|
Parietal Cell Antibody Screen
|
Facility
|
OP
|
$235.00
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
978033
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.53 |
| Max. Negotiated Rate |
$224.85 |
| Rate for Payer: Aetna Commercial |
$219.96
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$210.18
|
| Rate for Payer: Aetna Managed Medicare |
$12.53
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$46.99
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$21.93
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$20.80
|
| Rate for Payer: Anthem Medicare Advantage |
$12.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$129.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$12.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$12.53
|
| Rate for Payer: Cash Price |
$70.50
|
| Rate for Payer: Cash Price |
$70.50
|
| Rate for Payer: Cigna Commercial |
$224.85
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$12.53
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$136.77
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$12.53
|
| Rate for Payer: Health EOS Commercial |
$217.52
|
| Rate for Payer: HFN Commercial |
$224.85
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$46.62
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$12.53
|
| Rate for Payer: Independent Care Health Plan Medicare |
$12.53
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$12.53
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$12.53
|
| Rate for Payer: Multiplan Commercial |
$195.52
|
| Rate for Payer: NAPHCARE Commercial |
$18.80
|
| Rate for Payer: Preferred Network Access Commercial |
$224.85
|
| Rate for Payer: Quartz Beloit One Network |
$119.76
|
| Rate for Payer: Quartz Commercial |
$158.86
|
| Rate for Payer: Quartz Medicare Advantage |
$12.53
|
| Rate for Payer: The Alliance Commercial |
$50.13
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.53
|
| Rate for Payer: United Healthcare PPO |
$183.30
|
| Rate for Payer: WEA Trust Commercial |
$134.42
|
| Rate for Payer: Wellcare Medicare |
$12.53
|
| Rate for Payer: WPS Commercial |
$181.02
|
|
|
Paring of Lesion 11055
|
Professional
|
Both
|
$184.00
|
|
|
Service Code
|
CPT 11055
|
| Hospital Charge Code |
2572806
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$13.46 |
| Max. Negotiated Rate |
$181.79 |
| Rate for Payer: Aetna Commercial |
$181.79
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$164.57
|
| Rate for Payer: Aetna Managed Medicare |
$13.46
|
| Rate for Payer: Anthem Medicare Advantage |
$13.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$13.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$13.46
|
| Rate for Payer: Cash Price |
$55.20
|
| Rate for Payer: Cash Price |
$55.20
|
| Rate for Payer: Cash Price |
$55.20
|
| Rate for Payer: Cigna Commercial |
$181.79
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$26.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$13.46
|
| Rate for Payer: Health EOS Commercial |
$174.14
|
| Rate for Payer: HFN Commercial |
$181.79
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$56.02
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$56.02
|
| Rate for Payer: Independent Care Health Plan Medicare |
$13.46
|
| Rate for Payer: Multiplan Commercial |
$153.09
|
| Rate for Payer: NAPHCARE Commercial |
$20.19
|
| Rate for Payer: Preferred Network Access Commercial |
$181.79
|
| Rate for Payer: Quartz Beloit One Network |
$84.20
|
| Rate for Payer: Quartz Commercial |
$109.08
|
| Rate for Payer: Quartz Medicare Advantage |
$13.46
|
| Rate for Payer: The Alliance Commercial |
$57.19
|
| Rate for Payer: United Healthcare Medicaid |
$26.84
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.46
|
| Rate for Payer: WEA Trust Commercial |
$105.25
|
| Rate for Payer: WPS Commercial |
$60.56
|
|
|
Paring of Lesion 2-4 - 11056
|
Professional
|
Both
|
$322.00
|
|
|
Service Code
|
CPT 11056
|
| Hospital Charge Code |
2572813
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$19.45 |
| Max. Negotiated Rate |
$318.14 |
| Rate for Payer: Aetna Commercial |
$318.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$288.00
|
| Rate for Payer: Aetna Managed Medicare |
$19.45
|
| Rate for Payer: Anthem Medicare Advantage |
$19.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$19.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$19.45
|
| Rate for Payer: Cash Price |
$96.60
|
| Rate for Payer: Cash Price |
$96.60
|
| Rate for Payer: Cash Price |
$96.60
|
| Rate for Payer: Cigna Commercial |
$318.14
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$37.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$19.45
|
| Rate for Payer: Health EOS Commercial |
$304.74
|
| Rate for Payer: HFN Commercial |
$318.14
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$78.85
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$78.85
|
| Rate for Payer: Independent Care Health Plan Medicare |
$19.45
|
| Rate for Payer: Multiplan Commercial |
$267.90
|
| Rate for Payer: NAPHCARE Commercial |
$29.17
|
| Rate for Payer: Preferred Network Access Commercial |
$318.14
|
| Rate for Payer: Quartz Beloit One Network |
$147.35
|
| Rate for Payer: Quartz Commercial |
$190.88
|
| Rate for Payer: Quartz Medicare Advantage |
$19.45
|
| Rate for Payer: The Alliance Commercial |
$82.65
|
| Rate for Payer: United Healthcare Medicaid |
$37.56
|
| Rate for Payer: United Healthcare Medicare Advantage |
$19.45
|
| Rate for Payer: WEA Trust Commercial |
$184.18
|
| Rate for Payer: WPS Commercial |
$87.52
|
|
|
Paring of Lesion >4 - 11057
|
Professional
|
Both
|
$239.00
|
|
|
Service Code
|
CPT 11057
|
| Hospital Charge Code |
2572815
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$25.08 |
| Max. Negotiated Rate |
$236.13 |
| Rate for Payer: Quartz Medicare Advantage |
$25.08
|
| Rate for Payer: Aetna Commercial |
$236.13
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$213.76
|
| Rate for Payer: Aetna Managed Medicare |
$25.08
|
| Rate for Payer: Anthem Medicare Advantage |
$25.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$25.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$25.08
|
| Rate for Payer: Cash Price |
$71.70
|
| Rate for Payer: Cash Price |
$71.70
|
| Rate for Payer: Cash Price |
$71.70
|
| Rate for Payer: Cigna Commercial |
$236.13
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$48.30
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$25.08
|
| Rate for Payer: Health EOS Commercial |
$226.19
|
| Rate for Payer: HFN Commercial |
$236.13
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$102.06
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$102.06
|
| Rate for Payer: Independent Care Health Plan Medicare |
$25.08
|
| Rate for Payer: Multiplan Commercial |
$198.85
|
| Rate for Payer: NAPHCARE Commercial |
$37.63
|
| Rate for Payer: Preferred Network Access Commercial |
$236.13
|
| Rate for Payer: Quartz Beloit One Network |
$109.37
|
| Rate for Payer: Quartz Commercial |
$141.68
|
| Rate for Payer: The Alliance Commercial |
$106.61
|
| Rate for Payer: United Healthcare Medicaid |
$48.30
|
| Rate for Payer: United Healthcare Medicare Advantage |
$25.08
|
| Rate for Payer: WEA Trust Commercial |
$136.71
|
| Rate for Payer: WPS Commercial |
$112.88
|
|
|
PAROTIDECTOMY
|
Facility
|
OP
|
$3,935.00
|
|
| Hospital Charge Code |
2960306
|
|
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
|
|
|
PAROTIDECTOMY
|
Facility
|
IP
|
$3,935.00
|
|
| Hospital Charge Code |
2960306
|
|
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
|
|
|
Paroxysmal Nocturnal Hemoglobinuris (PNH)
|
Facility
|
OP
|
$693.00
|
|
|
Service Code
|
CPT 88184
|
| Hospital Charge Code |
5433344
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$353.15 |
| Max. Negotiated Rate |
$1,508.92 |
| Rate for Payer: Aetna Commercial |
$648.65
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$619.82
|
| 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 |
$381.98
|
| 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 |
$207.90
|
| Rate for Payer: Cash Price |
$207.90
|
| Rate for Payer: Cigna Commercial |
$663.06
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$377.23
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$403.33
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$377.23
|
| Rate for Payer: Health EOS Commercial |
$641.44
|
| Rate for Payer: HFN Commercial |
$663.06
|
| 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 |
$576.58
|
| Rate for Payer: NAPHCARE Commercial |
$565.84
|
| Rate for Payer: Preferred Network Access Commercial |
$663.06
|
| Rate for Payer: Quartz Beloit One Network |
$353.15
|
| Rate for Payer: Quartz Commercial |
$468.47
|
| 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 |
$540.54
|
| Rate for Payer: WEA Trust Commercial |
$396.40
|
| Rate for Payer: Wellcare Medicare |
$377.23
|
| Rate for Payer: WPS Commercial |
$533.82
|
|
|
Paroxysmal Nocturnal Hemoglobinuris (PNH)
|
Facility
|
IP
|
$693.00
|
|
|
Service Code
|
CPT 88184
|
| Hospital Charge Code |
5433344
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$353.15 |
| Max. Negotiated Rate |
$663.06 |
| Rate for Payer: Aetna Commercial |
$648.65
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$619.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$381.98
|
| Rate for Payer: Cash Price |
$207.90
|
| Rate for Payer: Cigna Commercial |
$663.06
|
| Rate for Payer: Health EOS Commercial |
$641.44
|
| Rate for Payer: HFN Commercial |
$663.06
|
| Rate for Payer: Multiplan Commercial |
$576.58
|
| Rate for Payer: Preferred Network Access Commercial |
$663.06
|
| Rate for Payer: Quartz Beloit One Network |
$353.15
|
| Rate for Payer: Quartz Commercial |
$432.43
|
| Rate for Payer: WEA Trust Commercial |
$396.40
|
| Rate for Payer: WPS Commercial |
$533.82
|
|
|
Paroxysmal Nocturnal Hemoglobinuris (PNH)
|
Professional
|
Both
|
$693.00
|
|
|
Service Code
|
CPT 88184
|
| Hospital Charge Code |
5433344
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$80.41 |
| Max. Negotiated Rate |
$684.68 |
| Rate for Payer: Aetna Commercial |
$684.68
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$619.82
|
| Rate for Payer: Aetna Managed Medicare |
$80.41
|
| Rate for Payer: Anthem Medicare Advantage |
$80.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$80.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$80.41
|
| Rate for Payer: Cash Price |
$207.90
|
| Rate for Payer: Cash Price |
$207.90
|
| Rate for Payer: Cigna Commercial |
$684.68
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$360.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$80.41
|
| Rate for Payer: Health EOS Commercial |
$655.86
|
| Rate for Payer: HFN Commercial |
$684.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$239.69
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$239.69
|
| Rate for Payer: Independent Care Health Plan Medicare |
$80.41
|
| Rate for Payer: Multiplan Commercial |
$576.58
|
| Rate for Payer: NAPHCARE Commercial |
$120.62
|
| Rate for Payer: Preferred Network Access Commercial |
$684.68
|
| Rate for Payer: Quartz Beloit One Network |
$317.12
|
| Rate for Payer: Quartz Commercial |
$410.81
|
| Rate for Payer: Quartz Medicare Advantage |
$80.41
|
| Rate for Payer: The Alliance Commercial |
$317.63
|
| Rate for Payer: United Healthcare Medicare Advantage |
$80.41
|
| Rate for Payer: WEA Trust Commercial |
$396.40
|
| Rate for Payer: WPS Commercial |
$353.82
|
|
|
Parsabiv 10.0 mg dose
|
Facility
|
IP
|
$9.00
|
|
|
Service Code
|
HCPCS J0606
|
| Hospital Charge Code |
5412964
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.59 |
| Max. Negotiated Rate |
$8.61 |
| Rate for Payer: Aetna Commercial |
$8.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4.96
|
| Rate for Payer: Cash Price |
$2.70
|
| Rate for Payer: Cigna Commercial |
$8.61
|
| Rate for Payer: Health EOS Commercial |
$8.33
|
| Rate for Payer: HFN Commercial |
$8.61
|
| Rate for Payer: Multiplan Commercial |
$7.49
|
| Rate for Payer: Preferred Network Access Commercial |
$8.61
|
| Rate for Payer: Quartz Beloit One Network |
$4.59
|
| Rate for Payer: Quartz Commercial |
$5.62
|
| Rate for Payer: WEA Trust Commercial |
$5.15
|
| Rate for Payer: WPS Commercial |
$6.93
|
|
|
Parsabiv 10.0 mg dose
|
Facility
|
OP
|
$9.00
|
|
|
Service Code
|
HCPCS J0606
|
| Hospital Charge Code |
5412964
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.57 |
| Max. Negotiated Rate |
$10.28 |
| Rate for Payer: Aetna Commercial |
$8.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8.05
|
| Rate for Payer: Aetna Managed Medicare |
$2.57
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6.08
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4.49
|
| Rate for Payer: Anthem Medicare Advantage |
$2.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$2.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$2.57
|
| Rate for Payer: Cash Price |
$2.70
|
| Rate for Payer: Cash Price |
$2.70
|
| Rate for Payer: Cigna Commercial |
$8.61
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$2.57
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5.24
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$2.57
|
| Rate for Payer: Health EOS Commercial |
$8.33
|
| Rate for Payer: HFN Commercial |
$8.61
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$9.56
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$2.57
|
| Rate for Payer: Independent Care Health Plan Medicare |
$2.57
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$2.57
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$2.57
|
| Rate for Payer: Multiplan Commercial |
$7.49
|
| Rate for Payer: NAPHCARE Commercial |
$3.85
|
| Rate for Payer: Preferred Network Access Commercial |
$8.61
|
| Rate for Payer: Quartz Beloit One Network |
$4.59
|
| Rate for Payer: Quartz Commercial |
$6.08
|
| Rate for Payer: Quartz Medicare Advantage |
$2.57
|
| Rate for Payer: The Alliance Commercial |
$10.28
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2.57
|
| Rate for Payer: WEA Trust Commercial |
$5.15
|
| Rate for Payer: Wellcare Medicare |
$2.57
|
| Rate for Payer: WPS Commercial |
$6.93
|
|
|
Parsabiv 12.5 mg dose
|
Facility
|
IP
|
$9.00
|
|
|
Service Code
|
HCPCS J0606
|
| Hospital Charge Code |
5412965
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.59 |
| Max. Negotiated Rate |
$8.61 |
| Rate for Payer: Aetna Commercial |
$8.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4.96
|
| Rate for Payer: Cash Price |
$2.70
|
| Rate for Payer: Cigna Commercial |
$8.61
|
| Rate for Payer: Health EOS Commercial |
$8.33
|
| Rate for Payer: HFN Commercial |
$8.61
|
| Rate for Payer: Multiplan Commercial |
$7.49
|
| Rate for Payer: Preferred Network Access Commercial |
$8.61
|
| Rate for Payer: Quartz Beloit One Network |
$4.59
|
| Rate for Payer: Quartz Commercial |
$5.62
|
| Rate for Payer: WEA Trust Commercial |
$5.15
|
| Rate for Payer: WPS Commercial |
$6.93
|
|
|
Parsabiv 12.5 mg dose
|
Facility
|
OP
|
$9.00
|
|
|
Service Code
|
HCPCS J0606
|
| Hospital Charge Code |
5412965
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.57 |
| Max. Negotiated Rate |
$10.28 |
| Rate for Payer: Aetna Commercial |
$8.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8.05
|
| Rate for Payer: Aetna Managed Medicare |
$2.57
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6.08
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4.49
|
| Rate for Payer: Anthem Medicare Advantage |
$2.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$2.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$2.57
|
| Rate for Payer: Cash Price |
$2.70
|
| Rate for Payer: Cash Price |
$2.70
|
| Rate for Payer: Cigna Commercial |
$8.61
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$2.57
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5.24
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$2.57
|
| Rate for Payer: Health EOS Commercial |
$8.33
|
| Rate for Payer: HFN Commercial |
$8.61
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$9.56
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$2.57
|
| Rate for Payer: Independent Care Health Plan Medicare |
$2.57
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$2.57
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$2.57
|
| Rate for Payer: Multiplan Commercial |
$7.49
|
| Rate for Payer: NAPHCARE Commercial |
$3.85
|
| Rate for Payer: Preferred Network Access Commercial |
$8.61
|
| Rate for Payer: Quartz Beloit One Network |
$4.59
|
| Rate for Payer: Quartz Commercial |
$6.08
|
| Rate for Payer: Quartz Medicare Advantage |
$2.57
|
| Rate for Payer: The Alliance Commercial |
$10.28
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2.57
|
| Rate for Payer: WEA Trust Commercial |
$5.15
|
| Rate for Payer: Wellcare Medicare |
$2.57
|
| Rate for Payer: WPS Commercial |
$6.93
|
|
|
Parsabiv 15.0 mg dose
|
Facility
|
IP
|
$9.00
|
|
|
Service Code
|
HCPCS J0606
|
| Hospital Charge Code |
5412966
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.59 |
| Max. Negotiated Rate |
$8.61 |
| Rate for Payer: Aetna Commercial |
$8.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4.96
|
| Rate for Payer: Cash Price |
$2.70
|
| Rate for Payer: Cigna Commercial |
$8.61
|
| Rate for Payer: Health EOS Commercial |
$8.33
|
| Rate for Payer: HFN Commercial |
$8.61
|
| Rate for Payer: Multiplan Commercial |
$7.49
|
| Rate for Payer: Preferred Network Access Commercial |
$8.61
|
| Rate for Payer: Quartz Beloit One Network |
$4.59
|
| Rate for Payer: Quartz Commercial |
$5.62
|
| Rate for Payer: WEA Trust Commercial |
$5.15
|
| Rate for Payer: WPS Commercial |
$6.93
|
|
|
Parsabiv 15.0 mg dose
|
Facility
|
OP
|
$9.00
|
|
|
Service Code
|
HCPCS J0606
|
| Hospital Charge Code |
5412966
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.57 |
| Max. Negotiated Rate |
$10.28 |
| Rate for Payer: Aetna Commercial |
$8.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8.05
|
| Rate for Payer: Aetna Managed Medicare |
$2.57
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6.08
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4.49
|
| Rate for Payer: Anthem Medicare Advantage |
$2.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$2.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$2.57
|
| Rate for Payer: Cash Price |
$2.70
|
| Rate for Payer: Cash Price |
$2.70
|
| Rate for Payer: Cigna Commercial |
$8.61
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$2.57
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5.24
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$2.57
|
| Rate for Payer: Health EOS Commercial |
$8.33
|
| Rate for Payer: HFN Commercial |
$8.61
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$9.56
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$2.57
|
| Rate for Payer: Independent Care Health Plan Medicare |
$2.57
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$2.57
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$2.57
|
| Rate for Payer: Multiplan Commercial |
$7.49
|
| Rate for Payer: NAPHCARE Commercial |
$3.85
|
| Rate for Payer: Preferred Network Access Commercial |
$8.61
|
| Rate for Payer: Quartz Beloit One Network |
$4.59
|
| Rate for Payer: Quartz Commercial |
$6.08
|
| Rate for Payer: Quartz Medicare Advantage |
$2.57
|
| Rate for Payer: The Alliance Commercial |
$10.28
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2.57
|
| Rate for Payer: WEA Trust Commercial |
$5.15
|
| Rate for Payer: Wellcare Medicare |
$2.57
|
| Rate for Payer: WPS Commercial |
$6.93
|
|
|
Parsabiv 2.5 mg dose
|
Facility
|
IP
|
$9.00
|
|
|
Service Code
|
HCPCS J0606
|
| Hospital Charge Code |
5400629
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.59 |
| Max. Negotiated Rate |
$8.61 |
| Rate for Payer: Aetna Commercial |
$8.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4.96
|
| Rate for Payer: Cash Price |
$2.70
|
| Rate for Payer: Cigna Commercial |
$8.61
|
| Rate for Payer: Health EOS Commercial |
$8.33
|
| Rate for Payer: HFN Commercial |
$8.61
|
| Rate for Payer: Multiplan Commercial |
$7.49
|
| Rate for Payer: Preferred Network Access Commercial |
$8.61
|
| Rate for Payer: Quartz Beloit One Network |
$4.59
|
| Rate for Payer: Quartz Commercial |
$5.62
|
| Rate for Payer: WEA Trust Commercial |
$5.15
|
| Rate for Payer: WPS Commercial |
$6.93
|
|
|
Parsabiv 2.5 mg dose
|
Facility
|
OP
|
$9.00
|
|
|
Service Code
|
HCPCS J0606
|
| Hospital Charge Code |
5400629
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.57 |
| Max. Negotiated Rate |
$10.28 |
| Rate for Payer: Aetna Commercial |
$8.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8.05
|
| Rate for Payer: Aetna Managed Medicare |
$2.57
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6.08
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4.49
|
| Rate for Payer: Anthem Medicare Advantage |
$2.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$2.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$2.57
|
| Rate for Payer: Cash Price |
$2.70
|
| Rate for Payer: Cash Price |
$2.70
|
| Rate for Payer: Cigna Commercial |
$8.61
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$2.57
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5.24
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$2.57
|
| Rate for Payer: Health EOS Commercial |
$8.33
|
| Rate for Payer: HFN Commercial |
$8.61
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$9.56
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$2.57
|
| Rate for Payer: Independent Care Health Plan Medicare |
$2.57
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$2.57
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$2.57
|
| Rate for Payer: Multiplan Commercial |
$7.49
|
| Rate for Payer: NAPHCARE Commercial |
$3.85
|
| Rate for Payer: Preferred Network Access Commercial |
$8.61
|
| Rate for Payer: Quartz Beloit One Network |
$4.59
|
| Rate for Payer: Quartz Commercial |
$6.08
|
| Rate for Payer: Quartz Medicare Advantage |
$2.57
|
| Rate for Payer: The Alliance Commercial |
$10.28
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2.57
|
| Rate for Payer: WEA Trust Commercial |
$5.15
|
| Rate for Payer: Wellcare Medicare |
$2.57
|
| Rate for Payer: WPS Commercial |
$6.93
|
|
|
Parsabiv 5.0 mg dose
|
Facility
|
IP
|
$9.00
|
|
|
Service Code
|
HCPCS J0606
|
| Hospital Charge Code |
5412962
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.59 |
| Max. Negotiated Rate |
$8.61 |
| Rate for Payer: Aetna Commercial |
$8.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4.96
|
| Rate for Payer: Cash Price |
$2.70
|
| Rate for Payer: Cigna Commercial |
$8.61
|
| Rate for Payer: Health EOS Commercial |
$8.33
|
| Rate for Payer: HFN Commercial |
$8.61
|
| Rate for Payer: Multiplan Commercial |
$7.49
|
| Rate for Payer: Preferred Network Access Commercial |
$8.61
|
| Rate for Payer: Quartz Beloit One Network |
$4.59
|
| Rate for Payer: Quartz Commercial |
$5.62
|
| Rate for Payer: WEA Trust Commercial |
$5.15
|
| Rate for Payer: WPS Commercial |
$6.93
|
|
|
Parsabiv 5.0 mg dose
|
Facility
|
OP
|
$9.00
|
|
|
Service Code
|
HCPCS J0606
|
| Hospital Charge Code |
5412962
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.57 |
| Max. Negotiated Rate |
$10.28 |
| Rate for Payer: Aetna Commercial |
$8.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8.05
|
| Rate for Payer: Aetna Managed Medicare |
$2.57
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6.08
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4.49
|
| Rate for Payer: Anthem Medicare Advantage |
$2.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$2.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$2.57
|
| Rate for Payer: Cash Price |
$2.70
|
| Rate for Payer: Cash Price |
$2.70
|
| Rate for Payer: Cigna Commercial |
$8.61
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$2.57
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5.24
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$2.57
|
| Rate for Payer: Health EOS Commercial |
$8.33
|
| Rate for Payer: HFN Commercial |
$8.61
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$9.56
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$2.57
|
| Rate for Payer: Independent Care Health Plan Medicare |
$2.57
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$2.57
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$2.57
|
| Rate for Payer: Multiplan Commercial |
$7.49
|
| Rate for Payer: NAPHCARE Commercial |
$3.85
|
| Rate for Payer: Preferred Network Access Commercial |
$8.61
|
| Rate for Payer: Quartz Beloit One Network |
$4.59
|
| Rate for Payer: Quartz Commercial |
$6.08
|
| Rate for Payer: Quartz Medicare Advantage |
$2.57
|
| Rate for Payer: The Alliance Commercial |
$10.28
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2.57
|
| Rate for Payer: WEA Trust Commercial |
$5.15
|
| Rate for Payer: Wellcare Medicare |
$2.57
|
| Rate for Payer: WPS Commercial |
$6.93
|
|
|
Parsabiv 7.5 mg dose
|
Facility
|
IP
|
$9.00
|
|
|
Service Code
|
HCPCS J0606
|
| Hospital Charge Code |
5412963
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.59 |
| Max. Negotiated Rate |
$8.61 |
| Rate for Payer: Aetna Commercial |
$8.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4.96
|
| Rate for Payer: Cash Price |
$2.70
|
| Rate for Payer: Cigna Commercial |
$8.61
|
| Rate for Payer: Health EOS Commercial |
$8.33
|
| Rate for Payer: HFN Commercial |
$8.61
|
| Rate for Payer: Multiplan Commercial |
$7.49
|
| Rate for Payer: Preferred Network Access Commercial |
$8.61
|
| Rate for Payer: Quartz Beloit One Network |
$4.59
|
| Rate for Payer: Quartz Commercial |
$5.62
|
| Rate for Payer: WEA Trust Commercial |
$5.15
|
| Rate for Payer: WPS Commercial |
$6.93
|
|
|
Parsabiv 7.5 mg dose
|
Facility
|
OP
|
$9.00
|
|
|
Service Code
|
HCPCS J0606
|
| Hospital Charge Code |
5412963
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.57 |
| Max. Negotiated Rate |
$10.28 |
| Rate for Payer: Aetna Commercial |
$8.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8.05
|
| Rate for Payer: Aetna Managed Medicare |
$2.57
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6.08
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4.49
|
| Rate for Payer: Anthem Medicare Advantage |
$2.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$2.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$2.57
|
| Rate for Payer: Cash Price |
$2.70
|
| Rate for Payer: Cash Price |
$2.70
|
| Rate for Payer: Cigna Commercial |
$8.61
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$2.57
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5.24
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$2.57
|
| Rate for Payer: Health EOS Commercial |
$8.33
|
| Rate for Payer: HFN Commercial |
$8.61
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$9.56
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$2.57
|
| Rate for Payer: Independent Care Health Plan Medicare |
$2.57
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$2.57
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$2.57
|
| Rate for Payer: Multiplan Commercial |
$7.49
|
| Rate for Payer: NAPHCARE Commercial |
$3.85
|
| Rate for Payer: Preferred Network Access Commercial |
$8.61
|
| Rate for Payer: Quartz Beloit One Network |
$4.59
|
| Rate for Payer: Quartz Commercial |
$6.08
|
| Rate for Payer: Quartz Medicare Advantage |
$2.57
|
| Rate for Payer: The Alliance Commercial |
$10.28
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2.57
|
| Rate for Payer: WEA Trust Commercial |
$5.15
|
| Rate for Payer: Wellcare Medicare |
$2.57
|
| Rate for Payer: WPS Commercial |
$6.93
|
|
|
PARTIAL AMPUTATION OF TOE 28825
|
Professional
|
Both
|
$1,504.00
|
|
|
Service Code
|
CPT 28825
|
| Hospital Charge Code |
3014286
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$151.78 |
| Max. Negotiated Rate |
$1,485.95 |
| Rate for Payer: Aetna Commercial |
$1,485.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,345.18
|
| Rate for Payer: Aetna Managed Medicare |
$151.78
|
| Rate for Payer: Anthem Medicare Advantage |
$151.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$151.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$151.78
|
| Rate for Payer: Cash Price |
$451.20
|
| Rate for Payer: Cash Price |
$451.20
|
| Rate for Payer: Cash Price |
$451.20
|
| Rate for Payer: Cigna Commercial |
$1,485.95
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$156.69
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$151.78
|
| Rate for Payer: Health EOS Commercial |
$1,423.39
|
| Rate for Payer: HFN Commercial |
$1,485.95
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$609.61
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$609.61
|
| Rate for Payer: Independent Care Health Plan Medicare |
$151.78
|
| Rate for Payer: Multiplan Commercial |
$1,251.33
|
| Rate for Payer: NAPHCARE Commercial |
$227.67
|
| Rate for Payer: Preferred Network Access Commercial |
$1,485.95
|
| Rate for Payer: Quartz Beloit One Network |
$688.23
|
| Rate for Payer: Quartz Commercial |
$891.57
|
| Rate for Payer: Quartz Medicare Advantage |
$151.78
|
| Rate for Payer: The Alliance Commercial |
$645.05
|
| Rate for Payer: United Healthcare Medicaid |
$156.69
|
| Rate for Payer: United Healthcare Medicare Advantage |
$151.78
|
| Rate for Payer: WEA Trust Commercial |
$860.29
|
| Rate for Payer: WPS Commercial |
$683.00
|
|
|
PARTIAL EXCISION (CRATERIZATION, SAUCERIZATION, OR DIAPHYSECTOMY) BONE (EG, OSTEOMYELITIS); DISTAL PHALANX OF FINGER
|
Facility
|
OP
|
$6,807.99
|
|
|
Service Code
|
CPT 26236
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,692.24 |
| Max. Negotiated Rate |
$6,807.99 |
| Rate for Payer: Aetna Managed Medicare |
$1,692.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,635.84
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,985.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,835.04
|
| Rate for Payer: Anthem Medicare Advantage |
$1,692.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$1,692.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$1,692.24
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$1,692.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,807.99
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$1,692.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,295.12
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,692.24
|
| Rate for Payer: Independent Care Health Plan Medicare |
$1,692.24
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$1,692.24
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$1,692.24
|
| Rate for Payer: NAPHCARE Commercial |
$2,538.35
|
| Rate for Payer: Quartz Medicare Advantage |
$1,692.24
|
| Rate for Payer: The Alliance Commercial |
$2,876.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,692.24
|
| Rate for Payer: United Healthcare PPO |
$3,726.32
|
| Rate for Payer: Wellcare Medicare |
$1,692.24
|
|
|
PARTIAL EXCISION (CRATERIZATION, SAUCERIZATION, OR DIAPHYSECTOMY), BONE (EG, OSTEOMYELITIS); FIBULA
|
Facility
|
OP
|
$12,809.52
|
|
|
Service Code
|
CPT 27641
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,443.42 |
| Max. Negotiated Rate |
$12,809.52 |
| Rate for Payer: Aetna Managed Medicare |
$3,443.42
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$10,303.28
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8,364.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7,944.56
|
| Rate for Payer: Anthem Medicare Advantage |
$3,443.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$3,443.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$3,443.42
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$3,443.42
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,947.89
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$3,443.42
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$12,809.52
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$3,443.42
|
| Rate for Payer: Independent Care Health Plan Medicare |
$3,443.42
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$3,443.42
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$3,443.42
|
| Rate for Payer: NAPHCARE Commercial |
$5,165.13
|
| Rate for Payer: Quartz Medicare Advantage |
$3,443.42
|
| Rate for Payer: The Alliance Commercial |
$5,853.81
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,443.42
|
| Rate for Payer: United Healthcare PPO |
$4,267.12
|
| Rate for Payer: Wellcare Medicare |
$3,443.42
|
|
|
PARTIAL EXCISION (CRATERIZATION, SAUCERIZATION, OR DIAPHYSECTOMY) BONE (EG, OSTEOMYELITIS), OLECRANON PROCESS
|
Facility
|
OP
|
$12,809.52
|
|
|
Service Code
|
CPT 24147
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,443.42 |
| Max. Negotiated Rate |
$12,809.52 |
| Rate for Payer: Aetna Managed Medicare |
$3,443.42
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$10,303.28
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8,364.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7,944.56
|
| Rate for Payer: Anthem Medicare Advantage |
$3,443.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$3,443.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$3,443.42
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$3,443.42
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,947.89
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$3,443.42
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$12,809.52
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$3,443.42
|
| Rate for Payer: Independent Care Health Plan Medicare |
$3,443.42
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$3,443.42
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$3,443.42
|
| Rate for Payer: NAPHCARE Commercial |
$5,165.13
|
| Rate for Payer: Quartz Medicare Advantage |
$3,443.42
|
| Rate for Payer: The Alliance Commercial |
$5,853.81
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,443.42
|
| Rate for Payer: United Healthcare PPO |
$4,267.12
|
| Rate for Payer: Wellcare Medicare |
$3,443.42
|
|
