|
Fecal Fat Qualitative
|
Facility
|
OP
|
$131.00
|
|
|
Service Code
|
CPT 82705
|
| Hospital Charge Code |
977947
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.10 |
| Max. Negotiated Rate |
$120.52 |
| Rate for Payer: Aetna Commercial |
$117.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$112.66
|
| Rate for Payer: Aetna Managed Medicare |
$5.10
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$19.12
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$8.47
|
| Rate for Payer: Anthem Medicaid |
$5.27
|
| Rate for Payer: Anthem Medicare Advantage |
$5.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$69.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5.10
|
| Rate for Payer: Cash Price |
$39.30
|
| Rate for Payer: Cash Price |
$39.30
|
| Rate for Payer: Cigna Commercial |
$120.52
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$5.10
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$5.27
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$73.31
|
| Rate for Payer: Dean Health Medicaid |
$5.27
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$5.10
|
| Rate for Payer: Health EOS Commercial |
$116.59
|
| Rate for Payer: HFN Commercial |
$120.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$18.97
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$5.10
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$5.27
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5.10
|
| Rate for Payer: Managed Health Services Medicaid |
$5.48
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$5.10
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$5.10
|
| Rate for Payer: Multiplan Commercial |
$104.80
|
| Rate for Payer: NAPHCARE Commercial |
$7.65
|
| Rate for Payer: Preferred Network Access Commercial |
$120.52
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$5.27
|
| Rate for Payer: Quartz Beloit One Network |
$64.19
|
| Rate for Payer: Quartz Commercial |
$85.15
|
| Rate for Payer: Quartz Medicare Advantage |
$5.10
|
| Rate for Payer: The Alliance Commercial |
$20.40
|
| Rate for Payer: United Healthcare Medicaid |
$5.27
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.10
|
| Rate for Payer: United Healthcare PPO |
$98.25
|
| Rate for Payer: WEA Trust Commercial |
$72.05
|
| Rate for Payer: Wellcare Medicare |
$5.10
|
| Rate for Payer: WMAP Medicaid |
$5.27
|
| Rate for Payer: WPS Commercial |
$97.03
|
|
|
Fecal Fat Qualitative
|
Facility
|
IP
|
$131.00
|
|
|
Service Code
|
CPT 82705
|
| Hospital Charge Code |
977947
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$64.19 |
| Max. Negotiated Rate |
$120.52 |
| Rate for Payer: Aetna Commercial |
$117.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$112.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$69.43
|
| Rate for Payer: Cash Price |
$39.30
|
| Rate for Payer: Cigna Commercial |
$120.52
|
| Rate for Payer: Health EOS Commercial |
$116.59
|
| Rate for Payer: HFN Commercial |
$120.52
|
| Rate for Payer: Multiplan Commercial |
$104.80
|
| Rate for Payer: NAPHCARE Commercial |
$78.60
|
| Rate for Payer: Preferred Network Access Commercial |
$120.52
|
| Rate for Payer: Quartz Beloit One Network |
$64.19
|
| Rate for Payer: Quartz Commercial |
$78.60
|
| Rate for Payer: WEA Trust Commercial |
$72.05
|
| Rate for Payer: WPS Commercial |
$97.03
|
|
|
Fecal Fat, Total, Quantitative 24,48 Hour
|
Professional
|
Both
|
$53.00
|
|
|
Service Code
|
CPT 82710
|
| Hospital Charge Code |
4494784
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$23.32 |
| Max. Negotiated Rate |
$59.30 |
| Rate for Payer: Aetna Commercial |
$50.35
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$45.58
|
| Rate for Payer: Cash Price |
$15.90
|
| Rate for Payer: Cash Price |
$15.90
|
| Rate for Payer: Cigna Commercial |
$50.35
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$26.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$31.80
|
| Rate for Payer: Health EOS Commercial |
$48.23
|
| Rate for Payer: HFN Commercial |
$50.35
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$59.30
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$59.30
|
| Rate for Payer: Multiplan Commercial |
$42.40
|
| Rate for Payer: Preferred Network Access Commercial |
$50.35
|
| Rate for Payer: Quartz Beloit One Network |
$23.32
|
| Rate for Payer: Quartz Commercial |
$30.21
|
| Rate for Payer: The Alliance Commercial |
$26.50
|
| Rate for Payer: WEA Trust Commercial |
$29.15
|
| Rate for Payer: WPS Commercial |
$39.26
|
|
|
Fecal Fat, Total, Quantitative 24,48 Hour
|
Facility
|
IP
|
$53.00
|
|
|
Service Code
|
CPT 82710
|
| Hospital Charge Code |
4494784
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$25.97 |
| Max. Negotiated Rate |
$48.76 |
| Rate for Payer: Aetna Commercial |
$47.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$45.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$28.09
|
| Rate for Payer: Cash Price |
$15.90
|
| Rate for Payer: Cigna Commercial |
$48.76
|
| Rate for Payer: Health EOS Commercial |
$47.17
|
| Rate for Payer: HFN Commercial |
$48.76
|
| Rate for Payer: Multiplan Commercial |
$42.40
|
| Rate for Payer: NAPHCARE Commercial |
$31.80
|
| Rate for Payer: Preferred Network Access Commercial |
$48.76
|
| Rate for Payer: Quartz Beloit One Network |
$25.97
|
| Rate for Payer: Quartz Commercial |
$31.80
|
| Rate for Payer: WEA Trust Commercial |
$29.15
|
| Rate for Payer: WPS Commercial |
$39.26
|
|
|
Fecal Fat, Total, Quantitative 24,48 Hour
|
Facility
|
OP
|
$53.00
|
|
|
Service Code
|
CPT 82710
|
| Hospital Charge Code |
4494784
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$16.80 |
| Max. Negotiated Rate |
$67.20 |
| Rate for Payer: Aetna Commercial |
$47.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$45.58
|
| Rate for Payer: Aetna Managed Medicare |
$16.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$63.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$29.40
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$27.89
|
| Rate for Payer: Anthem Medicaid |
$17.36
|
| Rate for Payer: Anthem Medicare Advantage |
$16.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$28.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$16.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$16.80
|
| Rate for Payer: Cash Price |
$15.90
|
| Rate for Payer: Cash Price |
$15.90
|
| Rate for Payer: Cigna Commercial |
$48.76
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$16.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$17.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$29.66
|
| Rate for Payer: Dean Health Medicaid |
$17.36
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$16.80
|
| Rate for Payer: Health EOS Commercial |
$47.17
|
| Rate for Payer: HFN Commercial |
$48.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$62.50
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$16.80
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$17.36
|
| Rate for Payer: Independent Care Health Plan Medicare |
$16.80
|
| Rate for Payer: Managed Health Services Medicaid |
$18.05
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$16.80
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$16.80
|
| Rate for Payer: Multiplan Commercial |
$42.40
|
| Rate for Payer: NAPHCARE Commercial |
$25.20
|
| Rate for Payer: Preferred Network Access Commercial |
$48.76
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$17.36
|
| Rate for Payer: Quartz Beloit One Network |
$25.97
|
| Rate for Payer: Quartz Commercial |
$34.45
|
| Rate for Payer: Quartz Medicare Advantage |
$16.80
|
| Rate for Payer: The Alliance Commercial |
$67.20
|
| Rate for Payer: United Healthcare Medicaid |
$17.36
|
| Rate for Payer: United Healthcare Medicare Advantage |
$16.80
|
| Rate for Payer: United Healthcare PPO |
$39.75
|
| Rate for Payer: WEA Trust Commercial |
$29.15
|
| Rate for Payer: Wellcare Medicare |
$16.80
|
| Rate for Payer: WMAP Medicaid |
$17.36
|
| Rate for Payer: WPS Commercial |
$39.26
|
|
|
Fecal Incontinence Mngt
|
Facility
|
IP
|
$223.00
|
|
|
Service Code
|
CPT 99211
|
| Hospital Charge Code |
3005550
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$109.27 |
| Max. Negotiated Rate |
$205.16 |
| Rate for Payer: Aetna Commercial |
$200.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$191.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$118.19
|
| Rate for Payer: Cash Price |
$66.90
|
| Rate for Payer: Cigna Commercial |
$205.16
|
| Rate for Payer: Health EOS Commercial |
$198.47
|
| Rate for Payer: HFN Commercial |
$205.16
|
| Rate for Payer: Multiplan Commercial |
$178.40
|
| Rate for Payer: NAPHCARE Commercial |
$133.80
|
| Rate for Payer: Preferred Network Access Commercial |
$205.16
|
| Rate for Payer: Quartz Beloit One Network |
$109.27
|
| Rate for Payer: Quartz Commercial |
$133.80
|
| Rate for Payer: WEA Trust Commercial |
$122.65
|
| Rate for Payer: WPS Commercial |
$165.18
|
|
|
Fecal Incontinence Mngt
|
Facility
|
OP
|
$223.00
|
|
|
Service Code
|
CPT 99211
|
| Hospital Charge Code |
3005550
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$62.44 |
| Max. Negotiated Rate |
$892.00 |
| Rate for Payer: Aetna Commercial |
$200.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$191.78
|
| Rate for Payer: Aetna Managed Medicare |
$62.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$144.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$111.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$107.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$118.19
|
| Rate for Payer: Cash Price |
$66.90
|
| Rate for Payer: Cigna Commercial |
$205.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$124.79
|
| Rate for Payer: Health EOS Commercial |
$198.47
|
| Rate for Payer: HFN Commercial |
$205.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$167.25
|
| Rate for Payer: Multiplan Commercial |
$178.40
|
| Rate for Payer: NAPHCARE Commercial |
$133.80
|
| Rate for Payer: Preferred Network Access Commercial |
$205.16
|
| Rate for Payer: Quartz Beloit One Network |
$109.27
|
| Rate for Payer: Quartz Commercial |
$144.95
|
| Rate for Payer: Quartz Medicare Advantage |
$133.80
|
| Rate for Payer: The Alliance Commercial |
$892.00
|
| Rate for Payer: WEA Trust Commercial |
$122.65
|
| Rate for Payer: WPS Commercial |
$165.18
|
|
|
FEEDING PUMP
|
Facility
|
IP
|
$207.00
|
|
| Hospital Charge Code |
3075877
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$101.43 |
| Max. Negotiated Rate |
$190.44 |
| Rate for Payer: Aetna Commercial |
$186.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$178.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$109.71
|
| Rate for Payer: Cash Price |
$62.10
|
| Rate for Payer: Cigna Commercial |
$190.44
|
| Rate for Payer: Health EOS Commercial |
$184.23
|
| Rate for Payer: HFN Commercial |
$190.44
|
| Rate for Payer: Multiplan Commercial |
$165.60
|
| Rate for Payer: NAPHCARE Commercial |
$124.20
|
| Rate for Payer: Preferred Network Access Commercial |
$190.44
|
| Rate for Payer: Quartz Beloit One Network |
$101.43
|
| Rate for Payer: Quartz Commercial |
$124.20
|
| Rate for Payer: WEA Trust Commercial |
$113.85
|
| Rate for Payer: WPS Commercial |
$153.32
|
|
|
FEEDING PUMP
|
Facility
|
OP
|
$207.00
|
|
| Hospital Charge Code |
3075877
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$57.96 |
| Max. Negotiated Rate |
$828.00 |
| Rate for Payer: Aetna Commercial |
$186.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$178.02
|
| Rate for Payer: Aetna Managed Medicare |
$57.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$134.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$103.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$99.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$109.71
|
| Rate for Payer: Cash Price |
$62.10
|
| Rate for Payer: Cigna Commercial |
$190.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$115.84
|
| Rate for Payer: Health EOS Commercial |
$184.23
|
| Rate for Payer: HFN Commercial |
$190.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$155.25
|
| Rate for Payer: Multiplan Commercial |
$165.60
|
| Rate for Payer: NAPHCARE Commercial |
$124.20
|
| Rate for Payer: Preferred Network Access Commercial |
$190.44
|
| Rate for Payer: Quartz Beloit One Network |
$101.43
|
| Rate for Payer: Quartz Commercial |
$134.55
|
| Rate for Payer: Quartz Medicare Advantage |
$124.20
|
| Rate for Payer: The Alliance Commercial |
$828.00
|
| Rate for Payer: WEA Trust Commercial |
$113.85
|
| Rate for Payer: WPS Commercial |
$153.32
|
|
|
FEEDING TUBE JEJUNAL BENT TIP 12F X 68CM M00566340
|
Facility
|
OP
|
$2,059.00
|
|
| Hospital Charge Code |
4154498
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$576.52 |
| Max. Negotiated Rate |
$8,236.00 |
| Rate for Payer: Aetna Commercial |
$1,853.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,770.74
|
| Rate for Payer: Aetna Managed Medicare |
$576.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,338.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,029.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$988.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,091.27
|
| Rate for Payer: Cash Price |
$617.70
|
| Rate for Payer: Cigna Commercial |
$1,894.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,152.22
|
| Rate for Payer: Health EOS Commercial |
$1,832.51
|
| Rate for Payer: HFN Commercial |
$1,894.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,544.25
|
| Rate for Payer: Multiplan Commercial |
$1,647.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,235.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,894.28
|
| Rate for Payer: Quartz Beloit One Network |
$1,008.91
|
| Rate for Payer: Quartz Commercial |
$1,338.35
|
| Rate for Payer: Quartz Medicare Advantage |
$1,235.40
|
| Rate for Payer: The Alliance Commercial |
$8,236.00
|
| Rate for Payer: WEA Trust Commercial |
$1,132.45
|
| Rate for Payer: WPS Commercial |
$1,525.10
|
|
|
FEEDING TUBE JEJUNAL BENT TIP 12F X 68CM M00566340
|
Facility
|
IP
|
$2,059.00
|
|
| Hospital Charge Code |
4154498
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,008.91 |
| Max. Negotiated Rate |
$1,894.28 |
| Rate for Payer: Aetna Commercial |
$1,853.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,770.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,091.27
|
| Rate for Payer: Cash Price |
$617.70
|
| Rate for Payer: Cigna Commercial |
$1,894.28
|
| Rate for Payer: Health EOS Commercial |
$1,832.51
|
| Rate for Payer: HFN Commercial |
$1,894.28
|
| Rate for Payer: Multiplan Commercial |
$1,647.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,235.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,894.28
|
| Rate for Payer: Quartz Beloit One Network |
$1,008.91
|
| Rate for Payer: Quartz Commercial |
$1,235.40
|
| Rate for Payer: WEA Trust Commercial |
$1,132.45
|
| Rate for Payer: WPS Commercial |
$1,525.10
|
|
|
FEEDING TUBE JEJUNAL PIGTAIL TIP 12F X 68CM M00566350
|
Facility
|
OP
|
$2,059.00
|
|
| Hospital Charge Code |
4154499
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$576.52 |
| Max. Negotiated Rate |
$8,236.00 |
| Rate for Payer: Aetna Commercial |
$1,853.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,770.74
|
| Rate for Payer: Aetna Managed Medicare |
$576.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,338.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,029.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$988.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,091.27
|
| Rate for Payer: Cash Price |
$617.70
|
| Rate for Payer: Cigna Commercial |
$1,894.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,152.22
|
| Rate for Payer: Health EOS Commercial |
$1,832.51
|
| Rate for Payer: HFN Commercial |
$1,894.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,544.25
|
| Rate for Payer: Multiplan Commercial |
$1,647.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,235.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,894.28
|
| Rate for Payer: Quartz Beloit One Network |
$1,008.91
|
| Rate for Payer: Quartz Commercial |
$1,338.35
|
| Rate for Payer: Quartz Medicare Advantage |
$1,235.40
|
| Rate for Payer: The Alliance Commercial |
$8,236.00
|
| Rate for Payer: WEA Trust Commercial |
$1,132.45
|
| Rate for Payer: WPS Commercial |
$1,525.10
|
|
|
FEEDING TUBE JEJUNAL PIGTAIL TIP 12F X 68CM M00566350
|
Facility
|
IP
|
$2,059.00
|
|
| Hospital Charge Code |
4154499
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,008.91 |
| Max. Negotiated Rate |
$1,894.28 |
| Rate for Payer: Aetna Commercial |
$1,853.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,770.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,091.27
|
| Rate for Payer: Cash Price |
$617.70
|
| Rate for Payer: Cigna Commercial |
$1,894.28
|
| Rate for Payer: Health EOS Commercial |
$1,832.51
|
| Rate for Payer: HFN Commercial |
$1,894.28
|
| Rate for Payer: Multiplan Commercial |
$1,647.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,235.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,894.28
|
| Rate for Payer: Quartz Beloit One Network |
$1,008.91
|
| Rate for Payer: Quartz Commercial |
$1,235.40
|
| Rate for Payer: WEA Trust Commercial |
$1,132.45
|
| Rate for Payer: WPS Commercial |
$1,525.10
|
|
|
FEEDING TUBE MIC BOLUS G-TUBE 18FR 0110-18
|
Facility
|
IP
|
$788.00
|
|
|
Service Code
|
HCPCS B4087
|
| Hospital Charge Code |
5286775
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$386.12 |
| Max. Negotiated Rate |
$724.96 |
| Rate for Payer: Aetna Commercial |
$709.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$677.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$417.64
|
| Rate for Payer: Cash Price |
$236.40
|
| Rate for Payer: Cigna Commercial |
$724.96
|
| Rate for Payer: Health EOS Commercial |
$701.32
|
| Rate for Payer: HFN Commercial |
$724.96
|
| Rate for Payer: Multiplan Commercial |
$630.40
|
| Rate for Payer: NAPHCARE Commercial |
$472.80
|
| Rate for Payer: Preferred Network Access Commercial |
$724.96
|
| Rate for Payer: Quartz Beloit One Network |
$386.12
|
| Rate for Payer: Quartz Commercial |
$472.80
|
| Rate for Payer: WEA Trust Commercial |
$433.40
|
| Rate for Payer: WPS Commercial |
$583.67
|
|
|
FEEDING TUBE MIC BOLUS G-TUBE 18FR 0110-18
|
Facility
|
OP
|
$788.00
|
|
|
Service Code
|
HCPCS B4087
|
| Hospital Charge Code |
5286775
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$220.64 |
| Max. Negotiated Rate |
$3,152.00 |
| Rate for Payer: Aetna Commercial |
$709.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$677.68
|
| Rate for Payer: Aetna Managed Medicare |
$220.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$512.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$394.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$378.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$417.64
|
| Rate for Payer: Cash Price |
$236.40
|
| Rate for Payer: Cigna Commercial |
$724.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$440.96
|
| Rate for Payer: Health EOS Commercial |
$701.32
|
| Rate for Payer: HFN Commercial |
$724.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$591.00
|
| Rate for Payer: Multiplan Commercial |
$630.40
|
| Rate for Payer: NAPHCARE Commercial |
$472.80
|
| Rate for Payer: Preferred Network Access Commercial |
$724.96
|
| Rate for Payer: Quartz Beloit One Network |
$386.12
|
| Rate for Payer: Quartz Commercial |
$512.20
|
| Rate for Payer: Quartz Medicare Advantage |
$472.80
|
| Rate for Payer: The Alliance Commercial |
$3,152.00
|
| Rate for Payer: WEA Trust Commercial |
$433.40
|
| Rate for Payer: WPS Commercial |
$583.67
|
|
|
FEEDING TUBE MIC BOLUS G-TUBE 18FR ENFIT CONNECT 8110-18
|
Facility
|
IP
|
$687.00
|
|
| Hospital Charge Code |
5563636
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$336.63 |
| Max. Negotiated Rate |
$632.04 |
| Rate for Payer: Aetna Commercial |
$618.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$590.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$364.11
|
| Rate for Payer: Cash Price |
$206.10
|
| Rate for Payer: Cigna Commercial |
$632.04
|
| Rate for Payer: Health EOS Commercial |
$611.43
|
| Rate for Payer: HFN Commercial |
$632.04
|
| Rate for Payer: Multiplan Commercial |
$549.60
|
| Rate for Payer: NAPHCARE Commercial |
$412.20
|
| Rate for Payer: Preferred Network Access Commercial |
$632.04
|
| Rate for Payer: Quartz Beloit One Network |
$336.63
|
| Rate for Payer: Quartz Commercial |
$412.20
|
| Rate for Payer: WEA Trust Commercial |
$377.85
|
| Rate for Payer: WPS Commercial |
$508.86
|
|
|
FEEDING TUBE MIC BOLUS G-TUBE 18FR ENFIT CONNECT 8110-18
|
Facility
|
OP
|
$687.00
|
|
| Hospital Charge Code |
5563636
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$192.36 |
| Max. Negotiated Rate |
$2,748.00 |
| Rate for Payer: Aetna Commercial |
$618.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$590.82
|
| Rate for Payer: Aetna Managed Medicare |
$192.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$446.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$343.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$329.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$364.11
|
| Rate for Payer: Cash Price |
$206.10
|
| Rate for Payer: Cigna Commercial |
$632.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$384.45
|
| Rate for Payer: Health EOS Commercial |
$611.43
|
| Rate for Payer: HFN Commercial |
$632.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$515.25
|
| Rate for Payer: Multiplan Commercial |
$549.60
|
| Rate for Payer: NAPHCARE Commercial |
$412.20
|
| Rate for Payer: Preferred Network Access Commercial |
$632.04
|
| Rate for Payer: Quartz Beloit One Network |
$336.63
|
| Rate for Payer: Quartz Commercial |
$446.55
|
| Rate for Payer: Quartz Medicare Advantage |
$412.20
|
| Rate for Payer: The Alliance Commercial |
$2,748.00
|
| Rate for Payer: WEA Trust Commercial |
$377.85
|
| Rate for Payer: WPS Commercial |
$508.86
|
|
|
FEEDING TUBE MIC BOLUS G-TUBE 20FR 0110-20
|
Facility
|
IP
|
$788.00
|
|
|
Service Code
|
HCPCS B4087
|
| Hospital Charge Code |
5286776
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$386.12 |
| Max. Negotiated Rate |
$724.96 |
| Rate for Payer: Aetna Commercial |
$709.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$677.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$417.64
|
| Rate for Payer: Cash Price |
$236.40
|
| Rate for Payer: Cigna Commercial |
$724.96
|
| Rate for Payer: Health EOS Commercial |
$701.32
|
| Rate for Payer: HFN Commercial |
$724.96
|
| Rate for Payer: Multiplan Commercial |
$630.40
|
| Rate for Payer: NAPHCARE Commercial |
$472.80
|
| Rate for Payer: Preferred Network Access Commercial |
$724.96
|
| Rate for Payer: Quartz Beloit One Network |
$386.12
|
| Rate for Payer: Quartz Commercial |
$472.80
|
| Rate for Payer: WEA Trust Commercial |
$433.40
|
| Rate for Payer: WPS Commercial |
$583.67
|
|
|
FEEDING TUBE MIC BOLUS G-TUBE 20FR 0110-20
|
Facility
|
OP
|
$788.00
|
|
|
Service Code
|
HCPCS B4087
|
| Hospital Charge Code |
5286776
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$220.64 |
| Max. Negotiated Rate |
$3,152.00 |
| Rate for Payer: Aetna Commercial |
$709.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$677.68
|
| Rate for Payer: Aetna Managed Medicare |
$220.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$512.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$394.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$378.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$417.64
|
| Rate for Payer: Cash Price |
$236.40
|
| Rate for Payer: Cigna Commercial |
$724.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$440.96
|
| Rate for Payer: Health EOS Commercial |
$701.32
|
| Rate for Payer: HFN Commercial |
$724.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$591.00
|
| Rate for Payer: Multiplan Commercial |
$630.40
|
| Rate for Payer: NAPHCARE Commercial |
$472.80
|
| Rate for Payer: Preferred Network Access Commercial |
$724.96
|
| Rate for Payer: Quartz Beloit One Network |
$386.12
|
| Rate for Payer: Quartz Commercial |
$512.20
|
| Rate for Payer: Quartz Medicare Advantage |
$472.80
|
| Rate for Payer: The Alliance Commercial |
$3,152.00
|
| Rate for Payer: WEA Trust Commercial |
$433.40
|
| Rate for Payer: WPS Commercial |
$583.67
|
|
|
FEEDING TUBE MIC BOLUS G-TUBE 20FR ENFIT CONNECT 8110-20
|
Facility
|
OP
|
$687.00
|
|
| Hospital Charge Code |
5563637
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$192.36 |
| Max. Negotiated Rate |
$2,748.00 |
| Rate for Payer: Aetna Commercial |
$618.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$590.82
|
| Rate for Payer: Aetna Managed Medicare |
$192.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$446.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$343.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$329.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$364.11
|
| Rate for Payer: Cash Price |
$206.10
|
| Rate for Payer: Cigna Commercial |
$632.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$384.45
|
| Rate for Payer: Health EOS Commercial |
$611.43
|
| Rate for Payer: HFN Commercial |
$632.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$515.25
|
| Rate for Payer: Multiplan Commercial |
$549.60
|
| Rate for Payer: NAPHCARE Commercial |
$412.20
|
| Rate for Payer: Preferred Network Access Commercial |
$632.04
|
| Rate for Payer: Quartz Beloit One Network |
$336.63
|
| Rate for Payer: Quartz Commercial |
$446.55
|
| Rate for Payer: Quartz Medicare Advantage |
$412.20
|
| Rate for Payer: The Alliance Commercial |
$2,748.00
|
| Rate for Payer: WEA Trust Commercial |
$377.85
|
| Rate for Payer: WPS Commercial |
$508.86
|
|
|
FEEDING TUBE MIC BOLUS G-TUBE 20FR ENFIT CONNECT 8110-20
|
Facility
|
IP
|
$687.00
|
|
| Hospital Charge Code |
5563637
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$336.63 |
| Max. Negotiated Rate |
$632.04 |
| Rate for Payer: Aetna Commercial |
$618.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$590.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$364.11
|
| Rate for Payer: Cash Price |
$206.10
|
| Rate for Payer: Cigna Commercial |
$632.04
|
| Rate for Payer: Health EOS Commercial |
$611.43
|
| Rate for Payer: HFN Commercial |
$632.04
|
| Rate for Payer: Multiplan Commercial |
$549.60
|
| Rate for Payer: NAPHCARE Commercial |
$412.20
|
| Rate for Payer: Preferred Network Access Commercial |
$632.04
|
| Rate for Payer: Quartz Beloit One Network |
$336.63
|
| Rate for Payer: Quartz Commercial |
$412.20
|
| Rate for Payer: WEA Trust Commercial |
$377.85
|
| Rate for Payer: WPS Commercial |
$508.86
|
|
|
FEEDING TUBE MIC J-TUBE 12FR 0200-12LV
|
Facility
|
IP
|
$2,056.00
|
|
|
Service Code
|
HCPCS B4087
|
| Hospital Charge Code |
5286774
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,007.44 |
| Max. Negotiated Rate |
$1,891.52 |
| Rate for Payer: Aetna Commercial |
$1,850.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,768.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,089.68
|
| Rate for Payer: Cash Price |
$616.80
|
| Rate for Payer: Cigna Commercial |
$1,891.52
|
| Rate for Payer: Health EOS Commercial |
$1,829.84
|
| Rate for Payer: HFN Commercial |
$1,891.52
|
| Rate for Payer: Multiplan Commercial |
$1,644.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,233.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,891.52
|
| Rate for Payer: Quartz Beloit One Network |
$1,007.44
|
| Rate for Payer: Quartz Commercial |
$1,233.60
|
| Rate for Payer: WEA Trust Commercial |
$1,130.80
|
| Rate for Payer: WPS Commercial |
$1,522.88
|
|
|
FEEDING TUBE MIC J-TUBE 12FR 0200-12LV
|
Facility
|
OP
|
$2,056.00
|
|
|
Service Code
|
HCPCS B4087
|
| Hospital Charge Code |
5286774
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$575.68 |
| Max. Negotiated Rate |
$8,224.00 |
| Rate for Payer: Aetna Commercial |
$1,850.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,768.16
|
| Rate for Payer: Aetna Managed Medicare |
$575.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,336.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,028.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$986.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,089.68
|
| Rate for Payer: Cash Price |
$616.80
|
| Rate for Payer: Cigna Commercial |
$1,891.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,150.54
|
| Rate for Payer: Health EOS Commercial |
$1,829.84
|
| Rate for Payer: HFN Commercial |
$1,891.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,542.00
|
| Rate for Payer: Multiplan Commercial |
$1,644.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,233.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,891.52
|
| Rate for Payer: Quartz Beloit One Network |
$1,007.44
|
| Rate for Payer: Quartz Commercial |
$1,336.40
|
| Rate for Payer: Quartz Medicare Advantage |
$1,233.60
|
| Rate for Payer: The Alliance Commercial |
$8,224.00
|
| Rate for Payer: WEA Trust Commercial |
$1,130.80
|
| Rate for Payer: WPS Commercial |
$1,522.88
|
|
|
FEEDING TUBE MIC J-TUBE 12FR ENFIT CONNECT 8200-12LV
|
Facility
|
IP
|
$1,796.00
|
|
|
Service Code
|
HCPCS B4087
|
| Hospital Charge Code |
5563635
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$880.04 |
| Max. Negotiated Rate |
$1,652.32 |
| Rate for Payer: Aetna Commercial |
$1,616.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,544.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$951.88
|
| Rate for Payer: Cash Price |
$538.80
|
| Rate for Payer: Cigna Commercial |
$1,652.32
|
| Rate for Payer: Health EOS Commercial |
$1,598.44
|
| Rate for Payer: HFN Commercial |
$1,652.32
|
| Rate for Payer: Multiplan Commercial |
$1,436.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,077.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,652.32
|
| Rate for Payer: Quartz Beloit One Network |
$880.04
|
| Rate for Payer: Quartz Commercial |
$1,077.60
|
| Rate for Payer: WEA Trust Commercial |
$987.80
|
| Rate for Payer: WPS Commercial |
$1,330.30
|
|
|
FEEDING TUBE MIC J-TUBE 12FR ENFIT CONNECT 8200-12LV
|
Facility
|
OP
|
$1,796.00
|
|
|
Service Code
|
HCPCS B4087
|
| Hospital Charge Code |
5563635
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$502.88 |
| Max. Negotiated Rate |
$7,184.00 |
| Rate for Payer: Aetna Commercial |
$1,616.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,544.56
|
| Rate for Payer: Aetna Managed Medicare |
$502.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,167.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$898.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$862.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$951.88
|
| Rate for Payer: Cash Price |
$538.80
|
| Rate for Payer: Cigna Commercial |
$1,652.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,005.04
|
| Rate for Payer: Health EOS Commercial |
$1,598.44
|
| Rate for Payer: HFN Commercial |
$1,652.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,347.00
|
| Rate for Payer: Multiplan Commercial |
$1,436.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,077.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,652.32
|
| Rate for Payer: Quartz Beloit One Network |
$880.04
|
| Rate for Payer: Quartz Commercial |
$1,167.40
|
| Rate for Payer: Quartz Medicare Advantage |
$1,077.60
|
| Rate for Payer: The Alliance Commercial |
$7,184.00
|
| Rate for Payer: WEA Trust Commercial |
$987.80
|
| Rate for Payer: WPS Commercial |
$1,330.30
|
|
