|
Negative - Urine Pregnancy POC
|
Facility
|
OP
|
$168.00
|
|
|
Service Code
|
CPT 81025
|
| Hospital Charge Code |
3120177
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.95 |
| Max. Negotiated Rate |
$160.74 |
| Rate for Payer: Aetna Commercial |
$157.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$150.26
|
| Rate for Payer: Aetna Managed Medicare |
$8.95
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$33.58
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$15.67
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$14.86
|
| Rate for Payer: Anthem Medicare Advantage |
$8.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$92.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$8.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$8.95
|
| Rate for Payer: Cash Price |
$50.40
|
| Rate for Payer: Cash Price |
$50.40
|
| Rate for Payer: Cigna Commercial |
$160.74
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$8.95
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$97.78
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$8.95
|
| Rate for Payer: Health EOS Commercial |
$155.50
|
| Rate for Payer: HFN Commercial |
$160.74
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$33.31
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$8.95
|
| Rate for Payer: Independent Care Health Plan Medicare |
$8.95
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$8.95
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$8.95
|
| Rate for Payer: Multiplan Commercial |
$139.78
|
| Rate for Payer: NAPHCARE Commercial |
$13.43
|
| Rate for Payer: Preferred Network Access Commercial |
$160.74
|
| Rate for Payer: Quartz Beloit One Network |
$85.61
|
| Rate for Payer: Quartz Commercial |
$113.57
|
| Rate for Payer: Quartz Medicare Advantage |
$8.95
|
| Rate for Payer: The Alliance Commercial |
$35.82
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8.95
|
| Rate for Payer: United Healthcare PPO |
$131.04
|
| Rate for Payer: WEA Trust Commercial |
$96.10
|
| Rate for Payer: Wellcare Medicare |
$8.95
|
| Rate for Payer: WPS Commercial |
$129.41
|
|
|
Negative - Urine Pregnancy POC
|
Facility
|
IP
|
$168.00
|
|
|
Service Code
|
CPT 81025
|
| Hospital Charge Code |
3120177
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$85.61 |
| Max. Negotiated Rate |
$160.74 |
| Rate for Payer: Aetna Commercial |
$157.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$150.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$92.60
|
| Rate for Payer: Cash Price |
$50.40
|
| Rate for Payer: Cigna Commercial |
$160.74
|
| Rate for Payer: Health EOS Commercial |
$155.50
|
| Rate for Payer: HFN Commercial |
$160.74
|
| Rate for Payer: Multiplan Commercial |
$139.78
|
| Rate for Payer: Preferred Network Access Commercial |
$160.74
|
| Rate for Payer: Quartz Beloit One Network |
$85.61
|
| Rate for Payer: Quartz Commercial |
$104.83
|
| Rate for Payer: WEA Trust Commercial |
$96.10
|
| Rate for Payer: WPS Commercial |
$129.41
|
|
|
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 |
$20.48 |
| Max. Negotiated Rate |
$1,179.74 |
| Rate for Payer: Aetna Commercial |
$237.12
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$214.66
|
| Rate for Payer: Aetna Managed Medicare |
$20.48
|
| Rate for Payer: Anthem Medicare Advantage |
$20.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$20.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$20.48
|
| 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 |
$237.12
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$32.39
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$20.48
|
| Rate for Payer: Health EOS Commercial |
$227.14
|
| Rate for Payer: HFN Commercial |
$237.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,179.74
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,179.74
|
| Rate for Payer: Independent Care Health Plan Medicare |
$20.48
|
| Rate for Payer: Multiplan Commercial |
$199.68
|
| Rate for Payer: NAPHCARE Commercial |
$30.72
|
| Rate for Payer: Preferred Network Access Commercial |
$237.12
|
| Rate for Payer: Quartz Beloit One Network |
$109.82
|
| Rate for Payer: Quartz Commercial |
$142.27
|
| Rate for Payer: Quartz Medicare Advantage |
$20.48
|
| Rate for Payer: The Alliance Commercial |
$51.19
|
| Rate for Payer: United Healthcare Medicaid |
$32.39
|
| Rate for Payer: United Healthcare Medicare Advantage |
$20.48
|
| Rate for Payer: WEA Trust Commercial |
$137.28
|
| Rate for Payer: WPS Commercial |
$81.91
|
|
|
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 |
$17.87 |
| Max. Negotiated Rate |
$1,211.93 |
| Rate for Payer: Aetna Commercial |
$238.11
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$215.55
|
| Rate for Payer: Aetna Managed Medicare |
$17.87
|
| Rate for Payer: Anthem Medicare Advantage |
$17.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$17.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$17.87
|
| 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 |
$238.11
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$32.39
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$17.87
|
| Rate for Payer: Health EOS Commercial |
$228.08
|
| Rate for Payer: HFN Commercial |
$238.11
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,211.93
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,211.93
|
| Rate for Payer: Independent Care Health Plan Medicare |
$17.87
|
| Rate for Payer: Multiplan Commercial |
$200.51
|
| Rate for Payer: NAPHCARE Commercial |
$26.80
|
| Rate for Payer: Preferred Network Access Commercial |
$238.11
|
| Rate for Payer: Quartz Beloit One Network |
$110.28
|
| Rate for Payer: Quartz Commercial |
$142.86
|
| Rate for Payer: Quartz Medicare Advantage |
$17.87
|
| Rate for Payer: The Alliance Commercial |
$44.67
|
| Rate for Payer: United Healthcare Medicaid |
$32.39
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17.87
|
| Rate for Payer: WEA Trust Commercial |
$137.85
|
| Rate for Payer: WPS Commercial |
$71.47
|
|
|
Neg/Urine Combo Panel 45
|
Facility
|
IP
|
$187.00
|
|
|
Service Code
|
CPT 87186
|
| Hospital Charge Code |
2983119
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$95.30 |
| Max. Negotiated Rate |
$178.92 |
| Rate for Payer: Aetna Commercial |
$175.03
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$167.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$103.07
|
| Rate for Payer: Cash Price |
$56.10
|
| Rate for Payer: Cigna Commercial |
$178.92
|
| Rate for Payer: Health EOS Commercial |
$173.09
|
| Rate for Payer: HFN Commercial |
$178.92
|
| Rate for Payer: Multiplan Commercial |
$155.58
|
| Rate for Payer: Preferred Network Access Commercial |
$178.92
|
| Rate for Payer: Quartz Beloit One Network |
$95.30
|
| Rate for Payer: Quartz Commercial |
$116.69
|
| Rate for Payer: WEA Trust Commercial |
$106.96
|
| Rate for Payer: WPS Commercial |
$144.05
|
|
|
Neg/Urine Combo Panel 45
|
Facility
|
OP
|
$187.00
|
|
|
Service Code
|
CPT 87186
|
| Hospital Charge Code |
2983119
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.00 |
| Max. Negotiated Rate |
$178.92 |
| Rate for Payer: Aetna Commercial |
$175.03
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$167.25
|
| Rate for Payer: Aetna Managed Medicare |
$9.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$33.73
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$15.74
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$14.93
|
| Rate for Payer: Anthem Medicare Advantage |
$9.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$103.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$9.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$9.00
|
| Rate for Payer: Cash Price |
$56.10
|
| Rate for Payer: Cash Price |
$56.10
|
| Rate for Payer: Cigna Commercial |
$178.92
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$9.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$108.83
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$9.00
|
| Rate for Payer: Health EOS Commercial |
$173.09
|
| Rate for Payer: HFN Commercial |
$178.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$33.47
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$9.00
|
| Rate for Payer: Independent Care Health Plan Medicare |
$9.00
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$9.00
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$9.00
|
| Rate for Payer: Multiplan Commercial |
$155.58
|
| Rate for Payer: NAPHCARE Commercial |
$13.49
|
| Rate for Payer: Preferred Network Access Commercial |
$178.92
|
| Rate for Payer: Quartz Beloit One Network |
$95.30
|
| Rate for Payer: Quartz Commercial |
$126.41
|
| Rate for Payer: Quartz Medicare Advantage |
$9.00
|
| Rate for Payer: The Alliance Commercial |
$35.98
|
| Rate for Payer: United Healthcare Medicare Advantage |
$9.00
|
| Rate for Payer: United Healthcare PPO |
$145.86
|
| Rate for Payer: WEA Trust Commercial |
$106.96
|
| Rate for Payer: Wellcare Medicare |
$9.00
|
| Rate for Payer: WPS Commercial |
$144.05
|
|
|
Neg/Urine Combo Panel 45
|
Professional
|
Both
|
$187.00
|
|
|
Service Code
|
CPT 87186
|
| Hospital Charge Code |
2983119
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.00 |
| Max. Negotiated Rate |
$184.76 |
| Rate for Payer: Aetna Commercial |
$184.76
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$167.25
|
| Rate for Payer: Aetna Managed Medicare |
$9.00
|
| Rate for Payer: Anthem Medicare Advantage |
$9.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$9.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$9.00
|
| Rate for Payer: Cash Price |
$56.10
|
| Rate for Payer: Cash Price |
$56.10
|
| Rate for Payer: Cigna Commercial |
$184.76
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$97.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$9.00
|
| Rate for Payer: Health EOS Commercial |
$176.98
|
| Rate for Payer: HFN Commercial |
$184.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$31.75
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$31.75
|
| Rate for Payer: Independent Care Health Plan Medicare |
$9.00
|
| Rate for Payer: Multiplan Commercial |
$155.58
|
| Rate for Payer: NAPHCARE Commercial |
$13.49
|
| Rate for Payer: Preferred Network Access Commercial |
$184.76
|
| Rate for Payer: Quartz Beloit One Network |
$85.57
|
| Rate for Payer: Quartz Commercial |
$110.85
|
| Rate for Payer: Quartz Medicare Advantage |
$9.00
|
| Rate for Payer: The Alliance Commercial |
$35.53
|
| Rate for Payer: United Healthcare Medicare Advantage |
$9.00
|
| Rate for Payer: WEA Trust Commercial |
$106.96
|
| Rate for Payer: WPS Commercial |
$39.58
|
|
|
Neg/Urine Combo Panel 74
|
Facility
|
OP
|
$194.00
|
|
|
Service Code
|
CPT 87186
|
| Hospital Charge Code |
4619052
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.00 |
| Max. Negotiated Rate |
$185.62 |
| Rate for Payer: Aetna Commercial |
$181.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$173.51
|
| Rate for Payer: Aetna Managed Medicare |
$9.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$33.73
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$15.74
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$14.93
|
| Rate for Payer: Anthem Medicare Advantage |
$9.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$106.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$9.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$9.00
|
| Rate for Payer: Cash Price |
$58.20
|
| Rate for Payer: Cash Price |
$58.20
|
| Rate for Payer: Cigna Commercial |
$185.62
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$9.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$112.91
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$9.00
|
| Rate for Payer: Health EOS Commercial |
$179.57
|
| Rate for Payer: HFN Commercial |
$185.62
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$33.47
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$9.00
|
| Rate for Payer: Independent Care Health Plan Medicare |
$9.00
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$9.00
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$9.00
|
| Rate for Payer: Multiplan Commercial |
$161.41
|
| Rate for Payer: NAPHCARE Commercial |
$13.49
|
| Rate for Payer: Preferred Network Access Commercial |
$185.62
|
| Rate for Payer: Quartz Beloit One Network |
$98.86
|
| Rate for Payer: Quartz Commercial |
$131.14
|
| Rate for Payer: Quartz Medicare Advantage |
$9.00
|
| Rate for Payer: The Alliance Commercial |
$35.98
|
| Rate for Payer: United Healthcare Medicare Advantage |
$9.00
|
| Rate for Payer: United Healthcare PPO |
$151.32
|
| Rate for Payer: WEA Trust Commercial |
$110.97
|
| Rate for Payer: Wellcare Medicare |
$9.00
|
| Rate for Payer: WPS Commercial |
$149.44
|
|
|
Neg/Urine Combo Panel 74
|
Professional
|
Both
|
$194.00
|
|
|
Service Code
|
CPT 87186
|
| Hospital Charge Code |
4619052
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.00 |
| Max. Negotiated Rate |
$191.67 |
| Rate for Payer: Aetna Commercial |
$191.67
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$173.51
|
| Rate for Payer: Aetna Managed Medicare |
$9.00
|
| Rate for Payer: Anthem Medicare Advantage |
$9.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$9.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$9.00
|
| Rate for Payer: Cash Price |
$58.20
|
| Rate for Payer: Cash Price |
$58.20
|
| Rate for Payer: Cigna Commercial |
$191.67
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$100.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$9.00
|
| Rate for Payer: Health EOS Commercial |
$183.60
|
| Rate for Payer: HFN Commercial |
$191.67
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$31.75
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$31.75
|
| Rate for Payer: Independent Care Health Plan Medicare |
$9.00
|
| Rate for Payer: Multiplan Commercial |
$161.41
|
| Rate for Payer: NAPHCARE Commercial |
$13.49
|
| Rate for Payer: Preferred Network Access Commercial |
$191.67
|
| Rate for Payer: Quartz Beloit One Network |
$88.77
|
| Rate for Payer: Quartz Commercial |
$115.00
|
| Rate for Payer: Quartz Medicare Advantage |
$9.00
|
| Rate for Payer: The Alliance Commercial |
$35.53
|
| Rate for Payer: United Healthcare Medicare Advantage |
$9.00
|
| Rate for Payer: WEA Trust Commercial |
$110.97
|
| Rate for Payer: WPS Commercial |
$39.58
|
|
|
Neg/Urine Combo Panel 74
|
Facility
|
IP
|
$194.00
|
|
|
Service Code
|
CPT 87186
|
| Hospital Charge Code |
4619052
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$98.86 |
| Max. Negotiated Rate |
$185.62 |
| Rate for Payer: Aetna Commercial |
$181.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$173.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$106.93
|
| Rate for Payer: Cash Price |
$58.20
|
| Rate for Payer: Cigna Commercial |
$185.62
|
| Rate for Payer: Health EOS Commercial |
$179.57
|
| Rate for Payer: HFN Commercial |
$185.62
|
| Rate for Payer: Multiplan Commercial |
$161.41
|
| Rate for Payer: Preferred Network Access Commercial |
$185.62
|
| Rate for Payer: Quartz Beloit One Network |
$98.86
|
| Rate for Payer: Quartz Commercial |
$121.06
|
| Rate for Payer: WEA Trust Commercial |
$110.97
|
| Rate for Payer: WPS Commercial |
$149.44
|
|
|
Neisseria gonorrhoeae RNA Throat
|
Facility
|
OP
|
$38.00
|
|
|
Service Code
|
CPT 87591
|
| Hospital Charge Code |
5080611
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$19.36 |
| Max. Negotiated Rate |
$145.97 |
| Rate for Payer: Aetna Commercial |
$35.57
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$33.99
|
| Rate for Payer: Aetna Managed Medicare |
$36.49
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$136.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$63.86
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$60.58
|
| Rate for Payer: Anthem Medicare Advantage |
$36.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$20.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$36.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$36.49
|
| Rate for Payer: Cash Price |
$11.40
|
| Rate for Payer: Cash Price |
$11.40
|
| Rate for Payer: Cigna Commercial |
$36.36
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$36.49
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$22.12
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$36.49
|
| Rate for Payer: Health EOS Commercial |
$35.17
|
| Rate for Payer: HFN Commercial |
$36.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$135.76
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$36.49
|
| Rate for Payer: Independent Care Health Plan Medicare |
$36.49
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$36.49
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$36.49
|
| Rate for Payer: Multiplan Commercial |
$31.62
|
| Rate for Payer: NAPHCARE Commercial |
$54.74
|
| Rate for Payer: Preferred Network Access Commercial |
$36.36
|
| Rate for Payer: Quartz Beloit One Network |
$19.36
|
| Rate for Payer: Quartz Commercial |
$25.69
|
| Rate for Payer: Quartz Medicare Advantage |
$36.49
|
| Rate for Payer: The Alliance Commercial |
$145.97
|
| Rate for Payer: United Healthcare Medicare Advantage |
$36.49
|
| Rate for Payer: United Healthcare PPO |
$29.64
|
| Rate for Payer: WEA Trust Commercial |
$21.74
|
| Rate for Payer: Wellcare Medicare |
$36.49
|
| Rate for Payer: WPS Commercial |
$29.27
|
|
|
Neisseria gonorrhoeae RNA Throat
|
Professional
|
Both
|
$38.00
|
|
|
Service Code
|
CPT 87591
|
| Hospital Charge Code |
5080611
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.39 |
| Max. Negotiated Rate |
$160.57 |
| Rate for Payer: Aetna Commercial |
$37.54
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$33.99
|
| Rate for Payer: Aetna Managed Medicare |
$36.49
|
| Rate for Payer: Anthem Medicare Advantage |
$36.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$36.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$36.49
|
| Rate for Payer: Cash Price |
$11.40
|
| Rate for Payer: Cash Price |
$11.40
|
| Rate for Payer: Cigna Commercial |
$37.54
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$19.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$36.49
|
| Rate for Payer: Health EOS Commercial |
$35.96
|
| Rate for Payer: HFN Commercial |
$37.54
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$128.82
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$128.82
|
| Rate for Payer: Independent Care Health Plan Medicare |
$36.49
|
| Rate for Payer: Multiplan Commercial |
$31.62
|
| Rate for Payer: NAPHCARE Commercial |
$54.74
|
| Rate for Payer: Preferred Network Access Commercial |
$37.54
|
| Rate for Payer: Quartz Beloit One Network |
$17.39
|
| Rate for Payer: Quartz Commercial |
$22.53
|
| Rate for Payer: Quartz Medicare Advantage |
$36.49
|
| Rate for Payer: The Alliance Commercial |
$144.15
|
| Rate for Payer: United Healthcare Medicare Advantage |
$36.49
|
| Rate for Payer: WEA Trust Commercial |
$21.74
|
| Rate for Payer: WPS Commercial |
$160.57
|
|
|
Neisseria gonorrhoeae RNA Throat
|
Facility
|
IP
|
$38.00
|
|
|
Service Code
|
CPT 87591
|
| Hospital Charge Code |
5080611
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$19.36 |
| Max. Negotiated Rate |
$36.36 |
| Rate for Payer: Aetna Commercial |
$35.57
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$33.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$20.95
|
| Rate for Payer: Cash Price |
$11.40
|
| Rate for Payer: Cigna Commercial |
$36.36
|
| Rate for Payer: Health EOS Commercial |
$35.17
|
| Rate for Payer: HFN Commercial |
$36.36
|
| Rate for Payer: Multiplan Commercial |
$31.62
|
| Rate for Payer: Preferred Network Access Commercial |
$36.36
|
| Rate for Payer: Quartz Beloit One Network |
$19.36
|
| Rate for Payer: Quartz Commercial |
$23.71
|
| Rate for Payer: WEA Trust Commercial |
$21.74
|
| Rate for Payer: WPS Commercial |
$29.27
|
|
|
NEOGUARD TRANSDUCER COVER 610-843
|
Facility
|
IP
|
$91.00
|
|
| Hospital Charge Code |
3989318
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$46.37 |
| Max. Negotiated Rate |
$87.07 |
| Rate for Payer: Aetna Commercial |
$85.18
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$81.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$50.16
|
| Rate for Payer: Cash Price |
$27.30
|
| Rate for Payer: Cigna Commercial |
$87.07
|
| Rate for Payer: Health EOS Commercial |
$84.23
|
| Rate for Payer: HFN Commercial |
$87.07
|
| Rate for Payer: Multiplan Commercial |
$75.71
|
| Rate for Payer: Preferred Network Access Commercial |
$87.07
|
| Rate for Payer: Quartz Beloit One Network |
$46.37
|
| Rate for Payer: Quartz Commercial |
$56.78
|
| Rate for Payer: WEA Trust Commercial |
$52.05
|
| Rate for Payer: WPS Commercial |
$70.10
|
|
|
NEOGUARD TRANSDUCER COVER 610-843
|
Facility
|
OP
|
$91.00
|
|
| Hospital Charge Code |
3989318
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$26.50 |
| Max. Negotiated Rate |
$87.07 |
| Rate for Payer: Aetna Commercial |
$85.18
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$81.39
|
| Rate for Payer: Aetna Managed Medicare |
$26.50
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$61.52
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$47.32
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$45.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$50.16
|
| Rate for Payer: Cash Price |
$27.30
|
| Rate for Payer: Cigna Commercial |
$87.07
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$52.96
|
| Rate for Payer: Health EOS Commercial |
$84.23
|
| Rate for Payer: HFN Commercial |
$87.07
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$70.98
|
| Rate for Payer: Multiplan Commercial |
$75.71
|
| Rate for Payer: NAPHCARE Commercial |
$56.78
|
| Rate for Payer: Preferred Network Access Commercial |
$87.07
|
| Rate for Payer: Quartz Beloit One Network |
$46.37
|
| Rate for Payer: Quartz Commercial |
$61.52
|
| Rate for Payer: Quartz Medicare Advantage |
$56.78
|
| Rate for Payer: The Alliance Commercial |
$47.32
|
| Rate for Payer: WEA Trust Commercial |
$52.05
|
| Rate for Payer: WPS Commercial |
$70.10
|
|
|
Neonatal 02 Transducer N25
|
Facility
|
OP
|
$573.00
|
|
| Hospital Charge Code |
3101750
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$166.86 |
| Max. Negotiated Rate |
$548.25 |
| Rate for Payer: Aetna Commercial |
$536.33
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$512.49
|
| Rate for Payer: Aetna Managed Medicare |
$166.86
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$387.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$297.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$286.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$315.84
|
| Rate for Payer: Cash Price |
$171.90
|
| Rate for Payer: Cigna Commercial |
$548.25
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$333.49
|
| Rate for Payer: Health EOS Commercial |
$530.37
|
| Rate for Payer: HFN Commercial |
$548.25
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$446.94
|
| Rate for Payer: Multiplan Commercial |
$476.74
|
| Rate for Payer: NAPHCARE Commercial |
$357.55
|
| Rate for Payer: Preferred Network Access Commercial |
$548.25
|
| Rate for Payer: Quartz Beloit One Network |
$292.00
|
| Rate for Payer: Quartz Commercial |
$387.35
|
| Rate for Payer: Quartz Medicare Advantage |
$357.55
|
| Rate for Payer: The Alliance Commercial |
$297.96
|
| Rate for Payer: WEA Trust Commercial |
$327.76
|
| Rate for Payer: WPS Commercial |
$441.38
|
|
|
Neonatal 02 Transducer N25
|
Facility
|
IP
|
$573.00
|
|
| Hospital Charge Code |
3101750
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$292.00 |
| Max. Negotiated Rate |
$548.25 |
| Rate for Payer: Aetna Commercial |
$536.33
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$512.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$315.84
|
| Rate for Payer: Cash Price |
$171.90
|
| Rate for Payer: Cigna Commercial |
$548.25
|
| Rate for Payer: Health EOS Commercial |
$530.37
|
| Rate for Payer: HFN Commercial |
$548.25
|
| Rate for Payer: Multiplan Commercial |
$476.74
|
| Rate for Payer: Preferred Network Access Commercial |
$548.25
|
| Rate for Payer: Quartz Beloit One Network |
$292.00
|
| Rate for Payer: Quartz Commercial |
$357.55
|
| Rate for Payer: WEA Trust Commercial |
$327.76
|
| Rate for Payer: WPS Commercial |
$441.38
|
|
|
NEONATAL AFTERCARE
|
Facility
|
IP
|
$81,019.18
|
|
|
Service Code
|
APR-DRG 8634
|
| Min. Negotiated Rate |
$71,966.29 |
| Max. Negotiated Rate |
$81,019.18 |
| Rate for Payer: Anthem Medicaid |
$77,580.33
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$77,580.33
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$77,580.33
|
| Rate for Payer: Dean Health Medicaid |
$77,580.33
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$71,966.29
|
| Rate for Payer: Managed Health Services Medicaid |
$81,019.18
|
| Rate for Payer: Molina Healthcare Medicaid |
$77,580.33
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$77,580.33
|
| Rate for Payer: United Healthcare Medicaid |
$77,580.33
|
|
|
NEONATAL AFTERCARE
|
Facility
|
IP
|
$41,474.11
|
|
|
Service Code
|
APR-DRG 8633
|
| Min. Negotiated Rate |
$36,839.89 |
| Max. Negotiated Rate |
$41,474.11 |
| Rate for Payer: Anthem Medicaid |
$39,713.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$39,713.74
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$39,713.74
|
| Rate for Payer: Dean Health Medicaid |
$39,713.74
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$36,839.89
|
| Rate for Payer: Managed Health Services Medicaid |
$41,474.11
|
| Rate for Payer: Molina Healthcare Medicaid |
$39,713.74
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$39,713.74
|
| Rate for Payer: United Healthcare Medicaid |
$39,713.74
|
|
|
NEONATAL AFTERCARE
|
Facility
|
OP
|
$96.96
|
|
|
Service Code
|
EAPG 00873
|
| Min. Negotiated Rate |
$93.23 |
| Max. Negotiated Rate |
$96.96 |
| Rate for Payer: Anthem Medicaid |
$93.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$93.23
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$93.23
|
| Rate for Payer: Dean Health Medicaid |
$93.23
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$93.23
|
| Rate for Payer: Managed Health Services Medicaid |
$96.96
|
| Rate for Payer: Molina Healthcare Medicaid |
$93.23
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$93.23
|
| Rate for Payer: United Healthcare Medicaid |
$93.23
|
|
|
NEONATAL AFTERCARE
|
Facility
|
IP
|
$21,394.68
|
|
|
Service Code
|
APR-DRG 8632
|
| Min. Negotiated Rate |
$19,004.09 |
| Max. Negotiated Rate |
$21,394.68 |
| Rate for Payer: Anthem Medicaid |
$20,486.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$20,486.58
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$20,486.58
|
| Rate for Payer: Dean Health Medicaid |
$20,486.58
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$19,004.09
|
| Rate for Payer: Managed Health Services Medicaid |
$21,394.68
|
| Rate for Payer: Molina Healthcare Medicaid |
$20,486.58
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$20,486.58
|
| Rate for Payer: United Healthcare Medicaid |
$20,486.58
|
|
|
NEONATAL AFTERCARE
|
Facility
|
IP
|
$11,749.54
|
|
|
Service Code
|
APR-DRG 8631
|
| Min. Negotiated Rate |
$10,436.67 |
| Max. Negotiated Rate |
$11,749.54 |
| Rate for Payer: Anthem Medicaid |
$11,250.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$11,250.83
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$11,250.83
|
| Rate for Payer: Dean Health Medicaid |
$11,250.83
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$10,436.67
|
| Rate for Payer: Managed Health Services Medicaid |
$11,749.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$11,250.83
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$11,250.83
|
| Rate for Payer: United Healthcare Medicaid |
$11,250.83
|
|
|
NEONATAL DIAGNOSES
|
Facility
|
OP
|
$100.89
|
|
|
Service Code
|
EAPG 00771
|
| Min. Negotiated Rate |
$97.01 |
| Max. Negotiated Rate |
$100.89 |
| Rate for Payer: Anthem Medicaid |
$97.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$97.01
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$97.01
|
| Rate for Payer: Dean Health Medicaid |
$97.01
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$97.01
|
| Rate for Payer: Managed Health Services Medicaid |
$100.89
|
| Rate for Payer: Molina Healthcare Medicaid |
$97.01
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$97.01
|
| Rate for Payer: United Healthcare Medicaid |
$97.01
|
|
|
NEONATE BIRTH WEIGHT 1000-1249 GRAMS WITH OR WITHOUT SIGNIFICANT CONDITION
|
Facility
|
IP
|
$7,102.33
|
|
|
Service Code
|
APR-DRG 6031
|
| Min. Negotiated Rate |
$6,308.73 |
| Max. Negotiated Rate |
$7,102.33 |
| Rate for Payer: Anthem Medicaid |
$6,800.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$6,800.87
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$6,800.87
|
| Rate for Payer: Dean Health Medicaid |
$6,800.87
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$6,308.73
|
| Rate for Payer: Managed Health Services Medicaid |
$7,102.33
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,800.87
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$6,800.87
|
| Rate for Payer: United Healthcare Medicaid |
$6,800.87
|
|
|
NEONATE BIRTH WEIGHT 1000-1249 GRAMS WITH OR WITHOUT SIGNIFICANT CONDITION
|
Facility
|
IP
|
$94,259.33
|
|
|
Service Code
|
APR-DRG 6034
|
| Min. Negotiated Rate |
$83,727.02 |
| Max. Negotiated Rate |
$94,259.33 |
| Rate for Payer: Anthem Medicaid |
$90,258.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$90,258.51
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$90,258.51
|
| Rate for Payer: Dean Health Medicaid |
$90,258.51
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$83,727.02
|
| Rate for Payer: Managed Health Services Medicaid |
$94,259.33
|
| Rate for Payer: Molina Healthcare Medicaid |
$90,258.51
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$90,258.51
|
| Rate for Payer: United Healthcare Medicaid |
$90,258.51
|
|
