|
COLONOSCOPY WITH DECOMPRESSION
|
Facility
|
OP
|
$1,948.00
|
|
|
Service Code
|
CPT 45393
|
| Hospital Charge Code |
4494706
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$992.70 |
| Max. Negotiated Rate |
$5,037.34 |
| Rate for Payer: Aetna Commercial |
$1,823.33
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,742.29
|
| 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 Blue Cross PPO |
$1,073.74
|
| 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: Cash Price |
$584.40
|
| Rate for Payer: Cash Price |
$584.40
|
| Rate for Payer: Cash Price |
$584.40
|
| Rate for Payer: Cigna Commercial |
$1,863.85
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$1,259.34
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,947.89
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$1,259.34
|
| Rate for Payer: Health EOS Commercial |
$1,803.07
|
| Rate for Payer: HFN Commercial |
$1,863.85
|
| 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: Multiplan Commercial |
$1,620.74
|
| Rate for Payer: NAPHCARE Commercial |
$1,889.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,863.85
|
| Rate for Payer: Quartz Beloit One Network |
$992.70
|
| Rate for Payer: Quartz Commercial |
$1,316.85
|
| 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: WEA Trust Commercial |
$1,114.26
|
| Rate for Payer: Wellcare Medicare |
$1,259.34
|
| Rate for Payer: WPS Commercial |
$1,500.54
|
|
|
COLONOSCOPY WITH POLYPECTOMY
|
Facility
|
OP
|
$7,205.00
|
|
| Hospital Charge Code |
2960554
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$2,098.10 |
| Max. Negotiated Rate |
$6,893.74 |
| Rate for Payer: Aetna Commercial |
$6,743.88
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,444.15
|
| Rate for Payer: Aetna Managed Medicare |
$2,098.10
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,870.58
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,746.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,596.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,971.40
|
| Rate for Payer: Cash Price |
$2,161.50
|
| Rate for Payer: Cigna Commercial |
$6,893.74
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,193.31
|
| Rate for Payer: Health EOS Commercial |
$6,668.95
|
| Rate for Payer: HFN Commercial |
$6,893.74
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,619.90
|
| Rate for Payer: Multiplan Commercial |
$5,994.56
|
| Rate for Payer: NAPHCARE Commercial |
$4,495.92
|
| Rate for Payer: Preferred Network Access Commercial |
$6,893.74
|
| Rate for Payer: Quartz Beloit One Network |
$3,671.67
|
| Rate for Payer: Quartz Commercial |
$4,870.58
|
| Rate for Payer: Quartz Medicare Advantage |
$4,495.92
|
| Rate for Payer: The Alliance Commercial |
$3,746.60
|
| Rate for Payer: WEA Trust Commercial |
$4,121.26
|
| Rate for Payer: WPS Commercial |
$5,550.01
|
|
|
COLONOSCOPY WITH POLYPECTOMY
|
Facility
|
IP
|
$7,205.00
|
|
| Hospital Charge Code |
2960554
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$3,671.67 |
| Max. Negotiated Rate |
$6,893.74 |
| Rate for Payer: Aetna Commercial |
$6,743.88
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,444.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,971.40
|
| Rate for Payer: Cash Price |
$2,161.50
|
| Rate for Payer: Cigna Commercial |
$6,893.74
|
| Rate for Payer: Health EOS Commercial |
$6,668.95
|
| Rate for Payer: HFN Commercial |
$6,893.74
|
| Rate for Payer: Multiplan Commercial |
$5,994.56
|
| Rate for Payer: Preferred Network Access Commercial |
$6,893.74
|
| Rate for Payer: Quartz Beloit One Network |
$3,671.67
|
| Rate for Payer: Quartz Commercial |
$4,495.92
|
| Rate for Payer: WEA Trust Commercial |
$4,121.26
|
| Rate for Payer: WPS Commercial |
$5,550.01
|
|
|
COLONOSCOPY WITH POLYPECTOMY AND BIOPSY
|
Facility
|
OP
|
$7,221.00
|
|
| Hospital Charge Code |
2960555
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$2,102.76 |
| Max. Negotiated Rate |
$6,909.05 |
| Rate for Payer: Aetna Commercial |
$6,758.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,458.46
|
| Rate for Payer: Aetna Managed Medicare |
$2,102.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,881.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,754.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,604.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,980.22
|
| Rate for Payer: Cash Price |
$2,166.30
|
| Rate for Payer: Cigna Commercial |
$6,909.05
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,202.62
|
| Rate for Payer: Health EOS Commercial |
$6,683.76
|
| Rate for Payer: HFN Commercial |
$6,909.05
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,632.38
|
| Rate for Payer: Multiplan Commercial |
$6,007.87
|
| Rate for Payer: NAPHCARE Commercial |
$4,505.90
|
| Rate for Payer: Preferred Network Access Commercial |
$6,909.05
|
| Rate for Payer: Quartz Beloit One Network |
$3,679.82
|
| Rate for Payer: Quartz Commercial |
$4,881.40
|
| Rate for Payer: Quartz Medicare Advantage |
$4,505.90
|
| Rate for Payer: The Alliance Commercial |
$3,754.92
|
| Rate for Payer: WEA Trust Commercial |
$4,130.41
|
| Rate for Payer: WPS Commercial |
$5,562.34
|
|
|
COLONOSCOPY WITH POLYPECTOMY AND BIOPSY
|
Facility
|
IP
|
$7,221.00
|
|
| Hospital Charge Code |
2960555
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$3,679.82 |
| Max. Negotiated Rate |
$6,909.05 |
| Rate for Payer: Aetna Commercial |
$6,758.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,458.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,980.22
|
| Rate for Payer: Cash Price |
$2,166.30
|
| Rate for Payer: Cigna Commercial |
$6,909.05
|
| Rate for Payer: Health EOS Commercial |
$6,683.76
|
| Rate for Payer: HFN Commercial |
$6,909.05
|
| Rate for Payer: Multiplan Commercial |
$6,007.87
|
| Rate for Payer: Preferred Network Access Commercial |
$6,909.05
|
| Rate for Payer: Quartz Beloit One Network |
$3,679.82
|
| Rate for Payer: Quartz Commercial |
$4,505.90
|
| Rate for Payer: WEA Trust Commercial |
$4,130.41
|
| Rate for Payer: WPS Commercial |
$5,562.34
|
|
|
COLONOSCOPY WITH STENT PLACEMENT
|
Facility
|
OP
|
$4,569.00
|
|
|
Service Code
|
CPT 45389
|
| Hospital Charge Code |
4494708
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$2,328.36 |
| Max. Negotiated Rate |
$25,555.80 |
| Rate for Payer: Aetna Commercial |
$4,276.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,086.51
|
| Rate for Payer: Aetna Managed Medicare |
$6,388.95
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$12,727.52
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$11,350.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$10,781.68
|
| Rate for Payer: Anthem Medicare Advantage |
$6,388.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,518.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$6,388.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$6,388.95
|
| Rate for Payer: Cash Price |
$1,370.70
|
| Rate for Payer: Cash Price |
$1,370.70
|
| Rate for Payer: Cash Price |
$1,370.70
|
| Rate for Payer: Cigna Commercial |
$4,371.62
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$6,388.95
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,947.89
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$6,388.95
|
| Rate for Payer: Health EOS Commercial |
$4,229.07
|
| Rate for Payer: HFN Commercial |
$4,371.62
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$23,766.89
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$6,388.95
|
| Rate for Payer: Independent Care Health Plan Medicare |
$6,388.95
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$6,388.95
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$6,388.95
|
| Rate for Payer: Multiplan Commercial |
$3,801.41
|
| Rate for Payer: NAPHCARE Commercial |
$9,583.42
|
| Rate for Payer: Preferred Network Access Commercial |
$4,371.62
|
| Rate for Payer: Quartz Beloit One Network |
$2,328.36
|
| Rate for Payer: Quartz Commercial |
$3,088.64
|
| Rate for Payer: Quartz Medicare Advantage |
$6,388.95
|
| Rate for Payer: The Alliance Commercial |
$25,555.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,388.95
|
| Rate for Payer: United Healthcare PPO |
$4,409.60
|
| Rate for Payer: WEA Trust Commercial |
$2,613.47
|
| Rate for Payer: Wellcare Medicare |
$6,388.95
|
| Rate for Payer: WPS Commercial |
$3,519.50
|
|
|
COLONOSCOPY WITH STENT PLACEMENT
|
Facility
|
IP
|
$4,569.00
|
|
|
Service Code
|
CPT 45389
|
| Hospital Charge Code |
4494708
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$2,328.36 |
| Max. Negotiated Rate |
$4,371.62 |
| Rate for Payer: Aetna Commercial |
$4,276.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,086.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,518.43
|
| Rate for Payer: Cash Price |
$1,370.70
|
| Rate for Payer: Cigna Commercial |
$4,371.62
|
| Rate for Payer: Health EOS Commercial |
$4,229.07
|
| Rate for Payer: HFN Commercial |
$4,371.62
|
| Rate for Payer: Multiplan Commercial |
$3,801.41
|
| Rate for Payer: Preferred Network Access Commercial |
$4,371.62
|
| Rate for Payer: Quartz Beloit One Network |
$2,328.36
|
| Rate for Payer: Quartz Commercial |
$2,851.06
|
| Rate for Payer: WEA Trust Commercial |
$2,613.47
|
| Rate for Payer: WPS Commercial |
$3,519.50
|
|
|
COLON RESECTION
|
Facility
|
IP
|
$4,803.00
|
|
| Hospital Charge Code |
2959938
|
|
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
|
|
|
COLON RESECTION
|
Facility
|
OP
|
$4,803.00
|
|
| Hospital Charge Code |
2959938
|
|
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
|
|
|
Colorectal Cancer Screening: Flexible Sigmoidoscopy
|
Professional
|
Both
|
$461.00
|
|
|
Service Code
|
CPT 45330
|
| Hospital Charge Code |
1188849
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$52.06 |
| Max. Negotiated Rate |
$455.47 |
| Rate for Payer: Aetna Commercial |
$455.47
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$412.32
|
| Rate for Payer: Aetna Managed Medicare |
$52.06
|
| Rate for Payer: Anthem Medicare Advantage |
$52.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$52.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$52.06
|
| Rate for Payer: Cash Price |
$138.30
|
| Rate for Payer: Cash Price |
$138.30
|
| Rate for Payer: Cash Price |
$138.30
|
| Rate for Payer: Cigna Commercial |
$455.47
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$69.90
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$52.06
|
| Rate for Payer: Health EOS Commercial |
$436.29
|
| Rate for Payer: HFN Commercial |
$455.47
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$192.63
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$192.63
|
| Rate for Payer: Independent Care Health Plan Medicare |
$52.06
|
| Rate for Payer: Multiplan Commercial |
$383.55
|
| Rate for Payer: NAPHCARE Commercial |
$78.09
|
| Rate for Payer: Preferred Network Access Commercial |
$455.47
|
| Rate for Payer: Quartz Beloit One Network |
$210.95
|
| Rate for Payer: Quartz Commercial |
$273.28
|
| Rate for Payer: Quartz Medicare Advantage |
$52.06
|
| Rate for Payer: The Alliance Commercial |
$221.27
|
| Rate for Payer: United Healthcare Medicaid |
$69.90
|
| Rate for Payer: United Healthcare Medicare Advantage |
$52.06
|
| Rate for Payer: WEA Trust Commercial |
$263.69
|
| Rate for Payer: WPS Commercial |
$234.28
|
|
|
Colorectal Cancer Screening: Flexible Sigmoidoscopy Medicare Screening
|
Professional
|
Both
|
$382.00
|
|
|
Service Code
|
HCPCS G0104
|
| Hospital Charge Code |
1188848
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$51.96 |
| Max. Negotiated Rate |
$377.42 |
| Rate for Payer: Aetna Commercial |
$377.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$341.66
|
| Rate for Payer: Aetna Managed Medicare |
$51.96
|
| Rate for Payer: Anthem Medicare Advantage |
$51.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$51.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$51.96
|
| Rate for Payer: Cash Price |
$114.60
|
| Rate for Payer: Cash Price |
$114.60
|
| Rate for Payer: Cigna Commercial |
$377.42
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$105.41
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$51.96
|
| Rate for Payer: Health EOS Commercial |
$361.52
|
| Rate for Payer: HFN Commercial |
$377.42
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$192.63
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$192.63
|
| Rate for Payer: Independent Care Health Plan Medicare |
$51.96
|
| Rate for Payer: Multiplan Commercial |
$317.82
|
| Rate for Payer: NAPHCARE Commercial |
$77.94
|
| Rate for Payer: Preferred Network Access Commercial |
$377.42
|
| Rate for Payer: Quartz Beloit One Network |
$174.80
|
| Rate for Payer: Quartz Commercial |
$226.45
|
| Rate for Payer: Quartz Medicare Advantage |
$51.96
|
| Rate for Payer: The Alliance Commercial |
$142.89
|
| Rate for Payer: United Healthcare Medicaid |
$105.41
|
| Rate for Payer: United Healthcare Medicare Advantage |
$51.96
|
| Rate for Payer: WEA Trust Commercial |
$218.50
|
| Rate for Payer: WPS Commercial |
$90.93
|
|
|
Color Flow 93325
|
Facility
|
OP
|
$917.00
|
|
|
Service Code
|
CPT 93325
|
| Hospital Charge Code |
5381791
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$94.93 |
| Max. Negotiated Rate |
$877.39 |
| Rate for Payer: Aetna Commercial |
$858.31
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$820.16
|
| Rate for Payer: Aetna Managed Medicare |
$267.03
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$619.89
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$476.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$457.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$505.45
|
| Rate for Payer: Cash Price |
$275.10
|
| Rate for Payer: Cash Price |
$275.10
|
| Rate for Payer: Cigna Commercial |
$877.39
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$533.69
|
| Rate for Payer: Health EOS Commercial |
$848.78
|
| Rate for Payer: HFN Commercial |
$877.39
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$715.26
|
| Rate for Payer: Multiplan Commercial |
$762.94
|
| Rate for Payer: NAPHCARE Commercial |
$572.21
|
| Rate for Payer: Preferred Network Access Commercial |
$877.39
|
| Rate for Payer: Quartz Beloit One Network |
$467.30
|
| Rate for Payer: Quartz Commercial |
$619.89
|
| Rate for Payer: Quartz Medicare Advantage |
$572.21
|
| Rate for Payer: The Alliance Commercial |
$94.93
|
| Rate for Payer: United Healthcare PPO |
$715.26
|
| Rate for Payer: WEA Trust Commercial |
$524.52
|
| Rate for Payer: WPS Commercial |
$706.37
|
|
|
Color Flow 93325
|
Facility
|
IP
|
$917.00
|
|
|
Service Code
|
CPT 93325
|
| Hospital Charge Code |
5381791
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$467.30 |
| Max. Negotiated Rate |
$877.39 |
| Rate for Payer: Aetna Commercial |
$858.31
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$820.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$505.45
|
| Rate for Payer: Cash Price |
$275.10
|
| Rate for Payer: Cigna Commercial |
$877.39
|
| Rate for Payer: Health EOS Commercial |
$848.78
|
| Rate for Payer: HFN Commercial |
$877.39
|
| Rate for Payer: Multiplan Commercial |
$762.94
|
| Rate for Payer: Preferred Network Access Commercial |
$877.39
|
| Rate for Payer: Quartz Beloit One Network |
$467.30
|
| Rate for Payer: Quartz Commercial |
$572.21
|
| Rate for Payer: WEA Trust Commercial |
$524.52
|
| Rate for Payer: WPS Commercial |
$706.37
|
|
|
Color vision examination, extended, eg. 92283
|
Professional
|
Both
|
$46.00
|
|
|
Service Code
|
CPT 92283
|
| Hospital Charge Code |
1188936
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$16.85 |
| Max. Negotiated Rate |
$218.82 |
| Rate for Payer: Aetna Commercial |
$45.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$41.14
|
| Rate for Payer: Aetna Managed Medicare |
$54.70
|
| Rate for Payer: Anthem Medicare Advantage |
$54.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$54.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$54.70
|
| Rate for Payer: Cash Price |
$13.80
|
| Rate for Payer: Cash Price |
$13.80
|
| Rate for Payer: Cash Price |
$13.80
|
| Rate for Payer: Cigna Commercial |
$45.45
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$16.85
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$54.70
|
| Rate for Payer: Health EOS Commercial |
$43.53
|
| Rate for Payer: HFN Commercial |
$45.45
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$191.48
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$191.48
|
| Rate for Payer: Independent Care Health Plan Medicare |
$54.70
|
| Rate for Payer: Multiplan Commercial |
$38.27
|
| Rate for Payer: NAPHCARE Commercial |
$82.06
|
| Rate for Payer: Preferred Network Access Commercial |
$45.45
|
| Rate for Payer: Quartz Beloit One Network |
$21.05
|
| Rate for Payer: Quartz Commercial |
$27.27
|
| Rate for Payer: Quartz Medicare Advantage |
$54.70
|
| Rate for Payer: The Alliance Commercial |
$136.76
|
| Rate for Payer: United Healthcare Medicaid |
$16.85
|
| Rate for Payer: United Healthcare Medicare Advantage |
$54.70
|
| Rate for Payer: WEA Trust Commercial |
$26.31
|
| Rate for Payer: WPS Commercial |
$218.82
|
|
|
Color vision examination, extended, eg. 9228326
|
Professional
|
Both
|
$46.00
|
|
|
Service Code
|
CPT 92283 26
|
| Hospital Charge Code |
5551952
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$8.67 |
| Max. Negotiated Rate |
$45.45 |
| Rate for Payer: Aetna Commercial |
$45.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$41.14
|
| Rate for Payer: Aetna Managed Medicare |
$8.67
|
| Rate for Payer: Anthem Medicare Advantage |
$8.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$8.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$8.67
|
| Rate for Payer: Cash Price |
$13.80
|
| Rate for Payer: Cash Price |
$13.80
|
| Rate for Payer: Cash Price |
$13.80
|
| Rate for Payer: Cigna Commercial |
$45.45
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$9.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$8.67
|
| Rate for Payer: Health EOS Commercial |
$43.53
|
| Rate for Payer: HFN Commercial |
$45.45
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$31.79
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$31.79
|
| Rate for Payer: Independent Care Health Plan Medicare |
$8.67
|
| Rate for Payer: Multiplan Commercial |
$38.27
|
| Rate for Payer: NAPHCARE Commercial |
$13.01
|
| Rate for Payer: Preferred Network Access Commercial |
$45.45
|
| Rate for Payer: Quartz Beloit One Network |
$21.05
|
| Rate for Payer: Quartz Commercial |
$27.27
|
| Rate for Payer: Quartz Medicare Advantage |
$8.67
|
| Rate for Payer: The Alliance Commercial |
$21.68
|
| Rate for Payer: United Healthcare Medicaid |
$9.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8.67
|
| Rate for Payer: WEA Trust Commercial |
$26.31
|
| Rate for Payer: WPS Commercial |
$34.69
|
|
|
COLOSTOMY
|
Facility
|
IP
|
$4,803.00
|
|
| Hospital Charge Code |
2959941
|
|
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
|
|
|
COLOSTOMY
|
Facility
|
OP
|
$4,803.00
|
|
| Hospital Charge Code |
2959941
|
|
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
|
|
|
COLOSTOMY KIT 2 3/4 19154
|
Facility
|
OP
|
$204.00
|
|
|
Service Code
|
HCPCS A5063
|
| Hospital Charge Code |
2963748
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$16.06 |
| Max. Negotiated Rate |
$195.19 |
| Rate for Payer: Aetna Commercial |
$190.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$182.46
|
| Rate for Payer: Aetna Managed Medicare |
$59.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$137.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$106.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$101.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$112.44
|
| Rate for Payer: Cash Price |
$61.20
|
| Rate for Payer: Cash Price |
$61.20
|
| Rate for Payer: Cigna Commercial |
$195.19
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$118.73
|
| Rate for Payer: Health EOS Commercial |
$188.82
|
| Rate for Payer: HFN Commercial |
$195.19
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$159.12
|
| Rate for Payer: Multiplan Commercial |
$169.73
|
| Rate for Payer: NAPHCARE Commercial |
$127.30
|
| Rate for Payer: Preferred Network Access Commercial |
$195.19
|
| Rate for Payer: Quartz Beloit One Network |
$103.96
|
| Rate for Payer: Quartz Commercial |
$137.90
|
| Rate for Payer: Quartz Medicare Advantage |
$127.30
|
| Rate for Payer: The Alliance Commercial |
$16.06
|
| Rate for Payer: WEA Trust Commercial |
$116.69
|
| Rate for Payer: WPS Commercial |
$157.14
|
|
|
COLOSTOMY KIT 2 3/4 19154
|
Facility
|
IP
|
$204.00
|
|
|
Service Code
|
HCPCS A5063
|
| Hospital Charge Code |
2963748
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$103.96 |
| Max. Negotiated Rate |
$195.19 |
| Rate for Payer: Aetna Commercial |
$190.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$182.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$112.44
|
| Rate for Payer: Cash Price |
$61.20
|
| Rate for Payer: Cigna Commercial |
$195.19
|
| Rate for Payer: Health EOS Commercial |
$188.82
|
| Rate for Payer: HFN Commercial |
$195.19
|
| Rate for Payer: Multiplan Commercial |
$169.73
|
| Rate for Payer: Preferred Network Access Commercial |
$195.19
|
| Rate for Payer: Quartz Beloit One Network |
$103.96
|
| Rate for Payer: Quartz Commercial |
$127.30
|
| Rate for Payer: WEA Trust Commercial |
$116.69
|
| Rate for Payer: WPS Commercial |
$157.14
|
|
|
COLOSTOMY TAKEDOWN
|
Facility
|
IP
|
$4,803.00
|
|
| Hospital Charge Code |
2959940
|
|
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
|
|
|
COLOSTOMY TAKEDOWN
|
Facility
|
OP
|
$4,803.00
|
|
| Hospital Charge Code |
2959940
|
|
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
|
|
|
COLPOSCOPY
|
Facility
|
OP
|
$1,006.00
|
|
| Hospital Charge Code |
2959943
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$292.95 |
| Max. Negotiated Rate |
$962.54 |
| Rate for Payer: Aetna Commercial |
$941.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$899.77
|
| Rate for Payer: Aetna Managed Medicare |
$292.95
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$680.06
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$523.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$502.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$554.51
|
| Rate for Payer: Cash Price |
$301.80
|
| Rate for Payer: Cigna Commercial |
$962.54
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$585.49
|
| Rate for Payer: Health EOS Commercial |
$931.15
|
| Rate for Payer: HFN Commercial |
$962.54
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$784.68
|
| Rate for Payer: Multiplan Commercial |
$836.99
|
| Rate for Payer: NAPHCARE Commercial |
$627.74
|
| Rate for Payer: Preferred Network Access Commercial |
$962.54
|
| Rate for Payer: Quartz Beloit One Network |
$512.66
|
| Rate for Payer: Quartz Commercial |
$680.06
|
| Rate for Payer: Quartz Medicare Advantage |
$627.74
|
| Rate for Payer: The Alliance Commercial |
$523.12
|
| Rate for Payer: WEA Trust Commercial |
$575.43
|
| Rate for Payer: WPS Commercial |
$774.92
|
|
|
COLPOSCOPY
|
Facility
|
IP
|
$1,006.00
|
|
| Hospital Charge Code |
2959943
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$512.66 |
| Max. Negotiated Rate |
$962.54 |
| Rate for Payer: Aetna Commercial |
$941.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$899.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$554.51
|
| Rate for Payer: Cash Price |
$301.80
|
| Rate for Payer: Cigna Commercial |
$962.54
|
| Rate for Payer: Health EOS Commercial |
$931.15
|
| Rate for Payer: HFN Commercial |
$962.54
|
| Rate for Payer: Multiplan Commercial |
$836.99
|
| Rate for Payer: Preferred Network Access Commercial |
$962.54
|
| Rate for Payer: Quartz Beloit One Network |
$512.66
|
| Rate for Payer: Quartz Commercial |
$627.74
|
| Rate for Payer: WEA Trust Commercial |
$575.43
|
| Rate for Payer: WPS Commercial |
$774.92
|
|
|
COLPOSCOPY CERVIX VAG ELTRD CONIZATION CERVIX - 57461
|
Professional
|
Both
|
$1,371.00
|
|
|
Service Code
|
CPT 57461
|
| Hospital Charge Code |
6135630
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$152.39 |
| Max. Negotiated Rate |
$1,354.55 |
| Rate for Payer: Aetna Commercial |
$1,354.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,226.22
|
| Rate for Payer: Aetna Managed Medicare |
$152.39
|
| Rate for Payer: Anthem Medicare Advantage |
$152.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$152.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$152.39
|
| Rate for Payer: Cash Price |
$411.30
|
| Rate for Payer: Cash Price |
$411.30
|
| Rate for Payer: Cash Price |
$411.30
|
| Rate for Payer: Cigna Commercial |
$1,354.55
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$306.29
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$152.39
|
| Rate for Payer: Health EOS Commercial |
$1,297.51
|
| Rate for Payer: HFN Commercial |
$1,354.55
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$634.83
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$634.83
|
| Rate for Payer: Independent Care Health Plan Medicare |
$152.39
|
| Rate for Payer: Multiplan Commercial |
$1,140.67
|
| Rate for Payer: NAPHCARE Commercial |
$228.59
|
| Rate for Payer: Preferred Network Access Commercial |
$1,354.55
|
| Rate for Payer: Quartz Beloit One Network |
$627.37
|
| Rate for Payer: Quartz Commercial |
$812.73
|
| Rate for Payer: Quartz Medicare Advantage |
$152.39
|
| Rate for Payer: The Alliance Commercial |
$647.66
|
| Rate for Payer: United Healthcare Medicaid |
$306.29
|
| Rate for Payer: United Healthcare Medicare Advantage |
$152.39
|
| Rate for Payer: WEA Trust Commercial |
$784.21
|
| Rate for Payer: WPS Commercial |
$685.76
|
|
|
Colposcopy Entire Vagina W/Cervix if present 57420
|
Professional
|
Both
|
$519.00
|
|
|
Service Code
|
CPT 57420
|
| Hospital Charge Code |
4780606
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$76.37 |
| Max. Negotiated Rate |
$512.77 |
| Rate for Payer: Aetna Commercial |
$512.77
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$464.19
|
| Rate for Payer: Aetna Managed Medicare |
$76.37
|
| Rate for Payer: Anthem Medicare Advantage |
$76.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$76.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$76.37
|
| Rate for Payer: Cash Price |
$155.70
|
| Rate for Payer: Cash Price |
$155.70
|
| Rate for Payer: Cash Price |
$155.70
|
| Rate for Payer: Cigna Commercial |
$512.77
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$107.11
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$76.37
|
| Rate for Payer: Health EOS Commercial |
$491.18
|
| Rate for Payer: HFN Commercial |
$512.77
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$308.57
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$308.57
|
| Rate for Payer: Independent Care Health Plan Medicare |
$76.37
|
| Rate for Payer: Multiplan Commercial |
$431.81
|
| Rate for Payer: NAPHCARE Commercial |
$114.55
|
| Rate for Payer: Preferred Network Access Commercial |
$512.77
|
| Rate for Payer: Quartz Beloit One Network |
$237.49
|
| Rate for Payer: Quartz Commercial |
$307.66
|
| Rate for Payer: Quartz Medicare Advantage |
$76.37
|
| Rate for Payer: The Alliance Commercial |
$324.56
|
| Rate for Payer: United Healthcare Medicaid |
$107.11
|
| Rate for Payer: United Healthcare Medicare Advantage |
$76.37
|
| Rate for Payer: WEA Trust Commercial |
$296.87
|
| Rate for Payer: WPS Commercial |
$343.65
|
|
