|
ANKLE ARTHRODESIS
|
Facility
IP
|
$4,560.00
|
|
| Hospital Charge Code |
2959815
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,234.40 |
| Max. Negotiated Rate |
$4,195.20 |
| Rate for Payer: Aetna Commercial |
$4,104.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,416.80
|
| Rate for Payer: Cash Price |
$1,368.00
|
| Rate for Payer: Cigna Commercial |
$4,195.20
|
| Rate for Payer: Health EOS Commercial |
$4,058.40
|
| Rate for Payer: HFN Commercial |
$4,195.20
|
| Rate for Payer: Multiplan Commercial |
$3,648.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,736.00
|
| Rate for Payer: Preferred Network Access Commercial |
$4,195.20
|
| Rate for Payer: Quartz Beloit One Network |
$2,234.40
|
| Rate for Payer: Quartz Commercial |
$2,736.00
|
| Rate for Payer: WEA Trust Commercial |
$2,508.00
|
| Rate for Payer: WPS Commercial |
$3,377.59
|
|
|
ANKLE ARTHROPLASTY
|
Facility
IP
|
$8,012.00
|
|
| Hospital Charge Code |
2960440
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,925.88 |
| Max. Negotiated Rate |
$7,371.04 |
| Rate for Payer: Aetna Commercial |
$7,210.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,246.36
|
| Rate for Payer: Cash Price |
$2,403.60
|
| Rate for Payer: Cigna Commercial |
$7,371.04
|
| Rate for Payer: Health EOS Commercial |
$7,130.68
|
| Rate for Payer: HFN Commercial |
$7,371.04
|
| Rate for Payer: Multiplan Commercial |
$6,409.60
|
| Rate for Payer: NAPHCARE Commercial |
$4,807.20
|
| Rate for Payer: Preferred Network Access Commercial |
$7,371.04
|
| Rate for Payer: Quartz Beloit One Network |
$3,925.88
|
| Rate for Payer: Quartz Commercial |
$4,807.20
|
| Rate for Payer: WEA Trust Commercial |
$4,406.60
|
| Rate for Payer: WPS Commercial |
$5,934.49
|
|
|
ANKLE ARTHROPLASTY
|
Facility
OP
|
$8,012.00
|
|
| Hospital Charge Code |
2960440
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,243.36 |
| Max. Negotiated Rate |
$32,048.00 |
| Rate for Payer: Aetna Commercial |
$7,210.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,890.32
|
| Rate for Payer: Aetna Managed Medicare |
$2,243.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,207.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,006.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,845.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,246.36
|
| Rate for Payer: Cash Price |
$2,403.60
|
| Rate for Payer: Cigna Commercial |
$7,371.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,483.52
|
| Rate for Payer: Health EOS Commercial |
$7,130.68
|
| Rate for Payer: HFN Commercial |
$7,371.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,009.00
|
| Rate for Payer: Multiplan Commercial |
$6,409.60
|
| Rate for Payer: NAPHCARE Commercial |
$4,807.20
|
| Rate for Payer: Preferred Network Access Commercial |
$7,371.04
|
| Rate for Payer: Quartz Beloit One Network |
$3,925.88
|
| Rate for Payer: Quartz Commercial |
$5,207.80
|
| Rate for Payer: Quartz Medicare Advantage |
$4,807.20
|
| Rate for Payer: The Alliance Commercial |
$32,048.00
|
| Rate for Payer: WEA Trust Commercial |
$4,406.60
|
| Rate for Payer: WPS Commercial |
$5,934.49
|
|
|
ANKLE ARTHROSCOPY
|
Facility
OP
|
$8,560.00
|
|
| Hospital Charge Code |
2959826
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,396.80 |
| Max. Negotiated Rate |
$34,240.00 |
| Rate for Payer: Aetna Commercial |
$7,704.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,361.60
|
| Rate for Payer: Aetna Managed Medicare |
$2,396.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,564.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,280.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,108.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,536.80
|
| Rate for Payer: Cash Price |
$2,568.00
|
| Rate for Payer: Cigna Commercial |
$7,875.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,790.18
|
| Rate for Payer: Health EOS Commercial |
$7,618.40
|
| Rate for Payer: HFN Commercial |
$7,875.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,420.00
|
| Rate for Payer: Multiplan Commercial |
$6,848.00
|
| Rate for Payer: NAPHCARE Commercial |
$5,136.00
|
| Rate for Payer: Preferred Network Access Commercial |
$7,875.20
|
| Rate for Payer: Quartz Beloit One Network |
$4,194.40
|
| Rate for Payer: Quartz Commercial |
$5,564.00
|
| Rate for Payer: Quartz Medicare Advantage |
$5,136.00
|
| Rate for Payer: The Alliance Commercial |
$34,240.00
|
| Rate for Payer: WEA Trust Commercial |
$4,708.00
|
| Rate for Payer: WPS Commercial |
$6,340.39
|
|
|
ANKLE ARTHROSCOPY
|
Facility
IP
|
$8,560.00
|
|
| Hospital Charge Code |
2959826
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4,194.40 |
| Max. Negotiated Rate |
$7,875.20 |
| Rate for Payer: Aetna Commercial |
$7,704.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,536.80
|
| Rate for Payer: Cash Price |
$2,568.00
|
| Rate for Payer: Cigna Commercial |
$7,875.20
|
| Rate for Payer: Health EOS Commercial |
$7,618.40
|
| Rate for Payer: HFN Commercial |
$7,875.20
|
| Rate for Payer: Multiplan Commercial |
$6,848.00
|
| Rate for Payer: NAPHCARE Commercial |
$5,136.00
|
| Rate for Payer: Preferred Network Access Commercial |
$7,875.20
|
| Rate for Payer: Quartz Beloit One Network |
$4,194.40
|
| Rate for Payer: Quartz Commercial |
$5,136.00
|
| Rate for Payer: WEA Trust Commercial |
$4,708.00
|
| Rate for Payer: WPS Commercial |
$6,340.39
|
|
|
ANKLE BONE GRAFTING
|
Facility
OP
|
$4,170.00
|
|
| Hospital Charge Code |
2959856
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,167.60 |
| Max. Negotiated Rate |
$16,680.00 |
| Rate for Payer: Aetna Commercial |
$3,753.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,586.20
|
| Rate for Payer: Aetna Managed Medicare |
$1,167.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,710.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,085.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,001.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,210.10
|
| Rate for Payer: Cash Price |
$1,251.00
|
| Rate for Payer: Cigna Commercial |
$3,836.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,333.53
|
| Rate for Payer: Health EOS Commercial |
$3,711.30
|
| Rate for Payer: HFN Commercial |
$3,836.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,127.50
|
| Rate for Payer: Multiplan Commercial |
$3,336.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,502.00
|
| Rate for Payer: Preferred Network Access Commercial |
$3,836.40
|
| Rate for Payer: Quartz Beloit One Network |
$2,043.30
|
| Rate for Payer: Quartz Commercial |
$2,710.50
|
| Rate for Payer: Quartz Medicare Advantage |
$2,502.00
|
| Rate for Payer: The Alliance Commercial |
$16,680.00
|
| Rate for Payer: WEA Trust Commercial |
$2,293.50
|
| Rate for Payer: WPS Commercial |
$3,088.72
|
|
|
ANKLE BONE GRAFTING
|
Facility
IP
|
$4,170.00
|
|
| Hospital Charge Code |
2959856
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,043.30 |
| Max. Negotiated Rate |
$3,836.40 |
| Rate for Payer: Aetna Commercial |
$3,753.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,210.10
|
| Rate for Payer: Cash Price |
$1,251.00
|
| Rate for Payer: Cigna Commercial |
$3,836.40
|
| Rate for Payer: Health EOS Commercial |
$3,711.30
|
| Rate for Payer: HFN Commercial |
$3,836.40
|
| Rate for Payer: Multiplan Commercial |
$3,336.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,502.00
|
| Rate for Payer: Preferred Network Access Commercial |
$3,836.40
|
| Rate for Payer: Quartz Beloit One Network |
$2,043.30
|
| Rate for Payer: Quartz Commercial |
$2,502.00
|
| Rate for Payer: WEA Trust Commercial |
$2,293.50
|
| Rate for Payer: WPS Commercial |
$3,088.72
|
|
|
ANKLE BRACE UNIVERSAL LIGHT
|
Facility
OP
|
$603.00
|
|
| Hospital Charge Code |
2971457
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$168.84 |
| Max. Negotiated Rate |
$2,412.00 |
| Rate for Payer: Aetna Commercial |
$542.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$518.58
|
| Rate for Payer: Aetna Managed Medicare |
$168.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$391.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$301.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$289.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$319.59
|
| Rate for Payer: Cash Price |
$180.90
|
| Rate for Payer: Cigna Commercial |
$554.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$337.44
|
| Rate for Payer: Health EOS Commercial |
$536.67
|
| Rate for Payer: HFN Commercial |
$554.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$452.25
|
| Rate for Payer: Multiplan Commercial |
$482.40
|
| Rate for Payer: NAPHCARE Commercial |
$361.80
|
| Rate for Payer: Preferred Network Access Commercial |
$554.76
|
| Rate for Payer: Quartz Beloit One Network |
$295.47
|
| Rate for Payer: Quartz Commercial |
$391.95
|
| Rate for Payer: Quartz Medicare Advantage |
$361.80
|
| Rate for Payer: The Alliance Commercial |
$2,412.00
|
| Rate for Payer: WEA Trust Commercial |
$331.65
|
| Rate for Payer: WPS Commercial |
$446.64
|
|
|
ANKLE BRACE UNIVERSAL LIGHT
|
Facility
IP
|
$603.00
|
|
| Hospital Charge Code |
2971457
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$295.47 |
| Max. Negotiated Rate |
$554.76 |
| Rate for Payer: Aetna Commercial |
$542.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$319.59
|
| Rate for Payer: Cash Price |
$180.90
|
| Rate for Payer: Cigna Commercial |
$554.76
|
| Rate for Payer: Health EOS Commercial |
$536.67
|
| Rate for Payer: HFN Commercial |
$554.76
|
| Rate for Payer: Multiplan Commercial |
$482.40
|
| Rate for Payer: NAPHCARE Commercial |
$361.80
|
| Rate for Payer: Preferred Network Access Commercial |
$554.76
|
| Rate for Payer: Quartz Beloit One Network |
$295.47
|
| Rate for Payer: Quartz Commercial |
$361.80
|
| Rate for Payer: WEA Trust Commercial |
$331.65
|
| Rate for Payer: WPS Commercial |
$446.64
|
|
|
ANKLE, LIGAMENT RECONSTRUCTION
|
Facility
IP
|
$4,560.00
|
|
| Hospital Charge Code |
2960200
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,234.40 |
| Max. Negotiated Rate |
$4,195.20 |
| Rate for Payer: Aetna Commercial |
$4,104.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,416.80
|
| Rate for Payer: Cash Price |
$1,368.00
|
| Rate for Payer: Cigna Commercial |
$4,195.20
|
| Rate for Payer: Health EOS Commercial |
$4,058.40
|
| Rate for Payer: HFN Commercial |
$4,195.20
|
| Rate for Payer: Multiplan Commercial |
$3,648.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,736.00
|
| Rate for Payer: Preferred Network Access Commercial |
$4,195.20
|
| Rate for Payer: Quartz Beloit One Network |
$2,234.40
|
| Rate for Payer: Quartz Commercial |
$2,736.00
|
| Rate for Payer: WEA Trust Commercial |
$2,508.00
|
| Rate for Payer: WPS Commercial |
$3,377.59
|
|
|
ANKLE, LIGAMENT RECONSTRUCTION
|
Facility
OP
|
$4,560.00
|
|
| Hospital Charge Code |
2960200
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,276.80 |
| Max. Negotiated Rate |
$18,240.00 |
| Rate for Payer: Aetna Commercial |
$4,104.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,921.60
|
| Rate for Payer: Aetna Managed Medicare |
$1,276.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,964.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,280.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,188.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,416.80
|
| Rate for Payer: Cash Price |
$1,368.00
|
| Rate for Payer: Cigna Commercial |
$4,195.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,551.78
|
| Rate for Payer: Health EOS Commercial |
$4,058.40
|
| Rate for Payer: HFN Commercial |
$4,195.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,420.00
|
| Rate for Payer: Multiplan Commercial |
$3,648.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,736.00
|
| Rate for Payer: Preferred Network Access Commercial |
$4,195.20
|
| Rate for Payer: Quartz Beloit One Network |
$2,234.40
|
| Rate for Payer: Quartz Commercial |
$2,964.00
|
| Rate for Payer: Quartz Medicare Advantage |
$2,736.00
|
| Rate for Payer: The Alliance Commercial |
$18,240.00
|
| Rate for Payer: WEA Trust Commercial |
$2,508.00
|
| Rate for Payer: WPS Commercial |
$3,377.59
|
|
|
ANKLE, TENDON & NERVE REPAIR
|
Facility
IP
|
$4,170.00
|
|
| Hospital Charge Code |
2960415
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,043.30 |
| Max. Negotiated Rate |
$3,836.40 |
| Rate for Payer: Aetna Commercial |
$3,753.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,210.10
|
| Rate for Payer: Cash Price |
$1,251.00
|
| Rate for Payer: Cigna Commercial |
$3,836.40
|
| Rate for Payer: Health EOS Commercial |
$3,711.30
|
| Rate for Payer: HFN Commercial |
$3,836.40
|
| Rate for Payer: Multiplan Commercial |
$3,336.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,502.00
|
| Rate for Payer: Preferred Network Access Commercial |
$3,836.40
|
| Rate for Payer: Quartz Beloit One Network |
$2,043.30
|
| Rate for Payer: Quartz Commercial |
$2,502.00
|
| Rate for Payer: WEA Trust Commercial |
$2,293.50
|
| Rate for Payer: WPS Commercial |
$3,088.72
|
|
|
ANKLE, TENDON & NERVE REPAIR
|
Facility
OP
|
$4,170.00
|
|
| Hospital Charge Code |
2960415
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,167.60 |
| Max. Negotiated Rate |
$16,680.00 |
| Rate for Payer: Aetna Commercial |
$3,753.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,586.20
|
| Rate for Payer: Aetna Managed Medicare |
$1,167.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,710.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,085.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,001.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,210.10
|
| Rate for Payer: Cash Price |
$1,251.00
|
| Rate for Payer: Cigna Commercial |
$3,836.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,333.53
|
| Rate for Payer: Health EOS Commercial |
$3,711.30
|
| Rate for Payer: HFN Commercial |
$3,836.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,127.50
|
| Rate for Payer: Multiplan Commercial |
$3,336.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,502.00
|
| Rate for Payer: Preferred Network Access Commercial |
$3,836.40
|
| Rate for Payer: Quartz Beloit One Network |
$2,043.30
|
| Rate for Payer: Quartz Commercial |
$2,710.50
|
| Rate for Payer: Quartz Medicare Advantage |
$2,502.00
|
| Rate for Payer: The Alliance Commercial |
$16,680.00
|
| Rate for Payer: WEA Trust Commercial |
$2,293.50
|
| Rate for Payer: WPS Commercial |
$3,088.72
|
|
|
ANNA-2 & 3
|
Facility
IP
|
$346.00
|
|
|
Service Code
|
CPT 88275
|
| Hospital Charge Code |
4514772
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$169.54 |
| Max. Negotiated Rate |
$318.32 |
| Rate for Payer: Aetna Commercial |
$311.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$183.38
|
| Rate for Payer: Cash Price |
$103.80
|
| Rate for Payer: Cigna Commercial |
$318.32
|
| Rate for Payer: Health EOS Commercial |
$307.94
|
| Rate for Payer: HFN Commercial |
$318.32
|
| Rate for Payer: Multiplan Commercial |
$276.80
|
| Rate for Payer: NAPHCARE Commercial |
$207.60
|
| Rate for Payer: Preferred Network Access Commercial |
$318.32
|
| Rate for Payer: Quartz Beloit One Network |
$169.54
|
| Rate for Payer: Quartz Commercial |
$207.60
|
| Rate for Payer: WEA Trust Commercial |
$190.30
|
| Rate for Payer: WPS Commercial |
$256.28
|
|
|
ANNA-2 & 3
|
Professional
|
$346.00
|
|
|
Service Code
|
CPT 88275
|
| Hospital Charge Code |
4514772
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$51.19 |
| Max. Negotiated Rate |
$328.70 |
| Rate for Payer: Aetna Commercial |
$328.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$297.56
|
| Rate for Payer: Aetna Managed Medicare |
$51.19
|
| Rate for Payer: Anthem Medicare Advantage |
$51.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$51.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$51.19
|
| Rate for Payer: Cash Price |
$103.80
|
| Rate for Payer: Cash Price |
$103.80
|
| Rate for Payer: Cigna Commercial |
$328.70
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$173.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$51.19
|
| Rate for Payer: Health EOS Commercial |
$314.86
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$180.70
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$180.70
|
| Rate for Payer: Independent Care Health Plan Medicare |
$51.19
|
| Rate for Payer: Multiplan Commercial |
$276.80
|
| Rate for Payer: Preferred Network Access Commercial |
$328.70
|
| Rate for Payer: Quartz Beloit One Network |
$152.24
|
| Rate for Payer: Quartz Commercial |
$197.22
|
| Rate for Payer: Quartz Medicare Advantage |
$51.19
|
| Rate for Payer: The Alliance Commercial |
$202.20
|
| Rate for Payer: United Healthcare Medicare Advantage |
$51.19
|
| Rate for Payer: WEA Trust Commercial |
$190.30
|
| Rate for Payer: WPS Commercial |
$225.24
|
|
|
ANNA-2 & 3
|
Facility
OP
|
$346.00
|
|
|
Service Code
|
CPT 88275
|
| Hospital Charge Code |
4514772
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$51.19 |
| Max. Negotiated Rate |
$1,384.00 |
| Rate for Payer: Aetna Commercial |
$311.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$297.56
|
| Rate for Payer: Aetna Managed Medicare |
$51.19
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$191.96
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$89.58
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$84.98
|
| Rate for Payer: Anthem Medicaid |
$52.89
|
| Rate for Payer: Anthem Medicare Advantage |
$51.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$183.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$51.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$51.19
|
| Rate for Payer: Cash Price |
$103.80
|
| Rate for Payer: Cash Price |
$103.80
|
| Rate for Payer: Cigna Commercial |
$318.32
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$51.19
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$52.89
|
| Rate for Payer: Dean Health Medicaid |
$52.89
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$51.19
|
| Rate for Payer: Health EOS Commercial |
$307.94
|
| Rate for Payer: HFN Commercial |
$318.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$190.43
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$51.19
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$52.89
|
| Rate for Payer: Independent Care Health Plan Medicare |
$51.19
|
| Rate for Payer: Managed Health Services Medicaid |
$55.01
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$51.19
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$51.19
|
| Rate for Payer: Multiplan Commercial |
$276.80
|
| Rate for Payer: NAPHCARE Commercial |
$76.78
|
| Rate for Payer: Preferred Network Access Commercial |
$318.32
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$52.89
|
| Rate for Payer: Quartz Beloit One Network |
$169.54
|
| Rate for Payer: Quartz Commercial |
$224.90
|
| Rate for Payer: Quartz Medicare Advantage |
$51.19
|
| Rate for Payer: The Alliance Commercial |
$1,384.00
|
| Rate for Payer: United Healthcare Medicaid |
$52.89
|
| Rate for Payer: United Healthcare Medicare Advantage |
$51.19
|
| Rate for Payer: United Healthcare PPO |
$259.50
|
| Rate for Payer: WEA Trust Commercial |
$190.30
|
| Rate for Payer: Wellcare Medicare |
$51.19
|
| Rate for Payer: WMAP Medicaid |
$52.89
|
| Rate for Payer: WPS Commercial |
$256.28
|
|
|
ANNA-2 and 3
|
Facility
OP
|
$178.00
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
2942980
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.05 |
| Max. Negotiated Rate |
$712.00 |
| Rate for Payer: Aetna Commercial |
$160.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$153.08
|
| Rate for Payer: Aetna Managed Medicare |
$12.05
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$45.19
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$21.09
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$20.00
|
| Rate for Payer: Anthem Medicaid |
$12.45
|
| Rate for Payer: Anthem Medicare Advantage |
$12.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$94.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$12.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$12.05
|
| Rate for Payer: Cash Price |
$53.40
|
| Rate for Payer: Cash Price |
$53.40
|
| Rate for Payer: Cigna Commercial |
$163.76
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$12.05
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$12.45
|
| Rate for Payer: Dean Health Medicaid |
$12.45
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$12.05
|
| Rate for Payer: Health EOS Commercial |
$158.42
|
| Rate for Payer: HFN Commercial |
$163.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$44.83
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$12.05
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$12.45
|
| Rate for Payer: Independent Care Health Plan Medicare |
$12.05
|
| Rate for Payer: Managed Health Services Medicaid |
$12.95
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$12.05
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$12.05
|
| Rate for Payer: Multiplan Commercial |
$142.40
|
| Rate for Payer: NAPHCARE Commercial |
$18.08
|
| Rate for Payer: Preferred Network Access Commercial |
$163.76
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$12.45
|
| Rate for Payer: Quartz Beloit One Network |
$87.22
|
| Rate for Payer: Quartz Commercial |
$115.70
|
| Rate for Payer: Quartz Medicare Advantage |
$12.05
|
| Rate for Payer: The Alliance Commercial |
$712.00
|
| Rate for Payer: United Healthcare Medicaid |
$12.45
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.05
|
| Rate for Payer: United Healthcare PPO |
$133.50
|
| Rate for Payer: WEA Trust Commercial |
$97.90
|
| Rate for Payer: Wellcare Medicare |
$12.05
|
| Rate for Payer: WMAP Medicaid |
$12.45
|
| Rate for Payer: WPS Commercial |
$131.84
|
|
|
ANNA-2 and 3
|
Professional
|
$178.00
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
2942980
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.05 |
| Max. Negotiated Rate |
$169.10 |
| Rate for Payer: Aetna Commercial |
$169.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$153.08
|
| Rate for Payer: Aetna Managed Medicare |
$12.05
|
| Rate for Payer: Anthem Commercial |
$16.61
|
| Rate for Payer: Anthem Medicare Advantage |
$12.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$12.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$12.05
|
| Rate for Payer: Cash Price |
$53.40
|
| Rate for Payer: Cash Price |
$53.40
|
| Rate for Payer: Cigna Commercial |
$169.10
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$89.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12.05
|
| Rate for Payer: Health EOS Commercial |
$161.98
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$42.54
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$42.54
|
| Rate for Payer: Independent Care Health Plan Medicare |
$12.05
|
| Rate for Payer: Multiplan Commercial |
$142.40
|
| Rate for Payer: Preferred Network Access Commercial |
$169.10
|
| Rate for Payer: Quartz Beloit One Network |
$78.32
|
| Rate for Payer: Quartz Commercial |
$101.46
|
| Rate for Payer: Quartz Medicare Advantage |
$12.05
|
| Rate for Payer: The Alliance Commercial |
$47.60
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.05
|
| Rate for Payer: WEA Trust Commercial |
$97.90
|
| Rate for Payer: WPS Commercial |
$53.02
|
|
|
ANNA-2 and 3
|
Facility
IP
|
$178.00
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
2942980
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$87.22 |
| Max. Negotiated Rate |
$163.76 |
| Rate for Payer: Aetna Commercial |
$160.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$94.34
|
| Rate for Payer: Cash Price |
$53.40
|
| Rate for Payer: Cigna Commercial |
$163.76
|
| Rate for Payer: Health EOS Commercial |
$158.42
|
| Rate for Payer: HFN Commercial |
$163.76
|
| Rate for Payer: Multiplan Commercial |
$142.40
|
| Rate for Payer: NAPHCARE Commercial |
$106.80
|
| Rate for Payer: Preferred Network Access Commercial |
$163.76
|
| Rate for Payer: Quartz Beloit One Network |
$87.22
|
| Rate for Payer: Quartz Commercial |
$106.80
|
| Rate for Payer: WEA Trust Commercial |
$97.90
|
| Rate for Payer: WPS Commercial |
$131.84
|
|
|
ANNA-3
|
Facility
OP
|
$81.00
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
2942952
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.05 |
| Max. Negotiated Rate |
$324.00 |
| Rate for Payer: Aetna Commercial |
$72.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$69.66
|
| Rate for Payer: Aetna Managed Medicare |
$12.05
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$45.19
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$21.09
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$20.00
|
| Rate for Payer: Anthem Medicaid |
$12.45
|
| Rate for Payer: Anthem Medicare Advantage |
$12.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$42.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$12.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$12.05
|
| Rate for Payer: Cash Price |
$24.30
|
| Rate for Payer: Cash Price |
$24.30
|
| Rate for Payer: Cigna Commercial |
$74.52
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$12.05
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$12.45
|
| Rate for Payer: Dean Health Medicaid |
$12.45
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$12.05
|
| Rate for Payer: Health EOS Commercial |
$72.09
|
| Rate for Payer: HFN Commercial |
$74.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$44.83
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$12.05
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$12.45
|
| Rate for Payer: Independent Care Health Plan Medicare |
$12.05
|
| Rate for Payer: Managed Health Services Medicaid |
$12.95
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$12.05
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$12.05
|
| Rate for Payer: Multiplan Commercial |
$64.80
|
| Rate for Payer: NAPHCARE Commercial |
$18.08
|
| Rate for Payer: Preferred Network Access Commercial |
$74.52
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$12.45
|
| Rate for Payer: Quartz Beloit One Network |
$39.69
|
| Rate for Payer: Quartz Commercial |
$52.65
|
| Rate for Payer: Quartz Medicare Advantage |
$12.05
|
| Rate for Payer: The Alliance Commercial |
$324.00
|
| Rate for Payer: United Healthcare Medicaid |
$12.45
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.05
|
| Rate for Payer: United Healthcare PPO |
$60.75
|
| Rate for Payer: WEA Trust Commercial |
$44.55
|
| Rate for Payer: Wellcare Medicare |
$12.05
|
| Rate for Payer: WMAP Medicaid |
$12.45
|
| Rate for Payer: WPS Commercial |
$60.00
|
|
|
ANNA-3
|
Professional
|
$81.00
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
2942952
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.05 |
| Max. Negotiated Rate |
$76.95 |
| Rate for Payer: Aetna Commercial |
$76.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$69.66
|
| Rate for Payer: Aetna Managed Medicare |
$12.05
|
| Rate for Payer: Anthem Commercial |
$16.61
|
| Rate for Payer: Anthem Medicare Advantage |
$12.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$12.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$12.05
|
| Rate for Payer: Cash Price |
$24.30
|
| Rate for Payer: Cash Price |
$24.30
|
| Rate for Payer: Cigna Commercial |
$76.95
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$40.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12.05
|
| Rate for Payer: Health EOS Commercial |
$73.71
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$42.54
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$42.54
|
| Rate for Payer: Independent Care Health Plan Medicare |
$12.05
|
| Rate for Payer: Multiplan Commercial |
$64.80
|
| Rate for Payer: Preferred Network Access Commercial |
$76.95
|
| Rate for Payer: Quartz Beloit One Network |
$35.64
|
| Rate for Payer: Quartz Commercial |
$46.17
|
| Rate for Payer: Quartz Medicare Advantage |
$12.05
|
| Rate for Payer: The Alliance Commercial |
$47.60
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.05
|
| Rate for Payer: WEA Trust Commercial |
$44.55
|
| Rate for Payer: WPS Commercial |
$53.02
|
|
|
ANNA-3
|
Facility
IP
|
$81.00
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
2942952
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$39.69 |
| Max. Negotiated Rate |
$74.52 |
| Rate for Payer: Aetna Commercial |
$72.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$42.93
|
| Rate for Payer: Cash Price |
$24.30
|
| Rate for Payer: Cigna Commercial |
$74.52
|
| Rate for Payer: Health EOS Commercial |
$72.09
|
| Rate for Payer: HFN Commercial |
$74.52
|
| Rate for Payer: Multiplan Commercial |
$64.80
|
| Rate for Payer: NAPHCARE Commercial |
$48.60
|
| Rate for Payer: Preferred Network Access Commercial |
$74.52
|
| Rate for Payer: Quartz Beloit One Network |
$39.69
|
| Rate for Payer: Quartz Commercial |
$48.60
|
| Rate for Payer: WEA Trust Commercial |
$44.55
|
| Rate for Payer: WPS Commercial |
$60.00
|
|
|
Annual depression screening, 15 minutes G0444
|
Professional
|
$26.00
|
|
|
Service Code
|
HCPCS G0444
|
| Hospital Charge Code |
5472856
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$8.78 |
| Max. Negotiated Rate |
$31.81 |
| Rate for Payer: Aetna Commercial |
$24.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$22.36
|
| Rate for Payer: Aetna Managed Medicare |
$8.78
|
| Rate for Payer: Anthem Medicare Advantage |
$8.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$8.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$8.78
|
| Rate for Payer: Cash Price |
$7.80
|
| Rate for Payer: Cash Price |
$7.80
|
| Rate for Payer: Cigna Commercial |
$24.70
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$13.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$8.78
|
| Rate for Payer: Health EOS Commercial |
$23.66
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$31.81
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$31.81
|
| Rate for Payer: Independent Care Health Plan Medicare |
$8.78
|
| Rate for Payer: Multiplan Commercial |
$20.80
|
| Rate for Payer: Preferred Network Access Commercial |
$24.70
|
| Rate for Payer: Quartz Beloit One Network |
$11.44
|
| Rate for Payer: Quartz Commercial |
$14.82
|
| Rate for Payer: Quartz Medicare Advantage |
$8.78
|
| Rate for Payer: The Alliance Commercial |
$24.14
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8.78
|
| Rate for Payer: WEA Trust Commercial |
$14.30
|
| Rate for Payer: WPS Commercial |
$15.36
|
|
|
Annual Wellness Visit Initial
|
Professional
|
$375.00
|
|
|
Service Code
|
HCPCS G0438
|
| Hospital Charge Code |
1122841
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$158.59 |
| Max. Negotiated Rate |
$569.39 |
| Rate for Payer: Aetna Commercial |
$356.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$322.50
|
| Rate for Payer: Aetna Managed Medicare |
$158.59
|
| Rate for Payer: Anthem Medicare Advantage |
$158.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$158.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$158.59
|
| Rate for Payer: Cash Price |
$112.50
|
| Rate for Payer: Cash Price |
$112.50
|
| Rate for Payer: Cigna Commercial |
$356.25
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$187.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$158.59
|
| Rate for Payer: Health EOS Commercial |
$341.25
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$569.39
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$569.39
|
| Rate for Payer: Independent Care Health Plan Medicare |
$158.59
|
| Rate for Payer: Multiplan Commercial |
$300.00
|
| Rate for Payer: Preferred Network Access Commercial |
$356.25
|
| Rate for Payer: Quartz Beloit One Network |
$165.00
|
| Rate for Payer: Quartz Commercial |
$213.75
|
| Rate for Payer: Quartz Medicare Advantage |
$158.59
|
| Rate for Payer: The Alliance Commercial |
$436.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$158.59
|
| Rate for Payer: WEA Trust Commercial |
$206.25
|
| Rate for Payer: WPS Commercial |
$277.53
|
|
|
Annual Wellness Visit Subsequent
|
Professional
|
$200.00
|
|
|
Service Code
|
HCPCS G0439
|
| Hospital Charge Code |
1122842
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$88.00 |
| Max. Negotiated Rate |
$447.75 |
| Rate for Payer: Aetna Commercial |
$190.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$172.00
|
| Rate for Payer: Aetna Managed Medicare |
$124.29
|
| Rate for Payer: Anthem Medicare Advantage |
$124.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$124.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$124.29
|
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Cigna Commercial |
$190.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$100.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$124.29
|
| Rate for Payer: Health EOS Commercial |
$182.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$447.75
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$447.75
|
| Rate for Payer: Independent Care Health Plan Medicare |
$124.29
|
| Rate for Payer: Multiplan Commercial |
$160.00
|
| Rate for Payer: Preferred Network Access Commercial |
$190.00
|
| Rate for Payer: Quartz Beloit One Network |
$88.00
|
| Rate for Payer: Quartz Commercial |
$114.00
|
| Rate for Payer: Quartz Medicare Advantage |
$124.29
|
| Rate for Payer: The Alliance Commercial |
$341.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$124.29
|
| Rate for Payer: WEA Trust Commercial |
$110.00
|
| Rate for Payer: WPS Commercial |
$217.51
|
|
