|
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
|
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
|
|
|
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
|
|
|
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
|
|
|
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
|
|
|
Nickel, Blood
|
Professional
|
Both
|
$112.00
|
|
|
Service Code
|
CPT 83885
|
| Hospital Charge Code |
983343
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$25.49 |
| Max. Negotiated Rate |
$112.16 |
| Rate for Payer: Aetna Commercial |
$110.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$100.17
|
| Rate for Payer: Aetna Managed Medicare |
$25.49
|
| Rate for Payer: Anthem Medicare Advantage |
$25.49
|
| 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 |
$110.66
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$58.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$25.49
|
| Rate for Payer: Health EOS Commercial |
$106.00
|
| Rate for Payer: HFN Commercial |
$110.66
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$89.98
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$89.98
|
| Rate for Payer: Independent Care Health Plan Medicare |
$25.49
|
| Rate for Payer: Multiplan Commercial |
$93.18
|
| Rate for Payer: NAPHCARE Commercial |
$38.24
|
| Rate for Payer: Preferred Network Access Commercial |
$110.66
|
| Rate for Payer: Quartz Beloit One Network |
$51.25
|
| Rate for Payer: Quartz Commercial |
$66.39
|
| Rate for Payer: Quartz Medicare Advantage |
$25.49
|
| Rate for Payer: The Alliance Commercial |
$100.69
|
| Rate for Payer: United Healthcare Medicare Advantage |
$25.49
|
| Rate for Payer: WEA Trust Commercial |
$64.06
|
| Rate for Payer: WPS Commercial |
$112.16
|
|
|
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
|
|
|
Nickel, Blood
|
Facility
|
IP
|
$112.00
|
|
|
Service Code
|
CPT 83885
|
| Hospital Charge Code |
983343
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$57.08 |
| Max. Negotiated Rate |
$107.16 |
| Rate for Payer: Aetna Commercial |
$104.83
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$100.17
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$61.73
|
| Rate for Payer: Cash Price |
$33.60
|
| Rate for Payer: Cigna Commercial |
$107.16
|
| Rate for Payer: Health EOS Commercial |
$103.67
|
| Rate for Payer: HFN Commercial |
$107.16
|
| Rate for Payer: Multiplan Commercial |
$93.18
|
| Rate for Payer: Preferred Network Access Commercial |
$107.16
|
| Rate for Payer: Quartz Beloit One Network |
$57.08
|
| Rate for Payer: Quartz Commercial |
$69.89
|
| Rate for Payer: WEA Trust Commercial |
$64.06
|
| Rate for Payer: WPS Commercial |
$86.27
|
|
|
Nicotine and Cotinine, LC/MS.MS, Urine
|
Facility
|
IP
|
$92.00
|
|
|
Service Code
|
CPT 80323
|
| Hospital Charge Code |
4464751
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$46.88 |
| Max. Negotiated Rate |
$88.03 |
| Rate for Payer: Aetna Commercial |
$86.11
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$82.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$50.71
|
| Rate for Payer: Cash Price |
$27.60
|
| Rate for Payer: Cigna Commercial |
$88.03
|
| Rate for Payer: Health EOS Commercial |
$85.16
|
| Rate for Payer: HFN Commercial |
$88.03
|
| Rate for Payer: Multiplan Commercial |
$76.54
|
| Rate for Payer: Preferred Network Access Commercial |
$88.03
|
| Rate for Payer: Quartz Beloit One Network |
$46.88
|
| Rate for Payer: Quartz Commercial |
$57.41
|
| Rate for Payer: WEA Trust Commercial |
$52.62
|
| Rate for Payer: WPS Commercial |
$70.87
|
|
|
Nicotine and Cotinine, LC/MS.MS, Urine
|
Professional
|
Both
|
$92.00
|
|
|
Service Code
|
CPT 80323
|
| Hospital Charge Code |
4464751
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$42.10 |
| Max. Negotiated Rate |
$90.90 |
| Rate for Payer: Aetna Commercial |
$90.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$82.28
|
| Rate for Payer: Cash Price |
$27.60
|
| Rate for Payer: Cash Price |
$27.60
|
| Rate for Payer: Cigna Commercial |
$90.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$47.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$57.41
|
| Rate for Payer: Health EOS Commercial |
$87.07
|
| Rate for Payer: HFN Commercial |
$90.90
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$83.26
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$83.26
|
| Rate for Payer: Multiplan Commercial |
$76.54
|
| Rate for Payer: Preferred Network Access Commercial |
$90.90
|
| Rate for Payer: Quartz Beloit One Network |
$42.10
|
| Rate for Payer: Quartz Commercial |
$54.54
|
| Rate for Payer: The Alliance Commercial |
$47.84
|
| Rate for Payer: WEA Trust Commercial |
$52.62
|
| Rate for Payer: WPS Commercial |
$70.87
|
|
|
Nicotine and Cotinine, LC/MS.MS, Urine
|
Facility
|
OP
|
$92.00
|
|
|
Service Code
|
CPT 80323
|
| Hospital Charge Code |
4464751
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$26.79 |
| Max. Negotiated Rate |
$88.03 |
| Rate for Payer: Aetna Commercial |
$86.11
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$82.28
|
| Rate for Payer: Aetna Managed Medicare |
$26.79
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$62.19
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$47.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$45.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$50.71
|
| Rate for Payer: Cash Price |
$27.60
|
| Rate for Payer: Cigna Commercial |
$88.03
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$53.54
|
| Rate for Payer: Health EOS Commercial |
$85.16
|
| Rate for Payer: HFN Commercial |
$88.03
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$71.76
|
| Rate for Payer: Multiplan Commercial |
$76.54
|
| Rate for Payer: NAPHCARE Commercial |
$57.41
|
| Rate for Payer: Preferred Network Access Commercial |
$88.03
|
| Rate for Payer: Quartz Beloit One Network |
$46.88
|
| Rate for Payer: Quartz Commercial |
$62.19
|
| Rate for Payer: Quartz Medicare Advantage |
$57.41
|
| Rate for Payer: The Alliance Commercial |
$47.84
|
| Rate for Payer: United Healthcare PPO |
$71.76
|
| Rate for Payer: WEA Trust Commercial |
$52.62
|
| Rate for Payer: WPS Commercial |
$70.87
|
|
|
Nicotine & Cotinine, LC/MS/MS
|
Facility
|
IP
|
$300.00
|
|
|
Service Code
|
CPT 80323
|
| Hospital Charge Code |
983344
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$152.88 |
| Max. Negotiated Rate |
$287.04 |
| Rate for Payer: Aetna Commercial |
$280.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$268.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$165.36
|
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: Cigna Commercial |
$287.04
|
| Rate for Payer: Health EOS Commercial |
$277.68
|
| Rate for Payer: HFN Commercial |
$287.04
|
| Rate for Payer: Multiplan Commercial |
$249.60
|
| Rate for Payer: Preferred Network Access Commercial |
$287.04
|
| Rate for Payer: Quartz Beloit One Network |
$152.88
|
| Rate for Payer: Quartz Commercial |
$187.20
|
| Rate for Payer: WEA Trust Commercial |
$171.60
|
| Rate for Payer: WPS Commercial |
$231.09
|
|
|
Nicotine & Cotinine, LC/MS/MS
|
Professional
|
Both
|
$300.00
|
|
|
Service Code
|
CPT 80323
|
| Hospital Charge Code |
983344
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$83.26 |
| Max. Negotiated Rate |
$296.40 |
| Rate for Payer: Aetna Commercial |
$296.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$268.32
|
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: Cigna Commercial |
$296.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$156.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$187.20
|
| Rate for Payer: Health EOS Commercial |
$283.92
|
| Rate for Payer: HFN Commercial |
$296.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$83.26
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$83.26
|
| Rate for Payer: Multiplan Commercial |
$249.60
|
| Rate for Payer: Preferred Network Access Commercial |
$296.40
|
| Rate for Payer: Quartz Beloit One Network |
$137.28
|
| Rate for Payer: Quartz Commercial |
$177.84
|
| Rate for Payer: The Alliance Commercial |
$156.00
|
| Rate for Payer: WEA Trust Commercial |
$171.60
|
| Rate for Payer: WPS Commercial |
$231.09
|
|
|
Nicotine & Cotinine, LC/MS/MS
|
Facility
|
OP
|
$300.00
|
|
|
Service Code
|
CPT 80323
|
| Hospital Charge Code |
983344
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$87.36 |
| Max. Negotiated Rate |
$287.04 |
| Rate for Payer: Aetna Commercial |
$280.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$268.32
|
| Rate for Payer: Aetna Managed Medicare |
$87.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$202.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$156.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$149.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$165.36
|
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: Cigna Commercial |
$287.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$174.60
|
| Rate for Payer: Health EOS Commercial |
$277.68
|
| Rate for Payer: HFN Commercial |
$287.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$234.00
|
| Rate for Payer: Multiplan Commercial |
$249.60
|
| Rate for Payer: NAPHCARE Commercial |
$187.20
|
| Rate for Payer: Preferred Network Access Commercial |
$287.04
|
| Rate for Payer: Quartz Beloit One Network |
$152.88
|
| Rate for Payer: Quartz Commercial |
$202.80
|
| Rate for Payer: Quartz Medicare Advantage |
$187.20
|
| Rate for Payer: The Alliance Commercial |
$156.00
|
| Rate for Payer: United Healthcare PPO |
$234.00
|
| Rate for Payer: WEA Trust Commercial |
$171.60
|
| Rate for Payer: WPS Commercial |
$231.09
|
|
|
Night Splint L4396
|
Facility
|
IP
|
$46.00
|
|
|
Service Code
|
HCPCS L4396
|
| Hospital Charge Code |
3133672
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$23.44 |
| Max. Negotiated Rate |
$44.01 |
| Rate for Payer: Aetna Commercial |
$43.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$41.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$25.36
|
| Rate for Payer: Cash Price |
$13.80
|
| Rate for Payer: Cigna Commercial |
$44.01
|
| Rate for Payer: Health EOS Commercial |
$42.58
|
| Rate for Payer: HFN Commercial |
$44.01
|
| Rate for Payer: Multiplan Commercial |
$38.27
|
| Rate for Payer: Preferred Network Access Commercial |
$44.01
|
| Rate for Payer: Quartz Beloit One Network |
$23.44
|
| Rate for Payer: Quartz Commercial |
$28.70
|
| Rate for Payer: WEA Trust Commercial |
$26.31
|
| Rate for Payer: WPS Commercial |
$35.43
|
|
|
Night Splint L4396
|
Professional
|
Both
|
$46.00
|
|
|
Service Code
|
HCPCS L4396
|
| Hospital Charge Code |
3133672
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$21.05 |
| Max. Negotiated Rate |
$618.45 |
| Rate for Payer: Aetna Commercial |
$45.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$41.14
|
| Rate for Payer: Aetna Managed Medicare |
$214.48
|
| Rate for Payer: Anthem Medicare Advantage |
$214.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$214.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$214.48
|
| Rate for Payer: Cash Price |
$13.80
|
| Rate for Payer: Cash Price |
$13.80
|
| Rate for Payer: Cigna Commercial |
$45.45
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$23.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$214.48
|
| Rate for Payer: Health EOS Commercial |
$43.53
|
| Rate for Payer: HFN Commercial |
$45.45
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$618.45
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$618.45
|
| Rate for Payer: Independent Care Health Plan Medicare |
$214.48
|
| Rate for Payer: Multiplan Commercial |
$38.27
|
| Rate for Payer: NAPHCARE Commercial |
$321.72
|
| Rate for Payer: Preferred Network Access Commercial |
$45.45
|
| Rate for Payer: Quartz Beloit One Network |
$21.05
|
| Rate for Payer: Quartz Commercial |
$27.27
|
| Rate for Payer: Quartz Medicare Advantage |
$214.48
|
| Rate for Payer: The Alliance Commercial |
$589.82
|
| Rate for Payer: United Healthcare Medicare Advantage |
$214.48
|
| Rate for Payer: WEA Trust Commercial |
$26.31
|
| Rate for Payer: WPS Commercial |
$375.34
|
|
|
Night Splint L4396
|
Facility
|
OP
|
$46.00
|
|
|
Service Code
|
HCPCS L4396
|
| Hospital Charge Code |
3133672
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$13.40 |
| Max. Negotiated Rate |
$857.92 |
| Rate for Payer: Aetna Commercial |
$43.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$41.14
|
| Rate for Payer: Aetna Managed Medicare |
$13.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$120.28
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$120.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$120.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$25.36
|
| Rate for Payer: Cash Price |
$13.80
|
| Rate for Payer: Cash Price |
$13.80
|
| Rate for Payer: Cigna Commercial |
$44.01
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$26.77
|
| Rate for Payer: Health EOS Commercial |
$42.58
|
| Rate for Payer: HFN Commercial |
$44.01
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$35.88
|
| Rate for Payer: Multiplan Commercial |
$38.27
|
| Rate for Payer: NAPHCARE Commercial |
$28.70
|
| Rate for Payer: Preferred Network Access Commercial |
$44.01
|
| Rate for Payer: Quartz Beloit One Network |
$23.44
|
| Rate for Payer: Quartz Commercial |
$31.10
|
| Rate for Payer: Quartz Medicare Advantage |
$28.70
|
| Rate for Payer: The Alliance Commercial |
$857.92
|
| Rate for Payer: WEA Trust Commercial |
$26.31
|
| Rate for Payer: WPS Commercial |
$35.43
|
|
|
NIGHT SPLINT SMALL
|
Facility
|
OP
|
$578.00
|
|
| Hospital Charge Code |
2974505
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$168.31 |
| Max. Negotiated Rate |
$553.03 |
| Rate for Payer: Aetna Commercial |
$541.01
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$516.96
|
| Rate for Payer: Aetna Managed Medicare |
$168.31
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$390.73
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$300.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$288.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$318.59
|
| Rate for Payer: Cash Price |
$173.40
|
| Rate for Payer: Cigna Commercial |
$553.03
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$336.40
|
| Rate for Payer: Health EOS Commercial |
$535.00
|
| Rate for Payer: HFN Commercial |
$553.03
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$450.84
|
| Rate for Payer: Multiplan Commercial |
$480.90
|
| Rate for Payer: NAPHCARE Commercial |
$360.67
|
| Rate for Payer: Preferred Network Access Commercial |
$553.03
|
| Rate for Payer: Quartz Beloit One Network |
$294.55
|
| Rate for Payer: Quartz Commercial |
$390.73
|
| Rate for Payer: Quartz Medicare Advantage |
$360.67
|
| Rate for Payer: The Alliance Commercial |
$300.56
|
| Rate for Payer: WEA Trust Commercial |
$330.62
|
| Rate for Payer: WPS Commercial |
$445.23
|
|
|
NIGHT SPLINT SMALL
|
Facility
|
IP
|
$578.00
|
|
| Hospital Charge Code |
2974505
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$294.55 |
| Max. Negotiated Rate |
$553.03 |
| Rate for Payer: Aetna Commercial |
$541.01
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$516.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$318.59
|
| Rate for Payer: Cash Price |
$173.40
|
| Rate for Payer: Cigna Commercial |
$553.03
|
| Rate for Payer: Health EOS Commercial |
$535.00
|
| Rate for Payer: HFN Commercial |
$553.03
|
| Rate for Payer: Multiplan Commercial |
$480.90
|
| Rate for Payer: Preferred Network Access Commercial |
$553.03
|
| Rate for Payer: Quartz Beloit One Network |
$294.55
|
| Rate for Payer: Quartz Commercial |
$360.67
|
| Rate for Payer: WEA Trust Commercial |
$330.62
|
| Rate for Payer: WPS Commercial |
$445.23
|
|
|
NIPPER CUTICAL
|
Facility
|
IP
|
$389.00
|
|
| Hospital Charge Code |
2971048
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$198.23 |
| Max. Negotiated Rate |
$372.20 |
| Rate for Payer: Aetna Commercial |
$364.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$347.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$214.42
|
| Rate for Payer: Cash Price |
$116.70
|
| Rate for Payer: Cigna Commercial |
$372.20
|
| Rate for Payer: Health EOS Commercial |
$360.06
|
| Rate for Payer: HFN Commercial |
$372.20
|
| Rate for Payer: Multiplan Commercial |
$323.65
|
| Rate for Payer: Preferred Network Access Commercial |
$372.20
|
| Rate for Payer: Quartz Beloit One Network |
$198.23
|
| Rate for Payer: Quartz Commercial |
$242.74
|
| Rate for Payer: WEA Trust Commercial |
$222.51
|
| Rate for Payer: WPS Commercial |
$299.65
|
|
|
NIPPER CUTICAL
|
Facility
|
OP
|
$389.00
|
|
| Hospital Charge Code |
2971048
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$113.28 |
| Max. Negotiated Rate |
$372.20 |
| Rate for Payer: Aetna Commercial |
$364.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$347.92
|
| Rate for Payer: Aetna Managed Medicare |
$113.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$262.96
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$202.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$194.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$214.42
|
| Rate for Payer: Cash Price |
$116.70
|
| Rate for Payer: Cigna Commercial |
$372.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$226.40
|
| Rate for Payer: Health EOS Commercial |
$360.06
|
| Rate for Payer: HFN Commercial |
$372.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$303.42
|
| Rate for Payer: Multiplan Commercial |
$323.65
|
| Rate for Payer: NAPHCARE Commercial |
$242.74
|
| Rate for Payer: Preferred Network Access Commercial |
$372.20
|
| Rate for Payer: Quartz Beloit One Network |
$198.23
|
| Rate for Payer: Quartz Commercial |
$262.96
|
| Rate for Payer: Quartz Medicare Advantage |
$242.74
|
| Rate for Payer: The Alliance Commercial |
$202.28
|
| Rate for Payer: WEA Trust Commercial |
$222.51
|
| Rate for Payer: WPS Commercial |
$299.65
|
|
|
NIPPLE EXPLORATION 19110
|
Professional
|
Both
|
$1,125.00
|
|
|
Service Code
|
CPT 19110
|
| Hospital Charge Code |
3013678
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$318.16 |
| Max. Negotiated Rate |
$1,508.46 |
| Rate for Payer: Aetna Commercial |
$1,111.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,006.20
|
| Rate for Payer: Aetna Managed Medicare |
$335.21
|
| Rate for Payer: Anthem Medicare Advantage |
$335.21
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$335.21
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$335.21
|
| Rate for Payer: Cash Price |
$337.50
|
| Rate for Payer: Cash Price |
$337.50
|
| Rate for Payer: Cash Price |
$337.50
|
| Rate for Payer: Cigna Commercial |
$1,111.50
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$318.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$335.21
|
| Rate for Payer: Health EOS Commercial |
$1,064.70
|
| Rate for Payer: HFN Commercial |
$1,111.50
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,196.55
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,196.55
|
| Rate for Payer: Independent Care Health Plan Medicare |
$335.21
|
| Rate for Payer: Multiplan Commercial |
$936.00
|
| Rate for Payer: NAPHCARE Commercial |
$502.82
|
| Rate for Payer: Preferred Network Access Commercial |
$1,111.50
|
| Rate for Payer: Quartz Beloit One Network |
$514.80
|
| Rate for Payer: Quartz Commercial |
$666.90
|
| Rate for Payer: Quartz Medicare Advantage |
$335.21
|
| Rate for Payer: The Alliance Commercial |
$1,424.65
|
| Rate for Payer: United Healthcare Medicaid |
$318.16
|
| Rate for Payer: United Healthcare Medicare Advantage |
$335.21
|
| Rate for Payer: WEA Trust Commercial |
$643.50
|
| Rate for Payer: WPS Commercial |
$1,508.46
|
|
|
NIPPLE RECONSTRUCTION/INVERTED, CORRECTION
|
Facility
|
OP
|
$1,006.00
|
|
| Hospital Charge Code |
2960251
|
|
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
|
|
