|
PIN SNAP-OFF 1.9MM X 10MM FULL THREAD AR-9919-10
|
Facility
|
OP
|
$3,341.84
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6252126
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$935.72 |
| Max. Negotiated Rate |
$13,367.36 |
| Rate for Payer: Aetna Commercial |
$3,007.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,873.98
|
| Rate for Payer: Aetna Managed Medicare |
$935.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,172.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,670.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,604.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,771.18
|
| Rate for Payer: Cash Price |
$1,002.55
|
| Rate for Payer: Cigna Commercial |
$3,074.49
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,870.09
|
| Rate for Payer: Health EOS Commercial |
$2,974.24
|
| Rate for Payer: HFN Commercial |
$3,074.49
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,506.38
|
| Rate for Payer: Multiplan Commercial |
$2,673.47
|
| Rate for Payer: NAPHCARE Commercial |
$2,005.10
|
| Rate for Payer: Preferred Network Access Commercial |
$3,074.49
|
| Rate for Payer: Quartz Beloit One Network |
$1,637.50
|
| Rate for Payer: Quartz Commercial |
$2,172.20
|
| Rate for Payer: Quartz Medicare Advantage |
$2,005.10
|
| Rate for Payer: The Alliance Commercial |
$13,367.36
|
| Rate for Payer: WEA Trust Commercial |
$1,838.01
|
| Rate for Payer: WPS Commercial |
$2,475.30
|
|
|
PIN SNAP-OFF 1.9MM X 12MM FULL THREAD AR-9919-12
|
Facility
|
IP
|
$3,341.84
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6252127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,637.50 |
| Max. Negotiated Rate |
$3,074.49 |
| Rate for Payer: Aetna Commercial |
$3,007.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,873.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,771.18
|
| Rate for Payer: Cash Price |
$1,002.55
|
| Rate for Payer: Cigna Commercial |
$3,074.49
|
| Rate for Payer: Health EOS Commercial |
$2,974.24
|
| Rate for Payer: HFN Commercial |
$3,074.49
|
| Rate for Payer: Multiplan Commercial |
$2,673.47
|
| Rate for Payer: NAPHCARE Commercial |
$2,005.10
|
| Rate for Payer: Preferred Network Access Commercial |
$3,074.49
|
| Rate for Payer: Quartz Beloit One Network |
$1,637.50
|
| Rate for Payer: Quartz Commercial |
$2,005.10
|
| Rate for Payer: WEA Trust Commercial |
$1,838.01
|
| Rate for Payer: WPS Commercial |
$2,475.30
|
|
|
PIN SNAP-OFF 1.9MM X 12MM FULL THREAD AR-9919-12
|
Facility
|
OP
|
$3,341.84
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6252127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$935.72 |
| Max. Negotiated Rate |
$13,367.36 |
| Rate for Payer: Aetna Commercial |
$3,007.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,873.98
|
| Rate for Payer: Aetna Managed Medicare |
$935.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,172.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,670.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,604.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,771.18
|
| Rate for Payer: Cash Price |
$1,002.55
|
| Rate for Payer: Cigna Commercial |
$3,074.49
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,870.09
|
| Rate for Payer: Health EOS Commercial |
$2,974.24
|
| Rate for Payer: HFN Commercial |
$3,074.49
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,506.38
|
| Rate for Payer: Multiplan Commercial |
$2,673.47
|
| Rate for Payer: NAPHCARE Commercial |
$2,005.10
|
| Rate for Payer: Preferred Network Access Commercial |
$3,074.49
|
| Rate for Payer: Quartz Beloit One Network |
$1,637.50
|
| Rate for Payer: Quartz Commercial |
$2,172.20
|
| Rate for Payer: Quartz Medicare Advantage |
$2,005.10
|
| Rate for Payer: The Alliance Commercial |
$13,367.36
|
| Rate for Payer: WEA Trust Commercial |
$1,838.01
|
| Rate for Payer: WPS Commercial |
$2,475.30
|
|
|
PIN STEINMAN TRACTION 4.0 X 200 CENTRAL THREAD 293.72
|
Facility
|
OP
|
$795.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4518607
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$222.60 |
| Max. Negotiated Rate |
$3,180.00 |
| Rate for Payer: Aetna Commercial |
$715.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$683.70
|
| Rate for Payer: Aetna Managed Medicare |
$222.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$516.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$397.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$381.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$421.35
|
| Rate for Payer: Cash Price |
$238.50
|
| Rate for Payer: Cigna Commercial |
$731.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$444.88
|
| Rate for Payer: Health EOS Commercial |
$707.55
|
| Rate for Payer: HFN Commercial |
$731.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$596.25
|
| Rate for Payer: Multiplan Commercial |
$636.00
|
| Rate for Payer: NAPHCARE Commercial |
$477.00
|
| Rate for Payer: Preferred Network Access Commercial |
$731.40
|
| Rate for Payer: Quartz Beloit One Network |
$389.55
|
| Rate for Payer: Quartz Commercial |
$516.75
|
| Rate for Payer: Quartz Medicare Advantage |
$477.00
|
| Rate for Payer: The Alliance Commercial |
$3,180.00
|
| Rate for Payer: WEA Trust Commercial |
$437.25
|
| Rate for Payer: WPS Commercial |
$588.86
|
|
|
PIN STEINMAN TRACTION 4.0 X 200 CENTRAL THREAD 293.72
|
Facility
|
IP
|
$795.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4518607
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$389.55 |
| Max. Negotiated Rate |
$731.40 |
| Rate for Payer: Aetna Commercial |
$715.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$683.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$421.35
|
| Rate for Payer: Cash Price |
$238.50
|
| Rate for Payer: Cigna Commercial |
$731.40
|
| Rate for Payer: Health EOS Commercial |
$707.55
|
| Rate for Payer: HFN Commercial |
$731.40
|
| Rate for Payer: Multiplan Commercial |
$636.00
|
| Rate for Payer: NAPHCARE Commercial |
$477.00
|
| Rate for Payer: Preferred Network Access Commercial |
$731.40
|
| Rate for Payer: Quartz Beloit One Network |
$389.55
|
| Rate for Payer: Quartz Commercial |
$477.00
|
| Rate for Payer: WEA Trust Commercial |
$437.25
|
| Rate for Payer: WPS Commercial |
$588.86
|
|
|
PIN TEMP FIX 2.0MM THREADED ORTHOLOC 59250050
|
Facility
|
IP
|
$1,292.00
|
|
| Hospital Charge Code |
6201066
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$633.08 |
| Max. Negotiated Rate |
$1,188.64 |
| Rate for Payer: Aetna Commercial |
$1,162.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,111.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$684.76
|
| Rate for Payer: Cash Price |
$387.60
|
| Rate for Payer: Cigna Commercial |
$1,188.64
|
| Rate for Payer: Health EOS Commercial |
$1,149.88
|
| Rate for Payer: HFN Commercial |
$1,188.64
|
| Rate for Payer: Multiplan Commercial |
$1,033.60
|
| Rate for Payer: NAPHCARE Commercial |
$775.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,188.64
|
| Rate for Payer: Quartz Beloit One Network |
$633.08
|
| Rate for Payer: Quartz Commercial |
$775.20
|
| Rate for Payer: WEA Trust Commercial |
$710.60
|
| Rate for Payer: WPS Commercial |
$956.98
|
|
|
PIN TEMP FIX 2.0MM THREADED ORTHOLOC 59250050
|
Facility
|
OP
|
$1,292.00
|
|
| Hospital Charge Code |
6201066
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$361.76 |
| Max. Negotiated Rate |
$5,168.00 |
| Rate for Payer: Aetna Commercial |
$1,162.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,111.12
|
| Rate for Payer: Aetna Managed Medicare |
$361.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$839.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$646.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$620.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$684.76
|
| Rate for Payer: Cash Price |
$387.60
|
| Rate for Payer: Cigna Commercial |
$1,188.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$723.00
|
| Rate for Payer: Health EOS Commercial |
$1,149.88
|
| Rate for Payer: HFN Commercial |
$1,188.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$969.00
|
| Rate for Payer: Multiplan Commercial |
$1,033.60
|
| Rate for Payer: NAPHCARE Commercial |
$775.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,188.64
|
| Rate for Payer: Quartz Beloit One Network |
$633.08
|
| Rate for Payer: Quartz Commercial |
$839.80
|
| Rate for Payer: Quartz Medicare Advantage |
$775.20
|
| Rate for Payer: The Alliance Commercial |
$5,168.00
|
| Rate for Payer: WEA Trust Commercial |
$710.60
|
| Rate for Payer: WPS Commercial |
$956.98
|
|
|
PIN TEMP FIXATION1.1MM DC4212
|
Facility
|
IP
|
$1,329.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
5957651
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$651.21 |
| Max. Negotiated Rate |
$1,222.68 |
| Rate for Payer: Aetna Commercial |
$1,196.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,142.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$704.37
|
| Rate for Payer: Cash Price |
$398.70
|
| Rate for Payer: Cigna Commercial |
$1,222.68
|
| Rate for Payer: Health EOS Commercial |
$1,182.81
|
| Rate for Payer: HFN Commercial |
$1,222.68
|
| Rate for Payer: Multiplan Commercial |
$1,063.20
|
| Rate for Payer: NAPHCARE Commercial |
$797.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,222.68
|
| Rate for Payer: Quartz Beloit One Network |
$651.21
|
| Rate for Payer: Quartz Commercial |
$797.40
|
| Rate for Payer: WEA Trust Commercial |
$730.95
|
| Rate for Payer: WPS Commercial |
$984.39
|
|
|
PIN TEMP FIXATION1.1MM DC4212
|
Facility
|
OP
|
$1,329.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
5957651
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$372.12 |
| Max. Negotiated Rate |
$5,316.00 |
| Rate for Payer: Aetna Commercial |
$1,196.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,142.94
|
| Rate for Payer: Aetna Managed Medicare |
$372.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$863.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$664.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$637.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$704.37
|
| Rate for Payer: Cash Price |
$398.70
|
| Rate for Payer: Cigna Commercial |
$1,222.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$743.71
|
| Rate for Payer: Health EOS Commercial |
$1,182.81
|
| Rate for Payer: HFN Commercial |
$1,222.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$996.75
|
| Rate for Payer: Multiplan Commercial |
$1,063.20
|
| Rate for Payer: NAPHCARE Commercial |
$797.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,222.68
|
| Rate for Payer: Quartz Beloit One Network |
$651.21
|
| Rate for Payer: Quartz Commercial |
$863.85
|
| Rate for Payer: Quartz Medicare Advantage |
$797.40
|
| Rate for Payer: The Alliance Commercial |
$5,316.00
|
| Rate for Payer: WEA Trust Commercial |
$730.95
|
| Rate for Payer: WPS Commercial |
$984.39
|
|
|
PIN TRANSFIX 6.0 X 225 294.950
|
Facility
|
IP
|
$3,065.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966309
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,501.85 |
| Max. Negotiated Rate |
$2,819.80 |
| Rate for Payer: Aetna Commercial |
$2,758.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,635.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,624.45
|
| Rate for Payer: Cash Price |
$919.50
|
| Rate for Payer: Cigna Commercial |
$2,819.80
|
| Rate for Payer: Health EOS Commercial |
$2,727.85
|
| Rate for Payer: HFN Commercial |
$2,819.80
|
| Rate for Payer: Multiplan Commercial |
$2,452.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,839.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,819.80
|
| Rate for Payer: Quartz Beloit One Network |
$1,501.85
|
| Rate for Payer: Quartz Commercial |
$1,839.00
|
| Rate for Payer: WEA Trust Commercial |
$1,685.75
|
| Rate for Payer: WPS Commercial |
$2,270.25
|
|
|
PIN TRANSFIX 6.0 X 225 294.950
|
Facility
|
OP
|
$3,065.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966309
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$858.20 |
| Max. Negotiated Rate |
$12,260.00 |
| Rate for Payer: Aetna Commercial |
$2,758.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,635.90
|
| Rate for Payer: Aetna Managed Medicare |
$858.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,992.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,532.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,471.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,624.45
|
| Rate for Payer: Cash Price |
$919.50
|
| Rate for Payer: Cigna Commercial |
$2,819.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,715.17
|
| Rate for Payer: Health EOS Commercial |
$2,727.85
|
| Rate for Payer: HFN Commercial |
$2,819.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,298.75
|
| Rate for Payer: Multiplan Commercial |
$2,452.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,839.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,819.80
|
| Rate for Payer: Quartz Beloit One Network |
$1,501.85
|
| Rate for Payer: Quartz Commercial |
$1,992.25
|
| Rate for Payer: Quartz Medicare Advantage |
$1,839.00
|
| Rate for Payer: The Alliance Commercial |
$12,260.00
|
| Rate for Payer: WEA Trust Commercial |
$1,685.75
|
| Rate for Payer: WPS Commercial |
$2,270.25
|
|
|
PIN TRANSFIXING 4mmx200mm 50mm
|
Facility
|
OP
|
$2,025.00
|
|
| Hospital Charge Code |
2966087
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$567.00 |
| Max. Negotiated Rate |
$8,100.00 |
| Rate for Payer: Aetna Commercial |
$1,822.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,741.50
|
| Rate for Payer: Aetna Managed Medicare |
$567.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,316.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,012.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$972.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,073.25
|
| Rate for Payer: Cash Price |
$607.50
|
| Rate for Payer: Cigna Commercial |
$1,863.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,133.19
|
| Rate for Payer: Health EOS Commercial |
$1,802.25
|
| Rate for Payer: HFN Commercial |
$1,863.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,518.75
|
| Rate for Payer: Multiplan Commercial |
$1,620.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,215.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,863.00
|
| Rate for Payer: Quartz Beloit One Network |
$992.25
|
| Rate for Payer: Quartz Commercial |
$1,316.25
|
| Rate for Payer: Quartz Medicare Advantage |
$1,215.00
|
| Rate for Payer: The Alliance Commercial |
$8,100.00
|
| Rate for Payer: WEA Trust Commercial |
$1,113.75
|
| Rate for Payer: WPS Commercial |
$1,499.92
|
|
|
PIN TRANSFIXING 4mmx200mm 50mm
|
Facility
|
IP
|
$2,025.00
|
|
| Hospital Charge Code |
2966087
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$992.25 |
| Max. Negotiated Rate |
$1,863.00 |
| Rate for Payer: Aetna Commercial |
$1,822.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,741.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,073.25
|
| Rate for Payer: Cash Price |
$607.50
|
| Rate for Payer: Cigna Commercial |
$1,863.00
|
| Rate for Payer: Health EOS Commercial |
$1,802.25
|
| Rate for Payer: HFN Commercial |
$1,863.00
|
| Rate for Payer: Multiplan Commercial |
$1,620.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,215.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,863.00
|
| Rate for Payer: Quartz Beloit One Network |
$992.25
|
| Rate for Payer: Quartz Commercial |
$1,215.00
|
| Rate for Payer: WEA Trust Commercial |
$1,113.75
|
| Rate for Payer: WPS Commercial |
$1,499.92
|
|
|
Pinworm Prep
|
Facility
|
OP
|
$86.00
|
|
|
Service Code
|
CPT 87172
|
| Hospital Charge Code |
633912
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.27 |
| Max. Negotiated Rate |
$79.12 |
| Rate for Payer: Aetna Commercial |
$77.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$73.96
|
| Rate for Payer: Aetna Managed Medicare |
$4.27
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$16.01
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$7.47
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7.09
|
| Rate for Payer: Anthem Medicaid |
$4.41
|
| Rate for Payer: Anthem Medicare Advantage |
$4.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$45.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$4.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$4.27
|
| Rate for Payer: Cash Price |
$25.80
|
| Rate for Payer: Cash Price |
$25.80
|
| Rate for Payer: Cigna Commercial |
$79.12
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$4.27
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$4.41
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$48.13
|
| Rate for Payer: Dean Health Medicaid |
$4.41
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$4.27
|
| Rate for Payer: Health EOS Commercial |
$76.54
|
| Rate for Payer: HFN Commercial |
$79.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$15.88
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$4.27
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$4.41
|
| Rate for Payer: Independent Care Health Plan Medicare |
$4.27
|
| Rate for Payer: Managed Health Services Medicaid |
$4.59
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$4.27
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$4.27
|
| Rate for Payer: Multiplan Commercial |
$68.80
|
| Rate for Payer: NAPHCARE Commercial |
$6.40
|
| Rate for Payer: Preferred Network Access Commercial |
$79.12
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$4.41
|
| Rate for Payer: Quartz Beloit One Network |
$42.14
|
| Rate for Payer: Quartz Commercial |
$55.90
|
| Rate for Payer: Quartz Medicare Advantage |
$4.27
|
| Rate for Payer: The Alliance Commercial |
$17.08
|
| Rate for Payer: United Healthcare Medicaid |
$4.41
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4.27
|
| Rate for Payer: United Healthcare PPO |
$64.50
|
| Rate for Payer: WEA Trust Commercial |
$47.30
|
| Rate for Payer: Wellcare Medicare |
$4.27
|
| Rate for Payer: WMAP Medicaid |
$4.41
|
| Rate for Payer: WPS Commercial |
$63.70
|
|
|
Pinworm Prep
|
Professional
|
Both
|
$86.00
|
|
|
Service Code
|
CPT 87172
|
| Hospital Charge Code |
633912
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$15.07 |
| Max. Negotiated Rate |
$81.70 |
| Rate for Payer: Aetna Commercial |
$81.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$73.96
|
| Rate for Payer: Cash Price |
$25.80
|
| Rate for Payer: Cash Price |
$25.80
|
| Rate for Payer: Cigna Commercial |
$81.70
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$43.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$51.60
|
| Rate for Payer: Health EOS Commercial |
$78.26
|
| Rate for Payer: HFN Commercial |
$81.70
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$15.07
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$15.07
|
| Rate for Payer: Multiplan Commercial |
$68.80
|
| Rate for Payer: Preferred Network Access Commercial |
$81.70
|
| Rate for Payer: Quartz Beloit One Network |
$37.84
|
| Rate for Payer: Quartz Commercial |
$49.02
|
| Rate for Payer: The Alliance Commercial |
$43.00
|
| Rate for Payer: WEA Trust Commercial |
$47.30
|
| Rate for Payer: WPS Commercial |
$63.70
|
|
|
Pinworm Prep
|
Facility
|
IP
|
$86.00
|
|
|
Service Code
|
CPT 87172
|
| Hospital Charge Code |
633912
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$42.14 |
| Max. Negotiated Rate |
$79.12 |
| Rate for Payer: Aetna Commercial |
$77.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$73.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$45.58
|
| Rate for Payer: Cash Price |
$25.80
|
| Rate for Payer: Cigna Commercial |
$79.12
|
| Rate for Payer: Health EOS Commercial |
$76.54
|
| Rate for Payer: HFN Commercial |
$79.12
|
| Rate for Payer: Multiplan Commercial |
$68.80
|
| Rate for Payer: NAPHCARE Commercial |
$51.60
|
| Rate for Payer: Preferred Network Access Commercial |
$79.12
|
| Rate for Payer: Quartz Beloit One Network |
$42.14
|
| Rate for Payer: Quartz Commercial |
$51.60
|
| Rate for Payer: WEA Trust Commercial |
$47.30
|
| Rate for Payer: WPS Commercial |
$63.70
|
|
|
Pioneer Catheter
|
Facility
|
OP
|
$19,209.00
|
|
|
Service Code
|
HCPCS C1753
|
| Hospital Charge Code |
4139311
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$5,378.52 |
| Max. Negotiated Rate |
$76,836.00 |
| Rate for Payer: Aetna Commercial |
$17,288.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$16,519.74
|
| Rate for Payer: Aetna Managed Medicare |
$5,378.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$12,485.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$9,604.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$9,220.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$10,180.77
|
| Rate for Payer: Cash Price |
$5,762.70
|
| Rate for Payer: Cigna Commercial |
$17,672.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$10,749.36
|
| Rate for Payer: Health EOS Commercial |
$17,096.01
|
| Rate for Payer: HFN Commercial |
$17,672.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$14,406.75
|
| Rate for Payer: Multiplan Commercial |
$15,367.20
|
| Rate for Payer: NAPHCARE Commercial |
$11,525.40
|
| Rate for Payer: Preferred Network Access Commercial |
$17,672.28
|
| Rate for Payer: Quartz Beloit One Network |
$9,412.41
|
| Rate for Payer: Quartz Commercial |
$12,485.85
|
| Rate for Payer: Quartz Medicare Advantage |
$11,525.40
|
| Rate for Payer: The Alliance Commercial |
$76,836.00
|
| Rate for Payer: WEA Trust Commercial |
$10,564.95
|
| Rate for Payer: WPS Commercial |
$14,228.11
|
|
|
Pioneer Catheter
|
Facility
|
IP
|
$19,209.00
|
|
|
Service Code
|
HCPCS C1753
|
| Hospital Charge Code |
4139311
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$9,412.41 |
| Max. Negotiated Rate |
$17,672.28 |
| Rate for Payer: Aetna Commercial |
$17,288.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$16,519.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$10,180.77
|
| Rate for Payer: Cash Price |
$5,762.70
|
| Rate for Payer: Cigna Commercial |
$17,672.28
|
| Rate for Payer: Health EOS Commercial |
$17,096.01
|
| Rate for Payer: HFN Commercial |
$17,672.28
|
| Rate for Payer: Multiplan Commercial |
$15,367.20
|
| Rate for Payer: NAPHCARE Commercial |
$11,525.40
|
| Rate for Payer: Preferred Network Access Commercial |
$17,672.28
|
| Rate for Payer: Quartz Beloit One Network |
$9,412.41
|
| Rate for Payer: Quartz Commercial |
$11,525.40
|
| Rate for Payer: WEA Trust Commercial |
$10,564.95
|
| Rate for Payer: WPS Commercial |
$14,228.11
|
|
|
Piperacillin-Tazobactam JW Waste Charge per 1 gm
|
Facility
|
IP
|
$21.00
|
|
|
Service Code
|
HCPCS J2543 JW
|
| Hospital Charge Code |
5266705
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.29 |
| Max. Negotiated Rate |
$19.32 |
| Rate for Payer: Aetna Commercial |
$18.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$18.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$11.13
|
| Rate for Payer: Cash Price |
$6.30
|
| Rate for Payer: Cigna Commercial |
$19.32
|
| Rate for Payer: Health EOS Commercial |
$18.69
|
| Rate for Payer: HFN Commercial |
$19.32
|
| Rate for Payer: Multiplan Commercial |
$16.80
|
| Rate for Payer: NAPHCARE Commercial |
$12.60
|
| Rate for Payer: Preferred Network Access Commercial |
$19.32
|
| Rate for Payer: Quartz Beloit One Network |
$10.29
|
| Rate for Payer: Quartz Commercial |
$12.60
|
| Rate for Payer: WEA Trust Commercial |
$11.55
|
| Rate for Payer: WPS Commercial |
$15.55
|
|
|
Piperacillin-Tazobactam JW Waste Charge per 1 gm
|
Professional
|
Both
|
$21.00
|
|
|
Service Code
|
HCPCS J2543 JW
|
| Hospital Charge Code |
5266705
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.05 |
| Max. Negotiated Rate |
$19.95 |
| Rate for Payer: Aetna Commercial |
$19.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$18.06
|
| Rate for Payer: Cash Price |
$6.30
|
| Rate for Payer: Cash Price |
$6.30
|
| Rate for Payer: Cigna Commercial |
$19.95
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1.18
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1.05
|
| Rate for Payer: Health EOS Commercial |
$19.11
|
| Rate for Payer: HFN Commercial |
$19.95
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2.20
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$2.20
|
| Rate for Payer: Multiplan Commercial |
$16.80
|
| Rate for Payer: Preferred Network Access Commercial |
$19.95
|
| Rate for Payer: Quartz Beloit One Network |
$9.24
|
| Rate for Payer: Quartz Commercial |
$11.97
|
| Rate for Payer: The Alliance Commercial |
$10.50
|
| Rate for Payer: United Healthcare Medicaid |
$1.18
|
| Rate for Payer: WEA Trust Commercial |
$11.55
|
| Rate for Payer: WPS Commercial |
$2.62
|
|
|
Piperacillin-Tazobactam JW Waste Charge per 1 gm
|
Facility
|
OP
|
$21.00
|
|
|
Service Code
|
HCPCS J2543 JW
|
| Hospital Charge Code |
5266705
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.39 |
| Max. Negotiated Rate |
$84.00 |
| Rate for Payer: Aetna Commercial |
$18.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$18.06
|
| Rate for Payer: Aetna Managed Medicare |
$5.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$13.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$10.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$10.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$11.13
|
| Rate for Payer: Cash Price |
$6.30
|
| Rate for Payer: Cash Price |
$6.30
|
| Rate for Payer: Cigna Commercial |
$19.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1.39
|
| Rate for Payer: Health EOS Commercial |
$18.69
|
| Rate for Payer: HFN Commercial |
$19.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$15.75
|
| Rate for Payer: Multiplan Commercial |
$16.80
|
| Rate for Payer: NAPHCARE Commercial |
$12.60
|
| Rate for Payer: Preferred Network Access Commercial |
$19.32
|
| Rate for Payer: Quartz Beloit One Network |
$10.29
|
| Rate for Payer: Quartz Commercial |
$13.65
|
| Rate for Payer: Quartz Medicare Advantage |
$12.60
|
| Rate for Payer: The Alliance Commercial |
$84.00
|
| Rate for Payer: WEA Trust Commercial |
$11.55
|
| Rate for Payer: WPS Commercial |
$2.62
|
|
|
P. jirovecii / 34286
|
Facility
|
IP
|
$150.00
|
|
|
Service Code
|
CPT 87015
|
| Hospital Charge Code |
5096625
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$73.50 |
| Max. Negotiated Rate |
$138.00 |
| Rate for Payer: Aetna Commercial |
$135.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$129.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$79.50
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Cigna Commercial |
$138.00
|
| Rate for Payer: Health EOS Commercial |
$133.50
|
| Rate for Payer: HFN Commercial |
$138.00
|
| Rate for Payer: Multiplan Commercial |
$120.00
|
| Rate for Payer: NAPHCARE Commercial |
$90.00
|
| Rate for Payer: Preferred Network Access Commercial |
$138.00
|
| Rate for Payer: Quartz Beloit One Network |
$73.50
|
| Rate for Payer: Quartz Commercial |
$90.00
|
| Rate for Payer: WEA Trust Commercial |
$82.50
|
| Rate for Payer: WPS Commercial |
$111.10
|
|
|
P. jirovecii / 34286
|
Professional
|
Both
|
$150.00
|
|
|
Service Code
|
CPT 87015
|
| Hospital Charge Code |
5096625
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$23.58 |
| Max. Negotiated Rate |
$142.50 |
| Rate for Payer: Aetna Commercial |
$142.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$129.00
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Cigna Commercial |
$142.50
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$75.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$90.00
|
| Rate for Payer: Health EOS Commercial |
$136.50
|
| Rate for Payer: HFN Commercial |
$142.50
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$23.58
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$23.58
|
| Rate for Payer: Multiplan Commercial |
$120.00
|
| Rate for Payer: Preferred Network Access Commercial |
$142.50
|
| Rate for Payer: Quartz Beloit One Network |
$66.00
|
| Rate for Payer: Quartz Commercial |
$85.50
|
| Rate for Payer: The Alliance Commercial |
$75.00
|
| Rate for Payer: WEA Trust Commercial |
$82.50
|
| Rate for Payer: WPS Commercial |
$111.10
|
|
|
P. jirovecii / 34286
|
Facility
|
OP
|
$150.00
|
|
|
Service Code
|
CPT 87015
|
| Hospital Charge Code |
5096625
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.25 |
| Max. Negotiated Rate |
$138.00 |
| Rate for Payer: Aetna Commercial |
$135.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$129.00
|
| Rate for Payer: Aetna Managed Medicare |
$6.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$25.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$11.69
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$11.09
|
| Rate for Payer: Anthem Medicaid |
$5.25
|
| Rate for Payer: Anthem Medicare Advantage |
$6.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$79.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$6.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$6.68
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Cigna Commercial |
$138.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$6.68
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$5.25
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$83.94
|
| Rate for Payer: Dean Health Medicaid |
$5.25
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$6.68
|
| Rate for Payer: Health EOS Commercial |
$133.50
|
| Rate for Payer: HFN Commercial |
$138.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$24.85
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$6.68
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$5.25
|
| Rate for Payer: Independent Care Health Plan Medicare |
$6.68
|
| Rate for Payer: Managed Health Services Medicaid |
$5.46
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$6.68
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$6.68
|
| Rate for Payer: Multiplan Commercial |
$120.00
|
| Rate for Payer: NAPHCARE Commercial |
$10.02
|
| Rate for Payer: Preferred Network Access Commercial |
$138.00
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$5.25
|
| Rate for Payer: Quartz Beloit One Network |
$73.50
|
| Rate for Payer: Quartz Commercial |
$97.50
|
| Rate for Payer: Quartz Medicare Advantage |
$6.68
|
| Rate for Payer: The Alliance Commercial |
$26.72
|
| Rate for Payer: United Healthcare Medicaid |
$5.25
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6.68
|
| Rate for Payer: United Healthcare PPO |
$112.50
|
| Rate for Payer: WEA Trust Commercial |
$82.50
|
| Rate for Payer: Wellcare Medicare |
$6.68
|
| Rate for Payer: WMAP Medicaid |
$5.25
|
| Rate for Payer: WPS Commercial |
$111.10
|
|
|
PKU
|
Professional
|
Both
|
$443.00
|
|
|
Service Code
|
CPT 84035
|
| Hospital Charge Code |
1042935
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.05 |
| Max. Negotiated Rate |
$420.85 |
| Rate for Payer: Aetna Commercial |
$420.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$380.98
|
| Rate for Payer: Cash Price |
$132.90
|
| Rate for Payer: Cash Price |
$132.90
|
| Rate for Payer: Cigna Commercial |
$420.85
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$221.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$265.80
|
| Rate for Payer: Health EOS Commercial |
$403.13
|
| Rate for Payer: HFN Commercial |
$420.85
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$14.05
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$14.05
|
| Rate for Payer: Multiplan Commercial |
$354.40
|
| Rate for Payer: Preferred Network Access Commercial |
$420.85
|
| Rate for Payer: Quartz Beloit One Network |
$194.92
|
| Rate for Payer: Quartz Commercial |
$252.51
|
| Rate for Payer: The Alliance Commercial |
$221.50
|
| Rate for Payer: WEA Trust Commercial |
$243.65
|
| Rate for Payer: WPS Commercial |
$328.13
|
|
