|
Penicillin V
|
Facility
|
OP
|
$37.00
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
5230629
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.57 |
| Max. Negotiated Rate |
$34.04 |
| Rate for Payer: Aetna Commercial |
$33.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$31.82
|
| Rate for Payer: Aetna Managed Medicare |
$5.22
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$19.58
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$9.14
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$8.67
|
| Rate for Payer: Anthem Medicaid |
$4.57
|
| Rate for Payer: Anthem Medicare Advantage |
$5.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$19.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5.22
|
| Rate for Payer: Cash Price |
$11.10
|
| Rate for Payer: Cash Price |
$11.10
|
| Rate for Payer: Cigna Commercial |
$34.04
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$5.22
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$4.57
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$20.71
|
| Rate for Payer: Dean Health Medicaid |
$4.57
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$5.22
|
| Rate for Payer: Health EOS Commercial |
$32.93
|
| Rate for Payer: HFN Commercial |
$34.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$19.42
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$5.22
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$4.57
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5.22
|
| Rate for Payer: Managed Health Services Medicaid |
$4.75
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$5.22
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$5.22
|
| Rate for Payer: Multiplan Commercial |
$29.60
|
| Rate for Payer: NAPHCARE Commercial |
$7.83
|
| Rate for Payer: Preferred Network Access Commercial |
$34.04
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$4.57
|
| Rate for Payer: Quartz Beloit One Network |
$18.13
|
| Rate for Payer: Quartz Commercial |
$24.05
|
| Rate for Payer: Quartz Medicare Advantage |
$5.22
|
| Rate for Payer: The Alliance Commercial |
$20.88
|
| Rate for Payer: United Healthcare Medicaid |
$4.57
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.22
|
| Rate for Payer: United Healthcare PPO |
$27.75
|
| Rate for Payer: WEA Trust Commercial |
$20.35
|
| Rate for Payer: Wellcare Medicare |
$5.22
|
| Rate for Payer: WMAP Medicaid |
$4.57
|
| Rate for Payer: WPS Commercial |
$27.41
|
|
|
Penicillin V
|
Professional
|
Both
|
$37.00
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
5230629
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$16.28 |
| Max. Negotiated Rate |
$35.15 |
| Rate for Payer: Aetna Commercial |
$35.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$31.82
|
| Rate for Payer: Cash Price |
$11.10
|
| Rate for Payer: Cash Price |
$11.10
|
| Rate for Payer: Cigna Commercial |
$35.15
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$18.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$22.20
|
| Rate for Payer: Health EOS Commercial |
$33.67
|
| Rate for Payer: HFN Commercial |
$35.15
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$18.43
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$18.43
|
| Rate for Payer: Multiplan Commercial |
$29.60
|
| Rate for Payer: Preferred Network Access Commercial |
$35.15
|
| Rate for Payer: Quartz Beloit One Network |
$16.28
|
| Rate for Payer: Quartz Commercial |
$21.09
|
| Rate for Payer: The Alliance Commercial |
$18.50
|
| Rate for Payer: WEA Trust Commercial |
$20.35
|
| Rate for Payer: WPS Commercial |
$27.41
|
|
|
Penicillin V
|
Facility
|
IP
|
$37.00
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
5230629
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.13 |
| Max. Negotiated Rate |
$34.04 |
| Rate for Payer: Aetna Commercial |
$33.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$31.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$19.61
|
| Rate for Payer: Cash Price |
$11.10
|
| Rate for Payer: Cigna Commercial |
$34.04
|
| Rate for Payer: Health EOS Commercial |
$32.93
|
| Rate for Payer: HFN Commercial |
$34.04
|
| Rate for Payer: Multiplan Commercial |
$29.60
|
| Rate for Payer: NAPHCARE Commercial |
$22.20
|
| Rate for Payer: Preferred Network Access Commercial |
$34.04
|
| Rate for Payer: Quartz Beloit One Network |
$18.13
|
| Rate for Payer: Quartz Commercial |
$22.20
|
| Rate for Payer: WEA Trust Commercial |
$20.35
|
| Rate for Payer: WPS Commercial |
$27.41
|
|
|
PENILE CONDYLOMA, CAUTERY OF
|
Facility
|
IP
|
$1,006.00
|
|
| Hospital Charge Code |
2959948
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$492.94 |
| Max. Negotiated Rate |
$925.52 |
| Rate for Payer: Aetna Commercial |
$905.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$865.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$533.18
|
| Rate for Payer: Cash Price |
$301.80
|
| Rate for Payer: Cigna Commercial |
$925.52
|
| Rate for Payer: Health EOS Commercial |
$895.34
|
| Rate for Payer: HFN Commercial |
$925.52
|
| Rate for Payer: Multiplan Commercial |
$804.80
|
| Rate for Payer: NAPHCARE Commercial |
$603.60
|
| Rate for Payer: Preferred Network Access Commercial |
$925.52
|
| Rate for Payer: Quartz Beloit One Network |
$492.94
|
| Rate for Payer: Quartz Commercial |
$603.60
|
| Rate for Payer: WEA Trust Commercial |
$553.30
|
| Rate for Payer: WPS Commercial |
$745.14
|
|
|
PENILE CONDYLOMA, CAUTERY OF
|
Facility
|
OP
|
$1,006.00
|
|
| Hospital Charge Code |
2959948
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$281.68 |
| Max. Negotiated Rate |
$4,024.00 |
| Rate for Payer: Aetna Commercial |
$905.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$865.16
|
| Rate for Payer: Aetna Managed Medicare |
$281.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$653.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$503.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$482.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$533.18
|
| Rate for Payer: Cash Price |
$301.80
|
| Rate for Payer: Cigna Commercial |
$925.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$562.96
|
| Rate for Payer: Health EOS Commercial |
$895.34
|
| Rate for Payer: HFN Commercial |
$925.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$754.50
|
| Rate for Payer: Multiplan Commercial |
$804.80
|
| Rate for Payer: NAPHCARE Commercial |
$603.60
|
| Rate for Payer: Preferred Network Access Commercial |
$925.52
|
| Rate for Payer: Quartz Beloit One Network |
$492.94
|
| Rate for Payer: Quartz Commercial |
$653.90
|
| Rate for Payer: Quartz Medicare Advantage |
$603.60
|
| Rate for Payer: The Alliance Commercial |
$4,024.00
|
| Rate for Payer: WEA Trust Commercial |
$553.30
|
| Rate for Payer: WPS Commercial |
$745.14
|
|
|
PENILE INJECTION 54235
|
Professional
|
Both
|
$387.00
|
|
|
Service Code
|
CPT 54235
|
| Hospital Charge Code |
3015029
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$170.28 |
| Max. Negotiated Rate |
$367.65 |
| Rate for Payer: Aetna Commercial |
$367.65
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$332.82
|
| Rate for Payer: Cash Price |
$116.10
|
| Rate for Payer: Cash Price |
$116.10
|
| Rate for Payer: Cash Price |
$116.10
|
| Rate for Payer: Cigna Commercial |
$367.65
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$193.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$232.20
|
| Rate for Payer: Health EOS Commercial |
$352.17
|
| Rate for Payer: HFN Commercial |
$367.65
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$243.36
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$243.36
|
| Rate for Payer: Multiplan Commercial |
$309.60
|
| Rate for Payer: Preferred Network Access Commercial |
$367.65
|
| Rate for Payer: Quartz Beloit One Network |
$170.28
|
| Rate for Payer: Quartz Commercial |
$220.59
|
| Rate for Payer: The Alliance Commercial |
$193.50
|
| Rate for Payer: WEA Trust Commercial |
$212.85
|
| Rate for Payer: WPS Commercial |
$286.65
|
|
|
PENILE PROSTHESIS
|
Facility
|
OP
|
$3,935.00
|
|
| Hospital Charge Code |
2960342
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,101.80 |
| Max. Negotiated Rate |
$15,740.00 |
| Rate for Payer: Aetna Commercial |
$3,541.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,384.10
|
| Rate for Payer: Aetna Managed Medicare |
$1,101.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,557.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,967.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,888.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,085.55
|
| Rate for Payer: Cash Price |
$1,180.50
|
| Rate for Payer: Cigna Commercial |
$3,620.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,202.03
|
| Rate for Payer: Health EOS Commercial |
$3,502.15
|
| Rate for Payer: HFN Commercial |
$3,620.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,951.25
|
| Rate for Payer: Multiplan Commercial |
$3,148.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,361.00
|
| Rate for Payer: Preferred Network Access Commercial |
$3,620.20
|
| Rate for Payer: Quartz Beloit One Network |
$1,928.15
|
| Rate for Payer: Quartz Commercial |
$2,557.75
|
| Rate for Payer: Quartz Medicare Advantage |
$2,361.00
|
| Rate for Payer: The Alliance Commercial |
$15,740.00
|
| Rate for Payer: WEA Trust Commercial |
$2,164.25
|
| Rate for Payer: WPS Commercial |
$2,914.65
|
|
|
PENILE PROSTHESIS
|
Facility
|
IP
|
$3,935.00
|
|
| Hospital Charge Code |
2960342
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,928.15 |
| Max. Negotiated Rate |
$3,620.20 |
| Rate for Payer: Aetna Commercial |
$3,541.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,384.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,085.55
|
| Rate for Payer: Cash Price |
$1,180.50
|
| Rate for Payer: Cigna Commercial |
$3,620.20
|
| Rate for Payer: Health EOS Commercial |
$3,502.15
|
| Rate for Payer: HFN Commercial |
$3,620.20
|
| Rate for Payer: Multiplan Commercial |
$3,148.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,361.00
|
| Rate for Payer: Preferred Network Access Commercial |
$3,620.20
|
| Rate for Payer: Quartz Beloit One Network |
$1,928.15
|
| Rate for Payer: Quartz Commercial |
$2,361.00
|
| Rate for Payer: WEA Trust Commercial |
$2,164.25
|
| Rate for Payer: WPS Commercial |
$2,914.65
|
|
|
PEN ISOLATOR TRANSPOLAR MAX1
|
Facility
|
IP
|
$15,713.00
|
|
| Hospital Charge Code |
2964754
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7,699.37 |
| Max. Negotiated Rate |
$14,455.96 |
| Rate for Payer: Aetna Commercial |
$14,141.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$13,513.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$8,327.89
|
| Rate for Payer: Cash Price |
$4,713.90
|
| Rate for Payer: Cigna Commercial |
$14,455.96
|
| Rate for Payer: Health EOS Commercial |
$13,984.57
|
| Rate for Payer: HFN Commercial |
$14,455.96
|
| Rate for Payer: Multiplan Commercial |
$12,570.40
|
| Rate for Payer: NAPHCARE Commercial |
$9,427.80
|
| Rate for Payer: Preferred Network Access Commercial |
$14,455.96
|
| Rate for Payer: Quartz Beloit One Network |
$7,699.37
|
| Rate for Payer: Quartz Commercial |
$9,427.80
|
| Rate for Payer: WEA Trust Commercial |
$8,642.15
|
| Rate for Payer: WPS Commercial |
$11,638.62
|
|
|
PEN ISOLATOR TRANSPOLAR MAX1
|
Facility
|
OP
|
$15,713.00
|
|
| Hospital Charge Code |
2964754
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4,399.64 |
| Max. Negotiated Rate |
$62,852.00 |
| Rate for Payer: Aetna Commercial |
$14,141.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$13,513.18
|
| Rate for Payer: Aetna Managed Medicare |
$4,399.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$10,213.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$7,856.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7,542.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$8,327.89
|
| Rate for Payer: Cash Price |
$4,713.90
|
| Rate for Payer: Cigna Commercial |
$14,455.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$8,792.99
|
| Rate for Payer: Health EOS Commercial |
$13,984.57
|
| Rate for Payer: HFN Commercial |
$14,455.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$11,784.75
|
| Rate for Payer: Multiplan Commercial |
$12,570.40
|
| Rate for Payer: NAPHCARE Commercial |
$9,427.80
|
| Rate for Payer: Preferred Network Access Commercial |
$14,455.96
|
| Rate for Payer: Quartz Beloit One Network |
$7,699.37
|
| Rate for Payer: Quartz Commercial |
$10,213.45
|
| Rate for Payer: Quartz Medicare Advantage |
$9,427.80
|
| Rate for Payer: The Alliance Commercial |
$62,852.00
|
| Rate for Payer: WEA Trust Commercial |
$8,642.15
|
| Rate for Payer: WPS Commercial |
$11,638.62
|
|
|
PENIS PROCEDURES WITH CC/MCC
|
Facility
|
IP
|
$58,033.00
|
|
|
Service Code
|
MSDRG 709
|
| Min. Negotiated Rate |
$20,875.26 |
| Max. Negotiated Rate |
$58,033.00 |
| Rate for Payer: Aetna Managed Medicare |
$20,875.26
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$44,477.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$34,091.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$32,389.36
|
| Rate for Payer: Anthem Medicare Advantage |
$20,875.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$20,875.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$20,875.26
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$20,875.26
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$35,955.16
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$20,875.26
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$41,340.00
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$20,875.26
|
| Rate for Payer: Independent Care Health Plan Medicare |
$20,875.26
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$20,875.26
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$20,875.26
|
| Rate for Payer: NAPHCARE Commercial |
$31,312.89
|
| Rate for Payer: Quartz Medicare Advantage |
$20,875.26
|
| Rate for Payer: The Alliance Commercial |
$58,033.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$20,875.26
|
| Rate for Payer: United Healthcare PPO |
$32,183.72
|
| Rate for Payer: Wellcare Medicare |
$20,875.26
|
|
|
PENIS PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$34,810.00
|
|
|
Service Code
|
MSDRG 710
|
| Min. Negotiated Rate |
$12,521.73 |
| Max. Negotiated Rate |
$34,810.00 |
| Rate for Payer: Aetna Managed Medicare |
$12,521.73
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$25,805.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$19,779.63
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$18,791.94
|
| Rate for Payer: Anthem Medicare Advantage |
$12,521.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$12,521.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$12,521.73
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$12,521.73
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$20,860.78
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$12,521.73
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$24,068.85
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$12,521.73
|
| Rate for Payer: Independent Care Health Plan Medicare |
$12,521.73
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$12,521.73
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$12,521.73
|
| Rate for Payer: NAPHCARE Commercial |
$18,782.60
|
| Rate for Payer: Quartz Medicare Advantage |
$12,521.73
|
| Rate for Payer: The Alliance Commercial |
$34,810.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12,521.73
|
| Rate for Payer: United Healthcare PPO |
$18,737.91
|
| Rate for Payer: Wellcare Medicare |
$12,521.73
|
|
|
PENIS STUDY 54240
|
Professional
|
Both
|
$383.00
|
|
|
Service Code
|
CPT 54240
|
| Hospital Charge Code |
3015030
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$168.52 |
| Max. Negotiated Rate |
$363.85 |
| Rate for Payer: Aetna Commercial |
$363.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$329.38
|
| Rate for Payer: Cash Price |
$114.90
|
| Rate for Payer: Cash Price |
$114.90
|
| Rate for Payer: Cash Price |
$114.90
|
| Rate for Payer: Cigna Commercial |
$363.85
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$191.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$229.80
|
| Rate for Payer: Health EOS Commercial |
$348.53
|
| Rate for Payer: HFN Commercial |
$363.85
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$349.36
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$349.36
|
| Rate for Payer: Multiplan Commercial |
$306.40
|
| Rate for Payer: Preferred Network Access Commercial |
$363.85
|
| Rate for Payer: Quartz Beloit One Network |
$168.52
|
| Rate for Payer: Quartz Commercial |
$218.31
|
| Rate for Payer: The Alliance Commercial |
$191.50
|
| Rate for Payer: WEA Trust Commercial |
$210.65
|
| Rate for Payer: WPS Commercial |
$283.69
|
|
|
PEP therapy
|
Facility
|
OP
|
$139.00
|
|
|
Service Code
|
CPT 94667
|
| Hospital Charge Code |
2989712
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$66.72 |
| Max. Negotiated Rate |
$505.04 |
| Rate for Payer: Aetna Commercial |
$125.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$119.54
|
| Rate for Payer: Aetna Managed Medicare |
$126.26
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$90.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$69.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$66.72
|
| Rate for Payer: Anthem Medicare Advantage |
$126.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$73.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$126.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$126.26
|
| Rate for Payer: Cash Price |
$41.70
|
| Rate for Payer: Cash Price |
$41.70
|
| Rate for Payer: Cigna Commercial |
$127.88
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$126.26
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$77.78
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$126.26
|
| Rate for Payer: Health EOS Commercial |
$123.71
|
| Rate for Payer: HFN Commercial |
$127.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$469.69
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$126.26
|
| Rate for Payer: Independent Care Health Plan Medicare |
$126.26
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$126.26
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$126.26
|
| Rate for Payer: Multiplan Commercial |
$111.20
|
| Rate for Payer: NAPHCARE Commercial |
$189.39
|
| Rate for Payer: Preferred Network Access Commercial |
$127.88
|
| Rate for Payer: Quartz Beloit One Network |
$68.11
|
| Rate for Payer: Quartz Commercial |
$90.35
|
| Rate for Payer: Quartz Medicare Advantage |
$126.26
|
| Rate for Payer: The Alliance Commercial |
$505.04
|
| Rate for Payer: United Healthcare Medicare Advantage |
$126.26
|
| Rate for Payer: United Healthcare PPO |
$104.25
|
| Rate for Payer: WEA Trust Commercial |
$76.45
|
| Rate for Payer: Wellcare Medicare |
$126.26
|
| Rate for Payer: WPS Commercial |
$102.96
|
|
|
PEP therapy
|
Facility
|
IP
|
$139.00
|
|
|
Service Code
|
CPT 94667
|
| Hospital Charge Code |
2989712
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$68.11 |
| Max. Negotiated Rate |
$127.88 |
| Rate for Payer: Aetna Commercial |
$125.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$119.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$73.67
|
| Rate for Payer: Cash Price |
$41.70
|
| Rate for Payer: Cigna Commercial |
$127.88
|
| Rate for Payer: Health EOS Commercial |
$123.71
|
| Rate for Payer: HFN Commercial |
$127.88
|
| Rate for Payer: Multiplan Commercial |
$111.20
|
| Rate for Payer: NAPHCARE Commercial |
$83.40
|
| Rate for Payer: Preferred Network Access Commercial |
$127.88
|
| Rate for Payer: Quartz Beloit One Network |
$68.11
|
| Rate for Payer: Quartz Commercial |
$83.40
|
| Rate for Payer: WEA Trust Commercial |
$76.45
|
| Rate for Payer: WPS Commercial |
$102.96
|
|
|
Perclose
|
Facility
|
OP
|
$2,646.00
|
|
| Hospital Charge Code |
5273178
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$740.88 |
| Max. Negotiated Rate |
$10,584.00 |
| Rate for Payer: Aetna Commercial |
$2,381.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,275.56
|
| Rate for Payer: Aetna Managed Medicare |
$740.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,719.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,323.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,270.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,402.38
|
| Rate for Payer: Cash Price |
$793.80
|
| Rate for Payer: Cigna Commercial |
$2,434.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,480.70
|
| Rate for Payer: Health EOS Commercial |
$2,354.94
|
| Rate for Payer: HFN Commercial |
$2,434.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,984.50
|
| Rate for Payer: Multiplan Commercial |
$2,116.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,587.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,434.32
|
| Rate for Payer: Quartz Beloit One Network |
$1,296.54
|
| Rate for Payer: Quartz Commercial |
$1,719.90
|
| Rate for Payer: Quartz Medicare Advantage |
$1,587.60
|
| Rate for Payer: The Alliance Commercial |
$10,584.00
|
| Rate for Payer: WEA Trust Commercial |
$1,455.30
|
| Rate for Payer: WPS Commercial |
$1,959.89
|
|
|
Perclose
|
Facility
|
IP
|
$2,646.00
|
|
| Hospital Charge Code |
5273178
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,296.54 |
| Max. Negotiated Rate |
$2,434.32 |
| Rate for Payer: Aetna Commercial |
$2,381.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,275.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,402.38
|
| Rate for Payer: Cash Price |
$793.80
|
| Rate for Payer: Cigna Commercial |
$2,434.32
|
| Rate for Payer: Health EOS Commercial |
$2,354.94
|
| Rate for Payer: HFN Commercial |
$2,434.32
|
| Rate for Payer: Multiplan Commercial |
$2,116.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,587.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,434.32
|
| Rate for Payer: Quartz Beloit One Network |
$1,296.54
|
| Rate for Payer: Quartz Commercial |
$1,587.60
|
| Rate for Payer: WEA Trust Commercial |
$1,455.30
|
| Rate for Payer: WPS Commercial |
$1,959.89
|
|
|
Perc Test with Venom 95017
|
Professional
|
Both
|
$142.00
|
|
|
Service Code
|
CPT 95017
|
| Hospital Charge Code |
3353531
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$6.98 |
| Max. Negotiated Rate |
$134.90 |
| Rate for Payer: Aetna Commercial |
$134.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$122.12
|
| Rate for Payer: Cash Price |
$42.60
|
| Rate for Payer: Cash Price |
$42.60
|
| Rate for Payer: Cash Price |
$42.60
|
| Rate for Payer: Cigna Commercial |
$134.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$6.98
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$85.20
|
| Rate for Payer: Health EOS Commercial |
$129.22
|
| Rate for Payer: HFN Commercial |
$134.90
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$28.70
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$28.70
|
| Rate for Payer: Multiplan Commercial |
$113.60
|
| Rate for Payer: Preferred Network Access Commercial |
$134.90
|
| Rate for Payer: Quartz Beloit One Network |
$62.48
|
| Rate for Payer: Quartz Commercial |
$80.94
|
| Rate for Payer: The Alliance Commercial |
$71.00
|
| Rate for Payer: United Healthcare Medicaid |
$6.98
|
| Rate for Payer: WEA Trust Commercial |
$78.10
|
| Rate for Payer: WPS Commercial |
$105.18
|
|
|
PERCUTANEOUS ACCESS NEEDLE 18GA X 20CM M0067001220
|
Facility
|
IP
|
$624.00
|
|
|
Service Code
|
HCPCS A4215
|
| Hospital Charge Code |
5415302
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$305.76 |
| Max. Negotiated Rate |
$574.08 |
| Rate for Payer: Aetna Commercial |
$561.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$536.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$330.72
|
| Rate for Payer: Cash Price |
$187.20
|
| Rate for Payer: Cigna Commercial |
$574.08
|
| Rate for Payer: Health EOS Commercial |
$555.36
|
| Rate for Payer: HFN Commercial |
$574.08
|
| Rate for Payer: Multiplan Commercial |
$499.20
|
| Rate for Payer: NAPHCARE Commercial |
$374.40
|
| Rate for Payer: Preferred Network Access Commercial |
$574.08
|
| Rate for Payer: Quartz Beloit One Network |
$305.76
|
| Rate for Payer: Quartz Commercial |
$374.40
|
| Rate for Payer: WEA Trust Commercial |
$343.20
|
| Rate for Payer: WPS Commercial |
$462.20
|
|
|
PERCUTANEOUS ACCESS NEEDLE 18GA X 20CM M0067001220
|
Facility
|
OP
|
$624.00
|
|
|
Service Code
|
HCPCS A4215
|
| Hospital Charge Code |
5415302
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$174.72 |
| Max. Negotiated Rate |
$2,496.00 |
| Rate for Payer: Aetna Commercial |
$561.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$536.64
|
| Rate for Payer: Aetna Managed Medicare |
$174.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$405.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$312.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$299.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$330.72
|
| Rate for Payer: Cash Price |
$187.20
|
| Rate for Payer: Cigna Commercial |
$574.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$349.19
|
| Rate for Payer: Health EOS Commercial |
$555.36
|
| Rate for Payer: HFN Commercial |
$574.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$468.00
|
| Rate for Payer: Multiplan Commercial |
$499.20
|
| Rate for Payer: NAPHCARE Commercial |
$374.40
|
| Rate for Payer: Preferred Network Access Commercial |
$574.08
|
| Rate for Payer: Quartz Beloit One Network |
$305.76
|
| Rate for Payer: Quartz Commercial |
$405.60
|
| Rate for Payer: Quartz Medicare Advantage |
$374.40
|
| Rate for Payer: The Alliance Commercial |
$2,496.00
|
| Rate for Payer: WEA Trust Commercial |
$343.20
|
| Rate for Payer: WPS Commercial |
$462.20
|
|
|
PERCUTANEOUS AND OTHER INTRACARDIAC PROCEDURES WITH MCC
|
Facility
|
IP
|
$103,926.00
|
|
|
Service Code
|
MSDRG 273
|
| Min. Negotiated Rate |
$37,383.43 |
| Max. Negotiated Rate |
$103,926.00 |
| Rate for Payer: Aetna Managed Medicare |
$37,383.43
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$81,822.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$62,715.90
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$59,584.20
|
| Rate for Payer: Anthem Medicare Advantage |
$37,383.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$37,383.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$37,383.43
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$37,383.43
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$66,143.92
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$37,383.43
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$75,991.50
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$37,383.43
|
| Rate for Payer: Independent Care Health Plan Medicare |
$37,383.43
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$37,383.43
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$37,383.43
|
| Rate for Payer: NAPHCARE Commercial |
$56,075.14
|
| Rate for Payer: Quartz Medicare Advantage |
$37,383.43
|
| Rate for Payer: The Alliance Commercial |
$103,926.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$37,383.43
|
| Rate for Payer: United Healthcare PPO |
$59,160.36
|
| Rate for Payer: Wellcare Medicare |
$37,383.43
|
|
|
PERCUTANEOUS AND OTHER INTRACARDIAC PROCEDURES WITHOUT MCC
|
Facility
|
IP
|
$86,480.00
|
|
|
Service Code
|
MSDRG 274
|
| Min. Negotiated Rate |
$31,107.99 |
| Max. Negotiated Rate |
$86,480.00 |
| Rate for Payer: Aetna Managed Medicare |
$31,107.99
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$67,975.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$52,102.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$49,500.72
|
| Rate for Payer: Anthem Medicare Advantage |
$31,107.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$31,107.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$31,107.99
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$31,107.99
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$54,950.34
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$31,107.99
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$63,195.60
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$31,107.99
|
| Rate for Payer: Independent Care Health Plan Medicare |
$31,107.99
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$31,107.99
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$31,107.99
|
| Rate for Payer: NAPHCARE Commercial |
$46,661.98
|
| Rate for Payer: Quartz Medicare Advantage |
$31,107.99
|
| Rate for Payer: The Alliance Commercial |
$86,480.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$31,107.99
|
| Rate for Payer: United Healthcare PPO |
$49,198.58
|
| Rate for Payer: Wellcare Medicare |
$31,107.99
|
|
|
PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITH INTRALUMINAL DEVICE WITH MCC OR 4+ ARTERIES/INTRALUMINAL DEVICES
|
Facility
|
IP
|
$76,747.00
|
|
|
Service Code
|
MSDRG 321
|
| Min. Negotiated Rate |
$27,606.86 |
| Max. Negotiated Rate |
$76,747.00 |
| Rate for Payer: Aetna Managed Medicare |
$27,606.86
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$60,212.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$46,152.47
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$43,847.86
|
| Rate for Payer: Anthem Medicare Advantage |
$27,606.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$27,606.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$27,606.86
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$27,606.86
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$48,675.14
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$27,606.86
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$56,056.65
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$27,606.86
|
| Rate for Payer: Independent Care Health Plan Medicare |
$27,606.86
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$27,606.86
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$27,606.86
|
| Rate for Payer: NAPHCARE Commercial |
$41,410.29
|
| Rate for Payer: Quartz Medicare Advantage |
$27,606.86
|
| Rate for Payer: The Alliance Commercial |
$76,747.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$27,606.86
|
| Rate for Payer: United Healthcare PPO |
$43,640.82
|
| Rate for Payer: Wellcare Medicare |
$27,606.86
|
|
|
PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITH INTRALUMINAL DEVICE WITHOUT MCC
|
Facility
|
IP
|
$48,797.00
|
|
|
Service Code
|
MSDRG 322
|
| Min. Negotiated Rate |
$17,552.97 |
| Max. Negotiated Rate |
$48,797.00 |
| Rate for Payer: Aetna Managed Medicare |
$17,552.97
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$38,183.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$29,267.42
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$27,805.96
|
| Rate for Payer: Anthem Medicare Advantage |
$17,552.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$17,552.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$17,552.97
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$17,552.97
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$30,867.16
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$17,552.97
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$35,556.30
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$17,552.97
|
| Rate for Payer: Independent Care Health Plan Medicare |
$17,552.97
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$17,552.97
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$17,552.97
|
| Rate for Payer: NAPHCARE Commercial |
$26,329.46
|
| Rate for Payer: Quartz Medicare Advantage |
$17,552.97
|
| Rate for Payer: The Alliance Commercial |
$48,797.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17,552.97
|
| Rate for Payer: United Healthcare PPO |
$27,681.04
|
| Rate for Payer: Wellcare Medicare |
$17,552.97
|
|
|
PERCUTANEOUS CARDIOVASCULAR PROCEDURES WITHOUT INTRALUMINAL DEVICE WITH MCC
|
Facility
|
IP
|
$62,819.00
|
|
|
Service Code
|
MSDRG 250
|
| Min. Negotiated Rate |
$22,596.65 |
| Max. Negotiated Rate |
$62,819.00 |
| Rate for Payer: Aetna Managed Medicare |
$22,596.65
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$49,303.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$37,790.35
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$35,903.30
|
| Rate for Payer: Anthem Medicare Advantage |
$22,596.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$22,596.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$22,596.65
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$22,596.65
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$39,855.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$22,596.65
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$45,840.60
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$22,596.65
|
| Rate for Payer: Independent Care Health Plan Medicare |
$22,596.65
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$22,596.65
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$22,596.65
|
| Rate for Payer: NAPHCARE Commercial |
$33,894.98
|
| Rate for Payer: Quartz Medicare Advantage |
$22,596.65
|
| Rate for Payer: The Alliance Commercial |
$62,819.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$22,596.65
|
| Rate for Payer: United Healthcare PPO |
$35,687.49
|
| Rate for Payer: Wellcare Medicare |
$22,596.65
|
|
