|
PROCTOPEXY (EG, FOR PROLAPSE); PERINEAL APPROACH
|
Facility
|
OP
|
$12,349.86
|
|
|
Service Code
|
CPT 45541
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,835.04 |
| Max. Negotiated Rate |
$12,349.86 |
| Rate for Payer: Aetna Managed Medicare |
$2,921.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,635.84
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,985.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,835.04
|
| Rate for Payer: Anthem Medicare Advantage |
$2,921.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$2,921.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$2,921.08
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$2,921.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12,349.86
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$2,921.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$10,866.41
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$2,921.08
|
| Rate for Payer: Independent Care Health Plan Medicare |
$2,921.08
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$2,921.08
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$2,921.08
|
| Rate for Payer: NAPHCARE Commercial |
$4,381.62
|
| Rate for Payer: Quartz Medicare Advantage |
$2,921.08
|
| Rate for Payer: The Alliance Commercial |
$11,684.32
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,921.08
|
| Rate for Payer: United Healthcare PPO |
$3,726.32
|
| Rate for Payer: Wellcare Medicare |
$2,921.08
|
|
|
PROCTOSCOPE LIGHT-SCOPE RECTO MAXI LED & BULB STERILE DISP 800118
|
Facility
|
OP
|
$959.00
|
|
| Hospital Charge Code |
5248711
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$279.26 |
| Max. Negotiated Rate |
$917.57 |
| Rate for Payer: Aetna Commercial |
$897.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$857.73
|
| Rate for Payer: Aetna Managed Medicare |
$279.26
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$648.28
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$498.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$478.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$528.60
|
| Rate for Payer: Cash Price |
$287.70
|
| Rate for Payer: Cigna Commercial |
$917.57
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$558.14
|
| Rate for Payer: Health EOS Commercial |
$887.65
|
| Rate for Payer: HFN Commercial |
$917.57
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$748.02
|
| Rate for Payer: Multiplan Commercial |
$797.89
|
| Rate for Payer: NAPHCARE Commercial |
$598.42
|
| Rate for Payer: Preferred Network Access Commercial |
$917.57
|
| Rate for Payer: Quartz Beloit One Network |
$488.71
|
| Rate for Payer: Quartz Commercial |
$648.28
|
| Rate for Payer: Quartz Medicare Advantage |
$598.42
|
| Rate for Payer: The Alliance Commercial |
$498.68
|
| Rate for Payer: WEA Trust Commercial |
$548.55
|
| Rate for Payer: WPS Commercial |
$738.72
|
|
|
PROCTOSCOPE LIGHT-SCOPE RECTO MAXI LED & BULB STERILE DISP 800118
|
Facility
|
IP
|
$959.00
|
|
| Hospital Charge Code |
5248711
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$488.71 |
| Max. Negotiated Rate |
$917.57 |
| Rate for Payer: Aetna Commercial |
$897.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$857.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$528.60
|
| Rate for Payer: Cash Price |
$287.70
|
| Rate for Payer: Cigna Commercial |
$917.57
|
| Rate for Payer: Health EOS Commercial |
$887.65
|
| Rate for Payer: HFN Commercial |
$917.57
|
| Rate for Payer: Multiplan Commercial |
$797.89
|
| Rate for Payer: Preferred Network Access Commercial |
$917.57
|
| Rate for Payer: Quartz Beloit One Network |
$488.71
|
| Rate for Payer: Quartz Commercial |
$598.42
|
| Rate for Payer: WEA Trust Commercial |
$548.55
|
| Rate for Payer: WPS Commercial |
$738.72
|
|
|
PROCTOSCOPY/PROCTOPEXY
|
Facility
|
IP
|
$1,084.00
|
|
| Hospital Charge Code |
2960321
|
|
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
|
|
|
PROCTOSCOPY/PROCTOPEXY
|
Facility
|
OP
|
$1,084.00
|
|
| Hospital Charge Code |
2960321
|
|
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
|
|
|
PROCTOSIGMOIDOSCOPY
|
Facility
|
IP
|
$1,084.00
|
|
| Hospital Charge Code |
2960322
|
|
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
|
|
|
PROCTOSIGMOIDOSCOPY
|
Facility
|
OP
|
$1,084.00
|
|
| Hospital Charge Code |
2960322
|
|
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
|
|
|
PROCTOSIGMOIDOSCOPY ABLATE 45320
|
Professional
|
Both
|
$1,460.00
|
|
|
Service Code
|
CPT 45320
|
| Hospital Charge Code |
3014795
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$91.85 |
| Max. Negotiated Rate |
$1,442.48 |
| Rate for Payer: Aetna Commercial |
$1,442.48
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,305.82
|
| Rate for Payer: Aetna Managed Medicare |
$91.85
|
| Rate for Payer: Anthem Medicare Advantage |
$91.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$91.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$91.85
|
| Rate for Payer: Cash Price |
$438.00
|
| Rate for Payer: Cash Price |
$438.00
|
| Rate for Payer: Cash Price |
$438.00
|
| Rate for Payer: Cigna Commercial |
$1,442.48
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$145.61
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$91.85
|
| Rate for Payer: Health EOS Commercial |
$1,381.74
|
| Rate for Payer: HFN Commercial |
$1,442.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$350.60
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$350.60
|
| Rate for Payer: Independent Care Health Plan Medicare |
$91.85
|
| Rate for Payer: Multiplan Commercial |
$1,214.72
|
| Rate for Payer: NAPHCARE Commercial |
$137.78
|
| Rate for Payer: Preferred Network Access Commercial |
$1,442.48
|
| Rate for Payer: Quartz Beloit One Network |
$668.10
|
| Rate for Payer: Quartz Commercial |
$865.49
|
| Rate for Payer: Quartz Medicare Advantage |
$91.85
|
| Rate for Payer: The Alliance Commercial |
$390.37
|
| Rate for Payer: United Healthcare Medicaid |
$145.61
|
| Rate for Payer: United Healthcare Medicare Advantage |
$91.85
|
| Rate for Payer: WEA Trust Commercial |
$835.12
|
| Rate for Payer: WPS Commercial |
$413.34
|
|
|
PROCTOSIGMOIDOSCOPY DX 45300
|
Professional
|
Both
|
$293.00
|
|
|
Service Code
|
CPT 45300
|
| Hospital Charge Code |
3014791
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$43.13 |
| Max. Negotiated Rate |
$289.48 |
| Rate for Payer: Aetna Commercial |
$289.48
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$262.06
|
| Rate for Payer: Aetna Managed Medicare |
$43.13
|
| Rate for Payer: Anthem Medicare Advantage |
$43.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$43.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$43.13
|
| Rate for Payer: Cash Price |
$87.90
|
| Rate for Payer: Cash Price |
$87.90
|
| Rate for Payer: Cash Price |
$87.90
|
| Rate for Payer: Cigna Commercial |
$289.48
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$63.06
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$43.13
|
| Rate for Payer: Health EOS Commercial |
$277.30
|
| Rate for Payer: HFN Commercial |
$289.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$165.32
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$165.32
|
| Rate for Payer: Independent Care Health Plan Medicare |
$43.13
|
| Rate for Payer: Multiplan Commercial |
$243.78
|
| Rate for Payer: NAPHCARE Commercial |
$64.69
|
| Rate for Payer: Preferred Network Access Commercial |
$289.48
|
| Rate for Payer: Quartz Beloit One Network |
$134.08
|
| Rate for Payer: Quartz Commercial |
$173.69
|
| Rate for Payer: Quartz Medicare Advantage |
$43.13
|
| Rate for Payer: The Alliance Commercial |
$183.30
|
| Rate for Payer: United Healthcare Medicaid |
$63.06
|
| Rate for Payer: United Healthcare Medicare Advantage |
$43.13
|
| Rate for Payer: WEA Trust Commercial |
$167.60
|
| Rate for Payer: WPS Commercial |
$194.08
|
|
|
PROCTOSIGMOIDOSCOPY REMOVAL 45315
|
Professional
|
Both
|
$885.00
|
|
|
Service Code
|
CPT 45315
|
| Hospital Charge Code |
3014794
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$92.55 |
| Max. Negotiated Rate |
$874.38 |
| Rate for Payer: Aetna Commercial |
$874.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$791.54
|
| Rate for Payer: Aetna Managed Medicare |
$92.55
|
| Rate for Payer: Anthem Medicare Advantage |
$92.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$92.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$92.55
|
| Rate for Payer: Cash Price |
$265.50
|
| Rate for Payer: Cash Price |
$265.50
|
| Rate for Payer: Cash Price |
$265.50
|
| Rate for Payer: Cigna Commercial |
$874.38
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$110.86
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$92.55
|
| Rate for Payer: Health EOS Commercial |
$837.56
|
| Rate for Payer: HFN Commercial |
$874.38
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$354.74
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$354.74
|
| Rate for Payer: Independent Care Health Plan Medicare |
$92.55
|
| Rate for Payer: Multiplan Commercial |
$736.32
|
| Rate for Payer: NAPHCARE Commercial |
$138.82
|
| Rate for Payer: Preferred Network Access Commercial |
$874.38
|
| Rate for Payer: Quartz Beloit One Network |
$404.98
|
| Rate for Payer: Quartz Commercial |
$524.63
|
| Rate for Payer: Quartz Medicare Advantage |
$92.55
|
| Rate for Payer: The Alliance Commercial |
$393.34
|
| Rate for Payer: United Healthcare Medicaid |
$110.86
|
| Rate for Payer: United Healthcare Medicare Advantage |
$92.55
|
| Rate for Payer: WEA Trust Commercial |
$506.22
|
| Rate for Payer: WPS Commercial |
$416.47
|
|
|
PROCTOSIGMOIDOSCOPY, RIGID; WITH BIOPSY, SINGLE OR MULTIPLE
|
Facility
|
OP
|
$5,037.34
|
|
|
Service Code
|
CPT 45305
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,259.34 |
| Max. Negotiated Rate |
$5,037.34 |
| Rate for Payer: Aetna Managed Medicare |
$1,259.34
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,635.84
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,985.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,835.04
|
| Rate for Payer: Anthem Medicare Advantage |
$1,259.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$1,259.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$1,259.34
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$1,259.34
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$1,259.34
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,684.73
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,259.34
|
| Rate for Payer: Independent Care Health Plan Medicare |
$1,259.34
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$1,259.34
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$1,259.34
|
| Rate for Payer: NAPHCARE Commercial |
$1,889.00
|
| Rate for Payer: Quartz Medicare Advantage |
$1,259.34
|
| Rate for Payer: The Alliance Commercial |
$5,037.34
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,259.34
|
| Rate for Payer: United Healthcare PPO |
$3,726.32
|
| Rate for Payer: Wellcare Medicare |
$1,259.34
|
|
|
PROCTOSIGMOIDOSCOPY, RIGID; WITH DILATION (EG, BALLOON, GUIDE WIRE, BOUGIE)
|
Facility
|
OP
|
$5,037.34
|
|
|
Service Code
|
CPT 45303
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,259.34 |
| Max. Negotiated Rate |
$5,037.34 |
| Rate for Payer: Aetna Managed Medicare |
$1,259.34
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,635.84
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,985.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,835.04
|
| Rate for Payer: Anthem Medicare Advantage |
$1,259.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$1,259.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$1,259.34
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$1,259.34
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$1,259.34
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,684.73
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,259.34
|
| Rate for Payer: Independent Care Health Plan Medicare |
$1,259.34
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$1,259.34
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$1,259.34
|
| Rate for Payer: NAPHCARE Commercial |
$1,889.00
|
| Rate for Payer: Quartz Medicare Advantage |
$1,259.34
|
| Rate for Payer: The Alliance Commercial |
$5,037.34
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,259.34
|
| Rate for Payer: United Healthcare PPO |
$3,726.32
|
| Rate for Payer: Wellcare Medicare |
$1,259.34
|
|
|
PROCTOSIGMOIDOSCOPY W/BX 45305
|
Professional
|
Both
|
$704.00
|
|
|
Service Code
|
CPT 45305
|
| Hospital Charge Code |
3014792
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$66.01 |
| Max. Negotiated Rate |
$695.55 |
| Rate for Payer: Aetna Commercial |
$695.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$629.66
|
| Rate for Payer: Aetna Managed Medicare |
$66.01
|
| Rate for Payer: Anthem Medicare Advantage |
$66.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$66.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$66.01
|
| Rate for Payer: Cash Price |
$211.20
|
| Rate for Payer: Cash Price |
$211.20
|
| Rate for Payer: Cash Price |
$211.20
|
| Rate for Payer: Cigna Commercial |
$695.55
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$69.90
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$66.01
|
| Rate for Payer: Health EOS Commercial |
$666.27
|
| Rate for Payer: HFN Commercial |
$695.55
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$249.02
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$249.02
|
| Rate for Payer: Independent Care Health Plan Medicare |
$66.01
|
| Rate for Payer: Multiplan Commercial |
$585.73
|
| Rate for Payer: NAPHCARE Commercial |
$99.01
|
| Rate for Payer: Preferred Network Access Commercial |
$695.55
|
| Rate for Payer: Quartz Beloit One Network |
$322.15
|
| Rate for Payer: Quartz Commercial |
$417.33
|
| Rate for Payer: Quartz Medicare Advantage |
$66.01
|
| Rate for Payer: The Alliance Commercial |
$280.54
|
| Rate for Payer: United Healthcare Medicaid |
$69.90
|
| Rate for Payer: United Healthcare Medicare Advantage |
$66.01
|
| Rate for Payer: WEA Trust Commercial |
$402.69
|
| Rate for Payer: WPS Commercial |
$297.04
|
|
|
PRO-DENSE INJECTABLE CALCIUM SULFATE CALCIUM PHOSPHATE 5CC 87SR0050
|
Facility
|
OP
|
$14,472.05
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6240148
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,214.26 |
| Max. Negotiated Rate |
$13,846.86 |
| Rate for Payer: Aetna Commercial |
$13,545.84
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$12,943.80
|
| Rate for Payer: Aetna Managed Medicare |
$4,214.26
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$9,783.11
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$7,525.47
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7,224.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$7,976.99
|
| Rate for Payer: Cash Price |
$4,341.62
|
| Rate for Payer: Cigna Commercial |
$13,846.86
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$8,422.73
|
| Rate for Payer: Health EOS Commercial |
$13,395.33
|
| Rate for Payer: HFN Commercial |
$13,846.86
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$11,288.20
|
| Rate for Payer: Multiplan Commercial |
$12,040.75
|
| Rate for Payer: NAPHCARE Commercial |
$9,030.56
|
| Rate for Payer: Preferred Network Access Commercial |
$13,846.86
|
| Rate for Payer: Quartz Beloit One Network |
$7,374.96
|
| Rate for Payer: Quartz Commercial |
$9,783.11
|
| Rate for Payer: Quartz Medicare Advantage |
$9,030.56
|
| Rate for Payer: The Alliance Commercial |
$7,525.47
|
| Rate for Payer: WEA Trust Commercial |
$8,278.01
|
| Rate for Payer: WPS Commercial |
$11,147.82
|
|
|
PRO-DENSE INJECTABLE CALCIUM SULFATE CALCIUM PHOSPHATE 5CC 87SR0050
|
Facility
|
IP
|
$14,472.05
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6240148
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,374.96 |
| Max. Negotiated Rate |
$13,846.86 |
| Rate for Payer: Aetna Commercial |
$13,545.84
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$12,943.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$7,976.99
|
| Rate for Payer: Cash Price |
$4,341.62
|
| Rate for Payer: Cigna Commercial |
$13,846.86
|
| Rate for Payer: Health EOS Commercial |
$13,395.33
|
| Rate for Payer: HFN Commercial |
$13,846.86
|
| Rate for Payer: Multiplan Commercial |
$12,040.75
|
| Rate for Payer: Preferred Network Access Commercial |
$13,846.86
|
| Rate for Payer: Quartz Beloit One Network |
$7,374.96
|
| Rate for Payer: Quartz Commercial |
$9,030.56
|
| Rate for Payer: WEA Trust Commercial |
$8,278.01
|
| Rate for Payer: WPS Commercial |
$11,147.82
|
|
|
Profess Serv,Supervis Of Prep/Provisn Of Antigen, Allergen Immthrpy
|
Professional
|
Both
|
$35.00
|
|
|
Service Code
|
CPT 95145
|
| Hospital Charge Code |
1188811
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$2.53 |
| Max. Negotiated Rate |
$120.31 |
| Rate for Payer: Aetna Commercial |
$34.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$31.30
|
| Rate for Payer: Aetna Managed Medicare |
$2.53
|
| Rate for Payer: Anthem Medicare Advantage |
$2.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$2.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$2.53
|
| Rate for Payer: Cash Price |
$10.50
|
| Rate for Payer: Cash Price |
$10.50
|
| Rate for Payer: Cash Price |
$10.50
|
| Rate for Payer: Cigna Commercial |
$34.58
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$20.79
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2.53
|
| Rate for Payer: Health EOS Commercial |
$33.12
|
| Rate for Payer: HFN Commercial |
$34.58
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$120.31
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$120.31
|
| Rate for Payer: Independent Care Health Plan Medicare |
$2.53
|
| Rate for Payer: Multiplan Commercial |
$29.12
|
| Rate for Payer: NAPHCARE Commercial |
$3.79
|
| Rate for Payer: Preferred Network Access Commercial |
$34.58
|
| Rate for Payer: Quartz Beloit One Network |
$16.02
|
| Rate for Payer: Quartz Commercial |
$20.75
|
| Rate for Payer: Quartz Medicare Advantage |
$2.53
|
| Rate for Payer: The Alliance Commercial |
$6.32
|
| Rate for Payer: United Healthcare Medicaid |
$20.79
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2.53
|
| Rate for Payer: WEA Trust Commercial |
$20.02
|
| Rate for Payer: WPS Commercial |
$10.11
|
|
|
PROFILE FORM
|
Facility
|
OP
|
$27.00
|
|
| Hospital Charge Code |
2971441
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$7.86 |
| Max. Negotiated Rate |
$25.83 |
| Rate for Payer: Aetna Commercial |
$25.27
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$24.15
|
| Rate for Payer: Aetna Managed Medicare |
$7.86
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$18.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$14.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$13.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$14.88
|
| Rate for Payer: Cash Price |
$8.10
|
| Rate for Payer: Cigna Commercial |
$25.83
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$15.71
|
| Rate for Payer: Health EOS Commercial |
$24.99
|
| Rate for Payer: HFN Commercial |
$25.83
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$21.06
|
| Rate for Payer: Multiplan Commercial |
$22.46
|
| Rate for Payer: NAPHCARE Commercial |
$16.85
|
| Rate for Payer: Preferred Network Access Commercial |
$25.83
|
| Rate for Payer: Quartz Beloit One Network |
$13.76
|
| Rate for Payer: Quartz Commercial |
$18.25
|
| Rate for Payer: Quartz Medicare Advantage |
$16.85
|
| Rate for Payer: The Alliance Commercial |
$14.04
|
| Rate for Payer: WEA Trust Commercial |
$15.44
|
| Rate for Payer: WPS Commercial |
$20.80
|
|
|
PROFILE FORM
|
Facility
|
IP
|
$27.00
|
|
| Hospital Charge Code |
2971441
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$13.76 |
| Max. Negotiated Rate |
$25.83 |
| Rate for Payer: Aetna Commercial |
$25.27
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$24.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$14.88
|
| Rate for Payer: Cash Price |
$8.10
|
| Rate for Payer: Cigna Commercial |
$25.83
|
| Rate for Payer: Health EOS Commercial |
$24.99
|
| Rate for Payer: HFN Commercial |
$25.83
|
| Rate for Payer: Multiplan Commercial |
$22.46
|
| Rate for Payer: Preferred Network Access Commercial |
$25.83
|
| Rate for Payer: Quartz Beloit One Network |
$13.76
|
| Rate for Payer: Quartz Commercial |
$16.85
|
| Rate for Payer: WEA Trust Commercial |
$15.44
|
| Rate for Payer: WPS Commercial |
$20.80
|
|
|
PROFILE FORMS STAXI-2
|
Facility
|
IP
|
$1,408.00
|
|
| Hospital Charge Code |
2972253
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$717.52 |
| Max. Negotiated Rate |
$1,347.17 |
| Rate for Payer: Aetna Commercial |
$1,317.89
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,259.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$776.09
|
| Rate for Payer: Cash Price |
$422.40
|
| Rate for Payer: Cigna Commercial |
$1,347.17
|
| Rate for Payer: Health EOS Commercial |
$1,303.24
|
| Rate for Payer: HFN Commercial |
$1,347.17
|
| Rate for Payer: Multiplan Commercial |
$1,171.46
|
| Rate for Payer: Preferred Network Access Commercial |
$1,347.17
|
| Rate for Payer: Quartz Beloit One Network |
$717.52
|
| Rate for Payer: Quartz Commercial |
$878.59
|
| Rate for Payer: WEA Trust Commercial |
$805.38
|
| Rate for Payer: WPS Commercial |
$1,084.58
|
|
|
PROFILE FORMS STAXI-2
|
Facility
|
OP
|
$1,408.00
|
|
| Hospital Charge Code |
2972253
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$410.01 |
| Max. Negotiated Rate |
$1,347.17 |
| Rate for Payer: Aetna Commercial |
$1,317.89
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,259.32
|
| Rate for Payer: Aetna Managed Medicare |
$410.01
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$951.81
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$732.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$702.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$776.09
|
| Rate for Payer: Cash Price |
$422.40
|
| Rate for Payer: Cigna Commercial |
$1,347.17
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$819.46
|
| Rate for Payer: Health EOS Commercial |
$1,303.24
|
| Rate for Payer: HFN Commercial |
$1,347.17
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,098.24
|
| Rate for Payer: Multiplan Commercial |
$1,171.46
|
| Rate for Payer: NAPHCARE Commercial |
$878.59
|
| Rate for Payer: Preferred Network Access Commercial |
$1,347.17
|
| Rate for Payer: Quartz Beloit One Network |
$717.52
|
| Rate for Payer: Quartz Commercial |
$951.81
|
| Rate for Payer: Quartz Medicare Advantage |
$878.59
|
| Rate for Payer: The Alliance Commercial |
$732.16
|
| Rate for Payer: WEA Trust Commercial |
$805.38
|
| Rate for Payer: WPS Commercial |
$1,084.58
|
|
|
PROF & INST - SUB GRFT F/S/N/H/F/G/M/D >/= 100SCM ADL 100SQ CM 15278
|
Professional
|
Both
|
$205.00
|
|
|
Service Code
|
CPT 15278
|
| Hospital Charge Code |
6149815
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$45.50 |
| Max. Negotiated Rate |
$204.75 |
| Rate for Payer: Aetna Commercial |
$202.54
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$183.35
|
| Rate for Payer: Aetna Managed Medicare |
$45.50
|
| Rate for Payer: Anthem Medicare Advantage |
$45.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$45.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$45.50
|
| Rate for Payer: Cash Price |
$61.50
|
| Rate for Payer: Cash Price |
$61.50
|
| Rate for Payer: Cash Price |
$61.50
|
| Rate for Payer: Cigna Commercial |
$202.54
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$64.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$45.50
|
| Rate for Payer: Health EOS Commercial |
$194.01
|
| Rate for Payer: HFN Commercial |
$202.54
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$191.19
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$191.19
|
| Rate for Payer: Independent Care Health Plan Medicare |
$45.50
|
| Rate for Payer: Multiplan Commercial |
$170.56
|
| Rate for Payer: NAPHCARE Commercial |
$68.25
|
| Rate for Payer: Preferred Network Access Commercial |
$202.54
|
| Rate for Payer: Quartz Beloit One Network |
$93.81
|
| Rate for Payer: Quartz Commercial |
$121.52
|
| Rate for Payer: Quartz Medicare Advantage |
$45.50
|
| Rate for Payer: The Alliance Commercial |
$193.38
|
| Rate for Payer: United Healthcare Medicaid |
$64.92
|
| Rate for Payer: United Healthcare Medicare Advantage |
$45.50
|
| Rate for Payer: WEA Trust Commercial |
$117.26
|
| Rate for Payer: WPS Commercial |
$204.75
|
|
|
Progesterone, LC/MS/MS
|
Facility
|
OP
|
$88.00
|
|
|
Service Code
|
CPT 84144
|
| Hospital Charge Code |
4614608
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$21.69 |
| Max. Negotiated Rate |
$86.78 |
| Rate for Payer: Aetna Commercial |
$82.37
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$78.71
|
| Rate for Payer: Aetna Managed Medicare |
$21.69
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$81.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$37.97
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$36.01
|
| Rate for Payer: Anthem Medicare Advantage |
$21.69
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$48.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$21.69
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$21.69
|
| Rate for Payer: Cash Price |
$26.40
|
| Rate for Payer: Cash Price |
$26.40
|
| Rate for Payer: Cigna Commercial |
$84.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$21.69
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$51.22
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$21.69
|
| Rate for Payer: Health EOS Commercial |
$81.45
|
| Rate for Payer: HFN Commercial |
$84.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$80.70
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$21.69
|
| Rate for Payer: Independent Care Health Plan Medicare |
$21.69
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$21.69
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$21.69
|
| Rate for Payer: Multiplan Commercial |
$73.22
|
| Rate for Payer: NAPHCARE Commercial |
$32.54
|
| Rate for Payer: Preferred Network Access Commercial |
$84.20
|
| Rate for Payer: Quartz Beloit One Network |
$44.84
|
| Rate for Payer: Quartz Commercial |
$59.49
|
| Rate for Payer: Quartz Medicare Advantage |
$21.69
|
| Rate for Payer: The Alliance Commercial |
$86.78
|
| Rate for Payer: United Healthcare Medicare Advantage |
$21.69
|
| Rate for Payer: United Healthcare PPO |
$68.64
|
| Rate for Payer: WEA Trust Commercial |
$50.34
|
| Rate for Payer: Wellcare Medicare |
$21.69
|
| Rate for Payer: WPS Commercial |
$67.79
|
|
|
Progesterone, LC/MS/MS
|
Facility
|
IP
|
$88.00
|
|
|
Service Code
|
CPT 84144
|
| Hospital Charge Code |
4614608
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$44.84 |
| Max. Negotiated Rate |
$84.20 |
| Rate for Payer: Aetna Commercial |
$82.37
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$78.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$48.51
|
| Rate for Payer: Cash Price |
$26.40
|
| Rate for Payer: Cigna Commercial |
$84.20
|
| Rate for Payer: Health EOS Commercial |
$81.45
|
| Rate for Payer: HFN Commercial |
$84.20
|
| Rate for Payer: Multiplan Commercial |
$73.22
|
| Rate for Payer: Preferred Network Access Commercial |
$84.20
|
| Rate for Payer: Quartz Beloit One Network |
$44.84
|
| Rate for Payer: Quartz Commercial |
$54.91
|
| Rate for Payer: WEA Trust Commercial |
$50.34
|
| Rate for Payer: WPS Commercial |
$67.79
|
|
|
Progesterone, LC/MS/MS
|
Professional
|
Both
|
$88.00
|
|
|
Service Code
|
CPT 84144
|
| Hospital Charge Code |
4614608
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$21.69 |
| Max. Negotiated Rate |
$95.46 |
| Rate for Payer: Aetna Commercial |
$86.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$78.71
|
| Rate for Payer: Aetna Managed Medicare |
$21.69
|
| Rate for Payer: Anthem Medicare Advantage |
$21.69
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$21.69
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$21.69
|
| Rate for Payer: Cash Price |
$26.40
|
| Rate for Payer: Cash Price |
$26.40
|
| Rate for Payer: Cigna Commercial |
$86.94
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$45.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$21.69
|
| Rate for Payer: Health EOS Commercial |
$83.28
|
| Rate for Payer: HFN Commercial |
$86.94
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$76.59
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$76.59
|
| Rate for Payer: Independent Care Health Plan Medicare |
$21.69
|
| Rate for Payer: Multiplan Commercial |
$73.22
|
| Rate for Payer: NAPHCARE Commercial |
$32.54
|
| Rate for Payer: Preferred Network Access Commercial |
$86.94
|
| Rate for Payer: Quartz Beloit One Network |
$40.27
|
| Rate for Payer: Quartz Commercial |
$52.17
|
| Rate for Payer: Quartz Medicare Advantage |
$21.69
|
| Rate for Payer: The Alliance Commercial |
$85.69
|
| Rate for Payer: United Healthcare Medicare Advantage |
$21.69
|
| Rate for Payer: WEA Trust Commercial |
$50.34
|
| Rate for Payer: WPS Commercial |
$95.46
|
|
|
Progesterone Level
|
Facility
|
IP
|
$293.00
|
|
|
Service Code
|
CPT 84144
|
| Hospital Charge Code |
633808
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$149.31 |
| Max. Negotiated Rate |
$280.34 |
| Rate for Payer: Aetna Commercial |
$274.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$262.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$161.50
|
| Rate for Payer: Cash Price |
$87.90
|
| Rate for Payer: Cigna Commercial |
$280.34
|
| Rate for Payer: Health EOS Commercial |
$271.20
|
| Rate for Payer: HFN Commercial |
$280.34
|
| Rate for Payer: Multiplan Commercial |
$243.78
|
| Rate for Payer: Preferred Network Access Commercial |
$280.34
|
| Rate for Payer: Quartz Beloit One Network |
$149.31
|
| Rate for Payer: Quartz Commercial |
$182.83
|
| Rate for Payer: WEA Trust Commercial |
$167.60
|
| Rate for Payer: WPS Commercial |
$225.70
|
|
