|
NM Abscess Loc/Limited - Ceretec
|
Professional
|
Both
|
$2,121.00
|
|
|
Service Code
|
CPT 78800
|
| Hospital Charge Code |
2586799
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$229.60 |
| Max. Negotiated Rate |
$2,095.55 |
| Rate for Payer: Aetna Commercial |
$2,095.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,897.02
|
| Rate for Payer: Aetna Managed Medicare |
$229.60
|
| Rate for Payer: Anthem Medicare Advantage |
$229.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$229.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$229.60
|
| Rate for Payer: Cash Price |
$636.30
|
| Rate for Payer: Cash Price |
$636.30
|
| Rate for Payer: Cash Price |
$636.30
|
| Rate for Payer: Cigna Commercial |
$2,095.55
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,102.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$229.60
|
| Rate for Payer: Health EOS Commercial |
$2,007.31
|
| Rate for Payer: HFN Commercial |
$2,095.55
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$905.94
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$905.94
|
| Rate for Payer: Independent Care Health Plan Medicare |
$229.60
|
| Rate for Payer: Multiplan Commercial |
$1,764.67
|
| Rate for Payer: NAPHCARE Commercial |
$344.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,095.55
|
| Rate for Payer: Quartz Beloit One Network |
$970.57
|
| Rate for Payer: Quartz Commercial |
$1,257.33
|
| Rate for Payer: Quartz Medicare Advantage |
$229.60
|
| Rate for Payer: The Alliance Commercial |
$872.48
|
| Rate for Payer: United Healthcare Medicare Advantage |
$229.60
|
| Rate for Payer: WEA Trust Commercial |
$1,213.21
|
| Rate for Payer: WPS Commercial |
$1,148.00
|
|
|
NM Abscess Loc/Limited - Ceretec
|
Professional
|
Both
|
$1,965.00
|
|
|
Service Code
|
CPT 78800
|
| Hospital Charge Code |
675699
|
| Min. Negotiated Rate |
$229.60 |
| Max. Negotiated Rate |
$1,941.42 |
| Rate for Payer: Aetna Commercial |
$1,941.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,757.50
|
| Rate for Payer: Aetna Managed Medicare |
$229.60
|
| Rate for Payer: Anthem Medicare Advantage |
$229.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$229.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$229.60
|
| Rate for Payer: Cash Price |
$589.50
|
| Rate for Payer: Cash Price |
$589.50
|
| Rate for Payer: Cash Price |
$589.50
|
| Rate for Payer: Cigna Commercial |
$1,941.42
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,021.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$229.60
|
| Rate for Payer: Health EOS Commercial |
$1,859.68
|
| Rate for Payer: HFN Commercial |
$1,941.42
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$905.94
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$905.94
|
| Rate for Payer: Independent Care Health Plan Medicare |
$229.60
|
| Rate for Payer: Multiplan Commercial |
$1,634.88
|
| Rate for Payer: NAPHCARE Commercial |
$344.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,941.42
|
| Rate for Payer: Quartz Beloit One Network |
$899.18
|
| Rate for Payer: Quartz Commercial |
$1,164.85
|
| Rate for Payer: Quartz Medicare Advantage |
$229.60
|
| Rate for Payer: The Alliance Commercial |
$872.48
|
| Rate for Payer: United Healthcare Medicare Advantage |
$229.60
|
| Rate for Payer: WEA Trust Commercial |
$1,123.98
|
| Rate for Payer: WPS Commercial |
$1,148.00
|
|
|
NM Abscess Loc/Limited - Ceretec
|
Facility
|
OP
|
$1,965.00
|
|
|
Service Code
|
CPT 78800
|
| Hospital Charge Code |
675699
|
| Min. Negotiated Rate |
$420.71 |
| Max. Negotiated Rate |
$1,880.11 |
| Rate for Payer: Aetna Commercial |
$1,839.24
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,757.50
|
| Rate for Payer: Aetna Managed Medicare |
$420.71
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,328.34
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,021.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$980.93
|
| Rate for Payer: Anthem Medicare Advantage |
$420.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,083.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$420.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$420.71
|
| Rate for Payer: Cash Price |
$589.50
|
| Rate for Payer: Cash Price |
$589.50
|
| Rate for Payer: Cigna Commercial |
$1,880.11
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$420.71
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,143.63
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$420.71
|
| Rate for Payer: Health EOS Commercial |
$1,818.80
|
| Rate for Payer: HFN Commercial |
$1,880.11
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,565.05
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$420.71
|
| Rate for Payer: Independent Care Health Plan Medicare |
$420.71
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$420.71
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$420.71
|
| Rate for Payer: Multiplan Commercial |
$1,634.88
|
| Rate for Payer: NAPHCARE Commercial |
$631.07
|
| Rate for Payer: Preferred Network Access Commercial |
$1,880.11
|
| Rate for Payer: Quartz Beloit One Network |
$1,001.36
|
| Rate for Payer: Quartz Commercial |
$1,328.34
|
| Rate for Payer: Quartz Medicare Advantage |
$420.71
|
| Rate for Payer: The Alliance Commercial |
$1,682.84
|
| Rate for Payer: United Healthcare Medicare Advantage |
$420.71
|
| Rate for Payer: WEA Trust Commercial |
$1,123.98
|
| Rate for Payer: Wellcare Medicare |
$420.71
|
| Rate for Payer: WPS Commercial |
$1,513.64
|
|
|
NM Abscess Loc/Limited - Ceretec
|
Facility
|
OP
|
$2,121.00
|
|
|
Service Code
|
CPT 78800
|
| Hospital Charge Code |
2586799
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$420.71 |
| Max. Negotiated Rate |
$2,396.16 |
| Rate for Payer: Aetna Commercial |
$1,985.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,897.02
|
| Rate for Payer: Aetna Managed Medicare |
$420.71
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,589.87
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,271.90
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,208.30
|
| Rate for Payer: Anthem Medicare Advantage |
$420.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,169.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$420.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$420.71
|
| Rate for Payer: Cash Price |
$636.30
|
| Rate for Payer: Cash Price |
$636.30
|
| Rate for Payer: Cash Price |
$636.30
|
| Rate for Payer: Cigna Commercial |
$2,029.37
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$420.71
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,234.42
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$420.71
|
| Rate for Payer: Health EOS Commercial |
$1,963.20
|
| Rate for Payer: HFN Commercial |
$2,029.37
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,565.05
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$420.71
|
| Rate for Payer: Independent Care Health Plan Medicare |
$420.71
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$420.71
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$420.71
|
| Rate for Payer: Multiplan Commercial |
$1,764.67
|
| Rate for Payer: NAPHCARE Commercial |
$631.07
|
| Rate for Payer: Preferred Network Access Commercial |
$2,029.37
|
| Rate for Payer: Quartz Beloit One Network |
$1,080.86
|
| Rate for Payer: Quartz Commercial |
$1,433.80
|
| Rate for Payer: Quartz Medicare Advantage |
$420.71
|
| Rate for Payer: The Alliance Commercial |
$1,682.84
|
| Rate for Payer: United Healthcare Medicare Advantage |
$420.71
|
| Rate for Payer: United Healthcare PPO |
$2,396.16
|
| Rate for Payer: WEA Trust Commercial |
$1,213.21
|
| Rate for Payer: Wellcare Medicare |
$420.71
|
| Rate for Payer: WPS Commercial |
$1,633.81
|
|
|
NM Abscess Loc/Limited - Ceretec
|
Facility
|
IP
|
$2,121.00
|
|
|
Service Code
|
CPT 78800
|
| Hospital Charge Code |
2586799
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$1,080.86 |
| Max. Negotiated Rate |
$2,029.37 |
| Rate for Payer: Aetna Commercial |
$1,985.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,897.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,169.10
|
| Rate for Payer: Cash Price |
$636.30
|
| Rate for Payer: Cigna Commercial |
$2,029.37
|
| Rate for Payer: Health EOS Commercial |
$1,963.20
|
| Rate for Payer: HFN Commercial |
$2,029.37
|
| Rate for Payer: Multiplan Commercial |
$1,764.67
|
| Rate for Payer: Preferred Network Access Commercial |
$2,029.37
|
| Rate for Payer: Quartz Beloit One Network |
$1,080.86
|
| Rate for Payer: Quartz Commercial |
$1,323.50
|
| Rate for Payer: WEA Trust Commercial |
$1,213.21
|
| Rate for Payer: WPS Commercial |
$1,633.81
|
|
|
NM Abscess Loc/Limited - Ceretec
|
Facility
|
IP
|
$1,965.00
|
|
|
Service Code
|
CPT 78800
|
| Hospital Charge Code |
675699
|
| Min. Negotiated Rate |
$1,001.36 |
| Max. Negotiated Rate |
$1,880.11 |
| Rate for Payer: Aetna Commercial |
$1,839.24
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,757.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,083.11
|
| Rate for Payer: Cash Price |
$589.50
|
| Rate for Payer: Cigna Commercial |
$1,880.11
|
| Rate for Payer: Health EOS Commercial |
$1,818.80
|
| Rate for Payer: HFN Commercial |
$1,880.11
|
| Rate for Payer: Multiplan Commercial |
$1,634.88
|
| Rate for Payer: Preferred Network Access Commercial |
$1,880.11
|
| Rate for Payer: Quartz Beloit One Network |
$1,001.36
|
| Rate for Payer: Quartz Commercial |
$1,226.16
|
| Rate for Payer: WEA Trust Commercial |
$1,123.98
|
| Rate for Payer: WPS Commercial |
$1,513.64
|
|
|
NM Abscess Loc/Limited - Gallium
|
Professional
|
Both
|
$1,965.00
|
|
|
Service Code
|
CPT 78801
|
| Hospital Charge Code |
675697
|
| Min. Negotiated Rate |
$238.50 |
| Max. Negotiated Rate |
$1,941.42 |
| Rate for Payer: Aetna Commercial |
$1,941.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,757.50
|
| Rate for Payer: Aetna Managed Medicare |
$238.50
|
| Rate for Payer: Anthem Medicare Advantage |
$238.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$238.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$238.50
|
| Rate for Payer: Cash Price |
$589.50
|
| Rate for Payer: Cash Price |
$589.50
|
| Rate for Payer: Cash Price |
$589.50
|
| Rate for Payer: Cigna Commercial |
$1,941.42
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,021.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$238.50
|
| Rate for Payer: Health EOS Commercial |
$1,859.68
|
| Rate for Payer: HFN Commercial |
$1,941.42
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,000.73
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,000.73
|
| Rate for Payer: Independent Care Health Plan Medicare |
$238.50
|
| Rate for Payer: Multiplan Commercial |
$1,634.88
|
| Rate for Payer: NAPHCARE Commercial |
$357.75
|
| Rate for Payer: Preferred Network Access Commercial |
$1,941.42
|
| Rate for Payer: Quartz Beloit One Network |
$899.18
|
| Rate for Payer: Quartz Commercial |
$1,164.85
|
| Rate for Payer: Quartz Medicare Advantage |
$238.50
|
| Rate for Payer: The Alliance Commercial |
$906.31
|
| Rate for Payer: United Healthcare Medicare Advantage |
$238.50
|
| Rate for Payer: WEA Trust Commercial |
$1,123.98
|
| Rate for Payer: WPS Commercial |
$1,192.52
|
|
|
NM Abscess Loc/Limited - Gallium
|
Facility
|
OP
|
$2,044.00
|
|
|
Service Code
|
CPT 78801
|
| Hospital Charge Code |
2586801
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$420.71 |
| Max. Negotiated Rate |
$2,396.16 |
| Rate for Payer: Aetna Commercial |
$1,913.18
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,828.15
|
| Rate for Payer: Aetna Managed Medicare |
$420.71
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,589.87
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,271.90
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,208.30
|
| Rate for Payer: Anthem Medicare Advantage |
$420.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,126.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$420.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$420.71
|
| Rate for Payer: Cash Price |
$613.20
|
| Rate for Payer: Cash Price |
$613.20
|
| Rate for Payer: Cash Price |
$613.20
|
| Rate for Payer: Cigna Commercial |
$1,955.70
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$420.71
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,189.61
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$420.71
|
| Rate for Payer: Health EOS Commercial |
$1,891.93
|
| Rate for Payer: HFN Commercial |
$1,955.70
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,565.05
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$420.71
|
| Rate for Payer: Independent Care Health Plan Medicare |
$420.71
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$420.71
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$420.71
|
| Rate for Payer: Multiplan Commercial |
$1,700.61
|
| Rate for Payer: NAPHCARE Commercial |
$631.07
|
| Rate for Payer: Preferred Network Access Commercial |
$1,955.70
|
| Rate for Payer: Quartz Beloit One Network |
$1,041.62
|
| Rate for Payer: Quartz Commercial |
$1,381.74
|
| Rate for Payer: Quartz Medicare Advantage |
$420.71
|
| Rate for Payer: The Alliance Commercial |
$1,682.84
|
| Rate for Payer: United Healthcare Medicare Advantage |
$420.71
|
| Rate for Payer: United Healthcare PPO |
$2,396.16
|
| Rate for Payer: WEA Trust Commercial |
$1,169.17
|
| Rate for Payer: Wellcare Medicare |
$420.71
|
| Rate for Payer: WPS Commercial |
$1,574.49
|
|
|
NM Abscess Loc/Limited - Gallium
|
Facility
|
OP
|
$1,965.00
|
|
|
Service Code
|
CPT 78801
|
| Hospital Charge Code |
675697
|
| Min. Negotiated Rate |
$420.71 |
| Max. Negotiated Rate |
$1,880.11 |
| Rate for Payer: Aetna Commercial |
$1,839.24
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,757.50
|
| Rate for Payer: Aetna Managed Medicare |
$420.71
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,328.34
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,021.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$980.93
|
| Rate for Payer: Anthem Medicare Advantage |
$420.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,083.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$420.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$420.71
|
| Rate for Payer: Cash Price |
$589.50
|
| Rate for Payer: Cash Price |
$589.50
|
| Rate for Payer: Cigna Commercial |
$1,880.11
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$420.71
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,143.63
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$420.71
|
| Rate for Payer: Health EOS Commercial |
$1,818.80
|
| Rate for Payer: HFN Commercial |
$1,880.11
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,565.05
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$420.71
|
| Rate for Payer: Independent Care Health Plan Medicare |
$420.71
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$420.71
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$420.71
|
| Rate for Payer: Multiplan Commercial |
$1,634.88
|
| Rate for Payer: NAPHCARE Commercial |
$631.07
|
| Rate for Payer: Preferred Network Access Commercial |
$1,880.11
|
| Rate for Payer: Quartz Beloit One Network |
$1,001.36
|
| Rate for Payer: Quartz Commercial |
$1,328.34
|
| Rate for Payer: Quartz Medicare Advantage |
$420.71
|
| Rate for Payer: The Alliance Commercial |
$1,682.84
|
| Rate for Payer: United Healthcare Medicare Advantage |
$420.71
|
| Rate for Payer: WEA Trust Commercial |
$1,123.98
|
| Rate for Payer: Wellcare Medicare |
$420.71
|
| Rate for Payer: WPS Commercial |
$1,513.64
|
|
|
NM Abscess Loc/Limited - Gallium
|
Facility
|
IP
|
$2,044.00
|
|
|
Service Code
|
CPT 78801
|
| Hospital Charge Code |
2586801
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$1,041.62 |
| Max. Negotiated Rate |
$1,955.70 |
| Rate for Payer: Aetna Commercial |
$1,913.18
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,828.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,126.65
|
| Rate for Payer: Cash Price |
$613.20
|
| Rate for Payer: Cigna Commercial |
$1,955.70
|
| Rate for Payer: Health EOS Commercial |
$1,891.93
|
| Rate for Payer: HFN Commercial |
$1,955.70
|
| Rate for Payer: Multiplan Commercial |
$1,700.61
|
| Rate for Payer: Preferred Network Access Commercial |
$1,955.70
|
| Rate for Payer: Quartz Beloit One Network |
$1,041.62
|
| Rate for Payer: Quartz Commercial |
$1,275.46
|
| Rate for Payer: WEA Trust Commercial |
$1,169.17
|
| Rate for Payer: WPS Commercial |
$1,574.49
|
|
|
NM Abscess Loc/Limited - Gallium
|
Professional
|
Both
|
$2,044.00
|
|
|
Service Code
|
CPT 78801
|
| Hospital Charge Code |
2586801
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$238.50 |
| Max. Negotiated Rate |
$2,019.47 |
| Rate for Payer: Aetna Commercial |
$2,019.47
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,828.15
|
| Rate for Payer: Aetna Managed Medicare |
$238.50
|
| Rate for Payer: Anthem Medicare Advantage |
$238.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$238.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$238.50
|
| Rate for Payer: Cash Price |
$613.20
|
| Rate for Payer: Cash Price |
$613.20
|
| Rate for Payer: Cash Price |
$613.20
|
| Rate for Payer: Cigna Commercial |
$2,019.47
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,062.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$238.50
|
| Rate for Payer: Health EOS Commercial |
$1,934.44
|
| Rate for Payer: HFN Commercial |
$2,019.47
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,000.73
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,000.73
|
| Rate for Payer: Independent Care Health Plan Medicare |
$238.50
|
| Rate for Payer: Multiplan Commercial |
$1,700.61
|
| Rate for Payer: NAPHCARE Commercial |
$357.75
|
| Rate for Payer: Preferred Network Access Commercial |
$2,019.47
|
| Rate for Payer: Quartz Beloit One Network |
$935.33
|
| Rate for Payer: Quartz Commercial |
$1,211.68
|
| Rate for Payer: Quartz Medicare Advantage |
$238.50
|
| Rate for Payer: The Alliance Commercial |
$906.31
|
| Rate for Payer: United Healthcare Medicare Advantage |
$238.50
|
| Rate for Payer: WEA Trust Commercial |
$1,169.17
|
| Rate for Payer: WPS Commercial |
$1,192.52
|
|
|
NM Abscess Loc/Limited - Gallium
|
Facility
|
IP
|
$1,965.00
|
|
|
Service Code
|
CPT 78801
|
| Hospital Charge Code |
675697
|
| Min. Negotiated Rate |
$1,001.36 |
| Max. Negotiated Rate |
$1,880.11 |
| Rate for Payer: Aetna Commercial |
$1,839.24
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,757.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,083.11
|
| Rate for Payer: Cash Price |
$589.50
|
| Rate for Payer: Cigna Commercial |
$1,880.11
|
| Rate for Payer: Health EOS Commercial |
$1,818.80
|
| Rate for Payer: HFN Commercial |
$1,880.11
|
| Rate for Payer: Multiplan Commercial |
$1,634.88
|
| Rate for Payer: Preferred Network Access Commercial |
$1,880.11
|
| Rate for Payer: Quartz Beloit One Network |
$1,001.36
|
| Rate for Payer: Quartz Commercial |
$1,226.16
|
| Rate for Payer: WEA Trust Commercial |
$1,123.98
|
| Rate for Payer: WPS Commercial |
$1,513.64
|
|
|
NM Abscess Loc/Limited - Indium
|
Facility
|
OP
|
$2,121.00
|
|
|
Service Code
|
CPT 78801
|
| Hospital Charge Code |
2586803
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$420.71 |
| Max. Negotiated Rate |
$2,396.16 |
| Rate for Payer: Aetna Commercial |
$1,985.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,897.02
|
| Rate for Payer: Aetna Managed Medicare |
$420.71
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,589.87
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,271.90
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,208.30
|
| Rate for Payer: Anthem Medicare Advantage |
$420.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,169.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$420.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$420.71
|
| Rate for Payer: Cash Price |
$636.30
|
| Rate for Payer: Cash Price |
$636.30
|
| Rate for Payer: Cash Price |
$636.30
|
| Rate for Payer: Cigna Commercial |
$2,029.37
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$420.71
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,234.42
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$420.71
|
| Rate for Payer: Health EOS Commercial |
$1,963.20
|
| Rate for Payer: HFN Commercial |
$2,029.37
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,565.05
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$420.71
|
| Rate for Payer: Independent Care Health Plan Medicare |
$420.71
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$420.71
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$420.71
|
| Rate for Payer: Multiplan Commercial |
$1,764.67
|
| Rate for Payer: NAPHCARE Commercial |
$631.07
|
| Rate for Payer: Preferred Network Access Commercial |
$2,029.37
|
| Rate for Payer: Quartz Beloit One Network |
$1,080.86
|
| Rate for Payer: Quartz Commercial |
$1,433.80
|
| Rate for Payer: Quartz Medicare Advantage |
$420.71
|
| Rate for Payer: The Alliance Commercial |
$1,682.84
|
| Rate for Payer: United Healthcare Medicare Advantage |
$420.71
|
| Rate for Payer: United Healthcare PPO |
$2,396.16
|
| Rate for Payer: WEA Trust Commercial |
$1,213.21
|
| Rate for Payer: Wellcare Medicare |
$420.71
|
| Rate for Payer: WPS Commercial |
$1,633.81
|
|
|
NM Abscess Loc/Limited - Indium
|
Professional
|
Both
|
$2,121.00
|
|
|
Service Code
|
CPT 78801
|
| Hospital Charge Code |
2586803
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$238.50 |
| Max. Negotiated Rate |
$2,095.55 |
| Rate for Payer: Aetna Commercial |
$2,095.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,897.02
|
| Rate for Payer: Aetna Managed Medicare |
$238.50
|
| Rate for Payer: Anthem Medicare Advantage |
$238.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$238.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$238.50
|
| Rate for Payer: Cash Price |
$636.30
|
| Rate for Payer: Cash Price |
$636.30
|
| Rate for Payer: Cash Price |
$636.30
|
| Rate for Payer: Cigna Commercial |
$2,095.55
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,102.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$238.50
|
| Rate for Payer: Health EOS Commercial |
$2,007.31
|
| Rate for Payer: HFN Commercial |
$2,095.55
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,000.73
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,000.73
|
| Rate for Payer: Independent Care Health Plan Medicare |
$238.50
|
| Rate for Payer: Multiplan Commercial |
$1,764.67
|
| Rate for Payer: NAPHCARE Commercial |
$357.75
|
| Rate for Payer: Preferred Network Access Commercial |
$2,095.55
|
| Rate for Payer: Quartz Beloit One Network |
$970.57
|
| Rate for Payer: Quartz Commercial |
$1,257.33
|
| Rate for Payer: Quartz Medicare Advantage |
$238.50
|
| Rate for Payer: The Alliance Commercial |
$906.31
|
| Rate for Payer: United Healthcare Medicare Advantage |
$238.50
|
| Rate for Payer: WEA Trust Commercial |
$1,213.21
|
| Rate for Payer: WPS Commercial |
$1,192.52
|
|
|
NM Abscess Loc/Limited - Indium
|
Facility
|
IP
|
$1,965.00
|
|
|
Service Code
|
CPT 78801
|
| Hospital Charge Code |
675695
|
| Min. Negotiated Rate |
$1,001.36 |
| Max. Negotiated Rate |
$1,880.11 |
| Rate for Payer: Aetna Commercial |
$1,839.24
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,757.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,083.11
|
| Rate for Payer: Cash Price |
$589.50
|
| Rate for Payer: Cigna Commercial |
$1,880.11
|
| Rate for Payer: Health EOS Commercial |
$1,818.80
|
| Rate for Payer: HFN Commercial |
$1,880.11
|
| Rate for Payer: Multiplan Commercial |
$1,634.88
|
| Rate for Payer: Preferred Network Access Commercial |
$1,880.11
|
| Rate for Payer: Quartz Beloit One Network |
$1,001.36
|
| Rate for Payer: Quartz Commercial |
$1,226.16
|
| Rate for Payer: WEA Trust Commercial |
$1,123.98
|
| Rate for Payer: WPS Commercial |
$1,513.64
|
|
|
NM Abscess Loc/Limited - Indium
|
Facility
|
OP
|
$1,965.00
|
|
|
Service Code
|
CPT 78801
|
| Hospital Charge Code |
675695
|
| Min. Negotiated Rate |
$420.71 |
| Max. Negotiated Rate |
$1,880.11 |
| Rate for Payer: Aetna Commercial |
$1,839.24
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,757.50
|
| Rate for Payer: Aetna Managed Medicare |
$420.71
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,328.34
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,021.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$980.93
|
| Rate for Payer: Anthem Medicare Advantage |
$420.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,083.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$420.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$420.71
|
| Rate for Payer: Cash Price |
$589.50
|
| Rate for Payer: Cash Price |
$589.50
|
| Rate for Payer: Cigna Commercial |
$1,880.11
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$420.71
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,143.63
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$420.71
|
| Rate for Payer: Health EOS Commercial |
$1,818.80
|
| Rate for Payer: HFN Commercial |
$1,880.11
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,565.05
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$420.71
|
| Rate for Payer: Independent Care Health Plan Medicare |
$420.71
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$420.71
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$420.71
|
| Rate for Payer: Multiplan Commercial |
$1,634.88
|
| Rate for Payer: NAPHCARE Commercial |
$631.07
|
| Rate for Payer: Preferred Network Access Commercial |
$1,880.11
|
| Rate for Payer: Quartz Beloit One Network |
$1,001.36
|
| Rate for Payer: Quartz Commercial |
$1,328.34
|
| Rate for Payer: Quartz Medicare Advantage |
$420.71
|
| Rate for Payer: The Alliance Commercial |
$1,682.84
|
| Rate for Payer: United Healthcare Medicare Advantage |
$420.71
|
| Rate for Payer: WEA Trust Commercial |
$1,123.98
|
| Rate for Payer: Wellcare Medicare |
$420.71
|
| Rate for Payer: WPS Commercial |
$1,513.64
|
|
|
NM Abscess Loc/Limited - Indium
|
Professional
|
Both
|
$1,965.00
|
|
|
Service Code
|
CPT 78801
|
| Hospital Charge Code |
675695
|
| Min. Negotiated Rate |
$238.50 |
| Max. Negotiated Rate |
$1,941.42 |
| Rate for Payer: Aetna Commercial |
$1,941.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,757.50
|
| Rate for Payer: Aetna Managed Medicare |
$238.50
|
| Rate for Payer: Anthem Medicare Advantage |
$238.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$238.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$238.50
|
| Rate for Payer: Cash Price |
$589.50
|
| Rate for Payer: Cash Price |
$589.50
|
| Rate for Payer: Cash Price |
$589.50
|
| Rate for Payer: Cigna Commercial |
$1,941.42
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,021.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$238.50
|
| Rate for Payer: Health EOS Commercial |
$1,859.68
|
| Rate for Payer: HFN Commercial |
$1,941.42
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,000.73
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,000.73
|
| Rate for Payer: Independent Care Health Plan Medicare |
$238.50
|
| Rate for Payer: Multiplan Commercial |
$1,634.88
|
| Rate for Payer: NAPHCARE Commercial |
$357.75
|
| Rate for Payer: Preferred Network Access Commercial |
$1,941.42
|
| Rate for Payer: Quartz Beloit One Network |
$899.18
|
| Rate for Payer: Quartz Commercial |
$1,164.85
|
| Rate for Payer: Quartz Medicare Advantage |
$238.50
|
| Rate for Payer: The Alliance Commercial |
$906.31
|
| Rate for Payer: United Healthcare Medicare Advantage |
$238.50
|
| Rate for Payer: WEA Trust Commercial |
$1,123.98
|
| Rate for Payer: WPS Commercial |
$1,192.52
|
|
|
NM Abscess Loc/Limited - Indium
|
Facility
|
IP
|
$2,121.00
|
|
|
Service Code
|
CPT 78801
|
| Hospital Charge Code |
2586803
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$1,080.86 |
| Max. Negotiated Rate |
$2,029.37 |
| Rate for Payer: Aetna Commercial |
$1,985.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,897.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,169.10
|
| Rate for Payer: Cash Price |
$636.30
|
| Rate for Payer: Cigna Commercial |
$2,029.37
|
| Rate for Payer: Health EOS Commercial |
$1,963.20
|
| Rate for Payer: HFN Commercial |
$2,029.37
|
| Rate for Payer: Multiplan Commercial |
$1,764.67
|
| Rate for Payer: Preferred Network Access Commercial |
$2,029.37
|
| Rate for Payer: Quartz Beloit One Network |
$1,080.86
|
| Rate for Payer: Quartz Commercial |
$1,323.50
|
| Rate for Payer: WEA Trust Commercial |
$1,213.21
|
| Rate for Payer: WPS Commercial |
$1,633.81
|
|
|
NM Abscess Loc/Whole Body - Ceretec
|
Facility
|
OP
|
$4,294.00
|
|
|
Service Code
|
CPT 78802
|
| Hospital Charge Code |
2586805
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$571.42 |
| Max. Negotiated Rate |
$5,473.65 |
| Rate for Payer: Aetna Commercial |
$4,019.18
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,840.55
|
| Rate for Payer: Aetna Managed Medicare |
$571.42
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,473.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,378.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,159.97
|
| Rate for Payer: Anthem Medicare Advantage |
$571.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,366.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$571.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$571.42
|
| Rate for Payer: Cash Price |
$1,288.20
|
| Rate for Payer: Cash Price |
$1,288.20
|
| Rate for Payer: Cash Price |
$1,288.20
|
| Rate for Payer: Cigna Commercial |
$4,108.50
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$571.42
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,499.11
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$571.42
|
| Rate for Payer: Health EOS Commercial |
$3,974.53
|
| Rate for Payer: HFN Commercial |
$4,108.50
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,125.67
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$571.42
|
| Rate for Payer: Independent Care Health Plan Medicare |
$571.42
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$571.42
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$571.42
|
| Rate for Payer: Multiplan Commercial |
$3,572.61
|
| Rate for Payer: NAPHCARE Commercial |
$857.13
|
| Rate for Payer: Preferred Network Access Commercial |
$4,108.50
|
| Rate for Payer: Quartz Beloit One Network |
$2,188.22
|
| Rate for Payer: Quartz Commercial |
$2,902.74
|
| Rate for Payer: Quartz Medicare Advantage |
$571.42
|
| Rate for Payer: The Alliance Commercial |
$2,285.67
|
| Rate for Payer: United Healthcare Medicare Advantage |
$571.42
|
| Rate for Payer: United Healthcare PPO |
$2,396.16
|
| Rate for Payer: WEA Trust Commercial |
$2,456.17
|
| Rate for Payer: Wellcare Medicare |
$571.42
|
| Rate for Payer: WPS Commercial |
$3,307.67
|
|
|
NM Abscess Loc/Whole Body - Ceretec
|
Professional
|
Both
|
$4,294.00
|
|
|
Service Code
|
CPT 78802
|
| Hospital Charge Code |
2586805
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$268.55 |
| Max. Negotiated Rate |
$4,242.47 |
| Rate for Payer: Aetna Commercial |
$4,242.47
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,840.55
|
| Rate for Payer: Aetna Managed Medicare |
$268.55
|
| Rate for Payer: Anthem Medicare Advantage |
$268.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$268.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$268.55
|
| Rate for Payer: Cash Price |
$1,288.20
|
| Rate for Payer: Cash Price |
$1,288.20
|
| Rate for Payer: Cash Price |
$1,288.20
|
| Rate for Payer: Cigna Commercial |
$4,242.47
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,232.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$268.55
|
| Rate for Payer: Health EOS Commercial |
$4,063.84
|
| Rate for Payer: HFN Commercial |
$4,242.47
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,110.69
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,110.69
|
| Rate for Payer: Independent Care Health Plan Medicare |
$268.55
|
| Rate for Payer: Multiplan Commercial |
$3,572.61
|
| Rate for Payer: NAPHCARE Commercial |
$402.82
|
| Rate for Payer: Preferred Network Access Commercial |
$4,242.47
|
| Rate for Payer: Quartz Beloit One Network |
$1,964.93
|
| Rate for Payer: Quartz Commercial |
$2,545.48
|
| Rate for Payer: Quartz Medicare Advantage |
$268.55
|
| Rate for Payer: The Alliance Commercial |
$1,020.49
|
| Rate for Payer: United Healthcare Medicare Advantage |
$268.55
|
| Rate for Payer: WEA Trust Commercial |
$2,456.17
|
| Rate for Payer: WPS Commercial |
$1,342.74
|
|
|
NM Abscess Loc/Whole Body - Ceretec
|
Facility
|
IP
|
$4,294.00
|
|
|
Service Code
|
CPT 78802
|
| Hospital Charge Code |
2586805
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$2,188.22 |
| Max. Negotiated Rate |
$4,108.50 |
| Rate for Payer: Aetna Commercial |
$4,019.18
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,840.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,366.85
|
| Rate for Payer: Cash Price |
$1,288.20
|
| Rate for Payer: Cigna Commercial |
$4,108.50
|
| Rate for Payer: Health EOS Commercial |
$3,974.53
|
| Rate for Payer: HFN Commercial |
$4,108.50
|
| Rate for Payer: Multiplan Commercial |
$3,572.61
|
| Rate for Payer: Preferred Network Access Commercial |
$4,108.50
|
| Rate for Payer: Quartz Beloit One Network |
$2,188.22
|
| Rate for Payer: Quartz Commercial |
$2,679.46
|
| Rate for Payer: WEA Trust Commercial |
$2,456.17
|
| Rate for Payer: WPS Commercial |
$3,307.67
|
|
|
NM Abscess Loc/Whole Body - Ceretec
|
Professional
|
Both
|
$3,369.00
|
|
| Hospital Charge Code |
675693
|
| Min. Negotiated Rate |
$1,541.65 |
| Max. Negotiated Rate |
$3,328.57 |
| Rate for Payer: Aetna Commercial |
$3,328.57
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,013.23
|
| Rate for Payer: Cash Price |
$1,010.70
|
| Rate for Payer: Cigna Commercial |
$3,328.57
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,751.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,102.26
|
| Rate for Payer: Health EOS Commercial |
$3,188.42
|
| Rate for Payer: HFN Commercial |
$3,328.57
|
| Rate for Payer: Multiplan Commercial |
$2,803.01
|
| Rate for Payer: Preferred Network Access Commercial |
$3,328.57
|
| Rate for Payer: Quartz Beloit One Network |
$1,541.65
|
| Rate for Payer: Quartz Commercial |
$1,997.14
|
| Rate for Payer: The Alliance Commercial |
$1,751.88
|
| Rate for Payer: WEA Trust Commercial |
$1,927.07
|
| Rate for Payer: WPS Commercial |
$2,595.14
|
|
|
NM Abscess Loc/Whole Body - Ceretec
|
Facility
|
OP
|
$3,369.00
|
|
| Hospital Charge Code |
675693
|
| Min. Negotiated Rate |
$981.05 |
| Max. Negotiated Rate |
$3,223.46 |
| Rate for Payer: Aetna Commercial |
$3,153.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,013.23
|
| Rate for Payer: Aetna Managed Medicare |
$981.05
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,277.44
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,751.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,681.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,856.99
|
| Rate for Payer: Cash Price |
$1,010.70
|
| Rate for Payer: Cigna Commercial |
$3,223.46
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,960.76
|
| Rate for Payer: Health EOS Commercial |
$3,118.35
|
| Rate for Payer: HFN Commercial |
$3,223.46
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,627.82
|
| Rate for Payer: Multiplan Commercial |
$2,803.01
|
| Rate for Payer: NAPHCARE Commercial |
$2,102.26
|
| Rate for Payer: Preferred Network Access Commercial |
$3,223.46
|
| Rate for Payer: Quartz Beloit One Network |
$1,716.84
|
| Rate for Payer: Quartz Commercial |
$2,277.44
|
| Rate for Payer: Quartz Medicare Advantage |
$2,102.26
|
| Rate for Payer: The Alliance Commercial |
$1,751.88
|
| Rate for Payer: WEA Trust Commercial |
$1,927.07
|
| Rate for Payer: WPS Commercial |
$2,595.14
|
|
|
NM Abscess Loc/Whole Body - Ceretec
|
Facility
|
IP
|
$3,369.00
|
|
| Hospital Charge Code |
675693
|
| Min. Negotiated Rate |
$1,716.84 |
| Max. Negotiated Rate |
$3,223.46 |
| Rate for Payer: Aetna Commercial |
$3,153.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,013.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,856.99
|
| Rate for Payer: Cash Price |
$1,010.70
|
| Rate for Payer: Cigna Commercial |
$3,223.46
|
| Rate for Payer: Health EOS Commercial |
$3,118.35
|
| Rate for Payer: HFN Commercial |
$3,223.46
|
| Rate for Payer: Multiplan Commercial |
$2,803.01
|
| Rate for Payer: Preferred Network Access Commercial |
$3,223.46
|
| Rate for Payer: Quartz Beloit One Network |
$1,716.84
|
| Rate for Payer: Quartz Commercial |
$2,102.26
|
| Rate for Payer: WEA Trust Commercial |
$1,927.07
|
| Rate for Payer: WPS Commercial |
$2,595.14
|
|
|
NM Abscess Loc/Whole Body - Gallium
|
Facility
|
IP
|
$3,504.00
|
|
|
Service Code
|
CPT 78804
|
| Hospital Charge Code |
2586807
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$1,785.64 |
| Max. Negotiated Rate |
$3,352.63 |
| Rate for Payer: Aetna Commercial |
$3,279.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,133.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,931.40
|
| Rate for Payer: Cash Price |
$1,051.20
|
| Rate for Payer: Cigna Commercial |
$3,352.63
|
| Rate for Payer: Health EOS Commercial |
$3,243.30
|
| Rate for Payer: HFN Commercial |
$3,352.63
|
| Rate for Payer: Multiplan Commercial |
$2,915.33
|
| Rate for Payer: Preferred Network Access Commercial |
$3,352.63
|
| Rate for Payer: Quartz Beloit One Network |
$1,785.64
|
| Rate for Payer: Quartz Commercial |
$2,186.50
|
| Rate for Payer: WEA Trust Commercial |
$2,004.29
|
| Rate for Payer: WPS Commercial |
$2,699.13
|
|
