|
PUMP TUBE ID3.2
|
Facility
|
IP
|
$577.00
|
|
| Hospital Charge Code |
2973553
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$294.04 |
| Max. Negotiated Rate |
$552.07 |
| Rate for Payer: Aetna Commercial |
$540.07
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$516.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$318.04
|
| Rate for Payer: Cash Price |
$173.10
|
| Rate for Payer: Cigna Commercial |
$552.07
|
| Rate for Payer: Health EOS Commercial |
$534.07
|
| Rate for Payer: HFN Commercial |
$552.07
|
| Rate for Payer: Multiplan Commercial |
$480.06
|
| Rate for Payer: Preferred Network Access Commercial |
$552.07
|
| Rate for Payer: Quartz Beloit One Network |
$294.04
|
| Rate for Payer: Quartz Commercial |
$360.05
|
| Rate for Payer: WEA Trust Commercial |
$330.04
|
| Rate for Payer: WPS Commercial |
$444.46
|
|
|
PUMP TUBE ID4.8
|
Facility
|
IP
|
$634.00
|
|
| Hospital Charge Code |
2983108
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$323.09 |
| Max. Negotiated Rate |
$606.61 |
| Rate for Payer: Aetna Commercial |
$593.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$567.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$349.46
|
| Rate for Payer: Cash Price |
$190.20
|
| Rate for Payer: Cigna Commercial |
$606.61
|
| Rate for Payer: Health EOS Commercial |
$586.83
|
| Rate for Payer: HFN Commercial |
$606.61
|
| Rate for Payer: Multiplan Commercial |
$527.49
|
| Rate for Payer: Preferred Network Access Commercial |
$606.61
|
| Rate for Payer: Quartz Beloit One Network |
$323.09
|
| Rate for Payer: Quartz Commercial |
$395.62
|
| Rate for Payer: WEA Trust Commercial |
$362.65
|
| Rate for Payer: WPS Commercial |
$488.37
|
|
|
PUMP TUBE ID4.8
|
Facility
|
OP
|
$634.00
|
|
| Hospital Charge Code |
2983108
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$184.62 |
| Max. Negotiated Rate |
$606.61 |
| Rate for Payer: Aetna Commercial |
$593.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$567.05
|
| Rate for Payer: Aetna Managed Medicare |
$184.62
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$428.58
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$329.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$316.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$349.46
|
| Rate for Payer: Cash Price |
$190.20
|
| Rate for Payer: Cigna Commercial |
$606.61
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$368.99
|
| Rate for Payer: Health EOS Commercial |
$586.83
|
| Rate for Payer: HFN Commercial |
$606.61
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$494.52
|
| Rate for Payer: Multiplan Commercial |
$527.49
|
| Rate for Payer: NAPHCARE Commercial |
$395.62
|
| Rate for Payer: Preferred Network Access Commercial |
$606.61
|
| Rate for Payer: Quartz Beloit One Network |
$323.09
|
| Rate for Payer: Quartz Commercial |
$428.58
|
| Rate for Payer: Quartz Medicare Advantage |
$395.62
|
| Rate for Payer: The Alliance Commercial |
$329.68
|
| Rate for Payer: WEA Trust Commercial |
$362.65
|
| Rate for Payer: WPS Commercial |
$488.37
|
|
|
PUMP TUBING ARTHROSCOPY MAIN ARTHREX AR-6410
|
Facility
|
OP
|
$1,160.00
|
|
| Hospital Charge Code |
5074886
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$337.79 |
| Max. Negotiated Rate |
$1,109.89 |
| Rate for Payer: Aetna Commercial |
$1,085.76
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,037.50
|
| Rate for Payer: Aetna Managed Medicare |
$337.79
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$784.16
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$603.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$579.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$639.39
|
| Rate for Payer: Cash Price |
$348.00
|
| Rate for Payer: Cigna Commercial |
$1,109.89
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$675.12
|
| Rate for Payer: Health EOS Commercial |
$1,073.70
|
| Rate for Payer: HFN Commercial |
$1,109.89
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$904.80
|
| Rate for Payer: Multiplan Commercial |
$965.12
|
| Rate for Payer: NAPHCARE Commercial |
$723.84
|
| Rate for Payer: Preferred Network Access Commercial |
$1,109.89
|
| Rate for Payer: Quartz Beloit One Network |
$591.14
|
| Rate for Payer: Quartz Commercial |
$784.16
|
| Rate for Payer: Quartz Medicare Advantage |
$723.84
|
| Rate for Payer: The Alliance Commercial |
$603.20
|
| Rate for Payer: WEA Trust Commercial |
$663.52
|
| Rate for Payer: WPS Commercial |
$893.55
|
|
|
PUMP TUBING ARTHROSCOPY MAIN ARTHREX AR-6410
|
Facility
|
IP
|
$1,160.00
|
|
| Hospital Charge Code |
5074886
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$591.14 |
| Max. Negotiated Rate |
$1,109.89 |
| Rate for Payer: Aetna Commercial |
$1,085.76
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,037.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$639.39
|
| Rate for Payer: Cash Price |
$348.00
|
| Rate for Payer: Cigna Commercial |
$1,109.89
|
| Rate for Payer: Health EOS Commercial |
$1,073.70
|
| Rate for Payer: HFN Commercial |
$1,109.89
|
| Rate for Payer: Multiplan Commercial |
$965.12
|
| Rate for Payer: Preferred Network Access Commercial |
$1,109.89
|
| Rate for Payer: Quartz Beloit One Network |
$591.14
|
| Rate for Payer: Quartz Commercial |
$723.84
|
| Rate for Payer: WEA Trust Commercial |
$663.52
|
| Rate for Payer: WPS Commercial |
$893.55
|
|
|
Pump tubing changed - Peripheral IV Care:
|
Facility
|
IP
|
$154.00
|
|
| Hospital Charge Code |
3025930
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$78.48 |
| Max. Negotiated Rate |
$147.35 |
| Rate for Payer: Aetna Commercial |
$144.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$137.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$84.88
|
| Rate for Payer: Cash Price |
$46.20
|
| Rate for Payer: Cigna Commercial |
$147.35
|
| Rate for Payer: Health EOS Commercial |
$142.54
|
| Rate for Payer: HFN Commercial |
$147.35
|
| Rate for Payer: Multiplan Commercial |
$128.13
|
| Rate for Payer: Preferred Network Access Commercial |
$147.35
|
| Rate for Payer: Quartz Beloit One Network |
$78.48
|
| Rate for Payer: Quartz Commercial |
$96.10
|
| Rate for Payer: WEA Trust Commercial |
$88.09
|
| Rate for Payer: WPS Commercial |
$118.63
|
|
|
Pump tubing changed - Peripheral IV Care:
|
Facility
|
OP
|
$154.00
|
|
| Hospital Charge Code |
3025930
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$44.84 |
| Max. Negotiated Rate |
$147.35 |
| Rate for Payer: Aetna Commercial |
$144.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$137.74
|
| Rate for Payer: Aetna Managed Medicare |
$44.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$104.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$80.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$76.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$84.88
|
| Rate for Payer: Cash Price |
$46.20
|
| Rate for Payer: Cigna Commercial |
$147.35
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$89.63
|
| Rate for Payer: Health EOS Commercial |
$142.54
|
| Rate for Payer: HFN Commercial |
$147.35
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$120.12
|
| Rate for Payer: Multiplan Commercial |
$128.13
|
| Rate for Payer: NAPHCARE Commercial |
$96.10
|
| Rate for Payer: Preferred Network Access Commercial |
$147.35
|
| Rate for Payer: Quartz Beloit One Network |
$78.48
|
| Rate for Payer: Quartz Commercial |
$104.10
|
| Rate for Payer: Quartz Medicare Advantage |
$96.10
|
| Rate for Payer: The Alliance Commercial |
$80.08
|
| Rate for Payer: WEA Trust Commercial |
$88.09
|
| Rate for Payer: WPS Commercial |
$118.63
|
|
|
Pump tubing - Peripheral IV Equipment:
|
Facility
|
IP
|
$154.00
|
|
| Hospital Charge Code |
3003556
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$78.48 |
| Max. Negotiated Rate |
$147.35 |
| Rate for Payer: Aetna Commercial |
$144.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$137.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$84.88
|
| Rate for Payer: Cash Price |
$46.20
|
| Rate for Payer: Cigna Commercial |
$147.35
|
| Rate for Payer: Health EOS Commercial |
$142.54
|
| Rate for Payer: HFN Commercial |
$147.35
|
| Rate for Payer: Multiplan Commercial |
$128.13
|
| Rate for Payer: Preferred Network Access Commercial |
$147.35
|
| Rate for Payer: Quartz Beloit One Network |
$78.48
|
| Rate for Payer: Quartz Commercial |
$96.10
|
| Rate for Payer: WEA Trust Commercial |
$88.09
|
| Rate for Payer: WPS Commercial |
$118.63
|
|
|
Pump tubing - Peripheral IV Equipment:
|
Facility
|
OP
|
$154.00
|
|
| Hospital Charge Code |
3003556
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$44.84 |
| Max. Negotiated Rate |
$147.35 |
| Rate for Payer: Aetna Commercial |
$144.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$137.74
|
| Rate for Payer: Aetna Managed Medicare |
$44.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$104.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$80.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$76.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$84.88
|
| Rate for Payer: Cash Price |
$46.20
|
| Rate for Payer: Cigna Commercial |
$147.35
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$89.63
|
| Rate for Payer: Health EOS Commercial |
$142.54
|
| Rate for Payer: HFN Commercial |
$147.35
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$120.12
|
| Rate for Payer: Multiplan Commercial |
$128.13
|
| Rate for Payer: NAPHCARE Commercial |
$96.10
|
| Rate for Payer: Preferred Network Access Commercial |
$147.35
|
| Rate for Payer: Quartz Beloit One Network |
$78.48
|
| Rate for Payer: Quartz Commercial |
$104.10
|
| Rate for Payer: Quartz Medicare Advantage |
$96.10
|
| Rate for Payer: The Alliance Commercial |
$80.08
|
| Rate for Payer: WEA Trust Commercial |
$88.09
|
| Rate for Payer: WPS Commercial |
$118.63
|
|
|
PUMP TUBING SET 152cm #PS-360/10
|
Facility
|
OP
|
$274.00
|
|
| Hospital Charge Code |
2972475
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$79.79 |
| Max. Negotiated Rate |
$262.16 |
| Rate for Payer: Aetna Commercial |
$256.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$245.07
|
| Rate for Payer: Aetna Managed Medicare |
$79.79
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$185.22
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$142.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$136.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$151.03
|
| Rate for Payer: Cash Price |
$82.20
|
| Rate for Payer: Cigna Commercial |
$262.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$159.47
|
| Rate for Payer: Health EOS Commercial |
$253.61
|
| Rate for Payer: HFN Commercial |
$262.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$213.72
|
| Rate for Payer: Multiplan Commercial |
$227.97
|
| Rate for Payer: NAPHCARE Commercial |
$170.98
|
| Rate for Payer: Preferred Network Access Commercial |
$262.16
|
| Rate for Payer: Quartz Beloit One Network |
$139.63
|
| Rate for Payer: Quartz Commercial |
$185.22
|
| Rate for Payer: Quartz Medicare Advantage |
$170.98
|
| Rate for Payer: The Alliance Commercial |
$142.48
|
| Rate for Payer: WEA Trust Commercial |
$156.73
|
| Rate for Payer: WPS Commercial |
$211.06
|
|
|
PUMP TUBING SET 152cm #PS-360/10
|
Facility
|
IP
|
$274.00
|
|
| Hospital Charge Code |
2972475
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$139.63 |
| Max. Negotiated Rate |
$262.16 |
| Rate for Payer: Aetna Commercial |
$256.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$245.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$151.03
|
| Rate for Payer: Cash Price |
$82.20
|
| Rate for Payer: Cigna Commercial |
$262.16
|
| Rate for Payer: Health EOS Commercial |
$253.61
|
| Rate for Payer: HFN Commercial |
$262.16
|
| Rate for Payer: Multiplan Commercial |
$227.97
|
| Rate for Payer: Preferred Network Access Commercial |
$262.16
|
| Rate for Payer: Quartz Beloit One Network |
$139.63
|
| Rate for Payer: Quartz Commercial |
$170.98
|
| Rate for Payer: WEA Trust Commercial |
$156.73
|
| Rate for Payer: WPS Commercial |
$211.06
|
|
|
PUNCH AORTIC 4.0 RCL40
|
Facility
|
IP
|
$421.00
|
|
| Hospital Charge Code |
2965939
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$214.54 |
| Max. Negotiated Rate |
$402.81 |
| Rate for Payer: Aetna Commercial |
$394.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$376.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$232.06
|
| Rate for Payer: Cash Price |
$126.30
|
| Rate for Payer: Cigna Commercial |
$402.81
|
| Rate for Payer: Health EOS Commercial |
$389.68
|
| Rate for Payer: HFN Commercial |
$402.81
|
| Rate for Payer: Multiplan Commercial |
$350.27
|
| Rate for Payer: Preferred Network Access Commercial |
$402.81
|
| Rate for Payer: Quartz Beloit One Network |
$214.54
|
| Rate for Payer: Quartz Commercial |
$262.70
|
| Rate for Payer: WEA Trust Commercial |
$240.81
|
| Rate for Payer: WPS Commercial |
$324.30
|
|
|
PUNCH AORTIC 4.0 RCL40
|
Facility
|
OP
|
$421.00
|
|
| Hospital Charge Code |
2965939
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$122.60 |
| Max. Negotiated Rate |
$402.81 |
| Rate for Payer: Aetna Commercial |
$394.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$376.54
|
| Rate for Payer: Aetna Managed Medicare |
$122.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$284.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$218.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$210.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$232.06
|
| Rate for Payer: Cash Price |
$126.30
|
| Rate for Payer: Cigna Commercial |
$402.81
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$245.02
|
| Rate for Payer: Health EOS Commercial |
$389.68
|
| Rate for Payer: HFN Commercial |
$402.81
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$328.38
|
| Rate for Payer: Multiplan Commercial |
$350.27
|
| Rate for Payer: NAPHCARE Commercial |
$262.70
|
| Rate for Payer: Preferred Network Access Commercial |
$402.81
|
| Rate for Payer: Quartz Beloit One Network |
$214.54
|
| Rate for Payer: Quartz Commercial |
$284.60
|
| Rate for Payer: Quartz Medicare Advantage |
$262.70
|
| Rate for Payer: The Alliance Commercial |
$218.92
|
| Rate for Payer: WEA Trust Commercial |
$240.81
|
| Rate for Payer: WPS Commercial |
$324.30
|
|
|
PUNCH BIOPSY OF SKIN (INCLUDING SIMPLE CLOSURE, WHEN PERFORMED); SINGLE LESION
|
Facility
|
OP
|
$4,386.95
|
|
|
Service Code
|
CPT 11104
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$427.81 |
| Max. Negotiated Rate |
$4,386.95 |
| Rate for Payer: Aetna Managed Medicare |
$427.81
|
| 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 |
$427.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$427.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$427.81
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$427.81
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$427.81
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,591.47
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$427.81
|
| Rate for Payer: Independent Care Health Plan Medicare |
$427.81
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$427.81
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$427.81
|
| Rate for Payer: NAPHCARE Commercial |
$641.72
|
| Rate for Payer: Quartz Medicare Advantage |
$427.81
|
| Rate for Payer: The Alliance Commercial |
$1,711.26
|
| Rate for Payer: United Healthcare Medicare Advantage |
$427.81
|
| Rate for Payer: United Healthcare PPO |
$2,347.28
|
| Rate for Payer: Wellcare Medicare |
$427.81
|
|
|
Punch Biopsy Skin Ea Sep/Additional Lesion 11105
|
Professional
|
Both
|
$124.00
|
|
|
Service Code
|
CPT 11105
|
| Hospital Charge Code |
5454808
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$20.36 |
| Max. Negotiated Rate |
$122.51 |
| Rate for Payer: Aetna Commercial |
$122.51
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$110.91
|
| Rate for Payer: Aetna Managed Medicare |
$20.36
|
| Rate for Payer: Anthem Medicare Advantage |
$20.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$20.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$20.36
|
| Rate for Payer: Cash Price |
$37.20
|
| Rate for Payer: Cash Price |
$37.20
|
| Rate for Payer: Cash Price |
$37.20
|
| Rate for Payer: Cigna Commercial |
$122.51
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$49.14
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$20.36
|
| Rate for Payer: Health EOS Commercial |
$117.35
|
| Rate for Payer: HFN Commercial |
$122.51
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$89.72
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$89.72
|
| Rate for Payer: Independent Care Health Plan Medicare |
$20.36
|
| Rate for Payer: Multiplan Commercial |
$103.17
|
| Rate for Payer: NAPHCARE Commercial |
$30.54
|
| Rate for Payer: Preferred Network Access Commercial |
$122.51
|
| Rate for Payer: Quartz Beloit One Network |
$56.74
|
| Rate for Payer: Quartz Commercial |
$73.51
|
| Rate for Payer: Quartz Medicare Advantage |
$20.36
|
| Rate for Payer: The Alliance Commercial |
$86.54
|
| Rate for Payer: United Healthcare Medicaid |
$49.14
|
| Rate for Payer: United Healthcare Medicare Advantage |
$20.36
|
| Rate for Payer: WEA Trust Commercial |
$70.93
|
| Rate for Payer: WPS Commercial |
$91.63
|
|
|
Punch Biopsy Skin Single Lesion 11104
|
Professional
|
Both
|
$400.00
|
|
|
Service Code
|
CPT 11104
|
| Hospital Charge Code |
5454809
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$37.09 |
| Max. Negotiated Rate |
$395.20 |
| Rate for Payer: Aetna Commercial |
$395.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$357.76
|
| Rate for Payer: Aetna Managed Medicare |
$37.09
|
| Rate for Payer: Anthem Medicare Advantage |
$37.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$37.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$37.09
|
| Rate for Payer: Cash Price |
$120.00
|
| Rate for Payer: Cash Price |
$120.00
|
| Rate for Payer: Cash Price |
$120.00
|
| Rate for Payer: Cigna Commercial |
$395.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$100.10
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$37.09
|
| Rate for Payer: Health EOS Commercial |
$378.56
|
| Rate for Payer: HFN Commercial |
$395.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$165.25
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$165.25
|
| Rate for Payer: Independent Care Health Plan Medicare |
$37.09
|
| Rate for Payer: Multiplan Commercial |
$332.80
|
| Rate for Payer: NAPHCARE Commercial |
$55.63
|
| Rate for Payer: Preferred Network Access Commercial |
$395.20
|
| Rate for Payer: Quartz Beloit One Network |
$183.04
|
| Rate for Payer: Quartz Commercial |
$237.12
|
| Rate for Payer: Quartz Medicare Advantage |
$37.09
|
| Rate for Payer: The Alliance Commercial |
$157.62
|
| Rate for Payer: United Healthcare Medicaid |
$100.10
|
| Rate for Payer: United Healthcare Medicare Advantage |
$37.09
|
| Rate for Payer: WEA Trust Commercial |
$228.80
|
| Rate for Payer: WPS Commercial |
$166.89
|
|
|
Puncture aspiration of abscess, hematoma, bulla, or cyst 10160
|
Professional
|
Both
|
$362.00
|
|
|
Service Code
|
CPT 10160
|
| Hospital Charge Code |
3013508
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$31.38 |
| Max. Negotiated Rate |
$402.06 |
| Rate for Payer: Aetna Commercial |
$357.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$323.77
|
| Rate for Payer: Aetna Managed Medicare |
$89.35
|
| Rate for Payer: Anthem Medicare Advantage |
$89.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$89.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$89.35
|
| Rate for Payer: Cash Price |
$108.60
|
| Rate for Payer: Cash Price |
$108.60
|
| Rate for Payer: Cash Price |
$108.60
|
| Rate for Payer: Cigna Commercial |
$357.66
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$31.38
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$89.35
|
| Rate for Payer: Health EOS Commercial |
$342.60
|
| Rate for Payer: HFN Commercial |
$357.66
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$331.15
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$331.15
|
| Rate for Payer: Independent Care Health Plan Medicare |
$89.35
|
| Rate for Payer: Multiplan Commercial |
$301.18
|
| Rate for Payer: NAPHCARE Commercial |
$134.02
|
| Rate for Payer: Preferred Network Access Commercial |
$357.66
|
| Rate for Payer: Quartz Beloit One Network |
$165.65
|
| Rate for Payer: Quartz Commercial |
$214.59
|
| Rate for Payer: Quartz Medicare Advantage |
$89.35
|
| Rate for Payer: The Alliance Commercial |
$379.72
|
| Rate for Payer: United Healthcare Medicaid |
$31.38
|
| Rate for Payer: United Healthcare Medicare Advantage |
$89.35
|
| Rate for Payer: WEA Trust Commercial |
$207.06
|
| Rate for Payer: WPS Commercial |
$402.06
|
|
|
Puncture Aspiration Of Cyst Of Breast 19000
|
Professional
|
Both
|
$395.00
|
|
|
Service Code
|
CPT 19000
|
| Hospital Charge Code |
2572831
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$34.99 |
| Max. Negotiated Rate |
$390.26 |
| Rate for Payer: Aetna Commercial |
$390.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$353.29
|
| Rate for Payer: Aetna Managed Medicare |
$34.99
|
| Rate for Payer: Anthem Medicare Advantage |
$34.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$34.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$34.99
|
| Rate for Payer: Cash Price |
$118.50
|
| Rate for Payer: Cash Price |
$118.50
|
| Rate for Payer: Cash Price |
$118.50
|
| Rate for Payer: Cigna Commercial |
$390.26
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$38.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$34.99
|
| Rate for Payer: Health EOS Commercial |
$373.83
|
| Rate for Payer: HFN Commercial |
$390.26
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$149.20
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$149.20
|
| Rate for Payer: Independent Care Health Plan Medicare |
$34.99
|
| Rate for Payer: Multiplan Commercial |
$328.64
|
| Rate for Payer: NAPHCARE Commercial |
$52.48
|
| Rate for Payer: Preferred Network Access Commercial |
$390.26
|
| Rate for Payer: Quartz Beloit One Network |
$180.75
|
| Rate for Payer: Quartz Commercial |
$234.16
|
| Rate for Payer: Quartz Medicare Advantage |
$34.99
|
| Rate for Payer: The Alliance Commercial |
$148.69
|
| Rate for Payer: United Healthcare Medicaid |
$38.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$34.99
|
| Rate for Payer: WEA Trust Commercial |
$225.94
|
| Rate for Payer: WPS Commercial |
$157.44
|
|
|
Puncture Aspiration Of Cyst Of Breast, Each Add'l 19001
|
Professional
|
Both
|
$114.00
|
|
|
Service Code
|
CPT 19001
|
| Hospital Charge Code |
2572832
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$17.44 |
| Max. Negotiated Rate |
$112.63 |
| Rate for Payer: Aetna Commercial |
$112.63
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$101.96
|
| Rate for Payer: Aetna Managed Medicare |
$17.44
|
| Rate for Payer: Anthem Medicare Advantage |
$17.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$17.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$17.44
|
| Rate for Payer: Cash Price |
$34.20
|
| Rate for Payer: Cash Price |
$34.20
|
| Rate for Payer: Cash Price |
$34.20
|
| Rate for Payer: Cigna Commercial |
$112.63
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$21.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$17.44
|
| Rate for Payer: Health EOS Commercial |
$107.89
|
| Rate for Payer: HFN Commercial |
$112.63
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$73.79
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$73.79
|
| Rate for Payer: Independent Care Health Plan Medicare |
$17.44
|
| Rate for Payer: Multiplan Commercial |
$94.85
|
| Rate for Payer: NAPHCARE Commercial |
$26.16
|
| Rate for Payer: Preferred Network Access Commercial |
$112.63
|
| Rate for Payer: Quartz Beloit One Network |
$52.17
|
| Rate for Payer: Quartz Commercial |
$67.58
|
| Rate for Payer: Quartz Medicare Advantage |
$17.44
|
| Rate for Payer: The Alliance Commercial |
$74.12
|
| Rate for Payer: United Healthcare Medicaid |
$21.76
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17.44
|
| Rate for Payer: WEA Trust Commercial |
$65.21
|
| Rate for Payer: WPS Commercial |
$78.48
|
|
|
PUNCTURE ASPIRATION OF HYDROCELE, TUNICA VAGINALIS, WITH OR WITHOUT INJECTION OF MEDICATION
|
Facility
|
OP
|
$4,386.95
|
|
|
Service Code
|
CPT 55000
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$745.23 |
| Max. Negotiated Rate |
$4,386.95 |
| Rate for Payer: Aetna Managed Medicare |
$745.23
|
| 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 |
$745.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$745.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$745.23
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$745.23
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$745.23
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,772.27
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$745.23
|
| Rate for Payer: Independent Care Health Plan Medicare |
$745.23
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$745.23
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$745.23
|
| Rate for Payer: NAPHCARE Commercial |
$1,117.85
|
| Rate for Payer: Quartz Medicare Advantage |
$745.23
|
| Rate for Payer: The Alliance Commercial |
$2,980.93
|
| Rate for Payer: United Healthcare Medicare Advantage |
$745.23
|
| Rate for Payer: United Healthcare PPO |
$2,347.28
|
| Rate for Payer: Wellcare Medicare |
$745.23
|
|
|
PURAPLY AM 1.6 CM DISC (1.6 SQ CM)
|
Facility
|
OP
|
$4,787.00
|
|
|
Service Code
|
HCPCS Q4196
|
| Hospital Charge Code |
5456980
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$130.97 |
| Max. Negotiated Rate |
$4,580.20 |
| Rate for Payer: Aetna Commercial |
$4,480.63
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,281.49
|
| Rate for Payer: Aetna Managed Medicare |
$130.97
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,236.01
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,489.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,389.67
|
| Rate for Payer: Anthem Medicare Advantage |
$130.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,638.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$130.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$130.97
|
| Rate for Payer: Cash Price |
$1,436.10
|
| Rate for Payer: Cash Price |
$1,436.10
|
| Rate for Payer: Cigna Commercial |
$4,580.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$130.97
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$143.32
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$130.97
|
| Rate for Payer: Health EOS Commercial |
$4,430.85
|
| Rate for Payer: HFN Commercial |
$4,580.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$487.20
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$130.97
|
| Rate for Payer: Independent Care Health Plan Medicare |
$130.97
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$130.97
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$130.97
|
| Rate for Payer: Multiplan Commercial |
$3,982.78
|
| Rate for Payer: NAPHCARE Commercial |
$196.45
|
| Rate for Payer: Preferred Network Access Commercial |
$4,580.20
|
| Rate for Payer: Quartz Beloit One Network |
$2,439.46
|
| Rate for Payer: Quartz Commercial |
$3,236.01
|
| Rate for Payer: Quartz Medicare Advantage |
$130.97
|
| Rate for Payer: The Alliance Commercial |
$523.87
|
| Rate for Payer: United Healthcare Medicare Advantage |
$130.97
|
| Rate for Payer: WEA Trust Commercial |
$2,738.16
|
| Rate for Payer: Wellcare Medicare |
$130.97
|
| Rate for Payer: WPS Commercial |
$270.82
|
|
|
PURAPLY AM 1.6 CM DISC (1.6 SQ CM)
|
Facility
|
IP
|
$4,787.00
|
|
|
Service Code
|
HCPCS Q4196
|
| Hospital Charge Code |
5456980
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2,439.46 |
| Max. Negotiated Rate |
$4,580.20 |
| Rate for Payer: Aetna Commercial |
$4,480.63
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,281.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,638.59
|
| Rate for Payer: Cash Price |
$1,436.10
|
| Rate for Payer: Cigna Commercial |
$4,580.20
|
| Rate for Payer: Health EOS Commercial |
$4,430.85
|
| Rate for Payer: HFN Commercial |
$4,580.20
|
| Rate for Payer: Multiplan Commercial |
$3,982.78
|
| Rate for Payer: Preferred Network Access Commercial |
$4,580.20
|
| Rate for Payer: Quartz Beloit One Network |
$2,439.46
|
| Rate for Payer: Quartz Commercial |
$2,987.09
|
| Rate for Payer: WEA Trust Commercial |
$2,738.16
|
| Rate for Payer: WPS Commercial |
$3,687.43
|
|
|
PURAPLY AM 2X2 (4 SQ CM) PURAPLYAM-COM 2X2
|
Facility
|
IP
|
$5,984.00
|
|
|
Service Code
|
HCPCS Q4196
|
| Hospital Charge Code |
4520548
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3,049.45 |
| Max. Negotiated Rate |
$5,725.49 |
| Rate for Payer: Aetna Commercial |
$5,601.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,352.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,298.38
|
| Rate for Payer: Cash Price |
$1,795.20
|
| Rate for Payer: Cigna Commercial |
$5,725.49
|
| Rate for Payer: Health EOS Commercial |
$5,538.79
|
| Rate for Payer: HFN Commercial |
$5,725.49
|
| Rate for Payer: Multiplan Commercial |
$4,978.69
|
| Rate for Payer: Preferred Network Access Commercial |
$5,725.49
|
| Rate for Payer: Quartz Beloit One Network |
$3,049.45
|
| Rate for Payer: Quartz Commercial |
$3,734.02
|
| Rate for Payer: WEA Trust Commercial |
$3,422.85
|
| Rate for Payer: WPS Commercial |
$4,609.48
|
|
|
PURAPLY AM 2X2 (4 SQ CM) PURAPLYAM-COM 2X2
|
Facility
|
OP
|
$5,984.00
|
|
|
Service Code
|
HCPCS Q4196
|
| Hospital Charge Code |
4520548
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$130.97 |
| Max. Negotiated Rate |
$5,725.49 |
| Rate for Payer: Aetna Commercial |
$5,601.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,352.09
|
| Rate for Payer: Aetna Managed Medicare |
$130.97
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,045.18
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,111.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,987.21
|
| Rate for Payer: Anthem Medicare Advantage |
$130.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,298.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$130.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$130.97
|
| Rate for Payer: Cash Price |
$1,795.20
|
| Rate for Payer: Cash Price |
$1,795.20
|
| Rate for Payer: Cigna Commercial |
$5,725.49
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$130.97
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$143.32
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$130.97
|
| Rate for Payer: Health EOS Commercial |
$5,538.79
|
| Rate for Payer: HFN Commercial |
$5,725.49
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$487.20
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$130.97
|
| Rate for Payer: Independent Care Health Plan Medicare |
$130.97
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$130.97
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$130.97
|
| Rate for Payer: Multiplan Commercial |
$4,978.69
|
| Rate for Payer: NAPHCARE Commercial |
$196.45
|
| Rate for Payer: Preferred Network Access Commercial |
$5,725.49
|
| Rate for Payer: Quartz Beloit One Network |
$3,049.45
|
| Rate for Payer: Quartz Commercial |
$4,045.18
|
| Rate for Payer: Quartz Medicare Advantage |
$130.97
|
| Rate for Payer: The Alliance Commercial |
$523.87
|
| Rate for Payer: United Healthcare Medicare Advantage |
$130.97
|
| Rate for Payer: WEA Trust Commercial |
$3,422.85
|
| Rate for Payer: Wellcare Medicare |
$130.97
|
| Rate for Payer: WPS Commercial |
$270.82
|
|
|
PURAPLY AM 2X4 (8 SQ CM) PURAPLYAM-COM 2X4
|
Facility
|
OP
|
$7,181.00
|
|
|
Service Code
|
HCPCS Q4196
|
| Hospital Charge Code |
4520549
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$130.97 |
| Max. Negotiated Rate |
$6,870.78 |
| Rate for Payer: Aetna Commercial |
$6,721.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,422.69
|
| Rate for Payer: Aetna Managed Medicare |
$130.97
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,854.36
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,734.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,584.76
|
| Rate for Payer: Anthem Medicare Advantage |
$130.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,958.17
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$130.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$130.97
|
| Rate for Payer: Cash Price |
$2,154.30
|
| Rate for Payer: Cash Price |
$2,154.30
|
| Rate for Payer: Cigna Commercial |
$6,870.78
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$130.97
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$143.32
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$130.97
|
| Rate for Payer: Health EOS Commercial |
$6,646.73
|
| Rate for Payer: HFN Commercial |
$6,870.78
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$487.20
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$130.97
|
| Rate for Payer: Independent Care Health Plan Medicare |
$130.97
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$130.97
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$130.97
|
| Rate for Payer: Multiplan Commercial |
$5,974.59
|
| Rate for Payer: NAPHCARE Commercial |
$196.45
|
| Rate for Payer: Preferred Network Access Commercial |
$6,870.78
|
| Rate for Payer: Quartz Beloit One Network |
$3,659.44
|
| Rate for Payer: Quartz Commercial |
$4,854.36
|
| Rate for Payer: Quartz Medicare Advantage |
$130.97
|
| Rate for Payer: The Alliance Commercial |
$523.87
|
| Rate for Payer: United Healthcare Medicare Advantage |
$130.97
|
| Rate for Payer: WEA Trust Commercial |
$4,107.53
|
| Rate for Payer: Wellcare Medicare |
$130.97
|
| Rate for Payer: WPS Commercial |
$270.82
|
|
