|
Physical Perf Test WH Eval Charges OT
|
Facility
|
IP
|
$173.00
|
|
|
Service Code
|
CPT 97750 GO
|
| Hospital Charge Code |
5294653
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$88.16 |
| Max. Negotiated Rate |
$165.53 |
| Rate for Payer: Aetna Commercial |
$161.93
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$154.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$95.36
|
| Rate for Payer: Cash Price |
$51.90
|
| Rate for Payer: Cigna Commercial |
$165.53
|
| Rate for Payer: Health EOS Commercial |
$160.13
|
| Rate for Payer: HFN Commercial |
$165.53
|
| Rate for Payer: Multiplan Commercial |
$143.94
|
| Rate for Payer: Preferred Network Access Commercial |
$165.53
|
| Rate for Payer: Quartz Beloit One Network |
$88.16
|
| Rate for Payer: Quartz Commercial |
$107.95
|
| Rate for Payer: WEA Trust Commercial |
$98.96
|
| Rate for Payer: WPS Commercial |
$133.26
|
|
|
Physical Perf Test WH Eval Charges OT
|
Facility
|
OP
|
$173.00
|
|
|
Service Code
|
CPT 97750 GO
|
| Hospital Charge Code |
5294653
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$50.38 |
| Max. Negotiated Rate |
$362.96 |
| Rate for Payer: Aetna Commercial |
$161.93
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$154.73
|
| Rate for Payer: Aetna Managed Medicare |
$50.38
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$362.96
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$298.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$282.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$95.36
|
| Rate for Payer: Cash Price |
$51.90
|
| Rate for Payer: Cash Price |
$51.90
|
| Rate for Payer: Cigna Commercial |
$165.53
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$100.69
|
| Rate for Payer: Health EOS Commercial |
$160.13
|
| Rate for Payer: HFN Commercial |
$165.53
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$210.08
|
| Rate for Payer: Multiplan Commercial |
$143.94
|
| Rate for Payer: NAPHCARE Commercial |
$107.95
|
| Rate for Payer: Preferred Network Access Commercial |
$165.53
|
| Rate for Payer: Quartz Beloit One Network |
$88.16
|
| Rate for Payer: Quartz Commercial |
$116.95
|
| Rate for Payer: Quartz Medicare Advantage |
$107.95
|
| Rate for Payer: The Alliance Commercial |
$89.96
|
| Rate for Payer: United Healthcare PPO |
$134.94
|
| Rate for Payer: WEA Trust Commercial |
$98.96
|
| Rate for Payer: WPS Commercial |
$133.26
|
|
|
PHYSICAL THERAPY
|
Facility
|
OP
|
$50.25
|
|
|
Service Code
|
EAPG 00271
|
| Min. Negotiated Rate |
$48.32 |
| Max. Negotiated Rate |
$50.25 |
| Rate for Payer: Anthem Medicaid |
$48.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$48.32
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$48.32
|
| Rate for Payer: Dean Health Medicaid |
$48.32
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$48.32
|
| Rate for Payer: Managed Health Services Medicaid |
$50.25
|
| Rate for Payer: Molina Healthcare Medicaid |
$48.32
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$48.32
|
| Rate for Payer: United Healthcare Medicaid |
$48.32
|
|
|
Physician Certification For MC Home Health Service
|
Professional
|
Both
|
$194.00
|
|
|
Service Code
|
HCPCS G0180
|
| Hospital Charge Code |
2957678
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$56.39 |
| Max. Negotiated Rate |
$191.67 |
| Rate for Payer: Aetna Commercial |
$191.67
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$173.51
|
| Rate for Payer: Aetna Managed Medicare |
$56.39
|
| Rate for Payer: Anthem Medicare Advantage |
$56.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$56.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$56.39
|
| Rate for Payer: Cash Price |
$58.20
|
| Rate for Payer: Cash Price |
$58.20
|
| Rate for Payer: Cigna Commercial |
$191.67
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$100.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$56.39
|
| Rate for Payer: Health EOS Commercial |
$183.60
|
| Rate for Payer: HFN Commercial |
$191.67
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$185.47
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$185.47
|
| Rate for Payer: Independent Care Health Plan Medicare |
$56.39
|
| Rate for Payer: Multiplan Commercial |
$161.41
|
| Rate for Payer: NAPHCARE Commercial |
$84.58
|
| Rate for Payer: Preferred Network Access Commercial |
$191.67
|
| Rate for Payer: Quartz Beloit One Network |
$88.77
|
| Rate for Payer: Quartz Commercial |
$115.00
|
| Rate for Payer: Quartz Medicare Advantage |
$56.39
|
| Rate for Payer: The Alliance Commercial |
$155.07
|
| Rate for Payer: United Healthcare Medicare Advantage |
$56.39
|
| Rate for Payer: WEA Trust Commercial |
$110.97
|
| Rate for Payer: WPS Commercial |
$98.68
|
|
|
Physician Recertification For MC Home Health Services
|
Professional
|
Both
|
$72.00
|
|
|
Service Code
|
HCPCS G0179
|
| Hospital Charge Code |
2957677
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$32.95 |
| Max. Negotiated Rate |
$143.61 |
| Rate for Payer: Aetna Commercial |
$71.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$64.40
|
| Rate for Payer: Aetna Managed Medicare |
$44.22
|
| Rate for Payer: Anthem Medicare Advantage |
$44.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$44.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$44.22
|
| Rate for Payer: Cash Price |
$21.60
|
| Rate for Payer: Cash Price |
$21.60
|
| Rate for Payer: Cigna Commercial |
$71.14
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$37.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$44.22
|
| Rate for Payer: Health EOS Commercial |
$68.14
|
| Rate for Payer: HFN Commercial |
$71.14
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$143.61
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$143.61
|
| Rate for Payer: Independent Care Health Plan Medicare |
$44.22
|
| Rate for Payer: Multiplan Commercial |
$59.90
|
| Rate for Payer: NAPHCARE Commercial |
$66.33
|
| Rate for Payer: Preferred Network Access Commercial |
$71.14
|
| Rate for Payer: Quartz Beloit One Network |
$32.95
|
| Rate for Payer: Quartz Commercial |
$42.68
|
| Rate for Payer: Quartz Medicare Advantage |
$44.22
|
| Rate for Payer: The Alliance Commercial |
$121.61
|
| Rate for Payer: United Healthcare Medicare Advantage |
$44.22
|
| Rate for Payer: WEA Trust Commercial |
$41.18
|
| Rate for Payer: WPS Commercial |
$77.39
|
|
|
PHYSIO RING II ANNULOPLASTY
|
Facility
|
IP
|
$24,772.00
|
|
| Hospital Charge Code |
2965105
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$12,623.81 |
| Max. Negotiated Rate |
$23,701.85 |
| Rate for Payer: Aetna Commercial |
$23,186.59
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$22,156.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$13,654.33
|
| Rate for Payer: Cash Price |
$7,431.60
|
| Rate for Payer: Cigna Commercial |
$23,701.85
|
| Rate for Payer: Health EOS Commercial |
$22,928.96
|
| Rate for Payer: HFN Commercial |
$23,701.85
|
| Rate for Payer: Multiplan Commercial |
$20,610.30
|
| Rate for Payer: Preferred Network Access Commercial |
$23,701.85
|
| Rate for Payer: Quartz Beloit One Network |
$12,623.81
|
| Rate for Payer: Quartz Commercial |
$15,457.73
|
| Rate for Payer: WEA Trust Commercial |
$14,169.58
|
| Rate for Payer: WPS Commercial |
$19,081.87
|
|
|
PHYSIO RING II ANNULOPLASTY
|
Facility
|
OP
|
$24,772.00
|
|
| Hospital Charge Code |
2965105
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,213.61 |
| Max. Negotiated Rate |
$23,701.85 |
| Rate for Payer: Aetna Commercial |
$23,186.59
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$22,156.08
|
| Rate for Payer: Aetna Managed Medicare |
$7,213.61
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$16,745.87
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$12,881.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$12,366.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$13,654.33
|
| Rate for Payer: Cash Price |
$7,431.60
|
| Rate for Payer: Cigna Commercial |
$23,701.85
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$14,417.30
|
| Rate for Payer: Health EOS Commercial |
$22,928.96
|
| Rate for Payer: HFN Commercial |
$23,701.85
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$19,322.16
|
| Rate for Payer: Multiplan Commercial |
$20,610.30
|
| Rate for Payer: NAPHCARE Commercial |
$15,457.73
|
| Rate for Payer: Preferred Network Access Commercial |
$23,701.85
|
| Rate for Payer: Quartz Beloit One Network |
$12,623.81
|
| Rate for Payer: Quartz Commercial |
$16,745.87
|
| Rate for Payer: Quartz Medicare Advantage |
$15,457.73
|
| Rate for Payer: The Alliance Commercial |
$12,881.44
|
| Rate for Payer: WEA Trust Commercial |
$14,169.58
|
| Rate for Payer: WPS Commercial |
$19,081.87
|
|
|
Phytonadione JW Waste Charge per 1 mg
|
Facility
|
OP
|
$36.00
|
|
|
Service Code
|
HCPCS J3430 JW
|
| Hospital Charge Code |
5266686
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.86 |
| Max. Negotiated Rate |
$34.44 |
| Rate for Payer: Aetna Commercial |
$33.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$32.20
|
| Rate for Payer: Aetna Managed Medicare |
$10.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$24.34
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$18.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$17.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$19.84
|
| Rate for Payer: Cash Price |
$10.80
|
| Rate for Payer: Cash Price |
$10.80
|
| Rate for Payer: Cigna Commercial |
$34.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3.86
|
| Rate for Payer: Health EOS Commercial |
$33.32
|
| Rate for Payer: HFN Commercial |
$34.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$28.08
|
| Rate for Payer: Multiplan Commercial |
$29.95
|
| Rate for Payer: NAPHCARE Commercial |
$22.46
|
| Rate for Payer: Preferred Network Access Commercial |
$34.44
|
| Rate for Payer: Quartz Beloit One Network |
$18.35
|
| Rate for Payer: Quartz Commercial |
$24.34
|
| Rate for Payer: Quartz Medicare Advantage |
$22.46
|
| Rate for Payer: The Alliance Commercial |
$18.72
|
| Rate for Payer: WEA Trust Commercial |
$20.59
|
| Rate for Payer: WPS Commercial |
$7.29
|
|
|
Phytonadione JW Waste Charge per 1 mg
|
Facility
|
IP
|
$36.00
|
|
|
Service Code
|
HCPCS J3430 JW
|
| Hospital Charge Code |
5266686
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$18.35 |
| Max. Negotiated Rate |
$34.44 |
| Rate for Payer: Aetna Commercial |
$33.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$32.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$19.84
|
| Rate for Payer: Cash Price |
$10.80
|
| Rate for Payer: Cigna Commercial |
$34.44
|
| Rate for Payer: Health EOS Commercial |
$33.32
|
| Rate for Payer: HFN Commercial |
$34.44
|
| Rate for Payer: Multiplan Commercial |
$29.95
|
| Rate for Payer: Preferred Network Access Commercial |
$34.44
|
| Rate for Payer: Quartz Beloit One Network |
$18.35
|
| Rate for Payer: Quartz Commercial |
$22.46
|
| Rate for Payer: WEA Trust Commercial |
$20.59
|
| Rate for Payer: WPS Commercial |
$27.73
|
|
|
Phytonadione JW Waste Charge per 1 mg
|
Professional
|
Both
|
$36.00
|
|
|
Service Code
|
HCPCS J3430 JW
|
| Hospital Charge Code |
5266686
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.92 |
| Max. Negotiated Rate |
$35.57 |
| Rate for Payer: Aetna Commercial |
$35.57
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$32.20
|
| Rate for Payer: Cash Price |
$10.80
|
| Rate for Payer: Cash Price |
$10.80
|
| Rate for Payer: Cigna Commercial |
$35.57
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2.92
|
| Rate for Payer: Health EOS Commercial |
$34.07
|
| Rate for Payer: HFN Commercial |
$35.57
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5.68
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$5.68
|
| Rate for Payer: Multiplan Commercial |
$29.95
|
| Rate for Payer: Preferred Network Access Commercial |
$35.57
|
| Rate for Payer: Quartz Beloit One Network |
$16.47
|
| Rate for Payer: Quartz Commercial |
$21.34
|
| Rate for Payer: The Alliance Commercial |
$18.72
|
| Rate for Payer: United Healthcare Medicaid |
$2.92
|
| Rate for Payer: WEA Trust Commercial |
$20.59
|
| Rate for Payer: WPS Commercial |
$7.29
|
|
|
PICC - blood drawn - Central IV Activity:
|
Facility
|
OP
|
$213.00
|
|
|
Service Code
|
CPT 36592
|
| Hospital Charge Code |
4558646
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$106.33 |
| Max. Negotiated Rate |
$560.06 |
| Rate for Payer: Aetna Commercial |
$199.37
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$190.51
|
| Rate for Payer: Aetna Managed Medicare |
$140.02
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$143.99
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$110.76
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$106.33
|
| Rate for Payer: Anthem Medicare Advantage |
$140.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$117.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$140.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$140.02
|
| Rate for Payer: Cash Price |
$63.90
|
| Rate for Payer: Cash Price |
$63.90
|
| Rate for Payer: Cash Price |
$63.90
|
| Rate for Payer: Cigna Commercial |
$203.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$140.02
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$140.02
|
| Rate for Payer: Health EOS Commercial |
$197.15
|
| Rate for Payer: HFN Commercial |
$203.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$520.86
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$140.02
|
| Rate for Payer: Independent Care Health Plan Medicare |
$140.02
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$140.02
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$140.02
|
| Rate for Payer: Multiplan Commercial |
$177.22
|
| Rate for Payer: NAPHCARE Commercial |
$210.02
|
| Rate for Payer: Preferred Network Access Commercial |
$203.80
|
| Rate for Payer: Quartz Beloit One Network |
$108.54
|
| Rate for Payer: Quartz Commercial |
$143.99
|
| Rate for Payer: Quartz Medicare Advantage |
$140.02
|
| Rate for Payer: The Alliance Commercial |
$560.06
|
| Rate for Payer: United Healthcare Medicare Advantage |
$140.02
|
| Rate for Payer: United Healthcare PPO |
$166.14
|
| Rate for Payer: WEA Trust Commercial |
$121.84
|
| Rate for Payer: Wellcare Medicare |
$140.02
|
| Rate for Payer: WPS Commercial |
$164.07
|
|
|
PICC - blood drawn - Central IV Activity:
|
Facility
|
IP
|
$213.00
|
|
|
Service Code
|
CPT 36592
|
| Hospital Charge Code |
4558646
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$108.54 |
| Max. Negotiated Rate |
$203.80 |
| Rate for Payer: Aetna Commercial |
$199.37
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$190.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$117.41
|
| Rate for Payer: Cash Price |
$63.90
|
| Rate for Payer: Cigna Commercial |
$203.80
|
| Rate for Payer: Health EOS Commercial |
$197.15
|
| Rate for Payer: HFN Commercial |
$203.80
|
| Rate for Payer: Multiplan Commercial |
$177.22
|
| Rate for Payer: Preferred Network Access Commercial |
$203.80
|
| Rate for Payer: Quartz Beloit One Network |
$108.54
|
| Rate for Payer: Quartz Commercial |
$132.91
|
| Rate for Payer: WEA Trust Commercial |
$121.84
|
| Rate for Payer: WPS Commercial |
$164.07
|
|
|
PICC Foam Plus - Central IV Dressing:
|
Facility
|
OP
|
$146.00
|
|
| Hospital Charge Code |
3120170
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$42.52 |
| Max. Negotiated Rate |
$139.69 |
| Rate for Payer: Aetna Commercial |
$136.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$130.58
|
| Rate for Payer: Aetna Managed Medicare |
$42.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$98.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$75.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$72.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$80.48
|
| Rate for Payer: Cash Price |
$43.80
|
| Rate for Payer: Cigna Commercial |
$139.69
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$84.97
|
| Rate for Payer: Health EOS Commercial |
$135.14
|
| Rate for Payer: HFN Commercial |
$139.69
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$113.88
|
| Rate for Payer: Multiplan Commercial |
$121.47
|
| Rate for Payer: NAPHCARE Commercial |
$91.10
|
| Rate for Payer: Preferred Network Access Commercial |
$139.69
|
| Rate for Payer: Quartz Beloit One Network |
$74.40
|
| Rate for Payer: Quartz Commercial |
$98.70
|
| Rate for Payer: Quartz Medicare Advantage |
$91.10
|
| Rate for Payer: The Alliance Commercial |
$75.92
|
| Rate for Payer: WEA Trust Commercial |
$83.51
|
| Rate for Payer: WPS Commercial |
$112.46
|
|
|
PICC Foam Plus - Central IV Dressing:
|
Facility
|
IP
|
$146.00
|
|
| Hospital Charge Code |
3120170
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$74.40 |
| Max. Negotiated Rate |
$139.69 |
| Rate for Payer: Aetna Commercial |
$136.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$130.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$80.48
|
| Rate for Payer: Cash Price |
$43.80
|
| Rate for Payer: Cigna Commercial |
$139.69
|
| Rate for Payer: Health EOS Commercial |
$135.14
|
| Rate for Payer: HFN Commercial |
$139.69
|
| Rate for Payer: Multiplan Commercial |
$121.47
|
| Rate for Payer: Preferred Network Access Commercial |
$139.69
|
| Rate for Payer: Quartz Beloit One Network |
$74.40
|
| Rate for Payer: Quartz Commercial |
$91.10
|
| Rate for Payer: WEA Trust Commercial |
$83.51
|
| Rate for Payer: WPS Commercial |
$112.46
|
|
|
PICC Line Placement - CATH LAB ONLY
|
Facility
|
IP
|
$2,606.00
|
|
|
Service Code
|
CPT 36569
|
| Hospital Charge Code |
4548725
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,328.02 |
| Max. Negotiated Rate |
$2,493.42 |
| Rate for Payer: Aetna Commercial |
$2,439.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,330.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,436.43
|
| Rate for Payer: Cash Price |
$781.80
|
| Rate for Payer: Cigna Commercial |
$2,493.42
|
| Rate for Payer: Health EOS Commercial |
$2,412.11
|
| Rate for Payer: HFN Commercial |
$2,493.42
|
| Rate for Payer: Multiplan Commercial |
$2,168.19
|
| Rate for Payer: Preferred Network Access Commercial |
$2,493.42
|
| Rate for Payer: Quartz Beloit One Network |
$1,328.02
|
| Rate for Payer: Quartz Commercial |
$1,626.14
|
| Rate for Payer: WEA Trust Commercial |
$1,490.63
|
| Rate for Payer: WPS Commercial |
$2,007.40
|
|
|
PICC Line Placement - CATH LAB ONLY
|
Facility
|
OP
|
$2,606.00
|
|
|
Service Code
|
CPT 36569
|
| Hospital Charge Code |
4548725
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,328.02 |
| Max. Negotiated Rate |
$6,626.51 |
| Rate for Payer: Aetna Commercial |
$2,439.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,330.81
|
| Rate for Payer: Aetna Managed Medicare |
$1,656.63
|
| 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 |
$1,656.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,436.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$1,656.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$1,656.63
|
| Rate for Payer: Cash Price |
$781.80
|
| Rate for Payer: Cash Price |
$781.80
|
| Rate for Payer: Cash Price |
$781.80
|
| Rate for Payer: Cigna Commercial |
$2,493.42
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$1,656.63
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$1,656.63
|
| Rate for Payer: Health EOS Commercial |
$2,412.11
|
| Rate for Payer: HFN Commercial |
$2,493.42
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,162.65
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,656.63
|
| Rate for Payer: Independent Care Health Plan Medicare |
$1,656.63
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$1,656.63
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$1,656.63
|
| Rate for Payer: Multiplan Commercial |
$2,168.19
|
| Rate for Payer: NAPHCARE Commercial |
$2,484.94
|
| Rate for Payer: Preferred Network Access Commercial |
$2,493.42
|
| Rate for Payer: Quartz Beloit One Network |
$1,328.02
|
| Rate for Payer: Quartz Commercial |
$1,761.66
|
| Rate for Payer: Quartz Medicare Advantage |
$1,656.63
|
| Rate for Payer: The Alliance Commercial |
$6,626.51
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,656.63
|
| Rate for Payer: United Healthcare PPO |
$3,726.32
|
| Rate for Payer: WEA Trust Commercial |
$1,490.63
|
| Rate for Payer: Wellcare Medicare |
$1,656.63
|
| Rate for Payer: WPS Commercial |
$2,007.40
|
|
|
Pigeon Serum
|
Facility
|
IP
|
$109.00
|
|
|
Service Code
|
CPT 86331
|
| Hospital Charge Code |
2942919
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$55.55 |
| Max. Negotiated Rate |
$104.29 |
| Rate for Payer: Aetna Commercial |
$102.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$97.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$60.08
|
| Rate for Payer: Cash Price |
$32.70
|
| Rate for Payer: Cigna Commercial |
$104.29
|
| Rate for Payer: Health EOS Commercial |
$100.89
|
| Rate for Payer: HFN Commercial |
$104.29
|
| Rate for Payer: Multiplan Commercial |
$90.69
|
| Rate for Payer: Preferred Network Access Commercial |
$104.29
|
| Rate for Payer: Quartz Beloit One Network |
$55.55
|
| Rate for Payer: Quartz Commercial |
$68.02
|
| Rate for Payer: WEA Trust Commercial |
$62.35
|
| Rate for Payer: WPS Commercial |
$83.96
|
|
|
Pigeon Serum
|
Professional
|
Both
|
$109.00
|
|
|
Service Code
|
CPT 86331
|
| Hospital Charge Code |
2942919
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.46 |
| Max. Negotiated Rate |
$107.69 |
| Rate for Payer: Aetna Commercial |
$107.69
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$97.49
|
| Rate for Payer: Aetna Managed Medicare |
$12.46
|
| Rate for Payer: Anthem Medicare Advantage |
$12.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$12.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$12.46
|
| Rate for Payer: Cash Price |
$32.70
|
| Rate for Payer: Cash Price |
$32.70
|
| Rate for Payer: Cigna Commercial |
$107.69
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$56.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12.46
|
| Rate for Payer: Health EOS Commercial |
$103.16
|
| Rate for Payer: HFN Commercial |
$107.69
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$43.98
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$43.98
|
| Rate for Payer: Independent Care Health Plan Medicare |
$12.46
|
| Rate for Payer: Multiplan Commercial |
$90.69
|
| Rate for Payer: NAPHCARE Commercial |
$18.69
|
| Rate for Payer: Preferred Network Access Commercial |
$107.69
|
| Rate for Payer: Quartz Beloit One Network |
$49.88
|
| Rate for Payer: Quartz Commercial |
$64.62
|
| Rate for Payer: Quartz Medicare Advantage |
$12.46
|
| Rate for Payer: The Alliance Commercial |
$49.21
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.46
|
| Rate for Payer: WEA Trust Commercial |
$62.35
|
| Rate for Payer: WPS Commercial |
$54.82
|
|
|
Pigeon Serum
|
Facility
|
OP
|
$109.00
|
|
|
Service Code
|
CPT 86331
|
| Hospital Charge Code |
2942919
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.46 |
| Max. Negotiated Rate |
$104.29 |
| Rate for Payer: Aetna Commercial |
$102.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$97.49
|
| Rate for Payer: Aetna Managed Medicare |
$12.46
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$46.72
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$21.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$20.68
|
| Rate for Payer: Anthem Medicare Advantage |
$12.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$60.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$12.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$12.46
|
| Rate for Payer: Cash Price |
$32.70
|
| Rate for Payer: Cash Price |
$32.70
|
| Rate for Payer: Cigna Commercial |
$104.29
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$12.46
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$63.44
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$12.46
|
| Rate for Payer: Health EOS Commercial |
$100.89
|
| Rate for Payer: HFN Commercial |
$104.29
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$46.35
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$12.46
|
| Rate for Payer: Independent Care Health Plan Medicare |
$12.46
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$12.46
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$12.46
|
| Rate for Payer: Multiplan Commercial |
$90.69
|
| Rate for Payer: NAPHCARE Commercial |
$18.69
|
| Rate for Payer: Preferred Network Access Commercial |
$104.29
|
| Rate for Payer: Quartz Beloit One Network |
$55.55
|
| Rate for Payer: Quartz Commercial |
$73.68
|
| Rate for Payer: Quartz Medicare Advantage |
$12.46
|
| Rate for Payer: The Alliance Commercial |
$49.84
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.46
|
| Rate for Payer: United Healthcare PPO |
$85.02
|
| Rate for Payer: WEA Trust Commercial |
$62.35
|
| Rate for Payer: Wellcare Medicare |
$12.46
|
| Rate for Payer: WPS Commercial |
$83.96
|
|
|
Pillcam Patency 91299-91110
|
Professional
|
Both
|
$1,948.00
|
|
|
Service Code
|
CPT 91299
|
| Hospital Charge Code |
4846612
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$891.40 |
| Max. Negotiated Rate |
$1,924.62 |
| Rate for Payer: Aetna Commercial |
$1,924.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,742.29
|
| Rate for Payer: Cash Price |
$584.40
|
| Rate for Payer: Cigna Commercial |
$1,924.62
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,012.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,215.55
|
| Rate for Payer: Health EOS Commercial |
$1,843.59
|
| Rate for Payer: HFN Commercial |
$1,924.62
|
| Rate for Payer: Multiplan Commercial |
$1,620.74
|
| Rate for Payer: Preferred Network Access Commercial |
$1,924.62
|
| Rate for Payer: Quartz Beloit One Network |
$891.40
|
| Rate for Payer: Quartz Commercial |
$1,154.77
|
| Rate for Payer: The Alliance Commercial |
$1,012.96
|
| Rate for Payer: WEA Trust Commercial |
$1,114.26
|
| Rate for Payer: WPS Commercial |
$1,500.54
|
|
|
PILLOW ABDUCTION M60-024-M Yellow
|
Facility
|
IP
|
$668.00
|
|
| Hospital Charge Code |
2963051
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$340.41 |
| Max. Negotiated Rate |
$639.14 |
| Rate for Payer: Aetna Commercial |
$625.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$597.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$368.20
|
| Rate for Payer: Cash Price |
$200.40
|
| Rate for Payer: Cigna Commercial |
$639.14
|
| Rate for Payer: Health EOS Commercial |
$618.30
|
| Rate for Payer: HFN Commercial |
$639.14
|
| Rate for Payer: Multiplan Commercial |
$555.78
|
| Rate for Payer: Preferred Network Access Commercial |
$639.14
|
| Rate for Payer: Quartz Beloit One Network |
$340.41
|
| Rate for Payer: Quartz Commercial |
$416.83
|
| Rate for Payer: WEA Trust Commercial |
$382.10
|
| Rate for Payer: WPS Commercial |
$514.56
|
|
|
PILLOW ABDUCTION M60-024-M Yellow
|
Facility
|
OP
|
$668.00
|
|
| Hospital Charge Code |
2963051
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$194.52 |
| Max. Negotiated Rate |
$639.14 |
| Rate for Payer: Aetna Commercial |
$625.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$597.46
|
| Rate for Payer: Aetna Managed Medicare |
$194.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$451.57
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$347.36
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$333.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$368.20
|
| Rate for Payer: Cash Price |
$200.40
|
| Rate for Payer: Cigna Commercial |
$639.14
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$388.78
|
| Rate for Payer: Health EOS Commercial |
$618.30
|
| Rate for Payer: HFN Commercial |
$639.14
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$521.04
|
| Rate for Payer: Multiplan Commercial |
$555.78
|
| Rate for Payer: NAPHCARE Commercial |
$416.83
|
| Rate for Payer: Preferred Network Access Commercial |
$639.14
|
| Rate for Payer: Quartz Beloit One Network |
$340.41
|
| Rate for Payer: Quartz Commercial |
$451.57
|
| Rate for Payer: Quartz Medicare Advantage |
$416.83
|
| Rate for Payer: The Alliance Commercial |
$347.36
|
| Rate for Payer: WEA Trust Commercial |
$382.10
|
| Rate for Payer: WPS Commercial |
$514.56
|
|
|
Pilocarpine 4% Ophth Solution 15ml [Med]
|
Facility
|
IP
|
$334.00
|
|
| Hospital Charge Code |
2974971
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$170.21 |
| Max. Negotiated Rate |
$319.57 |
| Rate for Payer: Aetna Commercial |
$312.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$298.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$184.10
|
| Rate for Payer: Cash Price |
$100.20
|
| Rate for Payer: Cigna Commercial |
$319.57
|
| Rate for Payer: Health EOS Commercial |
$309.15
|
| Rate for Payer: HFN Commercial |
$319.57
|
| Rate for Payer: Multiplan Commercial |
$277.89
|
| Rate for Payer: Preferred Network Access Commercial |
$319.57
|
| Rate for Payer: Quartz Beloit One Network |
$170.21
|
| Rate for Payer: Quartz Commercial |
$208.42
|
| Rate for Payer: WEA Trust Commercial |
$191.05
|
| Rate for Payer: WPS Commercial |
$257.28
|
|
|
Pilocarpine 4% Ophth Solution 15ml [Med]
|
Facility
|
OP
|
$334.00
|
|
| Hospital Charge Code |
2974971
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$97.26 |
| Max. Negotiated Rate |
$319.57 |
| Rate for Payer: Aetna Commercial |
$312.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$298.73
|
| Rate for Payer: Aetna Managed Medicare |
$97.26
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$225.78
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$173.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$166.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$184.10
|
| Rate for Payer: Cash Price |
$100.20
|
| Rate for Payer: Cigna Commercial |
$319.57
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$194.39
|
| Rate for Payer: Health EOS Commercial |
$309.15
|
| Rate for Payer: HFN Commercial |
$319.57
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$260.52
|
| Rate for Payer: Multiplan Commercial |
$277.89
|
| Rate for Payer: NAPHCARE Commercial |
$208.42
|
| Rate for Payer: Preferred Network Access Commercial |
$319.57
|
| Rate for Payer: Quartz Beloit One Network |
$170.21
|
| Rate for Payer: Quartz Commercial |
$225.78
|
| Rate for Payer: Quartz Medicare Advantage |
$208.42
|
| Rate for Payer: The Alliance Commercial |
$173.68
|
| Rate for Payer: WEA Trust Commercial |
$191.05
|
| Rate for Payer: WPS Commercial |
$257.28
|
|
|
PILONIDAL CYSTECTOMY
|
Facility
|
IP
|
$1,084.00
|
|
| Hospital Charge Code |
2960316
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$552.41 |
| Max. Negotiated Rate |
$1,037.17 |
| Rate for Payer: Aetna Commercial |
$1,014.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$969.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$597.50
|
| Rate for Payer: Cash Price |
$325.20
|
| Rate for Payer: Cigna Commercial |
$1,037.17
|
| Rate for Payer: Health EOS Commercial |
$1,003.35
|
| Rate for Payer: HFN Commercial |
$1,037.17
|
| Rate for Payer: Multiplan Commercial |
$901.89
|
| Rate for Payer: Preferred Network Access Commercial |
$1,037.17
|
| Rate for Payer: Quartz Beloit One Network |
$552.41
|
| Rate for Payer: Quartz Commercial |
$676.42
|
| Rate for Payer: WEA Trust Commercial |
$620.05
|
| Rate for Payer: WPS Commercial |
$835.01
|
|
