|
FASCIAL SURGICAL WOUND REPAIR
|
Facility
|
OP
|
$1,006.00
|
|
| Hospital Charge Code |
2960047
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$281.68 |
| Max. Negotiated Rate |
$4,024.00 |
| Rate for Payer: Aetna Commercial |
$905.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$865.16
|
| Rate for Payer: Aetna Managed Medicare |
$281.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$653.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$503.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$482.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$533.18
|
| Rate for Payer: Cash Price |
$301.80
|
| Rate for Payer: Cigna Commercial |
$925.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$562.96
|
| Rate for Payer: Health EOS Commercial |
$895.34
|
| Rate for Payer: HFN Commercial |
$925.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$754.50
|
| Rate for Payer: Multiplan Commercial |
$804.80
|
| Rate for Payer: NAPHCARE Commercial |
$603.60
|
| Rate for Payer: Preferred Network Access Commercial |
$925.52
|
| Rate for Payer: Quartz Beloit One Network |
$492.94
|
| Rate for Payer: Quartz Commercial |
$653.90
|
| Rate for Payer: Quartz Medicare Advantage |
$603.60
|
| Rate for Payer: The Alliance Commercial |
$4,024.00
|
| Rate for Payer: WEA Trust Commercial |
$553.30
|
| Rate for Payer: WPS Commercial |
$745.14
|
|
|
FASCIAL SURGICAL WOUND REPAIR
|
Facility
|
IP
|
$1,006.00
|
|
| Hospital Charge Code |
2960047
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$492.94 |
| Max. Negotiated Rate |
$925.52 |
| Rate for Payer: Aetna Commercial |
$905.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$865.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$533.18
|
| Rate for Payer: Cash Price |
$301.80
|
| Rate for Payer: Cigna Commercial |
$925.52
|
| Rate for Payer: Health EOS Commercial |
$895.34
|
| Rate for Payer: HFN Commercial |
$925.52
|
| Rate for Payer: Multiplan Commercial |
$804.80
|
| Rate for Payer: NAPHCARE Commercial |
$603.60
|
| Rate for Payer: Preferred Network Access Commercial |
$925.52
|
| Rate for Payer: Quartz Beloit One Network |
$492.94
|
| Rate for Payer: Quartz Commercial |
$603.60
|
| Rate for Payer: WEA Trust Commercial |
$553.30
|
| Rate for Payer: WPS Commercial |
$745.14
|
|
|
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
|
$12,797.24
|
|
|
Service Code
|
CPT 26123
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,199.31 |
| Max. Negotiated Rate |
$12,797.24 |
| Rate for Payer: Aetna Managed Medicare |
$3,199.31
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$9,907.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8,043.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7,639.00
|
| Rate for Payer: Anthem Medicare Advantage |
$3,199.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$3,199.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$3,199.31
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$3,199.31
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$7,795.33
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$3,199.31
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$11,901.43
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$3,199.31
|
| Rate for Payer: Independent Care Health Plan Medicare |
$3,199.31
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$3,199.31
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$3,199.31
|
| Rate for Payer: NAPHCARE Commercial |
$4,798.96
|
| Rate for Payer: Quartz Medicare Advantage |
$3,199.31
|
| Rate for Payer: The Alliance Commercial |
$12,797.24
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,199.31
|
| Rate for Payer: United Healthcare PPO |
$4,103.00
|
| Rate for Payer: Wellcare Medicare |
$3,199.31
|
|
|
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
|
$7,795.33
|
|
|
Service Code
|
CPT 26125
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$7,795.33 |
| Max. Negotiated Rate |
$7,795.33 |
| Rate for Payer: Dean Health DHI/DHP/ASO |
$7,795.33
|
|
|
FASCIOTOMY LOWER EXTREMITY
|
Facility
|
IP
|
$1,084.00
|
|
| Hospital Charge Code |
2960052
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$531.16 |
| Max. Negotiated Rate |
$997.28 |
| Rate for Payer: Aetna Commercial |
$975.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$932.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$574.52
|
| Rate for Payer: Cash Price |
$325.20
|
| Rate for Payer: Cigna Commercial |
$997.28
|
| Rate for Payer: Health EOS Commercial |
$964.76
|
| Rate for Payer: HFN Commercial |
$997.28
|
| Rate for Payer: Multiplan Commercial |
$867.20
|
| Rate for Payer: NAPHCARE Commercial |
$650.40
|
| Rate for Payer: Preferred Network Access Commercial |
$997.28
|
| Rate for Payer: Quartz Beloit One Network |
$531.16
|
| Rate for Payer: Quartz Commercial |
$650.40
|
| Rate for Payer: WEA Trust Commercial |
$596.20
|
| Rate for Payer: WPS Commercial |
$802.92
|
|
|
FASCIOTOMY LOWER EXTREMITY
|
Facility
|
OP
|
$1,084.00
|
|
| Hospital Charge Code |
2960052
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$303.52 |
| Max. Negotiated Rate |
$4,336.00 |
| Rate for Payer: Aetna Commercial |
$975.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$932.24
|
| Rate for Payer: Aetna Managed Medicare |
$303.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$704.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$542.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$520.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$574.52
|
| Rate for Payer: Cash Price |
$325.20
|
| Rate for Payer: Cigna Commercial |
$997.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$606.61
|
| Rate for Payer: Health EOS Commercial |
$964.76
|
| Rate for Payer: HFN Commercial |
$997.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$813.00
|
| Rate for Payer: Multiplan Commercial |
$867.20
|
| Rate for Payer: NAPHCARE Commercial |
$650.40
|
| Rate for Payer: Preferred Network Access Commercial |
$997.28
|
| Rate for Payer: Quartz Beloit One Network |
$531.16
|
| Rate for Payer: Quartz Commercial |
$704.60
|
| Rate for Payer: Quartz Medicare Advantage |
$650.40
|
| Rate for Payer: The Alliance Commercial |
$4,336.00
|
| Rate for Payer: WEA Trust Commercial |
$596.20
|
| Rate for Payer: WPS Commercial |
$802.92
|
|
|
FASCIOTOMY, PALMAR (EG, DUPUYTREN'S CONTRACTURE); OPEN, PARTIAL
|
Facility
|
OP
|
$12,797.24
|
|
|
Service Code
|
CPT 26045
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,199.31 |
| Max. Negotiated Rate |
$12,797.24 |
| Rate for Payer: Aetna Managed Medicare |
$3,199.31
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$9,907.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8,043.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7,639.00
|
| Rate for Payer: Anthem Medicare Advantage |
$3,199.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$3,199.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$3,199.31
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$3,199.31
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,546.14
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$3,199.31
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$11,901.43
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$3,199.31
|
| Rate for Payer: Independent Care Health Plan Medicare |
$3,199.31
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$3,199.31
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$3,199.31
|
| Rate for Payer: NAPHCARE Commercial |
$4,798.96
|
| Rate for Payer: Quartz Medicare Advantage |
$3,199.31
|
| Rate for Payer: The Alliance Commercial |
$12,797.24
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,199.31
|
| Rate for Payer: United Healthcare PPO |
$4,103.00
|
| Rate for Payer: Wellcare Medicare |
$3,199.31
|
|
|
FASCIOTOMY UPPER EXTREMITY
|
Facility
|
IP
|
$1,006.00
|
|
| Hospital Charge Code |
2960055
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$492.94 |
| Max. Negotiated Rate |
$925.52 |
| Rate for Payer: Aetna Commercial |
$905.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$865.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$533.18
|
| Rate for Payer: Cash Price |
$301.80
|
| Rate for Payer: Cigna Commercial |
$925.52
|
| Rate for Payer: Health EOS Commercial |
$895.34
|
| Rate for Payer: HFN Commercial |
$925.52
|
| Rate for Payer: Multiplan Commercial |
$804.80
|
| Rate for Payer: NAPHCARE Commercial |
$603.60
|
| Rate for Payer: Preferred Network Access Commercial |
$925.52
|
| Rate for Payer: Quartz Beloit One Network |
$492.94
|
| Rate for Payer: Quartz Commercial |
$603.60
|
| Rate for Payer: WEA Trust Commercial |
$553.30
|
| Rate for Payer: WPS Commercial |
$745.14
|
|
|
FASCIOTOMY UPPER EXTREMITY
|
Facility
|
OP
|
$1,006.00
|
|
| Hospital Charge Code |
2960055
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$281.68 |
| Max. Negotiated Rate |
$4,024.00 |
| Rate for Payer: Aetna Commercial |
$905.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$865.16
|
| Rate for Payer: Aetna Managed Medicare |
$281.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$653.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$503.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$482.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$533.18
|
| Rate for Payer: Cash Price |
$301.80
|
| Rate for Payer: Cigna Commercial |
$925.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$562.96
|
| Rate for Payer: Health EOS Commercial |
$895.34
|
| Rate for Payer: HFN Commercial |
$925.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$754.50
|
| Rate for Payer: Multiplan Commercial |
$804.80
|
| Rate for Payer: NAPHCARE Commercial |
$603.60
|
| Rate for Payer: Preferred Network Access Commercial |
$925.52
|
| Rate for Payer: Quartz Beloit One Network |
$492.94
|
| Rate for Payer: Quartz Commercial |
$653.90
|
| Rate for Payer: Quartz Medicare Advantage |
$603.60
|
| Rate for Payer: The Alliance Commercial |
$4,024.00
|
| Rate for Payer: WEA Trust Commercial |
$553.30
|
| Rate for Payer: WPS Commercial |
$745.14
|
|
|
FASK MASK DISP FOR POSITIONING 7210559
|
Facility
|
OP
|
$533.00
|
|
| Hospital Charge Code |
6220214
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$149.24 |
| Max. Negotiated Rate |
$2,132.00 |
| Rate for Payer: Aetna Commercial |
$479.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$458.38
|
| Rate for Payer: Aetna Managed Medicare |
$149.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$346.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$266.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$255.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$282.49
|
| Rate for Payer: Cash Price |
$159.90
|
| Rate for Payer: Cigna Commercial |
$490.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$298.27
|
| Rate for Payer: Health EOS Commercial |
$474.37
|
| Rate for Payer: HFN Commercial |
$490.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$399.75
|
| Rate for Payer: Multiplan Commercial |
$426.40
|
| Rate for Payer: NAPHCARE Commercial |
$319.80
|
| Rate for Payer: Preferred Network Access Commercial |
$490.36
|
| Rate for Payer: Quartz Beloit One Network |
$261.17
|
| Rate for Payer: Quartz Commercial |
$346.45
|
| Rate for Payer: Quartz Medicare Advantage |
$319.80
|
| Rate for Payer: The Alliance Commercial |
$2,132.00
|
| Rate for Payer: WEA Trust Commercial |
$293.15
|
| Rate for Payer: WPS Commercial |
$394.79
|
|
|
FASK MASK DISP FOR POSITIONING 7210559
|
Facility
|
IP
|
$533.00
|
|
| Hospital Charge Code |
6220214
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$261.17 |
| Max. Negotiated Rate |
$490.36 |
| Rate for Payer: Aetna Commercial |
$479.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$458.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$282.49
|
| Rate for Payer: Cash Price |
$159.90
|
| Rate for Payer: Cigna Commercial |
$490.36
|
| Rate for Payer: Health EOS Commercial |
$474.37
|
| Rate for Payer: HFN Commercial |
$490.36
|
| Rate for Payer: Multiplan Commercial |
$426.40
|
| Rate for Payer: NAPHCARE Commercial |
$319.80
|
| Rate for Payer: Preferred Network Access Commercial |
$490.36
|
| Rate for Payer: Quartz Beloit One Network |
$261.17
|
| Rate for Payer: Quartz Commercial |
$319.80
|
| Rate for Payer: WEA Trust Commercial |
$293.15
|
| Rate for Payer: WPS Commercial |
$394.79
|
|
|
Faslodex 25 mg Charge
|
Facility
|
IP
|
$197.00
|
|
|
Service Code
|
HCPCS J9395
|
| Hospital Charge Code |
2958987
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$96.53 |
| Max. Negotiated Rate |
$181.24 |
| Rate for Payer: Aetna Commercial |
$177.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$169.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$104.41
|
| Rate for Payer: Cash Price |
$59.10
|
| Rate for Payer: Cigna Commercial |
$181.24
|
| Rate for Payer: Health EOS Commercial |
$175.33
|
| Rate for Payer: HFN Commercial |
$181.24
|
| Rate for Payer: Multiplan Commercial |
$157.60
|
| Rate for Payer: NAPHCARE Commercial |
$118.20
|
| Rate for Payer: Preferred Network Access Commercial |
$181.24
|
| Rate for Payer: Quartz Beloit One Network |
$96.53
|
| Rate for Payer: Quartz Commercial |
$118.20
|
| Rate for Payer: WEA Trust Commercial |
$108.35
|
| Rate for Payer: WPS Commercial |
$145.92
|
|
|
Faslodex 25 mg Charge
|
Facility
|
OP
|
$197.00
|
|
|
Service Code
|
HCPCS J9395
|
| Hospital Charge Code |
2958987
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.44 |
| Max. Negotiated Rate |
$181.24 |
| Rate for Payer: Aetna Commercial |
$177.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$169.42
|
| Rate for Payer: Aetna Managed Medicare |
$8.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$128.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$98.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$94.56
|
| Rate for Payer: Anthem Medicare Advantage |
$8.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$104.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$8.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$8.44
|
| Rate for Payer: Cash Price |
$59.10
|
| Rate for Payer: Cash Price |
$59.10
|
| Rate for Payer: Cigna Commercial |
$181.24
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$8.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$10.81
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$8.44
|
| Rate for Payer: Health EOS Commercial |
$175.33
|
| Rate for Payer: HFN Commercial |
$181.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$31.42
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$8.44
|
| Rate for Payer: Independent Care Health Plan Medicare |
$8.44
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$8.44
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$8.44
|
| Rate for Payer: Multiplan Commercial |
$157.60
|
| Rate for Payer: NAPHCARE Commercial |
$12.67
|
| Rate for Payer: Preferred Network Access Commercial |
$181.24
|
| Rate for Payer: Quartz Beloit One Network |
$96.53
|
| Rate for Payer: Quartz Commercial |
$128.05
|
| Rate for Payer: Quartz Medicare Advantage |
$8.44
|
| Rate for Payer: The Alliance Commercial |
$33.78
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8.44
|
| Rate for Payer: WEA Trust Commercial |
$108.35
|
| Rate for Payer: Wellcare Medicare |
$8.44
|
| Rate for Payer: WPS Commercial |
$20.42
|
|
|
Faslodex 25 mg Charge
|
Professional
|
Both
|
$197.00
|
|
|
Service Code
|
HCPCS J9395
|
| Hospital Charge Code |
2958987
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.17 |
| Max. Negotiated Rate |
$187.15 |
| Rate for Payer: Aetna Commercial |
$187.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$169.42
|
| Rate for Payer: Cash Price |
$59.10
|
| Rate for Payer: Cash Price |
$59.10
|
| Rate for Payer: Cigna Commercial |
$187.15
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$8.17
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$8.17
|
| Rate for Payer: Health EOS Commercial |
$179.27
|
| Rate for Payer: HFN Commercial |
$187.15
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$65.85
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$65.85
|
| Rate for Payer: Multiplan Commercial |
$157.60
|
| Rate for Payer: Preferred Network Access Commercial |
$187.15
|
| Rate for Payer: Quartz Beloit One Network |
$86.68
|
| Rate for Payer: Quartz Commercial |
$112.29
|
| Rate for Payer: The Alliance Commercial |
$98.50
|
| Rate for Payer: United Healthcare Medicaid |
$8.17
|
| Rate for Payer: WEA Trust Commercial |
$108.35
|
| Rate for Payer: WPS Commercial |
$20.42
|
|
|
FAST-FIX DELIVERY NEEDLE CURVED 72201491
|
Facility
|
OP
|
$3,454.00
|
|
| Hospital Charge Code |
2965965
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$967.12 |
| Max. Negotiated Rate |
$13,816.00 |
| Rate for Payer: Aetna Commercial |
$3,108.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,970.44
|
| Rate for Payer: Aetna Managed Medicare |
$967.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,245.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,727.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,657.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,830.62
|
| Rate for Payer: Cash Price |
$1,036.20
|
| Rate for Payer: Cigna Commercial |
$3,177.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,932.86
|
| Rate for Payer: Health EOS Commercial |
$3,074.06
|
| Rate for Payer: HFN Commercial |
$3,177.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,590.50
|
| Rate for Payer: Multiplan Commercial |
$2,763.20
|
| Rate for Payer: NAPHCARE Commercial |
$2,072.40
|
| Rate for Payer: Preferred Network Access Commercial |
$3,177.68
|
| Rate for Payer: Quartz Beloit One Network |
$1,692.46
|
| Rate for Payer: Quartz Commercial |
$2,245.10
|
| Rate for Payer: Quartz Medicare Advantage |
$2,072.40
|
| Rate for Payer: The Alliance Commercial |
$13,816.00
|
| Rate for Payer: WEA Trust Commercial |
$1,899.70
|
| Rate for Payer: WPS Commercial |
$2,558.38
|
|
|
FAST-FIX DELIVERY NEEDLE CURVED 72201491
|
Facility
|
IP
|
$3,454.00
|
|
| Hospital Charge Code |
2965965
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,692.46 |
| Max. Negotiated Rate |
$3,177.68 |
| Rate for Payer: Aetna Commercial |
$3,108.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,970.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,830.62
|
| Rate for Payer: Cash Price |
$1,036.20
|
| Rate for Payer: Cigna Commercial |
$3,177.68
|
| Rate for Payer: Health EOS Commercial |
$3,074.06
|
| Rate for Payer: HFN Commercial |
$3,177.68
|
| Rate for Payer: Multiplan Commercial |
$2,763.20
|
| Rate for Payer: NAPHCARE Commercial |
$2,072.40
|
| Rate for Payer: Preferred Network Access Commercial |
$3,177.68
|
| Rate for Payer: Quartz Beloit One Network |
$1,692.46
|
| Rate for Payer: Quartz Commercial |
$2,072.40
|
| Rate for Payer: WEA Trust Commercial |
$1,899.70
|
| Rate for Payer: WPS Commercial |
$2,558.38
|
|
|
FAST-FIX STR NEEDLE DELIVERY 72201490
|
Facility
|
IP
|
$3,843.00
|
|
| Hospital Charge Code |
2965966
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,883.07 |
| Max. Negotiated Rate |
$3,535.56 |
| Rate for Payer: Aetna Commercial |
$3,458.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,304.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,036.79
|
| Rate for Payer: Cash Price |
$1,152.90
|
| Rate for Payer: Cigna Commercial |
$3,535.56
|
| Rate for Payer: Health EOS Commercial |
$3,420.27
|
| Rate for Payer: HFN Commercial |
$3,535.56
|
| Rate for Payer: Multiplan Commercial |
$3,074.40
|
| Rate for Payer: NAPHCARE Commercial |
$2,305.80
|
| Rate for Payer: Preferred Network Access Commercial |
$3,535.56
|
| Rate for Payer: Quartz Beloit One Network |
$1,883.07
|
| Rate for Payer: Quartz Commercial |
$2,305.80
|
| Rate for Payer: WEA Trust Commercial |
$2,113.65
|
| Rate for Payer: WPS Commercial |
$2,846.51
|
|
|
FAST-FIX STR NEEDLE DELIVERY 72201490
|
Facility
|
OP
|
$3,843.00
|
|
| Hospital Charge Code |
2965966
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,076.04 |
| Max. Negotiated Rate |
$15,372.00 |
| Rate for Payer: Aetna Commercial |
$3,458.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,304.98
|
| Rate for Payer: Aetna Managed Medicare |
$1,076.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,497.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,921.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,844.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,036.79
|
| Rate for Payer: Cash Price |
$1,152.90
|
| Rate for Payer: Cigna Commercial |
$3,535.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,150.54
|
| Rate for Payer: Health EOS Commercial |
$3,420.27
|
| Rate for Payer: HFN Commercial |
$3,535.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,882.25
|
| Rate for Payer: Multiplan Commercial |
$3,074.40
|
| Rate for Payer: NAPHCARE Commercial |
$2,305.80
|
| Rate for Payer: Preferred Network Access Commercial |
$3,535.56
|
| Rate for Payer: Quartz Beloit One Network |
$1,883.07
|
| Rate for Payer: Quartz Commercial |
$2,497.95
|
| Rate for Payer: Quartz Medicare Advantage |
$2,305.80
|
| Rate for Payer: The Alliance Commercial |
$15,372.00
|
| Rate for Payer: WEA Trust Commercial |
$2,113.65
|
| Rate for Payer: WPS Commercial |
$2,846.51
|
|
|
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 |
$24.09 |
| Max. Negotiated Rate |
$650.44 |
| Rate for Payer: Aetna Commercial |
$636.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$608.02
|
| Rate for Payer: Aetna Managed Medicare |
$24.09
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$90.34
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$42.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$39.99
|
| Rate for Payer: Anthem Medicaid |
$24.89
|
| Rate for Payer: Anthem Medicare Advantage |
$24.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$374.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$24.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$24.09
|
| Rate for Payer: Cash Price |
$212.10
|
| Rate for Payer: Cash Price |
$212.10
|
| Rate for Payer: Cigna Commercial |
$650.44
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$24.09
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$24.89
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$395.64
|
| Rate for Payer: Dean Health Medicaid |
$24.89
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$24.09
|
| Rate for Payer: Health EOS Commercial |
$629.23
|
| Rate for Payer: HFN Commercial |
$650.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$89.61
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$24.09
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$24.89
|
| Rate for Payer: Independent Care Health Plan Medicare |
$24.09
|
| Rate for Payer: Managed Health Services Medicaid |
$25.89
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$24.09
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$24.09
|
| Rate for Payer: Multiplan Commercial |
$565.60
|
| Rate for Payer: NAPHCARE Commercial |
$36.14
|
| Rate for Payer: Preferred Network Access Commercial |
$650.44
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$24.89
|
| Rate for Payer: Quartz Beloit One Network |
$346.43
|
| Rate for Payer: Quartz Commercial |
$459.55
|
| Rate for Payer: Quartz Medicare Advantage |
$24.09
|
| Rate for Payer: The Alliance Commercial |
$96.36
|
| Rate for Payer: United Healthcare Medicaid |
$24.89
|
| Rate for Payer: United Healthcare Medicare Advantage |
$24.09
|
| Rate for Payer: United Healthcare PPO |
$530.25
|
| Rate for Payer: WEA Trust Commercial |
$388.85
|
| Rate for Payer: Wellcare Medicare |
$24.09
|
| Rate for Payer: WMAP Medicaid |
$24.89
|
| Rate for Payer: WPS Commercial |
$523.67
|
|
|
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 |
$346.43 |
| Max. Negotiated Rate |
$650.44 |
| Rate for Payer: Aetna Commercial |
$636.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$608.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$374.71
|
| Rate for Payer: Cash Price |
$212.10
|
| Rate for Payer: Cigna Commercial |
$650.44
|
| Rate for Payer: Health EOS Commercial |
$629.23
|
| Rate for Payer: HFN Commercial |
$650.44
|
| Rate for Payer: Multiplan Commercial |
$565.60
|
| Rate for Payer: NAPHCARE Commercial |
$424.20
|
| Rate for Payer: Preferred Network Access Commercial |
$650.44
|
| Rate for Payer: Quartz Beloit One Network |
$346.43
|
| Rate for Payer: Quartz Commercial |
$424.20
|
| Rate for Payer: WEA Trust Commercial |
$388.85
|
| Rate for Payer: WPS Commercial |
$523.67
|
|
|
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 |
$85.04 |
| Max. Negotiated Rate |
$671.65 |
| Rate for Payer: Aetna Commercial |
$671.65
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$608.02
|
| Rate for Payer: Cash Price |
$212.10
|
| Rate for Payer: Cash Price |
$212.10
|
| Rate for Payer: Cigna Commercial |
$671.65
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$353.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$424.20
|
| Rate for Payer: Health EOS Commercial |
$643.37
|
| Rate for Payer: HFN Commercial |
$671.65
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$85.04
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$85.04
|
| Rate for Payer: Multiplan Commercial |
$565.60
|
| Rate for Payer: Preferred Network Access Commercial |
$671.65
|
| Rate for Payer: Quartz Beloit One Network |
$311.08
|
| Rate for Payer: Quartz Commercial |
$402.99
|
| Rate for Payer: The Alliance Commercial |
$353.50
|
| Rate for Payer: WEA Trust Commercial |
$388.85
|
| Rate for Payer: WPS Commercial |
$523.67
|
|
|
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 |
$126.42 |
| Max. Negotiated Rate |
$237.36 |
| Rate for Payer: Aetna Commercial |
$232.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$221.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$136.74
|
| Rate for Payer: Cash Price |
$77.40
|
| Rate for Payer: Cigna Commercial |
$237.36
|
| Rate for Payer: Health EOS Commercial |
$229.62
|
| Rate for Payer: HFN Commercial |
$237.36
|
| Rate for Payer: Multiplan Commercial |
$206.40
|
| Rate for Payer: NAPHCARE Commercial |
$154.80
|
| Rate for Payer: Preferred Network Access Commercial |
$237.36
|
| Rate for Payer: Quartz Beloit One Network |
$126.42
|
| Rate for Payer: Quartz Commercial |
$154.80
|
| Rate for Payer: WEA Trust Commercial |
$141.90
|
| Rate for Payer: WPS Commercial |
$191.10
|
|
|
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 |
$69.72 |
| Max. Negotiated Rate |
$245.10 |
| Rate for Payer: Aetna Commercial |
$245.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$221.88
|
| Rate for Payer: Cash Price |
$77.40
|
| Rate for Payer: Cash Price |
$77.40
|
| Rate for Payer: Cigna Commercial |
$245.10
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$129.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$154.80
|
| Rate for Payer: Health EOS Commercial |
$234.78
|
| Rate for Payer: HFN Commercial |
$245.10
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$69.72
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$69.72
|
| Rate for Payer: Multiplan Commercial |
$206.40
|
| Rate for Payer: Preferred Network Access Commercial |
$245.10
|
| Rate for Payer: Quartz Beloit One Network |
$113.52
|
| Rate for Payer: Quartz Commercial |
$147.06
|
| Rate for Payer: The Alliance Commercial |
$129.00
|
| Rate for Payer: WEA Trust Commercial |
$141.90
|
| Rate for Payer: WPS Commercial |
$191.10
|
|
|
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 |
$19.75 |
| Max. Negotiated Rate |
$237.36 |
| Rate for Payer: Aetna Commercial |
$232.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$221.88
|
| Rate for Payer: Aetna Managed Medicare |
$19.75
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$74.06
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$34.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$32.78
|
| Rate for Payer: Anthem Medicaid |
$20.41
|
| Rate for Payer: Anthem Medicare Advantage |
$19.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$136.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$19.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$19.75
|
| Rate for Payer: Cash Price |
$77.40
|
| Rate for Payer: Cash Price |
$77.40
|
| Rate for Payer: Cigna Commercial |
$237.36
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$19.75
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$20.41
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$144.38
|
| Rate for Payer: Dean Health Medicaid |
$20.41
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$19.75
|
| Rate for Payer: Health EOS Commercial |
$229.62
|
| Rate for Payer: HFN Commercial |
$237.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$73.47
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$19.75
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$20.41
|
| Rate for Payer: Independent Care Health Plan Medicare |
$19.75
|
| Rate for Payer: Managed Health Services Medicaid |
$21.23
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$19.75
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$19.75
|
| Rate for Payer: Multiplan Commercial |
$206.40
|
| Rate for Payer: NAPHCARE Commercial |
$29.62
|
| Rate for Payer: Preferred Network Access Commercial |
$237.36
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$20.41
|
| Rate for Payer: Quartz Beloit One Network |
$126.42
|
| Rate for Payer: Quartz Commercial |
$167.70
|
| Rate for Payer: Quartz Medicare Advantage |
$19.75
|
| Rate for Payer: The Alliance Commercial |
$79.00
|
| Rate for Payer: United Healthcare Medicaid |
$20.41
|
| Rate for Payer: United Healthcare Medicare Advantage |
$19.75
|
| Rate for Payer: United Healthcare PPO |
$193.50
|
| Rate for Payer: WEA Trust Commercial |
$141.90
|
| Rate for Payer: Wellcare Medicare |
$19.75
|
| Rate for Payer: WMAP Medicaid |
$20.41
|
| Rate for Payer: WPS Commercial |
$191.10
|
|
|
Fecal Fat Qualitative
|
Professional
|
Both
|
$131.00
|
|
|
Service Code
|
CPT 82705
|
| Hospital Charge Code |
977947
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.00 |
| Max. Negotiated Rate |
$124.45 |
| Rate for Payer: Aetna Commercial |
$124.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$112.66
|
| Rate for Payer: Cash Price |
$39.30
|
| Rate for Payer: Cash Price |
$39.30
|
| Rate for Payer: Cigna Commercial |
$124.45
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$65.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$78.60
|
| Rate for Payer: Health EOS Commercial |
$119.21
|
| Rate for Payer: HFN Commercial |
$124.45
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$18.00
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$18.00
|
| Rate for Payer: Multiplan Commercial |
$104.80
|
| Rate for Payer: Preferred Network Access Commercial |
$124.45
|
| Rate for Payer: Quartz Beloit One Network |
$57.64
|
| Rate for Payer: Quartz Commercial |
$74.67
|
| Rate for Payer: The Alliance Commercial |
$65.50
|
| Rate for Payer: WEA Trust Commercial |
$72.05
|
| Rate for Payer: WPS Commercial |
$97.03
|
|
