|
Pancreatic Polypeptide
|
Professional
|
Both
|
$372.00
|
|
|
Service Code
|
CPT 83519
|
| Hospital Charge Code |
978032
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$64.95 |
| Max. Negotiated Rate |
$353.40 |
| Rate for Payer: Aetna Commercial |
$353.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$319.92
|
| Rate for Payer: Cash Price |
$111.60
|
| Rate for Payer: Cash Price |
$111.60
|
| Rate for Payer: Cigna Commercial |
$353.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$186.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$223.20
|
| Rate for Payer: Health EOS Commercial |
$338.52
|
| Rate for Payer: HFN Commercial |
$353.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$64.95
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$64.95
|
| Rate for Payer: Multiplan Commercial |
$297.60
|
| Rate for Payer: Preferred Network Access Commercial |
$353.40
|
| Rate for Payer: Quartz Beloit One Network |
$163.68
|
| Rate for Payer: Quartz Commercial |
$212.04
|
| Rate for Payer: The Alliance Commercial |
$186.00
|
| Rate for Payer: WEA Trust Commercial |
$204.60
|
| Rate for Payer: WPS Commercial |
$275.54
|
|
|
Panel *1 - ID Bill
|
Facility
|
OP
|
$357.00
|
|
|
Service Code
|
CPT 86870
|
| Hospital Charge Code |
2952711
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$174.93 |
| Max. Negotiated Rate |
$1,421.12 |
| Rate for Payer: Aetna Commercial |
$321.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$307.02
|
| Rate for Payer: Aetna Managed Medicare |
$355.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,332.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$621.74
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$589.76
|
| Rate for Payer: Anthem Medicare Advantage |
$355.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$189.21
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$355.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$355.28
|
| Rate for Payer: Cash Price |
$107.10
|
| Rate for Payer: Cash Price |
$107.10
|
| Rate for Payer: Cigna Commercial |
$328.44
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$355.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$199.78
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$355.28
|
| Rate for Payer: Health EOS Commercial |
$317.73
|
| Rate for Payer: HFN Commercial |
$328.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,321.64
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$355.28
|
| Rate for Payer: Independent Care Health Plan Medicare |
$355.28
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$355.28
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$355.28
|
| Rate for Payer: Multiplan Commercial |
$285.60
|
| Rate for Payer: NAPHCARE Commercial |
$532.92
|
| Rate for Payer: Preferred Network Access Commercial |
$328.44
|
| Rate for Payer: Quartz Beloit One Network |
$174.93
|
| Rate for Payer: Quartz Commercial |
$232.05
|
| Rate for Payer: Quartz Medicare Advantage |
$355.28
|
| Rate for Payer: The Alliance Commercial |
$1,421.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$355.28
|
| Rate for Payer: United Healthcare PPO |
$267.75
|
| Rate for Payer: WEA Trust Commercial |
$196.35
|
| Rate for Payer: Wellcare Medicare |
$355.28
|
| Rate for Payer: WPS Commercial |
$264.43
|
|
|
Panel *1 - ID Bill
|
Facility
|
IP
|
$357.00
|
|
|
Service Code
|
CPT 86870
|
| Hospital Charge Code |
2952711
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$174.93 |
| Max. Negotiated Rate |
$328.44 |
| Rate for Payer: Aetna Commercial |
$321.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$307.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$189.21
|
| Rate for Payer: Cash Price |
$107.10
|
| Rate for Payer: Cigna Commercial |
$328.44
|
| Rate for Payer: Health EOS Commercial |
$317.73
|
| Rate for Payer: HFN Commercial |
$328.44
|
| Rate for Payer: Multiplan Commercial |
$285.60
|
| Rate for Payer: NAPHCARE Commercial |
$214.20
|
| Rate for Payer: Preferred Network Access Commercial |
$328.44
|
| Rate for Payer: Quartz Beloit One Network |
$174.93
|
| Rate for Payer: Quartz Commercial |
$214.20
|
| Rate for Payer: WEA Trust Commercial |
$196.35
|
| Rate for Payer: WPS Commercial |
$264.43
|
|
|
Panel *2 - ID Bill
|
Facility
|
IP
|
$357.00
|
|
|
Service Code
|
CPT 86870
|
| Hospital Charge Code |
2952710
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$174.93 |
| Max. Negotiated Rate |
$328.44 |
| Rate for Payer: Aetna Commercial |
$321.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$307.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$189.21
|
| Rate for Payer: Cash Price |
$107.10
|
| Rate for Payer: Cigna Commercial |
$328.44
|
| Rate for Payer: Health EOS Commercial |
$317.73
|
| Rate for Payer: HFN Commercial |
$328.44
|
| Rate for Payer: Multiplan Commercial |
$285.60
|
| Rate for Payer: NAPHCARE Commercial |
$214.20
|
| Rate for Payer: Preferred Network Access Commercial |
$328.44
|
| Rate for Payer: Quartz Beloit One Network |
$174.93
|
| Rate for Payer: Quartz Commercial |
$214.20
|
| Rate for Payer: WEA Trust Commercial |
$196.35
|
| Rate for Payer: WPS Commercial |
$264.43
|
|
|
Panel *2 - ID Bill
|
Facility
|
OP
|
$357.00
|
|
|
Service Code
|
CPT 86870
|
| Hospital Charge Code |
2952710
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$174.93 |
| Max. Negotiated Rate |
$1,421.12 |
| Rate for Payer: Aetna Commercial |
$321.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$307.02
|
| Rate for Payer: Aetna Managed Medicare |
$355.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,332.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$621.74
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$589.76
|
| Rate for Payer: Anthem Medicare Advantage |
$355.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$189.21
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$355.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$355.28
|
| Rate for Payer: Cash Price |
$107.10
|
| Rate for Payer: Cash Price |
$107.10
|
| Rate for Payer: Cigna Commercial |
$328.44
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$355.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$199.78
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$355.28
|
| Rate for Payer: Health EOS Commercial |
$317.73
|
| Rate for Payer: HFN Commercial |
$328.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,321.64
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$355.28
|
| Rate for Payer: Independent Care Health Plan Medicare |
$355.28
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$355.28
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$355.28
|
| Rate for Payer: Multiplan Commercial |
$285.60
|
| Rate for Payer: NAPHCARE Commercial |
$532.92
|
| Rate for Payer: Preferred Network Access Commercial |
$328.44
|
| Rate for Payer: Quartz Beloit One Network |
$174.93
|
| Rate for Payer: Quartz Commercial |
$232.05
|
| Rate for Payer: Quartz Medicare Advantage |
$355.28
|
| Rate for Payer: The Alliance Commercial |
$1,421.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$355.28
|
| Rate for Payer: United Healthcare PPO |
$267.75
|
| Rate for Payer: WEA Trust Commercial |
$196.35
|
| Rate for Payer: Wellcare Medicare |
$355.28
|
| Rate for Payer: WPS Commercial |
$264.43
|
|
|
Panel *3 - ID Bill
|
Facility
|
OP
|
$357.00
|
|
|
Service Code
|
CPT 86870
|
| Hospital Charge Code |
2952709
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$174.93 |
| Max. Negotiated Rate |
$1,421.12 |
| Rate for Payer: Aetna Commercial |
$321.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$307.02
|
| Rate for Payer: Aetna Managed Medicare |
$355.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,332.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$621.74
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$589.76
|
| Rate for Payer: Anthem Medicare Advantage |
$355.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$189.21
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$355.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$355.28
|
| Rate for Payer: Cash Price |
$107.10
|
| Rate for Payer: Cash Price |
$107.10
|
| Rate for Payer: Cigna Commercial |
$328.44
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$355.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$199.78
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$355.28
|
| Rate for Payer: Health EOS Commercial |
$317.73
|
| Rate for Payer: HFN Commercial |
$328.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,321.64
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$355.28
|
| Rate for Payer: Independent Care Health Plan Medicare |
$355.28
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$355.28
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$355.28
|
| Rate for Payer: Multiplan Commercial |
$285.60
|
| Rate for Payer: NAPHCARE Commercial |
$532.92
|
| Rate for Payer: Preferred Network Access Commercial |
$328.44
|
| Rate for Payer: Quartz Beloit One Network |
$174.93
|
| Rate for Payer: Quartz Commercial |
$232.05
|
| Rate for Payer: Quartz Medicare Advantage |
$355.28
|
| Rate for Payer: The Alliance Commercial |
$1,421.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$355.28
|
| Rate for Payer: United Healthcare PPO |
$267.75
|
| Rate for Payer: WEA Trust Commercial |
$196.35
|
| Rate for Payer: Wellcare Medicare |
$355.28
|
| Rate for Payer: WPS Commercial |
$264.43
|
|
|
Panel *3 - ID Bill
|
Facility
|
IP
|
$357.00
|
|
|
Service Code
|
CPT 86870
|
| Hospital Charge Code |
2952709
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$174.93 |
| Max. Negotiated Rate |
$328.44 |
| Rate for Payer: Aetna Commercial |
$321.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$307.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$189.21
|
| Rate for Payer: Cash Price |
$107.10
|
| Rate for Payer: Cigna Commercial |
$328.44
|
| Rate for Payer: Health EOS Commercial |
$317.73
|
| Rate for Payer: HFN Commercial |
$328.44
|
| Rate for Payer: Multiplan Commercial |
$285.60
|
| Rate for Payer: NAPHCARE Commercial |
$214.20
|
| Rate for Payer: Preferred Network Access Commercial |
$328.44
|
| Rate for Payer: Quartz Beloit One Network |
$174.93
|
| Rate for Payer: Quartz Commercial |
$214.20
|
| Rate for Payer: WEA Trust Commercial |
$196.35
|
| Rate for Payer: WPS Commercial |
$264.43
|
|
|
Panel *4 - ID Bill
|
Facility
|
IP
|
$357.00
|
|
|
Service Code
|
CPT 86870
|
| Hospital Charge Code |
2952708
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$174.93 |
| Max. Negotiated Rate |
$328.44 |
| Rate for Payer: Aetna Commercial |
$321.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$307.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$189.21
|
| Rate for Payer: Cash Price |
$107.10
|
| Rate for Payer: Cigna Commercial |
$328.44
|
| Rate for Payer: Health EOS Commercial |
$317.73
|
| Rate for Payer: HFN Commercial |
$328.44
|
| Rate for Payer: Multiplan Commercial |
$285.60
|
| Rate for Payer: NAPHCARE Commercial |
$214.20
|
| Rate for Payer: Preferred Network Access Commercial |
$328.44
|
| Rate for Payer: Quartz Beloit One Network |
$174.93
|
| Rate for Payer: Quartz Commercial |
$214.20
|
| Rate for Payer: WEA Trust Commercial |
$196.35
|
| Rate for Payer: WPS Commercial |
$264.43
|
|
|
Panel *4 - ID Bill
|
Facility
|
OP
|
$357.00
|
|
|
Service Code
|
CPT 86870
|
| Hospital Charge Code |
2952708
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$174.93 |
| Max. Negotiated Rate |
$1,421.12 |
| Rate for Payer: Aetna Commercial |
$321.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$307.02
|
| Rate for Payer: Aetna Managed Medicare |
$355.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,332.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$621.74
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$589.76
|
| Rate for Payer: Anthem Medicare Advantage |
$355.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$189.21
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$355.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$355.28
|
| Rate for Payer: Cash Price |
$107.10
|
| Rate for Payer: Cash Price |
$107.10
|
| Rate for Payer: Cigna Commercial |
$328.44
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$355.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$199.78
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$355.28
|
| Rate for Payer: Health EOS Commercial |
$317.73
|
| Rate for Payer: HFN Commercial |
$328.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,321.64
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$355.28
|
| Rate for Payer: Independent Care Health Plan Medicare |
$355.28
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$355.28
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$355.28
|
| Rate for Payer: Multiplan Commercial |
$285.60
|
| Rate for Payer: NAPHCARE Commercial |
$532.92
|
| Rate for Payer: Preferred Network Access Commercial |
$328.44
|
| Rate for Payer: Quartz Beloit One Network |
$174.93
|
| Rate for Payer: Quartz Commercial |
$232.05
|
| Rate for Payer: Quartz Medicare Advantage |
$355.28
|
| Rate for Payer: The Alliance Commercial |
$1,421.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$355.28
|
| Rate for Payer: United Healthcare PPO |
$267.75
|
| Rate for Payer: WEA Trust Commercial |
$196.35
|
| Rate for Payer: Wellcare Medicare |
$355.28
|
| Rate for Payer: WPS Commercial |
$264.43
|
|
|
Papaverine 30mg/1ml 2ml SDV [Med]
|
Facility
|
OP
|
$172.00
|
|
|
Service Code
|
HCPCS J2440
|
| Hospital Charge Code |
2974968
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$48.16 |
| Max. Negotiated Rate |
$688.00 |
| Rate for Payer: Aetna Commercial |
$154.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$147.92
|
| Rate for Payer: Aetna Managed Medicare |
$48.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$111.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$86.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$82.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$91.16
|
| Rate for Payer: Cash Price |
$51.60
|
| Rate for Payer: Cigna Commercial |
$158.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$96.25
|
| Rate for Payer: Health EOS Commercial |
$153.08
|
| Rate for Payer: HFN Commercial |
$158.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$129.00
|
| Rate for Payer: Multiplan Commercial |
$137.60
|
| Rate for Payer: NAPHCARE Commercial |
$103.20
|
| Rate for Payer: Preferred Network Access Commercial |
$158.24
|
| Rate for Payer: Quartz Beloit One Network |
$84.28
|
| Rate for Payer: Quartz Commercial |
$111.80
|
| Rate for Payer: Quartz Medicare Advantage |
$103.20
|
| Rate for Payer: The Alliance Commercial |
$688.00
|
| Rate for Payer: WEA Trust Commercial |
$94.60
|
| Rate for Payer: WPS Commercial |
$127.40
|
|
|
Papaverine 30mg/1ml 2ml SDV [Med]
|
Facility
|
IP
|
$172.00
|
|
|
Service Code
|
HCPCS J2440
|
| Hospital Charge Code |
2974968
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$84.28 |
| Max. Negotiated Rate |
$158.24 |
| Rate for Payer: Aetna Commercial |
$154.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$147.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$91.16
|
| Rate for Payer: Cash Price |
$51.60
|
| Rate for Payer: Cigna Commercial |
$158.24
|
| Rate for Payer: Health EOS Commercial |
$153.08
|
| Rate for Payer: HFN Commercial |
$158.24
|
| Rate for Payer: Multiplan Commercial |
$137.60
|
| Rate for Payer: NAPHCARE Commercial |
$103.20
|
| Rate for Payer: Preferred Network Access Commercial |
$158.24
|
| Rate for Payer: Quartz Beloit One Network |
$84.28
|
| Rate for Payer: Quartz Commercial |
$103.20
|
| Rate for Payer: WEA Trust Commercial |
$94.60
|
| Rate for Payer: WPS Commercial |
$127.40
|
|
|
Paracentesis Performed By
|
Facility
|
OP
|
$1,453.00
|
|
|
Service Code
|
CPT 49082
|
| Hospital Charge Code |
2844881
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$301.00 |
| Max. Negotiated Rate |
$4,757.59 |
| Rate for Payer: Aetna Commercial |
$1,307.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,249.58
|
| Rate for Payer: Aetna Managed Medicare |
$895.97
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$944.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$726.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$697.44
|
| Rate for Payer: Anthem Medicare Advantage |
$895.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$770.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$895.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$895.97
|
| Rate for Payer: Cash Price |
$435.90
|
| Rate for Payer: Cash Price |
$435.90
|
| Rate for Payer: Cash Price |
$435.90
|
| Rate for Payer: Cigna Commercial |
$1,336.76
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$895.97
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,757.59
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$895.97
|
| Rate for Payer: Health EOS Commercial |
$1,293.17
|
| Rate for Payer: HFN Commercial |
$1,336.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,333.01
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$895.97
|
| Rate for Payer: Independent Care Health Plan Medicare |
$895.97
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$895.97
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$895.97
|
| Rate for Payer: Multiplan Commercial |
$1,162.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,343.96
|
| Rate for Payer: Preferred Network Access Commercial |
$1,336.76
|
| Rate for Payer: Quartz Beloit One Network |
$711.97
|
| Rate for Payer: Quartz Commercial |
$944.45
|
| Rate for Payer: Quartz Medicare Advantage |
$895.97
|
| Rate for Payer: The Alliance Commercial |
$3,583.88
|
| Rate for Payer: United Healthcare Medicare Advantage |
$895.97
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$799.15
|
| Rate for Payer: Wellcare Medicare |
$895.97
|
| Rate for Payer: WPS Commercial |
$1,076.24
|
|
|
Paracentesis Performed By
|
Facility
|
IP
|
$1,453.00
|
|
|
Service Code
|
CPT 49082
|
| Hospital Charge Code |
2844881
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$711.97 |
| Max. Negotiated Rate |
$1,336.76 |
| Rate for Payer: Aetna Commercial |
$1,307.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,249.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$770.09
|
| Rate for Payer: Cash Price |
$435.90
|
| Rate for Payer: Cigna Commercial |
$1,336.76
|
| Rate for Payer: Health EOS Commercial |
$1,293.17
|
| Rate for Payer: HFN Commercial |
$1,336.76
|
| Rate for Payer: Multiplan Commercial |
$1,162.40
|
| Rate for Payer: NAPHCARE Commercial |
$871.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,336.76
|
| Rate for Payer: Quartz Beloit One Network |
$711.97
|
| Rate for Payer: Quartz Commercial |
$871.80
|
| Rate for Payer: WEA Trust Commercial |
$799.15
|
| Rate for Payer: WPS Commercial |
$1,076.24
|
|
|
Paracervical/Pudendal Block Kit - Individual Charges
|
Facility
|
IP
|
$249.00
|
|
| Hospital Charge Code |
3004344
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$122.01 |
| Max. Negotiated Rate |
$229.08 |
| Rate for Payer: Aetna Commercial |
$224.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$214.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$131.97
|
| Rate for Payer: Cash Price |
$74.70
|
| Rate for Payer: Cigna Commercial |
$229.08
|
| Rate for Payer: Health EOS Commercial |
$221.61
|
| Rate for Payer: HFN Commercial |
$229.08
|
| Rate for Payer: Multiplan Commercial |
$199.20
|
| Rate for Payer: NAPHCARE Commercial |
$149.40
|
| Rate for Payer: Preferred Network Access Commercial |
$229.08
|
| Rate for Payer: Quartz Beloit One Network |
$122.01
|
| Rate for Payer: Quartz Commercial |
$149.40
|
| Rate for Payer: WEA Trust Commercial |
$136.95
|
| Rate for Payer: WPS Commercial |
$184.43
|
|
|
Paracervical/Pudendal Block Kit - Individual Charges
|
Facility
|
OP
|
$249.00
|
|
| Hospital Charge Code |
3004344
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$69.72 |
| Max. Negotiated Rate |
$996.00 |
| Rate for Payer: Aetna Commercial |
$224.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$214.14
|
| Rate for Payer: Aetna Managed Medicare |
$69.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$161.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$124.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$119.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$131.97
|
| Rate for Payer: Cash Price |
$74.70
|
| Rate for Payer: Cigna Commercial |
$229.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$139.34
|
| Rate for Payer: Health EOS Commercial |
$221.61
|
| Rate for Payer: HFN Commercial |
$229.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$186.75
|
| Rate for Payer: Multiplan Commercial |
$199.20
|
| Rate for Payer: NAPHCARE Commercial |
$149.40
|
| Rate for Payer: Preferred Network Access Commercial |
$229.08
|
| Rate for Payer: Quartz Beloit One Network |
$122.01
|
| Rate for Payer: Quartz Commercial |
$161.85
|
| Rate for Payer: Quartz Medicare Advantage |
$149.40
|
| Rate for Payer: The Alliance Commercial |
$996.00
|
| Rate for Payer: WEA Trust Commercial |
$136.95
|
| Rate for Payer: WPS Commercial |
$184.43
|
|
|
PARACHUTE DEVICE LESLIE 3.1 X 120 0 DEG 320-302
|
Facility
|
IP
|
$4,312.00
|
|
| Hospital Charge Code |
3295462
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,112.88 |
| Max. Negotiated Rate |
$3,967.04 |
| Rate for Payer: Aetna Commercial |
$3,880.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,708.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,285.36
|
| Rate for Payer: Cash Price |
$1,293.60
|
| Rate for Payer: Cigna Commercial |
$3,967.04
|
| Rate for Payer: Health EOS Commercial |
$3,837.68
|
| Rate for Payer: HFN Commercial |
$3,967.04
|
| Rate for Payer: Multiplan Commercial |
$3,449.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,587.20
|
| Rate for Payer: Preferred Network Access Commercial |
$3,967.04
|
| Rate for Payer: Quartz Beloit One Network |
$2,112.88
|
| Rate for Payer: Quartz Commercial |
$2,587.20
|
| Rate for Payer: WEA Trust Commercial |
$2,371.60
|
| Rate for Payer: WPS Commercial |
$3,193.90
|
|
|
PARACHUTE DEVICE LESLIE 3.1 X 120 0 DEG 320-302
|
Facility
|
OP
|
$4,312.00
|
|
| Hospital Charge Code |
3295462
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,207.36 |
| Max. Negotiated Rate |
$17,248.00 |
| Rate for Payer: Aetna Commercial |
$3,880.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,708.32
|
| Rate for Payer: Aetna Managed Medicare |
$1,207.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,802.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,156.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,069.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,285.36
|
| Rate for Payer: Cash Price |
$1,293.60
|
| Rate for Payer: Cigna Commercial |
$3,967.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,413.00
|
| Rate for Payer: Health EOS Commercial |
$3,837.68
|
| Rate for Payer: HFN Commercial |
$3,967.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,234.00
|
| Rate for Payer: Multiplan Commercial |
$3,449.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,587.20
|
| Rate for Payer: Preferred Network Access Commercial |
$3,967.04
|
| Rate for Payer: Quartz Beloit One Network |
$2,112.88
|
| Rate for Payer: Quartz Commercial |
$2,802.80
|
| Rate for Payer: Quartz Medicare Advantage |
$2,587.20
|
| Rate for Payer: The Alliance Commercial |
$17,248.00
|
| Rate for Payer: WEA Trust Commercial |
$2,371.60
|
| Rate for Payer: WPS Commercial |
$3,193.90
|
|
|
PARAFFIN ECONOMY 6# BK #514203
|
Facility
|
OP
|
$312.00
|
|
| Hospital Charge Code |
2970914
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$87.36 |
| Max. Negotiated Rate |
$1,248.00 |
| Rate for Payer: Aetna Commercial |
$280.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$268.32
|
| Rate for Payer: Aetna Managed Medicare |
$87.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$202.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$156.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$149.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$165.36
|
| Rate for Payer: Cash Price |
$93.60
|
| Rate for Payer: Cigna Commercial |
$287.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$174.60
|
| Rate for Payer: Health EOS Commercial |
$277.68
|
| Rate for Payer: HFN Commercial |
$287.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$234.00
|
| Rate for Payer: Multiplan Commercial |
$249.60
|
| Rate for Payer: NAPHCARE Commercial |
$187.20
|
| Rate for Payer: Preferred Network Access Commercial |
$287.04
|
| Rate for Payer: Quartz Beloit One Network |
$152.88
|
| Rate for Payer: Quartz Commercial |
$202.80
|
| Rate for Payer: Quartz Medicare Advantage |
$187.20
|
| Rate for Payer: The Alliance Commercial |
$1,248.00
|
| Rate for Payer: WEA Trust Commercial |
$171.60
|
| Rate for Payer: WPS Commercial |
$231.10
|
|
|
PARAFFIN ECONOMY 6# BK #514203
|
Facility
|
IP
|
$312.00
|
|
| Hospital Charge Code |
2970914
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$152.88 |
| Max. Negotiated Rate |
$287.04 |
| Rate for Payer: Aetna Commercial |
$280.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$268.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$165.36
|
| Rate for Payer: Cash Price |
$93.60
|
| Rate for Payer: Cigna Commercial |
$287.04
|
| Rate for Payer: Health EOS Commercial |
$277.68
|
| Rate for Payer: HFN Commercial |
$287.04
|
| Rate for Payer: Multiplan Commercial |
$249.60
|
| Rate for Payer: NAPHCARE Commercial |
$187.20
|
| Rate for Payer: Preferred Network Access Commercial |
$287.04
|
| Rate for Payer: Quartz Beloit One Network |
$152.88
|
| Rate for Payer: Quartz Commercial |
$187.20
|
| Rate for Payer: WEA Trust Commercial |
$171.60
|
| Rate for Payer: WPS Commercial |
$231.10
|
|
|
Paragard 1 Unit Charge
|
Facility
|
OP
|
$2,654.00
|
|
|
Service Code
|
HCPCS J7300
|
| Hospital Charge Code |
2958958
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$743.12 |
| Max. Negotiated Rate |
$10,616.00 |
| Rate for Payer: Aetna Commercial |
$2,388.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,282.44
|
| Rate for Payer: Aetna Managed Medicare |
$743.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,725.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,327.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,273.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,406.62
|
| Rate for Payer: Cash Price |
$796.20
|
| Rate for Payer: Cigna Commercial |
$2,441.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,485.18
|
| Rate for Payer: Health EOS Commercial |
$2,362.06
|
| Rate for Payer: HFN Commercial |
$2,441.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,990.50
|
| Rate for Payer: Multiplan Commercial |
$2,123.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,592.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,441.68
|
| Rate for Payer: Quartz Beloit One Network |
$1,300.46
|
| Rate for Payer: Quartz Commercial |
$1,725.10
|
| Rate for Payer: Quartz Medicare Advantage |
$1,592.40
|
| Rate for Payer: The Alliance Commercial |
$10,616.00
|
| Rate for Payer: WEA Trust Commercial |
$1,459.70
|
| Rate for Payer: WPS Commercial |
$1,965.82
|
|
|
Paragard 1 Unit Charge
|
Facility
|
IP
|
$2,654.00
|
|
|
Service Code
|
HCPCS J7300
|
| Hospital Charge Code |
2958958
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,300.46 |
| Max. Negotiated Rate |
$2,441.68 |
| Rate for Payer: Aetna Commercial |
$2,388.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,282.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,406.62
|
| Rate for Payer: Cash Price |
$796.20
|
| Rate for Payer: Cigna Commercial |
$2,441.68
|
| Rate for Payer: Health EOS Commercial |
$2,362.06
|
| Rate for Payer: HFN Commercial |
$2,441.68
|
| Rate for Payer: Multiplan Commercial |
$2,123.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,592.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,441.68
|
| Rate for Payer: Quartz Beloit One Network |
$1,300.46
|
| Rate for Payer: Quartz Commercial |
$1,592.40
|
| Rate for Payer: WEA Trust Commercial |
$1,459.70
|
| Rate for Payer: WPS Commercial |
$1,965.82
|
|
|
Paragard 1 Unit Charge
|
Professional
|
Both
|
$2,654.00
|
|
|
Service Code
|
HCPCS J7300
|
| Hospital Charge Code |
2958958
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$937.00 |
| Max. Negotiated Rate |
$2,521.30 |
| Rate for Payer: Aetna Commercial |
$2,521.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,282.44
|
| Rate for Payer: Anthem Commercial |
$937.00
|
| Rate for Payer: Cash Price |
$796.20
|
| Rate for Payer: Cash Price |
$796.20
|
| Rate for Payer: Cigna Commercial |
$2,521.30
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,025.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,592.40
|
| Rate for Payer: Health EOS Commercial |
$2,415.14
|
| Rate for Payer: HFN Commercial |
$2,521.30
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,323.65
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,323.65
|
| Rate for Payer: Multiplan Commercial |
$2,123.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,521.30
|
| Rate for Payer: Quartz Beloit One Network |
$1,167.76
|
| Rate for Payer: Quartz Commercial |
$1,512.78
|
| Rate for Payer: The Alliance Commercial |
$1,327.00
|
| Rate for Payer: United Healthcare Medicaid |
$1,025.00
|
| Rate for Payer: WEA Trust Commercial |
$1,459.70
|
| Rate for Payer: WPS Commercial |
$1,965.82
|
|
|
.Paraneoplastic Ab, Line Blot
|
Facility
|
OP
|
$100.46
|
|
|
Service Code
|
CPT 86043
|
| Hospital Charge Code |
6187207
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.64 |
| Max. Negotiated Rate |
$401.84 |
| Rate for Payer: Aetna Commercial |
$90.41
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$86.40
|
| Rate for Payer: Aetna Managed Medicare |
$28.13
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$65.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$50.23
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$48.22
|
| Rate for Payer: Anthem Medicaid |
$9.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$53.24
|
| Rate for Payer: Cash Price |
$30.14
|
| Rate for Payer: Cash Price |
$30.14
|
| Rate for Payer: Cigna Commercial |
$92.42
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$9.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$56.22
|
| Rate for Payer: Dean Health Medicaid |
$9.64
|
| Rate for Payer: Health EOS Commercial |
$89.41
|
| Rate for Payer: HFN Commercial |
$92.42
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$75.34
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$9.64
|
| Rate for Payer: Managed Health Services Medicaid |
$10.03
|
| Rate for Payer: Multiplan Commercial |
$80.37
|
| Rate for Payer: NAPHCARE Commercial |
$60.28
|
| Rate for Payer: Preferred Network Access Commercial |
$92.42
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$9.64
|
| Rate for Payer: Quartz Beloit One Network |
$49.23
|
| Rate for Payer: Quartz Commercial |
$65.30
|
| Rate for Payer: Quartz Medicare Advantage |
$60.28
|
| Rate for Payer: The Alliance Commercial |
$401.84
|
| Rate for Payer: United Healthcare Medicaid |
$9.64
|
| Rate for Payer: United Healthcare PPO |
$75.34
|
| Rate for Payer: WEA Trust Commercial |
$55.25
|
| Rate for Payer: WMAP Medicaid |
$9.64
|
| Rate for Payer: WPS Commercial |
$74.41
|
|
|
.Paraneoplastic Ab, Line Blot
|
Professional
|
Both
|
$100.46
|
|
|
Service Code
|
CPT 86043
|
| Hospital Charge Code |
6187207
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$44.20 |
| Max. Negotiated Rate |
$95.44 |
| Rate for Payer: Aetna Commercial |
$95.44
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$86.40
|
| Rate for Payer: Cash Price |
$30.14
|
| Rate for Payer: Cigna Commercial |
$95.44
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$50.23
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$60.28
|
| Rate for Payer: Health EOS Commercial |
$91.42
|
| Rate for Payer: HFN Commercial |
$95.44
|
| Rate for Payer: Multiplan Commercial |
$80.37
|
| Rate for Payer: Preferred Network Access Commercial |
$95.44
|
| Rate for Payer: Quartz Beloit One Network |
$44.20
|
| Rate for Payer: Quartz Commercial |
$57.26
|
| Rate for Payer: The Alliance Commercial |
$50.23
|
| Rate for Payer: WEA Trust Commercial |
$55.25
|
| Rate for Payer: WPS Commercial |
$74.41
|
|
|
.Paraneoplastic Ab, Line Blot
|
Facility
|
IP
|
$100.46
|
|
|
Service Code
|
CPT 86043
|
| Hospital Charge Code |
6187207
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$49.23 |
| Max. Negotiated Rate |
$92.42 |
| Rate for Payer: Aetna Commercial |
$90.41
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$86.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$53.24
|
| Rate for Payer: Cash Price |
$30.14
|
| Rate for Payer: Cigna Commercial |
$92.42
|
| Rate for Payer: Health EOS Commercial |
$89.41
|
| Rate for Payer: HFN Commercial |
$92.42
|
| Rate for Payer: Multiplan Commercial |
$80.37
|
| Rate for Payer: NAPHCARE Commercial |
$60.28
|
| Rate for Payer: Preferred Network Access Commercial |
$92.42
|
| Rate for Payer: Quartz Beloit One Network |
$49.23
|
| Rate for Payer: Quartz Commercial |
$60.28
|
| Rate for Payer: WEA Trust Commercial |
$55.25
|
| Rate for Payer: WPS Commercial |
$74.41
|
|
