|
PL 7 Autoabs
|
Facility
|
IP
|
$167.00
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
4592894
|
|
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
|
|
|
PLACE CATHETER IN AORTA 36200
|
Professional
|
Both
|
$1,751.00
|
|
|
Service Code
|
CPT 36200
|
| Hospital Charge Code |
3014511
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$112.40 |
| Max. Negotiated Rate |
$1,729.99 |
| Rate for Payer: Aetna Commercial |
$1,729.99
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,566.09
|
| Rate for Payer: Aetna Managed Medicare |
$112.40
|
| Rate for Payer: Anthem Medicare Advantage |
$112.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$112.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$112.40
|
| Rate for Payer: Cash Price |
$525.30
|
| Rate for Payer: Cash Price |
$525.30
|
| Rate for Payer: Cash Price |
$525.30
|
| Rate for Payer: Cigna Commercial |
$1,729.99
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$251.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$112.40
|
| Rate for Payer: Health EOS Commercial |
$1,657.15
|
| Rate for Payer: HFN Commercial |
$1,729.99
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$460.48
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$460.48
|
| Rate for Payer: Independent Care Health Plan Medicare |
$112.40
|
| Rate for Payer: Multiplan Commercial |
$1,456.83
|
| Rate for Payer: NAPHCARE Commercial |
$168.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,729.99
|
| Rate for Payer: Quartz Beloit One Network |
$801.26
|
| Rate for Payer: Quartz Commercial |
$1,037.99
|
| Rate for Payer: Quartz Medicare Advantage |
$112.40
|
| Rate for Payer: The Alliance Commercial |
$477.71
|
| Rate for Payer: United Healthcare Medicaid |
$251.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$112.40
|
| Rate for Payer: WEA Trust Commercial |
$1,001.57
|
| Rate for Payer: WPS Commercial |
$505.81
|
|
|
Place Catheter In Aorta 3620022
|
Professional
|
Both
|
$2,102.00
|
|
|
Service Code
|
CPT 36200 22
|
| Hospital Charge Code |
5246750
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$251.00 |
| Max. Negotiated Rate |
$2,076.78 |
| Rate for Payer: Aetna Commercial |
$2,076.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,880.03
|
| Rate for Payer: Cash Price |
$630.60
|
| Rate for Payer: Cash Price |
$630.60
|
| Rate for Payer: Cash Price |
$630.60
|
| Rate for Payer: Cigna Commercial |
$2,076.78
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$251.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,311.65
|
| Rate for Payer: Health EOS Commercial |
$1,989.33
|
| Rate for Payer: HFN Commercial |
$2,076.78
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$460.48
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$460.48
|
| Rate for Payer: Multiplan Commercial |
$1,748.86
|
| Rate for Payer: Preferred Network Access Commercial |
$2,076.78
|
| Rate for Payer: Quartz Beloit One Network |
$961.88
|
| Rate for Payer: Quartz Commercial |
$1,246.07
|
| Rate for Payer: The Alliance Commercial |
$1,093.04
|
| Rate for Payer: United Healthcare Medicaid |
$251.00
|
| Rate for Payer: WEA Trust Commercial |
$1,202.34
|
| Rate for Payer: WPS Commercial |
$1,619.17
|
|
|
PLACEMENT OF ACCESS THROUGH THE BILIARY TREE AND INTO SMALL BOWEL TO ASSIST WITH AN ENDOSCOPIC BILIARY PROCEDURE (EG, RENDEZVOUS PROCEDURE), PERCUTANEOUS, INCLUDING DIAGNOSTIC CHOLANGIOGRAPHY WHEN PERFORMED, IMAGING GUIDANCE (EG, ULTRASOUND AND/OR FLUOROSCOPY), AND ALL ASSOCIATED RADIOLOGICAL SUPERVISION AND INTERPRETATION, NEW ACCESS
|
Facility
|
OP
|
$27,251.91
|
|
|
Service Code
|
CPT 47541
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4,267.12 |
| Max. Negotiated Rate |
$27,251.91 |
| Rate for Payer: Aetna Managed Medicare |
$6,812.98
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$10,303.28
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8,364.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7,944.56
|
| Rate for Payer: Anthem Medicare Advantage |
$6,812.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$6,812.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$6,812.98
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$6,812.98
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$6,812.98
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$25,344.28
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$6,812.98
|
| Rate for Payer: Independent Care Health Plan Medicare |
$6,812.98
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$6,812.98
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$6,812.98
|
| Rate for Payer: NAPHCARE Commercial |
$10,219.47
|
| Rate for Payer: Quartz Medicare Advantage |
$6,812.98
|
| Rate for Payer: The Alliance Commercial |
$27,251.91
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,812.98
|
| Rate for Payer: United Healthcare PPO |
$4,267.12
|
| Rate for Payer: Wellcare Medicare |
$6,812.98
|
|
|
Placement of breast localization device(s) (e.g., clip, metallic pellet, wire/needle, radioactive seeds), percutaneous; first lesion, including mammographic guidance
|
Facility
|
OP
|
$6,952.48
|
|
|
Service Code
|
CPT 19281
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,738.12 |
| Max. Negotiated Rate |
$6,952.48 |
| Rate for Payer: Aetna Managed Medicare |
$1,738.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,030.56
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,388.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,270.32
|
| Rate for Payer: Anthem Medicare Advantage |
$1,738.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$1,738.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$1,738.12
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$1,738.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,947.89
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$1,738.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,465.81
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,738.12
|
| Rate for Payer: Independent Care Health Plan Medicare |
$1,738.12
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$1,738.12
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$1,738.12
|
| Rate for Payer: NAPHCARE Commercial |
$2,607.18
|
| Rate for Payer: Quartz Medicare Advantage |
$1,738.12
|
| Rate for Payer: The Alliance Commercial |
$6,952.48
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,738.12
|
| Rate for Payer: United Healthcare PPO |
$2,347.28
|
| Rate for Payer: Wellcare Medicare |
$1,738.12
|
|
|
PLACEMENT OF INTERSTITIAL DEVICE(S) FOR RADIATION THERAPY GUIDANCE (EG, FIDUCIAL MARKERS, DOSIMETER), PROSTATE (VIA NEEDLE, ANY APPROACH), SINGLE OR MULTIPLE
|
Facility
|
OP
|
$8,107.14
|
|
|
Service Code
|
CPT 55876
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,456.64 |
| Max. Negotiated Rate |
$8,107.14 |
| Rate for Payer: Aetna Managed Medicare |
$1,456.64
|
| 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 |
$1,456.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$1,456.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$1,456.64
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$1,456.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$8,107.14
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$1,456.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,418.72
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,456.64
|
| Rate for Payer: Independent Care Health Plan Medicare |
$1,456.64
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$1,456.64
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$1,456.64
|
| Rate for Payer: NAPHCARE Commercial |
$2,184.97
|
| Rate for Payer: Quartz Medicare Advantage |
$1,456.64
|
| Rate for Payer: The Alliance Commercial |
$5,826.58
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,456.64
|
| Rate for Payer: United Healthcare PPO |
$3,726.32
|
| Rate for Payer: Wellcare Medicare |
$1,456.64
|
|
|
Placement of needle for intraosseous infusion - Peripheral IV Equipment:
|
Facility
|
OP
|
$217.00
|
|
|
Service Code
|
CPT 36680
|
| Hospital Charge Code |
3025931
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$108.33 |
| Max. Negotiated Rate |
$4,386.95 |
| Rate for Payer: Aetna Commercial |
$203.11
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$194.08
|
| Rate for Payer: Aetna Managed Medicare |
$470.13
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$146.69
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$112.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$108.33
|
| Rate for Payer: Anthem Medicare Advantage |
$470.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$119.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$470.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$470.13
|
| Rate for Payer: Cash Price |
$65.10
|
| Rate for Payer: Cash Price |
$65.10
|
| Rate for Payer: Cash Price |
$65.10
|
| Rate for Payer: Cigna Commercial |
$207.63
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$470.13
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$470.13
|
| Rate for Payer: Health EOS Commercial |
$200.86
|
| Rate for Payer: HFN Commercial |
$207.63
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,748.89
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$470.13
|
| Rate for Payer: Independent Care Health Plan Medicare |
$470.13
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$470.13
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$470.13
|
| Rate for Payer: Multiplan Commercial |
$180.54
|
| Rate for Payer: NAPHCARE Commercial |
$705.20
|
| Rate for Payer: Preferred Network Access Commercial |
$207.63
|
| Rate for Payer: Quartz Beloit One Network |
$110.58
|
| Rate for Payer: Quartz Commercial |
$146.69
|
| Rate for Payer: Quartz Medicare Advantage |
$470.13
|
| Rate for Payer: The Alliance Commercial |
$1,880.53
|
| Rate for Payer: United Healthcare Medicare Advantage |
$470.13
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$124.12
|
| Rate for Payer: Wellcare Medicare |
$470.13
|
| Rate for Payer: WPS Commercial |
$167.16
|
|
|
Placement of needle for intraosseous infusion - Peripheral IV Equipment:
|
Facility
|
IP
|
$217.00
|
|
|
Service Code
|
CPT 36680
|
| Hospital Charge Code |
3025931
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$110.58 |
| Max. Negotiated Rate |
$207.63 |
| Rate for Payer: Aetna Commercial |
$203.11
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$194.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$119.61
|
| Rate for Payer: Cash Price |
$65.10
|
| Rate for Payer: Cigna Commercial |
$207.63
|
| Rate for Payer: Health EOS Commercial |
$200.86
|
| Rate for Payer: HFN Commercial |
$207.63
|
| Rate for Payer: Multiplan Commercial |
$180.54
|
| Rate for Payer: Preferred Network Access Commercial |
$207.63
|
| Rate for Payer: Quartz Beloit One Network |
$110.58
|
| Rate for Payer: Quartz Commercial |
$135.41
|
| Rate for Payer: WEA Trust Commercial |
$124.12
|
| Rate for Payer: WPS Commercial |
$167.16
|
|
|
PLACEMENT OF NEPHROSTOMY CATHETER, PERCUTANEOUS, INCLUDING DIAGNOSTIC NEPHROSTOGRAM AND/OR URETEROGRAM WHEN PERFORMED, IMAGING GUIDANCE (EG, ULTRASOUND AND/OR FLUOROSCOPY) AND ALL ASSOCIATED RADIOLOGICAL SUPERVISION AND INTERPRETATION
|
Facility
|
OP
|
$8,799.61
|
|
|
Service Code
|
CPT 50432
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,199.90 |
| Max. Negotiated Rate |
$8,799.61 |
| Rate for Payer: Aetna Managed Medicare |
$2,199.90
|
| 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 |
$2,199.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$2,199.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$2,199.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$2,199.90
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,947.89
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$2,199.90
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$8,183.63
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$2,199.90
|
| Rate for Payer: Independent Care Health Plan Medicare |
$2,199.90
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$2,199.90
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$2,199.90
|
| Rate for Payer: NAPHCARE Commercial |
$3,299.85
|
| Rate for Payer: Quartz Medicare Advantage |
$2,199.90
|
| Rate for Payer: The Alliance Commercial |
$8,799.61
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,199.90
|
| Rate for Payer: United Healthcare PPO |
$3,726.32
|
| Rate for Payer: Wellcare Medicare |
$2,199.90
|
|
|
PLACEMENT OF NEPHROURETERAL CATHETER, PERCUTANEOUS, INCLUDING DIAGNOSTIC NEPHROSTOGRAM AND/OR URETEROGRAM WHEN PERFORMED, IMAGING GUIDANCE (EG, ULTRASOUND AND/OR FLUOROSCOPY) AND ALL ASSOCIATED RADIOLOGICAL SUPERVISION AND INTERPRETATION, NEW ACCESS
|
Facility
|
OP
|
$14,838.60
|
|
|
Service Code
|
CPT 50433
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,835.04 |
| Max. Negotiated Rate |
$14,838.60 |
| Rate for Payer: Aetna Managed Medicare |
$3,709.65
|
| 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 |
$3,709.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$3,709.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$3,709.65
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$3,709.65
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,947.89
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$3,709.65
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$13,799.89
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$3,709.65
|
| Rate for Payer: Independent Care Health Plan Medicare |
$3,709.65
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$3,709.65
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$3,709.65
|
| Rate for Payer: NAPHCARE Commercial |
$5,564.47
|
| Rate for Payer: Quartz Medicare Advantage |
$3,709.65
|
| Rate for Payer: The Alliance Commercial |
$14,838.60
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,709.65
|
| Rate for Payer: United Healthcare PPO |
$3,726.32
|
| Rate for Payer: Wellcare Medicare |
$3,709.65
|
|
|
PLACEMENT OF SETON
|
Facility
|
OP
|
$11,684.32
|
|
|
Service Code
|
CPT 46020
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,835.04 |
| Max. Negotiated Rate |
$11,684.32 |
| Rate for Payer: Aetna Managed Medicare |
$2,921.08
|
| 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 |
$2,921.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$2,921.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$2,921.08
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$2,921.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,807.99
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$2,921.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$10,866.41
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$2,921.08
|
| Rate for Payer: Independent Care Health Plan Medicare |
$2,921.08
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$2,921.08
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$2,921.08
|
| Rate for Payer: NAPHCARE Commercial |
$4,381.62
|
| Rate for Payer: Quartz Medicare Advantage |
$2,921.08
|
| Rate for Payer: The Alliance Commercial |
$11,684.32
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,921.08
|
| Rate for Payer: United Healthcare PPO |
$3,726.32
|
| Rate for Payer: Wellcare Medicare |
$2,921.08
|
|
|
PLACEMENT OF SETON 46020
|
Professional
|
Both
|
$445.00
|
|
|
Service Code
|
CPT 46020
|
| Hospital Charge Code |
3014819
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$105.00 |
| Max. Negotiated Rate |
$826.76 |
| Rate for Payer: Aetna Commercial |
$439.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$398.01
|
| Rate for Payer: Aetna Managed Medicare |
$105.00
|
| Rate for Payer: Anthem Medicare Advantage |
$105.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$105.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$105.00
|
| Rate for Payer: Cash Price |
$133.50
|
| Rate for Payer: Cash Price |
$133.50
|
| Rate for Payer: Cash Price |
$133.50
|
| Rate for Payer: Cigna Commercial |
$439.66
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$208.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$105.00
|
| Rate for Payer: Health EOS Commercial |
$421.15
|
| Rate for Payer: HFN Commercial |
$439.66
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$826.76
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$826.76
|
| Rate for Payer: Independent Care Health Plan Medicare |
$105.00
|
| Rate for Payer: Multiplan Commercial |
$370.24
|
| Rate for Payer: NAPHCARE Commercial |
$157.50
|
| Rate for Payer: Preferred Network Access Commercial |
$439.66
|
| Rate for Payer: Quartz Beloit One Network |
$203.63
|
| Rate for Payer: Quartz Commercial |
$263.80
|
| Rate for Payer: Quartz Medicare Advantage |
$105.00
|
| Rate for Payer: The Alliance Commercial |
$446.24
|
| Rate for Payer: United Healthcare Medicaid |
$208.24
|
| Rate for Payer: United Healthcare Medicare Advantage |
$105.00
|
| Rate for Payer: WEA Trust Commercial |
$254.54
|
| Rate for Payer: WPS Commercial |
$472.49
|
|
|
PLACEMENT OF URETERAL STENT, PERCUTANEOUS, INCLUDING DIAGNOSTIC NEPHROSTOGRAM AND/OR URETEROGRAM WHEN PERFORMED, IMAGING GUIDANCE (EG, ULTRASOUND AND/OR FLUOROSCOPY), AND ALL ASSOCIATED RADIOLOGICAL SUPERVISION AND INTERPRETATION; NEW ACCESS, WITHOUT SEPARATE NEPHROSTOMY CATHETER
|
Facility
|
OP
|
$14,838.60
|
|
|
Service Code
|
CPT 50694
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,709.65 |
| Max. Negotiated Rate |
$14,838.60 |
| Rate for Payer: Aetna Managed Medicare |
$3,709.65
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$10,303.28
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8,364.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7,944.56
|
| Rate for Payer: Anthem Medicare Advantage |
$3,709.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$3,709.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$3,709.65
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$3,709.65
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,947.89
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$3,709.65
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$13,799.89
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$3,709.65
|
| Rate for Payer: Independent Care Health Plan Medicare |
$3,709.65
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$3,709.65
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$3,709.65
|
| Rate for Payer: NAPHCARE Commercial |
$5,564.47
|
| Rate for Payer: Quartz Medicare Advantage |
$3,709.65
|
| Rate for Payer: The Alliance Commercial |
$14,838.60
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,709.65
|
| Rate for Payer: United Healthcare PPO |
$4,267.12
|
| Rate for Payer: Wellcare Medicare |
$3,709.65
|
|
|
PLACE NEEDLE IN VEIN 36000
|
Professional
|
Both
|
$165.00
|
|
|
Service Code
|
CPT 36000
|
| Hospital Charge Code |
3014503
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$23.48 |
| Max. Negotiated Rate |
$163.02 |
| Rate for Payer: Aetna Commercial |
$163.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$147.58
|
| Rate for Payer: Cash Price |
$49.50
|
| Rate for Payer: Cash Price |
$49.50
|
| Rate for Payer: Cash Price |
$49.50
|
| Rate for Payer: Cigna Commercial |
$163.02
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$23.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$102.96
|
| Rate for Payer: Health EOS Commercial |
$156.16
|
| Rate for Payer: HFN Commercial |
$163.02
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$31.87
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$31.87
|
| Rate for Payer: Multiplan Commercial |
$137.28
|
| Rate for Payer: Preferred Network Access Commercial |
$163.02
|
| Rate for Payer: Quartz Beloit One Network |
$75.50
|
| Rate for Payer: Quartz Commercial |
$97.81
|
| Rate for Payer: The Alliance Commercial |
$85.80
|
| Rate for Payer: United Healthcare Medicaid |
$23.48
|
| Rate for Payer: WEA Trust Commercial |
$94.38
|
| Rate for Payer: WPS Commercial |
$127.10
|
|
|
Plantar Common Digital Nerve 64632
|
Professional
|
Both
|
$496.00
|
|
|
Service Code
|
CPT 64632
|
| Hospital Charge Code |
4066544
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$61.29 |
| Max. Negotiated Rate |
$490.05 |
| Rate for Payer: Aetna Commercial |
$490.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$443.62
|
| Rate for Payer: Aetna Managed Medicare |
$61.29
|
| Rate for Payer: Anthem Medicare Advantage |
$61.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$61.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$61.29
|
| Rate for Payer: Cash Price |
$148.80
|
| Rate for Payer: Cash Price |
$148.80
|
| Rate for Payer: Cash Price |
$148.80
|
| Rate for Payer: Cigna Commercial |
$490.05
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$78.59
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$61.29
|
| Rate for Payer: Health EOS Commercial |
$469.41
|
| Rate for Payer: HFN Commercial |
$490.05
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$234.96
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$234.96
|
| Rate for Payer: Independent Care Health Plan Medicare |
$61.29
|
| Rate for Payer: Multiplan Commercial |
$412.67
|
| Rate for Payer: NAPHCARE Commercial |
$91.93
|
| Rate for Payer: Preferred Network Access Commercial |
$490.05
|
| Rate for Payer: Quartz Beloit One Network |
$226.97
|
| Rate for Payer: Quartz Commercial |
$294.03
|
| Rate for Payer: Quartz Medicare Advantage |
$61.29
|
| Rate for Payer: The Alliance Commercial |
$260.47
|
| Rate for Payer: United Healthcare Medicaid |
$78.59
|
| Rate for Payer: United Healthcare Medicare Advantage |
$61.29
|
| Rate for Payer: WEA Trust Commercial |
$283.71
|
| Rate for Payer: WPS Commercial |
$275.79
|
|
|
PLANTAR FASCIOTOMY
|
Facility
|
IP
|
$1,337.00
|
|
| Hospital Charge Code |
2960054
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$681.34 |
| Max. Negotiated Rate |
$1,279.24 |
| Rate for Payer: Aetna Commercial |
$1,251.43
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,195.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$736.95
|
| Rate for Payer: Cash Price |
$401.10
|
| Rate for Payer: Cigna Commercial |
$1,279.24
|
| Rate for Payer: Health EOS Commercial |
$1,237.53
|
| Rate for Payer: HFN Commercial |
$1,279.24
|
| Rate for Payer: Multiplan Commercial |
$1,112.38
|
| Rate for Payer: Preferred Network Access Commercial |
$1,279.24
|
| Rate for Payer: Quartz Beloit One Network |
$681.34
|
| Rate for Payer: Quartz Commercial |
$834.29
|
| Rate for Payer: WEA Trust Commercial |
$764.76
|
| Rate for Payer: WPS Commercial |
$1,029.89
|
|
|
PLANTAR FASCIOTOMY
|
Facility
|
OP
|
$1,337.00
|
|
| Hospital Charge Code |
2960054
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$389.33 |
| Max. Negotiated Rate |
$1,279.24 |
| Rate for Payer: Aetna Commercial |
$1,251.43
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,195.81
|
| Rate for Payer: Aetna Managed Medicare |
$389.33
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$903.81
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$695.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$667.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$736.95
|
| Rate for Payer: Cash Price |
$401.10
|
| Rate for Payer: Cigna Commercial |
$1,279.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$778.13
|
| Rate for Payer: Health EOS Commercial |
$1,237.53
|
| Rate for Payer: HFN Commercial |
$1,279.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,042.86
|
| Rate for Payer: Multiplan Commercial |
$1,112.38
|
| Rate for Payer: NAPHCARE Commercial |
$834.29
|
| Rate for Payer: Preferred Network Access Commercial |
$1,279.24
|
| Rate for Payer: Quartz Beloit One Network |
$681.34
|
| Rate for Payer: Quartz Commercial |
$903.81
|
| Rate for Payer: Quartz Medicare Advantage |
$834.29
|
| Rate for Payer: The Alliance Commercial |
$695.24
|
| Rate for Payer: WEA Trust Commercial |
$764.76
|
| Rate for Payer: WPS Commercial |
$1,029.89
|
|
|
Plantinol AQ 10 mg Charge
|
Facility
|
IP
|
$21.00
|
|
|
Service Code
|
HCPCS J9060
|
| Hospital Charge Code |
2958961
|
|
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
|
|
|
Plantinol AQ 10 mg Charge
|
Professional
|
Both
|
$21.00
|
|
|
Service Code
|
HCPCS J9060
|
| Hospital Charge Code |
2958961
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.19 |
| Max. Negotiated Rate |
$20.75 |
| Rate for Payer: Aetna Commercial |
$20.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$18.78
|
| Rate for Payer: Aetna Managed Medicare |
$2.22
|
| Rate for Payer: Anthem Medicare Advantage |
$2.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$2.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$2.22
|
| 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 |
$2.19
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3.40
|
| Rate for Payer: Health EOS Commercial |
$19.87
|
| Rate for Payer: HFN Commercial |
$20.75
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2.87
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$2.87
|
| Rate for Payer: Independent Care Health Plan Medicare |
$2.22
|
| Rate for Payer: Multiplan Commercial |
$17.47
|
| Rate for Payer: NAPHCARE Commercial |
$3.32
|
| 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: Quartz Medicare Advantage |
$2.22
|
| Rate for Payer: The Alliance Commercial |
$6.09
|
| Rate for Payer: United Healthcare Medicaid |
$2.19
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2.22
|
| Rate for Payer: WEA Trust Commercial |
$12.01
|
| Rate for Payer: WPS Commercial |
$8.50
|
|
|
Plantinol AQ 10 mg Charge
|
Facility
|
OP
|
$21.00
|
|
|
Service Code
|
HCPCS J9060
|
| Hospital Charge Code |
2958961
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.50 |
| 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 |
$4.50
|
| 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 |
$8.86
|
| Rate for Payer: WEA Trust Commercial |
$12.01
|
| Rate for Payer: WPS Commercial |
$8.50
|
|
|
Plasma CPD Cryo Red
|
Facility
|
OP
|
$385.00
|
|
|
Service Code
|
HCPCS P9017
|
| Hospital Charge Code |
1052808
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$88.57 |
| Max. Negotiated Rate |
$368.37 |
| Rate for Payer: Aetna Commercial |
$360.36
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$344.34
|
| Rate for Payer: Aetna Managed Medicare |
$88.57
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$260.26
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$200.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$192.19
|
| Rate for Payer: Anthem Medicare Advantage |
$88.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$212.21
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$88.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$88.57
|
| Rate for Payer: Cash Price |
$115.50
|
| Rate for Payer: Cash Price |
$115.50
|
| Rate for Payer: Cigna Commercial |
$368.37
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$88.57
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$224.07
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$88.57
|
| Rate for Payer: Health EOS Commercial |
$356.36
|
| Rate for Payer: HFN Commercial |
$368.37
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$329.47
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$88.57
|
| Rate for Payer: Independent Care Health Plan Medicare |
$88.57
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$88.57
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$88.57
|
| Rate for Payer: Multiplan Commercial |
$320.32
|
| Rate for Payer: NAPHCARE Commercial |
$132.85
|
| Rate for Payer: Preferred Network Access Commercial |
$368.37
|
| Rate for Payer: Quartz Beloit One Network |
$196.20
|
| Rate for Payer: Quartz Commercial |
$260.26
|
| Rate for Payer: Quartz Medicare Advantage |
$88.57
|
| Rate for Payer: The Alliance Commercial |
$354.27
|
| Rate for Payer: United Healthcare Medicare Advantage |
$88.57
|
| Rate for Payer: United Healthcare PPO |
$300.30
|
| Rate for Payer: WEA Trust Commercial |
$220.22
|
| Rate for Payer: Wellcare Medicare |
$88.57
|
| Rate for Payer: WPS Commercial |
$296.57
|
|
|
Plasma CPD Cryo Red
|
Facility
|
IP
|
$385.00
|
|
|
Service Code
|
HCPCS P9017
|
| Hospital Charge Code |
1052808
|
|
Hospital Revenue Code
|
390
|
| Min. Negotiated Rate |
$196.20 |
| Max. Negotiated Rate |
$368.37 |
| Rate for Payer: Aetna Commercial |
$360.36
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$344.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$212.21
|
| Rate for Payer: Cash Price |
$115.50
|
| Rate for Payer: Cigna Commercial |
$368.37
|
| Rate for Payer: Health EOS Commercial |
$356.36
|
| Rate for Payer: HFN Commercial |
$368.37
|
| Rate for Payer: Multiplan Commercial |
$320.32
|
| Rate for Payer: Preferred Network Access Commercial |
$368.37
|
| Rate for Payer: Quartz Beloit One Network |
$196.20
|
| Rate for Payer: Quartz Commercial |
$240.24
|
| Rate for Payer: WEA Trust Commercial |
$220.22
|
| Rate for Payer: WPS Commercial |
$296.57
|
|
|
Plastic mod low ext pad/line L2275
|
Facility
|
OP
|
$445.00
|
|
|
Service Code
|
HCPCS L2275
|
| Hospital Charge Code |
4524748
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$95.28 |
| Max. Negotiated Rate |
$666.39 |
| Rate for Payer: Aetna Commercial |
$416.52
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$398.01
|
| Rate for Payer: Aetna Managed Medicare |
$129.58
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$95.28
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$95.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$95.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$245.28
|
| Rate for Payer: Cash Price |
$133.50
|
| Rate for Payer: Cash Price |
$133.50
|
| Rate for Payer: Cigna Commercial |
$425.78
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$258.99
|
| Rate for Payer: Health EOS Commercial |
$411.89
|
| Rate for Payer: HFN Commercial |
$425.78
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$347.10
|
| Rate for Payer: Multiplan Commercial |
$370.24
|
| Rate for Payer: NAPHCARE Commercial |
$277.68
|
| Rate for Payer: Preferred Network Access Commercial |
$425.78
|
| Rate for Payer: Quartz Beloit One Network |
$226.77
|
| Rate for Payer: Quartz Commercial |
$300.82
|
| Rate for Payer: Quartz Medicare Advantage |
$277.68
|
| Rate for Payer: The Alliance Commercial |
$666.39
|
| Rate for Payer: WEA Trust Commercial |
$254.54
|
| Rate for Payer: WPS Commercial |
$342.78
|
|
|
Plastic mod low ext pad/line L2275
|
Professional
|
Both
|
$445.00
|
|
|
Service Code
|
HCPCS L2275
|
| Hospital Charge Code |
4524748
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$166.60 |
| Max. Negotiated Rate |
$480.38 |
| Rate for Payer: Aetna Commercial |
$439.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$398.01
|
| Rate for Payer: Aetna Managed Medicare |
$166.60
|
| Rate for Payer: Anthem Medicare Advantage |
$166.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$166.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$166.60
|
| Rate for Payer: Cash Price |
$133.50
|
| Rate for Payer: Cash Price |
$133.50
|
| Rate for Payer: Cigna Commercial |
$439.66
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$231.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$166.60
|
| Rate for Payer: Health EOS Commercial |
$421.15
|
| Rate for Payer: HFN Commercial |
$439.66
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$480.38
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$480.38
|
| Rate for Payer: Independent Care Health Plan Medicare |
$166.60
|
| Rate for Payer: Multiplan Commercial |
$370.24
|
| Rate for Payer: NAPHCARE Commercial |
$249.90
|
| Rate for Payer: Preferred Network Access Commercial |
$439.66
|
| Rate for Payer: Quartz Beloit One Network |
$203.63
|
| Rate for Payer: Quartz Commercial |
$263.80
|
| Rate for Payer: Quartz Medicare Advantage |
$166.60
|
| Rate for Payer: The Alliance Commercial |
$458.14
|
| Rate for Payer: United Healthcare Medicare Advantage |
$166.60
|
| Rate for Payer: WEA Trust Commercial |
$254.54
|
| Rate for Payer: WPS Commercial |
$291.55
|
|
