|
DE QUERVAIN'S RELEASE
|
Facility
|
OP
|
$1,337.00
|
|
| Hospital Charge Code |
2959994
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$389.33 |
| Max. Negotiated Rate |
$1,279.24 |
| Rate for Payer: Aetna Commercial |
$1,251.43
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,195.81
|
| Rate for Payer: Aetna Managed Medicare |
$389.33
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$903.81
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$695.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$667.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$736.95
|
| Rate for Payer: Cash Price |
$401.10
|
| Rate for Payer: Cigna Commercial |
$1,279.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$778.13
|
| Rate for Payer: Health EOS Commercial |
$1,237.53
|
| Rate for Payer: HFN Commercial |
$1,279.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,042.86
|
| Rate for Payer: Multiplan Commercial |
$1,112.38
|
| Rate for Payer: NAPHCARE Commercial |
$834.29
|
| Rate for Payer: Preferred Network Access Commercial |
$1,279.24
|
| Rate for Payer: Quartz Beloit One Network |
$681.34
|
| Rate for Payer: Quartz Commercial |
$903.81
|
| Rate for Payer: Quartz Medicare Advantage |
$834.29
|
| Rate for Payer: The Alliance Commercial |
$695.24
|
| Rate for Payer: WEA Trust Commercial |
$764.76
|
| Rate for Payer: WPS Commercial |
$1,029.89
|
|
|
DERMABOND PRINEO SKIN CLOSURE SYSTEM 22CM CLR222US
|
Facility
|
OP
|
$1,274.00
|
|
| Hospital Charge Code |
5349538
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$370.99 |
| Max. Negotiated Rate |
$1,218.96 |
| Rate for Payer: Aetna Commercial |
$1,192.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,139.47
|
| Rate for Payer: Aetna Managed Medicare |
$370.99
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$861.22
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$662.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$635.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$702.23
|
| Rate for Payer: Cash Price |
$382.20
|
| Rate for Payer: Cigna Commercial |
$1,218.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$741.47
|
| Rate for Payer: Health EOS Commercial |
$1,179.21
|
| Rate for Payer: HFN Commercial |
$1,218.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$993.72
|
| Rate for Payer: Multiplan Commercial |
$1,059.97
|
| Rate for Payer: NAPHCARE Commercial |
$794.98
|
| Rate for Payer: Preferred Network Access Commercial |
$1,218.96
|
| Rate for Payer: Quartz Beloit One Network |
$649.23
|
| Rate for Payer: Quartz Commercial |
$861.22
|
| Rate for Payer: Quartz Medicare Advantage |
$794.98
|
| Rate for Payer: The Alliance Commercial |
$662.48
|
| Rate for Payer: WEA Trust Commercial |
$728.73
|
| Rate for Payer: WPS Commercial |
$981.36
|
|
|
DERMABOND PRINEO SKIN CLOSURE SYSTEM 22CM CLR222US
|
Facility
|
IP
|
$1,274.00
|
|
| Hospital Charge Code |
5349538
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$649.23 |
| Max. Negotiated Rate |
$1,218.96 |
| Rate for Payer: Aetna Commercial |
$1,192.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,139.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$702.23
|
| Rate for Payer: Cash Price |
$382.20
|
| Rate for Payer: Cigna Commercial |
$1,218.96
|
| Rate for Payer: Health EOS Commercial |
$1,179.21
|
| Rate for Payer: HFN Commercial |
$1,218.96
|
| Rate for Payer: Multiplan Commercial |
$1,059.97
|
| Rate for Payer: Preferred Network Access Commercial |
$1,218.96
|
| Rate for Payer: Quartz Beloit One Network |
$649.23
|
| Rate for Payer: Quartz Commercial |
$794.98
|
| Rate for Payer: WEA Trust Commercial |
$728.73
|
| Rate for Payer: WPS Commercial |
$981.36
|
|
|
DERMABOND PRINEO SKIN CLOSURE SYSTEM 42CM CLR422US
|
Facility
|
OP
|
$1,634.00
|
|
| Hospital Charge Code |
5384952
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$475.82 |
| Max. Negotiated Rate |
$1,563.41 |
| Rate for Payer: Aetna Commercial |
$1,529.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,461.45
|
| Rate for Payer: Aetna Managed Medicare |
$475.82
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,104.58
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$849.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$815.69
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$900.66
|
| Rate for Payer: Cash Price |
$490.20
|
| Rate for Payer: Cigna Commercial |
$1,563.41
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$950.99
|
| Rate for Payer: Health EOS Commercial |
$1,512.43
|
| Rate for Payer: HFN Commercial |
$1,563.41
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,274.52
|
| Rate for Payer: Multiplan Commercial |
$1,359.49
|
| Rate for Payer: NAPHCARE Commercial |
$1,019.62
|
| Rate for Payer: Preferred Network Access Commercial |
$1,563.41
|
| Rate for Payer: Quartz Beloit One Network |
$832.69
|
| Rate for Payer: Quartz Commercial |
$1,104.58
|
| Rate for Payer: Quartz Medicare Advantage |
$1,019.62
|
| Rate for Payer: The Alliance Commercial |
$849.68
|
| Rate for Payer: WEA Trust Commercial |
$934.65
|
| Rate for Payer: WPS Commercial |
$1,258.67
|
|
|
DERMABOND PRINEO SKIN CLOSURE SYSTEM 42CM CLR422US
|
Facility
|
IP
|
$1,634.00
|
|
| Hospital Charge Code |
5384952
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$832.69 |
| Max. Negotiated Rate |
$1,563.41 |
| Rate for Payer: Aetna Commercial |
$1,529.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,461.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$900.66
|
| Rate for Payer: Cash Price |
$490.20
|
| Rate for Payer: Cigna Commercial |
$1,563.41
|
| Rate for Payer: Health EOS Commercial |
$1,512.43
|
| Rate for Payer: HFN Commercial |
$1,563.41
|
| Rate for Payer: Multiplan Commercial |
$1,359.49
|
| Rate for Payer: Preferred Network Access Commercial |
$1,563.41
|
| Rate for Payer: Quartz Beloit One Network |
$832.69
|
| Rate for Payer: Quartz Commercial |
$1,019.62
|
| Rate for Payer: WEA Trust Commercial |
$934.65
|
| Rate for Payer: WPS Commercial |
$1,258.67
|
|
|
DERMABOND SKIN ADHESIVE
|
Facility
|
OP
|
$547.00
|
|
| Hospital Charge Code |
2973470
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$159.29 |
| Max. Negotiated Rate |
$523.37 |
| Rate for Payer: Aetna Commercial |
$511.99
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$489.24
|
| Rate for Payer: Aetna Managed Medicare |
$159.29
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$369.77
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$284.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$273.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$301.51
|
| Rate for Payer: Cash Price |
$164.10
|
| Rate for Payer: Cigna Commercial |
$523.37
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$318.35
|
| Rate for Payer: Health EOS Commercial |
$506.30
|
| Rate for Payer: HFN Commercial |
$523.37
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$426.66
|
| Rate for Payer: Multiplan Commercial |
$455.10
|
| Rate for Payer: NAPHCARE Commercial |
$341.33
|
| Rate for Payer: Preferred Network Access Commercial |
$523.37
|
| Rate for Payer: Quartz Beloit One Network |
$278.75
|
| Rate for Payer: Quartz Commercial |
$369.77
|
| Rate for Payer: Quartz Medicare Advantage |
$341.33
|
| Rate for Payer: The Alliance Commercial |
$284.44
|
| Rate for Payer: WEA Trust Commercial |
$312.88
|
| Rate for Payer: WPS Commercial |
$421.35
|
|
|
DERMABOND SKIN ADHESIVE
|
Facility
|
IP
|
$547.00
|
|
| Hospital Charge Code |
2973470
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$278.75 |
| Max. Negotiated Rate |
$523.37 |
| Rate for Payer: Aetna Commercial |
$511.99
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$489.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$301.51
|
| Rate for Payer: Cash Price |
$164.10
|
| Rate for Payer: Cigna Commercial |
$523.37
|
| Rate for Payer: Health EOS Commercial |
$506.30
|
| Rate for Payer: HFN Commercial |
$523.37
|
| Rate for Payer: Multiplan Commercial |
$455.10
|
| Rate for Payer: Preferred Network Access Commercial |
$523.37
|
| Rate for Payer: Quartz Beloit One Network |
$278.75
|
| Rate for Payer: Quartz Commercial |
$341.33
|
| Rate for Payer: WEA Trust Commercial |
$312.88
|
| Rate for Payer: WPS Commercial |
$421.35
|
|
|
Dermabond UD Packet [Med]
|
Facility
|
OP
|
$78.00
|
|
| Hospital Charge Code |
2974927
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$22.71 |
| Max. Negotiated Rate |
$74.63 |
| Rate for Payer: Aetna Commercial |
$73.01
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$69.76
|
| Rate for Payer: Aetna Managed Medicare |
$22.71
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$52.73
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$40.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$38.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$42.99
|
| Rate for Payer: Cash Price |
$23.40
|
| Rate for Payer: Cigna Commercial |
$74.63
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$45.40
|
| Rate for Payer: Health EOS Commercial |
$72.20
|
| Rate for Payer: HFN Commercial |
$74.63
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$60.84
|
| Rate for Payer: Multiplan Commercial |
$64.90
|
| Rate for Payer: NAPHCARE Commercial |
$48.67
|
| Rate for Payer: Preferred Network Access Commercial |
$74.63
|
| Rate for Payer: Quartz Beloit One Network |
$39.75
|
| Rate for Payer: Quartz Commercial |
$52.73
|
| Rate for Payer: Quartz Medicare Advantage |
$48.67
|
| Rate for Payer: The Alliance Commercial |
$40.56
|
| Rate for Payer: WEA Trust Commercial |
$44.62
|
| Rate for Payer: WPS Commercial |
$60.08
|
|
|
Dermabond UD Packet [Med]
|
Facility
|
IP
|
$78.00
|
|
| Hospital Charge Code |
2974927
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$39.75 |
| Max. Negotiated Rate |
$74.63 |
| Rate for Payer: Aetna Commercial |
$73.01
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$69.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$42.99
|
| Rate for Payer: Cash Price |
$23.40
|
| Rate for Payer: Cigna Commercial |
$74.63
|
| Rate for Payer: Health EOS Commercial |
$72.20
|
| Rate for Payer: HFN Commercial |
$74.63
|
| Rate for Payer: Multiplan Commercial |
$64.90
|
| Rate for Payer: Preferred Network Access Commercial |
$74.63
|
| Rate for Payer: Quartz Beloit One Network |
$39.75
|
| Rate for Payer: Quartz Commercial |
$48.67
|
| Rate for Payer: WEA Trust Commercial |
$44.62
|
| Rate for Payer: WPS Commercial |
$60.08
|
|
|
DERMABRASION SEGMENTAL FACE 15781
|
Professional
|
Both
|
$973.00
|
|
|
Service Code
|
CPT 15781
|
| Hospital Charge Code |
6113632
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$361.10 |
| Max. Negotiated Rate |
$1,624.94 |
| Rate for Payer: Aetna Commercial |
$961.32
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$870.25
|
| Rate for Payer: Aetna Managed Medicare |
$361.10
|
| Rate for Payer: Anthem Medicare Advantage |
$361.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$361.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$361.10
|
| Rate for Payer: Cash Price |
$291.90
|
| Rate for Payer: Cash Price |
$291.90
|
| Rate for Payer: Cash Price |
$291.90
|
| Rate for Payer: Cigna Commercial |
$961.32
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$765.94
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$361.10
|
| Rate for Payer: Health EOS Commercial |
$920.85
|
| Rate for Payer: HFN Commercial |
$961.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,487.97
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,487.97
|
| Rate for Payer: Independent Care Health Plan Medicare |
$361.10
|
| Rate for Payer: Multiplan Commercial |
$809.54
|
| Rate for Payer: NAPHCARE Commercial |
$541.65
|
| Rate for Payer: Preferred Network Access Commercial |
$961.32
|
| Rate for Payer: Quartz Beloit One Network |
$445.24
|
| Rate for Payer: Quartz Commercial |
$576.79
|
| Rate for Payer: Quartz Medicare Advantage |
$361.10
|
| Rate for Payer: The Alliance Commercial |
$1,534.67
|
| Rate for Payer: United Healthcare Medicaid |
$765.94
|
| Rate for Payer: United Healthcare Medicare Advantage |
$361.10
|
| Rate for Payer: WEA Trust Commercial |
$556.56
|
| Rate for Payer: WPS Commercial |
$1,624.94
|
|
|
DERMACARRIER 8 STERILE 00-7708-000-10
|
Facility
|
OP
|
$657.00
|
|
| Hospital Charge Code |
2967417
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$191.32 |
| Max. Negotiated Rate |
$628.62 |
| Rate for Payer: Aetna Commercial |
$614.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$587.62
|
| Rate for Payer: Aetna Managed Medicare |
$191.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$444.13
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$341.64
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$327.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$362.14
|
| Rate for Payer: Cash Price |
$197.10
|
| Rate for Payer: Cigna Commercial |
$628.62
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$382.37
|
| Rate for Payer: Health EOS Commercial |
$608.12
|
| Rate for Payer: HFN Commercial |
$628.62
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$512.46
|
| Rate for Payer: Multiplan Commercial |
$546.62
|
| Rate for Payer: NAPHCARE Commercial |
$409.97
|
| Rate for Payer: Preferred Network Access Commercial |
$628.62
|
| Rate for Payer: Quartz Beloit One Network |
$334.81
|
| Rate for Payer: Quartz Commercial |
$444.13
|
| Rate for Payer: Quartz Medicare Advantage |
$409.97
|
| Rate for Payer: The Alliance Commercial |
$341.64
|
| Rate for Payer: WEA Trust Commercial |
$375.80
|
| Rate for Payer: WPS Commercial |
$506.09
|
|
|
DERMACARRIER 8 STERILE 00-7708-000-10
|
Facility
|
IP
|
$657.00
|
|
| Hospital Charge Code |
2967417
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$334.81 |
| Max. Negotiated Rate |
$628.62 |
| Rate for Payer: Aetna Commercial |
$614.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$587.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$362.14
|
| Rate for Payer: Cash Price |
$197.10
|
| Rate for Payer: Cigna Commercial |
$628.62
|
| Rate for Payer: Health EOS Commercial |
$608.12
|
| Rate for Payer: HFN Commercial |
$628.62
|
| Rate for Payer: Multiplan Commercial |
$546.62
|
| Rate for Payer: Preferred Network Access Commercial |
$628.62
|
| Rate for Payer: Quartz Beloit One Network |
$334.81
|
| Rate for Payer: Quartz Commercial |
$409.97
|
| Rate for Payer: WEA Trust Commercial |
$375.80
|
| Rate for Payer: WPS Commercial |
$506.09
|
|
|
Dermagraft per sq cm Q4106
|
Facility
|
OP
|
$123.00
|
|
|
Service Code
|
HCPCS Q4106
|
| Hospital Charge Code |
3133667
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$35.82 |
| Max. Negotiated Rate |
$117.69 |
| Rate for Payer: Aetna Commercial |
$115.13
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$110.01
|
| Rate for Payer: Aetna Managed Medicare |
$35.82
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$83.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$63.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$61.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$67.80
|
| Rate for Payer: Cash Price |
$36.90
|
| Rate for Payer: Cigna Commercial |
$117.69
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$71.59
|
| Rate for Payer: Health EOS Commercial |
$113.85
|
| Rate for Payer: HFN Commercial |
$117.69
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$95.94
|
| Rate for Payer: Multiplan Commercial |
$102.34
|
| Rate for Payer: NAPHCARE Commercial |
$76.75
|
| Rate for Payer: Preferred Network Access Commercial |
$117.69
|
| Rate for Payer: Quartz Beloit One Network |
$62.68
|
| Rate for Payer: Quartz Commercial |
$83.15
|
| Rate for Payer: Quartz Medicare Advantage |
$76.75
|
| Rate for Payer: The Alliance Commercial |
$63.96
|
| Rate for Payer: WEA Trust Commercial |
$70.36
|
| Rate for Payer: WPS Commercial |
$94.75
|
|
|
Dermagraft per sq cm Q4106
|
Facility
|
IP
|
$123.00
|
|
|
Service Code
|
HCPCS Q4106
|
| Hospital Charge Code |
3133667
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$62.68 |
| Max. Negotiated Rate |
$117.69 |
| Rate for Payer: Aetna Commercial |
$115.13
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$110.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$67.80
|
| Rate for Payer: Cash Price |
$36.90
|
| Rate for Payer: Cigna Commercial |
$117.69
|
| Rate for Payer: Health EOS Commercial |
$113.85
|
| Rate for Payer: HFN Commercial |
$117.69
|
| Rate for Payer: Multiplan Commercial |
$102.34
|
| Rate for Payer: Preferred Network Access Commercial |
$117.69
|
| Rate for Payer: Quartz Beloit One Network |
$62.68
|
| Rate for Payer: Quartz Commercial |
$76.75
|
| Rate for Payer: WEA Trust Commercial |
$70.36
|
| Rate for Payer: WPS Commercial |
$94.75
|
|
|
Dermagraft per sq cm Q4106
|
Professional
|
Both
|
$123.00
|
|
|
Service Code
|
HCPCS Q4106
|
| Hospital Charge Code |
3133667
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$56.28 |
| Max. Negotiated Rate |
$121.52 |
| Rate for Payer: Aetna Commercial |
$121.52
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$110.01
|
| Rate for Payer: Cash Price |
$36.90
|
| Rate for Payer: Cash Price |
$36.90
|
| Rate for Payer: Cigna Commercial |
$121.52
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$63.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$76.75
|
| Rate for Payer: Health EOS Commercial |
$116.41
|
| Rate for Payer: HFN Commercial |
$121.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$116.45
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$116.45
|
| Rate for Payer: Multiplan Commercial |
$102.34
|
| Rate for Payer: Preferred Network Access Commercial |
$121.52
|
| Rate for Payer: Quartz Beloit One Network |
$56.28
|
| Rate for Payer: Quartz Commercial |
$72.91
|
| Rate for Payer: The Alliance Commercial |
$63.96
|
| Rate for Payer: WEA Trust Commercial |
$70.36
|
| Rate for Payer: WPS Commercial |
$94.75
|
|
|
Dermatopathology Consult
|
Facility
|
IP
|
$207.00
|
|
|
Service Code
|
CPT 88321
|
| Hospital Charge Code |
3781385
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$105.49 |
| Max. Negotiated Rate |
$198.06 |
| Rate for Payer: Aetna Commercial |
$193.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$185.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$114.10
|
| Rate for Payer: Cash Price |
$62.10
|
| Rate for Payer: Cigna Commercial |
$198.06
|
| Rate for Payer: Health EOS Commercial |
$191.60
|
| Rate for Payer: HFN Commercial |
$198.06
|
| Rate for Payer: Multiplan Commercial |
$172.22
|
| Rate for Payer: Preferred Network Access Commercial |
$198.06
|
| Rate for Payer: Quartz Beloit One Network |
$105.49
|
| Rate for Payer: Quartz Commercial |
$129.17
|
| Rate for Payer: WEA Trust Commercial |
$118.40
|
| Rate for Payer: WPS Commercial |
$159.45
|
|
|
Dermatopathology Consult
|
Facility
|
OP
|
$207.00
|
|
|
Service Code
|
CPT 88321
|
| Hospital Charge Code |
3781385
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$39.31 |
| Max. Negotiated Rate |
$198.06 |
| Rate for Payer: Aetna Commercial |
$193.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$185.14
|
| Rate for Payer: Aetna Managed Medicare |
$39.31
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$154.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$72.14
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$68.43
|
| Rate for Payer: Anthem Medicare Advantage |
$39.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$114.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$39.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$39.31
|
| Rate for Payer: Cash Price |
$62.10
|
| Rate for Payer: Cash Price |
$62.10
|
| Rate for Payer: Cigna Commercial |
$198.06
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$39.31
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$120.47
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$39.31
|
| Rate for Payer: Health EOS Commercial |
$191.60
|
| Rate for Payer: HFN Commercial |
$198.06
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$146.24
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$39.31
|
| Rate for Payer: Independent Care Health Plan Medicare |
$39.31
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$39.31
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$39.31
|
| Rate for Payer: Multiplan Commercial |
$172.22
|
| Rate for Payer: NAPHCARE Commercial |
$58.97
|
| Rate for Payer: Preferred Network Access Commercial |
$198.06
|
| Rate for Payer: Quartz Beloit One Network |
$105.49
|
| Rate for Payer: Quartz Commercial |
$139.93
|
| Rate for Payer: Quartz Medicare Advantage |
$39.31
|
| Rate for Payer: The Alliance Commercial |
$157.25
|
| Rate for Payer: United Healthcare Medicare Advantage |
$39.31
|
| Rate for Payer: United Healthcare PPO |
$161.46
|
| Rate for Payer: WEA Trust Commercial |
$118.40
|
| Rate for Payer: Wellcare Medicare |
$39.31
|
| Rate for Payer: WPS Commercial |
$159.45
|
|
|
Dermatopathology Consult
|
Professional
|
Both
|
$207.00
|
|
|
Service Code
|
CPT 88321
|
| Hospital Charge Code |
3781385
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$67.96 |
| Max. Negotiated Rate |
$347.37 |
| Rate for Payer: Aetna Commercial |
$204.52
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$185.14
|
| Rate for Payer: Aetna Managed Medicare |
$67.96
|
| Rate for Payer: Anthem Medicare Advantage |
$67.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$67.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$67.96
|
| Rate for Payer: Cash Price |
$62.10
|
| Rate for Payer: Cash Price |
$62.10
|
| Rate for Payer: Cigna Commercial |
$204.52
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$107.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$67.96
|
| Rate for Payer: Health EOS Commercial |
$195.90
|
| Rate for Payer: HFN Commercial |
$204.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$347.37
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$347.37
|
| Rate for Payer: Independent Care Health Plan Medicare |
$67.96
|
| Rate for Payer: Multiplan Commercial |
$172.22
|
| Rate for Payer: NAPHCARE Commercial |
$101.95
|
| Rate for Payer: Preferred Network Access Commercial |
$204.52
|
| Rate for Payer: Quartz Beloit One Network |
$94.72
|
| Rate for Payer: Quartz Commercial |
$122.71
|
| Rate for Payer: Quartz Medicare Advantage |
$67.96
|
| Rate for Payer: The Alliance Commercial |
$268.46
|
| Rate for Payer: United Healthcare Medicare Advantage |
$67.96
|
| Rate for Payer: WEA Trust Commercial |
$118.40
|
| Rate for Payer: WPS Commercial |
$299.04
|
|
|
Dermatophyte Screen
|
Facility
|
OP
|
$158.00
|
|
|
Service Code
|
CPT 87101
|
| Hospital Charge Code |
979919
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.02 |
| Max. Negotiated Rate |
$151.17 |
| Rate for Payer: Aetna Commercial |
$147.89
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$141.32
|
| Rate for Payer: Aetna Managed Medicare |
$8.02
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$30.07
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$14.03
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$13.31
|
| Rate for Payer: Anthem Medicare Advantage |
$8.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$87.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$8.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$8.02
|
| Rate for Payer: Cash Price |
$47.40
|
| Rate for Payer: Cash Price |
$47.40
|
| Rate for Payer: Cigna Commercial |
$151.17
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$8.02
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$91.96
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$8.02
|
| Rate for Payer: Health EOS Commercial |
$146.24
|
| Rate for Payer: HFN Commercial |
$151.17
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$29.83
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$8.02
|
| Rate for Payer: Independent Care Health Plan Medicare |
$8.02
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$8.02
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$8.02
|
| Rate for Payer: Multiplan Commercial |
$131.46
|
| Rate for Payer: NAPHCARE Commercial |
$12.03
|
| Rate for Payer: Preferred Network Access Commercial |
$151.17
|
| Rate for Payer: Quartz Beloit One Network |
$80.52
|
| Rate for Payer: Quartz Commercial |
$106.81
|
| Rate for Payer: Quartz Medicare Advantage |
$8.02
|
| Rate for Payer: The Alliance Commercial |
$32.07
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8.02
|
| Rate for Payer: United Healthcare PPO |
$123.24
|
| Rate for Payer: WEA Trust Commercial |
$90.38
|
| Rate for Payer: Wellcare Medicare |
$8.02
|
| Rate for Payer: WPS Commercial |
$121.71
|
|
|
Dermatophyte Screen
|
Professional
|
Both
|
$158.00
|
|
|
Service Code
|
CPT 87101
|
| Hospital Charge Code |
979919
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.02 |
| Max. Negotiated Rate |
$156.10 |
| Rate for Payer: Aetna Commercial |
$156.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$141.32
|
| Rate for Payer: Aetna Managed Medicare |
$8.02
|
| Rate for Payer: Anthem Medicare Advantage |
$8.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$8.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$8.02
|
| Rate for Payer: Cash Price |
$47.40
|
| Rate for Payer: Cash Price |
$47.40
|
| Rate for Payer: Cigna Commercial |
$156.10
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$82.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$8.02
|
| Rate for Payer: Health EOS Commercial |
$149.53
|
| Rate for Payer: HFN Commercial |
$156.10
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$28.31
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$28.31
|
| Rate for Payer: Independent Care Health Plan Medicare |
$8.02
|
| Rate for Payer: Multiplan Commercial |
$131.46
|
| Rate for Payer: NAPHCARE Commercial |
$12.03
|
| Rate for Payer: Preferred Network Access Commercial |
$156.10
|
| Rate for Payer: Quartz Beloit One Network |
$72.30
|
| Rate for Payer: Quartz Commercial |
$93.66
|
| Rate for Payer: Quartz Medicare Advantage |
$8.02
|
| Rate for Payer: The Alliance Commercial |
$31.67
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8.02
|
| Rate for Payer: WEA Trust Commercial |
$90.38
|
| Rate for Payer: WPS Commercial |
$35.28
|
|
|
Dermatophyte Screen
|
Facility
|
IP
|
$158.00
|
|
|
Service Code
|
CPT 87101
|
| Hospital Charge Code |
979919
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$80.52 |
| Max. Negotiated Rate |
$151.17 |
| Rate for Payer: Aetna Commercial |
$147.89
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$141.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$87.09
|
| Rate for Payer: Cash Price |
$47.40
|
| Rate for Payer: Cigna Commercial |
$151.17
|
| Rate for Payer: Health EOS Commercial |
$146.24
|
| Rate for Payer: HFN Commercial |
$151.17
|
| Rate for Payer: Multiplan Commercial |
$131.46
|
| Rate for Payer: Preferred Network Access Commercial |
$151.17
|
| Rate for Payer: Quartz Beloit One Network |
$80.52
|
| Rate for Payer: Quartz Commercial |
$98.59
|
| Rate for Payer: WEA Trust Commercial |
$90.38
|
| Rate for Payer: WPS Commercial |
$121.71
|
|
|
DERM AUTOGRAFT, TRNK/ARM/LEG 15130
|
Professional
|
Both
|
$3,149.00
|
|
|
Service Code
|
CPT 15130
|
| Hospital Charge Code |
3013638
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$528.65 |
| Max. Negotiated Rate |
$3,111.21 |
| Rate for Payer: Aetna Commercial |
$3,111.21
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,816.47
|
| Rate for Payer: Aetna Managed Medicare |
$528.65
|
| Rate for Payer: Anthem Medicare Advantage |
$528.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$528.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$528.65
|
| Rate for Payer: Cash Price |
$944.70
|
| Rate for Payer: Cash Price |
$944.70
|
| Rate for Payer: Cash Price |
$944.70
|
| Rate for Payer: Cigna Commercial |
$3,111.21
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$576.11
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$528.65
|
| Rate for Payer: Health EOS Commercial |
$2,980.21
|
| Rate for Payer: HFN Commercial |
$3,111.21
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,053.16
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$2,053.16
|
| Rate for Payer: Independent Care Health Plan Medicare |
$528.65
|
| Rate for Payer: Multiplan Commercial |
$2,619.97
|
| Rate for Payer: NAPHCARE Commercial |
$792.98
|
| Rate for Payer: Preferred Network Access Commercial |
$3,111.21
|
| Rate for Payer: Quartz Beloit One Network |
$1,440.98
|
| Rate for Payer: Quartz Commercial |
$1,866.73
|
| Rate for Payer: Quartz Medicare Advantage |
$528.65
|
| Rate for Payer: The Alliance Commercial |
$2,246.77
|
| Rate for Payer: United Healthcare Medicaid |
$576.11
|
| Rate for Payer: United Healthcare Medicare Advantage |
$528.65
|
| Rate for Payer: WEA Trust Commercial |
$1,801.23
|
| Rate for Payer: WPS Commercial |
$2,378.94
|
|
|
DermPath Level IV
|
Facility
|
OP
|
$224.00
|
|
|
Service Code
|
CPT 88305
|
| Hospital Charge Code |
3279479
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$54.84 |
| Max. Negotiated Rate |
$219.36 |
| Rate for Payer: Aetna Commercial |
$209.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$200.35
|
| Rate for Payer: Aetna Managed Medicare |
$54.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$208.88
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$97.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$92.47
|
| Rate for Payer: Anthem Medicare Advantage |
$54.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$123.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$54.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$54.84
|
| Rate for Payer: Cash Price |
$67.20
|
| Rate for Payer: Cash Price |
$67.20
|
| Rate for Payer: Cigna Commercial |
$214.32
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$54.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$130.37
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$54.84
|
| Rate for Payer: Health EOS Commercial |
$207.33
|
| Rate for Payer: HFN Commercial |
$214.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$204.00
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$54.84
|
| Rate for Payer: Independent Care Health Plan Medicare |
$54.84
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$54.84
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$54.84
|
| Rate for Payer: Multiplan Commercial |
$186.37
|
| Rate for Payer: NAPHCARE Commercial |
$82.26
|
| Rate for Payer: Preferred Network Access Commercial |
$214.32
|
| Rate for Payer: Quartz Beloit One Network |
$114.15
|
| Rate for Payer: Quartz Commercial |
$151.42
|
| Rate for Payer: Quartz Medicare Advantage |
$54.84
|
| Rate for Payer: The Alliance Commercial |
$219.36
|
| Rate for Payer: United Healthcare Medicare Advantage |
$54.84
|
| Rate for Payer: United Healthcare PPO |
$174.72
|
| Rate for Payer: WEA Trust Commercial |
$128.13
|
| Rate for Payer: Wellcare Medicare |
$54.84
|
| Rate for Payer: WPS Commercial |
$172.55
|
|
|
DermPath Level IV
|
Professional
|
Both
|
$224.00
|
|
|
Service Code
|
CPT 88305
|
| Hospital Charge Code |
3279479
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$36.08 |
| Max. Negotiated Rate |
$310.21 |
| Rate for Payer: Aetna Commercial |
$221.31
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$200.35
|
| Rate for Payer: Aetna Managed Medicare |
$70.50
|
| Rate for Payer: Anthem Commercial |
$36.08
|
| Rate for Payer: Anthem Medicare Advantage |
$70.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$70.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$70.50
|
| Rate for Payer: Cash Price |
$67.20
|
| Rate for Payer: Cash Price |
$67.20
|
| Rate for Payer: Cigna Commercial |
$221.31
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$116.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$70.50
|
| Rate for Payer: Health EOS Commercial |
$211.99
|
| Rate for Payer: HFN Commercial |
$221.31
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$251.30
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$251.30
|
| Rate for Payer: Independent Care Health Plan Medicare |
$70.50
|
| Rate for Payer: Multiplan Commercial |
$186.37
|
| Rate for Payer: NAPHCARE Commercial |
$105.75
|
| Rate for Payer: Preferred Network Access Commercial |
$221.31
|
| Rate for Payer: Quartz Beloit One Network |
$102.50
|
| Rate for Payer: Quartz Commercial |
$132.79
|
| Rate for Payer: Quartz Medicare Advantage |
$70.50
|
| Rate for Payer: The Alliance Commercial |
$278.48
|
| Rate for Payer: United Healthcare Medicare Advantage |
$70.50
|
| Rate for Payer: WEA Trust Commercial |
$128.13
|
| Rate for Payer: WPS Commercial |
$310.21
|
|
|
DermPath Level IV
|
Facility
|
IP
|
$224.00
|
|
|
Service Code
|
CPT 88305
|
| Hospital Charge Code |
3279479
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$114.15 |
| Max. Negotiated Rate |
$214.32 |
| Rate for Payer: Aetna Commercial |
$209.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$200.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$123.47
|
| Rate for Payer: Cash Price |
$67.20
|
| Rate for Payer: Cigna Commercial |
$214.32
|
| Rate for Payer: Health EOS Commercial |
$207.33
|
| Rate for Payer: HFN Commercial |
$214.32
|
| Rate for Payer: Multiplan Commercial |
$186.37
|
| Rate for Payer: Preferred Network Access Commercial |
$214.32
|
| Rate for Payer: Quartz Beloit One Network |
$114.15
|
| Rate for Payer: Quartz Commercial |
$139.78
|
| Rate for Payer: WEA Trust Commercial |
$128.13
|
| Rate for Payer: WPS Commercial |
$172.55
|
|
