|
PKU
|
Facility
|
IP
|
$443.00
|
|
|
Service Code
|
CPT 84035
|
| Hospital Charge Code |
1042935
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$217.07 |
| Max. Negotiated Rate |
$407.56 |
| Rate for Payer: Aetna Commercial |
$398.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$380.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$234.79
|
| Rate for Payer: Cash Price |
$132.90
|
| Rate for Payer: Cigna Commercial |
$407.56
|
| Rate for Payer: Health EOS Commercial |
$394.27
|
| Rate for Payer: HFN Commercial |
$407.56
|
| Rate for Payer: Multiplan Commercial |
$354.40
|
| Rate for Payer: NAPHCARE Commercial |
$265.80
|
| Rate for Payer: Preferred Network Access Commercial |
$407.56
|
| Rate for Payer: Quartz Beloit One Network |
$217.07
|
| Rate for Payer: Quartz Commercial |
$265.80
|
| Rate for Payer: WEA Trust Commercial |
$243.65
|
| Rate for Payer: WPS Commercial |
$328.13
|
|
|
PKU
|
Facility
|
OP
|
$443.00
|
|
|
Service Code
|
CPT 84035
|
| Hospital Charge Code |
1042935
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.98 |
| Max. Negotiated Rate |
$407.56 |
| Rate for Payer: Aetna Commercial |
$398.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$380.98
|
| Rate for Payer: Aetna Managed Medicare |
$3.98
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$14.92
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$6.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$6.61
|
| Rate for Payer: Anthem Medicaid |
$4.11
|
| Rate for Payer: Anthem Medicare Advantage |
$3.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$234.79
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$3.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$3.98
|
| Rate for Payer: Cash Price |
$132.90
|
| Rate for Payer: Cash Price |
$132.90
|
| Rate for Payer: Cigna Commercial |
$407.56
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$3.98
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$4.11
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$247.90
|
| Rate for Payer: Dean Health Medicaid |
$4.11
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$3.98
|
| Rate for Payer: Health EOS Commercial |
$394.27
|
| Rate for Payer: HFN Commercial |
$407.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$14.81
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$3.98
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$4.11
|
| Rate for Payer: Independent Care Health Plan Medicare |
$3.98
|
| Rate for Payer: Managed Health Services Medicaid |
$4.27
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$3.98
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$3.98
|
| Rate for Payer: Multiplan Commercial |
$354.40
|
| Rate for Payer: NAPHCARE Commercial |
$5.97
|
| Rate for Payer: Preferred Network Access Commercial |
$407.56
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$4.11
|
| Rate for Payer: Quartz Beloit One Network |
$217.07
|
| Rate for Payer: Quartz Commercial |
$287.95
|
| Rate for Payer: Quartz Medicare Advantage |
$3.98
|
| Rate for Payer: The Alliance Commercial |
$15.92
|
| Rate for Payer: United Healthcare Medicaid |
$4.11
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3.98
|
| Rate for Payer: United Healthcare PPO |
$332.25
|
| Rate for Payer: WEA Trust Commercial |
$243.65
|
| Rate for Payer: Wellcare Medicare |
$3.98
|
| Rate for Payer: WMAP Medicaid |
$4.11
|
| Rate for Payer: WPS Commercial |
$328.13
|
|
|
PL 12 Autoabs
|
Professional
|
Both
|
$167.00
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
4592895
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$63.29 |
| Max. Negotiated Rate |
$158.65 |
| Rate for Payer: Aetna Commercial |
$158.65
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$143.62
|
| Rate for Payer: Cash Price |
$50.10
|
| Rate for Payer: Cash Price |
$50.10
|
| Rate for Payer: Cigna Commercial |
$158.65
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$83.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$100.20
|
| Rate for Payer: Health EOS Commercial |
$151.97
|
| Rate for Payer: HFN Commercial |
$158.65
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$63.29
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$63.29
|
| Rate for Payer: Multiplan Commercial |
$133.60
|
| Rate for Payer: Preferred Network Access Commercial |
$158.65
|
| Rate for Payer: Quartz Beloit One Network |
$73.48
|
| Rate for Payer: Quartz Commercial |
$95.19
|
| Rate for Payer: The Alliance Commercial |
$83.50
|
| Rate for Payer: WEA Trust Commercial |
$91.85
|
| Rate for Payer: WPS Commercial |
$123.70
|
|
|
PL 12 Autoabs
|
Facility
|
OP
|
$167.00
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
4592895
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.93 |
| Max. Negotiated Rate |
$153.64 |
| Rate for Payer: Aetna Commercial |
$150.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$143.62
|
| Rate for Payer: Aetna Managed Medicare |
$17.93
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$67.24
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$31.38
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$29.76
|
| Rate for Payer: Anthem Medicaid |
$18.53
|
| Rate for Payer: Anthem Medicare Advantage |
$17.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$88.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$17.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$17.93
|
| Rate for Payer: Cash Price |
$50.10
|
| Rate for Payer: Cash Price |
$50.10
|
| Rate for Payer: Cigna Commercial |
$153.64
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$17.93
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$18.53
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$93.45
|
| Rate for Payer: Dean Health Medicaid |
$18.53
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$17.93
|
| Rate for Payer: Health EOS Commercial |
$148.63
|
| Rate for Payer: HFN Commercial |
$153.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$66.70
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$17.93
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$18.53
|
| Rate for Payer: Independent Care Health Plan Medicare |
$17.93
|
| Rate for Payer: Managed Health Services Medicaid |
$19.27
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$17.93
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$17.93
|
| Rate for Payer: Multiplan Commercial |
$133.60
|
| Rate for Payer: NAPHCARE Commercial |
$26.90
|
| Rate for Payer: Preferred Network Access Commercial |
$153.64
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$18.53
|
| Rate for Payer: Quartz Beloit One Network |
$81.83
|
| Rate for Payer: Quartz Commercial |
$108.55
|
| Rate for Payer: Quartz Medicare Advantage |
$17.93
|
| Rate for Payer: The Alliance Commercial |
$71.72
|
| Rate for Payer: United Healthcare Medicaid |
$18.53
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17.93
|
| Rate for Payer: United Healthcare PPO |
$125.25
|
| Rate for Payer: WEA Trust Commercial |
$91.85
|
| Rate for Payer: Wellcare Medicare |
$17.93
|
| Rate for Payer: WMAP Medicaid |
$18.53
|
| Rate for Payer: WPS Commercial |
$123.70
|
|
|
PL 12 Autoabs
|
Facility
|
IP
|
$167.00
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
4592895
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$81.83 |
| Max. Negotiated Rate |
$153.64 |
| Rate for Payer: Aetna Commercial |
$150.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$143.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$88.51
|
| Rate for Payer: Cash Price |
$50.10
|
| Rate for Payer: Cigna Commercial |
$153.64
|
| Rate for Payer: Health EOS Commercial |
$148.63
|
| Rate for Payer: HFN Commercial |
$153.64
|
| Rate for Payer: Multiplan Commercial |
$133.60
|
| Rate for Payer: NAPHCARE Commercial |
$100.20
|
| Rate for Payer: Preferred Network Access Commercial |
$153.64
|
| Rate for Payer: Quartz Beloit One Network |
$81.83
|
| Rate for Payer: Quartz Commercial |
$100.20
|
| Rate for Payer: WEA Trust Commercial |
$91.85
|
| Rate for Payer: WPS Commercial |
$123.70
|
|
|
PL 7 Autoabs
|
Facility
|
IP
|
$167.00
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
4592894
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$81.83 |
| Max. Negotiated Rate |
$153.64 |
| Rate for Payer: Aetna Commercial |
$150.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$143.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$88.51
|
| Rate for Payer: Cash Price |
$50.10
|
| Rate for Payer: Cigna Commercial |
$153.64
|
| Rate for Payer: Health EOS Commercial |
$148.63
|
| Rate for Payer: HFN Commercial |
$153.64
|
| Rate for Payer: Multiplan Commercial |
$133.60
|
| Rate for Payer: NAPHCARE Commercial |
$100.20
|
| Rate for Payer: Preferred Network Access Commercial |
$153.64
|
| Rate for Payer: Quartz Beloit One Network |
$81.83
|
| Rate for Payer: Quartz Commercial |
$100.20
|
| Rate for Payer: WEA Trust Commercial |
$91.85
|
| Rate for Payer: WPS Commercial |
$123.70
|
|
|
PL 7 Autoabs
|
Facility
|
OP
|
$167.00
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
4592894
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.93 |
| Max. Negotiated Rate |
$153.64 |
| Rate for Payer: Aetna Commercial |
$150.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$143.62
|
| Rate for Payer: Aetna Managed Medicare |
$17.93
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$67.24
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$31.38
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$29.76
|
| Rate for Payer: Anthem Medicaid |
$18.53
|
| Rate for Payer: Anthem Medicare Advantage |
$17.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$88.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$17.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$17.93
|
| Rate for Payer: Cash Price |
$50.10
|
| Rate for Payer: Cash Price |
$50.10
|
| Rate for Payer: Cigna Commercial |
$153.64
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$17.93
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$18.53
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$93.45
|
| Rate for Payer: Dean Health Medicaid |
$18.53
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$17.93
|
| Rate for Payer: Health EOS Commercial |
$148.63
|
| Rate for Payer: HFN Commercial |
$153.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$66.70
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$17.93
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$18.53
|
| Rate for Payer: Independent Care Health Plan Medicare |
$17.93
|
| Rate for Payer: Managed Health Services Medicaid |
$19.27
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$17.93
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$17.93
|
| Rate for Payer: Multiplan Commercial |
$133.60
|
| Rate for Payer: NAPHCARE Commercial |
$26.90
|
| Rate for Payer: Preferred Network Access Commercial |
$153.64
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$18.53
|
| Rate for Payer: Quartz Beloit One Network |
$81.83
|
| Rate for Payer: Quartz Commercial |
$108.55
|
| Rate for Payer: Quartz Medicare Advantage |
$17.93
|
| Rate for Payer: The Alliance Commercial |
$71.72
|
| Rate for Payer: United Healthcare Medicaid |
$18.53
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17.93
|
| Rate for Payer: United Healthcare PPO |
$125.25
|
| Rate for Payer: WEA Trust Commercial |
$91.85
|
| Rate for Payer: Wellcare Medicare |
$17.93
|
| Rate for Payer: WMAP Medicaid |
$18.53
|
| Rate for Payer: WPS Commercial |
$123.70
|
|
|
PL 7 Autoabs
|
Professional
|
Both
|
$167.00
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
4592894
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$63.29 |
| Max. Negotiated Rate |
$158.65 |
| Rate for Payer: Aetna Commercial |
$158.65
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$143.62
|
| Rate for Payer: Cash Price |
$50.10
|
| Rate for Payer: Cash Price |
$50.10
|
| Rate for Payer: Cigna Commercial |
$158.65
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$83.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$100.20
|
| Rate for Payer: Health EOS Commercial |
$151.97
|
| Rate for Payer: HFN Commercial |
$158.65
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$63.29
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$63.29
|
| Rate for Payer: Multiplan Commercial |
$133.60
|
| Rate for Payer: Preferred Network Access Commercial |
$158.65
|
| Rate for Payer: Quartz Beloit One Network |
$73.48
|
| Rate for Payer: Quartz Commercial |
$95.19
|
| Rate for Payer: The Alliance Commercial |
$83.50
|
| Rate for Payer: WEA Trust Commercial |
$91.85
|
| Rate for Payer: WPS Commercial |
$123.70
|
|
|
PLACE CATHETER IN AORTA 36200
|
Professional
|
Both
|
$1,751.00
|
|
|
Service Code
|
CPT 36200
|
| Hospital Charge Code |
3014511
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$241.35 |
| Max. Negotiated Rate |
$1,663.45 |
| Rate for Payer: Aetna Commercial |
$1,663.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,505.86
|
| Rate for Payer: Cash Price |
$525.30
|
| Rate for Payer: Cash Price |
$525.30
|
| Rate for Payer: Cash Price |
$525.30
|
| Rate for Payer: Cigna Commercial |
$1,663.45
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$241.35
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,050.60
|
| Rate for Payer: Health EOS Commercial |
$1,593.41
|
| Rate for Payer: HFN Commercial |
$1,663.45
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$442.77
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$442.77
|
| Rate for Payer: Multiplan Commercial |
$1,400.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,663.45
|
| Rate for Payer: Quartz Beloit One Network |
$770.44
|
| Rate for Payer: Quartz Commercial |
$998.07
|
| Rate for Payer: The Alliance Commercial |
$875.50
|
| Rate for Payer: United Healthcare Medicaid |
$241.35
|
| Rate for Payer: WEA Trust Commercial |
$963.05
|
| Rate for Payer: WPS Commercial |
$1,296.97
|
|
|
Place Catheter In Aorta 3620022
|
Professional
|
Both
|
$2,102.00
|
|
|
Service Code
|
CPT 36200 22
|
| Hospital Charge Code |
5246750
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$241.35 |
| Max. Negotiated Rate |
$1,996.90 |
| Rate for Payer: Aetna Commercial |
$1,996.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,807.72
|
| Rate for Payer: Cash Price |
$630.60
|
| Rate for Payer: Cash Price |
$630.60
|
| Rate for Payer: Cash Price |
$630.60
|
| Rate for Payer: Cigna Commercial |
$1,996.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$241.35
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,261.20
|
| Rate for Payer: Health EOS Commercial |
$1,912.82
|
| Rate for Payer: HFN Commercial |
$1,996.90
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$442.77
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$442.77
|
| Rate for Payer: Multiplan Commercial |
$1,681.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,996.90
|
| Rate for Payer: Quartz Beloit One Network |
$924.88
|
| Rate for Payer: Quartz Commercial |
$1,198.14
|
| Rate for Payer: The Alliance Commercial |
$1,051.00
|
| Rate for Payer: United Healthcare Medicaid |
$241.35
|
| Rate for Payer: WEA Trust Commercial |
$1,156.10
|
| Rate for Payer: WPS Commercial |
$1,556.95
|
|
|
PLACEMENT OF INTERSTITIAL DEVICE(S) FOR RADIATION THERAPY GUIDANCE (EG, FIDUCIAL MARKERS, DOSIMETER), PROSTATE (VIA NEEDLE, ANY APPROACH), SINGLE OR MULTIPLE
|
Facility
|
OP
|
$7,795.33
|
|
|
Service Code
|
CPT 55876
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,369.56 |
| Max. Negotiated Rate |
$7,795.33 |
| Rate for Payer: Aetna Managed Medicare |
$1,369.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,496.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,871.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,726.00
|
| Rate for Payer: Anthem Medicare Advantage |
$1,369.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$1,369.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$1,369.56
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$1,369.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$7,795.33
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$1,369.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,094.76
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,369.56
|
| Rate for Payer: Independent Care Health Plan Medicare |
$1,369.56
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$1,369.56
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$1,369.56
|
| Rate for Payer: NAPHCARE Commercial |
$2,054.34
|
| Rate for Payer: Quartz Medicare Advantage |
$1,369.56
|
| Rate for Payer: The Alliance Commercial |
$5,478.24
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,369.56
|
| Rate for Payer: United Healthcare PPO |
$3,583.00
|
| Rate for Payer: Wellcare Medicare |
$1,369.56
|
|
|
Placement of needle for intraosseous infusion - Peripheral IV Equipment:
|
Facility
|
IP
|
$217.00
|
|
|
Service Code
|
CPT 36680
|
| Hospital Charge Code |
3025931
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$106.33 |
| Max. Negotiated Rate |
$199.64 |
| Rate for Payer: Aetna Commercial |
$195.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$186.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$115.01
|
| Rate for Payer: Cash Price |
$65.10
|
| Rate for Payer: Cigna Commercial |
$199.64
|
| Rate for Payer: Health EOS Commercial |
$193.13
|
| Rate for Payer: HFN Commercial |
$199.64
|
| Rate for Payer: Multiplan Commercial |
$173.60
|
| Rate for Payer: NAPHCARE Commercial |
$130.20
|
| Rate for Payer: Preferred Network Access Commercial |
$199.64
|
| Rate for Payer: Quartz Beloit One Network |
$106.33
|
| Rate for Payer: Quartz Commercial |
$130.20
|
| Rate for Payer: WEA Trust Commercial |
$119.35
|
| Rate for Payer: WPS Commercial |
$160.73
|
|
|
Placement of needle for intraosseous infusion - Peripheral IV Equipment:
|
Facility
|
OP
|
$217.00
|
|
|
Service Code
|
CPT 36680
|
| Hospital Charge Code |
3025931
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$104.16 |
| Max. Negotiated Rate |
$4,218.22 |
| Rate for Payer: Aetna Commercial |
$195.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$186.62
|
| Rate for Payer: Aetna Managed Medicare |
$393.82
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$141.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$108.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$104.16
|
| Rate for Payer: Anthem Medicare Advantage |
$393.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$115.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$393.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$393.82
|
| Rate for Payer: Cash Price |
$65.10
|
| Rate for Payer: Cash Price |
$65.10
|
| Rate for Payer: Cash Price |
$65.10
|
| Rate for Payer: Cigna Commercial |
$199.64
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$393.82
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,218.22
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$393.82
|
| Rate for Payer: Health EOS Commercial |
$193.13
|
| Rate for Payer: HFN Commercial |
$199.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,465.01
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$393.82
|
| Rate for Payer: Independent Care Health Plan Medicare |
$393.82
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$393.82
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$393.82
|
| Rate for Payer: Multiplan Commercial |
$173.60
|
| Rate for Payer: NAPHCARE Commercial |
$590.73
|
| Rate for Payer: Preferred Network Access Commercial |
$199.64
|
| Rate for Payer: Quartz Beloit One Network |
$106.33
|
| Rate for Payer: Quartz Commercial |
$141.05
|
| Rate for Payer: Quartz Medicare Advantage |
$393.82
|
| Rate for Payer: The Alliance Commercial |
$1,575.28
|
| Rate for Payer: United Healthcare Medicare Advantage |
$393.82
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$119.35
|
| Rate for Payer: Wellcare Medicare |
$393.82
|
| Rate for Payer: WPS Commercial |
$160.73
|
|
|
PLACEMENT OF NEPHROSTOMY CATHETER, PERCUTANEOUS, INCLUDING DIAGNOSTIC NEPHROSTOGRAM AND/OR URETEROGRAM WHEN PERFORMED, IMAGING GUIDANCE (EG, ULTRASOUND AND/OR FLUOROSCOPY) AND ALL ASSOCIATED RADIOLOGICAL SUPERVISION AND INTERPRETATION
|
Facility
|
OP
|
$8,052.80
|
|
|
Service Code
|
CPT 50432
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,013.20 |
| Max. Negotiated Rate |
$8,052.80 |
| Rate for Payer: Aetna Managed Medicare |
$2,013.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,496.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,871.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,726.00
|
| Rate for Payer: Anthem Medicare Advantage |
$2,013.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$2,013.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$2,013.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$2,013.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,757.59
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$2,013.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7,489.10
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$2,013.20
|
| Rate for Payer: Independent Care Health Plan Medicare |
$2,013.20
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$2,013.20
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$2,013.20
|
| Rate for Payer: NAPHCARE Commercial |
$3,019.80
|
| Rate for Payer: Quartz Medicare Advantage |
$2,013.20
|
| Rate for Payer: The Alliance Commercial |
$8,052.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,013.20
|
| Rate for Payer: United Healthcare PPO |
$3,583.00
|
| Rate for Payer: Wellcare Medicare |
$2,013.20
|
|
|
PLACEMENT OF SETON 46020
|
Professional
|
Both
|
$445.00
|
|
|
Service Code
|
CPT 46020
|
| Hospital Charge Code |
3014819
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$195.80 |
| Max. Negotiated Rate |
$794.96 |
| Rate for Payer: Aetna Commercial |
$422.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$382.70
|
| Rate for Payer: Cash Price |
$133.50
|
| Rate for Payer: Cash Price |
$133.50
|
| Rate for Payer: Cash Price |
$133.50
|
| Rate for Payer: Cigna Commercial |
$422.75
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$200.23
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$267.00
|
| Rate for Payer: Health EOS Commercial |
$404.95
|
| Rate for Payer: HFN Commercial |
$422.75
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$794.96
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$794.96
|
| Rate for Payer: Multiplan Commercial |
$356.00
|
| Rate for Payer: Preferred Network Access Commercial |
$422.75
|
| Rate for Payer: Quartz Beloit One Network |
$195.80
|
| Rate for Payer: Quartz Commercial |
$253.65
|
| Rate for Payer: The Alliance Commercial |
$222.50
|
| Rate for Payer: United Healthcare Medicaid |
$200.23
|
| Rate for Payer: WEA Trust Commercial |
$244.75
|
| Rate for Payer: WPS Commercial |
$329.61
|
|
|
PLACE NEEDLE IN VEIN 36000
|
Professional
|
Both
|
$165.00
|
|
|
Service Code
|
CPT 36000
|
| Hospital Charge Code |
3014503
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$22.58 |
| Max. Negotiated Rate |
$156.75 |
| Rate for Payer: Aetna Commercial |
$156.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$141.90
|
| Rate for Payer: Cash Price |
$49.50
|
| Rate for Payer: Cash Price |
$49.50
|
| Rate for Payer: Cash Price |
$49.50
|
| Rate for Payer: Cigna Commercial |
$156.75
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$22.58
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$99.00
|
| Rate for Payer: Health EOS Commercial |
$150.15
|
| Rate for Payer: HFN Commercial |
$156.75
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$30.64
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$30.64
|
| Rate for Payer: Multiplan Commercial |
$132.00
|
| Rate for Payer: Preferred Network Access Commercial |
$156.75
|
| Rate for Payer: Quartz Beloit One Network |
$72.60
|
| Rate for Payer: Quartz Commercial |
$94.05
|
| Rate for Payer: The Alliance Commercial |
$82.50
|
| Rate for Payer: United Healthcare Medicaid |
$22.58
|
| Rate for Payer: WEA Trust Commercial |
$90.75
|
| Rate for Payer: WPS Commercial |
$122.22
|
|
|
Plantar Common Digital Nerve 64632
|
Professional
|
Both
|
$496.00
|
|
|
Service Code
|
CPT 64632
|
| Hospital Charge Code |
4066544
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$75.57 |
| Max. Negotiated Rate |
$471.20 |
| Rate for Payer: Aetna Commercial |
$471.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$426.56
|
| Rate for Payer: Cash Price |
$148.80
|
| Rate for Payer: Cash Price |
$148.80
|
| Rate for Payer: Cash Price |
$148.80
|
| Rate for Payer: Cigna Commercial |
$471.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$75.57
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$297.60
|
| Rate for Payer: Health EOS Commercial |
$451.36
|
| Rate for Payer: HFN Commercial |
$471.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$225.92
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$225.92
|
| Rate for Payer: Multiplan Commercial |
$396.80
|
| Rate for Payer: Preferred Network Access Commercial |
$471.20
|
| Rate for Payer: Quartz Beloit One Network |
$218.24
|
| Rate for Payer: Quartz Commercial |
$282.72
|
| Rate for Payer: The Alliance Commercial |
$248.00
|
| Rate for Payer: United Healthcare Medicaid |
$75.57
|
| Rate for Payer: WEA Trust Commercial |
$272.80
|
| Rate for Payer: WPS Commercial |
$367.39
|
|
|
PLANTAR FASCIOTOMY
|
Facility
|
IP
|
$1,337.00
|
|
| Hospital Charge Code |
2960054
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$655.13 |
| Max. Negotiated Rate |
$1,230.04 |
| Rate for Payer: Aetna Commercial |
$1,203.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,149.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$708.61
|
| Rate for Payer: Cash Price |
$401.10
|
| Rate for Payer: Cigna Commercial |
$1,230.04
|
| Rate for Payer: Health EOS Commercial |
$1,189.93
|
| Rate for Payer: HFN Commercial |
$1,230.04
|
| Rate for Payer: Multiplan Commercial |
$1,069.60
|
| Rate for Payer: NAPHCARE Commercial |
$802.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,230.04
|
| Rate for Payer: Quartz Beloit One Network |
$655.13
|
| Rate for Payer: Quartz Commercial |
$802.20
|
| Rate for Payer: WEA Trust Commercial |
$735.35
|
| Rate for Payer: WPS Commercial |
$990.32
|
|
|
PLANTAR FASCIOTOMY
|
Facility
|
OP
|
$1,337.00
|
|
| Hospital Charge Code |
2960054
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$374.36 |
| Max. Negotiated Rate |
$5,348.00 |
| Rate for Payer: Aetna Commercial |
$1,203.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,149.82
|
| Rate for Payer: Aetna Managed Medicare |
$374.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$869.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$668.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$641.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$708.61
|
| Rate for Payer: Cash Price |
$401.10
|
| Rate for Payer: Cigna Commercial |
$1,230.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$748.19
|
| Rate for Payer: Health EOS Commercial |
$1,189.93
|
| Rate for Payer: HFN Commercial |
$1,230.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,002.75
|
| Rate for Payer: Multiplan Commercial |
$1,069.60
|
| Rate for Payer: NAPHCARE Commercial |
$802.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,230.04
|
| Rate for Payer: Quartz Beloit One Network |
$655.13
|
| Rate for Payer: Quartz Commercial |
$869.05
|
| Rate for Payer: Quartz Medicare Advantage |
$802.20
|
| Rate for Payer: The Alliance Commercial |
$5,348.00
|
| Rate for Payer: WEA Trust Commercial |
$735.35
|
| Rate for Payer: WPS Commercial |
$990.32
|
|
|
Plantinol AQ 10 mg Charge
|
Professional
|
Both
|
$21.00
|
|
|
Service Code
|
HCPCS J9060
|
| Hospital Charge Code |
2958961
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.76 |
| 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 |
$3.27
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3.27
|
| Rate for Payer: Health EOS Commercial |
$19.11
|
| Rate for Payer: HFN Commercial |
$19.95
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2.76
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$2.76
|
| 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 |
$3.27
|
| Rate for Payer: WEA Trust Commercial |
$11.55
|
| Rate for Payer: WPS Commercial |
$8.18
|
|
|
Plantinol AQ 10 mg Charge
|
Facility
|
OP
|
$21.00
|
|
|
Service Code
|
HCPCS J9060
|
| Hospital Charge Code |
2958961
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.33 |
| 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 |
$4.33
|
| 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 |
$8.18
|
|
|
Plantinol AQ 10 mg Charge
|
Facility
|
IP
|
$21.00
|
|
|
Service Code
|
HCPCS J9060
|
| Hospital Charge Code |
2958961
|
|
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
|
|
|
Plasma CPD Cryo Red
|
Facility
|
IP
|
$385.00
|
|
|
Service Code
|
HCPCS P9017
|
| Hospital Charge Code |
1052808
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$188.65 |
| Max. Negotiated Rate |
$354.20 |
| Rate for Payer: Aetna Commercial |
$346.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$331.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$204.05
|
| Rate for Payer: Cash Price |
$115.50
|
| Rate for Payer: Cigna Commercial |
$354.20
|
| Rate for Payer: Health EOS Commercial |
$342.65
|
| Rate for Payer: HFN Commercial |
$354.20
|
| Rate for Payer: Multiplan Commercial |
$308.00
|
| Rate for Payer: NAPHCARE Commercial |
$231.00
|
| Rate for Payer: Preferred Network Access Commercial |
$354.20
|
| Rate for Payer: Quartz Beloit One Network |
$188.65
|
| Rate for Payer: Quartz Commercial |
$231.00
|
| Rate for Payer: WEA Trust Commercial |
$211.75
|
| Rate for Payer: WPS Commercial |
$285.17
|
|
|
Plasma CPD Cryo Red
|
Facility
|
OP
|
$385.00
|
|
|
Service Code
|
HCPCS P9017
|
| Hospital Charge Code |
1052808
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$38.65 |
| Max. Negotiated Rate |
$354.20 |
| Rate for Payer: Aetna Commercial |
$346.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$331.10
|
| Rate for Payer: Aetna Managed Medicare |
$82.95
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$250.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$192.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$184.80
|
| Rate for Payer: Anthem Medicaid |
$38.65
|
| Rate for Payer: Anthem Medicare Advantage |
$82.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$204.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$82.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$82.95
|
| Rate for Payer: Cash Price |
$115.50
|
| Rate for Payer: Cash Price |
$115.50
|
| Rate for Payer: Cigna Commercial |
$354.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$82.95
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$38.65
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$215.45
|
| Rate for Payer: Dean Health Medicaid |
$38.65
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$82.95
|
| Rate for Payer: Health EOS Commercial |
$342.65
|
| Rate for Payer: HFN Commercial |
$354.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$308.57
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$82.95
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$38.65
|
| Rate for Payer: Independent Care Health Plan Medicare |
$82.95
|
| Rate for Payer: Managed Health Services Medicaid |
$40.20
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$82.95
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$82.95
|
| Rate for Payer: Multiplan Commercial |
$308.00
|
| Rate for Payer: NAPHCARE Commercial |
$124.42
|
| Rate for Payer: Preferred Network Access Commercial |
$354.20
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$38.65
|
| Rate for Payer: Quartz Beloit One Network |
$188.65
|
| Rate for Payer: Quartz Commercial |
$250.25
|
| Rate for Payer: Quartz Medicare Advantage |
$82.95
|
| Rate for Payer: The Alliance Commercial |
$331.80
|
| Rate for Payer: United Healthcare Medicaid |
$38.65
|
| Rate for Payer: United Healthcare Medicare Advantage |
$82.95
|
| Rate for Payer: United Healthcare PPO |
$288.75
|
| Rate for Payer: WEA Trust Commercial |
$211.75
|
| Rate for Payer: Wellcare Medicare |
$82.95
|
| Rate for Payer: WMAP Medicaid |
$38.65
|
| Rate for Payer: WPS Commercial |
$285.17
|
|
|
Plastic mod low ext pad/line L2275
|
Professional
|
Both
|
$445.00
|
|
|
Service Code
|
HCPCS L2275
|
| Hospital Charge Code |
4524748
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$195.80 |
| Max. Negotiated Rate |
$461.90 |
| Rate for Payer: Aetna Commercial |
$422.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$382.70
|
| Rate for Payer: Cash Price |
$133.50
|
| Rate for Payer: Cash Price |
$133.50
|
| Rate for Payer: Cigna Commercial |
$422.75
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$222.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$267.00
|
| Rate for Payer: Health EOS Commercial |
$404.95
|
| Rate for Payer: HFN Commercial |
$422.75
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$461.90
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$461.90
|
| Rate for Payer: Multiplan Commercial |
$356.00
|
| Rate for Payer: Preferred Network Access Commercial |
$422.75
|
| Rate for Payer: Quartz Beloit One Network |
$195.80
|
| Rate for Payer: Quartz Commercial |
$253.65
|
| Rate for Payer: The Alliance Commercial |
$222.50
|
| Rate for Payer: WEA Trust Commercial |
$244.75
|
| Rate for Payer: WPS Commercial |
$329.61
|
|
