|
S & I Code 74425
|
Facility
|
OP
|
$1,032.00
|
|
|
Service Code
|
CPT 74425
|
| Hospital Charge Code |
4125411
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$367.15 |
| Max. Negotiated Rate |
$1,468.60 |
| Rate for Payer: Aetna Commercial |
$965.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$923.02
|
| Rate for Payer: Aetna Managed Medicare |
$367.15
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$697.63
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$536.64
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$515.17
|
| Rate for Payer: Anthem Medicare Advantage |
$367.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$568.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$367.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$367.15
|
| Rate for Payer: Cash Price |
$309.60
|
| Rate for Payer: Cash Price |
$309.60
|
| Rate for Payer: Cigna Commercial |
$987.42
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$367.15
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$600.62
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$367.15
|
| Rate for Payer: Health EOS Commercial |
$955.22
|
| Rate for Payer: HFN Commercial |
$987.42
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,365.80
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$367.15
|
| Rate for Payer: Independent Care Health Plan Medicare |
$367.15
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$367.15
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$367.15
|
| Rate for Payer: Multiplan Commercial |
$858.62
|
| Rate for Payer: NAPHCARE Commercial |
$550.73
|
| Rate for Payer: Preferred Network Access Commercial |
$987.42
|
| Rate for Payer: Quartz Beloit One Network |
$525.91
|
| Rate for Payer: Quartz Commercial |
$697.63
|
| Rate for Payer: Quartz Medicare Advantage |
$367.15
|
| Rate for Payer: The Alliance Commercial |
$1,468.60
|
| Rate for Payer: United Healthcare Medicare Advantage |
$367.15
|
| Rate for Payer: WEA Trust Commercial |
$590.30
|
| Rate for Payer: Wellcare Medicare |
$367.15
|
| Rate for Payer: WPS Commercial |
$794.95
|
|
|
SIDEKICK NEEDLE COAPTITE 21GA X 14.6 IN M0068903040
|
Facility
|
IP
|
$951.00
|
|
| Hospital Charge Code |
5382983
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$484.63 |
| Max. Negotiated Rate |
$909.92 |
| Rate for Payer: Aetna Commercial |
$890.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$850.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$524.19
|
| Rate for Payer: Cash Price |
$285.30
|
| Rate for Payer: Cigna Commercial |
$909.92
|
| Rate for Payer: Health EOS Commercial |
$880.25
|
| Rate for Payer: HFN Commercial |
$909.92
|
| Rate for Payer: Multiplan Commercial |
$791.23
|
| Rate for Payer: Preferred Network Access Commercial |
$909.92
|
| Rate for Payer: Quartz Beloit One Network |
$484.63
|
| Rate for Payer: Quartz Commercial |
$593.42
|
| Rate for Payer: WEA Trust Commercial |
$543.97
|
| Rate for Payer: WPS Commercial |
$732.56
|
|
|
SIDEKICK NEEDLE COAPTITE 21GA X 14.6 IN M0068903040
|
Facility
|
OP
|
$951.00
|
|
| Hospital Charge Code |
5382983
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$276.93 |
| Max. Negotiated Rate |
$909.92 |
| Rate for Payer: Aetna Commercial |
$890.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$850.57
|
| Rate for Payer: Aetna Managed Medicare |
$276.93
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$642.88
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$494.52
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$474.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$524.19
|
| Rate for Payer: Cash Price |
$285.30
|
| Rate for Payer: Cigna Commercial |
$909.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$553.48
|
| Rate for Payer: Health EOS Commercial |
$880.25
|
| Rate for Payer: HFN Commercial |
$909.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$741.78
|
| Rate for Payer: Multiplan Commercial |
$791.23
|
| Rate for Payer: NAPHCARE Commercial |
$593.42
|
| Rate for Payer: Preferred Network Access Commercial |
$909.92
|
| Rate for Payer: Quartz Beloit One Network |
$484.63
|
| Rate for Payer: Quartz Commercial |
$642.88
|
| Rate for Payer: Quartz Medicare Advantage |
$593.42
|
| Rate for Payer: The Alliance Commercial |
$494.52
|
| Rate for Payer: WEA Trust Commercial |
$543.97
|
| Rate for Payer: WPS Commercial |
$732.56
|
|
|
SIDEPLATE 4HL 135 DHS LCP DHHS
|
Facility
|
OP
|
$5,722.00
|
|
| Hospital Charge Code |
2966582
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,666.25 |
| Max. Negotiated Rate |
$5,474.81 |
| Rate for Payer: Aetna Commercial |
$5,355.79
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,117.76
|
| Rate for Payer: Aetna Managed Medicare |
$1,666.25
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,868.07
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,975.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,856.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,153.97
|
| Rate for Payer: Cash Price |
$1,716.60
|
| Rate for Payer: Cigna Commercial |
$5,474.81
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,330.20
|
| Rate for Payer: Health EOS Commercial |
$5,296.28
|
| Rate for Payer: HFN Commercial |
$5,474.81
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,463.16
|
| Rate for Payer: Multiplan Commercial |
$4,760.70
|
| Rate for Payer: NAPHCARE Commercial |
$3,570.53
|
| Rate for Payer: Preferred Network Access Commercial |
$5,474.81
|
| Rate for Payer: Quartz Beloit One Network |
$2,915.93
|
| Rate for Payer: Quartz Commercial |
$3,868.07
|
| Rate for Payer: Quartz Medicare Advantage |
$3,570.53
|
| Rate for Payer: The Alliance Commercial |
$2,975.44
|
| Rate for Payer: WEA Trust Commercial |
$3,272.98
|
| Rate for Payer: WPS Commercial |
$4,407.66
|
|
|
SIDEPLATE 4HL 135 DHS LCP DHHS
|
Facility
|
IP
|
$5,722.00
|
|
| Hospital Charge Code |
2966582
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,915.93 |
| Max. Negotiated Rate |
$5,474.81 |
| Rate for Payer: Aetna Commercial |
$5,355.79
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,117.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,153.97
|
| Rate for Payer: Cash Price |
$1,716.60
|
| Rate for Payer: Cigna Commercial |
$5,474.81
|
| Rate for Payer: Health EOS Commercial |
$5,296.28
|
| Rate for Payer: HFN Commercial |
$5,474.81
|
| Rate for Payer: Multiplan Commercial |
$4,760.70
|
| Rate for Payer: Preferred Network Access Commercial |
$5,474.81
|
| Rate for Payer: Quartz Beloit One Network |
$2,915.93
|
| Rate for Payer: Quartz Commercial |
$3,570.53
|
| Rate for Payer: WEA Trust Commercial |
$3,272.98
|
| Rate for Payer: WPS Commercial |
$4,407.66
|
|
|
SIDEPLATE DHHS SYNTHES
|
Facility
|
OP
|
$5,722.00
|
|
| Hospital Charge Code |
2966583
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,666.25 |
| Max. Negotiated Rate |
$5,474.81 |
| Rate for Payer: Aetna Commercial |
$5,355.79
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,117.76
|
| Rate for Payer: Aetna Managed Medicare |
$1,666.25
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,868.07
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,975.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,856.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,153.97
|
| Rate for Payer: Cash Price |
$1,716.60
|
| Rate for Payer: Cigna Commercial |
$5,474.81
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,330.20
|
| Rate for Payer: Health EOS Commercial |
$5,296.28
|
| Rate for Payer: HFN Commercial |
$5,474.81
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,463.16
|
| Rate for Payer: Multiplan Commercial |
$4,760.70
|
| Rate for Payer: NAPHCARE Commercial |
$3,570.53
|
| Rate for Payer: Preferred Network Access Commercial |
$5,474.81
|
| Rate for Payer: Quartz Beloit One Network |
$2,915.93
|
| Rate for Payer: Quartz Commercial |
$3,868.07
|
| Rate for Payer: Quartz Medicare Advantage |
$3,570.53
|
| Rate for Payer: The Alliance Commercial |
$2,975.44
|
| Rate for Payer: WEA Trust Commercial |
$3,272.98
|
| Rate for Payer: WPS Commercial |
$4,407.66
|
|
|
SIDEPLATE DHHS SYNTHES
|
Facility
|
IP
|
$5,722.00
|
|
| Hospital Charge Code |
2966583
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,915.93 |
| Max. Negotiated Rate |
$5,474.81 |
| Rate for Payer: Aetna Commercial |
$5,355.79
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,117.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,153.97
|
| Rate for Payer: Cash Price |
$1,716.60
|
| Rate for Payer: Cigna Commercial |
$5,474.81
|
| Rate for Payer: Health EOS Commercial |
$5,296.28
|
| Rate for Payer: HFN Commercial |
$5,474.81
|
| Rate for Payer: Multiplan Commercial |
$4,760.70
|
| Rate for Payer: Preferred Network Access Commercial |
$5,474.81
|
| Rate for Payer: Quartz Beloit One Network |
$2,915.93
|
| Rate for Payer: Quartz Commercial |
$3,570.53
|
| Rate for Payer: WEA Trust Commercial |
$3,272.98
|
| Rate for Payer: WPS Commercial |
$4,407.66
|
|
|
SIDEPORT 1.2MM 8065921541
|
Facility
|
OP
|
$236.00
|
|
| Hospital Charge Code |
5415574
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$68.72 |
| Max. Negotiated Rate |
$225.80 |
| Rate for Payer: Aetna Commercial |
$220.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$211.08
|
| Rate for Payer: Aetna Managed Medicare |
$68.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$159.54
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$122.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$117.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$130.08
|
| Rate for Payer: Cash Price |
$70.80
|
| Rate for Payer: Cigna Commercial |
$225.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$137.35
|
| Rate for Payer: Health EOS Commercial |
$218.44
|
| Rate for Payer: HFN Commercial |
$225.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$184.08
|
| Rate for Payer: Multiplan Commercial |
$196.35
|
| Rate for Payer: NAPHCARE Commercial |
$147.26
|
| Rate for Payer: Preferred Network Access Commercial |
$225.80
|
| Rate for Payer: Quartz Beloit One Network |
$120.27
|
| Rate for Payer: Quartz Commercial |
$159.54
|
| Rate for Payer: Quartz Medicare Advantage |
$147.26
|
| Rate for Payer: The Alliance Commercial |
$122.72
|
| Rate for Payer: WEA Trust Commercial |
$134.99
|
| Rate for Payer: WPS Commercial |
$181.79
|
|
|
SIDEPORT 1.2MM 8065921541
|
Facility
|
IP
|
$236.00
|
|
| Hospital Charge Code |
5415574
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$120.27 |
| Max. Negotiated Rate |
$225.80 |
| Rate for Payer: Aetna Commercial |
$220.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$211.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$130.08
|
| Rate for Payer: Cash Price |
$70.80
|
| Rate for Payer: Cigna Commercial |
$225.80
|
| Rate for Payer: Health EOS Commercial |
$218.44
|
| Rate for Payer: HFN Commercial |
$225.80
|
| Rate for Payer: Multiplan Commercial |
$196.35
|
| Rate for Payer: Preferred Network Access Commercial |
$225.80
|
| Rate for Payer: Quartz Beloit One Network |
$120.27
|
| Rate for Payer: Quartz Commercial |
$147.26
|
| Rate for Payer: WEA Trust Commercial |
$134.99
|
| Rate for Payer: WPS Commercial |
$181.79
|
|
|
SIGMOID COLECTOMY/RESECTION/LOW ANTERIOR RESECTION
|
Facility
|
IP
|
$4,803.00
|
|
| Hospital Charge Code |
2960374
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,447.61 |
| Max. Negotiated Rate |
$4,595.51 |
| Rate for Payer: Aetna Commercial |
$4,495.61
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,295.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,647.41
|
| Rate for Payer: Cash Price |
$1,440.90
|
| Rate for Payer: Cigna Commercial |
$4,595.51
|
| Rate for Payer: Health EOS Commercial |
$4,445.66
|
| Rate for Payer: HFN Commercial |
$4,595.51
|
| Rate for Payer: Multiplan Commercial |
$3,996.10
|
| Rate for Payer: Preferred Network Access Commercial |
$4,595.51
|
| Rate for Payer: Quartz Beloit One Network |
$2,447.61
|
| Rate for Payer: Quartz Commercial |
$2,997.07
|
| Rate for Payer: WEA Trust Commercial |
$2,747.32
|
| Rate for Payer: WPS Commercial |
$3,699.75
|
|
|
SIGMOID COLECTOMY/RESECTION/LOW ANTERIOR RESECTION
|
Facility
|
OP
|
$4,803.00
|
|
| Hospital Charge Code |
2960374
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,398.63 |
| Max. Negotiated Rate |
$4,595.51 |
| Rate for Payer: Aetna Commercial |
$4,495.61
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,295.80
|
| Rate for Payer: Aetna Managed Medicare |
$1,398.63
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,246.83
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,497.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,397.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,647.41
|
| Rate for Payer: Cash Price |
$1,440.90
|
| Rate for Payer: Cigna Commercial |
$4,595.51
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,795.35
|
| Rate for Payer: Health EOS Commercial |
$4,445.66
|
| Rate for Payer: HFN Commercial |
$4,595.51
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,746.34
|
| Rate for Payer: Multiplan Commercial |
$3,996.10
|
| Rate for Payer: NAPHCARE Commercial |
$2,997.07
|
| Rate for Payer: Preferred Network Access Commercial |
$4,595.51
|
| Rate for Payer: Quartz Beloit One Network |
$2,447.61
|
| Rate for Payer: Quartz Commercial |
$3,246.83
|
| Rate for Payer: Quartz Medicare Advantage |
$2,997.07
|
| Rate for Payer: The Alliance Commercial |
$2,497.56
|
| Rate for Payer: WEA Trust Commercial |
$2,747.32
|
| Rate for Payer: WPS Commercial |
$3,699.75
|
|
|
SIGMOIDOSCOPE DISPOSABLE 53130
|
Facility
|
OP
|
$93.00
|
|
| Hospital Charge Code |
2963026
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$27.08 |
| Max. Negotiated Rate |
$88.98 |
| Rate for Payer: Aetna Commercial |
$87.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$83.18
|
| Rate for Payer: Aetna Managed Medicare |
$27.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$62.87
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$48.36
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$46.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$51.26
|
| Rate for Payer: Cash Price |
$27.90
|
| Rate for Payer: Cigna Commercial |
$88.98
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$54.13
|
| Rate for Payer: Health EOS Commercial |
$86.08
|
| Rate for Payer: HFN Commercial |
$88.98
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$72.54
|
| Rate for Payer: Multiplan Commercial |
$77.38
|
| Rate for Payer: NAPHCARE Commercial |
$58.03
|
| Rate for Payer: Preferred Network Access Commercial |
$88.98
|
| Rate for Payer: Quartz Beloit One Network |
$47.39
|
| Rate for Payer: Quartz Commercial |
$62.87
|
| Rate for Payer: Quartz Medicare Advantage |
$58.03
|
| Rate for Payer: The Alliance Commercial |
$48.36
|
| Rate for Payer: WEA Trust Commercial |
$53.20
|
| Rate for Payer: WPS Commercial |
$71.64
|
|
|
SIGMOIDOSCOPE DISPOSABLE 53130
|
Facility
|
IP
|
$93.00
|
|
| Hospital Charge Code |
2963026
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$47.39 |
| Max. Negotiated Rate |
$88.98 |
| Rate for Payer: Aetna Commercial |
$87.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$83.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$51.26
|
| Rate for Payer: Cash Price |
$27.90
|
| Rate for Payer: Cigna Commercial |
$88.98
|
| Rate for Payer: Health EOS Commercial |
$86.08
|
| Rate for Payer: HFN Commercial |
$88.98
|
| Rate for Payer: Multiplan Commercial |
$77.38
|
| Rate for Payer: Preferred Network Access Commercial |
$88.98
|
| Rate for Payer: Quartz Beloit One Network |
$47.39
|
| Rate for Payer: Quartz Commercial |
$58.03
|
| Rate for Payer: WEA Trust Commercial |
$53.20
|
| Rate for Payer: WPS Commercial |
$71.64
|
|
|
SIGMOIDOSCOPE SUCTION TIP 0033050
|
Facility
|
OP
|
$86.00
|
|
| Hospital Charge Code |
2963604
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$25.04 |
| Max. Negotiated Rate |
$82.28 |
| Rate for Payer: Aetna Commercial |
$80.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$76.92
|
| Rate for Payer: Aetna Managed Medicare |
$25.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$58.14
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$44.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$42.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$47.40
|
| Rate for Payer: Cash Price |
$25.80
|
| Rate for Payer: Cigna Commercial |
$82.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$50.05
|
| Rate for Payer: Health EOS Commercial |
$79.60
|
| Rate for Payer: HFN Commercial |
$82.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$67.08
|
| Rate for Payer: Multiplan Commercial |
$71.55
|
| Rate for Payer: NAPHCARE Commercial |
$53.66
|
| Rate for Payer: Preferred Network Access Commercial |
$82.28
|
| Rate for Payer: Quartz Beloit One Network |
$43.83
|
| Rate for Payer: Quartz Commercial |
$58.14
|
| Rate for Payer: Quartz Medicare Advantage |
$53.66
|
| Rate for Payer: The Alliance Commercial |
$44.72
|
| Rate for Payer: WEA Trust Commercial |
$49.19
|
| Rate for Payer: WPS Commercial |
$66.25
|
|
|
SIGMOIDOSCOPE SUCTION TIP 0033050
|
Facility
|
IP
|
$86.00
|
|
| Hospital Charge Code |
2963604
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$43.83 |
| Max. Negotiated Rate |
$82.28 |
| Rate for Payer: Aetna Commercial |
$80.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$76.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$47.40
|
| Rate for Payer: Cash Price |
$25.80
|
| Rate for Payer: Cigna Commercial |
$82.28
|
| Rate for Payer: Health EOS Commercial |
$79.60
|
| Rate for Payer: HFN Commercial |
$82.28
|
| Rate for Payer: Multiplan Commercial |
$71.55
|
| Rate for Payer: Preferred Network Access Commercial |
$82.28
|
| Rate for Payer: Quartz Beloit One Network |
$43.83
|
| Rate for Payer: Quartz Commercial |
$53.66
|
| Rate for Payer: WEA Trust Commercial |
$49.19
|
| Rate for Payer: WPS Commercial |
$66.25
|
|
|
SIGMOIDOSCOPY AND BIOPSY 45331
|
Professional
|
Both
|
$275.00
|
|
|
Service Code
|
CPT 45331
|
| Hospital Charge Code |
3014796
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$65.01 |
| Max. Negotiated Rate |
$292.55 |
| Rate for Payer: Aetna Commercial |
$271.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$245.96
|
| Rate for Payer: Aetna Managed Medicare |
$65.01
|
| Rate for Payer: Anthem Medicare Advantage |
$65.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$65.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$65.01
|
| Rate for Payer: Cash Price |
$82.50
|
| Rate for Payer: Cash Price |
$82.50
|
| Rate for Payer: Cash Price |
$82.50
|
| Rate for Payer: Cigna Commercial |
$271.70
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$111.81
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$65.01
|
| Rate for Payer: Health EOS Commercial |
$260.26
|
| Rate for Payer: HFN Commercial |
$271.70
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$249.09
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$249.09
|
| Rate for Payer: Independent Care Health Plan Medicare |
$65.01
|
| Rate for Payer: Multiplan Commercial |
$228.80
|
| Rate for Payer: NAPHCARE Commercial |
$97.52
|
| Rate for Payer: Preferred Network Access Commercial |
$271.70
|
| Rate for Payer: Quartz Beloit One Network |
$125.84
|
| Rate for Payer: Quartz Commercial |
$163.02
|
| Rate for Payer: Quartz Medicare Advantage |
$65.01
|
| Rate for Payer: The Alliance Commercial |
$276.29
|
| Rate for Payer: United Healthcare Medicaid |
$111.81
|
| Rate for Payer: United Healthcare Medicare Advantage |
$65.01
|
| Rate for Payer: WEA Trust Commercial |
$157.30
|
| Rate for Payer: WPS Commercial |
$292.55
|
|
|
SIGMOIDOSCOPY AND POLYPECTOMY 45333
|
Professional
|
Both
|
$553.00
|
|
|
Service Code
|
CPT 45333
|
| Hospital Charge Code |
3014798
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$83.43 |
| Max. Negotiated Rate |
$546.36 |
| Rate for Payer: Aetna Commercial |
$546.36
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$494.60
|
| Rate for Payer: Aetna Managed Medicare |
$83.43
|
| Rate for Payer: Anthem Medicare Advantage |
$83.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$83.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$83.43
|
| Rate for Payer: Cash Price |
$165.90
|
| Rate for Payer: Cash Price |
$165.90
|
| Rate for Payer: Cash Price |
$165.90
|
| Rate for Payer: Cigna Commercial |
$546.36
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$110.86
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$83.43
|
| Rate for Payer: Health EOS Commercial |
$523.36
|
| Rate for Payer: HFN Commercial |
$546.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$323.58
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$323.58
|
| Rate for Payer: Independent Care Health Plan Medicare |
$83.43
|
| Rate for Payer: Multiplan Commercial |
$460.10
|
| Rate for Payer: NAPHCARE Commercial |
$125.14
|
| Rate for Payer: Preferred Network Access Commercial |
$546.36
|
| Rate for Payer: Quartz Beloit One Network |
$253.05
|
| Rate for Payer: Quartz Commercial |
$327.82
|
| Rate for Payer: Quartz Medicare Advantage |
$83.43
|
| Rate for Payer: The Alliance Commercial |
$354.57
|
| Rate for Payer: United Healthcare Medicaid |
$110.86
|
| Rate for Payer: United Healthcare Medicare Advantage |
$83.43
|
| Rate for Payer: WEA Trust Commercial |
$316.32
|
| Rate for Payer: WPS Commercial |
$375.43
|
|
|
SIGMOIDOSCOPY, FLEXIBLE; DIAGNOSTIC, INCLUDING COLLECTION OF SPECIMEN(S) BY BRUSHING OR WASHING, WHEN PERFORMED (SEPARATE PROCEDURE)
|
Facility
|
OP
|
$3,914.73
|
|
|
Service Code
|
CPT 45330
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$661.47 |
| Max. Negotiated Rate |
$3,914.73 |
| Rate for Payer: Aetna Managed Medicare |
$978.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,030.56
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,388.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,270.32
|
| Rate for Payer: Anthem Medicare Advantage |
$978.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$978.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$978.68
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$978.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$661.47
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$978.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,640.70
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$978.68
|
| Rate for Payer: Independent Care Health Plan Medicare |
$978.68
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$978.68
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$978.68
|
| Rate for Payer: NAPHCARE Commercial |
$1,468.02
|
| Rate for Payer: Quartz Medicare Advantage |
$978.68
|
| Rate for Payer: The Alliance Commercial |
$3,914.73
|
| Rate for Payer: United Healthcare Medicare Advantage |
$978.68
|
| Rate for Payer: United Healthcare PPO |
$2,347.28
|
| Rate for Payer: Wellcare Medicare |
$978.68
|
|
|
SIGMOIDOSCOPY, FLEXIBLE; WITH BIOPSY, SINGLE OR MULTIPLE
|
Facility
|
OP
|
$4,386.95
|
|
|
Service Code
|
CPT 45331
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$978.68 |
| Max. Negotiated Rate |
$4,386.95 |
| Rate for Payer: Aetna Managed Medicare |
$978.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,030.56
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,388.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,270.32
|
| Rate for Payer: Anthem Medicare Advantage |
$978.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$978.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$978.68
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$978.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$978.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,640.70
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$978.68
|
| Rate for Payer: Independent Care Health Plan Medicare |
$978.68
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$978.68
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$978.68
|
| Rate for Payer: NAPHCARE Commercial |
$1,468.02
|
| Rate for Payer: Quartz Medicare Advantage |
$978.68
|
| Rate for Payer: The Alliance Commercial |
$3,914.73
|
| Rate for Payer: United Healthcare Medicare Advantage |
$978.68
|
| Rate for Payer: United Healthcare PPO |
$2,347.28
|
| Rate for Payer: Wellcare Medicare |
$978.68
|
|
|
SIGMOIDOSCOPY, FLEXIBLE; WITH DIRECTED SUBMUCOSAL INJECTION(S), ANY SUBSTANCE
|
Facility
|
OP
|
$4,386.95
|
|
|
Service Code
|
CPT 45335
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$978.68 |
| Max. Negotiated Rate |
$4,386.95 |
| Rate for Payer: Aetna Managed Medicare |
$978.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,030.56
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,388.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,270.32
|
| Rate for Payer: Anthem Medicare Advantage |
$978.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$978.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$978.68
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$978.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$978.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,640.70
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$978.68
|
| Rate for Payer: Independent Care Health Plan Medicare |
$978.68
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$978.68
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$978.68
|
| Rate for Payer: NAPHCARE Commercial |
$1,468.02
|
| Rate for Payer: Quartz Medicare Advantage |
$978.68
|
| Rate for Payer: The Alliance Commercial |
$3,914.73
|
| Rate for Payer: United Healthcare Medicare Advantage |
$978.68
|
| Rate for Payer: United Healthcare PPO |
$2,347.28
|
| Rate for Payer: Wellcare Medicare |
$978.68
|
|
|
Sigmoidoscopy Flx with Band Ligation(s) 45350
|
Professional
|
Both
|
$1,518.00
|
|
|
Service Code
|
CPT 45350
|
| Hospital Charge Code |
5430717
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$89.17 |
| Max. Negotiated Rate |
$1,499.78 |
| Rate for Payer: Aetna Commercial |
$1,499.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,357.70
|
| Rate for Payer: Aetna Managed Medicare |
$89.17
|
| Rate for Payer: Anthem Medicare Advantage |
$89.17
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$89.17
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$89.17
|
| Rate for Payer: Cash Price |
$455.40
|
| Rate for Payer: Cash Price |
$455.40
|
| Rate for Payer: Cash Price |
$455.40
|
| Rate for Payer: Cigna Commercial |
$1,499.78
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$136.43
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$89.17
|
| Rate for Payer: Health EOS Commercial |
$1,436.64
|
| Rate for Payer: HFN Commercial |
$1,499.78
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$348.65
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$348.65
|
| Rate for Payer: Independent Care Health Plan Medicare |
$89.17
|
| Rate for Payer: Multiplan Commercial |
$1,262.98
|
| Rate for Payer: NAPHCARE Commercial |
$133.75
|
| Rate for Payer: Preferred Network Access Commercial |
$1,499.78
|
| Rate for Payer: Quartz Beloit One Network |
$694.64
|
| Rate for Payer: Quartz Commercial |
$899.87
|
| Rate for Payer: Quartz Medicare Advantage |
$89.17
|
| Rate for Payer: The Alliance Commercial |
$378.97
|
| Rate for Payer: United Healthcare Medicaid |
$136.43
|
| Rate for Payer: United Healthcare Medicare Advantage |
$89.17
|
| Rate for Payer: WEA Trust Commercial |
$868.30
|
| Rate for Payer: WPS Commercial |
$401.26
|
|
|
SIGMOIDOSCOPY W/ABLATE TUMR 45339
|
Professional
|
Both
|
$1,362.00
|
|
| Hospital Charge Code |
3014802
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$623.25 |
| Max. Negotiated Rate |
$1,345.66 |
| Rate for Payer: Aetna Commercial |
$1,345.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,218.17
|
| Rate for Payer: Cash Price |
$408.60
|
| Rate for Payer: Cigna Commercial |
$1,345.66
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$708.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$849.89
|
| Rate for Payer: Health EOS Commercial |
$1,289.00
|
| Rate for Payer: HFN Commercial |
$1,345.66
|
| Rate for Payer: Multiplan Commercial |
$1,133.18
|
| Rate for Payer: Preferred Network Access Commercial |
$1,345.66
|
| Rate for Payer: Quartz Beloit One Network |
$623.25
|
| Rate for Payer: Quartz Commercial |
$807.39
|
| Rate for Payer: The Alliance Commercial |
$708.24
|
| Rate for Payer: WEA Trust Commercial |
$779.06
|
| Rate for Payer: WPS Commercial |
$1,049.15
|
|
|
SIGMOIDOSCOPY W/FB REMOVAL 45332
|
Professional
|
Both
|
$616.00
|
|
|
Service Code
|
CPT 45332
|
| Hospital Charge Code |
3014797
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$93.05 |
| Max. Negotiated Rate |
$608.61 |
| Rate for Payer: Aetna Commercial |
$608.61
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$550.95
|
| Rate for Payer: Aetna Managed Medicare |
$93.05
|
| Rate for Payer: Anthem Medicare Advantage |
$93.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$93.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$93.05
|
| Rate for Payer: Cash Price |
$184.80
|
| Rate for Payer: Cash Price |
$184.80
|
| Rate for Payer: Cash Price |
$184.80
|
| Rate for Payer: Cigna Commercial |
$608.61
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$116.58
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$93.05
|
| Rate for Payer: Health EOS Commercial |
$582.98
|
| Rate for Payer: HFN Commercial |
$608.61
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$362.90
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$362.90
|
| Rate for Payer: Independent Care Health Plan Medicare |
$93.05
|
| Rate for Payer: Multiplan Commercial |
$512.51
|
| Rate for Payer: NAPHCARE Commercial |
$139.57
|
| Rate for Payer: Preferred Network Access Commercial |
$608.61
|
| Rate for Payer: Quartz Beloit One Network |
$281.88
|
| Rate for Payer: Quartz Commercial |
$365.16
|
| Rate for Payer: Quartz Medicare Advantage |
$93.05
|
| Rate for Payer: The Alliance Commercial |
$395.46
|
| Rate for Payer: United Healthcare Medicaid |
$116.58
|
| Rate for Payer: United Healthcare Medicare Advantage |
$93.05
|
| Rate for Payer: WEA Trust Commercial |
$352.35
|
| Rate for Payer: WPS Commercial |
$418.72
|
|
|
SIGMOIDOSCOPY W/SUBMUC INJ 45335
|
Professional
|
Both
|
$1,627.00
|
|
|
Service Code
|
CPT 45335
|
| Hospital Charge Code |
3014800
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$60.54 |
| Max. Negotiated Rate |
$1,607.48 |
| Rate for Payer: Aetna Commercial |
$1,607.48
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,455.19
|
| Rate for Payer: Aetna Managed Medicare |
$60.54
|
| Rate for Payer: Anthem Medicare Advantage |
$60.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$60.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$60.54
|
| Rate for Payer: Cash Price |
$488.10
|
| Rate for Payer: Cash Price |
$488.10
|
| Rate for Payer: Cash Price |
$488.10
|
| Rate for Payer: Cigna Commercial |
$1,607.48
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$161.69
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$60.54
|
| Rate for Payer: Health EOS Commercial |
$1,539.79
|
| Rate for Payer: HFN Commercial |
$1,607.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$230.26
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$230.26
|
| Rate for Payer: Independent Care Health Plan Medicare |
$60.54
|
| Rate for Payer: Multiplan Commercial |
$1,353.66
|
| Rate for Payer: NAPHCARE Commercial |
$90.81
|
| Rate for Payer: Preferred Network Access Commercial |
$1,607.48
|
| Rate for Payer: Quartz Beloit One Network |
$744.52
|
| Rate for Payer: Quartz Commercial |
$964.49
|
| Rate for Payer: Quartz Medicare Advantage |
$60.54
|
| Rate for Payer: The Alliance Commercial |
$257.29
|
| Rate for Payer: United Healthcare Medicaid |
$161.69
|
| Rate for Payer: United Healthcare Medicare Advantage |
$60.54
|
| Rate for Payer: WEA Trust Commercial |
$930.64
|
| Rate for Payer: WPS Commercial |
$272.42
|
|
|
SIGNS AND SYMPTOMS OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH MCC
|
Facility
|
IP
|
$39,014.56
|
|
|
Service Code
|
MSDRG 555
|
| Min. Negotiated Rate |
$10,629.38 |
| Max. Negotiated Rate |
$39,014.56 |
| Rate for Payer: Aetna Managed Medicare |
$10,629.38
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$28,840.62
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$22,106.10
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$21,002.24
|
| Rate for Payer: Anthem Medicare Advantage |
$10,629.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$10,629.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$10,629.38
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$10,629.38
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$23,314.41
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$10,629.38
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$28,371.72
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$10,629.38
|
| Rate for Payer: Independent Care Health Plan Medicare |
$10,629.38
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$10,629.38
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$10,629.38
|
| Rate for Payer: NAPHCARE Commercial |
$15,944.07
|
| Rate for Payer: Quartz Medicare Advantage |
$10,629.38
|
| Rate for Payer: The Alliance Commercial |
$39,014.56
|
| Rate for Payer: United Healthcare Medicare Advantage |
$10,629.38
|
| Rate for Payer: United Healthcare PPO |
$22,087.75
|
| Rate for Payer: Wellcare Medicare |
$10,629.38
|
|
