|
PLATE WIDE 12HL BIOMET 73-2634
|
Facility
|
IP
|
$4,584.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4206002
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,246.16 |
| Max. Negotiated Rate |
$4,217.28 |
| Rate for Payer: Aetna Commercial |
$4,125.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,942.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,429.52
|
| Rate for Payer: Cash Price |
$1,375.20
|
| Rate for Payer: Cigna Commercial |
$4,217.28
|
| Rate for Payer: Health EOS Commercial |
$4,079.76
|
| Rate for Payer: HFN Commercial |
$4,217.28
|
| Rate for Payer: Multiplan Commercial |
$3,667.20
|
| Rate for Payer: NAPHCARE Commercial |
$2,750.40
|
| Rate for Payer: Preferred Network Access Commercial |
$4,217.28
|
| Rate for Payer: Quartz Beloit One Network |
$2,246.16
|
| Rate for Payer: Quartz Commercial |
$2,750.40
|
| Rate for Payer: WEA Trust Commercial |
$2,521.20
|
| Rate for Payer: WPS Commercial |
$3,395.37
|
|
|
PLATE WIDE 12HL BIOMET 73-2634
|
Facility
|
OP
|
$4,584.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
4206002
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,283.52 |
| Max. Negotiated Rate |
$18,336.00 |
| Rate for Payer: Aetna Commercial |
$4,125.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,942.24
|
| Rate for Payer: Aetna Managed Medicare |
$1,283.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,979.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,292.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,200.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,429.52
|
| Rate for Payer: Cash Price |
$1,375.20
|
| Rate for Payer: Cigna Commercial |
$4,217.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,565.21
|
| Rate for Payer: Health EOS Commercial |
$4,079.76
|
| Rate for Payer: HFN Commercial |
$4,217.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,438.00
|
| Rate for Payer: Multiplan Commercial |
$3,667.20
|
| Rate for Payer: NAPHCARE Commercial |
$2,750.40
|
| Rate for Payer: Preferred Network Access Commercial |
$4,217.28
|
| Rate for Payer: Quartz Beloit One Network |
$2,246.16
|
| Rate for Payer: Quartz Commercial |
$2,979.60
|
| Rate for Payer: Quartz Medicare Advantage |
$2,750.40
|
| Rate for Payer: The Alliance Commercial |
$18,336.00
|
| Rate for Payer: WEA Trust Commercial |
$2,521.20
|
| Rate for Payer: WPS Commercial |
$3,395.37
|
|
|
PLATE WRIST FUSION SHORT BEND 629589
|
Facility
|
IP
|
$6,743.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6220202
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,304.07 |
| Max. Negotiated Rate |
$6,203.56 |
| Rate for Payer: Aetna Commercial |
$6,068.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,798.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,573.79
|
| Rate for Payer: Cash Price |
$2,022.90
|
| Rate for Payer: Cigna Commercial |
$6,203.56
|
| Rate for Payer: Health EOS Commercial |
$6,001.27
|
| Rate for Payer: HFN Commercial |
$6,203.56
|
| Rate for Payer: Multiplan Commercial |
$5,394.40
|
| Rate for Payer: NAPHCARE Commercial |
$4,045.80
|
| Rate for Payer: Preferred Network Access Commercial |
$6,203.56
|
| Rate for Payer: Quartz Beloit One Network |
$3,304.07
|
| Rate for Payer: Quartz Commercial |
$4,045.80
|
| Rate for Payer: WEA Trust Commercial |
$3,708.65
|
| Rate for Payer: WPS Commercial |
$4,994.54
|
|
|
PLATE WRIST FUSION SHORT BEND 629589
|
Facility
|
OP
|
$6,743.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6220202
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,888.04 |
| Max. Negotiated Rate |
$26,972.00 |
| Rate for Payer: Aetna Commercial |
$6,068.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,798.98
|
| Rate for Payer: Aetna Managed Medicare |
$1,888.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,382.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,371.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,236.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,573.79
|
| Rate for Payer: Cash Price |
$2,022.90
|
| Rate for Payer: Cigna Commercial |
$6,203.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,773.38
|
| Rate for Payer: Health EOS Commercial |
$6,001.27
|
| Rate for Payer: HFN Commercial |
$6,203.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,057.25
|
| Rate for Payer: Multiplan Commercial |
$5,394.40
|
| Rate for Payer: NAPHCARE Commercial |
$4,045.80
|
| Rate for Payer: Preferred Network Access Commercial |
$6,203.56
|
| Rate for Payer: Quartz Beloit One Network |
$3,304.07
|
| Rate for Payer: Quartz Commercial |
$4,382.95
|
| Rate for Payer: Quartz Medicare Advantage |
$4,045.80
|
| Rate for Payer: The Alliance Commercial |
$26,972.00
|
| Rate for Payer: WEA Trust Commercial |
$3,708.65
|
| Rate for Payer: WPS Commercial |
$4,994.54
|
|
|
PLATE WRIST FUSION STD BEND 629579
|
Facility
|
IP
|
$6,483.55
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6252124
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,176.94 |
| Max. Negotiated Rate |
$5,964.87 |
| Rate for Payer: Aetna Commercial |
$5,835.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,575.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,436.28
|
| Rate for Payer: Cash Price |
$1,945.07
|
| Rate for Payer: Cigna Commercial |
$5,964.87
|
| Rate for Payer: Health EOS Commercial |
$5,770.36
|
| Rate for Payer: HFN Commercial |
$5,964.87
|
| Rate for Payer: Multiplan Commercial |
$5,186.84
|
| Rate for Payer: NAPHCARE Commercial |
$3,890.13
|
| Rate for Payer: Preferred Network Access Commercial |
$5,964.87
|
| Rate for Payer: Quartz Beloit One Network |
$3,176.94
|
| Rate for Payer: Quartz Commercial |
$3,890.13
|
| Rate for Payer: WEA Trust Commercial |
$3,565.95
|
| Rate for Payer: WPS Commercial |
$4,802.37
|
|
|
PLATE WRIST FUSION STD BEND 629579
|
Facility
|
OP
|
$6,483.55
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6252124
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,815.39 |
| Max. Negotiated Rate |
$25,934.20 |
| Rate for Payer: Aetna Commercial |
$5,835.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,575.85
|
| Rate for Payer: Aetna Managed Medicare |
$1,815.39
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,214.31
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,241.78
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,112.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,436.28
|
| Rate for Payer: Cash Price |
$1,945.07
|
| Rate for Payer: Cigna Commercial |
$5,964.87
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,628.19
|
| Rate for Payer: Health EOS Commercial |
$5,770.36
|
| Rate for Payer: HFN Commercial |
$5,964.87
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,862.66
|
| Rate for Payer: Multiplan Commercial |
$5,186.84
|
| Rate for Payer: NAPHCARE Commercial |
$3,890.13
|
| Rate for Payer: Preferred Network Access Commercial |
$5,964.87
|
| Rate for Payer: Quartz Beloit One Network |
$3,176.94
|
| Rate for Payer: Quartz Commercial |
$4,214.31
|
| Rate for Payer: Quartz Medicare Advantage |
$3,890.13
|
| Rate for Payer: The Alliance Commercial |
$25,934.20
|
| Rate for Payer: WEA Trust Commercial |
$3,565.95
|
| Rate for Payer: WPS Commercial |
$4,802.37
|
|
|
PLEDGETS FELT PTFE 4.5MM X 6MM 1.65 007970
|
Facility
|
IP
|
$467.00
|
|
| Hospital Charge Code |
2974001
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$228.83 |
| Max. Negotiated Rate |
$429.64 |
| Rate for Payer: Aetna Commercial |
$420.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$401.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$247.51
|
| Rate for Payer: Cash Price |
$140.10
|
| Rate for Payer: Cigna Commercial |
$429.64
|
| Rate for Payer: Health EOS Commercial |
$415.63
|
| Rate for Payer: HFN Commercial |
$429.64
|
| Rate for Payer: Multiplan Commercial |
$373.60
|
| Rate for Payer: NAPHCARE Commercial |
$280.20
|
| Rate for Payer: Preferred Network Access Commercial |
$429.64
|
| Rate for Payer: Quartz Beloit One Network |
$228.83
|
| Rate for Payer: Quartz Commercial |
$280.20
|
| Rate for Payer: WEA Trust Commercial |
$256.85
|
| Rate for Payer: WPS Commercial |
$345.91
|
|
|
PLEDGETS FELT PTFE 4.5MM X 6MM 1.65 007970
|
Facility
|
OP
|
$467.00
|
|
| Hospital Charge Code |
2974001
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$130.76 |
| Max. Negotiated Rate |
$1,868.00 |
| Rate for Payer: Aetna Commercial |
$420.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$401.62
|
| Rate for Payer: Aetna Managed Medicare |
$130.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$303.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$233.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$224.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$247.51
|
| Rate for Payer: Cash Price |
$140.10
|
| Rate for Payer: Cigna Commercial |
$429.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$261.33
|
| Rate for Payer: Health EOS Commercial |
$415.63
|
| Rate for Payer: HFN Commercial |
$429.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$350.25
|
| Rate for Payer: Multiplan Commercial |
$373.60
|
| Rate for Payer: NAPHCARE Commercial |
$280.20
|
| Rate for Payer: Preferred Network Access Commercial |
$429.64
|
| Rate for Payer: Quartz Beloit One Network |
$228.83
|
| Rate for Payer: Quartz Commercial |
$303.55
|
| Rate for Payer: Quartz Medicare Advantage |
$280.20
|
| Rate for Payer: The Alliance Commercial |
$1,868.00
|
| Rate for Payer: WEA Trust Commercial |
$256.85
|
| Rate for Payer: WPS Commercial |
$345.91
|
|
|
Pleural Cath
|
Facility
|
OP
|
$1,809.00
|
|
|
Service Code
|
HCPCS C1729
|
| Hospital Charge Code |
5364746
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$301.00 |
| Max. Negotiated Rate |
$7,236.00 |
| Rate for Payer: Aetna Commercial |
$1,628.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,555.74
|
| Rate for Payer: Aetna Managed Medicare |
$506.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,175.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$904.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$868.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$958.77
|
| Rate for Payer: Cash Price |
$542.70
|
| Rate for Payer: Cash Price |
$542.70
|
| Rate for Payer: Cigna Commercial |
$1,664.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,012.32
|
| Rate for Payer: Health EOS Commercial |
$1,610.01
|
| Rate for Payer: HFN Commercial |
$1,664.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,356.75
|
| Rate for Payer: Multiplan Commercial |
$1,447.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,085.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,664.28
|
| Rate for Payer: Quartz Beloit One Network |
$886.41
|
| Rate for Payer: Quartz Commercial |
$1,175.85
|
| Rate for Payer: Quartz Medicare Advantage |
$1,085.40
|
| Rate for Payer: The Alliance Commercial |
$7,236.00
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$994.95
|
| Rate for Payer: WPS Commercial |
$1,339.93
|
|
|
Pleural Cath
|
Professional
|
Both
|
$1,809.00
|
|
|
Service Code
|
HCPCS C1729
|
| Hospital Charge Code |
5364746
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$795.96 |
| Max. Negotiated Rate |
$1,718.55 |
| Rate for Payer: Aetna Commercial |
$1,718.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,555.74
|
| Rate for Payer: Cash Price |
$542.70
|
| Rate for Payer: Cigna Commercial |
$1,718.55
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$904.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,085.40
|
| Rate for Payer: Health EOS Commercial |
$1,646.19
|
| Rate for Payer: HFN Commercial |
$1,718.55
|
| Rate for Payer: Multiplan Commercial |
$1,447.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,718.55
|
| Rate for Payer: Quartz Beloit One Network |
$795.96
|
| Rate for Payer: Quartz Commercial |
$1,031.13
|
| Rate for Payer: The Alliance Commercial |
$904.50
|
| Rate for Payer: WEA Trust Commercial |
$994.95
|
| Rate for Payer: WPS Commercial |
$1,339.93
|
|
|
Pleural Cath
|
Facility
|
IP
|
$1,809.00
|
|
|
Service Code
|
HCPCS C1729
|
| Hospital Charge Code |
5364746
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$886.41 |
| Max. Negotiated Rate |
$1,664.28 |
| Rate for Payer: Aetna Commercial |
$1,628.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,555.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$958.77
|
| Rate for Payer: Cash Price |
$542.70
|
| Rate for Payer: Cigna Commercial |
$1,664.28
|
| Rate for Payer: Health EOS Commercial |
$1,610.01
|
| Rate for Payer: HFN Commercial |
$1,664.28
|
| Rate for Payer: Multiplan Commercial |
$1,447.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,085.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,664.28
|
| Rate for Payer: Quartz Beloit One Network |
$886.41
|
| Rate for Payer: Quartz Commercial |
$1,085.40
|
| Rate for Payer: WEA Trust Commercial |
$994.95
|
| Rate for Payer: WPS Commercial |
$1,339.93
|
|
|
PLEURAL EFFUSION WITH CC
|
Facility
|
IP
|
$26,808.00
|
|
|
Service Code
|
MSDRG 187
|
| Min. Negotiated Rate |
$9,643.17 |
| Max. Negotiated Rate |
$26,808.00 |
| Rate for Payer: Aetna Managed Medicare |
$9,643.17
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$20,980.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$16,081.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$15,278.00
|
| Rate for Payer: Anthem Medicare Advantage |
$9,643.17
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$9,643.17
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$9,643.17
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$9,643.17
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$16,959.98
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$9,643.17
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$19,427.85
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$9,643.17
|
| Rate for Payer: Independent Care Health Plan Medicare |
$9,643.17
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$9,643.17
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$9,643.17
|
| Rate for Payer: NAPHCARE Commercial |
$14,464.76
|
| Rate for Payer: Quartz Medicare Advantage |
$9,643.17
|
| Rate for Payer: The Alliance Commercial |
$26,808.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$9,643.17
|
| Rate for Payer: United Healthcare PPO |
$15,124.83
|
| Rate for Payer: Wellcare Medicare |
$9,643.17
|
|
|
PLEURAL EFFUSION WITH MCC
|
Facility
|
IP
|
$41,584.00
|
|
|
Service Code
|
MSDRG 186
|
| Min. Negotiated Rate |
$14,958.45 |
| Max. Negotiated Rate |
$41,584.00 |
| Rate for Payer: Aetna Managed Medicare |
$14,958.45
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$32,519.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$24,925.55
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$23,680.90
|
| Rate for Payer: Anthem Medicare Advantage |
$14,958.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$14,958.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$14,958.45
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$14,958.45
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$26,287.97
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$14,958.45
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$30,265.95
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$14,958.45
|
| Rate for Payer: Independent Care Health Plan Medicare |
$14,958.45
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$14,958.45
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$14,958.45
|
| Rate for Payer: NAPHCARE Commercial |
$22,437.68
|
| Rate for Payer: Quartz Medicare Advantage |
$14,958.45
|
| Rate for Payer: The Alliance Commercial |
$41,584.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14,958.45
|
| Rate for Payer: United Healthcare PPO |
$23,562.43
|
| Rate for Payer: Wellcare Medicare |
$14,958.45
|
|
|
PLEURAL EFFUSION WITHOUT CC/MCC
|
Facility
|
IP
|
$20,167.00
|
|
|
Service Code
|
MSDRG 188
|
| Min. Negotiated Rate |
$7,254.27 |
| Max. Negotiated Rate |
$20,167.00 |
| Rate for Payer: Aetna Managed Medicare |
$7,254.27
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$15,735.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$12,060.75
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$11,458.50
|
| Rate for Payer: Anthem Medicare Advantage |
$7,254.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$7,254.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$7,254.27
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$7,254.27
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12,719.98
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$7,254.27
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$14,556.75
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$7,254.27
|
| Rate for Payer: Independent Care Health Plan Medicare |
$7,254.27
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$7,254.27
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$7,254.27
|
| Rate for Payer: NAPHCARE Commercial |
$10,881.40
|
| Rate for Payer: Quartz Medicare Advantage |
$7,254.27
|
| Rate for Payer: The Alliance Commercial |
$20,167.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$7,254.27
|
| Rate for Payer: United Healthcare PPO |
$11,332.62
|
| Rate for Payer: Wellcare Medicare |
$7,254.27
|
|
|
PleurX Catheter Removal
|
Professional
|
Both
|
$967.00
|
|
|
Service Code
|
CPT 32552
|
| Hospital Charge Code |
5364744
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$148.30 |
| Max. Negotiated Rate |
$918.65 |
| Rate for Payer: Aetna Commercial |
$918.65
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$831.62
|
| Rate for Payer: Cash Price |
$290.10
|
| Rate for Payer: Cash Price |
$290.10
|
| Rate for Payer: Cash Price |
$290.10
|
| Rate for Payer: Cigna Commercial |
$918.65
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$148.30
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$580.20
|
| Rate for Payer: Health EOS Commercial |
$879.97
|
| Rate for Payer: HFN Commercial |
$918.65
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$526.64
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$526.64
|
| Rate for Payer: Multiplan Commercial |
$773.60
|
| Rate for Payer: Preferred Network Access Commercial |
$918.65
|
| Rate for Payer: Quartz Beloit One Network |
$425.48
|
| Rate for Payer: Quartz Commercial |
$551.19
|
| Rate for Payer: The Alliance Commercial |
$483.50
|
| Rate for Payer: United Healthcare Medicaid |
$148.30
|
| Rate for Payer: WEA Trust Commercial |
$531.85
|
| Rate for Payer: WPS Commercial |
$716.26
|
|
|
PleurX Catheter Removal
|
Facility
|
IP
|
$967.00
|
|
|
Service Code
|
CPT 32552
|
| Hospital Charge Code |
5364744
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$473.83 |
| Max. Negotiated Rate |
$889.64 |
| Rate for Payer: Aetna Commercial |
$870.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$831.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$512.51
|
| Rate for Payer: Cash Price |
$290.10
|
| Rate for Payer: Cigna Commercial |
$889.64
|
| Rate for Payer: Health EOS Commercial |
$860.63
|
| Rate for Payer: HFN Commercial |
$889.64
|
| Rate for Payer: Multiplan Commercial |
$773.60
|
| Rate for Payer: NAPHCARE Commercial |
$580.20
|
| Rate for Payer: Preferred Network Access Commercial |
$889.64
|
| Rate for Payer: Quartz Beloit One Network |
$473.83
|
| Rate for Payer: Quartz Commercial |
$580.20
|
| Rate for Payer: WEA Trust Commercial |
$531.85
|
| Rate for Payer: WPS Commercial |
$716.26
|
|
|
PleurX Catheter Removal
|
Facility
|
OP
|
$967.00
|
|
|
Service Code
|
CPT 32552
|
| Hospital Charge Code |
5364744
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$301.00 |
| Max. Negotiated Rate |
$4,218.22 |
| Rate for Payer: Aetna Commercial |
$870.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$831.62
|
| Rate for Payer: Aetna Managed Medicare |
$620.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$628.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$483.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$464.16
|
| Rate for Payer: Anthem Medicare Advantage |
$620.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$512.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$620.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$620.92
|
| Rate for Payer: Cash Price |
$290.10
|
| Rate for Payer: Cash Price |
$290.10
|
| Rate for Payer: Cash Price |
$290.10
|
| Rate for Payer: Cigna Commercial |
$889.64
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$620.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,218.22
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$620.92
|
| Rate for Payer: Health EOS Commercial |
$860.63
|
| Rate for Payer: HFN Commercial |
$889.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,309.82
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$620.92
|
| Rate for Payer: Independent Care Health Plan Medicare |
$620.92
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$620.92
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$620.92
|
| Rate for Payer: Multiplan Commercial |
$773.60
|
| Rate for Payer: NAPHCARE Commercial |
$931.38
|
| Rate for Payer: Preferred Network Access Commercial |
$889.64
|
| Rate for Payer: Quartz Beloit One Network |
$473.83
|
| Rate for Payer: Quartz Commercial |
$628.55
|
| Rate for Payer: Quartz Medicare Advantage |
$620.92
|
| Rate for Payer: The Alliance Commercial |
$2,483.68
|
| Rate for Payer: United Healthcare Medicare Advantage |
$620.92
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$531.85
|
| Rate for Payer: Wellcare Medicare |
$620.92
|
| Rate for Payer: WPS Commercial |
$716.26
|
|
|
PLUG ANAL FISTULA SURGISIS 0.6 X 9.5 G53614
|
Facility
|
OP
|
$6,553.00
|
|
| Hospital Charge Code |
5307117
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,834.84 |
| Max. Negotiated Rate |
$26,212.00 |
| Rate for Payer: Aetna Commercial |
$5,897.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,635.58
|
| Rate for Payer: Aetna Managed Medicare |
$1,834.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,259.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,276.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,145.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,473.09
|
| Rate for Payer: Cash Price |
$1,965.90
|
| Rate for Payer: Cigna Commercial |
$6,028.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,667.06
|
| Rate for Payer: Health EOS Commercial |
$5,832.17
|
| Rate for Payer: HFN Commercial |
$6,028.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,914.75
|
| Rate for Payer: Multiplan Commercial |
$5,242.40
|
| Rate for Payer: NAPHCARE Commercial |
$3,931.80
|
| Rate for Payer: Preferred Network Access Commercial |
$6,028.76
|
| Rate for Payer: Quartz Beloit One Network |
$3,210.97
|
| Rate for Payer: Quartz Commercial |
$4,259.45
|
| Rate for Payer: Quartz Medicare Advantage |
$3,931.80
|
| Rate for Payer: The Alliance Commercial |
$26,212.00
|
| Rate for Payer: WEA Trust Commercial |
$3,604.15
|
| Rate for Payer: WPS Commercial |
$4,853.81
|
|
|
PLUG ANAL FISTULA SURGISIS 0.6 X 9.5 G53614
|
Facility
|
IP
|
$6,553.00
|
|
| Hospital Charge Code |
5307117
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3,210.97 |
| Max. Negotiated Rate |
$6,028.76 |
| Rate for Payer: Aetna Commercial |
$5,897.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,635.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,473.09
|
| Rate for Payer: Cash Price |
$1,965.90
|
| Rate for Payer: Cigna Commercial |
$6,028.76
|
| Rate for Payer: Health EOS Commercial |
$5,832.17
|
| Rate for Payer: HFN Commercial |
$6,028.76
|
| Rate for Payer: Multiplan Commercial |
$5,242.40
|
| Rate for Payer: NAPHCARE Commercial |
$3,931.80
|
| Rate for Payer: Preferred Network Access Commercial |
$6,028.76
|
| Rate for Payer: Quartz Beloit One Network |
$3,210.97
|
| Rate for Payer: Quartz Commercial |
$3,931.80
|
| Rate for Payer: WEA Trust Commercial |
$3,604.15
|
| Rate for Payer: WPS Commercial |
$4,853.81
|
|
|
PLUNGER CAPILLARY C4100-377 VIALS OF 50EA
|
Facility
|
OP
|
$147.00
|
|
| Hospital Charge Code |
2969871
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$41.16 |
| Max. Negotiated Rate |
$588.00 |
| Rate for Payer: Aetna Commercial |
$132.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$126.42
|
| Rate for Payer: Aetna Managed Medicare |
$41.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$95.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$73.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$70.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$77.91
|
| Rate for Payer: Cash Price |
$44.10
|
| Rate for Payer: Cigna Commercial |
$135.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$82.26
|
| Rate for Payer: Health EOS Commercial |
$130.83
|
| Rate for Payer: HFN Commercial |
$135.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$110.25
|
| Rate for Payer: Multiplan Commercial |
$117.60
|
| Rate for Payer: NAPHCARE Commercial |
$88.20
|
| Rate for Payer: Preferred Network Access Commercial |
$135.24
|
| Rate for Payer: Quartz Beloit One Network |
$72.03
|
| Rate for Payer: Quartz Commercial |
$95.55
|
| Rate for Payer: Quartz Medicare Advantage |
$88.20
|
| Rate for Payer: The Alliance Commercial |
$588.00
|
| Rate for Payer: WEA Trust Commercial |
$80.85
|
| Rate for Payer: WPS Commercial |
$108.88
|
|
|
PLUNGER CAPILLARY C4100-377 VIALS OF 50EA
|
Facility
|
IP
|
$147.00
|
|
| Hospital Charge Code |
2969871
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$72.03 |
| Max. Negotiated Rate |
$135.24 |
| Rate for Payer: Aetna Commercial |
$132.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$126.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$77.91
|
| Rate for Payer: Cash Price |
$44.10
|
| Rate for Payer: Cigna Commercial |
$135.24
|
| Rate for Payer: Health EOS Commercial |
$130.83
|
| Rate for Payer: HFN Commercial |
$135.24
|
| Rate for Payer: Multiplan Commercial |
$117.60
|
| Rate for Payer: NAPHCARE Commercial |
$88.20
|
| Rate for Payer: Preferred Network Access Commercial |
$135.24
|
| Rate for Payer: Quartz Beloit One Network |
$72.03
|
| Rate for Payer: Quartz Commercial |
$88.20
|
| Rate for Payer: WEA Trust Commercial |
$80.85
|
| Rate for Payer: WPS Commercial |
$108.88
|
|
|
PMIC 110
|
Professional
|
Both
|
$112.00
|
|
|
Service Code
|
CPT 87186
|
| Hospital Charge Code |
6196549
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$30.53 |
| Max. Negotiated Rate |
$106.40 |
| Rate for Payer: Aetna Commercial |
$106.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$96.32
|
| Rate for Payer: Cash Price |
$33.60
|
| Rate for Payer: Cash Price |
$33.60
|
| Rate for Payer: Cigna Commercial |
$106.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$56.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$67.20
|
| Rate for Payer: Health EOS Commercial |
$101.92
|
| Rate for Payer: HFN Commercial |
$106.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$30.53
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$30.53
|
| Rate for Payer: Multiplan Commercial |
$89.60
|
| Rate for Payer: Preferred Network Access Commercial |
$106.40
|
| Rate for Payer: Quartz Beloit One Network |
$49.28
|
| Rate for Payer: Quartz Commercial |
$63.84
|
| Rate for Payer: The Alliance Commercial |
$56.00
|
| Rate for Payer: WEA Trust Commercial |
$61.60
|
| Rate for Payer: WPS Commercial |
$82.96
|
|
|
PMIC 110
|
Facility
|
IP
|
$112.00
|
|
|
Service Code
|
CPT 87186
|
| Hospital Charge Code |
6196549
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$54.88 |
| Max. Negotiated Rate |
$103.04 |
| Rate for Payer: Aetna Commercial |
$100.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$96.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$59.36
|
| Rate for Payer: Cash Price |
$33.60
|
| Rate for Payer: Cigna Commercial |
$103.04
|
| Rate for Payer: Health EOS Commercial |
$99.68
|
| Rate for Payer: HFN Commercial |
$103.04
|
| Rate for Payer: Multiplan Commercial |
$89.60
|
| Rate for Payer: NAPHCARE Commercial |
$67.20
|
| Rate for Payer: Preferred Network Access Commercial |
$103.04
|
| Rate for Payer: Quartz Beloit One Network |
$54.88
|
| Rate for Payer: Quartz Commercial |
$67.20
|
| Rate for Payer: WEA Trust Commercial |
$61.60
|
| Rate for Payer: WPS Commercial |
$82.96
|
|
|
PMIC 110
|
Facility
|
OP
|
$112.00
|
|
|
Service Code
|
CPT 87186
|
| Hospital Charge Code |
6196549
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.65 |
| Max. Negotiated Rate |
$103.04 |
| Rate for Payer: Aetna Commercial |
$100.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$96.32
|
| Rate for Payer: Aetna Managed Medicare |
$8.65
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$32.44
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$15.14
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$14.36
|
| Rate for Payer: Anthem Medicaid |
$8.94
|
| Rate for Payer: Anthem Medicare Advantage |
$8.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$59.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$8.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$8.65
|
| Rate for Payer: Cash Price |
$33.60
|
| Rate for Payer: Cash Price |
$33.60
|
| Rate for Payer: Cigna Commercial |
$103.04
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$8.65
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$8.94
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$62.68
|
| Rate for Payer: Dean Health Medicaid |
$8.94
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$8.65
|
| Rate for Payer: Health EOS Commercial |
$99.68
|
| Rate for Payer: HFN Commercial |
$103.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$32.18
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$8.65
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$8.94
|
| Rate for Payer: Independent Care Health Plan Medicare |
$8.65
|
| Rate for Payer: Managed Health Services Medicaid |
$9.30
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$8.65
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$8.65
|
| Rate for Payer: Multiplan Commercial |
$89.60
|
| Rate for Payer: NAPHCARE Commercial |
$12.98
|
| Rate for Payer: Preferred Network Access Commercial |
$103.04
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$8.94
|
| Rate for Payer: Quartz Beloit One Network |
$54.88
|
| Rate for Payer: Quartz Commercial |
$72.80
|
| Rate for Payer: Quartz Medicare Advantage |
$8.65
|
| Rate for Payer: The Alliance Commercial |
$34.60
|
| Rate for Payer: United Healthcare Medicaid |
$8.94
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8.65
|
| Rate for Payer: United Healthcare PPO |
$84.00
|
| Rate for Payer: WEA Trust Commercial |
$61.60
|
| Rate for Payer: Wellcare Medicare |
$8.65
|
| Rate for Payer: WMAP Medicaid |
$8.94
|
| Rate for Payer: WPS Commercial |
$82.96
|
|
|
PMIC/ID109
|
Professional
|
Both
|
$196.00
|
|
|
Service Code
|
CPT 87186
|
| Hospital Charge Code |
5313515
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$30.53 |
| Max. Negotiated Rate |
$186.20 |
| Rate for Payer: Aetna Commercial |
$186.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$168.56
|
| Rate for Payer: Cash Price |
$58.80
|
| Rate for Payer: Cash Price |
$58.80
|
| Rate for Payer: Cigna Commercial |
$186.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$98.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$117.60
|
| Rate for Payer: Health EOS Commercial |
$178.36
|
| Rate for Payer: HFN Commercial |
$186.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$30.53
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$30.53
|
| Rate for Payer: Multiplan Commercial |
$156.80
|
| Rate for Payer: Preferred Network Access Commercial |
$186.20
|
| Rate for Payer: Quartz Beloit One Network |
$86.24
|
| Rate for Payer: Quartz Commercial |
$111.72
|
| Rate for Payer: The Alliance Commercial |
$98.00
|
| Rate for Payer: WEA Trust Commercial |
$107.80
|
| Rate for Payer: WPS Commercial |
$145.18
|
|
