|
Wet Prep
|
Professional
|
Both
|
$69.00
|
|
|
Service Code
|
CPT 87210
|
| Hospital Charge Code |
1098799
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$6.05 |
| Max. Negotiated Rate |
$68.17 |
| Rate for Payer: Aetna Commercial |
$68.17
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$61.71
|
| Rate for Payer: Aetna Managed Medicare |
$6.05
|
| Rate for Payer: Anthem Medicare Advantage |
$6.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$6.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$6.05
|
| Rate for Payer: Cash Price |
$20.70
|
| Rate for Payer: Cash Price |
$20.70
|
| Rate for Payer: Cigna Commercial |
$68.17
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$35.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6.05
|
| Rate for Payer: Health EOS Commercial |
$65.30
|
| Rate for Payer: HFN Commercial |
$68.17
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$21.36
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$21.36
|
| Rate for Payer: Independent Care Health Plan Medicare |
$6.05
|
| Rate for Payer: Multiplan Commercial |
$57.41
|
| Rate for Payer: NAPHCARE Commercial |
$9.08
|
| Rate for Payer: Preferred Network Access Commercial |
$68.17
|
| Rate for Payer: Quartz Beloit One Network |
$31.57
|
| Rate for Payer: Quartz Commercial |
$40.90
|
| Rate for Payer: Quartz Medicare Advantage |
$6.05
|
| Rate for Payer: The Alliance Commercial |
$23.91
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6.05
|
| Rate for Payer: WEA Trust Commercial |
$39.47
|
| Rate for Payer: WPS Commercial |
$26.63
|
|
|
Wet Prep
|
Facility
|
IP
|
$69.00
|
|
|
Service Code
|
CPT 87210
|
| Hospital Charge Code |
1098799
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$35.16 |
| Max. Negotiated Rate |
$66.02 |
| Rate for Payer: Aetna Commercial |
$64.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$61.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$38.03
|
| Rate for Payer: Cash Price |
$20.70
|
| Rate for Payer: Cigna Commercial |
$66.02
|
| Rate for Payer: Health EOS Commercial |
$63.87
|
| Rate for Payer: HFN Commercial |
$66.02
|
| Rate for Payer: Multiplan Commercial |
$57.41
|
| Rate for Payer: Preferred Network Access Commercial |
$66.02
|
| Rate for Payer: Quartz Beloit One Network |
$35.16
|
| Rate for Payer: Quartz Commercial |
$43.06
|
| Rate for Payer: WEA Trust Commercial |
$39.47
|
| Rate for Payer: WPS Commercial |
$53.15
|
|
|
Wet Prep POC
|
Facility
|
IP
|
$64.00
|
|
|
Service Code
|
CPT 87210
|
| Hospital Charge Code |
3080730
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$32.61 |
| Max. Negotiated Rate |
$61.24 |
| Rate for Payer: Aetna Commercial |
$59.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$57.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$35.28
|
| Rate for Payer: Cash Price |
$19.20
|
| Rate for Payer: Cigna Commercial |
$61.24
|
| Rate for Payer: Health EOS Commercial |
$59.24
|
| Rate for Payer: HFN Commercial |
$61.24
|
| Rate for Payer: Multiplan Commercial |
$53.25
|
| Rate for Payer: Preferred Network Access Commercial |
$61.24
|
| Rate for Payer: Quartz Beloit One Network |
$32.61
|
| Rate for Payer: Quartz Commercial |
$39.94
|
| Rate for Payer: WEA Trust Commercial |
$36.61
|
| Rate for Payer: WPS Commercial |
$49.30
|
|
|
Wet Prep POC
|
Facility
|
OP
|
$64.00
|
|
|
Service Code
|
CPT 87210
|
| Hospital Charge Code |
3080730
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$6.05 |
| Max. Negotiated Rate |
$61.24 |
| Rate for Payer: Aetna Commercial |
$59.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$57.24
|
| Rate for Payer: Aetna Managed Medicare |
$6.05
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$43.26
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$33.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$31.95
|
| Rate for Payer: Anthem Medicare Advantage |
$6.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$35.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$6.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$6.05
|
| Rate for Payer: Cash Price |
$19.20
|
| Rate for Payer: Cash Price |
$19.20
|
| Rate for Payer: Cigna Commercial |
$61.24
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$6.05
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$37.25
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$6.05
|
| Rate for Payer: Health EOS Commercial |
$59.24
|
| Rate for Payer: HFN Commercial |
$61.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$22.52
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$6.05
|
| Rate for Payer: Independent Care Health Plan Medicare |
$6.05
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$6.05
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$6.05
|
| Rate for Payer: Multiplan Commercial |
$53.25
|
| Rate for Payer: NAPHCARE Commercial |
$9.08
|
| Rate for Payer: Preferred Network Access Commercial |
$61.24
|
| Rate for Payer: Quartz Beloit One Network |
$32.61
|
| Rate for Payer: Quartz Commercial |
$43.26
|
| Rate for Payer: Quartz Medicare Advantage |
$6.05
|
| Rate for Payer: The Alliance Commercial |
$24.21
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6.05
|
| Rate for Payer: WEA Trust Commercial |
$36.61
|
| Rate for Payer: Wellcare Medicare |
$6.05
|
| Rate for Payer: WPS Commercial |
$49.30
|
|
|
Wet Prep POC
|
Professional
|
Both
|
$64.00
|
|
|
Service Code
|
CPT 87210
|
| Hospital Charge Code |
3080730
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$6.05 |
| Max. Negotiated Rate |
$63.23 |
| Rate for Payer: Aetna Commercial |
$63.23
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$57.24
|
| Rate for Payer: Aetna Managed Medicare |
$6.05
|
| Rate for Payer: Anthem Medicare Advantage |
$6.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$6.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$6.05
|
| Rate for Payer: Cash Price |
$19.20
|
| Rate for Payer: Cash Price |
$19.20
|
| Rate for Payer: Cigna Commercial |
$63.23
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$33.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6.05
|
| Rate for Payer: Health EOS Commercial |
$60.57
|
| Rate for Payer: HFN Commercial |
$63.23
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$21.36
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$21.36
|
| Rate for Payer: Independent Care Health Plan Medicare |
$6.05
|
| Rate for Payer: Multiplan Commercial |
$53.25
|
| Rate for Payer: NAPHCARE Commercial |
$9.08
|
| Rate for Payer: Preferred Network Access Commercial |
$63.23
|
| Rate for Payer: Quartz Beloit One Network |
$29.29
|
| Rate for Payer: Quartz Commercial |
$37.94
|
| Rate for Payer: Quartz Medicare Advantage |
$6.05
|
| Rate for Payer: The Alliance Commercial |
$23.91
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6.05
|
| Rate for Payer: WEA Trust Commercial |
$36.61
|
| Rate for Payer: WPS Commercial |
$26.63
|
|
|
WHFO,no joint,prefabricated L3807
|
Facility
|
IP
|
$52.00
|
|
|
Service Code
|
HCPCS L3807
|
| Hospital Charge Code |
3983438
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$26.50 |
| Max. Negotiated Rate |
$49.75 |
| Rate for Payer: Aetna Commercial |
$48.67
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$46.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$28.66
|
| Rate for Payer: Cash Price |
$15.60
|
| Rate for Payer: Cigna Commercial |
$49.75
|
| Rate for Payer: Health EOS Commercial |
$48.13
|
| Rate for Payer: HFN Commercial |
$49.75
|
| Rate for Payer: Multiplan Commercial |
$43.26
|
| Rate for Payer: Preferred Network Access Commercial |
$49.75
|
| Rate for Payer: Quartz Beloit One Network |
$26.50
|
| Rate for Payer: Quartz Commercial |
$32.45
|
| Rate for Payer: WEA Trust Commercial |
$29.74
|
| Rate for Payer: WPS Commercial |
$40.06
|
|
|
WHFO,no joint,prefabricated L3807
|
Professional
|
Both
|
$52.00
|
|
|
Service Code
|
HCPCS L3807
|
| Hospital Charge Code |
3983438
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$23.80 |
| Max. Negotiated Rate |
$838.61 |
| Rate for Payer: Aetna Commercial |
$51.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$46.51
|
| Rate for Payer: Aetna Managed Medicare |
$290.86
|
| Rate for Payer: Anthem Medicare Advantage |
$290.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$290.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$290.86
|
| Rate for Payer: Cash Price |
$15.60
|
| Rate for Payer: Cash Price |
$15.60
|
| Rate for Payer: Cigna Commercial |
$51.38
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$27.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$290.86
|
| Rate for Payer: Health EOS Commercial |
$49.21
|
| Rate for Payer: HFN Commercial |
$51.38
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$838.61
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$838.61
|
| Rate for Payer: Independent Care Health Plan Medicare |
$290.86
|
| Rate for Payer: Multiplan Commercial |
$43.26
|
| Rate for Payer: NAPHCARE Commercial |
$436.29
|
| Rate for Payer: Preferred Network Access Commercial |
$51.38
|
| Rate for Payer: Quartz Beloit One Network |
$23.80
|
| Rate for Payer: Quartz Commercial |
$30.83
|
| Rate for Payer: Quartz Medicare Advantage |
$290.86
|
| Rate for Payer: The Alliance Commercial |
$799.86
|
| Rate for Payer: United Healthcare Medicare Advantage |
$290.86
|
| Rate for Payer: WEA Trust Commercial |
$29.74
|
| Rate for Payer: WPS Commercial |
$509.00
|
|
|
WHFO,no joint,prefabricated L3807
|
Facility
|
OP
|
$52.00
|
|
|
Service Code
|
HCPCS L3807
|
| Hospital Charge Code |
3983438
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$15.14 |
| Max. Negotiated Rate |
$1,163.43 |
| Rate for Payer: Aetna Commercial |
$48.67
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$46.51
|
| Rate for Payer: Aetna Managed Medicare |
$15.14
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$148.54
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$148.54
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$148.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$28.66
|
| Rate for Payer: Cash Price |
$15.60
|
| Rate for Payer: Cash Price |
$15.60
|
| Rate for Payer: Cigna Commercial |
$49.75
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$30.26
|
| Rate for Payer: Health EOS Commercial |
$48.13
|
| Rate for Payer: HFN Commercial |
$49.75
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$40.56
|
| Rate for Payer: Multiplan Commercial |
$43.26
|
| Rate for Payer: NAPHCARE Commercial |
$32.45
|
| Rate for Payer: Preferred Network Access Commercial |
$49.75
|
| Rate for Payer: Quartz Beloit One Network |
$26.50
|
| Rate for Payer: Quartz Commercial |
$35.15
|
| Rate for Payer: Quartz Medicare Advantage |
$32.45
|
| Rate for Payer: The Alliance Commercial |
$1,163.43
|
| Rate for Payer: WEA Trust Commercial |
$29.74
|
| Rate for Payer: WPS Commercial |
$40.06
|
|
|
WHFO W/O Joints Pre OTS L3809
|
Facility
|
IP
|
$778.00
|
|
|
Service Code
|
HCPCS L3809
|
| Hospital Charge Code |
4392949
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$396.47 |
| Max. Negotiated Rate |
$744.39 |
| Rate for Payer: Aetna Commercial |
$728.21
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$695.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$428.83
|
| Rate for Payer: Cash Price |
$233.40
|
| Rate for Payer: Cigna Commercial |
$744.39
|
| Rate for Payer: Health EOS Commercial |
$720.12
|
| Rate for Payer: HFN Commercial |
$744.39
|
| Rate for Payer: Multiplan Commercial |
$647.30
|
| Rate for Payer: Preferred Network Access Commercial |
$744.39
|
| Rate for Payer: Quartz Beloit One Network |
$396.47
|
| Rate for Payer: Quartz Commercial |
$485.47
|
| Rate for Payer: WEA Trust Commercial |
$445.02
|
| Rate for Payer: WPS Commercial |
$599.29
|
|
|
WHFO W/O Joints Pre OTS L3809
|
Facility
|
OP
|
$778.00
|
|
|
Service Code
|
HCPCS L3809
|
| Hospital Charge Code |
4392949
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$56.71 |
| Max. Negotiated Rate |
$1,163.43 |
| Rate for Payer: Aetna Commercial |
$728.21
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$695.84
|
| Rate for Payer: Aetna Managed Medicare |
$226.55
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$56.71
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$56.71
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$56.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$428.83
|
| Rate for Payer: Cash Price |
$233.40
|
| Rate for Payer: Cash Price |
$233.40
|
| Rate for Payer: Cigna Commercial |
$744.39
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$452.80
|
| Rate for Payer: Health EOS Commercial |
$720.12
|
| Rate for Payer: HFN Commercial |
$744.39
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$606.84
|
| Rate for Payer: Multiplan Commercial |
$647.30
|
| Rate for Payer: NAPHCARE Commercial |
$485.47
|
| Rate for Payer: Preferred Network Access Commercial |
$744.39
|
| Rate for Payer: Quartz Beloit One Network |
$396.47
|
| Rate for Payer: Quartz Commercial |
$525.93
|
| Rate for Payer: Quartz Medicare Advantage |
$485.47
|
| Rate for Payer: The Alliance Commercial |
$1,163.43
|
| Rate for Payer: WEA Trust Commercial |
$445.02
|
| Rate for Payer: WPS Commercial |
$599.29
|
|
|
WHFO W/O Joints Pre OTS L3809
|
Professional
|
Both
|
$778.00
|
|
|
Service Code
|
HCPCS L3809
|
| Hospital Charge Code |
4392949
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$290.86 |
| Max. Negotiated Rate |
$838.61 |
| Rate for Payer: Aetna Commercial |
$768.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$695.84
|
| Rate for Payer: Aetna Managed Medicare |
$290.86
|
| Rate for Payer: Anthem Medicare Advantage |
$290.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$290.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$290.86
|
| Rate for Payer: Cash Price |
$233.40
|
| Rate for Payer: Cash Price |
$233.40
|
| Rate for Payer: Cigna Commercial |
$768.66
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$404.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$290.86
|
| Rate for Payer: Health EOS Commercial |
$736.30
|
| Rate for Payer: HFN Commercial |
$768.66
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$838.61
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$838.61
|
| Rate for Payer: Independent Care Health Plan Medicare |
$290.86
|
| Rate for Payer: Multiplan Commercial |
$647.30
|
| Rate for Payer: NAPHCARE Commercial |
$436.29
|
| Rate for Payer: Preferred Network Access Commercial |
$768.66
|
| Rate for Payer: Quartz Beloit One Network |
$356.01
|
| Rate for Payer: Quartz Commercial |
$461.20
|
| Rate for Payer: Quartz Medicare Advantage |
$290.86
|
| Rate for Payer: The Alliance Commercial |
$799.86
|
| Rate for Payer: United Healthcare Medicare Advantage |
$290.86
|
| Rate for Payer: WEA Trust Commercial |
$445.02
|
| Rate for Payer: WPS Commercial |
$509.00
|
|
|
WHISHERS MINI #MW100
|
Facility
|
IP
|
$261.00
|
|
| Hospital Charge Code |
2972425
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$133.01 |
| Max. Negotiated Rate |
$249.72 |
| Rate for Payer: Aetna Commercial |
$244.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$233.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$143.86
|
| Rate for Payer: Cash Price |
$78.30
|
| Rate for Payer: Cigna Commercial |
$249.72
|
| Rate for Payer: Health EOS Commercial |
$241.58
|
| Rate for Payer: HFN Commercial |
$249.72
|
| Rate for Payer: Multiplan Commercial |
$217.15
|
| Rate for Payer: Preferred Network Access Commercial |
$249.72
|
| Rate for Payer: Quartz Beloit One Network |
$133.01
|
| Rate for Payer: Quartz Commercial |
$162.86
|
| Rate for Payer: WEA Trust Commercial |
$149.29
|
| Rate for Payer: WPS Commercial |
$201.05
|
|
|
WHISHERS MINI #MW100
|
Facility
|
OP
|
$261.00
|
|
| Hospital Charge Code |
2972425
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$76.00 |
| Max. Negotiated Rate |
$249.72 |
| Rate for Payer: Aetna Commercial |
$244.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$233.44
|
| Rate for Payer: Aetna Managed Medicare |
$76.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$176.44
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$135.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$130.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$143.86
|
| Rate for Payer: Cash Price |
$78.30
|
| Rate for Payer: Cigna Commercial |
$249.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$151.90
|
| Rate for Payer: Health EOS Commercial |
$241.58
|
| Rate for Payer: HFN Commercial |
$249.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$203.58
|
| Rate for Payer: Multiplan Commercial |
$217.15
|
| Rate for Payer: NAPHCARE Commercial |
$162.86
|
| Rate for Payer: Preferred Network Access Commercial |
$249.72
|
| Rate for Payer: Quartz Beloit One Network |
$133.01
|
| Rate for Payer: Quartz Commercial |
$176.44
|
| Rate for Payer: Quartz Medicare Advantage |
$162.86
|
| Rate for Payer: The Alliance Commercial |
$135.72
|
| Rate for Payer: WEA Trust Commercial |
$149.29
|
| Rate for Payer: WPS Commercial |
$201.05
|
|
|
Whitacre Spinal Ndl 22Ga x 3.5 7080""
|
Facility
|
OP
|
$124.00
|
|
| Hospital Charge Code |
3101768
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$36.11 |
| Max. Negotiated Rate |
$118.64 |
| Rate for Payer: Aetna Commercial |
$116.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$110.91
|
| Rate for Payer: Aetna Managed Medicare |
$36.11
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$83.82
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$64.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$61.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$68.35
|
| Rate for Payer: Cash Price |
$37.20
|
| Rate for Payer: Cigna Commercial |
$118.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$72.17
|
| Rate for Payer: Health EOS Commercial |
$114.77
|
| Rate for Payer: HFN Commercial |
$118.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$96.72
|
| Rate for Payer: Multiplan Commercial |
$103.17
|
| Rate for Payer: NAPHCARE Commercial |
$77.38
|
| Rate for Payer: Preferred Network Access Commercial |
$118.64
|
| Rate for Payer: Quartz Beloit One Network |
$63.19
|
| Rate for Payer: Quartz Commercial |
$83.82
|
| Rate for Payer: Quartz Medicare Advantage |
$77.38
|
| Rate for Payer: The Alliance Commercial |
$64.48
|
| Rate for Payer: WEA Trust Commercial |
$70.93
|
| Rate for Payer: WPS Commercial |
$95.52
|
|
|
Whitacre Spinal Ndl 22Ga x 3.5 7080""
|
Facility
|
IP
|
$124.00
|
|
| Hospital Charge Code |
3101768
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$63.19 |
| Max. Negotiated Rate |
$118.64 |
| Rate for Payer: Aetna Commercial |
$116.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$110.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$68.35
|
| Rate for Payer: Cash Price |
$37.20
|
| Rate for Payer: Cigna Commercial |
$118.64
|
| Rate for Payer: Health EOS Commercial |
$114.77
|
| Rate for Payer: HFN Commercial |
$118.64
|
| Rate for Payer: Multiplan Commercial |
$103.17
|
| Rate for Payer: Preferred Network Access Commercial |
$118.64
|
| Rate for Payer: Quartz Beloit One Network |
$63.19
|
| Rate for Payer: Quartz Commercial |
$77.38
|
| Rate for Payer: WEA Trust Commercial |
$70.93
|
| Rate for Payer: WPS Commercial |
$95.52
|
|
|
White Blood Count
|
Facility
|
OP
|
$63.00
|
|
|
Service Code
|
CPT 85048
|
| Hospital Charge Code |
633873
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$2.64 |
| Max. Negotiated Rate |
$60.28 |
| Rate for Payer: Aetna Commercial |
$58.97
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$56.35
|
| Rate for Payer: Aetna Managed Medicare |
$2.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$9.91
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4.62
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4.39
|
| Rate for Payer: Anthem Medicare Advantage |
$2.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$34.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$2.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$2.64
|
| Rate for Payer: Cash Price |
$18.90
|
| Rate for Payer: Cash Price |
$18.90
|
| Rate for Payer: Cigna Commercial |
$60.28
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$2.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$36.67
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$2.64
|
| Rate for Payer: Health EOS Commercial |
$58.31
|
| Rate for Payer: HFN Commercial |
$60.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$9.83
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$2.64
|
| Rate for Payer: Independent Care Health Plan Medicare |
$2.64
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$2.64
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$2.64
|
| Rate for Payer: Multiplan Commercial |
$52.42
|
| Rate for Payer: NAPHCARE Commercial |
$3.96
|
| Rate for Payer: Preferred Network Access Commercial |
$60.28
|
| Rate for Payer: Quartz Beloit One Network |
$32.10
|
| Rate for Payer: Quartz Commercial |
$42.59
|
| Rate for Payer: Quartz Medicare Advantage |
$2.64
|
| Rate for Payer: The Alliance Commercial |
$10.57
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2.64
|
| Rate for Payer: United Healthcare PPO |
$49.14
|
| Rate for Payer: WEA Trust Commercial |
$36.04
|
| Rate for Payer: Wellcare Medicare |
$2.64
|
| Rate for Payer: WPS Commercial |
$48.53
|
|
|
White Blood Count
|
Facility
|
IP
|
$63.00
|
|
|
Service Code
|
CPT 85048
|
| Hospital Charge Code |
633873
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$32.10 |
| Max. Negotiated Rate |
$60.28 |
| Rate for Payer: Aetna Commercial |
$58.97
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$56.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$34.73
|
| Rate for Payer: Cash Price |
$18.90
|
| Rate for Payer: Cigna Commercial |
$60.28
|
| Rate for Payer: Health EOS Commercial |
$58.31
|
| Rate for Payer: HFN Commercial |
$60.28
|
| Rate for Payer: Multiplan Commercial |
$52.42
|
| Rate for Payer: Preferred Network Access Commercial |
$60.28
|
| Rate for Payer: Quartz Beloit One Network |
$32.10
|
| Rate for Payer: Quartz Commercial |
$39.31
|
| Rate for Payer: WEA Trust Commercial |
$36.04
|
| Rate for Payer: WPS Commercial |
$48.53
|
|
|
White Blood Count
|
Professional
|
Both
|
$63.00
|
|
|
Service Code
|
CPT 85048
|
| Hospital Charge Code |
633873
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$2.64 |
| Max. Negotiated Rate |
$62.24 |
| Rate for Payer: Aetna Commercial |
$62.24
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$56.35
|
| Rate for Payer: Aetna Managed Medicare |
$2.64
|
| Rate for Payer: Anthem Medicare Advantage |
$2.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$2.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$2.64
|
| Rate for Payer: Cash Price |
$18.90
|
| Rate for Payer: Cash Price |
$18.90
|
| Rate for Payer: Cigna Commercial |
$62.24
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$32.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2.64
|
| Rate for Payer: Health EOS Commercial |
$59.62
|
| Rate for Payer: HFN Commercial |
$62.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$9.33
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$9.33
|
| Rate for Payer: Independent Care Health Plan Medicare |
$2.64
|
| Rate for Payer: Multiplan Commercial |
$52.42
|
| Rate for Payer: NAPHCARE Commercial |
$3.96
|
| Rate for Payer: Preferred Network Access Commercial |
$62.24
|
| Rate for Payer: Quartz Beloit One Network |
$28.83
|
| Rate for Payer: Quartz Commercial |
$37.35
|
| Rate for Payer: Quartz Medicare Advantage |
$2.64
|
| Rate for Payer: The Alliance Commercial |
$10.43
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2.64
|
| Rate for Payer: WEA Trust Commercial |
$36.04
|
| Rate for Payer: WPS Commercial |
$11.62
|
|
|
WICKS POPE EAR #7014-0095
|
Facility
|
IP
|
$66.00
|
|
| Hospital Charge Code |
2969529
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$33.63 |
| Max. Negotiated Rate |
$63.15 |
| Rate for Payer: Aetna Commercial |
$61.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$59.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$36.38
|
| Rate for Payer: Cash Price |
$19.80
|
| Rate for Payer: Cigna Commercial |
$63.15
|
| Rate for Payer: Health EOS Commercial |
$61.09
|
| Rate for Payer: HFN Commercial |
$63.15
|
| Rate for Payer: Multiplan Commercial |
$54.91
|
| Rate for Payer: Preferred Network Access Commercial |
$63.15
|
| Rate for Payer: Quartz Beloit One Network |
$33.63
|
| Rate for Payer: Quartz Commercial |
$41.18
|
| Rate for Payer: WEA Trust Commercial |
$37.75
|
| Rate for Payer: WPS Commercial |
$50.84
|
|
|
WICKS POPE EAR #7014-0095
|
Facility
|
OP
|
$66.00
|
|
| Hospital Charge Code |
2969529
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$19.22 |
| Max. Negotiated Rate |
$63.15 |
| Rate for Payer: Aetna Commercial |
$61.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$59.03
|
| Rate for Payer: Aetna Managed Medicare |
$19.22
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$44.62
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$34.32
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$32.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$36.38
|
| Rate for Payer: Cash Price |
$19.80
|
| Rate for Payer: Cigna Commercial |
$63.15
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$38.41
|
| Rate for Payer: Health EOS Commercial |
$61.09
|
| Rate for Payer: HFN Commercial |
$63.15
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$51.48
|
| Rate for Payer: Multiplan Commercial |
$54.91
|
| Rate for Payer: NAPHCARE Commercial |
$41.18
|
| Rate for Payer: Preferred Network Access Commercial |
$63.15
|
| Rate for Payer: Quartz Beloit One Network |
$33.63
|
| Rate for Payer: Quartz Commercial |
$44.62
|
| Rate for Payer: Quartz Medicare Advantage |
$41.18
|
| Rate for Payer: The Alliance Commercial |
$34.32
|
| Rate for Payer: WEA Trust Commercial |
$37.75
|
| Rate for Payer: WPS Commercial |
$50.84
|
|
|
WIDE LOCAL EXCISION (LOWER BODY)
|
Facility
|
IP
|
$1,084.00
|
|
| Hospital Charge Code |
4688606
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$552.41 |
| Max. Negotiated Rate |
$1,037.17 |
| Rate for Payer: Aetna Commercial |
$1,014.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$969.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$597.50
|
| Rate for Payer: Cash Price |
$325.20
|
| Rate for Payer: Cigna Commercial |
$1,037.17
|
| Rate for Payer: Health EOS Commercial |
$1,003.35
|
| Rate for Payer: HFN Commercial |
$1,037.17
|
| Rate for Payer: Multiplan Commercial |
$901.89
|
| Rate for Payer: Preferred Network Access Commercial |
$1,037.17
|
| Rate for Payer: Quartz Beloit One Network |
$552.41
|
| Rate for Payer: Quartz Commercial |
$676.42
|
| Rate for Payer: WEA Trust Commercial |
$620.05
|
| Rate for Payer: WPS Commercial |
$835.01
|
|
|
WIDE LOCAL EXCISION (LOWER BODY)
|
Facility
|
OP
|
$1,084.00
|
|
| Hospital Charge Code |
4688606
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$315.66 |
| Max. Negotiated Rate |
$1,037.17 |
| Rate for Payer: Aetna Commercial |
$1,014.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$969.53
|
| Rate for Payer: Aetna Managed Medicare |
$315.66
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$732.78
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$563.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$541.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$597.50
|
| Rate for Payer: Cash Price |
$325.20
|
| Rate for Payer: Cigna Commercial |
$1,037.17
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$630.89
|
| Rate for Payer: Health EOS Commercial |
$1,003.35
|
| Rate for Payer: HFN Commercial |
$1,037.17
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$845.52
|
| Rate for Payer: Multiplan Commercial |
$901.89
|
| Rate for Payer: NAPHCARE Commercial |
$676.42
|
| Rate for Payer: Preferred Network Access Commercial |
$1,037.17
|
| Rate for Payer: Quartz Beloit One Network |
$552.41
|
| Rate for Payer: Quartz Commercial |
$732.78
|
| Rate for Payer: Quartz Medicare Advantage |
$676.42
|
| Rate for Payer: The Alliance Commercial |
$563.68
|
| Rate for Payer: WEA Trust Commercial |
$620.05
|
| Rate for Payer: WPS Commercial |
$835.01
|
|
|
WIDE LOCAL EXCISION (UPPER BODY)
|
Facility
|
IP
|
$1,084.00
|
|
| Hospital Charge Code |
2960509
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$552.41 |
| Max. Negotiated Rate |
$1,037.17 |
| Rate for Payer: Aetna Commercial |
$1,014.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$969.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$597.50
|
| Rate for Payer: Cash Price |
$325.20
|
| Rate for Payer: Cigna Commercial |
$1,037.17
|
| Rate for Payer: Health EOS Commercial |
$1,003.35
|
| Rate for Payer: HFN Commercial |
$1,037.17
|
| Rate for Payer: Multiplan Commercial |
$901.89
|
| Rate for Payer: Preferred Network Access Commercial |
$1,037.17
|
| Rate for Payer: Quartz Beloit One Network |
$552.41
|
| Rate for Payer: Quartz Commercial |
$676.42
|
| Rate for Payer: WEA Trust Commercial |
$620.05
|
| Rate for Payer: WPS Commercial |
$835.01
|
|
|
WIDE LOCAL EXCISION (UPPER BODY)
|
Facility
|
OP
|
$1,084.00
|
|
| Hospital Charge Code |
2960509
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$315.66 |
| Max. Negotiated Rate |
$1,037.17 |
| Rate for Payer: Aetna Commercial |
$1,014.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$969.53
|
| Rate for Payer: Aetna Managed Medicare |
$315.66
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$732.78
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$563.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$541.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$597.50
|
| Rate for Payer: Cash Price |
$325.20
|
| Rate for Payer: Cigna Commercial |
$1,037.17
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$630.89
|
| Rate for Payer: Health EOS Commercial |
$1,003.35
|
| Rate for Payer: HFN Commercial |
$1,037.17
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$845.52
|
| Rate for Payer: Multiplan Commercial |
$901.89
|
| Rate for Payer: NAPHCARE Commercial |
$676.42
|
| Rate for Payer: Preferred Network Access Commercial |
$1,037.17
|
| Rate for Payer: Quartz Beloit One Network |
$552.41
|
| Rate for Payer: Quartz Commercial |
$732.78
|
| Rate for Payer: Quartz Medicare Advantage |
$676.42
|
| Rate for Payer: The Alliance Commercial |
$563.68
|
| Rate for Payer: WEA Trust Commercial |
$620.05
|
| Rate for Payer: WPS Commercial |
$835.01
|
|
|
Wilson Disease Full Gene Analysis
|
Professional
|
Both
|
$2,848.00
|
|
|
Service Code
|
CPT 81406
|
| Hospital Charge Code |
5426838
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$294.20 |
| Max. Negotiated Rate |
$2,813.82 |
| Rate for Payer: Aetna Commercial |
$2,813.82
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,547.25
|
| Rate for Payer: Aetna Managed Medicare |
$294.20
|
| Rate for Payer: Anthem Medicare Advantage |
$294.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$294.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$294.20
|
| Rate for Payer: Cash Price |
$854.40
|
| Rate for Payer: Cash Price |
$854.40
|
| Rate for Payer: Cigna Commercial |
$2,813.82
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,480.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$294.20
|
| Rate for Payer: Health EOS Commercial |
$2,695.35
|
| Rate for Payer: HFN Commercial |
$2,813.82
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,038.51
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,038.51
|
| Rate for Payer: Independent Care Health Plan Medicare |
$294.20
|
| Rate for Payer: Multiplan Commercial |
$2,369.54
|
| Rate for Payer: NAPHCARE Commercial |
$441.29
|
| Rate for Payer: Preferred Network Access Commercial |
$2,813.82
|
| Rate for Payer: Quartz Beloit One Network |
$1,303.24
|
| Rate for Payer: Quartz Commercial |
$1,688.29
|
| Rate for Payer: Quartz Medicare Advantage |
$294.20
|
| Rate for Payer: The Alliance Commercial |
$1,162.07
|
| Rate for Payer: United Healthcare Medicare Advantage |
$294.20
|
| Rate for Payer: WEA Trust Commercial |
$1,629.06
|
| Rate for Payer: WPS Commercial |
$1,294.46
|
|
