|
Needs practice/supervision
|
Facility
|
OP
|
$53.00
|
|
| Hospital Charge Code |
2990163
|
| Min. Negotiated Rate |
$14.84 |
| Max. Negotiated Rate |
$212.00 |
| Rate for Payer: Aetna Commercial |
$47.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$45.58
|
| Rate for Payer: Aetna Managed Medicare |
$14.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$34.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$26.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$25.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$28.09
|
| Rate for Payer: Cash Price |
$15.90
|
| Rate for Payer: Cigna Commercial |
$48.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$29.66
|
| Rate for Payer: Health EOS Commercial |
$47.17
|
| Rate for Payer: HFN Commercial |
$48.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$39.75
|
| Rate for Payer: Multiplan Commercial |
$42.40
|
| Rate for Payer: NAPHCARE Commercial |
$31.80
|
| Rate for Payer: Preferred Network Access Commercial |
$48.76
|
| Rate for Payer: Quartz Beloit One Network |
$25.97
|
| Rate for Payer: Quartz Commercial |
$34.45
|
| Rate for Payer: Quartz Medicare Advantage |
$31.80
|
| Rate for Payer: The Alliance Commercial |
$212.00
|
| Rate for Payer: WEA Trust Commercial |
$29.15
|
| Rate for Payer: WPS Commercial |
$39.26
|
|
|
Needs practice/supervision
|
Facility
|
IP
|
$53.00
|
|
| Hospital Charge Code |
2990167
|
| Min. Negotiated Rate |
$25.97 |
| Max. Negotiated Rate |
$48.76 |
| Rate for Payer: Aetna Commercial |
$47.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$45.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$28.09
|
| Rate for Payer: Cash Price |
$15.90
|
| Rate for Payer: Cigna Commercial |
$48.76
|
| Rate for Payer: Health EOS Commercial |
$47.17
|
| Rate for Payer: HFN Commercial |
$48.76
|
| Rate for Payer: Multiplan Commercial |
$42.40
|
| Rate for Payer: NAPHCARE Commercial |
$31.80
|
| Rate for Payer: Preferred Network Access Commercial |
$48.76
|
| Rate for Payer: Quartz Beloit One Network |
$25.97
|
| Rate for Payer: Quartz Commercial |
$31.80
|
| Rate for Payer: WEA Trust Commercial |
$29.15
|
| Rate for Payer: WPS Commercial |
$39.26
|
|
|
Needs practice/supervision
|
Facility
|
IP
|
$53.00
|
|
| Hospital Charge Code |
2990175
|
| Min. Negotiated Rate |
$25.97 |
| Max. Negotiated Rate |
$48.76 |
| Rate for Payer: Aetna Commercial |
$47.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$45.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$28.09
|
| Rate for Payer: Cash Price |
$15.90
|
| Rate for Payer: Cigna Commercial |
$48.76
|
| Rate for Payer: Health EOS Commercial |
$47.17
|
| Rate for Payer: HFN Commercial |
$48.76
|
| Rate for Payer: Multiplan Commercial |
$42.40
|
| Rate for Payer: NAPHCARE Commercial |
$31.80
|
| Rate for Payer: Preferred Network Access Commercial |
$48.76
|
| Rate for Payer: Quartz Beloit One Network |
$25.97
|
| Rate for Payer: Quartz Commercial |
$31.80
|
| Rate for Payer: WEA Trust Commercial |
$29.15
|
| Rate for Payer: WPS Commercial |
$39.26
|
|
|
Needs practice/supervision
|
Facility
|
IP
|
$53.00
|
|
| Hospital Charge Code |
2990171
|
| Min. Negotiated Rate |
$25.97 |
| Max. Negotiated Rate |
$48.76 |
| Rate for Payer: Aetna Commercial |
$47.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$45.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$28.09
|
| Rate for Payer: Cash Price |
$15.90
|
| Rate for Payer: Cigna Commercial |
$48.76
|
| Rate for Payer: Health EOS Commercial |
$47.17
|
| Rate for Payer: HFN Commercial |
$48.76
|
| Rate for Payer: Multiplan Commercial |
$42.40
|
| Rate for Payer: NAPHCARE Commercial |
$31.80
|
| Rate for Payer: Preferred Network Access Commercial |
$48.76
|
| Rate for Payer: Quartz Beloit One Network |
$25.97
|
| Rate for Payer: Quartz Commercial |
$31.80
|
| Rate for Payer: WEA Trust Commercial |
$29.15
|
| Rate for Payer: WPS Commercial |
$39.26
|
|
|
Negative Pressure Wound Therapy >50 sq. cm
|
Professional
|
Both
|
$427.00
|
|
|
Service Code
|
CPT 97606
|
| Hospital Charge Code |
1188990
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$31.14 |
| Max. Negotiated Rate |
$405.65 |
| Rate for Payer: Aetna Commercial |
$405.65
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$367.22
|
| Rate for Payer: Cash Price |
$128.10
|
| Rate for Payer: Cash Price |
$128.10
|
| Rate for Payer: Cash Price |
$128.10
|
| Rate for Payer: Cigna Commercial |
$405.65
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$31.14
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$256.20
|
| Rate for Payer: Health EOS Commercial |
$388.57
|
| Rate for Payer: HFN Commercial |
$405.65
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$95.52
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$95.52
|
| Rate for Payer: Multiplan Commercial |
$341.60
|
| Rate for Payer: Preferred Network Access Commercial |
$405.65
|
| Rate for Payer: Quartz Beloit One Network |
$187.88
|
| Rate for Payer: Quartz Commercial |
$243.39
|
| Rate for Payer: The Alliance Commercial |
$213.50
|
| Rate for Payer: United Healthcare Medicaid |
$31.14
|
| Rate for Payer: WEA Trust Commercial |
$234.85
|
| Rate for Payer: WPS Commercial |
$316.28
|
|
|
Negative Pressure Wound Therapy-up to 50 sq. cm
|
Professional
|
Both
|
$199.00
|
|
|
Service Code
|
CPT 97605
|
| Hospital Charge Code |
1188989
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$28.83 |
| Max. Negotiated Rate |
$189.05 |
| Rate for Payer: Aetna Commercial |
$189.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$171.14
|
| Rate for Payer: Cash Price |
$59.70
|
| Rate for Payer: Cash Price |
$59.70
|
| Rate for Payer: Cash Price |
$59.70
|
| Rate for Payer: Cigna Commercial |
$189.05
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$28.83
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$119.40
|
| Rate for Payer: Health EOS Commercial |
$181.09
|
| Rate for Payer: HFN Commercial |
$189.05
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$87.05
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$87.05
|
| Rate for Payer: Multiplan Commercial |
$159.20
|
| Rate for Payer: Preferred Network Access Commercial |
$189.05
|
| Rate for Payer: Quartz Beloit One Network |
$87.56
|
| Rate for Payer: Quartz Commercial |
$113.43
|
| Rate for Payer: The Alliance Commercial |
$99.50
|
| Rate for Payer: United Healthcare Medicaid |
$28.83
|
| Rate for Payer: WEA Trust Commercial |
$109.45
|
| Rate for Payer: WPS Commercial |
$147.40
|
|
|
Negative - Rapid Strep Test
|
Facility
|
OP
|
$199.00
|
|
|
Service Code
|
CPT 87880
|
| Hospital Charge Code |
3052341
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$16.53 |
| Max. Negotiated Rate |
$183.08 |
| Rate for Payer: Aetna Commercial |
$179.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$171.14
|
| Rate for Payer: Aetna Managed Medicare |
$16.53
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$61.99
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$28.93
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$27.44
|
| Rate for Payer: Anthem Medicaid |
$16.86
|
| Rate for Payer: Anthem Medicare Advantage |
$16.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$105.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$16.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$16.53
|
| Rate for Payer: Cash Price |
$59.70
|
| Rate for Payer: Cash Price |
$59.70
|
| Rate for Payer: Cigna Commercial |
$183.08
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$16.53
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$16.86
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$111.36
|
| Rate for Payer: Dean Health Medicaid |
$16.86
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$16.53
|
| Rate for Payer: Health EOS Commercial |
$177.11
|
| Rate for Payer: HFN Commercial |
$183.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$61.49
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$16.53
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$16.86
|
| Rate for Payer: Independent Care Health Plan Medicare |
$16.53
|
| Rate for Payer: Managed Health Services Medicaid |
$17.53
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$16.53
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$16.53
|
| Rate for Payer: Multiplan Commercial |
$159.20
|
| Rate for Payer: NAPHCARE Commercial |
$24.80
|
| Rate for Payer: Preferred Network Access Commercial |
$183.08
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$16.86
|
| Rate for Payer: Quartz Beloit One Network |
$97.51
|
| Rate for Payer: Quartz Commercial |
$129.35
|
| Rate for Payer: Quartz Medicare Advantage |
$16.53
|
| Rate for Payer: The Alliance Commercial |
$66.12
|
| Rate for Payer: United Healthcare Medicaid |
$16.86
|
| Rate for Payer: United Healthcare Medicare Advantage |
$16.53
|
| Rate for Payer: United Healthcare PPO |
$149.25
|
| Rate for Payer: WEA Trust Commercial |
$109.45
|
| Rate for Payer: Wellcare Medicare |
$16.53
|
| Rate for Payer: WMAP Medicaid |
$16.86
|
| Rate for Payer: WPS Commercial |
$147.40
|
|
|
Negative - Rapid Strep Test
|
Facility
|
IP
|
$199.00
|
|
|
Service Code
|
CPT 87880
|
| Hospital Charge Code |
3052341
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$97.51 |
| Max. Negotiated Rate |
$183.08 |
| Rate for Payer: Aetna Commercial |
$179.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$171.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$105.47
|
| Rate for Payer: Cash Price |
$59.70
|
| Rate for Payer: Cigna Commercial |
$183.08
|
| Rate for Payer: Health EOS Commercial |
$177.11
|
| Rate for Payer: HFN Commercial |
$183.08
|
| Rate for Payer: Multiplan Commercial |
$159.20
|
| Rate for Payer: NAPHCARE Commercial |
$119.40
|
| Rate for Payer: Preferred Network Access Commercial |
$183.08
|
| Rate for Payer: Quartz Beloit One Network |
$97.51
|
| Rate for Payer: Quartz Commercial |
$119.40
|
| Rate for Payer: WEA Trust Commercial |
$109.45
|
| Rate for Payer: WPS Commercial |
$147.40
|
|
|
Negative - Urine Pregnancy POC
|
Facility
|
OP
|
$168.00
|
|
|
Service Code
|
CPT 81025
|
| Hospital Charge Code |
3120177
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.61 |
| Max. Negotiated Rate |
$154.56 |
| Rate for Payer: Aetna Commercial |
$151.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$144.48
|
| 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 |
$89.04
|
| 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 |
$50.40
|
| Rate for Payer: Cash Price |
$50.40
|
| Rate for Payer: Cigna Commercial |
$154.56
|
| 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 |
$94.01
|
| 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 |
$149.52
|
| Rate for Payer: HFN Commercial |
$154.56
|
| 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 |
$134.40
|
| Rate for Payer: NAPHCARE Commercial |
$12.92
|
| Rate for Payer: Preferred Network Access Commercial |
$154.56
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$8.90
|
| Rate for Payer: Quartz Beloit One Network |
$82.32
|
| Rate for Payer: Quartz Commercial |
$109.20
|
| 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 |
$126.00
|
| Rate for Payer: WEA Trust Commercial |
$92.40
|
| Rate for Payer: Wellcare Medicare |
$8.61
|
| Rate for Payer: WMAP Medicaid |
$8.90
|
| Rate for Payer: WPS Commercial |
$124.44
|
|
|
Negative - Urine Pregnancy POC
|
Facility
|
IP
|
$168.00
|
|
|
Service Code
|
CPT 81025
|
| Hospital Charge Code |
3120177
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$82.32 |
| Max. Negotiated Rate |
$154.56 |
| Rate for Payer: Aetna Commercial |
$151.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$144.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$89.04
|
| Rate for Payer: Cash Price |
$50.40
|
| Rate for Payer: Cigna Commercial |
$154.56
|
| Rate for Payer: Health EOS Commercial |
$149.52
|
| Rate for Payer: HFN Commercial |
$154.56
|
| Rate for Payer: Multiplan Commercial |
$134.40
|
| Rate for Payer: NAPHCARE Commercial |
$100.80
|
| Rate for Payer: Preferred Network Access Commercial |
$154.56
|
| Rate for Payer: Quartz Beloit One Network |
$82.32
|
| Rate for Payer: Quartz Commercial |
$100.80
|
| Rate for Payer: WEA Trust Commercial |
$92.40
|
| Rate for Payer: WPS Commercial |
$124.44
|
|
|
Neg pressure wound therapy NON DME > 50 sq cm 97608
|
Professional
|
Both
|
$240.00
|
|
|
Service Code
|
CPT 97608
|
| Hospital Charge Code |
5082634
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$31.14 |
| Max. Negotiated Rate |
$1,134.37 |
| Rate for Payer: Aetna Commercial |
$228.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$206.40
|
| Rate for Payer: Cash Price |
$72.00
|
| Rate for Payer: Cash Price |
$72.00
|
| Rate for Payer: Cash Price |
$72.00
|
| Rate for Payer: Cigna Commercial |
$228.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$31.14
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$144.00
|
| Rate for Payer: Health EOS Commercial |
$218.40
|
| Rate for Payer: HFN Commercial |
$228.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,134.37
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,134.37
|
| Rate for Payer: Multiplan Commercial |
$192.00
|
| Rate for Payer: Preferred Network Access Commercial |
$228.00
|
| Rate for Payer: Quartz Beloit One Network |
$105.60
|
| Rate for Payer: Quartz Commercial |
$136.80
|
| Rate for Payer: The Alliance Commercial |
$120.00
|
| Rate for Payer: United Healthcare Medicaid |
$31.14
|
| Rate for Payer: WEA Trust Commercial |
$132.00
|
| Rate for Payer: WPS Commercial |
$177.77
|
|
|
Neg Pressure wound therapy NON DME PROVENA 97607
|
Professional
|
Both
|
$241.00
|
|
|
Service Code
|
CPT 97607
|
| Hospital Charge Code |
5082633
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$31.14 |
| Max. Negotiated Rate |
$1,165.32 |
| Rate for Payer: Aetna Commercial |
$228.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$207.26
|
| Rate for Payer: Cash Price |
$72.30
|
| Rate for Payer: Cash Price |
$72.30
|
| Rate for Payer: Cash Price |
$72.30
|
| Rate for Payer: Cigna Commercial |
$228.95
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$31.14
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$144.60
|
| Rate for Payer: Health EOS Commercial |
$219.31
|
| Rate for Payer: HFN Commercial |
$228.95
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,165.32
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,165.32
|
| Rate for Payer: Multiplan Commercial |
$192.80
|
| Rate for Payer: Preferred Network Access Commercial |
$228.95
|
| Rate for Payer: Quartz Beloit One Network |
$106.04
|
| Rate for Payer: Quartz Commercial |
$137.37
|
| Rate for Payer: The Alliance Commercial |
$120.50
|
| Rate for Payer: United Healthcare Medicaid |
$31.14
|
| Rate for Payer: WEA Trust Commercial |
$132.55
|
| Rate for Payer: WPS Commercial |
$178.51
|
|
|
Neg/Urine Combo Panel 45
|
Facility
|
IP
|
$187.00
|
|
|
Service Code
|
CPT 87186
|
| Hospital Charge Code |
2983119
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$91.63 |
| Max. Negotiated Rate |
$172.04 |
| Rate for Payer: Aetna Commercial |
$168.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$160.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$99.11
|
| Rate for Payer: Cash Price |
$56.10
|
| Rate for Payer: Cigna Commercial |
$172.04
|
| Rate for Payer: Health EOS Commercial |
$166.43
|
| Rate for Payer: HFN Commercial |
$172.04
|
| Rate for Payer: Multiplan Commercial |
$149.60
|
| Rate for Payer: NAPHCARE Commercial |
$112.20
|
| Rate for Payer: Preferred Network Access Commercial |
$172.04
|
| Rate for Payer: Quartz Beloit One Network |
$91.63
|
| Rate for Payer: Quartz Commercial |
$112.20
|
| Rate for Payer: WEA Trust Commercial |
$102.85
|
| Rate for Payer: WPS Commercial |
$138.51
|
|
|
Neg/Urine Combo Panel 45
|
Professional
|
Both
|
$187.00
|
|
|
Service Code
|
CPT 87186
|
| Hospital Charge Code |
2983119
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$30.53 |
| Max. Negotiated Rate |
$177.65 |
| Rate for Payer: Aetna Commercial |
$177.65
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$160.82
|
| Rate for Payer: Cash Price |
$56.10
|
| Rate for Payer: Cash Price |
$56.10
|
| Rate for Payer: Cigna Commercial |
$177.65
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$93.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$112.20
|
| Rate for Payer: Health EOS Commercial |
$170.17
|
| Rate for Payer: HFN Commercial |
$177.65
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$30.53
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$30.53
|
| Rate for Payer: Multiplan Commercial |
$149.60
|
| Rate for Payer: Preferred Network Access Commercial |
$177.65
|
| Rate for Payer: Quartz Beloit One Network |
$82.28
|
| Rate for Payer: Quartz Commercial |
$106.59
|
| Rate for Payer: The Alliance Commercial |
$93.50
|
| Rate for Payer: WEA Trust Commercial |
$102.85
|
| Rate for Payer: WPS Commercial |
$138.51
|
|
|
Neg/Urine Combo Panel 45
|
Facility
|
OP
|
$187.00
|
|
|
Service Code
|
CPT 87186
|
| Hospital Charge Code |
2983119
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.65 |
| Max. Negotiated Rate |
$172.04 |
| Rate for Payer: Aetna Commercial |
$168.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$160.82
|
| Rate for Payer: Aetna Managed Medicare |
$8.65
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$32.44
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$15.14
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$14.36
|
| Rate for Payer: Anthem Medicaid |
$8.94
|
| Rate for Payer: Anthem Medicare Advantage |
$8.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$99.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$8.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$8.65
|
| Rate for Payer: Cash Price |
$56.10
|
| Rate for Payer: Cash Price |
$56.10
|
| Rate for Payer: Cigna Commercial |
$172.04
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$8.65
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$8.94
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$104.65
|
| Rate for Payer: Dean Health Medicaid |
$8.94
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$8.65
|
| Rate for Payer: Health EOS Commercial |
$166.43
|
| Rate for Payer: HFN Commercial |
$172.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$32.18
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$8.65
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$8.94
|
| Rate for Payer: Independent Care Health Plan Medicare |
$8.65
|
| Rate for Payer: Managed Health Services Medicaid |
$9.30
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$8.65
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$8.65
|
| Rate for Payer: Multiplan Commercial |
$149.60
|
| Rate for Payer: NAPHCARE Commercial |
$12.98
|
| Rate for Payer: Preferred Network Access Commercial |
$172.04
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$8.94
|
| Rate for Payer: Quartz Beloit One Network |
$91.63
|
| Rate for Payer: Quartz Commercial |
$121.55
|
| Rate for Payer: Quartz Medicare Advantage |
$8.65
|
| Rate for Payer: The Alliance Commercial |
$34.60
|
| Rate for Payer: United Healthcare Medicaid |
$8.94
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8.65
|
| Rate for Payer: United Healthcare PPO |
$140.25
|
| Rate for Payer: WEA Trust Commercial |
$102.85
|
| Rate for Payer: Wellcare Medicare |
$8.65
|
| Rate for Payer: WMAP Medicaid |
$8.94
|
| Rate for Payer: WPS Commercial |
$138.51
|
|
|
Neg/Urine Combo Panel 74
|
Facility
|
OP
|
$194.00
|
|
|
Service Code
|
CPT 87186
|
| Hospital Charge Code |
4619052
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.65 |
| Max. Negotiated Rate |
$178.48 |
| Rate for Payer: Aetna Commercial |
$174.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$166.84
|
| Rate for Payer: Aetna Managed Medicare |
$8.65
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$32.44
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$15.14
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$14.36
|
| Rate for Payer: Anthem Medicaid |
$8.94
|
| Rate for Payer: Anthem Medicare Advantage |
$8.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$102.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$8.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$8.65
|
| Rate for Payer: Cash Price |
$58.20
|
| Rate for Payer: Cash Price |
$58.20
|
| Rate for Payer: Cigna Commercial |
$178.48
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$8.65
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$8.94
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$108.56
|
| Rate for Payer: Dean Health Medicaid |
$8.94
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$8.65
|
| Rate for Payer: Health EOS Commercial |
$172.66
|
| Rate for Payer: HFN Commercial |
$178.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$32.18
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$8.65
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$8.94
|
| Rate for Payer: Independent Care Health Plan Medicare |
$8.65
|
| Rate for Payer: Managed Health Services Medicaid |
$9.30
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$8.65
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$8.65
|
| Rate for Payer: Multiplan Commercial |
$155.20
|
| Rate for Payer: NAPHCARE Commercial |
$12.98
|
| Rate for Payer: Preferred Network Access Commercial |
$178.48
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$8.94
|
| Rate for Payer: Quartz Beloit One Network |
$95.06
|
| Rate for Payer: Quartz Commercial |
$126.10
|
| Rate for Payer: Quartz Medicare Advantage |
$8.65
|
| Rate for Payer: The Alliance Commercial |
$34.60
|
| Rate for Payer: United Healthcare Medicaid |
$8.94
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8.65
|
| Rate for Payer: United Healthcare PPO |
$145.50
|
| Rate for Payer: WEA Trust Commercial |
$106.70
|
| Rate for Payer: Wellcare Medicare |
$8.65
|
| Rate for Payer: WMAP Medicaid |
$8.94
|
| Rate for Payer: WPS Commercial |
$143.70
|
|
|
Neg/Urine Combo Panel 74
|
Facility
|
IP
|
$194.00
|
|
|
Service Code
|
CPT 87186
|
| Hospital Charge Code |
4619052
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$95.06 |
| Max. Negotiated Rate |
$178.48 |
| Rate for Payer: Aetna Commercial |
$174.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$166.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$102.82
|
| Rate for Payer: Cash Price |
$58.20
|
| Rate for Payer: Cigna Commercial |
$178.48
|
| Rate for Payer: Health EOS Commercial |
$172.66
|
| Rate for Payer: HFN Commercial |
$178.48
|
| Rate for Payer: Multiplan Commercial |
$155.20
|
| Rate for Payer: NAPHCARE Commercial |
$116.40
|
| Rate for Payer: Preferred Network Access Commercial |
$178.48
|
| Rate for Payer: Quartz Beloit One Network |
$95.06
|
| Rate for Payer: Quartz Commercial |
$116.40
|
| Rate for Payer: WEA Trust Commercial |
$106.70
|
| Rate for Payer: WPS Commercial |
$143.70
|
|
|
Neg/Urine Combo Panel 74
|
Professional
|
Both
|
$194.00
|
|
|
Service Code
|
CPT 87186
|
| Hospital Charge Code |
4619052
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$30.53 |
| Max. Negotiated Rate |
$184.30 |
| Rate for Payer: Aetna Commercial |
$184.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$166.84
|
| Rate for Payer: Cash Price |
$58.20
|
| Rate for Payer: Cash Price |
$58.20
|
| Rate for Payer: Cigna Commercial |
$184.30
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$97.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$116.40
|
| Rate for Payer: Health EOS Commercial |
$176.54
|
| Rate for Payer: HFN Commercial |
$184.30
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$30.53
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$30.53
|
| Rate for Payer: Multiplan Commercial |
$155.20
|
| Rate for Payer: Preferred Network Access Commercial |
$184.30
|
| Rate for Payer: Quartz Beloit One Network |
$85.36
|
| Rate for Payer: Quartz Commercial |
$110.58
|
| Rate for Payer: The Alliance Commercial |
$97.00
|
| Rate for Payer: WEA Trust Commercial |
$106.70
|
| Rate for Payer: WPS Commercial |
$143.70
|
|
|
Neisseria gonorrhoeae RNA Throat
|
Facility
|
OP
|
$38.00
|
|
|
Service Code
|
CPT 87591
|
| Hospital Charge Code |
5080611
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.62 |
| Max. Negotiated Rate |
$140.36 |
| Rate for Payer: Aetna Commercial |
$34.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$32.68
|
| Rate for Payer: Aetna Managed Medicare |
$35.09
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$131.59
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$61.41
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$58.25
|
| Rate for Payer: Anthem Medicaid |
$36.26
|
| Rate for Payer: Anthem Medicare Advantage |
$35.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$20.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$35.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$35.09
|
| Rate for Payer: Cash Price |
$11.40
|
| Rate for Payer: Cash Price |
$11.40
|
| Rate for Payer: Cigna Commercial |
$34.96
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$35.09
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$36.26
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$21.26
|
| Rate for Payer: Dean Health Medicaid |
$36.26
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$35.09
|
| Rate for Payer: Health EOS Commercial |
$33.82
|
| Rate for Payer: HFN Commercial |
$34.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$130.53
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$35.09
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$36.26
|
| Rate for Payer: Independent Care Health Plan Medicare |
$35.09
|
| Rate for Payer: Managed Health Services Medicaid |
$37.71
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$35.09
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$35.09
|
| Rate for Payer: Multiplan Commercial |
$30.40
|
| Rate for Payer: NAPHCARE Commercial |
$52.64
|
| Rate for Payer: Preferred Network Access Commercial |
$34.96
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$36.26
|
| Rate for Payer: Quartz Beloit One Network |
$18.62
|
| Rate for Payer: Quartz Commercial |
$24.70
|
| Rate for Payer: Quartz Medicare Advantage |
$35.09
|
| Rate for Payer: The Alliance Commercial |
$140.36
|
| Rate for Payer: United Healthcare Medicaid |
$36.26
|
| Rate for Payer: United Healthcare Medicare Advantage |
$35.09
|
| Rate for Payer: United Healthcare PPO |
$28.50
|
| Rate for Payer: WEA Trust Commercial |
$20.90
|
| Rate for Payer: Wellcare Medicare |
$35.09
|
| Rate for Payer: WMAP Medicaid |
$36.26
|
| Rate for Payer: WPS Commercial |
$28.15
|
|
|
Neisseria gonorrhoeae RNA Throat
|
Professional
|
Both
|
$38.00
|
|
|
Service Code
|
CPT 87591
|
| Hospital Charge Code |
5080611
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$16.72 |
| Max. Negotiated Rate |
$123.87 |
| Rate for Payer: Aetna Commercial |
$36.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$32.68
|
| Rate for Payer: Cash Price |
$11.40
|
| Rate for Payer: Cash Price |
$11.40
|
| Rate for Payer: Cigna Commercial |
$36.10
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$19.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$22.80
|
| Rate for Payer: Health EOS Commercial |
$34.58
|
| Rate for Payer: HFN Commercial |
$36.10
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$123.87
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$123.87
|
| Rate for Payer: Multiplan Commercial |
$30.40
|
| Rate for Payer: Preferred Network Access Commercial |
$36.10
|
| Rate for Payer: Quartz Beloit One Network |
$16.72
|
| Rate for Payer: Quartz Commercial |
$21.66
|
| Rate for Payer: The Alliance Commercial |
$19.00
|
| Rate for Payer: WEA Trust Commercial |
$20.90
|
| Rate for Payer: WPS Commercial |
$28.15
|
|
|
Neisseria gonorrhoeae RNA Throat
|
Facility
|
IP
|
$38.00
|
|
|
Service Code
|
CPT 87591
|
| Hospital Charge Code |
5080611
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.62 |
| Max. Negotiated Rate |
$34.96 |
| Rate for Payer: Aetna Commercial |
$34.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$32.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$20.14
|
| Rate for Payer: Cash Price |
$11.40
|
| Rate for Payer: Cigna Commercial |
$34.96
|
| Rate for Payer: Health EOS Commercial |
$33.82
|
| Rate for Payer: HFN Commercial |
$34.96
|
| Rate for Payer: Multiplan Commercial |
$30.40
|
| Rate for Payer: NAPHCARE Commercial |
$22.80
|
| Rate for Payer: Preferred Network Access Commercial |
$34.96
|
| Rate for Payer: Quartz Beloit One Network |
$18.62
|
| Rate for Payer: Quartz Commercial |
$22.80
|
| Rate for Payer: WEA Trust Commercial |
$20.90
|
| Rate for Payer: WPS Commercial |
$28.15
|
|
|
NEOGUARD TRANSDUCER COVER 610-843
|
Facility
|
IP
|
$91.00
|
|
| Hospital Charge Code |
3989318
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$44.59 |
| Max. Negotiated Rate |
$83.72 |
| Rate for Payer: Aetna Commercial |
$81.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$78.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$48.23
|
| Rate for Payer: Cash Price |
$27.30
|
| Rate for Payer: Cigna Commercial |
$83.72
|
| Rate for Payer: Health EOS Commercial |
$80.99
|
| Rate for Payer: HFN Commercial |
$83.72
|
| Rate for Payer: Multiplan Commercial |
$72.80
|
| Rate for Payer: NAPHCARE Commercial |
$54.60
|
| Rate for Payer: Preferred Network Access Commercial |
$83.72
|
| Rate for Payer: Quartz Beloit One Network |
$44.59
|
| Rate for Payer: Quartz Commercial |
$54.60
|
| Rate for Payer: WEA Trust Commercial |
$50.05
|
| Rate for Payer: WPS Commercial |
$67.40
|
|
|
NEOGUARD TRANSDUCER COVER 610-843
|
Facility
|
OP
|
$91.00
|
|
| Hospital Charge Code |
3989318
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$25.48 |
| Max. Negotiated Rate |
$364.00 |
| Rate for Payer: Aetna Commercial |
$81.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$78.26
|
| Rate for Payer: Aetna Managed Medicare |
$25.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$59.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$45.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$43.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$48.23
|
| Rate for Payer: Cash Price |
$27.30
|
| Rate for Payer: Cigna Commercial |
$83.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$50.92
|
| Rate for Payer: Health EOS Commercial |
$80.99
|
| Rate for Payer: HFN Commercial |
$83.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$68.25
|
| Rate for Payer: Multiplan Commercial |
$72.80
|
| Rate for Payer: NAPHCARE Commercial |
$54.60
|
| Rate for Payer: Preferred Network Access Commercial |
$83.72
|
| Rate for Payer: Quartz Beloit One Network |
$44.59
|
| Rate for Payer: Quartz Commercial |
$59.15
|
| Rate for Payer: Quartz Medicare Advantage |
$54.60
|
| Rate for Payer: The Alliance Commercial |
$364.00
|
| Rate for Payer: WEA Trust Commercial |
$50.05
|
| Rate for Payer: WPS Commercial |
$67.40
|
|
|
Neonatal 02 Transducer N25
|
Facility
|
IP
|
$573.00
|
|
| Hospital Charge Code |
3101750
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$280.77 |
| Max. Negotiated Rate |
$527.16 |
| Rate for Payer: Aetna Commercial |
$515.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$492.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$303.69
|
| Rate for Payer: Cash Price |
$171.90
|
| Rate for Payer: Cigna Commercial |
$527.16
|
| Rate for Payer: Health EOS Commercial |
$509.97
|
| Rate for Payer: HFN Commercial |
$527.16
|
| Rate for Payer: Multiplan Commercial |
$458.40
|
| Rate for Payer: NAPHCARE Commercial |
$343.80
|
| Rate for Payer: Preferred Network Access Commercial |
$527.16
|
| Rate for Payer: Quartz Beloit One Network |
$280.77
|
| Rate for Payer: Quartz Commercial |
$343.80
|
| Rate for Payer: WEA Trust Commercial |
$315.15
|
| Rate for Payer: WPS Commercial |
$424.42
|
|
|
Neonatal 02 Transducer N25
|
Facility
|
OP
|
$573.00
|
|
| Hospital Charge Code |
3101750
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$160.44 |
| Max. Negotiated Rate |
$2,292.00 |
| Rate for Payer: Aetna Commercial |
$515.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$492.78
|
| Rate for Payer: Aetna Managed Medicare |
$160.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$372.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$286.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$275.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$303.69
|
| Rate for Payer: Cash Price |
$171.90
|
| Rate for Payer: Cigna Commercial |
$527.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$320.65
|
| Rate for Payer: Health EOS Commercial |
$509.97
|
| Rate for Payer: HFN Commercial |
$527.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$429.75
|
| Rate for Payer: Multiplan Commercial |
$458.40
|
| Rate for Payer: NAPHCARE Commercial |
$343.80
|
| Rate for Payer: Preferred Network Access Commercial |
$527.16
|
| Rate for Payer: Quartz Beloit One Network |
$280.77
|
| Rate for Payer: Quartz Commercial |
$372.45
|
| Rate for Payer: Quartz Medicare Advantage |
$343.80
|
| Rate for Payer: The Alliance Commercial |
$2,292.00
|
| Rate for Payer: WEA Trust Commercial |
$315.15
|
| Rate for Payer: WPS Commercial |
$424.42
|
|
