|
Wet Prep POC
|
Facility
|
OP
|
$64.00
|
|
|
Service Code
|
CPT 87210
|
| Hospital Charge Code |
3080730
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$5.82 |
| Max. Negotiated Rate |
$58.88 |
| Rate for Payer: Aetna Commercial |
$57.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$55.04
|
| Rate for Payer: Aetna Managed Medicare |
$5.82
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$41.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$32.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$30.72
|
| Rate for Payer: Anthem Medicaid |
$6.00
|
| Rate for Payer: Anthem Medicare Advantage |
$5.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$33.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5.82
|
| Rate for Payer: Cash Price |
$19.20
|
| Rate for Payer: Cash Price |
$19.20
|
| Rate for Payer: Cigna Commercial |
$58.88
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$5.82
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$6.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$35.81
|
| Rate for Payer: Dean Health Medicaid |
$6.00
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$5.82
|
| Rate for Payer: Health EOS Commercial |
$56.96
|
| Rate for Payer: HFN Commercial |
$58.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$21.65
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$5.82
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$6.00
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5.82
|
| Rate for Payer: Managed Health Services Medicaid |
$6.24
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$5.82
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$5.82
|
| Rate for Payer: Multiplan Commercial |
$51.20
|
| Rate for Payer: NAPHCARE Commercial |
$8.73
|
| Rate for Payer: Preferred Network Access Commercial |
$58.88
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$6.00
|
| Rate for Payer: Quartz Beloit One Network |
$31.36
|
| Rate for Payer: Quartz Commercial |
$41.60
|
| Rate for Payer: Quartz Medicare Advantage |
$5.82
|
| Rate for Payer: The Alliance Commercial |
$23.28
|
| Rate for Payer: United Healthcare Medicaid |
$6.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.82
|
| Rate for Payer: WEA Trust Commercial |
$35.20
|
| Rate for Payer: Wellcare Medicare |
$5.82
|
| Rate for Payer: WMAP Medicaid |
$6.00
|
| Rate for Payer: WPS Commercial |
$47.40
|
|
|
Wet Prep POC
|
Facility
|
IP
|
$64.00
|
|
|
Service Code
|
CPT 87210
|
| Hospital Charge Code |
3080730
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$31.36 |
| Max. Negotiated Rate |
$58.88 |
| Rate for Payer: Aetna Commercial |
$57.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$55.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$33.92
|
| Rate for Payer: Cash Price |
$19.20
|
| Rate for Payer: Cigna Commercial |
$58.88
|
| Rate for Payer: Health EOS Commercial |
$56.96
|
| Rate for Payer: HFN Commercial |
$58.88
|
| Rate for Payer: Multiplan Commercial |
$51.20
|
| Rate for Payer: NAPHCARE Commercial |
$38.40
|
| Rate for Payer: Preferred Network Access Commercial |
$58.88
|
| Rate for Payer: Quartz Beloit One Network |
$31.36
|
| Rate for Payer: Quartz Commercial |
$38.40
|
| Rate for Payer: WEA Trust Commercial |
$35.20
|
| Rate for Payer: WPS Commercial |
$47.40
|
|
|
WHFO,no joint,prefabricated L3807
|
Professional
|
Both
|
$52.00
|
|
|
Service Code
|
HCPCS L3807
|
| Hospital Charge Code |
3983438
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$22.88 |
| Max. Negotiated Rate |
$806.36 |
| Rate for Payer: Aetna Commercial |
$49.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$44.72
|
| Rate for Payer: Cash Price |
$15.60
|
| Rate for Payer: Cash Price |
$15.60
|
| Rate for Payer: Cigna Commercial |
$49.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$26.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$31.20
|
| Rate for Payer: Health EOS Commercial |
$47.32
|
| Rate for Payer: HFN Commercial |
$49.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$806.36
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$806.36
|
| Rate for Payer: Multiplan Commercial |
$41.60
|
| Rate for Payer: Preferred Network Access Commercial |
$49.40
|
| Rate for Payer: Quartz Beloit One Network |
$22.88
|
| Rate for Payer: Quartz Commercial |
$29.64
|
| Rate for Payer: The Alliance Commercial |
$26.00
|
| Rate for Payer: WEA Trust Commercial |
$28.60
|
| Rate for Payer: WPS Commercial |
$38.52
|
|
|
WHFO,no joint,prefabricated L3807
|
Facility
|
OP
|
$52.00
|
|
|
Service Code
|
HCPCS L3807
|
| Hospital Charge Code |
3983438
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$14.56 |
| Max. Negotiated Rate |
$208.00 |
| Rate for Payer: Aetna Commercial |
$46.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$44.72
|
| Rate for Payer: Aetna Managed Medicare |
$14.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$142.83
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$142.83
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$142.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$27.56
|
| Rate for Payer: Cash Price |
$15.60
|
| Rate for Payer: Cash Price |
$15.60
|
| Rate for Payer: Cigna Commercial |
$47.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$29.10
|
| Rate for Payer: Health EOS Commercial |
$46.28
|
| Rate for Payer: HFN Commercial |
$47.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$39.00
|
| Rate for Payer: Multiplan Commercial |
$41.60
|
| Rate for Payer: NAPHCARE Commercial |
$31.20
|
| Rate for Payer: Preferred Network Access Commercial |
$47.84
|
| Rate for Payer: Quartz Beloit One Network |
$25.48
|
| Rate for Payer: Quartz Commercial |
$33.80
|
| Rate for Payer: Quartz Medicare Advantage |
$31.20
|
| Rate for Payer: The Alliance Commercial |
$208.00
|
| Rate for Payer: WEA Trust Commercial |
$28.60
|
| Rate for Payer: WPS Commercial |
$38.52
|
|
|
WHFO,no joint,prefabricated L3807
|
Facility
|
IP
|
$52.00
|
|
|
Service Code
|
HCPCS L3807
|
| Hospital Charge Code |
3983438
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$25.48 |
| Max. Negotiated Rate |
$47.84 |
| Rate for Payer: Aetna Commercial |
$46.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$44.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$27.56
|
| Rate for Payer: Cash Price |
$15.60
|
| Rate for Payer: Cigna Commercial |
$47.84
|
| Rate for Payer: Health EOS Commercial |
$46.28
|
| Rate for Payer: HFN Commercial |
$47.84
|
| Rate for Payer: Multiplan Commercial |
$41.60
|
| Rate for Payer: NAPHCARE Commercial |
$31.20
|
| Rate for Payer: Preferred Network Access Commercial |
$47.84
|
| Rate for Payer: Quartz Beloit One Network |
$25.48
|
| Rate for Payer: Quartz Commercial |
$31.20
|
| Rate for Payer: WEA Trust Commercial |
$28.60
|
| Rate for Payer: WPS Commercial |
$38.52
|
|
|
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 |
$54.53 |
| Max. Negotiated Rate |
$3,112.00 |
| Rate for Payer: Aetna Commercial |
$700.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$669.08
|
| Rate for Payer: Aetna Managed Medicare |
$217.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$54.53
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$54.53
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$54.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$412.34
|
| Rate for Payer: Cash Price |
$233.40
|
| Rate for Payer: Cash Price |
$233.40
|
| Rate for Payer: Cigna Commercial |
$715.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$435.37
|
| Rate for Payer: Health EOS Commercial |
$692.42
|
| Rate for Payer: HFN Commercial |
$715.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$583.50
|
| Rate for Payer: Multiplan Commercial |
$622.40
|
| Rate for Payer: NAPHCARE Commercial |
$466.80
|
| Rate for Payer: Preferred Network Access Commercial |
$715.76
|
| Rate for Payer: Quartz Beloit One Network |
$381.22
|
| Rate for Payer: Quartz Commercial |
$505.70
|
| Rate for Payer: Quartz Medicare Advantage |
$466.80
|
| Rate for Payer: The Alliance Commercial |
$3,112.00
|
| Rate for Payer: WEA Trust Commercial |
$427.90
|
| Rate for Payer: WPS Commercial |
$576.26
|
|
|
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 |
$381.22 |
| Max. Negotiated Rate |
$715.76 |
| Rate for Payer: Aetna Commercial |
$700.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$669.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$412.34
|
| Rate for Payer: Cash Price |
$233.40
|
| Rate for Payer: Cigna Commercial |
$715.76
|
| Rate for Payer: Health EOS Commercial |
$692.42
|
| Rate for Payer: HFN Commercial |
$715.76
|
| Rate for Payer: Multiplan Commercial |
$622.40
|
| Rate for Payer: NAPHCARE Commercial |
$466.80
|
| Rate for Payer: Preferred Network Access Commercial |
$715.76
|
| Rate for Payer: Quartz Beloit One Network |
$381.22
|
| Rate for Payer: Quartz Commercial |
$466.80
|
| Rate for Payer: WEA Trust Commercial |
$427.90
|
| Rate for Payer: WPS Commercial |
$576.26
|
|
|
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 |
$342.32 |
| Max. Negotiated Rate |
$806.36 |
| Rate for Payer: Aetna Commercial |
$739.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$669.08
|
| Rate for Payer: Cash Price |
$233.40
|
| Rate for Payer: Cash Price |
$233.40
|
| Rate for Payer: Cigna Commercial |
$739.10
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$389.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$466.80
|
| Rate for Payer: Health EOS Commercial |
$707.98
|
| Rate for Payer: HFN Commercial |
$739.10
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$806.36
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$806.36
|
| Rate for Payer: Multiplan Commercial |
$622.40
|
| Rate for Payer: Preferred Network Access Commercial |
$739.10
|
| Rate for Payer: Quartz Beloit One Network |
$342.32
|
| Rate for Payer: Quartz Commercial |
$443.46
|
| Rate for Payer: The Alliance Commercial |
$389.00
|
| Rate for Payer: WEA Trust Commercial |
$427.90
|
| Rate for Payer: WPS Commercial |
$576.26
|
|
|
WHISHERS MINI #MW100
|
Facility
|
IP
|
$261.00
|
|
| Hospital Charge Code |
2972425
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$127.89 |
| Max. Negotiated Rate |
$240.12 |
| Rate for Payer: Aetna Commercial |
$234.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$224.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$138.33
|
| Rate for Payer: Cash Price |
$78.30
|
| Rate for Payer: Cigna Commercial |
$240.12
|
| Rate for Payer: Health EOS Commercial |
$232.29
|
| Rate for Payer: HFN Commercial |
$240.12
|
| Rate for Payer: Multiplan Commercial |
$208.80
|
| Rate for Payer: NAPHCARE Commercial |
$156.60
|
| Rate for Payer: Preferred Network Access Commercial |
$240.12
|
| Rate for Payer: Quartz Beloit One Network |
$127.89
|
| Rate for Payer: Quartz Commercial |
$156.60
|
| Rate for Payer: WEA Trust Commercial |
$143.55
|
| Rate for Payer: WPS Commercial |
$193.32
|
|
|
WHISHERS MINI #MW100
|
Facility
|
OP
|
$261.00
|
|
| Hospital Charge Code |
2972425
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$73.08 |
| Max. Negotiated Rate |
$1,044.00 |
| Rate for Payer: Aetna Commercial |
$234.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$224.46
|
| Rate for Payer: Aetna Managed Medicare |
$73.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$169.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$130.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$125.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$138.33
|
| Rate for Payer: Cash Price |
$78.30
|
| Rate for Payer: Cigna Commercial |
$240.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$146.06
|
| Rate for Payer: Health EOS Commercial |
$232.29
|
| Rate for Payer: HFN Commercial |
$240.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$195.75
|
| Rate for Payer: Multiplan Commercial |
$208.80
|
| Rate for Payer: NAPHCARE Commercial |
$156.60
|
| Rate for Payer: Preferred Network Access Commercial |
$240.12
|
| Rate for Payer: Quartz Beloit One Network |
$127.89
|
| Rate for Payer: Quartz Commercial |
$169.65
|
| Rate for Payer: Quartz Medicare Advantage |
$156.60
|
| Rate for Payer: The Alliance Commercial |
$1,044.00
|
| Rate for Payer: WEA Trust Commercial |
$143.55
|
| Rate for Payer: WPS Commercial |
$193.32
|
|
|
Whitacre Spinal Ndl 22Ga x 3.5 7080""
|
Facility
|
OP
|
$124.00
|
|
| Hospital Charge Code |
3101768
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$34.72 |
| Max. Negotiated Rate |
$496.00 |
| Rate for Payer: Aetna Commercial |
$111.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$106.64
|
| Rate for Payer: Aetna Managed Medicare |
$34.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$80.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$62.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$59.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$65.72
|
| Rate for Payer: Cash Price |
$37.20
|
| Rate for Payer: Cigna Commercial |
$114.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$69.39
|
| Rate for Payer: Health EOS Commercial |
$110.36
|
| Rate for Payer: HFN Commercial |
$114.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$93.00
|
| Rate for Payer: Multiplan Commercial |
$99.20
|
| Rate for Payer: NAPHCARE Commercial |
$74.40
|
| Rate for Payer: Preferred Network Access Commercial |
$114.08
|
| Rate for Payer: Quartz Beloit One Network |
$60.76
|
| Rate for Payer: Quartz Commercial |
$80.60
|
| Rate for Payer: Quartz Medicare Advantage |
$74.40
|
| Rate for Payer: The Alliance Commercial |
$496.00
|
| Rate for Payer: WEA Trust Commercial |
$68.20
|
| Rate for Payer: WPS Commercial |
$91.85
|
|
|
Whitacre Spinal Ndl 22Ga x 3.5 7080""
|
Facility
|
IP
|
$124.00
|
|
| Hospital Charge Code |
3101768
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$60.76 |
| Max. Negotiated Rate |
$114.08 |
| Rate for Payer: Aetna Commercial |
$111.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$106.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$65.72
|
| Rate for Payer: Cash Price |
$37.20
|
| Rate for Payer: Cigna Commercial |
$114.08
|
| Rate for Payer: Health EOS Commercial |
$110.36
|
| Rate for Payer: HFN Commercial |
$114.08
|
| Rate for Payer: Multiplan Commercial |
$99.20
|
| Rate for Payer: NAPHCARE Commercial |
$74.40
|
| Rate for Payer: Preferred Network Access Commercial |
$114.08
|
| Rate for Payer: Quartz Beloit One Network |
$60.76
|
| Rate for Payer: Quartz Commercial |
$74.40
|
| Rate for Payer: WEA Trust Commercial |
$68.20
|
| Rate for Payer: WPS Commercial |
$91.85
|
|
|
White Blood Count
|
Facility
|
IP
|
$63.00
|
|
|
Service Code
|
CPT 85048
|
| Hospital Charge Code |
633873
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$30.87 |
| Max. Negotiated Rate |
$57.96 |
| Rate for Payer: Aetna Commercial |
$56.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$54.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$33.39
|
| Rate for Payer: Cash Price |
$18.90
|
| Rate for Payer: Cigna Commercial |
$57.96
|
| Rate for Payer: Health EOS Commercial |
$56.07
|
| Rate for Payer: HFN Commercial |
$57.96
|
| Rate for Payer: Multiplan Commercial |
$50.40
|
| Rate for Payer: NAPHCARE Commercial |
$37.80
|
| Rate for Payer: Preferred Network Access Commercial |
$57.96
|
| Rate for Payer: Quartz Beloit One Network |
$30.87
|
| Rate for Payer: Quartz Commercial |
$37.80
|
| Rate for Payer: WEA Trust Commercial |
$34.65
|
| Rate for Payer: WPS Commercial |
$46.66
|
|
|
White Blood Count
|
Professional
|
Both
|
$63.00
|
|
|
Service Code
|
CPT 85048
|
| Hospital Charge Code |
633873
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.97 |
| Max. Negotiated Rate |
$59.85 |
| Rate for Payer: Aetna Commercial |
$59.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$54.18
|
| Rate for Payer: Cash Price |
$18.90
|
| Rate for Payer: Cash Price |
$18.90
|
| Rate for Payer: Cigna Commercial |
$59.85
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$31.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$37.80
|
| Rate for Payer: Health EOS Commercial |
$57.33
|
| Rate for Payer: HFN Commercial |
$59.85
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$8.97
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$8.97
|
| Rate for Payer: Multiplan Commercial |
$50.40
|
| Rate for Payer: Preferred Network Access Commercial |
$59.85
|
| Rate for Payer: Quartz Beloit One Network |
$27.72
|
| Rate for Payer: Quartz Commercial |
$35.91
|
| Rate for Payer: The Alliance Commercial |
$31.50
|
| Rate for Payer: WEA Trust Commercial |
$34.65
|
| Rate for Payer: WPS Commercial |
$46.66
|
|
|
White Blood Count
|
Facility
|
OP
|
$63.00
|
|
|
Service Code
|
CPT 85048
|
| Hospital Charge Code |
633873
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$2.54 |
| Max. Negotiated Rate |
$57.96 |
| Rate for Payer: Aetna Commercial |
$56.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$54.18
|
| Rate for Payer: Aetna Managed Medicare |
$2.54
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$9.52
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4.22
|
| Rate for Payer: Anthem Medicaid |
$2.62
|
| Rate for Payer: Anthem Medicare Advantage |
$2.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$33.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$2.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$2.54
|
| Rate for Payer: Cash Price |
$18.90
|
| Rate for Payer: Cash Price |
$18.90
|
| Rate for Payer: Cigna Commercial |
$57.96
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$2.54
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2.62
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$35.25
|
| Rate for Payer: Dean Health Medicaid |
$2.62
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$2.54
|
| Rate for Payer: Health EOS Commercial |
$56.07
|
| Rate for Payer: HFN Commercial |
$57.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$9.45
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$2.54
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$2.62
|
| Rate for Payer: Independent Care Health Plan Medicare |
$2.54
|
| Rate for Payer: Managed Health Services Medicaid |
$2.72
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$2.54
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$2.54
|
| Rate for Payer: Multiplan Commercial |
$50.40
|
| Rate for Payer: NAPHCARE Commercial |
$3.81
|
| Rate for Payer: Preferred Network Access Commercial |
$57.96
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$2.62
|
| Rate for Payer: Quartz Beloit One Network |
$30.87
|
| Rate for Payer: Quartz Commercial |
$40.95
|
| Rate for Payer: Quartz Medicare Advantage |
$2.54
|
| Rate for Payer: The Alliance Commercial |
$10.16
|
| Rate for Payer: United Healthcare Medicaid |
$2.62
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2.54
|
| Rate for Payer: United Healthcare PPO |
$47.25
|
| Rate for Payer: WEA Trust Commercial |
$34.65
|
| Rate for Payer: Wellcare Medicare |
$2.54
|
| Rate for Payer: WMAP Medicaid |
$2.62
|
| Rate for Payer: WPS Commercial |
$46.66
|
|
|
WICKS POPE EAR #7014-0095
|
Facility
|
IP
|
$66.00
|
|
| Hospital Charge Code |
2969529
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$32.34 |
| Max. Negotiated Rate |
$60.72 |
| Rate for Payer: Aetna Commercial |
$59.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$56.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$34.98
|
| Rate for Payer: Cash Price |
$19.80
|
| Rate for Payer: Cigna Commercial |
$60.72
|
| Rate for Payer: Health EOS Commercial |
$58.74
|
| Rate for Payer: HFN Commercial |
$60.72
|
| Rate for Payer: Multiplan Commercial |
$52.80
|
| Rate for Payer: NAPHCARE Commercial |
$39.60
|
| Rate for Payer: Preferred Network Access Commercial |
$60.72
|
| Rate for Payer: Quartz Beloit One Network |
$32.34
|
| Rate for Payer: Quartz Commercial |
$39.60
|
| Rate for Payer: WEA Trust Commercial |
$36.30
|
| Rate for Payer: WPS Commercial |
$48.89
|
|
|
WICKS POPE EAR #7014-0095
|
Facility
|
OP
|
$66.00
|
|
| Hospital Charge Code |
2969529
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$18.48 |
| Max. Negotiated Rate |
$264.00 |
| Rate for Payer: Aetna Commercial |
$59.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$56.76
|
| Rate for Payer: Aetna Managed Medicare |
$18.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$42.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$33.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$31.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$34.98
|
| Rate for Payer: Cash Price |
$19.80
|
| Rate for Payer: Cigna Commercial |
$60.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$36.93
|
| Rate for Payer: Health EOS Commercial |
$58.74
|
| Rate for Payer: HFN Commercial |
$60.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$49.50
|
| Rate for Payer: Multiplan Commercial |
$52.80
|
| Rate for Payer: NAPHCARE Commercial |
$39.60
|
| Rate for Payer: Preferred Network Access Commercial |
$60.72
|
| Rate for Payer: Quartz Beloit One Network |
$32.34
|
| Rate for Payer: Quartz Commercial |
$42.90
|
| Rate for Payer: Quartz Medicare Advantage |
$39.60
|
| Rate for Payer: The Alliance Commercial |
$264.00
|
| Rate for Payer: WEA Trust Commercial |
$36.30
|
| Rate for Payer: WPS Commercial |
$48.89
|
|
|
WIDE LOCAL EXCISION (LOWER BODY)
|
Facility
|
OP
|
$1,084.00
|
|
| Hospital Charge Code |
4688606
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$303.52 |
| Max. Negotiated Rate |
$4,336.00 |
| Rate for Payer: Aetna Commercial |
$975.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$932.24
|
| Rate for Payer: Aetna Managed Medicare |
$303.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$704.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$542.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$520.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$574.52
|
| Rate for Payer: Cash Price |
$325.20
|
| Rate for Payer: Cigna Commercial |
$997.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$606.61
|
| Rate for Payer: Health EOS Commercial |
$964.76
|
| Rate for Payer: HFN Commercial |
$997.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$813.00
|
| Rate for Payer: Multiplan Commercial |
$867.20
|
| Rate for Payer: NAPHCARE Commercial |
$650.40
|
| Rate for Payer: Preferred Network Access Commercial |
$997.28
|
| Rate for Payer: Quartz Beloit One Network |
$531.16
|
| Rate for Payer: Quartz Commercial |
$704.60
|
| Rate for Payer: Quartz Medicare Advantage |
$650.40
|
| Rate for Payer: The Alliance Commercial |
$4,336.00
|
| Rate for Payer: WEA Trust Commercial |
$596.20
|
| Rate for Payer: WPS Commercial |
$802.92
|
|
|
WIDE LOCAL EXCISION (LOWER BODY)
|
Facility
|
IP
|
$1,084.00
|
|
| Hospital Charge Code |
4688606
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$531.16 |
| Max. Negotiated Rate |
$997.28 |
| Rate for Payer: Aetna Commercial |
$975.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$932.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$574.52
|
| Rate for Payer: Cash Price |
$325.20
|
| Rate for Payer: Cigna Commercial |
$997.28
|
| Rate for Payer: Health EOS Commercial |
$964.76
|
| Rate for Payer: HFN Commercial |
$997.28
|
| Rate for Payer: Multiplan Commercial |
$867.20
|
| Rate for Payer: NAPHCARE Commercial |
$650.40
|
| Rate for Payer: Preferred Network Access Commercial |
$997.28
|
| Rate for Payer: Quartz Beloit One Network |
$531.16
|
| Rate for Payer: Quartz Commercial |
$650.40
|
| Rate for Payer: WEA Trust Commercial |
$596.20
|
| Rate for Payer: WPS Commercial |
$802.92
|
|
|
WIDE LOCAL EXCISION (UPPER BODY)
|
Facility
|
OP
|
$1,084.00
|
|
| Hospital Charge Code |
2960509
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$303.52 |
| Max. Negotiated Rate |
$4,336.00 |
| Rate for Payer: Aetna Commercial |
$975.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$932.24
|
| Rate for Payer: Aetna Managed Medicare |
$303.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$704.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$542.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$520.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$574.52
|
| Rate for Payer: Cash Price |
$325.20
|
| Rate for Payer: Cigna Commercial |
$997.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$606.61
|
| Rate for Payer: Health EOS Commercial |
$964.76
|
| Rate for Payer: HFN Commercial |
$997.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$813.00
|
| Rate for Payer: Multiplan Commercial |
$867.20
|
| Rate for Payer: NAPHCARE Commercial |
$650.40
|
| Rate for Payer: Preferred Network Access Commercial |
$997.28
|
| Rate for Payer: Quartz Beloit One Network |
$531.16
|
| Rate for Payer: Quartz Commercial |
$704.60
|
| Rate for Payer: Quartz Medicare Advantage |
$650.40
|
| Rate for Payer: The Alliance Commercial |
$4,336.00
|
| Rate for Payer: WEA Trust Commercial |
$596.20
|
| Rate for Payer: WPS Commercial |
$802.92
|
|
|
WIDE LOCAL EXCISION (UPPER BODY)
|
Facility
|
IP
|
$1,084.00
|
|
| Hospital Charge Code |
2960509
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$531.16 |
| Max. Negotiated Rate |
$997.28 |
| Rate for Payer: Aetna Commercial |
$975.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$932.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$574.52
|
| Rate for Payer: Cash Price |
$325.20
|
| Rate for Payer: Cigna Commercial |
$997.28
|
| Rate for Payer: Health EOS Commercial |
$964.76
|
| Rate for Payer: HFN Commercial |
$997.28
|
| Rate for Payer: Multiplan Commercial |
$867.20
|
| Rate for Payer: NAPHCARE Commercial |
$650.40
|
| Rate for Payer: Preferred Network Access Commercial |
$997.28
|
| Rate for Payer: Quartz Beloit One Network |
$531.16
|
| Rate for Payer: Quartz Commercial |
$650.40
|
| Rate for Payer: WEA Trust Commercial |
$596.20
|
| Rate for Payer: WPS Commercial |
$802.92
|
|
|
Wilson Disease Full Gene Analysis
|
Facility
|
OP
|
$2,848.00
|
|
|
Service Code
|
CPT 81406
|
| Hospital Charge Code |
5426838
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$282.88 |
| Max. Negotiated Rate |
$2,620.16 |
| Rate for Payer: Aetna Commercial |
$2,563.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,449.28
|
| Rate for Payer: Aetna Managed Medicare |
$282.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,060.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$495.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$469.58
|
| Rate for Payer: Anthem Medicaid |
$282.88
|
| Rate for Payer: Anthem Medicare Advantage |
$282.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,509.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$282.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$282.88
|
| Rate for Payer: Cash Price |
$854.40
|
| Rate for Payer: Cash Price |
$854.40
|
| Rate for Payer: Cigna Commercial |
$2,620.16
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$282.88
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$282.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,593.74
|
| Rate for Payer: Dean Health Medicaid |
$282.88
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$282.88
|
| Rate for Payer: Health EOS Commercial |
$2,534.72
|
| Rate for Payer: HFN Commercial |
$2,620.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,052.31
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$282.88
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$282.88
|
| Rate for Payer: Independent Care Health Plan Medicare |
$282.88
|
| Rate for Payer: Managed Health Services Medicaid |
$294.20
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$282.88
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$282.88
|
| Rate for Payer: Multiplan Commercial |
$2,278.40
|
| Rate for Payer: NAPHCARE Commercial |
$424.32
|
| Rate for Payer: Preferred Network Access Commercial |
$2,620.16
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$282.88
|
| Rate for Payer: Quartz Beloit One Network |
$1,395.52
|
| Rate for Payer: Quartz Commercial |
$1,851.20
|
| Rate for Payer: Quartz Medicare Advantage |
$282.88
|
| Rate for Payer: The Alliance Commercial |
$1,131.52
|
| Rate for Payer: United Healthcare Medicaid |
$282.88
|
| Rate for Payer: United Healthcare Medicare Advantage |
$282.88
|
| Rate for Payer: United Healthcare PPO |
$2,136.00
|
| Rate for Payer: WEA Trust Commercial |
$1,566.40
|
| Rate for Payer: Wellcare Medicare |
$282.88
|
| Rate for Payer: WMAP Medicaid |
$282.88
|
| Rate for Payer: WPS Commercial |
$2,109.51
|
|
|
Wilson Disease Full Gene Analysis
|
Facility
|
IP
|
$2,848.00
|
|
|
Service Code
|
CPT 81406
|
| Hospital Charge Code |
5426838
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$1,395.52 |
| Max. Negotiated Rate |
$2,620.16 |
| Rate for Payer: Aetna Commercial |
$2,563.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,449.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,509.44
|
| Rate for Payer: Cash Price |
$854.40
|
| Rate for Payer: Cigna Commercial |
$2,620.16
|
| Rate for Payer: Health EOS Commercial |
$2,534.72
|
| Rate for Payer: HFN Commercial |
$2,620.16
|
| Rate for Payer: Multiplan Commercial |
$2,278.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,708.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,620.16
|
| Rate for Payer: Quartz Beloit One Network |
$1,395.52
|
| Rate for Payer: Quartz Commercial |
$1,708.80
|
| Rate for Payer: WEA Trust Commercial |
$1,566.40
|
| Rate for Payer: WPS Commercial |
$2,109.51
|
|
|
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 |
$998.57 |
| Max. Negotiated Rate |
$2,705.60 |
| Rate for Payer: Aetna Commercial |
$2,705.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,449.28
|
| Rate for Payer: Cash Price |
$854.40
|
| Rate for Payer: Cash Price |
$854.40
|
| Rate for Payer: Cigna Commercial |
$2,705.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,424.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,708.80
|
| Rate for Payer: Health EOS Commercial |
$2,591.68
|
| Rate for Payer: HFN Commercial |
$2,705.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$998.57
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$998.57
|
| Rate for Payer: Multiplan Commercial |
$2,278.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,705.60
|
| Rate for Payer: Quartz Beloit One Network |
$1,253.12
|
| Rate for Payer: Quartz Commercial |
$1,623.36
|
| Rate for Payer: The Alliance Commercial |
$1,424.00
|
| Rate for Payer: WEA Trust Commercial |
$1,566.40
|
| Rate for Payer: WPS Commercial |
$2,109.51
|
|
|
WIPES BABY UNSCENTED SENSITIVE
|
Facility
|
OP
|
$93.00
|
|
| Hospital Charge Code |
2963837
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$26.04 |
| Max. Negotiated Rate |
$372.00 |
| Rate for Payer: Aetna Commercial |
$83.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$79.98
|
| Rate for Payer: Aetna Managed Medicare |
$26.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$60.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$46.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$44.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$49.29
|
| Rate for Payer: Cash Price |
$27.90
|
| Rate for Payer: Cigna Commercial |
$85.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$52.04
|
| Rate for Payer: Health EOS Commercial |
$82.77
|
| Rate for Payer: HFN Commercial |
$85.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$69.75
|
| Rate for Payer: Multiplan Commercial |
$74.40
|
| Rate for Payer: NAPHCARE Commercial |
$55.80
|
| Rate for Payer: Preferred Network Access Commercial |
$85.56
|
| Rate for Payer: Quartz Beloit One Network |
$45.57
|
| Rate for Payer: Quartz Commercial |
$60.45
|
| Rate for Payer: Quartz Medicare Advantage |
$55.80
|
| Rate for Payer: The Alliance Commercial |
$372.00
|
| Rate for Payer: WEA Trust Commercial |
$51.15
|
| Rate for Payer: WPS Commercial |
$68.89
|
|
