|
NEUROSTIMULATOR IMPLANTABLE INTERSTIM II (RECHARGE FREE) 3058
|
Facility
|
OP
|
$71,120.00
|
|
|
Service Code
|
HCPCS C1767
|
| Hospital Charge Code |
5349493
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$20,710.14 |
| Max. Negotiated Rate |
$68,047.62 |
| Rate for Payer: Aetna Commercial |
$66,568.32
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$63,609.73
|
| Rate for Payer: Aetna Managed Medicare |
$20,710.14
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$48,077.12
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$36,982.40
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$35,503.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$39,201.34
|
| Rate for Payer: Cash Price |
$21,336.00
|
| Rate for Payer: Cigna Commercial |
$68,047.62
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$41,391.84
|
| Rate for Payer: Health EOS Commercial |
$65,828.67
|
| Rate for Payer: HFN Commercial |
$68,047.62
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$55,473.60
|
| Rate for Payer: Multiplan Commercial |
$59,171.84
|
| Rate for Payer: NAPHCARE Commercial |
$44,378.88
|
| Rate for Payer: Preferred Network Access Commercial |
$68,047.62
|
| Rate for Payer: Quartz Beloit One Network |
$36,242.75
|
| Rate for Payer: Quartz Commercial |
$48,077.12
|
| Rate for Payer: Quartz Medicare Advantage |
$44,378.88
|
| Rate for Payer: The Alliance Commercial |
$36,982.40
|
| Rate for Payer: WEA Trust Commercial |
$40,680.64
|
| Rate for Payer: WPS Commercial |
$54,783.74
|
|
|
NEUROSTIMULATOR IMPLANTABLE INTERSTIM X (RECHARGE FREE) 97800
|
Facility
|
IP
|
$50,425.00
|
|
| Hospital Charge Code |
6049662
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$25,696.58 |
| Max. Negotiated Rate |
$48,246.64 |
| Rate for Payer: Aetna Commercial |
$47,197.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$45,100.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$27,794.26
|
| Rate for Payer: Cash Price |
$15,127.50
|
| Rate for Payer: Cigna Commercial |
$48,246.64
|
| Rate for Payer: Health EOS Commercial |
$46,673.38
|
| Rate for Payer: HFN Commercial |
$48,246.64
|
| Rate for Payer: Multiplan Commercial |
$41,953.60
|
| Rate for Payer: Preferred Network Access Commercial |
$48,246.64
|
| Rate for Payer: Quartz Beloit One Network |
$25,696.58
|
| Rate for Payer: Quartz Commercial |
$31,465.20
|
| Rate for Payer: WEA Trust Commercial |
$28,843.10
|
| Rate for Payer: WPS Commercial |
$38,842.38
|
|
|
NEUROSTIMULATOR IMPLANTABLE INTERSTIM X (RECHARGE FREE) 97800
|
Facility
|
OP
|
$50,425.00
|
|
| Hospital Charge Code |
6049662
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$14,683.76 |
| Max. Negotiated Rate |
$48,246.64 |
| Rate for Payer: Aetna Commercial |
$47,197.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$45,100.12
|
| Rate for Payer: Aetna Managed Medicare |
$14,683.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$34,087.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$26,221.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$25,172.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$27,794.26
|
| Rate for Payer: Cash Price |
$15,127.50
|
| Rate for Payer: Cigna Commercial |
$48,246.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$29,347.35
|
| Rate for Payer: Health EOS Commercial |
$46,673.38
|
| Rate for Payer: HFN Commercial |
$48,246.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$39,331.50
|
| Rate for Payer: Multiplan Commercial |
$41,953.60
|
| Rate for Payer: NAPHCARE Commercial |
$31,465.20
|
| Rate for Payer: Preferred Network Access Commercial |
$48,246.64
|
| Rate for Payer: Quartz Beloit One Network |
$25,696.58
|
| Rate for Payer: Quartz Commercial |
$34,087.30
|
| Rate for Payer: Quartz Medicare Advantage |
$31,465.20
|
| Rate for Payer: The Alliance Commercial |
$26,221.00
|
| Rate for Payer: WEA Trust Commercial |
$28,843.10
|
| Rate for Payer: WPS Commercial |
$38,842.38
|
|
|
Neutrophil Function, Oxidative Burst
|
Facility
|
OP
|
$289.00
|
|
|
Service Code
|
CPT 82657
|
| Hospital Charge Code |
3579519
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$23.06 |
| Max. Negotiated Rate |
$276.52 |
| Rate for Payer: Aetna Commercial |
$270.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$258.48
|
| Rate for Payer: Aetna Managed Medicare |
$23.06
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$86.46
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$40.35
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$38.27
|
| Rate for Payer: Anthem Medicare Advantage |
$23.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$159.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$23.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$23.06
|
| Rate for Payer: Cash Price |
$86.70
|
| Rate for Payer: Cash Price |
$86.70
|
| Rate for Payer: Cigna Commercial |
$276.52
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$23.06
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$168.20
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$23.06
|
| Rate for Payer: Health EOS Commercial |
$267.50
|
| Rate for Payer: HFN Commercial |
$276.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$85.77
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$23.06
|
| Rate for Payer: Independent Care Health Plan Medicare |
$23.06
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$23.06
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$23.06
|
| Rate for Payer: Multiplan Commercial |
$240.45
|
| Rate for Payer: NAPHCARE Commercial |
$34.59
|
| Rate for Payer: Preferred Network Access Commercial |
$276.52
|
| Rate for Payer: Quartz Beloit One Network |
$147.27
|
| Rate for Payer: Quartz Commercial |
$195.36
|
| Rate for Payer: Quartz Medicare Advantage |
$23.06
|
| Rate for Payer: The Alliance Commercial |
$92.23
|
| Rate for Payer: United Healthcare Medicare Advantage |
$23.06
|
| Rate for Payer: United Healthcare PPO |
$225.42
|
| Rate for Payer: WEA Trust Commercial |
$165.31
|
| Rate for Payer: Wellcare Medicare |
$23.06
|
| Rate for Payer: WPS Commercial |
$222.62
|
|
|
Neutrophil Function, Oxidative Burst
|
Professional
|
Both
|
$289.00
|
|
|
Service Code
|
CPT 82657
|
| Hospital Charge Code |
3579519
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$23.06 |
| Max. Negotiated Rate |
$285.53 |
| Rate for Payer: Aetna Commercial |
$285.53
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$258.48
|
| Rate for Payer: Aetna Managed Medicare |
$23.06
|
| Rate for Payer: Anthem Medicare Advantage |
$23.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$23.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$23.06
|
| Rate for Payer: Cash Price |
$86.70
|
| Rate for Payer: Cash Price |
$86.70
|
| Rate for Payer: Cigna Commercial |
$285.53
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$150.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$23.06
|
| Rate for Payer: Health EOS Commercial |
$273.51
|
| Rate for Payer: HFN Commercial |
$285.53
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$81.39
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$81.39
|
| Rate for Payer: Independent Care Health Plan Medicare |
$23.06
|
| Rate for Payer: Multiplan Commercial |
$240.45
|
| Rate for Payer: NAPHCARE Commercial |
$34.59
|
| Rate for Payer: Preferred Network Access Commercial |
$285.53
|
| Rate for Payer: Quartz Beloit One Network |
$132.25
|
| Rate for Payer: Quartz Commercial |
$171.32
|
| Rate for Payer: Quartz Medicare Advantage |
$23.06
|
| Rate for Payer: The Alliance Commercial |
$91.07
|
| Rate for Payer: United Healthcare Medicare Advantage |
$23.06
|
| Rate for Payer: WEA Trust Commercial |
$165.31
|
| Rate for Payer: WPS Commercial |
$101.45
|
|
|
Neutrophil Function, Oxidative Burst
|
Facility
|
IP
|
$289.00
|
|
|
Service Code
|
CPT 82657
|
| Hospital Charge Code |
3579519
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$147.27 |
| Max. Negotiated Rate |
$276.52 |
| Rate for Payer: Aetna Commercial |
$270.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$258.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$159.30
|
| Rate for Payer: Cash Price |
$86.70
|
| Rate for Payer: Cigna Commercial |
$276.52
|
| Rate for Payer: Health EOS Commercial |
$267.50
|
| Rate for Payer: HFN Commercial |
$276.52
|
| Rate for Payer: Multiplan Commercial |
$240.45
|
| Rate for Payer: Preferred Network Access Commercial |
$276.52
|
| Rate for Payer: Quartz Beloit One Network |
$147.27
|
| Rate for Payer: Quartz Commercial |
$180.34
|
| Rate for Payer: WEA Trust Commercial |
$165.31
|
| Rate for Payer: WPS Commercial |
$222.62
|
|
|
Newborn Follow-Up
|
Facility
|
OP
|
$128.00
|
|
|
Service Code
|
CPT 99211
|
| Hospital Charge Code |
3000436
|
|
Hospital Revenue Code
|
514
|
| Min. Negotiated Rate |
$30.74 |
| Max. Negotiated Rate |
$122.47 |
| Rate for Payer: Aetna Commercial |
$119.81
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$114.48
|
| Rate for Payer: Aetna Managed Medicare |
$37.27
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$86.53
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$66.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$63.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$70.55
|
| Rate for Payer: Cash Price |
$38.40
|
| Rate for Payer: Cash Price |
$38.40
|
| Rate for Payer: Cigna Commercial |
$122.47
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$74.50
|
| Rate for Payer: Health EOS Commercial |
$118.48
|
| Rate for Payer: HFN Commercial |
$122.47
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$99.84
|
| Rate for Payer: Multiplan Commercial |
$106.50
|
| Rate for Payer: NAPHCARE Commercial |
$79.87
|
| Rate for Payer: Preferred Network Access Commercial |
$122.47
|
| Rate for Payer: Quartz Beloit One Network |
$65.23
|
| Rate for Payer: Quartz Commercial |
$86.53
|
| Rate for Payer: Quartz Medicare Advantage |
$79.87
|
| Rate for Payer: The Alliance Commercial |
$30.74
|
| Rate for Payer: WEA Trust Commercial |
$73.22
|
| Rate for Payer: WPS Commercial |
$98.60
|
|
|
Newborn Follow-Up
|
Facility
|
IP
|
$128.00
|
|
|
Service Code
|
CPT 99211
|
| Hospital Charge Code |
3000436
|
|
Hospital Revenue Code
|
514
|
| Min. Negotiated Rate |
$65.23 |
| Max. Negotiated Rate |
$122.47 |
| Rate for Payer: Aetna Commercial |
$119.81
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$114.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$70.55
|
| Rate for Payer: Cash Price |
$38.40
|
| Rate for Payer: Cigna Commercial |
$122.47
|
| Rate for Payer: Health EOS Commercial |
$118.48
|
| Rate for Payer: HFN Commercial |
$122.47
|
| Rate for Payer: Multiplan Commercial |
$106.50
|
| Rate for Payer: Preferred Network Access Commercial |
$122.47
|
| Rate for Payer: Quartz Beloit One Network |
$65.23
|
| Rate for Payer: Quartz Commercial |
$79.87
|
| Rate for Payer: WEA Trust Commercial |
$73.22
|
| Rate for Payer: WPS Commercial |
$98.60
|
|
|
Newborn Follow-Up: Lactation visit <30 minutes - Outpatient Newborn Follow-Up Charges
|
Facility
|
IP
|
$158.00
|
|
|
Service Code
|
CPT 99211
|
| Hospital Charge Code |
5356647
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$80.52 |
| Max. Negotiated Rate |
$151.17 |
| Rate for Payer: Aetna Commercial |
$147.89
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$141.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$87.09
|
| Rate for Payer: Cash Price |
$47.40
|
| Rate for Payer: Cigna Commercial |
$151.17
|
| Rate for Payer: Health EOS Commercial |
$146.24
|
| Rate for Payer: HFN Commercial |
$151.17
|
| Rate for Payer: Multiplan Commercial |
$131.46
|
| Rate for Payer: Preferred Network Access Commercial |
$151.17
|
| Rate for Payer: Quartz Beloit One Network |
$80.52
|
| Rate for Payer: Quartz Commercial |
$98.59
|
| Rate for Payer: WEA Trust Commercial |
$90.38
|
| Rate for Payer: WPS Commercial |
$121.71
|
|
|
Newborn Follow-Up: Lactation visit <30 minutes - Outpatient Newborn Follow-Up Charges
|
Facility
|
OP
|
$158.00
|
|
|
Service Code
|
CPT 99211
|
| Hospital Charge Code |
5356647
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$30.74 |
| Max. Negotiated Rate |
$151.17 |
| Rate for Payer: Aetna Commercial |
$147.89
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$141.32
|
| Rate for Payer: Aetna Managed Medicare |
$46.01
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$106.81
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$82.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$78.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$87.09
|
| Rate for Payer: Cash Price |
$47.40
|
| Rate for Payer: Cash Price |
$47.40
|
| Rate for Payer: Cigna Commercial |
$151.17
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$91.96
|
| Rate for Payer: Health EOS Commercial |
$146.24
|
| Rate for Payer: HFN Commercial |
$151.17
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$123.24
|
| Rate for Payer: Multiplan Commercial |
$131.46
|
| Rate for Payer: NAPHCARE Commercial |
$98.59
|
| Rate for Payer: Preferred Network Access Commercial |
$151.17
|
| Rate for Payer: Quartz Beloit One Network |
$80.52
|
| Rate for Payer: Quartz Commercial |
$106.81
|
| Rate for Payer: Quartz Medicare Advantage |
$98.59
|
| Rate for Payer: The Alliance Commercial |
$30.74
|
| Rate for Payer: WEA Trust Commercial |
$90.38
|
| Rate for Payer: WPS Commercial |
$121.71
|
|
|
Newborn Follow-Up: Lactation visit >30 minutes - Outpatient Newborn Follow-Up Charges
|
Facility
|
OP
|
$194.00
|
|
|
Service Code
|
CPT 99211
|
| Hospital Charge Code |
5356646
|
|
Hospital Revenue Code
|
514
|
| Min. Negotiated Rate |
$30.74 |
| 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 |
$56.49
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$131.14
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$100.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$96.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$106.93
|
| Rate for Payer: Cash Price |
$58.20
|
| Rate for Payer: Cash Price |
$58.20
|
| Rate for Payer: Cigna Commercial |
$185.62
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$112.91
|
| Rate for Payer: Health EOS Commercial |
$179.57
|
| Rate for Payer: HFN Commercial |
$185.62
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$151.32
|
| Rate for Payer: Multiplan Commercial |
$161.41
|
| Rate for Payer: NAPHCARE Commercial |
$121.06
|
| 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 |
$121.06
|
| Rate for Payer: The Alliance Commercial |
$30.74
|
| Rate for Payer: WEA Trust Commercial |
$110.97
|
| Rate for Payer: WPS Commercial |
$149.44
|
|
|
Newborn Follow-Up: Lactation visit >30 minutes - Outpatient Newborn Follow-Up Charges
|
Facility
|
IP
|
$194.00
|
|
|
Service Code
|
CPT 99211
|
| Hospital Charge Code |
5356646
|
|
Hospital Revenue Code
|
514
|
| 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
|
|
|
Newborn Follow-Up - Outpatient Newborn Follow-Up Charges
|
Facility
|
OP
|
$128.00
|
|
|
Service Code
|
CPT 99211
|
| Hospital Charge Code |
5356648
|
|
Hospital Revenue Code
|
514
|
| Min. Negotiated Rate |
$30.74 |
| Max. Negotiated Rate |
$122.47 |
| Rate for Payer: Aetna Commercial |
$119.81
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$114.48
|
| Rate for Payer: Aetna Managed Medicare |
$37.27
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$86.53
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$66.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$63.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$70.55
|
| Rate for Payer: Cash Price |
$38.40
|
| Rate for Payer: Cash Price |
$38.40
|
| Rate for Payer: Cigna Commercial |
$122.47
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$74.50
|
| Rate for Payer: Health EOS Commercial |
$118.48
|
| Rate for Payer: HFN Commercial |
$122.47
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$99.84
|
| Rate for Payer: Multiplan Commercial |
$106.50
|
| Rate for Payer: NAPHCARE Commercial |
$79.87
|
| Rate for Payer: Preferred Network Access Commercial |
$122.47
|
| Rate for Payer: Quartz Beloit One Network |
$65.23
|
| Rate for Payer: Quartz Commercial |
$86.53
|
| Rate for Payer: Quartz Medicare Advantage |
$79.87
|
| Rate for Payer: The Alliance Commercial |
$30.74
|
| Rate for Payer: WEA Trust Commercial |
$73.22
|
| Rate for Payer: WPS Commercial |
$98.60
|
|
|
Newborn Follow-Up - Outpatient Newborn Follow-Up Charges
|
Facility
|
IP
|
$128.00
|
|
|
Service Code
|
CPT 99211
|
| Hospital Charge Code |
5356648
|
|
Hospital Revenue Code
|
514
|
| Min. Negotiated Rate |
$65.23 |
| Max. Negotiated Rate |
$122.47 |
| Rate for Payer: Aetna Commercial |
$119.81
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$114.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$70.55
|
| Rate for Payer: Cash Price |
$38.40
|
| Rate for Payer: Cigna Commercial |
$122.47
|
| Rate for Payer: Health EOS Commercial |
$118.48
|
| Rate for Payer: HFN Commercial |
$122.47
|
| Rate for Payer: Multiplan Commercial |
$106.50
|
| Rate for Payer: Preferred Network Access Commercial |
$122.47
|
| Rate for Payer: Quartz Beloit One Network |
$65.23
|
| Rate for Payer: Quartz Commercial |
$79.87
|
| Rate for Payer: WEA Trust Commercial |
$73.22
|
| Rate for Payer: WPS Commercial |
$98.60
|
|
|
New major dressing charge
|
Facility
|
IP
|
$196.00
|
|
|
Service Code
|
CPT 99202
|
| Hospital Charge Code |
3228203
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$99.88 |
| Max. Negotiated Rate |
$187.53 |
| Rate for Payer: Aetna Commercial |
$183.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$175.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$108.04
|
| Rate for Payer: Cash Price |
$58.80
|
| Rate for Payer: Cigna Commercial |
$187.53
|
| Rate for Payer: Health EOS Commercial |
$181.42
|
| Rate for Payer: HFN Commercial |
$187.53
|
| Rate for Payer: Multiplan Commercial |
$163.07
|
| Rate for Payer: Preferred Network Access Commercial |
$187.53
|
| Rate for Payer: Quartz Beloit One Network |
$99.88
|
| Rate for Payer: Quartz Commercial |
$122.30
|
| Rate for Payer: WEA Trust Commercial |
$112.11
|
| Rate for Payer: WPS Commercial |
$150.98
|
|
|
New major dressing charge
|
Facility
|
OP
|
$196.00
|
|
|
Service Code
|
CPT 99202
|
| Hospital Charge Code |
3228203
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$57.08 |
| Max. Negotiated Rate |
$187.53 |
| Rate for Payer: Aetna Commercial |
$183.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$175.30
|
| Rate for Payer: Aetna Managed Medicare |
$57.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$132.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$101.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$97.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$108.04
|
| Rate for Payer: Cash Price |
$58.80
|
| Rate for Payer: Cash Price |
$58.80
|
| Rate for Payer: Cigna Commercial |
$187.53
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$114.07
|
| Rate for Payer: Health EOS Commercial |
$181.42
|
| Rate for Payer: HFN Commercial |
$187.53
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$152.88
|
| Rate for Payer: Multiplan Commercial |
$163.07
|
| Rate for Payer: NAPHCARE Commercial |
$122.30
|
| Rate for Payer: Preferred Network Access Commercial |
$187.53
|
| Rate for Payer: Quartz Beloit One Network |
$99.88
|
| Rate for Payer: Quartz Commercial |
$132.50
|
| Rate for Payer: Quartz Medicare Advantage |
$122.30
|
| Rate for Payer: The Alliance Commercial |
$162.82
|
| Rate for Payer: WEA Trust Commercial |
$112.11
|
| Rate for Payer: WPS Commercial |
$150.98
|
|
|
NEXGEN PATELLA 26MM 5973-65-26
|
Facility
|
OP
|
$4,778.00
|
|
| Hospital Charge Code |
2967757
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,391.35 |
| Max. Negotiated Rate |
$4,571.59 |
| Rate for Payer: Aetna Commercial |
$4,472.21
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,273.44
|
| Rate for Payer: Aetna Managed Medicare |
$1,391.35
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,229.93
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,484.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,385.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,633.63
|
| Rate for Payer: Cash Price |
$1,433.40
|
| Rate for Payer: Cigna Commercial |
$4,571.59
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,780.80
|
| Rate for Payer: Health EOS Commercial |
$4,422.52
|
| Rate for Payer: HFN Commercial |
$4,571.59
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,726.84
|
| Rate for Payer: Multiplan Commercial |
$3,975.30
|
| Rate for Payer: NAPHCARE Commercial |
$2,981.47
|
| Rate for Payer: Preferred Network Access Commercial |
$4,571.59
|
| Rate for Payer: Quartz Beloit One Network |
$2,434.87
|
| Rate for Payer: Quartz Commercial |
$3,229.93
|
| Rate for Payer: Quartz Medicare Advantage |
$2,981.47
|
| Rate for Payer: The Alliance Commercial |
$2,484.56
|
| Rate for Payer: WEA Trust Commercial |
$2,733.02
|
| Rate for Payer: WPS Commercial |
$3,680.49
|
|
|
NEXGEN PATELLA 26MM 5973-65-26
|
Facility
|
IP
|
$4,778.00
|
|
| Hospital Charge Code |
2967757
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,434.87 |
| Max. Negotiated Rate |
$4,571.59 |
| Rate for Payer: Aetna Commercial |
$4,472.21
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,273.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,633.63
|
| Rate for Payer: Cash Price |
$1,433.40
|
| Rate for Payer: Cigna Commercial |
$4,571.59
|
| Rate for Payer: Health EOS Commercial |
$4,422.52
|
| Rate for Payer: HFN Commercial |
$4,571.59
|
| Rate for Payer: Multiplan Commercial |
$3,975.30
|
| Rate for Payer: Preferred Network Access Commercial |
$4,571.59
|
| Rate for Payer: Quartz Beloit One Network |
$2,434.87
|
| Rate for Payer: Quartz Commercial |
$2,981.47
|
| Rate for Payer: WEA Trust Commercial |
$2,733.02
|
| Rate for Payer: WPS Commercial |
$3,680.49
|
|
|
Nexplanon 1 Unit Charge
|
Professional
|
Both
|
$1,575.00
|
|
|
Service Code
|
HCPCS J7307
|
| Hospital Charge Code |
2958857
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$720.72 |
| Max. Negotiated Rate |
$1,556.10 |
| Rate for Payer: Aetna Commercial |
$1,556.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,408.68
|
| Rate for Payer: Anthem Commercial |
$1,020.82
|
| Rate for Payer: Cash Price |
$472.50
|
| Rate for Payer: Cash Price |
$472.50
|
| Rate for Payer: Cigna Commercial |
$1,556.10
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,326.37
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$982.80
|
| Rate for Payer: Health EOS Commercial |
$1,490.58
|
| Rate for Payer: HFN Commercial |
$1,556.10
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,527.67
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,527.67
|
| Rate for Payer: Multiplan Commercial |
$1,310.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,556.10
|
| Rate for Payer: Quartz Beloit One Network |
$720.72
|
| Rate for Payer: Quartz Commercial |
$933.66
|
| Rate for Payer: The Alliance Commercial |
$819.00
|
| Rate for Payer: United Healthcare Medicaid |
$1,326.37
|
| Rate for Payer: WEA Trust Commercial |
$900.90
|
| Rate for Payer: WPS Commercial |
$1,213.22
|
|
|
Nexplanon 1 Unit Charge
|
Facility
|
IP
|
$1,575.00
|
|
|
Service Code
|
HCPCS J7307
|
| Hospital Charge Code |
2958857
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$802.62 |
| Max. Negotiated Rate |
$1,506.96 |
| Rate for Payer: Aetna Commercial |
$1,474.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,408.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$868.14
|
| Rate for Payer: Cash Price |
$472.50
|
| Rate for Payer: Cigna Commercial |
$1,506.96
|
| Rate for Payer: Health EOS Commercial |
$1,457.82
|
| Rate for Payer: HFN Commercial |
$1,506.96
|
| Rate for Payer: Multiplan Commercial |
$1,310.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,506.96
|
| Rate for Payer: Quartz Beloit One Network |
$802.62
|
| Rate for Payer: Quartz Commercial |
$982.80
|
| Rate for Payer: WEA Trust Commercial |
$900.90
|
| Rate for Payer: WPS Commercial |
$1,213.22
|
|
|
Nexplanon 1 Unit Charge
|
Facility
|
OP
|
$1,575.00
|
|
|
Service Code
|
HCPCS J7307
|
| Hospital Charge Code |
2958857
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$458.64 |
| Max. Negotiated Rate |
$1,506.96 |
| Rate for Payer: Aetna Commercial |
$1,474.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,408.68
|
| Rate for Payer: Aetna Managed Medicare |
$458.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,064.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$819.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$786.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$868.14
|
| Rate for Payer: Cash Price |
$472.50
|
| Rate for Payer: Cigna Commercial |
$1,506.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$916.65
|
| Rate for Payer: Health EOS Commercial |
$1,457.82
|
| Rate for Payer: HFN Commercial |
$1,506.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,228.50
|
| Rate for Payer: Multiplan Commercial |
$1,310.40
|
| Rate for Payer: NAPHCARE Commercial |
$982.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,506.96
|
| Rate for Payer: Quartz Beloit One Network |
$802.62
|
| Rate for Payer: Quartz Commercial |
$1,064.70
|
| Rate for Payer: Quartz Medicare Advantage |
$982.80
|
| Rate for Payer: The Alliance Commercial |
$819.00
|
| Rate for Payer: WEA Trust Commercial |
$900.90
|
| Rate for Payer: WPS Commercial |
$1,213.22
|
|
|
N. gonorrhoeae RNA
|
Facility
|
OP
|
$84.00
|
|
|
Service Code
|
CPT 87591
|
| Hospital Charge Code |
5619696
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$36.49 |
| Max. Negotiated Rate |
$145.97 |
| Rate for Payer: Aetna Commercial |
$78.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$75.13
|
| 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 |
$46.30
|
| 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 |
$25.20
|
| Rate for Payer: Cash Price |
$25.20
|
| Rate for Payer: Cigna Commercial |
$80.37
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$36.49
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$48.89
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$36.49
|
| Rate for Payer: Health EOS Commercial |
$77.75
|
| Rate for Payer: HFN Commercial |
$80.37
|
| 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 |
$69.89
|
| Rate for Payer: NAPHCARE Commercial |
$54.74
|
| Rate for Payer: Preferred Network Access Commercial |
$80.37
|
| Rate for Payer: Quartz Beloit One Network |
$42.81
|
| Rate for Payer: Quartz Commercial |
$56.78
|
| 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 |
$65.52
|
| Rate for Payer: WEA Trust Commercial |
$48.05
|
| Rate for Payer: Wellcare Medicare |
$36.49
|
| Rate for Payer: WPS Commercial |
$64.71
|
|
|
N. gonorrhoeae RNA
|
Professional
|
Both
|
$84.00
|
|
|
Service Code
|
CPT 87591
|
| Hospital Charge Code |
5619696
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$36.49 |
| Max. Negotiated Rate |
$160.57 |
| Rate for Payer: Aetna Commercial |
$82.99
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$75.13
|
| 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 |
$25.20
|
| Rate for Payer: Cash Price |
$25.20
|
| Rate for Payer: Cigna Commercial |
$82.99
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$43.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$36.49
|
| Rate for Payer: Health EOS Commercial |
$79.50
|
| Rate for Payer: HFN Commercial |
$82.99
|
| 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 |
$69.89
|
| Rate for Payer: NAPHCARE Commercial |
$54.74
|
| Rate for Payer: Preferred Network Access Commercial |
$82.99
|
| Rate for Payer: Quartz Beloit One Network |
$38.44
|
| Rate for Payer: Quartz Commercial |
$49.80
|
| 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 |
$48.05
|
| Rate for Payer: WPS Commercial |
$160.57
|
|
|
N. gonorrhoeae RNA
|
Facility
|
IP
|
$84.00
|
|
|
Service Code
|
CPT 87591
|
| Hospital Charge Code |
5619696
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$42.81 |
| Max. Negotiated Rate |
$80.37 |
| Rate for Payer: Aetna Commercial |
$78.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$75.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$46.30
|
| Rate for Payer: Cash Price |
$25.20
|
| Rate for Payer: Cigna Commercial |
$80.37
|
| Rate for Payer: Health EOS Commercial |
$77.75
|
| Rate for Payer: HFN Commercial |
$80.37
|
| Rate for Payer: Multiplan Commercial |
$69.89
|
| Rate for Payer: Preferred Network Access Commercial |
$80.37
|
| Rate for Payer: Quartz Beloit One Network |
$42.81
|
| Rate for Payer: Quartz Commercial |
$52.42
|
| Rate for Payer: WEA Trust Commercial |
$48.05
|
| Rate for Payer: WPS Commercial |
$64.71
|
|
|
Nickel, Blood
|
Facility
|
OP
|
$112.00
|
|
|
Service Code
|
CPT 83885
|
| Hospital Charge Code |
983343
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$25.49 |
| Max. Negotiated Rate |
$107.16 |
| Rate for Payer: Aetna Commercial |
$104.83
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$100.17
|
| Rate for Payer: Aetna Managed Medicare |
$25.49
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$95.59
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$44.61
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$42.31
|
| Rate for Payer: Anthem Medicare Advantage |
$25.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$61.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$25.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$25.49
|
| Rate for Payer: Cash Price |
$33.60
|
| Rate for Payer: Cash Price |
$33.60
|
| Rate for Payer: Cigna Commercial |
$107.16
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$25.49
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$65.18
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$25.49
|
| Rate for Payer: Health EOS Commercial |
$103.67
|
| Rate for Payer: HFN Commercial |
$107.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$94.82
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$25.49
|
| Rate for Payer: Independent Care Health Plan Medicare |
$25.49
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$25.49
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$25.49
|
| Rate for Payer: Multiplan Commercial |
$93.18
|
| Rate for Payer: NAPHCARE Commercial |
$38.24
|
| Rate for Payer: Preferred Network Access Commercial |
$107.16
|
| Rate for Payer: Quartz Beloit One Network |
$57.08
|
| Rate for Payer: Quartz Commercial |
$75.71
|
| Rate for Payer: Quartz Medicare Advantage |
$25.49
|
| Rate for Payer: The Alliance Commercial |
$101.96
|
| Rate for Payer: United Healthcare Medicare Advantage |
$25.49
|
| Rate for Payer: United Healthcare PPO |
$87.36
|
| Rate for Payer: WEA Trust Commercial |
$64.06
|
| Rate for Payer: Wellcare Medicare |
$25.49
|
| Rate for Payer: WPS Commercial |
$86.27
|
|
