|
CUP UNI REVERS 36/ NEUTRAL CTD AR-9502-36CPC
|
Facility
|
OP
|
$9,494.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
4520170
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,764.65 |
| Max. Negotiated Rate |
$9,083.86 |
| Rate for Payer: Aetna Commercial |
$8,886.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,491.43
|
| Rate for Payer: Aetna Managed Medicare |
$2,764.65
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6,417.94
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,936.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,739.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,233.09
|
| Rate for Payer: Cash Price |
$2,848.20
|
| Rate for Payer: Cigna Commercial |
$9,083.86
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,525.51
|
| Rate for Payer: Health EOS Commercial |
$8,787.65
|
| Rate for Payer: HFN Commercial |
$9,083.86
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7,405.32
|
| Rate for Payer: Multiplan Commercial |
$7,899.01
|
| Rate for Payer: NAPHCARE Commercial |
$5,924.26
|
| Rate for Payer: Preferred Network Access Commercial |
$9,083.86
|
| Rate for Payer: Quartz Beloit One Network |
$4,838.14
|
| Rate for Payer: Quartz Commercial |
$6,417.94
|
| Rate for Payer: Quartz Medicare Advantage |
$5,924.26
|
| Rate for Payer: The Alliance Commercial |
$4,936.88
|
| Rate for Payer: WEA Trust Commercial |
$5,430.57
|
| Rate for Payer: WPS Commercial |
$7,313.23
|
|
|
CUP UNI REVERS 36/ NEUTRAL CTD AR-9502-36CPC
|
Facility
|
IP
|
$9,494.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
4520170
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,838.14 |
| Max. Negotiated Rate |
$9,083.86 |
| Rate for Payer: Aetna Commercial |
$8,886.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,491.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,233.09
|
| Rate for Payer: Cash Price |
$2,848.20
|
| Rate for Payer: Cigna Commercial |
$9,083.86
|
| Rate for Payer: Health EOS Commercial |
$8,787.65
|
| Rate for Payer: HFN Commercial |
$9,083.86
|
| Rate for Payer: Multiplan Commercial |
$7,899.01
|
| Rate for Payer: Preferred Network Access Commercial |
$9,083.86
|
| Rate for Payer: Quartz Beloit One Network |
$4,838.14
|
| Rate for Payer: Quartz Commercial |
$5,924.26
|
| Rate for Payer: WEA Trust Commercial |
$5,430.57
|
| Rate for Payer: WPS Commercial |
$7,313.23
|
|
|
CUP UNIVERSAL REVERSE CUP - CAP COATED 39/+2MM LT OFFSET AR-9502-39LCPC
|
Facility
|
IP
|
$8,778.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
4595653
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,473.27 |
| Max. Negotiated Rate |
$8,398.79 |
| Rate for Payer: Aetna Commercial |
$8,216.21
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,851.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,838.43
|
| Rate for Payer: Cash Price |
$2,633.40
|
| Rate for Payer: Cigna Commercial |
$8,398.79
|
| Rate for Payer: Health EOS Commercial |
$8,124.92
|
| Rate for Payer: HFN Commercial |
$8,398.79
|
| Rate for Payer: Multiplan Commercial |
$7,303.30
|
| Rate for Payer: Preferred Network Access Commercial |
$8,398.79
|
| Rate for Payer: Quartz Beloit One Network |
$4,473.27
|
| Rate for Payer: Quartz Commercial |
$5,477.47
|
| Rate for Payer: WEA Trust Commercial |
$5,021.02
|
| Rate for Payer: WPS Commercial |
$6,761.69
|
|
|
CUP UNIVERSAL REVERSE CUP - CAP COATED 39/+2MM LT OFFSET AR-9502-39LCPC
|
Facility
|
OP
|
$8,778.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
4595653
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,556.15 |
| Max. Negotiated Rate |
$8,398.79 |
| Rate for Payer: Aetna Commercial |
$8,216.21
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,851.04
|
| Rate for Payer: Aetna Managed Medicare |
$2,556.15
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,933.93
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,564.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,381.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,838.43
|
| Rate for Payer: Cash Price |
$2,633.40
|
| Rate for Payer: Cigna Commercial |
$8,398.79
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,108.80
|
| Rate for Payer: Health EOS Commercial |
$8,124.92
|
| Rate for Payer: HFN Commercial |
$8,398.79
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,846.84
|
| Rate for Payer: Multiplan Commercial |
$7,303.30
|
| Rate for Payer: NAPHCARE Commercial |
$5,477.47
|
| Rate for Payer: Preferred Network Access Commercial |
$8,398.79
|
| Rate for Payer: Quartz Beloit One Network |
$4,473.27
|
| Rate for Payer: Quartz Commercial |
$5,933.93
|
| Rate for Payer: Quartz Medicare Advantage |
$5,477.47
|
| Rate for Payer: The Alliance Commercial |
$4,564.56
|
| Rate for Payer: WEA Trust Commercial |
$5,021.02
|
| Rate for Payer: WPS Commercial |
$6,761.69
|
|
|
CURETTAGE, POSTPARTUM
|
Facility
|
OP
|
$13,626.87
|
|
|
Service Code
|
CPT 59160
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,835.04 |
| Max. Negotiated Rate |
$13,626.87 |
| Rate for Payer: Aetna Managed Medicare |
$3,406.72
|
| 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 |
$3,406.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$3,406.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$3,406.72
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$3,406.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$3,406.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$12,672.99
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$3,406.72
|
| Rate for Payer: Independent Care Health Plan Medicare |
$3,406.72
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$3,406.72
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$3,406.72
|
| Rate for Payer: NAPHCARE Commercial |
$5,110.08
|
| Rate for Payer: Quartz Medicare Advantage |
$3,406.72
|
| Rate for Payer: The Alliance Commercial |
$13,626.87
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,406.72
|
| Rate for Payer: United Healthcare PPO |
$3,726.32
|
| Rate for Payer: Wellcare Medicare |
$3,406.72
|
|
|
Curette/Treat Cornea 65435
|
Professional
|
Both
|
$298.00
|
|
|
Service Code
|
CPT 65435
|
| Hospital Charge Code |
4608614
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$59.97 |
| Max. Negotiated Rate |
$294.42 |
| Rate for Payer: Aetna Commercial |
$294.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$266.53
|
| Rate for Payer: Aetna Managed Medicare |
$59.97
|
| Rate for Payer: Anthem Medicare Advantage |
$59.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$59.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$59.97
|
| Rate for Payer: Cash Price |
$89.40
|
| Rate for Payer: Cash Price |
$89.40
|
| Rate for Payer: Cash Price |
$89.40
|
| Rate for Payer: Cigna Commercial |
$294.42
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$61.46
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$59.97
|
| Rate for Payer: Health EOS Commercial |
$282.03
|
| Rate for Payer: HFN Commercial |
$294.42
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$240.79
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$240.79
|
| Rate for Payer: Independent Care Health Plan Medicare |
$59.97
|
| Rate for Payer: Multiplan Commercial |
$247.94
|
| Rate for Payer: NAPHCARE Commercial |
$89.95
|
| Rate for Payer: Preferred Network Access Commercial |
$294.42
|
| Rate for Payer: Quartz Beloit One Network |
$136.36
|
| Rate for Payer: Quartz Commercial |
$176.65
|
| Rate for Payer: Quartz Medicare Advantage |
$59.97
|
| Rate for Payer: The Alliance Commercial |
$254.86
|
| Rate for Payer: United Healthcare Medicaid |
$61.46
|
| Rate for Payer: United Healthcare Medicare Advantage |
$59.97
|
| Rate for Payer: WEA Trust Commercial |
$170.46
|
| Rate for Payer: WPS Commercial |
$269.85
|
|
|
CUSHION INFLATABLE VINYL
|
Facility
|
OP
|
$93.00
|
|
| Hospital Charge Code |
2964027
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$27.08 |
| Max. Negotiated Rate |
$88.98 |
| Rate for Payer: Aetna Commercial |
$87.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$83.18
|
| Rate for Payer: Aetna Managed Medicare |
$27.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$62.87
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$48.36
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$46.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$51.26
|
| Rate for Payer: Cash Price |
$27.90
|
| Rate for Payer: Cigna Commercial |
$88.98
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$54.13
|
| Rate for Payer: Health EOS Commercial |
$86.08
|
| Rate for Payer: HFN Commercial |
$88.98
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$72.54
|
| Rate for Payer: Multiplan Commercial |
$77.38
|
| Rate for Payer: NAPHCARE Commercial |
$58.03
|
| Rate for Payer: Preferred Network Access Commercial |
$88.98
|
| Rate for Payer: Quartz Beloit One Network |
$47.39
|
| Rate for Payer: Quartz Commercial |
$62.87
|
| Rate for Payer: Quartz Medicare Advantage |
$58.03
|
| Rate for Payer: The Alliance Commercial |
$48.36
|
| Rate for Payer: WEA Trust Commercial |
$53.20
|
| Rate for Payer: WPS Commercial |
$71.64
|
|
|
CUSHION INFLATABLE VINYL
|
Facility
|
IP
|
$93.00
|
|
| Hospital Charge Code |
2964027
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$47.39 |
| Max. Negotiated Rate |
$88.98 |
| Rate for Payer: Aetna Commercial |
$87.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$83.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$51.26
|
| Rate for Payer: Cash Price |
$27.90
|
| Rate for Payer: Cigna Commercial |
$88.98
|
| Rate for Payer: Health EOS Commercial |
$86.08
|
| Rate for Payer: HFN Commercial |
$88.98
|
| Rate for Payer: Multiplan Commercial |
$77.38
|
| Rate for Payer: Preferred Network Access Commercial |
$88.98
|
| Rate for Payer: Quartz Beloit One Network |
$47.39
|
| Rate for Payer: Quartz Commercial |
$58.03
|
| Rate for Payer: WEA Trust Commercial |
$53.20
|
| Rate for Payer: WPS Commercial |
$71.64
|
|
|
CUSHION WAFFLE SEAT
|
Facility
|
OP
|
$519.00
|
|
| Hospital Charge Code |
2963017
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$151.13 |
| Max. Negotiated Rate |
$496.58 |
| Rate for Payer: Aetna Commercial |
$485.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$464.19
|
| Rate for Payer: Aetna Managed Medicare |
$151.13
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$350.84
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$269.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$259.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$286.07
|
| Rate for Payer: Cash Price |
$155.70
|
| Rate for Payer: Cigna Commercial |
$496.58
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$302.06
|
| Rate for Payer: Health EOS Commercial |
$480.39
|
| Rate for Payer: HFN Commercial |
$496.58
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$404.82
|
| Rate for Payer: Multiplan Commercial |
$431.81
|
| Rate for Payer: NAPHCARE Commercial |
$323.86
|
| Rate for Payer: Preferred Network Access Commercial |
$496.58
|
| Rate for Payer: Quartz Beloit One Network |
$264.48
|
| Rate for Payer: Quartz Commercial |
$350.84
|
| Rate for Payer: Quartz Medicare Advantage |
$323.86
|
| Rate for Payer: The Alliance Commercial |
$269.88
|
| Rate for Payer: WEA Trust Commercial |
$296.87
|
| Rate for Payer: WPS Commercial |
$399.79
|
|
|
CUSHION WAFFLE SEAT
|
Facility
|
IP
|
$519.00
|
|
| Hospital Charge Code |
2963017
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$264.48 |
| Max. Negotiated Rate |
$496.58 |
| Rate for Payer: Aetna Commercial |
$485.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$464.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$286.07
|
| Rate for Payer: Cash Price |
$155.70
|
| Rate for Payer: Cigna Commercial |
$496.58
|
| Rate for Payer: Health EOS Commercial |
$480.39
|
| Rate for Payer: HFN Commercial |
$496.58
|
| Rate for Payer: Multiplan Commercial |
$431.81
|
| Rate for Payer: Preferred Network Access Commercial |
$496.58
|
| Rate for Payer: Quartz Beloit One Network |
$264.48
|
| Rate for Payer: Quartz Commercial |
$323.86
|
| Rate for Payer: WEA Trust Commercial |
$296.87
|
| Rate for Payer: WPS Commercial |
$399.79
|
|
|
Cutaneous Direct Immunofluorescence
|
Facility
|
IP
|
$105.00
|
|
|
Service Code
|
CPT 88346
|
| Hospital Charge Code |
2796803
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$53.51 |
| Max. Negotiated Rate |
$100.46 |
| Rate for Payer: Aetna Commercial |
$98.28
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$93.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$57.88
|
| Rate for Payer: Cash Price |
$31.50
|
| Rate for Payer: Cigna Commercial |
$100.46
|
| Rate for Payer: Health EOS Commercial |
$97.19
|
| Rate for Payer: HFN Commercial |
$100.46
|
| Rate for Payer: Multiplan Commercial |
$87.36
|
| Rate for Payer: Preferred Network Access Commercial |
$100.46
|
| Rate for Payer: Quartz Beloit One Network |
$53.51
|
| Rate for Payer: Quartz Commercial |
$65.52
|
| Rate for Payer: WEA Trust Commercial |
$60.06
|
| Rate for Payer: WPS Commercial |
$80.88
|
|
|
Cutaneous Direct Immunofluorescence
|
Professional
|
Both
|
$105.00
|
|
|
Service Code
|
CPT 88346
|
| Hospital Charge Code |
2796803
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$34.77 |
| Max. Negotiated Rate |
$601.97 |
| Rate for Payer: Aetna Commercial |
$103.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$93.91
|
| Rate for Payer: Aetna Managed Medicare |
$136.81
|
| Rate for Payer: Anthem Commercial |
$34.77
|
| Rate for Payer: Anthem Medicare Advantage |
$136.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$136.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$136.81
|
| Rate for Payer: Cash Price |
$31.50
|
| Rate for Payer: Cash Price |
$31.50
|
| Rate for Payer: Cigna Commercial |
$103.74
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$54.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$136.81
|
| Rate for Payer: Health EOS Commercial |
$99.37
|
| Rate for Payer: HFN Commercial |
$103.74
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$508.24
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$508.24
|
| Rate for Payer: Independent Care Health Plan Medicare |
$136.81
|
| Rate for Payer: Multiplan Commercial |
$87.36
|
| Rate for Payer: NAPHCARE Commercial |
$205.22
|
| Rate for Payer: Preferred Network Access Commercial |
$103.74
|
| Rate for Payer: Quartz Beloit One Network |
$48.05
|
| Rate for Payer: Quartz Commercial |
$62.24
|
| Rate for Payer: Quartz Medicare Advantage |
$136.81
|
| Rate for Payer: The Alliance Commercial |
$540.41
|
| Rate for Payer: United Healthcare Medicare Advantage |
$136.81
|
| Rate for Payer: WEA Trust Commercial |
$60.06
|
| Rate for Payer: WPS Commercial |
$601.97
|
|
|
Cutaneous Direct Immunofluorescence
|
Facility
|
OP
|
$632.00
|
|
|
Service Code
|
CPT 88346
|
| Hospital Charge Code |
1124805
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$179.30 |
| Max. Negotiated Rate |
$717.18 |
| Rate for Payer: Aetna Commercial |
$591.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$565.26
|
| Rate for Payer: Aetna Managed Medicare |
$179.30
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$658.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$307.25
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$291.45
|
| Rate for Payer: Anthem Medicare Advantage |
$179.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$348.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$179.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$179.30
|
| Rate for Payer: Cash Price |
$189.60
|
| Rate for Payer: Cash Price |
$189.60
|
| Rate for Payer: Cigna Commercial |
$604.70
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$179.30
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$367.82
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$179.30
|
| Rate for Payer: Health EOS Commercial |
$584.98
|
| Rate for Payer: HFN Commercial |
$604.70
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$666.98
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$179.30
|
| Rate for Payer: Independent Care Health Plan Medicare |
$179.30
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$179.30
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$179.30
|
| Rate for Payer: Multiplan Commercial |
$525.82
|
| Rate for Payer: NAPHCARE Commercial |
$268.94
|
| Rate for Payer: Preferred Network Access Commercial |
$604.70
|
| Rate for Payer: Quartz Beloit One Network |
$322.07
|
| Rate for Payer: Quartz Commercial |
$427.23
|
| Rate for Payer: Quartz Medicare Advantage |
$179.30
|
| Rate for Payer: The Alliance Commercial |
$717.18
|
| Rate for Payer: United Healthcare Medicare Advantage |
$179.30
|
| Rate for Payer: United Healthcare PPO |
$492.96
|
| Rate for Payer: WEA Trust Commercial |
$361.50
|
| Rate for Payer: Wellcare Medicare |
$179.30
|
| Rate for Payer: WPS Commercial |
$486.83
|
|
|
Cutaneous Direct Immunofluorescence
|
Facility
|
OP
|
$105.00
|
|
|
Service Code
|
CPT 88346
|
| Hospital Charge Code |
2796803
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$53.51 |
| Max. Negotiated Rate |
$717.18 |
| Rate for Payer: Aetna Commercial |
$98.28
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$93.91
|
| Rate for Payer: Aetna Managed Medicare |
$179.30
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$658.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$307.25
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$291.45
|
| Rate for Payer: Anthem Medicare Advantage |
$179.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$57.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$179.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$179.30
|
| Rate for Payer: Cash Price |
$31.50
|
| Rate for Payer: Cash Price |
$31.50
|
| Rate for Payer: Cigna Commercial |
$100.46
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$179.30
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$61.11
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$179.30
|
| Rate for Payer: Health EOS Commercial |
$97.19
|
| Rate for Payer: HFN Commercial |
$100.46
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$666.98
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$179.30
|
| Rate for Payer: Independent Care Health Plan Medicare |
$179.30
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$179.30
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$179.30
|
| Rate for Payer: Multiplan Commercial |
$87.36
|
| Rate for Payer: NAPHCARE Commercial |
$268.94
|
| Rate for Payer: Preferred Network Access Commercial |
$100.46
|
| Rate for Payer: Quartz Beloit One Network |
$53.51
|
| Rate for Payer: Quartz Commercial |
$70.98
|
| Rate for Payer: Quartz Medicare Advantage |
$179.30
|
| Rate for Payer: The Alliance Commercial |
$717.18
|
| Rate for Payer: United Healthcare Medicare Advantage |
$179.30
|
| Rate for Payer: United Healthcare PPO |
$81.90
|
| Rate for Payer: WEA Trust Commercial |
$60.06
|
| Rate for Payer: Wellcare Medicare |
$179.30
|
| Rate for Payer: WPS Commercial |
$80.88
|
|
|
Cutaneous Direct Immunofluorescence
|
Facility
|
IP
|
$632.00
|
|
|
Service Code
|
CPT 88346
|
| Hospital Charge Code |
1124805
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$322.07 |
| Max. Negotiated Rate |
$604.70 |
| Rate for Payer: Aetna Commercial |
$591.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$565.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$348.36
|
| Rate for Payer: Cash Price |
$189.60
|
| Rate for Payer: Cigna Commercial |
$604.70
|
| Rate for Payer: Health EOS Commercial |
$584.98
|
| Rate for Payer: HFN Commercial |
$604.70
|
| Rate for Payer: Multiplan Commercial |
$525.82
|
| Rate for Payer: Preferred Network Access Commercial |
$604.70
|
| Rate for Payer: Quartz Beloit One Network |
$322.07
|
| Rate for Payer: Quartz Commercial |
$394.37
|
| Rate for Payer: WEA Trust Commercial |
$361.50
|
| Rate for Payer: WPS Commercial |
$486.83
|
|
|
Cutaneous Direct Immunofluorescence
|
Professional
|
Both
|
$632.00
|
|
|
Service Code
|
CPT 88346
|
| Hospital Charge Code |
1124805
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$34.77 |
| Max. Negotiated Rate |
$624.42 |
| Rate for Payer: Aetna Commercial |
$624.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$565.26
|
| Rate for Payer: Aetna Managed Medicare |
$136.81
|
| Rate for Payer: Anthem Commercial |
$34.77
|
| Rate for Payer: Anthem Medicare Advantage |
$136.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$136.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$136.81
|
| Rate for Payer: Cash Price |
$189.60
|
| Rate for Payer: Cash Price |
$189.60
|
| Rate for Payer: Cigna Commercial |
$624.42
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$328.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$136.81
|
| Rate for Payer: Health EOS Commercial |
$598.12
|
| Rate for Payer: HFN Commercial |
$624.42
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$508.24
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$508.24
|
| Rate for Payer: Independent Care Health Plan Medicare |
$136.81
|
| Rate for Payer: Multiplan Commercial |
$525.82
|
| Rate for Payer: NAPHCARE Commercial |
$205.22
|
| Rate for Payer: Preferred Network Access Commercial |
$624.42
|
| Rate for Payer: Quartz Beloit One Network |
$289.20
|
| Rate for Payer: Quartz Commercial |
$374.65
|
| Rate for Payer: Quartz Medicare Advantage |
$136.81
|
| Rate for Payer: The Alliance Commercial |
$540.41
|
| Rate for Payer: United Healthcare Medicare Advantage |
$136.81
|
| Rate for Payer: WEA Trust Commercial |
$361.50
|
| Rate for Payer: WPS Commercial |
$601.97
|
|
|
CUTICERIN GAUZE 3 X 3
|
Facility
|
IP
|
$18.00
|
|
| Hospital Charge Code |
2974416
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$9.17 |
| Max. Negotiated Rate |
$17.22 |
| Rate for Payer: Aetna Commercial |
$16.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$16.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9.92
|
| Rate for Payer: Cash Price |
$5.40
|
| Rate for Payer: Cigna Commercial |
$17.22
|
| Rate for Payer: Health EOS Commercial |
$16.66
|
| Rate for Payer: HFN Commercial |
$17.22
|
| Rate for Payer: Multiplan Commercial |
$14.98
|
| Rate for Payer: Preferred Network Access Commercial |
$17.22
|
| Rate for Payer: Quartz Beloit One Network |
$9.17
|
| Rate for Payer: Quartz Commercial |
$11.23
|
| Rate for Payer: WEA Trust Commercial |
$10.30
|
| Rate for Payer: WPS Commercial |
$13.87
|
|
|
CUTICERIN GAUZE 3 X 3
|
Facility
|
OP
|
$18.00
|
|
| Hospital Charge Code |
2974416
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$5.24 |
| Max. Negotiated Rate |
$17.22 |
| Rate for Payer: Aetna Commercial |
$16.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$16.10
|
| Rate for Payer: Aetna Managed Medicare |
$5.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$12.17
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$9.36
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$8.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9.92
|
| Rate for Payer: Cash Price |
$5.40
|
| Rate for Payer: Cigna Commercial |
$17.22
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$10.48
|
| Rate for Payer: Health EOS Commercial |
$16.66
|
| Rate for Payer: HFN Commercial |
$17.22
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$14.04
|
| Rate for Payer: Multiplan Commercial |
$14.98
|
| Rate for Payer: NAPHCARE Commercial |
$11.23
|
| Rate for Payer: Preferred Network Access Commercial |
$17.22
|
| Rate for Payer: Quartz Beloit One Network |
$9.17
|
| Rate for Payer: Quartz Commercial |
$12.17
|
| Rate for Payer: Quartz Medicare Advantage |
$11.23
|
| Rate for Payer: The Alliance Commercial |
$9.36
|
| Rate for Payer: WEA Trust Commercial |
$10.30
|
| Rate for Payer: WPS Commercial |
$13.87
|
|
|
CUTTER STITCH REMOVER STERILE
|
Facility
|
OP
|
$21.00
|
|
| Hospital Charge Code |
2974226
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.12 |
| 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: Cigna Commercial |
$20.09
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12.22
|
| Rate for Payer: Health EOS Commercial |
$19.44
|
| Rate for Payer: HFN Commercial |
$20.09
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$16.38
|
| Rate for Payer: Multiplan Commercial |
$17.47
|
| Rate for Payer: NAPHCARE Commercial |
$13.10
|
| Rate for Payer: Preferred Network Access Commercial |
$20.09
|
| Rate for Payer: Quartz Beloit One Network |
$10.70
|
| Rate for Payer: Quartz Commercial |
$14.20
|
| Rate for Payer: Quartz Medicare Advantage |
$13.10
|
| Rate for Payer: The Alliance Commercial |
$10.92
|
| Rate for Payer: WEA Trust Commercial |
$12.01
|
| Rate for Payer: WPS Commercial |
$16.18
|
|
|
CUTTER STITCH REMOVER STERILE
|
Facility
|
IP
|
$21.00
|
|
| Hospital Charge Code |
2974226
|
|
Hospital Revenue Code
|
272
|
| 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
|
|
|
Cutting 2.0mm x 10mm
|
Facility
|
OP
|
$1,904.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
1159084
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$554.44 |
| Max. Negotiated Rate |
$1,821.75 |
| Rate for Payer: Aetna Commercial |
$1,782.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,702.94
|
| Rate for Payer: Aetna Managed Medicare |
$554.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,287.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$990.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$950.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,049.48
|
| Rate for Payer: Cash Price |
$571.20
|
| Rate for Payer: Cigna Commercial |
$1,821.75
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,108.13
|
| Rate for Payer: Health EOS Commercial |
$1,762.34
|
| Rate for Payer: HFN Commercial |
$1,821.75
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,485.12
|
| Rate for Payer: Multiplan Commercial |
$1,584.13
|
| Rate for Payer: NAPHCARE Commercial |
$1,188.10
|
| Rate for Payer: Preferred Network Access Commercial |
$1,821.75
|
| Rate for Payer: Quartz Beloit One Network |
$970.28
|
| Rate for Payer: Quartz Commercial |
$1,287.10
|
| Rate for Payer: Quartz Medicare Advantage |
$1,188.10
|
| Rate for Payer: The Alliance Commercial |
$990.08
|
| Rate for Payer: WEA Trust Commercial |
$1,089.09
|
| Rate for Payer: WPS Commercial |
$1,466.65
|
|
|
Cutting 2.0mm x 10mm
|
Facility
|
IP
|
$1,904.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
1159084
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$970.28 |
| Max. Negotiated Rate |
$1,821.75 |
| Rate for Payer: Aetna Commercial |
$1,782.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,702.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,049.48
|
| Rate for Payer: Cash Price |
$571.20
|
| Rate for Payer: Cigna Commercial |
$1,821.75
|
| Rate for Payer: Health EOS Commercial |
$1,762.34
|
| Rate for Payer: HFN Commercial |
$1,821.75
|
| Rate for Payer: Multiplan Commercial |
$1,584.13
|
| Rate for Payer: Preferred Network Access Commercial |
$1,821.75
|
| Rate for Payer: Quartz Beloit One Network |
$970.28
|
| Rate for Payer: Quartz Commercial |
$1,188.10
|
| Rate for Payer: WEA Trust Commercial |
$1,089.09
|
| Rate for Payer: WPS Commercial |
$1,466.65
|
|
|
Cutting 2.0mm x 10mm
|
Professional
|
Both
|
$1,904.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
1159084
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$871.27 |
| Max. Negotiated Rate |
$1,881.15 |
| Rate for Payer: Aetna Commercial |
$1,881.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,702.94
|
| Rate for Payer: Cash Price |
$571.20
|
| Rate for Payer: Cigna Commercial |
$1,881.15
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$990.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,188.10
|
| Rate for Payer: Health EOS Commercial |
$1,801.95
|
| Rate for Payer: HFN Commercial |
$1,881.15
|
| Rate for Payer: Multiplan Commercial |
$1,584.13
|
| Rate for Payer: Preferred Network Access Commercial |
$1,881.15
|
| Rate for Payer: Quartz Beloit One Network |
$871.27
|
| Rate for Payer: Quartz Commercial |
$1,128.69
|
| Rate for Payer: The Alliance Commercial |
$990.08
|
| Rate for Payer: WEA Trust Commercial |
$1,089.09
|
| Rate for Payer: WPS Commercial |
$1,466.65
|
|
|
Cutting 2.0mm x 15mm
|
Professional
|
Both
|
$1,904.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
1159086
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$871.27 |
| Max. Negotiated Rate |
$1,881.15 |
| Rate for Payer: Aetna Commercial |
$1,881.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,702.94
|
| Rate for Payer: Cash Price |
$571.20
|
| Rate for Payer: Cigna Commercial |
$1,881.15
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$990.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,188.10
|
| Rate for Payer: Health EOS Commercial |
$1,801.95
|
| Rate for Payer: HFN Commercial |
$1,881.15
|
| Rate for Payer: Multiplan Commercial |
$1,584.13
|
| Rate for Payer: Preferred Network Access Commercial |
$1,881.15
|
| Rate for Payer: Quartz Beloit One Network |
$871.27
|
| Rate for Payer: Quartz Commercial |
$1,128.69
|
| Rate for Payer: The Alliance Commercial |
$990.08
|
| Rate for Payer: WEA Trust Commercial |
$1,089.09
|
| Rate for Payer: WPS Commercial |
$1,466.65
|
|
|
Cutting 2.0mm x 15mm
|
Facility
|
OP
|
$1,904.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
1159086
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$554.44 |
| Max. Negotiated Rate |
$1,821.75 |
| Rate for Payer: Aetna Commercial |
$1,782.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,702.94
|
| Rate for Payer: Aetna Managed Medicare |
$554.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,287.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$990.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$950.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,049.48
|
| Rate for Payer: Cash Price |
$571.20
|
| Rate for Payer: Cigna Commercial |
$1,821.75
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,108.13
|
| Rate for Payer: Health EOS Commercial |
$1,762.34
|
| Rate for Payer: HFN Commercial |
$1,821.75
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,485.12
|
| Rate for Payer: Multiplan Commercial |
$1,584.13
|
| Rate for Payer: NAPHCARE Commercial |
$1,188.10
|
| Rate for Payer: Preferred Network Access Commercial |
$1,821.75
|
| Rate for Payer: Quartz Beloit One Network |
$970.28
|
| Rate for Payer: Quartz Commercial |
$1,287.10
|
| Rate for Payer: Quartz Medicare Advantage |
$1,188.10
|
| Rate for Payer: The Alliance Commercial |
$990.08
|
| Rate for Payer: WEA Trust Commercial |
$1,089.09
|
| Rate for Payer: WPS Commercial |
$1,466.65
|
|
