash Price |
$4,759.20
|
| Rate for Payer: Cigna Commercial |
$15,178.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$9,232.85
|
| Rate for Payer: Health EOS Commercial |
$14,683.72
|
| Rate for Payer: HFN Commercial |
$15,178.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$12,373.92
|
| Rate for Payer: Multiplan Commercial |
$13,198.85
|
| Rate for Payer: NAPHCARE Commercial |
$9,899.14
|
| Rate for Payer: Preferred Network Access Commercial |
$15,178.68
|
| Rate for Payer: Quartz Beloit One Network |
$8,084.29
|
| Rate for Payer: Quartz Commercial |
$10,724.06
|
| Rate for Payer: Quartz Medicare Advantage |
$9,899.14
|
| Rate for Payer: The Alliance Commercial |
$8,249.28
|
| Rate for Payer: WEA Trust Commercial |
$9,074.21
|
| Rate for Payer: WPS Commercial |
$12,220.04
|
|
|
TRICUSPID RING 34MM TRI-AD #900SFC-34
|
Facility
|
IP
|
$15,864.00
|
|
| Hospital Charge Code |
2973917
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,084.29 |
| Max. Negotiated Rate |
$15,178.68 |
| Rate for Payer: Aetna Commercial |
$14,848.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$14,188.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$8,744.24
|
| Rate for Payer: Cash Price |
$4,759.20
|
| Rate for Payer: Cigna Commercial |
$15,178.68
|
| Rate for Payer: Health EOS Commercial |
$14,683.72
|
| Rate for Payer: HFN Commercial |
$15,178.68
|
| Rate for Payer: Multiplan Commercial |
$13,198.85
|
| Rate for Payer: Preferred Network Access Commercial |
$15,178.68
|
| Rate for Payer: Quartz Beloit One Network |
$8,084.29
|
| Rate for Payer: Quartz Commercial |
$9,899.14
|
| Rate for Payer: WEA Trust Commercial |
$9,074.21
|
| Rate for Payer: WPS Commercial |
$12,220.04
|
|
|
TRICUSPID RING 34MM TRI-AD #900SFC-34
|
Facility
|
OP
|
$15,864.00
|
|
| Hospital Charge Code |
2973917
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,619.60 |
| Max. Negotiated Rate |
$15,178.68 |
| Rate for Payer: Aetna Commercial |
$14,848.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$14,188.76
|
| Rate for Payer: Aetna Managed Medicare |
$4,619.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$10,724.06
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8,249.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7,919.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$8,744.24
|
| Rate for Payer: Cash Price |
$4,759.20
|
| Rate for Payer: Cigna Commercial |
$15,178.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$9,232.85
|
| Rate for Payer: Health EOS Commercial |
$14,683.72
|
| Rate for Payer: HFN Commercial |
$15,178.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$12,373.92
|
| Rate for Payer: Multiplan Commercial |
$13,198.85
|
| Rate for Payer: NAPHCARE Commercial |
$9,899.14
|
| Rate for Payer: Preferred Network Access Commercial |
$15,178.68
|
| Rate for Payer: Quartz Beloit One Network |
$8,084.29
|
| Rate for Payer: Quartz Commercial |
$10,724.06
|
| Rate for Payer: Quartz Medicare Advantage |
$9,899.14
|
| Rate for Payer: The Alliance Commercial |
$8,249.28
|
| Rate for Payer: WEA Trust Commercial |
$9,074.21
|
| Rate for Payer: WPS Commercial |
$12,220.04
|
|
|
TRICUSPID RING 36MM TRI-AD #900SFC-36
|
Facility
|
OP
|
$15,864.00
|
|
| Hospital Charge Code |
2973918
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,619.60 |
| Max. Negotiated Rate |
$15,178.68 |
| Rate for Payer: Aetna Commercial |
$14,848.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$14,188.76
|
| Rate for Payer: Aetna Managed Medicare |
$4,619.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$10,724.06
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8,249.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7,919.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$8,744.24
|
| Rate for Payer: Cash Price |
$4,759.20
|
| Rate for Payer: Cigna Commercial |
$15,178.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$9,232.85
|
| Rate for Payer: Health EOS Commercial |
$14,683.72
|
| Rate for Payer: HFN Commercial |
$15,178.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$12,373.92
|
| Rate for Payer: Multiplan Commercial |
$13,198.85
|
| Rate for Payer: NAPHCARE Commercial |
$9,899.14
|
| Rate for Payer: Preferred Network Access Commercial |
$15,178.68
|
| Rate for Payer: Quartz Beloit One Network |
$8,084.29
|
| Rate for Payer: Quartz Commercial |
$10,724.06
|
| Rate for Payer: Quartz Medicare Advantage |
$9,899.14
|
| Rate for Payer: The Alliance Commercial |
$8,249.28
|
| Rate for Payer: WEA Trust Commercial |
$9,074.21
|
| Rate for Payer: WPS Commercial |
$12,220.04
|
|
|
TRICUSPID RING 36MM TRI-AD #900SFC-36
|
Facility
|
IP
|
$15,864.00
|
|
| Hospital Charge Code |
2973918
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,084.29 |
| Max. Negotiated Rate |
$15,178.68 |
| Rate for Payer: Aetna Commercial |
$14,848.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$14,188.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$8,744.24
|
| Rate for Payer: Cash Price |
$4,759.20
|
| Rate for Payer: Cigna Commercial |
$15,178.68
|
| Rate for Payer: Health EOS Commercial |
$14,683.72
|
| Rate for Payer: HFN Commercial |
$15,178.68
|
| Rate for Payer: Multiplan Commercial |
$13,198.85
|
| Rate for Payer: Preferred Network Access Commercial |
$15,178.68
|
| Rate for Payer: Quartz Beloit One Network |
$8,084.29
|
| Rate for Payer: Quartz Commercial |
$9,899.14
|
| Rate for Payer: WEA Trust Commercial |
$9,074.21
|
| Rate for Payer: WPS Commercial |
$12,220.04
|
|
