|
FASCIECTOMY, PARTIAL PALMAR WITH RELEASE OF SINGLE DIGIT INCLUDING PROXIMAL INTERPHALANGEAL JOINT, WITH OR WITHOUT Z-PLASTY, OTHER LOCAL TISSUE REARRANGEMENT, OR SKIN GRAFTING (INCLUDES OBTAINING GRAFT);
|
Facility
|
OP
|
$13,773.68
|
|
|
Service Code
|
CPT 26123
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,443.42 |
| Max. Negotiated Rate |
$13,773.68 |
| Rate for Payer: Aetna Managed Medicare |
$3,443.42
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$10,303.28
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8,364.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7,944.56
|
| Rate for Payer: Anthem Medicare Advantage |
$3,443.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$3,443.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$3,443.42
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$3,443.42
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$8,107.14
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$3,443.42
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$12,809.52
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$3,443.42
|
| Rate for Payer: Independent Care Health Plan Medicare |
$3,443.42
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$3,443.42
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$3,443.42
|
| Rate for Payer: NAPHCARE Commercial |
$5,165.13
|
| Rate for Payer: Quartz Medicare Advantage |
$3,443.42
|
| Rate for Payer: The Alliance Commercial |
$13,773.68
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,443.42
|
| Rate for Payer: United Healthcare PPO |
$4,267.12
|
| Rate for Payer: Wellcare Medicare |
$3,443.42
|
|
|
FASCIECTOMY, PARTIAL PALMAR WITH RELEASE OF SINGLE DIGIT INCLUDING PROXIMAL INTERPHALANGEAL JOINT, WITH OR WITHOUT Z-PLASTY, OTHER LOCAL TISSUE REARRANGEMENT, OR SKIN GRAFTING (INCLUDES OBTAINING GRAFT); EACH ADDITIONAL DIGIT (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)
|
Facility
|
OP
|
$8,107.14
|
|
|
Service Code
|
CPT 26125
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$857.67 |
| Max. Negotiated Rate |
$8,107.14 |
| Rate for Payer: Dean Health DHI/DHP/ASO |
$8,107.14
|
| Rate for Payer: The Alliance Commercial |
$857.67
|
|
|
FASCIOTOMY LOWER EXTREMITY
|
Facility
|
OP
|
$1,084.00
|
|
| Hospital Charge Code |
2960052
|
|
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
|
|
|
FASCIOTOMY LOWER EXTREMITY
|
Facility
|
IP
|
$1,084.00
|
|
| Hospital Charge Code |
2960052
|
|
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
|
|
|
FASCIOTOMY, PALMAR (EG, DUPUYTREN'S CONTRACTURE); OPEN, PARTIAL
|
Facility
|
OP
|
$13,773.68
|
|
|
Service Code
|
CPT 26045
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,443.42 |
| Max. Negotiated Rate |
$13,773.68 |
| Rate for Payer: Aetna Managed Medicare |
$3,443.42
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$10,303.28
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8,364.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7,944.56
|
| Rate for Payer: Anthem Medicare Advantage |
$3,443.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$3,443.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$3,443.42
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$3,443.42
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,807.99
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$3,443.42
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$12,809.52
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$3,443.42
|
| Rate for Payer: Independent Care Health Plan Medicare |
$3,443.42
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$3,443.42
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$3,443.42
|
| Rate for Payer: NAPHCARE Commercial |
$5,165.13
|
| Rate for Payer: Quartz Medicare Advantage |
$3,443.42
|
| Rate for Payer: The Alliance Commercial |
$13,773.68
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,443.42
|
| Rate for Payer: United Healthcare PPO |
$4,267.12
|
| Rate for Payer: Wellcare Medicare |
$3,443.42
|
|
|
FASCIOTOMY UPPER EXTREMITY
|
Facility
|
IP
|
$1,006.00
|
|
| Hospital Charge Code |
2960055
|
|
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
|
|
|
FASCIOTOMY UPPER EXTREMITY
|
Facility
|
OP
|
$1,006.00
|
|
| Hospital Charge Code |
2960055
|
|
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
|
|
|
FASK MASK DISP FOR POSITIONING 7210559
|
Facility
|
IP
|
$533.00
|
|
| Hospital Charge Code |
6220214
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$271.62 |
| Max. Negotiated Rate |
$509.97 |
| Rate for Payer: Aetna Commercial |
$498.89
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$476.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$293.79
|
| Rate for Payer: Cash Price |
$159.90
|
| Rate for Payer: Cigna Commercial |
$509.97
|
| Rate for Payer: Health EOS Commercial |
$493.34
|
| Rate for Payer: HFN Commercial |
$509.97
|
| Rate for Payer: Multiplan Commercial |
$443.46
|
| Rate for Payer: Preferred Network Access Commercial |
$509.97
|
| Rate for Payer: Quartz Beloit One Network |
$271.62
|
| Rate for Payer: Quartz Commercial |
$332.59
|
| Rate for Payer: WEA Trust Commercial |
$304.88
|
| Rate for Payer: WPS Commercial |
$410.57
|
|
|
FASK MASK DISP FOR POSITIONING 7210559
|
Facility
|
OP
|
$533.00
|
|
| Hospital Charge Code |
6220214
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$155.21 |
| Max. Negotiated Rate |
$509.97 |
| Rate for Payer: Aetna Commercial |
$498.89
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$476.72
|
| Rate for Payer: Aetna Managed Medicare |
$155.21
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$360.31
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$277.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$266.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$293.79
|
| Rate for Payer: Cash Price |
$159.90
|
| Rate for Payer: Cigna Commercial |
$509.97
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$310.21
|
| Rate for Payer: Health EOS Commercial |
$493.34
|
| Rate for Payer: HFN Commercial |
$509.97
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$415.74
|
| Rate for Payer: Multiplan Commercial |
$443.46
|
| Rate for Payer: NAPHCARE Commercial |
$332.59
|
| Rate for Payer: Preferred Network Access Commercial |
$509.97
|
| Rate for Payer: Quartz Beloit One Network |
$271.62
|
| Rate for Payer: Quartz Commercial |
$360.31
|
| Rate for Payer: Quartz Medicare Advantage |
$332.59
|
| Rate for Payer: The Alliance Commercial |
$277.16
|
| Rate for Payer: WEA Trust Commercial |
$304.88
|
| Rate for Payer: WPS Commercial |
$410.57
|
|
|
Faslodex 25 mg Charge
|
Facility
|
OP
|
$197.00
|
|
|
Service Code
|
HCPCS J9395
|
| Hospital Charge Code |
2958987
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.24 |
| Max. Negotiated Rate |
$188.49 |
| Rate for Payer: Aetna Commercial |
$184.39
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$176.20
|
| Rate for Payer: Aetna Managed Medicare |
$57.37
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$133.17
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$102.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$98.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$108.59
|
| Rate for Payer: Cash Price |
$59.10
|
| Rate for Payer: Cash Price |
$59.10
|
| Rate for Payer: Cigna Commercial |
$188.49
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$11.24
|
| Rate for Payer: Health EOS Commercial |
$182.34
|
| Rate for Payer: HFN Commercial |
$188.49
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$153.66
|
| Rate for Payer: Multiplan Commercial |
$163.90
|
| Rate for Payer: NAPHCARE Commercial |
$122.93
|
| Rate for Payer: Preferred Network Access Commercial |
$188.49
|
| Rate for Payer: Quartz Beloit One Network |
$100.39
|
| Rate for Payer: Quartz Commercial |
$133.17
|
| Rate for Payer: Quartz Medicare Advantage |
$122.93
|
| Rate for Payer: The Alliance Commercial |
$23.80
|
| Rate for Payer: WEA Trust Commercial |
$112.68
|
| Rate for Payer: WPS Commercial |
$21.24
|
|
|
Faslodex 25 mg Charge
|
Facility
|
IP
|
$197.00
|
|
|
Service Code
|
HCPCS J9395
|
| Hospital Charge Code |
2958987
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$100.39 |
| Max. Negotiated Rate |
$188.49 |
| Rate for Payer: Aetna Commercial |
$184.39
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$176.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$108.59
|
| Rate for Payer: Cash Price |
$59.10
|
| Rate for Payer: Cigna Commercial |
$188.49
|
| Rate for Payer: Health EOS Commercial |
$182.34
|
| Rate for Payer: HFN Commercial |
$188.49
|
| Rate for Payer: Multiplan Commercial |
$163.90
|
| Rate for Payer: Preferred Network Access Commercial |
$188.49
|
| Rate for Payer: Quartz Beloit One Network |
$100.39
|
| Rate for Payer: Quartz Commercial |
$122.93
|
| Rate for Payer: WEA Trust Commercial |
$112.68
|
| Rate for Payer: WPS Commercial |
$151.75
|
|
|
Faslodex 25 mg Charge
|
Professional
|
Both
|
$197.00
|
|
|
Service Code
|
HCPCS J9395
|
| Hospital Charge Code |
2958987
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.95 |
| Max. Negotiated Rate |
$194.64 |
| Rate for Payer: Aetna Commercial |
$194.64
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$176.20
|
| Rate for Payer: Aetna Managed Medicare |
$5.95
|
| Rate for Payer: Anthem Medicare Advantage |
$5.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5.95
|
| Rate for Payer: Cash Price |
$59.10
|
| Rate for Payer: Cash Price |
$59.10
|
| Rate for Payer: Cigna Commercial |
$194.64
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$5.95
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$8.50
|
| Rate for Payer: Health EOS Commercial |
$186.44
|
| Rate for Payer: HFN Commercial |
$194.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$68.48
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$68.48
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5.95
|
| Rate for Payer: Multiplan Commercial |
$163.90
|
| Rate for Payer: NAPHCARE Commercial |
$8.92
|
| Rate for Payer: Preferred Network Access Commercial |
$194.64
|
| Rate for Payer: Quartz Beloit One Network |
$90.15
|
| Rate for Payer: Quartz Commercial |
$116.78
|
| Rate for Payer: Quartz Medicare Advantage |
$5.95
|
| Rate for Payer: The Alliance Commercial |
$16.36
|
| Rate for Payer: United Healthcare Medicaid |
$5.95
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.95
|
| Rate for Payer: WEA Trust Commercial |
$112.68
|
| Rate for Payer: WPS Commercial |
$21.24
|
|
|
FAST-FIX DELIVERY NEEDLE CURVED 72201491
|
Facility
|
IP
|
$3,454.00
|
|
| Hospital Charge Code |
2965965
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,760.16 |
| Max. Negotiated Rate |
$3,304.79 |
| Rate for Payer: Aetna Commercial |
$3,232.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,089.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,903.84
|
| Rate for Payer: Cash Price |
$1,036.20
|
| Rate for Payer: Cigna Commercial |
$3,304.79
|
| Rate for Payer: Health EOS Commercial |
$3,197.02
|
| Rate for Payer: HFN Commercial |
$3,304.79
|
| Rate for Payer: Multiplan Commercial |
$2,873.73
|
| Rate for Payer: Preferred Network Access Commercial |
$3,304.79
|
| Rate for Payer: Quartz Beloit One Network |
$1,760.16
|
| Rate for Payer: Quartz Commercial |
$2,155.30
|
| Rate for Payer: WEA Trust Commercial |
$1,975.69
|
| Rate for Payer: WPS Commercial |
$2,660.62
|
|
|
FAST-FIX DELIVERY NEEDLE CURVED 72201491
|
Facility
|
OP
|
$3,454.00
|
|
| Hospital Charge Code |
2965965
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,005.80 |
| Max. Negotiated Rate |
$3,304.79 |
| Rate for Payer: Aetna Commercial |
$3,232.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,089.26
|
| Rate for Payer: Aetna Managed Medicare |
$1,005.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,334.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,796.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,724.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,903.84
|
| Rate for Payer: Cash Price |
$1,036.20
|
| Rate for Payer: Cigna Commercial |
$3,304.79
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,010.23
|
| Rate for Payer: Health EOS Commercial |
$3,197.02
|
| Rate for Payer: HFN Commercial |
$3,304.79
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,694.12
|
| Rate for Payer: Multiplan Commercial |
$2,873.73
|
| Rate for Payer: NAPHCARE Commercial |
$2,155.30
|
| Rate for Payer: Preferred Network Access Commercial |
$3,304.79
|
| Rate for Payer: Quartz Beloit One Network |
$1,760.16
|
| Rate for Payer: Quartz Commercial |
$2,334.90
|
| Rate for Payer: Quartz Medicare Advantage |
$2,155.30
|
| Rate for Payer: The Alliance Commercial |
$1,796.08
|
| Rate for Payer: WEA Trust Commercial |
$1,975.69
|
| Rate for Payer: WPS Commercial |
$2,660.62
|
|
|
FAST-FIX STR NEEDLE DELIVERY 72201490
|
Facility
|
IP
|
$3,843.00
|
|
| Hospital Charge Code |
2965966
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,958.39 |
| Max. Negotiated Rate |
$3,676.98 |
| Rate for Payer: Aetna Commercial |
$3,597.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,437.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,118.26
|
| Rate for Payer: Cash Price |
$1,152.90
|
| Rate for Payer: Cigna Commercial |
$3,676.98
|
| Rate for Payer: Health EOS Commercial |
$3,557.08
|
| Rate for Payer: HFN Commercial |
$3,676.98
|
| Rate for Payer: Multiplan Commercial |
$3,197.38
|
| Rate for Payer: Preferred Network Access Commercial |
$3,676.98
|
| Rate for Payer: Quartz Beloit One Network |
$1,958.39
|
| Rate for Payer: Quartz Commercial |
$2,398.03
|
| Rate for Payer: WEA Trust Commercial |
$2,198.20
|
| Rate for Payer: WPS Commercial |
$2,960.26
|
|
|
FAST-FIX STR NEEDLE DELIVERY 72201490
|
Facility
|
OP
|
$3,843.00
|
|
| Hospital Charge Code |
2965966
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,119.08 |
| Max. Negotiated Rate |
$3,676.98 |
| Rate for Payer: Aetna Commercial |
$3,597.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,437.18
|
| Rate for Payer: Aetna Managed Medicare |
$1,119.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,597.87
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,998.36
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,918.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,118.26
|
| Rate for Payer: Cash Price |
$1,152.90
|
| Rate for Payer: Cigna Commercial |
$3,676.98
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,236.63
|
| Rate for Payer: Health EOS Commercial |
$3,557.08
|
| Rate for Payer: HFN Commercial |
$3,676.98
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,997.54
|
| Rate for Payer: Multiplan Commercial |
$3,197.38
|
| Rate for Payer: NAPHCARE Commercial |
$2,398.03
|
| Rate for Payer: Preferred Network Access Commercial |
$3,676.98
|
| Rate for Payer: Quartz Beloit One Network |
$1,958.39
|
| Rate for Payer: Quartz Commercial |
$2,597.87
|
| Rate for Payer: Quartz Medicare Advantage |
$2,398.03
|
| Rate for Payer: The Alliance Commercial |
$1,998.36
|
| Rate for Payer: WEA Trust Commercial |
$2,198.20
|
| Rate for Payer: WPS Commercial |
$2,960.26
|
|
|
Fatty Acid Profile, Essential (C12-C22)
|
Professional
|
Both
|
$707.00
|
|
|
Service Code
|
CPT 82542
|
| Hospital Charge Code |
3837493
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$25.05 |
| Max. Negotiated Rate |
$698.52 |
| Rate for Payer: Aetna Commercial |
$698.52
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$632.34
|
| Rate for Payer: Aetna Managed Medicare |
$25.05
|
| Rate for Payer: Anthem Medicare Advantage |
$25.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$25.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$25.05
|
| Rate for Payer: Cash Price |
$212.10
|
| Rate for Payer: Cash Price |
$212.10
|
| Rate for Payer: Cigna Commercial |
$698.52
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$367.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$25.05
|
| Rate for Payer: Health EOS Commercial |
$669.10
|
| Rate for Payer: HFN Commercial |
$698.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$88.44
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$88.44
|
| Rate for Payer: Independent Care Health Plan Medicare |
$25.05
|
| Rate for Payer: Multiplan Commercial |
$588.22
|
| Rate for Payer: NAPHCARE Commercial |
$37.58
|
| Rate for Payer: Preferred Network Access Commercial |
$698.52
|
| Rate for Payer: Quartz Beloit One Network |
$323.52
|
| Rate for Payer: Quartz Commercial |
$419.11
|
| Rate for Payer: Quartz Medicare Advantage |
$25.05
|
| Rate for Payer: The Alliance Commercial |
$98.96
|
| Rate for Payer: United Healthcare Medicare Advantage |
$25.05
|
| Rate for Payer: WEA Trust Commercial |
$404.40
|
| Rate for Payer: WPS Commercial |
$110.24
|
|
|
Fatty Acid Profile, Essential (C12-C22)
|
Facility
|
OP
|
$707.00
|
|
|
Service Code
|
CPT 82542
|
| Hospital Charge Code |
3837493
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$25.05 |
| Max. Negotiated Rate |
$676.46 |
| Rate for Payer: Aetna Commercial |
$661.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$632.34
|
| Rate for Payer: Aetna Managed Medicare |
$25.05
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$93.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$43.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$41.59
|
| Rate for Payer: Anthem Medicare Advantage |
$25.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$389.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$25.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$25.05
|
| Rate for Payer: Cash Price |
$212.10
|
| Rate for Payer: Cash Price |
$212.10
|
| Rate for Payer: Cigna Commercial |
$676.46
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$25.05
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$411.47
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$25.05
|
| Rate for Payer: Health EOS Commercial |
$654.40
|
| Rate for Payer: HFN Commercial |
$676.46
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$93.20
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$25.05
|
| Rate for Payer: Independent Care Health Plan Medicare |
$25.05
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$25.05
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$25.05
|
| Rate for Payer: Multiplan Commercial |
$588.22
|
| Rate for Payer: NAPHCARE Commercial |
$37.58
|
| Rate for Payer: Preferred Network Access Commercial |
$676.46
|
| Rate for Payer: Quartz Beloit One Network |
$360.29
|
| Rate for Payer: Quartz Commercial |
$477.93
|
| Rate for Payer: Quartz Medicare Advantage |
$25.05
|
| Rate for Payer: The Alliance Commercial |
$100.21
|
| Rate for Payer: United Healthcare Medicare Advantage |
$25.05
|
| Rate for Payer: United Healthcare PPO |
$551.46
|
| Rate for Payer: WEA Trust Commercial |
$404.40
|
| Rate for Payer: Wellcare Medicare |
$25.05
|
| Rate for Payer: WPS Commercial |
$544.60
|
|
|
Fatty Acid Profile, Essential (C12-C22)
|
Facility
|
IP
|
$707.00
|
|
|
Service Code
|
CPT 82542
|
| Hospital Charge Code |
3837493
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$360.29 |
| Max. Negotiated Rate |
$676.46 |
| Rate for Payer: Aetna Commercial |
$661.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$632.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$389.70
|
| Rate for Payer: Cash Price |
$212.10
|
| Rate for Payer: Cigna Commercial |
$676.46
|
| Rate for Payer: Health EOS Commercial |
$654.40
|
| Rate for Payer: HFN Commercial |
$676.46
|
| Rate for Payer: Multiplan Commercial |
$588.22
|
| Rate for Payer: Preferred Network Access Commercial |
$676.46
|
| Rate for Payer: Quartz Beloit One Network |
$360.29
|
| Rate for Payer: Quartz Commercial |
$441.17
|
| Rate for Payer: WEA Trust Commercial |
$404.40
|
| Rate for Payer: WPS Commercial |
$544.60
|
|
|
Fatty Acid Profile, Peroxisomal (C22-C26)
|
Facility
|
OP
|
$258.00
|
|
|
Service Code
|
CPT 82726
|
| Hospital Charge Code |
5484747
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$20.54 |
| Max. Negotiated Rate |
$246.85 |
| Rate for Payer: Aetna Commercial |
$241.49
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$230.76
|
| Rate for Payer: Aetna Managed Medicare |
$20.54
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$77.03
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$35.95
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$34.10
|
| Rate for Payer: Anthem Medicare Advantage |
$20.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$142.21
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$20.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$20.54
|
| Rate for Payer: Cash Price |
$77.40
|
| Rate for Payer: Cash Price |
$77.40
|
| Rate for Payer: Cigna Commercial |
$246.85
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$20.54
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$150.16
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$20.54
|
| Rate for Payer: Health EOS Commercial |
$238.80
|
| Rate for Payer: HFN Commercial |
$246.85
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$76.41
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$20.54
|
| Rate for Payer: Independent Care Health Plan Medicare |
$20.54
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$20.54
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$20.54
|
| Rate for Payer: Multiplan Commercial |
$214.66
|
| Rate for Payer: NAPHCARE Commercial |
$30.81
|
| Rate for Payer: Preferred Network Access Commercial |
$246.85
|
| Rate for Payer: Quartz Beloit One Network |
$131.48
|
| Rate for Payer: Quartz Commercial |
$174.41
|
| Rate for Payer: Quartz Medicare Advantage |
$20.54
|
| Rate for Payer: The Alliance Commercial |
$82.16
|
| Rate for Payer: United Healthcare Medicare Advantage |
$20.54
|
| Rate for Payer: United Healthcare PPO |
$201.24
|
| Rate for Payer: WEA Trust Commercial |
$147.58
|
| Rate for Payer: Wellcare Medicare |
$20.54
|
| Rate for Payer: WPS Commercial |
$198.74
|
|
|
Fatty Acid Profile, Peroxisomal (C22-C26)
|
Facility
|
IP
|
$258.00
|
|
|
Service Code
|
CPT 82726
|
| Hospital Charge Code |
5484747
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$131.48 |
| Max. Negotiated Rate |
$246.85 |
| Rate for Payer: Aetna Commercial |
$241.49
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$230.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$142.21
|
| Rate for Payer: Cash Price |
$77.40
|
| Rate for Payer: Cigna Commercial |
$246.85
|
| Rate for Payer: Health EOS Commercial |
$238.80
|
| Rate for Payer: HFN Commercial |
$246.85
|
| Rate for Payer: Multiplan Commercial |
$214.66
|
| Rate for Payer: Preferred Network Access Commercial |
$246.85
|
| Rate for Payer: Quartz Beloit One Network |
$131.48
|
| Rate for Payer: Quartz Commercial |
$160.99
|
| Rate for Payer: WEA Trust Commercial |
$147.58
|
| Rate for Payer: WPS Commercial |
$198.74
|
|
|
Fatty Acid Profile, Peroxisomal (C22-C26)
|
Professional
|
Both
|
$258.00
|
|
|
Service Code
|
CPT 82726
|
| Hospital Charge Code |
5484747
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$20.54 |
| Max. Negotiated Rate |
$254.90 |
| Rate for Payer: Aetna Commercial |
$254.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$230.76
|
| Rate for Payer: Aetna Managed Medicare |
$20.54
|
| Rate for Payer: Anthem Medicare Advantage |
$20.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$20.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$20.54
|
| Rate for Payer: Cash Price |
$77.40
|
| Rate for Payer: Cash Price |
$77.40
|
| Rate for Payer: Cigna Commercial |
$254.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$134.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$20.54
|
| Rate for Payer: Health EOS Commercial |
$244.17
|
| Rate for Payer: HFN Commercial |
$254.90
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$72.51
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$72.51
|
| Rate for Payer: Independent Care Health Plan Medicare |
$20.54
|
| Rate for Payer: Multiplan Commercial |
$214.66
|
| Rate for Payer: NAPHCARE Commercial |
$30.81
|
| Rate for Payer: Preferred Network Access Commercial |
$254.90
|
| Rate for Payer: Quartz Beloit One Network |
$118.06
|
| Rate for Payer: Quartz Commercial |
$152.94
|
| Rate for Payer: Quartz Medicare Advantage |
$20.54
|
| Rate for Payer: The Alliance Commercial |
$81.13
|
| Rate for Payer: United Healthcare Medicare Advantage |
$20.54
|
| Rate for Payer: WEA Trust Commercial |
$147.58
|
| Rate for Payer: WPS Commercial |
$90.38
|
|
|
Fecal Fat Qualitative
|
Professional
|
Both
|
$131.00
|
|
|
Service Code
|
CPT 82705
|
| Hospital Charge Code |
977947
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.30 |
| Max. Negotiated Rate |
$129.43 |
| Rate for Payer: Aetna Commercial |
$129.43
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$117.17
|
| Rate for Payer: Aetna Managed Medicare |
$5.30
|
| Rate for Payer: Anthem Medicare Advantage |
$5.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5.30
|
| Rate for Payer: Cash Price |
$39.30
|
| Rate for Payer: Cash Price |
$39.30
|
| Rate for Payer: Cigna Commercial |
$129.43
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$68.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5.30
|
| Rate for Payer: Health EOS Commercial |
$123.98
|
| Rate for Payer: HFN Commercial |
$129.43
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$18.72
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$18.72
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5.30
|
| Rate for Payer: Multiplan Commercial |
$108.99
|
| Rate for Payer: NAPHCARE Commercial |
$7.96
|
| Rate for Payer: Preferred Network Access Commercial |
$129.43
|
| Rate for Payer: Quartz Beloit One Network |
$59.95
|
| Rate for Payer: Quartz Commercial |
$77.66
|
| Rate for Payer: Quartz Medicare Advantage |
$5.30
|
| Rate for Payer: The Alliance Commercial |
$20.95
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.30
|
| Rate for Payer: WEA Trust Commercial |
$74.93
|
| Rate for Payer: WPS Commercial |
$23.34
|
|
|
Fecal Fat Qualitative
|
Facility
|
OP
|
$131.00
|
|
|
Service Code
|
CPT 82705
|
| Hospital Charge Code |
977947
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.30 |
| Max. Negotiated Rate |
$125.34 |
| Rate for Payer: Aetna Commercial |
$122.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$117.17
|
| Rate for Payer: Aetna Managed Medicare |
$5.30
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$19.89
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$9.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$8.80
|
| Rate for Payer: Anthem Medicare Advantage |
$5.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$72.21
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5.30
|
| Rate for Payer: Cash Price |
$39.30
|
| Rate for Payer: Cash Price |
$39.30
|
| Rate for Payer: Cigna Commercial |
$125.34
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$5.30
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$76.24
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$5.30
|
| Rate for Payer: Health EOS Commercial |
$121.25
|
| Rate for Payer: HFN Commercial |
$125.34
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$19.73
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$5.30
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5.30
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$5.30
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$5.30
|
| Rate for Payer: Multiplan Commercial |
$108.99
|
| Rate for Payer: NAPHCARE Commercial |
$7.96
|
| Rate for Payer: Preferred Network Access Commercial |
$125.34
|
| Rate for Payer: Quartz Beloit One Network |
$66.76
|
| Rate for Payer: Quartz Commercial |
$88.56
|
| Rate for Payer: Quartz Medicare Advantage |
$5.30
|
| Rate for Payer: The Alliance Commercial |
$21.22
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.30
|
| Rate for Payer: United Healthcare PPO |
$102.18
|
| Rate for Payer: WEA Trust Commercial |
$74.93
|
| Rate for Payer: Wellcare Medicare |
$5.30
|
| Rate for Payer: WPS Commercial |
$100.91
|
|
|
Fecal Fat Qualitative
|
Facility
|
IP
|
$131.00
|
|
|
Service Code
|
CPT 82705
|
| Hospital Charge Code |
977947
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$66.76 |
| Max. Negotiated Rate |
$125.34 |
| Rate for Payer: Aetna Commercial |
$122.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$117.17
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$72.21
|
| Rate for Payer: Cash Price |
$39.30
|
| Rate for Payer: Cigna Commercial |
$125.34
|
| Rate for Payer: Health EOS Commercial |
$121.25
|
| Rate for Payer: HFN Commercial |
$125.34
|
| Rate for Payer: Multiplan Commercial |
$108.99
|
| Rate for Payer: Preferred Network Access Commercial |
$125.34
|
| Rate for Payer: Quartz Beloit One Network |
$66.76
|
| Rate for Payer: Quartz Commercial |
$81.74
|
| Rate for Payer: WEA Trust Commercial |
$74.93
|
| Rate for Payer: WPS Commercial |
$100.91
|
|
