|
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
|
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
|
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 *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 *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
|
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
|
|
|
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
|
|
|
PAP SMEARS
|
Facility
|
OP
|
$3.63
|
|
|
Service Code
|
EAPG 00392
|
| Min. Negotiated Rate |
$3.49 |
| Max. Negotiated Rate |
$3.63 |
| Rate for Payer: Anthem Medicaid |
$3.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$3.49
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$3.49
|
| Rate for Payer: Dean Health Medicaid |
$3.49
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$3.49
|
| Rate for Payer: Managed Health Services Medicaid |
$3.63
|
| Rate for Payer: Molina Healthcare Medicaid |
$3.49
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$3.49
|
| Rate for Payer: United Healthcare Medicaid |
$3.49
|
|
|
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
|
|
|
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
|
|
|
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
|
|
|
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
|
|
|
PARACHUTE DEVICE LESLIE 3.1 X 120 0 DEG 320-302
|
Facility
|
OP
|
$4,312.00
|
|
| Hospital Charge Code |
3295462
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,255.65 |
| Max. Negotiated Rate |
$4,125.72 |
| Rate for Payer: Quartz Medicare Advantage |
$2,690.69
|
| Rate for Payer: Aetna Commercial |
$4,036.03
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,856.65
|
| Rate for Payer: Aetna Managed Medicare |
$1,255.65
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,914.91
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,242.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,152.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,376.77
|
| Rate for Payer: Cash Price |
$1,293.60
|
| Rate for Payer: Cigna Commercial |
$4,125.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,509.58
|
| Rate for Payer: Health EOS Commercial |
$3,991.19
|
| Rate for Payer: HFN Commercial |
$4,125.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,363.36
|
| Rate for Payer: Multiplan Commercial |
$3,587.58
|
| Rate for Payer: NAPHCARE Commercial |
$2,690.69
|
| Rate for Payer: Preferred Network Access Commercial |
$4,125.72
|
| Rate for Payer: Quartz Beloit One Network |
$2,197.40
|
| Rate for Payer: Quartz Commercial |
$2,914.91
|
| Rate for Payer: The Alliance Commercial |
$2,242.24
|
| Rate for Payer: WEA Trust Commercial |
$2,466.46
|
| Rate for Payer: WPS Commercial |
$3,321.53
|
|
|
PARACHUTE DEVICE LESLIE 3.1 X 120 0 DEG 320-302
|
Facility
|
IP
|
$4,312.00
|
|
| Hospital Charge Code |
3295462
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,197.40 |
| Max. Negotiated Rate |
$4,125.72 |
| Rate for Payer: Aetna Commercial |
$4,036.03
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,856.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,376.77
|
| Rate for Payer: Cash Price |
$1,293.60
|
| Rate for Payer: Cigna Commercial |
$4,125.72
|
| Rate for Payer: Health EOS Commercial |
$3,991.19
|
| Rate for Payer: HFN Commercial |
$4,125.72
|
| Rate for Payer: Multiplan Commercial |
$3,587.58
|
| Rate for Payer: Preferred Network Access Commercial |
$4,125.72
|
| Rate for Payer: Quartz Beloit One Network |
$2,197.40
|
| Rate for Payer: Quartz Commercial |
$2,690.69
|
| Rate for Payer: WEA Trust Commercial |
$2,466.46
|
| Rate for Payer: WPS Commercial |
$3,321.53
|
|
|
PARAFFIN ECONOMY 6# BK #514203
|
Facility
|
IP
|
$312.00
|
|
| Hospital Charge Code |
2970914
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$159.00 |
| Max. Negotiated Rate |
$298.52 |
| Rate for Payer: Aetna Commercial |
$292.03
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$279.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$171.97
|
| Rate for Payer: Cash Price |
$93.60
|
| Rate for Payer: Cigna Commercial |
$298.52
|
| Rate for Payer: Health EOS Commercial |
$288.79
|
| Rate for Payer: HFN Commercial |
$298.52
|
| Rate for Payer: Multiplan Commercial |
$259.58
|
| Rate for Payer: Preferred Network Access Commercial |
$298.52
|
| Rate for Payer: Quartz Beloit One Network |
$159.00
|
| Rate for Payer: Quartz Commercial |
$194.69
|
| Rate for Payer: WEA Trust Commercial |
$178.46
|
| Rate for Payer: WPS Commercial |
$240.33
|
|
|
PARAFFIN ECONOMY 6# BK #514203
|
Facility
|
OP
|
$312.00
|
|
| Hospital Charge Code |
2970914
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$90.85 |
| Max. Negotiated Rate |
$298.52 |
| Rate for Payer: Aetna Commercial |
$292.03
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$279.05
|
| Rate for Payer: Aetna Managed Medicare |
$90.85
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$210.91
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$162.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$155.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$171.97
|
| Rate for Payer: Cash Price |
$93.60
|
| Rate for Payer: Cigna Commercial |
$298.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$181.58
|
| Rate for Payer: Health EOS Commercial |
$288.79
|
| Rate for Payer: HFN Commercial |
$298.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$243.36
|
| Rate for Payer: Multiplan Commercial |
$259.58
|
| Rate for Payer: NAPHCARE Commercial |
$194.69
|
| Rate for Payer: Preferred Network Access Commercial |
$298.52
|
| Rate for Payer: Quartz Beloit One Network |
$159.00
|
| Rate for Payer: Quartz Commercial |
$210.91
|
| Rate for Payer: Quartz Medicare Advantage |
$194.69
|
| Rate for Payer: The Alliance Commercial |
$162.24
|
| Rate for Payer: WEA Trust Commercial |
$178.46
|
| Rate for Payer: WPS Commercial |
$240.33
|
|
|
Paragard 1 Unit Charge
|
Facility
|
OP
|
$2,654.00
|
|
|
Service Code
|
HCPCS J7300
|
| Hospital Charge Code |
2958958
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$772.84 |
| Max. Negotiated Rate |
$2,539.35 |
| Rate for Payer: Aetna Commercial |
$2,484.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,373.74
|
| Rate for Payer: Aetna Managed Medicare |
$772.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,794.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,380.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,324.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,462.88
|
| Rate for Payer: Cash Price |
$796.20
|
| Rate for Payer: Cigna Commercial |
$2,539.35
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,544.63
|
| Rate for Payer: Health EOS Commercial |
$2,456.54
|
| Rate for Payer: HFN Commercial |
$2,539.35
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,070.12
|
| Rate for Payer: Multiplan Commercial |
$2,208.13
|
| Rate for Payer: NAPHCARE Commercial |
$1,656.10
|
| Rate for Payer: Preferred Network Access Commercial |
$2,539.35
|
| Rate for Payer: Quartz Beloit One Network |
$1,352.48
|
| Rate for Payer: Quartz Commercial |
$1,794.10
|
| Rate for Payer: Quartz Medicare Advantage |
$1,656.10
|
| Rate for Payer: The Alliance Commercial |
$1,380.08
|
| Rate for Payer: WEA Trust Commercial |
$1,518.09
|
| Rate for Payer: WPS Commercial |
$2,044.38
|
|
|
Paragard 1 Unit Charge
|
Professional
|
Both
|
$2,654.00
|
|
|
Service Code
|
HCPCS J7300
|
| Hospital Charge Code |
2958958
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$974.48 |
| Max. Negotiated Rate |
$2,622.15 |
| Rate for Payer: Aetna Commercial |
$2,622.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,373.74
|
| Rate for Payer: Anthem Commercial |
$974.48
|
| Rate for Payer: Cash Price |
$796.20
|
| Rate for Payer: Cash Price |
$796.20
|
| Rate for Payer: Cigna Commercial |
$2,622.15
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,184.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,656.10
|
| Rate for Payer: Health EOS Commercial |
$2,511.75
|
| Rate for Payer: HFN Commercial |
$2,622.15
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,376.60
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,376.60
|
| Rate for Payer: Multiplan Commercial |
$2,208.13
|
| Rate for Payer: Preferred Network Access Commercial |
$2,622.15
|
| Rate for Payer: Quartz Beloit One Network |
$1,214.47
|
| Rate for Payer: Quartz Commercial |
$1,573.29
|
| Rate for Payer: The Alliance Commercial |
$1,380.08
|
| Rate for Payer: United Healthcare Medicaid |
$1,184.56
|
| Rate for Payer: WEA Trust Commercial |
$1,518.09
|
| Rate for Payer: WPS Commercial |
$2,044.38
|
|
|
Paragard 1 Unit Charge
|
Facility
|
IP
|
$2,654.00
|
|
|
Service Code
|
HCPCS J7300
|
| Hospital Charge Code |
2958958
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,352.48 |
| Max. Negotiated Rate |
$2,539.35 |
| Rate for Payer: Aetna Commercial |
$2,484.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,373.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,462.88
|
| Rate for Payer: Cash Price |
$796.20
|
| Rate for Payer: Cigna Commercial |
$2,539.35
|
| Rate for Payer: Health EOS Commercial |
$2,456.54
|
| Rate for Payer: HFN Commercial |
$2,539.35
|
| Rate for Payer: Multiplan Commercial |
$2,208.13
|
| Rate for Payer: Preferred Network Access Commercial |
$2,539.35
|
| Rate for Payer: Quartz Beloit One Network |
$1,352.48
|
| Rate for Payer: Quartz Commercial |
$1,656.10
|
| Rate for Payer: WEA Trust Commercial |
$1,518.09
|
| Rate for Payer: WPS Commercial |
$2,044.38
|
|
|
.Paraneoplastic Ab, Line Blot
|
Facility
|
IP
|
$100.46
|
|
|
Service Code
|
CPT 86043
|
| Hospital Charge Code |
6187207
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$51.19 |
| Max. Negotiated Rate |
$96.12 |
| Rate for Payer: Aetna Commercial |
$94.03
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$89.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$55.37
|
| Rate for Payer: Cash Price |
$30.14
|
| Rate for Payer: Cigna Commercial |
$96.12
|
| Rate for Payer: Health EOS Commercial |
$92.99
|
| Rate for Payer: HFN Commercial |
$96.12
|
| Rate for Payer: Multiplan Commercial |
$83.58
|
| Rate for Payer: Preferred Network Access Commercial |
$96.12
|
| Rate for Payer: Quartz Beloit One Network |
$51.19
|
| Rate for Payer: Quartz Commercial |
$62.69
|
| Rate for Payer: WEA Trust Commercial |
$57.46
|
| Rate for Payer: WPS Commercial |
$77.38
|
|
