|
PANCREAS TRANSPLANT
|
Facility
|
IP
|
$66,989.89
|
|
|
Service Code
|
APR-DRG 0062
|
| Min. Negotiated Rate |
$59,504.60 |
| Max. Negotiated Rate |
$66,989.89 |
| Rate for Payer: Anthem Medicaid |
$64,146.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$64,146.51
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$64,146.51
|
| Rate for Payer: Dean Health Medicaid |
$64,146.51
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$59,504.60
|
| Rate for Payer: Managed Health Services Medicaid |
$66,989.89
|
| Rate for Payer: Molina Healthcare Medicaid |
$64,146.51
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$64,146.51
|
| Rate for Payer: United Healthcare Medicaid |
$64,146.51
|
|
|
PANCREAS TRANSPLANT
|
Facility
|
IP
|
$100,835.57
|
|
|
Service Code
|
APR-DRG 0064
|
| Min. Negotiated Rate |
$89,568.44 |
| Max. Negotiated Rate |
$100,835.57 |
| Rate for Payer: Anthem Medicaid |
$96,555.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$96,555.61
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$96,555.61
|
| Rate for Payer: Dean Health Medicaid |
$96,555.61
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$89,568.44
|
| Rate for Payer: Managed Health Services Medicaid |
$100,835.57
|
| Rate for Payer: Molina Healthcare Medicaid |
$96,555.61
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$96,555.61
|
| Rate for Payer: United Healthcare Medicaid |
$96,555.61
|
|
|
PANCREATECTOMY
|
Facility
|
IP
|
$7,912.00
|
|
| Hospital Charge Code |
2960302
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4,031.96 |
| Max. Negotiated Rate |
$7,570.20 |
| Rate for Payer: Aetna Commercial |
$7,405.63
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,076.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,361.09
|
| Rate for Payer: Cash Price |
$2,373.60
|
| Rate for Payer: Cigna Commercial |
$7,570.20
|
| Rate for Payer: Health EOS Commercial |
$7,323.35
|
| Rate for Payer: HFN Commercial |
$7,570.20
|
| Rate for Payer: Multiplan Commercial |
$6,582.78
|
| Rate for Payer: Preferred Network Access Commercial |
$7,570.20
|
| Rate for Payer: Quartz Beloit One Network |
$4,031.96
|
| Rate for Payer: Quartz Commercial |
$4,937.09
|
| Rate for Payer: WEA Trust Commercial |
$4,525.66
|
| Rate for Payer: WPS Commercial |
$6,094.61
|
|
|
PANCREATECTOMY
|
Facility
|
OP
|
$7,912.00
|
|
| Hospital Charge Code |
2960302
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,303.97 |
| Max. Negotiated Rate |
$7,570.20 |
| Rate for Payer: Aetna Commercial |
$7,405.63
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,076.49
|
| Rate for Payer: Aetna Managed Medicare |
$2,303.97
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,348.51
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,114.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,949.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,361.09
|
| Rate for Payer: Cash Price |
$2,373.60
|
| Rate for Payer: Cigna Commercial |
$7,570.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,604.78
|
| Rate for Payer: Health EOS Commercial |
$7,323.35
|
| Rate for Payer: HFN Commercial |
$7,570.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,171.36
|
| Rate for Payer: Multiplan Commercial |
$6,582.78
|
| Rate for Payer: NAPHCARE Commercial |
$4,937.09
|
| Rate for Payer: Preferred Network Access Commercial |
$7,570.20
|
| Rate for Payer: Quartz Beloit One Network |
$4,031.96
|
| Rate for Payer: Quartz Commercial |
$5,348.51
|
| Rate for Payer: Quartz Medicare Advantage |
$4,937.09
|
| Rate for Payer: The Alliance Commercial |
$4,114.24
|
| Rate for Payer: WEA Trust Commercial |
$4,525.66
|
| Rate for Payer: WPS Commercial |
$6,094.61
|
|
|
Pancreatic Elastase-1
|
Professional
|
Both
|
$371.00
|
|
|
Service Code
|
CPT 82656
|
| Hospital Charge Code |
983355
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.99 |
| Max. Negotiated Rate |
$366.55 |
| Rate for Payer: Aetna Commercial |
$366.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$331.82
|
| Rate for Payer: Aetna Managed Medicare |
$11.99
|
| Rate for Payer: Anthem Medicare Advantage |
$11.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$11.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$11.99
|
| Rate for Payer: Cash Price |
$111.30
|
| Rate for Payer: Cash Price |
$111.30
|
| Rate for Payer: Cigna Commercial |
$366.55
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$192.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$11.99
|
| Rate for Payer: Health EOS Commercial |
$351.11
|
| Rate for Payer: HFN Commercial |
$366.55
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$42.33
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$42.33
|
| Rate for Payer: Independent Care Health Plan Medicare |
$11.99
|
| Rate for Payer: Multiplan Commercial |
$308.67
|
| Rate for Payer: NAPHCARE Commercial |
$17.99
|
| Rate for Payer: Preferred Network Access Commercial |
$366.55
|
| Rate for Payer: Quartz Beloit One Network |
$169.77
|
| Rate for Payer: Quartz Commercial |
$219.93
|
| Rate for Payer: Quartz Medicare Advantage |
$11.99
|
| Rate for Payer: The Alliance Commercial |
$47.37
|
| Rate for Payer: United Healthcare Medicare Advantage |
$11.99
|
| Rate for Payer: WEA Trust Commercial |
$212.21
|
| Rate for Payer: WPS Commercial |
$52.76
|
|
|
Pancreatic Elastase-1
|
Facility
|
IP
|
$371.00
|
|
|
Service Code
|
CPT 82656
|
| Hospital Charge Code |
983355
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$189.06 |
| Max. Negotiated Rate |
$354.97 |
| Rate for Payer: Aetna Commercial |
$347.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$331.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$204.50
|
| Rate for Payer: Cash Price |
$111.30
|
| Rate for Payer: Cigna Commercial |
$354.97
|
| Rate for Payer: Health EOS Commercial |
$343.40
|
| Rate for Payer: HFN Commercial |
$354.97
|
| Rate for Payer: Multiplan Commercial |
$308.67
|
| Rate for Payer: Preferred Network Access Commercial |
$354.97
|
| Rate for Payer: Quartz Beloit One Network |
$189.06
|
| Rate for Payer: Quartz Commercial |
$231.50
|
| Rate for Payer: WEA Trust Commercial |
$212.21
|
| Rate for Payer: WPS Commercial |
$285.78
|
|
|
Pancreatic Elastase-1
|
Facility
|
OP
|
$371.00
|
|
|
Service Code
|
CPT 82656
|
| Hospital Charge Code |
983355
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.99 |
| Max. Negotiated Rate |
$354.97 |
| Rate for Payer: Aetna Commercial |
$347.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$331.82
|
| Rate for Payer: Aetna Managed Medicare |
$11.99
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$44.97
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$20.98
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$19.91
|
| Rate for Payer: Anthem Medicare Advantage |
$11.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$204.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$11.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$11.99
|
| Rate for Payer: Cash Price |
$111.30
|
| Rate for Payer: Cash Price |
$111.30
|
| Rate for Payer: Cigna Commercial |
$354.97
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$11.99
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$215.92
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$11.99
|
| Rate for Payer: Health EOS Commercial |
$343.40
|
| Rate for Payer: HFN Commercial |
$354.97
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$44.61
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$11.99
|
| Rate for Payer: Independent Care Health Plan Medicare |
$11.99
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$11.99
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$11.99
|
| Rate for Payer: Multiplan Commercial |
$308.67
|
| Rate for Payer: NAPHCARE Commercial |
$17.99
|
| Rate for Payer: Preferred Network Access Commercial |
$354.97
|
| Rate for Payer: Quartz Beloit One Network |
$189.06
|
| Rate for Payer: Quartz Commercial |
$250.80
|
| Rate for Payer: Quartz Medicare Advantage |
$11.99
|
| Rate for Payer: The Alliance Commercial |
$47.96
|
| Rate for Payer: United Healthcare Medicare Advantage |
$11.99
|
| Rate for Payer: United Healthcare PPO |
$289.38
|
| Rate for Payer: WEA Trust Commercial |
$212.21
|
| Rate for Payer: Wellcare Medicare |
$11.99
|
| Rate for Payer: WPS Commercial |
$285.78
|
|
|
Pancreatic Polypeptide
|
Facility
|
IP
|
$372.00
|
|
|
Service Code
|
CPT 83519
|
| Hospital Charge Code |
978032
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$189.57 |
| Max. Negotiated Rate |
$355.93 |
| Rate for Payer: Aetna Commercial |
$348.19
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$332.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$205.05
|
| Rate for Payer: Cash Price |
$111.60
|
| Rate for Payer: Cigna Commercial |
$355.93
|
| Rate for Payer: Health EOS Commercial |
$344.32
|
| Rate for Payer: HFN Commercial |
$355.93
|
| Rate for Payer: Multiplan Commercial |
$309.50
|
| Rate for Payer: Preferred Network Access Commercial |
$355.93
|
| Rate for Payer: Quartz Beloit One Network |
$189.57
|
| Rate for Payer: Quartz Commercial |
$232.13
|
| Rate for Payer: WEA Trust Commercial |
$212.78
|
| Rate for Payer: WPS Commercial |
$286.55
|
|
|
Pancreatic Polypeptide
|
Facility
|
OP
|
$372.00
|
|
|
Service Code
|
CPT 83519
|
| Hospital Charge Code |
978032
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$19.14 |
| Max. Negotiated Rate |
$355.93 |
| Rate for Payer: Aetna Commercial |
$348.19
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$332.72
|
| Rate for Payer: Aetna Managed Medicare |
$19.14
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$71.76
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$33.49
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$31.77
|
| Rate for Payer: Anthem Medicare Advantage |
$19.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$205.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$19.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$19.14
|
| Rate for Payer: Cash Price |
$111.60
|
| Rate for Payer: Cash Price |
$111.60
|
| Rate for Payer: Cigna Commercial |
$355.93
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$19.14
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$216.50
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$19.14
|
| Rate for Payer: Health EOS Commercial |
$344.32
|
| Rate for Payer: HFN Commercial |
$355.93
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$71.19
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$19.14
|
| Rate for Payer: Independent Care Health Plan Medicare |
$19.14
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$19.14
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$19.14
|
| Rate for Payer: Multiplan Commercial |
$309.50
|
| Rate for Payer: NAPHCARE Commercial |
$28.70
|
| Rate for Payer: Preferred Network Access Commercial |
$355.93
|
| Rate for Payer: Quartz Beloit One Network |
$189.57
|
| Rate for Payer: Quartz Commercial |
$251.47
|
| Rate for Payer: Quartz Medicare Advantage |
$19.14
|
| Rate for Payer: The Alliance Commercial |
$76.54
|
| Rate for Payer: United Healthcare Medicare Advantage |
$19.14
|
| Rate for Payer: United Healthcare PPO |
$290.16
|
| Rate for Payer: WEA Trust Commercial |
$212.78
|
| Rate for Payer: Wellcare Medicare |
$19.14
|
| Rate for Payer: WPS Commercial |
$286.55
|
|
|
Pancreatic Polypeptide
|
Professional
|
Both
|
$372.00
|
|
|
Service Code
|
CPT 83519
|
| Hospital Charge Code |
978032
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$19.14 |
| Max. Negotiated Rate |
$367.54 |
| Rate for Payer: Aetna Commercial |
$367.54
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$332.72
|
| Rate for Payer: Aetna Managed Medicare |
$19.14
|
| Rate for Payer: Anthem Medicare Advantage |
$19.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$19.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$19.14
|
| Rate for Payer: Cash Price |
$111.60
|
| Rate for Payer: Cash Price |
$111.60
|
| Rate for Payer: Cigna Commercial |
$367.54
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$193.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$19.14
|
| Rate for Payer: Health EOS Commercial |
$352.06
|
| Rate for Payer: HFN Commercial |
$367.54
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$67.55
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$67.55
|
| Rate for Payer: Independent Care Health Plan Medicare |
$19.14
|
| Rate for Payer: Multiplan Commercial |
$309.50
|
| Rate for Payer: NAPHCARE Commercial |
$28.70
|
| Rate for Payer: Preferred Network Access Commercial |
$367.54
|
| Rate for Payer: Quartz Beloit One Network |
$170.23
|
| Rate for Payer: Quartz Commercial |
$220.52
|
| Rate for Payer: Quartz Medicare Advantage |
$19.14
|
| Rate for Payer: The Alliance Commercial |
$75.59
|
| Rate for Payer: United Healthcare Medicare Advantage |
$19.14
|
| Rate for Payer: WEA Trust Commercial |
$212.78
|
| Rate for Payer: WPS Commercial |
$84.20
|
|
|
Panel *1 - ID Bill
|
Facility
|
OP
|
$357.00
|
|
|
Service Code
|
CPT 86870
|
| Hospital Charge Code |
2952711
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$181.93 |
| Max. Negotiated Rate |
$1,508.92 |
| Rate for Payer: Aetna Commercial |
$334.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$319.30
|
| Rate for Payer: Aetna Managed Medicare |
$377.23
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,385.59
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$646.61
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$613.36
|
| Rate for Payer: Anthem Medicare Advantage |
$377.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$196.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$377.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$377.23
|
| Rate for Payer: Cash Price |
$107.10
|
| Rate for Payer: Cash Price |
$107.10
|
| Rate for Payer: Cigna Commercial |
$341.58
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$377.23
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$207.77
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$377.23
|
| Rate for Payer: Health EOS Commercial |
$330.44
|
| Rate for Payer: HFN Commercial |
$341.58
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,403.29
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$377.23
|
| Rate for Payer: Independent Care Health Plan Medicare |
$377.23
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$377.23
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$377.23
|
| Rate for Payer: Multiplan Commercial |
$297.02
|
| Rate for Payer: NAPHCARE Commercial |
$565.84
|
| Rate for Payer: Preferred Network Access Commercial |
$341.58
|
| Rate for Payer: Quartz Beloit One Network |
$181.93
|
| Rate for Payer: Quartz Commercial |
$241.33
|
| Rate for Payer: Quartz Medicare Advantage |
$377.23
|
| Rate for Payer: The Alliance Commercial |
$1,508.92
|
| Rate for Payer: United Healthcare Medicare Advantage |
$377.23
|
| Rate for Payer: United Healthcare PPO |
$278.46
|
| Rate for Payer: WEA Trust Commercial |
$204.20
|
| Rate for Payer: Wellcare Medicare |
$377.23
|
| Rate for Payer: WPS Commercial |
$275.00
|
|
|
Panel *1 - ID Bill
|
Facility
|
IP
|
$357.00
|
|
|
Service Code
|
CPT 86870
|
| Hospital Charge Code |
2952711
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$181.93 |
| Max. Negotiated Rate |
$341.58 |
| Rate for Payer: Aetna Commercial |
$334.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$319.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$196.78
|
| Rate for Payer: Cash Price |
$107.10
|
| Rate for Payer: Cigna Commercial |
$341.58
|
| Rate for Payer: Health EOS Commercial |
$330.44
|
| Rate for Payer: HFN Commercial |
$341.58
|
| Rate for Payer: Multiplan Commercial |
$297.02
|
| Rate for Payer: Preferred Network Access Commercial |
$341.58
|
| Rate for Payer: Quartz Beloit One Network |
$181.93
|
| Rate for Payer: Quartz Commercial |
$222.77
|
| Rate for Payer: WEA Trust Commercial |
$204.20
|
| Rate for Payer: WPS Commercial |
$275.00
|
|
|
Panel *2 - ID Bill
|
Facility
|
IP
|
$357.00
|
|
|
Service Code
|
CPT 86870
|
| Hospital Charge Code |
2952710
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$181.93 |
| Max. Negotiated Rate |
$341.58 |
| Rate for Payer: Aetna Commercial |
$334.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$319.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$196.78
|
| Rate for Payer: Cash Price |
$107.10
|
| Rate for Payer: Cigna Commercial |
$341.58
|
| Rate for Payer: Health EOS Commercial |
$330.44
|
| Rate for Payer: HFN Commercial |
$341.58
|
| Rate for Payer: Multiplan Commercial |
$297.02
|
| Rate for Payer: Preferred Network Access Commercial |
$341.58
|
| Rate for Payer: Quartz Beloit One Network |
$181.93
|
| Rate for Payer: Quartz Commercial |
$222.77
|
| Rate for Payer: WEA Trust Commercial |
$204.20
|
| Rate for Payer: WPS Commercial |
$275.00
|
|
|
Panel *2 - ID Bill
|
Facility
|
OP
|
$357.00
|
|
|
Service Code
|
CPT 86870
|
| Hospital Charge Code |
2952710
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$181.93 |
| Max. Negotiated Rate |
$1,508.92 |
| Rate for Payer: Aetna Commercial |
$334.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$319.30
|
| Rate for Payer: Aetna Managed Medicare |
$377.23
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,385.59
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$646.61
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$613.36
|
| Rate for Payer: Anthem Medicare Advantage |
$377.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$196.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$377.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$377.23
|
| Rate for Payer: Cash Price |
$107.10
|
| Rate for Payer: Cash Price |
$107.10
|
| Rate for Payer: Cigna Commercial |
$341.58
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$377.23
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$207.77
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$377.23
|
| Rate for Payer: Health EOS Commercial |
$330.44
|
| Rate for Payer: HFN Commercial |
$341.58
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,403.29
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$377.23
|
| Rate for Payer: Independent Care Health Plan Medicare |
$377.23
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$377.23
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$377.23
|
| Rate for Payer: Multiplan Commercial |
$297.02
|
| Rate for Payer: NAPHCARE Commercial |
$565.84
|
| Rate for Payer: Preferred Network Access Commercial |
$341.58
|
| Rate for Payer: Quartz Beloit One Network |
$181.93
|
| Rate for Payer: Quartz Commercial |
$241.33
|
| Rate for Payer: Quartz Medicare Advantage |
$377.23
|
| Rate for Payer: The Alliance Commercial |
$1,508.92
|
| Rate for Payer: United Healthcare Medicare Advantage |
$377.23
|
| Rate for Payer: United Healthcare PPO |
$278.46
|
| Rate for Payer: WEA Trust Commercial |
$204.20
|
| Rate for Payer: Wellcare Medicare |
$377.23
|
| Rate for Payer: WPS Commercial |
$275.00
|
|
|
Panel *3 - ID Bill
|
Facility
|
OP
|
$357.00
|
|
|
Service Code
|
CPT 86870
|
| Hospital Charge Code |
2952709
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$181.93 |
| Max. Negotiated Rate |
$1,508.92 |
| Rate for Payer: Aetna Commercial |
$334.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$319.30
|
| Rate for Payer: Aetna Managed Medicare |
$377.23
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,385.59
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$646.61
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$613.36
|
| Rate for Payer: Anthem Medicare Advantage |
$377.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$196.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$377.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$377.23
|
| Rate for Payer: Cash Price |
$107.10
|
| Rate for Payer: Cash Price |
$107.10
|
| Rate for Payer: Cigna Commercial |
$341.58
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$377.23
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$207.77
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$377.23
|
| Rate for Payer: Health EOS Commercial |
$330.44
|
| Rate for Payer: HFN Commercial |
$341.58
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,403.29
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$377.23
|
| Rate for Payer: Independent Care Health Plan Medicare |
$377.23
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$377.23
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$377.23
|
| Rate for Payer: Multiplan Commercial |
$297.02
|
| Rate for Payer: NAPHCARE Commercial |
$565.84
|
| Rate for Payer: Preferred Network Access Commercial |
$341.58
|
| Rate for Payer: Quartz Beloit One Network |
$181.93
|
| Rate for Payer: Quartz Commercial |
$241.33
|
| Rate for Payer: Quartz Medicare Advantage |
$377.23
|
| Rate for Payer: The Alliance Commercial |
$1,508.92
|
| Rate for Payer: United Healthcare Medicare Advantage |
$377.23
|
| Rate for Payer: United Healthcare PPO |
$278.46
|
| Rate for Payer: WEA Trust Commercial |
$204.20
|
| Rate for Payer: Wellcare Medicare |
$377.23
|
| Rate for Payer: WPS Commercial |
$275.00
|
|
|
Panel *3 - ID Bill
|
Facility
|
IP
|
$357.00
|
|
|
Service Code
|
CPT 86870
|
| Hospital Charge Code |
2952709
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$181.93 |
| Max. Negotiated Rate |
$341.58 |
| Rate for Payer: Aetna Commercial |
$334.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$319.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$196.78
|
| Rate for Payer: Cash Price |
$107.10
|
| Rate for Payer: Cigna Commercial |
$341.58
|
| Rate for Payer: Health EOS Commercial |
$330.44
|
| Rate for Payer: HFN Commercial |
$341.58
|
| Rate for Payer: Multiplan Commercial |
$297.02
|
| Rate for Payer: Preferred Network Access Commercial |
$341.58
|
| Rate for Payer: Quartz Beloit One Network |
$181.93
|
| Rate for Payer: Quartz Commercial |
$222.77
|
| Rate for Payer: WEA Trust Commercial |
$204.20
|
| Rate for Payer: WPS Commercial |
$275.00
|
|
|
Panel *4 - ID Bill
|
Facility
|
OP
|
$357.00
|
|
|
Service Code
|
CPT 86870
|
| Hospital Charge Code |
2952708
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$181.93 |
| Max. Negotiated Rate |
$1,508.92 |
| Rate for Payer: Aetna Commercial |
$334.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$319.30
|
| Rate for Payer: Aetna Managed Medicare |
$377.23
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,385.59
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$646.61
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$613.36
|
| Rate for Payer: Anthem Medicare Advantage |
$377.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$196.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$377.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$377.23
|
| Rate for Payer: Cash Price |
$107.10
|
| Rate for Payer: Cash Price |
$107.10
|
| Rate for Payer: Cigna Commercial |
$341.58
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$377.23
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$207.77
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$377.23
|
| Rate for Payer: Health EOS Commercial |
$330.44
|
| Rate for Payer: HFN Commercial |
$341.58
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,403.29
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$377.23
|
| Rate for Payer: Independent Care Health Plan Medicare |
$377.23
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$377.23
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$377.23
|
| Rate for Payer: Multiplan Commercial |
$297.02
|
| Rate for Payer: NAPHCARE Commercial |
$565.84
|
| Rate for Payer: Preferred Network Access Commercial |
$341.58
|
| Rate for Payer: Quartz Beloit One Network |
$181.93
|
| Rate for Payer: Quartz Commercial |
$241.33
|
| Rate for Payer: Quartz Medicare Advantage |
$377.23
|
| Rate for Payer: The Alliance Commercial |
$1,508.92
|
| Rate for Payer: United Healthcare Medicare Advantage |
$377.23
|
| Rate for Payer: United Healthcare PPO |
$278.46
|
| Rate for Payer: WEA Trust Commercial |
$204.20
|
| Rate for Payer: Wellcare Medicare |
$377.23
|
| Rate for Payer: WPS Commercial |
$275.00
|
|
|
Panel *4 - ID Bill
|
Facility
|
IP
|
$357.00
|
|
|
Service Code
|
CPT 86870
|
| Hospital Charge Code |
2952708
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$181.93 |
| Max. Negotiated Rate |
$341.58 |
| Rate for Payer: Aetna Commercial |
$334.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$319.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$196.78
|
| Rate for Payer: Cash Price |
$107.10
|
| Rate for Payer: Cigna Commercial |
$341.58
|
| Rate for Payer: Health EOS Commercial |
$330.44
|
| Rate for Payer: HFN Commercial |
$341.58
|
| Rate for Payer: Multiplan Commercial |
$297.02
|
| Rate for Payer: Preferred Network Access Commercial |
$341.58
|
| Rate for Payer: Quartz Beloit One Network |
$181.93
|
| Rate for Payer: Quartz Commercial |
$222.77
|
| Rate for Payer: WEA Trust Commercial |
$204.20
|
| Rate for Payer: WPS Commercial |
$275.00
|
|
|
Papaverine 30mg/1ml 2ml SDV [Med]
|
Facility
|
OP
|
$172.00
|
|
|
Service Code
|
HCPCS J2440
|
| Hospital Charge Code |
2974968
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$50.09 |
| Max. Negotiated Rate |
$164.57 |
| Rate for Payer: Aetna Commercial |
$160.99
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$153.84
|
| Rate for Payer: Aetna Managed Medicare |
$50.09
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$116.27
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$89.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$85.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$94.81
|
| Rate for Payer: Cash Price |
$51.60
|
| Rate for Payer: Cigna Commercial |
$164.57
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$100.10
|
| Rate for Payer: Health EOS Commercial |
$159.20
|
| Rate for Payer: HFN Commercial |
$164.57
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$134.16
|
| Rate for Payer: Multiplan Commercial |
$143.10
|
| Rate for Payer: NAPHCARE Commercial |
$107.33
|
| Rate for Payer: Preferred Network Access Commercial |
$164.57
|
| Rate for Payer: Quartz Beloit One Network |
$87.65
|
| Rate for Payer: Quartz Commercial |
$116.27
|
| Rate for Payer: Quartz Medicare Advantage |
$107.33
|
| Rate for Payer: The Alliance Commercial |
$89.44
|
| Rate for Payer: WEA Trust Commercial |
$98.38
|
| Rate for Payer: WPS Commercial |
$132.49
|
|
|
Papaverine 30mg/1ml 2ml SDV [Med]
|
Facility
|
IP
|
$172.00
|
|
|
Service Code
|
HCPCS J2440
|
| Hospital Charge Code |
2974968
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$87.65 |
| Max. Negotiated Rate |
$164.57 |
| Rate for Payer: Aetna Commercial |
$160.99
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$153.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$94.81
|
| Rate for Payer: Cash Price |
$51.60
|
| Rate for Payer: Cigna Commercial |
$164.57
|
| Rate for Payer: Health EOS Commercial |
$159.20
|
| Rate for Payer: HFN Commercial |
$164.57
|
| Rate for Payer: Multiplan Commercial |
$143.10
|
| Rate for Payer: Preferred Network Access Commercial |
$164.57
|
| Rate for Payer: Quartz Beloit One Network |
$87.65
|
| Rate for Payer: Quartz Commercial |
$107.33
|
| Rate for Payer: WEA Trust Commercial |
$98.38
|
| Rate for Payer: WPS Commercial |
$132.49
|
|
|
PAP SMEARS
|
Facility
|
OP
|
$23.59
|
|
|
Service Code
|
EAPG 00392
|
| Min. Negotiated Rate |
$22.68 |
| Max. Negotiated Rate |
$23.59 |
| Rate for Payer: Anthem Medicaid |
$22.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$22.68
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$22.68
|
| Rate for Payer: Dean Health Medicaid |
$22.68
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$22.68
|
| Rate for Payer: Managed Health Services Medicaid |
$23.59
|
| Rate for Payer: Molina Healthcare Medicaid |
$22.68
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$22.68
|
| Rate for Payer: United Healthcare Medicaid |
$22.68
|
|
|
Paracentesis Performed By
|
Facility
|
OP
|
$1,453.00
|
|
|
Service Code
|
CPT 49082
|
| Hospital Charge Code |
2844881
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$313.04 |
| Max. Negotiated Rate |
$4,947.89 |
| Rate for Payer: Aetna Commercial |
$1,360.01
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,299.56
|
| Rate for Payer: Aetna Managed Medicare |
$954.50
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$982.23
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$755.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$725.34
|
| Rate for Payer: Anthem Medicare Advantage |
$954.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$800.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$954.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$954.50
|
| Rate for Payer: Cash Price |
$435.90
|
| Rate for Payer: Cash Price |
$435.90
|
| Rate for Payer: Cash Price |
$435.90
|
| Rate for Payer: Cigna Commercial |
$1,390.23
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$954.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,947.89
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$954.50
|
| Rate for Payer: Health EOS Commercial |
$1,344.90
|
| Rate for Payer: HFN Commercial |
$1,390.23
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,550.75
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$954.50
|
| Rate for Payer: Independent Care Health Plan Medicare |
$954.50
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$954.50
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$954.50
|
| Rate for Payer: Multiplan Commercial |
$1,208.90
|
| Rate for Payer: NAPHCARE Commercial |
$1,431.75
|
| Rate for Payer: Preferred Network Access Commercial |
$1,390.23
|
| Rate for Payer: Quartz Beloit One Network |
$740.45
|
| Rate for Payer: Quartz Commercial |
$982.23
|
| Rate for Payer: Quartz Medicare Advantage |
$954.50
|
| Rate for Payer: The Alliance Commercial |
$3,818.01
|
| Rate for Payer: United Healthcare Medicare Advantage |
$954.50
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$831.12
|
| Rate for Payer: Wellcare Medicare |
$954.50
|
| Rate for Payer: WPS Commercial |
$1,119.25
|
|
|
Paracentesis Performed By
|
Facility
|
IP
|
$1,453.00
|
|
|
Service Code
|
CPT 49082
|
| Hospital Charge Code |
2844881
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$740.45 |
| Max. Negotiated Rate |
$1,390.23 |
| Rate for Payer: Aetna Commercial |
$1,360.01
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,299.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$800.89
|
| Rate for Payer: Cash Price |
$435.90
|
| Rate for Payer: Cigna Commercial |
$1,390.23
|
| Rate for Payer: Health EOS Commercial |
$1,344.90
|
| Rate for Payer: HFN Commercial |
$1,390.23
|
| Rate for Payer: Multiplan Commercial |
$1,208.90
|
| Rate for Payer: Preferred Network Access Commercial |
$1,390.23
|
| Rate for Payer: Quartz Beloit One Network |
$740.45
|
| Rate for Payer: Quartz Commercial |
$906.67
|
| Rate for Payer: WEA Trust Commercial |
$831.12
|
| Rate for Payer: WPS Commercial |
$1,119.25
|
|
|
Paracervical/Pudendal Block Kit - Individual Charges
|
Facility
|
IP
|
$249.00
|
|
| Hospital Charge Code |
3004344
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$126.89 |
| Max. Negotiated Rate |
$238.24 |
| Rate for Payer: Aetna Commercial |
$233.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$222.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$137.25
|
| Rate for Payer: Cash Price |
$74.70
|
| Rate for Payer: Cigna Commercial |
$238.24
|
| Rate for Payer: Health EOS Commercial |
$230.47
|
| Rate for Payer: HFN Commercial |
$238.24
|
| Rate for Payer: Multiplan Commercial |
$207.17
|
| Rate for Payer: Preferred Network Access Commercial |
$238.24
|
| Rate for Payer: Quartz Beloit One Network |
$126.89
|
| Rate for Payer: Quartz Commercial |
$155.38
|
| Rate for Payer: WEA Trust Commercial |
$142.43
|
| Rate for Payer: WPS Commercial |
$191.80
|
|
|
Paracervical/Pudendal Block Kit - Individual Charges
|
Facility
|
OP
|
$249.00
|
|
| Hospital Charge Code |
3004344
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$72.51 |
| Max. Negotiated Rate |
$238.24 |
| Rate for Payer: Aetna Commercial |
$233.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$222.71
|
| Rate for Payer: Aetna Managed Medicare |
$72.51
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$168.32
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$129.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$124.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$137.25
|
| Rate for Payer: Cash Price |
$74.70
|
| Rate for Payer: Cigna Commercial |
$238.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$144.92
|
| Rate for Payer: Health EOS Commercial |
$230.47
|
| Rate for Payer: HFN Commercial |
$238.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$194.22
|
| Rate for Payer: Multiplan Commercial |
$207.17
|
| Rate for Payer: NAPHCARE Commercial |
$155.38
|
| Rate for Payer: Preferred Network Access Commercial |
$238.24
|
| Rate for Payer: Quartz Beloit One Network |
$126.89
|
| Rate for Payer: Quartz Commercial |
$168.32
|
| Rate for Payer: Quartz Medicare Advantage |
$155.38
|
| Rate for Payer: The Alliance Commercial |
$129.48
|
| Rate for Payer: WEA Trust Commercial |
$142.43
|
| Rate for Payer: WPS Commercial |
$191.80
|
|
