|
***FIBERSTITCH IMPLANT STRAIGHT *** DO NOT USE ***
|
Facility
|
IP
|
$5,063.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5685683
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,580.10 |
| Max. Negotiated Rate |
$4,844.28 |
| Rate for Payer: Aetna Commercial |
$4,738.97
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,528.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,790.73
|
| Rate for Payer: Cash Price |
$1,518.90
|
| Rate for Payer: Cigna Commercial |
$4,844.28
|
| Rate for Payer: Health EOS Commercial |
$4,686.31
|
| Rate for Payer: HFN Commercial |
$4,844.28
|
| Rate for Payer: Multiplan Commercial |
$4,212.42
|
| Rate for Payer: Preferred Network Access Commercial |
$4,844.28
|
| Rate for Payer: Quartz Beloit One Network |
$2,580.10
|
| Rate for Payer: Quartz Commercial |
$3,159.31
|
| Rate for Payer: WEA Trust Commercial |
$2,896.04
|
| Rate for Payer: WPS Commercial |
$3,900.03
|
|
|
***FIBERSTITCH IMPLANT STRAIGHT *** DO NOT USE ***
|
Facility
|
OP
|
$5,063.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5685683
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,474.35 |
| Max. Negotiated Rate |
$4,844.28 |
| Rate for Payer: Aetna Commercial |
$4,738.97
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,528.35
|
| Rate for Payer: Aetna Managed Medicare |
$1,474.35
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,422.59
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,632.76
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,527.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,790.73
|
| Rate for Payer: Cash Price |
$1,518.90
|
| Rate for Payer: Cigna Commercial |
$4,844.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,946.67
|
| Rate for Payer: Health EOS Commercial |
$4,686.31
|
| Rate for Payer: HFN Commercial |
$4,844.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,949.14
|
| Rate for Payer: Multiplan Commercial |
$4,212.42
|
| Rate for Payer: NAPHCARE Commercial |
$3,159.31
|
| Rate for Payer: Preferred Network Access Commercial |
$4,844.28
|
| Rate for Payer: Quartz Beloit One Network |
$2,580.10
|
| Rate for Payer: Quartz Commercial |
$3,422.59
|
| Rate for Payer: Quartz Medicare Advantage |
$3,159.31
|
| Rate for Payer: The Alliance Commercial |
$2,632.76
|
| Rate for Payer: WEA Trust Commercial |
$2,896.04
|
| Rate for Payer: WPS Commercial |
$3,900.03
|
|
|
FIBERTAG TIGHTROPE II ABS AR-1588TNT2
|
Facility
|
IP
|
$3,830.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6216983
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,951.77 |
| Max. Negotiated Rate |
$3,664.54 |
| Rate for Payer: Aetna Commercial |
$3,584.88
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,425.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,111.10
|
| Rate for Payer: Cash Price |
$1,149.00
|
| Rate for Payer: Cigna Commercial |
$3,664.54
|
| Rate for Payer: Health EOS Commercial |
$3,545.05
|
| Rate for Payer: HFN Commercial |
$3,664.54
|
| Rate for Payer: Multiplan Commercial |
$3,186.56
|
| Rate for Payer: Preferred Network Access Commercial |
$3,664.54
|
| Rate for Payer: Quartz Beloit One Network |
$1,951.77
|
| Rate for Payer: Quartz Commercial |
$2,389.92
|
| Rate for Payer: WEA Trust Commercial |
$2,190.76
|
| Rate for Payer: WPS Commercial |
$2,950.25
|
|
|
FIBERTAG TIGHTROPE II ABS AR-1588TNT2
|
Facility
|
OP
|
$3,830.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6216983
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,115.30 |
| Max. Negotiated Rate |
$3,664.54 |
| Rate for Payer: Aetna Commercial |
$3,584.88
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,425.55
|
| Rate for Payer: Aetna Managed Medicare |
$1,115.30
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,589.08
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,991.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,911.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,111.10
|
| Rate for Payer: Cash Price |
$1,149.00
|
| Rate for Payer: Cigna Commercial |
$3,664.54
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,229.06
|
| Rate for Payer: Health EOS Commercial |
$3,545.05
|
| Rate for Payer: HFN Commercial |
$3,664.54
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,987.40
|
| Rate for Payer: Multiplan Commercial |
$3,186.56
|
| Rate for Payer: NAPHCARE Commercial |
$2,389.92
|
| Rate for Payer: Preferred Network Access Commercial |
$3,664.54
|
| Rate for Payer: Quartz Beloit One Network |
$1,951.77
|
| Rate for Payer: Quartz Commercial |
$2,589.08
|
| Rate for Payer: Quartz Medicare Advantage |
$2,389.92
|
| Rate for Payer: The Alliance Commercial |
$1,991.60
|
| Rate for Payer: WEA Trust Commercial |
$2,190.76
|
| Rate for Payer: WPS Commercial |
$2,950.25
|
|
|
FIBERTAG TIGHTROPE II WITH ATTACHED NEEDLE AR-1588RTT2
|
Facility
|
OP
|
$4,220.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
6220211
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,228.86 |
| Max. Negotiated Rate |
$4,037.70 |
| Rate for Payer: Aetna Commercial |
$3,949.92
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,774.37
|
| Rate for Payer: Aetna Managed Medicare |
$1,228.86
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,852.72
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,194.40
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,106.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,326.06
|
| Rate for Payer: Cash Price |
$1,266.00
|
| Rate for Payer: Cigna Commercial |
$4,037.70
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,456.04
|
| Rate for Payer: Health EOS Commercial |
$3,906.03
|
| Rate for Payer: HFN Commercial |
$4,037.70
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,291.60
|
| Rate for Payer: Multiplan Commercial |
$3,511.04
|
| Rate for Payer: NAPHCARE Commercial |
$2,633.28
|
| Rate for Payer: Preferred Network Access Commercial |
$4,037.70
|
| Rate for Payer: Quartz Beloit One Network |
$2,150.51
|
| Rate for Payer: Quartz Commercial |
$2,852.72
|
| Rate for Payer: Quartz Medicare Advantage |
$2,633.28
|
| Rate for Payer: The Alliance Commercial |
$2,194.40
|
| Rate for Payer: WEA Trust Commercial |
$2,413.84
|
| Rate for Payer: WPS Commercial |
$3,250.67
|
|
|
FIBERTAG TIGHTROPE II WITH ATTACHED NEEDLE AR-1588RTT2
|
Facility
|
IP
|
$4,220.00
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
6220211
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,150.51 |
| Max. Negotiated Rate |
$4,037.70 |
| Rate for Payer: Aetna Commercial |
$3,949.92
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,774.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,326.06
|
| Rate for Payer: Cash Price |
$1,266.00
|
| Rate for Payer: Cigna Commercial |
$4,037.70
|
| Rate for Payer: Health EOS Commercial |
$3,906.03
|
| Rate for Payer: HFN Commercial |
$4,037.70
|
| Rate for Payer: Multiplan Commercial |
$3,511.04
|
| Rate for Payer: Preferred Network Access Commercial |
$4,037.70
|
| Rate for Payer: Quartz Beloit One Network |
$2,150.51
|
| Rate for Payer: Quartz Commercial |
$2,633.28
|
| Rate for Payer: WEA Trust Commercial |
$2,413.84
|
| Rate for Payer: WPS Commercial |
$3,250.67
|
|
|
FIBERTAG TIGHTROPE II WITH INTERNALBRACE AR-1588RTT2-IB
|
Facility
|
IP
|
$5,142.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6216982
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,620.36 |
| Max. Negotiated Rate |
$4,919.87 |
| Rate for Payer: Aetna Commercial |
$4,812.91
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,599.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,834.27
|
| Rate for Payer: Cash Price |
$1,542.60
|
| Rate for Payer: Cigna Commercial |
$4,919.87
|
| Rate for Payer: Health EOS Commercial |
$4,759.44
|
| Rate for Payer: HFN Commercial |
$4,919.87
|
| Rate for Payer: Multiplan Commercial |
$4,278.14
|
| Rate for Payer: Preferred Network Access Commercial |
$4,919.87
|
| Rate for Payer: Quartz Beloit One Network |
$2,620.36
|
| Rate for Payer: Quartz Commercial |
$3,208.61
|
| Rate for Payer: WEA Trust Commercial |
$2,941.22
|
| Rate for Payer: WPS Commercial |
$3,960.88
|
|
|
FIBERTAG TIGHTROPE II WITH INTERNALBRACE AR-1588RTT2-IB
|
Facility
|
OP
|
$5,142.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6216982
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,497.35 |
| Max. Negotiated Rate |
$4,919.87 |
| Rate for Payer: Aetna Commercial |
$4,812.91
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,599.00
|
| Rate for Payer: Aetna Managed Medicare |
$1,497.35
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,475.99
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,673.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,566.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,834.27
|
| Rate for Payer: Cash Price |
$1,542.60
|
| Rate for Payer: Cigna Commercial |
$4,919.87
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,992.64
|
| Rate for Payer: Health EOS Commercial |
$4,759.44
|
| Rate for Payer: HFN Commercial |
$4,919.87
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,010.76
|
| Rate for Payer: Multiplan Commercial |
$4,278.14
|
| Rate for Payer: NAPHCARE Commercial |
$3,208.61
|
| Rate for Payer: Preferred Network Access Commercial |
$4,919.87
|
| Rate for Payer: Quartz Beloit One Network |
$2,620.36
|
| Rate for Payer: Quartz Commercial |
$3,475.99
|
| Rate for Payer: Quartz Medicare Advantage |
$3,208.61
|
| Rate for Payer: The Alliance Commercial |
$2,673.84
|
| Rate for Payer: WEA Trust Commercial |
$2,941.22
|
| Rate for Payer: WPS Commercial |
$3,960.88
|
|
|
FIBERTAPE 2MM WITH BRAIDED SUTURE BLUE LONG NEEDLE AR-7237-17LN
|
Facility
|
OP
|
$2,969.00
|
|
| Hospital Charge Code |
5459424
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$864.57 |
| Max. Negotiated Rate |
$2,840.74 |
| Rate for Payer: Aetna Commercial |
$2,778.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,655.47
|
| Rate for Payer: Aetna Managed Medicare |
$864.57
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,007.04
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,543.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,482.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,636.51
|
| Rate for Payer: Cash Price |
$890.70
|
| Rate for Payer: Cigna Commercial |
$2,840.74
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,727.96
|
| Rate for Payer: Health EOS Commercial |
$2,748.11
|
| Rate for Payer: HFN Commercial |
$2,840.74
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,315.82
|
| Rate for Payer: Multiplan Commercial |
$2,470.21
|
| Rate for Payer: NAPHCARE Commercial |
$1,852.66
|
| Rate for Payer: Preferred Network Access Commercial |
$2,840.74
|
| Rate for Payer: Quartz Beloit One Network |
$1,513.00
|
| Rate for Payer: Quartz Commercial |
$2,007.04
|
| Rate for Payer: Quartz Medicare Advantage |
$1,852.66
|
| Rate for Payer: The Alliance Commercial |
$1,543.88
|
| Rate for Payer: WEA Trust Commercial |
$1,698.27
|
| Rate for Payer: WPS Commercial |
$2,287.02
|
|
|
FIBERTAPE 2MM WITH BRAIDED SUTURE BLUE LONG NEEDLE AR-7237-17LN
|
Facility
|
IP
|
$2,969.00
|
|
| Hospital Charge Code |
5459424
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,513.00 |
| Max. Negotiated Rate |
$2,840.74 |
| Rate for Payer: Aetna Commercial |
$2,778.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,655.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,636.51
|
| Rate for Payer: Cash Price |
$890.70
|
| Rate for Payer: Cigna Commercial |
$2,840.74
|
| Rate for Payer: Health EOS Commercial |
$2,748.11
|
| Rate for Payer: HFN Commercial |
$2,840.74
|
| Rate for Payer: Multiplan Commercial |
$2,470.21
|
| Rate for Payer: Preferred Network Access Commercial |
$2,840.74
|
| Rate for Payer: Quartz Beloit One Network |
$1,513.00
|
| Rate for Payer: Quartz Commercial |
$1,852.66
|
| Rate for Payer: WEA Trust Commercial |
$1,698.27
|
| Rate for Payer: WPS Commercial |
$2,287.02
|
|
|
Fibrinogen
|
Facility
|
OP
|
$130.00
|
|
|
Service Code
|
CPT 85384
|
| Hospital Charge Code |
633728
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.11 |
| Max. Negotiated Rate |
$124.38 |
| Rate for Payer: Aetna Commercial |
$121.68
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$116.27
|
| Rate for Payer: Aetna Managed Medicare |
$10.11
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$37.91
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$17.69
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$16.78
|
| Rate for Payer: Anthem Medicare Advantage |
$10.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$71.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$10.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$10.11
|
| Rate for Payer: Cash Price |
$39.00
|
| Rate for Payer: Cash Price |
$39.00
|
| Rate for Payer: Cigna Commercial |
$124.38
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$10.11
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$75.66
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$10.11
|
| Rate for Payer: Health EOS Commercial |
$120.33
|
| Rate for Payer: HFN Commercial |
$124.38
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$37.60
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$10.11
|
| Rate for Payer: Independent Care Health Plan Medicare |
$10.11
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$10.11
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$10.11
|
| Rate for Payer: Multiplan Commercial |
$108.16
|
| Rate for Payer: NAPHCARE Commercial |
$15.16
|
| Rate for Payer: Preferred Network Access Commercial |
$124.38
|
| Rate for Payer: Quartz Beloit One Network |
$66.25
|
| Rate for Payer: Quartz Commercial |
$87.88
|
| Rate for Payer: Quartz Medicare Advantage |
$10.11
|
| Rate for Payer: The Alliance Commercial |
$40.44
|
| Rate for Payer: United Healthcare Medicare Advantage |
$10.11
|
| Rate for Payer: United Healthcare PPO |
$101.40
|
| Rate for Payer: WEA Trust Commercial |
$74.36
|
| Rate for Payer: Wellcare Medicare |
$10.11
|
| Rate for Payer: WPS Commercial |
$100.14
|
|
|
Fibrinogen
|
Facility
|
IP
|
$130.00
|
|
|
Service Code
|
CPT 85384
|
| Hospital Charge Code |
633728
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$66.25 |
| Max. Negotiated Rate |
$124.38 |
| Rate for Payer: Aetna Commercial |
$121.68
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$116.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$71.66
|
| Rate for Payer: Cash Price |
$39.00
|
| Rate for Payer: Cigna Commercial |
$124.38
|
| Rate for Payer: Health EOS Commercial |
$120.33
|
| Rate for Payer: HFN Commercial |
$124.38
|
| Rate for Payer: Multiplan Commercial |
$108.16
|
| Rate for Payer: Preferred Network Access Commercial |
$124.38
|
| Rate for Payer: Quartz Beloit One Network |
$66.25
|
| Rate for Payer: Quartz Commercial |
$81.12
|
| Rate for Payer: WEA Trust Commercial |
$74.36
|
| Rate for Payer: WPS Commercial |
$100.14
|
|
|
Fibrinogen
|
Professional
|
Both
|
$130.00
|
|
|
Service Code
|
CPT 85384
|
| Hospital Charge Code |
633728
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.11 |
| Max. Negotiated Rate |
$128.44 |
| Rate for Payer: Aetna Commercial |
$128.44
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$116.27
|
| Rate for Payer: Aetna Managed Medicare |
$10.11
|
| Rate for Payer: Anthem Medicare Advantage |
$10.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$10.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$10.11
|
| Rate for Payer: Cash Price |
$39.00
|
| Rate for Payer: Cash Price |
$39.00
|
| Rate for Payer: Cigna Commercial |
$128.44
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$67.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$10.11
|
| Rate for Payer: Health EOS Commercial |
$123.03
|
| Rate for Payer: HFN Commercial |
$128.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$35.68
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$35.68
|
| Rate for Payer: Independent Care Health Plan Medicare |
$10.11
|
| Rate for Payer: Multiplan Commercial |
$108.16
|
| Rate for Payer: NAPHCARE Commercial |
$15.16
|
| Rate for Payer: Preferred Network Access Commercial |
$128.44
|
| Rate for Payer: Quartz Beloit One Network |
$59.49
|
| Rate for Payer: Quartz Commercial |
$77.06
|
| Rate for Payer: Quartz Medicare Advantage |
$10.11
|
| Rate for Payer: The Alliance Commercial |
$39.93
|
| Rate for Payer: United Healthcare Medicare Advantage |
$10.11
|
| Rate for Payer: WEA Trust Commercial |
$74.36
|
| Rate for Payer: WPS Commercial |
$44.48
|
|
|
Fibrinogen Degradation Products, Semi Quantitative
|
Facility
|
IP
|
$111.00
|
|
|
Service Code
|
CPT 85362
|
| Hospital Charge Code |
3949340
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$56.57 |
| Max. Negotiated Rate |
$106.20 |
| Rate for Payer: Aetna Commercial |
$103.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$99.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$61.18
|
| Rate for Payer: Cash Price |
$33.30
|
| Rate for Payer: Cigna Commercial |
$106.20
|
| Rate for Payer: Health EOS Commercial |
$102.74
|
| Rate for Payer: HFN Commercial |
$106.20
|
| Rate for Payer: Multiplan Commercial |
$92.35
|
| Rate for Payer: Preferred Network Access Commercial |
$106.20
|
| Rate for Payer: Quartz Beloit One Network |
$56.57
|
| Rate for Payer: Quartz Commercial |
$69.26
|
| Rate for Payer: WEA Trust Commercial |
$63.49
|
| Rate for Payer: WPS Commercial |
$85.50
|
|
|
Fibrinogen Degradation Products, Semi Quantitative
|
Facility
|
OP
|
$111.00
|
|
|
Service Code
|
CPT 85362
|
| Hospital Charge Code |
3949340
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$7.17 |
| Max. Negotiated Rate |
$106.20 |
| Rate for Payer: Aetna Commercial |
$103.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$99.28
|
| Rate for Payer: Aetna Managed Medicare |
$7.17
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$26.87
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$12.54
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$11.89
|
| Rate for Payer: Anthem Medicare Advantage |
$7.17
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$61.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$7.17
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$7.17
|
| Rate for Payer: Cash Price |
$33.30
|
| Rate for Payer: Cash Price |
$33.30
|
| Rate for Payer: Cigna Commercial |
$106.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$7.17
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$64.60
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$7.17
|
| Rate for Payer: Health EOS Commercial |
$102.74
|
| Rate for Payer: HFN Commercial |
$106.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$26.66
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$7.17
|
| Rate for Payer: Independent Care Health Plan Medicare |
$7.17
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$7.17
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$7.17
|
| Rate for Payer: Multiplan Commercial |
$92.35
|
| Rate for Payer: NAPHCARE Commercial |
$10.75
|
| Rate for Payer: Preferred Network Access Commercial |
$106.20
|
| Rate for Payer: Quartz Beloit One Network |
$56.57
|
| Rate for Payer: Quartz Commercial |
$75.04
|
| Rate for Payer: Quartz Medicare Advantage |
$7.17
|
| Rate for Payer: The Alliance Commercial |
$28.66
|
| Rate for Payer: United Healthcare Medicare Advantage |
$7.17
|
| Rate for Payer: United Healthcare PPO |
$86.58
|
| Rate for Payer: WEA Trust Commercial |
$63.49
|
| Rate for Payer: Wellcare Medicare |
$7.17
|
| Rate for Payer: WPS Commercial |
$85.50
|
|
|
Fibrinogen Degradation Products, Semi Quantitative
|
Professional
|
Both
|
$111.00
|
|
|
Service Code
|
CPT 85362
|
| Hospital Charge Code |
3949340
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$7.17 |
| Max. Negotiated Rate |
$109.67 |
| Rate for Payer: Aetna Commercial |
$109.67
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$99.28
|
| Rate for Payer: Aetna Managed Medicare |
$7.17
|
| Rate for Payer: Anthem Medicare Advantage |
$7.17
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$7.17
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$7.17
|
| Rate for Payer: Cash Price |
$33.30
|
| Rate for Payer: Cash Price |
$33.30
|
| Rate for Payer: Cigna Commercial |
$109.67
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$57.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$7.17
|
| Rate for Payer: Health EOS Commercial |
$105.05
|
| Rate for Payer: HFN Commercial |
$109.67
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$25.29
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$25.29
|
| Rate for Payer: Independent Care Health Plan Medicare |
$7.17
|
| Rate for Payer: Multiplan Commercial |
$92.35
|
| Rate for Payer: NAPHCARE Commercial |
$10.75
|
| Rate for Payer: Preferred Network Access Commercial |
$109.67
|
| Rate for Payer: Quartz Beloit One Network |
$50.79
|
| Rate for Payer: Quartz Commercial |
$65.80
|
| Rate for Payer: Quartz Medicare Advantage |
$7.17
|
| Rate for Payer: The Alliance Commercial |
$28.30
|
| Rate for Payer: United Healthcare Medicare Advantage |
$7.17
|
| Rate for Payer: WEA Trust Commercial |
$63.49
|
| Rate for Payer: WPS Commercial |
$31.53
|
|
|
FIBULA BONE GRAFTING
|
Facility
|
OP
|
$4,170.00
|
|
| Hospital Charge Code |
2959859
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,214.30 |
| Max. Negotiated Rate |
$3,989.86 |
| Rate for Payer: Aetna Commercial |
$3,903.12
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,729.65
|
| Rate for Payer: Aetna Managed Medicare |
$1,214.30
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,818.92
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,168.40
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,081.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,298.50
|
| Rate for Payer: Cash Price |
$1,251.00
|
| Rate for Payer: Cigna Commercial |
$3,989.86
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,426.94
|
| Rate for Payer: Health EOS Commercial |
$3,859.75
|
| Rate for Payer: HFN Commercial |
$3,989.86
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,252.60
|
| Rate for Payer: Multiplan Commercial |
$3,469.44
|
| Rate for Payer: NAPHCARE Commercial |
$2,602.08
|
| Rate for Payer: Preferred Network Access Commercial |
$3,989.86
|
| Rate for Payer: Quartz Beloit One Network |
$2,125.03
|
| Rate for Payer: Quartz Commercial |
$2,818.92
|
| Rate for Payer: Quartz Medicare Advantage |
$2,602.08
|
| Rate for Payer: The Alliance Commercial |
$2,168.40
|
| Rate for Payer: WEA Trust Commercial |
$2,385.24
|
| Rate for Payer: WPS Commercial |
$3,212.15
|
|
|
FIBULA BONE GRAFTING
|
Facility
|
IP
|
$4,170.00
|
|
| Hospital Charge Code |
2959859
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,125.03 |
| Max. Negotiated Rate |
$3,989.86 |
| Rate for Payer: Aetna Commercial |
$3,903.12
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,729.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,298.50
|
| Rate for Payer: Cash Price |
$1,251.00
|
| Rate for Payer: Cigna Commercial |
$3,989.86
|
| Rate for Payer: Health EOS Commercial |
$3,859.75
|
| Rate for Payer: HFN Commercial |
$3,989.86
|
| Rate for Payer: Multiplan Commercial |
$3,469.44
|
| Rate for Payer: Preferred Network Access Commercial |
$3,989.86
|
| Rate for Payer: Quartz Beloit One Network |
$2,125.03
|
| Rate for Payer: Quartz Commercial |
$2,602.08
|
| Rate for Payer: WEA Trust Commercial |
$2,385.24
|
| Rate for Payer: WPS Commercial |
$3,212.15
|
|
|
FIBULA, EPIPHYSIODESIS
|
Facility
|
IP
|
$4,560.00
|
|
| Hospital Charge Code |
2960014
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,323.78 |
| Max. Negotiated Rate |
$4,363.01 |
| Rate for Payer: Aetna Commercial |
$4,268.16
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,078.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,513.47
|
| Rate for Payer: Cash Price |
$1,368.00
|
| Rate for Payer: Cigna Commercial |
$4,363.01
|
| Rate for Payer: Health EOS Commercial |
$4,220.74
|
| Rate for Payer: HFN Commercial |
$4,363.01
|
| Rate for Payer: Multiplan Commercial |
$3,793.92
|
| Rate for Payer: Preferred Network Access Commercial |
$4,363.01
|
| Rate for Payer: Quartz Beloit One Network |
$2,323.78
|
| Rate for Payer: Quartz Commercial |
$2,845.44
|
| Rate for Payer: WEA Trust Commercial |
$2,608.32
|
| Rate for Payer: WPS Commercial |
$3,512.57
|
|
|
FIBULA, EPIPHYSIODESIS
|
Facility
|
OP
|
$4,560.00
|
|
| Hospital Charge Code |
2960014
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,327.87 |
| Max. Negotiated Rate |
$4,363.01 |
| Rate for Payer: Aetna Commercial |
$4,268.16
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,078.46
|
| Rate for Payer: Aetna Managed Medicare |
$1,327.87
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,082.56
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,371.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,276.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,513.47
|
| Rate for Payer: Cash Price |
$1,368.00
|
| Rate for Payer: Cigna Commercial |
$4,363.01
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,653.92
|
| Rate for Payer: Health EOS Commercial |
$4,220.74
|
| Rate for Payer: HFN Commercial |
$4,363.01
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,556.80
|
| Rate for Payer: Multiplan Commercial |
$3,793.92
|
| Rate for Payer: NAPHCARE Commercial |
$2,845.44
|
| Rate for Payer: Preferred Network Access Commercial |
$4,363.01
|
| Rate for Payer: Quartz Beloit One Network |
$2,323.78
|
| Rate for Payer: Quartz Commercial |
$3,082.56
|
| Rate for Payer: Quartz Medicare Advantage |
$2,845.44
|
| Rate for Payer: The Alliance Commercial |
$2,371.20
|
| Rate for Payer: WEA Trust Commercial |
$2,608.32
|
| Rate for Payer: WPS Commercial |
$3,512.57
|
|
|
FIBULA OSTEOTOMY
|
Facility
|
IP
|
$4,560.00
|
|
| Hospital Charge Code |
2960287
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,323.78 |
| Max. Negotiated Rate |
$4,363.01 |
| Rate for Payer: Aetna Commercial |
$4,268.16
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,078.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,513.47
|
| Rate for Payer: Cash Price |
$1,368.00
|
| Rate for Payer: Cigna Commercial |
$4,363.01
|
| Rate for Payer: Health EOS Commercial |
$4,220.74
|
| Rate for Payer: HFN Commercial |
$4,363.01
|
| Rate for Payer: Multiplan Commercial |
$3,793.92
|
| Rate for Payer: Preferred Network Access Commercial |
$4,363.01
|
| Rate for Payer: Quartz Beloit One Network |
$2,323.78
|
| Rate for Payer: Quartz Commercial |
$2,845.44
|
| Rate for Payer: WEA Trust Commercial |
$2,608.32
|
| Rate for Payer: WPS Commercial |
$3,512.57
|
|
|
FIBULA OSTEOTOMY
|
Facility
|
OP
|
$4,560.00
|
|
| Hospital Charge Code |
2960287
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,327.87 |
| Max. Negotiated Rate |
$4,363.01 |
| Rate for Payer: Aetna Commercial |
$4,268.16
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,078.46
|
| Rate for Payer: Aetna Managed Medicare |
$1,327.87
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,082.56
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,371.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,276.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,513.47
|
| Rate for Payer: Cash Price |
$1,368.00
|
| Rate for Payer: Cigna Commercial |
$4,363.01
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,653.92
|
| Rate for Payer: Health EOS Commercial |
$4,220.74
|
| Rate for Payer: HFN Commercial |
$4,363.01
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,556.80
|
| Rate for Payer: Multiplan Commercial |
$3,793.92
|
| Rate for Payer: NAPHCARE Commercial |
$2,845.44
|
| Rate for Payer: Preferred Network Access Commercial |
$4,363.01
|
| Rate for Payer: Quartz Beloit One Network |
$2,323.78
|
| Rate for Payer: Quartz Commercial |
$3,082.56
|
| Rate for Payer: Quartz Medicare Advantage |
$2,845.44
|
| Rate for Payer: The Alliance Commercial |
$2,371.20
|
| Rate for Payer: WEA Trust Commercial |
$2,608.32
|
| Rate for Payer: WPS Commercial |
$3,512.57
|
|
|
Fiducial Markers
|
Facility
|
IP
|
$2,776.00
|
|
|
Service Code
|
CPT 49411 TC
|
| Hospital Charge Code |
5677659
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$1,414.65 |
| Max. Negotiated Rate |
$2,656.08 |
| Rate for Payer: Aetna Commercial |
$2,598.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,482.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,530.13
|
| Rate for Payer: Cash Price |
$832.80
|
| Rate for Payer: Cigna Commercial |
$2,656.08
|
| Rate for Payer: Health EOS Commercial |
$2,569.47
|
| Rate for Payer: HFN Commercial |
$2,656.08
|
| Rate for Payer: Multiplan Commercial |
$2,309.63
|
| Rate for Payer: Preferred Network Access Commercial |
$2,656.08
|
| Rate for Payer: Quartz Beloit One Network |
$1,414.65
|
| Rate for Payer: Quartz Commercial |
$1,732.22
|
| Rate for Payer: WEA Trust Commercial |
$1,587.87
|
| Rate for Payer: WPS Commercial |
$2,138.35
|
|
|
Fiducial Markers
|
Facility
|
OP
|
$2,776.00
|
|
|
Service Code
|
CPT 49411 TC
|
| Hospital Charge Code |
5677659
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$808.37 |
| Max. Negotiated Rate |
$4,386.95 |
| Rate for Payer: Aetna Commercial |
$2,598.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,482.85
|
| Rate for Payer: Aetna Managed Medicare |
$808.37
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,333.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,689.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,552.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,530.13
|
| Rate for Payer: Cash Price |
$832.80
|
| Rate for Payer: Cash Price |
$832.80
|
| Rate for Payer: Cash Price |
$832.80
|
| Rate for Payer: Cash Price |
$832.80
|
| Rate for Payer: Cigna Commercial |
$2,656.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Health EOS Commercial |
$2,569.47
|
| Rate for Payer: HFN Commercial |
$2,656.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,165.28
|
| Rate for Payer: Multiplan Commercial |
$2,309.63
|
| Rate for Payer: NAPHCARE Commercial |
$1,732.22
|
| Rate for Payer: Preferred Network Access Commercial |
$2,656.08
|
| Rate for Payer: Quartz Beloit One Network |
$1,414.65
|
| Rate for Payer: Quartz Commercial |
$1,876.58
|
| Rate for Payer: Quartz Medicare Advantage |
$1,732.22
|
| Rate for Payer: The Alliance Commercial |
$1,443.52
|
| Rate for Payer: United Healthcare PPO |
$2,147.60
|
| Rate for Payer: WEA Trust Commercial |
$1,587.87
|
| Rate for Payer: WPS Commercial |
$2,138.35
|
|
|
Fiducial Markers
|
Professional
|
Both
|
$2,776.00
|
|
|
Service Code
|
CPT 49411 TC
|
| Hospital Charge Code |
5677659
|
|
Hospital Revenue Code
|
350
|
| Min. Negotiated Rate |
$439.12 |
| Max. Negotiated Rate |
$2,742.69 |
| Rate for Payer: Aetna Commercial |
$2,742.69
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,482.85
|
| Rate for Payer: Cash Price |
$832.80
|
| Rate for Payer: Cash Price |
$832.80
|
| Rate for Payer: Cash Price |
$832.80
|
| Rate for Payer: Cigna Commercial |
$2,742.69
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$439.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,732.22
|
| Rate for Payer: Health EOS Commercial |
$2,627.21
|
| Rate for Payer: HFN Commercial |
$2,742.69
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$643.67
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$643.67
|
| Rate for Payer: Multiplan Commercial |
$2,309.63
|
| Rate for Payer: Preferred Network Access Commercial |
$2,742.69
|
| Rate for Payer: Quartz Beloit One Network |
$1,270.30
|
| Rate for Payer: Quartz Commercial |
$1,645.61
|
| Rate for Payer: The Alliance Commercial |
$1,443.52
|
| Rate for Payer: United Healthcare Medicaid |
$439.12
|
| Rate for Payer: WEA Trust Commercial |
$1,587.87
|
| Rate for Payer: WPS Commercial |
$2,138.35
|
|
