|
Purkinje Type 1, 2 & TR
|
Professional
|
Both
|
$266.00
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
2942954
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.53 |
| Max. Negotiated Rate |
$262.81 |
| Rate for Payer: Aetna Commercial |
$262.81
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$237.91
|
| Rate for Payer: Aetna Managed Medicare |
$12.53
|
| Rate for Payer: Anthem Commercial |
$17.27
|
| Rate for Payer: Anthem Medicare Advantage |
$12.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$12.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$12.53
|
| Rate for Payer: Cash Price |
$79.80
|
| Rate for Payer: Cash Price |
$79.80
|
| Rate for Payer: Cigna Commercial |
$262.81
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$138.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12.53
|
| Rate for Payer: Health EOS Commercial |
$251.74
|
| Rate for Payer: HFN Commercial |
$262.81
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$44.24
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$44.24
|
| Rate for Payer: Independent Care Health Plan Medicare |
$12.53
|
| Rate for Payer: Multiplan Commercial |
$221.31
|
| Rate for Payer: NAPHCARE Commercial |
$18.80
|
| Rate for Payer: Preferred Network Access Commercial |
$262.81
|
| Rate for Payer: Quartz Beloit One Network |
$121.72
|
| Rate for Payer: Quartz Commercial |
$157.68
|
| Rate for Payer: Quartz Medicare Advantage |
$12.53
|
| Rate for Payer: The Alliance Commercial |
$49.50
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.53
|
| Rate for Payer: WEA Trust Commercial |
$152.15
|
| Rate for Payer: WPS Commercial |
$55.14
|
|
|
Purkinje Type 1, 2 & TR
|
Facility
|
IP
|
$266.00
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
2942954
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$135.55 |
| Max. Negotiated Rate |
$254.51 |
| Rate for Payer: Aetna Commercial |
$248.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$237.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$146.62
|
| Rate for Payer: Cash Price |
$79.80
|
| Rate for Payer: Cigna Commercial |
$254.51
|
| Rate for Payer: Health EOS Commercial |
$246.21
|
| Rate for Payer: HFN Commercial |
$254.51
|
| Rate for Payer: Multiplan Commercial |
$221.31
|
| Rate for Payer: Preferred Network Access Commercial |
$254.51
|
| Rate for Payer: Quartz Beloit One Network |
$135.55
|
| Rate for Payer: Quartz Commercial |
$165.98
|
| Rate for Payer: WEA Trust Commercial |
$152.15
|
| Rate for Payer: WPS Commercial |
$204.90
|
|
|
Purkinje Type 1, 2 & TR
|
Facility
|
OP
|
$266.00
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
2942954
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.53 |
| Max. Negotiated Rate |
$254.51 |
| Rate for Payer: Aetna Commercial |
$248.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$237.91
|
| Rate for Payer: Aetna Managed Medicare |
$12.53
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$46.99
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$21.93
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$20.80
|
| Rate for Payer: Anthem Medicare Advantage |
$12.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$146.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$12.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$12.53
|
| Rate for Payer: Cash Price |
$79.80
|
| Rate for Payer: Cash Price |
$79.80
|
| Rate for Payer: Cigna Commercial |
$254.51
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$12.53
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$154.81
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$12.53
|
| Rate for Payer: Health EOS Commercial |
$246.21
|
| Rate for Payer: HFN Commercial |
$254.51
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$46.62
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$12.53
|
| Rate for Payer: Independent Care Health Plan Medicare |
$12.53
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$12.53
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$12.53
|
| Rate for Payer: Multiplan Commercial |
$221.31
|
| Rate for Payer: NAPHCARE Commercial |
$18.80
|
| Rate for Payer: Preferred Network Access Commercial |
$254.51
|
| Rate for Payer: Quartz Beloit One Network |
$135.55
|
| Rate for Payer: Quartz Commercial |
$179.82
|
| Rate for Payer: Quartz Medicare Advantage |
$12.53
|
| Rate for Payer: The Alliance Commercial |
$50.13
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.53
|
| Rate for Payer: United Healthcare PPO |
$207.48
|
| Rate for Payer: WEA Trust Commercial |
$152.15
|
| Rate for Payer: Wellcare Medicare |
$12.53
|
| Rate for Payer: WPS Commercial |
$204.90
|
|
|
Purkinje Type 2
|
Facility
|
IP
|
$81.00
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
2942955
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$41.28 |
| Max. Negotiated Rate |
$77.50 |
| Rate for Payer: Aetna Commercial |
$75.82
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$72.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$44.65
|
| Rate for Payer: Cash Price |
$24.30
|
| Rate for Payer: Cigna Commercial |
$77.50
|
| Rate for Payer: Health EOS Commercial |
$74.97
|
| Rate for Payer: HFN Commercial |
$77.50
|
| Rate for Payer: Multiplan Commercial |
$67.39
|
| Rate for Payer: Preferred Network Access Commercial |
$77.50
|
| Rate for Payer: Quartz Beloit One Network |
$41.28
|
| Rate for Payer: Quartz Commercial |
$50.54
|
| Rate for Payer: WEA Trust Commercial |
$46.33
|
| Rate for Payer: WPS Commercial |
$62.39
|
|
|
Purkinje Type 2
|
Facility
|
OP
|
$81.00
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
2942955
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.53 |
| Max. Negotiated Rate |
$77.50 |
| Rate for Payer: Aetna Commercial |
$75.82
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$72.45
|
| Rate for Payer: Aetna Managed Medicare |
$12.53
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$46.99
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$21.93
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$20.80
|
| Rate for Payer: Anthem Medicare Advantage |
$12.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$44.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$12.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$12.53
|
| Rate for Payer: Cash Price |
$24.30
|
| Rate for Payer: Cash Price |
$24.30
|
| Rate for Payer: Cigna Commercial |
$77.50
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$12.53
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$47.14
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$12.53
|
| Rate for Payer: Health EOS Commercial |
$74.97
|
| Rate for Payer: HFN Commercial |
$77.50
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$46.62
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$12.53
|
| Rate for Payer: Independent Care Health Plan Medicare |
$12.53
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$12.53
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$12.53
|
| Rate for Payer: Multiplan Commercial |
$67.39
|
| Rate for Payer: NAPHCARE Commercial |
$18.80
|
| Rate for Payer: Preferred Network Access Commercial |
$77.50
|
| Rate for Payer: Quartz Beloit One Network |
$41.28
|
| Rate for Payer: Quartz Commercial |
$54.76
|
| Rate for Payer: Quartz Medicare Advantage |
$12.53
|
| Rate for Payer: The Alliance Commercial |
$50.13
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.53
|
| Rate for Payer: United Healthcare PPO |
$63.18
|
| Rate for Payer: WEA Trust Commercial |
$46.33
|
| Rate for Payer: Wellcare Medicare |
$12.53
|
| Rate for Payer: WPS Commercial |
$62.39
|
|
|
Purkinje Type 2
|
Professional
|
Both
|
$81.00
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
2942955
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.53 |
| Max. Negotiated Rate |
$80.03 |
| Rate for Payer: Aetna Commercial |
$80.03
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$72.45
|
| Rate for Payer: Aetna Managed Medicare |
$12.53
|
| Rate for Payer: Anthem Commercial |
$17.27
|
| Rate for Payer: Anthem Medicare Advantage |
$12.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$12.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$12.53
|
| Rate for Payer: Cash Price |
$24.30
|
| Rate for Payer: Cash Price |
$24.30
|
| Rate for Payer: Cigna Commercial |
$80.03
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$42.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12.53
|
| Rate for Payer: Health EOS Commercial |
$76.66
|
| Rate for Payer: HFN Commercial |
$80.03
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$44.24
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$44.24
|
| Rate for Payer: Independent Care Health Plan Medicare |
$12.53
|
| Rate for Payer: Multiplan Commercial |
$67.39
|
| Rate for Payer: NAPHCARE Commercial |
$18.80
|
| Rate for Payer: Preferred Network Access Commercial |
$80.03
|
| Rate for Payer: Quartz Beloit One Network |
$37.07
|
| Rate for Payer: Quartz Commercial |
$48.02
|
| Rate for Payer: Quartz Medicare Advantage |
$12.53
|
| Rate for Payer: The Alliance Commercial |
$49.50
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.53
|
| Rate for Payer: WEA Trust Commercial |
$46.33
|
| Rate for Payer: WPS Commercial |
$55.14
|
|
|
Purkinje Type TR
|
Facility
|
OP
|
$81.00
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
2942956
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.53 |
| Max. Negotiated Rate |
$77.50 |
| Rate for Payer: Aetna Commercial |
$75.82
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$72.45
|
| Rate for Payer: Aetna Managed Medicare |
$12.53
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$46.99
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$21.93
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$20.80
|
| Rate for Payer: Anthem Medicare Advantage |
$12.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$44.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$12.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$12.53
|
| Rate for Payer: Cash Price |
$24.30
|
| Rate for Payer: Cash Price |
$24.30
|
| Rate for Payer: Cigna Commercial |
$77.50
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$12.53
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$47.14
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$12.53
|
| Rate for Payer: Health EOS Commercial |
$74.97
|
| Rate for Payer: HFN Commercial |
$77.50
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$46.62
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$12.53
|
| Rate for Payer: Independent Care Health Plan Medicare |
$12.53
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$12.53
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$12.53
|
| Rate for Payer: Multiplan Commercial |
$67.39
|
| Rate for Payer: NAPHCARE Commercial |
$18.80
|
| Rate for Payer: Preferred Network Access Commercial |
$77.50
|
| Rate for Payer: Quartz Beloit One Network |
$41.28
|
| Rate for Payer: Quartz Commercial |
$54.76
|
| Rate for Payer: Quartz Medicare Advantage |
$12.53
|
| Rate for Payer: The Alliance Commercial |
$50.13
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.53
|
| Rate for Payer: United Healthcare PPO |
$63.18
|
| Rate for Payer: WEA Trust Commercial |
$46.33
|
| Rate for Payer: Wellcare Medicare |
$12.53
|
| Rate for Payer: WPS Commercial |
$62.39
|
|
|
Purkinje Type TR
|
Professional
|
Both
|
$81.00
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
2942956
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.53 |
| Max. Negotiated Rate |
$80.03 |
| Rate for Payer: Aetna Commercial |
$80.03
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$72.45
|
| Rate for Payer: Aetna Managed Medicare |
$12.53
|
| Rate for Payer: Anthem Commercial |
$17.27
|
| Rate for Payer: Anthem Medicare Advantage |
$12.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$12.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$12.53
|
| Rate for Payer: Cash Price |
$24.30
|
| Rate for Payer: Cash Price |
$24.30
|
| Rate for Payer: Cigna Commercial |
$80.03
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$42.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12.53
|
| Rate for Payer: Health EOS Commercial |
$76.66
|
| Rate for Payer: HFN Commercial |
$80.03
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$44.24
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$44.24
|
| Rate for Payer: Independent Care Health Plan Medicare |
$12.53
|
| Rate for Payer: Multiplan Commercial |
$67.39
|
| Rate for Payer: NAPHCARE Commercial |
$18.80
|
| Rate for Payer: Preferred Network Access Commercial |
$80.03
|
| Rate for Payer: Quartz Beloit One Network |
$37.07
|
| Rate for Payer: Quartz Commercial |
$48.02
|
| Rate for Payer: Quartz Medicare Advantage |
$12.53
|
| Rate for Payer: The Alliance Commercial |
$49.50
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.53
|
| Rate for Payer: WEA Trust Commercial |
$46.33
|
| Rate for Payer: WPS Commercial |
$55.14
|
|
|
Purkinje Type TR
|
Facility
|
IP
|
$81.00
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
2942956
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$41.28 |
| Max. Negotiated Rate |
$77.50 |
| Rate for Payer: Aetna Commercial |
$75.82
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$72.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$44.65
|
| Rate for Payer: Cash Price |
$24.30
|
| Rate for Payer: Cigna Commercial |
$77.50
|
| Rate for Payer: Health EOS Commercial |
$74.97
|
| Rate for Payer: HFN Commercial |
$77.50
|
| Rate for Payer: Multiplan Commercial |
$67.39
|
| Rate for Payer: Preferred Network Access Commercial |
$77.50
|
| Rate for Payer: Quartz Beloit One Network |
$41.28
|
| Rate for Payer: Quartz Commercial |
$50.54
|
| Rate for Payer: WEA Trust Commercial |
$46.33
|
| Rate for Payer: WPS Commercial |
$62.39
|
|
|
Put on patient* - Defibrillator Pads
|
Facility
|
OP
|
$753.00
|
|
| Hospital Charge Code |
4075873
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$219.27 |
| Max. Negotiated Rate |
$720.47 |
| Rate for Payer: Aetna Commercial |
$704.81
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$673.48
|
| Rate for Payer: Aetna Managed Medicare |
$219.27
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$509.03
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$391.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$375.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$415.05
|
| Rate for Payer: Cash Price |
$225.90
|
| Rate for Payer: Cigna Commercial |
$720.47
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$438.25
|
| Rate for Payer: Health EOS Commercial |
$696.98
|
| Rate for Payer: HFN Commercial |
$720.47
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$587.34
|
| Rate for Payer: Multiplan Commercial |
$626.50
|
| Rate for Payer: NAPHCARE Commercial |
$469.87
|
| Rate for Payer: Preferred Network Access Commercial |
$720.47
|
| Rate for Payer: Quartz Beloit One Network |
$383.73
|
| Rate for Payer: Quartz Commercial |
$509.03
|
| Rate for Payer: Quartz Medicare Advantage |
$469.87
|
| Rate for Payer: The Alliance Commercial |
$391.56
|
| Rate for Payer: WEA Trust Commercial |
$430.72
|
| Rate for Payer: WPS Commercial |
$580.04
|
|
|
Put on patient* - Defibrillator Pads
|
Facility
|
IP
|
$753.00
|
|
| Hospital Charge Code |
4075873
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$383.73 |
| Max. Negotiated Rate |
$720.47 |
| Rate for Payer: Aetna Commercial |
$704.81
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$673.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$415.05
|
| Rate for Payer: Cash Price |
$225.90
|
| Rate for Payer: Cigna Commercial |
$720.47
|
| Rate for Payer: Health EOS Commercial |
$696.98
|
| Rate for Payer: HFN Commercial |
$720.47
|
| Rate for Payer: Multiplan Commercial |
$626.50
|
| Rate for Payer: Preferred Network Access Commercial |
$720.47
|
| Rate for Payer: Quartz Beloit One Network |
$383.73
|
| Rate for Payer: Quartz Commercial |
$469.87
|
| Rate for Payer: WEA Trust Commercial |
$430.72
|
| Rate for Payer: WPS Commercial |
$580.04
|
|
|
PUTTY FIBERGRAFT BONE GRAFT SUBSTITUTE 4CC (BIOACTIVE GLASS MATRIX) 78000040
|
Facility
|
OP
|
$4,729.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6226144
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,377.08 |
| Max. Negotiated Rate |
$4,524.71 |
| Rate for Payer: Aetna Commercial |
$4,426.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,229.62
|
| Rate for Payer: Aetna Managed Medicare |
$1,377.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,196.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,459.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,360.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,606.62
|
| Rate for Payer: Cash Price |
$1,418.70
|
| Rate for Payer: Cigna Commercial |
$4,524.71
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,752.28
|
| Rate for Payer: Health EOS Commercial |
$4,377.16
|
| Rate for Payer: HFN Commercial |
$4,524.71
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,688.62
|
| Rate for Payer: Multiplan Commercial |
$3,934.53
|
| Rate for Payer: NAPHCARE Commercial |
$2,950.90
|
| Rate for Payer: Preferred Network Access Commercial |
$4,524.71
|
| Rate for Payer: Quartz Beloit One Network |
$2,409.90
|
| Rate for Payer: Quartz Commercial |
$3,196.80
|
| Rate for Payer: Quartz Medicare Advantage |
$2,950.90
|
| Rate for Payer: The Alliance Commercial |
$2,459.08
|
| Rate for Payer: WEA Trust Commercial |
$2,704.99
|
| Rate for Payer: WPS Commercial |
$3,642.75
|
|
|
PUTTY FIBERGRAFT BONE GRAFT SUBSTITUTE 4CC (BIOACTIVE GLASS MATRIX) 78000040
|
Facility
|
IP
|
$4,729.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6226144
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,409.90 |
| Max. Negotiated Rate |
$4,524.71 |
| Rate for Payer: Aetna Commercial |
$4,426.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,229.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,606.62
|
| Rate for Payer: Cash Price |
$1,418.70
|
| Rate for Payer: Cigna Commercial |
$4,524.71
|
| Rate for Payer: Health EOS Commercial |
$4,377.16
|
| Rate for Payer: HFN Commercial |
$4,524.71
|
| Rate for Payer: Multiplan Commercial |
$3,934.53
|
| Rate for Payer: Preferred Network Access Commercial |
$4,524.71
|
| Rate for Payer: Quartz Beloit One Network |
$2,409.90
|
| Rate for Payer: Quartz Commercial |
$2,950.90
|
| Rate for Payer: WEA Trust Commercial |
$2,704.99
|
| Rate for Payer: WPS Commercial |
$3,642.75
|
|
|
PUTTY THERA MED-SOFT RED 5# #50719905
|
Facility
|
OP
|
$988.00
|
|
| Hospital Charge Code |
2969541
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$287.71 |
| Max. Negotiated Rate |
$945.32 |
| Rate for Payer: Aetna Commercial |
$924.77
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$883.67
|
| Rate for Payer: Aetna Managed Medicare |
$287.71
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$667.89
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$513.76
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$493.21
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$544.59
|
| Rate for Payer: Cash Price |
$296.40
|
| Rate for Payer: Cigna Commercial |
$945.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$575.02
|
| Rate for Payer: Health EOS Commercial |
$914.49
|
| Rate for Payer: HFN Commercial |
$945.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$770.64
|
| Rate for Payer: Multiplan Commercial |
$822.02
|
| Rate for Payer: NAPHCARE Commercial |
$616.51
|
| Rate for Payer: Preferred Network Access Commercial |
$945.32
|
| Rate for Payer: Quartz Beloit One Network |
$503.48
|
| Rate for Payer: Quartz Commercial |
$667.89
|
| Rate for Payer: Quartz Medicare Advantage |
$616.51
|
| Rate for Payer: The Alliance Commercial |
$513.76
|
| Rate for Payer: WEA Trust Commercial |
$565.14
|
| Rate for Payer: WPS Commercial |
$761.06
|
|
|
PUTTY THERA MED-SOFT RED 5# #50719905
|
Facility
|
IP
|
$988.00
|
|
| Hospital Charge Code |
2969541
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$503.48 |
| Max. Negotiated Rate |
$945.32 |
| Rate for Payer: Aetna Commercial |
$924.77
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$883.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$544.59
|
| Rate for Payer: Cash Price |
$296.40
|
| Rate for Payer: Cigna Commercial |
$945.32
|
| Rate for Payer: Health EOS Commercial |
$914.49
|
| Rate for Payer: HFN Commercial |
$945.32
|
| Rate for Payer: Multiplan Commercial |
$822.02
|
| Rate for Payer: Preferred Network Access Commercial |
$945.32
|
| Rate for Payer: Quartz Beloit One Network |
$503.48
|
| Rate for Payer: Quartz Commercial |
$616.51
|
| Rate for Payer: WEA Trust Commercial |
$565.14
|
| Rate for Payer: WPS Commercial |
$761.06
|
|
|
PUTTY THERAPY 5# YELLOW #5071-05
|
Facility
|
OP
|
$809.00
|
|
| Hospital Charge Code |
2969615
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$235.58 |
| Max. Negotiated Rate |
$774.05 |
| Rate for Payer: Aetna Commercial |
$757.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$723.57
|
| Rate for Payer: Aetna Managed Medicare |
$235.58
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$546.88
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$420.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$403.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$445.92
|
| Rate for Payer: Cash Price |
$242.70
|
| Rate for Payer: Cigna Commercial |
$774.05
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$470.84
|
| Rate for Payer: Health EOS Commercial |
$748.81
|
| Rate for Payer: HFN Commercial |
$774.05
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$631.02
|
| Rate for Payer: Multiplan Commercial |
$673.09
|
| Rate for Payer: NAPHCARE Commercial |
$504.82
|
| Rate for Payer: Preferred Network Access Commercial |
$774.05
|
| Rate for Payer: Quartz Beloit One Network |
$412.27
|
| Rate for Payer: Quartz Commercial |
$546.88
|
| Rate for Payer: Quartz Medicare Advantage |
$504.82
|
| Rate for Payer: The Alliance Commercial |
$420.68
|
| Rate for Payer: WEA Trust Commercial |
$462.75
|
| Rate for Payer: WPS Commercial |
$623.17
|
|
|
PUTTY THERAPY 5# YELLOW #5071-05
|
Facility
|
IP
|
$809.00
|
|
| Hospital Charge Code |
2969615
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$412.27 |
| Max. Negotiated Rate |
$774.05 |
| Rate for Payer: Aetna Commercial |
$757.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$723.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$445.92
|
| Rate for Payer: Cash Price |
$242.70
|
| Rate for Payer: Cigna Commercial |
$774.05
|
| Rate for Payer: Health EOS Commercial |
$748.81
|
| Rate for Payer: HFN Commercial |
$774.05
|
| Rate for Payer: Multiplan Commercial |
$673.09
|
| Rate for Payer: Preferred Network Access Commercial |
$774.05
|
| Rate for Payer: Quartz Beloit One Network |
$412.27
|
| Rate for Payer: Quartz Commercial |
$504.82
|
| Rate for Payer: WEA Trust Commercial |
$462.75
|
| Rate for Payer: WPS Commercial |
$623.17
|
|
|
PYELOPLASTY
|
Facility
|
IP
|
$4,460.00
|
|
| Hospital Charge Code |
2960328
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,272.82 |
| Max. Negotiated Rate |
$4,267.33 |
| Rate for Payer: Aetna Commercial |
$4,174.56
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,989.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,458.35
|
| Rate for Payer: Cash Price |
$1,338.00
|
| Rate for Payer: Cigna Commercial |
$4,267.33
|
| Rate for Payer: Health EOS Commercial |
$4,128.18
|
| Rate for Payer: HFN Commercial |
$4,267.33
|
| Rate for Payer: Multiplan Commercial |
$3,710.72
|
| Rate for Payer: Preferred Network Access Commercial |
$4,267.33
|
| Rate for Payer: Quartz Beloit One Network |
$2,272.82
|
| Rate for Payer: Quartz Commercial |
$2,783.04
|
| Rate for Payer: WEA Trust Commercial |
$2,551.12
|
| Rate for Payer: WPS Commercial |
$3,435.54
|
|
|
PYELOPLASTY
|
Facility
|
OP
|
$4,460.00
|
|
| Hospital Charge Code |
2960328
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,298.75 |
| Max. Negotiated Rate |
$4,267.33 |
| Rate for Payer: Aetna Commercial |
$4,174.56
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,989.02
|
| Rate for Payer: Aetna Managed Medicare |
$1,298.75
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,014.96
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,319.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,226.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,458.35
|
| Rate for Payer: Cash Price |
$1,338.00
|
| Rate for Payer: Cigna Commercial |
$4,267.33
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,595.72
|
| Rate for Payer: Health EOS Commercial |
$4,128.18
|
| Rate for Payer: HFN Commercial |
$4,267.33
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,478.80
|
| Rate for Payer: Multiplan Commercial |
$3,710.72
|
| Rate for Payer: NAPHCARE Commercial |
$2,783.04
|
| Rate for Payer: Preferred Network Access Commercial |
$4,267.33
|
| Rate for Payer: Quartz Beloit One Network |
$2,272.82
|
| Rate for Payer: Quartz Commercial |
$3,014.96
|
| Rate for Payer: Quartz Medicare Advantage |
$2,783.04
|
| Rate for Payer: The Alliance Commercial |
$2,319.20
|
| Rate for Payer: WEA Trust Commercial |
$2,551.12
|
| Rate for Payer: WPS Commercial |
$3,435.54
|
|
|
PYELOSTOMY
|
Facility
|
OP
|
$4,460.00
|
|
| Hospital Charge Code |
2960329
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,298.75 |
| Max. Negotiated Rate |
$4,267.33 |
| Rate for Payer: Aetna Commercial |
$4,174.56
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,989.02
|
| Rate for Payer: Aetna Managed Medicare |
$1,298.75
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,014.96
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,319.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,226.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,458.35
|
| Rate for Payer: Cash Price |
$1,338.00
|
| Rate for Payer: Cigna Commercial |
$4,267.33
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,595.72
|
| Rate for Payer: Health EOS Commercial |
$4,128.18
|
| Rate for Payer: HFN Commercial |
$4,267.33
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,478.80
|
| Rate for Payer: Multiplan Commercial |
$3,710.72
|
| Rate for Payer: NAPHCARE Commercial |
$2,783.04
|
| Rate for Payer: Preferred Network Access Commercial |
$4,267.33
|
| Rate for Payer: Quartz Beloit One Network |
$2,272.82
|
| Rate for Payer: Quartz Commercial |
$3,014.96
|
| Rate for Payer: Quartz Medicare Advantage |
$2,783.04
|
| Rate for Payer: The Alliance Commercial |
$2,319.20
|
| Rate for Payer: WEA Trust Commercial |
$2,551.12
|
| Rate for Payer: WPS Commercial |
$3,435.54
|
|
|
PYELOSTOMY
|
Facility
|
IP
|
$4,460.00
|
|
| Hospital Charge Code |
2960329
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,272.82 |
| Max. Negotiated Rate |
$4,267.33 |
| Rate for Payer: Aetna Commercial |
$4,174.56
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,989.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,458.35
|
| Rate for Payer: Cash Price |
$1,338.00
|
| Rate for Payer: Cigna Commercial |
$4,267.33
|
| Rate for Payer: Health EOS Commercial |
$4,128.18
|
| Rate for Payer: HFN Commercial |
$4,267.33
|
| Rate for Payer: Multiplan Commercial |
$3,710.72
|
| Rate for Payer: Preferred Network Access Commercial |
$4,267.33
|
| Rate for Payer: Quartz Beloit One Network |
$2,272.82
|
| Rate for Payer: Quartz Commercial |
$2,783.04
|
| Rate for Payer: WEA Trust Commercial |
$2,551.12
|
| Rate for Payer: WPS Commercial |
$3,435.54
|
|
|
PYELOTOMY
|
Facility
|
IP
|
$4,460.00
|
|
| Hospital Charge Code |
2960330
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,272.82 |
| Max. Negotiated Rate |
$4,267.33 |
| Rate for Payer: Aetna Commercial |
$4,174.56
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,989.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,458.35
|
| Rate for Payer: Cash Price |
$1,338.00
|
| Rate for Payer: Cigna Commercial |
$4,267.33
|
| Rate for Payer: Health EOS Commercial |
$4,128.18
|
| Rate for Payer: HFN Commercial |
$4,267.33
|
| Rate for Payer: Multiplan Commercial |
$3,710.72
|
| Rate for Payer: Preferred Network Access Commercial |
$4,267.33
|
| Rate for Payer: Quartz Beloit One Network |
$2,272.82
|
| Rate for Payer: Quartz Commercial |
$2,783.04
|
| Rate for Payer: WEA Trust Commercial |
$2,551.12
|
| Rate for Payer: WPS Commercial |
$3,435.54
|
|
|
PYELOTOMY
|
Facility
|
OP
|
$4,460.00
|
|
| Hospital Charge Code |
2960330
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,298.75 |
| Max. Negotiated Rate |
$4,267.33 |
| Rate for Payer: Aetna Commercial |
$4,174.56
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,989.02
|
| Rate for Payer: Aetna Managed Medicare |
$1,298.75
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,014.96
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,319.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,226.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,458.35
|
| Rate for Payer: Cash Price |
$1,338.00
|
| Rate for Payer: Cigna Commercial |
$4,267.33
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,595.72
|
| Rate for Payer: Health EOS Commercial |
$4,128.18
|
| Rate for Payer: HFN Commercial |
$4,267.33
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,478.80
|
| Rate for Payer: Multiplan Commercial |
$3,710.72
|
| Rate for Payer: NAPHCARE Commercial |
$2,783.04
|
| Rate for Payer: Preferred Network Access Commercial |
$4,267.33
|
| Rate for Payer: Quartz Beloit One Network |
$2,272.82
|
| Rate for Payer: Quartz Commercial |
$3,014.96
|
| Rate for Payer: Quartz Medicare Advantage |
$2,783.04
|
| Rate for Payer: The Alliance Commercial |
$2,319.20
|
| Rate for Payer: WEA Trust Commercial |
$2,551.12
|
| Rate for Payer: WPS Commercial |
$3,435.54
|
|
|
PYLOROMYOTOMY, PEDIATRIC/RAMSTEDT PROCEDURE
|
Facility
|
IP
|
$3,935.00
|
|
| Hospital Charge Code |
2960331
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,005.28 |
| Max. Negotiated Rate |
$3,765.01 |
| Rate for Payer: Aetna Commercial |
$3,683.16
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,519.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,168.97
|
| Rate for Payer: Cash Price |
$1,180.50
|
| Rate for Payer: Cigna Commercial |
$3,765.01
|
| Rate for Payer: Health EOS Commercial |
$3,642.24
|
| Rate for Payer: HFN Commercial |
$3,765.01
|
| Rate for Payer: Multiplan Commercial |
$3,273.92
|
| Rate for Payer: Preferred Network Access Commercial |
$3,765.01
|
| Rate for Payer: Quartz Beloit One Network |
$2,005.28
|
| Rate for Payer: Quartz Commercial |
$2,455.44
|
| Rate for Payer: WEA Trust Commercial |
$2,250.82
|
| Rate for Payer: WPS Commercial |
$3,031.13
|
|
|
PYLOROMYOTOMY, PEDIATRIC/RAMSTEDT PROCEDURE
|
Facility
|
OP
|
$3,935.00
|
|
| Hospital Charge Code |
2960331
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,145.87 |
| Max. Negotiated Rate |
$3,765.01 |
| Rate for Payer: Aetna Commercial |
$3,683.16
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,519.46
|
| Rate for Payer: Aetna Managed Medicare |
$1,145.87
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,660.06
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,046.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,964.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,168.97
|
| Rate for Payer: Cash Price |
$1,180.50
|
| Rate for Payer: Cigna Commercial |
$3,765.01
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,290.17
|
| Rate for Payer: Health EOS Commercial |
$3,642.24
|
| Rate for Payer: HFN Commercial |
$3,765.01
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,069.30
|
| Rate for Payer: Multiplan Commercial |
$3,273.92
|
| Rate for Payer: NAPHCARE Commercial |
$2,455.44
|
| Rate for Payer: Preferred Network Access Commercial |
$3,765.01
|
| Rate for Payer: Quartz Beloit One Network |
$2,005.28
|
| Rate for Payer: Quartz Commercial |
$2,660.06
|
| Rate for Payer: Quartz Medicare Advantage |
$2,455.44
|
| Rate for Payer: The Alliance Commercial |
$2,046.20
|
| Rate for Payer: WEA Trust Commercial |
$2,250.82
|
| Rate for Payer: WPS Commercial |
$3,031.13
|
|
