|
FIXATION STUD 8.5mm
|
Facility
|
OP
|
$5,235.00
|
|
| Hospital Charge Code |
2964730
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,465.80 |
| Max. Negotiated Rate |
$20,940.00 |
| Rate for Payer: Aetna Commercial |
$4,711.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,502.10
|
| Rate for Payer: Aetna Managed Medicare |
$1,465.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,402.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,617.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,512.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,774.55
|
| Rate for Payer: Cash Price |
$1,570.50
|
| Rate for Payer: Cigna Commercial |
$4,816.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,929.51
|
| Rate for Payer: Health EOS Commercial |
$4,659.15
|
| Rate for Payer: HFN Commercial |
$4,816.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,926.25
|
| Rate for Payer: Multiplan Commercial |
$4,188.00
|
| Rate for Payer: NAPHCARE Commercial |
$3,141.00
|
| Rate for Payer: Preferred Network Access Commercial |
$4,816.20
|
| Rate for Payer: Quartz Beloit One Network |
$2,565.15
|
| Rate for Payer: Quartz Commercial |
$3,402.75
|
| Rate for Payer: Quartz Medicare Advantage |
$3,141.00
|
| Rate for Payer: The Alliance Commercial |
$20,940.00
|
| Rate for Payer: WEA Trust Commercial |
$2,879.25
|
| Rate for Payer: WPS Commercial |
$3,877.56
|
|
|
FIXATION STUD 8.5mm
|
Facility
|
IP
|
$5,235.00
|
|
| Hospital Charge Code |
2964730
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,565.15 |
| Max. Negotiated Rate |
$4,816.20 |
| Rate for Payer: Aetna Commercial |
$4,711.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,502.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,774.55
|
| Rate for Payer: Cash Price |
$1,570.50
|
| Rate for Payer: Cigna Commercial |
$4,816.20
|
| Rate for Payer: Health EOS Commercial |
$4,659.15
|
| Rate for Payer: HFN Commercial |
$4,816.20
|
| Rate for Payer: Multiplan Commercial |
$4,188.00
|
| Rate for Payer: NAPHCARE Commercial |
$3,141.00
|
| Rate for Payer: Preferred Network Access Commercial |
$4,816.20
|
| Rate for Payer: Quartz Beloit One Network |
$2,565.15
|
| Rate for Payer: Quartz Commercial |
$3,141.00
|
| Rate for Payer: WEA Trust Commercial |
$2,879.25
|
| Rate for Payer: WPS Commercial |
$3,877.56
|
|
|
FIX G/COLON TUBE W/DEVICE 49460
|
Professional
|
Both
|
$6,214.00
|
|
|
Service Code
|
CPT 49460
|
| Hospital Charge Code |
3014889
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$162.87 |
| Max. Negotiated Rate |
$5,903.30 |
| Rate for Payer: Aetna Commercial |
$5,903.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,344.04
|
| Rate for Payer: Cash Price |
$1,864.20
|
| Rate for Payer: Cash Price |
$1,864.20
|
| Rate for Payer: Cash Price |
$1,864.20
|
| Rate for Payer: Cigna Commercial |
$5,903.30
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$613.53
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,728.40
|
| Rate for Payer: Health EOS Commercial |
$5,654.74
|
| Rate for Payer: HFN Commercial |
$5,903.30
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$162.87
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$162.87
|
| Rate for Payer: Multiplan Commercial |
$4,971.20
|
| Rate for Payer: Preferred Network Access Commercial |
$5,903.30
|
| Rate for Payer: Quartz Beloit One Network |
$2,734.16
|
| Rate for Payer: Quartz Commercial |
$3,541.98
|
| Rate for Payer: The Alliance Commercial |
$3,107.00
|
| Rate for Payer: United Healthcare Medicaid |
$613.53
|
| Rate for Payer: WEA Trust Commercial |
$3,417.70
|
| Rate for Payer: WPS Commercial |
$4,602.71
|
|
|
FLANGE CONVEX 1.75 IN 14802
|
Facility
|
IP
|
$86.00
|
|
| Hospital Charge Code |
5107220
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$42.14 |
| Max. Negotiated Rate |
$79.12 |
| Rate for Payer: Aetna Commercial |
$77.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$73.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$45.58
|
| Rate for Payer: Cash Price |
$25.80
|
| Rate for Payer: Cigna Commercial |
$79.12
|
| Rate for Payer: Health EOS Commercial |
$76.54
|
| Rate for Payer: HFN Commercial |
$79.12
|
| Rate for Payer: Multiplan Commercial |
$68.80
|
| Rate for Payer: NAPHCARE Commercial |
$51.60
|
| Rate for Payer: Preferred Network Access Commercial |
$79.12
|
| Rate for Payer: Quartz Beloit One Network |
$42.14
|
| Rate for Payer: Quartz Commercial |
$51.60
|
| Rate for Payer: WEA Trust Commercial |
$47.30
|
| Rate for Payer: WPS Commercial |
$63.70
|
|
|
FLANGE CONVEX 1.75 IN 14802
|
Facility
|
OP
|
$86.00
|
|
| Hospital Charge Code |
5107220
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$24.08 |
| Max. Negotiated Rate |
$344.00 |
| Rate for Payer: Aetna Commercial |
$77.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$73.96
|
| Rate for Payer: Aetna Managed Medicare |
$24.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$55.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$43.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$41.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$45.58
|
| Rate for Payer: Cash Price |
$25.80
|
| Rate for Payer: Cigna Commercial |
$79.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$48.13
|
| Rate for Payer: Health EOS Commercial |
$76.54
|
| Rate for Payer: HFN Commercial |
$79.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$64.50
|
| Rate for Payer: Multiplan Commercial |
$68.80
|
| Rate for Payer: NAPHCARE Commercial |
$51.60
|
| Rate for Payer: Preferred Network Access Commercial |
$79.12
|
| Rate for Payer: Quartz Beloit One Network |
$42.14
|
| Rate for Payer: Quartz Commercial |
$55.90
|
| Rate for Payer: Quartz Medicare Advantage |
$51.60
|
| Rate for Payer: The Alliance Commercial |
$344.00
|
| Rate for Payer: WEA Trust Commercial |
$47.30
|
| Rate for Payer: WPS Commercial |
$63.70
|
|
|
FLANGE FLOATING 2.25 14203
|
Facility
|
OP
|
$56.00
|
|
| Hospital Charge Code |
2964062
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$15.68 |
| Max. Negotiated Rate |
$224.00 |
| Rate for Payer: Aetna Commercial |
$50.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$48.16
|
| Rate for Payer: Aetna Managed Medicare |
$15.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$36.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$28.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$26.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$29.68
|
| Rate for Payer: Cash Price |
$16.80
|
| Rate for Payer: Cigna Commercial |
$51.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$31.34
|
| Rate for Payer: Health EOS Commercial |
$49.84
|
| Rate for Payer: HFN Commercial |
$51.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$42.00
|
| Rate for Payer: Multiplan Commercial |
$44.80
|
| Rate for Payer: NAPHCARE Commercial |
$33.60
|
| Rate for Payer: Preferred Network Access Commercial |
$51.52
|
| Rate for Payer: Quartz Beloit One Network |
$27.44
|
| Rate for Payer: Quartz Commercial |
$36.40
|
| Rate for Payer: Quartz Medicare Advantage |
$33.60
|
| Rate for Payer: The Alliance Commercial |
$224.00
|
| Rate for Payer: WEA Trust Commercial |
$30.80
|
| Rate for Payer: WPS Commercial |
$41.48
|
|
|
FLANGE FLOATING 2.25 14203
|
Facility
|
IP
|
$56.00
|
|
| Hospital Charge Code |
2964062
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$27.44 |
| Max. Negotiated Rate |
$51.52 |
| Rate for Payer: Aetna Commercial |
$50.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$48.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$29.68
|
| Rate for Payer: Cash Price |
$16.80
|
| Rate for Payer: Cigna Commercial |
$51.52
|
| Rate for Payer: Health EOS Commercial |
$49.84
|
| Rate for Payer: HFN Commercial |
$51.52
|
| Rate for Payer: Multiplan Commercial |
$44.80
|
| Rate for Payer: NAPHCARE Commercial |
$33.60
|
| Rate for Payer: Preferred Network Access Commercial |
$51.52
|
| Rate for Payer: Quartz Beloit One Network |
$27.44
|
| Rate for Payer: Quartz Commercial |
$33.60
|
| Rate for Payer: WEA Trust Commercial |
$30.80
|
| Rate for Payer: WPS Commercial |
$41.48
|
|
|
FLAP CLOSURE
|
Facility
|
IP
|
$1,084.00
|
|
| Hospital Charge Code |
2959783
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$531.16 |
| Max. Negotiated Rate |
$997.28 |
| Rate for Payer: Aetna Commercial |
$975.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$932.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$574.52
|
| Rate for Payer: Cash Price |
$325.20
|
| Rate for Payer: Cigna Commercial |
$997.28
|
| Rate for Payer: Health EOS Commercial |
$964.76
|
| Rate for Payer: HFN Commercial |
$997.28
|
| Rate for Payer: Multiplan Commercial |
$867.20
|
| Rate for Payer: NAPHCARE Commercial |
$650.40
|
| Rate for Payer: Preferred Network Access Commercial |
$997.28
|
| Rate for Payer: Quartz Beloit One Network |
$531.16
|
| Rate for Payer: Quartz Commercial |
$650.40
|
| Rate for Payer: WEA Trust Commercial |
$596.20
|
| Rate for Payer: WPS Commercial |
$802.92
|
|
|
FLAP CLOSURE
|
Facility
|
OP
|
$1,084.00
|
|
| Hospital Charge Code |
2959783
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$303.52 |
| Max. Negotiated Rate |
$4,336.00 |
| Rate for Payer: Aetna Commercial |
$975.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$932.24
|
| Rate for Payer: Aetna Managed Medicare |
$303.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$704.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$542.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$520.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$574.52
|
| Rate for Payer: Cash Price |
$325.20
|
| Rate for Payer: Cigna Commercial |
$997.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$606.61
|
| Rate for Payer: Health EOS Commercial |
$964.76
|
| Rate for Payer: HFN Commercial |
$997.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$813.00
|
| Rate for Payer: Multiplan Commercial |
$867.20
|
| Rate for Payer: NAPHCARE Commercial |
$650.40
|
| Rate for Payer: Preferred Network Access Commercial |
$997.28
|
| Rate for Payer: Quartz Beloit One Network |
$531.16
|
| Rate for Payer: Quartz Commercial |
$704.60
|
| Rate for Payer: Quartz Medicare Advantage |
$650.40
|
| Rate for Payer: The Alliance Commercial |
$4,336.00
|
| Rate for Payer: WEA Trust Commercial |
$596.20
|
| Rate for Payer: WPS Commercial |
$802.92
|
|
|
FLAT FOOT RECONSTRUCTION
|
Facility
|
OP
|
$4,560.00
|
|
| Hospital Charge Code |
2960338
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,276.80 |
| Max. Negotiated Rate |
$18,240.00 |
| Rate for Payer: Aetna Commercial |
$4,104.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,921.60
|
| Rate for Payer: Aetna Managed Medicare |
$1,276.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,964.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,280.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,188.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,416.80
|
| Rate for Payer: Cash Price |
$1,368.00
|
| Rate for Payer: Cigna Commercial |
$4,195.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,551.78
|
| Rate for Payer: Health EOS Commercial |
$4,058.40
|
| Rate for Payer: HFN Commercial |
$4,195.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,420.00
|
| Rate for Payer: Multiplan Commercial |
$3,648.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,736.00
|
| Rate for Payer: Preferred Network Access Commercial |
$4,195.20
|
| Rate for Payer: Quartz Beloit One Network |
$2,234.40
|
| Rate for Payer: Quartz Commercial |
$2,964.00
|
| Rate for Payer: Quartz Medicare Advantage |
$2,736.00
|
| Rate for Payer: The Alliance Commercial |
$18,240.00
|
| Rate for Payer: WEA Trust Commercial |
$2,508.00
|
| Rate for Payer: WPS Commercial |
$3,377.59
|
|
|
FLAT FOOT RECONSTRUCTION
|
Facility
|
IP
|
$4,560.00
|
|
| Hospital Charge Code |
2960338
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,234.40 |
| Max. Negotiated Rate |
$4,195.20 |
| Rate for Payer: Aetna Commercial |
$4,104.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,921.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,416.80
|
| Rate for Payer: Cash Price |
$1,368.00
|
| Rate for Payer: Cigna Commercial |
$4,195.20
|
| Rate for Payer: Health EOS Commercial |
$4,058.40
|
| Rate for Payer: HFN Commercial |
$4,195.20
|
| Rate for Payer: Multiplan Commercial |
$3,648.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,736.00
|
| Rate for Payer: Preferred Network Access Commercial |
$4,195.20
|
| Rate for Payer: Quartz Beloit One Network |
$2,234.40
|
| Rate for Payer: Quartz Commercial |
$2,736.00
|
| Rate for Payer: WEA Trust Commercial |
$2,508.00
|
| Rate for Payer: WPS Commercial |
$3,377.59
|
|
|
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 |
$111.16 |
| Max. Negotiated Rate |
$1,588.00 |
| Rate for Payer: Aetna Commercial |
$357.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$341.42
|
| Rate for Payer: Aetna Managed Medicare |
$111.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$258.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$198.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$190.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$210.41
|
| Rate for Payer: Cash Price |
$119.10
|
| Rate for Payer: Cigna Commercial |
$365.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$222.16
|
| Rate for Payer: Health EOS Commercial |
$353.33
|
| Rate for Payer: HFN Commercial |
$365.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$297.75
|
| Rate for Payer: Multiplan Commercial |
$317.60
|
| Rate for Payer: NAPHCARE Commercial |
$238.20
|
| Rate for Payer: Preferred Network Access Commercial |
$365.24
|
| Rate for Payer: Quartz Beloit One Network |
$194.53
|
| Rate for Payer: Quartz Commercial |
$258.05
|
| Rate for Payer: Quartz Medicare Advantage |
$238.20
|
| Rate for Payer: The Alliance Commercial |
$1,588.00
|
| Rate for Payer: United Healthcare PPO |
$297.75
|
| Rate for Payer: WEA Trust Commercial |
$218.35
|
| Rate for Payer: WPS Commercial |
$294.06
|
|
|
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 |
$174.68 |
| Max. Negotiated Rate |
$377.15 |
| Rate for Payer: Aetna Commercial |
$377.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$341.42
|
| Rate for Payer: Cash Price |
$119.10
|
| Rate for Payer: Cigna Commercial |
$377.15
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$198.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$238.20
|
| Rate for Payer: Health EOS Commercial |
$361.27
|
| Rate for Payer: HFN Commercial |
$377.15
|
| Rate for Payer: Multiplan Commercial |
$317.60
|
| Rate for Payer: Preferred Network Access Commercial |
$377.15
|
| Rate for Payer: Quartz Beloit One Network |
$174.68
|
| Rate for Payer: Quartz Commercial |
$226.29
|
| Rate for Payer: The Alliance Commercial |
$198.50
|
| Rate for Payer: WEA Trust Commercial |
$218.35
|
| Rate for Payer: WPS Commercial |
$294.06
|
|
|
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 |
$194.53 |
| Max. Negotiated Rate |
$365.24 |
| Rate for Payer: Aetna Commercial |
$357.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$341.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$210.41
|
| Rate for Payer: Cash Price |
$119.10
|
| Rate for Payer: Cigna Commercial |
$365.24
|
| Rate for Payer: Health EOS Commercial |
$353.33
|
| Rate for Payer: HFN Commercial |
$365.24
|
| Rate for Payer: Multiplan Commercial |
$317.60
|
| Rate for Payer: NAPHCARE Commercial |
$238.20
|
| Rate for Payer: Preferred Network Access Commercial |
$365.24
|
| Rate for Payer: Quartz Beloit One Network |
$194.53
|
| Rate for Payer: Quartz Commercial |
$238.20
|
| Rate for Payer: WEA Trust Commercial |
$218.35
|
| Rate for Payer: WPS Commercial |
$294.06
|
|
|
Flebogamma 0.5 gram Charge
|
Facility
|
OP
|
$115.00
|
|
|
Service Code
|
HCPCS J1572
|
| Hospital Charge Code |
2958850
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$55.20 |
| Max. Negotiated Rate |
$224.46 |
| Rate for Payer: Aetna Commercial |
$103.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$98.90
|
| Rate for Payer: Aetna Managed Medicare |
$56.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$74.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$57.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$55.20
|
| Rate for Payer: Anthem Medicare Advantage |
$56.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$60.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$56.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$56.12
|
| Rate for Payer: Cash Price |
$34.50
|
| Rate for Payer: Cash Price |
$34.50
|
| Rate for Payer: Cigna Commercial |
$105.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$56.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$64.35
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$56.12
|
| Rate for Payer: Health EOS Commercial |
$102.35
|
| Rate for Payer: HFN Commercial |
$105.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$208.75
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$56.12
|
| Rate for Payer: Independent Care Health Plan Medicare |
$56.12
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$56.12
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$56.12
|
| Rate for Payer: Multiplan Commercial |
$92.00
|
| Rate for Payer: NAPHCARE Commercial |
$84.17
|
| Rate for Payer: Preferred Network Access Commercial |
$105.80
|
| Rate for Payer: Quartz Beloit One Network |
$56.35
|
| Rate for Payer: Quartz Commercial |
$74.75
|
| Rate for Payer: Quartz Medicare Advantage |
$56.12
|
| Rate for Payer: The Alliance Commercial |
$224.46
|
| Rate for Payer: United Healthcare Medicare Advantage |
$56.12
|
| Rate for Payer: WEA Trust Commercial |
$63.25
|
| Rate for Payer: Wellcare Medicare |
$56.12
|
| Rate for Payer: WPS Commercial |
$85.18
|
|
|
Flebogamma 0.5 gram Charge
|
Professional
|
Both
|
$115.00
|
|
|
Service Code
|
HCPCS J1572
|
| Hospital Charge Code |
2958850
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$50.60 |
| Max. Negotiated Rate |
$109.25 |
| Rate for Payer: Aetna Commercial |
$109.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$98.90
|
| Rate for Payer: Cash Price |
$34.50
|
| Rate for Payer: Cash Price |
$34.50
|
| Rate for Payer: Cigna Commercial |
$109.25
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$56.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$69.00
|
| Rate for Payer: Health EOS Commercial |
$104.65
|
| Rate for Payer: HFN Commercial |
$109.25
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$52.68
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$52.68
|
| Rate for Payer: Multiplan Commercial |
$92.00
|
| Rate for Payer: Preferred Network Access Commercial |
$109.25
|
| Rate for Payer: Quartz Beloit One Network |
$50.60
|
| Rate for Payer: Quartz Commercial |
$65.55
|
| Rate for Payer: The Alliance Commercial |
$57.50
|
| Rate for Payer: United Healthcare Medicaid |
$56.12
|
| Rate for Payer: WEA Trust Commercial |
$63.25
|
| Rate for Payer: WPS Commercial |
$85.18
|
|
|
Flebogamma 0.5 gram Charge
|
Facility
|
IP
|
$115.00
|
|
|
Service Code
|
HCPCS J1572
|
| Hospital Charge Code |
2958850
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$56.35 |
| Max. Negotiated Rate |
$105.80 |
| Rate for Payer: Aetna Commercial |
$103.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$98.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$60.95
|
| Rate for Payer: Cash Price |
$34.50
|
| Rate for Payer: Cigna Commercial |
$105.80
|
| Rate for Payer: Health EOS Commercial |
$102.35
|
| Rate for Payer: HFN Commercial |
$105.80
|
| Rate for Payer: Multiplan Commercial |
$92.00
|
| Rate for Payer: NAPHCARE Commercial |
$69.00
|
| Rate for Payer: Preferred Network Access Commercial |
$105.80
|
| Rate for Payer: Quartz Beloit One Network |
$56.35
|
| Rate for Payer: Quartz Commercial |
$69.00
|
| Rate for Payer: WEA Trust Commercial |
$63.25
|
| Rate for Payer: WPS Commercial |
$85.18
|
|
|
Flecainide Level
|
Professional
|
Both
|
$205.00
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
977951
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$65.80 |
| Max. Negotiated Rate |
$194.75 |
| Rate for Payer: Aetna Commercial |
$194.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$176.30
|
| Rate for Payer: Cash Price |
$61.50
|
| Rate for Payer: Cash Price |
$61.50
|
| Rate for Payer: Cigna Commercial |
$194.75
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$102.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$123.00
|
| Rate for Payer: Health EOS Commercial |
$186.55
|
| Rate for Payer: HFN Commercial |
$194.75
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$65.80
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$65.80
|
| Rate for Payer: Multiplan Commercial |
$164.00
|
| Rate for Payer: Preferred Network Access Commercial |
$194.75
|
| Rate for Payer: Quartz Beloit One Network |
$90.20
|
| Rate for Payer: Quartz Commercial |
$116.85
|
| Rate for Payer: The Alliance Commercial |
$102.50
|
| Rate for Payer: WEA Trust Commercial |
$112.75
|
| Rate for Payer: WPS Commercial |
$151.84
|
|
|
Flecainide Level
|
Facility
|
OP
|
$205.00
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
977951
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.64 |
| Max. Negotiated Rate |
$188.60 |
| Rate for Payer: Aetna Commercial |
$184.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$176.30
|
| Rate for Payer: Aetna Managed Medicare |
$18.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$69.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$32.62
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$30.94
|
| Rate for Payer: Anthem Medicaid |
$19.26
|
| Rate for Payer: Anthem Medicare Advantage |
$18.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$108.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$18.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$18.64
|
| Rate for Payer: Cash Price |
$61.50
|
| Rate for Payer: Cash Price |
$61.50
|
| Rate for Payer: Cigna Commercial |
$188.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$18.64
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$19.26
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$114.72
|
| Rate for Payer: Dean Health Medicaid |
$19.26
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$18.64
|
| Rate for Payer: Health EOS Commercial |
$182.45
|
| Rate for Payer: HFN Commercial |
$188.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$69.34
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$18.64
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$19.26
|
| Rate for Payer: Independent Care Health Plan Medicare |
$18.64
|
| Rate for Payer: Managed Health Services Medicaid |
$20.03
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$18.64
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$18.64
|
| Rate for Payer: Multiplan Commercial |
$164.00
|
| Rate for Payer: NAPHCARE Commercial |
$27.96
|
| Rate for Payer: Preferred Network Access Commercial |
$188.60
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$19.26
|
| Rate for Payer: Quartz Beloit One Network |
$100.45
|
| Rate for Payer: Quartz Commercial |
$133.25
|
| Rate for Payer: Quartz Medicare Advantage |
$18.64
|
| Rate for Payer: The Alliance Commercial |
$74.56
|
| Rate for Payer: United Healthcare Medicaid |
$19.26
|
| Rate for Payer: United Healthcare Medicare Advantage |
$18.64
|
| Rate for Payer: United Healthcare PPO |
$153.75
|
| Rate for Payer: WEA Trust Commercial |
$112.75
|
| Rate for Payer: Wellcare Medicare |
$18.64
|
| Rate for Payer: WMAP Medicaid |
$19.26
|
| Rate for Payer: WPS Commercial |
$151.84
|
|
|
Flecainide Level
|
Facility
|
IP
|
$205.00
|
|
|
Service Code
|
CPT 80299
|
| Hospital Charge Code |
977951
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$100.45 |
| Max. Negotiated Rate |
$188.60 |
| Rate for Payer: Aetna Commercial |
$184.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$176.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$108.65
|
| Rate for Payer: Cash Price |
$61.50
|
| Rate for Payer: Cigna Commercial |
$188.60
|
| Rate for Payer: Health EOS Commercial |
$182.45
|
| Rate for Payer: HFN Commercial |
$188.60
|
| Rate for Payer: Multiplan Commercial |
$164.00
|
| Rate for Payer: NAPHCARE Commercial |
$123.00
|
| Rate for Payer: Preferred Network Access Commercial |
$188.60
|
| Rate for Payer: Quartz Beloit One Network |
$100.45
|
| Rate for Payer: Quartz Commercial |
$123.00
|
| Rate for Payer: WEA Trust Commercial |
$112.75
|
| Rate for Payer: WPS Commercial |
$151.84
|
|
|
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 |
$1,145.48 |
| Max. Negotiated Rate |
$16,364.00 |
| Rate for Payer: Aetna Commercial |
$3,681.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,518.26
|
| Rate for Payer: Aetna Managed Medicare |
$1,145.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,659.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,045.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,963.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,168.23
|
| Rate for Payer: Cash Price |
$1,227.30
|
| Rate for Payer: Cigna Commercial |
$3,763.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,289.32
|
| Rate for Payer: Health EOS Commercial |
$3,640.99
|
| Rate for Payer: HFN Commercial |
$3,763.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,068.25
|
| Rate for Payer: Multiplan Commercial |
$3,272.80
|
| Rate for Payer: NAPHCARE Commercial |
$2,454.60
|
| Rate for Payer: Preferred Network Access Commercial |
$3,763.72
|
| Rate for Payer: Quartz Beloit One Network |
$2,004.59
|
| Rate for Payer: Quartz Commercial |
$2,659.15
|
| Rate for Payer: Quartz Medicare Advantage |
$2,454.60
|
| Rate for Payer: The Alliance Commercial |
$16,364.00
|
| Rate for Payer: WEA Trust Commercial |
$2,250.05
|
| Rate for Payer: WPS Commercial |
$3,030.20
|
|
|
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 |
$2,004.59 |
| Max. Negotiated Rate |
$3,763.72 |
| Rate for Payer: Aetna Commercial |
$3,681.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,518.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,168.23
|
| Rate for Payer: Cash Price |
$1,227.30
|
| Rate for Payer: Cigna Commercial |
$3,763.72
|
| Rate for Payer: Health EOS Commercial |
$3,640.99
|
| Rate for Payer: HFN Commercial |
$3,763.72
|
| Rate for Payer: Multiplan Commercial |
$3,272.80
|
| Rate for Payer: NAPHCARE Commercial |
$2,454.60
|
| Rate for Payer: Preferred Network Access Commercial |
$3,763.72
|
| Rate for Payer: Quartz Beloit One Network |
$2,004.59
|
| Rate for Payer: Quartz Commercial |
$2,454.60
|
| Rate for Payer: WEA Trust Commercial |
$2,250.05
|
| Rate for Payer: WPS Commercial |
$3,030.20
|
|
|
FLEXIBLE SIGMOIDOSCOPY
|
Facility
|
IP
|
$1,114.00
|
|
| Hospital Charge Code |
2959445
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$545.86 |
| Max. Negotiated Rate |
$1,024.88 |
| Rate for Payer: Aetna Commercial |
$1,002.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$958.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$590.42
|
| Rate for Payer: Cash Price |
$334.20
|
| Rate for Payer: Cigna Commercial |
$1,024.88
|
| Rate for Payer: Health EOS Commercial |
$991.46
|
| Rate for Payer: HFN Commercial |
$1,024.88
|
| Rate for Payer: Multiplan Commercial |
$891.20
|
| Rate for Payer: NAPHCARE Commercial |
$668.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,024.88
|
| Rate for Payer: Quartz Beloit One Network |
$545.86
|
| Rate for Payer: Quartz Commercial |
$668.40
|
| Rate for Payer: WEA Trust Commercial |
$612.70
|
| Rate for Payer: WPS Commercial |
$825.14
|
|
|
FLEXIBLE SIGMOIDOSCOPY
|
Facility
|
OP
|
$1,114.00
|
|
| Hospital Charge Code |
2959445
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$311.92 |
| Max. Negotiated Rate |
$4,456.00 |
| Rate for Payer: Aetna Commercial |
$1,002.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$958.04
|
| Rate for Payer: Aetna Managed Medicare |
$311.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$724.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$557.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$534.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$590.42
|
| Rate for Payer: Cash Price |
$334.20
|
| Rate for Payer: Cigna Commercial |
$1,024.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$623.39
|
| Rate for Payer: Health EOS Commercial |
$991.46
|
| Rate for Payer: HFN Commercial |
$1,024.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$835.50
|
| Rate for Payer: Multiplan Commercial |
$891.20
|
| Rate for Payer: NAPHCARE Commercial |
$668.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,024.88
|
| Rate for Payer: Quartz Beloit One Network |
$545.86
|
| Rate for Payer: Quartz Commercial |
$724.10
|
| Rate for Payer: Quartz Medicare Advantage |
$668.40
|
| Rate for Payer: The Alliance Commercial |
$4,456.00
|
| Rate for Payer: WEA Trust Commercial |
$612.70
|
| Rate for Payer: WPS Commercial |
$825.14
|
|
|
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 |
$798.70 |
| Max. Negotiated Rate |
$4,665.56 |
| Rate for Payer: Aetna Commercial |
$1,467.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,401.80
|
| Rate for Payer: Aetna Managed Medicare |
$1,166.39
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,496.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,871.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,726.00
|
| Rate for Payer: Anthem Medicare Advantage |
$1,166.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$863.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$1,166.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$1,166.39
|
| 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 |
$1,499.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$1,166.39
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,218.22
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$1,166.39
|
| Rate for Payer: Health EOS Commercial |
$1,450.70
|
| Rate for Payer: HFN Commercial |
$1,499.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,338.97
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,166.39
|
| Rate for Payer: Independent Care Health Plan Medicare |
$1,166.39
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$1,166.39
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$1,166.39
|
| Rate for Payer: Multiplan Commercial |
$1,304.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,749.58
|
| Rate for Payer: Preferred Network Access Commercial |
$1,499.60
|
| Rate for Payer: Quartz Beloit One Network |
$798.70
|
| Rate for Payer: Quartz Commercial |
$1,059.50
|
| Rate for Payer: Quartz Medicare Advantage |
$1,166.39
|
| Rate for Payer: The Alliance Commercial |
$4,665.56
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,166.39
|
| Rate for Payer: United Healthcare PPO |
$3,583.00
|
| Rate for Payer: WEA Trust Commercial |
$896.50
|
| Rate for Payer: Wellcare Medicare |
$1,166.39
|
| Rate for Payer: WPS Commercial |
$1,207.34
|
|
