|
Identification, Anaerobic to Mayo
|
Facility
|
IP
|
$367.00
|
|
|
Service Code
|
CPT 87076
|
| Hospital Charge Code |
6173408
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$179.83 |
| Max. Negotiated Rate |
$337.64 |
| Rate for Payer: Aetna Commercial |
$330.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$315.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$194.51
|
| Rate for Payer: Cash Price |
$110.10
|
| Rate for Payer: Cigna Commercial |
$337.64
|
| Rate for Payer: Health EOS Commercial |
$326.63
|
| Rate for Payer: HFN Commercial |
$337.64
|
| Rate for Payer: Multiplan Commercial |
$293.60
|
| Rate for Payer: NAPHCARE Commercial |
$220.20
|
| Rate for Payer: Preferred Network Access Commercial |
$337.64
|
| Rate for Payer: Quartz Beloit One Network |
$179.83
|
| Rate for Payer: Quartz Commercial |
$220.20
|
| Rate for Payer: WEA Trust Commercial |
$201.85
|
| Rate for Payer: WPS Commercial |
$271.84
|
|
|
Identification, Fungus
|
Professional
|
Both
|
$56.00
|
|
|
Service Code
|
CPT 87107
|
| Hospital Charge Code |
4732610
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$24.64 |
| Max. Negotiated Rate |
$53.20 |
| Rate for Payer: Aetna Commercial |
$53.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$48.16
|
| Rate for Payer: Cash Price |
$16.80
|
| Rate for Payer: Cash Price |
$16.80
|
| Rate for Payer: Cigna Commercial |
$53.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$28.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$33.60
|
| Rate for Payer: Health EOS Commercial |
$50.96
|
| Rate for Payer: HFN Commercial |
$53.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$36.43
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$36.43
|
| Rate for Payer: Multiplan Commercial |
$44.80
|
| Rate for Payer: Preferred Network Access Commercial |
$53.20
|
| Rate for Payer: Quartz Beloit One Network |
$24.64
|
| Rate for Payer: Quartz Commercial |
$31.92
|
| Rate for Payer: The Alliance Commercial |
$28.00
|
| Rate for Payer: WEA Trust Commercial |
$30.80
|
| Rate for Payer: WPS Commercial |
$41.48
|
|
|
Identification, Fungus
|
Facility
|
OP
|
$56.00
|
|
|
Service Code
|
CPT 87107
|
| Hospital Charge Code |
4732610
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.32 |
| Max. Negotiated Rate |
$51.52 |
| Rate for Payer: Aetna Commercial |
$50.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$48.16
|
| Rate for Payer: Aetna Managed Medicare |
$10.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$38.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$18.06
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$17.13
|
| Rate for Payer: Anthem Medicaid |
$10.66
|
| Rate for Payer: Anthem Medicare Advantage |
$10.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$29.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$10.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$10.32
|
| Rate for Payer: Cash Price |
$16.80
|
| Rate for Payer: Cash Price |
$16.80
|
| Rate for Payer: Cigna Commercial |
$51.52
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$10.32
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$10.66
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$31.34
|
| Rate for Payer: Dean Health Medicaid |
$10.66
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$10.32
|
| Rate for Payer: Health EOS Commercial |
$49.84
|
| Rate for Payer: HFN Commercial |
$51.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$38.39
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$10.32
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$10.66
|
| Rate for Payer: Independent Care Health Plan Medicare |
$10.32
|
| Rate for Payer: Managed Health Services Medicaid |
$11.09
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$10.32
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$10.32
|
| Rate for Payer: Multiplan Commercial |
$44.80
|
| Rate for Payer: NAPHCARE Commercial |
$15.48
|
| Rate for Payer: Preferred Network Access Commercial |
$51.52
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$10.66
|
| Rate for Payer: Quartz Beloit One Network |
$27.44
|
| Rate for Payer: Quartz Commercial |
$36.40
|
| Rate for Payer: Quartz Medicare Advantage |
$10.32
|
| Rate for Payer: The Alliance Commercial |
$41.28
|
| Rate for Payer: United Healthcare Medicaid |
$10.66
|
| Rate for Payer: United Healthcare Medicare Advantage |
$10.32
|
| Rate for Payer: United Healthcare PPO |
$42.00
|
| Rate for Payer: WEA Trust Commercial |
$30.80
|
| Rate for Payer: Wellcare Medicare |
$10.32
|
| Rate for Payer: WMAP Medicaid |
$10.66
|
| Rate for Payer: WPS Commercial |
$41.48
|
|
|
Identification, Fungus
|
Facility
|
IP
|
$56.00
|
|
|
Service Code
|
CPT 87107
|
| Hospital Charge Code |
4732610
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$27.44 |
| Max. Negotiated Rate |
$51.52 |
| Rate for Payer: Aetna Commercial |
$50.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$48.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$29.68
|
| Rate for Payer: Cash Price |
$16.80
|
| Rate for Payer: Cigna Commercial |
$51.52
|
| Rate for Payer: Health EOS Commercial |
$49.84
|
| Rate for Payer: HFN Commercial |
$51.52
|
| Rate for Payer: Multiplan Commercial |
$44.80
|
| Rate for Payer: NAPHCARE Commercial |
$33.60
|
| Rate for Payer: Preferred Network Access Commercial |
$51.52
|
| Rate for Payer: Quartz Beloit One Network |
$27.44
|
| Rate for Payer: Quartz Commercial |
$33.60
|
| Rate for Payer: WEA Trust Commercial |
$30.80
|
| Rate for Payer: WPS Commercial |
$41.48
|
|
|
Identification Nocardia/Actinomyces
|
Facility
|
OP
|
$334.00
|
|
|
Service Code
|
CPT 87118
|
| Hospital Charge Code |
5390643
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.61 |
| Max. Negotiated Rate |
$307.28 |
| Rate for Payer: Aetna Commercial |
$300.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$287.24
|
| Rate for Payer: Aetna Managed Medicare |
$14.61
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$54.79
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$25.57
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$24.25
|
| Rate for Payer: Anthem Medicaid |
$15.10
|
| Rate for Payer: Anthem Medicare Advantage |
$14.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$177.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$14.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$14.61
|
| Rate for Payer: Cash Price |
$100.20
|
| Rate for Payer: Cash Price |
$100.20
|
| Rate for Payer: Cigna Commercial |
$307.28
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$14.61
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$15.10
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$186.91
|
| Rate for Payer: Dean Health Medicaid |
$15.10
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$14.61
|
| Rate for Payer: Health EOS Commercial |
$297.26
|
| Rate for Payer: HFN Commercial |
$307.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$54.35
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$14.61
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$15.10
|
| Rate for Payer: Independent Care Health Plan Medicare |
$14.61
|
| Rate for Payer: Managed Health Services Medicaid |
$15.70
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$14.61
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$14.61
|
| Rate for Payer: Multiplan Commercial |
$267.20
|
| Rate for Payer: NAPHCARE Commercial |
$21.92
|
| Rate for Payer: Preferred Network Access Commercial |
$307.28
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$15.10
|
| Rate for Payer: Quartz Beloit One Network |
$163.66
|
| Rate for Payer: Quartz Commercial |
$217.10
|
| Rate for Payer: Quartz Medicare Advantage |
$14.61
|
| Rate for Payer: The Alliance Commercial |
$58.44
|
| Rate for Payer: United Healthcare Medicaid |
$15.10
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14.61
|
| Rate for Payer: United Healthcare PPO |
$250.50
|
| Rate for Payer: WEA Trust Commercial |
$183.70
|
| Rate for Payer: Wellcare Medicare |
$14.61
|
| Rate for Payer: WMAP Medicaid |
$15.10
|
| Rate for Payer: WPS Commercial |
$247.39
|
|
|
Identification Nocardia/Actinomyces
|
Facility
|
IP
|
$334.00
|
|
|
Service Code
|
CPT 87118
|
| Hospital Charge Code |
5390643
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$163.66 |
| Max. Negotiated Rate |
$307.28 |
| Rate for Payer: Aetna Commercial |
$300.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$287.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$177.02
|
| Rate for Payer: Cash Price |
$100.20
|
| Rate for Payer: Cigna Commercial |
$307.28
|
| Rate for Payer: Health EOS Commercial |
$297.26
|
| Rate for Payer: HFN Commercial |
$307.28
|
| Rate for Payer: Multiplan Commercial |
$267.20
|
| Rate for Payer: NAPHCARE Commercial |
$200.40
|
| Rate for Payer: Preferred Network Access Commercial |
$307.28
|
| Rate for Payer: Quartz Beloit One Network |
$163.66
|
| Rate for Payer: Quartz Commercial |
$200.40
|
| Rate for Payer: WEA Trust Commercial |
$183.70
|
| Rate for Payer: WPS Commercial |
$247.39
|
|
|
Identification Nocardia/Actinomyces
|
Professional
|
Both
|
$334.00
|
|
|
Service Code
|
CPT 87118
|
| Hospital Charge Code |
5390643
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$51.57 |
| Max. Negotiated Rate |
$317.30 |
| Rate for Payer: Aetna Commercial |
$317.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$287.24
|
| Rate for Payer: Cash Price |
$100.20
|
| Rate for Payer: Cash Price |
$100.20
|
| Rate for Payer: Cigna Commercial |
$317.30
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$167.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$200.40
|
| Rate for Payer: Health EOS Commercial |
$303.94
|
| Rate for Payer: HFN Commercial |
$317.30
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$51.57
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$51.57
|
| Rate for Payer: Multiplan Commercial |
$267.20
|
| Rate for Payer: Preferred Network Access Commercial |
$317.30
|
| Rate for Payer: Quartz Beloit One Network |
$146.96
|
| Rate for Payer: Quartz Commercial |
$190.38
|
| Rate for Payer: The Alliance Commercial |
$167.00
|
| Rate for Payer: WEA Trust Commercial |
$183.70
|
| Rate for Payer: WPS Commercial |
$247.39
|
|
|
I&D HEMATOMA SEROMA/FLUID COLLECTION - 10140
|
Facility
|
IP
|
$810.00
|
|
|
Service Code
|
CPT 10140
|
| Hospital Charge Code |
5843793
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$396.90 |
| Max. Negotiated Rate |
$745.20 |
| Rate for Payer: Aetna Commercial |
$729.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$696.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$429.30
|
| Rate for Payer: Cash Price |
$243.00
|
| Rate for Payer: Cigna Commercial |
$745.20
|
| Rate for Payer: Health EOS Commercial |
$720.90
|
| Rate for Payer: HFN Commercial |
$745.20
|
| Rate for Payer: Multiplan Commercial |
$648.00
|
| Rate for Payer: NAPHCARE Commercial |
$486.00
|
| Rate for Payer: Preferred Network Access Commercial |
$745.20
|
| Rate for Payer: Quartz Beloit One Network |
$396.90
|
| Rate for Payer: Quartz Commercial |
$486.00
|
| Rate for Payer: WEA Trust Commercial |
$445.50
|
| Rate for Payer: WPS Commercial |
$599.97
|
|
|
I&D HEMATOMA SEROMA/FLUID COLLECTION - 10140
|
Facility
|
OP
|
$810.00
|
|
|
Service Code
|
CPT 10140
|
| Hospital Charge Code |
5843793
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$388.80 |
| Max. Negotiated Rate |
$6,409.96 |
| Rate for Payer: Aetna Commercial |
$729.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$696.60
|
| Rate for Payer: Aetna Managed Medicare |
$1,602.49
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$526.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$405.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$388.80
|
| Rate for Payer: Anthem Medicare Advantage |
$1,602.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$429.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$1,602.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$1,602.49
|
| Rate for Payer: Cash Price |
$243.00
|
| Rate for Payer: Cash Price |
$243.00
|
| Rate for Payer: Cigna Commercial |
$745.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$1,602.49
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,218.22
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$1,602.49
|
| Rate for Payer: Health EOS Commercial |
$720.90
|
| Rate for Payer: HFN Commercial |
$745.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,961.26
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,602.49
|
| Rate for Payer: Independent Care Health Plan Medicare |
$1,602.49
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$1,602.49
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$1,602.49
|
| Rate for Payer: Multiplan Commercial |
$648.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,403.74
|
| Rate for Payer: Preferred Network Access Commercial |
$745.20
|
| Rate for Payer: Quartz Beloit One Network |
$396.90
|
| Rate for Payer: Quartz Commercial |
$526.50
|
| Rate for Payer: Quartz Medicare Advantage |
$1,602.49
|
| Rate for Payer: The Alliance Commercial |
$6,409.96
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,602.49
|
| Rate for Payer: WEA Trust Commercial |
$445.50
|
| Rate for Payer: Wellcare Medicare |
$1,602.49
|
| Rate for Payer: WPS Commercial |
$599.97
|
|
|
I&D HEMATOMA SEROMA/FLUID COLLECTION 10140
|
Professional
|
Both
|
$443.00
|
|
|
Service Code
|
CPT 10140
|
| Hospital Charge Code |
5843792
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$44.46 |
| Max. Negotiated Rate |
$420.85 |
| Rate for Payer: Aetna Commercial |
$420.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$380.98
|
| Rate for Payer: Cash Price |
$132.90
|
| Rate for Payer: Cash Price |
$132.90
|
| Rate for Payer: Cash Price |
$132.90
|
| Rate for Payer: Cigna Commercial |
$420.85
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$44.46
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$265.80
|
| Rate for Payer: Health EOS Commercial |
$403.13
|
| Rate for Payer: HFN Commercial |
$420.85
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$396.03
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$396.03
|
| Rate for Payer: Multiplan Commercial |
$354.40
|
| Rate for Payer: Preferred Network Access Commercial |
$420.85
|
| Rate for Payer: Quartz Beloit One Network |
$194.92
|
| Rate for Payer: Quartz Commercial |
$252.51
|
| Rate for Payer: The Alliance Commercial |
$221.50
|
| Rate for Payer: United Healthcare Medicaid |
$44.46
|
| Rate for Payer: WEA Trust Commercial |
$243.65
|
| Rate for Payer: WPS Commercial |
$328.13
|
|
|
ID KIT HEXAPOD STRUT 4935-1-100
|
Facility
|
IP
|
$3,934.00
|
|
| Hospital Charge Code |
6206987
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,927.66 |
| Max. Negotiated Rate |
$3,619.28 |
| Rate for Payer: Aetna Commercial |
$3,540.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,383.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,085.02
|
| Rate for Payer: Cash Price |
$1,180.20
|
| Rate for Payer: Cigna Commercial |
$3,619.28
|
| Rate for Payer: Health EOS Commercial |
$3,501.26
|
| Rate for Payer: HFN Commercial |
$3,619.28
|
| Rate for Payer: Multiplan Commercial |
$3,147.20
|
| Rate for Payer: NAPHCARE Commercial |
$2,360.40
|
| Rate for Payer: Preferred Network Access Commercial |
$3,619.28
|
| Rate for Payer: Quartz Beloit One Network |
$1,927.66
|
| Rate for Payer: Quartz Commercial |
$2,360.40
|
| Rate for Payer: WEA Trust Commercial |
$2,163.70
|
| Rate for Payer: WPS Commercial |
$2,913.91
|
|
|
ID KIT HEXAPOD STRUT 4935-1-100
|
Facility
|
OP
|
$3,934.00
|
|
| Hospital Charge Code |
6206987
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,101.52 |
| Max. Negotiated Rate |
$15,736.00 |
| Rate for Payer: Aetna Commercial |
$3,540.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,383.24
|
| Rate for Payer: Aetna Managed Medicare |
$1,101.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,557.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,967.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,888.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,085.02
|
| Rate for Payer: Cash Price |
$1,180.20
|
| Rate for Payer: Cigna Commercial |
$3,619.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,201.47
|
| Rate for Payer: Health EOS Commercial |
$3,501.26
|
| Rate for Payer: HFN Commercial |
$3,619.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,950.50
|
| Rate for Payer: Multiplan Commercial |
$3,147.20
|
| Rate for Payer: NAPHCARE Commercial |
$2,360.40
|
| Rate for Payer: Preferred Network Access Commercial |
$3,619.28
|
| Rate for Payer: Quartz Beloit One Network |
$1,927.66
|
| Rate for Payer: Quartz Commercial |
$2,557.10
|
| Rate for Payer: Quartz Medicare Advantage |
$2,360.40
|
| Rate for Payer: The Alliance Commercial |
$15,736.00
|
| Rate for Payer: WEA Trust Commercial |
$2,163.70
|
| Rate for Payer: WPS Commercial |
$2,913.91
|
|
|
I&D of hematoma, seroma or fluid collection 10140
|
Professional
|
Both
|
$443.00
|
|
|
Service Code
|
CPT 10140
|
| Hospital Charge Code |
3013507
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$44.46 |
| Max. Negotiated Rate |
$420.85 |
| Rate for Payer: Aetna Commercial |
$420.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$380.98
|
| Rate for Payer: Cash Price |
$132.90
|
| Rate for Payer: Cash Price |
$132.90
|
| Rate for Payer: Cash Price |
$132.90
|
| Rate for Payer: Cigna Commercial |
$420.85
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$44.46
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$265.80
|
| Rate for Payer: Health EOS Commercial |
$403.13
|
| Rate for Payer: HFN Commercial |
$420.85
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$396.03
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$396.03
|
| Rate for Payer: Multiplan Commercial |
$354.40
|
| Rate for Payer: Preferred Network Access Commercial |
$420.85
|
| Rate for Payer: Quartz Beloit One Network |
$194.92
|
| Rate for Payer: Quartz Commercial |
$252.51
|
| Rate for Payer: The Alliance Commercial |
$221.50
|
| Rate for Payer: United Healthcare Medicaid |
$44.46
|
| Rate for Payer: WEA Trust Commercial |
$243.65
|
| Rate for Payer: WPS Commercial |
$328.13
|
|
|
I&D of hematoma, seroma or fluid collection 1014022
|
Professional
|
Both
|
$531.00
|
|
|
Service Code
|
CPT 10140 22
|
| Hospital Charge Code |
5250606
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$44.46 |
| Max. Negotiated Rate |
$504.45 |
| Rate for Payer: Aetna Commercial |
$504.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$456.66
|
| Rate for Payer: Cash Price |
$159.30
|
| Rate for Payer: Cash Price |
$159.30
|
| Rate for Payer: Cash Price |
$159.30
|
| Rate for Payer: Cigna Commercial |
$504.45
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$44.46
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$318.60
|
| Rate for Payer: Health EOS Commercial |
$483.21
|
| Rate for Payer: HFN Commercial |
$504.45
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$396.03
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$396.03
|
| Rate for Payer: Multiplan Commercial |
$424.80
|
| Rate for Payer: Preferred Network Access Commercial |
$504.45
|
| Rate for Payer: Quartz Beloit One Network |
$233.64
|
| Rate for Payer: Quartz Commercial |
$302.67
|
| Rate for Payer: The Alliance Commercial |
$265.50
|
| Rate for Payer: United Healthcare Medicaid |
$44.46
|
| Rate for Payer: WEA Trust Commercial |
$292.05
|
| Rate for Payer: WPS Commercial |
$393.31
|
|
|
IEF Confirms
|
Professional
|
Both
|
$105.00
|
|
|
Service Code
|
CPT 82664
|
| Hospital Charge Code |
3525525
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$46.20 |
| Max. Negotiated Rate |
$217.10 |
| Rate for Payer: Aetna Commercial |
$99.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$90.30
|
| Rate for Payer: Cash Price |
$31.50
|
| Rate for Payer: Cash Price |
$31.50
|
| Rate for Payer: Cigna Commercial |
$99.75
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$52.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$63.00
|
| Rate for Payer: Health EOS Commercial |
$95.55
|
| Rate for Payer: HFN Commercial |
$99.75
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$217.10
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$217.10
|
| Rate for Payer: Multiplan Commercial |
$84.00
|
| Rate for Payer: Preferred Network Access Commercial |
$99.75
|
| Rate for Payer: Quartz Beloit One Network |
$46.20
|
| Rate for Payer: Quartz Commercial |
$59.85
|
| Rate for Payer: The Alliance Commercial |
$52.50
|
| Rate for Payer: WEA Trust Commercial |
$57.75
|
| Rate for Payer: WPS Commercial |
$77.77
|
|
|
IEF Confirms
|
Facility
|
OP
|
$105.00
|
|
|
Service Code
|
CPT 82664
|
| Hospital Charge Code |
3525525
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$48.31 |
| Max. Negotiated Rate |
$246.00 |
| Rate for Payer: Aetna Commercial |
$94.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$90.30
|
| Rate for Payer: Aetna Managed Medicare |
$61.50
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$230.62
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$107.62
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$102.09
|
| Rate for Payer: Anthem Medicaid |
$48.31
|
| Rate for Payer: Anthem Medicare Advantage |
$61.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$55.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$61.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$61.50
|
| Rate for Payer: Cash Price |
$31.50
|
| Rate for Payer: Cash Price |
$31.50
|
| Rate for Payer: Cigna Commercial |
$96.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$61.50
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$48.31
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$58.76
|
| Rate for Payer: Dean Health Medicaid |
$48.31
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$61.50
|
| Rate for Payer: Health EOS Commercial |
$93.45
|
| Rate for Payer: HFN Commercial |
$96.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$228.78
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$61.50
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$48.31
|
| Rate for Payer: Independent Care Health Plan Medicare |
$61.50
|
| Rate for Payer: Managed Health Services Medicaid |
$50.24
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$61.50
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$61.50
|
| Rate for Payer: Multiplan Commercial |
$84.00
|
| Rate for Payer: NAPHCARE Commercial |
$92.25
|
| Rate for Payer: Preferred Network Access Commercial |
$96.60
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$48.31
|
| Rate for Payer: Quartz Beloit One Network |
$51.45
|
| Rate for Payer: Quartz Commercial |
$68.25
|
| Rate for Payer: Quartz Medicare Advantage |
$61.50
|
| Rate for Payer: The Alliance Commercial |
$246.00
|
| Rate for Payer: United Healthcare Medicaid |
$48.31
|
| Rate for Payer: United Healthcare Medicare Advantage |
$61.50
|
| Rate for Payer: United Healthcare PPO |
$78.75
|
| Rate for Payer: WEA Trust Commercial |
$57.75
|
| Rate for Payer: Wellcare Medicare |
$61.50
|
| Rate for Payer: WMAP Medicaid |
$48.31
|
| Rate for Payer: WPS Commercial |
$77.77
|
|
|
IEF Confirms
|
Facility
|
IP
|
$105.00
|
|
|
Service Code
|
CPT 82664
|
| Hospital Charge Code |
3525525
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$51.45 |
| Max. Negotiated Rate |
$96.60 |
| Rate for Payer: Aetna Commercial |
$94.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$90.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$55.65
|
| Rate for Payer: Cash Price |
$31.50
|
| Rate for Payer: Cigna Commercial |
$96.60
|
| Rate for Payer: Health EOS Commercial |
$93.45
|
| Rate for Payer: HFN Commercial |
$96.60
|
| Rate for Payer: Multiplan Commercial |
$84.00
|
| Rate for Payer: NAPHCARE Commercial |
$63.00
|
| Rate for Payer: Preferred Network Access Commercial |
$96.60
|
| Rate for Payer: Quartz Beloit One Network |
$51.45
|
| Rate for Payer: Quartz Commercial |
$63.00
|
| Rate for Payer: WEA Trust Commercial |
$57.75
|
| Rate for Payer: WPS Commercial |
$77.77
|
|
|
iFEX 3000 mg Charge
|
Facility
|
OP
|
$276.00
|
|
|
Service Code
|
HCPCS J9208
|
| Hospital Charge Code |
2958859
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$34.99 |
| Max. Negotiated Rate |
$1,104.00 |
| Rate for Payer: Aetna Commercial |
$248.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$237.36
|
| Rate for Payer: Aetna Managed Medicare |
$77.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$179.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$138.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$132.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$146.28
|
| Rate for Payer: Cash Price |
$82.80
|
| Rate for Payer: Cash Price |
$82.80
|
| Rate for Payer: Cigna Commercial |
$253.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$34.99
|
| Rate for Payer: Health EOS Commercial |
$245.64
|
| Rate for Payer: HFN Commercial |
$253.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$207.00
|
| Rate for Payer: Multiplan Commercial |
$220.80
|
| Rate for Payer: NAPHCARE Commercial |
$165.60
|
| Rate for Payer: Preferred Network Access Commercial |
$253.92
|
| Rate for Payer: Quartz Beloit One Network |
$135.24
|
| Rate for Payer: Quartz Commercial |
$179.40
|
| Rate for Payer: Quartz Medicare Advantage |
$165.60
|
| Rate for Payer: The Alliance Commercial |
$1,104.00
|
| Rate for Payer: WEA Trust Commercial |
$151.80
|
| Rate for Payer: WPS Commercial |
$66.12
|
|
|
iFEX 3000 mg Charge
|
Facility
|
IP
|
$276.00
|
|
|
Service Code
|
HCPCS J9208
|
| Hospital Charge Code |
2958859
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$135.24 |
| Max. Negotiated Rate |
$253.92 |
| Rate for Payer: Aetna Commercial |
$248.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$237.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$146.28
|
| Rate for Payer: Cash Price |
$82.80
|
| Rate for Payer: Cigna Commercial |
$253.92
|
| Rate for Payer: Health EOS Commercial |
$245.64
|
| Rate for Payer: HFN Commercial |
$253.92
|
| Rate for Payer: Multiplan Commercial |
$220.80
|
| Rate for Payer: NAPHCARE Commercial |
$165.60
|
| Rate for Payer: Preferred Network Access Commercial |
$253.92
|
| Rate for Payer: Quartz Beloit One Network |
$135.24
|
| Rate for Payer: Quartz Commercial |
$165.60
|
| Rate for Payer: WEA Trust Commercial |
$151.80
|
| Rate for Payer: WPS Commercial |
$204.43
|
|
|
iFEX 3000 mg Charge
|
Professional
|
Both
|
$276.00
|
|
|
Service Code
|
HCPCS J9208
|
| Hospital Charge Code |
2958859
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$26.45 |
| Max. Negotiated Rate |
$262.20 |
| Rate for Payer: Aetna Commercial |
$262.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$237.36
|
| Rate for Payer: Cash Price |
$82.80
|
| Rate for Payer: Cash Price |
$82.80
|
| Rate for Payer: Cigna Commercial |
$262.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$26.45
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$26.45
|
| Rate for Payer: Health EOS Commercial |
$251.16
|
| Rate for Payer: HFN Commercial |
$262.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$38.22
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$38.22
|
| Rate for Payer: Multiplan Commercial |
$220.80
|
| Rate for Payer: Preferred Network Access Commercial |
$262.20
|
| Rate for Payer: Quartz Beloit One Network |
$121.44
|
| Rate for Payer: Quartz Commercial |
$157.32
|
| Rate for Payer: The Alliance Commercial |
$138.00
|
| Rate for Payer: United Healthcare Medicaid |
$26.45
|
| Rate for Payer: WEA Trust Commercial |
$151.80
|
| Rate for Payer: WPS Commercial |
$66.12
|
|
|
IgA
|
Facility
|
IP
|
$245.00
|
|
|
Service Code
|
CPT 82784
|
| Hospital Charge Code |
977985
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$120.05 |
| Max. Negotiated Rate |
$225.40 |
| Rate for Payer: Aetna Commercial |
$220.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$210.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$129.85
|
| Rate for Payer: Cash Price |
$73.50
|
| Rate for Payer: Cigna Commercial |
$225.40
|
| Rate for Payer: Health EOS Commercial |
$218.05
|
| Rate for Payer: HFN Commercial |
$225.40
|
| Rate for Payer: Multiplan Commercial |
$196.00
|
| Rate for Payer: NAPHCARE Commercial |
$147.00
|
| Rate for Payer: Preferred Network Access Commercial |
$225.40
|
| Rate for Payer: Quartz Beloit One Network |
$120.05
|
| Rate for Payer: Quartz Commercial |
$147.00
|
| Rate for Payer: WEA Trust Commercial |
$134.75
|
| Rate for Payer: WPS Commercial |
$181.47
|
|
|
IgA
|
Facility
|
OP
|
$177.00
|
|
|
Service Code
|
CPT 82784
|
| Hospital Charge Code |
2942877
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.30 |
| Max. Negotiated Rate |
$162.84 |
| Rate for Payer: Aetna Commercial |
$159.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$152.22
|
| Rate for Payer: Aetna Managed Medicare |
$9.30
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$34.88
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$16.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$15.44
|
| Rate for Payer: Anthem Medicaid |
$9.61
|
| Rate for Payer: Anthem Medicare Advantage |
$9.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$93.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$9.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$9.30
|
| Rate for Payer: Cash Price |
$53.10
|
| Rate for Payer: Cash Price |
$53.10
|
| Rate for Payer: Cigna Commercial |
$162.84
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$9.30
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$9.61
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$99.05
|
| Rate for Payer: Dean Health Medicaid |
$9.61
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$9.30
|
| Rate for Payer: Health EOS Commercial |
$157.53
|
| Rate for Payer: HFN Commercial |
$162.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$34.60
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$9.30
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$9.61
|
| Rate for Payer: Independent Care Health Plan Medicare |
$9.30
|
| Rate for Payer: Managed Health Services Medicaid |
$9.99
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$9.30
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$9.30
|
| Rate for Payer: Multiplan Commercial |
$141.60
|
| Rate for Payer: NAPHCARE Commercial |
$13.95
|
| Rate for Payer: Preferred Network Access Commercial |
$162.84
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$9.61
|
| Rate for Payer: Quartz Beloit One Network |
$86.73
|
| Rate for Payer: Quartz Commercial |
$115.05
|
| Rate for Payer: Quartz Medicare Advantage |
$9.30
|
| Rate for Payer: The Alliance Commercial |
$37.20
|
| Rate for Payer: United Healthcare Medicaid |
$9.61
|
| Rate for Payer: United Healthcare Medicare Advantage |
$9.30
|
| Rate for Payer: United Healthcare PPO |
$132.75
|
| Rate for Payer: WEA Trust Commercial |
$97.35
|
| Rate for Payer: Wellcare Medicare |
$9.30
|
| Rate for Payer: WMAP Medicaid |
$9.61
|
| Rate for Payer: WPS Commercial |
$131.10
|
|
|
IgA
|
Professional
|
Both
|
$177.00
|
|
|
Service Code
|
CPT 82784
|
| Hospital Charge Code |
2942877
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$32.83 |
| Max. Negotiated Rate |
$168.15 |
| Rate for Payer: Aetna Commercial |
$168.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$152.22
|
| Rate for Payer: Cash Price |
$53.10
|
| Rate for Payer: Cash Price |
$53.10
|
| Rate for Payer: Cigna Commercial |
$168.15
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$88.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$106.20
|
| Rate for Payer: Health EOS Commercial |
$161.07
|
| Rate for Payer: HFN Commercial |
$168.15
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$32.83
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$32.83
|
| Rate for Payer: Multiplan Commercial |
$141.60
|
| Rate for Payer: Preferred Network Access Commercial |
$168.15
|
| Rate for Payer: Quartz Beloit One Network |
$77.88
|
| Rate for Payer: Quartz Commercial |
$100.89
|
| Rate for Payer: The Alliance Commercial |
$88.50
|
| Rate for Payer: WEA Trust Commercial |
$97.35
|
| Rate for Payer: WPS Commercial |
$131.10
|
|
|
IgA
|
Facility
|
IP
|
$177.00
|
|
|
Service Code
|
CPT 82784
|
| Hospital Charge Code |
2942877
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$86.73 |
| Max. Negotiated Rate |
$162.84 |
| Rate for Payer: Aetna Commercial |
$159.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$152.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$93.81
|
| Rate for Payer: Cash Price |
$53.10
|
| Rate for Payer: Cigna Commercial |
$162.84
|
| Rate for Payer: Health EOS Commercial |
$157.53
|
| Rate for Payer: HFN Commercial |
$162.84
|
| Rate for Payer: Multiplan Commercial |
$141.60
|
| Rate for Payer: NAPHCARE Commercial |
$106.20
|
| Rate for Payer: Preferred Network Access Commercial |
$162.84
|
| Rate for Payer: Quartz Beloit One Network |
$86.73
|
| Rate for Payer: Quartz Commercial |
$106.20
|
| Rate for Payer: WEA Trust Commercial |
$97.35
|
| Rate for Payer: WPS Commercial |
$131.10
|
|
|
IgA
|
Professional
|
Both
|
$245.00
|
|
|
Service Code
|
CPT 82784
|
| Hospital Charge Code |
977985
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$32.83 |
| Max. Negotiated Rate |
$232.75 |
| Rate for Payer: Aetna Commercial |
$232.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$210.70
|
| Rate for Payer: Cash Price |
$73.50
|
| Rate for Payer: Cash Price |
$73.50
|
| Rate for Payer: Cigna Commercial |
$232.75
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$122.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$147.00
|
| Rate for Payer: Health EOS Commercial |
$222.95
|
| Rate for Payer: HFN Commercial |
$232.75
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$32.83
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$32.83
|
| Rate for Payer: Multiplan Commercial |
$196.00
|
| Rate for Payer: Preferred Network Access Commercial |
$232.75
|
| Rate for Payer: Quartz Beloit One Network |
$107.80
|
| Rate for Payer: Quartz Commercial |
$139.65
|
| Rate for Payer: The Alliance Commercial |
$122.50
|
| Rate for Payer: WEA Trust Commercial |
$134.75
|
| Rate for Payer: WPS Commercial |
$181.47
|
|
