|
FLAP CLOSURE
|
Facility
|
IP
|
$1,084.00
|
|
| Hospital Charge Code |
2959783
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$552.41 |
| Max. Negotiated Rate |
$1,037.17 |
| Rate for Payer: Aetna Commercial |
$1,014.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$969.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$597.50
|
| Rate for Payer: Cash Price |
$325.20
|
| Rate for Payer: Cigna Commercial |
$1,037.17
|
| Rate for Payer: Health EOS Commercial |
$1,003.35
|
| Rate for Payer: HFN Commercial |
$1,037.17
|
| Rate for Payer: Multiplan Commercial |
$901.89
|
| Rate for Payer: Preferred Network Access Commercial |
$1,037.17
|
| Rate for Payer: Quartz Beloit One Network |
$552.41
|
| Rate for Payer: Quartz Commercial |
$676.42
|
| Rate for Payer: WEA Trust Commercial |
$620.05
|
| Rate for Payer: WPS Commercial |
$835.01
|
|
|
FLAP CLOSURE
|
Facility
|
OP
|
$1,084.00
|
|
| Hospital Charge Code |
2959783
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$315.66 |
| Max. Negotiated Rate |
$1,037.17 |
| Rate for Payer: Aetna Commercial |
$1,014.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$969.53
|
| Rate for Payer: Aetna Managed Medicare |
$315.66
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$732.78
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$563.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$541.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$597.50
|
| Rate for Payer: Cash Price |
$325.20
|
| Rate for Payer: Cigna Commercial |
$1,037.17
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$630.89
|
| Rate for Payer: Health EOS Commercial |
$1,003.35
|
| Rate for Payer: HFN Commercial |
$1,037.17
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$845.52
|
| Rate for Payer: Multiplan Commercial |
$901.89
|
| Rate for Payer: NAPHCARE Commercial |
$676.42
|
| Rate for Payer: Preferred Network Access Commercial |
$1,037.17
|
| Rate for Payer: Quartz Beloit One Network |
$552.41
|
| Rate for Payer: Quartz Commercial |
$732.78
|
| Rate for Payer: Quartz Medicare Advantage |
$676.42
|
| Rate for Payer: The Alliance Commercial |
$563.68
|
| Rate for Payer: WEA Trust Commercial |
$620.05
|
| Rate for Payer: WPS Commercial |
$835.01
|
|
|
FLAT FOOT RECONSTRUCTION
|
Facility
|
OP
|
$4,560.00
|
|
| Hospital Charge Code |
2960338
|
|
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
|
|
|
FLAT FOOT RECONSTRUCTION
|
Facility
|
IP
|
$4,560.00
|
|
| Hospital Charge Code |
2960338
|
|
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
|
|
|
FLCN Sequencing and Del/Dup / 38806
|
Professional
|
Both
|
$397.00
|
|
|
Service Code
|
CPT 81479
|
| Hospital Charge Code |
6179671
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$181.67 |
| Max. Negotiated Rate |
$392.24 |
| Rate for Payer: Aetna Commercial |
$392.24
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$355.08
|
| Rate for Payer: Cash Price |
$119.10
|
| Rate for Payer: Cigna Commercial |
$392.24
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$206.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$247.73
|
| Rate for Payer: Health EOS Commercial |
$375.72
|
| Rate for Payer: HFN Commercial |
$392.24
|
| Rate for Payer: Multiplan Commercial |
$330.30
|
| Rate for Payer: Preferred Network Access Commercial |
$392.24
|
| Rate for Payer: Quartz Beloit One Network |
$181.67
|
| Rate for Payer: Quartz Commercial |
$235.34
|
| Rate for Payer: The Alliance Commercial |
$206.44
|
| Rate for Payer: WEA Trust Commercial |
$227.08
|
| Rate for Payer: WPS Commercial |
$305.81
|
|
|
FLCN Sequencing and Del/Dup / 38806
|
Facility
|
OP
|
$397.00
|
|
|
Service Code
|
CPT 81479
|
| Hospital Charge Code |
6179671
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$115.61 |
| Max. Negotiated Rate |
$379.85 |
| Rate for Payer: Aetna Commercial |
$371.59
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$355.08
|
| Rate for Payer: Aetna Managed Medicare |
$115.61
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$268.37
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$206.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$198.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$218.83
|
| Rate for Payer: Cash Price |
$119.10
|
| Rate for Payer: Cigna Commercial |
$379.85
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$231.05
|
| Rate for Payer: Health EOS Commercial |
$367.46
|
| Rate for Payer: HFN Commercial |
$379.85
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$309.66
|
| Rate for Payer: Multiplan Commercial |
$330.30
|
| Rate for Payer: NAPHCARE Commercial |
$247.73
|
| Rate for Payer: Preferred Network Access Commercial |
$379.85
|
| Rate for Payer: Quartz Beloit One Network |
$202.31
|
| Rate for Payer: Quartz Commercial |
$268.37
|
| Rate for Payer: Quartz Medicare Advantage |
$247.73
|
| Rate for Payer: The Alliance Commercial |
$206.44
|
| Rate for Payer: United Healthcare PPO |
$309.66
|
| Rate for Payer: WEA Trust Commercial |
$227.08
|
| Rate for Payer: WPS Commercial |
$305.81
|
|
|
FLCN Sequencing and Del/Dup / 38806
|
Facility
|
IP
|
$397.00
|
|
|
Service Code
|
CPT 81479
|
| Hospital Charge Code |
6179671
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$202.31 |
| Max. Negotiated Rate |
$379.85 |
| Rate for Payer: Aetna Commercial |
$371.59
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$355.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$218.83
|
| Rate for Payer: Cash Price |
$119.10
|
| Rate for Payer: Cigna Commercial |
$379.85
|
| Rate for Payer: Health EOS Commercial |
$367.46
|
| Rate for Payer: HFN Commercial |
$379.85
|
| Rate for Payer: Multiplan Commercial |
$330.30
|
| Rate for Payer: Preferred Network Access Commercial |
$379.85
|
| Rate for Payer: Quartz Beloit One Network |
$202.31
|
| Rate for Payer: Quartz Commercial |
$247.73
|
| Rate for Payer: WEA Trust Commercial |
$227.08
|
| Rate for Payer: WPS Commercial |
$305.81
|
|
|
Flebogamma 0.5 gram Charge
|
Facility
|
OP
|
$115.00
|
|
|
Service Code
|
HCPCS J1572
|
| Hospital Charge Code |
2958850
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$57.41 |
| Max. Negotiated Rate |
$377.48 |
| Rate for Payer: Aetna Commercial |
$107.64
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$102.86
|
| Rate for Payer: Aetna Managed Medicare |
$94.37
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$77.74
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$59.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$57.41
|
| Rate for Payer: Anthem Medicare Advantage |
$94.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$63.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$94.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$94.37
|
| Rate for Payer: Cash Price |
$34.50
|
| Rate for Payer: Cash Price |
$34.50
|
| Rate for Payer: Cigna Commercial |
$110.03
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$94.37
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$66.93
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$94.37
|
| Rate for Payer: Health EOS Commercial |
$106.44
|
| Rate for Payer: HFN Commercial |
$110.03
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$351.05
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$94.37
|
| Rate for Payer: Independent Care Health Plan Medicare |
$94.37
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$94.37
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$94.37
|
| Rate for Payer: Multiplan Commercial |
$95.68
|
| Rate for Payer: NAPHCARE Commercial |
$141.55
|
| Rate for Payer: Preferred Network Access Commercial |
$110.03
|
| Rate for Payer: Quartz Beloit One Network |
$58.60
|
| Rate for Payer: Quartz Commercial |
$77.74
|
| Rate for Payer: Quartz Medicare Advantage |
$94.37
|
| Rate for Payer: The Alliance Commercial |
$377.48
|
| Rate for Payer: United Healthcare Medicare Advantage |
$94.37
|
| Rate for Payer: WEA Trust Commercial |
$65.78
|
| Rate for Payer: Wellcare Medicare |
$94.37
|
| Rate for Payer: WPS Commercial |
$88.58
|
|
|
Flebogamma 0.5 gram Charge
|
Facility
|
IP
|
$115.00
|
|
|
Service Code
|
HCPCS J1572
|
| Hospital Charge Code |
2958850
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$58.60 |
| Max. Negotiated Rate |
$110.03 |
| Rate for Payer: Aetna Commercial |
$107.64
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$102.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$63.39
|
| Rate for Payer: Cash Price |
$34.50
|
| Rate for Payer: Cigna Commercial |
$110.03
|
| Rate for Payer: Health EOS Commercial |
$106.44
|
| Rate for Payer: HFN Commercial |
$110.03
|
| Rate for Payer: Multiplan Commercial |
$95.68
|
| Rate for Payer: Preferred Network Access Commercial |
$110.03
|
| Rate for Payer: Quartz Beloit One Network |
$58.60
|
| Rate for Payer: Quartz Commercial |
$71.76
|
| Rate for Payer: WEA Trust Commercial |
$65.78
|
| Rate for Payer: WPS Commercial |
$88.58
|
|
|
Flebogamma 0.5 gram Charge
|
Professional
|
Both
|
$115.00
|
|
|
Service Code
|
HCPCS J1572
|
| Hospital Charge Code |
2958850
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$52.62 |
| Max. Negotiated Rate |
$113.62 |
| Rate for Payer: Aetna Commercial |
$113.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$102.86
|
| Rate for Payer: Cash Price |
$34.50
|
| Rate for Payer: Cash Price |
$34.50
|
| Rate for Payer: Cigna Commercial |
$113.62
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$59.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$71.76
|
| Rate for Payer: Health EOS Commercial |
$108.84
|
| Rate for Payer: HFN Commercial |
$113.62
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$54.79
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$54.79
|
| Rate for Payer: Multiplan Commercial |
$95.68
|
| Rate for Payer: Preferred Network Access Commercial |
$113.62
|
| Rate for Payer: Quartz Beloit One Network |
$52.62
|
| Rate for Payer: Quartz Commercial |
$68.17
|
| Rate for Payer: The Alliance Commercial |
$59.80
|
| Rate for Payer: WEA Trust Commercial |
$65.78
|
| Rate for Payer: WPS Commercial |
$88.58
|
|
|
Flecainide Level
|
Facility
|
OP
|
$205.00
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
977951
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$19.39 |
| Max. Negotiated Rate |
$196.14 |
| Rate for Payer: Aetna Commercial |
$191.88
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$183.35
|
| Rate for Payer: Aetna Managed Medicare |
$19.39
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$72.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$33.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$32.18
|
| Rate for Payer: Anthem Medicare Advantage |
$19.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$113.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$19.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$19.39
|
| Rate for Payer: Cash Price |
$61.50
|
| Rate for Payer: Cash Price |
$61.50
|
| Rate for Payer: Cigna Commercial |
$196.14
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$19.39
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$119.31
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$19.39
|
| Rate for Payer: Health EOS Commercial |
$189.75
|
| Rate for Payer: HFN Commercial |
$196.14
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$72.11
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$19.39
|
| Rate for Payer: Independent Care Health Plan Medicare |
$19.39
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$19.39
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$19.39
|
| Rate for Payer: Multiplan Commercial |
$170.56
|
| Rate for Payer: NAPHCARE Commercial |
$29.08
|
| Rate for Payer: Preferred Network Access Commercial |
$196.14
|
| Rate for Payer: Quartz Beloit One Network |
$104.47
|
| Rate for Payer: Quartz Commercial |
$138.58
|
| Rate for Payer: Quartz Medicare Advantage |
$19.39
|
| Rate for Payer: The Alliance Commercial |
$77.54
|
| Rate for Payer: United Healthcare Medicare Advantage |
$19.39
|
| Rate for Payer: United Healthcare PPO |
$159.90
|
| Rate for Payer: WEA Trust Commercial |
$117.26
|
| Rate for Payer: Wellcare Medicare |
$19.39
|
| Rate for Payer: WPS Commercial |
$157.91
|
|
|
Flecainide Level
|
Professional
|
Both
|
$205.00
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
977951
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$19.39 |
| Max. Negotiated Rate |
$202.54 |
| Rate for Payer: Aetna Commercial |
$202.54
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$183.35
|
| Rate for Payer: Aetna Managed Medicare |
$19.39
|
| Rate for Payer: Anthem Medicare Advantage |
$19.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$19.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$19.39
|
| Rate for Payer: Cash Price |
$61.50
|
| Rate for Payer: Cash Price |
$61.50
|
| Rate for Payer: Cigna Commercial |
$202.54
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$106.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$19.39
|
| Rate for Payer: Health EOS Commercial |
$194.01
|
| Rate for Payer: HFN Commercial |
$202.54
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$68.43
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$68.43
|
| Rate for Payer: Independent Care Health Plan Medicare |
$19.39
|
| Rate for Payer: Multiplan Commercial |
$170.56
|
| Rate for Payer: NAPHCARE Commercial |
$29.08
|
| Rate for Payer: Preferred Network Access Commercial |
$202.54
|
| Rate for Payer: Quartz Beloit One Network |
$93.81
|
| Rate for Payer: Quartz Commercial |
$121.52
|
| Rate for Payer: Quartz Medicare Advantage |
$19.39
|
| Rate for Payer: The Alliance Commercial |
$76.57
|
| Rate for Payer: United Healthcare Medicare Advantage |
$19.39
|
| Rate for Payer: WEA Trust Commercial |
$117.26
|
| Rate for Payer: WPS Commercial |
$85.30
|
|
|
Flecainide Level
|
Facility
|
IP
|
$205.00
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
977951
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$104.47 |
| Max. Negotiated Rate |
$196.14 |
| Rate for Payer: Aetna Commercial |
$191.88
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$183.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$113.00
|
| Rate for Payer: Cash Price |
$61.50
|
| Rate for Payer: Cigna Commercial |
$196.14
|
| Rate for Payer: Health EOS Commercial |
$189.75
|
| Rate for Payer: HFN Commercial |
$196.14
|
| Rate for Payer: Multiplan Commercial |
$170.56
|
| Rate for Payer: Preferred Network Access Commercial |
$196.14
|
| Rate for Payer: Quartz Beloit One Network |
$104.47
|
| Rate for Payer: Quartz Commercial |
$127.92
|
| Rate for Payer: WEA Trust Commercial |
$117.26
|
| Rate for Payer: WPS Commercial |
$157.91
|
|
|
FLEXIBLE PLATE PDS (POLYDIOXANONE) 0.15X50X40MM ZFP8
|
Facility
|
IP
|
$4,091.00
|
|
|
Service Code
|
HCPCS A4649
|
| Hospital Charge Code |
5917634
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,084.77 |
| Max. Negotiated Rate |
$3,914.27 |
| Rate for Payer: Aetna Commercial |
$3,829.18
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,658.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,254.96
|
| Rate for Payer: Cash Price |
$1,227.30
|
| Rate for Payer: Cigna Commercial |
$3,914.27
|
| Rate for Payer: Health EOS Commercial |
$3,786.63
|
| Rate for Payer: HFN Commercial |
$3,914.27
|
| Rate for Payer: Multiplan Commercial |
$3,403.71
|
| Rate for Payer: Preferred Network Access Commercial |
$3,914.27
|
| Rate for Payer: Quartz Beloit One Network |
$2,084.77
|
| Rate for Payer: Quartz Commercial |
$2,552.78
|
| Rate for Payer: WEA Trust Commercial |
$2,340.05
|
| Rate for Payer: WPS Commercial |
$3,151.30
|
|
|
FLEXIBLE PLATE PDS (POLYDIOXANONE) 0.15X50X40MM ZFP8
|
Facility
|
OP
|
$4,091.00
|
|
|
Service Code
|
HCPCS A4649
|
| Hospital Charge Code |
5917634
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,191.30 |
| Max. Negotiated Rate |
$3,914.27 |
| Rate for Payer: Aetna Commercial |
$3,829.18
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,658.99
|
| Rate for Payer: Aetna Managed Medicare |
$1,191.30
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,765.52
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,127.32
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,042.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,254.96
|
| Rate for Payer: Cash Price |
$1,227.30
|
| Rate for Payer: Cigna Commercial |
$3,914.27
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,380.96
|
| Rate for Payer: Health EOS Commercial |
$3,786.63
|
| Rate for Payer: HFN Commercial |
$3,914.27
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,190.98
|
| Rate for Payer: Multiplan Commercial |
$3,403.71
|
| Rate for Payer: NAPHCARE Commercial |
$2,552.78
|
| Rate for Payer: Preferred Network Access Commercial |
$3,914.27
|
| Rate for Payer: Quartz Beloit One Network |
$2,084.77
|
| Rate for Payer: Quartz Commercial |
$2,765.52
|
| Rate for Payer: Quartz Medicare Advantage |
$2,552.78
|
| Rate for Payer: The Alliance Commercial |
$2,127.32
|
| Rate for Payer: WEA Trust Commercial |
$2,340.05
|
| Rate for Payer: WPS Commercial |
$3,151.30
|
|
|
FLEXIBLE SIGMOIDOSCOPY
|
Facility
|
OP
|
$1,114.00
|
|
| Hospital Charge Code |
2959445
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$324.40 |
| Max. Negotiated Rate |
$1,065.88 |
| Rate for Payer: Aetna Commercial |
$1,042.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$996.36
|
| Rate for Payer: Aetna Managed Medicare |
$324.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$753.06
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$579.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$556.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$614.04
|
| Rate for Payer: Cash Price |
$334.20
|
| Rate for Payer: Cigna Commercial |
$1,065.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$648.35
|
| Rate for Payer: Health EOS Commercial |
$1,031.12
|
| Rate for Payer: HFN Commercial |
$1,065.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$868.92
|
| Rate for Payer: Multiplan Commercial |
$926.85
|
| Rate for Payer: NAPHCARE Commercial |
$695.14
|
| Rate for Payer: Preferred Network Access Commercial |
$1,065.88
|
| Rate for Payer: Quartz Beloit One Network |
$567.69
|
| Rate for Payer: Quartz Commercial |
$753.06
|
| Rate for Payer: Quartz Medicare Advantage |
$695.14
|
| Rate for Payer: The Alliance Commercial |
$579.28
|
| Rate for Payer: WEA Trust Commercial |
$637.21
|
| Rate for Payer: WPS Commercial |
$858.11
|
|
|
FLEXIBLE SIGMOIDOSCOPY
|
Facility
|
IP
|
$1,114.00
|
|
| Hospital Charge Code |
2959445
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$567.69 |
| Max. Negotiated Rate |
$1,065.88 |
| Rate for Payer: Aetna Commercial |
$1,042.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$996.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$614.04
|
| Rate for Payer: Cash Price |
$334.20
|
| Rate for Payer: Cigna Commercial |
$1,065.88
|
| Rate for Payer: Health EOS Commercial |
$1,031.12
|
| Rate for Payer: HFN Commercial |
$1,065.88
|
| Rate for Payer: Multiplan Commercial |
$926.85
|
| Rate for Payer: Preferred Network Access Commercial |
$1,065.88
|
| Rate for Payer: Quartz Beloit One Network |
$567.69
|
| Rate for Payer: Quartz Commercial |
$695.14
|
| Rate for Payer: WEA Trust Commercial |
$637.21
|
| Rate for Payer: WPS Commercial |
$858.11
|
|
|
FLEXIBLE SIGMOIDOSCOPY WITH ABLATION OF TUMOR, POLYP OR LESION
|
Facility
|
OP
|
$1,630.00
|
|
|
Service Code
|
CPT 45346
|
| Hospital Charge Code |
4494717
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$830.65 |
| Max. Negotiated Rate |
$5,037.34 |
| Rate for Payer: Aetna Commercial |
$1,525.68
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,457.87
|
| Rate for Payer: Aetna Managed Medicare |
$1,259.34
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,635.84
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,985.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,835.04
|
| Rate for Payer: Anthem Medicare Advantage |
$1,259.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$898.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$1,259.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$1,259.34
|
| Rate for Payer: Cash Price |
$489.00
|
| Rate for Payer: Cash Price |
$489.00
|
| Rate for Payer: Cash Price |
$489.00
|
| Rate for Payer: Cigna Commercial |
$1,559.58
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$1,259.34
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$1,259.34
|
| Rate for Payer: Health EOS Commercial |
$1,508.73
|
| Rate for Payer: HFN Commercial |
$1,559.58
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,684.73
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,259.34
|
| Rate for Payer: Independent Care Health Plan Medicare |
$1,259.34
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$1,259.34
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$1,259.34
|
| Rate for Payer: Multiplan Commercial |
$1,356.16
|
| Rate for Payer: NAPHCARE Commercial |
$1,889.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,559.58
|
| Rate for Payer: Quartz Beloit One Network |
$830.65
|
| Rate for Payer: Quartz Commercial |
$1,101.88
|
| Rate for Payer: Quartz Medicare Advantage |
$1,259.34
|
| Rate for Payer: The Alliance Commercial |
$5,037.34
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,259.34
|
| Rate for Payer: United Healthcare PPO |
$3,726.32
|
| Rate for Payer: WEA Trust Commercial |
$932.36
|
| Rate for Payer: Wellcare Medicare |
$1,259.34
|
| Rate for Payer: WPS Commercial |
$1,255.59
|
|
|
FLEXIBLE SIGMOIDOSCOPY WITH ABLATION OF TUMOR, POLYP OR LESION
|
Facility
|
IP
|
$1,630.00
|
|
|
Service Code
|
CPT 45346
|
| Hospital Charge Code |
4494717
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$830.65 |
| Max. Negotiated Rate |
$1,559.58 |
| Rate for Payer: Aetna Commercial |
$1,525.68
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,457.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$898.46
|
| Rate for Payer: Cash Price |
$489.00
|
| Rate for Payer: Cigna Commercial |
$1,559.58
|
| Rate for Payer: Health EOS Commercial |
$1,508.73
|
| Rate for Payer: HFN Commercial |
$1,559.58
|
| Rate for Payer: Multiplan Commercial |
$1,356.16
|
| Rate for Payer: Preferred Network Access Commercial |
$1,559.58
|
| Rate for Payer: Quartz Beloit One Network |
$830.65
|
| Rate for Payer: Quartz Commercial |
$1,017.12
|
| Rate for Payer: WEA Trust Commercial |
$932.36
|
| Rate for Payer: WPS Commercial |
$1,255.59
|
|
|
FLEXIBLE SIGMOIDOSCOPY WITH BANDING
|
Facility
|
OP
|
$1,546.00
|
|
|
Service Code
|
CPT 45350
|
| Hospital Charge Code |
4494715
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$787.84 |
| Max. Negotiated Rate |
$5,037.34 |
| Rate for Payer: Aetna Commercial |
$1,447.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,382.74
|
| Rate for Payer: Aetna Managed Medicare |
$1,259.34
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,635.84
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,985.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,835.04
|
| Rate for Payer: Anthem Medicare Advantage |
$1,259.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$852.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$1,259.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$1,259.34
|
| Rate for Payer: Cash Price |
$463.80
|
| Rate for Payer: Cash Price |
$463.80
|
| Rate for Payer: Cash Price |
$463.80
|
| Rate for Payer: Cigna Commercial |
$1,479.21
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$1,259.34
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$1,259.34
|
| Rate for Payer: Health EOS Commercial |
$1,430.98
|
| Rate for Payer: HFN Commercial |
$1,479.21
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,684.73
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,259.34
|
| Rate for Payer: Independent Care Health Plan Medicare |
$1,259.34
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$1,259.34
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$1,259.34
|
| Rate for Payer: Multiplan Commercial |
$1,286.27
|
| Rate for Payer: NAPHCARE Commercial |
$1,889.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,479.21
|
| Rate for Payer: Quartz Beloit One Network |
$787.84
|
| Rate for Payer: Quartz Commercial |
$1,045.10
|
| Rate for Payer: Quartz Medicare Advantage |
$1,259.34
|
| Rate for Payer: The Alliance Commercial |
$5,037.34
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,259.34
|
| Rate for Payer: United Healthcare PPO |
$3,726.32
|
| Rate for Payer: WEA Trust Commercial |
$884.31
|
| Rate for Payer: Wellcare Medicare |
$1,259.34
|
| Rate for Payer: WPS Commercial |
$1,190.88
|
|
|
FLEXIBLE SIGMOIDOSCOPY WITH BANDING
|
Facility
|
IP
|
$1,546.00
|
|
|
Service Code
|
CPT 45350
|
| Hospital Charge Code |
4494715
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$787.84 |
| Max. Negotiated Rate |
$1,479.21 |
| Rate for Payer: Aetna Commercial |
$1,447.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,382.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$852.16
|
| Rate for Payer: Cash Price |
$463.80
|
| Rate for Payer: Cigna Commercial |
$1,479.21
|
| Rate for Payer: Health EOS Commercial |
$1,430.98
|
| Rate for Payer: HFN Commercial |
$1,479.21
|
| Rate for Payer: Multiplan Commercial |
$1,286.27
|
| Rate for Payer: Preferred Network Access Commercial |
$1,479.21
|
| Rate for Payer: Quartz Beloit One Network |
$787.84
|
| Rate for Payer: Quartz Commercial |
$964.70
|
| Rate for Payer: WEA Trust Commercial |
$884.31
|
| Rate for Payer: WPS Commercial |
$1,190.88
|
|
|
FLEXIBLE SIGMOIDOSCOPY WITH BIOPSY
|
Facility
|
IP
|
$2,098.00
|
|
| Hospital Charge Code |
2975832
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,069.14 |
| Max. Negotiated Rate |
$2,007.37 |
| Rate for Payer: Aetna Commercial |
$1,963.73
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,876.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,156.42
|
| Rate for Payer: Cash Price |
$629.40
|
| Rate for Payer: Cigna Commercial |
$2,007.37
|
| Rate for Payer: Health EOS Commercial |
$1,941.91
|
| Rate for Payer: HFN Commercial |
$2,007.37
|
| Rate for Payer: Multiplan Commercial |
$1,745.54
|
| Rate for Payer: Preferred Network Access Commercial |
$2,007.37
|
| Rate for Payer: Quartz Beloit One Network |
$1,069.14
|
| Rate for Payer: Quartz Commercial |
$1,309.15
|
| Rate for Payer: WEA Trust Commercial |
$1,200.06
|
| Rate for Payer: WPS Commercial |
$1,616.09
|
|
|
FLEXIBLE SIGMOIDOSCOPY WITH BIOPSY
|
Facility
|
OP
|
$2,098.00
|
|
| Hospital Charge Code |
2975832
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$610.94 |
| Max. Negotiated Rate |
$2,007.37 |
| Rate for Payer: Aetna Commercial |
$1,963.73
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,876.45
|
| Rate for Payer: Aetna Managed Medicare |
$610.94
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,418.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,090.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,047.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,156.42
|
| Rate for Payer: Cash Price |
$629.40
|
| Rate for Payer: Cigna Commercial |
$2,007.37
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,221.04
|
| Rate for Payer: Health EOS Commercial |
$1,941.91
|
| Rate for Payer: HFN Commercial |
$2,007.37
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,636.44
|
| Rate for Payer: Multiplan Commercial |
$1,745.54
|
| Rate for Payer: NAPHCARE Commercial |
$1,309.15
|
| Rate for Payer: Preferred Network Access Commercial |
$2,007.37
|
| Rate for Payer: Quartz Beloit One Network |
$1,069.14
|
| Rate for Payer: Quartz Commercial |
$1,418.25
|
| Rate for Payer: Quartz Medicare Advantage |
$1,309.15
|
| Rate for Payer: The Alliance Commercial |
$1,090.96
|
| Rate for Payer: WEA Trust Commercial |
$1,200.06
|
| Rate for Payer: WPS Commercial |
$1,616.09
|
|
|
FLEXIBLE SIGMOIDOSCOPY WITH BIOPSY AND POLYPECTOMY
|
Facility
|
OP
|
$4,454.00
|
|
| Hospital Charge Code |
2975833
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,297.00 |
| Max. Negotiated Rate |
$4,261.59 |
| Rate for Payer: Aetna Commercial |
$4,168.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,983.66
|
| Rate for Payer: Aetna Managed Medicare |
$1,297.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,010.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,316.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,223.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,455.04
|
| Rate for Payer: Cash Price |
$1,336.20
|
| Rate for Payer: Cigna Commercial |
$4,261.59
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,592.23
|
| Rate for Payer: Health EOS Commercial |
$4,122.62
|
| Rate for Payer: HFN Commercial |
$4,261.59
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,474.12
|
| Rate for Payer: Multiplan Commercial |
$3,705.73
|
| Rate for Payer: NAPHCARE Commercial |
$2,779.30
|
| Rate for Payer: Preferred Network Access Commercial |
$4,261.59
|
| Rate for Payer: Quartz Beloit One Network |
$2,269.76
|
| Rate for Payer: Quartz Commercial |
$3,010.90
|
| Rate for Payer: Quartz Medicare Advantage |
$2,779.30
|
| Rate for Payer: The Alliance Commercial |
$2,316.08
|
| Rate for Payer: WEA Trust Commercial |
$2,547.69
|
| Rate for Payer: WPS Commercial |
$3,430.92
|
|
|
FLEXIBLE SIGMOIDOSCOPY WITH BIOPSY AND POLYPECTOMY
|
Facility
|
IP
|
$4,454.00
|
|
| Hospital Charge Code |
2975833
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$2,269.76 |
| Max. Negotiated Rate |
$4,261.59 |
| Rate for Payer: Aetna Commercial |
$4,168.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,983.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,455.04
|
| Rate for Payer: Cash Price |
$1,336.20
|
| Rate for Payer: Cigna Commercial |
$4,261.59
|
| Rate for Payer: Health EOS Commercial |
$4,122.62
|
| Rate for Payer: HFN Commercial |
$4,261.59
|
| Rate for Payer: Multiplan Commercial |
$3,705.73
|
| Rate for Payer: Preferred Network Access Commercial |
$4,261.59
|
| Rate for Payer: Quartz Beloit One Network |
$2,269.76
|
| Rate for Payer: Quartz Commercial |
$2,779.30
|
| Rate for Payer: WEA Trust Commercial |
$2,547.69
|
| Rate for Payer: WPS Commercial |
$3,430.92
|
|
