|
NEONATES, DIED OR TRANSFERRED TO ANOTHER ACUTE CARE FACILITY
|
Facility
|
IP
|
$48,691.00
|
|
|
Service Code
|
MSDRG 789
|
| Min. Negotiated Rate |
$1,600.00 |
| Max. Negotiated Rate |
$48,691.00 |
| Rate for Payer: Aetna Managed Medicare |
$17,514.73
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,496.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,297.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,637.00
|
| Rate for Payer: Anthem Medicare Advantage |
$17,514.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$17,514.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$17,514.73
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$17,514.73
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$30,867.16
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$17,514.73
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$35,478.30
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$17,514.73
|
| Rate for Payer: Independent Care Health Plan Medicare |
$17,514.73
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$17,514.73
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$17,514.73
|
| Rate for Payer: NAPHCARE Commercial |
$26,272.10
|
| Rate for Payer: Quartz Medicare Advantage |
$17,514.73
|
| Rate for Payer: The Alliance Commercial |
$48,691.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17,514.73
|
| Rate for Payer: United Healthcare PPO |
$1,600.00
|
| Rate for Payer: Wellcare Medicare |
$17,514.73
|
|
|
NEONATE WITH OTHER SIGNIFICANT PROBLEMS
|
Facility
|
IP
|
$39,931.00
|
|
|
Service Code
|
MSDRG 794
|
| Min. Negotiated Rate |
$1,600.00 |
| Max. Negotiated Rate |
$39,931.00 |
| Rate for Payer: Aetna Managed Medicare |
$14,363.61
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,496.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,297.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,637.00
|
| Rate for Payer: Anthem Medicare Advantage |
$14,363.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$14,363.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$14,363.61
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$14,363.61
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$25,270.37
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$14,363.61
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$29,053.05
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$14,363.61
|
| Rate for Payer: Independent Care Health Plan Medicare |
$14,363.61
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$14,363.61
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$14,363.61
|
| Rate for Payer: NAPHCARE Commercial |
$21,545.42
|
| Rate for Payer: Quartz Medicare Advantage |
$14,363.61
|
| Rate for Payer: The Alliance Commercial |
$39,931.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14,363.61
|
| Rate for Payer: United Healthcare PPO |
$1,600.00
|
| Rate for Payer: Wellcare Medicare |
$14,363.61
|
|
|
Neo/Poly/Dexameth Ophth Ointment 3.5gm [Med]
|
Facility
|
IP
|
$62.00
|
|
| Hospital Charge Code |
2974929
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$30.38 |
| Max. Negotiated Rate |
$57.04 |
| Rate for Payer: Aetna Commercial |
$55.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$53.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$32.86
|
| Rate for Payer: Cash Price |
$18.60
|
| Rate for Payer: Cigna Commercial |
$57.04
|
| Rate for Payer: Health EOS Commercial |
$55.18
|
| Rate for Payer: HFN Commercial |
$57.04
|
| Rate for Payer: Multiplan Commercial |
$49.60
|
| Rate for Payer: NAPHCARE Commercial |
$37.20
|
| Rate for Payer: Preferred Network Access Commercial |
$57.04
|
| Rate for Payer: Quartz Beloit One Network |
$30.38
|
| Rate for Payer: Quartz Commercial |
$37.20
|
| Rate for Payer: WEA Trust Commercial |
$34.10
|
| Rate for Payer: WPS Commercial |
$45.92
|
|
|
Neo/Poly/Dexameth Ophth Ointment 3.5gm [Med]
|
Facility
|
OP
|
$62.00
|
|
| Hospital Charge Code |
2974929
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$17.36 |
| Max. Negotiated Rate |
$248.00 |
| Rate for Payer: Aetna Commercial |
$55.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$53.32
|
| Rate for Payer: Aetna Managed Medicare |
$17.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$40.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$31.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$29.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$32.86
|
| Rate for Payer: Cash Price |
$18.60
|
| Rate for Payer: Cigna Commercial |
$57.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$34.70
|
| Rate for Payer: Health EOS Commercial |
$55.18
|
| Rate for Payer: HFN Commercial |
$57.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$46.50
|
| Rate for Payer: Multiplan Commercial |
$49.60
|
| Rate for Payer: NAPHCARE Commercial |
$37.20
|
| Rate for Payer: Preferred Network Access Commercial |
$57.04
|
| Rate for Payer: Quartz Beloit One Network |
$30.38
|
| Rate for Payer: Quartz Commercial |
$40.30
|
| Rate for Payer: Quartz Medicare Advantage |
$37.20
|
| Rate for Payer: The Alliance Commercial |
$248.00
|
| Rate for Payer: WEA Trust Commercial |
$34.10
|
| Rate for Payer: WPS Commercial |
$45.92
|
|
|
Neo/Poly/Dexameth Ophth Suspension 5ml [Med]
|
Facility
|
OP
|
$38.00
|
|
| Hospital Charge Code |
2974930
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$10.64 |
| Max. Negotiated Rate |
$152.00 |
| Rate for Payer: Aetna Commercial |
$34.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$32.68
|
| Rate for Payer: Aetna Managed Medicare |
$10.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$24.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$19.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$18.24
|
| 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: Dean Health DHI/DHP/ASO |
$21.26
|
| Rate for Payer: Health EOS Commercial |
$33.82
|
| Rate for Payer: HFN Commercial |
$34.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$28.50
|
| 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 |
$24.70
|
| Rate for Payer: Quartz Medicare Advantage |
$22.80
|
| Rate for Payer: The Alliance Commercial |
$152.00
|
| Rate for Payer: WEA Trust Commercial |
$20.90
|
| Rate for Payer: WPS Commercial |
$28.15
|
|
|
Neo/Poly/Dexameth Ophth Suspension 5ml [Med]
|
Facility
|
IP
|
$38.00
|
|
| Hospital Charge Code |
2974930
|
|
Hospital Revenue Code
|
250
|
| 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
|
|
|
Nephelometry, Fibrospect II
|
Facility
|
OP
|
$254.00
|
|
|
Service Code
|
CPT 83883
|
| Hospital Charge Code |
2776843
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.60 |
| Max. Negotiated Rate |
$233.68 |
| Rate for Payer: Aetna Commercial |
$228.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$218.44
|
| Rate for Payer: Aetna Managed Medicare |
$13.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$51.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$23.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$22.58
|
| Rate for Payer: Anthem Medicaid |
$14.05
|
| Rate for Payer: Anthem Medicare Advantage |
$13.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$134.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$13.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$13.60
|
| Rate for Payer: Cash Price |
$76.20
|
| Rate for Payer: Cash Price |
$76.20
|
| Rate for Payer: Cigna Commercial |
$233.68
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$13.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$14.05
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$142.14
|
| Rate for Payer: Dean Health Medicaid |
$14.05
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$13.60
|
| Rate for Payer: Health EOS Commercial |
$226.06
|
| Rate for Payer: HFN Commercial |
$233.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$50.59
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$13.60
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$14.05
|
| Rate for Payer: Independent Care Health Plan Medicare |
$13.60
|
| Rate for Payer: Managed Health Services Medicaid |
$14.61
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$13.60
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$13.60
|
| Rate for Payer: Multiplan Commercial |
$203.20
|
| Rate for Payer: NAPHCARE Commercial |
$20.40
|
| Rate for Payer: Preferred Network Access Commercial |
$233.68
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$14.05
|
| Rate for Payer: Quartz Beloit One Network |
$124.46
|
| Rate for Payer: Quartz Commercial |
$165.10
|
| Rate for Payer: Quartz Medicare Advantage |
$13.60
|
| Rate for Payer: The Alliance Commercial |
$54.40
|
| Rate for Payer: United Healthcare Medicaid |
$14.05
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.60
|
| Rate for Payer: United Healthcare PPO |
$190.50
|
| Rate for Payer: WEA Trust Commercial |
$139.70
|
| Rate for Payer: Wellcare Medicare |
$13.60
|
| Rate for Payer: WMAP Medicaid |
$14.05
|
| Rate for Payer: WPS Commercial |
$188.14
|
|
|
Nephelometry, Fibrospect II
|
Facility
|
IP
|
$254.00
|
|
|
Service Code
|
CPT 83883
|
| Hospital Charge Code |
2776843
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$124.46 |
| Max. Negotiated Rate |
$233.68 |
| Rate for Payer: Aetna Commercial |
$228.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$218.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$134.62
|
| Rate for Payer: Cash Price |
$76.20
|
| Rate for Payer: Cigna Commercial |
$233.68
|
| Rate for Payer: Health EOS Commercial |
$226.06
|
| Rate for Payer: HFN Commercial |
$233.68
|
| Rate for Payer: Multiplan Commercial |
$203.20
|
| Rate for Payer: NAPHCARE Commercial |
$152.40
|
| Rate for Payer: Preferred Network Access Commercial |
$233.68
|
| Rate for Payer: Quartz Beloit One Network |
$124.46
|
| Rate for Payer: Quartz Commercial |
$152.40
|
| Rate for Payer: WEA Trust Commercial |
$139.70
|
| Rate for Payer: WPS Commercial |
$188.14
|
|
|
Nephelometry, Fibrospect II
|
Professional
|
Both
|
$254.00
|
|
|
Service Code
|
CPT 83883
|
| Hospital Charge Code |
2776843
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$48.01 |
| Max. Negotiated Rate |
$241.30 |
| Rate for Payer: Aetna Commercial |
$241.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$218.44
|
| Rate for Payer: Cash Price |
$76.20
|
| Rate for Payer: Cash Price |
$76.20
|
| Rate for Payer: Cigna Commercial |
$241.30
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$127.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$152.40
|
| Rate for Payer: Health EOS Commercial |
$231.14
|
| Rate for Payer: HFN Commercial |
$241.30
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$48.01
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$48.01
|
| Rate for Payer: Multiplan Commercial |
$203.20
|
| Rate for Payer: Preferred Network Access Commercial |
$241.30
|
| Rate for Payer: Quartz Beloit One Network |
$111.76
|
| Rate for Payer: Quartz Commercial |
$144.78
|
| Rate for Payer: The Alliance Commercial |
$127.00
|
| Rate for Payer: WEA Trust Commercial |
$139.70
|
| Rate for Payer: WPS Commercial |
$188.14
|
|
|
NEPHRECTOMY, PARTIAL/RADICAL
|
Facility
|
OP
|
$8,521.00
|
|
| Hospital Charge Code |
2960240
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,385.88 |
| Max. Negotiated Rate |
$34,084.00 |
| Rate for Payer: Aetna Commercial |
$7,668.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,328.06
|
| Rate for Payer: Aetna Managed Medicare |
$2,385.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,538.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,260.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,090.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,516.13
|
| Rate for Payer: Cash Price |
$2,556.30
|
| Rate for Payer: Cigna Commercial |
$7,839.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,768.35
|
| Rate for Payer: Health EOS Commercial |
$7,583.69
|
| Rate for Payer: HFN Commercial |
$7,839.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,390.75
|
| Rate for Payer: Multiplan Commercial |
$6,816.80
|
| Rate for Payer: NAPHCARE Commercial |
$5,112.60
|
| Rate for Payer: Preferred Network Access Commercial |
$7,839.32
|
| Rate for Payer: Quartz Beloit One Network |
$4,175.29
|
| Rate for Payer: Quartz Commercial |
$5,538.65
|
| Rate for Payer: Quartz Medicare Advantage |
$5,112.60
|
| Rate for Payer: The Alliance Commercial |
$34,084.00
|
| Rate for Payer: WEA Trust Commercial |
$4,686.55
|
| Rate for Payer: WPS Commercial |
$6,311.50
|
|
|
NEPHRECTOMY, PARTIAL/RADICAL
|
Facility
|
IP
|
$8,521.00
|
|
| Hospital Charge Code |
2960240
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4,175.29 |
| Max. Negotiated Rate |
$7,839.32 |
| Rate for Payer: Aetna Commercial |
$7,668.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,328.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,516.13
|
| Rate for Payer: Cash Price |
$2,556.30
|
| Rate for Payer: Cigna Commercial |
$7,839.32
|
| Rate for Payer: Health EOS Commercial |
$7,583.69
|
| Rate for Payer: HFN Commercial |
$7,839.32
|
| Rate for Payer: Multiplan Commercial |
$6,816.80
|
| Rate for Payer: NAPHCARE Commercial |
$5,112.60
|
| Rate for Payer: Preferred Network Access Commercial |
$7,839.32
|
| Rate for Payer: Quartz Beloit One Network |
$4,175.29
|
| Rate for Payer: Quartz Commercial |
$5,112.60
|
| Rate for Payer: WEA Trust Commercial |
$4,686.55
|
| Rate for Payer: WPS Commercial |
$6,311.50
|
|
|
NEPHROGRAM
|
Facility
|
OP
|
$291.00
|
|
| Hospital Charge Code |
2960241
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$81.48 |
| Max. Negotiated Rate |
$1,164.00 |
| Rate for Payer: Aetna Commercial |
$261.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$250.26
|
| Rate for Payer: Aetna Managed Medicare |
$81.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$189.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$145.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$139.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$154.23
|
| Rate for Payer: Cash Price |
$87.30
|
| Rate for Payer: Cigna Commercial |
$267.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$162.84
|
| Rate for Payer: Health EOS Commercial |
$258.99
|
| Rate for Payer: HFN Commercial |
$267.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$218.25
|
| Rate for Payer: Multiplan Commercial |
$232.80
|
| Rate for Payer: NAPHCARE Commercial |
$174.60
|
| Rate for Payer: Preferred Network Access Commercial |
$267.72
|
| Rate for Payer: Quartz Beloit One Network |
$142.59
|
| Rate for Payer: Quartz Commercial |
$189.15
|
| Rate for Payer: Quartz Medicare Advantage |
$174.60
|
| Rate for Payer: The Alliance Commercial |
$1,164.00
|
| Rate for Payer: WEA Trust Commercial |
$160.05
|
| Rate for Payer: WPS Commercial |
$215.54
|
|
|
NEPHROGRAM
|
Facility
|
IP
|
$291.00
|
|
| Hospital Charge Code |
2960241
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$142.59 |
| Max. Negotiated Rate |
$267.72 |
| Rate for Payer: Aetna Commercial |
$261.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$250.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$154.23
|
| Rate for Payer: Cash Price |
$87.30
|
| Rate for Payer: Cigna Commercial |
$267.72
|
| Rate for Payer: Health EOS Commercial |
$258.99
|
| Rate for Payer: HFN Commercial |
$267.72
|
| Rate for Payer: Multiplan Commercial |
$232.80
|
| Rate for Payer: NAPHCARE Commercial |
$174.60
|
| Rate for Payer: Preferred Network Access Commercial |
$267.72
|
| Rate for Payer: Quartz Beloit One Network |
$142.59
|
| Rate for Payer: Quartz Commercial |
$174.60
|
| Rate for Payer: WEA Trust Commercial |
$160.05
|
| Rate for Payer: WPS Commercial |
$215.54
|
|
|
NEPHROLITHOTOMY
|
Facility
|
OP
|
$4,460.00
|
|
| Hospital Charge Code |
2960242
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,248.80 |
| Max. Negotiated Rate |
$17,840.00 |
| Rate for Payer: Aetna Commercial |
$4,014.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,835.60
|
| Rate for Payer: Aetna Managed Medicare |
$1,248.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,899.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,230.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,140.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,363.80
|
| Rate for Payer: Cash Price |
$1,338.00
|
| Rate for Payer: Cigna Commercial |
$4,103.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,495.82
|
| Rate for Payer: Health EOS Commercial |
$3,969.40
|
| Rate for Payer: HFN Commercial |
$4,103.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,345.00
|
| Rate for Payer: Multiplan Commercial |
$3,568.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,676.00
|
| Rate for Payer: Preferred Network Access Commercial |
$4,103.20
|
| Rate for Payer: Quartz Beloit One Network |
$2,185.40
|
| Rate for Payer: Quartz Commercial |
$2,899.00
|
| Rate for Payer: Quartz Medicare Advantage |
$2,676.00
|
| Rate for Payer: The Alliance Commercial |
$17,840.00
|
| Rate for Payer: WEA Trust Commercial |
$2,453.00
|
| Rate for Payer: WPS Commercial |
$3,303.52
|
|
|
NEPHROLITHOTOMY
|
Facility
|
IP
|
$4,460.00
|
|
| Hospital Charge Code |
2960242
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,185.40 |
| Max. Negotiated Rate |
$4,103.20 |
| Rate for Payer: Aetna Commercial |
$4,014.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,835.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,363.80
|
| Rate for Payer: Cash Price |
$1,338.00
|
| Rate for Payer: Cigna Commercial |
$4,103.20
|
| Rate for Payer: Health EOS Commercial |
$3,969.40
|
| Rate for Payer: HFN Commercial |
$4,103.20
|
| Rate for Payer: Multiplan Commercial |
$3,568.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,676.00
|
| Rate for Payer: Preferred Network Access Commercial |
$4,103.20
|
| Rate for Payer: Quartz Beloit One Network |
$2,185.40
|
| Rate for Payer: Quartz Commercial |
$2,676.00
|
| Rate for Payer: WEA Trust Commercial |
$2,453.00
|
| Rate for Payer: WPS Commercial |
$3,303.52
|
|
|
NEPHROPEXY
|
Facility
|
IP
|
$4,460.00
|
|
| Hospital Charge Code |
2960243
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,185.40 |
| Max. Negotiated Rate |
$4,103.20 |
| Rate for Payer: Aetna Commercial |
$4,014.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,835.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,363.80
|
| Rate for Payer: Cash Price |
$1,338.00
|
| Rate for Payer: Cigna Commercial |
$4,103.20
|
| Rate for Payer: Health EOS Commercial |
$3,969.40
|
| Rate for Payer: HFN Commercial |
$4,103.20
|
| Rate for Payer: Multiplan Commercial |
$3,568.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,676.00
|
| Rate for Payer: Preferred Network Access Commercial |
$4,103.20
|
| Rate for Payer: Quartz Beloit One Network |
$2,185.40
|
| Rate for Payer: Quartz Commercial |
$2,676.00
|
| Rate for Payer: WEA Trust Commercial |
$2,453.00
|
| Rate for Payer: WPS Commercial |
$3,303.52
|
|
|
NEPHROPEXY
|
Facility
|
OP
|
$4,460.00
|
|
| Hospital Charge Code |
2960243
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,248.80 |
| Max. Negotiated Rate |
$17,840.00 |
| Rate for Payer: Aetna Commercial |
$4,014.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,835.60
|
| Rate for Payer: Aetna Managed Medicare |
$1,248.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,899.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,230.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,140.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,363.80
|
| Rate for Payer: Cash Price |
$1,338.00
|
| Rate for Payer: Cigna Commercial |
$4,103.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,495.82
|
| Rate for Payer: Health EOS Commercial |
$3,969.40
|
| Rate for Payer: HFN Commercial |
$4,103.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,345.00
|
| Rate for Payer: Multiplan Commercial |
$3,568.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,676.00
|
| Rate for Payer: Preferred Network Access Commercial |
$4,103.20
|
| Rate for Payer: Quartz Beloit One Network |
$2,185.40
|
| Rate for Payer: Quartz Commercial |
$2,899.00
|
| Rate for Payer: Quartz Medicare Advantage |
$2,676.00
|
| Rate for Payer: The Alliance Commercial |
$17,840.00
|
| Rate for Payer: WEA Trust Commercial |
$2,453.00
|
| Rate for Payer: WPS Commercial |
$3,303.52
|
|
|
NEPHROSTOMY TUBE
|
Facility
|
OP
|
$1,084.00
|
|
| Hospital Charge Code |
2960245
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$303.52 |
| Max. Negotiated Rate |
$4,336.00 |
| Rate for Payer: Aetna Commercial |
$975.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$932.24
|
| Rate for Payer: Aetna Managed Medicare |
$303.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$704.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$542.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$520.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$574.52
|
| Rate for Payer: Cash Price |
$325.20
|
| Rate for Payer: Cigna Commercial |
$997.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$606.61
|
| Rate for Payer: Health EOS Commercial |
$964.76
|
| Rate for Payer: HFN Commercial |
$997.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$813.00
|
| Rate for Payer: Multiplan Commercial |
$867.20
|
| Rate for Payer: NAPHCARE Commercial |
$650.40
|
| Rate for Payer: Preferred Network Access Commercial |
$997.28
|
| Rate for Payer: Quartz Beloit One Network |
$531.16
|
| Rate for Payer: Quartz Commercial |
$704.60
|
| Rate for Payer: Quartz Medicare Advantage |
$650.40
|
| Rate for Payer: The Alliance Commercial |
$4,336.00
|
| Rate for Payer: WEA Trust Commercial |
$596.20
|
| Rate for Payer: WPS Commercial |
$802.92
|
|
|
NEPHROSTOMY TUBE
|
Facility
|
IP
|
$1,084.00
|
|
| Hospital Charge Code |
2960245
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$531.16 |
| Max. Negotiated Rate |
$997.28 |
| Rate for Payer: Aetna Commercial |
$975.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$932.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$574.52
|
| Rate for Payer: Cash Price |
$325.20
|
| Rate for Payer: Cigna Commercial |
$997.28
|
| Rate for Payer: Health EOS Commercial |
$964.76
|
| Rate for Payer: HFN Commercial |
$997.28
|
| Rate for Payer: Multiplan Commercial |
$867.20
|
| Rate for Payer: NAPHCARE Commercial |
$650.40
|
| Rate for Payer: Preferred Network Access Commercial |
$997.28
|
| Rate for Payer: Quartz Beloit One Network |
$531.16
|
| Rate for Payer: Quartz Commercial |
$650.40
|
| Rate for Payer: WEA Trust Commercial |
$596.20
|
| Rate for Payer: WPS Commercial |
$802.92
|
|
|
Nephrostomy Tube Placement
|
Facility
|
IP
|
$3,338.00
|
|
|
Service Code
|
CPT 50432
|
| Hospital Charge Code |
3052535
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,635.62 |
| Max. Negotiated Rate |
$3,070.96 |
| Rate for Payer: Aetna Commercial |
$3,004.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,870.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,769.14
|
| Rate for Payer: Cash Price |
$1,001.40
|
| Rate for Payer: Cigna Commercial |
$3,070.96
|
| Rate for Payer: Health EOS Commercial |
$2,970.82
|
| Rate for Payer: HFN Commercial |
$3,070.96
|
| Rate for Payer: Multiplan Commercial |
$2,670.40
|
| Rate for Payer: NAPHCARE Commercial |
$2,002.80
|
| Rate for Payer: Preferred Network Access Commercial |
$3,070.96
|
| Rate for Payer: Quartz Beloit One Network |
$1,635.62
|
| Rate for Payer: Quartz Commercial |
$2,002.80
|
| Rate for Payer: WEA Trust Commercial |
$1,835.90
|
| Rate for Payer: WPS Commercial |
$2,472.46
|
|
|
Nephrostomy Tube Placement
|
Facility
|
OP
|
$3,338.00
|
|
|
Service Code
|
CPT 50432
|
| Hospital Charge Code |
3052535
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,635.62 |
| Max. Negotiated Rate |
$8,052.80 |
| Rate for Payer: Aetna Commercial |
$3,004.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,870.68
|
| Rate for Payer: Aetna Managed Medicare |
$2,013.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,496.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,871.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,726.00
|
| Rate for Payer: Anthem Medicare Advantage |
$2,013.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,769.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$2,013.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$2,013.20
|
| Rate for Payer: Cash Price |
$1,001.40
|
| Rate for Payer: Cash Price |
$1,001.40
|
| Rate for Payer: Cash Price |
$1,001.40
|
| Rate for Payer: Cigna Commercial |
$3,070.96
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$2,013.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,757.59
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$2,013.20
|
| Rate for Payer: Health EOS Commercial |
$2,970.82
|
| Rate for Payer: HFN Commercial |
$3,070.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7,489.10
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$2,013.20
|
| Rate for Payer: Independent Care Health Plan Medicare |
$2,013.20
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$2,013.20
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$2,013.20
|
| Rate for Payer: Multiplan Commercial |
$2,670.40
|
| Rate for Payer: NAPHCARE Commercial |
$3,019.80
|
| Rate for Payer: Preferred Network Access Commercial |
$3,070.96
|
| Rate for Payer: Quartz Beloit One Network |
$1,635.62
|
| Rate for Payer: Quartz Commercial |
$2,169.70
|
| Rate for Payer: Quartz Medicare Advantage |
$2,013.20
|
| Rate for Payer: The Alliance Commercial |
$8,052.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,013.20
|
| Rate for Payer: United Healthcare PPO |
$3,583.00
|
| Rate for Payer: WEA Trust Commercial |
$1,835.90
|
| Rate for Payer: Wellcare Medicare |
$2,013.20
|
| Rate for Payer: WPS Commercial |
$2,472.46
|
|
|
NEPHROURETERECTOMY
|
Facility
|
OP
|
$4,803.00
|
|
| Hospital Charge Code |
2960244
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,344.84 |
| Max. Negotiated Rate |
$19,212.00 |
| Rate for Payer: Aetna Commercial |
$4,322.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,130.58
|
| Rate for Payer: Aetna Managed Medicare |
$1,344.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,121.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,401.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,305.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,545.59
|
| Rate for Payer: Cash Price |
$1,440.90
|
| Rate for Payer: Cigna Commercial |
$4,418.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,687.76
|
| Rate for Payer: Health EOS Commercial |
$4,274.67
|
| Rate for Payer: HFN Commercial |
$4,418.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,602.25
|
| Rate for Payer: Multiplan Commercial |
$3,842.40
|
| Rate for Payer: NAPHCARE Commercial |
$2,881.80
|
| Rate for Payer: Preferred Network Access Commercial |
$4,418.76
|
| Rate for Payer: Quartz Beloit One Network |
$2,353.47
|
| Rate for Payer: Quartz Commercial |
$3,121.95
|
| Rate for Payer: Quartz Medicare Advantage |
$2,881.80
|
| Rate for Payer: The Alliance Commercial |
$19,212.00
|
| Rate for Payer: WEA Trust Commercial |
$2,641.65
|
| Rate for Payer: WPS Commercial |
$3,557.58
|
|
|
NEPHROURETERECTOMY
|
Facility
|
IP
|
$4,803.00
|
|
| Hospital Charge Code |
2960244
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,353.47 |
| Max. Negotiated Rate |
$4,418.76 |
| Rate for Payer: Aetna Commercial |
$4,322.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,130.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,545.59
|
| Rate for Payer: Cash Price |
$1,440.90
|
| Rate for Payer: Cigna Commercial |
$4,418.76
|
| Rate for Payer: Health EOS Commercial |
$4,274.67
|
| Rate for Payer: HFN Commercial |
$4,418.76
|
| Rate for Payer: Multiplan Commercial |
$3,842.40
|
| Rate for Payer: NAPHCARE Commercial |
$2,881.80
|
| Rate for Payer: Preferred Network Access Commercial |
$4,418.76
|
| Rate for Payer: Quartz Beloit One Network |
$2,353.47
|
| Rate for Payer: Quartz Commercial |
$2,881.80
|
| Rate for Payer: WEA Trust Commercial |
$2,641.65
|
| Rate for Payer: WPS Commercial |
$3,557.58
|
|
|
Nepro 8oz Can
|
Facility
|
IP
|
$6.00
|
|
|
Service Code
|
HCPCS B4154
|
| Hospital Charge Code |
3031444
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.94 |
| Max. Negotiated Rate |
$5.52 |
| Rate for Payer: Aetna Commercial |
$5.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3.18
|
| Rate for Payer: Cash Price |
$1.80
|
| Rate for Payer: Cigna Commercial |
$5.52
|
| Rate for Payer: Health EOS Commercial |
$5.34
|
| Rate for Payer: HFN Commercial |
$5.52
|
| Rate for Payer: Multiplan Commercial |
$4.80
|
| Rate for Payer: NAPHCARE Commercial |
$3.60
|
| Rate for Payer: Preferred Network Access Commercial |
$5.52
|
| Rate for Payer: Quartz Beloit One Network |
$2.94
|
| Rate for Payer: Quartz Commercial |
$3.60
|
| Rate for Payer: WEA Trust Commercial |
$3.30
|
| Rate for Payer: WPS Commercial |
$4.44
|
|
|
Nepro 8oz Can
|
Facility
|
OP
|
$6.00
|
|
|
Service Code
|
HCPCS B4154
|
| Hospital Charge Code |
3031444
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.68 |
| Max. Negotiated Rate |
$24.00 |
| Rate for Payer: Aetna Commercial |
$5.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5.16
|
| Rate for Payer: Aetna Managed Medicare |
$1.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3.18
|
| Rate for Payer: Cash Price |
$1.80
|
| Rate for Payer: Cigna Commercial |
$5.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3.36
|
| Rate for Payer: Health EOS Commercial |
$5.34
|
| Rate for Payer: HFN Commercial |
$5.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4.50
|
| Rate for Payer: Multiplan Commercial |
$4.80
|
| Rate for Payer: NAPHCARE Commercial |
$3.60
|
| Rate for Payer: Preferred Network Access Commercial |
$5.52
|
| Rate for Payer: Quartz Beloit One Network |
$2.94
|
| Rate for Payer: Quartz Commercial |
$3.90
|
| Rate for Payer: Quartz Medicare Advantage |
$3.60
|
| Rate for Payer: The Alliance Commercial |
$24.00
|
| Rate for Payer: WEA Trust Commercial |
$3.30
|
| Rate for Payer: WPS Commercial |
$4.44
|
|
