|
NERVE BLOCK TRIGEMINAL
|
Facility
|
OP
|
$869.00
|
|
| Hospital Charge Code |
5262632
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$253.05 |
| Max. Negotiated Rate |
$831.46 |
| Rate for Payer: Aetna Commercial |
$813.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$777.23
|
| Rate for Payer: Aetna Managed Medicare |
$253.05
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$587.44
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$451.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$433.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$478.99
|
| Rate for Payer: Cash Price |
$260.70
|
| Rate for Payer: Cigna Commercial |
$831.46
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$505.76
|
| Rate for Payer: Health EOS Commercial |
$804.35
|
| Rate for Payer: HFN Commercial |
$831.46
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$677.82
|
| Rate for Payer: Multiplan Commercial |
$723.01
|
| Rate for Payer: NAPHCARE Commercial |
$542.26
|
| Rate for Payer: Preferred Network Access Commercial |
$831.46
|
| Rate for Payer: Quartz Beloit One Network |
$442.84
|
| Rate for Payer: Quartz Commercial |
$587.44
|
| Rate for Payer: Quartz Medicare Advantage |
$542.26
|
| Rate for Payer: The Alliance Commercial |
$451.88
|
| Rate for Payer: WEA Trust Commercial |
$497.07
|
| Rate for Payer: WPS Commercial |
$669.39
|
|
|
NERVE BLOCK TRIGEMINAL
|
Facility
|
IP
|
$869.00
|
|
| Hospital Charge Code |
5262632
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$442.84 |
| Max. Negotiated Rate |
$831.46 |
| Rate for Payer: Aetna Commercial |
$813.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$777.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$478.99
|
| Rate for Payer: Cash Price |
$260.70
|
| Rate for Payer: Cigna Commercial |
$831.46
|
| Rate for Payer: Health EOS Commercial |
$804.35
|
| Rate for Payer: HFN Commercial |
$831.46
|
| Rate for Payer: Multiplan Commercial |
$723.01
|
| Rate for Payer: Preferred Network Access Commercial |
$831.46
|
| Rate for Payer: Quartz Beloit One Network |
$442.84
|
| Rate for Payer: Quartz Commercial |
$542.26
|
| Rate for Payer: WEA Trust Commercial |
$497.07
|
| Rate for Payer: WPS Commercial |
$669.39
|
|
|
Nerve Conduction Studies 13/> Studies 95913
|
Professional
|
Both
|
$3,008.00
|
|
|
Service Code
|
CPT 95913
|
| Hospital Charge Code |
4596649
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$241.69 |
| Max. Negotiated Rate |
$2,971.90 |
| Rate for Payer: Aetna Commercial |
$2,971.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,690.36
|
| Rate for Payer: Aetna Managed Medicare |
$300.29
|
| Rate for Payer: Anthem Medicare Advantage |
$300.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$300.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$300.29
|
| Rate for Payer: Cash Price |
$902.40
|
| Rate for Payer: Cash Price |
$902.40
|
| Rate for Payer: Cash Price |
$902.40
|
| Rate for Payer: Cigna Commercial |
$2,971.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$241.69
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$300.29
|
| Rate for Payer: Health EOS Commercial |
$2,846.77
|
| Rate for Payer: HFN Commercial |
$2,971.90
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,083.92
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,083.92
|
| Rate for Payer: Independent Care Health Plan Medicare |
$300.29
|
| Rate for Payer: Multiplan Commercial |
$2,502.66
|
| Rate for Payer: NAPHCARE Commercial |
$450.43
|
| Rate for Payer: Preferred Network Access Commercial |
$2,971.90
|
| Rate for Payer: Quartz Beloit One Network |
$1,376.46
|
| Rate for Payer: Quartz Commercial |
$1,783.14
|
| Rate for Payer: Quartz Medicare Advantage |
$300.29
|
| Rate for Payer: The Alliance Commercial |
$750.72
|
| Rate for Payer: United Healthcare Medicaid |
$241.69
|
| Rate for Payer: United Healthcare Medicare Advantage |
$300.29
|
| Rate for Payer: WEA Trust Commercial |
$1,720.58
|
| Rate for Payer: WPS Commercial |
$1,201.16
|
|
|
NERVE GRAFT
|
Facility
|
IP
|
$1,006.00
|
|
| Hospital Charge Code |
2960090
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$512.66 |
| Max. Negotiated Rate |
$962.54 |
| Rate for Payer: Aetna Commercial |
$941.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$899.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$554.51
|
| Rate for Payer: Cash Price |
$301.80
|
| Rate for Payer: Cigna Commercial |
$962.54
|
| Rate for Payer: Health EOS Commercial |
$931.15
|
| Rate for Payer: HFN Commercial |
$962.54
|
| Rate for Payer: Multiplan Commercial |
$836.99
|
| Rate for Payer: Preferred Network Access Commercial |
$962.54
|
| Rate for Payer: Quartz Beloit One Network |
$512.66
|
| Rate for Payer: Quartz Commercial |
$627.74
|
| Rate for Payer: WEA Trust Commercial |
$575.43
|
| Rate for Payer: WPS Commercial |
$774.92
|
|
|
NERVE GRAFT
|
Facility
|
OP
|
$1,006.00
|
|
| Hospital Charge Code |
2960090
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$292.95 |
| Max. Negotiated Rate |
$962.54 |
| Rate for Payer: Aetna Commercial |
$941.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$899.77
|
| Rate for Payer: Aetna Managed Medicare |
$292.95
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$680.06
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$523.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$502.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$554.51
|
| Rate for Payer: Cash Price |
$301.80
|
| Rate for Payer: Cigna Commercial |
$962.54
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$585.49
|
| Rate for Payer: Health EOS Commercial |
$931.15
|
| Rate for Payer: HFN Commercial |
$962.54
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$784.68
|
| Rate for Payer: Multiplan Commercial |
$836.99
|
| Rate for Payer: NAPHCARE Commercial |
$627.74
|
| Rate for Payer: Preferred Network Access Commercial |
$962.54
|
| Rate for Payer: Quartz Beloit One Network |
$512.66
|
| Rate for Payer: Quartz Commercial |
$680.06
|
| Rate for Payer: Quartz Medicare Advantage |
$627.74
|
| Rate for Payer: The Alliance Commercial |
$523.12
|
| Rate for Payer: WEA Trust Commercial |
$575.43
|
| Rate for Payer: WPS Commercial |
$774.92
|
|
|
NERVE GUIDE NEURAGEN 5MM ID X 3CM (C9352 PER CM LENGTH) LENGTH PNG530
|
Facility
|
IP
|
$13,647.00
|
|
|
Service Code
|
HCPCS C9352
|
| Hospital Charge Code |
6199065
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,954.51 |
| Max. Negotiated Rate |
$13,057.45 |
| Rate for Payer: Aetna Commercial |
$12,773.59
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$12,205.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$7,522.23
|
| Rate for Payer: Cash Price |
$4,094.10
|
| Rate for Payer: Cigna Commercial |
$13,057.45
|
| Rate for Payer: Health EOS Commercial |
$12,631.66
|
| Rate for Payer: HFN Commercial |
$13,057.45
|
| Rate for Payer: Multiplan Commercial |
$11,354.30
|
| Rate for Payer: Preferred Network Access Commercial |
$13,057.45
|
| Rate for Payer: Quartz Beloit One Network |
$6,954.51
|
| Rate for Payer: Quartz Commercial |
$8,515.73
|
| Rate for Payer: WEA Trust Commercial |
$7,806.08
|
| Rate for Payer: WPS Commercial |
$10,512.28
|
|
|
NERVE GUIDE NEURAGEN 5MM ID X 3CM (C9352 PER CM LENGTH) LENGTH PNG530
|
Facility
|
OP
|
$13,647.00
|
|
|
Service Code
|
HCPCS C9352
|
| Hospital Charge Code |
6199065
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,974.01 |
| Max. Negotiated Rate |
$13,057.45 |
| Rate for Payer: Aetna Commercial |
$12,773.59
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$12,205.88
|
| Rate for Payer: Aetna Managed Medicare |
$3,974.01
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$9,225.37
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$7,096.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$6,812.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$7,522.23
|
| Rate for Payer: Cash Price |
$4,094.10
|
| Rate for Payer: Cigna Commercial |
$13,057.45
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$7,942.55
|
| Rate for Payer: Health EOS Commercial |
$12,631.66
|
| Rate for Payer: HFN Commercial |
$13,057.45
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$10,644.66
|
| Rate for Payer: Multiplan Commercial |
$11,354.30
|
| Rate for Payer: NAPHCARE Commercial |
$8,515.73
|
| Rate for Payer: Preferred Network Access Commercial |
$13,057.45
|
| Rate for Payer: Quartz Beloit One Network |
$6,954.51
|
| Rate for Payer: Quartz Commercial |
$9,225.37
|
| Rate for Payer: Quartz Medicare Advantage |
$8,515.73
|
| Rate for Payer: The Alliance Commercial |
$7,096.44
|
| Rate for Payer: WEA Trust Commercial |
$7,806.08
|
| Rate for Payer: WPS Commercial |
$10,512.28
|
|
|
NERVE LOCATOR VARI-STIM III 8562010
|
Facility
|
OP
|
$864.00
|
|
| Hospital Charge Code |
2965317
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$251.60 |
| Max. Negotiated Rate |
$826.68 |
| Rate for Payer: Aetna Commercial |
$808.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$772.76
|
| Rate for Payer: Aetna Managed Medicare |
$251.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$584.06
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$449.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$431.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$476.24
|
| Rate for Payer: Cash Price |
$259.20
|
| Rate for Payer: Cigna Commercial |
$826.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$502.85
|
| Rate for Payer: Health EOS Commercial |
$799.72
|
| Rate for Payer: HFN Commercial |
$826.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$673.92
|
| Rate for Payer: Multiplan Commercial |
$718.85
|
| Rate for Payer: NAPHCARE Commercial |
$539.14
|
| Rate for Payer: Preferred Network Access Commercial |
$826.68
|
| Rate for Payer: Quartz Beloit One Network |
$440.29
|
| Rate for Payer: Quartz Commercial |
$584.06
|
| Rate for Payer: Quartz Medicare Advantage |
$539.14
|
| Rate for Payer: The Alliance Commercial |
$449.28
|
| Rate for Payer: WEA Trust Commercial |
$494.21
|
| Rate for Payer: WPS Commercial |
$665.54
|
|
|
NERVE LOCATOR VARI-STIM III 8562010
|
Facility
|
IP
|
$864.00
|
|
| Hospital Charge Code |
2965317
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$440.29 |
| Max. Negotiated Rate |
$826.68 |
| Rate for Payer: Aetna Commercial |
$808.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$772.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$476.24
|
| Rate for Payer: Cash Price |
$259.20
|
| Rate for Payer: Cigna Commercial |
$826.68
|
| Rate for Payer: Health EOS Commercial |
$799.72
|
| Rate for Payer: HFN Commercial |
$826.68
|
| Rate for Payer: Multiplan Commercial |
$718.85
|
| Rate for Payer: Preferred Network Access Commercial |
$826.68
|
| Rate for Payer: Quartz Beloit One Network |
$440.29
|
| Rate for Payer: Quartz Commercial |
$539.14
|
| Rate for Payer: WEA Trust Commercial |
$494.21
|
| Rate for Payer: WPS Commercial |
$665.54
|
|
|
NERVE SURGERY, PERIPHERAL
|
Facility
|
OP
|
$7,388.00
|
|
| Hospital Charge Code |
2960247
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,151.39 |
| Max. Negotiated Rate |
$7,068.84 |
| Rate for Payer: Aetna Commercial |
$6,915.17
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,607.83
|
| Rate for Payer: Aetna Managed Medicare |
$2,151.39
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,994.29
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,841.76
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,688.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,072.27
|
| Rate for Payer: Cash Price |
$2,216.40
|
| Rate for Payer: Cigna Commercial |
$7,068.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,299.82
|
| Rate for Payer: Health EOS Commercial |
$6,838.33
|
| Rate for Payer: HFN Commercial |
$7,068.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,762.64
|
| Rate for Payer: Multiplan Commercial |
$6,146.82
|
| Rate for Payer: NAPHCARE Commercial |
$4,610.11
|
| Rate for Payer: Preferred Network Access Commercial |
$7,068.84
|
| Rate for Payer: Quartz Beloit One Network |
$3,764.92
|
| Rate for Payer: Quartz Commercial |
$4,994.29
|
| Rate for Payer: Quartz Medicare Advantage |
$4,610.11
|
| Rate for Payer: The Alliance Commercial |
$3,841.76
|
| Rate for Payer: WEA Trust Commercial |
$4,225.94
|
| Rate for Payer: WPS Commercial |
$5,690.98
|
|
|
NERVE SURGERY, PERIPHERAL
|
Facility
|
IP
|
$7,388.00
|
|
| Hospital Charge Code |
2960247
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,764.92 |
| Max. Negotiated Rate |
$7,068.84 |
| Rate for Payer: Aetna Commercial |
$6,915.17
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,607.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,072.27
|
| Rate for Payer: Cash Price |
$2,216.40
|
| Rate for Payer: Cigna Commercial |
$7,068.84
|
| Rate for Payer: Health EOS Commercial |
$6,838.33
|
| Rate for Payer: HFN Commercial |
$7,068.84
|
| Rate for Payer: Multiplan Commercial |
$6,146.82
|
| Rate for Payer: Preferred Network Access Commercial |
$7,068.84
|
| Rate for Payer: Quartz Beloit One Network |
$3,764.92
|
| Rate for Payer: Quartz Commercial |
$4,610.11
|
| Rate for Payer: WEA Trust Commercial |
$4,225.94
|
| Rate for Payer: WPS Commercial |
$5,690.98
|
|
|
NERVOUS SYSTEM MALIGNANCY
|
Facility
|
IP
|
$17,799.67
|
|
|
Service Code
|
APR-DRG 0414
|
| Min. Negotiated Rate |
$15,810.78 |
| Max. Negotiated Rate |
$17,799.67 |
| Rate for Payer: Anthem Medicaid |
$17,044.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$17,044.16
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$17,044.16
|
| Rate for Payer: Dean Health Medicaid |
$17,044.16
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$15,810.78
|
| Rate for Payer: Managed Health Services Medicaid |
$17,799.67
|
| Rate for Payer: Molina Healthcare Medicaid |
$17,044.16
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$17,044.16
|
| Rate for Payer: United Healthcare Medicaid |
$17,044.16
|
|
|
NERVOUS SYSTEM MALIGNANCY
|
Facility
|
OP
|
$94.34
|
|
|
Service Code
|
EAPG 00521
|
| Min. Negotiated Rate |
$90.71 |
| Max. Negotiated Rate |
$94.34 |
| Rate for Payer: Anthem Medicaid |
$90.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$90.71
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$90.71
|
| Rate for Payer: Dean Health Medicaid |
$90.71
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$90.71
|
| Rate for Payer: Managed Health Services Medicaid |
$94.34
|
| Rate for Payer: Molina Healthcare Medicaid |
$90.71
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$90.71
|
| Rate for Payer: United Healthcare Medicaid |
$90.71
|
|
|
NERVOUS SYSTEM MALIGNANCY
|
Facility
|
IP
|
$7,716.11
|
|
|
Service Code
|
APR-DRG 0411
|
| Min. Negotiated Rate |
$6,853.93 |
| Max. Negotiated Rate |
$7,716.11 |
| Rate for Payer: Anthem Medicaid |
$7,388.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$7,388.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$7,388.60
|
| Rate for Payer: Dean Health Medicaid |
$7,388.60
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$6,853.93
|
| Rate for Payer: Managed Health Services Medicaid |
$7,716.11
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,388.60
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$7,388.60
|
| Rate for Payer: United Healthcare Medicaid |
$7,388.60
|
|
|
NERVOUS SYSTEM MALIGNANCY
|
Facility
|
IP
|
$8,943.68
|
|
|
Service Code
|
APR-DRG 0412
|
| Min. Negotiated Rate |
$7,944.33 |
| Max. Negotiated Rate |
$8,943.68 |
| Rate for Payer: Anthem Medicaid |
$8,564.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$8,564.06
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$8,564.06
|
| Rate for Payer: Dean Health Medicaid |
$8,564.06
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$7,944.33
|
| Rate for Payer: Managed Health Services Medicaid |
$8,943.68
|
| Rate for Payer: Molina Healthcare Medicaid |
$8,564.06
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$8,564.06
|
| Rate for Payer: United Healthcare Medicaid |
$8,564.06
|
|
|
NERVOUS SYSTEM MALIGNANCY
|
Facility
|
IP
|
$12,363.32
|
|
|
Service Code
|
APR-DRG 0413
|
| Min. Negotiated Rate |
$10,981.87 |
| Max. Negotiated Rate |
$12,363.32 |
| Rate for Payer: Anthem Medicaid |
$11,838.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$11,838.56
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$11,838.56
|
| Rate for Payer: Dean Health Medicaid |
$11,838.56
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$10,981.87
|
| Rate for Payer: Managed Health Services Medicaid |
$12,363.32
|
| Rate for Payer: Molina Healthcare Medicaid |
$11,838.56
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$11,838.56
|
| Rate for Payer: United Healthcare Medicaid |
$11,838.56
|
|
|
NERVOUS SYSTEM NEOPLASMS WITH MCC
|
Facility
|
IP
|
$41,074.80
|
|
|
Service Code
|
MSDRG 054
|
| Min. Negotiated Rate |
$12,200.09 |
| Max. Negotiated Rate |
$41,074.80 |
| Rate for Payer: Aetna Managed Medicare |
$12,200.09
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$33,315.74
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$25,536.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$24,261.10
|
| Rate for Payer: Anthem Medicare Advantage |
$12,200.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$12,200.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$12,200.09
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$12,200.09
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$26,932.04
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$12,200.09
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$29,882.58
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$12,200.09
|
| Rate for Payer: Independent Care Health Plan Medicare |
$12,200.09
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$12,200.09
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$12,200.09
|
| Rate for Payer: NAPHCARE Commercial |
$18,300.14
|
| Rate for Payer: Quartz Medicare Advantage |
$12,200.09
|
| Rate for Payer: The Alliance Commercial |
$41,074.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12,200.09
|
| Rate for Payer: United Healthcare PPO |
$23,263.97
|
| Rate for Payer: Wellcare Medicare |
$12,200.09
|
|
|
NERVOUS SYSTEM NEOPLASMS WITHOUT MCC
|
Facility
|
IP
|
$30,006.08
|
|
|
Service Code
|
MSDRG 055
|
| Min. Negotiated Rate |
$8,315.07 |
| Max. Negotiated Rate |
$30,006.08 |
| Rate for Payer: Aetna Managed Medicare |
$8,315.07
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$22,246.86
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$17,052.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$16,200.55
|
| Rate for Payer: Anthem Medicare Advantage |
$8,315.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$8,315.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$8,315.07
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$8,315.07
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$17,984.09
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$8,315.07
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$21,764.50
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$8,315.07
|
| Rate for Payer: Independent Care Health Plan Medicare |
$8,315.07
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$8,315.07
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$8,315.07
|
| Rate for Payer: NAPHCARE Commercial |
$12,472.61
|
| Rate for Payer: Quartz Medicare Advantage |
$8,315.07
|
| Rate for Payer: The Alliance Commercial |
$30,006.08
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8,315.07
|
| Rate for Payer: United Healthcare PPO |
$16,943.94
|
| Rate for Payer: Wellcare Medicare |
$8,315.07
|
|
|
NESBIT PROCEDURE
|
Facility
|
IP
|
$4,238.00
|
|
| Hospital Charge Code |
2960248
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,159.68 |
| Max. Negotiated Rate |
$4,054.92 |
| Rate for Payer: Aetna Commercial |
$3,966.77
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,790.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,335.99
|
| Rate for Payer: Cash Price |
$1,271.40
|
| Rate for Payer: Cigna Commercial |
$4,054.92
|
| Rate for Payer: Health EOS Commercial |
$3,922.69
|
| Rate for Payer: HFN Commercial |
$4,054.92
|
| Rate for Payer: Multiplan Commercial |
$3,526.02
|
| Rate for Payer: Preferred Network Access Commercial |
$4,054.92
|
| Rate for Payer: Quartz Beloit One Network |
$2,159.68
|
| Rate for Payer: Quartz Commercial |
$2,644.51
|
| Rate for Payer: WEA Trust Commercial |
$2,424.14
|
| Rate for Payer: WPS Commercial |
$3,264.53
|
|
|
NESBIT PROCEDURE
|
Facility
|
OP
|
$4,238.00
|
|
| Hospital Charge Code |
2960248
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,234.11 |
| Max. Negotiated Rate |
$4,054.92 |
| Rate for Payer: Aetna Commercial |
$3,966.77
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,790.47
|
| Rate for Payer: Aetna Managed Medicare |
$1,234.11
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,864.89
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,203.76
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,115.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,335.99
|
| Rate for Payer: Cash Price |
$1,271.40
|
| Rate for Payer: Cigna Commercial |
$4,054.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,466.52
|
| Rate for Payer: Health EOS Commercial |
$3,922.69
|
| Rate for Payer: HFN Commercial |
$4,054.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,305.64
|
| Rate for Payer: Multiplan Commercial |
$3,526.02
|
| Rate for Payer: NAPHCARE Commercial |
$2,644.51
|
| Rate for Payer: Preferred Network Access Commercial |
$4,054.92
|
| Rate for Payer: Quartz Beloit One Network |
$2,159.68
|
| Rate for Payer: Quartz Commercial |
$2,864.89
|
| Rate for Payer: Quartz Medicare Advantage |
$2,644.51
|
| Rate for Payer: The Alliance Commercial |
$2,203.76
|
| Rate for Payer: WEA Trust Commercial |
$2,424.14
|
| Rate for Payer: WPS Commercial |
$3,264.53
|
|
|
NET RESCUE DGN-538-5
|
Facility
|
OP
|
$1,494.00
|
|
| Hospital Charge Code |
5414814
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$435.05 |
| Max. Negotiated Rate |
$1,429.46 |
| Rate for Payer: Aetna Commercial |
$1,398.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,336.23
|
| Rate for Payer: Aetna Managed Medicare |
$435.05
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,009.94
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$776.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$745.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$823.49
|
| Rate for Payer: Cash Price |
$448.20
|
| Rate for Payer: Cigna Commercial |
$1,429.46
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$869.51
|
| Rate for Payer: Health EOS Commercial |
$1,382.85
|
| Rate for Payer: HFN Commercial |
$1,429.46
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,165.32
|
| Rate for Payer: Multiplan Commercial |
$1,243.01
|
| Rate for Payer: NAPHCARE Commercial |
$932.26
|
| Rate for Payer: Preferred Network Access Commercial |
$1,429.46
|
| Rate for Payer: Quartz Beloit One Network |
$761.34
|
| Rate for Payer: Quartz Commercial |
$1,009.94
|
| Rate for Payer: Quartz Medicare Advantage |
$932.26
|
| Rate for Payer: The Alliance Commercial |
$776.88
|
| Rate for Payer: WEA Trust Commercial |
$854.57
|
| Rate for Payer: WPS Commercial |
$1,150.83
|
|
|
NET RESCUE DGN-538-5
|
Facility
|
IP
|
$1,494.00
|
|
| Hospital Charge Code |
5414814
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$761.34 |
| Max. Negotiated Rate |
$1,429.46 |
| Rate for Payer: Aetna Commercial |
$1,398.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,336.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$823.49
|
| Rate for Payer: Cash Price |
$448.20
|
| Rate for Payer: Cigna Commercial |
$1,429.46
|
| Rate for Payer: Health EOS Commercial |
$1,382.85
|
| Rate for Payer: HFN Commercial |
$1,429.46
|
| Rate for Payer: Multiplan Commercial |
$1,243.01
|
| Rate for Payer: Preferred Network Access Commercial |
$1,429.46
|
| Rate for Payer: Quartz Beloit One Network |
$761.34
|
| Rate for Payer: Quartz Commercial |
$932.26
|
| Rate for Payer: WEA Trust Commercial |
$854.57
|
| Rate for Payer: WPS Commercial |
$1,150.83
|
|
|
Neulasta 6 mg Charge
|
Facility
|
IP
|
$4,643.00
|
|
|
Service Code
|
HCPCS J2506
|
| Hospital Charge Code |
3002824
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2,366.07 |
| Max. Negotiated Rate |
$4,442.42 |
| Rate for Payer: Aetna Commercial |
$4,345.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,152.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,559.22
|
| Rate for Payer: Cash Price |
$1,392.90
|
| Rate for Payer: Cigna Commercial |
$4,442.42
|
| Rate for Payer: Health EOS Commercial |
$4,297.56
|
| Rate for Payer: HFN Commercial |
$4,442.42
|
| Rate for Payer: Multiplan Commercial |
$3,862.98
|
| Rate for Payer: Preferred Network Access Commercial |
$4,442.42
|
| Rate for Payer: Quartz Beloit One Network |
$2,366.07
|
| Rate for Payer: Quartz Commercial |
$2,897.23
|
| Rate for Payer: WEA Trust Commercial |
$2,655.80
|
| Rate for Payer: WPS Commercial |
$3,576.50
|
|
|
Neulasta 6 mg Charge
|
Facility
|
OP
|
$4,643.00
|
|
|
Service Code
|
HCPCS J2506
|
| Hospital Charge Code |
3002824
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$114.14 |
| Max. Negotiated Rate |
$4,442.42 |
| Rate for Payer: Aetna Commercial |
$4,345.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,152.70
|
| Rate for Payer: Aetna Managed Medicare |
$127.75
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$114.14
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$114.14
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$114.14
|
| Rate for Payer: Anthem Medicare Advantage |
$127.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,559.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$127.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$127.75
|
| Rate for Payer: Cash Price |
$1,392.90
|
| Rate for Payer: Cash Price |
$1,392.90
|
| Rate for Payer: Cigna Commercial |
$4,442.42
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$127.75
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$151.01
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$127.75
|
| Rate for Payer: Health EOS Commercial |
$4,297.56
|
| Rate for Payer: HFN Commercial |
$4,442.42
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$475.24
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$127.75
|
| Rate for Payer: Independent Care Health Plan Medicare |
$127.75
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$127.75
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$127.75
|
| Rate for Payer: Multiplan Commercial |
$3,862.98
|
| Rate for Payer: NAPHCARE Commercial |
$191.63
|
| Rate for Payer: Preferred Network Access Commercial |
$4,442.42
|
| Rate for Payer: Quartz Beloit One Network |
$2,366.07
|
| Rate for Payer: Quartz Commercial |
$3,138.67
|
| Rate for Payer: Quartz Medicare Advantage |
$127.75
|
| Rate for Payer: The Alliance Commercial |
$511.01
|
| Rate for Payer: United Healthcare Medicare Advantage |
$127.75
|
| Rate for Payer: WEA Trust Commercial |
$2,655.80
|
| Rate for Payer: Wellcare Medicare |
$127.75
|
| Rate for Payer: WPS Commercial |
$285.36
|
|
|
Neulasta 6 mg Charge
|
Professional
|
Both
|
$4,643.00
|
|
|
Service Code
|
HCPCS J2506
|
| Hospital Charge Code |
3002824
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$114.14 |
| Max. Negotiated Rate |
$4,587.28 |
| Rate for Payer: Aetna Commercial |
$4,587.28
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,152.70
|
| Rate for Payer: Aetna Managed Medicare |
$127.75
|
| Rate for Payer: Anthem Medicare Advantage |
$127.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$127.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$127.75
|
| Rate for Payer: Cash Price |
$1,392.90
|
| Rate for Payer: Cash Price |
$1,392.90
|
| Rate for Payer: Cigna Commercial |
$4,587.28
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$127.75
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$114.14
|
| Rate for Payer: Health EOS Commercial |
$4,394.14
|
| Rate for Payer: HFN Commercial |
$4,587.28
|
| Rate for Payer: Independent Care Health Plan Medicare |
$127.75
|
| Rate for Payer: Multiplan Commercial |
$3,862.98
|
| Rate for Payer: NAPHCARE Commercial |
$191.63
|
| Rate for Payer: Preferred Network Access Commercial |
$4,587.28
|
| Rate for Payer: Quartz Beloit One Network |
$2,124.64
|
| Rate for Payer: Quartz Commercial |
$2,752.37
|
| Rate for Payer: Quartz Medicare Advantage |
$127.75
|
| Rate for Payer: The Alliance Commercial |
$351.32
|
| Rate for Payer: United Healthcare Medicaid |
$127.75
|
| Rate for Payer: United Healthcare Medicare Advantage |
$127.75
|
| Rate for Payer: WEA Trust Commercial |
$2,655.80
|
| Rate for Payer: WPS Commercial |
$285.36
|
|
