|
NEPHRITIS AND NEPHROSIS
|
Facility
|
OP
|
$96.96
|
|
|
Service Code
|
EAPG 00722
|
| 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
|
|
|
NEPHROGRAM
|
Facility
|
IP
|
$291.00
|
|
| Hospital Charge Code |
2960241
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$148.29 |
| Max. Negotiated Rate |
$278.43 |
| Rate for Payer: Aetna Commercial |
$272.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$260.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$160.40
|
| Rate for Payer: Cash Price |
$87.30
|
| Rate for Payer: Cigna Commercial |
$278.43
|
| Rate for Payer: Health EOS Commercial |
$269.35
|
| Rate for Payer: HFN Commercial |
$278.43
|
| Rate for Payer: Multiplan Commercial |
$242.11
|
| Rate for Payer: Preferred Network Access Commercial |
$278.43
|
| Rate for Payer: Quartz Beloit One Network |
$148.29
|
| Rate for Payer: Quartz Commercial |
$181.58
|
| Rate for Payer: WEA Trust Commercial |
$166.45
|
| Rate for Payer: WPS Commercial |
$224.16
|
|
|
NEPHROGRAM
|
Facility
|
OP
|
$291.00
|
|
| Hospital Charge Code |
2960241
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$84.74 |
| Max. Negotiated Rate |
$278.43 |
| Rate for Payer: Aetna Commercial |
$272.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$260.27
|
| Rate for Payer: Aetna Managed Medicare |
$84.74
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$196.72
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$151.32
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$145.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$160.40
|
| Rate for Payer: Cash Price |
$87.30
|
| Rate for Payer: Cigna Commercial |
$278.43
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$169.36
|
| Rate for Payer: Health EOS Commercial |
$269.35
|
| Rate for Payer: HFN Commercial |
$278.43
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$226.98
|
| Rate for Payer: Multiplan Commercial |
$242.11
|
| Rate for Payer: NAPHCARE Commercial |
$181.58
|
| Rate for Payer: Preferred Network Access Commercial |
$278.43
|
| Rate for Payer: Quartz Beloit One Network |
$148.29
|
| Rate for Payer: Quartz Commercial |
$196.72
|
| Rate for Payer: Quartz Medicare Advantage |
$181.58
|
| Rate for Payer: The Alliance Commercial |
$151.32
|
| Rate for Payer: WEA Trust Commercial |
$166.45
|
| Rate for Payer: WPS Commercial |
$224.16
|
|
|
NEPHROLITHOTOMY
|
Facility
|
OP
|
$4,460.00
|
|
| Hospital Charge Code |
2960242
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,298.75 |
| Max. Negotiated Rate |
$4,267.33 |
| Rate for Payer: Aetna Commercial |
$4,174.56
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,989.02
|
| Rate for Payer: Aetna Managed Medicare |
$1,298.75
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,014.96
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,319.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,226.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,458.35
|
| Rate for Payer: Cash Price |
$1,338.00
|
| Rate for Payer: Cigna Commercial |
$4,267.33
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,595.72
|
| Rate for Payer: Health EOS Commercial |
$4,128.18
|
| Rate for Payer: HFN Commercial |
$4,267.33
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,478.80
|
| Rate for Payer: Multiplan Commercial |
$3,710.72
|
| Rate for Payer: NAPHCARE Commercial |
$2,783.04
|
| Rate for Payer: Preferred Network Access Commercial |
$4,267.33
|
| Rate for Payer: Quartz Beloit One Network |
$2,272.82
|
| Rate for Payer: Quartz Commercial |
$3,014.96
|
| Rate for Payer: Quartz Medicare Advantage |
$2,783.04
|
| Rate for Payer: The Alliance Commercial |
$2,319.20
|
| Rate for Payer: WEA Trust Commercial |
$2,551.12
|
| Rate for Payer: WPS Commercial |
$3,435.54
|
|
|
NEPHROLITHOTOMY
|
Facility
|
IP
|
$4,460.00
|
|
| Hospital Charge Code |
2960242
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,272.82 |
| Max. Negotiated Rate |
$4,267.33 |
| Rate for Payer: Aetna Commercial |
$4,174.56
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,989.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,458.35
|
| Rate for Payer: Cash Price |
$1,338.00
|
| Rate for Payer: Cigna Commercial |
$4,267.33
|
| Rate for Payer: Health EOS Commercial |
$4,128.18
|
| Rate for Payer: HFN Commercial |
$4,267.33
|
| Rate for Payer: Multiplan Commercial |
$3,710.72
|
| Rate for Payer: Preferred Network Access Commercial |
$4,267.33
|
| Rate for Payer: Quartz Beloit One Network |
$2,272.82
|
| Rate for Payer: Quartz Commercial |
$2,783.04
|
| Rate for Payer: WEA Trust Commercial |
$2,551.12
|
| Rate for Payer: WPS Commercial |
$3,435.54
|
|
|
NEPHROPEXY
|
Facility
|
IP
|
$4,460.00
|
|
| Hospital Charge Code |
2960243
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,272.82 |
| Max. Negotiated Rate |
$4,267.33 |
| Rate for Payer: Aetna Commercial |
$4,174.56
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,989.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,458.35
|
| Rate for Payer: Cash Price |
$1,338.00
|
| Rate for Payer: Cigna Commercial |
$4,267.33
|
| Rate for Payer: Health EOS Commercial |
$4,128.18
|
| Rate for Payer: HFN Commercial |
$4,267.33
|
| Rate for Payer: Multiplan Commercial |
$3,710.72
|
| Rate for Payer: Preferred Network Access Commercial |
$4,267.33
|
| Rate for Payer: Quartz Beloit One Network |
$2,272.82
|
| Rate for Payer: Quartz Commercial |
$2,783.04
|
| Rate for Payer: WEA Trust Commercial |
$2,551.12
|
| Rate for Payer: WPS Commercial |
$3,435.54
|
|
|
NEPHROPEXY
|
Facility
|
OP
|
$4,460.00
|
|
| Hospital Charge Code |
2960243
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,298.75 |
| Max. Negotiated Rate |
$4,267.33 |
| Rate for Payer: Aetna Commercial |
$4,174.56
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,989.02
|
| Rate for Payer: Aetna Managed Medicare |
$1,298.75
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,014.96
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,319.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,226.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,458.35
|
| Rate for Payer: Cash Price |
$1,338.00
|
| Rate for Payer: Cigna Commercial |
$4,267.33
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,595.72
|
| Rate for Payer: Health EOS Commercial |
$4,128.18
|
| Rate for Payer: HFN Commercial |
$4,267.33
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,478.80
|
| Rate for Payer: Multiplan Commercial |
$3,710.72
|
| Rate for Payer: NAPHCARE Commercial |
$2,783.04
|
| Rate for Payer: Preferred Network Access Commercial |
$4,267.33
|
| Rate for Payer: Quartz Beloit One Network |
$2,272.82
|
| Rate for Payer: Quartz Commercial |
$3,014.96
|
| Rate for Payer: Quartz Medicare Advantage |
$2,783.04
|
| Rate for Payer: The Alliance Commercial |
$2,319.20
|
| Rate for Payer: WEA Trust Commercial |
$2,551.12
|
| Rate for Payer: WPS Commercial |
$3,435.54
|
|
|
NEPHROSTOMY TUBE
|
Facility
|
IP
|
$1,084.00
|
|
| Hospital Charge Code |
2960245
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$552.41 |
| Max. Negotiated Rate |
$1,037.17 |
| Rate for Payer: Aetna Commercial |
$1,014.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$969.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$597.50
|
| Rate for Payer: Cash Price |
$325.20
|
| Rate for Payer: Cigna Commercial |
$1,037.17
|
| Rate for Payer: Health EOS Commercial |
$1,003.35
|
| Rate for Payer: HFN Commercial |
$1,037.17
|
| Rate for Payer: Multiplan Commercial |
$901.89
|
| Rate for Payer: Preferred Network Access Commercial |
$1,037.17
|
| Rate for Payer: Quartz Beloit One Network |
$552.41
|
| Rate for Payer: Quartz Commercial |
$676.42
|
| Rate for Payer: WEA Trust Commercial |
$620.05
|
| Rate for Payer: WPS Commercial |
$835.01
|
|
|
NEPHROSTOMY TUBE
|
Facility
|
OP
|
$1,084.00
|
|
| Hospital Charge Code |
2960245
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$315.66 |
| Max. Negotiated Rate |
$1,037.17 |
| Rate for Payer: Aetna Commercial |
$1,014.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$969.53
|
| Rate for Payer: Aetna Managed Medicare |
$315.66
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$732.78
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$563.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$541.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$597.50
|
| Rate for Payer: Cash Price |
$325.20
|
| Rate for Payer: Cigna Commercial |
$1,037.17
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$630.89
|
| Rate for Payer: Health EOS Commercial |
$1,003.35
|
| Rate for Payer: HFN Commercial |
$1,037.17
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$845.52
|
| Rate for Payer: Multiplan Commercial |
$901.89
|
| Rate for Payer: NAPHCARE Commercial |
$676.42
|
| Rate for Payer: Preferred Network Access Commercial |
$1,037.17
|
| Rate for Payer: Quartz Beloit One Network |
$552.41
|
| Rate for Payer: Quartz Commercial |
$732.78
|
| Rate for Payer: Quartz Medicare Advantage |
$676.42
|
| Rate for Payer: The Alliance Commercial |
$563.68
|
| Rate for Payer: WEA Trust Commercial |
$620.05
|
| Rate for Payer: WPS Commercial |
$835.01
|
|
|
Nephrostomy Tube Placement
|
Facility
|
IP
|
$3,338.00
|
|
|
Service Code
|
CPT 50432
|
| Hospital Charge Code |
3052535
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,701.04 |
| Max. Negotiated Rate |
$3,193.80 |
| Rate for Payer: Aetna Commercial |
$3,124.37
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,985.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,839.91
|
| Rate for Payer: Cash Price |
$1,001.40
|
| Rate for Payer: Cigna Commercial |
$3,193.80
|
| Rate for Payer: Health EOS Commercial |
$3,089.65
|
| Rate for Payer: HFN Commercial |
$3,193.80
|
| Rate for Payer: Multiplan Commercial |
$2,777.22
|
| Rate for Payer: Preferred Network Access Commercial |
$3,193.80
|
| Rate for Payer: Quartz Beloit One Network |
$1,701.04
|
| Rate for Payer: Quartz Commercial |
$2,082.91
|
| Rate for Payer: WEA Trust Commercial |
$1,909.34
|
| Rate for Payer: WPS Commercial |
$2,571.26
|
|
|
Nephrostomy Tube Placement
|
Facility
|
OP
|
$3,338.00
|
|
|
Service Code
|
CPT 50432
|
| Hospital Charge Code |
3052535
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,701.04 |
| Max. Negotiated Rate |
$8,799.61 |
| Rate for Payer: Aetna Commercial |
$3,124.37
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,985.51
|
| Rate for Payer: Aetna Managed Medicare |
$2,199.90
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,635.84
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,985.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,835.04
|
| Rate for Payer: Anthem Medicare Advantage |
$2,199.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,839.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$2,199.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$2,199.90
|
| 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 |
$3,193.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$2,199.90
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,947.89
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$2,199.90
|
| Rate for Payer: Health EOS Commercial |
$3,089.65
|
| Rate for Payer: HFN Commercial |
$3,193.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$8,183.63
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$2,199.90
|
| Rate for Payer: Independent Care Health Plan Medicare |
$2,199.90
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$2,199.90
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$2,199.90
|
| Rate for Payer: Multiplan Commercial |
$2,777.22
|
| Rate for Payer: NAPHCARE Commercial |
$3,299.85
|
| Rate for Payer: Preferred Network Access Commercial |
$3,193.80
|
| Rate for Payer: Quartz Beloit One Network |
$1,701.04
|
| Rate for Payer: Quartz Commercial |
$2,256.49
|
| Rate for Payer: Quartz Medicare Advantage |
$2,199.90
|
| Rate for Payer: The Alliance Commercial |
$8,799.61
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,199.90
|
| Rate for Payer: United Healthcare PPO |
$3,726.32
|
| Rate for Payer: WEA Trust Commercial |
$1,909.34
|
| Rate for Payer: Wellcare Medicare |
$2,199.90
|
| Rate for Payer: WPS Commercial |
$2,571.26
|
|
|
NEPHROURETERECTOMY
|
Facility
|
OP
|
$4,803.00
|
|
| Hospital Charge Code |
2960244
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,398.63 |
| Max. Negotiated Rate |
$4,595.51 |
| Rate for Payer: Aetna Commercial |
$4,495.61
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,295.80
|
| Rate for Payer: Aetna Managed Medicare |
$1,398.63
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,246.83
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,497.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,397.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,647.41
|
| Rate for Payer: Cash Price |
$1,440.90
|
| Rate for Payer: Cigna Commercial |
$4,595.51
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,795.35
|
| Rate for Payer: Health EOS Commercial |
$4,445.66
|
| Rate for Payer: HFN Commercial |
$4,595.51
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,746.34
|
| Rate for Payer: Multiplan Commercial |
$3,996.10
|
| Rate for Payer: NAPHCARE Commercial |
$2,997.07
|
| Rate for Payer: Preferred Network Access Commercial |
$4,595.51
|
| Rate for Payer: Quartz Beloit One Network |
$2,447.61
|
| Rate for Payer: Quartz Commercial |
$3,246.83
|
| Rate for Payer: Quartz Medicare Advantage |
$2,997.07
|
| Rate for Payer: The Alliance Commercial |
$2,497.56
|
| Rate for Payer: WEA Trust Commercial |
$2,747.32
|
| Rate for Payer: WPS Commercial |
$3,699.75
|
|
|
NEPHROURETERECTOMY
|
Facility
|
IP
|
$4,803.00
|
|
| Hospital Charge Code |
2960244
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,447.61 |
| Max. Negotiated Rate |
$4,595.51 |
| Rate for Payer: Aetna Commercial |
$4,495.61
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,295.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,647.41
|
| Rate for Payer: Cash Price |
$1,440.90
|
| Rate for Payer: Cigna Commercial |
$4,595.51
|
| Rate for Payer: Health EOS Commercial |
$4,445.66
|
| Rate for Payer: HFN Commercial |
$4,595.51
|
| Rate for Payer: Multiplan Commercial |
$3,996.10
|
| Rate for Payer: Preferred Network Access Commercial |
$4,595.51
|
| Rate for Payer: Quartz Beloit One Network |
$2,447.61
|
| Rate for Payer: Quartz Commercial |
$2,997.07
|
| Rate for Payer: WEA Trust Commercial |
$2,747.32
|
| Rate for Payer: WPS Commercial |
$3,699.75
|
|
|
Nepro 8oz Can
|
Facility
|
OP
|
$6.00
|
|
|
Service Code
|
HCPCS B4154
|
| Hospital Charge Code |
3031444
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.75 |
| Max. Negotiated Rate |
$5.74 |
| Rate for Payer: Aetna Commercial |
$5.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5.37
|
| Rate for Payer: Aetna Managed Medicare |
$1.75
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4.06
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3.31
|
| Rate for Payer: Cash Price |
$1.80
|
| Rate for Payer: Cigna Commercial |
$5.74
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3.49
|
| Rate for Payer: Health EOS Commercial |
$5.55
|
| Rate for Payer: HFN Commercial |
$5.74
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4.68
|
| Rate for Payer: Multiplan Commercial |
$4.99
|
| Rate for Payer: NAPHCARE Commercial |
$3.74
|
| Rate for Payer: Preferred Network Access Commercial |
$5.74
|
| Rate for Payer: Quartz Beloit One Network |
$3.06
|
| Rate for Payer: Quartz Commercial |
$4.06
|
| Rate for Payer: Quartz Medicare Advantage |
$3.74
|
| Rate for Payer: The Alliance Commercial |
$3.12
|
| Rate for Payer: WEA Trust Commercial |
$3.43
|
| Rate for Payer: WPS Commercial |
$4.62
|
|
|
Nepro 8oz Can
|
Facility
|
IP
|
$6.00
|
|
|
Service Code
|
HCPCS B4154
|
| Hospital Charge Code |
3031444
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.06 |
| Max. Negotiated Rate |
$5.74 |
| Rate for Payer: Aetna Commercial |
$5.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3.31
|
| Rate for Payer: Cash Price |
$1.80
|
| Rate for Payer: Cigna Commercial |
$5.74
|
| Rate for Payer: Health EOS Commercial |
$5.55
|
| Rate for Payer: HFN Commercial |
$5.74
|
| Rate for Payer: Multiplan Commercial |
$4.99
|
| Rate for Payer: Preferred Network Access Commercial |
$5.74
|
| Rate for Payer: Quartz Beloit One Network |
$3.06
|
| Rate for Payer: Quartz Commercial |
$3.74
|
| Rate for Payer: WEA Trust Commercial |
$3.43
|
| Rate for Payer: WPS Commercial |
$4.62
|
|
|
Nepro Rth 1000 mL
|
Facility
|
IP
|
$404.00
|
|
|
Service Code
|
HCPCS B4154
|
| Hospital Charge Code |
3031445
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$205.88 |
| Max. Negotiated Rate |
$386.55 |
| Rate for Payer: Aetna Commercial |
$378.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$361.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$222.68
|
| Rate for Payer: Cash Price |
$121.20
|
| Rate for Payer: Cigna Commercial |
$386.55
|
| Rate for Payer: Health EOS Commercial |
$373.94
|
| Rate for Payer: HFN Commercial |
$386.55
|
| Rate for Payer: Multiplan Commercial |
$336.13
|
| Rate for Payer: Preferred Network Access Commercial |
$386.55
|
| Rate for Payer: Quartz Beloit One Network |
$205.88
|
| Rate for Payer: Quartz Commercial |
$252.10
|
| Rate for Payer: WEA Trust Commercial |
$231.09
|
| Rate for Payer: WPS Commercial |
$311.20
|
|
|
Nepro Rth 1000 mL
|
Facility
|
OP
|
$404.00
|
|
|
Service Code
|
HCPCS B4154
|
| Hospital Charge Code |
3031445
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$117.64 |
| Max. Negotiated Rate |
$386.55 |
| Rate for Payer: Aetna Commercial |
$378.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$361.34
|
| Rate for Payer: Aetna Managed Medicare |
$117.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$273.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$210.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$201.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$222.68
|
| Rate for Payer: Cash Price |
$121.20
|
| Rate for Payer: Cigna Commercial |
$386.55
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$235.13
|
| Rate for Payer: Health EOS Commercial |
$373.94
|
| Rate for Payer: HFN Commercial |
$386.55
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$315.12
|
| Rate for Payer: Multiplan Commercial |
$336.13
|
| Rate for Payer: NAPHCARE Commercial |
$252.10
|
| Rate for Payer: Preferred Network Access Commercial |
$386.55
|
| Rate for Payer: Quartz Beloit One Network |
$205.88
|
| Rate for Payer: Quartz Commercial |
$273.10
|
| Rate for Payer: Quartz Medicare Advantage |
$252.10
|
| Rate for Payer: The Alliance Commercial |
$210.08
|
| Rate for Payer: WEA Trust Commercial |
$231.09
|
| Rate for Payer: WPS Commercial |
$311.20
|
|
|
NEPSY-II KIT & SCORING ASST. &
|
Facility
|
IP
|
$9,144.00
|
|
| Hospital Charge Code |
2973755
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$4,659.78 |
| Max. Negotiated Rate |
$8,748.98 |
| Rate for Payer: Aetna Commercial |
$8,558.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,178.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,040.17
|
| Rate for Payer: Cash Price |
$2,743.20
|
| Rate for Payer: Cigna Commercial |
$8,748.98
|
| Rate for Payer: Health EOS Commercial |
$8,463.69
|
| Rate for Payer: HFN Commercial |
$8,748.98
|
| Rate for Payer: Multiplan Commercial |
$7,607.81
|
| Rate for Payer: Preferred Network Access Commercial |
$8,748.98
|
| Rate for Payer: Quartz Beloit One Network |
$4,659.78
|
| Rate for Payer: Quartz Commercial |
$5,705.86
|
| Rate for Payer: WEA Trust Commercial |
$5,230.37
|
| Rate for Payer: WPS Commercial |
$7,043.62
|
|
|
NEPSY-II KIT & SCORING ASST. &
|
Facility
|
OP
|
$9,144.00
|
|
| Hospital Charge Code |
2973755
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$2,662.73 |
| Max. Negotiated Rate |
$8,748.98 |
| Rate for Payer: Aetna Commercial |
$8,558.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,178.39
|
| Rate for Payer: Aetna Managed Medicare |
$2,662.73
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6,181.34
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,754.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,564.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,040.17
|
| Rate for Payer: Cash Price |
$2,743.20
|
| Rate for Payer: Cigna Commercial |
$8,748.98
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,321.81
|
| Rate for Payer: Health EOS Commercial |
$8,463.69
|
| Rate for Payer: HFN Commercial |
$8,748.98
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7,132.32
|
| Rate for Payer: Multiplan Commercial |
$7,607.81
|
| Rate for Payer: NAPHCARE Commercial |
$5,705.86
|
| Rate for Payer: Preferred Network Access Commercial |
$8,748.98
|
| Rate for Payer: Quartz Beloit One Network |
$4,659.78
|
| Rate for Payer: Quartz Commercial |
$6,181.34
|
| Rate for Payer: Quartz Medicare Advantage |
$5,705.86
|
| Rate for Payer: The Alliance Commercial |
$4,754.88
|
| Rate for Payer: WEA Trust Commercial |
$5,230.37
|
| Rate for Payer: WPS Commercial |
$7,043.62
|
|
|
NERVE AND MUSCLE TESTS
|
Facility
|
OP
|
$98.27
|
|
|
Service Code
|
EAPG 00213
|
| Min. Negotiated Rate |
$94.49 |
| Max. Negotiated Rate |
$98.27 |
| Rate for Payer: Anthem Medicaid |
$94.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$94.49
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$94.49
|
| Rate for Payer: Dean Health Medicaid |
$94.49
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$94.49
|
| Rate for Payer: Managed Health Services Medicaid |
$98.27
|
| Rate for Payer: Molina Healthcare Medicaid |
$94.49
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$94.49
|
| Rate for Payer: United Healthcare Medicaid |
$94.49
|
|
|
NERVE BLOCK CERVICAL PLEXUS
|
Facility
|
IP
|
$714.00
|
|
| Hospital Charge Code |
5262634
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$363.85 |
| Max. Negotiated Rate |
$683.16 |
| Rate for Payer: Aetna Commercial |
$668.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$638.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$393.56
|
| Rate for Payer: Cash Price |
$214.20
|
| Rate for Payer: Cigna Commercial |
$683.16
|
| Rate for Payer: Health EOS Commercial |
$660.88
|
| Rate for Payer: HFN Commercial |
$683.16
|
| Rate for Payer: Multiplan Commercial |
$594.05
|
| Rate for Payer: Preferred Network Access Commercial |
$683.16
|
| Rate for Payer: Quartz Beloit One Network |
$363.85
|
| Rate for Payer: Quartz Commercial |
$445.54
|
| Rate for Payer: WEA Trust Commercial |
$408.41
|
| Rate for Payer: WPS Commercial |
$549.99
|
|
|
NERVE BLOCK CERVICAL PLEXUS
|
Facility
|
OP
|
$714.00
|
|
| Hospital Charge Code |
5262634
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$207.92 |
| Max. Negotiated Rate |
$683.16 |
| Rate for Payer: Aetna Commercial |
$668.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$638.60
|
| Rate for Payer: Aetna Managed Medicare |
$207.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$482.66
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$371.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$356.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$393.56
|
| Rate for Payer: Cash Price |
$214.20
|
| Rate for Payer: Cigna Commercial |
$683.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$415.55
|
| Rate for Payer: Health EOS Commercial |
$660.88
|
| Rate for Payer: HFN Commercial |
$683.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$556.92
|
| Rate for Payer: Multiplan Commercial |
$594.05
|
| Rate for Payer: NAPHCARE Commercial |
$445.54
|
| Rate for Payer: Preferred Network Access Commercial |
$683.16
|
| Rate for Payer: Quartz Beloit One Network |
$363.85
|
| Rate for Payer: Quartz Commercial |
$482.66
|
| Rate for Payer: Quartz Medicare Advantage |
$445.54
|
| Rate for Payer: The Alliance Commercial |
$371.28
|
| Rate for Payer: WEA Trust Commercial |
$408.41
|
| Rate for Payer: WPS Commercial |
$549.99
|
|
|
NERVE BLOCK FEM CONTINUOUS
|
Facility
|
OP
|
$958.00
|
|
| Hospital Charge Code |
5262652
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$278.97 |
| Max. Negotiated Rate |
$916.61 |
| Rate for Payer: Aetna Commercial |
$896.69
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$856.84
|
| Rate for Payer: Aetna Managed Medicare |
$278.97
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$647.61
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$498.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$478.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$528.05
|
| Rate for Payer: Cash Price |
$287.40
|
| Rate for Payer: Cigna Commercial |
$916.61
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$557.56
|
| Rate for Payer: Health EOS Commercial |
$886.72
|
| Rate for Payer: HFN Commercial |
$916.61
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$747.24
|
| Rate for Payer: Multiplan Commercial |
$797.06
|
| Rate for Payer: NAPHCARE Commercial |
$597.79
|
| Rate for Payer: Preferred Network Access Commercial |
$916.61
|
| Rate for Payer: Quartz Beloit One Network |
$488.20
|
| Rate for Payer: Quartz Commercial |
$647.61
|
| Rate for Payer: Quartz Medicare Advantage |
$597.79
|
| Rate for Payer: The Alliance Commercial |
$498.16
|
| Rate for Payer: WEA Trust Commercial |
$547.98
|
| Rate for Payer: WPS Commercial |
$737.95
|
|
|
NERVE BLOCK FEM CONTINUOUS
|
Facility
|
IP
|
$958.00
|
|
| Hospital Charge Code |
5262652
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$488.20 |
| Max. Negotiated Rate |
$916.61 |
| Rate for Payer: Aetna Commercial |
$896.69
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$856.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$528.05
|
| Rate for Payer: Cash Price |
$287.40
|
| Rate for Payer: Cigna Commercial |
$916.61
|
| Rate for Payer: Health EOS Commercial |
$886.72
|
| Rate for Payer: HFN Commercial |
$916.61
|
| Rate for Payer: Multiplan Commercial |
$797.06
|
| Rate for Payer: Preferred Network Access Commercial |
$916.61
|
| Rate for Payer: Quartz Beloit One Network |
$488.20
|
| Rate for Payer: Quartz Commercial |
$597.79
|
| Rate for Payer: WEA Trust Commercial |
$547.98
|
| Rate for Payer: WPS Commercial |
$737.95
|
|
|
NERVE BLOCK GENICULAR
|
Facility
|
IP
|
$1,289.00
|
|
| Hospital Charge Code |
5262657
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$656.87 |
| Max. Negotiated Rate |
$1,233.32 |
| Rate for Payer: Aetna Commercial |
$1,206.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,152.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$710.50
|
| Rate for Payer: Cash Price |
$386.70
|
| Rate for Payer: Cigna Commercial |
$1,233.32
|
| Rate for Payer: Health EOS Commercial |
$1,193.10
|
| Rate for Payer: HFN Commercial |
$1,233.32
|
| Rate for Payer: Multiplan Commercial |
$1,072.45
|
| Rate for Payer: Preferred Network Access Commercial |
$1,233.32
|
| Rate for Payer: Quartz Beloit One Network |
$656.87
|
| Rate for Payer: Quartz Commercial |
$804.34
|
| Rate for Payer: WEA Trust Commercial |
$737.31
|
| Rate for Payer: WPS Commercial |
$992.92
|
|
