|
PIN TEMP FIX 2.0MM THREADED ORTHOLOC 59250050
|
Facility
|
OP
|
$1,292.00
|
|
| Hospital Charge Code |
6201066
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$376.23 |
| Max. Negotiated Rate |
$1,236.19 |
| Rate for Payer: Aetna Commercial |
$1,209.31
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,155.56
|
| Rate for Payer: Aetna Managed Medicare |
$376.23
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$873.39
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$671.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$644.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$712.15
|
| Rate for Payer: Cash Price |
$387.60
|
| Rate for Payer: Cigna Commercial |
$1,236.19
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$751.94
|
| Rate for Payer: Health EOS Commercial |
$1,195.88
|
| Rate for Payer: HFN Commercial |
$1,236.19
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,007.76
|
| Rate for Payer: Multiplan Commercial |
$1,074.94
|
| Rate for Payer: NAPHCARE Commercial |
$806.21
|
| Rate for Payer: Preferred Network Access Commercial |
$1,236.19
|
| Rate for Payer: Quartz Beloit One Network |
$658.40
|
| Rate for Payer: Quartz Commercial |
$873.39
|
| Rate for Payer: Quartz Medicare Advantage |
$806.21
|
| Rate for Payer: The Alliance Commercial |
$671.84
|
| Rate for Payer: WEA Trust Commercial |
$739.02
|
| Rate for Payer: WPS Commercial |
$995.23
|
|
|
PIN TEMP FIXATION1.1MM DC4212
|
Facility
|
OP
|
$1,329.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
5957651
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$387.00 |
| Max. Negotiated Rate |
$1,271.59 |
| Rate for Payer: Aetna Commercial |
$1,243.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,188.66
|
| Rate for Payer: Aetna Managed Medicare |
$387.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$898.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$691.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$663.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$732.54
|
| Rate for Payer: Cash Price |
$398.70
|
| Rate for Payer: Cigna Commercial |
$1,271.59
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$773.48
|
| Rate for Payer: Health EOS Commercial |
$1,230.12
|
| Rate for Payer: HFN Commercial |
$1,271.59
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,036.62
|
| Rate for Payer: Multiplan Commercial |
$1,105.73
|
| Rate for Payer: NAPHCARE Commercial |
$829.30
|
| Rate for Payer: Preferred Network Access Commercial |
$1,271.59
|
| Rate for Payer: Quartz Beloit One Network |
$677.26
|
| Rate for Payer: Quartz Commercial |
$898.40
|
| Rate for Payer: Quartz Medicare Advantage |
$829.30
|
| Rate for Payer: The Alliance Commercial |
$691.08
|
| Rate for Payer: WEA Trust Commercial |
$760.19
|
| Rate for Payer: WPS Commercial |
$1,023.73
|
|
|
PIN TEMP FIXATION1.1MM DC4212
|
Facility
|
IP
|
$1,329.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
5957651
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$677.26 |
| Max. Negotiated Rate |
$1,271.59 |
| Rate for Payer: Aetna Commercial |
$1,243.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,188.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$732.54
|
| Rate for Payer: Cash Price |
$398.70
|
| Rate for Payer: Cigna Commercial |
$1,271.59
|
| Rate for Payer: Health EOS Commercial |
$1,230.12
|
| Rate for Payer: HFN Commercial |
$1,271.59
|
| Rate for Payer: Multiplan Commercial |
$1,105.73
|
| Rate for Payer: Preferred Network Access Commercial |
$1,271.59
|
| Rate for Payer: Quartz Beloit One Network |
$677.26
|
| Rate for Payer: Quartz Commercial |
$829.30
|
| Rate for Payer: WEA Trust Commercial |
$760.19
|
| Rate for Payer: WPS Commercial |
$1,023.73
|
|
|
PIN TRANSFIX 6.0 X 225 294.950
|
Facility
|
OP
|
$3,065.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966309
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$892.53 |
| Max. Negotiated Rate |
$2,932.59 |
| Rate for Payer: Aetna Commercial |
$2,868.84
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,741.34
|
| Rate for Payer: Aetna Managed Medicare |
$892.53
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,071.94
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,593.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,530.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,689.43
|
| Rate for Payer: Cash Price |
$919.50
|
| Rate for Payer: Cigna Commercial |
$2,932.59
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,783.83
|
| Rate for Payer: Health EOS Commercial |
$2,836.96
|
| Rate for Payer: HFN Commercial |
$2,932.59
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,390.70
|
| Rate for Payer: Multiplan Commercial |
$2,550.08
|
| Rate for Payer: NAPHCARE Commercial |
$1,912.56
|
| Rate for Payer: Preferred Network Access Commercial |
$2,932.59
|
| Rate for Payer: Quartz Beloit One Network |
$1,561.92
|
| Rate for Payer: Quartz Commercial |
$2,071.94
|
| Rate for Payer: Quartz Medicare Advantage |
$1,912.56
|
| Rate for Payer: The Alliance Commercial |
$1,593.80
|
| Rate for Payer: WEA Trust Commercial |
$1,753.18
|
| Rate for Payer: WPS Commercial |
$2,360.97
|
|
|
PIN TRANSFIX 6.0 X 225 294.950
|
Facility
|
IP
|
$3,065.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
2966309
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,561.92 |
| Max. Negotiated Rate |
$2,932.59 |
| Rate for Payer: Aetna Commercial |
$2,868.84
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,741.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,689.43
|
| Rate for Payer: Cash Price |
$919.50
|
| Rate for Payer: Cigna Commercial |
$2,932.59
|
| Rate for Payer: Health EOS Commercial |
$2,836.96
|
| Rate for Payer: HFN Commercial |
$2,932.59
|
| Rate for Payer: Multiplan Commercial |
$2,550.08
|
| Rate for Payer: Preferred Network Access Commercial |
$2,932.59
|
| Rate for Payer: Quartz Beloit One Network |
$1,561.92
|
| Rate for Payer: Quartz Commercial |
$1,912.56
|
| Rate for Payer: WEA Trust Commercial |
$1,753.18
|
| Rate for Payer: WPS Commercial |
$2,360.97
|
|
|
PIN TRANSFIXING 4mmx200mm 50mm
|
Facility
|
OP
|
$2,025.00
|
|
| Hospital Charge Code |
2966087
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$589.68 |
| Max. Negotiated Rate |
$1,937.52 |
| Rate for Payer: Aetna Commercial |
$1,895.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,811.16
|
| Rate for Payer: Aetna Managed Medicare |
$589.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,368.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,053.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,010.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,116.18
|
| Rate for Payer: Cash Price |
$607.50
|
| Rate for Payer: Cigna Commercial |
$1,937.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,178.55
|
| Rate for Payer: Health EOS Commercial |
$1,874.34
|
| Rate for Payer: HFN Commercial |
$1,937.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,579.50
|
| Rate for Payer: Multiplan Commercial |
$1,684.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,263.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,937.52
|
| Rate for Payer: Quartz Beloit One Network |
$1,031.94
|
| Rate for Payer: Quartz Commercial |
$1,368.90
|
| Rate for Payer: Quartz Medicare Advantage |
$1,263.60
|
| Rate for Payer: The Alliance Commercial |
$1,053.00
|
| Rate for Payer: WEA Trust Commercial |
$1,158.30
|
| Rate for Payer: WPS Commercial |
$1,559.86
|
|
|
PIN TRANSFIXING 4mmx200mm 50mm
|
Facility
|
IP
|
$2,025.00
|
|
| Hospital Charge Code |
2966087
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,031.94 |
| Max. Negotiated Rate |
$1,937.52 |
| Rate for Payer: Aetna Commercial |
$1,895.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,811.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,116.18
|
| Rate for Payer: Cash Price |
$607.50
|
| Rate for Payer: Cigna Commercial |
$1,937.52
|
| Rate for Payer: Health EOS Commercial |
$1,874.34
|
| Rate for Payer: HFN Commercial |
$1,937.52
|
| Rate for Payer: Multiplan Commercial |
$1,684.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,937.52
|
| Rate for Payer: Quartz Beloit One Network |
$1,031.94
|
| Rate for Payer: Quartz Commercial |
$1,263.60
|
| Rate for Payer: WEA Trust Commercial |
$1,158.30
|
| Rate for Payer: WPS Commercial |
$1,559.86
|
|
|
Pinworm Prep
|
Professional
|
Both
|
$86.00
|
|
|
Service Code
|
CPT 87172
|
| Hospital Charge Code |
633912
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.44 |
| Max. Negotiated Rate |
$84.97 |
| Rate for Payer: Aetna Commercial |
$84.97
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$76.92
|
| Rate for Payer: Aetna Managed Medicare |
$4.44
|
| Rate for Payer: Anthem Medicare Advantage |
$4.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$4.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$4.44
|
| Rate for Payer: Cash Price |
$25.80
|
| Rate for Payer: Cash Price |
$25.80
|
| Rate for Payer: Cigna Commercial |
$84.97
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$44.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4.44
|
| Rate for Payer: Health EOS Commercial |
$81.39
|
| Rate for Payer: HFN Commercial |
$84.97
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$15.67
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$15.67
|
| Rate for Payer: Independent Care Health Plan Medicare |
$4.44
|
| Rate for Payer: Multiplan Commercial |
$71.55
|
| Rate for Payer: NAPHCARE Commercial |
$6.66
|
| Rate for Payer: Preferred Network Access Commercial |
$84.97
|
| Rate for Payer: Quartz Beloit One Network |
$39.35
|
| Rate for Payer: Quartz Commercial |
$50.98
|
| Rate for Payer: Quartz Medicare Advantage |
$4.44
|
| Rate for Payer: The Alliance Commercial |
$17.54
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4.44
|
| Rate for Payer: WEA Trust Commercial |
$49.19
|
| Rate for Payer: WPS Commercial |
$19.54
|
|
|
Pinworm Prep
|
Facility
|
OP
|
$86.00
|
|
|
Service Code
|
CPT 87172
|
| Hospital Charge Code |
633912
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.44 |
| Max. Negotiated Rate |
$82.28 |
| Rate for Payer: Aetna Commercial |
$80.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$76.92
|
| Rate for Payer: Aetna Managed Medicare |
$4.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$16.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$7.77
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7.37
|
| Rate for Payer: Anthem Medicare Advantage |
$4.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$47.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$4.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$4.44
|
| Rate for Payer: Cash Price |
$25.80
|
| Rate for Payer: Cash Price |
$25.80
|
| Rate for Payer: Cigna Commercial |
$82.28
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$4.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$50.05
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$4.44
|
| Rate for Payer: Health EOS Commercial |
$79.60
|
| Rate for Payer: HFN Commercial |
$82.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$16.52
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$4.44
|
| Rate for Payer: Independent Care Health Plan Medicare |
$4.44
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$4.44
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$4.44
|
| Rate for Payer: Multiplan Commercial |
$71.55
|
| Rate for Payer: NAPHCARE Commercial |
$6.66
|
| Rate for Payer: Preferred Network Access Commercial |
$82.28
|
| Rate for Payer: Quartz Beloit One Network |
$43.83
|
| Rate for Payer: Quartz Commercial |
$58.14
|
| Rate for Payer: Quartz Medicare Advantage |
$4.44
|
| Rate for Payer: The Alliance Commercial |
$17.76
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4.44
|
| Rate for Payer: United Healthcare PPO |
$67.08
|
| Rate for Payer: WEA Trust Commercial |
$49.19
|
| Rate for Payer: Wellcare Medicare |
$4.44
|
| Rate for Payer: WPS Commercial |
$66.25
|
|
|
Pinworm Prep
|
Facility
|
IP
|
$86.00
|
|
|
Service Code
|
CPT 87172
|
| Hospital Charge Code |
633912
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$43.83 |
| Max. Negotiated Rate |
$82.28 |
| Rate for Payer: Aetna Commercial |
$80.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$76.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$47.40
|
| Rate for Payer: Cash Price |
$25.80
|
| Rate for Payer: Cigna Commercial |
$82.28
|
| Rate for Payer: Health EOS Commercial |
$79.60
|
| Rate for Payer: HFN Commercial |
$82.28
|
| Rate for Payer: Multiplan Commercial |
$71.55
|
| Rate for Payer: Preferred Network Access Commercial |
$82.28
|
| Rate for Payer: Quartz Beloit One Network |
$43.83
|
| Rate for Payer: Quartz Commercial |
$53.66
|
| Rate for Payer: WEA Trust Commercial |
$49.19
|
| Rate for Payer: WPS Commercial |
$66.25
|
|
|
Pioneer Catheter
|
Facility
|
OP
|
$19,209.00
|
|
|
Service Code
|
HCPCS C1753
|
| Hospital Charge Code |
4139311
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$5,593.66 |
| Max. Negotiated Rate |
$18,379.17 |
| Rate for Payer: Aetna Commercial |
$17,979.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$17,180.53
|
| Rate for Payer: Aetna Managed Medicare |
$5,593.66
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$12,985.28
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$9,988.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$9,589.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$10,588.00
|
| Rate for Payer: Cash Price |
$5,762.70
|
| Rate for Payer: Cigna Commercial |
$18,379.17
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$11,179.64
|
| Rate for Payer: Health EOS Commercial |
$17,779.85
|
| Rate for Payer: HFN Commercial |
$18,379.17
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$14,983.02
|
| Rate for Payer: Multiplan Commercial |
$15,981.89
|
| Rate for Payer: NAPHCARE Commercial |
$11,986.42
|
| Rate for Payer: Preferred Network Access Commercial |
$18,379.17
|
| Rate for Payer: Quartz Beloit One Network |
$9,788.91
|
| Rate for Payer: Quartz Commercial |
$12,985.28
|
| Rate for Payer: Quartz Medicare Advantage |
$11,986.42
|
| Rate for Payer: The Alliance Commercial |
$9,988.68
|
| Rate for Payer: WEA Trust Commercial |
$10,987.55
|
| Rate for Payer: WPS Commercial |
$14,796.69
|
|
|
Pioneer Catheter
|
Facility
|
IP
|
$19,209.00
|
|
|
Service Code
|
HCPCS C1753
|
| Hospital Charge Code |
4139311
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$9,788.91 |
| Max. Negotiated Rate |
$18,379.17 |
| Rate for Payer: Aetna Commercial |
$17,979.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$17,180.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$10,588.00
|
| Rate for Payer: Cash Price |
$5,762.70
|
| Rate for Payer: Cigna Commercial |
$18,379.17
|
| Rate for Payer: Health EOS Commercial |
$17,779.85
|
| Rate for Payer: HFN Commercial |
$18,379.17
|
| Rate for Payer: Multiplan Commercial |
$15,981.89
|
| Rate for Payer: Preferred Network Access Commercial |
$18,379.17
|
| Rate for Payer: Quartz Beloit One Network |
$9,788.91
|
| Rate for Payer: Quartz Commercial |
$11,986.42
|
| Rate for Payer: WEA Trust Commercial |
$10,987.55
|
| Rate for Payer: WPS Commercial |
$14,796.69
|
|
|
Piperacillin-Tazobactam JW Waste Charge per 1 gm
|
Facility
|
OP
|
$21.00
|
|
|
Service Code
|
HCPCS J2543 JW
|
| Hospital Charge Code |
5266705
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.44 |
| Max. Negotiated Rate |
$20.09 |
| Rate for Payer: Aetna Commercial |
$19.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$18.78
|
| Rate for Payer: Aetna Managed Medicare |
$6.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$14.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$10.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$10.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$11.58
|
| Rate for Payer: Cash Price |
$6.30
|
| Rate for Payer: Cash Price |
$6.30
|
| Rate for Payer: Cigna Commercial |
$20.09
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1.44
|
| Rate for Payer: Health EOS Commercial |
$19.44
|
| Rate for Payer: HFN Commercial |
$20.09
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$16.38
|
| Rate for Payer: Multiplan Commercial |
$17.47
|
| Rate for Payer: NAPHCARE Commercial |
$13.10
|
| Rate for Payer: Preferred Network Access Commercial |
$20.09
|
| Rate for Payer: Quartz Beloit One Network |
$10.70
|
| Rate for Payer: Quartz Commercial |
$14.20
|
| Rate for Payer: Quartz Medicare Advantage |
$13.10
|
| Rate for Payer: The Alliance Commercial |
$10.92
|
| Rate for Payer: WEA Trust Commercial |
$12.01
|
| Rate for Payer: WPS Commercial |
$2.73
|
|
|
Piperacillin-Tazobactam JW Waste Charge per 1 gm
|
Facility
|
IP
|
$21.00
|
|
|
Service Code
|
HCPCS J2543 JW
|
| Hospital Charge Code |
5266705
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.70 |
| Max. Negotiated Rate |
$20.09 |
| Rate for Payer: Aetna Commercial |
$19.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$18.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$11.58
|
| Rate for Payer: Cash Price |
$6.30
|
| Rate for Payer: Cigna Commercial |
$20.09
|
| Rate for Payer: Health EOS Commercial |
$19.44
|
| Rate for Payer: HFN Commercial |
$20.09
|
| Rate for Payer: Multiplan Commercial |
$17.47
|
| Rate for Payer: Preferred Network Access Commercial |
$20.09
|
| Rate for Payer: Quartz Beloit One Network |
$10.70
|
| Rate for Payer: Quartz Commercial |
$13.10
|
| Rate for Payer: WEA Trust Commercial |
$12.01
|
| Rate for Payer: WPS Commercial |
$16.18
|
|
|
Piperacillin-Tazobactam JW Waste Charge per 1 gm
|
Professional
|
Both
|
$21.00
|
|
|
Service Code
|
HCPCS J2543 JW
|
| Hospital Charge Code |
5266705
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.09 |
| Max. Negotiated Rate |
$20.75 |
| Rate for Payer: Aetna Commercial |
$20.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$18.78
|
| Rate for Payer: Cash Price |
$6.30
|
| Rate for Payer: Cash Price |
$6.30
|
| Rate for Payer: Cigna Commercial |
$20.75
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1.13
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1.09
|
| Rate for Payer: Health EOS Commercial |
$19.87
|
| Rate for Payer: HFN Commercial |
$20.75
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2.29
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$2.29
|
| Rate for Payer: Multiplan Commercial |
$17.47
|
| Rate for Payer: Preferred Network Access Commercial |
$20.75
|
| Rate for Payer: Quartz Beloit One Network |
$9.61
|
| Rate for Payer: Quartz Commercial |
$12.45
|
| Rate for Payer: The Alliance Commercial |
$10.92
|
| Rate for Payer: United Healthcare Medicaid |
$1.13
|
| Rate for Payer: WEA Trust Commercial |
$12.01
|
| Rate for Payer: WPS Commercial |
$2.73
|
|
|
P. jirovecii / 34286
|
Facility
|
IP
|
$150.00
|
|
|
Service Code
|
CPT 87015
|
| Hospital Charge Code |
5096625
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$76.44 |
| Max. Negotiated Rate |
$143.52 |
| Rate for Payer: Aetna Commercial |
$140.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$134.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$82.68
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Cigna Commercial |
$143.52
|
| Rate for Payer: Health EOS Commercial |
$138.84
|
| Rate for Payer: HFN Commercial |
$143.52
|
| Rate for Payer: Multiplan Commercial |
$124.80
|
| Rate for Payer: Preferred Network Access Commercial |
$143.52
|
| Rate for Payer: Quartz Beloit One Network |
$76.44
|
| Rate for Payer: Quartz Commercial |
$93.60
|
| Rate for Payer: WEA Trust Commercial |
$85.80
|
| Rate for Payer: WPS Commercial |
$115.55
|
|
|
P. jirovecii / 34286
|
Professional
|
Both
|
$150.00
|
|
|
Service Code
|
CPT 87015
|
| Hospital Charge Code |
5096625
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.95 |
| Max. Negotiated Rate |
$148.20 |
| Rate for Payer: Aetna Commercial |
$148.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$134.16
|
| Rate for Payer: Aetna Managed Medicare |
$6.95
|
| Rate for Payer: Anthem Medicare Advantage |
$6.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$6.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$6.95
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Cigna Commercial |
$148.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$78.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6.95
|
| Rate for Payer: Health EOS Commercial |
$141.96
|
| Rate for Payer: HFN Commercial |
$148.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$24.52
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$24.52
|
| Rate for Payer: Independent Care Health Plan Medicare |
$6.95
|
| Rate for Payer: Multiplan Commercial |
$124.80
|
| Rate for Payer: NAPHCARE Commercial |
$10.42
|
| Rate for Payer: Preferred Network Access Commercial |
$148.20
|
| Rate for Payer: Quartz Beloit One Network |
$68.64
|
| Rate for Payer: Quartz Commercial |
$88.92
|
| Rate for Payer: Quartz Medicare Advantage |
$6.95
|
| Rate for Payer: The Alliance Commercial |
$27.44
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6.95
|
| Rate for Payer: WEA Trust Commercial |
$85.80
|
| Rate for Payer: WPS Commercial |
$30.57
|
|
|
P. jirovecii / 34286
|
Facility
|
OP
|
$150.00
|
|
|
Service Code
|
CPT 87015
|
| Hospital Charge Code |
5096625
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.95 |
| Max. Negotiated Rate |
$143.52 |
| Rate for Payer: Aetna Commercial |
$140.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$134.16
|
| Rate for Payer: Aetna Managed Medicare |
$6.95
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$26.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$12.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$11.53
|
| Rate for Payer: Anthem Medicare Advantage |
$6.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$82.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$6.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$6.95
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Cigna Commercial |
$143.52
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$6.95
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$87.30
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$6.95
|
| Rate for Payer: Health EOS Commercial |
$138.84
|
| Rate for Payer: HFN Commercial |
$143.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$25.84
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$6.95
|
| Rate for Payer: Independent Care Health Plan Medicare |
$6.95
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$6.95
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$6.95
|
| Rate for Payer: Multiplan Commercial |
$124.80
|
| Rate for Payer: NAPHCARE Commercial |
$10.42
|
| Rate for Payer: Preferred Network Access Commercial |
$143.52
|
| Rate for Payer: Quartz Beloit One Network |
$76.44
|
| Rate for Payer: Quartz Commercial |
$101.40
|
| Rate for Payer: Quartz Medicare Advantage |
$6.95
|
| Rate for Payer: The Alliance Commercial |
$27.79
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6.95
|
| Rate for Payer: United Healthcare PPO |
$117.00
|
| Rate for Payer: WEA Trust Commercial |
$85.80
|
| Rate for Payer: Wellcare Medicare |
$6.95
|
| Rate for Payer: WPS Commercial |
$115.55
|
|
|
PKU
|
Professional
|
Both
|
$443.00
|
|
|
Service Code
|
CPT 84035
|
| Hospital Charge Code |
1042935
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.14 |
| Max. Negotiated Rate |
$437.68 |
| Rate for Payer: Aetna Commercial |
$437.68
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$396.22
|
| Rate for Payer: Aetna Managed Medicare |
$4.14
|
| Rate for Payer: Anthem Medicare Advantage |
$4.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$4.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$4.14
|
| Rate for Payer: Cash Price |
$132.90
|
| Rate for Payer: Cash Price |
$132.90
|
| Rate for Payer: Cigna Commercial |
$437.68
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$230.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4.14
|
| Rate for Payer: Health EOS Commercial |
$419.26
|
| Rate for Payer: HFN Commercial |
$437.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$14.61
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$14.61
|
| Rate for Payer: Independent Care Health Plan Medicare |
$4.14
|
| Rate for Payer: Multiplan Commercial |
$368.58
|
| Rate for Payer: NAPHCARE Commercial |
$6.21
|
| Rate for Payer: Preferred Network Access Commercial |
$437.68
|
| Rate for Payer: Quartz Beloit One Network |
$202.72
|
| Rate for Payer: Quartz Commercial |
$262.61
|
| Rate for Payer: Quartz Medicare Advantage |
$4.14
|
| Rate for Payer: The Alliance Commercial |
$16.35
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4.14
|
| Rate for Payer: WEA Trust Commercial |
$253.40
|
| Rate for Payer: WPS Commercial |
$18.21
|
|
|
PKU
|
Facility
|
OP
|
$443.00
|
|
|
Service Code
|
CPT 84035
|
| Hospital Charge Code |
1042935
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.14 |
| Max. Negotiated Rate |
$423.86 |
| Rate for Payer: Aetna Commercial |
$414.65
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$396.22
|
| Rate for Payer: Aetna Managed Medicare |
$4.14
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$15.52
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$7.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$6.87
|
| Rate for Payer: Anthem Medicare Advantage |
$4.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$244.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$4.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$4.14
|
| Rate for Payer: Cash Price |
$132.90
|
| Rate for Payer: Cash Price |
$132.90
|
| Rate for Payer: Cigna Commercial |
$423.86
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$4.14
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$257.83
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$4.14
|
| Rate for Payer: Health EOS Commercial |
$410.04
|
| Rate for Payer: HFN Commercial |
$423.86
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$15.40
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$4.14
|
| Rate for Payer: Independent Care Health Plan Medicare |
$4.14
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$4.14
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$4.14
|
| Rate for Payer: Multiplan Commercial |
$368.58
|
| Rate for Payer: NAPHCARE Commercial |
$6.21
|
| Rate for Payer: Preferred Network Access Commercial |
$423.86
|
| Rate for Payer: Quartz Beloit One Network |
$225.75
|
| Rate for Payer: Quartz Commercial |
$299.47
|
| Rate for Payer: Quartz Medicare Advantage |
$4.14
|
| Rate for Payer: The Alliance Commercial |
$16.56
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4.14
|
| Rate for Payer: United Healthcare PPO |
$345.54
|
| Rate for Payer: WEA Trust Commercial |
$253.40
|
| Rate for Payer: Wellcare Medicare |
$4.14
|
| Rate for Payer: WPS Commercial |
$341.24
|
|
|
PKU
|
Facility
|
IP
|
$443.00
|
|
|
Service Code
|
CPT 84035
|
| Hospital Charge Code |
1042935
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$225.75 |
| Max. Negotiated Rate |
$423.86 |
| Rate for Payer: Aetna Commercial |
$414.65
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$396.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$244.18
|
| Rate for Payer: Cash Price |
$132.90
|
| Rate for Payer: Cigna Commercial |
$423.86
|
| Rate for Payer: Health EOS Commercial |
$410.04
|
| Rate for Payer: HFN Commercial |
$423.86
|
| Rate for Payer: Multiplan Commercial |
$368.58
|
| Rate for Payer: Preferred Network Access Commercial |
$423.86
|
| Rate for Payer: Quartz Beloit One Network |
$225.75
|
| Rate for Payer: Quartz Commercial |
$276.43
|
| Rate for Payer: WEA Trust Commercial |
$253.40
|
| Rate for Payer: WPS Commercial |
$341.24
|
|
|
PL 12 Autoabs
|
Professional
|
Both
|
$167.00
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
4592895
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.65 |
| Max. Negotiated Rate |
$165.00 |
| Rate for Payer: Aetna Commercial |
$165.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$149.36
|
| Rate for Payer: Aetna Managed Medicare |
$18.65
|
| Rate for Payer: Anthem Medicare Advantage |
$18.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$18.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$18.65
|
| Rate for Payer: Cash Price |
$50.10
|
| Rate for Payer: Cash Price |
$50.10
|
| Rate for Payer: Cigna Commercial |
$165.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$86.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$18.65
|
| Rate for Payer: Health EOS Commercial |
$158.05
|
| Rate for Payer: HFN Commercial |
$165.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$65.82
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$65.82
|
| Rate for Payer: Independent Care Health Plan Medicare |
$18.65
|
| Rate for Payer: Multiplan Commercial |
$138.94
|
| Rate for Payer: NAPHCARE Commercial |
$27.97
|
| Rate for Payer: Preferred Network Access Commercial |
$165.00
|
| Rate for Payer: Quartz Beloit One Network |
$76.42
|
| Rate for Payer: Quartz Commercial |
$99.00
|
| Rate for Payer: Quartz Medicare Advantage |
$18.65
|
| Rate for Payer: The Alliance Commercial |
$73.66
|
| Rate for Payer: United Healthcare Medicare Advantage |
$18.65
|
| Rate for Payer: WEA Trust Commercial |
$95.52
|
| Rate for Payer: WPS Commercial |
$82.05
|
|
|
PL 12 Autoabs
|
Facility
|
OP
|
$167.00
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
4592895
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.65 |
| Max. Negotiated Rate |
$159.79 |
| Rate for Payer: Aetna Commercial |
$156.31
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$149.36
|
| Rate for Payer: Aetna Managed Medicare |
$18.65
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$69.93
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$32.63
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$30.95
|
| Rate for Payer: Anthem Medicare Advantage |
$18.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$92.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$18.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$18.65
|
| Rate for Payer: Cash Price |
$50.10
|
| Rate for Payer: Cash Price |
$50.10
|
| Rate for Payer: Cigna Commercial |
$159.79
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$18.65
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$97.19
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$18.65
|
| Rate for Payer: Health EOS Commercial |
$154.58
|
| Rate for Payer: HFN Commercial |
$159.79
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$69.37
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$18.65
|
| Rate for Payer: Independent Care Health Plan Medicare |
$18.65
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$18.65
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$18.65
|
| Rate for Payer: Multiplan Commercial |
$138.94
|
| Rate for Payer: NAPHCARE Commercial |
$27.97
|
| Rate for Payer: Preferred Network Access Commercial |
$159.79
|
| Rate for Payer: Quartz Beloit One Network |
$85.10
|
| Rate for Payer: Quartz Commercial |
$112.89
|
| Rate for Payer: Quartz Medicare Advantage |
$18.65
|
| Rate for Payer: The Alliance Commercial |
$74.59
|
| Rate for Payer: United Healthcare Medicare Advantage |
$18.65
|
| Rate for Payer: United Healthcare PPO |
$130.26
|
| Rate for Payer: WEA Trust Commercial |
$95.52
|
| Rate for Payer: Wellcare Medicare |
$18.65
|
| Rate for Payer: WPS Commercial |
$128.64
|
|
|
PL 12 Autoabs
|
Facility
|
IP
|
$167.00
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
4592895
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$85.10 |
| Max. Negotiated Rate |
$159.79 |
| Rate for Payer: Aetna Commercial |
$156.31
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$149.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$92.05
|
| Rate for Payer: Cash Price |
$50.10
|
| Rate for Payer: Cigna Commercial |
$159.79
|
| Rate for Payer: Health EOS Commercial |
$154.58
|
| Rate for Payer: HFN Commercial |
$159.79
|
| Rate for Payer: Multiplan Commercial |
$138.94
|
| Rate for Payer: Preferred Network Access Commercial |
$159.79
|
| Rate for Payer: Quartz Beloit One Network |
$85.10
|
| Rate for Payer: Quartz Commercial |
$104.21
|
| Rate for Payer: WEA Trust Commercial |
$95.52
|
| Rate for Payer: WPS Commercial |
$128.64
|
|
|
PL 7 Autoabs
|
Professional
|
Both
|
$167.00
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
4592894
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.65 |
| Max. Negotiated Rate |
$165.00 |
| Rate for Payer: Aetna Commercial |
$165.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$149.36
|
| Rate for Payer: Aetna Managed Medicare |
$18.65
|
| Rate for Payer: Anthem Medicare Advantage |
$18.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$18.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$18.65
|
| Rate for Payer: Cash Price |
$50.10
|
| Rate for Payer: Cash Price |
$50.10
|
| Rate for Payer: Cigna Commercial |
$165.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$86.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$18.65
|
| Rate for Payer: Health EOS Commercial |
$158.05
|
| Rate for Payer: HFN Commercial |
$165.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$65.82
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$65.82
|
| Rate for Payer: Independent Care Health Plan Medicare |
$18.65
|
| Rate for Payer: Multiplan Commercial |
$138.94
|
| Rate for Payer: NAPHCARE Commercial |
$27.97
|
| Rate for Payer: Preferred Network Access Commercial |
$165.00
|
| Rate for Payer: Quartz Beloit One Network |
$76.42
|
| Rate for Payer: Quartz Commercial |
$99.00
|
| Rate for Payer: Quartz Medicare Advantage |
$18.65
|
| Rate for Payer: The Alliance Commercial |
$73.66
|
| Rate for Payer: United Healthcare Medicare Advantage |
$18.65
|
| Rate for Payer: WEA Trust Commercial |
$95.52
|
| Rate for Payer: WPS Commercial |
$82.05
|
|
