|
NIPPLE RECONSTRUCTION/INVERTED, CORRECTION
|
Facility
|
OP
|
$1,006.00
|
|
| Hospital Charge Code |
2960251
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$292.95 |
| Max. Negotiated Rate |
$962.54 |
| Rate for Payer: Aetna Commercial |
$941.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$899.77
|
| Rate for Payer: Aetna Managed Medicare |
$292.95
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$680.06
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$523.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$502.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$554.51
|
| Rate for Payer: Cash Price |
$301.80
|
| Rate for Payer: Cigna Commercial |
$962.54
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$585.49
|
| Rate for Payer: Health EOS Commercial |
$931.15
|
| Rate for Payer: HFN Commercial |
$962.54
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$784.68
|
| Rate for Payer: Multiplan Commercial |
$836.99
|
| Rate for Payer: NAPHCARE Commercial |
$627.74
|
| Rate for Payer: Preferred Network Access Commercial |
$962.54
|
| Rate for Payer: Quartz Beloit One Network |
$512.66
|
| Rate for Payer: Quartz Commercial |
$680.06
|
| Rate for Payer: Quartz Medicare Advantage |
$627.74
|
| Rate for Payer: The Alliance Commercial |
$523.12
|
| Rate for Payer: WEA Trust Commercial |
$575.43
|
| Rate for Payer: WPS Commercial |
$774.92
|
|
|
NITROGLYCERIN 2% TOPICAL OINTMENT UD (MED)
|
Facility
|
OP
|
$6.00
|
|
| Hospital Charge Code |
6175011
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$1.75 |
| Max. Negotiated Rate |
$5.74 |
| Rate for Payer: Aetna Commercial |
$5.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5.37
|
| Rate for Payer: Aetna Managed Medicare |
$1.75
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4.06
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3.31
|
| Rate for Payer: Cash Price |
$1.80
|
| Rate for Payer: Cigna Commercial |
$5.74
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3.49
|
| Rate for Payer: Health EOS Commercial |
$5.55
|
| Rate for Payer: HFN Commercial |
$5.74
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4.68
|
| Rate for Payer: Multiplan Commercial |
$4.99
|
| Rate for Payer: NAPHCARE Commercial |
$3.74
|
| Rate for Payer: Preferred Network Access Commercial |
$5.74
|
| Rate for Payer: Quartz Beloit One Network |
$3.06
|
| Rate for Payer: Quartz Commercial |
$4.06
|
| Rate for Payer: Quartz Medicare Advantage |
$3.74
|
| Rate for Payer: The Alliance Commercial |
$3.12
|
| Rate for Payer: WEA Trust Commercial |
$3.43
|
| Rate for Payer: WPS Commercial |
$4.62
|
|
|
NITROGLYCERIN 2% TOPICAL OINTMENT UD (MED)
|
Facility
|
IP
|
$6.00
|
|
| Hospital Charge Code |
6175011
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$3.06 |
| Max. Negotiated Rate |
$5.74 |
| Rate for Payer: Aetna Commercial |
$5.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3.31
|
| Rate for Payer: Cash Price |
$1.80
|
| Rate for Payer: Cigna Commercial |
$5.74
|
| Rate for Payer: Health EOS Commercial |
$5.55
|
| Rate for Payer: HFN Commercial |
$5.74
|
| Rate for Payer: Multiplan Commercial |
$4.99
|
| Rate for Payer: Preferred Network Access Commercial |
$5.74
|
| Rate for Payer: Quartz Beloit One Network |
$3.06
|
| Rate for Payer: Quartz Commercial |
$3.74
|
| Rate for Payer: WEA Trust Commercial |
$3.43
|
| Rate for Payer: WPS Commercial |
$4.62
|
|
|
Njx aa&/strd axillary nrv 64417
|
Professional
|
Both
|
$676.00
|
|
|
Service Code
|
CPT 64417
|
| Hospital Charge Code |
6178527
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$46.99 |
| Max. Negotiated Rate |
$667.89 |
| Rate for Payer: Aetna Commercial |
$667.89
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$604.61
|
| Rate for Payer: Aetna Managed Medicare |
$60.16
|
| Rate for Payer: Anthem Medicare Advantage |
$60.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$60.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$60.16
|
| Rate for Payer: Cash Price |
$202.80
|
| Rate for Payer: Cash Price |
$202.80
|
| Rate for Payer: Cash Price |
$202.80
|
| Rate for Payer: Cigna Commercial |
$667.89
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$46.99
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$60.16
|
| Rate for Payer: Health EOS Commercial |
$639.77
|
| Rate for Payer: HFN Commercial |
$667.89
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$213.92
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$213.92
|
| Rate for Payer: Independent Care Health Plan Medicare |
$60.16
|
| Rate for Payer: Multiplan Commercial |
$562.43
|
| Rate for Payer: NAPHCARE Commercial |
$90.25
|
| Rate for Payer: Preferred Network Access Commercial |
$667.89
|
| Rate for Payer: Quartz Beloit One Network |
$309.34
|
| Rate for Payer: Quartz Commercial |
$400.73
|
| Rate for Payer: Quartz Medicare Advantage |
$60.16
|
| Rate for Payer: The Alliance Commercial |
$255.70
|
| Rate for Payer: United Healthcare Medicaid |
$46.99
|
| Rate for Payer: United Healthcare Medicare Advantage |
$60.16
|
| Rate for Payer: WEA Trust Commercial |
$386.67
|
| Rate for Payer: WPS Commercial |
$270.74
|
|
|
Njx aa&/strd brach plex nfs 64416
|
Professional
|
Both
|
$1,643.00
|
|
|
Service Code
|
CPT 64416
|
| Hospital Charge Code |
6178528
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$71.40 |
| Max. Negotiated Rate |
$1,623.28 |
| Rate for Payer: Aetna Commercial |
$1,623.28
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,469.50
|
| Rate for Payer: Aetna Managed Medicare |
$71.40
|
| Rate for Payer: Anthem Medicare Advantage |
$71.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$71.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$71.40
|
| Rate for Payer: Cash Price |
$492.90
|
| Rate for Payer: Cash Price |
$492.90
|
| Rate for Payer: Cash Price |
$492.90
|
| Rate for Payer: Cigna Commercial |
$1,623.28
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$85.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$71.40
|
| Rate for Payer: Health EOS Commercial |
$1,554.94
|
| Rate for Payer: HFN Commercial |
$1,623.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$227.10
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$227.10
|
| Rate for Payer: Independent Care Health Plan Medicare |
$71.40
|
| Rate for Payer: Multiplan Commercial |
$1,366.98
|
| Rate for Payer: NAPHCARE Commercial |
$107.09
|
| Rate for Payer: Preferred Network Access Commercial |
$1,623.28
|
| Rate for Payer: Quartz Beloit One Network |
$751.84
|
| Rate for Payer: Quartz Commercial |
$973.97
|
| Rate for Payer: Quartz Medicare Advantage |
$71.40
|
| Rate for Payer: The Alliance Commercial |
$303.43
|
| Rate for Payer: United Healthcare Medicaid |
$85.08
|
| Rate for Payer: United Healthcare Medicare Advantage |
$71.40
|
| Rate for Payer: WEA Trust Commercial |
$939.80
|
| Rate for Payer: WPS Commercial |
$321.28
|
|
|
Njx aa&/strd tfrm epi c/t ea 64480
|
Professional
|
Both
|
$624.00
|
|
|
Service Code
|
CPT 64480
|
| Hospital Charge Code |
6178529
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$52.14 |
| Max. Negotiated Rate |
$616.51 |
| Rate for Payer: Aetna Commercial |
$616.51
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$558.11
|
| Rate for Payer: Aetna Managed Medicare |
$52.14
|
| Rate for Payer: Anthem Medicare Advantage |
$52.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$52.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$52.14
|
| Rate for Payer: Cash Price |
$187.20
|
| Rate for Payer: Cash Price |
$187.20
|
| Rate for Payer: Cash Price |
$187.20
|
| Rate for Payer: Cigna Commercial |
$616.51
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$204.35
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$52.14
|
| Rate for Payer: Health EOS Commercial |
$590.55
|
| Rate for Payer: HFN Commercial |
$616.51
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$217.78
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$217.78
|
| Rate for Payer: Independent Care Health Plan Medicare |
$52.14
|
| Rate for Payer: Multiplan Commercial |
$519.17
|
| Rate for Payer: NAPHCARE Commercial |
$78.20
|
| Rate for Payer: Preferred Network Access Commercial |
$616.51
|
| Rate for Payer: Quartz Beloit One Network |
$285.54
|
| Rate for Payer: Quartz Commercial |
$369.91
|
| Rate for Payer: Quartz Medicare Advantage |
$52.14
|
| Rate for Payer: The Alliance Commercial |
$221.57
|
| Rate for Payer: United Healthcare Medicaid |
$204.35
|
| Rate for Payer: United Healthcare Medicare Advantage |
$52.14
|
| Rate for Payer: WEA Trust Commercial |
$356.93
|
| Rate for Payer: WPS Commercial |
$234.61
|
|
|
NJX Ans&/Steroid Plantar Common Digital Nerve 64455
|
Professional
|
Both
|
$113.00
|
|
|
Service Code
|
CPT 64455
|
| Hospital Charge Code |
4163758
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$29.43 |
| Max. Negotiated Rate |
$132.44 |
| Rate for Payer: Aetna Commercial |
$111.64
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$101.07
|
| Rate for Payer: Aetna Managed Medicare |
$29.43
|
| Rate for Payer: Anthem Medicare Advantage |
$29.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$29.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$29.43
|
| Rate for Payer: Cash Price |
$33.90
|
| Rate for Payer: Cash Price |
$33.90
|
| Rate for Payer: Cash Price |
$33.90
|
| Rate for Payer: Cigna Commercial |
$111.64
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$47.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$29.43
|
| Rate for Payer: Health EOS Commercial |
$106.94
|
| Rate for Payer: HFN Commercial |
$111.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$119.68
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$119.68
|
| Rate for Payer: Independent Care Health Plan Medicare |
$29.43
|
| Rate for Payer: Multiplan Commercial |
$94.02
|
| Rate for Payer: NAPHCARE Commercial |
$44.15
|
| Rate for Payer: Preferred Network Access Commercial |
$111.64
|
| Rate for Payer: Quartz Beloit One Network |
$51.71
|
| Rate for Payer: Quartz Commercial |
$66.99
|
| Rate for Payer: Quartz Medicare Advantage |
$29.43
|
| Rate for Payer: The Alliance Commercial |
$125.09
|
| Rate for Payer: United Healthcare Medicaid |
$47.48
|
| Rate for Payer: United Healthcare Medicare Advantage |
$29.43
|
| Rate for Payer: WEA Trust Commercial |
$64.64
|
| Rate for Payer: WPS Commercial |
$132.44
|
|
|
Njx px discography lumbar 62290
|
Professional
|
Both
|
$1,960.00
|
|
|
Service Code
|
CPT 62290
|
| Hospital Charge Code |
6178532
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$140.50 |
| Max. Negotiated Rate |
$1,936.48 |
| Rate for Payer: Aetna Commercial |
$1,936.48
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,753.02
|
| Rate for Payer: Aetna Managed Medicare |
$140.50
|
| Rate for Payer: Anthem Medicare Advantage |
$140.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$140.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$140.50
|
| Rate for Payer: Cash Price |
$588.00
|
| Rate for Payer: Cash Price |
$588.00
|
| Rate for Payer: Cash Price |
$588.00
|
| Rate for Payer: Cigna Commercial |
$1,936.48
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$186.75
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$140.50
|
| Rate for Payer: Health EOS Commercial |
$1,854.94
|
| Rate for Payer: HFN Commercial |
$1,936.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$576.74
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$576.74
|
| Rate for Payer: Independent Care Health Plan Medicare |
$140.50
|
| Rate for Payer: Multiplan Commercial |
$1,630.72
|
| Rate for Payer: NAPHCARE Commercial |
$210.76
|
| Rate for Payer: Preferred Network Access Commercial |
$1,936.48
|
| Rate for Payer: Quartz Beloit One Network |
$896.90
|
| Rate for Payer: Quartz Commercial |
$1,161.89
|
| Rate for Payer: Quartz Medicare Advantage |
$140.50
|
| Rate for Payer: The Alliance Commercial |
$597.14
|
| Rate for Payer: United Healthcare Medicaid |
$186.75
|
| Rate for Payer: United Healthcare Medicare Advantage |
$140.50
|
| Rate for Payer: WEA Trust Commercial |
$1,121.12
|
| Rate for Payer: WPS Commercial |
$632.27
|
|
|
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
|
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: Dean Health DHI/DHP/ASO |
$1,234.42
|
| 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 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
|
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
|
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 - 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 - 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
|
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
|
$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
|
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
|
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 - 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 - 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
|
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/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
|
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
|
|
