|
PELVIC PLATE L STRAIGHT 122.5MM X 8HL 425708
|
Facility
|
OP
|
$4,218.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6198986
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,228.28 |
| Max. Negotiated Rate |
$4,035.78 |
| Rate for Payer: Aetna Commercial |
$3,948.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,772.58
|
| Rate for Payer: Aetna Managed Medicare |
$1,228.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,851.37
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,193.36
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,105.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,324.96
|
| Rate for Payer: Cash Price |
$1,265.40
|
| Rate for Payer: Cigna Commercial |
$4,035.78
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,454.88
|
| Rate for Payer: Health EOS Commercial |
$3,904.18
|
| Rate for Payer: HFN Commercial |
$4,035.78
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,290.04
|
| Rate for Payer: Multiplan Commercial |
$3,509.38
|
| Rate for Payer: NAPHCARE Commercial |
$2,632.03
|
| Rate for Payer: Preferred Network Access Commercial |
$4,035.78
|
| Rate for Payer: Quartz Beloit One Network |
$2,149.49
|
| Rate for Payer: Quartz Commercial |
$2,851.37
|
| Rate for Payer: Quartz Medicare Advantage |
$2,632.03
|
| Rate for Payer: The Alliance Commercial |
$2,193.36
|
| Rate for Payer: WEA Trust Commercial |
$2,412.70
|
| Rate for Payer: WPS Commercial |
$3,249.13
|
|
|
PELVIS, FEMUR AND UPPER LEG PROCEDURES
|
Facility
|
OP
|
$1,567.12
|
|
|
Service Code
|
EAPG 00027
|
| Min. Negotiated Rate |
$1,506.84 |
| Max. Negotiated Rate |
$1,567.12 |
| Rate for Payer: Anthem Medicaid |
$1,506.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$1,506.84
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,506.84
|
| Rate for Payer: Dean Health Medicaid |
$1,506.84
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$1,506.84
|
| Rate for Payer: Managed Health Services Medicaid |
$1,567.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,506.84
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$1,506.84
|
| Rate for Payer: United Healthcare Medicaid |
$1,506.84
|
|
|
PENCIL HAND SWITCHING DISP E2515H
|
Facility
|
OP
|
$111.00
|
|
| Hospital Charge Code |
2963133
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$32.32 |
| Max. Negotiated Rate |
$106.20 |
| Rate for Payer: Aetna Commercial |
$103.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$99.28
|
| Rate for Payer: Aetna Managed Medicare |
$32.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$75.04
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$57.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$55.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$61.18
|
| Rate for Payer: Cash Price |
$33.30
|
| Rate for Payer: Cigna Commercial |
$106.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$64.60
|
| Rate for Payer: Health EOS Commercial |
$102.74
|
| Rate for Payer: HFN Commercial |
$106.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$86.58
|
| Rate for Payer: Multiplan Commercial |
$92.35
|
| Rate for Payer: NAPHCARE Commercial |
$69.26
|
| Rate for Payer: Preferred Network Access Commercial |
$106.20
|
| Rate for Payer: Quartz Beloit One Network |
$56.57
|
| Rate for Payer: Quartz Commercial |
$75.04
|
| Rate for Payer: Quartz Medicare Advantage |
$69.26
|
| Rate for Payer: The Alliance Commercial |
$57.72
|
| Rate for Payer: WEA Trust Commercial |
$63.49
|
| Rate for Payer: WPS Commercial |
$85.50
|
|
|
PENCIL HAND SWITCHING DISP E2515H
|
Facility
|
IP
|
$111.00
|
|
| Hospital Charge Code |
2963133
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$56.57 |
| Max. Negotiated Rate |
$106.20 |
| Rate for Payer: Aetna Commercial |
$103.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$99.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$61.18
|
| Rate for Payer: Cash Price |
$33.30
|
| Rate for Payer: Cigna Commercial |
$106.20
|
| Rate for Payer: Health EOS Commercial |
$102.74
|
| Rate for Payer: HFN Commercial |
$106.20
|
| Rate for Payer: Multiplan Commercial |
$92.35
|
| Rate for Payer: Preferred Network Access Commercial |
$106.20
|
| Rate for Payer: Quartz Beloit One Network |
$56.57
|
| Rate for Payer: Quartz Commercial |
$69.26
|
| Rate for Payer: WEA Trust Commercial |
$63.49
|
| Rate for Payer: WPS Commercial |
$85.50
|
|
|
PENCIL SMOKE EVAC 0703-046-000
|
Facility
|
IP
|
$667.00
|
|
| Hospital Charge Code |
4520032
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$339.90 |
| Max. Negotiated Rate |
$638.19 |
| Rate for Payer: Aetna Commercial |
$624.31
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$596.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$367.65
|
| Rate for Payer: Cash Price |
$200.10
|
| Rate for Payer: Cigna Commercial |
$638.19
|
| Rate for Payer: Health EOS Commercial |
$617.38
|
| Rate for Payer: HFN Commercial |
$638.19
|
| Rate for Payer: Multiplan Commercial |
$554.94
|
| Rate for Payer: Preferred Network Access Commercial |
$638.19
|
| Rate for Payer: Quartz Beloit One Network |
$339.90
|
| Rate for Payer: Quartz Commercial |
$416.21
|
| Rate for Payer: WEA Trust Commercial |
$381.52
|
| Rate for Payer: WPS Commercial |
$513.79
|
|
|
PENCIL SMOKE EVAC 0703-046-000
|
Facility
|
OP
|
$667.00
|
|
| Hospital Charge Code |
4520032
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$194.23 |
| Max. Negotiated Rate |
$638.19 |
| Rate for Payer: Aetna Commercial |
$624.31
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$596.56
|
| Rate for Payer: Aetna Managed Medicare |
$194.23
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$450.89
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$346.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$332.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$367.65
|
| Rate for Payer: Cash Price |
$200.10
|
| Rate for Payer: Cigna Commercial |
$638.19
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$388.19
|
| Rate for Payer: Health EOS Commercial |
$617.38
|
| Rate for Payer: HFN Commercial |
$638.19
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$520.26
|
| Rate for Payer: Multiplan Commercial |
$554.94
|
| Rate for Payer: NAPHCARE Commercial |
$416.21
|
| Rate for Payer: Preferred Network Access Commercial |
$638.19
|
| Rate for Payer: Quartz Beloit One Network |
$339.90
|
| Rate for Payer: Quartz Commercial |
$450.89
|
| Rate for Payer: Quartz Medicare Advantage |
$416.21
|
| Rate for Payer: The Alliance Commercial |
$346.84
|
| Rate for Payer: WEA Trust Commercial |
$381.52
|
| Rate for Payer: WPS Commercial |
$513.79
|
|
|
PEN ELECTRODE ISOLATOR 20MM MLP1
|
Facility
|
IP
|
$17,682.00
|
|
| Hospital Charge Code |
2964753
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$9,010.75 |
| Max. Negotiated Rate |
$16,918.14 |
| Rate for Payer: Aetna Commercial |
$16,550.35
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$15,814.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,746.32
|
| Rate for Payer: Cash Price |
$5,304.60
|
| Rate for Payer: Cigna Commercial |
$16,918.14
|
| Rate for Payer: Health EOS Commercial |
$16,366.46
|
| Rate for Payer: HFN Commercial |
$16,918.14
|
| Rate for Payer: Multiplan Commercial |
$14,711.42
|
| Rate for Payer: Preferred Network Access Commercial |
$16,918.14
|
| Rate for Payer: Quartz Beloit One Network |
$9,010.75
|
| Rate for Payer: Quartz Commercial |
$11,033.57
|
| Rate for Payer: WEA Trust Commercial |
$10,114.10
|
| Rate for Payer: WPS Commercial |
$13,620.44
|
|
|
PEN ELECTRODE ISOLATOR 20MM MLP1
|
Facility
|
OP
|
$17,682.00
|
|
| Hospital Charge Code |
2964753
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5,149.00 |
| Max. Negotiated Rate |
$16,918.14 |
| Rate for Payer: Aetna Commercial |
$16,550.35
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$15,814.78
|
| Rate for Payer: Aetna Managed Medicare |
$5,149.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$11,953.03
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$9,194.64
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$8,826.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,746.32
|
| Rate for Payer: Cash Price |
$5,304.60
|
| Rate for Payer: Cigna Commercial |
$16,918.14
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$10,290.92
|
| Rate for Payer: Health EOS Commercial |
$16,366.46
|
| Rate for Payer: HFN Commercial |
$16,918.14
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$13,791.96
|
| Rate for Payer: Multiplan Commercial |
$14,711.42
|
| Rate for Payer: NAPHCARE Commercial |
$11,033.57
|
| Rate for Payer: Preferred Network Access Commercial |
$16,918.14
|
| Rate for Payer: Quartz Beloit One Network |
$9,010.75
|
| Rate for Payer: Quartz Commercial |
$11,953.03
|
| Rate for Payer: Quartz Medicare Advantage |
$11,033.57
|
| Rate for Payer: The Alliance Commercial |
$9,194.64
|
| Rate for Payer: WEA Trust Commercial |
$10,114.10
|
| Rate for Payer: WPS Commercial |
$13,620.44
|
|
|
Penicillin G Benzathine 100,000=1 uniti Charge
|
Professional
|
Both
|
$64.00
|
|
|
Service Code
|
HCPCS J0561
|
| Hospital Charge Code |
2983535
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$22.88 |
| Max. Negotiated Rate |
$91.43 |
| Rate for Payer: Aetna Commercial |
$63.23
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$57.24
|
| Rate for Payer: Aetna Managed Medicare |
$33.25
|
| Rate for Payer: Anthem Medicare Advantage |
$33.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$33.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$33.25
|
| Rate for Payer: Cash Price |
$19.20
|
| Rate for Payer: Cash Price |
$19.20
|
| Rate for Payer: Cigna Commercial |
$63.23
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$33.25
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$22.88
|
| Rate for Payer: Health EOS Commercial |
$60.57
|
| Rate for Payer: HFN Commercial |
$63.23
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$23.13
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$23.13
|
| Rate for Payer: Independent Care Health Plan Medicare |
$33.25
|
| Rate for Payer: Multiplan Commercial |
$53.25
|
| Rate for Payer: NAPHCARE Commercial |
$49.87
|
| Rate for Payer: Preferred Network Access Commercial |
$63.23
|
| Rate for Payer: Quartz Beloit One Network |
$29.29
|
| Rate for Payer: Quartz Commercial |
$37.94
|
| Rate for Payer: Quartz Medicare Advantage |
$33.25
|
| Rate for Payer: The Alliance Commercial |
$91.43
|
| Rate for Payer: United Healthcare Medicaid |
$33.25
|
| Rate for Payer: United Healthcare Medicare Advantage |
$33.25
|
| Rate for Payer: WEA Trust Commercial |
$36.61
|
| Rate for Payer: WPS Commercial |
$57.19
|
|
|
Penicillin G Benzathine 100,000=1 uniti Charge
|
Facility
|
OP
|
$64.00
|
|
|
Service Code
|
HCPCS J0561
|
| Hospital Charge Code |
2983535
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$30.27 |
| Max. Negotiated Rate |
$133.00 |
| Rate for Payer: Aetna Commercial |
$59.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$57.24
|
| Rate for Payer: Aetna Managed Medicare |
$33.25
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$43.26
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$33.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$31.95
|
| Rate for Payer: Anthem Medicare Advantage |
$33.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$35.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$33.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$33.25
|
| Rate for Payer: Cash Price |
$19.20
|
| Rate for Payer: Cash Price |
$19.20
|
| Rate for Payer: Cigna Commercial |
$61.24
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$33.25
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$30.27
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$33.25
|
| Rate for Payer: Health EOS Commercial |
$59.24
|
| Rate for Payer: HFN Commercial |
$61.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$123.69
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$33.25
|
| Rate for Payer: Independent Care Health Plan Medicare |
$33.25
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$33.25
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$33.25
|
| Rate for Payer: Multiplan Commercial |
$53.25
|
| Rate for Payer: NAPHCARE Commercial |
$49.87
|
| Rate for Payer: Preferred Network Access Commercial |
$61.24
|
| Rate for Payer: Quartz Beloit One Network |
$32.61
|
| Rate for Payer: Quartz Commercial |
$43.26
|
| Rate for Payer: Quartz Medicare Advantage |
$33.25
|
| Rate for Payer: The Alliance Commercial |
$133.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$33.25
|
| Rate for Payer: WEA Trust Commercial |
$36.61
|
| Rate for Payer: Wellcare Medicare |
$33.25
|
| Rate for Payer: WPS Commercial |
$57.19
|
|
|
Penicillin G Benzathine 100,000=1 uniti Charge
|
Facility
|
IP
|
$64.00
|
|
|
Service Code
|
HCPCS J0561
|
| Hospital Charge Code |
2983535
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$32.61 |
| Max. Negotiated Rate |
$61.24 |
| Rate for Payer: Aetna Commercial |
$59.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$57.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$35.28
|
| Rate for Payer: Cash Price |
$19.20
|
| Rate for Payer: Cigna Commercial |
$61.24
|
| Rate for Payer: Health EOS Commercial |
$59.24
|
| Rate for Payer: HFN Commercial |
$61.24
|
| Rate for Payer: Multiplan Commercial |
$53.25
|
| Rate for Payer: Preferred Network Access Commercial |
$61.24
|
| Rate for Payer: Quartz Beloit One Network |
$32.61
|
| Rate for Payer: Quartz Commercial |
$39.94
|
| Rate for Payer: WEA Trust Commercial |
$36.61
|
| Rate for Payer: WPS Commercial |
$49.30
|
|
|
Penicillin G Benzathine JW Waste Chg per 100,000 u
|
Facility
|
OP
|
$53.00
|
|
|
Service Code
|
HCPCS J0561 JW
|
| Hospital Charge Code |
5266701
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$15.43 |
| Max. Negotiated Rate |
$57.19 |
| Rate for Payer: Aetna Commercial |
$49.61
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$47.40
|
| Rate for Payer: Aetna Managed Medicare |
$15.43
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$35.83
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$27.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$26.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$29.21
|
| Rate for Payer: Cash Price |
$15.90
|
| Rate for Payer: Cash Price |
$15.90
|
| Rate for Payer: Cigna Commercial |
$50.71
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$30.27
|
| Rate for Payer: Health EOS Commercial |
$49.06
|
| Rate for Payer: HFN Commercial |
$50.71
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$41.34
|
| Rate for Payer: Multiplan Commercial |
$44.10
|
| Rate for Payer: NAPHCARE Commercial |
$33.07
|
| Rate for Payer: Preferred Network Access Commercial |
$50.71
|
| Rate for Payer: Quartz Beloit One Network |
$27.01
|
| Rate for Payer: Quartz Commercial |
$35.83
|
| Rate for Payer: Quartz Medicare Advantage |
$33.07
|
| Rate for Payer: The Alliance Commercial |
$27.56
|
| Rate for Payer: WEA Trust Commercial |
$30.32
|
| Rate for Payer: WPS Commercial |
$57.19
|
|
|
Penicillin G Benzathine JW Waste Chg per 100,000 u
|
Facility
|
IP
|
$53.00
|
|
|
Service Code
|
HCPCS J0561 JW
|
| Hospital Charge Code |
5266701
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$27.01 |
| Max. Negotiated Rate |
$50.71 |
| Rate for Payer: Aetna Commercial |
$49.61
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$47.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$29.21
|
| Rate for Payer: Cash Price |
$15.90
|
| Rate for Payer: Cigna Commercial |
$50.71
|
| Rate for Payer: Health EOS Commercial |
$49.06
|
| Rate for Payer: HFN Commercial |
$50.71
|
| Rate for Payer: Multiplan Commercial |
$44.10
|
| Rate for Payer: Preferred Network Access Commercial |
$50.71
|
| Rate for Payer: Quartz Beloit One Network |
$27.01
|
| Rate for Payer: Quartz Commercial |
$33.07
|
| Rate for Payer: WEA Trust Commercial |
$30.32
|
| Rate for Payer: WPS Commercial |
$40.83
|
|
|
Penicillin G Benzathine JW Waste Chg per 100,000 u
|
Professional
|
Both
|
$53.00
|
|
|
Service Code
|
HCPCS J0561 JW
|
| Hospital Charge Code |
5266701
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$22.88 |
| Max. Negotiated Rate |
$57.19 |
| Rate for Payer: Aetna Commercial |
$52.36
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$47.40
|
| Rate for Payer: Cash Price |
$15.90
|
| Rate for Payer: Cash Price |
$15.90
|
| Rate for Payer: Cigna Commercial |
$52.36
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$33.25
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$22.88
|
| Rate for Payer: Health EOS Commercial |
$50.16
|
| Rate for Payer: HFN Commercial |
$52.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$23.13
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$23.13
|
| Rate for Payer: Multiplan Commercial |
$44.10
|
| Rate for Payer: Preferred Network Access Commercial |
$52.36
|
| Rate for Payer: Quartz Beloit One Network |
$24.25
|
| Rate for Payer: Quartz Commercial |
$31.42
|
| Rate for Payer: The Alliance Commercial |
$27.56
|
| Rate for Payer: United Healthcare Medicaid |
$33.25
|
| Rate for Payer: WEA Trust Commercial |
$30.32
|
| Rate for Payer: WPS Commercial |
$57.19
|
|
|
Penicillin G / Procaine 1,200,000 Charge
|
Facility
|
IP
|
$521.00
|
|
|
Service Code
|
HCPCS J0558
|
| Hospital Charge Code |
2983474
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$265.50 |
| Max. Negotiated Rate |
$498.49 |
| Rate for Payer: Aetna Commercial |
$487.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$465.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$287.18
|
| Rate for Payer: Cash Price |
$156.30
|
| Rate for Payer: Cigna Commercial |
$498.49
|
| Rate for Payer: Health EOS Commercial |
$482.24
|
| Rate for Payer: HFN Commercial |
$498.49
|
| Rate for Payer: Multiplan Commercial |
$433.47
|
| Rate for Payer: Preferred Network Access Commercial |
$498.49
|
| Rate for Payer: Quartz Beloit One Network |
$265.50
|
| Rate for Payer: Quartz Commercial |
$325.10
|
| Rate for Payer: WEA Trust Commercial |
$298.01
|
| Rate for Payer: WPS Commercial |
$401.33
|
|
|
Penicillin G / Procaine 1,200,000 Charge
|
Facility
|
OP
|
$521.00
|
|
|
Service Code
|
HCPCS J0558
|
| Hospital Charge Code |
2983474
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$20.30 |
| Max. Negotiated Rate |
$498.49 |
| Rate for Payer: Aetna Commercial |
$487.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$465.98
|
| Rate for Payer: Aetna Managed Medicare |
$20.30
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$352.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$270.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$260.08
|
| Rate for Payer: Anthem Medicare Advantage |
$20.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$287.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$20.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$20.30
|
| Rate for Payer: Cash Price |
$156.30
|
| Rate for Payer: Cash Price |
$156.30
|
| Rate for Payer: Cigna Commercial |
$498.49
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$20.30
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$23.90
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$20.30
|
| Rate for Payer: Health EOS Commercial |
$482.24
|
| Rate for Payer: HFN Commercial |
$498.49
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$75.52
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$20.30
|
| Rate for Payer: Independent Care Health Plan Medicare |
$20.30
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$20.30
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$20.30
|
| Rate for Payer: Multiplan Commercial |
$433.47
|
| Rate for Payer: NAPHCARE Commercial |
$30.45
|
| Rate for Payer: Preferred Network Access Commercial |
$498.49
|
| Rate for Payer: Quartz Beloit One Network |
$265.50
|
| Rate for Payer: Quartz Commercial |
$352.20
|
| Rate for Payer: Quartz Medicare Advantage |
$20.30
|
| Rate for Payer: The Alliance Commercial |
$81.20
|
| Rate for Payer: United Healthcare Medicare Advantage |
$20.30
|
| Rate for Payer: WEA Trust Commercial |
$298.01
|
| Rate for Payer: Wellcare Medicare |
$20.30
|
| Rate for Payer: WPS Commercial |
$45.16
|
|
|
Penicillin G / Procaine 1,200,000 Charge
|
Professional
|
Both
|
$521.00
|
|
|
Service Code
|
HCPCS J0558
|
| Hospital Charge Code |
2983474
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$18.06 |
| Max. Negotiated Rate |
$514.75 |
| Rate for Payer: Aetna Commercial |
$514.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$465.98
|
| Rate for Payer: Aetna Managed Medicare |
$20.30
|
| Rate for Payer: Anthem Medicare Advantage |
$20.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$20.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$20.30
|
| Rate for Payer: Cash Price |
$156.30
|
| Rate for Payer: Cash Price |
$156.30
|
| Rate for Payer: Cigna Commercial |
$514.75
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$20.30
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$18.06
|
| Rate for Payer: Health EOS Commercial |
$493.07
|
| Rate for Payer: HFN Commercial |
$514.75
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$18.31
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$18.31
|
| Rate for Payer: Independent Care Health Plan Medicare |
$20.30
|
| Rate for Payer: Multiplan Commercial |
$433.47
|
| Rate for Payer: NAPHCARE Commercial |
$30.45
|
| Rate for Payer: Preferred Network Access Commercial |
$514.75
|
| Rate for Payer: Quartz Beloit One Network |
$238.41
|
| Rate for Payer: Quartz Commercial |
$308.85
|
| Rate for Payer: Quartz Medicare Advantage |
$20.30
|
| Rate for Payer: The Alliance Commercial |
$55.83
|
| Rate for Payer: United Healthcare Medicaid |
$20.30
|
| Rate for Payer: United Healthcare Medicare Advantage |
$20.30
|
| Rate for Payer: WEA Trust Commercial |
$298.01
|
| Rate for Payer: WPS Commercial |
$45.16
|
|
|
Penicillin V
|
Professional
|
Both
|
$37.00
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
5230629
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.43 |
| Max. Negotiated Rate |
$36.56 |
| Rate for Payer: Aetna Commercial |
$36.56
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$33.09
|
| Rate for Payer: Aetna Managed Medicare |
$5.43
|
| Rate for Payer: Anthem Medicare Advantage |
$5.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5.43
|
| Rate for Payer: Cash Price |
$11.10
|
| Rate for Payer: Cash Price |
$11.10
|
| Rate for Payer: Cigna Commercial |
$36.56
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$19.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5.43
|
| Rate for Payer: Health EOS Commercial |
$35.02
|
| Rate for Payer: HFN Commercial |
$36.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$19.17
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$19.17
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5.43
|
| Rate for Payer: Multiplan Commercial |
$30.78
|
| Rate for Payer: NAPHCARE Commercial |
$8.14
|
| Rate for Payer: Preferred Network Access Commercial |
$36.56
|
| Rate for Payer: Quartz Beloit One Network |
$16.93
|
| Rate for Payer: Quartz Commercial |
$21.93
|
| Rate for Payer: Quartz Medicare Advantage |
$5.43
|
| Rate for Payer: The Alliance Commercial |
$21.44
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.43
|
| Rate for Payer: WEA Trust Commercial |
$21.16
|
| Rate for Payer: WPS Commercial |
$23.89
|
|
|
Penicillin V
|
Facility
|
IP
|
$37.00
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
5230629
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.86 |
| Max. Negotiated Rate |
$35.40 |
| Rate for Payer: Aetna Commercial |
$34.63
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$33.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$20.39
|
| Rate for Payer: Cash Price |
$11.10
|
| Rate for Payer: Cigna Commercial |
$35.40
|
| Rate for Payer: Health EOS Commercial |
$34.25
|
| Rate for Payer: HFN Commercial |
$35.40
|
| Rate for Payer: Multiplan Commercial |
$30.78
|
| Rate for Payer: Preferred Network Access Commercial |
$35.40
|
| Rate for Payer: Quartz Beloit One Network |
$18.86
|
| Rate for Payer: Quartz Commercial |
$23.09
|
| Rate for Payer: WEA Trust Commercial |
$21.16
|
| Rate for Payer: WPS Commercial |
$28.50
|
|
|
Penicillin V
|
Facility
|
OP
|
$37.00
|
|
|
Service Code
|
CPT 86003
|
| Hospital Charge Code |
5230629
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.43 |
| Max. Negotiated Rate |
$35.40 |
| Rate for Payer: Aetna Commercial |
$34.63
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$33.09
|
| Rate for Payer: Aetna Managed Medicare |
$5.43
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$20.36
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$9.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$9.01
|
| Rate for Payer: Anthem Medicare Advantage |
$5.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$20.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5.43
|
| Rate for Payer: Cash Price |
$11.10
|
| Rate for Payer: Cash Price |
$11.10
|
| Rate for Payer: Cigna Commercial |
$35.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$5.43
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$21.53
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$5.43
|
| Rate for Payer: Health EOS Commercial |
$34.25
|
| Rate for Payer: HFN Commercial |
$35.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$20.20
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$5.43
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5.43
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$5.43
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$5.43
|
| Rate for Payer: Multiplan Commercial |
$30.78
|
| Rate for Payer: NAPHCARE Commercial |
$8.14
|
| Rate for Payer: Preferred Network Access Commercial |
$35.40
|
| Rate for Payer: Quartz Beloit One Network |
$18.86
|
| Rate for Payer: Quartz Commercial |
$25.01
|
| Rate for Payer: Quartz Medicare Advantage |
$5.43
|
| Rate for Payer: The Alliance Commercial |
$21.72
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.43
|
| Rate for Payer: United Healthcare PPO |
$28.86
|
| Rate for Payer: WEA Trust Commercial |
$21.16
|
| Rate for Payer: Wellcare Medicare |
$5.43
|
| Rate for Payer: WPS Commercial |
$28.50
|
|
|
PENILE CONDYLOMA, CAUTERY OF
|
Facility
|
OP
|
$1,006.00
|
|
| Hospital Charge Code |
2959948
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$292.95 |
| Max. Negotiated Rate |
$962.54 |
| Rate for Payer: Aetna Commercial |
$941.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$899.77
|
| Rate for Payer: Aetna Managed Medicare |
$292.95
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$680.06
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$523.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$502.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$554.51
|
| Rate for Payer: Cash Price |
$301.80
|
| Rate for Payer: Cigna Commercial |
$962.54
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$585.49
|
| Rate for Payer: Health EOS Commercial |
$931.15
|
| Rate for Payer: HFN Commercial |
$962.54
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$784.68
|
| Rate for Payer: Multiplan Commercial |
$836.99
|
| Rate for Payer: NAPHCARE Commercial |
$627.74
|
| Rate for Payer: Preferred Network Access Commercial |
$962.54
|
| Rate for Payer: Quartz Beloit One Network |
$512.66
|
| Rate for Payer: Quartz Commercial |
$680.06
|
| Rate for Payer: Quartz Medicare Advantage |
$627.74
|
| Rate for Payer: The Alliance Commercial |
$523.12
|
| Rate for Payer: WEA Trust Commercial |
$575.43
|
| Rate for Payer: WPS Commercial |
$774.92
|
|
|
PENILE CONDYLOMA, CAUTERY OF
|
Facility
|
IP
|
$1,006.00
|
|
| Hospital Charge Code |
2959948
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$512.66 |
| Max. Negotiated Rate |
$962.54 |
| Rate for Payer: Aetna Commercial |
$941.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$899.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$554.51
|
| Rate for Payer: Cash Price |
$301.80
|
| Rate for Payer: Cigna Commercial |
$962.54
|
| Rate for Payer: Health EOS Commercial |
$931.15
|
| Rate for Payer: HFN Commercial |
$962.54
|
| Rate for Payer: Multiplan Commercial |
$836.99
|
| Rate for Payer: Preferred Network Access Commercial |
$962.54
|
| Rate for Payer: Quartz Beloit One Network |
$512.66
|
| Rate for Payer: Quartz Commercial |
$627.74
|
| Rate for Payer: WEA Trust Commercial |
$575.43
|
| Rate for Payer: WPS Commercial |
$774.92
|
|
|
PENILE INJECTION 54235
|
Professional
|
Both
|
$387.00
|
|
|
Service Code
|
CPT 54235
|
| Hospital Charge Code |
3015029
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$66.20 |
| Max. Negotiated Rate |
$382.36 |
| Rate for Payer: Aetna Commercial |
$382.36
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$346.13
|
| Rate for Payer: Aetna Managed Medicare |
$66.20
|
| Rate for Payer: Anthem Medicare Advantage |
$66.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$66.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$66.20
|
| Rate for Payer: Cash Price |
$116.10
|
| Rate for Payer: Cash Price |
$116.10
|
| Rate for Payer: Cash Price |
$116.10
|
| Rate for Payer: Cigna Commercial |
$382.36
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$201.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$66.20
|
| Rate for Payer: Health EOS Commercial |
$366.26
|
| Rate for Payer: HFN Commercial |
$382.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$253.09
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$253.09
|
| Rate for Payer: Independent Care Health Plan Medicare |
$66.20
|
| Rate for Payer: Multiplan Commercial |
$321.98
|
| Rate for Payer: NAPHCARE Commercial |
$99.29
|
| Rate for Payer: Preferred Network Access Commercial |
$382.36
|
| Rate for Payer: Quartz Beloit One Network |
$177.09
|
| Rate for Payer: Quartz Commercial |
$229.41
|
| Rate for Payer: Quartz Medicare Advantage |
$66.20
|
| Rate for Payer: The Alliance Commercial |
$281.33
|
| Rate for Payer: United Healthcare Medicare Advantage |
$66.20
|
| Rate for Payer: WEA Trust Commercial |
$221.36
|
| Rate for Payer: WPS Commercial |
$297.88
|
|
|
PENILE PROSTHESIS
|
Facility
|
IP
|
$3,935.00
|
|
| Hospital Charge Code |
2960342
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,005.28 |
| Max. Negotiated Rate |
$3,765.01 |
| Rate for Payer: Aetna Commercial |
$3,683.16
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,519.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,168.97
|
| Rate for Payer: Cash Price |
$1,180.50
|
| Rate for Payer: Cigna Commercial |
$3,765.01
|
| Rate for Payer: Health EOS Commercial |
$3,642.24
|
| Rate for Payer: HFN Commercial |
$3,765.01
|
| Rate for Payer: Multiplan Commercial |
$3,273.92
|
| Rate for Payer: Preferred Network Access Commercial |
$3,765.01
|
| Rate for Payer: Quartz Beloit One Network |
$2,005.28
|
| Rate for Payer: Quartz Commercial |
$2,455.44
|
| Rate for Payer: WEA Trust Commercial |
$2,250.82
|
| Rate for Payer: WPS Commercial |
$3,031.13
|
|
|
PENILE PROSTHESIS
|
Facility
|
OP
|
$3,935.00
|
|
| Hospital Charge Code |
2960342
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,145.87 |
| Max. Negotiated Rate |
$3,765.01 |
| Rate for Payer: Aetna Commercial |
$3,683.16
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,519.46
|
| Rate for Payer: Aetna Managed Medicare |
$1,145.87
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,660.06
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,046.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,964.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,168.97
|
| Rate for Payer: Cash Price |
$1,180.50
|
| Rate for Payer: Cigna Commercial |
$3,765.01
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,290.17
|
| Rate for Payer: Health EOS Commercial |
$3,642.24
|
| Rate for Payer: HFN Commercial |
$3,765.01
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,069.30
|
| Rate for Payer: Multiplan Commercial |
$3,273.92
|
| Rate for Payer: NAPHCARE Commercial |
$2,455.44
|
| Rate for Payer: Preferred Network Access Commercial |
$3,765.01
|
| Rate for Payer: Quartz Beloit One Network |
$2,005.28
|
| Rate for Payer: Quartz Commercial |
$2,660.06
|
| Rate for Payer: Quartz Medicare Advantage |
$2,455.44
|
| Rate for Payer: The Alliance Commercial |
$2,046.20
|
| Rate for Payer: WEA Trust Commercial |
$2,250.82
|
| Rate for Payer: WPS Commercial |
$3,031.13
|
|
