|
INCISION OF FOOT FASCIA 28008
|
Professional
|
Both
|
$2,074.00
|
|
|
Service Code
|
CPT 28008
|
| Hospital Charge Code |
3014178
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$150.66 |
| Max. Negotiated Rate |
$1,970.30 |
| Rate for Payer: Aetna Commercial |
$1,970.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,783.64
|
| Rate for Payer: Cash Price |
$622.20
|
| Rate for Payer: Cash Price |
$622.20
|
| Rate for Payer: Cash Price |
$622.20
|
| Rate for Payer: Cigna Commercial |
$1,970.30
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$150.66
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,244.40
|
| Rate for Payer: Health EOS Commercial |
$1,887.34
|
| Rate for Payer: HFN Commercial |
$1,970.30
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$999.91
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$999.91
|
| Rate for Payer: Multiplan Commercial |
$1,659.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,970.30
|
| Rate for Payer: Quartz Beloit One Network |
$912.56
|
| Rate for Payer: Quartz Commercial |
$1,182.18
|
| Rate for Payer: The Alliance Commercial |
$1,037.00
|
| Rate for Payer: United Healthcare Medicaid |
$150.66
|
| Rate for Payer: WEA Trust Commercial |
$1,140.70
|
| Rate for Payer: WPS Commercial |
$1,536.21
|
|
|
INCISION OF FOOT TENDON 28234
|
Professional
|
Both
|
$620.00
|
|
|
Service Code
|
CPT 28234
|
| Hospital Charge Code |
3014222
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$60.27 |
| Max. Negotiated Rate |
$899.76 |
| Rate for Payer: Aetna Commercial |
$589.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$533.20
|
| Rate for Payer: Cash Price |
$186.00
|
| Rate for Payer: Cash Price |
$186.00
|
| Rate for Payer: Cash Price |
$186.00
|
| Rate for Payer: Cigna Commercial |
$589.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$60.27
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$372.00
|
| Rate for Payer: Health EOS Commercial |
$564.20
|
| Rate for Payer: HFN Commercial |
$589.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$899.76
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$899.76
|
| Rate for Payer: Multiplan Commercial |
$496.00
|
| Rate for Payer: Preferred Network Access Commercial |
$589.00
|
| Rate for Payer: Quartz Beloit One Network |
$272.80
|
| Rate for Payer: Quartz Commercial |
$353.40
|
| Rate for Payer: The Alliance Commercial |
$310.00
|
| Rate for Payer: United Healthcare Medicaid |
$60.27
|
| Rate for Payer: WEA Trust Commercial |
$341.00
|
| Rate for Payer: WPS Commercial |
$459.23
|
|
|
INCISION OF FOOT TENDON(S) 28230
|
Professional
|
Both
|
$916.00
|
|
|
Service Code
|
CPT 28230
|
| Hospital Charge Code |
3014220
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$180.80 |
| Max. Negotiated Rate |
$958.82 |
| Rate for Payer: Aetna Commercial |
$870.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$787.76
|
| Rate for Payer: Cash Price |
$274.80
|
| Rate for Payer: Cash Price |
$274.80
|
| Rate for Payer: Cash Price |
$274.80
|
| Rate for Payer: Cigna Commercial |
$870.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$180.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$549.60
|
| Rate for Payer: Health EOS Commercial |
$833.56
|
| Rate for Payer: HFN Commercial |
$870.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$958.82
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$958.82
|
| Rate for Payer: Multiplan Commercial |
$732.80
|
| Rate for Payer: Preferred Network Access Commercial |
$870.20
|
| Rate for Payer: Quartz Beloit One Network |
$403.04
|
| Rate for Payer: Quartz Commercial |
$522.12
|
| Rate for Payer: The Alliance Commercial |
$458.00
|
| Rate for Payer: United Healthcare Medicaid |
$180.80
|
| Rate for Payer: WEA Trust Commercial |
$503.80
|
| Rate for Payer: WPS Commercial |
$678.48
|
|
|
INCISION OF LIP FOLD 40806
|
Professional
|
Both
|
$484.00
|
|
|
Service Code
|
CPT 40806
|
| Hospital Charge Code |
3014606
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$30.11 |
| Max. Negotiated Rate |
$459.80 |
| Rate for Payer: Aetna Commercial |
$459.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$416.24
|
| Rate for Payer: Cash Price |
$145.20
|
| Rate for Payer: Cash Price |
$145.20
|
| Rate for Payer: Cash Price |
$145.20
|
| Rate for Payer: Cigna Commercial |
$459.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$30.11
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$290.40
|
| Rate for Payer: Health EOS Commercial |
$440.44
|
| Rate for Payer: HFN Commercial |
$459.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$95.35
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$95.35
|
| Rate for Payer: Multiplan Commercial |
$387.20
|
| Rate for Payer: Preferred Network Access Commercial |
$459.80
|
| Rate for Payer: Quartz Beloit One Network |
$212.96
|
| Rate for Payer: Quartz Commercial |
$275.88
|
| Rate for Payer: The Alliance Commercial |
$242.00
|
| Rate for Payer: United Healthcare Medicaid |
$30.11
|
| Rate for Payer: WEA Trust Commercial |
$266.20
|
| Rate for Payer: WPS Commercial |
$358.50
|
|
|
INCISION OF METATARSAL 28306
|
Professional
|
Both
|
$2,592.00
|
|
|
Service Code
|
CPT 28306
|
| Hospital Charge Code |
3014240
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$350.65 |
| Max. Negotiated Rate |
$2,462.40 |
| Rate for Payer: Aetna Commercial |
$2,462.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,229.12
|
| Rate for Payer: Cash Price |
$777.60
|
| Rate for Payer: Cash Price |
$777.60
|
| Rate for Payer: Cash Price |
$777.60
|
| Rate for Payer: Cigna Commercial |
$2,462.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$350.65
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,555.20
|
| Rate for Payer: Health EOS Commercial |
$2,358.72
|
| Rate for Payer: HFN Commercial |
$2,462.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,340.34
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,340.34
|
| Rate for Payer: Multiplan Commercial |
$2,073.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,462.40
|
| Rate for Payer: Quartz Beloit One Network |
$1,140.48
|
| Rate for Payer: Quartz Commercial |
$1,477.44
|
| Rate for Payer: The Alliance Commercial |
$1,296.00
|
| Rate for Payer: United Healthcare Medicaid |
$350.65
|
| Rate for Payer: WEA Trust Commercial |
$1,425.60
|
| Rate for Payer: WPS Commercial |
$1,919.89
|
|
|
INCISION OF METATARSAL 28308
|
Professional
|
Both
|
$2,922.00
|
|
|
Service Code
|
CPT 28308
|
| Hospital Charge Code |
3014241
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$278.56 |
| Max. Negotiated Rate |
$2,775.90 |
| Rate for Payer: Aetna Commercial |
$2,775.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,512.92
|
| Rate for Payer: Cash Price |
$876.60
|
| Rate for Payer: Cash Price |
$876.60
|
| Rate for Payer: Cash Price |
$876.60
|
| Rate for Payer: Cigna Commercial |
$2,775.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$278.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,753.20
|
| Rate for Payer: Health EOS Commercial |
$2,659.02
|
| Rate for Payer: HFN Commercial |
$2,775.90
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,290.07
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,290.07
|
| Rate for Payer: Multiplan Commercial |
$2,337.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,775.90
|
| Rate for Payer: Quartz Beloit One Network |
$1,285.68
|
| Rate for Payer: Quartz Commercial |
$1,665.54
|
| Rate for Payer: The Alliance Commercial |
$1,461.00
|
| Rate for Payer: United Healthcare Medicaid |
$278.56
|
| Rate for Payer: WEA Trust Commercial |
$1,607.10
|
| Rate for Payer: WPS Commercial |
$2,164.33
|
|
|
INCISION OF RECTAL ABSCESS 46040
|
Professional
|
Both
|
$1,603.00
|
|
|
Service Code
|
CPT 46040
|
| Hospital Charge Code |
3014820
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$188.66 |
| Max. Negotiated Rate |
$1,522.85 |
| Rate for Payer: Aetna Commercial |
$1,522.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,378.58
|
| Rate for Payer: Cash Price |
$480.90
|
| Rate for Payer: Cash Price |
$480.90
|
| Rate for Payer: Cash Price |
$480.90
|
| Rate for Payer: Cigna Commercial |
$1,522.85
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$188.66
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$961.80
|
| Rate for Payer: Health EOS Commercial |
$1,458.73
|
| Rate for Payer: HFN Commercial |
$1,522.85
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,405.40
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,405.40
|
| Rate for Payer: Multiplan Commercial |
$1,282.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,522.85
|
| Rate for Payer: Quartz Beloit One Network |
$705.32
|
| Rate for Payer: Quartz Commercial |
$913.71
|
| Rate for Payer: The Alliance Commercial |
$801.50
|
| Rate for Payer: United Healthcare Medicaid |
$188.66
|
| Rate for Payer: WEA Trust Commercial |
$881.65
|
| Rate for Payer: WPS Commercial |
$1,187.34
|
|
|
INCISION OF TOE TENDON 28010
|
Professional
|
Both
|
$1,058.00
|
|
|
Service Code
|
CPT 28010
|
| Hospital Charge Code |
3014179
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$75.33 |
| Max. Negotiated Rate |
$1,005.10 |
| Rate for Payer: Aetna Commercial |
$1,005.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$909.88
|
| Rate for Payer: Cash Price |
$317.40
|
| Rate for Payer: Cash Price |
$317.40
|
| Rate for Payer: Cash Price |
$317.40
|
| Rate for Payer: Cigna Commercial |
$1,005.10
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$75.33
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$634.80
|
| Rate for Payer: Health EOS Commercial |
$962.78
|
| Rate for Payer: HFN Commercial |
$1,005.10
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$700.99
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$700.99
|
| Rate for Payer: Multiplan Commercial |
$846.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,005.10
|
| Rate for Payer: Quartz Beloit One Network |
$465.52
|
| Rate for Payer: Quartz Commercial |
$603.06
|
| Rate for Payer: The Alliance Commercial |
$529.00
|
| Rate for Payer: United Healthcare Medicaid |
$75.33
|
| Rate for Payer: WEA Trust Commercial |
$581.90
|
| Rate for Payer: WPS Commercial |
$783.66
|
|
|
INCISION OF TOE TENDON 28232
|
Professional
|
Both
|
$586.00
|
|
|
Service Code
|
CPT 28232
|
| Hospital Charge Code |
3014221
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$90.38 |
| Max. Negotiated Rate |
$814.94 |
| Rate for Payer: Aetna Commercial |
$556.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$503.96
|
| Rate for Payer: Cash Price |
$175.80
|
| Rate for Payer: Cash Price |
$175.80
|
| Rate for Payer: Cash Price |
$175.80
|
| Rate for Payer: Cigna Commercial |
$556.70
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$90.38
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$351.60
|
| Rate for Payer: Health EOS Commercial |
$533.26
|
| Rate for Payer: HFN Commercial |
$556.70
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$814.94
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$814.94
|
| Rate for Payer: Multiplan Commercial |
$468.80
|
| Rate for Payer: Preferred Network Access Commercial |
$556.70
|
| Rate for Payer: Quartz Beloit One Network |
$257.84
|
| Rate for Payer: Quartz Commercial |
$334.02
|
| Rate for Payer: The Alliance Commercial |
$293.00
|
| Rate for Payer: United Healthcare Medicaid |
$90.38
|
| Rate for Payer: WEA Trust Commercial |
$322.30
|
| Rate for Payer: WPS Commercial |
$434.05
|
|
|
INCISION OF TOE TENDONS 28011
|
Professional
|
Both
|
$794.00
|
|
|
Service Code
|
CPT 28011
|
| Hospital Charge Code |
3014180
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$112.98 |
| Max. Negotiated Rate |
$945.90 |
| Rate for Payer: Aetna Commercial |
$754.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$682.84
|
| Rate for Payer: Cash Price |
$238.20
|
| Rate for Payer: Cash Price |
$238.20
|
| Rate for Payer: Cash Price |
$238.20
|
| Rate for Payer: Cigna Commercial |
$754.30
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$112.98
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$476.40
|
| Rate for Payer: Health EOS Commercial |
$722.54
|
| Rate for Payer: HFN Commercial |
$754.30
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$945.90
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$945.90
|
| Rate for Payer: Multiplan Commercial |
$635.20
|
| Rate for Payer: Preferred Network Access Commercial |
$754.30
|
| Rate for Payer: Quartz Beloit One Network |
$349.36
|
| Rate for Payer: Quartz Commercial |
$452.58
|
| Rate for Payer: The Alliance Commercial |
$397.00
|
| Rate for Payer: United Healthcare Medicaid |
$112.98
|
| Rate for Payer: WEA Trust Commercial |
$436.70
|
| Rate for Payer: WPS Commercial |
$588.12
|
|
|
INCISOR DEVICE PLUS TRUCLEAR 7209509
|
Facility
|
IP
|
$4,932.00
|
|
| Hospital Charge Code |
5106992
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,416.68 |
| Max. Negotiated Rate |
$4,537.44 |
| Rate for Payer: Aetna Commercial |
$4,438.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,241.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,613.96
|
| Rate for Payer: Cash Price |
$1,479.60
|
| Rate for Payer: Cigna Commercial |
$4,537.44
|
| Rate for Payer: Health EOS Commercial |
$4,389.48
|
| Rate for Payer: HFN Commercial |
$4,537.44
|
| Rate for Payer: Multiplan Commercial |
$3,945.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,959.20
|
| Rate for Payer: Preferred Network Access Commercial |
$4,537.44
|
| Rate for Payer: Quartz Beloit One Network |
$2,416.68
|
| Rate for Payer: Quartz Commercial |
$2,959.20
|
| Rate for Payer: WEA Trust Commercial |
$2,712.60
|
| Rate for Payer: WPS Commercial |
$3,653.13
|
|
|
INCISOR DEVICE PLUS TRUCLEAR 7209509
|
Facility
|
OP
|
$4,932.00
|
|
| Hospital Charge Code |
5106992
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,380.96 |
| Max. Negotiated Rate |
$19,728.00 |
| Rate for Payer: Aetna Commercial |
$4,438.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,241.52
|
| Rate for Payer: Aetna Managed Medicare |
$1,380.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,205.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,466.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,367.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,613.96
|
| Rate for Payer: Cash Price |
$1,479.60
|
| Rate for Payer: Cigna Commercial |
$4,537.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,759.95
|
| Rate for Payer: Health EOS Commercial |
$4,389.48
|
| Rate for Payer: HFN Commercial |
$4,537.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,699.00
|
| Rate for Payer: Multiplan Commercial |
$3,945.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,959.20
|
| Rate for Payer: Preferred Network Access Commercial |
$4,537.44
|
| Rate for Payer: Quartz Beloit One Network |
$2,416.68
|
| Rate for Payer: Quartz Commercial |
$3,205.80
|
| Rate for Payer: Quartz Medicare Advantage |
$2,959.20
|
| Rate for Payer: The Alliance Commercial |
$19,728.00
|
| Rate for Payer: WEA Trust Commercial |
$2,712.60
|
| Rate for Payer: WPS Commercial |
$3,653.13
|
|
|
INCISOR DEVICE TRUCLEAR 72202536
|
Facility
|
IP
|
$6,020.00
|
|
| Hospital Charge Code |
5074635
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,949.80 |
| Max. Negotiated Rate |
$5,538.40 |
| Rate for Payer: Aetna Commercial |
$5,418.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,177.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,190.60
|
| Rate for Payer: Cash Price |
$1,806.00
|
| Rate for Payer: Cigna Commercial |
$5,538.40
|
| Rate for Payer: Health EOS Commercial |
$5,357.80
|
| Rate for Payer: HFN Commercial |
$5,538.40
|
| Rate for Payer: Multiplan Commercial |
$4,816.00
|
| Rate for Payer: NAPHCARE Commercial |
$3,612.00
|
| Rate for Payer: Preferred Network Access Commercial |
$5,538.40
|
| Rate for Payer: Quartz Beloit One Network |
$2,949.80
|
| Rate for Payer: Quartz Commercial |
$3,612.00
|
| Rate for Payer: WEA Trust Commercial |
$3,311.00
|
| Rate for Payer: WPS Commercial |
$4,459.01
|
|
|
INCISOR DEVICE TRUCLEAR 72202536
|
Facility
|
OP
|
$6,020.00
|
|
| Hospital Charge Code |
5074635
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,685.60 |
| Max. Negotiated Rate |
$24,080.00 |
| Rate for Payer: Aetna Commercial |
$5,418.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,177.20
|
| Rate for Payer: Aetna Managed Medicare |
$1,685.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,913.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,010.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,889.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,190.60
|
| Rate for Payer: Cash Price |
$1,806.00
|
| Rate for Payer: Cigna Commercial |
$5,538.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,368.79
|
| Rate for Payer: Health EOS Commercial |
$5,357.80
|
| Rate for Payer: HFN Commercial |
$5,538.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,515.00
|
| Rate for Payer: Multiplan Commercial |
$4,816.00
|
| Rate for Payer: NAPHCARE Commercial |
$3,612.00
|
| Rate for Payer: Preferred Network Access Commercial |
$5,538.40
|
| Rate for Payer: Quartz Beloit One Network |
$2,949.80
|
| Rate for Payer: Quartz Commercial |
$3,913.00
|
| Rate for Payer: Quartz Medicare Advantage |
$3,612.00
|
| Rate for Payer: The Alliance Commercial |
$24,080.00
|
| Rate for Payer: WEA Trust Commercial |
$3,311.00
|
| Rate for Payer: WPS Commercial |
$4,459.01
|
|
|
Inconclusive - Urine Pregnancy POC
|
Facility
|
IP
|
$166.00
|
|
|
Service Code
|
CPT 81025
|
| Hospital Charge Code |
3120178
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$81.34 |
| Max. Negotiated Rate |
$152.72 |
| Rate for Payer: Aetna Commercial |
$149.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$142.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$87.98
|
| Rate for Payer: Cash Price |
$49.80
|
| Rate for Payer: Cigna Commercial |
$152.72
|
| Rate for Payer: Health EOS Commercial |
$147.74
|
| Rate for Payer: HFN Commercial |
$152.72
|
| Rate for Payer: Multiplan Commercial |
$132.80
|
| Rate for Payer: NAPHCARE Commercial |
$99.60
|
| Rate for Payer: Preferred Network Access Commercial |
$152.72
|
| Rate for Payer: Quartz Beloit One Network |
$81.34
|
| Rate for Payer: Quartz Commercial |
$99.60
|
| Rate for Payer: WEA Trust Commercial |
$91.30
|
| Rate for Payer: WPS Commercial |
$122.96
|
|
|
Inconclusive - Urine Pregnancy POC
|
Facility
|
OP
|
$166.00
|
|
|
Service Code
|
CPT 81025
|
| Hospital Charge Code |
3120178
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.61 |
| Max. Negotiated Rate |
$152.72 |
| Rate for Payer: Aetna Commercial |
$149.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$142.76
|
| Rate for Payer: Aetna Managed Medicare |
$8.61
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$32.29
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$15.07
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$14.29
|
| Rate for Payer: Anthem Medicaid |
$8.90
|
| Rate for Payer: Anthem Medicare Advantage |
$8.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$87.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$8.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$8.61
|
| Rate for Payer: Cash Price |
$49.80
|
| Rate for Payer: Cash Price |
$49.80
|
| Rate for Payer: Cigna Commercial |
$152.72
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$8.61
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$8.90
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$92.89
|
| Rate for Payer: Dean Health Medicaid |
$8.90
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$8.61
|
| Rate for Payer: Health EOS Commercial |
$147.74
|
| Rate for Payer: HFN Commercial |
$152.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$32.03
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$8.61
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$8.90
|
| Rate for Payer: Independent Care Health Plan Medicare |
$8.61
|
| Rate for Payer: Managed Health Services Medicaid |
$9.26
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$8.61
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$8.61
|
| Rate for Payer: Multiplan Commercial |
$132.80
|
| Rate for Payer: NAPHCARE Commercial |
$12.92
|
| Rate for Payer: Preferred Network Access Commercial |
$152.72
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$8.90
|
| Rate for Payer: Quartz Beloit One Network |
$81.34
|
| Rate for Payer: Quartz Commercial |
$107.90
|
| Rate for Payer: Quartz Medicare Advantage |
$8.61
|
| Rate for Payer: The Alliance Commercial |
$34.44
|
| Rate for Payer: United Healthcare Medicaid |
$8.90
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8.61
|
| Rate for Payer: United Healthcare PPO |
$124.50
|
| Rate for Payer: WEA Trust Commercial |
$91.30
|
| Rate for Payer: Wellcare Medicare |
$8.61
|
| Rate for Payer: WMAP Medicaid |
$8.90
|
| Rate for Payer: WPS Commercial |
$122.96
|
|
|
Incontinence Service
|
Facility
|
IP
|
$480.00
|
|
|
Service Code
|
CPT 99211
|
| Hospital Charge Code |
3005561
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$235.20 |
| Max. Negotiated Rate |
$441.60 |
| Rate for Payer: Aetna Commercial |
$432.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$412.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$254.40
|
| Rate for Payer: Cash Price |
$144.00
|
| Rate for Payer: Cigna Commercial |
$441.60
|
| Rate for Payer: Health EOS Commercial |
$427.20
|
| Rate for Payer: HFN Commercial |
$441.60
|
| Rate for Payer: Multiplan Commercial |
$384.00
|
| Rate for Payer: NAPHCARE Commercial |
$288.00
|
| Rate for Payer: Preferred Network Access Commercial |
$441.60
|
| Rate for Payer: Quartz Beloit One Network |
$235.20
|
| Rate for Payer: Quartz Commercial |
$288.00
|
| Rate for Payer: WEA Trust Commercial |
$264.00
|
| Rate for Payer: WPS Commercial |
$355.54
|
|
|
Incontinence Service
|
Facility
|
OP
|
$480.00
|
|
|
Service Code
|
CPT 99211
|
| Hospital Charge Code |
3005561
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$134.40 |
| Max. Negotiated Rate |
$1,920.00 |
| Rate for Payer: Aetna Commercial |
$432.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$412.80
|
| Rate for Payer: Aetna Managed Medicare |
$134.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$312.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$240.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$230.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$254.40
|
| Rate for Payer: Cash Price |
$144.00
|
| Rate for Payer: Cigna Commercial |
$441.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$268.61
|
| Rate for Payer: Health EOS Commercial |
$427.20
|
| Rate for Payer: HFN Commercial |
$441.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$360.00
|
| Rate for Payer: Multiplan Commercial |
$384.00
|
| Rate for Payer: NAPHCARE Commercial |
$288.00
|
| Rate for Payer: Preferred Network Access Commercial |
$441.60
|
| Rate for Payer: Quartz Beloit One Network |
$235.20
|
| Rate for Payer: Quartz Commercial |
$312.00
|
| Rate for Payer: Quartz Medicare Advantage |
$288.00
|
| Rate for Payer: The Alliance Commercial |
$1,920.00
|
| Rate for Payer: WEA Trust Commercial |
$264.00
|
| Rate for Payer: WPS Commercial |
$355.54
|
|
|
Indigo Carmine 5ml ampule [Med]
|
Facility
|
IP
|
$96.00
|
|
| Hospital Charge Code |
2974948
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$47.04 |
| Max. Negotiated Rate |
$88.32 |
| Rate for Payer: Aetna Commercial |
$86.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$82.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$50.88
|
| Rate for Payer: Cash Price |
$28.80
|
| Rate for Payer: Cigna Commercial |
$88.32
|
| Rate for Payer: Health EOS Commercial |
$85.44
|
| Rate for Payer: HFN Commercial |
$88.32
|
| Rate for Payer: Multiplan Commercial |
$76.80
|
| Rate for Payer: NAPHCARE Commercial |
$57.60
|
| Rate for Payer: Preferred Network Access Commercial |
$88.32
|
| Rate for Payer: Quartz Beloit One Network |
$47.04
|
| Rate for Payer: Quartz Commercial |
$57.60
|
| Rate for Payer: WEA Trust Commercial |
$52.80
|
| Rate for Payer: WPS Commercial |
$71.11
|
|
|
Indigo Carmine 5ml ampule [Med]
|
Facility
|
OP
|
$96.00
|
|
| Hospital Charge Code |
2974948
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$26.88 |
| Max. Negotiated Rate |
$384.00 |
| Rate for Payer: Aetna Commercial |
$86.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$82.56
|
| Rate for Payer: Aetna Managed Medicare |
$26.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$62.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$48.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$46.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$50.88
|
| Rate for Payer: Cash Price |
$28.80
|
| Rate for Payer: Cigna Commercial |
$88.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$53.72
|
| Rate for Payer: Health EOS Commercial |
$85.44
|
| Rate for Payer: HFN Commercial |
$88.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$72.00
|
| Rate for Payer: Multiplan Commercial |
$76.80
|
| Rate for Payer: NAPHCARE Commercial |
$57.60
|
| Rate for Payer: Preferred Network Access Commercial |
$88.32
|
| Rate for Payer: Quartz Beloit One Network |
$47.04
|
| Rate for Payer: Quartz Commercial |
$62.40
|
| Rate for Payer: Quartz Medicare Advantage |
$57.60
|
| Rate for Payer: The Alliance Commercial |
$384.00
|
| Rate for Payer: WEA Trust Commercial |
$52.80
|
| Rate for Payer: WPS Commercial |
$71.11
|
|
|
Indium-111 pentetate (DTPA)
|
Facility
|
OP
|
$2,955.00
|
|
|
Service Code
|
HCPCS A9548
|
| Hospital Charge Code |
2550992
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$827.40 |
| Max. Negotiated Rate |
$11,820.00 |
| Rate for Payer: Aetna Commercial |
$2,659.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,541.30
|
| Rate for Payer: Aetna Managed Medicare |
$827.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,920.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,477.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,418.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,566.15
|
| Rate for Payer: Cash Price |
$886.50
|
| Rate for Payer: Cigna Commercial |
$2,718.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,653.62
|
| Rate for Payer: Health EOS Commercial |
$2,629.95
|
| Rate for Payer: HFN Commercial |
$2,718.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,216.25
|
| Rate for Payer: Multiplan Commercial |
$2,364.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,773.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,718.60
|
| Rate for Payer: Quartz Beloit One Network |
$1,447.95
|
| Rate for Payer: Quartz Commercial |
$1,920.75
|
| Rate for Payer: Quartz Medicare Advantage |
$1,773.00
|
| Rate for Payer: The Alliance Commercial |
$11,820.00
|
| Rate for Payer: WEA Trust Commercial |
$1,625.25
|
| Rate for Payer: WPS Commercial |
$2,188.77
|
|
|
Indium-111 pentetate (DTPA)
|
Facility
|
IP
|
$2,955.00
|
|
|
Service Code
|
HCPCS A9548
|
| Hospital Charge Code |
2550992
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$1,447.95 |
| Max. Negotiated Rate |
$2,718.60 |
| Rate for Payer: Aetna Commercial |
$2,659.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,541.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,566.15
|
| Rate for Payer: Cash Price |
$886.50
|
| Rate for Payer: Cigna Commercial |
$2,718.60
|
| Rate for Payer: Health EOS Commercial |
$2,629.95
|
| Rate for Payer: HFN Commercial |
$2,718.60
|
| Rate for Payer: Multiplan Commercial |
$2,364.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,773.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,718.60
|
| Rate for Payer: Quartz Beloit One Network |
$1,447.95
|
| Rate for Payer: Quartz Commercial |
$1,773.00
|
| Rate for Payer: WEA Trust Commercial |
$1,625.25
|
| Rate for Payer: WPS Commercial |
$2,188.77
|
|
|
Indium-111 pentetate (DTPA)
|
Professional
|
Both
|
$2,955.00
|
|
|
Service Code
|
HCPCS A9548
|
| Hospital Charge Code |
2550992
|
|
Hospital Revenue Code
|
343
|
| Min. Negotiated Rate |
$723.91 |
| Max. Negotiated Rate |
$2,807.25 |
| Rate for Payer: Aetna Commercial |
$2,807.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,541.30
|
| Rate for Payer: Cash Price |
$886.50
|
| Rate for Payer: Cash Price |
$886.50
|
| Rate for Payer: Cigna Commercial |
$2,807.25
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,477.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,773.00
|
| Rate for Payer: Health EOS Commercial |
$2,689.05
|
| Rate for Payer: HFN Commercial |
$2,807.25
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$723.91
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$723.91
|
| Rate for Payer: Multiplan Commercial |
$2,364.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,807.25
|
| Rate for Payer: Quartz Beloit One Network |
$1,300.20
|
| Rate for Payer: Quartz Commercial |
$1,684.35
|
| Rate for Payer: The Alliance Commercial |
$1,477.50
|
| Rate for Payer: WEA Trust Commercial |
$1,625.25
|
| Rate for Payer: WPS Commercial |
$2,188.77
|
|
|
Indwelling catheter latex A4338
|
Professional
|
Both
|
$18.00
|
|
|
Service Code
|
HCPCS A4338
|
| Hospital Charge Code |
3133582
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$7.92 |
| Max. Negotiated Rate |
$50.41 |
| Rate for Payer: Aetna Commercial |
$17.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$15.48
|
| Rate for Payer: Cash Price |
$5.40
|
| Rate for Payer: Cash Price |
$5.40
|
| Rate for Payer: Cigna Commercial |
$17.10
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$9.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$10.80
|
| Rate for Payer: Health EOS Commercial |
$16.38
|
| Rate for Payer: HFN Commercial |
$17.10
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$50.41
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$50.41
|
| Rate for Payer: Multiplan Commercial |
$14.40
|
| Rate for Payer: Preferred Network Access Commercial |
$17.10
|
| Rate for Payer: Quartz Beloit One Network |
$7.92
|
| Rate for Payer: Quartz Commercial |
$10.26
|
| Rate for Payer: The Alliance Commercial |
$9.00
|
| Rate for Payer: WEA Trust Commercial |
$9.90
|
| Rate for Payer: WPS Commercial |
$13.33
|
|
|
Indwelling catheter latex A4338
|
Facility
|
OP
|
$18.00
|
|
|
Service Code
|
HCPCS A4338
|
| Hospital Charge Code |
3133582
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5.04 |
| Max. Negotiated Rate |
$72.00 |
| Rate for Payer: Aetna Commercial |
$16.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$15.48
|
| Rate for Payer: Aetna Managed Medicare |
$5.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$11.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$9.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$8.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9.54
|
| Rate for Payer: Cash Price |
$5.40
|
| Rate for Payer: Cigna Commercial |
$16.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$10.07
|
| Rate for Payer: Health EOS Commercial |
$16.02
|
| Rate for Payer: HFN Commercial |
$16.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$13.50
|
| Rate for Payer: Multiplan Commercial |
$14.40
|
| Rate for Payer: NAPHCARE Commercial |
$10.80
|
| Rate for Payer: Preferred Network Access Commercial |
$16.56
|
| Rate for Payer: Quartz Beloit One Network |
$8.82
|
| Rate for Payer: Quartz Commercial |
$11.70
|
| Rate for Payer: Quartz Medicare Advantage |
$10.80
|
| Rate for Payer: The Alliance Commercial |
$72.00
|
| Rate for Payer: WEA Trust Commercial |
$9.90
|
| Rate for Payer: WPS Commercial |
$13.33
|
|
